Americans spent about $2.9 billion on homeopathic medicines in 2007, according to the NHIS, but debate still rages over whether it is effective. So a recent article in the BMJ raised the question: Should doctors recommend homeopathic medicine to patients?
Homeopathy was developed in Germany at the end of the 18th century, and is comprised of two main theories. First, like treats like: A disease can be cured by a substance that provokes a similar response in healthy people. And second, the lower the dose of the medication, the greater its effectiveness.
These may seem like scoff-worthy notions to some people, but the ideas do have interesting correlations in peanut allergy studies. For example, a 2014 study gave children doses of 2-800 mg of peanuts, with doses increasing over the course of several months. By the end of the second stage, the children given the oral peanut immunotherapy were able to safely consume about 10 peanuts.
In other words: Low-dose exposure to the substance provoking an allergy helped participants tolerate the allergy much more greatly than those not exposed.
But, a 2015 assessment by Australia’s National Health and Medical Research Council concluded that the evidence in favor of homeopathy is nonexistent. Further, while the FDA does regulate homeopathic remedies, it does not evaluate them for safety or effectiveness, meaning as long as they meet certain criteria (“Conditions Under Which Homeopathic Drugs May be Marketed”), they can be sold to the public, regardless of whether they help you or contain harmful doses.
So what did doctors have to say on the matter?
Those in favor
Doctor Peter Fisher, the director of research at the Royal London Hospital for Integrated Medicine, argued in favor of doctors recommending homeopathic treatment. His first target was aforementioned Australian government study.
He told the BMJ, “this report used unusual methods of analysis: The reviewers assumed that a positive trial showing a homeopathic treatment to be effective was negated by a different trial showing a different homeopathic treatment for the same condition to be ineffective. But the fact that one homeopathic treatment for a condition is ineffective doesn’t mean that another is ineffective.”
Further, he argued, the study entirely ignored some homeopathy reviews and meta-analyses (statistical techniques used to combine the findings from independent studies in order to identify patterns and relationships between them). For example, some studies targeting specific illnesses found positive effects from homeopathic treatment, including childhood diarrhea, vertigo, and the upper respiratory tract infections and allergies.
There are also several nationwide studies that show the utility of homeopathy. “Studies in France and Germany show that general practitioners (GPs) who integrate homeopathy in their practice have better outcomes than those who do not, for a range of conditions commonly treated in general practice; costs are equivalent and homeopathic GPs use fewer antimicrobial drugs.”
Finally, he urged that doctors “put aside bias based on the alleged implausibility of homeopathy,” saying they should recommend its use in an integrated manner.
Those opposed
Edzard Ernst, MD, PhD, and emeritus professor of the University of Exeter, opposes doctors recommending homeopathy.
His first argument targeted the second principle of homeopathy—the small dosages. While he acknowledged the fact that some homeopathic substances are known to be pharmacologically active, the amounts found in remedies may be suspect. “One of the most commercially successful remedies, for example, is based on an extract of duck liver in the C200 ‘potency,’ which means it is diluted at a ratio of 1:10 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000,” he wrote.
Next, he mentioned the lack of evidence from trials: “To avoid cherry picking, it is advisable to evaluate the totality of the reliable evidence. Most independent systematic reviews of randomized controlled trials have failed to show that homeopathy is effective, and reviews with positive conclusions usually have serious methodological flaws.” He posits that the perceived benefits of homeopathy are nothing more than placebo effect.
Finally, he noted that homeopathy can be harmful, both physically and financially. “As the typical homeopathic remedy is devoid of active molecules, it is unlikely to cause serious adverse effects. However, even a placebo can cause harm, if it replaces an effective therapy. In the words of the Australian report: ‘People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.’ ”
Plus, residents of the EU spends more than $1 billion on homeopathic remedies, including some millions spent the National Health Service in the UK. “These funds could and should be spent more usefully elsewhere.”
THE BOTTOM LINE
It appears that one of the major problems with proving homeopathy is study design. As homeopathic treatments are often specialized to patients, it’s difficult to garner a large group for a study. Further, studies and meta-analyses face issues with investigator biases and design flaws, meaning that few people seem able to agree which ones are, in fact, factual.
What do you think? Do you have any experiences with homeopathy? Let us know in the comments!
Follow Susanna Pilny on Twitter @PlinyTheShorter
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