A blog from my website that may be of interest here.

Homeopathy is often criticized for having little research evidence available. This blog is a compilation of what I have learned in examining research evidence for homeopathy published in conventional medical journals. For more info on homeopathy, please see a previous blog entitled “Homeopathy primer.”

One of the major reasons that the results of most mainstream research on homeopathy are often inconclusive because the methods used usually do not honour the principles of homeopathy and therefore the research does not actually evaluate the practice of homeopathy. Aphorism 104 in the Organon explains how a practitioner can take and treat a case homeopathically:

“Once the totality of symptoms that principally determine and distinguish the disease case … has been exactly recorded, the most difficult work is done … He can then select … a well-aimed, similar, artificial disease potence, in the form of a homeopathically chosen medicinal means, to oppose the total disease image (1).”

Unfortunately, remedies are often not prescribed individually and are instead selected based on typical clinical presentation of pathology.

A meta-analysis published by Shang et al. in the Lancet in 2005 compared placebo-controlled homeopathy trials to conventional medicine trials matched by disorder and type and determined that “the clinical effects of homoeopathy, but not those of conventional medicine, are unspecific placebo or context effects (2).” The homeopathy trials were categorized classical, clinical, or complex homoeopathy (or as isopathy). Specifically,

“Classical homoeopathy was defined as comprehensive homoeopathic history-taking, followed by the prescription of a single individualised remedy, possibly with subsequent change of remedy in response to changing symptoms. If no comprehensive homoeopathic history was taken and all patients received a single, identical remedy, interventions were classified as clinical homoeopathy (2).”

Only “classical” homeopathy trials actually reflect the use of remedies according to homeopathic principles as set out in the Organon. “Clinical” homeopathy is the substitution of homeopathic remedies for conventional medicine and therefore not the practice of homeopathy. Of 110 homeopathy trials analyzed, only 18 were categorized as “classical” while 48 “clinical” homeopathy trials were analyzed. The selection of trials for this analysis therefore precluded results that would accurately evaluate the effects of homeopathic treatment.

Rutten and Stolper analyzed post-publication data from the Shang paper and concluded that:

“Re-analysis of Shang's post-publication data did not support the conclusion that homeopathy is a placebo effect. The conclusion that homeopathy is and that conventional is not a placebo effect was not based on comparative analysis and not justified because of heterogeneity and lack of sensitivity analysis. If we confine ourselves to the predefined hypotheses and the part of the analysis that is indeed comparative, the conclusion should be that quality of homeopathic trials is better than of conventional trials, for all trials (p=0.03) as well as for smaller trials (p=0.003) (3).”

A review by Lüdtke and Rutten also came to this conclusion. Their meta-analysis determined that “homeopathy had a significant effect beyond placebo (OR=0.76; 95% CI: 0.59-0.99; p=0.039) (4).” and that, “Shang's negative results were mainly influenced by one single trial (4).” They concluded: “Shang's results and conclusions are less definite than had been presented (4).”

Linde et al. published a review of randomized controlled trials of individualized homeopathy in the Lancet in 1998. In this review, the team clarified that, “in individualized homeopathy the choice of the remedy for treatment is not based on a conventional diagnosis but on the match of the patient’s particular symptoms with the ‘remedy picture (5)’” and also conceded that, “no attempt was made to assess the ‘homeopathic’ quality of the trials. The reviewer’s knowledge and experience homeopathy are insufficient for such judgments (5).” While recognizing their limited comprehension of homeopathy, Linde et al. reviewed 32 studies, providing detailed information about each study’s methodology, including whether remedies were indeed prescribed homeopathically:

“In 20 trials, the choice of the remedy seemed to be unrestricted (approach 1), in 2 trials patients were included only if they matched the remedy picture of one of a preset range of remedies (approach 2), in 7 studies patients were included (without taking into account "homeopathic" aspects) and then the best fitting remedy had to be chosen from a range of predefined remedies was prescribed (approach 3), and in 3 trials only one remedy was applied and patients were entered only if they matched the remedy picture (approach 4) (5).”

Only 19 trials provided “sufficient data for meta-analysis (5),” although not all of these trials were of high methodological quality nor did all of them use individualized therapy. Of 12 trials categorized as “likely to have good methodological quality” or “unlikely to have major flaws,” all except two favoured homeopathy over placebo (5). Of these 12 highest quality trials, seven were individualized, and all except one favoured homeopathy. This review relied on the data from the 19 trials (both individualized and otherwise) and concluded: “while overall the results indicate that individualized homeopathy is superior to placebo, the methodologically better trials have less positive results and confirmatory independent replications are lacking. The evidence from these trials that individualized is clearly more efficacious than placebo is, therefore, not fully convincing (5).”

This review, which recognized individualization of treatment in homeopathy, is a step in the right direction. Conducting useful research on homeopathy within the conventional medical paradigm requires a greater understanding of the system of medicine being investigated in order to truly evaluate the use of homeopathy as a treatment modality.

Finally, a long-term observational study by Witt et al. assessed perceived change in complaint severity and quality of life at baseline, and after 2 and 8 years in 3,709 patients treated with homeopathy. In this study, physicians were free to choose treatment which “usually included the prescription of homeopathic medicines according to homeopathic principles, but also could include the onset, change, or withdrawal of a conventional medicine, referrals to specialists, or admission to a hospital (6).” At eight years, 32.9% of patients were still receiving homeopathic treatment, 29.2% of patients stopped treatment due to perceived major improvements in health, 26.0% stopped treatment because they did not feel homeopathy helped enough, 7.1% of patients stopped treatment for reasons unrelated to efficacy of therapy, and 3.6% stopped treatment without reason (6). The researchers concluded that, “patients who seek homeopathic treatment are likely to improve considerably, although this effect must not be attributed to homeopathic treatment alone. These effects persisted for 8 years (6).”

1. Hahnemann S. Organon of the Medical Art. Palo Alto: Birdcage Books; 1996, p. 141.
2. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.
3. Rutten AL, Stolper CF. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy. 2008 Oct;97(4):169-77.
4. Lüdtke R, Rutten AL. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol. 2008 Dec;61(12):1197-204. Epub 2008 Oct 1. Review.
5. Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Altern Complement Med. 1998 Winter;4(4):371-88. Review.
6. Witt CM, Lüdtke R, Mengler N, Willich SN. How healthy are chronically ill patients after eight years of homeopathic treatment?--Results from a long term observational study. BMC Public Health. 2008 Dec 17;8:413.
7. MacRepertory. Roger Morrison. Desktop Guide to Keynotes and Confirmatory Symptoms.
8. MacRepertory. Franz Vermeuelen. Concordant Materia Medica.
9. MacRepertory. Complete Repertory 2009.
10. Bordet MF, Colas A, Marijnen P, Masson J, Trichard M. Treating hot flushes in menopausal women with homeopathic treatment--results of an observational study. Homeopathy. 2008 Jan;97(1):10-5.

One of the most common criticisms of natural medicine is that it lacks supportive evidence. This is simply not true! In many cases, there is as much or more research evidence for natural medicine as conventional medicine. However, there are also areas in which the research evidence is sparse or incomplete. The purpose of this blog is to clarify the true meaning of evidence-based medicine (EBM) and explore its role in contributing to natural medicine.

Evidence-based medicine (EBM) is defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients (1).” Furthermore:

“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice (1).”

This definition of evidence-based medicine does not conflict with the principles of naturopathic medicine. Naturopathic medicine is based on a large body of evidence gathered through systematic research and knowledge gained through clinical experience. Its principles support the application of this information to devise the most effective treatment for our patients.

However, the colloquial understanding of EBM supports randomized, double blind, placebo-controlled studies as gold standard of knowledge and leaves little room for other forms of research or for clinical experience.

Conventionally understood EBM is limited in encouraging health care that adheres to naturopathic principles. First, EBM does not recognize holistic treatment of individuals, and in fact seeks to boil down complex information to a simple conclusion recognizing only how the majority of subjects respond to a single intervention. Not only does this ignore the knowledge that could be gained through examining all the subjects in a study and why they each responded in the way that they did, but also is not necessarily applicable to real life health care since patients are nearly never under controlled conditions and subject to only one intervention. Naturopathic doctors are interested in treating real patients in the real world and therefore in gathering knowledge in any area that will serve this purpose. In many cases, this knowledge includes clinical observation and experience with real patients.

Second, funding committed to research is not allocated based on what areas of knowledge are the most interesting, warrant the most investigation, or even may be the most beneficial to the public. Most research is conducted by pharmaceutical companies on products they hope to bring to market in order to earn profits for shareholders. Unfortunately, this capitalist drive behind health knowledge is not conducive to researching how low-cost treatments such as diet and lifestyle changes can be far more effective than any drug. It is also not conducive to gaining knowledge through “failed” experiments, such as when pharmaceutical research does not yield results favourable to the drug being researched. Currently, pharmaceutical companies are not required to publish such research, although there is a movement to change this, thankfully. Naturopathic doctors are interested in achieving results, even if there is no particular product to sell.

Finally, naturopathic doctors also act as teachers, seeking to empower patients with information so that they can care for themselves. EBM places power in a faceless research environment, removing it from clinicians with decades of experience, and therefore also removing it from individual patients who may know their unique needs best.

Therefore, while the official definition of EBM does fit with naturopathic principles, the applied definition, in terms of how the health care system actually operates, does not.

For more information and more of my thoughts on conventional medical research, please see my previous blog entitled “Mythology of science-based medicine.”

1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312 (7023):71–2.

What do you think is the most important quality of a successful entrepreneur?

Confidence?

Creativity?

Risk taking?

Would you believe that the most important trait is good health?

Not only must entrepreneurs work hard, often for long hours, but also they are usually self-employed, so they do not have an employer subsidized health insurance plan. Plus, every moment they are off work literally costs them income. So it actually makes a lot of sense that good health is key to success! These people can’t afford to take a sick day, much less develop chronic disease! This idea holds true for many other professions too, such as contract employees, performers, and other self-employed workers.

Naturopathic medicine can be a cost effective way for self-employed people to optimize their health today and stay healthy through prevention. In the short-term, it is far better to avoid coming down with every cold or flu going around, and in the long-term it is imperative to stay healthy and vital until retirement. Health is one of the most valuable assets we have and successful entrepreneurs recognize the value of investing in health rather than only treating disease.

Check out this list of common traits of successful entrepreneurs, based on research done by Southern Methodist University's Cox School of Business for more details.

After 3 years of schooling during which I took 57 courses (and I don’t even want to try to count the number of tests and assignments I completed!), I will finally begin seeing patients in my school’s clinic on May 13th! I have a few thoughts:

Thought 1:
This was a lot harder than I thought it would be. I guess I knew it would be hard in terms of having to work hard, but I had no idea how physically, mentally, and emotionally draining these years would be (at times). Until you spend all day in class and then the rest of your time either eating, sleeping, working, or studying (at least that is what it feels like), you have no idea as to the true capacity and ability of your brain nor do you know your physical and emotional limits. I hope I now know and can back off from that cliff edge a bit.

Thought 2:
Naturopathic doctors (at least those educated at an accredited school over 4 years) are very knowledgeable. I knew that I would learn a lot but I still greatly underestimated how much information could be shoved into my brain in just a few years. I think if the general public knew just what naturopathic education meant, it would be impossible to claim that naturopathic doctors are “hippies” and that naturopathic medicine is unfounded.

Thought 3:
Embracing a holistic view of the world is the most important task facing humanity. I don’t think this is an understatement. Everything you do really does affect everyone else (and you too). Emotions, actions, purchases, chemicals (everywhere!), food, drugs, etc. This is overwhelming, but if everyone became just a little bit more aware of this reality, I don’t think it would be difficult to make major changes in the world. The good news is, if you as an individual want to embrace this view, you can make a difference without having to wait for everyone else to catch on.

Another piece of news is that I have created my own website using my current/future business name (Wavelength Wellness). There you will find some info about me, a blog (which will mostly parallel this one), information on how to book with me at the Robert Schad Naturopathic Clinic, and miscellaneous other info.

I’m recruiting for new patients as of now, so if you or anyone you know lives in the Toronto area and looking for a naturopathic doctor, please consider me!

As goes the tradition in my blog, I will share my New Year’s Resolutions. My overall resolution that covers all those below is to do things that I enjoy more often this year and to feel healthier. Last year was difficult stress-wise and I often felt sad that I have lost some of my enthusiasm for my life and spend too much time doing things (or thinking about things) that I don’t like. Since this is all up to me, really, this year I have decided to not only make more time for things I want to do but also put more energy into those things that I have to do and thus make them more enjoyable.

Diet
After living as a not-always-compliant Gatherer in 2008, I am starting 2009 as an Explorer! Based on my measurements and other info I come out close to either genotype, with the final decision resting on finger measurements! My fingers are so debatable, I’m just assuming they are equal lengths and that made me a Gatherer by the book. However, I also have many features of an Explorer (and some of Hunter, for that matter). Plugging all my info into SWAMI tells me I’m an Explorer, although the diet created for me is not the textbook Explorer diet since it is customized for my needs.

My first resolution is to get familiar with my food lists and improve my diet a bit. Meaning more vegetables and fruits and less sugar and caffeine. I’ve been getting sloppy, mostly because I am sometimes so tired and hungry at the end of the day that I eat whatever is closest to me!

Another dietary change I’ve already implemented that I plan to stick with is to be gluten-free. In October I went to a seminar on gluten sensitivity (will write a blog about it soon!) and since then have been nearly 100% gluten-free. I think I have accidentally eaten a few things with gluten, but I’m avoiding anything obvious and also cut out some gluten-contaminated foods such as oats. I think I do better gluten-free and I also think I have the least white lines in my fingerprints now than ever (comparing back to prints taken in 2005 and 2007). It will be interesting to see if this improves even further.

Exercise
This is a resolution every year! I would love to get to a point sometime in my life when I feel that I have enough time to exercise as much as I would like. I know this will not happen while I’m still in school, but hopefully soon after graduating I will have more control over my time…

Anyway, I would like to get to the gym twice per week on average. I love being there, I love how I feel after being there, and I have the ability to do this. So I will. Not every week will be perfect, but this should be doable most of the time. While there I will do what I feel like doing, as long as it is exercise. I would also like to get back into running semi-regularly. I ran a lot in the summer (sometimes 4-5 times per week) and loved it. I like being outside, I love the feeling of running, and it adds variety to my exercise routine. About once per week (or more) I’d like to get outside for a run (however short it may be). Finally, I would like to do some other exercise activities that are fun. One is to play squash with my boyfriend. I’ve never played (but want to learn) he wants to teach me, so this will be fun. I also want to maybe go swimming sometimes, do more yoga, go ice skating, etc.

The rest
The rest of my resolutions are more minor, mostly habits and health promotion stuff:
• Meditate daily before bed and hopefully other times in the day
• Body brushing
• Give advice only when asked
• Embrace silence
• Make time to do things I enjoy: read, talk to friends, see my boyfriend, cook, exercise, rest