Homeopathic medicine has now been in use for over two centuries since its basic ideas were rehabilitated by the German physician Samuel Hahnemann. And its essential concepts have always seemed strange to anyone with any scientific training. The central idea is that people have a life force that, if disturbed, can lead to illness. The second idea is the "doctrine of similars, " or of "like curing like." If you peel an onion, then your eyes and nose may start to run. So one treatment for a person with runny eyes and nose might be onion. The third peculiarity of homeopathy is the use of super-dilute remedies that are prepared in a very precise way. There is a nice summary article of some of the basic ideas.
There is an important principle in scientific research which sometimes gets forgotten: there are many different types of study and one of the most fundamental of errors is to mix up pragmatic (does it work?) and mechanistic (how does it work?) experiments. Pragmatic studies usually follow on from clinical observations, and even if something is shown to work, it can take years to work out the mechanisms. Aspirin would be a good example: it was used in various forms for over a century before it was discovered how it worked.
In August of this year the Lancet published an article on homeopathy that has been taken to signal the end of homeopathy. In fact in an accompanying editorial, there was a call for homeopathy to be abandoned, altogether. However, in the three months since then, a number of us have been through the Lancet study very carefully, and have found some snags in it. So far the Lancet has chosen not to publish responses to the article, and the authors themselves have, as of now, refused to disclose exactly which studies they analyzed. This is highly unusual, and should give pause to gleeful skeptics who have taken this one study to be the death knell of this form of treatment. Worse yet, the folk who have dismissed homeopathy based upon media reports of the study, without examining the original.
As examples of some of the astonishing problems identified in the Lancet publication: there was no clear statement of aim. This is normally required before you even begin a piece of research. The investigators first look at every homeopathic study that they could find and then decided which studies to include. This is again a very unusual way of doing things. And then there are a lot of questions about the statistical analysis. We all know that you can use statistics to prove almost anything that you want to, and the debate about the appropriateness of the methods used is going to go on for a very long time.
The next time that somebody tells you that homeopathy is now a dead duck, tell them that the study is still being discussed. And as I have said on previous occasions, we do not make progress on the basis of one single paper. Even Watson and Crick’s model of the structure of DNA had to be confirmed before it was accepted, and going back further, some of the brilliant insights of Albert Einstein were not confirmed for almost fourteen years. But this study has already led to the Swiss Government deciding to reduce reimbursement for homeopathic treatment.
I have also seen some violent criticism of a six-year study involving around 6,500 patients who attended the Bristol Homeopathic Hospital in England. This was a simple naturalistic study that asked a simple question: of all the people who visited the hospital, how many felt better afterwards? This is the kind of audit that is being done all the time to see how people have got on with a hospital or a treatment. It does not "prove" or "disprove" homeopathy, it just asks people how they feel. And most said that they had benefited. To criticize it for not being randomized or placebo controlled is a bit like going to an Italian restaurant and complaining that they don’t serve Chinese food!
Homeopathy is no "cure all," but I will not abandon it unless we get some far more impressive data than that from the Lancet paper, for not only have I seen it work in patients and in animals with monotonous regularity, but because behind the scenes, we have been seeing more and more research coming not from patient studies, but from physics and cell biology laboratories, that seems to be giving the specialty a firm theoretical footing.
I shall continue to report both the positive and the negative studies as they are published, and offering guidance about how we can use different forms of treatment in combination.
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Sounds like very useful info, very descriptive. I didn't know myself that there were so manu natural ingredients that are used in homeopathy.
Posted by: neil | July 26, 2008 at 12:22 AM