Sat, Aug 27, 2005 page6

• Homeopathy no better than placebo

  • THE GUARDIAN
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  Homeopathy, favored 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 on Thursday.

  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.

  An editorial in the Lancet, entitled "The end of homeopathy," demands that doctors recognize the absence of real curative powers in homeopathic medicine. Around 42 percent of GPs in England will refer patients to a homeopath. In Scotland, where homeopathy has taken off to an even greater extent, 86 percent are said to be in favor 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 unfavorable 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 British health service (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.

  "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 personalized 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," Egger said. "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, expects 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."

  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.
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