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Homeopaths Without Borders practice exploitation not humanitarianism

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5448 (Published 17 September 2013) Cite this as: BMJ 2013;347:f5448

Re: Homeopaths Without Borders practice exploitation not humanitarianism

Guy Chapman’s attempted slam dunk of homeopathy - which apparently undermines modern medicine, and dares to poke its quacking beak into disaster-struck areas - forgets to mention how the (presumably now out dated?) ancient ethical covenant; ‘First, do no harm’ has been blatantly ignored:-

1. So, do homeopaths ‘tick boxes’, leave patients to dehydrate and wallow in their own excrement, or are responsible for the scandalous high death rates seen recently in some of our NHS hospitals [1]? No.

2. Do homeopaths prescribe lethal drug cocktails, hoping they might cure [2] life-threatening illnesses like cancer? No.

3. Would the relatives of Stafford’s and other hospital’s unnecessary victims [1], or Lord Maurice Saatchi (who referred to his wife’s cancer treatment as ‘medieval’ [3]) agree with Chapman’s assertion that, “the medicine Hahnemann despised no longer exists”? Probably not.

4. Speaking of which, were homeopaths in any way responsible for the 4.5% of the UK population (around 2.68 million, including deaths) harmed by conventional medicine in the NHS, as reported by the House of Commons All Party Public Accounts Committee in 2006 [4]? No.

5. Is homeopathy such “a pressing public health risk when real illness is involved” because patients are flocking like lemmings to homeopathy rather than conventional healthcare? No.

It may surprise Chapman to learn that not only is homeopathy quite safe with little risk of harm [5], patients rarely use homeopathy as primary care. Strange as it might seem, most seek homeopathic treatment only after having tried conventional approaches first [6].

Stranger still, homeopaths act humanely by referring patients back to conventional healthcare after in-depth homeopathic consultation – the very same consultation so-called “apostate homeopath”, Professor Edzard Ernst seems to admire so much [7] - red flags a serious but missed underlying condition. So instead of being “a pressing public health risk”, homeopaths can act as potential extra safeguards.

Homeopaths will doubtless feel embarrassed by the praise Chapman heaps on them when he calls their profession “…a monstrous fraud [practiced] on the vulnerable…”. For surely this means he considers them at least on a par with the big boys, e.g., GlaxoSmithKline?

Chapman might recall they pleaded guilty to off-label marketing of drugs to vulnerable minors in June 2012, in the process being found guilty of paying kickbacks to doctors. Fined a staggering $3billion by the FDA (the largest healthcare fraud settlement in US history [8]), a few weeks later, GSK were providing services for the anti-doping laboratory at the 2012 London Olympics [9]: a case of poacher turned Games keeper, perhaps?

Chapman’s enthusiastic praise aside, most homeopaths would readily admit they have some way to go before their fraudulent antics ascend to that level of monstrosity. But clearly, monstrous fraud pays dividends, so perhaps Homeopathy Without Borders might consider living up to Chapman’s high expectations by planning to provide performance-enhancing substances (prepared in the homeopathic manner, of course) for the Rio Olympics in 2016?

Repeating the shibboleth that homeopathy’s “core notions are wrong”, Chapman ignores the conventional medical literature on hormesis [10]. This is the biphasic dose response to a substance, characterized by a low-dose stimulating/beneficial effect, and a high-dose inhibitory/toxic effect [11], a phenomenon that has been known and practiced since ancient times (mithridatism is the practice of protecting oneself against a poison by gradually self-administering non-lethal amounts [12]).

Increasingly, it seems that hormesis, while not necessarily ‘proving’ one of homeopathy’s core notions [13] – that remedial substances are considered more potent the more they are both serially diluted and violently agitated – at least looks as if it is beginning to support it.
Hormesis, as Calabrese notes, “. . . is far more common and fundamental (in medicine) than the (linear) dose-response models used in toxicology and risk assessment. . . . hormesis has the potential to profoundly affect the practice of toxicology and risk assessment….[10].

Importantly, therefore, modern toxicology contradicts Chapman. And far from having stagnated for several centuries, as he suggests, there is much joint active research work going on in Europe and elsewhere, into homeopathy’s core notions [14]: research that is now turning out to be of increasing reproducibility [15].

So finally we come to Chapman’s rebooting of Baum and Ernst’s [16] earlier “…parallel universe, in which the laws of physics are profoundly different”, that homeopaths are supposed to inhabit. Actually, they don’t. Like almost everybody else, they occupy an expanding universe in which:-

1. Their humanitarian (that’s without quotation marks) contribution is as welcome and appreciated in the disaster zones they visit, as are any of the other agencies involved;

2. Better understanding of the laws of physics and chemistry, especially how they apply to materials science at the nano-scale, is leading to plausible but importantly, testable hypotheses as to how ultra-high dilutions might operate beyond Avogadro’s number [17].

3. Even from inside conventional medicine, it is realized the current version of evidence-based medicine, with its “gold standard” randomized-controlled trial sitting atop a “hierarchy” of evidence, is an illusion [18,19]. Thus, when it comes to properly assessing a therapeutic intervention, new ways are needed of analyzing clinical evidence that replace hierarchies with a diversity of approaches involving not just trials, but the totality of the evidence base, including observational studies [18,20].

If he wants to be taken seriously as a critic of the bio-medical scene, Chapman would do well to concentrate less on unattributed armchair hyperbole, and more on getting his (properly referenced) facts straight. Otherwise his interventions will continue to be judged for what they are, “….full of sound of fury, indicating nothing”, [21] and therefore, in his own words, “an ignorable side-show.”

References
1. http://www.independent.co.uk/news/uk/crime/after-midstaffordshire-scanda...
2. See, http://www.telegraph.co.uk/health/10069585/15000-people-die-every-year-b...
3. http://www.nbcnews.com/id/51161248/ns/health-mens_health/t/grieving-husb...
4. E. Leigh. A Safer Place for Patients: Learning to Improve Patient Safety. 51st report of session 2005–06 report, together with formal minutes, oral, and written evidence. House of Commons papers 831 2005–06, The Stationery Office. July 6, 2006. See http://www.health- care-reform.net/causedeath.htm
5. B.J. Kirby. Safety of Homeopathic Products. J Royal Soc Med 2002; 95: 221–222.
6. M. Markman, Safety Issues in Using Complementary and Alternative Medicine JCO 2002; 20: 39–41.
7. Ernst E. Homeopathy, non-specific effects and good medicine: Have we lost core medical values? Rheumatology (Oxford) 2011;50:1007–1008.
8. See http://www.bbc.co.uk/news/world-us-canada-18673220
9. See, http://www.kcl.ac.uk/newsevents/news/newsrecords/2012/01Jan/London-2012-...
10. Mattson, M.P., and Calabrese, EJ. (Editors). (2010). Hormesis – A Revolution in Biology, Toxicology and Medicine. Humana Press. New York NY, pp. 208.
11. Calabrese EJ. Toxicological Awakenings: the Rebirth of Hormesis as a Central Pillar of Toxicology. Toxicol Appl Pharmacol 2005; 204(1): 1–8, and references therein.
12. McGing, BC. The Foreign Policy of Mithridates VI Eupator, King of Pontus. 1986, Leiden, The Netherlands: E. J. Brill. p. 43.
13. Calabrese EJ, and Jonas WB. Homeopathy: clarifying its relationship to hormesis. BELLE Newsletter, 2010;16(1):4-11.
14. See, http://www.hribarcelona2013.org/ and proceedings to be published in January 2014.
15. Endler PC et al. Repetitions of fundamental research models for homeopathically prepared dilutions beyond 1023: a bibliometric study. Homeopathy (2010) 99, 25–36.
16. a; Baum M, Ernst E. Should we maintain an open mind about homeopathy? Am J Med 2009;122:973–974: b; Milgrom LR. The eternal closure of the biased mind? The clinical and scientific relevance of biophysics, infinitesimal dilutions, and the memory of water. J Altern Comp Med 2009;15:1255-1257.
17. a; Chikramane, PS, et al. Why extreme dilutions reach non-zero asymptotes: a nanoparticulate hypothesis based on froth flotation. Langmuir 2012;28(45):15864-75: b; Aimé C, et al. Controlling the nano-bio interface to build collagen-silica self-assembled networks. Langmuir 2012 Jan 31;28(4):2156-65: b; Relaix S et al. Memory effect in composites of liquid crystal and silica aerosol. Phys Rev E84, 061705 (2011): d; Bell IR and Koithen M. A model for homeopathic remedy effects: low-dose nanoparticles, allostatic cross-adaptation, and time dependent sensitization in a complex adaptive system. BMC Comp Alt Med 2012;12:191-212.
18. Rawlins M. Harveian Oration: De testimonio: on the evidence for decisions about the use of
therapeutic interventions Lancet 2008;372:2152–61.
19. Smith GCS and Pell JP. Parachute Use to Prevent Death and Major Trauma Related to
Gravitational Challenge: Systematic Review of RCTs. BMJ 2003; 327: 1459–1451
20. Spence D, Thompson E, Barron S. Homeopathic treatment for chronic disease: A 6-year
university hospital-based out- patient observational study. J Altern Complement Med
2005;5:793–798.
21. Shakespeare W. Macbeth; Act 5, Scene 5, lines 27-28; circa 1606.

Competing interests: No competing interests

01 October 2013
Lionel R Milgrom
scientist, homeopath, writer
Program for Advanced Homeopathic Studies
London NW2 3ES