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. 2000 May 13;320(7245):1341.

The debate over complementary medicine continues

Evidence for homoeopathy is lacking

David Ramey 1
PMCID: PMC1127328  PMID: 10885926

Editor—Apologists for homoeopathy must continue to overlook a mounting tide of evidence that the remedies are not effective. Indeed, there have been at least 13 reviews and meta-analyses conducted since the mid-1980s on various aspects of homoeopathy.1,2 These reviews have failed to identify a single condition for which the remedies are efficacious and, more recently, have noted that the best studies show no effect. Add to the mix the fact that homoeopathic remedies are at odds with well established principles of physics, chemistry, and pharmacology, and one has ample grounds for sustained scepticism.

What is of most concern about the article on homoeopathy by Vickers and Zollman is the selective quotation in the discussion.3 The authors noted that “practitioners select a drug that would, if given to a healthy volunteer, cause the presenting symptoms of the patient” but failed to note that blinded studies have shown that such volunteers are unable to distinguish between homoeopathic remedies and water.4 Vickers and Zollman also stated that “there is currently insufficient evidence concerning the relative benefits of the different approaches to treatment” while failing to note that there is no evidence or good reason to believe that there is benefit to any of those approaches. The authors also said that the “notorious Benveniste affair, which involved accusations of fraud and scientific misconduct after the publication of an in vitro experiment in Nature, continues to dampen enthusiasm for basic research in homoeopathy” while failing to note that at least three attempts at replication of the experiment using similar or identical methodology have failed. There are numerous other examples.

One wonders at what point the evidence showing that the medications are ineffective and, indeed, cannot be effective will be adequate to convince the true believers in homoeopathy. Most likely it will be never, as evidence does not seem to be able to consistently change beliefs.

References

  • 1.Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol. 1999;52:631–636. doi: 10.1016/s0895-4356(99)00048-7. [DOI] [PubMed] [Google Scholar]
  • 2.Ernst E, Barnes J. Meta-analysis of homoeopathy trials. Lancet. 1998;351:366–368. doi: 10.1016/S0140-6736(05)78310-0. [DOI] [PubMed] [Google Scholar]
  • 3.Vickers A, Zollman C. ABC of complementary medicine: homoeopathy. BMJ. 1999;319:1115–1118. doi: 10.1136/bmj.319.7217.1115. . (23 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Wallach H. Does a highly diluted homeopathic drug act as a placebo in healthy volunteers? Experimental study of belladonna 30C in a double blind crossover design—a pilot study. J Psychosomatic Res. 1993;37:851–860. doi: 10.1016/0022-3999(93)90174-e. [DOI] [PubMed] [Google Scholar]
BMJ. 2000 May 13;320(7245):1341.

“Complementogenic” disease may be increasing

Anne M Pettigrew 1

Editor—Your series on complementary medicine was timely.1-1 More and more problems are caused by patients' use of complementary and alternative medicines, and all doctors should ask patients specifically about their use of these treatments as it may well be that much NHS time and money is being wasted on “complementogenic” disease. It is only since I qualified as a homoeopath that patients have been open in admitting that they use such treatments, and a recent survey at our large general practice found that over 50% of the women aged 20-60 were consulting complementary practitioners or taking supplements or herbal products. In discussions of these problems at a journal club, other practitioners have been surprised at how many symptoms can be attributed to supplements. Certainly a few treatments such as kava (Piper methysticum), which is rich in coumarins which interfere with warfarin, have been mentioned in the BMJ in the past year.

In our practice we have seen a case of severe dyspepsia caused by zinc, which had been bought by mail after hair analysis by mail, being taken at six times the recommended daily allowance; a patient with blood pressure that was difficult to control because of ginseng; a patient with severe headaches on waking caused by evening primrose oil; and a patient with myopathy caused by creatine, to mention only a few. These conditions necessitated an endoscopy, a medical referral, and a computed axial tomography scan, as well as numerous blood tests. The aetiology was only ascertained by direct questioning. All cases resolved when the patients stopped taking the substance. We suspect that these cases represent the tip of the iceberg.

Caution should be exercised in condoning the use of any supplement or herbal preparation without checking with a pharmacist or reliable source. Many herbal remedies are dangerous to patients with epilepsy or diabetes and to those taking warfarin; they also have the propensity to cause illness in those who are otherwise healthy and not taking drugs.

It is to be hoped that the scientific committee in the House of Lords that is looking at complementary and alternative medicine will regulate the sale of these products and the practice of those who supply them; it is important that we educate ourselves to recognise their potential problems and acknowledge why our patients seem so keen to consult practitioners other than ourselves. Perhaps if more doctors qualified in the treatments known to be superior to placebo, such as homoeopathy and acupuncture, there would be less need for patients to consult other practitioners.

References

  • 1-1.Vickers A, Zollman C. ABC of complementary medicine: homoeopathy. BMJ. 1999;319:1115–1118. doi: 10.1136/bmj.319.7217.1115. . (23 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2000 May 13;320(7245):1341.

Debate of the 1840s is revisited

Peter Morrell 1

Editor—Vickers and Zollman's article on homoeopathy was a balanced account of homoeopathic medicine.2-1 However, the ensuing dialogue between medicine and “evil quackery” shows some parallels with that in the 1840s. In both cases, the engagement has been vigorous and hostile; alternative medical systems were booming then, just as they are today.

The pressure of public popularity is driving the worldwide growth of alternative medicine.2-2 Clearly patients who turn to alternative medicine are unhappy with some aspect of conventional treatment, and they should reveal their motives to their doctors. Unless their disappointments are addressed, more patients will inevitably flock to such therapists. Holistic treatments may offer slender hope to patients, but they seem to prefer hopes to drugs and surgery.

Many people refer to the unproved efficacy of homoeopathy and the “ludicrous” nature of its minimum doses. The usual argument is that because “it cannot work” therefore “it does not work.” In the 1840s, Sir John Forbes, physician to Queen Victoria's household, called “the infinitesimal doses” of homoeopathy “an outrage to human reason.”2-3 Its successes were written off as “self limiting diseases.” But as patients know, few diseases improve when left alone. Thus, to claim that homoeopathy works because patients “would get better anyway” does not square with human experience: if doing nothing for self limiting diseases is the reason that homoeopathy works, then why should anyone bother giving any drugs at all?

It is doubtful that patients would pay high fees for treatments of no value. The argument that they are rich and desperate (or stupid) enough not to know whether a treatment works seems unconvincing. Vickers and Zollman state that there is a lack of “evidence that homoeopathy is clearly efficacious for any single condition.” How does one define “evidence” when homoeopaths deny the existence of single conditions? Trials of homoeopathy have been disappointing, but the weight of anecdotal evidence must count for something. In the 1850s it was widely predicted that “medical fads” such as homoeopathy would fizzle out in a few years.2-4 That they have failed to do so either indicates that they do work or stands as a testament to human credulity.

The growing demand for these treatments is a central and uncomfortable reality which medicine must face up to.2-5

References

  • 2-1.Vickers A, Zollman C. ABC of complementary medicine: homoeopathy. BMJ. 1999;319:1115–1118. doi: 10.1136/bmj.319.7217.1115. . (23 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2-2.Sharma U. Complementary medicine today: patients and practitioners. London: Routledge; 1992. [Google Scholar]
  • 2-3.Nicholls PA. Homeopathy and the medical profession. London: Croom Helm; 1988. p. 121. [Google Scholar]
  • 2-4.Inglis B. Fringe medicine. London: Faber; 1964. [PMC free article] [PubMed] [Google Scholar]
  • 2-5.Freund P, McGuire M. Health, illness and the social body: a critical sociology. Upper Saddle River, NJ: Prentice Hall; 1995. [Google Scholar]

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