Head To Head

Should doctors recommend homeopathy?

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3735 (Published 14 July 2015) Cite this as: BMJ 2015;351:h3735
  1. Peter Fisher, director of research, Royal London Hospital for Integrated Medicine, London WC1N 3HR,
  2. Edzard Ernst, emeritus professor, University of Exeter
  1. Correspondence to: P Fisher peter.fisher{at}uclh.nhs.uk, E Ernst E.Ernst{at}exeter.ac.uk

Peter Fisher criticises the methods of a recent review that found no evidence to support homeopathy. But inconclusive evidence, lack of rational explanation, and questions about safety make Edzard Ernst question Europe’s €1bn annual spend on such remedies

Yes—Peter Fisher

Of all the major forms of complementary medicine, homeopathy is the most misunderstood. Based on the concept of “treating like with like,” homeopathy originated with the German physician Samuel Hahnemann (1755-1843). But similar ideas are found in the Hippocratic Corpus, in the work of Paracelsus, and in the medical traditions of several Asian countries.

Homeopathy is part of a family of toxicological and pharmacological phenomena that are attracting growing interest, characterised by secondary, reverse, or paradoxical reactions to drugs or toxins as a function of dose or time or both. These include hormesis (the paradoxical, stimulatory, or beneficial effect of low doses of toxins), paradoxical pharmacology, and rebound effects.

The controversial element of homeopathy is that some medicines are highly dilute, including “ultra-molecular” dilutions, in which it is highly unlikely that any of the original material is present. This is a major scientific concern and the source of the view that homeopathy “doesn’t work because it can’t work.”

However, recent in vitro research shows repeatable effects (for instance, inhibition of basophil degranulation by highly dilute histamine1) while basic physical research shows that the homeopathic manufacturing process changes the structure of the diluent, including the formation of nanoparticles of silica and gas.2 The physical research is of little clinical relevance but provides a possible mechanism of action for the controversial high dilutions.

Systematic reviews and meta-analyses

A recent review by the Australian National Health and Medical Research Council concluded that “there are no health conditions for which there is reliable evidence that homeopathy is effective.”3 But this report used unusual methods of analysis: the …

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