1. COMPLEMENTARY AND ALTERNATIVE MEDICINE HOMEOPATHY M. Kršiak Department of Pharmacology, Third Faculty of Medicine, Charles University in Prague Lecture for students of medicine, Subject „General pharmacology“ 2013/2014 http://vyuka.lf3.cuni.cz CVSE3P0012 ID 9204

2. “ALTERNATIVE” MEDICINE ( or rather “COMPLEMENTARY” MEDICINE because it does not substitute a standard medicine [e.g. an astrologist is not an alternative astronomist] [dr. O. Vinař] some dare to say a „fringe medicine“ or „healer‘s medicine“ Complementary & Alternative Medicine - CAM

3. Some examples of CAM (Complementary and Alternative Medicine):  homeopathy  acupuncture,  TCHM traditional Chinese medicine  herbal medicine  chiropractice

4. Homeopathy Founder: Dr. S. Hahnemann (1755-1843) German physician

5. 1/ The 'Principle of Similars', 'like cures like ' ‚ „Similia similibus curantur”) Hahnemann noticed, that quinine produces symptoms of malaria at high doses, while it produces the opposite at low doses let likes cure likes… Homeopathy holds the premise of treating the sick with extremely diluted agents that, in undiluted doses, produce similar symptoms in the healthy. Principles of homeopathy I:

6. DILUTION decimal 1:10  1:10  … D6 =10 -6 centesimal 1:100  1:100  … CH10 = 10 -20 (CH centesimal according to Hahnemann) … Hahnemann advocated CH30 dilutions for most purposes This „thirtieth potency“ (1 in 10 60) provides solution which practically contains no molecule of the initial drug (a Mother Tincture) Mainstream medicine in Hahneman‘s days: bloodletting, purging …

7. 2/ The principle of „dynamization“ Vigorous shaking of solutions during their successive dilutions increases the potency of the preparation The higher the number of dilutions, the higher the potency Principles of homeopathy II:

8. What do homeopathic preparations contain? Classical homeopathics: mostly contain no effective drug Initial components: - Mineral (e.g. mercury, sulphur, lava, coral) - Herbal - Animal (e.g. ants, whale ambergris, corpora lutea [nosoda – not in Cz.R.])

9. Major problem of homeopathy: It lacks the rigorous evidence of efficacy required by modern standards (scientific, objective evidence, e.g. EBM) E Ernst. A systematic review of systematic reviews of homeopathy. British Journal of Clinical Pharmacology 2002 54: 577-582. WB Jonas et al. A critical overview of homeopathy. Annals of Internal Medicine 2003 138: 393-399 Bandolier 116

10. Current errors of present homeopaths: - They believe effects of homeopathics can be proven by current meta-analyses - They strive after scientific explanation of effects of homeopathics Current errors of opponents of homeopathy: - they require scientific/objective evidence of efficacy of homeopathics ( by current meta-analyses) - they ascribe effects of homeopathics only to the effect of placebo

11. 1. People are not only rational machines, computers (as some economists presume), but also emotional [and moral] beeings. Their decissions are influenced also by emotional (and moral) aspects. If an emotional (or moral) value of something (e.g. health or life of their own or of their dearest) prevails, they disregard the rational or material value WHY IS HOMEOPATHY (AND HEALER‘S PRACTICES) STILL SO POPULAR ? (even in well educated populations, developed countries )

12. 2. People need hope. Homeopaths (and healers) fill up a niche of a huge demand for hope hope-sellers WHY IS HOMEOPATHY (AND HEALER‘S PRACTICES) STILL SO POPULAR ? (even in well educated populations, developed countries )

13. 3. Homeopaths and healers (in contrast to modern science) do not stonewall [deny] mystery, spiritual influences. In the contrary, they build on them (more or less appropriately) WHY IS HOMEOPATHY (AND HEALERS PRACTICES) STILL SO POPULAR ?

14. DOSTOEVSKY: "Man needs the mysterious and the infinite just as much as he does the small planet which he inhabits ". Humans seem to be able to feel a mystery. They even seem to need a mystery. If the need for mystery is not satisfied properly, the need is satisfied e.g. by astrology, horoscopes, occultism and false healing practices.

15. 4. Homeopaths and healers create a good personal therapeutic relationship with the patient WHY IS HOMEOPATHY (AND HEALER‘S PRACTICES) STILL SO POPULAR ? (even in well educated populations, developed countries ) Which is so much neglected in the present technological medicine. Development of individual (personal) therapeutic relationship is essential for a sucessful treatment in many disorders/ patients

16. 5. Homeopathy (and some healer‘s practices) is a big bussiness, an excellent source of money WHY IS HOMEOPATHY (AND HEALER‘S PRACTICES) STILL SO POPULAR ? (even in well educated populations, developed countries )

17. Risks of homeopathy I: Risks knowable by a reason (a common sense): hindering of early diagnosis  hindering of effective treatment  regression to a magic thinking  waisting human talent and faculties (knowledge, initiative)

18. Risks of homeopathy II: Risks in addition (according to some spiritual views) spiritual risks: - Risks of entrusting oneself to doubtful powers Mt 7,22-23 22 Many will say to me on that day, 'Lord, Lord, did we not prophesy in your name, and in your name drive out demons and perform many miracles?' 23 Then I will tell them plainly, 'I never knew you. Away from me, you evildoers!'.' - Putting the Lord to the test Mt 4,5-7 5 Then the devil took him to the holy city and had him stand on the highest point of the temple. 6 "If you are the Son of God," he said, "throw yourself down. For it is written: "'He will command his angels concerning you, and they will lift you up in their hands, so that you will not strike your foot against a stone.'" 7 Jesus answered him, "It is also written: 'Do not put the Lord your God to the test.'" -Waisting own and other humans capabilities (hiding own talent in the ground) Mt 25,14-29 and L 19: 15-26 Spiritually advanced people resort in a severe disease to a prayer rather than to homeopathy (or another „alternative“ medicine). The most advanced and strongest know they have no right for a preferential treatment (Mt 26,39) such as changing the natural laws or removal of freedom in man. So, a negative result of their prayer they do not consider as evidence of ineffectiveness of praying.

19. So, when to use homeopathy (or CAM)? Only as a treatment of last choice if modern medicine fails – as „ultimum refugium“ (last resort)