Letter from the Publisher

Homeopathy Under Review by the FDA

Monday mornings are never my best, but it was a warm spring day, and I was braced to face a pile of charts, nurse queries, and prescription-refill requests. While enjoying some pleasantries with the hospital staff and drinking some coffee, I was requested to see Dr. E., the medical chief. This was not the usual routine, and I became a little anxious and sweaty walking through the hallway to his office. “Take a seat,” I was told. “I’ve been informed that you asked the pharmacy to prescribe a homeopathic remedy to one of the patients.” I had just returned from a conference and training in Dallas, and I had been impressed with the safety and effectiveness of homeopathic medicine – I wanted to add homeopathy to my treatment repertory.

“Yes,” I told Dr. E.

“Well, the pharmacy has informed me that you prescribed arsenic to the patient,” he countered.

“Yes, well, no, yes, I did prescribe a homeopathic remedy, but it was Arsenicum, not arsenic, and homeopathic remedies are very low dosage, miniscule in dosage,” I stammered.

“What do you mean? Arsenic is a poison – and you are prescribing a poison to the patient,” Dr. E. responded sternly.

“Uh, no, yes, it is derived from arsenic, but it has been diluted over and over, repeatedly, so that in fact there is no arsenic. All that remains is the carrier, a milk sugar pill and the arsenic’s energetic imprint, but there is no arsenic, so it is not a poison, there is no poison in the remedy,” I tried to explain.

“What do you mean!” Dr. E. yelled, “Arsenic is arsenic, it is a poison, and you prescribed this to the patient!”

By now I was flustered, trying to give a quick synopsis of homeopathy and homeopathic prescribing; but Dr. E. was neither impressed nor agreeable. “I don’t want you to prescribe homeopathy to any of our patients,” he demanded, and I was excused from his office.

Homeopathy was not the only unconventional medical treatment that I had been administering in the Carville, Louisiana, leprosy hospital in 1977. I had begun to prescribe nutritional supplements, herbs, and chelation. The leprosy patients, most of whom were being treated with one or more pharmaceutical medications, were definitely interested in homeopathic and herbal remedies. Asked to use these products, most were quite eager to add them to their program. None of the patients experienced adverse effects using the remedies. Nevertheless, Dr. E. was not impressed with my explanations and asked me some time later to find a clinic elsewhere for my alternative medicine practice. (The US Public Health Service closed the leprosy hospital in the 1990s; it was used briefly by the state of Louisiana as a prison, and now it serves as a museum.)

I was later to learn that what I had been prescribing is known as “classical” homeopathy. Classical homeopathy is based on a single material, be it plant, animal, mineral, or other substance, serially diluted to create a remedy of low potency or high potency. Homeopathy’s most powerful remedies are diluted repeatedly so that the strongest homeopathic is diluted the most, the weaker homeopathic is diluted less. Neither a strong or weak potency actually contains the original material; in fact, for most remedies, the amount of dilution is thought to exceed the limit of Avogadro’s number in terms of the presence of chemical molecules in the dilution. For chemists and pharmacologists, if there is no detection of the original chemical molecule in the remedy, the remedy contains nothing and can have no therapeutic activity. However, homeopathy is based on the fact that while the chemical molecule is no longer in the remedy, there is an “energetic imprint” of the material retained that exerts a therapeutic effect. If this explanation does not make sense, it is because homeopathy is predicated on “activating” the body’s innate healing, not on drugging the system. For those who insist that healing can only ensue with the administration of a drug, a classical homeopathic remedy makes no sense. Yet strong empirical evidence and studies have established the effectiveness of homeopathy.

If homeopathy had remained “classical” with single, individual remedies, there would probably be little issue with the prescribing and sale of homeopathic remedies. However, over the last several decades, homeopathic companies have hypothesized that if one classical remedy were mixed with a second classical remedy, then the effect of the mixture would provide a different effect and a different and potentially stronger benefit. The problem with this thinking is that classical homeopathy is based on the practitioner’s prescribing a single remedy for the patient’s current condition. When two or more remedies are prescribed simultaneously, the practitioner is no longer prescribing homeopathy according to classical prescribing, known as “repertorizing.” However, when two or more remedies are used, the new homeopathic mixture is thought to have a specific therapeutic effect, such as relieving cough, calming nerves, or easing pain. The homeopathic medicine may now be prescribed based on general symptoms, and the remedy can be sold in the marketplace for that purpose. It is the sale of these homeopathic mixtures that has come to the attention of the FDA; now the FDA wishes to regulate homeopathy.

On the professional level, homeopathic medicine has become complicated by innovations in prescribing practices. Practitioners have acquired devices that measure various energies, or “energetics.” A device that has been used for many years is “electroacupuncture according to Voll” (EAV). The EAV device can be used to measure so-called weaknesses or blockages of the chi (qi). Based on measurements provided by the EAV device, a patient may be “diagnosed” with weakness in different body systems, such as the liver, kidney, or lungs. EAV practitioners use the energetic measurements the device provides to “energize” or “potentize” a water or alcohol or glycerol base with the homeopathic energetic “imprint” needed to overcome the weaknesses or blockages. In other words, the EAV device is being used to create a patient-specific homeopathic remedy.

Homeopathic remedies known as nosodes are used to treat infection and/or inflammation. Nosodes are preparations potentized from pathogens such as viruses, bacteria, and fungi. Once again, without knowledge of homeopathic principles, one can assume that a nosode prescription contains infectious organisms. However, nosode prescriptions are based on homeopathic dilution; there is no pathogen in a nosode prescription. However, it is difficult to explain that a nosode is not infectious nor contains any infectious agents. One can only imagine what the FDA will say about nosode remedies.

In April, the FDA held hearings for two days about homeopathic medicine. Let us hope that the FDA commission is not filled with doctors like Dr. E. who do not understand or condone homeopathy.

The Hypertension Game

For the healthy population, two medical conditions are fraught with a possible lifetime of medication: hypercholesterolemia and hypertension. Neither condition poses any symptomatic concern for the patient; hence the patient takes it upon good faith that the prescription is necessary as well as safe and effective. For an elevated cholesterol, the pharmaceutical du jour has become the “statin.” For high blood pressure, there is no single drug that is paramount; an antihypertensive recipe may call for a diuretic, ACE inhibitor, calcium channel blocker, beta blocker, vasodilator, or other agent. In fact, the “need” for a “statin” as well as one or more antihypertensive medications has become the bread and butter of cardiology practices. Medical protocol requires that there is adequate treatment of elevated cholesterol; the recent necessity that the “LDL” score be 70 mg/dl or less has compelled patients to swallow ever-higher doses of statins. However, with sufficient dosing of statins, this end point is usually achieved easily. Hypertension treatment is a more complex matter, given the broad number of drugs available for treatment and the need for polypharmacy. What makes blood pressure treatment challenging is that despite the use of one or more drugs, many patients fail to lower their blood pressure adequately, defined as a reading below 140/90 mmHg. For the cardiologist, this turns hypertension into a weird science experiment with ever-increasing doses of medication, as well as an increasing combination of meds. Most patients can tolerate high-dose polypharmacy, but part of the cardiologist’s treatment program is to “manage” the potpourri of side effects. The big problem is when an elderly patient is being treated for not only hypercholesterolemia and hypertension but also depression, osteoporosis, diabetes, urinary incontinence, osteoarthritis, and atrial fibrillation.

In the office I see another aspect of the hypertension game – the blood pressure measurement. I still use the out-of-fashion blood pressure cuff with sphygmomanometer manually inflating the cuff and auscultating the sounds to measure blood pressure. Many physicians’ offices are using electronically inflated cuffs that record blood pressure readings, and a growing number of patients are measuring their blood pressure at home with similar devices. Electronic devices have been upgraded, and rather than wrapping the cuff around the upper arm, newer devices can be put on the wrist or even index finger. The result is that doctor and patient are recording blood pressures, but it is infrequent that the readings in the office and at home are the same. Invariably the reading at the cardiologist’s office is elevated; however, let’s not forget the ophthalmologist or dentist who also frequently records higher readings. At the same time, the patient is measuring at home; and lo and behold, the reading is normal or at least lower. Of course, there is the well-documented “white coat syndrome”: the outpouring of epinephrine by the adrenal glands during a state of fear acts as a vasoconstrictor and increases the blood pressure. Unfortunately, if the measurement is elevated, another drug may be required to “control” the blood pressure. It may be that a 24-hour monitoring of blood pressure needs to be done to get a better assessment of the average pressure before medication is increased. However, there is another side to the white coat syndrome that is equally concerning: when the patient attempts to decrease the blood pressure measurement by lying supine and meditating quietly. Of course, a relaxed, quiet state will lower the pressure, but is that lower reading an accurate depiction of the blood pressure state throughout the hectic day? Wouldn’t it make more sense to take a reading after one has come home from doing errands or has been busy doing chores?

My final take on the game of hypertension is my curmudgeonly stance on digital devices. In my unscientific study at the office, invariably, a measurement by me manually auscultating the blood pressure, and a subsequent measurement using the patient’s device, do not match. And it is not a consistent pattern. My measurement is frequently higher; however, often it is lower – maybe one-third of the time, they do match. I admit that it is possible that I am not measuring the blood pressure properly. However, there are times when the readings diverge so much, higher or lower, that I insist that the patient invest in a new device. There is nothing to guarantee the accuracy of these devices, and when patients claim that they always get lower (or higher) blood pressure readings at home than the office, I have them do a recording in the office and compare it with my reading. The wrist and finger digital machines I find particularly suspect.

Rheumatoid Arthritis

A trip to the larger art museum in most cities generally includes a work by Pierre August Renoir, the great 19th-century French impressionist. Renoir was a prolific painter, known to have completed more than 6000 paintings, but less known is that not a few of these paintings were done while he was crippled with rheumatoid arthritis. Renoir’s arthritis progressively worsened, as there were no effective medications at the beginning of the 20th century. In the years before his death in 1919, his hands were completely mangled and gnarled, and he was unable to move his arms except with poorly controlled thrusts. Confined to a wheelchair, he still painted until the control of his arm movements completely failed. Not willing to give up art, which soothed his soul and the pain of his disease, he took up sculpture, directing a worker to place the clay according to his instructions. Nowadays, it is rare for a patient with rheumatoid arthritis to deteriorate to such a degree. After the development of corticosteroids, chemotherapy agents such as methotrexate became mainstays in RA treatment. The recent development of biologic modifying agents known as disease modifying anti-rheumatic drugs (DMARD) has revolutionized rheumatology and the treatment of arthritis. The terrible progression of arthritis has been essentially eliminated; unfortunately, these agents are extremely expensive, and insurance companies frequently balk at ongoing payment. Additionally, DMARDs pose rare but serious risk for major unrelated conditions, including malignancy and death. How can the naturopathic or integrative physician contribute to the care of the rheumatoid arthritis patient?

In this issue, Alena Guggenheim, ND, who has written previously in the Townsend Letter about the management of arthritis, discusses hormone alterations in rheumatoid arthritis and systemic lupus erythematosus. Guggenheim reviews the interrelationship of adrenal and gonadal hormones upon inflammatory cytokines that increase inflammation in both RA and SLE. She notes that the measurement of a fat-related cytokine, adipokine, is the “best marker to predict the severity of joint destruction”; an elevated adipokine before treatment initiation foretells greater severity of disease. Guggeneim’s thesis is that low adrenal and gonadal hormones will exacerbate the RA and SLE process. Her other major concern is that estrogen activity must be closely monitored and addressed. Consumption of xenoestrogens, as found in conventionally grown foods and water from plastic containers, must be curtailed. The measurement of estrogen metabolites allows the practitioner to monitor if untoward estrogen activity is being well controlled.

Jonathan Collin, MD