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.