French doctors’ response
16 December 2017 (online)
We read attentively the articles published in The Lancet 1 relating to homeopathy; the meta-analysis, editorial and Comment raise many questions for us.
The first point concerns the meta-analysis:[ 1 ] the authors state that they updated the previous search for placebo-controlled trials of homeopathy of Linde et al.[ 2 ] However, why did they ignore another meta-analysis which asked the same question,[ 3 ] or other systematic reviews analysing the efficacy of homeopathy for specific conditions?[ 4 ] We also wonder about the method of selection of the trials retained for the results analysis, in particular for the eight ‘larger, higher quality’ trials. Why are they not identified? How were they selected among the 21 trials of higher quality (vs 9 for the conventional treatments) described in table 2?
The second point concerns the existence of plausible mechanisms of the action of high dilutions used in homeopathy. Shang et al take the example of the eight (unidentified) trials of homeopathic remedies in acute infections of the upper respiratory tract. According to the authors, ‘the sensitivity analysis might suggest that there is robust evidence that the treatment works, but the biases might promote the conclusions that the results cannot be trusted’. In his comment,[ 5 ] Vandenbroucke promotes this possibility into a certainty: he refers to the safety of the biological data for conventional treatment compared to homeopathy ‘because we know that the pharmacological action of the high dilutions is highly implausible’.
Is this enough to remove any interest in the results of correctly carried out clinical trials? The question “are the results of randomised double-blind trials convincing only if there is a plausible mechanism of action?” has already been asked:[ 6 ] and a complementary light is shed by basic research studies. A recent database on basic research in homeopathy[ 7 ] included 829 experiments in 782 publications. If a critical analysis of these studies remains necessary, why did Shang et al ignore them? Why deny a priori any interest in the work of many scientists who have opened up the scientific debate about the action of the high dilutions?
The third point concerns The Lancet’s editorial,[ 8 ] which reappraises the quality of our practice and medical ethics. We would like, in the light of our everyday experience, to discuss the consequences of your recommendation for the patients and for Western health systems. We agree that homeopathy has to deal with scientific truth. Such an objective requires an adapted method of evaluation, integrating the fact that homeopathic therapy, when chosen by an experienced doctor, is centred on both the patient and the disease (and this fact has consequences for the recruitment of patients for clinical trials). Any scientific debate on research about homeopathy has to be well-balanced: if this is not the case for the forthcoming WHO report on homeopathy, The Lancet is right to ask that it be revised.[ 9 ]
However, we also await a critical and balanced analysis from The Lancet. The debate on this subject should be calmer because it has direct consequences on the patients. The last sentence of your editorial, ‘Now doctors need to be bold and honest with their patients about homoeopathy's lack of benefit, and with themselves about the failings of modern medicine to address patients’ needs for personalised care’ is very moralistic, and was widely reported in the media. If the aim is the exclusion of homeopathy from the field of medical practice, it is necessary to consider all the consequences of such a policy.
Patient demand for homeopathy does not seem to be decreasing, quite the contrary. If the doctors practising homeopathy did not answer this request for care, then the patients would look elsewhere for answers; outside the field of medicine, with all the dangers that such a choice represents. As doctors, general practitioners or specialists, we use modern medical technical data, we carry out diagnoses and we have a holistic approach towards our patients. Their health and their safety are our constant concern. Our daily experience suggests that the integration of homeopathy in health systems,[ 10 ] and the development of research using appropriately-adapted methods, and in which some among us participate actively,[ 11 ] are necessary to give the patients treated by homeopathy the best quality of care. We want to continue contributing to the progress of medical practice in homeopathy, following the way of a complex and contradictory truth, enlightened by a well-balanced scientific debate.
- 1 Shang A., Huwiler-Müntener K., Nartey L. et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726-732.
- 2 Linde K., Clausius N., Ramirez G. et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 2003; 350: 834-843.
- 3 Cucherat M., Haugh M.C., Gooch M., Boissel J.P. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. Eur J Clin Pharmacol 2000; 56: 27-33.
- 4 Jonas W.B., Kaptchuk T.J., Linde K. A critical overview of homeopathy. Ann Int Med 2003; 138: 393-399.
- 5 Vandenbroucke J.P. Homeopathy and the “growth of truth”. Lancet 2005; 366: 691-692.
- 6 Kleijnen J., Knipschild P., ter Riet G. Clinical trials of homeopathy. BMJ 1991; 302: 316-323.
- 7 Albrecht H., Van Wijck R., Ditloff S. A new database on basic research in homeopathy. Homeopathy 2002; 91: 162-165.
- 8 The Lancet. The end of homeopathy. Lancet 2005; 366: 390.
- 9 Mac Carthy M. Critics slam draft WHO report on homeopathy. Lancet 2005; 366: 705-706.
- 10 Poitevin B. Integrating homoeopathy in health systems. Bull World Health Org 1999; 77 (02) 160-166.
- 11 Demangeat J.L., Gries P., Poitevin B. et al. Low-field NMR water proton longitudinal relaxation in ultrahighly diluted aqueous solutions of silica-lactose prepared in glass material for pharmaceutical use. Appl Magn Res 2004; 26: 485-491.