If you rely on the personal experience of patients, there
are a large number of people who will claim, usually with great certainty, that
they had been cured or at least helped by homeopathy when orthodox medicine had
failed. One can see why. The system is easy to understand and seems safe. This is especially important since many of the diseases
treated by homeopaths are either transient and disappear spontaneously, or they
are cyclical, consisting of a series of attacks followed by spontaneous
remissions. If a visit to a homeopath happens to be followed by a remission or
the total disappearance of a disease, homeopathic medicine gets the credit.
If there was ever a medical system which cried out for a
careful scientific trial it is homeopathy. One of the early trials, carried out
in 1835, is astonishing because it was very close to a double-blind, randomized
controlled trial, undertaken with great care long before the mid-twentieth
century when most of us believed that such randomized trials were first devised
and carried out. It showed, incidentally, that homeopathy was ineffective.13
This was followed by such a long series of clinical trials and systematic
reviews, stretching up to the present time, that to review all of them would
take up more space than the whole of this paper; but a useful account of
clinical trials of homeopathy in the nineteenth century was published very
recently.
Some homeopathic practitioners argue that carrying out
randomized controlled trials is an appropriate activity for orthodox medicine
but inappropriate for homeopathy, where effectiveness should only be judged by
patient satisfaction. Where clinical trials and systematic reviews have been
carried out, however, the results remain uncertain. A few seemed to show that
homeopathy was effective, but only slightly; a majority showed that homeopathy
had no therapeutic effect. Unfortunately many of the trials included in
systematic reviews were less than perfect in design, application or sample
size.
A recent authoritative paper concluded that ‘the evidence of
the effectiveness of homeopathy for specific clinical conditions is scant, is
of uneven quality, and is generally of poorer quality than research done in
allopathic (mainstream) medicine.’ Nevertheless ‘when only high quality studies
have been selected... a surprising number show positive results’ although ‘even
the best systematic reviews cannot disentangle components of bias in small
trials.’ These authors conclude that ‘more and better research is needed,
unobstructed by belief or disbelief in the system.’
When one recalls the underlying beliefs of the homeopathic
system, such as the process of extreme dilution with the transformation of a
drug into a ‘dematerialized spiritual force’, a totally neutral and
‘unobstructed’ attitude may be impossible. We can, however, be reasonably
certain that in the context of the total provision of medical care, homeopathy
has played and still plays a large part, judged by the number of patients who
believe, rightly or wrongly, that homeopathy has helped them.
The late Sir Douglas Black should have the last word. In a
very balanced article on complementary medicine, he wrote:
‘Although mainstream medical intervention is critical in
only a minority of episodes of illness, in those particular episodes it is
critical indeed; and I would plead that at least in acute illness, and possibly
in any illness, “complementary” medicine should also be subsequent to an
assessment of the clinical situation by competent “orthodox” means.’