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Case Reporting in Homeopathy—An Overview of Guidelines and Scientific Tools

Michael teut.

1 Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Luisenstr. 57, Berlin, Germany

Robbert A. van Haselen

2 International Institute for Integrated Medicine, Kingston, UK

3 Independent Researcher, Breda, Netherlands

Chetna Deep Lamba

4 Central Council for Research in Homoeopathy, Janak Puri, New Delhi, India

Gerhard Bleul

5 Family Physician, Hünstetten, Kesselbach, Germany

Susanne Ulbrich-Zürni

6 Institute of Integrative Medicine, Universität Witten-Herdecke, Herdecke, Germany

Case reports have been of central importance to the development of homeopathy over the past 200 years. With a special focus on homeopathy, we give an overview on guidelines and tools that may help to improve the quality of case reports. Reporting guidelines such as CARE ( Ca se Re port), HOM-CASE ( Hom eopathic Clinical Case Reports), and the WissHom Documentation Standard help to improve the quality of reporting and strengthen the scientific value of a case report. Additional scientific tools such as prospective outcome assessment, prognostic factor research, cognition-based medicine, and the Mo dified Nar anjo C riteria for H omeopathy (MONARCH) score may be helpful in improving case documentation and evaluation.

Case reports have been of central importance for the development of homeopathy since it was founded more than 200 years ago. They document homeopathic clinical experiences and they explore homeopathic principles: e.g., they serve to corroborate proving symptoms and can extend the materia medica by adding symptoms based on clinical experience. As a didactic tool, they support homeopathic training and enable in-depth materia medica studies. Case reports can also be used as a scientific tool to help assess therapeutic effects, to generate hypotheses for research (e.g., observational studies and randomized controlled trials) and to identify or validate prescription criteria via the accumulation of high-quality case series. Moreover, case reports are also essential for evaluating the side effects of drugs (pharmacovigilance), the occurrence of homeopathic aggravations, and the appearance of old or proving symptoms during treatment.

Why are case reports still so attractive to clinicians in times of complex analytical statistical methods? Every case and every treatment is always, in a way, an “experiment” because it has never been done before with this individual patient. The clinician, researcher and epidemiologist Alvan Feinstein said, “In caring for patients, clinicians constantly perform experiments. During a single week of active practice, a busy clinician conducts more experiments than most of his laboratory colleagues do in a year”. 1 2

The narrative aspect of case reports may also be important. Van Haselen 3 reflects on the art of case reports: “So what is the secret behind the lasting appeal of Clinical Case Reports? One factor is that storytelling as a way of communication goes back to the moment we developed the ability to speak. We are therefore evolutionarily hardwired to listening to stories as a way of passing on information from generation to generation. Stories have added value to the community for thousands of years, so we should ask ourselves the question of what value case reports can add to medicine, particularly to complementary and alternative medicine …”

A homeopathy case report, like any other clinical case report, should be very well and comprehensively documented. However, which information is most important and makes the most sense to include?

At present, there are a few international guidelines available on how medical case reports and homeopathy case reports can be optimally reported. Here, we present an overview of the CARE, HOM-CASE, and WissHom Guidelines that all aim to support the writing of a high-quality homeopathy case report.

Later in this article, we will also introduce the newest developments, tools and methods for assessing the likelihood of therapeutic causality in single cases.

The CARE guidelines (for Case Reports) were developed and published in 2013 by an international group of experts, including homeopathic and anthroposophic medicine doctors. The CARE guidelines are designed to increase the accuracy, transparency, and usefulness of all medical case reports and have been adopted by many international medical journals as a standard for case reporting. Homeopathic case reports should at least fulfil the CARE criteria. A CARE criteria checklist ( Table 1 ) is available in various languages. The CARE guidelines are available online at the CARE Case Report guideline homepage, with open access via https://www.care-statement.org/ The guidelines have been published in several journals. 4 5

Abbreviations: HMP, homeopathic medicinal product; MONARCH, Modified Naranjo Criteria for Homeopathy.

HOM-CASE stands for Hom eopathic Clinical Case Reports. This guideline is a supplement/extension to the more general CARE guidelines, with additional focus on homeopathy needs. Using an online Delphi process, a panel of 19 homeopathic experts developed a criteria-catalogue serving as a guideline for authors to improve the quality of clinical case reports in homeopathy. This is the only case reporting guideline developed exclusively for homeopathy that has been published in an international peer-reviewed journal. Eight “core” items specific for homeopathy were selected: (1) the type of homeopathy; (2) the clinical history from a homeopathy perspective; (3) a detailed description of the medication; (4) manufacturer, (5) galenic form + dosage; (6) outcomes, objective evidence if available; (7) outcomes, occurrence of homeopathic aggravation; and (8) assessment of possible causal attribution of changes to the homeopathic treatment. We have added those criteria to the CARE guidelines in Table 1 . In addition, five “optional” items were identified for consideration, in particular when clinical case reports are used for educational or research purposes: (1) individualizing symptoms are reported; (2) repertorization data are provided; (3) disease evolution in accordance with homeopathic principles is reported; (4) the prescription strategy is made explicit; and (5) individual remedy-related symptoms are identified and analyzed. The guideline is available at the Complementary Therapies in Medicine journal website 6 : https://www.sciencedirect.com/science/article/pii/S0965229915300406?via%3Dihub.

WissHom Documentation Standard, Homeopathy

This documentation standard was published by the German Scientific Society of Homeopathy (WissHom) and was developed in cooperation among three German homeopathy organizations between 2002 and 2008. The guideline includes seven areas: patient information, medical history, homeopathic interview, physical findings, case analysis, prescription, and follow-up monitoring; it includes 16 criteria for documenting case reports. This guideline is especially important for reporting and discussing cases in homeopathy journals as it relates more to practical and clinical homeopathy topics. The English and German versions are openly accessible at the WissHom website: https://www.wisshom.de/documentation-standard/ (last downloaded October 21, 2020). More information is also available from related publications of Gerhard Bleul. 7 8 9

Synthesis of Criteria

Table 1 is a synopsis of the criteria for scientific case reporting as laid out by the international CARE and HOM-CASE guidelines. The WissHom documentation standard is not included.

Scientific Tools and Methods

In addition to high-quality case reports, researchers have developed several tools for homeopathic case research within the last two decades. Some of the tools, such as prospective outcome assessment, have been in use for a long time, whilst others, such as the Modified Naranjo Criteria score, are relatively new and require further research and validation.

Prospective Outcome Assessment

A method to improve the internal validity of case reports and also the quality of case reports from a quantitative perspective is to make use of prospective outcome assessment. “Prospective” means that in the first treatment session related to the clinical problem, the outcome assessments are defined, and then the patient is treated and observed over the follow-up. Identifying potential outcome measures that fit the patient and reflect the therapeutic aims at baseline (first consultation) is essential. When choosing outcomes for scientific case reports, validated outcome measures may be considered for use. Conducting a literature review and choosing a common outcome measure for the clinical problem could be helpful. Examples are the “Conners Global Index” for ADHD, the “Hamilton Rating Scale for Depression”, or the “Beck Depression Inventory”. However, not all outcome measures are applicable or make sense for single-case research and for comparisons between baseline and the follow-up assessments. The ideal outcome measure should be easy to assess for the clinician and/or the patient and easy to evaluate (e.g., sum-scores, Likert scales). Using measures that assess general changes, which can be useful when comparing cases across different types of disease conditions, may also be considered. Examples of general outcome measures typically used for case research could be the intensity of symptoms on a numeric or visual rating scale, 10 the Measure Yourself Medical Outcome Profile (MYMOP), 11 12 13 and Outcome Related to Impact on Daily Living (ORIDL) (formerly known as the Glasgow Homeopathic Hospital Outcome Scale). 14 15

Consideration might also be given to using Goal Attainment Scaling (GAS), 16 which is an instrument used mainly in psychotherapy to check the achievement of individually defined therapeutic goals. It can be adapted to individualized homeopathic purposes. It first requires the definition of one or more therapeutic goals (outcomes). Indicators are then defined for each objective, and then the achievement of the objective can be checked. These indicators are converted into a five-step scale with the expected result in the middle. On this basis, usually two levels are formed upward (“more than expected” and “much more than expected”) and two levels downward (“less than expected” and “much less than expected”). It is also possible to scale the GAS numerically, as a percentage or in words (“more achieved than the therapeutic goal; therapeutic goal achieved; therapeutic goal partially achieved; therapeutic goal not achieved”).

The advantages of a prospective outcome assessment are better and more relevant feedback from the patient, improvement of the quality of the documentation, and an improvement in the quantitative assessment of the therapeutic outcome in case reports.

The disadvantages are that in many cases, especially in complicated and/or multi-morbid cases, clinicians may not have knowledge of an appropriate specific outcome measure at baseline. Moreover, these specific outcome measures can also be very comprehensive, and therefore their application can be time consuming and overwhelming for patients. Effort and benefit must therefore be carefully weighed. General outcome measures or individualized ones are much easier to apply. From a clinical perspective, prospective outcome assessment will lead to a deviation from routine clinical practice, and this could change, influence or disturb the “naturalistic” consultation process. When using prospective outcome measures, it may also be necessary to reflect whether the design has changed into an experimental study and if a research ethics committee's approval is therefore necessary. In this case the intervention has become experimental and is not a routine clinical intervention any more. Also, making use of an informed consent form for participation and an agreement for publishing anonymized or pseudonymized data may be necessary.

Prognostic Factor Research and Bayes' Theorem

According to the Simile principle, the prescription of homeopathic medicinal products (HMPs) in individualized homeopathy is based on the expectation that specific symptoms of the patient are accompanied by specific symptoms of an HMP and that a positive therapeutic course is predictable from this. This basic expectation has been answered in the 200-year history of homeopathy from clinical experience, but not with mathematical concepts. Rutten et al developed an innovative mathematical model that uses Bayes' theorem and homeopathic symptoms as prognostic factors to establish the relationship between specific homeopathic symptoms and the effectiveness of a specific HMP. 17 In this way, based on good case reports, homeopathic symptoms in materia medica and repertories can be systematically checked, confirmed, or rejected. This approach has recently been used, for example, to create a homeopathic repertory for the treatment of COVID-19 patients on the basis of casuistics. 17 This is based on case collections, a promising research model for the future to improve the validity and prescription safety of homeopathic materia medica and repertories. This innovative approach has many methodological advantages but requires basic statistical and methodological knowledge and interest on the part of the practitioner.

Prognostic Factors

An essential prerequisite of homeopathy is that usually an HMP cannot be selected on the basis of the patient's main complaint/diagnosis alone; the HMP should also fit personal characteristics and symptoms. This insight is not exclusive to homeopathy or other complementary and alternative treatment modalities and is also accepted in personalized or stratified (conventional) medicine. 18 Personal characteristics and symptoms can be regarded as prognostic factors influencing the outcome of the treatment, 19 and this principle was recently illustrated in an individual patient data meta-analysis. 20

In homeopathic case collection, the personal characteristics and symptoms of the patient are distinct from the biomedical condition/diagnosis and outcome measures with respect to the definition, standardization and validation. Homeopathic characteristics and symptoms typically represent the experience of an individual patient with a particular disease/diagnosis. Therefore, the variation due to semantics and confounders is considerably greater than the variation in the common characteristics and symptoms of patients with a particular disease/diagnosis. As an example of semantics in homeopathy, what is the difference between an “angry person” and an “irritable person”? The answer to this question may vary depending on age, gender, geographics, culture, and many others. A symptom such as “desire for sweets” is interpreted differently in southern India and in northern India regarding the cut-off for average sweets consumption. Homeopathic practitioners adjust the cut-off/threshold value for each symptom for each patient and their clinical judgment of confounders within the context of that therapeutic encounter. They estimate the intensity of symptoms in terms of “stronger than in most comparable people” or “stronger than in the average comparable person”. As an example, a 4-year-old child stealing the left-overs in the coffee cups of visitors will be interpreted as “desire for coffee”, but the daily consumption of five coffees by a salesman will be interpreted differently.

The interpretation of the intensity of symptoms is also influenced by the inclusion, confirmation or exclusion of HMPs deemed to be eligible for specific patients. As an example, the occurrence of herpes of the lips more than five times a year will be regarded as a reason to include the HMP Natrium muriaticum , whilst an occurrence of once in 2 years will only be regarded as a confirmation if the HMP is already indicated for other reasons. 21 Exclusion of HMPs because a specific symptom is absent is relatively rare in homeopathy.

Homeopathic practitioners are not trained as observers in prognostic factor research. For an extensive discussion on this topic, see the book published by Rutten. 22 Before participating in such research, they have to learn that they should handle the same threshold/cut-off values for inclusion (not confirmation) in case collection as in prescribing in daily practice. 23 This involves clinical judgment, which may feel counterintuitive for many as part of a scientific assessment. This, however, is often the case in a prospective assessment of symptoms because, in that case, the symptoms are separated from their context. In daily practice, the threshold for “recurrent herpes of the lips” will be lowered to the confirmatory threshold if the context already indicates Natrium muriaticum , whilst it would introduce a lower threshold in prospective research. Therefore, on the one hand, the observer in prospective research has to use clinical judgment about the intensity of the symptom, but on the other hand, they should be aware that the presence of other symptoms may influence the threshold for any specific symptom.

The above-mentioned problem of varying thresholds can be resolved by allowing clinical judgment and using Likert scales. Such a Likert scale could contain items such as “Average”, “Slightly more”, “More”, and “More than in most people”. The “average” should be estimated by the homeopathic practitioner. Completion of the questionnaire should be guided by the practitioner explaining to the patient how the questionnaire can help reduce bias in the assessment of the patient's symptoms. Note that a Likert scale indicating the intensity of the complaint/symptom as experienced by the patient may need to be adjusted by the practitioner based on comparing the intensity of the complaint/symptom with a clinical judgment of the “average” in similar patients. The intensity of a symptom can be both underestimated and overestimated by the patient. Underestimation could occur if the patient has had symptoms for a long time and has become accustomed to them. Overestimation could be caused by willingness to please or by anxiety.

A further indication of the relevance or the intensity of a symptom is whether it is spontaneously reported by the patient or obtained based on questioning or questionnaires. Because spontaneously reported symptoms are potentially less affected by the problem of varying thresholds, it could be useful to “flag” symptoms obtained in this way.

Another criterion for including a symptom in the case description could be that the symptom appeared concomitantly with or after the onset of the illness.

In classical homeopathy, it is recommended that the practitioner deal carefully with “gut feelings” about possibly indicated HMPs until the final stages of the HMP selection process, when all or most of the symptoms have been collected and, ideally, the repertorization has been completed. Whilst this type of clinical judgment can be useful in the final stages of differentiating potentially indicated HMPs, during the earlier stages of the consultation, these types of “clinical intuition” as a “mental shortcut” (heuristic) may lead to confirmation bias. The latter is considered to be the most common bias affecting clinical decision making in medicine and is also referred to as “overconfidence” bias. 24 For a more detailed discussion on biases and heuristics (shortcuts) in homeopathic decision making, see the article by Souter. 25

Quantitative Research and Bayes' Theorem

When, say, the personal characteristic of “being an angry/irritable person” indicates a specific HMP, we intuitively interpret this as the characteristic being stronger than average in this person. This intuition can be translated into a mathematical formula using Bayes' theorem:

Posterior odds = LR × prior odds

where LR = likelihood ratio = (prevalence in the medicine population)/(prevalence in the remainder of the population); odds = chance/(1 − chance), and chance = odds/(1 + odds)

The “medicine population” is the population responding well to a specific medicine. Bayes' theorem indicates that if the prevalence of a characteristic/symptom in a specific medicine population is higher than in the remainder of the population (LR >1), the chance that the HMP will work increases, more so if the LR is higher. Since a population responding well to a specific HMP is only a small part of the whole population, LR >1 corresponds to “more than average”.

Applying Bayes' theorem in homeopathy requires recording symptoms in the entire population and in sub-populations responding well to specific HMPs. This recording requires standardization of many symptoms, such as “anger” and all its semantic equivalents.

Assessment of Therapeutic Causality

Therapeutic causality assessment means assessing the likelihood of a causal relationship between a therapeutic intervention and outcome. To assess causality in a case report is a very difficult task scientifically. In conventional medical science, case reports are often treated with ambivalence because their internal validity (as proof of the effectiveness of HMPs) is low. Case reports are an example of evidence that is frequently ignored because many people think that they cannot address causal links between a treatment and outcomes. Statistical analyses on efficacy or effectiveness mostly rely on repeated observations in a large number of patients, mostly in comparison with a group of untreated or differently treated patients.

However, there are some scientific tools available that may help to assess the likelihood of therapeutic causality in case reports.

Modified Naranjo Criteria

The Modified Naranjo Criteria for Homeopathy (Causal Attribution Inventory) tool was originally adapted by Rutten from the Naranjo algorithm, 26 which was developed to assess therapeutic causalities for adverse drug reactions in single cases. This was further developed over several years by the Clinical Data Working Group of the Homoeopathic Pharmacopoeia Convention of the United States (HPCUS) to assess the likelihood of causal attribution of the clinical outcome to HMPs prescribed in homeopathic cases and case reports. The HOM-CASE guideline refers to these criteria in the Modified Naranjo Criteria score for the assessment of causality. 6 These criteria were further investigated and updated by Lamba et al, 27 who referred to the Inventory under the acronym MONARCH, which stands for Mo dified Nar anjo C riteria for H omeopathy.

Based on the assessment of 60 case reports of sufficient quality, except for items related to “direction of cure” (domains 6A and 6B), the reliability and validity of all other domains of MONARCH were largely established. 27

According to the final outcome in a case, which can also involve the sequential prescription of more than one HMP, a score is assigned to each domain of the MONARCH criteria. The higher the score, the more likely there is therapeutic causality. However, more research is needed on a potential threshold score of the MONARCH causality assessment. Also, exceptions may occur, depending on the nature of the disease, therapeutic goals, etc. Therefore, a low score does not rule out causal attribution to homeopathic treatment, but in such cases, justification of why the changes are considered to be due to the prescribed HMP(s) is even more important.

Cognition-Based Medicine Assessment

Another possibility for assessing therapeutic causality in single cases, which is even more demanding for the evaluator, is the assessment of a so-called “causal Gestalt process” in a case, also referred to as a cognition-based medicine (CBM) approach. This method was developed by Helmut Kiene and is based on Karl Duncker's Gestalt theory. 28 29 30 31 It aims to assess therapeutic causalities at an individual level. The general idea is that doctors always judge the therapeutic effects of their intervention according to a set of cognitive criteria. Kiene identified cognitive patterns of causal relationship assessment in Duncker's Gestalt theory and adapted these to the assessment of therapeutic causalities in single patients. CBM adheres to the idea that cause and effect are generally connected by a so-called “Gestaltbezug”, which is not arbitrarily related to time and space but potentially recognizable and understandable. The time and space of the cause are connected and interwoven with the time and space of the effect. When assessing the therapeutic causality of a case, the natural history of the disease, the success of previous treatments, and the fluctuations of disease symptoms before starting the reported treatment (baseline) must be considered.

More information on the CBM Gestalt approach can be obtained from Kiene, 28 Kiene et al, 31 and Teut. 32

Using case reporting guidelines and assessment tools helps to improve the quality of homeopathic case reports. Good case reports serve as an inspiration for the practitioner and clinical work, and can deepen the knowledge and skills of authors and readers on how to document cases in a better way and to question the role of the treatment. Applying a prospective outcome assessment in routine clinical work can further improve the internal validity and quality of a case report. The use of case reports in prognostic factor research is aimed at improving homeopathic clinical skills as well as enhancing the reliability of the materia medica and repertory rubrics. The MONARCH inventory can be used to assess the likelihood of therapeutic causality, but it is an innovation in homeopathy in need of further validation and elaboration.

Our review does not address single-case experimental study designs, such as single-case experiments, multiple baseline designs, and n-of-1 randomized controlled trials. Readers interested in performing experimental research with single patients are referred to Teut, 32 Guyatt, 33 Baker, 34 Teut & Linde, 35 Kravitz et al, 36 and Ulbrich-Zürni et al 37 for further information.

Since homeopathic practitioners play an essential role in homeopathy research, they should be trained from the start in reporting cases properly and in critical thinking as applied to case taking and decision making. This review illustrates that in recent years, a variety of guidelines and inventories have become available to improve the transparency and quality of clinical case reporting. Moreover, practitioners should be familiar with biases in decision-making, cut-off/threshold values, and basic statistical notions such as variation, covariation, prevalence, and likelihood ratio. This will empower all practitioners to contribute meaningful, high-quality data that are eligible for subsequent pooling and further interpretation.

  • We give an overview on case reporting guidelines and tools that can help to improve the scientific quality of homeopathy case reports.
  • Guidelines such as CARE, HOM-CASE, and the WissHom Documentation Standard help to improve the quality of reporting and strengthen the scientific value of a case report.
  • Additional tools can be used for documentation (prospective outcome assessment) and evaluation (prognostic factors, Bayes' theorem, MONARCH, cognition-based medicine) to further improve the scientific quality of case reports.

Acknowledgements

We thank Homöopathie-Stiftung des Deutschen Zentralvereins homöopathischer Ärzte, Robert-Bosch Stiftung, and Wissenschaftliche Gesellschaft für Homöopathie (WissHom), Germany, for supporting this project, the discussion process, and the publication of this manuscript. We thank all participants of the 2019 HRI Workshop in London on “Guidelines for designing and reporting homeopathic research” for reviewing and discussing an early draft of our manuscript.

We remember and thank our co-author Gerhard Bleul, who has died in 2020, for his lifelong contributions to homeopathy, especially in the field of case reporting. He was responsible for developing the WissHom Documentation Standard.

Funding Statement

Funding This is a project of Wissenschaftliche Gesellschaft für Homöopathie (WissHom) and was funded by Homöopathie Stiftung des Deutschen Zentralvereins homöopathischer Ärzte and Robert Bosch Stiftung as part of the Homeopathic Guideline Project.

Conflict of Interest None declared.

† Dr. Gerhard Bleul died on June 3rd, 2020.

Homeopathy effects in patients during oncological treatment: a systematic review

  • Original Article – Clinical Oncology
  • Open access
  • Published: 22 June 2022
  • Volume 149 , pages 1785–1810, ( 2023 )

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  • Anna Wagenknecht 1 ,
  • Jennifer Dörfler 1 ,
  • Maren Freuding 1 ,
  • Lena Josfeld 1 &
  • Jutta Huebner   ORCID: orcid.org/0000-0003-4931-568X 1  

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In this systematic review we included clinical studies from 1800 until 2020 to evaluate evidence of the effectiveness of homeopathy on physical and mental conditions in patients during oncological treatment.

In February 2021 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning use, effectiveness and potential harm of homeopathy in cancer patients.

From all 1352 search results, 18 studies with 2016 patients were included in this SR. The patients treated with homeopathy were mainly diagnosed with breast cancer. The therapy concepts include single and combination homeopathic remedies (used systemically or as mouth rinses) of various dilutions. Outcomes assessed were the influence on toxicity of cancer treatment (mostly hot flashes and menopausal symptoms), time to drain removal in breast cancer patients after mastectomy, survival, quality of life, global health and subjective well-being, anxiety and depression as well as safety and tolerance. The included studies reported heterogeneous results: some studies described significant differences in quality of life or toxicity of cancer treatment favouring homeopathy, whereas others did not find an effect or reported significant differences to the disadvantage of homeopathy or side effects caused by homeopathy. The majority of the studies have a low methodological quality.

Conclusions

For homeopathy, there is neither a scientifically based hypothesis of its mode of action nor conclusive evidence from clinical studies in cancer care.

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Introduction

Cancer embodies one of the leading causes of death; morbidity and mortality due to cancer are increasing steadily (Radtke 2022 ). Receiving the diagnosis, many patients are desperate and try additional treatment to their standard cancer therapy. More than 25% of the general population in Europe is using complementary and alternative medicine (CAM) regularly on less severe health conditions such as neck pain or allergies (Laura et al. 2018 ), prescribed by some physicians as a placebo with few side effects. Faced with a cancer diagnosis, many patients revert to the use of CAM. Homeopathy is a CAM system that, globally, became more and more popular over the past decades. Based on the “Law of Similars” by the German physician Samuel Hahnemann, homeopaths assume that a substance, which causes certain effects, can also be used to treat them if prescribed in a very low dosage (Shah 2018 ). Therefore, homeopathic remedies (e.g. plant, animal or mineral) are diluted to so-called potencies. In classical homeopathy, these steps of dilution (1:10; 1:100 or 1:50.000) are repeated so many times that there is not a single molecule of the substance left in the remedy (Tschech 2022 ). Nevertheless, homeopaths are convinced of the effectiveness of homeopathic treatments, while science expresses criticism and doubt. Some explanation attempts for the mode of action of homeopathy are nanoparticles and water memory, but none of these were verified through clinical studies yet (Fritzsche 2011 ; Nuhn 2005 ).

The most common dilution (1:100) is the C- potency, or, using Hahnemann’s dilution method, CH-potency. Repeating this dilution-method for a second time creates a C2-potency (1:10.000). C2 diluted again results in a C3-potency and so forth (Genneper 2017 ). There exist three main approaches to homeopathic prescribing: in the individualised or classical homeopathy single remedies are used depending on the patients individual condition and history, in the clinical homeopathy the same remedy is used for a group of patients with specific conditions and in the complex homeopathy a number of remedies is used in a defined combination for particular symptoms (Pérol et al. 2012 ).

Due to the controversial discussions on homeopathic therapies, a wide variety of publications exists addressing this matter. But for homeopathy being such a popular treatment method, there are surprisingly few clinical studies, systematic reviews (SRs) or meta-analyses, and only of limited quality. Likewise, only a few studies examine the influence of homeopathy on carcinoma, while homeopathy is frequently used against the toxicity of cancer treatments and even for its cure. Therefore, SRs and an extensive evaluation of clinical studies are needed to provide high-level evidence of the effects of homeopathy in cancer patients.

Criteria for including and excluding studies in the review

Inclusion and exclusion criteria are listed in Table 1 based on a PICO- model. Generally, all study types were included if they reported patient-relevant outcomes after guideline-based treatment of adult cancer patients with any intervention containing homeopathy. Because of the wide range of application fields, all cancer entities were included. Since little high-quality evidence was expected, systematic reviews and randomized controlled trials were included as well as controlled trials, one-armed studies and retrospective studies. Criteria for rejecting studies were primary prevention, grey literature, other publication type than primary investigation/report (e.g. comments, letters, abstracts) and study population with children (under the age of 18) or precancerous conditions, if results or numeral details of adult patients with cancer were not reported separately. Additionally, studies were excluded if they reported no patient centred outcomes (laboratory parameters except Prostate Specific Antigen (PSA) which is a valuable parameter for cancer progression of prostate cancer). Language restrictions were made to English and German.

Study selection

A systematic research was conducted using five databases (Medline (Ovid), CINAHL (EBSCO), EMBASE (Ovid), Cochrane CENTRAL and PsycINFO (EBSCO)) in February 2021. For each of these databases a complex search strategy was developed consisting of a combination of MeshTerms, keywords and text words in different spellings connected to cancer and homeopathic therapy (Table 2 ). The search string was highly sensitive, since it was not restricted by filters of study or publication type. After importing the search results into EndNote X9, all duplicates were removed and a title- abstract- screening was carried out by two independent reviewers (AW and JD). In case of disagreement consensus was made by discussion or a third reviewer was consulted (JH). After that, all full texts were retrieved and screened again independently by both reviewers. When title and abstract did not have sufficient information for screening purposes, a full-text copy was retrieved as well. Additionally bibliography lists of all retrieved articles were searched for relevant studies.

Assessment of risk of bias and methodological quality

All characteristics were assessed by two independent reviewers (AW and JD). In case of disagreement a third reviewer was consulted (JH) and consensus was made by discussion.

The risk of bias in the included studies was analysed with the SIGN- Checklist (“ https://www.sign.ac.uk/what-we-do/methodology/checklists/ ”) for controlled trials Version 2.0 and IHE Quality Appraisal Checklist for Case Series Studies (“ http://sandbox.ihe.ca/research-programs/methodology-development/case-series-studies-quality-appraisal/cssqac-about ”). In addition, blinding of researchers, blinding of outcome assessment and comparability of groups before treatment, not only in terms of demographic variables but also concerning the outcomes, was examined.

The included studies were rated with the Oxford criteria. Additional criteria concerning methodology were size of population, application of power analysis, dealing with missing data and drop-out (report of drop-out reasons, application of intention-to-treat-analysis), adequacy of statistical tests (e.g. control of premises or multiple testing) and selective outcome reporting (report of all assessed outcomes with specification of statistical data as the p-value).

Data extraction

Data extraction was performed by one reviewer (AW) and controlled by two independent reviewers (JD, JH). As a template for data extraction, the evidence tables from the National Guideline on Complementary and Alternative Medicine in Oncological Patients of the German Guideline Program in Oncology (“ https://www.leitlinienprogramm-onkologie.de/english-language/ ”) were used. Concerning systematic reviews, only data from primary literature meeting the inclusion criteria of the present work were extracted.

The systematic search revealed 1352 results. No study was added by hand search. At first, duplicates were removed leaving 1007 studies. After screening title and abstract, 110 studies remained to complete review.

Finally, 18 publications were considered relevant due to the inclusion criteria of this present work and were included in this SR. We included 11 studies for endpoints: 0 SRs, 9 randomized controlled trials (RCTs) (Balzarini et al. 2000 ; Frass et al. 2015 ; Frass et al. 2020a , b ; Heudel et al. 2019 ; Jacobs et al. 2005 ; Lotan et al. 2020 ; Luca Sorrentino 2017 ; Pérol et al. 2012 ; Thompson et al. 2005 ) and 2 controlled trials (CTs) (Karp et al. 2016 ; Steinmann et al. 2012 ) which investigated the efficacy of homeopathic treatment in cancer therapy. These studies were heterogeneous in terms of the assessed homeopathic intervention and cancer type. Additional seven studies were included only for safety and side effects due to severe lack of methodical and reporting quality (one uncontrolled three-armed pilot outcome study, five prospective single-armed studies and one single-armed retrospective study). The majority of studies observed breast cancer patients, the most common primary endpoint was influence of homeopathic treatment on toxicity of cancer treatment and one of the most frequent secondary endpoints was QoL. Detailed characterization of the included studies may be seen in Table 3 . The flow of studies through the review can be seen in Fig.  1 .

figure 1

Flow Diagram

Characteristics of included studies

Concerning all relevant studies, 2016 patients were included, of whom 1594 were analysed, due to 422 drop-outs. The age of the mostly female patients ranged from 20 to 87 years, with a mean age of 54.5 (47.9–64.9) years. Reported was the inclusion of patients with breast cancer ( N =  1448), lung cancer ( N =  213), gastrointestinal cancer ( N =  54), hematological cancer ( N =  45), head and neck tumours ( N =  40), renal cell cancer ( N =  28), sarcoma ( N =  23), pancreas cancer ( N =  9) and other types of cancer ( N =  61).

Risk of bias in included studies

The results are presented in Table 4 . Eleven of the included studies have moderate quality. Seven studies were included only for side effects and AEs due to their severe lack of methodological and reporting quality (poor quality).

Excluded studies

A list of excluded studies after full-text screening and reasons for the exclusion can be seen in Table 5 . The studies that could not be found for full-text screening (eSupplement) are listed in the appendix. One of the studies (Genre et al. 2003 ) was not available and our lending request remained unanswered, so we were not able to analyse the results. But while searching for the study we came across the following two reviews that had excluded the study: Mathie et al. ( 2013 ) rated the trial as a minor journal article with only an abstract available and Kassab et al. ( 2009 ) excluded the study for the following reason: “it was only available in abstract form and the results were not included in the abstract […]: the lead author was contacted but not willing to provide us with the results as the data was not published”.

Efficacy of homeopathic therapy

Influence on toxicity of cancer treatment: skin reaction.

Balzarini et al. ( 2000 ) analysed the effects of Belladonna 7CH globules (two times a day) and X-ray globules (once a day) associated in the treatment of acute radiodermatitis compared to a placebo in 61 randomized breast cancer patients. Over 30 days after radiotherapy the physician assessed skin color, temperature to the touch, edema and hyperpigmentation at eight defined times ( t 1– t 8). There were no differences in skin color (all p ’s > 0.050) and hyperpigmentation (all p ’s ≥ 0.050) but the study found significant differences in temperature for t 3, t 4, t 6 and t 7 ( p =  0.008; p =  0.016; p =  0.023; p =  0.011) in favour of the homeopathy group. They also found a difference for oedema on at t 5 and t 6 in favour of the placebo group ( p =  0.025; p =  0.025).

Influence on toxicity of cancer treatment: nausea and vomiting

Pérol et al. ( 2012 ) included 403 breast cancer patients in a RCT to investigate chemotherapy-induced nausea and vomiting. Patients in the intervention group took the complex homeopathic remedy “Cocculine”, while the control group was given a placebo in addition to the standard antiemetic therapy during six chemotherapy cycles. Instruments to assess nausea and emesis were the Functional Living Index for Emesis questionnaire, patient diaries and the Common Terminology Criteria for Adverse Events Scale. There was no significant difference between the arms during first, second or third chemotherapy cycle (all p ’s > 0.050), except for significantly more vomiting episodes during third cycle (assessed with patient diaries, p =  0.030) in favour of the homeopathy arm.

Influence on toxicity of cancer treatment: joint pain (JP) and joint stiffness (JS)

In an open, not randomized CT by Karp et al. ( 2016 ) 27 breast cancer patients were included, taking only aromatase inhibitors in the control group or additionally Ruta graveolens 5CH and Rhus toxicodendron 9CH (twice a day for 3 months) in the homeopathic group. The overall scores showed a significant advantage in the homeopathic arm for JP ( p =  0.000) but not for JS ( p =  0.057). More results of significance, all in favour of the homeopathy arm, were frequency, intensity and number of sites regarding JP ( p =  0.000; p =  0.000; p =  0.032), morning (not daytime) intensity, worsening of JS and time to disappearance of morning stiffness and ( p =  0.020; p =  0.179; p =  0.014; p =  0.022) as well as frequency and increase of analgesic use concerning JP ( p =  0.003; p =  0.008). At inclusion, 65% and 80% of patients in the homeopathic and control arm complained of JP, whereas 76.9% and 62.5% had taken analgesics in the week before inclusion.

Influence on toxicity of cancer treatment: oral mucositis

Another non-blinded and not randomized CT by Steinmann et al. ( 2012 ) analysed the grade of oral mucositis in 20 patients with head and neck tumours receiving radiotherapy or radio-chemotherapy. Patients in the homeopathic arm carried out mouth rinses with a Traumeel S solution, the control group with sage tea (Salvia officinalis) for 6–7 weeks. The authors found no significant differences in the grade of oral mucositis between both groups (no p values given) and reported a consistent worsening of intraoral pain during the study period, except for one single time in week 5 in the homeopathic arm. At the end of the study, 6 and 3 out of 10 patients took systemic analgesics in the homeopathic and placebo arm, while 5 and 1 out of 10 patients used local analgesics, but no statistical analysis was made. Regarding xerostomia (difficulty in speech and eating), they reported a significant difference in preservation of taste favouring Traumeel in week 4, but presented no p value.

Influence on toxicity of cancer treatment: influence of JP on sleep

Twenty-seven breast cancer patients were assessed regarding the impact of JP on quality and quantity of sleep in an open, not randomized CT by Karp et al. ( 2016 ). While patients in the control group were taking aromatase inhibitors only, patients in the homeopathic group received additionally Ruta graveolens 5CH and Rhus toxicodendron 9CH (twice a day for 3 months).

The impact of JP on sleep after 3 months showed a significant difference in favour of the homeopathy arm ( p =  0.008). No statistical analyses were done for the results of patients who stated that pain never disturbed their sleep.

Time to drain removal after mastectomy

A RCT by Luca Sorrentino et al. ( 2017 ) observed 53 breast cancer patients (intention to treat (ITT)-sample; in the per protocol (PP)-sample 43 patients) who were either taking Arnica montana 1000 K or a placebo (3 times a day) from one day before until 4 days after surgery. The results of reduction in drained blood and serum volumes were analysed with three different models.

Regarding the changes in volume collected from day one, analysed with the analysis of variance (ANOVA), neither the PP- nor the ITT- sample showed significant overall differences ( p =  0.772; p =  0.122). When analysed with the regression model including treatment and collected volume on the day of intervention, the differences between the groups in the PP-sample were significant on days 2 and 3 to the advantage of homeopathy ( p =  0.033; p =  0.022). The estimates of the mean difference in total volume analysed with regression models showed significant differences only in the PP-sample for the model including treatment, collected volume on the day of surgery and patient weight ( p =  0.030). The differences in the ITT- sample were not significant ( p =  0.600).

Regarding self-evaluation of pain , bruises and haematomas or breast swelling after surgery both arms showed no significant differences ( p  > 0.050; p =  0.670; p =  0.570).

Fifty-five patients with breast cancer or risk patients wishing for risk reduction by undergoing mastectomy and immediate breast reconstruction were assessed in a RCT (Lotan et al. 2020 ). Patients were either taking three globes of Arnica montana Bellis C30 & perennis C30 each or a placebo until drain removal. Concerning this matter, a significant difference favouring homeopathy was found (11.1 ± 6.1 days in study group, 13.5 ± 6.4 days in placebo group, p <  0.050), but because the amputated breast weight and implant volume may affect drainage and differed significantly between both groups ( p <  0.001), this result cannot be fully attributed as intervention effect. Concerning postoperative pain, haemoglobin, opioid intake and cortisol levels, no significant differences were found.

Frass et al. ( 2020a , b ) observed 150 randomized patients with advanced non-small cell lung cancer until death or in case of survival for a maximum of 24 months. Fifty-two patients gave no consent to randomization and were, therefore, used as a control group for this endpoint only (arm C), while the other groups received chemotherapy and either individualized homeopathic medicine (daily on a 3-week interval, arm A) or a placebo (arm B). Over the observed 2 years, median- and 2-year mortality differed significantly between arm A and B (435 and 257 days, p =  0.010; 45.1% and 23.4%, p =  0.020), arms A and C (228 days, p <  0.001; 13.5%, p <  0.001) but not between arms B and C ( p =  0.258; p =  0.154). Further significant differences were found for the estimated survival time between arms A and B (477 and 352 days, p =  0.014), arms A and C (477 and 274 days, p <  0.001) but not arm B vs arm C ( p =  0.145), as well as for patients who died within the 2 years (A vs C, p =  0.020; not A vs B p =  0.172 and B vs C p =  0.747).

Hot flashes (HF) and other menopausal symptoms

To explore the effect of homeopathy on HF, Jacobs et al. ( 2005 ) conducted a randomized study with 66 breast cancer patients receiving either a placebo combination medicine and a homeopathic single remedy (arm A), a homeopathic combination medicine (Hyland’s Menopause) and a placebo single remedy (arm B) or 2 placebos (single and combination remedy, arm C). The overall results regarding severity and frequency of HF and typical menopausal symptoms (via Kupperman Menopausal Index) did not differ significantly, except for an increase of headache in arm B at 6 and 12 months ( p =  0.040; p =  0.030). A subgroup analysis including only patients without tamoxifen regimen showed significant differences, arm B, in HF severity score (frequency times severity: B vs C p =  0.010, A vs B p <  0.001) and in the total number of HF (B vs C p =  0.006, A vs B p =  0.002). Furthermore, patients in arm A had a lower severity score and fewer HF in total.

Assessing 53 breast cancer patients, a RCT by Thompson et al. ( 2005 ) did not find any significant differences in activity- and profile-scores (all p ’s > 0.05) between the intervention group receiving individual homeopathic treatment for 16 weeks and the placebo group. No significant differences were found in menopausal symptoms (conducted through a questionnaire) as well, assessing night sweats frequency and influence on sleep ( p =  0.750; p =  0.870) and day sweats frequency and disturbance of everyday functioning ( p =  0.300; 0.220). Only the differences in terms of satisfaction were significant, but in favour of the placebo group ( p =  0.010). On HF -severity and -frequency no data were reported.

In another study, 138 randomised patients took the homeopathic remedy BRN-01 (Actheane ® ) or a placebo twice a day for at least 8 weeks in addition to their adjuvant endocrine therapy (aromatase inhibitor or tamoxifen with/without ovarian suppression). There were no significant differences in the HF-score after 4 or 8 weeks ( p =  0.756; p =  0.775), compliance ( p =  0.606) or satisfaction (Heudel et al. 2019 ).

Quality of life (QoL), quality of recovery (QoR), global health and subjective well-being

The influence of homeopathy on improving the global health status or subjective wellbeing was assessed in an RCT by Frass et al. ( 2015 ). For an unstated duration, 373 unblinded patients with different kinds and stages of carcinoma received either chemotherapy or radiotherapy only or an additional individual homeopathic treatment. After 4 months, the arms showed significant differences in global health (via EORTC QLQ-C30, p =  0.005) and subjective wellbeing (via visual analogue scale (VAS), p <  0.001) favouring homeopathy.

Assessing 150 patients with advanced non-small cell lung cancer (NSCLC) receiving chemotherapy and an individualized homeopathic treatment or a placebo, the authors found comparable results in their RCT in 2020 after 9 and 18 weeks in global health status/QoL ( p <  0.001) and subjective well-being (via SF-36, p <  0.001) (Frass et al. 2020a , b ). In both trials, most of the assessed function- and symptom- scales showed significant differences favouring homeopathy after 4 months (Frass et al. 2015 ): p <  0.001 for physical, cognitive, social and emotional functioning as well as fatigue and pain; role functioning p =  0.040, dyspnoea p =  0.002, insomnia p =  0.029, appetite loss p =  0.007) and after 9 and 18 weeks (Frass et al. 2020a , b : p  ≤ 0.001 for physical, role, emotional and social functioning as well as fatigue, nausea and vomiting, dyspnoea, insomnia, appetite loss as well as constipation ( p =  0.008; p =  0.005). Significant differences only after 18 (and not 9) weeks were found in cognitive function ( p =  0.113; p =  0.001), pain ( p =  0.061; p <  0.001), diarrhoea ( p =  0.590; p =  0.017) and financial difficulties ( p =  0.134; p =  0.021). The results for vomiting and nausea, constipation and diarrhoea in the study by (Frass et al. 2015 ) did not reach significance.

Patients with former homeopathic experience were surveyed regarding their attitude concerning homeopathy by Frass et al. 2020a , b ) in their study on patients with NSCLC. The majority of patients in the study arm receiving homeopathy had been referred to the former homeopathic treatment by doctors (57.1%, arm B 17.6%) and their expectations regarding a homeopathic effect were significantly lower ( p =  0.010) than the expectations of patients in the placebo arm, who had significantly more often used homeopathy without a doctor’s recommendation ( p =  0.039).

In a RCT by Jacobs et al. ( 2005 ) 66 breast cancer patients were analysed and received either a placebo combination medicine plus a homeopathic single remedy (arm A), Hyland’s Menopause (a homeopathic combination medicine) plus a placebo single remedy (arm B) or 2 placebo medications (arm C). After 1 year the study found significant results in QoL not in terms of physical function but in general health (via SF-36) favouring both homeopathic arms A and B over placebo ( p =  0.020; p =  0.030).

Further studies observing QoL did not find significant differences: neither in a controlled trial with 20 non-blinded and non-randomized patients with head and neck tumours (Steinmann et al. 2012 ), no p values reported) receiving Traumeel S or sage tea for mouth rinses against radiotherapy- or radiochemotherapy- induced oral mucositis, nor in a RCT with 138 patients who took, additionally to their adjuvant endocrine therapy, the homeopathic remedy BRN-01 (Actheane ® ) or a placebo (Heudel et al. 2019 ). In the latter study no statistical analysis was made between the groups and the result presentation was incomprehensible.

Two RCTs (Lotan et al. 2020 ; Thompson et al. 2005 ) found no significant differences in general health, QoL or QoR comparing the effects of Arnica montana and an indiviualized homeopathic remedy to a placebo (no p value reported; p =  0.850).

Anxiety and depression

This endpoint was assessed by Thompson et al. ( 2005 ), who found no significant differences for anxiety and depression between the homeopathic and placebo arm in 53 randomized breast-cancer patients.

Safety, tolerance and side effects

Two studies analysed safety and side effects as one of their secondary endpoints.

The reported adverse events (AEs) in the RCT by Luca Sorrentinoet al. ( 2017 ) by five patients taking Arnica montana were not correlated with the homeopathic treatment. None of the AEs stated in another RCT were related to the study treatment with BRN-01 (Actheane ® ) or the placebo, as well (Heudel et al. 2019 ).

Six studies reported no side effects related to the intervention drug (Frass et al. 2015 ; Frass et al. 2020a , b ; Freyer et al. 2014 ; Karp et al. 2016 ; Lotan et al. 2020 ; Pérol et al. 2012 ). Further four studies (Clover and Ratsey 2002 ; Gaertner et al. 2014 ; Schlappack 2004 ; Steinmann et al. 2012 ) gave no information on side effects of the study remedies. Because the studies assessed the homeopathic treatment during cancer care, it was often impossible to define the exact cause of the reported AEs. Balzarini et al. ( 2000 ) reported one drop-out due to homeopathic exacerbation (Belladonna 7cH globules, two times a day and X-ray globules once a day) and four drop-outs due to the AE’s of radiation.

In another study (Jacobs et al. 2005 ) there were no AEs reported by the breast cancer patients receiving a placebo combination medicine and a verum single remedy in arm A, a verum combination medicine (Hyland’s menopause) and a placebo single remedy in arm B or 2 placebo medications in arm C. But statistical analysis showed an increase of HF and headaches in arm B although the overall incidence (any type, any grade) was equally distributed between all groups.

Thompson et al. ( 2005 ) reported that about 25% of patients in both groups (receiving an individualized homeopathic remedy or a placebo) suffered side effects with only minor differences in terms of aggravations, appearance of new symptoms or return of former symptoms. Details about severity, kind of AE and whether they relate to the remedies were not given.

Further seven studies were included for side effects (Clover and Ratsey 2002 ; Forner-Cordero et al. 2009 ; Freyer et al. 2014 ; Gaertner et al. 2014 ; Schlappack 2004 ; Thompson and Reilly 2002 ; 2003 ). Of these, two studies reported no information about AEs and were, therefore, mentioned in the listing above (Gaertner et al. 2014 ; Schlappack 2004 ).

A study by Forner-Cordero et al. ( 2009 ) analysed 17 breast cancer patients after unilateral breast surgery with exhibited arm- lymphedema, who were treated with oral Lymphomyosot (15 drops or 3 tablets) for three times a day over the study period, in combination with compression hosiery, daily kinesiotherapy and skin care. Eight patients experienced treatment-emergent AE ‘s and four patients had to discontinue their treatment due to AEs (one patient each with nycturia, hypertensive crisis, right hypochondrial pain, heartburn, no further information given). Further AEs reported were anxiety, constipation and dry mouth.

Another study by Thompson and Reilly ( 2002 ) reported reactions of homeopathic remedies that were given according to individual assessment in 17 of 57 patients with different cancer types receiving conventional cancer treatments. Reactions included aggravation of symptoms, development of old symptoms from years ago (reported as part of the healing) and transient worsening of symptoms (which settled on stopping the remedy). None of the AEs necessitated withdrawal of homeopathic medicines, but one patient was advised to stop the treatment because of an acute blast phase of chronic myeloid leukaemia.

In 2003 the authors assessed individualised homeopathic medicine in breast cancer patients under conventional cancer therapy and reported new symptoms in 7 of 40 patients, return of old symptoms in 10 patients and 1 patient suffering a difficult aggravation of symptoms which stopped with pausing the homeopathic treatment (no further information given) (Thompson and Reilly 2003 ).

Before summing up the main results it should be noted that due to the variety of remedies, potencies and indications used in the included studies, finding evidence of the effectiveness of homeopathic treatment in cancer patients is problematic. Patients receiving individualized and changing homeopathic treatment even within a single study generate difficulties in deriving results for certain symptoms. As heterogeneous as the homeopathic agents were the types of cancer and, consequently, the conventional anti-cancer therapies, leading to many different observed endpoints.

All of the included studies showed strong methodical deficits in study design and reporting of the data such as incomplete description of sample, patient characteristics, drop-out, dose, duration of intervention or statistical data.

Regarding the influence of homeopathy on toxicity of cancer treatment, one study analysed skin reactions of irradiation (Balzarini et al. 2000 ) and obtained conflicting results both to the advantage and disadvantage of homeopathy which may have been biased by the small sample size. The authors reported a trend of less dermatitis and for one assessment (t5) interpreted a p =  0.05 wrongly as significant in favour of the homeopathy group. It remains unclear why the authors used invalid scores instead of internationally accepted and valid scores (Radiation Therapy Oncology Group -score for example).

One study by Karp et al. ( 2016 ) addressed the homeopathic influence on JP and JS caused by aromatase inhibitors. Patients who received homeopathic treatment were reported to have a significantly greater improvement in all results concerning JP and analgesic use. Contrary to this, only a few measurements were significant (mean time to disappearance of JS, morning intensity and worsening of JS). Strangely, more patients in the control group stated JP at inclusion, but took less analgesics than patients in the homeopathic group. The analgesic consumption, however, was not properly described at materials and methods. Moreover, the study shows severe methodological weaknesses: both arms were unblinded, not randomized and important inclusion criteria, such as cancer stage, are not mentioned. The authors report only few p values that mostly refer to the composite scores for joint pain and joint stiffness, leading to highly significant p values. But these scores are not valid and seem questionable. Moreover, the generated percentages are based on different baseline values. For their calculations, the authors seem to use either two different numbers of patients at inclusion for each study arm or the number of patients after 3 months. It remains incomprehensible and unreported which dataset is used for which endpoint and some calculated results stay questionable. Also, some numbers reported in the text differ from those in the tables. Furthermore, the comparability of both groups is questionable: each group was treated at a different hospital and patients showed severe differences at inclusion already. Besides, the drop-out was high and differed in both arms (homeopathy arm 45%, control arm 20%).

Chemotherapy-induced nausea and vomiting (Pérol et al. 2012 ) as well as oral mucositis during radiotherapy or radio-chemotherapy (Steinmann et al. 2012 ) were studied in one trial only, and both were unable to find a homeopathy effect. Vomiting episodes that Perol et al. reported significantly more often in the placebo group during the 3rd chemotherapy cycle, were not obtained over the 4–6th cycle and had no impact on the Functional Living Index. Although Steinmann et al. reported a significant advantage for the homeopathic group regarding preservation of taste in week 4, the authors provided no data on significance for this statement that was based on diaries of the 20 patients. Furthermore, the use of systemic and local analgesics was higher in the homeopathy group compared to the control group. Whether this is the result of harm caused by the homeopathic remedy or other reasons remains unclear.

Only one study assessed the influence on JP on quality and quantity of sleep (Karp et al. 2016 ). The patients in this controlled trial received either aromatase inhibitors only or additionally Ruta graveolens 5CH and Rhus toxicodendron 9CH. To the benefit of homeopathy, the study showed a significantly worsened impact of pain on sleep concerning JP in the placebo group after 3 months, while the homeopathy group remained unchanged. Regarding the results of patients whose sleep was never disturbed by pain, no statistical analyses were done. However, the authors use different baseline values for their calculations and it remains incomprehensible and unreported which dataset is used for which result. Also, the patients in this study were neither blinded nor randomized and important inclusion criteria, such as cancer stage, was not reported. Furthermore, the patients in the study arms showed strong differences right from the start and were treated at two different hospitals, which limits the comparability. Additionally, the drop-out was high and uneven (homeopathy arm 45%, control arm 20%).

Inconsistent findings were obtained in two blinded and placebo-controlled studies assessing the effects of homeopathic interventions on time to drain removal in breast cancer patients after mastectomy (Lotan et al. 2020 ; Luca Sorrentino et al. 2017 ). Luca Sorrentino et al. ( 2017 ) reported significant differences favouring homeopathy in two different regression models of the per-protocol-analysis only: in total volume (including treatment, collected volume on day of surgery, patient weight) and in changes in volume collected from day 1 to each following day in two time points (including treatment, collected volume on day of surgery). Yet, neither the overall results in the ANOVA—nor the regression- model of the ITT-sample did reach significance. The study lacks reporting quality: only few baseline characteristics are described, details on cancer stage are missing and the reporting of results for the endpoints is incomplete. The comparability of both study arms is questionable due to missing detail about whether mastectomy was performed with or without reconstruction, which most likely affects the amount of volume. Most importantly, the authors do not report whether both arms of the PP-analysis are comparable to the baseline data or not. That is why the results of the PP-dataset are not usable. Furthermore, the high and uneven drop-out (homeopathic arm 12%, placebo arm 26%) and the small sample size (53 patients) may have biased the PP-dataset and limits the generalizability of the results even more.

Lotan et al. ( 2020 ) reported significant advantages for the homeopathic group, but included patients for therapeutic as well as prophylactic mastectomy which may have gone along with different radicality of the operation in both arms. Also, the volume of the operated breast and the implant were different in both arms. This, and a different radicalism of the operation, most likely affected the drained volume and postoperative complications and biased the outcome. Additionally, the durations until drain removal in the results are in contrast with the range of drain times stated in the limitations (3–32 days). Further severe inconsistencies are the changed trial protocols during the study, as well as the uneven compliance and drop-out of patients. They were kept in the statistical analysis as partially treated, but no data were reported. Besides, only few patient characteristics are stated. Last but not least, the authors either report wrong numbers or transposed them. Further limitations of this study were discussed by the authors. Hence, these trials cannot serve as evidence for the effectiveness of homeopathic treatment in breast cancer patients.

Frass et al. ( 2020a , b ) conducted the only study observing the use of a homeopathic treatment on survival among patients with advanced non-small-cell lung cancer. Significant differences in median-, 2-year- mortality and estimated survival time were found favouring a homeopathic over a placebo and a not randomized control group. But as discussed by the authors the comparability between the arms is restricted as there were significantly more patients with N (Nodus) stages 0–1 in the placebo arm, and more patients with N stage 3 in the homeopathic arm ( p =  0.010). Furthermore, there are serious concerns with respect to the reporting of this study: the authors gave contradictory statements in the text and study protocol on whether the control group, that refused randomization, was given verum or not. Additionally, the high and uneven drop-out (homeopathy 9.8%, placebo 29.8%, no data for control group) might be the result of some selection bias. A serious concern also is the unusually high number of deaths in the first weeks in the placebo group, for which there is no explanation. The fact which is most serious concerning the scientific conduct of the study is the fact that the trial protocol has been changed for several times. This is well documented as the study was registered in clinicaltrials.gov (“ https://clinicaltrials.gov/ct2/show/ NCT01509612?term = 33010094 + %5BPUBMED-IDS%5D&draw = 2&rank = 1”). Instead of 3 pre-planned only data on patients with one cancer type was reported, instead of 600 participants as stated in the registration only 150 were included in the final manuscript of the study while the number of exclusion criteria was raised from 1 to 20. The date of a document with modifications (January 2011), is set a year before the study was first registered in January 2012, but already contains changed parameters similar to those in the published paper (but lists 300 patients to include). Moreover, the planned follow-up was reduced from 104 to 18 weeks.

Three studies assessed the influence of homeopathic interventions on HF and menopausal symptoms. Two of the studies, that were placebo-controlled and double-blinded, demonstrated no significant effect on HF or menopausal symptoms (Heudel et al. 2019 ; Thompson et al. 2005 ). On the contrary, according to Thompson et al. ( 2005 ), patients receiving homeopathy were, to a significant degree, even more unsatisfied with the treatment than the placebo group.

Contrary to this, in a subgroup without tamoxifen regimen, a three-armed, placebo-controlled, blinded study (Jacobs et al. 2005 ) showed a significant increase in the total number of HF in arm B (homeopathic combination medicine (Hyland’s Menopause)) compared to arm C (2 placebos) and compared to arm A (placebo plus an individualized homeopathic single remedy). Whether or not that was the result of a harmful impact of the homeopathic combination remedy is not discussed by the authors. The study also showed a lower severity score and fewer HF in total in patients in arm A. The p values for mean difference of HF severity score also showed significance to the disadvantage of arm B, but looking at the confidence intervals the calculated significance is highly uncertain. The comparison of the single homeopathic remedy and a placebo did not reach statistical significance. While the patients in arm B showed a higher number of HF, had a worse HF severity score and an increase of headache, they showed, just as the single homeopathic remedy, a significantly improved general health score (via SF-36) compared to the placebo group after 1 year. Strangely, the non-responding placebo group did not receive significantly more changes of prescription. These inconsistencies might be the result of numerous methodological weaknesses of the study: most importantly, the high and uneven number of patients that had dropped out at 12 months (single remedy 36.7%, combination remedy 23.1%, placebo 40.7%), although all of the randomized patients were analysed. Methodologically questionable is the inclusion of patients with only 3 HF per day, which leaves only a low potential for improvement. It remains unreported whether patients in arm A had taken the remedy before the first telephone interview (after 1 month) because it was mostly given monthly or every 2 months. Furthermore, the patients were analysed in small subgroups with only ten patients in some groups. Baseline data for the endpoints are missing, and many results were (most likely due to missing significance) not reported at all. Therefore, the statements in this study should be viewed with caution.

Six studies investigated the effect of homeopathic interventions on QoL and QoR. Two trials reported a positive influence on global health status and subjective wellbeing (Frass et al. 2015 ; Frass et al. 2020a , b ). Significant differences were found for the majority of the assessed function- and symptom-scales after 4 months or 9 and 18 weeks, which were valued subjectively by the patients themselves. Contrary to this, Jacobs et al. ( 2005 ) reported an effect of homeopathy regarding QoL only in general health, but not in physical function. Four studies (Heudel et al. 2019 ; Lotan et al. 2020 ; Steinmann et al. 2012 ; Thompson et al. 2005 ) did not show a significant effect on QoL or QoR.

Again, the seemingly positive studies have numerous methodological weaknesses. The patients in the trial by Frass et al. ( 2015 ) were unblinded and not compared to a placebo- or active control group. Moreover, the results were reported for patients without chemotherapy and metastases, while the authors state that 24.4% of the patients had metastases and 49.1% received chemotherapy. Furthermore, the VAS used in the study is not a valid score. The authors used multiple imputation models without reporting the quantity of the calculated missings. Taking a closer look, 37 out of 410 randomized patients dropped out, leaving 373 patients to receive study treatment. Only 335 completed the questionnaires at the first and second visit and only 282 patients completed the third visit, while 373 patients were analysed. Thus, about 10% of the data for the second visit was imputed, about 24% for the third. Considering the high dropout (homeopathic arm 34.8%, control arm 27.5%) and the different attention between groups, the multiple imputation techniques that were used might have led to incorrect results: patients in the homeopathic arm (who might expect an improvement in well-being due to the remedy or talks to a homeopath) are more likely to drop out because of disappointment than patients in the control arm (mostly taking part to support science). Perhaps because these results were more pleasant for the authors, they compared only visit one and three and did not report the results of the second visit.

The second study by the author Frass et al. 2020a , b ) has been discussed above— due to the serious concerns on that study, also the data on QoL do not provide sound evidence. The follow-up for QoL changed from 2 years to 18 months. Likewise, as mentioned already, the drop-out in the study by Jacobs et al. ( 2005 ) was high and uneven (single remedy 36.7%, combination remedy 23.1%, placebo 40.7%) and might have, together with the small sample size of the subgroups (ten patients only in some groups) biased the results.

No effect of homeopathy was found regarding anxiety and depression by Thompson et al. ( 2005 ), the sole study in this review assessing that endpoint and lacking report quality.

All in all, our systematic review does not provide any evidence on the effectiveness of homeopathy in cancer care that is higher than a placebo effect.

As in higher dilutions there is no substance left any more, this result is in accordance with scientific knowledge. Accordingly, we doubt that any further well-conducted studies will come to another result. Some physicians may be inclined to use homeopathy as a placebo due to its high acceptance and reputation in the society and for patients. This makes it much easier to use the placebo effect than prescribing an unknown receipt. Moreover, homeopathy seemingly has no strong side-effects. Yet, lower dilutions may contain an amount of the substance that may lead to allergies or other side effects. Mostly, these effects will be small. Yet, this seeming advantage is no argument to justify the use of homeopathy as a placebo. Patients having a positive experience with homeopathy and other CAM tend to use these ineffective methods also in case of serious diseases (Huebner et al. 2014 ). Also, any delay in symptom management during cancer treatments in favour of a homeopathic treatment goes along with a deterioration of the patient’s supportive management.

Important to know, homeopaths have their own interpretation of symptoms going on or even increasing while the patient is taking homeopathy: initial worsening allegedly is a proof of the correct choice of the homeopathic remedy. For cancer patients, this idea is highly dangerous as it may lead to a further delay of treatment. Such worsening has been reported and misinterpreted in several studies in our review (Balzarini et al. 2000 ; Jacobs et al. 2005 ; Thompson et al. 2005 ; Thompson and Reilly 2002 ; 2003 ).

Limitations of this work

This systematic review exhibits some limitations that must be mentioned. As listed in the exclusion criteria in Table 1 , studies concerning children or teenagers were excluded and only trials with adult patients were analysed in this SR. Excluded were also other publication types than primary investigations or reports; preclinical studies, case reports or gray literature such as ongoing studies, unpublished literature, conference articles, abstracts, comments or letters. Besides, we included only studies in English or German language, leaving possible studies in other languages unconsidered. Furthermore, we could not conduct a meta-analysis. The essential reason for this is the large heterogeneity of the included studies, which was already described in the beginning of the discussion. We had to compare trials with differing design, endpoints, homeopathic intervention, type of cancer, cancer stage or cancer care to gain a comprehensive overlook. Besides, most of the subgroups were small and the majority of studies had a high risk of bias. The points mentioned would have limited the quality of a meta-analysis severely so we decided to summarize the included studies as a systematic review.

All in all, the results for the effectiveness of homeopathy in cancer patients are heterogeneous, mostly not significant and fail to show an advantage of homeopathy over other active or passive comparison groups. No evidence can be provided that homeopathy exceeds the placebo effect. Furthermore, the majority of the included studies shows numerous and severe methodological weaknesses leading to a high level of bias and are consequently hardly reliable. Therefore, based on the findings of this SR, no evidence for positive effectiveness of homeopathy can be verified.

Availability of data and material

Not applicable.

Code availability

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Wagenknecht, A., Dörfler, J., Freuding, M. et al. Homeopathy effects in patients during oncological treatment: a systematic review. J Cancer Res Clin Oncol 149 , 1785–1810 (2023). https://doi.org/10.1007/s00432-022-04054-6

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The Efficacy of Homoeopathic Remedy: A Case Report of Adhesive Capsulitis

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Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by pain and stiffness of the shoulder joint. Frozen shoulder is more common in women, though it can also occur in men. It occurs mainly after 50 years of age. This study has been conducted to evaluate the role of homoeopathic treatment in cases of frozen shoulder disorder. Homoeopathy has also demonstrated great efficacy in curing symptoms and reducing severity of frozen shoulder.

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Indian Journal of Research in Homoeopathy

Home > JOURNAL > Vol. 11 (2017) > Iss. 1

Indian Journal of Research in Homoeopathy

Article title.

A retrospective study of homoeopathic treatment in patients with heel pain with or without Calcaneal Spur

Suraia Parveen , Dr. Anjali Chatterjee Regional Research Institute (H), Kolkata, West Bengal

Calcaneal spur, Calcarea flouricum, heel pain

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Background: Heel pain is a common clinical condition which significantly affects the quality of life. It is frequently associated with calcaneal spur (CS). Despite its high prevalence, the optimal treatment remains unclear. The aim and objective of this study is to evaluate the extent of CS in heel pain; correlation of CS with some sociodemographic and health-related factors; and outcome of homoeopathic treatment over a period of 6 months. Methodology: It was a retrospective study done at Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy, Kolkata. Samples were selected from the patients referred for ankle X-ray from August 2014 to July 2015 for nontraumatic heel pain. Their files were traced from outpatient department, and treatment records were reviewed over the next 6 months. Results: Totally 92 patients, 70 women and 22 men, had undergone lateral X-ray of ankle for nontraumatic heel pain, of which 76 (82.6%) patients had CS. Extent of CS was found to be higher in case of females, older age, overweight, and profession of housemaid or manual labor. Homoeopathic treatment showed positive response in nearly 75% of the CS patients. The most useful medicines were Calcarea flouricum, Rhus toxicodendron, Ledum palustre, and Aranea diadema. Conclusion: CS was found in nearly 80% of patients presenting with heel pain, which showed association with female sex, overweight, increasing age, and profession requiring heel stress. Homoeopathic treatment was effective in 3/4th of CS patients, and Rhus toxicodendron and Calcarea flouricum are the two most commonly used medicines.

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Parveen S. A retrospective study of homoeopathic treatment in patients with heel pain with or without Calcaneal Spur. Indian J Res Homoeopathy 2017;11(1):64-73. doi: 10.4103/0974-7168.200844

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Vickers, Andrew J. "Homoeopathy and clinical trials." Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.302395.

Chou, J. Y. "Reforming towards a scientific medicine and a changing social identity : British homoeopathy, 1866-1893." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1474209/.

Benwell, Martin James. "Medical and professional homoeopathy in the UK : a study of tensions in a heterodox healthcare profession." Thesis, City University London, 1998. http://openaccess.city.ac.uk/12048/.

Marques, Rosimar Maria. "Vigor de sementes de milho tratadas com os preparados homeopáticos Antimonium crudum e Arsenicum album." Universidade Federal de Viçosa, 2007. http://locus.ufv.br/handle/123456789/4651.

Bohneberger, Ariane Luckmann. "Ocorrência do gorgulho conotrachelus psidii (coleoptera: curculionidae) e manejo das principais doenças e pragas na goiabeira serrana acca sellowiana com ênfase na homeopatia." Universidade do Estado de Santa Catarina, 2009. http://tede.udesc.br/handle/handle/1078.

Richardson, Janet. "Assessing the impact of complementary therapy on health status : a service evaluation of the benefits of acupuncture, homoeopathy and osteopathy using the SF-36 health survey and a waiting list control group." Thesis, King's College London (University of London), 1999. https://kclpure.kcl.ac.uk/portal/en/theses/assessing-the-impact-of-complementary-therapy-on-health-status--a-service-evaluation-of-the-benefits-of-acupuncture-homoeopathy-and-osteopathy-using-the-sf36-health-survey-and-a-waiting-list-control-group(b4968a98-5108-428e-89b0-53a4c18e9f67).html.

Chatwin, John. "Communication in homoeopathic therapeutic encounters." Thesis, University of York, 2003. http://etheses.whiterose.ac.uk/14170/.

Eatwell, Alan Rowan. "The efficacy of a homoeopathic complex (Aconitum napellus 30CH, Arnica montana 30CH and China officinalis 30CH) on the transport of broiler chickens to the abattoir, in terms of mortality rate, damage and weight loss." Thesis, 2003. http://hdl.handle.net/10321/53.

Maharaj, Prashadhna Devi. "The efficacy of a topical naturopathic complex (Allium sativum MT, Hydrastis canadensis MT, Apis mellifica D3 and Urtica urens D3) in the treatment of Tinea pedis." Thesis, 2006. http://hdl.handle.net/10321/25.

Small, Deirdre. "The perception of homoeopathy amongst grade 12 learners in Durban, South Africa." Thesis, 2004. http://hdl.handle.net/10321/48.

Gillespie, Nerena Beatrice. "Hypercholesterolaemia and homoeopathy." Thesis, 1994. http://hdl.handle.net/10321/2775.

Joseph, Jeanine Dorothy. "Homoeopathy in hypercholesterolaemia." Thesis, 1994. http://hdl.handle.net/10321/1804.

Botha, Izel. "A comparative study of the nuclear magnetic resonance spectra of Kalium Bichromicum 12CH manufactured from 3CH and 4CH triturations respectively." Thesis, 2005. http://hdl.handle.net/10321/322.

Lyell, Daphne. "An NMR study of the effect of succussion on parallel potencies of Natrum muriaticum." Thesis, 2004. http://hdl.handle.net/10321/50.

Erasmus, Fourie. "A comparative study of the NMR spectra of parallel potencies of Pulsatilla pratensis, prepared according to Hahnemannian and anthroposophical extended medicine methods respectively." Thesis, 2004. http://hdl.handle.net/10321/324.

Singh, Shamini. "A comparative in vitro study of the antimicrobial effectiveness of baptisia tinctoria extract in 62% ethanol and baptisia tinctoria extract in distilled water." Thesis, 2004. http://hdl.handle.net/10321/329.

Nijland, Grant. "The efficacy of kalium bromatum 30CH in the treatment of acne vulgaris." Thesis, 2005. http://hdl.handle.net/10321/21.

Smal, Lorna. "A study of the proving of Naja mossambica with a subsequent comparison of an existing proven homoeopathic remedy; Naja tripudians in terms of the mental and dream symptomatology." Thesis, 2004. http://hdl.handle.net/10321/62.

Hofmeyr, Dorita. "A nuclear magnetic resonance study of potencies of natrum muriaticum 15CH prepared by trituration and succussion versus natrum muriaticum 15CH prepared by succussion alone." Thesis, 2004. http://hdl.handle.net/10321/47.

Naidoo, Deena. "A study comparing the anti-microbial effectiveness of a water-based preparation of hydrastis canadensis to that of an ethanol based preparation on the in vitro growth of candida albicans and escherichia coli." Thesis, 2004. http://hdl.handle.net/10321/49.

Singh, Veeran Ramesh. "A study comparing the anti-microbial effectiveness of a water-based preparation of echinacea purpura to that of an ethanol-based preparation on the vitro growth of candida albicans and escherichia coli." Thesis, 2004. http://hdl.handle.net/10321/72.

Maharaj, Ashnie. "The efficacy of homoeopathic simillimum in the treatment of chronic primary insomnia." Thesis, 2005. http://hdl.handle.net/10321/52.

Govender, Nervashnee. "A study comparing the effectiveness of a herbal-complex (Arctium lappa, Berberis aquifolium, Echinacea purpurea and Taraxacum officinale) as compared to homoeopathic simillimum in the treatment of Acne vulgaris." Thesis, 2003. http://hdl.handle.net/10321/59.

Dlamini, Nomthandazo. "The efficacy of the main miasmatic nosodes in the treatment of chronic sinusitis." Thesis, 2003. http://hdl.handle.net/10321/63.

Ismail, Shaida. "The efficacy of homoeopathic simillimum in the treatment of chronic sinusitis." Thesis, 2003. http://hdl.handle.net/10321/64.

Ebrahim, Shera. "A study investigating the efficacy of a homoeopathic complex (Hydrastis canadensis 9CH, Kalium bichromicum 9CH, Sambucus nigra 9CH) on the treatment of chronic sinusitis." Thesis, 2003. http://hdl.handle.net/10321/70.

McTeer, Taryn. "The efficacy of ProgestoNat cream in the treatment of menopausal syndrome." Thesis, 2003. http://hdl.handle.net/10321/71.

Kent, Keri. "The effectiveness of an oral homoeopathic preparation of selenium sulphide 12X in the management of dandruff (seborrheic dermatitis of the scalp)." Thesis, 2005. http://hdl.handle.net/10321/60.

Main, Shelley. "The efficacy of nasosinus (hepar sulphuris calcareum D3, nux vomica D3 and pulsatilla pratensis D3) in the treatment of acute sinusitis." Thesis, 2004. http://hdl.handle.net/10321/69.

Olivier, Monique. "An evaluation of the triple-blind homoeopathic drug proving of an indigenous South African substance, Erythrina lysistemon 30CH, and the traditional uses of the crude substance." Thesis, 2007. http://hdl.handle.net/10321/27.

Hillermann, Roland. "Hypercholesterolemia : the role of homoeopathy." Thesis, 1996. http://hdl.handle.net/10321/1855.

Motara, Farhad Essop. "Determination of the antimicrobial properties of Withania somnifera and Xysmalobium undulatum plant tinctures in terms of the disc diffusion assay and the agar dilution sensitivity test." Thesis, 2007. http://hdl.handle.net/10321/326.

Lutchman-Maharaj, Sapna. "A placebo controlled study determining the effectiveness of a homoeopathic complex (Caladium seguinum 30CH, Nux vomica 30CH, and Staphysagria delphinium 30CH) as compared with homoeopathic similimum treatment in the management of tobacco addiction." Thesis, 2005. http://hdl.handle.net/10321/66.

Budree, Rohan Sewdayal. "A controlled in vitro study of the effectiveness of the plant tinctures, Commiphora molmol, Hydrastis canadensis and Warburgia salutaris against Candida albicans using the disc diffusion assay." Thesis, 2004. http://hdl.handle.net/10321/323.

Taylor, Liesel. "An evaluation of the homoeopathic drug proving of Naja Mossambica in the light of a doctrine of signatures analysis and a comparison between the proving symptons and the venom toxicology." Thesis, 2004. http://hdl.handle.net/10321/61.

Vaithilingam, Heshma. "The effectiveness of homoeopathic simillimum in the treatment of job burnout in the human service field." Thesis, 2005. http://hdl.handle.net/10321/20.

Thorvaldsen, Sara. "A survey to determine the perception of the third year medical students at the University of Cape Town and the University of KwaZulu Natal towards homoeopathy." Thesis, 2007. http://hdl.handle.net/10321/29.

Paruk, Fatima. "A survey to dertermine the perceptions that exist amongst pregnant adults towards the use of homoeopathy during pregnancy." Thesis, 2006. http://hdl.handle.net/10321/36.

Teleman, Silvana. "The effectiveness of topical homoeopathic preparation of Selenium sulphide 8X shampoo in the management of dandruff (Pityriasis Capitis)." Thesis, 2005. http://hdl.handle.net/10321/68.

Babaletakis, Fotini Nicoleta. "A retrospective survey of post-graduate career paths of Durban Institute of Technology (DIT-formerly Technikon Natal) homoeopathic graduates from 1994 to 2004." Thesis, 2006. http://hdl.handle.net/10321/45.

Thomson, Bruce. "A homoeopathic drug proving of the venom of Bitis gabonica gabonica." Thesis, 2004. http://hdl.handle.net/10321/51.

Prakasam, Deva S. "Homoeopathy in curing cancer (A sociological study)." Thesis, 1993. http://hdl.handle.net/2009/4830.

Sweidan, Melanie Jill. "A retrospective survey of post-graduate career paths of Technikon Witwatersrand (TWR) homoeopathic graduates from 1998 to 2004." Thesis, 2007. http://hdl.handle.net/10321/54.

Thiel, Gregory Justin. "A comparison of the results of a triple-blind homoeopathic drug proving of Erythrina lysistemon 30CH, to the doctrine of signatures." Thesis, 2007. http://hdl.handle.net/10321/330.

Macquet, Thomas. "The perceptions and awareness of homoeopathy and the Homoeopathic Day Clinic (H.D.C) amongst students at the Durban University of Technology (D.U.T.)." Thesis, 2007. http://hdl.handle.net/10321/30.

Turner, Taryn-Lee. "A survey to determine the perceptions of veterinarians towards homoeopathy and the utilization of homoeopathy by veterinarians in KwaZulu-Natal." Thesis, 2005. http://hdl.handle.net/10321/1834.

Saul, Wayne. "The effectiveness of homoeopathic similimum treatment in chronic fatigue syndrome (CFS)." Thesis, 2005. http://hdl.handle.net/10321/44.

Vogel, Alta. "A group analysis evaluation of the class Insecta in terms of known materia medica." Thesis, 2007. http://hdl.handle.net/10321/33.

Leisegang, Kristian. "A group analysis evaluation of the kingdom fungi of homoeopathic remedies in terms of known materia medica." Thesis, 2007. http://hdl.handle.net/10321/34.

Ngobese, Jabulile Cresancia. "The relative efficacy of homoeopathic Simillimum treatment as compared to psychological counseling (cognitive therapy and behavioral therapy) in the management of Generalized Anxiety Disorder." Thesis, 2006. http://hdl.handle.net/10321/26.

Monetary Tightening, Commercial Real Estate Distress, and US Bank Fragility

Building on the work of Jiang et al. (2023) we develop a framework to analyze the effects of credit risk on the solvency of U.S. banks in the rising interest rate environment. We focus on commercial real estate (CRE) loans that account for about quarter of assets for an average bank and about $2.7 trillion of bank assets in the aggregate. Using loan-level data we find that after recent declines in property values following higher interest rates and adoption of hybrid working patterns about 14% of all loans and 44% of office loans appear to be in a “negative equity” where their current property values are less than the outstanding loan balances. Additionally, around one-third of all loans and the majority of office loans may encounter substantial cash flow problems and refinancing challenges. A 10% (20%) default rate on CRE loans – a range close to what one saw in the Great Recession on the lower end -- would result in about $80 ($160) billion of additional bank losses. If CRE loan distress would manifest itself early in 2022 when interest rates were low, not a single bank would fail, even under our most pessimistic scenario. However, after more than $2 trillion decline in banks’ asset values following the monetary tightening of 2022, additional 231 (482) banks with aggregate assets of $1 trillion ($1.4 trillion) would have their marked to market value of assets below the face value of all their non-equity liabilities. To assess the risk of solvency bank runs induced by higher rates and credit losses, we expand the Uninsured Depositors Run Risk (UDRR) financial stability measure developed by Jiang et al. (2023) where we incorporate the impact of credit losses into the market-to-market asset calculation, along with the effects of higher interest rates. Our analysis, reflecting market conditions up to 2023:Q3, reveals that CRE distress can induce anywhere from dozens to over 300 mainly smaller regional banks joining the ranks of banks at risk of solvency runs. These findings carry significant implications for financial regulation, risk supervision, and the transmission of monetary policy.

We thank seminar and conference participants at Stanford, Northwestern, Hoover, Columbia, UCLA, Fannie Mae, Mortgage Bankers Association, NBER Corporate Research Associates Symposium, and Commercial Real Estate Data Alliance Research Symposium for helpful comments. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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  • 12 December 2023

More than 10,000 research papers were retracted in 2023 — a new record

  • Richard Van Noorden

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Retractions are skyrocketing as publishers work to remove sham articles from the literature. Credit: Klaus Ohlenschläger/Getty

The number of retractions issued for research articles in 2023 has passed 10,000 — smashing annual records — as publishers struggle to clean up a slew of sham papers and peer-review fraud. Among large research-producing nations, Saudi Arabia, Pakistan, Russia and China have the highest retraction rates over the past two decades, a Nature analysis has found.

The bulk of 2023’s retractions were from journals owned by Hindawi, a London-based subsidiary of the publisher Wiley (see ‘A bumper year for retractions’). So far this year, Hindawi journals have pulled more than 8,000 articles, citing factors such as “concerns that the peer review process has been compromised” and “systematic manipulation of the publication and peer-review process”, after investigations prompted by internal editors and by research-integrity sleuths who raised questions about incoherent text and irrelevant references in thousands of papers.

A BUMPER YEAR FOR RETRACTIONS. Chart shows retraction notices in 2023 have passed 10,000.

Most of the Hindawi retractions are from special issues: collections of articles that are often overseen by guest editors and that have become notorious for being exploited by scammers to rapidly publish low-quality or sham papers .

On 6 December, Wiley announced on an earnings call that it would stop using the Hindawi brand name altogether, having previously shuttered four Hindawi titles and, towards the end of 2022, temporarily paused special-issue publication. Wiley will fold existing titles back into its own brand. As a result of the problems, said Wiley’s interim chief executive, Matthew Kissner, the publisher expects to lose out on between US$35 million and $40 million in revenue this fiscal year.

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‘Tortured phrases’ give away fabricated research papers

A Wiley spokesperson said that the publisher anticipated further retractions — they did not say how many — but that the company takes the view that “special issues continue to play a valuable role in serving the research community”. The spokesperson added that Wiley had put in place more rigorous processes to confirm the identity of guest editors and oversee manuscripts, removed ‘hundreds’ of bad actors — some of whom had held guest editor roles — from its systems, and scaled up its research-integrity team. It is also “pursuing legal means” to share data about the bad actors with other publishers and providers of tools and databases.

Hindawi’s retracted papers might have been mostly sham articles, but they were still collectively cited more than 35,000 times, says Guillaume Cabanac, a computer scientist at the University of Toulouse in France who tracks problems in papers, including ‘tortured phrases’ — strange wording choices used in efforts to evade plagiarism detectors — and signs of undisclosed use of artificial intelligence . “These problematic papers get cited,” he says.

RISING RETRACTION RATES. Graphic shows the ratio of retracted papers to articles published has risen to above 0.2%

Retractions are rising at a rate that outstrips the growth of scientific papers (see ‘Rising retraction rates’), and this year’s deluge means that the total number of retractions issued so far has passed 50,000. Although analyses have previously shown that the majority of retractions are due to misconduct, this is not always the case: some are led by authors who discover honest errors in their work.

The world’s largest database to track retractions, collated by the media organization Retraction Watch, does not yet include all of 2023’s withdrawn papers. To analyse trends, Nature combined the roughly 45,000 retractions detailed in that data set — which in September was acquired for public distribution by Crossref , a non-profit organization that indexes publishing data — with another 5,000 retractions from Hindawi and other publishers, with the aid of the Dimensions database.

Rising rates

Nature ’s analysis suggests that the retraction rate — the proportion of papers published in any given year that go on to be retracted — has more than trebled in the past decade. In 2022, it exceeded 0.2%.

Among countries that have published more than 100,000 articles in the past two decades, Nature ’s analysis suggests that Saudi Arabia has the highest retraction rate, of 30 per 10,000 articles, excluding retractions based on conference papers. (This analysis counts an article for a country if at least one co-author has an affiliation in that country.) If conference papers are included, withdrawals from the Institute of Electrical and Electronics Engineers (IEEE) in New York City put China in the lead, with a retraction rate above 30 per 10,000 articles (see ‘Countries with highest retraction rates’).

COUNTRIES WITH HIGHEST RETRACTION RATES. Chart shows the top 8 countries with the highest retraction rates over the past two decades.

The analysis shows that around one-quarter of the total number of retractions are conference papers — and the bulk of those comprise withdrawals by the IEEE, which has pulled more than 10,000 such papers in the past two decades. The IEEE was the publisher with the highest number of retractions. It does not record when it retracts papers, but most of those removed were published between 2010 and 2011.

Preventive measures

Monika Stickel, director of corporate communications at the IEEE, says that the institute thinks its preventive measures and efforts identify almost all submitted papers that do not meet the organization’s standards.

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AI intensifies fight against ‘paper mills’ that churn out fake research

However, Cabanac and Kendra Albert, a technology lawyer at Harvard Law School in Cambridge, Massachusetts, have found issues, including tortured phrases, citation fraud and plagiarism, in hundreds of IEEE papers published in the past few years, Retraction Watch reported earlier this year . Stickel says that the IEEE has evaluated those papers and found fewer than 60 that didn’t conform to its publication standards, with 39 retracted so far.

The 50,000 or so retractions recorded around the world thus far are only the tip of the iceberg of work that should be retracted, integrity sleuths say. The number of articles produced by ‘paper mills’ — businesses that sell bogus work and authorships to scientists — is estimated to be in the hundreds of thousands alone, quite apart from genuine papers that might be scientifically flawed. “Paper-mill products are a problem even if no-one reads them, because they get aggregated with others into review articles and laundered into the mainstream literature,” says David Bimler, a New Zealand-based research-integrity sleuth also known by the pseudonym Smut Clyde .

Nature 624 , 479-481 (2023)

doi: https://doi.org/10.1038/d41586-023-03974-8

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Artificial Intelligence

Generative AI research from MIT Sloan

Dec 18, 2023

In the year since OpenAI introduced the ChatGPT chatbot, generative artificial intelligence has burst into the public consciousness and jumped to the top of most corporate agendas.

Most companies and business leaders are still finding their way with this new technology, from understanding more about how generative AI works and how it will affect businesses and workers to anticipating how it will be regulated. There is also growing emphasis on how to make sure it is used responsibly.

Researchers at MIT Sloan have been examining generative AI and the best ways to use it in the enterprise. Here’s what they’ve found.

AI and workers

Inexperienced workers stand to benefit the most from generative AI , according to research by MIT Sloan associate professor Danielle Li, MIT Sloan PhD candidate Lindsey Raymond, and Stanford University professor Erik Brynjolfsson, PhD ’91.

The researchers found that contact center agents with access to a conversational assistant saw a 14% boost in productivity, with the largest gains impacting new or low-skilled workers.

“Generative AI seems to be able to decrease inequality in productivity, helping lower-skilled workers significantly but with little effect on high-skilled workers,” Li said. “Without access to an AI tool, less-experienced workers would slowly get better at their jobs. Now they can get better faster.”

Generative AI can boost highly skilled workers’ productivity too , according to a research paper co-authored by MIT Sloan professor Kate Kellogg — though it has to be introduced the right way.

It is not always obvious to highly skilled knowledge workers which of their everyday tasks could easily be performed by AI, the researchers found. To introduce generative AI to highly skilled workers and boost productivity, organizations should establish a culture of accountability, reward peer training, and encourage role reconfiguration.

And MIT Sloan professor John J. Horton notes that several factors have to be in place for a human-AI interaction to be worthwhile . He recommends that leaders consider four points before swapping in AI for human labor: how much time the task will take without assistance, how much the employee performing a task is paid, whether AI is capable of performing the task correctly, and how easy it is for humans to determine whether the AI output is accurate. 

Generative AI could also help people get hired.  Job applicants who were randomly assigned algorithmic assistance with their resumes — such as suggestions to improve spelling and grammar — were 8% more likely to be hired, according to an experiment conducted by Horton, MIT Sloan PhD student Emma van Inwegen, and MIT Sloan PhD student Zanele Munyikwa.

“If you take two identical workers with the same skills and background, the one with the better-written resume is more likely to get hired,” van Inwegen said. “The takeaway is that employers actually care about the writing in the resume — it’s not just a correlation.” That means that AI assistance can be a useful tool for those hoping to get hired, she said.

Using AI to the best advantage

It’s time for everyone in your organization to understand generative AI , according to MIT Sloan senior lecturer George Westerman. In a webinar, he outlined early use cases, such as summarizing documents, creating personalized shopping experiments, and writing code. Generative AI is the latest in a line of advanced analytics tools, he noted, which vary in how much data and domain expertise is needed to use them, whether their results are repeatable, and how easy it is to understand how they generate results.

For businesses, using work generated by AI will depend in part on how consumers perceive that work . With this in mind, MIT Sloan senior lecturer and research scientist Renee Richardson Gosline and Yunhao Zhang SM ’20, PhD ’23, a postdoctoral fellow at the Psychology of Technology Institute, studied how people perceive work created by generative AI, humans, or some combination of the two.

They found that when people knew a product’s source, they expressed a positive bias toward content created by humans. Yet at the same time, and contrary to the traditional idea of “algorithmic aversion,” people did not express a negative bias toward AI-generated content when they knew how it was created. In fact, when respondents were not told how content was created, they preferred AI-generated content.

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Users can make the most of generative AI by using it in concert with external tools to answer complex questions and execute actions. MIT Sloan professor of the practice Rama Ramakrishnan looked at how to use ChatGPT as an agent to do things like search the web, order groceries, purchase plane tickets, or send emails.

And businesses that find success with generative AI will also harness human-centric capabilities , such as creativity, curiosity, and compassion, according to MIT Sloan senior lecturer Paul McDonagh-Smith. The key is figuring out how humans and machines can best work together, resulting in humans’ abilities being multiplied, rather than divided, by machines’ capabilities, McDonagh-Smith said during a webinar.

It’s time to talk about how to rechart the course of technology so it complements human capabilities , according to MIT economists Daron Acemoglu and Simon Johnson. In their new book, “Power and Progress: Our Thousand-Year Struggle Over Technology and Prosperity,” they decry the economic and social damage caused by the concentrated power of business and show how the tremendous computing advances of the past half century can become empowering and democratizing tools.

“Society and its powerful gatekeepers need to stop being mesmerized by tech billionaires and their agenda,” they write in an excerpt from the book. “Debates on new technology ought to center not just on the brilliance of new products and algorithms but also on whether they are working for the people or against the people.”

In a policy memo co-authored with MIT professor David Autor, Acemoglu and Johnson suggested five policies that could steer AI implementation  in a direction that complements humans and augments their skills. These include equalizing tax rates on employing workers and owning equipment or algorithms, updating Occupational Safety and Health Administration rules to create safeguards against worker surveillance, and creating an AI center of expertise within government.

When President Joe Biden issued an executive order in October on AI safety and security, one part of it addressed using content labels to identify content generated by artificial intelligence . A new working paper co-authored by MIT Sloan professor David Rand looked at the right terms to use for those labels. The researchers found that people associated certain terms, such as “AI generated” and “AI manipulated,” most closely with content created using AI. Conversely, the labels “deepfake” and “manipulated” were most associated with  misleading  content, whether AI created it or not.

Read next: Study finds industry now dominates AI research 

The book cover of "Unmasking AI" -  an illustration of a person of color holding a white mask

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    Clinical Research. The published homeopathic clinical trial and meta-analysis review was very detailed (as many as 80 studies were reviewed). Results varied, and the following observations were extensively discussed during the course of the conference: (i) homeopathic research requires more rigorous trials; (ii) clinical studies on asthma, allergies and other respiratory pathologies yielded ...

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    Homeopathy is a therapeutic method using preparations of substances whose effects when administered to healthy subjects correspond to the manifestations of the disorder (symptoms, clinical signs, pathological states) in the individual patient. The method was developed by Samuel Hahnemann (1755-1843) and is now practised throughout the world [ 1 ].

  4. Homeopathy

    Private and institutionalised patients' use of homeopathy in the early nineteenth century. Silvia Waisse. November 2017 ... an international cooperative research project. Edited by Leoni Bonamin, Paolo Bellavite. 3 November 2017 ... Resources for authors Track your accepted paper Journal Finder Researcher Academy Rights and permissions Journal ...

  5. Case Reporting in Homeopathy—An Overview of Guidelines and Scientific

    Since homeopathic practitioners play an essential role in homeopathy research, they should be trained from the start in reporting cases properly and in critical thinking as applied to case taking and decision making. ... Teut M. Scientific case studies in homoeopathy Paper presented at: New Directions in Homeopathy Research—Advice from an ...

  6. Research on homeopathy: state of the art

    In this paper, we review research on homeopathy from four perspectives, focusing on reviews and some landmark studies. These perspectives are laboratory studies, clinical trials, observational studies, and theoretical work. In laboratory models, numerous effects and anomalies have been reported.

  7. Efficacy of individualized homeopathy in bronchial asthma in adults

    Research evidence for of homeopathy in bronchial asthma is limited, with little research for all available forms of homeopathy - individualized (classical), complex, standardized (non-individualized), and isopathy (immunotherapy). ... The institution has no role to play in analysis of the study results and publication of the paper ...

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    Purpose In this systematic review we included clinical studies from 1800 until 2020 to evaluate evidence of the effectiveness of homeopathy on physical and mental conditions in patients during oncological treatment. Method In February 2021 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning use ...

  9. Evidence of clinical efficacy of homeopathy. A meta-analysis of

    Objective: To establish, using a systematic review and meta-analysis, whether there is any evidence from randomised controlled clinical trials of the efficacy of homeopathic treatment in patients with any disease. Data sources: Published and unpublished reports of controlled clinical trials available up to June 1998, identified by searching bibliographic databases (Medline, Embase, Biosis ...

  10. Free Full-Text

    Homeopathy is a popular, although highly debated, medicinal practice based on the administration of remedies in which active substances are so diluted that no detectable trace of them remains in the final product. This hypothesis paper aims to outline a possible reinterpretation of homeopathy in the light of psychological therapies in order to improve its clinical safety and sustainability.

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    Research Quotable Homeopathy Research image description More Research Resources Become a Member Today! NCH is your vital source for homeopathy information. We are stronger together and supporting NCH means that you are standing up for homeopathy and helping to make the world a healthier, happier place.

  12. The Efficacy of Homoeopathic Remedy: A Case Report of Adhesive

    Homoeopathy has also demonstrated great efficacy in curing symptoms and reducing severity of frozen shoulder. Adhesive capsulitis, also known as frozen shoulder, is a condition characterized by pain and stiffness of the shoulder joint. Frozen shoulder is more common in women, though it can also occur in men. It occurs mainly after 50 years of age.

  13. Homeopathy Research Papers

    Please find a list of research papers on Homeopathy you can search using the text search and filters, click for more.

  14. Journal of Integrated Standardized Homoeopathy

    The Journal of Integrated Standardized Homoeopathy (JISH) is an open access peer-reviewed journal committed to publishing high-quality articles, with the main aim to promote Evidence based Scientific Homoeopathy, by publishing original research papers in Homoeopathy, well documented evidence based case reports and papers demonstrating the application of Homoeopathy in different areas of ...

  15. Indian Journal of Research in Homoeopathy

    Indian Journal of Research in Homoeopathy, a publication of Central Council For Research In Homoeopathy, is a peer-reviewed online journal. Visit the Indian Journal of Research in Homoeopathy journal homepage to see the latest issue. At a Glance Top 10 Downloads All time Recent Additions 20 most recent additions Activity by year Paper of the Day

  16. Indian Journal of Research in Homoeopathy

    Indian Journal of Research in Homoeopathy (IJRH) with print ISSN: 0974-7168 and E-ISSN: 2320-7094 is an internationally acclaimed official publication of Central Council for Research in Homoeopathy, New Delhi, publishing quarterly in print as well as online.

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    Homeopathy for Allergic Rhinitis: A Systematic Review. The aim of this study was to evaluate the efficacy and effectiveness of homeopathic intervention in the treatment of seasonal or perennial allergic rhinitis (AR). Randomized controlled trials evaluating all forms of homeopathic treatment... more. Download.

  18. Indian Journal of Research in Homoeopathy

    The aim and objective of this study is to evaluate the extent of CS in heel pain; correlation of CS with some sociodemographic and health-related factors; and outcome of homoeopathic treatment over a period of 6 months. Methodology: It was a retrospective study done at Dr. Anjali Chatterjee Regional Research Institute for Homoeopathy, Kolkata.

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    Consult the top 50 dissertations / theses for your research on the topic 'Homoeopathy.' Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.

  20. Monetary Tightening, Commercial Real Estate Distress, and US Bank

    If CRE loan distress would manifest itself early in 2022 when interest rates were low, not a single bank would fail, even under our most pessimistic scenario. However, after more than $2 trillion decline in banks' asset values following the monetary tightening of 2022, additional 231 (482) banks with aggregate assets of $1 trillion ($1.4 ...

  21. Mathematical discoveries from program search with large ...

    Large Language Models (LLMs) have demonstrated tremendous capabilities in solving complex tasks, from quantitative reasoning to understanding natural language. However, LLMs sometimes suffer from ...

  22. PDF LLM in a flash Efficient Large Language Model Inference with Limited Memory

    documented in preceding research. The OPT 6.7B model, for instance, exhibits a notable 97% spar-sity within its FFN layer. Similarly, the Falcon 7B model has been adapted through fine-tuning, which involves swapping their activation functions to ReLU, resulting in 95% sparsity while being al-most similar in accuracy (Mirzadeh et al.,2023). In

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    Up to four times more researchers pump out more than 60 papers a year than less than a decade ago 1. Saudi Arabia and Thailand saw the sharpest uptick in the number of such scientists over the ...

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  26. More than 10k scientific papers were retracted in 2023

    Ok that's interesting - I haven't perused Pubpeer in detail recently and had sort of assumed that junk papers weren't much represented there, though to be honest, I'm not sure why I would have assumed that other than my focus on what are the much more interesting problematic papers discussed there.