Keywords
homeopathy research - systematic review - conference - HRI - clinical trials - fundamental
research
A Vital Role for Research
A Vital Role for Research
In recent years, the volume and quality of the homeopathy evidence base have increased,
yet rather than reducing the degree of controversy around the topic as one might expect,
the homeopathy debate has intensified.
Given the challenges currently faced by the homeopathy sector, we were proud to host
our largest conference at a suitably iconic venue in central London. The conference
was held right on the bank of the river Thames, next to the Tower of London and Tower
Bridge. In his opening address, Mr David Tredinnick, Member of UK Parliament for Bosworth,
a long-time advocate of complementary medicine and chairman of the All-Party Parliamentary
Group for Integrated Healthcare since 2002, described his vision of the future where
every home has a homeopathy kit. He also acknowledged the vital role of research in
gaining acceptance of homeopathy, saying, ‘It's quite clear that we need this valuable research to interact with the medical
establishment. It's only a matter of time in my view before the weight of this new
evidence is going to win the day.’
HRI London 2019
As expected, the Homeopathy Research Institute (HRI) conference was a truly international
event, demonstrated not only by our 352 delegates from 38 countries, but also by the
75 researchers and medics from 27 countries who presented their latest findings.
To create the scientific programme, 132 abstracts were rigorously peer-reviewed to
select 34 for oral presentation. The standard of submissions was the highest to date,
making the final selection for our limited number of talks particularly challenging.
It was also encouraging to see the significant increase in the number of abstracts
which met the quality threshold for poster presentation: 45 posters were presented
in London compared with 25 at HRI Barcelona 2013 and 37 at HRI Malta 2017.
We were particularly delighted to bring this year's event to the UK to mark HRI's
10th anniversary. As we'd hoped, this resulted in many UK-based researchers and homeopaths
attending for the first time. The HRI Educational Grants scheme, generously funded
by the Manchester Homeopathy Clinic, once again provided financial support to UK residents
wishing to attend the conference. This investment in the future of the homeopathy
research sector is invaluable, helping educate a new generation of practitioners and
researchers.
A Fair Hearing?
To open the plenary sessions keynote speaker, Professor Robert Hahn (Sweden), and HRI's Chief Executive, Rachel Roberts (UK) tackled the somewhat loaded question of whether homeopathy gets a fair hearing.
Professor Hahn discussed the ‘primary bias’ against homeopathy and how this influenced
the methodological and data interpretation approaches used in a small number of influential
systematic reviews that concluded homeopathy is no different from placebo.[1] That is, the analyses published by Shang et al[2] and Ernst and Pittler[3] ignored the majority of the evidence reviewed and/or drew a negative conclusion
based on extrapolated data, rather than providing an objective and fair conclusion
based on the actual data.
The topic of ‘primary bias’ was discussed further by Rachel Roberts in the context
of the 2017 statement produced by the European Academies Scientific Advisory Council
(EASAC),[4] which presented a definitively negative position, clearly held from the outset.
Attendees heard about the work done by the HRI team and European colleagues to challenge
this extreme example of biased science. At an early stage in the process, HRI was
particularly interested to be told directly by Professor Courvoisier (EASAC President)
that ‘it was never our intention to write a balanced statement’. And again, the final meeting between leading figures in homeopathy research and
authors of the EASAC statement exposed a shocking unwillingness of EASAC to acknowledge
the full evidence base on which they took their strong public position, leaving many
pertinent questions asked by the HRI delegation unanswered.
Taking Stock
The HRI London 2019 programme fully captured the ‘cutting edge’ theme of the conference,
with a diverse range of talks from highly specialised clinical, fundamental, basic
and veterinary research topics, to overviews of the evidence base as a whole. This
combination of ‘close up’ investigations and summary analyses enabled the community
to take stock of what the evidence is actually showing us, against the uninformed and often repeated claim that there is ‘no evidence’.
Dr Robert Mathie (UK) presented the summary results of his extensive 10-year programme of work systematically
reviewing the randomised controlled trial (RCT) evidence in homeopathy. One hundred
and thirty-one RCTs were included in the full systematic review, 90 of which contained
extractable data for meta-analysis. In turn, 13 RCTs with minimal risk of bias were
identified (10 being suitable for meta-analysis), of which 5 were rated as ‘highly
reliable evidence’, considering internal validity, model validity and external validity.
Meta-analysis showed an unequivocally positive and statistically robust result for
homeopathy compared with placebo, whether analysing all 10 RCTs with minimal risk
of bias (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.25 to 2.24, p < 0.001) or only the 5 ‘very best’ studies (OR = 2.05, 95% CI: 1.33 to 3.15, p = 0.001).
Dr Katharina Gaertner (Switzerland) continued in a similar vein, highlighting the need to apply our understanding of
the evidence base in homeopathy toward outcome-specific reviews of RCTs, tackling
the more clinically relevant question of ‘what evidence is there that homeopathy works
in my condition?’, moving the debate beyond the oft-repeated question of whether homeopathy
‘works’ at all. Dr Gaertner has identified 452 RCTs out of a total of 631 controlled
studies in 209 specific conditions and plans to look closely at the 59 conditions
with at least 2 studies with the same homeopathic intervention.
Beyond the clinical evidence, Dr Alexander Tournier (Germany) presented results from an extensive review of physicochemical research in homeopathy,
summarising the evidence from over 130 manuscripts, reporting on more than 200 experiments,
indicating promising research avenues.[5] Similarly, Dr Annekathrin Ücker (Germany) provided a welcome overview of the growing body of evidence from plant-based experiments,
highlighting the need for further independent replications as well as identification
of factors that may influence the experiments.[6]
Primary Clinical Research
Primary Clinical Research
Keynote speaker, Dr Elizabeth Thompson (UK), shared her personal experience of integrating homeopathy in cancer care, emphasising
the value of this approach in the management of side effects during cancer therapy.
Dr Thompson presented several clinical trials relevant to real-life situations, especially
in the context of women's health, showing how targeted research can promote the integration
of homeopathy, filling known gaps in the conventional care regimen.
Three further presentations reported on work involving homeopathy in the context of
cancer management: promising results from homeopathic additional treatment to treat
radiodermatitis in breast cancer patients (Rossi, on behalf of Dr Cristina Noberasco, Italy); how homeopathic treatment can help ameliorate fatigue in similar patients (Freed, Israel); and, to help oncologists better integrate homeopathy in their daily practice, Dr
Jean-Lionel Bagot and Dr Ingrid Theunyssen (France) presented their work creating expert consensus recommendations in the context of
oncological supportive care.
Other primary clinical studies presented during the conference included a simplified
prescribing scheme for sciatic pain (To & Fok, Hong Kong); a long-term observational study of homeopathic treatment of atopic diseases in
a cohort of 563 atopic adult patients (Rossi, Italy); a trial of individualised homeopathy in the treatment of stage I hypertension (Varanasi, India); an observational study assessing the potential of Oscillococcinum to reduce URTI
exacerbations in patients with Chronic Obstructive Pulmonary Disease (Saez, Spain)[7]; and a study looking at the strength of association between specific symptoms and
patient responses to the muriatic group of remedies (Eizayaga, Argentina).
Public Health and Patient Interests
Public Health and Patient Interests
At a time when we are witnessing the impact of biased, negative reports limiting public
access to homeopathy in some countries, stakeholders and patients alike deserve to
know more about the potential role homeopathy can play in primary healthcare, particularly
when many services are in crisis.
This particular challenge was described by Dr Russell Malcolm (UK), who presented the results of a qualitative audit of patients seen in an NHS clinic,
whose funding was threatened. Dr Malcolm stressed the perception that homeopaths ‘push
sugar pills at the worried well’, when in reality homeopathy provides a treatment
option to a wide range of patients, many of whom are intolerant to drugs, no other
treatment options are available, or have chronic multi-morbidities that are refractory
to conventional treatment.
Adding to this ‘grass-roots’ experience, keynote speaker Dr Michael Teut (Germany) explained how decision-makers can be well-informed by comparative effectiveness
research testing homeopathy against other treatment choices. Dr Teut highlighted the
lack of ‘actionable intelligence’ for clinicians that arises from the widely accepted
gold-standard RCT, where demonstrating efficacy beyond placebo has little bearing
on a treatment's effectiveness under real-life conditions. This divergence between
the information being generated by placebo-controlled trials and information needed
to understand what treatments really do for patients is particularly common in complementary
and alternative medical interventions.
Keynote speaker, Dr Clare Relton, described the development of an innovative pragmatic
RCT design. Her ‘TwiCs’ (Trials within Cohorts) design, born from frustration with
performing ‘gold-standard’ double-blind RCTs, maintains best research practice, while
a usual care setting makes trial involvement more palatable to patients and ensures
that the findings are directly relevant to real clinical situations.[8]
In India, such patient-centred approaches to studying the impact of homeopathy in
public healthcare are already being performed on a large scale, often in resource-limited
situations. Dr Debadatta Nayak showed how individualised homeopathy can play a role
in the management of thrombocytopenia (low blood platelet count) associated with Dengue,
alongside conventional care[9]; Dr Raj Manchanda presented encouraging positive results from a trial of homeopathy,
used as an adjunct to conventional medicine, in the treatment of encephalitis in children[10]; and Dr Anil Khurana presented the results of a public health initiative involving
use of a six-remedy kit to promote healthy development in the teething stage in 11,426
children.[11]
Veterinary Studies
It was encouraging to see a greater number of veterinary contributions to the programme
this year, with more oral and poster presentations than HRI Malta 2017. Dr Cidéli
Coelho (Brazil) described a randomised and blinded study of the remedies Papaver somniferum and Arnica montana in assisting the recovery of dogs after ovariohysterectomy. Dr Franscinne Narita
(Brazil) presented a small study (n = 10) treating liver conditions in rescued Magellanic penguins housed in a zoo: the
remedy Carduus marianus 6 cH had comparable effects to conventional treatment without any side effects and
at lower cost.
Beyond the Placebo Effect
Beyond the Placebo Effect
Given the continuing ‘homeopathy is only placebo’ echo-chamber in the media and scientific
establishment, experiments investigating the biological activity of homeopathic preparations
in plant, animal and cell models—in the complete absence of placebo effects—have particular
relevance to the debate.
Presentations included description of an experimental system that simulates the human
gut microbiome and its response to infection showing an activating effect of Okoubaka aubrevillei mother tincture and 3C (Buchheim-Schmidt, Germany); the protective activity of a combination of remedies commonly used in cough against
cigarette smoke extract-intoxicated bronchial cells in vitro (Marzotto, Italy); subcutaneous isopathic immunotherapy showing a significant positive effect in an
experimental model of allergic asthma (Shahabi, Iran)[12]; and Ferrum phosphoricum D12 treatment of macrophage and pre-adipocyte cell lines grown in vitro showing significant
alteration of expression level in a range of genes involved in iron uptake, antioxidant
enzymes and immunostimulation (Tasinov, Bulgaria).
Dr Stephan Baumgartner (Switzerland) and Sandra Würtenberger (Germany) also presented the results of an extensive series of studies by the late Dr Tim
Jäger (1970–2019) using a biological model of mercury-stressed Lemna gibba L. (duckweed): treatment of plants with Mercurius corrosivus 24x–30x enhanced plant growth under mild stress but reduced growth in severe stress.
Furthermore, Professor Christian Endler and Dr Corinne Kraus (Austria) confirmed previous results using the wheat germination model, showing that higher
germination rates were seen when the remedy (Silver nitrate in 10−2 to 10−24 dilutions) was agitated, compared with being applied by simple pipetting. These results
directly support the theory that succussion contributes to biological activity—a central
tenet of homeopathy.
Strengthening the Foundations
Strengthening the Foundations
The keynote presentation by Professor Vladimir Voeikov (Russia) addressed the core question in the homeopathy debate: are homeopathic ultra-high
dilutions different in their physicochemical properties compared with water? Professor
Voeikov presented the work of his colleague, Professor Alexander Konavalov, proposing
that water forms structures—‘nanoassociates’—which result in different physicochemical
properties (conductivity and zeta potential) as well as appearing as structures approximately
100 nm in diameter in Dynamic Light Scattering and Nanoparticle Tracking Analysis
measurements. These nanoassociates seem to disappear when the containers are shielded
from ambient electromagnetic frequencies (EMF), leading to the idea that nanoassociates
are quasi-stable or dissipative structures dependent on ambient EMF noise for their
continued existence. Thus, Professor Voeikov concluded that, ‘Homeopathy doesn’t contradict modern physics and chemistry. It has a very solid scientific
foundation.'
To add to this experimental evidence, Dr Steven Cartwright (UK) presented further results from his work using the spectral properties of solvatochromic
dyes to explore the physicochemistry of homeopathic preparations. Preventing the aggregation
of dyes using encapsulation or immobilisation on a membrane, he was able to confirm
the presence of a strong electromagnetic field in homeopathic preparations.
Also looking into the properties of homeopathic dilutions, Dr Maria Olga Kokornaczyk
(Switzerland) reported on work with the ‘droplet evaporation method’, where the patterns formed
when a liquid sample is left to evaporate were found to be distinguishable between
low potencies of different homeopathic remedies. Using a similar technique, Paul Doesburg
(Holland) presented results using the ‘cress seedling, copper sulfate crystallization’ technique
where extracts from cress seeds treated with Stannum met 30x reproducibly formed different crystallisation patterns compared with controls,
similar to those reported in a preliminary study.
Moving Beyond Medicine
At a time when researchers worldwide are focusing on sustainable agriculture, organic
farming and environmental restoration, the potential role of homeopathy beyond medicine
must be considered.
Keynote speaker, Professor Leoni Bonamin (Brazil) introduced a novel and powerfully simple biological system to test the impact of
homeopathy on environmentally stressed organisms. Artemia salina, a small crustacean which can be grown easily in the laboratory, can be used as a
biosensor for ecological disruption given its sensitivity to pollution. Specifically,
Professor Bonamin reported on the results of treating Glyphosate-exposed Artemia with Glyphosate 6C isotherapy which improved their general health (behaviour, hatching and reduced
defects). Using the same system, Professor Bonamin's group tested the use of isotherapy
after intoxication with mercury chloride. A strong effect of the moon on the hatching
rate of the Artemia salina was seen, as expected for a marine organism, but this effect was distinct from the
beneficial effects of Mercury chloride 30C.
Our Thanks
As we reflect on another successful conference, our heartfelt thanks go to the delegates,
presenters, sponsors and exhibitors without whom the HRI conferences would not be
possible. Thanks also go to the HRI conference team—particularly Event Organiser Simon
Wilkinson-Blake—who worked tirelessly for 18 months to bring the event together.
As we close the door on this first 10-year chapter of HRI, we look forward to what
the future brings, knowing that we are all part of a highly talented and resolute
community that is committed to continually striving for excellence in homeopathy research.
Full details of HRI London 2019, including free-to-view filmed speaker presentations,
can be found at www.HRILondon2019.org.
Presentations from HRI's previous conferences are also available free of charge at
www.HRIBarcelona2013.org/films, www.HRIRome2015.org/films and www.HRIMalta2017.org/films).
