http://www.mp2.worldfriend.com/sustainable_development_forum.htm

Did my reply get lost?

I’ve no idea but probably. You’re approved for participation on this blog so your responses come straight through unmoderated.

The paper you are talking about has no control group so can yield no meaningful information.

Here we go again. The paper I’m referring to can yield no comparative information (ie. homeopathy vs placebo or no treatment or conventional medicine), but that doesn’t mean it yields no meaningful information. It demonstrates what it demonstrates, which is

Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period. Our findings indicate that homeopathic medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.

And since the findings are in broad agreement with other similar studies, then it’s reasonable to assume they’re robust.

You can carry on ad nauseam trying to dismiss whole studies out of hand because you can find something to criticise in each, but surely you must realise this approach is not exactly scientific. As I keep on saying, lower quality evidence does not equate to no evidence at all.

David Reilly again:

Professor Sackett opens his seminal book on Evidence Based Medicine 3 with “Evidence­-based medicine is the integration of best research evidence with clinical expertise and patient values.” Perhaps that’s our best guide at a time when the RCT (randomised controlled trial) research evidence only allows some comment on whether homoeopathy varies from placebo, but is not good enough to comment on individual conditions, and observational studies and qualitative work show that patients are satisfied.

In the ‘The 5th Wave’ 4 document The Public Health Institute of Scotland argued that we are struggling in another wave of change in medicine when the cultural and conceptual divergence of ‘objective’ (nomothetic, scientific, falsifiable, reproducible) truth and ‘subjective’ (idiographic, personal experience) truth is not ‘resolvable’ a balanced view must emerge embracing both with respect. No one experiences illness or care in the same way, our unique experience cannot be exactly replicated, and even the road to ‘objective’ science is approached via the idiographic route. The time has not yet arrived when the homoeopathic puzzle is ready to be ‘solved’.

The Evidence For Homoeopathy, D. Reilly. V8.3 Sept06

Also, patient perceptions are used to monitor treatment outcomes rather than any biochemical marker of disease remission so you may simply be assessing patients mental state rather than actual remission.

It’s pretty obvious how stupid you think the average homeopathic patient is, but give people credit for knowing when they’ve got better or not! And your blinkers must be size 10s, because it wasn’t the only outcome measure used, as I’ve already stated on your blog. Physician assessments were used as well and the two were in agreement.

In a prospective, multicentre cohort study with 103 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data from all patients (age >1 year) consulting the physician for the first time were observed. The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10) and quality of life at baseline, and after 3, 12, and 24 months.

[...]

For physicians, we developed a standardised questionnaire that allowed for continuous documentation during the treatment/follow-up period (24 months), as well as standardised points of assessment at 0, 3, 12 and 24 months. At each of these time points, the severity of a maximum of 4 diagnoses and maximum of 8 symptoms was rated by participating physicians using a numerical rating scale [8]. This information was then forwarded to the study office. The type of homeopathic treatment, the use of any conventional therapy, as well as any referrals to other physicians were recorded on a continuous basis.

[...]

A total of 103 physicians participated in the study (51 male, 45 ± 7 years of age; 52 female, 45 ± 7 years of age). Twenty-six percent of the participating physicians were specialists (10% internists, 9% paediatricians, 7% other) and 74% were general practitioners. The average duration of overall medical practice was 17.4 ± 8.4 years with 9.0 ± 4.4 years of practice in homeopathy (range 3–20 years). Forty percent of the physicians were certified to work in the public health care system, and 60% were in private practice.

Witt, Claudia M, Lüdtke, Rainer, Baur, Roland, and Willich, Stefan N. Homeopathic medical practice: Long-term results of a cohort study with 3981 patients BMC Public Health 2005, 5:115 doi:10.1186/1471-2458-5-115

Tiny study? 3,981 patients? I don’t think so.

… it stood out that where biographical information about members shines through, they do not tend to be doctors …

Ah yes — I’d noticed this too and was saying exactly this on Goodscience’s blog yesterday. Interesting, isn’t it? It appears also that quite a few of the most vocal critics are academic scientists working in highly controlled conditions which simply aren’t replicable or applicable in the consulting room or hospital ward. More and more GPs and front-line healthworkers I speak to volunteer quite freely that they have serious doubts about the theoretical assumptions underlying much of “scientific” medicine because “real life isn’t like that”.

A few years back I was at a series of seminars which were also attended by a good number of GP homeopaths. We all got to swapping stories at lunch-breaks about how we’d come to study homeopathy, and pretty much without exception this was the reason the GPs gave. This is good science in operation — it’s an absolutely fundamental requirement of scientific method that all hypotheses and theories must be tested against observations of the natural world, ie. any hypothesis must fit the observed data. If many GPs feel the biomedical model is failing in that test and that the homeopathic model is a better fit, then this is of quite some significance.

As for ‘it doesn’t matter how it works’: quite right. And before any stray sceptic wears out the letters R, C & T on his or her keyboard any further, it might be worth highlighting again how very little is known about the actual mechanisms active in a large proportion of mainstream medicine. How often do we come across the words ‘not well understood’ or ‘not understood’ in research and in expositions about this or that medical intervention, as well as any number of biomedical processes? How many every-day medical interventions are actually chosen on the basis of the ‘gold standard’ RCT – and of those RCTs, how many actually demonstrate how and why a particular drug has a medical effect? If medicine restricted itself to processes that are fully ‘understood’ and to evidence base according to research ‘gold standards’ only, GPs and consultants up and down the country would have a serious problem finding enough validated treatment options.

I don’t often look at sceptics’ blogs any more because by and large one hears the same old same old rehashed at infinitum. But in my various sojourns into that strange land of ‘we-all-agree-so-we-all-are-right-and-if-you-try-shatter-our-certainties-we’ll- have-your-guts-for-garters’, it stood out that where biographical information about members shines through, they do not tend to be doctors – with the notable exception of young Ben, who however can’t have had much time to gather an extensive body of experience in the realities of clinical practice and its evidence base, being far too busy with his journalistic career and feeding his faithful band of fans.

Studies of GP attitudes reveal again and again that a majority prefer being able to offer complementary therapies to their patients where indicated – surely they wouldn’t all be cynically opting for ‘offering placebo’? No, most people in the health care sector who actually care about people’s wellbeing are happy to go with what appears to work while minimising harm, whether we understand ‘how it works’ or not.

But laughingmysocksoff- you are sounding the most clear and intelligent of any blogger about the topic of homeopathy and obviously know what you are saying and have the research to back it up. Unfortunately, I get the sense that there is a lot of parlor (magic?) tricks out there to prevent truth about homeopathy and how well it works getting out.