Myths about homeopathy 7:

"There are no tests which have shown homeopathy to work"

To begin with we need to be clear about what we mean by tests, since homeopathy has been shown to work in a number of different types of test, and this myth generally refers only to randomised control trials (RCTs).

And this is where the lack of logic kicks in. Some conventional medical treatments cannot be tested using the RCT model, and so evidence of effectiveness is based on the clinical evidence of cases. One example is surgery, another is psychiatry, and it is even the case that some drugs are prescribed on the basis of clinical evidence, rather than on the evidence from RCTs. In addition, drugs are usually withdrawn on the basis of the clinical evidence revealing dangers not identified in the RCTs, so clinical evidence is actually considered more important in the evaluation of treatent than RCTs. Homeopathy has an unequaled level of detail in its case histories which makes it possible to verify the success of treatment by study of clinical practice, and there are also good reasons for it not being easily tested using RCTs. As a result the demand for evidence from RCTs is inappropriate and intended to distort the truth.

There are two particular reasons why homeopathy cannot be tested properly in RCTs:

• The remedy has to be individualised.   RCTs are based on giving the same treatment to a large number of people and looking at the results, compared with those for a group which has been given an "inactive" treatment. If you give the same remedy to a large number of people who nominally have the same illness, but whose individual symptoms do not indicate that the remedy is appropriate, then it is an "inactive" treatment for some proportion of those people. The result is that you are comparing an "inactive" treatment not with an "active" one, but with a combination of "active" and "inactive" treatments. This will dilute the difference between the groups and make the treatment appear ineffective.
•  The sequence of remedies has to be individualised.   The best RCTs are generally conducted so that neither the patient nor the practitioner knows who is getting the "active" treatment and who the "inactive" one (double blind). In homeopathy, however, the practitioner needs to assess the patient's reaction to the previous remedy in order to decide how to proceed with the case. A lack of reaction to the remedy is important information as it may indicate that the wrong remedy or the wrong potency has been prescribed. Study of the case will lead to a decision about whether to change the remedy or potency. If the practitioner does not know whether the patient actually received the remedy, then it is impossible to make any accurate assessment of the case, and so the treatment becomes confused. This again will dilute the difference between the groups and make the treatment appear ineffective.

It is a measure of the power of homeopathy that even so there are trials which show it to be successful. A study of clinical trials of homeopathy by Kleijnen et al. (BMJ 1991; 302:316-323) concluded: ‘Overall, of the 105 trials with interpretable results, 81 trials (77%) indicated positive results.’ They also stated: ‘At the moment the evidence of clinical trials is positive but not sufficient to draw definite conclusions.’