Abstract Little is known about long-term effects of homeopathic treatment. Following a double-blind, placebo controlled trial of classical homeopathy in chronic headaches, we conducted a 1-year observational study of 18 patients following the double-blind phase, and a complete follow-up study of all trial participants. Eighteen patients received free treatment for daily diary data (frequency, intensity, duration of headaches) over the course of 1 y. All patients enrolled in the double-blind study were sent a 6-week headache diary, a follow-up questionnaire, a personality inventory and a complaint list. Eighty-seven, of the original 98 patients enrolled returned questionnaires, 81 returned diaries. There was no additional change from the end of the trial to the one-year follow-up. The improvement seen at the end of the 12-week trial was stable after 1 y. No differential effects according to treatment after the trial could be seen. Patients with no treatment following the trial had the most improvement after 1 y. Five of 18 patients can be counted responders according to ARIMA analysis of single-case time-series. Patients with double diagnoses and longer treatment duration tended to have clearer improvements than the rest of the patients. Approximately 30% of patients in homeopathic treatment will benefit after 1 y of treatment. There is no indication of a specific, or of a delayed effect of homeopathy.
We report an Outcome Survey carried out at Liverpool Regional Department of Homoeopathic Medicine, over a 12-month period between 1 June 1999 and 31 May 2000, using self-assessment by the Glasgow Homoeopathic Hospital Outcome Score (GHHOS). Overall 76.6% of patients reported an improvement in their conditions since starting homeopathic treatment, while 60.3% scored +2,+3 or+4 on the GHHOS. Fifty-two percent of patients reduced their conventional medication.
This invitation for co-operation is addressed to all interested groups. Its purpose is data collection for clinical verification of symptoms from homeopathic proving and collection of clinical symptoms not derived from homeopathic pathogenetic trials (provings). To date no consensus exists on this topic. The European Committee for Homoeopathy (ECH) research sub-committee has created a working group on this topic. This paper is the result of a review of papers on the topic, exchanges between members and a meeting.
Homeopathy has been continuously faced with the problem of explaining the therapeutic action of medicines diluted beyond the theoretical Avogadro limit of molecular presence. This paradox has lent weight to the hypothesis of solvent as a likely support of therapeutic action. Way back in 1941, Boyd (1) put forward the notion of physical modifications induced in the solvent, a notion which, in late sixties, was to evolve into the ‘imprint theory’, and which is based on water polymer formation. Imprint theories are still considered nowadays, involving electromagnetic interactions, water clusters, isotopic effects or coherent states. Whatever the hypothesis, the study of the chemicophysical properties of solvents remains a major path to follow in conventional research in this field. In this respect, proton NMR appears as a choice method: whether in alcoholic or aqueous diluted solutions, water protons (H2O) or ethanol protons (CH3CH2OH) are to be found in quasi-constant maximal quantities, thereby yielding an optimal signal to noise ratio.
Abstract Alternative therapies in general, and homeopathy in particular, lack clear scientific evaluation of efficacy. Controlled clinical trials are urgently needed, especially for conditions that are not helped by conventional methods. The objective of this work was to assess the efficacy of homeopathic treatment in relieving symptoms associated with premenstrual syndrome (PMS). It was a randomised controlled double-blind clinical trial. Two months baseline assessment with post-intervention follow-up for 3 months was conducted at Hadassah Hospital outpatient gynaecology clinic in Jerusalem in Israel 1992–1994. The subjects were 20 women, aged 20–48, suffering from PMS. Homeopathic intervention was chosen individually for each patient, according to a model of symptom clusters. Recruited volunteers with PMS were treated randomly with one oral dose of a homeopathic medication or placebo. The main outcome measure was scores of a daily menstrual distress questionnaire (MDQ) before and after treatment. Psychological tests for suggestibility were used to examine the possible effects of suggestion. Mean MDQ scores fell from 0.44 to 0.13 (P<0.05) with active treatment, and from 0.38 to 0.34 with placebo (NS). (Between group P=0.057). Improvement >30% was observed in 90% of patients receiving active treatment and 37.5% receiving placebo (P=0.048). Homeopathic treatment was found to be effective in alleviating the symptoms of PMS in comparison to placebo. The use of symptom clusters in this trial may offer a novel approach that will facilitate clinical trials in homeopathy. Further research is in progress.
The sharp increase of the prescription of methylphenidate (MPD) in hyperactive children in recent years is a matter of increasing uneasiness among professionals, parents and politicians. There is little awareness of treatment alternatives. The purpose of this prospective trial was to assess the efficacy of homeopathy in hyperactive patients and to compare it MPD. The study was performed in a paediatric practice with conventional and homeopathic backgrounds. Children aged 3–17y, conforming to the DSM-IV criteria for attention deficit hyperactivity disorder (ADHD) with a Conners Global Index (CGI) of 14 or higher were eligible for the study. All of them received an individual homeopathic treatment. When clinical improvement reached 50%, the parents were asked to reevaluate the symptoms. Those who did not improve sufficiently on homeopathy were changed to MPD, and again evaluated after 3 months. One hundred and fifteen children (92 boys, 23 girls) with a mean age of 8.3y at diagnosis were included in the study. Prior to treatment the mean CGI was 20.63 (14–30), the mean index of the homeopathy group 20.52 and of the MPD-group 20.94. After an average treatment time of 3.5 months 86 children (75%) had responded to homeopathy, reaching a clinical improvement rating of 73% and an amelioration of the CGI of 55%. Twenty-five children (22%) needed MPD; the average duration of homeopathic (pre-) treatment in this group was 22 months. Clinical improvement under MPD reached 65%, the lowering of the CGI 48%. Three children did not respond to homeopathy nor to MPD, and one left the study. In cases where treatment of a hyperactive child is not urgent, homeopathy is a valuable alternative to MPD. The reported results of homeopathic treatment appear to be similar to the effects of MPD. Only children who did not reach the high level of sensory integration for school had to be changed to MPD. In preschoolers, homeopathy appears a particularly useful treatment for ADHD.
The European wolf spider, Lycosa tarentula, said to have caused the historical phenomenon of 'tarantism', is the official medicinal source of the homeopathic remedy Tarentula hispanica. Yet, scientific evidence links the spider's venomous effects with mild necrotic and minor systemic effects that contrast with the proving symptoms of Tarentula hispanica which show a cerebral and neural component. A comparative investigation by use of toxicological, clinical findings, supported by modern and antique biological texts, as well as homeopathic materia medica, traces the source of the remedy Tarentula hispanica to the Mediterranean widow spider Latrodectus tredecimguttatus, thus warranting a re-evaluation of pharmacological preparation.
Acute low back pain is a very common condition in Western industrialised countries. In most cases analgesics or topical medications are prescribed at first encounter with the general practitioner (GP). The aim of this study was to investigate whether the homeopathic gel Spiroflor SRL gel (SRL) is equally effective and better tolerated than Cremor Capsici Compositus FNA (CCC) in patients with acute low back pain. A multi-centre, randomised, double-blind, controlled clinical trial was conducted in the practices of 19 GPs in the districts of Bristol and Manchester, UK. One hundred and sixty-one subjects suffering from acute low back pain were treated for one week either with SRL or with CCC. Pain was scored on a 100 mm visual analogue scale (VAS). Main efficacy parameter VAS reduction was compared between treatments. Evaluation of safety was primarily based on the number of subjects with adverse events (AEs), withdrawals due to an AE and adverse drug reactions (ADRs). The mean difference between the VAS reduction in the SRL group and the CCC group adjusted for VAS at baseline and age was -0.6mm (90% CI = -6.5-5.3mm). Fewer subjects in the SRL group (11%) experienced an AE than in the CCC group (26%). The same applies to the number of subjects with an ADR (3/81 = 4% vs 18/74 = 24%) and the number of subjects withdrawn due to an ADR (0/81 = 0% vs 8/74 = 11%). In conclusion, SRL and CCC are equally effective in the treatment of acute low back pain, however, SRL has a better safety profile. Spiroflor SRL gel is preferable to Capsicum-based products for the topical treatment of low back pain, because of the lower risk of adverse effects.
Two homeopathic pathogenetic trials (HPTs, provings), of identical design were conducted: of Acidum malicum 12cH and Acidum ascorbicum 12cH. Each trial included 20 healthy volunteers. Both were of double-blind, placebo-controlled, randomised, four period crossover design, with two sequences. ‘Healthy’ was defined in terms of SF-36 scores, medical judgement and blood tests. All volunteers had regular interviews with the same supervisor. No serious adverse reactions occurred. The causal relationship of each symptom with treatment was judged, blind, by the volunteer, the supervisor and a 9-item pathogenetic index. For Acidum malicum 79 symptoms were identified by the supervisor, 57 were included in the final analysis, 22 occurred in verum treatment periods. For Acidum ascorbicum, of 55 symptoms, 39 were included in the analysis. 16 occurred in verum treatment periods.
One of the ‘side-effects’ of evidence-based medicine has been the fetishisation of research, which is sometimes treated as an end in itself. Of course medical practice should be based on evidence of its safety and effectiveness. But lack of evidence of effectiveness is quite different from evidence of lack of effectiveness. The former is often the case with homeopathy, although sceptics frequently interpret it as the latter. Research is not an end in itself, it is a tool, a collection of methods for addressing specific questions. The issue then arises, which questions, asked by whom, should clinical research in homeopathy attempt to answer? Broadly speaking there are three constituencies corresponding to three main categories of questions. The sceptical academic constituency asks ‘is there any evidence that homeopathy is not a placebo effect, that its clinical effects are not entirely attributable to non-specific effects associated with homeopathic treatment: belief, reassurance, advice etc?’ Homeopaths are more likely to pose questions about improving their practice: ‘how can we prescribe better, improve our understanding of materia medica, which prescribing strategies work best etc?’
A study of the consistency of responses by allergic patients in repeated studies of the homeopathic remedy Betula 30c or placebo against birch pollen allergy, was made. A randomized, double-blind, placebo-controlled trial was performed including participants with a known allergy to birch pollen. Allergy symptoms were assessed on a visual analogue scale (VAS) by patients or parents each day during a 20-day period during two different pollen seasons. The work was carried out in Oslo, Norway during May 1995, 1996 and 1997. There were 51 patients ranging in age from 7 to 50y. The homeopathic remedy Betula 30c or placebo was given as tablets, both as a prophylactic agent, once a week for 4 weeks before the pollen season started, and as an acute remedy during the pollen season. The mean value of the symptom scores on the visual analogue scale, for all registration days from each patient was the main outcome. The patient groups that received either placebo or Betula 30c for two successive years showed a consistent response (r=0.75, P=0.01 and r=0.70, P=0.003, respectively). No such correlation was found in the two groups that changed remedy from one year to another (either from placebo to Betula or vice versa). Subjective assessment of allergic symptoms to birch pollen differed more from one year to another when different regimens (placebo or homeopathic) had been administered these two seasons, than when the same treatment had been given.
This study describes the results obtained from a prospective observational research of homeopathic treatment for patients suffering from headache (migraine with- and without aura and tension-type headache). Fifty-three patients were asked to complete the SF-36 questionnaire at the beginning of the treatment and after 4–6 months. The homeopathic medicine and potency were not pre-defined, but were adapted to each single patient according to individualised homeopathic prescription. Most patients (73.6%) completed the study. There was heterogeneity in the answers (patients in very poor health as well as those with only slight disorders). Analysis of the data according to the concept of ‘intention-to-treat’ showed that after therapy, the mean and median scores of all life quality dimensions rose. More than 60% of the cases experienced an improvement in pain and the limitations caused by pain, as well as in limitations in social activities and health in general. All the differences between pre/post treatment were statistically highly significant, with the strongest results in the ‘bodily pain’ and ‘vitality’ parameters (P<0.0001).
‘Prover 105, the placebo, produced a lot of symptoms which also seem to fit with the overall remedy picture. This at first hand seems unusual, but may be explained in that those involved in the proving were students from the college. Sankaran has talked about ‘communal consciousness’ and the students were known to each other and met at college monthly, so there was a communal experience in which the provers and the supervisors were involved. It is possible in such a situation that despite the fact that 105 was given placebo, she may have developed symptoms of the proving by being part of the group and college community involved in the proving. All information on the placebo is included as anecdotal evidence rather than within the main proving.’
Homeopathy was introduced into the USA by Hans Burch Gram in 1825. It developed largely through immigration of German homeopaths. The first homeopathic medical college was established in Allentown, PA in 1835. The American institute of Homeopathy (AIH) was founded in 1844. The American Medical Association was founded in 1847 and pursued policies hostile to homeopathy from the outset. Eclectic medicine was widespread in nineteenth century medicine, one of the greatest homeopaths, JT Kent had originally been an eclectic. The International Hahnemannian Association split from the AIH in 1880. The Flexner Report of 1910 resulted in many homeopathic medical colleges being closed down. Homeopathy in the USA was in steep decline from the 1920s to the 1960s but has had a strong recovery since the 1970s.
Osteoarthritis is a common rheumatic disease. Limitations of conventional medical management of this condition indicate a real need for safe and effective treatment of osteoarthritic patients. The authors review the clinical evidence for and against the effectiveness of homeopathic medicines in the treatment of patients with osteoarthritis. A systematic review of all randomised controlled clinical trials of homeopathic treatment of patients with this condition is presented. A comprehensive search yielded four trials which are discussed in detail. The authors conclude that the small number of randomised clinical trials conducted to date, although favouring homeopathic treatment, do not allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis. The clinical evidence appears promising, however, and more research into this area seems warranted.
This lecture attempts to analyse the progress made by homeopathy in recent years, by analysing consumer awareness, sales and distribution trends of homeopathic products, and research publications. Sales of homeopathic medicines are growing rapidly, but remain a very small fraction of the total pharmaceutical market. The proportion of combination to single medicines varies widely between countries. The market is concentrated in a relatively small number of the available medicines; many available homeopathic medicines are never used. Regulation of homeopathic practitioners and medicines is problematic, the legal position varies between countries. The volume of research is growing steadily. A series of recommendations is made, including modernisation of the terminology of homeopathy, training of more practitioners, a defined research agenda and integration into the medical system.
In homeopathy the choice of a medicine is based on the total 'picture' presented by the patient. This picture includes 'constitutional type' which comprises personality, and general physical features. The Constitutional Type Questionnaire (CTQ) is designed to systematically assess constitutional types. This study examines the reliability and validity of the CTQ. Four hundred and seventy-two outpatients attending clinics at the Royal London Homoeopathic Hospital completed the CTQ, a 152-item scale rating features traditionally considered typical of 19 constitutional homeopathic medicine 'pictures' on 5-point frequency or severity scales. A subsample was retested after 1 week to measure the test-retest reliability. Another subsample was prescribed a medicine by a homeopathic doctor. Prescriptions were compared with the CTQ, to assess the content validity of the scale. The construct validity was measured by Grade of Membership (GOM) analysis. The scale demonstrated good test-retest reliability (r=0.73), internal consistency (r=0.95). The correlation between CTQ results and the medicine prescribed by the homeopathic doctor was 75.8%. The GOM analyses are reported by Davidson et al elsewhere in this issue of the journal. Although the CTQ could be improved, the scale displays good reliability and validity.
