Here comes the science bit

Janice Acquah was struck down with rheumatoid arthritis four years ago, when she was pregnant with her daughter Savannah. The pregnancy meant that she was reluctant to take anything stronger than paracetamol for the pain in her joints. "I'd be crying at night because I was in such agony - and if I hadn't been in such a bad way, I would never have visited a homeopath," says the 36-year-old actor and presenter.

With a degree in environmental biology and a healthy scepticism about any therapy that doesn't pass rigorous scientific scrutiny, Acquah admits to being a touch embarrassed at the extent to which homeopathy has worked for her. And she's not alone in finding it effective.

One of the most popular complementary therapies, homeopathy is used by one in five of the population, including pop stars, politicians, footballers and the entire royal family. But no one has yet managed to provide a convincing explanation as to how solutions diluted beyond the point at which any of the original substance remains can have a therapeutic effect. Nor have clinical trials shown that even the most popular remedies work better than dummy pills.

This time last year, the BBC's Horizon programme filmed a panel of respected scientists failing dismally to differentiate between homeopathic solutions and pure water. Two highly publicised studies also failed to find anything more than a placebo effect in two homeopathic remedies - the first for childhood asthma and the second, homeopathic arnica for post-surgery bruising and swelling.

Even the converted are showing signs of impatience with the therapy. At least as far as bruises are concerned, people should "save their money for something more effective," warns Edzard Ernst, the first (and only) professor of complementary medicine, at Exeter University.

So when Acquah first opted to visit a homeopath, she had to acknowledge that there was no evidence from any clinical trial to prove that her treatment would be worthwhile. Indeed, when her first foray to a local homeopath resulted in her taking a remedy that didn't really work, she wasn't surprised. But a homeopathic cream did make a difference and sixteen months later, having given a new regime of anti-rheumatic medication (sulfasalazine) every chance to work, she got herself referred to the Royal London for help with the persistent fatigue and continuing pain that made lifting Savannah a trial.

"The medication had helped, but I was hoping for more," she says. And right from the start, the doctor was upbeat, promising that homeopathy could help. Acquah was given phosphorus as a homeopathic remedy and advised to take high doses (4,000mgs) of fish oil.

Within four weeks, the pain had subsided and her tiredness was a thing of the past. "Every day I was getting better. It could have been the fish oil, the sulfasalazine or the phosphorus. I really didn't care what it was," says Acquah, who has now stopped both the homeopathic and the prescription medication and is sailing through her second pregnancy without any rheumatic symptoms at all.

"I'm not a credulous convert. But it seems very probable that without the homeopathy, I would have suffered more pain, endured longer episodes of fatigue and might not have been pregnant now," she says with confidence.

Thousands of such stories, it seems, fuel the ever-growing enthusiasm for homeopathy. Despite the warnings from Professor Ernst, sales of homeopathic remedies are increasing by a steady 12 per cent every year, and there's undiminished demand for treatment from Britain's five NHS homeopathic hospitals and the hundreds of homeopathic doctors with flourishing practices.

And at long last, the Government is taking action to create a proper research foundation, able to provide clinical investigation into a therapy that public demand deems successful. It follows the House of Lords' Science and Technology Committee inquiry into complementary medicine in 2000, which warned that the NHS could no longer allow therapies such as homeopathy to sit on the sidelines of publicly funded healthcare simply because "theories about their modes of action are not congruent with current scientific knowledge".

Three months ago, the Department of Health announced a £1.3m programme to build a new type of research capacity in British universities with the specific aim of bridging the credibility gap between homeopathy and other therapies. Instead of testing homeopathic remedies in the same way as prescription drugs, the emphasis will be on taking homeopathy to pieces, rather like an old radio, to find out how it works.

Sheffield University, for instance, has been funded by the Department of Health to compare the impact of homeopathic remedies for hot flushes not with a dummy pill, but with counselling. A further study compares homeopathic treatment of chronic fatigue syndrome with cognitive behavioural therapy. "The science of homeopathic practice is to identify the individual response to the symptom and to provide not just the appropriate homeopathic pill but also the right support. That's why we want to break down what is in fact a complex social interaction and find out what components of a consultation really make a difference," explains the researcher Dr Elaine Weatherley Jones.

Back in the 19th century, the originator of homeopathy, Dr Samuel Hahnemann, spoke of "obstacles to cure", whether they be the wrong food, poor environment, an imbalance of hormones or simply people's thoughts. "A homeopathic consultation deals with all of these layers," says the former GP and researcher Dr Mollie Hunton. "So while it's worthwhile finding out whether or not a particular homeopathic remedy has more effect than a placebo, it's not the whole story by any means."

That view lays homeopaths open to the accusation that they're simply evading rigorous testing and going for a soft option that provides positive but not necessarily accurate results. Not so, claims Dr David Spence, who has just completed a massive "outcome" study of 5,729 patients treated at the Bristol Homeopathic Hospital over the last five years. The results, due to be published in a scientific journal next year, reflect the findings of other smaller outcome studies, which suggest that about 70 per cent of people benefit from good homeopathic treatment (ie treatment provided by homeopaths who are also qualified doctors).

The highest rates of success are for childhood eczema and other childhood conditions, with unexpected findings showing up for some conditions such as inflammatory bowel disease where people either respond very well or not at all.

"The value of this kind of research is that it looks at what happens in the real world - not what happens to groups of carefully selected patients when they are given controlled treatments in controlled conditions, as happens in conventional clinical trials. Life is far more complicated than is allowed for in a standardised controlled trial - and it's the real world that GPs and their patients want to know about," Dr Spence says.

Peter Fisher, a research director at the Royal London Hospital and homeopath to the Queen, says that science will eventually explain how homeopathy works - and will probably come up with surprising findings: "I believe that science will show that there is an effect from the homeopathic remedy and that there is also an effect from the nutritional advice and reassurance provided by the homeopathic practitioner. There may also, however, be a synergy between the two, which creates an effect greater than the sum of the two different parts of the consultation. When that explanation is available, it will convince people that, while there is a place for placebo-controlled trials in homeopathy, it's not the whole story."

HOMEOPATHY: THE THEORIES AND THE FACTS

* Homeopathy uses like-with-like treatment, giving patients remedies that produce a similar effect to the illness they're complaining of. Belladonna, for instance, which induces symptoms of dry mouth, fever, flushing, delirium and thirst, matches the symptoms of tonsillitis; it is hence a homeopathic remedy for tonsillitis.

* At least two papers have attempted to explain how very diluted solutions can have a therapeutic effect. Both have been published in reputable journals and have claimed to prove that water retains a memory of its ingredient, even when it is virtually impossible that a single molecule of that ingredient remains in the solution.

* The goal of homeopathic treatment is to stimulate the patient's natural healing response rather than to treat the symptoms directly. Homeopathy takes an individualised approach to treatment, and two patients with the same diagnosis can be treated with very different homeopathic medicines depending on the manifestation of symptoms, and how life events have affected the patient's physical and mental wellbeing.

* It's available on the NHS, with five homeopathic hospitals in the country and more than 1,000 medically qualified homeopathic practitioners. More than 25 per cent of Scottish GPs have some training in homeopathy.