The benefits of Arnica

The questions Professor Ernst raises in his Arnica case reports are not about homeopathy but about science in general.[ ¹ ] There is much casuistry of questionable validity concerning the relation between cure and therapy, both in conventional and non-conventional medicine. Neither opponents nor proponents can ever prove their points this way. Until recently, we thought it possible to end the discussion around the effectiveness of homeopathy by randomised trials. As far as I know Professor Vandenbroucke's challenge to produce a conventional therapy with better evidence than homeopathy still stands.[ ² ] This means, at least, that there are conventional therapies supported by less proof than homeopathy, such as psychotherapy or physical therapy. But can we do without these unproven methods? Clearly we cannot, because we have no ‘scientific’ alternative. It is also clear that we cannot do without homeopathy as long as conventional medicine has gaps in its possibilities. There are cases that can better and safer be solved by homeopathy but homeopathy cannot solve many cases. This has nothing to do with the question of whether the method is a placebo or not. Maybe we should accept that clinical evidence cannot prove right or wrong.

Beyond the randomised trials a new challenge has been thrown down: plausibility. We need to produce more and better evidence because our method is not plausible. Why? How much more evidence should we produce? I doubt if we can produce better/stronger evidence. Our method is far from perfect: the homeopathic materia medica is partly incorrect and very incomplete and the repertory outdated. Probably more than 50% of our prescriptions are incorrect because of these shortcomings. Therefore many participants in a clinical trial get a placebo (=not the right medicine) instead of the verum that they should receive. This is like a trial with a conventional medicine produced by a very unreliable production process. The first thing we should do is improve our ‘production process’, more clinical trials with our present instruments are useless. Improving our method can also be a scientific process. It is different in some respects from trials to prove effectiveness, but every method deserves its own scientific identity.

We should not claim that we are sure that homeopathy is effective but instead work on the shortcomings of our methods. Conventional medicine on the other hand should acknowledge that we deserve some space to develop our own scientific identity. So far we have done what was required and not too badly, considering our defective method. How necessary is plausibility and how can we discover the mechanism of action of homeopathy? At the moment fundamental research which yields positive results is tantamount to scientific suicide and is therefore not attractive for scientists who have a reputation to loose. Is this discussion actually about science or about vested interests?

• References

• 1 Ernst E. The benefits of Arnica: 16 case reports, Homeopathy 2003; 92: 217–219.
• 2 Vandenbroucke JP. Medical journals and the shaping of medical knowledge. Lancet 1998; 352: 2001–2006.