September 2018 - The Need for a Sustainable Medical System like Homeopathy

1. ͞The Need for a Sustainable
Medical System like
Homeopathy in a Chronic
Diseased World͟
REFLECTIVE ARTICLE
By Narain Mahtani H
BSc Biomedical Sciences

2. The Need for a Sustainable Medical System like
Homeopathy in a Chronic Diseased World
According to the U.S National Center for Health Statistics a chronic disease is defined as such
when it persists for at least a period of 3 months or more, and they cannot be prevented by
vaccines or cured by medication, nor they just disappear.
Having given a definition of chronic diseases, did you know that according to the World Health
Organization (WHO) the burden of chronic diseases is rapidly increasing worldwide? It has been
calculated that, in 2001, chronic diseases contributed approximately 60% of the 56.5 million total
reported deaths in the world and approximately 46% of the global burden of disease. The
proportion of the burden of NCDs (non communicable diseases) is expected to increase to 57%
by 2020. Almost half of the total chronic disease deaths are attributable to cardiovascular
diseases; obesity and diabetes are also showing worrying trends, not only because they already
affect a large proportion of the population, but also because they have started to appear earlier
in life.This might seem unbeleiveable
but these are the facts, and there’s no
masking or manipulation of any sort of
data, it’s a pure and true scenario.
But there is more. It has been projected
that, by 2020, chronic diseases will
account for almost three-quarters of all
deaths worldwide, and that 71% of
deaths due to ischaemic heart disease
(IHD), 75% of deaths due to stroke, and
70% of deaths due to diabetes will occur in developing countries. The number of people in the
developing world with diabetes will increase by more than 2.5-fold, from 84 million in 1995 to
228 million in 2025. On a global basis, 60% of the burden of chronic diseases will occur in
developing countries. Indeed, cardiovascular diseases are even now more numerous in India
and China than in all the economically developed countries in the world put together. As for
overweight and obesity, not only has the current prevalence already reached unprecedented
levels, but the rate at which it is annually increasing in most developing regions is substantial.
The public health implications of this phenomenon are staggering, and are already becoming
apparent.
Now think about this: with the rate of numbers of patients suffering from these chronic diseases,
would there be any health system in the world able to support the costs of this impact in the way
they have been handling the situation until present time? Let’s take a close look at some
overwhelming data regarding this fact in conventional medicine.
The Crippling Costs of Chronic Conditions: A Huge Burden for World Health Systems
What if I told you that chronic diseases account for 3 US dollars of every 4 US dollars spent on
healthcare in the United States of America for instance? Or in other words chronic diseases
account for 7.900 US dollars for every American with a chronic disease? Even with health
insurance, chronic conditions can pose a significant financial burden, particularly when work is
affected. Furthermore, what if I also told you that the health care costs for a person with one or
ALMOST HALF OF THE TOTAL CHRONIC DISEASE
DEATHS ARE ATTRIBUTABLE TO
CARDIOVASCULAR DISEASES. DIABETES AND
OBESITY HAVE STARTED TO APPEAR EARLIER IN
LIFE

3. more chronic conditions are five times higher compared to individuals without a chronic disease?
Or that chronic diseases cause 7 out of every 10 deaths?
But there are also additional collateral issues in the impact of chronic conditions, for instance
people with these conditions are at highest risk of medical errors and generate duplicated, multi
or unneeded services. This particular problem deserves a whole article in itself, because over
diagnosis and over prescribing as well as medical errors in itself are factors that are getting more
relevant day by day in the medical practice, but this is not the purpose of this article. Another
collateral damage in suffering chronic conditions is that about 25% of those patients have some
type of activity restricition like mobility, ability fo personal care, work or schooling. This generates
a significant indirect cost in terms of productivity due to sick leaves and under the corporate point
of view it can become a severe problem in the middle and long run. Let me give you some
examples of the cost of important chronic
conditions in the US: The costs of
cardiovascular diseases (CVDs) in the
US adds up to a total $317 billion per
year, split between $193.7 billion in direct
medical costs and $123.5 billion in lost
productivity; diabetes care cost $245
billion in 2016. Seventy-one percent of
diabetes treatment costs ($176 billion)
were related to direct healthcare expenses. That equates to 20 percent of US healthcare
spending. You can just imagine how this can be easily increased if we speak about multi-chronic
conditions in a single patient.
Do you find this information staggering? If you do so, I will certainly agree with you, and again
it’s the true reality of the chronic pathologies that impact our present and future world, the former
is even more worrying because of the rapidly increasing population, and not only in number but
in stages of the onset, even earlier in diseases like diabetes, obesity and cardiovascular
conditions, and in terms of costs what do you think this translates to? At this pace the way
conventional healthcare and medical systems are set up they will not be able to sustain and
comply with the disruptive impact of chronic diseases in the next 15-20 years or even earlier.
This might seem an economic or a global financial issue, it might even seem that it is only a
matter of performance or even a change in management, or even productivity outcomes, which
they are but they do not solely rely on these, it really doesn’t, there is much more at stake than
what it appears. All this has to do also with the way pharmaceuticals and other research institutes
interact with the healthcare systems including the goverments and of course the regulatory
organisms who are supposed to be responsible for the approval of drugs and medical devices
in order to “safeguard patient’s wellbeing”. Let’s not forget that the medical device industry is
probably bigger than the pharma industries at the present stage, and I refer not only to the
medical devices marketed to doctors and healthcare professionals but also to patients, like many
OTC drugs (over the counter drugs). But we will get to this later on where I will be discussing
some interesting aspects of modern clinical trials and how regulatory affairs departments have
a critical and specific weight on the decision to launch new drugs or medical devices to the
market. I think up to here, you can already glimpse at a vicious circle of factors that influence the
negative impact of the global management of chronic conditions, it’s a complex and huge living
entity in itself that unfortunately is difficult to control. There are many pathways within this global
problem that need to be addressed and solved independently but at the same time there are
many personal and corporate interests that makes this task a huge ordeal.
THE HEALTH CARE COSTS FOR A PERSON WITH
ONE OR MORE CHRONIC CONDITIONS ARE FIVE
TIMES HIGHER COMPARED TO INDIVIDUALS
WITHOUT A CHRONIC DISEASE

4. It’s time to start thinking and implementing other sustainable ways to be able not only to support
this global impact but to bring better outcomes and due to the practical evidence that I have been
experiencing I am convinced that homeopathy and other alternative therapies can be of great
help in achieving so. I will be discussing later on how a sustainable medical system like
homeopathy can achieve great outcomes in the management and prevention of chronic patients,
but there is nothing new about this, the NHS in the UK has already been doing so for more than
70 years with a significant decreasement in the cost of chronic disease management and
Switzerland has already adopted this in their national health system as well. As you may know
there are other countries which adopt homeopathy as a routinary therapeutic method in itself or
combined with conventional medicine (allopathy).
Medicine Based on Convenient Evidence
Conventional medicine claims that all medical practice is based on evidence and science, and
experimental data analysis like the Random Clinical Trials (RCTs) are actually the most robust
tools to conclude hypothesis and reach to evidenced based conclusions at least in what new
drug targets are concerned and it is a widely accepted method of proving whether or not a
medical intervention works.One group of patients, the control group, receive placebo (a “dummy”
pill) or standard treatment, and another group of patients receive the medicine being tested. The
trial becomes double-blinded when neither the patient nor the practitioner knows which treatment
the patient is getting. RCTs are often referred to as the “gold standard” of clinical research.
In basic medical research like molecular pathology, biochemistry and in basic molecular biology
mechanisms we use statistical tools as well to objectively understand a biological phenomenon.
And this is all fine, this is how it should be actually, in any science we need to contrast hypothesis
and discover phenomena under a very strict and objective criteria and experimental data
analysis is completely necessary and definately justified. But the question is, its all the data
generated in the trials and research
intentionally organized in order to show
convenient evidence? Is all the bulk
information considered and published?
Or are only the positive results published
and approved accordingly? But then
what happens with the negative results
generated during the actual
experimental process and analysis? In
an ideal and parallel universe regulatory
affair departments would review systematically all the data generated in the trials, both positive
and negative and bring out a conclusion about the approval based on that thorough review.
Medical journals would encourage research groups and pharmas to publish not only the positive
results but also the negative results, as they know that hiding information might bring deadly
outcomes to patients and distorted information to physicians who prescribe the drugs. The
deontology and ethical entities would actually be doing their job to watch over the patients’
interests and of course the pharma and medical device industries, if not motivated on abolishing
a disease, at least fulfill the mandatory requirements imposed by law and ethics. Doctors or
physicians would trust the chain of evidence and they would easily comply with their patients in
order to bring the best outcomes for them. Unfortunately this is not the case in the planet we
are living now. I would give you specific details and information on how this is managed but again
THERE’S NO DOUBT: CONVENTIONAL MEDICINE
HAS CONTRIBUTED VASTLY TO MODERN
THERAPEUTICS BUT THIS DOES NOT GIVE
ANYONE CARTE BLANCHE TO DISTORT EVIDENCE
AND PRODUCE UNETHICAL PRAXIS

5. it is not the intention of this article, and I wouldn’t be saying anything new, it has already been
detailed in the book “Bad Pharma” by Dr. Ben Goldacre, he has exposed and researched
extensively this problem in his text, and if you are really interested in going deeper in this topic
this is certainly the research you are looking for.
In any case, don’t get me wrong, allopathy or conventional medicine has contributed vastly in
many areas of pharmacology and surgery and personally I wouldn’t dare to deny those
achievements because that wouldn’t be fair neither objective. But this does not give anyone carte
blanche to distort evidence and produce unethical praxis and if we claim that any medical
practice should be based on evidence, let’s produce real evidence then and not convenient
evidence according to our personal, financial or collective interests.
The Evidence and Challenge of Homeopathy
Now here’s the first paradox. The same group that praises the evidence in conventional medicine
claims that homeopathy is not a system of medicine because it is not based on evidence, even
more they claim that it does not have any better therapeutic effect than placebo, or even much
more, some claim it is just quakery. Kind of incongruent to assume this, I believe, after the
“evidence” that they have been distorting just for the sake of whatever it is, except science.
But that’s not all, they also claim that homeopathy is far from being a scientific phenomenon
because some research shows inconclusive data or as I’ve mentioned previously, homeopathy
does not show better results than placebo itself in some trials. And here we trip on again on a
second paradox: if results are inconclusive wouldn’t that mean that further and more higher
quality research is needed to confirm the mechanism of action of homeopathy? Or in other
words, shouldn’t we go beyond Avogadro and classic biochemistry rather than banging our
heads continuously into the same wall and feeling pity about ourselves as scientists, insisting
that there isn’t a single molecule in the dilution and thus it cannot have any therapeutic effect? I
mean Einstein’s theory of relativity went beyond Newton’s gravitational law because he did not
assume that the reality of the universe was so simple. In the same way, why should be assume
that allopathy is the only therapeutic approach available? As scientists we should not assume
anything, we should be thorough unbiased observers, watch the phenomenon under different
angles, collect data and then, whenever the opportunity comes, try to find a way to interpret
objectively such observations using the tools we have available at the present time.
There is nothing wrong in accepting that homeopathy research is still in its infancy, and the
timeline is actually even more justified in the case of homeopathy, because if we are really talking
about a radically and relatively new system of medicine that does not respond to conventional
laws, we should be patient and grant the time it deserves at the same time that we should be all
working in the same direction to make this happen sooner or later.
It might be in its infancy yes, but that does not mean that there is a growing body of published
research in good quality peer-reviewed journals showing that homeopathy has a positive effect.
The body of evidence that exists shows that much more investigation is required – 44% of all
the randomised controlled trials carried out have been positive, 5% negative and 47%
inconclusive. Unfortunately, homeopathy does not attract large amounts of funding. More
funding is required to conduct high quality trials using suitable research methods. At present,
for example, only 63 of the 188 RCT papers have studied classical, individualised homeopathy;
each of the other 125 RCT papers has investigated the effect of one selected homeopathic
medicine.

6. Up to the end of 2014, a total of 104 papers reporting good-quality placebo-controlled RCTs in
homeopathy (on 61 different medical conditions) have been published in peer-reviewed journals.
41% of these RCTs have reported a balance of positive evidence, 5% a balance of negative
evidence, and 54% have not been conclusively positive or negative.
Strikingly, the above figures are similar to data obtained from an analysis of 1016 systematic
reviews of RCTs (and therefore of many more than that number of RCTs) in conventional
medicine: 44% of the reviews concluded that the interventions studied were likely to be beneficial
(positive); 7% concluded that the interventions were likely to be harmful (negative); and 49%
reported that the evidence did not support either benefit or harm (non-conclusive) [El Dib RP,
Atallah AN, Andriolo RB (2007). Mapping the Cochrane evidence for decision making in health
care. Journal of Evaluation in Clinical Practice; 13:689–692.].
The RCT model of measuring efficacy in homeopathy is a bit of a challenge, and let me tell you
why. In homeopathy, treatment is usually tailored to the individual. A homeopathic prescription
is based not only on the symptoms of disease in the patient but also on a host of other factors
that are particular to that patient, including lifestyle, emotional health, personality, eating habits
and medical history. The “efficacy” of an individualised homeopathic intervention is thus a
complex blend of the prescribed medicine together with the other facets of the in-depth
consultation and integrated health recommendations provided by the practitioner; under these
circumstances, the specific effect of the homeopathic medicine itself may be difficult to quantify
with precision in RCTs.
Because of the complexity and number of variables that we are managing in homeopathy, it
might be interesting to focus initially into basic research -and not into efficacy studies of the
remedies- within a molecular context, considering the fact that the action of the remedies are
manifested in deeper layers, we can expect to find biological response as such a molecular level
much before it is manifested at the physiological or surface level. Such is the initiative published
in a paper in 2014 where Apis mellifica homeopathic preparations were used to study the human
gene expression profile, with the stunning conclusion that this remedy modifies gene expression
in human cells and has inhibitory effects on regulatory processes of inflammation; in addition,
extremely diluted dynamized dilutions (3C, 5C and 7C) still exert significant effects on genes
involved in inflammation and oxidative stress.
Another paper published in 2016 has contributed in conducting a research in the same line, this
time using Arnica montana in order to study the gene expression profile using quantitative real
time PCR (Polymerase Chain Reaction) in a human macrophage cell line. Although this was
more of a exploratory proposal, it was concluded that the study provides new insights into the
cellular and molecular mechanisms of action of Arnica montana as a promoter of healing, since
some of the genes it modifies are key regulators of tissue remodelling, inflammation and
chemotaxis.
Contributing with this line of research, under my perspective as a molecular biologist, it may offer
a solid basis in order to understand the ripple effect of the remedies once it manifests at the
genomic level and very interestingly at the oxidative stress level which has significant importance
in the molecular mechanisms of pathology. After gathering a solid pool of data within the basic
research of homeopathy at the molecular level that I’ve mentioned, we can start brainstorming
on how to design studies of efficacy of remedies either using well designed RCTs or other forms
of experimental data analysis that considers the complexity of variables that are inherent to
homeopathy.

7. But there is another possibility. What if we go even deeper and focus all research within the line
of Jacques Benveniste and Luc Montaigner on the biodigital information stored in clusters of
water molecules when exposed to an ultradiluted form of a remedy? We can even expand this
thought and shift research models into the field of electromagnetic (EM) energy, comparing and
contrasting frequencies and patterns of different remedies and make them match with the EM
patterns generated in persons who suffer a disease. Using statistical tools we can analyze how
much the patterns match between each other and this would tell us the level of similimum that
we encounter. At this stage, one day maybe, efficacy studies in homeopathy using random
clinical trials will become obsolete, because all we need is to do is to analyze the control EM
pattern of a healthy person and compare it with the pattern of the patient and estimate the
deviation produced before and after the treatment.
The Doubtful Safety of Modern Pharmacology and the Unsustainable Cost of Treatments
in Chronic Conditions
It might seem that present pharmacology has evolved infinitely, and in some research pipelines
this is true, particularly in gene and stem cell therapy are areas that in the past two decades
have advanced tremendously at an unthinkable pace. But these kind of therapies cannot be
considered essential pharmacology, we can speak more in terms of molecular medicine or even
biological medicine. When we speak about pharmacology, I am referring mostly to the essential
drug design, the molecule engineering in itself, the pharmacodynamics and the
pharmacokinetics of a compound that either binds to a specific receptor to produce or alter a
signal or interferes in a metabolic pathway to block an enzyme or promote a specific substrate,
that sort of thing. And here is where particularly one may find questionable experiences in the
short and long term use. Because getting rid of a particular group of symptoms and producing
new ones, in my point of view, shouldn’t be considered a full therapeutic outcome, and by
producing new set of symptoms I am not referring only to the secondary effects of drugs, but
also the way they can disturb the patient in the long term. As you have read until now, giving
some graphic examples makes it easier to understand what exactly I am referring to, so for
instance let’s talk about metformin, a widely used drug prescribed in diabetes type 2 patients
and sometimes in women who suffer polycystic ovary syndrome. In the case of diabetic patients
metformin lowers your blood sugar levels by improving the way your body handles insulin and
it's usually prescribed when diet and exercise alone have not been enough solution to handle
situations of hyperglycemia. And let’s be fair, this drug works amazingly well, without any doubt,
even more, it does not produce hypoglycemic situations (lowering of blood sugar levels) in any
of the cases and this is a great advantage in a diabetic condition. But of course together with
this marvelous therapeutic advantages, the most common side effects that this drug carries
along with are the sick feeling sensation, vomiting, diarrhoea, stomach ache and going off your
food, which to be honest, if you think about it, the major therapeutic outcome might compensate
these kind of disturbances, and one is completely free to decide to carry on with the treatment
or not. However, this does not end up here. In the past two or three years studies have shown a
significant correlation between the long terms use of metformin and vitamin B12 deficiency,
particularly this research paper published in 2016 by the Journal of Clinical Endocrinology
Metabolism shows clearly the fact that vitamin B12 deficiency associated with metformin use is
thought to occur due to vitamin B12 malabsorption. Initial theories included alteration of bile acid
metabolism, small intestinal bacterial overgrowth, or effects on intrinsic factor secretion, but a
more currently accepted explanation is the interference by metformin on calcium-dependent

8. membrane action responsible for vitamin B12-intrinsic factor absorption in the terminal ileum.
And the evidence of this fact keeps on accumulating in well known research journals.
Let’s recap the symptoms of vitamin B12 deficiency: weakness, tiredness, or lightheadedness,
heart palpitations and shortness of breath, pale skin, a smooth tongue, constipation, diarrhea,
loss of appetite, or gas, nerve problems like numbness or tingling, muscle weakness, and
problems walking, vision loss, mental problems like depression, memory loss, or behavioral
changes. Now did set of symptoms popped out initially during the clinical trials and they were
not reported? If they appeared much later it must have been because a large number of patients
that were under this medication for a long period time must have either reported this symptoms
or a good number of physicians that observed this correlation must have reported them
themselves. So, the question is, does these set of severe symptoms really compensate the
single positive therapeutic action of a drug like metformin? I thought it was interesting to go
through the common side effects of common drug types, so I have plotted this in the following
chart for your reference.
DRUG TYPE COMMON SIDE EFFECTS
Antibiotics Nausea, diarrhea, rash, yeast infection, fever
Antidepresants Weight gain, insomnia, nervousness
Antihistamines, allergy medications Drowsiness, insomnia, weakness
Asthma medications Nervousness, sweating, nausea, vomiting
Decongestants Nose bleed, nasal irritation
Diabetes medications Nausea, heartburn, fatigue, dizziness
Heart and blood pressure medications Dizziness, drowsiness, chest pain, loss of appetite,
leg pain
Heartburn medications Constipation, bloating
Pain releivers Stomach upset, tinnitus, nausea
From 2011 to mid-2017, the FDA received more than 5.4 million reports of prescription drug
adverse events, including more than 1 million deaths. The agency keeps these reports in its FDA
Adverse Events Reporting System (FAERS) database. Consumers can search for side effects
of specific drugs reported to the FDA at the agency’s Public Dashboard.
Secondary effects can become really severe to the extent that they can even produce death, like
in the cases of drugs like Abilify, Fluoroquinolones (because they also induce suicide), SSRIs,
Taxotere, just to name some examples. Others may induce cancer like Talc or Testosterone.
As you know in homeopathy we cannot speak about secondary effects or harmful long term
effects of a remedy, but we can normally deal with aggravations in patients. But aggravations
are not secondary effects whatsoever. If such aggravations occur under Herring’s law of cure,
we believe that the dynamics of the healing process is progressing in the right direction, and
more importantly aggravations are mechanisms that are under the control of a qualified and
trained homeopath, but the secondary effects produced by a drug like metformin for example,
are artificial or induced symptoms due to a primary course of a physiological action. In this point,
you can either prescribe new allopathic drugs again to treat secondary induced symptoms –with
the expected cascade of consequences from these new drugs- or tell the patient to stop taking
the original medication.

9. This means that homeopathic remedies are safe, some might say that they are really safe
because they actually do not produce any therapeutic action, but we have already discussed
about this in the previous paragraphs.
I have mentioned previously the doubtful safety of modern pharmacology, but what about the
costs out of patients’ pockets? In previous paragraphs I have mentioned the high costs of
treatments in chronic conditions, you can see that the problem is two-fold: the safety issues and
also the high costs of modern pharmacological treatment. So on one hand we search for a cure,
we get a prescription for that particular problem, and then we might end up suffering a new set
of symptoms, which in many cases it might be severe, and on the other hand we have to pay
large sums of money to go through all that process. Do you agree with me that there is something
not quite right here?
Let’s take a look at the particular case of asthma, for instance. This is a costly disease. People
with moderate to severe asthma often need at least three different drugs. A 2003 study published
in the Journal of Allergy and Clinical Immunology estimated the annual costs for asthma
treatment was over $4,900 per
person. These include both direct
costs -- such as medicine and visits to
the doctor or hospital -- and indirect
costs, such as time off from work. But
the most interesting aspect of this
study is that the medicines make up
about half of the expense. When
patients enjoy a full insurance
coverage maybe this might not seem
such a big problem in terms of the
patients’ concerns, but what about
those who are uninsured? They are at the greatest risk. More than one in six people with asthma
don't have insurance, according to a 2005 study prepared by the Urban Institute and the
University of Maryland, Baltimore County. That adds up to about 2 million Americans, just for the
sake of focusing on a specific region of the world, but this may be scaled to other nations. As
costs rise, many people with limited resources try to stretch their medication. One 2004 study
published in The Journal of the American Medical Association found that when co-pays doubled,
people with asthma reduced the use of their drugs by 32%. They stopped taking their medicine
every day. They began to use it only for emergencies.
The 2005 Health Costs Survey bears this out. The researchers found that 44% of all people with
asthma tried to save cash by not taking their medicine or skipping doctor's visits, and I did not
mention this when I spoke about the therapeutic adherence, but the financial issue happening
with asthma and other chronic diseases affects directly the therapeutic adherence of chronic
patients as well as we can see from the studies mentioned. And this is very obvious.
The cost per patient in an asthmatic chronic condition when treated homeopatically is far away
from those figures. And once again, if classic homeopathy treatment is applied, there’s a unique
and single constitutional dose prescribed in the first consultation, which in many cases is
included in the cost of the appointment itself. If the remedy is prescribed correctly we expect to
observe an overall progress of the patient so in the follow up appointments the constitutional
SO ON ONE HAND WE SEARCH FOR A CURE, WE GET
A PRESCRIPTION FOR THAT PARTICULAR PROBLEM,
AND WE MIGHT END UP SUFFERING A NEW SET OF
SYMPTOMS, WHICH IN MANY CASES IT MIGHT BE
SEVERE, AND ON THE OTHER HAND WE HAVE TO
PAY LARGE SUMS OF MONEY FOR IT

10. treatment is not repeated nor changed and we normally prescribe placebo in the cases where
we believe it is necessary, the cost of placebo as you all know is practically insignificant. And
even if the patient requires organopathic support for SOS acute situations (mother tinctures) the
annual cost won’t even reach to a 5% of the net annual cost of allopathic drugs in the case of
asthma for example. More over, organopathics are prescribed not only to manage acute
conditions in SOS situations, the homeopath’s intention is to wean-off gradually the allopathic
treatment to the point where the patient does not require any more inhalers like salbutamol or
beclomethasone (corticosteroidal inhaler), as we have seen in many cases of asthma during
homeopathic consultations for example. But to be even more specific, our intention as
homeopaths is that the patient ends up living without any single medication, nor allopathic nor
homeopathic, so organopathics will be also weaned-off once the patient is able to manage
without them after a medium or long term treatment with homeopathy, and this is quite frequent
to observe in the daily practice.
Is Our Health Care in Safe Hands?
There’s a huge bureaucratic machinery that runs and that is perfectly synchronized with the
pharmaceutical industry – and viceversa - in the discovery of new patentable drugs and as I’ve
mentioned previously, regulatory organisms, governments, even highly respectable medical
journals and of course the pharma itsef are all essential parts of this complex machinery. Note
that I have highlighted “patentable drugs” and not any active compound like a natural molecule
that has a therapeutic effect does not have any interest in terms of the business model of big
pharmas because they are simply and legally unable to be patented and thus they cannot be
under the control of any public or private
entity. It is necessary to modify the
original molecule itself to acquire legal
and patentable rights in order to make
this drug a real financial asset that can
have a long life return on investment.
Don’t forget that pharmaceutical
industries at the end are corporations,
private companies which exist not for
the sake of curing diseases, but to make big cash, because at the end it’s like any other business
and firms are created for this purpose. But that is how it has to be and if any of you runs a start
up or is managing a company knows very well what this is about, and there is nothing wrong
with this, it’s the nature of the offer and demand and to deploy a service or product requires a
cost and a benefit for the partners involved. But when it comes to health care business models
should be strictly regulated and the main goal of this corporations should be to safeguard
patient’s interest rather than generating revenues by all means. The parts of the machinery in
this business are supposed to watch over patients’ interests, but are they really doing so? By
definition, if you think about it, a business model based on disease eradication is unsustainable
in itself in terms of financial growth and equity, but chronic diseases on the other hand offer a
high turn over because prescriptions are mostly given away for life time. Wars are needed in
order to generate demand for guns and missiles, peace would simply bring bankruptcy to this
corporations, similarly disease is necessary in order for the drug industry (and other related
healthcare industries) to keep cashing, and in this vicious circle all parts involved want their piece
of this huge cake.
THE PHARMA AND MEDICAL DEVICE INDUSTRY
TOGETHER WITH THE REGULATORY ORGANISMS
ARE SUPPOSED TO WATCH OVER PATIENTS’
INTERESTS, BUT ARE THEY REALLY DOING SO?

11. Let me give you an example. Recently in a Goldman Sachs report known as “The Genome
Revolution” the question if curing patients was a sustainable business model was one of the
touchy topics and this is what literally was stated: "The potential to deliver 'one shot cures' is one
of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene
editing. However, such treatments offer a very different outlook with regard to recurring revenue
versus chronic therapies". Chief analyst Salveen Richter from Goldman Sachs – and in charge
of this report- wrote in the note to clients: "While this proposition carries tremendous value for
patients and society, it could represent a challenge for genome medicine developers looking for
sustained cash flow."
Richter cited Gilead Sciences' treatments for hepatitis C, which achieved cure rates of more than
90 percent. The company's U.S. sales for these hepatitis C treatments peaked at $12.5 billion in
2015, but have been falling ever since. Goldman estimates the U.S. sales for these treatments
will be less than $4 billion this year, according to a table in the report.
"GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted
the available pool of treatable patients," the analyst wrote. "In the case of infectious diseases
such as hepatitis C, curing existing patients also decreases the number of carriers able to
transmit the virus to new patients, thus the incident pool also declines … Where an incident pool
remains stable (i.e, in cancer) the potential for a cure poses less risk to the sustainability of a
franchise."
In conclusion, is our health care in safe hands? To be honest, under my personal point of view
and after looking at the scenario, the responsibility of our health care relies solely on us as
patients. And what does this mean exactly? As patients we need to become smarter, widely
informed about our chronic condition to the extent that we are able to speak at the level of our
doctor, so when we come out of the consultation room we know exactly what needs to be done
and we feel self confident about the outcome of the appointment. It is very important that we
have a clear understanding about the disease and there are many resources out there to make
this happen, the different network of associations of a specific chronic disease can help you train
and instruct you on the disease management and therapeutic adherence of your treatment.
Other tools that can help you understand your condition can be found in the internet, for instance
interacting with patients that suffer your same condition is a brilliant tool to keep your health on
track, you can find this in a very well known portal for patients known as Patients Like Me. If we
need good outcomes in our health care plan, we need to be critical but to be critical it is necessary
a good portion of knowledge first and beleive me I have met patients who have ended up
knowing more about their condition than their physician itself. It is possible and necessary.
Without knowledge about our pathology we are left adrift, there’s a big loss of control and thus
we end up insecure and vulnerable, at this stage our health care increases the risk of disruption
within the chain of our present health system.
Becoming a smart or empowered patient, that is a patient with knowledge and control over the
diseased condition, offers an even greater opportunity to safeguard health care and that is the
will to be able to choose how the patient wants to be cured or treated. And here is where
homeopathy opens up as an alternative therapeutic approach as well as other non conventional
treatments. A smart patient will be able to combine alternative therapies together with
conventional treatment and reach to an overall better outcome, the need for clinical
investigations in most of the chronic diseases are necessary and the management of very
serious acute situations are factors that can be managed through conventional medical systems,

12. but homeopathy can be a great candidate for the long term response to chronic conditions,
bringing out in many cases better outcomes than allopathy. I will be explaining this more in detail
in the next section of this article.
Homeopathy is a Sustainable Solution for Absorbing the Impact of Chronic Diseases
Previously I have mentioned how smart patients can produce better outcomes in relation to their
health care, and how with that knowledge and control over the condition can help us make
decisions in order to optimize health care. But more importantly, you get the freedom of choosing
how you want your chronic condition to be treated, and I have mentioned that if you choose
homeopathy as the leading treatment you will be certainly benefited. Even more, a sustainable
medical system like homeopathy can globally reduce the impact of chronic conditions and let me
explain why.
First of all the consultations in homeopathy are therapeutic in themselves, the time of dedication
to the patient is far longer than a usual appointment with a specialist or a general practitioner
and the patient finds immediate relief just for the sake of the story telling and more importantly,
homeopaths tend to convey compassion and this factor is inherently therapeutic as well. A recent
and very interesting article about this topic states the following: “The medical interview is a pillar
of medicine. It allows patients and clinicians to build a relationship. Ideally, this process is
inherently therapeutic, allowing the clinician to convey compassion, and be responsive to the
needs of each patient. Eliciting and understanding the patient’s agenda enhances and facilitates
patient-clinician communication.” And astonishingly it also states from several research papers
that patients get and average of 11 seconds to explain reason for visit before doctors interrupt.
Secondly, as we know and in relation to the homeopathic prescriptions, the remedies act upon
a much deeper plane than allopathic drugs which act upon the physiological level, this fact
reduces the risk of interaction to zero with other allopathic drugs and within the homeopathic
treatment in itself because we prescribe constitutionally with a single remedy – take into account
that a multiple chronic patient is normally running under several prescriptions, depending on the
conditions- but not only that, allopathic drugs can interact also with food and other nutritional
supplements, not to mention that the interaction can reach even to the genetic constitution of the
patient, and this is what pharmacogenomics focuses on. This relatively new science, offers the
physician a profile on the interactions between a specific drug and the susceptibility of the patient
at the genetic level and thus offer an adequate prescription that minimizes the amount of
interaction between the prescribed drugs and with the genetic constitution of the patient.
Unfortunately, it is not a very common procedure amongst physicians at the present time.
Anyhow, this key factor in the homeopathic prescription already saves up costs as many of the
health issues produced by sometimes known and others unknown drug interactions in a multiple
chronic condition – even in single conditions- are completely avoided. On the other hand
homeopaths can prescribe organopathics (homeopathic mother tinctures) with the intention to
wean-off gradually conventional drugs from their patients but even doing so, the dilution will be
still minimally 1x and sometimes even 3x or 6x.
Thirdly, let’s talk about the important aspect of the direct cost of the treatments that actually
show a decreasement prescribing homeopathic medicines versus allopathic prescriptions. The
direct costs of drugs are a significant burden in relation to the impact of chronic diseases in any
health system around the world, but of course the burden does not limit to direct costs only, we

13. need to consider other indirect costs as well in order to value the global economic impact of
chronic conditions, however some of the indirect costs that are applied to conventional medical
practices can be also applied to homeopathic practices like cost of consultations and work
absenteeism. To simplify the matter, we should consider mostly the weight in terms of costs
between allopathic drugs and homeopathic remedies.
There are several studies that correlate the cost-benefit evaluation of homeopathic versus
conventional therapy. A paper released in 2009 concluded that homeopathic treatment for
respiratory diseases (asthma, allergic complaints, Acute Recurrent Respiratory Infections) was
associated with a significant reduction in the use and costs of conventional drugs. Costs for
homeopathic therapy are significantly lower than those for conventional pharmacological
therapy. Another paper published in 2005 and based on the pharmacoeconomic comparison
between homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in
children concluded that homeopathy may be a cost-effective alternative to antibiotics in the
treatment of recurrent infantile rhinopharyngitis. There are other research which show significant
improvement using homeopathic treatment versus allopathic but in terms of costs they don’t
show significant differences, but there are no details about the number of doses used and the
number of consultations and the cost of each one, nor if polypharmacy has been prescribed. In
any case using classical homeopathy, that is single dose minimum dosage and follow up
consultations every one and a half months or every two months, generally in chronic conditions,
the net cost should be significantly lower than allopathics, as stated in the previous research
papers. Unfortunately there is not much research done in this matter and further consistent
analysis is necessary if governments are really willing to find solutions, of course, that is if they
clear once and for all that homeopathy works better than placebo and they end up accepting that
it is a proper medical alternative to conventional ones.
There are other two relatively new key factors which are extremely relevant: one is the
therapeutic adherence and the patient disease management. Let’s start explaining what is
therapeutic adherence and how can this influence the outcome of health response, and it would
be appropriate to start with the definition. According to the WHO, in a document released in
2003, therapeutic adherence is the extent to which a person’s behaviour – taking medication,
following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations
from a health care provider. Surprisingly in developed countries, adherence to long-term
therapies in the general population
is around 50% and much lower in developing countries, this is related to the data conducted in
research referring to conventional medicine. Some examples will probably give you a better view
about the potential damage that can produce in the overall control of chronic conditions in
patients and how this indirectly affects the global expenditure in country’s health systems.
Poor adherence to the treatment for diabetes results in avoidable suffering for the patients and
excess costs to the health system. The CODE-2 study (Cost of Diabetes in Europe – type 2)
found that, in Europe,only 28% of patients treated for diabetes achieved good glycaemic control.
And research worldwide has documented poor adherence to treatments for asthma although
there are large variations between countries. Rates of nonadherence among patients with
asthma range
from 30% to 70%, whether adherence is measured as percentage of prescribed medication
taken,

14. serum theophylline levels, days of medication adherence, or percentage of patients who failed
to reach a clinically estimated adherence minimum. Evidence shows that adherence rates for
the regular taking of preventive therapies are as low as 28% in developed countries.
In the case of hypertension it is well known that high blood pressure increases the risk of
ischaemic heart disease 3- to 4-fold and of overall cardiovascular risk by 2- to 3-fold. The
incidence of stroke increases approximately 3-fold in patients with borderline hypertension and
approximately 8-fold in those with definite hypertension. It has been estimated that 40% of cases
of acute myocardial infarction or stroke are attributable to hypertension. Despite the availability
of effective treatments, studies have shown that in many countries less than 25% of patients
treated for hypertension achieve optimum blood pressure. As you can see this has become a
world wide problem to the extent that even the WHO had to release the above mentioned
research on this matter –and that was 15 years ago- , because when we speak about the impact
of chronic conditions, indirect causes like the therapeutic adherence together with the
questionable effectiveness of drugs can become key factors that might explain the minimum
control of many chronic conditions. If I have awakened your interest in this topic, I strongly
suggest you read the WHO document linked in this page above.
Despite I can’t make allusions to any research, in terms of classical homeopathy, the therapeutic
adherence based only on daily practice seems to be quite straight forward. A constitutional
remedy taken in a single dose doesn’t seem to produce much of a disruption in terms of
medicinal adherence. Other factors that influence the therapeutic adherence, such as diet and
life style are equally out of the control in homeopathy like it is in conventional medicine, but as
far as the pure treatment is concerned the complexity of the posology and the prescription in
homeopathy is quite simple. We have to take into account the previous concerns on the case
taking and the time dedicated to the patients in a homeopathic consultation, where there is
enough time frame to explain to the patient how homeopathic remedies should be taken.
In the same way patient disease management (PDM) is another concept related to the
therapeutic adherence. Non-compliant patients aren't simply ignoring their chronic disease
management plans and they usually have a series of barriers keeping them from adherence.
This aspect is very interesting as well to contribute in lowering the impact of chronic conditions,
and with the help of technology we can generate a high level of engagement with the patients in
obtaining better outcomes for their overall wellbeing. As homeopaths, and due to the nature of
our case takings and consultation procedures, it would be quite straight forward to implement
engagement models with our patients using modern technology. The patient disease
management is a huge topic in itself and an extensive article can be dedicated only to this and
probably I will be doing so in relation to homeopathy in the near future. In the meantime I just
wanted to mention the value of the disease management in relation to the increasement of the
therapeutic adherence that I’ve mentioned before and the importance in the management of
chronic conditions, and how we as health providers can contribute to this with our patients.

15. KEY FACTORS CONVENTIONAL MEDICINE HOMEOPATHIC MEDICINE
Consultations Usually fast in time, very frequent
interruptions and lack of compassion to
the patients are a common practice.
Ti e i vested i liste i g to patie t’s
complaints is a problem due to
pressure and other educational factors.
Normally for the first appointment 60
to 90 minutes per patient, and follows
ups can go from 30 to 40 minutes.
Compassion and empathy are more
likely to occur during consultation.
Prescriptions Normally life time in chronic
conditions. Adverse and secondary
reactions as well as possible
interactions between drugs and the
genetical constitution of the patient.
Constitutional treatment in single
remedy and minimum dose (classical
homeopathy).
Essential organopathics to gradually
wean-off conventional treatments.
No interactions at the physiological
level.
Cost of Treatment
(conventional drugs vs.
homeopathic)
Practically unsustainable.
Spending is expected to continue to
grow at an average of 5.5 percent
through 2025, with chronic diseases
treatment comprising a major portion
of that spending.
For reimbursable medicines the public
sales price of homeopathic products is
less than a quarter of the average and
depe di g o the patie t’s chro ic
prognosis.
Therapeutic Adherence
(drug versus remedy
compliance)
Usually quite low, data reveals
different percentages depending on
the chronic condition
High and very straight forward if
treatment is based on classical
homeopathy (single dose)
In conclusion, as homeopaths we need to focus in 3 essential pillars: the lobbying for fundings
in order to produce and conduct high quality research, get training from robust and regulated
educational models in both undergraduate and post-graduate programs and open up to
encourage patient engagement and disease management. Let me comment more on these
matters:
- Much more further research is needed in homeopathy, not only in order to dilucidate the
mechanism of action of the remedies, but also in terms of cost-benefit models.
- As homeopaths, and thus as health providers, we should expand our scope with the use of
modern technology and engage our patients in disease management programs in order to
increase therapeutic adherence within other key factors different from the prescription itself.
We need to generate encouragement in patients in order to empower their skills about their
chronic conditions.
- Although I haven’t mentioned it previously, unqualified homeopaths trained by low quality
educational programs is definitely an issue that can affect the health care model of
homeopathy in the short and long term and regulatory aspects should be considered by the
corresponding bureaus in order to generate a collective of highly qualified professionals. In
this sense, it is necessary to avoid instrusiveness in our sector and gradually build up a
community of well trained homeopaths.
By BSc Narain Mahtani.H - ©Copyright Content - Email: naresh.mahtani@gmail.com
Graduated in Molecular Biology & Biochemistry by the University of Navarra (UNAV Spain)
End Year Student @ Allen College of Homeopathy (ACH Chelmsford United Kingdom)
CEO and Teacher of Life & Basic Medical Sciences at Nashmq E-Learning School

16. Reviewed Resources
Trichard M, Chaufferin G, Nicoloyannis N. Pharmaeconomic comparison between
homeopathic and antibiotic treatment strategies in recurrent acute rhinopharyngitis in
children. Homeomathy. 2005;94:3–9.[PubMed]
Jain A. Does homeopathy reduce the cost of conventional drug prescribing? A study of
comparative prescribing costs in general practice. Homeopathy. 2003;92(2):71–76. [PubMed]
Chaufferin G. Improving the evaluation of homeopathy: economic considerations and impact
on health. Homeopathy. 2000;89(1, supplement):S27–S30. [PubMed]
“Bad Pharma” by Ben Goldacre, M.D
Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters - Naykky
Singh OspinaKari A. PhillipsRene Rodriguez-GutierrezAna Castaneda-GuarderasMichael R.
GionfriddoMegan E. BrandaVictor M. Montori [Journal of General Internal Medicine]
Cost-benefit evaluation of homeopathic versus conventional therapy in respiratory diseases.
Rossi E1, Crudeli L, Endrizzi C, Garibaldi D. [PubMed]
Outcome and costs of homoeopathic and conventional treatment strategies: a comparative
cohort study in patients with chronic disorders - Witt C1, Keil T, Selim D, Roll S, Vance W,
Wegscheider K, Willich SN.[PubMed]
A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term
economic outcomes - Julia K. Ostermann, [PubMed]
Therapeutic Adherence WHO (By the World Health Organization) [Get link to PDF ]
Acknowledgements
I would like to thank Dr. S.K. Banerjea and Mrs. Janet Banerjea for reviewing and correcting
the original text of this article, and also would like to thank Dr. Maria Angels Carrera as she
has taken some time for me to review this text in spite of her busy schedule.