How should homeopathy be

assessed?
Still applying conventional science

Lex Rutten, the Netherlands

 Belief or science

Belief: conventional medicine works; homeopathy does not.

Homeopathy cannot succeed in Randomised Controlled Trial

 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 (????)

‘It works’ doesn’t mean it works

• 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
 Why not 100% success?

RCT side-effects
diagnosis therapy-result
co-morbidity circumstances

Unreal certainty
 From complaint towards result

diagnostic research RCT

symptom A
symptom B diagnosis result
test X
test Y probability chances
of diagnosis placebo < 0.05
 Homeopathic ‘diagnosis’
Diagnostic/prognostic research
symptom A
symptom B
Diagnosis Result
symptom C
symptom D Probability of result
Diagnosis
 Effect modification
Diagnostic/prognostic research
comorbidity
age > 65
Result
sex
social status
suicidal? Probability of result
 Bayes method
• Knowledge from experience
• Direct results in practice
• Handling of complex clinical symptoms
• Probability instead of certainty
• Step-by-step increasing certainty by adding
data
 Bayes and homeopathy
• More symptoms more certainty
• Peculiar symptoms are more important
• Vagueness is no problem
• Disadvantage: difficult calculations (use a
calculator)
 Likelihood Ratio (LR)
Occurrence in target population
LR+ =
Occurrence in rest-population

Odds = chance / (1-chance)

Chance = odds / (1+odds)

Bayes’ rule: posterior odds = LR x prior odds

 Prior to posterior chance
(LR+=5)
Prior chance Posterior chance
• 1% 4.8%
• 10% 35.7%
• 30% 68.1%
• 50% 83.3%
• 80% 95.2%
 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%
 Repertory with LR

Partly hypothetical rubric ‘Fear of death’:

FEAR
- Death, of: in general, more than expected considering circumstances;
occurring almost daily. Prevalence 5% (±0.5)
Acon. (4), act-sp., agn. (2.5) , all-s, ..., Anac.(13) , apis (3) , arg-n. (3) ,
Ars. (6) , asaf., aur. (1) , ... Calc. (2) ,
lach.(3.5) , Lat-m. (6), led., ...
 Practical homeopathic research
• Relation between symptom and success
• No conflict with daily practice
• Takes a few seconds during each
consultation
• Outcome: a reliable repertory
 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
A few seconds of each consultation
 Results fear of death
medicine fear death, n= medicine population, LR+
n=
Anacardium 2 4 13.36
Arsenicum album 2 8 6.66
Calcarea carbonica 2 27 1.95

Fear of death in whole population: 3.8%

Does this lead us to a more reliable repertory?

Repertory: Anac., Ars., Calc.

 Results after 15 months, n=1634

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
 medicine LR+

Sens. injustice bell. 3.4

caust. 6

Loquacity hyos. 7.8

lach. 4.7
 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 with
menopausal complaints with Lachesis
 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
 Vagueness

Herpes lip Loquacity

herpeslips loquacity

14,00% 30,00%

12,00% 25,00%
10,00%
20,00%
8,00% herpes=1 loquax=1
15,00%
6,00% herpes=2 loquax=2
10,00%
4,00%

2,00% 5,00%

0,00% 0,00%
1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9
doctor doctor