Homeopathy – Failing Randomized Controlled Trials Since 1835
Published by Joseph Albietz under Homeopathy
Bron : Science-Based Medicine, 16 april 2010
I’m sad to say that this is the last day of World Homeopathy Awareness Week. We’ve tried to give homeopathy its due honor, providing it the attention its practitioners clearly desire, while continuing to cover pertinent news in the world of homeopathy and providing a somewhat more sober, rational discussion of it on our homeopathy reference page.
Of course, most of this has not been news in the literal sense of the word. There hasn’t been anything truly new in homeopathy since its invention (no, not discovery; discovery implies that something actually exists to be found) by Hahnemann in 1796.
Well, perhaps that’s not quite fair. As our knowledge of reality (medicine, pharmacology, chemistry, physics, etc) has steadily improved, homeopathy’s plausibility has dwindled to the point of being indistinguishable from the roundest of numbers (0). And I suppose the recent contortions of logic, abuses of legitimate science, and pure magical thinking put forth to protect homeopathy from the relentless assault of science are far more impressive than that laid out by Hahnemann. So that’s news of a sort.
There’s also homeopathy’s long and rich tradition of abject failure in randomized controlled trials to consider. The overwhelming mountain of evidence showing homeopathy to have no effect beyond placebo is impressive and definitive. That’s data Hahnemann didn’t have, so that’s news too.
Each of these properly conducted studies and analyses demonstrates the scientific method’s utility to help us understand reality and protect us from our own delusions, but frankly, at this point they are about as exciting and useful as proving that the sun will rise in the east tomorrow morning. News? Not so much.
Nuremberg’s Less Famous Trial
I found myself wondering how far back this trail of negative trials goes; how long we’ve been having the identical argument. Pubmed’s earliest mention of homeopathy was in 1906, and the first RCT I found in its database was in 1980. However, the oldest double-blind RCT of which I found record was conducted in 1835 in Nuremberg, Bavaria, and subsequently described in an editorial in 2006 entitled “Inventing the randomized double-blind trial: The Nuremberg salt test of 1835.” Though the trial has its flaws, it was of sufficient quality to satisfy my historical curiosity with a thoroughly depressing answer: 175 years.
The local physicians and public health officials of Nuremberg held an understandably dim view of homeopathy, and as it gained popularity in Nuremburg they became more vocal, and more public, in their opposition:
Von Hoven accused homeopathy of lacking any scientific foundation. He suggested that homeopathic drugs were not real medicines at all and alleged homeopathic cures were either due to dietetic regimens and the healing powers of nature, or showed the power of belief. He called for an objective, comparative assessment by impartial experts. If, as he expected, homeopathic treatment proved ineffective, the government would need to take drastic measures to protect the lives of deceived patients.”
Sounds familiar, doesn’t it? Nuremburg’s resident homeopath Karl Prue’s defense should as well:
[Prue] pointed out that even children, lunatics and animals had been successfully cured. Based on Hahnemann’s assertions, he challenged Wahrhold/von Hoven to try the effects of a C30 dilution of salt on himself. The odds were 10 to 1, he claimed, that his opponent would experience some extraordinary sensations as a result – and these were nothing compared to the much stronger effects on the sick.”
Eventually a trial was designed and agreed upon by both parties to test the effect of a 30C dilution of salt. The trial design was surprisingly good, as it was:
Randomized: participants had an equal chance of being in either the control or experimental group
Controlled: participants not given the experimental therapy were given an indistinguishable and inert placebo
Blinded: participants didn’t know if they received the homeopathic dilution or placebo
Double-blinded: the experimenters didn’t know which participants received the homeopathic dilution or placebo, as the placebo and homeopathic dilution were prepared and the vials containing them randomized and coded by people independent from the experimenters.
Well Powered: the trial contained enough participants so that if, as Prue claimed “the odds were 10 to 1… to experience some extraordinary sensations” that it could detect a difference between the two groups.
Transparent: The design, hypothesis, methods and outcomes were agreed upon beforehand and explained in detail to all participants, conducted publicly (in a literal Pub in fact; these people were full of good ideas), results were published quickly, and any deviation from protocol was acknowledged.
Of the 54 people they managed to enroll, 50 completed the study three weeks later by reporting what, if any, “extraordinary sensations” they had experienced following ingestion of their vial. 5 people reported sensations in the homeopathic group, 3 in the control, which was statistically insignificant. Homeopathy had failed the first of many RCTs.
I am not putting this trial forward as the final (though perhaps it could be considered one of the first) nail in homeopathy’s coffin. The trial design had areas of potential bias, most notably that the symptoms which qualified as “extraordinary” are not well defined (though a glance at the homeopathic proving of “Natrum Muriaticum” or “table salt” provides some insight into this particular problem), and the fact that it relied upon participants to honestly report all symptoms; a hostile or imperceptive set of participants could easily confound the study. Nevertheless, on the whole it was solidly designed and executed, particularly when one considers that this is one of the first double-blind, randomized controlled trials ever documented.
Time To Move On
Here we are in 2010, 175 years after the first of legion negative RCTs of homeopathy, yet it persists with the same tired old arguments. Is there anything to gain from investing more time, money, resources, and ignoring the highly dubious ethics of subjecting human subjects to a trial that has no hope of benefiting them or humanity, just to prove one more time that homeopathy is an utter failure? No, and here’s why.
I look at the current debate surrounding homeopathy, and I see three primary groups. The first accepts the last two centuries of scientific progress and evidence and concludes that homeopathy is a delusion unworthy of further study. They don’t need another trial.
The second believes in homeopathy in spite of the gargantuan volume of evidence; further evidence will do nothing to change their minds. They don’t need another trial.
The final group is comprised of people who are unaware of the nature of homeopathy or the evidence that already exists. This final group requires exposure and education; they require World Homeopathy Awareness Week (SBM edition). They don’t need another trial.