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PubMed2005

Homeopathy for depression: a systematic review of the research evidence.

OBJECTIVE: To systematically review the research evidence on the effectiveness of homeopathy for the treatment of depression and depressive disorders. METHODS: A comprehensive search of major biomedical databases including MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine (CAM) databases including AMED, CISCOM and Hom-Inform were also searched. Additionally, efforts were made to identify unpublished and ongoing research using relevant sources and experts in the field. Relevant research was categorised by study type and appraised according to study design. Clinical commentaries were obtained for studies reporting clinical outcomes. RESULTS: Only two randomised controlled trials (RCTs) were identified. One of these, a feasibility study, demonstrated problems with recruitment of patients in primary care. Several uncontrolled and observational studies have reported positive results including high levels of patient satisfaction but because of the lack of a control group, it is difficult to assess the extent to which any response is due to specific effects of homeopathy. Single-case reports/studies were the most frequently encountered clinical study type. We also found surveys, but no relevant qualitative research studies were located.: Adverse effects reported appear limited to 'remedy reactions' ('aggravations') including temporary worsening of symptoms, symptom shifts and reappearance of old symptoms. These remedy reactions were generally transient but in one study, aggravation of symptoms caused withdrawal of the treatment in one patient. CONCLUSIONS: A comprehensive search for published and unpublished studies has demonstrated that the evidence for the effectiveness of homeopathy in depression is limited due to lack of clinical trials of high quality. Further research is required, and should include well-designed controlled studies with sufficient numbers of participants. Qualitative studies aimed at overcoming recruitment and other problems should precede further RCTs. Methodological options include the incorporation of preference arms or uncontrolled observational studies. The highly individualised nature of much homeopathic treatment and the specificity of response may require innovative methods of analysis of individual treatment response.

Control Groups↗
PubMed2006

Evaluation of specific and non-specific effects in homeopathy: feasibility study for a randomised trial.

OBJECTIVE: To determine the feasibility, in terms of acceptability to patients, physicians and other staff; data return and statistical power of a study to elucidate the relative contributions of specific and non-specific effects in homeopathic treatment of dermatitis. DESIGN: Randomised, controlled 4-arm trial, 2 arms double-blind. SETTING: Outpatient clinic, Royal London Homoeopathic Hospital. PARTICIPANTS: Seventy-five adult patients with dermatitis. INTERVENTIONS: Patients were randomly allocated to: 'fast track' open verum homeopathy, 'fast track' double-blind verum homeopathy, 'fast track' double-blind placebo homeopathy or waiting list control. MAIN OUTCOME MEASURES: One hundred millimeter visual analogue scale of overall symptom severity; 10 point digital scores of sleep, itching, skin condition; weekly 5-point Likert scale of topical steroid use; Dermatology Life Quality Index at entry and completion. RESULTS: Recruitment was below target, but the study was acceptable to staff and feasible. Blinded patients were more likely to withdraw (P=0.021, chi2 test). After correction for baseline differences and multiple comparisons, no outcome measure showed statistically significant between group differences. Blindness appeared to have a negative effect, but this was confounded by differential withdrawal. CONCLUSIONS: A definitive trial of this design is unlikely to discriminate the relative contributions of the non-specific and specific effects to the outcome of homeopathic treatment of dermatitis, because of patient preference issues.

Adult↗
PubMed2007

Randomised controlled trials of homeopathy in hyperactive children: treatment procedure leads to an unconventional study design. Experience with open-label homeopathic treatment preceding the Swiss ADHD placebo controlled, randomised, double-blind, cross-over trial.

BACKGROUND: Treatment of patients with attention deficit hyperactivity disorder (ADHD) with homeopathy is difficult. The Swiss randomised, placebo controlled, cross-over trial in ADHD patients (Swiss ADHD trial) was designed with an open-label screening phase prior to the randomised controlled phase. During the screening phase, the response of each child to successive homeopathic medications was observed until the optimal medication was identified. Only children who reached a predefined level of improvement participated in the randomised, cross-over phase. Although the randomised phase revealed a significant beneficial effect of homeopathy, the cross-over caused a strong carryover effect diminishing the apparent difference between placebo and verum treatment. METHODS: This retrospective analysis explores the screening phase data with respect to the risk of failure to demonstrate a specific effect of a randomised controlled trial (RCT) with randomisation at the start of the treatment. RESULTS: During the screening phase, 84% (70/83) of the children responded to treatment and reached eligibility for the randomised trial after a median time of 5 months (range 1-18), with a median of 3 different medications (range 1-9). Thirteen children (16%) did not reach eligibility. Five months after treatment start, the difference in Conners Global Index (CGI) rating between responders and non-responders became highly significant (p = 0.0006). Improvement in CGI was much greater following the identification of the optimal medication than in the preceding suboptimal treatment period (p < 0.0001). CONCLUSIONS: Because of the necessity of identifying an optimal medication before response to treatment can be expected, randomisation at the start of treatment in an RCT of homeopathy in ADHD children has a high risk of failure to demonstrate a specific treatment effect, if the observation time is shorter than 12 months.

Adolescent↗
PubMed2003

Treating dyspepsia with acupuncture and homeopathy: reflections on a pilot study by researchers, practitioners and participants.

OBJECTIVES: For people with dyspepsia who are receiving orthodox general practice care, what is the effect on outcome and on NHS costs of adding treatment by a choice of acupuncture or homeopathy? This paper describes and reflects upon a pilot study with user involvement. DESIGN: A randomised pilot study. Patients chose between acupuncture and homeopathy and were then randomised to this preference or to the control group of normal GP care. SETTING AND PARTICIPANTS: Sixty people with dyspepsia (>/=2 weeks) presenting in one UK general practice were recruited in consultations and by letter to those on repeat prescriptions. There were few exclusion criteria. The homeopath and the acupuncturist treated the patient individually according to their normal practice for up to 6 months. After the trial there was a focus group for participants. OUTCOME MEASURES: SF-36 health survey, Measure Yourself Medical Outcome Profile (MYMOP), and General Well-being Index (GWBI). Counts of prescriptions, consultations and referrals from practice computer records. RESULTS: No trend or significant difference between the groups for clinical outcome or NHS costs. Major costs for the 6 months, mean (S.D.) cost per patient, were general practitioner consultations pound 8 (18), prescriptions pound 64 (73), acupuncture pound 175 (52), homeopathy pound 105 (33). Participants gave insights and suggestions which will inform the full trial design. CONCLUSIONS: Reflection on the pilot study data and experience by participants, treating practitioners and researchers led to modifications in the design and a sample size calculation. How to demonstrate individual responses to treatment remains a problem.

Acupuncture Therapy↗
PubMed2002

A systematic review of systematic reviews of homeopathy.

Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews. Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.

Arnica↗
PubMed2003

Homeopathy in dermatology.

Alternative methods are commonly used in patients with dermatologic diseases, with homeopathy being one of the most common. Homeopathy was developed by Samuel Hahnemann (1755-1843) and is based on the law of similars and the law of infinitesimals. It is a regulatory therapy where high dilutions of particular compounds are thought to induce a counterreaction in the organism. In dermatology, homeopathy is often used in atopic dermatitis, other forms of eczema, psoriasis, and many other conditions. To date, however, there is no convincing evidence for a therapeutic effect. There are only a few controlled trials, most of them with negative results. The few studies with positive results have not been reproduced. Acceptance by the patient seems largely based on counseling and emotional care rather than on objective responses to the homeopathic drugs.

Evidence-Based Medicine↗
PubMed2001

On the scientific status of homeopathy.

Critics of homeopathy often claim that it is non-scientific. By offering adequate tools for the analysis of the foundations, structure and implications of scientific theories, philosophy of science can help to clarify this medical controversy. However, homeopathy has not yet attracted the attention of philosophers of science to any noticeable extent. Among the many topics to which philosophy of science could contribute, this paper selects two, not only for their intrinsic importance, but also because they are essential for any fruitful discussion of the rest. It is shown, first, that in homeopathy, as developed by Hahnemann, two related, but distinct theoretical levels can be identified. Then it is indicated that at least one of them-the phenomenological level-can be seen as embodying a largely autonomous research programme, on which homeopathic medical practice can rest. Finally, it is argued that this programme displays the basic theoretical and methodological traits of a genuine science, according to an influential contemporary approach in philosophy of science. Some misunderstandings involved in the debate are pointed out.

History, 18th Century↗
PubMed2000

Pharmacodynamic principles of homeopathy.

Homeopathy was already known to Hippocrates and further studied by Hahnemann. However, since the discovery of the medical effects of digitalis by William Withering around 1785, and the first synthesis of an organic molecule, urea, by Friedrich Wöhler in 1828, and through the further rapid evolution of modern pharmacological chemistry and molecular biology, it has gradually been abandoned as a serious therapeutic alternative to allopathy by most practitioners of scientifically founded medicine. Because a credible scientific explanation for its mode of action has been lacking, homeopathy is regarded by many medical researchers and scientists as, at best, placebo therapy, in spite of the fact that for centuries hosts of patients have testified to its effects. It is suggested that the gulf between homeopathy and allopathy can be reconciled if one takes into consideration modern knowledge of physiology, biochemistry and the physical properties of the water used in the potentiation process. A description of the mechanisms occurring during potentiation, both inside and outside a live mammalian organism, is presented.

Homeopathy↗
PubMed2001

The puzzle of homeopathy.

Homeopathy is a branch of Western medicine that has mostly been rejected by Western orthodoxy for the last 200 years because of conceptual and scientific clashes. Homeopathy uses microdoses of potential toxins to provoke defense and self-regulatory responses, rather than the more orthodox approach of blocking body reactions. This approach hints at its clinical scope: it can help, at times resolve, conditions that are intrinsically reversible rather than mechanical problems, deficiencies, or irreversible breakdowns in body functions where it is only palliative. In recent years, there has been a renaissance of interest. Public demand has soared, and with it professional interest. Approximately 20% of Scotland's general practitioners have completed basic training. This is partly occasioned by public interest in complementary medicine and a sympathy with the more mind-body approach of homeopathy, and partly by recent scientific evidence. Some homeopathic dilutions are so extreme they are dismissed by critics as only placebo. Yet trials and meta-analyses of controlled trials are pointing toward real effects, mechanism of action unknown. Clinical outcome studies suggest useful clinical impact and excellent safety. There seems to be a potential to enhance patient care by integrating the two systems.

Evidence-Based Medicine↗
PubMed1998

Out of step with the Lancet homeopathy meta-analysis: more objections than objectivity?

The meta-analysis of homeopathy trials that appeared in the Lancet in 1997 seemed to endorse the experience of practitioners and patients that homeopathic medicines have specific clinically relevant effects. However, results from later unsuccessful trials, and negative inferences from a review of trials for a condition excluded from the meta-analysis--delayed onset muscle soreness (DOMS)--have since been presented to suggest that the meta-analysis may well have overestimated the positive effects of homeopathy, and that the "placebo question is still not resolved." This article reviews the evidence underlying this challenge to the meta-analysis and homeopathy, and demonstrates that it would be valid if it were based on: a comprehensive literature search; appropriate classification of primary studies; clear discrimination between clinical effectiveness and placebo questions; sound and transparent review methods; and a reliable and unconfounded clinical treatment model for testing the ultramolecular hypothesis. It is suggested that different models are needed to answer different questions.

Bias↗
PubMed2005

Homeopathy for menopausal symptoms in breast cancer survivors: a preliminary randomized controlled trial.

OBJECTIVES: To carry out a preliminary trial evaluating the effectiveness of two types of homeopathy for the treatment of menopausal symptoms in breast cancer survivors. DESIGN: Randomized, double-blinded, placebo-controlled. SETTINGS/LOCATION: Private medical clinic, Seattle, WA. SUBJECTS: Women with a history of breast cancer who had completed all surgery, chemotherapy, and radiation treatment and who had an average of at least three hot flashes per day for the previous month. INTERVENTIONS: Subjects were randomized to receive either an individualized homeopathic single remedy, a homeopathic combination medicine, or placebo. Patients were seen by homeopathic providers every 2 months for 1 year. OUTCOME MEASURES: Hot flash frequency and severity, Kupperman Menopausal Index (KMI), Short Form 36 (SF-36). RESULTS: There was no significant difference found in the primary outcome measure, the hot flash severity score, although there was a positive trend in the single remedy group during the first 3 months of the study (p = 0.1). A statistically significant improvement in general health score in both homeopathy groups (p < 0.05) on the SF-36 after 1 year was found. Evidence of a homeopathic "drug proving" in the subjects receiving the homeopathic combination medicine who were not taking tamoxifen also was found. CONCLUSIONS: Small sample size precludes definitive answers, but results from this preliminary trial suggest that homeopathy may be of value in the treatment of menopausal symptoms and improving quality of life, especially in those women not on tamoxifen. Larger studies should be carried out that also include healthy women who want to avoid hormone replacement therapy.

Adult↗
PubMed2001

The methodological quality of randomized controlled trials of homeopathy, herbal medicines and acupuncture.

BACKGROUND: To investigate the methodological quality of randomized controlled trials in three areas of complementary medicine. METHODS: The methodological quality of 207 randomized trials collected for five previously published systematic reviews on homeopathy, herbal medicine (Hypericum for depression, Echinacea for common cold), and acupuncture (for asthma and chronic headache) was assessed using a validated scale (the Jadad scale) and single quality items. RESULTS: While the methodological quality of the trials was highly variable, the majority had important shortcomings in reporting and/or methodology. Major problems in most trials were the description of allocation concealment and the reporting of drop-outs and withdrawals. There were relevant differences in single quality components between the different complementary therapies: For example, acupuncture trials reported adequate allocation concealment less often (6% versus 32% of homeopathy and 26% of herb trials), and trials on herbal extracts had better summary scores (mean score 3.12 versus 2.33 for homeopathy and 2.19 for acupuncture trials). Larger trials published more recently in journals listed in Medline and in English language scored significantly higher than trials not meeting these criteria. CONCLUSION: Trials of complementary therapies often have relevant methodological weaknesses. The type of weaknesses varies considerably across interventions.

Acupuncture Therapy↗
PubMed2003

Characteristics and quality of systematic reviews of acupuncture, herbal medicines, and homeopathy.

BACKGROUND: We aimed to describe the approaches and characteristics of systematic reviews on three major complementary therapies and to assess their methodological quality. METHODS: Systematic reviews of clinical trials of acupuncture, herbal medicines, and homeopathy were identified from a database developed for the Cochrane Collaboration Complementary Medicine Field. Information on conditions, interventions, methods, results, and conclusions was extracted using a pre-tested form; methodological quality was assessed using the Oxman scale. RESULTS: 115 reviews were included (39 on acupuncture, 58 on herbal medicine, 18 on homeopathy). Research questions were most specific in herbal medicine, and tended to be very general in homeopathy. The main comparison in most reviews was with placebo. The methodological quality of reviews was highly variable. Deficiencies were most frequent for the description of the selection process and the summary of the results of primary studies. CONCLUSION: Systematic reviews tend to approach different complementary therapies in different manner. Compared to a set of reviews on analgesic interventions methodological quality was slightly better on the average, but there is ample room for improvement in future complementary medicine reviews.

Acupuncture Therapy↗
PubMed1994

Homeopathy and the treatment of mental illness in the 19th century.

In the 19th century, when bleeding and purging were widely used in mainstream medicine, homeopathy was warmly embraced by some U.S. practitioners as a more humane alternative. Developed by the German physician Samuel Hahnemann, homeopathy sought to cure symptoms of disease by use of drugs that induced similar symptoms and restored the patient's "vital force." This paper describes the general principles of homeopathy and recounts specific treatments of mental illness from the homeopathic literature. It also describes the application of homeopathic principles to the institutional care of mental illness, using New York's Middletown Homeopathic Asylum for the Insane as an example.

History, 19th Century↗
PubMed2006

Homeopathy--what are the active ingredients? An exploratory study using the UK Medical Research Council's framework for the evaluation of complex interventions.

BACKGROUND: Research in homeopathy has traditionally addressed itself to defining the effectiveness of homeopathic potencies in comparison to placebo medication. There is now increasing awareness that the homeopathic consultation is in itself a therapeutic intervention working independently or synergistically with the prescribed remedy. Our objective was to identify and evalute potential "active ingredients" of the homeopathic approach as a whole, in a prospective formal case series, which draws on actual consultation data, and is based on the MRC framework for the evaluation of complex interventions. METHODS: Following on from a theoretical review of how homeopathic care might mediate its effects, 18 patients were prospectively recruited to a case series based at Bristol Homeopathic Hospital. Patients, who lived with one of three index conditions, were interviewed before and after a five visit "package of care". All consultations were recorded and transcribed verbatim. Additional data, including generic and condition-specific questionnaires, artwork and "significant other" reports were collected. Textual data was subject to thematic analysis and triangulated with other sources. RESULTS: We judged that around one third of patients had experienced a major improvement in their health over the study period, a third had some improvement and a third had no improvement. 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. CONCLUSION: This study has has identified, using primary consultation and other data, a range of factors that might account for the effectiveness of homeopathic care. Some of these, such as empathy, are non-specific. Others, such as the remedy matching process, are specific to homeopathy. 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.

Adult↗
PubMed2005

Homeopathy and acupuncture teaching at Faculdade de Medicina da Universidade de São Paulo: the undergraduates' attitudes.

CONTEXT AND OBJECTIVE: Homeopathy and acupuncture, although recognized as medical specializations in Brazil, are not taught in most medical schools. The objective was to evaluate undergraduate attitudes towards them following their inclusion as optional disciplines at Faculdade de Medicina da Universidade de São Paulo (FMUSP) in 2002. DESIGN AND SETTING: Questionnaire, at FMUSP. METHODS: 484 students answered a self-administered questionnaire on these therapies, regarding their interest in learning, the teaching methods, their knowledge/experience (or that of someone close to them) and how it was acquired, the main indicators and general effectiveness of these therapies, and the possibilities for offering and integrating them within public healthcare units. RESULTS: Over 85% of the students considered that homeopathy and acupuncture should be included in curricula, as options (72%) or compulsorily (19%); 56% showed great interest in learning about them. Although 76% had little or no knowledge, 67% believed that these therapies had some effectiveness, and that chronic diseases (37%) or even chronic and acute diseases (29%) would be the main indicators for their use. Around 35% were receptive towards offering public primary care using both therapies, while 34% thought these treatments should also be available in hospitals and 60% believed they could be integrated with conventional medical practices. CONCLUSION: The medical students were interested in learning the principles of homeopathy and acupuncture, were able to observe and report on the effectiveness of these treatments and defended the use of these medical specializations within public healthcare.

Acupuncture↗
PubMed2004

Homeopathy: natural mind-body healing.

1. Homeopathy is an accepted form of health care in many countries worldwide. 2. Homeopathy is deeply healing, yet does so without causing side effects, tolerance, or addiction problems. 3. Homeopathic remedies are available over the counter in health food stores and some pharmacies. 4. Homeopathy is distinct from herbal medicine and does not interact with conventional treatments.

Evidence-Based Medicine↗
PubMed1999

[Is homeopathy superior to placebo? Controversy apropos of a meta-analysis of controlled studies].

At a time when scientists support Evidence-Based Medicine, the Parliament of Belgium has recently decided to recognize four alternative medicines, among which homeopathy. Whereas this discipline does not rely on any scientific basis, it appears to be popular, especially in general practice. The homeopaths have recently taken arguments from a meta-analysis published in 1997 in the Lancet of 89 placebo-controlled trials. This study indeed concluded that the results are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, this meta-analysis contains several methodological flaws. Furthermore, it is recognized that results of a meta-analysis may not be confirmed in large well-performed clinical trials. Thus, homeopathy should still provide the evidence that conventional medicine has regularly brought during the last two decades in many fields of therapeutics, with the respect of the rigorous rules of "Good Clinical Practice", leading to "Evidence-Based Medicine".

Belgium↗