Homeopathy, Pragmatic Medicine, Dogmatic Science, and Supposedly "Unscientific" Religion

Preliminary Observations

1. I freely acknowledge that there is a great deal of quackery which pretends to be science. This is true even in so-called "respectable" circles. When homeopathy was flourishing in the mid-1800s, "conventional" medicine was routinely engaging in such practices as blood-letting. Evolutionists and anthropologists often espoused flat-out racism, based on body type, as late as the 1920s (phrenology). The flourishing eugenics movement at that time called for the involuntary sterilization of black people.

Margaret Sanger, founder of Planned Parenthood, was in the forefront of this hideous movement, elements of which were picked up by the Nazis in the 1930s. Just as Hitler loved abortions of Jewish children, but not German, Sanger was more enthused about abortions of black babies than of white babies (though I'm sure she didn't lose much sleep over the latter, either). Even very recently, pro-abortionists couldn't figure out that the "thing" developing in a mother's womb as a result of fertile copulation was human life from conception, even though this is a straightforward fact of genetics, and could hardly be otherwise (what else would this "blob" be, pray tell: a racoon or a skunk or a turtle?). All the genetic information that a person needs for the rest of their life is present from conception.

Piltdown Man was a hoax (and obviously so, as S.J. Gould noted), but was accepted for over forty years (1912-1954) in the scientific community as excellent proof of human evolution. So-called Nebraska Man was "extrapolated" from a single tooth: later determined to be that of an extinct pig-like creature. A lot of psuedo-science is fraudulent, and charlatanism. Whether homeopathy falls under the category of quack science, I know not. It strikes me as very strange and bizarre, prima facie, but then, so does a lot of modern physics, and I don't claim to be an expert in these matters. My interest is solely in the question of why it works.

2. Advocates of homeopathy could very well be right for the wrong reasons. If the pills work and are effective treatments of various maladies, something must account for that. I assume that the usual, accepted biochemical explanations can be discovered one day, and one need not accept the premise that effectiveness must be explained according to traditional homeopathic principles. Others may be "wrong for the right reasons." They might deny that homeopathic remedies work at all, in the face of overwhelming anecdotal and now (increasingly) rigorous experimental evidence, because they refuse to acknowledge the possibility of anything outside of currently-accepted paradigms. They place virtually all their emphasis on theory, to the exclusion of anomalous evidence (which is dismissed out of hand). I find that to be an unbalanced and unscientific and improperly dogmatic mentality.

3. A person can and should use homeopathic medicines because they work. This is an entirely rational attitude and approach to life, having nothing whatever to do with being a quack, crank, or nutcase. Virtually all people take pills or do other things all the time, without knowing all the inner mechanics of them. Every time I turn on a light switch, I pragmatically take advantage of technology and discoveries and inventions I know next to nothing about, so I can see at night (electricity and the intricacies of a light bulb; alternating current, power generators, etc.). Likewise, when I take acetaminophen (Tylenol) for a headache, I have no idea how it works -- nor do I particularly care to know. All I care about is that it takes my headache away. Maalox takes my stomach upset away. I don't care about how it does that; I hated chemistry in high school. I become very pragmatic when it comes to pain, and quite "unmystical" and "unmagical." I assume there is a scientific explanation; I don't have to know it myself in order to benefit from same.

I take homeopathic pills for allergy and they work; not totally, but in terms of significant reduction of symptoms (allergy drugs work temporarily, but you have to "pay back" by having a return of the symptoms when the pills run out -- I have gone through that process in the last few days with Claritin, because I spent the night in a house with three cats and a dog). I have taken hundreds of such pills (without side effects). It's not a self-induced "placebo improvement." Usually I am engaged in other things and am not thinking about allergies. I pop the pills and my nose stops running; very simple and straightforward; utterly "empirical" (I'm sure any allergy sufferer can readily relate). Someone else can believe about that what they wish. I feel better! I also take a homeopathic sleeping pill (I did last night). It works; every time.

Now, this is all entirely rational and sensible behavior whether one knows all the inner mechanics of it or not. Let me illustrate by example. It is well-known that people were using molds for infections long before science discovered that penicillin could be derived from certain molds (the same could be said for many, many herbal medicines). That was the primitive scientific attitude: trial and error; discovery through experimentation and observation. The people who developed these cures didn't say to themselves, "well, this doesn't fit into our theory about how things are supposed to work, so we won't believe in it, no matter how effective." The goal was to alleviate suffering, by whatever means, not to bolster one's theories at all costs -- up to and including needless human suffering --, or to arrogantly pretend that all knowledge about matter is known and that there is nothing left to discover. This was rational, as is taking a pill without knowing how it works. One could analyze this in quasi-algebraic terms:

A) Infection + mold (including x) = cure.
(x = unknown scientific processes, later discovered to be the workings of a form of penicillin)

B) Headache + acetaminophen (including x)  =  cure.
(x = scientific processes unknown by many users of acetaminophen, but known to scientists in detail)

C) Allergies + homeopathic remedy (including x)  = reduction or elimination of allergic symptoms.
(x = scientific processes not yet known, but possibly yet to be known; meanwhile, the positive results of these unknown processes can be readily verified by present scientific method)

[the presence of discoverable, observable scientific, biochemical laws and processes is assumed throughout]

All three scenarios (from the sufferer's vantage-point) are equally rational. Galileo is said to have uttered the following words about the earth when he was being pilloried by folks who were behind the times in science: "even so, it moves." Users of homeopathy might be excused their retort to hard-nosed scientists who are convinced that their improved health is merely in their head: "even so, it works."

This same dynamic is repeated in excessive "scientific" skepticism towards herbs, vitamins, health food diets, and chiropractic: all long since demonstrated to alleviate pain and various illnesses and maladies (as often verified in the standard medical-scientific literature). The fact that nuts can be found in the health food or nutritional or weight loss or paranormal / occultic "communities" (who tend to believe in some of these alternative treatments) doesn't change the fact that certain things work.

There were and are nuts and kooks and evil people in the "conventional" scientific community also: people like Jack Kevorkian ("Dr. Death"), who gets off by watching people die (he helps them commit suicide), or the Nazi doctors who experimented on living Jewish people, or folks who sell human aborted baby parts for cosmetics, or who advocate cloning, or the ruthless, heartless butchers who stab full-term babies in the back of the neck and suck their brains out, because the child's mother didn't want it (while one million couples wait, hope, and pray to adopt a child), or the "doctors" in China who perform forced abortions, where not even the mother agrees.

4. If I understand correctly, conventional allergy shots give the person some of the substance they are allergic to, in order to build up their immunity. Homeopathic pills for hay fever include ragweed and pollen. If one principle is valid, why is not the other, at least insofar as it has similarity to the first?

5. There are a host of things in natural science that are insufficiently understood, or not at all: sub-atomic particles, black holes, the origins of the universe and of life, etc. Evolutionists have little inkling about many details of many of the processes which produce the biological, morphological change that occurs in organisms. They simply assume that some explanation will be possible in due course. Why cannot the same approach be taken with regard to homeopathy? Granted, the concepts are very radical, but so has science always proceeded. Heliocentric theories overturned geocentric ones.

The theory of relativity and quantum mechanics superseded Newtonian physics. Uniformitarianism transformed geology, and Darwinian evolution, biology. The germ theory and understanding of circulation caused a revolution in medicine and hygiene. Here, however, I am simply stating that if something works (especially where health is concerned), the inquisitive and open mind ought to wonder why and how it works, and study it further. If it can be explained by currently-understood processes, (as I suspect), great. If not, then that is something else we can learn about. The inquirer rejoices in a chance to learn more.

6. Given the vast amount of experimental evidence, documented below, it seems to me that four choices exist:

i) Traditional homeopathic theory accounts for the demonstrated effects.

ii) "Conventional" biochemical understanding will eventually account for these effects, with further study and experimentation.

iii) A combination of i) and ii).

iv) All the studies in reputable journals are sheer nonsense, undertaken by quacks and pseudo-scientists who already have their minds made up, with biased subjects who wish for these results to be true, and thus create them, with shoddy research methods (all of which, somehow, journals like Lancet and the British Medical Journal inadvertantly overlooked when they published the results).

I opt for ii) myself.

A friend of mine who is skeptical of homeopathy claimed that using a homeopathic remedy was an example of "folk religion" and "magical thinking." But I fail to see what is "religious" or "magical" about either popping a pill to stop a runny nose or a double-blind, randomized, placebo-including rigorous study undertaken by Ph.D. skeptics of homeopathy, documented in Lancet or the British Medical Journal.

I was told that symptoms can be "fuzzy" and difficult to analyze with regard to cause and effect. Those aspects are well-covered in the studies documented below, as far as they are concerned with objectivity and measurability. As for the "layman's level of perception" (very much the category I am in), I don't think it takes a rocket scientist to deduce that a migraine is gone, or a scratchy throat, watery, itchy eyes, and a runny nose no longer present. Any one-year-old child; nay, any dog or squirrel possesses that amount of self-awareness.

When I am concerned about my runny nose, the last thing on my mind is a scientific study. More often, it is social considerations and the annoyance that I am concerned about. But for me to know that my nose is no longer running requires neither a Ph.D. nor a nuanced, sophisticated understanding of the history of science, scientific method, or the anatomy, physiology, and biochemistry of the nose, and/or the immune and respiratory systems. It's rather simple, really.

I am not interested in the theoretical justification of homeopathy. It sounds as weird to me as it does to many of its critics. I am only interested in why homeopathy works -- precisely as the researchers documented below were and are. The results of even goofy, eccentric theory can be tested. In this case, we find surprising results that can't be dismissed, even by those who refuse to accept any tidbit of knowledge that doesn't neatly fit into their preconceived notions.

I'm inclined to agree that homeopathy is fundamentally at odds with many scientific beliefs as held today (insofar as I know anything about it at all), but it has no effect on the testing of results, which is virtually my only interest here. I could think homeopathy was as ridiculous as a moon made of green cheese and a flat earth, and all homeopaths dumber than a box of nails, and still be intrigued as to how the potions concocted by such oddballs somehow work.

In any event, the principles of relativity and quantum mechanics were vastly different ways of looking at things, compared to the known laws of Newtonian physics, as late as the 1920s. Lyell's principles of uniformitarianism went against the common understanding of geology as late as 1833. This happens all the time in the history of science. But again, none of this has any bearing on whether or why these remedies work.

My friend expressed skepticism that my homeopathic allergy pills worked, and implied that I was experiencing only a placebo effect. I had a great deal of fun with that:

Maybe we only pretend to "take the pill" too, since we are -- according to you -- merely pretending to "get better." Just like I pretended to "fall asleep" last night after popping my bedside pills . . . I really was awake, only pretending to be asleep. I thought I was dreaming about being awake, but I was really awake and dreaming about being asleep.

. . .  So when my runny nose and generally clogged-up throat improve (when I take the homeopathic pill) and get worse (when the effects wear off; it takes about two hours) repetitively for six weeks during hay fever season, I am only deluding myself that I go back and forth, and in fact, this is obviously a steady course of "natural improvement"? Interesting.

Such personal experience was demeaned as merely "subjective verification." Let's see, then; I guess that would be the "subjective" evidence of my nose not running at the dinner table and my kids noticing that. Not that this proves anything. Maybe they only think that they don't see my nose running, huh?  They're blinded by their love for me. Or, this is "wishful thinking." I confess that I do wish that my nose would stop running, but I am not deluding myself when it actually does.

If something works, I take it. I take Tylenol for my migraines, and it works. Or is that to be immediately dismissed as "anecdotal, wishful thinking, subjective, memory confabulation," etc.? Does anecdotal evidence count only for conventional medicine but not for homeopathic ones? How does that work? Or is it that when a doctor asks me "how do I feel?," my reply has little relation to reality, since it is merely anecdotal and thus of no rational import?

My friend then said that it is not enough that a remedy works; one must understand the principles behind it. But do most people understand all the biochemical ins and outs of acetaminophen or aspirin or cough syrup? Some do, but most people certainly don't. Perhaps my friend should go on a door-to-door crusade to convince people that they must know everything about every medicine they take, in exhaustive biochemical detail?

There are plenty of remedies where we don't fully understand how they work (I think one scientist or doctor mentioned quinine). That doesn't stop them from being prescribed. One simply has to take my position on homeopathy: that it will be explained one day according to the consensus of science. In the meantime, we can participate in its medicinal benefits, just as primitive peoples in the jungle benefitted from molds (penicillin) and a host of herbal medicines without knowing why. It is completely rational behavior to take a pill that works, not knowing how it works. It is not strictly scientific as far as I am concerned personally, inasmuch as I don't know why and how something works; I'll grant that.

My friend stated that taking such a pill was "religious." But it is not at all; no more than taking aspirin or Tylenol is a religious act. It is a pragmatic act which incorporates laws of science and their particular effects, to my benefit, just as I utilize the laws of internal combustion engines to give me the blessing of traveling from point A to point B. The Wright brothers learned aerodynamics and learned how to fly, so I can now fly from point A to point B, too. Or do I have to learn about all that (including jet propulsion now) before I can set foot on a jet, lest I be "unscientific" and unduly "religious" while flying?Tylenol works for most people who take it, I think. It's not a matter of separate "realities," but of common experience.

I'm not trying to place personal experience and anecdotal evidence over clinical experimentation and verification. I'm all for clinical evidence as the clincher and determinant of "successfulness" within a scientific framework of testing and falsifiability. But I don't completely dismiss anecdotal and personal confirmation of health improvement. Nor does any scientific study, which has to rely on the reports of subjects to even test what it is testing in the first place (where human health matters are concerned). The two cannot be separated; they are inevitably intertwined.

And now, here is the documentation in support of the effectiveness of various homeopathic remedies, and even some aspects of homeopathic theory (in a few of the studies, near the end of the list):

1) From: http://www.heall.com/body/altmed/treatment/homeopathy/lancet.html

Lancet Publishes Major Review of Research on Homeopathic Medicine

The Lancet published the most significant and comprehensive review of homeopathic research ever published in its September 20, 1997 issue. This article was a meta-analysis of 89 blinded, randomized, placebo-controlled clinical trials. The authors conclude that the clinical effects of homeopathic medicines are not simply the results of placebo.

The researchers uncovered 186 studies, 119 of which were double-blind and/or randomized placebo-control trials, and 89 of which met pre-defined criteria for inclusion into a pooled meta-analysis. The researchers found that by pooling the 89 trials together that homeopathic medicines had a 2.45 times greater effect than placebo.

The Lancet concurrently published two critiques of the homeopathic research. One critique by Jan Vanderbroucke, MD, a Dutch professor, acknowledged, "The meta-analysis is completely state of the art." And yet, despite its results, he asserts that homeopathic medicines "cannot possibly produce any effect."

Because homeopathic medicines are often so small in dose that physicians and scientists commonly assert that they cannot work, an increasing number of controlled trials and an ever increasing public interest in homeopathy is proving them wrong.

The authors of the research include Klaus Linde, MD, German professor and author of the famed review of research on the herb, St. Johns wort, for depression, and Wayne Jonas, MD, head of the NIH Office of Alternative Medicine . . .

A new survey of primary care physicians who are members of the AMA revealed that an astonishing 49% of them expressed interest in training in homeopathy (British Homeopathic Journal, July, 1997). This survey was conducted by researchers at the University of Maryland. They had earlier surveyed Maryland family practice doctors and discovered that 69% expressed interest in homeopathic training (Journal of the American Board of Family Practice, 1995, 8, 361-6).

(see: Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997;350:834-843)

2) From: http://www.healthy.net/library/journals/resonance/17.2/study.htm

Clinical Study in The Lancet
Efficacy in Allergic Asthma demonstrated
by Thierry Montfort

The Lancet, an internationally renowned peer-reviewed medical journal has just published a clinical study carried out on individuals suffering from allergic asthma. The results of the study clearly demonstrate the efficacy of a homeopathic treatment of this condition.
This work is the result of a collaboration between the author, David Reilly, MD, (an honorary clinical senior lecturer at the University of Glasgow)and foundations including la Fondation Française pour la Rechercheen Homeopathie (FFRH), the European sister foundation of the Boiron Research Foundation. All homeopathic medicines used in this trial were provided by Boiron Laboratories. Another work of Doctor Reilly had previously been published in The Lancet in 1986. This prior study demonstrated the efficacy of a homeopathic treatment of allergic rhinitis.

Facts

The clinical study was conducted during February of 1990, in the double-blind, placebo controlled format, on 24 patients suffering from allergic asthma.

Following a detailed medical examination, the patients were randomly separated into two groups; the first group of patients received the prescribed homeopathic medicine (verum; to which these patients were most sensitive). The second group of patients received placebo instead.

The presentations of the two treatments (verum and placebo) were rigorously identical. The treatment required that a single dose be placed directly in the mouth of the patient by the hospital pharmacist.

During the course of four weeks, the patients made notations of the evolution of their symptoms on a visual analog scale.

Respiratory function tests and, whenever possible, the test of bronchial reactivity to histamine, as well as a complete clinical examination were conducted at the end of the four-week period.

Results

The authors of the article note, "a difference in favor of homeopathy within one week... this difference is confirmed from that point forward." The statistical analysis indicates that the results are indeed statistically significant with a p value = .003.

Background

The article summarizes, in the form of a meta analysis, the results of three clinical studies; the one which is just published, the clinical study of 144 patients with allergic rhinitis which was published in The Lancet in 1986, and a pilot study published in 1985 in the British Homeopathic Journal.

Of these three studies, all conducted in the field of allergy, with identical criteria of evaluation, using a causal agent and a comparable homeopathic treatment, for a total of 202 patients, the average statistical significance is p = .004.

This result clearly justifies the editorial in The Lancet which admits to being confronted with the following choice:

"Either there is something amiss with the clinical trial as conventionally conducted (Dr. Reilly's was done with exceptional rigor); or the effects of homeopathic immunotherapy differ from those of placebo."

Doctor Reilly concluded his study with the following comments: "Could the explanation be three false positive results?... Our results lead us to conclude that homeopathy differs from placebo in an inexplicable but reproducible way."

See:

Reilly, D. et al. "Is evidence for homeopathy reproducible?" The Lancet, December 10, 1994.

(Reilly D, Taylor M, Beattie NG, et al. Is evidence for homeopathy reproducible? Lancet. 1994:344(8937):1601-1606)

This study successfully reproduced evidence from two previous double-blinded trials all of which used the same model of homeopathic immunotherapy in inhalant allergy. In this third study, 9 of 11 patients on homeopathic treatment improved compared to only 5 of 13 patients on placebo. The researchers concluded that either homeopathic medicines work or controlled studies don't. Their work has again be recently replicated and is submitted for publication.

3) Reilly, D., et. al. (1986) Is homeopathy a placebo response? Controlled trial of homeopathic potency, with pollen in hayfever as model. Lancet (October 18): 881-6. This double-blinded, placebo-controlled, randomized trial tested homeopathic preparations for symptoms of hay fever in 160 patients. The study demonstrated a greater overall reduction in symptoms from the homeopathic preparations than placebo.

(Reilly D, Taylor M, McSharry C, Aitchison T. Is homoeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hay fever as model. Lancet. 1986;2(8512):881-886)

The double-blind study compared a high dilution homeopathic preparation of grass pollens against a placebo in 144 patients with active hay fever. The study method considered pollen counts, aggravation in symptoms and use of antihistamines and concluded that patients using homeopathy showed greater improvement in symptoms than those on placebo, and that this difference was reflected in a significantly reduced need for antihistamines among the homeopathically treated group. The results confirmed those of the pilot study and demonstrate that homeopathic potencies show effects distinct from those of the placebo

4) Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of homeopathy: a meta-analysis of clinical trials. Eur J Clin Pharmacol. 2000;56:27-33.

5) Ernst E, Kaptchuk TJ. Homeopathy revisited. Arch Intern Med. 1996;156:2162-2164.

6) Fisher P, Greenwood A, Huskisson EC, Turner P, Belon P. Effect of homeopathic treatment on fibrositis (primary fibromyalgia). British Medical Journal. 1989;229:365-366.

7) Freise KH, Kruse S, Moeller H. Acute otitis media in children: a comparison of conventional and homeopathic treatment. Biomedical Therapy. 1997;15(4):113-122.

8) Kleijnen J, Knipschild P, TerRiet G. Clinical trials of homeopathy. British Medical Journal.  1991;302:316-323.

Review of 107 studies, 81 of which (77%) showed positive effects from homeopathic medicines; researchers concluded: “The evidence presented in this review would probably be sufficient for establishing homeopathy as a regular treatment for certain indications.”

9) Paterson IC. Homeopathy: what is it and is it of value in the care of patients with cancer? Clin Oncol (R Coll Radiol). 2002;14(3):250-253.

10) Ratcliffe J, Van Haselen R, Buxton M, Hardy K, Colehan J, Partridge M. Assessing patients' preferences for characteristics associated with homeopathic and conventional treatment of asthma: a conjoint analysis study. Thorax. 2002;57(6):503-508.

11) van Haselen RA, Fisher PA. A randomized controlled trial comparing topical piroxicam gel with a homeopathic gel in osteoarthritis of the knee. Rheumatology (Oxford). 2000;39(7):714-719.

12) Weiser M, Strosser W, Klein P. Homeopathic vs. conventional treatment of vertigo: a randomized double-blind controlled clinical study. Arch Otolaryngol Head Neck Surg. 1998;124(8):879-885.

This was a study with 119 subjects with various types of vertigo, half of whom were given a homeopathic medicine (a combination of four homeopathic medicines) and half were given a leading conventional drug in Europe for vertigo, betahistine hydrochloride. The homeopathic medicines were found to be similarly effective and significantly safer than the conventional control.

13) C. N. Shealy, MD, R.P. Thomlinson, V. Borgmeyer, Osteoarthritic Pain: A Comparison of Homeopathy and Acetaminophen American Journal of Pain Management, 1998;8:89-91

A double-blinded study to document the relative efficacy of homeopathic remedies in comparison to acetaminophen for the treatment of pain associated with osteoarthritis (OA) among 65 patients. An IRB approved protocol. Results of the study documented better pain relief in the homeopathic group (55% achieved measured relief from homeopathy as compared to 38% from acetaminophen); however, the superiority of this treatment, in comparison with the acetaminophen group, did not reach statistical significance. The investigators conclude that homeopathic treatments for pain in OA patients appear to be safe and at least as effective as acetaminophen, and are without its potential adverse effects including compromise to both liver and kidney function. Many of the patients asked to continue with the homeopathic treatment.

14) J. Jacobs, L. Jimenez, S. Gloyd, Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua, Pediatrics, May 1994, 93,5:719-25.

This study was the first on homeopathy to be published in an American medical journal. The study compared individualized high potency homeopathic preparations against a placebo in 81 children, between ages 6 mo. and 5 yrs., suffering with acute diarrhea. The treatment group benefited from a statistically significant 15% decrease in duration. The authors noted that the clinical significance would extend to decreasing dehydration and postdiarrheal malnutrition and a significant reduction in morbidity.

15) E. Ernst, T. Saradeth, and K.L. Resch, Complementary Treatment of Varicose Veins: A Randomized Placebo-controlled, Double-Blind Trial, Phlebology, 1990, 5:157-163.

This study of 61 patients showed a 44% improvement in venous filling time in the homeopathic treated group when compared with placebo.

16) P. Fisher, A. Greenwood, E.C. Huskisson, et al., Effect of Homoeopathic Treatment on Fibrositis British Medical Journal, August 5, 1989, 299:365-66.

This trial was double-blind with a crossover design, comparing R toxicodendron to a placebo in 30 patients all suffering from an identical syndrome identified as the admission criteria. It showed a significant reduction in tender spots, by 25%, when patients were given the homeopathic medicine, as compared to when they were given the placebo.

17) Homoeopathic therapy in rheumatoid arthritis: evaluation by double-blind clinical therapeutic trial.

Gibson RG; Gibson SL; MacNeill AD; Buchanan WW

Br J Clin Pharmacol, 1980 May, 9:5, 453-9

Twenty-three patients with rheumatoid arthritis on orthodox first-line anti-inflammatory treatment plus homeopathy were compared with a similar group of twenty-three patients on orthodox first-line treatment plus an inert preparation. There was a significant improvement in subjective pain, articular index, stiffness and grip strength in those patients receiving homoeopathic remedies whereas there was no significant change in the patients who received placebo. Two physicians were involved in prescribing for the patients and there were no significant differences in the results which they obtained. No side effects were observed with the homoeopathic remedies.

18) Survey of the use of homeopathic medicine in the UK health system.

Swayne JM

J R Coll Gen Pract, 1989 Dec, 39:329, 503-6

An analysis of 7218 consultations showed that homeopathic medicines are being used to treat a wide range of morbidity in the United Kingdom. The data were derived from all consecutive consultations during one week by 73 doctors who used homeopathic medicine. Of these consultations 88% were conducted as part of the National Health Service (the majority in general practice). Thirty five per cent overall and 25% of general practice consultations were managed using homeopathic medicines, and these were combined with conventional drugs in 8.5% of the prescriptions.

19) Mistletoe in homoeopathic cancer treatment.

Mellor D

Prof Nurse, 1989 Sep, 4:12, 605-7

Mistletoe, or 'iscador' as its homoeopathic preparation is called, has been found beneficial in treating patients with some forms of cancer. It can be used with conventional treatments.

20) A review of the incorporation of complementary and alternative medicine by mainstream physicians.

Astin JA; Marie A; Pelletier KR; Hansen E; Haskell WL

Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Calif 94304-1583, USA.

Arch Intern Med, 1998 Nov, 158:21, 2303-10

BACKGROUND: Studies suggest that between 30% and 50% of the adult population in industrialized nations use some form of complementary and/or alternative medicine (CAM) to prevent or treat a variety of health-related problems. METHOD: A comprehensive literature search identified 25 surveys conducted between 1982 and 1995 that examined the practices and beliefs of conventional physicians with regard to 5 of the more prominent CAM therapies: acupuncture, chiropractic, homeopathy, herbal medicine, and massage. Six studies were excluded owing to their methodological limitations. RESULTS: Across surveys, acupuncture had the highest rate of physician referral (43%) among the 5 CAM therapies, followed by chiropractic (40%) and massage (21%). Rates of CAM practice by conventional physicians varied from a low of 9% for homeopathy to a high of 19% for chiropractic and massage therapy. Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), while fewer believed in the value of homeopathy (26%) and herbal approaches (13%). CONCLUSIONS: This review suggests that large numbers of physicians are either referring to or practicing some of the more prominent and well-known forms of CAM and that many physicians believe that these therapies are useful or efficacious. These data vary considerably across surveys, most likely because of regional differences and sampling methods, suggesting the need for more rigorous surveys using national, representative samples. Finally, outcomes studies are needed so that physicians can make decisions about the use of CAM based on scientific evidence of efficacy rather than on regional economics and cultural norms.

21) Unconventional therapies in asthma: an overview.

Lewith GT; Watkins AD

University of Southampton, UK.

Allergy, 1996 Nov, 51:11, 761-9

Acupuncture, homoeopathy, mind-body therapies, and nutritional, herbal, and environmental medicine have all been used in the management of patients with asthma. This paper reviews the evidence base for the use of these unconventional or complementary therapies. Although there is a paucity of large randomized, controlled trials in this area, there is sufficient evidence to suggest that many of these therapies can produce objective and subjective benefit in selected groups of patients. In view of the increasing popularity of complementary medicine among patients and general practitioners, there is now an urgent need for high-quality research to determine how, or whether, these therapies may be interwoven with the more orthodox treatments currently available.

22) Apparent response of small cell lung cancer to an extract of mistletoe and homoeopathic treatment.

Bradley GW; Clover A

William Harvey Hospital, Ashford, Kent.

Thorax, 1989 Dec, 44:12, 1047-8

A patient with small cell lung carcinoma was treated initially with extracts of mistletoe and homoeopathic treatment and appeared to respond. Subsequently radiotherapy was given and the patient lived for five years seven months, which is much longer than is usual with this type of tumour.

23) A controlled evaluation of a homoeopathic preparation in the treatment of influenza-like syndromes.

Ferley JP; Zmirou D; DAdhemar D; Balducci F

Centre Alpin de Recherche EpidÆemiologique et de PrÆevention Sanitaire, Grenoble University Hospital, France.

Br J Clin Pharmacol, 1989 Mar, 27:3, 329-35

1. A controlled clinical trial was conducted to assess the effectiveness of a homoeopathic preparation in the treatment of influenza-like syndromes. 2. 237 cases received the test drug and 241 were assigned to placebo. Patients recorded their rectal temperature twice a day, and the presence or absence of five cardinal symptoms (headache, stiffness, lumbar and articular pain, shivers) along with cough, coryza and fatigue. 3. Recovery was defined as a rectal temperature less than 37.5 degrees C and complete resolution of the five cardinal symptoms. 4. The proportion of cases who recovered within 48 h of treatment was greater among the active drug group than among the placebo group (17.1% against 10.3%, P = 0.03). 5. The result cannot be explained given our present state of knowledge, but it calls for further rigorously designed clinical studies.

24) Double-blind trial comparing the effectiveness of the homeopathic preparation Galphimia potentiation D6, Galphimia dilution 10(-6) and placebo on pollinosis.

Wiesenauer M; Gaus W

Arzneimittelforschung, 1985, 35:11, 1745-7

The preparation of homeopathic drugs is based on potentiation. In this potentiation the primary substance is specially mixed with a carrier (typically 90% ethanol) in the ratio 1:10. Usually this potentiation is done repeatedly and the final drug is labeled, e.g., "D6" which means a 6 times decimal potentiation. In a controlled randomized strictly double-blind trial with 164 patients the effectiveness of homeopathically prepared Galphimia D6, a conventional Galphimia dilution 10(-6) and a placebo was investigated for the therapy of pollinosis. The average duration of treatment was about 5 weeks. Although no statistical significance was achieved, it is remarkable that there was a clear trend for the superiority of Galphimia D6 while the Galphimia dilution 10(-6) was about equally effective compared with placebo. The study itself demonstrates that it is possible to do strictly controlled trials for homeopathic drugs and with medical practitioners.

25) Andrade, L.; et al. (1991). A randomised controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis. Scand. Journal Rheumatology, 20: 204-8.

26) Davenas, E.; Beauvais, F.; and Amara, J. (1988). Human basophil degranulation triggered by very dilute antiserum against IgE. Nature, 333: 816-18.

27) de Lange de Klerk, E. S. M.; et al. (1994). Effect of homeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. British Medical Journal, 6965: 1329-32.

28) Labrecque, M.; et al. (1992). Homeopathic treatment of plantar warts. Canadian Medical Association Journal, 146: 1749-53.

29) Linde, K.; et al. (1994). Critical review and meta-analysis of serial agitated dilutions in experimental toxicology. Human and Experimental Toxicology, 13: 481-92.

30) Shipley, M.; et al. (1983). Controlled trial of homeopathic treatment of osteoarthritis. Lancet, 1: 97-98.

31) British Medical Journal 1999;319:1115-1118 ( 23 October )
(http://bmj.com/cgi/content/full/319/7217/1115)

Clinical review
ABC of complementary medicine

Homoeopathy
Andrew Vickers,  Catherine Zollman.

Excerpt:

Many scientists have suggested that the clinical effects of homoeopathic medicines are solely due to the placebo effect. However, there have been rigorous, replicated, double blind, randomised trials showing significant differences between homoeopathic and placebo tablets.
The response to this has been mixed. Some people remain unconvinced by the evidence, claiming that there must be another explanation, such as methodological bias, for the results. Others point out that the evidence is very strong and argue that homoeopathic medicines must work by some, as yet undefined, biophysical mechanism . . . Given the difficulties in understanding how homoeopathy may work, researchers have concentrated on establishing whether it is a placebo treatment. Current evidence suggests that this is probably not the case. A recent meta-analysis, published in the Lancet, examined over 100 randomised, placebo controlled trials and found an odds ratio of 2.45 (95% confidence interval 2.05 to 2.93) in favour of homoeopathy. The authors concluded that, even allowing for publication bias, "the results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homoeopathy are completely due to placebo."

32) Barnes J, Resch K-L, Ernst E. Homoeopathy for postoperative Ileus J Clin Gastroenterol 1997; 25: 628-633.

33) British Medical Journal 2000;321:471-476 ( 19 August )

Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series

Morag A Taylor, research associate, a David Reilly, honorary senior lecturer in medicine, a Robert H Llewellyn-Jones, lecturer, b Charles McSharry, principal immunologist, c Tom C Aitchison, senior lecturer in statistics. d a University Department of Medicine, Glasgow Royal Infirmary, Glasgow G31 2ER, b Department of Psychological Medicine, University of Sydney, New South Wales 2006, Australia, c University Department of Immunology, Western Infirmary, Glasgow G11 6NT, d Department of Statistics, University of Glasgow, Glasgow G12 8QQ

Correspondence to: D Reilly, Academic Departments, Glasgow Homoeopathic Hospital, Glasgow G12 0XQ davidreilly1@compuserve.com

Objective: To test the hypothesis that homoeopathy is a placebo by examining its effect in patients with allergic rhinitis and so contest the evidence from three previous trials in this series.

Design: Randomised, double blind, placebo controlled, parallel group, multicentre study.

Setting: Four general practices and a hospital ear, nose, and throat outpatient department.
Participants: 51 patients with perennial allergic rhinitis.

Intervention: Random assignment to an oral 30c homoeopathic preparation of principal inhalant allergen or to placebo.

Main outcome measures: Changes from baseline in nasal inspiratory peak flow and symptom visual analogue scale score over third and fourth weeks after randomisation.

Results: Fifty patients completed the study. The homoeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min, 95% confidence interval 10.4 to 29.1, P=0.0001). Both groups reported improvement in symptoms, with patients taking homoeopathy reporting more improvement in all but one of the centres, which had more patients with aggravations. On average no significant difference between the groups was seen on visual analogue scale scores. Initial aggravations of rhinitis symptoms were more common with homoeopathy than placebo (7 (30%) v 2 (7%), P=0.04). Addition of these results to those of three previous trials (n=253) showed a mean symptom reduction on visual analogue scores of 28% (10.9 mm) for homoeopathy compared with 3% (1.1 mm) for placebo (95% confidence interval 4.2 to 15.4, P=0.0007).

Conclusion: The objective results reinforce earlier evidence that homoeopathic dilutions differ from placebo.

(see: http://bmj.com/cgi/content/short/321/7259/471)

Excerpts from complete paper (http://bmj.com/cgi/content/full/321/7259/471)

Validity of results

Like any other therapy, homoeopathy requires rigorous scientific testing, and one study is insufficient evidence. Some perspective may be gleaned by viewing the results of this trial in the context of the series of which it is part. Except for the subjective measure in this fourth trial, the subjective and objective results show a trend across these four trials clearly pointing to homoeopathy being different from placebo. If the results were due to chance then some trends in favour of placebo would be expected. So does homoeopathy work or are our results due to some other factor?

Recent attempts to resolve the controversy surrounding homoeopathy have centred on the 180 or so controlled trials to date. A criteria based review in 1991 found that the evidence was positive but not conclusive.29 In a 1997 update, other workers concluded that 73% of the existing trial data supported homoeopathy being more effective than placebo, with the pooled odds ratio from a criteria based meta-analysis of 89 trials suggesting homoeopathy showed around twice the overall mean effect of placebo. The difference was significant and proved robust in sensitivity analyses that included correction for publication bias.30 A third working group, independently set up by the European Commission, selected 17 comparisons in 2001 patients for a meta-analysis. The pooled P value was highly significant, and the group commented that "it is likely that among the tested homeopathic approaches some had an added effect over nothing or placebo."31 Are these findings "meta-errors" or, however implausible, does something tangible lie at the core of homoeopathy?

To interpret these findings as arguing for homoeopathy having an effect may now be more plausible than our previous hypothesis of serial false positive results. 3 32 For now, we conclude that this study has failed to confirm our original hypothesis that homoeopathy is a placebo.

34) British Medical Journal 2002;324:498-499 ( 2 March )

Editorials
Randomised controlled trials for homoeopathy

Gene Feder, professor of primary care research and development.

Department of General Practice and Primary Care, Queen Mary's School of Medicine and Dentistry, London E1 4NS

Tessa Katz, general practitioner.

Lower Clapton Group Practice, London E5 0PD

Excerpt:

Most trials of homoeopathy have a different function from those in orthodox medicine: their underlying rationale is to test whether homoeopathic medicines have any clinical effect greater than placebo. Without evidence of such an effect, it is difficult for orthodox clinicians to justify referral to homoeopathic services. The use of randomised controlled trials to test the legitimacy of homoeopathic treatments is the latest chapter in an ideological and scientific struggle between homoeopathy and orthodox medicine going back to the 19th century.5 The fervour of this struggle is reflected in the 58 electronic responses to another trial of homoeopathy reported in the BMJ.6

Are the results of placebo controlled trials in homoeopathy convincing? Linde et al's meta-analysis of 89 trials suggests an effect of homoeopathic medicines greater than placebo.7 The aggregated effect size of homoeopathic treatments, when possible publication bias is taken into account or only high quality trials are included, is modest.8 How seriously clinicians take these findings depends on their prior beliefs.9 . . . the flurry of trials in the past 20 years has changed the terms of the debate. At the very least, those who consider homoeopathy to be absurd have had to muster different philosophical and methodological arguments to defend their position. Randomised controlled trials may be efficient arbiters of clinical effectiveness, but they are not particularly good for resolving philosophical disputes.

Current trials are of a high methodological standard and, if positive, may sway agnostics. Opponents of homoeopathy have made it clear that no number of well designed trials showing an effect greater than placebo will overcome their prior belief that homoeopathy cannot work.

(see: http://bmj.com/cgi/content/full/324/7336/498)

35) JAMA (J. of the American Medical Association)
Vol. 280, pp. 784-787, Sep. 2, 1998

Courses Involving Complementary and Alternative Medicine at US Medical Schools

Miriam S. Wetzel, PhD; David M. Eisenberg, MD; Ted J. Kaptchuk, OMD

(http://www.ama-assn.org/sci-pubs/msjama/articles/vol_280/no_9/joc80673.htm)

Excerpts:

Replies were received from 117 (94%) of the 125 US medical schools. Of schools that replied, 75 (64%) reported offering elective courses in complementary or alternative medicine or including these topics in required courses . . . Common topics included chiropractic, acupuncture, homeopathy, herbal therapies, and mind-body techniques . . .

In 1997, the Group on Educational Affairs of the Association of American Medical Colleges (AAMC) announced the formation of the Special Interest Group in Alternative and Complementary Medicine . . .

The course at Harvard Medical School, Boston, Mass, emphasizes critical reading of the literature and discussion of data from controlled trials relating to the efficacy and mechanisms of action for specific alternative therapies. As a final required project, each student designs and presents a detailed plan for a controlled clinical trial of a chosen alternative therapy . . .

A recent AAMC report on the Medical School Objectives Project refers to the importance of physicians being "sufficiently knowledgeable about both traditional and nontraditional modes of care to provide intelligent guidance to their patients" . . .

In a study exploring the attitudes of 180 family physicians, Berman et al[10] found that physicians had a high degree of interest in complementary and alternative medicine. Blumberg et al[11] found similar results in 572 responses to a survey of primary care internists. More than half indicated that they would encourage patients who raise the possibility of complementary and alternative medicine, and 57% were willing to refer their patients for treatment for 6 or more complementary and alternative therapies.

36) First Ever Homeopathic Study Based on Modern Scientific Methodology Published in JAMA

April 15, 2002 - — VERTIGOHEEL Shown to be Safe and Effective in the Treatment of Vertigo
ALBUQUERQUE, N.M., August 13, 1998 — A study published in the August issue of the Journal of American Medical Association Archives of Otolaryngology - Head and Neck Surgery shows that VERTIGOHEEL, a prescription homeopathic medication, is as effective and safe as betahistine, a histamine analogue considered standard therapy in Europe for the management of vertigo symptoms. The publication of this study in JAMA reflects the growing interest in homeopathic medicine. In fact, in the July 15, 1998 issue of the Journal of the American Medical Association (JAMA), a survey of readers identified "alternative medicine" such as homeopathy, as one of the top ten topics of which more information should be published.

Vestibular or balance disorders such as vertigo, dizziness, and motion sickness affect approximately two million people in the U.S. Despite the severity of vertigo, American physicians lack a conventional medication proven to be an effective treatment for the disease. This study represents the first equivalence trial comparing a homeopathic treatment for vertigo to standard drug therapy.

"This is the first time that the AMA has published a study of a homeopathic drug - a study that was designed according to modern scientific methodology," said Dana Ullman, MPH, president of the Foundation for Homeopathic Education and Research and author of numerous books on homeopathy. "Other respected, peer-reviewed medical publications such as The Lancet, Pediatrics and British Medical Journal are now joined by the AMA’s Archives of Otolaryngology in their scientific review of homeopathic studies."

The year-long, double-blind, randomized, controlled clinical trial compared the efficacy and safety of VERTIGOHEEL with betahistine. The study included 119 male and female patients with acute or chronic vertigo symptoms of various origins. The clinical trial was conducted from 1995 to 1996 at 15 medical clinics throughout Germany. In accordance with good clinical practices, patients were assigned to one of two treatment groups: the VERTIGOHEEL group or the betahistine group. Patients in both groups were given 15 drops three times per day of the active drug (VERTIGOHEEL or betahistine) for 42 consecutive days.

Study Results

The primary efficacy variables for the study were the frequency, duration, and intensity of vertigo attacks. After six weeks, vertigo-specific complaints were significantly reduced in both treatment groups. VERTIGOHEEL and betahistine were therapeutically equivalent in reducing the duration and intensity of vertigo attacks. Although not clinically significant, VERTIGOHEEL was marginally superior to betahistine in reducing the frequency of vertigo attacks.

The study's secondary efficacy variables involved quality of life measurements, including physical health and mental activity, from the patients' point of view. These were assessed using the standardized

MOS-SF36 validated quality of life questionnaire as well as a four-part vertigo-specific questionnaire. The patients' and investigators' global assessment of efficacy also comprised the study’s secondary efficacy variables. There was an increase in the patients' quality of life and a significant decrease in vertigo-specific symptoms in both treatment groups. According to investigators, more than 70 percent of patients in both of the VERTIGOHEEL and betahistine groups reported a significant improvement in quality of life. In addition, for more than 90 percent of study patients in both treatment groups, the tolerability of both drugs was rated as "good" or "excellent."

Clinical laboratory data and vital signs for each patient remained essentially unchanged throughout the course of the study, indicating a favorable safety profile for both VERTIGOHEEL and betahistine.

"These results establish VERTIGOHEEL as a safe and effective treatment for vertigo," said study investigator Michael Weiser, PhD, Director of Clinical Research, Heel, GmbH. "VERTIGOHEEL was shown to be as effective as betahistine, a standard anti-vertigo drug, in significantly reducing the frequency and severity of vertigo attacks and was also very well-tolerated. Because of the lack of effective conventional treatments, VERTIGOHEEL fills a serious void for treating millions of Americans suffering from vertigo and other types of dizziness."

"We are excited about the publication of this head-to-head clinical comparison in an American Medical Association (AMA) journal," said Perry Pedersen, Vice President, General Manager, Heel Inc., the U.S. manufacturer and exclusive distributor of VERTIGOHEEL . "Not only does it prove that VERTIGOHEEL is an effective and safe drug for treating vertigo, but it also demonstrates why homeopathic drugs are gaining acceptance among patients and medical practitioners throughout the world. The fact that such a study has been published in an AMA journal is a landmark in itself. The clinical utility of homeopathic drugs like VERTIGOHEEL is now being objectively assessed by our most respected medical institutions."

(see: http://www.vitamin-resource.com/health/detail.cfm?id=240)

37) Bastide M, Doucet-Jaboeuf M, Daurat V. / Activity and chronopharmacology of very low doses of physiological immune inducers. / Immunol Today. 1985;6:234-235.

38) Bastide M, Daurat V, Doucet-Jaboeuf M, Pèlegrin A, Dorfman P. / Immunomodulatory activity of very low doses of thymulin in mice. / Int J Immunotherapy 1987;3:191-200.

39) Carrière V, Bastide M. / Influence of mouse age on PMA-induced chemiluminescence of peritoneal cells incubated with alpha/beta interferon at very low and moderate doses./ Intern J Immunopharmacol 1990;6:211-214.

40) Davenas E, Poitevin B, Benveniste J./ Effect on mouse peritoneal macrophages of orally
administrered very high dilutions of silica. / Eur J Pharmacol 1987;135:313-319.

41) Petit C., Belon P., Got R./ Effect of Homeopathic Dilutions on Subcellular Enzymatic Activity./
Human Toxicology 1989;8:125-129.

42) Poitevin B, Davenas E, Benveniste J./ In vitro immunological degranulation of human basophils is modulated by Lung histamine and Apis mellifica./ Brit J Pharmacol 1988;25:439-444.

43) Fisher P, House I, Belon P, Turner P. / The influence of the homeopathic remedy plumbum met. on the excretion kinetics of lead in rats. / Human Toxicol 1987;6:321-324.

44) Doutremepuich C., De Sèze O., Anne M.C., Hariveau E., Quilicheii R./ Platelet aggregation in the whole blood after administration of ultra low dosis Acetylsalicylic Acid in healthy volunteers./ Thrombosis Research 1987;47:373-377.

45) Doutremepuich C., De Sèze O., Le Roy D., Lalanne M.C., Anne M.C./ Aspirin at very low dosage
in healthy volunteers:effects on bleeding time,platelet aggregation and coagulation./ Haemostasis
1990;20,99-105.

46) Maddox J./ Waves causes by extreme dilution./ Nature 1988;335,287-289.

47) Morimoto H., Safrit J.S., Bonavida B./ Synergistic effect of tumor necrosis factor and diphteria toxin-mediated cytotoxicity in sensitive and resistant human ovarian tumor cell lines/ J.Immunol. 1991;147,2609-2616.

48) Sainte-Laudy J./ Standardisation of basophil degranulation for pharmacological studies./ Journal of Immunological Methods 1987;98:279-282.

49) Tsuchitani T., Zighelboim J., Berek J., Bonavida B./ Potentiation of cytotoxicity against human ovarian cell-lines with combinations of subtoxic concentrations of tumor necrosis factor and adrianamycin or cisplatinum./ J. Cell. Pharmacol. 1991;2:1-11

50) Van Wijk R., Ooms H., Wiegant F.A.C., Souren J.E.M., Ovelgönne J.H., van Aken J.M. and Bol
A.W.J.M.(1994a)/ A molecular basis for understanding the benefits from subharmful doses of toxicants; an experimental approach to the concept of hormesis and the homeopathic similia law./ Environm. Management and Health 5:13-25.

Index of Journals Cited Above (34 total)

Lancet 1,2,3,30
British Medical Journal (BMJ) 6,8,16,27,31,33,34
Journal of the American Medical Association (JAMA) 35,36
Nature 26,46
Pediatrics 14
Arch Intern Med 5,20
Brit J Pharmacol 42
Br J Clin Pharmacol 17,23
Eur J Clin Pharmacol 4,40
J Cell Pharmacol 49
Thorax 10,22
Allergy 21
J Immunol 47
Journal of Immunological Methods 48
Immunol Today 37
Int J Immunotherapy 38
Intern J Immunopharmacol 39
Rheumatology (Oxford) 11
Scand. Journal Rheumatology 25
Arch Otolaryngol Head Neck Surg 12
Human Toxicology 41,43
Human and Experimental Toxicology 29
Biomedical Therapy 7
Clin Oncol (R Coll Radiol) 9
J Clin Gastroenterol 32
American Journal of Pain Management 13
Phlebology 15
Thrombosis Research 44
Haemostasis 45
Environm. Management and Health 50
J R Coll Gen Pract 18
Prof Nurse 19
Canadian Medical Association Journal 28
Arzneimittelforschung 24

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