Assessment of Likelihood Ratio for Four Contact Dermatitis Symptoms of Vinca Minor

Probabilistic Reasoning in Homeopathy Practice and its Implications for Clinical Research

The principle of similitude put forward by Hahnemann has challenging practical consequences in the selection of the right homeopathic medicine for a patient. According to this principle, only the medicines that best fit the totality of the symptoms of a given patient are supposed to really cure: this greatly depends on the homeopath's clinical analysis. In addition, a patient's illness may be more or less curable, depending on the characteristics of the disease. In their daily practice, homeopaths typically apply Bayesian reasoning to deal with uncertainty associated with both medicine and disease. We suggest that clinical research on homeopathy would gain by integrating this kind of prior estimation of (1) the probability of a given medicine being effective for that particular patient and (2) the probability of the patient's disease (or symptoms) being curable. We therefore suggest that future trials of N-of-1 design may gain (1) by testing a small number of "best candidate" medicines (instead of one) for a given patient facing a given disease, and (2) by including careful prior estimations of the probabilities that (a) each selected medicine will be efficient for that patient and (b) the patient's disease will be reversible with the medicine.

Estimation of the Likelihood Ratio of Different Symptoms for Six Homeopathic Medicines: Prognostic Factor Research

BACKGROUND

 Arsenicum album, Causticum, Nux vomica, Pulsatilla nigricans, Rhus toxicodendron and Sulphur are frequently prescribed homeopathic medicines; however, their symptoms, as mentioned in different homeopathic literature works, have rarely been investigated systematically. Likelihood ratio (LR), based on Bayesian statistics, may reflect a better estimation of the strengths of symptoms than the existing entries in the homeopathic literature.

METHODS

 A prospective, longitudinal, analytical patient outcome study was conducted in the outpatient departments of D. N. De Homeopathic Medical College and Hospital, Kolkata, on 1,954 patients over 21 months. The outcomes were recorded at each follow-up using the Outcome Related to Impact on Daily Living (ORIDL) +4 to -4 scale. The average period of treatment for each participant was 3 months. The LRs of four symptoms for each of the six selected medicines were calculated.

RESULTS

 One hundred and two different remedies were prescribed. The prevalence, LR + , and LR - , with respective 95% confidence intervals, of different symptoms were reported. The study found that the following symptoms had particularly high LR+ scores: "intense sympathy for the suffering of others" (Causticum, LR+ = 12.0); "dyspepsia from business anxiety" (Nux vomica, LR+ = 27.4); "burning pain relieved by heat" (Arsenicum album, LR+ = 29.6); "envy" (Pulsatilla nigricans, LR+ = 13.2); "desire for milk" (Rhus toxicodendron, LR+ = 7.5); "very selfish, no regard for others" (Sulphur, LR+ = 20.6). The findings corroborated well with the presentation of the symptoms in different homeopathic materia medica and repertories. ORIDL scores of +2 or greater were identified most prominently for Pulsatilla nigricans (n = 138) and Sulphur (n = 119).

CONCLUSION

 There was adequate evidence to attribute all the assessed symptoms to the medicines investigated. Further studies with a larger population are warranted to tackle the possible confirmation bias.

A Broader Vision for Homeopathy: Medicine Needs Healing, and Homeopathy Has a Part to Play

The controversial claim that homeopathic medicines actively stimulate the innate capacity of body and mind for healing and repair demands continuing and energetic investigation. But regardless of the outcome of this scientific controversy, the reported changes associated with applying the homeopathic method are matters of clinical fact. There is thus a case to be made that the homeopathic approach, the way that it studies and construes the experience of illness in individual patients, enriches our understanding of health, illness and healing; and is itself an essential contribution that homeopathy can make to the advancement of medicine. Practitioners and researchers involved in homeopathy can, and should, be more energetic and forceful in making that case.

Prevalence and Likelihood Ratio of Six Objective Signs among Good Responders to Natrum muriaticum: Multi-centre Observational Assessment

BACKGROUND

 The reliability of homeopathic prescriptions may increase through resource to objective signs and guiding symptoms with significant positive likelihood ratio (LR). We estimated LR for six objective signs attributed to the homeopathic medicine Natrum muriaticum (Nat-m).

METHODS

 In this multi-centre observational assessment, we investigated the prevalence of six signs in the general patient population and among good responders to Nat-m in daily homeopathic practice. Next, we calculated LR for these six signs.

RESULTS

 Data from 36 good responders to Nat-m and 836 general population patients were compared. We found statistically significant positive LR (95% confidence interval) for signs such as lip cracks (1.94; 1.15 to 3.24), recurrent herpes (2.29; 1.20 to 4.37), hairline eruptions (2.07; 1.03 to 4.18), and dry hands (2.13; 1.23 to 3.69).

CONCLUSIONS

 Objective signs with significant positive LR might increase the reliability of homeopathic prescriptions. Further studies are warranted to confirm the validity of this approach.