2012ScottishUniversitiesMedicalJournal

Publishedonline:October2012

ElectronicallyPublishedSUMJ15

MalcolmR(2012).SmallbutIntriguingThe
UnfoldingStoryofHomeopathicMedicine

SmallbutIntriguingTheUnfoldingStoryofHomeopathic
Medicine

BALANCINGMEDICALMATTERSOPINION

DrRussellMalcolmMBChB(Dundee)BAFFHom(DeanoftheFacultyofHomeopathy)
Correspondenceto:DrRussellMalcolm(russellmalcolm@uku.co.uk)

Abstract

Therearestrongadvocatesandopponentstoalternativemedicinebeingwidelyavailableto
the general population, whether this is over the counter or through the NHS. Indeed, if
anything this area is increasingly becoming a major discussion point both medically and
socially, especially with new constraints on budgets. In this balancing medical matters
opinion piece, Dr Russell Malcolm outlines the unfolding story and background of
homeopathicmedicineandsuggeststhatthemedicalandscientificcommunitiesshouldbe
lessresistanttosomeoftheseinterventions.

Introductiontoatopicaldebate

AsIwritethis,theRoyalSocietyofChemistryhasofferedacashprizetoanyonewhocan
explain why hot water freezes more quickly than cold1, while in quite another part of
LondonachangetotheconsolidatedMedicinesActthreatenspointofsaleavailabilityof
homeopathicmedicines.Thismovewouldnotonlythreateneachpatientsrightofchoice,
but also threatens the economics of a small and highly specialised discipline. At present
there are over 2000 unlicensed homeopathic medicines that many patients obtain under
guidancebytelephoningoremailingahomeopathicpharmacy.

Why should I mention two apparently coincidental and unrelated items of news? The first
story underlines the gaping holes that exist in our understanding of water. Indeed, I am
certain we would not be facing the second situation if we currently understood how high
aqueousdilutionsofspecificsubstancesevoketheirspecificbiologicaleffects.However,just
likethefreezingphenomenoninwater,justbecausewehaventexplainedityet,doesnot
meanitisnttrue.

TheObservedPhenomenaevolvingsciencefromempiricism

Homeopathyinvolvesverysmallconcentrationsofanactivematerial:amaterialthatcould
under other circumstances give rise to serious systems disturbances. The science of
toxicology already recognises the paradox that tiny exposures to toxins induce better
tolerance in living organisms that are then exposed to higher concentrations2. Toxicologist
EdwardCalabreseandcolleagueLindaBaldwindidasurveyofsome4,000toxicologystudies
reported in science journals3. They found that about 350 showed chemicals had opposite
effects at low levels. The actual prevalence could exceed that, as most of these studies
weren'tspecificallydesignedtoexaminesubtleeffectsattinydoses3.

If this seems improbable as it should to any critical mind you might ponder on the fact
that the inverse response curve that occurs in enzymatic reactions at low substrate
concentrationsalsoseemsparadoxicalandimprobableandisnotcompletelyunderstood.34
What is more controversial, however, is the idea that tiny doses of a specific material can
induceacorrectingresponseinanillnessstate.

Controversyorheresy

Much of the controversy centres on the inescapable fact that water, as a diluent, must
behave counterintuitively in the way that it selforganises and preserves unique pattern
informationfromeveryactivesubstancethatisintroducedintoit.Thisisnotsofarfetched
whenweconsiderthatwateristheorganisedmediumthatallourbiochemicalentitiesmust
traverse. This concept is important for our bodies to perform every improbable, three
dimensional docking manoeuvre with a specific target enzyme or receptor site5. Our very
existenceindicatestheveryrealdifferencebetweenimprobabilityandimpossibility.

Debateordenial

The same individuals who limit themselves to early twentieth century models for the
behaviourofwaterandlowdosephenomena,alsodecrytheavailabilityofhomeopathyon
theNHS6,onthebasisthatitcannotwork.Denialofthesephenomenaandtheavailable
research evidence is, of course, a matter of personal freedom, but to deny patient access
meansthatyoualsohavetodismissthehighlevelsofsatisfactionexpressedbypatientswho
havereceivedhomeopathictreatment7.

Asurveyofover23,000outpatientconsultationsattheBristolHomeopathicHospitalfrom
November1997toOctober2003revealedthatmorethan70%ofthesefollowuppatients
(n=6500)recordedclinicalimprovementfollowinghomeopathictreatment(seeTable1)7.

Table1:Resultssurveyofover23,000outpatientconsultationsattheBristolHomeopathic
Hospital(19972003)
Clinicalcondition

%followuppatientsshowingclinical
improvement

Asthma(under16s)

89%

Chronicfatiguesyndrome

72%

Crohn'sdisease/ulcerativecolitis

76%

Depression

71%

Eczema(under16s)

82%

Headache/migraine

74%

Irritablebowelsyndrome

71%

Menopausalsyndrome

77%

Rheumatoidarthritis

70%

Argumentsoncost
Thosewhoarestilloutragedthatpublicmoneysupportsthisspecialitymightnotrealisethat
thisentireskillsbase,withtwohundredyearsofcumulativedataandexperiencebehindit,
costs the taxpayer less than our total annual spend on just one minor symptomatic
medicine: (paracetamol elixir, given for infant fever).8 However, at a time of increasing
financial pressure, it is important to preserve and carefully evaluate any discipline, with a
low cost base and high safety profile. The Swiss Health Technology Assessment (HTA) was
commissioned in 2003 by the Swiss health Authorities with the objective of informing
decisionmakinginSwitzerland.

It concluded: There is sufficient evidence for the preclinical effectiveness and the clinical
efficacy of homeopathy and for its safety and economy compared with conventional
treatment.9

Inanotherstudy,indicatorsofhospitalisationanddrugusewereobtainedfromtheHealth
Statistical Document System of Tuscany10. Investigators compared users of homeopathic
serviceswiththegeneralpopulation.Thestudyshowedthatthehomeopathicpatientsused
fewerdrugsthanthereferencepopulation.Asignificantdecreaseindrugusewasalsofound
on comparing the same patients before and after homeopathic treatment. Hospitalisation
indicators also tended to favour patients who had received homeopathic treatment,
althoughthelatterobservationswerenotalwaysstatisticallysignificant.
Perhapsweshouldconsidertheeffectonthehealthcarebudgetifhomeopathywasableto
achieve a reduction in requirement for medication across the board. Consider the change
recordedinthistestimonybyapatientwithrheumatoidarthritis11.

Stakeholders,interestsandideologies

Does it matter? This depends entirely on whom you pose the question to. Research
organisations, manufacturers, R&D funding bodies, academic departments, teaching
programmes and professorial chairs are almost all dependent on the economics of the
patentable device or molecule. Indeed, there is so much investment of time, money and
energy in biomedical models for healthcare, that there is understandable wariness of
physicianslikeme,whoalthoughwechoosetoworkwithinconventionaldiagnosticmodels,
also wish to retain the freedom to recommend natural (and therefore unpatentable)
treatmentsthatlieoutsidetheboundsofconventionaltherapeutics.

ProfessorSirPeterRubinrecentlymadethefollowingpronouncementinanopenletterto
theBritainsregistereddoctors12:

Doctors whatever our area of practice must synthesise conflicting and incomplete
information to establish a diagnosis; we must deal with uncertainty and often work off
protocol;wemustmanagerisk;wemustacceptresponsibilityforactions.

ProfessionalChoice

Thisfreedomofeverydoctortothinkforthemselves,ratherthanmerelytoapplyprotocolis
adefiningattributeforwhatitmeanstobeaprofessionalandthosewhostudyhomeopathy
findthattheyareenabledtodojustthat.

Homeopathicpractitionersinterviewthepatientfromanopenlyindividualisedperspective;
then model the signs and symptoms either diagnostically or phenomenologically. They are
then in a position to select treatments which either manage the patients symptoms
conventionally, or facilitate adaptive change and healing with a homeopathic stimulus.
These treatment choices can be complex and may involve computerised searches for a
homeopathic systemsmatched remedy, in addition to more traditional investigative
measures.

So why would I spend my working life in a difficult and misrepresented speciality? Firstly,
because the results for the patient can be lifetransforming. Secondly, the outcomes,
materialsandpracticesarebothsustainableandunconditional.Thirdly,thelearningprocess
for the homeopathic physician is one that liberates them to observe, interpret and alter
biological phenomena using facilitatory methods that contrast significantly with orthodox
practices.

InthewordsofDrJeremySwayne:Whetherhomeopathicmedicinesareactiveornot,the
homeopathic approach is a powerful mediator of nonspecific therapeutic effects. The

process and outcome of homeopathic interventions provide an exceptional opportunity to

studytheroleofspecificandnonspecificfactorsintreatment.13

Before learning about homeopathy I often found myself juggling with the operational
constraintsthatareinherentinmanyofourtreatmentprotocolsandsystemsofhealthcare
delivery. Evidenceconstrained medicine and a widespread shortfall in the education and
practice of preventative medicine, means that many patients are stuck in one medical
paradigm,remainingbothsymptomaticandincompletelymanagedwitheverlengthening
druglists.

I would ask those readers who have worked in, for example, rheumatology or
gastroenterology to consider how difficult it can be to get any useful response at all
placebo or otherwise in many chronic cases, without recourse to steroids or
immunosuppressants.Dontaskapharmacistoranacademic,butaskthecliniciansittingin
front of his most intractable cases in the pain clinic week after week. Why should the
homeopathsuddenlyachieveaplaceboresponse14inpatientswhohavebeenfailedbya
combination of expensive high tech treatment and appropriately red coloured pills for
years?Andwhyshouldrecentlyintroducedcaseanalysismethodsresultinanimprovement
inresponseratestohomeopathy,ifthephenomenaareplacebogenerated15?

Although chance and pure coincidence can never be ruled out, many clinical responses to
homeopathy are sometimes so improbable16, that it demands complete ideological
blindnessnottobecurious.If,however,theeffectsofhomeopathywerealltocomedown
to the placebo response, then every conventional doctor really needs to learn the trick,
because these outcomes represent safe, inexpensive and clinically valuable phenomena.
Rememberhowever,thatanimalstudiesandmetanalysesofhomeopathydonotsupporta
predominantlyplacebodependenteffect17.

Impossible,ormerelyimplausiblefromourcurrentstandpoint

Critics of homeopathy, draw a line in the sand about the action of the remedies by
hammeringonabouttheimpossibilityofapharmacologicaleffectfromverylowdosesofan
activesubstance.Homeopathicphysicianshaveneverclaimedthattheseremediesworkon
the basis of a conventional lock and key model. To say, however, that there is nothing
activeinanyhomeopathicremedyisbothdisingenuousandmisleading.Manyremediesare
usedatconcentrationsakintopituitaryhormones,botoxandcertainvaccinations.

Those same critics in their appraisal of ultramolecular dilutions ignore the data available
within the HomBRex database (database of basic research experiments on homeopathy
indexes studies on biological systems). This includes 830 experiments employing ultra
moleculardilutions.In745ofthese(90%)atleastonepositiveresultwasreported.Animals
represent the most often used model system (n=371), followed by plants (n=201), human
material(n=92),bacteriaandviruses(n=37)andfungi(n=32).1920

Advances in basic science are elucidating phenomena in water that hitherto we havent
dreamedofincludingexclusionzonesatsurfaceinterfacesthatarethousandsofmolecules
thick, electrical gradients across these zones due to the movement of protons, energy
gradientsduetotheeffectsoflight,andpolaritygradientsaroundsolutemoleculeswhich
affecttheirspatialorientation1920.InthewordsofProfessorBrianCoxItistheresistanceto
newideasthatactuallyleadstoconfusion,nottheinherentdifficultyoftheideasthemselves,
becausetherealworlddoesnotbehaveinaneverydayway.21

Balancingriskandbenefitinmedicine

TheHippocraticOathhasbeenquietly(andconveniently)shelvedinthemedicalgraduation
ceremoniesofmostBritishUniversities.Itissimplytoomuchtoaskdoctors,itseems,toput
their hand on their heart and firstly do no harm while placing the National Prescribing
Formulary in their other hand. Yet, this fundamentally important principle would be a
perfectlyrealisticexpectationforamedicalhomeopath,yesterday,todayandtomorrow.
`Prescriberpower,however,isthebattlegroundofbothmedicalideologyandcommerce
andweshouldbeundernoillusionsabouttheimplicationsthishasforthecontentofour
undergraduate medical curricula, the priorities for research funding and the availability of
treatment.Theissueofavailabilitybringsusbacktothecurrentproposedchangestothe
consolidated Medicines Act. The desire of some to restrict the availability of homeopathy
cannotbefullyaccountedforbyshortcomingsintheevidencebaseforhomeopathy.After
all, there are many conventional treatments that are applied every day on the basis of
incompleteevidence.

MaryD.,whosetestimonyyoucanhearforyourself22,boughtahomeopathictreatmentfor
herself,acrossthecounterofherlocalhomeopathicchemist,intreatmentoflongstanding
symptoms of Sjgrens syndrome. She then observed and reported an improvement that
exceededeverythingelsethatshehadtriedovertheyears.Marysresponseisafact.And
like tens of thousands of other comparable experiences around the world, was attended
with objective physical and physiological changes. Although the indications for her chosen
treatment are not yet fully validated, there is also no evidence that selfprescribed
homeopathictreatments,likeMarys,arenotsafetouse.

Toitscritics,however,homeopathymustsurelyrepresentsuchadangertothepublicthatit
must be put beyond reach of anyone who is not in receipt of a prescription! Yet, in over
twentyfiveyearsofhomeopathicpracticeIdonotrecallhearingofasingledeathdirectly
attributable to an overthecounter homeopathic prescription. Contrast this with the 100
200 people that are known to die every year in the UK from paracetamol that was freely
bought over the counter without prescription23. If paracetamol is not an elephant in the
committeeroomofdrugregulation,Ireallydontknowwhatis.Inmylifetime,paracetamol
haskilledapopulationapproximatelyequivalenttothatofStAndrews.

This raises serious questions about what is motivating the movement towards regulatory
changeswhichrestrictaccesstohomeopathy:surelyasledgehammertosplitanatom.

References

1.www.hermes2012.org/iceMpembaeffect/RoyalSocietyofChemistryJune2012
2.Mattson,MP.&CalabreseEJ(2009).Hormesis:ARevolutioninBiology,ToxicologyandMedicine
ISBN10:1607614944ISBN13:9781607614944
3.CalabreseEJandBaldwinLA(2003).Hormesis:TheDoseresponseRevolution.AnnualReviewof
PharmacologyandToxicology.43:17597.
4.Bindslev,N.Drugacceptorinteractions
http://journals.sfu.ca/coactionbks/index.php/Bindslev/article/viewArticle/19/6214.4.4.Allosterywith
th
ReverseBellshapedPTXsensitiveSynagics(LastAccessedSeptember30 2012)
5.Dewey,T.G(1999).FractalsinMolecularBiophysics.OxfordUniversityPressUSA.ISBN10:
0195084470;ISBN13:9780195084474
6.MalcolmR(2011).ShouldhomeopathybeavailableintheNHSdebateresponse:RoyalCollegeof
Physicians,Edinburgh.Part1:http://youtu.be/VijvxgFutIPart2:http://youtu.be/GW2AB3QeZ3c
7.SpenceD.&ThomsonE(2005).HomeopathicTreatmentforChronicDisease:A6Year,University
HospitalOutpatientObservationalStudyJournalofAlternativeandComplementaryMedicine.Vol11:
(5),pp.79398

8.BrindleyM(2012)WalesHealthOnline.ParacetamolprescriptionscostingWelshNHSupto50ma
yearhttp://www.walesonline.co.uk/news/walesnews/2012/04/09/paracetamolprescriptions
th
costingwelshnhsupto50mayear9146630719111/(LastAccessedSeptember30 2012)
9.BornhftG,WolfU,vonAmmonK,etal(2006).Effectiveness,safetyandcosteffectivenessof
homeopathyingeneralpracticesummarizedhealthtechnologyassessment.Forsch
Komplementmed13(Suppl2):1929
10.LeoneL,MarchitielloM,NatilliMetal(2011).Measuringtheeffectivenessofhomeopathiccare
throughobjectiveandsharedindicators.Homeopathy.100(4):2129.
11.CentreforIntegrativeMedicalTraining(2011).Liveconsultationextractinpatienttreatedwith
homeopathyforrheumatoidhttp://www.youtube.com/watch?v=nVKJ1zIWgC0(LastAccessed
th
September30 2012)
12.Rubin,P(2011).DefiningwhatdoctorsdoLettertotheprofession.GeneralMedicalCouncilNov.
2011
13.Swayne,J(2012).Remodellingmedicine.GlasgowSaltireBooksLimited,2012486pp.ISBN978
9081270006
14.CentreforIntegrativeMedicalTraining(2011).Liveconsultationextractinpatienttreatedwith
homeopathyforintractableposttraumaticpainof20yearduration
th
https://www.youtube.com/watch?v=yCFlxW3Tjak(LastAccessedSeptember30 2012)
15.Frei,H(2009).Polarityanalysis,anewapproachtoincreasetheprecisionofhomeopathic
prescriptions.Homeopathy.98(1):4955
16.CentreforIntegrativeMedicalTraining(2012).Patienttestimony:Improbableresponseinacase
ofchronicpaintoanultramolecularpotencyofSodiumchloride,inapatientblindedtothenatureof
th
theprescription.http://youtu.be/O3LFq0zDeJk(LastAccessedSeptember30 2012)
17.FacultyofHomeopathy.Research:Theevidencebase.Availablefrom:
th
http://www.facultyofhomeopathy.org/research/(LastAccessedSeptember30 2012)
18.ClausenJ,vanWijkR,AlbrechtH.(2011).Reviewoftheuseofhighpotenciesinbasicresearchon
homeopathy.Homeopathy.100(4):28892.
19.PollackG(2006).Freshviewsfromthewatersedge.UniversityofWashington
th
http://www.uwtv.org/video/player.aspx?mediaid=16213809(LastAccessedSeptember30 2012)
20.VanWijkR,AlbrechtH(2007).ProvingandtherapeuticexperimentsintheHomBRexbasic
homeopathyresearchdatabase.Homeopathy.96(4):2527.
21.Cox,B&ForshawJ(2011).TheQuantumUniverse:Everythingthatcanhappendoeshappen.
AllenLane.ISBN:9780241952702
22.CentreforIntegrativeMedicalTraining(2012).Homeopathyoverthecounterapatientdescribes
th
herresponsehttps://www.youtube.com/watch?v=X1tk15WkeYA(LastAccessedSeptember30
2012)
23.AtchaZ.,MajeedA(2000).ParacetamolrelateddeathsinEnglandandWales19937.Health
StatisticsQuarterly07(4Autumn)pp.59

FurtherReading
MHRAProposalforconsolidationoftheMedicinesAct1968(2012).
http://www.mhra.gov.uk/Howweregulate/Medicines/Overviewofmedicineslegislationandguidance/Pr
th
ojecttoconsolidateandreviewUKmedicineslegislation/index.htm(LastAccessedSeptember30 2012)

HouseofCommonsScienceandTechnologyCommittee(2010).EvidenceCheck2:Homeopathy.
FourthReportofSession200910.TheStationaryOfficeLtd,London.

Biologicaleffectsoflowdoseexposures(BELLE)Committee(2012).
th
http://www.belleonline.com/bios/calabrese.htm(LastAccessedSeptember30 2012)

Internationaldoseresponsesociety(2012)http://www.doseresponse.org/(LastAccessed
th
September30 2012)

FacultyofHomeopathy:TrainingProgrammesforHealthCareProfessionals(2012)
th
http://www.facultyofhomeopathy.org/training/(LastAccessedSeptember30 2012)