Dr Alex Tournier Homeoevidenceoverviewjune2008

Overview of the current state of the research in Homeopathy

Dr Alexander Tournier BSc 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 Science of Homeopathy

Experimentation

Theories

Understanding

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

CAM model

Screening

Practice

Mechanism

Safety

Trials of efficacy

Effectiveness

Effectiveness in practise

Efficacy of components

Safety

Mechanism of action

Adapted from Fonnebo etal BMC Med Res Meth 2007 11(7) 7

Homeopathy: a new science Number of scientific publications over the last 20 year

Adhami H.R. , S.Shamloo D., Mesgarpour B., H.Tehrani S.A. “The trend of homeopathic articles indexed in pubmed and ISI” LMHI 2008

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



*Quality assessed using SAPEH scores, high-quality > 6 Review: C Witt etal J Alt Comp Med 2003 9:1, 113-32

Molecular and cellular systems


Enzymatic reactions (7/9 Hi-Qt* pub)







Cultured cells







Basophil degranulation

(5/9 Hi-Qt pub)

(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

Human provings or Human pathogenetic trials 




Only one review up to 1995




More recent trials are of higher quality




Need a review of the recent provings




Need more trials

Human provings Average number of Symptoms

A successful example 14 12 10

Associated p = 0.0002 Arsenicum specific symptoms Nat-mur specific symptoms Non-specific symptoms

8 6 4 2 0 -2 -4

Arsenicum group

Nat-mur group

Placebo group

Adapted from H. Möllinger ‘Homeopathic Drug Provings between historical and scientific demand’ LMHI 2008

Meta-analyses Kleijnen 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)

Shang etal 2005 Meta-analysis


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)

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 I

Overall (3/3 Hi-Qt meta-analyses)

I

Allergic rhinitis, post-operative ileus, rheumatoid arthritis, protection from toxic substances

IIa

IIb

Asthma, fibrosis, influenza, muscular pain, otitis media, strains ENT infections, side effect radiotherapy 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 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

Thank you For more information: [email protected] www.homeopathyresearchinstitute.org