Thursday, July 25, 2024

Homeopathic Medicine. Do They Work?

 

When I was in school in the late 1950’s I heard of homeopathic medicine. I then thought it was an Indian system of medicine. This belief was reinforced when I went to Calcutta to study where I found there were courses in homeopathic medicine offered as well as on conventional medicine with students in both these two systems of medicines staying together in the same hostel. I did not think much about this as I still thought it was a system of traditional Indian medicine until I went to the University of London for my postgraduate studies.

In one of my trainings in London I went to the world-famous Hospital for Children in Great Ormond St, London WC1N 3HR where to my great surprise I saw the Royal Homeopathic Hospital located just beside the Children Hospital in the same street.

I then wondered how Indian medicine came to London, England. Out of curiosity I went inside the Royal Homeopathic Hospital, and I was amazed the doctors there were also medically qualified in conventional medicine with additional qualifications on homeopathic medicine.

I then found homeopathic medicine is not an Indian system of medicine, but a western medical system founded by a German physician by the name of Samuel Hahnemann (1755-1843). We shall go into that shortly.

But let us for the moment look at how homeopathic medicine came to London, to my amazement of course.

 The London Homoeopathic Hospital was established by Dr Frederick Foster Hervey Quin in 1849.

He was among the first doctors to practice homeopathy in Britain, and had studied with its founder, Hahnemann. The original London Homoeopathic Hospital was in Golden Square, Soho, and was established on 10 October 1849, although it did not receive its first patient until March the following year.

Quin was a prominent figure in London society and very well connected, having been physician to Queen Victoria’s father-in-law Prince Leopold, father of Prince Albert. He was a personal friend of Charles Dickens and godfather to one of his children. Among his other patients were the painter Landseer and the novelist Thackeray. But, despite his connections, Quin was always committed to bringing homeopathy to the people.

The hospital’s first great success came in 1854, when a cholera epidemic broke out in Soho, originating from the water of the Broad Street pump (this was the infamous epidemic which came to an abrupt end when Dr John Snow removed the handle of the pump. At that time, the London Homoeopathic Hospital was the closest hospital to the pumps and achieved remarkable success in treating the victims of the epidemic. The Hospital’s mortality rate was 16 per cent, compared to 53 per cent at the nearby Middlesex Hospital.

Even then there was scepticism towards homeopathy. A report on the epidemic for Parliament the following year omitted the figures from the hospital. These were only published after a thunderous speech in the House of Lords by Lord Grosvenor, Chairman of the Hospital Board.

The Hospital's reputation continued to grow, and homeopathy gained increasing support. Just ten years after its establishment, in 1859 a new and larger Homoeopathic Hospital was built in 1893-5 on its present site in Great Ormond Street and a new wing, facing Queen Square, was added in 1911.

Many well-known homeopathic physicians were associated with the RLHH in the 19th and 20th centuries, including Robert Ellis Dudgeon, John Henry Clarke, James Compton Burnett, Edward Bach, Charles E Wheeler, James Kenyon, Margaret Tyler, Douglas Borland, Sir John Weir, Donald Foubister, Margery Blackie and Ralph Twentyman among others. The famous names are not only doctors, but Miss Marion Brew, ‘Lady Superintendent’ or Matron from 1875 to 1906, was a prominent figure in the nursing profession.

A cache of 300 volumes containing the case notes of 1,426 patients treated from 1889 to 1923 was discovered in the vaults in 1992. This rare material offers a fascinating insight into the Hospital's work during that period.

The Royal Homeopathic Hospital in London has since integrated other alternative and complementary systems of medicine into its service. It has now become The Royal London Hospital for Integrated Medicine as part of the University College London Hospitals under the British National Health Service (NHS)

The Royal London Hospital for Integrated Medicine (RLHIM) is a centre for evidence-based practice, education and research, specialising in chronic and complex medical conditions.

Their mission is to provide a person-centred, holistic approach, including self-care, in order to help people with chronic and complex medical conditions live well and feel better.

Their approach considers the whole person and their environment in the quest for optimal health and wellbeing.

In order to achieve this, the Royal Integrated Medicine Hospital provides a combination of lifestyle strategies, medical, physical and psychological treatment, as well as advice on safe and appropriate use of complementary therapies. They also deliver and encourage self-care approaches which can continue to be used by patients after discharge.

All RLHIM services are outpatient-based and are staffed by experienced healthcare professionals.

The hospital provides an integrated Pharmacy service that includes a retail pharmacy where patients and the public can obtain advice from pharmacists specialising in complementary medicines.

The RLHIM also provides a Complementary and Alternative Medicine Library and Information Service (CAMLIS) that is open to the public with an education department that runs courses for healthcare professionals; and a research department specialising in self-care and integrated medicine approaches to health.

Let’s have a look at the history of medicine in the United Kingdom.

Before the adoption of conventional medicine, treatments in the UK, Europe, and America relied heavily on herbal remedies, folk practices, and rudimentary surgical techniques. The transition to modern medical treatments began in the 19th century with scientific advancements in understanding diseases, developing new drugs, and improving surgical methods. This transformation was further solidified in the 20th century with the industrial production of pharmaceuticals, the establishment of healthcare systems, and the professionalization of medical practice.

For instance, in the United Kingdom where I am more familiar with medicine practised there, during the ancient and medieval periods, before conventional medicine came into existence, herbal medicine was utilized extensively, with remedies derived from plants like foxglove (Digitalis) for heart conditions and willow bark (aspirin's precursor) for pain relief. They also have folk remedies that included charms, amulets, and rituals believed to have healing powers.

Then they went into bloodletting and leeching based on the theory of humours, these practices aimed to balance bodily fluids.

In the 16th - 18th Centuries, came the apothecaries and barber-surgeons that provided herbal remedies and performed basic surgical procedures.

Early hospitals in the UK were institutions like St Bartholomew's Hospital in London began to emerge, focusing on care rather than cures.

The adoption of conventional medicine emerged in the 19th Century with scientific advances.  The germ theory of disease (by Pasteur and Koch) and the development of anaesthesia (by Morton and Simpson) revolutionized surgery and disease treatment.

Then came the understanding of pharmacology with the isolation of active ingredients from plants (e.g., morphine from opium) and the synthesis of new compounds (e.g., chloroform) began. In the UK medical schools began to be established.  The establishment of medical schools and professional societies improved the training of physicians and standardized treatments.

In the 20th Century antibiotics were used.  The discovery of penicillin by Alexander Fleming in 1928 marked the beginning of the antibiotic era. After that in the UK the National Health Service (NHS) was established in 1948. It provided universal healthcare, making modern medical treatments accessible to the entire population.

Almost the same situation was in the rest of Europe and in America, but we shall not dwell into their medical history as this essay will become too lengthy except on the history of homeopathy that arose in Germany, Europe.  

The history of homeopathy started with Samuel Hahnemann (1755-1843) who was a German physician. He developed the practice in the late 1700s. Dissatisfied with the medical practices of his time, Hahnemann proposed an alternative method based on his observation.  Hahnemann published his findings in "Organon of the Medical Art" (1810), outlining the principles of homeopathy. The practice gained popularity in Europe and North America in the 19th century.

It is based on the principles of "like cures like" (similia similibus curentur) and "law of minimum dose," suggesting that substances that produce symptoms in a healthy person can be used to treat similar symptoms in a sick person, and that the lower the dose, the more potent the remedy.

The training in homeopathy can vary by country, but generally includes, like in conventional allopathic medicine, basic medical sciences like anatomy, physiology, pathology, and pharmacology. Homeopathic philosophy and the principles of homeopathy, history, and ethics are then taught. In their Materia medica students study homeopathic remedies, their sources, and their effects.

A homeopathic doctor learns the use of homeopathic repertories, which are indexes of symptoms and remedies. Their clinical training like in conventional medicine includes history and case taking, case analysis, and prescription of remedies.

The practical training is supervised clinical practice with real patients.

The length of a formal course in homeopathy is a full-time course, typically 3-5 years for a diploma or degree in homeopathy.

There are also part-time and online courses that can vary widely in length depending on the institution and country, but I do not recommend this unless they are already medical doctors who want to learn further.

But how does homeopathy work? Homeopathy is based on the idea of stimulating the body's own healing responses. It uses highly diluted substances, which proponents believe trigger the body's natural defences. Remedies are prepared through a process of serial dilution and succussion (vigorous shaking).

The clinical efficacy of homeopathy is highly debated. Proponents claim that homeopathy is effective for a wide range of conditions, from acute illnesses like colds and flu to chronic conditions like asthma and arthritis. But there are also sceptics’ views.  Many in the scientific community argue that homeopathy lacks empirical support and that any positive effects are due to the placebo effect. Studies often show that homeopathic remedies are no more effective than placebo.

As far as I know reviews and meta-analyses typically conclude that there is insufficient evidence to support homeopathy as an effective treatment for any specific condition.

Despite what conventional medical doctors think there are important personalities advocating homeopathy. These personalities, among them, were and are

1.      Mahatma Gandhi advocated homeopathy, referring to it as a "refined method of treating patients economically and non-violently."

2.      Sir Yehudi Menuhin, the late world-famous violinist

3.      Paul McCartney, the former Beatles member, has publicly supported homeopathy.

4.      Cher, the singer and actress, has spoken about her use of homeopathic treatments.

5.      David Beckham, the footballer, has reportedly used homeopathy for his injuries.

6.      And even the Late Queen Elizabeth II and the British royal family including King Charles III all have a long history of using homeopathy.

So, there is something there we cannot ignore.  

While homeopathy remains popular among some groups and has notable advocates, its clinical efficacy is not supported by the majority of scientific evidence. The debate continues, and individuals considering homeopathic treatments should do so in consultation with qualified healthcare professionals and consider the broader body of scientific research.

The clinical efficacy of homeopathy is a contentious issue within the medical community. Numerous studies and reviews have sought to determine whether homeopathic treatments are more effective than placebo.

Some studies report positive outcomes for homeopathic treatments. For example, a meta-analysis by Linde et al. (1997) initially suggested that homeopathic remedies had more than placebo effects. However, these findings were later critiqued for methodological flaws.

Certain randomized controlled trials (RCTs) have found positive effects of homeopathy for specific conditions. However, these are often small-scale studies, and their results are not always replicable in larger, more rigorous trials.

A significant body of research, including a comprehensive meta-analysis by Shang et al. (2005), published in "The Lancet," concluded that the clinical effects of homeopathy are indistinguishable from placebo effects. This analysis indicated that studies with higher methodological quality tend to show less effect for homeopathy.

Reviews and meta-analyses by Ernst (2002) in the "British Journal of Clinical Pharmacology" also found no compelling evidence that homeopathy was effective for any clinical condition beyond placebo.

As far as my own experience is concerned, I had patients who were not cured by conventional hospital drug-based medicine. They were not satisfied with the results of conventional medicine. They then came to me wanting homeopathic treatment instead. Unfortunately, I am not trained in homeopathic medicine, but from their medical history and all the investigations they had earlier, I knew what they suffered.

Fortunately, there were homeopathic pharmacies in Kuala Lumpur with whom I could seek advice. I then wrote out the homeopathic prescription for them and asked them to come back for follow up. But they never did. So, I have no clue on the clinical efficacy of these homeopathic treatments for these patients. I presumed they all got cured and need not come for follow-up anymore.

Nevertheless, homeopathy remains a polarizing topic. While some individuals and practitioners advocate for its use based on personal experiences and historical practice, the majority of scientific evidence does not support its efficacy beyond placebo. But many patients strongly say yes. They said they were cured using homeopathic medicine. So, this controversy continues between conventional drug-based and homeopathic medicines.

But I think it is best that individuals considering homeopathic treatments should also consult with conventional healthcare professionals and consider the broader body of scientific research when making informed decisions about their health. Both can be equally effective because the human body definitely is not some kind of a biochemical machine that can only be cured by some chemicals under the hidden gloried name as “medicines” (drugs). The human body also has a soul, spirit, and a mind, and is definitely not some kind of a biochemistry that can only be altered by chemical drugs and pharmaceuticals

Medicine is extremely challenging and very complex.


References:

 

References on the Systematic Reviews and Meta-Analyses of Homeopathy.

 

National Centre for Complementary and Integrative Health (NCCIH) reports

1.      Shang et al. (2005): This meta-analysis of 110 placebo-controlled trials compared homeopathy and conventional medicine. A comprehensive meta-analysis published in "The Lancet" concluded that the clinical effects of homeopathy are placebo effects. 

2.      Ernst (2002): This review examined multiple systematic reviews and individual trials, finding no reliable evidence supporting homeopathy's efficacy for any medical condition. A review in "British Journal of Clinical Pharmacology" found no compelling evidence to recommend homeopathy for any clinical condition. "A systematic review of systematic reviews of homeopathy." British Journal of Clinical Pharmacology, 54(6), 577-582. 

3.      Australian National Health and Medical Research Council (NHMRC) (2015): This review assessed over 1800 studies and concluded that there are no health conditions for which there is reliable evidence that homeopathy is effective.

4.      Shang A, Huwiler-Müntener K, Nartey L, et al. (2005). "Are the clinical effects of homeopathy placebo effects? Comparative study of placebo-controlled trials of homeopathy and allopathy." The Lancet, 366(9487), 726-732.

This meta-analysis found that when accounting for study quality, homeopathic treatments do not produce effects different from placebos.

This review concluded that there is no condition for which homeopathy has been proven to be an effective treatment.

5.      Linde K, Clausius N, Ramirez G, et al. (1997). "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials." The Lancet, 350(9081), 834-843. Initially reported a positive effect, but subsequent analyses highlighted methodological concerns.

6.      "The Organon of the Medical Art" by Samuel Hahnemann.

7.      "Homeopathy: Science or Myth?" by Bill Gray.

 

 

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