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*Corresponding author: E-mail: [email protected], [email protected];
Current Clinical Status of Homeopathy; An Evidence Based Retrospective Six Years Review
Rizwan Ahmad1*
1Natural Products and Alternative Medicines, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Author’s contribution The sole author designed, analyzed and interpreted and prepared the manuscript.
Article Information
DOI: 10.9734/ARRB/2018/37676 Editor(s):
(1)Robin Maskey, Internal Medicine, BPKIHS, University in Dharan, Nepal.
(2)Bechan Sharma, Department of Biochemistry, University of Allahabad, Allahabad, India.
(3)George Perry, Dean and Professor of Biology, University of Texas at San Antonio, USA.
Reviewers:
(1)Tushita Thakur, India.
(2)Helvo Slomp Junior, Federal University of Paraná, Brazil.
Complete Peer review History:http://www.sciencedomain.org/review-history/22644
Received 24th October 2017 Accepted 5th December 2017 Published 9th January 2018
ABSTRACT
Background: Homeopathy, as an alternative treatment system for the treatment of various diseases, is widely used in various regions of the world. However the clinical benefits of homeopathy remains controversial.
Aim of the Study: This review highlights the most up-to-date and current clinical trials and research carried out in the field of homeopathy and to compare its effectiveness in combating various diseases.
Methodology: A retrospective literature search was performed from 2012 to 2017. All the articles, containing clinical trials in human subjects, were searched in different databases such as google scholar, science direct, web of science, Scopus, Springer Link and Sci Finder etc. using the keywords i.e. clinical trials in homeopathy, current clinical status of homeopathy, homeopathy and treatment of diseases, clinical cases in homeopathy and clinical studies in homeopathy.
Results: Twenty one articles met the inclusion criteria and were included in this review. The results of these clinical studies showed an effective outcome for homeopathy treatment in various diseases such as atopic dermatitis, eczema, respiratory tract infections, asthma, hay fever and pulmonary tuberculosis etc. However, for some of the diseases such as depression, mental fatigue, cancer, HIV, anxiety, dementia, induction of labor, osteoarthritis, migraine and insomnia etc. no proper clinical evidence for a safe and effective use of homeopathy exists. Furthermore, the
Review Article
research quality of most the homeopathy clinical trials are objectionable and negatively analyzed by various authors in terms of sample size, reproducibility and replication of data as well as lack of proper guidelines for performing homeopathy research.
Conclusion: To build credibility in health care system and attract more patients as well as professional practitioners towards this system of alternative treatment, more focus in terms of quality research and practically applicable clinical trials i.e. efficacy trials (near to optimal laboratory conditions) is needed.
Keywords: Homeopathy; research; current status; clinical trials; retrospective review.
1. INTRODUCTION
Homeopathy is a form of complementary and alternative medicines (CAMs) utilized for the treatment of various diseases. This practice of treatment was invented by a German physician Samuel Christian Hahnemann, at the end of 18th century. Hahnemann decided to experiment cinchona bark on himself and soon after its use he experienced the symptoms of anxiety, palpitations, trembling and diffuse joint stiffness without any fever. Hahnemann used the cinchona bark again and the effects observed lasted two to three hours each time after its ingestion. This experiment led Hahnemann to conclude, “Similia Similibus Curantur” or “like cures like” which later on turned to a complete system of treatment with its own tenets of therapy called homeopathy [1,2].
The basic tenets used by homeopathy includes;
i) doctrine of signatures i.e. diseases are cured through drugs having the potential to produce effects similar to symptoms of a disease [3,4], ii) principle of dilution i.e. increasing the dilution of a drug increases its effect to treat a disease properly [5-10], iii) law of minimum dose i.e. the diseases are treated with the lowest dilution possible as this system focuses the stimulation of immune system to combat the disease thus the role of a drug is just to initiate immune response whereas the eradication of a disease from the body is sole responsibility of immune system [4,11], iv) do not treat the symptoms i.e. this system believes symptoms to be a manifestation of what is going on inside human body hence any attempt to treat symptoms may suppress the disease inside the body [4,11,12].
The publication of “Hahnemann’s Organon” in homeopathy attracted a number of active and enthusiastic followers who took this new idea to other countries and soon homeopathy started to become a well-known and acceptable treatment system [13]. Different schools of thought were soon established throughout the world i.e.
Germany, Belgium, Romania, Bulgaria, Hungary, South Africa, Canada, United States, New Zealand including more than 100 homeopathic colleges with 100,000 licensed homeopath in India [14,15]. About 5 million adults as well as 1 million children used homeopathy in United States in the year 2011 as per National Health Interview Survey (NHIS) report [16]. In another report by Italian National Institute of Statistics (ISTAT) survey, approximately 2.5 million peoples in Italy used homeopathy (2010-2013) prescribed by more than 20, 000 physicians [17].
A number of literature reports are available which supports the use of homeopathy in different regions of the world [18-20] however still some of the authors have negatively evaluated the use and effects of homeopathy and homeopathic medicines. They consider homeopathic medicine no more than as a placebo [21,22]. Furthermore, many researcher believes homeopathy as a system of treatment based on anecdotal data with no proper mechanisms [23-29]. Most of the systemic analysis, regarding homeopathy research as well as clinical trials, also produced a little support for homeopathy as an effective treatment system for a specific condition [30].
Homeopathy remained a controversial and complex topic for researchers always. Different concepts of homeopathy are even not in-line with any of the fundamental concepts of physics or chemistry. For example, it is difficult to explain a therapy with minute or no active ingredient [31]
as well as an extremely dilute solution may work scientifically to treat a disease [32]. The Australian government's National Health and Medical Research Council in its comprehensive assessment report 2012 states; no reliable evidence exists whereby it may be confirmed that homeopathy is effective for a specific health conditions [33].
Homeopathy as a profession observed many rise and fall [34]. At times it ruled and remained at peak in the health care system while on the other hand it witnessed objections and different challenges from various researchers too. This
study aims to review the current clinical status and acceptance of homeopathy through a comprehensive retrospective six year review i.e.
2012 to 2017.
2. MATERIALS AND METHODS 2.1 Databases Searched
Google and Google scholar, PubMed, Science direct, Web of science, Central library Imam Abdulrahman Bin Faisal University (formerly University of Dammam), Science Hub, Scopus, Springer Link, Sci Finder, TRIP database, Books and chapters, Theses.
2.2 Keywords Searched
Homeopathy, Homeopathy Cases, Clinical trials about homeopathy, Clinical status of homeopathy, Clinical evidences in homeopathy, Individualized homeopathy, Homeopathy treatment in disease. The relevant research/review article were downloaded using the free access portal of Imam Abdulrahman Bin Faisal University (formerly University of Dammam), for specific libraries.
2.3 Review Period
Retrospective six (06) years review from 2012 to 2017.
2.4 Inclusion Criteria
This study includes clinical cases or trials conducted in human subjects only. All the clinical cases, treatments or trials for any homeopathic medicine carried out in any clinical phase i.e. I, II, II or IV were included in the study.
2.5 Exclusion Criteria
The clinical cases or trials other than homeopathy i.e. aromatherapy, chiropractic, massage therapy and magneto therapy etc. were excluded from the study. Similarly, any study which was pre-clinical i.e. In-vitro or performed in animals rather than human volunteers was excluded from the study.
2.6 Search Results
A total of twenty one (21) articles met the eligibility criteria and were reported in the literature review section.
3. LITERATURE REVIEW
An extensive literature review was carried out and the relevant articles were downloaded, studied and reported in the current article. The literature searched was categorized as clinical cases reported in each respective year as below;
A) Clinical trials observed in 2012
A total of nine clinical cases were observed in the year 2012 reported as below;
i) Effectiveness of homeopathy in treating low back pain
This was a first time study conducted in 192 patients (age group; 18 to 75), using a homeopathic combination Lymphdiaral basistropfen for treatment of edema and swelling in chronic low back patients. A total of 137 patients completed the study (72 verum vs. 65 placebo) using 10 drops of verum or placebo solution (three time a day for 105 days). The treatment was tolerated well (92.9% vs. 95.4%) whereas the effects were recorded on an hannover functional ability questionnaire which showed an increase in intention-to-treat-analysis (verum: 6.6 vs. placebo: 3.4; p = 0.11) alongwith a significant increases in per-protocol-analysis (verum: 9.4 vs. placebo: 4.1; p = 0.029). The incidence of adverse reactions were similar in both treatment groups with an improvement in chronic low back pain treatment [35].
ii) Homeopathy and eczema
Ernst 2012, reviewed clinical trials regarding evidences for usefulness of homeopathy in the treatment of eczema. One randomized and two nonrandomized clinical trials were found satisfying the inclusion criteria however none of them demonstrated the clinical efficacy of homeopathy in the treatment of eczema [36].
iii) Homeopathy for mental fatigue
Dean et al. [37] reported a clinical trial using homeopathic formula consisting of potassium phosphate (Kali phos 6x) for patients with attention or cognitive problems associated with mental fatigue. Eighty six patients were randomized and administered with Kali phos 6x or placebo ten minutes prior to a psychological test of attention i.e. (Stroop Colour-Word Test).
No evidence of clinical efficacy for Kali phos 6x was observed as compared to placebo (Kali phos minus placebo = -1.1 (95% CI -3.0 to 0.9, P =
0.3) Stroop score units, Cohen effect size = - 0.17).
iv) Homeopathy and chemotherapy induced nausea and vomiting
A randomized placebo controlled phase-III study, using homeopathic medicine i.e. Cocculine, was conducted in 431 non-metastatic breast cancer patients having chemotherapy induced nausea and vomiting (September 2005 to January 2008).
After analysis of primary endpoint analysis, no significant difference between the two arms was observed. In addition, no significant difference was observed between the two study arms regarding nausea, vomiting and global emesis score. This study reveals that addition of homeopathic medicine (Cocculine) to standard antiemetic treatment does not improve nausea and vomiting in breast cancer patients [38].
v) Homeopathy and chronic sinusitis
Therapeutic efficiency of 13 homeopathic medication in 550 patients with chronic sinusitis was observed whereas the symptoms were assessed using chronic sinusitis assessment score (CSAS). A significant reduction (P=0.0001) was observed for CSAS after a treatment of 3 to 6 months, without any complications in the treatment. The homeopathic medicines prescribed and found more effective were; Kali iod. (65% of 40), Phos. (66.7% of 45), Lyc. (69%
of 55), Calc. (62.5% of 98) and Sil. (55.2% of 210). Homeopathy possesses an effective role in the treatment of chronic sinusitis [39].
vi) Homeopathy Vs conventional therapy in acute otitis media
Sinha et al. [40] compared homeopathy against conventional therapy in 80 patients with acute otitis media (40 homeopathic subjects vs 40 conventional subjects). In the group of patients treated with conventional system 39 patients (97.5%) were prescribed with antibiotics whereas in homeopathy group 85% of the patients received six homeopathic medicines for treatment of acute otitis media. In conventional group 100% of the patients were cured whereas in homeopathy group 95% i.e. 38 patient were cured. Two patients required a follow up for further two days. However, during the course of treatment 4 patients in homeopathy group were cured on day 3rd whereas no patient of conventional group was cured. Although there was no significant difference in the main outcome
between the two groups however homeopathy may be favored here as; quick symptomatic improvement and need for no antibiotic was observed in homeopathy group.
vii) Homeopathy as an adjunct treatment in Asthma
Shafei et al. [41] studied the effect of homeopathic medicines as conjunctive to conventional medicine in 30 children’s. The aim of the study was to observe any improvement in asthmatic attacks and its frequency, spirometry and night awakening at baseline and after a follow-up of 6 months treatment. The result after 3 months exhibited a relative improvement whereas an absolute improvement was observed after 6 months of treatment. This study supports the effectiveness of homeopathy in improving the severity of asthma in children’s.
viii) Homeopathy and atopic diseases
This study reviewed the use of homeopathy and its long term effects (September 1998 to December 2008) at a homeopathic clinic of Lucca (Italy) in 213 children’s with atopic diseases. The detail of children’s with atopic diseases included in the study was as; asthma (39%), allergic rhino conjunctivitis (24%), atopic dermatitis (AD) (36%) and food intolerance (1%).
The results assessed after a long term treatment of 8 to 10 years were as; 70% of children’s with AD had complete disappearance of AD, 80% of the children’s with asthma as well as allergic rhinitis were completely cured. These results supports the positive therapeutic effect of homeopathy in children’s with atopic diseases [42].
ix) Adverse effects of Homeopathy
Posadzki et al. [43] reported a study regarding adverse effects (AEs) of homeopathy. In this review study 38 reports were found to meet the inclusion criteria out of which 30 reports showed direct AEs of homeopathic remedies whereas remaining 8 studies showed AEs related to substitution of homeopathic remedies with any conventional treatments. The total number of patient observed in the review literature were 1159. The nature of AEs were from mild to severe alongwith 4 fatalities whereas the most commonly observed AEs were allergic reaction and intoxications. This is an evidence based support to conclude; homeopathy may harm the patients in direct or indirect way.
B) Clinical trials observed in 2013
A total of two clinical cases were observed in the year 2013 which are reported in detail as below;
i) Homeopathy Vs Conventional treatment in atopic dermatitis
A study was conducted in 135 patients (48 patient homeopathic vs 87 patients conventional) for assessing SCORAD (SCORing-Atopic- Dermatitis). After a follow up for a 36 months, no significant difference was observed between the two groups; homeopathy group 13.68 ±2.91 at 95% CI [7.88–19.48] Vs conventional group 14.90 ±2.25 at 95% CI [10.41–19.40] with p = 0.741. Total costs were higher in the homoeopathic versus the conventional group (months 31–36 200.54 Euro [132.33–268.76] vs.
68.86 Euro [9.13–128.58], p = 0.005) [44].
ii) Homeopathy and treatment of depression
A total of 44 patients (23 homeopathic vs 21 conventional treated), including men and women in the age group 18 to 65 years were treated with homeopathic medicines and placebo for six weeks. The results showed no significant difference between homeopathic and placebo treated groups [45].
C) Clinical trials observed in 2014
A total of three clinical cases were observed in the year 2014 which are reported in detail as below;
i) Homeopathy in multi drug resistant pulmonary tuberculosis (MDR-TB)
A double blind, placebo controlled study was conducted on 120 MDR-TB patients from 2003 to 2008. The patients were grouped as i. Standard Regimen + individualized homeopathic medicine (SR + H) and ii. Standard Regimen + identical placebo (SR + P) whereas the study outcomes were measured as changes in chest X-ray (CXR), hemoglobin, sputum conversion, weight gain and erythrocyte sedimentation rate (ESR).
The results observed were as; a change of sputum culture conversion from positive to negative i.e. 23 (38.3%) in SR + H; 23 (38.3%) patients in SR + P group; (p = 0.269) and 27 (55.1); 21 (42.8%), p = 0.225, weight gain
observed was 2.4 ± 4.9 in SR+H group and 0.8 ± 4.4 in SR+P group with p = 0.071, reduction in ESR i.e. −8.7 ± 13.2 for SR + H whereas for SR + P it was 3.9 ± 15.4 at p = 0.068. The hemoglobin was increased by 0.6 ± 1.7 for SR + H group alongwith an increase of 0.3 ± 2.3 for SR+P group at p = 0.440 and CI 95%.
Furthermore a significant improvement was observed in CXR for SR+H group i.e. 37 (61.7%) and SR+P group i.e. 20 (33.3%) at p = 0.002.
Thus addition of homeopathy to a standard therapy may improve the outcomes in MDR-TB patients [46].
ii) Homeopathy and irritable bowel syndrome (IBS)
Peckham et al. [47] conducted a three-armed trial i.e. Usual care, Usual care + homeopathy treatment and Usual care + supportive listening, in order to see the comparative effect in modulating the IBS severity score between baseline and 26 weeks.
The results revealed; Usual care + homeopathic treatment as compared to Usual care alone had a significant with regard to IBS symptoms severity hence favoring homeopathy treatment.
Furthermore, 62.5% of homeopathy treated patients (compared to 25.0 percent of those in the usual care arm) achieved a significant clinical improvement in IBS symptoms severity score.
These results indicate a promising effects of homeopathy to be used as a treatment for IBS [47].
iii) Influence of Homeopathy on global health and well-being in cancer patients
Mullner 2014, reviewed a data on 538 cancer patients (62.8% women with 20% breast cancer) who visited Outpatient Unit for Homeopathy in Malignant Diseases, Medical University Vienna, Department of Medicine I, Vienna, Austria for at least three homeopathic consultations. The neoplasm surveyed were; cholangiocellular and pancreatic carcinoma, glio blastoma, renal cell carcinoma and metastasized sarcoma. An extended and prolonged survival time was observed in these patients using homeopathic treatment [48].
D) Clinical trials observed in 2015
A total of two clinical cases were observed in the year 2015 reported as below;
i) Homeopathy Vs global health status and subjective wellbeing in cancer patients
Homeopathy was applied as an adjunct to conventional therapy in 373 cancer patients who were treated with standard anti-neoplastic therapy. Patients were asked to fill in two different questionnaires at each three visits i.e.
one baseline and two follow-up visits. A significantly much stringer improvement in global health status was observed for homeopathy group i.e. 7.7 (CI=95%, 2.3–13.0, p = 0.005) as compared to control group. In addition, a significant group difference towards subjective well-being was observed in homeopathy group by 14.7 (95% CI 8.5–21.0, p < 0.001) as compared to control group. The findings of these results suggests a significant improvement in overall global health status and subjective well- being through the use of homeopathy as an adjunct to conventional system [49].
ii) Homeopathy and treatment of moderate to severe depression in Peri- and Postmenopausal Women (HOMDEP- MENOP Study)
This study aimed to assess the efficacy of individualized homeopathic treatment against placebo and fluoxetine versus placebo in 133 peri- and postmenopausal women with moderate to severe depression. After a 6 weeks follow-up the outcomes were measured on 17- item Hamilton rating scale used for evaluating beck depression and Greene Climacteric Scale.
The homeopathic group was more effective by 5 points on Hamilton scale as compared to placebo whereas fluoxetine-placebo difference was 3.2 points. Similarly, homeopathy group exhibited a superiority over placebo in Greene Climacteric Scale i.e. 8.6 points. Homeopathy improves menopausal symptoms as scored by Greene Climacteric Scale [50].
E) Clinical trials observed in 2016
A total of three clinical cases were observed in the year 2016 reported as below;
i) Use of Homeopathy in patients with organ transplant
A study in Switzerland was conducted in 118 patients (55 women and 63 men) for the use of CAMs especially homeopathy during organ transplantation. After analysis of filled questionnaire, 64 patients indicated the use of
CAMS whereas 54 patient reported no use of CAMS during organ transplantation. The reason observed for not using CAMs were; interactions with conventional medicines (46%) and lack of knowledge (28%) about CAMs [51].
ii) Use of Homeopathy in preventing respiratory tract infection (RTI)
This study reports the comparative analysis of 459 patients (homeopathic medicine treated 248:non-homeopathic treated 211) examined for preventing RTIs after a follow-up of minimum 1 year or maximum 10 years. The results showed a significant reduction in RTIs frequency in homeopathic medicine treated groups thus confirming the positive effects of homeopathy in prevention of RTIs [52].
iii) Use of Homeopathy in the alleviation of hay fever symptoms
A clinical study, for assessment of homeopathic treatment in alleviation of hay fever symptoms, was conducted in 8 patients over a 2 year period using Measure Yourself Medical Outcome Profile (MYMOP) self-evaluation questionnaire. The results of the study showed an improvement in eye and nose symptoms, activity and general well-being after 2 and 4 weeks of homeopathy treatment. This study supports the use of homeopathy for alleviation of hay fever symptoms [53].
F) Clinical trials observed in 2017
A total of two clinical cases were observed in the year 2017 reported as below;
i) Homeopathy and Allergic Rhinitis
A systemic review including all the articles (up to December, 2015), published regarding the use of homeopathy in seasonal or perennial allergic rhinitis (AR) was reported by Banerjee et al. [54].
The trials were placebo controlled. Only eleven studies were eligible for SR out of which 8 studies were found as “high risk of bias” whereas only one trial possessed reliable evidence. Three trials using Galphimia glauca as a treatment for seasonal AR were included in the meta-analysis whereby the results observed were as; a relief of nasal symptoms at week 2 and 4 with risk ratio = 1.48 [95% CI 1.24–1.77] and 1.27 [95% CI 1.10–
1.46], respectively and a relief of ocular symptoms at week 2 and 4 with risk ratio = 1.55 [95% CI 1.33–1.80] and 1.37 [95% CI 1.21–1.56],
respectively. The results support the favor of homeopathy in AR.
ii) Homeopathy and methicillin-resistant Staphylococcus aureus (MRSA) previously treated with homeopathic medicines
In this study in vitro antibacterial effect, deoxyribonuclease (DNAase) and hemolysin activity were evaluated using Bell and MRSA nosode alone and in combination with the antibiotic oxacillin. The nosodes were prepared as per Brazilian Homeopathic Pharmacopeia i.e.
6cH and 30cH potencies nosodes in using the solvents (30% alcohol and sterile water) and tested on MRSA National Collection of Type Cultures (NCTC) 10442. A significant in vitro growth inhibition as compared to control was observed as; Bell and nosode 6cH and 30cH alone (p < 0.0001) and oxacillin + Bell and nosode 6cH and 30cH (p < 0.001). A decrease production (p < 0.001) in bacterial DNAse production was also observed for Bell and nosode 6cH and 30cH alone and oxacillin + Bell and nosode 6cH and 30cH [55].
4. DISCUSSION
Homeopathy spread throughout the world in the early 19th century. It was Dr Constantin Hering (1800-1880), who introduced homeopathy in the United states of America (USA) in the year 1833.
In India, homeopathy was first practiced by Dr.
John Martin Honigberger (1795-1869) in 1839 whereas in Brazil, it was first introduced in 1843 by Frenchman Benoit Mure (1809-1858) who developed an institute i.e. Instituto Homeopático do Brasil in Rio de Janeiro and later on introduced homeopathy in Egypt [56]. However a different fate was observed for homeopathy in USA and India. The report on medical education in 1910 by Abraham Flexner, resulted a closure of all the alternative systems of treatment in USA which was followed by a sharp decline in schools and number of practicing doctors in the state [56]. On contrast, the homeopathy grew as a profession in India and by the end of 2009 about 178 homeopathic medical colleges (35 government institutions) with more than 200,000 registered homeopath as well as 300 homeopathic hospitals with over 8000 homeopathic dispensaries were reported [57].
Furthermore, homeopathy also gained popularity in Europe during the first half of 19th century [58].
Various reasons may be attributed for this
widespread and rapid popularity of homeopathy.
The spoke high of homeopathy by famous scientists violinist Paganini and Charles Darwin increased its popularity. Though Darwin was sceptical regarding use of high dilutions in homeopathic treatment however his experiment
“highly dilute Ammonium phosphate and its effect on carnivorous plant Drosera” imparted a high reputation to homeopathy system [59,60].
Another contributing factor for the rise of homeopathy was its success in the epidemic cholera, swept from Europe during 19th century.
Homeopathy was 89%-96% successful in saving lives of patients in the epidemic while conventional hospitals were reported with a death ratio up to 74% [61]. In addition, homeopathy is used widespread in the world now a days. European commission in 1997 reported the use of homeopathy by 29% of its citizens.
Due to its high practice in many parts of the world it has been officially recognized by governments in various countries such as Latin America (Chile, Brazil, Costa Rica, Colombia, Cuba, Mexico, Ecuador, Mexico), Europe (Hungary, Belgium, Bulgaria, Romania, Portugal, United Kingdom) and Asia (Pakistan, India, Sri Lanka). Few of the aforementioned countries i.e.
Pakistan, India, Brazil, Mexico, Sri Lanka and United Kingdom, have already integrated homeopathy into national healthcare system [62].
Whereas some of the countries like France, India, Germany, Brazil and USA have officially recognized homeopathic pharmacopoeias as well as a proper registration procedure for homeopathic medicines. Furthermore, World Health Organization has published safety issues regarding preparation of homeopathic products [63].
The widespread acceptance for homeopathy is mainly due to its logical principle of “like cure likes” which is easy to comprehend for common people as well as the involvement of old Chinese and Indian medicines in its treatment. The individualized treatment plan and long consultation session with practitioners, attract more patients towards homeopathy. Moreover, the common believe of “Homeopathy is safe”, helped homeopathy to prosper and survive for centuries as an effective treatment approach [64]. Homeopathy got a huge reputation after the hospital was given a royal name by Edward prince who was patron of London homeopathic hospital [64]. At the end of 19th century, an increase in the number of patients was seen particularly among middle economic class and middle age [65] and homeopathy is still popular
in many regions of the world such as Latin America, Indian subcontinent as well as Western Europe [66].
However, other regions of the world including USA in 20th century and Russia alongwith Eastern Europe in communist period saw a terminal decline in the field of homeopathy [66].
Various reasons exist for this decline which are discussed in detail as below;
4.1 Clinical Effects of Homeopathy are no More than Placebo
Some of the authors have negatively evaluated the effects of homeopathic medicines and claim its effects as similar as placebo rather than any clinical effects [67,68]. However the clinical effects of homeopathy are not placebo effects and many systemic reviews as well as met- analysis of randomized controlled trials (RCTs) as a whole and for specific conditions treated by homeopathic medicines have been published.
The results form most of these studies suggests the effects of homeopathy as clinical effects rather than placebo. A meta-analysis including 186 placebo-controlled studies was published in
“The Lancet” in 1997. The result from this analysis concluded; the clinical effects of homeopathy are not similar to placebo and are more better in effects as compared to placebo”
[69]. Another such study identified 184 clinical trials and analyzed RCTs including 2001 patients. The results revealed a far more better effect of homeopathy compared to placebo [70].
Shang et al. [68] reported a meta-analysis which compared 110 placebo controlled trials of homeopathy and 110 trials for conventional medicines at the same time. The results showed an overall similar positive treatment effect. These studies alongwith the clinical trials reported in this review article are self-explanatory evidence for the rejection of hypothesis i.e. clinical effects of homeopathy are no more different than placebo effects.
4.2 Controlled Clinical Trial are Required to Validate the Effectiveness of Homeopathy
Homeopathy uses individualized treatment and focuses on each particular clinical situations as well as use of any homeopathic medicine in a particular treatment. The fact may be described by the systemic reviews where homeopathy have performed clinical trials and achieved positive conclusion such as to alleviate adverse effects of
cancer treatments [71], Allergies and upper respiratory tract infections including otitis media [72,73], Childhood diarrhea [74], Fibromyalgia [75], Influenza [76], Post-operative ileus [77], Rheumatic diseases [78], Seasonal allergic rhinitis (hay fever) [79-81] and Vertigo [82]. This is also a fact that homeopathy, due to lack of high quality evidence have some deficient area.
For instance, in some of the clinical conditions homeopathy have inconclusive result such as Anxiety [83], Chronic asthma [84], Dementia [85], Depression [86], Headache and migraine treatment [87], HIV/AIDS [88], Induction of labor [89] and Osteoarthritis [90] whereas in other diseases such as Ailments of childhood and adolescence [91], Attention deficit hyperactivity disorder [92], Cancer [93], Delayed-onset muscle soreness [94], Headache and migraine prevention [95] and Insomnia [96], homeopathy have little or no evidence of treatment. The research in homeopathy may be focused and special attention should be provided towards diseases where little or no evidence of homeopathic treatment is present. This may be overcome by conducting RCTs in these particular diseases using large number of patients or subjects.
4.3 Clinical Areas of Homeopathy RCTs are Not Applicable in Practice
It has been observed that due to use of simple model such as isopathic treatment for allergy, commercial motives as well as expediency, clinical areas of homeopathic RCTs aren’t applicable in practice. For example, homeopathy is used for clinical problems however in practice there is little or no RCTs evidence for gastrointestinal or dermatological conditions.
Though it’s a fact that homeopathy carries little or no evidence in many circumstances however the observational studies always focuses on what happens to patients who uses homeopathic treatment. Homeopathy have many such observational studies reported where the patients are using homeopathic medicines for various ailments and have reported positive results with major improvements. A study at Bristol Homoeopathic Hospital including 6,500 patients in a 6 year period reported improved health (70%) alongwith major improvement (50%). The diseases with best treatment responses as reported were childhood asthma, eczema and inflammatory bowel diseases [97]. A study in Italy conducted in a public sector also yielded the same results [98]. Another study in Germany and Switzerland was conducted in 3709 patients with
an 8-year follow up for allergic rhinitis and headaches in adults as well as atopic dermatitis in children. The results of the study showed an improvement in patient conditions and quality of life (p < 0.001) between baseline, 2 years and 8 years [99]. Similarly, a study in 500 patients at Royal London Homoeopathic Hospital showed that majority of the patients (72%) either reduced or stop the use of conventional medicine following homeopathic treatment [100]. These mentioned studies favor the use of homeopathy in different disease conditions however to make it more coherent with practical applications, clinical studies and research with perfect design, sample size and reproducible data with application in emerging diseases such as cancer, HIV, leishmaniosis, depression etc. are needed. In our study we found many practical applications of homeopathy in various diseases as mentioned in literature review section.
4.4 Homeopathy is Not Without Side Effects
The common concept of “being safe” among common people is one of the reason for widespread publicity and acceptability of homeopathy. However different reports are available where the side effects and hazards associated with the use of homeopathic medicines have been highlighted. Posadzki et al.
[43] reported allergic reactions and intoxications with the use of homeopathy. Similarly another study reported the incidence of adverse effects provoked with the use of homeopathic medications [101]. Though various such studies have reported the side effects of homeopathy however most of them are mild. These side effects are also related to prescribers error mostly rather than homeopathic medicine itself [102]. Furthermore, the rate of side effects in homeopathic system is much less as compared to conventional medicines [103]. It’s evident from this discussion that hazards from homeopathy are less as compared to conventional system and supports the use of homeopathy as safe treatment system for various diseases.
4.5 The Quality of Homeopathic Clinical Trials
Homeopathy as a form of CAMs is becoming more popular worldwide and much research and clinical trials are on the way for different diseases such as stroke, influenza, fibromyalgia and upper respiratory tract infections where outstanding positive results have been observed [104,105].
However in general, many areas of homeopathy research are still either weak or contains some deficiencies which are objectionable and inacceptable for researchers. The problems associated with the use of homeopathic clinical trials is heterogeneity of data, extraction method used and risks of bias. Jones et al., 2001 reviewed 59 studies [106]. The weakness observed in these trials was lack of data replication. Similarly, most of the studies had a low sample size of less than 100. Furthermore, homeopathic research in clinical trials have a high attrition rate whereby the data reported and analyzed is mostly lower than entry sample size.
Different reasons such as dropouts, no consent to fill the surveys as well as incorrectly filled surveys have been reported for such attrition [106]. Critical evaluation of research methodologies used in homeopathy clinical trials such as use of more sample size, replication of data, proper guidance and collection of data from patients with consent to fill out the survey, developing quality guidelines for conducting homeopathy research as well as use of independent investigator may root out these problems and enhance further the quality of homeopathic research. We observed during the review of clinical trials that most of the studies are well developed and a critical analysis of results have been performed which proves that quality of homeopathy clinical trials have been improved up to great extent.
4.6 Pragmatic Trials in Homeopathy May Produce Bias
Pragmatic trials are defined as “trials where the hypothesis and study design are constructed on the basis of information required for making a decision”. In such trials the test treatment is compared with any relevant clinical interventions or placebo [107]. Ernst and Canter 2005, claimed the results from pragmatic trials to be meaningless and biased. According to these authors, the results in pragmatic trials whether positive or negative may be interpreted in one or other way. Also in some areas the pragmatic trials are conducted by practitioners with strong interest to promote their therapy thus the use of weak design as well as chances of spin in interpreting the results are more in such instances. These factors can make the pragmatic trial susceptible to bias [108]. In order to enhance the quality of research and its application in practical health care system, more focus on clinical trials rather than pragmatic trials is needed. The homeopathy research has already
improved through conducting clinical trials more near to efficacy trials (like under optimal laboratory conditions) whereby positive results have been observed already in treating different diseases [104,105].
4.7 Interactions of Homeopathy Medicines with Conventional Medicines
The research in the field of herbal treatment and CAMs have reported many studies with potential interactions in the case of herbs or CAMs used in conjunction with conventional medicines. One study by Matrin et al. [51] reported that most of the people did not choose CAMs due to insecurity regarding interactions of homeopathy with conventional treatment (46%) and lack of knowledge (28%) about homeopathy. Thus researchers in homeopathy should step to make common awareness as well as educate the patients about the use of homeopathy alongwith conventional treatment system and its consequences. A special emphasis to study and report the side effects or hazards associated with the conjunctive use of homeopathic and conventional medications is much needed.
Despite the controversies and, rise and fall which homeopathy faced, its use and popularity increased with the passage of time. Towards the end of 20th century and then particularly due to advancement in conventional system, this system witnessed a reduction in its effects and use however as a conjunctive system as well as an integrative system alongwith conventional system it is still very effective and famous. In many regions of the world such as Japan and South Africa, its use is increasing. It is also a fact that most of the claims of homeopathy are not evidence based however this cannot rule out homeopathy to be used an alternative treatment system as it is more famous in patients [66].
Even if proved to be ineffective as an individual treatment system in some circumstances, homeopathy alongwith conventional system exhibited an ability to treat effectively various diseases. Various studies with clinical trials such as atopic dermatitis [42,44], chronic sinusitis [39], acute otitis media [40], asthma [41], pulmonary tuberculosis [46], irritable bowel syndrome [47], moderate to severe depression in Peri- and Postmenopausal Women [50], respiratory tract infections [52], hay fever [53 and allergic rhinitis [54] etc. have been reviewed in this article whereby an enhanced and positive effects of
homeopathy in conjunction with conventional system have been observed. Though many diseases i.e. anxiety, depression, cancer, HIV etc. exist where homeopathy have no evidence or supportive studies for effective treatment and need to be clinically studied using a higher quality research, still the number of clinical trials with effective outcomes are much more as compared to clinical trials with lack of established efficacy. This review article highlighted the most up-to-date current clinical trials available which supports the fact; despite of some deficient areas in research and treatment which needs to be focused for more effective healthcare outcomes, homeopathy is still used very widely particularly in conjunction with conventional treatment
system with significant and effective results.
5. CONCLUSION
Since introduction of the concept of homeopathy by Samuel Hahnemann, the use of homeopathy increased. At the end of 20th century it got a lessening in its use due to advancement in conventional research. However in conjunction with conventional system, homeopathy has proved to have more added advantages for effective treatment of various diseases. In order to build credibility and exist as a profession, high quality research i.e. multi-site research with multiple replication of the same approach to treat the same medical conditions on a large scale sample is required. This will improve the reproducibility, generalizability and confidence of findings to effectively treat any emerging diseases.
6. HIGHLIGHTS
Clinical trials conducted in homeopathy since 2012-2017.
Up-to-date and most recent development in healthcare system contributed by homeopathy.
Current status of homeopathy.
The quality of research and clinical studies in homeopathy.
The need for more development through special factors to be focused.
Negative investigation of homeopathy by different authors and its explanation with evidences.
COMPETING INTERESTS
Author has declared that no competing interests exist.
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