Can homeopathy 'work' even when there's no evidence?

by **Nanneerose** Tue Jun 03, 2014 11:35 pm

For many, homeopathy is quackery based on unscientific principles, but those who regularly use homeopathic treatments hold a very different view. So what's going on?

Can homeopathy 'work' even when there's no evidence? Homeopathy_m2186255

The debate about the effectiveness of homeopathy is nothing new. Most recently it made headlines after Australia's National Health and Medical Research Council released a draft information paper on homeopathywhich found there were "no health conditions for which there was reliable evidence that homeopathy was effective".
Back in 2010 a report from the UK House of Commons said the evidence failed to show a credible physiological mode of action for homeopathic products, and what data was available showed homeopathic products were no better than placebo.
Yet plenty of people turn to homeopathy for treatment of a range of health conditions, including colds, coughs, ear infections, skin conditions, arthritis and headaches. There are no recent figures available on the use of homeopathy in Australia, but data collected by the Complementary Healthcare Council in 2008 showed that Australians spent at least $11 million that year on a form of therapy that all available mainstream evidence suggests doesn't work.
So what's going on? If Australians – and citizens of many other nations around the world including Germany, France and India – are voting with their wallets, does this mean homeopathy must be doing something right?
"For me, the crux of the debate is a disjunction between how the scientific and medical community view homeopathy, and what many in our communities are getting out of it," says Professor Alex Broom, Head of Sociology at the University of Queensland.
"The really interesting question is how can we possibly have something that people think works when for all intents and purposes, from a scientific perspective, it doesn't?"
What is homeopathy?
Homeopathy is based on the theory of treating 'like with like', and is supposed to work by giving you very small amounts of substances that in larger doses would cause the very symptoms you want cured.
The idea is that taking small doses of these substances – which are derived from plants, animals or minerals – will strengthen the body's own ability to heal and increase its resistance to illness or infection.
The amounts of these substances contained in homeopathic products are so small they are usually undetectable, but it's argued they still have a biological effect.
Homeopathy is used to treat a wide variety of complaints – coughs, colds, depression, headaches, asthma, arthritis – in fact most common day-to-day ailments.
The relationship
Part of homeopathy's appeal may lie in the nature of the patient-practitioner consultation. In contrast to a typical GP consultation, which lasts an average of around 15 minutes, a first homeopathy consultation might be an hour and a half.
"That's a really important part of what homeopathy does because we don't look at just an individual symptom by itself – for us that individual symptom is part of someone's overall health condition," says Greg Cope, spokesman for the Australian Homeopathic Association.
"Often we'll have a consultation with someone and we'll find details that their GP simply didn't have time to find in a 10 minute consult, which often results in them going back to their GP with more information than what they had before."
Writer Johanna Ashmore sees her homeopath once a month for a one-hour consultation, with a telephone check-up in between.
"The fact that your first appointment is a good hour and a half where she asks about your history, what kind of child you were – the profiling thing that they do – I feel that if I go to her and say I've got this health concern, she's going to treat my body to fight it rather than just treat the symptom," Ashmore says.
She first saw a homeopath to treat a rash on her face that developed after pregnancy. She was aware of homeopathy's popularity, particularly through friends living in France, and decided to try it instead of taking the medical route she assumed her GP would recommend. The results impressed her and now she goes regularly, takes her children along to treat minor conditions such as worms, and has even convinced her skeptical husband who also appears to benefit from it despite his reservations.
Alternative to medication
Most people visit a homeopath after having received a diagnosis from a 'mainstream' practitioner, often because they want an alternative choice to medication, says Cope.
"Generally speaking, for a homeopath their preference is if someone has a diagnosis from a medical practitioner before starting homeopathic treatment, so it's rare for someone to come and see us with an undiagnosed condition and certainly if they do come undiagnosed, we'd want to refer them on and get that medical evaluation before starting a course of treatment," he says.
Given that homeopathic medicines are by their very nature incredibly dilute – and some might argue diluted beyond all hope of efficacy – they are unlikely to cause any kind of adverse effects, so where's the harm?
Professor Paul Glasziou, who chaired the NHMRC's Homeopathy Working Committee, says cost is one harm, but the more important harm is the opportunity cost associated with missing out on effective treatments.
"If it's just a cold, I'm not too worried. But if it's for a serious illness, you may not be taking disease-modifying treatments, and most worrying is things like HIV which affect not only you but people around you," says Glasziou, professor of evidence-based practice at Bond University.
This is a particular concern with homeopathic vaccines, he says, which jeopardise the "herd immunity" – the immunity of a significant proportion of the population – that's needed to contain outbreaks of vaccine-preventable diseases.
As effective as placebo
The question of a placebo effect inevitably comes up, as studies showing homeopathy is equivalent to placebo suggesting that what benefits are being derived are a product of patient faith rather than any active ingredient of the medications.
However Cope dismisses the argument that homeopathy benefits disproportionately from the placebo effect, pointing out that homeopathy appears to benefit even the skeptics.
"I certainly see in my practice, we commonly see kids first, then we might treat Mum and after a couple of years of nagging Dad will come along and even though Dad's only there because Mum's nagged him, we get wonderful results," Cope says.
"What a homeopath sees in their clinic every day cannot be explained by the placebo effect."
'I don't care how it works'
Ashmore is aware scientific evidence doesn't work in homeopathy's favour but can still see its benefits.
"I take the approach that if seeing my homeopath once a month psychosomatically improves my health then I'm happy with that," she says.
"I don't care how it works – I just know that for me it does."
Flawed criteria?
Homeopathic practitioners vigorously deny the accusation that it doesn't work, arguing that it is being judged by criteria that fail to recognise the individualised nature of homeopathic therapy.
Cope says the recent NHMRC review only considered a certain type of evidence, such as the randomised controlled trial that has become the gold standard for western medicine, which puts homeopathy at a disadvantage.
"They're used to the western evidence model where everyone has the same condition, everyone has the same treatment, and that's the criteria they judged the quality of a trial by, which doesn't work for homeopathy because that's exactly the opposite to how homeopathy prescribes in practice," says Cope.
"We take a hundred people with headaches and they each get a different medicine or different prescribing technique depending on their individual circumstances so that does make it very difficult for folks like the NHMRC."
However, Glasziou says while that might be a reasonable claim, it is also a testable one. He cites a trial that was done of Chinese herbal medicine, which compared personalised treatment and standard treatment with placebo for the treatment of irritable bowel syndrome.
"Homeopathy could copy that format of trial, they could test that theory," says Glasziou, however he still argues that the principles of homeopathy don't make scientific sense, and is yet to see any convincing evidence that the treatment works.
Cope also points out that the NHRMC review only considered papers published in English when many homeopathy studies are published in other languages, especially German.
But if so many people around the world are placing their faith in homeopathy, despite the evidence against it, Broom questions why homeopathy seeks scientific validation.
"The problem lies in the fact that if you're going to dance with conventional medicine and say 'we want to be proven to be effective in dealing with discrete physiological conditions', then you indeed do have to show efficacy," says Broom.
"In my view this is not about broader credibility per se, it's about scientific and medical credibility – there is actually quite a lot of cultural credibility surrounding homeopathy within the community but that's not replicated within the scientific literature."
http://www.abc.net.au/health/features/stories/2014/05/23/4010063.htm

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