Friday, May 15, 2020

Arsenicum Album 30 vis-à-vis nCov19 infection – a prophylactic medicine or a mere hype?



In homeopathy, arsenicum album (Arsen. alb.) is a solution prepared by diluting aqueous arsenic trioxide generally until there is little or no arsenic remaining in the solution. It is used by homeopaths in an attempt to treat a range of symptoms that include digestive disorders and, as an application of the so-called Law of Similars, has been suggested by homeopaths as a treatment for arsenic poisoning. Since the arsenic oxide in a homeopathic preparation is normally non-existent, it is considered generally safe, although cases of arsenic poisoning from poorly prepared homeopathic treatments sold in India have been reported. When properly prepared, however, the extreme dilutions, typically to at least 1 in 1024, or 12C in homeopathic notation, mean that a pill would not contain even a molecule of the original arsenic used. While Anisur Khuda-Bukhsh's unblinded studies have claimed an effect on reducing arsenic toxicity, they do not recommend its large-scale use, and studies of homeopathic remedies have been shown to generally have problems that prevent them from being considered unambiguous evidence. There is no known mechanism for how arsenicum album could remove arsenic from a body, and there is insufficient evidence for it to be considered effective medicine (for any condition) by the scientific community.

However MCGM is distributing Arsenicum Album 30 homoeopathic medicine free of charge as preventive measure to fight nCov19 as recommended by Ministry of Ayush, Government of India. State Home Minister Mr. Rajesh Tope is telling public that Arsenicum Album 30 has been approved by AYUSH as preventive medicine for nCov19 infection.

The Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa Rigpa and Homoeopathy (AYUSH) of India released two advisories via PIB on the preventative and treatment measures that can be taken for the coronavirus epidemic. One of the advisories was using the homoeopathy drug Arsenicum album 30 as a ‘prophylactic medicine’ for the prevention of the infection:

“At the instance of Ministry of AYUSH, Central Council for Research in Homoeopathy (CCRH) discussed the ways and means of prevention of Coronavirus infection through Homoeopathy in 64th meeting of its Scientific Advisory Board on 28th January 2020. The Group of Experts inter-alia has recommended that homoeopathy medicine Arsenicum album30 could be taken as prophylactic medicine against Coronavirus infections, which has also been advised for prevention of ILI. It has recommended one doze of Arsenicum album 30, daily in empty stomach for three days. The dose should be repeated after one month by following the same schedule in case Coronavirus infections prevail in the community. The Expert Group has further suggested that general hygienic measures for prevention of air-borne infections suggested by the Ministry of Health and Family Welfare, Govt. of India, for prevention of the disease should also be followed by the public.

It is pertinent to note the caveat incorporated by the Ministry of Ayush in Annexure 1 to its directive dated 06/03/2020 which states that - During Ebola outbreak in 2014 expert group of WHO has recommended that "it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention" keeping in view no vaccine or anti-virals were available.

Thus Ministry of AYUSH itself categorically admits that:

1.   Arsenicum Album 30 is an unproven intervention;
2.   It has unknown efficacy and
3.   It has unknown adverse effects.

While AYUSH cites centuries of practitioners’ experiences with these products as evidence behind its advice, the media and the scientific community criticized the guidance as being counterproductive in dealing with a serious health emergency.

David Robert Grimes, an Irish science writer who has published research showing homeopathy to be ineffective, in an email to The Scientist said “It is profoundly irresponsible of the Ministry of AYUSH to endorse homeopathy as this entirely undermines public understanding of science and medicine, and elevates pseudoscience with potentially dangerous consequences.” Grimes has argued that the proposed mechanisms of homeopathy are implausible when analysed from a physical and chemical perspective, and says that it is not surprising, therefore, that the biological effects of homeopathy cannot be measured in large-scale clinical trials. 

According to Dr Edzard Ernst, an emeritus professor at the University of Exeter in the UK and a critic of homeopathy “The claim of some homeopaths that homeopathic remedies are effective in treating or preventing coronavirus infections is not based on any evidence at all.”  Dr Ernst points to a study that found no difference between Arsenicum album and a placebo in preventing fever after vaccination. Other studies in which homeopathy was found to be ineffective include one on acute respiratory tract infections, another on middle ear infections, and yet another on influenza-like illness.

Dr Ernst further comments, “Using homeopathy as an alternative therapy risks forfeiting effective causative or symptomatic treatments or if such treatments are not available creating a false sense of security. In any case, it would be a waste of resources.”

Even among proponents of homeopathy, there is disagreement about the best way to prevent the coronavirus. Mitchell Fleisher, the second vice president of the American Institute of Homeopathy, says that the Lancet article that scientists at CCRH used to come up with their advice does not provide enough information on symptoms to make an accurate homeopathic prescription.

He says that perhaps the best way to validate the therapeutic value of homeopathy would be to perform a comparative clinical outcome study of acute corona viral infection by giving individualized homeopathic medicines to one experimental group and allopathic medicines to another, with a minimum of 250 patients in each group. Mitchell Fleisher says “A careful and honest, statistical analysis of the study results will speak the scientific truth.”  

Countering Fleisher’s proposal, Grimes says that this is completely unethical. He says “Homeopathy has no plausible mechanism of action, and it is downright irresponsible to suggest it in a trial for a serious potential pandemic. Large scale studies of homeopathy have clearly shown over decades the same result—that it simply does not work.”

Thailand Medical News’s director, Jakkapong Watcharachaijunta has said, “Its total ridiculous and outright irresponsible for the Indian government to have allowed such a health advisory to be released as it also affects the image of the whole healthcare and medical industry in India which have always been held in high esteem internationally. Everyone knows that homeopathy is even worse than placebo as it just some charlatans trying to make money out of sugar pills and compounds with no scientific basis or even solid evidence so far even after hundreds of years. It’s a shame that the Indian government did not turn to its own traditional Indian Aurvedic Medicine where are many concoctions and hebs with antiviral properties and proper research into some of those could perhaps yield results. One interesting candidate is the licorice root which has been used in both Chinese Traditional Medicine (TCM) as well as in Indian Ayurvedic Medcine.”

To summarise:

1. Evidence for Arsenicum album 30 for coronavirus: No studies were found that researched the effect of Arsenicum album for coronavirus in humans or animals (in vivo). Also, there were also no studies found in an ex-vivo (outside the animal/human body) to study the drug efficacy.

2. Evidence for any homoeopathy drug for coronavirus: No studies were found that linked the efficacy of any homoeopathy drug in coronavirus infections.

3. Evidence for Arsenicum album 30 for any infection: Searching for evidence in the homoeopathic research for evidence for the drug Arsenicum album 30, only one paper was found, published in British Homoeopathic Journal (Kayne & Rafferty, 1994) that studied its use in neonatal diarrhoea in calves. This study was not only in animals on a different type of infection, but was found to be statistically invalid by Verdier, Öhagen & Alenius in 2003.

Thus, Arsenicum album 30 has not been proven or researched scientifically by homoeopaths to prevent or cure coronavirus or any other infections in humans.

As with other homoeopathic drugs, Arsenicum album 30 has never been tested or proven to reduce coronavirus infections or to prevent coronavirus infections.

The claim of the AYUSH Ministry and the AYUSH homoeopaths therefore is not only false, dangerous but deceitful too and can lead to India’s own coronavirus epidemic, as the infected patients’ caregivers and general public can assume false protection based on the government of India’s advisory.

This misinformed advice, if followed, risks millions of people’s lives during such a dangerous and contagious epidemic.

The moot question is: What convinced Ministry of AYUSH to issue such an advisory telling people to take Arsenicum Album 30 pills to prevent nCov19 infection?

Hope Vaidya Rajesh Kotecha from Ministry of Ayush who has authored the Directive would offer specific answer.

Kishor Satwick
(15/05/2020)

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