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      Homöopathie – eine Therapieoption für die Praxis? : Bewertung unter dem Blickwinkel der evidenzbasierten Medizin Translated title: Homeopathy—a therapeutic option for medical practice? : An evaluation from the perspective of evidence-based medicine

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          Abstract

          Viele Veröffentlichungen bezeichnen die Homöopathie als „umstritten“. Angesichts umfangreicher Forschungsergebnisse zur Homöopathie besteht jedoch längst weitestgehend wissenschaftlicher Konsens dahin, dass es keinen belastbaren Beleg für eine spezifische medizinische Wirksamkeit gibt. Die Gesamtevidenz spricht klar gegen Effekte, die über die von Placebo- und anderen Kontexteffekten hinausgehen. Umso mehr muss es als Phänomen erscheinen, dass die Homöopathie nach wie vor Gegenstand medizinisch-therapeutischer Praxis ist. Dies mag eine wesentliche Ursache darin haben, dass sich die homöopathische Szene der medizinischen Forschung und des Evidenzbegriffs auf eine Weise bemächtigt, die geeignet ist, den Anschein aufrechtzuerhalten, es gäbe noch einen wissenschaftlich relevanten Diskurs zu bestreiten. Dass dies nicht der Fall ist und deshalb die Homöopathie als therapeutische Option, auch nach den Grundsätzen zeitgemäßer Medizinethik, obsolet ist, will der nachstehende Beitrag begründen.

          Translated abstract

          Many publications declare homeopathy to be “controversial.” However, based on the findings of extensive research on homeopathy, there has long been a broad scientific consensus that there is no reliable evidence of specific medical effectiveness. Overall, the evidence clearly denies effects beyond those of placebo and context. All the more must it be seen as a phenomenon that homeopathy is still the subject of medical and therapeutic practice. This may lie largely in the fact that the homeopathic scene appropriates medical research and the concept of evidence in a way that is suitable to maintain the appearance that there is still a scientifically relevant discourse to dispute. The following article aims to justify that this is not the case, and that homeopathy is, therefore, obsolete as a therapeutic option, even according to the principles of contemporary medical ethics.

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          Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials

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            Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment.

            Placebo treatments have been reported to help patients with many diseases, but the quality of the evidence supporting this finding has not been rigorously evaluated. We conducted a systematic review of clinical trials in which patients were randomly assigned to either placebo or no treatment. A placebo could be pharmacologic (e.g., a tablet), physical (e.g., a manipulation), or psychological (e.g., a conversation). We identified 130 trials that met our inclusion criteria. After the exclusion of 16 trials without relevant data on outcomes, there were 32 with binary outcomes (involving 3795 patients, with a median of 51 patients per trial) and 82 with continuous outcomes (involving 4730 patients, with a median of 27 patients per trial). As compared with no treatment, placebo had no significant effect on binary outcomes (pooled relative risk of an unwanted outcome with placebo, 0.95; 95 percent confidence interval, 0.88 to 1.02), regardless of whether these outcomes were subjective or objective. For the trials with continuous outcomes, placebo had a beneficial effect (pooled standardized mean difference in the value for an unwanted outcome between the placebo and untreated groups, -0.28; 95 percent confidence interval, -0.38 to -0.19), but the effect decreased with increasing sample size, indicating a possible bias related to the effects of small trials. The pooled standardized mean difference was significant for the trials with subjective outcomes (-0.36; 95 percent confidence interval, -0.47 to -0.25) but not for those with objective outcomes. In 27 trials involving the treatment of pain, placebo had a beneficial effect (-0.27; 95 percent confidence interval, -0.40 to -0.15). This corresponded to a reduction in the intensity of pain of 6.5 mm on a 100-mm visual-analogue scale. We found little evidence in general that placebos had powerful clinical effects. Although placebos had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos.
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              Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis

              Background A rigorous systematic review and meta-analysis focused on randomised controlled trials (RCTs) of non-individualised homeopathic treatment has not previously been reported. We tested the null hypothesis that the main outcome of treatment using a non-individualised (standardised) homeopathic medicine is indistinguishable from that of placebo. An additional aim was to quantify any condition-specific effects of non-individualised homeopathic treatment. Methods Literature search strategy, data extraction and statistical analysis all followed the methods described in a pre-published protocol. A trial comprised ‘reliable evidence’ if its risk of bias was low or it was unclear in one specified domain of assessment. ‘Effect size’ was reported as standardised mean difference (SMD), with arithmetic transformation for dichotomous data carried out as required; a negative SMD indicated an effect favouring homeopathy. Results Forty-eight different clinical conditions were represented in 75 eligible RCTs. Forty-nine trials were classed as ‘high risk of bias’ and 23 as ‘uncertain risk of bias’; the remaining three, clinically heterogeneous, trials displayed sufficiently low risk of bias to be designated reliable evidence. Fifty-four trials had extractable data: pooled SMD was –0.33 (95% confidence interval (CI) –0.44, –0.21), which was attenuated to –0.16 (95% CI –0.31, –0.02) after adjustment for publication bias. The three trials with reliable evidence yielded a non-significant pooled SMD: –0.18 (95% CI –0.46, 0.09). There was no single clinical condition for which meta-analysis included reliable evidence. Conclusions The quality of the body of evidence is low. A meta-analysis of all extractable data leads to rejection of our null hypothesis, but analysis of a small sub-group of reliable evidence does not support that rejection. Reliable evidence is lacking in condition-specific meta-analyses, precluding relevant conclusions. Better designed and more rigorous RCTs are needed in order to develop an evidence base that can decisively provide reliable effect estimates of non-individualised homeopathic treatment. Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0445-3) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                c.luebbers@hno-weilheim.de
                Journal
                HNO
                HNO
                Hno
                Springer Medizin (Heidelberg )
                0017-6192
                1433-0458
                19 May 2021
                19 May 2021
                2021
                : 69
                : 8
                : 679-690
                Affiliations
                [1 ]HNO Weilheim, Pöltnerstraße 22, 82362 Weilheim, Deutschland
                [2 ]Krayer Straße 227, 45307 Essen, Deutschland
                Author notes
                [Wissenschaftliche Leitung]

                M. Canis, München

                T. Hoffmann, Ulm

                J. Löhler, Bad Bramstedt

                P. Mir-Salim, Berlin

                S. Strieth, Bonn

                Article
                1061
                10.1007/s00106-021-01061-w
                8316206
                34009440
                889c667c-8c2f-4dad-ad9b-06787b515c91
                © The Author(s) 2021, korrigierte Publikation 2021

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                History
                : 28 April 2021
                Categories
                CME
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                qualitätssicherung im gesundheitswesen ,berufsethik,systematische übersichtsarbeit,placeboeffekt,medizinethik,health care quality assurance,professional ethics,systematic review,placebo effect,medical ethics

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