Complementary Therapy – Homoeopathy

‘Similia similibus curentur’ translated to ‘like cures like’ is the basis of

homoeopathy (E. Ernst & E. G. Hahn, 1998). This basis was founded upon the
experiments of Samuel Hahnemann, a German physician (C. Zollman & A. Vickers,
2000, p20). His experiments began in 1796, in which he began to take a malaria
remedy in perfect health noticing that he acquired symptoms which were similar to
patients with malaria. After repeated trials on other volunteers he came to the
conclusion that if a compound caused symptoms in a healthy person, it would serve as
a remedy to those very same symptoms in an ill patient thus forming the basis of
homoeopathy (E. Ernst & E. G. Hahn, 1998).

Many homoeopathic remedies are produced from plants, herbs, fruits and
vegetables. There are however, a few others produced from animal products, minerals
and even biochemical substances such as histamines. Traditionally, the remedies are
prepared by diluting and vigorously shaking a solution of the base material and water.
The more this process is done in series the greater the potency of the remedy thus
requiring a reduced intake for the patient (C. Zollman & A. Vickers, 2000, p20).

All remedies prescribed in homoeopathy are ultra-molecular, which means

that the medicines are diluted to a point where none of the original solute is present.
There are many theories into the mechanism of action of homoeopathic remedies with
some arguing that these remedies work via an undefined biophysical method.
However, others believe the interactions between the solvent, in this case water, and
the solute enable the water molecules to retain a ‘memory’ of the original solution (C.
Zollman & A. Vickers, 2000, p20).

Homoeopathic remedies are usually used to treat conditions such as eczema,

rheumatoid arthritis, mood disorders and asthma. Many practitioners also treat
conditions which have no clear diagnosis. There are many prescribing strategies
employed in homoeopathy with classical practitioners opting for a single remedy for a
‘general constitution’. This constitution incorporates details of a patient such as past
and present illnesses, behaviour and personality. With this a ‘symptom picture’ is
produced and is then matched with a ‘drug picture’, which in turn will allow a
practitioner to prescribe. Other strategies of prescribing are combinations of remedies
based on a conventional diagnosis (C. Zollman & A. Vickers, 2000, p21).

The theories of the mechanism of action combined with the method of

production of the remedies are the cause of much of the criticism by the scientific
community, who question the efficacy of the remedies. Many have been quick to
point out that they believe any effects produced are purely placebo and therefore as
good as taking a ‘dummy pill’ (White et al, 2003). However, due to our inability to
understand the mechanism of action and individualistic nature of the treatment many
argue that current methods of research are unable to truly reflect the efficacy of the
treatment (E. Ernst & E. G. Hahn, 1998). Therefore, I believe it is important we
discuss the current procedure for research studies and how they have been applied to
homoeopathy.

A realisation that all clinical practice should be based on scientific evidence

has recently occurred. This been especially applied to therapeutics to ensure that
treatments provided are efficient and effective at treating patients. There are currently
three approaches to research. These are randomized controlled trials (RCT),
controlled observational trials and uncontrolled observational studies (M. Rawlins and
J. A. Vale, 2005). The RCT is widely accepted as being the most accurate at judging
the benefits of treatments whereas the other two study methods are seen as less
reliable (S. Barton, 2000). The RCT can be further split into 2 different designs the
parallel group design, which we will be focusing on, and the Cross-over design. The
parallel group design method requires the selection of patients with a certain condition
to obtain one of two treatments. The treatments are distributed randomly to each
patient, in order to reduce patient bias by not allowing the patient to be aware of what
type of treatment has been allocated to them. This is known as the single-blind trial.
To further reduce any bias from the distributors of the treatment, the treatment
distribution is also withheld from them. This is known as a double-blind trial. When
trials are being designed to test if a treatment is better than another, this is known as a
superiority trial. In this type of trial the treatment being assessed is sometimes
compared to a placebo. These methods all combined form the basis of the RCT and is
the reason it is the ‘gold standard’ for all trials (M. Rawlins and J. A. Vale, 2005,
p998). RCTs have been conducted for homoeopathy in the past. These have been
done through an assessment of patients to see if they are suitable for the specific
homoeopathic therapy which is under scrutiny. Then these patients are included in the
trial and then randomized in the conventional method (W. Lehmacher, 1998, p6).

There have been over 200 RCTs of homoeopathy which have been published.
Within this there are several review articles by a variety of authors including J.
Kleijnen, P. Knipschild & G. ter Riet (1991). The vast majority of these studies have
shown that homoeopathic medicine does have an improved effect over the placebo
given in the trial. However, many people within the scientific community have
claimed that these trials have significant fundamental methodological errors
concerning the lack of statistical evidence. Furthermore, large numbers of positive
trials is not recognised as evidence of efficacy for any treatment. This is due to the
inherent nature of publishers to preferentially publish positive results. This
phenomenon is known as publication bias and with its extent in this situation
unknown due to our inability to tell how many studies have occurred in this area is a
valid concern (J. Kleijnen, P. Knipschild & G. ter Riet, 1991)

In addition, more recently studies have shown that homoeopathic remedies

prescribed by an experienced homoeopathic practitioner are no more effective then
placebos. The study conducted was a randomised, double-blind, placebo controlled
trial which aimed to compare the effects of individualised homoeopathic remedies
against a placebo. The outcomes were measured through a questionnaire on the
quality of living which was given at the start of the trial and again at the end (White et
al, 2003). Other claims from major journals such as The Lancet have called for
doctors to be open about the ‘lack of benefit’ that homoeopathic drugs provide to
patients (M. Egger, 2005). Furthermore, there have been other studies which looked
at the efficacy of homoeopathy in relation to inducing labour. These trials also
presented negative results for the use of homoeopathic remedies (C. A. Smith, 2001).
This trial however has been criticised by O’Meara et al. (2002) for having a small
sample size. O’Meara et al. however, suggests that further trials are required with
larger sample sizes. In addition, Waalch (1998) claims that the RCT are not suitable
studies for looking at homoeopathy. He calls for the acknowledgement that causal
efficacy should be tested for alongside clinical effectiveness in order to really judge
homoeopathy. Furthermore, homoeopathy is not as simple as a single specific
treatment to a disease. It should however, be considered as a therapeutic approach
which is holistic and may in many places surpass conventional medicine due to the
unique relationship which is formed between the practitioner and the therapist.
Walaach (1998) highlights that the double-blinded trials place an added insecurity on
the mind of the homoeopathic doctors due to their inability to tell if the treatment is
not working because of the placebo allocation or whether it is to do with the treatment
not being the correct one for the patient. This may lead to the doctor in the study
assuming that any therapies not functioning are as a result of the patient taking the
placebo rather then it being the wrong remedy. This could therefore produce false
negatives and positives. Furthermore, any studies conducted also can contribute to the
discomfort of patient thus not allowing the patient to really provide very personal
psychological habits such as sexual behaviour and jealousy. This will therefore not
allow a homoeopathic doctor to truly build up a ‘symptom picture’ which as a result
will not allow the correct treatment to be administered (H. Walaach, 1998, p49-55).

There have been several reviews looking at homoeopathy in a generalised

way. One of these reviews compared individualised homoeopathy with a placebo or
no treatment in a randomised, quasi-randomised or in double-blind trials. The results
where pooled from nineteen trials, with the results suggesting that homoeopathy had a
significant effect against the placebo. However, if this list was narrowed down to
trials with a good methodological quality, the statistical significant encountered
initially was no longer apparent. Conversely, due to the clinical heterogeneity i.e. the
use of different population features such as some of the trials containing placebo and
others with no treatment the results may contain statistical heterogeneity. Therefore as
a result any conclusions which can be drawn from this review must be observed with
caution. Other reviews have looked at the effectiveness of homoeopathy in
comparison to conventional treatment. In these reviews it has been found that
homoeopathy is more superior to conventional drug therapies in treatment of
rheumatoid arthritis and otitis media in children. However, problems also have arisen
with this review due to a lack of information on the details of the individual studies
not being presented (O’Meara et al, 2002).

A study conducted by Vincent & Furnham (1994) looked at perceived

effectiveness of homoeopathy in comparison to other complementary medicines as
well as with orthodox medicine by the public. The results of the study clearly showed
that the majority of people believed that orthodox medicine was the most effective at
treating life-threatening conditions such as cancer and myocardial infarction.
However, complementary therapies including homoeopathy where seen to be
particularly effective in treating minor conditions such as hay fever and insomnia as
well as more chronic conditions such as allergies and asthma. Furthermore, this study
uncovered a belief that psychological factors were associated with the effectiveness of
these therapies. However, the authors of this trial felt that this did not necessarily
mean that patients view complementary therapies as placebos rather that the other
therapies took the psychological perspective more into account (A. Furham, 1998,
p209).

Current NHS policy on the provision of homoeopathic treatment is the need of

a patient to request a letter of referral by their GP to either a homoeopathic hospital or
clinic (British Homoeopathic Association, 2006). Recently, there has been much
debate on whether the NHS should provide such services with Prof. G. Born, urging
the NHS to reject homoeopathy due to its lack of evidence to prove efficacy. This call
does seem to be having an affect, with many NHS Trusts planning to withdraw
funding or restrict funding to this particular area of therapy. However, many
supporters of homoeopathic treatment, particular those who provide therapy within
the NHS feel that homoeopathy is very effective when used in conjunction with
conventional medicine (BBC, 2007)

After careful analysing the information on homoeopathy I feel that there is

insufficient data to suggest any recommendations for its use in the NHS for specific
treatments. However, I do feel that there is also not enough data to merit any
significant change to the provision of homoeopathy on the NHS.
It is clear from all the trials on the efficacy of homoeopathy that there is
neither evidence to suggest its therapeutic effect or that it simply has a placebo effect.
From many systematic reviews which have correlated results from different trials it is
apparent that all produce positive results highlighting that homoeopathy has an effect
greater then that of a placebo. However, after careful examination of the
methodological quality the studies many of these trials come under dispute (O’Meara
et al, 2002). Also factors such as publication bias must also be taken into account for
assessing the actual validity of the number of positive results as there is no clear
indication of the total number of trials actually carried out on this area (W.
Lehmacher, 1998, p6). Furthermore, recent trials conducted by White et al. (2003)
have also added data which proves that homoeopathy has no significant effect for
certain medical conditions such as asthma. However, the arguments made by Waalch
(1998), which are given as a response to negative research results I feel, are also valid.
The individualistic nature of homoeopathic medicine and the consultation process
alongside the detailed history, which a homoeopathic practitioner obtains from his
patient all contribute to the treatment. It is these aspects of homoeopathy which are
standardised during RCTs and therefore remove their influence in the trials. In
addition, many past researchers of pharmacological agents have pointed out that there
is in many cases a large gap of knowledge between what RCTs indicate and long-term
clinical management in daily practice (B. G. Charlton, 1991). Therefore, I feel that I
must agree that more specially designed trials which take into account both clinical
efficacy and effectiveness need to be performed.
Research also into the perceptions of the effectiveness of homoeopathy must
be considered as well. There is evidence from a study carried out by Vincent &
Furnham (1994) that complementary therapies do have a significant role to play in
treatment. This further supported by surveys which show a substantial uptake of
complementary therapies in UK and Northern Ireland. Many patients believing that
complementary medicine can be combined with conventional medicine to produce a
truly positive outcome (BBC, 2007). With these changes in trends and the apparent
willingness of patients to privately pay for such treatments I believe that by removing
homoeopathy from the NHS could possible give the public a negative view on
conventional medicine and its supporters. This could therefore potentially lead to
patients feeling obliged to choose one method or the thus causing more harm then the
intended good. Furthermore, I feel homoeopathy can be integrated with conventional
medicine particularly for those patients who request the services. This would as a
result allow a doctor to satisfy his requirement to treat the patient holistically.
 Furthermore, there are no studies which provide evidence that homoeopathy
will have a positive or negative impact on the economic situation of the NHS.
Therefore homoeopathy really should not be ruled out until such studies are
conducted into the economic condition of the NHS (A. R. White, 1998, p219). I do
however; understand the frustration felt by many scientists who feel homoeopathy
should be removed of the NHS. The unclear basis of the homoeopathic mechanism of
action and the lack of studies which can conclusively prove its efficacy seem to point
to the fact that homeopathy is merely relaying upon a two hundred year old tradition
of general observation. Waalch (1998) and many other homoeopathic supporters feel
that this is proof in itself that homoeopathy is an effective treatment.
However, within the present day situation where budgets are beginning to
tighten on the NHS, trials need to be conducted thoroughly with some of the finer
points of the trials being changed to produce the most natural environment for the
study. Obviously, these changes must also minimise any bias which can be introduced
into the scenario. It is important that these trials are undertaken as quickly as possible
in order for a balanced judgement to be made on the future of homoeopathy in the
NHS.
References

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