Efficacy of homoeopathic treatment: Systematic review of meta-analyses of randomised placebo-controlled homoeopathy trials for any indication.

BACKGROUND AND OBJECTIVE: Since 1997, several meta-analyses (MAs) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAIs) have been published with different methods, results and conclusions. To date, a formal assessment of these MAs has not been performed. The main objective of this systematic review of MAs of PRETHAIs was to evaluate the efficacy of homoeopathic treatment. METHODS: The inclusion criteria were as follows: MAs of PRETHAIs in humans; all ages, countries, settings, publication languages; and MAs published from 1 Jan. 1990 to 30 Apr. 2023. The exclusion criteria were as follows: systematic reviews without MAs; MAs restricted to age or gender groups, specific indications, or specific homoeopathic treatments; and MAs that did not assess efficacy. We searched 8 electronic databases up to 14 Dec. 2020, with an update search in 6 databases up to 30 April 2023. The primary outcome was the effect estimate for all included trials in each MA and after restricting the sample to trials with high methodological quality, according to predefined criteria. The risk of bias for each MA was assessed by the ROBIS (Risk Of Bias In Systematic reviews) tool. The quality of evidence was assessed by the GRADE framework. Statistical analyses were performed to determine the proportion of MAs showing a significant positive effect of homoeopathy vs. no significant difference. RESULTS: Six MAs were included, covering individualised homoeopathy (I-HOM, n = 2), nonindividualised homoeopathy (NI-HOM, n = 1) and all homoeopathy types (ALL-HOM = I-HOM + NI-HOM, n = 3). The MAs comprised between 16 and 110 trials, and the included trials were published from 1943-2014. The median trial sample size ranged from 45 to 97 patients. The risk of bias (low/unclear/high) was rated as low for three MAs and high for three MAs. Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy compared to placebo (5 of 5 MAs, no data in 1 MA). Sensitivity analyses with sample restriction to high-quality trials were available from 4 MAs; the effect remained significant in 3 of the MAs (2 MAs assessed ALL-HOM, 1 MA assessed I-HOM) and was no longer significant in 1 MA (which assessed NI-HOM). DISCUSSION: The quality of evidence for positive effects of homoeopathy beyond placebo (high/moderate/low/very low) was high for I-HOM and moderate for ALL-HOM and NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo. The available MAs of PRETHAIs reveal significant positive effects of homoeopathy beyond placebo. This is in accordance with laboratory experiments showing partially replicable effects of homoeopathically potentised preparations in physico-chemical, in vitro, plant-based and animal-based test systems. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020209661. The protocol for this SR was finalised and submitted on 25 Nov. 2020 and registered on 26 Dec. 2020.

International integrative primary care outcomes study (IIPCOS-2): an international research project of homeopathy in primary care.

OBJECTIVE: The primary objective is to evaluate the effectiveness of homeopathic treatment compared to conventional treatment for respiratory and ear complaints commonly seen in the primary care setting: runny nose, sore throat, ear pain, sinus pain, and cough. METHOD: This study is an international, multi-center, prospective, outcomes study on the effectiveness of homeopathic treatment compared to conventional treatment. The participating investigators will be divided into three groups: * Homeopathic treatment; * Homeopathic or conventional treatment according to the patient's preference, either randomized or non-randomized; * Conventional treatment. A total of 2400 patients will be recruited. Consecutive patients, age one month or older, presenting with one of the five chief complaints, and onset of symptoms less than seven days will be included into the study. Prior to enrolment into the trial each patient must provide written informed consent. Patient outcome will be measured using the Integrative Medicine Outcomes Scale (IMOS) at 7-, 14- and 28-d telephone follow-up. In addition, covariate data related to the following will be collected: patient demographics and medical history, patient preference for treatment and willingness to be randomized, health-related quality of life, primary treatment and adjunctive therapies prescribed, adverse events, type and length of consultation, follow-up recommendation, patient compliance, patient satisfaction with treatment, and patient willingness to choose therapy and health care provider again. The main outcome criterion will be the response rate according to the IMOS after 14 days of treatment. RESULTS: Preliminary interim results will be presented. CONCLUSIONS: Lessons learned from the study will be discussed.

Tests of behavior momentum in simple and multiple schedules with rats and pigeons.

Four experiments examined the relationship between rate of reinforcement and resistance to change in rats' and pigeons' responses under simple and multiple schedules of reinforcement. In Experiment 1, 28 rats responded under either simple fixed-ratio, variable-ratio, fixed-interval, or variable-interval schedules; in Experiment 2, 3 pigeons responded under simple fixed-ratio schedules. Under each schedule, rate of reinforcement varied across four successive conditions. In Experiment 3, 14 rats responded under either a multiple fixed-ratio schedule or a multiple fixed-interval schedule, each with two components that differed in rate of reinforcement. In Experiment 4, 7 pigeons responded under either a multiple fixed-ratio or a multiple fixed-interval schedule, each with three components that also differed in rate of reinforcement. Under each condition of each experiment, resistance to change was studied by measuring schedule-controlled performance under conditions with prefeeding, response-independent food during the schedule or during timeouts that separated components of the multiple schedules, and by measuring behavior under extinction. There were no consistent differences between rats and pigeons. There was no direct relationship between rates of reinforcement and resistance to change when rates of reinforcement varied across successive conditions in the simple schedules. By comparison, in the multiple schedules there was a direct relationship between rates of reinforcement and resistance to change during most tests of resistance to change. The major exception was delivering response-independent food during the schedule; this disrupted responding, but there was no direct relationship between rates of reinforcement and resistance to change in simple- or multiple-schedule contexts. The data suggest that rate of reinforcement determines resistance to change in multiple schedules, but that this relationship does not hold under simple schedules.