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Evidence-based medicine is a worthy objective. According to the Oxford-based Centre for Evidence Based Medicine, “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

The present campaign against homeopathy and other complementary therapies makes extensive use of these aims to justify calls for these therapies’ exclusion from the NHS on the grounds that there is “no evidence” for their efficacy. I’ve gone into the evidence question in relation to homeopathy in other posts. This one looks at the evidence base for biomedical treatment. After all, if biomedical treatment is to be so clearly preferred over the complementary therapies which presently lack the robust evidence base being demanded, then one would assume that biomedical treatments have a clear advantage here.

One would assume wrongly.

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This is the first paragraph from Ben Goldacre’s recent comment piece Benefits and risks of homeopathy in The Lancet‘s November 17 edition.

Five large meta-analyses of homoeopathy trials have been done. All have had the same result: after excluding methodologically inadequate trials and accounting for publication bias, homoeopathy produced no statistically significant benefit over placebo. 1–5

(1) Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. BMJ 1991; 302: 316–23.
(2) Boissel JP, Cucherat M, Haugh M, Gauthier E. Critical literature review on the effectiveness of homoeopathy: overview of data from homoeopathic medicine trials. Brussels, Belgium: Homoeopathic Medicine Research Group. Report to the European Commission. 1996: 195–210.
(3) Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Alter Complement Med 1998; 4: 371–88.
(4) Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of homeopathy: a meta-analysis of clinical trials. Eur J Clin Pharmacol 2000; 56: 27–33
(5) Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726–32

Note that Goldacre omits the Linde et al meta-analysis published in The Lancet in 1997 (6) from his listed studies.

Below are comments and conclusions from each of these studies. Remember, Goldacre is saying that they each support his assertion that homeopathy has no statistically significant benefit over placebo.

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