Today I chat with homeopath Robert Medhurst. Robert is a Naturopath and Homoeopath with 28 years clinical experience. He’s lectured throughout Australia and the U.S. and authored numerous articles and two books, the latest being his massive work, The Concordant Clinical Homeopathic Repertory. He was formerly Expert Advisor on Homeopathy to the Federal Government of Australia, Dept. of Health & Ageing.
AS: Welcome Robert! For the last couple of years Hpathy has been publishing your articles on the latest research into homeopathy. What kind of research would you like to see done? Doe we need more defensive research (ie. proving homeopathy works) or research to improve the way homeopathy is practiced?
RM: It’s all valuable, every bit of it. There are two areas that stand out that need more work: basic research into the mechanism of how homeopathy works and replication of previously conducted randomised controlled clinical trials. The main problem we have though is funding. It’s very expensive to carry out good quality research. Currently, it’s not possible to patent a homeopathic medicine so there’s little incentive for the commercial funding of large-scale research by homeopathic manufacturers, so the research that has been done to date is relatively poorly funded. There is some public funding available through a small number of universities and through organisations such as India’s Central Council for Research in Homeopathy, but this funding is quite small. As a result, what we commonly see are trials with a relatively small sample size. This wouldn’t necessarily be a huge problem were it not for the fact that homeopathics generally don’t produce dramatic effects when compared to placebo, so statistically, the effects of the medicines being tested are often only marginally statistically significant. Generally, the larger the sample size, the more obvious the effect becomes. Claudia Witt and her colleagues have done some excellent work in this area with sample sizes running into the thousands but much larger trials would be extremely valuable.
AS: While we’re on the subject of studies, the NHMRC recently announced a study on homeopathy which purported to show that homeopathy was not effective for a number of ailments. That study is now being used widely to bash homeopathy. Could you comment on that?
RM: The Australian National Health and Medical Research Council (NHMRC) was ostensibly given a brief by the Australian Government to advise them on what the evidence said about homeopathy, with a view to using this to guide national healthcare policy. Australians seeking the services of local homeopaths, who have private healthcare insurance, can in some cases have part of the consultation cost for these services refunded or rebated to them. The government provides financial support for these healthcare insurance rebates. So the role of the NHMRC in this seems to have been whether or not it can provide the government with an excuse to stop supporting these rebates if the NHMRC can come up with one. A finding that there’s no evidence to support homeopathy would potentially give them this excuse.
In carrying out this assessment, the NHMRC considered a body of research evidence. They included some studies and excluded others. Much of the important work that’s been done in this area, such as that done by Philippe Belon and colleagues for example, wasn’t considered at all. Some of the great work done by Paolo Bellavite and colleagues was considered, but it was all excluded. Some of the excellent work done by Iris Bell and colleagues was considered, but all of it except for one study was excluded. Most of the excellent work done by Claudia Witt and colleagues was excluded. Many of the landmark papers such as David Reilly’s 1994 Lancet study, and the meta-analysis by Kleijnen, published in the British Medical Journal in 1991, were excluded. Now someone a bit dubious about the process used by the NHMRC might take the view that the evidence was stacked to come up with the conclusion that there’s no evidence for homeopathy. There’s definite echoes here of the process used by Shang and colleagues in their 2005 Lancet study that found no evidence for homeopathy, and the 2010 UK House of Commons report that came to the same conclusion.
AS: For our readers who may not be familiar, the Shang study was contrived using cherry picked evidence, and the UK report was also a stacked deck where none of the pro- homeopathy evidence was considered. Such phony studies are followed by articles in the press disparaging homeopathy. It often seems like the bad guys are winning the propaganda war. Can you see any way of turning this around?
RM: Not in the short term, as this battle’s been going on for 200 years and doesn’t show any signs of abating. Personally, I try not to think about good guys or bad guys and hope that it’s simply down to interested parties who feel that what they have to offer provides the most effective form of healthcare. It’s very easy to fall into the trap of focusing on the process rather than the outcome and the modality rather than the person who needs help. Many of us working in homeopathy focus too much on homeopathy as a process and forget what might be best for the person suffering from an illness. Many working in orthodox Western medicine do the same. This polarity doesn’t help the person who needs relief from suffering. If my client is experiencing anaphylaxis, a broken bone or a heart attack, I want them in a hospital receiving the best acute care that they can receive within that healthcare paradigm. If they’re suffering from a chronic inflammatory disease I want them being treated with homeopathy. Everything has its place but I don’t think any healthcare philosophy should have a monopoly on healing.
So, can I see the situation turning around? I can when we can all agree on what we should be focusing on- the person who needs our help. Twenty years ago it was medical heresy to suggest that Glucosamine was often a better choice than surgery for people suffering from osteoarthritis, that Hypericum (St Johns Wort) is a viable option to antidepressants and that Vitamin B9 (Folate) is essential for the prevention of spina bifida. These days, these things are accepted tools in orthodox medicine. There may come a day when we’re no longer having to fight for the existence of homeopathy and it becomes an acceptable healthcare tool, but for that to happen, it’ll need to have the same level of acceptance as things such as Glucosamine, Hypericum and Folate. It’ll need to have proved its worth. I have hope that this may occur with the acceptance of the success of things such as Arnica for people experiencing trauma. As one of the most widely used medicines in our dispensaries, I think it stands a good chance. But, the turnaround will require large and replicated clinical trials and will require us to jump the biggest hurdle of all- a clear and demonstrable mechanism of action that’s scientifically plausible. Until then, I wouldn’t be putting your boxing gloves away!
AS: How does you background in naturopathy, your knowledge of herbal medicine and nutrition change the way you practice? Can you give an example from a case?
RM: In Aphorism 261 of the Organon Of Medicine, Hahnemann discusses the need to use appropriate exercise, as well as a suitable and nutritious diet, to support the action of the simillimum. So, lifestyle programs that incorporate these elements always form part of my treatment protocols, and my background in naturopathy and nutrition assists in this. In the same aphorism and in other places throughout the Organon, Hahnemann talks about the need to remove obstacles to cure, and my naturopathy training is also useful in identifying these obstacles and removing them or minimising their impact.
Here’s an example. I was consulted recently by a 38 year old woman who works as a school teacher and she complained of chronic anxiety and increasing fatigue. After collecting data on the presenting symptoms and other factors that characterised her experience of these problems (I’ll spare you the symptom and remedy analysis), I was guided to Phosphorus as the simillimum. I know from experience that many people who present with chronic anxiety and fatigue have poorly functioning adrenal glands and I also know from experience that the simillimum is very slow to work in these cases. So I carried out an assessment of her adrenal capacity and found that this was diminished. As a means of dealing with this I asked her to use a diet high in nuts, leafy green vegetables, garlic and onions, avoid sources of sugar and fructose, get 30 minutes of moderate exercise a day, practice daily deep breathing exercises and use Vitamin C and Siberian Ginseng. I asked her to do all of this for 6 weeks. At the end of this period I took her case again and once again was guided to Phosphorus as the simillimum. I gave this to her in a 30C potency and asked her to use one dose every 3 days for 3 doses. I saw her again 1 month after this and she stated that she’d experienced a marked improvement in both of the issues that were troubling her and several other minor health issues. This was nearly 2 years ago and via email every 6 months she tells me that she continues to improve in all areas.
AS: Your new book, The Concordant Clinical Homeopathic Repertory is now available. How can it help in one’s practice? Where can readers order a copy? (Readers can see Alastair Gray’s review of your book here: https://hpathy.com/homeopathy-repertory/concordant-clinical-homeopathic-repertory-robert-medhurst/ )
RM: The practice of homeopathy is based on Hahnemann’s law of similars. The job of the homeopath, in accordance with this principle, is to define the patient’s individual symptoms, match these against the proving symptoms and arrive at the correct one for that patient at that time. The tools we use to do this are the material medica and repertory, but there are problems with these tools.
The world’s best homeopaths rarely get the prescription right more than 50% of the time initially, and that’s because our material medicas and repertories contain inaccurate information, which leads to inaccurate prescribing. The information in these texts comes from a number of sources; toxicology, the clinical experiences of the author and primarily, from provings. Unfortunately, the methodology used to carry out provings, particularly many of the older ones, leaves a lot to be desired.
For example, toxicology trials on Secale performed by Strahler, as reported in Hughes and Dakes’ Cyclopedia of Drug Pathogenesy (Jain, New Delhi, 2000, 76 et seq) were done on dogs using powders or infusions of Secale. The same text carries reports from Wernich performing toxicology trials on frogs. Page 52 of the text reports the results of human provings by Dr Hooker using oil of ergot (Secale), obtained by macerating powder in sulphuric ether. Other provers swallowed infusions, some swallowed powders and some had Secale spread on bread. This is far from being an isolated case and all of the results from these studies have gone into the materia medicas and repertories, unqualified, for Secale, despite the different dose forms used and the substances they were potentially contaminated with, and despite the different dose volumes used, different levels of supervision, different proving durations used and the different life forms with their varying physiologies that were given the drug. This is but one of many examples that could be used to illustrate the point that much of the data that’s gone into proving reports and subsequently into material medicas and repertories is questionable and may have a considerable influence on the accuracy of individualised homeopathic prescribing.
I struggled with this problem for decades and after many successes and failures in my homeopathic practice came to rely far more on the remedies that had clinical confirmation for the rubric in question, than on the traditional reportorial or material medica texts. Over the last 15 years I developed quite a large body of information on clinically confirmed remedies- confirmed by some of the world’s greatest homeopaths, from my own clinical experience over 30 years of practice, and from clinical trials that have been done in specific disease areas. This was all formed into The Concordant Clinical Homeopathic Repertory and it’s a homeopathic repertory with a difference.
AS: Yes, errors in the repertory are an ongoing problem. We published an article by P. Shetye and F. Khariwala who pointed out some glaring errors in repertories that were carried through from historical texts to the present repertories. https://hpathy.com/homeopathy-repertory/illustrative-examples-of-repertory-our-tool/ Can you further elaborate on how your repertory differs from standard repertories?
RM: In contrast to the standard repertory structure, the body of this text is formed entirely from clinically confirmed remedies and constructed into concordance tables for clinically defined conditions. The book’s 922 pages contain entries for over 3200 individual diseases, making it the ultimate authority on clinically confirmed homeopathy and an essential text for any serious prescriber or user of homeopathic medicine. I use it in my own clinic and get great results with it and it’s now being used in clinics and hospitals around the world and the feedback has been excellent. I’m not suggesting that one should completely abandon the use of material medicas or standard repertories, simply that while the remedies they indicate should be studied with all diligence, there’s a strong case to be made for considering remedies that have shown consistent results for specific clinical conditions, and an even greater case to be made for a text that operates in the same way as any other repertory, but is arranged on the basis of clinical conditions, using remedies that have been clinically confirmed for that condition.
The Concordant Clinical Homeopathic Repertory is available from all leading booksellers for a recommended retail price of $165.00 Australian, or directly from the author for $92.00 Australian, plus postage. An electronic copy in PDF format is also available for purchase from the author for a cost of $55.00 Australian. ISBN 978-0-9580798-2-2. For more details contact firstname.lastname@example.org
AS: Every homeopath has had memorable cases. What was the most satisfying case you ever had? What was the most frustrating?
RM: The most satisfying case occurred fairly early on in my homeopathic career and involved a 5 year old girl who appeared to be suffering from otitis media. She had a history of this condition and had been treated by her doctor with antibiotics. She was unresponsive to this treatment and the doctor had said that the next option was grommets, which the mother was trying to avoid. Her mother brought her to me as a “last resort”. The girl complained of pain in her right ear. Her right auditory meatus was swollen and her eardrum inflamed. Being outdoors seemed to reduce the pain. She appeared timid and nervous, wept when describing her symptoms, and was described by her mother as being thirstless. I gave her a single dose of Pulsatilla 30C. Her mother had an appointment booked with an Osteopath who worked in my clinic and so took the girl with her out to the waiting room while she had her osteopathic treatment. I came out to the waiting room some 10 minutes later to collect my next client and saw the girl sitting on the floor giggling up at me while a thick yellow-green discharge flowed slowly from her right ear, down her neck and onto the collar of the jacket she was wearing. We cleaned up the discharge and covered the area with an absorbent dressing. She didn’t experience otitis again after this and is now grown with her own children and studying to be a Homeopath.
The most frustrating case involved my late father who asked me for help with eczema, which had bothered him for a number of years, and it taught me a lesson about being very cautious in the treatment of friends and relatives. The psoriasis was behind his right ear and exuded a thin, sticky, yellow discharge that appeared to inflame the areas that it flowed onto. These and other symptoms prompted me to prescribe Graphites 6C and I asked him to use 1 dose daily for 1 week. I was quite confident that the prescription was correct but it failed to ameliorate the symptoms and after a period of 4 weeks had elapsed I re-took the case. Again, Graphites was clearly indicated and I prescribed a single dose at a 30C potency and again, no response. I turned my homeopathic library inside out, looked at associated remedies as being possible simillimums, looked at the symptoms, modalities and everything else involved from every possible angle, retook the case a number of times, examined any possible obstacle to cure and could find none. The symptoms kept on coming up as Graphites and I tried a number of other potencies, all to no avail.
After about 6 months of this I said to my father, “I really don’t know what the problem with the therapy is, nothing seems to be working.” To which he replied, “No, and the steroids I’ve been taking from the doctor don’t seem to be doing anything either.” Hmmm… Despite my asking him repeatedly if he was using any other medication, he’d kept that one quiet and on asking him about the steroids, he told me that he was reluctant to mention it because he thought that I’d think that it was some sort of betrayal. He’d been using them for about 9 months. So, armed with that information, I gave him a single dose of Cortisone 30C, waited 2 weeks, then gave him a single dose of Graphites 200C. Within a month the psoriasis had gone and never returned.
AS: I think that last case is one we can all relate to. You’ve given us a lot of food for thought. Thank you for sharing with us today.