The Case for Homeopathy
B. POSITIVE CLINICAL EFFECT OF HOMEOPATHY IN MANY CONDITIONS
THE PLACE OF HOMEOPATHY IN CLINICAL CARE
i. Shortcomings of RCT’s (randomized controlled trials)
ii. Systematic review nullifying the hypothesis that homeopathy does
not have an effect superior to that of other active treatment
iii. Randomized controlled trials showing positive effect of homeopathy
iv. Non-exclusionary guidelines for conditions in which homeopathy may
be used
Shortcomings of RCT’s
Meta-analyses of randomized clinical trials analyse end-points and are
dependent on the quality of research of the individual randomized controlled
trials which are included in the metanalysis. In the previous section
which highlighted the meta-analyses that have shown that homeopathy
has an effect greater than that of placebo, less than half of the RCT’s
were considered by the authors of these reviews to be of superior research
quality. The other RCT’s may have been flawed in their design,
for example studying homeopathic medicines in situations in which they
would not be used, such as bruising after carpal tunnel surgery (bruising
is an infrequent complication after this procedure due to use of tourniquets
intra-operatively) or using end-points which are inappropriate (for
example measuring the effect of homeopathy in asthma compared to a group
of control-patients in whom lung function was minimally impaired: you
cannot improve patients beyond normal!), or have insufficient numbers
of patients for meaningful statistical analysis. This last obstacle
may be overcome by the methodology used in the meta-analysis, but other
weaknesses in study design remain as flaws.
Other evidence may also be used to ‘make the
case’ for homeopathy, such as systematic reviews, or case series,
or case studies.
Systematic review nullifying the hypothesis
that homeopathy does not have an effect superior to that of other active
treatment
A fresh approach to the homeopathic database was taken by Dr. Robert
Mathie, research consultant to the U.K. Faculty of Homeopathy, who conducted
a systematic review of the homeopathic literature, which was published
in the peer-reviewed journal, Homeopathy, in 200310. Dr. Mathie set
out to examine the novel hypothesis that homeopathic treatment does
not have an effect superior to that of other active treatment. His findings
nullified this hypothesis.
Dr. Mathie defined four levels of strength of evidence
in the trials that he reviewed:
i. Multiple trials that showed a positive outcome
ii. Single trials, of good design, that showed a positive outcome
iii. Single trials of poor design that showed a positive outcome
iv. Trials reflecting consensual / experiential validation
He concluded that the present weight of evidence favours
homeopathic treatment effectiveness in eight conditions:
1. Childhood diarrhea
2. Fibrositis (fibromyalgia)
3. Hayfever / allergic rhinitis
4. Influenza
5. Pain (of various origins)
6. Side-effects of radio-/chemotherapy
7. Sprains
8. Upper respiratory tract infection
This remarkable paper demonstrates clinical effectiveness
of homeopathy in the above conditions.
Randomised Clinical Trials showing positive
effect of homeopathy
There is an ever-growing database of randomized controlled
trials highlighting the effectiveness of homeopathy in various clinical
situations. The following selection includes studies in infants, women
in labour and brain-injured people, who are less susceptible to the
power of suggestion, which is part of the placebo effect. This selection
also includes studies in which there are objectively measured end-points,
such as sperm count or pain-points, grip strength and mobility, demonstrating
that homeopathy is not ‘all in the mind’.
Diarrhoea
Dr. Jennifer Jacobs, M.D. Ph.D., studied children with acute diarrhoea
in Nicaragua, where diarrhoea is the primary cause of mortality during
the first year of life and accounts for 19% of all outpatient consultations
in children aged 1-4 years. Her study, published in the prestigious
medical journal, Paediatrics, showed a statistical difference in favour
of children treated with homeopathy: they recovered faster, at less
cost to the health system 11.
This is of particular relevance to South Africa, where
child-hood diarrhoea is a significant drain on scarce resources.
Otitis media
Dr. K. Friese and colleagues published their results of a prospective
trial on children with acute middle ear infection in Biomedical Therapy,
in 1997. They showed that the homeopathically treated children became
pain-free in a shorter time period than those treated conventionally
and had a lower rate of recurrence of infection 12.
A group of Swiss physicians looked at whether homeopathic
treatment of acute otitis media could be demonstrated not to be due
to spontaneous resolution, which happens frequently in acute otitis
media, whether treated with antibiotics or not. The authors found that
pain control was achieved in 39% of patients treated homeopathically
within 6 hours of onset of treatment and another 33% after 12 hours.
This rate of resolution was 3.4 times faster than placebo controls 13.
Head injury
Dr. Chapman M.D., published a pilot study of 60 patients with mild traumatic
brain dysfunction conducted in Boston, which showed a significant improvement
from homeopathic treatment versus the control 14.
Duration of labour
A homeopathic medicine, Caulophyllum 7C, has been shown in double-blind
trials to reduce the duration of labour, defined as period of cervical
dilatation 15.
Vertigo
A study published in the ENT-specialists journal, the Archives of Otolaryngology
16, showed the homeopathic preparation,
Vertigoheel® to be as effective as betahistine, a pharmaceutic preparation,
in significantly reducing frequency and severity of vertigo .
Rheumatoid arthritis
Dr. Gibson compared a group of patients with rheumatoid arthritis treated
with homeopathy to those only on conventional pharmaceuticals 17.
The objective tests, for example grip strength and articular mobility
were more improved in the homeopathic group. 42% of these patients were
able to cease taking their pharmaceutical agents within one year of
taking part in the study.
An additional two points were of interest in this study: objective tests
were carried out to measure effectiveness, it was not just subjective
and also it shows that homeopathic medicines often work for a long time.
Migraines
Dr. Brigo found that homeopathically-treated patients with migraines
showed significant improvement in frequency, intensity and characteristics
of pain 18.
Note that whilst conventional medicine has some powerful drugs to squash
acute migraine attacks, it is not as effective in decreasing the frequency
or intensity of recurrent attacks.
Influenza
Dr. Ferley looked at the treatment of influenza with a single homeopathic
medicine and found that a statistically significant greater number of
homeopathically-treated patients got better (and faster), than those
treated with conventional medicines 19.
Hyperactive children
A group of Swiss paediatricians compared the efficacy of homeopathic
treatment of ADHD children 20 with that
of children treated with methylphenidate (Ritalin).
* 75% of the children treated with homeopathy reached a clinical improvement
rating of 73% versus 65% of children treated with methylphenidate.
* In only 22% of the children in whom initial treatment with homeopathy
did not reach required levels of improvement was it deemed necessary
to transfer them onto methylphenidate.
Male infertility
A clinical outcomes-based study showed that individualized homeopathy
improved sperm count in men with infertility problems 21.
Post-operative ileus
A noted skeptic of homeopathic scientific validity, Professor E. Ernst
of the Complementary Medicine department of the Postgraduate Medical
School, University of Exeter, U.K., performed a meta-analysis of
clinical trials using homeopathy for post-operative ileus 22.
His conclusion, published in the peer-reviewed Journal of Clinical Gastroenterology
in 1997:
“There is evidence that homeopathic treatment can reduce the duration
of ileus after abdominal or gynecologic surgery”.
It is note-worthy that a published skeptic (regarding homeopathy vis
á vis placebo) would reach such a conclusion.
Topical treatment of osteoarthritis
Homeopathy can also be effective when used locally. Dr. P.A. Fisher
of the Royal London Homeopathic Hospital, homeopathic physician to H.R.H.
Queen Elizabeth, found that a homeopathic gel used to treat osteo-arthritis
of the knee was at least as effective and as well tolerated as an anti-inflammatory
gel, in a comparative study published in 2000 in the British Society
for Rheumatology’s journal, Rheumatology23.
Fibromyalgia
A study conducted by the Department of Psychiatry at the University
of Tucson, USA, published in Rheumatology in 200424, assessed the efficacy
of individualized classical homeopathy in the treatment of fibromyalgia.
This was a double-blind, randomized, parallel-group, placebo-controlled
trial in which 62 persons with physician-confirmed fibromyalgia were
allocated ‘LM’ homeopathic medicines, or indistinguishable
placebo in consultation with two experienced homeopaths. The primary
clinical outcomes were tender point count and tender point pain on examination
by a medical assessor uninvolved in providing care, as well as self-rating
scales on quality-of-life, pain, mood and global health. 43 people completed
the protocol. Participants on active treatment showed significantly
greater improvements in tender point count and tender point pain, quality
of life, global health, and a trend towards less depression, compared
to those on placebo.
Guidelines for conditions in which homeopathy
may be used
The U.K. Faculty has published the following (non-exclusionary) guide-lines
for conditions in which homeopathy may be used.
I: No effective allopathic treatment
This is an important group of conditions in which allopathic medicine
is relatively ineffective and homeopathy offers a good alternative.
• Allergies • Anal fissures • Chilblains
• Anger • Bruises • Colic
• Fear/phobias • Glandular fever • Grief
• Intermittent claudication • Impotence • Mastalgia
• Chronic Fatigue Syndrome • Nightmares/terrors •
Warts
• Pre-menstrual syndrome • Teething • Urethral syndrome
II: Unsafe situation for allopathy
• Pregnant women • The elderly • Young children •
Anticipatory anxiety
III: Complementary: reduce long-term allopathic
treatment
• Neuralgias • Menopause • Dysmenorrhoea • Asthma
• AD/HD • Migraine • Otitis media • Constipation
• Eczema • Convulsions
IV: Complementary: reduce symptoms / improve
well-being
• Malignancy • Multiple sclerosis • Parkinson’s
disease
It is emphasized that these guide-lines are merely
that: homeopathy may be used in almost every clinical condition, often
alone. No system of medicine can claim to be complete. Whilst this assuredly
applies to modern ‘conventional’ medicine, as the search
for additional methods of treatment by doctors and their patient’s
attests, this also applies to homeopathy, which may then be usefully
employed alongside whatever other modality of treatment is being used.
References:
10. Mathie R.T. The research evidence base for
homeopathy: a fresh assessment of the literature Homeopathy 2003 92:84-91
11. Jacobs, J. et al. Treatment of acute childhood
diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua.
Pediatrics 1998 93(5):719-725.
12. Friese K.H.Y. et.al. Acute otitis media in
children: a comparison of conventional and homeopathic treatment. Biomedical
Therapy 1997 15:113-122
13. Frei H., Thurneysen A. homeopathy in acute
otitis media in children: treatment effect or spontaneous resolution?
Br Homeopath J 2001 90(4):180-2
14. Chapman E.H. et.al. Homeopathic treatment of
mild traumatic brain injury: A randomized, double-blind, placebo-controlled
clinical trial. J. Head Trauma Rehabil 1999. 14(6) 521-542
15. Eid P. Applicability of homoeopathic caulophyllum
during labour. Brit. Hom. J. 1993 82 245.
16. Weiser, M. et al. Treatment of vertigo: a randomized
double-blind controlled study. Archives of Otolaryngology - Head and
Neck surgery. 1998. 124:8. 879-885.
17. Gibson R.G. Homeopathic Therapy in Rheumatoid
Arthritis: Evaluation by Double-Blind Clinical Therapeutic Trial Br.
J. Clin. Pharm. 1960. 9. 453-459
18. Brigo B. et al Homeopathic treatment of migraines.
Berlin J. Res. Homeopathy 1991. 1(2): 98
19. Ferley J.P. et al Controlled evaluation of
a homeopathic preparation in the treatment of influenza-like syndrome
Br. J. Clin. Pharm. 1989. 3: 329-325
20. Frei H., Thurneysen A. Treatment for hyperactive
children: homeopathy and methylphenidate compared in a family setting
Br Hom J 2001 90(4):183-8
21. Gerhard I., Wallis E. Individualized homeopathic
therapy for male infertility Homeopathy 2002 91:133-144
22. Barnes J. et al Homeopathy for post-operative
ileus? A meta-analysis. J Clin Gastroenterol 1997 25(4):628-33
23. Van Haselen R.A. and Fisher P.A. A randomized
controlled trial comparing topical piroxicam gel with a homeopathic
gel in osteoarthritis of the knee. Rheumatology 2000 39:714-719
24. Bell I.R. et al Improved clinical status in
fibromyalgia patients treated with individualised homeopathic remedies
versus placebo Rheumatology 2004 43(5): 577-82
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