Monday, January 17, 2011
Pellets or Placebo?
There is often an interesting timing that happens with certain events in life. I practice at a clinic called Balanced Living a portion of the GTA (Greater Toronto Area) called "Markham". At one time, Markham was a small town with one main street, no "mall" and was moated by farmland and trees. Despite the fact that Markham has become a place of sprawling suburbia and new condos, it tries to maintain it's small town charm. It has its own little newspaper that lists it's own little community goings-on and that features it's own little yearly awards to various up and coming businesses. Included in these awards are the "Readers Choice Awards" which feature "Markham's best voted Massage Therapist" and "Markham's best voted Homeopath" and the "Markhams best voted Reflexologist". Unfortunately, there is no award "the best voted Naturopathic Doctor", however, because NDs use homeopathic medicines, yours truly was nominated for AND WON the Homeopath award! All of us at the clinic were thrilled, not only because I obtained my first award, but also because Fiona Thompson, one of our Massage Therapists also won!
The celebration of last Thursday night was short lived. 24 hours after I was informed of my new title as best "Homeopath", a 20 minute feature on CBC Marketplace discussing homeopathy as both an “unproven practice” and a “scam that is not evidence-base” was aired.
So, lets talk about this a little. First, as a Naturopathic Doctor, I have a 4-year, post graduate degree in Naturopathic Medicine which is an evidenced-based medicine that has qualified me to practice like an MD but naturally: I perform physical exams (the same ones you might get from your MD), draw blood (phlebotomy), treat with acupuncture, chinese medicine, homeopathy, botanical medicine, lifestyle counselling, nutrition, bodywork (massage), chiropractics and nutrition, to name a few. As you can see, Naturopathic Medicine encompasses a broader scope of practice than simply homeopathy.
Now let's talk a little about the homeopathy controversy: does it work? Homeopathic medicines are based on a theory on micro-dosing. This involves taking a chemical constituent and diluting it to a minuscule amount. Traditional homeopathic preparations are in the form of small pellets that are dissolved under the tongue, which contain lactose as part of their base. Interestingly, the "study" performed for CBC Marketplace involved evaluating homeopathics for the amount of active substance in them: the researcher concluded that there is no active ingredient in homeopathic preparations and that they are simply sugar pills. This is already well known by practitioners who use homeopathy: despite there being no detectable ingredient, the homeopathic still contains the energetic "blueprint" of the original substance which is undetectable in the laboratory. Sound like a scam .. well, ya, kind of sounds like it ...
The television feature went on to say that there are no research studies supporting the efficacy of homeopathic medications. This is true: most of the research out there is in the form on case studies on a variety of individuals that have had success with homeopathic preparations. But why are there no double-blind, placebo trials, you ask?? Well, for starters, homeopathics don't work the same way as pharmaceuticals: there is no one homeopathic designed for folliculitis, for instance. Homeopathics are prescribed on the basis of a collection of signs and symptoms as opposed to one pathology. So, two people with folliculitis might be given two entirely different homeopathic preparations that work equally well. Because the preparations are so individually prescribed, it would be very difficult to do a double-blind placebo trial on one homeopathic medicine for one specific pathology. Make sense?
And what about their effect? Do they really work? In my practice, I am in the habit of using homeopathic medicine in conjunction with other naturopathic interventions. So, what's working? Well, fortunately, I am not a lab and don't have to submit data! Perhaps my patients improve strictly because of the homeopathic or perhaps it's due to the counselling we often indulge in together or maybe other naturopathic nutraceuticals (natural medicines) bring success or perhaps it's even a combination of all of these things, the bottom line is that I see changes that can be measured scientifically: through blood work and through physical exams (blood pressure, etc). Would I used homeopathic in a case of breast cancer? Personally, I would not as both MDs and NDs recognize that there are more effective natural and pharmaceutical approaches for cancer care.
A significant part of what we do as Naturopathic Doctors is to encourage the body to find its own equilibrium so that it can heal itself. Encouraging the body to heal involves correcting physiological imbalances. There is extensive research supporting the mind's role in healing: meditation has been proven to assist in lowering blood pressure for instance. So, really, whether the little sugar pill assists in healing or whether the result is attributable to a placebo effect created by the mind's belief that homeopath medicine does work, doesn't really matter in practice. The bottom line is that people are getting better and, isn't that why we are in this business?
Check out the CBC Marketplace feature here:
Check out an abstract supporting the blood pressure lowering effect of meditation: