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NHMRC INFORMATION PAPER

Evidence on the effectiveness of  

homeopathy for treating health conditions

March 2015

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Publication Details

Publication title:  

 NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating 
health conditions

Published:  

March 2015

Publisher:   

National Health and Medical Research Council

NHMRC Publication reference:  

CAM02A

Online version:   

www.nhmrc.gov.au/guidelines-publications/cam02

ISBN Online:  

978-1-925129-29-8

Suggested citation: 

 National Health and Medical Research Council. 2015. 

NHMRC Information Paper: Evidence on the 

effectiveness of homeopathy for treating health conditions

. Canberra: National Health and Medical 

Research Council; 2015

Copyright

© Commonwealth of Australia 2015 

All material presented in this publication is provided under 
a Creative Commons Attribution 3.0 Australia licence 
(http://creativecommons.org.au), with the exception of the 
Commonwealth Coat of Arms, NHMRC logo and content 
identified as being owned by third parties. The details of 
the relevant licence conditions are available on the Creative 
Commons website (http://creativecommons.org.au), as is the 
full legal code for the CC BY 3.0 AU licence.

Attribution

Creative Commons Attribution 3.0 Australia Licence is a standard 
form license agreement that allows you to copy, distribute, 
transmit and adapt this publication provided that you attribute 
the work. The NHMRC’s preference is that you attribute this 
publication (and any material sourced from it) using the following 
wording: Source: National Health and Medical Research Council.

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images, icons and illustrations) are copyrighted by their original 
owners.

Contact us

To obtain information regarding NHMRC publications or submit a copyright request, contact:

E: nhmrc.publications@nhmrc.gov.au 

P: 13 000 NHMRC (13 000 64672)  
or call (02) 6217 9000 

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Contents

About NHMRC 

4

Executive summary 

5

Homeopathy 5
Methods 5
Findings 6
Conclusions 6

Introduction 7

Purpose 7
Scope 7
What is homeopathy? 

7

Why did NHMRC conduct an assessment of homeopathy? 

8

NHMRC’s approach to assessing health evidence 

9

About NHMRC’s assessment of the evidence 

11

Sources of information 

11

How did NHMRC assess the evidence about homeopathy? 

14

What quality checks were applied to NHMRC’s assessment of the evidence on homeopathy? 

15

Findings of the NHMRC assessment of the evidence 

16

Overview 16
Information provided by homeopathy interest groups and individuals 

21

Overall findings based on the evidence 

24

Limitations of the assessment and evidence base for homeopathy 

25

NHMRC’s interpretation of the assessment of the evidence on the  
effectiveness of homeopathy 

27

Definition of special terms 

28

Appendix A. NHMRC evidence hierarchy, including explanatory notes 

30

Explanatory notes 

30

Appendix B. The Homeopathy Working Committee 

31

Appendix C. Criteria for the development of evidence statements 

33

Purpose and role of the criteria 

33

Introduction to the criteria 

33

References 39

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About NHMRC

NHMRC is Australia’s peak body for supporting health and medical research by funding the best 
research, selected through a competitive peer review process. NHMRC also develops health advice 
for the Australian community, health professionals and governments in the form of public health 
and clinical practice guidelines, Statements, Information Papers and evidence reviews. NHMRC also 
provides advice on ethical behaviour in health care and in the conduct of health and medical research.

The work of NHMRC is guided by its Strategic Plan, and defined by the 

National Health and Medical 

Research Council (NHMRC) Act 1992

. The Strategic Plan covers a three year period and is submitted 

to the Health Minster for approval, prior to being tabled in Parliament. The NHMRC Strategic Plan 
2013–2015

[1] 

has identified ‘claiming benefit for human health not based on evidence’ as a major health 

issue for consideration.

This Information Paper is an example of NHMRC’s function to ‘advise the community’ under section 
7(1)(a) of the 

NHMRC Act 1992

. Published research on a topic of interest has been identified, 

analysed and synthesised into a summary of the evidence for the Australian community, health 
professionals and policy makers. This information can then be utilised to assist people in making 
healthcare choices, guide clinical practice or influence policy and perhaps new funding approaches, 
all of which lead to improvements in health and health care delivery.

Within our health system, there are practices which are currently not based on sturdy evidence. 
Health and medical research is the means by which we test the value of procedures, processes, 
systems and products offered to patients, or proposed as preventive means by the health system 
and its policy and decision makers.

NHMRC is a strong advocate for the development and use of evidence to inform policy and practice 
and in recent years, NHMRC and other health research funding bodies have increased funding for 
such research.

NHMRC is of the view that when offering treatments for illness, all registered health practitioners must 
give consideration to the evidence for the effectiveness of such treatments. This consideration should 
be reflected in their professional ethics and clinical practices.

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Executive summary

Homeopathy

Homeopathy is a type of complementary and alternative medicine that is commonly used in Australia 
and around the world. It is based on two premises: 

• 

that substances that may cause illness or symptoms in a healthy person can, in very small doses, 
treat those symptoms in a person who is unwell, and 

• 

that highly diluted preparations retain a ‘memory’ of the original substance. Homeopathic 
medicines are prepared by taking a substance (e.g. plant, animal material, or chemical), diluting 
it in water or alcohol, then forcefully hitting the container against a hand or a surface. This process 
is repeated several times. 

Homeopathic medicines include pellets placed under the tongue, tablets, liquids, ointments, 
sprays and creams.

Methods

The National Health and Medical Research Council (NHMRC) undertook an assessment of the 
evidence of the effectiveness of homeopathy. This assessment was based on:

• 

an overview of published systematic reviews by an independent contractor

[2]

,

• 

an independent evaluation of information provided by homeopathy interest groups and the  
public

[3, 4]

, and 

• 

consideration of clinical practice guidelines and government reports on homeopathy published 
in other countries.

The assessment of the evidence used standardised, accepted methods for assessing the quality 
and reliability of evidence for whether or not a therapy is effective for treating health conditions.

This work was overseen by the Homeopathy Working Committee established by the NHMRC. 
Given their collective expertise in evidence-based medicine, study design, and complementary and 
alternative medicine research, the Homeopathy Working Committee also provided advice on how the 
evidence should be interpreted in developing an Information Paper. An approach, similar to that of a 
Health Technology Assessment, was used to consider the outcomes of the assessment of the evidence. 
This means that for a treatment to be considered effective, it must result in health improvements that 
cannot be explained by the placebo effect, and these health improvements must be meaningful for 
a person’s overall health. There must be evidence that the health improvements in people taking the 
treatment are unlikely to be due to chance and the result must be seen consistently in several studies.

Evidence on homeopathy was collected by identifying systematic reviews which evaluated the 
effectiveness of homeopathy in treating health conditions in humans. In total, 57 systematic reviews 
were identified that contained 176 individual studies. Studies were only considered by NHMRC if 
they compared a group of people who were given homeopathic treatment with a similar group of 
people who were not given homeopathic treatment (controlled studies). For each health condition, 
the evidence reviewers assessed the quality of the systematic reviews using a standard, internationally 

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accepted method, and recorded the number and type of studies that were included in the systematic 
reviews. Using the information provided by the systematic reviews, the reviewers also assessed the 
quality of each individual study and its number of participants, taking into account factors that could 
bias the results in favour of homeopathy, placebo or another treatment.

Additional information was submitted to NHMRC, for consideration as part of its review of 
homeopathy, by homeopathy interest groups and the public on two occasions: before the 
commissioned overview of evidence (preliminary submitted literature) and during the review of 
the draft Information Paper (public consultation submitted literature). The preliminary and public 
consultation submitted literature was assessed using a similar method to that applied in the overview.

Where a clinical condition had already been considered in the overview, the results from the 
submitted literature were compared to the conclusions of the overview to examine the consistency 
of results against the body of evidence. Where a clinical condition had not been considered in the 
overview, the results of the submitted literature were assessed with regards to their study design, size 
and different kinds of bias to see if any comment on the effectiveness of homeopathy could be made.

Findings

There was no reliable evidence from research in humans that homeopathy was effective for 
treating the range of health conditions considered: no good-quality, well-designed studies with 
enough participants for a meaningful result reported either that homeopathy caused greater health 
improvements than placebo, or caused health improvements equal to those of another treatment.

For some health conditions, studies reported that homeopathy was not more effective than placebo. 
For other health conditions, there were poor-quality studies that reported homeopathy was more 
effective than placebo, or as effective as another treatment. However, based on their limitations, those 
studies were not reliable for making conclusions about whether homeopathy was effective. For the 
remaining health conditions it was not possible to make any conclusion about whether homeopathy 
was effective or not, because there was not enough evidence.

Conclusions

Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that 
there are no health conditions for which there is reliable evidence that homeopathy is effective.

Homeopathy should not be used to treat health conditions that are chronic, serious, or could become 
serious. People who choose homeopathy may put their health at risk if they reject or delay treatments 
for which there is good evidence for safety and effectiveness. People who are considering whether 
to use homeopathy should first get advice from a registered health practitioner. Those who use 
homeopathy should tell their health practitioner and should keep taking any prescribed treatments.

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Introduction

Purpose

This Information Paper provides a summary of evidence from research on the effectiveness of 
homeopathy in treating health conditions in humans.

Scope

NHMRC assessed the evidence on homeopathy to answer this question: 

Is homeopathy an effective 

treatment for health conditions, compared with no homeopathy, or compared to other treatments?

NHMRC did not consider any of these types of evidence:

• 

laboratory studies;

• 

studies in animals;

• 

studies in humans without a specific health condition, including:

 

studies investigating whether or not homeopathy is effective for preventing health conditions;

 

evidence about homeopathic ‘vaccines’; and

 

whether homeopathy is good for general health and wellbeing.

The focus of the assessment of the evidence was on the effectiveness of homeopathic medicines, 
not their safety.

What is homeopathy?

Homeopathy is a type of complementary and alternative medicine. It is based on two premises:

• 

that substances that may cause illness or symptoms in a healthy person can, in very small doses, 
treat those symptoms in a person who is unwell (‘like cures like’); and

• 

that highly diluted preparations retain a ‘memory’ of the original substance.

Homeopathic medicines are prepared by taking a substance (e.g. plant, animal material, or chemical) 
and repeatedly diluting it in water or alcohol. The container holding the preparation is then forcefully 
hit against a hand or a surface in a process known as ‘potentiation’ or ‘dynamisation’. Homeopathic 
medicines can include pellets placed under the tongue, tablets, liquids, ointments, sprays and creams.

Homeopaths provide either ‘individualised homeopathy’ or ‘clinical homeopathy’. In individualised 
homeopathy, the homeopath matches all the person’s symptoms to a single homeopathic medicine, 
rather than treating the person for a particular health condition using one or more homeopathic 
medicines. In clinical homeopathy, the homeopath chooses one or more homeopathic medicines 
to treat a particular health condition.

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Homeopathy is commonly used around the world, however, there are no reliable estimates of 
Australians’ current use of homeopathic medicines. A 2009 World Health Organisation review on the 
safety of homeopathy reported that each year, Australians spend an estimated US $7.3 million on 
homeopathic medicines.

[5]

Why did NHMRC conduct an assessment of homeopathy?

NHMRC is responsible for supporting health and medical research as well as providing Australians 
with advice based on the best available evidence. This advice assists people in making informed 
decisions about their health care. This includes providing advice about the use of conventional 
therapies, as well as complementary and alternative medicines or traditional practices which, 
despite their longstanding history of use, may not have been demonstrated to be effective.

Many health care practices and products are promoted as beneficial to health when there is little 
or no evidence to support these claims. In some cases these claims may mislead people to reject 
practices and treatments that are proven to be effective, in favour of non-evidence-based treatments.

People who use homeopathy need to understand the potential benefits and risks to enable them 
to make an informed decision. Health practitioners also need to know what homeopathy is, be 
aware of the current scientific evidence from research on homeopathy, and understand any possible 
benefits and risks to patients—particularly when people decide to use homeopathy instead of other 
evidence-based treatments.

For these reasons, NHMRC undertook an assessment of the evidence to provide Australians with 
reliable information on the effectiveness of homeopathy.

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NHMRC’s approach to assessing health evidence 

When assessing the effectiveness of treatments for health conditions, not all evidence has equal value.

It is not possible to tell whether a health treatment is effective or not simply by considering 
individuals’ experiences or healthcare practitioners’ beliefs. One reason personal testimonials are 
not reliable is that people may experience health benefits because they believe that a treatment is 
effective. This is known as the ‘placebo effect’. Another reason is that healthcare practitioners cannot 
always tell whether changes in a person’s health condition are due to the treatment or some other 
reason. For these reasons, medicines must be tested in a planned, structured scientific research project 
designed to prevent these kinds of experiences giving the false impression that a medicine is more or 
less effective than it really is.

Some types of studies provide stronger evidence than others because of how they are designed. If 
studies are poorly designed, there is a risk that results may be biased; that is, the results may under or 
over-estimate the real effect of the treatment being tested. Researchers have developed particular ways 
of designing studies that aim to minimise the potential for such bias. Reliable information about whether 
a particular medicine is effective for treating a health condition or not, comes from studies in which:

• 

the medicine is compared with a substance that has no effect (placebo) in a group of people 
with the health condition (placebo-controlled trial), or the medicine is compared with an effective 
standard treatment (controlled trial);

• 

each participant is given either the medicine or the placebo/other treatment at random 
(randomised trial);

• 

participants do not know whether they are taking the medicine or the placebo/other treatment, 
and researchers to not know which participants are taking each treatment, until the study is 
finished (double-blinded trial);

• 

there are enough participants to be reasonably confident that, if there is a bigger change in the 
health condition in one group compared to another, this is not just due to chance; and

• 

the correct statistical methods are used to analyse the results.

When treatments are intended to be adjusted for the individual patient (e.g. different doses or 
combinations of medicines), it is still necessary to test whether the medicine is effective or not. It is 
possible to design high-quality studies to assess treatment approaches that involve individualisation, 
such as homeopathy.

Even where researchers take care to design studies in a way that minimises bias, there is a chance 
that the results will show a statistically significant difference in favour of a treatment, when there 
is actually no effect. Therefore, the results of individual studies need to be repeated in other 
independent studies, to make sure the effects seen were not just due to chance. The most reliable 
information comes from research that combines the results of all available similar studies and analyses 
the results together (systematic reviews).

When evaluating health evidence and drafting health advice, NHMRC uses a rigorous approach that 
has been developed by Australian experts in research methods.

[6]

 Under the NHMRC system, there 

are different levels of evidence, ranging from level one (highest level, strongest evidence) to level 
four (lowest level, weakest evidence).

[7]

 Further detail about this hierarchy is provided at Appendix A. 

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The level of evidence assigned to each study design is based on the extent to which each study 
design is expected to minimise bias. The level of evidence is used to decide how much a study’s 
results should be relied upon, when judging the overall evidence.

A treatment is considered effective for treating a health condition if it meets all of these key criteria:

• 

the treatment causes health improvements that cannot be explained by the placebo effect;

• 

health improvements that occur in people taking the treatment are unlikely to be due to chance;

• 

the health improvements caused by the treatment are meaningful for a person’s overall health; and

• 

the health improvement occurs consistently in several studies.

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About NHMRC’s assessment of the evidence

Sources of information

The NHMRC assessment of the evidence used a combination of three main sources of information 
about the effectiveness of homeopathy (Figure 1):

• 

an evidence review (the ‘overview of systematic reviews’), comprising a systematic review 
of published systematic reviews (summarised in the Overview report)

[2]

;

• 

evidence provided by homeopathy interest groups and the public at the beginning of the process, 
before the commissioned overview of evidence (preliminary submitted literature) and during 
review of the draft Information Paper (public consultation submitted literature).

[3, 4]

 

• 

evidence-based clinical practice guidelines, government reports on homeopathy published in other 
countries, and other reports.

The NHMRC’s assessment was guided by a committee of experts in evidence evaluation, 
the Homeopathy Working Committee, appointed in April 2012 (Appendix B).

Overview of systematic reviews

Many systematic reviews of homeopathy studies have already been published. NHMRC commissioned 
a professional research group OptumInsight (Optum) to do a thorough search of published research 
to find systematic reviews of studies (prospective, controlled studies) that compared homeopathy 
with no homeopathy or with other treatments and measured effectiveness in patients with any health 
condition.

The researchers searched databases of health publications to find systematic reviews published 
in English between 1 January 1997 and 3 January 2013.

For each health condition, the research group collated the findings of the systematic reviews and 
assessed the quality and reliability of the evidence. The findings are described in detail in the 
Overview Report.

[2]

The purpose of this approach was to use published systematic reviews as a way of identifying the 
body of evidence for homeopathic treatments. The professional research group did not accept the 
conclusions or interpretations of the systematic reviews, but instead considered the included studies. 
The professional research group evaluated the quality of each of the included studies (Appendix C), 
using the information provided by the systematic reviews. This process had some limitations as well 
as strengths (see Limitations of the assessment and evidence base for homeopathy).

Evidence provided by homeopathy interest groups and individuals

Additional information was submitted by homeopathy interest groups and the public to NHMRC, for 
its consideration as a part of its review of homeopathy, on two occasions. The preliminary submitted 
literature on the effectiveness of homeopathy was provided by the Australian Homoeopathy 
Association and the Australian Medical Fellowship of Homeopathy as well as members of the 
public. During public consultation on the draft Information Paper, a range of stakeholders submitted 

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additional literature for consideration in the development of this Information Paper (public 
consultation submitted literature).

All submitted literature was assessed by independent contractors to identify evidence within the 
scope of NHMRC’s assessment. Only the types of studies that were included in the overview 
(prospective, controlled studies) were assessed in detail. For each study included, the independent 
contractors assessed the quality and reliability of the results and summarised the findings in a 
review of submitted literature.

[3, 4]

This evidence was considered when preparing this Information Paper.

Evidence-based guidelines, government reports

NHMRC identified a small number of relevant, recent European reports and guidelines which were 
considered when developing this Information Paper:

• 

a major United Kingdom Government report

[8]

• 

several evidence-based clinical practice guidelines,

[9–14]

 published or funded by the United 

Kingdom National Institute for Health and Clinical Excellence, which included recommendations 
about the use of homeopathy in the treatment of various health conditions; and

• 

a book on homeopathy by a Swiss group of authors.

[15]

  This book was based on an earlier 

literature review of homeopathy

[16]

 commissioned by the Swiss Government’s evaluation program 

for complementary and alternative medicines. Although neither the book nor the literature 
review was published by the Swiss Government as a health technology assessment report

[17]

, the 

NHMRC assessment considered the 2006 literature review because it is often described as a Swiss 
Government publication.

[18]

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Figure 1. Components of NHMRC’s assessment of homeopathy

EVIDENCE ASSESSMENT

•  Overview report
•  Preliminary submitted literature
•  Other government reports and guidelines

DRAFT INFORMATION PAPER

•  Summarises the assessment of the evidence 
  in non-technical language
•  Provides advice for the general community about 
  he evidence on the effectiveness of homeopathy

Homeopathy Working Committee 
•  Review of public consultation submissions, 
  including submitted literature
•  Expert review considerations
•  Final Information Paper

NHMRC Council consideration

NHMRC Information Paper

NHMRC Statement

Homeopathy Working Committee consideration

Independent

expert review

Public consultation

submissions

Independent methodological

review of Overview report

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How did NHMRC assess the evidence about homeopathy?

NHMRC used standardised, accepted methods for assessing the quality and reliability of evidence 
for whether or not a therapy is effective for treating health conditions (see NHMRC’s approach to 
assessing health evidence).

Overview of systematic reviews

In assessing the systematic reviews, the following factors were considered:

• 

the relevance of the review to the question of whether or not homeopathy is effective for treating 
health conditions;

• 

the type of studies and whether they were well designed;

• 

whether the reports included enough information to judge whether the studies were done well 
and whether the results were likely to be reliable or unreliable;

• 

whether studies included enough participants to provide meaningful results; and

• 

whether studies compared homeopathy with placebo or with another treatment.

The overview considered only studies with these features:

• 

the health outcomes to be measured were defined in advance; the way to measure the effects 
of treatment on these outcomes was planned in advance; and the results were then measured 
at specified times (prospectively designed studies); and

• 

the study compared a group of people who were given homeopathic treatment with a similar 
group of people who were not given homeopathic treatment (controlled studies).

For each health condition, all the available evidence was grouped together to form a body of 
evidence on that condition. A body of evidence was considered more reliable if it included studies 
that were high quality, well designed and with enough participants to make its results meaningful. 
A body of evidence was considered less reliable if there were very few studies, or if the studies were 
poor quality, badly designed, or included too few participants. The methods are described in detail 
in the Overview Report.

[2]

For each health condition, the body of evidence was summarised in a statement, using standard 
wording and applying the same considerations consistently (see Appendix C).

In general, the systematic reviews included in the overview did not consider or evaluate the potential 
for publication bias (see Limitations of the assessment and evidence base for homeopathy). Therefore, 
it was not possible to estimate whether the results of unpublished studies may have altered the 
balance of evidence.

Evidence provided by homeopathy interest groups and individuals

The preliminary and public consultation submitted literature was assessed using a similar method 
to that applied in the overview. Only prospectively designed and controlled studies conducted in 
humans (including randomised controlled trials, pseudo-randomised controlled trials, non-randomised 
controlled trials and prospective cohort studies) were considered.

NHMRC did not consider observational studies, individual experiences and testimonials, case series 
and reports, or research that was not done using standard methods.

Studies that had already been identified and included in the overview were not considered again. 
For the remaining prospectively designed and controlled studies that had not already been included 

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in the overview, the quality of each study was evaluated using a standardised, internationally 
accepted method.

A full description of the methods used are provided in the 

Effectiveness of homeopathy for any clinical 

condition: evaluation of the evidence—Review of submitted literature

[3]

 and 

Effectiveness of homeopathy 

for clinical conditions: evaluation of the evidence—Review of literature from public submissions

.

[4]

For more information on NHMRC’s processes for reviewing evidence, see About the NHMRC 
assessment of the evidence.

What quality checks were applied to NHMRC’s assessment of the evidence 
on homeopathy?

NHMRC has a number of processes in place to ensure that the evidence was identified and reviewed 
in a robust and transparent manner. In developing this Information Paper, the following steps occurred:

• 

expert, methodological review of the research methods used to identify and analyse the evidence 
in the overview report;

• 

the opportunity for the public to comment on the clarity of the draft Information Paper as well 
as submit additional evidence for consideration, through a public consultation process;

• 

expert review of the draft Information Paper to ensure that evidence had been interpreted in an 
appropriate, robust and transparent manner; and

• 

consideration of the Information Paper and supporting documents by the Council of NHMRC. 
Recommendation to release the advice is provided by Council when it is satisfied that the process 
followed is robust and transparent.

Expert review 

NHMRC commissioned an independent organisation with expertise in research methodology (The 
Australasian Cochrane Centre) to review the methods used in the overview and ensure that processes 
for identifying and assessing the evidence were scientifically rigorous, consistently applied, and clearly 
documented. All the reviewer’s comments and suggestions were considered in consultation with the 
Homeopathy Working Committee and the report amended accordingly.

NHMRC invited three national and international reviewers, with expertise in complementary 
medicines research, to comment on the draft Information Paper to ensure that the evidence had 
been accurately interpreted. All comments received were considered by the Homeopathy Working 
Committee and the draft Information Paper was amended accordingly. A summary of the expert 
reviewers’ comments and the considerations of the Homeopathy Working Committee is available 
at www.nhmrc.gov.au/guidelines-publications/cam02.

Public consultation 

A public consultation process was undertaken on the draft Information Paper. Public consultation 
ensured that relevant studies, examining the effectiveness of homeopathy that occurred outside of the 
search dates of the systematic reviews included in the overview, could be considered. Consultation 
also provided the opportunity for comment on the clarity of the process by which the Homeopathy 
Working Committee translated the research findings into advice.

All comments received from public consultation were collated and considered by the Homeopathy 
Working Committee. A report outlining the common themes raised during public consultation, the 
Homeopathy Working Committee consideration of those themes and the subsequent changes to the 
Information Paper is available at www.nhmrc.gov.au/guidelines-publications/cam02.

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Findings of the NHMRC assessment of the evidence

Overview

The overview

[2]

 considered 57 systematic reviews that assessed the effectiveness of homeopathy 

(individualised homeopathy or clinical homeopathy) compared to placebo or other treatment, for 
treating health conditions.

These systematic reviews searched for published research on homeopathy for 68 health conditions 
and found published research on 61 of these conditions. No published research was found for the 
remaining seven conditions.

The systematic reviews included 176 individual studies. The overview assessed the quality and 
considered the findings of each study using the information provided in the systematic reviews.  
A list of all included studies is available at www.nhmrc.gov.au/guidelines-publications/cam02.

Based on all the evidence considered, there were no health conditions for which there was 
reliable evidence that homeopathy was effective. No good-quality, well-designed studies with 
enough participants for a meaningful result reported either that homeopathy caused greater health 
improvements than placebo, or caused health improvements equal to those of another treatment.

Homeopathy compared with placebo

Studies that compare a medicine with placebo are designed to test whether the medicine is effective 
as a treatment for the health condition. The systematic reviews identified studies that compared 
homeopathy with placebo for 55 health conditions (this included one condition, diarrhoea in 
children, for which studies of a combined homeopathy tablet (clinical homeopathy) and studies 
of individualised homeopathy were analysed separately).

For 13 health conditions (Table 1), homeopathy was reported to be not more effective than placebo 
in either:

• 

all the studies found (regardless of size and quality), or

• 

a large majority of those studies that were reliable (good-quality, well designed and with enough 
participants for a meaningful result).

For 14 health conditions (Table 1), some studies reported that homeopathy was more effective than 
placebo, but these studies were not reliable. They were not good quality (well designed and well 
done), or they had too few participants, or both. To be confident that the reported health benefits 
were not just due to chance or the placebo effect, they would need to be confirmed by other 
well-designed studies with adequate numbers of participants.

For 29 health conditions (Table 1), only one study that compared homeopathy with placebo was 
found and each of these studies was unreliable. They were either poor quality (poorly designed or 
poorly done) or unknown quality, or they had too few participants, or both. For these conditions, 
it was not possible to make any conclusion about whether homeopathy was effective or not.

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Homeopathy compared with other treatments

Studies that compare a medicine with another treatment are designed to test whether the medicine is 
as effective as, or more effective than, existing treatment options. This type of study is normally used 
when previous studies have already shown that the test medicine is more effective than placebo. The 
systematic reviews identified studies that compared homeopathy with at least one other treatment for 
15 conditions (these included 10 health conditions for which there were also studies that compared 
homeopathy with placebo).

Comparative studies can only provide useful information if the comparator treatment is already 
known to be effective. Some studies that compare two treatments also include a group of people who 
receive placebo, to make sure health effects in the groups taking the test medicine or the comparator 
treatment are not just due to the placebo effect.

In some studies considered in NHMRC’s assessment, homeopathy was compared with treatments that 
were not standard treatments for the condition. In those studies, it was not possible to judge the true 
effect of homeopathy on the health condition.

For eight health conditions (Table 1), some studies reported that homeopathy was as effective as 
another treatment, or more effective than another treatment, but these studies were not reliable. They 
were not good quality (well designed and well done), or they had too few participants, or both. To 
be confident that the reported health benefits were not just due to chance or the placebo effect, they 
would need to be confirmed by other well-designed studies with adequate numbers of participants.

For seven health conditions (Table 1), only one study that compared homeopathy with another 
treatment was found and each of these studies was unreliable. They were either poor quality (poorly 
designed or poorly done) or unknown quality, or they had too few participants, or both. For these 
conditions, it was not possible to make any conclusion about whether homeopathy was effective or not.

These findings are reported in detail in 

Effectiveness of homeopathy for any clinical condition: 

evaluation of the evidence. Overview report

.

[2]

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Table 1. Summary of evidence from studies of homeopathy

Conclusions

Why NHMRC reached this 
conclusion

Homeopathy is not more effective than placebo for the treatment of these health conditions:

• 

adenoid vegetation in children (abnormal growth of adenoid tonsils behind the nose)

• 

asthma

• 

anxiety or stress-related conditions

• 

diarrhoea in children—combined homeopathy tablet (clinical homeopathy)

• 

headache and migraine

• 

muscle soreness (delayed onset)

• 

labour (inducing or shortening labour)

• 

pain due to dental work 

• 

pain due to orthopaedic surgery

• 

postoperative ileus (abnormally slow movement of bowel after surgery) 

• 

premenstrual syndrome

• 

upper respiratory tract infections (e.g. colds)

• 

warts.

For each condition, 
homeopathy was reported to 
be not more effective than 
placebo in either:

• 

all the studies found 
(regardless of size and 
quality), or 

• 

a large majority of 
those studies that were 
reliable (good-quality, 
well designed and with 
enough participants for a 
meaningful result).

There is no reliable evidence that homeopathy is more effective than placebo for the 
treatment of these health conditions:

• 

allergic rhinitis

• 

attention deficit/hyperactivity disorder (ADHD) in children

• 

bruising

• 

chronic fatigue syndrome 

• 

diarrhoea in children—individualised homeopathy

• 

fibromyalgia

• 

hot flushes in women who have had breast cancer 

• 

human immunodeficiency virus (HIV) infection

• 

influenza-like illness

• 

rheumatoid arthritis

• 

sinusitis

• 

sleep disturbances or circadian rhythm disturbances

• 

stomatitis (inflammation of the mouth) due to chemotherapy

• 

ulcers.

For each condition, although 
some studies reported that 
homeopathy was more 
effective than placebo, 
these studies were not 
reliable. They were not good 
quality (well designed and 
well done), or they had too 
few participants to give a 
meaningful result, or both.

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Conclusions

Why NHMRC reached this 
conclusion

There is no reliable evidence on which to draw a conclusion about the effectiveness of 

homeopathy, compared with placebo, for the treatment of these health conditions:

• 

acne vulgaris 

• 

acute otitis media (inflammation of the middle ear) in children

• 

acute ankle sprain

• 

acute trauma in orthopaedic patients

• 

amoebiasis and giardiasis (gastrointestinal conditions caused by parasites)

• 

ankylosing spondylitis 

• 

boils and pyoderma (types of skin infections)

• 

Broca’s aphasia in people who have had a stroke 

• 

bronchitis

• 

cholera

• 

cough

• 

chronic polyarthritis

• 

dystocia (difficult labour)

• 

eczema

• 

heroin addiction

• 

knee joint haematoma (bruising)

• 

lower back pain

• 

nausea and vomiting associated with chemotherapy

• 

oral lichen planus

• 

osteoarthritis

• 

proctocolitis

• 

postoperative pain-agitation syndrome

• 

radiodermatitis (skin damage caused by radiotherapy) in women with breast cancer

• 

seborrhoeic dermatitis

• 

suppression of lactation after childbirth in women who elect not to breastfeed

• 

stroke

• 

traumatic brain injury (mild)

• 

uraemic pruritis

• 

vein problems due to cannulas in people receiving chemotherapy.

For each condition, only 

one study that compared 

homeopathy with placebo 

was found, and this study 

was unreliable. It was 

either poor quality (poorly 

designed or poorly done) or 

unknown quality, or it had 

too few participants to give a 

meaningful result, or both.

There is no reliable evidence that homeopathy is as effective as the other therapies for the 

treatment of these health conditions:

• 

acute otitis media or otitis media with effusion (inflammation of the middle ear) in 

children (compared with antibiotics, mucolytic medicines, secretolytic medicines, 

antipyretic medicines, nasal sprays, or monitoring the condition but not providing 

treatment [‘watchful waiting’])

• 

allergic rhinitis (compared with antihistamines, cortisone or intranasal cromolyn sodium)

• 

anxiety or stress-related conditions (compared with lorazepam, diazepam or cognitive 

behavioural therapy)

• 

depression (compared with fluoxetine or diazepam)

• 

eczema (compared with corticosteroids, antihistamines, or other unspecified therapies)

• 

non-allergic rhinitis (compared with aspirin, xylometazoline or other therapies)

• 

osteoarthritis (compared with paracetamol or various nonsteroidal anti-inflammatory 

drugs)

• 

upper respiratory tract infection (compared with anti-inflammatory drugs, antibiotics or 

other therapies).

For each condition, although 

some studies reported that 

homeopathy was as effective 

as or more effective than 

another treatment, these 

studies were not reliable. They 

were not good quality (well 

designed and well done), or 

they had too few participants 

to give a meaningful result, or 

both.

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Conclusions

Why NHMRC reached this 
conclusion

There is no reliable evidence on which to draw a conclusion about the effectiveness of 
homeopathy compared with other therapies for the treatment of these health conditions:

• 

burns (second- and third-degree)

• 

fibromyalgia

• 

irritable bowel syndrome

• 

malaria

• 

proctocolitis (inflammation of the rectum and colon)

• 

recurrent vulvovaginal candidiasis (yeast infection of the vagina and/or vulva, 
also called ‘thrush’)

• 

rheumatoid arthritis.

For each condition, only 
one study that compared 
homeopathy with another 
treatment was found, and 
this study was unreliable. It 
was either poor quality (poorly 
designed or poorly done) or 
unknown quality, or it had 
too few participants to give a 
meaningful result, or both.

Notes:

Systematic reviews included in the overview searched for, but did not find, studies assessing homeopathy in people with these conditions: 
borderline personality disorder, dementia, constipation in children, glaucoma, nocturnal enuresis (bedwetting), lower urinary tract symptoms in 
men, and chronic facial pain.

Systematic reviews included in the overview searched for, but did not find, studies that compared homeopathy with placebo in people with these 
conditions: burns (second and third degree), depression, irritable bowel syndrome, lower back pain, malaria, non-allergic rhinitis, and vulvovaginal 
candidiasis. For these conditions, systematic reviews found only studies that compared homeopathy with other treatments.

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Information provided by homeopathy interest groups and individuals

Preliminary submitted literature

The findings from evidence submitted before the commissioned overview of evidence are summarised 
in the report 

Effectiveness of homeopathy for any clinical condition: evaluation of the evidence. Review 

of submitted literature

.

[3]

A total of 343 articles were submitted to NHMRC, of which a large majority (234) were of a research 
or publication type not meeting the inclusion criteria. A further 79 articles had already been included 
or considered in the Overview Report. On considering the remaining 30 articles, studies were 
excluded if they: covered an intervention not meeting the inclusion criteria; were of a research type 
not meeting the inclusion criteria; did not report on efficacy outcomes; the study design confounded 
the results; or were not published in English. This resulted in nine studies examining the effectiveness 
of homeopathy for the treatment of eight different clinical conditions identified for further assessment.

Five of the eight conditions (otitis media, delayed-onset muscle soreness, depression, bruising, and 
sleep or circadian rhythm disturbances) were examined in the overview. The results of these studies 
were considered in relation to the body of evidence identified in the overview but did not alter the 
overall conclusions about the effectiveness of homeopathy because of their poor quality, poor design, 
poor reporting of the study design or method, or too few participants.

Three additional health conditions not included the overview were identified:

• 

pain after total abdominal hysterectomy;

• 

tracheal secretions in critically ill patients with a history of tobacco use and chronic obstructive 
pulmonary disease; and

• 

wound healing after foot surgery.

These studies were of poor quality. Problems included poor design, poor reporting of the study 
design or method, or too few participants. The results of these studies did not alter the overall 
conclusions about the effectiveness of homeopathy because of their poor quality, and because 
they were only selected examples of studies on those conditions. 

Public consultation submitted literature

A detailed description of the evidence submitted during pubic consultation and the independent 
assessment is summarised in the report 

Effectiveness of homeopathy for clinical conditions: evaluation 

of the evidence. Review of evidence from public submissions

.

[4]

A total of 48 submissions were received from consumers, consumer groups, health care professionals, 
homeopathy practitioners and homeopathy organisations. Of the 153 articles cited in these 
submissions, 94 were excluded because they did not meet the criteria for the NHMRC review 
(e.g. they did not investigate the treatment of health conditions in humans, they had already 
been considered in an earlier stage of the NHMRC review, or they were not published studies). 
The remaining 59 studies, which had not been included in the overview report, were assessed 
against pre-determined criteria for consideration. After this assessment, 17 more of these studies 
were excluded because they did not meet the criteria for the NHMRC review. Of the remaining 42 
published studies, three represented a single study, resulting in a final total of 40 studies assessing the 
effectiveness of homeopathy for the treatment of health conditions, compared with no homeopathy or 
with other treatment. For each study, the risk of bias was systematically assessed using a standardised 
method (the Cochrane Collaboration’s tool for assessing risk of bias)

[19]

 and analysed.

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Health conditions already covered by the overview

The included studies investigated homeopathy for the treatment of 14 health conditions (16 studies) 
that were covered by systematic reviews included in the overview: rheumatoid arthritis, influenza-like 
illness, hot flushes, rhinosinusitis, ankle sprain, oral dryness, psychophysiological-onset insomnia, 
stress, dermatological reactions to radiotherapy, warts, osteoarthritis of the knee, chronic low back 
pain, upper respiratory tract infection and otitis media.

Most studies were assessed to have a moderate, moderate-to-high or high risk of bias. Many of these 
studies were poorly designed, poorly conducted or poorly reported. In addition, the studies had too 
few participants to be able to detect differences in health outcomes between the treatment groups.

The findings of these studies did not alter the overall conclusions of the NHMRC review. Although 
one small study with a low risk of bias favoured homeopathy for the treatment of cough in upper 
respiratory tract infections, this study did not have enough participants to outweigh the wider body 
of evidence considered in the overview, which found that homeopathy was not more effective than 
placebo overall (Table 1).

Health conditions not already covered by the NHMRC overview

The submissions also included published studies on 21 clinical conditions (24 studies) that were not 
covered by systematic reviews included in the overview:

• 

coffee-related insomnia;

• 

arsenic toxicity;

• 

anal fissures;

• 

haemorrhoids;

• 

pulmonary tuberculosis;

• 

plantar fasciitis; 

• 

mental fatigue;

• 

acute febrile infections;

• 

varicose veins;

• 

vertigo;

• 

chronic periodontitis;

• 

cat allergy;

• 

diaper dermatitis;

• 

diabetic polyneuropathy;

• 

pain after tonsillectomy;

• 

essential hypertension;

• 

end-stage renal failure;

• 

subcutaneous mechanical injury in athletes;

• 

mucositis during stem cell therapy;

• 

post-rhinoplasty ecchymosis and oedema; 

• 

malnourishment.

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The majority of these studies reported results in favour of homeopathy. However, they were generally 
poor quality. Only one study

[20]

 was assessed as having a low risk of bias, and evaluated the effect 

of homeopathy, compared with placebo, on self-reported mental fatigue in 86 university staff and 
students. This study reported no difference between treatment groups, however it had too few 
participants to give a meaningful result.

For all other studies, the risk of bias ranged from moderate to high. Many of these studies were 
poorly designed, poorly conducted or poorly reported. Many of the studies had too few participants 
to be able to detect differences in health outcomes between the treatment groups.

The findings of studies on health conditions not already considered by the overview did not alter 
the overall conclusions of the NHMRC review. Although some studies reported results favouring 
homeopathy, none were high-quality studies judged to be at low risk of bias. In addition, these were 
only selected examples of studies on those health conditions. 

Evidence-based guidelines and government reports

A number of evidence-based clinical practice guidelines published or funded by the United Kingdom 
National Institute for Health and Clinical Excellence recommend against the use of homeopathy for 
treating various health conditions, due to lack of evidence for its effectiveness.

[9-14]

A report by the United Kingdom House of Commons Science and Technology Committee stated 
that ‘the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products 
perform no better than placebos’.

[8]

 This report concluded that any health benefits that people 

experience when they use homeopathy is solely due to the placebo effect.

A report on homeopathy research submitted to the Swiss government during its 1998–2005 
complementary and alternative medicines evaluation program concluded that its findings were 
‘compatible with the notion that the clinical effects of homoeopathy are placebo effects’.

[21]

 Another, 

broader, literature review on homeopathy

[16]

, which included published and unpublished studies 

of various methodologies, was submitted to the Swiss government complementary and alternative 
medicines evaluation program. This work was not part of the Swiss government’s published health 
technology assessment

[17]

, but was later published independently by its authors as a summary article

[16]

 

and as a book which concluded that homeopathy was a ‘valuable addition to the conventional 
medical landscape’.

[15]

 The Swiss government evaluation program resulted in a decision for health 

insurance to cease covering homeopathy.

[17]

 However, this decision was reversed after a popular vote 

in support of complementary and alternative medicines.

[17]

The difference between the findings of these publications was mainly due to their different methods 
for assessing research evidence. Both the United Kingdom report and the Swiss literature review have 
been criticised by those who disagree with their methods and findings on either side of the debate. 
The United Kingdom House of Commons Science and Technology Committee report

[8]

 was criticised 

by the British Homeopathic Association, which argued that the Committee failed to take into account 
certain systematic reviews and meta-analyses, and omitted or misrepresented evidence in favour of 
homeopathy.

[22]

 The Swiss literature review favourable to homeopathy

[16]

 was criticised by a review that 

argued it was ‘scientifically, logically and ethically flawed’, ‘misinterprets studies previously exposed as 
weak’ and ‘attempts to discredit randomised controlled trials as the gold standard of evidence’.

[18]

These reports and their methodologies were considered in assessing the evidence.

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Overall findings based on the evidence

There is no reliable evidence from research in humans that homeopathy is effective for treating 
the range of health conditions considered.

There were no health conditions for which there was reliable evidence that homeopathy was effective.

For some health conditions, studies reported that homeopathy was not more effective than placebo.

For other health conditions, some studies reported that homeopathy was more effective than placebo, 
or as effective as another treatment, but those studies were not reliable. To be confident that the 
reported health benefits of homeopathy were not just due to chance or the placebo effect, they would 
need to be confirmed by other well-designed studies with an adequate number of participants.

For the remaining health conditions it was not possible to make any conclusion about whether 
homeopathy was effective or not, because there was not enough evidence.

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Limitations of the assessment and evidence base 

for homeopathy

The studies of homeopathy were generally poor quality. For some health conditions, this meant that 
no conclusion could be made on whether or not homeopathy was effective. For other conditions, 
this meant that NHMRC could not be confident that the results reported by studies were reliable.

The overview was based on finding systematic reviews of homeopathy, rather than searching for all 
individual published studies of homeopathy. The advantage of this strategy was to make use of the 
large amount of work that had already been done by researchers around the world in finding and 
assessing studies and to provide an overarching picture of the whole body of evidence. However, 
there were also some disadvantages:

• 

As the overview only included systematic reviews, some individual studies of homeopathy may not 
have been considered (particularly recent studies published since the latest systematic reviews). 
This risk was offset by inviting homeopathy interest groups and the public to provide extra 
evidence at two stages of the review: before the overview and at public consultation on the draft 
of this Information Paper. From this process an additional 42 studies were considered as part of the 
assessment of the evidence. These studies did not alter the overall findings of the assessment of the 
evidence.

• 

To assess the quality of individual studies, the research group had to rely on the way that these 
were reported by systematic reviews. Details of study design (e.g. the outcomes measured and the 
length of follow up), the statistical significance of the results and the clinical importance of any 
reported health benefits were not always available. Also, the description of an individual study 
was sometimes inconsistent between systematic reviews. In these instances, the findings of the 
systematic review which was assessed to be of a higher quality was considered.

• 

It was not possible to separate the evidence for clinical homeopathy (in which the homeopath 
chooses one or more homeopathic medicines to treat a particular health condition) and 
individualised homeopathy (in which the homeopath matches all the person’s symptoms to a single 
homeopathic medicine), because most of the systematic reviews did not analyse these separately. 
Most of the studies used clinical homeopathy.

• 

It was not possible to make conclusions about the effects of homeopathy on each of the specific 
health outcomes (e.g. pain, mobility) relevant to a particular health condition (e.g. arthritis), 
because of the large number of outcomes and the different reporting of outcomes between the 
different systematic reviews. Instead, outcomes were aggregated for each health condition and 
a single conclusion made.

• 

It was often difficult in studies to find the details of other treatments with which homeopathy 
was compared. To interpret the studies that compared homeopathy with another treatment, it 
is necessary to understand whether the other treatment is an effective standard treatment. This 
information was often not available from the systematic reviews.

• 

It is also likely that some studies assessing homeopathic treatments have never been published. 
Searching of clinical trials registries can identify unpublished studies and enable researchers to 
obtain and analyse the results, but cannot identify studies that have not been registered. The 
overview identified only 10 systematic reviews that reported having considered publication bias, 
and only two of these made a comprehensive, systematic search for missing studies.  

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One of these systematic reviews reported significant publication bias, which the authors suggested 
was primarily due to under-reporting of studies with statistically non-significant effects and with 
negative effects.

[2]

 Clinical trial registries (included the World Health Organisation Clinical Trials 

Registry, the US government’s ClinicalTrials.gov and the Australian New Zealand Clinical Trials 
Registry) were searched but did not identify any extra studies.

Despite the above limitations, it is unlikely that a review of primary studies (rather than of systematic 
reviews) would have altered the findings. This is because the studies on homeopathy identified 
through this process were generally small and of poor quality (either poorly designed or poorly 
done). Due to the poor quality of the evidence base, the Homeopathy Working Committee had to 
apply caution when considering the results reported by studies. For some health conditions, this 
meant that no conclusion could be made on whether or not homeopathy was effective. For other 
conditions, this meant that NHMRC could not be confident that the results reported by studies 
were reliable.

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NHMRC’s interpretation of the assessment of the 

evidence on the effectiveness of homeopathy

Based on the overall findings of the assessment of the evidence of effectiveness of homeopathy, 
NHMRC has reached these conclusions:

• 

There is no reliable evidence that homeopathy is effective for treating health conditions.

• 

Homeopathy should not be used to treat health conditions that are chronic, serious, or could 
become serious.

• 

People who choose homeopathy may put their health at risk if they reject or delay treatments for 
which there is good evidence for safety and effectiveness.

• 

People who are considering whether to use homeopathy should first get advice from a registered 
health practitioner. Those who use homeopathy should tell their health practitioner, and should 
keep taking any prescribed treatments.

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Definition of special terms

Body of evidence

The set of collected research evidence on a specified research question.

Complementary and alternative medicine

The range of health care practices, therapies, procedures and devices that 
are not currently considered to be part of conventional medicine.

Confidence (level of confidence)

A measure of the overall quality of evidence from studies for a health 
condition. The level of confidence in the body of evidence was recorded as 
‘very low’ if any estimate of effect was uncertain (i.e. overall, the quality of 
the available information was not good enough to be able to estimate the 
true effect of homeopathy on that health condition). The level of confidence 
in the body of evidence was recorded as ‘high’ when further research 
was very unlikely to change confidence in the estimate of effect (i.e. the 
available evidence was high quality and the effect of homeopathy in that 
health condition was clear).

Controlled trial (controlled study)

A study in which the treatment being evaluated was compared with either 
another treatment, or placebo (a treatment or substance known to have no 
health benefits), in similar groups of people with the health condition.

Effectiveness  
(of a treatment for a health condition)

The extent to which a treatment works or not when used to treat health 
conditions in patients.

Evidence  
(medical evidence or clinical evidence)

Published findings of health research in humans using internationally 
accepted methods (e.g. studies that have been properly designed to assess 
whether or not a treatment is effective). It does not include individual 
experiences, testimonials or case reports, or research that was not done 
using standard methods.

Health condition (also clinical condition)

Any medical condition or health problem that causes a person to have 
symptoms or causes physical changes that can be recognised by a health 
professional. Health conditions include side effects of treatments such as 
medicines or surgery. 

Homeopathy

A type of complementary and alternative medicine (See What is 
homeopathy?).

Placebo (in studies)

A sham treatment that is compared with the treatment being tested.

Placebo effect

An effect people experience when they believe that a treatment is effective, 
even if the treatment is a sham (e.g. an empty pill capsule or coloured water 
used in a study).

Prospective trial (prospective study)

A study that measures effects as they occur over time, beginning from 
an agreed time point (not by using records made in the past). The health 
outcomes to be measured are defined in advance, the way to measure the 
effects of treatment on these outcomes is planned in advance, and the 
results are then measured at specified times.

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Randomised controlled trial

A study conducted in a standardised way to test whether a treatment is 
effective or not, by comparing it with another treatment or with placebo. This 
involves randomly allocating participants to receive the treatment or not, 
and measuring the effects on their health using pre-defined measurements.

Registered Health Practitioner    

A Registered Health Practitioner, as defined in the Health Practitioner 
Regulation National Law, as in force in each State and Territory.  For further 
information, please see www.ahpra.gov.au.

Statistically significant 

Describes the difference between results for groups being compared in a 
study (e.g. a health measure in participants taking one treatment versus 
another treatment), when analysis of the results using standardised 
statistical methods has found that there is a less than one-in-20 probability 
that the difference is just due to chance. In a health study, ‘statistically 
significant’ results favouring one treatment or another do not mean that the 
finding important for a person’s overall health or is useful for making health 
decisions.

Study (research study)

A planned, structured scientific research project designed to see whether a 
treatment is effective in humans (e.g. a clinical trial).

Systematic review

A type of research that involves searching for all the published evidence 
(e.g. studies) to answer a particular question, such as whether a particular 
treatment is more effective than no treatment or as effective as another 
treatment for treating a specified health condition in a certain group of 
patients (e.g. children, adults). There are internationally accepted standards 
for good quality systematic reviews.

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Appendix A. NHMRC evidence hierarchy, 

including explanatory notes

NHMRC levels of evidence for evaluating interventions (NHMRC 2009)

Level

Research question: intervention

1

I

2

A systematic review of level II studies

II

A randomised controlled trial

III-1

A pseudo-randomised controlled trial (i.e. alternate allocation or some other method)

III-2

A comparative study with concurrent controls:

• 

Non-randomised, experimental trial

• 

Cohort study

• 

Case-control study

• 

Interrupted time series with a control group

III-3

A comparative study without concurrent controls:

• 

Historical control study

• 

Two or more single arm study

• 

Interrupted time series without a parallel control group

IV

Case series with either post-test or pre-test/post-test outcomes

Explanatory notes

1.   Definitions of these study designs are provided on pages 7–8 of 

How to use the evidence: assessment and application of scientific evidence

 

(NHMRC 2000). 

2.   A systematic review will only be assigned a level of evidence as high as the studies it contains, excepting where those studies are of level 

II evidence. Systematic reviews of level II evidence provide more data than the individual studies and any meta-analyses will increase the 
precision of the overall results, reducing the likelihood that the results are affected by chance. Systematic reviews of lower level evidence 
present results of likely poor internal validity and thus are rated on the likelihood that the results have been affected by bias, rather than 
whether the systematic review itself is of good quality. Systematic review quality should be assessed separately. A systematic review should 
consist of at least two studies. In systematic reviews that include different study designs, the overall level of evidence should relate to each 
individual outcome/result, as different studies (and study designs) might contribute to each different outcome.

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Appendix B. The Homeopathy Working Committee

The Homeopathy Working Committee was made up of experts in evidence-based medicine, study 
design, and complementary medicines research. The Committee’s roles were:

• 

to guide an independent review of the evidence on the effectiveness of homeopathy. This included 
providing advice on methods of evaluating and interpreting relevant information.

• 

to guide NHMRC to produce a document that summarises current evidence on whether 
homeopathy is effective for health conditions, and give Australians information to help them make 
decisions about using homeopathy as part of their health care.

Homeopathy Working Committee members are listed in Table 2. Information about individual 
committee members’ credentials and declarations of interest are available at www.nhmrc.gov.au/your-
health/complementary-medicines/membership-homeopathy-working-committee

Table 2. The Homeopathy Working Committee

Name and qualifications

Job title and other relevant roles

Chair

Professor Paul Glasziou, MBBS, PhD, FRACGP 

General practitioner
Professor and Director of the Centre for Research into EvidenceBased 
Practice, Bond University, Queensland
Expert in evidence-based medicine

Professor Peter Brooks, AM, MBBS, MD (Lund), 
FRACP, FAFRM, FAFPHM, MDHonCausa, FRCP 
(Glas, Edin)

Rheumatologist
Director of the Australian Health Workforce Institute, University of 
Melbourne, Victoria (to September 2013)
Executive Director Research, Northern Hospital, Epping, Victoria
Former board member, Australian Centre for Complementary Medicine 
Education and Research, University of Queensland

Professor Frederick Mendelsohn, AO, MB BS, 
PhD, MD, FRACP

Neuroscientist
Former Chair in Medicine and Director of the Howard Florey Institute, 
University of Melbourne, Victoria

Mr John Stubbs, BA, DipAcct

Consumer
Executive Officer, canSpeak
Honorary Associate, School of Medicine, University of Sydney, New South 
Wales
Member, Australian Health Ethics Committee, NHMRC
Member, Consumer Consultative Group, NHMRC

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Name and qualifications

Job title and other relevant roles

Associate Professor Evelin Tiralongo, 
BPharm(Hons), PhD, GradCertHigherEd

Pharmacist
Discipline head for complementary medicine teaching and research, School 
of Pharmacy and Griffith Health Institute, Griffith University, Gold Coast, 
Queensland
Member, Clinical Trials Coordinating Centre, Griffith University
Member, Society for Medicinal Plant and Natural Product Research

Dr Nikolajs Zeps, BSc(Hons), PhD

Research scientist
Director, St John of God Subiaco Hospital Research network
Adjunct Professor School of Health Sciences, Curtin University
Adjunct Professor, Centre for Comparative Genomics, Murdoch University
Adjunct Associate Professor, School of Surgery and School of Pathology and 
Laboratory Medicine, University of Western Australia 
Adjunct Associate Professor, Faculty of Medicine, University of Notre Dame, 
Western Australia
Founding Director, Australian Clinical Trials Alliance
Member, Research Committee, NHMRC
Member, Australian Health Ethics Committee, NHMRC:  
Triennium 2010–2012

Professor Chris Baggoley, AO, BVSc(Hons), 
MBBS, BSocAdmin, FACEM, FIFEM
Member May 2012–March 2013
Observer March–June 2013

Australian Government Chief Medical Officer

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Appendix C. Criteria for the development of 

evidence statements

Purpose and role of the criteria

The Effectiveness of Homeopathy for Clinical Conditions: Evaluation of the Evidence—Overview 
Report (the Overview Report) included an evidence statement for each of the clinical conditions 
considered. The purpose of the evidence statement was to synthesise the type, quality and 
conclusions of the examined evidence base.

In order to ensure that the content and formulation of the evidence statements was consistent and 
transparent across each of the clinical conditions considered, the HWC agreed that it was necessary 
to develop a set of criteria. These criteria reflect the discussions and agreement of the HWC members 
about the key features of the evidence base

1

. The nature of these criteria, and indeed the need for 

them at all, reflects many of the features of the homeopathy Overview Report, particularly:

• 

it was very broad in nature, including 61 clinical conditions; 

• 

data on individual studies was limited by the information reported in the included systematic 
reviews and the quality, reliability and currency of those systematic reviews; and

• 

the overall shortcomings of the primary evidence base which was largely comprised of small 
studies that were not of high quality.

Introduction to the criteria 

A standard format for evidence statements was developed, comprising three elements:

Element 1:  

 Body of evidence 

A description of the body of evidence which included the number of systematic 
reviews and included studies, the quality of these, the total number of participants, 
and a statement of findings.

Element 2:  

 Level of confidence 

A level of confidence (LOC) rating for the body of evidence as a whole. 

Element 3:  

 Conclusion 

A concluding statement that described the effectiveness of homeopathy as a 
treatment for a particular condition, compared with either placebo or other 
treatment(s).

The three elements of the evidence statement were designed to be read together, to give an overall 
impression of the body of evidence.

1   These criteria should not be treated as universal rules or principles that are applicable to all clinical contexts. The criteria were developed in 

response to a specific activity—NHMRC’s overview of the effectiveness of homeopathy for treating clinical conditions in humans.

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When there was a body of evidence addressing the intervention versus placebo, and another body of 
evidence addressing the intervention versus another comparator, two separate evidence statements 
were generally prepared (with all ‘other comparators’ included in the one evidence statement).

Separate evidence statements were not developed where there was more than one specific type of 
homeopathic intervention. For example, where one study examined ‘X’ homeopathic treatment and 
another examined ‘Y’ homeopathic treatment, the evidence statement refers broadly to ‘homeopathy’ 
rather than the specific treatment. This approach is consistent with other studies that assess the 
efficacy of an entire class of therapies: for example under the headings ‘antibiotics’ or ‘physiotherapy’ 
for some conditions.

Guidance for Element 1—Describing the body of evidence

The description of the body of evidence included 

1. A statement of the 

number of systematic reviews

 and the 

quality

 of those reviews.

 

The quality of systematic reviews was assessed using the AMSTAR instrument. For the 
homeopathy overview, a score of 5 or less was considered poor, 6–8 medium, and 9+ good 
(out of a total score of either 10 or 11).

2. The number of studies included within systematic reviews, stratified by the type of those studies 

if relevant (RCTs or prospectively designed, non-randomised controlled studies).

 

Where relevant, the different levels of evidence were separately described, for example Level II 
evidence was described first, followed by Level III-1 and then Level III-2 evidence.

3. The quality of studies included within systematic reviews.

 

The quality of studies was an interpretation of the quality ratings assigned to individual studies 
in the systematic review/s by the authors of each review. The systematic reviews used a range 
of systems to assess the methodological quality of the included studies. For the homeopathy 
overview, studies were categorised as poor, medium or good quality based on the following:

• 

Jadad scores: 1 or 2 = poor; 3 or 4 = medium; 5 = good.

• 

SIGN scores: a negative (-) sign = poor; a positive (+) sign = good.

• 

Internal validity scores: 0-2.5 = poor; 3-4.5 = medium; 5-6 = good.

• 

Scores out of 100 and scores expressed as percentages: 0-40 = poor; 40-70 = medium;  
>70 = good.

• 

Risk of bias assessments: ‘low’ risk of bias = good; ‘high’ risk of bias = poor; ‘unclear’ risk 
of bias = quality unclear.

• 

Scores ‘expressed as Jadad / internal validity score’ (used in Linde et al (1997), where two 
separate quality scores are shown as percentages of the total maximum score (i.e. out of 100), 
separated by a ‘ / ’ : The first score (Jadad score expressed out of 100) was used to assess the 
quality of the primary studies as it was the most commonly used scoring system throughout 
the overview. This means that where the first score was 20 or 40 = poor; 60 or 80 = medium; 
100 = good.

 

If several systematic reviews reported different quality levels for the same study there were two 
ways that the decision was made:

• 

if more than two reviews reported a quality score, the quality reported by the majority was 
used for the purpose of formulating evidence statements.

• 

if only two reviews reported quality scores and they were conflicting, the quality score from 
the review with the highest AMSTAR score was used for the purpose of formulating evidence 

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statements. If the reviews still could not be split, the lower quality score was used in the 
evidence statement to avoid any overestimation of the study’s quality.

• 

If the quality of studies was variable, the quality range was stated, for example ‘poor—
medium’; ‘poor—good’.

• 

If the authors did not assess quality then it was stated as ‘unreported’.

4. The number of participants (total number of participants across all studies and the range).

 

Number of participants was listed as the total number of participants ever randomised for each 
question, and a range for the smallest to largest study.

 

Where there were only two included studies, the number of participants for each study was 
stated, rather than the total number of participants or the range.

 

Where there was only one study, the description of the body of evidence included the size 
of the study described in words, as follows

2

:

• 

< 50 : very small

• 

50 to 149: small

• 

150 to 499: medium

• 

500 to 999: large

• 

≥1000: very large

5. A description of the intervention.

 

Where all studies examined one specific homeopathic treatment (eg homeopathic Arnica), 
this was explicitly stated. Otherwise, the intervention was simply described as ‘homeopathy’.

6. A description of the comparator.

 

As noted above, placebo and ‘other’ comparators were addressed separately, in two distinct 
evidence statements.

 

Where multiple ‘other comparators’ were examined, these were referred to as ‘other therapies’, 
with details provided in brackets.

 

Where only one or two other comparators were examined, the comparator was explicitly 
described, rather than using the term ‘other therapy’.

7. A statement about the findings of the included studies / reviews.

 

A description of the findings of the included studies / reviews was only included in the evidence 
statement where there were good quality studies of sufficient size, for example: ‘The one 
medium sized, good quality trial ([number] participants) did not detect a difference between 
homeopathy and placebo in the treatment of people with [condition].’

• 

For the purposes of the homeopathy overview, studies were considered to be of sufficient size 
where N>150 (i.e. those studies categorised as ‘medium’ sized or larger), as the outcomes were 
generally continuous outcomes.

• 

If different systematic reviews reported different numbers of participants for the same study, 
it was generally assumed that the study was of the smallest size reported to avoid any 
overestimation of the sample size.

• 

If the study quality was unreported, it was generally assumed to be poor quality to avoid any 
overestimation of the study’s quality.

2   Thresholds for descriptions of study sizes were determined as a general guide for intervention studies of this nature, based on the (generally) 

continuous outcomes measured in the studies. The following study was considered in the development of these thresholds: Influence of trial 
sample size on treatment effect estimates: meta-epidemiological study. BMJ2013;346:f2304. 

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• 

If different systematic reviews reported different quality scores for the same study, it 
was generally assumed that the study was of the lowest quality reported to avoid any 
overestimation of the study’s quality.

 

In theory, the results of meta-analyses may have also been discussed in this part of the evidence 
statement. However, it was considered that all of the meta-analyses for specific conditions 
(i.e. those that had the potential to be included in evidence statements) had included studies 
that were of poor methodological quality/had a high risk of bias. A decision was made to state 
the findings of studies that were of good methodological quality and sufficient size in favour 
of meta-analyses that included poor quality studies.

 

If there was more than one study that suggested that homeopathy is more effective than placebo 
or as effective as other therapies but due to the number, size and/or quality of those studies the 
findings are not reliable, a general statement to that effect was made, for example: ‘These studies 
are of insufficient [quality] / [size] / [quality and size] / [quality and/or size] / [quality or size] to 
warrant further consideration of their findings.

 

In all other circumstances, no ‘statement of findings’ was included in the evidence statement.

 

Where a systematic review did not identify any studies, this was stated and the date of the 
systematic review was included, for example: ‘One systematic review ([year]) did not identify any 
prospectively designed and controlled studies that assessed the effectiveness of homeopathy in 
people with [condition].’

Guidance for Element 2—Assigning a level of confidence

A level of confidence (LOC) rating was assigned to the body of evidence as a whole, for each condition.

Assigning a LOC was based on judgment and expertise using a framework informed by the GRADE 
framework

3

. Usually GRADE is applied outcome by outcome rather than to the body of evidence as a 

whole. This is because the availability and quality of evidence may differ for each outcome. However, 
an adapted version of GRADE was used in order to make broad statements about the LOC in the 
body of evidence as a whole.

As per the GRADE methodology, each condition’s evidence base was assigned a starting LOC of ‘high’ 
(Table B.i)

Table B.i:

 Level of confidence (adapted from GRADE)

GRADE rating
(Level of confidence: LOC)

GRADE description

High

Further research is very unlikely to change our confidence in the estimate 
of effect

Moderate 

Further research is likely to have an important impact on our confidence in 
the estimate of effect and may change the estimate

Low

Further research is very likely to have an important impact on our 
confidence in the estimate of effect and is likely to change the estimate

Very low

Any estimate of effect is very uncertain

3   For further information on the GRADE methodology see: 

Grading Quality of Evidence and Strength of Recommendations

. Grade Working Group. 

BMJ V328, 19 June 2004.

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The LOC was then upgraded or downgraded depending on the limitations or strengths of the studies 
contained in the systematic reviews (see Table B.ii).

Table B.ii:

 Upgrading and downgrading

Decrease grade if:

Increase grade if:

Serious ( − 1) or very serious ( − 2) limitation to 
study quality
Important inconsistency ( − 1)
Some ( − 1) or major ( − 2) uncertainty about 
directness
Imprecise or sparse data ( − 1)
High probability of reporting bias ( − 1)

Strong evidence of association—significant relative risk of > 2  
( < 0.5) based on consistent evidence from two or more 
observational studies, with no plausible confounders (+1)
Very strong evidence of association—significant relative risk of > 5  
( < 0.2) based on direct evidence with no major threats to validity (+2)
Evidence of a dose response gradient (+1)
All plausible confounders would have reduced the effect (+1)

For the homeopathy overview, the information available for downgrading evidence was 
predominantly as follows:

• 

Quality

: -1 or -2 depending on seriousness of limitation to study quality.

 

If quality of the included studies was not reported in the systematic review then those studies 
were assumed to be poor quality (-2).

 

NB: if quality is assessed using Jadad then any score <5 could indicate serious or very serious 
bias. Therefore it was often appropriate to give a range for the LOC (i.e. subtracting both -1 and 
-2) e.g. moderate-low.

• 

Precision

: related to the number of participants in individual studies and as a whole. Small is 

relative but in general any study with less than 150 participants is small.

 

Very sparse data = ≤50 (-2).

 

Sparse data = 51 – 149 (-1).

 

A level of judgement was required. For example, three small / very small studies with a total 
sample size of 110 might be considered ‘sparse’ to ‘very sparse’, so would be downgraded by 1–2 
and a range presented.

The remaining GRADE factors were difficult to apply to an overview; however, downgrading based 
on the quality of the systematic review/s was also appropriate in some situations (as a poorer quality 
systematic review is more likely to result in bias).

Guidance for Element 3—Final conclusion

The final statement provides a conclusion (defined by the Oxford Dictionary as ‘a judgement or 
decision reached by reasoning’) about the effectiveness of homeopathy as a treatment for a particular 
condition, compared with either placebo or other treatment(s).

The conclusions were generally based on whether or not any statistically significant findings were 
reported for any outcome (unless it was determined that the outcome had no clinical relevance). It is 
acknowledge that the assessment of ‘effectiveness’ based on statistical significance and not clinical 
significance is not ideal. However, this approach was necessary due to the poor reporting (e.g. no 
reporting of primary outcomes, effect estimates or confidence intervals) and lack of analyses by the 
included systematic reviews and primary studies. Further, it was not possible to create a hierarchy of 
clinically relevant outcomes prior to conducting the overview (due to the number of conditions and 
systematic reviews included in the overview) and making post hoc decisions about the importance of 
outcomes is likely to be subject to bias.

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There are two approaches for designing studies to evaluate medicines; null hypothesis and estimation 
of effect. The standard approach used in Health Technology Assessments is the null hypothesis, 
with the onus of proof on those who are proposing that the treatment be used (e.g. manufacturers, 
practitioners or researchers). Any claims about the effectiveness of a medicine are not accepted 
without evidence from clinical trials that compare the treatment with placebo in patients with the 
clinical condition.

In this review of homeopathy, the null hypothesis for each clinical condition was that homeopathy 
has no effect as a treatment for that condition unless there was sufficient reliable evidence to 
demonstrate otherwise. The only exceptions to this principle were:

• 

where there were no studies (or only one small and/or poor/unknown quality study) identified 
for a particular clinical condition; or

• 

where the evidence was so poorly reported so as to be uninterpretable. 

In these cases, the HWC determined that no conclusion could be drawn about effectiveness, 
rather than assuming the null hypothesis.

In general, separate conclusions were not developed where there was more than one specific type of 
homeopathic intervention. That is, where one study examined ‘X’ homeopathic treatment and another 
examined ‘Y’ homeopathic treatment, the conclusion refers broadly to ‘homeopathy’ rather than the 
specific treatment. The only exception to this principle was for the condition ‘Children with diarrhoea’, 
where there was a difference in the evidence base for ‘combined homeopathy’ and ‘individualised 
homeopathy’. In this instance, the conclusion sentence separately reflected the evidence base for each 
type of homeopathy.

In the final concluding statement, the intervention is described as ‘homeopathy’ even if a more 
detailed description is provided in Element 1 of the evidence statement.

For studies that compared homeopathy with placebo, the null hypothesis assumed by the HWC 
was that homeopathy is no more effective than placebo.

For studies that compare homeopathy with another therapy, the null hypothesis assumed by the 
HWC was that homeopathy is not as effective as the other therapy. It is noted however, that due to 
the scope of the homeopathy overview, the 

appropriateness

 of the comparator was generally not 

assessed. For the purpose of framing the null hypothesis, an implicit assumption has been made that 
the comparator is more effective than placebo (i.e. the concluding statement is based around whether 
homeopathy is ‘as effective as’ another treatment, without a consideration of the appropriateness 
of that treatment). The HWC acknowledged that this could mean that homeopathy is found to be 
‘as effective as’ an ineffective treatment. 

Further detail on the development of evidence statements is provided at Appendix C of the 
Overview Report.

[2]

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