Tuesday, May 5, 2009

On cam lesions, arthritis and the bizarre world of homeopathy

So I haven't been blogging as much recently, give a guy a break.

As it happens, I've been back on the slab having an open hip debridement to remove 'cam' lesions - basically opening up the hip, dislocating the femur, and removing all the osteophytes (bony growths) on it that were causing pain and restricted movement. Hopefully this will greatly slow the progression of osteoarthritis already apparent in the hip joint.

All of which means I have plenty of blogging time to make up for the past month or so, as well as an extremely bruised arse. A friend wryly offered me some arnica ("everyone knows that arnica heals bruising") so I sent her an (admittedly small) placebo controlled trial comparing metronidazole with arnica and placebo in the prevention of post-surgical complications. The trial showed the metronidazole did what it was supposed to, but more interestingly, the arnica gave rise to more pain and increased swelling compared to placebo.

Homeopaths have an odd relationship with arthritis in general. The reasons for getting osteoarthritis are not at clear - there appears to be a large element of heredity involved, with obesity and previous joint injury also playing an important part. There is plenty of research going in to finding out why it happens, because the truth is, we don't completely know.

Or perhaps I should qualify that statement - 'we' includes the medical establishment and arthritis charities, but doesn't include homeopaths.

The College of Practical Homeopathy in London would rather have you believe that:
Poor nutrition, allergies, infections and food sensitivities can lead to [arthritis] problems. Overuse and dietary imbalance can lead to a breakdown of cartilage.
More bizarrely, arthritic conditions are linked to
the underlying emotional states of resentment, feeling victimized, bitterness and lacking in love.
That's right, your arthritis will get worse unless you get yourself some good ol' loving and stop being such a sourpuss.

Of course, I'm trapped in the modern medical paradigm of wanting my disease cured, or failing that, having the symptoms managed so that I can live with the problem, unlike the complementary therapists who look at you holistically:
Our practically trained Homeopaths will establish the causes of your symptoms. If they can see clear causes (physical traumas or emotional shock etc), in your time line, they may treat these first before going on to a detox program.
You see, if people come to a homeopath regarding arthritis, they'll already know the causes of the symptoms - it's the arthritis. You can tell them that it's because they are unloved or that they don't eat enough goji berries, but that would be bollocks. And a 'detox' (a crock of nonsense in itself) will do nothing for arthritis.
They will take into consideration your nutritional states, and support you in developing a healthier approach to your nutritional needs and in taking action to achieve a healthy lifestyle.
More confusion - what are they going to do for the arthritis? And why are they calling themselves homeopaths? There's nothing homeopathic in their plan. In summary, they are incorrect in the causes, they are bizarre in their understanding of disease progression, and they are clueless about their own ability. They'll happily take your your money of course, caveat emptor but, as long they don't do anything inappropriate, Ofquack, the 'regulator', is happy.

Even Dr Peter Fisher, homeopath to the Royal Family is confused:
Osteoarthritis ... is basically 'wear and tear' of the joints.
Whoops, wrong again. So give us an example, Dr Fisher, of a cause of arthritis. No seriously. The article is here.
For instance, a woman came to consult me with extra-articular manifestations of rheumatoid arthritis...when I enquired into the social background it turned out she had been through a messy divorce, including a court battle for custody of the children, which she eventually won. The onset of her illness coincided almost to the day with the end of the custody case. I was amazed that she did not make the connection.
Ah yes, causes of arthritis include joint injury, obesity, heredity and custody battles? This is the royal physician, remember.

In the last part of this fun rant, I'd like to direct you to an article written on the National Rheumatoid Arthritis Society Website, titled "Homeopathy in Rheumatoid Arthritis". The article was written by Professor David L Scott of King's College, London and near the end, discusses a small clinical trial (58 people) of rheumatoid arthritis that was 15 years in the preparation:
During the 6 months of treatment the pain scores fell by 18%, their tender joint counts fell by 24% and their and ESRs fell by 11%. However these improvements were unrelated to homeopathic treatment. They reflected the fact that only patients with improving disease could remain on this type of therapy. Not only were there no benefits from homeopathic treatment but the placebo-treated cases actually showed greater improvements in pain scores. Mean pain scores were significantly lower after 3 months' placebo therapy than 3 months' active homeopathic therapy.
I'm not sure if this was ever published - PUBMed draws a blank - but Prof Scott is 'unclear how to interpret the negative results', concerning more with the question of
is it cost-effective to complement conventional therapy in patients requesting homeopathy? It seems more important to define if homeopathists can genuinely control patients' symptoms and less relevant to have concerns about whether this is due to a ‘genuine’ effect or to influencing the placebo response.
I disagree with this completely - and so should every self-respecting homeopath, but for different reasons. Surely homeopaths don't look at symptoms, they look at the whole person? Surely, any self-respecting homeopath with belief in the religion of dilution would be looking to reestablish the 'natural curing abilities of the body' and remove the rheumatoid arthritis completely? Surely only nasty 'conventional' medicine treats only the symptoms?

It's pretty clear to me from the homeopaths themselves they are clueless about arthritis - it's cause, it's progression and most importantly, it's alleviation and cure.

And that's without having to mention that homeopathy itself is drivel.

BPSDB

4 comments:

  1. This looks like the Scott paper:

    http://www.ncbi.nlm.nih.gov/pubmed/11561118

    Fisher P, Scott DL: A randomized controlled trial of homeopathy in rheumatoid arthritis. Rheumatology 2001 Sep;40(9):1052-5.

    ReplyDelete
  2. Ah, many thanks Mojo.

    Still can't find it on PubMed search! (Maybe the hefty painkillers are weakening my powers....)

    It's quite an interesting paper. "We found no evidence that active homeopathy improves the symptoms of RA, over 3 months, in patients attending a routine clinic who are stabilized on NSAIDs or DMARDs" - who'd've thunk it?

    ReplyDelete
  3. "For instance, a woman came to consult me with extra-articular manifestations of rheumatoid arthritis...when I enquired into the social background it turned out she had been through a messy divorce, including a court battle for custody of the children, which she eventually won. The onset of her illness coincided almost to the day with the end of the custody case. I was amazed that she did not make the connection."

    To me this indicates if there is a connection between stress and rheumatiod arthritis, then it is that stress prevents rheumatiod arthritis, her illness started on the day the stress was over.

    ReplyDelete
  4. Heh, that is an equally sensible interpretation. Can you get 'stress' on prescription?


    :)

    ReplyDelete

Share it