Oscillococcinum - made of Anas Barbariae Hepatis and Cordis Extractum HPUS 200 C - is such a drug. The vehicle is made of lactose and saccharose and a placebo of identical appearance was made up consisting of lactose and saccharose alone. The study took place during an influenza epidemic. Patients who took part in the study were chosen from those attending GP surgeries with influenza-like syndromes, defined as a rectal temperature equal to or above 38° C or above and at least two of the following symptoms: headache, stiffness, lumbar and articular pain, shivers. Most of the participating GPs were not homeopathic clinicians.

The standard treatment is five doses of Oscillococcinum. The first was given at the medical practice and the patients took the remaining four on the following mornings and evenings. 237 patients received the test drug and 241 the placebo. They recorded their rectal temperature twice a day and the presence or absence of five cardinal symptoms (headache, stiffness, lumbar and articular pain, shivers) as well as cough, coryza and fatigue. Recovery was defined as a rectal temperature of less than 37.5° C and complete resolution of the cardinal symptoms.

The results showed that the proportion of patients who recovered within 48 hours of treatment was greater among the drug group than among the placebo group: 17.1% compared with 10.3% (P = 0.03).

The researchers say that the positive effect of the homeopathic preparation 'cannot be explained in our present state of knowledge' and they call for further investigation.

A repeat trial conducted by Papp et al was recently published in the British Homeopathic Journal (1998- 87). This showed that the symptoms of patients receiving Oscillococcinum were significantly milder (P = 0.023) after 48 hours than patients in the placebo group. The number of patients with no symptoms was significantly higher in the group receiving Oscillococcinum from the second day onwards (verum 17.4%, placebo 6.6%) until the end of the patients' recording.

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Treatment of acute childhood diarrhoea
(Jacobs J, Jimenez M, Gloyd S et al. Treatment of acute childhood diarrhoea with homoeopathic medicine: a randomised clinical trial in Nicaragua. Pediatrics 1994; 93: 719-725.)

Jacobs' work set out to discover whether homeopathic treatment was useful in the treatment of acute diarrhoea in children, the leading cause of paediatric morbidity and mortality.

This randomised double-blind trial took place in two clinics in poor districts of Nicaragua, a country where diarrhoea is the primary cause of mortality during the first year of life and accounts for 19% of all outpatient consultations in children aged from one to four years.

The researchers thought that acute childhood diarrhoea was an ideal condition for a homeopathic study because the short duration of illness would allow for intensive follow up, there was no standard allopathic treatment that would have to be withheld during the trial and the public health importance was great.

Eighty-one children aged between six months and five years took part. An initial history was taken for each child, a physical examination was carried out, a stool specimen obtained and a diarrhoea index score was assigned to each child. Children with type A or B dehydration were prescribed oral rehydration therapy. Those with type C were transferred to hospital and did not take part in the study.

The children were then given a homeopathic interview and examination. Information about the nature of stools, abdominal pain, vomiting, mood and temperature, degree of thirst and appetite, presence of fever, abdominal bloating, sleep disturbance, perspiration and other signs and symptoms was collected. Each child was then prescribed one homeopathic medication on an individual basis. Identical tablets without medication were used as a placebo. Follow up was daily for five days.

The treatment group had a statistically significant (P<.05) decrease in duration of diarrhoea, defined as the number of days until there were less than three unformed stools daily for two consecutive days. there was also a significant difference (P<.05) in the number of stools per day between the two groups after 72 hours of treatment.

The researchers conclude that homeopathic treatment might be useful in this condition and add that further study should be considered.

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Homoeopathic immunotherapy
(Reilly D, Taylor MA, Beattie NGM et al. Is evidence for homoeopathy reproducible? Lancet 1994; 344: 1601-1606.

Reilly D, Taylor MA. Potent placebo or potency? A proposed study model with initial findings using homoeopathically prepared pollens in hay fever. British Homoeopathic Journal 1985; 74: 65-75.

Reilly D, Taylor M, McSharry C, Aitchison T. Is homoeopathy a placebo response? Lancet 1986; 2 (8520): 881-886.)

This research was designed to answer the question: "Is homeopathy a placebo response?". The results of the first two trials suggested that it was not but, because the findings were so controversial, the researchers asked independent colleagues to see if the results could be replicated in a third trial.

The three studies all used homeopathic immunotherapy in inhalant allergy as a model, the first two in hay fever and the third in asthma, with the same main outcome measure: a visual analogue score of overall symptom intensity.

Subjects were chosen from people attending an asthma outpatient clinic. Their symptoms and compliance were monitored for a four-week run-in period and they were asked not to take any new allergen-avoidance measures during the trial.

At the beginning of the run-in each patient was assessed by a homeopathic and an asthma clinic doctor. A nurse did skin tests and a respiratory physiologist measured pulmonary function and bronchial reactivity to histamine.

The study design was a randomised double-blind assessment of two parallel groups, one receiving homeopathic treatment and the other a placebo. Twenty-eight patients with allergic asthma, most of them sensitive to house-dust mite, were randomly allocated to receive either oral homeopathic immunotherapy to their principle allergen or an identical placebo. The homeopathic doctor selected the homeopathic prescription on the basis of the largest skin-test weal concordant with allergy history. The test treatments were given as a complement to patients' usual conventional care.

At the main end point four weeks after the treatment began, patients were reassessed by both doctors, diaries were checked and pulmonary function tested.

A difference in visual analogue score in favour of homeopathic immunotherapy appeared within one week of starting treatment and persisted for up to eight weeks (P=0.003). There were similar trends in respiratory function and bronchial reactivity tests.

A meta-analysis of this research and the two previous studies found a similar pattern of change: the homeopathically treated groups showed a greater improvement in visual analogue scale scores than the placebo groups. The researchers go on to ask if the explanation could be three false-positives and argue that if this were so, then the technique of randomised controlled clinical trials itself would have to be fundamentally flawed. The evidence is that either homeopathy works or that the clinical trial does not, they conclude.