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• W1519167910 abstract "People have been using homeopathy for the last 200 years and for almost all of that time it has been a matter of debate largely because of its mechanistic implausibility. Historically, homeopaths have been pilloried for being nothing more than quacks and consequently any positive evidence that has emerged in relation to the clinical effects of homeopathy has been questioned by conventional doctors. Interestingly, homeopaths were among the first to initiate clinical trials [1] and that included randomization and placebo so their efforts to produce good science predate Bradford Hill by more than a hundred years. However, the often quoted observation that those receiving homeopathy during the last great London cholera outbreak in 1856 were far more likely to survive than those treated conventionally may have been because homeopathy elicits less side effects than conventional medicine, particularly when the conventional medicine at the time involved bleeding already dehydrated patients [1]. This debate has moved into the 21st century through the process of meta-analysis and systematic review. People continually review and re-review a limited body of clinical research in homeopathy looking for evidence that the remedy has a real effect. Linde et al. in 1997 and 1998 [2,3] produced systematic reviews for The Lancet, suggesting that homeopathy was certainly more than placebo. Subsequently, Shang et al. [4] re-analysed the same data and focused on slightly different questions coming to entirely the opposite conclusion. The process of systematic review involves a great deal of science and statistics but also considerable judgement in relation to the inclusion and exclusion of particular studies and the specific research question posed. In an area such as homeopathy where there are limited, small amounts of data, how you ask the question and include or exclude certain particular clinical trials has a very substantial effect on the ultimate conclusion. What is clear from the homeopathic literature is that there is very little of it that is clinically relevant. Many trials look at interesting models where single homeopathic remedies can be prescribed, for instance post-surgical paralytic ileus where homeopathy is almost never used in practice on a surgical ward. Another series of trials [2] looked carefully at isopathy particularly in relation to simple allergies like asthma and hayfever [5,6]. These studies, both equally rigorous, again came to entirely different conclusions in apparently similar populations. This serves only to deepen our confusion rather than present us with any realistic enlightenment. However, an interesting series of trials looking at individualized homeopathy may be important. The treatment of fibromyalgia requires a classical homeopathic approach. It is an illness that causes great distress in clinical practice and is associated with high morbidity and diminished quality of life. Three studies have looked at individualized homeopathy versus placebo using slightly different methodology. In Fisher et al.'s study carried out during in the late 1980s [7], patients were selected on the basis that they could be individualized to one particular remedy (Rhus tox) they were then randomized to receive either the real treatment or the placebo. Studies by Relton et al. [8] and Bell et al. [9] allowed the homeopath to choose any homeopathic individualized remedy at any potency and again compared real treatment with placebo. The fact that this now presents a body of systematic work, all of which suggests that individualized homeopathy has an effect that is greater than placebo must give us cause for considered thought. However, are fastidious randomized controlled trials the right way forward? Rutten et al.'s [10] work presents us with an approach that is firmly embedded in clinical practice. We must remember that the discipline of homeopathy has been rigorously recorded in these vital materiae medicae and it is the continual updating of these clinical encyclopaedias that allows the homeopath to select an appropriate remedy that may actually treat the patient's presenting condition. It is very probable that only through a rigorous and pragmatic study of homeopathy in a clinically relevant environment will we really be able to ascertain whether some of its fundamental ‘rules’ are simply an obtuse fiction or have some scientific validity. Inappropriate and externally invalid placebo controlled randomized clinically trials have not, by and large, addressed the relevant issues within clinical practice and it is essential that we design experiments that do address the clinical practice of homeopathy. Rutten et al.'s approach is to use clinical practice as the basis to try and address whether expected signs and symptoms and consequent clinical improvement can be linked, and if they can, how likely is that link to result in a long-term and sustained positive clinical outcome. He presents us with a mechanism of evaluating homeopathy in clinical practice, as it is practised, in accordance with a whole system approach [11,12]. Homeopathy has its foundations in careful observation in practice. It is therefore very likely that if we are to create a body of literature that reflects the reality of homeopathic practice, we will only be able to achieve this through identifying methodologies that pragmatically but rigorously reflect the approach suggested by Rutten et al. He has suggested a small step that should identify ‘likelihood ratios’ from major presenting symptoms and to try and link an appropriate homeopathic prescription with a positive clinical outcome. Rather than attempting to apply homeopathy to the pharmaceutically based predominant methodology, he has instead developed a methodology that reflects the validity of homeopathy as a whole system. This work is in its early stages but within its conceptual and philosophical framework it presents an important development that needs to be rigorously and thoughtfully assessed. Professor Lewith's post is funded by a grant from the Rufford Maurice Laing Foundation." @default.
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• W1519167910 date "2009-12-01" @default.
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• W1519167910 title "The conundrum of homeopathy. A Commentary on Rutten, A. L. B. & Stolper, C. F. (2009)" @default.
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• W1519167910 doi "https://doi.org/10.1111/j.1365-2753.2009.01261.x" @default.
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