Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 10:49|| |
Review of Research in Homeopathy: Theory and Methodology
Michael Carlston, MD
(This article is reprinted from Carlston M: Homeopathic research, in Carlston M, Micozzi MS (eds): Classical Homeopathy. Philadelphia, PA, Churchill Livingstone, 2003, pp 63-75 Address reprint requests to Michael Carlston, MD, 987 Airway Court, Suite 19, Santa Rosa, CA 95403-2050. E-mail: email@example.com)
“There are three kinds of lies: lies, damned lies, and statistics.” —Benjamin Disraeli edical research and the scientiﬁc method have been part of homeopathy since its inception. Hahnemann’s experimentalist temperament led him to reject conventional wisdom and medical practices because he observed the harm they caused while providing little beneﬁt to the patient. As a result of this observation, he developed an alternative approach and tested it methodically. Ever since, the homeopathic scientiﬁc community has spent much of its time attempting to prove that he did not go astray. The customary means of developing that proof has been through scientiﬁc experimentation. As early as 1833, clinical trials instigated by homeopaths compared conventional and homeopathic treatments.1 Throughout the second half of the nineteenth century, the American Institute of Homeopathy annually challenged the American Medical Association (AMA) to compare treatment effectiveness in a scientiﬁc study. The AMA ignored the challenge. When homeopaths were ﬁnally accepted into the AMA early in the twentieth century, the challenge was dropped in the new, less contentious social climate. Research is an extremely important tool for evaluating the merits of any medical therapy. Certainly, we should respect the clinical wisdom of any experienced health care provider. However, the complexity and variety of human experience can lead to incorrect conclusions. Experience and common sense can be inadequate or even misleading at times when we study complex living organisms. One of the classic examples of research disproving a “common sense” treatment was the famous study of internal mammary artery ligation for angina pectoris.2 Because angina is caused by inadequate blood ﬂow to the heart, in the late 1950s surgeons attempted to divert blood ﬂow to the heart by ligating the internal mammary artery. Many physicians thought the treatment effective until the publication of a study that would never be approved by a human subjects committee today. In this study, the surgeon performed either the usual mammary artery ligation procedure or a fake operation. The highly invasive placebo proved as effective as the real surgery. Formalized research, particularly human clinical research, can help bring objectivity to the analysis of healing interventions. This ritualized investigation process is particularly important when the intervention is controversial. Although a double-blind randomized placebo controlled trial (RCT) does not automatically produce truth, it does lend credibility. Several types of studies are currently in use, some of them observational and others experimental. Ideally, for the sake of credibility and comparison, experimenters should use conventional research designs. However, as we will discuss in the following section, homeopathy, like acupuncture and some other forms of complementary medicine, does not lend itself well to many conventional research designs. Unfortunately, this is particularly true of the double-blind RCT design. Although consensus is difﬁcult to achieve when the topic is homeopathy, most of the medical community agrees that research is important. It is wise to keep Disraeli’s caution in mind, but research support for the controversial theories of homeopathy is essential. Homeopathy does have some research support. Furthermore, this support has had an important effect on increasing physician awareness and acceptance of homeopathic medicine. When conventional physicians and the conventional medical community are asked to consider any form of complementary medicine, the ﬁrst response is asking to see the research. Questions about patient safety are also important, but scientiﬁc evidence of efﬁcacy is the foundation for credibility. This demand for research evidence is reasonable and customary in modern medicine. The worth of a conventional medicine is proved by research evidence that it is superior to placebo or, better still, clinically effective (ie, the treatment has an effect on the disease that is meaningful to the patient) in a rigorous trial. Achieving such standards can be difﬁcult, expensive, and time consuming. Some observers believe that, when homeopathic medicine is being studied, the standard must be higher than for conventional medicine, because the ability of extreme dilutions, or perhaps the “memory” of the therapeutic agent, to generate physiologic effects would ﬂy in the face of current scientiﬁc understanding. Supporters of homeopathy respond by claiming that the scientiﬁc evaluation of a treatment is based on its effectiveness, not on our understanding of the mechanism of its effect. In this view, the focus is on whether it works, not why it works. Our failure to understand why something works is not an indication that it does not work. Is it hypocritical— or prudent—to demand more than proof of effectiveness for an intervention whose mechanism of action we do not understand?
73 clinical trials in our efforts to answer this question. Survey data are seldom convincing because of uncontrolled confounding factors. To establish credibility, investigations of homeopathy and other forms of CAM must be of the very highest quality. Is it fair to require higher standards of CAM therapies than would otherwise be necessary? Probably not, but present realities necessitate the very highest standards. The most highly regarded study design is the doubleblind, placebo controlled RCT. RCTs, whether single-blind or double-blind, are costly and laborious. The requirements of a well-designed RCT can make the results difﬁcult to generalize to less-precisely deﬁned circumstances (ie, “the real world”). RCT design can be extremely difﬁcult to apply in therapies like homeopathy or acupuncture, which make blinding the patient practically impossible (discussed later in more detail). Although these factors limit the practicality of RCTs, they remain important because they are the gold standard of today’s medical research.
The Nature of Proof
Is credibility synonymous with scientiﬁc proof? Studies of physicians ﬁnd that we do not customarily rely on research ﬁndings when we make decisions about complementary and alternative medicine (CAM) therapies or even in our use of conventional medicines.3-16 Noncompliance with formal guidelines for clinical practice is common, and its causes are many.17-26 Although the reasons for our ambiguous relationship with scientiﬁc evidence are complex and poorly understood, our recommendations are clearly more arbitrary than the average patient believes. Too often it appears that some physicians selectively recognize research evidence supporting their preexisting opinions and ignore studies that contradict those opinions. This is as true of physicians who use CAM as of those who use only conventional medicine. Such bias is most unfortunate. Although we might prefer to categorize evidence in terms of simple dichotomies (eg, wonderful or worthless), the complexity of contradictory or seemingly contradictory ﬁndings often leads to greater understanding. Two examples from nutritional medicine might be helpful. We have good evidence that high dietary consumption of foods containing beta carotene is associated with many health beneﬁts, including decreased risk of lung cancer. We also have evidence that supplementation with synthetic beta carotene actually increases this risk. Why? Also, high levels of urinary calcium are associated with increased
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 10:50|| |
risk of kidney stones, so for many years patients were told to restrict dietary calcium. The medical literature of those years contained articles supporting the efﬁcacy of this intervention.27,28 However, we now believe that high calcium intake does not lead to calcium-containing renal calculi— but rather prevents them.29,30 The instances when common sense conﬂicts with observed facts or when research data are inconsistent are precisely when we can learn the most. It is unwise and unscientiﬁc to blind ourselves to contradictions or data that make our world a little less tidy than we formerly believed it to be. Although an argument could be made that the statistical methods employed by medical researchers serve to ﬁnd artifact as well as truth, the impetus for research is the search for proof, proof of efﬁcacy, and proof that an intervention works. We can collect survey data or conduct case control studies or
Stages of Proof
Usually these trials are “ideal-world” studies in the sense that investigators select the problem, practitioners, and patients to maximize the chances of a positive ﬁnding. If the initial ideal-world scenario shows promise, further research follows. If subsequent research, most commonly investigations of other ideal-world circumstances, is similarly positive, the medical community might conclude that the method works. Besides being somewhat premature, this conclusion is also naïve, for reasons discussed later. Proof is relative, and there are different levels or stages of proof along the path to integrating an unfamiliar system of therapy into conventional medicine. The ﬁrst investigation stage is to consider whether the entire therapeutic system is faulty. This initial process is extremely dependent on making optimal investigative choices. For example, we know that surgery is a useful technique under the correct circumstances. A study of a surgical intervention for appendicitis will show positive outcomes. A single study, or even a series of studies, of surgical treatment for viral gastroenteritis would lead investigators to the conclusion that surgery does not work. If a fanatical supporter of surgery with an unlimited budget persisted and conducted trials investigating surgical treatment of anxiety and hay fever, the cumulative negative ﬁndings would make it difﬁcult to argue the case that surgery has a legitimate role within modern medical practice. The ﬁrst stage of investigation is much like sending out a scouting party for a quick glimpse of the terrain. The information obtained at this level of investigation is quite inadequate and very frustrating for patients and clinicians, because while a positive ﬁnding can raise hopes, it does not give us the practical information necessary in clinical practice–we need to know for what it works and when. On the other hand, this stage is a necessary screening hurdle that a therapy must jump before more energy is dedicated to the investigative process. After demonstrating a pattern of apparent effectiveness, investigations proceed to the next level. This next stage has two components. The ﬁrst is building an evidence base for the use of a treatment in speciﬁc clinical conditions. The second is conducting more real-world investigations of the treatment as applied in the average community setting. Realworld studies are important because they most truly reﬂect the average patient’s clinical experience. Eventually the focus of study can move to other matters, such as delineating differences between treatment approaches and evaluating the therapy’s cost effectiveness for example. The recent National Institutes of Health (NIH) Panel Consensus on Acupuncture is a good example of the early stages of this process. After critically reviewing MedLine’s indexed studies, the panel concluded that there was promising evidence of acupuncture’s efﬁcacy in certain clinical conditions. They also determined that there was suggestive but inconclusive evidence about a number of other conditions. They reached these positive conclusions despite an admitted lack of understanding for the mechanisms behind acupuncture’s effects.31-34 other, more important, facets of the patient’s health. Patients often share the homeopathic perspective, recognizing that they feel better because of their improved mental state, for example, although their skin condition may have worsened. The current state of homeopathic research is ambiguous and complicated. We do not have simple answers about clinical homeopathic medicine or the basic science questions its efﬁcacy would pose. Homeopathic research is a conundrum—fertile ground for questions about homeopathy and the process of scientiﬁc research. Although it is not easy to use conventional scientiﬁc protocols to examine homeopathy, the attempt teaches researchers a great deal about homeopathic principles. A researcher must overcome considerable challenges if he or she is to simultaneously respect homeopathic principles and conventional research methodology. Designing homeopathic clinical trials can be more than a little challenging; however, with great understanding and effort, it is possible.
“A poorly or improperly designed study involving human subjects is, by deﬁnition, unethical.” —Science, 11/18/1977 Because a clinical trial must inevitably expose subjects to some risk of adverse effects, a study that does not lead to an answer needlessly places subjects in harm’s way. The essential principles of homeopathy must be respected for research investigations to produce meaningful answers. Mistakes do occur and they are an inevitable part of the learning process. If we do not learn from our research mistakes we only compound them and act irresponsibly. First, let us consider the most essential homeopathic principle, using like to cure like. In practical terms, this principle necessitates highly individualized prescriptions for each patient. The intense and usually lengthy homeopathic interview, which is a necessary step toward providing highly individualized prescriptions, may be an ideal setting to maximize placebo effects. The interview also makes blinding uniquely difﬁcult. The practitioner carefully considers the patient’s words and expressions as she draws conclusions about the nature of the patient and the correct homeopathic prescription. The patient becomes an important party in the decision-making process as questions and answers pass back and forth conﬁrming or denying the practitioner’s suspicions. Subtle indications of the practitioner’s certainty about the prescription are likely to affect the patient’s expectations about the response to the treatment. Interpersonal perception and interaction is central to the homeopathic clinical process. Although these interpersonal elements might be controlled by a dispassionate third party actually administering the medicine, other issues arise. Most obvious is the certainty that, in an unknown percentage of cases, the interaction between practitioner and patient is the cure. The placebo effect may be even more important to the success of homeopathy than to conventional medicine. Taken to the extreme, if the
“The patient’s opinion is the ultimate outcome measure.” —Ian Chalmers I would be remiss not to include some discussion of outcome measures, because this issue strikes very close to the heart of the philosophic differences between many CAM therapies and conventional medicine. Many conventional medicine practitioners would argue that this division exists within conventional medicine as well. What do you measure to determine a treatment response? Clearly the most acceptable and perhaps the most objective way to measure response is via physiologic parameters that can be measured by laboratory tests. We have a great deal of experience with such measures, and precise information about the reliability of the testing procedures themselves. These procedures can be costly, always an issue in clinical trials, but more importantly the information may not tell us what we hope it will. Although we use these tests as surrogate disease markers, very few tests indisputably quantify a patient’s disease state. Most importantly, these
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 10:51|| |
tests do not tell us whether the patient feels better and is more fully able to function. A good example of this deﬁciency is found in clinical cancer research, which increasingly includes valuation of the quality of a patient’s life as well as the traditional method of simply tracking the length of a patient’s survival. We are in the infant stages of developing reliable measures to answer the very simple question, the one most crucial to the patient, “How do you feel?” Many CAM therapies, homeopathy more than most others, espouse a philosophy of health based on all aspects of a human being: physical, mental, emotional, and even spiritual. It is therefore essential to attempt to measure patients’ health just as broadly. Homeopathic principles sometimes deﬁne even the worsening of some physical symptoms as an improvement in a patient’s condition, provided this decline is linked to improvement in effects of homeopathy were predominantly the result of placebo, it would not mean that homeopathic treatment is worthless, but that the most important element is the interaction, that the person was more important than the pill. Several years ago, I had an interesting discussion with a European homeopathic researcher in which we lamented the vanishing opportunity to test this hypothesis by conducting a “homeopathic trial” with American patients whose only treatment would have been the homeopathic interview. Americans were starting to learn enough about homeopathy to expect more from a homeopath than only an interview, no matter how insightful. Most homeopaths believe that the success of homeopathic treatment is almost entirely dependent on the accuracy of the practitioner’s prescription. A trial of classical homeopathy cannot be credible, therefore, unless it is based on accurate prescriptions. A trial design not meeting this requirement that leads to a negative ﬁnding would generate a loud chorus of complaint from the homeopathic community about the inadequacy of the homeopath who chose the homeopathic remedy. Negative ﬁndings from poorly designed trials are meaningless, because an informed advocate or critic would expect that failure was the only likely outcome. One means of overcoming this difﬁculty is for a panel of homeopaths to select the correct homeopathic remedy for each patient. This method makes it necessary for each panelist to independently interview every patient or for the panel as a group to examine each patient (a circumstance that would very likely signiﬁcantly alter patients’ behavior) or for the panel to watch videotaped cases. A videotaped case does not allow for interaction between the patient and the panelists, thus changing the dynamic and each practitioner’s perception of the patient. The practitioners viewing the videotape could not question the patient, thus limiting the information on which they based their prescriptions. On the whole, the process of prescription by committee is very timeconsuming and potentially contentious. Another research-complicating factor involved in providing highly individualized prescriptions is that every disease must be treated with one of a large number of homeopathic remedies. For example, one of the classic texts in homeopathy, Kent’s Repertory of the Homeopathic Materia Medica lists more than 120 different homeopathic medicines for asthma.35 No classical homeopath believes that all of them would be useful for any one patient with asthma. To the contrary, the classical homeopath believes that there is one best choice for each patient. Other remedies may be of limited beneﬁt, but one will be uniquely helpful. It is worth emphasizing— the choice of the homeopathic remedy is crucially important. Another issue was brought to my attention a decade ago during a research meeting in the Department of Family and Community Medicine at the University of California, San Francisco. After I proposed a trial and explained some of the methodology issues, one of the two department research specialists insisted that any homeopathic study must use only one homeopathic remedy for proper statistical analysis. She argued that every different remedy was a different treatment. The other disagreed. If “correct design” in a trial of classical homeopathy means using only one single remedy, homeopathic clinical research would be so impractical it would be essentially impossible. Although we might reach a point were we can compare the effectiveness of various homeopathic remedies in certain disease conditions, at this point we have yet to produce incontestable research evidence settling the more fundamental question of homeopathy’s effectiveness as a system of medicine. Clinical trials using classical homeopathic principles represent only a small fraction of homeopathic clinical research. Given the foregoing difﬁculties, it is easy to sympathize with researchers who choose not to try to pick their way through this Gordian knot complicating homeopathic clinical research. Unfortunately such expediency is unacceptable when we must be consistent with homeopathic principles to get meaningful answers. Like the many-headed Hydra, a new series of problems arise to take the place of each one conquered by the researcher. Ignoring the demands of classical homeopathy simpliﬁes the problems; however, the requirements posed by more simplistic versions of homeopathy are still formidable. Each challenge demands careful consideration from a conscientious researcher. Overlooked, they can easily negate any conclusions derived from what will surely be a poorly designed study.
Response Expectations Change with the Passage of Time
Patient response varies with time. Once a patient takes the correct homeopathic remedy, he is expected to improve after a certain interval (Fig. 1). That interval is dependent on several factors, among them the patient’s disease severity, duration of illness, general health, and age. In addition, homeopaths expect a short-term intensiﬁcation of patients’ symptoms (aggravation) before long-term improvement sets in. Homeopaths expect the correct remedy to make the patient worse at time B but better at time C. Choosing the correct time to measure response is one of the arts of combining homeopathic clinical experience with research methodology. Some studies creatively used the homeopathic aggravation as an outcome measure, identifying a temporary decline in patients’ condition as a successful intervention. A correct homeopathic prescription should lead to persistent improvement in the patient’s clinical condition. This process should continue long after the patient stops taking the homeopathic remedy. Theoretically, the long term effect 76 of homeopathy would be expected to confound the response of a study group changing from active treatment to placebo. This effect makes it very difﬁcult to perform crossover studies. There are points of contact. A homeopath looking at conventional medicine will recognize that homeopathy’s primary principle, like cures like, has been used to a limited degree in conventional medicine and in many forms of traditional healing. However, this principle is far from general acceptance. Homeopathic and conventional opinions about the effects of a speciﬁc treatment on a speciﬁc patient are often diametrically opposed. These disagreements are a daily event in the practice of clinical medicine. A seminal ﬁgure in homeopathic history, Constantine Hering, developed an outline of clinical response patterns to treatment which is used to assess the effects (favorable or unfavorable) of a treatment intervention. Homeopaths call this the “Law of Cure.” In some instances, viewing the patient’s clinical response to conventional treatment through the lens of Hering’s Laws of Cure leads to the conclusion that the conventional medical treatment harmed the patient. This interpretation is usually at odds with the conventional interpretation of the same experience. The matter of homeopathic dilution is quite disturbing to most scientiﬁcally trained professionals. How could any physiologic effect possibly result from ingesting such fantastic dilutions? It is so unsettling that some ﬁnd it impossible to seriously consider the possibility that there may be something of value in the other elements of the homeopathic approach to patients. Another factor heightening the belief that homeopathy’s effects may result solely from the placebo effect is the homeopathic interview. The classical homeopathic interview, with its carefully detailed, respectful inquiry into the patient’s medical and life history, appears ideally suited to maximize the placebo effect. These many fundamental questions about homeopathic medicine require attention. It is important to consider the possibility that homeopathic treatment is synonymous with placebo treatment. Some within the homeopathic community are offended when this issue is raised. They are threatened by the derogatory implications of the word placebo and consider raising the question of placebo tantamount to impugning their honesty or intelligence. They point
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 10:51|| |
out that homeopathy has continued in much the same form for nearly 200 years, with a large cadre of enthusiastic patients. Surely this lengthy track record of satisﬁed patients must prove efﬁcacy and therefore disprove the supposition that homeopathy is placebo. Other homeopaths take a broader view. They are not frightened by the complicated questions growing out of our ignorance about the nature of the placebo effect. They consider discussion of the placebo issue fascinating and potentially laden with vitally important information about the healing process—information from which all health care providers can learn. Their view is that homeopathy has survived because it appears to have some degree of clinical efﬁcacy and therefore considerable implications for medicine. This is true regardless of whether homeopathy is entirely or only partially placebo. This second group of homeopaths agrees with the opinion, widely accepted within conventional medicine, that alterna-
Provings Make the Patient Worse
A patient who takes too much of the correct homeopathic remedy for too long a time will get worse. Healthy people test homeopathic remedies by taking them for a time, hoping to develop a reaction to the medicine (proving) and thereby learn what symptoms suggest its use. In the same manner, patients who take a remedy repeatedly will pass the point of improvement and get worse from taking too much of what would otherwise be a beneﬁcial remedy. In addition, patients who overmedicate often temporarily develop symptoms of the remedy they did not previously suffer.
Questions about dosage may be homeopathy’s not-so-secret Achilles heel. Although dosage is the most obvious sticking point, it is separate from and secondary to the principle of using like to treat like. Perhaps like to treat like will prove useful for certain conditions only if certain doses are administered. Homeopaths often argue amongst themselves, sometimes heatedly, about appropriate dosage regimens, whereas conventional critics seldom investigate homeopathy any further than the dilution controversy. There are many different points of view on this issue, which is a question of interest to all parties debating the worth of homeopathic medicine.
Reﬂections on Placebo
Why Talk About Placebo?
The use of placebo controls in research is an important component of the effort to develop a foundation of evidence on which to base the clinical practice of medicine. Unfortunately, the term placebo has pejorative connotations in clinical medicine.36 Considerations of alternative forms of medical care, for example, inevitably rouse cries of “placebo” from the most skeptical corners of the medical community.37-39 Placebo is too often a term of disparagement, not discussion. Given homeopathy’s marked difference from conventional medicine—its extreme “otherness”—the placebo issue naturally arises and must be examined when considering homeopathy as a medical science.
Homeopathy as “Other”
Homeopathy is nearly archetypal in the numerous challenges it poses to conventional medical thinking. Metaphors of battle often appear when an author on one side writes about the other side. The differences between the systems are so profound that the use of such metaphors is understandable. Although it is less wide than in the past, a gulf remains between the medical philosophies of the average homeopathic physician and the typical conventional physician. The differences between these understandings of patient health continue to create a great deal of mistrust on both sides. Just as conventional medical practices need to be critically evaluated, this age of evidence-based medicine demands nothing less of alternative medical treatments. The gold standard of research in clinical medicine is the doubleblind placebo controlled RCT. Because RCTs often use placebos as controls, understanding the placebo is essential to the process of understanding medicine, including alternative medical practices such as homeopathy. circumstance that is the crux of the placebo–alternative therapy question. The following example may illustrate this point. A patient receives a treatment from an individual who believes it will help the patient. Later, a placebo-controlled trial shows no difference between the treatment and placebo. Despite the research ﬁnding, using the deﬁnition in the previous paragraph, the practitioner’s belief that the treatment would have a speciﬁc effect on the patient’s disease would mean the treatment was not a placebo. A historical example of this circumstance in conventional medicine might be helpful. In the late 1970s, Benson and McCallie reviewed various treatments for angina, treatments that were later found ineffective.44 They learned that many of these ineffective therapies showed response rates up to 100% in early open and double-blind trials (mean response 82.4%) involving 1187 patients. Several patients who were improved by these interventions continued to be well for more than a year (unfortunately, few patients had such extended follow up). Benson’s analysis was a dramatic demonstration of the effectiveness of “ineffective” treatments. The clinicians did not realize that their interventions were merely placebo. Most deﬁnitions of placebo require that the physician believe that the treatment is ineffective. By these deﬁnitions, placebo is at some level a deceit.45 Traditional treatments acquire the placebo label when the medical community acknowledges that they were ineffective. Although the past errors of conventional medicines are recognized, no one seems eager to label those misguided practitioners as quacks. Similarly if practitioners of homeopathy and other forms of CAM are making clinical errors, these mistakes are most likely the result of well-intentioned ignorance rather than deliberate deceit. Muddling these uses of the term placebo (placebo equals trickery as opposed to placebo equals error) may contribute to physician mistrust of alternative medicine.
Homeopathy is Placebo, But
Is homeopathy then placebo? The brief and misleading answer is certainly yes. Every patient encounter generates placebo effects, whether the treatment is homeopathy, psychiatry, or surgery (interestingly, surgical procedures appear to create some of the most powerful placebo effects known40). A better question is this: How much of the beneﬁt derived from homeopathic treatment is exclusively the result of placebo? The answer to this question is much more difﬁcult, and likely to change with differing circumstances. Unfortunately, despite the routine use of placebo in clinical trials, few in the medical profession have any clear understanding of the nature of placebo. Because of the limited amount of research and its inconsistent results, even placebo experts debate the nature or even existence of placebo. One of the few points of agreement is our ignorance; we do not understand placebo as well as we should, given its omnipresence and its apparent power as a healing force.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 10:52|| |
What is Placebo?
“Placebos, in other words, are not only puzzles to be ‘solved,’ but—to the extent that they elude ready solutions—they also teach us how far we still are from closure on the question of what it will mean to create a science subtle and complex enough to encompass all that is entailed in being human.”41 —Anne Harrington, Harvard University The word placebo, literally translated, means I shall please. Deﬁning placebo is far more difﬁcult than simply translating the word from Latin. In fact, it is reasonable to argue that there is no satisfactory deﬁnition of placebo at this time. Nearly every author on the subject has devised a different deﬁnition. Each deﬁnition is at odds with some part of what we know about placebo. Some academicians recommend abandoning the concept entirely because of the immense confusion about what placebo is.42,43 One of the most commonly accepted deﬁnitions in clinical research deﬁnes placebo as an intervention believed to lack a speciﬁc effect (there is no empirically supported theory for its action) on the studied condition, but which has been demonstrated better than no intervention. By this deﬁnition, placebo is something that works when we believe it should not. This is most unsatisfying because it merely highlights our ignorance—we do not understand it, therefore it is placebo. In clinical practice the deﬁciencies of this deﬁnition are even more apparent. The deﬁnition does not encompass the
Many theories have been proposed to explain the mechanism of placebo action. The popularity of each theory waxes or wanes as new information comes to light, and the relative importance of each is open to debate. Placebo effects most likely derive from a variety of causes uniﬁed only by the patient’s experience of improved wellbeing. The placebo-reactor theory maintained that certain individuals were susceptible to placebo and others were not. Research in the 1970s proved otherwise.46 There is no correlation between clinical placebo effects and suggestibility. The sole personality characteristic consistently associated with a greater likelihood of placebo response is anxiety. We also learned that everyone is a placebo-reactor at one time or another. Placebo reactivity varies more from one time to another in an individual than it does from person to person. Unfortunately many physicians are unaware of the inaccuracies of the placebo-reactor theory. Sadly, some of these confused physicians view a placebo reaction as an indication that the patient is hysterical.47 Another theory that has impeded our understanding of placebo is the misattribution theory. This theory argues that the patient would have gotten better anyway and wrongly attributed improvement to an inactive intervention. Most acute illnesses and minor complaints do tend to go away with the passage of time, and the symptoms of many major chronic diseases vary in intensity over time. We know that a positive beneﬁt from placebo is more likely in conditions that have a variable natural history. Also, because of the phenomenon of regression toward the mean (ie, extreme states are unusual and change is therefore likely to be in a beneﬁcial direction), repeated measurements or patient contacts are likely to show improvement. However, there is a signiﬁcant accumulated body of research demonstrating reproducible physiologic changes following placebo administration in human being and animal experimental models. It does appear that something “real” happens from placebo. Pain appears particularly responsive to placebo treatment.48 The discoveries of endorphin biochemistry and its importance in the central nervous system, stimulation by placebo, and blockage of placebo pain relief by naloxone were very exciting to placebo researchers. However, the answers we gained chieﬂy succeeded in multiplying our questions.49 Although placebo-induced endorphin release can account for placebo effectiveness in pain control, how does placebo induce endorphin release? Even more importantly, what could placebo-induced endorphin release have to do with non–pain-related placebo effects? There is much to learn from the conditioning model of placebo. Essentially this theory maintains that associating an intervention with an outcome leads to a persistent linkage. Patients then achieve the identical response even if the active part of the intervention is missing. For example, people who believe they are drinking alcohol will develop symptoms of alcohol intoxication even if the drink is entirely alcohol-free. Building on Ader’s earlier work (see discussion of nocebo later in this chapter), Olness and Ader reported on a patient for whom they were able to use this linkage of expectation to the patient’s beneﬁt.50 A child undergoing chemotherapy had difﬁculty tolerating cyclophosphamide treatment for lupus. The cyclophosphamide was routinely administered with cod liver oil. The researchers then gave the child cod liver oil alone for half of the chemotherapy sessions, resulting in the same beneﬁt as the cyclophosphamide but without the same degree of adverse effects. Placebo theories include societal factors as well. The theory of ritualized healing recognizes the potency of cultural elements. Shamanic rituals, for example, typically require participation of the patient’s family and community in the healing process. Of course, our own system of clinics, pharmacies, and hospitals can be viewed as an alternative form of ritualized healing. The most often repeated example of another placebo theory is of great interest to homeopaths. This theory is that placebo effects logically follow expectations about the treatment. Patients respond as they have, in some way, been told they should respond. Unlike the conditioning theory, patients need not have any prior experience with an active agent associated with the treatment. In 1950, Wolf reported that ipecac was a successful means of treating disabling nausea in a pregnant woman when she was told it would be helpful.51 He even documented the physical effects of the ipecac through gastric pressure monitoring. The use of ipecac in conventional medicine is limited to its emetic effects—precisely the opposite action sought in this pregnant patient. Of course, when ipecac is used in homeopathy, the patient is expected to suffer from nausea that the ipecac is expected to relieve, giving this classic example an alternative explanation. The most appealing placebo theory to many clinicians is the interpersonal theory. Patients who perceive their physician as warm, caring, attentive, and positive are more likely to enjoy the beneﬁts of the placebo response than are other patients. Some have said that the most powerful placebo is the physician. The idea that healing can happen just by listening and attending to the patient is a powerful concept, one distinctly at odds with the weaknesses of modern technologic medicine. This quality, so highly valued by patients, is also highly valued by homeopaths. None of these theories can account for all instances and aspects of placebo. Each of them provides some information, helping us get a sense of the bounds of our understanding of placebo—much like the tale of four blind men describing an elephant by the part each was touching. Perhaps the best way to understand placebo is by its effects—what it can do and when it does it.
Characteristics of the Placebo Response
“You should treat as many patients as possible with the new drugs while they still have the power to heal.” —Trousseau The response of patients to placebo varies. The patient’s anxiety, perception of the physician, expectations, and prior experience of the treatment affect his or her response. As Trousseau wrote long ago, enthusiasm for a new or unfamiliar treatment can accentuate the reaction. Interestingly, patient compliance is also associated with a positive placebo response. In a study of patients taking a drug to lower cholesterol, those who took their pills regularly had a reduced mortality rate in both the active and placebo treatment arms of the trial.52 Most published placebo research suggests that every human ill responds to placebo, at least transiently. Pain is particularly responsive to placebo, as are diseases that have an erratic clinical course. Human case reports and animal studies indicate that even serious diseases appear to respond to placebo. Unfortunately, some misguided physicians have erroneously convinced themselves
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 10:52|| |
that a patient’s response to placebo is proof that the patient did not have a “real” medical illness. Few doctors believe such reasoning has any role in the ethical practice of medicine. The placebo response occurs in every clinical encounter. The evidence suggests that every clinical interaction has the potential for an entire spectrum of patient response, ranging from wonderfully beneﬁcial to extremely harmful. Clinicians have a professional obligation to recognize this potential. We must carefully avoid interactions that harm the patient as we strive to help to the best of our ability. Some research supports the idea that transience is a characteristic of placebo response. Benson’s angina work44 and a few other studies suggest otherwise. To those who prefer a world ruled by common sense, proof that placebo effects are transient would provide a mind-settling conﬁrmation of placebo’s ephemeral nature. In addition, a pattern of ﬂeeting response could become the key to distinguishing placebo effects from the “real” effects of active treatment. Only time and further research will tell.
Another viewpoint considers the issue of placebo irrelevant. The patient’s beneﬁcial response to a treatment is important. The means to that end is not. This view is most commonly that of clinicians, and of course, patients themselves. A recent Lancet editorial advocated more research into this aspect of the placebo: Second, perhaps there should be more investigations into the role of placebo, not as a confounding factor interfering with study design, but as a method of enhancing the efﬁcacy of and reducing the variable response to analgesics and other methods of pain control.54 Carrying the idea of patient beneﬁt as the physician’s primary ethical duty further, some believe that raising the specter of placebo might have unethical repercussions. Discussing the concept of placebo could be harmful to the patient, because acknowledging the possibility of placebo treatment alters the interaction with the patient. The possibility that the treatment might be placebo can reduce the response to an effective nonplacebo treatment.55 Placebo effects are not restricted to inactive treatments. They also augment effective ones.56 In a study by Skovlund, women who had just given birth were treated for postpartum uterine pain.57 In the ﬁrst phase, following an informed consent procedure, they were given either paracetamol or placebo. In the second phase, conducted immediately afterward, a new group of patients on the same hospital ward were randomly given paracetamol or naproxen knowing they might receive either medication. Interestingly, the effect of the paracetamol in the second trial was markedly enhanced, apparently by the patients’ knowledge that they were certain to receive active treatment Although complementary medicine is certainly not entirely placebo, placebos appear to be a form of complementary medicine, because their effects augment the effectiveness of conventional medicine. Conversely, the knowledge that he or she might not be receiving an effective treatment diminishes a patient’s expectations and therefore the clinical response. One could argue that it is the ethical duty of the physician to set aside doubts about the effectiveness of a treatment and administer treatment with a full measure of conviction to maximally beneﬁt the patient.
Adverse Effects of Placebo
Another false belief about placebo, a belief that is particularly relevant to homeopathy, concerns adverse effects. Some have claimed that one of the proofs that the effects of homeopathic treatment are not solely attributable to placebo is that homeopathic remedies can cause adverse effects. Homeopaths accept that the correctly chosen homeopathic remedy for a chronic condition is likely to create a transient exacerbation of symptoms. The term aggravation is used to describe this process. The aggravation concept is so well accepted that homeopaths sometimes express concern that the correct remedy was not given if an aggravation does not take place. However, the ability to produce adverse effects does not prove that homeopathy is more than placebo, because placebos can generate adverse effects. Before discussing adverse effects created by placebo, it is important to distinguish adverse placebo effects from nocebo effects. Nocebo, which means I shall harm, is the true opposite of placebo. Nocebo effects are those that result from negative expectations. In other words, a patient expects some damaging effect from an inactive treatment and the expectation leads to the undesired outcome. One of the most famous studies in placebo literature is an example of the power of nocebo. In 1975, Ader and Cohen released a study regarding the administration of cyclophosphamide mixed in saccharin water to rats.53 While tracking the rats’ death rate following ingestion of this combination, they discovered that, even when cyclophosphamide was no longer administered, rats receiving saccharin alone continued to die as if they were still suffering the ill effects of the cyclophosphamide. Rats are not alone in their vulnerability to placebo or nocebo. Conditioned nocebo effects also occur in human beings. Various reports, usually unsubstantiated, of “voodoo death,” in which a person dies after having been the subject of a curse placed by a powerful member of the community, have been a part of the lore of placebo for generations. There have been a number of recent reports of mass hysterical-symptom outbreaks following perceived (but subsequently disproved) exposures to toxins. Unlike nocebo, adverse effects are unexpected, undesired reactions to treatment. The patient’s high hopes are disappointed or accompanied by additional unforeseen unpleasant effects. The study by Shapiro and associates46 cited previously found that more than half of a group of patients taking pla-
Limitations of Placebo in Research
Although these concepts have many repercussions for clinical medicine, the challenges created for researchers are no less signiﬁcant.58 Distinguishing a treatment from placebo is the usual objective of clinical trials. Although this is a difﬁcult task, it is often by itself insufﬁcient to meet the needs of patients and clinicians. Because placebo can be effective treatment for many patients, its power must be recognized and respected. When placebo’s power is respected, comparing a treatment to placebo becomes a consideration of the degree of effect as well as the frequency and nature of adverse effects. Statistical superiority over placebo can be misleading. Some homeopathic trials have been criticized on this basis. A difference that is statistically signiﬁcant but not clinically meaningful to the patient is irrelevant to that patient and his physician unless there is some other compelling advantage, either in the adverse effect proﬁle or cost of the treatment. An important limitation of RCTs is the issue of clinical relevance—sometimes the individual patient is forgotten in clinical research. Researchers who are primarily interested in measuring quality of life have come to believe that the patient’s sense of well-being is the ultimate outcome measure.59 In addition, there is some evidence that the patient’s opinion might be the best discriminator between placebo and active treatment.60 It is essential that the patient never be forgotten in research as well as in clinical medicine. demeanor has considerable effect on patients’ well being. A reasonable summary of placebo research regarding patient– physician interaction is that the effect of physicians can range from extremely positive to extremely negative. Perhaps another of the lessons to learn from homeopathy has to do with the attention a homeopath gives to the patient. The interview must be conducted with careful and respectful attention to the patient’s complaints and to the patient as a unique individual. The great homeopaths have always taught their students about the tremendous importance of the interview process. When properly conducted, the homeopathic interview appears ideally suited to maximize placebo effects. We must approach each clinical encounter thoughtfully if we hope to
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 10:53|| |
provide the best possible care to our patients. Modern medical practice has become increasingly technological, and many believe we have neglected the relationship aspect of the healing process. Homeopathy, through the interview, represents one pathway back toward a healthier relationship between physician and patient. Just as patients are increasingly displeased with the medical care they receive, physicians are increasingly disenchanted with the system of medical care in which we ﬁnd ourselves immersed. Time constraints often force the hurried conventional physician to view the patient as a runny nose that must be treated and sent back out the door as quickly as possible. Homeopaths learn that the story of every patient is in some way interesting. The richness of the homeopathic interview enlivens the patient–physician interaction. Perhaps this interaction, which can heal the patient, can also heal the physician in a certain way.
Lessons from Placebo and Homeopathy
“Homeopathy may bring beneﬁt, as do so many other forms of alternative medicine, because its practitioners are friendly and unhurried, taking into account the patient’s values and teaching that illness is a part of life, to be overcome when it cannot be eliminated.” —Howard Spiro, Yale University Medical School, in The Power of Hope: A Doctor’s Perspective There is evidence that homeopaths were the ﬁrst to use placebo controls as a consistent part of clinical research; placebos have been used in homeopathic provings since 1828.61 Hahnemann used placebo routinely in his clinical practice as early as 1819 to establish a symptom wash-out period for new patients and to provide them with otherwise needless daily treatment. There is also evidence that placebo controls were used in attempts to challenge and to prove the efﬁcacy of homeopathy, perhaps as early as 1834 but certainly by 1846 (despite the rather lengthy investigation conducted since then, we still do not have clear answers).62 Although there is ample reason to believe otherwise, if homeopathy is solely placebo, studying such a popular therapy could help teach us a great deal about the nature of placebo. Similarly, an exclusively placebo homeopathy could teach us something about current medical practice. Why favor a conventional treatment that is no more effective than a homeopathic placebo? If the adverse effects produced by conventional treatment outweigh those produced by a similarly effective placebo, does it follow that the placebo is the better prescription? The ﬁrst line of the Hippocratic Oath— primum no nocere–(ﬁrst do no harm)—leaps to mind and suggests so. One of the greatest truths to be gained from placebo research is that the most powerful placebo is the physician.
1. Coulter H: The Origins of Modern Western Medicine. Berkeley, CA; North Point Press, 1988 2. Dimond E, Kittle C, Crockett J: Comparison of internal mammary artery ligation and sham operation for angina pectoris. Am J Cardiol 6:483-486, 1960 3. Wharton R, Lewith G: Complementary medicine and the general practitioner. Br Med J (Clin Res Ed) 292:1498-1500, 1986 4. Gonzales R, Steiner JF, Sande MA: Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. J Am Med Assoc 278:901-904, 1997 5. Pichichero ME: Understanding antibiotic overuse for respiratory tract infections in children. Pediatrics 104:1384-1388, 1999 6. Watson RL, Dowell SF, Jayaraman M, et al: Antimicrobial use for pediatric upper respiratory infections: reported practice, actual practice, and parent beliefs. Pediatrics 104:1251-1257, 1999 7. Conly J: Controlling antibiotic resistance by quelling the epidemic of overuse and misuse of antibiotics. Can Fam Physician 44:1769-1773, 1780-1784, 1998 8. Lynoe N, Svensson T: Doctors’ attitudes towards empirical data—a comparative study. Scand J Soc Med 25:210-216, 1997 9. Greenhalgh T, Gill P: Pressure to prescribe. Br Med J 315:1482-1483, 1997 10. Wears RL: What is necessary for proof? Is 95% sure unrealistic? J Am Med Assoc 271:272, 1994 11. Berman BM, Singh BB, Hartnoll SM, et al: Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns. J Am Board Fam Pract 11:272-281, 1998 12. Ernst E: Unconventional cancer therapies: what we need is rigorous research, not closed minds. Chest 117:307-308, 2000 13. Ernst E, Resch KL: Reviewer bias against the unconventional? A randomized double-blind study of peer review. Complement Ther Med 7:19-23, 1999 Jonas W: Alternative medicine and the conventional practitioner. J Am Med Assoc 279:708-709, 1998 Schwartz MP, Wagner PJ: Which medicines do our patients want from us? J Fam Pract 49:339-341, 2000 Jonas WB: Alternative medicine—learning from the past, examining the present, advancing to the future (editorial). J Am Med Assoc 280: 1616 –1618, 1998 Crim C: Clinical practice guidelines vs actual clinical practice: the asthma paradigm. Chest 118:62S-64S, 2000 (suppl 2) Ellrodt AG, Conner L, Erieding M, et al: Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial. Ann Intern Med 122:277-282, 1995 Vinker S, Nakar S, Rosenberg E, et al: Attitudes of Israeli family physicians toward clinical guidelines. Arch Fam Med 9:835-840, 2000 Lewis LM, Lasater LC, Ruoff BE: Failure of a chest pain clinical policy to modify physician evaluation and management. Ann Emerg Med 25:914, 1995 Gonzales R, Barrett PH Jr, Crane LA, et al: Factors associated with antibiotic use for acute bronchitis. J Gen Intern Med 13:541-548, 1998 Hueston WJ, Hopper JE, Dacus EN, et al: Why are antibiotics prescribed for patients with acute bronchitis? A postintervention analysis. J Am Board Fam Pract 13:398-402, 2000 Worrall G, Freake D, Kelland J, et al: Care of patients with type II diabetes: a study of family physicians’ compliance with clinical practice guidelines. J Fam Pract 44:374-381, 1997 Zerr DM, Del Beccaro MA, Cummings P: Predictors of physician compliance with a published guideline on management of febrile infants. Pediatr Infect Dis J 18:232-238, 1999 Seto TB, Kwiat D, Taira DA, et al: Physicians’ recommendations to patients for use of antibiotic prophylaxis to prevent endocarditis. J Am Med Assoc 284:68-71, 2000 van Weel C, Knottnerus JA: Evidence-based interventions and comprehensive treatment. Lancet 353:916-918, 1999 Holdaway IM, Evans MC, Frengley PA, et al: Related articles investigation and treatment of renal calculi associated with hypercalciuria. J Endocrinol Invest 5:361-365, 1982 Evans RA, Maher PO, Agostino M, et al: Investigation and treatment of renal calculi. Med J Aust 143:278-281, 1985 Borghi L, Schianchi T, Meschi T et al: Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. New Engl J Med 46:77-84, 2002 Martini LA, Wood RJ: Should dietary calcium and protein be restricted in patients with nephrolithiasis? Nutr Rev 58:111-117, 2000 Acupuncture. NIH Consensus Statement 15:1-34, 1997 NIH Consensus Conference: Acupuncture. J Am Med Assoc 280:15181524, 1998. Bareta JC: Evidence presented to consensus panel on acupuncture’s efﬁcacy. Altern Ther Health Med 4:22-30:102, 1998 Wootton J: National Institutes of Health consensus development statement on acupuncture. J Altern Complement Med 3:419-420, 1997 Kent JT: Repertory of the Homeopathic Materia Medica [First Indian Edition]. Calcutta, India, Sett Dey & Co, 1969 Brody H: The lie that heals: The ethics of giving placebos. Ann Intern Med 97:112-118, 1982 37. Lynoe N: Is the effect of alternative medical treatment only a placebo effect? Scand J Soc Med 18:149-153, 1990 38. Joyce CR: Placebo and complementary medicine. Lancet 344:12791281, 1994 39. Jonas WB: Magic and methodology: When paradigms clash (editorial). J Altern Complement Med 5:319 –321, 1999 40. Johnson AG: Surgery as a placebo. Lancet 344:1140-1142, 1994 41. Harrington A: The Placebo Effect. Cambridge, MA, Harvard University Press, 1997 42. Gotzsche PC: Is there logic in the placebo? Lancet 344:925-926, 1994 43. Gotzsche PC: Placebo effects: concept of placebo should be discarded. Br Med J 311:1640-1641, 1995 44. Benson H, McCallie DP Jr: Angina pectoris and the placebo effect. N Engl J Med 300:1424-1429, 1979 45. Kleinman J, Brown P, Librach L, et al: Placebo pain medication: Ethical and practical considerations. Arch Fam Med 3:453-457, 1994 46. Shapiro AK, Struening EL, Barten H, et al: Correlates of placebo reaction in an outpatient population. Psychol Med 5:389-396, 1975 47. Stagno SJ, Smith ML: The use of placebo in diagnosing psychogenic seizures: who is being deceived? Semin Neurol 17:213-218, 1997 48. Hrobjartsson A, Gotzche PC: Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N Engl J Med 344:1594-1602, 2001 49. Levine JD, Gordon NC, Fields HL, et al: The mechanism of placebo analgesia. Lancet 2:654-657, 1978 50. Olness K, Ader R: Conditioning as an adjunct in the pharmacotherapy of lupus erythematosus. J Dev Behav Pediatr 13:124-125, 1992 51. Wolf S: Effects of suggestion and conditioning on the action of chemical agents in human subjects: The pharmacology of placebos. J Clin Invest 29:100-109, 1950 52. Coronary Drug Project: Inﬂuence of adherence to treatment and response of cholesterol on mortality in the Coronary Drug Project. N Engl J Med 303:1038-1041, 1980 53. Ader R, Cohen N: Behaviorally conditioned immunosuppression. Psychosom Med 37:333-340, 1975 54. Rowbotham DJ: Endogenous opioids, placebo response, and pain. Lancet 357:1901-1902, 2001 55. Rochon P, Binns MA, Litner JA, et al: Are randomized control trial outcomes inﬂuenced by the inclusion of a placebo group? A systematic review of nonsteroidal antiinﬂammatory drug trials for arthritis treatment. J Clin Epidemiol 52:113-122, 1999 56. Kleijnen J, de Craen AJ, van Everdingen J, et al: Placebo effect in double-blind clinical trials: A review of interactions with medications. Lancet 344:1347-1349, 1994 57. Skovlund E: Should we tell trial patients that they might receive placebo? (letter). Lancet 337:1041, 1991 58. Rothman KJ, Michels KB: The continuing unethical use of placebo controls [see comments]. N Engl J Med 331:394-398, 1994 59. Ware JE: Measuring patients’ views: The optimum outcome measure. Br Med J 306:1429-1430, 1993 60. Gotzsche PC: Sensitivity of effect variables in rheumatoid arthritis: a metaanalysis of 130 placebo controlled NSAID trials. J Clin Epidemiol 43:1313-1318, 1990 61. Dean ME: A homeopathic origin for placebo controls: “an invaluable gift of God.” Altern Ther Health Med 6:58-66, 2000 62. Kaptchuk TJ: Intentional ignorance a history of blind assessment and placebo controls in medicine. Bull Hist Med 72:389-433, 1998
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 17:27|| |
"...for the purposes of popular discourse, it is not necessary for homeopaths to prove their case. It is merely necessary for them to create walls of obfuscation, and superficially plausible technical documents that support their case, in order to keep the dream alive in the imaginations of both the media and their defenders." --Ben Goldacre
If homeopathy works, then obviously the less you use it, the stronger it gets. So the best way to apply homeopathy is to not use it at all. --Phil Plait
Classical homeopathy originated in the 19th century with Samuel Christian Friedrich Hahnemann (1755-1843) as an alternative to the standard medical practices of the day, such as phlebotomy or bloodletting. Opening veins to bleed patients, force disease out of the body, and restore the humors to a proper balance was a popular medical practice until the late19th century (Williams 2000: 265). Hahnemann rejected the notion that disease should be treated by letting out the offensive matter causing the illness. In this, he was right. On the other hand, he argued that disease should be treated by helping the vital force restore the body to harmony and balance. In this, he was wrong. He rejected other common medical practices of his day such as purgatives and emetics "with opium and mercury-based calomel" (ibid.: 145). He was right to do so. Hahnemann's alternative medicine was more humane and less likely to cause harm than many of the conventional practices of his day.
Scientific medicine was developing in Hahnemann's time but homeopathy would not be part of that development. Scientific medicine is essentially materialistic. It is based on such disciplines as anatomy, physiology, and chemistry. While Hahnemann's methods involve empirical observation, his theory of disease and cure is essentially non-empirical and involves the appeal to metaphysical entities and processes.
Hahnemann put forth his ideas of disease and treatment in The Organon of Homeopathic Medicine (1810) and Theory of Chronic Diseases (1821). The term 'homeopathy' is derived from two Greek words: homeo (similar) and pathos (suffering). Hahnemann meant to contrast his method with the convention of his day of trying to balance "humors" by treating a disorder with its opposite (allos). He referred to conventional practice as allopathy. Even though modern scientific medicine bears no resemblance to the theory of balancing humors or treating disease with its opposite, modern homeopaths and other advocates of "alternative" medicine misleadingly refer to today's science-trained physicians as allopaths (Jarvis 1994).
Classical homeopathy is generally defined as a system of medical treatment based on the use of minute quantities of remedies that in larger doses produce effects similar to those of the disease being treated. Hahnemann believed that very small doses of a medication could have very powerful healing effects because their potency could be affected by vigorous and methodical shaking (succussion). Hahnemann referred to this alleged increase in potency by vigorous shaking as dynamization. Hahnemann thought succussion could release "immaterial and spiritual powers," thereby making substances more active. "Tapping on a leather pad or the heel of the hand was alleged to double the dilution" (ibid.).
Dynamization was for Hahnemann a process of releasing an energy that he regarded as essentially immaterial and spiritual. As time went on he became more and more impressed with the power of the technique he had discovered and he issued dire warnings about the perils of dynamizing medicines too much. This might have serious or even fatal consequences, and he advised homeopaths not to carry medicines about in their waistcoat pockets lest they inadvertently make them too powerful. Eventually he even claimed that there was no need for patients to swallow the medicines at all; it was enough if they merely smelt them. (Campbell)
Two potency scales are in common use: the decimal, which proceeds by 1:10 steps, and the centesimal (1:100). Starting from the original "mother tincture" (in the case of a plant this is an alcoholic extract) a 1:10 or 1:100 dilution is made. This is succussed and the resulting solution is known as the first potency. This now serves as the starting point for the next step in dilution and succussion, which results in the second potency, and so on. The 1:10 potencies are usually indicated by x and the 1:100 by c; thus Pulsatilla 6c means the 6th centesimal potency of Pulsatilla, which has received six succussions and has a concentration of one part in a thousand billion. (Campbell)
Like most of his contemporaries, Hahnemann believed that health was a matter of balance and harmony, but for him it was the vital force, the spirit in the body, that did the balancing and harmonizing, that is, the healing.
Hahnemann claimed that most chronic diseases were caused by miasms and the worst of these miasms were the 'psora.' The evidence for the miasm theory, however, is completely absent and seems to have been the result of some sort of divine revelation (Campbell). The word 'miasm'
derives from the Greek and means something like "taint" or "contamination". Hahnemann supposed that chronic disease results from invasion of the body by one of the miasms through the skin. The first sign of disease is thus always a skin disorder of some kind (Campbell).
His method of treatment might seem very modern: Find the right drug for the illness. However, his medicines were not designed to help the body fight off infection or rebuild tissue, but to help the vital spirit work its magic. In fact, Hahnemann believed it is "inherently impossible to know the inner nature of disease processes and it was therefore fruitless to speculate about them or to base treatment on theories" (Campbell). His remedies were determined by the patient's symptoms, not by the supposed disease causing those symptoms.
Homeopaths refer to "the Law of Infinitesimals" and the "Law of Similars" as grounds for using minute substances and for believing that like heals like, but these are not natural laws of science. If they are laws at all, they are metaphysical laws, i.e., beliefs about the nature of reality that would be impossible to test by empirical means. Hahnemann's ideas did originate in experience. That he drew metaphysical conclusions from empirical events does not, however, make his ideas empirically testable. The law of infinitesimals seems to have been partly derived from his notion that any remedy would cause the patient to get worse before getting better and that one could minimize this negative effect by significantly reducing the size of the dose. Most critics of homeopathy balk at this "law" because it leads to remedies that have been so diluted as to have nary a single molecule of the substance one starts with.
Hahnemann came upon his Law of Similars (like cures like) in 1790 while translating William Cullen's Materia Medica into German (Loudon 1997: 94). He began experimenting on himself with various substances, starting with cinchona.
Daily for several days, he wrote, he had been taking four drams of the drug. Each time he had repeated the dose, his feet and finger tips had become cold, and other symptoms had followed which were typical of malaria. Each time he had stopped taking the cinchona, he had returned rapidly to a state of good health. (Williams 1981: 184)
Hahnemann experimented on himself with various drugs over several years and concluded that "a doctor should use only those remedies which would have the power to create, in a healthy body, symptoms similar to those that might be seen in the sick person being treated (ibid.)." Medicines should be given in single doses, he claimed, not in complex mixtures. His conclusions seem to have been based upon intuition or revelation. He did not experiment with patients by giving them drugs to discover which remedies worked with which illnesses or that only unmixed substances were effective. Indeed, he couldn't experiment on sick people because he assumed the remedy must produce an effect similar to the disease and he'd never be able to tell what remedies to use because the symptoms of the disease would be difficult to distinguish from those of the remedy in a sick person. Instead, he assumed that whatever caused the symptoms in a healthy person would be a remedy for a disease with similar symptoms.
Hahnemann called this method of finding what symptoms a drug caused in a healthy person "proving."
Hahnemann did not leave us any details of the doses he used or the manner of giving the drugs, but from chance remarks elsewhere in his writings and from the accounts of his provers we have a pretty fair idea of what went on. All the provings at this time were carried out with tinctures (extracts) of herbs or, in the case of insoluble substances, with 'first triturations' (one part of substance ground up with nine parts of sugar or milk)....
His usual practice seems to have been to give repeated doses until some effect was produced; the actual amount was calculated on the basis of his own previous experience. The provers were expected to record their symptoms with the utmost care, and on presenting their notebooks to Hahnemann they had to offer him their hands - the customary way of taking an oath at German universities at that time - and swear that what they had reported was the truth. Hahnemann would then question them closely about their symptoms to elicit the details of time, factors that made them better or worse, and so on. Coffee, tea, wine, brandy and spices were forbidden to provers and so was chess (which Hahnemann considered too exciting), but beer was allowed and moderate exercise was encouraged. (Campbell)
Working on the principle of similarities, Hahnemann created remedies for various disorders that had symptoms similar to those of the substances his provers had taken. However, "....methods of proving are highly personalised and of individual relevance to the homoeopath or experimenter."* In other words, one hundred homeopaths preparing a remedy for one patient might well come up with one hundred different remedies.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 17:27|| |
Hahnemann may be praised for empirically testing his medicines, but his method of testing is obviously flawed. He wasn't actually testing the medicines for effectiveness on sick people but for their effects on healthy people. In any case, he had to rely upon the subjective evaluations of his provers, all of whom were his disciples or family members and all of whom were interrogated by the master himself. (Later investigators would use more controlled methods of proving.*) But even if his data weren't tainted by the possibility of his suggesting symptoms to his provers or their reporting symptoms to impress or gain the approval of the master, it is a belief in magic that connects this list of symptoms with the cure of a disease with similar symptoms. In logic, this kind of leap of reasoning is called a non sequitur: It does not follow from the fact that drug A produces symptoms similar to disease B that taking A will relieve the symptoms of B. However, homeopaths take customer satisfaction with A as evidence that A works.
There is some evidence that Hahnemann did not use healthy subjects to prove any of the remedies he recommended for most disorders: sulfur, cuttlefish ink, salt, and sand.
What appears to have happened is that Hahnemann based his new provings largely on symptoms supposed to have been produced in his chronic patients. By his own rules this procedure was inadmissible, and in fact it undoubtedly led him to attribute to the effect of the medicines a number of symptoms that were really due to the diseases the patients were suffering from. (Campbell)
While we might excuse Hahnemann for not doing properly controlled experiments, we shouldn't be so generous toward modern homeopaths for not understanding the nature of anecdotes and testimonial evidence. However, we can't accuse them of not doing any properly designed controlled experiments. But we can blame them for not understanding some fundamental principles of evaluating the results of controlled experiments that involve giving drugs or even inert substances to humans.
Today's homeopaths should know that because of the complexity of each individual human body, fifty different people may react in fifty different ways to the same substance. This makes doing clinical trials on potential medicines a procedure that should rarely claim dramatic results on the basis of one set of trials. Finding a statistically significant difference, positive or negative, between an experimental (drug therapy) group and a control group in one trial of a drug should usually be taken with a grain of salt. So should not finding anything statistically significant. It is not uncommon for twenty trials of a drug to result in several with positive, several with negative, and several with mixed or inconclusive results.
Yet, despite the fact that of the hundreds of studies that have been done on homeopathic remedies the vast majority have found no value in the remedies, some defenders of homeopathy insist not only that homeopathic remedies work but they claim they know how they work. It seems, however, that scientists like Jacques Benveniste, who claim to know how homeopathy works, have put the cart before the horse. Benveniste claims to have proven that homeopathic remedies work by altering the structure of water, thereby allowing the water to retain a "memory" of the structure of the homeopathic substance that has been diluted out of existence (Nature Vol. 333, No. 6176, pp. 816-818, 30th June, 1988).* The work in Benveniste's lab was thoroughly discredited by a team of investigators who evaluated an attempted replication of the study published in Nature. Neither Benveniste nor any other advocate of the memory-of-water speculation have explained how water is so selective in its memory that it has forgotten all the other billions of substances its molecules have been in contact with over the millennia. One wonders in vain how water remembers only the molecules the homeopath has introduced at some point in the water's history and forgets all those trips down the toilet bowel, etc. (Benveniste even claims that a homeopathic solution's biological activity can be digitally recorded, stored on a hard drive, sent over the Internet, and transferred to water at the receiving end. He was a successful biologist working in a state-run lab until he started making such claims, which have cost him his status and reputation as a reputable scientist. He is now considered by his critics (such as James Randi) to be another Blondlot.) Since homeopathic remedies don't work any better than placebos or doing nothing, there is no need for an elaborate explanation as to how they work. What there is need of is an explanation for why so many people are satisfied with their homeopath despite all the evidence that homeopathic remedies are inert and no more effective than a placebo or just letting an illness run its natural course.
Why does anyone believe homeopathy works?
Before attempting to explain why so many people believe homeopathy works, let me first defend the claim that homeopathic remedies, if effective, are no more effective than placebos. There have been several reviews of various studies of the effectiveness of homeopathic treatments and not one of these reviews concludes that there is good evidence for any homeopathic remedy (HR) being more effective than a placebo. Homeopaths have had over 200 years to demonstrate their wares and have failed to do so. Sure, there are single studies that have found statistically significant differences between groups treated with an HR and control groups, but none of these have been replicated or they have been marred by methodological faults. Two hundred years and we're still waiting for proof! Having an open mind is one thing; waiting forever for evidence is more akin to wishful thinking.
A review of the reviews of homeopathic studies has been done by Terence Hines (2003: 360-362). He reviewed Taylor et al. (2000), Wagner (1997), Sampson and London (1995), Kleijen, Knipschild, and ter Riet (1991), and Hill and Doyon (1990). More than 100 studies have failed to come to any definitive positive conclusions about homeopathic potions. Ramey (2000) notes that
Homeopathy has been the subject of at least 12 scientific reviews, including meta-analytic studies, published since the mid-1980s....[And] the findings are remarkably consistent:....homeopathic "remedies" are not effective.
Nevertheless, homeopathy will always have its advocates, despite the lack of proof that its remedies are more effective than a placebo. Why? One reason is the prevalence of a misunderstanding of the causes of disease and how the human body deals with disease. Hahnemann was able to attract followers because he appeared to be a healer compared to those who were cutting veins or using poisonous purgatives to balance humors. More of his patients may have survived and recovered not because he healed them but because he didn't infect them or kill them by draining out needed blood or weaken them with strong poisons. Hahnemann's medicines were essentially nothing more than common liquids and were unlikely to cause harm in themselves. He didn't have to have too many patients survive and get better to look impressive compared to his competitors. If there is any positive effect on health it is not due to the homeopathic remedy, which is inert, but to the body's own natural curative mechanisms or to the belief of the patient (the placebo effect) or to the effect the manner of the homeopath has on the patient.
Stress can enhance and even cause illness. If a practitioner has a calming effect on the patient, that alone might result in a significant change in the feeling of well-being of the patient. And that feeling might well translate into beneficial physiological effects. The homeopathic method involves spending a lot of time with each patient to get a complete list of symptoms. It's possible this has a significant calming effect on some patients. This effect could enhance the body's own healing mechanisms in some cases. As homeopath Anthony Campbell (2008) puts it: "A homeopathic consultation affords the patient an opportunity to talk at length about her or his problems to an attentive and sympathetic listener in a structured environment, and this in itself is therapeutic." In other words, homeopathy is a form of psychotherapy.
....most homeopaths like to allow at least 45 minutes for a first consultation and many prefer an hour or more. Second, patients feel that they are being treated "as an individual". They are asked a lot of questions about their lives and their likes and dislikes in food, weather, and so on, much of which has no obvious connection with the problem that has led to the consultation. Then the homeopath will quite probably refer to an impressively large and imposing source of information to help with choosing the right "remedy". (Campbell)
We know that the sum of all the scientific evidence shows clearly that homeopathic remedies are no more effective than placebos. This does not mean that patients don't feel better or actually get better after seeing a homeopath. That is quite another matter and is clearly the reason for the satisfied customers. (Here the reader might consult the entries on the placebo effect, the post hoc fallacy and the regressive fallacy.)
Before moving on, I should note that homeopaths believe, in the words of one spokeswoman for the Society of Homeopaths:
Many previous studies have demonstrated that homeopathy has an effect over and above placebo....It has been established beyond doubt and accepted by many researchers, that the placebo-controlled randomised controlled trial is not a fitting research tool with which to test homeopathy.*
There are not two kinds of science, conventional and non-conventional. There is just science. You are either doing it or not. True, some are doing science well and some are not. What this homeopath is saying is that control group testing of homeopathic remedies is irrelevant to whether homeopathic remedies are effective beyond their placebo effect. Why should homeopathy be exempt from a fundamental precept of sound science? If homeopathy claims a special exemption from the rules of logic and science, why should any other discipline be expected to do controlled studies? There are good reasons science uses controlled studies. The dangers of self-deception should be apparent. The vulnerability to post hoc fallacies like the regressive fallacy should be obvious. How could we ever separate out placebo and false placebo effects, from unique remedy effect if we did not do controlled studies? Homeopaths are asking that they be given a free pass to draw conclusions about their treatments based on their subjective impressions and self-serving testing methods. Their special pleading is absurd on its face.
Wendy Kaminer, a satisfied customer
Wendy Kaminer, a critic of various irrational behaviors, is one of those satisfied customers. Even so, she told her homeopath that her greatest fear "was that someone would find out
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Gio 17 Set 2009 - 17:28|| |
I'd consulted a homeopath" (1999; p. 3), which is obviously not her greatest fear or she wouldn't have announced it to the world in her book.
When I go to my homeopath maybe I'm following one of the precepts of the recovery movement that I've always derided: I'm thinking with my heart and not my head. Or maybe I'm acting rationally after all. Believing in homeopathy may be irrational, but not using homeopathy if it works would be even more irrational. I care only if medicine works, not why. (I have the vaguest understanding of antibiotics.)
So I don't listen to scientists eager to tell me why homeopathic remedies can't possibly work, because they violate the laws of chemistry. Assuming that the scientists are right, and the remedies I've taken are mere placebos, why would I want to start doubting - and diminishing - their effectiveness? Why not be susceptible to placebos? (ibid.)
Here we have a rational person who decries irrational behavior admitting that she does something that many rational people would consider irrational. It is interesting how she has dealt with this cognitive dissonance. She has made the irrational rational (or at least less irrational than the alternative) by focusing on her belief that homeopathy works. But we know the potions don't work any better than a placebo, so what is Kaminer talking about? She is not talking about scientific studies that show homeopathic remedies are more effective than doing nothing or taking a placebo, because such studies point in the opposite direction. In fact, she doesn't seem concerned whether such studies even exist. She means that she believes "homeopathy has helped me" (p. 4). Her caveat to the reader is don't take my word for it, try it yourself, which seems to imply that if I go to a homeopath and think it's helped me, then I'd be irrational not to continue seeing the homeopath. But what does help or helps mean? These are weasel words; they have no cognitive content though they are full of emotive meaning. Her only concession to the idea that perhaps she is acting irrationally is in her musing
....maybe I'm imagining that homeopathy has helped me. Maybe I'm confusing correlation with causation: perhaps I began feeling better coincidentally, for some unknown reason, at about the time I turned to homeopathy (ibid., p. 4).
She advises us not to take her word for it and tells us that we should ask her to substantiate her claim. She even advises us to try to duplicate her experience. Perhaps this is her notion of what a rational, scientifically-minded person should do. But there is no way I or anyone else can substantiate her claim by trying to duplicate it. We don't have a clear enough idea about her claim to know what we would be trying to substantiate. Her claim that something helped her is too vague to be of any value in trying to duplicate. Is she really saying that if I go to a homeopath and feel better afterward then I have substantiated and duplicated her claim? I think she is. And I think she is mistaken.
Yet, I think I understand what she is saying. If I, for example, went to a homeopath and found that under treatment the pain in my knees went away completely, the pain that I have been having for several years and which my physician tells me is due to bursitis, then I would be irrational not to continue with the homeopathic remedy. Furthermore, it would be irrational not to consult my homeopath should I begin suffering pain, say, in my elbow or shoulder or back. If I could start jogging again, I would be irrational not to continue seeing my homeopath. I might agree. But, if I consulted a homeopath about a new pain that my physician had been unable to relieve me of with science-based therapy and after the homeopathic treatment the pain went away, I would not consider it irrational to not continue going to the homeopath. I would consider it likely that the pain would have gone away had I not consulted the homeopath. (If you are wondering why, consult my entry on the regressive fallacy or read my essay on evaluating personal experience.)
Furthermore, if a homeopathic remedy did cure me of my knee pain, I would want to investigate what was in the remedy. Even though most homeopathic remedies in the U.S. and the UK are little more than water or alcohol, there are a number of products on the market that are labeled homeopathic that have active ingredients in them (see complex homeopathy, isopathy, and nosodes). However, if I did find that my remedy was one of those that had been diluted so many times that there weren't any molecules remaining of the original active substance, I would rather believe that my pain had suddenly gone away than that the homeopathic remedy had cured me of my pain. Why? Because the known laws of physics and chemistry would have to be completely revamped if a tonic from which nearly every molecule of the active ingredient were removed could be shown to be effective. But if I could yo-yo the pain by stopping and starting the homeopathic remedy under double-blind conditions, I would have to conclude that the potion was having the effect and would have to become an advocate of that homeopathic remedy. This is just to say that homeopathic remedies can be empirically tested. That no remedy has yet been shown to have the effect I have outlined is strong evidence against homeopathic remedies.
Even though classical homeopathic remedies are inert, homeopathy itself is very effective or it wouldn't have lasted and grown for the past 200 years. It is very popular in Europe, especially among the royal family of Britain. There are schools of homeopathy all over the world. Homeopathy is said to be $200 million a year industry in the United States. "The fact that it is condemned as unscientific by some orthodox doctors is for many people a positive merit, not a criticism" (Campbell).
harm from homeopathy
The main harm from classical homeopathy is not likely to come from its remedies, which are probably safe because they are inert, though this is changing as homeopathy becomes indiscernible from herbalism in some places. One potential danger is in the encouragement to self-diagnosis and treatment. Another danger lurks in not getting proper treatment by a science-trained medical doctor in those cases where the patient could be helped by such treatment, such as for a bladder or yeast infection, asthma, or cancer.* Homeopathy might work in the sense of helping some people feel better some of the time. Homeopathy does not work, however, in the sense of explaining pathologies or their cures in a way which not only conforms with the data but which promises to lead us to a greater understanding of the nature of health and disease.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Ven 18 Set 2009 - 11:42|| |
Homeopathy and Its Kindred Delusions
Oliver Wendell Holmes
This essay was presented as two lectures to the Boston Society for the Diffusion of Useful Knowledge in 1842 and was reproduced in Examining Holistic Medicine (Prometheus Books, 1985). The author achieved prominence as a physician, poet, and humorist. His son, Oliver Wendell Holmes, Jr., became a justice of the U.S. Supreme Court.
It is necessary, for the sake of those to whom the whole subject may be new, to give in the smallest possible compass the substance of the Homeopathic Doctrine. Samuel Hahnemann, its founder, is a German physician, now living in Paris, at the age of eighty-seven years. In 1796 he published the first paper containing his peculiar notions; in 1805 his first work on the subject; in 1810 his somewhat famous "Organon of the Healing Art;" the next year what he called the "Pure Materia Medica;" and in 1828 his last work, the "Treatise on Chronic Diseases." He has therefore been writing at intervals on his favorite subject for nearly half a century. [Hahnemann died in 1843.]
The one great doctrine which constitutes the basis of Homeopathy as a system is expressed by the Latin aphorism,
"SIMILIA SIMILIBUS CURANTUR,"
or like cures like, that is, diseases are cured by agents capable of producing symptoms resembling those found in the disease under treatment. A disease for Hahnemann consists essentially in a group of symptoms. The proper medicine for any disease is the one which is capable of producing a similar group of symptoms when given to a healthy person.
It is of course necessary to know what are the trains of symptoms excited by different substances, when administered to persons in health, if any such can be shown to exist. Hahnemann and his disciples give catalogues of the symptoms which they affirm were produced upon themselves or others by a large number of drugs which they submitted to experiment.
The second great fact which Hahnemann professes to have established is the efficacy of medicinal substances reduced to a wonderful degree of minuteness or dilution. The following account of his mode of preparing his medicines is from his work on Chronic Diseases, which has not, I believe, yet been translated into English. A grain of the substance, if it is solid, a drop if it is liquid, is to be added to about a third part of one hundred grains of sugar of milk in an unglazed porcelain capsule which has had the polish removed from the lower part of its cavity by rubbing it with wet sand; they are to be mingled for an instant with a bone or horn spatula, and then rubbed together for six minutes; then the mass is to be scraped together from the mortar and pestle, which is to take four minutes; then to be again rubbed for six minutes. Four minutes are then to be devoted to scraping the powder into a heap, and the second third of the hundred grains of sugar of milk to be added. Then they are to be stirred an instant and rubbed six minutes, again to be scraped together four minutes and forcibly rubbed six; once more scraped together for four minutes, when the last third of the hundred grains of sugar of milk is to be added and mingled by stirring with the spatula; six minutes of forcible rubbing, four of scraping together, and six more (positively the last six) of rubbing, finish this part of the process.
Every grain of this powder contains the hundredth of a grain of the medicinal substance mingled with the sugar of milk. If, therefore, a grain of the powder just prepared is mingled with another hundred grains of sugar of milk, and the process just described repeated, we shall have a powder of which every grain contains the hundredth of the hundredth, or the ten thousandth part of a' grain of the medicinal substance. Repeat the same process with the same quantity of fresh sugar of milk, and every grain of your powder will contain the millionth of a grain of the medicinal substance. When the powder is of this strength, it is ready to employ in the further solutions and dilutions to be made use of in practice.
A grain of the powder is to be taken, a hundred drops of alcohol are to be poured on it, the vial is to be slowly turned for a few minutes, until the powder is dissolved, and two shakes are to be given to it. On this point I will quote Hahnemann's own words. "A long experience and multiplied observations upon the sick lead me within the last few years to prefer giving only two shakes to medicinal liquids, whereas I formerly used to give ten." The process of dilution is carried on in the same way as the attenuation of the powder was done; each successive dilution with alcohol reducing the medicine to a hundredth part of the quantity of that which preceded it. In this way the dilution of the original millionth of a grain of medicine contained in the grain of powder operated on is carried successively to the billionth, trillionth, quadrillionth, quintillionth, and very often much higher fractional divisions. A dose of any of these medicines is a minute fraction of a drop, obtained by moistening with them one or more little globules of sugar, of which Hahnemann says it takes about two hundred to weigh a grain.
As an instance of the strength of the medicines prescribed by Hahnemann, I will mention carbonate of lime. He does not employ common chalk, but prefers a little portion of the friable part of an oyster-shell. Of this substance, carried to the sextillionth degree, so much as one or two globules of the size mentioned can convey is a common dose. But for persons of very delicate nerves it is proper that the dilution should be carried to the decillionth degree. That is, an important medicinal effect is to be expected from the two hundredth or hundredth part of the millionth of the millionth of the millionth of the millionth of the millionth of the millionth of the millionth of the millionth of the millionth of the millionth of a grain of oyster-shell. This is only the tenth degree of potency, but some of his disciples profess to have obtained palpable effects from much higher dilutions.
The degrees of DILUTION must not be confounded with those of POTENCY. Their relations may be seen by this table:
1st dilution—One hundredth of a drop or grain.
2d dilution—One ten thousandth.
3d dilution—One millionth.—marked I.
4th dilution—One hundred millionth.
5th dilution—One ten thousand millionth.
6th dilution—One millionth millionth, or one billionth—marked II.
7th dilution—One hundred billionth.
8th dilution—One ten thousand billionth.
9th dilution—One million billionth, or one trillionth—marked III.
10th dilution—One hundred trillionth.
11th dilution—One ten thousand trillionth.
12th dilution—One million trillionth, or one quadrillionth—marked IV.—and so on indefinitedly.
The large figures denote the degrees of POTENCY.
The third great doctrine of Hahnemann is the following. Seven eighths at least of all chronic diseases are produced by the existence in the system of that infectious disorder known in the language of science by the appellation of PSORA, but to the less refined portion of the community by the name of ITCH. in the words of Hahnemann's "Organon," "This Psora is the sole true and fundamental cause that produces all the other countless forms of disease, which, under the names of nervous debility, hysteria, hypochondriasis, insanity, melancholy, idiocy, madness, epilepsy, and spasms of all kinds, softening of the bones, or rickets, scoliosis and cyphosis, caries, cancer, fungus haematodes, gout—yellow jaundice and cyanosis, dropsy—gastralgia, epistaxis, haemoptysis—asthma and suppuration of the lungs—megrim, deafness, cataract and amaurosis—paralysis, loss of sense, pains of every kind, etc., appear in our pathology as so many peculiar, distinct, and independent diseases."
For the last three centuries, if the same authority may be trusted, under the influence of the more refined personal habits which have prevailed, and the application of various external remedies which repel the affection from the skin, Psora has revealed itself in these numerous forms of internal disease, instead of appearing, as in former periods, under the aspect of an external malady.
These are the three cardinal doctrines of Hahnemann, as laid down in those standard works of Homeopathy, the "Organon" and the "Treatise on Chronic Diseases."
Several other principles may be added, upon all of which he insists with great force, and which are very generally received by his disciples.
1. Very little power is allowed to the curative efforts of nature. Hahnemann goes so far as to say that no one has ever seen the simple efforts of nature effect the durable recovery of a patient from a chronic disease. In general, the Homeopathist calls every recovery which happens under his treatment a cure.
2. Every medicinal substance must be administered in a state of the most perfect purity, and uncombined with any other. The union of several remedies in a single prescription destroys its utility, and, according to the "Organon," frequently adds a new disease.
3. A large number of substances commonly thought to be inert develop great medicinal powers when prepared in the manner already described; and a great proportion of them are ascertained to have specific antidotes in case their excessive effects require to be neutralized.
4. Diseases should be recognized, as far as possible, not by any of the common names imposed upon them, as fever or epilepsy, but as individual collections of symptoms, each of which differs from every other collection.
5. The symptoms of any complaint must be described with the most minute exactness, and so far as possible in the patient's own words. To illustrate the kind of circumstances the patient is expected to record, I will mention one or two from the 313th page of the "Treatise on Chronic Diseases," —being the first one at which I opened accidentally.
"After dinner, disposition to sleep; the patient winks."
"After dinner, prostration and feeling of weakness (nine days after taking the remedy)."
This remedy was that same oyster-shell which is to be prescribed in fractions of the sextillionth or decillionth degree. According to Hahnemann, the action of a single dose of the size mentioned does not fully display itself in some cases until twenty-four or even thirty days after it is taken, and in such instances has not exhausted its good effects until towards the fortieth or fiftieth day,-before which time it would be absurd and injurious to administer a new remedy.
So much for the doctrines of Hahnemann, which have been stated without comment, or exaggeration of any of their features, very much as any adherent of his opinions might have stated them, if obliged to compress them into so narrow a space.
Does Hahnemann himself represent Homeopathy as it now exists? He certainly ought to be its best representative, after having created it, and devoted his life to it for half a century. He is spoken of as the great physician of the time, in most, if not all Homeopathic works. If he is not authority on the subject of his own doctrines, who is? So far as I am aware, not one tangible discovery in the so-called science has ever been ascribed to any other observer, at least, no general principle or law, of consequence enough to claim any prominence in Homeopathic works, has ever been pretended to have originated with any of his illustrious disciples. He is one of the only two Homeopathic writers with whom, as I shall mention, the Paris publisher will have anything to do with upon his own account. The other is Jahr, whose Manual is little more than a catalogue of symptoms and remedies. If any persons choose to reject Hahnemann as not in the main representing Homeopathy, if they strike at his authority, if they wink out of sight his deliberate and formally announced results, it is an act of suicidal rashness; for upon his sagacity and powers of observation, and experience, as embodied in his works, and especially in his Materia, Medica, repose the foundations of Homeopathy as a practical system.
So far as I can learn from the conflicting statements made upon the subject, the following is the present condition of belief:
1. All of any note agree that the law Similia similibus is the only fundamental principle in medicine. Of course if any man does not agree to this the name Homeopathist can no longer be applied to him with propriety.
2. The belief in and employment of the infinitesimal doses is general, and in some places universal, among the advocates of Homeopathy; but a distinct movement has been made in Germany to get rid of any restriction to the use of these doses, and to employ medicines with the same license as other practitioners.
3. The doctrine of the origin of most chronic diseases in Psora, notwithstanding Hahnemann says it cost him twelve years of study and research to establish the fact and its practical consequences, has met with great neglect and even opposition from very many of his own disciples.
It is true, notwithstanding, that, throughout most of their writings which I have seen, there runs a prevailing tone of great deference to Hahnemann's opinions, a constant reference to his authority, a general agreement with the minor points of his belief, and a pretense of harmonious union in a common faith. [Those who will take the trouble to look over Hull's Translation of Jahr's Manual may observe how little comparative space is given to remedies resting upon any other authority than that of Hahnemann.]
* * *
The three great asserted discoveries of Hahnemann are entirely unconnected with and independent of each other. Were there any natural relation between them it would seem probable enough that the discovery of the first would have led to that of the others. But assuming it to be a fact that diseases are cured by remedies capable of producing symptoms like their own, no manifest relation exists between this fact and the next assertion, namely, the power of the infinitesimal doses. And allowing both these to be true, neither has the remotest affinity to the third new doctrine, that which declares seven eighths of an chronic diseases to be owing to Psora.
* * *
Let us look a moment at the first of his doctrines. Improbable though it may seem to some, there is no essential absurdity involved in the proposition that diseases yield to remedies capable of producing like symptoms. There are, on the other hand, some analogies which lend a degree of plausibility to the statement. There are well-ascertained facts, known from the earliest periods of medicine, showing that, under certain circumstances, the very medicine which, from its known effects, one would expect to aggravate the disease, may contribute to its relief. I may be permitted to allude, in the most general way, to the case in which the spontaneous efforts of an overtasked stomach are quieted by the agency of a drug which that organ refuses to entertain upon any terms. But that every cure ever performed by medicine should have been founded upon this principle, although without the knowledge of a physician; that the Homeopathic axiom is, as Hahnemann asserts, "the sole law of nature in therapeutics," a law of which nothing more than a transient glimpse ever presented itself to the innumerable host of medical observers, is a dogma of such sweeping extent, and pregnant novelty, that it demands a corresponding breadth and depth of unquestionable facts to cover its vast pretensions.
So much ridicule has been thrown upon the pretended powers of the minute doses that I shall only touch upon this point for the purpose of conveying, by illustrations, some shadow of ideas far transcending the powers of the imagination to realize. It must be remembered that these comparisons are not matters susceptible of dispute, being founded on simple arithmetical computations, level to the capacity of any intelligent schoolboy. A person who once wrote a very small pamphlet made some show of objecting to calculations of this kind, on the ground that the highest dilutions could easily be made with a few ounces of alcohol. But he should have remembered that at every successive dilution he lays aside or throws away ninety-nine hundredths of the fluid on which he is operating, and that, although he begins with a drop, he only prepares a millionth, billionth, trillionth, and similar fractions of it, all of which, added together, would constitute but a vastly minute portion of the drop with which he began. But now let us suppose we take one single drop of the Tincture of Camomile, and that the whole of this were to be carried through the common series of dilutions.
A calculation nearly like the following was made by Dr. Panvini, and may be readily followed in its essential particulars by any one who chooses.
For the first dilution it would take 100 drops of alcohol.
For the second dilution it would take 10,000 drops, or about a pint.
For the third dilution it would take 100 pints.
For the fourth dilution it would take 10,000 pints, or more than 1,000 gallons, and so on to the ninth dilution, which would take ten billion gallons, which he computed would fill the basin of Lake Agnano, a body of water two miles in circumference. The twelfth dilution would of course fill a million such lakes. By the time the seventeenth degree of dilution should be reached, the alcohol required would equal in quantity the waters of ten thousand Adriatic seas. Trifling errors must be expected, but they are as likely to be on one side as the other, and any little matter like Lake Superior or the Caspian would be but a drop in the bucket.
Swallowers of globules, one of your little pellets, moistened in the mingled waves of one million lakes of alcohol, each two miles in circumference, with which had been blended that one drop of Tincture of Camomile, would be of precisely the strength recommended for that medicine in your favorite Jahr's Manual, against the most sudden, frightful, and fatal diseases! [In the French edition of 1834, the proper doses of the medicines are mentioned, and Camomile is marked IV. Why are the doses omitted in Hull's Translation, except in three instances out of the whole two hundred remedies, notwithstanding the promise in the preface that -some remarks upon the doses used may be found at the head of each medicine"? Possibly because it makes no difference whether they are employed in one Homoeopathic dose or another; but then it is very singular that such precise directions were formerly given in the same work, and that Hahnemann's "experience" should have led him to draw the nice distinctions we have seen in a former part of this Lecture.]
And proceeding on the common data, I have just made a calculation which shows that this single drop of Tincture of Camomile, given in the quantity ordered by Jahr's Manual, would have supplied every individual of the whole human family, past and present, with more than five billion doses each, the action of each dose lasting about four days.
Yet this is given only at the quadrillionth, or fourth degree of potency, and various substances are frequently administered at the decillionth or tenth degree, and occasionally at still higher attenuations with professed medicinal results. is there not in this as great an exception to all the hitherto received laws of nature as in the miracle of the loaves and fishes? Ask this question of a Homeopathist, and he will answer by referring to the effects produced by a very minute portion of vaccine matter, or the extraordinary diffusion of odors. But the vaccine matter is one of those substances called morbid poisons, of which it is a peculiar character to multiply themselves, when introduced into the system, as a seed does in the soil. Therefore the hundredth part of a grain of the vaccine matter, if no more than this is employed, soon increases in quantity, until, in the course of about a week, it is a grain or more, and can be removed in considerable drops. And what is a very curious illustration of Homeopathy, it does not produce its most characteristic effects until it is already in sufficient quantity not merely to be visible, but to be collected for further use. The thoughtlessness which can allow an inference to be extended from a product of disease possessing this susceptibility of multiplication when conveyed into the living body, to substances of inorganic origin, such as silex or sulphur, would be capable of arguing that a pebble may produce a mountain, because an acorn can become a forest.
As to the analogy to be found between the alleged action of the infinitely attenuated doses, and the effects of some odorous substances which possess the extraordinary power of diffusing their imponderable emanations through a very wide space, however it may be abused in argument, and rapidly as it evaporates on examination, it is not like that just mentioned, wholly without meaning. The fact of the vast diffusion of some odors, as that of musk or the rose, for instance, has long been cited as the most remarkable illustration of the divisibility of matter, and the nicety of the senses. And if this were compared with the effects of a very minute dose of morphia on the whole system, or the sudden and fatal impression of a single drop of prussic acid, or, with what comes still nearer, the poisonous influence of an atmosphere impregnated with invisible malaria, we should find in each of these examples an evidence of the degree to which nature, in some few instances, concentrates powerful qualities in minute or subtile forms of matter. But if a man comes to me with a pestle and mortar in his hand, and tells me that he will take a little speck of some substance which nobody ever thought to have any smell at all, as, for instance, a grain of chalk or of charcoal, and that he will, after an hour or two of rubbing and scraping, develop in a portion of it an odor which, if the whole grain were used, would be capable of pervading an apartment, a house, a village, a province, an empire, nay, the entire atmosphere of this broad planet upon which we tread, and that from each of fifty or sixty substances he can in this way develop a distinct and hitherto unknown odor; and if he tries to show that all this is rendered quite reasonable by the analogy of musk and roses, I shall certainly be justified in considering him incapable of reasoning, and beyond the reach of my argument. what if, instead of this, he professes to develop new and wonderful medicinal powers from the same speck of chalk or charcoal, in such proportions as would impregnate every pond, lake, river, sea, and ocean of our globe, and appeals to the same analogy in favor of the probability of his assertion.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Ven 18 Set 2009 - 11:43|| |
All this may be true, notwithstanding these considerations. But so extraordinary would be the fact, that a single atom of substances which a child might swallow without harm by the teaspoonful could, by an easy mechanical process, be made to develop such inconceivable powers, that nothing but the strictest agreement of the most cautious experimenters, secured by every guaranty that they were honest and faithful, appealing to repeated experiments in public, with every precaution to guard against error, and with the most plain and peremptory results, should induce us to lend any credence to such pretensions.
The third doctrine, that Psora, the other name of which you remember, is the cause of the great majority of chronic diseases, is a startling one, to say the least. That an affection always recognized as a very unpleasant personal companion, but generally regarded as a mere temporary incommodity, readily yielding to treatment in those unfortunate enough to suffer from it, and hardly known among the better classes of society, should be all at once found out by a German physician to be the great scourge of mankind, the cause of their severest bodily and mental calamities, cancer and consumption, idiocy and madness, must excite our unqualified surprise. And when the originator of this singular truth ascribes, as in this page now open before me, the declining health of a disgraced courtier, the chronic malady of a bereaved mother, even the melancholy of the love-sick and slighted maiden, to nothing more nor less than the insignificant, unseemly, and almost unmentionable ITCH, does it not seem as if the very soil upon which we stand were dissolving into chaos, over the earthquake-heaving of discovery?
And when one man claims to have established these three independent truths, which are about as remote from each other as the discovery of the law of gravitation, the invention of printing, and that of the mariner's compass, unless the facts in their favor are overwhelming and unanimous, the question naturally arises, Is not this man deceiving himself, or trying to deceive others?
I proceed to examine the proofs of the leading ideas of Hahnemann and his school.
In order to show the axiom, similia similibus curantur (or like is cured by like), to be the basis of the healing art—"the sole law of nature in therapeutics"—it is necessary—
That the symptoms produced by drugs in healthy persons should be faithfully studied and recorded.
That drugs should be shown to be always capable of curing those, diseases most like their own symptoms.
That remedies should be shown not to cure diseases when they do not produce symptoms resembling those presented in these diseases.
1. The effects of drugs upon healthy persons have been studied by Hahnemann and his associates. Their results were made known in his Materia Medica, a work in three large volumes in the French translation, published about eight years ago. The mode of experimentation appears to have been, to take the substance on trial, either in common or minute doses, and then to set down every little sensation, every little movement of mind or body, which occurred within many succeeding hours or days, as being produced solely by the substance employed. When I have enumerated some of the symptoms attributed to the power of the drugs taken, you will be able to judge how much value is to be ascribed to the assertions of such observers.
The following list was taken literally from the Materia Medica of Hahnemann, by my friend M. Vernois, for whose accuracy I am willing to be responsible. He has given seven pages of these symptoms, not selected, but taken at hazard from the French translation of the work. I shall be very brief in my citations.
"After stooping some time, sense of painful weight about the head upon resuming the erect posture."
"An itching, tickling sensation at the outer edge of the palm of the left hand, which obliges the person to scratch." The medicine was acetate of lime, and as the action of the globule taken is said to last twenty-eight days, you may judge how many such symptoms as the last might be supposed to happen.
Among the symptoms attributed to muriatic acid are these: a catarrh, sighing, pimples; "after having written a long time with the back a little bent over, violent pain in the back and shoulder-blades, as if from a strain,"—"dreams which are not remembered—disposition to mental dejection—wakefulness before and after midnight."
I might extend this catalogue almost indefinitely. I have not cited these specimens with any view to exciting a sense of the ridiculous, which many others of those mentioned would not fail to do, but to show that the common accidents of sensation, the little bodily inconveniences to which all of us are subject, are seriously and systematically ascribed to whatever medicine may have been exhibited, even in the minute doses I have mentioned, whole days or weeks previously.
To these are added all the symptoms ever said by anybody, whether deserving confidence or not, as I shall hereafter illustrate, to be produced by the substance in question.
The effects of sixty-four medicinal substances, ascertained by one or both of these methods, are enumerated in the Materia Medica of Hahnemann, which May be considered as the basis of practical Homeopathy. In the Manual of Jahr, which is the common guide, so far as I know, of those who practise Homeopathy in these regions, two hundred remedies are enumerated, many Of which, however, have never been employed in practice. In at least one edition there were no means of distinguishing those which had been tried upon the sick from the others. It is true that marks have been added in the edition employed here, which serve to distinguish them; but what are we to think of a standard practical author on Materia Medica, who at one time omits to designate the proper doses of his remedies, and at another to let us have any means of knowing whether a remedy has ever been tried or not, while he is recommending its employment in the most critical and threatening diseases?
I think that, from what I have shown of the character of Hahnemann's experiments, it would be a satisfaction to any candid inquirer to know whether other persons, to whose assertions he could look with confidence, confirm these pretended facts. Now there are many individuals, long and well known to the scientific world, who have tried these experiments upon healthy subjects, and utterly deny that their effects have at all corresponded to Hahnemann's assertions.
I will take, for instance, the statements of Andral (and I am not referring to his well-known public experiments in his hospital) as to the result of his own trials. This distinguished physician is Professor of Medicine in the School of Paris, and one of the most widely known and valued authors upon practical and theoretical subjects the profession can claim in any country. He is a man of great kindness of character, a most liberal eclectic by nature and habit, of unquestioned integrity, and is called, in the leading article of the fast number of the "Homeopathic Examiner," "an eminent and very enlightened allopathist." Assisted by a number of other persons in good health, he experimented on the effects of cinchona, aconite, sulphur, arnica, and the other most highly extolled remedies. His experiments lasted a year, and he stated publicly to the Academy of Medicine that they never produced the slightest appearance of the symptoms attributed to them. The results of a man like this, so extensively known as one of the most philosophical and candid, as well as brilliant of instructors, and whose admirable abilities and signal liberality are generally conceded, ought to be of great weight in deciding the question.
M. Double, a well-known medical writer and a physician of high standing in Paris, had occasion so long ago as 1801, before he had heard of Homeopathy, to make experiments upon Cinchona, or Peruvian bark. He and several others took the drug in every kind of dose for four months, and the fever it is pretended by Hahnemann to excite never was produced.
M. Bonnet, President of the Royal Society of Medicine of Bordeaux, had occasion to observe many soldiers during the Peninsular War, who made use of Cinchona as a preservative against different diseases,-but he never found it to produce the pretended paroxysms.
If any objection were made to evidence of this kind, I would refer to the express experiments on many of the Homeopathic substances, which were given to healthy persons with every precaution as to diet and regimen, by M Louis Fleury, without being followed by the slightest of the pretended consequences. And let me mention as a curious fact, that the same quantity of arsenic given to one animal in the common form of the unprepared powder, and to another after having been rubbed up into six hundred globules, offered no particular difference of activity in the two cases. This is a strange contradiction to the doctrine of the development of what they call dynamic power, by means of friction and subdivision.
In 1835 a public challenge was offered to the best-known Homeopathic physician in Paris to select any ten substances asserted to produce the most striking effects; to prepare them himself; to choose one by lot without knowing which of them he had taken, and try it upon himself or an intelligent and devoted Homeopathist, and, waiting his own time, to come forward and tell what substance had been employed. The challenge was at first accepted, but the acceptance retracted before the time of trial arrived.
From all this I think it fair to conclude that the catalogues of symptoms attributed in Homeopathic works to the influence of various drugs upon healthy persons are not entitled to any confidence.
2. It is necessary to show, in the next place, that medicinal substances are always capable of curing diseases most like their own symptoms. For facts relating to this question we must look to two sources; the recorded experience of the medical profession in general, and the results of trials made according to Homeopathic principles, and capable of testing the truth of the doctrine.
No person, that I am aware of, has ever denied that in some cases there exists a resemblance between the effects of a remedy and the symptoms of diseases in which it is beneficial. This has been recognized, as Hahnemann himself has shown, from the time of Hippocrates. But according to the records of the Medical profession, as they have been hitherto interpreted, this is true of only a very small proportion of useful remedies. Nor has it ever been considered as an established truth that the efficacy of even these few remedies was in any definite ratio to their power of producing symptoms more or less like those they cured.
Such was the state of opinion when Hahnemann came forward with the proposition that all the cases of successful treatment found in the works of all preceding medical writers were to be ascribed solely to the operation of the Homeopathic principle, which had effected the cure, although without the physician's knowledge that this was the real secret. And strange as it may seem he was enabled to give such a degree of plausibility to this assertion, that any Person not acquainted somewhat with medical literature, not quite familiar, I should rather say, with the relative value of medical evidence, according to the Sources whence it is derived, would be almost frightened into the belief, at seeing the pages upon pages of Latin names he has summoned as his witnesses.
It has hitherto been customary, when examining the writings of authors of Preceding ages, upon subjects as to which they were less enlightened than ourselves, and which they were very liable to misrepresent, to exercise some little discretion; to discriminate, in some measure, between writers deserving confidence and those not entitled to it. But there is not the least appearance of any such delicacy on the part of Hahnemann. A large majority of the names of old authors he cites are wholly unknown to science. With some of them I have been long acquainted, and I know that their accounts of diseases are no more to be trusted than their contemporary Ambroise Paré stories of mermen, and similar absurdities. But if my judgment is rejected, as being a prejudiced one, I can refer to Cullen, who mentioned three of Hahnemann's authors in one sentence, as being "not necessarily bad authorities; but certainly such when they delivered very improbable events;" and as this was said more than half a century ago, it could not have had any reference to Hahnemann. But although not the slightest sign of discrimination is visible in his quotations—although for him a handful of chaff from Schenck is all the same thing as a measure of wheat from Morgagni—there is a formidable display of authorities, and an abundant proof of ingenious researches to be found in each of the great works of Hahnemann with which I am familiar.
It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has proved many of Hahnemann's quotations from old authors to be adulterate and false. What particular instances he has pointed out I have no means of learning. And it is probably wholly impossible on this side of the Atlantic, and even in most of the public libraries of Europe, to find anything more than a small fraction of the innumerable obscure publications which the neglect of grocers and trunk-makers has spared to be ransacked by the all-devouring genius of Homeopathy. I have endeavored to verify such passages as my own library afforded me the means of doing. For some I have looked in vain, for want, as I am willing to believe, of more exact references. But this I am able to affirm, that, out of the very small number which I have been able to trace back to their original authors, I have found two to be wrongly quoted, one of them being a gross misrepresentation.
The first is from the ancient Roman author, Caelius Aurelianus; the second from the venerable folio of Forestus. Hahnemann uses the following expressions,-if he is not misrepresented in the English Translation of the "Organon": "Asclepiades on one occasion cured an inflammation of the brain by administering a small quantity of wine." After correcting the erroneous reference of the Translator, I can find no such case alluded to in the chapter. But Caelius Aurelianus, mentions two modes of treatment employed by Asclepiades, into both of which the use of wine entered, as being in the highest degree irrational and dangerous [Caelius Aurel De Morb. Acut. et Chron. lib. 1. cap. xv, not xvi. Amsterdam. Wetstein, 1755].
In speaking of the oil of anise-seed, Hahnemann says that Forestus observed violent colic caused by its administration. But, as the author tells the story, a young man took, by the counsel of a surgeon, an acrid and virulent medicine, the name of which is not given, which brought on a most cruel fit of the gripes and colic. After this another surgeon was called, who gave him oil of anise-seed and wine, which increased his suffering [Observ. et Curat. Med. lib. XXI. obs. xiii. Frankfort, 1614]. Now if this was the Homeopathic remedy, as Hahnemann pretends, it might be a fair question why the young man was not . cured by it. But it is a much graver question why a man who has shrewdness and learning enough to go so far after his facts, should think it right to treat them with such astonishing negligence or such artful unfairness.
Even if every word he had pretended to take from his old authorities were to be found in them, even if the authority of every one of these authors were beyond question, the looseness with which they are used to prove whatever Hahnemann chooses is beyond the bounds of credibility. Let me give one instance to illustrate the character of this man's mind. Hahnemann asserts, in a note annexed to the 110th paragraph of the "Organon," that the smell of the rose will cause certain persons to faint. And he says in the text that substances which produce peculiar effects of this nature on particular constitutions cure the same symptoms in people in general. Then in another note to the same paragraph he quotes the following fact from one of the last sources one would have looked to for medical information, the Byzantine Historians.
"It was by these means" (i.e. Homeopathically) "that the Princess Eudosia with rose-water restored a person who had fainted!"
Is it possible that a man who is guilty of such pedantic folly as this,-a man who can see a confirmation of his doctrine in such a recovery as this—a recovery which is happening every day, from a breath of air, a drop or two of water, untying a bonnet-string, loosening a stay-lace, and which can hardly help happening, whatever is done—is it possible that a man, of whose pages, not here and there one, but hundreds upon hundreds are loaded with such trivialities, is the Newton, the Columbus, the Harvey of the nineteenth century!
The whole process of demonstration he employs is this. An experiment is instituted with some drug upon one or more healthy persons. Everything that happens for a number of days or weeks is, as we have seen, set down as an effect of the medicine. Old volumes are then ransacked promiscuously, and every morbid sensation or change that anybody ever said was produced by the drug in question is added to the list of symptoms. By one or both of these methods, each of the sixty-four substances enumerated by Hahnemann is shown to produce a very large number of symptoms, the lowest in his scale being ninety-seven, and the highest fourteen hundred and ninety-one. And having made out this fist respecting any drug, a catalogue which, as you may observe in any Homeopathic manual, contains various symptoms belonging to every organ of the body, what can be easier than to find alleged cures in every medical author which can at once be attributed to the Homeopathic principle; still more if the grave of extinguished credulity is called upon to give up its dead bones as living witnesses; and worst of all, if the monuments of the past are to be mutilated in favor of "the sole law of Nature in therapeutics"?
There are a few familiar facts of which great use has been made as an entering wedge for the Homeopathic doctrine. They have been suffered to pass current so long that it is time they should be nailed to the counter, a little operation which I undertake, with perfect cheerfulness, to perform for them.
The first is a supposed illustration of the Homeopathic law found in the precept given for the treatment of parts which have been frozen, by friction with snow or similar means. But we deceive ourselves by names, if we suppose the frozen part to be treated by cold, and not by heat. The snow may even be actually warmer than the part to which it is applied. But even if it were at the same temperature when applied, it never did and never could do the least good to a frozen part, except as a mode of regulating the application of what? of heat. But the heat must be applied gradually, just as food must be given a little at a time to those perishing with hunger. If the patient were brought into a warm room, heat would be applied very rapidly, were not something interposed to prevent this, and allow its gradual admission. Snow or iced water is exactly what is wanted; it is not cold to the part; it is very possibly warm, on the contrary, for these terms are relative, and if it does not melt and let the heat in, or is not taken away, the part will remain frozen up until doomsday. Now the treatment of a frozen limb by heat, in large or small quantities, is not Homoeopathy.
The next supposed illustration of the Homoeopathic law is the alleged successful management of burns, by holding them to the fire. This is a popular mode of treating those burns which are of too little consequence to require any more efficacious remedy, and would inevitably get well of themselves, without any trouble being bestowed upon them. It produces a most acute pain in the part, which is followed by some loss of sensibility, as happens with the eye after exposure to strong light, and the ear after being subjected to very intense sounds. This is all it is capable of doing, and all further notions of its efficacy must be attributed merely to the vulgar love of paradox. If this example affords any comfort to the Homoeopathist, it seems as cruel to deprive him of it as it would be to convince the mistress of the smoke-jack or the flat-iron that the fire does not literally "draw the fire out," which is her hypothesis.
But if it were true that frost-bites were cured by cold and bums by heat, it would be subversive, so far as it went, of the great principle of Homoeopathy. For you will remember that this principle is that Like cures Like, and not that Same cures Same; that there is resemblance and not identity between the symptoms of the disease and those produced by the drug which cures it, and none have been readier to insist upon this distinction than the Homoeopathists themselves. For if Same cures Same, then every poison must be its own antidote, which is neither a part of their theory nor their so-called experience. They have been asked often enough, why it was that arsenic could not cure the mischief which arsenic had caused, and why the infectious cause of small-pox did not remedy the disease it had produced, and then they were ready enough to see the distinction I have pointed out. O no! it was not the hair of the same dog, but only of one very much like him!
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Ven 18 Set 2009 - 11:44|| |
A third instance in proof of the Homoeopathic law is sought for in the acknowledged efficacy of vaccination. And how does the law apply to this? It is granted by the advocates of Homoeopathy that there is a resemblance between the effects of the vaccine virus on a person in health and the symptoms of smallpox. Therefore, according to the rule, the vaccine virus will cure the small-pox which, as everybody knows, is entirely untrue. But it prevents small-pox, say the Homoeopathists. Yes, and so does small-pox prevent itself from ever happening again, and we know just as much of the principle involved in the one caw as in the other. For this is only one of a series of facts which we are wholly unable to explain. Small-pox, measles, scarlet-fever, hooping-cough, protect those who have them once from future attacks; but nettle-rash and catarrh and lung fever,- each of which is just as Homoeopathic to itself as any one of the others, have no such preservative power. We are obliged to accept the fact, unexplained, and we can do no more for vaccination than for the rest.
I come now to the most directly practical point connected with the subject, namely—
What is the state of the evidence as to the efficacy of the proper Homoeopathic treatment in the cure of diseases.
As the treatment adopted by the Homoeopathists has been almost universally by means of the infinitesimal doses, the question of their efficacy is thrown open, in common with that of the truth of their fundamental axiom, as both are tested in practice.
We must look for facts as to the actual working of Homoeopathy to three sources.
The statements of the unprofessional public.
The assertions of Homoeopathic practitioners.
The results of trials by competent and honest physicians, not pledged to the system.
I think, after what we have seen of medical facts, as they are represented by incompetent persons, we are disposed to attribute little value to all statements of wonderful cures, coming from those who have never been accustomed to watch the caprices of disease, and have not cooled down their young enthusiasm by the habit of tranquil observation. Those who know nothing of the natural progress of a malady, of its ordinary duration, of its various modes of terminating, of its liability to accidental complications, of the signs which mark its insignificance or severity, of what is to be expected of it when left to itself, of how much or how little is to be anticipated from remedies, those who know nothing or next to nothing of all these things, and who are in a great state of excitement from benevolence, sympathy, or zeal for a new medical discovery, can hardly be expected to be sound judges of facts which have misled so many sagacious men, who have spent their lives in the daily study and observation of them. I believe that, after having drawn the portrait of defunct Perkinism, with its rive thousand printed cures, and its million and a half computed ones, its miracles blazoned about through America, Denmark, and England; after relating that forty years ago women carried the Tractors about in their pockets, and workmen could not make them fast enough for the public demand; and then showing you, as a curiosity, a single one of these instruments, an odd 6ne of a pair, which I obtained only by a lucky accident, so utterly lost is the memory of all their wonderful achievements; I believe, after all this, I need not waste time in showing that medical accuracy is not to be looked for in the florid reports of benevolent associations, the assertions of illustrious patrons, the lax effusions of daily journals, or the effervescent gossip of the tea-table.
Dr. Hering, whose name is somewhat familiar to the champions of Homoeopathy, has said that "the new healing art is not to be judged by its success in isolated cases only, but according to its success in general, its innate truth, and the incontrovertible nature of its innate principles."
We have seen something of "the incontrovertible nature of its innate principles," and it seems probable, on the whole, that its success in general must be made up of its success in isolated cases. Some attempts have been made, however, to finish the whole matter by sweeping statistical documents, which are intended to prove its triumphant success over the common practice.
It is well known to those who have had the good fortune to see the "Homoeopathic Examiner," that this journal led off, in its first number, with a grand display of everything the newly imported doctrine had to show for itself. It is well remarked, on the twenty-third page of this article, that "the comparison of bills of mortality among an equal number of sick, treated by divers methods, is a most poor and lame way to get at conclusions touching principles of the healing art." In confirmation of which, the author proceeds upon the twenty-fifth page to prove the superiority of the Homoeopathic treatment of cholera, by precisely these very bills of mortality. Now, every intelligent physician is aware that the poison of cholera differed so much in its activity at different times and places, that it was next to impossible to form any opinion as to the results of treatment, unless every precaution was taken to secure the most perfectly corresponding conditions in the patients treated, and hardly even then. Of course, then, a Russian Admiral, by the name of Mordvinow, backed by a number of so-called physicians practising in Russian villages, is singularly competent to the task of settling the whole question of the utility of this or that kind of treatment; to prove that, if not more than eight and a half per cent of those attacked with the disease perished, the rest owed their immunity to Hahnemann. I can remember when more than a hundred patients in a public institution were attacked with what, I doubt not, many Homoeopathic physicians (to say nothing of Homoeopathic admirals) would have called cholera, and not one of them died, though treated in the common way, and it is my firm belief that, if such a result had followed the administration of the omnipotent globules, it would have been in the mouth of every adept in Europe, from Quin of London to Spohr of Gandersheim. No longer ago than yesterday, in one of the most widely circulated papers of this city, there was published an assertion that the mortality in several Homoeopathic Hospitals was not quite five in a hundred, whereas, in what am called by the writer Allopathic Hospitals, it is said to be eleven in a hundred. An honest man should be ashamed of such an argumentum ad ignorandam. The mortality of a hospital depends not merely on the treatment of the patients, but on the class of diseases it is in the habit of receiving on the place where it is, on the season, and many other circumstances. For instance, them are many hospitals in the great cities of Europe that receive few diseases of a nature to endanger life, and, on the other hand, there are others where dangerous diseases are accumulated out of the common proportion. Thus, in the wards of Louis, at the Hospital of La Pitia, a vast number of patients in the last stages of consumption were constantly entering, to swell the mortality of that hospital. It was because he was known to pay particular attention to the diseases of the chest that patients laboring under those fatal affections to an incurable extent were so constantly coming in upon him. It is always a miserable appeal to the thoughtlessness of the vulgar, to allege the naked fact of the less comparative mortality in the practice of one hospital or of one physician than another, as an evidence of the superiority of their treatment. Other things being equal, it must always be expected that those institutions and individuals enjoying to the highest degree the confidence of the community will lose the largest proportion of their patients; for the simple reason that they will naturally be looked to by those suffering from the gravest class of diseases; that many, who know that they are affected with mortal disease, will choose to die under their care or shelter, while the subjects of trifling maladies, and merely troublesome symptoms, amuse themselves to any extent among the fancy practitioners. When, therefore, Dr. Muhlenbein, as stated in the "Homoeopathic Examiner," and quoted in yesterday's "Daily Advertiser," asserts that the mortality among his patients is only one per cent since he has practised Homoeopathy, whereas it was six per cent when he employed the common mode of practice, I am convinced by this, his own statement, that the citizens of Brunswick, whenever they are seriously sick, take good care not to send for Dr. Muhlenbein!
It is evidently impossible that I should attempt, within the compass of a single lecture, any detailed examination of the very numerous cases reported in the Homoeopathic Treatises and Journals. Having been in the habit of receiving the French "Archives of Homoeopathic Medicine" until the premature decease of that Journal, I have had the opportunity of becoming acquainted somewhat with the style of these documents, and experiencing whatever degree of conviction they were calculated to produce. Although of course I do not wish any value to be assumed for my opinion, such as it is, I consider that you are entitled to hear it. So far, then, as I am acquainted with the general character of the cases reported by the Homoeopathic physicians, they would for the most part be considered as wholly undeserving a place in any English, French, or America periodical of high standing if, instead of favoring the doctrine they were intended to support, they were brought forward to prove the efficacy of any common remedy administered by any common practitioner. There are occasional exceptions to this remark; but the general truth of it is rendered probable by the fact that these cases are always, or almost always, written with the single object of showing the efficacy of the medicine used, or the skill of the practitioner, and it is recognized as a general rule that such cases deserve very little confidence. Yet they may sound well enough, one at a time, to those who are not fully aware of the fallacies of medical evidence. Let me state a case in illustration. Nobody doubts that some patients recover under every form of practice. Probably all are willing to allow that a large majority, for instance, ninety in a hundred, of such cases as a physician is called to in daily practice, would recover, sooner or later, with more or less difficulty, provided nothing were done to interfere seriously with the efforts of nature.
Suppose, then, a physician who has a hundred patients prescribes to each of them pills made of some entirely inert substance, as starch, for instance. Ninety of them get well, or if he chooses to use such language, he cures ninety of them. It is evident, according to the doctrine of chances, that there must be a considerable number of coincidences between the relief of the patient and the administration of the remedy. It is altogether probable that there will happen two or three very striking coincidences out of the whole ninety cases, in which it would seem evident that the medicine produced the relief, though it had, as we assumed, nothing to do with it. Now. suppose that the physician publishes these cases, will they not have a plausible appearance of proving that which, as we granted at the outset, was entirely false? Suppose that instead of pills of starch he employs microscopic sugarplums, with the five million billion trillionth part of a suspicion of aconite or pulsatilla, and then publishes his successful cases, through the leaden lips of the press, or the living ones of his female acquaintances,-does that make the impression a less erroneous one? But so it is that in Homoeopathic works and journals and gossip one can never, or next to never, find anything but successful cases, which might do very well as a proof of superior skill, did it not prove as much for the swindling advertisers whose certificates disgrace so many of our newspapers. How long will it take mankind to learn that while they listen to "the speaking hundreds and units, who make the world ring" with the pretended triumphs they have witnessed, the "dumb millions" of deluded and injured victims are paying the daily forfeit of their misplaced confidence!
I am sorry to see, also, that a degree of ignorance as to the natural course of diseases is often shown in these published cases, which, although it may not be detected by the unprofessional reader, conveys an unpleasant impression to those who are acquainted with the subject. Thus a young woman affected with jaundice is mentioned in the German "Annals of Clinical Homoeopathy" as having been cured in twenty-nine days by pulsatilla and nux vomica. Rummel, a well-known writer of the same school, speaks of curing a case of jaundice in thirty-four days by Homoeopathic doses of pulsatilla, aconite, and cinchona. I happened to have a case in my own household, a few weeks since, which lasted about ten days, and this was longer than I have repeatedly seen it in hospital practice, so that it was nothing to boast of.
Dr. Munneche of Lichtenburg in Saxony is called to a patient with a sprained ankle who had been a fortnight under the common treatment. The patient gets well by the use of arnica in a little more than a month longer, and this extraordinary fact is published in the French "Archives of Homoeopathic Medicine."
In the same journal is recorded the case of a patient who with nothing more, so far as any proof goes, than influenza, gets down to her shop upon the sixth day.
And again, the cool way in which everything favorable in a case is set down by these people entirely to their treatment, may be seen in a case of croup reported in the "Homoeopathic Gazette" of Leipsic, in which leeches, blistering, inhalation of hot vapor, and powerful internal medicine had been employed, and yet the merit was all attributed to one drop of some Homoeopathic fluid.
I need not multiply these quotations, which illustrate the grounds of an opinion which the time does not allow me to justify more at length; other such cases are lying open before me; there is no end to them if more were wanted; for nothing is necessary but to look into any of the numerous broken-down Journals of Homoeopathy, the volumes of which may be found on the shelves of those curious in such matters.
A number of public trials of Homoeopathy have been made in different parts of the world. Six of these are mentioned in the Manifesto of the "Homoeopathic Examiner." Now to suppose that any trial can absolutely silence people, would be to forget the whole experience of the past. Dr. Haygarth and Dr. Alderson could not stop the sale of the five-guinea Tractors, although they proved that they could work the same miracles with pieces of wood and tobacco-pipe. It takes time for truth to operate as well as Homoeopathic globules. Many persons thought the results of these trials were decisive enough of the nullity of the treatment; those who wish to see the kind of special pleading and evasion by which it is attempted to cover results which, stated by the "Homoeopathic Examiner" itself, look exceedingly like a miserable failure, may consult the opening flourish of that Journal. I had not the intention to speak of these public trials at all, having abundant other evidence on the point. But I think it best, on the whole, to mention two of them in a few words—that instituted at Naples and that of Andral.
There have been few names in the medical profession, for the last half century, so widely known throughout the world of science as that of M. Esquirol, whose life was devoted to the treatment of insanity, and who was without a rival in that department of practical medicine. It is from an analysis communicated by him to the "Gazette Médicale de Paris" that I derive my acquaintance with the account of the trial at Naples by Dr. Panvini, physician to the Hospital della Pace. This account seems to be entirely deserving of credit. Ten patients were set apart, and not allowed to take any medicine at all,-Much against the wish of the Homoeopathic physician. All of them got well, and of course all of them would have been claimed as triumphs if they had been submitted to the treatment. Six other slight cases (each of which is specified) got well under the Homoeopathic treatment—none of its asserted specific effects being manifested. All the rest were cases of grave disease; and so far as the trial, which was interrupted about the fortieth day, extended, the patients grew worse, or received no benefit. A case is reported on the page before me of a soldier affected with acute inflammation in the chest, who took successively aconite, bryonia, nux vomica, and pulsatilla, and after thirty-eight days of treatment remained without any important change in his disease. The Homoeopathic physician who treated these patients was M. de Horatiis, who had the previous year been announcing his wonderful cures. And M. Esquirol asserted to the Academy of Medicine in 1835, that this M. de Horatiis, who is one of the prominent personages in the "Examiner's" Manifesto published in 1840, had subsequently renounced Homoeopathy. I may remark, by the way, that this same periodical, which is so very easy in explaining away the results of these trials, makes a mistake of only six years or a little more as to the time when this at Naples was instituted.
M. Andral, the "eminent and very enlightened allopathist" of the "Homoeopathic Examiner," made the following statement in March, 1835, to the Academy of Medicine: "I have submitted this doctrine to experiment; I can reckon at this time from one hundred and thirty to one hundred and forty cases, recorded with perfect fairness, in a great hospital, under the eye of numerous witnesses; to avoid every objection I obtained my remedies of M. Guibourt, who keeps a Homoeopathic pharmacy, and whose strict exactness is well known; the regimen has been scrupulously observed, and I obtained from the sisters attached to the hospital a special regimen, such as Hahnemann orders. I was told, however, some months since, that I had not been faithful to all the rules of the doctrine. I therefore took the trouble to begin again; I have studied the practice of the Parisian Homoeopathists, as I had studied their books, and I became convinced that they treated their patients as I had treated mine, and I affirm that I have been as rigorously exact in the treatment as any other person."
And he expressly asserts the entire nullity of the influence of all the Homoeopathic remedies tried by him in modifying, so far as he could observe, the progress or termination of diseases. It deserves notice that he experimented with the most boasted substances—cinchona, aconite, mercury, bryonia, belladonna. Aconite, for instance, he says he administered in more than forty cases of that collection of feverish symptoms in which it exerts so much power, according to Hahnemann, and in not one of them did it have the slightest influence, the pulse and heat remaining as before.
These statements look pretty honest, and would seem hard to be explained away, but it is calmly said that he "did not know enough of the method to select the remedies with any tolerable precision." [Homoeopathic Examiner, vol. i. p. 22. "Nothing is left to the caprice of the physician. ('In a word, instead of being dependent upon blind chance, that there is an infallible law, guided by which the physician must select the proper remedies.')" Ibid., in a notice of Menzel's paper.]
Who are they that practice Homoeopathy, and say this of a man with the Materia, Medica of Hahnemann lying before him? Who are they that send these same globules, on which he experimented, accompanied by a little book, into families, whose members are thought competent to employ them, when they deny any such capacity to a man whose life has been passed at the bedside of patients, the most prominent teacher in the first Medical Faculty in the world, the consulting physician of the King of France, and one of the most renowned practical writers, not merely of his nation, but of his age? I leave the quibbles by which such persons would try to creep out from under the crushing weight of these conclusions to the unfortunates who suppose that a reply is equivalent to an answer.
Dr. Baillie, one of the physicians in the great Hótel Dieu of Paris, invited two Homoeopathic practitioners to experiment in his wards. One of these was Curie, now of London, whose works are on the counters of some of our bookstores, and probably in the hands of some of my audience. This gentleman, whom Dr. Baillie declares to be an enlightened man, and perfectly sincere in his convictions, brought his own medicines from the pharmacy which furnished Hahnemann himself, and employed them for four or five months upon patients in his ward, and with results equally unsatisfactory, as appears from Dr. Baillie's statement at a meeting of the Academy of Medicine. And a similar experiment was permitted by the Clinical Professor of the Hótel Dieu of Lyons, with the same complete failure.
But these are old and prejudiced practitioners. Very well, then take the statement of Dr. Fleury, a most intelligent young physician, who treated homoeopathically more than fifty patients, suffering from diseases which it was not dangerous to treat in this way, taking every kind of precaution as to regimen, removal of disturbing influences, and the state of the atmosphere, insisted upon by the most vigorous partisans of the doctrine, and found not the slightest effect produced by the medicines. And more than this, read nine of these cases, which he has published, as I have just done, and observe the absolute nullity of aconite, belladonna, and bryonia, against the symptoms over which they are pretended to exert such palpable, such obvious, such astonishing influences. In the view of these statements, it is impossible not to realize the entire futility of attempting to silence this asserted science by the flattest and most peremptory results of experiment. Were all the hospital physicians of Europe and America to devote themselves, for the requisite period, to this sole pursuit, and were their results to be unanimous as to the total worthlessness of the whole system in practice, this slippery delusion would slide through their fingers without the slightest discomposure, when, as they supposed, they had crushed every joint in its tortuous and trailing body.
3. 1 have said, that to show the truth of the Homoeopathic doctrine, as announced by Hahnemann, it would be necessary to show, in the third place, that remedies never cure diseases when they are not capable of producing similar symptoms. The burden of this somewhat comprehensive demonstration lying entirely upon the advocates of this doctrine, it may be left to their mature reflections.
It entered into my original plan to treat of the doctrine relating to Psora, or itch—an almost insane conception, which I am glad to get rid of, for this is a subject one does not care to handle without gloves. I am saved this trouble, however, by finding that many of the disciples of Hahnemann, those disciples the very gospel of whose faith stands upon his word, make very light of his authority on this point, although he himself says, "it has cost me twelve years of study and research to trace out the source of this incredible number of chronic affections, to discover this great truth, which remained concealed from all my predecessors and contemporaries, to establish the basis of its demonstration, and find out, at the same time, the curative medicines that were fit to combat this hydra in all its different forms.
But, in the face of all this, the following remarks are made by Wolff, of Dresden, whose essays, according to the editor of the "Homoeopathic Examiner," "represent the opinions of a large majority of Hornoeopathists in Europe."
"It cannot be unknown to any one at all familiar with Homoeopathic literature, that Hahnemann's idea of tracing the large majority of chronic diseases to actual itch has met with the greatest opposition from Homoeopathic physicians themselves." And again, "If the Psoric theory has led to no proper schism, the reason is to be found in the fact that it is almost without any influence in practice."
We are told by Jahr, that Dr. Griesselich, "Surgeon to the Grand Duke of Baden," and a "distinguished" Homoeopathist, actually asked Hahnemann for the proof that chronic diseases, such as dropsy, for instance, never arise from any other cause than itch; and that, according to common report, the venerable sage was highly incensed (forct courroucé) with Dr. Hartmann, of Leipsic, another "distinguished" Homoeopathist, for maintaining that they certainly did arise from other causes.
And Dr. Fielitz, in the "Homoeopathic: Gazette" of Leipsic, after saying, in a good-natured way, that Psora is the Devil in medicine, and that physicians are divided on this point into diabolists and exorcists, declares that, according to a remark of Hahnemann, the whole civilized world is affected with Psora. I must therefore disappoint any advocate of Hahnemann who may honor me with his presence, by not attacking a doctrine on which some of the disciples of his creed would be very happy to have its adversaries waste their time and strength. I will not meddle with this excrescence, which, though often used in time of peace, would be dropped, like the limb of a shell-fish, the moment it was assailed; time is too precious, and the harvest of living extravagances nods too heavily to my sickle, that I should blunt it upon straw and stubble.
This article was posted on March 26, 1999.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Studio osservazionale sulla qualità della vita di pazienti cefalalgici in trattamento omeopatico Ven 25 Set 2009 - 6:34|| |
Studio osservazionale sulla qualità della vita di pazienti cefalalgici in trattamento omeopatico
Gennaro Muscari Tomaioli(1)(2), Federico Allegri(1), Elvino Miali(1), Raffaella Pomposelli(2)(3), Pierluigi Tubia(1)(2) , Alessandro Targhetta(1), Maurizio Castellini(2) e Paolo Bellavite(4)
(1) Gruppo di studio sulle Medicine Non Convenzionali presso l’Ordine dei Medici Ch.O. di Venezia
(2) Scuola di Medicina Omeopatica, Verona
(3) Associazione Omeopatica Belladonna, Milano
(4) Osservatorio Medicine Complementari, Dipartimento di Scienze Morfologico Biomediche e Azienda Ospedaliera, Verona
I medici omeopatici sostengono che l’omeopatia sia una terapia efficace. Migliaia di pazienti dichiarano che con l’omeopatia la loro salute è migliorata o la loro malattia è stata curata. Eppure, gli effetti del trattamento omeopatico sono ancora oggetto di discussione nel mondo della ricerca biomedica, perché sono stati condotti pochi studi secondo metodologie accettate nella medicina convenzionale. Secondo alcuni, l’omeopatia non sarebbe affrontabile secondo i criteri comunemente usati nella medicina moderna. Proprio per questo, il Parlamento Europeo nel 1993 ha approvato una risoluzione che ha chiesto alla Commissione Europea di esplorare le condizioni per lo studio scientifico dell’omeopatia. L’iniziativa, presa dal Direttorato Generale XII (Scienza, Ricerca e Sviluppo) ha portato alla costituzione di un Gruppo di Esperti, chiamato Homeopathic Medicine Research Group (HMRG), che ha affrontato proprio la questione della qualità della ricerca scientifica in omeopatia. Tale gruppo ha pubblicato vari documenti, tra cui una relazione finale, la cui principale conclusione è proprio che l’omeopatia è studiabile scientificamente, anche se con una sua propria specificità (1). Questo concetto è in accordo con altre recenti rassegne sulle basi scientifiche dell'omeopatia (2, 3).
I metodi di ricerca clinica si possono distinguere in modo schematico in due categorie. Esistono gli studi sperimentali, in cui i trattamenti e la scelta del campione sono decisi e controllati dallo sperimentatore in funzione della questione che si vuole investigare e gli studi non sperimentali (o osservazionali), in cui il trattamento e la scelta del campione non sono determinati o sono solo in piccola parte determinati dalle intenzioni del ricercatore (ad esempio quando si studia la pratica clinica reale in un ambulatorio o quando si fanno studi epidemiologici in una certa popolazione esposta ad un rischio ambientale). Se è vero che gli studi sperimentali sono più affidabili per stabilire l'efficacia di un determinato medicinale (soprattutto se eseguiti con un gruppo di controllo che assume il placebo, costituito mediante adeguata randomizzazione), è anche vero che gli studi osservazionali hanno il vantaggio di rispettare più facilmente le reali condizioni in cui una terapia complessa come quella omeopatica si svolge. Di solito, gli studi controllati e randomizzati sono preceduti da studi osservazionali per stabilire in via preliminare se un certo trattamento merita di essere studiato più approfonditamente ed in modo sperimentale.
Un altro aspetto importante da considerare è il maggior valore che viene assegnato agli studi osservazionali prospettici rispetto a quelli retrospettivi. Nel primo caso, infatti, è possibile valutare con maggiore precisione ed attendibilità il numero di casi arruolati e i drop-outs (pazienti che per ragioni note o ignote lasciano lo studio).
Il presente lavoro descrive i primi risultati di uno studio osservazionale prospettico nel campo del trattamento omeopatico di pazienti con cefalea. Si tratta di uno studio che ha come scopo la valutazione - mediante appositi questionari - dei cambiamenti nella qualità di vita e nella sintomatologia in pazienti cefalalgici trattati ambulatorialmente da medici qualificati in omeopatia. Il protocollo è stato messo a punto e viene eseguito da un gruppo di medici omeopati, per la maggior parte docenti alla Scuola di Medicina Omeopatica di Verona, in collaborazione con l’Ordine dei Medici Ch.O. di Venezia e con l’Osservatorio per le Medicine Complementari (OMC) attivato a Verona nel 1999 per iniziativa dell’Università e dell’Ordine dei Medici Ch.O.
La specificità del problema omeopatico sta essenzialmente nei seguenti aspetti: a) il medico deve porre attenzione alla globalità della persona del paziente; la prescrizione richiede molta esperienza e non può essere fatta in modo “automatico” sulla base di una diagnosi nosologica; b) il “medicinale” è una sostanza data in dosi molto basse o addirittura infinitesimali, i cui effetti terapeutici si presumono da sperimentazioni su soggetti sani (“provings”); c) la scelta del rimedio si basa sulla “presa del caso” (anamnesi) di tipo omeopatico; d) nella metodologia omeopatica è prevista di solito una “seconda prescrizione” sulla base degli effetti riscontrati nella prima; e) l'effetto della terapia omeopatica deve essere valutato non solo a riguardo del sintomo principale che di solito ha portato il paziente dal medico, ma anche a riguardo della sua "qualità di vita": al limite, potrebbe essere possibile che dopo la terapia non si attenui un sintomo come il dolore, ma aumenti la capacità di sopportarlo e si riduca l'impatto dello stesso sintomo sulla vita quotidiana.
Proprio per tali specificità il risultato di uno studio clinico in omeopatia richiede di essere valutato mediante strumenti che esaminino il maggior numero di variabili riguardanti la salute nella sua globalità. A tale scopo si è ritenuto opportuno effettuare la misurazione dello stato di salute mediante risposte standardizzate a domande standardizzate (questionari), un metodo efficiente e di crescente diffusione. Tuttavia, è necessario utilizzare strumenti che siano comprensibili, attendibili sul piano psicometrico oltre che corporeo e siano brevi in modo da consentirne l’utilizzo in un contesto ambulatoriale. Adottando in questa ricerca il questionario SF-36, già validato in campo convenzionale (4, 5, 6, 7,
, si è inteso rispettare sia le necessità di una documentazione quanto possibile obiettiva e completa dell’evoluzione clinica e psicologica, sia le peculiarità della terapia omeopatica. Un altro obiettivo dello studio è quello di valutare la applicabilità di un sistema di monitoraggio dei risultati delle cure applicate a livello ambulatoriale e di medicina di base.
Si è previsto di effettuare lo studio con la raccolta di almeno 50 casi da parte di un gruppo di medici omeopati che utilizzano il metodo classico (unicista) di prescrizione del rimedio omeopatico e alte diluizioni/dinamizzazioni di medicinali. Quest’ultimo punto è particolarmente importante alla luce delle implicazioni etiche e normative che comporta, perché l’uso di alte diluizioni, oltre ad essere coerente con la metodologia omeopatica unicista più diffusa, elimina ogni possibilità di effetti di tossicità. I medicinali utilizzati in questo studio fanno parte di quelli attualmente autorizzati ai sensi del D. L.vo 185/1995 integrato dalla Legge 347/1997, che disciplinano la materia.
Tipo di studio e criteri di inclusione
Si tratta di uno studio di tipo osservazionale prospettico, comprendente una valutazione all’inizio della terapia (prima visita) ed una valutazione dopo 4-6 mesi (indipendentemente dal numero di visite che sono state eventualmente effettuate nel frattempo). Il risultato viene valutato in base al confronto dei dati clinici e sintomatologici delle valutazioni prima e dopo la cura utilizzando il questionario per la qualità della vita SF-36 (outcome).
Criteri di inclusione: pazienti di entrambi i sessi, di età dai 15 ai 65 anni, con diagnosi - da almeno due anni - di cefalea tensiva cronica o di emicrania senza aura apparente, presentanti almeno due episodi al mese negli ultimi 6 mesi.
Criteri di esclusione: sindromi dolorose al capo secondarie ad altre patologie, alta probabilità di compliance insufficiente nella cura omeopatica o nella compilazione dei questionari per problemi psichici o caratteriali.
Tempi e sedi dello studio
La ricerca è stata eseguita eseguita dal giugno 1999 al dicembre 2000 presso gli studi professionali privati dei medici partecipanti (autori di questo lavoro, eccetto P.B.), situati in varie città del Veneto e Lombardia. La documentazione veniva inviata, in modo prospettico (v. Protocollo) al Prof. Paolo Bellavite dell’Osservatorio Medicine Complementari (OMC) (Dipartimento di Scienze Morfologico Biomediche e Azienda Ospedaliera, Verona), sede di custodia dei questionari e di elaborazione dei dati. L’OMC è sorto per iniziativa dell’Università di Verona e dell’Ordine dei Medici Chirurghi e degli Odontoiatri della Provincia di Verona.
Metodo di scelta del medicinale
Secondo il metodo omeopatico, l'obiettivo della cura è la totalità della persona e solo secondariamente la cura delle malattie a livello organico. Una corretta metodologia usata nella raccolta e nella elaborazione dei sintomi detti dal paziente e dei segni che il medico osserva, è essenziale per la scelta del medicinale omeopatico. A livello operativo, si elencano i seguenti parametri fondamentali:
La prescrizione omeopatica deriva da una profonda relazione fra il medico ed il paziente. Il medico omeopata visita il paziente con le scadenze che ritiene più opportune (incluse ovviamente la visita dopo 6 mesi e quella dopo 12 mesi). Egli è inoltre disponibile per chiamate telefoniche per eventuali consigli urgenti. I sintomi scelti (sintomi omeopatici) devono riflettere la peculiarità di espressione del paziente rispetto alla sua situazione patologica, piuttosto che i sintomi tipici della sua patologia. Per esempio, un paziente soffre di cefalea, e presenta contemporaneamente due sintomi (1. la cefalea è migliorata dal riposo, 2. la cefalea peggiora bevendo la birra), il medico omeopata darà importanza soprattutto al secondo sintomo, in quanto peculiare di quel paziente e non condiviso dalla maggioranza dei pazienti che soffrono di cefalea (viceversa, il miglioramento col riposo è molto più comune fra chi soffre di cefalea). La corretta prescrizione omeopatica richiede l’uso del repertorio (raccolta sistematica dei sintomi omeopatici). È preferibile (anche se non obbligatorio) l’uso di un repertorio informatizzato, che permette una più facile sistematizzazione dei sintomi. I sintomi omeopatici così raccolti non devono, come numero, essere né toppo pochi (indicativamente inferiori a tre) né troppi (massimo otto-dieci, ma molto dipende anche dal caso individuale). Non è infatti tecnicamente possibile ricavare una rosa di medicinali omeopatici fra cui scegliere il medicamento appropriato, se non si hanno almeno tre sintomi omeopatici. Viceversa, una scelta del medicinale fatta con troppi sintomi implicherebbe l’incapacità di scegliere, nel caso specifico, i sintomi più caratterizzanti dal punto di vista della similitudine omeopatica, necessari per la prescrizione corretta. Il medico omeopata dà la preferenza, nella scelta dei sintomi a quelli: a) espressi con intensità e nettezza da parte del paziente, b) presenti nel paziente sia al momento della visita, sia nei mesi o negli anni precedenti (sintomi storici). Una volta raccolti i sintomi omeopatici, il medico omeopata, tramite la repertorizzazione, ottiene una rosa di alcuni medicinali omeopatici che presentano i sintomi da lui scelti. Fra i medicinali candidati, espressi dalla repertorizzazione, il medico effettua la prescrizione di un solo medicinale confrontando l’insieme dei sintomi e dei segni presentati dal paziente (sintomi e segni omeopatici + sintomi e segni comuni alla patologia) con l’insieme dei sintomi prodotti dai diversi medicinali candidati nei testi che descrivono l’azione dei medicinali omeopatici (materie mediche omeopatiche). Il medicinale prescritto è quello che: a) in base alla repertorizzazione presenta la maggiore similitudine come sintomi (sia come frequenza,sia come intensità) rispetto a quelli presentati dal paziente, b) è caratterizzato da un quadro, ricavato dalle materie mediche , il più simile possibile rispetto alla totalità dei sintomi del paziente (sintomi omeopatici + sintomi tipici della patologia). Quanto alle diluizioni/dinamizzazioni dei medicinali omeopatici ed alle posologie, esse sono lasciate alla scelta del medico omeopata in relazione alla valutazione omeopatica del decorso clinico, ma sono comunque in diluizioni/dinamizzazioni uguali o superiori alla 30 centesimale. Nel follow-up del caso, l’eventuale apparire di nuovi sintomi viene giudicato nella medicina omeopatica secondo le categorie sinteticamente espresse dal cosiddetto principio di Hering: “la guarigione procede dall’alto in basso, dall’interno all’esterno, dagli organi più importanti a quelli meno importanti, e nell’ordine temporale inverso di apparizione dei sintomi” (9).
L’SF-36 comprende 36 domande che esplorano molti aspetti della salute psichica, fisica e relazionale (vedi risultati). Le risposte a tali domande sono poi elaborate in modo da rappresentare dei punteggi (da 0 a 100) che rappresentano otto diversi concetti (o dimensioni) relativi alla salute: Attività fisica, Ruolo e salute fisica, Attività sociali, Limitazioni di ruolo dovute alla salute fisica, Limitazioni di ruolo dovute allo stato emotivo, Salute mentale, Vitalità, Dolore fisico, Salute in generale. Bisogna sottolineare il fatto che le domande nella maggior parte dei casi si riferiscono ai sintomi o alle sensazioni provati nelle ultime 4 settimane precedenti alla compilazione del questionario. C’è poi una domanda relativa alla percezione del cambiamento dello stato di salute rispetto all’anno precedente. La tabella 1 riassume i principali concetti e le scale dell’SF-36 (10, 11). In essa sono anche riportati i concetti espressi nella versione originale americana. In base ai parametri espressi in tale elenco è evidente che si tratta di uno strumento adeguato alla valutazione dell’evoluzione di malattie croniche e del loro impatto su vari aspetti della qualità della vita. Una volta compilato, il questionario è subito inviato all’OMC, che lo acquisisce agli atti e vi attribuisce un numero progressivo. Ciò garantisce che i risultati siano riportati in riferimento a tutti i pazienti reclutati e che si possa calcolare esattamente il numero dei drop-outs.
Il paziente viene visitato dal medico, che effettua la diagnosi e valuta l’eleggibilità. Il paziente, dopo essere stato informato sulle caratteristiche della terapia omeopatica e dello studio, se lo crede dà il consenso scritto alla terapia ed al trattamento dei dati personali a fini di ricerca. Egli riceve un questionario, comprendente le domande del SF-36. Egli lo compila secondo istruzioni date oralmente e riportate anche su un apposito foglietto. In particolare, in tale foglietto al paziente viene spiegato: a) che si deve sentire libera/o di rispondere sinceramente e obiettivamente a tutte le domande, b) che i dati saranno trattati in modo assolutamente anonimo e codificato da osservatori indipendenti, c) che le risposte non avranno nessuna influenza sul tipo di assistenza da parte del medico, d) che il questionario deve essere compilato in ogni sua parte e che nel caso che fosse incerta/o su qualche risposta, non segni due caselle ma solo una, quella che comunque sembra la più vicina alla realtà. Solo se necessario e su sua esplicita richiesta, il paziente può essere assistito dal medico nella compilazione del questionario.
Il medico presenta al paziente il questionario seguendo le seguenti indicazioni: a) La proposta di partecipazione allo studio dovrebbe essere fatta a tutti i pazienti indistintamente che rispettino i criteri di inclusione, senza cioè effettuare una scelta a priori (quale ad esempio quella di includere solo i pazienti in cui si pensa di aver trovato il rimedio giusto), b) il paziente deve compilare i questionari da solo e dovrebbe per questo avere uno spazio a disposizione, c) solo in caso di reale incapacità a comprendere il significato di qualche domanda, il paziente può chiedere spiegazioni, che gli devono essere date per compilare i questionari, senza in alcun modo influenzare la scelta d) nella seconda visita, il paziente non deve aver copia del primo questionario (altrimenti ciò potrebbe influenzare le risposte nel secondo), e) una volta riconsegnati i questionari e prima che il paziente lasci lo studio, il medico li controlla rapidamente per vedere che non vi siano omissioni e che siano firmati, f) i questionari compilati male e che perciò indicano una incapacità del paziente a comprendere le domande o a compilare i questionari stessi devono comunque essere inviati all’OMC, scrivendo chiaramente nel frontespizio la parola “annullato”. I questionari e i moduli di consenso informato devono essere subito (entro pochi giorni) inviati all’OMC. Il medico deve registrare su apposita scheda i medicinali prescritti ad ogni visita ed accertarsi, nella visita successiva, se il paziente ha seguito le indicazioni terapeutiche.
Dopo 4-6 mesi (idealmente 5 mesi), quando il paziente torna per un controllo, dopo la normale visita gli si dà un nuovo questionario identico al primo (questa volta non è necessario compilare il consenso informato), che deve essere compilato autonomamente, con le stesse modalità del primo (vedi sopra). Nel caso che il paziente non si presentasse spontaneamente nel periodo che va dai 4 ai 6 mesi dopo la prima visita, 10 giorni prima dello scadere dei 6 mesi bisogna assolutamente contattarlo (telefonicamente o per lettera), invitandolo a venire almeno a compilare il questionario. Il secondo questionario, con lo stesso codice del primo, deve essere inviato all’indirizzo sopra riportato, assieme alle notizie sulla terapia che il medico ha raccolto nel corso delle visite precedenti e dell’ultima fatta.
Il rimedio omeopatico e la sua posologia non erano predeterminati, ma venivano adattati al singolo paziente secondo la metodologia omeopatica unicista. Si stabilisce che la diluizione/dinamizzazione utilizzata sia media o alta, comunque superiore alla diluizione - dinamizzazione (“potenza” secondo la dizione omeopatica) corrispondente al numero di Avogadro, cioè la 12 CH. Dei rimedi prescritti, delle posologie e delle date della loro prescrizione tiene apposito registro il medico omeopata, che consegna copia all’OMC assieme all’ultimo questionario. È consentito ai pazienti di assumere qualsiasi altro farmaco antidolorifico, che deve essere comunque dichiarato al medico curante.
Dopo un periodo di trattamento di 4-6 mesi (che può richiedere più visite intercorrenti ed anche il cambiamento della prescrizione omeopatica), quando i pazienti si ripresentano per il controllo, essi sono invitati a compilare un secondo questionario SF-36, con le stesse modalità del precedente e che viene anch’esso subito inviato all’OMC, dove si procede alla raccolta ed all’elaborazione dei dati.
Ultima modifica di Admin il Ven 25 Set 2009 - 6:35, modificato 1 volta
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Ven 25 Set 2009 - 6:34|| |
Calcoli dei punteggi e statistica
I punteggi globali delle 8 dimensioni della qualità della vita sono stati calcolati come indicato dagli Autori del questionario (10, 11). In breve, le scale di ogni domanda sono state invertite quando il valore di migliore salute era quello indicato da un punteggio minimo, si sono riuniti i punteggi di diverse domande con significato simile e si è infine ricalcolato il punteggio totale in base all’intervallo (v. tabella 1) tra il minimo punteggio possibile (posto uguale a 0) ed il massimo posto uguale a 100. Tutte le operazioni sono state effettuate con un algoritmo impostato nel software “Stata”. Poiché in molte domande la distribuzione delle risposte non era normale, le differenze tra prima e dopo la terapia sono state calcolate con un test non parametrico e precisamente col test dei ranghi col segno (test di Wilcoxon) per dati appaiati (pre-post terapia) (12, 13).
Nel corso dello studio sono stati reclutati 53 pazienti e l’OMC ha ricevuto le prime schede di tutti i pazienti reclutati. Cinque pazienti non hanno completato la terapia per ragioni sconosciute e non sono stati più rintracciabili al fine di compilare il secondo questionario. I casi comprendenti almeno due questionari (prima della terapia e dopo un periodo di osservazione indicativamente di 5 mesi) sono stati quindi 48. Di questi, l’OMC ha giudicato non valutabili i seguenti casi: 6 in quanto i due questionari (pre-post) recavano la stessa data ed erano stati compilati in occasione della seconda visita (il primo questionario era quindi compilato retrospettivamente (è opportuno notare che in questi casi il risultato della terapia era giudicato buono sia dal paziente che dal medico curante), uno per aver sospeso l’assunzione del medicinale a causa della gravidanza, uno per aver inviato un questionario largamente incompleto, uno per essere di età inferiore al minimo compreso nei criteri di inclusione. In totale i casi completi e valutabili sono stati 39, 31 femmine e 8 maschi, di età media di 37.1 ± 13.5 anni (range: 16-66). Il periodo di trattamento medio, cioè l’intervallo di tempo tra il primo ed il secondo questionario, è stato di 4.9 ± 2.9 mesi (range: 1-15). Qualche paziente ha mancato di dare tutte le risposte lasciando di tanto in tanto qualche domanda senza risposta. Nel caso si sia trattato di casi sporadici (1-3 per questionario) si è proceduto ugualmente alla valutazione del questionario.
I medicinali utilizzati come prima scelta sono stati i seguenti: 4 casi Natrum muriaticum, 3 casi Staphysagria e Nux vomica, 2 casi Pulsatilla, Arsenicum album, Lycopodium, Lachesis, Stramonium, Sepia e Ignatia, 1 caso Nux moscata, Sulphur, Helleborus niger, Conium maculatum, Lac caninum, Thuya occidentalis, Sabadilla, Phosphorus, Arnica, China, Calcarea sulfurica, Bryonia, Carbo vegetabilis, Tuberculinum, Carcinosinum. In 8 casi è stato cambiato il medicinale nel corso della terapia e precisamente: Carbo vegetabilis dopo Nux moscata, Natrum muriaticum dopo Lycopodium, Sepia dopo Pulsatilla, Chelidonium dopo Nux vomica, Phosphoric acidum dopo Lachesis, Pulsatilla dopo China e Pulsatilla dopo Nux vomica.
L’SF-36 consta di 11 questioni principali, alcune delle quali suddivise in sotto-problemi, volte ad esplorare molti aspetti della vita quotidiana del paziente oltre che i suoi sintomi. L’utilizzo da parte di pazienti è stato piuttosto semplice e gradito, ha richiesto dai dieci minuti a mezz’ora e solo in un caso il paziente si è rifiutato di compilarlo. Molti soggetti (oltre il 50 %) hanno chiesto alcune delucidazioni al medico o al personale assistente dello studio medico in merito al significato di alcune domande ed alle modalità di compilazione.
Le 11 questioni principali del SF-36
Qui si descrivono analiticamente i risultati delle diverse questioni poste e poi si presentano i risultati sotto forma di punteggi ricalcolati in forma statistica. La questione n. 1, riguardante la salute in generale (Figura 1, pannello superiore) ha evidenziato un netto e significativo miglioramento dello stato post-terapia rispetto a quello pre-terapia. Per quanto la mediana dei pazienti (19 su 39) si riferisce sempre ad una salute giudicata “buona”, il numero dei casi che ha dichiarato di avere una salute scadente è passato da 10 a 3, mentre quelli che hanno dichiarato una salute “molto buona” è passato da 0 a 7. La questione n. 2, riguardante una valutazione soggettiva generale della propria salute rispetto all'anno precedente (Figura 1, pannello inferiore) ha evidenziato un chiaro spostamento dei giudizi verso le condizioni di salute migliore dopo la terapia.
La figura 2 riporta un'analisi molto dettagliata della qualità della vita per ciò che riguarda le capacità di svolgere attività fisiche usuali, secondo diversi parametri proposti dal questionario SF-36 (questione 3). Alla domanda "La Sua salute La limita attualmente nello svolgimento di attività di tipo fisico?" i pazienti hanno risposto evidenziando un miglioramento nel periodo post-terapia, soprattutto negli sforzi più impegnativi o di moderato impegno fisico. Il fatto che le risposte siano graduate sulla base di crescenti impegni fisici (e questo sia pre- che post-terapia) indica che il test è "dose-dipendente", quindi sensibile ed adatto alla valutazione quantitativa di questi parametri. Nel complesso, si vede che la popolazione di pazienti studiati anche prima della terapia è in discrete condizioni fisiche, se si considera che la maggior parte di essi dichiara di non avere problemi a svolgere le attività richieste. Ciò pare coerente con i criteri di inclusione e con l’età media della popolazione studiata.
Anche se la forza fisica (figura 2) e le condizioni generali di salute (figura 1) si possono definire discrete o buone, la salute fisica ha ugualmente causato problemi sul lavoro e nelle altre attività sociali (questione 4, figura 3). In particolare, la maggior parte i pazienti si sono lamentati di “problemi sul lavoro” e di aver “reso meno di quanto voluto”. Il numero di pazienti lamentantisi di tali problemi si è notevolmente ridotto dopo la terapia (rispettivamente da 31 a 13 e da 30 a 16). Anche l’impatto dello stato emotivo sul lavoro (questione 5, figura 4) è notevolmente diminuito dopo la terapia.
La domanda n. 6 del questionario verte sul grado con cui i problemi di salute (sia fisici che psicologici) hanno limitato le normali attività sociali. La figura 5 mostra che i pazienti con cefalea sono disturbati (da “molto” a “un po’) in questo importante parametro della qualità della vita. Dopo il periodo di terapia sono nettamente diminuiti (da 10 a 2) i pazienti che dichiarano che lamentano “molto” tale problema mentre sono nettamente aumentati quelli che non lo lamentano affatto (da 4 a 11).
I risultati riguardanti il dolore fisico (questioni 7 e
sono particolarmente significativi, in quanto si tratta del sintomo principale che ha condotto il paziente dal medico. Anche se il questionario non è stato disegnato per un preciso tipo o localizzazione del sintomo, è evidente che nella popolazione in studio il dolore si riferisce a quello cefalalgico. Solo in un caso il medico ha segnalato che si trattava di un paziente con neoplasie che è peggiorato nel corso del periodo di osservazione (tale caso è stato ugualmente inserito nella valutazione in quanto la neoplasia non era criterio di esclusione). Dalla distribuzione dei dati sul dolore fisico (figura 6 pannello superiore) si vede che il picco massimo si sposta decisamente da “moderato-forte” a “lieve-molto lieve”. Il grado di interferenza del dolore col lavoro e le altre attività quotidiane (figura 6 pannello inferiore) è diminuito dopo la cura omeopatica ed una buona percentuale dei casi ha dichiarato che esso ha interferito “molto poco” o “per nulla”.
La questione n. 9 del SF-36 comprende ben 9 diverse sotto-questioni che esplorano sia la “vitalità” (“vitality” nell’originale americano) intesa come vivacità ed energia, sia la salute psicologica ed il benessere. Nella figura 7 sono raccolti i dati sulla vitalità che mostrano un miglioramento dopo la terapia soprattutto come riduzione del numero di persone che si sentiva “sfinito” (il picco si sposta decisamente da “parte del tempo” a “quasi mai”). Anche gli altri parametri denotano un miglioramento a seguito della terapia, ma non in modo così deciso da spostare i picco mediano. Nella figura 8 si osserva che alcuni parametri come “sentirsi agitato” e soprattutto “sentirsi molto giù di morale” hanno registrato un netto miglioramento nel confronto tra dopo e prima della terapia, mentre altri che si riferiscono a sensazioni come la “calma”, “serenità”, “tristezza” o “felicità” hanno mostrato solo un lieve miglioramento. Ovviamente, questo tipo di osservazioni - che denotano anche la accuratezza del questionario nel discriminare diversi concetti relativi alla salute mentale - sono molto importanti da un punto di vista omeopatico per la definizione tipologica e patogenetica.
In risposta alla questione n. 10 del SF-36, gran parte dei pazienti con cefalea (26/39) riferiscono che i loro problemi di salute nelle ultime quattro settimane hanno interferito “in parte” con le normali attività sociali (figura 9); dopo la terapia il gruppo più consistente (17/39) riporta che tale problema non si è presentato “quasi mai”.
L’ultima serie di domande del questionario riguardano un ulteriore approfondimento sul giudizio soggettivo del proprio stato di salute (figura 10). Le risposte a queste domande denotano un notevole grado di incertezza, distribuendosi prevalentemente (sia prima sia dopo la terapia) tra le scelte “parzialmente vero”,”non so” e “parzialmente falso”. L’unica eccezione significativa sta nel fatto che dopo la terapia molti pazienti (19/39) considerano falsa la affermazione secondo cui si ammalerebbero più facilmente degli altri e ciò è in accordo col trend verso il miglioramento riscontrato nelle altre questioni.
Le 8 dimensioni della qualità della vita
L’elaborazione dei punteggi SF-36 secondo le regole codificate dalla letteratura internazionale consente di ridurre tutta la serie di questioni a 8 dimensioni fondamentali, con il notevole vantaggio che i punteggi in tal modo vengono anche standardizzati in scale numeriche da un minimo di 0 (salute pessima) a 100 (salute ottimale), scale che consentono valutazioni statistiche quantitative. In generale, i risultati dei calcoli (tabella 2) confermano in modo quantitativo le impressioni derivate dalla osservazione dei dati grezzi delle singole questioni. Si vede che i punteggi medi delle dimensioni dei pazienti prima della terapia sono molto bassi per ciò che concerne soprattutto il dolore (35.5/100) e le “limitazioni di ruolo”, sia per problemi fisici sia per lo stato emotivo (rispettivamente 32.9/100 e 35.0/100). La capacità fisica generale è invece buona (come già notato in modo semi-quantitativo nei dati riportati in figura 2). In generale, quindi, la popolazione è caratterizzata da una discreta-buona attività fisica, da sufficiente salute mentale e sufficiente salute in generale, ma da marcata sofferenza dovuta al dolore per la cefalea ed alle limitazioni che tale condizione comporta. Dopo la terapia tutti i punteggi si sono alzati e particolarmente eclatanti sono quelli relativi alle limitazioni di ruolo (passate a 65.8/100 e 66.6/100 per le limitazioni da salute fisica e psichica rispettivamente). Si nota anche che le deviazioni standard dalla media e le differenze inter-percentili sono alte, indicando che esiste eterogeneità nelle risposte (pazienti in pessime condizioni ed altri con scarsi disturbi). Anche nei cambiamenti delle mediane dopo la terapia in grande evidenza sono il miglioramento del dolore e la riduzione dell'impedimento causato dallo stesso dolore.
La tabella 2 riporta anche il numero dei pazienti che sono migliorati, peggiorati o rimasti uguali nel confronto prima-dopo la terapia. Più del 70% dei casi sono migliorati in riferimento al dolore, alle limitazioni nelle attività sociali e alla salute in generale. Tutte le differenze per/post sono altamente significative (p< 0.002) con la massima significatività nel parametro “dolore fisico” (p<0.0001), tranne quelle relative alla attività fisica che raggiungono per poco la significatività (p = 0.02). Ovviamente, la differenza nelle limitazioni della attività fisica è piccola perché le condizioni di partenza erano già discrete o buone (punteggio 80.2/100).
La figura 11 riassume graficamente i risultati delle 8 dimensioni del questionario, confrontandoli con dei valori di riferimento. I valori normali sono quelli di un campione rappresentativo di popolazione di italiani adulti (2031 soggetti scelti a caso dalle liste elettorali) (7). Si conferma visivamente l’ottimo risultato ottenuto durante il periodo di osservazione per ciò che riguarda l’insieme dei parametri di qualità della vita. La massima differenza pre-post terapia riguarda i ruoli sociali e il dolore. Dopo la terapia rimangono delle differenze rispetto alla media dei controlli in quasi tutti i parametri, tranne la attività fisica, la salute mentale e la salute generale, parametri che si possono verosimilmente considerare come rientrati nella normalità, pur tenendo conto che la comparazione col gruppo di riferimento è puramente indicativa.
La ricerca clinica ha l’obiettivo di investigare i cambiamenti nello stato di salute, di malattia e di guarigione in rapporto a vari tipi di trattamento nell’essere umano malato. Le ricerche cliniche coprono un ampio spettro di argomenti e di metodi, che differiscono in base ai problemi affrontati, agli obiettivi e alle questioni etiche implicate. L’oggetto della ricerca clinica è di solito l’effetto di varie misure terapeutiche o di altri interventi che possono influenzare lo stato di salute. Vi sono interventi consistenti nella somministrazione di specifici farmaci, mentre altri consistono in strategie terapeutiche più complesse, misure preventive, variazioni dietetiche, cambiamenti comportamentali o ambientali ecc. Vi sono anche diverse questioni che possono essere affrontate in una ricerca clinica. Ad esempio, quando si sviluppa una nuova medicina, si dovrà chiedersi quali sono: il giusto dosaggio, gli effetti secondari, la farmacocinetica, l’efficacia clinica, la via ottimale di somministrazione, e così via. Vi sono questioni molto limitate riguardanti ad esempio l’efficacia di un farmaco in una precisa situazione clinica ed altre più generali che esplorano una serie di variabili su un’ampia casistica (screening), in modo da generare successivamente delle ipotesi circostanziate per ricerche successive.
Tra i più importanti sviluppi della ricerca clinico-epidemiologica nel campo sanitario negli ultimi 10-15 anni c’è un crescente consenso sulla centralità del giudizio dei pazienti nel monitoraggio dei risultati delle terapie. A nessuno sfugge la necessità di includere nell’ambito delle ricerche e degli interessi del medico la soggettività del paziente, “l’attenzione al sé” della persona, il concetto di pieno ben-essere in cui rientra anche lo star bene con se stessi. Cura della propria corporeità, efficienza e soddisfazione nel lavoro, attività ricreative e culturali assumono un ruolo sempre più importante nella nuova concezione della salute. La malattia non viene quindi più vista solo come danno biochimico-anatomico funzionale di un certo organo, ma come fenomeno complesso che interferisce a vari livelli con l’integrità psicosomatica del soggetto. Altro fondamentale aspetto della medicina del terzo millennio è il superamento di un certo paternalismo medico ancora persistente. Il malato di oggi, e sempre più quello di domani, desidera essere valorizzato nella sua competenza e capacità decisionale. Vuole essere informato adeguatamente e decidere consapevolmente. In questo contesto si possono inquadrare i nuovi sviluppi delle medicine complementari - tra le quali l’omeopatia assume particolare rilevanza quantitativa - le quali oggi godono del favore del pubblico molto di più che del credito da parte delle Istituzioni sanitarie ed accademiche. Tale discrepanza è dovuta a molte ragioni che risalgono alla storia della medicina degli ultimi secoli ma che si riconducono essenzialmente alla scarsità di ricerche cliniche e particolarmente di ricerche condotte con metodi condivisi da tutti.
Benché l’omeopatia sia una medicina prevalentemente empirica e molta ricerca sia stata fatta negli ultimi duecento anni, resta ancora senza una risposta definitiva sia la domanda a riguardo della portata dell’efficacia clinica dell’omeopatia (e dei suoi vari approcci), sia la domanda sui suoi possibili meccanismi d’azione. Infatti, da una parte (efficacia clinica) le ricerche condotte secondo criteri metodologicamente inoppugnabili sono poche e i loro risultati non univoci, dall’altra (meccanismo d’azione) si sono aperti molti problemi più di quelli che le sperimentazioni abbiano potuto chiarire.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Ven 25 Set 2009 - 6:35|| |
La difficoltà principale che interessa la ricerca in omeopatia sta nel fatto che questa materia è un approccio complesso, con molte componenti. Non si tratta di studiare un farmaco in una patologia, perché il “rimedio” è considerato parte di una metodologia elaborata che implica la comprensione da parte del medico della “globalità” del paziente e del possibile effetto del rimedio (spesso ancora non del tutto esplorato dalle stesse sperimentazioni omeopatiche). Tuttavia, questo non è un impedimento assoluto alla ricerca clinica in omeopatia, è solo una condizione di cui si deve tenere conto nel disegnare appropriati studi.
Sul piano storico ed epistemologico, è in corso un importante dibattito su un punto-chiave: quali sono i criteri di evidenza sufficienti per validare una medicina? I dati ottenuti secondo i più rigorosi metodi di trials clinici sarebbero fondamentali ed auspicabili, ma non possono da soli costituire la validazione di una medicina o di un sistema terapeutico. Se si accettasse il principio che è richiesta un'evidenza scientifica incontrovertibile prima di giudicare come valida una medicina, si rischierebbe una “paralisi terapeutica”, in quanto la maggior parte delle conoscenze e delle procedure, anche della medicina convenzionale, non è stata provata a livello di trials clinici e di quei criteri ancor più rigorosi fissati dalle meta-analisi. L'esperienza clinica dei medici ed il “gradimento” della popolazione in un certo periodo storico costituiscono altri criteri fondamentali per affermare che una medicina ha o no delle “evidenze”, quanto meno riguardo alla sua effettività ed efficienza. D’altra parte, anche in alcuni ambiti della medicina convenzionale sono evidenziati i limiti della metodologia basata sulla sperimentazione clinica randomizzata ed in doppio cieco, soprattutto per terapie in corso di malattie croniche.
In discipline complesse come quelle qui considerate dovrebbero essere rivalutati e valorizzati anche gli studi epidemiologici di tipo osservazionale. Gli studi osservazionali hanno il grande pregio di poter essere condotti con relativa facilità in condizioni che rispettano totalmente la pratica reale di una certa medicina. Se ben disegnati, possono fornire moltissime utili informazioni sia per migliorare tale pratica, sia eventualmente per impostare gli studi sperimentali. Un approccio di questo tipo, quindi, potrebbe colmare la distanza tra i risultati delle sperimentazioni cliniche e le decisioni terapeutiche del singolo medico che invece spesso si basano sull’esperienza personale o su “abitudini” consolidate.
In particolare, quando gli studi sperimentali non possono essere condotti (per una varietà di ragioni, da quelle etiche a quelle economiche), dei metodi osservazionali ben disegnati offrono un'ottima alternativa rispetto al non fare nessuna ricerca e non raccogliere nessuna informazione attendibile (14). Essi, inoltre, offrono la possibilità di stabilire la "validità esterna" di una determinata terapia precedentemente applicata a livello sperimentale, cioè di osservarne l'applicazione nelle reali condizioni d'impiego e per tempi anche molto più lunghi rispetto ai trials.
In questa ricerca abbiamo posto come oggetto la terapia omeopatica unicista nel campo delle cefalee, eseguita a livello di uno studio professionale, e come questione fondamentale se tale trattamento cambia lo stato di salute valutato come la qualità di vita.
Il questionario sullo stato di salute SF-36 è, attualmente, lo strumento più utilizzato nel mondo per la misurazione della qualità della vita. Esso è stato costruito sulla base di sicuri presupposti teorici e metodologici ed è il frutto della progressiva esperienza di molti centri internazionali che lo hanno elaborato. In Italia è stato accuratamente tradotto e quindi applicato in molte situazioni cliniche. Sono anche noti gli standard della popolazione.
I risultati ottenuti in questo studio osservazionale sono sicuramente positivi, anche se è opportuna una nota di cautela, perché è noto che gli studi osservazionali basati su questionari non possono, per gli intrinseci limiti metodologici (impossibilità di valutare l'andamento spontaneo della patologia, difficoltà di garantire l'obiettività nelle risposte), assicurare una certezza assoluta sull'efficacia di un determinato trattamento (sia in ambito convenzionale che complementare). Chiaramente, la mancanza di un gruppo di controllo parallelo è il limite principale di questa ricerca ed impedisce di discriminare l’efficacia della terapia dal possibile miglioramento spontaneo e/o dal correlato fenomeno detto “regressione verso la media” (per cui il paziente tenderebbe a presentarsi dal medico per la prima visita nelle fasi di massima esacerbazione dei sintomi mentre nelle visite successive sarebbe rappresentata la situazione normale della sua patologia). Tuttavia, a parziale risposta a tale obiezione, si deve considerare che i criteri di inclusione prevedevano casi con cefalea da almeno due anni e quindi con una situazione cronica la quale è stata alleviata nella maggior parte dei casi in un periodo di alcuni mesi di terapia omeopatica. In ogni caso, si è visto che il follow-up della terapia omeopatica mediante il questionario sullo stato di salute consente di documentare con sensibilità, precisione e selettività i cambiamenti che avvengono, nel modo di vivere una malattia cronica a prevalente sintomatologia algica, nel corso dei mesi.
Dovendo - per precisa scelta di metodo - rispettare la tipologia del follow-up omeopatico, che prevede sia un approfondito e spesso ripetuto colloquio col paziente, sia la possibile successione di diversi medicinali, questo studio non è stato eseguito "in cieco" e quindi non permette di rispondere alla domanda - spesso ritenuta cruciale - se il farmaco omeopatico è equivalente ad un placebo. D’altra parte, esso affronta la questione - probabilmente ancora più importante dal punto di vista pratico - del metodo di verifica dell’"effettività" di tale terapia, cioè dei suoi effetti in una comune patologia, verificandola nelle reali condizioni di applicazione della stessa.
Quanto al risultato clinico in termini di giudizio soggettivo dei pazienti, si evidenzia che il sintomo dolore si è notevolmente ridotto nel corso dei cinque mesi di osservazione in circa il 70% dei casi e ciò ha comportato un notevole miglioramento nella vita quotidiana, il lavoro e le attività sociali. Il numero dei “drop-out”, cioè dei pazienti che non hanno completato il secondo questionario (circa il 10%), è basso e sostanzialmente accettabile per una ricerca di questo tipo.
Si deve segnalare alcuni problemi emersi nella esecuzione dello studio. La prima applicazione della metodologia che utilizza i questionari a livello dell’ambulatorio privato ha comportato difficoltà di comprensione e adeguamento ai metodi sia da parte dei medici che da parte dei pazienti. Molti pazienti hanno chiesto delucidazioni su alcune domande del questionario; inoltre, in ben sei casi il secondo questionario è stato compilato contemporaneamente al primo, riferendo lo stato di sei mesi prima così come il paziente lo ricordava e denotando in questo una scarsa attenzione da parte del medico al rispetto del protocollo. Questi casi riferivano un netto miglioramento della sintomatologia dopo la cura omeopatica, ma sono stati scartati dalla elaborazione perché non conformi al protocollo.
Trattandosi di uno studio preliminare che ha lo scopo di verificare l’applicabilità della metodica in normali studi professionali di omeopati, il protocollo non ha considerato l’inclusione di un gruppo di controllo (pazienti non trattati o trattati con placebo). In uno studio successivo, grazie a questi incoraggianti risultati preliminari, si potrà procedere anche al confronto dell’effettività della cura omeopatica con l’effettività della cura convenzionale o con l’evoluzione spontanea del quadro (gruppo trattato con placebo o non trattato).
In conclusione, l’esperienza finora fatta consente di giudicare positivamente il questionario SF-36 come un valido strumento per documentare i cambiamenti che si verificano nella salute fisica e nello stato emotivo in corso di terapia omeopatica. Il lavoro finora fatto incoraggia fortemente la prosecuzione dello studio che, con un minimo di impegno da parte del medico curante, si è dimostrato fattibile anche in studi professionali privati coordinati da un osservatorio esterno e indipendente. Infine, questa esperienza preliminare può aiutare la progettazione di studi in diverse patologie e secondo altri protocolli terapeutici.
Lavoro eseguito con fondi del Ministero Università e Ricerca Scientifica (fondo 60%) e dell’A.N.I.P.R.O. (Associazione Nazionale Importatori e Produttori di Medicinali Omeopatici).
1. Cucherat M, Haugh MC, Gooch M, Boissel JP. 2000. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. Eur. J Clin. Pharmacol. 56:27-33
2. Bellavite P, Andrioli G, Lussignoli S, Bertani S, Conforti A. 1999. Homeopathy in the perspective of scientific research. Ann Ist. Super. Sanita 35:517-27
3. Eskinazi D. 1999. Homeopathy re-revisited: is homeopathy compatible with biomedical observations? Arch. Intern. Med. 159:1981-7
4. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. 1992. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305:160-4
5. Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. 1993. The SF-36 health survey questionnaire: an outcome measure suitable for routine use within the NHS?. BMJ 306:1440-4
6. Mingardi G, Cornalba L, Cortinovis E, Ruggiata R, Mosconi P, Apolone G. 1999. Health-related quality of life in dialysis patients. A report from an Italian study using the SF-36 Health Survey. DIA-QOL Group. Nephrol. Dial. Transplant. 14:1503-10
7. Apolone G, Mosconi P. 1998. The Italian SF-36 health survey: translation, validation and norming. J.Clin.Epidemiol. 51 :1025-1036.
8. McHorney CA, Ware JE, Jr., Raczek AE. 1993. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med.Care 31: 247-263.
9. Vithoulkas G. 1980. The Science of Homeopathy. New York: Grove Press Inc.
10. Ware JE, Jr., Sherbourne CD. 1992. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med. Care 30:473-83
11. Apolone G, Mosconi P, Ware JE, Jr. 1997. Questionario sullo stato di salute SF-36. Manuale d'uso e interpretazione dei risultati. Milano: Guerini e Ass.
12. Woolson RF. 1987. Statistical methods for the analysis of biomedical data. Chichester: Wiley & Sons.
13. Marubini E, Valsecchi MG. 1997. Analysing survival data from clinical trials and observational studies Chichester: Wiley & Sons.
14. Black N. 1996. Why we need observational studies to evaluate the effectiveness of health care. Br. Med. J. 312: 1215-1218
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:39|| |
Homeopathic Theories and Practices
Homeopathy: The Ultimate Fake
Stephen Barrett, M.D.
Homeopathic "remedies" enjoy a unique status in the health marketplace: They are the only category of quack products legally marketable as drugs. This situation is the result of two circumstances. First, the 1938 Federal Food, Drug, and Cosmetic Act, which was shepherded through Congress by a homeopathic physician who was a senator, recognizes as drugs all substances included in the Homeopathic Pharmacopeia of the United States. Second, the FDA has not held homeopathic products to the same standards as other drugs. Today they are marketed in health-food stores, in pharmacies, in practitioner offices, by multilevel distributors, through the mail, and on the Internet.
Samuel Hahnemann (1755-1843), a German physician, began formulating homeopathy's basic principles in the late 1700s. Hahnemann was justifiably distressed about bloodletting, leeching, purging, and other medical procedures of his day that did far more harm than good. Thinking that these treatments were intended to "balance the body's 'humors' by opposite effects," he developed his "law of similars"—a notion that symptoms of disease can be cured by extremely small amounts of substances that produce similar symptoms in healthy people when administered in large amounts. The word "homeopathy" is derived from the Greek words homoios (similar) and pathos (suffering or disease).
Hahnemann and his early followers conducted "provings" in which they administered herbs, minerals, and other substances to healthy people, including themselves, and kept detailed records of what they observed. Later these records were compiled into lengthy reference books called materia medica, which are used to match a patient's symptoms with a "corresponding" drug.
Hahnemann declared that diseases represent a disturbance in the body's ability to heal itself and that only a small stimulus is needed to begin the healing process. He also claimed that chronic diseases were manifestations of a suppressed itch (psora), a kind of miasma or evil spirit. At first he used small doses of accepted medications. But later he used enormous dilutions and theorized that the smaller the dose, the more powerful the effect—a notion commonly referred to as the "law of infinitesimals." That, of course, is just the opposite of the dose-response relationship that pharmacologists have demonstrated.
The basis for inclusion in the Homeopathic Pharmacopeia is not modern scientific testing, but homeopathic "provings" conducted during the 1800s and early 1900s. The current (ninth) edition describes how more than a thousand substances are prepared for homeopathic use. It does not identify the symptoms or diseases for which homeopathic products should be used; that is decided by the practitioner (or manufacturer). The fact that substances listed in the Homeopathic Pharmacopeia are legally recognized as "drugs" does not mean that either the law or the FDA recognizes them as effective.
Because homeopathic remedies were actually less dangerous than those of nineteenth-century medical orthodoxy, many medical practitioners began using them. At the turn of the twentieth century, homeopathy had about 14,000 practitioners and 22 schools in the United States. But as medical science and medical education advanced, homeopathy declined sharply in America, where its schools either closed or converted to modern methods. The last pure homeopathic school in this country closed during the 1920s .
Many homeopaths maintain that certain people have a special affinity to a particular remedy (their "constitutional remedy") and will respond to it for a variety of ailments. Such remedies can be prescribed according to the person's "constitutional type"—named after the corresponding remedy in a manner resembling astrologic typing. The "Ignatia Type," for example, is said to be nervous and often tearful, and to dislike tobacco smoke. The typical "Pulsatilla" is a young woman, with blond or light-brown hair, blue eyes, and a delicate complexion, who is gentle, fearful, romantic, emotional, and friendly but shy. The "Nux Vomica Type" is said to be aggressive, bellicose, ambitious, and hyperactive. The "Sulfur Type" likes to be independent. And so on. Does this sound to you like a rational basis for diagnosis and treatment?
At Best, the "Remedies" Are Placebos
Homeopathic products are made from minerals, botanical substances, and several other sources. If the original substance is soluble, one part is diluted with either nine or ninety-nine parts of distilled water and/or alcohol and shaken vigorously (succussed); if insoluble, it is finely ground and pulverized in similar proportions with powdered lactose (milk sugar). One part of the diluted medicine is then further diluted, and the process is repeated until the desired concentration is reached. Dilutions of 1 to 10 are designated by the Roman numeral X (1X = 1/10, 3X = 1/1,000, 6X = 1/1,000,000). Similarly, dilutions of 1 to 100 are designated by the Roman numeral C (1C = 1/100, 3C = 1/1,000,000, and so on). Most remedies today range from 6X to 30X, but products of 30C or more are marketed.
A 30X dilution means that the original substance has been diluted 1,000,000,000,000,000,000,000,000,000,000 times. Assuming that a cubic centimeter of water contains 15 drops, this number is greater than the number of drops of water that would fill a container more than 50 times the size of the Earth. Imagine placing a drop of red dye into such a container so that it disperses evenly. Homeopathy's "law of infinitesimals" is the equivalent of saying that any drop of water subsequently removed from that container will possess an essence of redness. Robert L. Park, Ph.D., a prominent physicist who is executive director of The American Physical Society, has noted that since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.
Oscillococcinum, a 200C product "for the relief of colds and flu-like symptoms," involves "dilutions" that are even more far-fetched. Its "active ingredient" is prepared by incubating small amounts of a freshly killed duck's liver and heart for 40 days. The resultant solution is then filtered, freeze-dried, rehydrated, repeatedly diluted, and impregnated into sugar granules. If a single molecule of the duck's heart or liver were to survive the dilution, its concentration would be 1 in 100200. This huge number, which has 400 zeroes, is vastly greater than the estimated number of molecules in the universe (about one googol, which is a 1 followed by 100 zeroes). In its February 17, 1997, issue, U.S. News & World Report noted that only one duck per year is needed to manufacture the product, which had total sales of $20 million in 1996. The magazine dubbed that unlucky bird "the $20-million duck."
Actually, the laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether. This limit, which is related to Avogadro's number, corresponds to homeopathic potencies of 12C or 24X (1 part in 1024). Hahnemann himself realized that there is virtually no chance that even one molecule of original substance would remain after extreme dilutions. But he believed that the vigorous shaking or pulverizing with each step of dilution leaves behind a "spirit-like" essence—"no longer perceptible to the senses"—which cures by reviving the body's "vital force." Modern proponents assert that even when the last molecule is gone, a "memory" of the substance is retained. This notion is unsubstantiated. Moreover, if it were true, every substance encountered by a molecule of water might imprint an "essence" that could exert powerful (and unpredictable) medicinal effects when ingested by a person.
Many proponents claim that homeopathic products resemble vaccines because both provide a small stimulus that triggers an immune response. This comparison is not valid. The amounts of active ingredients in vaccines are much greater and can be measured. Moreover, immunizations produce antibodies whose concentration in the blood can be measured, but high-dilution homeopathic products produce no measurable response. In addition, vaccines are used preventively, not for curing symptoms.
Stan Polanski, a physician assistant working in public health near Asheville, North Carolina, has provided additional insights:
• Imagine how many compounds must be present, in quantities of a molecule or more, in every dose of a homeopathic drug. Even under the most scrupulously clean conditions, airborne dust in the manufacturing facility must carry thousands of different molecules of biological origin derived from local sources (bacteria, viruses, fungi, respiratory droplets, sloughed skin cells, insect feces) as well as distant ones (pollens, soil particles, products of combustion), along with mineral particles of terrestrial and even extraterrestrial origin (meteor dust). Similarly, the "inert" diluents used in the process must have their own library of microcontaminants.
• The dilution/potentiation process in homeopathy involves a stepwise dilution carried to fantastic extremes, with "succussion" between each dilution. Succussion involves shaking or rapping the container a certain way. During the step-by-step dilution process, how is the emerging drug preparation supposed to know which of the countless substances in the container is the One that means business? How is it that thousands (millions?) of chemical compounds know that they are required to lay low, to just stand around while the Potent One is anointed to the status of Healer? That this scenario could lead to distinct products uniquely suited to treat particular illnesses is beyond implausible.
• Thus, until homeopathy's apologists can supply a plausible (nonmagical) mechanism for the "potentiation"-through-dilution of precisely one of the many substances in each of their products, it is impossible to accept that they have correctly identified the active ingredients in their products. Any study claiming to demonstrate effectiveness of a homeopathic medication should be rejected out-of-hand unless it includes a list of all the substances present in concentrations equal to or greater than the purported active ingredient at every stage of the dilution process, along with a rationale for rejecting each of them as a suspect.
• The process of "proving" through which homeopaths decided which medicine matches which symptom is no more sensible. Provings involved taking various substances recording every twitch, sneeze, ache or itch that occurred afterward—often for several days. Homeopathy's followers take for granted that every sensation reported was caused by whatever substance was administered, and that extremely dilute doses of that substance would then be just the right thing to treat anyone with those specific symptoms.
Dr. Park has noted that to expect to get even one molecule of the "medicinal" substance allegedly present in 30X pills, it would be necessary to take some two billion of them, which would total about a thousand tons of lactose plus whatever impurities the lactose contained.
Some homeopathic manufacturers market twelve highly diluted mineral products called "cell salts" or "tissue salts." These are claimed to be effective against a wide variety of diseases, including appendicitis (ruptured or not), baldness, deafness, insomnia, and worms. Their use is based on the notion that mineral deficiency is the basic cause of disease. However, many are so diluted that they could not correct a mineral deficiency even if one were present. Development of this approach is attributed to a nineteenth-century physician named W.H. Schuessler.
Some physicians, dentists, and chiropractors use "electrodiagnostic" devices to help select the homeopathic remedies they prescribe. These practitioners claim they can determine the cause of any disease by detecting the "energy imbalance" causing the problem. Some also claim that the devices can detect whether someone is allergic or sensitive to foods, vitamins, and/or other substances. The procedure, called electroacupuncture according to Voll (EAV), electrodiagnosis, or electrodermal screening, was begun during the late 1950s by Reinhold Voll, M.D., a West German physician who developed the original device. Subsequent models include the Vega, Dermatron, Accupath 1000, and Interro.
Proponents claim these devices measure disturbances in the flow of "electro-magnetic energy" along the body's "acupuncture meridians." Actually, they are fancy galvanometers that measure electrical resistance of the patient's skin when touched by a probe. Each device contains a low-voltage source. One wire from the device goes to a brass cylinder covered by moist gauze, which the patient holds in one hand. A second wire is connected to a probe, which the operator touches to "acupuncture points" on the patient's foot or other hand. This completes a circuit, and the device registers the flow of current. The information is then relayed to a gauge that provides a numerical readout. The size of the number depends on how hard the probe is pressed against the patient's skin. Recent versions, such as the Interro make sounds and provide the readout on a computer screen. The treatment selected depends on the scope of the practitioner's practice and may include acupuncture, dietary change, and/or vitamin supplements, as well as homeopathic products. Regulatory agencies have seized several types of electroacupuncture devices but have not made a systematic effort to drive them from the marketplace.
For more information about these devices and pictures of some of them, click here. If you encounter such a device, please read this article and report the device to the practitioner's state licensing board, the state attorney general, the Federal Trade Commission, the FBI, the National Fraud Information Center, and any insurance company to which the practitioner submits claims that involve use of the device. For the addresses of these agencies, click here.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:40|| |
Since many homeopathic remedies contain no detectable amount of active ingredient, it is impossible to test whether they contain what their label says. Unlike most potent drugs, they have not been proven effective against disease by double-blind clinical testing. In fact, the vast majority of homeopathic products have never even been tested; proponents simply rely on "provings" to tell them what should work.
In 1990, an article in Review of Epidemiology analyzed 40 randomized trials that had compared homeopathic treatment with standard treatment, a placebo, or no treatment. The authors concluded that all but three of the trials had major flaws in their design and that only one of those three had reported a positive result. The authors concluded that there is no evidence that homeopathic treatment has any more value than a placebo .
In 1994, the journal Pediatrics published an article claiming that homeopathic treatment had been demonstrated to be effective against mild cases of diarrhea among Nicaraguan children . The claim was based on findings that, on certain days, the "treated" group had fewer loose stools than the placebo group. However, Sampson and London noted: (1) the study used an unreliable and unproved diagnostic and therapeutic scheme, (2) there was no safeguard against product adulteration, (3) treatment selection was arbitrary, (4) the data were oddly grouped and contained errors and inconsistencies, (5) the results had questionable clinical significance, and (6) there was no public health significance because the only remedy needed for mild childhood diarrhea is adequate fluid intake to prevent or correct dehydration .
In 1995, Prescrire International, a French journal that evaluates pharmaceutical products, published a literature review that concluded:
As homeopathic treatments are generally used in conditions with variable outcome or showing spontaneous recovery (hence their placebo-responsiveness), these treatments are widely considered to have an effect in some patients. However, despite the large number of comparative trials carried out to date there is no evidence that homeopathy is any more effective than placebo therapy given in identical conditions.
In December 1996, a lengthy report was published by the Homoeopathic Medicine Research Group (HMRG), an expert panel convened by the Commission of the European Communities. The HMRG included homeopathic physician-researchers and experts in clinical research, clinical pharmacology, biostatistics, and clinical epidemiology. Its aim was to evaluate published and unpublished reports of controlled trials of homeopathic treatment. After examining 184 reports, the panelists concluded: (1) only 17 were designed and reported well enough to be worth considering; (2) in some of these trials, homeopathic approaches may have exerted a greater effect than a placebo or no treatment; and (3) the number of participants in these 17 trials was too small to draw any conclusions about the effectiveness of homeopathic treatment for any specific condition . Simply put: Most homeopathic research is worthless, and no homeopathic product has been proven effective for any therapeutic purpose. The National Council Against Health Fraud has warned that "the sectarian nature of homeopathy raises serious questions about the trustworthiness of homeopathic researchers." 
In 1997, a London health authority decided to stop paying for homeopathic treatment after concluding that there was not enough evidence to support its use. The Lambeth, Southwark, and Lewisham Health Authority had been referring more than 500 patients per year to the Royal Homoeopathic Hospital in London. Public health doctors at the authority reviewed the published scientific literature as part of a general move toward purchasing only evidence-based treatments. The group concluded that many of the studies were methodologically flawed and that recent research produced by the Royal Homoeopathic Hospital contained no convincing evidence that homeopathy offered clinical benefit .
In 2007, another review team concluded that homeopathic provings have been so poorly designed that the data they have generated is not trustworthy .
Proponents trumpet the few "positive" studies as proof that "homeopathy works." Even if their results can be consistently reproduced (which seems unlikely), the most that the study of a single remedy for a single disease could prove is that the remedy is effective against that disease. It would not validate homeopathy's basic theories or prove that homeopathic treatment is useful for other diseases.
Placebo effects can be powerful, of course, but the potential benefit of relieving symptoms with placebos should be weighed against the harm that can result from relying upon—and wasting money on—ineffective products. Spontaneous remission is also a factor in homeopathy's popularity. I believe that most people who credit a homeopathic product for their recovery would have fared equally well without it.
Homeopaths claim to provide care that is safer, gentler, "natural," and less expensive than conventional care—and more concerned with prevention. However, homeopathic treatments prevent nothing, and many homeopathic leaders preach against immunization. Equally bad, a report on the National Center for Homeopathy's 1997 conference described how a homeopathic physician had suggested using homeopathic products to help prevent and treat coronary artery disease. According to the article, the speaker recommended various 30C and 200C products as alternatives to aspirin or cholesterol-lowering drugs, both of which are proven to reduce the incidence of heart attacks and strokes .
In a survey conducted in 1982, the FDA found some over-the-counter products being marketed for serious illnesses, including heart disease, kidney disorders, and cancer. An extract of tarantula was being purveyed for multiple sclerosis; an extract of cobra venom for cancer.
In 1984, the FDA warned Botanical Laboratories, Inc., of Bellingham, Washington, that none of its homeopathic products could be legally marketed with drug claims because they did not have FDA approval to make such claims. The illegal claims included effectivness against angina pectoris, heart rhythm distrubances, hypoglycemia, gout, pneumonia, and lung abscess .
America's most blatant homeopathic marketer appears to be Biological Homeopathic Industries (BHI) of Albuquerque, New Mexico, which, in 1983, sent a 123-page catalog to 200,000 physicians nationwide. Its products included BHI Anticancer Stimulating, BHI Antivirus, BHI Stroke, and 50 other types of tablets claimed to be effective against serious diseases. In 1984, the FDA forced BHI to stop distributing several of the products and to tone down its claims for others. However, BHI has continued to make illegal claims. Its 1991 Physicians' Reference ("for use only by health care professionals") inappropriately recommended products for heart failure, syphilis, kidney failure, blurred vision, and many other serious conditions. The company's publishing arm issues the quarterly Biological Therapy: Journal of Natural Medicine, which regularly contains articles whose authors make questionable claims. An article in the April 1992 issue, for example, listed "indications" for using BHI and Heel products (distributed by BHI) for more than fifty conditions—including cancer, angina pectoris, and paralysis. And the October 1993 issue, devoted to the homeopathic treatment of children, includes an article recommending products for acute bacterial infections of the ear and tonsils. The article is described as selections from Heel seminars given in several cities by a Nevada homeopath who also served as medical editor of Biological Therapy. In 1993, Heel published a 500-page hardcover book describing how to use its products to treat about 450 conditions . Twelve pages of the book cover "Neoplasia and neoplastic phases of disease." (Neoplasm is a medical term for tumor.) In March 1998, during an osteopathic convention in Las Vegas, Nevada, a Heel exhibitor distributed copies of the book when asked for detailed information on how to use Heel products. A 2000 edition is larger but does not have the neoplasia section .
Between June 1987 and September 1994, the FDA issued at least five more warning letters to homeopathic marketers:
• Bio-Botanica was ordered to stop marketing "Nature's Answer" brand Homeopatic Herpes Cream for the relief of skin eruptions cases by Herpes viruses. The notice also warned that the company's Acne Remedy and Allergy Remedy were misbranded .
• BHI was ordered to stop making claims that BHI Cold, which contained sulfur and pulsatilla, were effective against mumps, whooping cough, chronic respiratory diseases, herpes zoster, all viral infections, and measles. In addition, when combined with other BHI remedies, it had been illegally claimed to be effective against otitis, pleurisy, bronchitis or pneumonia, conjunctivitis, and tracheitis.
• Botanical Laboratories, Inc., which distributed Natra-Bio products, was ordered to stop claiming that BioAllers was a homeopathic remedy for reliving symptoms of allergy due to pollen, animal hair, dander, mold, yeast, and dust. The products were promoted as homeopathic even though some ingredients were not in the Homeopathic Pharmacopeia.
• L.B.L.-Bot.Bio.Hom.Corp, of Roosevelt, New York, was ordered to stop making false claims that products could prevent AIDS, reduce cholesterol, cure diabetes and other pancreas disorders, and cancerous blood disorders.
• Nutrition Express, of Houston, Texas, was warned that products it was marketing for the temporary relief of infection, minor liver disorders, lymphatic disorders, and menstrual discomforts were misbranded because their labels or labeling included statements that represented that the products were intended to be used for curing or preventing disease.
During 1988, the FDA took action against companies marketing "diet patches" with false claims that they could suppress appetite. The largest such company, Meditrend International, of San Diego, instructed users to place 1 or 2 drops of a "homeopathic appetite control solution" on a patch and wear it all day affixed to an "acupuncture point" on the wrist to "bioelectrically" suppress the appetite control center of the brain.
Greater Regulation Is Needed
As far as I can tell, the FDA has never recognized any homeopathic remedy as safe and effective for any medical purpose. In 1995, I filed a Freedom of Information Act request that stated:
I am interested in learning whether the FDA has: (1) received evidence that any homeopathic remedy, now marketed in this country, is effective against any disease or health problem; (2) concluded that any homeopathic product now marketed in the United States is effective against any health problem or condition; (3) concluded that homeopathic remedies are generally effective; or (4) concluded that homeopathic remedies are generally not effective. Please send me copies of all documents in your possession that pertain to these questions .
An official from the FDA Center for Drug Evaluation and Research replied that several dozen homeopathic products were approved many years ago, but these approvals were withdrawn by 1970 . In other words, after 1970, no homeopathic remedy had FDA as "safe and effective" for its intended purpose. As far as I can tell, that statement is still true today.
If the FDA required homeopathic remedies to be proven effective in order to remain marketable—the standard it applies to other categories of drugs—homeopathy would face extinction in the United States . However, there is no indication that the agency is considering this. FDA officials regard homeopathy as relatively benign (compared, for example, to unsubstantiated products marketed for cancer and AIDS) and believe that other problems should get enforcement priority. If the FDA attacks homeopathy too vigorously, its proponents might even persuade a lobby-susceptible Congress to rescue them. Regardless of this risk, the FDA should not permit worthless products to be marketed with claims that they are effective. Nor should it continue to tolerate the presence of quack "electrodiagnostic" devices in the marketplace.
In 1994, 42 prominent critics of quackery and pseudoscience asked the agency to curb the sale of homeopathic products. The petition urges the FDA to initiate a rulemaking procedure to require that all over-the-counter (OTC) homeopathic drugs meet the same standards of safety and effectiveness as nonhomeopathic OTC drugs. It also asks for a public warning that although the FDA has permitted homeopathic remedies to be sold, it does not recognize them as effective. The FDA has not yet responded to the petition. However, on March 3, 1998, at a symposium sponsored by Good Housekeeping magazine, former FDA Commissioner David A. Kessler, M.D., J.D., acknowledged that homeopathic remedies do not work but that he did not attempt to ban them because he felt that Congress would not support a ban .
1. Kaufman M. Homeopathy in America. Baltimore, 1971, The Johns Hopkins University Press.
2. Hill C, Doyon F. Review of randomized trials of homeopathy. Review of Epidemiology 38:139-142, 1990.
3. Jacob J and others. Treatment of childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 93:719-725, 1994.
4. Sampson W, London W. Analysis of homeopathic treatment of childhood diarrhea. Pediatrics 96:961-964, 1995.
5. Homoeopathic Medicine Research Group. Report. Commission of the European Communities, December 1996.
6. NCAHF Position Paper on Homeopathy. Loma Linda, Calif.: National Council Against Health Fraud, 1994.
7. Wise, J. Health authority stops buying homoeopathy. British Medical Journal 314:1574, 1997.
8. Dantas E. A systematic review of the quality of homeopathic pathogenetic trials published from 1945 to 1995. Homeopathy 96:4-16, 2007.
9. Hauck KG. Homeopathy and coronary artery disease. Homeopathy Today 17(
10. Michels DL. Regulatory letter to James M. Lyons, Dec 11, 1984.
11. Biotherapeutic Index. Baden-Baden, Germany: Biologische Heilmittel Heel GmbH, 1993.
12. Biotherapeutic Index, 5th revised English edition. Baden-Baden, Germany: Biologische Heilmittel GmbH, 2000.
13. Faline JJ. Regulatory letter to Josephine Perricone, June 11, 1987.
14. Barrett S. Letter to FDA Office of Freedom of Information, Feb 7, 1995.
15. Davis H. Letter to Stephen Barrett, M.D., April 24, 1995.
16. Pinco RG. Status of homeopathy in the United States: Important ominous developments. Memo to Willard Eldredge, president, American Association of Homeopathic Pharmacists, Jan 17, 1985.
17. Kessler DA. Panel discussion on herbal dietary supplements. Consumer Safety Symposium on Dietary Supplements and Herbs, New York City, March 3, 1998.
• Quack "Electrodiagnostic" Devices Used for Selecting Remedies
• FDA Compliance Policy Guide 7132.15 for Homeopathic Products
• Homoeopathy and Its Kindred Delusions (Essay by Oliver Wendell Holmes, 1842)
• Homeopathy and Science: A Closer Look
• Petition to Ban the Marketing of Homeopathic Products
• Why Extraordinary Claims Require Extraordinary Proof
• Alternative Medicine and the Laws of Physics
• Samuel Hahnemann's Book: Organon of Medicine
• The Scientific Evaluation of Homeopathy
• Hahnemann's Homeopathy (Seven articles debunking homeopathic theory and practice)
• Homeopathy: All the Idiocy That Fits (Satire by Peter Bowditch)
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:40|| |
From a Californian who runs seminars teaching people "how to reduce stress by finding their natural breathing pattern":
I am very open minded. I would use drugs, surgery whatever it takes . . . but I feel homeopathy has value and the word "fake" is counterproductive and judgemental. I feel you have not researched the many scholars around the globe that are researching the quantum biological perspective. A few key biophysicists are gaining knowledge that there are subatomic fields that interpenetrate and structure the molecular level. These fields can directly relate to how homeopathy works. YOU DO NOT NEED ANY MOLECULES OF THE SUBSTANCE IN THE REMEDY TO AFFECT THESE UNDERLYING FIELDS. A SUBATOMIC WAVE FIELD THAT IS CARRYED BY THE WATER OR SUGAR IN THE REMEDY IS INTERACTING WITH THE SUBATOMIC FIELDS UNDERLYING THE PHYSICAL MATTER OF THE PATIENT. The problem is our limited technology can only measure a limited band of the energy spectrum. WE ARE NOT THAT ADVANCED AS A CIVILISATION. JUST WATCH THE NEWS.
From an unidentified homeopathic enthusiast:
Homeopathy works and you simply are too narrow-minded to understand that this world is made up of more than the mere physical and chemical natures. You overlook the spiritual and the energetic. You are the quack.
From a retired criminal investigator:
Homeopathic practices tend to be from the biblical roots of good natural medicine. There are millions that will fight any intrusion on homeopathy and its tenets. God have mercy on the persecutors.
From another homeopathic enthusiast:
What a sad sorry piece of shit masquerading as science your article is. Which drug company are you a front for? Do you know how many people die each year as a result of prescribed "scientifically validated" drugs? How many people do you murder (sorry treat) each week? How it must irk you that homeopathy is making a huge resurgence worldwide and safely treating iatrogenic and "incurable" diseases. We must start a web site to encourage people to sue doctors and drug companies for harmful side effects, lying and murder. It will be a huge counter punch to established medical quackery.
P.S. Oh I nearly forgot—FUCK YOU!!!!
This page was revised on August 23, 2009.
Homeopathy's "Law of Similars"
Stephen Barrett, M.D.
Proponents call homeopathy's defining principle the "Law of Similars." ("Like cures like.") This holds that substances that cause healthy people to get symptoms can cure diseases that have these symptoms. This idea is a form of "sympathetic magic" similar to the primitive idea that eating the heart of a lion will make a person brave.
Homeopathy's founder, Samuel Hahnemann, M.D., is said to have based his theory on an experience in which he ingested cinchona bark, the source of quinine used to treat malaria. After taking it, he experienced thirst, throbbing in the head, and fever -- symptoms common to malaria. He decided that the drug's power to cure the disease arose from its ability to produce symptoms similar to the disease itself. He and his early followers then conducted "provings" in which they administered herbs, minerals, and other substances to healthy people, including themselves, and kept detailed records of what they observed.
The symptoms reported during provings have been compiled into lengthy reference books called materia medica, which proponents regard as gospel. However, most of the provings were done between 100 and 200 years ago, when medical science was in its infancy. Very little was known about the nature of health and disease or about how to conduct experiments that separate cause and effect from coincidence.
The fact that a symptom occurs after taking a substance can have several explanations. During a typical day, most people experience occasional unpleasant thoughts and bodily sensations. To determine whether a substance actually causes a symptom, it would be necessary to compare people who receive the substance with people who receive a control substance. To guard against bias, neither the experimenters nor the test subjects should know who gets which.
The provings used to compile materia medica were not conducted in this manner. There were wide variations in the amounts of substances administered, the timing of the administrations, the way in which data were recorded, and the length of the studies -- and there were no controls. Thus it is impossible to know whether the reported symptoms were actually related to administration of the test substances. In addition, many symptoms may have resulted from suggestibility of the test subjects.
"A Dictionary of Practical Materia Medica," a widely used 3-volume set authored by John Henry Clarke, M.D., illustrates the foolishness involved in provings. The book contains about 2,500 pages that describe the symptoms that supposedly were reported following administration of about 1200 substances. Most descriptive pages contain more than 100 claims, which means that total number of symptoms exceeds 200,000. The book does not indicate when or how the original "provings" were done or who reported most of the specific findings. Thus it would be impossible to examine whether the studies were properly done, who did them, and whether the findings were accurately reported.
Many of the listed symptoms are odd. Lac felinum includes "Cannot bear the smell of clams, of which she is naturally fond." Lacrodectus mactans includes "Screams fearfully, exclaiming that she would lose her breath and die." Magnesia sulphurica includes "stupidity." Oleum animale includes "Singing, tinkling, and buzzing in ears." Natrum carbonicum includes "hurries out of bed in the morning." Some listings include symptoms that occur predominantly on one side of the body, such as "sickening sensation in left testicle." All are supposedly useful in determining whether the patient might "fit" a particular remedy.
Even if the proving reports were consistent, there is no logical reason why substances that could produce symptoms should cure such symptoms. Nor is there evidence from appropriately designed studies that the "law of similars" actually operates. The real way to test something works is to test whether it helps sick people. This requires clinical trials in which people who get the test substance are compared with people who do not. No homeopathic product has ever been proven effective; and the vast majority of products have never even been clinically tested.
Homeopathy's "Law of Infinitesimals"
Stephen Barrett, M.D.
Homeopathic products are formulated by taking a sample of a substance and repeatedly diluting it with water, water/alcohol, or milk sugar. The products are derived from minerals, plants, zoological substances, microorganisms, and several other sources. If the allegedly medicinal substance is soluble, 1 part is diluted in either 9 or 99 parts of distilled water and/or alcohol and "succussed" (shaken) vigorously; if insoluble, it is finely ground and "triturated" (pulverized) in similar proportions with powdered lactose (milk sugar). One part of the diluted medicine is diluted, and the process is repeated to reach the desired concentration, after which it may be bottled or used to impregnate sugar granules.
Dilutions of 1 to 10 are designated by the Roman numeral X (1X = 1/10, 2X = 1/100, 3X = 1/1,000, 6X = 1/1,000,000). Similarly, dilutions of 1 to 100 are designated by the Roman numeral C (1C = 1/100, 2C = 1/10,000, 3C = 1/1,000,000, and so on). Most remedies today range from 6X to 30C, but some carry designations as high as 200C.
Advocates claim that the lower the concentration of a substance, the more potent it becomes. This concept, often referred to as the "Law of Infinitestimals," is the equivalent of saying that the less sugar you put into a cup of coffee, the sweeter it will become. This is just the opposite of the dose-response relationship that pharmacologists have demonstrated.
The laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether. This limit, which is related to Avogadro's number (6.023 x 1023), corresponds to homeopathic potencies of 12C or 24X (1 part in 1024). Modern proponents claim that even when the last molecule is gone, a "memory" of the original substance is retained. A 30X dilution means that the original substance has been diluted 1,000,000,000,000,000,000,000,000,000,000 times. Assuming that a cubic centimeter contains 15 drops, this number is greater than the number of drops of water that would fill a container more than 50 times the size of the earth and a 30C solution would require a container more than 30 billion times the size of the Earth.
For practical purposes, this means that "30X" and "30C" solutions do not actually exist, because it is not possible to create a solution in which one molecule of an original substance is dissolved in a container of water bigger than the Earth.
Oscillococcinum, a 200C product "for the relief of colds and flu-like symptoms," involves "dilutions" that are even more far-fetched. Its "active ingredient" is prepared by incubating small amounts of a freshly killed duck's liver and heart for 40 days. The resultant solution is then filtered, freeze-dried, rehydrated, repeatedly diluted, and impregnated into sugar granules. If a single molecule of the duck's heart or liver were to survive the dilution, its concentration would be 1 in 100200 This huge number, which has 400 zeroes, is vastly greater than the estimated number of molecules in the universe (about one googol, which is a 1 followed by 100 zeroes).
Homeopathy's founder (Samuel Hahnemann, M.D.) himself realized there was virtually no chance that an original molecule would remain after extreme dilutions. But he declared that vigorous shaking ("succussion") or pulverizing between dilutions would leave behind a spirit-like essence that cures by reviving the body's "vital force."
Modern chemistry, which has developed understanding of the molecular nature of matter, and of the size of molecules, has found no "spirit-like" essence that could be left behind following dilutions past Avogadro's number.
Modern proponents postulate that the solution retains a "memory" of the substance. If this were true, every substance encountered by a molecule of water, alcohol, or milk sugar might imprint an "essence" that could exert powerful and unpredictable medicinal effects. Moreover, water is never 100% pure, and impurities can enter the solution from the container or surrounding air. So if a few molecules could determine how a remedy acts, there is no reason to assume that the original substance will prevail over the impurities encountered along the way.
Many proponents allege that homeopathic products resemble vaccines because both provide a small stimulus that triggers an immune response. This comparison is not valid. The amounts of active ingredients in vaccines are much greater and are measurable. Immunizations produce measurable antibodies, but highly dilute homeopathic products have no measurable active ingredients and produce no measurable response. In addition, vaccines are used preventively, not for curing symptoms.
Homeopathic Products Used for Mass "Suicide"
Scientists, doctors, and other rational thinkers in Belgium were dismayed last year when the country’s major health insurance companies announced that they would begin covering part of the costs of homeopathy, a widely-used but medically invalid and worthless form of quackery. Responding to the protests, the companies justified their action by claiming that “people like it.”
Critics were incredulous. SKEPP, the Belgian skeptical organization, promptly suggested that costs of Bordeaux wine also be reimbursed. Why? Because, unlike the situation with homeopathy, there is substantial evidence that red wine, taken in moderation, is good for your health. When this argument failed to prevail, according to a report in the Skeptical Inquirer by public health professor Luc Bonneaux, the skeptics decided to make their point by staging what they called a mass “suicide.”
In front of reporters from Belgium’s major newspapers and television stations, 23 volunteers—respected medical professors, a well-known TV producer, a top publicist, and several ordinary citizens—gulped down large quantities of over-the-counter homeopathic solutions based on deadly poisons. These included snake venom, deadly nightshade, arsenic and, just for the hell of it, dog milk. Dog milk was included because a homeopathic reference book (materia medica) actually says that undiluted dog milk can cause such disturbances as vomiting, bloody pus discharges, sciatica (right side) and “dreams of snakes.”
Even more ominous, the solutions were labeled “30C.” This meant that one part of the original substance had been diluted in 100 parts of water or alcohol, shaken, and then diluted again at a ratio of 100 to one, a process that was repeated 30 times. According to homeopaths, each time a solution is shaken, the properties of the original substance are miraculously transferred to the water or alcohol solvent, and each cycle enhances or “dynamizes” the :properties of the solution. Shouldn’t that make the original poison even more potent? Apparently not. All of the 23 volunteers survived, but some who came by car had to wait before returning home because the alcohol in their homeopathic solutions had made them too dizzy to drive.
The assembled press also heard a brief talk by medical professor Willem Betz, whom Bonneaux describes as “the Scourge of Homeopathy.” Dr.Betz read some ludicrous passages from a materia medica and explained that 30C homeopathic solutions are essentially just water or alcohol—plus any impurities introduced during their manufacture. Indeed, in homeopathic potions labeled 24X, produced by diluting the active ingredient 24 times at only a ten-to-one ratio, the laws of chemistry dictate that there is just a 50% chance that a single molecule of the active substance remains.
In the aftermath of the mass “suicide,” says Dr. Betz, “the homeopaths were spitting undiluted venom,” but refused to participate in a test proposed by Belgian skeptics. Summarizing what the public should have learned from the demonstration, Bonneaux writes, “Permitting yourself to be deceived by a silly theory that was outdated and untenable even in the nineteenth century does not show an open or tolerant mind. It only shows you are gullible and an easy prey to smooth-talking quacks.”
Mr. Jaroff is a science writer for Time magazine
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:41|| |
Misuse of the Term "Allopathy"
William T. Jarvis, Ph.D
The term "allopathy" was invented by German physician Samuel Hahnemann (1755-1843). He conjoined allos "opposite" and pathos "suffering" as a referent to harsh medical practices of his era which included bleeding, purging, vomiting and the administration of highly toxic drugs. These practices were based on the ancient Greek humoral theory which attributed disease to an imbalance of four humors (i.e., blood, phlegm, and black and yellow bile) and four bodily conditions (i.e, hot, cold, wet and dry) that corresponded to four elements (earth, air, fire, and water). Physicians following the Hippocratic tradition attempted to balance the humors by treating symptoms with "opposites." For instance, fever (hot) was believed due to excess blood because patients were flush; therefore, balance was sought by blood-letting in order to "cool" the patient. Hahnemann sought to replace allopathy with his "law of similia" that treated "like with like," a prescientific idea that he had discovered from reading ancient sources. Hahnemann had abandoned medical practice because of his inability to heal his patients by the methods of his era. He earned money by translating classical works into German leading him to ancient medical ideas. (Kaufman M. "Homeopathy in America: The Rise and Fall and Persistence of a Medical Heresy," in Other Healers: Unorthodox Medicine in America, Ed. Norman Gevitz, Johns Hopkins, 1988.
Although many modern therapies can be construed to conform to an allopathic rationale (eg, using a laxative to relieve constipation), standard medicine has never paid allegiance to an allopathic principle. The label "allopath" was considered highly derisive by regular medicine. A 1902 book intended for new medical graduates reveals just how vehemently Medical Doctors once opposed and resented the label:
Remember that the term "Allopath" is a false nickname not chosen by regular physicians at all, but cunningly coined, and put in wicked use against us, in his venomous crusade against Regular Medicine by its enemy, Hahnemann, and ever since applied to us by our enemies with all the insinuations and derisive use the term afford. "Allopathy" applied to regular medicine is both untrue and offensive and is no more accepted by us that the term "Heretics" is accepted by the Protestants, or "Niggers" by the Blacks . The terms "allopath" and "allopathy" are often used in reference to Medical Doctors and standard medicine by medical writers. Such use generally reflects an alternate definition of allopathy: "a system of medical practice making use of all measures proved of value (emphasis added) in treatment of disease."  This definition accurately describes modern, science-based medicine, but is inconsistent with its root words "allos" and "pathos." The duplicity of the term aids those who wish to misrepresent medicine as ideologically allopathic (i.e., symptom suppression). NCAHF recommends that these terms not be used in reference to standard medicine or MDs.
Significance of a Misnomer.
Although medicine never accepted the label of allopathy, nonmedical practitioners such as chiropractors, homeopaths, and naturopaths regularly misrepresent physicians as "allopaths." This is usually done in order to make differences between their practice guilds appear based upon conflicting philosophies rather than ideology versus science. Opponents of medicine claim that they treat the underlying causes of disease, while MDs treat only the symptoms. Further, they claim that medicine suppresses the symptoms, thus interfering with the body's inherent healing processes. A close examination reveals that this line of reasoning is only clever rhetoric. When they say the are treating the underlying causes, these vitalistic ideologists refer to a metaphysical life force rather than actual causes of disease such as viruses, bacteria, protozoa, genetic defects, radiation, chemical insult, and so forth. In reality, chiropractic manipulative therapy's main value is symptomatic relief from back pain. Homeopathy has always been based upon symptomatic relief. Homeopathic remedies are based upon a process called "proving" which identifies prospective remedies by matching the symptoms they produce in high dosages with the symptoms reported by a patient.
Naturopathy is eclectic, but none of its nonstandard medical modalities is truly aimed at causation. The discovery of the true causes of disease can be attributed to the basic sciences. Pasteur was a chemist trying to understand how wine was made. The idea of a metaphysical life force has never been objectively verified, nor is the theory of its existence required to explain a single biological phenomenon. Scientific work on the real causes of disease are on-going. For a state of the art look at this, NCAHF recommends a review of the Human Genome Project at the National Institutes of Health.
Nonscientific Health Care Based upon Vitalism
A number of healing systems care are rooted in vitalism: "a doctrine that the functions of a living organism are due to a vital principle distinct from physicochemical forces, " or, "the theory that biological activities are directed by a supernatural force; opposed to mechanism,"  which denotes a paranormal "life force." Vitalists are not just nonscientific, they are antiscientific because they abhor the reductionism (ie, versus holism) of science, the materialism (versus etherealism) of science, and the mechanistic (versus mystical) causal processes of science. They prefer subjective experience to objective testing, and place intuitiveness above reason and logic. Vitalistics are in sync with postmodernist antiscience liberal arts academics and are receiving aid and comfort from many of them who are in positions of influece. Vitalism is a powerful motivating force because it is inextricably linked to the concept of an immortal human soul—a piece of the Divine that is the essence of existence. This connects vitalism to religious ideologies and explains why Sarton stated that "it is impossible to suppress the vitalist point of view; it dodges every blow and reappears under a new form."  This table lists the names given to the alleged "life force" in the commonly promoted vitalistic systems:
Healing System // Originator Name(s) Given the Alleged "Life Force"
Anthroposophical Medicine // Rudolph Steiner Divine element in nature; astral body; formative force; ether body
Ayurvedic Medicine // Traditional Hindu medicine Prana
Chiropractic // Daniel D. Palmer Innate
Energy Medicine Energy body, aura, Kirlian effect, etc.
Homeopathy // Samuel Hahnemann) Vital energy
Magnetic Healing // Franz Anton Mesmer Animal magnetism
Naturopathy Vis Medicatrix Naturae
Primitive Medicine (see cultural manifestations above)
Radiesthesia (Medical Dowsing) Radiation
Reichian psychotherapy // Wilhelm Reich Orgone energy
Therapeutic Touch // Dolores Krieger Prana ("pranic healing" in ancient earth/fertility religion, Wicca)
Traditional Chinese Medicine // Taoism Chi, Qi, Ki
Quotations from authoritative sources from a few of the above healing systems express the quasi-religious natures of vitalistic ideologies better than any words NCAHF could choose.
Chiropractic. "The founder of...chiropractic appreciated the working of Universal Intelligence (God); the function of Innate Intelligence (Soul, Spirit or Spark of Life) within each, which he recognized as a minute segment of Universal; and the fundamental causes of interference to the planned expression of that Innate Intelligence in the form of Mental, Chemical and/or Mechanical Stresses, which create the structural distortions that interfere with nerve supply." 
Homeopathy. "Hahnemann is a child of the modern age of natural science, an adept in the chemistry of his day. But he can still hold a conviction that an immaterial vital entity animates our organism until death when the purely chemical forces prevail and decompose it. This vital entity which he characterizes as immaterial, spirit-like, and which maintains in health the harmonious wholeness of the organism, is in fact the wholeness of it."  Naturopathy. "Orthodox medicine assumes that the world is chaotic, mechanistic. We believe in the Vital Force which has inherent organization, is intelligent and intelligible. Chiropractors have adjustments, Acupuncturists have needles, we have Vis Medicatrix Naturae. Our way is to research the mystery and beauty of the life force, in which we have faith. Our power and our responsibility is to bring the life force into the light." 
Naturopaths claim to be the inheritors of the Hippocratic tradition, and pay lip service to the Vis Medicatrix Naturae , but their belief in the "life force" reveals that they do not understand the most important point of Hippocrates's revolutionary proposition that the healing power of nature was not a supernatural force.
1. Cathel DW and Cathel W. Book on the Physician Himself, Philadelphia: Davis, 1902, pp.300-301; in Stalker and Glymour. Examining Holistic Medicine, Buffalo: Prometheus, 1985, p.34.
2. Webster's New Collegiate Dictionary.
3. Webster's New Collegiate Dictionary.
4. Dorland's Illustrated Medical Dictionary, 25th Edition. WB Saunders Co. 1974.
5. Sarton. A History of Science, Volume I. W.W. Norton & Company, 1952, p.497.
6. Homewood. The Neurodynamics of the Vertebral Subluxation. Chiropractic Publishers, 1973.
7. Twentyman. "The nature of homeopathy," Royal Soc Hlth J, 1982;102:221-5.
8. Pam Snider, ND, 1991 AANP Convention, Into the Light. Townsend Letter for Doctors, April, 1992, p.261.
9. Statement of philosophy, Bulletin of the National College of Naturopathic Medicine, undated, circa 1993.
© 1996 National Council Against Health Fraud. With proper citation, this article may be reproduced for noncommercial purposes
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:41|| |
Comments on the AANP
Position on Homeopathy
Stephen Barrett, M.D.
The American Association of Naturopathic Physicians position statement on homeopathy is one of the most damning indictments of naturopathy I have found. Homeopathy is a pseudoscience based on delusions that (a) a substance that produces symptoms in a healthy person can cure ill people with similar symptoms; and (b) the more dilute the remedy, the greater the effect.
All of the full-time naturopathic schools require their students to take several courses on homeopathy. A report on the AANP Web site indicates that in 1995 or 1996, three of the schools listed 66, 140, and 144 hours of homeopathy training in their catalogs. I cannot imagine how a clear-thinking person could tolerate spending so many hours studying nonsense or would want to belong to a profession that embraces it.
HOMEOPATHY PRACTICED BY NATUROPATHIC PHYSICIANS
WHEREAS homeopathy has been an integral part of naturopathic medicine since its inception and is a recognized specialty for which the naturopathic profession has created a distinct specialty organization, the Homeopathic Academy of Naturopathic Physicians,
WHEREAS homeopathy has been recognized, through rigorous testing and experimentation, as having significant scientific evidence supporting its efficacy and safety.
WHEREAS homeopathic products are being subjected to intensified federal regulations and restrictions,
WHEREAS products are being promoted and marketed as "homeopathic" for a variety of uses ranging from weight-loss aids to immunizations. Many of these preparations are not homeopathic and many have not been satisfactorily proven to be efficacious,
THEREFORE, LET IT BE RESOLVED that it is the position of the American Association of Naturopathic Physicians that:
I. Homeopathy is taught in the Naturopathic Colleges and its practice should be included in the naturopathic licensing laws. Naturopathic physicians recognize other licensed practitioners of the healing arts who are properly trained in homeopathy.
II. The naturopathic profession initiate more clinical trials and provings to further evaluate the effectiveness of homeopathy.
III. Naturopathic physicians be authorized to prescribe and dispense all products included in the Homeopathic Pharmacopoeia of the United States (HPUS).
IV. Homeopathic products be subject to strict labeling requirements. Preparations which are not prepared in accord with the manufacturing principles in the HPUS should not use the term "homeopathic.". If parents choose homeopathic preparations for their children or their wards for the prophylaxis of infectious disease as an alternative to conventional vaccines, the physician should clearly state that they are unproven and that they are not legal substitutes for the state-mandated requirements.
V. Homeopathic prescriptions should be made with careful evaluation of their effect on the entire organism.
-- Adopted at the 1993 Annual Convention of American Association of Naturopathic Physicians. Principal Authors: Michael Traub, Lauri Aesoph, Peggy Rollo, Bruce Dickson, Brent Mathieu, Judyth Reichenberg-Ullman, Stephen King, Julian Winston, Louise Edwards, Prudence Broadwell
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:42|| |
Is Homeopathy "New Science" or "New Age"?
Mahlon W. Wagner, Ph.D.
Homeopathy has existed for about 200 years, yet reports in the media have suggested that homeopathy is the medicine of the future. Today, homeopathy is found in almost every country. In Europe, 40% of French physicians use homeopathy; 40% of Dutch, 37% of British, and 20% of German physicians use homeopathy . In the United States, hundreds of thousands of people take homeopathic remedies each year. Indeed, homeopathy seems to be becoming more popular.
Samuel Hahnemann, a German physician, developed homeopathy in about 1796. He was dissatisfied with the conventional medicine of his time. The accepted medical remedies at that time were often dangerous for the patient. There was a joke that more people died of medical treatment than from the disease itself.
Hahnemann laid out two principles of his homeopathy. First, he said that "like cures like" (Similia similibus curentur). This meant that a substance that produces certain symptoms in a healthy person can be used to cure similar symptoms in a sick person.
Second, Hahnemann asserted that smaller and smaller doses of the remedy would be even more effective. (In a way, perhaps this was a good idea because some of Hahnemann's remedies were poisonous.) So Hahnemann used more and more extreme dilutions of the remedies. In a process he named "potentization," Hahnemann would take an original natural substance and often dilute it 1-to-99 (called "C1"). A second dilution of 1-to-99 would be called "C2." Between each dilution, the remedy must be vigorously shaken. This shaking, or succussion, supposedly released the healing energy of the remedy. This healing energy has never been adequately defined nor measured.
Hahnemann found C30 dilutions to be quite effective. For Hahnemann, these very high dilutions presented no problem. He did not believe in atoms, and he thought that matter could be divided endlessly. Today we know that any dilution greater than C12 is unlikely to contain even one single molecule of the remedy. Sometimes Hahnemann diluted a substance 1-to-9 (called "D1"). In this case any dilution of D24 or greater would also not likely contain any molecules of the remedy.
Homeopathy claims to use only "natural" substances. This is an attempt to contrast itself with conventional medicine. For example, homeopathic remedies include raw bovine testicles, crushed honey bees (Apis mellifica), Belladonna (deadly nightshade), cadmium, sulfur, poison nut (Nux vomica), hemlock (Conium), silica (Silicea), monkshood (Aconite), salt (Natrium mur), mountain daisy (Arnica), venom of the Bushmaster snake (Lachesis), arsenic (Arsenicum album), Spanish fly (Cantharis), rattlesnake venom (Crotalus horridus), Ipecac (Ipecacuahna), dog milk (Lac canidum), poison ivy (Rhus toxicodendron), and more. Some of these substances are quite harmless, but others can be toxic (especially at D4 and lower dilutions).
How did Hahnemann know that a remedy was appropriate for a particular disease (actually for a particular symptom)? Hahnemann and his students tested remedies on themselves. They would eat various plant, animal, and mineral substances and carefully observe what symptoms occurred. This is called "proving." These reactions (or symptoms) were collected together into a book Materia Medica. For example, one of the symptoms of Pulsatilla (windflower) is "An unpleasant message makes him deeply sad and depressed after 20 hours." During provings, the people knew which substance they were taking. This is a problem because one might anticipate a certain reaction or exaggerate some symptom.
Today, in modern science, we try to prevent this bias by not letting the person know what he or she is taking -- a "test-blind" procedure. When evaluating symptoms, it is also important that the researcher does not know which remedy is being tested (a double-blind procedure) because the researcher can also be biased.
One recent German study  did compare a remedy (Belladonna C30) to a placebo. Those who received the placebo reported even more symptoms than those who received the remedy. The symptoms reported included minor aches and pains in various parts of the body. Did the patient mistakenly assume that a normal ache or pain must be related to the remedy? It is possible that the ache or pain was the result of a confounding factor such as not enough sleep.
As we can see, homeopathy is not concerned with the disease. It concentrates on the symptoms reported by the patient. Homeopathy then matches these symptoms to those symptoms that a remedy causes in a healthy person. By contrast, scientific bio-medicine uses symptoms to identify the disease and then treats the disease itself.
There are two points of view about homeopathy that are in conflict. One viewpoint says that homeopathy should not attempt to meet the rigorous requirements of scientific medicine. It is sufficient that there have been millions of satisfied patients during the last 200 years. Science is not relevant anyway because it rejects the concept of the energy of the "vital force" which is essential to homeopathy. This vital force is identical to the concept of vitalism -- a primitive concept used to explain health and disease. And, besides, scientific medicine is unfairly prejudiced and biased against homeopathy. Dana Ullman , a leading spokesman for American homeopathy, says that personal experience is much more convincing than any experiments. The emphasis on experience shows that most people simply do not understand that good science, based upon experiments, is essential to the development of knowledge.
The second viewpoint is that scientific research is necessary if homeopathy is to be accepted by medicine and society. In the past 15 years many experimental studies have been done to examine homeopathic remedies. Two reviews of homeopathy are perhaps the best known.
J. Kleinjen, P. Knipschild, and G. ter Riet examined 107 controlled clinical trials of homeopathy. They concluded that the evidence was not sufficient to support the claims of homeopathy. C. Hill and F. Doyon  examined 40 other clinical studies. They also concluded that there was no acceptable evidence that homeopathy is effective. Since the above reviews were written, four more research studies have appeared.
In 1992 the homeopathic treatment of plantar warts (on the feet) was examined . The homeopathic treatment was no more effective than a placebo.
A report in May 1994 examined the homeopathic treatment of diarrhea in children who lived in Nicaragua . On Day 3 of treatment the homeopathic group had one less unformed stool than the control group (3.1 Vs 2.1; p <.05). However, critics  pointed out that not only were the sickest children excluded, but there were no significant differences on Days 1, 2, 4, or 5. This suggests that the conclusion was not valid. Further, there was no assurance that the homeopathic remedy was not adulterated (contaminated). Finally, standard remedies which halt diarrhea were not used for comparison purposes.
In November 1994 a research report examined the effects of homeopathic remedies in children with upper respiratory infections (such as a cold) . Eighty-four children received the placebo, and 86 received individualized homeopathic remedies. The researchers concluded that the remedies produced no improvement in symptoms or in the infections.
In December 1994 a fourth study examined homeopathic treatment of allergic asthma in Scotland . The 13 patients who received the homeopathic remedy reported feeling better and breathing easier than the 15 patients who received the placebo. Then the researchers combined these data with several earlier experiments. They concluded that, in general, homeopathy is not a placebo and that homeopathy is reproducible.
However, there were too few patients for significant analysis. Second, personal reports of feeling better are not reliable. If a patient feels better, is that proof of recovering from the ailment? There are many diseases in which the patient feels good but is actually quite sick. What is needed are several proper physiological measurements of improvement. Third, it is inappropriate to combine this small study with previous studies of a different disorder.
The latest study from Norway  examined relief from the pain of tooth extraction/oral surgery by homeopathic remedies or placebos. Fourteen of the 24 subjects were students of homeopathy, and 2 of the 5 authors were homeopaths. It is safe to say that motivation was high to have homeopathy succeed. However, no positive evidence was found favoring homeopathy, either in relief of pain or inflammation of tissue.
The reader may ask why so much attention has been given to the scientific research when supporters of homeopathy reject the relevance of clinical trials to establish its validity. But the same people also claim that the 1991 review, and the Nicaragua and the Scotland studies are proof that homeopathy does indeed work. It is important to realize that all of the research that seems to support homeopathy is seriously flawed. The only conclusion that is justified at this time is that research has not conclusively shown that homeopathic remedies are effective.
What answer can be given to someone who says he took a remedy and it worked? Most people do not realize that in time most conditions will get better even if nothing is done. As the saying goes, "A cold will get better in 14 long days without treatment, but will get better in only two short weeks with medication." A wise medical doctor will say not to worry, that medication won't help much. (By the way, has anyone ever heard of a homeopath telling a patient that they need not worry and that the sickness will go away by itself?) When someone says the homeopathic remedy cured them, we can ask: "Would one have been cured just as quickly if nothing had been done?"
Another factor to consider is the "placebo effect." This means that if people "believe" that they are being properly treated, they will perceive themselves getting better faster. Recent research shows that up to 70% of medical/surgical patients will report good results from techniques that we know today are ineffective . (At the time of the treatment, both the patient and the physician were convinced that the treatment was effective.)
Since 1842, homeopaths have argued that the placebo argument is irrelevant because children and animals are helped by homeopathic remedies. But children and animals respond to suggestion when researchers and often the parents and pet owners are aware that a remedy has been given.
Supporters also claim that there are no risks from homeopathic treatment. They say that the ultra dilute remedies are safer and cheaper than most prescription drugs. First, it has been shown that several homeopathic remedies for asthma actually were contaminated with large amounts of artificial steroids. Second, some remedies do contain measurable amounts of the critical substance. If a patient takes 4 tablets daily of mercury (D4), he would receive a potentially toxic dose. And a dose of D6 cadmium exceeds the safe limits. Finally, a D6 or less dose of Aristolochia contains significant amounts of this cancer-causing herb. Therefore, we cannot easily and quickly claim that homeopathic remedies are always safe.
There is an additional risk of seeking homeopathic treatment. If someone is ill and requires immediate medical treatment, any delay could have serious consequences. This is the risk that is present with all alternative medical care.
Advocates of homeopathy often assert that using dilute remedies is similar to vaccinations. After all, vaccinations also use very dilute substances. Once again, homeopathy is trying to obtain respectability by showing that conventional medicine uses similar procedures. This is misleading for several reasons. First, vaccinations are used to prevent disease. Once one is sick and has symptoms, a vaccination will not help. The homeopathic remedy is given only after one is already sick. Vaccinations use similar or identical weakened microorganisms, but homeopathy is concerned with similar symptoms of illness. And last, many homeopathic remedies use D24 or C12 dilutions where none of the substance remains. Vaccinations on the other hand must contain a measurable amount of the microorganism or its protein.
Sometimes we can learn much about a topic by examining who or what it associates with. In the first 100 years, homeopathy was closely associated with many pseudosciences including Mesmerism and phrenology. In the United States, many early homeopaths were members of the mystical cult of Swedenborgianism.
Unfortunately, this has not changed today. Especially in the United States, chiropractic (spinal manipulation therapy) and applied kinesiology use homeopathic remedies. Many homeopaths use iridology, reflexology, dowsing, and electrodiagnosis. None of these methods has scientific validity. In America, if you want to learn more about homeopathy, the best place to go is to any New Age bookstore or meeting place.
Another connection of homeopathy with the New Age movement is found in the emphasis upon some mystical energy (called the "vital force") which, though unquantifiable, supposedly permeates the universe and is responsible for healing. Fritjof Capra and Deepak Chopra claim that the mysteries of quantum physics support this "healing energy" concept. But Victor Stenger  has shown that all of modern physics (including quantum physics) remains materialistic and reductionistic and offers no support for the mysterious energy supposedly present in potentized homeopathic remedies at dilutions of C12 or greater.
Is Homeopathy Quackery?
In the United States, we have a motto: "If it walks like a duck, and looks like a duck, and sounds like a duck, then it probably is a duck." To what extent does homeopathy look like quackery and sound like quackery?
One clear link that homeopathy has to quackery is its supporters' use of faulty logic. The first example is known as the "test of time" argument -- the fact that homeopathy has existed for a long time shows that it is valid. But longevity does not guarantee validity. Astrology, numerology, and dowsing have been around for a long time, but they are clear examples of pseudoscience. Longevity of an idea is never a good substitute for rigorous science.
The second argument is that many people have tried homeopathic remedies and are all satisfied, so homeopathy must be legitimate. Along the same lines, we are told that the following famous and important people all supported homeopathy: The British royal family, Johann Wolfgang Goethe, Mahatma Gandhi, Mother Teresa, Mark Twain, O. J. Simpson, Yehudi Menuhin, Angela Lansbury, and Mary Baker Eddy (founder of Christian Science). The Chinese have a saying that if a thousand people say something foolish, it is still foolish. Also a majority vote is no substitute for good science. In addition, we usually hear only about the successes, but the failures are conveniently forgotten or ignored.
A third argument is the "non sequitur." Typically, the crackpot says: "They laughed at Galileo, and he was right. Today they laugh at me; therefore I must be right." (Actually Galileo was not laughed at. Rather he was persecuted because he was devoid of a proper Christian faith to accept the correct dogma.) Homeopaths say that throughout history many great geniuses have rebelled against the prevailing wisdom; many of these were ultimately recognized as correct. Paracelsus, William Harvey, Louis Pasteur, and Joseph Lister were vindicated by history. Therefore, it is argued, Samuel Hahnemann and homeopathy also will ultimately be recognized as correct. But this argument forgets that many more who claimed to be geniuses were correctly rejected.
In the spirit of fair-mindedness, one may be tempted to give homeopathy the benefit of the doubt and simply conclude "not yet proven." However, what then are we to do when many lay practitioners report that merely writing the name of the remedy on a piece of paper, and putting this on the body of the patient results in a "cure." Even two respected national spokesmen were unwilling to reject these reports, and one of them suggested that quantum physics may ultimately explain these healings as well as those reported by patients who are given the remedy over the phone.
We must conclude that homeopathy certainly sounds like quackery.
Homeopathy in the United States
Before 1920, homeopathy was extremely popular in the United States. There were many homeopathic hospitals and medical colleges. But then conventional medicine established more rigorous standards for training students. In addition, pharmacology and the discovery of many useful drugs happened at the same time. Today in the United States, only about 500 of more than 600,000 physicians use homeopathic remedies.
However, many scientists are concerned because the popularity of homeopathy is increasing. Today almost anyone can buy homeopathic remedies without a prescription. This is because in 1938 a homeopath who also was a powerful politician (Royal Copeland, MD) was able to have a law passed that made homeopathic remedies exempt from all drug regulation. So homeopathic remedies do not have to be proved effective, as all other drugs must be. In addition, many unlicensed and untrained people can give homeopathic remedies to anyone who asks for them. Both German and French homeopathic companies recognize the large potential American market for their remedies. Sales of remedies are growing by 30% a year, and most remedies are sold in New Age and related natural health-food stores. Therefore, there is no control over the quality of homeopathic treatment received by patients; nor is there control over the quality or purity of the remedies.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:43|| |
Why Do People Accept Homeopathy?
Perhaps there are really two different questions here. The first question relates to the New Age in general. The second question relates to many alternative medicines as well as homeopathy.
Why do people read their horoscopes? Why do people believe in good luck and bad luck? Why do people ask a dowser for help? Why do people visit fortune-tellers? People who do these things want to know about the future, to avoid uncertainty, and to take control of their lives. For many people the uncertainty in life is unbearable. These people want explanations that they can understand. Modern science has become so complex that many people turn away in frustration. It is unfortunate that most people throughout the world do not understand what science is and what science does. For example, how many people can explain why it is warmer in the summer than in the winter? (Only 2 of 23 recent Harvard graduates could mention the tilt of the earth's axis.) Or how many people understand the basic ideas of biological evolution? A survey by the National Science Foundation in May 1966 reported that 48% of American adults believe that humans and dinosaurs coexisted, and only 47% knew that it takes one year for the earth to go around the sun. This scientific illiteracy, due in part to the shortcomings in our education systems, makes it easy for pseudoscience and superstition to succeed.
Why do people turn to homeopathy and other "alternative" medicines? Many people are dissatisfied with conventional medicine. They distrust physicians who may prescribe expensive drugs or painful surgery. Often physicians can find nothing wrong with the patient. Or else they tell the patient that time alone will cure the ailment. And, of course, physicians often cannot spend much time talking with the patient because they have too many patients to see that day. If the physician finds nothing wrong, this may offend the patient because it suggests that the cause is psychosomatic. The patient who wants to be cured and to be cured immediately is upset when the physician says that time alone will cure the problem. The patient may also be unhappy if the physician doesn't give some medication.
An initial visit to a homeopath can often take more than one hour. Patients are encouraged to talk about all of their cares, concerns, and pains. Patients may be asked whether they like oranges or apples; what kinds of music they enjoy; whether they sleep on their back or on their side.
Later the homeopath tells a patient that because he is a unique individual, the remedy will also be individualized for that patient alone. Thus, homeopathy is seductive to both the patient and the physician. The patient and physician become partners in fighting the illness. The homeopath is seen as a concerned and sympathetic health-care giver.
It must be concluded that by every objective, rational, and medical standard, homeopathy has failed to establish its scientific credibility. Homeopathy has not cast off the many characteristics of pseudoscience and quackery. How can conventional medicine, science, and patients respond to this challenge?
The problem of scientific illiteracy must be acknowledged. For example, if people understood the influence of suggestion and the placebo effect more clearly, homeopathy's attraction might diminish.
Intelligent people can encourage others to think more critically. Extraordinary claims demand extraordinary evidence. A miracle means a violation of the laws of nature. A miracle cure probably is not a miracle at all. If something seems too amazing to be true, it probably isn't true. We must demand that the claims of diagnosis and cure be supported with good evidence. To paraphrase another American motto: "The only thing necessary for quackery to succeed is for intelligent people to do nothing."
1. Fisher P, Ward A. Complementary medicine in Europe. BMJ. 1994; 309: 107-111.
2. Wallach H. Does a highly diluted homeopathic drug act as a placebo in health volunteers? Experimental study of Belladonna 30C in double-blind crossover design -- a pilot study. J Psychosom Res. 1993; 37(
3. Ullman D. Discovering Homeopathy: Medicine for the 21st Century. rev. ed. Berkeley, CA: North Atlantic Books; 1991.
4. Kleinjen J, Knipschild P, ter Reit G. Clinical trials of homeopathy. BMJ. 1991; 302: 316-323.
5. Hill C, Doyon F. Review of randomized trials of homeopathy. Rev Epidem et Sante Publ. 1990; 38: 139-147.
6. Labrecque M, Audet D, Latulippe LG, Drouin J. Homeopathic treatment of planter warts. Can Med Assoc J. 1992; 146 (10): 1749-1753.
7. Jacobs J, Jimenez LM, Gloyd SS, Gale JL, Crothers D. Treatment of acute childhood diarrhea with homeopathic remedies: a randomized clinical trial in Nicaragua. Pediatrics. 1994; 93(5): 719-725.
8. Sampson W, London W. Analysis of homeopathic treatment of childhood diarrhea. Pediatrics. 1995; 96(5): 961-964.
9. de Lange de Klerk ESM, Blommers J, Kuik DJ, Bezemer PD, Feenstra L. Effect of homeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. BMJ. 1994; 309: 1329-1332.
10. Reilly D, Taylor MA, Beattie NGM, et al. Is evidence for homeopathy reproducible? Lancet. 1994; 344: 1601-1606.
11. Lkken P, Straumsheim PA, Tveiten D, Skjelbred P, Borchgrevink CF. Effect of homeopathy on pain and otherevents after acute trauma: placebo controlled trial with bilateral oral surgery. BMJ. 1995; 310: 1439-1442.
12. Roberts AH, Kewman DG, Mercier L, and Hovell M. The power of nonspecific effects in healing: implications for psychological and biological treatments. Clin Psychol Rev. 1993; 13: 375-391.
13. Stenger VJ. The Unconscious Quantum: Metaphysics in Modern Physics and Cosmology. Amherst, NY: Prometheus Books; 1995.
14. Hanzen RM, Trefil J. Quick! what's a quark? NY Times. January 13, 1991; sec. 6, 24-26.
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:43|| |
Overview of Homeopathic Research
Stephen Barrett, M.D.
Homeopathy contends that substances that produce symptoms in healthy people can cure symptoms in sick people and that diluting substances makes them more powerful. Neither of these ideas makes sense.
Advocates also claim that research backs their claims. But a close look shows that this is not true. To prove that a treatment works, it is necessary to demonstrate that it is more effective than doing nothing. This requires showing that similar patients getting the treatment do better than patients who do not. The vast majority of homeopathic products have never been tested in this way.
A few "positive" homeopathy studies have been published in major medical journals. Proponents trumpet these studies as proof that "homeopathy works." Even if their results could be consistently reproduced (which seems unlikely), the most that studying a single remedy for a single disease could prove is that the remedy is effective against that disease. It would not validate homeopathy's basic theories or prove that homeopathic treatment is useful for other diseases.
Most reports of homeopathic research appear in publications that have little or no scientific recognition and are not readily accessible. However, several review teams have taken the trouble to gather what they could and have published detailed analyses of what they found.
In 1990, an article in Review of Epidemiology analyzed 40 randomized trials that had compared homeopathic treatment with standard treatment, a placebo, or no treatment. The authors concluded that all but three of the trials had major flaws in their design and that only one of those three had reported a positive result. The authors concluded that there is no evidence that homeopathic treatment has any more value than a placebo.
In 1995, Prescrire International, a French journal that evaluates pharmaceutical products, published a literature review that concluded: "As homeopathic treatments are generally used in conditions with variable outcome or showing spontaneous recovery (hence their placebo-responsiveness), these treatments are widely considered to have an effect in some patients. However, despite the large number of comparative trials carried out to date there is no evidence that homeopathy is any more effective than placebo therapy given in identical conditions."
In 1996, a lengthy report was published by the Homoeopathic Medicine Research Group (HMRG), an expert panel convened by the Commission of the European Communities. The HMRG included homeopathic physician-researchers and experts in clinical research, clinical pharmacology, biostatistics, and clinical epidemiology. Its aim was to evaluate published and unpublished reports of controlled trials of homeopathic treatment. After examining 184 reports, the panelists concluded: (a) only 17 were designed and reported well enough to be worth considering; (b) in some of these trials, homeopathic approaches may have exerted a greater effect than a placebo or no treatment; and (c) the number of participants in these 17 trials was too small to draw any conclusions about the effectiveness of homeopathic treatment for any specific conditions.
In 1997, the British journal Lancet published a meta-analysis that concluded: "We found insufficient evidence . . . that homeopathy is clearly efficacious for any single clinical condition."
The overall state of homeopathic research is easy to describe: Most is worthless, and no homeopathic product has been proven effective for any therapeutic purpose.
In 1999, The Medical Letter on Drugs and Therapeutics, which is the medical profession's most trusted drug advisory newsletter, summed up what health professionals should be should be telling patients: "The chemical content of homeopathic products is often undefined, and some are so diluted that they are unlikely to contain any of the original material. These products have not been proven effective for any clinical condition. There is no good reason to use them."
Numero di messaggi : 2141
Data d'iscrizione : 04.02.09
Età : 37
Località : Roma
|Oggetto: Re: homeopathy - Omeopatia Lun 28 Set 2009 - 17:44|| |
Why Water "Clumping" Does Not
Support Homeopathic Theory
Stephen Barrett, M.D.
On November 7, 2001, with the teaser, "homeopathy isn't all hokum," New Scientist magazine's Web site published an article that began:
It is a chance discovery so unexpected it defies belief and threatens to reignite debate about whether there is a scientific basis for thinking homeopathic medicines really work.
A team in South Korea has discovered a whole new dimension to just about the simplest chemical reaction in the book -- what happens when you dissolve a substance in water and then add more water.
Conventional wisdom says that the dissolved molecules simply spread further and further apart as a solution is diluted. But two chemists have found that some do the opposite: they clump together, first as clusters of molecules, then as bigger aggregates of those clusters. Far from drifting apart from their neighbours, they got closer together.
The discovery has stunned chemists, and could provide the first scientific insight into how some homeopathic remedies work. Homeopaths repeatedly dilute medications, believing that the higher the dilution, the more potent the remedy becomes.
Some dilute to "infinity" until no molecules of the remedy remain. They believe that water holds a memory, or "imprint" of the active ingredient which is more potent than the ingredient itself. But others use less dilute solutions. . . . The Korean findings might at last go some way to reconciling the potency of these less dilute solutions with orthodox science .
The article to which this referred was published in Chemical Communications, the journal of the Royal Society of Chemistry . Since the article does not mention homeopathy, I asked one of its authors (Kurt E. Geckeler, M.D., Ph.D.) whether the study implied anything about it. He replied:
As you stated correctly, the word homeopathy is not mentioned in the original paper and the study itself has nothing to do with it. It only states that on dilution (up to mM conc.) of a number of substances in water, an increase of particle size was observed. It was a laboratory study -- everything beyond that is speculation at this point. What journalists make out of our publication is beyond our control. Nevertheless, if confirmed, it might have implications in many different areas .
Homeopathic products are prepared by repeatedly diluting the original substance so that the each dilution is 1/10th or 1/100th as concentrated as the previous one. The clumping of molecules simply means that instead of each dilution taking a random sample of the molecules in a solution, it might take more-- or less -- than would be expected with an even distribution. (In other words, if molecules of a substance clumps in one place, there will be fewer molecules in other places.) With repeated dilution, the ultimate number of "active ingredient" molecules would approach zero whether clumping occurs or not. Clumping would not increase the number of molecules as the "active ingredient" is repeatedly diluted, so the remedy cannot grow stronger as the solution becomes more dilute. Nor does Dr. Geckeler's experiment support homeopathy's absurd notion that water can "remember" molecules that are no longer there.
1. Coghlin A. Bizarre chemical discovery gives homeopathic hint. New Scientist, Nov 10, 2001, pp 4-5.
2. Samal A, Geckeler KE. Unexpected solute aggregation in water on dilution. Chemical Communications 2224-2225, 2001.
3. E-mail message from Dr. Geckler to Dr. Barrett, November 12, 2001.
|Oggetto: Re: homeopathy - Omeopatia || |
|Abbiamo 505 membri registrati|
L'ultimo utente registrato è simona.rosselli
I nostri membri hanno inviato un totale di 4292 messaggi in 1183 argomenti
|Quali argomenti ti piacerebbe vedere maggiormente trattati in questo forum?|
|Sciamanesimo - testimonianze dirette|
| 6% ||[ 66 ]|
|Sciamanesimo - tecniche pratiche|
| 14% ||[ 168 ]|
|Sciamanesimo - Ricerche storiche e antropologiche|
| 12% ||[ 143 ]|
|Sciamanesimo - il lavoro sui sogni|
| 14% ||[ 163 ]|
| 11% ||[ 129 ]|
| 11% ||[ 127 ]|
| 10% ||[ 122 ]|
| 11% ||[ 127 ]|
|Altri argomenti già inseriti|
| 10% ||[ 122 ]|
|Totale dei voti : 1167|