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How should homeopathy be
assessed?
Still applying conventional science
Lex Rutten, the Netherlands
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Belief or science
Belief: conventional medicine works; homeopathy does not.
Homeopathy cannot succeed in Randomised Controlled Trial
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Scientific mirror
Homeopathy - conventional medicine: same results in RCT
Hypothesis: selection bias, low quality, heterogeneity
Shang, the Lancet aug. 2005
RCT works only for conventional medicine (????)
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Allen Roses (GSK, December 2003):
90% of conventional medicines work
in 30-50% of all patients
Pharmacogenetics: not only the disease, but
the whole person: genotype
Homeopathy: same, but phenotype
It works doesnt mean it works
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Why not 100% success?
diagnosis
RCT
co-morbidity
side-effects
circumstances
therapy-result
Unreal certainty
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From complaint towards result
symptom A
symptom B
test X
test Y
diagnosis result
diagnostic research
probabilityof diagnosis
RCT
chancesplacebo < 0.05
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Homeopathic diagnosis
Diagnosis Result
Diagnosis
Diagnostic/prognostic researchDiagnostic/prognostic research
Probability of resultProbability of result
symptom A
symptom B
symptom C
symptom D
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Effect modification
comorbidity
age > 65
sex
social status
Result
Diagnostic/prognostic researchDiagnostic/prognostic research
Probability of resultProbability of resultsuicidal?
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Bayes method
Knowledge from experience
Direct results in practice
Handling of complex clinical symptoms
Probability instead of certainty
Step-by-step increasing certainty by addingdata
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Bayes and homeopathy
More symptoms more certainty
Peculiar symptoms are more important
Vagueness is no problem
Disadvantage: difficult calculations (use a
calculator)
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Prior to posterior chance
(LR+=5)Prior chance
1%
10%
30%
50%
80%
Posterior chance
4.8%
35.7%
68.1%
83.3%
95.2%
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Homeopathic diagnosis stepwise
Lachesis in menopausal complaints
symptom LR success (%)
1. menopause 10%?
2. loquacity 5 35%
3. left-sided complaints 3? 62%4. clothing < 3? 83%
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Repertory with LR
Partly hypothetical rubric Fear of death:
Acon. , act-sp., agn. , all-s, ..., Anac. , apis , arg-n. ,Ars. , asaf., aur. , ... Calc. ,
lach. , Lat-m. , led., ...
FEAR- Death, of: in general, more than expected considering circumstances;occurring almost daily. Prevalence 5% (0.5)
(6)
(4) (2.5) (3)(1)(6)
(3)
(3.5)
(2)(13)
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Practical homeopathic research
Relation between symptom and success
No conflict with daily practice
Takes a few seconds during each
consultation
Outcome: a reliable repertory
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Prospective research
Check the presence of 6 symptoms in each
new patient
Keep record of medicines and results
a=occurrence of symptom in Lachesis-
population
b=occurrence of symptom in rest-population
Likelihood Ratio = a / b
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A few seconds of each consultation
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Results fear of death
medicine fear death, n= medicine population,
n=
LR+
Anacardium 2 4 13.36
Arsenicum album 2 8 6.66Calcarea carbonica 2 27 1.95
Repertory: Anac., Ars., Calc.
Fear of death in whole population: 3.8%
Does this lead us to a more reliable repertory?
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medicine LR+
Diarrhea anticip. arg-n. 15
calc. 2.2
ph-ac 10
Grinding teeth bell. 6.1
carc. 2.6
merc. 5
tub. 7.3
Results after 15 months, n=1634
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medicine LR+
Sens. injustice bell. 3.4
caust. 6
Loquacity hyos. 7.8
lach. 4.7
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Lachesis in menopausal complaints
LR+ loquacity - Lachesis = 5 (1,8-12,3)
succes by Lachesis in menopausal complaints
with loquacity goes from 10%(?) to 35%.
Dear GP,
Treat your most loquacious patients withmenopausal complaints with Lachesis
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Conclusions
Homeopathy (and conventional medicine) is
bayesian science
LR research is easy, cheap and rewarding
Effectiveness of homeopathy can be much
improved by LR research
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Vagueness
herpeslips
0,00%
2,00%
4,00%
6,00%
8,00%
10,00%
12,00%
14,00%
1 2 3 4 5 6 7 8 9
doctor
herpes=1
herpes=2
loquacity
0,00%
5,00%
10,00%
15,00%
20,00%
25,00%
30,00%
1 2 3 4 5 6 7 8 9
doctor
loquax=1
loquax=2
Herpes lip Loquacity