Despite opposition from many quarters, Homeopathy as a medicinal practice has not only survived in India but flourished on the basis of the belief that it is safer than modern medicine. Dr. Anil Khurana, Director General , Central Council for Research in Homeopathy (CCRH) under Indian Ministry of Ayush talks to THIP Media about Homeopathy’s effectiveness, it’s relevance during the times of COVID-19, the CCRH’s efforts during the pandemic and the controversy surrounding the recommendation of Arsenicum Album 30 as a prophylactic.
Explain what Homeopathy medicine is and its role in a pandemic situation caused by a modern day disease.
It is a therapeutic system of medicine premised on the principle, “Similia Similibus Curentur” or ‘let likes be treated by likes’. It is a method of treatment for curing the patient by medicines that possess the power of producing similar symptoms in a healthy human being simulating the natural disease, which it can cure in the diseased person. It treats the patients not only through holistic approach but also considers individualistic characteristics of the person. Homoeopathy has the vast potentialities in providing healthcare which can enrich the public health system and strengthen quality of life; contribute to the value of economic and social development; improve health and development of local communities; safeguard cultural differences; focus attention on healthcare centres intended for physical, mental, spiritual and social wellbeing of people. It has a basic instinct of having a patient-centred approach and a holistic focus on healthcare which opens vast avenues of services. There have been major leaps in Homoeopathic research in the last couple of decades, and the effects of those breakthrough leaps in form of international publications is eventually being palpated through the slow but steady change in perception for Homoeopathy.
The prophylactic aspect of Homoeopathy is well known, and historically, Homoeopathy has reportedly been used for prevention during the epidemics of Cholera, Spanish Influenza, Yellow fever, Scarlet fever, Diphtheria, Typhoid etc. The anecdotal evidence that Homeopathy was successful during the Spanish flu epidemic of 1918 to 1919, in which at least 20 million people died worldwide, more than 500,000 in the United States alone. According to the historian Julian Winston, the death rates for patients treated with homeopathy (genus epidemicus) were 1 to 2% compared with a 30 to 60% mortality for those treated by conventional physicians. As in all collective diseases, the image of the clinical picture emerges after observing a considerable number of patients; In order to paint “the full picture of the disease”, “totality of characteristic signs and symptoms” or “epidemic genius”, according to the homeopathic connotation of this term. In India, during recent past Homoeopathy has been successfully used during various disease outbreaks for preventing the spread of diseases like Chikungunya, Dengue Fever, Japanese Encephalitis with good results. The detailed account of use of homoeopathy in control of epidemics has also been specified in recent publication in American Journal of Homeopathic Medicine.
The pandemic situation caught medical professionals unprepared. How did the homeopathy doctors in India react?
The unprecedented lockdown and cordon sanitaire that this pandemic has forced upon the whole world, but, on the other hand, has indeed given a level playing ground for all Alternative medicine practitioners which may include Homoeopathy. As the world grapples in the uncertainty of these times, the Homoeopathic doctors has definitely been able to rise up to the occasion, an effective, safe, evidence based and less invasive treatment is the need of the hour in the current scenario.
Homoeopaths of India have given more than 1000 proposals in use of Homoeopathy for treatment and prophylaxis of COVID-19 to the Ministry of AYUSH. A clinical trial could be initiated as early as the first week of May 2020 in prophylaxis and treatment of COVID-19. Till date, about 18 trials in Homoeopathy are registered in the Clinical Trial Registry of India (CTRI).
As per official records, Arsenic album 30 has, so far, been distributed to more than 45 lac people by Homoeopathic colleges as an immune booster.
Other than this many Homoeopathic practitioners, philanthropists and NGOs also distributed the medicine other than scores of individuals who have also taken the medicine by themselves. Many State Governments issued advisory in the line of Ministry of AYUSH, Govt. of India for use of Arsenicum Album 30c.
Trials in Homoeopathy were initiated with permission from the Ministry of AYUSH. CCRH has undertaken studies to estimate the protective effect of Arsenicum Album on COVID infection. Documented scientific evidence will be submitted to Ministry of AYUSH once trials are completed and analysed. Treatment trials have also been undertaken and are in progress. The results will be made public in due course by Ministry of AYUSH.
But the recommendation of the Arsenicum Album has been criticized a lot. Fact Checkers have written off the medicine due to lack of any evidence. Your comments.
The Ministry of AYUSH responded on a first hand basis when they released the recommendation of Homoeopathic prophylactic medicine as an immunity booster on 29thJan. 2020. Yes, it attracted loads of criticism.
But we need to understand the concept of Homoeoprophylaxis to understand why the Arsenicum Album was recommended in the first place.
Homoeoprophylaxis (HP), i.e., medicine selected according to the Law of Similar to prevent targeted infectious diseases, was first used by Hahnemann in 1798 and has been used since to protect a significant number of people against a range of infectious diseases in many countries. The Genus Epidemicus is identified through observation of several cases of an epidemic disease, and analysing the symptomatology of those cases for the most indicated medicine. This medicine is the preventive medicine for the ongoing epidemic of that disease. According to a study, the effectiveness of HP was between 63% and 99% with a weighted average around 90%, with proven benefits from the widespread use of appropriate HP interventions. However, I agree, the evidence base needs to be improved in a range of ways. Requiring a standardised checklist to be completed by researchers both before and after an intervention offers one method to improve the quality and consistency of evidence collected.
Yes, we indeed realize that the Arsenic Album 30 has not been supported by the research evidence against COVID-19. The trials of Arsenic Album on COVID-19 started only in May.
But the critics forgot that the Arsenic Album had been used to prevent Swine flu (H1N1) in 2009. Central Council for Research in Homoeopathy (CCRH) endeavoured to find usefulness of Homoeopathic Genus Epidemicus (Bryonia Alba 30C) for the prevention of Chikungunya during its epidemic outbreak in the state of Kerala. The result reflects a 19.76% relative risk reduction in the medicine group compared to placebo.
During 2016 in Delhi there was a severe outbreak of both Dengue and Chikungunya. CCRH had undertaken preventive study with Eupatorium Perfoliatum as Genus Epidemicus in Mayapuri JJ clusters. About eighty-five percent (85%) of the population were protected in the homoeopathic group compared to no intervention cohort.
During dengue outbreak in 2015 in Delhi, adjuvant homoeopathic treatment was given to Dengue hemorrhagic fever cases at a tertiary care hospital. The patient who received homoeopathy had a rapid rise in platelet count and lesser duration of hospitalization requirement compared to those who received standard care alone.
In Japanese Encephalitis, (JE) positive role of Belladonna as Genus Epidemicus was witnessed in Andhra Pradesh (undivided) during severe outbreaks in the 90’s with reduction in incidence of reported cases. These protective effects were also evidenced through preclinical studies, conducted in collaboration with School of Tropical Medicine, Kolkata.
Further molecular studies conducted in collaboration with KGMU, Lucknow establishes the rationale of Genus Epidemicus approach for homoeopathic preventive medicine. We must all agree that the conservative ways of placing new drugs in market after going through phases of clinical trials cannot be directly applied to Homoeopathy especially in epidemic condition with new emerging disease.
Moreover, during Ebola outbreak in 2014 expert group of WHO has recommended that “it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention” keeping in view no vaccine or anti-virals were available.
As far as safety of Homoeopathic medicine is concerned, there cannot be any comparison between apples and oranges. There is so far, no evidence that homoeopathic medicines cause any serious or long-lasting harm. Scientific scepticism about Homeopathy may arise due to its use of highly dilute medicines, although we must mention here that, a recent review found 98 replicated experiments, over 70% of them positive.
We often find even homeopathy doctors do not agree to each other on the efficacy of a particular medicine or treatment procedure. Why the difference of opinion?
The concept of Genus Epidemicus in homoeopathy depends on the signs and symptoms of the prevailing disease. This may differ among different geographical regions due to mutations of the micro-organisms/virus and immunity of people due to genetic, dietary habits and previous exposure to related micro-organisms etc. Therefore, the different presentation leads to different indicated medicines and sometime due to biases in individual physicians’ perceptions also.
But don’t you think the difference of opinion between doctors or the outright rejection of an advice – all these could have been avoided if we had better scientific approach? Why will a medicinal discipline so old, have so little research documented ?
Arsenicum Album was decided following a standard scientific procedure of Scientific Advisory Board considering the available published signs and symptoms from leading medical journal ‘Lancet’ when infections in India was not there. Scientific Advisory Board considered that the same medicine has been advised for prevention of Influenza like illness. Subsequently, data of COVID-19 infected patients in India were collected and analyzed following similar procedure and Arsenicum album was found to be indicated.
Also, it is wrong to say that Homoeopathy does not have documented research. So many research studies are available in medical databases, and anybody can look into that. The CORE-Hom database contains 1,383 clinical studies on homeopathy. In the HomBRex database you will find 2,418 experiments on basic homeopathic research. Of these experiments 89% reported at least one positive result. A recent review of biochemical, immunological, botanical, cell biological and zoological experiments on homeopathic dilutions found 98 replicated experiments with over 70% of replications positive.
CCRH itself has taken many studies and these are available in CCRH website. Individualization in choice of medicine and interpretation of symptoms may lead to different drugs.
Public demand also gives anecdotal evidence of its effectiveness. Over 200 million people worldwide use homeopathy on a regular basis. Arsenicum Album 30 is also well accepted and masses have used this as prophylactic medicine.
Countries like Brazil, Chile, India, Mexico, Pakistan, Switzerland included Homeopathy in the national health systems.
5 global systematic reviews were conducted up to 2005, each conducting a meta-analysis of clinical trials on all types of homeopathic treatment for all medical conditions together. Out of which 4 were in favour of Homoeopathy. And all these reviews are out of date, the last one was 13 year old. However the negative one was still used against Homoeopathy, though it was criticised for its methodological flaw.
The recent and most robust data on efficacy of homeopathy comes from a 2014 meta-analysis of placebo-controlled double-blind randomised controlled trials which found that homeopathic medicines, when prescribed during individualised treatment, are 1.5- to 2.0-times more likely to have a beneficial effects than placebo.
Largest comparative effectiveness study of homeopathy published to date is the EPI3 study. A nationwide study in France, coordinated by the Department of Pharmacoepidemiology at the University of Bordeaux, it included 6,379 patients at 804 medical practices. These public health impact studies concluded homoeopathy has beneficial effect in musculoskeletal disorder, anxiety and upper respiratory tract infections.
In multiple states of India, Homeopathy doctors have been not allowed to treat COVID-19 patients. There are online petitions asking the Government to allow homeopathy doctors to treat COVID-19 patients. But even if allowed, what will be the basis of these treatments?
COVID-19 is a new disease and facts are changing fast in the understanding of disease in various dimensions. There is no curative treatment available for the disease. Leave alone homeopathy, all the systems of medicine are struggling to find a suitable remedial for COVID-19 and for this search they have claimed many drugs during the last 7 months including repurposing of many existing drugs.
In the name of treatment, they have used many drugs without any evidence and more over uses of these drugs are against their theoretical base. The very basis of selection of Homoeopathic medicine is symptom based following the Law of Similar. This principle is applied for every disease condition and outcomes are seen accordingly. We have noticed that an integrative approach has always worked better for patients and tested in diseases like acute encephalitis syndrome, dengue hemorrhagic fever etc. and is within the spirit of National Health Policy 2017 of India.
In that background, if we face a particular claim about a Homeopathy medicine on social media or via a WhatsApp message, where do we look for documented evidence? Or how do we go ahead validating the claim?
First of all, learn to distrust social media forwards. Check for the validity of the claim on authentic websites. Advisories given by healthcare authorities like the Ministry of AYUSH, Central Council for Research in Homoeopathy are often available on official websites. Fact checkers can also make use of websites like www.ayush.gov.in, www.ccrhindia.nic.in and www.ijrh.org.
Second, for claims related to Homeopathy, please consult qualified homeopathy physicians. For qualified doctors, information is available on CCH website as a central register of Homoeopathy.
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