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 | |||