Dr Alex Tournier Homeoevidenceoverviewjune2008
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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
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
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