Thanks for the opportunity to raise the profile of homeopathy through your radio station. The only bad publicity is no publicity of course so thanks for your help with this.
During our telephone discussion it became obvious that you don’t know a great deal about homeopathy. In an effort to help you with this so that during any further discussion that we may have you’re better informed about this subject, I’ve inserted some material below. Please note here that I’m not refusing to answer your questions, but so I’m sure I’m not wasting my time and therefore Brauer’s time, before I respond to your questions I’d like a detailed response from you to the material below, and an answer to the question I’ve asked you at the end. I’d also appreciate it if you could tell me if your “Reality Check” program has featured any stories on medical iatrogenesis, which is responsible for at least 14,000 deaths in Australia every year, and upwards of 750,000 human deaths in places like the USA, or any stories featuring the fact that only 13% of medical practices and products has been validated by good quality evidence, and if you have not, why you’ve ignored these areas?
Firstly, it might be useful for you to know the extent to which homoeopathic medicines are used around the world. Globally, homoeopathy is an extremely popular modality and to reflect this, in 1999 the World Health Organisation (WHO) called for closer incorporation of homoeopathy into “western medical systems”1 and a ranking of the world’s top healing systems (including pharmaceutical drug therapy) carried out in 2003 had homoeopathy second only in popularity to Traditional Chinese Medicine2.
In Germany, 20% of medical practitioners prescribe homoeopathic medicines for their patients 3, 4, 5 and they’re used by 90% of German veterinarians6. It’s interesting that given the fact that homeopathy was originally developed by Dr Samuel Hahnemann in Germany, there isn’t a higher level of use by medical practitioners.
In the UK a study carried out in 1994 found that 10 out of the 16 university pharmacy schools taught homoeopathy as an undergraduate subject and in 1999, 66% of pharmacies sold homoeopathic medicines7, 8, 9 with some particular pharmacy groups such as Boots producing their own range of homoeopathic medicines10 . Still in the UK, there are 5 homoeopathic hospitals run by the British National Health Service (NHS), as well as 2 private homoeopathic hospitals and homoeopathy has been supported by the NHS since it’s inception in 194811, 12. A 1992 study found that 42% of British doctors refer their patients for homoeopathic treatment13 . By 2001 20% of Scottish GPs had been trained in homoeopathy 14 and by 2003, 86% of Scottish GPs surveyed were found to be in favour of homoeopathy 15 . Currently, homoeopathy is the second most popular complementary medicine in the UK 16, 17.
The situation in France is also interesting. Most French pharmacies carry these products18, 19 and in 1999 the French Medical Association called for homeopathy to be included in all medical degree training20. A 1998 study concluded that people using prescribed homoeopathic medicine cost the French government half of that for patients who used pharmaceutical treatments21, 22 .
Around the rest of Europe, 45% of doctors in the Netherlands use homoeopathy (40% of GPs in the Netherlands use homoeopathy23, 85% of Belgian medical practitioners provide homoeopathic treatment for their patients24, 25, 47% of Dutch doctors use homoeopathy26 and in the 10 years to 2002, interest in homoeopathy in Switzerland had risen by 300%27 and homoeopathy is rebatable by most health insurance providers27. In 1997, 37% of Norwegians who were surveyed had visited a homoeopath 28 and homoeopathy is the most frequently used system of veterinary medicine in Norway29.
In Europe generally, a 2003 survey found that 20-25% of all Europeans used homoeopathic medicines30, 31 and homoeopathy was the most frequently used complementary medicine in France, Belgium, the Netherlands, Norway, Italy and Switzerland32. In 1999 The European Parliament called for homoeopathy to be integrated into medical practice33 and the EU recommended that homoeopathy and herbs be used as first line treatments in veterinary medicine34
Pakistan appears to have a high level of interest in homoeopathy. Last year, the Pakistani Government established homoeopathic dispensaries in Pakistani hospitals35 and there are 165 government recognised homoeopathic medicine colleges operating throughout the country36. For the last few years the Pakistan government has set up homoeopathic medicine camps to treat the pilgrims who travel on the Haj to Mecca. Last year, 50,000 people were treated in these camps37. In India, 54% of medical practitioners prescribe homoeopathic medicines38 .They are widely used in Indian hospitals and homoeopathy is the most commonly used complementary medicine in this country39, 40, 41.
In 2003 in Sri Lanka, construction began on a government-funded homoeopathic hospital at Welisara42 and Columbian President, Alvaro Uribe, uses homoeopathic medicines to “stay in mental shape”43. It’s estimated that there are 15,000 homoeopathic doctors practising in Brazil44 and it’s a government requirement that homoeopathy is taught as an undergraduate subject in all pharmacy courses at Brazilian universities45. In the USA, 58% of US medical schools teach homoeopathy46. In Australia, the level of use of these medicines is a little difficult to determine. One relatively recent study said that around 12% of Australians use homoeopathic medicines but this figure has yet to be verified47. However, 78% of pharmacies here carry products made from homoeopathic ingredients and many of the larger pharmacy groups recommend these products as a core range, i.e. it’s mandatory for anyone setting up one of these stores to have them on their shelves 48. In New Zealand49 and South Africa50, homoeopathy forms part of the undergraduate program in pharmacy courses in some universities.
NOTE: ARTICLE CONTINUES AFTER CITATIONS:
1. Poitevin B, Integrating Homoepathy in Health Systems, WHO Bulletin, 1999, 77, 2, 160-166.
2. Kemper KJ, Jacobs J, Homeopathy in Pediatrics- No harm likely but how much good? Contemporary Pediatrics, May, 2003, 20, 97-111.
3. Ludtke R et al, Forsch Komplementarmed Klass Natureheilkd, 2001, 8, 4, 213-8.
4. BMJ 2 November 2002;325:990.
5. WHO Bulletin op cit.
6. HomInt R&D Newsletter, Glasgow Homoeopathic Hospital, 1998.
7. Jain, A, “Does Homeopathy reduce the cost of drug prescribing?” Homeopathy, 2003, 92, 71-6.
8. Barnes J, Uncovering Potential Problems with Complementary Remedies: A Survey of Community Pharmacies, Royal Pharmaceutical Society, Report on Complementary and Alternative Medicines, Response to the House of Lords Science and Technology Committee, Sob-Committee III, October, 1999, Appendix 2.
9. BBC News, 20 Aril 2003.
10. Authors personal observations, London 1995.
11. Owen DK et al, “Can doctors respond to patient’s increasing interest in complementary and alternative medicine?”, “, British Medical Journal, 20 January, 2001, 322, 154-8.
12. Natural Medicine Society News, 21, June 1992.
13. Natural Medicine Society News, op cit.
14. Reilly D, The Puzzle of Homoeopathy, J Alt Compl Med, 2001, 7, Suppl 1, S103-9.
15. Hamilton E, Exploring General Practitioners attitudes to homeopathy in Dumfries and Galloway, Homeopathy, 2003, 92, 190-194.
16. “New research in the Times Body and Soul reveals disenchanted Britons turning to complementary therapy”, PRNewswire, London Jan 9, 2004.
17. The Independent, 17 November, 2003.
18. Author, personal observations, Paris, 1993, 1995.
19. Pharmacoepidemiol Drug Saf, 2004, Mar, 18, 13, 10, 711.
20. Archives of Internal Medicine, 1999, 17, September 27.
21. Archives of Family Medicine, 1998, 7, 537-40.
22. Economic facts and figures, European Coalition on Homoeopathic and Anthroposophical Medicinal Products, September 2003, 9-10.
23. Visser GJ, et al. Alternative Medicine and General Practitioners in the Netherlands, Family Practice, 1990, 7, 3, 227-232.
24. Aldridge D. Europe looks at Complementary Medicines, BMJ, 1989, 299, 1121-1122.
25. Watson R. “Belgium is to Regulate Complementary Medicine, British Medical Journal, 22 May, 1999, 318, 1372.
26. Pirotta MV et al, Complementary Therapies- have they been accepted in general practice?, Medical Journal of Australia, 2000, 172, 105-109.
27. Swiss Radio International, May 2, 2002.
28. News Briefs, Complementary Medicine, March/April 2003, 11.
29. Viksveen P, Antibiotics and the development of resistant microorganisms. Can homeopathy be an alternative? Homeopathy, 2003, 92, 99-107.
30. Viksveen P, op cit
31. European Coalition on Homoeopathic and Anthroposophical Medicinal Products, op cit
32. Viksveen P, op cit
33. Archives of Internal Medicine, 1999, 17, September 27.
34. Viksveen P, op cit.
35. www.paknews.com, 21.6.03.
36. www.paknews.com, 21.6.03
37. “Ailing Haj pilgrims provided treatment”, Pakistan Daily Times, Mar 3, 2003.
38. The Daily Star, Sept 26, 2002.
39. Times of India, 9.6.03.
40. J Ethnopharmacol, 2001, May, 75, 2-3, 71-5.
41. The Hindu, October 23, 2003.
42. Daily News, Sri Lanka, Jan 3, 2003.
43. “A Year In, Uribe Racing to Reform”, St Petersburg Times, August 4, 2003.
44. Yasgur J. “Homeopathy In Brasil”, Homeopathy Today, Jan 2003, 34.
45. Yasgur J. op cit
46. Acad Med, 2002, September, 77 (9), 876-81.
47. Brauer Natural Medicine, Industry marketing data 2004
48. Brauer Natural Medicine, Industry marketing data, op cit
49. Personal correspondance, Dr Steven Kayne, PhD, MBA, LLB, DAgVetPharm, MRPharmS, MCPP, MPS (NZ), ACNZP, Visiting Lecturer, Dept of Pharmaceutical Sciences, University of Strathclyde, Tutor, Homoeopathic Hospitals of Glasgow and London, Tutor, Pharmacy Dept, Otago PolytechnicMay 1995.
50. Personal correspondance, Dr Steven Kayne, op cit.
Homeopathic medicines have been used around the world continuously for over 210 years. During that time they’ve been subjected to attack by medical practitioners who’ve lost patients to prescribers of homeopathy, by pharmaceutical companies who lose profits due to the reduced sales of drugs, and by the organisations and individuals who directly or indirectly are supported by these organisations. In recent times these attacks on homeopathy have been vigorously supported by the media, which is sustained to a significant degree by the advertising revenue received from pharmaceutical manufacturers. Despite these attacks, homeopathy continues to survive and in many places during several periods of history has flourished. The nature of these attacks has taken several forms but the 2 enduring criticisms of homeopathy are that it’s “unscientific” and that it lacks the backing of clinical trials. The latter is interesting given the fact that only 10-20% of conventional medical practices are validated by appropriate evidence1.
Arguments Against Homeopathy
To enlarge on the above, the main argument against homeopathy appears to be, “I don’t understand how it can work, therefore it can’t work.” For many who take this position no amount of properly conducted research that shows clearly that it does work will convince them otherwise. Plainly, this is intellectually dishonest. Some people also take the view that homeopathy can’t work because there’s no scientific basis for its activity. The only problem with this view is that it assumes that the body of science that’s been accumulated to date is fixed and will never be added to, and that there’ll be no new discoveries of fact, observation or mechanism. It also assumes that there’s no evidence for a mechanism that either partly or fully explains the action of homeopathics. Such evidence does exist and is easy to find2,3 but even if this wasn’t the case, an absence of evidence does not constitute evidence of absence.
A number of publications are cited by sceptics of homeopathy that are used to support their views. The flagship is a review published in the Lancet entitled “Are the clinical effects of homeopathy placebo effects?”4 Here, after ultimately comparing 8 trials on homeopathy with 6 on conventional medicine, Shang et al boldly assert that homeopathy is no more effective than placebo. A cursory examination of this article reveals it to be dodgy in the extreme. To quote the authors of the study, “We assumed that the (positive) effects observed in placebo-controlled trials of homeopathy could be explained by a combination of methodological deficiencies and biased reporting.” The article was riddled with methodological flaws and received widespread condemnation from academics and other experts in this field, including a denunciation by the Indian Health Minister, Prof. Chaturbhuj Nayak.5 Subsequent re-analysis of this article in fact found that homeopathy was more effective than placebo6, 7.
Another criticism levelled at homeopathy is that clinical trials haven’t been replicated. This isn’t strictly the case as replication has occurred in several areas (hay fever and diarrhoea to name just 2) but it’s true that more replication would be useful. The reason for a comparatively low level of replication of trials in this area is that unlike pharmaceuticals, homoeopathic medicines in most cases can’t be patented, and there’s little incentive to invest large amounts of money in clinical trials if the product sponsors can’t monopolise the results.
So, is there any evidence that homeopathy works and if so, what form does that evidence take? It’s important to bear in mind here that critics of homeopathy confidently declare that there is NO evidence for homeopathy. This is a long way from the truth of the matter and the evidence for the effectiveness of homeopathy is remarkably easy to find.
Human Clinical Trial Meta-analyses
These are systematic statistical analyses of existing human controlled trials that have met certain quality criteria and are carried out to determine if the research can show that a trend exists one way or the other.
- Kleijnan, et al in the BMJ8 report that of the 105 clinical trials that met the reviewers’ quality criteria, 81 of those trials showed a positive effect for homeopathy.
- Cucherat, et al9 state, “There is some evidence that homeopathic treatments are more effective than placebo.” 16 studies were evaluated.
- Barnes J, et al, on post operative ileus10, “There is evidence that homeopathic treatment can reduce the duration of ileus after abdominal or gynaecological surgery”. 6 studies were evaluated.
- From Bornhoft, et al11, “Effectiveness of homeopathy can be supported by clinical evidence“. 74 studies were evaluated.
- Linde, et al12 report. “Among the high quality studies, positive effects were reported 50% more often than negative effects.” 105 studies were evaluated.
- Mathie13 states, “The weight of evidence currently favours a positive treatment effect in eight (areas): childhood diarrhoea, fibrositis, hayfever, influenza, pain (miscellaneous), side effects of radio-or chemotherapy, sprains and upper respiratory tract infections.” 93 studies were evaluated.
- On a meta-analysis for the homeopathic medicine, Galphimia, for hay fever, Wiesenauer, et al14 state, “A significant superiority of Galphimia glauca over placebo is demonstrated. Estimates of verum success rates are comparable with those of conventional antihistaminics, but no side effects occurred.” 11 studies were evaluated.
- Witt, et al15 reports, “Even experiments with a high methodological standard could demonstrate an effect of high potencies.” 75 studies were evaluated.
Individual Human Clinical Trials
There are a large number of high quality randomised controlled human clinical trials that have been carried out using homeopathy. Lack of space precludes listing these here but they’re easy to find either on Medline26, websites operated by institutions such as the Glasgow Homoeopathic Hospital27, websites that carry material on this subject such as Homeopathic Doctor28, and Nutrition Matters29.
A good example of the kind of work done here is that carried out by David Reilly and published in the Lancet in 199430, where he and others conducted a placebo controlled randomised trial looking at the use of homeopathic medicines with 28 patients diagnosed with allergic asthma. Homeopathy proved superior to placebo, and this trial was so well designed and conducted that the editors of the Lancet commented that, “either there is something amiss with the clinical trial as conventionally conducted, or the effects of homoeopathic immunotherapy differ from those of placebo…carefully done work of this sort should not be denied the attention of Lancet readers.”31
These are observational studies analysing quality of life, clinical or other outcomes that have come about as a result of some specific intervention.
- A study by Spence et al16 found that of 6544 consecutive UK NHS patients treated with homeopathy 70.7% reported positive health changes, with 50.7% recording their improvement as better or much better.
- Witt, et al17 found that of 3981 patients seen in Swiss and German medical clinics practising homeopathy, and who were treated with homeopathy, patient and physician scores for clinical outcomes found that disease severity decreased significantly (p < 0.001) between baseline and 24 months (adults from 6.2 +/- 1.7 to 3.0 +/- 2.2; children from 6.1 +/- 1.8 to 2.2 +/- 1.9).
- In another study by Witt et al18, of 3709 patients seen in Swiss and German medical clinics practising homeopathy, and who were treated with homeopathy, patient and physician scores for clinical outcomes found that disease severity decreased significantly (p < 0.001) between baseline, 2 and 8 years (adults from 6.2 +/- 1.7 to 2.9 +/- 2.2 and 2.7 +/- 2.1; children from 6.1 +/- 1.8 to 2.1 +/- 2.0 and 1.7 +/- 1.9). These effects persist for as long as 8 years.
- Marian, et al in a 2008 study19 found that “Overall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care.” 3126 patients were involved in this study.
- A study by Van Wassenhoven, et al20 found that, “Patients were very satisfied with their homeopathic treatment, both they and their physicians recorded significant improvement. Costs of homeopathic treatment were significantly lower than conventional treatment, and many previously prescribed drugs were discontinued.” 782 patients were involved in this study.
It may be useful to note here that these are only 5 of a larger number of cohort studies that have been carried out in this area. These 5 involve responses to the treatment of over 17,000 people suffering from various forms of illness. A statistically significant majority of these people experienced a beneficial outcome from this treatment. If we are to believe the critics of homeopathy, these people are either liars or deluded.
- Albrecht, et al21 found that, in the treatment of 1440 piglets, “Homeopathic metaphylaxis is significantly effective compared with placebo and routine low-dose antibiotic metaphylaxis for incidence of disease and rate of disease of the respiratory tract among the animals studied.”
- On the treatment of Salmonella infection in poultry, Berchieri et al22 found that when 180 one day old chicks were given either an active homeopathic medicine or control and then challenged with a culture of salmonella. “Birds receiving active treatment were less likely to grow the strain of Salmonella from cloacal swabs compared to control.”
- Bertani et al23, treating oedema in 307 rats with either a homeopathic medicine or control, found that homeopathy significantly reduced oedema in comparison to controls.
- From Cazin, et al24, 6 groups of 30 mice given radio-labelled arsenic were treated with various homeopathic potencies of arsenic and the level of retention compared to controls. All homeopathic potencies of arsenic were found to have a greater effect on arsenic elimination than controls.
- From Datta, et al25, the authors found that pre and post-feeding of homeopathically prepared Arsenicum Album 30C and 200C to mice exposed to arsenic trioxide reduced the genotoxic effects (chromosome aberrations, micronucleated erythrocytes and sperm head anomaly) of arsenic when compared to controls.
Does Homeopathy Work?
Even if the work referred to above hadn’t been carried out, 213 continuous years of use and growth throughout Europe, more than 150 years of continuous use in the USA, India, Australia and most other parts of the world to the point where it’s the world’s second most popular system of healthcare32, and millions of satisfied users, would tend to indicate that homeopathy works.
1. Fluhrer J, Integrative Practice Overview. Complementary Medicine, July/ August 2002, 33-35.
2. Endler PC, Schulte J.: Ultra High Dilution: Physiology and Physics. Kluwer Academic Publishers, Dordrecht, 1994, ISBN 07923-2676-8.
3. Homeopathy, July 2007, 96, 141-230
4. Shang A, Huwiler-MÃ»ntener K, et al. Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy. Lancet, 2005, August 27, 366, 726-32.
5. The Telegraph, Calcutta, India,12/9/05, Letter to the Editor, Prof. Chaturbhuj Nayak, Director, Central Council for Research in Homoeopathy, Ministry of Health and Family Welfare, New Delhi, India.
6. Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J of Clin Epidemiology 2008.
7. Rutten ALB, Stolper CF. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy 2008, 97, 169-177.
8. Kleijnen J, et al. Clinical trials of homeopathy. British Medical Journal 1991; 302: 316-323.
9. Cucherat M, et al. Evidence of Clinical efficacy of homeopathy. A meta-analysis of clinical trials. Eur J Clin Pharmacol, 2000, 56, 27.
10. Barnes J, et al. Homeopathy for post operative ileus: a meta-analysis. Biomedical Therapy, Vol XVII, 2, 1999, 65-70.
11. Bornhoft et al. Effectiveness, safety and cost-effectiveness of homeopathy in general practice – summarized health technology assessment. Forsch Komplementarmed. 2006;13 Suppl 2:19-29.
12. Linde K, et al. Critical Review and Meta-Analysis of serially agitated dilutions in Experimental Toxicology. Human & Experimental Toxicology, 1994, Vol. 13, No. 7, 481-492.
13. Mathie RT. The research evidence base for homeopathy: a fresh assessment of the literature. Homeopathy 2003, 92:84-91.
21. Albrecht H, et al. Homeopathy versus antibiotics in metaphylaxis of infectious diseases: a clinical study in pig fattening and its significance to consumers. Altern Ther Health Med. 1999 Sep;5(5):64-8.
25. Datta S, et al Efficacy of a potentized homoeopathic drug (Arsenicum Album-30) in reducing genotoxic effects produced by arsenic trioxide in mice: comparative studies of pre-, post- and combined pre- and post-oral administration and comparative efficacy of two microdoses. Complement Ther Med. 1999 Jun;7(2):62-75.
30. Reilly D, et al., “Is evidence for homoeopathy reproducible?”, Lancet, Vol 344, December 10, 1994, pp 1601-1606.
31. Lancet, Vol 344, December 10, 1994, p 1585.
32. Kemper KJ, Homeopathy in Pediatrics- No Harm Likely but How Much Good? Contemporary Pediatrics, May, 2003, 20, 97.
So Tony, my question to you is, if, as you infer, homeopathy is no better than placebo, how do you explain the levels of use around the world, the success of the trials and studies mentioned above and the fact that it has not only survived but grown vigorously over the last 213 years? I look forward to your response.