Rethinking Homeopathic Research Methodology: Why Comparative Effectiveness Research Matters
05 February 2020 (online)
In the last decades, a main focus of homeopathic research initiatives was experimental efficacy research to investigate specific effects of homeopathic drugs compared to placebo. Depending on inclusion and exclusion criteria, some meta-analyses have shown small specific effects of homeopathic drugs, but altogether evidence remains unreliable due to high risk of bias and methodological shortcomings.
Possible beneficial therapeutic strategies of the complex homeopathic treatment setting as a “whole medical system”, such as therapeutic relationship, empathy, triggering expectations, hope, use of suggestions and metaphors, resource activation, lifestyle advice, changing conventional medication and others, were reduced to experimental comparators in the classical approach.
Homeopathic observational and outcome studies under real medical life conditions have repeatedly shown that homeopaths yield comparable effects to those of conventional therapists, but with less conventional drugs exposure and often less costs. Those “unspecific effects” are still a blind spot in the researcher’s eyes but may in fact be highly beneficial for patients and a resource for the health care system.
Comparative effectiveness research (CER) strategies have been developed in the last decade to measure the extent to which an intervention, when deployed in the field in routine circumstances, does what it is intended to do for a specific population. CER methodology offers a wide range of research designs and advanced techniques, including pragmatic trials, cluster randomized trials, Bayesian approaches, observational research, and also registries. In addition, participatory stakeholder involvement is used to develop more practically relevant research questions, designs and outcomes. CER is a research strategy that would help homeopaths to better investigate and present its benefits and advantages under real life conditions, including the contribution of “unspecific effects”.
Advantages and disadvantages of this approach will be presented and discussed.
Keywords: Comparative effectiveness research, homeopathy, outcome studies, pragmatic studies