Monthly Archives: June 2012

research10

In Vitro Antibacterial Activity of Homoeopathy Medicines

research10Dr Puneet Mishra

Introduction:
Since beginning of homoeopathy the high dilution form of the homeopathy drugs is discussion theme of their activity. Many theories are present to show the activity of homoeopathy drugs.

1. Vital force theory

2. Storing energy Dr Benvenistye- Theory of the memory of water

In present era the homoeopathy medical stream proves their utility in all type of illness. The harmful stimuli, be it bacteria, virus or toxins cause a reaction in the vital force ( interior atmosphere of  body ) that depends on the health of the human as well as strength of harmful stimuli. The present study shows the “In vitro antibacterial activity of homoeopathy drug/remedy “ the present study shows the activity of drug against a particular class of bacteria in form of Q, 30 C, 200 C dilution.

Selection of Medicine:
In the selection of medicine firstly takes the main symptoms of bacterial illness which are mentioned in the leading book of practice of medicine, secondly the symptoms are repertories by repertory and higher graded drug were used for the experimental trial. The selected drugs are used in the standard form on the particular class of bacteria separated from 25 different patients’ sample.

Methods and Materials 

  1. Source of bacteria: The bacteria are isolated from the sample of patients, which come for the drug susceptibility test of allopathic medicines (antibiotic).
  2. Culture of bacteria: The bacteria are cultured by streak culture / surface plate method on solid media.
  3. Identification of bacteria: Bacteria are identified by colony characteristics, staining and by the biochemical tests.
  4. Examining the action of homoeopathic drug on bacteria using appropriate media, method and material, which are recognized in modern medicine. The evaluation of the results by the reaction of drug on bacteria.

a. Measure instrument  – Hot air oven, Incubator, Autoclave, Laminar flow bench, Microscope, Electronic Balance, Micropipette., centrifuge, freeze, densitometer.

  1. Test Material: –

(i)  Glassware – Petri dishes, Culture tubes, Slides, Cover slips, Glass pipettes, Flask, Measuring cylinder,

(ii)  Reagents – Solid and liquid media, staining reagents, different medicines.

(iii)  Plastic wares – Tips of micropipettes, Applicators

(iv) Others – Inoculation loop and needles.

Drug / remedy : – In this study , drugs of recognized pharmaceutical companies are used which are available in market. Frequently used different potencies of the drugs will be used to assess their in vitro action.

Observation:

Table No-1                

Summary of 25 Cases
Total Case Action Seen No Action Seen
25 16 09
100 % 64 % 36 %

Table-2

Details of Cases According to Potency

Potency Q 30 200
Action Seen 11 08 06
No Action Seen 14 17 19
Total Case 25 25 25

 Table No.3

Details of Action Seen According to Potency
Potency Q 30 200 Q 30 Q 200 30 200 Q 30 200 Total Case
Q 6 2 1 2 11
30 2 2 2 2 8
200 1 1 2 2 6

Discussion: There are two forms of activity in present study

1. Action seen (table no 1 (16) & table no 2 (11, 08, 06) Shows the activity against the bacteria means the harmful stimuli in the body is having less strength to the medicinal power.

2.  No action seen (table no 1, (09) & table 2 (14, 17, 19) shows no response against bacteria means the harmful stimuli is more powerful than medicinal strength.

In the mentioned process if any drug in standard condition shows the activity against the bacteria the drug is totally antibacterial in nature and if any drug in standard condition shows no any activity against the bacteria means it has no nature of antibacterial and if any drug shows the variable activity against the bacteria proves the variable power of bacteria inside the body. The above-mentioned details shows the activity of drug on the bacteria then this bacteria infect any part of the body is cured / controlled by this drug and corresponding dilution. This proves that homoeopathy theory single medicine treats whole body.

This study is an attempt to find out the variation in susceptibility of patient towards various drugs / remedy through the action of these drugs/ remedies against bacteria under in vitro conditions. This study provides supportive evidence to various observations made by Kent (twelve observation of Kent’s). This study provides tools for drugs standardization and the results support the uses of these medicine for the treatments of infections.

References:

  1. Allen H.C. – Keynotes and characteristics with compression of some of the leading   remedy of materia medica.
  2. Boericke – Pocket manual of Homoeopathic meteria medica with repertory.
  3. Kent – Lecture on materia medica with new remedy.
  4. Clark J.H. – Dictionary of Practical Materia medica (3 volumes).
  5. Clark J.H. – Clinical Repertory.
  6. Kent – Repertory (Expended).
  7. E.B.Nash – Leaders in Homoeopathic therapeutics grouping and classification.
  8. E.A. Farrington – Clinical materia medica.
  9. Organon of Medicin.
  10. D.D. Banerjee – Homoeopathic pharmacy.
  11. Todd.Sanford. Davidsohn – Clinical diagnosis and management by laboratory method (17th Edition)
  12. Emma Sheppard Oakham school, rutland, UK Homoeopathy A multifaceted scientific  renaissance Homoeo times  Vol-2 issue 11November 2005
  13. Davidson ‘s principles and practice of medicine Eighteenth edition
  14. Harrison’s Principles of internal medicine
  15. Robbinss and cotran Pathology basis of disease 17 th edition
  16. Ananthanarayan and Paniker’s Textbook of Microbiology 17 th edition

Dr. Puneet Mishra B Sc. B.H.M.S.
Technologist Paliwal Diagnostics P. Ltd.
Instructor Paliwal Institute of Medical Sciences
Lecturer J.S. Institute of Paramedical Sciences
Kanpur U.P,India 208020,
Email: drpuneetmishra18@yahoo.com

classroom (2)

Assessment of Classroom Competencies PG trainees

classroom (2)Towards a Formative Assessment of Classroom Competencies (FACCs) for   postgraduate medical trainees.

Background
An assumption of clinical competency is no longer acceptable or feasible in routine clinical practice. We sought to determine the feasibility, practicability and efficacy of undertaking a formal assessment of clinical competency for all postgraduate medical trainees in a large NHS foundation trust.

Methods
FY1 doctors were asked to complete a questionnaire to determine prior experience and self reported confidence in performing the GMC core competencies. From this a consensus panel of key partners considered and developed an 8 station Objective Structured Clinical Examination (OSCE) circuit to assess clinical competencies in all training grade medical staff… The OSCE was then administered to all training grade doctors as part of their NHS trust induction process.

Results
106 (87.6% of all trainees) participated in the assessment during the first 14 days of appointment. Candidates achieved high median raw percentage scores for the majority of stations however analysis of pre defined critical errors and omissions identified important areas for concern. Performance of newly qualified FY1 doctor was significantly better than other grades for the arterial blood gas estimation and nasogastric tube insertion stations.

Discussion
Delivering a formal classroom assessment of clinical competencies to all trainees as part of the induction process was both feasible and useful. The assessment identified areas of concern for future training and also served to reassure as to the proficiency of trainees in undertaking the majority of core competencies.

Download full paper : www.homeobook.com/pdf/physiology-pg.pdf

Kent

A Comparative Study on Kent’s repertory & Murphy’s Repertory

KentDr. Rita Chakraborty 

Editions   -1st – 1993, In India 1994.
2nd – 1996, 3rd – 2005 (Homoeopathic Clinical Repertory)

Success in repertorising depends on the ability to deal with symptoms which are collected through proper case taking for both acute and chronic cases and the repertories are the indices of symptoms of homoeopathic materia medica with their corresponding similar medicines arranged systematically. So for the selection of a similimum in both acute and chronic diseases the use of repertory is equally helpful. The repertory’s aim whatever be the structure and construction of it, is to simplify the process of selecting a similimum. It even suggest the competing remedies so that the choice and the judgement remains with the physician. The optimum use of repertory enhances the knowledge of materia meidica as it brings out the minute details of the drugs, their spheres of action and even their relationships.

A small attempt is to understand Murphy’s Repertory’s importance and effectiveness in practice in comparison with Kent’s repertory

Homoeopathy is a science of experiment and art of practice on the human beings. The methodology deals with the multiple type of symptoms ranging from those of mind to the organs, which can be significant as well as vague from the point of totality of the patient. With the evolution of dynamic theory in homoeopathy the qualitative study of drugs and patients got accelerated. The provers recorded a more of mental and physical symptoms. Knowledge of such symptoms was useful for the treatment of acute, chronic diseases as well as for constitutional therapy but it became confusing for the practitioners to find out the similimum out of many similars. Therefore a need was felt for a manual of symptoms, and the repertory was born.

Boger says, “It is a book of index of medicines under symptoms. It is well related with materia medica, therapeutics and organon.”

Bidwell defines, “ It is like a dictionary, a book of nature relating to the meaning of myriads of pathological phenomenon. It is a ground key for successful exploration of homoeopathic remedies.”

Dr. Knerr explains, “In repertory we have separation by analysis for the purpose of classification and ready reference, in materia medica combination by synthesis to enable us to study drug effects in their ground and relationship.”

Homeopathic Medical Repertory was to be a modern, practical and easy to use reference guide to the vast homeopathic materia medica. To achieve the goal a complete new repertory had to be created. The alphabetical format was chosen as the most natural method to organise large amounts of information, thus bringing the repertory in line with all the large homeopathic materia medica which are also alphabetically arranged. All of Kent’s & Knerr’s sections were used as the foundation for building the new repertory.

Homeopathic medical repertory By Robin Murphy, Preface. Ist Indian edition 1993)

Dr. D.P. Rastogi opines,
It is a reorganised and expanded version of Kent repertory with Knerr’s format. This book is compact, practical and easy like Kent’s repertory. Dr. Murphy has updated the language of the repertory in many places for which many new generations of homeopathic students will thank him many times. There is a bold organisation and expansion of repertorial (analysis) information with many practical rubrics such as the ones having to do with children, pregnancy. The environment, dreams and delusions including use of modern diagnostic terminology as Alzheimer’s syndrome, polycystic ovaries etc. He has created sections which make it easier to locate an experience such as symptoms related to music. Besides the separate sections which have music as a modality. There are plenty cross references and a very useful word index in the back of the book to locate difficult symptoms.

Similibus Homeopathic Digest 1998, Philosophical Background & Application of lesser known and latest repertories by D.P. Rastogi. Pg no.12 

A CRITICAL STUDY ON COMPARISON BETWEEN MURPHY’S AND KENT’S REPERTORY
When one thinks of the bewilderment and despair of uninitiated, engaged in a first tussel with Kent’s stupendous Repertory, one is haunted by the old time story of the man of great authority from Ethiopia, sitting in his chariot, reading as he journeyed, to whom a stranger joined himself with the pertinent question. “Understandest thou what thou readest?” and the prompt reply, “How can I, except some man should guide me?” There are mazes yet that badly need the “Silken clue” … Kent’s Repertory is such a maze.

Kent’s repertory is based on the philosophy of deductive logic: i.e from general to particular. The generals are dealt with in depth followed by particulars and minute particulars. A master of materia medica, Dr. Kent noticed that particulars do not fall in line with generals in all cases and hence he emphasized the importance of generals. In order to understand a person his expression at the level of generals must be noticed and relied upon. The symptoms noticeble at the level of parts come next in the order of importance. He said, “Man is prior to the organs. Man is the will and the house which he lives in, is his body.” What is expressed on the parts is always preceded by a deviation in the state of health of a person. Such deviation can be known through expressions at the level of generals.

This repertory is built to work the cases from general symptoms to particular symptoms. If a case is worked out merely from particulars it is more than probable that the remedy will not be seen and frequent failure will result. This is due to the fact that the particular direction in which the remedies in general rubric tend have not been observed and thus to depend upon a small group of remedies relating to some particular symptom, although not yet observed. But by working other way, from general to particular, the general rubric will include all the remedies that are related to the symptom.

As we know that the patient makes himself known to the physician by signs and symptoms and that the totality of symptoms is the sole representation of the patient, the patient presents a large number and varied type of symptoms but are they equally important? So it depends on physician’s’knowledge of case taking. “A case well taken is half cured” , one of the master said. For a good homoeopathic prescription a great deal of information is essential. The homoeopath must know his patient, spiritually, emotionally, mentally, physically and sociologically. He must give as much time as he needs to acquire this knowledge. Then it is the time to analyse the case. In order to do so we must go about it logically, we must have a starting point and a place to end. The start is made with the generals and the particulars end it. That is evaluation of symptoms. Kent has evaluated into 3 classes – general, particular and common and in his repertory he divides each into 3 grades – first, second and third. The generals and particulars have the greatest importance in our prescription.

Dr. Kent made use of the earlier materia medica but those which had been clinically observed and rejected numerous symptom of drugs which were sufficiently confirmed. Thus his repertory contains only 591 drugs though other drugs were known at that time.

Though Kent’s repertory has continued revisions upto 6th Edition with numerous additions but still it lacks many rubrics, medicines and especially its language which is very important to comprehend for using. Its logic as well as its language have already been and even today obstacle to correct use of this repertory. Many authors have attempted to do something about it viz. Dr. P. Schmidt, Dr. Barthel & Klunker, Frederick Schroyens, R.V.Zandwoort and Robin Murphy, etc. They did not only intend to complete the repertory, but they also had in mind the translation of the work.

The repertory is, only if one has efficient knowledge of its structural arrangement and understanding of the authors’ directions for its use, an unique tool. The homoeopathic Materia Medica contains about 3000 drugs with ever enlarging, ever advancing and new contributions which call for revising & updating. Homoeopathic Repertory meets the demand. This is modern alphabetical repertory written by Robin Murphy, N.D, published in 1993, U.S.A & India in May 1994. It is his 4 years’ work for compiling, editing, sorting & updating the work of Kent. It is reorganised and expanded version of Kent and Knerr’s format. There is no distinctive philosophy behind this Medical repertory but as it is based on Kent & Knerr’s format and Kent’s repertory has the philosophy of its own, Knerr’s one does not have any but it is a very good reference book. So it serves both the purposes.

The Homoeopathic Medical Repertory bears total 67 Chapters in which 30 new chapters are erected with 39000 new rubrics and 200000 new additions with updates. All of Kent’s Repertory and some sections of Knerr’s Repertory were used as the building block for constructing this new Repertory. In each of 67 chapters all the rubrics and sub rubrics are sorted into an alphabetical format. Thus Kent’s complicated system (side, time, modalities and extension) is tried to simplify here. Chapters start with Abdomen and end with wrists.

 SUMMARY AND CONCLUSION
This study has two mottos. The first one is to study the plan & construction of Homoeopathic Medical Repertory & Kent’s Repertory of Homoeopathic Materia Medica through comparison. Though the Medical Repertory is based on Kent’s philosophy but there is basic difference in plan & construction.

  1. Kent has followed the Hahnemannian schema with 37 chapters & Medical Repertory has 67 chapters arranged in alphabetical order which is the first change that makes the searching very easy. There are 30 new chapters. These new chapters are created mainly splitting Kent’s bigger chapters like extremities, chest, generalities, etc. Some very small chapters are concised into one like.
  2. Prostate is put into chapter Male
  3. Urethra under Bladder
  4. The chapter Extremities is very big and makes biggest problem because of its arrangements i.e. side, time, modalities & extension. For searching a rubric “aching in hand” it is to be searched – Pain, aching ® Bones ® Joints ® Upper limbs ® Shoulder ® Upper arm ® Elbow ®   Forearm ® Wrist ® Hand
  5. It is laborious and confusing. Medical Repertory has split this Extremities chapter into 12-13 small chapters viz. Ankle, Arm, Bones, Hand, Joints, etc. So it has become very easy to refer.
  6. There are many new chapters like Emergency, Toxicity which contain very useful indication for bed side prescription.
  7. The weak sides of Kent are very well improved in Murphy’s Repertory like Children, Pregnancy, Environmental factors, etc
  8. It is to be noted that certain anatomical regions have no corresponding section in Kent e.g. neck which is under throat external & back. It creates a problem for proper searching. But this problem is solved in Medical repertory making a chapter Neck.
  9. Further more lungs, heart, aorta, axillary glands. breast, breast milk appear under chapter chest in Kent. It is very difficult to locate these in Kent but this is made easier in Medical Repertory by creating small chapters with above names.
  10. Even there is no section for circulatory system, glands & nervous system though Kent’s Repertory is not based on system but parts of these systems are found scattered throughout the book under allied anatomical headings So these are other lacunae in Kent. Medical Repertory has brought this solution making the chapters like nerves, circulation, glands, etc. which contain full of pathological generals. The pathological generals tell the state of the whole body & its changes in relation to the constitution. They help us to concentrate on more concrete changes to select the similimum. They are like – Atrophy, Induration, Haemorrhagic tendency, Chlorosis, Convulsion, Muscles in general affection, Nerves in general, Obesity, Uraemia, etc.
  11. Clinical Rubrics – Medical Repertory has got highest number of clinical information which shows the drug affinity,  generic & Specific similarity (pathogenecity).

Pathology speaks the language of the individual. It is dainted by the colour of the constitution. It shows the reactive pattern so far the guiding indication. Where gross pathological changes are taken place, signs & Symptoms are not available – these clinical rubrics are very helpful as they are organ remedies so to find the similimum among so called specific & where palliation is mandatory for fast prescription in bedside practice. There are about 5 – 6 new additions in pain sensation which are used in patient’s language, e.g. sharp pain, violent pain, wandering pain, etc. Nosodes are well introduced.

Another important contribution is constitution & temperament which contain about 26 types – can be used as eliminating rubrics & narrows the area of selection.

Language of Repertory is different from the language of Materia Medica, different from the language of the patient because repertory uses more limited vocabulary. People may use different words & descriptions to express the same thing. The core of the expressed symptoms or idea will be found in one way in the repertory. It is laborious task to change each expression into repertorial language. We will have to think of all possible synonyms. In this context Medical repertory has tried to solve the problem using patient’s language along with all synonyms & cross reference with medicines in one place. e.g.

  1. Crying (weeping), Bleeding (Haemorrhage), Humiliation (Abusive, mortification)
  2. Homesickness (Nostalgia), Bedwetting (Enuresis), Childbirth (parturition), Belching (Eructation), Food undigested (lienteric)
  3. This makes the reference work easy and faster.
  4. In Kent’s Repertory we find many sub-rubrics are scattered here & there and those are very difficult to locate. In Medical Repertory all related rubrics & sub-rubrics are put under one heading, viz.

CONCLUSION
This study is comparative and an analytical one where the Murphy’s Repertory is taken for comparison with Kent’s Repertory, both of which are based on Herring’s Guiding symptoms
. But many of the symptoms of Herring’s guiding symptoms are to be found as rubrics in Kent’s. In order to bridge this gap Murphy’s Repertory is made more comprehensive where almost no symptom of Herring is left out and rather enriched from other 55 authentic sources.

As many rubrics are updated, simplified and patients language is used so it makes the repertorisation easier, authentic and reduces the confusion.

Many new chapters are included viz. Emergency, Toxicity which bear rubrics very useful in bed side practice.

There are some chapters which are created splitting bigger chapters of Kent which are really helpful for locating the exact rubrics e.g.- regarding food-in Kent it is to be searched in two places stomach and generalities but in Murphy’s Repertory it is in chapter food only.

Greatest improvement is alphabetical listing of chapter and rubrics (avoiding side, time, modalities and extension of Kent). Another important chapter constitution which contains 26 types helps as eliminating rubric.

The new inventions which strengthen weaker side of Kent’s repertory are children, pregnancy, constitution. These are very useful.

Murphy’s Repertory is enriched in clinical rubrics and pathological generals also. So Boger’s & Boericke’s method can be applied. As a whole any type of case can be repertorised by Murphy’s Repertory.

Dr. Rita Chakraborty
Professor, Dept. Of Repertory
Fr Muller Homoeopathic Medical College,Mangalore
Email : ritapranab@yahoo.com

Download full paper : www.homeobook.com/pdf/study-kent-murphy-repertory.pdf

mosquito

Efficacy of Homoeopathic Prophylaxis in Chikungunya

mosquitoDr. Kurian PJ
Lecturer, Dept of Repertory, Fr. Muller Homoeopathic Medical College, Deralakatte,
Mangalore, Karnataka, India, Pincode: 574160,  Email: drpjkurian@yahoo.com

Dr Ramakrishna Rao,
Tutor, Dept of Pathology, Fr. Muller Homoeopathic Medical College, Deralakatte,
Mangalore, Karnataka, India, Pincode: 574160, Email: ramakrishnaraop@gmail.com

Key words:- , Chikungunya,  Homoeopathic Prophylaxis

Abstract:– ‘Chikungunya’ a viral disease spread by Aedes mosquito is characterized by the presence of fever with chills, arthritis and rash. The arthritis is severe and it usually acquires the sub acute form. It may persist for 3-4 months in some cases. Old aged individuals usually succumb to this disease.

Homoeopathic medicine mainly Rhus tox 200 was administered as genus epidemicus. The remedies like Eupatorium perfoliatum, Ledum pal, Belladona and Bryonia alba were also used in some cases. Medicines were distrubuted for around 42,000 individuals. A random sample of 100 was taken and Chi-square test was conducted to evaluate the effectiveness of the prophylaxis which proved beyond doubt that it provided an effective prophylaxis against chikungunya.

Introduction:- ‘Chikungunya’ a viral disease caused by Arbovirus genus is transmitted by Aedes mosquito. This disease is characterized by chills with fever, arthritis and rash. The arthritis is one of the major symptoms of the disease which usually cripple the patient from few days to few months. Old aged individuals usually succumb to this disease due to its complications which are pneumonia and encephalitis. The chikungunya outbreak was notified in Puttur taluk of Dakshina Kanara district of Karnataka during April 2008.

Genus epidemic medicine which was Rhus-tox was distributed to around 38,232 individuals. Medicines like Eupatorium perfoliatum(849 individuals), Belladona(729individuals), Bryonia alba(1564individuals) and Ledum palustre(626 individuals) were also distributed to those who did not require Rhus-tox. This endevour was implemented by the joint effort of Preventive & Social Medicine department of   Fr. Muller Homoeopathic Medical College and Dept of Health, Govt of Karnataka.

Objective:- To find out the efficacy of Homoeopathic prophylaxis.

Null Hypothesis: Homoeopathic drugs are not effective prophylaxis for Chickungunya.

Alternative Hypothesis: Homoeopathic drugs are effective prophylaxis for Chikungunya.

Conclusion : Homoeopathic remedies are effective prophylactic for Chikungunya.

Download full paper : www.similima.com/pdf/homeopathy-chikungunya-mangalore.pdf

steth2

Ethics in Medical Research

steth2Dr.Cyriac Thomas
HOD, Dept. of Forensic Medicine & Toxicology
Govt. Homeopathic Medical College.Calicut

Introduction
The word ethics is derived from Ethos.
Ethos means the distinctive attitude which characterize the the cultural outlook of a professional group.
Every profession has an ethical code

It includes

  1. definite tradition
  2. sharing of customs and common experience
  3. commitment to a particular system of values

 Ethos of the physician has always noted for its DEDICATION to the service of ailing humanity

In the past, it was always characterized by close personal relationship with patient and his family

Medical Ethics
Medical ethics is a systemic effort to elaborate the perspectives and ethical norms governing the medical profession.

History
We have evidence from as far back as about 4000 BCE of physicians practicing medicine.

For example, in prehistoric Egypt medical practices included using malachite as an eye salve. There is evidence of dentistry, too: a mandible (jaw bone) was found in a Fourth Dynasty (2900-2750) tomb that had an alveolar process pierced to drain an abscess under the first molar.

Written codes of ethics for doctors may have existed in those times; however, the earliest evidence we have is the Ebers Papyrus from 3,550 years ago.

There are Egyptian medical papyri (such as Ebers and Smith) that describe the accepted medical practices and codes of ethics dating from about 2000 to 1090 BC . Imhotep is the earliest recorded name of a physician. When Imhotep died, he was deified as the Egyptian “God of Medicine”, and later as a universal God of Medicine. He was so important to the early Egyptians that in honor they built the Temple of Imhotep, the “first hospital”, and engraved his picture on the walls.

From even the earliest records through the present, physicians are exhorted to try to end human suffering.

They should do this in a disinterested manner, without concern for remuneration, status or personal reputation. Physicians should use all means available to them,

and be open to learning more methods from other physicians. Moreover, they should appreciate all life and treat all patients equally.

Such exhortations are found not only in ancient Egyptian records, but also in other early records. For example, we know of the 5th Century BC Greek Oath of Hippocrates and his On Epidemics (the source of the injunction, Primum non nocere!, or “First, do no harm!”),

  • the First Century Indian Oath of Initiation,
  • the 12th Century Jewish Daily Prayer of the Physician (Moses Maimonides),
  • the 16th Century Japanese 17 Rules of Enjuin.

Perhaps the earliest documented evidence of concerns about experimental medicine may be in Thomas Percival’s code, which appeared in England in 1803.

According to this code, the physician may try experimental treatments when all else fails, and when it can serve the public good.

In 1833 in America, William Beaumont’s code acknowledged the importance of experimental treatments, but added requirements stipulating that the subject must give voluntary, informed consent and the subject should be able to end the experiment at will. (Note: it is not clear that Beaumont, himself, heeded these requirements.)

Claude Bernard is often regarded as the founder of experimental medicine

In his Introduction to the Study of Experimental Medicine (1865), Bernard wrote that one should never perform an experiment “which might be harmful to [the subject]”; that experiments “that can only harm are forbidden”, that “innocent [experiments] are permissible”, “and those that may do good are obligatory.”

In 1898 in the United States of America, Walter Reed introduced a contract to augment and confirm oral informed consent. More significantly, Reed used healthy volunteer subjects in his medical experiments involving the transmission of Yellow Fever.

Increasing medical experimentation highlighted the increasing need for concern for subject consent and safety. In the 1900 Berlin Code, or Prussian Code, capacity to give consent was the central focus. In this code, if a subject is not competent to consent, or doesn’t completely understand the information being explained, or does not give unambiguous consent, the experiment may not be performed.

The 1931 Reich Circular reminded physicians that in medical experiments, physicians must be concerned primarily with the consent and well-being of the subjects.

The 1947 Nuremberg Code demonstrated increased concern, stating in its first sentence that, “the voluntary consent of the human subject is absolutely essential.”

In 1948, in the Physician’s Oath of the Declaration of Geneva, the primary concern returns to that which was expressed in even the most ancient documents: one must put health of the patient first, be unbiased in attitude toward the patient, and have the “utmost respect for human life.”

In 1954, the World Medical Association produced a set of Principles for Those in Research and Experimentation. Respect — for the rules of scientific research (constructed by convention) and the subjects — is presented as central.

In 1964 the world medical assembly meet at Helsinki and set a code of conduct ,known as Helsinki Declaration.

It was modified by the world medical assembly at Tokyo in 1975

The council for international organization of medical science 1982 along with World Health Organization has given international guidelines for Bio medical research.

In the 2000 Declaration of Helsinki, the primacy of patient health and well-being is reasserted. Also made explicit is the vulnerability and resulting need for special protection for research populations, especially for persons who cannot give or refuse consent.

In 1980 Indian council of medical research given guidelines for conduct of human experiment and research and was modified in 2000.

Even after Helsinki Declaration, Unethical human experimentation continued.Eg.is Tuskegee Study of untreated Syphilis, sponsored by U.S Public Health Service from 1932 to 1974.

Medical Experimentation In Man
 From the earliest time to our own day Medicine has been able to progress only by tentative steps and by successive experiment on living bodies, including human body

AIMS

  1. Experimentation for the good of the patient
  2. Experiment for the good of others ( long term benefit of Humanity )
  3. Benefit of a group of people suffering from that disease.
  4. Contribution to human knowledge.

1. EXPERIMENT FOR THE GOOD OF THE PATIENT
This includes any experiment on

(a) Diagnostic procedures

(b) Surgical procedures

(c) Clinical trials of medicine or any therapeutic agent or methods

Clinical Trial of Medicine :   As regards to therapy of new remedy, following principles are regulated

  • The remedy must be sufficiently
  • Tested in the laboratory and on animal
  • It may not be used if a certainly effective remedy is available
  • May not be used this new remedy is too long ,difficult or expensive
  • It is the only available treatment which most likely to help patient
  • Consent from patient or legal guardian

EXPERIMENT FOR THE GOOD OF OTHERS

  • Consent from patient or legal guardian
  • Research confirms moral and scientific principles based on lab. And animal experimentation or other scientifically established facts
  • Precaution against injury
  • Careful assessment of risk
  • Avoid disability

Important Requisites for medical Research

1. ESSENTIALITY
The proposed project must be necessary for the benefit of the people and advancement of knowledge. The principles of essentiality respect the ethical principle of beneficence.

2. INFORMED CONSENT
The rsearch subject or guardian or legal proxy should be fully apprised of the proposed research ,including the risk, benefit and the alternate procedure available.

  • The free informed consent should be obtained before the commencement of the research.
  • The research subject has the right to abstain from the research at any time.
  • Research involves any community or groups of people, the principles of informed consent applies to the community as a whole
  • The principle of Autonomy is observed by informed consent. It protects the individual’s freedom of choice. 

3.CONFIDENTIALITY
The identity and particulars of the research data should kept confidential. This may disclosed only for valid reasons.

  • Legal ( court orders)
  • Scientific ( therapy)
  • With written consent of the subject

4.  COMPENSATION
The research protocol shall include mechanisms for compensation through Insurance or other means to cover all risk and provide for remedial action and after care.

  • Provide compensation for mental and physical injury.
  • Rehabilitative measures should be taken
  • Paid for-inconvenence, time away from work-imbursement of expenses and free medical service.
  • In case of death material compensation to the dependents. 

5. COMPETENCE
The research should be conducted only by competent and qualified persons aware of ethical research

6. ACCOUNTABILITY, RESPONSIBILITY AND TRANSPARENCY
All person involved in the research (directly or indirectly) are responsible and accountable for observing all ethical principles and guidelines

  • Such persons are
  • The researcher
  • The sponsors and founders
  • Institutions
  • Those who use the result of research 
  • The research should be conducted in a fair, honest, impartial and transparent manner
  • All records should be retained for reasonable period for post research monitoring and evaluation.

7. RISK MINIMISATION
The subject should have minimum risk and should not suffer from irreversible adverse effect

8. SCENTIFIC COMMITTEE
The proposal must be submitted to to a scientific committee, who may or may not approve the proposal with or without modification

The scientific committee may review the protocol periodically.

9.ETHICS COMMITTEE
Ethical committee looks all the ethical aspect of the proposed research that may or may not approve the proposal with or without modification.  Committee may review research periodically

Responsibility of Ethical Committee

  • Protect right, safety and wellbeing of subject
  • Obtain following documents
  • Trial protocol, written informed consent, subject recruitment procedure, safety information, compensation available, biodata of investigators.
  • Ensure ethical principle in relation to local values and customs
  • Provide consultation to professional staff, patients, families on    ethical issues and problems
  • Provide education and advice to staff, patient/families
  • Formulate policies on ethical aspect of clinical care at organizational level
  • Coduct of seminars and wokshops periodically regarding ethical concern. 

Composition of Etical Committee

  • Clinicians
  • Basic scientist
  • Social worker
  • Nurse
  • Rehabilitation person
  • Priest/philosopher/ethicist
  • Lawyer or retired judge
  • A respected member of public 

10.INSTITUTIONAL ARRANGEMENT
The institutions make all arrangements for proper conduct of research and store and use of data and for ensuring confidentiality.

11.PUBLICATION OF RESULTS
The results of research (positive or negative) should available to public through scientific and other publications. The information should be accurate.

2.SPECIAL GROUP AS RESEARCH SUBJECTS
Pregnant and nursing should not be the subject of any clinical trial except such trials are designed to protect or promote their health  and for which non-pregnant or non nursing women’s are not suitable.

Children will be involved if the purpose of the research is to obtained specific information to the health needs of children

Venerable groups with reduced autonomy such as students, employees, service personas and prisoners may involve in research only if there is adequate justification.1

Right and welfare of the mentally ill or mentally retarded should be protected at all times.

Statistical Software in Medical Research

Dr R Rejikumar  

Common Statistical Software
Epi Info
SPSS

EPI Info – Version 3.5
Series of micro computer programs for handling epidemiological data (word processor/d Base in questionnaire format.
Processing and Analysis of data (features of SAS, SPSS)
Jointly developed by CDC/WHO (Turbo Pascal)
There are three levels of facilities for processing the structured data.

The first level (simplest one).

  • Running the main menu.
  • Typing or creating the questionnaire with EPED.
  • Entering the data through ENTER program.
  • Analyzing the data using Analysis program to produce lists, frequencies, cross tables etc.

Second Level of EPI Info 

  • Additional features to shape the data entry like building internal checks ,automatic coding, skip patterns, (CHECK program).
  • Selecting Records, Creating new variables, recoding of the variables (Analysis Program)
  • Carry out conditional operations with IF statements.
  • Incorporate the operators into program files so that they can be used repeatedly
  • Import file from other system like SAS,ASCII (IMPORT Program).
  • Export file from EPI INFO system to other systems like SAS,SPSS,ASCII (text) (EXPORT Program)

Third Level of EPI Info 

  • Linking two files analysis mode
  • suppose there are two files to be linked File1and File2
  • (Open file1 by Typing Read File1 in the analysis mode)
  • Type Relate Id file2 ( Id is unique identification key having the common Identifier in both files)
  • Enter data in more than one files with ENTER Program.
  • Compare duplicate files entered by different operators to detect entry operators. (VALIDATE Program)

Requirements for loading EPI Info 

  • IBM Compatible Micro Computer with PC-DOS or MS-DOS OS (version 2.0 or higher)
  • 512 K bytes of RAM.
  • At least one floppy disc drive
  • A graphics adapter to produce graphs.
  • An IBM Compatible printer
  • ** For large data , a hard disc drive of 640 KB RAM

Steps for Installing EPI Info 

  • Download the latest version of software from the website. http://www.cdc.gov/epiinfo/
  • Alternatively you can click on the icon Epiinfo3 in the CD package given to you.
  • Select the Destination Drive and proceed with installation.

Running the EPI Info 

  • Click on the shortcut icon
  • Click on Enter Data
  • Select the data file.
  • Start entering data
  • CHECK
  • STATCALC
  • CONVERT
  • IMPORT
  • MERGE
  • VALIDATE

Creating  questionnaires from EPED Editor

Run EPED from EPI Menu
Press <F2> for the file menu and create a new file (max of 8 character) with the extension “.qes” Press <F9>

If the file already exists, it will be displayed on the screen for editing.

When a questionnaire is being developed, it is necessary to tell the program variable names and type  of data fields to accept the values.

Field Types in EPI Info (EPED)

Text or general purpose  __ (* Any printable character can be entered Maximum length 80 Characters) 

  • Upper Case Text                               <A>
  • (entries will be converted to upper case)
  • Numeric                                                             #
  • (only numbers or spaces will be accepted)##.#
  • (max length 14 numbers)
  • Yes/No field                                         <Y>
  • Only Y,N and space or <enter>
  • Field Types contd..
  • Entering data through the ENTER Program
  • Run enter from the main menu
  • In response to the request for “data file”,type the name of the questionnaire “.qes”
  • Type the name of your data file (.rec)
  • Fill in the fields in the questionnaire
  • Repeat the same for all fields till the form is completed.
  • The message “write data to disk ? Y/N will appear at the bottom of the screen
  • Answer “Y” or “y”
  • Repeat the same process for several records. Press <f10>

Check : For filtration of data while data entry

Run the CHECK program from the EPI menu.

Enter the name of the record file. Type “Y”

Types of the checks :
(i) Range Checks (Min/Max): For lower range enter a value in the field and press  <f1>. Similarly for upper range enter the values and press <f2> and for adding  exceptional value press <f6>. Values other than  the specified values will not be entered .

(ii) Conditional Jumps <f7> : To set up cond. Jumps enter a value in the field and   and press <f7> . You will be asked the destination field for jump. Put the cursor  in that field and again press <f7>.

(iii) Listing of Fields and Automatic Coding <f5> and <f8>

Links two fields called DISEASE and DISEASECODE. Place the cursor in the first field  and press <f5> and then move the cursor to the field to be linked and press <f5>.Once the fields are  linked, then enter a value in the DISEASE like “Hep A” and press <f8>. The cursor will jump to field DISEASECODE ,the linked field. Suppose, say 10 and press <f8>. The Cursor will again jump back to DISEASE. Repeat this process till codes are exhausted .

Analysis

  • Run ANALYSIS program from the main menu.
  • Read data file name (.rec).
  • List * (to produce list of records in the file).
  • Freq Var (will count freq for specified variable).
  • Tables V1 V2 will result in count of two fields at the same time.
  • Charts and Graphs –  Histogram, PIE, BAR, Scatter produce the specified graphs.
  • Route command  will direct the results to file by name of your choice. (result.txt)
  • <f5> command route printer or route screen
  • Analysis Cont.
  • Means var1 var2/n    will produce means    of variable var1 by var2 and produce no frequency
  • Recode         we can decode the         variable
    • (1=“ Male, 2=     “female”)
  • Sort  <var1> <var2>   Allows us to sort the      records in the specified sequence.

Analysis

Relative processing time for 2,000 records
Comparison of Epi INFO
The Data entry package is very easy as  compared to other packages as the record files (.rec) of the EPI appears similar to the subject information sheet .

  • There is a provision for data entry  to be done in two or more  files related to each other ( Reg. And Follow up) records.
  • The dBase files can be read directly .No need to import them.
  • Compares duplicates files entered by different operators to detect data  entry errors.
  • The package is made by WHO and CDC is not copyrighted and free of cost.
  • Making copies for others is permitted and encouraged

Wanted Homeopathy doctors for Mumbai

Senior Homeopathic Consultant
No. of Vacancy: 3
Salary: 12000
Place of work: Matunga and Bhandup (Mumbai)
Work Experience: 5 years

Assistant Doctors
No. of Vacancy: 5
Salary: 3000
Place of work: Matunga and Bhandup (Mumbai)
Work Experience: Nil.
Interns preferable.

Contact mumbai@homoeocare.co.in with your CV

Web : www.homoeocare.co.in

Quality Control in Homeopathic Research

Dr Asha.K  MD(Hom) Pharmacy
Email : ashabelya123@yahoo.co.in

INTRODUCTION  
A. standard
The acceptability of any material in always established by prescribing a standard. It is a numerical value which “Quantify” a parameter and thus denotes the “Quality” and purity of material, thereby enhancing its “Efficacy”.

Any Standard Product Definitely possess certain amount of stability or shelf life.

Stability of a pharmaceutical product is defined as the capability of a particular formulation is a specific container to remain within its

  • Physical
  • Chemical
  • Microbiological
  • Therapeutic
  • Toxicological— specifications for a prescribed period.

The concepts of standardization in the current day practice is emphasized mainly due to the Industrialization of Homoeopathic pharmaceutics so as to meet the global needs and standard for uniformity in procedures, quality, quantification.

Stability
It is defined as the extent to which a product retains, within specified limits and throughout its period of storage and use. (its shelf life) the same properties and characteristics that is possessed at the time of its manufacture.

The 5 types of stability are

Physical    –   The original physical properties including

  •  Appearance
  • Palatability
  • Uniformity
  • Dissolution
  • Suspend ability are maintained  

Chemical  –  Each chemical “Ingredient” retains its chemical  integrity and labeled potency within the specified limits -Uninfluenced by storage conditions

  • Temp
  • Light
  • Humidity 

Microbiological –  Resistance to microbial growth is retained according to specified requirements.

Therapeutic  –Therapeutic effect remains unchanged

Toxicological     –   No significant increase in Toxicity

Chemical stability is very important.

They may be influenced by Storage conditions

  • Temp
  • Light
  • Humidity

Selection of proper CONTAINERS for ‘dispensing’

(ex) glass vs plastic

clear vs amber, opaque cap  liners

Stability / Shelf life / Expiry dating is based on “Reaction Kinetics”.

The study of rate of chemical change is infuenced by conditions of Concentration of reactants

Products
Other chemical species that may be present

By factors such as

  • Solvent
  • Pressure
  • Temperature

The pioneers of R & D wings and Research Institutes are entrusted is STANDARDIZATION works

Aim
The ultimate aim of standardization is to produce  Homoeopathy  drugs that are

  • Highly efficacious
  • Quality
  • Safety  

QUALITY MONITORING APEX BODY
The Homeopathic Pharmacopoeia  Laboratory (HPL) (1975) under the ministry of Health and Family Welfare, Government of India. HPL, Ghaziabad

  • Set up Sept 1975
  • As a Plan Scheme under 5th Plan (1975-80)
  • Subordinate institute of department of ISM & Homeopathy, GOI
  • Recognized by Dept of Science & Technology, GOI as Scientific, Technological and Research Institution
  • Recognized as Central Drugs Laboratory – for testing of Homeopathic drugs (under Rule 3A, under section-6 of D &C Act)
  • Functioning as STANDARD setting –cum-drug testing laboratory at National level 

Legislation
Standards of Homeopathic drugs are covered under

Second schedule of Drugs & Cosmetics Act, 1940 [D&C Act]     (Homeopathic medicines are defined in RULE 2  (dd))

Under item 4A of the second schedule, under section 8 and 16 of D&C Act, 1940.

Standards included in HPI, which include information on Characterization / Identification / Testing of Standards and Preparation of Homoeopathic medicines.

Statutory requirements to be followed by all the manufacturers of drugs for maintenance of quality of Homoeopathic drugs.

HPI
Standards as worked out by laboratory are approved by Homeopathic pharmacopoeia committee  (sept 1982) are published in the form of  Homeopathic Pharmacopoeia India (HPI)

Volumes Year of Publication Monographs
1 1971 180 drugs
2 1974 100 drugs
3 1987 105 drugs
4 1984 107 drugs
5 1986 114 drugs
6 1990 104 drugs
7 1999 105 drugs
8 2000 101 drugs

Total number of monographs in HPI – 916

HPI indicates in the monograph of each drug

  • Details for identification
  • Details for collection
  • Parts to be used
  • Method of preparation
  • Assessment of purity
  • Limits of impurity

It is essential that these instructions be strictly followed to obtain mother tinctures of desired standards.

Quality control is total procedure for providing the standard medicines to the patients.

QC is not only a laboratory procedures, but also the procedures through which a raw material is transformed to a drug and the finished product till it is used by the patient.

One of important function is to establish specifications for raw materials, packing materials, intermediates and finished products to assure the quality.

For the sake of convenience, Quality Control in Homeopathic medicines is discussed, under 3 headings as

  • Quality control
  • Raw materials & vehicles
  • Processing methods     or  “In Process” quality control
  • Finished products

Care should be taken right from the sampling of raw materials®, identification of adulterants, ® comparison with standards and analysed, ®testing of purity, ® manufacturing, ®processing® different methods of preparation, ® utensils, ® machinery, ® manufacturing area, ® workers hygiene and safety, ®monitoring industrial waste, ® analysis of finished products, ® manufacturing area, ® workers hygiene and safety, ®monitoring industrial waste, ® analysis of finished products,  packaging, ® storing, ® manufacturing area, ® workers hygiene and safety, ®monitoring industrial waste, ® analysis of finished products,  ® manufacturing area, ® workers hygiene and safety, ®monitoring industrial waste, ® analysis of finished products, ® manufacturing area, ® workers hygiene and safety, ®monitoring industrial waste, ® analysis of finished products, , ® dispensing, , ® handling and packaging of medicines while dispensing, the shelf in the physicians clinic  ® the patients methods of usage of medicines provided the shelf in the physicians clinic ® ® ® in the patients wardrobe till the patients consume the medicine.

In all these circumstances the quantity of products may decrease at any point along this long way. So to avoid these problems STANDARD OPERATING PROCEDURES  (S.O.P) are to be written and maintained all along the way from the raw materials to Patients room.

For ensuring that no substandard drugs are released to the Market

C.G.M.P – Current Good Manufacturing Practice is adopted in the manufacturing, they are written procedures for manufacturing operations and document is manufacturing area. Also

C.G.L.P – Current Good Laboratory Practices are adopted in the analytical laboratory. These are written procedures for analysis and documentation is analytical laboratory. (What is not recorded is not done)  

Raw materials 

The quality of raw materials are ascertained and standardized referring HPI.

The important raw materials used for manufacturing are

  • Alcohol
  • Lactose
  • Sugar
  • White petroleum jelly
  • Maize starch
  • Coconut oil
  • Wax
  • Minerals
  • Herbs and animals etc 

In process quality control

  • Embraces ‘every step of the preparation’ from raw materials to finished product.
  • It is critical in ensuring the purity and safety of homeopathic medicines.
  • It is mandatory for the manufacturers to have GMP certificate and to follow their guidelines in order to produce quality drugs. 

GMP has two parts

Part – I –  Lays down GMP guidelines

Part –II –  Lays down the machinery, equipment, details about minimum manufacturing premises required for various system of medicines

Schedule M –I, Rule 85-E(2)   

This schedule M-I, rule 85 – E(2) States Good Manufacturing Practices (GMP) and requirements of premises, plants and equipment for manufacture of Homeopathic preparations.

GMP guidelines are designed for the drug manufacturing units to ensure quality, efficacy and safety of their products for the benefit of the consumers.

Standardization of finished goods
Includes (1) mother tinctures, (2) potentised dilutions, (3) Biochemic tablets, (4) triturations (powder), (5) ointments, (6) Oils, (7) Globules, (8) Eye drops, (9) Ear drops.

CONCLUSION
The quality control procedures on raw materials governs the quality control of finished products and its procedures. So only a quality products is sold to market.

For this reason QC of homeopathy medicine prime requisite in the modern developing world.

Government should come forward with an

EXPERT TEAM consisting of

  • Institutionally trained practitioner
  • Medical Research Experts from Various Medical Field
  • Analytical chemist
  • Biochemist
  • Microbiologist
  • Biotechnologists
  • Pharmacologists
  • Botanist
  • Experts for handling equipments
  • Expert for data management
  • Pharmacovigilence etc.      to evolve standardization works

In terms of modernization, industrialization aiming at mass production, great care and caution should be taken that these is no compromise on Hahnemanian Principles, as well as quality of our medicines.

This would be an IDEAL WAY to promote efficacy, quality and safety of the homoepathy medicines and products

Organisation and Presentation of Data in Medical Research

Dr K Saji.MD(Hom)

Any data collected by a research or reference also known as raw data are always in an unorganized form and need to be organized and presented in a meaningful and readily comprehensible form in order to facilitate further statistical analysis. We can present the collected data in following ways:

  1. Classification and Tabulation
  2. Diagrammatic Presentation
  3. Graphical Presentation

 Classification and Tabulation :
Classification is the process of arranging things in the groups according to their resemblances, similarity, or identity.

Types of Classification

  1. Chronological or Temporal classification.
  2. Geographical or Spatial Classification.
  3. Qualitative classification.
  4. Quantitative classification.

 Chronological or Temporal Classification
In chronological classification the collected data are arranged according to the order of time expressed in years, months, weeks etc. The data are generally classified in ascending order of time.

Eg: the estimates of birth rates in India during 1990-99 are:

Year 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Birth Rate 36.8 36.9 36.6 34.6 34.5 35.2 34.2 33.0 33.3 33.0

Geographical or Spatial Classification
In this type of classification the data are classified according to geographical region or place.

Eg : No of AIDS death per year in different countries

1. When names of the countries are in Alphabetical order:

Country America China Denmark France India

Deaths  225         112    30            50        90

2. When the observations are in descending order:

Country America China India France Denmark

Deaths  225         112    90      50       30

Qualitative Classification
In this type of classification, data are classified on the basis of some attributes or quality like sex, literacy, religion, employment, etc.

Types ;

1. Simple or dichotomous classification. : Done with respect to one attribute, which is dichotomous in nature

               Audience

Male                Female

2. Manifold classification. : Where two or more attributes are constructed and several classes are formed

Quantitative Classification :
In quantitative classification, the collected data are grouped with reference to the characteristics, which can be measured and numerically described such as height, weight, sales, imports, age, income, etc.

Types : Data array, Frequency table ( Relative frequency, Cumulative frequency etc. )

Tabulation
Tabulation is the process of summarizing classified or grouped data in the form of a table so that it is easily understood and an investigator is quickly able to locate the desired information. A Table is a systematic arrangement of classified data in columns and rows. Thus, a statistical table makes it possible for the

investigator to present a huge mass of data in a detailed and orderly form. It facilitates comparison and often reveals certain patterns in data, which are otherwise not obvious. Classification and Tabulation, as a matter of fact; are not two distinct, processes. Actually they go together. Before tabulation data are classified and then displayed under different columns and rows of a table.

Advantages of Tabulation
Statistical data arranged in a tabular form serve following objectives:

  1. It simplifies complex data and the data presented are easily understood,
  2. It facilitates comparison of related facts.
  3. It facilitates computation of various statistical measures like averages, dispersion, correlation etc.
  4. It presents facts in minimum possible space and unnecessary repetitions and explanations are avoided. Moreover, the needed information can be easily located.
  5. Tabulated data are good for references and they make it easier to present the information in the form of graphs and diagrams.

Preparing a Table
The making of a compact table is itself an art. This should contain all the information needed within the smallest possible space. What the purpose of tabulation is and how the tabulated information is to be used are the main points to be kept in mind while preparing for a statistical table. An ideal table should consist of the following main parts:

  1. Table number.
  2. Title of the table
  3. Captions or column headings.
  4. Stubs or row designations
  5. Body of the table.
  6. Footnotes.
  7. Sources of data.

 Table Number
A table should be numbered for easy reference and identification.This number, if possible, should be written in the center at the top of the table.

Title
A good table should have a clearly worded, brief but unambiguous title explaining the nature of data contained in the table. It should also state arrangement of data and the period covered. The title should be placed centrally on the top of a table just below the table number.

Captions or Column Headings
Captions in a table stand for brief and self-explanatory headings of vertical columns. Captions may involve headings and subheadings as well. The unit of data contained should also be given for each column. Usually, a relatively less important and shorter classification should be tabulated in the columns.

Stubs or Row Designations
Stubs stands for brief and self explanatory headings of horizontal rows. Normally, a relatively more important classification is given in rows. Also a variable with a large number of classes is usually represented in rows.

Body
The body of the table contains the numerical information of frequency of observations in the different cells. This arrangement of data is according to the description of captions and stubs.

Footnotes
Footnotes are given at the foot of the table for explanation of any fact or information included in the table, which needs some explanation. Thus, they are meant for explaining or providing further details about the data that have not been covered in title, captions and stubs.

Sources of Data
Lastly one should also mention the source of information from which data are taken. This may preferably include the name of the author, volume, page and the year of publication. This should also state whether the data contained in the table is of primary or secondary nature.

Requirements of a Good Table

  1. A table should be formed in keeping with the objects of a statistical enquiry.
  2. A table should be carefully prepared so that it is easily understandable.
  3. A table should be formed so as to fit the screen. But such an adjustment should not be at the cost of legibility.
  4. If the figures in the table are large, they should be suitably rounded or approximated. The method of approximation and units of measurements too should be specified.
  5. Rows and columns in a table should be numbered and certain figures to be stressed may be put in ‘box’ or ‘circle’ or in bold letters.
  6. The arrangement of rows and columns should be in a logical and systematic order. This arrangement may be an alphabetical; chronological or according to size.
  7. The rows and columns are separated by single, double or thick lines to represent various classes and sub-classes used. The corresponding proportions or percentages should be given in adjoining rows and columns to enable comparison. A vertical expansion of the table is generally more convenient than the horizontal one.
  8. The averages or totals of different rows should be given at the right of the table and that of columns at the bottom of the table. Totals for every sub-class too should be mentioned.
  9. In case it is not possible to accommodate all the information in a single table, it is better to have two or more related tables.

 General Rules for Graphs, diagrams, pictures, etc. in a presentation

  • Make these as large as possible
  • Make any text be as large as possible.
  • Use appropriate significant figures on EXCEL plots or other types of plots that have numbers.
  • Don’t exceed four plots per page

Dr.K.Saji.MD(Hom)
Email : drsajik.md@gmail.com

Download full article : www.similima.com/pdf/presentation-data-research.pdf

Literature Review in Medical Research

Dr Arun Prasad K.P

A literature review is the effective evaluation of current knowledge on a research topic.   The “Literature” implies the works you consulted in order to understand and investigate your research problem.

Purpose
An effective review of medical literature should answer or clarify the following:

  • What we already know – in terms of theory & clinical practice
  • What is lacking
  • Why study the problem – Rationale / Relevance of study
  • What methods to use

Components

  • Searching for information – Sources & method of searching
  • Critical review
  • Documentation
  • People – convenient, easily accessible
  • Text – Traditional / Online – not the most updated, but a starting point
  • Primary / Non appraised sources – Research articles
    • Individual journals – Traditional / Online – are refereed by editorial board, evaluated, up-to-date, but has time lag.
  • Secondary / Pre-appraised sources / Integrative literature – Systematic Review, Meta-analyses etc
    • Individual journals / Books / Sites – Clinical Evidence (BMJ), Cochrane library
  • Grey Literature
    • Theses & Dissertations – inexperienced researchers
    • Conference Proceedings – Latest unpublished research, can identify people involved in research
  • Other – Govt./ NGO reports, Newspaper, Magazines etc

Searching – Sources of Information

Searching – Method
Finding references to articles most important.   References can be found in Text books / Articles / Index or Databases of references

Indexes or Databases of References
Databases – Traditional e.g. Index Medicus or Electronic / Online eg. Medline

Index Medicus

  • Published by US NLM, Started 1879, published monthly, stopped 2004
  • Cumulative Index Medicus – published annually, stopped 2000
  • Maintained by US NLM contain approx 17 million references to > 5000 life sciences journal articles, from 1950-51 to present
  • Indexed by Medical subject headings – MeSH
  • Search can be filtered by Author, Journal, Period, Article type etc more in Advanced search
  • Poor Homoeopathy representation especially English – only BHJ / Homeopathy, JAIH etc
  • Some abstracts, some have free full text archived in PubMed central or free journal sites
  • Clicking on each citation gives abstract, publication type, MeSH terms, Links to full text etc
  • Maintained by Elsevier, comprehensive pharmacological & biomedical database, more European journals, > 80% abstracts
  • Database of Indian biomedical journals – by Indian MEDLARS Centre – setup by NIC and ICMR – Free full text available at http://medind.nic.in/

Medline – MEDLARS Online – Medical Literature Analyses & Retrieval System 

EMBASE – Excerpta Medica Database 

IndMED – http://indmed.nic.in/  

Other – BIOSIS, SIGLE – System for Information on Grey Literature in Europe

Finding Homoeopathic Information- Problems
Scanty homoeopathic information in popular medical databases: e.g. Study by Department of Epidemiology, University of Limburg, Maastricht, NetherlandsKleijnen J, Knipschild P. The comprehensiveness of MEDLINE and EMBASE computer searches. Searches for controlled trials of homeopathy, ascorbic acid for common cold and ginkgo biloba for cerebral insufficiency and intermittent claudication.  Pharm Weekbl 1992;14:316–20

“RESULTS: For homoeopathy, ascorbic acid and ginkgo the proportion of all trials found by Medline was 17%, 36% and 31% respectively and for Embase 13%, 25% and 58% respectively. After checking of the references in the Medline articles 44%, 79% and 76% of all trials were identified. After checking of the references in the Embase articles 42%, 72% and 93% of all trials were identified.”

Finding Homoeopathic Information- Solution – Homoeopathic & CAM Databases

Hom-Inform Databasehttp://hominform.soutron.com

  • Homoeopathic Library Information Services of British Homoeopathic Library, part of Glasgow Homoeopathic Hospital
  • Database of over 25000 article & book references to Homoeopathy, free to search, some abstracts, photocopies possible

CCRH Librarywww.ccrhindia.org

  • Publishes CHLAS – Current Health Literature Awareness Services since 1988 gives citations of scientific articles published in journals subscribed by CCRH
  • Library provides photocopies of selected articles on specific requests
  • Also CCRH Quarterly Bulletin – A Cumulative Index, Theses index etc
  • Plan to launch HOMLINE, similar to Hominform

Provings Database – www.provings.com  – Jeremy Sherr & Archibel

  • More than 1000 new provings listed
  • Search for a proving, using the name of substance, of the proving investigator, the manufacturer, etc. – can also upload your own proving
  • For each proving gives name of investigator, year, contact details, rarely link to proving

HomBRex –  www.carstens-stiftung.de/hombrex/index.php

  • Database on Basic Research experiments on Homeopathy – indexes studies on biological systems including animal, human, plant, fungi and microbial organisms. – Needs free registration
  • More than 1190 experiments in more than 900 original articles
  • www.similima.com : A portal  for homoeopathic students teachers and professional

CAM Databases

o   CAMbase – http://cambase.dmz.uni-wh.de/opencam/start_en.html

  • Covers about 80,000 bibliographical records from more than 30 journals on complementary medicine most of them not listed in MEDLINE

User friendly – can type in his request as a naturally spoken phrase

o   AMED – www.bl.uk/collections/health/amed.html

Allied & Complementary Medicine Database of British Library

Finding a copy
References can be followed up in medical library / online libraries.   Look up abstract to know whether potentially interesting or not.

  • Can obtains articles by subscription at most journal sites
  • Free full text articles online – depends on individual journal policy
  • Free Article collections –www.freemedicaljournals.com , open access publishers like BioMed central – www.biomedcentral.com
  • Document delivery services 

Other ways to find relevant information:

  • Personal communication – Contact those who have conducted similar research
  • For dissertations, theses etc. contact colleges / universities
  • Web search with popular search engines or speciality tools like Google scholar (scholar.google.com)

Critical review of literature

  • For research paper assess
    • Type of study / Relevance to your study / Aims & Objectives / Materials & Methods / Sample size / Statistical Methods / Results & conclusions – whether appropriate
    • Bias or conflict of interest – transparent or  not
    • Peer reviewed articles most credible
    • Details in series of “Users’ guides to the medical literature” in JAMA – www.cche.net/
  • Re-organise, reshuffle & summarize as sequentially relevant text
  • Traps to avoid
    • Forgetting the purpose
    • Trying to read everything
    • Reading not writing
    • Not referencing your notes
  • Details of referencing methods at US NLM’s Citing Medicine site –  http://www.nlm.nih.gov/citingmedicine/
  • Details of manuscript submission in “Uniform requirements of manuscripts submitted to biomedical journals” published by International committee of medical journal editors http://www.icmje.org/

Dr Arun Prasad K.P.   MD (Hom)
Dept of Materia Medica
Govt.Homeopathic Medical COllege, Calicut
Email : appoo.ap@gmail.com

keyboard

Softwares in Homoeopathic Research

keyboardDr Ajith kumar D S

All homoeopathic software were made to assist the homeopath in analyzing a case and finding the simillimum.

This process can be broken down into several steps:
Take the case.
Select rubrics from the repertory.
Analyze the rubric selection in terms of finding likely remedies for the case.
Confirm the remedies from the repertorization in the materia medica.
Prescribe a remedy and update your records of the case. 

No computer software can really help you with the first step, but right from step 2 through 5, all three programs stand by your side and make your life easier to varying degrees. In fact, they really do more than that. Today’s repertorization software also makes studying remedies and differential materia medica much easier.

But still, a computer repertory is nothing but an index to the materia medica, sorted by individual symptoms. There are few things a computer does better than searching databases according to certain criteria, so putting a computer to work on the problem of repertorization is the most natural thing to do. All of the programs perform well in this respect; they find rubrics quickly and obviate the tedious task of writing out remedies in each rubric by hand. The most important question, though, is: How easy is it for the user to get them to do what s/he wants. The consistency and quality of the user interface is probably the most decisive factor in the buying decision.

Repertory books and Materia Medicas
Most programs come with different repertories in electronic form. Depending on the size of your wallet, you start out with one or two and then can add others if you feel the urge. Bear in mind, though, that the list of available repertories for each program is subject to change and will likely grow longer in the near future.

As you well know, after narrowing down the remedy selection to a choice of a few, those need to be confirmed in the materia medica. In general, it is a good and comforting idea to have the materia medica within easy reach when repertorizing a case. Each program tries to fill that need and offers you some selection of well known materia medica texts.

Searching for rubrics
Once you decide on a repertory, the next task is to find the appropriate rubrics for your case. Without the help of a computer, you have to know your repertory well. True to history, many repertories are based on J. T. Kent’s organization of his repertory and present chapters in the familiar head-to-toe sequence instead of in alphabetic order. There are advantages and disadvantages to each approach, and both sometimes have related symptoms scattered throughout the repertory showing up in places you would have never looked. The computer comes to your aid in that it lets you find rubrics based on words or combinations of words. The downside: if you start relying on this crutch too early, you will never really get to know your repertory; it will always remain a somewhat distant acquaintance to you.

As you find the rubrics for your case, you collect them into clipboards. Each clipboard holds a set of rubrics which can be analyzed separately later on. This allows you to take a look at what the mental picture suggests, separately from the physical symptoms, for example. Simply put all the mental rubrics into one clipboard and all the physical ones into another. The uses of these handy clipboards are really manifold, and all three programs have them. CARA offers three clipboards, RADAR has ten, and MacRepertory gives you six. In my own experience, anything less than three is too limiting, but three work fine.

Case analysis
Here is where having a computer really saves you time. However, the speed with which the computer suggests a remedy to you bears an element of danger. It is deceptive, because one tends to forget that no amount of whiz bang will give you the right remedy from the wrong selection of rubrics. The principle of GIGO (garbage-in-garbage-out) applies here more then anywhere else. Before describing the analysis capabilities of each program, let me explain briefly what analysis strategies are.

Probably the most common way to analyze a case is to take into account the grade of the remedy and the number of rubrics it appears in to compute a final “score”. One can modify this, by taking into account the “underlining” (i.e. importance of each rubric to the case) as well. Invariably, however, small remedies will not fare well with either of these strategies.

An important part of the case analysis is the ability to restrict your attention to only a certain class of remedies, e.g. the minerals, snake remedies, remedies belonging to the sycotic miasm, etc. Sometimes I found myself in a situation, where all I saw was polychrests. In this case, it is a great help to be able to simply tell the computer not to show any polychrests and exclude them from the analysis. The programs differ greatly in their ability to specify exactly on which remedies the analysis is to be performed.

Again, I found that CARA’s feature set of analysis strategies and options is sufficient in many circumstances. What RADAR adds on top of it, is its Vithoulkas Expert System (VES) and much expanded capabilities in terms of selecting remedies by family. MacRepertory is, however, the easiest and most straightforward system to use in this respect. In terms of fine tuning and selecting different case analysis strategies, it offers more than the other two programs. Selecting remedies by family and restricting repertorization to certain families is a breeze. Even though RADAR gives me a similar level of control, it feels a bit rough around the edges. Counting the number of mouse clicks necessary to perform a certain task in RADAR, it seems always to be that much more difficult and less intuitive than in MacRepertory.

As to the expert systems.
The one in CARA is simply a fixed analysis strategy, which has been honed on a large number of cases. The term “expert system” is, in my opinion, inappropriate. On the other hand, CARA performed well and suggested reasonable remedy choices using the “expert” analysis. Most of the time, I would look at a case using this setting as well as a simple “flat” repertorization. RADAR’s VES is touted to be akin to having George Vithoulkas looking over your shoulder. I can’t attest to this, since George has never looked over my shoulder, but I can see how it may be attractive to some users. Personally, I found that I preferred most of the intelligence to remain under my control and didn’t use the VES frequently. This may to a big part be due to my not using underlining in the manner necessary for the VES to show off its best side.

MacRepertory undoubtedly gives you the most control over the repertorization strategy. Everything is customizable and adaptable to your needs. The sheer number of possibilities can be confusing to the user, but fortunately all but the most frequently used controls are well hidden from plain view. This, I felt, gave me the control I wanted when I needed it, without being right up in my face with every little feature.

Both RADAR and MacRepertory offer specialized analysis features which draw upon the experience and techniques of several well known homeopaths. I already mentioned RADAR’s Vithoulkas Expert System, but there is also the Vakil and Herscu modules available. See further down for a brief description. MacRepertory extends its suite of analysis strategies by categorizing remedies into groups such as the five elements, or astrological planets, etc

Presentation of the repertorization
As any statistician will attest to, no data is worth its paper unless it is presented in a way that brings out the message it is trying to tell. What I was looking for in particular was the ability to manipulate the rubric information (e.g., changing the underlining, combining rubrics, substituting other rubrics, etc.), change the analysis strategy, and zoom in on a specific group of remedies (e.g., snakes, acids, solanaceae, etc.) while being able to see what impact my manipulations have on the repertorization.

Materia medica studies
I didn’t know it at first, but repertorization programs make great tools for studying remedies. It’s a breeze to extract rubrics for several remedies at the same time, and then compare and contrast them. Here’s an example: Platinum and Palladium are chemically related metals. How does this observation reflect in their respective delusions? To research this by hand would require to go through the entire chapter on delusions in the repertory and write down any rubric in which both remedies appear together. Did I hear you sigh? Fear not! Let the computer be your aid.

Patient charts and case management
As one follows a case over a period of time, there is a lot of information that needs to be recorded from visit to visit. Wouldn’t it be handy, if all the information pertaining to a patient could be stored in one file, easily accessible and amendable? You can rest calmly, all three programs provide some way of doing just that.

In principle, you can type your case notes right into the computer in front of the patient. I know several people who do just that, although I don’t do it personally (for one, I am not a good enough typist). You would thereby eliminate the need for a sheet of paper completely, and come a step closer to the paperless office. RADAR has just started to offer, as separate modules, an extensive patient information database system.

Special features in RADAR
In addition to the Vithoulkas Expert System, RADAR offers you the distilled wisdom of Prakash Vakil and Paul Herscu. Vakil focuses on the differentiation between remedies using the appearance of the tongue, colors and moon phases. At any stage during case analysis or remedy differentiation, one can use additional rubrics and symptoms pertaining specifically to these three chapters. These additional rubrics pertaining to tongue, moon and color are in part additions by Vakil himself, based on 30 years of research. Vakil claims that differentiation between similar remedies based on these three chapters with the additional information he provides makes remedy selection more certain and quicker. Part of the Vakil module is also an audio recording of coughs characteristic for certain remedies. There are 10 different coughs one can listen to and view a short description of the patient who was recorded. Unfortunately, the recording quality is so poor that I found this feature of little value.

Next to Vithoulkas and Vakil, Paul Herscu has lent his wisdom to RADAR. The Herscu module provides an interface to Herscu’s case analysis approach. It would be too much to describe its features here, but I can only recommend to read Herscu’s new book. Based on my personal style of case analysis, I found the Herscu module enlightening and easy to use. It has the potential of providing a new view on an old case, which hitherto proved resistant to any other strategy.

Special features in MacRepertory
MacRepertory, too, offers you the particular insights of some well known homeopaths. You can look at a case through the eyes of William Boyd’s groups, Robin Murphy’s planets, Vega Rozenberg’s boxes, and Berkely Digby’s five elements. All these schemes are different ways to classify remedies – in essence, each is a way of dividing remedies into families. Murphy uses the planets of the solar system, Digby bases his classification on the five alchemical elements, Earth, Water, Fire, and Ether. You can analyze a case in each system and therefore conclude, e.g., that a particular case has a preponderance of Water symptoms. A brief description accompanies each system, but is in no way sufficient to start using it with any measure of confidence and competence. People who have either studied with these homeopaths or are familiar with their writings will probably welcome this feature of MacRepertory most. For the rest of us it isn’t going to do much.

One are where MacRepertory really shines is the analysis of a case based on natural families. With only two mouse clicks you see your case projected onto the periodical table of elements and can easily locate the center of gravity and likely remedy relationships there. Or, maybe, you suspect a plant remedy and want to see which botanical families the repertorization favors. Nothing easier than that. You can view the botanical families in hierarchical order, while the darker shades of green show you where the repertorization falls. I really enjoyed playing with this part of the program, not the least because the pictures are well done and fun to look at. Besides chemical and botanical relationships, there are several others you can explore in a similar fashion (e.g., zoological or miasmatic).

Special features in Hompath Classic 8.0 has 11 modules

Classic :

  • Contains 29 repertories .
  • Gives expert strategies based on Boenninghausen, Kent and Bogerian concepts.
  • Gives you analysis  based on Animal, Mineral and Plant Kingdoms.
  • Guides you to potency and repetition.
  • A total patient analysis and management module .

Archives :

  • Has 270 books on Materia Medica, Philosophy, Therapeutics, Regional Therapeutics, Clinical, Drug Picture and Pharmacy.
  • With its unique indexing system, you can search for any word in any permutation   or combination in a matter of seconds and open the respective occurrences.
  • You can prepare your own notes for learning, presentations, lectures and seminars.
  • Confirm exact symptom before prescribing .

Utilities :

  • An academic module that makes learning a pleasurable experience.
  • It has group symptoms, therapeutics, prophylactic medicines, mother tinctures, question and answer sets on specific subjects like Materia Medica, Repertory etc., question sets of all subjects, cross references, word meanings and case analysis module. 

MM Elite : Incorporates multimedia presentation of 31 important remedies. 

MMLive : The world’s first Homoeopathic Multimedia C.D where 22 remedies come alive in front of you.

Tresorie : A compilation of over 4800 articles based on practical, clinical and homoeopathic  experiences of many generations of Homoeopaths as published in various journals.

Links Tresorie : This virtual treasure chest of knowledge includes a fabulous compilation of articles from“International Homoeopathic Links” from the year 1987 to 2000 .

You can search for any article based on topic, subject, author, remedy or volume of your choice.

Patient Management System

The ‘ Patient Management System ‘ or PMS, as you may call it, is a modern day application that allows an easy way to store and update all the information about the patient.

It includes Patient Registration, Electronic Medical Record, etc.

Case Analysis
‘Case Analysis’ module help you to analyze all the details of your cases including your successes and failures in practice.

The ‘Case Analysis’ is provided as a separate module to avoid conflicts with the main application.

This option has been designed as a personal research tool, that you can use not only for presentations and lectures but also for docu-menting and analyzing your cases for enhancing your practice.

Assist
Organiser; Bills ‘N’ More & Address Book

Important Homoeopathic software

  •  Homeos
  •  Organon 2001
  •  Clinician-
  •  Radar
  •  MacRepertory
  •  ISIS Vision
  •  Mercurius
  •  Herbal Remedy Finder and Homeopathic Remedy Finder
  •  Akiva
  •  Hompath
  •  Homeopathic Remedy Finder
  •  Homeopathic Remedy Browser
  •  British Homeopathic Library
  •  Homeopathic Remedy Finder
  •  Repertorium Homeopathicum digital II 

Dr.Ajith kumar.D.S, B.H.M.S, M.D.(Hom)
Department of Physiology & Biochemistry
Govt. Homoeopathic Medical College, Kozhikode

Sampling methods in medical research

Dr Bindu John Pulparampil

What is Sampling ?
Procedure by which some members of a population are selected as representative of the entire population

The sub-group thus selected to represent the whole population is known as SAMPLE

Methods Of  Sampling
Several methods are used to ascertain a particular aspect of the population,through an unbiased sample drawn from the population

Sampling is divided in two categories

 1. Probability Sampling

 2. Non probability Sampling

Probability sampling

  • It is any method of sampling that utilizes some form of random selection
  • The procedure should assure that the different units in the  population have equal probabilities of being chosen.

Non probability sampling

  • It does not involve random selection
  • May or may not represent the population well
  • Used when researcher lacks a sampling frame for the population

 Probability sampling includes

  • Simple Random Method
  • Systematic Sampling
  • Stratified Sampling
  • Cluster Sampling
  • Multistage Sampling

Non-probability Sampling includes

  • Accidental Sampling
  • Voluntary Sampling
  •  Purposive Sampling
  • Quota Sampling

Simple Random Sampling
A sample selected such that each possible sample combination has equal probability of being chosen.

Also called Unrestricted random sampling

Two types of Simple Random Sampling

1 ) Simple random sampling without replacement

  • In this method the population elements can enter the sample only once
  • The units once selected is not returned to the population before the next draw 

2 ) Simple random sampling with replacement

The population units may enter the sample more than once

Methods of selection of a simple random sampling:

  • Lottery Method
  • Table of Random numbers
  • Random number selections using calculators or computers

 Systematic Random Sampling

  • Also called Quasi-random sampling
  • Divide the population size by the sample size, to get sampling fraction
  • Select a random number between 1 and sampling fraction, which is the first sampling unit
  • Systematically select the remaining sample units, by adding sampling fraction

 Stratified Random Sampling

  • Stratification means division into groups.
  • In this method the population is divided into a number of subgroups or strata
  • From each stratum a simple random sample is selected and combined together to form the required sample from the population

 Multi- Stage Sampling

  • Used in large scale investigations
  • First stage- preparation of large sized sampling units
  • Randomly selecting a certain number
  • Second stage- Another list prepared from them
  • Sub-samples drawn by random sampling

 Multi –Phase Sampling

  • Used to obtain supplementary information
  • Certain items of information collected from all units of sample
  • Other items collected from only some of sampling units

 Cluster Sampling

  • Each sampling unit is a collection or cluster of elements
  • Used when units of population are natural groups or clusters like wards, villages etc
  •  The group is taken as a sampling unit

 NON- PROBABILITY SAMPLING

Accidental Sampling

  • The “person on the street” interviews conducted frequently by television news programs
  • Sampling those most convenient
  • Gets a quick reading of public opinion
  • Also called Haphazard or Convenience Sampling

Voluntary sampling

  • The sample is self selected
  • Sample consists of people who chose themselves by responding to a general appeal.
  • They often over represent people with strong opinions, most often negative opinions.

 Purposive Sampling

  • Sampling with a purpose in mind
  • Handpicking supposedly typical or interesting cases
  • Reaches a targeted sample quickly
  • Also known as Judgemental sampling

 Types of Purposive Sampling

  • Sampling for specific types of people – modal instance, expert, or quota sampling.
  • Sampling for diversity – heterogeneity   sampling.
  • Snowball sampling – capitalize on informal social networks to identify specific  respondents who are hard to locate otherwise

 Modal instance sampling

  • Sampling the most frequent case, or the “typical” case
  • Is only sensible for informal sampling contexts.

 Expert sampling
 It involves the assembling of a sample of persons with known or demonstrable experience and expertise in some area

Quota sampling

  • The population is first segmented into mutually exclusive sub-groups.
  • People are selected  nonrandomly according to some fixed quota
  • Judgement is used to select the subjects or units from each segment based on a specified proportion
  • Convenience sampling within population groups

  The quota sampling can be two types – Proportional and non proportional

  • Proportional quota sampling :It is  representing  the major characteristics of the population by sampling a proportional amount of each
  • Non-proportional quota sampling : The minimum number of sampled units in each category is specified

Heterogeneity Sampling
When  all opinions or views are to be included  and  are not concerned about representing these views proportionately

Snowball sampling

  • It begins by identifying someone who meets the criteria for inclusion in the  study.
  • They are asked  to recommend others who they may know who also meet the criteria

 Other Kinds Of  Sampling

  • Event Sampling : Using routine or special events as the basis for sampling
  • Time Sampling : Recognising that different parts of the day, week or year may be significant

 Summarising
Probability Sampling

  • Simple Random – Selection at Random
  • Systematic – Selecting every nth case
  • Stratified – Sampling within groups of Population
  • Cluster – Surveying whole clusters of Population
  • Multistage – Sub samples from large sample

Non- Probability Sampling

  • Accidental – Sampling those most convenient
  • Voluntary – Sample is self selected
  • Purposive – Handpicking typical cases
  • Quota – Sampling w/n groups of Population
  • Snowball – building sample thru informants

 The non- probability sampling is convenient and economical, the problem is that the results are unconvincing, as there are no criteria to measure representativeness or to assess the accuracy of estimators.

The element of randomness, in sampling procedures is essential for describing the representativeness and precicision of the survey and estimators

research

Homoeopathic Research Past, Present & Future

researchDr Harihara Iyer

Research – Past
To comment on the Researches made in the past, an in depth study of evolution and development of Homoeopathy along with the pioneers in general and the reformations and renovations made by Dr. Hahnemann since the inception of cinchona bark experiment in particular has to be carefully scrutinized and analysed.

Dr. Hahnemann claimed that Homoeopathy is a therapeutic system which is evolved through observations and experience rather than lab findings and experiments. One can perceive that Hahnemann’s conclusions were made not on speculation and intelligence, but it was woven out of an insight and philosophical vision. No intelligent brain in his time can think of anything besides material out look on diseases. But Hahnemann had a superior intuition to think of dynamical state of health and disease.

Secondly Hahnemann in the initial years of his Homoeopathic practice was using the same quantity of medicine as in the allopathic practice. Later, as he observed aggravation with that quantity of medicine, started to minimize the same.

The modification of crude drug to dilution, dilution to potentisation, potentisation to higher attenuation then to 50 millesimal, water potency and to the statement that the vital force will accept the homoeopathic medicine only if the preceding and following potencies are different, is a clear instance of Research made on the field of Homoeopathy to make the medicinal action speedy.

Human proving to drug substance for human being and his dictations on diet and regimen and various articles proves Hahnemann’s research and analytical mind.

Lastly when chronic disease treatment has curtailed by blunt edges of symptomatology alone, by twelve years of untiring study searched out the roots of obstruction, Hahnemann has shaped and sharpened the tool by introducing miasm theory.

Who else beside Hahnemann, the master, can make such dedication and conviction.

Later Dr. Boenninghausen and Dr. Kent, Dr. Richard Hughes, Dr. Hering, Dr. Allen and many others has made their own contributions by systematizing the proving records, made clinical verifications, preparation of Materia Medica and Repertory etc. This can be reckoned and recognized as a research work enabling a homoeopathic physician to make the drug selection easy. 

Research – Present
The present scenario on research in India unveils the meritorious works done by CCRH, CIRH and other Govt. organizations. Drug proving, reproving researches in effective and efficient management of cases, setting up of modalities and parameters for the same, necessity of setting up statistical data’s  are some of the works done.

But it is grace or otherwise for Homoeopathy, absolutely deviations form the principles are taking place by putting their own justifications for patent specific medicine and combination tab and mixtures, which Hahnemann objected vehmently. We have different “schools” on different outlooks on treatment but all have a goal of identifying a genuine working principle for chronic disease.

What is the reality today?
In spite of different methods of treatment parameters, a statistical and methodical study is lacking in the clinic of individual physician or in the Govt. /group institutions. Study should be done on the success rate, failure rate, visits, revisits, of patient’s aggravations, effect of first prescription, reverse order of appearance of symptoms etc.

Research – Future
Tomorrow’s era will be of challenges and threats to Homoeopathic system. This will come in the way of scepticism on the efficacy of Homoeopathic system in one hand from the same forces who opposed since Hahnemann’s time and the shattering weakness and lacunae’s we have on the other.

It is our duty to convince the common public that Homoeopathy is a therapeutic system, as a scientific or more scientific than other system, because there is calculated caliberated move with strong vigor and enthusiasm to prove otherwise. This goal can be achieved by coping with international standards of Research methodologies and publication of data’s incorporating with national and international research centres.

To rectify the pit falls before said we have to redeem ourselves with clear analysis and evaluation and a common platform on research should be set up to share novel ideas.

To conclude, the sincere and prudent endeavors to fulfill the vision of Hahnemann as said in the first and second aphorism comes under the true and faithful research.

Dr Harihara Iyer
Dr.Padiar Memorial Homeopathic Medical College.
Eranakulam. Kerala

Basic statistics in homoeopathic research

Dr Lizmy Ajith

Statistics is the field of science concerned with the collection, classification, summarising & interpretation of numerical data 

Biostatistics: application of statistical methods in biological sciences to deal with living things

Medical Statistics

Application of statistics in medicine

  • To compare efficacy of a drug
  • The % cured, relieved or died in experiment
  • To find an association B/W 2 attributes
  • In epidemiological studies 

Sources of data collection

  • Experiments
  • Surveys
  • Records 

Presentation of data

  • Tabulation
  • Diagrams 

Sampling

  • The process of selecting a representative part from the whole
  • Sample: the representative part
  • Population: the whole from which sample is drawn 

Measures of central Tendency

  • Mean
  • Median
  • Mode 

Mean
Arithmetic average obtained by summing up all the observation & dividing the total by the No: of observations

X = ∑ X

         n

Eg: E.S.R of 7 subjects – 7,5,3,4,6,4,5

Mean = 7+5+3+4+6+4+5    =  4.86

Median
The middle observation when  all the observation are arranged in ascending or descending order

It implies the mid value of series.

Eg: E.S.R. of 7 subjects arranged in ascending order are, 3, 4, 4, 5, 5, 6,7

The 4th observation i.e. ‘5’ is the median

Mode
Most frequently occurring observation in a series

Eg: the size of induration in tuberculin test of 10 boys – 3, 5, 7, 7, 8, 8, 8, 10 ,11, 12

The mode here is ‘8’

Measures of variability
Variability: biological data collected by measurement or counting.

No 2 measurements in man are absolutely equal

Measures of variability of observations help to find how individual observations are dispersed around the mean

Measures of variability

  • Range
  • Mean deviation
  • Standard deviation
  • Standard error 

Range
The normal limits of a biological characteristic

Eg: systolic B.P 100-140mm of Hg

Mean deviation
Mean of the absolute deviation from the central tendency

MD = ∑ X – X

                 n

Mean deviation about mean

                = sum of the absolute deviation from the mean / No: of observation

Standard deviation

Square root of the average of the sum of the squares of deviations taken from the mean

√ ∑ (x – x  )2

                    n

Indicates whether the variation of difference of an individual from the mean is by chance or real

Standard error

Difference between sample & population values

Is a measure of chance variation

SE = SD / √n

Correlation
The relationship or association between two quantitatively measured variables.

Eg: relation between cholesterol level & B.P

Regression

  • Change in the measurements of a variable character
  • Helps to predict the value of one character from the knowledge of the other character
  • Eg: to estimate height when weight is known 

Probability or chance
It is a ratio of occurrence of favorable chances out of the total possible outcomes.

Eg: chances of one drug being better than the other

Test of significance

  • Mathematical methods by which the probability of an observed difference occurring by chance is found
  • The common test in use are ‘Z’ test, ‘t’ test & ‘Chi square’ test. 

Stages in performing a test of significance

  • State null hypothesis(Ho) : statement of no differenceEg: vitamins A & D makes no difference in growth
  • State alternate hypothesis(H1): vitamins A & D play a significant role in promoting growth
  • Determine the probabiility(P) of occurrence of your estimate
  • Draw conclusion on the basis of ‘P’ value i.e accept or reject the null hypothesis – decide whether the difference observed is due to chance or due to vitamins A & D  

Paired ‘t’ test

  • Applied to paired data of independent observations from one sample only when each individual gives a pair of observation
  • To study the effect of a drug before & after
  • To compare the effects of 2 drugs

t = x

                SE

Dr Lizmy ajith, B.H.M.S, M.D(HOM)
Dept. of Practice of Medicine,
Govt. Homoeopathic Medical College,Kozhikode

Amendments required in the new PG Homeopathy regulations 2012

Whether the New P.G.(Amended) Regulations 2012 will serve the expected and the desired goal?

Prof. (Dr.) Ravi M. Nair

I would like to invite your attention to the Homoeopathy (Post Graduate Degree Course) M.D.(Hom.) (Amendment)   Regulations   2012 of   the   CCH published in the Gazette of India on 5th March, which  is available in the CCH website. If you go through it, you will get to know ever so many serious flaws, and defects rendering the whole exercise of P.G. course as worthless and purposeless, besides making it practically difficult on the part of the Universities, students, teachers, and the College authorities. This situation, as it appears to me, is not worth enough for the development of Homoeopathy. I have made an attempt to sort out certain deficiencies and flaws in these Regulations, a copy of which is enclosed for your information and appropriate reciprocation. I also enclose a copy of the detailed syllabus of the General Subjects included in the P.G. Regulations of 2001 for your information and response to the effect that whether these subjects need to  be  included in the New   Regulations. It   is desirable to have a debate conducted at national level at the earliest and try to bring home the authorities urgency for correcting and revising the Regulations before implementation. Hope you will do what is necessary.

P.G. Regulations in Homoeopathy were first brought into force in November 1989. It was subsequently amended in February 1993, involving only a few corrections in expressions or words. But on 31st October 2001, an amendment was notified bringing  in  comprehensive changes in the syllabus giving a scientific basis capable of giving a clear objective analogous with the Regulations  in the P.G. programmes of other systems of medicine. There were only 3 specialities in the first Regulations of 1989. In the second Regulations of 2001, the number of these specialities was increased to 7.

  1. P.G. Regulations in Homoeopathy were first brought into force in November 1989. It was subsequently amended in February 1993, involving only a few corrections in expressions or words. But on 31st October 2001, an amendment was notified bringing  in  comprehensive changes in the syllabus giving a scientific basis capable of giving a clear objective analogous with the Regulations  in the P.G. programmes of other systems of medicine. There were only 3 specialities in the first Regulations of 1989. In the second Regulations of 2001, the number of these specialities was increased to 7.
  2. The P.G. programmes existed prior to 2001 Regulations were only external P.G. programmes conducted in a few colleges under certain Universities. There were only a few colleges which conducted Regular P.G. Programmes as laid down in the 1st Regulations. It was only after the enforcement of the P.G. Regulations of 2001 that several colleges sprang up under more and more Universities. One decade has elapsed since the enforcement of the 2001 Regulations. Even at this juncture, it cannot be said that colleges and the Universities have become fully familiarised and equipped with the various formalities, infrastructures, schemes, teaching aids, programmes, method of training and evaluation / examinations etc. based on the above Regulations. But this smooth process of transition ensuring a sound foundation for the P.G. programmes in Homoeopathy on a  systematic basis capable of yielding the desired goal conceived in the above Regulations  has  been   totally jeopardized by the New Regulations of 2012 which smacks of nothing but a regression or roll-back to the stale Regulations of the last century! What it displays is only ignorance or absence of academic sense and sensibility on the part of the protagonists of the new Regulations , let alone their lack of resourcefulness and imaginative prowess embedded in experience in these matters.
  3. A Post Graduate programme should be derived and designed with the prime intention or objective to  impart   specialized    training on a specific subject. This alone can mould and produce a competent specialist and / or Medical teacher / Researcher  in a particular subject. The Regulations of 2001 were so structured as to give due consideration and weight on the above aspect of specialization. But the    latest   Regulations   strikes a    great    deviation   from the above by registering a   close   similarity   and   semblance  to the out-dated  Regulations of 1989.Accordingly, a scholar has to undergo  training in two subsidiary subjects along with the speciality subject. It is also stated that these subsidiary subjects have to be studied in depth and content of the syllabi as have been prescribed for their speciality course for all the intent and purpose of examinations. (Please  see the last sentence of the clause 4 of the new Regulations.)
  4. This is more clear from a perusal of the scheme of Examinations stated in clause 5 of the new Regulations. The only meager difference is that there is one more paper in the specialty subject in Part – II examinations. It is a serious point to be pondered over how it will be possible for a student to study all the 3 subjects in the same dimension of depth and content in a course of 3 years duration. This will definitely weaken his concentration and result in relatively lesser understanding and comprehensions of the speciality subject he will be choosing.
  5. The subjects  viz. Organon of Medicine, Materia Medica, Repertory are the basic ones  essentially required for the practice of Homoeopathy. Accordingly, they become clinical subjects. The clinical conditions are broadly classified into three viz. Medical, Surgical and Obstetric & Gynaecological. In the practice of Homoeopathy, the knowledge of basic subjects of Homoeopathy has to be applied in an integrated manner in tandem with the above clinical conditions. So when a P.G. curriculum for  the above said  Homoeopathic subjects is planned, the remaining two Homoeopathic subjects and the clinical subjects dealing with the above said broadly classified conditions should also be incorporated as allied / related subjects. Likewise, when a P.G. programme is chalked out for a clinical subject (viz. Medicine, Surgery, OBG or their sub specialities such as Paediatrics, Psychiatry etc.) the 3 basic subjects of Homoeopathy need to be studied as allied / related ones.  But these allied / related subjects are not to be dealt with in detail as separate entity as in the case of U.G. (BHMS) curriculum. If such a separate entity-wise study is further mooted in the P.G. programme, the P.G. course will demean itself to the level of U.G. course. In order to obtain the avowed depth in knowledge and skill in a particular speciality, that subject need to be taken in wholesome after effecting judicious integration with the related allied subjects. Any attempt aimed at a study without integration of the main speciality subject with the related subjects, only a smattering knowledge and skill can be achieved in that speciality.. This is the core defect of the Amended new Regulations of 2012.
  6. The new Regulations have deleted the general subjects like “Holistic concept of Man in Health and Disease” dealing with the study of basic medical subjects viz. Anatomy, Physiology, Biochemistry & Bio Physics, Psychology, Pathology, Pathophysiology, abnormal Psycology, Concept of Miams etc. from the Regulations of 2001. In all P.G. programmes in medical science, the applied aspects of basic medical subjects is a ‘must’ in the preliminary part of the course. The knowledge and skill of the desired speciality subject should be imbibed on the foundation of the above basic subjects. Even though the above basic subjects are taught in the U.G. level, it is an imperative necessity to study these subjects for the effective practical application of the knowledge in clinical conditions in an integrated manner. Despite the assertion that Homoeopathy holds high  “holistic concept in health and disease of a man”, nothing tangible is seen  ever undertaken in the curriculum of U.G. course. Unless and until these subjects are taught and  studied in an integrated manner, the Homoeopathic perspective will definitely get lost even in the P.G. programme. This is another major flaw seen in the new Regulations of 2012.
  7. In the New Regulations, the subsidiary subjects prescribed for P.G. course in Homoeopathic Pharmacy are Practice of Medicine and Materia Medica or Homoeopathic Philosophy similar to that of a clinical speciality in Homoeopathy, ignoring the fact that  Pharmacy is not at all a clinical subject. This is regarded only as a para medical / para  clinical subject every where. As Materia Medica has been separately provided for understanding the medicinal properties in Homoeopathy, what a physician can be expected to derive from the study of subject Pharmacy is only that relating to dispensing the medicines. This has no relevance in clinical practice of a Homoeopath. What a P.G. course in Pharmacy can aim at is only the moulding or making of a teacher in Pharmacy or an expert in the Homoeopathic Pharmaceuticals. In a P.G. course in Pharmacy, the subjects to be taught must be the ones related to Pharmacy alone. Homoeopathic subjects related to Pharmacy can be taught as allied subjects. In the New Regulations, Practice of Medicine has been included as compulsory subsidiary subject, which is against all logics and sane reasoning.
  8. The colleges will also confront great difficulties and hardships to provide and arrange the adequate  infrastructures    including    staff    designed towards  efficiently catering to such needs. If the new syllabus   is    insisted on, a college with two spcialities in P.G. course, for example  Psychiatry and    Paediatrics   or    Pharmacy    has   to   provide    the entire infrastructures and staff required for the remaining  4  subjects destined to become  subsidiary  subjects  viz.  Organon  of  Medicine, Materia Medica, Practice of Medicine and Repertory to the above specialities programme at one and the same time. Again if a P.G. programme has to be conducted in any one or two subjects viz. Organon of Medicine / Materia Medica / Practice of Medicine / Repertory, additional facilities and staff have to be brought in other three or two subjects also.
  9. The already existing facilities in the above 4 subjects for the U.G. level will never suffice the required infrastructure and staff demanded by the P.G. course. This factor has been lost sight of while prescribing the staff pattern for manning the P.G. course as stated in clause 7 (b) of the new Regulations.
  10. As one of the subsidiary subjects happens to be optional to the students, the students in a particular batch in full may be opting one subject against the two subjects. This will render the facilities and faculties reserved for the second subject to lie idle or unused for the whole year simultaneously requiring the management to preserve their existence unnecessarily for no use at all. In a Govt. college such additional staff and infrastructures will not be sanctioned in excess of the Regulations as such action will arouse unnecessary audit objections and irregular commitments on the part of the College authorities.
  11. There are no. P.G. courses in any other medical faculty insisting the study of  any subsidiary subjects (in full required in their speciality subject). Here two subjects are insisted on in Homoeopathy. There can be allied subjects concerned to a speciality subject in a P.G. programmes  as stated above.
  12. The P.G. programme in any clinical speciality in Homoeopathy shall require enough knowledge in the basic subjects of Homoeopathy viz. Organon of Medicine, Materia Medica and Repertory. The new Regulations provide a course only in any of the two basic subjects in Homoeopathy.  What is essentially required is the judicious integration of all these three subjects for efficient practice in Homoeopathy. It may thus be seen that the new Regulations are fraught with serious draw backs involving many omissions and commissions which will result in the failure of making and moulding even a competent Physician in Homoeopathy, let alone a competent medical teacher in the speciality discipline.
  13. These Regulations do not mould a specialist / or a competent teacher in any of the basic subjects of Homoeopathy viz. Organon of Medicine, Materia Medica and Repertory. It is because Practice of Medicine alone has been prescribed as subsidiary subject in their syllabus. The clinical conditions are broadly classified into three, viz. Medical, Surgical and Obstetrical & Gynaecological. Each of the 3 basic Homoeopathic subjects does have its own application in all the 3 clinical conditions stated above. This makes it imperative to have a comprehensive knowledge in the subject concerned. This being the case, in the new Regulations only Medical conditions (study through Practice of Medicine as subsidiary subject) has been prescribed. There is no mention of surgical or OBG conditions.
  14. Attempts are understood to be on to annex a detailed syllabus of each speciality and subsidiary subjects on the belated realization of the drawbacks of the New Regulations with regard to its implementation on the part of the CCH. It is learnt that this matter is being put to discussion sooner. The proposed detailed syllabus should have to be made part and parcel of the New Regulations if it is to acquire a uniform pattern making it worthy of being implemented in the country. It is in effect an Amendment to the New Regulations even though it appears to be a supplement to it. Any such  amendment   being thought of within the purview of Rule 20 of the HCC Act 1973 has to be circulated  to all State Governments by the CCH  for getting their comments in the matter. Only after then, this may be forwarded to the Central Govt. for its sanction.
  15. Even if it is granted that the proposed amendment will be ready for being published soon, the University will be requiring  at least a minimum of 6 months  to enforce it after duly  amending their Regulations in consistence  with the New Regulations. With a view to avoiding the time delay involved in amending the CCH Regulations as pointed out in the previous para, it may be felt expedient to circulate the supplementary syllabus to the University for including them in their new Regulations to implement them in this academic year itself. This will result  in more chaotic and confused state of affairs as the Universities will be at liberty to effect their own changes in the Regulations to suit their convenience which may be contrary to the uniformity and homogeneity of the Regulations in the national level, if this act is indulged in supersession without being included in the CCH Regulations.
  16. Thus whatever hasty action is taken to enforce the New Regulations in the current academic year itself, it will be clear that the entire P.G. programme will become  distorted and detrimental to the homogeneity and uniformity resulting in the total inability to achieve the avowed  purpose.
  17. It has been the usual practice with the formulators of syllabi that they used to make it a point to publish the Regulations sufficiently well  before the beginning of the academic year by atleast 6 to 7 months ahead. What this action displays is a seasoned wisdom on the part of the CCH to see that enough time is given to the University for amending their Regulations making available sufficient time to finalize their formalities by the different Bodies in the University.
  18. The P.G. Regulations of 1989 and those of 2001 were published in November of the respective years, giving sufficient time to the Universities at  their  disposal to satisfactorily complete their formalities before the advent of the subsequent academic year which formally starts on 1st June. But the  present Amended Regulations of 2012 were  published in March 2012,  with no regard being given to this factor, thereby  depriving the Universities of their essential convenience  to complete their formalities inherent in a process of transition before the beginning of the new academic year.
  19. What is at stake today is that almost all the Universities which  started their courses for the academic year 2012-2013 in June, could  not invoke the amended CCH Regulations 2012 (published in March). So what is possible  and practical left to be resorted to at this time   is that the Universities may be allowed to follow their Regulations in force as on the date of starting their courses in this  academic year.
  20. It is, therefore, requested that the CCH may be appreciative enough to grasp the above factors and to relent themselves to postpone the implementation of the New Regulations to a later period  atleast after a spell of one academic year  that is in 2013-14. The meantime can be properly utilized for making the New Regulations in conformity with the HCC Act 1973. In anyway a significant factor to be looked into is that the Universities should be given atleast a period of 6 months for preparing themselves to implement every New Regulations.

Prof. (Dr.) Ravi M. Nair                                                                                                                        

  • Former Advisor (Homoeopathy), Dept. of AYUSH,  M/o. H&FW, Govt. of India,
  • Rtd. – Sr. Principal & Controlling Officer, Homoeopathic Education, Govt. of Kerala
  • Former Dean, Faculty of Homoeopathy, University of Kerala.
  • Former Chairman, Boards of Studies in Homoeopathy for U.G & P.G., University of Kerala.
  • Former Member, Academic Council and Senate, University of Kerala.
  • Former Member, Senate, The Tamil Nadu Dr. M.G.R. Medical University, Chennai
  • Former Member, Executive Committee, Central Council of Homoeopathy, Govt. of India
  • Former Member, Governing Body & Spl. Commitee on Drug proving, CCRH, Govt. of India
  • Former Hon. Project Advisor, Central Research Institute of Homoeopathy, Kottayam, Kerala.
  • Former Chairman,  Board of Examinations in Homoeopathy, Govt. of Kerala.
  • Member, Committee of Experts on Homoeopathic Education, Dept. of AYUSH, M/o. H&FW, Govt. of India
  • Member, Screening Committee for ROT & CME Programme, Dept. of AYUSH, M/o. H&FW, Govt. of India
  • Member, Governing Body & SFC, National Institute of Homoeopathy, Kolkata, Govt. of India
  • Advisor, Sarada Krishna Homoeopathic Medical College, Kulasekharam, K.K. Dist., (T.N.)
  • Director, Nascent  Academy of Homoeopathy, Thiruvananthapuram.

Email : drravimnair@gmail.com
Mob : 09446344344

Related Links

MCI invites suggestions from Public – Why not CCH?
www.similima.com/mci-invites-suggestions-from-public-why-not-cch

Suggestion by Dr Mansoor Ali  http://www.homeobook.com/cch-revised-post-graduate-homoeopathy-syllabus

Hindi Version of regulation :  www.similima.com/pdf/pg-homeo-regulations-2012-hindi.pdf

English Version of regulation  :  www.similima.com/pdf/pg-homeo-regulations-2012.pdf

MD Homeopathy Syllabus of CCH & Various Universities  : www.similima.com/mdhomeopathysyllabus-of-cch-universities

research

Effective Research Design

researchDr Mansoor Ali  MD(Hom)

Research Design is a protocol that determines and influences the condition with ground rules for collection and analysis of data.
An appropriate research design is a prerequisite for a valid study

Proposal for research
A carefully made proposal helps in

  • Efficient planning of research protocol
  • Clearly communicating objectives of research and researcher
  • Providing predetermined parameters for evaluating outcomes of study
  • Providing researcher with transparent guidelines to conduct study
  • Setting a time limit to conclude the process of study

Selection of the topic for study has to be based on certain criteria.

Priority health problems of the country / community – These are the issues that are listed by an authority like World Health Organisation, Government of India or a locally active health watch group that could be a non governmental organisation or a condition that you encounter very frequently in practice.

Appropriateness of the topic in homeopathic context – The topic selected should be relevant for treatment with homeopathy.

Professional development of the learner – The topic selected should provide sufficient scope for the research scholar to grow as an individual and professional.

Before you select the topic for research, deliberate on its importance in your own thinking, then consult your peer group, guide / supervisor and some learned people from outside your discipline

Infra structure for designing a research

  • Infrastructure to carry out study – Such an infrastructure should be available in the institute where the study is being done.
  • Competent resource person to guide through study – the guide should be sufficiently competent to review the research work and provide support to conduct the study. However, in case of interdisciplinary research, a co-guide from the parallel field may be co-opted to validate the study.
  • Sufficient human resources – Like the required kind of patients, paramedical staff, etc
  • Adequate financial resources – Some of clinical trials may require expensive pre and post study tests.
  • Satisfactory library and referencing resources

First Step – Hypothesis:

Research is essentially a process that enables testing of hypothesis

Hypothesis is a statement that intends to establish a positive relationship, negative relationship or a non-relationship among the variables.

Hypothesis testing is made on the basis of a study design and the further interpretation and projection of results obtained from the study are based on certain biostatistical tests. A research scholar needs to have adequate understanding of study designing and working understanding of biostatistics.

Once you are convinced that a study is justified and feasible, you need to state the null hypothesis and in case the study is planned as experimental study, the experimental hypothesis.

For example, in a study aimed at recording Socio-Economic Status of population attending homeopathic consultation in urban health centre, and considering the popular myth that lower Socio-Economic group does not patronise homeopathy, null hypothesis would be that ‘there is no Socio-Economic criterion for the people attending homeopathic consultation in urban health centre’. Experimental hypothesis would state that ‘population of lower Socio-Economic Group of population doesn’t attend homeopathic consultation in urban health centre’.

Second – Pilot Study:
To assess whether you have sufficient infrastructure, financial support and necessary human resources including appropriate and sufficient sample to carryout research.

Types of Research

1. Descriptive   and   Analytical
Descriptive research is concerned with describing a state or issue as it exists. This research is useful to describe frequency of diseases among geographic, gender, socio-economic, occupational groups. Research methods like survey are useful in such cases. Descriptive research doesn’t have control over the variables.

Analytical research makes use of the data that is already available and analyses these to evaluate and make discoveries.

2. Fundamental or applied research
Fundamental research is concerned with developing theories and making generalisations. It  may imply generating evidence for principles such as Homeopathic Pathogenetic Trials, Drug Dynamisation, etc.

Applied research is application of fundamental principles to evaluate their practicality or to find solutions through the laws of basic sciences. It implies discovering application of existing principles.

3. Qualitative or quantitative research
Qualitative research deals with phenomena that can be expressed in terms of features or attributes. Quantitative research deals with measurement of quantity or volume.

4. Conceptual or experimental research
Conceptual research is concerned with abstract ideas. It is more in tune with studies based on philosophy.

Experimental research on the other hand deals with studies that are dependent on experience and observation. Conceptual research may be opinion based, while experimental research is evidence based.  

Designs of study
Next phase of program is to identify which type of study is more appropriate for the research question and indicate how data will be collected and which statistical test will be used to analyse data.

There are two broad research designs – experimental and correlational

Experimental design is the one where variables can be clearly categorised as dependent and independent.

Correlational design there is neither dependent nor independent variable; each of the variables has some sort of affinity without being influential on each other.

The type of study where same group of subjects is used is called as Same Subject Design.

More than one group of subjects is involved, such study is referred to as Different Subject Design.

Same Subject Design is the one where the entire group of subjects is influenced by one independent or experimental variable at a time, followed by the second independent or experimental variable.

Different Subject Design is the one where each of different groups of subjects is simultaneously subjected to one independent / experimental variable at a time to assess their reaction . 

Types of Study

A. Descriptive

1.        Co-relational

a.   Case studies
b.   Case reports

2.        Case series

3.        Cross sectional surveys

B. Analytical

1. Observational studies

a.   Case-control study
b. Cohort study

                               i.     Prospective cohort study

                              ii.     Retrospective cohort (trohoc) study

2. Interventional / Experimental studies

a. Randomised clinical trial

Case series are based reports of series of cases of a particular condition. A series of treated cases of a particular condition may also be used in case series. There is no necessity to have a control group, as it is only an observational study.

Cross-sectional studies consist of data collection from a cross section of population. The cross section selected may be entire population at a specified time (prevalence study) or a specified population over a period of time. These are useful to investigate disease trends over a period of time, to plan for health services, etc. These studies are comparatively economical.

Case control studies are conducted to assess whether exposure to a certain risk factor has caused a disease in a population. These are retrospective, interventionist studies and are also called as trohoc studies (the reverse form of cohort).

Case control studies involve gathering a number of subjects who have the clinical condition and a comparable number of subjects who do not have that clinical condition.

The advantage of case control studies is that they are faster and economical as compared to cohort studies. They are also suitable to investigate for rare forms of diseases.

The disadvantage is that they may not be accurate as the time gap of exposure and disease development.

Cohort studies are used to investigate disease causation or to estimate what are the risk factors for a disease. A number of subjects are selected for study and are divided into two groups – one group that is exposed to a risk factor that is supposed to cause a disease, and the other group, which is not, exposed that risk factor. It has to be ensured that none of the subjects have that disease at the beginning of the study and that all the subjects share similar characteristics. These subjects are followed-up over a period of time and data from both the groups are collected, analysed and interpreted to describe the outcomes of study.

The advantage of cohort studies is that rare causes can be faithfully evaluated as being pathogenic. The disadvantage of cohort studies is that they take very long time to complete and these can be very expensive to conduct. Moreover, it could be ethically incorrect to pose healthy subjects to the risks of potentially fatal exposures.

Randomised Controlled Trial is a program in which study is done on two groups for assessing the comparative value of the treatment given. These two groups are termed as control group and experimental group. Control group is the one, which is given a standard treatment modality or placebo. Experimental group is treated with the medicine that is to be tested for its effect – that is homeopathy.

Single blind RCT
These studies are usually done with a ‘blinding’ effect, i.e., often the subjects – both control and experimental – will not know who is getting the medicine and who is getting the placebo or the standard treatment. This technique is called ‘single blind’ study.

Double blind’ RCT
In case both the attending doctor / supervisor as well as the subjects (both experimental and control) are aware as to who is getting what, it is called ‘double blind’ study.

The advantage of RCT is that it allows for the evaluation of effectiveness of a treatment. The evidence that it provides for the effectiveness is strong. The disadvantage is that it is expensive and complicated to organise and a large sample is needed.

Systematic reviews are the studies that are done to assess the cumulative value of a group of experimental studies.

Meta-analysis is a type of systematic review, in which data from individual research studies is gathered and this data is reviewed.

MAL meta-analysis where abstraction of data is done from published papers

MAP, which the data is collected from the authors of the original research for the data of sample units (individual patients) or the data is gathered from unpublished literature.

MAP analyses are said to be more acute and sensitive than MAL analysis

Phase of study
Are the different stages in developing a drug.

There are four phases in the development

 Phase I study is the earliest type of studies that are carried out in humans. They are typically done using small numbers (less than 30) of healthy subjects and are to investigate pharmacodynamics, pharmacokinetics and toxicity.

Phase II: studies carried out in patients usually to find the best dose of drug and to investigate safety. Phase III are generally the major studies aimed at conclusively demonstrating efficacy of drug and dose. They are sometimes called confirmatory studies and these are the studies on which registration of a new product will be based.

Phase IV are the studies that are carried out for marketing purposes as well as to gain broader experience with using the new product.

Reference:

  • Research Methodology – Dr.Niranjan Mohanty
  • Dissertation made easy – Dr.Munir Ahammed
  • Research Methodology – Dr.Munir Ahammed
  • www.scholar.google.com
Question

Research Questions

research-design-desinition-types-explainedDr T Geetha Prasanth

Research is ‘a quest for knowledge through diligent search or investigation or experimentation aimed at the discovery and interpretation of new knowledge’ (WHO)

The research questionnaire forms the frame work of the entire research process. So to be precise and to reach our goal without hassles and with minimum effort and at the same time to cover all relevant aspects of our topic, we need to give maximum attention to the questions we select.

By now, we are all familiar with different case taking methods in homoeopathic case taking and our experience teaches us that a well taken case is half cured.

To perform a good data collection especially for the research purpose, we need to give importance to certain points.

Selection of the topic: The topics can be selected

  • For educational purpose
  • In response to a public health issue
  • To verify certain rough data we came across during our clinical practice etc

Whatever may be the subject of the topic, it should be of your own interest.

A good research questionnaire should fulfill the following criteria;

  • It should be framed in such a way that it should be easily interpreted and digested by the people. Try not to poster but to communicate
  • It should give a clear idea about the topic, including the pathological changes etc
  • It should be ethical
  • Also should help to individualize the patient and lead to a similimum.
  • Leading questions and repetitions should be avoided.

Since the research is focused on a particular subject, the researchers should have a good idea about the effectiveness of the research to be conducted on society or particular section of population, importance should be given to the following points

  1. Age, 2.Sex, 3. Community.  4. Nationality 5. Occupation.  6. Economic status etc.

There should be questions to gather

  1. Physiological and pathological data connected with the subject.
  2. Results of the clinical investigations

The researcher should be thorough with the research subject. She/he should not hesitate to modify and re-modify the questions till one gets a good frame. Always bear in mind that these questions should be

  • Evocative
  • Relevant
  • Clear

Though there should be uniformity in research process, no strict schedule is recommended for case taking part of homoeopathic researches as the methodology of case taking adopted varies with doctors.

Formulate each question and evaluate it as follows

  • Whether this question render light to what the researcher have in his / her mind
  • Whether this question is reasonable and easily understood by the people
  • Make sure that the questions does NOT give much opportunity to the people to give unnecessarily lengthy and elaborate answers.

Finally
Go through the questions and answers and assess

  1. Why this question is important for this particular research?
  2. Does the abbreviations used in questions are correctly explained and answered by the people?
  3. Does the answers to your questions fulfill the following style
    1. the questions are formed in such a way that the answers received are in past tense
    2. The statistical data and data obtained during discussions are in present tense

In conclusion as an example, let us examine a recent research undertaken by the department of Homoeopathy-Kerala with the help of government of Kerala. The aim was to assess and improve the mental health, IQ and memory of students selected schools in all districts.

It was started uniformly 2 years back with the students of VIIIth standard. Students are supported in their studies by three factors

  1. By themselves
  2. By their family, especially parents
  3. By their teachers

So the questionnaire for this research purpose was formulated in such a way that all these three groups are included to assess a student. Separate and relevant questionnaire was given to the student, family and teachers and the mark list which is a very important document for this particular research was collected. A class was assigned to each doctor who first went through all these particulars and then individual case taking including thorough physical examination was conducted. Clarification, if needed as regards to the questionnaire filled by the parents/teachers or students are obtained. Medicine was selected after cross repertorisation and before the administration of medicine, once again the three groups were given an idea as what was being done.

This research is going on and so far the results are excellent and imparts enthusiasm and  optimism to the process of research to the participants

Courtesy:

  • www.icmr.nic.in
  • Guidelines for methodology and research evaluation of traditional medicine-WHO 2001
  • Ethical guidelines for biomedical research on human participants- WHO 2002 

Dr T  Geetha Prasanth
Medical Officer, Department of Homeopathy
Government of Kerala

Homeopathy and the New fundamentalism: a critique of critics

Lionel R Milgrom PhD, FRSC, MARH

Abstract
Though in use for over 200 years, and still benefiting millions of people world-wide today, homeopathy is currently under continuous attacks for being ‘unscientific’. The reasons for this can be understood in terms of what might be called a ‘New Fundamentalism’, emanating particularly but not exclusively from within biomedicine, and supported in some sections of the media. Possible reasons for this are discussed.

New Fundamentalism’s hallmarks include the denial of evidence for the efficacy of any therapeutic modality that cannot be consistently ‘proven’ using double-blind randomised controlled trials. It excludes explanations of homeopathy’s efficacy; ignores, excoriates, or considers current research data supporting those explanations incomprehensible, particularly from outside biomedicine: it is also not averse to using experimental bias, hear-say, and innuendo in order to discredit homeopathy. Thus, New Fundamentalism is itself unscientific.

This may have consequences in the future for how practitioners, researchers, and patients of homeopathy/CAMs engage and negotiate with primary healthcare systems.

Introduction
Acts of terrorism aside, in a pluralistic society intolerance can work far more insidiously on an intellectual level, by stifling and ultimately removing access to alternative forms of knowledge. For example, the evidence-based discourse that some think has ‘colonised’ much of contemporary conventional medicine,1 could be said to be based on a ‘naïve inductivist’ scientific paradigm2 (i.e., that purely objective observations can be made which lead to irrefutable facts: that generalisations can be induced from these facts; and that scientific laws and theories result from these inductions) which ideologically excludes alternative therapies (such as homeopathy), and their discourses. The discourse of Evidence-Based Medicine (EBM) has recently been compared to a ‘fascist’ structure for its active intolerance of pluralism in healthcare systems.1 As such; over-zealous interpretation of the principles of EBM could be said to promote an attitude that demeans and attempts to disempower practitioners and patients of homeopathy/CAMs; ultimately seeking to deprive millions of people of these therapeutic choices because they are considered ‘unscientific’. The uglier side of this attitude is displayed on Internet web-sites virtually on a daily basis.

An examination of such sceptical web sites reveals a high level of emotive subjectivity directed against CAMs, particularly homeopathy. Given the warnings these sites display, about not tolerating offensive language, it is remarkable that what can only described as abuse masquerading as debate, is allowed onto a widely-used communication medium: easier, perhaps, to ignore these websites, and go about one’s business. Unfortunately that would be to bury one’s head in the sand, for it is now appearing in mainstream literature.

Take, for example, the respected and influential UK Sunday newspaper The Observer. One of its columnists, Nick Cohen (ironically, a popular scourge of political correctness in what is essentially a left-wing newspaper) recently had this to say.3a “….Yet dismissing homeopathy as quackery given by and for the feeble-minded is surprisingly hard. Anti-elitism dominates our society and many feel uncomfortable saying that the six million people who take alternative medicines are foolish – to put the case against them at its kindest. They sincerely believe in phoney remedies and sincerity trumps sense in modern culture.” And, “(homeopathy’s) effects can be positively deadly”, a sentiment repeated recently in the Lancet.3

All this ignores conventional medicine’s own highly questionable safety record, something that has recently come under scrutiny from the UK’s House of Commons Public Accounts Committee. Thus, it concluded that in 2006 alone and including fatalities, at least 2.68 million people were harmed by conventional medical intervention: that represents a staggering 4.5% of the UK population.4

Clearly, homeopathy is being deliberately misrepresented when it is referred to as ‘deadly’, but is now considered fair game; to be lambasted and lumped together with religion and creationism, etc: a point of view that uncritically condones a Procrustean version of scientific rationality. From whence does it spring?

The New Fundamentalism
In the UK, attacks on homeopathy/CAM as non-valid therapeutic procedures emanate mainly from individuals such as Edzard Ernst (oddly, the UK’s first professor of CAM at the University of Exeter), Oxford academic and author Richard Dawkins, pharmacologist David Colquhoun, and some emeritus medical professors and doctors (including oncologist Michael Baum, and gerontologist and philosopher Raymond Tallis) who recently wrote to the Times newspaper urging health authorities to stop supporting ‘unproven’ therapies like homeopathy/CAMs.5 As well as the recently formed organisation Sense About Science, they and those like them around the world, I call the ‘New Fundamentalists’.  It is perhaps only fair to say at this point that not all scientists who value the essentially scientific principles behind EBM are ‘New Fundamentalists’; equally not all those who defend homeopathy/CAMs do so within a spirit of scientific enquiry.

New Fundamentalists tend to represent themselves as the last bastions of reason, against a perceived tide of irrational belief in, among other things, ‘quack’ medicines. Their certainty that all the evidence indicates homeopathy doesn’t work and, in fact, is positively deadly, leads them to ignore or condemn out of hand anything which contradicts their beliefs. And behind them, like some Eminence Gris, is the financial reach of the globalised pharmaceutical industry.

In the UK, the New Fundamentalists’ raison d’être is to ensure the total exclusion from the National Health Service of all what they consier to be ‘quack’ therapies, and to bring about the closure of the five state-funded homeopathic hospitals, regardless of the many who have and continue to benefit from them.5 Subsequently, there have indeed been reductions in NHS referrals to homeopathy, and the Royal London Homeopathic Hospital is currently under threat of closure.

Though no more than a clash of paradigms, and in the history of science nothing new; what marks the present attacks on homeopathy/CAMs as different is that we now live in an age of easily accessible mass communication. And the New Fundamentalists are helped in propagating their ‘quack-busting’ message by many in the media, some of whom share their beliefs.

Science, Education, And Determinism
Journalism was not always specialised. So any journalist interested in the subject or commissioned to do so, wrote about science. For, the fact is, a good investigative reporter can usually turn their hands to anything and write balanced entertaining copy. But over the last couple of decades this situation has changed.

Increasingly, one finds journalists and writers who are ex-science graduates and post graduates, many with a bio-medical sciences training.6 Either they became bored with the practice of science and sought something new, or they could not find long-term gainful employment in their chosen disciplines (I exclude here career scientists who write in order to popularise their subject).

Some universities now offer post-graduate conversion courses in science communication. In addition, scientists have realised their subjects are perhaps not as well understood as they would like by the general public who, through their taxes, pay for state-sponsored scientific research. This has led to a growing ‘industry’ in the public understanding of science.

And there is nothing wrong with that per se. Ideally in any democratic society, the public should be well informed and able to engage with the big scientific and ethical questions of the day, e.g., climate change and stem-cell research. Then through the democratic process they can have their input into political debate concerning the choices that need to be made.

Education has a vital role to play here, but in the last 20 years, there has been serious dumbing-down of school science curricula, and evidence that in the developed world, children are increasingly being turned off science.7 This may be partly due to fears of real hands-on and engaging curiosity-driven experience – chemistry experiments in particular, can be dangerous, and parents litigious – and that perhaps in their early teens, children tend to be more interested in other things (including each other) than science.

There are also the effects on education of what some consider is a Post-Modernist anti-elitism,3 part of whose agenda has been to deconstruct the assumed supremacy of scientific ‘truth’ over other forms of discourse.8 New Fundamentalists might argue this attitude is at least partly to blame for the current disenchantment with science in the developed world. Thus instead of being humanity’s crowning achievement or indeed its ‘saviour’, as science was perceived to be back in the 1950’s, it could be argued that science has become a slave to ‘the military-industrial complex’, globalised (e.g., pharmaceutical) profit, and a corporate arrogance that, for example, regards genes as nothing more than sets of privatisable molecular ‘Lego®’ bricks. Between boredom, raging hormones, and Post-Modernism, is it any wonder the kids are turned off science?

So, there is a felt need for more and better science communication and qualified communicators. However, in a media age where sound-bites rule, science has to compete for time and space in a crowded and increasingly commercialised media market place. Inevitably, this leads to over-simplification of complex scientific issues. Thus, though perhaps a readily accessible and media-friendly version of science, the New Fundamentalists’ naïve inductivism2 had its limitations pointed out in the 1950’s by Karl Popper,9 not to mention being undermined by Post-Modernism8 and other philosophical movements.

In all this, it is perhaps easily forgotten that science is not a homogeneous entity, and that its separate disciplines do not all share the same intellectual depth and rigour. For example, compare the largely ‘belt and braces’ empirical approach of bio-medicine (which in an A&E setting saves lives, but is not so effective in treating chronic conditions), with the intellectual subtlety and sophistication of quantum physics. And through concepts such as non-locality and entanglement, the latter offers a worldview profoundly at odds with the determinism embedded in Western culture since the Enlightenment.

The consequences of the quantum worldview – that there is a subtle, indissoluble link between observer and observed, such that the universe cannot always be considered objectively separate from us – is however an ontological and for some, disturbing conundrum even within the academic teaching of the subject.10 It is simply referred to as ‘quantum weirdness’;11 a telling phrase indicating how difficult the quantum world-view is to understand within the confines of deterministic Western thinking. Yet this subtle connection between observer and observed has long been recognised in the social, anthropological, and psychological sciences.12 It could well be that it has a much more important role to play in the healing process than is currently admitted to in conventional medicine: certainly it is beginning to inform non-deterministic explanations and interpretations of how homeopathy/CAMs might work.13 

Trials, Tribulations, and the Memory of Water
The combination of New Fundamentalism with some science writers’ natural desire to inform and educate the public, can provoke in them a crusading zeal to rid the world of unreason, thoughtless belief, and anything that cannot readily be proved and explained by ‘black and white’ deterministic science, e.g., homeopathy/CAMs. Unfortunately, such an attitude does not accommodate ‘grey’ very well: so, it defaults to black in order to establish ‘the truth’.

Take, for example, that ‘gold standard’ of research quality, the double-blind randomised controlled trial (DBRCT). Against placebo, it provides at best only equivocal evidence of homeopathy’s efficacy; some trials proving positive, while others return negative results. To a New Fundamentalist, such inconclusiveness is intolerable (especially as homeopathy appears to contradict the bio-molecular paradigm of conventional medicine); the negative trial data are taken as ‘true’, positive trial data discounted, and so homeopathy is considered as being no better than placebo, i.e., it does not work. Yet around the world, millions of people have benefited, and continue to benefit from homeopathy. This is usually discounted as mass delusion, the workings of the placebo effect, or self-hypnosis.

The assumption here is that the DBRCT is the best research tool with which to establish the evidence base of any therapy. Indeed, it could be argued that the DBRCT is predicated more on Popperian principles of falsifiability, than on naïve inductivism. However, deconstructing the DBRCT’s rationale reveals that it imposes on any therapeutic procedure an implicit and simplistic division of therapy from context. This turns out to be nothing more than an arithmetic convenience which allows the measurements made, statistics gathered, and inferences drawn from a trial, ultimately to have significance within a deterministic framework.

It has been demonstrated14 and explained (by analogy with quantum theory’s notion of wave-function collapse during observation),15 that this separation can seriously interfere with homeopathy/CAMs’ therapeutic effects. However, such an explanation of the inconclusiveness of DBRCTs of homeopathy/CAMs has recently been dismissed by New Fundamentalists as ‘quantum mysticism’.16

What tends to be forgotten by those who promote an over-zealous adherence to the DBRCT as the ‘gold standard’ for testing any therapy’s efficacy is that no therapeutic modality, conventional medicine included, is ever practiced in real life according to the DBRCT’s procedural separation of therapy and context. As a result, the evidence-based movement’s increasing hold on the health sciences is now being challenged (even from within conventional medicine), for its exclusion of alternative therapeutic discourses.1, 12
Explanations of how homeopathic remedies might work, e.g., the Memory of Water effect,17 are similarly discounted,18 regardless of mounting evidence suggesting that memory effects may indeed exist.19, 20 They can be explained in materials science terms, as homeopathy’s succusive dilution process inducing observable alterations to the dynamic supra-molecular structure of liquid water.20, 21 Yet, cancer physician Stephen Sagar, for example, has dismissed the Memory of Water hypothesis as a ‘belief in undetected sub-atomic (my italics) fields’.18 Far from delivering the intended coup de grace to the Memory of Water and homeopathy, the use of the term ‘sub-stomic’ might be seen as inappropriate when describing what is in essence current research in molecular physics, materials science, and chemistry.

This attitude could partly explain why there is so little published research on how cellular water memory effects might lead to cure of the whole patient:22 it would require much closer collaboration and understanding between biomedical and physical scientists than currently exists, assuming it ever were to achieve proper levels of funding.

INNUENDOES AND BAD SCIENCE
Besides ignoring or not understanding the latest research, New Fundamentalists can sometimes employ insinuation and innuendo in order to discredit homeopathy. For example, Edzard Ernst reported recently that trials of homeopathy performed by the Nazis (which had been considered ‘lost’) were so “wholly and devastatingly negative”, German homeopaths have covered it up ever since.23

Apart from the ethical problems involved in quoting uncritically the results of Nazi research (especially as conventional medicine is well-known to have benefited from the Nazis’ medical ‘experiments’),24, 25 Ernst’s source material has proved to be highly suspect..27-30 At best, Ernst might be considered to be acting unethically and unscientifically by endorsing essentially 60-year-old hearsay as a condemnation of homeopathy.

Though exposing every case like this is no doubt necessary (if only to bolster morale!), ultimately this is a reactive strategy and doesn’t advance the cause of homeopathy/CAMs very far. Just like the sound-bite or the attention-grabbing headline, it is the initial impression that sticks, not the more complex retraction buried in the back pages that appears months later.

Perhaps the most famous case of this in point is the by-now (in)famous 2005 Lancet ‘meta-analysis’ by Shang et al.31 This managed to conclude that homeopathy is no better than placebo, even though it patently failed to meet any of the generally accepted standards and criteria (e.g., transparency)32 for such meta-analyses, some of which the Lancet itself had laid down.33

This Lancet meta-analysis appeared during that peculiar late-summer news ‘quiet time’ in the UK media cycle known as the ‘silly season’. As a result, the media descended en masse on this putative ‘end of homeopathy’ story.34 It is perhaps not surprising, that the fact that the Lancet meta-analysis was totally debunked in the literature a few months later by many reputable researchers and scientists,35 went totally unnoticed by the media.

THE ‘JOYS’ OF HERDING CATS
So, we are left with the dilemma of how to address pro-actively the New Fundamentalism. Obviously research on efficacy and possible modes of action of homeopathy/CAMs must continue to be prosecuted, published and promoted. However, it is unlikely in the near term to command the media’s attention in the way New Fundamentalists can. Nevertheless, debating with them should continue because, though a thankless task, it keeps these issues alive and before the public, however one-sided (through media exposure) the debate may appear at times.

But first things first: there is the problem of achieving unity amongst the various CAM professions; a vital pre-requisite for any concerted action. And this is not trivial; homeopathy being a case in point.

From Hahnemann to the present day, its history has been one of such factionalism herding cats might seem a more tempting prospect than getting homeopaths to agree. Apart from homeopathy in the UK apparently having been overtaken by a particularly narrow-minded form of political correctness, the profession itself is fragmented. There are medical homeopaths, classical homeopaths, polypharmacists, homotoxicologists, etc, all with their associated professional organisations, and all incapable of agreeing on a unified way forward. For example, after over six years of increasingly bad-tempered negotiations, homeopathic organisations in the UK finally gave up trying to achieve the modicum of unity necessary for them to combine under a single register. This would have given them at least some modicum of regulatory transparency.

The message of disunity and unprofessionalism this sends out especially to government, plays directly into the hands of the New Fundamentalists and makes it easier for them to isolate and target the CAM professions one at a time. Homeopaths as a group have simply got to wake up and learn to unite among themselves, and with other CAM disciplines. There are however, some encouraging signs going forward.

First, the UK is currently in the throes of modernising its much-admired National Health Service (NHS). Policy makers have realised there is an explosion of interest in CAM both from within and outside the NHS. So, like CAM, primary health care is increasingly being seen as inherently holistic, patient-centred, and multi-professional.36 Add to this that CAMs are low-tech and low-cost, policy makers see them as resonating with the central themes of government health policy. These include a pro-actively health-oriented NHS and informed patient choice of relevant CAM options, as well as conventional health care: in other words, central government policy is moving more towards a model where patients ‘own’ their health and healthcare.

So, by-passing the New Fundamentalists’ insistence on a narrowly-defined deterministic evidence base for homeopathy/CAMs, what the policy-makers are really after in order to properly integrate them into primary healthcare are, a) evidence of cost-effectiveness; b) many real-life working examples of CAM therapies in action; c) proper regulation of CAMs; and d) good clinical governance. Homeopaths and homeopathic organisations need to urgently take note, especially of points c) and d).

Second, and again in the UK, homeopaths are becoming increasingly impatient with the institutionalised torpor of their professional organisations in the face of continued attacks in the media and literature. An organisation has been formed called ‘Homeopathy: Medicine for the 21st Century’ or HMC21, which is asking satisfied patients to sign a declaration saying homeopathy has worked for them.37 In the very short time since its inception, and with no publicity except a web-site, HMC21 has already gathered thousands of signatures world-wide, and sent a wake-up call to the UK homeopathic community. Ultimately they hope to harvest a quarter of a million signatures by the middle of 2008, and so achieve the critical mass needed to bring public opinion to bear on the problems of saving homeopathy in the NHS, and the state-funded hospitals that provide it. This has been mirrored politically in the UK’s House of Commons recently, where over two hundred MPs across all parties, signed an Early Day Motion to debate the future of the Royal London Homeopathic Hospital, despite being targeted by sceptics.38

CONCLUSIONS
The continuous attacks on homeopathy/CAMs for being ‘unscientific’, emanating from an informal combination of largely bio-medically-oriented scientists and sections of the media (collectively termed the New Fundamentalists), are themselves unscientific.  

Regardless of their lack of compliance to a narrowly-defined version of evidence-based discourse, homeopathy/CAMs are used successfully on a regular basis by millions around the world. In the UK, there will be increasing opportunities for homeopathy/CAMs to make significant contributions to primary healthcare within a modernising more holistic NHS, if they can provide evidence of cost-effectiveness; real-life efficacy; proper regulation; and good clinical governance.

One can only hope it is not too late for the homeopathy/CAM community to unite; for public opinion to be galvanised; and for their combined might to be brought to bear on government and NHS Trusts in order to retain their homeopathy/CAM services. It would be the best possible critique of the New Fundamentalists; and would mark, not as they hope ‘the end of homeopathy’ but as Winston Churchill once said in a different context and a different century, “the end of the beginning”.

Acknowledgements
In preparing this article, the author gratefully acknowledges the help of Ms Suse Moebius RSHom, and Ms Jane Wilkinson, Senior Research Fellow, University of Westminster. 

References

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  3. See a; Nick Cohen. The cranks who swear by citronella oil. The Observer, Sunday, October 28th 2007. http://www.guardian.co.uk/commentisfree/story/0,,2200815,00.html. Accessed on 30th October 2007: b; Ben Goldacre. Benefits and risks of homeopathy. The Lancet 2007;370 (issue no. 9600): 1671-2: c; Udani Samararasekara. Pressure grows against homeopathy in the UK. ibid. 1677-8.
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  6. Drillsma B. The barriers are down: EUSJA advances across Europe. EUSJA, Turku, Finland, 2006, ISBN 951-9036-65-2.
  7. Schreiner C and Sjøberg S. Science education and youth’s identity construction – two incompatible projects? In, Corrigan D, Dillon J, and Gunstone R (eds). The re-emergence of values in the science  curriculum. Sense Publishers, Rotterdam, 2007.
  8. a; Derrida J. Speech and Phenomena and Other Essays on Husserl’s Theory of Signs. Northwestern  University Press, Evanston IL, USA, 1973: b; Lakatoé I. The Methodology of Scientific Research  Programmes: Philosophical Papers Vol 1. Cambridge: Cambridge University Press, 1978: c;      Feyerabend P.  Against Method: Outline of an Anarchistic Theory of Knowledge. Atlantic Highlands,         N.J.: Humanities Press, 1975: d; Feyerabend P. Science in a Free Society. London: Routledge, 1979.
  9. Popper K. The Logic of Scientific Discovery. New York: Basic Books, 1959.
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  11. Minkel JR. The gedanken experimenter. Scientific American August 2007 issue.
  12. Barry CA. The role of evidence in alternative medicine: contrasting biomedical and anthropological approaches. Soc Sci Med 2006;62:2646-2657.
  13. See Milgrom LR. Conspicuous by its absence: the memory of water, macro-entanglement, and the possibility of homeopathy. Homeopathy 2007;96:210-220 and references therein.
  14. Weatherley-Jones E, Thompson EA, Thomas KJ. The placebo-controlled trial as a test of complementrary and alternative medicine: observations from research experience and individualised   homeopathic treatment. Homeopathy 2004;93:186-9.
  15. Milgrom LR. Are randomised controlled trials (RCTs) redundant for testing the efficacy of homeopathy? A critique of RCT methodology based on entanglement theory. J Altern    Complement Med 2005; 11: 831–838, and references therein.
  16. Water in biology. http://waterinbiology.blogspot.com/2007_08_01.archive.html accessed on  November 2nd 2007.
  17. Arani R, Bono I, Del Guidice E, Preparata G. QED coherence and the thermodynamics of water. Int J Mod Phys B 1995;9(15):1813-1841.
  18. a; Sagar SM. Homeopathy: does a teaspoon of honey help the medicine go down? Curr Oncol  2007;14(4): 126-7: b; Milgrom LR. Homeopathy, fundamentalism, and the memory of water. Curr  Oncol 2007;14(6):221.
  19. Unless one counts Jacques Benveniste’s later highly controversial research on the transmission of  digitized water memory effects via the internet: see http://www.digibio.com (accessed 4th November 2007), and comments upon this work, e.g., Thomas Y, Kahhak L, Aissa J. The physical nature of the  biological signal, a puzzling phenomenon: the critical contribution of Jacques Benveniste; in Water  and the Cell, Pollack GH, Cameron IL, and Wheatley DN (eds), Springer 2006, pp325-340; and   Jonas WB, Ives JA, Rollwagen F, Denman DW, Hintz K, Hammer M, Crawford C, and Henry K. FASEB Journal 2006;20:23-28.
  20. a; Samal S, Geckler RE Unexpected solute aggregation in water on dilution. Chem Commun 2001;21:2224-5: b; Rey L. Thermoluminescence of ultra-high dilutions of lithium chloride and  sodium chloride. Physica A 2003;323:67-74: c; Elia V, Niccoli M. New physico-chemical properties of extremely diluted aqueous solutions. J. Thermal Anal Calorimetry 2004; 75: 815 and references         therein.
  21. For example, see Chaplin M. Water structure and behaviour. Regularly updated online document www.lsbu.ac.uk/water/. Accessed October 30th 2007.
  22. Roy R, Tiller WA, Bell I, Hoover MR. The structure of liquid water; novel insights from   materials research; potential relevance for homeopathy. Mat Res Innovat 2005;9:559-576.
  23. a; Ernst E. The truth about homeopathy. Br J Clin Pharmacol, doi:10,1111/j.1365-2125.2007.03007x: b; Milgrom LR and Moebius S. Is using Nazi research to condemn homeopathy ethical or scientific?    Br J Clin Pharmacol (in press).
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  32. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of  meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of    Meta-analyses. Lancet 1999; 354: 1896–900.
  33. Fisher P. Homeopathy and the Lancet. Evid Comp Altern Med 2006 3(1):145-147.
  34. Editorial. The end of homeopathy Lancet 2005; 366: 690.
  35. See, for example, a; Bell IR. All evidence is equal, but some evidence is more equal than others: Can   logic prevail over emotion in the homeopathy debate? J Altern Complement Med 2005;11:763–769:   b; Frass M, Schuster E, Muchitsch I, et al. Bias in the trial and reporting of trials of homeopathy: A  fundamental breakdown in peer review and standards? J Altern Complement Med 2005;11:780–782:     c; Kienle H. Failure to exclude false negative bias: A fundamental flaw in the trial of Shang et al. J Altern Complement Med 2005;11:783: d; Peters D. Shang, et al. Carelessness, collusion, or   conspiracy? J Altern Complement Med 2005;11:779–780.
  36. Wilkinson J, Peters D, and Donaldson J. Clinical governance for complementary and alternative medicine in primary care. Executive summary of the final report to the Department of Health and   King’s Fund: October 2004.
  37. Defending choice in medicine. http://www.hmc21.org/. Accessed November 2nd 2007.
  38. See the web-site; http://homeopathy.wildfalcon.com/archives/2007/12/08/responses-from-signatories-to-homeopathy-parliamentary-early-day-motion/ accessed 21/12/07.
  39. Churchill WS. Speech given at The Lord Mayor’s Luncheon, Mansion House, London after The  Battle of El-Alamein: November 10th 1942.

Contact : The Homeopathy Research Institute,  63 Vale Road,
London N4 1PP:
Tel: 0044(0) 208 450 8760; and 0044(0) 7970 852156:
e-mail:  lionel.milgrom@hotmail.com

smell

A study of Allergic Rhinitis in children & Homoeopathy

smellA prospective study of Allergic Rhinitis in children & its Homoeopathic management.
Dr Nahida M Mulla

Abstract:
Allergic rhinitis is one of the most commonly diagnosed health disorders among children. AR affects up to 20 percent of children. Boys are twice as likely to get allergic rhinitis as girls. The median age of onset of the condition is 10 years old, meaning that equal numbers of children develop the condition before and after age 10. Half of children develop the condition before age 10, and half after that time. Allergic rhinitis is the most common chronic disease in children. About one in five children has symptoms by the age of 2 or 3 years .A study in  found that 42% of children were diagnosed with allergic rhinitis by the age of six.  Commonly called hay fever. Allergy symptoms can have a profound effect on a child’s health, behavior and ability to learn. Left untreated, allergic rhinitis also can lead to a host of other serious conditions, including asthma, recurrent middle-ear infections, sinusitis, sleep disorders and chronic cough. The present study was undertaken to fulfill the following objectives:  

Aims and Objectives:

  • To study the pattern of presentation of allergic rhinitis in children.
  • To study the miasmatic background and its implication on allergic rhinitis in children.
  • To study the Homoeopathic management of allergic rhinitis in children.
  • To study the efficacy of Homoeopathic remedies in the treatment of allergic rhinitis in children.

Material and Methods:

SOURCES OF DATA
The subject for this study were taken from A.M. Shaikh Homoeopathic Medical College and Hospital, OPD/IPD and village health camps.

METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE, (IF ANY)

Following is the inclusion criteria fixed for the study:

Subjects from 0-12 years and of both the sexes irrespective of socioeconomic status.

Following is the exclusion criteria fixed for the study:

  • Subjects with active treatment for any other chronic disease.
  • Subjects with worm infestations having high eosinophil count.

Patients were selected on the basis of inclusion & exclusion criterias. A detailed case history was taken with clinical presentation & necessary investigations were done.

Patients were reviewed on every seventh day for the first two months and later every 15 days for the remaining period of study.

No sampling procedure was adapted.

All the cases of allergic rhinitis were taken for the study, between the periods of December 2005 to 31st December 2007. (No new cases were taken up for the study after June 2007. only follow up was continued till December 2007).

Total Number of cases = 77.

CRITERIA OF BASIC ASSESSMENT OF RESPONSE:

(A)  Subjective: General condition; Appetite; Thirst; Bowels; Sleep; Itching.

(B)  Objective: Sneezing; Nasal discharge; Nasal obstruction.

Results: 1) To study the pattern of presentation of Allergic rhinitis in children.

SL NO.

PRESENTING COMPLAINTS

NO. OF CASES

PERCENTAGE (%)

1

Sneezing

56

73 %

2

Nasal discharge

48

62 %

3

Cough

44

57 %

4

Itching of eyes

39

51 %

5

Itching of nostrils

35

46 %

6

Increased   lachrymation

27

35 %

7

 Mouth breathing

20

26 %

8

Nasal obstruction

20

26 %

 2) To study the miasmatic background & its implications on Allergic Rhinitis in children.

S.No

Miasm Involved

No. of cases

Percentage %

1. Psora-syphilitic

4

5  %

2. Psora-Syco-Syphilitic

73

95  %

 3) To study the Homoeopathic management of Allergic Rhinitis in children.

REMEDIES — USED:

S.NO.

REMEDY

— USED

NO OF CASES

%

1. Ars Alb

20

26

2. Nux Vom

12

16

3. Pulsatilla

10

13

4. Sulphur

7

9

5. Nat Mur

7

9

6. Kali mur

3

4

7. Silicea

7

9

8. Calc carb

3

4

9. Nat sulph

4

5

10. Kali bich

4

5

4) To study the efficacy of Homoeopathic remedies in the treatment of Allergic rhinitis in children.

Conclusion:

The following valid conclusion can be drawn from the study.

  1. The maximum incidence of the patients suffering from allergic rhinitis is in the age group of 2-10  years.
  2. Males were found to be more prone to allergic rhinitis compared to females in this study.
  3. The constitutional remedies which gave maximum benefit to the patients were mainly Ars Album, Nux Vom, Pulsatilla, Sulphur, Nat Mur,  Kali mur, Silicea, Calc carb, Natrum sulph & Kali bich.
  4. The constitutional remedies gave maximum relief to the patients. The patient improved faster after the administration of constitutional remedies.
  5. The miasmatic and constitutional approach of treatment was only successful when they were integrated. This study gave me a better idea in my attempt to treat cases of Allergic rhinitis.
  6. Homoeopathic Management of Allergic rhinitis is able to annihilate the disease and helps to reduce the intensity and frequency of the episode of Allergic rhinitis.
  7. There is a better scope in Homoeopathic for the treatment of Allergic rhinitis, since the treatment is based on holistic and individualistic approach.
  8. Homoeopathic remedies not only annihilate the disease but also prevents the complications associated with it. However further studies need to be carried out to understand the finer menaces of the disease.
  9. This was a modest effort on my part to find the role of Homoeopathic medicines in the treatment of different types of Allergic rhinitis and the response in this study is quite satisfactory. 

Dr Nahida M Mulla
Principal, AM Shik Homoeopathic Medical College
Belagaum

Homeopathic Research is Perfect?

Dr Georgios Loukas   

Every day we have discussions with people who think suspiciously of homeopathy. On the other hand, some people are fanatics and convinced of its effectiveness. The latter are those who have experienced a spectacular cure in themselves or in their immediate family.

While homeopathy is not recognized by the majority of doctors, homeopaths considered the action of homeopathic medicine as a given, and therefore did not attempt to prove it. They therefore focused on experiments related to the action of certain substances aiming at enriching knowledge of homeopathic materia medica, without going into the process of proving to the ‘unfaithful’ how the homeopathic medicine works.

Some scientists often criticize homeopathy claiming that it uses medicines without knowing their action mechanism. This does not happen only in homeopathy. It is known that today there are several conventional medicines which are given by prescription and are effective, but we do not know their action mechanism. As an example I can mention aspirin and some antibiotics which, although they are given by prescription, their action mechanism is still unknown.

In order to consider the action of homeopathic medicine we must refer to a recognized principle in pharmacology called the “biphasic response of drugs”. According to this principle every medicine has two action phases that depend on dosage. Therefore, rather than the effectiveness of a medicine increasing with the increase of the dosage, research has consistently proven that very small dosages of a substance have the opposite result of larger ones. For example, it has been proven that the usual medical dosages of atropine inhibit the parasympathetic system and cause dryness in the pituitaries, while very small dosages cause increased secretions.

The above principle was discovered in 1870 simultaneously by Hugo Schulz and Rudolf Arndt. Initially it was named as the law of Arndt – Schulz and it has been registered in the medical dictionaries under this name until today. More specifically, these researchers discovered that weak stimuli accelerate normal activity, moderate stimuli suspend it and strong stimuli stop the activity completely. For example very weak concentrations of iodine, bromine, mercuric chloride and arsenic acid will enhance the development of yeast (fungus), moderate dosages of these elements will suspend it and large dosages will kill it.

The first officially registered study of the effectiveness of homeopathy was conducted in the 19th century when an epidemic of cholera broke out in the 1850s. When the mortality from cholera in London hospitals was announced in the Parliament, information from homeopathic hospitals was not included. One of the members of Parliament insisted on obtaining information from homeopathic hospitals. Due to his intervention, information about the enormous benefits of homeopathy in the treatment of cholera was presented. According to data from the homeopathic hospital of London, the mortality rate of patients suffering from cholera was 16,4% while in all other hospitals it was 51,8%.

The most serious attempts to prove the action of homeopathic medicine took place in the last century. Several research projects on the effectiveness of homeopathic medicine will follow below.

One group of studies refers to the individualized administration of homeopathic medicines. In 1991, three professors of Medicine from the Netherlands conducted a meta-analysis of the clinical studies of the last 25 years in which homeopathic medicines were used, and published the results in the British Medical Journal. (J. Kleijnen, P. Knipschild, G. ter Riet, “Clinical Trials of Homoeopathy,” British Medical Journal, February 9, 1991, 302:316-323).

This meta-analysis covered 107 controlled test-studies out of which 81 showed that homeopathic medicines are effective, 24 showed that they are not effective and 2 were inconclusive. The professors concluded that ‘the amount of positive results came as a surprise to us’. More specifically they noted the following:

13 out of 19 tests showed successful cure in cases of upper respiratory tract infection.
6 out of 7 tests showed positive results in the treatment of other infections.
6 out of 7 tests showed improvement in affections of the digestive apparatus.
5 out of 5 tests showed successful cure of spring allergy.
5 out of 7 showed faster recovery after intra-abdominal surgical operation.
4 out of 6 helped the cure of rheumatological diseases.
18 out of 20 showed benefit in the treatment of pain or trauma.
8 out of 10 showed positive results in the relief of mental problems.
13 out of 15 showed benefit in the cure of various diseases.

Despite the high percentage of studies providing successful data from the use of homeopathic medicines, most of these studies were – in one way or another – incomplete. However, researchers found 22 highly precise studies, 15 of which showed that homeopathic medicines were effective. It is of great interest the fact that 11 out of the 15 best studies showed that these natural medicines were effective, indicating that the better the design and execution of these studies, the higher the percentage of finding these medicines as effective.

This is not something that is observed only in the field of homeopathy; during the last 25 years, a similar percentage of incomplete studies is revealed by conventional medicine. Therefore the researchers of meta-analysis concluded that ‘the proof presented in this review would probably be satisfactory to establish homeopathy as a valid therapeutic method with specific therapeutic indications’. 

Another research project on the action of homeopathic medicine was an isolated study for the homeopathic treatment of asthma (David Reilly, Morag Taylor, Neil Beattie, et al., “Is Evidence for Homoeopathy Reproducible?” Lancet, December 10, 1994, 344:1601-6.).

Researchers at the University of Glasgow used conventional allergy tests to see which allergic substances the patients of asthma were most sensitive to. After defining the substances the patients were randomized into 2 groups – one to be treated with homeopathic medicine and the other with placebo. Patients to be treated with homeopathic medicine were given the substance they were most sensitive to in its 30th centesimal potency (the most common substance was the acarid from home dust.). The persons that participated in the experiment were examined and evaluated by homeopaths and conventional doctors. This study showed that 82% of the patients treated with homeopathic medicines had improved, while only 38% of those treated with placebo felt a similar relief.

Another study published in the American Journal of Pediatrics, examined the use of homeopathic medicine in the treatment of childhood diarrhea. (Jennifer Jacobs, L. Jimenez, Margarita, Stephen Gloyd, “Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua,” Pediatrics, May 1994, 93,5:719-25). Over 5 million children die every year of diarrhea mainly in non-industrialised countries.

This randomized double-blind study involving 81 children was conducted in Nicaragua in cooperation with the University of Washington and the University of Guadalajara. The results showed that, the individualized homeopathic medicine showed clinically and statistically significant improvement in the children’s diarrhea, compared to the children treated with placebo. Children that received homeopathic medicine recovered from infection 20% faster than the children treated with placebo. The children who were more sick reacted to the homeopathic treatment in a spectacular manner. In total the study used 18 different homeopathic medicines selected on an individualized basis according to the symptoms of each child.

In Italy, a study was conducted on the effectiveness of homeopathic treatment on migraine, with 60 patients who were chosen randomly and participated in the double-blind study. Patients filled in a questionnaire on the frequency, intensity and the characteristics of the headache (Bruno Brigo, and G. Serpelloni, “Homeopathic Treatment of Migraines: A Randomized Double-blind Controlled Study of 60 Cases,” Berlin Journal on Research in Homeopathy, March 1991, 1,2:98-106).

They were given homeopathic medicine, a single dosage of the 30th centesimal potency, which was repeated four times in total with two week intervals. Eight medicines were chosen and therapists were allowed to give any of the two medicines to each patient. While only 17% of placebo-treated patients felt relief from migraine, an impressive 93% of patients who were given homeopathic medicine had good results.

Another study concerning individualized homeopathic treatment focused on the effectiveness of homeopathy in the treatment of rheumatoid arthritis. (R.G. Gibson, S. Gibson, A.D. MacNeill, et al., “Homoeopathic Therapy in Rheumatoid Arthritis: Evaluation by Double-blind Clinical Therapeutic Trial,” British Journal of Clinical Pharmacology, 1980, 9:453-59).

The study included forty six patients. Two homeopaths prescribed individualized homeopathic medicines to every patient, although only half of them were given the real medicine; the rest were given placebo. The study showed that 82% of the patients treated with individualized homeopathic medicine felt some relief in their symptoms, while only 21% of the placebo-treated patients felt relief of a similar degree.

Apart from studies based on prescribed homeopathic medicines, there is also another research method where isolated medicines are tested based on the cause of the illness. It is known that if a toxic factor affects different diatheses, symptoms will appear related to the effect of the factor, regardless of the type of the diathesis. For example the symptoms from the bite of a poisonous snake in different diatheses are commonly independent from the diathesis of the person. Some of the studies conducted based on the cause of the illness are mentioned below.

During World War II the British government financed a research which was conducted separately in two different centres (London and Glasgow) using the double–blind control trial with similar results. (R.M.M. Owen and G. Ives, “The Mustard Gas Experiments of the British Homeopathic Society: 1941-1942, Proceedings of the 35th International Homeopathic Congress, 1982, 258-59).

The study concerned volunteers who had burns from neurotoxic chemical weapons (‘mustard gases’) and who received homeopathic treatment. The treatment scheme included Mustard Gas 30CH as a prophylactic substance, and Rhus Toxicodendron 30CH and Kali Bichromicum 30CH was given as treatment. The individuals that received the homeopathic treatment presented significant improvement.

It must be mentioned that researchers also tested the effectiveness of Opium 30CH, Cantharis 30CH and Variolinum 30CH, none of which proved to be effective. If research had only tested these medicines, researchers could have concluded that homeopathic medicines are not effective for the treatment of burns from the mustard gas. The key to an effective homeopathic treatment is and always will be the identification of the appropriate medicine.

Another illness for which the effectiveness of homeopathic treatment was proved is diabetic retinitis. (Zicari, et al., “Valutazione dell’azione Angioprotettiva di Preparati di Arnica nel Trattamento della Retinpatia Diabetica,” Bolletino de Oculistica, 1992, 5:841-848).

Retinitis is a complication of diabetes in which there is retina inflammation, causing vision problems, edema, and secretion from the eye and sometimes bleeding inside the retina. In the double–blind study of 60 patients Arnica 5CH was given. The results showed that 47% of patients treated with Arnica 5CH showed an improvement in the central blood flow of the eye, while only 1% of the placebo-treated patients showed this improvement. Additionally 52% of patients who received the medicine showed improvement in the blood flow in other parts of the eye as well, while only 1% of the placebo group showed a similar improvement.

In France, the best-selling anti-flu drug is actually a homeopathic medicine. Anas Barbariae 200CH, which is marketed under the trade name of Oscillococcinum TM, is highly effective during the early stages of flu. A double-blind study was conducted on 478 patients having the flu. (J.P. Ferley, D. Zmirou, D. D’Admehar, et al., “A Controlled Evaluation of a Homoeopathic Preparation in the Treatment of Influenza-like Syndrome,” British Journal of Clinical Pharmacology, March 1989, 27:329-35).

The study also indicated that almost double the number of the subjects who received the medicine overcame flu within 48 hours in comparison with those who received placebo.

Although the medicine seemed to be effective in all age groups, it showed its maximum action in subjects under 30 years old rather than in older subjects. However it was not proven effective in advanced symptoms of flu where homeopathic medicine with greater individualization of symptoms would be advisable.

In a study conducted in the University of Crimea (Influence of various dilutions of homeopathic drugs on blood sedimentation rate by E. Sokol, E. Tefukova, G. Loukas) the homeopathic medicines Arnica, Millefolium and Acidum Salicylicum were given in potencies of 6X, 12CH and 30CH in healthy subjects. In another group of 9 people, placebo was given. The medicine Salicylicum Acidum was the only one that caused an objective increase of ESR in relation to placebo. Later the medicine Salicylicum Acidum was given to a group of 10 people after it was boiled for 5 minutes. The results in this case did not differ from the group who took placebo.

Studies using animals and plants are also of significant interest. It was observed that the dispensing of the homeopathic medicine Apis Melifica 7CH- 9CH (a medicine that comes from the poison of the sting of a bee), had a protective effect in the erythema caused in guinea-pigs with ionized radiation. (J. Bildet, M. Guyot, F. Bonini, et al., “Demonstrating the Effects of Apis mellifica and Apium virus Dilutions on Erythema Induced by U.V. Radiation on Guinea Pigs,” Berlin Journal of Research in Homeopathy, 1990, 1:28).

In another experiment white mice were exposed to X radiation with a power of 100 to 200 rad (non lethal dosage) and were then evaluated after 24, 48 and 72 hours. Ginseng 6X, 30CH and 200CH and Ruta graveolans 30CH and 200CH were given before and after the radiation. In comparison to mice who received placebo, those who were administered with homeopathic medicines presented significantly less damage in cells and chromosomes. (A.R. Khuda-Bukhsh, S. Banik, “Assessment of Cytogenetic Damage in X-irradiated Mice and its Alteration by Oral Administration of Potentized Homeopathic Drug, Ginseng D200,” Berlin Journal of Research in Homeopathy, 1991, 1,4/5:254. Also Khuda-Bukhsh, A.R. Maity, S., “Alteration of Cytogenetic Effects by Oral Administration of Potentized Homeopathic Drug, Ruta graveolens in Mice Exposed to Sub-lethal X-radiation,” Berlin Journal of Research in Homeopathy, 1991, 1, 4/5:264).

There are over 100 research studies which evaluate the preventive and therapeutic action of homeopathic dosages of naturally toxic substances. Scientists from German research institutes and from America’s Walter Reed Hospital, worked together to conduct a meta-analysis of these research studies. (K. Linde, W.B. Jonas, D. Melchart, D., et al., “Critical Review and Meta-Analysis of Serial Agitated Dilutions in Experimental Toxicology,” Human and Experimental Toxicology, 1994, 13:481-92).

As was the case for the meta-analysis of clinical research for homeopathic medicines, it was now found that most studies were, in a way, incomplete. However, it was also found that in high quality studies positive results were more than double the negative ones. It was worth noting that researchers who tested dosages of sub-molecular level (potencies greater than 12CH), designed the most complete studies available and often with statistically more important results.

More specifically, several researchers gave, usually to mice, crude dosages of arsenic, bismuth, cadmium, mercuric chloride and lead. Research showed that animals which had been preventively given homeopathic micro dosages of these toxic elements and that received treatment with repetitive homeopathic dosages, after the exposure to crude dosages of the substances, excreted these substances in greater percentage through urine, stool and perspiration in comparison to the animals that received placebo.

German researchers concluded that milk cows that received Sepia 200CH, presented much less complications in giving birth than those taking placebo. (A.V. Williamson, W.L. Mackie, W.J. Crawford, et al., “A Study Using Sepia 200CH given Prophylactically Postpartum to Prevent Anoestrus Problems in the Dairy Cow,” British Homoeopathic Journal, 1991, 80:149. Also refer to the following by the same researchers: “A Trial of Sepia 200,” British Homoeopathic Journal, 1995, 84:14-20).

Other experiments showed that the administration of low potency medicine combinations such as the Lachesis, Pulsatilla and Sabina, or Lachesis, Echinacea and Pyrogenium, together with Caulophyllum, given to pigs, provided protective and therapeutic action against infections (inflammation of udders and uterus) as well as diarrhea in young swine. (G. Both, “Zur Prophylaxe und Therapie des Metritis-Mastitis- Agalactic: Komplexes des Schweines mit Biologischen Arzneimitteln,” Biologische Tiermedizen, 1987, 4:39).

Another study involving pigs showed that homeopathic medicines and especially Caulophyllum 30CH could reduce stillbirths. Pigs who received placebo, presented 103 normal births and 27 stillbirths (20.8%) while those who received Caulophyllum 30CH had 104 normal births and 12 stillbirths (10.3%). (Christopher Day, “Control of Stillbirths in Pigs Using Homoeopathy,” Veterinary Record, March 3, 1984, 114,9, 216. Also Journal of the American Institute of Homeopathy, December 1986, 779, 4:146-47).

In another interesting experiment, Thyroxine 30X (thyroid hormone) was placed in water for tadpoles. In comparison to the tadpoles who received placebo, the morphogenesis of tadpoles who received homeopathic dosages into frogs slowed down. Because the intake of crude forms of thyroxine accelerates the morphogenesis, it is logical from a homeopathy aspect that the intake of potentized thyroxine will slow it down. (P.C. Endler, W. Pongratz, G. Kastberg, et al., “The Effect of Highly Diluted Agitated Thyroxine on the Climbing Activity of Frogs,” Veterinary and Human Toxicology, 1994, 36:56. Also, P.C. Endler, W. Pongratz, R. van Wijk, et al., “Transmission of Hormone Information by Non-molecular Means,” FASEB Journal, 1994, 8, Abs.2313).

An extensive and very thorough research was conducted back in 1941-42 by W.E Boyd, a Scottish homeopathy scientist. (W.E. Boyd, “The Action of Micro doses of Mercuric Chloride on Diastase,” British Homoeopathic Journal, 1941, 31:1-28; 1942, 32:106-11). This research showed that micro dosages of mercuric chloride had a statistically significant effect in the action of diastase (an enzyme produced during the sprouting of seeds). This research was so carefully designed and executed that the dean of an American medical school commented that “the precision of Boyd’s technique sets an example of scientific study of the highest level”. (Mock, D., “What’s Going on Here, Anyway? A Review of Boyd’s ‘Biochemical and Biological Evidence of the Activity of High Potencies,'” Journal of the American Institute of Homeopathy, 1969, 62:197).

In a study conducted in the Moscow People’s Friendship University, the electric activity of the muscular wall of the stomach and duodenum was studied after the effect of the homeopathic medicine Nux Vomica (A. Zavadskaya, K. Privalova, S. Pasin, G. Loukas, Department of Homeopathy). In an experiment using cats the effect of the medicine Nux Vomica 30CH was studied after applying it to the region of electrodes in the cardia of the stomach, the body, the pylorus and the duodenal bulb. After the application of the medicine, the muscular activity in the body increased by 3.2 times, 2.1 times in the pylorus, while in the duodenal bulb it was reduced by 2.2 times. The experiment proved the ability of the homeopathic medicine Nux Vomica to have an effect on the function of the stomach. The results of this experiment agree with the results of the homeopathy experimental proof for this medicine.

In another research conducted in the same university, the endurance of mice under hypoxia conditions due to the administration of the homeopathic medicine Hydrogenium Peroxydatum 30CH was studied (A. Chochlov, A. Zavadskaya, Ch. Efstathiou, G. Loukas, Department of Homeopathy). Two groups of mice were used, one of which received homeopathic medicine and the other placebo. Mice who received placebo were the healthier ones while mice that received the homeopathic medicine were the weaker ones. An experimental model was used, where the two groups were placed under high altitude conditions. Mice that received the homeopathic medicine showed faster and better adaptation to hypoxia conditions. Furthermore, when they returned to normal conditions, they reverted to their normal state more quickly and had longer life duration than the mice of the other group.

In another research conducted in the same university, the effect of the homeopathic medicine Berberis vulgaris on the lymphatic drainage was studied (A. Zavadskaya et al.). Plant tincture and homeopathic medicines in the 3rd, 6th and 30th potency were given to mice. Initially the time of drainage of the coloring substance from the intestine to the mesentery was measured before providing any medicine. Then the various medicines were tested and the drainage time was measured. The study of the results showed that the potentized forms of Berberis vulgaris increase the lymphatic drainage while the corresponding plant tincture contains it. Especially the 3rd and 6th potencies increased the drainage more in the intestine than in the mesentery while the 30th increased it to the same degree in both the intestine and the mesentery.

We have discussed the results of certain studies concerning the effectiveness of homeopathic medicine.

For some, the above studies are adequate enough to prove the effectiveness of homeopathic medicine while for others, they do not prove anything. Although the best proof is the thousands of patients that have been helped from the application of homeopathy, there is a great interest in the progress of research on the effectiveness of homeopathic medicine.

Homoeopathic Medicine in Benign hypertrophy of prostate

Homoeopathic Constitutional Medicine in Benign hypertrophy of prostate
Dr Joby Johny

Introduction
“If I did not know for what purpose I was put here on earth -to become better myself as far as possible and to make better everything around me, that is within my power to improve- I should have to consider myself as lacking very much in worldly prudence to make known for the common good, even before my death, an art which I alone possess, and which it is within my power to make as profitable as possible by simply keeping it secret.” Dr. Samuel Hahnemann

The Organon and The theory of Chronic Diseases are two books by Hahnemann which reveal new thoughts and inspiration every time one gives a reading to them.

The theory of “The Chronic Diseases” – throws a light on the burning zeal in the heart of Dr Samuel Hahnemann for the alleviation of Human suffering. Hahnemann was a great servant, inquirer and discoverer; he was as true a man, without falsity, candid and open as a child, and inspired with pure benevolence and with a holy zeal for science.

Hahnemann himself observed that homoeopathic medicines were successfully curing his patients’ ailments, but that after a period of time some patients returned with similar but stronger symptoms, and he realized that the disease was actually progressing. This led him to think that the Homoeopathic physician with such a chronic (non-venereal) case has not only to  combat the disease presented before his eyes, but that he has always to encounter only some separate fragment of a more deep-seated original disease. This lead to the discovery of Chronic Miasms as the cause of chronic diseases.

The  true natural chronic diseases are those  that arise  from  a chronic  miasm, which when left to themselves, and  unchecked  by the  employment  of those remedies that are  specific  for  them, always  go on increasing and growing worse,  notwithstanding  the best mental and corporeal regimen, and torment the patient to the end  of  his  life  with  ever  aggravated  sufferings. The most robust constitution, the best regulated mode of living and the most vigorous energy of the vital force are insufficient for their eradication.

Hahnemann says “In Europe and also on the other continents so far as it is known, according to all investigations, only three chronic miasms are found, the diseases caused by which manifest themselves through local symptoms, and from which most, if not all, the chronic diseases originate; namely, first, syphilis, which I have also called the venereal chancre disease; then sycosis, or the fig-wart disease, and finally the chronic disease which lies at the foundation of the eruption of itch; i. e., the psora.”

This triune of the subversive forces  (chronic miasmata), are the vicarious embodiment of  the internal disease, each having its own peculiar type or  character by  which its sole purpose and effort is to conform the  organism to its nature. Each of these forces becomes a creative force, and at no time is the life force able to free itself the bond of  any of them (either alone or in combination with the others), without some assistance.

The introduction of these subversive forces into the organism (which has undergone a process of adaptation capable of receiving them) is followed by an endless history of subversive changes and diseased phenomena peculiar to each type. They have its primary, secondary and tertiary stages, and world of phenomena peculiar to itself accompanying each stage or setting of the disease.

We can summarize the different stigmata, remembering that  we may  get all shadings of all the stigmata in their  groupings  in our  patient,  but  one stigma will  predominate  above  all  the others.  They all have their  characteristic  differences.  The accentuation of  psora is functional; the  accentuation  of  the syphilitic  taint is ulcerative; the accentuation of  sycosis  is infiltration and deposits.   When  suppressed,  the syphilitic stigma spends  itself  on  the meninges  of  the  brain, and affects the larynx  and  throat  in general, the eyes, the bones and the periosteum.   Psora spends its action very largely upon the nervous system and the  nerve centres, producing functional disturbances, which  are better by surface manifestations.   Sycosis  attacks the internal organs, especially the pelvic  and sexual  organs.  In  this  stigma we  find  the  worst  forms  of inflammation,  infiltration  of the  tissues  causing  abscesses, hypertrophies,  cystic  degeneration; when thrown back  into  the system  by  suppression  this  stigma  causes  dishonesty,  moral degeneracy and mania.

Benign prostatic hypertrophy (BPH) is a benign tumor that originates from periurethral prostatic tissue. So, it should be due to underlying sycotic miasm. In BPH, the normal elements of the prostate gland grow in size and number. The important symptoms of benign prostatic hypertrophy (BPH) – progressive urinary frequency, urgency, and nocturia are due to incomplete emptying and rapid refilling of the bladder.

Benign prostatic hypertrophy (BPH) is rare before the age of forty. After the age of fifty, approximately 50 percent of males manifest typical symptoms and lesions histologically, and after the age of eighty, 75 percent of males are so affected. Based on autopsy studies, the prevalence of histologically diagnosed BPH increases from 8% in men aged 31 to 40 year to 40 to 50% in men aged 51 to 60 year and > 80% in men older than 80 year. Based on clinical criteria in men aged 55 to 74 year without prostate cancer, the prevalence of  BPH is 19% using the criteria of a prostate volume > 30 mL and a high International Prostate Symptom score.

Modern Medicine, through Medical textbooks, has taken pains to name various clinical conditions (syndromes) and infections in an attempt to create some order in the chaotic world of disease expression. In spite of this detailing of symptom presentation for a diagnosis of disease, these authors (all well-read and experienced MD’s) would be the first to admit it is often difficult to get a grasp of a clear diagnosis when a patient presents clinically. When diagnosis becomes the only basis for treatment (as in Modern Medicine), one is lulled into a false sense of complacency that after making a diagnosis, one has the answer to treating disease! A truly sincere MD will confess that more often than not in the clinical situation, they have NO IDEA what (disease) they are dealing with, much less being able to cure it!

The scope of Homeopathy primarily relates to the dynamic pathology of diseases and not the organic pathology.  Primarily Homeopathy has nothing to do with any product of disease, although secondarily it is related to all of them. The morbid processes from which the gross pathological tissue changes or organic lesions arise or to which they lead are amenable to Homeopathic medication. Homoeopathy is the best therapeutic method which can avoid many dangerous surgeries, injections and hormone therapies.

As is obvious, any patient must be treated on its individuality and not on the disease symptoms. BPH is a condition, which may mislead any physician due to dominance of disease symptoms taking priority in the hands of patient. He is so disturbed, so embarrassed that he will sometimes not give importance to his particular, uncommon peculiar and constitutional symptoms. It is prudent for a physician to take some symptoms for relief of the patient as palliative measure but if he wants to give him permanent or long lasting relief, a proper prescription on the basis of miasm, constitution, individuality, general and particular symptoms is important.

My topic of study is ”Clinical study on the predominance of sycotic background in benign prostatic hypertrophy and the efficacy of homoeopathic constitutional medicine in the management of benign prostatic hypertrophy.” In my observation I found that as a student of Homoeopathic system of medicine, Homoeopathic Medicines especially anti sycotic medicine shows a considerable control upon the growths, and therefore I presume that it can play a vital role in the successful treatment of benign prostatic hypertrophy.  Hence further investigations and studies will be useful in this regard.

Aims and Objectives: –

  1. To study the predominance of sycotic miasm in benign prostatic hypertrophy.
  2. To study the efficacy of homoeopathic constitutional medicine in the management of benign prostatic hypertrophy.

DISCUSSION
To arrive at a valid conclusion, I am indebted to discuss some of the findings that have evolved out of this study. The result is exclusively based on the observation and result presented in former section.

1. Age incidence: The incidence was maximum in the age group 50 -55. The next greater prevalence was in age group 56 – 60.

2.Domicile: Rural population amount to 26.67% and urban population 73.33%. It may be due to the particular diet habits and sedentary life style of urban people which are contributors to the progress of sycotic miasm.

3.Distribution of patients according to socio economic class:-In this study conducted, benign prostatic hypertrophy is found more among middle class (66.7%)

4.Distribution of patients according to associate complaints:-In this study conducted benign prostatic hypertrophy is found to be associated with infiltration and deposition of various organs and tissues which confirms the sycotic predominance in BHP patients. In USG renal calculi, renal cortical cyst and fatty liver and in analysis of case records warts, hydrogenoid constitutions etc which are all pathologies having base on sycotic miasm are found associated with BHP.

5.Economic aspect: Only 13% of the total patients were in the poor economic class. Majority belonged to middle and higher class, showing the more prevalence of disease among the middle and higher class due to their life style.

6.Distribution of clinical features: Among the symptoms given in the IPSS sheet, the predominance of the symptoms were noted as follows, Incomplete emptying of bladder (16%), increased frequency of micturation (16%), urgency (15%), weak stream (14%), straining (13%), nocturia (13%) intermittency (13%).

7.Distribution of miasm: All patients showed predominance of sycotic miasm. From the analysis of the general and particular symptoms (total 430 symptoms) of the 30 cases, it has been noted that sycosis shows maximum predominance, 57.67 % of symptoms. Psora shows a predominance of 22.56%, syhilis 11.63% and pseudopsora 8.14 % of symptoms

8.Evaluation of change in disease criteria: The comparison of the USG measurement of prostate and the IPS Score before and after treatment showed statistically significant result.

9.Medicines used: Among 30 cases medicine indicated most of times is Thuja- 23%. Then Medorrhinum 10%, followed by Calc carb, Causticum, Conium mac, Lyco, Pulsatilla, Staphysagria, Sulphur 7%. This shows the effectiveness of antisycotic constitutional drugs in the treatment of Benign prostatic hypertrophy.

CONCLUSION
From the evaluation of results obtained after the statistical analysis of the benign prostatic hypertrophy cases, it is obvious that sycotic miasm shows a pre-dominance of 57.67%.

  • Anti-sycotic medicines like Thuja, Medorrhinum, Staphysagria, Causticum, Conium mac were found to be effective. Also trimiasmatic medicines like Calcarea carb, Lycopodium also found to be effective.
  • By anti-miasmatic constitutional treatment it is found that the enlargement of prostate can be retarded or prevented. Miasmatic symptoms should be given prime importance in the selection of remedy.
  • The other observed facts in this study are the maximum representation was from the age group 50 -55. The next greater prevalence was in age group 56 – 60
  • Complaints such as renal calculi, fatty infiltration of liver, renal cortical cyst, and gallstone were found to be associated with benign prostatic hypertrophy.
  • It is found that the comparison of the USG measurement of prostate and the IPS Score before and after treatment showed statistically significant result. It can also be claimed that Homoeopathy is safe, simple, less expensive and more effective in treating benign prostatic hypertrophy cases. Unnecessary surgery can be avoided.
  • Homoeopathy as a system of medical treatment has a philosophy of its own and its therapeutics is based on certain fundamental principles.  Out of these fundamental principles theory of chronic disease play a vital role in treating chronic cases.

To conclude in Hahnemann’s words “He, who has had as many opportunities as I to make observations,… he, who is induced by his desire for the welfare of his fellow beings to think and act for himself, he, who like myself feels hatred for the prejudices and preferences for old or new, or, generally speaking, for any kind of recognition or great name, and he, who eagerly endeavours, as I myself have done, to act and to think independently…. he will see excellent results for his industry which is the greatest reward that an honest physician can expect”.

Limited reliability can only be guaranteed with such a study involving a chronic disease with 30 cases, for 2 year period. A long term follow-up study will be more reliable. Increasing the sample size can be considered in further studies, to furnish more statistical evidence. Comparative studies involving other systems of medicines can also be accomplished with better results.

Dr Joby Johny  BHMS,MD(Hom)
Medical Officer, Department of Homoeopathy, Govt of Kerala
Email : drjobyjohny@yahoo.com

Download full paper : www.homeobook.com/pdf/homoeopathy-bhp.pdf  v

Childhood CT scans linked to leukemia and brain cancer

NIH study finds childhood CT scans linked to leukemia and brain cancer later in life

Children and young adults scanned multiple times by computed tomography (CT), a commonly used diagnostic tool, have a small increased risk of leukemia and brain tumors in the decade following their first scan. These findings are from a study of more than 175,000 children and young adults that was led by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and at the Institute of Health and Society, Newcastle University, England.

The researchers emphasize that when a child suffers a major head injury or develops a life-threatening illness, the benefits of clinically appropriate CT scans should outweigh future cancer risks. The results of the study were published online in The Lancet on June 7, 2012.

This cohort study provides the first direct evidence of a link between exposure to radiation from CT and cancer risk in children,” said senior investigator Amy Berrington de González, Ph.D., Division of Cancer Epidemiology and Genetics, NCI. “Ours is the first population-based study to capture data on every CT scan to an individual during childhood or young adulthood and then measure the subsequent cancer risk.”

Nurse practitioner reviews films from a CT scan of the brain.

Despite the elevation in cancer risk, these two malignancies are relatively rare and the actual number of additional cases caused by radiation exposure from CT scans is small. The most recent (2009) U.S. annual cancer incidence rates for children from birth through age 21 for leukemia and brain and other nervous system cancers are 4.3 per 100,000 and 2.9 per 100,000, respectively. The investigators estimate that for every 10,000 head CT scans performed on children 10 years of age or younger, one case of leukemia and one brain tumor would occur in the decade following the first CT beyond what would have been expected had no CT scans been performed.

CT scans deliver a dose of ionizing radiation to the body part being scanned and to nearby tissues. Even at relatively low doses, ionizing radiation can break the chemical bonds in DNA, causing damage to genes that may increase a person’s risk of developing cancer. Children typically face a higher risk of cancer from ionizing radiation exposure than do adults exposed to similar doses.

The investigators obtained CT examination records from radiology departments in hospitals across Britain and linked them to data on cancer diagnoses and deaths. The study included people who underwent CT scans at British National Health Service hospitals from birth to 22 years of age between 1985 and 2002. Information on cancer incidence and mortality from 1985 through 2008 was obtained from the National Health Service Central Registry, a national database of cancer registrations, deaths and emigrations.

Approximately sixty percent of the CT scans were of the head, with similar proportions in males and females. The investigators estimated cumulative doses from the CT scans received by each patient, and assessed the subsequent cancer risk for an average of 10 years after the first CT. The researchers found a clear relationship between the increase in cancer risk and increasing cumulative dose of radiation. A three-fold increase in the risk of brain tumors appeared following a cumulative absorbed dose to the head of 50 to 60 milligray (abbreviated mGy, which is a unit of estimated absorbed dose of ionizing radiation). Similarly, a three-fold increase in the risk of leukemia appeared after the same dose to bone marrow (the part of the body responsible for generating blood cells). The comparison group consisted of individuals who had cumulative doses of less than 5 mGy to the relevant regions of the body.

The absorbed dose from a CT scan depends on factors including age at exposure, sex, examination type, and year of scan. Broadly speaking, two or three CT scans of the head using current scanner settings would be required to yield a dose of 50 to 60 mGy to the brain. The same dose to bone marrow would be produced by five to 10 head CT scans, using current scanner settings for children under age 15.

In countries like the United States and Britain, the use of CT scans in children and adults has increased rapidly since their introduction 30 years ago. Due to efforts by medical societies, government regulators, and CT manufacturers, scans performed on young children in 2012 can have 50 percent lower radiation doses, compared to scans carried out in the 1980s and 1990s, say the investigators. However, the amount of radiation delivered during a single CT scan can still vary greatly and is often up to 10 times higher than that delivered in a conventional X-ray procedure.

The lead author of the study was Mark S. Pearce, Ph.D., Institute of Health and Society, Newcastle University. “CT can be highly beneficial for early diagnosis, for clinical decision-making, and for saving lives. However, greater efforts should be made to ensure clinical justification and to keep doses as low as reasonably achievable,” said Pearce.

 Source :  http://www.nih.gov/news/health/jun2012/nci-07.htm

Delhi zoo uses Homeopathy medicine to treat animals

tigerNEW DELHI: It’s not part of the regular treatment but in a pinch, alternative medicine in the form of homeopathy, ayurveda or herbal concoctions, does the trick. And the doctors responsible for animals at the National Zoological Park, Delhi, find, that they sometimes work when allopathy doesn’t.

“We started using them seven-eight years ago,” says Delhi zoo veterinary officer Paneer Selvam. “We get them wheneve necessity arises.” The zoo’s standard line of treatment is allopathy but whenever a particularly difficult case comes up, Selvam consults practitioners of alternative medicine. ‘About two years ago, one of the Asiatic lions had hind-quarter paralysis. Another one developed the condition some time back.

In both cases we first tried with allopathic treatment but when that didn’t work we used homeopathic treatment,” says Selvam, “In my experience, we have got good results.” A Himalayan black bear that was afflicted with the same condition a year ago and was cured by homeopathy. “Many of the zoo vets prefer to try alternative medicine now,” says Selvam.

One of the first time he tried it was some years ago with an old white tiger with a stone in the urinary bladder. Surgery was too much of a risk for the aged tiger and homeopathy was used instead. But the black herbal concoction, a potent medicine for wounds, Selvam’s been using for a decade. “It is a very good ointment for maggot wounds,” he says.

The zoo doesn’t stock homeopathy or ayurvedic medicines. The vet says that homeopathic courses typically last for about three months and they stock enough for one. The decision to attempt the other lines for treatment isn’t Selvam’s own. Health issues pertaining to animals at the zoo are attended to by a health committee that consists of a team of doctors and meets once in three months.

Source : http://timesofindia.indiatimes.com/city/delhi/Delhi-zoo-uses-alternative-medicine-to-treat-animals/articleshow/13849952.cms

Homeopathy India – Google Groups

Technical problems corrected…now everyone can join – Homeopathy India

This Google group is open to all Homeopathy students, teachers, associations and professionals in India.

You can post and discuss anything related to Homeopathy.

To join/post to this group, visit  https://groups.google.com/group/homeopathy-india  or  Sign in and apply for membership

Following are some things you can do with this Google Groups:

  • Engage in serious discussions about a specific subject, topic, problems or cases.
  • Organize meetings, conferences, or social events among members of a group.
  • Discussion with teachers, leading practitioners, policy makers and stalwarts
  • To raise our voice against the threats and mal practices
  • To provide quality medical care to all Indians by promoting  excellence in Homeopathic education
  • For a better media coverage to homeopathy
  • Helping the young buds on Clinical practice, career and Placement
  • To discuss various problems faced by practitioners, students and teachers in Homoeopathy…and many more  

You can read group posts through email, the online interface, or both.

Your suggestions are invited

patients2

Current status of homeopathic research

patients2Dr Achamma Lenu Thomas   MD(Hom)
Medical Officer, Department of Homeopathy
Govt. of Kerala

Many of the research works in homeopathic field are done in an unscientific manner. When research is not conducted in proper scientific way and when there are no valid statistical data it becomes unacceptable to the scientific community.

Clinical research is an area where we cannot make a lot of mistakes so each and every step of the research has to be properly planned.

Flow chart of research
Confirm the availability of resources – time, money and men

Define the problem we are going to study, its aims and objectives, the type of study we are conducting and the statistical test we are going to apply.

Consult a bio statistician and find out about the feasibility of the study, whether the test we are going to apply is appropriate, seek expert opinions from him.

Read the latest developments in the topic we are going to study, read the research papers done earlier about this topic.

Work out a time table

Set up a case record which includes the diagnostic criteria and scaling of symptoms

Prepare a master chart

Case taking, repertorisation, selection of similimum and follow up

Statistical analysis and conclusions

Presentation of research work in form of thesis or an article or as paper to be presented of scientific seminars

Areas of Committing mistakes by a newcomer to research
Scaling of symptoms not recorded in the case format

Scaling of symptoms has to be recorded in the case record. Suppose if the research work is completed and we forgot to do the scaling of symptoms before the treatment, it will be difficult to find out whether a particular patient had a particular symptoms at the time of starting the research.

A sample size above 30 is considered as an appropriate sample which gives a more or less unbiased report about the population. A new comer or a student who fixes the sample size as 30 must bear in mind that 3 or 4 patient may drop out in midst of research due to various reasons.

One of the areas where bias becomes a problem is when the investigator has to deal with subjective information only. In such cases a report of patients condition obtained by a third person can be recorded.

Remember our research works can be a topic of investigation for another research worker who wants to challenge our conclusions. Further Govt. has published a list of disease for which a claim to complete cure is considered as illegal. So claims the “Effectiveness of homeopathic medicines in the cure of psoriasis” should be made after due consideration.