- Email: [email protected]
Response to Dr English's letter
61
Volume 85, January 1996
in the interim, to assume substantial safety for homoeopathic medicines? No smoke, so no fire? I think we are. Professor Ernst next raises the question of levels of clinical competence: the risk that those without medical training might fail to recognize serious disease. This too needs to be examined. So far, there is little evidence of it. To produce, as he does, two reported cases is actually to make the opposite point. If it were common, he'd have found at least 202. From conversations with those who insure non-medically qualified homoeopaths, I understand that actions against them are almost unheard of. And before we as physicians claim to be whiter than white, we should look at the numbers of wrong and missed diagnoses perpetrated at both primary and secondary levels in the NHS. Having served on complaints panels for years, I know this to be so. We must not be 'holier than thou'. Professor Ernst's best point is perhaps the one c o n c e r n i n g u n d e r s t a n d i n g w h e n a deterioration is an aggravation or a deterioration in pathology. There is a danger of non-medical practitioners missing the latter. Any apparent aggravation which does not r e m i t in the e x p e c t e d w a y s h o u l d be reviewed with the latter possibility in mind. Professor Ernst referred to my paper on vaccination, 2 pointing out how few nonmedically qualified homoeopaths recommend vaccination. I still believe that we are right to recommend it, that the balance of evidence supports that point of view. I do so with some reluctance, however. Whereas we are talking about side-effects, it would be fair to mention the very reasonable doubts as to the long-term effects of vaccination on the population. Research to prove or disprove this would be most valuable. But this would require enormous numbers, take many years to complete, and would be extremely expensive. Yet the possibility of such side-effects remains. 1 Ernst E. The safety of homoeopathy. Editorial. Br Horn J 1995; 84: 193-4. 2 English J. The issue of immunization. Br Horn J 1992; 81: 161-3.
JOHN M. ENGLISH 87 Greencroft Street Salisbury Wiltshire SP1 1JF
Response to Dr English's letter SIR--One of my aims in writing the editorial ' T h e s a f e t y o f h o m o e o p a t h y ' was to raise awareness of this topic. Dr English's letter is t h e r e f o r e m o s t w e l c o m e . It touches on several important points which may deserve further comment. Dr English asks where the evidence is for or against the notion that any treatment that works does have potential dangers. I agree that this is an unproven assumption, but only if we talk about direct harm. Harm can be done indirectly, even with a perfectly innocent treatment, e.g. by applying it wrongly (example: if a patient is treated homoeopathically only for an operable cancer, this would unquestionably be harmful). Raising awareness of side-effects might indeed cause anxiety in practitioners, as Dr English puts it. This could be a necessary precondition. To frighten patients, however, is never intended in writing about the subject in a professional journal. How would one research side-effects? This is a good methodological question, in-depth answers to which may be found in the relevant literature. My editorial is not a substitute for studying this. Dr English goes on to ask when are we entitled to assume that a treatment is safe? Again this is a difficult question, and I am afraid I have no simple answer. However, we should remember that absence of evidence must not be equated with e v i d e n c e for absence of adverse effects. At present we know too little about the potential risks of homoeopathy. The fact that I cited two cases where things had gone badly wrong does not mean that a systematic search would not find the 202 cases Dr English demands. At our Ciba meeting a Medline search was stated to have identified no references relating to sideeffects of h o m o e o p a t h y , but one would expect to find these in the grey literature rather than in Medline or to have remained altogether unpublished. The question as to whether a patient getting worse following homoeopathic treatment is an aggravation or deterioration in function or pathology is indeed fascinating. It would be valuable if expert homoeopaths would come up with a clear distinction between the two. In principle (and with some degree of over-simplification) three things can happen
62
British Homoeopathic Journal
after any consultation: improvement in some way; no change; deterioration. Homoeopathy is the only type of medicine that may declare any of these outcomes a 'success'. Finally, Dr English touched on the vaccination issue. All advocates of this intervention agree that immunizations are burdened with risks. The question, however, is whether it does more good than harm. On the basis of the information available today there can be little doubt that the net benefit outweighs the risks. Just as we evaluate immunizations by such risk/benefit estimates, we must judge all treatments, including homoeopathy. I feel that safety cannot be discussed without looking at efficacy/effectiveness, which are two sides of the same coin. It also follows that the argument 'homoeopathy is associated with fewer side-effects than conventional medicine' is seriously flawed. The relevant question to address is 'is homoeopathy associated with a m o r e f a v o u r a b l e r i s k / b e n e f i t ratio than conventional medicine?' Sadly we have not enough hard data to answer it at present. E. ERNST Centre for Complementary Health Studies University of Exeter 25 Victoria Park Road Exeter EX2 4NT Kensal Green Cemetery
SIR--Our recent researches at KensalGreen C e m e t e r y have shown that several early homoeopathic practitioners are interred here. The earliest grave is that of Dr David Uwins (1780-1837), MD Edinburgh 1803. He was a medical writer and one of the first homoeopathic physicians, a friend of Dr Quin. He studied at various London hospitals. The very first homoeopathic physician to practise in Britain was Dr Frederick Hervey Quin (1799-1878), MD Edinburgh 1820. He converted to homoeopathy in 1826 and began public practice in 1832, founded the British H o m o e o p a t h i c Society in 1844 and the British Hospital' in 1850. He was a great wit and dandy, a n d a friend of Dickens, T h a c k e r a y and L a n d s e e r . His g r a v e is marked by a badly weathered monument, with an inscription in lead lettering only partly legible. A long epitaph included the statement that the monument was erected by 'H.R.H. The Prince of Wales'. /
Two other h o m o e o p a t h i c practitioners h a v e i m p r e s s i v e m o n u m e n t s in K e n s a l Green. One is John Epps (1805-1869), MD Edinburgh 1826. He was also involved in many public questions, such a parliamentary, religious and social reform. The grave is marked by a ledger with bas-relief of Epps at the head. The other is G e o r g e N a p o l e o n E p p s (1815-1874), half-brother of John, homoeopathic physician, surgeon to the Homoeopathic Hospital in 1945. Known as the Cocoa King, he was particularly successful in the treatment of spinal deformities. Large pink granite memorial. The restoration of the graves of Drs Uwins and Quin would be an expensive undertaking, but worthwhile if funds were available. If any readers would like to visit these graves, please contact me. S. E. BULL Friends of Kensal Green Cemetery Flat 1 Cranfield Court 21 Homer Street London W I H 1HE e-mail
S I R - - M a y I bring to the attention of your readers the news that the Royal London Homoeopathic Hospital is now on e-mail? We have set up a mailing list for the discussion of issues in complementary medicine, including homoeopathy, and readers with access to e-mail are invited to subscribe. To do t h i s , s e n d an e - m a i l m e s s a g e to [email protected]. Your name will then be added to the mailing list and you will receive copies of any items which are circulated; you can of course submit your own items as well. My own e-mail address at the R L H H is acampbell @ rlhh.demon.co.uk. ANTHONYCAMPBELL Royal London Homoeopathic Hospital Great Ormond Street London W C I N 3HR Tincture combinations
SIR--Because of my busy practice, I was not in a p o s i t i o n to f o l l o w H a h n e m a n n i a n principles of homoeopathic treatment and searched for a better and easy method of
Volume 85, January 1996
in the interim, to assume substantial safety for homoeopathic medicines? No smoke, so no fire? I think we are. Professor Ernst next raises the question of levels of clinical competence: the risk that those without medical training might fail to recognize serious disease. This too needs to be examined. So far, there is little evidence of it. To produce, as he does, two reported cases is actually to make the opposite point. If it were common, he'd have found at least 202. From conversations with those who insure non-medically qualified homoeopaths, I understand that actions against them are almost unheard of. And before we as physicians claim to be whiter than white, we should look at the numbers of wrong and missed diagnoses perpetrated at both primary and secondary levels in the NHS. Having served on complaints panels for years, I know this to be so. We must not be 'holier than thou'. Professor Ernst's best point is perhaps the one c o n c e r n i n g u n d e r s t a n d i n g w h e n a deterioration is an aggravation or a deterioration in pathology. There is a danger of non-medical practitioners missing the latter. Any apparent aggravation which does not r e m i t in the e x p e c t e d w a y s h o u l d be reviewed with the latter possibility in mind. Professor Ernst referred to my paper on vaccination, 2 pointing out how few nonmedically qualified homoeopaths recommend vaccination. I still believe that we are right to recommend it, that the balance of evidence supports that point of view. I do so with some reluctance, however. Whereas we are talking about side-effects, it would be fair to mention the very reasonable doubts as to the long-term effects of vaccination on the population. Research to prove or disprove this would be most valuable. But this would require enormous numbers, take many years to complete, and would be extremely expensive. Yet the possibility of such side-effects remains. 1 Ernst E. The safety of homoeopathy. Editorial. Br Horn J 1995; 84: 193-4. 2 English J. The issue of immunization. Br Horn J 1992; 81: 161-3.
JOHN M. ENGLISH 87 Greencroft Street Salisbury Wiltshire SP1 1JF
Response to Dr English's letter SIR--One of my aims in writing the editorial ' T h e s a f e t y o f h o m o e o p a t h y ' was to raise awareness of this topic. Dr English's letter is t h e r e f o r e m o s t w e l c o m e . It touches on several important points which may deserve further comment. Dr English asks where the evidence is for or against the notion that any treatment that works does have potential dangers. I agree that this is an unproven assumption, but only if we talk about direct harm. Harm can be done indirectly, even with a perfectly innocent treatment, e.g. by applying it wrongly (example: if a patient is treated homoeopathically only for an operable cancer, this would unquestionably be harmful). Raising awareness of side-effects might indeed cause anxiety in practitioners, as Dr English puts it. This could be a necessary precondition. To frighten patients, however, is never intended in writing about the subject in a professional journal. How would one research side-effects? This is a good methodological question, in-depth answers to which may be found in the relevant literature. My editorial is not a substitute for studying this. Dr English goes on to ask when are we entitled to assume that a treatment is safe? Again this is a difficult question, and I am afraid I have no simple answer. However, we should remember that absence of evidence must not be equated with e v i d e n c e for absence of adverse effects. At present we know too little about the potential risks of homoeopathy. The fact that I cited two cases where things had gone badly wrong does not mean that a systematic search would not find the 202 cases Dr English demands. At our Ciba meeting a Medline search was stated to have identified no references relating to sideeffects of h o m o e o p a t h y , but one would expect to find these in the grey literature rather than in Medline or to have remained altogether unpublished. The question as to whether a patient getting worse following homoeopathic treatment is an aggravation or deterioration in function or pathology is indeed fascinating. It would be valuable if expert homoeopaths would come up with a clear distinction between the two. In principle (and with some degree of over-simplification) three things can happen
62
British Homoeopathic Journal
after any consultation: improvement in some way; no change; deterioration. Homoeopathy is the only type of medicine that may declare any of these outcomes a 'success'. Finally, Dr English touched on the vaccination issue. All advocates of this intervention agree that immunizations are burdened with risks. The question, however, is whether it does more good than harm. On the basis of the information available today there can be little doubt that the net benefit outweighs the risks. Just as we evaluate immunizations by such risk/benefit estimates, we must judge all treatments, including homoeopathy. I feel that safety cannot be discussed without looking at efficacy/effectiveness, which are two sides of the same coin. It also follows that the argument 'homoeopathy is associated with fewer side-effects than conventional medicine' is seriously flawed. The relevant question to address is 'is homoeopathy associated with a m o r e f a v o u r a b l e r i s k / b e n e f i t ratio than conventional medicine?' Sadly we have not enough hard data to answer it at present. E. ERNST Centre for Complementary Health Studies University of Exeter 25 Victoria Park Road Exeter EX2 4NT Kensal Green Cemetery
SIR--Our recent researches at KensalGreen C e m e t e r y have shown that several early homoeopathic practitioners are interred here. The earliest grave is that of Dr David Uwins (1780-1837), MD Edinburgh 1803. He was a medical writer and one of the first homoeopathic physicians, a friend of Dr Quin. He studied at various London hospitals. The very first homoeopathic physician to practise in Britain was Dr Frederick Hervey Quin (1799-1878), MD Edinburgh 1820. He converted to homoeopathy in 1826 and began public practice in 1832, founded the British H o m o e o p a t h i c Society in 1844 and the British Hospital' in 1850. He was a great wit and dandy, a n d a friend of Dickens, T h a c k e r a y and L a n d s e e r . His g r a v e is marked by a badly weathered monument, with an inscription in lead lettering only partly legible. A long epitaph included the statement that the monument was erected by 'H.R.H. The Prince of Wales'. /
Two other h o m o e o p a t h i c practitioners h a v e i m p r e s s i v e m o n u m e n t s in K e n s a l Green. One is John Epps (1805-1869), MD Edinburgh 1826. He was also involved in many public questions, such a parliamentary, religious and social reform. The grave is marked by a ledger with bas-relief of Epps at the head. The other is G e o r g e N a p o l e o n E p p s (1815-1874), half-brother of John, homoeopathic physician, surgeon to the Homoeopathic Hospital in 1945. Known as the Cocoa King, he was particularly successful in the treatment of spinal deformities. Large pink granite memorial. The restoration of the graves of Drs Uwins and Quin would be an expensive undertaking, but worthwhile if funds were available. If any readers would like to visit these graves, please contact me. S. E. BULL Friends of Kensal Green Cemetery Flat 1 Cranfield Court 21 Homer Street London W I H 1HE e-mail
S I R - - M a y I bring to the attention of your readers the news that the Royal London Homoeopathic Hospital is now on e-mail? We have set up a mailing list for the discussion of issues in complementary medicine, including homoeopathy, and readers with access to e-mail are invited to subscribe. To do t h i s , s e n d an e - m a i l m e s s a g e to [email protected]. Your name will then be added to the mailing list and you will receive copies of any items which are circulated; you can of course submit your own items as well. My own e-mail address at the R L H H is acampbell @ rlhh.demon.co.uk. ANTHONYCAMPBELL Royal London Homoeopathic Hospital Great Ormond Street London W C I N 3HR Tincture combinations
SIR--Because of my busy practice, I was not in a p o s i t i o n to f o l l o w H a h n e m a n n i a n principles of homoeopathic treatment and searched for a better and easy method of