Anecdotal claims in support of alternative medicine are a dime a dozen, and are often based upon a failure to closely and critically examine the sequence of events and other data before drawing a conclusion. An interesting example of this phenomenon is represented in some materials I recently received, notably one claiming wonderful benefits for homeopathy in a patient hospitalized for knee surgery.
I hit upon the material as a result of a mailing from Mosby Publishing house. Mosby of St. Louis, MO is a major publisher in the healthcare field. They publish a wide array of textbooks for nurses ranging from the basics to advanced critical care. About every 3 to 4 months I receive from Mosby a packet of about 50 index-sized cards ready to be mailed. Most cards feature a Mosby nursing textbook along with an occasional ad for a non-Mosby product or nursing journal.
Tucked in to a recent set was a card for the Clayton College of Natural Health. I thought this ad looked a little out of place, so I mailed in the card to see what CCNH had to offer. Before long a large envelope from CCNH arrived. It contained the CCNH 1997 school catalog, their latest newsletter, an application to the school and an advertisement for Dr. Clayton's vitamins, herbs and homeopathic remedies.
The catalog states the CCNH is accredited by the World Association of Universities and Colleges and the American Naturopathic Medical Certification and Accreditation Board. CCNH is also a member of National Health Federation and Nutritional Health Alliance. CCNH consists of two schools, the School of Natural Health and the School of (Holistic) Nutrition. The School of Natural Health is based on Naturopathy. One of the basic principles of Naturopathy, as listed in the Catalog, is, "Do no harm ... Naturopaths do not use harmful substances such as drugs and pharmaceuticals, and do not rely on dangerous procedures such as surgery ." I am glad that if my appendix were to rupture or if I was in a nasty car accident, my doctor would rely on such substances and procedures.
There is an interesting array of subjects listed in the catalog from biology and nutrition to homeopathy, iridology, Bach Flower therapy, Therapeutic Touch, herbology, Ayervedic Medicine and aromatherapy. Also mentioned are two rather ominous sounding courses, Alternative Approaches to Cancer and Alternative Approaches to Arthritis. It only costs $6015 to be called a doctor and to be able to put an ND after your name.
The most eye-opening item in the entire packet was an article in the Holistic Times, the Newsletter of CCNH, called "Homeopathy for Health: Arnica to the Rescue" by Joan Scott Lowe. The Catalog describes Lowe as an Academic Program Director with the abbreviations B.S.N. and M.P.H. Normally B.S.N. stands for Bachelor of Science in Nursing, but based on her actions, I would believe that her B.S. is in Naturopathy.
In this story, Lowe writes that she came to the rescue of another CCNH faculty member who was in the local Emergency Room with a fractured patella (kneecap).
The patient was Nella Oppenborn, B.A. in Philosophy and a Certified Light Therapist. Lowe, who was marking papers at the time, rushed to the hospital and arrived in a "rather benumbed state of mind," whatever that is supposed to mean.
Prior to visiting Oppenborn in the ER, Lowe was "sternly" told by the nurse, "No, no, I'm sure her doctor won't let you give her anything for shock." This is because, as Lowe writes, Oppenborn was NPO (nothing by mouth) awaiting "emergency" surgery in another 7 hours. Eight hours is optimum for a patient to have an empty stomach prior to anesthesia and surgery. This is to prevent aspiration of gastric contents into the airway which could be fatal. The surgery in this case is considered urgent rather than emergent since Oppenborn was obviously able to wait 7 more hours. When emergency surgery is necessary, anesthesia procedures are changed to accommodate this higher risk.
When she entered the room, Lowe thought Oppenborn's face was pale and "shocked-looking" with dilated pupils and "eyes glassed over" and that the intravenous line was the only anti-shock measure Oppenborn was receiving. Now "shock" has multiple meanings and it is difficult to pin down how Lowe is using it here. Oppenborn's appearance could have been a simple reaction to her pain, not necessarily shock.
Shock, in the physiological sense, means there is an inadequate circulating blood volume in the body. This can occur for various reasons including blood loss; fluid loss or shifts seen in burn or diabetic shock; cardiogenic shock (inadequate heart-pumping action); neurogenic and vascular shock where the blood volume is normal yet inadequate because the vascular bed increases in size. Physiological shock needs to be recognized and treated as soon as possible because it is life-threatening. The hallmark symptoms of shock are decreased blood pressure (BP) and increased heart rate (HR).
Other uses of the word "shock" include emotional shock which usually refers to a person's reaction to bad news. Although exceptionally bad news can cause a fainting spell (syncope) and the risk of a fall, emotional shock is not life-threatening as is physiological shock.
Although some internal blood loss is expected in a patellar fracture it is usually not significant. Lowe's assessment of Oppenborn's "shock" is inadequate because she fails to mention the patient's BP and HR. Moreover, if Oppenborn truly was in shock, her treatment would have been more aggressive, the surgery much sooner and Lowe might have not seen her friend prior to surgery at all.
Lowe was in the room at 10:50 AM when the nurse gave Oppenborn an intravenous dose of Demerol for pain. As soon as the nurse left, Lowe offered Oppenborn Arnica 200C, a homeopathic remedy for shock. At this time, Oppenborn was feeling cold, shivering and stated, "I feel like I am leaving my body." Lowe placed two pellets on Oppenborn's tongue and immediately Oppenborn's color returned, the shivering stopped and she stated, "I feel like I am coming back into my body now."
What we have here is two separate therapies given at roughly the same time. One is well-known, documented and supported by double-blind studies and has a mechanism that is at least partially understood. The other is not well known, is poorly documented, is not supported by double-blind studies and has a mechanism that not only is not understood, it defies the known sciences of physics, chemistry and pharmacology. Lowe credits this second one.
Demerol, meperidine hydrochloride, is a narcotic pain reliever similar in effect to morphine. The onset of an intravenous administration of Demerol is within minutes. The IV route would be beneficial in this case because of the quick onset and because it wouldn't violate the patient's NPO status. The warm feeling and calming are known effects of Demerol. Demerol is specifically given in the recovery room post-operatively for shivering. The flushing of the face is considered to be a side- effect of Demerol. A near "out of body" sensation could have been a transient effect of Demerol as it has the potential to cause euphoria, dysphoria, transient hallucinations, disorientation and visual disturbances.
The substance given by Lowe was arnica montana or leopard's bane. Since in homeopathy, "like causes like," someone somewhere must have ingested this plant and developed shock symptoms. With this effect established, the dilution process begins. A dilution of 200C means that the arnica was diluted by 1 part in 100. Then a portion of this liquid is diluted 1 part in 100 until this process has been done a total of 200 times! Although this dilution is well beyond the point where not a single molecule of the original substance remains, the solution somehow remembers the properties of the original, reverses the effect and now protects the user from the effects of shock. The most important concept in homeopathy is that the greater the dilution, the greater the effect.
Lowe states that after the 10:50 AM dose of Demerol, Oppenborn did not require anything else for pain. This could be because routine emergency room care of a patellar fracture would include two totally "natural," if not holistic, treatments consisting of splinting the leg to immobilize it and the application of ice bags. Lowe does not mention whether or not these interventions were in use. Normally, IV Demerol, immobilization and ice are adequate to control pain in a patellar fracture.
Lowe continued to "sneak" Oppenborn doses of Arnica 200C whenever Oppenborn became "cold and shaky" while waiting for the OR. This is what leads me to think that Lowe's BSN is not in Nursing. If I, as a registered nurse, violated Oppenborn's NPO status to give an unordered substance that wasn't indicated and was not medically necessary, I could be fired and lose my nursing license for jeopardizing my patient's safety.
Although Oppenborn consented to taking the Arnica 200C, having received a dose of Demerol, she was no longer legally competent. Had I done this, I would have been fully responsible for any disastrous effect that sneaking this substance to the patient could have had.
Those who claim that homeopathy does no harm are obviously not taking all the circumstances into account.