Hi Everyone. So a great deal of disscussion has been conducted online about the scientific evaluation of Homeopathy. Given the recent emphasis on Evidence based Medicine, and it’s methods of evaluation, much of the recent discussion has focused on Randomised Controlled Clinical Trials which have generally been accepted as the best methods to evaluate clinicl interventions (although I would refer readers to Harris Coulter’s publication on the subject for a more full view).
In short, a Randomized Controlled Clinical Trial is an examination of the results of an intervention, performed on different, but theoretically identical, populations. The intervention should be indistinguishable, and the evaluation of the patients should be done in such a way that any human element, or analysis, is conducted without knowledge of which group of patients have received which intervention.
This type of study is designed very well for allopathic style interventions. It presumes that the intervention is singular, static, and does not require feedback after administered, ie., as many prescription drugs. Homeopathy is not well suited to this style of trial, without some significant adjustments, for a number of reasons.
- Finding the remedy is difficult. The process of remedy selection is a challenging process, involving the consideration of multiple factors, etiology, the mental emotional state, and of course, the eventual success of administration. The only way to determine whether a remedy was Homeopathic to a case is the patient responding to the remedy, that is, feedback. Feedback and dose adjustment
- Sensitivity to Homeopathic Remedies varies. Some individuals will aggravate from the lowest potencies of a remedy, others need higher potencies than normal. Many individuals fall somewhere in the middle of susceptibility to remedies. Finding a proper Homeopathic prescription involves finding not only the right remedy, but the right potency.
- Potency changes as patient’s course unfolds. Almost universally, when a successful remedy and potency is found, over time the patient will respond progressively less to repeated doses of that potency, eventually failing to respond whatsoever. At this point, a higher, more potentised preparation of the same remedy is required.
- Occasionally intercurrent remedies, or remedies addressing a specific issue or obstacle to cure, will become apparent. When this occurs, the case must be retaken, a new remedy or other intervention performed, and the older remedy stopped. Often the older remedy can be restarted after the particular inercurrent remedy has completed it’s work
- Remedies change, oftentimes a person will completely resolve their symptom complex with a given remedy, and then will no longer requiring it, either needing no remedy, or another suited to whatever picture emerges.
These traits of Homeopathic care each require detailed feedback and adjustments to therapy. This kind of adjustment is impossible in a placebo controlled setting.
Despite these problems, a number of methodological refinements have been made to the process of clinical trials which do make this method of examination more suited to the examination of Homeopathy.
- The first refinement is to have the Homeopathic practitioner select the remedy and do whatever process of feedback needed to settle on an effective remedy, then blind the patient as to whether or not they are receiving the remedy or placebo, and measure their condition under both placebo and verum. The best example of this style of trial is Heiner Frei’s excellent trial of ADHD. You can read this trial here. While this does not address remedies changing, intercurrents, or the need for increased potency, it is certainly an improvement.
- The second refinement is to pre select for patients who will respond to a particular remedy. The premier example of this type of trial is Peter Fisher’s older trial where patients who would match the symptoms of Rhus Tox were screened from a population, and administered the remedy. You can read this trial here. While this method also does not account for individual sensitivity to remedies, need for increased potencies, intercurrent remedies or remedies changing, it still is a good method.
- A third method is to use prescribers with high levels of accuracy, and have a big enough sample size that it becomes possible to demonstrate smaller improvements, which are the likely outcome with all of the methodological issues described above. Numerous example of these trials exist, but one can be found here.
Despite these issues, as Mathie has demonstrated in his famous 2014 paper, the overall picture of Clinical trial research into individualized Homeopathy as a whole is positive. Due to a lack of trials in Homeopathy, it is difficult to assess individual conditions with any great accuracy. However, a metanalysis has recently been performed with respect to Homeopathic treatment of depression. In it, the researchers found 18 studies, including two placebo controlled trials, both positive, and one with a low risk of bias. Overall the researchers concluded that while the evidence was promising, but that more high quality studies were needed, but that the safety profile was potentially excellent ( as compared with the Standard of care of antidepressants with thier numerous side effects and increased risk of suicide). As Homeopathy research increases in quantity and quality, these suggestions will be met, and numerous other conditions will be studied.
The common line of discussion against Homeopathy is that it lacks evidence. This is fundamentally untrue, and those who repeat it are either ignorant or being actively deceptive. As Mathie demonstrated, the overall trend of Individualized clinical trial data is positive, even if it requires higher quality studies to be absolutely definitive. Taking these methodological issues into consideration when designing clinical trials will result in trials more accurately reflecting Homeopathic practice, and will assist in us producing the good evidence which will likely not silence our critics, but will end any legitimate scientific debate about Homeopathy.