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1.How do I choose a good homeopath?

Choose a fully qualified and registered homeopath and avoid homeopaths who shun conventional medicine. Homeopathy and conventional medicine can work well together and a good homeopath will always refer you to a medical doctor or specialist, if necessary. It's also worth knowing that there are many medical doctors out there who are qualified homeopaths.

This is probably the most frequently quoted, completely inaccurate statement about homeopathy. Homeopathy research is a relatively new field, so it's true to say that there are not a huge number of studies, but some evidence is very different from no evidence.

By the end of 2014, 189 randomised controlled trials of homeopathy on 100 different medical conditions had been published in peer-reviewed journals. Of these, 104 papers were placebo-controlled and were eligible for detailed review:

  • 41% were positive (43 trials) – finding that homeopathy was effective.
  • 5% were negative (5 trials) – finding that homeopathy was ineffective
  • 54% were inconclusive (56 trials)
How does this compare with evidence for conventional medicine?
An analysis of 1016 systematic reviews of RCTs of conventional medicine had strikingly similar findings:
  • 44% were positive – the treatments were likely to be beneficial
  • 7% were negative – the treatments were likely to be harmful
  • 49% were inconclusive – the evidence did not support either benefit or harm.
Although the percentages of positive, negative and inconclusive results are similar in homeopathy and conventional medicine, it is important to recognise a vast difference in the quantity of research carried out; chart A represents 189 individual trials on homeopathy, whereas chart B represents 1016 reviews on conventional medicine, each analysing multiple trials.

This highlights the need for more research in homeopathy, particularly large-scale high quality repetitions of the most promising positive studies.

The difference in quantity is also not surprising when one considers the tiny amounts of funding made available for research into 'complementary and alternative medicine' (CAM). For example, in the UK only 0.0085% of the total medical research ?budget is spent on CAM, of which homeopathy is only one example.

Many people believe that all high quality randomised controlled trials (RCT) testing homeopathy have been negative. This is untrue.

Below are examples of positive high quality RCTs and systematic reviews/meta-analyses testing various types of homeopathy:

  • Individualised homeopathic treatment for diarrhoea in children. A meta-analysis of three placebo-controlled randomised trials by Jacobs et al. 2003 showed that homeopathic treatment reduced the duration of diarrhea (p=0.008).
  • Individualised homeopathic treatment for ear infections (otitis media) in children.
  • The homeopathic medicine Galphimia glauca for hay fever (allergic rhinitis).
  • The isopathic medicine Pollen 30c for hay fever.
  • The complex homeopathic medicine Vertigoheel for vertigo.
More research is needed to confirm the findings of these promising studies, particularly large-scale repetitions by other research teams.

The issue of 'cherry picking'

'Cherry picking' is the practice of publishing or quoting only the positive trials on a given treatment, whilst ignoring conflicting negative trials. This can lead to distortion of the evidence, which is why there has been a recent drive to force research institutions and drug companies to disclose all trial results – both positive and negative – so that the balance of evidence can be considered in its entirety.

When strong positive studies are presented to critics of homeopathy, they often say that this is cherry picking because there are other negative trials on homeopathy. However, those negative trials are only relevant if they were testing the same homeopathic treatment for the same condition.

In the case of the studies listed above, to our knowledge there are no other repetitions of these trials which had negative results, so the evidence is unrefuted.

The need for replication of existing studies

As research in homeopathy is a relatively new field and there is very limited funding to support new trials, few high quality studies have been carried out, let alone repeated.

As and when more studies become available testing these same homeopathic treatments further, the evidence base will be updated as these findings are either confirmed, or contradicted, by new findings.

Some herbs and aromatic substances can directly decrease the effectiveness of homeopathic remedies. More importantly, however, other treatments that relieve or remove symptoms make it difficult for the homeopathic physician to fully appreciate the totality of your symptoms and thus find the proper homeopathic remedy.

Laboratory experiments have demonstrated that homeopathic medicines are not just sugar pills
Critics of homeopathy point to the fact that homeopathic medicines are so highly diluted that there is 'nothing in them'.

This comes from the fact that the liquids used to make some homeopathic medicines are diluted beyond the threshold known as Avogadros number (dilution 10-23). This means that the liquid is so highly diluted that you would not expect any molecules of the original substance to remain.

It is these 'ultra-high dilutions' (homeopathic medicines above 12c or 24x potency) which attract controversy, because they clearly cannot work in the same way as conventional medical drugs i.e. through molecules interacting directly with the body’s biochemistry.

Researchers around the world are investigating the mechanism of action of these medicines, which is likely to be based in physics rather than chemistry. Although there are various theories being explored, as yet, we do not understand how homeopathic medicines work.

What we do know is that many laboratory studies have shown ultra-high dilution homeopathic medicines having biological effects you would not see if they were 'just water' or 'just sugar pills',

for example:
Adding homeopathic histamine to basophils (white blood cells) can trigger them to release histamine.
Homeopathic thyroxine, at the ultra-high dilution of 30x, slows down the rate at which tadpoles turn into frogs.

Are these results just artifacts from 'bad science'?

This argument does not hold up to any scrutiny because even experiments with a high methodological standard can demonstrate ultra high dilutions (a.k.a. 'high potencies') having effects.

Why are these results not accepted by some scientists?

So far, no positive result has been stable enough to be reproduced by all researchers every time. Close to 75% of in vitro experiments on ultra-high dilutions show the substance having an effect, and nearly 75% of replications have been positive.

As scientists gain more experience experimenting on ultra-high dilutions, they are gradually understanding what factors are influencing the results and consequently, reproducibility is improving 9. The basophil and frog experiments described above have proved the most repeatable so far and progress is also being made in finding the most repeatable plant-based experiments.

However, until an experiment is achieved in which every team gets the same effect every time, this field will remain controversial. This is the ongoing challenge for basic science researchers in homeopathy.

The key appears to be in exactly how homeopathic medicines are made

Homeopathic medicines are made from plant, chemical, mineral or animal sources. The original material is diluted, then agitated vigorously (succussed). The number of times this is repeated determines the strength or ‘potency’ of the remedy e.g. a ‘6c’ remedy will have been diluted 1 part in 100 then succussed, six times over.

If you only dilute the substance over and over, of course you are eventually left with an inactive sample which is ‘just water’; it is the added succussion between each step of dilution which appears to imprint information from the original substance, into the water/alcohol it is diluted in.

This idea is supported by experiments which show that unsuccussed dilutions are inactive, but succussed dilutions can cause biological effects, suggesting that this aspect of the manufacturing process is essential in creating homeopathic medicines.

Exactly what physico-chemical changes succussion causes, and how this enables water to capture information about the substances diluted in it, are the big questions researchers are trying to answer.

Some people take the position that public money should not be spent on homeopathy because 'there is no proof that it works' or 'tax-payers money shouldn't be spent on placebos'.

How much does homeopathy cost?

  • In 2016, just £92,412 was spent on 40,000 homeopathy prescriptions from a total expenditure of £9.2 billion.
  • Out of the total NHS budget of £100 billion a year, roughly £4 million (0.004%) is spent annually on Homeopathy if you include everything from running the hospitals departments to paying the doctors.
When considering value for money, it should be remembered that if homeopathy patients were not treated with this service, they would have to be treated by other departments using more expensive conventional drugs.

Evidence-informed decision-making

Some people argue that the NHS should not pay for homeopathy because it has not been 'scientifically proven' to work , whereas conventional medical drugs are 'tried and tested'. Surprisingly this issue isn’t actually as clear-cut as one might think.

Analysis by the British Medical Journal's (BMJ) Clinical Evidence3 shows that just 11% of 3,000 commonly used NHS treatments are known to be beneficial:

This data clearly indicates that the NHS pays for many treatments besides homeopathy for which the evidence is still unclear.

What evidence is there that homeopathy helps NHS patients?

Five published observational studies carried out from 1999 to the present day have tracked the outcome of patients being treated at NHS homeopathic hospitals. These studies consistently show that patients improve clinically following homeopathic treatment (often from chronic, difficult to treat conditions); some also highlight areas of potential economic benefit in terms of reduced prescribing of conventional drugs. For example:

The largest study at Bristol Homeopathic Hospital followed over 6,500 consecutive patients with over 23,000 attendances in a six-year period. 70% of follow-up patients reported improved health; 50% reported major improvement.

A 500-patient survey at the Royal London Homeopathic Hospital showed that many patients were able to reduce or stop conventional medication following homeopathic treatment.

When assessing these clinical results it is important to remember that NHS patients are usually referred for homeopathy because conventional medicine has failed to give satisfactory results, or conventional treatment is contra-indicated in their case. One has to ask, if these homeopathy services were not available, who could treat these people instead? How ethical is it to remove a service that is currently valued by patients, without being able to offer them a viable alternative treatment?

Interesting related research from France

Homeopathy is widely used in France and a major study following 8559 patients attending GP practices was used to assess the effectiveness of homeopathic treatment. The authors of this study include Lucien Abenhaim – former French General Director of Health (Surgeon General) – and individuals from respected academic institutions such as the Institut Pasteur in Paris, University of Bordeaux and McGill University, Montreal.

Key findings of the EPI3 project:
  • Upper respiratory tract infections (URTIs) –
  • patients treated by GPs trained in homeopathy did as well clinically as those treated with conventional medicine, but used fewer conventional drugs.
  • Musculoskeletal disorders (MSDs) –
  • patients treated with homeopathy did as well clinically as those treated with conventional medicine, but used only half the amount of non-steroidal anti-inflammatory drugs (NSAIDs) and had fewer NSAID-related side effects.
  • Sleep, anxiety and depressive disorders (SADD) –
  • Patients treated by certified homeopathic physicians were less likely to be prescribed psychotropic drugs.

Only one study has compared the quality of homeopathy research with that of conventional medicine. Overall the homeopathy trials were found to be of higher quality than the conventional trials they were compared to.

Researchers compared 110 homoeopathy trials and 110 matched conventional-medicine trials: 21 homeopathy trials and 9 conventional-medical trials were assessed as ‘higher quality’ (19% of homoeopathy trials and 8% of conventional-medicine trials).

This study shows that raising research standards is an ongoing issue for both homeopathy and conventional medicine.

It is also true that some homeopathy studies are poor quality, particularly those carried out some decades ago which fall short of today’s quality standards.

However it is clearly not true that all homeopathy studies are poor quality. There are good quality studies which have found that homeopathy is effective.

There are critics who claim that homeopathy is ‘pseudoscience’ and only non-scientists are interested in the subject.

In fact, scientists in highly respected universities, research institutions and hospitals around the world are carrying out research into homeopathy using the same research techniques as those used to investigate conventional medical treatments.

Homeopathy research is a relatively new field, but the number of articles published in peer reviewed journals has risen significantly over the past 40 years.

This lag behind conventional medicine is hardly surprising when one considers the lack of funding available e.g. in the UK less than 0.0085% of the medical research budget is spent on research into complementary and alternative medicines.

International Research Conferences
  • Barcelona 2013 – Cutting Edge Research in Homeopathy.

  • The inaugural HRI International Homeopathy Research Conference was held in Barcelona in June 2013. The programmed included presentations by 5 Professors and 40 doctors (PhDs or medics) from over 20 countries, covering clinical, experimental and veterinary research.

  • Rome 2015 – Cutting Edge Research in Homeopathy

  • The 2nd HRI International Research Conference, held in Rome on 5-7 June 2015, continued the ongoing theme of Cutting Edge Research. The programme included presentations on clinical, fundamental and basic research, by 6 Professors and 28 doctors (PhDs or medics) from 17 countries.

  • Malta 2017 – Cutting Edge Research in Homeopathy

  • The 3rd HRI International Research Conference was held in Malta from 9-11 June 2017, continuing the established theme of Cutting Edge Research. The programme included presentations on clinical, fundamental and basic research, by 4 Professors and 28 doctors (PhDs or medics) from 18 countries.
So in what way is homeopathy ‘unscientific’?

Well-qualified scientists in respected institutions are continuing to carry out high quality basic research, clinical research and veterinary research in homeopathy, and are reporting their results in the peer-reviewed scientific literature. Therefore, the only basis for the argument that it is ‘pseudoscience’ is that we do not know how homeopathy works.

Usually, when a phenomenon is observed which cannot be explained by what ‘science’ already knows, this triggers fresh scientific enquiry – it is not dismissed as ‘unscientific’ purely because it has yet to be understood.