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© Charles Lowe May 2006 Introduction Galileo's frustration is legendary. In a letter to Johannes Kepler in 1630, he wrote: “My dear Kepler, what do you say of the leading philosophers here to whom I have offered a thousand times of my own accord to show my studies, but who, with the lazy obstinacy of a serpent who has eaten his fill, have never consented to look at the planets, or moon, or telescope? Verily, just as serpents close their eyes, so do men close their eyes to the light of truth”. Dr David Spence, Clinical Director of the NHS Bristol Homeopathic Hospital, reminded us in 2003 (Health and Homeopathy, Autumn 2003) of the story of scurvy in the navy. In 1553, Admiral Richard Hawkins reported to the Admiralty that, during his years at sea 10,000 seamen had died of scurvy under his command. He also reported, with anecdotal evidence, that oranges and lemons cured the condition. He was ignored completely. In 1753, James Lind, the Edinburgh naval clinician, reported a controlled trial in which he had given lemon juice to half his seamen and there had been no scurvy among them. (The rest unfortunately died!). James Lind was ridiculed and ignored. The year after he died, 40 years later, the Admiralty did equip a squadron with lemon juice before a long voyage, but not till 1804, a further ten years later, did a regulation come into force about citrus juices for sailors on long voyages. 251 years after the initial clear proof. Dr Spence further added, wanly, that Professor Gene Feder, writing in the British Medical Journal in 2002, said that “opponents of homeopathy have made it clear that no number of well-designed trials will overcome their prior belief that homeopathy cannot work”. If we add to these stories the misleading BBC Horizon programme, slanted against homeopathy but constructed to give the appearance of impartiality, then the attack on low-potency Arnica by Edzard Ernst at Exeter University, and finally the bizarre recent Lancet article in which a group of Swiss statisticians did a skewed meta-analysis on 8 out of 110 studies and confirmed the hypothesis they had started with, homeopaths can see that the barricades are stacked against them. Clearly, in the instance of Galileo, it was self-righteousness and religiosity which caused the resistance to his ideas, resistance to viewing even his telescope! As for the Admiralty, it was probably inertia and lack of concern for the seamen, which caused the unacceptable delay in implementing the lemon-juice regulations. But the resistance to homeopathy, which has lasted for 200 years, has other origins. Firstly, Hahnemann, though brilliant, was not interested in submitting his ideas to the contemporary medical establishment in an acceptable way. In the unshakeable knowledge that he was right, he alienated them. And many of his successors like Kent did the same. This feeling of distrust among medical professional bodies (the BMA, the AMA, etc) continues today. Secondly, ‘scientific' medicine advanced dramatically with the emergence of antibiotics and vaccinations in the early decades of the 20 th century. This was compounded by the considerable growth of technology, which could measure and monitor microscopically small biological events. Thirdly, homeopathy still does not have an agreed explanation – either for its basic mechanism or for its mode of efficacy. And fourthly, homeopathy could never make a profit for commercial purposes because it has always been unpatentable, cheap, and non-technological. On top of these, there is a fifth reason. Opponents claim that homeopathy is not ‘evidence-based'. This is despite 200 years of clinical evidence, millions of satisfied patients, and numerous research projects. Clearly, homeopathy is indeed evidence-based. So what we need is a model of science that demonstrates this, a credible model of science which suits the unusual way in which homeopathy works. I think it is time to bring homeopathy into the mainstream, and to find a language to communicate with. It may be that this language is science. A brief history of the philosophy of science1. Metaphors for science Science, since the 18 th century Enlightenment, has come to depend on two metaphors – the microscope and the machine. And these metaphors are extremely resilient. Within these metaphors, all things can be reduced to the working parts of a machine, or, however small, can be measured and monitored. Even very slow-moving systems, like evolution, can be made susceptible to this mechanistic metaphor, with the minutest parts of the machine being the genes themselves. And radio waves, which can not be seen, have effects which can be measured and replicated, and so their existence can be inferred. These metaphors have been liberating. There is no doubt that they have led to an extraordinary 300 years of discovery, development, and technological revolution. But they are also restrictive. Because they block the possibility of things which do not fit into them. Isaac Newton was second a mathematician, but first an alchemist. He pre-dated the Enlightenment and was not bound by its constructs. His scientific work was aimed, in his own words, at ‘uncovering the laws by which God had designed the universe'. He believed in the ‘breath' of a spirit which had made things – he believed in an intelligence which had formed the intricate order of the universe. Ironically, he then created a machine metaphor for the universe, which became a standard basis for Enlightenment science, and lasted until Einstein's re-statement of cosmological reality in 1905. But he was nevertheless a deeply religious, and spiritual, man, and would have spurned the lack of spirituality of his successors. Newton's successors came to believe that God's work in the cosmos was so well-ordered, so rational, that it must be based on reason. Furthermore, they argued that the workings of the human and physical worlds could be understood without having to bring religion, mysticism, or divinity into the explanation. Indeed, by the 19 th century, some scientists thought that God and religion obstructed the development of knowledge – we remember the furious debate between Bishop Samuel Wilberforce and T.H Huxley, Charles Darwin's young supporter, at the Oxford Union – and by the end of the 19 th century, so-called ‘objective science' had been developed into a quasi-religion in itself. The myth was that objective science delivered facts. What it had achieved was the ‘End of History' in the field of science research. There was both an unquestioning faith that objective science, or ‘the one scientific method', was unique in being able to uncover the truth, and a false acceptance that science was by its very nature objective and unbiased. But the evolution of scientific philosophy, from Aristotle, to Descartes, to Popper, to Kuhn, and now to Mary Midgley's ‘holistic science', shows us that such notions are untenable, however attractive such certainty is! And as physicists tell us that the universe is both self-organising and full of unmeasurable phenomena such as dark matter and dark energy, the microscope and machine metaphors on which Enlightenment Science is based, look increasingly obsolete. Professor Edzard Ernst, so-called Chair of Complementary Medicine at Peninsula Medical School in Exeter, is quoted as saying, ‘There is only one science'. It is clear that he is wrong. There have been many scientific methods, and they continue to evolve. 2. The nature of evidence Now, let me turn to the issue of evidence. The word ‘empiricism' as it was originally used, meant ‘objective observation', and Hahnemann was among the first to use the term. He was the epitome of a scientist. He observed acutely, he tested relentlessly, he experimented meticulously, he revised constantly. And he insisted that homeopathic doctors used the detailed observation of their patients' signs and symptoms, with an objective eye and with no preconceptions, in order to arrive at the correct and full remedy picture. As scientific philosophy progressed during the 19 th and into the 20 th centuries, logical positivism came to hold a strong grip in the natural sciences, and two key concepts developed – replicability and generalisability. In order for any theory to be tested in a reliable way, the theory had first to be capable of being formulated into a set of hypotheses, and then each hypothesis had to be capable of being tested. These tests then had to be capable of being repeated exactly, with consistent results. For conventional medical trials, the only way to achieve an ‘objective' result was to find a ‘measurable biological effect'. That is to say: if we can see it, if we can see that it is repeated, we can say that this it is the truth. And as the technology improves, the results become more fine-tuned. Medical trialling continued to evolve and incorporate further principles. For instance, placebo-control is necessary because it enhances objectivity. Double-blinding and randomising have the same effect. They also mean that each phase of a drug trial only needs to be carried out once, since all steps to maximise objectivity have been taken at the first step. This kind of trialling is clearly, in theory, valid and reliable for molecular medicine. Notwithstanding this, the unscrupulous utilisation of trialling data in the case of Merck's Vioxx, to name only one, demonstrates that, while the research scientists may do their job well, their executives may not be motivated by the same ideals. So far, despite the divergences, the paradigm holds good for molecular medicine. But what about energy medicine? We cannot use the evidence-collecting systems outlined above, because, firstly, there may be no direct measurable biological effect, and secondly, homeopathic remedies can not be used in a generalised way, which means they can not be widely tested on groups of patients with the same ailment. However, when a homeopathic patient takes a remedy, the evidence from that patient is highly detailed, objectively observed, and re-assessed over a sequence of patient consultations. It is also subjectively expressed by the patient, and this expression of personal sensation is deemed to be very important. However, it is on this point that homeopathy's detractors level their most vehement criticisms. After all, subjective expression is not replicable, therefore not verifiable, therefore not reliable. The charge is often levelled at homeopathy that it demonstrates a sophisticated placebo effect. But its apparent effectiveness on animals and babies may enable us to refute this charge relatively easily. There are further grounds for rejecting the criticism. Firstly, the personal experience of patients really is evidence. It is evidence on which homeopaths base their highly complex and ordered system of homeopathic diagnosis and remedy prescription. The consistency and internal logic of this truly remarkable repertory of symptoms collated over 200 years means, very simply, that homeopathic remedies heal people. Secondly, the clinical evidence base is both worldwide and hundreds of years old. It is clear therefore, were we to accept a new, and therefore unorthodox, paradigm, that, among other things, we would have to change the way we identify and evaluate evidence. But first of all, let us look at the orthodox paradigm. The ‘gold standard' of conventional medical scienceI want to outline two gold standards of a scientific approach. First of all, in this section, the orthodox protocol, carried out daily by medical laboratories around the world. Secondly, I want to explore a second and unorthodox protocol, a homeopathic science research paradigm in which reliable science is applied to the individualising system which homeopaths use with their patients. Because of the existence of the measurable biological effect, orthodox medicine has always been satisfied with its version of cause and effect. In the past, it was axiomatic that the immediate cause of any illness was either the pathogen, or a physical trauma such as injury. Recently, the patient's parentage has come to be regarded as more important with the newfound understanding of genes. And of course, diet and lifestyle now play an increasing role in diagnosis. As for the testing of medical drugs, the scientific paradigm which medical science has used since the mid-20 th century is the randomised double-blind placebo-controlled trial. To give it a fuller description, the testing of a new drug has to comply with the following principles. It has to be: • generalisable – given a clearly defined population sample, if a pre-defined percentage of this group respond in predicted ways then we have a substance which can be medically deployed • replicable – the trial has to be able to be repeated by other scientists, with an emphasis on biologically measurable observations and objectivity • statistically-significant – the results have to show effectiveness for a majority of participants • placebo-controlled – a clearly defined quantity of the medicine administered to the trial participants has to be non-reactive i.e. placebo • double-blind – both the givers of the medicine and the participants taking the medicine do not know whether they are receiving actual or placebo medicine; only the trial organisers know which is which, and who has been allocated what. • randomised – the selection of the participants who receive the actual medication has to be random. • open to peer review – the experiment or survey has to be presented in a public forum, such as a revered journal, so that it can be properly scrutinised This protocol can be summarised as ‘the randomised controlled trial', or RCT – the replicable randomised statistically-significant double-blind placebo-controlled generalisable trial. An example of a drug-trial administered under the above circumstances would go like this: 50 asthma patients would all receive a drug, or placebo, the results would be collated, and a conclusion would be drawn about the generalised applicability of the medicine. The tests would only focus on one small part of the body's machine, such as the lung molecules which inflame during asthma attacks. That drug would then be developed for treating these specific inflammations. Once cleared for commercial distribution, the drug's trialling would then continue into the post-clinical phase. This would involve clinical data (i.e. data drawn from doctors in practice about how their patients are responding to the drug) being collected and collated over a period of time, thereby adding to the overall picture of the drug's capabilities. This is called ‘post-trial surveillance'. A new paradigm for homeopathic scienceTwo of homeopathy's key notions are: the notion of the ‘life-force', and the notion of deep causation. As regards the life-force, we do not exactly know what it is yet, but that does not mean it does not exist. We cannot measure it, or see it, but this does not mean it does not exist. Every day, when people meditate, many say they feel that their own energy field is ‘tuned in' to a giant energy field which can somehow replenish them. In Chinese medicine, this is called ‘qi', and in Indian yoga, it is called ‘prana'. Even modern physicists are taking seriously something similar, called the zero point field. The idea that life itself has a ‘breath of life' is not difficult to grasp, but it is difficult for rationalist scientists to accept, especially when they relate it to medieval vitalism with its links to superstition. However, the life-force has nothing to do with religion. It is another part of Einstein's universe, in which all matter is energy, and energy is at the root of everything. As for deep causation, it is held that there are six levels of causation of dis-ease: (i) the trigger – the immediate cause at surface level, such as a bacterium or trauma (ii) the current state of the immune response as it ‘lets in' the pathogen (iii) the susceptibility of the patient to particular types of illness (iv) the unresolved long-term effects of bad diet, recreational and medical drugging, and vaccinations (v) maintaining causes in the patient's environment which prevent healing (vi) the ancestral imprint of disease in the patient. It is for reasons of depth that homeopaths insist on looking at the whole patient, the totality of symptoms (spiritual, mental, emotional, physical), because the immediate cause, though important, may only be a small part of the story. The implication of this analysis is to play down the ‘measurable biological effect', because this only examines the trigger, the pathogen, and therefore only looks for medicines that can counteract that trigger. In contrast, homeopaths seek the cause at the deeper level. So, can the gold standard used for testing molecular medicines be used for homeopathic medicines? I do not think so. At least not in its current form. Some principles can be adopted, and objectivity of evidence has to be central. In particular, the theory should be capable of being broken down into testable hypotheses. But, for testing the hypotheses, we need a new paradigm, specifically for homeopathy. True scientists are open, not closed. A true scientist does not say ‘Homeopathy is a preposterous idea, it cannot work, therefore it does not work'. He says ‘If it works sometimes, what is it that is working?' There are three key, but different, scientific lines of enquiry in homeopathy. First, the science of the mechanism . In other words, what is it (possibly at the quantum level, for that is where most interest is currently focussed) that is happening when substances are successively diluted and vigorously shaken? And can those ‘potentised' substances affect biological organisms in ways that we can not yet measure or define, but ways in which we can externally observe that the dis-eased organism is returned to a healthier state? Second, the science of the pharmacological effect . What is the full range of effects, including not only structural effects (physical changes) but also functional effects (subjective sensations and feelings), that are to be expected from a particular substance? Third, the science of prescriptive efficacy, the science of the treatment . What effect can homeopathic remedies have on the individual case of a patient's dis-ease over a period of time? For conventional medicine, the first question is rarely, if ever, posed. This is because conventional medicine is based on the unquestioned assumptions which surround the molecular model. With the molecular basis of medicine, most action and reaction is visible under the electron microscope or the MRI scanner. So, at a superficial level, cause and measurable biological effect are both visible and immediate. For conventional medicine, the second question is addressed through orthodox drug trialling, the ideal protocol for which is detailed above. The third question is addressed via the post-trialling phase of the drug's utilisation with patients, and further information is regularly added to the data as it emerges. For homeopathic medicine , this ‘science of the mechanism' – i.e. the question how does homeopathy work? – is truly a $64 billion question. Medicine is worth hundreds of billions of dollars to the companies that thrive today because medicine is molecular. Just imagine an ‘energy model of medicine' taking over – it would be a seismic revolution. The emergence of homeopathy, economical and simple, could wipe out companies and damage economies. No surprise, then, the hysterical resistance to homeopathy among vested interests, and the misuse of scientific principles exemplified in the recent Lancet article about homeopathy. But, as things stand, the truth is that we do not yet have an underlying theory of homeopathy, so we can not, strictly speaking, form valid hypotheses that can be reliably tested. The conundrum is this: how does a substance – diluted and potentised – have an effect, when the substance is below Avogadro's number, the lowest point of dilution at which a molecule still remains in the remedy? Well, we simply don't know. But we do have intriguing research. First Benveniste's ‘memory of water' thesis, in which it was postulated that water's crystalline organisation of hydrogen bonds, and its ‘trinary' ion structure (plus, minus, neutral), could be ‘meta-organised', and that this organisation could be transferred by using the water again in another context. The water photographs of Masaru Emoto offered tantalising and remarkable evidence of this crystalline structuring potential. Then Dr Madeleine Ennis's double-blind research into the effect of potentised histamine in 2004, in which she set out to debunk homeopathic science, but ended by concluding that nanodoses (e.g. 10 to the power minus 19) caused significant biological action on basophils (white blood cells), gave us a tantalising glimpse into the unknown world of sub-atomic (i.e. energetic) interactivity in the molecular (i.e. material) sphere. It is clear that open-minded scientists, far from saying that it doesn't work because it can't work, are saying ‘Let's find out how it works and why'. For example, Nobel Laureate and physicist Brian D. Josephson of the University of Cambridge wrote to the New Scientist in 1997: “Simple-minded analysis may suggest that water, being a fluid, cannot have a structure of the kind that such a picture would demand. But cases such as that of liquid crystals, which while flowing like an ordinary fluid can maintain an ordered structure over macroscopic distances, show the limitations of such ways of thinking. There have not, to the best of my knowledge, been any refutations of homeopathy that remain valid after this particular point is taken into account. A related topic is the phenomenon, claimed by Yolene Thomas and by others to be well established experimentally, known as the ‘memory of water'. If valid, this would be of greater significance than homeopathy itself, and it attests to the limited vision of the modern scientific community that, far from hastening to test such claims, the only response has been to dismiss them out of hand .” The science of the mechanism still eludes us, but an initial explanation may be close. After all, h omeopathic potentisation is not preposterous if we take the view that everything is energy, and humans are energy in solid form. A nd the explanation of its effects may reside somewhere in the extraordinary recesses of quantum physics. Or, more intriguingly, could it be traced to the zero point field, the universal field that connects all energy and all matter in space-time? Once the explanation is revealed, we will probably be looking, not just at a new era in medicine, but a new era in physics itself, and a new era in understanding the universe. And the ‘gold standard' for homeopathic research? As regards a protocol for this first area, the ‘science of the mechanism', I think it is clear that this would be a scientific, and not a medical, endeavour, and would probably emerge from the realm of physics. The work of Madeleine Ennis has come closest to finding an explanation, but further work may have to wait until new experimental designs are developed. Now let me turn to the ‘science of pharmacological effect' . The originators of homeopathy did make an apparently outrageous claim. They claimed that there was a Law of Nature which determined that a substance that caused some symptoms also cured those symptoms. For instance, arsenic causes vomiting, and arsenic – highly-potentised – cures vomiting. This idea has a good pedigree, with Hippocrates and Paracelsus to name but two. The science of pharmacological effect, in homeopathic terms, entails finding out the effects that substances can cause ! This apparent reversal of logic has always been difficult for conventional medics to accept. But it is essential to the process of homeopathic medicine, and so must remain a key part of the overall research picture. Briefly, a trial to find out what a substance (mineral, animal, plant) might cause would normally involve a large group of healthy people, managed under strict double-blind conditions, taking a substance (diluted and potentised), and diary-reporting the effects of this substance on them over a three-month period. The symptoms they experienced would not be like conventional drug side-effects, because, firstly, the doses would be infinitessimally small, and secondly, the symptoms would only be temporary. The diary records of the testers would then be collated, and a total pharmacological picture of the substance – known as the ‘remedy picture' – would be drawn up. T his process is called ‘proving', and the gold standard in the proving of remedies was established in modern times by the formidable homeopath, Jeremy Sherr. In relation to these provings, homeopathy's ‘gold standard' protocol for focusing on the action of substances, and what sy mptoms they can cause, has always had to be: • generalisable – given a defined sample of the population, symptoms which were experienced by most of the group would be prioritised; less common symptoms would be deemed less important • replicable – the trial has to be able to be repeated by other scientists, with an emphasis on subjectivity and the exact words used to describe sensations and experiences • placebo-controlled – a clearly defined quantity of the medicine administered to the trial participants has to be non-reactive • double-blind – both the managers of the trial and the participants taking the remedies do not know whether they are receiving (i) actual or placebo medicine (ii) high potency or low potency doses; only the trial organisers know which is which, and who has been allocated what. • randomised – the selection of the participants who receive the actual medication has to be random. • open to peer review – the experiment or survey has to be presented in a public forum, such as a revered journal, so that it can be properly scrutinised Records of provings of substances, done over the last 200 years, are plentiful in number. More recently, those of Jeremy Sherr are some of the most rigorous and notable. New substances continue to be proved on a regular basis, and the pharmacopoeia of homeopathy grows accordingly. Finally, let us move on to the ‘science of the treatment' . As I said above, we cannot use generalised drug-trials to test individualised homeopathic efficacy. Certainly, we have to use systematic enquiry. We have to use rigour and logic and empiricism and intellectual discipline. But the four key principles of homeopathic treatment are that it (i) looks for a detailed picture of symptoms to provide a total picture of the patient's dis-ease (ii) recognises that the symptoms are not the actual dis-ease, but the outward manifestations of the body's attempt to fight the dis-ease – the guide to the medicine not the target of the medicine (iii) is individualised – given to the patient according to the total picture presented (iv) is longitudinal – a sequence of remedies administered over time. Any appropriate scientific model to test homeopathic efficacy has to account for these four aspects of treatment. But it must also comply with the key precepts of objectivity demanded of any trial that wants to call itself scientific – namely, double-blindness, placebo-control, and randomisation. My proposal for a scientific paradigm for homeopathy is: the randomised, double-blind, placebo-controlled, group-wide, individualised, longitudinal trial. Or the ICT for short. Here, properly trained and experienced homeopaths would use individual remedy sequences on individual patients, across a group of patients with approximately the same set of symptoms e.g. hay fever. It is crucial that it is double-blind. And it is made double-blind when the pharmacists, using a number system, provide both actual and placebo remedies in equal measure to the practitioners in the survey, who themselves do not know whether they are administering actual or placebo. It is also crucial that the patients who receive the actual remedy are randomly selected. The trial would have to be longitudinal, possibly over weeks, and the remedies would have to be individualised to the patients' requirements, even though certain patients' sequences might be an entire string of placebo pills. To re-iterate, even if a remedy is requested, the practitioner wouldn't know if it was placebo or actual, and nor would the patient. The aim of this alternative paradigm is to show how longitudinal individualised treatment, based on detailed case-taking at every stage, can meet the standards of scientific rigour and objectivity, and still also be effective on the basis of individualised diagnosis, using individual remedy sequences. My hope is that such a paradigm would be acceptable to the medical community. A detailed ‘gold standard' protocol to examine the efficacy of a treatment, would have to be: • individualised – each patient would have to receive remedies according to the symptoms they presented, and according to remedies ‘proved' using the protocol outlined above; no attempt would be made to generalise from each treatment sequence • longitudinal – the treatment period would last an agreed length of time for all participants, usually not less than one year. • replicable – the trial has to be able to be repeated by other scientists, with an emphasis on biologically measurable observations and objectivity • statistically-significant – the results have to show effectiveness for a majority of participants • placebo-controlled – a clearly defined quantity of the medicine administered to the trial participants has to be non-reactive* • double-blind – both the givers of the medicine and the participants taking the medicine do not know whether they are receiving actual or placebo medicine; only the trial organisers know which is which, and who has been allocated what. • randomised – the selection of the participants who receive the actual medication has to be random. • open to peer review – the experiment or survey has to be presented in a public forum, such as a revered journal, so that it can be properly scrutinised. A great deal of research does already exist for homeopathic medicine. For example: three separate bodies of researchers have conducted successful clinical trials in the use of a homeopathic medicine called Oscillococcinum 200C , in the treatment of influenza-like syndromes. These were JP Ferley et al in1989, P Casanova et al in 1992, and R Papp et el in 1998. Each of these trials was relatively large in the number of subjects (487, 300, and 372), and all were multi-centered placebo-controlled and double-blinded (two of the three trials were also randomized). These were RCTs, not ICTs, and yet each of these trials showed statistically significant results. Also using the RCT approach, Dr David Riley of the Glasgow Homeopathic Hospital wrote in the Lancet (October 1986): “Is Homeopathy a Placebo Response? Controlled Trial of Homeopathic Potency of Pollen in Hay Fever”. This was a randomized double-blind placebo-controlled trial of 144 active hay fever sufferers, comparing the homeopathic preparation of mixed pollen with a placebo. The homeopathically-treated patients showed a significant reduction in both patient and doctor-assessed symptom scores. Most recently and famously, of course, Dr David Spence, at the Bristol Homeopathic Hospital, recently completed his 6-year study of 6,500 patients (with conditions including asthma, eczema, depression, IBS, menopausal symptoms, and arthritis), and found significant results, especially with children. Here, he used an ICT approach, but without a double-blind placebo element. Summary and conclusionProponents of orthodox medicine define health as ‘an absence of symptoms'. Homeopaths define health as ‘freedom, balance, and joy – the unblocked flow of energy within the whole person'. Perhaps there is even a metaphor that homeopaths could adopt, such as the one suggested by David Bohm in 2002, that a living being is: ‘a bio-transducer in sea of energy'. Research into homeopathy has to take into account this absolute commitment to the energy principle, and to a model of energy. It also has to be predicated on the individualised treatment of the patient rather than the generalised treatment of the disease. Throughout the 19 th and 20 th centuries, despite honourable exceptions, physicians, medicine companies, scientists, (and noisy but irrelevant media sceptics like James Randi), whether motivated by genuine scientific concerns, or by commercial malice, have frequently and incorrectly asserted that there is no research to prove that homeopathic medicines work, and further that the infinitessimal doses are implausible and therefore cannot possibly have any effect. They have found it expedient not only to repeat the tedious untruth that homeopathy is not evidence-based, but also to promote misinformation about what scientific evidence there actually is on homeopathic medicine. The 2005 Lancet article and the 2003 ‘Horizon' BBCTV programme are in this vein. I think that the refusal to accept the effectiveness of homeopathy is at best perverse, and at worst pernicious. I speculated at the beginning of this article about why Galileo's and James Lind's ideas were rejected. With homeopathy, I think the reason is fear – fear of a genuine revolution which would jeopardise livelihoods. More often than not, self-described sceptics are staunch defenders of the prevailing materialist realism of the scientific orthodoxy. The result is that inexpensive homeopathic intervention, evidence-based, safe and non-toxic, tried and tested over 200 years, supported by patients across the entire world, is often unfairly dismissed. Yet as a medicinal therapy complementary, even alternative, to orthodox medicine, it offers great advantages. Having said all of this, I am equally aware that, over the centuries, the homeopathic profession has done itself no favours. It has been divided by disagreement, it has been disdainful of scrutiny, and it has too often set itself up in opposition to the medical profession. In my view, this is ill-judged, because we are all on the side of the patient and our duty is to them. This has to mean working together, not apart. To me, it is essential to create a firm bridge of understanding between proponents of molecular medicine and proponents of energy medicine. For a homeopathic research model to be credible, it has to be accepted by the mainstream, and homeopaths have to embrace the possibility of being accepted by the mainstream. The protocols mentioned above, and the model that underpins them, are intended to achieve those objectives. I hope that one day those who support molecular medicine will embrace the possibilities of energy medicine, and vice versa. Some proponents of energy medicine would prefer that they do not ‘cowtow' to the methods used to scrutinise orthodox medicine, but I think this is insular and naïve. Until we can show we have a science, we can not expect to be taken seriously by the wider community. At the same time, when it happens, acceptance within the mainstream will have two edges – homeopathy will become more central in medicine, but it will also be put under greater scrutiny. PostscriptIn the last week of May 2006, a group of doctors publicly called for the inclusion of homeopathy and other complementary therapies in the NHS to be stopped. In the articles, interviews, weblogs, and letters that followed, there was outrage on both sides. As I listened to the debate, my impression was that the ‘experts' were becoming less credible, and that the patient public were becoming more independent. As practitioners, whether allopathic or homeopathic, we can only do our best, and working together rather than against each other is surely the best way forward. Ultimately, the debate created more heat than light. The fact remains that there are times when homeopathy appears to work in a way that is not placebo, and there are other times when it does not work. That it clearly works sometimes should be enough to give us an incentive to look further. The fact also remains that conventional treatment works sometimes, but it does not always work. And when it does not work we do not always know why. It is no good shouting at each other from different hilltops. There has to be reasoned debate and reasoned research. I hope that this article will lead to a new period of openness, and the promotion of a new chapter in research. And, while conventional research continues apace, as Dana Ullman recently wrote, ‘ One cannot help but sense and anticipate the veritable treasure-trove of knowledge that further research in homeopathy and nano-pharmacology will bring in this new millennium'. Charles Lowe, Member of the Alliance of Registered Homeopaths © May 2006 _______________________________________ *'Placebos' in research trials In a correspondence with Members of the Faculty of Homeopathy, it transpired that, in their experience of research into homeopathic effectiveness, the use of placebo double-blinding in longitudinal individualised RCTs had not worked. There has possibly been a misunderstanding however, where my suggestion was understood to mean that placebo was being compared across the whole trial population i.e. it was being used as if in a generalised drug trial. But actually the point is, that, even taking into account the individualising of the treatment, the prescriber may be given, blind, a LacSac pill, by the trial controller, to give to the patient, and this may continue for a specified period of time. I think outside observers would expect the addition of the blinded placebo element in the trial, to maximise objectivity. There are of course ethical issues here, as there equally are, increasingly, with orthodox trials and placebos. But I feel these can be overcome. Here is an extract from the British Homeopathic Association website. From BHA Website: Comments on homeopathy research ___________________________________________________________________________________________ Useful extra reading: http://www.liebertonline.com/toc/acm/12/1 [Journal Of Complementary and Alternative Medicine, October 2005, Vol 11, Number 5] |
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Southfields Homeopathic Practice |