Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 164–5
Randomised, controlled, double-blind, placebo trials of homoeopathic treatment that incorporate the rigorous features of randomised controlled trials (RCTs), while retaining the integrity of the therapy, can be designed and have been implemented in a number of published studies. The experiences of prescribing homoeopaths in such trials have brought to light an aspect of such RCTs that challenges the accuracy of the underlying assumptions about the model of the healing process that is implicit in RCT designs.
In trials of orthodox medicine, a patient’s lack of reaction to a medication has no implication for the competence of the prescribing clinician. Homoeopathic medicine is prescribed on an individual basis, determined by the homoeopath’s perception and interpretation of pertinent symptoms of the case. Therefore, in homoeopathic practice and trials of homoeopathic practice, a patient’s lack of reaction to medication has a number of possible interpretations, including that the homoeopath has prescribed an inappropriate medicine. Case management and prescribing are based on patients’ reactions to homoeopathic medicine. The inclusion of a placebo arm in a trial of homoeopathic treatment has implications for the practice of the prescribing homoeopaths. There are implications for the homoeopath’s confidence in their prescriptions, and for the degree to which the therapeutic relationship between homoeopath and patient may be affected.
The potential effect of patients’ reactions to medicines on the homoeopaths’ confidence is used to illustrate a model of the healing process that includes such interaction effects. Proposals for changes to the principles of RCTs are presented and reviewed.
