One of the most frequent criticisms of homeopathy is that it lacks a research basis. While perhaps true several decades ago, this criticism is no longer accurate. Homeopathic research has advanced considerably in the past several years. Methodological issues in homeopathic research however continue to distort this debate.
Despite these issues however, positive research continues to accumulate in favor of homeopathy.
In this blog post I will be going over some issues in homeopathic research, and some of the new homeopathic research taking these issues into account.
Methodology:
Due to differences in availability of research funding, very little homeopathic research is actually done by homeopaths. It is, quite frequently, conducted by researchers with very little understanding of how homeopathy works, or is practiced.
Quite frequently such studies would involve a procedure based on the prevailing pharmacological research model. This usually involves administering a given homeopathic remedy for a given disease. These trials, for the most part, are negative, with a few exceptions (for example arnica for post operative pain). Some examples follow below:
http://www.ncbi.nlm.nih.gov/pubmed/20233176
http://www.ncbi.nlm.nih.gov/pubmed/18251757
http://www.ncbi.nlm.nih.gov/pubmed/17362845
http://www.ncbi.nlm.nih.gov/pubmed/17105693
http://www.ncbi.nlm.nih.gov/pubmed/17227743
This research model in now way reflects homeopathic practice. In normal homeopathic practice the clinician will compile an individualized picture of the symptoms of the patient. This individualized picture is arrived at in a very different way from allopathic diagnoses( for a more complete view on this I refer the reader to Divided legacy vol 1-4 By Harris Coulter). More recent research has taken this selection process into account, and this has led to an increase in the positive findings of the trials. Much of modern research ahs also included homeopathics with multiple ingredients, which tend to be more successful, as they have more efficacy for a wider variety of patiens. Examples follow below:
http://www.ncbi.nlm.nih.gov/pubmed/20129178
http://www.ncbi.nlm.nih.gov/pubmed/20807867
http://www.ncbi.nlm.nih.gov/pubmed/19647206
http://www.ncbi.nlm.nih.gov/pubmed/19305007
http://www.ncbi.nlm.nih.gov/pubmed/19135954
http://www.ncbi.nlm.nih.gov/pubmed/17310359
http://www.ncbi.nlm.nih.gov/pubmed/17335565
http://www.ncbi.nlm.nih.gov/pubmed/16781624
http://www.ncbi.nlm.nih.gov/pubmed/16338192
http://www.ncbi.nlm.nih.gov/pubmed/16266440
http://www.ncbi.nlm.nih.gov/pubmed/16060203
http://www.ncbi.nlm.nih.gov/pubmed/19091085
In Vitro research:
In vitro research is conducted in a test tube or petri dish, and involves altering the environment of a research organism ( usually bacteria, plants usually) and observing how they react.
Very interestingly, in vitro research tends to show an very good efficacy rate for homeopathic medicines, showing alteration of multiple physiological variables in multiple organisms. Some examples follow below:
http://www.ncbi.nlm.nih.gov/pubmed/22489193
http://www.ncbi.nlm.nih.gov/pubmed/22226318
http://www.ncbi.nlm.nih.gov/pubmed/21978221
http://www.ncbi.nlm.nih.gov/pubmed/21962197
http://www.ncbi.nlm.nih.gov/pubmed/21962196
http://www.ncbi.nlm.nih.gov/pubmed/20043074
http://www.ncbi.nlm.nih.gov/pubmed/18066110
And very interestingly, as in human clinical trials, there appears to be an increase in sensitivity to homeopathic interventions when the cells under question are sensitised in some way, or made more responsive to thier environment through disruption of their normal homeostatic ( or balance inducing) mechanisms.
For instance, in Benevinistes landmark early study, he discovered that basophils ( a white blood cell type) would react when exposed to what could be described as a homeopathic solution of their triggering chemical. (http://www.ncbi.nlm.nih.gov/pubmed/2455231). This study was replicated, but the replication level remained at about 30%, that is about 30% of attempted replication attempts succeeded ( personal conversation with Dr. Peter Fisher 2009). However when the model was changes slightly, and highly sensitised basophils were used, the reproducibility improved considerably ( http://www.ncbi.nlm.nih.gov/pubmed/19945674)
And lastly the shang et al Meta-analysis:
The last issue to address in homeopathic research is the shang et al meta-analysis (http://www.ncbi.nlm.nih.gov/pubmed/16125589) . Shang did quite a large meta-analysis comparing trials of homeopathy and allopathic medicine. He obtained 110 trials each of allopathy and homeopathy and obtained a conclusion that that the effects of homeopathy are not statistically greater than those of placebo. However this conclusion is called into question by the methods by which the lancet obtained this statistical conclusion.
Firstly, in reaching this final conclusion, the lancet did not compare all 110 trials of allopathic medicine and homeopathy. Shang actually compared 8 studies from each branch of medicine. Moreover, in this comparison he did not identify which studies he used. Shang has, to this day, in personal interviews and public correspondence, refused to identify the trials he used. This precludes any analysis of the methodology of the trials used, as disscussed above. Moreover, it is quite dishonest of Shang to not disclose the full sources of his statistical analysis. It essentially stops any reasonable or rational criticism of the analysis because there is no basis for academic criticism without knowing the exact data Shang bases his meta-analysis on.
The purposes of the study become quite clear when one examines the editorial accompanying that metanalysis (http://www.ncbi.nlm.nih.gov/pubmed/16125567). This editorial was entitled “The End of Homeopathy” and proclamation that based on this analysis, homeopathy it was no longer viable or defensible to use homeopathy, or ascribe any effects beyond placebo to homeopathy.
I strongly suspect that the editorial and this omission in the meta-analysis were not coincidental and I highly doubt that the editorial was meant to be disputed. I suspect is was intended by the author and lancet editorial committee as the final blow against homeopathy as a medical system in the academic role.
However, with great effort, other researchers have managed to reconstruct, or to get the same results that Shang obtained with his analysis (http://www.ncbi.nlm.nih.gov/pubmed/18834714 and http://www.ncbi.nlm.nih.gov/pubmed/19371564). These papers showed that the results of the Shang meta-analysis greatly depended upon which set or clinical trials that were used to obtain the data used in the meta-analysis. Specifically, the inclusion of one study (http://www.ncbi.nlm.nih.gov/pubmed/9758072) caused the meta-analysis to reach a negative conclusion. This study is precisely the type of study I described in the methodology section above, in which a remedy is given in the same manner as an allopathic drug, with no attention payed to the actual methods homeopaths use with their patients. The truly ironic part of this is that one of the researchers in the arnica study which tilted the meta-analysis was Dr. Peter Fisher, the most voracious critic of the Shang meta-analysis. Fishers account of the meta-analysis and the coordinated nature of the intended blow to homeopathy are shown on this website (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375230/)
When the fisher study is removed, the Shang meta-analysis is positive.
Conclusions:
The broad scope of research, taking into account issues of methodology does overall show that homeopathy has a greater effect than placebo. Very little of this research focuses on how homeopathic remedies work, or their mechanism of action. This mechanism of action remains mysterious.
However the actual relevance of all this research to the daily life of someone practicing homeopathy, or someone who chooses it as their system of healthcare is minimal. Almost all homeopathic research is focused on the question of whether or not homeopathy actually works, and not on anything that would helpful in the clinic.
However that does not mean that there is no tradition of knowledge gathering in homeopathy. There is, and it is a very large and dynamic one. This tradition is called the proving. It will be the subject of my next blog.
Take care of yourselves!
Dr. Paul..