Yes to pluralistic health system, but no to homeopathy

I read the article by Chaturvedi et al¹ with great interest and would like to congratulate the authors for bringing a timely perspective on inclusion of traditional medicine (TM) in the movement towards universal health coverage (UHC) in India. TM can offer pathways to fill in critical therapeutic gaps as well as enhance access to care. Further, TM systems, specifically Ayurveda, deserves research attention and resources for establishing necessary evidence base and such focus will help the Indian health system in the long run.

However, this was an opportunity for the authors to explicitly discard homeopathy. While it is a complementary/alternative medicine system, homeopathy does not fall under Indian traditional medicine and it has consistently failed to prove its therapeutic potential. Based on unproven and controversial ideas such as ‘like cures like’, ‘extreme dilution’, and ‘dematerialized spiritual force’ among others, homeopathy originated in late 18th century Germany.² It was introduced in India by Imperial Austrian physician Dr. J. M. Honigberger in 1839.³ If inclusion of TM is supposed to be a part of the decolonial movement as suggested by the authors, then exclusion of homeopathy is necessary.

More important than its colonial origins is the lack of evidence for efficacy and safety of homeopathy for treating common ailments and severe diseases. Since the first trial conducted in 1835 that questioned homeopathy's efficacy,⁴ multiple randomized controlled trials (RCTs) and other studies compiled in several systematic reviews and meta-analyses have shown that there is no reliable and clinically significant effect of non-individualized or individualized homeopathic treatments across disease conditions ranging from irritable bowel syndrome in adults to acute respiratory tract infections in children when compared to placebo or other treatments.5, 6, 7, 8, 9, 10 Even reviews that support homeopathy's efficacy consistently caution about low quality of evidence and raise questions on its clinical use.^11,12 The most recent analysis of reporting bias in homeopathic trials depicted problematic trial conduction practices that further obscure reliability and validity of evidence.¹³ Homeopathic treatments have also been linked to aggravations and non-fatal and fatal adverse events.^14,15 The Lancet has previously published on another kind of harm that uptake of homeopathy encourages in India: delay to evidence-based clinical care that can lead to fatality.¹⁶

Authors have pointed out that evidence for some of the alternative systems of medicine may not come from RCTs. I agree that more appropriate study designs and analytical techniques are needed for carefully studying individualized treatment paradigms. However, the need for agreement on some consistent form of evidence synthesis and empirical testing across diverse disciplines cannot be discounted. Several other disciplines including psychology, economics, community health, implementation science, and public policy have adopted RCTs and related study designs and have passed the empirical tests of efficacy. Moreover, the ideas around mechanism of action in case of homeopathy still remain controversial and lack evidence after over a century. On the contrary, biochemical, molecular, and physiological mechanistic evidence supporting allopathic treatments has grown abundantly in the same period.

Owing to lack of evidence on its efficacy and safety, the World Health Organization had previously warned against the use of homeopathic treatments for severe diseases.¹⁷ Additionally, multiple countries, including Germany where the practice originated, have initiated mechanisms that discourage uptake of homeopathy while others are considering banning it.¹⁸ Homeopathy doesn't work, could be harmful, and is not a part of Indian traditional medicine. While we should welcome pluralistic approaches towards UHC, we need to drop homeopathy.

Declaration of interests

None.