Public profile of homoeopathy– the evidence base for homoeopathic prescribing

The Public Profile Of
Homoeopathy– The Evidence
Base For Homoeopathic
Prescribing
Presented at the Biannual Congress of Homoeopathic
Association of South Africa at Durban on 28-9-14
Gyandas G. Wadhwani MD(Hom)
Chief Medical Officer (Homoeopathy), Directorate of AYUSH,
Government of National Capital Territory of Delhi. India.
homoeopathygyan@gmail.com
drgyanwadhwani@yahoo.co.in

When you sing, sing
at the door so that
the child passing by
may learn wisdom.
African proverb

National Campaign on Homoeopathy
• The national campaign on “Homoeopathy for Mother and
Child Care” was launched by the Department of AYUSH, Govt
of India, in 2007. Pursuant to this, state level campaign was
launched in Delhi on 24/09/2009 by Hon’ble Chief Minister of
Delhi and Hon’ble Minister of Health & Family Welfare, Govt.
of NCT of Delhi.
• The campaign was designed to increase the awareness of
potential role of homoeopathy in ‘Mother and Child Health’
care and involved sensitization of policy makers and
practitioners of different medical systems.

DELHI GOVERNMENTTEAM DELHI MAKING THINGS HAPPEN
Govt. of NCT of Delhi
Directorate of ISM & Homoeopathy
(Homoeopathic Wing)
CSC-III, B-Block, Preet Vihar, New Delhi-110092
www.delhihomeo.com, www.homeo.delhigovt.nic.in
e-mail : ddhomeo.delhi@nic.in

AYUSH
(Ayurveda, Yoga & naturopathy, Unani, Siddha & Homoeopathy)
• The complementary and alternative medicinal
systems (including Homoeopathy) in India
enjoy both Public and Government patronage.
• This stems from the fact that all these systems
follow holistic philosophy, which appeals to
the indigenous culture and beliefs of people.
• However, the scenario is different globally!

• As a specialized system of therapeutics
and pharmacology, homoeopathy, has
withstood all possible criticism, from
quackery to witchcraft and placebo to
nocebo.
• Attempts have been made to curb the
rising popularity through various
publications and data analysis,
disproving homoeopathy, especially
published in ‘the lancet’, over last few
decades.

• In spite of numerous publications, reviews and
researches condemning all that is known as
homoeopathy, the financial sector has seen a
boom in business worldwide.
• In dollars the world homoeopathy market
according to ASSOCHAM is $5.35 billion.*
• But is it a bubble about to burst?
*http://johnbenneth.wordpress.com/2011/10/06/worlds-
fastest-growing-medicine/

The public profiling of homoeopathy
• Lately the pro-homoeopathy researchers/
scientists are throwing weight behind the
works of Archibald Leman Cochrane, widely
regarded as the father of ‘Evidence based
medicine’.

What is
“Evidence Based
Medicine
(EBM) ?”

What is the purpose of medicine?
 Public health promotion
and education
(awareness)
 Disease prevention
 Patient cure and care
 Research and
improvisation

Science Medicine Art
Deterministic Evidence based Open ended

What guides our decisions?
• Dogma: “Natural is best”
• Tradition: “We have always done it that way”
• Convention: “Everyone does it this way”
• Empiricism: “Experience as well as sensory
perception”
• Evidence-Based: “Evidence (read ‘research’)
supports this way”; “Nullius in verba”

What is EBM?
EBM is the conscientious, explicit and
judicious use of current best
evidence in making decisions about
the care of individual patients.
It's about integrating individual
clinical expertise and the best
external evidence from systematic
research.
Sackett, et al. BMJ 1996; 312:71-72
Clinical
Expertise
Best research
evidence
Patient
Concerns
EBM

EBM – a short history…
• In ancient China, during the reign of Emperor
Qianlong, the method of "kaozheng" ("practising
evidential research") was used to interpret ancient
Confucian texts (Woodhouse, personal
communication, 1998)
• And during the late-renaissance era, the French
Pierre Louis rejected the pronouncements of
authorities that venesection was good for
cholera and sought the truth in systematic
observation of patients

EBM – a short history…
• JAMA 1992
“EBM: a new approach…”
• JAMA 1993 – 2000
“Users' Guides to the
Medical Literature”
• 1990s – 3 trends
– Systematic reviews
– Search engines
– Knowledge distillation
and “push” services

An example of EBM practice
• Experimental data to prove the safety of most
practices is still sparse.
• It took more than 20 years and repeated huge
clinical trials to establish the efficacy of single
procedure, CABG, costing much much more
than 50 million US dollars!!*
• *Leape LL, Berwick DM, Bates DW. What Practices will most improve safety?
Reprinted JAMA, July 24/31, 2002-Vol 288, No 4, pp504

P.I.C.O.
– Patient/ Population/ Problem
– Intervention/ exposure
– Comparison
– Outcome

Question Evidence best provided
Cost • Cost-effectiveness study
Diagnosis • Diagnostic validation studies
• Prospective studies/ blind comparison to a
gold standard
Etiology/Harm • Cohort study
• Case control study
Prognosis • Cohort study
• Case control study
Quality of life • Qualitative studies
Therapy • Systematic review of Randomized Controlled
Trials (RCTs)
• Single RCT
1 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.
2 Glover, Jan, and Lei Wang. Find it Fast: The Clinical Question : www.med.yale.edu/library/education/guides/screencasts/finditfast/finditfast_2/

Evidence: systematic observation
Meta-Analysis
Systematic reviews
Randomized Controlled Trial
Cohort studies
Case control studies
Case Series
Anecdote or a single case report

Integrating evidence & practice
• Now I may be accused of ‘cherry picking’..
• One thing you could measure is how much of
medical practice is evidence based. This is not
easy. From the state of current knowledge,
around 13% of all treatments have good
evidence, and a further 21% are likely to be
beneficial.*
• *Goldacre B. Bad Science- Is mainstream medicine evil. Fourth
Estate, London; 2008; pp 199

The Trial of Homoeopathy
• Post hoc ergo proctor hoc….the fallacy of
homoeopathy
• From the ‘assumed-accidental’ appearance of
chills after intake of ‘china’ by Hahnemann to
the ‘conjuring-up’ of the law named similia
similibus curantur!

• Could be an idiosyncratic adverse reaction!
• However, Hahnemann (or homoeopathic
physicians) never claimed that China off
produces the malarial parasite in blood.
• The proving merely suggests it to be one of
the many remedies for certain kinds of
intermittent fevers, one of which is malarial
fever.

• And unlike the quinine (which high doses of china
officinalis contains), which most of malarial parasites
have become resistant to, if indicated as per
homoeopathic materia medica, china off shall cure
cases of intermittent fever (even malaria), without
fail.
• Moreover China is also a remedy for various kinds of
intermittent diseases (refer to aphorism 234)… in
which it may serve to break the intermittency.

• The placebo effect… the role of meaning in healing…
placebo explanations / placebo diagnosis/ placebo
treatments
• History and numerous clinical studies are full of genuine
examples how good bedside behaviour and reassurance
can be highly effective.
• If truly speaking, placebo effect is so strong, why even
waste so many resources and public money into drug
researches for functional diseases or routine
indispositions. Placebo treatment or explanation shall
certainly suffice.

• Dr Steward Wolf took the ‘placebo effect’ to the
limit…two women suffering with nausea and
vomiting (one of them was pregnant) were assured
of a treatment; through a naso-gastric tube ipecac
was adminstered; contrary to worsening, not just
symptoms improved but stomach contractions also
disappeared. Unconscious homoeopathy, as all
homoeopathic physicians shall agree.
• Wolf S. Effects of suggestion and conditioning on the action of chemical
agents in human subjects: the pharmacology of placebos. J Clin Invest, Jan
1950;29(1): 100-109

• Moreover, now, the the placebo controlled trials are
frowned over by the EBM community medicine!
• A treatment or therapy is only considered scientific if
it performs better than the accepted methodology,
already available.

• Regression to the mean
• Which means that in homoeopathic treatment
if it is not the ‘suggestion therapy’ working,
then surely it is spontaneous healing or the
disease would have ‘timed-out’
• As Voltaire said…..

The art of medicine consists in
amusing the patient, while
nature cures the disease.
Voltaire

• It certainly can’t explain the 100 plus patients visiting
daily the various (nearly 100) Delhi Government
homoeopathic primary health centres, situated in the
various parts of Delhi with residents full of poor socio-
economic status. For these persons every day of sickness
or absence means depletion of their meager sources of
income or loss of jobs!
• And most of these dispensaries are co-located with
allopathic set-ups, under the cafetaria approach of the
Delhi Govt.
• IT CAN’T BE A MERE COGNITIVE ILLUSION!

• Championing the ‘empirical data’
• The medicine of experience, and experience
alone, of Hahnemann, or his faithful disciples:
the guardians of homoeopathy
• The scientific medicine (read research based)
completely distances itself from the
epistemological approach of empiricism.

• However, it is certainly believed that EBM is
based on current best evidence. This
evidence, however may vary from time to
time.
• Homoeopathy, on the other hand, as a
medicine of experience, has withstood the
test of time. For us over two centuries, none
of the drugs gone off the counter and banned
from usage; for us the bryonia patient is as
thirsty in arctic regions as near the equator
and pulsatilla the opposite!

• Where are the RCT/ SR/ Meta-Analysis?
• Now this is one area, wherein barring the few
specific remedies viz. arnica, staphysagria,
bellis perennis in post-operative/ post partum
conditions, hekla lava in certain dental
conditions, phytolacca in mammary conditions
and a few others, it shall be exceedingly
difficult to conduct these trials
• Considering the doctrine of individualisation
in homoeopathy

• Where are the RCT/ SR/ Meta-Analysis?
• Even in simple injury, arnica, ruta, bellis,
hypericum, staphysagria, conium, calendula,
rhus tox etc. can be indicated, depending
upon the symptoms.
• Finding a specific remedy for the diagnostic
condition hence dimnishes the chances of
exact reproducibility in this ‘patient-centeric’
system of medicine called homoeopathy.

• Cherry picking evidence/ studies/ data/ stitch
up
• The ‘stitch’ up in a study explains the oddly
good Jadad score
• Jadad score is a standardised tool that
measures the quality of a study

• Ernst E, Pittler MH. Efficacy of homoeopathic
arnica: a systematic review of placebo
controlled clinical trials. Arch. Surg. 1998 Nov;
133 (11): 1187-90
• The scientific men could not understand how
or why the few studies could achieve 5 Jadad
score! Of course, the studies were stitched up
or tailored to produce certain results!

§ 53, Organon of the Art of Healing
…the pure homoeopathic
method of healing is the only
correct one, the only one
possible to human art; it is the
most direct one, just as
certainly as there is but one
possible straight line between
two given points…

Edmund Lee, On the successes of Lippe & Hering in
curing many chronic cases which other physicians could
not help in the least
“These men had no secret methods of practice,
no secret remedies; they had nothing more
than the humblest of us may acquire, a
profound knowledge of Hahnemann ’ s
Organon, of his Chronic Diseases, and of the
homoeopathic Materia Medica. Cannot we all
obtain that knowledge also, and having it,
cannot we, too, use it to cure these scourges of
the human race as they did?’

RETURN TO THE INNOCENCE
• MASTER ‘ORGANON OF THE HEALING ART’

James Tyler Kent,
An address preliminary to the study of
homoeopathics. Homoeopathician 1912; 1:6
..the masters of these living doctrines
and the materia medica have been
constant readers of this great work. Not
one of the great prescribers has ever
claimed a discovery not fully set forth in
this work, but in all their greatest
accomplishments have said that they
based their success upon the Organon…
…

James Tyler Kent
….It is the first book for the student to
read and the last for the old and busiest
physician to ponder over. When Lippe,
Wells and scores of others advocated a
continuous reading of this book during
their long careers, should we not likewise
look upon it with a feeling of profound
respect? ….

James Tyler Kent,
…. Should we not crave for the hidden
truths that has made these faithful
followers of law so successful? To whom
would a rational man apply for light
when desiring to follow law in healing the
sick and measuring out uses to man?
Naturally to Hahnemann and his faithful
adherents, and not to those who smile at
what they choose to consider ravings of
an aged man…

IT IS POSSIBLE TO FIND IN ORGANON,
THE HIGHEST WISDOM OR FOLLY AS
PER THE NATURAL TENDENCY OF
THE READER!
August Karl Gustav Bier (1861-
1949)
German surgeon & Pioneer of
Spinal Anaesthesia

• STUDY ‘TEXTBOOKS OF MATERIA MEDICA’ OR
THE ‘ROOTS OF MATERIA MEDICA’
– MATERIA MEDICA PURA
– THE CHRONIC DISEASES
– THE ENCYCLOPEDIA OF PURE MATERIA MEDICA
– THE CHRONIC DISEASES
– A DICTIONARY OF PRACTICAL MATERIA MEDICA
– CYCLOPEDIA OF DRUG PATHOGENESY

Earnest Albert Farrington
You must acknowledge, that Materia Medica is the
most important of all branches. You cannot
understand it unless you have a thorough knowledge
of the others. You must learn symptoms and not
mere words, and you cannot put any idea into them
until you know their meaning; and unless you can
interpret symptoms, you can never learn the genus
of a drug.

• COMMIT OURSELVES THROUGHLY BEFORE
‘ADDING ON’ TO MATERIA MEDICA

§ 144, Organon of the Art of Healing
…that all conjecture,
everything merely asserted or
entirely fabricated, must be
completely excluded from such
a materia medica; everything
must be the pure language of
nature carefully and honestly
interrogated.…

• Hahnemann has completely condemned
any way of ascertaining the power of
medicine by looking, tasting, feeling or
guessing.
In his essay on a new principle he talks
about doctrine of signatures and gives it
up thoroughly, with abundant reasons.

Cooper, however, contends that homeopaths
should "fall back upon experiences deduced from
acquaintance with disease and its treatment,”.
He feels at the outset that "the doctrine of
signatures…[ought to be brought] into accord
with modern thought,” especially considering
that "the appearance of the roots or other parts
of plants very often serve as a guide to their
administration in disease, owing to…[their]
resemblance to the diseases they cure,”

• In his quest for therapeutic enlightenment, Cooper
personally resolved "to throw aside all provings and
repertories and to rely simply upon the action of the
uninterfered-with curative principle of plants, which I
believe to be none other than growth-force.
These include the "virtues of Hydrangea in Diabetes,”
which everybody knows is "the thirstiest shrub known,
especially in the act of flowering,”;
The leaves of Ledum palustre are "somewhat spear-
shaped,”, and thus its use for "penetrating wounds, bee
and wasp stings, must have been guided…by a special
morphological feature of the plant,”.

But Cooper was extremely gifted and intuitive. Consider
he prescribed mother tinctures in drop doses and
waited without repetition!!
It doesn’t take long to understand that Cooper wasn’t
right in his claim that provings do not give information.
Try getting the FOLLOWING SYMPTOMS OF CHINA OR
CINA JUST from doctrine of signatures or going into
history of plant/ species or mythology.

…will hardly ever be found curative when
there are not present disturbances of the
night’s rest similar to those the medicine
causes in the healthy… (Introduction)
Footnote to Symptom no 904: 904, 905,
933, 938, 946. Restlessness sleep at night,
with anxious, frightful dreams, after which
on waking consciousness is not quite
perfect, or the anxiety they cause
continues (934, 935) are quite peculiar to
china, see 936, 937, 939, to 947
CHINA OFFICINALIS

293. The child is very lachrymose and
complaining.
294. Weeps piteously when one attempts to
touch or lead him (aft. 3 h.).
295. Great seriousness and sensitiveness; he takes
the slightest joke on bad part.
297. Restlessness.
298. Incessant restlessness.
299. Longs for many different things.
300. Refuses everything offered to him, even what
he used to like best.
301. Cannot be quieted by any persuasion;
insensible to caresses.
CINA

§145 Footnote
• At first, about forty years ago, ………But
what shall we not be able to effect in the
way of curing in the whole extent of the
infinitely large domain of disease, when
numbers of accurate and trustworthy
observers shall have rendered their
services in enriching this, the only true
materia medica, by careful experiments on
themselves! The healing art will then come
near the mathematical sciences in
certainty.

…The homoeopathic materia
medica is the basis of
homoeopathic practice. Without
a pure materia medica there can
be no homoeopathic practice.
Therefore the purity of the
materia medica is simply a
question of life and death to all
true homoeopaths…
Dr. Walter James & Dr. Edmund Lee, Editor, Homoeopathic Physician, 1887

• HOMOEOPATHIC DRUG PROVING, BASED ON
GUIDELINES OF ORGANON

Hahnemann was helped by 50 provers in
formulating his Materia Medica Pura, apart from
himself and the referencing from Old School
Authorities.
In spite of all turbulances, frequent travelling, fighting
litigations, seeing patients, reading stuff (researching),
writing his observations (without computer or
internet), delivering lectures, fighting apothecaries,
Hahnemann still managed to prove about 99 (plus
psorinum, published in Stapf’s archives, making it a 100
remedies) remedies in his 53 years as a homoeopathic
physician!

Provers furnished Hahnemann with a written
statement of the symptoms they observed, on
which Hahnemann examined them, carefully
going over all the symptoms, and correcting
or altering them so as to make them, as far as
possible, the exact sensation or pain observed
with all its conditions and concomitants.
It is these painstaking efforts that gave us
invaluable Materia Medica Pura, viz….

148. Shuddering on one side of the face.
f.n. The occurrence of symptoms on only
one half of the body is a frequent
peculiarity of pulsatilla. Comp. 906, 921,
1073, 1074, 1077, 1098, 1099, 1100,
Rhus, belladonna, cocculus show
something similar.
PULSATILLA

F.n. to 199: The so-called tearing pains of
pulsatilla are mostly a transient drawing
tension, which always changes into a
twitching like tearing-somewhat as if a
nerve were painfully drawn out and
stretched, and then let loose with a
sudden, painful jerk. Hence the
expression. "single tearing twitching,"
167, "drawing twitching," 208, &c.
PULSATILLA

• USE REPERTORY WHEN REQUIRED; EVERY
CASE DOES NOT REQUIRE REPERTORISATION
IF YOU ARE WELL AQUAINTED WITH
ORGANON & MATERIA MEDICA

• In actual practice there are two kinds of cases that come
to every physician. One is the case that may be
prescribed for with great certainty of success on the
symptoms that are styled characteristic and peculiar
(Organon § 153.) The other is where in all the case there
are no such symptoms appearing; then there is only one
way, viz, to hunt for the remedy that, in its pathogenesis,
contains what is called the "tout ensemble" of the case.
The majority of the cases, however, do have, standing
out like beacon lights. Some characteristic or key note
symptoms which guide to the study of the remedy that
has the whole case in its pathogenesis.

• DOCUMENT YOUR CASES: BESIDES
THOROUGH CASE TAKING, INVESTIGATIONS
AND DISEASE ACTIVITY SCORES
• A FEW EXAMPLES:

DVT
• A 46 years old lady visited In May 2013 with
Venous doppler report showing Rt side DVT.
• She received Argentum nitricum in LM
potencies over an year.
• The Venous doppler repeated on 1-5-14
showed no DVT traces, only superficial
varicosities.

OBJECTIVES
•To observe the effect of
Homoeopathic drug therapy in
Chikungunya fever and in Post
Chikungunya Chronic Arthritis in a
primary health care setup.

STUDY DESIGN
•A prospective observational without control was conducted
on non-randomised subjects at Delhi Government
Homoeopathic Dispensary Aali Village (DGHDAV).

Your faith is your fate, your devotion your destiny, your
determination, your goal, your desire shapes your life.
Homoeopathic career is not for the weak, the timid,
the vacillating and the sheltered cows but for the
rebel, the determined, the strong and courageous
lions. It is for them who want to win. The survival and
success do not depend on certificates and courses but
on strength and will power in you. The blessings of all
who suffered for homoeopathy and all who will benefit
from it is waiting to bless you. Choose. Stay for ever or
go today, now.
Dr B. K. Bose

Public profile of homoeopathy– the evidence base for homoeopathic prescribing

Public profile of homoeopathy– the evidence base for homoeopathic prescribing

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