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This week the BMJ published a debate between two researchers over the effectiveness of homeopathy in treatment of illness. played off a 2015 Australian NHMRC report citing that homeopathy was ineffective.
In the BMJ debate Peter Fisher, Director of Research at Royal London 黑料吃瓜群网 for Integrated Medicine writes,
鈥淎 recent review by the Australian National Health and Medical Research Council concluded that 鈥渢here are no health conditions for which there is reliable evidence that homeopathy is effective.鈥� But this report used unusual methods of analysis: the reviewers assumed that a positive trial showing a homeopathic treatment to be effective was negated by a different trial showing a different homeopathic treatment for the same condition to be ineffective. But the fact that one homeopathic treatment for a condition is ineffective doesn鈥檛 mean that another is ineffective. In addition, several key meta-analyses were unaccountably omitted. 鈥�
Fisher says the medical and scientific opinion of homeopathy has been influenced by negative reports such as the NHMRC鈥檚, yet public popularity is not waning. Even the Swiss government has concluded that homeopathy is 鈥減robably鈥� effective for upper respiratory tract infections and allergies.
Fisher cites clinical evidence accessible the CORE-HOM database of clinical research in homeopathy free of charge (). It includes 1117 clinical trials of homeopathy, of which about 300 are randomised controlled trials.
In addition, patients in France accessing homeopathic treatment for musculoskeletal conditions used less non-steroidal anti-inflammatory drugs.
However Edzard Ernst, Emeritus Professor at University of Exeter hits back, saying that just because homeopathy 丑补蝉苍鈥檛 been proven to not work, doesn鈥檛 mean that it does work. In fact, it has yet to be proven that it does work (did you follow that?).
He says, 鈥渢he perceived benefits of homeopathy are caused by non-specific effects. Once these are adequately controlled for in trials, the results tend to show that highly dilute homeopathic remedies are indistinguishable from placebos. Even a former consultant of the Royal London Homeopathic 黑料吃瓜群网 has agreed, writing, 鈥淭he great majority . . . of the improvement that patients experience is due to non-specific causes . . . Homeopathy has not been proven to work.鈥�
Ernst also worries about those using homeopathy at the delay of other treatments, or as a replacement all together (we only have to look at the popularity of wellness bloggers to see how many are willing to try these treatments).
"The axioms of homeopathy are implausible, it's benefits do not outweigh its risks, and its costs and opportunity costs are considerable. Therefore, it seems unreasonable, even unethical, for healthcare professionals to recommend its use." he says.
Dr Nik Zeps who worked on the NHMRC report has responded to the debate. He is a research scientist at the University of Western Australia and a member of the NHMRC Homeopathy Working Committee.
鈥淧eter Fisher makes several incorrect assertions about the methodology used in the NHMRC report which undermine his conclusions. The report was based upon a review of systematic reviews of clinical trials involving the use of homeopathy. As such it was the least biased evaluation of the current evidence that is possible and no important reviews were omitted to our knowledge. The quality of the reviews and the trials they were based upon found that most studies were unreliable due to the possibility of bias or poor design.
He also incorrectly suggests that the Swiss commissioned a report that was favourable forhomeopathy. As highlighted in the NHMRC report this was a public submission from a call for submissions made by the Swiss government and to imply it is a government sanctioned report is a misrepresentation of its status that appears to be commonly made by proponents ofhomeopathy.
Of course, we need to question the patient鈥檚 wishes as well. Joanne Barnes, Associate Professor in Herbal Medicines, School of Pharmacy, University of Auckland, says,
鈥淭his does not mean that health professionals should be dismissive if asked about homoeopathy by their patients. Patients are free to choose to use homoeopathic products and it is desirable and important that they are able to have respectful, non-judgemental and open conversations about this with health professionals responsible for their care. Highly dilute homoeopathic remedies are unlikely to cause adverse reactions or to have interactions with conventional (pharmaceutical) medicines if used concurrently.鈥�
鈥淗owever, patients should not stop taking conventional medicines without seeking advice from the prescriber of those medicines. If patients choose to use homoeopathic products, they should be advised only to use products that are manufactured according to the principles of good manufacturing practice, which is the pharmaceutical industry standard for quality of medicines.鈥�
And finally we need to remember the potential side effects of mixing complementary medicines with pharmaceutical products. As Grant Kardachi writes in our Winter Issue of Australian 黑料吃瓜群网 and Healthcare Bulletin,
Combining St John鈥檚 Wort with other medicines can lead to serious consequences including organ rejection (e.g. cyclosporin), worsening of HIV-AIDS (e.g. indinavir), risk of blood clots (e.g. warfarin) and breakthrough bleeding or unwanted pregnancy (e.g. oral contraceptives).
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