Homeopathy (2014) 103, 95e96 Ó 2014 The Faculty of Homeopathy http://dx.doi.org/10.1016/j.homp.2014.03.001, available online at http://www.sciencedirect.com
EDITORIAL
Homeopathy and antimicrobial resistance It is sometimes assumed that infectious disease has largely been conquered and the future global challenge for health services is chronic, long-term, non-communicable disease. Indeed the World Health Organisation’s projections for the evolution of the global burden of disease between 2004 and 2030 show a shift in the distribution of deaths and from infectious, perinatal and nutritional causes to non-communicable disease.1 But it is far too early to declare victory. HIV/AIDS remains one of the major causes of mortality in WHO’s projections, and infectious disease will be increasingly hardcore due to increasing antimicrobial resistance (AMR). The British government recently published a Five Year Antimicrobial Resistance Strategy covering the period 2013 to 2018. This warned ‘The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant (MDR) bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.’ It also pointed out that the rate of introduction of new antibiotics is at an all-time low.2 The main features of the strategy are: better stewardship of antibiotics, development and deployment of improved diagnostic methods for infection, and development of new antibiotics. This is essentially a convergent, ‘more of the same’ approach. Unless there is a turnaround in the long-term downward trend in antibiotic discovery, this strategy will only slow the spread of AMR, not reverse it. There is no discussion of alternative strategies, for instance boosting host resistance.
Multidrugresistant tuberculosis Among the most menacing forms of MDR is multidrug resistant tuberculosis (MDR-TB). WHO estimates that were about 450,000 new cases and 170,000 deaths from MDR-TB in 2012. The number of cases reported to WHO rose by an alarming 35% between 2011 and 2012, although this probably mostly reflects increased recognition and reporting. Over half the new cases were in India, China or the Russian Federation.3 This issue of Homeopathy features a paper by Dr Kusum Chand and colleagues reporting a randomized, double blind, placebo-controlled clinical trial of individualized homeopathic treatment or placebo in addition to standard antituberculous chemotherapy as specified by the Indian Revised National Tuberculosis Control Program, for MDR-TB. The results are encouraging, particularly in terms of radiographic appearances (all patients had advanced disease with severe radiological changes) and for patients
who were culture positive. A total of 12 different homeopathic medicines were used, with no clear pattern. However the same authors have published a study of tuberculous lymphadenopathy, in which they developed a treatment regime consisting of a disease specific biotherapy, a supportive homeopathic medicine and a patient specific constitutional medicine.4 They propose using this regime in a definitive study of larger scale.5
Reducingantibiotic prescribing This is not the first study which suggests that Homeopathy may have a role to play in drug resistant infections, or the overprescribing of antibiotics which promotes it. But it is the most significant in terms of potential impact on global public health. A Health Technology Assessment commissioned by the Swiss Federal government found 29 clinical trials of homeopathy for upper respiratory tract infection or allergies of which 24 were positive for homeopathy. When the 16 randomised placebo-controlled, trials only were analysed 8/16 were found to be statistically significantly positive, 4/16 showed a positive trend. Of trials comparing homeopathy with conventional treatment, 6/7 trials showed at least equivalence: 1/7 superior to conventional treatment, 5/7 equivalent to conventional treatment, one showed homeopathy to be inferior to conventional treatment (homeopathy v penicillin for streptococcal pharyngitis or tonsillitis). The conclusion for homeopathy is ‘probable effectiveness’ (the most favourable rating in the three-point scale used: probable/possible/unlikely).6 A study published since this Health Technology Assessment, supported by the Indian Ministry of Health involved collaboration between conventional ENT specialists and homeopathic doctors in a randomised controlled trial of homeopathy v conventional treatment in acute otitis media. The outcomes at 3 weeks were not significantly different, but the numbers of antibiotic prescriptions in the homeopathically-treated group were much lower.7 Other evidence relevant to AMR includes preliminary clinical trial data suggesting that homeopathy may improve outcomes of critically-ill patients in intensive care units8,9 and that it may be an effective treatment for E. coli diarrhoea in newborn piglets.10 Homeopathy’s potential contribution to dealing with the alarming rise of AMR is an important focus for research and practice. As in other areas we need repetition of scientific studies, it is to be hoped that Dr Chand’s group will conduct further studies in the context of the Indian national TB control programme. Also, as in other areas, we need
Editorial P Fisher
96
basic science studies to understand how homeopathy influences host factors.
References 1 Mathers CD, Loncar D. Updated projections of global mortality and burden of disease, 2002e2030: data sources, methods and results. Evidence and Information for Policy. World Health Organization, www.who.int/healthinfo/statistics/bod_projections2030_paper. pdf?ua=1; 2006. 2 UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. Department of Health, www.gov.uk/government/uploads/system/ uploads/attachment_data/file/244058/20130902_UK_5_year_ AMR_strategy.pdf; 2013. 3 World Health Organisation. Multidrug-resistant Tuberculosis (MDR-TB). Update, http://www.who.int/tb/challenges/mdr/mdr_ tb_factsheet.pdf?ua=1; October 2013. 4 Chand SK, Manchanda RK, Batra S, Mittal R. Homeopathy in the treatment of tubercular lymphadenitis (TBLN) - An Indian experience. Homeopathy 2011; 100: 157e167. 5 Chand KS, Manchanda RK, Mittal R, Batra S, Banavaliker JN, De I. Homeopathic treatment in addition to standard care in multi drug resistant pulmonary tuberculosis: a randomized, double blind, placebo controlled clinical trial. Homeopathy 2014; 103: 97e107.
Homeopathy
6 Bergemann SM, Bornh€ oft G, Bloch D, Vogt-Frank C, Righetti M, Thurneysen A. Clinical studies on the effectiveness of homeopathy for URTI/A (Upper Respiratory Tract Infections and Allergic Reactions). In: Bornh€ oft G, Matthiessen PF, eds. Homeopathy in Healthcare e Effectiveness, Appropriateness, Safety, Costs. Berlin: Springer, 2011. http://dx.doi.org/10.1007/ 978-3-642-20638-2_10. 7 Sinha MN, Siddiqui VA, Nayak C. Randomized controlled pilot study to compare Homeopathy and Conventional therapy in Acute Otitis Media. Homeopathy 2012; 101: 5e12. 8 Frass M, Dielacher C, Linkesch M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest 2005; 127: 936e941. 9 Frass M, Linkesch M, Banyai S, et al. Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, doubleblind, placebo-controlled trial in an intensive care unit. Homeopathy 2005;75e80. 10 Camerlink I, Ellinger L, Bakker EJ, Lantinga EA. Homeopathy as replacement to antibiotics in the case of Escherichia coli diarrhoea in neonatal piglets. Homeopathy 2010; 99: 57e62.
Peter Fisher Editor-in-Chief E-mail: [email protected]
EDITORIAL
Homeopathy and antimicrobial resistance It is sometimes assumed that infectious disease has largely been conquered and the future global challenge for health services is chronic, long-term, non-communicable disease. Indeed the World Health Organisation’s projections for the evolution of the global burden of disease between 2004 and 2030 show a shift in the distribution of deaths and from infectious, perinatal and nutritional causes to non-communicable disease.1 But it is far too early to declare victory. HIV/AIDS remains one of the major causes of mortality in WHO’s projections, and infectious disease will be increasingly hardcore due to increasing antimicrobial resistance (AMR). The British government recently published a Five Year Antimicrobial Resistance Strategy covering the period 2013 to 2018. This warned ‘The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant (MDR) bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.’ It also pointed out that the rate of introduction of new antibiotics is at an all-time low.2 The main features of the strategy are: better stewardship of antibiotics, development and deployment of improved diagnostic methods for infection, and development of new antibiotics. This is essentially a convergent, ‘more of the same’ approach. Unless there is a turnaround in the long-term downward trend in antibiotic discovery, this strategy will only slow the spread of AMR, not reverse it. There is no discussion of alternative strategies, for instance boosting host resistance.
Multidrugresistant tuberculosis Among the most menacing forms of MDR is multidrug resistant tuberculosis (MDR-TB). WHO estimates that were about 450,000 new cases and 170,000 deaths from MDR-TB in 2012. The number of cases reported to WHO rose by an alarming 35% between 2011 and 2012, although this probably mostly reflects increased recognition and reporting. Over half the new cases were in India, China or the Russian Federation.3 This issue of Homeopathy features a paper by Dr Kusum Chand and colleagues reporting a randomized, double blind, placebo-controlled clinical trial of individualized homeopathic treatment or placebo in addition to standard antituberculous chemotherapy as specified by the Indian Revised National Tuberculosis Control Program, for MDR-TB. The results are encouraging, particularly in terms of radiographic appearances (all patients had advanced disease with severe radiological changes) and for patients
who were culture positive. A total of 12 different homeopathic medicines were used, with no clear pattern. However the same authors have published a study of tuberculous lymphadenopathy, in which they developed a treatment regime consisting of a disease specific biotherapy, a supportive homeopathic medicine and a patient specific constitutional medicine.4 They propose using this regime in a definitive study of larger scale.5
Reducingantibiotic prescribing This is not the first study which suggests that Homeopathy may have a role to play in drug resistant infections, or the overprescribing of antibiotics which promotes it. But it is the most significant in terms of potential impact on global public health. A Health Technology Assessment commissioned by the Swiss Federal government found 29 clinical trials of homeopathy for upper respiratory tract infection or allergies of which 24 were positive for homeopathy. When the 16 randomised placebo-controlled, trials only were analysed 8/16 were found to be statistically significantly positive, 4/16 showed a positive trend. Of trials comparing homeopathy with conventional treatment, 6/7 trials showed at least equivalence: 1/7 superior to conventional treatment, 5/7 equivalent to conventional treatment, one showed homeopathy to be inferior to conventional treatment (homeopathy v penicillin for streptococcal pharyngitis or tonsillitis). The conclusion for homeopathy is ‘probable effectiveness’ (the most favourable rating in the three-point scale used: probable/possible/unlikely).6 A study published since this Health Technology Assessment, supported by the Indian Ministry of Health involved collaboration between conventional ENT specialists and homeopathic doctors in a randomised controlled trial of homeopathy v conventional treatment in acute otitis media. The outcomes at 3 weeks were not significantly different, but the numbers of antibiotic prescriptions in the homeopathically-treated group were much lower.7 Other evidence relevant to AMR includes preliminary clinical trial data suggesting that homeopathy may improve outcomes of critically-ill patients in intensive care units8,9 and that it may be an effective treatment for E. coli diarrhoea in newborn piglets.10 Homeopathy’s potential contribution to dealing with the alarming rise of AMR is an important focus for research and practice. As in other areas we need repetition of scientific studies, it is to be hoped that Dr Chand’s group will conduct further studies in the context of the Indian national TB control programme. Also, as in other areas, we need
Editorial P Fisher
96
basic science studies to understand how homeopathy influences host factors.
References 1 Mathers CD, Loncar D. Updated projections of global mortality and burden of disease, 2002e2030: data sources, methods and results. Evidence and Information for Policy. World Health Organization, www.who.int/healthinfo/statistics/bod_projections2030_paper. pdf?ua=1; 2006. 2 UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. Department of Health, www.gov.uk/government/uploads/system/ uploads/attachment_data/file/244058/20130902_UK_5_year_ AMR_strategy.pdf; 2013. 3 World Health Organisation. Multidrug-resistant Tuberculosis (MDR-TB). Update, http://www.who.int/tb/challenges/mdr/mdr_ tb_factsheet.pdf?ua=1; October 2013. 4 Chand SK, Manchanda RK, Batra S, Mittal R. Homeopathy in the treatment of tubercular lymphadenitis (TBLN) - An Indian experience. Homeopathy 2011; 100: 157e167. 5 Chand KS, Manchanda RK, Mittal R, Batra S, Banavaliker JN, De I. Homeopathic treatment in addition to standard care in multi drug resistant pulmonary tuberculosis: a randomized, double blind, placebo controlled clinical trial. Homeopathy 2014; 103: 97e107.
Homeopathy
6 Bergemann SM, Bornh€ oft G, Bloch D, Vogt-Frank C, Righetti M, Thurneysen A. Clinical studies on the effectiveness of homeopathy for URTI/A (Upper Respiratory Tract Infections and Allergic Reactions). In: Bornh€ oft G, Matthiessen PF, eds. Homeopathy in Healthcare e Effectiveness, Appropriateness, Safety, Costs. Berlin: Springer, 2011. http://dx.doi.org/10.1007/ 978-3-642-20638-2_10. 7 Sinha MN, Siddiqui VA, Nayak C. Randomized controlled pilot study to compare Homeopathy and Conventional therapy in Acute Otitis Media. Homeopathy 2012; 101: 5e12. 8 Frass M, Dielacher C, Linkesch M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest 2005; 127: 936e941. 9 Frass M, Linkesch M, Banyai S, et al. Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, doubleblind, placebo-controlled trial in an intensive care unit. Homeopathy 2005;75e80. 10 Camerlink I, Ellinger L, Bakker EJ, Lantinga EA. Homeopathy as replacement to antibiotics in the case of Escherichia coli diarrhoea in neonatal piglets. Homeopathy 2010; 99: 57e62.
Peter Fisher Editor-in-Chief E-mail: [email protected]
