Publisher: 2002. Milan, Guna S.r.l.
Reviewed By: Neil D. Shere
This slender volume was compiled through the joint efforts of Guna S.r.l., Italy’s largest homeopathic pharmaceutical company, and AIOT (Associazione Medica Italiana di Omotossicologia), a professional medical association – Italy’s largest such association for nonconventional physicians. Published in 2002 in English and Italian, a revised and updated Italian Second Edition has recently appeared; the English version has not yet been updated.
The authors of this volume identified roughly 400 studies of homeopathic efficacy published up to December 2001. From this number, a final roster of 127 studies was selected for review, excluding papers that failed to meet established standards for systematic trials. Excluded were studies that: did not permit treatment/trial outcomes to be specifically correlated to the homeopathic intervention (as opposed, for example, to other treatment interventions introduced simultaneously); retrospective studies; lack of homogeneity of the disorder(s) being investigated; small number of trial participants; and methodological inadequacies.
Of particular interest to the Classical prescriber, the editors of this volume observe that most controlled trials to date have tested efficacy of homeopathic drugs in treatment of specific (allopathic) diseases. Another increasingly important group of trials they identify are those comparing homeopathic and allopathic medicines, many of which have shown homeopathic remedies to be equal or superior to conventional medicines. In addition to these more or less traditional clinical efficacy trials, the editors of the present volume selected 65 papers representing findings in basic research regarding action of homeopathic medicines.
For the most part, this book represents a kind of hybrid, mixing features of the annotated bibliography with features of a meta-analysis. It has gathered together those studies that meet accepted methodological standards in research in controlled and systematic trials, as well as in basic research, and discussed the overall positive implications of the research findings from across this wide range of studies. In addition, it provides basic bibliographic and substantive information concerning each paper included within its covers. The editors have also selected 10 papers they deemed especially significant, and have provided a more detailed outline of their contents.
In short, this volume neatly encapsulates the field of research into homeopathy, clearly demonstrating the scope and variety of research activity, the recent trend to an increasing interest in the subject within the scientific community, and the clear tendency, across a large body of research, to supporting the notion of efficacy of homeopathic treatment.
In these regards, this book contributes a well organized, concisely presented overview of contemporary research – though one that is in need of being updated, to reflect not only new research conducted in the nearly 5 years since it’s publication, but also to reflect the appearance of new meta-analyses that have in some cases modified or even reversed positive findings from earlier meta-analyses.
In addition, the next edition would benefit from inclusion of even more detailed analysis of selected studies, or more detailed statistical analysis of trends within the body of cited research papers as a whole. In this connection, the current reliance on a schematic summary of trial designs and outcomes, while offering a more detailed picture of these trials than we often get in a meta-analysis, in the end leaves the reader hungry for a more substantive description of clinical findings.
Admittedly, adding this sort of material would considerably expand on the objectives of this work, and in that regard is more a recommendation for a different book than a criticism of the present one. Nevertheless, without such enhancements, we are left pretty much where we have been for some time now, one side claiming the evidence favors them, and the other side claiming the evidence is flawed. At the least, others interested in homeopathic research should approach this volume as a resource upon which to build, rather than a final summation of the subject – indeed, it was a specific hope of the editors that this compendium might serve in the role of such a foundational effort.
In any case, in this respect, as in so many others, an analytical (clinical) approach can shed light, by detailed weighing of strengths and weaknesses of specific trial reports. By comparison, this volume leaves us in the usual quandary, relying too exclusively on statistical analysis, which permits us to say with “certainty” only that there is such and such “probability” that the whole body of research supports this or that tentative conclusion. Unfortunately, in such a process, compelling evidence of efficacy is ignored, as I have previously argued (review of “The Trials of Homeopathy”, Homeopathy for Everyone, April 2006); conversely – as shown in Vithoulkas’ paper, reprinted elsewhere in this issue – such a process encourages naÃ¯ve acquiescence in the purported objectivity of numbers.
That which the therapist calls “case review” is the same as that which the statistician calls “nitpicking.” Both processes explore the information and data included in a published report, and analyze it, in accordance with standards appropriate to the respective disciplines, to ascertain the soundness of the project. In this regard, “nitpicking” is the application of critical reason to evaluation of quantitative data, and represents almost a “clinical,” and certainly an “individualized” assessment of the heuristic value of the particular document: in short, the fact that numbers add up the same way, regardless who punches the keys on the keypad, doesn’t guarantee that the right numbers have been found in the first place.
In research as in medical practice itself, statistics has nothing whatsoever to say about the individual case (or trial) report – a fact with which not even the most fanatical statistician would argue. But perhaps it is time we grow up as scientists, and underscore the importance of evaluating the quality of the individual case (or trial) report, rather than settling for the pointillistic impressionism of so-called “systematic” research. Perhaps it is time we put an end to the obscurantist tendencies inherent when we apply probabilities to practice, and demand that now, finally, we turn our attention to identifying the facts that lay behind the numbers.