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Overview of the current Overview of the current state of the research in state of the research in HomeopathyHomeopathy
Dr Alexander TournierBSc Cantab PhD LCHE RSHom
Aims
To show that science and homeopathy are indeed compatible
To present evidence coming from different fields of science
To present Homeopathy Research Institute
Definition of ‘Science’
“Any system of knowledge that is concerned with the physical world and its phenomena and that entails unbiased observations and systematic experimentation. ”
Encyclopaedia Britannica
Scientific discovery process
Observation
Experimentation
Theories
Understanding
Science ofHomeopathy
Unscientific argumentation
“Homeopathy does not work … … because it cannot
work”
is not scientific,
as it is not grounded in observation
Science of homeopathy
Hahnemann built homeopathy following a rigorous scientific approach:
Experimentation ◦Provings ◦Clinical experience
Theories and concepts◦Law of similars◦Principle of dilution◦Concept of the vital force
Different scientific approachesPharmaceutical model
Screening
Mechanism
Trials of efficacy
Effectiveness in practise
Safety
CAM model
Practice
Safety
Effectiveness
Efficacy of components
Mechanism of action
Adapted from Fonnebo etal BMC Med Res Meth 2007 11(7) 7
Homeopathy: a new science
Adhami H.R. , S.Shamloo D., Mesgarpour B., H.Tehrani S.A.“The trend of homeopathic articles indexed in pubmed and ISI” LMHI 2008
Number of scientific publications over the last 20 year
Scientific evidence in Homeopathy
Materials sciences
Molecular and cellular systems
Animal studies
Human studies
Evidence from Material Sciences
NMR evidence (5/5 Hi-Qt* pub)
Low temp thermoluminescence
Raman and UV-Vis Spectroscopy
Dielectric strength
Review: C Witt etal J Alt Comp Med 2003 9:1, 113-32
*Quality assessed using SAPEH scores, high-quality > 6
Molecular and cellular systems
Enzymatic reactions (7/9 Hi-Qt* pub)
Cultured cells (5/9 Hi-Qt pub)
Basophil degranulation (8/11 Hi-Qt pub)
*Quality assessed using SAPEH scores, high-quality > 6
C Witt etal Comp Ther Med, 2007 15 128-38
Animal systemsOne review in 1998 (no access)
One review in immunology in 2006 ◦Immunostimulation (16 pub)
◦Immunoregulation, inflammatory processes (20 pub)
No systematic review in this area despite wide use and high number of experiments
Effect of thyroxin on frog development
Human trials
134 RCT have been published◦59 (44%) positive ◦67 (50%) neutral (small effect) ◦8 (6%) negative
23 systematic reviews◦10 positive ◦8 non-conclusive ◦5 little or no evidence
P. Fisher ‘Research in Homoeopathy: Who needs it’ LMHI 2008
Only one review up to 1995
More recent trials are of higher quality
Need a review of the recent provings
Need more trials
Human provingsor Human pathogenetic trials
Human provingsA successful example
Adapted from H. Möllinger ‘Homeopathic Drug Provings between historical and scientific demand’ LMHI 2008
-4
-2
0
2
4
6
8
10
12
14
Ave
rag
e n
um
ber
of
Sym
pto
ms Arsenicum specific symptoms
Nat-mur specific symptomsNon-specific symptoms
Arsenicumgroup
Nat-murgroup
Placebogroup
Associated p = 0.0002
Meta-analysesKleijnen etal 1991 105 studies +
Boissel etal 1996 15 Hi-Qt
studies+
Linde etal 1997* 89 studies +Linde & Melchart 1998*
32 Hi-Qt
studies+
Cucherat etal 2000* 16 Hi-Qt
studies+
Shang etal 2005 8 (110) studies-
(+?)
*Included in UK DARE (Database of Abstracts of Reviews of Effects)
Conclusions based on comparison of 8 homeopathy vs. 6 conventional medicine trials, not 110 vs. 110
Criteria for selection of 8 high-quality trials were not given and no references were given
Does not conform with QUOROM guidelines for systematic reviews
Not classified as a systematic review by UK DARE (Database of Abstracts of Reviews of Effects)
Shang etal 2005 Meta-analysis
Levels of evidence
Level I meta-analyses and/or systematic reviews
Level IIa multiple controlled, randomised experiments
Level IIb some controlled, randomised experiments
Level IIIa studies with multiple cohorts
Level IIIb some cohort studies
Level IV opinion of expertsFrom Michel van Wassenhoven LMHI 2008
Levels of evidence
Material sciences IIa+ (one systematic review)
Molecular and cellular IIa+ (one systematic review)
Animals IIIa / IIb
Levels of evidence for human trials
I Overall (Meta analyses 5/6)
IAllergic rhinitis, post-operative ileus,
rheumatoid arthritis,
protection from toxic substances
IIaAsthma, fibrosis, influenza,
muscular pain, otitis media, strains
ENT infections, side effect radiotherapy
IIb
Anxiety, ADHD, IBS, migraine,
osteo-arthritis, PMS, Post-tonsillectiomy
analgesia,
nausea during chemotherapy, septicaemia
Michel van Wassenhofen, ECH publication LMHI 2008
Conclusions
A lot of scientific evidence exists
However, a lot of it is still of low quality
Need more studies, esp. animal studies
Many questions remain
Still need a lot of research
Homeopathy Research Institute
Aims:
◦To perform and promote high-quality scientific research in homeopathy
◦To collate, clarify and disseminate the existing scientific evidence in homeopathy
Homeopathy Research InstituteScientific committee
Dr Alexander Tournier PhD Clare Relton MSc
Dr Robert Mathie PhD
Dr Elizabeth Thompson BAOxon MBBS MRCP FFHom
Prof. Kate Thomas Dr Lionel Milgrom PhD
Dr Mike Emmans Dean PhD
Dr Nagin Lad PhD
Dr Natasa Peric-Concha PhD
Dr Patti Bayliss MBChB FRCGP
Homeopathy Research InstituteCurrent projects
◦Curated database of research articles
◦National survey of homeopathy practice
◦Scientific expertise for new research projects
◦Homeopathy use in breast cancer patients
◦Membership scheme
