Assessing the evidence base for homeopathy
A Health Technology Assessment report on homeopathy commissioned by the Swiss government, has concluded that homeopathy is clinically effective, cost-effective and safe.((‘Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs’ by Gudrun Bornhöft and Peter F. Matthiessen (Editors). 2011. ISBN 978-3-642-20637-5)) This HTA report exhaustively reviews the scientific literature and its unambiguous, positive conclusions have resulted in homeopathy being included on the list of medical treatments which are reimbursed through Switzerland’s national health insurance scheme. It summarises 22 reviews, 20 of which show positive results for homeopathy. Four of these showed strong evidence that homeopathy, as a system of medicine, is efficacious. It also finds strong supporting evidence for the homeopathic treatment of allergies and upper respiratory tract infections. The HTA methodology used is a cornerstone of the NIHR (National Institute of Health Research) strategy for assessing real-world effectiveness, safety and cost-effectiveness of therapeutic interventions for the NHS.
Randomised controlled trials
By 2010, 156 RCTs comparing homeopathy (covering 75 medical conditions) had been published in good quality journals. In terms of statistically significant results, 75 of these trials were able to draw firm conclusions: 64 were positive for homeopathy and eleven were negative.((British Homeopathic Association. http://www.britishhomeopathic.org/research/the_evidence_for_homeopathy.html [accessed, Apr 2012]))
Detractors of homeopathy continue to suggest that any beneficial effects of homeopathy are due to placebo alone. Over a period of 18 years Dr Reilly’s team at Glasgow University conducted four double-blind placebo controlled trials, specifically designed to examine the evidence for this placebo hypothesis. All four trials, involving a total of 252 patients, produced similar positive results, demonstrating that homeopathy has an effect greater than placebo and that these results are reproducible.((Taylor MA, Reilly D, Llewellyn-Jones RH, et al. Randomised controlled trials of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. Br Med J 2000; 321: 471–6)) As the trial design used is the same as that used to test conventional treatments, Reilly states that there are only two possible conclusions from these results – “either homeopathy works or the trial generates false positive results and is therefore not a useful tool for assessing any treatment – whether orthodox or homeopathic.”((Reilly D. The Evidence For Homeopathy, published by Adhom. Glasgow, http://www.adhom.com/2005)) ((Bornhöft G, Wolf U, Ammon K, et al. Effectiveness, safety and cost-effectiveness of homeopathy in general practice – summarized health technology assessment. Forsch Komplementärmed 2006; 13 Suppl 2: 19–29))
Evidence for specific conditions
Systematic reviews analysing results from several RCTs that investigated the homeopathic treatment of a given medical condition have reported positive conclusions in the following areas: ((British Homeopathic Association. http://www.britishhomeopathic.org/research/the_evidence_for_homeopathy.html [accessed, Apr 2012])) allergies and upper respiratory tract infections, ((Bornhöft G, Wolf U, Ammon K, et al. Effectiveness, safety and cost-effectiveness of homeopathy in general practice – summarized health technology assessment. Forsch Komplementärmed 2006; 13 Suppl 2: 19–29)) childhood diarrhoea, ((Jacobs J, Jonas WB, Jimenez-Perez M, Crothers D. Homeopathy for childhood diarrhea: combined results and metaanalysis from three randomized, controlled clinical trials. Pediatr Infect Dis J 2003; 22: 229–34)) influenza, ((Vickers A, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza like syndromes (Cochrane Review). In: The Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd. 2006; CD001957)) post-operative ileus((Barnes J, Resch K-L, Ernst E. Homeopathy for postoperative ileus? A meta-analysis. J Clin Gastroenterol 1997; 25: 628–33)), rheumatic diseases((Jonas WB, Linde K, Ramirez G. Homeopathy and rheumatic disease – Complementary and alternative therapies for rheumatic diseases II. Rheum Dis Clin North Am 2000; 26: 117–23)), seasonal allergic rhinitis ((Wiesenauer M, Lüdtke R. A meta-analysis of the homeopathic treatment of pollinosis with Galphimia glauca. Forsch Komplementärmed Klass Naturheilkd 1996; 3: 230–6))((Taylor MA, Reilly D, Llewellyn-Jones RH, et al. Randomised controlled trials of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. Br Med J 2000; 321: 471–6))((Bellavite P, Ortolani R, Pontarollo F, et al. Immunology and homeopathy. 4. Clinical studies – Part 2. eCAM 2006;3: 397–409)) and vertigo.((Schneider B, Klein P, Weiser M. Treatment of vertigo with a homeopathic complex remedy compared with usual treatments: a meta-analysis of clinical trials. Arzneimittelforschung 2005; 55: 23–9))
One of the above reviews included three double-blind clinical trials of diarrhoea in a total of 242 children aged 6 months to 5 years; the data from the three trials were analysed together.7 The results of this meta-analysis showed that the duration of acute childhood diarrhoea was reduced by individualised homeopathic treatment more than by placebo treatment, and that the results were highly significant (P=0.008).
Homeopathy in practice
A service evaluation at the Bristol Homeopathic Hospital recorded the outcome of homeopathic treatment in over 6,500 consecutive patients. In this study, carried out over a six-year period, 70% of patients reported an improvement in their health.((Spence D, Thompson E, Barron S. Homeopathic treatment for chronic disease: A 6-Year, university-hospital outpatient observational study. J Altern Complement Med 2005; 5:793-8.)) The best clinical results were seen in the treatment of children with eczema and asthma, and adults with inflammatory bowel disease, irritable bowel syndrome, menopausal problems and migraine. Other conditions which improved after homeopathic treatment included arthritis, depression and chronic fatigue syndrome.
A German study involving 493 patients seen in general practice found that treatment by a homeopath gave better outcomes than conventional treatment for similar costs.((Witt C, Keil T, Selim D, et al. Outcome and costs of homeopathic and conventional treatment strategies: a comparative cohort study in patients with chronic disorders. Complement Ther Med, 2005; 13: 79-86)) This study was commissioned by a German health insurance company to see whether they should continue to cover homeopathic treatment. The outcomes and costs of homeopathic and conventional treatment were compared in patients being treated for chronic conditions including headache, low back pain, depression, insomnia and sinusitis in adults, and atopic dermatitis, allergic rhinitis and asthma in children.
In the laboratory
75% of in vitro experiments have found that substances as dilute as homeopathic medicines have specific effects.((Witt CM, Bluth M, Albrecht H, et al. The in vitro evidence for an effect of high homeopathic potencies – a systematic review of the literature. Complement Ther Med, 2007; 15: 128–138)) For example, homeopathically-prepared thyroxine can slow down metamorphosis of tadpoles into frogs.((Endler PC, Heckmann C, Lauppert E, et al. The metamorphosis of amphibians and information of thyroxine. In: Schulte J, Endler PC (eds). Fundamental Research in Ultra High Dilution and Homoeopathy. Dordrecht: Kluwer Academic Publishers,1998)) These results were replicated by five separate laboratories in Austria and confirmed by the results of similar experiments carried out by an independent team in Brazil.((Guedes JR, Ferreira CM, Guimaraes HM et al. Homeopathically prepared dilution of Rana catesbeiana thyroid glands modifies its rate of metamorphosis. Homeopathy, 2004; 93:132–7)) The homeopathic thyroxine used was so highly diluted that you would not expect any molecules to be present.
It is frequently said that there is ‘no scientific evidence’ for homeopathy. Such a statement is incorrect for it ignores the positive research findings as outlined above. The homeopathic community welcomes more high quality research, however, to build on the existing evidence base.
For more information about homeopathy research please visit the Society of Homeopaths website at www.homeopathy-soh.org/research/
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