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Purgar M, Glasziou P, Klanjscek T, Nakagawa S, Culina A. Supporting study registration to reduce research waste. Nat Ecol Evol 2024:10.1038/s41559-024-02433-5. [PMID: 38839851 DOI: 10.1038/s41559-024-02433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
An estimated 82-89% of ecological research and 85% of medical research has limited or no value to the end user because of various inefficiencies. We argue that registration and registered reports can enhance the quality and impact of ecological research. Drawing on evidence from other fields, chiefly medicine, we support our claim that registration can reduce research waste. However, increasing registration rates, quality and impact will be very slow without coordinated effort of funders, publishers and research institutions. We therefore call on them to facilitate the adoption of registration by providing adequate support. We outline several aspects to be considered when designing a registration system that would best serve the field of ecology. To further inform the development of such a system, we call for more research to identify the causes of low registration rates in ecology. We suggest short- and long-term actions to bolster registration and reduce research waste.
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Affiliation(s)
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | | | - Shinichi Nakagawa
- Evolution & Ecology Research Centre and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Theoretical Sciences Visiting Program, Okinawa Institute of Science and Technology Graduate University, Onna, Japan
| | - Antica Culina
- Ruđer Bošković Institute, Zagreb, Croatia.
- Netherlands Institute of Ecology, Royal Netherlands Academy of Arts and Sciences, Wageningen, the Netherlands.
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Leemhuis H, Seifert R. Prescriptions of homeopathic remedies at the expense of the German statutory health insurance from 1985 to 2021: scientific, legal and pharmacoeconomic analysis. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03005-x. [PMID: 38430230 DOI: 10.1007/s00210-024-03005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
The prescription of homeopathic remedies at the expense of the statutory health insurance (SHI) system in Germany has been criticized for years due to a lack of evidence. Now, on the planned abolition of the reimbursement of homeopathic medicines in Germany, the debate on this topic has been reignited. The aim of this paper is to show the costs and their development over time incurred by homeopathic remedies in the healthcare system from 1985 to 2021. For this purpose, 15 selected homeopathic medicines were chosen from the drug prescription report (Arzneiverordnungsreport) and analyzed with regard to their development of DDD (Defined Daily Dose) using data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Funds) and compared with their respective rational pharmacological alternatives. The price comparison was based on the DDD costs and the pharmacy retail price of the smallest packaging in each case. The clinical study situation for the preparations was also analyzed. For this purpose, the clinical studies provided by the manufacturer and those on PubMed were divided into evidence levels and analyzed. In addition, the presentation of homeopathic remedies on company websites, in online pharmacies, in specialist information and package leaflets was analyzed with regard to side effects, interactions, indication, and information on the alleged effect/proof of efficacy. In many media, information on homeopathic medicines remained incomplete, and non-compliance with the Therapeutic Product Advertising Act (Heilmittelwerbegesetz) was noted. Naming of the products if often very suggestive, too. Manufacturers' claims of efficacy go far beyond what can be considered proven in terms of evidence-based medicine and the quality of most clinical studies is poor. Homeopathic remedies are on average significantly more expensive than their rational pharmacological alternatives. Furthermore, DDD costs have continued to rise over the years analyzed. In aggregate, from a pharmacoeconomic, legal, and scientific perspective, abolition of reimbursement of homeopathic medicines in Germany at the expense of the SHI system is well justified.
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Affiliation(s)
- Hauke Leemhuis
- Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany
| | - Roland Seifert
- Institute of Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, D-30625, Hannover, Germany.
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Gaertner K, Ulbrich-Zürni S, Baumgartner S, Walach H, Frass M, Weiermayer P. Systematic reviews and meta-analyses in Homeopathy: Recommendations for summarising evidence from homeopathic intervention studies (Sum-HomIS recommendations). Complement Ther Med 2023; 79:102999. [PMID: 37898390 DOI: 10.1016/j.ctim.2023.102999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Mainly due to the use of different inclusion criteria and quality assessments, systematic reviews (SRs) and meta-analyses (MAs) with homeopathic intervention studies (HOMIS) have shown inconsistent results. We aimed to build recommendations for "Summarizing evidence from Homeopathic Intervention Studies" (Sum-HomIS recommendations) in order to approach standardization. METHODS Against the background of a framework-project to update the evidence from homeopathic intervention studies, we launched an expert panel on how to assess the quality of HOMIS and how to summarize evidence from HOMIS. The results of a literature review and the expert communications in advance of the panel as well as the consensus from the discussions are presented here. We added specific considerations for homeopathic veterinary research. RESULTS On top of the general guidelines when planning a review we report five basic Sum-HomIS recommendations. These are: 1) A broad literature search including special archives and consideration of so-called grey-literature; 2) The inclusion of controlled observational studies alongside randomized controlled trials; 3) The choice of a clear clinical research question in the terms that, if possible, the review project includes studies with predominantly homogeneous populations, interventions, comparators and outcomes (PICOs); 4) The use of a global quality assessment including the assessment of external, model and internal validity; 5) A summary of evidence using the GRADE-approach if the body of evidence is sufficiently large and homogenous or a descriptive summary if it is not so. CONCLUSIONS We present recommendations for designing, conducting, and reporting SRs and MAs with HOMIS.
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Affiliation(s)
- Katharina Gaertner
- Institute of Integrative Medicine, University of Witten/Herdecke, Gerhard-Kienle-Weg 4, DE-58313 Herdecke, Germany
| | - Susanne Ulbrich-Zürni
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany
| | - Stephan Baumgartner
- Institute of Complementary and Integrative Medicine IKIM, University of Bern, Freiburgstr. 46, CH-3010 Bern, Switzerland
| | - Harald Walach
- Next Society Institute, Kazimieras Simonavicius University, Vilnius, Lituania; Change Health Institute, Berlin, Germany
| | - Michael Frass
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany; em. Medical University of Vienna, Department of Medicine I, A-1090 Vienna, Austria; Institute for Homeopathic Research, Columbusgasse 20, A-1100 Vienna, Austria
| | - Petra Weiermayer
- WissHom: Scientific Society for Homeopathy, Wallstraße 48, DE-06366 Koethen, Germany.
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Perrier Q, Coste A, Diallo A, Guigui A, Khouri C, Roustit M. Relationship between the conflicts of interest and the results of meta-analyses of homoeopathy trials. BMJ Evid Based Med 2023; 28:426-427. [PMID: 37197896 DOI: 10.1136/bmjebm-2022-112228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Quentin Perrier
- University Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
| | - Agathe Coste
- University Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
- University Grenoble Alpes, HP2, Inserm U1300, Grenoble, France
| | - Aminata Diallo
- University Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
- University Grenoble Alpes, HP2, Inserm U1300, Grenoble, France
| | - Alicia Guigui
- University Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
- University Grenoble Alpes, HP2, Inserm U1300, Grenoble, France
| | - Charles Khouri
- University Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
- University Grenoble Alpes, HP2, Inserm U1300, Grenoble, France
| | - Matthieu Roustit
- University Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
- University Grenoble Alpes, HP2, Inserm U1300, Grenoble, France
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Hamre HJ, Glockmann A, von Ammon K, Riley DS, Kiene H. Efficacy of homoeopathic treatment: Systematic review of meta-analyses of randomised placebo-controlled homoeopathy trials for any indication. Syst Rev 2023; 12:191. [PMID: 37805577 PMCID: PMC10559431 DOI: 10.1186/s13643-023-02313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/08/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Since 1997, several meta-analyses (MAs) of placebo-controlled randomised efficacy trials of homoeopathy for any indication (PRETHAIs) have been published with different methods, results and conclusions. To date, a formal assessment of these MAs has not been performed. The main objective of this systematic review of MAs of PRETHAIs was to evaluate the efficacy of homoeopathic treatment. METHODS The inclusion criteria were as follows: MAs of PRETHAIs in humans; all ages, countries, settings, publication languages; and MAs published from 1 Jan. 1990 to 30 Apr. 2023. The exclusion criteria were as follows: systematic reviews without MAs; MAs restricted to age or gender groups, specific indications, or specific homoeopathic treatments; and MAs that did not assess efficacy. We searched 8 electronic databases up to 14 Dec. 2020, with an update search in 6 databases up to 30 April 2023. The primary outcome was the effect estimate for all included trials in each MA and after restricting the sample to trials with high methodological quality, according to predefined criteria. The risk of bias for each MA was assessed by the ROBIS (Risk Of Bias In Systematic reviews) tool. The quality of evidence was assessed by the GRADE framework. Statistical analyses were performed to determine the proportion of MAs showing a significant positive effect of homoeopathy vs. no significant difference. RESULTS Six MAs were included, covering individualised homoeopathy (I-HOM, n = 2), nonindividualised homoeopathy (NI-HOM, n = 1) and all homoeopathy types (ALL-HOM = I-HOM + NI-HOM, n = 3). The MAs comprised between 16 and 110 trials, and the included trials were published from 1943-2014. The median trial sample size ranged from 45 to 97 patients. The risk of bias (low/unclear/high) was rated as low for three MAs and high for three MAs. Effect estimates for all trials in each MA showed a significant positive effect of homoeopathy compared to placebo (5 of 5 MAs, no data in 1 MA). Sensitivity analyses with sample restriction to high-quality trials were available from 4 MAs; the effect remained significant in 3 of the MAs (2 MAs assessed ALL-HOM, 1 MA assessed I-HOM) and was no longer significant in 1 MA (which assessed NI-HOM). DISCUSSION The quality of evidence for positive effects of homoeopathy beyond placebo (high/moderate/low/very low) was high for I-HOM and moderate for ALL-HOM and NI-HOM. There was no support for the alternative hypothesis of no outcome difference between homoeopathy and placebo. The available MAs of PRETHAIs reveal significant positive effects of homoeopathy beyond placebo. This is in accordance with laboratory experiments showing partially replicable effects of homoeopathically potentised preparations in physico-chemical, in vitro, plant-based and animal-based test systems. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020209661. The protocol for this SR was finalised and submitted on 25 Nov. 2020 and registered on 26 Dec. 2020.
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Affiliation(s)
- H J Hamre
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany.
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany.
| | - A Glockmann
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany
| | - K von Ammon
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany
| | - D S Riley
- Maryland University of Integrative Health (MUIH), Laurel, MD, USA
- Homeopathic Pharmacopoeia Convention of the United States (HPCUS), Southeastern, PA, USA
| | - H Kiene
- Institute for Applied Epistemology and Medical Methodology at Witten/Herdecke University (IFAEMM), Freiburg, Germany
- Faculty of Health, Department of Medicine, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Witten/Herdecke University, Witten, Germany
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Zadey S. Yes to pluralistic health system, but no to homeopathy. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100172. [PMID: 37383360 PMCID: PMC10305988 DOI: 10.1016/j.lansea.2023.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/10/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Siddhesh Zadey
- Corresponding author. 215, Bajaj Nagar, Nagpur, Maharashtra 440010, India.
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Seven days in medicine: 9-15 March 2022. BMJ 2022; 376:o673. [PMID: 35301185 DOI: 10.1136/bmj.o673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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