As a fourth study says it's no better than a placebo, is this the end for homeopathy?
As a fourth study says it's no better than a placebo, is this the end for homeopathy?
Sarah Boseley, health editor
Friday August 26, 2005
The Guardian
Homeopathy, favoured medical remedy of the royal family for generations and hugely popular in the UK, has an effect but only in the mind, according to a major study published in a leading medical journal today.
The conclusions of the Lancet analysis are a body blow for proponents of homeopathy, which has been around for 250 years and has attained cult-like status among its aficionados.
Swiss scientists compared the results of more than 100 trials of homeopathic medicines with the same number of trials of conventional medicines in a whole range of medical conditions, from respiratory infections to surgery. They found that homeopathy had no more than a placebo effect.
A hard-hitting editorial in the Lancet, entitled "The end of homeopathy", demands that doctors recognise the absence of real curative powers in homeopathic medicine. Around 42% of GPs in England will refer patients to a homeopath. In Scotland, where homeopathy has taken off to an even greater extent, 86% are said to be in favour of it.
It is hardly surprising that homeopathy does badly compared with conventional medicine, it says - it is more surprising that the debate continues after 150 years of unfavourable findings. "The more dilute the evidence for homeopathy becomes, the greater seems its popularity."
Some patients, unhappy with their treatment within the impersonal and hurried NHS, may well see in homeopathy "a holistic alternative to a disease-focussed, technology-driven medical model", it says. But they could be endangering their health.
Personalised care
"Now doctors need to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalised care."
Homeopathy was developed in Germany by Samuel Hahnemann in the late 1700s.
Hahnemann, a doctor and a chemist, believed that disease showed the body was out of balance, and that this could be put right by the "similia principle" - otherwise known as "like cures like". The theory is that a tiny dose of whatever is the source of the problem, diluted in many parts water, will stimulate the body into combating it.
Homeopathic remedies are tailored to the individual, which is part of their appeal. A homeopath will assess not just the physical cause of the illness but also the emotional state of the patient and their personality and temperament, before deciding what remedy to use.
The argument that many doctors and scientists have had with homeopathy is that the remedies are so dilute that it is unlikely they can have any effect on the body at all. Some do not contain even one molecule of the original herb. Homeopaths argue that the water retains the memory of the herb or mineral's "vital essence".
The authors of the new Lancet study were Matthias Egger and colleagues from the University of Berne in Switzerland. They looked at 110 trials using homeopathic remedies and 110 using conventional medicine in matching conditions.
They looked for an effect in both the smaller, low quality trials and in larger, higher quality trials. Homeopathic remedies were more likely to have had a positive effect in the small, low quality trials. In the better trials, they say, homeopathy was no better than placebo. "Our study powerfully illustrates the interplay and cumulative effect of different sources of bias," says Professor Egger. "We acknowledge that to prove a negative is impossible, but we have shown that the effects seen in placebo-controlled trials of homeopathy are compatible with the placebo-hypothesis."
Some would argue that the remedies at least cannot cause harm. Edzard Ernst, professor of complementary medicine at Exeter University, disagrees. Homeopaths expect the remedy to provoke a worsening of the disease before it effects a cure.
"According to homeopathic thinking, if I find the optimal remedy for you, I would expect an aggravation which could be very hefty and put you into hospital for several days with your symptoms," he said. "From the homeopathic point of view, the safety isn't there. They say it is necessary on the way to recovery."
Opposite view
He has known people who have had to be admitted into intensive care with what a homeopath would argue is a worsening of the symptoms prior to recovery, but which conventional medical opinion would say is simply a worsening of an untreated disease.
The new study is published as concern mounts among some doctors about a report, now in draft form, which has been prepared by an office of the World Health Organisation set up to examine traditional medicine.
The report, says Prof Ernst, comes to the opposite conclusion from the Swiss team and finds that homeopathic medicine is effective.
"It is totally scandalous," he said. "It is unbelievable considering it is the WHO. It does all the wrong things and it is very selective in what it includes and it exaggerates the positive conclusions of clinical trials and neglects the negative clinical trials."
A further article in the Lancet says that there is widespread concern among "sceptics of alternative medicine" over the WHO report, which states that most of the studies published in the last 40 years have shown homeopathic remedies to be superior to placebo and "equivalent to conventional medicines in the treatment of illnesses, in both humans and animals".
Xiaorui Zhang, acting team coordinator for traditional medicine at the WHO, who is a former "bare foot" doctor in China who went on to train in traditional medicine at Beijing University, told the journal that the report was only preliminary and that its purpose was to foster research and not to act as a recommendation.
Does alternative medicine work?
Acupuncture
This ancient Chinese therapy usually involves the insertion of fine needles into the body to soothe pains and restore good health.
It is thought to aid the treatment of arthritis, migraines, anxiety, rheumatism and general aches and pains. Advocates also use it to alleviate infertility, menstrual problems, nausea and dizziness.
Acupuncture is thought to be among the best researched and most effective of complementary therapies. Hundreds of studies in recent decades have produced strong evidence that it works for some conditions.
Aromatherapy
This form of treatment involves using essential oils to improve wellbeing. The oils, which have been extracted from plants thought to have therapeutic properties, are administered through massage, baths and inhalation.
It is used to treat a wide range of stress-related problems, as well as being used to promote general health.
Despite about 300 research papers on the subject, there is little evidence to support the effectiveness of aromatherapy in treating the wide range of ailments that aromatherapists claim it can be used for.
Osteopathy
Practitioners use manipulation to correct faulty body structures by releasing tension and stresses to make joints supple. Although similar to chiropractic treatment, osteopaths work on the whole body, while chiropractors tend to concentrate on the spine.
Osteopaths usually specialise in back problems, repetitive strain injury, arthritic pain, sports injuries and ailments relating to posture. Last year a 1,334-patient study concluded that spinal manipulation is a cost-effective addition to standard clinical treatment for back pain.
Alex Kumi
Sarah Boseley, health editor
Friday August 26, 2005
The Guardian
Homeopathy, favoured medical remedy of the royal family for generations and hugely popular in the UK, has an effect but only in the mind, according to a major study published in a leading medical journal today.
The conclusions of the Lancet analysis are a body blow for proponents of homeopathy, which has been around for 250 years and has attained cult-like status among its aficionados.
Swiss scientists compared the results of more than 100 trials of homeopathic medicines with the same number of trials of conventional medicines in a whole range of medical conditions, from respiratory infections to surgery. They found that homeopathy had no more than a placebo effect.
A hard-hitting editorial in the Lancet, entitled "The end of homeopathy", demands that doctors recognise the absence of real curative powers in homeopathic medicine. Around 42% of GPs in England will refer patients to a homeopath. In Scotland, where homeopathy has taken off to an even greater extent, 86% are said to be in favour of it.
It is hardly surprising that homeopathy does badly compared with conventional medicine, it says - it is more surprising that the debate continues after 150 years of unfavourable findings. "The more dilute the evidence for homeopathy becomes, the greater seems its popularity."
Some patients, unhappy with their treatment within the impersonal and hurried NHS, may well see in homeopathy "a holistic alternative to a disease-focussed, technology-driven medical model", it says. But they could be endangering their health.
Personalised care
"Now doctors need to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients' needs for personalised care."
Homeopathy was developed in Germany by Samuel Hahnemann in the late 1700s.
Hahnemann, a doctor and a chemist, believed that disease showed the body was out of balance, and that this could be put right by the "similia principle" - otherwise known as "like cures like". The theory is that a tiny dose of whatever is the source of the problem, diluted in many parts water, will stimulate the body into combating it.
Homeopathic remedies are tailored to the individual, which is part of their appeal. A homeopath will assess not just the physical cause of the illness but also the emotional state of the patient and their personality and temperament, before deciding what remedy to use.
The argument that many doctors and scientists have had with homeopathy is that the remedies are so dilute that it is unlikely they can have any effect on the body at all. Some do not contain even one molecule of the original herb. Homeopaths argue that the water retains the memory of the herb or mineral's "vital essence".
The authors of the new Lancet study were Matthias Egger and colleagues from the University of Berne in Switzerland. They looked at 110 trials using homeopathic remedies and 110 using conventional medicine in matching conditions.
They looked for an effect in both the smaller, low quality trials and in larger, higher quality trials. Homeopathic remedies were more likely to have had a positive effect in the small, low quality trials. In the better trials, they say, homeopathy was no better than placebo. "Our study powerfully illustrates the interplay and cumulative effect of different sources of bias," says Professor Egger. "We acknowledge that to prove a negative is impossible, but we have shown that the effects seen in placebo-controlled trials of homeopathy are compatible with the placebo-hypothesis."
Some would argue that the remedies at least cannot cause harm. Edzard Ernst, professor of complementary medicine at Exeter University, disagrees. Homeopaths expect the remedy to provoke a worsening of the disease before it effects a cure.
"According to homeopathic thinking, if I find the optimal remedy for you, I would expect an aggravation which could be very hefty and put you into hospital for several days with your symptoms," he said. "From the homeopathic point of view, the safety isn't there. They say it is necessary on the way to recovery."
Opposite view
He has known people who have had to be admitted into intensive care with what a homeopath would argue is a worsening of the symptoms prior to recovery, but which conventional medical opinion would say is simply a worsening of an untreated disease.
The new study is published as concern mounts among some doctors about a report, now in draft form, which has been prepared by an office of the World Health Organisation set up to examine traditional medicine.
The report, says Prof Ernst, comes to the opposite conclusion from the Swiss team and finds that homeopathic medicine is effective.
"It is totally scandalous," he said. "It is unbelievable considering it is the WHO. It does all the wrong things and it is very selective in what it includes and it exaggerates the positive conclusions of clinical trials and neglects the negative clinical trials."
A further article in the Lancet says that there is widespread concern among "sceptics of alternative medicine" over the WHO report, which states that most of the studies published in the last 40 years have shown homeopathic remedies to be superior to placebo and "equivalent to conventional medicines in the treatment of illnesses, in both humans and animals".
Xiaorui Zhang, acting team coordinator for traditional medicine at the WHO, who is a former "bare foot" doctor in China who went on to train in traditional medicine at Beijing University, told the journal that the report was only preliminary and that its purpose was to foster research and not to act as a recommendation.
Does alternative medicine work?
Acupuncture
This ancient Chinese therapy usually involves the insertion of fine needles into the body to soothe pains and restore good health.
It is thought to aid the treatment of arthritis, migraines, anxiety, rheumatism and general aches and pains. Advocates also use it to alleviate infertility, menstrual problems, nausea and dizziness.
Acupuncture is thought to be among the best researched and most effective of complementary therapies. Hundreds of studies in recent decades have produced strong evidence that it works for some conditions.
Aromatherapy
This form of treatment involves using essential oils to improve wellbeing. The oils, which have been extracted from plants thought to have therapeutic properties, are administered through massage, baths and inhalation.
It is used to treat a wide range of stress-related problems, as well as being used to promote general health.
Despite about 300 research papers on the subject, there is little evidence to support the effectiveness of aromatherapy in treating the wide range of ailments that aromatherapists claim it can be used for.
Osteopathy
Practitioners use manipulation to correct faulty body structures by releasing tension and stresses to make joints supple. Although similar to chiropractic treatment, osteopaths work on the whole body, while chiropractors tend to concentrate on the spine.
Osteopaths usually specialise in back problems, repetitive strain injury, arthritic pain, sports injuries and ailments relating to posture. Last year a 1,334-patient study concluded that spinal manipulation is a cost-effective addition to standard clinical treatment for back pain.
Alex Kumi
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