MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

As reported, the Bavarian government has set aside almost half a million Euros for research to determine whether the over-use of antibiotics can be reduced by replacing them with homeopathic remedies. Homeopaths in and beyond Germany were delighted, of course, but many experts were bewildered (see also this or this, if you read German).

While the Bavarians are entering the planning stage of this research, I want to elaborate on the question what methodology might be employed for this task. As far as I can see, there are, depending on the precise research questions, various options.

IN VITRO TESTS OF HOMEOPATHICS

The most straight forward way to find out whether homeopathics are an alternative to antibiotics would be to screen them for antibiotic activity. For this, we would take all homeopathic remedies in several potencies that are commonly used, for instance D12 and C30, and add them to bacterial cultures. To cover even part of the range of homeopathic remedies, several thousand such tests would be required. The remedies that show activity in vitro would then be candidates for further clinical tests.

I doubt that this will generate meaningful findings. As homeopaths would probably point out quickly, they never claimed that their remedies have any antibiotic effects. Homeopathics work not via pharmacological mechanisms (there is none), they stimulate the vital force, the immune system, or whatever mystical force you fancy. Faced with the inevitably negative results of in vitro tests, homeopaths would merely shrug their shoulders and say: ‘we told you so’.

ANIMAL MODELS

Thus it might be more constructive to go directly into animal models. Such tests could take several shapes and forms. For instance, scientists could infect animals with a bacterium and subsequently treat one group with a high potency homeopathic remedy and the control group with a placebo. If the homeopathic animals survive, while the controls die, the homeopathic treatment was effective.

Such concepts would run into problems on at least two levels. Firstly, any ethics committee worth its name would refuse to pass such a protocol and argue that it is not ethical to infect and then treat animals with two different types of placebo. Secondly, the homeopathic fraternity would explain that homeopathy must be individualised which cannot be done properly in animals. Faced with the inevitably negative results of such animal studies, homeopaths would merely shrug their shoulders and say: ‘we told you so’.

CLINICAL TRIALS

Homeopathy may, according to some homeopaths, defy in vitro and animal tests, but it is most certainly amenable to being tested in clinical trials. The simplest version of a clinical study would entail randomising a group of patients with bacterial infections – say pneumonia – into receiving either individualised homeopathy or placebo. Possibly, one could add a third group of patients being treated with appropriate antibiotics.

The problem here would again be the ethics; no proper ethic committee would pass such a concept (see above). Another problem might be that even the homeopathic fraternity would oppose such a study. Why? Because all but the most deluded homeopaths know only too well that the result of such a trial would be devastatingly negative for homeopathy.

Therefore, homeopaths are likely to go for a different study design, for instance, one where patients suspected to have a bacterial infection are randomised to two groups of GPs. One group of ‘normal’ GPs would proceed as usual, while the other group are also trained in homeopathy and would be free to give whatever they feel is right for each individual patient. With a bit of luck, the ‘normal’ GPs would over-prescribe antibiotics (because that’s what they are apparently doing routinely), while the homeopathic GPs would often use homeopathics instead.

Such a study would indeed generate a result alleging that the use of homeopathy reduces the use of antibiotics. Of course, to be truly ‘positive’ it would need to exclude any clinical outcome such as time to recovery, because that might not be in favour of homeopathy.

The problem might again be the ethics committee. Assuming they are scientifically switched on, they will see through the futility of a trial designed to produce the desired result. They might also argue that science is not for testing one faulty approach (over-prescribing) against another (homeopathy) and insist that science is about finding the best treatment (which is neither of the two).

There are, of course, many other study designs that could be considered. Generally, they fall into two different categories: if they are rigorous tests of a hypothesis, they are sure to produce a result unfavourable to homeopathy. Such studies will therefore be opposed to by the powerful homeopathic fraternity. If, however, studies are flimsily designed to generate a positive finding, they might be liked by homeopaths, yet rejected by scientists and ethicists.

SURVEYS

A much easier solution to the question ‘does the use of homeopathy reduce the use of antibiotics’ might be to not do a trial at all, but to run a simple survey. For instance, one could retrospectively assess how many antibiotics 100 homeopathic GPs have prescribed during the last year and compare this to the figure of 100 over-prescribing, ‘normal’ GPs. This type of ‘research’ is a sure winner for the homeopaths. Therefore, I predict that they will advocate this or a similarly flawed concept.

Most politicians are scientifically illiterate to such a degree that they might actually agree to finance such a survey and then confuse correlation with causation by triumphantly stating that the use of homeopathy reduces over-prescribing of antibiotics. Few, I fear, will realise that there is only one method for reducing the over-prescribing of antibiotics: remind doctors what they all learnt in medical school, namely to prescribe antibiotics only in cases where they are indicated. And for that we evidently need no homeopathy or other SCAM.

9 Responses to Homeopathy as a means to reduce over-prescribing of antibiotics

  • What about the “A vs A+B” approach? That one always works. Homeopaths like it.

    • antibiotics versus antibiotics plus homeopathics – yes that’s another design. if one used an appropriate outcome measure like for instance patient satisfaction, it might work for this scenario.

    • @Lenny

      One might imagine that individualized homeopathy might extend to determining the precise nature of the microbial species infecting a patient, but the germ theory of disease, established conclusively in the late 19th century, still appears not to be popular with many homeopaths and homeopathists.

      You talk about the “A vs A+B” approach. That might already be judged to be the standard of care, at least for cystitis, to judge from this article on the British Homeopathic Association website. It states that “Homeopathy can be used alongside conventional treatment with antibiotics and for cases where no infection is found [sic]. It can be very helpful in building up the constitution, thus reducing the risk of recurrence. There are also many other simple measures that can reduce the chances of re-infection.”

      The piece goes on to confirm that, in contrast to my skepticism (above) about homeopathy and germ theory, the BHA does expect that tests will be undertaken to determine the cause of infection.

      “In all cases of suspected urinary tract infection a detailed history is essential, not least of all to find the appropriate homeopathic remedy. A urine sample should always be sent off for analysis in the laboratory. A preliminary inspection of the urine is very useful. A strong smell, cloudiness or the presence of small amounts of blood are highly suggestive of a bacterial infection, but clear urine does not exclude it. The doctor [sic] may use a reagent strip to see if there are any blood or pus cells not visible to the naked eye.
      In a simple case of cystitis, when there is no fever or obvious general illness, the GP will usually wait for the results of the urine culture before prescribing antibiotics. As this can take several days, it is well worth trying a homeopathic remedy in the meantime to alleviate the discomfort.”

      While this account appears to represent a scientific approach to cystitis treatment, including sending off specimens for laboratory investigation, there’s no hint that the choice of remedy prescribed will in any way be influenced by the lab results. Indeed, the piece clearly states that the appropriate remedy is based on the case history.

      As with formal “A vs A+B” clinical trials, the recommendation of adding homeopathy to conventional treatment is a strategy that ensures homeopathy can’t be blamed for any treatment failures, and will even be interpreted by people who lack any real knowledge of biology or medicine as support for the contention that “homeopathy works”.

  • ‘……remind doctors what they all learnt in medical school, namely to prescribe antibiotics only in cases where they are indicated.”

    By this statement, you seem to confirm that antibiotics are being “over prescribed” today. The real issue for antibiotic resistance, exists, where the antibiotic is required, but the dosage and the period for which it is taken, is incorrect. Either it is too short or or too long. Both ways, it becomes the reason for the present problem.

    The real reason is that there are no guidelines providing clarity on dosage and period for which a particular antibiotic is to be taken for. If these exists, these are not based upon evidence. Doctors use their “experience” for prescribing, and errors are to be expected and routine.
    So even if the doctors “remember” what they learnt in the medical school, the problem remains as is.

    https://www.bmj.com/content/358/bmj.j3418 :The antibiotic course has had its day

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