Should doctors recommend homeopathy? – Expert reaction

In a head-to-head debate article in this week’s BMJ, UK academics argue the case for and against doctors recommending homeopathic products to their patients.

Drop of waterDr Peter Fisher, Director of Research at the Royal London Hospital for Integrated Medicine, says the research to date shows some evidence of benefit and claims recent reviews — such as a major Australian government report — have omitted key data.  “Doctors should put aside bias based on the alleged implausibility of homeopathy,” he concludes.

But Prof Edzard Ernst, Emeritus Professor at the University of Exeter, says most independent systematic reviews of randomised controlled trials “have failed to show that homeopathy is effective” and argues that the assumptions underlying homeopathy “fly in the face of science.”

Read more about the study on, or listen to The BMJ Podcast below.

Last month, Dr Stephen Child, chair of the New Zealand Medical Association (NZMA), said Kiwi GPs should not be prescribing or recommending homeopathic products.

“We do not believe there’s any evidence that it’s effective,” he told Pharmacy Today (subscription required).

“Medically, it’s unethical to provide a treatment that’s not proven.”

The Science Media Centre collected the following expert commentary from New Zealand researchers.

Dr Shaun Holt, Adjunct Professorial Research Fellow, Victoria University of Wellington, and Director of HoneyLab, comments:

“The practice involves diluting substances to such a degree that not a single molecule remains. Some people mistakenly think that homeopathic products work but are fooled by factors such as the placebo effect, the natural history of the condition and not attributing benefits to other treatments or lifestyle changes.

“A survey found that around that 1 in 8 New Zealand GPs either practice homeopathy or refer patients to homeopaths. However this is not consistent with either the ethical or regulatory requirements of practicing medicine whereby healthcare professionals should manage patients with treatments that are likely to be  effective according to medical research.

“Another survey found that 93 per cent of people in NZ do not actually know what it involves, and most mistakenly think that it is the use of low doses of natural products.The British Medical Association has rightly described it as witchcraft, as to claim that a product with no active ingredients can produce beneficial health effects is the same as saying that it has magical powers.

“The lunacy of homeopathy can be summed up by the following real product that is available from a main UK supplier : “Berlin Wall” – consists of dust from the Berlin Wall, diluted until none remains, sold to people to help them stop feeling repressed.

“Other products available include koala, vaginal ultrasound, light from Saturn, dog testes, dolphin song and jet fuel.

“Although homeopathic products themselves do no harm, as they do not contain any active ingredients, there can be serious problems when people use them instead of real medicines. An example is the death of an Australian baby from eczema after her parents treated her with homeopathic remedies.”

Assoc Prof Joanne Barnes, Associate Professor in Herbal Medicines, School of Pharmacy, University of Auckland, comments:

“Many users of homoeopathy report beneficial effects, likely due to ‘placebo’ effects or simply the natural course of the symptom or condition, but the evidence for efficacy of specific homoeopathic products to treat or prevent specific symptoms and conditions is not convincing. Yes, there are examples of robust clinical trials that have reported positive results for certain homoeopathic products, including when selected on an ‘individualised’ basis (as is advocated by homoeopaths,) and there are some systematic reviews or meta-analyses of all placebo-controlled clinical trials indicating that, collectively, homoeopathic treatment is better than a placebo.

“However, the evidence is not consistent – there are also trials and systematic reviews with negative results – and does not provide a definitive body of evidence to support the efficacy of specific homoeopathic products for specific medical conditions.

“This, together with the lack of a plausible mechanism of action for homoeopathy, and other claims, such as dilution effects, that are inconsistent with current scientific fact, preclude supporting that health professionals should actively recommend homoeopathy.

“This does not mean that health professionals should be dismissive if asked about homoeopathy by their patients. Patients are free to choose to use homoeopathic products and it is desirable and important that they are able to have respectful, non-judgemental and open conversations about this with health professionals responsible for their care. Highly dilute homoeopathic remedies are unlikely to cause adverse reactions or to have interactions with conventional (pharmaceutical) medicines if used concurrently.

“However, patients should not stop taking conventional medicines without seeking advice from the prescriber of those medicines. If patients choose to use homoeopathic products, they should be advised only to use products that are manufactured according to the principles of good manufacturing practice, which is the pharmaceutical industry standard for quality of medicines.”

From the AusSMC:

Dr Nik Zeps, research scientist at the University of Western Australia and a member of the National Health and Medical Research Council (NHMRC) Homeopathy Working Committee, comments:

“Peter Fisher makes several incorrect assertions about the methodology used in the NHMRC report which undermine his conclusions. The report was based upon a review of systematic reviews of clinical trials involving the use of homeopathy. As such it was the least biased evaluation of the current evidence that is possible and no important reviews were omitted to our knowledge. The quality of the reviews and the trials they were based upon found that most studies were unreliable due to the possibility of bias or poor design.

“He also incorrectly suggests that the Swiss commissioned a report that was favorable for homeopathy. As highlighted in the NHMRC report this was a public submission from a call for submissions made by the Swiss government and to imply it is a government sanctioned report is a misrepresentation of its status that appears to be commonly made by proponents of homeopathy.

“Peter Fisher refers to in vitro (laboratory) experiments that demonstrate a physiological action. Whilst this was not the focus of the NHMRC report it is important to remind the public to examine ‘evidence’ carefully and to note that these experiments have not been reproducible and remain controversial within the scientific community.

“The NHMRC report examined claims for effect in many conditions and did not focus on a particular form of homeopathy, rather it examined the evidence provided in the literature for claims of effect. Peter Fisher claims that evidence did not take into account an integrated approach when in fact it did.

“Many of the conditions outlined in the additional evidence he quotes are self limiting (eg,. respiratory infections) and people get better regardless of their treatments. The report of benefits for those who had homeopathy needs to be assessed in the light of their overall health and the reliability of the studies also needs to be independently assessed, as was done for each study in the NHMRC report. Quoting from single studies without such an evaluation is not a reliable way to assess the data.”