Research in Homeopathy, Homeopathy: the great debate

1. Homeopathy: the great debate

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Public demand for homeopathy continues to grow but, like all other forms of medicine, it must be able to demonstrate its effectiveness in order to be truly integrated into our healthcare system. The evidence for homeopathy continues to excite heated debate, much of which comes back to fundamental questions about how to measure effectiveness of a particular therapy or medicine.

Evidence Based Medicine (EBM) is the current vernacular, but what exactly is it and what does it mean for homeopathy? As described by Professor David Sackett in Teaching and Practising Evidence Based Medicine (see http://www.cche.net/usersguides/ebm.asp), it is the use of the best available evidence from research to inform the value-based decision making of individual patients who look to clinicians to give them guidance. However, this laudable goal is frequently subverted for very unscientific reasons, and EBM is claimed as a reason to abandon treatments which are appreciated and desired by patients or to dismiss treatments which a particular physician or manager just doesn't like.

Homeopathy has always been a controversial scientific clinical practice. The whole therapy was developed from a rigorous empirical method. The original idea of "like treats like" arose from the experimental use of a drug on a healthy person, and the therapy itself developed on the basis of two research methods that were ahead of their time. The first of these methods was what is known as a "proving". This is a qualitative research study observing and recording the experience of a group of healthy subjects who experimentally take a particular drug. Contemporary qualitative narrative-based methods are only recently becoming popular but are very similar to the techniques used in provings. The second method is that of the pragmatic, observational, clinical study. Such a research method is still at the heart of good reflective clinical practice.

So why has homeopathy remained so controversial if it has such a clear methodological basis? The answer is partly scientific and partly cultural. The mechanism of action of homeopathically prepared drugs has never been understood and the dominant biomolecular model finds the ultra-high dilutions used in homeopathy to be completely baffling, or even irrational. However, there are some striking findings emerging from research of ultra-high dilutions that are beginning to challenge the assumption that such substances cannot exert a biological effect. The cultural answer to the controversy is that homeopathy has always represented a professional challenge to the established practice of medicine. This is not the place to discuss that further.

Homeopathy, however, is still a scientific clinical practice and we present here the research evidence base to support it. All treatments are coming under review from three perspectives. Is it effective? Is it safe? Is it cost-effective? The research presented here presents the best current answers to those questions with regard to homeopathy.

It is fair to say that the meta-analyses (the "gold standard" of EBM) of homeopathy are pretty inconclusive. They don't present strong evidence in favour but they do in general present interesting evidence that supports claims of benefit greater than placebo. There is no doubt that further research is required and that the current meta-analyses do not provide sufficient information on which to base a decision about homeopathy in general. In the absence of clear, convincing meta-analyses, EBM then turns to good single randomised controlled trials, and here we have chosen several to present. EBM then looks to the experience of experts and the experience of patients, and again we have interesting results to present. It is completely unreasonable to claim that there is "no evidence" that homeopathy has a beneficial clinical effect.

There is an additional issue with homeopathic research, which is the matter of individualised treatments. This is not an insurmountable problem and we discuss it here, but the answers will lie in more and better designed clinical trials, with much greater funding support than has been available so far.

One of the appealing "side-effects" of homeopathy is that it challenges preconceptions and forces people to consider experience more carefully. In this regard, the issues of homeopathic research have highlighted some of the deficiencies of the EBM movement as it has been used in practice. Human beings are not diseases, and the over-reliance on the randomised controlled trial is leading to an overly disease-focused approach to medical care that significantly downplays the human factors. The difficulty a clinician faces with any research is in applying the results from highly selected groups of clinical trial volunteers to patients "in the real world". Many patients who present to the health services have more than one disease. Such a patient would never be accepted for a drug trial in conventional medicine. Many patients who present to the health services are too young, too old, (or too pregnant!) to be included in research studies. It is for this reason that clinical outcome studies - systematically recording clinical data in normal practice - are essential contributors to a growing evidence base in homeopathy.

If human beings are important in health care (both the individual patients and the individual carers), then the current methods are frequently insufficient to answer the question of which treatments will bring the greatest relief of suffering. The humanistic, individualised method of homeopathic medicine presents significant and healthy challenges to accepted clinical practice and to the dominant research methods. In this section we don't only present the evidence according to the EBM rules but we highlight the creative challenges that homeopathic research presents.

	1. Homeopathy: the great debate
Photograph Details	Public demand for homeopathy continues to grow but, like all other forms of medicine, it must be able to demonstrate its effectiveness in order to be truly integrated into our healthcare system. The evidence for homeopathy continues to excite heated debate, much of which comes back to fundamental questions about how to measure effectiveness of a particular therapy or medicine. Evidence Based Medicine (EBM) is the current vernacular, but what exactly is it and what does it mean for homeopathy? As described by Professor David Sackett in Teaching and Practising Evidence Based Medicine (see http://www.cche.net/usersguides/ebm.asp), it is the use of the best available evidence from research to inform the value-based decision making of individual patients who look to clinicians to give them guidance. However, this laudable goal is frequently subverted for very unscientific reasons, and EBM is claimed as a reason to abandon treatments which are appreciated and desired by patients or to dismiss treatments which a particular physician or manager just doesn't like. Homeopathy has always been a controversial scientific clinical practice. The whole therapy was developed from a rigorous empirical method. The original idea of "like treats like" arose from the experimental use of a drug on a healthy person, and the therapy itself developed on the basis of two research methods that were ahead of their time. The first of these methods was what is known as a "proving". This is a qualitative research study observing and recording the experience of a group of healthy subjects who experimentally take a particular drug. Contemporary qualitative narrative-based methods are only recently becoming popular but are very similar to the techniques used in provings. The second method is that of the pragmatic, observational, clinical study. Such a research method is still at the heart of good reflective clinical practice.	Table of contents Homeopathy: the great debate Clinical research in homeopathy Veterinary homeopathy Issues and controversies Mechanism of action Is homeopathy safe? Is homeopathy cost effective? BHA/Faculty’s research strategy References Research discussion forum C O N T A C T U S S I T E M A P H O M E
	So why has homeopathy remained so controversial if it has such a clear methodological basis? The answer is partly scientific and partly cultural. The mechanism of action of homeopathically prepared drugs has never been understood and the dominant biomolecular model finds the ultra-high dilutions used in homeopathy to be completely baffling, or even irrational. However, there are some striking findings emerging from research of ultra-high dilutions that are beginning to challenge the assumption that such substances cannot exert a biological effect. The cultural answer to the controversy is that homeopathy has always represented a professional challenge to the established practice of medicine. This is not the place to discuss that further. Homeopathy, however, is still a scientific clinical practice and we present here the research evidence base to support it. All treatments are coming under review from three perspectives. Is it effective? Is it safe? Is it cost-effective? The research presented here presents the best current answers to those questions with regard to homeopathy. It is fair to say that the meta-analyses (the "gold standard" of EBM) of homeopathy are pretty inconclusive. They don't present strong evidence in favour but they do in general present interesting evidence that supports claims of benefit greater than placebo. There is no doubt that further research is required and that the current meta-analyses do not provide sufficient information on which to base a decision about homeopathy in general. In the absence of clear, convincing meta-analyses, EBM then turns to good single randomised controlled trials, and here we have chosen several to present. EBM then looks to the experience of experts and the experience of patients, and again we have interesting results to present. It is completely unreasonable to claim that there is "no evidence" that homeopathy has a beneficial clinical effect. There is an additional issue with homeopathic research, which is the matter of individualised treatments. This is not an insurmountable problem and we discuss it here, but the answers will lie in more and better designed clinical trials, with much greater funding support than has been available so far. One of the appealing "side-effects" of homeopathy is that it challenges preconceptions and forces people to consider experience more carefully. In this regard, the issues of homeopathic research have highlighted some of the deficiencies of the EBM movement as it has been used in practice. Human beings are not diseases, and the over-reliance on the randomised controlled trial is leading to an overly disease-focused approach to medical care that significantly downplays the human factors. The difficulty a clinician faces with any research is in applying the results from highly selected groups of clinical trial volunteers to patients "in the real world". Many patients who present to the health services have more than one disease. Such a patient would never be accepted for a drug trial in conventional medicine. Many patients who present to the health services are too young, too old, (or too pregnant!) to be included in research studies. It is for this reason that clinical outcome studies - systematically recording clinical data in normal practice - are essential contributors to a growing evidence base in homeopathy. If human beings are important in health care (both the individual patients and the individual carers), then the current methods are frequently insufficient to answer the question of which treatments will bring the greatest relief of suffering. The humanistic, individualised method of homeopathic medicine presents significant and healthy challenges to accepted clinical practice and to the dominant research methods. In this section we don't only present the evidence according to the EBM rules but we highlight the creative challenges that homeopathic research presents.
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