Abstract

Background: Malaria is a vector borne infectious disease that affects over 200 million people worldwide every year. Access to treatments on a large-scale is challenging due to the vast geographical and rural spread. Homeopaths have treated infectious disease throughout its 200+ year history however robust data on the efficacy and effectiveness of homeopathic treatments for malaria are lacking. Objectives: To explore the research that has been conducted regarding the use of homeopathy for malaria. Methods: A literature search was performed on the following databases: EBSCO,CINAHL Plus with Full Text, Humanities International Complete Medline with Full Text, Social Sciences Abstracts (H.W. Wilson) and Google Scholar. The search terms used were: “malaria and homeopathy” and “plasmodium and homeopathy”. Articles were deemed ‘relevant’ if the article discussed homeopathy in relation to malaria or anti-malarial properties, and/or if they indicated treatment decisions. Results: Three studies were deemed relevant in this search. Rajan and Bagai studied an in vitro culture, Bagai, Rajan, and Kaur explored an in vivo test and the State Health Resource Centre in Chhattisgarh explored the distribution of a homeopathic intervention to almost 100,000 people. Conclusions: There is minimal data examining homeopathic treatments in the treatment and prevention of malaria. The few studies have shown some interesting findings and further research is needed to discern details such as an ideal choice of potency and ideal amount of remedy repetition for optimal results in this population.

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An examination of the use of Homeopathy for Malaria.

Introduction:

Malaria is affecting numerous people. As Goldsmith (2011, pp 5) states: “If the World Health Organization (WHO; an agency of the United Nations) had a most wanted list of dreaded diseases, malaria would make the top three”. It affects a variety of populations over vast geographical areas, much of it rural. This makes access to treatments on a large-scale challenging. Historically, homeopathy has had success in the capacity to treat malaria symptoms. The homeopathic remedies that have generated a reputation amongst homeopaths reading about success for malaria-like fever symptoms include arsenicum, china, eupatorium, natrum mur, pulsatilla and sulphur (Curtis, 1994). There are some significant positive efforts on behalf of some homeopaths using the homeopathic malaria nosode (a nosode is a homeopathic remedy made from the disease source) working in Africa who are helping people with Malaria (Ananda, 2010). This paper will explore research that has been conducted regarding the use of homeopathy for malaria. There are a few parasites namely Plasmodium berghei, Plasmodium vivax, Plasmodium ovale, Plasmodium gallinaecum, Plasmodium chabaudi, Plasmodium malariae and Plasmodium falciparum that have been found to be responsible for Malaria. People are vulnerable to Malaria by having the parasite introduced into their bloodstream in result of being bitten by female mosquitoes (Anopheles species) carrying the infection in their saliva. Because it

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is transferred by mosquito to humans Malaria is referred to as a vector-borne disease. Prevention of the mosquito bites with the use of mosquito netting has been well promoted. However, the option of staying under mosquito netting all the time can be cumbersome.

The prevalence of malaria in many countries that people are travelling to makes is a disease of interest relevant to a homeopathic practice in North America where people are asking for a natural way to protect them against Malaria. The pharmaceutical answer seems to be becoming a less palatable option to travelers wanting to avoid negative drug affects. Also, there is currently no travelers’ vaccine for Malaria.

There has been an emergence of a few laboratory studies using homeopathy for prevention of malaria. In this assignment, three projects involving homeopathy and malaria. The first is by the two researchers Rajan and Bagai (2012) with an in vitro culture, the second is the three authors Bagai, Rajan, and Kaur looking at an in vivo test (2012) and the third study is by the State Health Resource Centre in Chhattisgarh (2013) distributing a homeopathic intervention to almost 100,000 people.

Literature:

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Results of the literature search are presented in the Table 1 below and in more detail in appendix 1. In the first database search, a total of three of twenty titles were produced with the search terms Malaria and homeopathy were identified as relevant. For an article to be termed ‘relevant’ it had to discuss homeopathy in relation to Malaria or anti-malarial properties, and to indicate treatment decisions. The search was limited to English language and full text articles (using e- databases and e-journals from the University of Central Lancashire as noted below and in Table 1). Websites that were searched appeared and were looked at in the order as listed in Appendix 1. Editorials and public news articles were eliminated. Articles concerned with the homeopathic materia medica and malarial symptoms were excluded. Clinical data were searched for and included but case reports and research done prior to three years ago was excluded. Articles were generally selected on the basis of their abstracts in addition to a more discerning look after downloading the article if the exclusion criteria were not found by the first look at the abstract. One study with the relevant criteria was eliminated because it was essentially a very similar study written by the same researchers Rajan and Bagai (2011) to one that was already chosen.

Search Strategy:

The first search was with the EBSCO database using Academic Search Complete with the key words homeopathy and Malaria. The Medline with full text, CINAHL, Humanities International Complete and Social Sciences Abstracts (H.W

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Wilson) were included. A search using the google search engine using the two words Malaria and homeopathy allowed the discovery of other articles and studies. Some useful references in the Fran Sheffield (2013) article that was found online then lead to discovering further studies and to the Chhattisgarh study that was chosen.

TABLE 1

Results from literature search:

Databases Search word(s) Result1 Relevant2

Academic Search Complete: CINAHL Plus with Full Text Humanities International Complete Medline with Full Text

Social Sciences Abstracts (H.W. Wilson)

Homeopathy & Malaria

25

3

Plasmodium & Homeopathy

7

3

Web searches3:

homeopathy Malaria

9

1

1 Results listed as number of articles
2 Several articles were found in more than one journal/database 3 Appendix I lists website addresses

There were no review papers written as of yet about the research on homeopathy to do with Malaria.

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USEFUL TERMS:

Chemosuppression – the prevention of severe clinical manifestations and complication in infected persons (Lucas & Gilles, 2014).

Schizontocides: Blood schizontocides kill the erythrocytic stages inside the red blood cells, while tissue schizontocides kill the liver stages of the parasite. (Bastide, 2014)

Merozoites: A motile form of a sporazoan (plasmodia), resulting from asexual division of a schizont during schizogony occurring in liver of red cells (Bastide, 2014).

Critical examination of selected studies on homeopathy regarding malaria:

With all research, it is important that the appropriate questions are being asked and that they are answered with an appropriately designed method that is clearly described. In Rajan and Bagai’s (2012) look at anti-malarial potential of homeopathic medicines (china, chelidonium and arsenicum) against schizont maturation of Plasmodium berghei in short-term in vitro culture, the researchers conducted the same test to determine the standard anti-malarial drugs ability against the same in vitro culture. The introduction of this publication mentions the use of the short-term invasion inhibition assay for assessing the susceptibility to anti-malarial drugs. It also describes the aim of using this assay with

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homeopathic drugs. There was a lack of explanation as to why these specific homeopathic remedies and variety of potencies and dilutions were chosen. The number of and variety of homeopathic remedies that were tested is confusing especially because a rationale for these choices is not given. Therefore it is difficult to understand the specific question to do with the variety of homeopathic remedies and dilutions that is being asked. The writers describe the process and used a previously accepted method (Trager and Jensen’s 1976 method) that they have referenced which makes it clear to the reader. The problem within the experiment is that there is no mention how the observations were made. It was clear whether or not the observer(s) were blinded and done by one person or blinded and three different people for each of the repetitions of the experiment. Blinding is done in research to avoid the possibility for biases including the assessment bias. These factors should be outlined clearly in the description of the methods to clearly show absence of bias as Greenhalgh describes in her article discussing how to assess the methodological quality of a paper (1997). The problem can have an effect on the results or the way the data was counted or measured.

The researchers Rajan and Bagai (2012) came to a positive conclusion of the previous study that their in vitro testing method was a successful assay because it was able to demonstrate the use of homeopathic drugs in production of considerable anti-plasmodial activity. If so, why then would there be any necessity shown to justify the use of in vivo studies on mice? In the next study

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(Bagai et al. 2012) examined for this paper there was no discussion about the use of the in vivo method. The basic reasons behind choosing in vivo methods were not explained in order to justify the research code of ethics (Council Policy Statement, 2010). Despite the lack of explanation or justification of the in vivo approach for the research study (Bagai et al., 2012), it took place and was stated to have been approved by the authority of their University to examine the effectiveness of the homeopathic remedies named Malaria Nosode 30 and 200 in having a schizontidol effect using testing in mice. The ways this research study might have been improved would be to include a list of terms defining schizontidol effect, the Peter 4 day test and chemosuppression for the readers. The Peter 4 day test was not ever explained and this writer could not find a description of it as commonly used test. As Greenhalgh (1997) explains in the article on the topic of “Papers that report diagnostic or screening tests” the authors should clearly describe their tests and their reasons to choose the test so as to allow the reader to understand the appropriateness of the research more thoroughly. The authors mention some previous studies, some use of these remedies by the African homeopaths; all without references. The problem lies in that there is no reference to how to find these studies and therefore, no reference as to where their choice of homeopathic remedies came from, specifically. If the introduction had included some references on those previous studies it might help the reader get a more comprehensive understanding of what their study was aiming to accomplish. This study lacked a long-term result. If the trial had included repetitions of the dosing of the nosodes, their appropriateness with

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Malaria would have been measured. Another strange point is that the introduction of Bagai et al. (2012) describes what is in the Malaria Nosode by Ainsworth Pharmacy, but it isn’t the one list as what is used in their material and methods section without explanation as to why this was done (pp 73). In the discussion section, there are more examples of statements about homeopathy that it ‘offers more affordable and safer approach to disease management’ (pp 75). The English is cumbersome at its best and these types of sentences to not lend well to the credibility of the authors in this scientific context. An out of context mention of placebo effect was made in their discussion section where a sentence of poor grammar included some numbers without a reference of where those numbers came from (pp 75).

In the third study, a State-wide distribution (all blocks within the Chhattigarh area of India that is malaria-affected) of the homeopathic remedy Chininum sulph 200 over eight weeks of the typically high Malarial infection rates was implemented with a statistically significant result that lead to adding Chininum sulph 200 to the list of preventable measures against Malaria. The report was successful in accomplishing the well-stated goal by demonstrating the ability for this intervention to reduce the incidences of Malaria in the population it was distributed to. Despite that this study accomplished a large-scale distribution of a homeopathic intervention (approximately 100,000 people) this was not a research study written for the purpose of publication. The distinct goals and accomplishments could be more inclusively described in the executive summary

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and findings section. The executive summary doesn’t explicitly highlight the overall lower number of Malaria cases discovered and what their analysis of that is (despite the plethora of charts and tables of those numbers). It seems to be a lot of effort produced for this project in this overall enormous Chhattisgarh area to not use it further by being able to apply this information to possibly help other Malaria affected populations. Inclusion of the previous years’ methods for finding cases of Malaria and blood test criteria might allow this massive undertaking to more widely demonstrate the ability to use homeopathy in the prevention of Malaria making use of the parametric numbers instead of focusing only on the 470 confirmed cases of Malaria. With regards to the homeopathic remedy, there was no mention of what the 200 refers to (the potency and scale of the homeopathic remedy used) which only those readers who are familiar with homeopathy would already understand. This remedy chininum sulph, in the report was described as titrated, however, the method for homeopathic remedies is trituration. This is very confusing because titration is a completely different process than trituration and titration isn’t usually a process involved in making homeopathic remedies (Smith, 1994).

The potential contribution other research designs could make to understanding the topic:

In order to come to some conclusions as to the usefulness of homeopathy for Malaria, these studies have proven to be inspiring and create a good amount of

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interest and potential. They can be used as guidance for future studies. For example, if the same in vitro design by Rajan and Bagai (2012) could be conducted, using some of the same remedies (malaria nosode & china sulph) that apparently might have produced results in their study and a blind was included with a more thorough, better written description of that part of the procedure, it may prove useful. The study that involves observation of over 98,000 people across numerous states of India creates the strong impression that the homeopathic remedy Chininum sulph 200C potency might have been properly compared to the past years’ data collection so that the information can be published. The elements of this study that might need to be addressed in order to meet the standards expected of publishing this study would be to be to include a comparison of the standard data collection process for the area in 2010 and previous years possibly creating a cohort study. In order to do this, the authors would have to find the confidence interval for the population. From a cohort study design, an inference from the studied population to others could be made (Bowers, 2008).

Conclusion:

Learning from previous mistakes and asking the right questions are ways to keep moving forward in many aspects of life, including in research. There are a few researchers who are looking at the use of homeopathic remedies for preventing cases of Malaria, the quality of these studies are lacking. However, having taken

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a close look at specifically what the problems are, there is the opportunity to move forward without the previous errors as part of the future research. Some choices of homeopathic remedies to test for the prevention of Malaria have shown some interesting findings and now can be refined along with some possibilities in choices of potency and amount of repetition required for the potential for certain specific, repeatable results. The previous studies have illuminated the path for more carefully chosen research that when well written and precisely designed may likely produce some very useful results.

Appendix I – Website addresses

Websites searched with search words homeopathy and malaria (in summary):

Using Google: http://healthyhomeopathy.com/articles/the-homeopathic-treatment-of-malaria/ http://www.abhalight.org/neem.html http://safe-medicine.blogspot.ca/2012/11/the-treatment-of-malaria-with- homeopathy.html http://homeopathyplus.com.au/malaria-treated-and-prevented-by-homeopathy/ http://sueyounghistories.com/archives/2010/04/22/a-homeopathic-history-of- malaria/
http://www.incamresearch.ca/index.php?id=117,0,0,1,0,0 http://hpathy.com/homeopathy-papers/the-use-of-homeopathic-prophylaxis-and- treatment-for-malaria-in-endemic-areas-of-kenya/2/

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http://www.1023.org.uk/whats-the-harm-in-homeopathy.php http://www.pbhrfindia.org/index.php/homeopathy-a-various-diseases/16- homeopathy-a-various-diseases/31-malaria-a-homeopathy http://www.blueturtlegroup.com/
http://ccrhindia.org/PDF/English/Malaria.pdf
http://www.dcscience.net/?p=22 http://www.quackometer.net/blog/2009/09/homeopathy-warning-from-africa.html http://vaccinefree.wordpress.com/travel-tropical-diseases-homeopathic- prevention/

http://www.incamresearch.ca/index.php?id=117,0,0,1,0,0

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References:

Ananda, D. (2010). The Use of Homeopathic Prophylaxis and Treatment For Malaria in Endemic Areas of Kenya. Received by http://hpathy.com/homeopathy-papers/the-use-of-homeopathic- prophylaxis-and-treatment-for-malaria-in-endemic-areas-of-kenya/2/

Bagai, U., Rajan, A., & Kaur, S. (2012). Antimalarial potential of nosode 30 and 200 against plasmodium berghei infection in balb/c mice. Journal of Vector Borne Disease, 49 (72–77).

Bastide, M. (2014). Chemotherapy of Malaria. Received by http://www.icp.ucl.ac.be/~opperd/parasites/chemo1.html

Bowers, D. (2008). Medical Statistics from Scratch. An introduction for health professionals. West Sussex, England. John Wile & Sons Ltd.

Council Policy Statement. (2010). Ethical Conduct for Research Involving Humans. Retrieved from

http://pre.ethics.gc.ca/pdf/eng/tcps2/TCPS_2_FINAL_Web.pdf

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Curtis, S. (1994). Homoeopathic Alternatives to Immunisation. A guide for travelers and parents looking for an alternative to being immunized. West Wickham, Kent. Winter Press.

Goldsmith, C. (2011). Battling Malaria. On the front lines against a global killer. Minneapolis, U.S. Twenty-First Century Books.

Greenhalgh, T. (1997). How to read a paper: papers that report diagnostic or screening tests. British Medical Journal, 315(540).

doi: http://dx.doi.org/10.1136/bmj.315.7107.540

Greenhalgh, T. (1997). How to read a paper: assessing the methodological quality of published papers, British Medical Journal, 315(305).

doi: http://dx.doi.org/10.1136/bmj.315.7103.305

Greenhalgh, T. (1997). How to read a paper: statistics for the non-statistician. I: different types of data need different statistical tests, British Medical Journal, 315(364). doi: http://dx.doi.org/10.1136/bmj.315.7104.364

Jain, S., Kumar, R., & Misra, J. (2013). Efficacy of ‘chininum-sulph 200’
in prevention of malaria’; an operational research study. State Health Resource Centre, Chhattisgarh, India. received from http://www.shsrc.org/Downloads/Chininum%20-Final%20-(17June13).pdf

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Lucas, A., & Gilles, H. (2014). Short textbook of public health medicine for the tropics. Received by

http://books.google.ca/books?id=iAkfW2ZF6xEC&pg=PA377&lpg=PA377 &dq=chemosuppression+definition&source=bl&ots=xlAFkLplbt&sig=3XK1 YmL2kS_FL_hGLntb1axyR_0&hl=en&sa=X&ei=stVeU8DoOcqCyQHMw4 G4Dw&ved=0CEoQ6AEwBA#v=onepage&q=chemosuppression%20defini tion&f=false

Rajan, A., & Bagai, U. (2012). Antimalarial potential of china 30 and chelidonium 30 in combination therapy against lethal rodent malaria parasite: plasmodium berghei. Journal of Complementary and Integrative Medicine. 10(1), 89–96, ISSN (Online) 1553-3840, ISSN (Print) 2194-6329,

DOI: 10.1515/jcim-2012-0016,

Rajan, A., & Bagai, U. (2011). SEM studies on blood cells of plasmodium berghei infected balb/c mice treated with artesunate and homeopathic medicine china. Journal of Parasitic Disease, 35(2): 134–139.

doi: 10.1007/s12639-011-0059-y PMCID: PMC3235391

Sheffield, F. (2013). Homeoprophylaxis: human records, studies and trails. Received from www.fransheffieldhomeopathy.com

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Smith, T. (1994). An Encyclopedia of Homeopathy. Sussex, England. Insight Editions.

https://www.researchgate.net/publication/276928105_Literature_Review_of_the_In_Vitro_and_In_Vivo_Evidence_for_Homeopathic_Medicines_in_the_Treatment_or_Prevention_of_Malaria