Depression 

Homeopathy: Correcting the Record

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I was most displeased today to have read a recent opinion piece against the teaching of homeopathy in naturopathic medical schools, by Nelson, Perchaluk, Logan, and Katzman.1 While I support open dialogue about all aspects of the profession, such dialogue should be according to factual information. Such inaccuracy because this article presents demands an answer.

Article Rebuttals

Misunderstood Theory

Firstly, the authors possess a misunderstanding from the history and theoretical foundation of homeopathy that is truly remarkable for naturopathic doctors, theoretically educated within the subject. They state that homeopathy “is a Westernized theoretic approach first proposed by Samuel Hahnemann ; he and his followers maintained that ultradiluted substances may correct the physiologic imbalance of an unwell individual.” Homeopathy, however is not in line with the utilization of ultradiluted substances, as the authors assert. Rather, homeopathy is the use of the law of similars, as best articulated by Samuel Hahnemann, though not discovered by him. The law of similars is every bit applied when one utilizes a tincture or perhaps an ultramolecular preparation. Most of the key purposes of herbs from the empirical literature were explored in this way, giving rise to many longstanding and key botanical treatments still used within naturopathic medicine. Juniperus communis, for example, can be used extensively in crude tincture for issues for example bladder infections with discharge2 and a quantity of indications almost identical than its homeopathic usage. Other longstanding herbs are also utilized successfully according to homeopathic indications and often-unacknowledged homeopathic provings.3 These include Aconitum napellus,4 Atropa belladonna,5 as well as modern drugs for example nitroglycerine.

Nitroglycerine, because of its own extensive use in modern allopathy, deserves special mention like a medicine. Glonoinum, as nitroglycerine is named in the homeopathic materia medica, was first delivered to the interest of drugs by Constantine Hering, among the great homeopaths of the 19th century and something of Hahnemann's noticably pupils. The initial outcomes of the nitroglycerin proving were published in 1851 , and symptoms produced by administration from the substance were incorporated in the materia medica and grow there even today.6 As demonstrated in the wonderful historical analysis of Fye,7 this substance was later passed on to Field and Murrell, who, both affected by homeopathic physicians, experienced an inadvertent proving by touching some of the substance. As a result nitroglycerin was introduced to allopathic medicine and gradually displaced the older drug of choice, amyl nitrate. To this day, this substance remains a mainstay of allopathic cardiology and is an extremely widespread application of the law of similars in crude doses.

Misunderstood History

The authors also allege that the law of similars was the product of Hahnemann's experiments with ultradilute substances. This assertion is incorrect. The law of similars is a therapeutic principle that's present inside the most well-known textual sources available. The Ebers Papyrus8 of 1500 BCE offers several prescriptions that directly connect with the law of similars, such as treating blindness with pig eyes, or headaches with fish heads.9

The most notable example of the law of similars, however, is found in the Hippocratic Corpus10:

The pains will be removed by means of their opposite, each according to its very own characteristics. Thus, heat corresponds to a warm constitution that's been made ill by the cold, and so forth for the others. A way of removing pain may be the following: an illness develops by way of its like and it is cured by way of using its like. Thus, what causes urinary tenesmus in health cures it in disease. Cough is caused and cured by way of the same agent, as in the case of urinary tenesmus. Another method: the fever causing the growth and development of inflammation is going to be caused and cured through the same agent. Sometimes, it will be cured by the complete opposite of its cause.10

This text clearly points to the awareness of a law of similars, one among several therapeutic options at the disposal of physicians of times. The idea is also mentioned in a number of other works of note, such as those of Paracelsus,9 in addition to many other authors inside the empirical tradition of drugs, as described by Coulter.11,12 A whole book on the study from the simile in medicine was published in 1936, by Boyd.13

Again, the law of similars is not an invention of Hahnemann; it is a practical observation that precedes him by at least 3000 many was explicitly mentioned roughly 2000 years before within the Hippocratic Corpus. Hahnemann's great innovation was the thought of the proving, the thought of administering medicines to the healthy as a way of determining, in advance, their medicinal properties.

Prior to Hahnemann, the only system of discovery of therapeutics was either according to theory, like the systems of Cullen and Brown, or via learning from mistakes. Hahnemann's discovery, the very first time in medicine, opened up the potential of using prior research on substances, and was based on a strong theoretical foundation of application – the one that, as we can observe in the case of nitroglycerine above, is still applied successfully today, if unconsciously. Hahnemann's publishing of the principle in 179614 would be a major milestone in scientific research, and one that, even today, has not been replicated or substituted with those beyond homeopathy.

Using this process, Hahnemann noticed that patients displayed a peculiar sensitivity to well-selected drugs. As a result, they required far smaller doses compared to immense ones widely used in medical practice at that time. Hahnemann began reducing those doses of the drugs he used, based on the law of similars, and achieved far better and less toxic results . This phenomenon was referred to as early as 1801 in the essay “On the Power of Small Doses of drugs in General and Belladonna particularly.”15 Over the next several decades, Hahnemann observed increasing medicinal powers of remedies, increasing their strength with increasing degrees of trituration, dilution, and succussion.16

In short, the principles of dilution and succussion were a subsequent discovery of Hahnemann, predicated on the sensitivity of his patients to well-selected medicines. Clearly, the law of similars does not grow out of the experiments of Hahnemann, as incorrectly stated by Nelson at al.

Further historical inaccuracies could be identified later in Nelson et al's article once the authors assert that Hahnemann disparaged providers who sought environmental reasons for illness. In the seventh aphorism from the Organon,17 Hahnemann explicitly mentions installments of diseases in which you will find occasioning or maintaining causes to become removed, providing examples, in his Footnote 7, of environmental influences, mechanical injuries, and poisonings. Nelson et al also assert that Hahnemann also disputed that any approach other than homeopathic was ever curative. That as well is plainly contradicted with a close reading from the Organon. Aphorisms 286-291 from the sixth edition plainly describe the efficacy of measures for example magnetism, mesmerism, as well as therapeutic baths , which was gaining interest throughout Europe at that time but had not reached the peak of fame it would attain under Father Sebastian Kneipp after Hahnemann's death in 1843. It is also asserted that the daddy of contemporary naturopathy, Dr Benedict Lust, did not incorporate homeopathy into his practice. This is; however, it is remiss to say this while failing to mention that homeopathy was incorporated into the practices of other figures important to the introduction of naturopathic medicine, such as Henry Lindlahr,18 John Bastyr19 and Otis G. Carroll.

Homeopathy Has Not Been Disproven

Nelson et al also assert that homeopathy has been disproven, both in terms of chemistry and numerous studies. This is not correct, and would be evident to anyone with a cursory knowledge of the study about them.

Potentized testing of ultramolecular preparations has been performed since at least the 19th century and it has consistently delivered positive results. I have documented these produces a article by myself website.20 The most recent review paper about them, by Endler et al,21 provides an excellent synopsis of the research, including 128 in-vitro laboratory studies of ultramolecular preparations, of which 98 were replications. Of those replications, 70.4% got a new similar result as that reported in the original publication, 20.4% obtained an inconclusive result, and 9.2% an opposite result. At the date of publication , 5 designs include been independently replicated. Probably the most notable could well be the upgraded basophil model.

The original basophil model, developed by Benviniste and published in Nature in 1988,22 was a test purportedly demonstrating that basophils could be made to degranulate having a homeopathic preparation of IgE. Based on the late Dr Peter Fisher, this model, because of being according to normal cells, was replicable about 30% of times. However, recently a more recent model23 was developed that was according to pre-sensitizing basophils – ie, exposing these to homeopathic preparations of histamine – and afterward measuring the proportion of cells that degranulated. Dr Peter Fisher reported this method to be about 60% replicable. Indeed, this model was replicated in 3 independent labs in 2009, and in several more since, 1 being featured in the following paragraphs.24

Homeopathy is Backed by Quality Studies

Nelson et al also assert that homeopathy has no good-quality, well-designed studies demonstrating results better than placebo. The main source they quote for this may be the recent report on homeopathy through the National Health and Medical Research Council .25 This report, while widely touted in media for its findings, presents numerous oddities, which were compiled by the Homeopathy Research Institute .26

  1. NHMRC completed 2 reports: one in 2012, and a publicly released one out of 2023.
  2. The information on the very first report was concealed in the public, only to be found through Freedom of Information requests.
  3. NHMRC rejected the first report despite it being conducted through the author of NHMRC's own research guidelines.
  4. FOI requests confirmed that Fred Mendelsohn, a member of the NHMRC's oversight committee, confirmed the first report to constitute top quality.
  5. NHMRC publicly reported that its 2023 assessment was based on “over 1800 studies”; actually, it had been based on only 176 studies.
  6. NHMRC used a criterion – that has never been validated, nor used before or since – of requiring a threshold of 150 participants inside a study before considering it; of note, this figure is slightly above the number of 144 in a single NHMRC trial of high methodological quality on childhood diarrhea.
  7. The unique rule for this review led to 171 from the 176 studies being discarded, leaving 5 negative studies to form the basis of the conclusion.
  8. Members of the NHMRC committee have misrepresented themselves when it comes to reporting conflicts of great interest towards the committee, in that Peter Brooks was a member of an anti-homeopathy lobby group but failed to disclose this.
  9. The committee included not a single expert on homeopathy in its review, producing a quantity of misrepresentations and misunderstandings of homeopathic practice within the report, despite NHMRC guidelines requiring the presence of such an expert.*

Because of these oddities, the HRI initiated a complaint towards the relevant government ombudsman, that was found to be of sufficient merit to warrant a taxpayer-funded investigation.27 HRI continues to update the general public regarding the progress of this investigation, which remains ongoing.+

Aside from counting on the questionable NHMRC report, Nelson et al declare that homeopathy is affected by low-quality studies and offers no convincing argument for benefit beyond placebo. They cite several meta-analyses. One of these meta-analyses focuses on a single homeopathic indication , and another concentrates on a particular group of conditions , as opposed to concentrating on homeopathy as a whole. Another is the infamous Shang meta-analysis,30 which, like NHMRC's report, was launched to wide and uncritical media dissemination. This meta-analysis, however, also contained numerous irregularities, which have been detailed by HRI as follows:

  1. Despite advertising itself to be with different comparison on 110 comparable trials of homeopathy and allopathic medicine, Shang's analysis took it's origin from 8 homeopathy trials and 6 allopathic trials.
  2. If the analysis had been conducted on all 21 higher-quality trials, the meta-analysis might have found the alternative result.
  3. If 1 from the 8 studies was eliminated from the analysis, Shang would have found the alternative result.
  4. The 8 tested trials were all conducted using non-individualized homeopathy.
  5. Amazingly, the originally published study did not state which trials it employed for comparison. After much question and media furor, Shang did eventually release this information, but only 4 months later, following the media had lost interest and after a highly effective response had become possible.

Although Nelson et al included some reviews on specific conditions, they omitted a current systematic review on depression that revealed some limited positive evidence from 2 placebo-controlled, randomized numerous studies and a great risk:benefit ratio.31 The rest of the 2 meta-analyses are members of a long-term series done by Robert Mathie, beginning in 2023. This series consists of several meta-analyses of countless portions of the homeopathic research literature. Specific analyses were conducted on RCTs of individualized homeopathy,32 RCTs on non-individualized homeopathy,33 as well as on non-placebo-controlled trials.34 Nelson et al cite the 2nd and third meta-analyses – each of which could not reject the null hypothesis – yet neglect to discuss Mathie's first meta-analysis of individualized controlled RCTs – which yielded an optimistic result and which became more positive with higher qualities of evidence. The evidence, while certainly not unambiguously positive because of the higher-than-optimal level of bias in trials, points quite clearly to homeopathy using a greater-than-placebo level of efficacy. This is Mathie's earliest and many famous meta-analysis. That Nelson et al might have awareness of the 2 negative meta-analyses while neglecting to even mention the fir positive one, by chance, stretches credulity – even more so within their inclusion of countless negative meta-analyses outside of this main series by Mathie with no inclusion of the recent positive one on depression. Quite simply, Nelson et al are omitting specific trials to aid their opinion.

Conclusions

The latter portions of the article by Nelson et al detail the research around the 'placebo effect' in medicine, and can include the authors' beliefs concerning the plausibility of homeopathy and the ethics of prescribing homeopathy when one believes it to be a maximum of a placebo.

As we can see, this opinion piece is founded on a misrepresentation of openly available data. The extent of this misrepresentation suggests that it is a deliberate attempt to mislead readers concerning the true state of research in homeopathy and also to create an unfavorable opinion relating to this therapy within the profession.

Nelson et al, within their presentation of research literature, have uncritically accepted literature that is itself problematic and under government investigation. This may be regarded as simply a result of a superficial knowledge of the research into homeopathy; however, their quoting from the 2 negative meta-analyses by Mathie, while omitting and never even mentioning the positive one – in addition to completely ignoring a recent positive meta-analysis on homeopathy in depression while quoting several negative meta-analyses on specific conditions – does advise a level of intent. Such an oversight can't be due to chance, superficial knowledge, or mere incompetence; it may simply be due to deliberate intention to deceive.

Homeopathy comes with the groundwork in evidence, and is entirely sensible and understandable considering the historical growth and development of medicine in the western world. Criticism of the teaching of homeopathy in naturopathic colleges is unquestionably warranted. The basic principles of homeopathy in many cases are poorly taught, specifically in schools where homeopathy was marginalized towards the extent permitted by CNME guidelines, and lots of students often graduate with no ability to apply homeopathy to clinical practice. Indoctrinating students into believing – against the available laboratory and clinical evidence – that homeopathy is certainly not but a placebo, and encouraging these to look “critically” at Hahnemann's life and homeopathy's history is not the reply to this issue. Graduate practicing physicians, such as that offered by the recently reformed Homeopathic Academy of Naturopathic Physicians and Naturopathic Medicine Institute§ may be the solution, since it produces physicians skilled within the use of homeopathy, both in and of itself as well as in the context of whole-person naturopathic care.

The current homeopathic education of naturopathic physicians, when done well and never marginalized, either formally or informally, does provide a great platform that those that desire this advanced graduate training can acquire it. The precedents with this approach within the profession are lots of, with skills such as prolotherapy, numerous advanced injection procedures, many IV procedures, ozone therapies, and many others that require advanced training after graduation, when they are inside the scope of practice of a given jurisdiction. In British Columbia, where prescribing rights have increased, a graduate pharmacy course was developed by the Bc Naturopathic Association , along with an exam, to allow for the controlled act of prescribing restricted substances from the naturopathic formulary, as based on the College of Naturopathic Physicians of British Columbia. This same program, with a few small alterations, was utilized by Ontario once they received prescription rights, and will likely make up the basis of receiving these rights in Saskatchewan and Alberta, in addition to every other prescribing jurisdictions in Canada, when such rights are granted based on the scope of practice of naturopathic doctors. The greater basic pharmaceutical training received by NDs in naturopathic college is inadequate for prescribing many controlled substances safely. However, it will offer an excellent platform for post-graduate learning for those naturopathic doctors who would like to use pharmaceuticals within their practice.

I am not suggesting that homeopathy be treated like a restricted act, limited to naturopathic doctors with additional training and certifications. The extraordinarily safe profile of homeopathy should not prevent naturopathic doctors without detailed knowledge of homeopathy from prescribing. However the precedents for graduate education and special training within the profession are clearly set. It's disingenuous of Nelson at al to suggest to the inability of naturopathic graduates to achieve deep levels of expertise in an intricate discipline like homeopathy while failing to appreciate this precedent. Graduate training is paramount to the way forward for naturopathic medicine, but with no basic foundation in homeopathy, that graduate training could be significantly more difficult.

I am in favor of open discussion of facets of the profession. But such discussion must be founded on an accurate understanding, both of history and of the research available in the contemporary era. Deception and inaccuracy, such as exists in Nelson et al's article, does an immense disservice towards the profession and its ongoing discussions over education and it is future. The authors of this article should be called to take into account this deception, and the article should be retracted and rewritten on a factually correct basis.

*A presentation about this report by Rachel Roberts from the Homeopathic Research Institute are available at: https://www.youtube.com/watch?v=dWKHFsRJhWk&t=63s

+ The most recent update from HRI's Rachel Roberts are available at: https://www.youtube.com/watch?v=oTNwT53qaGc

Please visit: https://hanp.net

  • Please see: https://www.naturopathicmedicineinstitute.org/