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Table 1

The systematic review by Linde et al.[3] and its subsequent re-analyses.

ReferenceIncluded trials (number)Total patient numberAssessment of methodological qualityMeta-analysisOverall conclusion*Comment
Linde (1997) [3]All double-blind and/or randomized placebo-controlled trials of any clinical condition (n = 186)2588YesOf 89 trials which could be submitted to meta-analysis: OR = 2.45; of 26 ‘good quality trials’: OR = 1.66 (both in favour of homeopathy)Clinical effects of homeopathy are not completely due to placeboReview was criticised for 1) including different remedies 2) including different conditions 3) including nonrandomized trials
Ernst (1998) [4]All studies from Linde et al.[3] which received 90 (of 100) points in at least 1 of the 2 quality ratings, using highly dilute remedies, following the principles of ‘classical’° homeopathy (n = 5)587YesOR = 1.0 (no evidence in favour of homeopathy)Homeopathic remedies are associated with the same clinical effects as placeboThis analysis specifically tested the efficacy of highly diluted remedies (other remedies could still work via conventional pharmaceutical effects)
Linde (1998) [5]All trials from Linde et al.[3] which tested ‘classical’° homeopathic remedies against placebo, no treatment or another treatment (n = 32)1778Yes19 placebo-controlled trials were submitted to meta-analysis; OR = 1.62; however, when this analysis was restricted to the methodologically best trials the effect was no longer significantIndividualized homeopathy has an effect over placebo; the evidence, however, is not convincingNot all of the included trials were randomized and many had other serious methodological weaknesses
Linde (1999) [6]All trials from Linde et al.[3] which could be submitted to meta-analysis (n = 89)n.d.p.YesThe mean OR of the best studies was not in favour of homeopathyThere was clear evidence that studies with better methodological quality tended to yield less positive resultsThe authors felt that these results ‘weaken the findings of [their] original meta-analysis’
Morrison (2000) [7]26 trials classified by Linde et al.[3] as high quality (n = 26)n.d.p.YesNoneNo significant trend was seen when correlating security of randomization and trial resultLarge multicentre trials were recommended
Ernst (2000) [8]All trials from Linde et al.[3] that received quality ratings between 1 and 4 on the Jadad score (n = 77)n.d.p.YesNoneThere is a . . . strong linear correlation between OR and Jadad score (n = 0.97, P < 0.05); homeopathic remedies are, in fact, placebosExtrapolation from this correlation implies that the most rigorous studies yield an effect size of zero
Sterne (2001) [9]89 trials of Linde et al.[3] review compared with 89 trials of allopathic medicinesn.d.p.YesStrong evidence for publication bias causing a false positive result in favour of homeopathyWhen adjusting high quality trials [of homeopathy] for publication bias, the OR changed from 0.52 to 1.19 but remained unchanged for allopathyPaper probably not peer-reviewed, adjusting for bias nullified the effect of homeopathy but not for allopathy

RCT = randomized clinical trial, OR = odds ratio,

*= verbatim quotes, n.d.p. = no details provided.
°Classical homeopathy = approach where remedies are individualized according to patient characteristics deemed important by homeopaths.