Siegfried Letzel: Wouldn’t it be helpful to test and monitor these drugs under real conditions in practice, before they are administered to patients and prior to approval of a drug? Often, side effects become only obvious after many, many people have been harmed.
Prof. Dinges: Yes, is this a question about the number? You surely know that clinical trials are a normal part of such an approval protocol. I am not a pharmacologist who could make well thought out comments, as e.g. how many cases it takes in order to be able to evaluate whether a sufficient assessment for the approval exists. So, how can you verify the effectiveness of a medical procedure? In this connection, you have to think about the setting. So far, this has happened far too little. Of course, it is clear that a conventional doctor, who takes time for his patients and their ailments, gives them his attention and shows his interest will have more successful results in treating his patients than one who doesn’t do this. The exciting placebo research gives us a lot of knowledge about increasing the healing probability, whether this is the colour of the pills or whatever.
There are different minimum numbers of test persons and minimum durations, which are presumed, however, this means we are in the field of study designs and double-blind research. The real difficulty lies in the fact that the social discourse is not shaped by the homeopaths. Especially in the last ten years, we have just experienced it with the sceptics, how talking about homeopathy has increasingly turned into a talking about scientificity, about a certain type of scientificity. During this process, homeopathy is falling through the mesh. The sceptics have succeeded in shifting such discussions.
What do patients gain under a particular therapeutic system? What are the costs of such a system for the society? I think, in this respect, homeopathy is still in a very good position, even with regard to health care costs, which today is often the main argument – what does medical treatment cost?
Siegfried Letzel: Meta-analyses of randomized clinical trials (RCTs) indicate the highest level of evidence for homeopathy within the framework of Evidence Based Medicine (EBM). Four out of five global meta-analyses on homeopathy (all indications, all remedies), which have so far been published tend to show that potentized remedies have specific effects beyond the placebo effect. According to a thorough statistical analysis, the total result is only negative if a great number (90 – 95 %) of the available data has been excluded or if dubious statistical methods have been applied. What can be done to protect homeopathy from the damage caused by lobbyists and “professional” sceptics (paid by the pharmaceutical industry)?
Prof. Dinges: We are dealing here with highly selective data. It is well known how the political use of certain trials have been manipulated. You suggest that the effects of homeopathy are greater than in the case of a placebo. This is, indeed, normally the case, though not everywhere. The question is what you can do with it? Well, I think, it is very important, especially in this public discussion which focuses on the topic scientificity, to point out that there are reviews and that, in part, there is quite good evidence that firstly, homeopathy works better than a placebo, and secondly, that conventional medicine does not achieve better results in numerous areas.
In this respect, every healthcare provider is well-advised to maintain homeopathy as a further option of treatment for patients. I think that is important. The problem rather lies in the narrow-minded concept of science in public discussions and how we should deal with it. The relevant reviews of Shang et al. revealed the big manipulations in it. The study which the Australian evaluation had been based on was also highly manipulated. These studies are already known and thoroughly proven as false. The pharmaceutical industry and their accomplices, which means the sceptics [Letzel: “And the lobbyists”] who are paid by them have very big resources and they have a surprisingly good access to the so-called quality media which influence opinions. And this is a pity, whether it is the “Süddeutsche Zeitung” (German newspaper) or “Der Spiegel” (German news magazine) acting in concert.
Siegfried Letzel: What authority can protect homeopathy from unfounded accusations? Can the historians of medicine with all their knowledge establish s which methods of treatment have been most successful?
Prof. Dinges: The only authority which are you asking for and which is able to protect homeopathy from unfounded prejudgement is, in the end, not the history of medicine, but public opinion and politics, which you have to win over. God knows that this is difficult. This problem was also experienced by the German Carstens Foundation and by manufacturers of homeopathic remedies.
Siegfried Letzel: From the viewpoint of history, you get a good sense of what is ethically correct and what is ethically incorrect. Can you form an opinion based on history?
Prof. Dinges: Ethics is always a value-related behaviour. You have to agree on values. Of course, you could claim that normative is defined by how the pharmaceutical industry acts, which means deception to a high degree and which is not very acceptable. However, you won’t win any prizes with that in public.
Siegfried Letzel: The quantity of evidence in favour of homeopathy, even among the best studies, is quite surprising.
Prof. Dinges: Well, this depends. I think, as the available studies are mixed, which means sometimes they are better, sometimes they are less good. The available evidence shows that homeopathy is efficient in some areas and less efficient in other areas. And then there is a rule that you concentrate on areas in which you are efficient in order to be able to be competitive in the market.
Siegfried Letzel: Based on the proven evidence, would conventional medicine be prepared to accept that homeopathy can be effective if only the mechanism of action would be more plausible?
Prof. Dinges: From discussions with medical professionals which I have quite often, it is obvious that then they would rather be prepared to accept the effectiveness of homeopathy. If you could prove homeopathy’s own mechanism of action, this would correspond to scientific thinking. Naturally, if you don’t know how it works and surprisingly it works nevertheless, this will evoke questions. It is clear that conventional doctors would rather tend to accept it. The Robert Bosch Foundation has been struggling for a long time to prove the mechanism and failed to do so.
Earlier you raised a general criticism about evidence based medicine. The Evidence Based Medicine was an attempt to get away from a situation, where all kinds of people claimed what they could do. The attempt is to prove by very exact studies and evidence whether and to which extent medical drugs and therapies have an effect. This is what it essentially is all about. To start with, I think that this attempt to research into the effectiveness of different medical services in a controlled manner is progress. In contrast to this, is a situation in which everybody can go to the marketplace and blatantly claim: “I can do everything”.
The next question then is what do results in the field of EBM exactly mean. In order to answer this you must have a closer look at the individual studies. However, it is clear that clinical pharmacological trials, the way they are done – keyword double-blinded multi-arm trials – do, of course, not reflect reality. Like any trial, they can reflect reality only within certain limits. The fact that these trials cannot reflect the medical care situation is quite decisive. In this respect, you can discuss questions about study designs, statistics, etc. but I don’t find this interesting. I find it much more important to consider whether or how you, as homeopaths, can deal with the statement that you practice individualized medicine. Then you can carry out medical care studies. We look at a certain number of patients with particular symptoms and whether we can improve them or not – with a point of time at zero and a period of one month or one year, as you usually do this – and then we see the result.
In the end, the most important critics of these research results, of the research designs etc. come from this field itself., I don’t find it constructive to throw the baby out with the bathwater and to claim that the whole EBM is nonsense.
Because then the pharmaceutical industry could sell us any bullshit. And that and to which degree pharmaceutical research is under public pressure in the meantime, well that reaches as far as the criticism of the Karolinska Institute in Stockholm or of other renowned institutions which themselves also have to live off pharmaceutical contracts – this also shows that there are, in a way, interests involved which substantiate that public domains are also no longer prepared to believe every nonsense.
If you remember, when introducing so-called new medical drugs in the Federal Republic of Germany we developed new study designs, which seemed to be plain and harmless, and which are in favour of the pharmaceutical industry because lobbyism played a role in legislation. However, when looking back, it clearly shows that the allegedly “new” medical drugs, to a large extent, are neither new nor better acting than the older ones.
Obviously, the marketing and non-publication of many studies has to be criticised. You know that in the meantime the requirements have become more stringent as a result of this criticism. The public domains, the health insurers, and whoever else is sitting at the table will have to think about how they set limits to these activities also due to the cost situation.
In any case, a society is well-advised to keep open to alternatives; this is better than getting involved in monopolies. Many things go wrong in conventional medicine and in the pharmaceutical industry. You have described that very well and we can really be glad that there are alternatives which are of increasing importance. With good practice, acupuncturists have succeeded in proving what they can achieve and thus they have obtained public recognition in certain fields. Nevertheless, this is a sign indicating that our “healthcare system” is also able to integrate such alternatives.
Siegfried Letzel: Thank you very much for sharing your thoughts in this interview. We wish you all the best and much success for your future work.
(Translation by Martha Greiner-Jetha, certified translator and homeopath)