The Case FOR Homeopathic Medicine: The Historical and Scientific Evidence (Part 2)

The "best evidence" that homeopathy does not work is remarkably flawed, while high quality research in the best journals shows its efficacy.

To read PART I of this series, click HERE!

The So-Called Best Evidence that Homeopathy Does Not Work

Sadly and strangely, the skeptics of homeopathy put much of their belief that homeopathy does not work on a review and comparison of homeopathic and conventional medical research that was published in the Lancet in 2005.(23) The Lancet even published an editorial in this same issue entitled "The End of Homeopathy."

However, this "evidence" is a very controversial and some say extremely flawed review of homeopathic research.(24)(25) This review sought to compare 110 placebo-controlled homeopathic studies and with a "matched" group of 110 studies testing conventional medications. The researchers appropriately sought to evaluate only those studies that their criteria deemed of sufficiently "high quality."

Although the idea of comparing studies is a good idea, the way that this group of researchers evaluated only a small subset of all studies showed an initial and ongoing bias, as you shall soon see...

First, it is important to know that the leader of this review of homeopathic research is A. Shang's boss (and co-author of this article) M. Eggers, a vocal noted skeptic of homeopathy. Second, evidence of strong bias against homeopathy by these researchers was brought to light by the Lancet's senior editor, Zoe Mullan, who acknowledged that, "Professor Eggers stated at the onset that he expected to find that homeopathy had no effect other than that of placebo."(26)

Shang and his team deemed that "high quality trials" must fit certain criteria. It must be acknowledged that two other meta-analyses that have previously been published in the Lancet (1997) and the British Medical Journal (1991) have deemed several trials that had strongly positive effects from homeopathic treatment as "high quality" than was not deemed as such by Shang (and he has never commented about this discrepancy).

Despite the problems in comparing conventional medical research and homeopathic research, let's assume that the two groups of studies ARE comparable. It is therefore more than a tad ironic that they found 21 of the homeopathic studies fit this definition of "high quality" clinical researcher but only 9 of the conventional studies did so. One would have thought that the researchers would then compare these "high quality" trials. However, this result would have shown that there IS a difference between homeopathic treatment and a placebo in a variety of ailments, and authors (who are known skeptics of homeopathy) could not allow that conclusion.

Instead, Shang's group chose to only evaluate a much smaller subset of these high quality trials. They limited the review to the largest trials in both groups to 8 homeopathic trials (with at least 98 subjects) and six conventional trials (with at least 146 subjects). Strangely enough, when evaluating only this last group of larger studies, they were not comparable in ANY way. The diseases that they treated were all different. And conveniently enough, the researchers asserted that one of the large trials testing homeopathic medicines in the treatment of patients with polyarthritis (arthritis in multiple joints) did not have a comparable trial (they actually asserted with complete seriousness that there has never been a study of patients with this common malady, and rather than admit that this large trial of 175 patients which showed significant efficacy of treatment, they simply threw out the trial from their evaluation).

When one realizes that NONE of the studies in the final evaluation matched each other in any way, the researchers' decision to throw out this study on the homeopathic treatment of people with polyarthritis is additional evidence of the researcher's strong biases and their efforts to prove homeopathy as a placebo "by hook or by crook."

The researchers put a higher value of those studies with larger numbers of patients because they asserted that smaller trials are "biased," even though they were randomized double-blind and placebo studies (and many of which were published in the Lancet, the BMJ, and other highly respected conventional medical journals).

One group of four studies on patients with respiratory allergies which included 253 subjects and was published in the BMJ(27) was not even a part of the final analysis without explanation, though because of the obvious “bad faith” and questionable objectivity, it can be assumed that these important studies were omitted primarily because they provided too much positive evidence for the efficacy of homeopathic medicines.

An earlier study published in the Lancet with 144 subjects suffering from hay fever was also missing from the final analysis.(28) The fact that these studies showed a significant benefit from homeopathic treatment was ignored entirely.

Using large number of subjects is "do-able" in homeopathy, though it is simply less frequent, due to the high costs of such studies and due to the fact that the profit margin for the sale of homeopathic medicines does not even approach that of conventional drugs. Also, it is a lot easier using conventional medicine than homeopathic medicine in studies because the very nature of homeopathy is the necessity to evaluate a person's overall syndrome, not just any localized disease. This type of sophistication in individualized treatment is a part of good acupuncture treatment as well.

It is therefore not surprising that six of the eight large homeopathic trials gave the same homeopathic medicine to every subject, no matter what symptoms of the disease the subjects in the experiments experienced. Astonishingly enough, the Shang review included a "weight-loss" study in their final review. The "study" used Thyroidinum 30C (a small dose of thyroid gland), even though this remedy is not reported in the homeopathic literature as an appropriate medicine for this condition.

Even though a study can be "well designed" and "well conducted," it will become a "junk science" study if the drug used is totally inappropriate for the sick person. As it turns out, six of the eight homeopathic studies in the final analysis by Shang used homeopathic medicines that were unlikely to be prescribed by a practicing homeopath (they prescribe their medicines based on the overall syndrome of physical and psychological symptoms the patient has, not just based on the diagnosed name of the disease, except in exceptional situations).

In research and statistics, good studies need to have "internal validity" (how the study was designed and conducted) and "external validity" (how the treatment in the study can be generalized to clinical practice). The Shang group did not even seek to evaluate whether any of the studies had "external validity" or not. Sad, but true.

Perhaps the most interesting fact about this study was totally ignored by its authors. Shang and his team purposefully did not evaluate safety issues of treatment. Therefore, it is not surprising that at least three of the conventional medical treatments that were found to be "effective" initially were later found to be so dangerous that the drugs were withdrawn from medical use.

Finally, imagine if researchers evaluated ALL studies for which antibiotics were used. Although antibiotics are primarily effective in the treatment of bacterial infections, they have been tested to treat a wide variety of infections, not just bacterial, but as we all know, antibiotics are not effective for anything other than bacterial infection (and even then, the frequency of use of antibiotics will reduce their efficacy because the bacteria adapt to it). Just because antibiotics are not effective for most conditions does not mean that specific antibiotics are ineffective for specific conditions. Good science requires specificity, not over-generalized statements, as Shang and his ilk have made.

Although the above seems to be a simple and logical statement, skeptics of homeopathy prove their paucity of rational thought by lumping together ALL types of homeopathic research, then throwing out or ignoring the vast majority of studies (including MOST of the studies that the researchers defined as "high quality"), and using studies that are not good examples of how homeopathy is practiced.

For instance, the World Health Organization has deemed that childhood diarrhea represents one of the most serious public health problems in the world today because millions of children die each year as a result of dehydration from diarrhea. With this concern in mind, three randomized double-blind trials were conducted testing individually chosen homeopathic medicines for children with diarrhea. One of these studies was published in Pediatrics,(29) and another study was published in another highly respected pediatric medical journal.(30) All three of these trials showed a significant benefit from homeopathic treatment when compared with placebo.

Similarly, four double-blind placebo controlled trials has shown benefit from the homeopathic medicine, Oscillococcinum, in the treatment of influenza.(31) Research has consistently found it to be effective in the treatment of influenza, though it does not seem to be effective in its prevention.

As for homeopathy and respiratory allergies, reference above was already made to four studies that showed effectiveness of homeopathic treatment (2 of which were published in the BMJ and one of which was published in the Lancet). Further, a review of seven double-blind and placebo controlled studies showed that homeopathic doses of Galphimia glauca were effective in treating people with hay fever.(32)

The two new re-analyses of the Shang review of homeopathic research prove the old cliche, garbage in, garbage out. Junk data indeed creates junk science which creates junk and meaningless results. And ironically, THIS study is considered the 'best" evidence that homeopathy does not work. If this is the best that they have, skepticism of homeopathy is not only dead, it is stupid dead.

For the more detailed analysis of this Shang review and of other government-funded reviews of clinical research on homeopathy, see Dana Ullman’s article, An Analysis of Four Government-Funded Reviews of Research on Homeopathic Medicine.(32a)

While I would like to think that this article would finally put the last nail in the coffin of skeptics of homeopathy, I know that Big Pharma will not allow that to happen. Further, these skeptics are often like religious fundamentalists who will believe what they want to believe no matter what. And then, there's the impact from cognitive dissonance: many people who have invested their time and energy into conventional medicine simply cannot imagine admitting that homeopathy may have any benefit. It may be time to put that rotary telephone in the attic along with the typewriter and your former skepticism of homeopathic medicine.

A Simple Challenge to Skeptics

To adequately and accurately evaluate homeopathy, one has to evaluate the whole body of evidence that has enabled homeopathy to persist for 200+ years. While evaluating double-blind clinical trials is important, so is evaluating the wide body of basic sciences, as well as the clinical outcome trials, the epidemiological studies, the cost-effectiveness literature, and the serial case review trials. It is strange that these defenders of science would remain so ignorant of the whole body of evidence that homeopathic medicine stands. Some leading skeptics of homeopathy even pride themselves on the value of having a closed mind to homeopathy.(33)

Skeptics of homeopathy assume that homeopaths, more than any other type of health practitioner, have incredible magic powers to elicit a placebo effect. We all acknowledge a certain power of the placebo in treating the "worried well," but do skeptics of homeopathy really believe that a placebo effect is consistently effective to treat all of the serious illnesses that are commonly treated by homeopaths...and for which good double-blind studies show efficacy? Studies at the University of Vienna showed "substantial significance" in treating patients with COPD (chronic obstructive pulmonary disease...the number four reason that people in the USA die!)(34) and severe sepsis (a condition which kills 50 percent of patients in hospitals who are inflicted with it, and yet, homeopathic treatment has been found to cut this death rate in HALF!).(35)

This group of researchers at the University of Vienna also conducted a remarkable study of patients with small cell lung cancer and found statistically significant results from homeopathic treatment.(35a)

The vast majority of homeopaths throughout the world are medical doctors or some other licensed or certified health professional who practice family medicine and who see patients with varied acute and chronic ailments. Therefore, I personally challenge ANY skeptic of homeopathy to try to maintain a family practice and only dispense "sugar pills," rather than real homeopathic medicines. My challenge is simple: while seeing a wide variety of children and adults with various acute and chronic problems, take them off all of their conventional drugs (with the exception of insulin and a small selection of drugs of "medical necessity"), and prescribe only sugar pills...for just one week.

When you consider that homeopaths do this for 52 weeks of the year, skeptics of homeopathy should not have any problem IF they think that homeopaths are only prescribing placebos. Let's see how many patients complain, call you late at night expressing concern about the ineffectiveness of your "medicine," and simply do not return for future health care. Any skeptic of homeopathy will be "cured" by this experience in humility. (For the record, I have offered hundreds of skeptics with this challenge, and not a single one has agreed to "prove" that placebo treatment can work in family medicine).

To clarify, I honor good skepticism, for a healthy skepticism seeks to truly explore a subject with knowledge and without arrogance. Further, good skepticism seeks to understand the wide body of evidence that it is necessary to evaluate to determine veracity of phenomena. It is the bad or ugly skepticism that breeds an unscientific attitude and that is simply a form of denialism, or in some cases, hyper-denialism.

Sadly, many of today skeptics are fundamentalists who epitomize a "closed mind." Deepak Chopra said it so well when he asserted, "professional skeptics who are self-appointed vigilantes dedicated to the suppression of curiosity" (huffingtonpost, Dec 27, 2009). When such people do not want to learn from the past, do not even read the research (or only read those studies that confirm their own point of view), and maintain a high degree of arrogance, such "skepticism" isn't skepticism at all: it is bad scientific thinking, it is an unhealthy attitude towards science, and it is a model for how not to learn.

One of the leaders of the skeptics is famed magician James Randi, who like many skeptics is seemingly skeptical of everything (except conventional medicine). He, however, has begun to lose respect from his colleagues and scientists by his skepticism of global warming.(36)

When the denialists assert and insist that homeopathy "cannot" work, I remind them that "science" and "medicine" are not just nouns but verbs...science and medicine are ever-changing. ..and what may be today's medicine is tomorrow's quackery, and what may today's quackery may be tomorrow's medicine. This is not a prediction; this is history.

I encourage everyone and anyone who is seriously interested in the science and art of real healing to explore what homeopathic medicine has to offer. As Mark Twain once asserted in 1890, "you may honestly feel grateful that homeopathy survived the attempts of the allopathists [conventional physicians] to destroy it."

REFERENCES:

(NOTE: References #1 to #22 are for PART I of this series; the remaining references are from PART 2.)

(1) Murray CJL, Frenk J, Ranking 37th -- Measuring the Performance of the U.S. Health Care System. New England Journal of Medicine. 362;2 January 14, 2010. https://pubmed.ncbi.nlm.nih.gov/20054038/
(2) Ullman, Dana. Homeopathic Medicine: Europe's #1 Medical Alternative. www.huffingtonpost.com/dana-ullman ; also: Fisher, Peter, and Ward, Adam, "Complementary Medicine in Europe," British Medical Journal, July 9, 1994,309:107-110.

(2a) https://www.ajmc.com/view/us-health-care-system-ranks-last-overall-among-other-high-income-countries
(3) Coulter HL, Divided Legacy: The Schism in Medical Thought. Volumes 2 & 3. Berkeley: North Atlantic, 1975, 1973. (Note: Dr. Harris Coulter, a world renowned medical historian who specialized in the history of homeopathic medicine, passed away in October, 2009.)
(4) Rothstein, W. Physicians in the Nineteenth Century. Baltimore: Johns Hopkins University Press, 1972.
(5) Ullman Dana. The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy. Berkeley: North Atlantic, 2007.

(6) Jonas WB, Kaptchuk TJ, Linde K, A Critical Overview of Homeopathy, Annals in Internal Medicine, March 4, 2003:138:393-399.
(7) Linde K, Clausius N, Ramirez G, et al., "Are the Clinical Effects of Homoeopathy Placebo Effects? A Meta-analysis of Placebo-Controlled Trials," Lancet, September 20, 1997, 350:834-843. (In 1999, Linde acknowledged that some new research reduced the significance of this review, but he never said or implied that the significance was lost. In fact, in 2005, he sharply criticized the Shang review of homeopathic research.)
(8) Kleijnen J, Knipschild P, ter Riet G, "Clinical Trials of Homoeopathy," British Medical Journal, February 9, 1991, 302:316-323.
(9) Ullman Dana. Homeopathic Family Medicine: Evidence Based Nanopharmacology. An ebook.
(10) Ullman D (June 24, 2021) An Analysis of Four Government-Funded Reviews of Research on Homeopathic Medicine. Cureus 13(6): e15899. doi:10.7759/cureus.15899.

(11) https://www.hri-research.org/resources/research-databases/homeopathy-research-databases/ --This site provides links to several databases, all of which provide references and links to many high quality basic science studies.
(12) Witt CM, Bluth M, Albrecht H, Weisshuhn TE, Baumgartner S, Willich SN. The in vitro evidence for an effect of high homeopathic potencies--a systematic review of the literature. Complement Ther Med. 2007 Jun;15(2):128-38. Epub 2007 Mar 28.
(13) Rey, L. Thermoluminescence of Ultra-High Dilutions of Lithium Chloride and Sodium Chloride. Physica A, 323(2003)67-74.
(14) Elia, V, and Niccoli, M. Thermodynamics of Extremely Diluted Aqueous Solutions, Annals of the New York Academy of Sciences, 879, 1999:241-248. Elia, V, Baiano, S, Duro, I, Napoli, E, Niccoli, M, Nonatelli, L. Permanent Physio-chemical Properties of Extremely Diluted Aqueous Solutions of Homeopathic Medicines, Homeopathy, 93, 2004:144-150.
(15) International Journal of High Dilution Research.
(16) Homeopathic Research Institute — this link provides links to several databases providing references to various homeopathic research databases.
(17) Calabrese, Edward. Hormesis: a revolution in toxicology, risk assessment and medicine. EMBO 5,2004: S37-S40. doi:10.1038/sj.embor.7400222.
(18) Calabrese EJ, Linda A Baldwin LA. Applications of hormesis in toxicology, risk assessment and chemotherapeutics. Trends in Pharmacological Sciences, Volume 23, Issue 7, 331-337, 1 July 2002. doi:10.1016/S0165-6147(02)02034-5.
(19) Demangeat, J.-L, Gries, P, Poitevin, B, Droesbeke J.-J, Zahaf, T, Maton, F, Pierart, C, Muller, RN, Low-Field NMR Water Proton Longitudinal Relaxation in Ultrahighly Diluted Aqueous Solutions of Silica-Lactose Prepared in Glass Material for Pharmaceutical Use, Applied Magnetic Resonance, 26, 2004:465-481. Anick DJ, Ives JA. The silica hypothesis for homeopathy: physical chemistry. Homeopathy. 2007 Jul;96(3):189-95.

(19a) Chikramane PS, Kalita D, Suresh AK, Kane SG, Bellare JR. Why extreme dilutions reach non-zero asymptotes: a nanoparticulate hypothesis based on froth-flotation. Langmuir. 2012. Accessed July 18, 2020.

(19b) Ullman D. Exploring Possible Mechanisms of Hormesis and Homeopathy in the Light of Nanopharmacology and Ultra-High Dilutions. Dose Response. 2021 Jun 14;19(2):15593258211022983. doi: 10.1177/15593258211022983. PMID: 34177397; PMCID: PMC8207273.
(20) Ullman Dana. The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy. Berkeley: North Atlantic, 2007.
(21) Prasad R. Homoeopathy booming in India. Lancet, 370:November 17, 2007,1679-80.
(22) A C Neilsen survey backs homeopathy benefits. Business Standard. September 4, 2007. http://www.business-standard.com/india/news/a-c-nielsen-survey-backs-homeopathy-benefits/295891/
(23) Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. The Lancet. 366,9487, 27 August 2005:726-732.
(24) Ludtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analysed trials. Journal of Clinical Epidemiology. October 2008. doi: 10.1016/j.jclinepi.2008.06/015.
(25) Rutten ALB, Stolper CF, The 2005 meta-analysis of homeopathy: The importance of post-publication data. Homeopathy. October 2008, doi:10.1016/j.homp.2008.09/008
(26) EHM News Bureau. Condemnation for The Lancet's Stance on Homeopathy. Express Pharma Pulse, October 6, 2005.
(27) MA Taylor, D Reilly, RH Llewellyn-Jones, et al., Randomised Controlled Trial of Homoeopathy versus Placebo in Perennial Allergic Rhinitis with Overview of Four Trial Series, BMJ (August 19, 2000)321:471-476.
(28) Reilly D, Taylor M, McSharry C, et al., Is Homoeopathy a Placebo Response? Controlled Trial of Homoeopathic Potency, with Pollen in Hayfever as Model. Lancet, 1985:881-6.
(29) Jennifer Jacobs, L. Jimenez, Margarita, Stephen Gloyd, Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua, Pediatrics, May 1994, 93,5:719-25.
(30) Jacobs J, Jonas WB, Jimenez-Perez M, Crothers D, Homeopathy for Childhood Diarrhea: Combined Results and Meta-Analysis from Three Randomized-Controlled Clinical Trials. Pediatrics Infectious Disease Journal. . 2003;22:229-234.
(31) Mathie RT, Frye J, Fisher P. Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness. Cochrane Database Syst Rev. 2015 Jan 28;1(1):CD001957. doi: 10.1002/14651858.CD001957.pub6. PMID: 25629583; PMCID: PMC6726585.

(32) M. Wiesenauer, R. Ludtke, A Meta-analysis of the Homeopathic Treatment of Pollinosis with Galphimia glauca, Forsch Komplementarmed., 3(1996):230-234.

(32a) Ullman D (June 24, 2021) An Analysis of Four Government-Funded Reviews of Research on Homeopathic Medicine. Cureus 13(6): e15899. doi:10.7759/cureus.15899
(33) Baum M, Ernst E. Should we maintain an open mind about homeopathy? Am J Med 2009;122:973-974.
(34) Frass M, Dielacher C, Linkesch M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest 2005;127:936-941. (This journal is consider THE most respected journal in respiratory medicine.)
(35) Frass M, Linkesch M, Banyai S, et al. Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit. Homeopathy 2005;94;75-80.

(35a) Frass, M., Lechleitner, P., Gründling, C., Pirker, C., Grasmuk-Siegl, E., Domayer, J., Hochmair, M., Gaertner, K., Duscheck, C., Muchitsch, I., Marosi, C., Schumacher, M., Zöchbauer-Müller, S., Manchanda, R.K., Schrott, A. and Burghuber, O. (2020), Homeopathic Treatment as an Add-On Therapy May Improve Quality of Life and Prolong Survival in Patients with Non-Small Cell Lung Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blind, Three-Arm, Multicenter Study. The Oncol, 25: e13548. https://doi.org/10.1002/onco.13548
(36) http://www.randi.org/site/index.php/swift-blog/805-agw-revisited.html
(37) Twain, M. A Majestic Literary Fossil, Harper's Magazine, February 1890, 80(477):439-444.

BIO:

DANA ULLMAN, MPH, CCH, received his Bachelor’s degree (1975) and his masters in public health from UC Berkeley (1978). UC Berkeley’s alumni magazine published a feature interview with Dana Ullman here.

He is one of America’s leading advocates for homeopathy. He has authored 10 books, including The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy, Homeopathy A-Z, Homeopathic Medicines for Children and Infants, Discovering Homeopathy, and (the best-selling) Everybody’s Guide to Homeopathic Medicines (with Stephen Cummings, MD). Dana also created an e-course How to Use a Homeopathic Medicine Kit which integrates 80 short videos with his famous ebook that is a continually growing resource to 500+ clinical studies published in peer-review medical journals testing homeopathic medicines. This ebook is entitled Evidence Based Homeopathic Family Medicine.

Dana Ullman has also authored chapters on homeopathic medicine that included in medical textbooks published by Oxford University Press, the American Academy of Pain Management, and Mosby.

He is the founder of Homeopathic Educational Services, also known as www.homeopathic.com, America’s leading resource center for homeopathic books, tapes, medicines, software, and e-courses. Homeopathic Educational Services has co-published over 40 books on homeopathy with North Atlantic Books.

Dana previously wrote a regular column for the popular website, www.huffingtonpost.com (to access these articles, click HERE!)