The safety of homeopathic products * Author's reply

It is regrettable that Professor Kirby's editorial (May 2002 JRSM1) did not mention a review of this topic conducted and published by us2. This was a formal systematic review using prospectively defined inclusion and exclusion criteria and data extraction procedures. It comprised a review of English-language publications and enquiries with manufacturers and regulatory agencies. Table 1 shows a sample of the data: in therapeutic clinical trials (as opposed to healthy-volunteer homeopathic pathogenetic trials) the incidence of reported adverse effects (AEs) is higher in the verum group than in the placebo group (mean incidence 9.4/6.1). Table 1 Adverse effects (AEs) of homeopathy reported in therapeutic clinical trials The conclusions were based on these data and reports of apparent AEs from homeopathic pathogenetic trials (provings) and case reports. The main conclusions were: Homeopathic medicines may provoke AEs, but these are generally mild and transient There is under-reporting There are cases of ‘mistaken identity’, where herbal and other medicines were described as homeopathic The main risks associated with homeopathy are indirect, relating to the prescriber rather than the medicine. Although strictly speaking outside the remit of the editorial, the last point is particularly important. Not only is it the main risk of homeopathy, but it is a topical issue. Medical practice in the UK is currently essentially unregulated; anybody, irrespective of training or registration, can describe themselves as a homeopath. This is the main preventable source of risk. In their evidence to the House of Lords Select Committee on Complementary and Alternative Medicine3, bodies representing non medically qualified acupuncturists and herbalists stated that their professions wished to become statutorily regulated, the Select Committee's report endorsed this view, and the process towards statutory regulation of these professions is now underway. The non-medical homeopaths, however, indicated that they did not currently wish statutory regulation, despite the view of the Faculty of Homeopathy (doctors and other health professionals practising homeopathy) that homeopathy should be practised only by statutorily registered professionals, and that a new profession should be created if necessary.