The article ‘How effective is the alternative?’ by Dr Mark Colvin refers (Daily News, February 11). As a homeopath in private practice, I do not regard myself as an ‘alternative’ practitioner, but rather as a ‘complementary’ practitioner. My education over 5 years fulltime study in the Department of Homeopathy, Durban University of Technology, was 60% medical (chemistry, physics, biology, anatomy, physiology, pathology, diagnostics, pharmacology) and 40% homeopathic (material medica, clinical homeopathy) by teaching hours. I understand the limitations of homeopathic practice, and refer my patients out as appropriate. I am sure any responsible medical GP does the same.
My perspective on Dr Colvin’s condemnation of homeopathy is that he has committed a ‘straw person’ fallacy, in which an argument is presented which is based on a misrepresentation of the opponent’s position.
Firstly, there is substantial evidence that homeopathy is effective. A study by Linde et al (1997) published in The Lancet entitled, ‘Are clinical effects of homeopathy placebo effects?: A meta-analysis of placebo controlled trials’ analysed 189 studies and concluded that the clinical effects of homeopathy could not simply be ascribed to placebo, and called for further research on homeopathy. A more recent meta-nalysis by Shang et al (2005) published in The Lancet concluded that the clinical effects of homeopathy are placebo effects. However, this meta-analysis is subject to fundamental criticisms, the most notable being that it failed on multiple counts to meet the generally accepted standards for meta-analysis’the QUOROM statement (Quality of Reports of Meta-Analyses of Randomised Controlled Trials), published in The Lancet itself in 1999 (Fisher 2006). One recent example of a study which relied on objective outcome measures for evaluation of effectiveness was that conducted by Klopp et al (2006) as reported in Microvascular Research. They investigated the microcirculatory effects of a homeopathic preparation in patients with mild vestibular vertigo, using vital microscopy techniques. After 12 weeks of treatment, patients receiving the homoeopathic preparation exhibited an increased number of nodal points at the site selected for evaluation, increased flow rates of erythrocytes in both arterioles and venules, increased vasomotion, and a reduction in hematocrit vs. baseline. None of these changes were observed in the control group and the differences between groups were statistically significant. The microcirculatory changes were associated with a reduction in the severity of vertigo in the actively treated patients, both as assessed by the treating physician and by the patients themselves. The researchers concluded that the data supports a pharmacological effect on microcirculation from the treatment.
Secondly, homoeopathic medicine can be cost-effective. Tichard et al (2005) conducted a pharmacoeconomic comparison between homoeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children in France followed for 6 months, involving 499 patients. The ‘homoeopathic strategy’ yielded significantly better results than the ‘antibiotic strategy’ in terms of medical effectiveness (number of episodes of rhinopharyngitis: 2.71 vs 3.97, P<0.001; number of complications: 1.25 vs 1.95, P<0.001), and quality of life (global score: 21.38 vs 30.43, P<0.001), with lower direct medical costs covered by Social Security (88 Euros vs 99 Euros, P<0.05) and significantly less sick-leave (9.5% of parents vs 31.6% of parents, P<0.001). The researchers concluded that homoeopathy may be a cost-effective alternative to antibiotics in the treatment of recurrent infantile rhinopharyngitis. One of the reports arising from the Swiss governmental Program of Evaluation of Complementary Medicine (PEK) investigated costs of complementary and alternative medicine (CAM) and concluded that results of their literature survey suggest lower costs for CAM than for conventional patients (Maxion-Bergemann et al, 2006).
Thirdly, the premise of homoeopathy is not nonsensical. The ultra high dilution (or ultra low concentration) effect is a well known phenomena in nature. For example, the concentration of protein polypeptide hormones in the human body is 10-20M (Hall, 1990). The green sea turtle Chelonia mydas navigates from its feeding ground off the Brazilian coast to its mating and spawning grounds on Ascension Island 200km away. Researchers theorise that chemical substances originating from Ascension Island give rise to an odour plume within the South Atlantic equatorial current that turtles are able to sense and use as a navigational aid (Luschi et al, 1998). Homoeopathy takes advantage of biological sensitivity to ultra high dilutions, utilising substances diluted up to 10-1000 and higher. When considering dilution in homoeopathy, one needs to consider the methodology employed in the dilution process, which involves step-wise dilution with agitation of the fluid at each step. The step-wise dilution is either 1:10 or, more commonly, 1:100. In the latter case, 1 part of the previous step is mixed with 99 parts of a solvent such as 96% alcohol which is then subjected to vigorous agitation (most commonly succussion, but other methods of mixture are deployed depending on the manufacturer) to produce the next step. This continues for up to 1000 steps or beyond. Homoeopathic theory states that the higher the dilution the greater the therapeutic effect. Laboratory models have demonstrated that ultra high dilutions can retain an identity specific to their original substance. Ultra-high dilutions of lithium chloride and sodium chloride (10’30 gcm’3) have been irradiated by X- and Î³-rays at 77 K, then progressively rewarmed to room temperature. During that phase, their thermoluminescence has been studied and it was found that, despite their dilution beyond the Avogadro number, the emitted light was specific of the original salts dissolved initially (Rey, 2003). Hamman, Koning and Him Lok (2003) demonstrated that homoeopathic dilutions of the plant hormone giberrelic acid of up to 10-200 had a significant impact on germination performance of barley seed compared to plain giberrelic acid and a neutral control. A common explanation of how it is that such dilutions can retain information, is that the structure of water lends itself to this (for example Elia et al 2007 and Teixera 2007). Theories as to the role/purpose of agitation are varied, primarily to do with intensifying the presumed ‘existential conflict’ between the molecular organisation of the previous step (which has continuity with the original solute) and the molecular organisation of the diluent which does not have this continuity. This leads to a new combined level of organisation and therefore potential therapeutic impact (Resch and Gutmann, 1987 and 1991). However, Auerbach (1994) analyses the mechanical mixing process of dilutions in terms of fluid dynamics, and concludes that diffusion flow gives rise to the most active force in a mixture. Theoretically (according to Ficks’ law), if a concentrated substance is put into water then a trace of this substance will be found arbitrarily far away immediately: a trace of the substance moves with high velocity from a region of high concentration to a region of low concentration. Other forms of flow serve diffusion, and merely speed up bulk mixing. There is an explanation in homoeopathic history for the origin of dilution, but not for agitation. My own view is that agitation is inherited baggage which has not been sufficiently questioned and deconstructed, and the resulting confusion and criticism causes more damage than it may be worth.
Besides dilution, the other primary premise of homoeopathy is that of similimum or ‘like cures like’, meaning small, highly diluted quantities of medicinal substances are given to cure symptoms, when the same substances given at higher or more concentrated doses would actually cause those symptoms. This mechanism has been elegantly demonstrated in the laboratory by Van Wijk and Wiegant (1995) who applied toxic stress to mammalian cells by application of cadmium. They then ‘treated’ the damaged cells with low concentrations of Cadmium (10Î¼M). This activated synthesis of protector proteins (heat shock proteins), thus stimulating intrinsic mechanisms of repair and self-recovery. Normal cells given the same treatment were not affected. The effect was specific for the agent under investigation. One could possibly say that theoretically vaccination observes the principle of similar, if not similimum, in that a small dose of the ‘toxic’ product is administered in order to provoke the body to produce a protective response.
Clinical effects of homoeopathy have been demonstrated as enumerated above, and laboratory models are now being explored in order to explain the mechanism of action. Scientific research is being conducted mainly by non-homoeopaths in the fields of chemistry, physics and molecular and cellular biology. This is a strength as well as a weakness, in that homoeopaths themselves are seldom qualified to undertake such research or even to adequately understand it or communicate it.
As a result of this clinical and scientific research, there are now several explanations of homoeopathy which exist like pieces of the puzzle, but not yet enough to cohere as a whole.
The lack of adequate scientific explanation is a justifiable criticism of homoeopathy, and is articulated by homoeopaths as well, including the editor of the leading homoeopathic journal Homeopathy who entitled his most recent editorial ‘On the plausibility of homeopathy’ (2008). However, homoeopathy is in fact a young science, being articulated by Dr Hahnemann in Germany only about 200 years ago. What Dr Colvin refers to as ‘Western medicine’ has taken many centuries and huge capital/industrial/political/academic backing to get to the stage where it is today, and there are still gaps, inconsistencies and errors. That is to be expected and is not begrudged. What one looks for is effort in pursuing knowledge and understanding, appropriate training, registration and oversight of practitioners, and ethical standards of practice. This is evident in the Western medicine community, and I experience it to be the case in the homoeopathic medicine community as well, particularly in South Africa where there is a very rigorous framework for education and practice of homoeopathy under the auspices of a statutory body, namely, the Allied Health Professions Council of South Africa. There is even a growing corpus of local research as a result of the Masters degree research and dissertation process students are required to undertake in the process of qualification. The journal article by Technikon Natal (now Durban University of Technology) Masters student Him Lok (2003) on the effectiveness of diluted gibberelic acid in stimulating barley seedling vigour referred to earlier is a case in point.
I agree with Dr Colvin that we should seriously review the contribution that homoeopathy and other forms of complementary medicine make, or do not make, towards improving human health. The same goes for Western medicine. But shutting down the space for such review by seeking to suppress non-Western forms of medicine is not helpful, and flies in the face of moves by the Department of Health to open up this space by organising and formalising the practice of African Traditional Medicine in South Africa by means of the Traditional Health Practitioners Bill published in 2004 (Ndaki, 2004).
My view is that homoeopathy is working. My experience is that, although never 100% effective all the time (no health delivery system is), homoeopathy works for our patients. And we as homoeopaths, are constantly working as individuals and as a profession to improve our clinical and research capabilities.
Auerbach, D. 1994. Mass, fluid and wave motion during the preparations of ultra high dilutions. In: P. C. Endler and J. Schulte, Editors, Ultra High Dilution, Kluwer Academic Publishers (1994), pp. 129’135.
Elia, V., Napoli, E. & Germano, R., 2007. The `Memory of Water’: an almost deciphered enigma. Dissipative structures in extremely dilute aqueous solutions. Homeopathy, 96(3), p.163-169.
Fisher, P., 2006. Homeopathy and The Lancet. Evidence-based Complementary and Alternative Medicine, 3(1). Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1375230 [Accessed February 14, 2008].
Fisher, P., 2008. On the plausibility of Homeopathy. Homeopathy, 97(1), p.1-2.
Hall, E.A.H. 1990. Biosensors. Milton Keynes: Open University Press.
Hamman, B., Koning, G. & Lok, Him K. 2003. Homeopathically prepared gibberellic acid and barley seed germination. Homeopathy, 92(3), p.140-144.
Klopp, R., Niemer, W. & Weiser, M., 2005. Microcirculatory effects of a homeopathic preparation in patients with mild vertigo: an intravital microscopic study. Microvascular research, 69(1-2), p.10-6.
Linde, K. Clausius, N., Ramirez, G., Melchart, D., Eitel, F., Hedges, L.V. & Jonas WB. 1997. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet, 350(9081), p.834-43.
Luschi, P. Hays, G.C., Seppa, C. del, Marsh, R. & Papi, F. 1998. The navigational feats of green sea turtles migrating from Ascension Island investigated by satellite telemetry. Proceedings of the Royal Society B: Biological Sciences, 265(1412).
Maxion-Bergemann, S. Wolf, M., BornhÃ¶ft, G., Matthiessen, P.F. & Wolf, U. 2006. Complementary and alternative medicine costs – a systematic literature review. Forschende KomplementÃ¤rmedizin (2006), 13 Suppl 2, p.42-5.
Ndaki, K. 2004. Regulating Traditional Healers. [online] Available from https://health-e.org.za/news/article.php?uid=20031097 Accessed on 2008-02-14.
Resch, G & Gutmann, V. 1987. Scientific Foundations of Homeopathy. Barthel and Barthel Publishing.
Resch, G. & Gutmann, V. 1991 Structure and System Organization of Homoeopathic Potencies Berlin Journal on Research of Homoeopathy, Vol.1, No.4/5, p.229-235.
Rey, L., 2003. Thermoluminescence of ultra-high dilutions of lithium chloride and sodium chloride. Physica A: Statistical Mechanics and its Applications, 323, p.67-74.
Shang, A. et al., Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet, 366(9487), p.726-32.
Teixeira, J., 2007. Can water possibly have a memory? A sceptical view. Homeopathy, 96(3), p.158-162.
Trichard, M., Chaufferin, G. & Nicoloyannis, N., 2005. Pharmacoeconomic comparison between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in children. Homeopathy, 94(1), p.3-9.
Van Wijk, R. & Wiegant, F., 1995. Stimulation of self-recovery by similia principle?: Mode of testing in fundamental research. British Homoeopathic journal, 84(3), p.131-139.
Please Note: The above article is an opinion piece and does not necessarily reflect the views of Health-e. We are open to publishing contributions that will stimulate debate.
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