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How should homeopathy be

assessed?

Still applying conventional science

Lex Rutten, the Netherlands

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Belief or science

Belief: conventional medicine works; homeopathy does not.

Homeopathy cannot succeed in Randomised Controlled Trial

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Scientific mirror

Homeopathy - conventional medicine: same results in RCT

Hypothesis: selection bias, low quality, heterogeneity

Shang, the Lancet aug. 2005

RCT works only for conventional medicine (????)

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Allen Roses (GSK, December 2003):

90% of conventional medicines work

in 30-50% of all patients

Pharmacogenetics: not only the disease, but

the whole person: genotype

Homeopathy: same, but phenotype

It works doesnt mean it works

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Why not 100% success?

diagnosis

RCT

co-morbidity

side-effects

circumstances

therapy-result

Unreal certainty

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From complaint towards result

symptom A

symptom B

test X

test Y

diagnosis result

diagnostic research

probabilityof diagnosis

RCT

chancesplacebo < 0.05

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Homeopathic diagnosis

Diagnosis Result

Diagnosis

Diagnostic/prognostic researchDiagnostic/prognostic research

Probability of resultProbability of result

symptom A

symptom B

symptom C

symptom D

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Effect modification

comorbidity

age > 65

sex

social status

Result

Diagnostic/prognostic researchDiagnostic/prognostic research

Probability of resultProbability of resultsuicidal?

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Bayes method

Knowledge from experience

Direct results in practice

Handling of complex clinical symptoms

Probability instead of certainty

Step-by-step increasing certainty by addingdata

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Bayes and homeopathy

More symptoms more certainty

Peculiar symptoms are more important

Vagueness is no problem

Disadvantage: difficult calculations (use a

calculator)

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Prior to posterior chance

(LR+=5)Prior chance

1%

10%

30%

50%

80%

Posterior chance

4.8%

35.7%

68.1%

83.3%

95.2%

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Homeopathic diagnosis stepwise

Lachesis in menopausal complaints

symptom LR success (%)

1. menopause 10%?

2. loquacity 5 35%

3. left-sided complaints 3? 62%4. clothing < 3? 83%

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Repertory with LR

Partly hypothetical rubric Fear of death:

Acon. , act-sp., agn. , all-s, ..., Anac. , apis , arg-n. ,Ars. , asaf., aur. , ... Calc. ,

lach. , Lat-m. , led., ...

FEAR- Death, of: in general, more than expected considering circumstances;occurring almost daily. Prevalence 5% (0.5)

(6)

(4) (2.5) (3)(1)(6)

(3)

(3.5)

(2)(13)

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Practical homeopathic research

Relation between symptom and success

No conflict with daily practice

Takes a few seconds during each

consultation

Outcome: a reliable repertory

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Prospective research

Check the presence of 6 symptoms in each

new patient

Keep record of medicines and results

a=occurrence of symptom in Lachesis-

population

b=occurrence of symptom in rest-population

Likelihood Ratio = a / b

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A few seconds of each consultation

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Results fear of death

medicine fear death, n= medicine population,

n=

LR+

Anacardium 2 4 13.36

Arsenicum album 2 8 6.66Calcarea carbonica 2 27 1.95

Repertory: Anac., Ars., Calc.

Fear of death in whole population: 3.8%

Does this lead us to a more reliable repertory?

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medicine LR+

Diarrhea anticip. arg-n. 15

calc. 2.2

ph-ac 10

Grinding teeth bell. 6.1

carc. 2.6

merc. 5

tub. 7.3

Results after 15 months, n=1634

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medicine LR+

Sens. injustice bell. 3.4

caust. 6

Loquacity hyos. 7.8

lach. 4.7

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Lachesis in menopausal complaints

LR+ loquacity - Lachesis = 5 (1,8-12,3)

succes by Lachesis in menopausal complaints

with loquacity goes from 10%(?) to 35%.

Dear GP,

Treat your most loquacious patients withmenopausal complaints with Lachesis

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Conclusions

Homeopathy (and conventional medicine) is

bayesian science

LR research is easy, cheap and rewarding

Effectiveness of homeopathy can be much

improved by LR research

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Vagueness

herpeslips

0,00%

2,00%

4,00%

6,00%

8,00%

10,00%

12,00%

14,00%

1 2 3 4 5 6 7 8 9

doctor

herpes=1

herpes=2

loquacity

0,00%

5,00%

10,00%

15,00%

20,00%

25,00%

30,00%

1 2 3 4 5 6 7 8 9

doctor

loquax=1

loquax=2

Herpes lip Loquacity