This article by Robert Medhurst, is reproduced with kind permission from the Journal of the Australian Traditional Medicine Society.
Reference: Medhurst R. Homeopathy works. JATMS 2009 15(3) 163-165.
Evidence for Homeopathy: Homeopathy Works
by Robert Medhurst
Several weeks ago, Dr Simon Singh, UK author and science journalist, was in Adelaide for the Festival of Ideas and to promote his book, Trick or Treatment: Alternative Medicine on Trial, which is a supposed analysis of ‘alternative medicine’. Singh received a lot of attention in both the print and electronic media and, among other things, was widely quoted as saying that homœopathy doesn’t work(1).
Regular readers of this journal may recall that previous issues have carried articles confirming that homœopathy does, in fact, work. Unfortunately, none of the many people who interviewed Singh while he was in Australia bothered to verify his statements, so his remarks on homœopathy went unchallenged.
Since that time I, and others involved in homœopathic teaching and the homœopathic industry, have received requests from patients and practitioners to respond to Singh’s statements. This has been done in abundance but these responses failed to receive any mention in the media. It was also suggested that a brief document be produced for those who prescribe homœopathic medicines to help them to succinctly convey and confirm to their patients the efficacy of homœopathy. An attempt to do so follows.
One of the most obvious issues that needs addressing is that those who take the view that homœopathy doesn’t work usually have little or no exposure to the modality, either as a user or a prescriber. Another is that those in the orthodox medical profession who claim that homœopathy should be abandoned due to a lack of evidence, seem to be oblivious to the fact that only 10%–20% of conventional medical practices are validated by appropriate evidence(2).
The main argument against homœopathy appears to be, ‘I don’t understand how it can work therefore it can’t work.’ For many who take this position, no amount of properly conducted research showing clearly that it does work will convince them otherwise. Plainly, this is intellectually dishonest.
Some people also take the view that homœopathy can’t work because there’s no scientific basis for its activity. The only problem with this view is that it assumes that the body of science that’s been accumulated to date is fixed and will never be added to, and that there’ll be no new discoveries of fact, observation or mechanism. It also assumes that there’s no evidence for a mechanism that either partly or fully explains the action of homœopathics. Such evidence does exist and is easy to find (3,4) but even if this wasn’t the case, an absence of evidence does not constitute evidence of absence.
A number of publications are cited by sceptics of homœopathy to support their views. The flagship publication is a review published in the Lancet entitled, ‘Are the clinical effects of homœopathy placebo effects?’(5) Here, after ultimately comparing eight trials on homœopathy with six on conventional medicine, Shang, et al boldly assert that homœopathy is no more effective than placebo. A cursory examination of this article reveals it to be dodgy in the extreme. To quote the authors of the study, ‘We assumed that the [positive] effects observed in placebo-controlled trials of homœopathy could be explained by a combination of methodological deficiencies and biased reporting.’
The article was riddled with methodological flaws and received widespread condemnation from academics and other experts in this field, including a denunciation by the Indian Health Minister, Prof. Chaturbhuj Nayak(6). Subsequent re-analysis of this article in fact found that homœopathy was more effective than placebo(7,8).
Another criticism levelled at homœopathy is that clinical trials haven’t been replicated. This isn’t strictly the case as replication has occurred in several areas but it’s true that more replication would be useful. The reason for a compar- atively low level of trial replications in this area is that, unlike pharmaceuticals, homœopathic medicines in most cases can’t be patented, and there’s little incentive to invest large amounts of money in clinical trials if the product sponsors can’t monopolise the results.
So is there any evidence that homœopathy works, and if so, what form does that evidence take? It’s important to bear in mind that critics of homœopathy confidently declare that there is no evidence for homœopathy. This is a long way from the truth of the matter and the evidence for the effectiveness of homœopathy is remarkably easy to find.
Meta-analyses
Below are systematic statistical analyses of existing trials that have met certain quality criteria and are carried out to determine if the research can show that a trend exists one way or the other.
Kleijnan et al in the BMJ report that, of the 105 clinical trials that met the reviewers’ quality criteria, 81 of those trials showed a positive effect for homœopathy(9).
Cucherat et al state, ‘There is some evidence that homœopathic treatments are more effective than placebo’(10). Sixteen studies were evaluated.
Barnes J et al on post-operative ileus “There is evidence that homœopathic treatment can reduce the duration of ileus after abdominal or gynaecological surgery’(11). Six studies were evaluated.
From Bornhoft et al, ‘Effectiveness of homœopathy can be supported by clinical evidence’. Seventy-four studies were evaluated(12).
Linde et al report, ‘Among the high quality studies, positive effects were reported 50% more often than negative effects.’ One-hundred and five studies were evaluated(13).
Mathie states, ‘The weight of evidence currently favours a positive treatment effect in eight [areas]: childhood diarrhoea, fibrositis, hayfever, influenza, pain (miscellaneous), side-effects of radio- or chemotherapy, sprains, and upper respiratory tract infections.’ Ninety-three studies were evaluated(14).
On a meta-analysis for the homœopathic medicine, Galphimia glauca, for hayfever, Wiesenauer et al state, ‘A significant superiority of Galphimia glauca over placebo is demonstrated. Estimates of verum success rates are comparable with those of conventional antihistaminics, but no side-effects occurred.’ Eleven studies were evaluated(15)
Witt et al report, ‘Even experiments with a high methodological standard could demonstrate an effect of high potencies.’ Seventy-five studies were evaluated(16).
Evidence for homeopathy: Cohort studies
These are observational studies analysing quality of life, clinical, or other outcomes that have come about as a result of a specific intervention.
A study by Spence et al found that of 6,544 consecutive UK NHS patients treated with homœopathy, 70.7% reported positive health changes, with 50.7% recording their improvement as better or much better(17).
Witt et al found that of 3,981 patients seen in Swiss and German medical clinics practising homœopathy, and who were treated with homœopathy, patient and physician scores for clinical outcomes found that disease severity decreased significantly (p<0.001) between baseline and 24 months (adults from 6.2+/- 1.7 to 3.0+/-2.2; children from 6.1+/-1.8 to 2.2+/- 1.9)(18).
In another study by Witt et al of 3,709 patients seen in Swiss and German medical clinics practising homœopathy, and who were treated with homœopathy, patient and physician scores for clinical outcomes found that disease severity decreased significantly (p<0.001) between baseline, two, and eight years (adults from 6.2+/-1.7 to 2.9+/-2.2 and 2.7+/-2.1; children from 6.1+/-1.8 to 2.1+/-2.0 and 1.7+/-1.9). These effects persisted for as long as eight years(19).
Marian et al in a 2008 study found that, ‘Overall patient satisfaction was significantly higher in homœopathic than in conventional care. Homœopathic treatments were perceived as a low- risk therapy with two to three times fewer side-effects than conventional care.’ Three-thousand and twenty- six patients were involved in this study(20).
A study by Van Wassenhoven et al found that, ‘Patients were very satisfied with their homœopathic treatment, both they and their physicians recorded significant improvement. Costs of homœopathic treatment were significantly lower than conventional treatment, and many previously prescribed drugs were discontinued.’ Seven-hundred and eighty-two patients were involved in this study(21).
It may be useful to note that these studies are only five out of a larger number of cohort studies that have been carried out in this area. These five involve responses to the treatment of over 17,000 people suffering from various forms of illness. A statistically significant majority of these people experienced a beneficial outcome from homœopathic treatment. If we are to believe the critics of homœopathy, these people are either liars or deluded.
Veterinary studies
Albrecht et al found that, in the treatment of 1,440 piglets, ‘Homœopathic metaphylaxis is significantly effective compared with placebo and routine low- dose antibiotic metaphylaxis for incidence of disease and rate of disease of the respiratory tract among the animals studied(22).
On the treatment of Salmonella infection in poultry, Berchieri et al found that when 180 one-day-old chicks were given either an active homœopathic medicine or control and then challenged with a culture of Salmonella, ‘Birds receiving active treatment were less likely to grow the strain of Salmonella from cloacal swabs compared to control’(23).
Bertani et al, treating oedema in 307 rats with either a homœopathic medicine or control, found that homœopathy significantly reduced oedema in comparison to controls(24).
From Cazin et al, six groups of 30 mice given radio- labelled arsenic were treated with various homœopathic potencies of arsenic and the level of retention was compared to controls. All homœopathic potencies of arsenic were found to have a greater effect on arsenic elimination than controls(25). From Datta et al, the authors found that pre- and post- feeding of homœopathically prepared Arsenicum album 30C and 200C to mice exposed to arsenic tri- oxide reduced the genotoxic effects (chromosome aberrations, micronucleated erythrocytes and sperm head anomaly) of arsenic when compared to controls(26).
Evidence for Homeopathy: Human studies
There are a large number of high-quality randomised controlled human clinical trials that have been carried out using homœopathy. Lack of space precludes listing these but again, they’re easy to find either on Medline(27), websites operated by institutions such as the Glasgow Homœopathic Hospital(28), websites that carry material on this subject such as Homeopathic Doctor(29), and Nutrition Matters(30), or previous editions of this journal.
A good example of the kind of work undertaken was carried out by David Reilly and published in the Lancet in 1994(31). Reilly and others conducted a placebo-controlled randomised trial looking at the use of homœopathic medicines with 28 patients diagnosed with allergic asthma. Homœopathy proved superior to placebo and the trial was so well-designed and conducted that the editors of the Lancet commented that, ‘Either there is something amiss with the clinical trial as conventionally conducted, or the effects of homœopathic immunotherapy differ from those of placebo… carefully done work of this sort should not be denied the attention of Lancet readers’(32).
Does homœopathy work? Two-hundred and thirteen continuous years of use and growth throughout Europe, and more than 100 years of continuous use in the USA, India, Australia and most other parts of the world, to the point where it’s the world’s second most popular system of healthcare(33); numerous positive clinical and in-vitro trials; and millions of satisfied users; would tend to indicate that it does.
Evidence for Homeopathy: References
(1) Shepherd T. Simon Singh warns of ‘quack cures’. The Advertiser, 3 July 2009.
(2) Fluhrer J. Integrative practice overview. Complementary Medicine, July/August 2002:33–35.
(3) Endler PC, Schulte J. Ultra high dilution: physiology and physics. Dordrecht: Kluwer Academic Publishers, 1994.
(4) Homeopathy, July 2007;96:141–230.
(5) Shang A, Huwiler-Mûntener K, et al. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-con- trolled trials of homeopathy and allopathy. Lancet 2005;366:726–32.
(6) Nayak C, Director, Central Council for Research in Homoeopathy, Ministry of Health and Family Welfare, New Delhi, India. Letter to the editor. The Telegraph, Calcutta, India,12 September 2005.
(7) Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. Journal of Clinical Epidemiology 2008.
(8) Rutten ALB, Stolper CF. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy 2008;97:169–177.
(9) Kleijnen J et al. Clinical trials of homeopathy. British Medical Journal 1991;302:316–323.
(10) Cucherat M et al. Evidence of clinical efficacy of homeopathy. a meta-analysis of clinical trials. European Journal of Clinical Pharmacology 2000;56:27.
(11) Barnes J et al. Homeopathy for post operative ileus: a meta-analy- sis. Biomedical Therapy 1999;17(2):65–70.
(12) Bornhoft et al. Effectiveness, safety and cost-effectiveness of homeopathy in general practice: summarized health technology assessment. Forsch Komplementarmed. 2006;13 Suppl 2:19–29.
(13) Linde K et al. Critical review and meta-analysis of serially agitat- ed dilutions in experimental toxicology. Human & Experimental Toxicology 1994;13(7):481–492.
(14) Mathie RT. The research evidence base for homeopathy: a fresh assessment of the literature. Homeopathy 2003;92:84–91.
(15) Wiesenauer M et al. A meta-analysis of homeopathic treatment of pollinosis with Galphimia glauca. Wiener Medizinische Wochenschrift 1997;147(14):323–7.
(16) Witt CM et al. The in vitro evidence for an effect of high homeopathic potencies: a systematic review of the literature. Complementary Therapies in Medicine 2007;15(2):128–38.
(17) Spence DS et al. Homeopathic treatment for chronic disease: a 6- year, university-hospital outpatient observational study. Journal of Alternative and Complementary Medicine 2005;11(5):793–8.
(18) Witt CM et al. Homeopathic medical practice: long-term results of a cohort study with 3981 patients. BMC Public Health 2005;5:115.
(19) Witt CM et al. How healthy are chronically ill patients after eight years of homeopathic treatment? Results from a long term observational study. BMC Public Health 2008;8:413.
(20) Marian F et al. Patient satisfaction and side effects in primary care: an observational study comparing homeopathy and conventional medicine. BMC Complementary and Alternative Medicine 2008;8:52.
(21) Van Wassenhoven M et al. An observational study of patients receiving homeopathic treatment. Homeopathy 2004;93(1):3–11.
(22) Albrecht H et al. Homeopathy versus antibiotics in metaphylaxis of infectious diseases: a clinical study in pig fattening and its significance to consumers. Alternative Therapies in Health and Medicine 1999;5(5):64–8.
(23) Berchieri A Jr et al. Evaluation of isopathic treatment of Salmonella enteritidis in poultry. Homeopathy 2006;95(2):94–7.
(24) Bertani S, et al. Dual effects of a homeopathic mineral complex on carrageenan-induced oedema in rats. The British Homoeopathic Journal 1999;88(3):101–5.
(25) Cazin JC et al. A study of the effect of decimal and centesimal dilutions of arsenic on the retention and mobilization of arsenic in the rat. Human Toxicology 1987;6(4):315-20.
(26) Datta S et al. Efficacy of a potentized homoeopathic drug (Arsenicum Album-30) in reducing genotoxic effects produced by arsenic trioxide in mice: comparative studies of pre-, post- and combined pre- and post-oral administration and comparative efficacy of two microdoses. Complementary Therapies in Medicine 1999 Jun;7(2):62–75.
(27) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed. (28) http://www.adhom.com/adh_download/EVIDENCE_9.0_Sept_06.pdf.
(29) http://www.homeopathicdoctor.ca/reference/proof.pdf
(30) http://www.nutrition-matters.co.uk/misc/homeopathy.htm.
(31) Reilly D et al. Is evidence for homoeopathy reproducible? Lancet 1994;344(8937):1601–1606.
(32) Lancet 1994;344(8937):1585.
(33) Kemper KJ. Homeopathy in paediatrics: no harm likely but how much good? Contemporary Pediatrics 2003;20(5):97–111.
