Pediatr Infect Dis J, 2003;22:229–34
Copyright © 2003 by Lippincott Williams & Wilkins, Inc.
Vol. 22, No. 3
Printed in U.S.A.
Homeopathy for childhood diarrhea: combined
results and metaanalysis from three
randomized, controlled clinical trials
JENNIFER JACOBS, MD, MPH, WAYNE B. JONAS, MD, MARGARITA JIME´NEZ-PE´REZ, MD, PHD AND
DEAN CROTHERS, MD
Background. Previous studies have shown a
positive treatment effect of individualized ho-
meopathic treatment for acute childhood diar-
rhea, but sample sizes were small and results
were just at or near the level of statistical signif-
icance. Because all three studies followed the
same basic study design, the combined data from
these three studies were analyzed to obtain
greater statistical power.
Methods. Three double blind clinical trials of
diarrhea in 242 children ages 6 months to 5 years
were analyzed as 1 group. Children were ran-
domized to receive either an individualized ho-
meopathic medicine or placebo to be taken as a
single dose after each unformed stool for 5 days.
Parents recorded daily stools on diary cards, and
health workers made home visits daily to moni-
tor children. The duration of diarrhea was de-
fined as the time until there were less than 3
unformed stools per day for 2 consecutive days. A
metaanalysis of the effect-size difference of the
three studies was also conducted.
Results. Combined analysis shows a duration
of diarrhea of 3.3 days in the homeopathy group
compared with 4.1 in the placebo group (P ?
0.008). The metaanalysis shows a consistent ef-
fect-size difference of ?0.66 day (P ? 0.008).
Conclusions. The results from these studies
confirm that individualized homeopathic treat-
ment decreases the duration of acute childhood
diarrhea and suggest that larger sample sizes be
used in future homeopathic research to ensure
adequate statistical power. Homeopathy should
be considered for use as an adjunct to oral rehy-
dration for this illness.
Worldwide, homeopathy is one of the most popular of
complementary and alternative therapies. Nearly 40%
of physicians in England refer for homeopathic treat-
ment and ?60% of the French public use homeopa-
thy.1, 2Although less than in Europe, the use of home-
opathy in the United States has increased 5-fold since
1990, most of it in the over-the-counter self-treatment
market.3, 4Based on the principle of similars, or “like
cures like,” homeopathy postulates that small doses of
a substance that can cause symptoms in a healthy
person can be used to cure similar symptoms of disease
in someone who is ill.
In addition to being popular, homeopathy is one of
the most controversial of the complementary and alter-
native therapies. This is largely because of the high
dilutions of the medicines used, often beyond Avo-
gadro’s number (10?23M).2A tenet in homeopathy is
that drugs retain selective activity when they are
diluted if they are applied according to specific homeo-
pathic selection principles.5The use of these dilutions
has led some to reject homeopathy altogether without
examining the clinical evidence of its effects.6Homeo-
pathic remedies are generic and therefore inexpensive,
available in bottles of 100 tablets for as little as $6 to $8
in many health food stores in the US.
A recent metaanalysis of 89 homeopathic clinical
trials found a combined odds ratio of 2.45 (95% confi-
dence interval, 2.05, 2.93) in favor of homeopathy.7The
authors concluded that the effects of homeopathy can-
not be explained entirely by placebo but that the small
number of studies precluded concluding that homeop-
athy is effective for any one condition. In most homeo-
pathic clinical trials, the sample sizes have been small.
In the metaanalysis mentioned above, 65% of studies
had fewer than 100 subjects, 29% had 100 to 200 and
only 6% had ?200 participants.7This leads one to
question whether there was adequate statistical power
Accepted for publication Nov. 22, 2002.
From the Department of Epidemiology, University of Wash-
ington School of Public Health and Community Medicine, Seattle,
WA (JJ); Samueli Institute for Information Biology, Alexandria,
VA and Corona de Mar, CA (WBJ); Uniformed Services Univer-
sity of the Health Sciences, Bethesda, MD (WBJ); Department of
Public Health, Health Sciences Center, University of Guadala-
jara, Guadalajara, Mexico (MJP); and Evergreen Center for
Homeopathic Medicine, Edmonds, WA (DC).
Key words: Homeopathy, childhood diarrhea, complementary
and alternative medicine.
Address for reprints: Jennifer Jacobs, M.D., M.P.H., 23200
Edmonds Way, Edmonds, WA 98026. Fax 425-771-4789; E-mail
trial in Nepal. J Altern Complem Med 2000;6:131–9.
13. Bern C, Martines J, de Zoysa I, Glass RI. The magnitude of
the global problem of diarrhoeal disease: a ten-year update.
Bull World Health Organ 1992;70:705–14.
14. Anonymous. Oral rehydration therapy for childhood diar-
rhea. Popul Rep L 1980;8:41-l75.
15. Ladinsky M, Lehmann H, Santosham M. The cost effective-
ness of oral rehydration therapy for US children with acute
diarrhea. Med Interface 1996;9:113–9.
16. Richard L, Claeson M, Pierce NF. Management of acute
diarrhea in children: lessons learned. Pediatr Infect Dis J
17. Feachem, RG. Preventing diarrhea: what are the policy
options? Health Policy Plan 1988;1:109–17.
18. Molla AM, Molla A, Nath SK, Khatun M. Food-based oral
rehydration salt solution for acute childhood diarrhoea. Lan-
19. Harris S, Black RE. How useful are pharmaceuticals in
managing diarrhoeal diseases in developing countries?
Health Policy Plan 1991;6:141–7.
20. Bhan MK. Current and future management of acute diar-
rhea. Int J Antimicrob Agents 2000;14:71–3.
21. Bhutta A, Bird SM, Black RE, et al. Therapeutic effects of
oral zinc in acute and persistant diarrhea; pooled analysis of
randomized clinical trials. Am J Clin Nutr 2000;72:1516–22.
22. Ericsson C, Johnson P, DuPont H, Morgan D, Bitsura J,
DeLaCabada F. Ciprofloxacin or trimethoprim-sulfamethox-
azole as initial therapy for traveler’s diarrhea. Ann Intern
species and other enteric pathogens among children less than 5
years of age in Nepal. J Clin Microbiol 1995;33:3058–60.
24. Homeopathic pharmacopoeia of the United States. Washing-
ton, DC: The Homeopathic Pharmacopoeia Convention of the
United States, 1988.
25. World Health Organization. Program for control of diarrheal
diseases: eighth program report, 1990–91 (WHO/CDD/92.38.).
26. Freiman JA, Chalmers TC, Smith H Jr, Kuebler RR. The
importance of beta, the type II error and sample size in the
design and interpretation of the randomized control trial:
survey of 71 negative trials. N Engl J Med 1978;299:690–4.
27. Cappelleri JC, Ioannidis JP, Schmid CH, et al. Large trials
vs. meta-analysis of smaller trials: how do their results
compare? [Comments]. JAMA 1996;276:1332–8.
28. Brown GW. Errors, types I and II. Am J Dis Child 1983;137:
29. Linde K, Jonas WB, Melchart D, Willich S. The methodological
quality of randomized controlled trials of homeopathy, herbal
medicines and acupuncture. Int J Epidemiol 2001;30:526–31.
30. Moerman DE. Cultural variations in the placebo effect:
ulcers, anxiety, and blood pressure. Med Anthropol Q 2000;
31. Sampson W, London W. Homeopathic treatment of childhood
diarrhea. Pediatrics 1995;96:961–4.
Pediatr Infect Dis J, 2003;22:234–9
Copyright © 2003 by Lippincott Williams & Wilkins, Inc.
Vol. 22, No. 3
Printed in U.S.A.
among Venezuelan infants during 1998 through
2001: anticipating rotavirus vaccines
IRENE PE´REZ-SCHAEL, MSC, MARISOL ESCALONA, MD, BELE´N SALINAS, MD, MERCEDES MATERA´N, MD,
MARI´A EGLEE´PE´REZ, PHD AND GERMA´N GONZA´LEZ, MSC
Background. The first licensed rotavirus vac-
cine was withdrawn from use in the United
States because of a low risk of intussusception.
Consequently tests of new rotavirus vaccines
will require some baseline knowledge of the
rates and treatment of intussusception in coun-
tries where these vaccines will be tested. There-
fore the objective of this study was to assess
hospitalization rates and describe the epidemio-
logic and clinical characteristics of intussuscep-
tion in Carabobo, Venezuela.
Methods. This study reviewed hospital data
and clinical records of pediatric patients with
intussusception admitted to eight hospitals in
Carabobo between January 1, 1998 and Decem-
ber 31, 2001.
Results. For the 4-year period the average an-
nual hospitalization rate for intussusception
among infants (<1 year old) in Carabobo was 35
per 100 000 infants per year (range, 22 to 44), and
intussusception was more common among boys
(58 per 100 000 infants per year) than girls (29 per
Accepted for publication Nov. 20, 2002.
From Instituto de Biomedicina-Fuvesin, Universidad Central
de Venezuela, Ministerio de Salud y Desarrollo Social (IPS) and
Centro de Estadı ´stica y Software Matema ´tico, CESMa, Departa-
mento de Co ´mputo Cientı ´fico y Estadı ´stica, Universidad Simo ´n
Bolı ´var (MEP), Caracas; and Departamento de Microbiologı ´a
(GG), Ciudad Hospitalaria “Dr. Enrique Tejera,” Insalud (ME,
BS, MM), Universidad de Carabobo, Valencia, Venezuela.
Key words: Intussusception rate, rotavirus disease, Venezue-
Address for reprints: Irene Pe ´rez-Schael, M.Sc., Instituto de
Biomedicina-Fuvesin, AP 4043, Carmelitas, Caracas 1010A, Ven-
ezuela. Fax 00-58-212-8641007; E-mail firstname.lastname@example.org
234 Vol. 22, No. 3, March 2003
THE PEDIATRIC INFECTIOUS DISEASE JOURNAL