The Trials of Homeopathy

The Trials of Homeopathy

  • Michael Emmans Dean

DEA200

$32.00

$29.95

Overview

This book grew out of a PhD thesis, and was awarded the first ever Hans Walz Prize of the Robert Bosch Foundation. Deanís work is comprehensive and thorough in its undertaking; a worthy discussion of both historical and contemporary homeopathic trials with a focus on the research methods, and clinical application.

A CD with additional trial data is included.

DE
305pp PB
ISBN: 978-3-933351-40-1

Details

Evidence Based Medicine (EBM) versus Science Based Medicine(SBM) Ė the debate rages the world over. Homeopathy has been marginalized for over 200 years and continues to languish as policymakers contend there is no justification for homeopathic research, and lack the political will to include historical homeopathic evidence.

Dean purses up information gleaned from his wide-ranging survey of homeopathic trials undertaken in various countries, and over a long period of time, to present this accomplishment that "connects homeopathy to its past, and to that of orthodox medicine."

From the Book

3.3.4 Drug Preparation

Hahnemann's pharmacopeia was mainly herbal in the first two decades of homeopathy, and prepared solely from liquid tinctures. Juices were expressed from fresh plants, dried plants were steeped in alcohol for several hours, and in one or two cases metallic salts of various degrees of solubility, such as Causticum, were used to make a 'tincture' which could then be further diluted as needed (Hahnemann 1805b). He modified the process of simple dilution with succussion as a more efficient means of mixing the material with the diluent, but there is no suggestion at this time that he had discovered processes which not only made the medicines safer ó the original motivation for dilutions ó but also released a hidden medicinal power. Dilutions were standardized in 1816, on a metric (centesimal) scale quite dissimilar to the traditional apothecaries' measures used in homeopathy until then. Two years later Hahnemann claimed that even substances declared to be biologically inert because of their insolubility were capable of pathogenetic and therapeutic action, after lengthy trituration with lactose, and he now began to call the process 'dynamization' and the attenuations 'potencies'.

Plausible influences from alchemy are much easier to find here than with the similia principle, provings or poisonous plants. The call for common alchemical processes such as serial dilution to be used in the preparation of medicines was frequently heard in Europe from the time of Ramon Lull (c. 1232-1315, but the works fathered on him belong to more than one author, like the Hippocratic, Jabirian and Paracelsan writings) and the experimentalist philosopher Roger Bacon (c. 1214ó92) onwards. Instructions for alchemical projection - the final process of transmuting base metal with the philosophers' stone to produce gold - demand accurately measured serial dilutions, typically of one part in 100 (Lully 1330). And, of course, the more times the process was repeated the more powerful it became, as the cynical but well-informed Ben Jonson observed in 1610:

For look, how oft I iterate the work,
So many times, I add unto his virtue.
As, if at first one ounce convert a hundred,
After his second loose, he'll turn a thousand;
His third solution, ten; his fourth, a hundred.
After his fifth, a thousand, thousand ounces
Of any imperfect metal, into pure Silver or
gold, in all examinations As good as any of
the natural mine.

Trituration of insoluble substances was another of alchemy's many processes, and in his article of 1818 on Aurum foliatum Hahnemann records how he came to adopt the practice only after reading its history in early medico-alchemical texts:

I was delighted to find a number of Arabian physicians unanimously testifying to the medicinal powers of gold in a finely pulverized form, particularly in some serious morbid conditions, in some of which the solution of gold [trichloride] had already been of great use to me. (Hahnemann 1818; 1880)

The alchemists' legendary aurum potabile (drinkable gold) had of course disappeared from European medicine by the late eighteenth century, dismissed by nearly all Hahnemann's contemporaries as a primitive superstition. He recounts the history of gold therapy in Islamic and European medical alchemy, quoting Geber's celebrated phrase materia laetificans et in juventute corpus preservans (a substance that gladdens and preserves the youthfulness of the body) that he had found in De alchemia, in the edition of 1598 brought out by Lazarus Zetzner, a leading publisher of alchemical works (Geber 1598). The book was attributed to Jabir ibn-Hayyan (c.721-c.815), the 'father' of Islamic alchemy, until the twentieth century, when it was shown that it belongs to the thirteenth century and was probably written in Europe (Newman 1991). Nevertheless, the author of the Summa perfectionis, as it is usually called, had an intimate knowledge of Arabic alchemy, and the book has always been accepted as the fountainhead of the European alchemical tradition. Interestingly, this emergence of the 'gold as elixir of life' theme in Europe in the thirteenth century ties the practice ultimately to Taoist alchemy, rather than Hellenistic Egypt as previously thought: the Chinese took the immortality theme literally, unlike the Greek alchemists, and it was transmitted to Europe via the Middle East (Needham 1974).

Hahnemann then cites Serapion the younger (c.900) and Ibn Sina for their use of gold in various conditions including cardiac disease and depression, showing his knowledge of Arabic in the process. One of the conditions Ibn Sma treated with gold could be 'talking to oneself or 'dyspnea', depending on the diacritical mark. Hahnemann claims that his proving demonstrated it was the latter and respiratory distress is certainly accepted now as an aspect of gold toxicology. The early methods of making pure gold biologically available are then detailed: Abu'l-Qasim al- Zahrawi (Abulcasis, 936-1013) first showed how to prepare gold powder by rubbing it on a rough linen cloth in a basin filled with water, and Zacutus, the Portuguese, later rubbed gold on a grindstone. Hahnemann cites over 20 more recent alchemical and medical texts that recommend gold powder - including Francis Bacon's Historia vitae et mortis (1623) - and decided the idea was worth testing empirically:

But leaving these authorities out of the question, I thought I might attach more value to the testimony of the Arabians as to the curative powers of finely powdered gold than to the theoretical unfounded doubts of the moderns.

Accordingly, trituration with lactose was introduced for the first time into homeopathic pharmacy, though it was a common technique elsewhere. Here for example are Storck's (1762) instructions for preparing aconite:

Take extract of Blue Monkshood, two grains; white sugar, two drachms; mix and grind them together for a long time in a marble mortar, to the finest powder

Hahnemann's innovation combined an existing technique for preparing dried plant materials ó previously unused by him, because he preferred to steep them in alcohol - with an alchemical technique that had been eclipsed:

I triturated the finest gold leaf (its fineness is 23 carats, 6 grains) with 100 parts of milk-sugar for a full hour, for internal medicinal use. (Hahnemann 1880)

His provers took substantial quantities of triturate:

100 grains of this powder (containing one grain of gold), and on others, 200 grains (containing two grains of gold), dissolved in water, sufficed to excite very great alterations in the health and morbid symptoms.

The results satisfied him that:

the assertions of the Arabians are not without foundation, as even small doses of this metal given in the form mentioned caused even in healthy adults morbid states very similar to those cured (in unconscious homeopathic manner) by those Orientals, who deserve credit for their discovery of remedies.

Prior to 1818, metals had been available to homeopathy only as solutions of their salts such as copper sulphate, mercury sulphides and iron acetate (introduced respectively in 1805, 1811 and 1816). This seems to have been true of post-Paracelsan iatrochemistry generally: in spite of the example of gold powder, only the nitrate of silver had been used in Europe, notably by Robert Boyle (1627ó 91) whose renowned diuretic pills Hahnemann criticized for their large doses and antipathic action in his Argentum article (1811-21). Could Hahnemann have known of J.A. Chrestien's (1758-1840) successful revival of gold powder in the treatment of syphilis (Chrestien 1811)? Burnett (1879) thought Hahnemann probably did, while Hughes (1893) took the opposite view. Whether or not Hahnemann was aware of contemporary allopathic experimentation is less important than the use made of the discovery in the two schools: gold powder therapy did not function as an exemplar in allopathy and soon fell out of fashion, whereas the homeopathic materia medica was transformed following the successful experiment in 1818. Pure metals such as silver and tin and insoluble minerals and plant materials were submitted to the trituration process for the first time. Many of the post-1818 medicines are reputed to be the deepest- acting, in spite of their innocuous appearance before trituration: these include Silica, Carbo animalis and Carbo vegetabilis, and the notable triad of Calcarea, Lycopodium, Sulphur.

Hahnemann did not record whether he adopted centesimal dilutions from alchemical sources ó and he need not have as the metric scale was being used increasingly by scientists - but the date justifies the conjecture and his bibliographic references show he cannot have been unaware of the precedents.

Contents

1. Introduction -- 1

1.1. Rationale -- 1

1.2 Overview -- 3
  1.2.1. Homeopathy's place in the history of therapeutics -- 3
  1.2.2. Homeopathy and the development of clinical evaluation -- 4
  1.2.3. Is homeopathy clinically relevant? -- 5
  1.2.4. Retrospect and prospect -- 5

Part I: Homeopathy's Place in the History of Therapeutics -- 9
2. Homeopathy and 'the progress of science' -- 9
  2.1. Introduction -- 9
  2.2. Philosophy, medicine and the Aufklarung -- 11
  2.3. Conceptual foundation of homeopathy -- 14
  2.4. The appearance of the Organon -- 18
  2.5. The structure of the Organon -- 20
  2.6. Hahnemann and the academy -- 26
  2.7. The transformation of the Organon -- 27
  2.8. The grounds for rejection -- 30

3. Origins of Hahnemann's pharmacognosy and miasmatic theory -- 35
  3.1. The main objections -- 35
  3.2. Hahnemann and alchemy -- 37
  3.3. Pharmacology -- 39
    3.3.1.Similars and signatures -- 39
    3.3.2. Drug tests -- 41
    3.3.3. Therapeutic poisons and the minimum dose -- 42
    3.3.4. Drug preparation -- 44
  3.4 Disease theory -- 47
    3.4.1. Acute 'miasms' -- 47
    3.4.2. Sources of acute 'miasm' theory -- 51
    3.4.3. Chronic disease theory -- 54
  3.5. Discussion -- 58

4. Homeopathy after Hahnemann -- 63
  4.1. The division -- 63
  4.2 Symptomatic classical homeopathy -- 64
    4.2.1. Directions of cure -- 64
    4.2.2. Repertories and keynotes -- 65
    4.2.3. Constitutional types -- 66
  4.3. Nosological and pathological homeopathy -- 67
    4.3.1. Clinical -- 68
    4.3.2. Complex -- 69
    4.3.3. Isopathy and nosodes -- 70
  4.4 Parahomeopathic concepts and homeopathic neorationalism -- 72
    4.4.1. Organ remedies -- 72
    4.4.2. Biochemic tissue salts -- 72
    4.4.3. Constitutional biotypes and morphology -- 73
    4.4.4. Spiritual neorationalism -- 74
  4.5 The modern synthesis -- 76
    4.5.1. Layer theory -- 77
    4.5.2. Sequential therapy -- 78
  4.6. Conclusion -- 78

Part II: Homeopathy and the development of clinical evaluation. A systematic review of clinical trials of homeopathy, 1821-1953 -- 87
5. Why look at historical trials of homeopathy? -- 87
  5.1. The neglect of the pre-modern clinical trial -- 87
  5.2. The neglect of homeopathic trails in particular -- 89
  5.3. Homeopathic demands for trials -- 90
  5.4. Historiography of homeopathic trials -- 91
    5.4.1. Internal accounts -- 91
    5.4.2. External accounts -- 92
  5.5. Justification for reviewing early homeopathic trials -- 93
  5.6. Method -- 95
  5.7. Results -- 95

6. The earliest observational studies, 1821-35 -- 101
  6.1. Introduction -- 101
  6.2. Results -- 103
  6.3. Germanic trials -- 104
    6.3.1. Berlin 1821: Stapf, Wislicenius -- 104
    6.3.2. Vienna 1828: Marenzeller -- 104
    6.3.3. Naples 1828: de Horatiis -- 105
    6.3.4. Naples 1829: de Horatiis -- 105
    6.3.5. Tulzyn 1829: Herrmann -- 106
    6.3.6. St. Petersburg 1829-30: Herrmann -- 106
    6.3.7. Munich 1830-31: Attomyr and Ringseis -- 106
  6.4 French trials -- 107
    6.4.1. Lyons 1832: Gueyrard -- 107
    6.4.2. Paris 1834: Andral -- 108
    6.4.3. Paris 1835: Andral -- 109
    6.4.4. Paris 1834: Simon, Curie -- 110
  6.5. Discussion -- 111

7. Comparisons with allopathy, 1844-86 -- 113
  7.1. Introduction -- 113
  7.2. Results -- 114
    7.2.1. Miskolz, Austro-Hungary 1844: general -- 117
    7.2.2. St Petersburg 1847-54: general -- 117
    7.2.3. Paris 1847-49: pneumonia -- 118
    7.2.4. Paris 1849: cholera -- 120
    7.2.5. Paris 1849-51: general -- 120
    7.2.6. Vienna 1850-59: pneumonia -- 122
    7.2.7. London 1854: scarlet fever prevention -- 123
    7.2.8. Marseilles 1854: cholera -- 123
    7.2.9. London 1854: cholera -- 124
    7.2.10. Glasgow 1870s: mixed fevers -- 130
    7.2.11. Chicago 1880-86: general -- 130
  7.3 Discussion -- 131
    7.3.1. Planning and design -- 131
    7.3.2. Generalizability -- 133
    7.3.3. Reception -- 134

8. Placebo controls- in trials and in practice, 1810-1920 -- 137
  8.1. Introduction -- 137
  8.2. Placebo-controlled provings -- 138
  8.3. Therapeutic trials involving placebo -- 142
    8.3.1. Placebo-controlled trials -- 142
    8.3.2. Trials of placebo without homeopathic treatment -- 142
  8.4. Placebo in homeopathic practice -- 144
    8.4.1. Hahnemannian usage -- 144
    8.4.2. Early adoption by followers -- 145
    8.4.3. Hahnemannian placebos in trials -- 146
    8.4.4. Divided doses and placebo -- 147
    8.4.5. Later evidence -- 148
  8.5. Discussion -- 149

9. Adoption of the biomedical research perspective, 1914-53 -- 155
  9.1. Introduction -- 155
  9.2. Results -- 156
  9.3. USA 1914-38 -- 156
    9.3.1. Boston 1914: scarlet fever -- 160
    9.3.2. Boston 1914-16: scarlet fever -- 160
    9.3.3. Boston 1915: diphtheria -- 161
    9.3.4. Boston 1917: scarlet fever -- 161
    9.3.5. Boston 1921-23: mumps -- 162
    9.3.6. New York 1938: URTI -- 162
  9.4. Germany 1925-42 -- 163
    9.4.1. Berlin 1925: furunculosis -- 165
    9.4.2. Berlin 1925: skin conditions -- 165
    9.4.3. Hamburg 1938-39: pertussis -- 166
    9.4.4. 1942: diphtheria -- 166
  9.5. Great Britain 1941-53 -- 167
    9.5.1. Glasgow 1941: diphtheria -- 168
    9.5.2. Glasgow and London 1941-42: mustard gas burns -- 169
    9.5.3. Burton-on-Trent, 1951-53: surgical tuberculosis -- 171
  9.6 Discussion -- 171
    9.6.1. Conditions treated -- 171
    9.6.2. National styles of homeopathy -- 172
    9.6.3. Trial design -- 174

Part III: Is homeopathy clinically relevant? A systematic review of clinical trials, 1940-98 -- 179
10. Rationale. -- 179
  10.1. Previous reviews of homeopathic clinical trials -- 179
  10.2. Is another systematic review of homeopathic trials justified? -- 183
11. Methods -- 185
  11.1. Literature search and data sources -- 185
  11.2 Language restrictions -- 185
  11.3 Inclusion and exclusion criteria -- 186
    11.3.1. Therapy definition -- 186
    11.3.2. Medicine definition -- 186
    11.3.3. Trial design -- 186
  11.4. Data extraction -- 187
  11.5. Representing strength of results -- 188
  11.6. Methodological quality instrument -- 189
  11.7. Clinical relevance instrument -- 193
  11.8. Quality control and data integrity -- 194
  11.9. Sensitivity analysis and statistics -- 194
  12. Results -- 195
  12.1 Design -- 196
  12.2 Intrahomeopathic differences -- 198
  12.3 Treatment effects -- 201
  12.4. Adverse reactions -- 202
  12.5. Holism, quality of life and economic evaluation -- 203
  12.6. Methodological quality -- 204
    12.6.1. Comparison with other quality scales -- 208
  12.7. Highest quality trials -- 209
  12.8. Clinical relevance -- 210
  13. Discussion -- 211
  13.1. Overview -- 211
  13.2. Efficacy -- 211
    13.2.1. Classical -- 212
    13.2.2. Clinical -- 215
    13.2.3. Complex -- 219
    13.2.4. Isopathy -- 221
  13.3. Safety -- 222
  13.4. Holism, quality of life and economic evaluation -- 224
    13.4.1. Comorbidity and wellbeing -- 224
    13.4.2. Quality of life -- 225
    13.4.3. Economic evaluation -- 225
  13.5. Methodological quality measurement -- 226
  13.6. Clinical relevance -- 227
    13.6.1. Placebo problems -- 228
    13.6.2. Pragmatic trials -- 229
    13.6.3. Randomization and patient preferences -- 230
    13.6.4. Intrahomeopathic comparisons -- 231
    13.6.5. Clinically relevant trial proposals -- 232
  13.7. Limitations of the present review -- 235
  13.8. Further recommendations -- 236

Part IV: Conclusion -- 241
14. Retrospect and prospect -- 241
I: Homeopathy's place in the history of therapeutics -- 241
II: Homeopathy and the development of clinical evaluation -- 244
III: Is homeopathy clinically relevant? -- 245

Appendices -- 248
Glossary -- 249

Abbreviations and symbols used in tables -- 252
References -- 253
Trial reports 1821-1954 (Part II) -- 253
Trial reports 1941-1998 (Part III) -- 257
Excluded -- 257
Included -- 262
General references -- 276

Michael Emmans Dean

Michael Emmans Dean HMD,MHMA, Department of Health Science and Clinical Evaluation, University of York, Heslington. United Kingdom October 30, 2003, the Robert Bosch Foundationís Institute for the History of Medicine, in conjunction with the Karl und Veronica Carstens Foundation, awarded its first Hans Walz Prize to Michael Emmans Dean, Ph.D., for his historically grounded analysis of the use of the scientific method in homeopathy.

Reviews

Michael Emmans Dean completed a PhD thesis at the University of York, for which he won the Hans Walz prize, in October 2003 at the Robert Bosch Foundation of Stuttgart. This work shows that the prize was richly deserved. The book has now been published in a remarkably short time.

The book claims to be the first systematic review of all the clinical trials of homeopathy predominantly in Europe and North America from its beginnings until the present day. The original description was of a critical historical account of the origins, structure and development of Hahnemann's scientific therapeutics, and two systematic reviews of homeopathic clinical trials 1821-1953 and 1940-1998. Dean shows that homeopathy has a long history of scientifically conducted trials that have not received their deserved recognition. The first part of the book deals with Hahnemannís place in the history of therapeutics. The author has clarified the history of homeopathy as an unprejudiced observer, where previous writers have all assumed a particular viewpoint and assumed that this was the only correct viewpoint. Dean has disentangled the different schools of classic and complex homeopathy in order to assess the validity of the various trials going right back to the beginning. This is not only a discussion of trials but a true epistemology, showing the transmission of misinformation and erroneous ideas about the scope of our beloved homeopathy over more than two centuries. He goes on to describe trials, comparisons with allopathy, placebo and more, in great detail. He shows how homeopathic trials were ahead of their time in their methodology, including provings and masked trials, right from the start. The third part deals with clinical relevance, especially in modern trials.

I found the descriptions of Hahnemannís pharmacognosy and miasmatic theory to be especially interesting, and the analysis of homeopathy after Hahnemann to be really clear and helpful. The last chapter on prospect and retrospect should be read by trustees of all foundations with funds to spare. Most important, he has managed to make some of the successful trials exciting. They need to be displayed with more panache and appeal for the general reader as they are sometimes mired in detail. Deanís command of sources in many languages and from two centuries is impeccable and scholarly.

There is a plethora of detail of which it is quite hard to keep track. There are copious bibliographies as one would expect, but there are three: general references, and two lists of trial reports. It is confusing to look up references and not know which source is in which list. There is a CD with lists of excluded trials, presumably keep down the price and thickness of the book, and there is no index. This is the modern publisherís paradox. The result is that it is simpler to search the excluded trials on CD, than to search the rest of the book. The whole work could have been on CD and so be even more useful. It is clear that the book publishers in Germany did not employ a proof reader whose first language was English. The text is full of minor proof mistakes, and many sentences are marred by ending in a preposition. A real editor could have helped the author to structure the book to read less like a thesis.

These are minor flaws in a masterpiece of perspective and detective work. Dean has unearthed some treasures from our forgotten and recent history and made sense out of them; this is going to be one of the pivotal works to explain and develop our contribution to scientific medicine. There may be an art in our method, but this book should convince us to be even more rigorous in how we carry out research, including provings, and in persuading us to carry out even more of it. I hope that there will be a new edition in a few years, and this time from a mainstream publisher who will find a larger marketplace.

Reviewed by Francis Treuherz MA RSHom FSHom

Reprinted with permission.
Homeopathic Links 2 / 05 Vol 18, Summer 2005