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Aims of homeopathy research, 1994 and 2015
Homeopathy (2015) 104, 343e344 Ó 2015 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.homp.2015.10.004, available online at http://www.sciencedirect.com
GUEST EDITORIAL
Aims of homeopathy research, 1994 and 2015 ‘20 years after’ e almost one generation after its first appearance, Endler and Schulte are updating their book on Ultra High Dilution (UHD)1,2 in an actualized and renewed form. So 20 years later: where does homeopathy stand, and where does homeopathic research stand? After a great boom of homeopathy towards the end of the 20th century in many western countries, Latin America and India, there has been a certain stagnation, even a countermovement in the last 5e10 years, at least in some regions of Europe. The reasons for this development are probably multiple and regionally different. On the one hand homeopathy appears to be efficient in a broad spectrum of medical problems in primary care and not seldom leads to brilliant individual cures. Polls show its popularity: in a vote in 2009 the Swiss people voted in favour of a constitutional article for complementary medicine. On the other hand there are forces working against homeopathy as well: attacks and critical reports in media, restricted access to universities, research and finances, the organized ‘skeptics’ movement in Europe. And there are, of course, unsuccessful treatments, disappointed patients. Homeopathy as a healing method polarizes and remains a controversial issue.
Controversy Homeopathy research and its results are controversial too e among homeopaths, among conventional doctors, among researchers, in medical faculties and in public health discussions. What we typically encounter in discussions on research and homeopathy is a lack of basic knowledge about the scientific foundations of homeopathy itself. Both conventional medicine and homeopathy are based on empirical observations, but their procedures, case taking, and remedies are entirely different. Modern orthodox medicine reduces observations in a causalanalytical way, whereas homeopathy has always observed the totality of symptoms in a systemic way to ensure a suitable individual remedy selection. From its very beginning homeopathy was based on empirical observation and particular research for its own purposes, i.e. systemimmanent research; this laid the foundations for the method itself and its quality. Conventional medicine reacts skeptically and refuses the research evidence on homeopathy, arguing that homeopathy contains two incredible black boxes: the mecha-
Received 14 October 2015; accepted 14 October 2015
nism of action is unknown and the use of UHDs beyond Avogadro’s number appears to be hocus-pocus. This leads to considerable pressure on homeopathy to present proofs in order to be accepted by conventional science and medicine. In the last few decades a remarkable number of experimental and clinical studies have been conducted in homeopathy based on conventional methods. Basic research and experimental studies may be helpful in clarifying mechanisms of action, asserting quality of remedies and giving evidence for UHD action in principle. Some of the clinical studies performed can be used for the same goals, but mostly they are justification studies to the outer (nonhomoeopathic) world. Usually they are far away from real homeopathic practice; they do not provide deeper insight as such. Their internal validity may be high, but their external or model validity, i.e. how they represent real practice, is low. In spite of these difficult preconditions and sometimes appropriate approaches, the results of clinical studies are in general quite positive, although critical remarks are justified, e.g. on the low number of study reproductions, and on their variable quality. The remarkable conclusion of Kleijnen et al. after the first thorough analysis of clinical trials of homeopathy, in 1991 is still widespread: “The amount of positive evidence. came as a surprise to us. Based on this evidence we would be ready to accept that homeopathy can be efficacious, if only the mechanism of action were more plausible.”.3 The study results are better than expected e but it is doubtful whether UHDs may have any effects.
200 years of clinicalexperience Homeopathy has more than 200 years of clinical experience on millions of patients e can these ‘soft empirical facts’ be taken into account in the assessment of homeopathy? Outcome studies in medical care seem to be the most appropriate way to investigate evidence of homeopathy in real surroundings. Such studies regularly show convincing results, leaving open the question whether health improvement is specifically due to the remedy or to the homeopathic system on the whole. So far, homeopathy cannot be fully scientifically explained, nor is it generally accepted. It gently shakes some of the paradigms of conventional medicine and natural science. The updated edition of Ultra High Dilution deserves our attention and high respect in the controversial discussion on homeopathy.
Guest editorial M. Righetti
344
References 1 Endler PC, Schulte J, (eds). Ultra High Dilution: Physiology and Physics. Dordrecht: Kluwer Academic, 1994, pp 187e202. 2 Righetti M. Characteristics and selected results of research on homoeopathy. In: Endler PC and Schulte J (eds) Ultra High Dilution: Physiology and Physics. Dordrecht: Kluwer Academic, pp 223e228. 3 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. Br Med J 1991 Feb 9; 302(6772): 316e323.
Homeopathy
Marco Righetti* SVHA Academy (Schweiz. Verein homoeopathischer Aerzte), Zurich University, Z€ urich, Switzerland E-mail: [email protected] *Correspondence: Marco Righetti, Leonhardshalde 2, 8001 Zurich, Switzerland.
GUEST EDITORIAL
Aims of homeopathy research, 1994 and 2015 ‘20 years after’ e almost one generation after its first appearance, Endler and Schulte are updating their book on Ultra High Dilution (UHD)1,2 in an actualized and renewed form. So 20 years later: where does homeopathy stand, and where does homeopathic research stand? After a great boom of homeopathy towards the end of the 20th century in many western countries, Latin America and India, there has been a certain stagnation, even a countermovement in the last 5e10 years, at least in some regions of Europe. The reasons for this development are probably multiple and regionally different. On the one hand homeopathy appears to be efficient in a broad spectrum of medical problems in primary care and not seldom leads to brilliant individual cures. Polls show its popularity: in a vote in 2009 the Swiss people voted in favour of a constitutional article for complementary medicine. On the other hand there are forces working against homeopathy as well: attacks and critical reports in media, restricted access to universities, research and finances, the organized ‘skeptics’ movement in Europe. And there are, of course, unsuccessful treatments, disappointed patients. Homeopathy as a healing method polarizes and remains a controversial issue.
Controversy Homeopathy research and its results are controversial too e among homeopaths, among conventional doctors, among researchers, in medical faculties and in public health discussions. What we typically encounter in discussions on research and homeopathy is a lack of basic knowledge about the scientific foundations of homeopathy itself. Both conventional medicine and homeopathy are based on empirical observations, but their procedures, case taking, and remedies are entirely different. Modern orthodox medicine reduces observations in a causalanalytical way, whereas homeopathy has always observed the totality of symptoms in a systemic way to ensure a suitable individual remedy selection. From its very beginning homeopathy was based on empirical observation and particular research for its own purposes, i.e. systemimmanent research; this laid the foundations for the method itself and its quality. Conventional medicine reacts skeptically and refuses the research evidence on homeopathy, arguing that homeopathy contains two incredible black boxes: the mecha-
Received 14 October 2015; accepted 14 October 2015
nism of action is unknown and the use of UHDs beyond Avogadro’s number appears to be hocus-pocus. This leads to considerable pressure on homeopathy to present proofs in order to be accepted by conventional science and medicine. In the last few decades a remarkable number of experimental and clinical studies have been conducted in homeopathy based on conventional methods. Basic research and experimental studies may be helpful in clarifying mechanisms of action, asserting quality of remedies and giving evidence for UHD action in principle. Some of the clinical studies performed can be used for the same goals, but mostly they are justification studies to the outer (nonhomoeopathic) world. Usually they are far away from real homeopathic practice; they do not provide deeper insight as such. Their internal validity may be high, but their external or model validity, i.e. how they represent real practice, is low. In spite of these difficult preconditions and sometimes appropriate approaches, the results of clinical studies are in general quite positive, although critical remarks are justified, e.g. on the low number of study reproductions, and on their variable quality. The remarkable conclusion of Kleijnen et al. after the first thorough analysis of clinical trials of homeopathy, in 1991 is still widespread: “The amount of positive evidence. came as a surprise to us. Based on this evidence we would be ready to accept that homeopathy can be efficacious, if only the mechanism of action were more plausible.”.3 The study results are better than expected e but it is doubtful whether UHDs may have any effects.
200 years of clinicalexperience Homeopathy has more than 200 years of clinical experience on millions of patients e can these ‘soft empirical facts’ be taken into account in the assessment of homeopathy? Outcome studies in medical care seem to be the most appropriate way to investigate evidence of homeopathy in real surroundings. Such studies regularly show convincing results, leaving open the question whether health improvement is specifically due to the remedy or to the homeopathic system on the whole. So far, homeopathy cannot be fully scientifically explained, nor is it generally accepted. It gently shakes some of the paradigms of conventional medicine and natural science. The updated edition of Ultra High Dilution deserves our attention and high respect in the controversial discussion on homeopathy.
Guest editorial M. Righetti
344
References 1 Endler PC, Schulte J, (eds). Ultra High Dilution: Physiology and Physics. Dordrecht: Kluwer Academic, 1994, pp 187e202. 2 Righetti M. Characteristics and selected results of research on homoeopathy. In: Endler PC and Schulte J (eds) Ultra High Dilution: Physiology and Physics. Dordrecht: Kluwer Academic, pp 223e228. 3 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. Br Med J 1991 Feb 9; 302(6772): 316e323.
Homeopathy
Marco Righetti* SVHA Academy (Schweiz. Verein homoeopathischer Aerzte), Zurich University, Z€ urich, Switzerland E-mail: [email protected] *Correspondence: Marco Righetti, Leonhardshalde 2, 8001 Zurich, Switzerland.