Homeopathy: Is it Just a Placebo?
By Kimberly Beauchamp, ND
Healthnotes Newswire (September 15, 2005)—Practitioners and supporters of homeopathy are up in arms after a high-profile review published in the Lancet (2005;366:726–32) concluded the effects of homeopathy may be little more than a placebo effect. Our analysis finds that the truth still remains to be seen for this controversial system.
A brief history
Based on the premise that “like cures like,” homeopathy is a system of medicine that was developed in the late 1700s by the German physician and chemist Samuel Hahnemann. Hahnemann proposed that homeopathy could bring about healing in the body through the administration of highly diluted substances that, if taken in large amounts by a healthy person would cause the symptoms of an illness, while it would relieve the same symptoms in a person who is ill.
The starting material, derived from plants, minerals, or animals, is diluted and vigorously shaken (succussed) in a series of steps until very few or no molecules of the original substance remain; the resulting remedy is said to contain the “memory” of the original substance. According to practitioners, the more dilute a remedy, the greater its strength (for example, a 200C remedy is more dilute and hence stronger than a 30C). Remedies can be delivered in the form of tablets, pellets, or a liquid.
Ideally, homeopathic prescriptions are highly individualized, taking into account the physical, spiritual, emotional, mental, and temperamental contributors to disease. Many homeopathy supporters contend that a person’s relationship with the practitioner is as healing as the administered remedy. Constitutional remedies are often prescribed for more chronic conditions; these remedies are slower acting and effect deeper levels of change in the person. Acute remedies are chosen to treat illnesses of a short duration; they may be the same or different from a person’s constitutional remedy.
While support for homeopathy continues to grow, most practitioners of traditional Western medicine remain skeptical about its efficacy.
A new analysis
Though many studies have shown the effect of homeopathy to be more pronounced than that of a placebo, some critics argue that the effects of homeopathy are simply due to the placebo effect stemming from a strong belief in the medicine coupled with a positive practitioner–patient relationship.
The new study compared 110 homeopathy trials with 110 standard Western medicine trials in order to differentiate any clear effect of homeopathy from that of the placebo effect. Only randomized, placebo-controlled studies were included in the analysis. Each of the homeopathy trials was matched with a standard medicine trial with respect to the disorder being treated and the outcomes assessed. Respiratory tract infections were the most frequently investigated; other topics included asthma, allergies, gynecologic and obstetric conditions, surgery, anesthetics, gastroenterology, musculoskeletal disorders, and neurology.
Researchers judged the caliber of each study by what they deemed to be high-quality randomizations, blinding (making the treatment groups unknown to the participants and investigators), and data analysis. The different types of homeopathy used in the trials were also investigated separately.
Most of the homeopathic and standard medicine trials indicated a beneficial effect of the respective treatment. However, only 19% of the homeopathy trials and 8% of the standard medicine trials were determined to be of high quality. In both types of studies, the smaller and lower quality trials tended to yield more beneficial effects than those trials of larger size and higher quality. When the analysis was restricted to larger trials of higher quality, the researchers did not find convincing evidence that homeopathy was superior to placebo, nor did they find much difference in the effects between the different types of homeopathy used in the trials.
Food for thought
When considering these results, several points should be kept in mind:
Practitioners of standard Western medicine judged the quality of the studies by the methodology; however, homeopathic practitioners would argue that the quality of the homeopathy itself may be low in some of these otherwise well-designed studies. According to classical homeopathy, each remedy should be tailored to the individual; because of this, homeopathy may not always fit well with traditional scientific methodology.
Further confounding this uneasy fit between homeopathy and science is the difficulty in separating a homeopathic practitioner’s personal impact on a patient’s health from the treatment itself. In this age of fast-paced HMO-driven healthcare, it is not out of place to question whether a positive relationship between the person getting treatment and the healer is worthy of higher value. If the goal is for people to regain their health, and as many doctors, both traditional and nontraditional, have found that mental attitude is an essential part of healing, dismissing the significance of “strong belief in the medicine coupled with a positive practitioner–patient relationship” seems illogical.
Finally, even after accounting for several sources of potential bias, the researchers found a “substantial beneficial effect” in eight studies of homeopathy for the treatment of upper respiratory infections; however, they still caution that these results may not be trustworthy, claiming that certain biases are difficult to detect when the analyses are based on a small number of trials. They did not, however, offer a clear explanation of which biases may have confounded the results of these studies, which leaves the possibility that the researchers’ unsubstantiated suspicion of bias may itself be a biased conclusion.
As long as personal safety is carefully protected, it is not unreasonable for people to explore treatment options considered unproven by the medical community. Many potentially effective treatments may not yet have been adequately studied, and those that have may still be viewed by the medical community through a filter of heavy skepticism—even after substantial scientific evidence has been generated, as in the case of acupuncture and certain herbal and nutritional therapies (for example, St. John’s wort, echinacea, and vitamin C). The findings of the new Lancet study should be taken as a call for more research, but until homeopathy’s mechanisms are better understood people will need to judge for themselves whether they find this treatment method appealing or effective.
Kimberly Beauchamp, ND, earned her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She cofounded South County Naturopaths in Wakefield, RI. Dr. Beauchamp practices as a birth doula and lectures on topics including whole-foods nutrition, detoxification, and women’s health.
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