Is homeopathy evidence-based medicine? This is a question I have been asked, particularly as a Pharmacist also practicing homeopathy. As part of my study in the paper Quality in Healthcare, we have been looking at evidence based medicine, and asked to reflect on our understanding and use in practice. So I decided to consider what evidence-based medicine actually means, and how this applies to the practice of homeopathy.
First of all we need to have a definition and an understanding – including how this applies to conventional, allopathic medicine.
Sackett et al (1996) had this definition: “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”
Sounds easy right? Read the research and apply it. What this doesn’t say is following the use of protocols and guidelines exclusively, even though they may have been developed for an evidence-based approach.
Conscientious is doing work well and thoroughly, explicit is being clear, having the information in detail, and judicious is showing good judgement. So the use needs to be well thought through and chosen with good judgement.
Current best evidence includes the best research evidence, as well as clinical experience and knowledge, and patient preferences.
But the clincher here for me is the ‘care of individual patients’. Just like homeopathy, evidence-based medicine should consider the individual, their personal history, their beliefs and what they want from treatment, and then using judgement and considering the best evidence for that individual.
If we look at homeopathy, let’s start with that last part of the sentence. Individualised homeopathy, that is not the use of protocols, is just that, individual and takes the client’s story, beliefs, and preferences into account right from the first minute of the consultation. Classical homeopathy is founded in this principle of individualisation.
When we consider the conscientious, explicit and judicious use, we need to understand training and experience and how that turns into a considered judicious analysis of the case and choice of remedy. Most qualified homeopaths spend 3-4 years in formal training which includes philosophy and theory, allowing them to analyse a case, assess what is happening and consider the treatment plan. This is why many classical homeopaths, myself included, do not always give you a remedy on the spot. Sometimes we can, but often we need the time to be thorough, have a clear look at all the detail, and use our judgement to differentiate the many different remedies.
Now let’s consider the current best evidence. Homeopathy is founded on human trials of remedies (the proving, or human pathogenetic trial). For these older remedies we also have documented cases showing improvement after the remedy. Roger Morrison is completing a mammoth task at the moment to write ‘Clinically Verified Materia Medica’ which takes proving symptoms, and cured cases and looks at what has been seen in the case. I have his first volume and find that it really expands on themes for some remedies. There are also many other Materia Medica books, although some use evidence that is not directly taken from the source proving or clinical experience.
In more recent years we have also seen many clinical trials of homeopathy, and also increasing publishing of case reports using the MONARCH criteria (Modified Naranjo Criteria for Homeopathy) which is a peer-review process that assesses the likelihood of a causal link between the homeopathic remedy and the improvement in the patient’s symptoms. This is contributing to a growing body of evidence in the homeopathic field.
Potency choice and case management is another topic, and this is often where clinical judgement and experience comes into play in homeopathy. It is taught at homeopathy college, but time and practice as a homeopath distils this theoretical knowledge into a judgement about what is appropriate for the individual.
Sackett et al (1996) also has this to say, which aligns exactly with how homeopaths work: “Evidence based medicine is not “cookbook” medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice..”
This is why home based prescribing, protocols, and non-homeopaths prescribing remedies will never replace the classical Homeopath. Because our expertise and time allows us to sift the evidence, use our judgement, be clear in our path forward, and focus on the individual to support them in their health journey. So while homeopathy is not typically considered evidence based medicine when considered through a conventional, allopathic framework, the principles of homeopathy closely align with this definition. As the published evidence for homeopathy continues to grow and develop this will hopefully become a topic of further conversation.
At the end of the day, as homeopaths we are not trying to fit into this narrow box of evidence based medicine, our work speaks for itself in the 200+ years of case reports and the everyday results that is why we love what we do.
Reference:
Sackett, D. L., Rosenberg, W. M., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: what it is and what it isn’t. British Medical Journal, 312(7023), 71-72. https://doi.org/10.1136/bmj.312.7023.71