On Our Agenda: Debating Homeopathy
This week the BMJ published a debate between two researchers over the effectiveness of homeopathy in treatment of illness. Should Doctors Recommend Homeopathy? played off a 2015 Australian NHMRC report citing that homeopathy was ineffective.
In the BMJ debate Peter Fisher, Director of Research at Royal London Hospital for Integrated Medicine writes,
“A recent review by the Australian National Health and Medical Research Council concluded that “there are no health conditions for which there is reliable evidence that homeopathy is effective.”3 But this report used unusual methods of analysis: the reviewers assumed that a positive trial showing a homeopathic treatment to be effective was negated by a different trial showing a different homeopathic treatment for the same condition to be ineffective. But the fact that one homeopathic treatment for a condition is ineffective doesn’t mean that another is ineffective. In addition, several key meta-analyses were unaccountably omitted.4 5 6”
Fisher says the medical and scientific opinion of homeopathy has been influenced by negative reports such as the NHMRC’s, yet public popularity is not waning. Even the Swiss government has concluded that homeopathy is “probably” effective for upper respiratory tract infections and allergies.12
Fisher cites clinical evidence accessible the CORE-HOM database of clinical research in homeopathy free of charge (www.carstens-stiftung.de/core-hom). It includes 1117 clinical trials of homeopathy, of which about 300 are randomised controlled trials.
In addition, patients in France accessing homeopathic treatment for musculoskeletal conditions used less non-steroidal anti-inflammatory drugs.17
However Edzard Ernst, Emeritus Professor at University of Exeter hits back, saying that just because homeopathy hasn’t been proven to not work, doesn’t mean that it does work. In fact, it has yet to be proven that it does work (did you follow that?).
He says, “the perceived benefits of homeopathy are caused by non-specific effects. Once these are adequately controlled for in trials, the results tend to show that highly dilute homeopathic remedies are indistinguishable from placebos. Even a former consultant of the Royal London Homeopathic Hospital has agreed, writing, “The great majority . . . of the improvement that patients experience is due to non-specific causes . . . Homeopathy has not been proven to work.”22
Ernst also worries about those using homeopathy at the delay of other treatments, or as a replacement all together (we only have to look at the popularity of wellness bloggers to see how many are willing to try these treatments).
"The axioms of homeopathy are implausible, it's benefits do not outweigh its risks, and its costs and opportunity costs are considerable. Therefore, it seems unreasonable, even unethical, for healthcare professionals to recommend its use." he says.
Dr Nik Zeps who worked on the NHMRC report has responded to the debate. He is a research scientist at the University of Western Australia and a member of the NHMRC Homeopathy Working Committee.
“Peter Fisher makes several incorrect assertions about the methodology used in the NHMRC report which undermine his conclusions. The report was based upon a review of systematic reviews of clinical trials involving the use of homeopathy. As such it was the least biased evaluation of the current evidence that is possible and no important reviews were omitted to our knowledge. The quality of the reviews and the trials they were based upon found that most studies were unreliable due to the possibility of bias or poor design.
He also incorrectly suggests that the Swiss commissioned a report that was favourable forhomeopathy. As highlighted in the NHMRC report this was a public submission from a call for submissions made by the Swiss government and to imply it is a government sanctioned report is a misrepresentation of its status that appears to be commonly made by proponents ofhomeopathy.
Of course, we need to question the patient’s wishes as well. Joanne Barnes, Associate Professor in Herbal Medicines, School of Pharmacy, University of Auckland, says,
“This does not mean that health professionals should be dismissive if asked about homoeopathy by their patients. Patients are free to choose to use homoeopathic products and it is desirable and important that they are able to have respectful, non-judgemental and open conversations about this with health professionals responsible for their care. Highly dilute homoeopathic remedies are unlikely to cause adverse reactions or to have interactions with conventional (pharmaceutical) medicines if used concurrently.”
“However, patients should not stop taking conventional medicines without seeking advice from the prescriber of those medicines. If patients choose to use homoeopathic products, they should be advised only to use products that are manufactured according to the principles of good manufacturing practice, which is the pharmaceutical industry standard for quality of medicines.”
And finally we need to remember the potential side effects of mixing complementary medicines with pharmaceutical products. As Grant Kardachi writes in our Winter Issue of Australian Hospital and Healthcare Bulletin,
Combining St John’s Wort with other medicines can lead to serious consequences including organ rejection (e.g. cyclosporin), worsening of HIV-AIDS (e.g. indinavir), risk of blood clots (e.g. warfarin) and breakthrough bleeding or unwanted pregnancy (e.g. oral contraceptives).
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