Dr Jens Behnke answers questions from Dr Noémi Radványi, from Hungary, for www.homeopatika. blog.hu/, about the new evidence for homeopathy, research methodology and interpretation of data from clinical trials.
Dr N Radványi: There are many trials that measure the effectiveness of homeopathy. Some of them observe no difference between homeopathy and placebo [dummy pill], and many of them prove that homeopathy is an effective therapy. What research is valid? How is it possible to come to such different conclusions?
Dr Behnke: Different studies for different questions
First of all you have to distinguish between ‘effectiveness’ and ‘efficacy.’ The effectiveness of any intervention is measured in outcome studies under real life circumstances. Concerning homeopathy this means that you try to evaluate the effects of potentised remedies plus anamnesis [a patient’s account of their medical history], expectations of the patient, probable therapeutic suggestions and other context factors. Efficacy in contrast means the pure specific effects of potentised remedies without all these additional variables. Therefore, efficacy is measured in randomised, placebo-controlled, double-blind trials [RCTs] where all these possible confounding factors are ruled out by the study design.
THE EFFICACY PARADOX
Outcome studies provide answers to the question ‘What helps the patient in clinical practice?’ whereas RCTs give information about the causal relationship between a therapeutic effect and a substance. This is not the same, because some interventions might exhibit large specific effects, but they may prove to be not as useful in routine care as other treatments that show smaller specific effects in RCTs. This difference forms the so-called ‘Efficacy Paradox.’ Because of this paradox it has proven useful to evaluate medical interventions in different types of studies. A multi-perspective view highlights more particular features of interventions, enabling more detailed answers to heterogenous questions.
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