Most sincere thanks to Robert Medhurst for the following work :)
HOMEOPATHY IN AUSTRALIA
2009 has been a very busy year for attacks on homeopathy. We’ve had visits from people such as Dr Simon Singh, noted UK science journalist and critic of homeopathy, who was reported in just about every possible print and electronic media here as saying categorically the homeopathy doesn’t work.
We’ve had front-organisations for the pharmaceutical industry cajoling the World Health Organisation into making statements that appear to condemn the use of homeopathy, we’ve seen the unfortunate death of a child in Sydney that homeopathy sceptics have tried to link to the use of homeopathics.
There have been attacks on homeopathy in pharmacy journals by individuals in the pharmaceutical industry and attacks on homeopathy by New Zealand medical practitioners have been widely reported in the Australian media. Brauer and others in the industry have been vigorous in their defense against these attacks but if such experiences in places like the UK, where campaigns against homeopathy have caused consultation rates in some areas halve within as little as 12 months are anything to go by.
We need as much help as we can get to ensure that the viability of the industry and of homeopathic clinics in Australia remains healthy. History has shown that it’s primarily the users of homeopathics and their sheer numbers that have provided homeopathy with its longevity and resilience against attack. This being the case, one of the best ways to ensure the future viability of homeopathy in Australia is through the education of users and by encouraging them to defend and promote it among their friends, relatives and colleagues. In an effort to assist with this, you may find it useful to copy the following article and distribute it to patients with a request to distribute to those in their contact groups.
In an effort to assist with this, you may find it useful to copy the following article and distribute it to patients with a request to distribute to those in their contact groups.
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 organizations and individuals who directly or indirectly are supported by these organizations. 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 two 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 evidence 1.
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 find (2,3). 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 skeptics 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 placebo (6, 7) Another criticism leveled 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 diarrhea to name just two, 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 monopolize 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 of 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, fi brositis, 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 signifi cant 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 randomized 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 Hospital (27), websites that carry material on this subject such as Homeopathic Doctor (28), and Nutrition Matters (29).
A good example of the kind of work done here is that carried out by David Reilly and published in the Lancet in 1994 (30), where he and others conducted a placebo controlled randomized 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 ofsome specifi c 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, andwho were treated with homeopathy, patient and physician scores for clinical outcomes found that disease severity decreased signifi cantly (p < 0.001) between baseline and 24 months (adults from 6.2 +/- 1.7 to 3.0 +/- 2.2; childrenfrom 6.1 +/- 1.8 to 2.2 +/- 1.9).
• In another study by Witt et al18, of 3709 patients seen inSwiss and German medical clinics practicing 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 patientsatisfaction was significantly higher in homeopathic than inconventional care. Homeopathic treatments were perceivedas a low-risk therapy with two to three times fewer sideeffects than conventional care.” 3126 patients wereinvolved 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 previouslyprescribed drugs were discontinued.” 782 patients wereinvolved 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 outin this area. These 5 involve responses to the treatment ofover 17,000 people suffering from various forms of illness. A statistically significant majority of these people experienced abeneficial 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 signifi cantly 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 postfeeding 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 of 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 satisfi ed users, would tend to indicate that homeopathy works.
T H E B R A U E R D I S P E N S A R Y
References 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-Mûntener 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 metaanalysis 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 effi cacy 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.
14. Wiesenauer M,et al..A meta-analysis of homeopathic treatment of pollinosis with Galphimia glauca. Wien Med Wochenschr. 1997;147(14):323-7.
15. Witt CM, et al. The in vitro evidence for an effect of high homeopathic potencies--a systematic review of the literature. Complement Ther Med. 2007 Jun;15(2):128-38.
16. Spence DS, et al. Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med. 2005 Oct;11(5):793-8.
17. Witt CM, et al. Homeopathic medical practice: long-term results of a cohort study with 3981 patients. BMC Public Health. 2005 Nov 3;5:115
18. Witt CM, et al. How healthy are chronically ill patients after eight years of homeopathic treatment?-- Results from a long term observational study. BMC Public Health. 2008 Dec 17;8:413.
19. Marian F, et al. Patient satisfaction and side effects in primary care: an observational study comparing homeopathy and conventional medicine. BMC Complement Altern Med. 2008 Sep 18;8:52.
20. Van Wassenhoven M, et al An observational study of patients receiving homeopathic treatment. Homeopathy. 2004 Jan;93(1):3-11.
21. Albrecht H, et al. Homeopathy versus antibiotics in metaphylaxis of infectious diseases: a clinical study in pig fattening and its signifi cance to consumers. Altern Ther Health Med. 1999 Sep;5(5):64-8.
22. Berchieri A Jr, et al. Evaluation of isopathic treatment of Salmonella enteritidis in poultry. Homeopathy. 2006 Apr;95(2):94-7.
23. Bertani S, et al. Dual effects of a homeopathic mineral complex on carrageenan-induced oedema in rats. Br Homeopath J. 1999 Jul;88(3):101-5.
24. Cazin JC, et al. A study of the effect of decimal and centesimal dilutions of arsenic on the retention and mobilization of arsenic in the rat. Hum Toxicol. 1987 Jul;6(4):315-20.
25. Datta S, et al Effi cacy 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 effi cacy of two microdoses. Complement Ther Med. 1999 Jun;7(2):62-75.
EVIDENCE_9.0_Sept_06.pdf 28. www.homeopathicdoctor.ca/reference/
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.