Caroline Eyles Homeopathy Website


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MY RESEARCH In November 2004 I was employed by The University of Southampton with a Department of Health funded research fellowship to do a PhD exploring the homeopathic consultation at the Complementary Medicine Research Unit at the University of Southampton. The PhD was awarded in June 2009. In 2000 I was awarded a Masters degree in Health Education and Health Promotion. A qualitative study of homeopathic consultations The aim of this research was to gain an in depth understanding of homeopathic practitioners perceptions and experiences of the consultation. Additionally a theoretical model was to be generated that would explain the processes that underpin the homeopathic consultation. A qualitative approach was taken using a constructivist grounded theory methodology using two phases of data collection. In phase one I used in depth face to face interviews to gather my initial data. I then transcribed and systematically analysed the interviews. As part of this process I used constant comparison where I compared the interviews with eachother so that I could identify common codes and categories that capture commonalities and differences among homeopathic consultations. Following the analysis of the interviews a tentative theoretical model of the homeopathic consultation was developed and tested in phase two of data collection. Phase two of the study involved observations of homeopathic consultations and the completion of practitioner reflective diaries focussing on challenging consultations as a form of negative case analysis. The data from the observations and the diaries was analysed using a checklist that was developed from phase 1 of the data collection. A theoretical model of the homeopathic consultation was developed from phase 1 and phase 2. The findings of this study are due to be published in 2010 If you would like any more information about this research then please contact me at the following: Caroline Eyles RS Hom,PhD Complementary and Integrated Medicine Research Unit Primary Medical Care School of Medicine University of Southampton Aldermoor Health Center Aldermoor Close Southampton Hampshire SO16 5ST United Kingdom Telephone: +44(0)23 8024 1073 Fax: +44(0)23 8070 1125 Email: C.G.Eyles@soton.ac.uk. Publications Eyles, C., Walker, J., Brien, S. (2009) Homeopathic practitioners' experiences of the homeoapthic consultation: A protocol of a grounded theory study. The Journal of Alternative and Complementary Medicine. 15(4) pp347-352 Lewith, G., Brien, S., Barlow, F., Eyles, C., Flower, A., Hall, S., Hill, C., Hopwood, V., (2009) The meaning of evidence: Can practitioners be researchers? Forschende Komplementarmedizin. 16(5) pp343-347 The present state of homeopathy research The evidence for the effectiveness of homeopathy has included two areas of research: 1) Studies looking for biological effects from potencies especially ultra-high dilutions. Recently a rigorous laboratory study on high dilutions of histamine found that they exerted an effect on basophil activity (1,2). 2) Studies of the efficacy of homeopathic remedies for particular clinical conditions. Many randomised placebo controlled trials (RCTs) have assessed the efficacy of homeopathy in single medical conditions. When high quality studies have been selected for analysis (such as those with adequate randomisation, blinding, sample size and other methodological criteria that limit bias) a number show positive results (3,4). Moreover in a prospective observation study to evaluate the usefulness of homeopathy in the real world clinical setting of primary care, homeopathy was found to be at least as effective as conventional medicine (5). Homeopathy has been described as a complex intervention with multiple components that interrelate and are synergistic (6). For example the process of identifying the remedy is embedded in the consultation which is dependent on the patient practitioner relationship. Nevertheless research into homeopathy has consistently attempted to find specific effects of homeopathy from the remedy alone ignoring the effects of the consultation and treating the remedy as if it was a biomedical drug with specific physiological effects. Consequently there is conflicting evidence about its efficacy, as there are positive systematic reviews demonstrating effects above and beyond placebo (3,4,7-9), and negative systematic reviews suggesting any clinical effects are simply due to a placebo effect (10,11), although the methodological quality of Shang et al's meta analysis has been heavily criticized. It has been purported therefore that the benefits that patients can experience after homeopathic treatment are probably due to the therapeutic encounter that is experienced in the consultation (12), however this is still conjecture as no formal study has yet attempted to prove this is the case. The strengths and limitations of the use of RCT's to assess the efficacy of homeopathy have been widely debated. The limitations of RCT's can be categorised as either practical or methodological in nature. The practical challenges facing RCT homeopathy research include inadequate research infrastructure and inadequate funding for research. One of the main practical challenges has been that clinically orientated homeopathy research does not always research homeopathy as practiced in the field, but rather is research into some of the "tools of the trade" of homeopaths. For example the efficacy of a remedy may be tested rather than the whole treatment effect in a natural setting (13). Criticism of the use of RCTs for research into homeopathy was discussed by Weatherley-Jones et al (6) who suggested that follow up consultations of patients taking part in a RCT may be hampered by the use of placebo, as the homeopaths do not know if change or lack of it may be due to the patient receiving placebo or being on a remedy that is not working . Data from Bell et al's paper which investigated individualised homeopathic remedies versus placebo in fibromyalgia patients supports this. The number of remedies recommended by the homeopaths was significantly higher in the placebo group than in the active treatment group (14). More studies are needed to confirm or refute this proposal. There are many methodological challenges facing RCT homeopathy research. One of the main issues that underlies many other methodological challenges is concerned with the differences in philosophy and paradigm between homeopathy and conventional medicine (15). There is unease amongst many researchers and practitioners on the use of RCT's to investigate homeopathy, because the RCT method can be seen as deriving from a reductionist approach to the world whereas homeopathy embraces a highly individualised holistic approach to treatment (16). Another challenge facing researchers is the suggestion that it is not meaningful to examine the specific effects of a therapy (the remedy) as separate to the non specific effects of a therapy (the effects from the practitioner patient relationship etc). Both specific and non specific effects may interact rather than just being an additive of the homeopathic intervention (6). This view is reiterated in Paterson & Dieppe's (17) observations on acupuncture research. Additionally RCT's only address whether an intervention works but does not address the process of how it works and the context in which it works best (18). Homeopathy is popular amongst patients (19,20) and concerns surrounding the lack of information about its practices have stimulated a need for high quality research. This is necessary in order to ensure that the treatments that the public are accessing are safe, that the efficacy and effectiveness of different therapies are proven and that their cost effectiveness can also be established (21). An emerging research framework that addresses many of these issues and uses appropriate research designs and methods to assess complex interventions is Whole Systems Research (22). Within this framework is a range of approaches that included mixed method research where qualitative studies are nested within quantitative designs, observational studies and pragmatic methodologies that assess effectiveness rather than efficacy. Reference List 1 Belon P, Cumps J, Ennis M, Mannaioni PF, Roberfroid M, Sainte-Laudy J, Wiegant FA. Histamine dilutions modulate basophil activation. Inflammation Research 2004 May;53(5):181-8. 2 Witt CM, Bluth M, Albrecht H, Weibhuhn TER, Baumgartner S, Willich SN. The in vitro evidence for an effect of high homeopathic potencies. A systematic review of the literature. Complementary Therapies in Medicine 2007 June;15(2):128-38. 3 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homoeopathy. British Medical Jouranl 1991;302:316-23. 4 Linde K, Clausius N, Ramirez G, Melchart D, Eltel F, Hedges LV, Jonas WB. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. The Lancet 1997 September;350(9081):834-43. 5 Riley D, Fischer M, Singh B, Haidvogl M, Heger M. Homeopathy and conventional medicine: an outcomes study comparing effectiveness in a primary care setting. The Journal of Alternative and Complementary Medicine 2001;7(2):149-59. 6 Weatherley-Jones E, Thompson EA, Thomas KJ. The placebo-controlled trial as a test of complementary and alternative medicine: observations from research experience of individualised homeopathic treatment. Homeopathy 2004 October;93(4):186-9. 7 Boissel JP, Cucherat M, Haugh MC, Gauthier E. Critical literature review on the effectiveness of homeopathy: overview of data from homeopathic medicine trials. Homeopathic Medicine Research Group: report to the European Commission Directorate General XII: science, research and development: Brussels; 1996. 8 Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art-review. Journal of Alternative & Complementary Medicine 1998;4(4):371-88. 9 Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. European Journal of Clinical Pharmacology 2000 April;56(1):27-33. 10 Ernst E. A systematic review of systematic reviews of homeopathy. British Journal of Clinical Pharmacology 2002;54(6):577-82. 11 Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. The Lancet 2005 August 27;366(9487):726-32. 12 Zimmermann-Viehoff F, Meissner K. Homeopathy and Placebo-Synonym, Similar or Different? Forschende Komplementarmedizin 2007;14(4):247-8. 13 Cohen M. Evidence and CAM Research. In: Adams J, editor. Researching Complementary and Alternative Medicine.London: Routlledge; 2007. p. 89-104. 14 Bell IR, Lewis DA, II, Brooks AJ, Schwartz GE, Lewis SE, Walsh BT, Baldwin CM. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo. Rheumatology 2004 May 1;43(5):577-82. 15 Mason S, Tovey P, Long AF. Evaluating complementary medicine: methodological challenges of randomised controlled trials. British Medical Jouranl 2002 October 12;325(7368):832-4. 16 Thompson T. Can the caged bird sing? Reflections on the application of qualitative research methods to case study design in homeopathic medicine. BMC Medical Research Methodology 2004;4(1):4. 17 Paterson C, Dieppe P. Characteristic and incidental (placebo) effects in complex interventions such as acupuncture. British Medical Journal 2005 May 21;330(7501):1202-5. 18 Verhoef M, Vanderheyden LC. Combining Qualitative Methods and RCTs in CAM Intervention Research. In: Adams J, editor. Researching Complementary and Alternative Medicine.London: Routlledge; 2007. p. 72-86. 19 Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complementary Therapies in Medicine 2001 March;9(1):2-11. 20 Thomas K, Coleman P. Use of complementary or alternative medicine in a general population in Great Britain. Results from the National Omnibus survey. J Public Health 2004 June 1;26(2):152-7. 21 House of lords. Complementary and Alternative Medicine, Select Committee on Science and Technology. Available from: http://www publications parliament uk/pa/ld199900/ldselect/ldsctech/123/12301 htm (Accessed June 2005) 2000. 22 Verhoef MJ, Lewith G, Ritenbaugh C, Boon H, Fleishman S, Leis A. Complementary and alternative medicine whole systems research: Beyond identification of inadequacies of the RCT. Complementary Therapies in Medicine 2005 September;13(3):206-12.