The growth of
a lie and the end of “conventional” medicine
Domenico Mastrangelo 1, Cosimo Loré 2
SUMMARY
Throughout its over 200-year history, homeopathy
has been proven effective in treating diseases for which conventional
medicine has little to offer. However, given its low cost,
homeopathy has always represented a serious challenge and a
constant threat to the profits of drug companies. Moreover,
since drug companies represent the most relevant source of
funding for biomedical research worldwide, they are in a privileged
position to fi nance detractive campaigns against homeopathy
by manipulating the media as well as academic institutions
and the medical establishment. The basic argument against homeopathy
is that in some controlled clinical trials (CCTs), comparison
with conventional treatments shows that its effects are not
superior to those of placebo. Against this thesis we argue
that a) CCT methodology cannot be applied to homeopathy, b)
misconduct and fraud are common in CCTs, c) adverse drug reactions
and side effects show that CCT methodology is deeply fl awed,
d) an accurate testing of homeopathic remedies requires more
sophisticated techniques, e) the placebo effect is no more “plausible” than
homeopathy, and its real nature is still unexplained, and f)
the placebo effect is nevertheless a “cure” and,
as such, worthy of further investigation and analysis. It is
concluded that no arguments presently exist against homeopathy
and that the recurrent campaigns against it represent the specific
interests of the pharmaceutical industry which, in this way,
strives to protect its profits from the “threat” of
a safer, more effective, and much less expensive treatment
modality.
key words: homeopathy • controlled clinical trials • placebo • homeopathic
remedies • clinical research • pharmaceutical industries • law
of similars • pharmacogenetics
BACKGROUND
The August 2005 issue
of “The Lancet” contains
a coordinated attack of the medical establishment against homeopathy
[1] based on a report according to which a meta-analysis of
homeopathic clinical trials would show that homeopathy is no
more effective than placebo. On the force of this, two other
short but triumphant reports emphatically declare the “end
of homeopathy” [2] and the fi nal return of the light
of “truth” in medicine [3]. As professional physicians
and researchers, we would like to distance ourselves from the
positions expressed in the above-mentioned papers and show
that this new campaign against homeopathy is based on lies
rather than truth and represents a step toward the end of “conventional” medicine
rather than that of homeopathy.
THE EVER-CHANGING “TRUTHS OF “CONVENTIONAL” MEDICINE
In his “Lectures on Homeopathic Philosophy” [4],
James Tayler Kent, one of the founders of homeopathy in the
United States, gives us an extraordinary picture of conventional
medicine: ““...hence we may see, in this century,
a medical convention of a thousand physicians who rely entirely
upon experience, at which one will arise and relate of his
experience, and another will arise and tell his experience,
and the talkers of that convention continue to debate, and
no two talkers agree. When they have fi nished they compare
their experiences and that which they settle upon they call
science, no matter how far they may be from the truth. Next
year they come back and they have different ideas and have
had different experiences and they then vote out what they
voted in before… This is the wrong direction. The science
of medicine must be built on true foundation....Old-fashioned
medicine denies principle and law, calls its system the “medicine
of experience”, and hence its doctrines are kaleidoscopic,
changing every year and never appearing twice alike””.
How true this last sentence is can be easily appreciated if
we consider that in 1994 [5] and 1997 [6] “The Lancet” itself
published two important papers in which, using arguments and
methods identical to those reported by Shang [1], the authors
reached the conclusion that homeopathy is more effective than
placebo. Given the ever-changing nature of truth in conventional
medicine, would it not be wiser to wait for the next Lancet
report on this subject before proclaiming the end of homeopathy
[3]?
WHAT’S WRONG WITH THE PLACEBO?
Detractors of homeopathy worldwide compare it to placebo to
implicate its uselessness. However, for a more accurate evaluation
of the placebo effect and its signifi cance in conventional
medicine, a few significant facts appear worthy of consideration:
1. the real nature of the placebo effect is unknown;
2. it has never been explained in terms of interactions between
molecules and hence must be based on “immaterial” interactions,
if any (something like the “vital force” in homeopathy);
3. “immaterial”, and hence non-measurable, interactions
are commonly discarded as unproven by conventional medicine.
On the other hand, this is the subject of the current dispute
between homeopathy and conventional medicine;
4. nevertheless, conventional medicine looks at the placebo
effect as something “real”. As a matter of fact,
controlled clinical trials are commonly planned to include
a “control” group of patients to be treated with “sugar
pills” and therefore the placebo effect, although mysterious
and unexplainable, is still an integral part of the culture
of conventional medicine. It would be good to know why homeopathy
should not be treated in the same way;
5. in spite of all the above, the placebo still has a curative
effect since it refers to people cured by the administration
of a “sugar pill” instead of an active drug. Should
we still consider the placebo as a sort of unwanted effect
of treatment, or would it perhaps be wiser and more advisable
to try to better understand its nature and, eventually, exploit
it to reduce the incidence of adverse or fatal drug reactions
[7]?
“CURE THE INDIVIDUAL, NOT THE DISEASE!” (S.F.
HAHNEMANN)
(AND RESPECT HIM AS MUCH AS YOU CAN!)
It is a well-known fact that the US Institutes
of Health (NIH) long since created the National Center for
Complementary and Alternative Medicine (NCCAM) dedicated to
exploring complementary and alternative healing practices in
the context of rigorous science, training complementary and
alternative medicine (CAM) researchers, and disseminating authoritative
information to the public and professionals [8]. Although this
may not necessarily be an argument in favor of homeopathy,
it would appear at least bizarre to the average US citizen
that his/her income is being used to fi nance NCCAM research
on placebo or other useless drugs. On the other hand, it is
also very well known that the number of people resorting to
homeopathy is around 500 million worldwide [9], which is quite
a fi gure to ponder and investigate for a type of medicine
which is no more effective than placebo. Overall, Dr. Shang
and colleagues, having come to the conclusion that homeopathy
is not superior to placebo, do not seem to give much thought
to the fact that thousands of medical professionals, hundreds
of institutions, and, as already mentioned, hundreds of millions
of individuals worldwide believe in homeopathy, use it, and
work on it. Should we consider them all foolish, idiots, or
visionaries? We prefer to leave the burden of the answer to
Dr. Shang and colleagues [1]. It is a fact, however, that with
this new paper, conventional medicine attempts once again to
confirm its presumed supremacy not by demonstrating it with
facts, but rather by dismissing anything else as false or useless.
Since its early days, homeopathy has dealt with
sick individuals rather than diseases; the respect of the individual
is, therefore, the cornerstone of any homeopathic treatment.
Apparently, the same does not apply to conventional medicine,
which continues to use its “congenital” arrogance
and lack of respect for anyone else’s opinions and beliefs.
No wonder, therefore, that an ever-increasing number of patients
resort to homeopathy as the main treatment for their ailments,
and this number continues to increase in spite of the violent
campaigns, inspired and largely financed by multinational drug
companies, against “complementary” medicines.
THE CONTROLLED CLINICAL TRIAL:
THE APOCRYPHAL
GOSPEL OF “CONVENTIONAL” MEDICINE
The Lancelot campaign against homeopathy
was launched by experts on controlled clinical trials and it
is therefore based on the unproven assumption that the CCT
methodology is reliable, repeatable, accurate, and infallible.
This is simply not true. In 1991, Dr. Harris L. Coulter [10],
in his book “The Controlled Clinical Trial: An Analysis”,
reported that “CCT cannot guarantee drug safety and efficacy
because the theoretical requirements of CCT are both unrealistic
and unscientific”. This point of view was more recently
confirmed by scientists who reported that there is no evidence
for large-scale CCTs other than the vested interests of the
pharmaceutical industry to defy sound arguments which demonstrate
that the methodology of these studies is deeply fl awed [11].
As a matter of fact, CCT methodology is based on the unrealistic
and unscientific assumption that any given disease shows the
same characteristic features in different individuals and,
therefore, can be treated in the same way. In the real world,
however, there is no such thing as two identical individuals.
Dr. Coulter therefore concludes: “The CCT can never tell
a doctor how a given patient will react to a given drug at
any given time”. The relevance of individual differences
in drug treatment is highlighted by pharmacogenetics, a relatively
new branch of conventional medicine, confirming that this point
of view does not belong to homeopathy only [12,13]. On the
other hand, the unpredictability of the individual response
to drugs is confirmed by countless reports of deaths from adverse
drug reactions, leading US magazines and newspapers to claim
that “the FDA approves deadly drugs, and delays lifesaving
therapies” [14], or prestigious scientifi c journals
to declare that it is time for the creation of a new black
box warning and withdrawals for prescription medications [15].
According to Dr. Coulter, the CCT has become
popular primarily for political reasons [16]. Given its costs,
it is used by pharmaceutical companies to limit competition
and raise the costs of medications to the public. But monopolistic
objectives are not the only built-in fraud feature of the CCT.
Fraud in the safety testing of drugs is a strong likelihood,
since investigators may receive more than one million dollars
annually (in 1991!) from their testing programs. Among the
most frightful examples of dishonesty, fraud, negligence, and
other kinds of wrongdoing in clinical trials, the author mentions
the trials of a drug designed to prevent kidney transplant
rejection which led to 85 deaths among the 650 patients participating,
and not one of these deaths was reported to the Food and Drug
Administration (FDA). This trend towards fraud in CCTs has
not changed very much, but rather increased in recent years:
as reported by Nature [17] the attorney-general of New York
State sued GlaxoSmithKline (GSK) for allegedly suppressing
negative results of trials that tested the safety and efficacy
of four different studies on Paxil. Fraud in clinical research
and CCTs has been reported by some important scientific and
medical journals, such as the British Medical Journal [18],
Science [19], the Journal of Internal Medicine [20], and The
Lancet itself [21]. With this picture in mind, the reader may
now evaluate more objectively the clinical and scientific relevance
of the methodology behind CCTs and fi nally understand why
large collections of such investigations, as performed in meta-analyses,
would only lead to confusing, uncertain, and misleading conclusions.
HOMEOPATHY AND CCT: INVESTIGATING GALAXIES WITH MICROSCOPES
(OR CELLS WITH TELESCOPES)
It is known that pharmaceutical companies
look at the CCT as the gold standard (“gold” in
this circumstance having apt symbolic value) for drug testing,
although, as we have seen, this is an unrealistic and unscientifi
c procedure, heavily compromised by economic interests, dishonesty,
fraud, negligence, and many other kinds of wrongdoing. But
what is really wrong with CCT methodology and indicates that
no comparison can be made between conventional and homeopathic
medicine based on it? A practical example will clarify this
crucial issue. Let us suppose that a pharmaceutical company
has to test the effi cacy (and safety) of the new drug “ASA” (acetylsalicylic
acid) in the treatment of fever. According to CCT methodology,
one would simply select a group of patients with fever, assign
them, through the process of “randomization”, to
either the active drug (ASA) or a placebo treatment, and look
for differences in response. Hence: one disease (or symptom) – one
treatment.
Homeopathy, in contrast, teaches us that
fever may manifest differently in different individuals and
it may depend on several diverse causes. Therefore, homeopathy
will use Aconitum to treat a fever with sudden onset, Arsenicum
Album for a feverish, anxious, and fidgety child, Belladonna
for a feverish child who has chills and a flushed and heated
face and body, Bryonia for fever with strong thirst, Chamomilla
for fever associated with teething, Ferrum Phosphoricum for
moderate fever, Gelsemium for the child who sustains a fever
and whose whole body feels achy and flushed, Mercurius solubilis
for the feverish child with offensive-smelling breath, body,
stool, and/or urine, etc. [22–25], continuing with a
list of tens or maybe hundreds of different remedies, each
with a single and extremely specific indication. It is easy
to see that limiting the homeopathic treatment to one remedy
for a single indication, with no further specifi cation, would
inevitably end up destroying the essence of homeopathic treatment
itself, thus resulting in ineffective treatment. It is also
clear that the current CCT methodology is still largely imperfect
and cannot be applied to an eminently non-speculative, empirical,
and pragmatic science such as homeopathy.
IS THERE ANY PLACEBO EFFECT IN VETERINARY HOMEOPATHY?
Although controversial, homeopathy has gained
large popularity in veterinary medicine [26] and, as has been
recently reported, its intrinsic effi cacy is sometimes so
convincing that evidence against it, highly desired by the
veterinary medical establishment, is largely disregarded by
its routine users [27]. Clinical and laboratory evidence suggests
that homeopathy is effective beyond any reasonable doubt, as
recently demonstrated, for example, by controlled clinical
trials investigating the immunomodulating effect of water extracts
of Calendula Officinalis in animals [28], but apparently there
is no convincing evidence for the supporters of the placebo
effect of homeopathic treatment. However, the presumed or understood
existence of a placebo effect in animals still deserves a few
words of comment. The placebo effect is considered a psychobiological
phenomenon that can be due to different mechanisms, which Med
SciMonit, 2005; 11(12): SR27-31 Mastrangelo D et al – The
growth of a lie and the end of “conventional” medicine
SR29 SR include, among others, the expectation of clinical
benefits. As recently reported, placebo research underscores
the instability of the human mind and its somewhat dangerous
tendency to be manipulated not only in a positive (placebo),
but also in a negative sense (nocebo), depending on the individual
psychological traits and concerns and the ongoing psychosocial
context [29]. Have animals the power to reason whether a given
treatment is going to work or not? Can any animal be aware
of the treatment to be administered to it? Can any animal be
skeptical about an alternative medical approach, as a person
might? It is evident to us that homeopathy’s effi cacy
in successfully treating animals goes a long way to debunking
the claims of those who believe that its effects are “only
placebo” [30].
...MORE
ABOUT THE “TRUTH” IN MEDICINE
In the article entitled: "Homeopathy: the
growth of truth" [3], Dr. Vandenbrouke reminds us that "the
ultimate proof" of the efficacy of conventional medicine “is
that it makes progresses in preventing, alleviating and curing
disease ever more efficiently”. It is very diffi cult
to share such enthusiasm and trust in conventional medicine
if we look, for example, at the yearly tribute paid in human
lives to the use (and often misuse) of toxic drugs approved
for use in man after fraudulent or misconducted “controlled” clinical
trials. Estimates report a death toll from adverse drug reaction
of 108,000 in the United States during the year 1996 alone
[31], but it is clear that this figure must be much higher
[32]. Moreover, since medical research worldwide is in the
hands of drug companies, it is very hard to figure out how
and why they should become involved in any kind of disease
prevention campaign, their business being, as it is, strictly
dependent on the perpetuation of human sickness [33]. Finally,
while it is clear that conventional medicine can and does alleviate
symptoms, it is also evident that very often it cannot go any
further than that. Lifelong treatments with corticosteroids,
pain killers, antidepressants, antihypertensive, anti-diabetics,
antibiotics, and chemotherapeutic agents offered to patients
by conventional medicine do not exactly correspond to the idea
behind the concept of the curative power of medicines.
...AND MORE ABOUT THE “END” OF
HOMEOPATHY
The anonymous author of the article "The
End of Homeopathy" recommends: "Now doctors need to be bold
and honest about homeopathy’s lack of benefit, and with
themselves about the failing of modern medicine to address
patients’ needs for personalised care”. As we have
shown above, the “failing of modern medicine to address
patients’ needs for personalised care” largely
depends on ignorance, arrogance, and disrespect for others’ opinions
and beliefs, so typical of conventional medicine and exemplarily
represented in the last Lancet paper on homeopathy. As for
the “boldness” and “honesty” doctors
should adopt in reporting homeopathy’s presumed lack
of benefit, we would like to remind the reader that the effectiveness
(and safety) of homeopathy is demonstrated beyond any reasonable
doubt by the number of patients resorting to it and the countless
cures reported worldwide for about two hundred years, with
no side effects. The same, obviously, does not apply to conventional
medicine, and this is the reason why we would rather like to
recommend boldness and honesty to all those physicians who:
a. under the sponsorship of pharmaceutical companies and because
of it conceal year after year the hecatomb of deaths, adverse
drugs reactions, and similar disasters from the public view
by referring and publishing only the positive results of their
controlled clinical trials;
b. by using CCT methodology contribute to the FDA approval
of prescription drugs such as Rezulin, Lotronex, Propulsid,
Redux, Pondimin, Duract, Seldane, Hismanal, Posicor, Raxar
[34], just to mention a few examples, that have had to be withdrawn
from the market since 1997 because of harmful and potentially
lethal side effects;
c. in spite of all this information continue
(or pretend) to ignore that adverse drug reactions are between
the fourth and sixth leading cause of death in the USA [35]
and that the real figure is largely underestimated [32], thus
implying that the true amount of human lives annually sacrificed
for the sake of the business of drug companies must be kept
concealed from the public.
CONCLUDING REMARKS: “CUI PRODEST” (WHO’S
AFRAID OF HOMEOPATHY?)
Any open-minded physician should reasonably
welcome new treatments such as homeopathy which show effectiveness
and lack of toxicity. The same should apply to patients who,
with “unconventional” medicine,
can finally fulfil their need for less toxic drugs, individualized
treatments, and a closer relationship with their doctors. But
what about the drug companies? The growing popularity of homeopathy
and complementary medicine represents the most serious challenge
and is a constant threat to their multi-billion-dollar business.
No wonder, therefore, that they would invest considerable amounts
of money in detractive campaigns against homeopathy, even if
with poor results. Given all the above, we believe that no
bold and honest person, whether physician, scientist, or researcher,
should continue to support the drug industry and its businesses,
at least not until it becomes clear to all that medicine is
one, and that its only and higher scope is curing of the sick.
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