Clinical Trials

No relevant trials were available. Only trials on supportive and palliative treatment is available (Kulkarni 1988, Oberbaum, Yaniv, Ben-Gal 2001, Balzarini 2000, Jacobs, Herman, Heron 2005, Thompson, Montgomery, Douglas 2005).

Discussion

Systematic review

Kuhn (1962) developed the concept of paradigms in science and he argues how the prevailing paradigm sets the scene in science and how it cannot be seen as purely objective. The paradigm determines the questions to be asked and the methods to obtain them. As an example, the systematic review holds RCT to be the best evidence in CAM research, thus in contrast to the experience from several studies (Weatherley, Thompson and Weiss 2006). By leaving out case stories, the systematic review only allows some experience to enter research and thus flaws the knowledge of homeopathic treatment of cancer patients.

Chart review

In a chart review, surgeons propose the danger of non-existing information on CAM therapies used as a primary treatment in breast cancer and conclude that this non-existing information is one reason why operations are refused (Chang et al). As shown later in this study, information from case studies was available in 2006 when the chart review was made. The conclusion is in contrast with other findings on cancer patients’  decision making. These studies show how cancer patients seek information also and especially outside the conventional research area (Verhoef 2004, Ewans, Shaw, Thompson).

The review concludes that homeopathic treatment deprives cancer patients of efficacious conventional treatment. When looking in table 1, overview of patients choosing CAM therapy instead of surgery, homeopathy is not mentioned. A group called “unspecified” consistS of 1 patient. The general statement, that homeopathy instead of surgery is associated with recurrence and death, is not substantiated by the findings in the review.

Retrospective Chart Reviews of existing medical records that are intended as a systematic investigation designed to contribute to knowledge which can be generalized, require prior ethical approval (Human Subjects Research Office; 2008). This is not found in the paper.

Trials

No trials were conducted. Trials comparing conventional versus homeopathic cancer treatment are unethical in life threatening diseases. If homeopathic treatment is promising,  patients in control arm are deprived potential benefit and when control arm is known to be efficacious, which it is in the eyes of conventional medicine, patients in test arm are deprived of benefit. Recent research has shown placebo controlled trials to have fundamental problems in testing complementary and alternative medicine (CAM),  because specific effects of the homeopathic remedy and the non specific effect from the consultation are interdependent. Thus placebo is no longer only placebo and the measure of absolute efficacy of the homeopathic remedy is not possible. Instead,   pragmatic studies comparing untested treatments with conventional treatment with evidence of effectiveness, are put forward as a meaningful way of evaluating homeopathic treatment (Wheatherley Jones 2004).

Cases

The case reports were generally of a very high quality when compared to the limitations normally found in homeopathic cases (Thompson 2004). Precise information on diagnosis was present in all cases. Objective measures in the form of CT-Scan, blood tests and biopsies during the follow-up period were frequently used by all authors except one. Detailed information of duration of treatment was also present in all cases.

Wurster, Spinedi and Ramakrishnan gave very detailed information on the administration of the homeopathic remedy. Payrhuber, Wurster and Spinedy informed about repertorisation and gave very detailed information on symptoms. This helps the understanding and makes the decision clearer to the reader and in general makes case studies more valid (Yin 2003).

All cases were retrospective reports with the allowance of selection bias and therefore the extremely good outcomes cannot be seen as standards (Thompson 2004), but evidence for effect of homeopathic treatment of malignant tumours in humans does exist.

The different views of homeopathic treatment of metastasized cases need to be investigated further and rival explanations of the “miraculous cures looked into. A large number of prospective case studies of high quality is recommended.

The widespread use of CAM leads to the decision makers’ wish to assess efficacy and safety and strengthen the need for relevant research. The assessment methods normally used in conventional medicine are not appropriate. There is a general understanding of the complexity of individualised treatments leading to new methods of investigation. Outcome of the new designs needs to be relevant to patients, practitioners and policy decision makers. (Boon, Verhoef and Vanderheyden 2006)

Comparative studies are recommended by Weatherly-Jones, and FCS are suggested by Thompson.

Conclusion

The literature review shows that evidence of effect of homeopathic treatment of malignant tumours in humans does exist. It seems that present day homeopaths have revived the tradition from older times in spite of the higher level of pollution.

The general standard of the reviewed cases was above average when compared to the normal limitations found in homeopathic case reports.

With the large number of cases and the good results shown, Ramakrishnan’s work is very promising. Future examples carried out by other homeopaths would add to the reliability of Ramakrishnan’s  work.

The work carried out by Wurster et al also seems promising, with case studies of a very high quality (Yin).

There seems to be different ideas on what homeopathic treatment can do in metastasized cases. To investigate this further, a large number of prospective case studies of high quality is recommended.

There is a call from researchers (Milazzo et al) and government bodies (House of Lords 2000) to further investigate the anti-cancer effect of homeopathic treatment. This should be done both in a way that is in line with the underlying theories of homeopathy and also in a meaningful way for patients (Tonelle and Callahan). Meaningful evidence for cancer patients is close to the truth of everyday experience and often uses recommendations from friends and family (Verhoef 2004, Ewans, Shaw, Thompson).

Homeopaths have used case studies for more than 200 years as a way to transfer knowledge inside the community and the method is in line with the theory of homeopathy. Case studies serve the purpose of homeopaths and patients as well. However, the case studies need to be refined in order to share knowledge both inside and outside the homeopathic community. Thompson (2004) suggests improved research quality by introducing formal case study (FCS) thus improving the reliability and validity.

Case studies from homeopathy used as a supportive therapy were excluded, which may be seen as a weakness of the study. This strategy was chosen because little or no information about tumour size was revealed (Balzarini et al 2000, Jacobs et al 2005, Oberbaum et al 2001, Rajendran 2004, Thompson 2005).

Awknowledgement.

I thank Kate Chatfield for feedback and comments.

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Appendix I

Appendix II

List of databases/websites:
CAMEOL http://www.rccm.org.uk/cameol/Default.aspx
Interhomeopathy http://www.interhomeopathy.org
Narayana Verlag http://www.narayana-verlag.de/index.php/cPath/52_146
The Cochrane Library http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME

Appendix III

Success rates in of Ramakrishnan’s cancer cases.

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