The Pharmaceutical Journal
Vol 270 No 7245 p547
19 April 2003

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Letters to the Editor

Homoeopathy

Evidence comes through tests

From Mr L. N. Collin, MRPharmS

John Sharp raises an interesting point (PJ, 5 April, p477) concerning the diversity of claims made for calcium phosphate in a 6X potency. The evidence for such "pharmacological versatility" would have been noted in the original provings of this tissue salt in a group of healthy volunteers. Thus, some volunteers may have experienced stomach pain after eating, others rheumatic pain and yet others inflamed gums or pyorrhoea.

In a low potency like a 6X, the symptoms would have been predominantly in the physical sphere, whereas provers testing higher potencies (above 30C) would have noted more subtle effects on a mental or emotional level. It is those effects which came across strongly in several provers which would have been used to compile the characteristic properties (and keynotes) of calcium phosphate and led to a clear picture on which to base a homoeopathic prescription.

Lawrence Collin
Westcliff-on-Sea, Essex

Are placebos the ultimate?

From Mr M. Samson, MRPharmS

For many years I have been entertained and amused by the arguments for and against homoeopathy in your columns. It would appear to me, whenever homoeopaths are cornered, they move the goalposts.

I refer to an example by your correspondent Tony Pinkus (PJ, 22 March, p401), who states that the purpose of infinitesimal doses is to reduce toxicity. Surely the claim was that homoeopathy was safe because of the small doses and I have always understood from homoeopathic texts that dilution increased potency. An interesting double-blind trial could be conducted. To compare a homoeopathic preparation against lactose pilules would be paradoxical indeed.

Since the lactose pilule would contain no medication and since homoeopathic pilules increase in potency with increased dilution, lactose pilules would be the ultimate dilution and therefore homoeopathy at its most potent. I accept that whenever homoeopathic products are compared with orthodox medicines, the homoeopathic medicine never seems to perform more effectively than a placebo. Many people, due to some innate condition, do react to placebos and autosuggestion in certain types of affliction. This is a useful phenomenon but is hardly the cause a practitioner should follow when presented with a seriously ill patient.

Modern orthodox medicine has given the world spectacular cures which nobody can deny. Since homeopathy was conceived, where is the evidence that it has been made any breakthrough in treatment before modern specific approaches started in the early 20th century? What epidemics were eradicated in the 19th century which should be ascribed to homoeopathy, which was without serious competition and was widely practised? The truth is that people died like flies and life expectancy was low. Homoeopathy gave false hope.

Perhaps a more useful study would be to examine those people who believe in homoeopathy. Somehow there is something of the zealot in their psyche, a holier-than-thou attitude, a mystery wrapped up in an enigma — as Churchill would have put it. For my part, I only subscribe to logic.

Michael Samson
Worthing, West Sussex

Responsibility to advise appropriately

From Mr M. M. Ahmed, MRPharmS

I completely support Peter Burrill (PJ, 1 March, p302) and in response to Dr Kate Lloyd, medical director, Pfizer Ltd, I would say that it is not inappropriate to talk about any outcomes other than stroke in conjunction with amlodipine's effect in lowering blood pressure.

Heart failure is common in the elderly and is the cause of many hospital admissions. The burden of heart failure on individuals, the community, and the economy will continue to rise as the proportion of elderly persons in the population increases. Reducing morbidity and mortality from heart failure is a priority for primary care trusts. We also know that hypertension is a significant risk factor for developing heart failure.

It was deemed to be of sufficient importance for the doxazosin arm of ALLHAT to be prematurely terminated, largely due to an excess of heart failure.¹ The individual components of the combined outcomes in ALLHAT were prespecified and examined as endpoints.²

As the authors of ALLHAT say: "The results of ALLHAT indicate that thiazide-type diuretics should be considered first for pharmacological therapy in patients with hypertension. They are unsurpassed in lowering blood pressure, reducing clinical events, and tolerability, and they are less costly."²

As a prescribing adviser I have a responsibility to advise my prescribers of appropriate treatment according to randomised controlled trials and I have already discussed the Istin advertisement with them.

Mohammed Ahmed
Prescribing Adviser
Doncaster West Primary Care Trust

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