Homoeopathy as Evidence Based Medicine

Introduction –

In 1992 the phrase “EBM” came into being ⁽¹⁾. Although criticized by a few, by and large, it is accepted as a method to augment one’s clinical expertise and judgment.

An attempt is made here to indicate that Homoeopathy has grown, of course unwittingly, as Evidence–based Medicine. The current advances in biological science have not only reinforced the idea that this is a right method but have helped opening up a Pandora’s box for researchers in biology in general and medicine in particular.

Evidence-based Medicine (EBM) –

Evidence–based Medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patient⁽²⁾. It means one tries to integrate his/her clinical expertise with the best available external clinical evidence as well as other systematic research from related areas. In a way, it is a lifelong self-learning process. The ideas and the concepts associated with the phrase Evidence-based Medicine are discussed by Kamlesh Bhargava and Roman Jaseschke ⁽³⁾.

Homoeopathy –

Homoeopathy is a drug therapy wherein the drug effects (changes) produced by the drug on healthy human being and the changes produced in a patient by a disease are linked together by a law — the law of similars. Dr. Samuel Hahnemann (1755 – 1843), the founder of Homoeopathy put it in a descriptive way. He writes “There remains therefore no other mode of employing medicine in diseases, that promises to be of service, besides the homoeopathic, by means of which we seek for the totality of symptoms of the case of disease, a medicine which among all medicines (whose pathogenetic effects are known from having been tested in healthy individuals) has the power and the tendency to produce an artificial morbid state most similar to that of the case of disease in question” ⁽⁴⁾.

The phrase totality of symptoms’ can be regarded as a bridge linking a diseased individual (patient) and the specific medicine. Totality of symptoms denotes total picture of a disease. Essentially it means in addition to diagnostic symptoms of a disease, there will be “more striking, singular, uncommon and peculiar (characteristic) signs and symptoms —- to which the selected medicine must correspond ⁽⁵⁾. The totality of symptoms indicates individuality. For example, a patient suffering from a particular disease may need a drug A. Another patient suffering from the same disease may need the drug B as his totality of symptoms is different and corresponds to the drug B.

The application of this therapeutic law at bedside evolved over a period of time along with the progress in science in general.

 Major changes occurred during this period are noted below. It will demonstrate the progress of Homoeopathy in the past as Evidence-based Medicine.

Dr. Samuel Hahnemann had written the first edition of “The Organon of Rational Healing” in 1810. Sixth edition was written in 1842, one year before he died. He studied pathogenetic effects of 99 drugs and published the symptoms of these drugs in 2 volumes of Materia Medica Pura and chronic diseases. Thus Hahnemann improved on his method through the experience of his practice as evident from 6 editions in 32 years!

Boenninghausen (1785 – 1864) used to keep record of each patient meticulously. Between 1843 to 1862 he had 112 volumes of case records ⁽⁶⁾. Critical study of these cases as well as those of his colleagues led him to write extensively on analysis and synthesis of symptoms.

Constantine Hering (1800 – 1880) wrote 10 volumes on pathogenesis of number of drugs. In each drug he provides clinical references mentioning names of physicians and the journals. For example, 5 pages are devoted to clinical references while writing on the drug Sulphur.

James Tyler Kent (1849 – 1916), highly successful practitioner and an able teacher, through his vast clinical experience and those of others produced a repertory of Homoeopathic Materia Medica used by every homeopath even today. Repertory is an index to symptoms. Kent also mentions, in the repertory, some of the diseases and a list of drugs useful therein. C. M. Boger (1861 – 1935) through his clinical experience demonstrated that study of pathology is important in drug selection.

The information given in preceding paragraphs is convincing evidence that Homoeopathy grew on clinical experience and related scientific progress. Dr. Eidherr studied 107 cases of pneumonia, in a hospital between 1850 to 1859 to decide the dosage of the drug. Statistical analysis was made. This appears to be the first observational study in the history of Homoeopathy ⁽⁷⁾.

From 1920 onwards the practice of Homoeopathy declined in America, Europe and other countries. It is beyond the scope of this paper to discuss this issue.

Present scenario –

Currently there is an upsurge of interest in alternative/ complementary medicine amongst which Homoeopathy has aroused worldwide interest. However, fundamental issues through research are tackled at very few places. Bellavite and his group have extensively reviewed the clinical studies in Homoeopathy. ^(8,9). It is necessary to demarcate a definitive integrated approach to resolve the baffling questions related to Homoeopathy.

Association for Research in Homoeopathy (ARH) published a book “Scientific Basis of Homoeopathy” in 1990. System approach and bio molecular events at the cellular level were visualized as possible areas to explore in relation to Homoeopathy ⁽¹⁰⁾. Today systems biology and cell and molecular biology have assumed a prime role in medicine. Relevant information in these areas is given below followed by a theoretical construct to explain Homoeopathic theory and practice ⁽¹¹⁾.

Systems Biology –

Osler’s approach to human diseases based on clinical pathological correlation reign supreme in medicine from 19^th century till recently. Classification of diseases in this way was overgeneralization neglecting phenotype variants. It has been recognised now that pathobiological mechanisms extend beyond the disease defining organ systems and one needs to consider the molecular (deterministic) and environmental (stochastic) factors that govern the disease evolution from susceptibility state to preclinical pathophenotype to overt pathophenotype ⁽¹²⁾. Concepts of systems pathobiology can be applied to human disease in which genetic or environmental perturbations produce disease and drug perturbations restore normal system behavior ⁽¹³⁾.

System biology and Homoeopathy –

To illustrate the subject, I shall begin with 2 cases in practice. It is neither desirable nor possible to discuss the details of the cases. The salient features are given below.

1. Mr. X and Mr. Y, both were suffering from degenerative changes in lumbosacral region leading to pain along sciatic nerve due to impingement of the nerve root.
2. Full history of the cases revealed a few symptoms which wee different. However there was one which was more characteristic, peculiar on which the differentiation of the drugs was made.

In Mr. X pain used to come suddenly and disappear suddenly. In Mr. Y the pain used to come suddenly and disappear gradually. Mr. X received the drug Rhus tox and Mr. Y received Radium Bromide.

If we have to understand the difference as phenotype we need to know something about language and molecular biology.

Language and Molecular Biology

Genetic basis of language is being studied extensively. Patricia Bralley has tried to indicate the structural and functional correlates of words and sentences at DNA—RNA—Proteins machinery. ⁽¹⁴⁾ Max Planck Institute for psycholinguistic has a research programme investigating the molecular biology of language related to genes and proteins they encode. ⁽¹⁵⁾ May be in next few years time we will have a repertoire of biomolecules for language.

Now we will be able to analyze the two cases.

Storage (memory) of the two patients of the different descriptive words and its retrieval—

At some point in time the words were registered in the brain. The process starts with sound waves (mechanical energy) which reach inner hair cells (tympanic membrane)

Which transduce mechanical energy into electrical signals. Through auditory nerve it reaches auditory cortex. There is a specialization of the left auditory cortex for speech recognition and production, and of the right hemisphere for emotional and tonal aspects of speech. Ultimate storage of words might be in the form of proteins.

When the two patients experience pain the process is reversed, except the route is different and the vocal cord produce the sound waves of spoken words.

The drugs chosen have been shown to produce similar type of pain in healthy persons. We can deduce that DNA—RNA—Protein complex machinery has undergone similar changes temporarily, resembling the changes in the patient. According to the law of similars, the drug (drug perturbations) restore the genetic perturbations in the patient due to changes in the internal environment in turn due to degenerative changes in the spine.

Problems

I have given the example to indicate that the symptoms are most important in Homoeopathy deciding the individuality. I would like to bring to your notice that number of other aspects of the case are to be taken into consideration while formulating the totality of symptoms. The stage of the disease, rate of change of the disease process, its direction, organ/tissue involvement, pathophysiology etc. These may denote phenotype or genotype variants. One of the stumbling block in accepting Homoeopathy was the dosage in which the drugs are administered.

Drugs in Homoeopathy     

Drugs are prepared from inorganic substances, plants and animal sources. These are given in extremely minute dosage forms. For example, 30C potency (power) contains 1 part in 10⁶⁰ parts and 200C potency contains 1 part in 10⁴⁰⁰ parts of the original substance. Similarly, 1000, 10000 and further potencies are used in practice.

The material substance ultimately present in the drug was an enigma. Recently, Prof. Jayesh Bellare and his team from IIT (Mumbai) have demonstrated the presence of nano particles in some of the metal preparations used in homoeopathy. ⁽¹⁶⁾

Our attempt is to proceed with integrated approach to research in Homoeopathy wherein clinical and basic research go hand in hand.

Clinical research—We study patient as well as the drug at 3 levels.

Psycho-neural level— Symptoms

Organ systems level– Pathophysiology

Genetic cell level— Biomolecular correlations.

References —

1. Prof. Hassan Bella, Evidence based Medicine: conceptualization unto application, J Family Community Med., 2001,Jan-April,8(1):15-18.
2. David L. Sacket, Evidence based Medicine, Seminars in perinatology, vol.21,issue1,Feb. 1997.
3. Kamlesh Bhargava and Roman Jaseschke: Evidence-based Medicine: An overview, J Sci Res Medsci. 2001,octo: 3 (2 ): 105-112.
4. Samuel Hahnemann, Organon of Medicine, Aphorism 24, 6^th edition, M.Bhattacharya and Co. Pvt. Ltd. Calcutta. 1960.
5. Ibid Aphorism 153.
6. Julian Winston, The faces of homoeopathy, Great Auk Publishers. New Zealand. 1999,page 45.
7. Caroll Dunham, Homoeopathy: the Science of therapeutics, Haren and Brothers, Calcutta. Page 243-246.
8. Paolo Bellavite, et al. Immunology and Homeopathy. 4. Clinical Studies – Part 1 Evid Based Complement Alternate Med 2006 Sep; 3(3): 293–301.
9. Paolo Bellavite, et al. Immunology and Homeopathy. 4. Clinical Studies—Part 2 Evid Based Complement Alternate Med 2006 Dec; 3(4): 397–409.
10. Prof. Y. S. Apte, System Approach in Scientific Basis of Homoeopathy, published by Association for Research in Homoeopathy, Mulund (East), Bombay 400081. Page 1 to 5 and page 40.
11. Dr. S. S. Apte. Clinical Practice – Second step – Data Analysis in Scientific Basis of Homoeopathy, published by Association for Research in Homoeopathy, Mulund (East), Bombay 400081.  page 40.
12.  Joseph Loscalzo and Albert Laszlo barabasi, Systems Biology and the Future of medicine. Wiley Interdiscip Rev Syst Biol Med. 2011 Nov;  3 ( 6) : 619—627.
13. Joseph Loscalzo, Network Medicine: Systems Biology in Health and disease in Harrison’s Principles of Internal Medicine 19^th ed. McGraw Hill Education (India) Private Limited,2015, page 87_e 1
14.  Patricia Bralley. An introduction to Molecular Linguistics, Bioscience, vol.46, No2 Disease Ecology (Feb. 1996) pp146-153.
15.  www.mpi.nl publications, Defining the molecular architecture of language network. Max Planck Institute of psycholinguistics.
16.  Chikramane PS, Kalita D, Suresh AK, , Kane SG, Bellare JR. WhyExtreme dilutions reach non- zero asymptotes: a nanoparticulate hypothesis based on froth flotation.Langmuir. 2012 Nov 13;28(45):15864-75. Doi10.1021/la303477s. Epub 2012 Nov 1.