Homeopathy for attention deficit/hyperactivity disorder or hyperkinetic disorder.

BACKGROUND: Homeopathy is one form of complementary/alternative medicine which is promoted as being a safe and effective form of treatment for children and adults. Within the UK homeopathy use is estimated at 1.9% of the adult population (Thomas 2004), and around 11% for children under 16 years (Simpson 2001). There has been increased interest in homeopathy's potential as a non-pharmacological intervention for attention deficit/hyperactivity disorder as an alternative to the use of stimulant medications such as Ritalin. Homeopathy is a system of medicine based on the principle of treating "like with like" using various dilutions of natural or man-made substances. Homeopathy focuses on the unique characteristics of each patient's experience and symptomatology and uses this information to determine the appropriate prescription for each patient. OBJECTIVES: To assess the safety and effectiveness of homeopathy as a treatment for attention deficit/hyperactivity disorder. SEARCH STRATEGY: We searched a wide set of databases from their inception to March 2006 including: CENTRAL, MEDLINE, AMED, BIOSIS, CISCOM, CINAHL, Dissertation Abstracts, ECH (European Committee for Homeopathy thesis database), EMBASE, ERIC, HomInform (Glasgow Homeopathic Hospital Library), LILACS, PsycINFO, Science Citation Index, SIGLE, GIRI - International congress on ultra-low doses, Liga Medicorum Homeopathica Internationalis. We contacted experts in the field about ongoing or current research. SELECTION CRITERIA: All studies where individualised, clinical or formula homeopathy had been used to treat participants with ADHD or HKD who were randomly or quasi-randomly allocated to either true treatment or a control were selected. Control groups could include wait-list, no treatment, medication, placebo homeopathy, educational or behavioural interventions. DATA COLLECTION AND ANALYSIS: Data from four eligible studies (total n = 168) were extracted and entered into RevMan. Results were synthesised and estimates of the effect sizes were calculated and presented as appropriate (using standardised mean differences) in both graphical and narrative form (narrative only was used where no effect size calculation was possible). MAIN RESULTS: The forms of homeopathy evaluated to date do not suggest significant treatment effects for the global symptoms, core symptoms of inattention, hyperactivity or impulsivity, or related outcomes such as anxiety in Attention Deficit/Hyperactivity Disorder. AUTHORS' CONCLUSIONS: There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD. Development of optimal treatment protocols is recommended prior to further randomised controlled trials being undertaken.

Reporting data on homeopathic treatments (RedHot): a supplement to CONSORT.

When homeopathy is tested in clinical trials, understanding and appraisal is likely to be improved if published reports contain details of prescribing strategies and treatments. An international Delphi panel was convened to develop consensus guidelines for reporting homeopathic methods and treatments. The panel agreed 28 treatment- and provider-specific items that supplement the Consolidated Standards of Reporting Trials (CONSORT) Statement items 2, 3, 4 and 19. The authors recommend these for adoption by authors and journals when reporting trials of homeopathy.

More trials, fewer placebos, please.

The argument that randomized placebo-controlled trials of homeopathy might usefully be replaced by observational studies, audit and quality-of life assessment is considered. Randomized equivalence and patient-preference trials are proposed as more informative alternatives. They have the merit of providing hard information for health services on the comparative value of treatments, and can facilitate internal comparisons of competing homeopathic methods. The pragmatic approach also allows clinical change during the homeopathic treatment of chronic disease to be assessed without the time constraints usually imposed by placebo controls.

A homeopathic origin for placebo controls: 'an invaluable gift of God'.

The acknowledged early adoption of placebo controls in drug trials by homeopaths is currently thought to have been derived from prior external attempts to discredit the system. This claim is reexamined in the light of a comprehensive literature search for 19th-century homeopathic therapeutic trials and provings using placebo. Single-blind placebo controls, still used today, are shown to have originated independently within homeopathy's own disciplinary matrix before the first external evaluations. They are the most likely source for later placebo-controlled crossover and parallel group experiments by homeopaths.