Holistic therapy has come under the spotlight for not taking clinical trials, writes Sylvia Thompson.
THERE HAS been a war against homeopathy in the UK for the past five years or so, the effects of which are now spilling over into Ireland.
Last month's challenge to homeopaths to prove the scientific basis of homeopathy in a placebo-controlled trial is seen to be the latest attack on the holistic therapy, which has rising numbers of practitioners and clients in this country.
The challenge - together with a prize fund of £10,000 (€12,640) - has been put up by Simon Singh, science writer and Prof Edzard Ernst, professor of complementary medicine at the University of Exeter, England, whose book, Trick or Treatmentlooks at scientific evidence for and against alternative and complementary therapies. Their investigations found scientific results to back some alternative treatments but not homeopathy.
"We're saying to homeopaths to put up or shut up," said Singh in a report by New Scientistmagazine. This provocative stance follows on from a Swiss study which, in 2005, compared the results of 110 trials using homeopathic remedies with the same number using conventional medicines across a range of medical conditions from respiratory infections to surgery. That study, which was published in the Lancet, found that homeopathy had no more than a placebo (sugar pill) effect. An editorial in the same issue called for "the end of homeopathy".
Advocates of homeopathy are vociferous if somewhat confusing in their defence. On the one hand, they point to the increased evidence base for homeopathy (134 peer-reviewed controlled trials, 44 per cent of which are positive at the latest count) and on the other hand, they claim that the placebo controlled trial is too blunt an instrument to test the multi-dimensional, holistic nature of homeopathy. Dr Sebastian van Eynatten, a medically trained homeopathic doctor based in Cork city, says that homeopathy is an "individualised form of medicine, the effect of which can't be narrowed down to a particular disease. "The placebo-controlled trials model doesn't work for homeopathy," he says.
Van Eynatten says that clinical observational studies are preferable for studying the effects of homeopathy. It's not that we want to put down the evidence-based medical approach, but you have to include what patients say and look at qualitative research (which includes patients' narratives), as well as placebo-controlled trials, which are really only the standard trials for pharmaceutical drugs," he says.
However, Ernst - who previously worked as a medical doctor in Austria - has heard this argument before. "The complementary and alternative medicine lobby say you can't squeeze a holistic, individualised approach like homeopathy or spiritual healing into the strait jacket of randomised controlled trials. This argument surfaces on a daily basis and it is as frequent as it is wrong," he has said.
The argument that randomised-controlled trials are unsuitable for holistic therapies is certainty a common one. But, is it wrong? Van Eynatten says: "Ernst is part of the skeptics movement in the UK which follows a particular biochemical view of the world. In homeopathy, the answers lie on a more energetic level, which will probably be explained by quantum physics."
One of the most controversial aspects of homeopathy is that the individualised remedies are diluted sometimes hundreds of times before they are used. Homeopaths argue it is not so much the diluted nature, but the fact that they are shaken vigorously (technically called succussed) during the process. "The curative effect is in the imprint left by this shaking process, which changes the information patterns within the remedy during this process," says van Eynatten.
For many people, the highly diluted nature of homeopathic remedies is undoubtedly the aspect of homeopathy that goes against current established scientific knowledge. Even some homeopaths themselves will admit to a certain suspension of disbelief during their training, although they continue to see positive results in clinical practice. Kate Chatfield, a UK-based homeopath says: "It is hardly surprising that homeopathy is accused of being no more than placebo. This is a completely logical conclusion from the perspective of a person who thinks and works within the current prevailing scientific paradigm," she writes in a paper entitled In Pursuit of Evidence(see www.homeopathy-soh.org).
However, Chatfield argues that when you probe a little deeper, you discover that "the practice of allopathic medicine has been subject to many trends, driven not only by developing scientific knowledge but also in reaction to social, political and financial pressures. In the UK for instance, the funding of homeopathic hospitals has been central to much of the debate there.
Like many others, Chatfield points to the dominance of evidence-based medicine as yet another trend within medical practice. "Proponents of evidence-based medicine pride themselves on their attempt to realign medicine with science, while critics object that it emphasises exclusively the science of medicine while denying completely the art of medical practice," she writes.
However, patients vote with their feet and while homeopathy and allopathic medicine will perhaps always have fundamentally distinct value systems, patients have no problem using either or both, depending on their own particular approach to health and illness.
