That's wrong. Ernst says
"And that’s it! Except for some snide remarks (copied below) in the discussion section of the article, this is all Hahn has to say about my publications on homeopathy"
In 1998, he [Ernst] selected 5 studies using highly diluted remedies from the original 89 and concluded that homeopathy has no effect [5].
In 2000, Ernst and Pittler [6] sought to invalidate the statistically significant superiority of homeopathy over placebo in the 10 studies with the highest Jadad score. The odds ratio, as presented by Linde et al. in 1999 [3], was 2.00 (1.37–2.91). The new argument was that the Jadad score and odds ratio in favor of homeopathy seemed to follow a straight line (in fact, it is asymptotic at both ends). Hence, Ernst and Pittler [6] claimed that the highest Jadad scores should theoretically show zero effect. This reasoning argued that the assumed data are more correct than the real data.
Two years later, Ernst [7] summarized the systematic reviews of homeopathy published in the wake of Linde’s first metaanalysis [2]. To support the view that homeopathy lacks effect, Ernst cited his own publications from 1998 and 2000 [5, 6]. He also presented Linde’s 2 follow-up reports [3, 4] as being further evidence that homeopathy equals placebo.But Hahn says in fact much more than what you have quoted above.Edzard Ernst's Overview
Edzard Ernst's review of the literature from 2002 (Br J Clin Pharmacol 2002; 54: 577-582) is, despite its title, not a meta-analysis but a review article.He refers to the various follow-ups and re-analyzes made by Linde's study in the Lancet from from 1997. No statistical weighting of the material has been done.What about Edzard Ernst's ability to value literature?
In aprevious blog,Icriticized Ernst for being tendentious.He has put in place systems to perform meta-analyzes of various alternative medicine therapies and for various reasons exclude 95-99% of the material.Although the remaining studies show that a treatment effect is statistically significant, he still dismisses it.He always finds a reason!And he follows that pattern here as well.
We will now see what Ernst says about Cucherat's analysis, which showed that the risk was only 0.4 out of ten thousand that homeopathy has no effect.Well, he writes that the authors did not think the evidence was particularly strong!There is "some evidence" but no more.That is a far too narrow conclusion, and Ernst should have understood.
Ernst has listed Linde's re-analysis from 1999 with the comment that "the best studies show no benefit for homeopathy".That's not true, because the best studies were 55% better than placebo.A wiser person had understood the statistical weakening is a result of stratification being driven as far as to 8 subgroups.If we instead stratified to 7 subgroups, the significance arose!I can assure you that serious epidemiologists would have drawn a completely different conclusion than the one Ernst makes here.As we discussed in the first blog, Linde's main issue is the sequential analysis, where all data show that homeopathyhasan effect.All calculations Jadad score, which is common practice to use the quality assessments, showed thewellthat homeopathy is effective.But Ernst presents Linde's re-analysis as essentially to the detriment of homeopathy, and that is false.
This is how Ernst treats a meta-analysis by WB Jonas (Rheum Dis Clin North Am 2000; 26: 117-123) which shows that homeopathy is twice as good as placebo in rheumatic diseases.The result was also well statistically assured.Well, he criticizes the evidence value of the meta-analysis because it has not been possible to demonstrate a sufficiently convincing effect in any specific rheumatic disease.When the result did not fit, Ernst thus changes the question from the original, which is whether homeopathy is better than placebo.
Ernst himself participates in three re-analyzes of Linde's material.In his first, which was a quick reply to Linde's study in the Lancet, he peeled off almost all the evidence that was available.Five (!) Studies where “classic” homeopathy was used in extremely high dilutions were studied without any effect being found.At a quick screening, I can not find the journalPerfusiononline so I can not comment on details of the study.However, it sounds like a strange journal to publish a study on homeopathy in.
Subsequently, in 2000, Ernst published a review of Linde's 89 studies and performed a linear regression of all studies with different quality measures (Jadad score) from 1 to 4 and concluded that homeopathy would have no effect on the best studies, ie with a Jadad -score of 5. Why Ernst did not conduct an analysis of the studies that had Jadad 5 from the beginning feels strange.Linde had done this himself the year before (in J Clin Epidemiol, see above).In fact, the very best studies showed a more powerful effect in favor of homeopathy than the second best studies.This is exactly what underlines an old statistical truth, namely that linear regressions can be misleading if you move outside the range on which the regression is based.
When you see a plot between Jadad score and odds ratio for homeopathy (Linde's re-analysis, Figure 1), the spread appears so large that I personally would never dare to extrapolate anything based on that connection.Of course, Ernst knew that, but he broke that rule to get his obvious point, namely - as always - that alternative medicine does not work.The conclusion of Ernst's review is also that the material does not provide "sound evidence" for the use of homeopathic medicines.
My conclusion is again that Ernst is tendentious.His article is said to be a "meta-analysis of meta-analyzes" but it is not a meta-analysis but a review article.He himself has carried out 3 re-analyzes of Linde's material but shows an obvious interest in overthrowing his results.What I myself have read, and which is referenced by Ernst, I find misinterpreted.The idea of linear regression is the most obvious attempt to deceive readers - it also generated an erroneous conclusion, and should therefore not have been included in the review article at all.
This is thus one review of the literature that Dan Larhammar refers to as "evidence" that homeopathy is "scam" (harsh words that should be avoided in scientific contexts).I think that Dan Larhammar should wash Ernst as a guideline for what is true and false in science.Articles by Edzard Ernst should generally be disregarded.He is so obviously biased that what he writes is not reliable.
