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Prove or Improve? Less Funding? Use the Capital Available in Homeopathic Practice
09 February 2020
11 February 2020
14 May 2020 (online)
In their guest editorial, Rachel Roberts and Alexander Tournier referred to ‘fundamentally flawed assessment of the evidence [for homeopathy] … resulting in a crushing loss of public funding’ despite increasing quality of the evidence for homeopathy. Of course, improving the quality of the proof for homeopathy should never stop, but what about the quality of the homeopathic method? Homeopathic practitioners still use instruments, especially repertories, that have not changed essentially for a century and are based on observations of individuals. We are still involved in disputes between experienced practitioners about the meaning of many symptoms. Both problems have the same origin: statistical variation. We are still relying on the knowledge of a few individual experts rather than on the combined knowledge of many experienced practitioners.
I cite an example of combined knowledge versus individual knowledge. The symptom ‘Fear of death’ has been assessed in 4,094 patients in 10 Dutch practices and 158 of them (3.9%) had fear of death. In the sub-population of 88 patients responding well to Sulphur, only one (1.1%) had fear of death. Now, suppose that a repertory manufacturer invites the 100 best homeopathic practitioners each to bring in their very best case of Sulphur. It is very likely that one of these practitioners has a Sulphur patient with fear of death: this practitioner concludes that his most convincing Sulphur case has fear of death and so this medicine should be in the repertory rubric ‘Fear of death’. The other experts will say that this medicine should not be in this symptom rubric. In fact, Sulphur is in the repertory rubric ‘Fear of death’ because so far no repertory manufacturer invited 100 experts at the same time. It is also unlikely that 100 experts present their combined knowledge at the same Materia Medica course concerning one medicine.
Statistical knowledge implies that it is better to own a casino than to visit one: if you own the casino, you are certain of huge profits; if you attend one, your chance of huge profit is very small. Still, the homeopathy community rather visits the casino than buys it: we go to numerous courses of the best Materia Medica teachers instead of gathering the knowledge of 100 teachers about the same medicine at the same time.
And why do we not teach basic statistics to every homeopathic practitioner? Why do we not provide all experienced homeopathic practitioners with software that enables them to store their knowledge of each case in a few seconds? These practitioners will understand the importance of this collection of data once they understand statistics.
From the Dutch collection of data above, we can tell every new student of homeopathy that ‘Fear of death’ does not indicate Sulphur. The same symptom is only a weak indication for Calcarea carbonica with 4 out of 75 (5.3%) having that symptom, but a good indication for Magnesium carbonicum with two out of 19 (10.5%) of the patients having the symptom. Compare this knowledge with the existing repertory rubric. Our intuition already informs us that this knowledge is better, and mathematics (Bayes' theorem) provides the scientific explanation.
This new knowledge would probably be more enticing for the conventional practitioner searching for an alternative solution for his pneumonia patient resistant to antibiotics, especially because we can present it as personalised medicine based on prognostic factor research. It is this practitioner who we can convince of the merits of homeopathy. Scientific authorities will be much harder to convince because, like the philosopher Kuhn stated, their authority is based on a paradigm that does not support homeopathy.
Investing more widely in this new knowledge could be more effective than increasing the investment in experimental clinical research. The greatest capital needed for such clinical data collection is already available in the waiting rooms of thousands of homeopathic practitioners. The funds needed for it are much less than those required for experimental clinical trials, and the results far more relevant for patients.
- 1 Roberts ER, Tournier AL. HRI London 2019: marking 10 years of the Homeopathy Research Institute. Homeopathy 2020; 109: 1-2
- 2 Rutten ALB, Stolper CF, Lugten RFG, Barthels RWJM. Statistical analysis of six repertory rubrics after prospective assessment applying Bayes' theorem. Homeopathy 2009; 98: 26-34
- 3 Kuhn TS. The Structure of Scientific Revolutions. 2nd ed. Chicago: The University of Chicago Press; 1970