Homeopathy is back in the limelight this week with two experts going head to head in the BMJ to debate whether doctors should recommend homeopathy.

Taking the yes corner, Peter Fisher, Director of Research at the Royal London Hospital for Integrated Medicine, questioned the methods used in recent reviews of the evidence.

For example a recent analysis by the NHMRC that concluded there were no health conditions for which there was reliable evidence that homeopathy is effective used unusual methods of analysis, he said.

“The reviewers assumed that a positive trial showing a homeopathic treatment to be effective was negated by a different trial showing a different homeopathic treatment for the same condition to be ineffective,” he wrote.

For practical decisions about homeopathy the most relevant evidence is comparative effectiveness research examining effectiveness in real world situations, which the Australian review did not include, he said.

“When integrated with standard care homeopathy is safe, popular with patients, improves clinical outcomes without increasing costs, and reduces the use of potentially hazardous drugs, including antimicrobials,” he said. 

But on the other side of the debate Edzard Ernst, Emeritus Professor at the University of Exeter, said most independent systematic reviews of randomised controlled trials had failed to show that homeopathy was effective.

The assumptions underlying homeopathy “fly in the face of science” he said.

For instance one of the most commercially successful homeopathic remedies is based on an extract of duck liver in the C200 “potency,” which means it is diluted at a ratio of 1:10 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000.

The likelihood of a single “active” molecule being present in a homeopathic pill is effectively zero, he said.

“The axioms of homeopathy are implausible, it’s benefits do not outweigh its risks, and its costs and opportunity costs are considerable. Therefore, it seems unreasonable, even unethical, for healthcare professionals to recommend its use,” he concluded.