Time to consign homeopathy to the history books?

Homeopathy: inexplicably effective or no better than placebo? Steve Ainsworth examines the issues but can find no scientific evidence to support the claims made for the 'Law of Similars'

In Italy in 2011 a couple were accused of manslaughter after treating their four-year-old son with alternative medicine.

The boy, Luca Monsellato, was taken to hospital with a fever. He later died.

Marcello and Giovanna Monsellato, the boy's parents, had been giving the youngster fennel tea for three weeks to treat a respiratory illness. When it got worse they eventually took the boy to hospital, where medical staff were unable to save his life.

Luca's father Marcello is a doctor of alternative medicine, an expert on acupuncture and is honorary president of Italy's Homeopathic Sinergy Association.

Marcello Monsellato's supporters have rushed to his defence. Fausto Panni from Italy's Association Omeoimpresse, which oversees the supply of homeopathic remedies said: 'The latest statistics show that during the last five years just 21 people have had side effects from homeopathic medicine with no fatalities. That compares to many who have died as a result of medical malpractice or adverse reactions to medicine.'

Whether the fennel tea given to little Luca counts as a homeoepathic remedy is a moot point, but many Britons are keen believers in the power of homeopathy. Some 16% of Britons report having used homeopathic remedies, many under the auspices of the NHS.

The Royal London Hospital for Integrated Medicine (RLHIM) for example is the largest public-sector provider of 'integrated' medicine in Europe. Formerly known as the Royal London Homeopathic Hospital it is the leading centre for complementary medicine in the NHS. It joined University College London Hospitals, UCLH, in 2002, the merger coinciding with the Government's commitment to integrate complementary and conventional care within the NHS.

There are also other NHS homeopathic hospitals.

But what exactly is homeopathy?

Back in 1796 a German doctor named Samuel Hahnemann began promoting a theory that he called the 'law of similars'.

Quinine, widely used to treat malaria, also produces side effects similar to the symptoms of malaria itself. On the strength of that observation Hahnemann hypothesised that diseases are best treated by prescribing substances that in healthy persons produce symptoms identical to the diseases.

Hahnemann published his ideas in a book 'Organon der rationellen Heilkunst' - Organ of Rational Medicine.

The book, containing a complete exposition of Hahnemann theory, by now re-named 'Hom"oopathie', became a best seller.

Hahnemann's theory of 'Hom"oopathie' was not just confined to his 'law of similars'. He also believed that large doses of drugs made patients worse. Turning common clinical practice on its head, Hahnemann proclaimed that medicines became more effective by being diluted.

Given the state of medicine in the 18th century this part of Hahnemann's theory was undoubtedly true. Giving patients less rather than more of the mercury, arsenic, opium and other toxic substances frequently prescribed would certainly have been beneficial.

According to Hippocrates the most important rule of medicine is 'first do no harm'. And Hahnemann certainly followed that principle. Whether homeopathic remedies really did any good, as opposed to simply not causing any harm, however, remained an open question.

Two centuries later medical science has moved on.

Homeopathy has been criticised for being impossible to explain chemically. Homeopathic medicines require their 'active' ingredients to be diluted to such a degree that they may contain little more than a molecule or two of the original substance - perhaps even none at all. Can such a tiny quantity claim to have any pharmacological effect?

Supporters of homeopathy theorise that the water molecules can somehow 'remember' what was previously diluted in them. So far no repeatable scientific experiments have shown this to be true.

Factually, however, many of those who take homeopathic remedies for their illnesses do get better. Yet, as critics point out, so do many ill people who take no medicines at all. Chance and the placebo effect may well account for any apparent effectiveness of homeopathy.

To gain scientific acceptance homeopathy must demonstrate that its remedies are superior to no treatment at all. Such conclusive evidence has never been forthcoming.

Occasional studies do suggest that homeopathic remedies might have some effect - others, such as one that appeared in the Lancet in 2005, insist that results are no better than placebo. The National Institute for Health and Clinical Excellence has been asked to take a look but has so far avoided delivering an opinion.

Meanwhile not everyone working in the health service is happy with the NHS providing homeopathy services. And solid evidence for its efficacy remains absent.

Yet if anyone could prove homeopathy is effective there's a lot of money to be made.

The James Randi Educational Foundation in the USA has an open offer of a million dollar prize to anyone who can produce scientific evidence that homeopathy actually works.

Despite a thousand attempts to claim that million-dollar prize there have been no successes.

Back in Britain, four years ago, dozens of MPs signed an Early Day Motion that 'That this House welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals; notes that some six million people use complementary treatments each year; and believes that complementary medicine has the potential to offer clinically-effective and cost-effective solutions to common health problems faced by NHS patients.'

Sadly for those enthusiasts, a report published in 2010 by the House of Commons Science and Technology Committee came to very different conclusions.

The Chairman of the Committee, Phil Willis MP, said: 'We were seeking to determine whether the Government's policies on homeopathy are evidence-based on current evidence. They are not.'

The Committee's report was unequivocal.

'The Government's position on homeopathy is confused. On the one hand, it accepts that homeopathy is a placebo treatment... We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals - hospitals that specialise in the administration of placebos - should not continue".

With millions of believers, however, it seems unlikely that homeopathy will be consigned to the history books any time soon.

Meanwhile in Italy the parents of Luca Monsellato deny any wrongdoing. Their lawyer says they are thinking counter-suing hospital doctors for negligence.

REFERENCES

1. Science and Technology Committee - Fourth Report Evidence Check 2: Homeopathy 22 February 2010. Available at:

http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm Accessed June 2012