Homeopathy Research: State of the Science - Part 3

Clinical research on the efficacy of homeopathy

As mentioned at the beginning of this series, approximately 300 clinical trials have been conducted on homeopathic remedies in recent years. The test methodologies, homeopathic treatment approaches and remedies used in these studies have varied greatly. In evidence-based medicine, it is common to evaluate multiple trials investigating one treatment approach in reviews, in the form of a meta-analysis. In a meta-analysis, the number of patients or individual results from each study are summarized and evaluated in their entirety based on specified statistical criteria. This technique has also been utilized in the past for clinical trials of homeopathic medicines. These approaches and their associated issues are illustrated in the following

To research clinical studies that have been performed on homeopathic remedies and review further literature, consult the CAM-Quest database hosted and maintained by the Karl and Veronica Carstens Foundation: www.cam-quest.org

1. Different treatment methods make comparisons difficult

A general problem present in clinical homeopathy research is that positive study results are regularly disqualified because the study quality would not meet accepted standards. But the presence of negative results casts doubt on the efficacy of the entire treatment direction, even though “homeopathy” is not a uniform method of treatment. For example, in "traditional" or "classical homeopathy,” in which the accurate history (medical history and symptoms) of the patient is an essential part of treatment, the medicines utilized are individually selected. Consequently, the examination of the method according to current standards of clinical research becomes a challenge, since a particular disease is not treated in a large patient group with the same medicine. In addition, there are many other homeopathic treatment methods, such as complex homeopathy, which are more accessible to the standards of clinical research. Correspondingly, the current study situation is just as complex.

2. Review articles on the status of clinical research

The question most discussed in past reviews on the status of clinical homeopathy research has been whether homeopathic remedies work at all, regardless of drug type, treatment method, or particular indication (disease). Thus, a wide variety of clinical studies with homeopathic remedies have been lumped together and considered collectively, without further distinction between test specifics. Just as controversial are the major reviews that have been performed on homeopathy and subsequently widely published.

For example, K. Linde et al. published a meta-analysis in 1997 in which 89 placebo-controlled studies were evaluated in the internationally known medical journal “The Lancet.” The result of the meta-analysis was that homeopathy was statistically proven superior to placebo. R. Mathie, who analyzed 79 studies in 2003, and M. Dean (2004), who included 205 homeopathy studies in his analysis, found similarly positive results establishing the efficacy of homeopathy.

A furor was created by the 2005 overview study by Shang et al., also published in the “The Lancet,” that compared 110 placebo-controlled homeopathy studies with 110 comparable studies of conventional treatment. Though only 8 homeopathy studies and 6 conventional treatment studies were ultimately considered valid enough to be evaluated by the authors, the negative analysis presented of the homeopathy studies spurred the media to proclaim the “end of homeopathy” due to its summation that the lack of efficacy for homeopathy had finally been scientifically proven. The methodology and approach of the Shang et al. study was then heavily criticized by many sources. There has been further heated debate concerning which methods from evidence-based medicine can be used for homeopathy and the extent to which these do justice to homeopathy.

3 New approaches

The current trend in assessing clinical studies is to no longer test “homeopathy“ as a whole, but rather to perform smaller meta-analyses on specific indications, as this method will provide clearer results. Additionally, there are some positive meta-analyses on the efficacy of homeopathy for specific medical conditions. For example, the meta-analysis by Taylor et al. and the study by Lüdtke and Wiesenauer support the efficacy of homeopathic treatments for hay fever. In addition to these meta-analyses, there are several other positive analyses, such as those for the homeopathic treatment of fibromyalgia and life-threatening diarrhea in children.

Building on the knowledge that individualized treatment, especially in the field of classical homeopathy, can only be reproduced with difficulty using the usual standards of evidence-based medicine, increasing attempts are being made to demonstrate the efficacy of homeopathy using health services research methods. The long-term treatment success of homeopathically treated patients is investigated in what are referred to as outcome studies. The largest outcome study included about 4,000 patients and was published in 2005 by Witt et al. Generally, such studies demonstrate that the health of patients can be significantly improved with homeopathic treatments, and often, in the case of chronic diseases, the use of conventional drugs can be reduced or even completely avoided. Of course, critics of homeopathy attribute these successes exclusively to placebo effects.

Outlook for clinical research

In general, it is clear that the current state of research on the efficacy of homeopathic remedies and therapies is in much better shape than is often alleged by critics. There is abundant scientific literature that supports the efficacy of homeopathy. But, even though the existence of several hundred studies seems significant at first glance, it is still minuscule compared to the number of published clinical studies for conventional treatments. Due to this fact, it is important to address the positive results already obtained in order to verify and expand on them. To accomplish this goal, however, clinical homeopathy research needs more financial support.

The main problem is that clinical homeopathy research has thus far been almost exclusively financed through funds from complementary medicine foundations and homeopathic medicine manufacturers. Systematic research into the clinical efficacy of homeopathic remedies has not, as of yet, been supported by public research funds. Accordingly, the quality of many homeopathy studies has been called into question, since they are often not carried out in the same dimensions (e.g., number of participating patients and clinics) as conventional pharmaceutical research studies. However, as profit margins for complementary medicine remedies are significantly smaller than those of many conventional medicines, which can routinely cost many hundreds of dollars, and because homeopathic remedies can not be patented, very limited resources for clinical research are provided by pharmaceutical manufacturers. There are relatively few resources, especially in the field of basic research on the mechanism of action of potentized remedies, and the high-quality, large-scale studies demanded by critics can cost upwards of $5,000,000. In addition, as long as the sponsors of homeopathy research consist exclusively of complementary medicine-oriented foundations and homeopathic pharmaceutical manufacturers, allegations that the so-called “homeopathy lobby” is influencing study results may be difficult to refute.

However, as the acceptance of homeopathy in the population is very high, as several surveys have shown, and health services research studies into homeopathy attest to positive effects, it should also be in the public interest to increasingly support this research using public funds.

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