International Conference: Bridging the Credibility Gap; London, 3–4 April 2003

The Fourth International Research Conference in the series Improving the Success of Homeopathy, organised by The Royal London Homoeopathic Hospital was held at the Royal Pharmaceutical Society, London on 3–4 April. The theme was “Bridging the Credibility Gap”. One hundred and thirty eight people from 18 countries attended; unfortunately, a number who had signed up withdrew at the last minute because of the tense international situation. Thanks to the generosity of the RLHH Charitable Trust, we were able to give financial support to low-income attendees who would not otherwise have been able to attend.

The main themes were Homeopathy and Complexity Science and Patient Empowerment. Parallel sessions covered a range of topics including clinical trials, observational studies, the theoretical foundations of homeopathy and basic research. In addition, there was a 2 h parallel session on European dimensions for homeopathic medicines: threats and opportunities.

After a welcome address and introduction by Peter Fisher (Royal London Homoeopathic Hospital, UK), Dr Tim Wilson (Royal College of General Practitioners, UK) introduced the concept of complexity science and its implications for medicine. He pointed out that the only certainty is that we will have to live with uncertainty and unpredictability. He distinguished three ‘zones of reality’: Chaos, The Complex Zone, and the ‘Simple Zone’. He pointed out that predictable, linear behaviour in the ‘simple zone’ is the exception rather than the rule in practical medicine. Most of medicine takes place in the complex zone, where apart from using scientific principles, intuition and improvisation are also needed. One key characteristic predicted by complexity science is ‘amplification’: small causes can be amplified and lead to large effects. He suggested that such effects could possibly occur in response to homeopathic medicines.

Iris Bell (University of Arizona College of Medicine, USA) then took over, practically illustrating the connection between homeopathy and complexity science by reporting some of the findings of a system-oriented, whole-person research programme. Healing involves the hierarchical reorganisation of the system in the direction of cure. In line with the spirit of the conference she put these ideas to the test by conducting innovative experiments linking data from a clinical trial in fibromyalgia to biophysical measurements. After this presentation, Jose Leonel Torres (University of Michoacan, Mexico) took the audience further ‘back to basics’ by providing a theoretical, mathematical framework for homeopathic experiments. Complexity science predicts enhanced susceptibility of a system within a defined range, Torres used the internet to illustrate the principle. He suggested that we devise experiments related to homeopathy in the enhanced susceptibility range. The session on complexity science was eloquently rounded up by Paolo Bellavite (Department of Morphological Science, Verona Hospital, Italy). He synthesised the various concepts and data presented, explaining how they relate to homeopathy. In so doing, he illustrated how complexity science may help with ‘bridging the credibility gap’ of homeopathy.

In the afternoon, there were parallel sessions on a variety of topics. The session on European dimensions for homeopathic medicines: threats and opportunities was the first meeting jointly organised by representatives from regulatory authorities, the homeopathic pharmaceutical industry and homeopathic doctors. It was characterised by a very open discussion on practical aspects of the regulation of homeopathic medicines in Europe.

In between these parallel sessions, there was a plenary presentation by Robbert van Haselen (The Royal London Homoeopathic Hospital, UK). He illustrated that there are significant complexities associated with the conduct of clinical trials of, particularly, classical homeopathy, which may have led to the failure of such trials. There are, however, possible solutions for some (but not all) of these problems. In addition, he highlighted the importance of conducting trials on homeopathic over-the-counter medicines in pharmacy settings and illustrated that, contrary to what many believe, trials are possible in this clinical setting.

The first day's presentations were rounded off by David Spence (Bristol Homeopathic Hospital, UK) with the Blackie Memorial Lecture with the provocative title: ‘Homeopathy, a waste of time?’. In this excellent lecture (to be reported separately), Dr Spence illustrated that despite the trials and tribulations of trying scientifically to underpin homeopathy, we should not forget, and continue to by inspired by the fact that, in daily practice, homeopathy helps many patients. He proved his point with an impressive, comprehensive outcome survey of many thousands of patients seen at the Bristol Homoeopathic Hospital. He further underlined his case by giving historical examples of treatments (such as fruit to prevent scurvy in sailors) which have taken hundreds of years, despite the availability of empirical data, to become generally recognised. The day was completed by a lively reception at the nearby Museum of Garden History.

The plenary sessions of the second morning were dedicated to the second main theme of the conference: Patient Empowerment. In the first lecture of the day, Roger Steel (Consumers in NHS Research Support Unit, UK) spoke about the importance of involving patients at different levels and stages in research projects, to ensure that research is appropriate from the patient's point of view. His introduction was followed by a presentation by Rachel Purtell, a patient with a severe chronic disease who has responded well to homeopathy. She gave a personal account of her disease reminding us that it is very easy to forget at the ‘ivory tower’ of a scientific congress what it is all about: the patient. She underlined that health-care systems should acknowledge and facilitate the autonomy of patients to seek treatments that work best for them. Then Nuala Ahern (Member of European Parliament, Green Party, Ireland) provided a European political perspective. She pointed out that patients are represented at different levels in different European countries. Structures are available within the European framework to make the voices of patients seeking homeopathic treatment better heard, but they are still under-utilised. These presentations were followed by a lively panel discussion including representatives from the Patient's organisation of the European Committee of Homeopathy, the homeopathic industry and regulatory authorities.

This discussion was followed by presentations by Lee Kayne (University of Strathclyde, UK) and Karen Chapman (Nelsonbach, UK) on the role of the pharmacist in empowering the patient. Lee pointed out that a basis for this is further education of pharmacists. Fortunately, pharmacists in the UK have many opportunities to pursue appropriate training in complementary medicine at various levels ranging from Undergraduate to Advanced Postgraduate. Karen Chapman highlighted that market research has shown that the biggest barrier for patients to seek homeopathic medicines for common ailments is lack of information and that generally, the pharmacist was not seen as someone who could provide advice on such matters. It is clear that there is a huge potential for pharmacists to carve out a more proactive role here. Levels of interest in further training are high, as demonstrated by the success of a modular course for pharmacists (involving distance learning) on homeopathy organised by Nelsonbach and accredited by the National Pharmaceutical Association. A general conclusion was there is much more to be done to further empower patients seeking homeopathic treatment.

In the afternoon the emphasis turned to ‘real world’ studies investigating the cost-effectiveness of homeopathy, which was also a theme of ‘Improving the Success of Homeopathy 2’, which took place in 1999. It was encouraging to see that the amount of data on the ‘real-world’ cost-effectiveness of homeopathy has greatly increased in the 4 years that had passed. Gilles Chaufferin (Laboratoires Boiron, France) reported a study on the cost-effectiveness of homeopathy in children with recurrent acute rhinopharyngitis. The analysis of 500 cases treated by GPs with or without a ‘homeopathic orientation’ indicated that homeopathy could be a cost-effective alternative to antibiotics, delivering better outcomes for the same cost. Claudia Becker-Witt (Institute for Social Medicine, Humboldt University, Germany) reported a prospective cohort study, again comparing the effectiveness and costs of treatment by GPs with ‘homeopathic and conventional treatment in primary care, in a variety of chronic diseases’. The conclusions were very similar to those of Chaufferin: analysis of nearly 500 cases suggested that in terms of effectiveness, homeopathic treatment was equal to, and to some extent superior to conventional treatment at equal cost.

Corina Güthlin (University Hospital Freiburg, Germany) reported a large observational study on the effectiveness of homeopathy in general practice funded by a German Health Insurance company. She reported significant improvements in quality of life in patients treated with homeopathy. In addition, data on ‘days of work’ were presented. Due to the long-term follow-up (2 years), many patients were lost to follow-up which presented some problems in the analysis and interpretation of data.

The conference themes ensured there was a sharp contrast between presentations in terms of style and content, but a number of common areas, particularly around complexity, emerged. There was an encouraging openness and willingness to learn from each other. We believe that the conference contributed towards bridging the credibility gap of homeopathy by contributing to the theoretical framework and by suggesting and reporting both clinical and basic research projects required to verify the different hypotheses. At the other end of the spectrum, it addressed a broad range of issues on further empowering patients who might benefit from homeopathy.