Homeopathy

This is probably the most frequently quoted, completely inaccurate statement about homeopathy. Homeopathy research is a relatively new field, so it’s true to say that there are not a huge number of studies, but some evidence is very different from no evidence.

By the end of 2014, 189 randomised controlled trials of homeopathy on 100 different medical conditions had been published in peer-reviewed journals1. Of these, 104 papers were placebo-controlled and were eligible for detailed review.

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Many people believe that all high quality randomised controlled trials (RCT) testing homeopathy have been negative. This is untrue.

Below are examples of positive high quality RCTs and systematic reviews/meta-analyses testing various types of homeopathy.

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Science is a constantly evolving field and what the scientific establishment declares to be ‘impossible’ in one era, is often proved to be ‘fact’ in another.

To take just one famous example of medical U-turns, in 1982, when Dr Barry Marshall and Dr Robin Warren first put forward their theory that bacterial infection was an underlying cause of stomach ulclers, their idea was ridiculed.²

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Laboratory experiments have demonstrated that homeopathic medicines are not just sugar pills.

Critics of homeopathy point to the fact that homeopathic medicines are so highly diluted that there is ‘nothing in them’.

This comes from the fact that the liquids used to make some homeopathic medicines are diluted beyond the threshold known as Avogadros number (dilution 10-23). This means that the liquid is so highly diluted that you would not expect any molecules of the original substance to remain.

Researchers around the world are investigating the mechanism of action of these medicines, which is likely to be based in physics rather than chemistry. Although there are various theories being explored, as yet, we do not understand how homeopathic medicines work.

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It is frequently argued that homeopathic medicines are ‘just sugar pills’ that don’t contain any active ingredients, so any benefits patients report are due purely to the placebo effect i.e. people believe the pills are going to help and this belief alone triggers a healing response.

With any medical treatment there is likely to be some degree of ‘placebo effect’ and in this respect homeopathy is no different, but the theory that homeopathy’s effects are only a placebo response is not supported by the scientific evidence.

If homeopathy is really just a placebo effect, how does one explain:

1. The existence of positive high quality placebo-controlled trials?
2. Homeopathic medicines having effects in laboratory experiments?
3. The fact that homeopathy can work in animals?

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Some people take the position that public money should not be spent on homeopathy because “there is no proof that it works” or “tax-payers money shouldn’t be spent on placebos”.

How much is spent on homeopathy?
0ut of the total NHS budget of £100 billion a year, it spends £4 million (0.004%) on Homeopathy.¹

Approximately £4 million covers the whole service, from running the hospital departments to paying the doctors.¹ When considering value for money, it should be remembered that if patients were not treated with the NHS homeopathy service, they would have to be treated by other NHS departments using more expensive conventional drugs.

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¹Freedom of Information Act request to the Department of Health by the Faculty of Homeopathy. Cost was £11.89 million between 2005 and 2008.

Studies comparing the effectiveness of homeopathy and conventional medicine have shown that homeopathy can produce as good as, or even better results than conventional medicine.

Depression
A recent randomised placebo-controlled trial assessed the efficacy of individualised homeopathic treatment, and the efficacy of Fluoxetine (a.k.a Prozac), for moderate to severe depression in menopausal women.¹

Both treatments were found to be safe and to have an effect significantly different from placebo. Homeopathy caused greater clinical improvement in symptoms of depression than fluoxetine and also improved the patients’ menopausal symptoms, whereas fluoxetine did not.

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¹Macías-Cortés ED et al. Individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP study): a randomized, double-dummy, double-blind, placebo-controlled trial. PLoS One, 2015 ;10(3):e0118440

Only one study has compared the quality of homeopathy research with that of conventional medicine. Overall the homeopathy trials were found to be of higher quality than the conventional trials they were compared to.¹

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¹Shang A, Huwiler-Muntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet, 2005; 366: 726–32 | PubMed

By the ‘best studies’ people usually mean comprehensive systematic reviews, which analyse the results from all available randomised controlled trials (RCTs) on a given subject.

There have been 6 such studies on homeopathy:

Five were positive – suggesting that there was some evidence of an effect of homeopathy beyond placebo, but more high quality research would be needed to reach definitive conclusions^1,2,3,4,6
One was negative – concluding that homeopathy had no effect beyond placebo. ⁵

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References:
¹Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homeopathy. BMJ, 1991; 302: 960 | PubMed
²Linde K, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet, 1997; 350: 834–843 | PubMed
³Linde K, et al. Impact of study quality on outcome in placebo-controlled trials of homeopathy. Clin Epidemiol, 1999; 52: 631–636 | PubMed
⁴Cucherat M, Haugh M C, Gooch M, Boissel J P. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. J Clin Pharmacol, 2000; 56: 27–33 | PubMed
⁵Shang A, Huwiler-Muntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet, 2005; 366: 726–32 | PubMed

Homeopathy is based on the core principle that ‘like cures like’ i.e. a substance which can cause symptoms if taken in large doses, can be used in minute doses to treat similar symptoms.

The idea that a substance can be damaging in large amounts, but beneficial in small amounts is not new to science, in fact this concept (‘hormesis’) has been around for decades and is increasingly well documented in such fields as biology and toxicology.

There are even examples of ‘like cures like’ in conventional medicine, e.g.:

• Digitalis in high doses causes arrhythimias, but this drug is used routinely in low doses to treat this condition
• The stimulant amphetamine-based drug Ritalin is used to treat Attention Deficit Hyperactivity Disorder (ADHD)
• Small doses of allergens such as pollen are used to de-sensitise allergic patients.

However an important difference in homeopathy is that the medicinal doses given are so small that toxic side-effects are avoided.

Low potency homeopathic medicines (up to 12c or 24x potencies) will contain molecules of the original substance they are made from. For this reason, in most countries, remedies made from toxic substances are only available in higher potencies, from the ‘first safe dilution’ upwards.

It is the higher potencies, which do not contain molecules, which are most controversial as we do not yet understand their mechanism of action.

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Knowing how a medicine works has never been a pre-requisite for its use. Aspirin (acetylsalicylic acid) is one of the most widely used drugs in the world,¹ yet it was used for over 70 years before it’s mechanism of action was discovered in 1971.² The drug is still actively researched today, as it has numerous biological effects which are still not fully understood.³

Variations of acetylsalicylic acid have been used to treat pain and fevers since ancient times, beginning with preparations made from its natural forms – the leaves and bark of willow or poplar trees.¹

In 1899 an artificially synthesised form of the active ingredient passed clinical trials and the drug ‘aspirin’ as we know it today was launched.

Similarly, homeopathy has a long history of traditional use. This has led to our clinical understanding of what homeopathic medicines can do being ahead of our theoretical understanding of how these medicines have a biological effect.

Finding the mechanism of action of homeopathic medicines will be fascinating and many teams around the world are carrying out fundamental and basic research to investigate this important question.

References:
¹Norn S. et al. [From willow bark to acetylsalicylic acid].[Article in Danish]. Dan Medicinhist Arbog., 2009;37:79-98 | Abstract
²Bottling RM. Vane’s discovery of the mechanism of action of aspirin changed our understanding of its clinical pharmacology. Pharmacol Rep., 2010; 62(3):518-25 | Abstract | Full text
³Dr. Karsten Schrör, Head of the Institute of Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf. Medical News Today website Oct 2005

This is a commonly held belief, but in fact the situation is not nearly so clear cut.

Whether we are discussing conventional or homeopathic medicine, science is much more of a grey area than we might wish.

Analysis by the British Medical Journal’s (BMJ) Clinical Evidence¹ shows that just 11% of 3,000 commonly used NHS treatments are known to be beneficial:

The amount of research carried out in conventional medicine is vast compared with the relatively new field of homeopathy research, but when you look at the balance of evidence – the percentage of trials which are positive, negative or inconclusive – they are remarkably similar for the two disciplines.

Research must continue in all fields to help policy makers, patients and clinicians make the best possible decisions, but at the moment, many decisions cannot be based on scientific evidence, because there is just insufficient data.

References:
¹BMJ Clinical Evidence, Efficacy Categorisations. 2017. Available from http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html [Accessed 25 Sept 2017]

There are critics who claim that homeopathy is ‘pseudoscience’ and only non-scientists are interested in the subject.

In fact, scientists in highly respected universities, research institutions and hospitals around the world are carrying out research into homeopathy using the same research techniques as those used to investigate conventional medical treatments.

Homeopathy research is a relatively new field, but the number of articles published in peer reviewed journals has risen significantly over the past 40 years.

This lag behind conventional medicine is hardly surprising when one considers the lack of funding available e.g. in the UK less than 0.0085% of the medical research budget is spent on research into complementary and alternative medicines.¹

Well-qualified scientists in respected institutions are now carrying out high quality basic research, clinical research and veterinary research in homeopathy, and are reporting positive results which are published in the peer-reviewed scientific literature. Therefore the only basis for the argument that it is ‘pseudoscience’ is that we do not know how homeopathy works.

Usually, when a phenomenon is observed which cannot be explained by what ‘science’ already knows, this triggers fresh scientific enquiry – it is not dismissed as ‘unscientific’ purely because it has yet to be understood.
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References:
¹Lewith GT.Funding for CAM. BMJ., 2007; 335(7627):951. | Link