The trials of homeopathy : a critical historical account of the origins, structure and development of Hahnemann's scientific therapeutics and two systematic reviews of homeopathic clinical trials, 1821-1953 and 1940-1998

The controversial discipline of homeopathy is examined from three original
perspectives.
Conceptual background The structure and presentation of Hahnemann's
research programme is contrasted with philosophical assumptions about
medical science and emerging theoretical structures in German academic
medicine circa 1800, and the subsequent rift between homeopathy and
alfopathy is explained at this level. The sources of homeopathic theory and
method are located in mainstream eighteenth-century experiment. Alleged
relationships to alchemical medicine are discounted, with the exception of
certain pharmacy techniques introduced after 1816. Divergent schools and
approaches within homeopathy are traced to their sources, and mapped onto
a unified therapeutic field.
Historical importance A systematic review of prospective clinical
evaluations of homeopathy, 1821-1953, contends that these played an
important but neglected part in the evolution of the clinical trial. Placebocontrolled trials by sceptics most probably originated in prior Hahnemannian
use of within-patient placebo controls. Pragmatic trials of homeopathy versus
allopathy in the mid nineteenth century show that judgements of
homeopathic inefficacy made by influential nineteenth-century opponents,
which have coloured debate ever since, were not evidence-based. Early
twentieth-century clinical trials by homeopaths were methodologically in
advance of biomedical trials in some respects.
Clinical relevance A systematic review of 205 prospective controlled
clinical trials published since 1940 found evidence of homeopathy's safety,
and specific and global efficacy in trials of high internal validity. Implications
for clinical research and practice are considered, founded on analysis of
intrahomeopathic differences and trends. On the basis of trial evidence, the
relative merits of placebo-controlled and pragmatic evaluations of
homeopathy are discussed. Clinical relevance was found particularly in areas
that pose problems for biomedicine, and proposals for pragmatic trials of
homeopathy versus standard treatment are made in the following conditions:
unexplained female infertility; postviral fatigue syndrome; influenza; atopy.