The Pharmaceutical Journal
Vol 275 No 7367 p336-337
17 September 2005

This article
Reprint   Photocopy

PDF 110K, Acrobat Reader

· Homoeopathy (5)
· Dermatology
· Spacer devices
· The profession
· Best use of medicines
· Pharmacists in the media
· Reciprocity
· Return to practice
· The Society (4)

Letters to the Editor

Homoeopathy

Maybe the homoeopath, not the medicine, is the healer

From Dr R. J. Schmidt, MRPharmS

Kevin Leivers (PJ, 3 September, p289 PDF (170K)) makes a timely contribution to the homoeopathy debate. However, some entirely pragmatic questions remain unanswered.

The use of homoeopathic preparations of arnica for bruising seems to be based on a Chinese whisper that originated in the late 1800s when J.C. White, a prominent dermatologist, counselled against the use of arnica tincture on the skin (because of its great propensity to cause contact dermatitis) unless diluted to homoeopathic concentrations. Furthermore, arnica tincture in high doses does not cause bruising so there is no basis under Hahnemann’s law of similars for using arnica homoeopathically to treat bruising.¹ Or is there? Mr Leivers side-stepped this issue by asserting unhelpfully that homoeopathic arnica is actually a “polycrest”. What we need to see is the evidence that underpins the use of arnica as a homoeopathic polycrest remedy. This must surely have been documented somewhere?

In the context of the oft-cited assertion that there are no side effects with homoeopathic remedies, we also need to have revealed to us exactly what happens when 200C and higher potencies of arnica are administered. Again, the effects of high potency homoeopathic arnica preparations must have been documented somewhere? The scientific process through which we obtain evidence to support practice is a process in which we set out to disprove hypotheses. It is only when we fail to disprove a hypothesis that it becomes established as a “demonstrable fact” — but only until new data require that the hypothesis be rejected. It should trouble us, therefore, that homoeopaths set out only to “prove” their remedies in healthy individuals.

According to Ruddock,^2,3 Hahnemann developed his ideas when seeking to understand why tincture of cinchona bark worked as a remedy for ague. He noticed that high (ie, toxic) doses of cinchona produced ague-like symptoms in healthy individuals. This is (I suppose) a demonstrable fact. And this was evidently his first “proving” experiment. It was from this observation that he developed his “let like be treated with like” paradigm to explain why cinchona in “allopathic” doses ameliorated the symptoms of ague. He did not know that ague was malaria; and he did not use homoeopathic doses of cinchona (or indeed quinine). So, as a rather important side issue to this debate on the use of arnica, I am still waiting to hear from practising homoeopaths why high potency, side effect-free, homoeopathic doses of quinine are not used to treat malaria. The World Health Organization would, I am sure, be interested in such a remedy.

Perhaps I should clarify that it is not the practice of homoeopathy that troubles me but the explanations proffered by practitioners as to how it might work (if indeed it does). If they cannot provide adequate answers, then they should finally acknowledge that Hahnemann might have been wrong about how medicines work. And then we may be able to move forward.

We could start with the hypothesis that it is the homoeopath who is the healer, not the homoeopathically potentised medicine, and this cannot be tested using a randomised double blind placebo-controlled trial.

Richard Schmidt
Barnoldswick, Lancashire

References

1. Schmidt RJ. Same laws of science apply to all medical practices — if only people realised that. Pharmaceutical Journal 2003;270:398.
2. Ruddock EH. The Homoeopathic Vade Mecum of Modern Medicine and Surgery. London: Homoeopathic Publishing Company; 1937.
3. Schmidt RJ. Another example of muddled thinking. Pharmaceutical Journal 2003;270:618.

That homeopathy is an individualised therapy does not prevent the use of RCTs to assess it

From Professor B. L. Furman, FRPharmS

I tried, unsuccessfully, to resist responding yet again to the recurring debate on homoeopathy. I shall, however, confine my remarks to Lee Kayne’s explanation of the inappropriateness of randomised, controlled trials (RCTs) in assessing the effectiveness of homoeopathic remedies (PJ, 3 September, p277). The fact that homoeopathy is an individualised therapy does not prevent the use of RCTs to assess it. For example, if x subjects are entered into an RCT of, for example, the treatment of asthma, 50 per cent of them would receive placebo and 50 per cent of them would receive their individualised therapies.

As I understand it, the homoeopathic treatment of asthma depends on various factors, such as the specific group of symptoms and the triggers (eg, cold, stress, exercise, dust etc). Thus, each patient would receive either whatever homoeopathic treatment was deemed appropriate by the prescriber or a placebo, although the prescriber, the patient and those making the objective measurements of respiratory function would be blind to the specific treatment or to whether or not the individual was in the placebo group. The null hypothesis then would be that there is no difference between the group receiving individualised homoeopathic treatments and the group receiving placebo, as determined using a range of specified subjective and objective measurements.

It is unlikely that the trial could be sufficiently powered to detect effects of specific individual treatments because there may be an enormous variation in these, as Dr Kayne implies. Nevertheless, such a design would satisfy good practice criteria and would determine the effectiveness of the homoeopathic system per se relative to that of placebo. I cannot see the objection of homoeopathic practitioners to such studies. Without them, we are invited to accept the efficacy of homoeopathy as an act of faith, which is wholly unacceptable in the age of evidence-based medicine.

Brian L. Furman
Dean of Science
University of Strathclyde

Use of homoeopathic remedies is a social statement

From Mr M. Samson, MRPharmS

Further to the current and unending debate on homoeopathy, perhaps it would be better to examine the type of people who apparently benefit from such a weird and irrational treatment.

From my own experience, homoeopathy is far more popular in more affluent areas than in more down at heel districts. The users are trying to make a social statement about themselves.They prefer to consider themselves a cut above the average patient and are helped by the knowledge that homoeopathy is favoured by royalty.

Ordinary medicines are for ordinary people.Homoeopathy is for ephemeral or transient illnesses, where accurate diagnoses are difficult to pin down.

In short the believers can be compared with the television character Hyacinth Bucket. Nothing rational will shake their belief,and those who sell these preparations are only too happy to relieve these hypochondriacs of their money. For my part,if people can be cured by simple lactose pillules, then so be it — for common sense tells us that there is no medicament there.

Michael Samson
Worthing, West Sussex

The debate should move on

From Dr P. Bates, MRPharmS

The debate over whether or not proof is required for homoeopathy has been raised once more. I must say that I do not believe that homoeopathy has a sound scientific basis but I also accept that this has never been a barrier to people wanting to use it. Far from it; it is, in fact, the very “anti-science” that makes it appealing to some. The lack of credible evidence is understandable when the basis of therapy is individually tailored and is not easily analysed by large population studies. When therapy is centred on the individual patient the treatment will be more successful. Hopefully, this is what we wish to achieve with medication use reviews, so homoeopathy certainly has something to teach us.

Patients should have the freedom to buy a homoeopathic remedy and the pharmacist should be happy that it can do no harm. Relax everyone: we can think of many over-the-counter preparations that are no better than the underestimated placebo. Despite its long history and passionate advocates, homoeopathy does not merit any exemption from the present scrutiny. The debate should move on to whether homoeopathy should be allowed on the NHS and funded by the taxpayer, especially when some drugs and appliances are not allowed or are restricted by area or patient category. This thought always crosses my mind when dispensing an FP10 for a homoeopathic remedy.

Why not ban homoeopathy on the NHS? Patients who are committed to homoeopathy still retain their individual choice to buy the remedies. Homoeopathy will always exist for those interested in it. I do not think that the homoeopathic industry will collapse as a result of it not being available on the NHS and it will still have a role to play. It may be true that money could be saved if more homoeopathic treatments replaced conventional drugs. I would be interested to know if this is simply because many homoeopathic remedies are cheaper than more expensive antidepressants, for example. Certainly more research is required to establish if real cost-effectiveness could be achieved or only that expensive powerful drugs would be replaced by cheaper placebos. The search for undeniable proof for or against homoeopathy will go on and on. However, without solid proof it is becoming difficult to justify homoeopathy on the NHS.

Philip Bates
Southampton

Dubious benefits of distilled water

From Mr A. F. Huntley, MRPharmS

It is now time, sorely overdue, to usher Edzard Ernst to The Pharmaceutical Journal exit, now that this apostle of alternative medicine is finally discredited by no less an authority than The Lancet, the latter having exposed the dubious benefits of Samuel Hahnemann’s “distilled water” and of other fantasies relating to medicines devoid of evidential efficacy.

A. F. Huntley
Bristol

Send your letter to The Editor

Next Topic (Dermatology)