Deluded and Dangerous

I recently stumbled across a paper describing the work of the Abha Light organisation – a group of particularly dangerous homeopaths treating malaria in Kenya with homeopathy, and disparaging proper medicine for good measure.

It should go without saying that malaria is a serious, potentially fatal, disease that should not be treated with untested remedies – especially the sugar pills and magic water of homeopathy.  So committed are the homeopaths of Abha Light that they believe that their magic works and that it is superior to proven medicines.

These themes shine through the paper presented by Didi Ananda Ruchira at the Cuban Nosodes 2008 International Conference, entitled, “The Use of Homeopathic Prophylaxis and Treatment For Malaria in Endemic Areas Of Kenya: Part 2“.  It provides some alarming insights into the surreal world of Abha Light.

The Big Excuse

Frighteningly, it is clear that Ruchira actually understands that malaria is dangerous, but she still states that the, “…Abha Light Foundation has been working in the fields of malaria and HIV for 10 years, treating with homeopathy and natural medicines.”

Incredibly, she is not embarrassed to add:

“… I must tell you that in fact, I have done no laboratory research on this approach due to lack of funding. Homeopathy in capitalist countries is meeting great opposition simply because it challenges the pharmaceutical companies dominion over the health care of billions of people.”

The excuse for not having attempted even the most basic scientific work is The Great Pharmaceutical Conspiracy.  This does not square at all with the amount of published research on homeopathy – plenty of other homeopaths and their apologists have done research.  Neither does Ruchira’s lack of funding reflect an impoverished homeopathy industry.  For instance French manufacturer Borion turned over €536 million in 2009 and was the No.2 producer of OTC medicines in its home market^*.  According to the BHA the European homeopathy market was apparently worth €930million by 2005 and the UK, “over-the-counter market in homeopathy currently stands at around £40million.”  There are clearly substantial sums of money being made by homeopathy manufacturers.  The homeopathic industry clearly has the opportunity to fund appropriate research, should it wish to.  After all, unlike the pharmaceutical industry, they are not burdened with having to expensively develop novel compounds.  Blaming pharmaceutical companies for not having done a proper job is just not credible.  Ploughing on anyway is just not defensible.

No science please, I’m objective

Next this redoubtable homeopath waves away any concerns about the lack of evidence contained in the ‘paper’.

“The research as such it is, is purely on objective, observation of cases presented analyzed homeopathically and cured. In my opinion, it is no less scientific, since the results are repeatable and consistent.”

Claims that personal observations by a committed homoeopathist can be “objective” are as risible as they are dangerous.  Her opinion that this is in any sense “scientific” belies a total lack of appreciation for the values and methods of science.  Claims that the results are “repeatable and consistent” merely show that she has fooled herself.  Scientific methods like blinding and randomisation have been developed because the tendency to select the part of our experience that conforms to our beliefs is so strong.  The casting aside the wisdom of centuries of scientific development so easily shows that her work cannot be trusted.

Drugs are bad

After noting that many Kenyans with malaria self-medicate, chloroquin-based drugs are derided as “useless”.  Whilst problems of drug resistance mean that chloroquine is no longer universally recommended as a first-line treatment, superseded by artemisinin based combination therapies (ACTs), it is still recommended by the World Health Organisation (2010) under certain circumstances. For example, chloroquine combined with primaquine is the treatment of choice for chloroquine-sensitive infections.  One thing is certain: even this venerable drug is infinitely more effective than homeopathy.  Its is not “useless”.

Even more effective drugs are dismissed by this homeopath:

“But whether it is the latest drugs or outdated ones, the patient then self-medicates and does or doesn’t get over the bout of malaria. After a week, he or she is back to work, but with lingering malaise and never quite feeling right again. This suppression mixed with side-effects produces a lingering malarial miasm, that over time weakens the immune system and produces chronic diseases in the individual.”

Miasms^** – in homeopathic dogma – are the mythic cause of all chronic diseases.  However, they are not real.  They are just contrivances of the founder of homeopathy, Samuel Hahnemann, elaborated by later followers.

Although malaria is a relapsing infection, it is possible to cure.  The World Health Organisation (WHO, 2010) defines “cure” as the, “elimination of the symptoms and asexual blood stages of the malaria parasite that caused the patient or caregiver to seek treatment” and an extended “radical cure”, in P. vivax and P. ovale infections only, which goes on to prevent, “relapses by killing hypnozoites”.

Discussing recurring malaria further, Ruchira notes:

“[…] Relapses occur because P. vivax and P. ovale have dormant liver stage parasites (“hypnozoites”) that may reactivate. The challenge here is to remove the parasite from the spleen and liver in a natural way.

I will also propose that many relapses are in fact the effects of overdosing of quinine and synthetic quinine based drugs. The natural laws of homeopathic simillimum apply with all substances, whether they are intended or not.”

Ruchira understands the cause, but homeopathic dogma (‘natural laws of homeopathic simillimum’) seems to stop reality intruding much further.  Preventing relapses of this kind requires “killing hypnozoites” (WHO, 2010).  Resistance to drug therapy explains relapses, not “overdose”.  This is a reason to use more effective medication, not abandon it.

Neem and Malaria

The treatment regimen centres on the use of “Neem Tonic as a homeopathic 2x (or D2)” Many claims have been made for extracts of neem, a tree in the mahogany family.  Among them is that it can treat malaria.

“Patients are to take 5 drops a day for 2-3 weeks. We believe this destroys any parasites that may remain in the body and breaks the cycle of recurrent malaria.”

This is not a very homeopathic explanation, nor one grounded in evidence.  Her insistence on the universal nature of the, “natural laws of homeopathic simillimum” has vanished.  This treatment is justified on the basis that neem has anti-malarial activity, not that it produces malaria-like symptoms in healthy individuals; like curing like has been conveniently abandoned to allow for a superficially plausible biochemical explanation.  Even the less than objective Neem Foundation concedes, “Even though neem may be effective against the parasites that carry malaria, it has not been shown to prevent the malaria infection once it’s in the body.”

It is also worth noting that a homeopathic 2x (or D2) preparation is a 1 percent preparation of the initial substance, or mother tincture.  So, there is actually some putative medicine in the bottle.  It’s just not one that that has any proven efficacy.  Even though the concentration is comparable to that reported for neem-based repellents and lavicides (1% to 5%), five drops daily is a tiny dose, likely around 2.5 – 5 µl/day, depending how big a drop is assumed to be.^***

“2 weeks of Neem 2x, and concurrently 3-5 days dosing of China Sulph. We consider that the body has been detoxed from the past history of any lingering malaria parasites and from chemical drug poisoning. “

Once more, proven drugs are dismissed as part of the problem, on a par with the actual malaria parasites.

And now for something completely crazy …

Next, treatment with the delusional “ Abha Light complex” is described.

“Now the patient will be given a routine of prophylaxis by taking our Abha Light complex of 30c remedies that contains 5 ingredients, one of them being the Malaria Nosode, sold by Ainsworths Pharmacy, UK, which contains the four malaria Anopheles mosquitoes: P. falciparum, P. vivax, P. ovale and P. malariae. The complex also contains 4 other homeopathic remedies. The ingredients of this complex are Malaria nosode, china officinalis, natrum muriaticum, arsenicum album and eupatorium perfoliatum. We instruct clients to take it for 3 days, 1 dose a day, and after that, 1 dose (1 pill) every two weeks. I have reason to believe that this dosage routine could be extended to once every month, especially after taking a full course of Neem Tonic (2x) of 3-4 weeks.”

There is no need to focus on the alleged ‘contents’ of the pills.  At 30c ‘potency’ there is no medicine in the medicine (one part mother tincture to 10⁶⁰ parts solvent!).  Given that Ruchira made a fuss about “homeopathic simillimum” early in this ‘paper’ it’s worth noting that nosodes are prepared from a pathological specimen taken from someone with the disease.  So this is about treating with the causative agent, not something that produces similar symptoms in a health person.  As such, homeopathic simillimum has been abandoned in favour of isopathy.

It’s shocking that this quackery is enabled by a company based in the UK and then inflicted on a disadvantaged population.  There is no reason (well, except magical ones) to think that this could work and Ruchira has no evidence that it does.

Only patients fail

Ruchira also seems to rationalise failures away:

“Our malaria complex was first created to treat malaria and it is very effective in that too. In the case of malaria attacks, it will be effective immediately with patients reporting that they feel well within 24 hours. Our experience has been, however, that patients feel so well they return to their full work routine, only to relapse because they are not fully cured. So we now advise that patients should continue dosing with the malaria complex for a full week even if they are feeling well.”

Perhaps they relapse because the pills are empty promises?

Evidence, but not as we know it

The author makes claims about the effectiveness of this approach,

“At our 18 clinics in Kenya, the malaria complex is a regular prescription for hundreds of our patients. In September 2007 we partnered with a local NGO to distribute the malaria complex 3step program to over 1,500 families. Again in Uganda, at the refugee camps, we have provided the malaria complex to about 2000 people with, again, good effect.”

Widely distributing this sugar pill is presented as success.  The “good effects” are not substantiated.

Ruchira then presents the closest thing that there is to ‘evidence’ in this paper.  She describes the “Kendu Bay Malaria Prevention Project”.  From the 1500 families she claims have been given access to the, “malaria complex 3step program” Ruchira provides nine whole anecdotes!

The breadth of the author’s research is then summarised:

“Sadly, we have lacked the funding to perform proper research and I’m sorry I cannot present firmer results.”

But she is nevertheless convinced that the homeopathy is working.  Her conviction is clearly independent of the need for evidence.  Next, the results of “patient surveys” are cited:

“34 clients participated in the survey. Of those, about 30% have been using 3-Step for 3 months or more. 47% use a net regularly. The participants ages ranged from 2 years to 65 years of age -both male and female.”

I thought that 1500 families had been given the wonder pills?  34 participants seems like a very poor return.  In any event it’s a very small survey.  Also, only ten clients had been using the sugar pills for three months or more.  So, the remaining twenty-four had been taking the preparation for less than three months.  This all seems too few people and too short a time to make any sensible judgement.

“In the 6 months before starting the program, all 100% of participants had attacks of malaria or malaria-like symptoms at least once. Of the 34 participants 71% used to get malaria or malaria-like symptoms once a month or every two weeks.

• Of these, 47% actually took a test to confirm it.

• 33% self-medicated, 66% took conventional medicine by prescription, 1% treated with herbal or homeopathic medicine.

• Since starting the 3-step programme, only 12% or 4 out of the 34 respondents had an attack of malaria or malaria-like symptoms.  We can see even by these simple numbers that there has been a decrease in malaria or malaria-like symptoms.”

So, malaria was only confirmed in less than half of the thirty-four participants.  Ninety-nine percent of these had a history of taking conventional medication.  How does the good homeopath know that they stopped?  Again, given that only ten respondents had been taking the homeopathic pills for three months or more, attributing the alleged, “decrease in malaria or malaria-like symptoms” to the pills is premature in the extreme.

Given that thousands of people had access to the homeopathic treatment, quoting a survey with just 34 respondents is very poor.  Either, some apparent very short-term “success” lead a few enthusiastic people to fill in the survey, or the homeopaths and their helpers just didn’t take this very seriously.

Yet the author rashly concludes, “Homeopathy does indeed work for malaria. Homeopaths should not be afraid of this disease, nor prevented from treating it.”    After conceding that she had done no proper research, this is a dangerous delusion.

Compare and contrast

Ruchira’s blind belief in treating malaria with homeopathy brings to mind the reported views of Dr Peter Fisher, Clinical Director at the Royal London Homeopathic Hospital.  In 2006, he gave the BBC’s Newsnight programme a reaction to UK homeopaths being caught offering homeopathy for malaria prevention:

“I’m very angry about it because people are going to get malaria – there is absolutely no reason to think that homeopathy works to prevent malaria and you won’t find that in any textbook or journal of homeopathy so people will get malaria, people may even die of malaria if they follow this advice.”

Fisher’s anger seemed to have abated somewhat of late, but he was quoted in The Times last year criticising the use of homeopathy for preventing malaria:

“Malaria is a serious and life-threatening disease and there is no published evidence to support the use of homeopathy in the prevention of malaria.”

Though he can be found offering this self-serving advice to travellers:

“We advise that homeopathic medicines for the prevention of malaria should not be taken in isolation but alongside conventional medicines for the best possible protection against contracting malaria. There is no proof that homeopathic treatments provide adequate protection against the disease.'”

In other words, by all means use homeopathy, but don’t rely on it because it doesn’t work and malaria is rather serious.  Although this attitude doesn’t strike me as particularly honourable, compared to Ruchira he is a paragon of medical ethics and reason.  At any rate, Ruchira says homeopathy works for malaria, Dr Peter Fisher says that, “there is absolutely no reason to think that homeopathy works to prevent malaria” and, “there is no proof that homeopathic treatments provide adequate protection against the disease”.

The bottom line

Generally, I like to give people the benefit of the doubt.  I don’t like to say that things should be banned.  After reading this execrable ‘paper’, it is clear that Ruchira is a danger to the health and well-being of thousands of Africans.  She should not be allowed to treat people with malaria.  Neither should any other homeopath.

Useful Information

Other bloggers have more insights than I do on the activities of Abha Light and Didi Ananda Ruchira.

The Quackometer,  The Gentle Art of Homeopathic Killing (August 16, 2007)

DC’s Improbable Science, More homeopathic killing (March 16, 2010)

Gimpy’s blog, Jeremy Sherr does not act alone, but with the support of the homeopathic establishment (January 15, 2009)

The Quackometer, Secret Email Reveals more Homeopathic Killing in Kenya (July 25, 2010)

Gimpy’s blog, Statement from the Society of Homeopaths on the departure of Paula Ross (July 23, 2010)

Some good sources of information on malaria.

World Health Organisation

BBC Health

NHS Choices

Disclaimer

I try to make sure that what I write is both accurate and fair.  If you think that I have got anything wrong please let me know.  If you are right I will happily change what I have written.

This is not medical advice.  If you need that see a properly qualified and registered doctor.

Notes

*Figures taken from 2009 Financial Statement

**See Homeopathy – Miasms and disease in wikipedia

***Based on the range of ‘standard’ drop volumes cited in the ‘Drop (unit)‘ article of wikipedia

References

Guidelines for the treatment of malaria. World Health Organization, 20, avenue Appia, 1211 Geneva 27, Switzerland: WHO Press; 2010. Available from: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html.

Edits

None yet!

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