overview of the current state of the research in homeopathy alex tournier...p. fisher ‘research in...
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Overview of the current state of Overview of the current state of
the research in Homeopathythe research in Homeopathy
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 approaches
Pharmaceutical 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 systems
� One 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
Avera
ge n
um
ber
of
Sym
pto
ms Arsenicum specific symptoms
Nat-mur specific symptoms
Non-specific symptoms
Arsenicum
group
Nat-mur
group
Placebo
group
Associated p = 0.0002
Meta-analyses
- (?)8 (110) studiesShang etal 2005
+16 Hi-Qt studiesCucherat etal 2000*
+32 Hi-Qt studiesLinde & Melchart 1998*
+89 studiesLinde etal 1997*
+15 Hi-Qt studiesBoissel etal 1996
+105 studiesKleijnen etal 1991
*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 experts
From 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
Asthma, fibrosis, influenza,
muscular pain, otitis media, strains
ENT infections, side effect radiotherapy
IIa
Anxiety, ADHD, IBS, migraine,
osteo-arthritis, PMS, Post-tonsillectiomy analgesia,
nausea during chemotherapy, septicaemia
IIb
Allergic rhinitis, post-operative ileus,
rheumatoid arthritis,
protection from toxic substances
I
Overall (3/3 Hi-Qt meta-analyses)I
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 Institute
Scientific 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 Institute
Current 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
