Chikungunya: Is there an alternative?
Aedes aegypti
Introduction: (Read Part 2 here)
It is rarely that we find ourselves prepared to tackle emergencies and so it is only natural that things get badly messed up in such situations of crisis. It is not quite so rare to find many waiting to fish in the troubled waters.
Recently we witnessed such conditions during the outbreak of chikungunya epidemic in Dakshina Kannada district of Karnataka state. The officials of the dept. of health and family welfare, as always bereft of ideas or plans to tackle the epidemic, readily washed off their hands claiming that modern medicine does not offer any treatment for chikungunya. Further, it was claimed that homeopathy and ayurveda have remedies to offer, not only to provide for treatment but also for prevention of chikungunya . Many camps were organized in the Primary Health Centres, Anganwadis etc. for the free distribution of homeopathy drugs for the ‘prevention’ of chikungunya.
The Govt. of Karnataka issued a front page advertisement in all the dailies on June 13, 2008 detailing the steps taken by the government in tackling the epidemic. Among other things, the ad claimed ‘chikungunya is a self-limiting disease that resolves in 8-10 days‘ and that ‘it was not fatal‘, and furtuer went onto to claim that the government had ensured adequate supplies of ‘life saving drugs and other medicines needed‘ for the treatment of chikungunya. It also claimed that ‘homeopathy and ayurveda drugs are useful in preventing chikungunya and that ‘people can use these drugs‘ to prevent the infection.
Contrary to what is well known in the medical literature, the district health officer claimed that the incidence of chikungunya would drop following the rains! Meanwhile, thousands suffered from the infection across the district. Many doctors, who had never seen such cases in the past, were unclear about the management of the infection and some practitioners of alternative systems of medicine posed as experts of chikungunya and wrote reams on the virtues of alternative therapy in the management of this disease. While many doctors and hospitals rendered selfless service, stretching all their limits, some original, many alternative and most quacks hiked their fees and rendered ‘special’ service. The media reported the events ‘as they where’ and provided lots of space for the ‘experts from alternative medicine’ and all this only helped to worsen the confusion.
We wrote to the District Health Office and the state Health and family Welfare department seeking information under the Right to Information Act, 2005, regarding the reasons and supporting evidence for organising the camps distributing homeopathic tablets to prevent chikungunya. The answers received clearly reflect how the administration responds to such epidemics and how the public health administration irrationally surrenders itself to the ‘alternative medical systems’ when the specialists from modern medicine are found wanting in formulating a scientific and rational strategy to tackle the epidemic. (The full text of the questions and answers are providedin Part 2 of this article)
Chikungunya and Modern Medicine:
It has been widely reported in the media that modern medicine has nothing much to offer in the treatment of chikungunya. Combined with reports that there were deaths due to chikungunya (none of these deaths were ever confirmed as due to chikungunya), such statements have only increased confusion and panic among the people. This has provided a golden opportunity for the proponents of the ‘alternative systems’ to claim the market and make the most of it.
But what are the facts?[1-5] copyright : AJC1
chikungunya virus
Every attempt has been made to study chikungunya since its identification as a mosquito borne illness in 1952. The ultra structure of the virus, its modes of spread, symptoms, complications, manifestations in infected pregnant women, infants and the elderly, morbidity and mortality, chronic arthritis and its management strategies and many other aspects of chikungunya have been studied in detail in several countries and the reports have been published in many reputed scientific publications and by WHO.
In the recent years, chikungunya has been spreading across 23 countries of Africa and Asia, including India. The changes in the viral genome have apparently made it more virulent and the same viral serotype has been found across Africa and Asia. The disease is self-limiting and in most patients resolves in 4-10 days. There is no need for any specific treatment for chikungunya other than acetaminophen in case of high fever or severe joint pain. Rare complications may require specific supportive treatment. About 12% patients may have persistent joint pains and such patients may need chloroquine tablets. There are no drugs or vaccines to prevent chikugunya and the spread of infection can be prevented only by means of controlling the vector mosquito.
Thus, modern medicine is clear about the strategies for management and prevention of chikungunya. More research is underway to understand its pathogenesis and to develop a vaccine.
Is there any specific treatment available for chikungunya in the ‘alternative systems’ of medicine?
The answer is a big NO. The fact is, none of the ‘alternative systems’ of medicine even consider chikungunya as a separate disease entity. Most of the so called ‘alternative systems’ consider the various diseases that afflict humans as manifestations of imbalance between man’s internal and/or external environs and the concept of single causes like infectious agents does not exist in these systems. That being the case, these systems offer ‘treatment’ based largely on the symptoms alone, (fever, jaundice, joint pain etc.,) whatever be the cause.[See below] But ironically, while writing on chikungunya, most of these ‘experts’ of alternative medicine have not hesitated even a bit in ‘copy-pasting’ the details of chikugunya, including the fact that it is a viral illness, from various resources of modern medicine!
All these ‘alternative systems’ suggest piece meal treatment for the various manifestations of chikungunya and nowhere one finds a holistic or complete treatment. [6-13] The word chikungunya is nowhere to be found in the Boericke’s Homeopathic Materia Medica, often cited in the articles on the treatment of chikungunya written by homeopathic ‘experts’.[6,7,14] It is hard to find any studies on the efficacy of such alternative medicines in the treatment of chikungunya in any peer reviewed literature. Even the two studies, cited by the Karnataka Health and Family welfare department as evidence for the efficacy of homeopathy in the management of chikungunya, have not been published so far.[15-17] Therefore, there is no evidence or support to substantiate the claims of the ‘experts’ of the alternative systems that these systems provide specific and effective treatment for chikungunya while modern medicine has nothing to offer.
References:
1. Powers AM, Logue H. Changing patterns of chikungunya virus: reemergence of a zoonotic arbovirus. J Gen Virol. 2007;88:2363-2377 Full Text available at http://www.sgm.ac.uk/jgvdirect/82858/82858ft.pdf
2. Pialoux G et al. Chikungunya, an emerging arbovirus. Lancet Infect Dis. 2007;7:319-327 Full Text available at http://www.ifmt.auf.org/IMG/pdf/TLIDarticle.Chikungunya.pdf
3. Isabelle Quatresous. Chikungunya outbreak in Réunion, a French ‘overseas département’ Eurosurveillance, 2006;11(5) At http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2904
4. Chhabra M, Mittal V, Bhattacharya D, Rana U, Lal S. Chikungunya fever: A re-emerging viral infection. Indian J Med Microbiol [serial online] 2008 [cited 2008 Jun 24];26:5-12. Available from: http://www.ijmm.org/text.asp?2008/26/1/5/38850
5. Swaroop A, Jain A, Kumhar M, Parihar N, Jain S. Chikungunya Fever. Journal, Indian Academy of Clinical Medicine 2007;(2):164-68 Full Text Available at http://medind.nic.in/jac/t07/i2/jact07i2p164.pdf
6. Sunila Chikungunya: Homeopathic Management. Available at http://www.similima.com/chikungunya.html
7. Thomas M. Chikungunya and Homeopathy. Available at http://www.medindia.net/alternativemedicine/homeopathy/Chikungunya_References.htm
8. Chikungunya Available at http://www.hpathy.com/diseases/chikungunya-symptoms-treatment-cure.asp
9. Chikungunya – Homeopathy for treatment and prevention Available at http://www.homeopathyhelps.com/chikungunya-treatment.htm
10. 10. Thomas M. Chikungunya and Homeopathy. Available at http://www.medindia.net/alternativemedicine/homeopathy/Chikungunya_Homoeopathy_Treatment .htm
11. Vallabhassery BS. Chikungunya Available at http://www.hospitals-directory.com/harticle6.htm
12. Fight Chikungunya and Viral Fever with Ayurveda Available at http://www.keralaayurvedics.com/media/articles/fight-chikungunya-and-viral-fever-with-ayurveda.html
13. Spencer Jones Chikungunya [ Chicken Guinea ] Available at http://www.siddhaphysician.com/Chikungunya-Chicken-Guinea.html
14. William Boericke Homœopathic Materia Medica Available at
http://www.homeoint.org/books/boericmm/index.htm
15. Rejikumar R. Personal communication to author by e-mail
16. Biju SG, Sarathchandran. A Pilot Study on Treatment of Chikun Gunya. Available at http://www.slideshare.net/shebees/chiqun-gunya/ and http://similiacare.com/wp-content/uploads/2008/06/cgunya2t.pdf
17. Rejikumar R, Dinesh RS et al. A Study On The Prophylactic Efficacy Of Homoeopathic Preventive Medicine Against Chikungunya Fever. Available at http://www.similima.com/gen126.html
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This post was written by:
Srinivas Kakkilaya - who has written 7 posts on Nirmukta.
Physician practicing at Mangaluru, South India
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Dear PARAMESH, I am glad that you have asked these questions.
I will be grateful if you could kindly provide the complete citations for the references you have suggested. Kent’s Repertory is available online [http://www.homeoint.org/books/kentrep/kentextr.htm]and I neeed not buy it; I did not find Chikungunya anywhere there.
The methods of diagnosis of chikungunya are well established and my study fulfills those requirements. I am too happy that you have accepted the notions of ELISA, PCR etc., all techniques of modern medicine, but I wonder whether homeopathy recognises the CHIKV.
Regarding the claims of alternative medical specialists, suffice it to say that the officials of the govt. of Karnataka also got carried away and advertised in leading dailies that allopathy does not offer any medicines, but alternative systems do. And that is exactly what I question. If you have any specific answers to the following, please enlighten us all:
1. Does homeopathy recognise chikungunya as a specific disease that is caused by CHIKV?
2. Is there any mention of chikungunya by name in any of the homeopathy literature?
3. Is there any SPECIFIC treatment for chikungunya in homeopathy or is it only directed to its symptoms?
4. Does homeopathy offer SPECIFIC preventive drugs against chikungunya or is it ONLY against fevers with different manifestations?
Dear Dr Kakkilaya,
Thank you for your prompt reply.
You have repeatedly told that EXHAUSTIVE REVIEW OF THE AVAILABLE LITERATURE of modern medicine and alternative medicine. Your referrece may be true as far as modern medicine is concerned. But by referring 1 or 2 books on alternative medicines does not constitute exhastive review. For e/g In Homoeopathy you have quoted from William Boerickes Materia Medica and Hahnemanns organon. These 2 books represent only 2 % of Homeopathic literature. Kindly refer REPERTORY OF HOMOEOPATHIC MATERIA MEDICA BY DR J T KENT,extremities chapter, joints. REPERTORY BY BOGER – BBCR, Fever chapter, concomitants joint pain., THERAPEUTICS OF INTERMITTENT FEVER BY DR H C ALLEN, CLARKES DICTIONARY OF MATERIA MEDICA 3 VOLS, ENCYCLOPEDIA OF MATERIA MEDICA- 12 VOLS, HERRINGS GUDIDINGS SYMPTOMS OF MATERIAMEDICA- 10 VOLS, SYNTHESIS REPERTORY- DR FREDRICK SCHROYENS, PHILOSOPHY OF HOMOEOPATHY BY KENT, ROBRRTS H A, STuar close. these books are available in B Jain publishers NEW DELHI. After reading/referring all these major books regarding the management of fever with joint pain, then we can answer to your querries.
2. You must have treated more than 250 patients of acute chikungunya with chloroquine. BUT DO YOU HAVE ANY LABORATORY EVIDENCE FOR THE SAME. i.e. confirmed cases of chikungunya with IgM ELISA, PCR ETC. if no what is the guarantee that all these are chikungunya cases. These cases must be viral fever with arthromyalgias?
3. Third point which i want to stress is regarding publicity of alternative medicines in the management of chikungunya.
Our medical society is dominated by allopathic drs. This fact u all know. So when a chikungunya outbreak was there recently, it was the modern medicine people who were saying that you dont have any specific medicine, only symptomatic treatment. So people started coming to the drs of alternative medicine and felt symptomatically better, and they started spreading this information. Some articles also appeared in news paper by drs of alternative systems to make people more aware about these systems and their approach in chikungunya cases. Is that can be called as ‘ MISLEADING’ ? It is the patients who have all right to decide about the system of medicine. If there is no information about these systems, there would have been more and more consumptions of pain killers and NSAIDS.
Dear PARAMESH, Thank you for your interest in my article. As you have pointed out, the article is written after an exhaustive review of the available literature on chikungunya (and the use of chloroquine), from resources of modern medicine as well as alternative and I have provided the list of these at the end.
Knowledge is shared. It is acquired by various means – direct observations, discussions, from the relevant literature etc. It is unfair to expect everyone to be at the scene and learn everything directly. In any case, by now I have managed more than 250 cases of both acute chikungunya and its arthropathy and I have documented these cases in detail. I have also studied the efficacy of chloroquine in chikungunya arthropathy and I am planning to submit the paper for publication. My findings tally with those mentioned in larger series from other places. If you have found a very high incidence of persisting joint pain among the patients in Sullia/Puttur, I suggest that you must publish this data in some journal so that the whole of humanity is benefited from your observations.
I have not pointed at any one in particular for ‘fishing in troubled waters’, it is a fact that can apply to anyone who has done so. I have also acknowedged the fact that ‘many doctors and hospitals rendered selfless service, stretching all their limits’… and that ‘many doctors, who had never seen such cases in the past, were unclear about the management of the infection’. Please read the article again.
The purpose of the article was to point out just one thing: Contrary to what has been widely claimed and publicised, no alternative system of medicine offers any SPECIFIC treatment for chikungunya. Any treatment available in any system of medicine is ONLY symptomatic. That being the case, attempts to garner undue publicity by claims of ‘special treatment’, ‘preventive drugs’ etc., are misleading and nothing less than deciet.
dear Dr S Kakkilya,
Its really nice of you, for revealing astonishing facts about chikungunya treatment. While going through your whole article and its comments and reply one thing is very evident. i.e., YOU have not gone to the field in affected areas like sullia, puttur and in BANTWAL Talluk. According to your highly theoritical knowledge, chikungunya is a self limiting disease, and more than 50 % of the people recover totally within one week. Because with this point you have contradicted the study done by some KERALA HOMOEOPAHTIC DRS, BIJU/SARATHCHANDRAN,saying that it is natural recovery. I am cordially inviting you to visit the chikungunya affected regions of sullia and puttur and introspect yourself regarding the chikungunaya knowledge.
It is indeed a fact, that more than 50 % of the people have still not recovered from after effects of chikungunya like arthralgia, heel pains, finger stiffness. Many people could not return to their regualr work like agricultural labourers, People who are engaged in arecanut plucking, insecticide spraying etc. Many people are still dependent on others for their daily activity. NOW WHERE IS YOUR NATURAL SELF LIMITING CHIKUNGUNYA TELL ME.
2/ SECOND POINT:
YOU HAVE repeatedly said that alternative medicine doctors have misused the opprtunity of epidemics,( with your words like some fish in troubled water)Now according to me, it is not the alternative medicine doctors who have spoiled the scene, but it is mainly by the doctors of so callled MODERN MEDICINE. yOU HAVE TOLD YOUR APPROACH IN CHIKUNGUNYA…….it may sound rational, but how many of your collegues practicing in puttur, sullia, bantwal have followed these approach. I can say in whole south kanara, no one has followed your method. most of the drs have given over dosage of pain killers, NSAIDS, steroids, analgesic injection and what not. The fact finding committe lead by Dr Uday Kumar also revealed many people died because of over medication by pain killers. Is is called CLEAR STRATEGY ABOUT MANAGEMENT.
THIRD POINT3:
I have seen many ayurvedic and Homoeopathic doctors were sincerely helping the community in treating chikungunya without any painkillers. Many patients must have gone to these doctors but not more than 30 % of patients. By going to these doctors they are saved from the serious side effects of modern medicines. Is it a crime? YOU CAN DO A HOUSE TO HOUSE SURVEY AND CAN FIND OUT HOW PEOPLE REACT TO THESE SYSTEMS.
FOURTH POINT: 4
Chikungunya is new to this district. Hence many doctors were doing trial and error even in modern medicine. You are saying giving CHLOROQUINE IS SAFE. Any scientific study has been done regarding this. OR ELSE WHAT EVER YOU ARE ALL DOING DOES NOT REQUIRE ANY STUDY.
Dear Dr Rao, No two humans are alike and therefore any disease will manifest differently in different individuals, with many similar features (of different severities) that help us to identify it as a particulr entity. This fact is very well recognised in modern medicine as well. The major difference between modern medicine and other systems is that, in modern medicine the common factor of a particular disease among all sufferers is the cause of the disease, whose manifestations can vary, whereas in other systems, it is the symptom, whose casues can vary. It follows then that modern medicine treats the cause and with that the symptoms disappear while alternative systems try to provide relief for a symptom while the cause is undetected and untouched.
Chikungunya is spread by a mosquito and at any place, only 4-40% of people will be affected, leaving the rest. That is because, the others escape the mosquito bite due to reasons such as being unattractive to the mosquito, chance, self protection etc.
Even if a few drugs in alternative systems do good, they need to be tested with the basic principles of scientific research and if they pass the test, can be definitely used by all.
sir i agree with what you said , and i do agree that dis-ease is an “evolution” so one man said may not be apt for circumstances and situations present time , its also true that some physicians are clinging , and its also true that scientific reasearch paper is not upto the standards,
but one thing always lurking in my mind – no doubt that virus is the cause but what about individual succeptibility , i have seen many people who have not got chickungunya even if their house members are all affected ,(repeatedly varified). my thinking (not an hypothesis) is that there is many more things as per the cause is considered not only virus
Dear Dr Rao, That is the point I have made all along: Homeopathy DOES NOT recognise dieases, it recognises only the MANIFESTATIONS of the diseases. So a homeopath is treating FEVER, not the cause/s of fever.
Chikungunya is a disease caused by a virus (a fact many homeopathy authors have accepted) and it is known to cause subacute to chronic problems, related to immune response to the viral antigen. Lot of work is on to decipher the exact nature of these pathophysiological processes. The treatment is different for acute symptoms and chronic manifestations.
Understanding man’s interaction with nature cannot be a one man show and what one man said centuries ago need not be held as sacrosanct and very dear. Evolution of thought and ideas is the best thing that has happened to the human race and we need to be players in this great journey of seeking answers to the many questions that we have. Clinging onto what one man said and refusing to think beyond that cannot be a joyful experience, be it Hahnemann’s homeopathy, Charaka’s ayurveda or the many religious teachings. Nirmukta is a call to get liberated from thought blocks and we invite you all to jump in!
helo sir
thank you for the reply
with your reference to previous mail
you have stated that : 1. By your own assumption, homeopathy DOES NOT TREAT DISEASES, but ‘treats’ symptoms as it occurs differently in different individuals in different places. This ONLY means that there cannot be any objectivity to homeopathy, it is highly and purely subjective.
- sir i have clearly mentioned that we treat the totality of symptoms which inclue (according to the Homoeopathic concepts) physical generals, mental generals , and charecteristic particulars. it can be subjective as well as objective, Dr. Hahnemann had never told that “no to objective”, physician what he sees and feels are also taken in the totality. but its not given undue importance like many of of our neighbours do
do you consider that post chikungunya arthralgia is related with chickungunya, if yes then chikungunya is not an acute disease, it definite onset, progression and remession
if you consider only fever as part of chikungunya then it is an acute illness which ofcourse subside with or without medicine.
why the difference in presentation of chikungunya ( symptoms of artharlgia) ? the duration of it ?
and the intensity of it ?
there are 100′s & 1000′s of people here and there in front of our eyes who are taking painkillers for these arthalgia for past more than months now , still they remain same not getting better,
meanwhile we have enough number of cases who after taking homoeopathic medicine they feel really better.
i agree to your 3rd point
i will read the article again
you are free to ask any number of questions, your questions are keeping all of us alive
thank you
Dr. P. ramakrishna Rao
Dear Dr Rao, Your points are noted. Nothing that I have written is of my own, I have extensively quoted from the Homeopathy literature.
1. By your own assumption, homeopathy DOES NOT TREAT DISEASES, but ‘treats’ symptoms as it occurs differently in different individuals in different places. This ONLY means that there cannot be any objectivity to homeopathy, it is highly and purely subjective.
2. As homeopaths treat symptoms, they cannot claim that they can cure chikungunya, if it all what they ‘claim to cure’ is the joint pain due to chikungunya and not chikungunya. Homeopathy does not and cannot recognise chikungunya as a disease.
3. The research papers cited by the govt. of Karnataka are naive and cannot stand peer review by any standard of science. You may claim that they meet the standards of homeopathy, but scientific methods are basic standards that apply to ALL areas of scientific endeavor. We only wish and hope that the scientific research in homeopathy stands up to these standards.
4. I am aware of what modern medicine can do and cannot do. Please read the article again and you will find the comparison.
Helo sir ,
as you have said , eupatorium , china , pyrogen …..
1. Sir first and formost this is wrong concept of yours , homoeopaths dont treat by disease names or by single symptoms , eupatorium – body ache, china – aches and pain … this is not true , homoeopaths take the totality of symptoms and then treat.
2. there may be 100 people suffering from chikungunya but remedy differs , depending on individual variations , if you see on the outer aspect symptom may look similar , but if you analyse it throughly there will be difference. Example: if you take knee joint pain you have to diffrentiate it like side, locality (finer aspect), sensation , extension , modalities like aggravation and amiliorations, exact type of pain , and concomitant symptoms .
3. While the basis of clasification of symptoms of chikungunya …….
sir for your kind information symptom classification is not according to the disease but according to the individual as a whole
4.benifits of administering homoeopathic medicine for chikungunya patient is therefore not clear … i can only say this please be clear before comenting anything ,
1. its 5 1/2 year course in homoeopathy to get a degree , you can try it if you are intrested
gain proper knowledge (not by internet and by your imaginary ideations) by going through regular classes and then you can coment.
2. there are scientific reasearch going on in homoeopathy
3. what about your system what best you can do ?? always have this question in mind