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A letter to the editor is presented in response to the article "Are the Clinical Effects of Homoeopathy Placebo Effects? Comparative Study of Placebo-Controlled Trials of Homoeopathy and Allopathy," by A. Shang and his colleagues, published in a 2005 issue of the journal "The Lancet."

Objective: To relate prospectively initial consultation characteristics—length, empathy, and patient enablement— with perceived health changes in patients going to the Glasgow Homoeopathic Hospital (GHH). Methods: Consecutive outpatients completed the Consultation and Relational Empathy (CARE) measure and the Patient Enablement Instrument (PEI) immediately after their first consultations, again at 3 months, and the PEI also at 12 months. The Short Form–12 was completed immediately before and the Measure Yourself Medical Outcome (MYMOP) Profile during the first consultation, and both were repeated at 3 and 12 months. Perceived changes in main complaint and well-being were assessed using the Glasgow Homoeopathic Outcome Scale (GHHOS). Results: Empathy score at first consultation was highly predictive of ongoing empathy score at 3 months (Spearman's rho, 0.572, p < 0.0001). Empathy scores at first consultation also correlated significantly with enablement score at first consultation ( rho, 0.325, p < 0.0001) and overall enablement at 12 months ( rho, 0.281; p < 0.05). Controlling for the number of subsequent consultations, initial empathy scores were also predictive of change in main complaint, and general well-being, at 3 months ( rho, 0.225, 0.213 respectively; p < 0.05). Enablement score at first consultation also predicted overall enablement at 3 months ( rho, 0.255; p < 0.05) and 12 months ( rho, 0.282; p < 0.05). Initial enablement predicted GHOSS well-being score at 3 months after controlling for number of consultations ( rho, 0.279; p < 0.05). Both empathy and enablement at 3 months predicted overall enablement at 12 months ( rho, 0.327; p < 0.01 and rho, 0.577; p < 0.0001, respectively). Empathy at 3 months was not significantly related to GHHOS scores at 12 months, whereas enablement scores at 3 months were highly predictive of both GHHOS main complaint and well-being scores at 12 months ( rho, 0.459 and 0.507, respectively; p < 0.0001). Empathy and enablement scores did not correlate significantly with changes in SF-12 and MYMOP scores at any of the time points. The length of the first consultation was related to initial and subsequent CARE scores, overall enablement, and GHHOS scores at 3 and 12 months. Conclusions: Empathy is crucial for enablement, which, in turn, is strongly related to perceived change in main complaint and well-being. The length of time the clinician spends with a patient at initial consultation appears to be an important factor in these complex relationships among process and outcome. [ABSTRACT FROM AUTHOR]

To pilot an investigation of individualized homeopathy for symptoms of estrogen withdrawal in breast cancer survivors.Randomized, double-blinded, placebo-controlled trial.Outpatient department of a National Health Service (NHS) homeopathic hospital.Fifty-seven (57) women met inclusion criteria and 53 were randomized to the study.After 2 weeks of baseline assessment, all participants received a consultation plus either oral homeopathic medicine or placebo, assessed every 4 weeks for 16 weeks.The primary outcome measures were the activity score and profile score of the Measure Yourself Medical Outcome Profile (MYMOP).Eighty-five percent (85%) (45/53) of women completed the study. There was no evidence of a difference seen between groups for either activity (adjusted difference =–0.4, 95% confidence interval CI–1.0 to 0.2,= 0.17) or profile scores (adjusted difference =–0.4, 95% CI–0.9 to 0.1,= 0.13) using this trial design, althoughpower calculations suggests that 65–175 would be needed per group to detect differences of this magnitude with sufficient precision. Clinically relevant improvements in symptoms and mooddisturbance were seen for both groups over the study period.Improvements were seen for symptom scores over the study period. However, presuming these improvements were caused by the individualized homeopathic approach, the study failed to show clearly that the specific effect of the remedy added further to the nonspecific effects of the consultation. Future trial design must ensure adequate power to account for the nonspecific impact of such complex individualized interventions while pragmatic designs may more readily answer questions of clinical and cost effectiveness. [ABSTRACT FROM AUTHOR]

Homeopathy is a branch of Western medicine that has mostly been rejected by Western orthodoxy for the last 200 years because of conceptual and scientific clashes. Homeopathy uses microdoses of potential toxins to provoke defense and self-regulatory responses, rather than the more orthodox approach of blocking body reactions. This approach hints at its clinical scope: it can help, at times resolve, conditions that are intrinsically reversible rather than mechanical problems, deficiencies, or irreversible breakdowns in body functions where it is only palliative. In recent years, there has been a renaissance of interest. Public demand has soared, and with it professional interest. Approximately 20% of Scotland's general practitioners have completed basic training. This is partly occasioned by public interest in complementary medicine and a sympathy with the more mind–body approach of homeopathy, and partly by recent scientific evidence. Some homeopathic dilutions are so extreme they are dismissed by critics as only placebo. Yet trials and meta-analyses of controlled trials are pointing toward real effects, mechanism of action unknown. Clinical outcome studies suggest useful clinical impact and excellent safety. There seems to be a potential to enhance patient care by integrating the two systems. [ABSTRACT FROM AUTHOR]

Despite the advances in Western medicine, up to one in three people in populations served by this medical system are seeking some form of unorthodox care each year, and Europe is no exception. Patients have driven this change, to the point where complementary and alternative medicine (CAM) is the second biggest growth industry in Europe. Often patients have to rely on the growing numbers of CAM practitioners with a variable standard of care that ranges from excellent to dangerous. Many practitioners work without regulation or even work illegally. Many orthodox health care professionals have shared their patients' concerns. Over the last 15 years, these practitioners have moved from silent interest to open enquiry and growing use. For example, approximately one in five of Scotland's general practitioners have received basic training in integrating homeopathy with orthodox practice. The demand for CAM is in part a search for a broader range of therapies, but is also a call for a different approach to care, with less emphasis on drugs, and a more whole-person approach. Mostly, people look to CAM when orthodoxy has failed. But CAM is also increasingly becoming a first-line intervention for some, because of the worry about the side effects of conventional treatments and a perception that orthodoxy has become dehumanized. With some exceptions, research is still in its early stages and lacks infrastructure. Patient satisfaction, empirical clinical outcome, and cost are beginning to be emphasized over mechanism of action or explanatory models. Recent official reports are calling for national and European-level enquiry and response. Future development is likely to emphasize integrative care. The challenge is to create better medical systems, with a whole-person emphasis, calling on a broader range of approaches than is currently orthodox. We seem to need a reunion of the art and science of medicine. [ABSTRACT FROM AUTHOR]