On The Future of Medicine and Medicine of the Future

“Homeopathy not effective for treating any condition”, a recent headline in The Guardian stared at me on my computer screen from a newsfeed. The Guardian is a mainstream, respectable British newspaper, which boasts of winning the Pulitzer Prize. The newspaper was quoting the recent Australian National Health and Medical Research Council (NHMRC) statement. The statement said that there is no “good quality evidence” to support the claim that homeopathy is effective in treating health conditions. The conclusions of this report are allegedly based on a “rigorous assessment” of 1,800 papers, of which only 225 studies met the criteria to be included in NHMRC’s examination of the effectiveness of homeopathy.

People in Glass Houses

For over two centuries Homeopathy-bashing has served both as a hobby and a life-support to many who have lived on the pickings of the allopathic-pharmaceutical complex. While The Guardian congratulates itself for winning the Pulitzer, the Prize itself is not above controversy. The Chicago Tribune, a leading America newspaper opines that the Pulitzer Prize is nothing more than a ‘mutual admiration society’ and not to be taken seriously [1]. Also, the Prize is not without bias. The 2010 Pulitzer Prize Winner for Commentary, Kathleen Parker candidly admitted, “It’s only because I’m a conservative-basher that I’m now recognized”[2].

Let us take a look at the members of the Homeopathic Working Committee of NHMRC which prepared the report. Of the seven members, only one member, Prof. Peter Brooks MBBS, MD, had a background in Complementary and Alternative Medicine. Dr. Brooks was “required to step down” from the Chairmanship of HWC, because he had in the past been associated with establishing the Australian Centre for Complementary Medicine Education and Research at the University of Queensland, in association with Southern Cross University. All discussions were purported to be “robust and open”, yet ironically decision-making was majority-based, with no reference to dissent – thus ensuring that any sane voice would be drowned in the din of a motivated majority [3].

Turning a Blind Eye

The report also admits that it did not consider any evidence from (a) laboratory studies, (b) studies in animals, (c) studies in humans without a specific health condition; nor did it focus on the safety of homeopathic medicines. It did not take into consideration any personal testimonials as the HWC opined that they are not reliable as people may experience health benefits because they “believe that a treatment is effective”. So they relied on evidence based methods, in particular the Randomized Controlled Trials (RCTs) as they are claimed to be the “gold standard” for testing medical efficacy. For that reason NHMRC did not consider observational studies, individual experiences and testimonials, case series and reports, or research that was not done using standard methods [3]. This is quite strange because traditionally, surgeons have relied principally on three types of research: animal experiments, case reports and case series [4].

This only exposes the fact that the august Committee seemed to be unaware of “Single Case Experiments” as an important source of evidence [5].

According to NHMRC Chief Executive Officer professor Warwick Anderson, “All medical treatments and interventions should be underpinned by reliable evidence”. So what “evidence” is Prof. Anderson talking about? Obviously, he is referring to RCTs. Back in the 1960s and 1970s, Archibald Cochrane advocated for the utility of RCTs to sort the wheat from chaff. And soon people were referring to RCTs as the “gold standard” and anything that did not meet up to its scientific rigor was supposed to be deceit, chicanery and smacked of charlatanism – fit to be burned at the stake or lynched in the print (or digital) media.

Questioning RCTs not blasphemous anymore

However, in recent times, even such respected and conservative (and not-so-well-disposed-to-Homeopathy) journals such as The Lancet have been questioning the faith placed in RCTs and pointing to its serious limitations. One scholar admits that, “RCTs most often lack evidence that the treatment under investigation will prove of any use to a real patient seen by a doctor in the clinic [6]. The ritualistic worship of RCTs comes in for critical comment in a McGill University paper which concludes that, “the legitimacy of Evidence Based Medicine relies neither on experts nor numbers, but on distinct procedures for handling (non) Evidence, reflecting its ‘regulatory objectivity’”[7]. In a textbook on RCTs, Jadad and Enkin admonish us “to stop worshiping the randomized controlled trial as if it were a talisman that would guarantee objectivity”. As early as 1998, Rene Favaloro, the father of coronary artery bypass surgery (CABG) had warned against the “almost religious sanctification” of the ideology of RCTs [4].That is so because RCTs do a good job to solve simple or complicated problems, but have very limited use in complex problems like human health and well-being. To cite an example, raising a child and treating dementia would hardly lend itself to RCTs [8].

In its wisdom NHMRC chose to turn a blind eye to these realities.

Possible cause of bigotry against Homeopathy

As a student, practitioner and teacher of Homeopathy, I have always wondered why Homeopathy, which originated in the West, is facing such difficult times in that culture (although Germany is an exception – there is no legal monopoly on the practice of medicine). If you follow debates broadcast over the media in the US and the UK (and now Australia), you will find the views against Homeopathy virtually stink of bigotry. By contrast, Homeopathy is accepted and respected in places like India, Malaysia, Sri Lanka and in most South American countries.

Is there a deeper reason for such attitudes?

One view presented by some medical anthropologists is that present day practice of biomedicine in the West has evolved in a culture dominated by monotheistic traditions of belief. Monotheism is founded on a commitment to “universal truths”, and “unitary paradigms”. This has nurtured a culture of allowing only a single-minded approach to illness and care [9]. In the countries mentioned above, the medical pluralism matches the social and religious pluralism seen in society. One will find that medicine, like religion, ethnicity and other key social institutions, is a medium through which the pluralities of social life are expressed and recreated [9]. However, institutionalized modern medical practice in these pluralistic societies is also a victim to the same “medical monotheism” of the West. Thus it will not brook an alternative concept like Homeopathy. By contrast, ethnomedicine systems, be they TCM or Ayurveda, are open to ideas, concepts and practices of modern science and work towards a synergistic relationship. In these countries practitioners of all hues will often send their patients to a Homeopath (and vice-versa) for a difficult and chronic problem which has no clear-cut cure in their system.

One of the outgrowths of this has been that the institutions of Allopathy have complete control over establishing the criteria by which Homeopathy is judged. Another area of difference that lies in the world view of Allopathy is its insistence on questioning the grounds of knowledge within the present frame of knowledge. If Life Force cannot be measured, weighed or imaged, it is ridiculed to be non-existent. Similarly, therapeutic efficacy is measured only on the basis of RCTs and not by any other method.

But Homeopathy is not the only victim of this social order. Even within the practice of modern medicine, there is a tacitly approved caste system. Psychiatry, internal medicine, pediatrics and the like are viewed as the “soft” side of practice and the real “hard core” medicine is surgery. The “soft” specialties provide low incomes and attract more women practitioners, while the “hard” specialties pay more and command more respect. Perhaps that is one reason why some soft specialties like dermatology (internal medicine) have added surgery to their practices [9].

Given these realities, where do you think a homeopath giving sugary pills stands in the hierarchy?

Hope of a brighter future

In the light of what has been said above, it is foreseen that RCTs will lose their importance in the years to come. Researchers are now developing new methodologies to extract information from patient records and databases. Single-case studies are gaining ground. It is believed this will lead to a new form of personalized evaluation – one that will take into account the idiosyncrasies of patients, their genetic predispositions and similar individualizing factors. This may one day evolve into a new standard to evaluate Homeopathy which is all about individualization. But our culture’s anthropological baggage of insisting on doing medicine only one way may have to wait for some historical singularity – an event which will break the ivory towers of allopathic arrogance. Even today we have evidence of the memory of water and a quantum mechanics based paradigm of Patient-Practitioner-Remedy matrix developed by Lionel Milgrom that has not been contested. But the main stumbling block is the cultural outlook. Communism, caste-system, slavery, imperialism and many more dogmas and practices had their day, only to be swept away by the winds of liberal change.

Eventually Homeopathy will bring medicine home – to heal the sick.

References:

[1] Reardon, Patrick T (June 8, 1997). “A Parade of Pulitzers”. Chicago Tribune.

[2] Hagey, Keach (October 4, 2010). “Kathleen Parker: ‘Smallish-town girl’ hits cable”.Politico.

[3] National Health and Medical Research Council. 2015 Administrative Report: NHMRC Advice on the effectiveness of homeopathy for treating health conditions. Canberra: National Health and Medical Research Council; 2015 (Online version: www.nhmrc.gov.au/guidelines-publications/cam02).

[4] Jones, DS: Vision of a Cure, Science and the American Century: Readings from “Isis”, edited by Sally Gregory Kohlstedt, David Kaiser, University of Chicago Press, 2013.

[5] Kazdin, A.E : Single-Case Research Designs: Methods for Clinical and Applied Settings, 2nd edition. New York: Oxford University Press, 2010

[6] Rothwell PM: External validity of randomized controlled trials: “To whom do the results of this trial apply?”. Lancet 2005; 365: 82–9

[7] Knappen L: Being evidence based in the absence of evidence: The management of non-evidence in guideline development. Social Studies of ScienceOctober 2013, vol. 43 no. 5 pp. 681-706

[8] Jadad AR & Enkin MW: Randomized Controlled Trials: Questions, Answers and Musings, second edition, BMJ Books/Blackwell Publishing; 2007

[9] Kleinman A: What Is Specific to Biomedicine? In: Writing at the margin: Discourse between Anthropology and Medicine. Berkeley: University of California Press, 1995: 21–40.