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Podiatry & Homeopathy/ Complementary Practice

Discussion in 'General Issues and Discussion Forum' started by Mark Russell, May 23, 2006.

  1. Members do not see these Ads. Sign Up.
    In recent years, the use of marigold therapy and acupuncture have become widespread in podiatric practice, especially amongst private practitioners, yet the evidence base for both thearpies is dificult to substantiate. This morning a group of eminent physicians & scientists have written to highlight their concerns regarding the increased use of homeopathy and 'alternative' medicine within the NHS. Is it time that the podiatry profession examines its own relationship with these practices?



    Use of ‘alternative’ medicine in the NHS

    We are a group of physicians and scientists who are concerned about ways in which unproven or disproved treatments are being encouraged for general use in the NHS. We would ask you to review practices in your own trust, and to join us in representing our concerns to the Department of Health because we want patients to benefit from the best treatments available.

    There are two particular developments to which we would like to draw your attention. First, there is now overt promotion of homeopathy in parts of the NHS (including the NHS Direct website). It is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness. Despite this, a recently-published patient guide, promoting use of homeopathy without making the lack of proven efficacy clear to patients, is being made available through government funding. Further suggestions about benefits of homeopathy in the treatment of asthma have been made in the ‘Smallwood Report’ and in another publication by the Department of Health designed to give primary care groups “a basic source of reference on complementary and alternative therapies.” A Cochrane review of all relevant studies, however, failed to confirm any benefits for asthma treatment.

    Secondly, as you may know, there has been a concerted campaign to promote complementary and alternative medicine as a component of healthcare provision. Treatments covered by this definition include some which have not been tested as pharmaceutical products, but which are known to cause adverse effects, and others that have no demonstrable benefits. While medical practice must remain open to new discoveries for which there is convincing evidence, including any branded as ‘alternative’, it would be highly irresponsible to embrace any medicine as though it were a matter of principle.

    At a time when the NHS is under intense pressure, patients, the public and the NHS are best served by using the available funds for treatments that are based on solid evidence. Furthermore, as someone in a position of accountability for resource distribution, you will be familiar with just how publicly emotive the decisions concerning which therapies to provide under the NHS can be; our ability to explain and justify to patients the selection of treatments, and to account for expenditure on them more widely, is compromised if we abandon our reference to evidence. We are sensitive to the needs of patients for complementary care to enhance well-being and for spiritual support to deal with the fear of death at a time of critical illness, all of which can be supported through services already available within the NHS without resorting to false claims.

    These are not trivial matters. We urge you to take an early opportunity to review practice in your own trust with a view to ensuring that patients do not receive misleading information about the effectiveness of alternative medicines. We would also ask you to write to the Department of Health requesting evidence-based information for trusts and for patients with respect to alternative medicine.

    Yours sincerely

    Professor Michael Baum
    Emeritus Professor of Surgery, University College London

    Professor Frances Ashcroft FRS
    University Laboratory of Physiology, Oxford
    Professor Sir Colin Berry
    Emeritus Professor of Pathology, Queen Mary, London
    Professor Gustav Born FRS
    Emeritus Professor of Pharmacology, Kings College London
    Professor Sir James Black FRS
    Kings College London
    Professor David Colquhoun FRS
    University College London
    Professor Peter Dawson
    Clinical Director of Imaging, University College London
    Professor Edzard Ernst
    Peninsula Medical School, Exeter
    Professor John Garrow
    Emeritus Professor of Human Nutrition, London
    Professor Sir Keith Peters FRS
    President, The Academy of Medical Sciences
    Mr Leslie Rose
    Consultant Clinical Scientist
    Professor Raymond Tallis
    Emeritus Professor of Geriatric Medicine, University of Manchester
    Professor Lewis Wolpert CBE FRS
    University College London
    Last edited: May 23, 2006
  2. Peter

    Peter Well-Known Member


    A great point. In fact, I am planning to undertake a pilot research project with one of those aims. Its very early days, so I cannot give too much away. :cool:
  3. Craig Payne

    Craig Payne Moderator

    Mark - I could not agree more with the letter in your post. I scratch my head (...I seem to be doing that too much lately and look at the consequences) as to why podiatry in the UK is so much more accepting of homeopathy and not at all accepted by Podiatry in the USA and Australia (for eg) ..??? In the face of the overwhelming evidence people need to take note.
  4. Admin2

    Admin2 Administrator Staff Member

  5. Peter

    Peter Well-Known Member


    I hope I didn't give anybody the impression I use homeopathy. I use acupuncture a lot, particularly the periosteal type.

    I think that homeopathys' place is in those cheesy free magazines you get with TV listings.
  6. Craig Payne

    Craig Payne Moderator

    I would hardly call accupuncture alternative or complementary when you look at all the good evidence on it use.
  7. javier

    javier Senior Member

    Like foot function, there are lot of things we do not know about human body. For further info about acupuncture, I recomend reading the largest trial made on the subject: German Acupuncture Trial for Chronic Low-Back Pain (GERAC-cLBP).
    Haake M, Muller HH, Schade-Brittinger C, Prinz H, Basler HD, Streitberger K, Schafer H, Molsberger A. The German multicenter, randomized, partially blinded, prospective trial of acupuncture for chronic low-back pain: a preliminary report on the rationale and design of the trial. J Altern Complement Med. 2003 Oct;9(5):763-70.

    Its results are very interesting. Acupuncture works but works independently from the place where you put the needle.

    About homeopathy, it is covered by the French National Health System and homeopathic products fall under medical products regulation (it happens also in Spain, where homeopathic products can only be dispensed on pharmacies). Thus, I would avoid statements like "I think that homeopathys' place is in those cheesy free magazines you get with TV listings", because although it is difficult to understand how infinitesimal dosis can produce some effect, there are more than "one case report" studies on the subject.

    Also, I have had to heard from general practitioners and orthopods that foot orthotics have no use because the lack of research on the subject. Perhaps, we should be more open minded.
  8. Peter

    Peter Well-Known Member

    No disrespect Javier,

    In the UK, homeopathy IS found in the back of magazines. I simply cannot comment in what context it is used in mainland Europe.

    The Times today states " Homeopathy, Does it work? A review led by Matthias Agger, of the University of Berne, and published in the Lancet, examined 110 trials and suggested that it has a placebo effect".

    It all comes back to the evidence base.
  9. After discussions with a colleague this weekend I learnt of a particular branch of homeopathic treatment called nosode therapy where skin scrapings are taken from verrucae tissue and are sent to the pharmacist and prepared for oral ingestion. Varying strengths can be procured and it is claimed that verrucae undergo spontaneous immunological resolution following treatment. Any thoughts/experiences would be welcome.


    Mark Russell
  10. javier

    javier Senior Member

    I do not feel you disrespect me, since I do not use Homeopathic products. Furthermore, I belive that it is quite incredible that infinitesimal dosis can produce any affect. But, for every study that suggest (not conclude) A, you can find other that suggest B.

    Also, we tend to classify treatment results as placebo effect when we are not able to explain their mechanism.

    I have not heard about this. But, it sounds disgusting. Just think about other conditions you could take by oral ingestion :eek:
  11. NewsBot

    NewsBot The Admin that posts the news.

    Charlie vs the evidence?

    Associated Press are reporting:
    Prince Charles plugs acupuncture, herbal meds
    May. 23 2006 11:54 AM ET
  12. From The Times 24/5/2006

  13. Javier

    Have you tried using homeopathic medicines in your practice or are you basing your opinions on the orthodox view? I have to admit not having much experience with homeopathic products but there is a substantial library of published research which indicates successful clinical outcomes for a variety of podiatric conditions when homeopathy is employed. Have you heard of Marigold for example?


    Mark Russell
  14. javier

    javier Senior Member

    Yes, it was based on chemistry and statistics. When you use infinitesimal doses, the chance for a certain particle to interact with other to produce an effect it becomes almost improbable.

    The inability (at least currently) to reach the homeopathic molecules to infinitesimal doses is the main problem to perform evidence based trials. But, if we are not able to study infinitesimal doses, it does not mean that it can not be possible.

    My wife is a pharmacist and we have discussions about this subject (not so many for the sake of my marriage ;) ), because she beliefs about homeopathic medicines and results. Her objection about the "placebo effect" is homeopathy have been tried successfully with animals and neonates.

    I have heard about Marigold, but I do not know about it. Anyway, homeopathy is used by some Spanish podiatrists with good results (according to them).

    I think that the UK problem with homeopathy is related to NHS funds shortage instead of the use of these products. Or, It could be the lack of money incentives from the homeopathic industry for performing trials, studies, etc.
  15. I don't think Albert Hoffman would agree with you there.
    I think the problem is more complicated than just the allocation of public funds and has more to do with a threat to orthodoxy and the pharmaceutical industry than anything else. In western Africa, verrucae and warts in general are often successfully treated by applying a paste made from the chewed bark of the yohimbine tree. There is a not altogether unpleasant side-effect from this treatment as yohimbine is an extremely effective drug for erectile dysfunction and can sustain erections for up to 18 hours. It's use in ED was discontinued in the late 1970s (yohimbine hydrochloride) when some patients reported difficulties with prolonged priapism and the manufacturers (Pfizer) ceased production, thus denying the podiatric community from another potentially valuable armament in the treatment of VPs. And just think of the fun our undergraduates would have had at weekends - it might even have made VP treatment fashionable again!

    I think homeopathy is in danger of being regarded as everything not produced by the major pharmaceuticals yet many of the traditional remedies are just as potent - if not more so - than the chemotherapeutic agents we commonly see in the pharmacies today.

    It would be interesting to compare the differences in the undergraduate programs in the UK to USA & Australia to see if the supposed dichotomy, alluded to by Craig, occurs through education or experience.

    Mark Russell
    Last edited: May 25, 2006
  16. javier

    javier Senior Member

    Sorry Mark, but I do not find the relationship between Albert Hoffman and the supposed stochastic effects from homeopathic products :confused: Perhaps, I should take an LSD tablet for viewing homeopathic molecules working :)

    Pharmaceuticals know it very well. There is an increasing concern from UN about pharmaceuticals patents based on traditional remedies from third world countries. It is supposed to be regulated the Convention on Biological Diversity in 1993. For futher info: http://www.nature.com/nbt/journal/v22/n3/full/nbt0304-263.html
  17. The point being that an infinitesimal amount of an alkaloid synthesised from ergot produces remarkable psycho-physiological changes when ingested
    As you know the pharmaceutical industry is a multi-billion dollar business where the multinationals will do just about anything to protect their market share, including the suppression of traditional remedies by manipulation of the regulatory process. Homeopathic preparations have been used in chinese medicine for hundreds if not thousands of years and although not subject to the same processes as orthodox pharmaceuticals, still have a valuable part to play I would suggest. It would be interesting to hear the views of some who employ homeopathic preparations in their practice.
    Last edited: May 25, 2006
  18. javier

    javier Senior Member

    You can contact Boiron, the world largest homeopathic laboratory http://www.boiron.com/index_en.asp, I am sure that they will send you the information you request.
  19. Still the debate rages in The Times

    Sir, In their call for a halt to NHS funding of alternative therapies Professor Michael Baum and his colleagues are in danger of throwing the baby out with the bathwater (report, May 23). While the efficacy of some treatments, such as homoeopathy, reflexology and crystal healing, may be difficult to prove, other alternative treatments have been practised safely and effectively for thousands of years and have been proven by scientific studies.

    Western medicine is undoubtedly the most advanced medical system for treating the symptoms of illness and physically intervening in the functioning of the body to tackle the cause (for example, to remove cancerous cells). However, these scientific advances have often been at the expense of supporting the emotional and psychological wellbeing of the patient, which is where alternative treatments excel.

    In my experience as a Chinese acupuncturist and herbalist specialising in treating fertility, medicine is at its most effective when utilising the science of Western medicine for diagnosis and intervention, while using Chinese medicine to create a balance in the patient’s physical and emotional wellbeing that can allow the body to function as it should.

    Eighty per cent of couples who come to see me having failed to conceive using IVF succeed in getting pregnant when their next round of IVF is supported by acupuncture and herbal medicines.

    If the Professor Baum and his colleagues are really concerned about shortages and rationing in the NHS they should be calling for government-funded research into the efficacy of alternative treatments that complement Western medicine. As alternative treatments are almost always significantly cheaper to implement than Western pharmaceutical and surgical treatments, this could save the NHS and the taxpayer millions of pounds. The professors should also back those medical disciplines that wish to “professionalise” through systems of statutory regulation, in the way that the Chinese medical community has done in the UK.

    London NW4

    Sir, Resources are limited in the NHS. How can we justify spending millions on these unsubstantiated treatments while nurses are being laid off and people are denied access to treatments such as Herceptin?

    I understand that it is unfair to lump all alternative therapies together. There is a world of difference between acupuncture (which appears to work even if we do not fully understand how) and crystal therapy. Particular scorn should be reserved for homoeopathy which, by treating people with solutions so dilute that not a single molecule of the active ingredient remains, is almost the classic definition of a placebo. In time evidence may emerge to support the validity of some of these treatments, at which point public funding should be considered.

    But at present the choice is clear — does a 21st-century society opt to spend its limited resources on evidence-based medicine or mumbo-jumbo?


    Sir, The demand for complementary medicine in the UK is, in part, driven by the NHS. Patients seek the help of chiropractors and osteopaths for conditions such as back pain for a reason — their GP is unable to provide anything other than symptomatic relief while the problem rights itself. With back pain costing the country an estimated £11 billion a year, the need for effective treatment should be transparent.

    A. J. YATES
    Milton Keynes

    Sir, It is a sad day when the medical profession decides to “abandon” alternative medicine. Where is their scientific curiosity? I thought being “scientific” was to consider all options. The conclusion has been made without looking at the thousands of scientific papers which have been conducted on many therapies, under rigorous conditions.

    The real casualties here are not practitioners of alternative medicine, but the patients who, having tried orthodox medicine, have found solutions to their health problems.

    New South Wales

    Sir, In “All in the mind?” (report, May 24), it was reported that the Prince of Wales had “suggested that doctors prescribe coffee enemas to cancer patients”. This is not true. In a speech to the Royal College of Obstetricians and Gynaecologists in 2004, the Prince said he personally knew of one cancer patient who had used Gerson therapy (a treatment which includes the use of coffee enemas), and who was still alive seven years after being told her cancer was terminal. The Prince went on to say that while “one patient’s experience cannot hold water as evidence” that Gerson therapy worked, more evidence was needed to determine what the risks and benefits of the therapy might be.

    Communications Secretary to the Prince of Wales
    London SW1
  20. Leader and article from The Times
  21. elmsj

    elmsj Active Member

    NHS use of homoeopathy

    Just a thought -

    if the british medical establishment dont think that homoeopathy works, why are there about 6 ? NHS homoepathic hospitals in the uk? Why spend money on making doctors study extra time (is it 4 years) learning Homoeopathy.

    There is evidence that homoepathy works, and that is why it is used in the NHS.
    Also - placebos dont work on animals do they, so how come Vets also use homoeopathy now?

    as I said - just a thought.
  22. From the Sunday Times 28/5/2006

  23. Interestingly enough, I have it on good authority that Professor Michael Baum (principal author of the Times letter) once had his verruca successfully treated by the use of Marigold Therapy! :eek:
  24. Con

    Con Member

    Is it just me or do problems with the feet seem to attract odd alternative or home remedies?

    I've come across a few people who swear by the tail of a (living) black cat rubbed on the verruca, to cure it. There's plenty of empirical or anectdotal evidence for it, and I'm sure that with a carefully-designed study and enough funding (and a lack of obligation to publish negative studies) I could get you some very favorable evidence, although getting it published in peer-reviewed journals might be difficult. But how do we make money out of cats? Sadly my vet doesn't recommend it, but I'm sure I can find a vet who does.

    Plenty of things work when you try them. But the question is do they really do anything when compared with a suitable placebo under controlled conditions?

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