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Should doctors recommend homeopathy?

Should doctors recommend homeopathy? Two experts debate the issue in The BMJ this week.

Peter Fisher, Director of Research at the Royal London Hospital for Integrated Medicine, says that of all the major forms of complementary medicine, homeopathy is the most misunderstood.

He questions the methods used to review the evidence for homeopathy. For example, in a recent report by the Australian National Health and Medical Research Council which stated that "there are no health conditions for which there is reliable evidence that homeopathy is effective."

"The fact that one homeopathic treatment for a condition is ineffective doesn't mean that another is also ineffective." The review also unaccountably omitted several key pieces of evidence, he argues.

Most overviews have had more favourable conclusions, he says, including a Health Technology Assessment commissioned by the Swiss federal government which concluded that homeopathy is "probably" effective for upper respiratory tract infections and allergies - and several meta-analyses of homeopathy as a whole and for specific conditions have been positive

He also points to several studies comparing treatment outcomes of conventional family doctors with those who integrate homeopathy in their practice, showing better outcomes at equivalent cost in a range of conditions with reduced use of hazardous drugs including antibiotics.

He concludes that "Doctors should put aside bias based on the alleged implausibility of homeopathy. When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials. Health professionals trained in homeopathy do not oppose the use of conventional treatments, including immunisation."

But Edzard Ernst, Emeritus Professor at the University of Exeter, says most independent systematic reviews of randomised controlled trials "have failed to show that homeopathy is effective" and reviews with positive conclusions "usually have serious methodological flaws."

The assumptions underlying homeopathy "fly in the face of science" he says "and critics have long pointed out that unless our understanding of the laws of nature is incorrect, homeopathy's mode of action has no rational explanation."

He also argues that homeopathy can harm "if it replaces an effective therapy" and says he knows of "several deaths that have occurred in this unnecessary way."

Finally, he questions Europe's €1bn annual spend on such remedies, saying these funds "could and should be spent more usefully elsewhere."

In summary, he says, "the axioms of homeopathy are implausible, it's benefits do not outweigh its risks, and its costs and opportunity costs are considerable. Therefore, it seems unreasonable, even unethical, for healthcare professionals to recommend its use."

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