  
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. |
