Homeopathy or isopathy? - Letter to the Editor

Journal of Family Practice, Nov, 2002 by Mitchell A. Fleisher

TO THE EDITOR:

I would like to point out a major flaw in the article by Dr McCarter, (1) which appeared in the "Patient-Oriented Evidence that Matters" section of the July 2002 issue of thee Journal of Family Practice, and similarly in the study Dr McCarter reviewed. Essentially, the study by Lewith and colleagues (2) was not truly an evaluation of homeopathy per se, but of isopathy. The medication used was not prescribed according to the fundamental principles of homeopathy and therefore would not be expected to work.

Isopathy (derived from "isos pathos" or "equal suffering") refers to the use of the exact substance that causes an illness as a therapeutic tool for that same illness. Isopathy is the principle underlying conventional immunotherapy, eg, vaccinating with measles in an attempt to prevent measles, injecting pollen extract to try to subdue pollen allergies, etc.

Homeopathy (derived from "homoios pathos" or "similar suffering") is founded on the principle of similars. A medicinal substance that can produce a certain set of symptoms in healthy persons in a clinical investigation, can be used to stimulate a curative response in individuals experiencing a similar set of symptoms in an innate disease process.

To select the correct homeopathic medicine, one must elicit the totality of characteristic physical, emotional, and mental symptomology, making a careful analysis of the symptom picture. The homeopathic medicine possessing the ability to induce the most similar symptom picture to that being experienced by the patient is the one chosen for therapeutic intervention and has the greatest probability of cure in a given case. Using the true homeopathic approach is of utmost importance when treating complex diseases such as asthma and allergic diatheses, as well as autoimmune disorders, colitis, migraines, etc, if one is to achieve genuine therapeutic benefit.

In isopathic immunotherapy, none of the fundamental steps of case taking and case analysis, which are critical to the selection of the clinically appropriate homeopathic medicine, are undertaken. It is no small wonder that isopathic immunotherapy, as that used in the study by Lewith and associates, (2) would be ineffective in some cases.

Mitchell A. Fleisher, MD, DHt, FAAFP
Clinical Faculty, National Center for Homeopathy
Nellysford, Virginia
E-mail: info@alternativemedcare.com.

DR MCCARTER RESPONDS:

As Dr Fleisher indicates, isopathy is not synonymous with homeopathy. Isopathy is 1 of 4 basic types of homeopathy. Homeopathy as described by Dr Fleisher is considered by some authorities to be "classical homeopathy," another of the 4 basic types of homeopathy. (3) Lewith et al (2) were indeed using the isopathic form of homeopathy in their study. They were attempting to validate the method used in a smaller pilot study that showed a benefit to isopathic homeopathy) However, their results in this larger well-done study did not show a benefit.

The real issue is not the specific form of homeopathy used or even the proper definition of homeopathy; the article by Lewith and colleagues was not chosen for review because of the negative findings for homeopathy. It was selected because they studied the treatment of a common problem encountered by family physicians every day and measured patient-oriented outcomes. Ultimately, whether the treatment studied was homeopathy, isopathy, acupuncture, or a new pharmaceutical is immaterial. When a physician makes a treatment decision with a patient, he or she should have evidence of benefit before substituting a new' therapeutic modality for an already effective treatment.

Daniel F. McCarter, MD
Department of Family Medicine
University of Virginia
Stoney Creek Family Practice
Nellysford, Virginia
E-mail: dmccarter@virginia.edu

REFERENCES

(1.) McCarter DF. Homeopathy ineffective for asthma. J Fam Pract 2002; 51:602

(2.) Lewith GT, Watkins AD. Hyland ME. et al. Use of ultramolecular potencies of allergen to treat asthmatic people allergic to house dust mite: double blind randomised controlled clinical trial. BMJ 2002; 324:520-3.

(3.) Linde K, Jobst KA. Homeopathy for chronic asthma (Cochrane Review) In: The Cochrane Library. Issue 2, 2002. Oxford, England: Update Software.

(4.) Reilly D. Taylor MA, Beattie NG, et al. Is evidence for homeopathy reproducible? Lancet 1994; 344:1601-6.