Two previous articles in this series proved quite conclusively that homoeopathic remedies are worthless beyond their singular ritualistic value. The local homoeopathic fraternity were invited to present any evidence to the contrary, but either declined or subsequently withdrew their efforts as the strength of this thesis became evident. Similarly, the threats of legal action evaporated as the truth of this position set in.

It was originally the intention to expose only the monopolistic and fraudulent acts being perpetrated by the big homoeopathic companies from behind a sickening charade of public beneficence, but subsequent denial by homoeopaths themselves and refusal to consider evidence led to the publication of proof of their delusion. This led to even deeper denial as their peculiar cultic faith, and or ego's (besides considerations of financial concern) stood in the way of honest reappraisal and acceptance of the facts of solid wholistic science, presented in the main by actual proponents of homoeopathy and complementary medicine.

John Davidson, a highly respected modern esoteric author noted: "It is one of the most important, yet most neglected discoveries of medicine that 'nothing' will actually cure, regularly and frequently" (1).

In a British homoeopathic journal he wrote that "In homoeopathy, the issue may be even more complex: Homoeopathy it is often claimed, works through enhancing the self-healing processes; this could mean that homoeopathy simply maximises the placebo response" (2). Davidson has further written that "Even pathological and physiological symptoms can disappear when the individual's mind is convinced. If the mind is convinced ill-health will continue, then all the drug-molecules in the world will not help" (1).

Prof. Dr. W. Gaus and Dr Hogel (Univ. Ulm), developed a homoeopathic trial design which takes into account the individual selection of classical homoeopathic medicines. In a double-blind trial in patients with chronic headache, after two months of such treatment, patients suffered from headache on fewer days, duration of headache was less severe, and intake of analgesics had been reduced. Not bad for homoeopathy, generally not very successful with headache. However, therapy was equally successful in the placebo group. (3) Is it really so wrong to expose how much of healing, (incl. orthodox), is placebo?

A recent example of blind enthusiasm is a feature in the rather bland publication, 'Health Independent' (Sept 98), which ran a propaganda piece titled "Homoeopathy gaining acceptance throughout the world: AMA journal publishes positive study of homoeopathic medication for vertigo". The text implied that finally being featured in medical journals, attributed scientific credibility to homoeopathy, whereas anyone remotely honest would have to reach the opposite conclusion. The Lancet and BMJ (isopathy) and Pediatrics studies have been subsequently refuted due to flawed methodologies, and the Lancet meta-analysis failed homoeopathy on the same criteria, plus established no efficacy for any single application.

Significantly the obscure AMA Archives of Otolaryngology paper was a comparison of Vertigoheel with betahistidine as an equivalence control, rather than with placebo. Furthermore the study was unorthodox in that it was conducted by the manufacturer's: Heel Inc, and this story lifted off their commercial web-site. Most telling however, is that betahistine is described as "standard conventional therapy" and Vertigoheel as being "as effective", yet the spokesperson, also the principal author, goes on to reveal the illusion of efficacy by stating that "because of the lack of effective conventional treatments, Vertigoheel fills a serious void", but thereby logically admitting that the homoeopathic treatment was as effective as a non-effective conventional treatment. Enter spontaneous remission and placebo and hey presto: efficacy !

Vertigoheel, a combination clinical so-called homoeopathic medication, interestingly does not strictly qualify as such, since in the manufacturer's own words "unlike classical homoeopathic drugs, the active ingredients in Vertigoheel are not ultra-highly diluted and the pharmacological and clinical profiles can be defined within the conventional medical paradigm, a bridge between homoeopathy and conventional pharmacology". Furthermore, I note that the most concentrated active (D3)(Conium) is a potent toxin and is within a range where it admittedly functions pharmacologically. The 70% improvement attributed to both 'active' treatments is however also well within the same range of that expected from a good placebo.

Over and above the refuted evidence from homoeopathic clinical trials, really weak arguments include 'evidence' from case studies, materia medica 'provings' (observations), and healing with animals, which simply do not constitute an iota of scientific evidence, since the circumstances and numbers are not only inadequate, they are a joke, and spontaneous remission (we are all self-healing organisms) and placebo effects easily cover the observations. Animals also respond to care and concern and professor Ernst, Chair of Complementary Medicine at the University of Exeter has described the animal argument as "weak" (4).

Science has not embraced homoeopathy, and for good reason. New Scientist Magazine commented on the recent Linde et al homeopathic meta-analysis as follows: "A few teams failing to publish a negative trial; a few claiming they tested the remedy blind when in fact they were aware which patients were getting the remedy and which the placebo, and hey presto, homeopathy nudges ahead in the pooled analysis" (5). In a recent Scientific American article, Walter Brown (psychiatrist) of Brown University School of Medicine commented that "Although alternative medicine healers and their patients believe fervently in their effectiveness, many of these popular remedies probably derive their benefit from the placebo effect" (6).

Most people who think that they do, don't truly understand what the placebo effect is. Spontaneous remission and the placebo effect, known as nonspecific effects, are significant phenomena that have veiled impact. The major logical error in plotting disease progress is: post hoc, ergo propter hoc ("after and therefore because of"). This common fallacy credits improvement to a specific treatment merely because the improvement followed the treatment. Placebo is best understood in terms of the common factors associated with various types of therapy, such as expectancy, contact with a therapist, and therapeutic alliance. Not only medication, but also other features of the physician-patient encounter may recruit the healing response. Careful analysis may be far more comforting than immediate diagnosis (6).

The placebo is crucial in demonstrating that the improvement is not the result of the incidental aspects of treatment. The adoption of the randomized, placebo-controlled trial (provided that statistical significance is not falsely P-valued, but Bayesian analysed) ensures an elegant control, since experimenter or patient bias or a confound of patient differences with treatment method may be respectively countered by double-blinding and randomization. Although almost everyone controls for placebo, almost no one evaluates them, yet more placebos have been administered and confirmed than for any experimental drug. (ST) Some perceptive scholars, believe that the history of medicine is the history of the placebo response (7).

The standard textbook 30% for placebo is unrealistic low. Strauss and Cavanaugh showed placebo response rates for some psychiatric disorders: major panic disorder 51%; depression 67%; & generalized anxiety disorder 82% (8). A recent conference reported that 50-72% of the children in a Ritalin- Placebo evaluation, were rated as being improved while on placebo in both the home and school environment regarding the severity of problems, and the number of problems demonstrated (9). Verdugo and Ochoa, noted that after diagnostic intervention, pain/hypoaesthesia was relieved in 66,6% of patients (10). In its most general sense, "placebo" includes spontaneous remission, the patients belief, the healer's 'energy follows thought' contribution and other incidental factors. Medicinal efficacy are exclusive effects, if any.

Kirsh and Sapirstein, Ph.D's at Univ. Connecticut and Westwood Lodge Hospital, MA, respectively, using meta-analysis to evaluate the magnitude of the placebo response against 16 antidepressant medications (including Prozac) in 19 strict criteria double-blind clinical trials with 2,318 patients, determined that the inactive placebos produced improvement of 75% of the effect of the active drug. They concluded that "experiencing more side-effects, patients in active drug conditions concluded that they were in the drug group; and this can be expected to produce an enhanced placebo effect in drug conditions and thus, the apparent (additional) drug effect may in fact be an active placebo effect" (11).

Larry Beutler, University of California, added: "translating the mean placebo response effect size reveals that 88% of patients who received only placebos experienced improvement (12% stayed the same or got worse) and only 15% gained benefit by antidepressants over placebo alone. To some it might appear obvious that the front line treatment of choice is placebo, not antidepressants". He also commented: "Collectively, the poor showing of antidepressants in this and other meta-analytic studies raise an interesting question about why and how public enthusiasm and faith is maintained in these treatments, a research question whose importance may even exceed that of the effects of the drugs themselves". (12)

Beutler opinioned that "One may wonder whether the increase in the number of drug patients improved is worth the cost. These results challenge certain widely held beliefs about the effectiveness of medication and have direct relevance for questions about the adequacy of contemporary methodologies to control for the effects of expectation, hope, and nonspecific treatments" (12). Kirsh stated that "Although our data do not prove antidepressants to be ineffective, it does indicate that effectiveness still needs to be established" (13). The same for homoeopathic medicines, which to date have not achieved any proven success. Any statistical significance is negated by Bayesian analysis to standard arbitrary P-value results.

Dr Andrew Weil M.D. points out that "in 1842 Oliver Wendell Holmes (echoing Voltaire) wrote that the fact of homeopathic cures should not be admitted as evidence, because 90% of cases commonly seen by a physician would recover sooner or later, with more or less difficulty, provided that nothing were done to interfere seriously with the efforts of nature". Weil adds: "In other words, most sick people will get better no matter what you do, as long as you do not actively make them worse, a strong argument, consistent with the experience of most observers of illness, (and concludes that) we may quibble over the percentage of cases that will recover anyway, but it is certainly high, and may well be as high as 90%". (7)

Dr Robert Becker M.D. writes: "The minimal techniques of energy medicine are quite different from the placebo effect as depicted and condemned by orthodox medicine. The body's internal energetic systems may be accessed by the conscious mind through the use of several techniques that do not involve the addition of any external energy into the body. Standing in the shadows beyond the light of present day science, is the placebo effect which is capable of producing the desired medical effect in 60% of clinical cases overall". In line with my own conviction as a consumer, Dr Becker has suggested that "ethical practitioners of minimal-energy techniques not deceive their patients (but) tell them from the start that they are going to cure themselves by means of control over their own bodies / destinies" (14).

Such an approach would empower and ethically serve both patient and practitioner, yet most homoeo-paths apparently feel intimidated. Dr Weil relates a personal favourable encounter with homoeopathic treatment and concludes: "I feel comfortable with the conclusion that the homeopathic remedy functioned as a placebo" (7). A key concept at a recent conference was that complementary therapies construct the consultation to give non-specific factors prominence, where especially symptom relevance and congruence between health beliefs of the practitioner and the client may be particularly significant (15).

There can be no final verdict on the efficacy of any, (including all orthodox) treatment until researchers start to take the placebo effect seriously. This means evaluating instead of controlling it. Patients might not mind being given dummy pills engineered to produce a convincing but harmless array of side effects (16). The mere act of treatment, independent of its content, can elicit cures by means of the placebo response (7). Deliberate use of the placebo response will maximise patient satisfaction and treatment efficacy. If the placebo effect could be patented and bottled, it would be worth a fortune.

The placebo effect is an unpopular topic. In complementary medicine the 'aura of quackery', linked to any discussion of the placebo effect is for many, too close for comfort. At a recent conference titled "Placebo: Probing the Self-Healing Brain" Lawrence Sullivan, a historian of religion at Harvard Divinity School noted: "Nobody wants to own it. Even shamans and witch doctors would be offended by the idea that their healing powers depended on the placebo effect". Harvard Medical School anthropologist Arthur Kleinman asked: "Why is the placebo regarded as pejorative? Is it threatening to medicine?" (17)

The next part in this series will examine the local and international politics which established and sustains the delusion of homoeopathic (& often orthodox medicine) as a modality distinguishable from placebo; will examine the known dangers and drawbacks to patients and practitioners attendant to this delusion; will continue to prove beyond doubt that without the factors of spontaneous remission, placebo and the healers 'energy follows thought' contribution, homoeopathic remedies are worthless; will elaborate the healer's potential energy contribution and will suggest practical and ethical means of optimising these fundamental pillars of healing so as to enable patients and practitioners alike, to throw off the shackles of ignorance, indoctrination, limitation and deception and so set about mastering the most creative of all energies other than the Creator itself, namely that of refined elevated human thought and consciousness.

11 October 1998

Director

Gaia Research Institute

PO Box 2147, Knysna, 6570. E-mail : gaia.research@pixie.co.za