Homeopathy in the paediatric population

To the Editor;

As paediatricians and physicians who practice or take an interest in homeopathy, we broadly welcome the Canadian Paediatric Society’s position statement on homeopathy (1). Specifically, we welcome the recommendation that physicians should respond to questions about it in an informed and nonjudgemental manner. Regrettably, because of its bias against homeopathy, we wonder whether the statement will contribute to this laudable objective.

The bias is most clearly manifest in the very different treatment of criticisms of trials with positive and negative results for homeopathy. For instance, a double-blind, placebo-controlled study of a homeopathic preparation for chemotherapy-induced stomatitis in children with a positive result is described as suffering from “multiple design problems”. What exactly are these design problems? Not only are these problems not specified but no criticisms of this study have appeared in Medline-listed journals. We are unable to detect any serious flaws beyond the relatively small sample size, and this study would achieve a high Jadad score. In contrast, the position paper makes no criticism of a negative study in asthma of which multiple criticisms have been published (2). The Community Paediatrics Committee was aware of these criticisms (they appear in the reference list, references 48 to 51) yet did not mention the highly critical reaction. This trial could not have had a positive outcome because of a “ceiling effect” (ie, the values for the principal outcome were normal when patients entered the study, and could not have been expected to improve further). Some of the secondary outcome measures also suffered ceiling effects, but those that did not consistently favoured homeopathy.

A study on attention deficit hyperactivity disorder described as a “nonrandomized, noncontrolled trial” was said to suffer from “major methodological problems”. In fact, this was a good quality observational study, with an encouraging result: 75% of children improved by at least 50% in a mean period of 3.5 months. Again, there are no published criticisms. This study does not suffer from major methodological problems unless the Committee takes the view that observational studies are inherently flawed. It is true that such studies cannot distinguish specific from non-specific effects or from regression to the mean, although of course the traditional placebo-controlled trial cannot distinguish nonspecific effects from regression to the mean, unless it incorporates a waiting list or no treatment control. But observational studies also have important strengths, principally that they describe ‘real world’ situations. In addition, there is a double-blind trial of homeopathy for attention deficit hyperactivity disorder with a positive result, which is not cited (3). Similarly, there are three meta-analyses that examine homeopathy as a whole, all of which have essentially positive conclusions. Yet, the most recent of these is referenced only to criticize trial quality. However, the overall positive conclusion is not even mentioned (4), and a number of other instances of bias could be quoted.

Despite these misgivings, we fully share the Committee’s concern about the impact of homeopathy on immunization. Opposition to immunization is clearly not part of the authentic homeopathic tradition; however, it has come to pass that many nonmedical homeopaths oppose it. We deprecate the advice against childhood immunization. Hahnemann, the founder of homeopathy, was unequivocal in his support of vaccination: “… the remarkable and salutary result of the widespread use of Jenner’s cowpox vaccination. The small pox has not since then appeared among us with such widespread virulence. Forty or fifty years ago, when a city was stricken, it lost at least half, often three-quarters of its children” (5). The United Kingdom (UK) Faculty of Homeopathy, a statutory body that admits only legally recognized health professionals, firmly supports childhood immunization (a statement can be found, for instance, in the guidelines of the UK Department of Health [6]). Most medical practitioners who utilize homeopathy integrate their practice of it with conventional medicine, including immunization.

As the position paper acknowledges, homeopathy is widespread and popular and increasingly so. We would add that it is also very popular in all countries of the Indian subcontinent and some important Latin American nations, notably Argentina, Brazil (where it is part of the public health system) and Mexico, and that it has stood the test of time. The main reason for its popularity, broad geographical spread and durability is that many people find it to be a safe, low cost and effective form of treatment. The Community Paediatrics Committee is not alone among bodies representing the medical establishment in countenancing almost any explanation for the popularity of homeopathy except the obvious one – that it is effective!

Homeopathy has been reviewed many times in the past, frequently in much less-reasoned tones than this position statement. The effect of such criticisms has not been to diminish its use, but rather to force it into a disaffected, disenfranchised medical counterculture where it has become associated with ideas such as anti-immunization (and dubious ‘electronic machines’, which we likewise deprecate) to the detriment, above all, of patients. This hypothesis is supported by the sharply different attitudes to immunization of homeopathic doctors and unregistered practitioners (7).

The evidence for homeopathy is not conclusive, but, as all three comprehensive meta-analyses agree, on balance, it is positive. The interests of our young patients are much better served by genuine dialogue than by ‘spinning’ the evidence.