Rutten Research

How should homeopathy be assessed? Still applying conventional science Lex Rutten, the Netherlands

Belief or science Belief: conventional medicine works; homeopathy does not.

Homeopathy cannot succeed in Randomised Controlled Trial

Scientific mirror Homeopathy - conventional medicine: same results in RCT

Hypothesis: selection bias, low quality, heterogeneity Shang, the Lancet aug. 2005

RCT works only for conventional medicine (????)

‘It works’ doesn’t mean it works • Allen Roses (GSK, December 2003): 90% of conventional medicines work in 30-50% of all patients • Pharmacogenetics: not only the disease, but the whole person: genotype • Homeopathy: same, but phenotype

Why not 100% success? RCT

side-effects

diagnosis

therapy-result co-morbidity

circumstances

Unreal certainty

From complaint towards result diagnostic research

RCT

symptom A symptom B

diagnosis

result

test X test Y

probability of diagnosis

chances placebo < 0.05

Homeopathic ‘diagnosis’ symptom A symptom B

Diagnostic/prognostic research Diagnosis

Result

symptom C symptom D Diagnosis

Probability of result

Effect modification comorbidity age > 65 sex social status suicidal?

Diagnostic/prognostic research Result Probability of result

Bayes method • • • • •

Knowledge from experience Direct results in practice Handling of complex clinical symptoms Probability instead of certainty Step-by-step increasing certainty by adding data

Bayes and homeopathy • • • •

More symptoms more certainty Peculiar symptoms are more important Vagueness is no problem Disadvantage: difficult calculations (use a calculator)

Likelihood Ratio (LR) LR+ =

Occurrence in target population Occurrence in rest-population

Odds = chance / (1-chance) Chance = odds / (1+odds) Bayes’ rule:

posterior odds = LR x prior odds

Prior to posterior chance (LR+=5) Prior chance • 1% • 10% • 30% • 50% • 80%

Posterior chance 4.8% 35.7% 68.1% 83.3% 95.2%

Homeopathic diagnosis stepwise Lachesis in menopausal complaints symptom LR success (%) 1. menopause

10%?

2. loquacity

5

35%

3. left-sided complaints

3?

62%

4. clothing <

3?

83%

Repertory with LR Partly hypothetical rubric ‘Fear of death’: FEAR - Death, of: in general, more than expected considering circumstances; occurring almost daily. Prevalence 5% (±0.5) Acon. (4), act-sp., agn. (2.5) , all-s, ..., Anac.(13) , apis (3) , arg-n. (3) , Ars. (6) , asaf., aur. (1) , ... Calc. (2) , lach.(3.5) , Lat-m. (6), led., ...

Practical homeopathic research • Relation between symptom and success • No conflict with daily practice • Takes a few seconds during each consultation • Outcome: a reliable repertory

Prospective research • Check the presence of 6 symptoms in each new patient • Keep record of medicines and results • a=occurrence of symptom in Lachesispopulation • b=occurrence of symptom in restpopulation • Likelihood Ratio = a / b

A few seconds of each consultation

Results fear of death medicine

fear death, n=

Anacardium Arsenicum album Calcarea carbonica

2 2 2

medicine population, n= 4 8 27

Fear of death in whole population: 3.8% Does this lead us to a more reliable repertory?

Repertory: Anac., Ars., Calc.

LR+ 13.36 6.66 1.95

Results after 15 months, n=1634

medicine Diarrhea anticip. arg-n.

Grinding teeth

LR+ 15

calc.

2.2

ph-ac

10

bell.

6.1

carc.

2.6

merc.

5

tub.

7.3

Sens. injustice

Loquacity

medicine

LR+

bell.

3.4

caust.

6

hyos.

7.8

lach.

4.7

Lachesis in menopausal complaints • LR+ loquacity - Lachesis = 5 (1,8-12,3) • succes by Lachesis in menopausal complaints with loquacity goes from 10%(?) to 35%. Dear GP, Treat your most loquacious patients with menopausal complaints with Lachesis

Conclusions • Homeopathy (and conventional medicine) is bayesian science • LR research is easy, cheap and rewarding • Effectiveness of homeopathy can be much improved by LR research

Vagueness Herpes lip

Loquacity loquacity

herpeslips 14,00%

30,00%

12,00%

25,00%

10,00%

20,00%

8,00%

herpes=1

6,00%

herpes=2

loquax=1

15,00%

loquax=2

10,00%

4,00%

5,00%

2,00%

0,00%

0,00% 1

2

3

4

5 doctor

6

7

8

9

1

2

3

4

5 doctor

6

7

8

9