Trial shows that homoeopathic arnica is no better than placebo
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7384.303/c (Published 08 February 2003) Cite this as: BMJ 2003;326:303
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Using clinical trials that are badly designed to "prove" a
homeopathic remedy and by extension homeopathy does not work seems to me
to be poor practice. Surely a basic understanding of the subject would be
useful before setting up a trial. As many of your other respondents
pointed out Homeopathic remedies need to be given where indicated (which I
agree makes this sort of trial difficult). Arnica is routinely used for
the sort of injuries (and shock ) associated with childbirth and I would
have thought that it would be easier to run trialls for its value in
childbirth as a better indicator of the clinical usefulness of the remedy.
Be really radical and include some homeopaths in your group to determine
which patients would benefit from Arnica.
Speaking from personal experience I have seen Arnica work well for
post operative repair from surgery as well as after childbirth.
Competing interests:
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Reading the previous responses I could not help but wondering about
some correspondents whose convictions on the efficacy of therapies seem to
be solely based on revelation, anecdotes and personal experience. Why do
they bother to write to a journal that promotes evidence based medicine
and the randomized controlled clinical trial? As I understand it, they
want to contest the results of this trial because in their view homeopathy
has not been used in the correct way. Is there some truth in the saying
that there are as many homeopathies as there are homeopaths? According to
the correspondents and confimed by the results of the trial the numerous
homeopaths who always prescribed Arnica in that way were wrong, as were
the researchers who tested it for traumas caused by sharp instruments.
They should have known that Arnica is only indicated for blunt trauma and
preferably applied externally. It is refreshing to learn from homeopaths
that they knew all along that their brethren prescibed useless treatments
and to see this confirmed by scientific testing. Homeopathic science has
taken a giant step forward by confirming one more non-indication. The next
step should now be for the researchers to do another trial, taking into
account the bluntness of the trauma and avoiding to adminster Arnica
before the blow is delivered. What if it again shows to be not better than
placebo? Will the art of Arnica therapy be adjusted once more, or will
they abandon using Arnica, or will the faith prevail?
Competing interests:
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I wasn't surprised to read the conclusion that homeopathic doses of
arnica were no more effective than placebo. This is the result that would
be expected considering that they are in fact one and the same thing. This
certainly does not prove that arnica is ineffective, and, in common with
Janet Osborne, I have personal experience of its beneficial effects with
regard to bruising.
Competing interests:
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Competing interests: No competing interests
The BMJ has used a blunt and inaccurate headline to bludgeon
alternative medicine once again.
The report on a clinical trial using potentised arnica before and
after surgery is entitled 'Trial shows that homoeopathic arnica is no
better than placebo'. The trial did not demonstrate this at all: it
demonstrated that in surgery for carpal tunnel syndrome arnica 6c and 30c
given before and after surgery had no effect on pain and swelling. Does
that mean that arnica is no better than placebo? No: it means that arnica
was not effective in this situation, used this way. The headline suggests
that arnica is not effective, full stop.
The BMJ would have served its readers better by noting that the trial
is poorly designed. Firstly, they did not use the remedy in a homoeopathic
fashion: they gave the remedy when there were no symptoms present. Giving
the remedy in this fashion is quite likely to cause the symptoms it is
meant to cure, and few homoeopaths would recommend this approach to
treating any illness or injury.
Secondly, arnica is not likely to be an indicated remedy following
this type of surgery.
Unfortunately, the post-trial publicity has lost focus of what the
trial actually concluded: 'The results of this trial do not suggest that
homeopathic arnica has an advantage over placebo in reducing postoperative
pain, bruising and swelling in patients undergoing elective hand
surgery.'(Journal of the Royal Society of Medicine) This statement is
accurate, and as a student of homeopathy I also think it is self-evident
and not something that needed to be trialled at all - because arnica is
not likely to be an indicated remedy in this sort of post-operative
situation.
It is very easy to take a medicine, use it to treat something for
which the medicine is not indicated, and then declare that the medicine is
ineffective. Would you bother trialling antibiotics as a headache
medicine? Doing so is only a waste of time and resources. When this
approach is applied to alternative medicines, however, it is positively
dangerous, because a trial such as this is used to denigrate the specific
medicine and the health practice as a whole. Unfortunatley, the BMJ has
chosen to take this approach again rather than providing an accurate
report of a poorly-designed trial.
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Arnica montana in homeopathic doese like D30, 30X or 15C
should be used in treatment of injuries, blows, falls and bruises that are
made from blunt objects. It can be used in some post-surgery cases, but I
would rather think of Staphysagia or maby Ledum in a post-surgery case.
Arnica is probably a better remedy in after-birth treatment because
the typical injuries to the tissue will be more similar to the Arnica
case.
Arnica grows in nature where there has been a wound, like after a
forest fire, earthslide, quake, or intense logging.
Gunnar Sjögren
Homeopath
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I am not a homeopath but am quite puzzled by this recent study which
seems to have set out to fail in the first place. Homeopathic remedies
are not pills to be taken on a regular basis without symptoms, in the same
way you wouldn't take paracetamol on a daily basis for 7 days before and
14 days after a headache. In fact, I would have thought that taken in
these amounts, Arnica would start to cause the very symptoms that they
were trying to relieve.
I was pleased though to see that one of the researchers, Edzard
Ernst, said that the findings did not support the routine use of
homeopathic arnica for preventing or reducing post-operative
complications. Arnica should only be given if indicated, not as a routine
treatment.
I have proved the benefit of Arnica on numerous occasions, having
three boys aged 5 and under where bumps and bruises are a regular
occurrence in their boisterous play. One dose of Arnica is enough to
reduce swelling and bruising within a matter of hours. Studies like this
will not change anything for those of us who use Arnica as intended, and
we will continue to see the benefits.
Regards,
Hannah Hutton
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I believe in arnica too. I had my tonsils taken out at the age of 55
and the Dr. was surprised how fast I healed and no bleeding. My daughter
also used it on breast surgery and Dr. was surprised how she healed so
fast.
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I have always been a real sceptic to homeopathic /natural medicine, I
have always regarded it as charletans out to make money from the
vulnerable. However I work with therapy riding & the stables use
arnica both on the horses & on themselves when treating musculo-
skeletal problems.After I sustained a severely bruised toe from a horse
stepping on it the stables owner smeared arnica on it- I was amazed at how
quickly recovered, but was still not convinced. However on subsequent
occasions I have tried the arnica cure on other occasions not & I am
now converted to arnica. The horses are some stable owned & some
livery horses- all of us with private horses were completely sceptical to
the arnica treatment , only to gradually be converted as we see the horses
recovery from injury much more quickly- the swelling often disappearing
overnight as opposed to the traditional ice & bandaging, which seems
to take two - four days.
The biggest test was my very non- believing husband, who is now also
convinced that arnica works after trying it himself.
Patients can be influenced by their thoughts & attitudes- but
that does'nt explain why the horses get better more quickly.
Perhaps more studies should be done, not just with post - operative
patients.
Competing interests:
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Competing interests: No competing interests
Flawed trial?
This is with reference to the news item “Trial shows that
homoeopathic arnica is no better than placebo”. One of the important
principles of homoeopathic prescribing is Individualisation- the response
of an individual to any stimulus is unique and different from another who
is exposed to the same stimulus. This has been completely ignored in the
clinical trial conducted with Arnica on patients who had surgery for
carpal tunnel syndrome. It appears that the researchers did not consult a
homoeopath while conducting the trial. It is a misconception amongst
laypersons and non-homoeopathic health practitioners that arnica is a
panacea for the sequelae of all types of injuries. I wish to stress that
Arnica is useful mainly in injuries that cause contusions.
It is usually
not indicated in injuries where the skin has been broken open- like
lacerations and surgical incisions. There are many other homoeopathic
drugs for injuries, namely Calendula for lacerations and incised wounds
(it was used extensively as a local application in World War II),
Hypericum for injuries to nerves, Symphytum for fractures, Bellis perennis
for injuries to internal organs e.g. vehicular accidents with airbag
injuries, Ruta for injuries to the periosteum and the cartilages, etc.
Arnica is not the remedy that a homoeopath would prescribe for patients
who have undergone any surgical procedure for the carpal tunnel syndrome
mainly because the type of injury for which it is used is different from
the type of injury the patient has had as a result of surgery. This was
possibly the reason that the trial “showed no differences between the
three groups in the primary outcome of pain and bruising”. This trial was
not properly conceived and is a good example of a waste of funds and
manpower.
Many other aspects of patient management, like the knowledge of the
susceptibility of the patient and potency selection were ‘standarised’
during the trial, which is another flaw in any trial on homoeopathic drugs
using allopathic guidelines.
I can agree with only one statement in the news item attributed to
Edzard Ernst, Professor of Complementary Medicine at the University of
Exeter …. “ (the results) suggested that they did not support the routine
use of homoeopathic arnica for preventing or reducing postoperative
complications as bruising, swelling, or pain.” There are many other drugs
equally useful for trauma. At our hospital (Mumbadevi Homoeopathic
Hospital) in Mumbai, India, homoeopathic drugs are given to patients
postoperatively with very good results- probably because Arnica is not the
‘routine’ remedy.
Dr. Vijay H. Vaishnav
Asst. Professor, Dept. of Materia Medica
Smt. C M P Homoeopathic Medical College &
Shree Mumbadevi Homoeopathic Hospital,
Mumbai (Bombay),
India
Competing interests:
None declared
Competing interests: No competing interests