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Question homeopathy’s remedies but not its approach

Patients achieve real outcomes with homeopathic therapy – we more research to work out why. Flickr/Missy the universe

It seems the National Health and Medical Research Council (NHMRC) is likely to follow the lead of the UK and denounce homeopathy as an ineffective and unethical therapy that shouldn’t attract scarce government research funds.

This is within the remit of the NHMRC’s role to provide health advice to clinicians and the Australian public. But the NHMRC also funds the majority of health and medical research in Australia.

And this dual role means the NHMRC – or those looking to it for guidance – may look unfavourably at funding any research involving homoeopathy.

Homeophathy has its shortcomings but researchers still have a lot to learn from studying this practice.

Evidence base?

The evidence for homoeopathic remedies remains equivocal at best, but observational or population-based studies consistently show patients who use homoeopathic treatments get better, and often have good long-term health outcomes.

So if homoeopathy is nothing more than a watered-down placebo and patients still get better using it, we need more research to investigate this phenomenon.

If we can achieve better outcomes in patients without medicine, the benefits could be enormous.

Most detractors tend to focus on trials of individual homoeopathic remedies and the very scientific implausibility of homoeopathic theory.

But there is a lot more to homoeopathy than just the remedy. There is a fairly standardised consultation technique and the “ritual” of taking the medicine.

A recent study suggested it was the consultation, rather than the remedy, that worked in homoeopathy. In other words, the process of being counselled by an empathetic practitioner benefited the patient.

Other commentators argue it’s the extra time homoeopaths spend with patients that makes the treatment effective.

The homeopathic consultation

A trained homoeopath will generally structure the consultation around a method called repertorisation.

This is an interview process that lasts between one and two hours. The homoeopath asks very specific questions in order to identify which of the thousands of homoeopathic treatments is specifically indicated for the individual patient.

This detailed process may be therapeutic itself – but it may also drive patients to identify and act on other areas that are negatively affecting their health.

Such results may not be specific to the actual “medicine” prescribed in the homoeopathic consultation but it’s difficult to unpack the medicine from the entire “homoeopathic experience”.

In this sense a homoeopathic consultation is no more a placebo than any other formalised counselling or psychotherapy technique.

Power of empathy

Even if the positive effects of homoeopathy are a result of the therapist’s empathy and time, this shouldn’t be dismissed. Such soft skills can have hard outcomes.

A 2009 Canadian study shows significant system-wide savings can occur when patients feel more “connected” with their general practitioner. And many Primary Care Trusts in the UK are getting similar findings.

Both patients and general practitioners in Australia could benefit from longer consultations. But first the clinical and economic value of “more expensive” longer consults needs be formally explored.

Beyond issues of effectiveness, researching homoeopathy (and complementary medicines more generally) can help uncover current problems with our health system.

Consumer choice

Australia is the second largest private-sector health spender in the OECD (after the US) and as much as half of this is spent on complementary medicines. People are not just attracted to complementary medicines, they often feel pushed away from the health system.

So why are patients are choosing to pay so much out of their own pocket when free or subsidised health services are available?

The attraction of complementary medicine often has very little to do with the specific therapies. But studying these consumer patterns can tell us what patients want from their healthcare system. This, too, is an area where research is very much in its infancy.

There are clear risks of homoeopathy, particularly when patients use it as an alternative to essential medical services. And the NHMRC is well within its right to draft guidelines discouraging its use.

But it also needs to ensure that such guidelines don’t hamper research that may offer valuable insights into health service delivery, just because it happens to be looking at homoeopathy.

There may be more than just a remedy that can offer benefit to patients.

Do you think homeopathy research should be publicly funded, even if the “medicines” are merely a placebo? Leave your comments below.

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