Homeopathy – What does the evidence actually tell us?


homeopathy-820x550-2When faced with claims that Homeopathy works, then you might perhaps reply by citing a scientific study that demonstrates that it does not. If whoever you are conversing with is a practising homeopath, then this is not unfamiliar territory, and they in turn will have a similar scientific study that will soon be plucked out and waved back at you to demonstrate that it does actually work.

The thinking within the homeopathy community is that there exists a strong bias against homeopathy and that all the scientific studies that demonstrate it to be ineffective are flawed. As a contrast to that stance, those within the mainstream medicine field familiar with it all will comment that homeopaths are strongly biased against any evidence-based criticism because they are deeply invested in the concept both financially and also emotionally.

So who is right?

If those opposed have evidence-based studies that confirm their position, and those in favour also have evidence-based studies, then how can we possibly reach a meaningful conclusion?

The Cochrane Studies

Professor Edzard Ernst, formally the Professor of Complementary Medicine at the University of Exeter, the first such academic position in the world, has spent rather a lot of time looking into a vast assortment of various alternative medicines to discover what actually does and does not work. As a young doctor his life was a journey of discovery and as part of that process became a homeopath and practised at a homeopathy hospital in Munich.

He no longer practises Homeopathy and is now quite critical of it all, not because he has a mainstream bias, but instead because he followed the evidence and came to the conclusion that it really does not work.

So back to our question. How does he work out what is and is not viable evidence. When faced with a sea of apparently conflicting studies how does he determine which are good solid robust studies and which are fatally flawed?

A couple of weeks ago he was writing within the Spectator on this very topic and has a very interesting answer. He suggests that the Cochrane reviews are quite unique and well-positioned to address such conflicts. You don’t need to read all of the clinical studies one by one and assess each, they have done all the heavy lifting for you …

they follow an extremely rigorous peer-reviewed protocol; the studies they include are assessed in a standardised fashion; the review-authors have to justify why they exclude certain trials; the team of authors always includes experts from the subject in question (which means that reviews of homeopathy are conducted with the help of homeopaths); the extraction of the data is done in a transparent, standardised way; the reviews are carefully peer-reviewed and regularly updated; all reviews are freely accessible for everyone. 

Because of these features, there currently is a very broad consensus that, when it comes to judging the efficacy of medical interventions, Cochrane reviews are the best evidence available.

Now that is indeed a very sensible approach.

OK, so what do the Cochrane reviews tell us about Homeopathy?

Currently there are seven reviews that investigate the deployment of Homeopathy for the treatment of specific conditions, and here via Professor Edzard Ernst is a summary all seven with links to each that can be checked …

Does homeopathy work for asthma?
Six trials with a total of 556 people were included. The authors concluded that ‘there is not enough evidence to reliably assess the possible role of homeopathy in asthma.’

Does homeopathy work for dementia?
There were no studies that could be included and the authors concluded that ‘in view of the absence of evidence it is not possible to comment on the use of homeopathy in treating dementia’.

Does homeopathy work for the induction of labour?
Two trials, involving 133 women, were included. The authors concluded that ‘there is insufficient evidence to recommend the use of homoeopathy as a method of induction’.

Does homeopathy work for ADHD?
Four studies with a total of 168 patients were eligible for inclusion. The authors concluded that ‘there is currently little evidence for the efficacy of homeopathy for the treatment of ADHD’.

Does homeopathy alleviate the adverse effects of cancer treatments? 
Eight controlled trials with a total of 664 participants met the inclusion criteria. The authors concluded that ‘this review found preliminary data in support of the efficacy of topical calendula for prophylaxis of acute dermatitis during radiotherapy and Traumeel S mouthwash in the treatment of chemotherapy-induced stomatitis. These trials need replicating. There is no convincing evidence for the efficacy of homeopathic medicines for other adverse effects of cancer treatments.’

Does homeopathy work for irritable bowel syndrome? 
Three RCTs with a total of 213 participants were included. The authors concluded that ‘a pooled analysis of two small studies suggests a possible benefit for clinical homeopathy, using the remedy asafoetida, over placebo for people with constipation-predominant IBS. These results should be interpreted with caution due to the low quality of reporting in these trials, high or unknown risk of bias, short-term follow-up, and sparse data. One small study found no statistically significant difference between individualised homeopathy and usual care (defined as high doses of dicyclomine hydrochloride, faecal bulking agents and diet sheets advising a high fibre diet). No conclusions can be drawn from this study due to the low number of participants and the high risk of bias in this trial. In addition, it is likely that usual care has changed since this trial was conducted.’

Does homeopathic Oscillococcinum work for influenza?
The authors included six studies: two prophylaxis trials (327 young to middle-aged adults in Russia) and four treatment trials (1,196 teenagers and adults in France and Germany). They concluded that ‘there is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum in the prevention or treatment of influenza and influenza-like illness’.

In general, no Homeopathy does not work.

Oh but wait, what was that observations from Number 5 above that reads “this review found preliminary data in support of the efficacy of topical calendula for prophylaxis of acute dermatitis during radiotherapy and Traumeel S mouthwash in the treatment of chemotherapy-induced stomatitis”. There they looked at a total of eight trials …

  • 2 of the 8 appear to show some benefit … but, here is the catch … the homeopathy remedies deployed were not the usual highly diluted remedies, hence did actually contain some active molecules that might do something.

What exactly is Homeopathy?

If you are not familiar with the topic of Homeopathy, they it is well worth understanding what it actually is. Some might view it as a variation of herbal medicine, but that is simply not correct.

The idea, dreamed up by Samuel Hahnemann in 1796, is that like cures like. It is basically an extremely diluted remedy and this is on a logarithmic scale. A typical remedy can be as “potent” as 30C or might even be 100C, so what does that mean?

Take 1 part of the ingredient, add 100 parts of water, and then vigorously shake by 10 hard strikes against an elastic body. This is called “succession”. This is 1C. Now take 1 part of the 1C and add 100 parts of water, do the same and you have 2C.  Keep repeating until you get to 30C.

The claim also is that a solution that is more dilute is described as having a higher potency, and so these more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies.

To help you wrap your head around this, a 12C solution is equivalent to a “pinch of salt in both the North and South Atlantic Oceans”.  13C is one drop of that diluted in all the water on the planet.

In other words, by the time you get to 30C what you are given contains no active ingredients at all. What is of course bizarre is that this remedy is supposed to be magically infused with the property of the ingredient that you started with and to have somehow “forgotten” all about anything and everything else that ever came into contact with it. (Hint: the secret of plumbing is that it’s not all water).

If you are now beginning to think, “But that’s absurd” then you are beginning to get it, because this is indeed pseudoscientific nonsense and all you actually have is a placebo. This is not about some herbal remedy that just might do something, instead it is more or less magical thinking.

Is it just Professor Edzard Ernst opposed to it?

Not at all, amongst the many reputable organisations taking a stand against it you will find …

In the end if you do truly feel that it really is effective and does work, then your challenge is not to convince me, but instead is to convince medical subject matter experts who dedicate their lives to finding the most effective treatments available.

Links

The Wikipedia page on Homeopathy gives you a good comprehensive overview of the topic in great detail.

It is of course a topic that leads to some heated debate and so the Homeopathy Wikipedia page is controversial. For an insight into how the current stance taken by that page has been reached you may find that the associated Talk: page quite interesting. There they lay out their policy.

Leave a Reply