Research for whom?

One of the ‘side-effects’ of evidence-based medicine has been the fetishisation of research, which is sometimes treated as an end in itself. Of course medical practice should be based on evidence of its safety and effectiveness. But lack of evidence of effectiveness is quite different from evidence of lack of effectiveness. The former is often the case with homeopathy, although sceptics frequently interpret it as the latter. Research is not an end in itself, it is a tool, a collection of methods for addressing specific questions. The issue then arises, which questions, asked by whom, should clinical research in homeopathy attempt to answer? Broadly speaking there are three constituencies corresponding to three main categories of questions. The sceptical academic constituency asks ‘is there any evidence that homeopathy is not a placebo effect, that its clinical effects are not entirely attributable to non-specific effects associated with homeopathic treatment: belief, reassurance, advice etc?’ Homeopaths are more likely to pose questions about improving their practice: ‘how can we prescribe better, improve our understanding of materia medica, which prescribing strategies work best etc?’