Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Dissociation between objective and subjective responses to homeopathy in allergic rhinitis
- Brian J Lipworth (18 August 2000)
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homeopathic understandings
- Bob Leckridge (18 August 2000)
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Publication Bias
- Anthony Cleare (19 August 2000)
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The science of homoeopathy
- Roger A Fisken (19 August 2000)
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Applause for a study well done.
- James Spira (19 August 2000)
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Homeopathy Study may be flawed
- Blaine P Carmichael (20 August 2000)
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The Way Forward with Homoeopathy
- M J Savill (20 August 2000)
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What is a trend?
- David Evans (21 August 2000)
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Re: The Way Forward with Homoeopathy
- John P Heptonstall (21 August 2000)
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Unlikely probability Homeopathy is a collective delusion
- Anne Pettigrew (21 August 2000)
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Was it really allergic rhinitis?
- H Morrow Brown (21 August 2000)
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Homeopathy apparently can - but how?
- Syd Baumel (21 August 2000)
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Vigorously attack publication bias
- Jos van den Broek (21 August 2000)
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Re: The science of homoeopathy
- Brian J Lipworth (21 August 2000)
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Re: Vigorously attack publication bias
- Syd Baumel (22 August 2000)
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Homeopathic dilutions, 'NMR studies', 'Water Memory'
- Michael Cannell (23 August 2000)
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The next step? Individual medication for each patient.
- Francis Treuherz (23 August 2000)
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Different strokes for different folks
- Frank Leavitt (24 August 2000)
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Re: Publication Bias
- M J Savill (24 August 2000)
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Water Memory, Strange Crystals etc
- Peter von Kaehne (24 August 2000)
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Flying in the face of the RCT
- Stephen Pettit, U Kalum Amarasuriya, Anna Buckley, James Heath, Clara Russell (24 August 2000)
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In fact: It isn´t positive
- Jürgen Windeler (25 August 2000)
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Potentisation isn't homeopathy
- Janet Cobill (25 August 2000)
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Misleading commentary
- Michael Emmans Dean (26 August 2000)
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Re: Flying in the face of the RCT
- Michael Emmans Dean (26 August 2000)
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Flawed Statistics
- Barry Miller (27 August 2000)
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Flawed Experimental Design
- Richard Dawkins (30 August 2000)
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Testing the placebo hypothesis
- John Hopkins (31 August 2000)
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What is a homoeopathic placebo?
- Adam Jacobs (1 September 2000)
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Re: What is a homoeopathic placebo?
- Peter Morrell (1 September 2000)
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Thorough understanding of the original theoretical frameworks is necessary in CAM research
- Wainwright Churchill (2 September 2000)
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Confusion over Hahnemann’s Small Doses
- Peter Morrell (2 September 2000)
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Re: Confusion over Hahnemann’s Small Doses
- Wainwright Churchill (5 September 2000)
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Re: Re: Confusion over Hahnemann’s Small Doses
- Peter Morrell (5 September 2000)
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Behemoths
- David Gerring (6 September 2000)
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Re: Re: Re: Confusion over Hahnemann’s Small Doses
- Robert Green (7 September 2000)
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Similarities between Hahnemann’s ideas and those of Tibetan Medicine?
- Wainwright Churchill (7 September 2000)
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Re: Re: What is a homoeopathic placebo?
- Adam Jacobs (8 September 2000)
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Small Doses & Similars
- Peter Morrell (8 September 2000)
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Hoemoeopathy
- Marc Girard (8 September 2000)
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Re: Similarities between Hahnemann’s ideas and those of Tibetan Medicine?
- Peter Morrell (9 September 2000)
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Knowledge, probability,belief
- Dominic Stevens (9 September 2000)
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Science may be good, but it’s not that good
- Wainwright Churchill (10 September 2000)
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Re: Re: Re: What is a homeopathic placebo?
- Peter Morrell (11 September 2000)
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Homeopathy may be very useful
- Joseph Watine (11 September 2000)
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re:homoeopathy requires succussion, not dilution
- James B Semple (16 September 2000)
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The Emperor's New Therapy
- James FitzGerald (19 September 2000)
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Re: The Emperor's New Therapy
- Peter Morrell (21 September 2000)
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Re: Re: Re: Re: What is a homeopathic placebo?
- Adam Jacobs (21 September 2000)
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Declaration of motives
- Peter Morrell (23 September 2000)
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Reply to Adams and FitzGerald
- Peter Morrell (24 September 2000)
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Re: Declaration of motives
- Adam Jacobs (28 September 2000)
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Fallacious arguments
- Joseph Watine (2 October 2000)
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Does even the wrong homeopathy work?
- Christos Hadjicostas (9 October 2000)
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Re: Knowledge, probability,belief
- Dominic Stevens (11 October 2000)
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The data should be made available
- Odd O Aalen (26 October 2000)
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Homeopathic sodium chloride for allergic rhinitis
- Carole Hubbard (13 December 2000)
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Homeopathic "trials"
- Jeffrey V Sutherland (19 December 2001)
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Re: Was it really allergic rhinitis?
- Stephen M Grabosky (26 September 2002)
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Re: The science of homoeopathy
- Patrick J Ryan (12 October 2002)
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Re: What is a homoeopathic placebo?
- Tony Floyd (26 December 2002)
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Brian J Lipworth, Professor of allergy and respiratory medicine Asthma and Allergy Research Group,Dept Clinical Pharmacology,Ninewells Hospital ,Dundee
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The article of Morag Taylor is interesting because of the apparent dissociation between objective(domiciliary nasal peak flow)and subjective(nasal symptoms)responses to homeopathy after 4 weeks in 50 patients with allergic rhinitis.Indeed there are few randomised controlled studies which have measured domiciliary peak nasal inspiratory flow rate in patients with allergic rhinitis, which makes their results all the more intriguing.For example in a study of 38 patients with allergic rhinitis there were significant(p<0.01) correlations for nasal symptom scores versus morning and evening domiciliary nasal peak flow after 4 weeks of treatment(1).In the same study the mean overall improvement in domiciliary nasal peak flow was 25 l/min in response to 4 weeks of anti-histamine - which is comparable to the magnitude of the homeopathy peak flow response[20 l/min).Perhaps a longer period of homeopathy or a different dose might have resulted in a subjective treatment response in patients with allergic rhinitis.Moreover we need to know how homeopathy compares to conventional drug treatment such as intranasal corticosteroid or antihistamine ,given their proven long term efficacy on symptoms in allergic rhinitis(2) . References: (1)Wilson A,Dempsey OJ,Sims EJ,Coutie WJR,Paterson MC,Lipworth BJ .Evaluation of treatment response in pateints with seasonal allergic rhinitis using domiciliary nasal peak inspiratory flow.Clin Exper Allergy 2000;30:833-838. (2)Weiner JM,Abramson MJ,Puy RM.Intransal corticosteroids versus oral H1- receptor antagonists in allergic rhinitis:systematic review of randomised controlled trials.BMJ 1998;17:1624-29. Competing interests:The Asthma and Allergy research group have received funding from :Aventis,AstraZeneca,Schering Plough and GlaxoWellcome who make intranasal corticosteroids or anti-histamines. |
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Bob Leckridge, Associate Specialist in Homeopathic Medicine Glasgow Homeopathic Hospital
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As a General Practitioner, I used homeopathy in an integrated way in my daily work. Since 1995 I've worked full-time in an NHS homeopathic hospital. The insights of homeopathy were revolutionary when first described 200 years ago. Somewhat surprisingly, they are still considered revolutionary. One of the most interesting points in this study is the observation of the phenomenon of the aggravation. Homeopaths have observed that a correctly chosen remedy may temporarily make the patient's symptoms worse and, further, that this occurence has particularly good prognostic significance. If this phenomenon is not described in either placebo or allopathic literature then it is not only a significant challenge to those who wish to dismiss homeopathy as impossible but is also a useful addition to our understanding of the processes of human healing. There are many other such useful insights in homeopathy. Maybe Lancaster and Vickers are right to point out that we need larger RCTs, but, as doctors involved in clinical care, we and our patients would also benefit from more detailed qualitative research into the homeopathic clinical method. Maybe then we could move the debate from mere statistics to furthering our understandings of how people get sick, and how people heal. | |||
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Anthony Cleare, Senior Lecturer in Psychological Medicine GKT School of Medicine and the Institute of Psychiatry
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These studies are make interesting reading. However, what was not addressed in the paper or accompanying editorial, as far as I could see, was the possibility of a publication bias. I am aware of at least one large trial showing that placebo is significantly more effective than homeopathy that has remained unpublished for several years, and I suspect there are more. It is likely that there is a powerful publication bias in effect: there are obvious disincentives acting when homeopathic practitioners come to write up a negative trial. Until all such trials are reported, the 'true' comparison of homeopathy and placebo may remain obscured. |
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Roger A Fisken, Consultant physician Friarage Hospital, Northallerton
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The lack of a plausible biological (actually, biochemical or biophysical) modus operandi for homoeopathic treatments is not merely a minor irritation: it is a fundamental objection to the idea that homoeopathic treatments "work", despite the results of an excellent trial such as the one reported by Taylor and colleagues. We know a very great deal about the chemistry and physics of water, including how it behaves at a quantum level - if this were not true then technologies such as magnetic resonance imaging would not work. In the light of this knowledge the proposition that solutions diluted beyond the Avogadro number can act in a way which is different from that of pure water are, frankly, absurd, in the most literal sense of the term. It is not enough for trials to be made bigger, tighter, or whatever: those who seek to advance the cause of homoeopathy must come up with a reasonable notion of how the treatment might operate at molecular level. If there is new physics here let us hear about it; let us have confirmation at receptor, nuclear membrane or gene promotor. |
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James Spira, Head, Division of Health Psychology US Navy Medical Center
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Once again, Dr. Reilly and his colleagues have conducted an exquisitely designed scientific study into an area which defies scientific explanation. And while his study does not practice good homeopathy, but rather isopathy(possibly the reason subjective symptoms did not improve), it goes far in establishing the power and potential of homeopathic medicine. Such studies make many nervous, since the mechanisms of action can not be well understood by current biological standards. Positive findings for such "unexplained phenomenon" utilizing state of the art scientific method establishes a quandry: Either trust the scientific paradigm and the results of studies which use it, or reject such studies that do not make sense theoretically and at the same time reject all other findings from such studies and indeed the scientific method itself! |
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Blaine P Carmichael, Staff, Baptish Health System, San Antonio, Texas, USA Healthmaster Services
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If homeopathic remedies were produced according to their own strict formula, they would be chemically inert, with something like a single molecule of active ingredient per tankful of carrier substance. If they produce results significantly better than placebo, something must be fudged: maybe a violation of randomization or blinding protocols, or use of homeopathic test substances vastly more concentrated than they were purported to be, or the unsuspected presence of other active material in the carrier. I don't believe that a substance chemically indistinguishable from water has mystical healing powers any more than I believe that holy water sprinked on vampires causes them to burn. I don't believe in any form of magic. Science certainly doesn't have every answer, but we abandon it for magic at our extreme peril. |
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M J Savill, none retired(ill-health)
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As a scientist interested in homoeopathy, and a patient suffering from debilitating allergies, I find the series of papers published by David Reilly et al very exciting. His work, coupled with many other published studies suggesting a response to homoepathy not due to the placebo effect, surely implies that the wider medical community should now take homoeopathy seriously and carry out much larger trials. I call on the MRC and other funding bodies- in the interests of patients- to fund such studies.
The use of 'medicines diluted beyond the Avogadro number' is clearly a major stumbling block to wider acceptance of homoeopathy. I would like to suggest two possible mechanisms for the action of such medicines and some experiments that would help test these hypotheses: 1- It is very difficult to dilute accurately very dilute solutions because of edge effects (such as surface tension). It may be that the solutions prepared by homoeopathic methods are not as dilute as intended, and may in fact contain small numbers of molecules. This effect might perhaps be studied using radioactive labelling and other techniques. 2- The homoeopathic method of preparing medicines includes vigorous mechanical agitation at each dilution (ie 30 times for a 30C medicine). This suggests that energy transfer to the solvent may play an important part in the mechanism of action. The active principle may in fact be the solvent. This could be studied by spectroscopic and NMR comparisons of Homoeopathic solutions and controls of the same serial dilution - but no agitation. I would like to see main stream medicine get a little more excited by Reilly et al results and a little less negative. After all we have the possibility here of side-effect free, very cheap treatment for allergies (and possibly many other conditions). |
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David Evans, General Practitioner Cardiff
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The authors of this paper say "...the subjective and objective results show a trend across these four trials clearly pointing to homeopathy being different from placebo. If the results were due to chance then some trends in favour of placebo would be expected." When the same researchers conducted all the trials, the results could also point to the same mistakes being made four times in a row. Surely, it is independent replication that points to an emerging trend. |
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John P Heptonstall, Director of the Morley Acupuncture Clinic and Complementary Therapy Centre West Yorkshire
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Editor I would also like to see 'mainstream science' get a little more excited at Benveniste's work on the 'memory of water' and other more recent findings. The recurrent quoting of 'Avogadro's Number' as some kind of structure set in stone does little for free scientific expression - especially when a phenomenon such as the 'still active homeopathic dilution' flies in the face of Avogadro. Perhaps it's time to look again at Avogadro's Number in light of the post-modern physics and more recent quantum theories. The simple concept that every particle is affected by every other particle in the Universe, which has received moderate support scientifically through positive experimentation, suggests that particles can react in response to other particle activity lends support to Benveniste's 'memory of water'. The fact that he has also developed experimentation which suggests that this 'memory' is electromagnetic in nature (not surprising) lends further credibility to homeopathic lore. The regular tired old arguments, quoted as 'scientific', are little more than old versions of a reality left behind perhaps 50 years ago. It's time governments supported scientists who have moved on, as opposed to those who should be moved on. Regards John H. |
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Anne Pettigrew, general practitioner Ardgowan Practice, Greenock
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The PCT showing objective evidence in a prestigious medical journal is welcome, yet a derogatory article published immediately subsequent is disappointing.Positive clinical outcome trials of conventional medicine are rarely accompanied by such prejudice. To decry a result because we do not know how a therapy works seems ludicrous and hypocritical when we do not know exactly how anaesthetics nor quinine work, yet they are prescribed frequently. Furthermore there is ample evidence of the effect of diluted vibrated solutions beyond avogadro probability of "activity" on biological systems (e.g. Inhibition of human basophil degranulation by succesive histamine dilutions : result of a European multi-centre trial, Belon et al, Inflamm. Research, 48, supp., 1999,S17-18.) Homeopaths have a broader perspective of medicine and science, beleiving experience rather than intellect based only on contemporary knowledge limitations. Doubters should remember the incredulity of Earth rotating around the sun or of tides having anything to do with lunar activity before scoffing... Finally, the likelihood of thousands of homeopaths world wide over 200 years suffering from the same collective delusion of homeopathic efficacy must surely have a p value less than 0.0025. Some open minds might accelerate investigation of a contentious phenomenon which may have much to teach us. |
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H Morrow Brown, Emeritus Consultant Physician and Allergist Highfield House Highfield Gardens Derby DE22 1HT
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Can we really believe that the objective improvement resulted from the administration of 1Gm of lactose-sucrose globules,(whatever they are) at 8hourly intervals for only one day, 'impregnated' with either a 30c dilution of the allergen or placebo? Examination of the baseline clinical characteristics given in Table 1 could provide an explanation. 8 in the homeopathic group (HG) and 12 in the placebo group(PG) had previously been ineffectively treated with topical steroids, while 3 of the HG and 5 of the PG had been treated effectively. In the HG 8 had had immunotherapy, 3 effectively, and 5 of the PG, 2 effectively, but immunotherapy has been impossible in the UK since 1986. In the HG 5 had had surgery, one with benefit, and in the PG 6 had surgery, 2 with benefit. Then 35 were allergic to mites, but 10 to house dust, presumably not to mites, which is most unusual. Topical steroids are effective in true allergic rhinitis, confirmed by the presence of many eosinophil cells in the mucosal smear or blown specimen. Absence of eosinophils goes with lack of response to topical steroids, so the diagnosis of allergic rhinitis in this group is in serious doubt. It would appear that these results were obtained in a miscellaneous group of volunteers, dominated by 36 females. |
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Syd Baumel, Editor The Aquarian. Winnipeg, Canada.
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In response to the homeopathic study by Taylor et al., at least one correspondent to BMJ has expressed the perennial and inevitable doubt as to the how of homeopathy, even as Taylor et al.'s rigorous trial adds to the weight of controlled clinical evidence that homeopathy can. Anyone who studies the literature on homeopathy will soon find that considerable thought and research has already gone into attempting to answer this question. A common theme is that water, being the universal biological solvent, is somehow capable of being imprinted with information representing the identity of molecules that are vigorously "rubbed into it" during the succussion (vigorous shaking) phases of homeopathic dilution. As the toxic or pharmacologic potency of the diluted substance(s) are progressively (and, homeopaths believe, beneficially) reduced to the vanishing point, some transferable/recordable quality - perhaps an electromagnetic frequency pattern, as research by French immunologist Jacques Benveniste suggests (1) - is transferred deeper and deeper, as if by dyeing, into the watery medium. That such homeopathically treated water is physically different from untreated water is evidenced most recently by a study by Elia and Nicoli (2) in which the former generated significantly more exothermic heat upon mixing with acid or base solutions than identical water subjected to dilution without succussion. The effect lasted weeks.The difference between a homeopathic dilution and the distilled water with which it is made may be analogous to the informationally profound difference between a magnetic tape, CD, hard drive, or other storage medium imprinted with text, music, video or other data and a blank one. What remains to be demonstrated is how fluid ("you can never step into the same stream twice") water could be such a medium. References
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Jos van den Broek, editor in chief Natuur & Techniek science magazine
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M J Savill MA MSc MBA DipHom mentions that the homoeopathic method of preparing medicines includes vigorous mechanical agitation at each dilution (ie 30 times for a 30C medicine). He suggests that energy transfer to the solvent may play an important part in the mechanism of action, and that the active principle may in fact be the solvent. In my opinion he forgets that the 'energy' of the solvent is also diluted (through 30 stages of 1 in 99 dilutions). Therefore, Mr Savill's suggestion will not lead to a solution of the homoeopathy/placebo problem. We better vigorously attack publication bias... |
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Brian J Lipworth, Professor of allergy and respiratory medicine Asthma and Allergy Research Group,Dept Clinical Pharmacology,Ninewells Hospital ,Dundee
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I'm not really too bothered as to the science of homeopathy-as I would be quite happy for my patients to benefit whatever the mechanism,whether it be a "placebo" effect or not.If homeopathy is a form of expensive placebo and it makes patients feel better,then I'm all for it,especially if has no adverse effects.There are many patients I see with allegic rhinitis who clearly do not benefit from conventional therapies or who get side effects.A more mature attitude is to admit the limitations of conventional pharmacotherapy and suggest patients try elsewhere. To deny patients this opportunity is to assume a stance of extreme arrogance .If we can get the answers from RCT's that homeopathy is of benefit in allergic rhinitis then we should include in guidelines that it is a possible option for alternative therapy irrespective of the "science". |
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Syd Baumel, Editor The Aquarian. Winnipeg, Canada.
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In response to speculation by M. J. Savill, Jos van den Broek notes that whatever "energy" (I would suggest "signal" or "information") is theoretically imparted to the dilution medium (that is, water) through succussion is promptly and drastically rediluted, in Taylor et al.'s study by a factor of 99 to 1, twenty-nine additional times, to achieve the final dilution of 30C. Dr. van den Broek assumes this would dash any hopes for meaningful signal transfer, so "we better vigorously attack publication bias" instead. At first glance, this stark fact does seem to suggest that any traces of information gained by succussion are mostly thrown away before the next dilution. But the mystery posed by homeopathy deserves deeper thought. Theoretically, with each phase of succussion and dilution, a progressive change is occurring: the ratio of transferred signal to diluted molecules is growing. If, for example, the diluted material is house dust, the allergenic strength of the homeopathic solution is growing weaker while the putatively counterallergenic signal (a better "teacher" for the immune system?) is growing more dominant. Admittedly, this still leaves open the question of why homeopaths believe dilutions well beyond Avogadro's number (such as the 30C dilution used in the present trial) still continue to grow more clinically potent. As for "attacking publication bias," Linde et al. (1) have attempted to do just that in their meta-analysis of placebo-controlled trials of homeopathy. Their mathematical model predicts that either 923 or 4511 null effect trials would need to be buried in file drawers to reduce to statistical insignificance (p > .05) the odds ratio (1.78, already controlled for publication bias) of the 89 studies that qualified for their meta-analysis. References
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Michael Cannell, General Practice Midway Surgery St Albans UK
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M Saville writes 'NMR studies' should be done on homeopathic dilutions'. Well they have been. Smith and Boericke, in 1966 reported changes in NMR on some homeopathic dilutions and more recent research by Dr Poitevin, in 1992, cautiously reported unexplained NMR differences comparing homeopathic dilutions with placebo. (British Homeopathic Journal 82:1 p 59-60) We know that water molecules form tetrahedron structures in water but recent research suggests that large polymer structues are formed in water : so called 'unique stable non melting ice crystals found in room water temperatures'There was a recent international symposium on these so called IE crystals which are known to maintain an electrical field. Dr Lo reports that they are stable at high temperatures and exist with varying fluctuations after repeated dilutions. Modern Physics Letters b 10,19 1996 : 909-919 (and other similar papers) Is this the key to the concept of 'water memory' as the basis of homeopathic dilutions? We will have to await further research |
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Francis Treuherz, Registered Homeopath Fitzrovia Medical Centre, 31 Fitzroy Square, London W1P 5HH
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This is an interesting article and furthers the verification that something is happening when a potentised or attenuated medication is prescribed. But the meaning of the term homeopathy has been stretched. The application of homeopathy has been the application of a rule of similars, not a rule of equals. Using a medicine made from an allergen is an attempt to give each patient the same medicine, made from the substance which probably created the disturbance. The next step is to follow the rule of similars and to prescribe for each patient as an individual according to the precise symptoms of allergy and rhinitis which are observed. One patient may have worse symptoms of the eye, another of the nose, one my be warm, another may feel chilled so that different medications will be indicated. Then a follow up may be undertaken out of the season to investigate the individual susceptiblity of each patient and attempts made to prevent or diminish the impact of the problem in the next season. These methods will more closely mirror the way homeopaths actually work. |
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Frank Leavitt, Chairman, Centre for Asian and International Bioethics Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Francis Treuherz's remarks about individualized medication get considerable support from three truths which we are beginning to learn from conventional, scientific medicine. The first is that no epidemiological study or clinical trial ever seems to give 100% results: there are always exceptions to the rule. There are even heavy smokers who live long, active and happy lives. The second truth is that environmental factors (nutrition, upbringing, accidents, pollution exposure, psychological trauma, etc.) affecting one individual's health can always be expected to be unique to that individual. The third is that there is no such thing as "The Human Genome", your genome is significantly different from mine. This is what makes DNA fingerprinting possible. The second and third fact not only explain the first. They also suggest that whether or not we accept specific clinical trials, "complementary" therapists, especially homeopathic, Ayurvedic and Chinese, are teaching us a different way of thinking: individualized diagnosis and individualized treatment. It is significant that the worldwide interest in complementary medicine comes at the same time as the advances in the Human Genome Project. Understanding differences among individual genomes may facilitate more scientific trials of individualized medication. |
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M J Savill, retired(ill-health) none
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Surely the problem of 'publication bias' applies to virtually any subject under the sun - not just homoeopathy. I am not sure such ' bias' really matters if there are sufficient well conducted trials with positive outcome. There are, after all, many good reasons for failure of trials. For example, many are very poorly designed from the homeopathic standpoint and do not test homoeopathy,as formulated by its originators, at all. | |||
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Peter von Kaehne, General Practitioner Springburn Health Centre
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Several of the previous contributors mention the so-called water memory and particularly IE crystals found by a Dr Lo in US. It might be interesting to know that Dr Lo was apparently involved in financial fraud law suits primarily concerned with applications build on his IE crystals e.g fuel additives etc. The expert witness heard at these cases could not replicate any of these findings in independent experiments. The conclusion drawn on electron microscopic pictures supplied by Dr Lo was 'Bacteria' found in 'ageing sterilised water' rather than any new structures. Please read for further information http://www.doj.state.or.us/FinFraud/blueblaff.htm I do not have any particular views on homeopathy, but I found it rather irritating to follow the trail of these IE crystals through the internet, only to end up in pages on financial fraud. |
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Stephen Pettit, 4th Year Medical Students Department of Epidemiology & Public Health, The Medical School, University of Newcastle upon Tyne, U Kalum Amarasuriya, Anna Buckley, James Heath, Clara Russell
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The study by Taylor et al of homeopathy versus placebo in the treatment of perennial allergic rhinitis was objectively well conducted. No convincing theories for the physiological effect of homeopathy have been proposed. The results of this study are unpalatable to our rational biomedical community. The randomised controlled trial (RCT) is the foundation of evidence based medicine. Good clinical practice requires RCT evidence to be evaluated and applied according to merit. To reject the findings of this RCT simply due to lack of understanding is to question the principles of evidence based medicine. Can homeopathy be integrated into clinical practice? Trials are required to compare homeopathy with current standard therapy in a range of conditions. The safety of homeopathy in conjunction with standard therapy also needs to be proven. This would establish an appropriate role for homeopathy in the management of a range of conditions. |
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Jürgen Windeler, Head of Dep. Evidence Based Medicine Medical Advisory Service of Social Sickness Funds (MDS), Essen, Germany
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Before taking this study´s results as an opportunity to dive deeply in speculations how homoeopathy might work, we should first take a more careful look at the study and state that the trial was negative, the meta-analysis was (or may be) flawed, there was no homoeopathy at all. All three preceding trials used the change in VAS as the sole main endpoint - with significant results. In this trial the calculation of sample size was also done for one main endpoint only - the change in VAS, consistent with the others. The p-value is 0.82 which obviously means that the trial was by no means able to reproduce the positive results of the others. The discrepancy with additional "objective" data is interesting but not positive for homoeopathy: What is to be the interpretation of this discrepancy in the light of the preceding trial where the discrepancy was just the other way round? The meta-analysis is founded on 4 trials with different indications, different treatments, flaws in design and analysis and a significant heterogeneity in treatment effects. The latter is almost spectacular in a series of only 4 relatively small trials considering the low power of these statistical tests. Obviously, there were large differences between the trials. In such heterogeneous situations, researchers are advised to refrain from doing meta-analyses because these can lead to grossly misleading results. The patients in this study underwent allergic testing according to standards of orthodox medicine. The allergens were chosen on the basis of standards of orthodox medicine. There was no homoeopathy at all. The only part reminding the reader of homoeopathy is the dilution procedure. This whole scenario has nothing to do with the usual practice of homoeopathy – which, if the trial were perceived to be negative, would be the unanimous justification by homoeopaths. Do we learn anything from this publication which is convincingly in favour of homoeopathy? My answer is: No. |
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Janet Cobill, Registered homeopath
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I am puzzled about the reaction articles on the effectiveness of homeopathy always provoke from the medical profession. There are so many things that cannot be fully explained and to deny them because a satisfactory explanation can be given is a little foolish. What do you do today that could not be explained a hundred years ago? Does that mean it doesn't happen? And do we yet know how a bumble bee stays in the air? No, but clearly it does. Potentisation of remedies is a large part of homeopathy but it is not the basis of it. A remedy made of a dilution beyond Avagadro's number is not an essential part of homeopathy, indeed in mainland Europe remedies are frequently given in a very low dilution. A homeopathic prescription is one which is made on the basis of a substance being able to cause symptoms similar to the patients own, e.g. sore throat which is very red, with odema, where the patient experiences burning and stinging pains which are ameliorated by cold applications (drinking water)call for Apis (made from a bee sting) as could arthritis in which there was great heat, swelling and a sensation of burning and stinging pains ameliorated by cold applications. |
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Michael Emmans Dean, Doctoral student Department of Health Sciences & Clinical Evaluation, University of York, Heslington, York YO10 5DD
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In the latest homeopathy allergy trial report, [1] one objective and one subjective measure are clearly and consistently described as main outcomes of equal importance: 'nasal inspiratory peak flow and symptom visual analogue scale score' according to the abstract. Aggravations, adverse effects and drug usage are equally clearly listed as secondary outcomes. Why then do the authors of the commissioned commentary impose their own ranking on the two main outcomes? [2] They promote the negative visual analogue scale result as 'the primary outcome' and demote the positive peak flow result as 'a second outcome'. Unintentionally misleading, perhaps, but misleading nonetheless — especially for readers in a hurry — when important secondary outcomes such as homeopathic aggravation are not discussed at all in the commentary. 1. Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC. Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. Br Med J 2000;321:471–476. 2. Lancaster T, Vickers A. Commentary: Larger trials are needed. Br Med J 2000;321:476. |
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Michael Emmans Dean Department of Health Sciences & Clinical Evaluation, University of York, HeslingtonYork YO10 5DD
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Dear Editor Pettit et al raise the important question of whether positive homeopathic trials should be treated any differently from conventional treatments in health care that is ostensibly evidence-based. This brings to mind an interesting example of the unforeseen way double standards can rebound on those who refuse to accept positive results for homeopathy. The homeopathy meta-analysis by Linde and colleagues found a positive result in a sub-group of the most formally rigorous trials only — those with quality scores of >=70%.[1] More recently, Jüni and colleagues compared 25 quality scales including Linde’s by using them to rate a sample of 17 trials of low-molecular-weight heparin (LMWH) or standard heparin in prevention of deep vein thrombosis during surgery.[2] Trials rated as high-quality under the Linde scale showed greater benefit from LMWH, reversing the findings of the original meta-analysis from which the sample of 17 heparin trials was taken.[3] Jüni and colleagues attribute the spectrum of results obtained to the content of the scales themselves. Accepting this explanation, one of the authors of the earlier heparin meta-analysis has subsequently singled out Linde’s quality scale for attack: it not only ‘maximally disconfirmed’ his original findings, but had also achieved a ‘scientific impossibility’ — a positive result for homeopathy.[4] As usual, an alternative explanation is possible. The content of Linde’s scale is similar to others on test — such as the well-known Jadad scale [5] — that did not reverse the earlier heparin meta-analysis. The main difference is the exceptionally high cut point of the Linde scale relative to its median score of 50% for the 17 heparin trials — only 3 reached >=70%. Compare this with Jadad’s scale where the median score was 60%, and 9 of 17 trials were rated as high quality — because the cut point was also set at 60%. If cut points are the important variable here, Vandenbroucke’s implication that Linde’s scale is intrinsically unreliable because it overturned his LMHW conclusions is as questionable as his apriori refusal to accept the positive results of Linde’s homeopathy meta-analysis.[6] It would seem that the original heparin meta-analysis fell at a hurdle designed to trip homeopathy — one which homeopathy sailed over. 1. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, et al. Are the effects of homoeopathy all placebo effects? A meta-analysis of randomized, placebo controlled trials. Lancet 1997;350:834-843. 2. Jüni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta-analysis. J Am Med Ass 1999;282:1054–1060. 3. Nurmohamed MT, Rosendaal FR, Buller HR. Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery. Lancet 1992;340:152–156. 4. Vandenbroucke JP. Scoring the quality of clinical trials. J Am Med Ass 2000;283:1422. 5. Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–12. 6. Vandenbroucke JP. Homoeopathy trials: going nowhere. Lancet 1997;350:824. |
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Barry Miller, Consultant Anaesthetist Royal Oldham Hospital
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Editor - Taylor et al came to the conclusion that "this study has failed to confirm our original hypothesis that homeopathy is a placebo" [1]. Unfortunately, the statistics do not prove that. The basis for the study was a prestudy power calculation [2] which required 120 patients to prove the hypothesis, with a 5% significance and an 80% power, infact only the study only recruited 51 patients, but analysed the results as if they had the required number. In fact their only conclusion was that they do not have enough data to make a conclusion. If we accept the availability of only 51 patients at the outset, what are the relevant calculations ? The power calculation is only 43%, and to maintain the power calculation at 80%, the "p-value" becomes 34% ! The only conclusion is that the trial is not able to prove anything. Barry Miller, 1. Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC. Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. BMJ 2000; 321: 471 - 476. (19-26 August). 2. Reilly DT, Taylor MA, McSharry C, Aitchison T. Is homoeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hayfever as model. Lancet 1986; ii: 881-886 |
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Richard Dawkins, Charles Simonyi Professor of the Public Understanding of Science University of Oxford
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If double blind trials really show homeopathic doses to be effective, physicists and chemists should fall over themselves trying to find out how a solution so dilute as to contain not a single molecule of the alleged agent can still be active. It would certainly be worth a Nobel Prize, for it would have to involve a fundamentally new principle of Physics. It seems, on the face of it, more probable that an honest mistake has been made in the experimental design. I have one immediate suggestion. If I am right, the way to control for it would be to perform the successive dilution procedure separately for every patient. It is not clear whether Taylor et al’s French suppliers did this. I suspect not, since the process would have been tedious and time-consuming, and well worth mentioning alongside all the other exhaustive precautions so laudably taken. The 24 experimental patients received a homeopathic dose of their specific allergens, successively diluted 30 times by a factor of 99:1 each time. This is enough to achieve a dilution of 10 to the minus 60 -- the chance of any one patient encountering as much as a single molecule of active ingredient is therefore vanishingly small. The 27 control patients received a placebo made by passing the same diluent (30% alcohol) through the same procedure of 30 stages of successive ‘dilution’. The intention was that the only difference between experimental and control doses should be the presence or absence of a single drop of allergen solution in the first of the 30 successive dilution stages. But consider the solution finally administered to the 27 placebo patients. On the assumption that it was a bulk preparation administered to all of them, it would have been dominated, 99:1, by the last tranche of diluent used. One would normally assume that this was pure diluent, just 30% alcohol. Where homeopathy is concerned, however, things are by no means so clear. There must be trace impurities in the tank of diluent, and these are unlikely to be completely homogenously distributed. Trivial as this heterogeneity might seem to an ordinary chemist, its effects will be massive when compared with homeopathic dilutions of the allergens. The upshot is that different ‘brews’ of placebo are likely to be subtly different (and not so subtly, by homeopathic standards) from each other. If all patients were given their own individual brew of successively diluted solvent, the only consistent difference between experimental patients and controls would indeed be the single drop of allergen which initiated the process for experimentals. In fact, however, if all control patients were given a dose taken from the same ‘brew’, the data obtained from different patients is not independent. All would have received the same ‘batch’ of whatever trace impurities were heterogeneously distributed in the last tranche of diluent. This vitiates the independence-of-data criterion for statistical comparison. My criticism is quantitatively mitigated by the fact that not all experimental patients received the same homeopathic dose: each was given an individually tailored allergen. To that extent, separate dilution series must have been run. The authors do not say how many separate allergens were used. But the mere fact that (as I presume) only one batch of placebo was prepared, is enough to invalidate the conclusion. Admittedly, normal chemists are quite happy to assume that successive samples from the same bottle are the same substance. But we are talking homeopathy here, and successive samples from the same bottle are likely to differ from each other by much more than a homeopathic dose differs from a control. Richard Dawkins |
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John Hopkins, General Practitioner Darlington
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Dear Sir, This paper by Taylor et al is represented as attempting to compare placebo with homeopathic remedies. I know nothing about homeopathy but I spend a lot of time talking to people with allergic rhinitis and cannot help but wonder why Taylor and colleagues chose this condition to study. The search for statistical significance implies exquisite precision. However, symptoms relating to hay fever and a runny nose simply do not lend themselves to this kind of quantitative assessment. The measurement of nasal air flow rates is not part of standard clinical practice and has presumably been introduced on the grounds that you make important that which is measurable rather than measure that which is important. If Taylor can produce evidence of changes to blood glucose, or lipids or the calibre of patients coronary arteries then those of us at the coal face might start taking notice. Yours sincerely, Dr John Hopkins |
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Adam Jacobs, Director Dianthus Medical Limited
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The idea behind homoeopathy is that as a homoeopathic remedy is diluted, its therapeutic effect becomes more powerful, even if dilutions continue beyond the Avogadro number. Let us leave aside for the moment the problem that this is incompatible with the laws of chemistry and physics as we understand them, and look at a different problem. The problem is the nature of the placebo used in homoeopathic studies. Water is chemically an extremely stable substance, and the water used in the placebo will have been around for thousands or even millions of years. At some time, the water (or at least some of it) will certainly have been part of a large body of water, such as the Atlantic Ocean. Since the allergens investigated by Taylor et al are widely distributed in the environment, some allergen is sure to have entered this body of water at the time that the water molecules destined to become homoeopathic placebo were in it. At that time, the body of water would have been an extremely dilute solution of the allergen, and so in homoeopathic terms, a very powerful one. In the process of coming from this large body of water, through various purification stages, to a bottle of diluent in a homoeopathic laboratory, the water will have been diluted still further. It does not matter that none of the allergen was left in the water at an early stage in this purification process, of course, as this just makes the therapeutic effects all the more powerful. By the time the water ends up in the placebo, it will have been diluted many more times than even the extremely dilute active medication, and should, in homoeopathic terms, be incredibly powerful. What Taylor et al have therefore shown is that a powerful homoeopathic solution (the placebo) is less effective than a weaker one (the active medication). I think the homoeopaths have some explaining to do. |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir Adam Jacobs says: "At that time, the body of water would have been an extremely dilute solution of the allergen, and so in homoeopathic terms, a very powerful one." [1] This is false reasoning as homeopathy does not produce potency by dilution but through serial dilution combined with succussion. Both are necessary to produce a homeopathic potency, mere dilution alone does nothing. Therefore all the rest of his conclusions are equally flawed. "In the Organon, however, he [Hahnemann] stated that trituration and succussion release the ‘spirit-like power’ of the medicine - which is compatible with his assumption that medicines act through their spiritual [geistlich] or dynamic impact upon the organism." [2] ‘But with time there emerges ever more clearly the view that, by shaking and trituration, a uniform mixing, dilution and weakening of the medicinal substance is not all that is achieved; on the contrary, the material part of the medicine is thereby more and more eradicated and as a consequence the spiritual part of the medicine [not perceptible to human faculties] is released and extraordinarily increased. This is dynamization...be possible to increase the power by succussion; the more the medicine is succussed when prepared, the stronger its effect...’ [3] "By trituration and succussion, he says, the medicinal power of medicines may be increased almost to an infinite degree. Hence we are warned against succussing our succussive dilutions over-much." [4] “...in preparation the vial had to be ‘succussed’. A simple dilution was not sufficient; the vial containing the medicine had to be struck against a leather pad a number of times.” [5] "It is highly probable that during such dynamization...the material substance eventually dissolves completely into its individual spirit-like essence and that its crude state can be regarded as actually consisting only of this spirit-like essence, as yet undeveloped." [6] Sources [1] BMJ letter, 31 Aug 2000, Adam Jacobs, What is Homeopathic Placebo? [2] Coulter, Harris L, 1973, Divided Legacy, 3 vols, Wehawken Books, Washington USA, vol. 2, p.403 [3] Haehl, Dr Richard, 1923, Samuel Hahnemann His Life and Work, 2 vols, Jain, India, Vol. 1, p.324 [4] Dudgeon, Dr Robert E, 1853, Lectures on the Theory and Practice of Homeopathy, London, p.346 [5] Kaufman, Martin, 1972, Homeopathy in America, Johns Hopkins Univ Press, Baltimore, p.26 [6] Hahnemann, Dr Samuel, 1842, Organon of Medicine, combined 5th/6th edition of Dudgeon and Boericke, v.270, end |
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Wainwright Churchill, Traditional Chinese acupuncturist and Chinese medical herbalist London
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In biomedical research into complementary and alternative medicine (CAM) modalities, it is very important that the original theoretical framework be thoroughly understood and used as a basis of research. For example, in the case of homeopathy, the idea that potentisation is achieved through dilution is reductionist and incorrect. As Peter Morrell points out (1), in homeopathic theory, it is not dilution, but ‘spirit- like essence’ that is the basis of the efficacy of homeopathic medicines. Any research which is designed not taking this into account is in danger of being flawed in any respect in which such information is relevant. In biomedicine, research into a surgical procedure performed by people who know little about surgery would be considered unacceptable. It is regrettable that much biomedical research or interpretation of research into CAM modalities is performed by biomedically trained researchers who are not experts in the CAM modality itself. With acupuncture, for example, this has led to acupuncture points needled superficially being considered placebo points, which runs contrary to oriental medical understanding. Another example of a lack of understanding of CAM modalities’ own theoretical frameworks was provided by Prof. Ernst, Professor of Complementary Medicine at Exeter University, when he asserted that the existence of Yin and Yang have not been substantiated by scientific research, in the article "What's the Point”. (2) Yin and Yang are not things, and therefore cannot exist; they are comparative, descriptive concepts, such as saying that something is hotter than something else. Ernst’s statement is highly misleading to an audience that is not conversant with Chinese medical theory. Research based on erroneous premises is of dubious, if any, value. As the acupuncturist Charles Buck has pointed out, poor understanding of medical theory, CAM or conventional, can lead to absurd research, for example, dissecting a brain to find the thoughts that it is hypothesised the brain produces. There are many calls for rigorous research into CAM modalities, but if these are to have comprehensive and genuine value, they will have to be undertaken and interpreted by researches who have a thorough understanding of the CAM modalities’ own theoretical frameworks. References (1)Morrell, P. Re: What is a homeopathic placebo, September 1, at http://www.bmj.com/cgi/eletters/321/7259/471 ) (2)"What's the Point?", The Independent, 20 October, 1998. |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir, Because of the confusion in the letters to this article, I present a carefully arranged series of quotations, drawn from reputable sources, which convey the essence of how Hahnemann came upon, and developed the whole technique of small doses. Those wishing further detail can consult the texts here cited. Apologies for length. ‘When Hahnemann first announced cures of diseases by extremely small doses of medicine, his statements were received with incredulity and ridicule...Hahnemann’s appeal to the medical profession to test the new method and publish results to the world was met by active opposition. He was forbidden to practice and was driven from his home by relentless persecution....[even though] the use of the infinitesimal dose in homeopathy was the outcome of experience...’ [1] ‘[The] principle of the infinitesimal dose [is]...an outrage to human reason.' [2] “…the doctrines of potentiation and the infinitesimal dose has always been the central point of attack upon homeopathy by its enemies.” [3] 'In the United States, regular physicians...found Hahnemann's theories absurd and incredible. Reasoning that no one in his right mind could believe such arrant nonsense, they concluded that homeopaths must be either knaves or fools.' [4] “Hahnemann claimed that a dilution as minute as 1/500,000th of a grain or even 1/1,000,000th of a grain, could be effective...to orthodox practitioners, who in many cases prescribed drugs by the spoonful, Hahnemann’s ideas were ridiculous.” [5] “Hahnemann pointed to...classical literature to demonstrate that his discovery was known to writers of antiquity and was essentially rediscovered by him. He also recognised that his doses would be considered ludicrous by physicians accustomed to heroic therapy.” [6] “Hahnemann argued that skeptical regular physicians should not concern themselves with the logic of homeopathy, but rather look at the results.” [7] “The more he experimented with the proper homeopathic doses, the smaller the dose he recommended.” [8] "His discovery of the principle of potentisation came about gradually as he experimented in the reduction of his doses, in order to arrive at a point where severe aggravations would not occur. Gradually, by experience, he learned that the latent powers of drugs were released or developed by trituration, dilution and succussion." [9] “Hahnemann…perplexed by the aggravations resulting from ordinary doses, seeking to find a dose so small that it would not endanger life and desiring to accurately measure his degree of dilution so that he might repeat or retrace his steps, invented or adopted the centesimal scale…” [10] ‘Under certain conditions he found, perhaps to his surprise, that instead of weakening the drug he was actually increasing its curative power. In reducing the density of the mass he perceived that he was setting free powers previously latent, and that these powers were the greatest and most efficient for their therapeutic purposes...’ [11] “This reduction [in dose] was apparently due to Hahnemann’s observation that medicines administered in substantial amounts according to the law of similars caused severe aggravation of symptoms.” [12] “His chief endeavour was obviously to establish a theory of dosage.” [13] “From [1796] onwards he selected remedies from the standpoint of similarity, still administering, however, fairly large doses.” [14] “…in 1798…he still prescribed 8 grains of Ignatia and China in quantities of ½-1 grain…” [15] “In his essay announcing the discovery of a new therapeutic principle, published in 1796, no allusion is made to any doses different from those in ordinary use...and in his writings up to 1801 nothing is to be found to lead us to suppose that there was anything exceptional in his mode of employing drugs...” [16] “In his early years of practice Hahnemann used doses comparable to those of his colleagues...in 1799 he first announced the principle of the infinitesimal dose, and after 1800 his dose sizes were gradually reduced.” [17] 'We cannot fail to be struck by the sudden transition from the massive doses he prescribed in 1798 to the unheard-of minuteness of his doses only one year later, and we can but guess the causes for this abrupt transition.' [18] “In 1799 he suddenly announced without particular explanation very small and so-called infinitesimal doses.” [19] “It is in his little work on Scarlet Fever, published in 1801, that we have the first forebodings of an unusual mode of preparing the medicines...the dose of Opium there recommended...is very small compared with the ordinary dose...the object of this dilution was to diminish the power of the medicine chiefly...for patients of very tranquil disposition...” [20] “For the cure of the first stage of Scarlet Fever the dose of Belladonna prescribed was only the 432,000th part of a grain of the extract, a quantity intermediate betwixt our 2nd and 3rd dilution.” [21] “He gave her the one four hundred and thirty-two thousandth part of a grain of Belladonna, with the result that in about twenty four hours she became well...in Hufeland’s Journal, 13.2, January 1801, he published ‘On Small Doses of Medicine in General and of Belladonna in Particular’...and supports his doses of Belladonna previously given.” [22] “…the question of doses. Remarkably enough he even passes over them in silence in his first Materia Medica, which appeared in 1805…” [23] “…Materia Medica Pura…there are accurate statements in the second volume appearing in 1816…Arsenicum is recommended in 12th, 18th and 30th dilution; Hahnemann gives preference to the 30th…” [24] “…from 1824 to 1827…he gradually increased the dilution of remedies.” [25] “In the year 1829 Hahnemann came upon the strange idea of setting up a kind of standard dose for all curative remedies…this was to be the 30th centesimal.” [26] “...1/1,000,000 of its original strength. This constituted the third centesimal dilution; Hahnemann recommended the thirtieth dilution.” [27] ‘In the Organon, however, he stated that trituration and succussion release the ‘spirit-like power’ of the medicine - which is compatible with his assumption that medicines act through their spiritual [geistlich] or dynamic impact upon the organism.’ [28] ‘But with time there emerges ever more clearly the view that, by shaking and trituration, a uniform mixing, dilution and weakening of the medicinal substance is not all that is achieved; on the contrary, the material part of the medicine is thereby more and more eradicated and as a consequence the spiritual part of the medicine [not perceptible to human faculties] is released and extraordinarily increased. This is dynamization...the more the medicine is succussed when prepared, the stronger its effect...’ [29] ‘By trituration and succussion, he says, the medicinal power of medicines may be increased almost to an infinite degree. Hence we are warned against succussing our succussive dilutions over-much.’ [30] ‘Whilst in the earlier periods of the growth of his system he merely tells us to shake the bottle, to shake it strongly - to shake it for a minute or longer - he afterwards tells us that much shaking increases the power of the medicine to a dangerous extent, and therefore only two shakes must be used for each dilution. Latterly, however, he again loses his dread of shaking, and after once more appointing ten shakes for each dilution as the standard, he becomes more liberal and allows twenty, fifty, or more shakes, and half a dozen shakes to the bottle before each dose of the medicinal solution. Again, whereas in one place he says that the shaking is the only agent in the dynamization...in another he alleges that dilution is essential to the dynamizing effect of succussion, and that all the rubbing and shaking in the world will not dynamize an undiluted substance.’ [31] “...in preparation the vial had to be ‘succussed’. A simple dilution was not sufficient; the vial containing the medicine had to be struck against a leather pad a number of times.” [32] "It is highly probable that during such dynamization...the material substance eventually dissolves completely into its individual spiritlike essence and that its crude state can be regarded as actually consisting only of this spiritlike essence, as yet undeveloped." [33] ‘Homeopathy is opposed to the use...of drugs in physiological doses...it depends for all its results upon the dynamical action of single, pure, potentised medicines, prepared by a special mathematico- mechanical process and administered in minimum dose. [34] “...he would then prescribe this drug in a small dose. In some patients, the symptoms at first increased before there was any response. He then tried giving progressively smaller and smaller doses. He always advocated giving the smallest dose necessary to help the patient...he evolved a method of mixing, diluting and shaking which he called succussion...” [35] “He was well aware that some of the remedies in their most concentrated form were highly poisonous and he had, therefore, successively reduced the size of the dose. Experimenting in this way he found that not only was the effectiveness maintained, but even increased, when the dose was infinitesimally small.” [36] “...it was not long before Hahnemann’s persistent experimentation revealed that dilution and succussion of remedies somehow rendered them more effective...” [37] Sources [1] Close, Dr Stuart, 1924, The Genius of Homeopathy Lectures and Essays on Homeopathic Philosophy, New York, p.227 [2] Sir John Forbes, 1846, Homeopathy, Allopathy and Young Physic, p.17; quoted in Nicholls, Phillip A, 1988, Homeopathy and the Medical Profession, Croom Helm, London, p.121; Forbes was physician to Queen Victoria, 1840-61 [3] Close, op cit, p.215 [4] Blake, John B, 1981, Homeopathy in American History, Trans. Stud. Coll. Phys., Philadelphia, Series 5, vol. 3, 1981, pp.83-92, p.86 [5] Kaufman, Martin, 1972, Homeopathy in America, Johns Hopkins Univ Press, Baltimore, p.26 [6] Rothstein, William G, 1972, American Physicians in the Nineteenth Century From Sects to Science, Johns Hopkins Univ Press, Baltimore, p.157 [7] Rothstein, op cit, p.157 [8] Rothstein, op cit, p.155 [9] Close, op cit, p.190 [10] Close, op cit, p.218 [11] Close, op cit, p.216 [12] Coulter, vol. 2, p.400 [13] Haehl, Dr Richard, 1923, Samuel Hahnemann His Life and Work, 2 vols, Jain, India, Vol. 1, p.312 [14] Haehl, op cit, Vol. 1, p.311 [15] Haehl, op cit, Vol. 1, pp.311-2 [16] Dudgeon, Dr Robert E, 1853, Lectures on the Theory and Practice of Homeopathy, London, pp.337-8 [17] Coulter, Harris L, 1973, Divided Legacy, 3 vols, Wehawken Books, Washington USA, vol. 2, p.400 [18] Dudgeon, op cit, pp.395-6 [19] Haehl, op cit, Vol. 1, p.312 [20] Dudgeon, op cit, p.338 [21] Dudgeon, op cit, p.394 [22] Bradford, Dr Thomas L, 1895, Life and Letters of Hahnemann, Jain Indian Edition, p.70 [23] Haehl, op cit, Vol. 1, p.313 [24] Haehl, op cit, Vol. 1, p.317 [25] Haehl, op cit, Vol. 1, p.320 [26] Haehl, op cit, Vol. 1, p.322 [27] Rothstein, op cit, p.156 [28] Coulter, op cit, vol. 2, p.403 [29] Haehl, op cit, vol. 1, p.324 [30] Dudgeon, op cit, p.346 [31] Dudgeon, op cit, pp.349-50 [32] Kaufman, op cit, p.26 [33] Hahnemann, Dr Samuel, 1842, Organon of Medicine, combined 5th/6th edition of Dudgeon and Boericke, v.270, end [34] Close, op cit, pp.20-21 [35] Blackie, Dr Margery G, 1975, The Patient Not the Cure, London, p.6 [36] Cook, Trevor M, 1981, Samuel Hahnemann, The Founder of Homeopathy, Thorsons UK, pp.95-6 [37] Handley, Rima, 1997, In Search of the Later Hahnemann, Beaconsfield UK, pp.7-8 |
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Wainwright Churchill, Traditional Chinese acupuncturist and Chinese medical herbalist London
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With regard to the quotation in Peter Morrell's letter: 'Hahnemann pointed to...classical literature to demonstrate that his discovery was known to writers of antiquity and was essentially rediscovered by him.' I wonder if Mr. Morrell or someone else could quote this classical literature. |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir, This reference primarily refers to the 'law of similars' abundant evidence for which Hahnemann found and alluded to in the medical literature - mainly Hippocrates, Paracelsus and Sydenham. The precise attenuation of doses, used by Hahnemann, is not found in any medical literature that I am aware of preceeding him, and was clearly a system he elaborated for himself. As the string of quotations rightly suggests, he was led in the direction of small doses by trying to reduce the agravations induced in the sick by using similar medicines, which one presumes were more severe than those caused by dissimilar drugs. Hence, the smallness of the dose was entirely experiment-driven and designed to reduce the harmful effects of similar drugs. |
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David Gerring, Clinical Practitioner Tzu Chi Institute for Complementary and Alternative Medicine, Vancouver,BC. Canada
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Sir: what David Reilly et al have established very clearly is that the behemoths of modern medicine are just as obtuse as those of 200 years ago: the earth must be flat because we believe it to be so, despite the evidence. If modern physicists lead us to believe in the the existence of antimatter could it not be possible that something which we are currently unable to weigh is exerting the effect of homeopathic preparations? David Gerring,MD. Vancouver,BC. |
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Robert Green, Intrigued layperson
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It seems ironic that a system of medicine rooted mostly in 'similars' should always have been attacked and made famous for its small doses. Considering that the word homeopathy means "similar to disease" why and how did Hahnemann come to focus so much time and ingenuity on dose reduction? |
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Wainwright Churchill, Traditional Chinese acupuncturist and Chinese medical herbalist London
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With regard to the quotation in Peter Morrell’s eletter: "In the Organon, however, he [Hahnemann] stated that trituration and succussion release the ‘spirit-like power’ of the medicine - which is compatible with his assumption that medicines act through their spiritual [geistlich] or dynamic impact upon the organism." (1), it is interesting to ponder the following extract from an essay on the preparation of a Tibetan medicine: 'Also added to the compound are small amounts of medicines made and consecrated by famous, historical saints and sages. These are added as a kind of spiritual leavening. It is believed that their subtle psychic and spiritual energies can permeate a new batch of medicine blessing and empowering it. Therefore, even medicines themselves can have lineages, i.e. the pedigree of the ingredients they contain. This is called PHAP-DA in Tibetan. Here it is the blessings from the saint or sage that are believed to be primarily beneficial, not necessarily the medicinal ingredients of the miscellaneous medicaments that are added. These added medicines are something like an alchemical sourdough starter. For instance, Trogawa Rinpoche said that the Zur—thrul Dashel pills he distributed during his 1986 tour contained the PHAP—DA from medicines made by the famous Tantric Gurus Indrabodhi and Padmasambhava.’ (2) The medicine is made in a long process, in which spiritual rituals perform an important part. The main effect of the pill is to counteract ‘poison’. A main ingredient of the pill is ‘purified’ mercury. A modern Western observer might note several similarities with Hahnemann’s ideas – both spiritual essence within the medicine, and the use of poison to counteract poison, i.e. a version of the law of similars. (1) Morrell, P. Re: What is a homeopathic placebo, September 1, at http://www.bmj.com/cgi/eletters/321/7259/471 ) (2) Flaws, B. 1988. ‘Rejuvenation Alchemy in Tibetan Medicine: An Inroduction to the Zur-Trul Da-Shel Pill’ in Blue Poppy Essays 1988. Blue Poppy Press. p288. |
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Adam Jacobs, Director Dianthus Medical Limited
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One of the reasons Peter Morrell uses in disagreeing with my hypothesis that water is actually an extremely powerful homoeopathic remedy is that 'simple dilution was not sufficient; the vial containing the medicine had to be struck against a leather pad a number of times'. Do we have any information about whether the active homoeopathic solution used in the study was struck against a leather pad? Clearly this is important, but Taylor et al do not mention it in their paper. Perhaps someone should do a study in which a homoeopathic remedy prepared by striking against a leather pad is compared with a 'placebo' remedy struck against, say, a foam rubber mousemat. |
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Peter Morrell, Hon research associate, history of medicine Staffordshire University
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Sir, “It seems ironic that a system of medicine rooted mostly in 'similars' should always have been attacked and made famous for its small doses. Considering that the word homeopathy means "similar to disease" why and how did Hahnemann come to focus so much time and ingenuity on dose reduction?” It is the apparent absurdity of small doses that has always baffled people of a scientific bent. Stunned into disbelief that small doses can have any possible therapeutic effect, successive generations of sceptics have denounced homeopathy as a nonsense, without actually trying it. They should appraise the system personally; the microdose could, afterall, be a genuine scientific phenomenon. As previously described, the small doses of homeopathy were arrived at piecemeal and entirely through experiment, with which Hahnemann, like most of his contemporaries, had a lifelong obsession. To the great frustration of his followers, he was an incurable experimenter and never tired of introducing revisions, new innovations and modifications to his system, virtually on an annual basis. “To reduce aggravations” is the short answer to the question about dosage. His ceaseless experimentation sprang solely from his impulse to improvement, which in clinical terms meant making it as safe and gentle as possible. Initially, this meant him creating the greatest distance between homeopathy and Old Physic. The one became the shadow of the other. Thus small doses compared to large, similars compared to contraries, provings compared to signatures and single drugs compared with multiple prescriptions. He could not have made homeopathy any more different from allopathy - they are exact opposites. He adopted every principle of Old Physic and then turned it on its head! That was not coincidence; it was deliberate. The similar drugs that he used, such as Belladonna for Scarlet Fever and Mercury for Syphilis, showed themselves to be capable of inducing the most dreadful aggravations. And this bedevilled his progress. Having satisfied himself of the damage caused by contraries, and thus hewing to the law of similars as a dogma [like M Thatcher’s political maxim: ‘there is no alternative’], he therefore resolved to modify doses as the only available means to reduce these aggravations. His passion for accuracy then led him to invent scales of serial dilution and succussion, both so he knew by how much he had diluted something, and also so he could make a standard system for the dilution of all drugs, regardless of their toxicity in crude dose. As stated in the previous quotations, by following this line, he ended up firmly in the territory of microdoses. In effect, therefore, the microdose of homeopathy should be seen as a genuine discovery, borne entirely from ceaseless experiments with doses of similar single drugs in clinical practice. Hahnemann was actually advancing medical knowledge on several fronts at once, though this is not very well known, even within homeopathy. Not only did he investigate single drugs, similars and small doses, but also the primary and secondary effects of drugs, the effects of poisons, the biphasic or toxo-therapeutic effect of any drug, the way diseases can displace or suppress each other and the way drugs can induce temporary artificial illnesses [provings] which can, through close mimicry, displace natural diseases. He investigated all of these densely tangled matters simultaneously between 1782 and 1801, during his time as a translator of medical texts from English, Latin, and French into German, having abandoned medical practice between 1784 and 1790. The fruits of his labours can be read in his Organon of Medicine, especially aphorism 59 which deals with the actions of drugs. Finally, through incorporating his constant improvements, he repeatedly satisfied himself that his new system worked predictably and accurately and produced only the minimum of aggravation with the maximum of healing action. I hope for brevity that this will suffice as an answer. Further detail can be obtained from the sources listed below. My own articles on this subject have attempted to unravel these very tangled matters. Sources Dudgeon, Robert E, 1853, Lectures On the Theory & Practice of Homeopathy, Jain Reprint Gumpert, Martin, 1945, Hahnemann - The Adventurous Career of a Medical Rebel, L B Fischer Publ. Corp, New York, translated from the German by Claud W Sykes. Haehl, Richard, 1922, Samuel Hahnemann His Life and Works, 2 volumes, Jain reprint Hahnemann, Samuel, 1841, The Organon, combined 5th/6th Edition Edited by Boericke and Dudgeon, Jain Reprint; also viewable online at: http://homeoint.org/books/hahorgan/default.htm Hahnemann’s Lesser Writings, 1851, Edited by R E Dudgeon, London, Jain reprint Morrell, Peter, 1995, Hahnemann As Scientist, The Homeopath UK, April 1995, Similia, Australia, Oct 1996 Morrell, Peter, 1998, The Proving, Potentisation and The Law of Similars, Resonance, USA, June 1998 Morrell, Peter, 1998, From Poisonings and Provings to Holism, Similia 11.2, Australia, Dec. 1998 Morrell, Peter, 1999, Hunter, Hahnemann and the Origin of Homeopathy, New England Journal of Homeopathy [NEJH], Dec. 1999/Jan 2000, USA, pp.97- 110 Morrell, Peter, 2000, Some Reflections on the Origins of Hahnemann’s Ideas, Heilkunst, Canada, July 2000 Morrell, Peter, 2000, Hahnemann’s Evolution of Ideas - Single Drugs, Small Doses and Similars, NEJH 9.1, Summer 2000, pp.95-112 |
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Marc Girard
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Sir - The medical community has an increasing concern about the quality1 and fairness2 of reporting of clinical research, and experience as well as repeated stories suggest that, whatever their source, overstatements regarding the benefits or risks of therapeutic options may have serious consequences in terms of cost, safety or community health. In this context, one may be surprised by the BMJ commenting the work by Taylor et al3 as "evidence" favouring homoeopathy over placebo (p. 518) and, more generally, by the presentation of this paper as a significant one. Actually, the first "evidence" is that the study in question was a negative one as its results were clearly comparable for homoeopathy and placebo regarding the primary efficacy parameter. Additional evidence includes a relative weakness in experimental design, since the use of concomitant drugs was left to the patient's discretion : greater use in vasoconstrictors and antihistamine is all the more likely to account for the reported improvement in nasal inspiratory peak flow that initial aggravation of rhinitis symptoms in the homoeopathy group is likely to have worsened the baseline imbalance regarding the use of these agents (see the authors' Table 1). Concerning the experimental design on the other hand, one may remark that in an indication such as perennial rhinitis, the usual efficacy parameters are generally the consumption of anti-allergic drugs and symptoms scores4, and not visual analogue scales (VAS); likewise, one may wonder whether a total duration of 4 weeks might have the slightest clinical relevance in such a chronic disease. Finally, this is an elementary notion of the meta-analytic methodology that pooling data from some clinical trials (i.e. without any systematic method of selection) can never be seen as "evidence" of anything - especially when this pooling includes heterogeneous diseases, some of them acute (hay fever) and some chronic (asthma, perennial rhinitis); incidentally, it is uncertain whether VAS is robust parameter to assess efficacy in a disease such as asthma... It may be of interest to note that similar questions on selection biases as well as clinical relevance were raised about a previous review published in the Journal and also presented as suggesting an efficacy of homeopathy.5 In contrast to physics, chemistry or biology, most of clinical research cannot be reproduced (due to obvious problems of recruitment, duration of treatment, organisation, cost, etc.) and this is why we have a professional obsession of fraud, misleading reports or misstatements: this is one of the greatest challenge and responsibility for experts to develop, as a sixth sense, their ability to detect every indirect sign of fallacy. In the present case, the issue is by no means any suspicion of fraud or misconduct: but when published evidence itself does not support the authors' discussion, it is not expected that Editors will amplify overstatement by inappropriate comments. We need far more solid results prior to rejecting "the hypothesis that homoeopathy in a placebo response" i.e. before challenging our current understanding of physical world: for the time being, "evidence" from modern clinical research is still that homoeopathy results from an anachronistic persistence of outdated medical misconceptions. Marc GIRARD
Competing interest : none 1. Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC. Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. BMJ 2000; 321: 471- 476 2. Altman DG. Better reporting of randomised controlled trials: the CONSORT statement. BMJ 1996; 313: 570-1 3. Rennie D. Fari conduct and fair reporting of clinical trials. JAMA 1999; 282: 1766-9 4. Malling HJ. Immunotherapy as an effective tool in allergy treatment. Allergy 1998; 53: 461-472 5. Girard M. Trials of homoeopathy. BMJ 1991; 302: 727 |
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Peter Morrell, Hon research associate, history of medicine Staffordshire University
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Sir, In answer to Wainwright Churchill’s question about apparent similarities between homeopathy and Tibetan medicine, I have to say there are a few, but there are also too many important differences for it to be very significant. What follows will hopefully justify this judgement. It is very hard to make any definite conclusions about this very complex topic. Firstly, although Hahnemann does make frequent reference to ‘spirit-like power’ of remedies, obviously these words uttered in the early 19th century are likely to mean something different from the same words uttered today. Moreover, Hahnemann was not a very religious man, compared to the vast bulk of his contemporaries. It is therefore simply not credible that he had overtly religious notions about his remedies, whether in their mode of preparation or in their mode of action. He despised alchemy, mysticism and astrology, for example, and was not a big Bible reader even though a simple Lutheran churchgoer. Therefore, it is very hard to stick to him this ‘religious badge’ about his conception of homeopathy. The overriding impression one gets from reading him is that he was as close as you could get to the modern day scientist - detached, observation driven, highly intelligent, unimpressed by ideas in their own right, addicted to hypothesis and experimentation. I would therefore reject outright the view that he meant anything very profound from phrases like the one above. He merely meant that diluting something down by so much must release into the solvent some spirit-like power that is invisible in the crude substance. That is all it means. It is a handy phrase to signify something unknown; it does not mean some mystical spell. When coming to compare homeopathy with Tibetan medicine, therefore, we must be very cautious at the outset to carry the parallels too far. Yes, there are some parallels, but there are also some very obvious differences. For starters, Tibetan drugs were and are not proved on healthy volunteers and nor are they used singly. If they are not proven, then they are not used based on similarity. These may not sound important aspects, but they breach strict rules applying to homeopathy. To the uninformed eye, these might sound trivial differences, but as previously detailed, Hahnemann was intent first on analysing why Old Physic was as useless as he had found it, and second in creating something totally new that worked. He clearly identified mixed drugs and unproven drugs [used on the basis of the ‘law of signatures’] to be two of the fundamental fault lines running through Old Physic, and therefore he chose single drugs and provings quite deliberately in his formulation of homeopathy. Having found a bad principle, he rejected it and investigated its exact opposite. That was always his approach: find the error and look to its opposite. It therefore follows, that he could not use drugs in mixtures and he could not endorse the use of unproven drugs. In the same way, he had chosen similars [‘similia similibus’] as the guiding therapeutic principle to replace the old Galenic maxim of ‘contraria contrariis’. In addition, as we have also discussed, experiment alone led him to adopt as his fourth maxim small doses. Based on all these considerations, I have to reject both the notion of spirituality in homeopathy, implied by WCs comparison with Tibetan medicine, and the notion that ‘mumbling a few spells and incantations over a mixed pill’ can be remotely similar to anything done in homeopathy in the preparation of remedies. Finally, it is worth noting that many before, even during his lifetime, have tried to pin some accusation on Hahnemann of copying Paracelsus or of having deep roots in medieval hocus-pocus. He was a lifelong Freemason, for example. He also spent a lot of time in the laboratory of his step father-in-law Herr Haesler, doing experiments in the 1780s, presumably of an alchemical nature. He also spent 2 years in the vast library of esoteric medical texts in Sibiu in Transylvania, at the house of his patron, Baron von Bruckenthal, who inducted him into the Masons in 1777, and who paid for Hahnemann’s final years of medical education at Erlangen. Some choose to believe these events prove he was an esotericist, but the evidence is scant. His scientific credentials are far more impressive. Just because there are clear antecedents for some homeopathic principles in medieval medicine, does not mean that is where Hahnemann got them. Just because he was very widely read on medical history, does not inevitably mean that he stole ‘the whole show’ from previous systems. They must have played a part in his formulation of a new medical system, that is true. Much more important, however, in its entire development, and there is no getting away from this I’m afraid, was the central role of experimentation. The whole system was rooted firmly in his obsession with experiment. Every single aspect of it was thoroughly tested repeatedly until his creation was entirely observation-driven and experiment-driven. He was just about as scientific as one could be in the early 1800s, even in the most modern sense. In this sense, homeopathy is not an extension of rationalism, or of speculation, or of the ‘naturphilosophie’, as some have accused, but it is a monument to empiricism. Regardless, therefore, of how many philosophical and mystical elements one might choose to find in it, homeopathy is fundamentally scientific in every sense and even in the most modern sense - every part of derives from and has been confirmed through endless experiment and clinical practice. Moreover, none of it, not an atom of it, is speculative or deriving from hazy, spiritual notions or mystical forces. Even ‘vital force’ is a concept that explains a lot; it is merely a useful model, but which cannot be located, measured or defined. It is therefore a useful ‘conceptual entity’ just like an electron is. Its existence is probabilistic rather than proven. I hope this goes some way to explain why I think homeopathy and Tibetan medicine are very different beasts. |
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Dominic Stevens, GP London
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Given that there is no known mechanism in physics, chemistry or biology which could explain the action of homeopathy, the prior probability that homeopathy has effects which different from a placebo must be zero. It must still remain more likely that the results of this trial show the difficulties of running such trials, rather than the limitations of current fundamental science. It is more likely for another example, that billions of people are wrong in their believe of a virgin birth than that it actually happened. Or if unknown forces are to be considered in the explanation, the trial participants should declare if they prayed for a particular result. | |||
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Wainwright Churchill, Traditional Chinese acupuncturist and Chinese medical herbalist London
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Sir, Dominic Stevens states: ‘Given that there is no known mechanism in physics, chemistry or biology which could explain the action of homeopathy, the prior probability that homeopathy has effects which different from a placebo must be zero.’ (1) For the probability to be zero, there would need to be absolute certainty that all of the laws of physics, chemistry and biology are known and thoroughly understood. Science may be good, but it’s not that good! Reference (1) ‘Knowledge, probability, belief’ http://www.bmj.com/cgi/eletters/321/7259/471 |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir, Water is not "actually an extremely powerful homeopathic remedy" [1], never has been and never will be, no matter how many times you say it. That is the reason Adam Jacobs is wrong. 'Simple dilution was not sufficient; the vial containing the medicine had to be struck against a leather pad a number of times'. Hahnemann did use a leather pad, which he had made by some saddler, and stuffed with horsehair or felt. If you go to Stuttgart you can see the actual pad he used in the Hahnemann Museum. Homeopathic pharmacies today use a small electrical device into which the phial is placed and then shaken at very high speed, for a burst of a few seconds, in between each dilution. Any homeopathic pharmacist will assure Adam Jacobs that this is a perfectly standard method of making homeopathic potencies. And in no sense can it be supposed as being radically different from one establishment to another. Shaking is shaking is shaking... "Do we have any information about whether the active homeopathic solution used in the study was struck against a leather pad? Clearly this is important, but Taylor et al do not mention it in their paper." [1] It is not important at all; it is an irrelevant factor. "Perhaps someone should do a study in which a homeopathic remedy prepared by striking against a leather pad is compared with a 'placebo' remedy struck against, say, a foam rubber mousemat..." [1] This sounds a ridiculous notion. It is customary in any public discussion forum, [a] to know at least something about a subject, and [b] to have something useful to say, before entering into such a discussion. Adam Jacobs would do well to consider such advice soberly, as I'm afraid he appears to satisfy neither criterion. [1] BMJ letter, Re: Re: What is a homoeopathic placebo? 8 September 2000, Adam Jacobs |
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Joseph Watine, Eur Clin Chem Hôpital de Rodez
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One can agree with the intelligent e-letter written by Brian J. Lipworth [1] complaining about the “extreme arrogance of those who deny their patients the opportunity to try homeopathy”. May I add that even if homeopathic remedies were not more effective than placebos, at least these remedies may be not only less harmful to the patients but also cheaper than some conventional therapies that are used by some arrogant (and too often incompetent) conventional therapists. [1] http://www.bmj.com/cgi/eletters/321/7259/471#EL2 |
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James B Semple, amused pharmacist glasgow
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I take it waves don't count? |
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James FitzGerald
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Dear Editor - Taylor et al (1) report that their trial and three before it show a benefit of homeopathy over placebo. The publication of this paper in the BMJ is deeply worrying. Homeopathy is ridiculous. We are explicitly told that you take a substance and dilute it to such a degree that there cannot be a single molecule of it in the potion that you finally give to the patient. This has been called a dilution ‘beyond the Avogadro limit’. It is far more than that. A ‘30c’ dilution (30 stages of 1:99 as used by Taylor) equates to a factor 10 to the power 60 reduction in solute molecules, thirteen orders of magnitude greater than Avogadro’s number squared. Take for example carbon; in order to get one single atom in the resulting solution after a 30c dilution you would have to have started with a mass exceeding one billion times the mass of the earth. Your RCT is therefore comparing water against water. In 1988, Jacques Benveniste, until that time an eminent French biologist, published in the Journal Nature a paper purporting to demonstrate a ‘molecular memory of water’, i.e. that water molecules could somehow retain an imprint of a solute molecule even after it had been infinitessimally diluted (2). This was taken by homeopathy enthusiasts as a justification for their beliefs. The mere fact that the idea contravened the fundamental laws of physics and chemistry appeared to have escaped the peer reviewers. The editor of Nature, John Maddox, later systematically debunked the paper (3), but not before the journal had quite rightly come in for much criticism for having published it in the first place. Why then in the face of such incontrovertible difficulties are articles on homeopathy being published in respectable journals? Peer reviewers and editors have a responsibility to accept thought provoking and even unconventional material, but should that not stop short of publishing things which are intellectual bankruptcy? The fact that people are subjecting homeopathy to RCTs is worrying. More worrying still is the publication of such articles in mainstream literature, which is endowing them with a degree of credibility which they should be denied. The idea of homeopathy is preposterous yet people continue to entertain it. This truly is the Emperor’s New Therapy. James FitzGerald, Christopher Fang, 1 Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC. Randomised controlled trial of homeopathy versus placebo in perennial allergic rhinitis with an overview of four trial series. BMJ 2000; 321: 471-476. 2 Benveniste J. Human basophil degranulation triggered by very dilute antiserums against IgE. Nature 1988; 333: 816-818. 3 Maddox J, Randi J, Stewart WW. ‘High dilution’ experiments a delusion. Nature 1988; 334: 287. |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir, It is a great pity that James FitzGerald [1] cannot bring his vast “scientific skills” to bear on this matter. “The publication of this paper in the BMJ is deeply worrying. Homeopathy is ridiculous.” [1] “…the idea contravened the fundamental laws of physics and chemistry..” [1] “The idea of homeopathy is preposterous” [1] He has attacked homeopathy entirely on theoretical grounds, which of course is pretty worthless – because it cannot work therefore it does not work. Where is the science in such an argument? Who other than fellow sceptics are going to be impressed by such feeble ramblings? “Fundamental laws of physics and chemistry”, or indeed of anything else, are there to be challenged and amended in the light of new evidence. That is science. That is progress. The ‘small dose phenomenon’ of homeopathy could very well prove to be a genuine scientific phenomenon that has not yet been validated. There are many new discoveries like this which still wait to be made. How can any so -called scientist rule some of them out so hastily, so fiercely and so certainly, like a thundering, narrow-minded Pope of old? The same dogmatic attitude is clearly recognisable throughout the history of homeopathy: “Holcombe was convinced that homeopaths were impostors and that the infinitesimal doses were devoid of effect. ‘True, I had never tried them, nor would I credit the evidence of those who had. Unless I could be satisfactorily convinced of the why and how and the wherefore of the phenomena, I determined to deny the existence of the phenomena themselves...’” [2] “The regular physicians accused the homeopaths of chicanery in administering drugs which could have no possible therapeutic effect of any kind.” [3] “One doctor determined that a volume of water 61 times the size of the earth was needed for the 15th dilution. Others talked in terms of the Caspian or the Mediterranean, of Lake Huron or Superior. One man calculated that 140,000 hogsheads of arsenic were dumped every year into the Ohio and Mississippi Rivers from the poisoning of rats in Pittsburgh and St Louis, that this raised the Mississippi to the 4th decimal dynamisation, but it apparently had no effect on those living downstream.” [4] Nor is it really prudent to conclude that the many thousands of highly-qualified clinicians who have used homeopathy successfully over the last two centuries must all be deluded fools, and that their judgement of it is based, as James FitzGerald claims, entirely upon a ‘ridiculous belief’ [1]. While it is a very improbable conclusion to draw from a sober appraisal of all the facts, I suspect that sober appraisal is not actually what James FitzGerald wants. Homeopathic potencies are not just diluted substances, but vigorously succussed at each stage. Sceptics may well scoff that this is an irrelevant factor, but such sceptics should be reminded that their view is not scientific, to be so they should be prepared to test these potencies themselves before pontificating and denouncing them so easily on theoretical grounds as preposterous. That view is rooted entirely in a disbelief seemingly as immovable as a mountain. The same old points are founded upon a misperception of the experimental basis of homeopathy: “[Hahnemann] also discovered the principle of dynamisation - shaking a solution of a drug increases its medicinal powers.” [5] “...the effects of drugs could be heightened by administering them in minute doses. The more diluted the dose, the greater the ‘dynamic’ effect.” [6] “..Hahnemann, from 1797, made the observation that by diluting the dosages given, he increased the curative effect. Later on, influenced by the Romantic natural philosophy, he tried to explain this phenomenon which he admitted ‘he did not understand himself’ by referring to the ‘potentising’ and ‘dynamisation’ of the ‘spiritual’ medicinal powers, if the homeopathic drug was properly diluted and succussed.” [7] “Probably the major obstacle to allopathic acceptance of homeopathy was the idea of the infinitesimal dose...Hahnemann claimed to have arrived at the idea of the infinitesimal dose by observing the effects of progressively smaller doses and this doctrine was thus an outcome of experience.” [8] “The doctrine of the ‘spirituality of the remedy’ which was merely the homeopath’s way of stating that the remedy’s action...is not subject to chemical analysis, met a hostile reception...the idea of ‘dynamizing’ a substance by triturating it with milk sugar, so that ultimately only a ‘spiritual force’ was left, seemed totally unscientific and irrational.” [9] Nor is the attitude manifested very scientific, as the following quotes from Feyerabend clearly illustrate: “I have said that science has become rigid, that it has ceased to be an instrument of change and liberation….my criticism of modern science is that it inhibits freedom of thought.” [10] “.…the ideological pressures….which today make us listen to science to the exclusion of everything else. It is also true that phenomena like telekinesis and acupuncture may eventually be absorbed into the body of science and may therefore be called ‘scientific’.” [11] New discoveries in science should be judged on experimental evidence, on the practical facts, not on theoretical objections. I would therefore say that such sceptics should stop being so closed-minded, drop their theoretical objections, approach this matter with a more open mind and try things out for yourself before passing such severe judgement. That would be a truly scientific [i.e. neutral] appraisal of homeopathy and not the hateful prejudice we have seen presented here so dogmatically and arrogantly in this letter. Sources [1] BMJ letter, The Emperor's New Therapy, James FitzGerald, (19 September 2000) [2] Harris L Coulter, 1975, Divided Legacy The Schism in Medical Thought, Wehawken Books, Washington, 3 vols, vol. 3, p.105 [3] Coulter, op cit., p.170 [4] William G Rothstein, 1972, American Physicians in the 19th Century, From Sects to Science, Johns Hopkins Univ. Press, Baltimore, p.155 [5] Rothstein, op cit., pp.166-7 [6] Paul Starr, 1982, The Social Transformation of American Medicine, Harper & Row, NY, pp.96-7 [7] R Juette, G Risse and J Woodward [Eds.], 1998, Culture, Knowledge and Healing, Historical Perspectives of Homeopathy in Europe and North America, Sheffield Univ. Press, UK, pp.69-70 [8] Coulter, op cit., p.169 [9] Coulter, op cit., p.166 [10] Paul Feyerabend, How to Defend Society Against Science, in Ian Hacking [Ed.], Scientific Revolutions, OUP, 1983, Chapter 8 [11] ibid. |
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Adam Jacobs, Director Dianthus Medical Limited
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Morrell makes a valid point when he states that I do not know anything about the subject of homoeopathy. I have indeed completely failed to grasp the difference between diluting a substance in an ocean and by a process of serial dilution in a homoeopathic laboratory. Provided that none of the original allergen remains, I do not see how the manner of dilution can make any difference. Perhaps Morrell would like to explain exactly what the difference is and why it is important, for the benefit of those of us who do not understand the physical basis behind homoeopathy, rather than simply stating that my hypothesis ‘never has been and never will be, no matter how many times you say it.’ To give that as the reason why I am wrong strikes me as a circular argument. Morrell is also entirely correct in observing that my suggestion of an experiment to determine the importance of a leather pad in the process is ridiculous. It is true that whether a solution is mixed by striking against a leather pad or using some hi-tech modern equivalent could not, by any of the currently understood laws of chemistry of physics, make any difference. However, is this any more ridiculous than suggesting that two samples of pure water should differ because of some mystical powers imparted to one of them? I will not be impressed with an explanation that begins ‘Any homoeopathic pharmacist will assure...’. Any catholic priest would probably assure me that Jesus was the product of a virgin birth, but that will not be sufficient to change my views on reproductive biology. |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University
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Sir, For someone who freely confesses so little knowledge of homeopathy, and who is also manifestly eager to muscle into a discussion about it, as a non-medical practitioner, Adams seems to emanate some very confusing signals about his real interest in this subject. In order for me to give him the full benefit of my knowledge of homeopathy, it would therefore be helpful as a first step if he could publicly declare the basis of his interest in this subject. If, for example, his interest is solely academic, detached and neutral, or whether by contrast he has anything financial to gain from seeing the public denigration of alternative medicine, any competing interests, such as any strong links to the pharmaceutical industry, for example. If he can satisfy BMJ readers that he has no such connections of any kind, and that his motives are truly honourable, then I am willing to continue this discussion. If he cannot, then there is nothing more to be said. |
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Peter Morrell, Hon Research Associate, History Of Medicine Staffordshire University
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Sir, If I can address the matter highlighted by James FitzGerald [1] and Adam Jacobs [2], then I would describe this problem as basically one of disbelief. They do not believe that the mere shaking and diluting of drugs [beyond 10-23] can create therapeutically active substances. I think they will broadly agree that this is a fair account of their viewpoint. We could easily get side-tracked into why these people hold that view. That would take us into territory about their motives and commitments to certain belief systems dominated by science. It could also mean they have career paths attached to the pharmaceutical industry which frowns upon subjects like this and which prevents them being anything other than contemptuous of homeopathy. I would not call them scientists in the sense of being original thinkers and experimentalists, but I would call them ‘science believers’. In that sense, it means that their devotion to the ideology of science prevents them from accepting that a diluted and shaken substance does [can possibly] possess any therapeutic properties. I think it would therefore be helpful for me to state what properties such solutions possess and how they operate on living organisms. I do this on the assumption that this information may help them get a better grasp on this matter. I also do it fully aware that they are not going to believe me and that they are poking fun and giving me the run around! However, I will take the risk of that because it is a useful exercise in explaining to any ‘non-believers’ what the properties of shaken and diluted solutions actually are. Potentisation was entirely discovered and formulated by Hahnemann in the late 1790s. He found that by diluting and shaking a drug, its toxicity could be reduced [= his primary motivation] but its therapeutic power actually increases [= a secondary surprising discovery]. These solutions can then be used to impregnate lactose planchettes or pillules to form homeopathic drugs. He found that they posses the following range of clear properties: 1. they stimulate the innate healing power of the organism; they induce a healing response as symptoms are observed to subside and natural healing to be boosted; 2. they have the power to cause or reduce symptoms; the more frequently they are repeated the more healing effect they have; if they are excessively repeated, especially in sensitive individuals, then symptoms become aggravated; 3. such drugs are always denatured by heat, bright sunshine, strong fragrances [e.g. peppermint, camphor, menthol], magnetic fields and hard knocks; in some cases this loss can be recovered by prolonged succussion of the liquid; 4. such drugs have specific effects according to the crude substance from which it is derived; each drug possesses unique properties, and is linked to specific sets of symptoms - such as Belladonna red face, delirium, fever, hallucinations; the drug picture is derived from the provings and forms the sole basis for matching of patient symptom data with the drug to choose; 5. something must be present in these solutions even though the dilution has progressed way beyond the Avogadro limit; it appears to be non-physical, but could be an aspect of matter not yet fully elucidated; some workers have formulated models involving molecular memory and water polymers, which have not yet been confirmed; NMR studies have been inconclusive; 6. the effects can be and have been confirmed by experiment in any place and time and are not likely to be imaginary or belief-based, as such drugs have been repeatedly sown to operate on all living organisms such as babies, unconscious people, pregnant women, animals and plants. The above features of diluted and shaken drugs can only be discussed intelligently by people who have tried them and seen for themselves the often amazing power they possess. Someone who is not prepared to place them within the ambit of their own experience, and who insists, on purely theoretical grounds, that they are bogus, cannot be credited with much credibility. [1] BMJ letter, The Emperor's New Therapy, James FitzGerald, (19 September 2000) [2] BMJ letters, Re: Re: What is a homoeopathic placebo? 8 September 2000, Adam Jacobs and 20 September 2000 |
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Adam Jacobs, Director Dianthus Medical Limited
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Morrell asks that I declare my interest in homoeopathy, which I am happy to do. It is purely academic. In the interests of transparency, I should also mention that I make a living by providing medical writing services to the pharmaceutical industry, and that if the industry were to disappear, then I might be out of a job. However, if homoeopathy were to take over the world of medicine, then no doubt the manufacturers of homoeopathic medicines would become just as rich as pharmaceutical companies are now, and could afford the services of medical writers, so I am not unduly worried. Morrell's statement that I do not believe that homoeopathy can produce therapeutically active substances is indeed a fair account of my viewpoint. However, he is not quite right to say that I insist homoeopathy must be bogus. I would certainly be very surpised if it were anything else, but I agree entirely that progress in science is made by discoveries that contradict current theories. I cannot deny that it is possible that we are on the verge of such a discovery, and that some mechanism of 'water memory' may yet be discovered. Nonetheless, for each experiment that contradicts current theories and leads to the ground-breaking discovery of new ones, there are many others that contradict current theories because the experiments were flawed. Until someone can explain to me how homoeopathy works at the molecular level, I remain unconvinced. Finally, to show that I am willing to further the course of science by participating in experiments on the principles of homoeopathy, I would like to challenge Morrell to a drinking contest, in which he drinks neat gin and I drink gin diluted with 4 parts tonic. |
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Joseph Watine, Consultant, Eur Clin Chem Hôpital de Rodez, France
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Fallacious arguments Those who wish to be honest, scientifically speaking, should try to ban fallacious arguments from their “reasoning”. Unfortunately, some doctors, while pretending to reason scientifically, did not hesitate to use fallacious arguments during the controversy that ensued the recent publication in the BMJ of an homeopathy trial [1]. Thus, these doctors more or less tried to [2-11]:
Do we have to conclude that Peter Morrell was right in writing that these doctors should not be called scientists in the sense of being original thinkers and experimentalists, but rather ‘science believers’ [10]. [1] Morag A Taylor, research associate, David Reilly, honorary senior lecturer in medicine, Robert H Llewellyn-Jones, lecturer, Charles McSharry, principal immunologist, Tom C Aitchison, senior lecturer in statistics. Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis with overview of four trial series. BMJ 2000;321:471-476 (19 August). [2] http://www.bmj.com/cgi/eletters/321/7259/471#EL32 [3] http://www.bmj.com/cgi/eletters/321/7259/471#EL33 [4] http://www.bmj.com/cgi/eletters/321/7259/471#EL41 [5] http://www.bmj.com/cgi/eletters/321/7259/471#EL49 [6] http://www.bmj.com/cgi/eletters/321/7259/471#EL51 [7] http://www.bmj.com/cgi/eletters/321/7259/471#EL52 [8] http://www.bmj.com/cgi/eletters/321/7259/471#EL53 [9] http://www.bmj.com/cgi/eletters/321/7259/471#EL54 [10] http://www.bmj.com/cgi/eletters/321/7259/471#EL55 [11] http://www.bmj.com/cgi/eletters/321/7259/471#EL56 |
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Christos Hadjicostas
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Dear authors, it is very interesting that you give place in your magazine for homeopathy. I would like to say to the respectable members of the group who organized the research, that what they have done is not actually homeopathy, but something similar, and the astonishing thing is that even though it works! The real and original homeopathy doesnot give for treatmnet of the allergic rhinitis the allergen which mainly causes the problem in a potentized form! The real homeopathy gives the similimum ie the homeopathic medicine which is similar to the whole, to the constitution of the patient. We define as a constitution the totality of both the physical and the psychomental symptoms and characteristics of a patient. This medicine may be different in each patient and has nothing to do with the allergen "causing" the rhinitis. Only this medicine when is found after a careful analysis of the case from the MD, can show realy great results, end even cure the problem permanently. So I would suggest to do researches using the homeopathy in the right way, otherwise we cannot see the real therapeutical results can have in many cases of diseases. The Medical Institute for Homeopathic Research and Application, in Athens, is searching for scientist who are eager to work in this spirit, for collaboration. Yours sincerely
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Dominic Stevens, GP London
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I was wrong to think that the prior probability that homeopathy works is obviously zero. Many of the responses suggest that it is obviously one. Is this the defining characteristic of a magical idea - the complete disagreement over prior probability? |
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Odd O Aalen, Professor Section of Med. Statistics, University of Oslo
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As a statistician I would be very interested in seeing data on the individual responses of the patients in the study. Did all or most patients respond favorably to homoeopathy? Was there a group who did not respond? If one had the full data set available, then one could make other analyses of the data that might throw further light on them. In general I think data from published studies should be made available to readers. Another statistical question: How do Bayesian statisticians react to this study? It might be an interesting excercise to see whether the results of Taylor et al are strong enough to override a highly sceptical prior distribution. Are there any Bayesians who would like to comment on this? |
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Carole Hubbard, homeopathic user home
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I have been taking homeopathic 6x nat mur (sodium chloride) to treat allergic rhinitis and house dust allergies for 24+ years. It is interesting to see that a drug was administered in a homeopathic form for this experiment. I have been interested in tissue salts for 24+ years. According to tissue salt theory there are 12 mineral salts which are all taken in homeopathic form which treat many ailments from rheumatism, gout, asthma, headaches, mental states and so on. There are two interesting things to note here. Firstly, that many disease conditions are actually mineral deficiency symptoms and secondly, that homeopathic dilutions of the minerals can be used to treat the deficiency symptoms. Note also that milligram doses have the same effect of treating the symptoms, except in the case of sodium chloride deficiency symptoms which must have the homeopathic form of the mineral to have any effect in treating deficiency symptoms. See my website at http://members.dynamite.com.au/hubbca |
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Jeffrey V Sutherland, Chief Technology Officer PatientKeeper, Inc.
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The responses to Taylor's paper on the homeopathical allergic rhinitis is a fascinating portrayal of the controversy surrounding homeopathy in the medical community. As someone who has spent almost a decade funded by NIH doing cancer research and a co-founder of the Center for Vitamins and Cancer Research at the University of Colorado School of Medicine in the early 1980's, I have had a continuing interest in experimentation with complementary medicine for over two decades. Since I am now in the information technology area of healthcare, my clinical research program has to be self funded, and on my own time. However, it has led to some significant insights that might be persued effectively by funded researchers. In fact, I am looking for a partner with a good microbiology lab as I write. After completely eliminating my chronic severe allergies with homeopathy to the point where regular allergy testing produced no response (to the consternation of clinicians), I have moved on to comparing electromagnetic instruments to homeopathic effects. Many allergic responses can be terminated within two minutes by zapping the allergens with the right freqency. Homeopathy can then be used to prevent recurrence. As another example, I can induce the same effect with Candida 100C as I can with treatment at the resonant frequency of Candida (usually in the 386KHZ range). This can be objectively measured by scanning with an FSCAN, an approved medical device in Europe, that pulses the body with various frequencies and listens for a resonant response. So, treating with Candida 100C eliminates resonant frequencies with the FSCAN. Treating with the FSCAN at the resonant frequency produces exactly the same result. This is true for many other infections. In recent years, I have specialized in the detection and treatment of parasites and always use homeopathy as an adjuvant treatment since it immediately, and consistently improves repeatable results. I believe these experiments can easily be replicated in any laboratory and could shed some light on the homeopathic response. So I am constantly amazed at the armchair philosophy expoused by researchers who have never done the experiments themselves to prove or disprove what they are saying. If there is anyone with a microbiology lab with a capacity to view results of treatments with homeopathy vs. frequency generators under a microscope, I would be interested in working together to resolve some of this ongoing debate. Simple experiments could be done in vitro to demonstrate consistent effects. The research program could then move on to in vivo studies. Standard drug treatment could be tested against control groups treated with homeopathy, electronic devices, and a placebo. With a Ph.D. in Biometrics, I could help design the trial. My thesis advisor was John Bailar, M.D., Ph.D., the New England Journal of Medicine biostatistican for more than a decade. He might even give us some help if we had a convincing proposal. |
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Stephen M Grabosky, Medical Technologist unemployed; 27614
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Does nasal eosinophilia alone constitute allergic rhinitis? What about NARES? Suggest use of presence of specific IgE antibodies (in vitro or in vivo) in context of history and exam rather than eos. Refer to Crobach in Scandinavian Journal of Primary Health Care, 1998, vol 16, pp 16-30 |
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Patrick J Ryan, Clinical Audit Facilitator George Eliot Hospital CV10 0DJ
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I am an administrator and though not clinically trained, I have a personal interest in this topic. To say "It is not enough for trials to be made bigger, tighter, or whatever: those who seek to advance the cause of homoeopathy must come up with a reasonable notion of how the treatment might operate at molecular level" is akin to saying "You must prove to me that the world is round before I will believe it". This was an understandable position hundreds of years ago, but even before it was proved, the world was still round. |
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Tony Floyd, Medical Student Newcastle University, Newcastle Australia 2308
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A tautology. Competing interests: I regularly consume water, the particles of which may have come into contact with all sorts of things in the past million years or so, a powerful drug indeed. No effect on me so far, but perhaps the antidotes have balanced out the poisons? |
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