Letter from the Publisher

The Ongoing War Against Homeopathy

Wikipedia is well accepted as a digital encyclopedia and is an important “go-to” tool for a quick introduction to any topic with detailed references. Because it is a digital research source, it is edited frequently; however, each Wikipedia topic is assigned to an “editor” and without approval from the editor, text changes may not be made. Homeopathy is a topic that is discussed in great detail—it exceeds the text length of Wikipedia’s write-up of topics such as “World War 2” and “Physics.” The introductory sidebars are headlined by support of Skeptical Inquirer, a group that has a rabid dislike of alternative medicine, naturopathy, and homeopathy. As seen below, the Wikipedia intro finds that homeopathy is unscientific, ineffective, quackery, and a sham. Any benefit from homeopathy is thought to be placebo-based or the result of “tincture of time” without any benefit from the remedy.

Despite new research studies being published, critics argue that the studies yielding positive benefits were due to poor methodology and accepted by journals with biased peer-review; the biased writing observed throughout the Wikipedia report was not considered biased. The studies evaluating homeopathy in the Wikipedia report used a pharmaceutical-based model. Accepted studies required the use of double-blinded, placebo-controlled methodology with the use of non-individualized treatment of all subject patients–this violates all the tenets of homeopathy. Where patients were not randomized, where patients received individualized treatments, there were positive benefits compared to placebo, although the Wikipedia writers called this a minimal effect. Individual case reports were dismissed outright. And, of course, homeopathy’s modus of action based on a highly diluted substance exceeding Avogadro’s number was lambasted as absolute pseudoscience; one physicist was quoted as saying that a remedy of 30C potency would require an inconceivable volume to contain a single molecule of the original substance:

Physicist Robert L. Park, former executive director of the American Physical Society, is quoted as saying:

‘…since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 [or 10⁶⁰] molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.’

Barrett S (December 28, 2004). “Homeopathy: the ultimate fake”. Quackwatch. Retrieved July 25, 2007.

None of this would be terribly of concern except for the fact that politicians and administrators just like the public use Wikipedia as a “go-to” resource to get up to speed on a topic. The Wikipedia write-up is biased with only two types of references—those that are condemnatory and those that are slanted as ineffective. Given the policy decisions that have begun to increasingly curtail public resources for homeopathic treatment, Wikipedia’s report, as shown below, becomes a manifesto to eliminate homeopathy.

BLOCK QUOTE

Homeopathy

is a system of alternative medicine created in 1796 by Samuel Hahnemann, based on his doctrine of like cures like (similia similibus curentur), a claim that a substance that causes the symptoms of a disease in healthy people would cure similar symptoms in sick people.^[1] Homeopathy is a pseudoscience – a belief that is incorrectly presented as scientific. Homeopathic preparations are not effective for treating any condition;^[2][3][4][5] large-scale studies have found homeopathy to be no more effective than a placebo, indicating that any positive effects that follow treatment are only due to the placebo effect, normal recovery from illness, or regression toward the mean.^[6][7][8]

“Hahnemann believed the underlying causes of disease were phenomena that he termed miasms, and that homeopathic preparations addressed these. The preparations are manufactured using a process of homeopathic dilution, in which a chosen substance is repeatedly diluted in alcohol or distilled water, each time with the containing vessel being bashed against an elastic material, (commonly a leather-bound book).^[9] Dilution typically continues well past the point where no molecules of the original substance remain.^[10] Homeopaths select homeopathics^[11] by consulting reference books known as repertories, and by considering the totality of the patient’s symptoms, personal traits, physical and psychological state, and life history.^[12]

“Homeopathy is not a plausible system of treatment, as its dogmas about how drugs, illness, the human body, liquids and solutions operate are contradicted by a wide range of discoveries across biology, psychology, physics and chemistry made in the two centuries since its invention.^{[7][13][14][15][16][17]} Although some clinical trials produce positive results,^[18][19] multiple systematic reviews have indicated that this is because of chance, flawed research methods, and reporting bias. Continued homeopathic practice, despite the evidence that it does not work, has been criticized as unethical because it discourages the use of effective treatments,^[20] with the World Health Organization warning against using homeopathy to try to treat severe diseases such as HIV and malaria.^[21] The continued practice of homeopathy, despite a lack of evidence of efficacy,^[6][7][22] has led to it being characterized within the scientific and medical communities as nonsense,^[23] quackery,^[4][24] and a sham.^[25]

Wikipedia References

• 1.

  Hahnemann, Samuel (1833). The homœopathic medical doctrine, or “Organon of the healing art”. Dublin: W. F. Wakeman. pp. iii, 48–49. “Observation, reflection, and experience have unfolded to me that the best and true method of cure is founded on the principle, similia similibus curentur. To cure in a mild, prompt, safe, and durable manner, it is necessary to choose in each case a medicine that will excite an affection similar (ὅμοιος πάθος) to that against which it is employed.” Translator: Charles H. Devrient, Esq.

• 2. 
 Tuomela, R (1987). “Chapter 4: Science, Protoscience, and Pseudoscience”. In Pitt JC, Marcello P. Rational Changes in Science: Essays on Scientific Reasoning. Boston Studies in the Philosophy of Science.

  98

  . Springer. pp. 83–101. ISBN 978-94-010-8181-8. doi:10.1007/978-94-009-3779-6_4.

  3. Smith K (2012). “Homeopathy is Unscientific and Unethical”. Bioethics.

  26

  (9): 508–512. doi:10.1111/j.1467-8519.2011.01956.x.

  4. Baran GR, Kiana MF, Samuel SP (2014). Chapter 2: Science, Pseudoscience, and Not Science: How Do They Differ?. Healthcare and Biomedical Technology in the 21st Century. Springer. pp. 19–57. ISBN 978-1-4614-8540-7. doi:10.1007/978-1-4614-8541-4_2. “within the traditional medical community it is considered to be quackery”

  5. Ladyman J (2013). “Chapter 3: Towards a Demarcation of Science from Pseudoscience”. In Pigliucci M, Boudry M. Philosophy of Pseudoscience: Reconsidering the Demarcation Problem. University of Chicago Press. pp. 48–49. ISBN 978-0-226-05196-3. “Yet homeopathy is a paradigmatic example of pseudoscience. It is neither simply bad science nor science fraud, but rather profoundly departs from scientific method and theories while being described as scientific by some of its adherents (often sincerely).”

  6. Ernst, E. (2002). “A systematic review of systematic reviews of homeopathy”. British Journal of Clinical Pharmacology.

  54

  (6): 577–82. PMC 1874503 . PMID 12492603. doi:10.1046/j.1365-2125.2002.01699.x.

  7. Shang, Aijing; Huwiler-Müntener, Karin; Nartey, Linda; Jüni, Peter; Dörig, Stephan; Sterne, Jonathan AC; Pewsner, Daniel; Egger, Matthias (2005). “Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy”. The Lancet.

  366

  (9487): 726–732. PMID 16125589. doi:10.1016/S0140-6736(05)67177-2.

  8. “Evidence Check 2: Homeopathy – Science and Technology Committee”. British House of Commons Science and Technology Committee. February 22, 2010. Retrieved April 5, 2014.

  9. Hahnemann S (1921). The Organon of the Healing Art (6th ed.). aphorism 128. ISBN 0-87983-228-2.

  10. “Dynamization and dilution”. Complementary and Alternative Medicine. Creighton University Department of Pharmacology. Archived from the original on August 26, 2002. Retrieved March 24, 2009.

  11. “Homeopathic drugs: No better than placebos?”. The Washington Post. December 21, 2015. Retrieved December 22, 2015.

  12.

  Hahnemann S (1833). The Organon of the Healing Art (5th ed.). aphorisms 5 and 217. ISBN 0-87983-228-2.

  13.

  Ernst, E. (December 2012). “Homeopathy: a critique of current clinical research”. Skeptical Inquirer.

  36

  (6).

  14.

  “Homeopathy”. American Cancer Society. Retrieved October 12, 2014.

  15. UK Parliamentary Committee Science and Technology Committee – “Evidence Check 2: Homeopathy”

  16. Grimes, D. R. (2012). “Proposed mechanisms for homeopathy are physically impossible”. Focus on Alternative and Complementary Therapies.

  17

  (3): 149–155. doi:10.1111/j.2042-7166.2012.01162.x.

  17. “Homeopathic products and practices: assessing the evidence and ensuring consistency in regulating medical claims in the EU” (PDF). European Academies’ Science Advisory Council. September 2017. p. 1. Retrieved 1 October 2017. “… we agree with previous extensive evaluations concluding that there are no known diseases for which there is robust, reproducible evidence that homeopathy is effective beyond the placebo effect.”

  18. Cucherat, M; Haugh, MC; Gooch, M; Boissel, JP (2000). “Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group”. European journal of clinical pharmacology.

  56

  (1): 27–33. PMID 10853874. doi:10.1007/s002280050716.

  19. Caulfield, Timothy; Debow, Suzanne (2005). “A systematic review of how homeopathy is represented in conventional and CAM peer reviewed journals”. BMC Complementary and Alternative Medicine.

  5

  : 12. PMC 1177924 . PMID 15955254. doi:10.1186/1472-6882-5-12.

  20. Shaw, DM (2010). “Homeopathy is where the harm is: Five unethical effects of funding unscientific ‘remedies'”. Journal of Medical Ethics.

  36

  (3): 130–131. PMID 20211989. doi:10.1136/jme.2009.034959.

  21.

  Mashta, O (August 24, 2009). “WHO warns against using homoeopathy to treat serious diseases”. BMJ.

  339

  (aug24 2): b3447–b3447. doi:10.1136/bmj.b3447.

  22. Kleijnen, J; Knipschild, P; Ter Riet, G (1991). “Clinical trials of homoeopathy”. BMJ.

  302

  (6772): 316–23. PMC 1668980 . PMID 1825800. doi:10.1136/bmj.302.6772.316.

  23.

  “Homeopathy is nonsense, says new chief scientist”. The Daily Telegraph. April 18, 2013. Retrieved September 9, 2013.

  24.

  Paul S. Boyer. The Oxford companion to United States history. ISBN 9780195082098. Retrieved January 15, 2013. “After 1847, when regular doctors organized the American Medical Association (AMA), that body led the war on “quackery”, especially targeting dissenting medical groups such as homeopaths, who prescribed infinitesimally small doses of medicine. Ironically, even as the AMA attacked all homeopathy as quackery, educated homeopathic physicians were expelling untrained quacks from their ranks.”

  25. “Supported by science?: What Canadian naturopaths advertise to the public”. Retrieved January 15, 2013. “Within the non-CAM scientific community, homeopathy has long been viewed as a sham”

Russell Jaffe, MD, PhD, and Jayashree Mani, MS, CCN, on Predictive Biomarkers

Most laboratory testing is focused on establishing or confirming a medical diagnosis. Of course, it is very important to rule out a disease; and when a lab test does that, both the practitioner and the patient are assured. Contrarily, an abnormal result in laboratory screening may direct the practitioner to a diagnosis that was not even considered or assumed not to be likely. In the former scenario, a series of normal liver function tests generally dismisses liver disease; in the latter case, elevated thyroid hormone tests strongly suggest hyperthyroidism. Of course, there are many situations when an abnormal laboratory screen, while suggestive of a diagnosis, does not predictably confirm one. And, most practitioners routinely face the situation of normal lab test screening despite major acute symptom impairment. Abnormal antibody screening may suggest a disease but generally does not confirm it; chronic fatigue and fibromyalgia rarely demonstrate abnormal lab testing. Laboratory screening remains an important component of the diagnosis, and this is the primary function for running tests. What if another goal of laboratory testing was not to make a diagnosis but to assess an individual’s long-term survival and quality of life?

As challenging as that may seem, Russell Jaffe, MD, PhD, and Jayashree Mani, MS, CCN, review laboratory tests that serve as predictive biomarkers (PB) to assess one’s quality of life and likelihood of surviving for an ensuing ten years. A predictive biomarker not only must have a high degree of sensitivity and specificity but must have the capability of improving with positive changes in lifestyle and, contrariwise, worsening with negative changes in lifestyle. Antibody studies, for example, do not always have a high degree of sensitivity and specificity nor do they change with one’s lifestyle. Hence, most antibody studies would not be appropriate PB tests. While the WBC count and RBC count do have a high degree of sensitivity and specificity, these tests are frequently seen to be normal in healthy and sick individuals; hence they would not be appropriate PB tests. On the other hand, glycosylated hemoglobin (a1c), highly-specific C-Reactive Protein (hs-CRP), and homocysteine all have a high degree of sensitivity and specificity and respond positively and negatively to lifestyle changes. More importantly, optimal scores for glycosylated hemoglobin, hs-CRP, and homocysteine correlate well with greater likelihood of ten-year survival, while sub-optimal scores have lesser likelihood of ten-year survival. Furthermore, these tests serve as appropriate monitors of overall treatment success or failure.

Besides these tests, Jaffe and Mani detail five additional tests that also function as predictive biomarkers. With these eight tests the practitioner is able to provide the patient reasonable reassurance that the treatment strategy is not only sufficient for the immediate future but predicts a long-term positive outcome. When these tests are sub-optimal, the practitioner and patient are obligated to consider significant modification to treatment and lifestyle. The tests are reasonably inexpensive and can be repeated at frequent intervals providing a much more appropriate life assessment than the annual physical exam and basic lab screens.

Shalima Gordon, ND, on Assessing Testosterone and Prostate Cancer Risk

When we want information about prostate cancer risk, we usually measure a PSA level; if we are worried about low testosterone levels, we usually measure total testosterone and free testosterone. Shalima Gordon, ND, in this issue makes the case that these measurements are insufficient for understanding testosterone activity and assessing prostate cancer risk. Indeed, Dr. Gordon would argue that in order to understand testosterone activity and cancer risk we should do a thorough study of testosterone metabolites.

In 2003, the Prostate Cancer Prevention Trial (PCPT), a double-blind trial of finasteride studying 18,882 healthy males, determined that the drug reduced the risk of acquiring prostate cancer by 25%. However, the individuals using the finasteride had a 67% higher risk of developing aggressive high-risk prostate cancer.

How could this be? One of the testosterone metabolites, 3β-Adiol, known to inhibit prostate cancer cell proliferation, is generally reduced in the finasteride treatment group. Finasteride, a 5α-reductase inhibitor, blocks the conversion of testosterone to dihydrotestosterone (DHT). However, while that activity is beneficial it also blocks the production of 3β-Adiol. Hence, an assessment of the 3β-Adiol levels would provide important insight in assessing a patient’s prostate cancer risk.

David Quig, PhD, on Hip Implant Metallosis

One of the major boons in medicine during the past five decades has been hip replacement surgery. Rather than spending old age as a cripple, hip arthroplasty has restored normal functioning to countless individuals not only permitting standing and walking but performance activities such as dancing. However, total hip replacement requires implanting a prosthesis that is composed of metal. Although the metal composition was initially viewed as inert and without adverse effects on individuals, orthopedic research has demonstrated that metal on metal alloys frequently decompose, and the metals do enter the circulation before being absorbed within organ tissues. The prostheses are made from materials composed of cobalt, chromium, molybdenum, titanium, and vanadium. When the alloys decompose, elevated levels of these metals are measurable in blood and urine. In fact, very high levels of cobalt and chromium are not unusual when hip prostheses begin to decompose. For the orthopedic surgeon, routine measurements of cobalt and chromium appear to be reasonable in monitoring the status of patients who have undergone hip arthroplasty.

In this issue David Quig, PhD, examines the iatrogenic metal burdens patients face with metal-on-metal hip prosthesis surgery. Quig also reviews the important role that both oral and intravenous chelation play in removing cobalt, chromium, and other metals from the body. Not surprisingly chelation is very effective in reducing serum levels of the elevated metals. However, Quig is forthright in recommending those patients who do have evidence of metal corrosion in their metal prosthesis consider its removal rather than simply depend on chelation to reduce the burden of metallosis.

Ron McGuff Announces the Vitamin C Struggle is Over!

The past two decades saw the transition from manufactured to compounded injectables including minerals, chelation, vitamins, and more. But for the past three years, the FDA has issued a series of draconian regulations that have hindered the compounding of injectables and interfered with doctor office practices. Ron McGuff details the demise of manufactured injectables, the rise and fall of the compounding of injectables, and the recent approval by the FDA for the new manufacturing of ascorbic acid for the first time in 20 years.

Jonathan Collin, MD