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Everybody agree that homeopathy is “medicine” and must be accepted as such. Medicine is now using “standards” called “Evidence”.
What is “Evidence” in medicine?
Evidence is classified into 4 separated levels.
Level 4 is the level of EXPERT’S recommendations; this level has always existed into homeopathy. We have “master’s experts” like Hahnemann or other Professors but all teachers are experts and even each homeopath can reach this level of expertise when publishing clinical cases as example. This level is also very common in medicine. When “experts” are recommending 190 as maximum value for the total cholesterol by the population it is a level 4 of evidence.
To reach a level 1 of evidence, a controlled experimental design is needed. For homeopathy, a proving can be a controlled experimental design. When an audit (a literature review) of provings is done, it can reach a level 1 of evidence. This level is already obtained for provings published in English.
The clinical verification of symptoms, obtained during provings, is the keystone of the homeopathic medicine. The clinical verification is the study of the link between pathogenetic symptoms and curing of patients presenting these symptoms. About “evidence”, the best level that can be obtained with this kind of work is level 3. It is the same level that can be obtained for surgery, diagnostic procedures or psychoanalysis where double blind studies are of course excluded.
The 63rd LMHI congress is dedicated to this Evidence Based Homeopathy, meaning Provings and clinical studies. Final programme is accessible on the website www.lmhi2008.org
A single clinical case is a level 4 of evidence if the link between pathogenetic symptoms and cure of patients can be demonstrated. Better (level 3) is to present a systematic overview of clinical cases in the same way. The best is to do it using statistical existing tools.
Questions about the way to Evidence Based Homeopathy
1. How does Evidence Based Homeopathy work?
Evidence Based Homeopathy can be the clinical verification of
a proving symptom(s) for one remedy;
a specific idea out of the Materia Medica;
a specific clinical homeopathic approach;
a specific homeopathic methodology (Hahnemann, Kent, Masi, Sankaran, etc.);
a specific homeopathic strategy (Herscu, Scholten, Families of remedies, etc.)
To reach the level of evidence based homeopathy, the methodology must take into account the complete daily practice experience, cured cases, doubtful cases and failures. Verification of homeopathic symptoms can be done following different ways. The simplest way to do it is to check all data of patients having received the same remedy. One have to compare results of the treatments (good or bad) when a same symptom has indicated the remedy; to verify which symptom can be used with full confidence for the choice of the remedy and which one is uncertain or really bad. As conclusion, homeopathy will improve in quality and effectiveness.
2. Which are the difficulties of Evidence Based Homeopathy?
A first difficulty to come to “Evidence Based Homeopathy” is the VALIDATION of the scales used for the evaluation of the remedy “effects”. Standardization (or a correspondence between scales) must be accepted looking at the available published clinical cases.
A second difficulty is the DATA collection of all clinical files in a systematic way, standardization of files is a pre requirement. But this standardization is depending of the analysis method that will be used for evaluation of the results.
A third difficulty is the selection of the best scientifically accepted statistical method to reach a level of evidence. The Bayesians statistic is probably the best tool for such analysis.
3. Do you develop a concept for Evidence Based Homeopathy during the congress or are there already some initial ideas?
During the 63rd LMHI congress in Belgium we will present, very concretely, different examples to reach the level of evidence in Homeopathy. Series of cases analysed following different possible statistical approaches will be presented. The aim is not to limit EBH to the presented possibilities but to show everybody that this challenge is not some utopia but a very realistic goal that can be reached and is already reached by different authors.
4. Are there more similarities between Evidence Based Homeopathy and Evidence Based Medicine than just the names?
The proposed methodology is coming from modern medical conventional statistics for very specific conditions when double blinded studies are irrelevant or impossible. It is accepted today as evidence in some conventional domain but it is really very suitable for homeopathy, it is bridging the gap of Evidences that previous methodology could not do.
5. Could one say that Evidence Based Homeopathy is a kind of quality seal to convince people who still doubt about the effect of a homeopathic therapy that homeopathy does really work and that its success can be examined scientifically?
It is much more than that because it will IMPROVE homeopathy very greatly. When the proved symptoms (and our repertories) will be statistically verified in the daily practice and become clinical evidence, it will change in a dramatic way the probabilities that the symptoms of a patient are or are not linked to some remedies. From EBH a new, daily renewed and updated computerized repertory will emerge. Of course, the secondary effect will be that doubt about clinical results of homeopathic treatments will become difficult to be justified.
6. Is it possible to examine homeopathy through scientific experiments?
Out of the daily practice it is also possible to examine homeopathy through scientific experiments as already done several time in Universities. Looking at the laboratories evidence the effects of the homeopathic remedies cannot be discussed anymore even very high diluted remedies. To explain these facts, a new paradigm must be accepted because when a theory cannot explain the facts, it is the theory that would be questioned and not the facts (Claude Bernard.)
7. What do homeopathic physicians hope to get or reach thanks to Evidence Based Homeopathy?
As already explained above, a new clinically verified repertory of symptoms with statistical verified values for each remedy and each symptom meaning a much better concrete probability for successful treatment choice. Of course the process must be initiated and each of them would be aware that without collecting the daily evidences in his own practice nothing will happen. Think to give back to homeopathy what homeopathy has given to you and you will get much more in the future.
8. Does Evidence Based Homeopathy also include advantages for the patients?
Every time that chance to find an efficient remedy for a patient increases, it is of course very important for each patient individually. He is expecting curing in a fast, soft and efficient way. EBH will help the Homeopathic MD to reach that goal more often in his daily practice.
References :
1. Van Wassenhoven M. Priorities and methods for developing the evidence profile of homeopathy : Recommendations of the ECH General Assembly and XVIII Symposium of GIRI. Homeopathy 2005 April;Volume 94, n°2:107-124.
2. Van Wassenhoven M. Towards an evidence-based repertory: clinical evaluation of Veratrum Album. Homeopathy 2004:93, 71-77.
3. Van Wassenhoven M. XIX GIRI meeting “A Universal approach to health: the intelligent body” – Retrospective LR study. 2-4 December 2005 Monaco. www.giriweb.com
4. UNIO HOMEOPATHICA BELGICA. Homéopathie – Un guide pour les médecins généralistes. Décembre 2004. www.homeopathy.be
5. Rutten ALB, Stolper CF, Lugten RF, Barthels RJ.’Cure’ as the gold standard for likelihood ration assessment: theoretical considerations. Homeopathy 2004;93:78-83.
6. Stolper CF, Rutten ALB, Lugten RFG, Barthels RJWM. Improving homeopathic prescribing by applying epidemiological techniques: the role of LR. Homeopathy 2002;91, 230-238. & Rutten ALB et al. Repertory and the symptom loquacity: some results from a pilot study on LR. Homeopathy 2004: 93, 190-192. & Rutten ALB et al. LR onderzoek: uitkomsten September 2005. Similia Similibus Curentur 2005; 35:4, 9-12.
7. Riley D. Phase I clinical trials – Homeopathic Drug Proving. LMHI conference Amsterdam May 1998.
8. Walach H & all. Homeopathic proving symptoms: result of a local, non-local, or placebo process? A blinded, placebo-controlled pilot study. Homeopathy 2004 n°93, 179-185.
9. Dantas F, Fisher P. A systematic review of homeopathic pathogenetic trials published in the United Kingdom fromp 1945 to 1995. In: Ernst E, Hahn EG. Homeopathy – A critical appraisal 1998. Butterworth-Heinemann, United Kingdom.
10. Bastide M. et Lagache A, Revue Intern. Systémique, 1995 ;9 :237-249 and Altern Ther Health Med. 1997 ;3 :35-9
11. Homeopathic Drug Provings Guidelines. www.homeopathyeurope.org
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