Medical researchers in Switzerland are at odds over the value of homeopathy, after scientists at Bern University reported it was no better than a placebo.
The debate comes in the wake of a decision by the federal authorities to exclude alternative medicines from compulsory health insurance.
Researchers led by Matthias Egger of Bern University's department of social and preventive medicine recently stirred up a hornet's nest by claiming that homeopathic treatments were no better than giving patients sugar pills.
They compared clinical trial results of conventional medicines with those of homeopathic medications in a so-called meta-analysis of 220 studies.
Egger's team concluded that there was little evidence of specific effects of homeopathic remedies, but strong indications that conventional medicine did work.
"The larger the study, the smaller the effects of homeopathic treatment are, to the point of disappearing," Egger told swissinfo. "There is no difference between the placebo group and the homeopathic group."
"With conventional treatments, the effects get smaller as the study gets larger, but they are still there."
Beneficial to patients
But research led by André Thurneysen of the university's institute for complementary medicine seems to show otherwise. Thurneysen and his co-authors published another article showing that homeopathic treatment could benefit children suffering from Attention Deficit Hyperactivity Disorder (ADHD).
"Our study definitely shows that homeopathy can have beneficial effects and has a clinical value," said Thurneysen.
He believes the results have implications stretching beyond ADHD. "We don't understand how it works, but we see that it works efficiently."
The homeopathy specialist, who lectures on the subject at the university, reckons that Egger's meta-analysis fails to prove anything.
"They did not study trials that refer to proper homeopathic treatments. They have not analysed homeopathic treatment as it is practised," he told swissinfo.
Thurneysen also says that the team led by Egger was only made up of epidemiologists who could not understand how homeopathy functions.
Egger stands behind his research, and points out that one of his co-authors is an experienced homeopathic specialist. He says the attack, although very personal, is not unexpected.
"People tend to have a very strong belief in homeopathy and it fits with how they see the world," he said. "If someone comes along and says these effects are all in the mind, it is really a dramatic attack not only on commercial interests but also on a whole belief system."
He adds that his goal is not to add another nail into homeopathy's coffin.
"This doesn't mean homeopathy doesn't work," he told swissinfo. "It just means that the benefit people get out of these treatments is not related to any pharmacological effect, but probably has more to do with the interaction between the patient and his physician."
For Egger, the fact that physician and patient believe in this therapeutic system – a so-called context effect - is probably more important than in conventional medicine, where patient-doctor interaction is often more limited, due to time pressures.
"I think we need more research into how these context effects work and on whom, and in which situations they are particularly strong," he said. "We need to find out how the patient-doctor interaction can be optimised."
Not covered by insurance
The debate over homeopathy's effectiveness comes after the Swiss interior ministry in June decided to exclude alternative medicines from compulsory heath insurance.
Egger's study was one element used to reach this decision, although he believes all types of treatment should be considered.
"We are moving towards a health system where officials are looking closely at whether a treatment has specific effects or not, and removing those without proven effects from basic cover," he said. "But this should include all types of medicine."
The whole debate over homeopathy has been clouded by the decision of the ministry in charge of health matters.
But Thurneysen reckons it will always be difficult for some to admit the value of this type of treatment.
"Plenty of people will be convinced by our research, but there will be many others who will say it's rubbish because they don't want to understand what we have tried to accomplish."
swissinfo, Scott Capper
Homeopathic treatment involves giving a patient small amounts of drugs that, in larger quantities, cause symptoms like those suffered by the patient.
It also involves a great deal of interaction between the practitioner and the patient.
Egger's report was published in the Lancet medical journal.
Thurneysen's research was highlighted in an article in the European Journal of Paediatrics.