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Rapid Responses: Rapid Responses published:
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Holidays and housing help to
- john sharvill (6 July 2002)
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Sick to the back teeth
- Thomas G McPhee (6 July 2002)
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Withdraw funding for all useless medicaments
- John P Heptonstall (7 July 2002)
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Re: Withdraw funding for all useless medicaments
- Thomas G McPhee (9 July 2002)
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Re: Sick to the back teeth
- Peter Morrell (10 July 2002)
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Re: Re: Sick to the back teeth
- Thomas G McPhee (12 July 2002)
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Homeopathic dose or a dose of good medicine?
- Roger K.A. Allen (12 July 2002)
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Re: Homeopathic dose or a dose of good medicine?
- Tony Floyd (14 July 2002)
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Jibes from the armchair of theoretical medicine?
- Peter Morrell (18 July 2002)
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A simple question
- John Hopkins (19 July 2002)
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Distortion of science?
- Brian J Murray, JOSEPH TONY (5 August 2002)
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Nobody is smart enough to be wrong 100% of the time !
- Andy G Finucane (13 December 2004)
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Re: Nobody is smart enough to be wrong 100% of the time !
- John P Heptonstall (14 December 2004)
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Re: Nobody is smart enough to be wrong 100% of the time !
- Peter Morrell (15 December 2004)
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john sharvill, gp Deal kent
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The debate re homepathy seems to me slightly irrelant once (state) funding issues are removed. If people feel better from it all well and good because for the majority of minor illnesses that is all we want want. Providing dangerous claims such as regarding cancer cures, malaria prevention and childhood immunisation are exposed as false the debate should be re funding. Most people feel better during a good holiday, or moving from noisy neighbours. This is not a 'treatment' in the orthodox sense of the word but may work better than proven tratments like anti- depressants. John Sharvill |
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Thomas G McPhee, PRHO, Glasgow Royal Infirmary (starting August) Glasgow Royal Infirmary,
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The whole issue of homeopathy is flawed from the outset, and has been discussed to death. But there is something else which bothers me in particular. Being a member of the evil allopathic medical conspiracy can I say that I am sick to the back teeth of those involved in the homeopathic community implying that we don't 'treat the whole person'. What on Earth do they think we treat? An assessment of every patient's personality is critical to the success of any therapy we may attempt. To listen to some within the homeopathic camp you could be forgiven for thinking that all we did was admit 'bronchial reactives' or 'Gastro- oesophageal refluxes'. Contrary to what they might think we do not do this. We do not ask Mr Bloggs to sit downstairs in the canteen while we do work on his airways upstairs. We admit Joe Bloggs (or whoever) for assessment of his condition, whatever it may be, and shock, horror, we do take into account his psychological status. What we don't do is muck around adjusting doses minutely according to some 200 year old tome that has no scientific basis (except where the evidence has been chosen to coincide with what has already been written) because Mr Bloggs has a phlegmatic temperament. The homeopathic camp are expert at using logical fallacy- the 'allopathic physicians don't care' straw man would be a wonderful target (at least in a rhetorical sense), but only if it were actually true. The appeal to pity (Oh dear look at us, we are shunned by allopathic medicine) is another old argument. Begging the question is yet another time- honoured tactic, as used by paranormalists of all persuasions and denominations- just how much twisting does one need to do with the facts to prove that a phlegmatic temperament needs substance X, whilst someone of a more histrionic nature needs substance Y? I guess we'll never know since obviously homeopathy doesn't operate in the world of metaphysical naturalism. I'm afraid I have to agree with Dr Michael Foley, "...quacks will always be with us." |
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John P Heptonstall, Director of the Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG
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Sir If Michael Foley's suggestion that consumers should have some say in the withdrawal of funding for certain homeopathic medicaments, an even playing field would include allopathic medicaments, where would that leave allopathy; clearly the evidence is mounting for a vast array of useless drugs still available on prescription to the consumer (usually overlooked during typical 'trial and error' prescribing by GPs) but I have yet to hear of any physician declaring even one drug should have it's funding withdrawn. The nearest was in the eBMJ a couple of weeks ago when an enlightend physician declared that in 20 years he had no personal experience of a particular widely prescribed diuretic ever reducing blood pressure! A study in Germany a couple of years ago suggested that well over 50% of the 45,000 prescription drugs had avoided new licensing requirements so had never been subjected to rigorous licensing tests; after further deliberations on the evidence-base for the 45,000 candidate drugs the conclusion was that perhaps only 5,000 of all German prescription drugs had any reasonable evidence for continued use; perhaps Dr. Foley could request withdrawal of funding for all similarly 'unlicensed' and 'useless' medicaments from the UK compendium so GPs are not tempted to try yet another useless drug when several have failed during a typical 'trial and error' mode. The savings to the NHS budget could then be provided for a much needed uptake of various complementary and alternative therapies patients are having to pay privately for. Regards John H. |
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Thomas G McPhee, PRHO, Glasgow Royal Infirmary (starting August) Glasgow Royal Infirmary,
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It is a depressing fact that, indeed, the allopathic armamentarium does still contain numerous treatments which have never been proven to be effective. Fortunately that's what the latest drive towards evidence- based medicine is seeking to address. Perhaps the whole ethos of EBM has passed some people by. There is a whole world of difference, however, between a medication not yet being proven to be effective or otherwise and claiming that your particular medication isn't amenable to proper investigation by science, because it operates at some other level. But let's be frank- it either works or it doesn't. Even if it does work in some ethereal parallel universe of which the patient isn't aware that means diddly to the patient sitting in front of me, who is stuck in this version of reality. If homeopathic remedies were shown to be effective tomorrow then I would have no qualms about using them, despite my incredulity at their proposed 'mechanism of action'. Until such time I will reserve judgment, in much the same way as I am skeptical of various allopathic medicines. |
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Peter Morrell, freelance researcher, history of medicine, UK
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Sir, When Dr McPhee says that "The whole issue of homeopathy is flawed from the outset, and has been discussed to death," [1] then this is not entirely true and nor does he consider the reasons why homeopathy is still around 200 years on and harmlessly giving benefit to many patients around the world. Even by his own arguments it would seem peculiar indeed that such a medical system would have survived this long if it really was "flawed from the outset," [1] "has no scientific basis," [1] or that it rests upon "the time-honoured tactic, as used by paranormalists of all persuasions and denominations," [1] which for many people it clearly isn't. "Being a member of the evil allopathic medical conspiracy can I say that I am sick to the back teeth of those involved in the homeopathic community implying that we don't 'treat the whole person'. What on Earth do they think we treat? An assessment of every patient's personality is critical to the success of any therapy we may attempt." [1] His contention that allopathy is just as holistic as homeopathy, in his view, pretends to be, is not supported by the evidence. "Hahnemann, we know, classified all the methods of treatment under three heads, enantiopathic, allopathic, and homeopathic...[and denied] that the enantiopathic and allopathic cure at all." [2] When Hahnemann termed conventional medicine 'allopathy' or 'enantiopathy' - treatment by 'opposites' or treatment by 'other' - he did this so as to clearly distinguish his own medical system, based upon similars, from the then dominant system based on the use of antipathic agents. That modern medicine still employs antacids, anti-histamines, antibiotics, analgesics, anthelminthics, anti-pyretics, anti-emetics, anaesthetics, etc, goes some way to support the contention that allopathy is still antipathic in its mode of treatment, and does not enhance the natural healing efforts of the body, as Hahnemann contends, but tends to suppress such natural efforts of the organism. Homeopathy, by contrast, clearly stands in line with all ancient healing modalities, and all modern natural healing therapies, in its therapeutic efforts to assist the vital processes rather than work against them. Certainly in this respect one can easily contend that it is modern medicine that is the real 'medical deviant' [3] and not homeopathy. Likewise, when Dr McPhee contends that the psychological profiling of patients might be employed to a limited degree in modern medicine: "we do take into account his psychological status," [1] then this is not anywhere near the same thing as the use of complex psychophysical drug profiles as used in homeopathy, primarily because the homeopath is not seeking to counsel the patient as a psychological type, but to find the drug that most closely matches their medical problems, their likes and dislikes and the main aspects of their personality, sleep patterns etc, so far as they can be objectively determined, or how obvious they are, such as he implies in his jibes: "a phlegmatic temperament needs substance X, whilst someone of a more histrionic nature needs substance Y?" [1]; "because Mr Bloggs has a phlegmatic temperament." [1] Such is an obvious caricature of homeopathic consultation with patients. Although Dr McPhee makes a valiant effort to denounce homeopathy as a species of quackery: "...quacks will always be with us," [1] he has failed to do so primarily by merely manifesting his own appalling ignorance of the subject, and thereby regrettably proving the old adage that those who pontificate the loudest are all too often the most ignorant. Finally, of course, and what he dismally failed to point out, that this study by Lewith et al is not homeopathy and was fundamentally flawed, conceptually misconstrued and an ill-constructed study from the start, as it reveals an allopathic version of true homeopathy [constructed by MDs] masquerading as 'homeopathy' as defined by Hahnemann and his successors, and deceitfully attracting funding it plainly did not deserve. And all the disrespect they have attracted has predictably fallen not on these foolish MDs and their bastardised constructs of natural therapies, but on homeopathy in general, which this study has monumentally failed to investigate. Pity therefore that Dr McPhee's considerable word power and spleen had not been vented in the direction of that far more deserving target - his MD colleagues who failed the conceptual challenge of understanding what homeopathy is and how it should be practised. Sources [1] BMJ letter, Sick to the back teeth, 6 July 2002, Thomas G McPhee, PRHO, Glasgow Royal Infirmary (starting August) Glasgow Royal Infirmary http://bmj.com/cgi/eletters/325/7354/41#2365 [2] Similarities Between Hahnemann and Paracelsus by Robert E Dudgeon MD, Extracted from his 'Lectures On the Theory and Practice of Homeopathy', Sutherland & Knox, London, 1853, pp.9-18 [3] For an essay on this theme, see Don G Bates, Why Not Call Modern Medicine 'Alternative'?, Perspectives in Biology & Medicine, 43.4, 2000, 502-518 |
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Thomas G McPhee, PRHO, Glasgow Royal Infirmary (starting August) Glasgow Royal Infirmary,
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Sir, Mr Peter Morrell seems to believe that I am not aware of the history of homeopathy. I can assure him that I am more than aware of its past and the derivation of the words homeopathy and allopathy. I am certainly well aware of the original meaning of the phrase 'allopathy', and I am also aware of the subtle change which the word has undergone in order to mean, essentially, modern western medicine. One does not need to be a freelance history of medicine researcher in order to study history. Evidently he hasn't yet come across the scientific method in his study, however. Mr Morrell commits a logical fallacy in his first paragraph- that of the argumentum ad populum. There is no doubt that homeopathy still enjoys a remarkable popularity, but he should note that this bears no resemblance to its efficacy. Indeed I rather suspect it has much more to do with its utter lack of efficacy, and therefore lack of side effects. Need I point out that creationism enjoys a remarkable popularity in the US at the moment? Wrong ideas can endure for millennia, not just 200 years. Mr Morrell also argues that because homeopathy works on the 'law of similars' it is somehow more correct. I am unsure from his post whether he is arguing that this makes more sense than allopathy or whether it is simply good sense because it is helping the body to fight the way it should do. If it is the former I need only point out that if a patient has fallen in front of a train it does not make much more sense to run over them with a car in some attempt to cure them of the initial trauma. (Please excuse my rhetorical tactic). If it is the latter then he clearly misunderstands how the human organism even works, if he thinks that we are somehow hell-bent on working against it. To an extent he is absolutely correct- any 3rd year medical student with a knowledge of the inflammatory response can indicate exactly why we must work against it. All that is 'naturally' occurring is not good. It is the case that much of modern medicine is concerned with suppressing various features of the illness, whilst allowing the body to do its own job. If Mr Morrell had read the first few sentences of my post he would have realised that what I was railing against was not the merits or demerits of the latest 'homeopathic' study, but on the caricature that the homeopathic community tries to present of modern (note I am not using allopathic lest I cause confusion) medical practise that we do not somehow 'treat the whole person'. Since he brings up the topic of 'psychophysical' profiling I would be delighted to be directed to clinical trials detailing that the profiling as evidently carried out by homeopaths is valid. I would also kindly ask Mr Morrell from refraining from ad hominem attacks- I can assure him I know fine well what homeopathy involves, nor do I 'pontificate', but if he wishes to interpret it in that way that is his prerogative. I must be very ignorant, however, of homeopathy if I am not grasping some central concept that he and many others appear to be grasping. I think it must be the concept that for some reason homeopathy is not open to scientific enquiry. Somehow I can't quite get my head round that one. NOTE- I am not commenting on the study by Lewith et al. at any point in this discussion. |
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Roger K.A. Allen, Consultant Thoracic and Sleep Physician, Private Practice Suite 299,St Andrew's Place,33 North St, Spring Hill, Brisbane,Qld 4000, Australia
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To Australian medicos, the use of the term a 'homeopathic dose' (of medication) is a derogatory term meaning 'not worth a pinch of the proverbial'; no harm but no good. However it is sadly true that our current medical paradigm is, in general, far removed from recognising the complex interactions between Homo sapiens,the immunne system and the external world, such as work, family etc and internal environment including the psyche, religious and spirtual dimensions. All too often our cardiologists are content with the diagnoses of exclusion, such as 'non-cardiac chest pain' and are not interested in pursuing this further once blocked coronary arteries have been quickly excluded by an expensive coronary angiogram etc. Our medical procedures have their fair share of quackery. Are we blind to our own folly? Todays New York Times' (July 11, 2002) has headlines about the placebo effect of 'clean-out and trim' arthroplasties worth hundreds of millions of dollars per annum in the USA for osteoarthritic knees. How long has it taken us with HRT? We have much to do as physicians to reassess the efficacy our current western reductionist paradigm of life. Even our psychiatrists often limit themselves by not venturing out of their paradigm and into the realm of organic diseases and holistic medicine. I believe this impersonal, mechanistic approach is contributing to the growing malaise of medical litigation in Australia, particularly towards proceduralists. I believe as a thoracic and sleep physician both the homeopath and the MD have much to learn from each other as neither have the monopoly on the truth. As an aside,how many physicians (? and homeopaths)have a clue about sleep although we spend half our lives in this state. In Australia an increasing number of physicians have become discontent with the 'spot-weld' approach to treating the rusting hulk of humanity we see. On the other hand, where do homeopaths go at 2am when they wake up with crushing central chest pain radiating down their left arm? I believe that the use of double-blind cross-over trials to prove or disprove the validity of a complex paradigm such as the homeopathic approach, is like using a slide-rule to prove the existence of God or the enduring power of love. |
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Tony Floyd, Medical Student Newcastle University
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Sir, I was of the opinion that you had a point until I reached your concluding sentence, which stated that "the use of double-blind cross-over trials to prove or disprove the validity of a complex paradigm such as the homeopathic approach, is like using a slide-rule to prove the existence of God or the enduring power of love." I respect the right of people to believe in God & I'm not averse to romantic concepts either, however when someone I care about is prescribed some form of treatment I would like to know that the 'Health Professional' (with or without feathers, bill and a distinctive waddling gait) has some knowledge of evidence supporting it's use. Otherwise, they should be told that the treatment is based on some absurd unscientific principle and that if a real illness develops they should go and see someone qualified. Sincerely, Tony Floyd |
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Peter Morrell, freelance researcher, history of medicine, UK
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Sir, McPhee [1] can obtain at his leisure all the information he needs about homeopathy from any of the many excellent textbooks available [2], but if he insists on discussing a subject, he should at least be seen to have studied it. Employing mostly "sophistical whimsicalities" [3] and "looking only through the spectacles of hypothetical conceits, gross mechanical explanations, and pretensions to systems," [3; 426] he resembles Galen, that self-appointed "torch and trumpet of general therapeutics, a man more desirous of inventing a subtle system than of consulting experience. Disdaining to learn the powers of medicines by instituting experiments, he gave the bad example of generalizing and framing hypotheses;" [4] for it is even true today that "in the boundless region of speculation every one becomes a ruler who can most effectually elevate himself beyond the domain of the senses." [3; 421-2] Speaking merely as an armchair speculator, idly peeling grapes and stabbing the air with wordy sophistries, and "the display of the most fantastic, often most self-contradictory, hypotheses, explanations, demonstrations, conjectures, dogmas, and systems," [5] then it seems unlikely that McPhee has conducted any experiments himself with homeopathy and therefore, on that subject his lips should remain sealed. For, until he does conduct such experiments, in which homeopathy is entirely based, then his views are not founded upon a science rooted in the empirical investigations and experiments of Bacon, as he pretends, but more probably in armchair conjecture. Regarding the question of 'scientific evidence' for homeopathy, which is the only relevant point he raises, then of course, much depends on what you mean by 'evidence' and 'scientific', as these can mean different things to different people. For example, if science is defined in the old style, pure Baconian sense of induction rooted in empirical studies and experiments, then there is no medicine more scientific than homeopathy, it being based entirely upon repeatable experiments on the human subject, both in health and disease, as Bacon would have demanded. "Science derives its knowledge of life from a consideration of the facts of observation and experience," [6] Homeopathy was indeed "the logical and legitimate offspring of the Inductive Method and Philosophy of Aristotle and Lord Bacon." [6; 15] Being "founded and developed into a scientific system...by Hahnemann...under the principles of the Inductive method of science as developed by Lord Bacon," [6; 16-17] and even like "chemistry or physics, homeopathy is established under the principles of the inductive method...its elements are: 1. the phenomena of disease; 2. the phenomena produced by drugs when administered to healthy persons; and 3. the general law of mutual action...Newton's Third law of Motion...the law of similars, which connects the two series of phenomena," [6; 19]. Homeopathy involves: "1. the totality of the symptoms of the patient is the basis of medical treatment; 2. the use of single medicines...[whose] symptoms and sphere of action...have been predetermined by pure, controlled experiments upon healthy persons; 3. the principle of symptom-similarity as the guide to the choice of the remedy; 4. the minimum dose capable of producing a dynamic or functional reaction." [6; 22]. All these principles derive not from vain conceits and wordy conjecture, but solely from experiment, which is observation and experience, as defined by Bacon. In that sense, homeopathy is certainly a science in the accepted sense. That it is, secondarily, a science, which stands in conflict with orthodox science is, admittedly, another issue. As can also be appreciated, from the above list, Lewith et al's study fails on point 3 because House Dust and House Dust Mite are not proven homeopathic drugs, but are isopathic sarcodes [off-topic and another long story], which do not strictly comply with homeopathy as first defined by Hahnemann. Therefore, as I previously stated, this was not a study of homeopathy, but of isopathy. Alternatively, if we define science as being rooted in verifiability, then again, the amassed evidence of hundreds of entirely honourable and highly-qualified MD practitioners, spanning two centuries, would suffice for many. While I doubt that 'armchair disbelievers' are especially impressed by statistical proof, yet, again much impressive epidemiological data can be adduced from many times and places regarding the superiority of homeopathic treatment in Influenza, Cholera, Typhus and Scarlet Fever, etc. Here is a representative sample of such data: "During the great cholera epidemics in England in 1830 and 1854, Naples in 1854-5, Vienna in 1836, and New York in the 1850s, the average mortality rate of those treated regular old school medicine was 60-70%. In the hands of homeopathy, the death rate across Europe was 9%, and in New York 4-5%." [7] "In 1854 there was a severe outbreak of Cholera in London...figures revealed that where the death rate in other hospitals was 51.8%, in the London Homeopathic Hospital the rate was only 16.4% in all the true Cholera cases." [8; 11] "When [Cholera] struck Edinburgh in 1848, the homeopathic dispensary...achieved a mortality rate of 24%; the Board of Health's figures...had a mortality of 68%...at Liverpool in 1849...a death rate of 26% [pertained for homeopathy, as] against a general rate...of 46%." [9; 146] "In 1851, a physician from Cincinnati admitted to the Convention of the AMA that all his colleagues agreed with him - Camphor had been one of their most valuable remedies in the Cholera epidemics of 1848 and 1849," [10] Needless to say, Camphor was first recommended for Cholera by Hahnemann entirely on it its ability when ingested in crude dose to induce similar symptoms in the healthy. With regard to Yellow Fever in the American South, in 1879-80, then "homeopaths employed a number of remedies...Aconite, Belladonna, Arsenicum album, Carbo vegetabilis, Phosphorus, and the snake poisons, Lachesis [Bushmaster] and Crotalus [Rattlesnake]...employed in dilution up to the 30th decimal. Most interesting, however, were the homeopathic statistics. In New Orleans, homeopathic physicians had treated 1945 cases with a loss of 110 - a mortality of 5.6%. In the rest of the South they had treated 1969 cases with a loss of 151 - for a mortality of 7.7%...the overall death rate of reported cases was at least 16%." [11] In Germany, "homeopaths were highly successful in treating the typhoid fever that Napoleon's tattered remnant of an army brought back with them [in 1812] from Moscow." [12; 179] Homeopathic treatment "of cholera proved remarkably successful. Of the 1655 cholera patients treated in Raab [Hungary], for example, only six of the 154 patients treated homeopathically, died [3.9%], whilst of the remainder, 821 [almost 50%] treated conventionally, died." [12] Dr. MacLoughlin, "one of the medical inspectors appointed by the General Board of Health, visited the [Cholera] wards, examined the cases under treatment, and watched their progress. His statement, addressed to Mr. Hugh Cameron [1810-1897], a member of the medical staff, was as follows: "You are aware that I went to your hospital prepossessed against the homeopathic system, that you had in me in your camp an enemy rather than a friend... although an allopath by principle, education and practice, yet were it the will of Providence to afflict me with Cholera, and deprive me of the power of prescribing for myself, I would rather be in the hands of a homeopathic than an allopathic adviser." [13] If we define science as that which conforms to the beliefs of modern scientists about the nature of molecules and dilutions, then homeopathy certainly fails such a test as it flies in the face of modern molecular assumptions about matter in dilution. However, as times change, so do scientific beliefs. It would be a flimsy, will-o-the-wisp type of argument to suppose that just because homeopathy does seem illogical that it therefore must be nonsense. Such would be an unreasonable argument in the light of its clinical track record. Indeed, such is a familiar but also a very old argument: "Homeopathy 'is illogical' [1]; 'this doctrine is unbelievable - it runs against the known rules of medicine' [2]." [14] It is clearly preferable for science merely to denounce the observations of homeopathy as delusions, rather than investigate or adjust its own theories of matter in dilution. Finally, of course, there is a definition of science in relation to its view of the organism and the idea of 'propria' or 'communia' [symptoms individual vs. the common] in relation to whether you measure the health of the entire patient as a 'disease totality.' Or do you, as allopaths do, look solely at a narrow slice of the patient, which you term a 'disease'? Homeopathy, in differentiating between individual cases, is mostly rooted in propria, while allopathy, emphasising what is common to whole masses, in communia. Randomised trials and efforts of that ilk seem only to be apprehended as scientific when viewed through such a narrow conceptual mincing machine - a mincer holistic medicine cannot be squeezed through without destroying it. To do so is to try and unfairly compare the 'in vivo' situation with the 'in vitro' and such reductionism would be like comparing a living cow to minced beef, if dairy-farmers and vegetarians will forgive the analogy. It appears to me that McPhee presented some half-baked, impatiently- formed and armchair views of homeopathy, founded mostly on theoretical grounds, on speculation, based on no experiments of his own, on no proper study of the principles and methods of homeopathy, on no visible evidence of an appreciation of its literature, and revealing no profound understanding of the fundamental nature of allopathy and homeopathy - and upon which, all my own views rest. If you have studied these matters in such depth, then you are entitled to discuss them. Therefore, to adopt such a position as he has, seems just like making cheap jibes based on armchair speculation and disbelief, which would undercut any claim he might make for being logical, scientific and reasonable; because, if he was being logical, scientific and reasonable, then he would not have made the wild claims or the intemperate remarks which he seems guilty of. Sources [1] BMJ letter, Re: Re: Sick to the Back Teeth, Thomas McPhee, 12 July 2002 http://bmj.com/cgi/eletters/325/7354/41#23796 [2] For example The Complete Guide to Homeopathy, A Lockie, and N Geddes, London: Dorling Kindersley Ltd, 1995 http://www.drlockie.com/ [3] Samuel Hahnemann, Aesculapius in the Balance, 1805, in Hahnemann's Lesser Writings, edited by Dudgeon, London: Henry Turner & Co, 1895, 420 [4] Samuel Hahnemann, On The Helleborism of the Ancients, 1812, in Hahnemann's Lesser Writings, 592 [5] Samuel Hahnemann, On the Value of the Speculative Systems of Medicine, 1808, in Hahnemann's Lesser Writings, 489-90 [6] Stuart Close MD, Lectures and Essays on Homeopathic Philosophy, Philadelphia: Erhart & Karl, 1924, 11 [7] W John Diamond MD, The Clinical Practice of Complementary, Alternative and Western Medicine, Washington: CRC Press, 2001, 18 [8] Margery G Blackie MD, The Patient Not the Cure, London: McDonald & Janes, 1976, 35 [9] Reiterated in Phillip A Nicholls, Homeopathy and the Medical Profession, London: Croom Helm, 1988, 145-6 [10] Barbara Griggs, Green Pharmacy A History of Herbal Medicine, London: Jill Norman & Hobhouse, 1981, 229 [11] Harris L Coulter, Divided Legacy, A History of the Schism in Medical Thought, Washington: Wehawken Books, 1975, 3 volumes, 3, 302 [12] Trevor M Cook, Samuel Hahnemann, the Founder of Homeopathy, Wellingborough: Thorsons, 1981, 157 [13] Quoted in 'Sixty-five Years Work: a History of the London Homeopathic Hospital', 1914; a limited circulation document published by the Hospital. [14] Coulter, 2, 547, quoting 1. Achille Reguin, Homoeopathie, Paris: Martinet, 1851, 6; and 2. Journal des Connaissances Medico-Chirurgicales 1, 1833-4, 239] |
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John Hopkins, GP Stockton TS17 6EY
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Dear Dr Smith, The challenge, for those who question the basis of modern medicine, is to answer a simple question. If they were confronted by a seriously ill patient, or someone who appears well but is developing a life threatening condition, what exactly would they do, what practical steps would they follow to make the stranger in front of them safe and how would they cope if it all went wrong ? Medicine is not an intellectual exercise. It is a battle against enemies that always win; mortality and pain and grief. For those at the front line, the rhetoric of generals in their country houses rings a false and hollow note. Yours sincerley, Dr John Hopkins |
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Brian J Murray, Specialist Registrar Tindal Centre, Bierton Road, Aylesbury HP20 1HU, JOSEPH TONY
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Dear Sir, Dr Leckridge criticises Lewith’s research on homeopathic treatments, using a variation on the old chestnut ‘ absence of proof is not proof of absence’(1). Well, yes and no. This argument crops up so many times in the letter page that it needs exploring. Humans have an in-built preference for ‘positive’ results rather than negative ones. This is demonstrated by the prevalence of publication bias, for instance. A decent study with a negative outcome is not the same as a poor, inconclusive study. People who insist that negative research findings do not prove anything are invariably enthusiastic exponents of the treatment or hypothesis in question. They apply different standards of evaluation to positive compared with negative results: the former are snapped up, the latter dismissed as statistical anomalies. One of the reasons we use statistics is to try to compensate for the effect of our prejudices on the collection and evaluation of data. A randomised controlled trial, as used by Lewith, is justifiably considered superior to anecdotal evidence. The search beyond negative results is theoretically infinite unless we are prepared to set sensible limits to that search. The whole purpose of power calculations and P values is to set some parameters to the search, irrespective of the outcome. Failure to appreciate this leads to confusion as witnessed in e.g. the MMR debate, where those in favour of a connection between MMR and autism have consistently changed the goalposts when faced with negative data. We believe that the onus should be on critics of negative results to explain what reasonable criteria they are prepared to accept for a scientific study, and to stick with the results of said study. Failure to do so is to implicitly acknowledge that one’s position is based on prejudice rather than the evidence. Yours faithfully Brian Murray MRCPsych Joseph Tony MRCPsych Specialist Registrars in Adult Psychiatry, Tindal Centre, Bierton Road, Aylesbury HP20 1HU (1) Randomised controlled trials for homeopathy: language is being distorted. BMJ 2002;325:41 ( 6 July ) (letters) |
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Andy G Finucane, Higher Professional Training Fellow in General Practice University of Glasgow
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While looking at the evidence for and against the homeopathic model I am inclined to agree with the integral theorist Ken Wilber who states "that no system of inquiry can produce 100% error". It would take a very very smart person indeed to design an epistemology that was 100% false. All our models of reality contain some variable degree of "truthfulness". The question remains how much of the homeopathic model is valid ? Homeopathy starts with the assertion that an individual can manifest symptoms of imbalance on physical, emotional and mental levels? Fact or nonsense? Is there some truth to the fact that some of the compounds used by homeopaths produce symptoms similar to those observed in disease states ? What about the 'law of cure' ? 0-100% nonsense ? The effect of dilution on potency ? etc. As a physicist by training I am too much of a sceptic to deny the possibilty of anything. However possibility and probability are two different things. Where is the evidence ? I wait with interest. Competing interests: None declared |
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John P Heptonstall, Director of the Morley Acupuncture Clinic Leeds LS27 8EG
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Sir A refreshing observation by Andy Finucane but his last sentence troubles me; if Andy is so interested in evidence for homeopathy, and has a background in physics, has he not already investigated evidence widely circulated and assessed its validity rather that merely asking of others to supply evidence? His current assessment of the widely available evidence, from a physics perspective, would be interesting. Regards John H. Competing interests: None declared |
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Peter Morrell, Honorary Research Associate, History of Medicine, Staffordshire University, UK
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When Andy Finucane asks, "Homeopathy starts with the assertion that an individual can manifest symptoms of imbalance on physical, emotional and mental levels? Fact or nonsense?” [1] ...then I would have to take issue with his use of the word ‘start.’ I am not sure that many people of the homeopathic persuasion would agree that this is where "homeopathy starts," [1] either in its historical origins or in its application as a clinical method. Homeopathy more truly “started” with the empirical investigations by Hahnemann in using drugs on himself [1790s] and then with matching the symptoms so produced to observed symptoms in sickness, which thoroughly established to his own satisfaction a therapeutic 'law of similars.' Going slightly further back, his investigations of drugs on healthy people can be traced to his interest in and studies of the effects of poisons, upon which he published a number of essays [2]. In the rather seamless tapestry of Hahnemann’s life, these studies can in turn be seen to have their origin in his translation work [1784-1806], and so on. That is how it started. He was not alone in attempting such experiments at that time, but he was alone in developing what he found into a complete system of therapy. That his search quite incidentally then also came to involve a holistic evaluation of "symptoms of imbalance on physical, emotional and mental levels," [1] was a secondary aspect of his inquiry and not, as Finucane states, a primary one. It can in fact more truthfully be called an incidental discovery, and a fortuitous one, which he made along the way. Andy Finucane then asks, "Is there some truth to the fact that some of the compounds used by homeopaths produce symptoms similar to those observed in disease states?" [1] How can Finucane ask if there is 'truth' in what he then calls "the fact that..." [1] In other words, why even question the veracity of something that he states is a fact? Is it a fact or not? Surely, if it is, then it is not up for debate...if it is up for debate, then why call it a fact when it plainly is not? Briefly, yes there is truth to the assertion...absolutely so. Arsenic is on record as producing the exact effects that are compiled in the homeopathic materia medica such as pallor, diarrhoea, coldness and obsessive interest in small details, fear of death; Belladonna poisoning produces exactly the same symptoms found in the homeopathic materia medica which include incoherent rambling, hallucinations, extreme redness of the face, high temperature, swollen fauces of the throat etc. Indeed, the ONLY sources of the information contained in the homeopathic materia medica are either the symptoms recorded during actual cases of poisoning or of 'provings' using sub-lethal doses of the drugs in question as a short experimental trial. Andy Finucane asks, “what about the 'law of cure?'…” [1] If he can state more precisely what he means by "the law of cure," [1] then it might be possible to answer his question. He then asks, “the effect of dilution on potency? etc.” [1] Once again, this was entirely arrived at by Hahnemann through empirical experiment and not through a priori reasoning or theoretical inclination. He did not used diluted remedies until 1798 some eight years after his first experiment with Cinchona bark that established the 'law of similars' and even for some years subsequently he never used the high dilutions. In the early phase, he mostly used dilutions like 3x and 6x, which are still well within the Avogadro limit in strict dilution terms. The reasons Hahnemann gave for using drugs in such diluted form were twofold—one, to decrease the strong reaction often induced by the most similar drug and second, because he found that a patient was always peculiarly very sensitive indeed to the remedy most closely matching their symptom totality. Therefore, once again, we can see that these techniques were justified entirely by pragmatic concerns, were employed to reduce the strength of the reaction to the drug in crude dose, and were arrived at entirely through empirical experiment, which was his forte both as a long- established experimental chemist of high standing in Germany, and as a clinician. [3] Finally, when he asks, “where is the evidence?” [1]…then much depends on what he means by the word ‘evidence’ and what adherent theoretical contexts of that term he accepts, as these will in turn certainly determine what he can regard as acceptable evidence and which he can’t. Sources [1] Andy Finucane, Nobody is smart enough to be wrong 100% of the time! BMJ e-letter, 13 December 2004 [2] For example his publications: On Poisoning by Arsenic [1786], Directions for the Preparation of Soluble Mercury [1790] and What Are Poisons? What Are Medicines? [1806] [3] Peter Morrell, Small Doses & Similars, BMJ e-letter, 8 September 2000 http://bmj.bmjjournals.com/cgi/eletters/321/7259/471#9678 Competing interests: None declared |
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