Does homeopathy “fly in the face of science” or is it “the most misunderstood of all the major forms of complementary medicine?” Two doctors – one for and one against homeopathy – argue in The BMJ whether it should be recommended to patients.

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“The fact that one homeopathic treatment for a condition is ineffective doesn’t mean that another is also ineffective,” argues Dr. Fisher.

The two UK doctors are Dr. Peter Fisher, director of research at the Royal London Hospital for Integrated Medicine in London and Prof. Edzard Ernst, emeritus professor at the University of Exeter.

Prof. Ernst says most reviews of the randomized controlled trial evidence have “failed to show that homeopathy is effective.” Any systematic reviews with positive conclusions “usually have serious methodological flaws.”

But Dr. Fisher questions the methods used to review the evidence for homeopathy – citing as an example a recent report by the Australian National Health and Medical Research Council stating “there are no health conditions for which there is reliable evidence that homeopathy is effective.” He argues that the review omitted several key pieces of evidence, adding:

“The fact that one homeopathic treatment for a condition is ineffective doesn’t mean that another is also ineffective.”

Still, the assumptions underlying homeopathy “fly in the face of science,” says Prof. Ernst, “and critics have long pointed out that unless our understanding of the laws of nature is incorrect, homeopathy’s mode of action has no rational explanation.”

He argues that patients can be harmed when homeopathy replaces an effective therapy and says he knows of “several deaths that have occurred in this unnecessary way.”

Dr. Fisher disagrees that practitioners necessarily replace conventional medicine, concluding that “doctors should put aside bias based on the alleged implausibility of homeopathy.”

When integrated with standard care, homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials.

Health professionals trained in homeopathy do not oppose the use of conventional treatments, including immunization.”

Prof. Ernst questions Europe’s €1bn annual spend on homeopathic remedies, saying these funds could and should be “spent more usefully elsewhere.”

In summary, Prof. Ernst says “the axioms of homeopathy are implausible, it’s benefits do not outweigh its risks, and its costs and opportunity costs are considerable.

“Therefore, it seems unreasonable, even unethical, for health care professionals to recommend its use.”

Dr. Fisher returns to his point about how evidence for homeopathy has been reviewed, saying “most overviews have had more favourable conclusions” than the Australian one, including a health technology assessment commissioned by the Swiss federal government.

This concluded that homeopathy was “probably” effective for upper respiratory tract infections and allergies – and several meta-analyses of homeopathy as a whole and for specific conditions have been positive.

Dr. Fisher also points to several studies comparing treatment outcomes of conventional family doctors with those who integrate homeopathy into their practice. These show better outcomes at equivalent cost, with less use of “hazardous” drugs, including antibiotics.