Ideas for research in scientific and

Hom eopathy clinical

H A M I S H W . BOYD, M . B . , C I I . B . , M . R . C . P . , D . C . t t . , F . F . I t O M .

We have often been accused of making excuses for not carrying out research into the activity of our remedies. We state that laboratory research is unlikely to show the effect of the simile principle because it requires the rapport between patient and doctor in the selection and administration of the remedy. We believe that the mental symptoms are of the utmost importance in choosing the remedy; how can these be assessed in the laboratory? Certainly we acknow- ledge that animals respond well to Homceopathy and the mentals in these cases can be deduced from the behaviour of the animal, for example, reaction to noise, jealousy, desire for affection, restlessness, fear, etc.

In the clinical field it is often said that a double blind trial is impossible because the homceopathic doctor must know what remedy he is administering. I t is impossible to give the same remedy to a number of patients for a specific disease, because each must have the correct remedy for his own characteristic reaction to infection, trauma or stress, or" indeed, even his own constitutional remedy chosen as a result of assessing his personality.

While [ am sure that in many cases the selection of the remedy depends on the general and mental symptoms of the patient, I still think we should seek ways of demonstrating the action of our remedies in controlled conditions. I know there are those who maintain that the only way to spread Homceopathy is to encourage the individual doctor to come to a Postgraduate Course, teach him a little, give him some remedies and send him off to try them out, in the belief that he will soon see that they work in practice and will thereafter be a confirmed homceopathic physician. This undoubtedly happens in some cases, often with a doctor who is already well experienced in clinical medicine, and is still unhappy about his results, especially in chronic disease, or is concerned about the damage he may be doing with certain drugs. However, there are some who come to learn, but never pluck up courage to try out remedies in practice, or are too sceptical to t ry them, because they cannot see the scientific rationale behind their use. And, of course, there are many doctors who have never heard of Homceopathy, or brush it aside with a laugh.

I am convinced that we must attempt to demonstrate the effectiveness of Homceopathy in laboratory or controlled clinical conditions if we are to make any impact on medical thinking. Even if these trials are negative, at least they will show our willingness to attempt them, and may encourage others to seek for new ways of demonstrating homceopathic action.

I t is with these thoughts in mind that I will t ry to put forward some ideas, which may stimulate action in the field.

A paper read to the Scottish Branch of the Faculty of Hornceopathy.

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S C I E N T I F I C R E S E A R C H

There are two main lines of research which must be followed: (i) The simile principle;

(ii) The activity of potentized solutions, both at the molecular and the ultra- molecular level.

1. The simile principle This phenomenon is not new in medicine, and Lynn J. Boyd's book The Simile in Medicine is a fascinating study. Dr. Charles Kennedy gave some examples in a paper read to our Congress in Glasgow.

Kennedy (1968) 1 pointed out that X-rays can both cause and inhibit cancer and leukaemia. Digitalis is used to treat a condition presenting similar symptoms and signs to these also found in cases of digitalis overdose. I t is an interesting paradox that some clinical disorders to which steroids are directed are the very ones occasionally induced by them; urticaria, angioneurotic oedema, anaphy- lactic shock, aplastic anaemia, are among allergic reactions to A.C.T.H. and cortisone. Urticaria may also be caused by antihistamines.

Whether these could really be classified as Homceopathy is a moot point, but the phenomena are interesting.

Can we create an experimental situation in animals or tissues which will react to a specific? Can we for example produce an urticaria or allergic oedema which will respond to Urtica uren~ or Apis? Can we cause cramp in an animal by altering its biochemistry and expect it to respond to Cuprum metallicum? Can we create renal colic and measure the effect of Berberis on this? These are a few suggestions, but perhaps in discussion we could think of others.

I t is not really much help to the homceopathic principle to demonstrate the effect of Crataegus, Strophanthus or Convallaria in Mother Tinctnre on a heart preparation. I t may show that these plant tinctures are useful additions to medical treatment but it will neither demonstrate a simile action nor a potency action. Similarly, Arnica or Calendula applied locally may be seen to heal, but unless given orally in potency they will not prove the hom~eopathic case. In using Caulophyllum, do we really apply the simile principle or merely stimulate uterine function?

2. The effect of potencies Most of the research carried out in France and Germany has been on this question of the activity of potentized solutions, much of it on potencies below 24x, i.e. within the molecular range.

I t has been directed at demonstrating the stimulating or depressant effect of "potencies" on plant, animal or enzyme preparations.

Wurmser in France has published a considerable number of papers on these lines and Cier, Netien and Boiron in Lyons have also produced results using dilutions up to 10 -14 .

In the field of plants, Netien, Boiron and Matin (1966) u experimented with seeds obtained from dwarf pea plants sprayed with copper sulphate solution. Half of these were soaked in double distilled water and half in a 15c (10 -3~ potentized dilution of copper sulphate. The germination of the latter was much better than the former. In addition the excretion of copper from treated seeds grown on this 15c dilution was much more rapid than in those grown on potentized distilled water; i.e. a real detoxication of the seed.

Cier, Boiron, Vingert and Braise~ carried out experiments in mice. The

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hypoglycaemic reaction produced by an injection of alloxan could be completely inhibited by giving a 9c potency (10 -18) of alloxan intraperitoneally prior to the crude dose. Also after a diabetogenic injection of alloxan the blood sugar values returned to normal more rapidly when a 9c potency of alloxan was given.

The work of most interest from a biochemical point of view is that of W. E. Boyd 4 who demonstrated the effects of mercuric chloride on the digestion of starch by diastase, using diluted and succussed solutions of 10 -6~ Scepticism of these results is obviously justified, but I think they raise question marks in our thinking.

Professor I. A. Boyd (1968)5 published some experiments which demonstrated effects of acetylcholine in 10 -19 g/ml on perfused frog hearts. This again takes us to the limit of present-day scientific thinking. However, as he has so rightly pointed out, it is not enough merely to show that a dilution of this magnitude has an effect--we must also find out why. In addition we must also find out whether the action of succussion alters the solutions in some way, and if so, can this specific change be transferred from one vial to the next in ever- increasing dilution.

Barnard and Stephenson (1968)6 expounded an interesting theory about the possible physical changes occurring in the process of potentization.

Two reviews of scientific work are available in Stephenson's article in the American Homeopathic Journal of December 1969, and a more recent review carried out by Dr. Sheila Gibson. Smith and Boericke (1966) 7 described experi- ments using the effects of nuclear magnetic resonance to demonstrate potency activity, and recently RawsonS has called for more study in this field.

For some considerable time we have felt the necessity for trained research scientists to look at all these experiments critically and to design further projects in an a t tempt to demonstrate both the simile action and the potency effect and at the same time to study in a practical way the theories of Barnard regarding the patterns formed in solvents.

In Glasgow we have now commenced such a project. A full-time organic chemist with a sound knowledge of research technique and experience in biological work has been appointed for three years, with technical assistance and the equipment of the Physiology Department at Glasgow University. We hope it may be possible to appoint a second scholar with knowledge of other techniques to work in this team. Finance for this has come from the Scottish Homceopathic Research and Education Trust, The Board of Management for Glasgow Homceopathic Hospitals, and the Boyd Research Trust.

C L I N I C A L R E S E A R C H

While the skilled scientists are seeking to demonstrate effects in the laboratory, what can we do in the clinical field?

Let me list briefly the commonest conditions seen and treated in outpatient clinics using homceopathic remedies:

I. Headaches, including migraine 2. Respiratory conditions:

Catarrh, sinusitis, laryngitis, bronchitis, coughs in general, asthma 3. Gastric and bowel disorders:

Peptic ulcer and dyspepsia, hiatus hernia, colitis, diverticular disease, haemorrhoids

4. Genito-urinary: Recurring cystitis, dysmenorrhoea, leucorrhoea

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5. Skin disorders: Eczema, dermatitis, psoriasis, acne, shingles

6. Rheumatism and rheumatoid and osteoarthritis 7. Nervous disorders 8. Cardiac states: these I have placed here because in many cases of arrhyth-

miss and gross cardiac failure we often combine Homceopathy with orthodox drugs

9. Cancer The general practitioner will, of course, see more acute disease, fevers, acute

throats, pneumonia, influenza, gastroenteritis. The question is "Which of these disorders could lend itself to a controlled trial?" In many of these conditions, the doctor himself may be convinced that his remedy worked; but if he takes a critical look, can he really be sure that it was the remedy and not other factors, psychological, environmental or even just the natural course of the disease. In some conditions he may find it necessary to use some orthodox treatment, perhaps an analgesic or antispasmodic, a diuretic, digoxin, a sedative or even an antibiotic. I t would then be necessary to compare the patient taking these, with and without a homceopathic remedy, or to compare the orthodox with the homceopathic, rather than using a placebo, which might well cause distress, if the patient was forbidden to take any other drug. I f a homceopathic remedy is to be used it must be chosen along true homceopathic principles, bearing in mind the totality of symptoms and the fact that the remedy must match the patient and not the disease. This means that a number of different remedies may be used in different patients with the same condition. Would it not still be possible to run a crossover trial using remedy, orthodox drug and placebo. This means giving each of the three different types of treatment for a specified period, but in a different order. The problem here, to my mind, is that this may work if the treatment is purely symptomatic or palliative, but in the case of a homceopathic remedy, the effect of the remedy could well last throughout the following two periods, when the orthodox drug or the placebo is used.

Clinical trials Let me now say something about the conducting of clinical trials. For those wishing to plan a trial I can recommend two excellent books, An Introduction to Clinical Research by W. P. Small and Urban Krause, and The Principles and Practice of Clinical Trials by Harris and Fitzgerald.

A clinical trial has been defined by Bradford Hill as "A carefully and ethically designed experiment with the aim of answering some precisely framed question".

The following factors must be considered before embarking on a trial:

Statistical Advice must be obtained in planning the trial so that the method of trial will be suitable for the final collection of data on which statistical analysis can be used. I t is no use merely asking a statistician to analyze results after the trial is completed.

Ethical Considerations: I t may be necessary to explain to a patient that he will get a dummy tablet on certain occasions, and in some circumstances some form of treatment must be given, whether the patient is in or out of the trial.

Costing, technical feasibility and available clinical facilities should be estimated.

Patient Population must be assessed. Age range, sex, disease description,

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duration of disease, status of a particular parameter of measurement, previous therapy, current therapy, source of patients.

Follow-up is absolutely vital, and this can fail for a number of reasons. I t is the completeness of follow-up, the intensity of investigation and the control of variables that determine the value of a study, not merely its size or the number of participants.

In assessing results it is possible to use not merely impersonal results but also evaluation of the quality of life, as assessed by ability to work, to do house- work, behaviour or relationships within a family, etc.

I have mentioned the problem of carrying out a blind trial when different remedies must be used for different patients with the same disease. Can we therefore look for some reasonably specific remedies, and start a pilot trial, using these knowingly as an initial experiment, and if promising results are obtained then proceed to a carefully controlled trial using a placebo. Dr. Burns of Manchester is a keen exponent of low potency prescribing, and has a number of almost specific remedies which might be tried. I take the liberty of quoting some of these:

Throat infection in children--Belladonna 3x ~-Merc. biniodide 2x Catarrh - -Ka l i bic. 3x ~ Hydrastis l x Duodenal ulcer - - N u x yore. 3x alternating with Chelidonium l x Acne rosacea --Belladonna 3x b.d. Backache --Colocynth 30 and Bryonia 3x Piles Nux vom. 3x Angina --Spigelia and Arnica 3x Shingles ---Arsen. alb. 3x. Dr. James Runcie of Dunfermline also uses a number of specifics, a few of

which I quote: Recurrent cramp Head injury Cerebral thrombosis Tender liver Chronic hepatitis Osteoarthritis of knee Subacromial bursitis

- -Ledum --Helleborus 200, 1M, 10M --Hamamelis 10M --Chelidonium tinct., 5 drops t.i.d. --Carcinosin adenostom 200/1 ~Chelidonium --Osteoarthritic nosode and Ruta in the acute stage --Osteoarthritic nosode and Ruta in the acute stage

There are probably others, which you can add to this list. We should select some condition seen reasonably often in general practice or outpatient work and preferably with some criteria capable of measurement, e.g.E.S.R., rheuma- toid factor titres, liver function tests, transaminase levels, or X-ray appearances. We should then set out a proforma with the criteria necessary to include cases in a trial, with details about the patient as already mentioned, and then endeavour to interest some of our members or even colleagues in orthodox practice to cooperate in such a trial, preferably in more than one centre.

When one studies books on clinical trials and research, the problems seem immense, particularly obtaining adequate patients for follow-up and also select- ing some condition where improvement can be assessed in an objective and unbiased manner. I firmly believe, however, that this must be attempted by our Faculty if progress is to be made.

I have tried in this paper to put before you some ideas about clinical and scientific research, being only too aware of the difficulties and the need for us

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all to pool our suggestions and experience and I now ask you to discuss these in more detail so that some practical plan can be formulated.

R E F E R E N C E S

l Kennedy, C. O. (1968) The future of Homceopathy. The British Homoeopathle Journal, 57, 149. Netien, G., Boiron, J. , Marin, A. (1966) Copper sulphate and plant growth. The British Homveopathic Journal, 55, 186.

a Clef, A., Boiron, J. , Vingert and Braise (1969) Journal of the American Institute of Ho~r~eopathy, 62, 86.

4 Boyd, W. E. (1954) Biochemical and biological evidence of the activity of high poten- cies. The British Homveopathic Journal, 44, 6.

5 Boyd, I. A. (1968) Homoeopathy through the eyes of a physiologist. The British Homveopathic Journal, 57, 86. Barnard, G. P., and Stephenson, J. H. (1969) Journal of the American Institute of Homeopathy, 62, 73.

7 Smith and Boorieke (1966) Journal of the American Institute of Homeopathy, 59, 263. s Rawson, D. S. (1972) A scielltifie approach to ttomceopathy. The British Homveopathic

Journal, 61, 116.

International Congress for Homceopathic Medicine from 28th May to 2nd June, 1973,

held in Vienna

A small group from Britain had the pleasure of attending this wonderful Congress. Dr. and Mrs. L. R. Twentyman, Dr. Max Deacon, and Mr. and Mrs. Ainsworth (Nelson's) and their daughter, Hilary, from London, Mr. and Mrs. G. MacLeod, the Veterinary Surgeon, and Dr. and Mrs. I-I. W. Boyd, Dr. Anneliese Hennessy, Miss Mary Shields, Group Senior Nursing Officer, and Miss Bertram from Glasgow.

Vienna is an ideal setting for such a Congress. The weather was warm and sunny and the famous buildings have all been restored in their original form.

The Congress was attended by over 300 participants, doctors, dentists, veterinary surgeons, chemists, pharmacologists, and their wives and friends. Many were from Germany and Austria, but delegates were present from U.S.A., South America, India, Pakistan, Greece, Roumania, East Germany, Italy, France, Holland and Britain.

The Scientific Sessions covered a wide field and commenced each day at 8.30 a.m. Simultaneous translation in four languages was available in the main hall, but the additional working groups held in the afternoons did not have