Wednesday, June 06, 2007

What are the active ingredients of homeopathy?

I always thought homeopathic medication was nothing but water, so this title from Biomed Central Complementary and Alternative Medicine naturally caught my eye: Homeopathy – what are the active ingredients? An exploratory study using the UK Medical Research Council's framework for the evaluation of complex interventions. Expecting the latest woo based explanation I was surprised at paper’s results (italics mine)---

Putative active ingredients included the patients' "openness to the mind-body connection", consultational empathy, in-depth enquiry into bodily complaints, disclosure, the remedy matching process and, potentially, the homeopathic remedies themselves.

This paper, largely promotional and uncritical, (the lead author practices homeopathy and the paper contains numerous homeopathy promoting statements) lends insight into the mind of homeopathic practitioners. There is, for example, this revealing statement:

The relative contributions of remedy and context cannot be distinguished either in real-world homeopathy or in this study. Most homeopaths behave as if the remedy is the main active ingredient.

So, the authors seem to acknowledge that any benefits of homeopathy likely derive as much from the empathy and engagement of the practitioner as from the medication (the “remedy”) itself.

So what’s the take home message here? How do these observations inform the debate on homeopathy? From the paper’s abstract:

These findings counsel against the use of placebo-controlled RCT designs in which both arms would potentially be receiving specific active ingredients. Future research in homeopathy should focus on pragmatic trials and seek to confirm or refute the therapeutic role of constructs such as patient "openness", disclosure and homeopathicity.

In other words, don’t study the efficacy of the homeopathic medication with other variables (e.g. practitioner engagement and empathy) controlled. This mindset is already pervasive in much of CAM “research”. Orac provided a good example recently, citing a study of the benefits of Tai Chi which failed to control for the effects of exercise.

I wouldn’t be all hot and bothered, merely amused, by this paper were it not for this statement from Biomed Central Complementary and Alternative Medicine’s masthead: BMC Complementary and Alternative Medicine (ISSN 1472-6882) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE and Google Scholar. Which means, of course, that innumerable woo based papers will be legitimized and, worse, find their way into systemic reviews and meta-analyses.

3 comments:

Jon M. IƱarritu said...

interesting

Clive Stuart said...

As a homeopath, I wouldn't necessarily agree with everything this paper has stated. It is true that the standard double blind RCT is not the best tool with which to evaluate homeopathy. This is because homeopathy is an individualised treatment. For instance 5 different arthritis sufferers will probably get 5 different remedies tailored to their own individual symptom picture.

Having said that Swiss researchers have recently shown that it is possible to incorporate individualised homeopathic treatment into a double blind RCT of children with ADHD. This can be accessed at Springerlink.com and by typing ADHD homeopathy into the search field. The results found homeopathy to be effective for the condition.

Nobody can deny the therapeutic effects of the patient practitioner relationship. This is true for any modality though, be it conventional or alternative medicine. To suggest that this is the only aspect at work in homeopathy is missing the point. There is growing evidence that homeopathic medicines do exert a measurable biological effect on living cells / tissue. Prof Madeline Ennis' study published in "Inflammation research" 2 years back (AKA Belfast homeopathy trials) showed a measurable effect of ultra diluted histamine on basophils. The results were replicated in 3 other labs across Europe.
In my own experience I have seen impressive outcomes in everything from thyroid dysfunction to autism. If placebo worked for autism don't you think it would be the treatment of choice ??

Recently a study found that a specific homeopathic remedy was able to inhibit prostate cancer cell growth.
http://www.trusthomeopathy.org/csArticles/articles/000001/000116.htm
Placebo effect ? Hard to imagine, unless of course they were very suggestible cancer cells.

About 2 years ago a study from India found that homeopathic arsenic was able to reduce arsenic toxicity in placebo resistant mice.
http://news.bbc.co.uk/2/hi/health/3208528.stm

If you are interested in reading more I can suggest "The emerging science of homeopathy, complexity, biodynamics and nanopharmacology" by Bellavite and Signorini. There are many more studies contained in this book that show an effect of homeopathic preparations on animals and tissue. These have to be some of the more compelling studies on homeopathy, devoid of pesky human suggestibility.

If more funding for homeopathic research was available, it would probably have its place in mainstream medicine. One of the reasons this has not happened is because the majority of scientists shy away from homeopathic research, even if they are interested. It is a potentially career limiting choice of research when you help to validate a treatment that is in direct competition with the pharma funded industry that pays your wages

Heather Ann said...

As a user of homeopathic remedies I would TOTALLY disagree with this study. I have used remedies on my family and my pets and have seen AMAZING results. How could openness and empathy help my dog? It has to be the remedies themselves. I can tell by looking at my son's face if he's forgotten to take the remedy for his kidneys. How could that not be related to the actual remedy? That paper sounds like it was written by someone who is trying to discount homeopathy.