Can biological activity be maintained at ultra-high dilution? An overview of homeopathy, evidence, and Bayesian philosophy

Existence of Quantum Pharmacology in Sartans: Evidence in Isolated Rabbit Iliac Arteries

Quantum pharmacology introduces theoretical models to describe the possibility of ultra-high dilutions to produce biological effects, which may help to explain the placebo effect observed in hypertensive clinical trials. To determine this within physiology and to evaluate novel ARBs, we tested the ability of known angiotensin II receptor blockers (ARBs) (candesartan and telmisartan) used to treat hypertension and other cardiovascular diseases, as well as novel ARBs (benzimidazole-N-biphenyl tetrazole (ACC519T), benzimidazole-bis-N,N'-biphenyl tetrazole (ACC519T(2)) and 4-butyl-N,N0-bis[[20-2Htetrazol-5-yl)biphenyl-4-yl]methyl)imidazolium bromide (BV6(K+)2), and nirmatrelvir (the active ingredient in Paxlovid) to modulate vascular contraction in iliac rings from healthy male New Zealand White rabbits in responses to various vasopressors (angiotensin A, angiotensin II and phenylephrine). Additionally, the hemodynamic effect of ACC519T and telmisartan on mean arterial pressure in conscious rabbits was determined, while the ex vivo ability of BV6(K+)2 to activate angiotensin-converting enzyme-2 (ACE2) was also investigated. We show that commercially available and novel ARBs can modulate contraction responses at ultra-high dilutions to different vasopressors. ACC519T produced a dose-dependent reduction in rabbit mean arterial pressure while BV6(K+)2 significantly increased ACE2 metabolism. The ability of ARBs to inhibit contraction responses even at ultra-low concentrations provides evidence of the existence of quantum pharmacology. Furthermore, the ability of ACC519T and BV6(K+)2 to modulate blood pressure and ACE2 activity, respectively, indicates their therapeutic potential against hypertension.

Some Remarks on QBism and its Relevance to Metaphors for the Therapeutic Process Based on Conventional Quantum Theory

Background: Signs and symptoms of dis-ease are considered observable manifestations of an immaterial (i.e., not directly observable) Vital Force. Likewise, experimental results on quantum systems are thought to indicate the presence of something that does not show up. Consequently, the discourse of conventional quantum theory (CQT) - with its notions of non-locality and entanglement being objective (i.e., ontic) facets of reality – has been considered useful metaphor for the therapeutic process (TP) in homeopathy/CAMs. Thus, Patient-Practitioner-Remedy (PPR) entanglement, postulated an ontic non-local interaction between patient (Px), practitioner (Pr), and potentised medicine/curative procedure (Rx), resulting in the patient’s ‘journey to cure.’ Recently, a new epistemic interpretation of quantum theory has arisen called QBism. Rooted in the subjectivity of Bayesianism, QBism refutes the notion that the quantum state of a system is a separate ontic property of reality. In QBism therefore, non-locality and entanglement are not ontic but are considered ‘subjective degrees of belief’ of an agent, i.e., they are personally epistemic. Objective: To examine whether previous CQT-based entanglement metaphors for the therapeutic process need re-evaluation in the light of the subjective Bayesianism inherent in QBism. Method: Pr, Px and Rx quantum states/wavefunctions - Px, Rx, and Pr - are reinterpreted in QBist terms. Unlike CQT, this means each quantum state/wavefunction is postulated to have no ontic non-local existence in a presumed external reality. Instead, they are said to represent local subjective ‘degrees of belief’ of an agent who in this case, is the Pr. Results & Conclusion: Compared to earlier quantum entanglement metaphors based on CQT, QBism’s interpretation of the probabilities inherent in the Px, Rx, Pr quantum state/wavefunctions are Bayesian and subjective. Their resulting highly personal epistemology makes them more aligned with (and therefore potentially more useful to) how practitioners might experience the evolution of the TP. Also, because QBism predicts non-locality and entanglement can only be at best, subjective properties of a practitioner’s own beliefs, the overall significance of previous ontic non-local CQT-based entanglement metaphors for the TP is questioned.

Evaluating the anticancer activity and nanoparticulate nature of homeopathic preparations of Terminalia chebula

BACKGROUND

Breast cancer is the most common cancer diagnosed among women and is the second leading cause of cancer death. Homeopathic medicines are part of the alternative medicines that are given as a supportive therapy in breast cancer. The objective of this study was to investigate the anticancer activity of commercially available homeopathic preparations of Terminalia chebula (TC) and evaluate their nanoparticulate nature.

METHODS

Mother tincture (MT) and other homeopathic preparations (3X, 6C and 30C) of TC were tested for their effect on the viability of breast cancer (MDAMB231 and MCF7) and non-cancerous (HEK 293) cell lines by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell growth assay was performed to analyze the effect of the different potencies on the growth kinetics of breast cancer cells. MT and 6C were evaluated for the presence of nanoparticles by using scanning electron microscopy (SEM) and transmission electron microscopy (TEM).

RESULTS

MT decreased the viability of breast cancer (MDAMB231 and MCF7) and non-cancerous (HEK 293) cells. However, the other potencies (3X, 6C and 30C) decreased the viability of only breast cancer cells without affecting the viability of the non-cancerous cells. All the potencies, MT, 3X, 6C and 30C, reduced growth kinetics of breast cancer cells, more specifically at 1:10 dilution at 24, 48 and 72 h. Under SEM, MT appeared as a mesh-like structure whereas under TEM, it showed presence of nanoclusters. On the other hand, 6C potency contained 20 nm sized nanoparticles.

CONCLUSION

The current study reports the anticancer activity of homeopathic preparations of TC against breast cancer and reveals their nanoparticulate nature. These preliminary results warrant further mechanistic studies at both in vitro and in vivo levels to evaluate the potential of TC as nanomedicine in breast cancer.

Homeopathic drug discovery: theory update and methodological aspect

BACKGROUND

Homeopathy treats patient on the basis of totality of symptoms and is based on the principle of 'like cures like'. It uses ultra-low doses of highly diluted natural substances as remedies that originate from plants, minerals or animals.

OBJECTIVE

The objectives of this review are to discuss concepts, controversies and research related to understanding homeopathy in the light of modern science.

METHODS

Attempts have been made to focus on current views of homeopathy and to delineate its most plausible mechanism(s) of action.

RESULTS

Although some areas of concern remain, research carried out so far both in vitro and in vivo validates the effects of highly diluted homeopathic medicines in a wide variety of organisms.

CONCLUSION

The precise mechanism(s) and pathway(s) of action of highly diluted homeopathic drugs are still unknown.

Serial dilutions: a new area of research for animal behavior

This paper attempts to stimulate the psychological investigation of homeopathy and serially agitated dilutions. The history of homeopathy and serial dilutions is provided in a literature review of selected research areas. Two original illustrative experiments are also presented and discussed. The first examined the effect of serially agitated dilutions of Sevin on the mortality rate of honey bees (Apis mellifera). In a second experiment, the effect of serially agitated dilutions of sucrose on proboscis extension in honey bees was assessed. No differences were found between serially agitated dilutions of pesticides and sucrose compared with dilutions alone. Implications, limitations, and proposed further work are discussed.

Compellingness: assessing the practical relevance of clinical research results

While the critical appraisal of clinical research has generally focused on aspects of study design and statistical analysis, other features of clinical studies appear to be more important to clinicians for assessing the value of a particular study in the care of particular patients. These features relate to the quality of the knowledge derived from the research, the value of the results to the care of individual patients, and the responsibility of clinicians to be stewards of limited resources. Twelve features of clinical research studies that affect how compelling individual clinicians find the results are proposed and examined here. By better understanding what makes clinical research compelling enough to alter or reinforce clinical practice, clinical researchers can design future studies to better serve the needs of clinicians and patients.

Effects of the homeopathic remedy arnica on attenuating symptoms of exercise-induced muscle soreness

OBJECTIVE

To evaluate the clinical efficacy of Arnica at a high potency (200c), on moderating delayed onset muscle soreness and accompanying symptoms of muscle dysfunction.

METHODS

Twenty subjects completed a maximal eccentric exercise protocol with the non-dominate elbow flexors to induce delayed onset muscle soreness. Either Arnica or placebo tablets were administered in a random, double- blinded fashion immediately after exercise and at 24 hours and 72 hours after exercise. Before exercise, immediately post-exercise, and at 24, 48, 72, and 96 hours post-exercise, assessments of delayed onset muscle soreness and muscle function included: 1) muscle soreness and functional impairment; 2) maximum voluntary contraction torque; 3) muscle swelling; and 4) range of motion tests to document spontaneous muscle shortening and muscle shortening ability. Blood samples drawn before exercise and at 24, 48, and 96 hours after exercise were used to measure muscle enzymes as indirect indices of muscle damage.

RESULTS

Regardless of the intervention, the extent of delayed onset muscle soreness and elevations in muscle enzymes were similar on the days following the eccentric exercise protocol. The post-exercise time profiles of decreases in maximum voluntary contraction torque and muscle shortening ability and increases in muscle swelling and spontaneous muscle shortening were similar for each treatment intervention.

CONCLUSIONS

The results of this study did not substantiate the clinical efficacy of Arnica at a high potency on moderating delayed onset muscle soreness and accompanying symptoms of muscle dysfunction. Despite the findings of this study, future investigations on the clinical efficacy of homeopathic interventions should consider incorporating research strategies that emphasize differential therapeutics for each patient rather than treating a specific disease or symptom complex, such as DOMS, with a single homeopathic remedy.

A Methodological Framework for Evaluating the Evidence for Complementary and Alternative Medicine (CAM) for Cancer

In spite of lacking evidence for effects on cancer progression itself, an increasing number of cancer patients use various types of complementary and alternative medicine (CAM). There is disagreement between CAM practitioners, researchers and clinical oncologists, as to how evidence concerning effects of CAM can and should be produced, and how the existing evidence should be interpreted. This represents a considerable challenge for oncologists; both in terms of patient needs for an informed dialogue regarding CAM, and because some types of CAM may interact with standard treatments. There is a need for insight into which kinds of CAM may work, for whom they work, what the possible effects and side-effects are, and in what ways such effects may come about. The present article presents a framework for evaluating effects of CAM by suggesting a taxonomy of different levels of evidence related to different types of research questions and discussing the relevance of different research methodologies for different types of effects.

Evidence and simplicity: why we should reject homeopathy

Homeopathic medications are used by millions, and hundreds of millions of dollars are spent on these remedies in the USA alone. In the UK, the NHS covers homeopathic treatments. Nonetheless, homeopathy is held in considerable disrepute by much of the medical and scientific community. Many proponents of homeopathy are well aware of these criticisms but remain unimpressed. The differences of opinion run deep, and the debate seems deadlocked. We aim to shed some light on this situation. We briefly recap some of the major arguments on each side, but we try to go further by making explicit an underlying philosophical presupposition. In particular, we will claim that there is an important principle, which has ancient roots going back at least to Occam, some version of which constrains all empirical reasoning. We call this constraint the simplicity principle. We argue that this is not something specific to a scientific paradigm, but that, all of us, including proponents of homeopathy, are themselves deeply committed to the simplicity principle. However, once the simplicity principle is made explicit and applied to homeopathy, allegiance to homeopathy is clearly seen as irrational. The point is not merely the lack of clinical trials supporting homeopathy; rather, belief in the efficacy of homeopathy leaves a mountain of unexplained mysteries, and thereby flies in the face of the simplicity rule that guides the homeopaths' own reasoning and arguments. If nothing else, we hope that defenders of homeopathy will gain a greater understanding of why critics are so deeply reluctant to accept the efficacy of homeopathic interventions - and that this reluctance is not mere stubbornness or artificial allegiance to western medicine. Finally, we also hope thereby to illustrate the usefulness of philosophy in unearthing presuppositions in seemingly deadlocked debates.

Journeys in the country of the blind: entanglement theory and the effects of blinding on trials of homeopathy and homeopathic provings

The idea of quantum entanglement is borrowed from physics and developed into an algebraic argument to explain how double-blinding randomized controlled trials could lead to failure to provide unequivocal evidence for the efficacy of homeopathy, and inability to distinguish proving and placebo groups in homeopathic pathogenic trials. By analogy with the famous double-slit experiment of quantum physics, and more modern notions of quantum information processing, these failings are understood as blinding causing information loss resulting from a kind of quantum superposition between the remedy and placebo.

Immunology and homeopathy. 3. Experimental studies on animal models

A search of the literature and the experiments carried out by the authors of this review show that there are a number of animal models where the effect of homeopathic dilutions or the principles of homeopathic medicine have been tested. The results relate to the immunostimulation by ultralow doses of antigens, the immunological models of the ‘simile’, the regulation of acute or chronic inflammatory processes and the use of homeopathic medicines in farming. The models utilized by different research groups are extremely etherogeneous and differ as the test medicines, the dilutions and the outcomes are concerned. Some experimental lines, particularly those utilizing mice models of immunomodulation and anti-inflammatory effects of homeopathic complex formulations, give support to a real effect of homeopathic high dilutions in animals, but often these data are of preliminary nature and have not been independently replicated. The evidence emerging from animal models is supporting the traditional ‘simile’ rule, according to which ultralow doses of compounds, that in high doses are pathogenic, may have paradoxically a protective or curative effect. Despite a few encouraging observational studies, the effectiveness of the homeopathic prevention or therapy of infections in veterinary medicine is not sufficiently supported by randomized and controlled trials.

Entanglement, Knowledge, and Their Possible Effects on the Outcomes of Blinded Trials of Homeopathic Provings

INTRODUCTION

In two recent studies of double-blind placebo-controlled homeopathic provings, entanglement was reported to have occurred between verum and placebo arms of the trials. This contrasts directly with the entanglement-disrupting effects of blinding, recently proposed as the reason for the failure of randomized controlled trials (RCTs) to demonstrate unequivocally the efficacy of homeopathy. It is proposed here that such entanglement between remedy and placebo during these double-blind placebo controlled provings is the direct result of the blinding process.

METHOD

A previously developed theoretical model of entanglement in homeopathy among patient, practitioner, and remedy (called PPR entanglement) was used in this investigation.

RESULTS

In agreement with the results from the proving studies, the model predicts that application of the double-blind RCT methodology to homeopathic provings leads to entanglement between both remedy and placebo arms of the trial.

CONCLUSIONS

These theoretical findings can be understood in terms of the act of blinding leading to loss of information because of quantum-like state superposition of the verum and placebo proving groups. This is compared to conclusions drawn from the well-known double-slit experiment of quantum physics, and quantum information processing. It leads to a suggestion for testing entanglement in homeopathic provings.

Immunology and homeopathy. 2. Cells of the immune system and inflammation

Here we describe the results of some experimental laboratory studies aimed at verifying the efficacy of high dilutions of substances and of homeopathic medicines in models of inflammation and immunity. Studies carried out on basophils, lymphocytes, granulocytes and fibroblasts are reviewed. This approach may help to test under controlled conditions the main principles of homeopathy such as 'similarity' of drug action at the cellular level and the effects of dilution/dynamization on the drug activity. The current situation is that few and rather small groups are working on laboratory models for homeopathy. Regarding the interpretation of data in view of the simile principle, we observe that there are different levels of similarity and that the laboratory data give support to this principle, but have not yet yielded the ultimate answer to the action mechanism of homeopathy. Evidence of the biological activity in vitro of highly diluted-dynamized solutions is slowly accumulating, with some conflicting reports. It is our hope that this review of literature unknown to most people will give an original and useful insight into the 'state-of-the-art' of homeopathy, without final conclusions 'for' or 'against' this modality. This kind of uncertainty may be difficult to accept, but is conceivably the most open-minded position now.

Outcome and costs of homoeopathic and conventional treatment strategies: a comparative cohort study in patients with chronic disorders

OBJECTIVES

To evaluate the effectiveness of homoeopathy versus conventional treatment in routine care.

DESIGN

Comparative cohort study.

SETTING

Patients with selected chronic diagnoses were enrolled in medical practice.

INTERVENTIONS

Conventional treatment or homeopathy.

OUTCOME MEASURES

Severity of symptoms assessed by patients and physicians (visual rating scale, 0-10) at baseline, 6 and 12 months and costs.

RESULTS

The analyses of 493 patients (315 adults, 178 children) indicated greater improvement in patients' assessments after homoeopathic versus conventional treatment (adults: homeopathy from 5.7 to 3.2; conventional, 5.9-4.4; p=0.002; children from 5.1 to 2.6 and from 4.5 to 3.2). Physician assessments were also more favourable for children who had received homoeopathic treatment (4.6-2.0 and 3.9-2.7; p<0.001). Overall costs showed no significant differences between both treatment groups (adults, 2155 versus 2013, p=0.856; children, 1471 versus 786, p=0.137).

CONCLUSION

Patients seeking homoeopathic treatment had a better outcome overall compared with patients on conventional treatment, whereas total costs in both groups were similar.

Effects of homeopathic arsenic on tobacco plant resistance to tobacco mosaic virus. Theoretical suggestions about system variability, based on a large experimental data set

CONTEXT

This research aimed at verifying the efficacy of homeopathic treatments by plant-based bioassays, which may be suitable for basic research, because they lack placebo effects and provide large datasets for statistical analyses.

OBJECTIVE

To evaluate the effects of homeopathic treatments of arsenic trioxide (As2O3) on tobacco plants subjected to tobacco mosaic virus (TMV) inoculation as biotic stress.

DESIGN

Blind, randomized experiment using tobacco leaf disks.

MATERIALS AND METHODS

Tobacco plants (Nicotiana tabacum L. cultivar Samsun) carrying the TMV resistance gene N. TMV inoculated leaf disks were floated for 3 days in the following: Distilled water (control). H2O 5 and 45 decimal and centesimal potencies. As2O3 5 and 45 decimal and centesimal potencies. The main outcome measures is the number of hypersensitive lesions observed in a leaf disk.

RESULTS

Homeopathic treatments of arsenic induce two effects on the plant: (i) increased resistance to TMV; (ii) decrease variability between experiments (system variability).

CONCLUSIONS

In this experimental model two actions of homeopathic treatment were detected: decrease in system variability and enhancement of the natural tendency of the system towards an 'equilibrium point'.

Effects of ultrahigh dilutions of 3,5-dichlorophenol on the luminescence of the bacterium Vibrio fischeri

There is a great need for research in the field of homeopathy for laboratory test systems to investigate the actions of ultrahighly diluted biological effectors. With this in mind, we used the luminescent bacterium Vibrio fischeri, which is used throughout the world in testing water quality. Luminescence inhibition is utilized as a test parameter for the toxicity of a sample. We used ultrahigh dilutions (UHD) of 3,5-dichlorophenol as effector and adapted the standard test procedure for water toxicity in a way that let us evaluate very minute effects. Three groups of samples were prepared and then blinded: 45 dilutions of 3,5-dichlorophenol in steps of 10, starting with 4.2 x 10(-2) M, with vigorous shaking between dilution steps; 45 identical dilutions of 3,5-dichlorophenol without vigorous shaking; and 49 control samples of the diluent. The results of, and the discussion based on, a thorough statistical analysis led to the conclusion that an effect based on UHD, which results in an inhibition of luminescence of less than 1.5%, can be confirmed for some of the potency samples. There were both effective and ineffective samples in the three sample groups. The size of the effect was very small (ca. 1.5%), though statistically significant. The number of effective samples was significantly higher among the vigorously shaken samples than among the controls and the unshaken samples (14, 6 and 7 effective samples, respectively).

Clinical trials of classical homeopathy: reflections on appropriate research designs

The growing popularity of complementary medicine has been accompanied by a call for controlled clinical studies to examine the efficacy and validity of its various methods. The difficulties encountered in applying the evaluation methods of conventional medicine to complementary medicine are the result of the different paradigms underlying these two methods of medicine, and the differences in the healing process. This paper attempts to bridge the gap between these two approaches and to suggest a possibility to use conventional research methodology in clinical studies of classical homeopathy. Two methods are described. One is the randomization into a placebo or a treatment group after an individual remedy is chosen for each patient. This method requires an experienced homeopath and is reproducible only by the same homeopath in the same population. On the other hand, the expected success rate will be high. Another method is prescribing and treating according to so-called keynotes, a set of symptoms known to respond to a particular remedy that must be present in a patient in order to elicit a reaction from the remedy. This method is more suitable to a conventional design of a clinical study and is reproducible by anyone. Yet the expected success rate is much lower. Some general design issues that may have a particular impact on clinical trials of classical homeopathy are discussed, including the need for sufficiently powered trials to detect relatively small effects, strategies to deal with patient preference and embracing the use of "active-control" pragmatic trial designs.

Does a homeopathic ultramolecular dilution of Thyroidinum 30cH affect the rate of body weight reduction in fasting patients? A randomised placebo-controlled double-blind clinical trial

OBJECTIVE

To test whether an ultramolecular dilution of homeopathic Thyroidinum has an effect over placebo on weight reduction of fasting patients in so-called 'fasting crisis'.

DESIGN

Randomised, placebo-controlled, double-blind, parallel group, monocentre study.

SETTING/LOCATION

Hospital for internal and complementary medicine in Munich, Germany.

SUBJECTS

Two hundred and eight fasting patients encountering a stagnation or increase of weight after a weight reduction of at least 100 g/day in the preceding 3 days.

INTERVENTION

One oral dose of Thyroidinum 30cH (preparation of thyroid gland) or placebo.

OUTCOME MEASURES

Main outcome measure was reduction of body weight 2 days after treatment. Secondary outcome measures were weight reduction on days 1 and 3, 15 complaints on days 1-3, and 34 laboratory findings on days 1-2 after treatment.

RESULTS

Weight reduction on the second day after medication in the Thyroidinum group was less than in the placebo group (mean difference 92 g, 95% confidence interval 7-176 g, P=0.034). Adjustment for baseline differences in body weight and rate of weight reduction before medication, however, weakened the result to a non-significant level (P=0.094). There were no differences between groups in the secondary outcome measures.

CONCLUSIONS

Patients receiving Thyroidinum had less weight reduction on day 2 after treatment than those receiving placebo. Yet, since no significant differences were found in other outcomes and since adjustment for baseline differences rendered the difference for the main outcome measure non-significant, this result must be interpreted with caution. Post hoc evaluation of the data, however, suggests that by predefining the primary outcome measure in a different way, an augmented reduction of weight on day 1 after treatment with Thyroidinum may be demonstrated. Both results would be compatible with homeopathic doctrine (primary and secondary effect) as well as with findings from animal research.

A new database on basic research in homeopathy

A new database on 'Basic Research on Homeopathy' has been established. It contains research on biological systems and physico-chemical effects of the succussion process. It is aimed at the elucidation of the working mechanism of the homeopathic similia principle following application of low doses and potencies of substances. By the end of 2000, this database included 829 experiments in 782 primary publications. The publications are classified according to organism and field of interest. Several reasons for the relatively high number of experiments and publications are presented. It is concluded that the research community would benefit from a European research agenda with a priority on the translation of relevant publications from the different European languages into English.

Homeopathy: what is it and is it of value in the care of patients with cancer?

The underlying principles of homeopathy include treating 'like with like' by remedies which are potentized by serial dilution and succussion. These distinguish homeopathy from other forms of alternative or complementary therapy. Conventional scientific wisdom dictates that homeopathy should have no effect above and beyond placebo but experiments on ultra-high dilutions of solutes together with some clinical data suggest the intriguing possibility that it might do in some circumstances. However, most clinical evidence comes from treating relatively minor self-limiting diseases and little comes from treating life-threatening disorders such as cancer. This paper explains the principles of homeopathy and reviews the data on its use in cancer care.

Why alternative medicine cannot be evidence-based

The concept of evidence-based medicine (EBM) has been widely adopted by orthodox Western medicine. Proponents of EBM have argued that complementary and alternative medicine (CAM) modalities ought to be subjected to rigorous, controlled clinical trials in order to assess their efficacy. However, this does not represent a scientific necessity, but rather is a philosophical demand: promoters of EBM seek to establish their particular epistemology as the primary arbiter of all medical knowledge. This claim is problematic. The methods for obtaining knowledge in a healing art must be coherent with that art's underlying understanding and theory of illness. Thus, the method of EBM and the knowledge gained from population-based studies may not be the best way to assess certain CAM practices, which view illness and healing within the context of a particular individual only. In addition, many alternative approaches center on the notion of non-measurable but perceptible aspects of illness and health (e.g., Qi) that preclude study within the current framework of controlled clinical trials. Still, the methods of developing knowledge within CAM currently have limitations and are subject to bias and varied interpretation. CAM must develop and defend a rational and coherent method for assessing causality and efficacy, though not necessarily one based on the results of controlled clinical trials. Orthodox medicine should consider abandoning demands that CAM become evidence-based, at least as "evidence" is currently narrowly defined, but insist instead upon a more complete and coherent description and defense of the alternative epistemic methods and tools of these disciplines.

Alternative medicine for allergy and asthma

Orthodox medical approaches to asthma and allergic respiratory diseases are provided in guidelines developed by professional societies and national or state organizations that represent organized medicine. Alternative therapies may include such orthodox medical therapies as obsolescent formerly used agents, unusual but accepted agents, and agents that are in favor for orthodox therapy in other countries. However, the current growth of complementary and alternative medicine is based on the use of nonorthodox remedies that are becoming increasingly popular with patients and that should be familiar to physicians. Asthma and allergies are frequently treated with such remedies by patients, either as part of self-therapy or on the advice of a complementary and alternative medicine practitioner. The most popular alternative medical treatments are herbs (Western and Asiatic), acupuncture, various types of body manipulation, psychologic therapies, homeopathy, and unusual allergy therapies. There is little evidence in favor of most of these unorthodox treatments, although they are very often reported on favorably by patients. The published evidence that might support some alternative medical practices is reviewed so as to help physicians select alternatives that could appropriately be integrated into orthodox practice.

Recent advances in alternative therapies

Complementary and alternative medicine (CAM) is becoming more popular, and CAM remedies are used instead of, or integrated with, orthodox allopathic therapies by many patients with asthma. Although most CAM remedies may have no discernible effects when analyzed by conventional medical techniques, some double-blind controlled studies do suggest that a meaningful benefit can be obtained with acupunture and homeopathic management in asthma. Herbal medicine is more popular, despite little evidence that the vast majority of herbs for asthma have any useful effects other than a nonspecific expectorant action. Dietary adjustment may benefit a small percentage of patients with asthma, but extreme measures are very rarely indicated. Formal pyschologic approaches can help some patients by reducing anxiety. Although most CAM approaches are harmless, the lack of benefit of many remedies and the potential harm from some of them must be recognized.