Research
Anhang
[Lex Rutten & Heiner Frei]
Scientific research in homeopathy: to Prove or to Improve by Randomized
Controlled Trials (RCT)
20 years ago science seemed simple: If a few Randomized Controlled
Trials (RCT) give significant results you have scientific proof
that a method works.
In 1991 the first meta-analysis of homeopathic trials showed that proof
for homeopathy is as good as for conventional medicine. Coincidence or not,
since then RCT is
no longer a method without flaws. There are bad RCT and positive
homeopathic RCT must be bad. Why?
The same people who demand proof for homeopathy are convinced that
homeopathy cannot work.
This conviction is based on two misconceptions:
1. Homeopathic doctors expect the same results from a homeopathic
potency of a medicinal substance as from a pharmaceutical dose. Vandenbroucke: “Microbiologists
know for sure that infinite dilutions of an antibiotic will never show
any effect on bacterial growth”.
2. Medicines can only work as conventional medicines via chemical
interactions. Vandenbroucke: “Accepting that infinite
dilutions work would subvert more than conventional medicine; it wrecks a whole
edifice of chemistry and physics”.
It is amazing how these convictions have become dogmas. No homeopathic
doctor will expect any effect on bacterial growth from an infinitely diluted
antibiotic.
Does the world only consist of chemical interactions? Based on these
convictions positive results of homeopathic research can only prove fraud by
homeopathic doctors.
The only good homeopathic RCT is a negative homeopathic RCT, it will be
qualified as good more easily because quality judgments of RCT are quite subjective.
And beware, any negative result can and will be used against us!
Is it likely that a homeopathic RCT will produce a negative result, even
if the method works? Homeopathy is not a perfect method, we are uncertain about
many entries
in our materia medica
and repertories. Furthermore, RCT is based on indications and homeopathic
medicines cannot be prescribed only on indication.
Practice or experiment
RCT is an experiment where you want to optimize the possibility to
discern verum from placebo. Any social circumstance
can effect this possibility.
An attractive experimental opportunity is a marathon; it is limited in
time and the same for all participants. So we measure the effect of homeopathic
Arn. or Rhus-t.
on muscle soreness after a marathon. But is this illness? We think that
a homeopathic medicine stimulates the defense
mechanisms by a stimulus that resembles illness.
Marathon runners however, are highly trained; what is there to
stimulate? Many of us have the experience that we must stop a homeopathic
medicine after some period
because the complaints become worse again. Then the complaints subside,
apparently the patient is over-stimulated. There have been four high quality
trials testing Arnica
for this indication and it appeared that muscle soreness was less in
runners taking placebo (nearly significant). This could be proof for the
possibility of over-stimulation
by homeopathic medicines, but to our opponents it is proof that
homeopathy does not work.
Another way to optimize the experiment is to measure the effect on
something that can be easily measured like plantar warts. This indication was
tested for the homeopathic medicines Thuja, Ant-c.
and Nit-ac. in a highly qualified RCT by Labrecque et
al.
The outcome was negative; does this mean that homeopathy does not work
or that these 3 medicines are not the optimal choices? Needless to ask our
opponents.
These two indications played an important role in the negative
conclusion of the meta-analysis by Shang et al. The quality of the trials was
good in epidemiological respect,
but they reflect one of the problems of homeopathic research: there are
no phase I and phase II studies paving the way toward a sure outcome, like in
conventional medicine.
Classical homeopathy
Many of us will answer to the examples above that this proves that we
should use classical homeopathy. Unfortunately, there is no evidence for this
at the moment.
In the meta-analyses of Linde and Shang
classical homeopathy did not perform better than other forms of homeopathy.
A clear example is Walach’s trial on chronic
headaches, a very good trial with negative outcome. Walach
explained that the discontinuation of conventional prophylactic medicines could
have some effect in both verum and control groups,
and that the main problem in classical homeopathy is the long duration of the
consultations.
This might cause an extra placebo effect, so that the verum effect is less visible, see Figure 1.
One of the main advantages of classical homeopathy is that we can
systematically test hypotheses. Based on a number of symptoms we choose the
most likely medicine.
If it does not or partially work we re-analyze the case and prescribe
another medicine. But does RCT provide us with enough time to test several
medicines one after another? And how reliable are our repertories and materia medicas?
Preparations for RCT
The influence of the questionable quality of our instruments is shown in
a 5 year long preparation for a positive RCT on ADHD. This improved the success
rate of the first prescription from 21% to 54% and the effectiveness of the 5th
prescription from 68% to 84% by 4 consecutive steps modifying the conventional
homeopathic procedure.
The first step was to develop and test a questionnaire. Questions that
did not lead to successful prescriptions were removed from the questionnaire.
The next step was called ‘polarity analysis’. Many homeopathic medicines
exhibit both poles of a symptom: there are thirsty Phosphorus patients and
there are Phosphorus patients without thirst.
But the ‘mean Phosphorus patient’ is thirsty. In Kent’s repertory
Phosphorus is in bold type in the rubric ‘Thirst’ and in plain type in the
rubric ‘Thirstless’. Does this mean
that ‘thirstlessness’ pleads for Phosphorus?
No, the explanation follows under the paragraph ‘Bayesian science’. Analyzing
and calculating polarities improved the success
rate. Furthermore, Q-potencies were used because they have less
fluctuation in treatment effect. Figure 2 shows the influence of the
consecutive steps on results of treatment.
Another step necessary to obtain significant results was to insert a
screening phase before the actual trial in order to exclude non-responding
patients from the trial.
> motion 10x more frequent in Rhus-t. (50%)
patients than in other patients (5%)
Rare symptoms are most important Rhus-t. (20%)
patients than in other patients (0,1%)
These results suggest that every RCT should be prepared in this fashion.
This could take several years. Such a preparation fulfills
the same role as phase I and phase II
studies in conventional medicine. But then there is still the problem
that our materia medica and
repertories are largely based on expert opinion instead of scientific research.
This problem resembles conventional diagnostics: we know from expert opinion
that night-sweat could indicate tuberculosis, but scientific assessment should
indicate how strong the indication is. Here Bayesian science comes to help.
Bayesian science
In 1763 reverent Thomas Bayes published his
theorem describing the way we learn from experience. He showed how we make
valid predictions about the future from past experiences. Bayesian reasoning
has since invaded every field of science, because it can produce valid
conclusions in real-world phenomena. Now medicine can be assessed without
placebo-control and randomization, science can be used for improving instead of
proving homeopathy.
From experience to prognosis
The bayesian principle is in fact quite
simple: a diagnostic test is better as it is positive more frequently in people
with the disease than
in other people. Hahnemann also made this observation and in the same
fashion he concluded that rare and peculiar symptoms are the most valuable
symptoms.
Likelihood ratio (LR) expresses the relation between the prevalence of
the symptom in the population with the illness and the population without the
illness.
In the homeopathic translation: the relation between the prevalence of
the symptom in the population cured by a certain medicine and the rest of the
treated population.
Likelihood ratio - Bayesian science
Cure by Rhus-t. Chance
of cure (cumulative)
0. No symptoms 1%
Symptom 1 > Motion (LR=10) 9%
Symptom 2 Desires cold milk (LR=6) 37%
Symptom 3 < Wet weather (LR=4) 72%
After the first symptom posterior chance = 9%; after the second symptom
posterior chance = 37%
Do not mind about the formula, that’s the computers’ job
A symptom with a higher LR is more important. Peculiar symptoms have
high LR because they are specific for just a few medicines.
The bayesian formula is as follows:
Posterior odds = LR x prior odds
If a symptom is as frequent in the population cured by a certain
medicine as in the rest-population LR=1. Such a symptom gives no indication at
all for this medicine. When a medicine is frequently prescribed, like
Phosphorus, we will see a number of patients who are thirstless,
but when this occurs as frequently as in the rest-population, LR=1 and the
symptom is no indication for Phosphorus.
Homeopathic diagnosis
The choice of a homeopathic medicine is usually not based on one fact
(diagnosis). In bayesian perspective we can describe
the decision-process of a homeopathic physician: if we add symptoms, our certainty
about the curative effect of a medicine will grow; if our symptoms are better (eg if they are peculiar) our certainty will grow faster.
Suppose that the chance that a homeopathic medicine cures is 1% if there are no
symptoms, than our conviction that Rhus-t. will be
curative grows as follows with 3 subsequent symptoms (in this example odds are
translated into chance by the computer):
This is a normal procedure in homeopathy. The patient visits the doctor
because of joint pains. The homeopathic doctor then asks about circumstances
that influence the complaint. If the patient tells him that the pain is
ameliorated by motion, the homeopathic doctor thinks of Rhus-t.
as one of the possibilities. If further investigation learns that the patient
has a definite desire for cold milk his expectation that Rhus-t.
will help grows. The last symptom, < wet weather, is subsequently enough to
prescribe this medicine.
A new repertory
Bayesian thinking is a perfect starting point for scientific update of
the homeopathic method. Homeopathic symptoms can be assessed as diagnostic
instruments, like any other diagnostic test eg. ultrasonography. In conventional medicine we seek for the
relation between test and diagnosis, in homeopathy we seek for the relation
between symptom and cure.
Computers make it possible to collect an enormous amount of data about
our prescriptions with a minimal amount of work. Then it is easy to evaluate
which cases were successful and which symptoms led to these cases. And which
did not!
Type and LR
A correct repertory would indicate the difference between
medicine-population and rest of the population, expressed as LR. A homeopathic
medicine should be present in the rubric when the population responding to that
medicine shows the rubric-symptom clearly more often than the rest of the
population, say more than one and a half times more often. Table shows a
possible schema for translating LR into type face. Such a schema should be
evaluated in due course for correspondence with actual practice.
The intermediate values represented by Italics are just a rough
estimation; further research must indicate optimal values.
An example: ‘Fear of death’
The Committee for Methods and Validation of the Dutch homeopathic
doctors association started the first prospective assessment of six homeopathic
symptoms in June 2004. The planned duration is three years. After two years we
have 2266 evaluated prescriptions. One of the assessed symptoms is ‘Fear of
death’. The rubric ‘Fear of death’ contains 103 medicines in Kent’s repertory.
There are 103 patients in our assessment with this symptom. The prevalence of
the symptom in the whole population is 4%. According to the translation of LR
into type proposed above we expect a prevalence of 6% in the population cured
by the medicine before entering the medicine in the rubric. If the prevalence
in the medicine-population is 12% it can be entered in Italics, and if the
prevalence is over 24% it should be entered in bold type.
The results are shown in the next table. The expected prevalence is the
prevalence we expect according to the existing entry in the repertory; Calcarea carbonica is in bold
type, we therefore expect 24% (=6 times 4%) of the Calcarea
patients to have a fear of death. In table we show the results for this symptom.
We used exact binomial calculations (one-tailed) to calculate P-values, and
calculations via binomial approximation of normal distribution if (number of
patients cured by the medicine)x(expected prevalence of symptom)>5.
Table 2 - Fear of Death example - prevalence
Table 2: Entries from the repertory-rubric ‘Fear of death’ compared with
prospective assessment in 10 practices during two years; also LR for each
medicine, confidence interval (CI) is given if LR is significant.
The entry of Anac. should be upgraded,
probably to bold type (p=0.938, the p-value in the table is the probability
that LR>1.5).
The bold entry of Calc. is incorrect, plain type might still be correct
(p=0.675), but even that is uncertain. The same goes for Phos.
(p=0.699). Lyc. still might be possible, but plain,
not in Italics (p=0.599). Nat-m. should not be in this rubric.
Preliminary outcome
Interim results after two of the planned three years of investigation
are now available. At this moment we have evaluated 56 LR values considering
six repertory rubrics (‘Diarrhoea from anticipation’, ‘Fear of death’, ‘Herpes
lips’, ‘Grinding teeth in sleep’, ‘Sensitive to injustice’ and ‘Loquacity’).
Our results suggest the addition of 20 (35.7% of 56) entries to Kent’s original
repertory and the rubric ‘Sensitive to injustice’ in the RADAR-Synthesis
repertory, version 8.1.40. On the other hand 11 (19.6% of 56) of our outcome
values suggest removal of existing entries in the repertory.
Retrospective data
There are also retrospective data that give an indication of LR s of
homeopathic symptoms, like van Wassenhoven showed.
Such data should be handled with more care than prospective research, but they
are more reliable than expert opinion. Retrospective data can also be obtained
by analyzing successful cases. In the Netherlands homeopathic medicines are
validated by analyzing a number of successful cases by different practitioners.
One of the results was that ‘Loquacity’ is present in only 40% of all
successful cases of Lachesis. So it makes no sense to
withhold a patient Lachesis if he or she is not
loquacious. At the moment about 20 medicines are validated, none of these
medicines have their characteristic symptoms in more than 50% of all cases.
Conclusion
As long as the judges of homeopathic RCT are convinced of the
impossibility of homeopathy we are in a witch-trial. If the results are
negative the outcome is accepted, if the results are positive we must have
committed fraud. As long as this situation persists we should not perform any
RCT.
Even if the witch-hunt is over we should only do RCT after proper
preparation. Our method has too many weaknesses for optimal results. We made
some suggestions for such preparations.
In the long run we should revise our repertories by scientific research using
Bayes’ method. We have to improve our method before
we can convincingly prove it.
[Paolo Bellavite, Salvatore Chirumbolo and Marta Marzotto]
Hormesis and its relationship with
homeopathy
Abstract
Homeopathy is an ancient and complex therapeutic method that is
rediscovering its scientific foundations.
Hormesis is a frequently observed phenomenon
that has been rigorously reported with precise dose-response curves. The
therapeutic method based on the principle of ‘like cures like’ should not be
confused with hormesis, which has several different
implications from those of homeopathy. Yet, because both these approaches to
nature and medicine are very broad in scope, they do end up having some points
of contact. Thus, the well-established and consolidated field of hormesis can help cast light, through its ideas and
research methods, on the possible mechanisms of action of remedies in ultra-low
doses.
Keywords
Hormesis, Homeopathy, High Dilutions,
Similarity Principle, Ultra-low Doses
Introduction
Homeopathy and hormesis are two different
concepts, because the former is a therapeutic method whereas the latter is a
phenomenon inferred from careful observation of nature, and described through
mathematical curves. Therefore, hormesis is not
homeopathy, nor does it provide the ‘explanation’ for it. Homeopathy (as a
therapeutic method) and hormesis (as a natural
phenomenon) must each construct their own general theories and find their own
specific mechanisms and explanations. Nevertheless, as well illustrated by
Calabrese and Jonas, there exist various points of contact that can suggest
common avenues for future research. Often, the progress of science inspired by
analogies that reveal similarities between distinct systems: pre-existing
knowledge of a -generally simpler- reference system (so called archetype) is
used to construct working hypotheses for extending knowledge of a less
well-understood -and generally more complex- system.
Hormesis
Science is an instrument for knowledge whose language is prevailingly
quantitative and which has the specific episteme of creating ‘symbols’ for
describing and interpreting reality. Consequently, the success of scientific
theories is often also bound up with the symbols that they create and the words
that they use, such as ‘atom,’ ‘receptor,’ ‘antibody,’ ‘cytokines,’ ‘fractal,’
‘apoptosis,’ etc. These words evoke in our minds figures (symbols) that help us
to think about the ‘true’ objects and phenomena of nature. Hormesis
is a clear concept, with a simple definition, that is thus useful for
describing a phenomenon that occurs in both natural reality and in laboratory
(see note 1). The major symbols it employs are an upside-down U-shaped doseresponse curve and a rebound curve over time; it makes
extensive use of mathematical and statistical analysis. The word (‘hormesis’) and the symbols (‘reverse U’ and time-courses)
are effectively and widely used for describing the relationship between living
things (cells, tissues, entire organisms) and the chemical-physical world with
which they come into contact. This approach applies to an extremely wide range
of significant phenomena -from medicine to ecology- so that hormesis
has justifiably gained increasing importance.
Department of Pathology, University of Verona, Verona, Italy
Corresponding author: Paolo Bellavite,
Department of Pathology, University of Verona,
Strada Le Grazie, 37134 Verona, Italy
E-mail: paolo.bellavite@univr.it
Human and Experimental Toxicology
29(7) 573–579
Hormesis highlights certain phenomena (or
facts, or experimental evidence) but does not itself constitute any sort of
explanatory theory, least of all for homeopathy. Each example of hormetic curve requires its own explanatory theory, which
identifies the ‘mechanism’ accounting for this behaviour of matter and living
things, in the specific circumstances where it is observed. Precisely for this
reason, the concept of ‘hormesis’ is a highly
‘fertile’ ground for stimulating research on phenomena ranging from gene
expression to oncogenic risk and from microbiology to
radiation pollution.
Each of these fields can be explained through one or more mechanisms,
which are today being explored with ever greater detail and thoroughness:
transduction of extracellular signals into intracellular messages, molecular,
cellular and tissue defence and repair systems, control of cell growth and cell
death and neurobiology. These involve the formation of complex control networks
-based on multiple and interacting feedback loops- that have the ability
to adapt cell behaviour in extremely varied ways, making it possible to trace
the self-regulatory mechanisms of the functions activated by different doses of
the same substance.
This raises two issues with respect to hormesis,
connected with its presumed significance and universality. For what concerns
its significance, there is a tendency
to regard hormesis as
a ‘compensatory’ response to
stress. Now, this may doubtless be true in many cases, but it does not
constitute a rule. In some situations, hormesis may
have explanations, causes and functions other than ‘compensation’: for example,
at the cell level a hormetic phenomenon could be due
to the fact that a cell may have two types of receptors (with high and low
affinity) for the same substance; these two receptors could be coupled with
transduction pathways that are respectively excitatory and inhibitory; likewise
the differences in timing might not be due to ‘compensatory’ or ‘rebound’
mechanisms, but rather to the different speeds with which the two responses are
activated: if the positive response to small doses involves protein synthesis
or cell replication, it could easily be slower than, and hence occur
subsequently to, the more rapid effect of inhibitory blockage. In this case, we
cannot properly speak of compensation, but only of a simple overlap between two
distinct
pharmacological phenomena in the dose-response and time-course curves.
For what concerns the universality of the phenomenon, it must be said
that though hormesis is very common, it is not
observed unfailingly in every case. In our experimental work, especially in the
laboratory, we have always borne in mind the possibility of ‘discovering’ hormetic phenomena in the behaviour of human leukocytes
subjected to the most diverse treatments, and found it to often occur, under
certain conditions, but not indiscriminately. For example, podophyllotoxin
is a toxic substance that inhibits the function of granulocytes in high doses
but stimulates it when used in low doses (such as those contained in
homeopathic products); however, this stimulation does not occur when the cell
function is activated with phorbol-myristate acetate;
in this case, we observe only
an inhibitory effect, without the hormetic
effect.
Much more recently, we have described how quercetin,
a natural substance found in foods, dose-dependently inhibits the function of basophils stimulated with anti-IgE
antibodies (which simulate
the allergic mechanism), without a hormetic
effect; on the other hand, hormesis is observed, very
clearly, when the cells are stimulated with bacterial peptides, and in that
case the low doses of quercetin have an effect that
enhances the response to the peptides.
This difference in the presence or absence of hormetic
responses may have a distinct role in the pharmacologic regulation of
inflammatory phenomena. Note that this consideration on the universality of
scientific evidence also applies to homeopathy, and in particular to the
principle of ‘similars,’ which is not true always and
in every case but only under certain particular conditions.
One limitation of the possible application of hormesis
to homeopathic theories is the fact that hormesis -by
definition- concerns substances which in high doses have a toxic effect. In
reality, though, there exist substances with regulatory activity whose
‘toxicity,’ at least of direct type, is difficult to demonstrate.
Consider for example neuromediators, hormones,
cytokines and common mineral salts. Homeopathy does not use only diluted
‘poisons’ but also substances with modulating, regulatory action that are
not direct toxins. What is more, in our experience (but also in the
literature) there have been cases where a substance was found to have a
stimulatory effect on a particular cell function when used in high doses, but
an inhibitory effect when tested in low doses.
This ‘reverse hormesis’ is difficult to
explain within a framework that assumes toxic effects of high doses, unless we
consider the toxic effects to be the potential consequences on the entire
organism of the substance in high doses. For example, in the cases we have
cited, Human and Experimental
Toxicology 29(7) diclofenac stimulated platelets but, probably precisely for
this reason, could cause damage to the stomach mucosal circulation; bacterial
peptides in high doses stimulated the vitality of leukocytes, but this could
lead to an excess production of toxic oxygen radicals, etc.
Hormesis has had the great merit of
disproving, with incontrovertible evidence, the belief that cause and effect
must always be linearly related. This confutation of an old idea has, in its
turn, provoked a domino-like collapse of many other mistaken theories, such as
the claim of ‘conventional’ pharmacology that there must be a linear relation
between the dose of a drug and its clinical effect. If hormesis
were to be ‘taken seriously’ by the world of pharmacology, it would call into
question the interpretation of pharmacokinetic curves: in fact, the
concentration in the blood of any drug administered orally will be extremely
low during its initial stages of
absorption and in its final phases of excretion. During those times, if
a hormetic phenomenon were to occur, the effect of
the drug would be exactly the opposite of that intended. One strong indication
that this is a very concrete possibility, even for very common drugs, is
provided by the work of Doutremepuich et al. on
aspirin. 9-14 It is worth mentioning, in this regard, that these authors
observed the phenomenon of effect inversion with ‘ultra low’ doses and also
with ‘homeopathic’ doses.
In thus confuting the accepted theories, hormesis
reaches its peak of ‘unconventionality’ but also of ‘scientificity’,
because science is ‘strongest’ precisely when it demonstrates -on the strength
of evidence- that previously held views were limited or incorrect.
Interestingly, at this stage of its development, the role of hormesis is historically comparable to the challenges
levelled against conventional medicine by the homeopathic tradition.
Homeopathy
Homeopathy is a method devised to find remedies for curing patients at a
time (late 1700s, early 1800s) when therapeutic methods were only empirical and
for the most part ineffective. The books on the history of medicine often
neglect to mention that, in the historical period when it arose, homeopathy
constituted the most ‘scientific’ pharmacological approach discovered until
then, for the following reasons:
a) It was based on observations that were initially empirical, but which
gave rise to a pharmacological theory (or rather, a general
reference-principle): that of ‘like cures like’; this principle, irrespective
of whether or not it was correct, gave medicine a pharmacological theory to
work out.
b) This general principle, which existed already in Hippocrates, became,
after Hahnemann, a method for designing clinical tests on volunteers (relatives,
students), which enormously expanded the body of knowledge of
the 19th century pharmacopoeia; by way of example, we note that nitroglycerin was tested as a drug by Hering
in 1849, while its use in allopathic medicine began some 30 years later.
c) It was such tests, rather than abstract philosophical ideas, that
revealed new properties of remedies in very low doses or even in high
dilutions/dynamizations, thereby extending the
possibilities for
their use in hitherto undreamt range of dosages. Homeopathy thus should
have had no need to demonstrate its ‘scientificity.’
Yet, in practice, it ran into serious problems because the economic
implications of the new discoveries, and a lack of ‘diplomacy’ on the part of
Hahnemann, shifted the debate from the realm of scientific research to that of
a power struggle, implicating the very survival of entire fields of medicine
and pharmacy. Unfortunately, even homeopathic practitioners themselves are not
fully aware of the scientific basis of their discipline. The words and symbols
(‘similarity,’ ‘dynamization,’ ‘potency,’
‘miasm,’
‘vital force’) have remained the same for 200 years, and
homeopathic physicians have been ‘content’ with these original forms, which
have always enabled them to survive and practice their profession. Another
factor aiding the survival of homeopathy was that the competing fields of
‘clinical’ medicine did not have a great deal of scientific content at their
disposal, and medicine had great difficulty (and still does) incorporating
science into its conceptual arsenal. Homeopathic medical science has never
ceased constructing theories and working hypotheses about its basic principles,
which are essentially three:
the law of similia, the law of minimum dose
and the ‘holistic’ treatment of the patient. These principles can in their turn
be subdivided into many other points and sub-points, as typically occurs in any
scientific theory: moving from the general to the particular.
The homeopathic ‘simile’
To compare the fundamental principle of homeopathy with hormesis, we need to carefully define the working concepts.
We agree with Calabrese and Jonas in drawing a distinction between homeopathic
‘similars’ and hormesis. In
homeopathy, ‘like cures like’ essentially means that a particular
substance (in small doses or high dilutions, it doesn’t
matter here which) can cure a
disease whose symptomatology in the
patient is similar to that caused by the same substance in tests on healthy
subjects. This founding idea (theory) has been repeatedly tested in the
experiments of homeopathic practitioners and has held up over time, albeit not
in a sufficiently ‘strong’ manner to convince the entire world of medicine (see
note 3).
The theory of homeopathic ‘simile’ is starting to be explained from a
mechanistic standpoint, consistently with modern immunological and biological
theories, with which it is partly in agreement and partly in opposition (as is
also hormesis, in a different field).
For example, today it is possible to explain -or very closely approach
an explanation of- how a substance (e.g. bee poison) that causes pathological
symptoms in healthy subjects (pain, inflammation) can cure similar pathological
symptoms in subjects allergic to bee poison. The substance is administered
sublingually to the allergic subject, in extremely small doses, and induces
immunological tolerance by activating the counter-regulatory mechanisms of the
lymphocytes.
Much has also been written about so-called ‘paradoxical pharmacology,’
according to which it is possible to exploit the ‘pathogenic’ properties of
drugs (determined from the pathological symptoms which they provoke in healthy
subjects during phase 1 studies) for curing diseases that exhibit precisely
those symptoms.
Though this is not overtly called ‘homeopathy,’ it is nevertheless,
unintentionally, homeopathy: it is simply a question of agreeing on the words
and symbols that are used.
It is also possible to design laboratory studies to test the following
‘homeopathic’ idea: a given substance causes an effect (for example
stimulation) on resting cells or animals, but the same substance causes an
opposite effect (for example inhibition) when tested on cells or animals that
have been previously stressed or disturbed in some way. The idea -originally
described as the ‘Wilder rule’- has been tested in many studies of experimental
physiology, cell biology and molecular biology.
Obviously, each individual model makes it possible to highlight a small
aspect of such a general rule, thereby outlining some possible mechanisms. At
the basis of the Wilder rule are the changes of receptors and of signal
transduction pathways, caused by the pathology itself, which makes the stressed
subject or system more sensitive and responsive to certain treatments and less
so to others, even to the point of response inversion due to homeodynamic adaptations of the reactivity +/o. of the effector systems, typical of living organisms.
Another important mechanism that would explain the different actions on
healthy subjects and patients is that the remedies may target only diseased
tissues and not healthy tissues.
Doses
The homeopathic Materia Medica
includes many poisons and was compiled from observations of accidental
poisoning cases or through experiments on volunteers. The latter, obviously,
had to be conducted with doses capable of provoking ‘symptoms’ which, though
disagreeable (but at times also agreeable, as can happen with some drugs), would
not however cause serious damage to the subjects. So, it came naturally to
reduce the doses to the minimum amount that was able to provoke symptoms (in
the healthy subject) and to cure them (in the patient). It should be added that
the effects of any drug are multifarious, so that when subjects are asked what
symptoms they experienced after taking it, they will probably (or certainly,
according to homeopathic experience) report effects involving many aspects of
physiology and psychology. It is also likely that, as the dose is reduced and
the most noticeable ‘toxic’ symptoms which affect all subjects are abated,
other more specific symptoms, affecting more ‘sensitive’ subjects, may remain
or even emerge. This is why the homeopathic Materia Medica comprises such a ‘wealth’ of symptoms, observed and
meticulously described. We shall not debate here whether such methods are
correct and statistically validated - a question not relevant for our present
purposes, though it ‘weighs’ greatly on the quality of the medical
prescriptions based on such reports.
Therefore, for what concerns dosages, it is obvious that overly high
doses of any poison will have pathogenic effects, whereas low doses may have
slightly pathogenic effects (liable to cause unpleasant symptoms) or pleasant
or therapeutic effects, depending on the similitude we have discussed above.
Certainly, this aspect has many conceptual analogies with hormesis.
Nevertheless, we disagree with the general classification of these
pharmacological effects as ‘compensatory,’ that is responses to damage induced
by a high dose. In our view, the discussion on ‘primary’ (direct, stressful)
and ‘secondary’ (indirect, compensatory) effects -introduced by Hahnemann
himself to try to construct a theory of the remedy- is somewhat Human and
Experimental Toxicology 29(7)
contrived, and in any case unnecessary for clarifying the point of
therapeutic effects of low doses of poisons. In practice, biological systems
react in a unitary manner, so that these two types of effects of a remedy or
toxic substance can only be artificially separated. To give a very simple
example, consider the case of a single protein: if a chemical substance binds
to an amino acid, the entire protein alters its secondary and tertiary folding
or may form a complex with another protein etc. In this case, it is not
possible to say whether the effect of the chemical substance is direct or
indirect. Therefore, regardless of the theorized two types of actions of the
remedy, the general working principle remains the same: use the lowest possible
dosages, which appears to be in line with modern, intelligent pharmacology. The
more ‘specific’ and ‘targeted’ a remedy is (i.e. directed to highly sensitive
receiving systems), the lower will be its effective dose. A list of experiments
where reproducible biological effects induced by compounds used in the
concentration range of attomoles (10-18 moles/litre)
or even zeptomoles (10-21 moles/litre) was previously
reported.
Dilutions/dynamizations (see
note 4)
One fortunate circumstance for homeopathy, historically, was that
although Avogadro’s principle was formulated in the early decades of the 19th
century, the precise computation of the number of molecules in a gram mole was
published by Loschmidt only in 1865 (in fact today we
speak of the Avogadro-Loschmidt constant). This meant
that there was no ‘scientific’ objection to the use of ultra-diluted
substances, and homeopathy
was not theoretically destroyed, at least not in
those years. The worst period came between the 19th and 20th
centuries when, also thanks to the
discovery of chemotherapeutics, homeopathy was brought to
bay and reduced to a shadow of its former self. Today, in the computer era, we
understand a great deal more about the physics of
condensed matter and in particular of aqueous solutions containing
gases, silica and ions (pure water does not exist), and this enables us to
consider (at least as a hypothesis) various potential mechanisms by which ‘non
molecular’ information might be incorporated into ultra-diluted solutions and
transmitted to an organism.
We shall not here discuss this controversial question. However, to
clarify the relation with hormesis, it is sufficient
to note that many experiments conducted thus far on highly diluted solutions
tend to show that the biological action of a given substance does not
change direction when going from ‘very low dose’ to ‘highly diluted-dynamized solution.’ The most frequently described instance
is the modulation of the function of basophil
granulocytes by histamine, which is apparent both with low and unquestionably
molecular dilutions (for example 2CH which corresponds to 10-4 moles/litre) and
with high dilutions (for example 16CH which corresponds, theoretically, to
10-32 moles/litre).
The response of the living system to very high dilutions/dynamizations, when it can be observed, generally has the
same direction as that to low (sub-toxic) dilutions containing ponderal, molecular doses of the substance to which the
system itself is chemically sensitive. Considering histamine, the ‘inversion of
effects’ may be conceived only by comparing the effect of this substance in the
connective tissue (where at high doses it behaves as irritating,
pro-inflammatory compound) with the effect on basophils
(where it suppresses by internal
feedback the release
of histamine, thus behaving as anti-inflammatory compound). There are,
however, discrepancies between different laboratories on this point regarding
the inversion of biological effects in highly diluted solutions,
so that the question cannot be considered resolved.
We agree with Calabrese and Jonas 1 when they maintain that, in the
‘high-dilution’ field, it is difficult to find points of contact between
homeopathy and hormesis: the ‘classical’ hormetic curves are in fact correctly and completely
constructed only for ‘doses,’ -that is to say concentrations- from ‘zero’
(no effect, taken
as control) upward,
whereas homeopathy, as we have seen, also uses dilutions where
theoretically there are no molecules of the purported active principles inside.
In this second case, a ‘common ground’ between homeopathy and hormesis could be found only if we accept the possibility
of ‘supra-molecular’ states of organization of the solvent, influencing the
cell responses independently of the concentration of the solute. At present,
this hypothesis is widely speculative, but we cannot rule out that studies
based on the hormesis model may, in future, be
extended to ultra-diluted solutions, should it become possible to determine the
‘concentration’ of any clusters, nanobubbles, nanoparticles or the like. Most probably, given that hormesis, too, is a phenomenon that seeks wider application
in medicine, it would find fertile ground in the growing diffusion of
homeopathy worldwide.
[Dana Ulman]
http://www.wholehealthnow.com/homeopathy_pro/research_1.html
Scientific Evidence for Homeopathic Medicine
Excerpted from Consumer's Guide to Homeopathy, (Tarcher/Putnam)
Most people with a little experience in homeopathy have no doubt that these
medicines work, though inevitably they will have some family members, friends,
neighbours,
and physicians who will be sceptical about it. One way to deal with
these people's skepticism is to become familiar with
research on the efficacy of homeopathic medicines.
There is actually considerably more laboratory and clinical research on
homeopathic medicine than most people realize. That said, it must also be
recognized that more research is certainly needed, not simply to answer the
questions of sceptics but to help homeopaths optimize their use of these
powerful natural medicines.
Some sceptics insist that research on homeopathy is mandatory since the
exceptionally small doses used do not make sense and there is no known
mechanism for action for these drugs. While it is true that homeopaths
presently do not know precisely how the homeopathic microdoses
work, there are some compelling theories about their mechanism of action (see
the discussion in Chapter 1, " Dana Ulman The
Wisdom and Wonder of Small Doses").
More important, there is compelling evidence that they do work, as this
chapter will show. And although homeopaths may not understand how their
medicines work, keep in mind that leading contemporary pharmacologists readily
acknowledge that there are many commonly prescribed drugs today, including
aspirin and certain antibiotics, whose mechanism of action remains unknown, but
this gap in knowledge has yet to stop physicians from prescribing them.
Many conventional physicians express doubt about the efficacy of
homeopathy, asserting that they will "believe it when they see it."
It may be more appropriate for them
to acknowledge that they will "see it when they will believe
it." This is not meant as a criticism of conventional physicians as much
as of conventional medical thinking.
The biomedical paradigm has narrowed the view of, the thinking about,
and the practice of medicine to the treatment of specific disease entities with
supposedly symptom-specific drugs and procedures. An integral aspect of this
approach to medicine is the assumption that the larger the dose of a drug, the
stronger will be its effects. While this seems to make sense on the surface,
knowledgeable physicians and pharmacologists know that it isn't true.
There is a recognized principle in pharmacology called the
"biphasic response of drugs." Rather than a drug simply having
increased effects as its dose becomes larger, research has consistently shown
that exceedingly small doses of a substance will have the opposite effects of
large doses.
The two phases of a drug's action (thus the name "biphasic")
are dose-dependent. For instance, it is widely recognized that normal medical
doses of atropine block the parasympathetic nerves, causing mucous membranes to
dry up, while exceedingly small doses of atropine cause increased secretions to
mucous membranes.
This pharmacological principle was concurrently discovered in the 1870s
by two separate researchers, Hugo Schulz, a conventional scientist, and Rudolf
Arndt, a psychiatrist and homeopath. Initially called the Arndt-Schulz law,
this principle is still widely recognized, as witnessed by the fact that it is
commonly listed in medical dictionaries under the definition of
"law."
More specifically, these reseachers discovered
that weak stimuli accelerate physiological activity, medium stimuli inhibit
physiological activity, and strong stimuli halt physiological activity. For
example, very weak concentations of iodine, bromine,
mercuric chloride, and arsenious acid will stimulate
yeast growth, medium doses of these substances will inhibit yeast growth, and
large doses will kill the yeast.
In the 1920s, conventional scientists who tested and verified this
biphasic response termed the phenomenon "hormesis,"
and dozens of studies were published in a wide variety of fields to confirm
this biological principle.
In the past two decades there has again been a resurgence of interest in
this pharmacological law, and now hundreds of studies in numerous areas of
scientific investigation have verified it.3 Because these studies have been
performed by conventional scientists who are typically unfamiliar with
homeopathic medicine, they have not tested or even considered testing the
ultra-high dilutions commonly used in homeopathy. However, their research has
consistently shown very significant effects from such small microdoses
that even the researchers express confusion and surprise.
Reference to this research on the Arndt-Schulz law and hormesis is important for validating homeopathic research
because it demonstrates the evidence for the important biphasic responses and microdose effects that lie at the heart of homeopathy. This
research is readily available to physicians and scientists yet is often ignored
or not understood.
The amount of research on homeopathic medicines is growing, and it is
becoming increasingly difficult to ignore these studies, because they are now
appearing in many of
the most respected medical and scientific journals in the world. This
chapter is not meant to be exhaustive (that would require a book or two of its
own). It will include many of the best studies, most of which have been
published in conventional medical and scientific journals.
Some of the studies are discussed because of the impressive results they
showed, and others are included for their implications for better understanding
homeopathy and the healing process. The review of research is not simply to
provide evidence of the efficacy of homeopathic medicine but also to enlighten
readers on how to evaluate homeopathic research, whether positive or negative
results are obtained.
To best understand the remaining part of this chapter, some definitions
are helpful:
Double-blind trials
refer to experiments in which
neither the experimenter nor the subjects know whether a specific treatment was
prescribe or a placebo (a fake medicine that looks and tastes like real
homeopathic medicines) is called double blind.
Randomized trials
are those in which subjects of
an experiment are randomly placed either in treatment groups or in placebo
groups. The researchers attempt to place people with similar characteristics in
equal numbers in treatment and placebo groups.
Crossover studies
refer to experiments in which half
of the subjects of a study are given a placebo during one phase of a study and
then given the active treatment during the second phase, while the other half
begin with the active treatment and then receive the placebo during the second
phase. Crossover studies sometimes do not test a placebo and instead compare
one type of treatment with another type of treatment.
Modern research is designed to evaluate the results of a therapy as
compared to a placebo and/or another therapy. This type of study is valuable
because many patients respond very well to placebos, and this
"treatment" is so safe and inexpensive it is generally assumed that
"real treatments" should have considerably better results than
placebo medicine. One should note that placebo effects can be significant, and
clinically, these effects can be very positive (some people think of them as a
type of self-healing).
Double-blinding an experiment is important to research because
experimenters tend to treat people who are getting the real treatment differently
or better than those given
a placebo, thus throwing off the results of the experiment. Research is
randomized so that those people treated with the real medicine and those
treated with the placebo are
as similar as possible, making a comparison between real treatment and
placebo treatment more accurate. Crossover studies allow researchers to compare
the separate effects
of a placebo and a treatment on all subjects in an experiment.
Statistics obviously are an important part of research. A treatment is
thought to be considered better than a placebo if the results, according to
statistical analysis, have no more than a 5% possibility of happening at random
(the notation of this statistical probability is: P=.05). A study with a small
number of patients (for example, 30 or less) must show a large difference
between treatment and nontreatment groups for it to
become statistically significant. A study with a large number of patients (for
example, several hundred) needs to have only a small but consistent difference
to obtain a similar statistical significance. This information is provided so
that readers will know that all the studies described in this chapter are
statistically significant, except when otherwise noted.
Clinical Research
People are often confused by research, not only because it can be overly
technical but because some studies show that a therapy works and other studies
shows that it doesn't. To solve this problem, a recent development in research
is used, called a "meta-analysis," which is a systematic review of a
body of research that evaluates the overall results of experiments.
In 1991, three professors of medicine from the Netherlands, none of them
homeopaths, performed a meta-analysis of 25 years of clinical studies using
homeopathic medicines and published their results in the British Medical
Journal. This meta-analysis covered 107 controlled trials, of which 81 showed
that homeopathic medicines were effective, 24 showed they were ineffective, and
2 were inconclusive.
The professors concluded, "The amount of positive results came as a
surprise to us." Specifically, they found that:
13 of 19 trials showed
successful treatment of respiratory infections
6 of 7 trials showed positive
results in treating other infections
5 of 7 trials showed
improvement in diseases of the digestive system
5 of 5 showed successful
treatment of hay fever
5 of 7 showed faster recovery
after abdominal surgery
4 of 6 promoted healing in
treating rheumatological disease
18 of 20 showed benefit in
addressing pain or trauma
8 of 10 showed positive
results in relieving mental or psychological problems
13 of 15 showed benefit from
miscellaneous diagnoses
Despite the high percentage of studies that provided evidence of success
with homeopathic medicine, most of these studies were flawed in some way or
another. Still, the researchers found 22 high-caliber
studies, 15 of which showed that homeopathic medicines were effective. Of
further interest, they found that 11 of the best 15 studies showed efficacy of
these natural medicines, suggesting that the better designed and performed the
studies were, the higher the likelihood that the medicines were found to be
effective. Although people unfamiliar with research may be surprised to learn
that most of the studies on homeopathy were flawed in one significant way or
another,5 research in conventional medicine during the past 25 years has had a
similar percentage of flawed studies.
With this knowledge, the researchers of the meta-analysis on homeopathy
concluded, "The evidence presented in this review would probably be
sufficient for establishing homeopathy as a regular treatment for certain
indications."
There are different types of homeopathic clinical research, some of
which provide individualization of remedies; which is the hallmark of the
homeopathic methodology; some of which give a commonly prescribed remedy to all
people with a similar ailment, and some of which give a combination of
homeopathic medicines to people with a similar condition. While one can perform
good research using any of these methods, there are certain issues that
researchers have to be aware of and sensitive to in order to obtain the best
objective results.
For instance, if a study does not individualize a homeopathic medicine
to people suffering from a specific ailment and the results of the study show
that there was no difference between those given this remedy and those given a
placebo, the study does not disprove homeopathy; it simply proves that this one
remedy is not effective in treating every person suffering from that ailment,
each of whom may have a unique pattern of symptoms that requires an individual
prescription.
In describing specifics of the following studies using homeopathic
medicines, differentiation has been made between studies that allowed for
individualization of medicines and those that did not.
Some people incorrectly assume that research using homeopathic medicines
is impossibly complicated because each medicine must be individualized to the
patient. The following studies disprove this simplistic belief.
A recent clinical trial evaluating homeopathic medicine was a unique
study of the treatment of asthma.6 Researchers at the University of Glasgow
used conventional allergy testing to discover which substances these asthma
patients were most allergic to. Once this was determined, the subjects were
randomized into treatment and placebo groups.
Those patients chosen for treatment were given the 30c potency of the substance
to which they were most allergic (the most common substance was house dust
mite). The researchers called this unique method of individualizing remedies
"homeopathic immunotherapy" (homeopathic medicines are usually
prescribed based on the patient's idiosyncratic symptoms, not on laboratory
analysis or diagnostic categories). Subjects in this experiment were evaluated
by both homeopathic and conventional physicians.
This study showed that 82% of the patients given a homeopathic medicine
improved, while only 38% of patients given a placebo experienced a similar
degree of relief. When asked if they felt the patient received the homeopathic
medicine or the placebo, both the patients and the doctors tended to guess
correctly.
The experiment was relatively small, with only 24 patients. As noted,
for statistically significant results, small experiments must show a large
difference between those treated with a medicine and those given a placebo.
Such was the case in this study.
Along with this recent asthma study, the authors performed a
meta-analysis, reviewing all the data from three studies they performed on
allergic conditions, which totaled 202 subjects. The
researchers found a similar pattern in the three studies. Improvement began
within the first week and continued through to the end of the trial four weeks
later. The results of this meta-analysis were so substantial (P=0.0004) that
the authors concluded that either homeopathic medicines work or controlled
clinical trials do not. Because modern science is based on controlled clinical
trials, it is a more likely conclusion that homeopathic medicines are
effective.
Another recent study, published in the American journal Pediatrics, tested homeopathic medicine for the treatment
of a condition recognized to be the most serious public health problem today,
childhood diarrhea.7 Over 5 million children die each year as the result of diarrhea, mostly in nonindustrialized
countries. Conventional physicians prescribe oral rehydration therapy (ORT, a
salt solution that helps children maintain fluid balance), but this treatment
does not fight the infection that underlies the diarrhea.
Conducted in Nicaragua in association with the University of Washington
and the University of Guadalajara, this randomized double-blind,
placebo-controlled study of
81 children showed that an individually chosen remedy provided
statistically significant improvement of the children's diarrhea
as compared to those given a placebo.
Children given the homeopathic remedy were cured of their infection 20%
faster than those given a placebo, and the sicker children responded most
dramatically to the homeopathic treatment. A total of 18 different remedies
were used in this trial, individually chosen based on each child's symptoms.
A study of the homeopathic treatment of migraine headache was conducted
in Italy.8 Sixty patients were randomized and entered into a double-blind,
placebo-controlled trial. Patients regularly filled out a questionnaire on the
frequency, intensity, and characteristics of their head pain. They were
prescribed a single dose of a 30c remedy at four separate times over two-week
intervals. Eight remedies were considered, and prescribers were allowed to use
any two with a patient. While only 17% of patients given a placebo experienced
relief of their migraine pain, an impressive 93% of patients given an
individualized homeopathic medicine experienced good results.
A randomized double-blind, placebo-controlled trial was performed on 175
Dutch children suffering from recurrent upper respiratory tract infections.9
Children in the treatment group were prescribed a "constitutional
medicine" for their overall health as well as acute medicines to treat the
acute respiratory infections they developed.
The study found that the children given homeopathic medicines had a 16%
better daily symptom score than children given a placebo.
This study also found that the number of children given a placebo who
had to undergo adenoidectomy was 24% higher than for the children given
homeopathic remedies.
A 54.8% reduction in the use of antibiotics in the children given
homeopathic medicines was reported, while the children who received a placebo
experienced a 37.7% reduction in antibiotic use. (This reduction in both groups
was determined to be the result of the normal growth and development of the
child, dietary changes - the study provided written nutritional advice to the
parents - and the change in expectations as the result of being under medical
care.)
The statistical possibility of these results happening by chance was 6%
(P=0.06). Because statistical significance in science is recognized when there
is a 5% or less chance
of results happening at random, the researchers concluded that
homeopathic medicine seem to add little to the treatment of upper respiratory
tract infections. This more conservative conclusion appeared to be influenced
by the fact that the authors sought and received publication of their study in
the British Medical Journal. They should have more accurately said that
homeopathic medicines provided benefit to children with upper respiratory
infections, but there is a small chance (6%) that these good results happened
at random.
Considering the closeness of these results to 5%, considering the other
improvements in the homeopathic group's health, and considering the
increasingly widespread desire
to avoid antibiotics, it makes sense for physicians and parents to
consider seeking homeopathic care for children's upper respiratory infections.
Another study that involved individualized homeopathic care was in the
treatment of rheumatoid arthritis. The study involved 46 patients. Two
homeopathic physicians prescribed individually chosen medicines to each
patient, though only half of them were given the real remedy, while the other
half were given a placebo. The study found that 82% of those given an
individualized homeopathic remedy experienced some relief of symptoms, while
21% of those given a placebo experienced a similar degree of relief.
One other very interesting trial that utilized semi-individualization of
care was in the treatment of primary fibromyalgia (also called fibrositis). Patients with fibrositis
were admitted into a trial in which homeopathic physicians chose between three
possible remedies, Arnica, Rhus tox,
and Bryonia. Half of the patients were given one of
these remedies, and the other half were given a placebo. There was no
discernible difference between these groups. However, as an integral part of
the experiment's design, a panel of homeopaths evaluated the accuracy of each
prescription. This analysis found that those patients whom the panel considered
to have received the correct remedy experienced a statistically significant
improvement in symptoms as compared to those patients given the
"incorrect" remedy or the placebo.
These same researchers next conducted a more sophisticated trial in the
treatment of primary fibromyalgia. This double-blind, placebo-controlled,
crossover trial admitted only those patients who fit the symptoms of Rhus tox. The researchers found that
this constituted 42% of the patients interviewed. One-half of these 30 patients
were given
Rhus tox 6c during the
first phase of the experiment, while the other half were given a placebo.
During the second phase, those patients initially given the medicine were given
a placebo, and those patients initially given a placebo were now given the
homeopathic remedy. Researchers determined at the beginning of the experiment
that improvement in pain and sleeplessness were the outcome measures most
important in evaluating the results of this trial, and the results showed that
25% more of the patients experienced pain relief when taking the homeopathic
remedy compared to when they were given a placebo and almost twice as many had
improved sleep when taking the remedy.
This type of crossover design is considered a sophisticated type of
research because it compares each person when using a treatment with the same
person when using a placebo. Most other research compares two supposedly
similar groups of people, but researchers commonly acknowledge that it is
difficult and perhaps impossible to get two exactly similar groups of people.
The limitation of the crossover design for homeopathic treatment, however, is
that most homeopathic medicines provide long-term benefits,
so that once a person stops taking a homeopathic remedy he or she may
still continue to improve, even in the placebo stage of the trial. Low-potency
medicines, such as the 6c used in the above described experiment, generally
have short-acting effects, while higher potency medicines generally have
increasingly longer-term effects.
Clinical Research with Non-individualized Care
In addition to the studies on homeopathy in which individualized
remedies are prescribed, there is also a body of research testing single
remedies to people given in a non-individualized manner. Such research is
potentially problematic because homeopaths acknowledge that the remedies
require some degree of individualization to be effective. The results of a nonindividualized study, either positive or negative, can
be misunderstood by people who do not know basic principles of the homeopathic
method.
One study using nonindividualized homeopathic
treatment was sponsored by the British government during World War II and was
conducted in 1941-42 on volunteers
whose skin was burned with mustard gas. The study showed the efficacy of
Mustard gas 30c as a preventive or Rhus tox 30c and Kali bichromicum 30c
as therapy. The study was double-blind, placebo-controlled, and was conducted
at two centers (London and Glasgow), both showing
similarly positive results. A more recent analysis of the data further
substantiated the statistical significance of this study.
It should, however, be mentioned that the researchers also tested the
efficacy of Opium 30c, Cantharis 30c, and Variolinium
30c, none of which provided any noticeable benefit. If this trial had tested
only these medicines, the researchers might have concluded that homeopathic
medicines were ineffective in treating mustard gas burns. Finding the correct
remedy is the key to making homeopathy work.
Some skeptics and journalists inaccurately
report that homeopathy is primarily used to treat minor health problems.
Homeopaths today primarily treat various chronic ailments for which conventional
medicine has not provided effective treatment. One example of a chronic and
serious problem shown by a controlled study to be effective treated by
homeopathy is diabetic retinitis (retinitis is a common complication of
diabetes in which there is an inflammation of the retina causing impairment of
sight, perversion of vision, swelling, discharge from the eye, and sometimes hemorrhages into the retina).
This double-blind, randomized, placebo-controlled study on 60 patients
used Arnica 5c. The results of this study showed that 47% of patients given
Arnica 5c experienced improvement in central blood flow to the eye, while only
1% of patients given the placebo experience this improvement. Further, 52% of
patients given Arnica 5c experienced improvement in blood flow to other parts
of the eye, while only 1.5% of those given the placebo experienced a similar
degree of improvement.
The best-selling flu remedy in France is actually a homeopathic
medicine. Anas barbariae
200c, commonly marketed under the trade name Oscillococcinum
TM, is also popular in the U.S. and is effective primarily at the first signs
of influenza. A double-blind, placebo-controlled study with 478 patients
suffering from influenza was conducted, making this the largest trial yet performed
testing a homeopathic medicine. This trial showed that almost twice as many
people who took the homeopathic remedy got over the flu after 48 hours as
compared to those given a placebo.
Although this remedy was found to work for all age groups, it was considerably
more effective for people under 30 than for those over 30. However, it was not
found to be effective when subjects had severe flu symptoms. In severe cases of
the flu, a more individualized homeopathic remedy may be indicated.
In addition to various studies on human health, there have also been
some animal studies. British researchers have conducted trials showing that
homeopathic medicines, specifically Caulophyllum 30c,
could lower the rate of stillbirths in pigs. Pigs given a placebo had 103
births and 27 stillbirths (20.8%), while those given Caulophyllum
30c had 104 births and 12 stillbirths (10.3%).
Not all studies show efficacy of homeopathic medicines, not because they
don't work but mostly because the studies were poorly designed. One such study
tested a single homeopathic medicine in the treatment of osteoarthritis. This
study consisted of 36 patients, of whom one third were given Rhus tox 6c, one third were given
a conventional drug (fenoprofen, a nonsteroidal anti-inflammatory drug), and one third were
given a placebo.
Those patients given the conventional drug experienced some relief of
symptoms, but those given the homeopathic remedy and the placebo had a similar
lack of response
to treatment. While some people would erronously
conclude that homeopathic medicines are ineffective in the treatment of
osteoarthritis, it would be more appropriate and accurate to conclude that Rhus tox 6c is an ineffective
remedy when given without individualization to people with osteoarthritis.
One of the confounding variables from this trial was that 2 of the 12
patients given the homeopathic medicine were withdrawn from the trial because
they experienced an aggravation of symptoms after taking the medicine. Because
homeopathic medicines sometimes cause a temporary increase in chronic symptoms
before significant improvement, it was disappointing that the researchers did
not follow their status. Because this trial lasted only two weeks, it did not
allow time for the homeopathic remedy to be adequately evaluated. If, for
instance, these 2 patients experienced the significant relief that is common
after an initial aggravation of symptoms, the results of the trial would have
been different.
Further, it is unfair to compare a fast-acting conventional drug that
has side effects with a slower acting homeopathic medicine that is considerably
safer. Finally and of great significance is the fact that while Rhus tox is a common remedy for
rheumatoid arthritis, it is less common for osteoarthritis.
Homeopathic combination remedies are formulas in which several
homeopathic substances are mixed together into one remedy. This untraditional
approach to using homeopathic medicine is commercially popular in many
countries. While these remedies are not thought by homeopaths to be as
effective as individually chosen medicines, they do work and research has
verified this. Yet, homeopaths consistently find that single homeopathic
medicines have the potential to truly cure a person's disease, while
combination medicines at best provide safe but temporary relief of symptoms.
The same researchers who conducted the study on asthma earlier described
also performed a study on the treatment of hayfever.
This double-blind, placebo-controlled study prescribed a 30c potency of a
combination remedy made from 12 common pollens. The results showed that those
subjects taking the homeopathic remedy had six times fewer symptoms than those
given the placebo. Both groups of subjects were allowed to use an
"escape" medicine (an antihistamine) if their remedy didn't work
adequately.
The study showed that homeopathic subjects needed this medicine half as
often as did those given the placebo.
Another example of significant results from a homeopathic combination
remedy was in the treatment of women during their 9th month of
pregnancy. 90 women were given
the 5c potency of the following remedies: Caulophyllum,
Arnica, Cimicifuga, Pulsatilla,
and Gelsemium. They were given doses of this
combination remedy 2x daily during the 9th month. This double-blind,
placebo-controlled study showed that women given the homeopathic medicines
experienced a 40% (!) shorter labor than those given
a placebo. Also, the women given the placebo had four times (!) as many
complications of labor as those given the homeopathic
medicines.
One of the limitations of research on combination remedies is that the
results do not reveal whether the effective treatment came from one specific
medicine or from the unique combination of remedies. A recent study of 22
healthy women in their first pregnancies tested Caulophyllum,
one of the medicines used in the study cited above, which was administered in
the 7c potency during the active phase of labor (one
dose per hour repeated for a maximum of 4 hours). The time of labor for those women given the homeopathic medicine was
38% shorter than for women given a placebo.21 This trial was not double-blind;
however, the researchers recently completed a double-blind trial and confirmed
their earlier results.
A popular homeopathic external application marketed as TraumeelTM has been studied for its efficacy in the
treatment of sprained ankles. This combination of 14 remedies
in 2x to 6x potencies was given to subjects with sprained ankles. After
10 days, 24 of the 33 patients who were given the homeopathic medicine were
pain-free, while 13 of 36 patients given a placebo experienced a similar degree
of relief. This same medicine was also used in the treatment of traumatic hemarthrosis (joint swelling) and was shown to
significantly reduce healing time as compared to a placebo. Objective
measurements of joint swelling and movement and evaluation of the synovial
fluid at injury were assessed.
A study of 61 patients with varicose veins was performed double-blind
and placebo-controlled. Three doses of a popular German combination of eight
homeopathic medicines were given daily for 24 days. Measures were venous
filling time, leg volume, and subjective symptoms. The study found that venous
filling time improved in those given the homeopathic medicines by 44%, while it
deteriorated in the placebo group by 18%. Other measures also had significant
differences.
In addition to the various clinical studies on humans, there has also
been some research using homeopathic medicines to improve the health of
animals. German researchers have shown that dairy cows given Sepia 200c
experienced significantly fewer complications of birth than those given a
placebo.26 Low-potency (1x to 6x) combinations of Lachesis,
Pulsatilla, and Sabina, or Lachesis,
Echinacea, and Pyrogenium, along with Caulophyllum given to pigs had preventive and therapeutic
effects on infections (inflammation of the breasts and the uterus) as well as
on diarrhea in the piglets.
Not all clinical studies on homeopathic combination medicines find
efficacy of treatment, but there are often important factors that explain the
failure. A Canadian study on the treatment of plantar warts is one such
example. This randomized double-blind, placebo-controlled trial with 162
patients prescribed three medicines to each patient (Because the trial did not
mix the remedies together, it is not completely accurate to call the use of
these remedies a combination. It is more precise to consider it "polypharmacy," the use of several medicines). The
remedies used were Thuja 30c, Antimonium
crud 7c and Nitric acid 7c. Thuja was taken once a
week, and the other two remedies were taken once a day.
The trial lasted six weeks. The results showed that there was no
noticeable difference between those subjects given the homeopathic medicines
and those given a placebo.
Many homeopaths may be initially surprised at the result of this trial
because they consider these remedies commonly effective in the treatment of
warts. But while the remedies may be effective for treating warts, they are not
necessarily effective for all types of warts or in all people. A recent study
of homeopathic treatment for various types of warts found that 18 of 19 people
with plantar warts were cured in, on average, 2.2 months.29 The most common
remedy was Ruta, prescribed to 12 of the 19 patients.
Thuja was prescribed for only 3 patients, and Antimonium crud was prescribed for 2 patients.
This study teaches us that individualization and the use of well-chosen
remedies are necessary for most effective treatment.
One additional note about research using homeopathic combination
medicines: The homeopathic literature refers to the fact that some remedies are
antidoted by other remedies. While the medicines in
the Canadian trial are not known to antidote each other, homeopaths acknowledge
that our understanding of which remedies antidote each other is somewhat
primitive (for a listing of which remedies antidote each other, see the
appendix in Kent's Repertory or in the Indian edition of Boericke's
Pocket Manual of Materia Medica
with Repertory). Homeopathic research must, therefore, be aware of this
possibility so that conclusions from research are not overstated.
Laboratory Research
As valuable as clinical studies are, laboratory research is able to show
biological activity of homeopathic medicines that cannot be explained as a
placebo response, a common accusation of skeptics.
Laboratory research is also capable of shedding some light on how the
homeopathic medicines may work.
Distinct from clinical research which seeks to measure improvement in
the health of a person or an animal, laboratory research seeks to assess
changes in biological systems (cells, tissues, organs, viruses, etc.).
Typically, animal research can fit under either clinical or laboratory
research, depending on the goal of the study. If the study seeks to test the
efficacy of a treatment on the health of an animal, it can be considered an
animal clinical study. If the study seeks to test the effects of a treatment on
animals so that researchers can apply the information for human health or to
understand biological phenomena, it can be considered a laboratory study.
Admittedly, while some of the animal studies discussed here are humane,
others are not. Reference to these studies is not meant to suggest that this author
condones all such research. Rather, discussion of these studies is intended to
verify the benefits of homeopathic medicines, both to animals and to humans,
and to encourage wider use of homeopathic remedies.
Some of this section is somewhat technical, though an effort has been
made to describe the studies in a user-friendly manner.
Earlier in this chapter, reference was made to some important
double-blind clinical research with homeopathic medicines conducted as far back
as 1941. There were also
some high-quality scientific laboratory studies investigating
homeopathic microdoses as that time. One extensive
and meticulously controlled study was performed in 1941-42 by a Scottish
homeopath/scientist, W.E. Boyd.30 This work showed that microdoses
of mercuric chloride had statistically significant effects of diastase activity
(diastase is an enzyme produced during the germination of seeds). This research
was so well designed and performed that an associate dean of an American
medical school commented,
"The precision of [Boyd's] technique exemplifies a scientific study
at its highest level."
There have been over 100 studies evaluating the prophylactic and
therapeutic effects of homeopathic doses of normally toxic substances. A
collaborative effort of scientists from German research institutions and from
America's Walter Reed Hospital performed a meta-analysis of these studies.32
Like the meta-analysis described earlier on clinical trials using homeopathic
medicines, most of the studies were flawed in some way. However, of the high
quality studies, positive results were found 50% more often than negative
results.
What was particularly intriguing was that researchers who tested doses
in the submolecular range (potencies greater than
24x) were found to have the best designed studies and more frequently found statisticially significant results from these microdoses. Specifically, several researchers gave, usually
to rats, crude doses of arsenic, bismuth, cadmium, mercury chloride, or lead.
The research showed that animals who were pretreated
with homeopathic doses of these substances and then given repeated homeopathic
doses after exposure to the crude substance, excreted more of these toxic
substances through urine, feces, and sweat than did
those animals given a placebo.
Several studies noted that pretreatment and
treatment with potentized doses of substances
different from those to which the animal was being exposed did not provide any
benefit.
As horrible as this research may be for the animals tested, animal researchers
claim that it can have considerable benefit for treating animals and humans
exposed to toxic substances. Such studies cannot be performed humanely on human
subjects, and because of the newness of the research, no computer models to
simulate the effects of homeopathic medicines are presently possible. While
public health measures must primarily focus on preventing exposure to toxic
substances, medical treatment must be developed for healing if and when
exposure takes place. The research suggests that homeopathic medicine may play
a significant role in the treatment of toxicological exposure.
Homeopathic research has also explored the benefits of homeopathic
medicines to protect against radiation. Albino mice were exposed to 100 to 200 rad of X-rays (sublethal doses)
and then evaluated after 24, 48, and 72 hours. Ginseng 6x, 30x, and 200x and Ruta graveolens 30x and 200x were
administered before and after exposure.
When compared with mice given a placebo as treatment, mice given any of
the above homeopathic medicines experienced significantly less chromosomal or
cellular damage.
Albino guinea pigs were exposed to small doses of X-ray that cause
reddening of the skin. Studies showed that Apis mellifica 7c or 9c had a protective effect and a roughly 50%
curative effect on X-ray-induced redness of the skin. Apis
mellifica (honeybee) is a homeopathic medicine for
redness, swelling, and itching, common symptoms of
bee venom.
In one very intriguing study, Thyroxine 30x
(thyroid hormone) was placed in the water of tadpoles. When compared to
tadpoles who were given a placebo, the study showed, morphogenesis of the
tadpoles into frogs was slowed for those who were exposed to the homeopathic
doses. Because thyroid hormone in crude doses is known to speed up morphogenesis,
it makes sense from a homeopathic perspective that homeopathic doses would slow
it down.
What makes this study more interesting is that additional investigations
resulted in the same effect when a glass bottle of the homeopathic doses of
thyroid hormone was simply suspended in the water with the lip of the bottle
above the water line. This research was replicated at several laboratories, and
results were consistent.
The implications of this study are somewhat significant, not only for
verifying biological effects of homeopathic doses but for showing that these
medicines have some type of radiational effect
through glass. Some types of unconventional approaches to homeopathy have been
developed over the past decades in which pupil reflex, pulse, muscle strength,
and skin conductance have been changed as the result of simply holding on to a
bottle of an individually indicated homeopathic medicine. While this approach
may seem strange to classically oriented homeopaths, the above research
provides some basis for its application.
One other interesting experiment dealing with water is worthy of
mention. This study used nuclear magnetic resonance (NMR), also called magnetic
resonance imaging (MRI), to determine whether high potencies of homeopathic
medicines placed in water had any measurable effects. Without getting into the
details of this highly technical study, the researchers found that high
potencies of Silicea did, in fact, show a distinct
difference as compared with placebo-treated water.
There have been several studies investigating very high dilutions of
histamine (above 30x) on isolated guinea pig hearts, showing that this remedy
increases blood flow through the heart. What is particularly interesting about
these studies was that this effect was completely neutralized if the very high
dilutions were exposed to 70° C for 30 minutes or exposed to magnetic fields of
50 Hz for 15 minutes.37 Needless to say, it is unlikely that these microdoses could have only a placebo effect when known
physical stresses to the medicine can halt its activity.
A professor of hematology at the School of
Pharmacy of Bordeaux has carried out eight years of research on the effects of
acetylsalicylic acid (the active ingredient in aspirin) on blood.38 It is known
that crude doses of aspirin cause increased bleeding, while this research
showed that homeopathic doses of acetylsalicylic acid shorten bleeding time in
healthy subjects.
Two Dutch professors of molecular cell biology recently completed a
significant body of experimentation which not only provided evidence of the
effects of homeopathic microdoses on cell cultures
but that also suggested that these microdoses are
only effective when homeopathy's principle of similars
is followed. Specific reference to the body of studies cannot be provided in
this chapter, both due to the space necessary to describe this work and due to
its highly technical nature.
A now famous study by respected French physician and immunologist
Jacques Benveniste tested highly diluted doses of an
antibody on a type of white blood cells called basophils
(basophils increase in number when exposed to
substances such as antibodies which cause an allergic reaction). This work was
replicated at six different laboratories at four different universities (the University
of Paris South, the University of Toronto, Hebrew University, and the
University of Milano). Although the prestigious journal Nature published this
study,40 it also published concurrently an editorial stating that they did not
believe the results. The editor insisted on going to the primary researcher's
laboratory at the University of Paris South to observe the experiment conducted
in his presence along with two known experts in scientific fraud (one of whom
was a magician).
The details of what followed require more detail and technical
information than is appropriate for this book. In summary, the experiment did
not show significant results, leading the Nature editor to pronounce in his
journal that the original study was a fraud. The problem, however, was that the
editor and the fraud experts were not immunologists, and thus, they did not
seem aware that many studies in immunology require considerably more
replication than could be done in the couple of days that the Nature team
visited.
Another problem was in the study itself, which was very difficult to do.
The researchers later simplified it, provided even greater scientific controls,
and found significant results. Nature, however, chose not to publish these
results, and this study was published instead in the Journal of the French
Academy of Sciences.
Evidence of the bias that "defenders of science" have against
homeopathy is their refusal to publish or even comment on the increasing body
of research accruing to homeopathic medicine.
Science is supposed to be objective, though both physicists and
psychologists teach us that objectivity is impossible. Science's long-term
antagonism to homeopathy is slowly breaking down but not without significant
reaction, fear, anxiety, and sometimes downright attack against homeopaths.
Change is difficult, and significant change is even more difficult. Even
though science grows from new knowledge, it tends to be resistant, often very
resistant, to perspectives and knowledge that do not fit contemporary paradigms
and scientific theories. The information presented in this chapter and in this
book is not meant to overthrow science but to enlarge its perspective so that
it more broadly and accurately describes and accepts many presently
unexplainable phenomena of nature.
In Summary
This review of research is not meant to be complete. Readers are
encouraged to review the books listed in the Resources section of this chapter
for access to many other clinical and laboratory studies as well as to
theoretical foundations of homeopathic microdoses.
Despite the now strong evidence that homeopathic medicines promote
biological activity and clinical efficacy, there is still great resistance to
them. Recently, the Lancet published the research on the homeopathic treatment of
asthma. In a press release announcing this research, they emphasized that
although homeopathic medicines may provide some benefit to people with asthma,
conventional medicines offer greater benefit.
This was a strange statement for two reasons. First, the study didn't
compare homeopathic and conventional medicine; it only compared homeopathic
medicine with a placebo. Any other conjecture was not founded on the data
presented. Secondly, the Lancet refused to openly acknowledge that homeopathic
medicines may work after all.
One can't help but wonder whether if a man flew and science proved that
he flew, the editors of some medical journals would remark: "But he
doesn't fly as high or as fast as
a jet plane!"
Despite the resistance to change in general and to homeopathy
specifically, it is getting increasingly difficult for physicians and
scientists to doubt the benefits that homeopathic medicines offer. Italian hematologist Paolo Bellavite and
Italian homeopath Andrea Signorini's Homeopathy: A
Frontier in Medical Science is presently the most comprehensive resource of
controlled studies on homeopathy. The authors conclude, "The sum of the
clinical observations and experimental findings is beginning to prove so
extensive and intrinsically consistent that it is no longer possible to dodge
the issue by acting as if this body of evidence simply did not exist."
They go on to say, "To reject everything en bloc, as many are
tempted to do, means throwing out the observations along with the
interpretations, an operation which may be the line of least resistance, but
which is not scientific because unexplained observations have always been the
main hive of ideas for research."
To ignore the body of experimental data that presently exists on
homeopathic medicines and to deny the body of clinical experience of homeopaths
and homeopathic patients, one would have to be virtually blind. One can only
assume that this blindness is a temporary affliction, one that will soon be
cured.
References
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2 M. Oberbaum
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3 Oberbaum
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5 Because much research on
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6 David Reilly, Morag Taylor,
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22 P. Eid,
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24
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29 R. Gupta, O.P. Bhardwaj, and R.K. Manchanda,
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30 W.E. Boyd, "The Action of
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31 Mock, D., "What's Going
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32 K. Linde,
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33 A.R. Khuda-Bukhsh,
S. Banik, "Assessment of Cytogenetic Damage in
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34 J. Bildet,
M. Guyot, F. Bonini, et
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35 P.C. Endler,
W. Pongratz, G. Kastberg,
et al., "The Effect of Highly Diluted Agitated Thyroxine
on the Climbing Activity of Frogs," Veterinary and Human Toxicology, 1994,
36:56. Also, P.C. Endler, W. Pongratz,
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36 J.L. Demangeat,
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37 J. Benveniste,
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38 C. Doutremepuch,
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Aggregation and Coagulation," Haemostasis, 1990, 20:99.
39 Roeland
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Principle in Self-Recovery, Utrecht: University of Utrecht, 1994.
40 E. Davenas,
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41 J. Maddox, "When to
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42 J. Maddox, J. Randi, and W.
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43 J. Benveniste,
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44 Reilly, et al., 1994. See note
6.
45 Paolo Bellavite
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Medical Science. Berkeley: North Atlantic, 1995.
Resources
Paolo Bellavite and Andrea Signorini
book, Homeopathy: A Frontier in Medical Science. Berkeley: North Atlantic, 1995
Harris L. Coulter, Homoeopathic Science and Modern Medicine: The Physics
of Healing with Microdoses. Berkeley: North Atlantic,
1980
P.C. Endler and J. Schulte (editors), Ultra High
Dilution: Physiology and Physics. Dordrecht: Kluwer
Academic, 1994
Vorwort/Suchen Zeichen/Abkürzungen Impressum