Dr. Mahatma Gandhi and the practice of Homeopathy?

News release: Delhi government launches homeopathy site

29 September 2009

The government of Delhi has launched a homeopathy website Homeo.DelhiGovt.nic.in to provide online treatment facility and give advice to people. The website offers information about all the Delhi government homeopathic dispensaries, general homeopathic medicines and remedies for various diseases.

According to Delhi chief minister Sheila Dikshit, her government is committed to the development and expansion of homoeopathy as it offers the optimal mix of simplicity, economy, effectiveness of treatment and cultural acceptability among the diverse population.

”Day by day the popularity of homoeopathy is increasing as it cures diseases from their roots in a safe, harmless and gentle way,” Sheila Dikshit has said. ”Around 10 lakh people have come forward to avail of homoeopathic treatment in the first eight months of the calendar year (2009) in different dispensaries.”

Folks, Mahatma Gandhi has been recognized as the pre-eminent political and spiritual leader of India during the Indian independence movement. An English trained barrister who freed India from British colonialism through the path of non-violence and civil disobedience. With all due respect, what he was not…a student of medicine allopathic, osteopathic, homeopathic, naturopathic or any other pathic. And yet we have a Municipal government taking the lead in dangerously and inappropriately endorsing public health policy issues, in fact, giving treatment advice, and that, with the supposed stamp of approval of the Mahatma. And this from a nation concerned about “spurious” drugs imported from China.

And from the same government run website:

Homoeopathic department is committed to provide high quality curative & preventive homoeopathic healthcare facilities to all sections of society. Directorate consists of about 150 dedicated and competent homoeopaths, who are committed to provide comprehensive healthcare facilities to general public through a wide spread network of 82 dispensaries and two Homeopathic medical colleges and hospitals in Delhi. We treat about 1.5 to 1.6 million patients every year in these institutions.

1.6 million patients. I would imagine the burden of responsibility to educate people regarding public health should lie with the federal ministry of health especially in a country with such high rates of illiteracy (>65% as of 2001). I would also imagine the federal government should and MUST take this responsibility very seriously. Apparently we have the blind leading the blind. Or as the cynic in me suggests, the Not So Blind leading the blind and profiting nicely from it.

Now I’m not homeopathophobic and despite being an “allopathic” doctor I would humbly suggest these labeling conventions serve only to confuse the real issues. In a world of chemicals made of molecules it behooves us as a higher intelligence species to actually attempt to isolate that which causes effect and test and confirm the effect through scientific means and maybe even see if there are negative effects. It is not relevant to me whether the molecules come from a plant or soil or are synthetically manufactured. Let’s test ‘em shall we. I would suggest this is a more logical approach than simply “we have been doing it for generations” and “The Laws of Similars” or “Let likes be treated with likes”. If this was the more logical method then we would still think the Earth is flat (and not the way Thomas Friedman suggests) and we would still sacrifice a virgin to make sure next years crop harvest is plentiful (tribes used to do this to appease the gods for generations).

Let’s look first at examples of “allopathic” drugs which have been sourced from plants. There are well over a hundred drugs which are derived from plant and other natural sources, including aspirin, digoxin, atropine, codeine, quinine, etc etc etc. All these are commonly used and have been extensively investigated. Their therapeutic and side effect profiles are thoroughly documented as are drug interactions. These are labeled “allopathic” for some reason.

Now lets examine the treatment of one of the common conditions listed on the “government” and Mahatma “endorsed” website under FAQs.

From THE JOURNAL...

O.K. first paragraph is not particularly informative but I have no strong objection to it.

Paragraph 2 we should explore:

1. causticum

Energize Us

Encyclopedia of Health

International Academy of Homeopathic Medicine

Herbs 2000.com

After visiting these three sites, I feel like I have been taking another natural remedy, LSD. LSD is a hallucinogen derived from rye fungus. My point other than sarcasm is that some harmful things come from natural sources too. Other than the third source I challenge anyone to make logical head or tails of these “pharmaceutical therapeutic descriptions” here; and from the first source I gather it will not only treat your child’s seasonal bed-wetting but also his cataracts and erectile dysfunction. At least the third source gives us the chemical composition of potassium hydrate or potassium hyroxide. Well, thanks to Wikipedia (don’t worry I could find you far more authoritative sources on chemical compounds…lets stick with a simple one) , potassium hydroxide (KOH) is more aptly recognized as a component of biodiesel, soaps, and alkaline batteries. Who knew? Not our illiterate 1.6 million patients.

In addition, bed-wetting, or enuresis is suspected to be a developmental delay (especially primary). Although secondary enuresis (bedwetting after a period of full control) can have additional potential causes (psychological stress, urinary tract infection etc.), seasonality is not one of them. I would also argue that if your child wets from sneezing, coughing or laughing, this is a condition known as stress incontinence and suggests an anatomical or functional problem with pelvic muscles and definitely needs more investigation as it is more common in menopausal women especially after multiple births and in men who have had prostate surgery. No where do our benevolent friends at the “Delhi Ministry of Health” suggest seeing a pediatrician or pediatric urologist.

2. kreosote

Midnight's Children

ABC homeopathy

International Academy of Classical Homeopathy

Again according to our Wikipedia friends, Kreosote is either a coal tar derivative or a wood derivative (beech wood) and apparently a widely used EPA-registered wood preservative. This one is interesting so I quote a little:

Wood creosote

Wood creosote is a colourless to yellowish greasy liquid with a smoky odor and burned taste. Other than looks and taste, the chemical makeup is totally different than coal tar creosote. It is made of guaiacol, creosol, o-cresol, and 4-ethylguaiacol, plant phenolics, rather than petrochemicals.

Wood creosote has been used as a disinfectant, a laxative, and a cough treatment, but these have mostly been replaced by newer medicines.

The popular Japanese Kampo anti-diarrheic Seirogan has 133 mg wood creosote (from beech, maple or oak wood) per adult dose as its primary ingredient. [1]

Wood creosote also protects wood from shrinking from the sun, losing its colour and moulding from the rain.

Another form of creosote is coal tar creosote. Coal tar creosote is the most widely used wood preservative in the world. It is a thick, oily liquid typically amber to black in colour. The American Wood Preservers’ Association states that creosote “shall be a distillate derived entirely from tars produced from the carbonization of bituminous coal.” Coal tar used for certain applications may be a mixture of coal tar distillate and coal tar. See, AWPA Standards

The prevailing use of creosote in the United States is to preserve wooden utilities/telephone poles, railroad cross ties, switch ties and bridge timbers from decay. It is registered with USEPA for this purpose. Coal tar products are also used in medicines to treat diseases such as psoriasis, and as animal and bird repellents, insecticides, animal dips, and fungicides. Some over the counter anti-dandruff shampoos contain coal tar solutions. Due to its carcinogenic character, the European Union has banned the sale of creosote treated wood [1] and requires that the sale of creosote be limited to professional users.[2][3]
[edit] Health effects of coal tar creosote

According to the Agency for Toxic Substances and Disease Registry (ATSDR), eating food or drinking water contaminated with high levels of coal tar creosote may cause a burning in the mouth and throat, and stomach pains.

ATDSR also states that brief direct contact with large amounts of coal tar creosote may result in a rash or severe irritation of the skin, chemical burns of the surfaces of the eyes, convulsions and mental confusion, kidney or liver problems, unconsciousness, and even death. Longer direct skin contact with low levels of creosote mixtures or their vapors can result in increased light sensitivity, damage to the cornea, and skin damage. Longer exposure to creosote vapors can cause irritation of the respiratory tract.

The International Agency for Research on Cancer (IARC) has determined that coal tar creosote is probably carcinogenic to humans, based on adequate animal evidence and limited human evidence.

There is no unique exposure pathway of children to creosote. Children exposed to creosote will probably experience the same health effects seen in adults exposed to creosote. It is unknown whether children differ from adults in their susceptibility to health effects from creosote.

Is this the real cure for a child who wets his bed due to deep slumber? I think I prefer wet sheets to burning throat, stomach pains, convulsions, liver and kidney problems. Who knew? Not the 1.6 million illiterate patients.

The last paragraph is laughable and I won’t beat a dead horse with cina as you are all capable of looking it up yourselves… bedwetting, worms, ill humour, gritting teeth…well, I would be ill humoured if I had worms and wet sheets. But what makes me even more ill humoured is that this blatant self promotion has the so-called blessing of government as well as a figure, Mr. Gandhi-ji, most Indians, and quite a few non-Indians, admire, not to mention the nearly religious adoration of the illiterate.

And this discussion also opens the very appropriate question of why big pharma has not studied this space for potential significant therapeutic molecules. In conclusion, I quote from an admittedly aged yet very much relevant article , Farnsworth, N. R. 1988. Screening plants for new medicines. Chapter 9 in Biodiversity, ed. E.O. Wilson. Washington, D.C.: National Academy Press.

THE SEARCH FOR NEW PLANT DRUGS
There is a great deal of interest in and support for the search for new and useful drugs from higher plants in countries such as the People’s Republic of China, Japan, India, and the Federal Republic of Germany. Virtually every country of the world is active in this search to a limited degree. However, in light of its size and resources, the United States must be regarded as an underdeveloped country with regard to productivity and programs designed to study higher plants as sources of new drugs, both in terms of industrial and university-sponsored research.

Estimates of the number of higher plants that have been described on the face of the Earth vary greatly–from about 250,000 to 150,000. How many of these have been studied as a source of new drugs? This is an impossible question to answer for the following reason. The National Cancer Institute in the United States has tested 35,000 species of higher plants for anticancer activity. Many of these have shown reproducible anticancer effects, and the active principles have been extracted from most of these and their structures determined. However, none of these new drugs have yet been found to be safe and effective enough to be used routinely in humans. The question then arises, could any of these 35,000 species of plants contain drugs effective for other disease states, such as arthritis, high blood pressure, acquired immune deficiency syndrome (AIDS), or heart trouble? Of course they could, hut they must be subjected to other appropriate tests to determine these effects. In reality, there are only a handful of plants that have been exhaustively studied for their potential value as a source of drugs, i.e., tested for several effects instead of just only one. Thus, it is safe to presume that the entire flora of the world has not been systemically studied to determine if its constituent species contain potentially useful drugs. This is a sad commentary when one considers that interest in plants as a source of drugs started at the beginning of the nineteenth century and that technology and science have grown dramatically since that time.

Use of the NAPRALERT Data Base

It is possible to present certain types of data showing the relative interest in studying natural products as a source of drugs by means of the NAPRALERT data base that we maintain at the University of Illinois at Chicago (Farnsworth et al. 1981, 1983; Loub et al., 1985). This specialized computer data base of information on natural products was derived from a systematic search of the world literature. Data that can be retrieved from the system include folkloric medicinal claims for plants, the chemical constituents contained in plants (and other living organisms), the pharmacological effects of naturally occurring substances, or the pharmacological effects of crude extracts prepared from plants. More than 80,000 articles have been entered into the data base since 1975, and about 6,000 new articles are added each year. The system contains folkloric, chemical, or pharmacological information on about 25,000 species of higher plants alone.

Pharmacological Interest in Natural Products

To give some idea as to the interest (or lack thereof) in studying the pharmacological effects of natural products, we can cite the following data from NAPRALERT. In 1985, approximately 3,500 new chemical structures from natural sources were reported. Of these, 2,618 were obtained from higher plants, 512 from lower plants (lichens, filamentous fungi, and bacteria), and 372 from other sources (marine organisms, protozoa, arthropods, and chordates) (Table 9-2). A significant 56.6% of the new chemicals obtained from lower plants (primarily antibiotics produced in industrial laboratories) were reported to have been tested for biological effects. About 23.9% of those obtained from marine sources, protozoa, arthropods, and chordates were studied for biological effects, but only 9.5% of the new structures obtained from higher plants were tested for pharmacological effects. The probable reasons for the low, 9.5% figure are that a majority of these discoveries were reported from university laboratories where the interest is mainly on chemistry, where there is less interdisciplinary research (i.e., botanists, chemists, and biologists working in collaboration), and where routine testing services for pharmacological activity are not readily available.

Why is there so little interest and activity in plant-derived drug development in the United States? An attempt will be made to answer this question, but first it is important to describe briefly some of the more fruitful approaches to drug discovery from higher plants.

Approaches to Drug Discovery from Plants

There are many approaches to the search for new biologically active principles in higher plants (Farnsworth and Loub, 1983). One can simply look for new chemical constituents and hope to find a biologist who is willing to test each substance with whatever pharmacological test is available. This is not considered to be a very valid approach. A second approach is simply to collect every readily available plant, prepare extracts, and test each extract for one or more types of pharmacological activity. This random collection, broad screening method is a reasonable approach that eventually should produce useful drugs, but it is contingent on the availability of adequate funding and appropriate predictable bioassay systems. The last major useful drugs to have reached the marketplace based on this approach are the so-called vinca alkaloids, vincristine sulfate (leurocristine) and vinblastine sulfate (vincaleukoblastine). Vincristine is the drug of choice for the treatment of childhood leukemia; vinblastine is a secondary drug for the treatment of Hodgkin’s disease and other neoplasms.

Vincristine was discovered by Gordon H. Svoboda at the Lilly Research Laboratories. In January 1958, Svoboda submitted an extract of the Madagascan periwinkle plant [Catharanthus roseus (L.) G. Don] to a pharmacological screening program at Lilly (Farnsworth, 1982). This was the fortieth plant that he selected for inclusion in the program. Vincristine was marketed in the United States in 1963, less than 5 years after a crude extract of C. roseus was observed to have antitumor activity. In 1985, total domestic and international sales of vincristine (as Oncovin$) and vinblastine (as Velban$) were approximately $100 million, 88% of which was profit for the company (G. H. Svoboda, personal communication, 1986).

This discovery of new drugs from higher plants is one of the few that has evolved from a random-selection broad pharmacological screening program. For example, in the very expensive research and development effort undertaken by the National Cancer Institute described above, not one useful drug has emerged.

Recently we analyzed information on the l l9 known useful plant-derived drugs to determine how many were discovered because of medicinal folkloric information on the plants from which they were isolated. In other words, what correlation, if any, exists between the current medical use of the 119 drugs and the alleged medical uses of the plants from which they were derived? As shown in Table 9-1[a], [b], [c], [d], 74% of the 119 chemical compounds used as drugs have the same or related use as the plants from which they were derived. This does not mean that 74% of all medical claims for plants are valid, but it surely points out that there is a significance to medicinal folklore that was not previously documented.

Thus, in my opinion, future programs of drug development from higher plants should include a careful evaluation of historical as well as current claims of the effectiveness of plants as drugs from alien cultures. Such information is rapidly disappearing as our own culture and ideas permeate the less developed countries of the world where there remains a heavy dependence on plants as sources of drugs.

LACK OF INTEREST IN NEW DRUG DISCOVERY PROGRAMS FROM PLANTS

Why is there such a reluctance to initiate new programs involving plants as sources of drugs in the United States, where we have the most sophisticated pharmaceutical industry in the world and where expenditures for drug development are staggering? In my conversations with staff from U. S. pharmaceutical companies, the following reasons seem to be consistent:

* To recover the costs of developing such drugs, solid patent protection must be secured. It is generally believed that natural products cannot be patented with the same degree of assurance as can synthetic compounds. This of course cannot be a valid deterrent, since patent protection for vincristine and vinblastine was sufficiently secure that the Eli Lilly Company had exclusive marketing rights to these substances for the full term of patent protection.
* Most promising plants seem to be indigenous to developing countries, many of which do not have stable governments and thus cannot provide assurance that there will be a continued supply of the raw material needed to produce the useful drugs. This of course may be true in a strict sense; however, as history shows, it is rare when a useful plant grows only in one isolated developing country. In the course of developing a full program involving plants as a source of raw material, it would be normal logic to immediately seek sources of the useful plant from a large number of geographic areas. Cultivation programs should also be initiated. In the early stages of development of vincristine and vinblastine, the plant source C. roseus was collected from many different countries of the world and was also cultivated in eastern European countries and in the United States.
* There is reputed to be biological variation from lot to lot of plant drugs, but scientific documentation for this statement is difficult to find. This does not appear to be a problem affecting any of the plant sources required for production of the 119 drugs listed in Table 9-1[a], [b], [c], [d].

What really seems to be the problem is that most pharmaceutical firms, as well as decision-making offices in government agencies, lack personnel who have a full understanding and appreciation of the potential payoff in this area of research. For example, new programs in drug development are usually initiated by the presentation of a proposal by a research staff member before a group of peers and research administrators. Following is one possible scenario: Dr. E. Z. Greenleaf prepares his arguments for a new drug development program at the ABC Pharmaceutical Corporation in which he proposes to study plants as a source of new drugs. His approach to the program is to examine written medicinal folklore to obtain information on plants allegedly used by primitive peoples for certain specified diseases. He might even be brave enough to suggest that the ABC Pharmaceutical Corporation hire one or two physicians to travel to Africa, Borneo, New Caledonia, or other exotic areas to live with the people for a year or so. During this period, Drs. U. Canduit and 1. M. Reliant would observe the witch doctors treating patients and then would make their own diagnoses of each patient and conduct follow-up observations on outcome. When improvement is noted, they would record which plants had been used to treat the patients. These plants would then be collected and sent to the Research Laboratory of the ABC Pharmaceutical Corporation located in Heartbreak, Colorado, for scientific studies.

The second scientist from the ABC Pharmaceutical Corporation to make a new program presentation is Dr. Adam N. Molecule. He uses a long sequence of chemical equations to illustrate his theory that he can synthesize a series of chemical analogs based on computer analysis of structure-activity relationships in which his theoretical compounds will react favorably with specific receptor sites. He illustrates his plan with a full color videotape presentation of the computerized sequence of events that he hopes will take place at the molecular level. There is nothing left to the imagination. Molecule’s computer produces a flowchart projecting the full costs of each stage of the synthesis at 2-month intervals. Everything is predictable, based on a percentage of projected sales should the end product prove to be a useful drug, and ensuring at least a 75% profit margin.

At the end of the two presentations, management must decide on whether to follow the folkloric line of Dr. E. Z. Greenleaf or the molecular biology-computer graphic-theoretical approach of Dr. Adam N. Molecule. Since Dr. Greenleaf is probably the only person in the room with a background and appreciation for his approach and most of the scientists in attendance are well trained and highly skilled synthetic chemists, biochemists, and molecular biologists, it is not difficult to predict which program will he approved and implemented.

And there you have it. The can of worms is now open; let’s see the homeopaths out there, Delhi specialists or otherwise, step up to the plate!

Tej Deol, M.D.