Dr Peter Fisher (England)
Keynote Speaker
- The Efficacy of Homœopathy: the Evidence from Randomized Controlled Trials
- Is It Worth It? The 'Real World' Effectiveness and Cost-effectiveness of Homœopathy
- How Implausible is Homœopathy? The Scientific and Political Issues Facing Homœopathy
 Abstract 1: The Efficacy of Homœopathy: the Evidence from Randomized Controlled Trials
This lecture examines the so-called type Ia and Ib evidence for Homœopathy. Such derives from randomized controlled trials (RCTs) (Ib) and Systematic Reviews and Meta-analyses of these (Ia). Efficacy is the extent to which a treatment does what it is supposed to do, in ideal circumstances, usually meaning an RCT. RCTs generally have high internal, but lower external and ecological validity.
All four comprehensive systematic reviews of randomised controlled trials (RCTs) of Homœopathy have concluded that, overall, Homœopathy probably differs from placebo. A paper by Shang et al, published in the Lancet in 2005 included a meta-analysis, but was not a systematic review. It was subject to serious criticism including its lack of transparency and ‘data-dredging’.
Systematic reviews of RCTs in particular medical areas have been:
- Positive for Homœopathy in 10 cases: Childhood diarrhoea; HIV/AIDS; Influenza treatment with Oscillococcinum®; Osteoarthritis; Post-operative ileus; Rheumatic diseases; Seasonal allergic rhinitis (three); Upper respiratory tract infections (two).
- Inconclusive in 10: Anxiety; Arnica; Attention deficit hyperactivity disorder; Cancer; Childhood and adolescence ailments; Chronic asthma; Dementia; Depression; Headache and migraine treatment; Induction of labour
- Negative in 4: Arnica; Delayed-onset muscle soreness; Headache and migraine prevention; Influenza prevention with Oscillococcinum®.
Other reviews of the evidence of efficacy favour Homœopathy in childhood diarrhoea, treatment of influenza, osteoarthritis and other rheumatic diseases, post-operative ileus and seasonal allergic rhinitis.
134 RCTs had been published in the peer-reviewed literature by the end of 2007. 118 of these were placebo-controlled, the remainder against active comparators including 8 equivalence trials. In terms of statistically significant findings, positive effects of Homœopathy were reported in 59 RCTs (44% of the total) and negative findings in 8 (6%), while 67 (50%) were inconclusive either.
We will look in detail at RCTs of isopathy for allergies, individualised Homœopathy in childhood diarrhoea, the (somewhat contradictory) evidence for Arnica in exercise-induced muscle stiffness and various forms of trauma and surgery, individualised Homœopathy for critically-ill patients in intensive care, fibromyalgia and osteoarthritis and in children with various forms of upper respiratory tract infection and a trial of a homœopathic topical application against an active comparator.
Abstract 2: Is It Worth It? The 'Real World' Effectiveness and Cost-effectiveness of Homœopathy
Controlled but un-randomised, cost-effectiveness (Category II) and observational (III) studies have higher external and ecological validity than RCTs. They universally show that most patients report significant clinical improvement, and suggest that integrating Homœopathy into medical practice results in better outcomes for similar cost.
In some clinical situations, both RCTs and clinical observational studies have been conducted, providing a fuller picture of the role of Homœopathy. Such areas include upper respiratory tract and ear infections in children, attention deficit hyperactivity disorder (ADHD), and symptoms related to cancer treatment.
Cost-effectiveness studies suggest that integration of Homœopathy is associated with better outcomes for equivalent costs. A German study looked at homœopathic and conventional GPs’ outcomes in common chronic diagnoses. Patients treated by the two groups of GPs were generally similar. Patients who sought homœopathic treatment had better outcomes for similar cost. A 12-month cohort study comparing homœopathic and conventional treatment of eczema in children showed similar improvements in eczema and disease-related quality of life.
In a French comparison of ‘homœopathic strategy’ v ‘antibiotic strategy’ in recurrent acute rhino-pharyngitis, GPs using Homœopathy had significantly better results in terms of clinical effectiveness, complications, parents' quality of life and time lost from work, for lower cost to social security.
The clinical areas in which research has been done do not match well with those for which it is used in practice. Observational studies look at what happens to patients who receive homœopathic treatment. A study at the Bristol Homoeopathic Hospital included over 6,500 consecutive patients with over 23,000 attendances in a 6-year period. 70% of patients reported improved health, 50% major improvement. The best treatment responses were reported in childhood eczema or asthma, and in inflammatory bowel disease, irritable bowel syndrome, menopausal problems and migraine.
A 500-patient survey at the Royal London Homoeopathic Hospital showed that many patients seek Homœopathy because of adverse effects of conventional medicine, and many were able to reduce or stop conventional medication following homœopathic treatment.
A systematic review of the safety of Homœopathy concluded that homœopathic medicines may provoke adverse effects, but these are mild and transient. The main risks associated with Homœopathy are indirect.
Abstract 3: How Implausible is Homœopathy? The Scientific and Political Issues Facing Homœopathy
Homœopathy has been attacked in the media, particularly in the UK. The attacks have two main bases:
- Homœopathy is ‘implausible’, because of its use of ultramolecular dilutions and lack of understanding of the mechanism of action.
- Because of unsustainable and sometimes irresponsible claims from within the homœopathic community, principally on prevention, immunisation and arbitrary theories based on metaphor, not similarity.
We will look at the content of some of the attacks, including examples of bias against Homœopathy and statements and actions by homœopaths which have made them vulnerable, and compare them with Hahnemann’s position.
The basic idea of Homœopathy is similarity; we will discuss hormesis and its possible relevance to Homœopathy. But the main barrier to scientific acceptance of Homœopathy is its use of very high ‘ultra-molecular’ dilutions. Avogadro’s Constant, the number of particles in a gram mole of a substance, is of the order of 1023 (23x or 12c). Because of the lack of a plausible mechanism of action of ultramolecular dilutions, many scientists have a low Bayesian ‘prior’ for Homœopathy.
One example of a series of in-vitro experiments in Homœopathy is the human basophil degranulation test. The earliest study, by Benveniste et al., proved irreproducible and became notorious. Subsequent studies using ultra-molecular dilutions of histamine, have shown positive results. These findings in a multi-centre series of experiments.
A meta-analysis evaluated 67 in-vitro biological experiments in 75 research publications and found high-potency effects were reported in nearly 75% of all replicated studies; however, no positive result was stable enough to be reproduced by all investigators.
The most widespread hypothesis to explain the mechanism of action of homœopathic dilutions refers to ‘memory of water’. Standard physico-chemical techniques, thermoluminescence, Raman and UV–VIS spectroscopy and other methods have shown that water displays large changes in its physico-chemical properties as a function of its history. This suggests that the process of preparation generates dissipative structures. It remains to be proven whether such changes can account for effects of homœopathic medicines in-vivo.
I will conclude with a brief overview of the forthcoming WHO report on clinical research in Homœopathy.
Biography
Dr Peter Fisher is physician to Queen Elizabeth II, Clinical Director of the Royal London Homœopathic Hospital and Chairperson of the World Health Organisation (WHO) homœopathic working group. Besides his credentials, Dr Fisher is an outstanding presenter and an outspoken champion of complementary medicine. He has a wealth of experience as both a rheumatologist and Homœopath and his contribution to research is significant.
Current Appointments
- Clinical Director, Royal London Homoeopathic Hospital, University College London Hospitals NHS Trust (UCLH).
- Physician to HM The Queen
- Director of Research, Royal London Homoeopathic Hospital, UCLH.
- Consultant Physician, Royal London Homoeopathic Hospital, UCLH..
- Editor, Homeopathy.
- Chair, World Health Organisation homeopathy working group
- Clinical Lead, National Library for Health Complementary and Alternative Medicine Specialist Library (www.library.nhs.uk/cam)
- Member, National Cancer Research Institute Complementary Therapies Clinical Studies Development Group
Previous Appointments
- Honorary Consultant Rheumatologist, King's College Hospital (1994-2006).
- Medical Director, Royal London Homoeopathic Hospital NHS Trust (1998-9)
- Vice President, Faculty of Homeopathy (1991-4 and 1999-2003)
- National vice president for the UK, International Homeopathic Medical League
- Trustee, Homeopathic Trust
- Deputy Chair, Advisory Board on the Registration of Homoeopathic Products, Medicines Control Agency, Department of Health.
- Honorary Lecturer, Centre for Pharmacognosy, School of Pharmacy, University of London
- Honorary Lecturer in Rheumatology and Complementary Medicine,
- St Bartholomew's Hospital Medical College.
- Honorary Visiting Rheumatologist, St Bartholomew's Hospital.
- Research Fellow, Department of Clinical Pharmacology, St Bartholomew's Hospital.
- Member, European Commission Homoeopathic Medicine Group, European Commission Directorate-General XII, Brussels.
- Chairman, European Committee for Homoeopathy Clinical Research subcommittee
Summary
I am a registered medical practitioner with a long-standing interest in complementary medicine, particularly homeopathy. I am on the GMC specialist register for homeopathy and rheumatology, I am a Fellow of the Royal College of Physicians of London and of the Faculty of Homeopathy. I have a long track record of research in complementary medicine, my first double-blind clinical trial of CAM was published in 1986, the second in the BMJ in 1989. I have published a wide range of scientific methods, including cell culture and animal models, double-blind randomised clinicals trials, qualitative research, questionnaire-based surveys, systematic reviews (including one published Cochrane review and another whose protocol has been accepted) and book chapters.
I am Clinical Director of the Royal London Homoeopathic Hospital, having been Medical Director of the Royal London Homoeopathic Hospital NHS Trust until its merger with Parkside Health in April 1999. I am also Director of Research of the Royal London Homoeopathic Hospital and hold two consultant appointments: Consultant Physician to the Royal London Homoeopathic Hospital and Hon Consultant Rheumatologist to King's College Hospital. I was appointed Physician to The Queen in November 2001.
I am also Clinical Lead of the National Library for Health’s on-line Complementary and Alternative Medicine Specialist Library, the NHS’s official website for Complementary and Alternative Medicine (www.library.nhs.uk/cam) and Chair of the World Health Organisation’s working group on homeopathy, whose report is due for publication soon. I am Editor of Homeopathy, the leading international journal in its field, and the only journal dedicated to homeopathy indexed by Medline.
Past appointments include Deputy Chairman of the Advisory Board on the Registration of Homoeopathic Products, an expert committee which advises the Medicines Control Agency on homeopathic medications and member of the Homoeopathic Medicine Research Group, an advisory group convened by Directorate-General XII of the European Commission.
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