Make your own free website on Tripod.com

Creighton Home PageEfficacy

Up Scientific Validity Efficacy

Some homeopaths reject or choose not to defend Hahnemann's spiritual approach regarding the vital force and claim that regardless of the mechanism, homeopathic remedies actually work.  They argue that there are many conventional treatments are accepted without knowing why they work and that there are measurable effect of homeopathic remedies and these drugs should be used without regard to why they work to their mechanism.

Do homeopathic remedies work?  

Most people would agree that homeopathic remedies have indeed provided comfort and relief for many people.  However, the vast majority of the scientific community believes that the relief seen by these patients is exclusively due to the placebo response.    In the days of Hahnemann, such placebo treatment was preferable to the invasive, unpleasant and life-threatening treatments offered by the allopaths.  On this page the arguments equating homeopathy with a placebo are examined.  In the next section, we examine aspects of the placebo response itself.  

How do you evaluate the clinical efficacy of a drug?

The best clinical trials (i.e. those giving the most unequivocal results) have the following attributes:

Strict eligibility.  Patients selected for the study should have the same condition, at about the same stage of illness.  The number of patients recruited should be large.  
Strict endpoint.  Criteria for positive and negative response should be delineated before the study and should rely on objectively measurable parameters (e.g., blood pressure, tumor size, etc.)
Placebo controlled.  A group of patients should receive a drug that has the exact same appearance as the test drug and given by exactly the same regimen.  The difference between the response in the placebo group and the test drug represents the response of the drug.  In studies where it would be unethical to use placebo (e.g. an established treatment has already been shown to be better than placebo), the response to the test drug is compared to that of the established treatment
Double blinded.  Neither the patient nor the persons conducting the study should be aware of the identity of the the treatment (drug or placebo) in the protocol.
Multi-centered.  The trial should be replicated at different sites by different personnel simultaneously to ensure reliability of the data.  

Homeopathic Remedies Work No Better than Placebos.

A major difficulty in evaluating specific homeopathic remedies is the lack of good clinical data regarding specific remedies.  No published homeopathic study fulfills all of the criteria set forth above.  Homeopathic remedies have not been shown to be reliably better than placebo in carefully conducted clinical trials.  Some recent meta analyses (a study of all the studies) of homeopathy clinical trials showed no benefit of homeopathic remedies as compared to placebo. Some other meta analyses have shown some benefit.   Interpretation of meta analyses is risky, especially for the evaluation of homeopathy, because the quality of the studies that are lumped together is uneven.  Further, the studies examined tested different types of drugs for different types of illnesses.  This would not be useful or acceptable in conventional medicine.  

Clinical trials of homeopathic remedies fall into three categories:

Negative outcome.  Few negative studies with good or bad design are published in reputable journals showing that homeopathy doesn't work.  
Positive outcome, but poorly designed.  Represents the bulk of the output from the alternative and homeopathic medicine literature.  Unfortunately, many of these studies can not be relied upon due to their subjective nature and lack of proper controls.  
Positive outcome, well designed.  Few studies have had a positive outcome.  Below we will discuss the three most often cited as evidence for a specific healing response to homeopathic remedies.

Some Positive Studies

Hay Fever Study:  David Reilly and colleagues (Lancet 1986; ii:881-886) compared a homeopathic pollen remedy (30C) to placebo in hay fever in 144 human subjects.  They showed a small but statistically significant worsening of symptoms during the first two weeks of treatment but a small but significant improvement in the two weeks after completion of the treatment that was associated with a reduction in the amount of antihistamine needed to control their symptoms.  A summary of the published critiques:
Despite the huge potential impact, the study has never been repeated.  This is critical in the study of medicine.  Clinical trials are notoriously subject to unnoticed influences and effects.  All medical observations must be repeatable in a scientifically verifiable way.  (Note: an additional study, in which allergic asthma was the topic was performed subsequently by Reilly, et al.  (Lancet 1994 Dec 10;344(8937):1601-6).  The results of this very small (28 patients) were similarly positive, but suffer from the same deficiencies as the other study and do not constitute a replication of earlier work.  
The assessment of the response was subjective.  
only 67% of the patients who started the study finished it.  This is a low number of completions for a 5 week study.
The chemical composition of the treatment and the placebo was not assessed.  
Hay fever exhibits a large placebo response and ha a waxing and waning character that makes it hard to study clinically.  
Migraine study:  Brigo et al (Berlin J. Res Homeopathy 1991; 1: 98-106) reported that a homeopathic remedy performed significantly and dramatically better than placebo in a randomized 
Subsequent studies by Whitmarsh and colleagues at Charing Cross Hospital showed no effect of such treatments compared to placebo (Cephalalgia. 1997 Aug;17(5):600-4; J Altern Complement Med 1997 Winter;3(4):307-10).  Thus the study of Brigo, et al was not reproducible, and homeopathic treatment was no better than placebo.  
It should be noted that in the case of these migraine trials a number of patients did undergo dramatic responses; in the Whitmarsh study, the responses were evenly distributed between the placebo and treatment group, demonstrating the robustness of the placebo response in clinical trials
Benveniste Affair:  Benveniste and colleagues published a paper in Nature (Nature 1988; 333:316-318) that appeared to demonstrate that homeopathically prepared antiserum for IgE could cause human basophil degranulation.  This appeared to be clear evidence of the efficacy of a homeopathic remedy , since no placebo response was possible in isolated cells.
A team of scientists, including the noted skeptic James Randi, visited the Benveniste lab and concluded that the experimental methods employed were flawed (Nature 1988; 333: 287-290). 
A subsequent study by Hirst et al., duplicated the conditions under which Benveniste reported positive results and could find no effect of the treatment on degranulation (Nature 1993; 366: 525-527. 

Conclusion

Homeopathy appears to be an elaborate method for the manufacture of placebos.  This notion offends most homeopaths; however, people have been finding relief in placebos for thousands of years.