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	The Pharmaceutical Journal Vol 270 No 7237 p268 22 February 2003	This page Reprint Photocopy
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Homoeopathy

Arnica trial not big enough

Arnica can be of benefit at appropriate dose

Would not use arnica for pain relief

Arnica trial not big enough

From Mr K. R. Nathwani, MRPharmS

I would like to comment about the findings of the researchers from Exeter University with regards to their trial of homoeopathic arnica (PJ, 8 February, p180). I would like to question their understanding of homoeopathic philosophy and to remind those with no experience of homoeopathy that:

• Homoeopathy treats the whole person — it is a holistic science which treats by the laws of similars, ie, what causes also cures

• Every individual is different, some patients may respond to arnica, others may respond to hypericum or calendula or staphisagria depending on their individual symptom picture. In homoeopathy you cannot treat everybody with the same remedy (as allopaths do), treatment is based on individual prescription

• Arnica is an excellent remedy where the symptom picture characterises: sore, lame bruised feeling, after traumatic injuries, fears touch, indifference, nervous — cannot bear pain, wants to be left alone (It is doubtful that all patients on the trial fit this category.)

• The potency is questionable, homoeopathic remedies are not designed to be prophylactic and should not be prescribed allopathically. Some patients may have responded better to perhaps a 200C dose or even a 1M dose depending on the intensity of the symptoms

• Homoepathic remedies should only be repeated under the guidance of a qualified homoeopath, since these remedies should only be taken where symptoms agree, otherwise you could "prove" the remedy, ie, cause aggravations, or even the symptoms that the remedy is trying to cure.

• Homoeopathy is therefore designed to treat on all levels of the person, ie, mental, emotional and physical, by stimulating the body's own healing processes.

The trial was not sufficiently large to justify the researchers' statement on arnica, nor are they in any position to state that arnica is a waste of money (often cheaper and more effective than ibuprofen). In my practice I have had excellent response with homoeopathic remedies, especially arnica, when prescribed according to homoeopathic principles, which have remained sound and solid for over two centuries.

Any one involved in conducting a homoeopathic trial should consult a qualified practitioner before making unfounded claims and criticisms of homoeopathy.

Kamal Nathwani
Sanjivani Homoeopathic Pharmacy
Hertford

Arnica can be of benefit at appropriate dose

From Mr A. G. Simmons, MRPharmS

As a practising homoeopath, I question whether the study into the effects of arnica after hand surgery (PJ, 8 February, p180) has added significantly to our knowledge. It appears that the investigators have overlooked two major homoeopathic principles, namely those of individualising treatment to the patient's symptoms and the minimum dose.

In my experience, arnica can be of significant benefit after surgery, but only if it is the remedy indicated by the patient's symptoms. Also, within this study, the doses used and the frequency they were repeated are, in my opinion, inappropriate.

Andrew Simmons
Pharmacy Department,
Airedale General Hospital

Would not use arnica for pain relief

From Mr D. B. Needleman, MRPharmS

I should like to point out a number of things about the "study" of arnica reported in The Journal (8 February, p180).

The Research Council for Complementary Medicine has commented extensively regarding the poor quality and the flawed nature of this research and as they are far more experienced in this field than I, I can only state their opinion.

As a pharmacist and a homoeopath of many years standing I can only say that I was disappointed in the research and the media coverage. No mention has been made of the inappropriateness of the remedy to the condition it was used to address. I, along with many hundreds of my colleagues, would not use arnica for pain relief. We would most likely have used hypericum or possibly ruta graveolens, so the study was based on a false assumption. I would also like to point out that we would not use arnica in this way before and after an operation because the dosage is inappropriate.

I run the Homeopathic Helpline and since 1996 have answered more than 60,000 queries, many of which dealt with the use of remedies before and after surgery. Not once have I recommended the use of arnica before an operation — only after to aid healing and not for the relief of pain.

It is a great sadness to me that the only professor of complementary medicine at any United Kingdom university seems to make a career out of conducting research that is designed to detract from the benefits of complementary therapies.

It saddens me more that no homoeopath appears to have been consulted before, during or after this study in order to verify the use of the arnica in this way. We also do not know the source, storage or handling that related to the arnica used, which may have an impact on any results.

To end I would also like to state that homoeopaths often treat carpal tunnel syndrome and thereby obviate the need for surgery.

David Needleman
Director
Alliance of Registered Homeopaths

Professor EDZARD ERNST, director, complementary medicine, Peninsula Medical School, Exeter, replies:

Of course, homoeopathy usually requires individualised prescription according to the "like cures like" principle and we were, of course, well aware of this. In a study of homoeopathy for childhood asthma to be published shortly in Thorax, we conscientiously followed this concept. Arnica for trauma is, however, quite a different matter. Most homoeopaths use it for "acute" rather than "constitutional" prescribing regardless of the law of similars. Most if not all textbooks recommend it in that way and arnica is sold for self-medication in United Kingdom pharmacies following the concepts tested in our study. Thus we thought it important to design our study in the way we did.

The argument regarding the treatment schedule/dose might be valid. It could be that a modified dose is effective. To minimise the risk of a false negative result, we used two different potencies. The doses we ended up using were chosen after considerable thought and consultation with several trained homoeopaths (I am one myself). To be absolutely sure, one would need to test all doses/treatment schedules possible and several thousand combinations are conceivable — too many for our modest research budget.

Mr Nathwani comments that the study was "not sufficiently large". His letter continues reporting anecdotes from clinical practice. This is an almost farcical contradiction where the largest trial of arnica so far (ours) is deemed not big enough but single cases suffice as evidence in favour or arnica.

Mr Needleman argues that arnica is not a painkiller. True — that is why we used swelling and bruising as other primary outcome measures. The claim that we do research "designed to detract from the benefits of complementary therapies" is simply ridiculous. In this study, the plastic surgeon was a strong believer in arnica and we bent over backwards to design a fair and rigorous trial.

With all this intense and often ill-informed criticism of our arnica study in the professional and lay press, I often wonder: would the critics have found our methodology equally flawed if the result had been positive? Does nobody seriously consider the possibility that homoeopathic arnica simply does not work? This, I fear, is what both the trial and the systematic review of previous placebo-controlled studies¹ imply.

References

1. Ernst E, Pittler MH. Efficacy of homeopathic arnica. A systematic review of placebo-controlled clinical trials. Arch Surg 1998;133: 1187–90.

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