Should doctors recommend homeopathy over conventional medicine?
Two experts debated the issue inThe BMJ this week.
“Of all the major forms of complementary medicine, homeopathy is the most misunderstood," wrote Peter Fisher, MD, PhD, the Director of Research at Royal London Hospital for Integrated Medicine, UK.
Homeopathy is a type of complementary and alternative medicine.
It is based on two premises: that substances that cause illnesses or symptoms in a healthy person can (in very small doses) also treat those symptoms, and that highly diluted solutions can retain a "memory" of the original substance.
Homeopathic medicine is prepared by taking a substance — a plant, animal or chemical material — and repeatedly diluting it in water or alcohol.
These medicines can include tablets, liquids, ointments, sprays and creams.
According to the National Center for Complementary and Integrative Health, homeopathic medicine tends to be holistic and often requires the patient to take an active part in his or her treatment. Many homeopathic therapies are based on the idea of enabling the body to heal itself.
On the other hand, conventional medicine mainly focuses on understanding and correcting the underlying problems that are causing a patient's symptoms.
A recent review from the Australian National Health and Medical Research Council (NHMRC) concluded that "There are no health conditions for which there is reliable evidence that homeopathy is effective."
Dr. Fisher, however, questioned the methods of this review.
According to Dr. Fisher, the review assumed that a positive response to one type of homeopathic treatment was undone by a negative response to another homeopathic treatment.
“The fact that one homeopathic treatment for a condition is ineffective doesn’t mean that another is ineffective,” Dr. Fisher wrote.
Dr. Fisher pointed to studies from France, Switzerland and Germany, which found homeopathy to have positive outcomes (at an equivalent cost) for a range of conditions.
Dr. Fisher concluded by calling for unbiased decision making.
“Doctors should put aside bias based on the alleged implausibility of homeopathy,” Dr. Fisher wrote. "When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including [antibiotics]."
Edzard Ernst, MD, PhD, a professor of complementary medicine at the University of Exeter, disagrees with Dr. Fisher.
“The assumptions underlying homeopathy fly in the face of science, and critics have long pointed out that, unless our understanding of the laws of nature is incorrect, homeopathy’s mode of action has no rational explanation,” wrote Dr. Ernst.
Dr. Ernst argued that most studies do not show homeopathy’s effectiveness and that positive reviews "usually have serious methodological flaws."
According to Dr. Ernst, choosing homeopathic medicine over "effective" therapy can cause harm and that "several deaths have occurred in this unnecessary way."
Dr. Ernst criticized Europe’s annual spending on homeopathic remedies, writing that the funds "could and should be spent more usefully elsewhere."
“In summary, the [ideas] of homeopathy are implausible, its benefits do not outweigh its risks, and its costs and opportunity costs are considerable,” Dr. Ernst wrote. “Therefore, it seems unreasonable, even unethical, for healthcare professionals to recommend its use.”
Both the release and the article were published in the July issue of the journalThe BMJ.
