Pseudoscience & Religion

Chikungunya: Is there an alternative? – Part 2

Read Part 1 here

What are the alternative treatments for chikungunya?

Many types of ‘drugs’ have been suggested for the treatment of chikungunya in homeopathy, ayurveda, unani and Siddha systems.

Alternative Medicines in Belize

Alternative Medicines in Belize

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Homeopathy is based on the principle of like cures like, wherein a symptom is treated by the administration of minute concentrations (so miniscule, the pill may not have anything in it at all!) of a compound that causes the same symptom.[18] On that basis, many drugs have been suggested for the treatment of chikungunya[6,8-11,16,17,20] Eupatorium for body ache, china for severe aches and pains, pyrogen for rising temperature, arsenic for anxiety or restlessness due to fever, nux vomica for vomiting or pain with irritation, gelsimium for head ache, rhus tox for rashes and joint pains, arnica for redness, belladonna for high fevers when face looks flushed or pain with violence, bryonia for pounding pulse or pain with tranquility, coffea for pain paroxysms and excitability, chammomilla for pain with anger, ignatia for pain with weeping, aurum for pain with depression and other drugs like ledum pal, ruta graveolens, apis and formica rufa etc., have been suggested in homeopathy. While the basis for classifying the symptoms of chikungunya (or any other illness for that matter) are not clear and not supported by any evidence in any of the homeopathy literature, this gives us some idea on how a particular disease is analysed and understood and how the treatment of any disease is decided in homeopathic practice. This also makes it very clear, contrary to all the claims of the experts,that homeopathy has no specific treatment to offer for chikungunya.

Let us now examine the three documents provided by the Karnataka Health and Family Welfare Directorate, (H&FWD) in reply to our queries under the RTI, to support the claim that homeopathy is indeed effective in the treatment of chikungunya.[16,17,20] [These documents appeared like copies of some audio-visual presentations and we had to search for the detailed papers on the Internet] It appears that the two studies [16,17] cited by the state H&FWD have neither been peer reviewed nor published in any journals.[According to the author, the article (17) has been submitted to Br Homeo Journal and is still under review] One wonders how the H&FWD can make major decisions that involve lakhs of people and lots of money based on such unpublished data.

In the Pilot Study on Treatment of Chikun Gunya conducted in Kerala by Biju SG and Sarathchandran, nine drugs [ledum pal, ruta graveolens, rhus tox, belladonna, eupatorium, bryonia, apis, formica rufa and arsenic] have been used. But in a letter written to the H&FW directorate, the Karnataka region Director of Ayush, [the project of integrated alternative medical systems promoted by the Union Govt.,] recommends four drugs, namely rhus tox, belladonna, ledum pal or bryonia, for chikungunya in Karnataka.[20] Chikungunya in Kerala needs nine drugs, while four would do in Karnataka! But this significant difference (!) between the two states does not stop the state H&FW directorate from citing the study done in Kerala as evidence for the efficacy of homeopathy drugs in treating chikungunya in Karnataka! Given this difference, how is it that the officials do not find the need to conduct separate studies in Karnataka?

The Director of Ayush further states that the symptoms would subside in 70-80% of patients within 5 days. [Although he has quoted the Principal of Bangalore Homeopathy Medical College and the first grade physician’s report as the support for this claim, no such documents have been provided and no such study appears to have been conducted] On the other, does the study conducted in Kerala state reveal any benefits? The pilot study of Biju SG and Sarathchandran [16] included 532 patients of chikungunya. Among them, 16% patients had some relief in 3 days, 43% in 7 days, 28% in 14 days and 3% in 30 days and about 24 different symptoms improved to an extent of 11-87%. [That means, no patient had total relief from all the symptoms] In addition, the symptoms that persisted after the subsidence of fever improved to an extent of 8-50% (average 30%) only. But this pattern of recovery fits very well with the natural remission of the disease, without much treatment. The benefits of administering homeopathy drugs (nine of them!) to chikungunya patients are therefore not clear from this study.

Hahnemann in aphorisms 272-274 of ‘ Organon of Medicine’ states that only one single, simple medicinal substance is to be administered in a given case, because, the ingredients may even result in interactions that may have adverse effects in the body.[18] But in the pilot study, nine drugs were used for a week (or more) and the report does not make any mention of any efforts having been made to look for any adverse effects of these drugs.[16] It is therefore shocking, to say the least, that even with all these short comings and insignificant results, the authors have no hesitation to claim that ‘homeopathy medicines are highly effective in the management of chikungunya cases'[16] and that the state H&FW directorate quotes such a study as evidence to support the distribution of homeopathy drugs to the public at taxpayers’ expense!

Considering the fact that homeopaths have a unique way of classifying symptoms and treating, it is worthwhile to probe further. As homeopaths decide on the treatment based on the constellation of different symptoms in a given individual in a given locality, the treatment would be similar for similar symptoms, whatever the cause may be. Therefore, all diseases that cause fever, joint pains and other symptoms commonly seen in chikungunya may be given a similar treatment, as long as the symptoms remain similar. And that is true. Four of the drugs used in the treatment of chikungunya are also used in the treatment of dengue, five in malaria and one in tuberculosis![12,21-23] It is indeed unique that homeopathy offers the same treatment for viral diseases like chikungunya and dengue and a parasitic disease like malaria! Although chikungunya and dengue, being viral, may be self-limiting and non-fatal, what would be the fate of those patients who suffer from malaria, a potentially fatal illness?

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Other alternative systems of medicine like Ayurveda, Unani  and Siddha, also offer symptomatic treatment for  chikungunya. Ayurveda, and to a large extent Unani and  Siddha, are based on the concept of five bhootas, seven dhatus and three doshas. [24-27] There is no scope for a  viral aetiology in disease causation in these systems of  medicine as well.

As per the recommendations of the Principal of Ayurveda  Medical College, Bangalore, early treatment of chikungunya  with Amritadi guggulu and Rasana eranda kwata choorna will provide relief in 3 days.[20] Vilavadi and Sudarshana tablets have also been suggested.[12] However, there are no studies to support these claims.

According to Unani, majoon-e-suranjan, hapa-e-suranjan, rogan-e-surk, habe-e-askand, safoofa-e-tabashir (costing Rs. 200 per patient) would provide relief to 50% of the patients within a week and another 25% patients would improve in 1-2 weeks.[Based on the recommendation of the Principal, Unani Medical College, Bangalore and the experience with 200 patients who attended the out patient dept. of Unani Medical College][20] As mentioned above, the pattern of recovery is similar to the natural history of the illness!

Siddha system recommends the following for the symptomatic treatment of chikungunya: Nilavembu Kudineer (for fever), Vathajura Kudineer(for joint pain and swelling), Santha Chandrodaya Mathirai, Balasanjeevi Mathirai, Brahmananda Bhairava Mathirai, Ashta Bhairava Mathirai and Vasantha Kusumaraga Mathirai.[13] Further details or studies to support these claims are not available.

Considering all these, it can be safely said that none of the alternative systems of medicine have any specific or proven treatment to offer for chikungunya. The remission of symptoms among the patients treated with the alternative medicines follows the pattern of natural remission of the disease in the absence of any specific treatment and therefore as of now, there is no evidence to show that alternative medicines either hasten the recovery, prevent complications or lasting symptoms or change the course of the disease in any significant manner.

Can chikungunya be prevented by ‘alternative medicines’?

As the unsupported claims of specific treatment for chikungunya available in ‘alternative systems’ went unchallenged, the ‘experts’ of alternative medicine got emboldened to further claim that the spread of chikungunya could be prevented by the use of alternative medicines. Absence of an effective vaccine and the panic and confusion among the officials of the health dept. in the face of the rapidly spreading infection provided a golden opportunity for the alternative systems to not only make such tall claims, but also to conduct camps in many areas to distribute the ‘alternative drugs’ to lakhs of people at the expense of the exchequer.

What about the evidence? According to the experts of homeopathy, drugs that are used in the treatment of chikungunya are also useful in preventing the infection – no difference whatsoever in the drugs administered to those who already suffered and the general public yet to be infected! This looks simple and easy, even thogh it defies all logic! But no, there is some twist to the tale. .Even though chikungunya is caused by the same virus everywhere (this fact of modern medicine, of course, is not accepted by homeopathy!?), the drugs to prevent its spread has to be different from place to place and the suitability of a particular drug has to be decided only by an ‘expert’ of homeopathy after considering the local conditions. According to the Central Council for Research in Homoeopathy (CCRH), established by Govt. of India, the following drugs are useful in preventing chikungunya in different parts of India: Bryonia for Kottayam in Kerala, Eupatorium for Calicut in Kerala and Hyderabad in Andhrapradesh, rhusd tox for Rajasthan and Karnataka, Ledum pal and Chamomilla for Chennai in Tamilnadu.[28] (Rajasthan in north western India and Karnataka in south western India at last have something in common!) On the other, the Director of Ayush for Karnataka, in his letter to the dept. of H&FW, recommends rhus tox, ledum pal and tuberculinum for prevention of chikungunya in Karnataka, while at the same time informing that the results of the studies in this regard are as yet awaited. [20] But the state H&FW directorate goes on to cite a study conducted in Trivandrum, using Eupatorium, as evidence to support the use of homeopathic drugs in Karnataka![29] How can a study, using Eupatorium and done in Trivandrum, support the use of Rhus tox, Ledum pal and tuberculinum in Karnataka? If it is true that different drugs have to be used in different places, is it not necessary to study the efficacy of thee drugs separately? How can major public health policies, that involve considerable expenditure, be decided How is it that the officials and medical professionals of the H&FW dept., decide to distribute drugs to lakhs of people at considerable expense to the exchequer, without seeking any scientific evidence to support such an action?

But is the study done at Trivandrum reliable?[17,29] Although the authors claim that the study was conducted to assess the efficacy of homeopathy drugs in the prophylaxis of chikungunya, the only outcome that was studied in the treated population of only fever and not the manifestations of chikungunya. No explanation is found in the report to the fact that 376 of the 2000 subjects included in the study were later excluded. Also, there is no mention of any adverse effects of the drugs having been studied. The homeopaths may be for sure (and forever) believe that the drugs may not have any adverse effects and accordingly might not have found it necessary to study any possible adverse effects in the study population; but the same cannot be said of the officials of the H&FW dept., who are responsible for the drugs that they distribute to lakhs of people. This study claims that the homeopathy drugs were effective in preventing fever in the study population, but the fact remains that the attack rate of chikungunya varies widely from 4-45% [30] and drawing such sweeping conclusions on the basis of such a not-so-well-designed study is unjustified.

Conclusion:

In conclusion, the information provided by the H&FWD in response o our query seeking the scientific evidence to support the claim that ‘alternative systems’ of medicine provide drugs that are effective in the treatment and prevention of chikungunya raises more questions than answers.

(Back to Part 1)

References:

18. All scientific studies regarding the various aspects of chikungunya have been conducted only by the scientists of modern medicine and such studies are continuing, including the research on development of a vaccine.

19. Chikungunya is a self limiting, non-fatal viral illness that resolves in 4-10 days. Simple, almost harmless drugs are available in modern medicine to treat the symptoms such as high fever or severe jopint pains.

20. There are is no specific or special treatment available in any alternative systems of medicine for treating chikungunya and no research in this regard has been published in any scientific publication of repute so far. All alternative systems only suggest drugs for the various symptoms of chikungunya and no studies have been published on the efficacy or adverse effects of such drugs.

21. No evidence that supports the efficacy of homeopathy or any other alternative systems in preventing the spread of chikungunya are available either with the state H&FWD or the Internet or in any scientific literature.

22. Therefore, there is no evidence to support the claim that the ‘alternative systems’ provide better treatment for chikungunya than modern medicine.

23.   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

24.   Homeopathy Principles Available at http://www.hpathy.com/basics/homeopathicprinciples.asp

25.   Biju SG. A Pilot Study on Treatment of Chikun Gunya. Found in the copy of the presentation provided by the Karnataka Health and Family Welfare Directorate. [Copy with the author]

26.   Communication from Director, Ayush, Karnataka. Provided by the Karnataka Health and Family Welfare Directorate under the provisions of RTI, 2005. In the possession of the author.

27.   Thomas M. Dengue and Homeopathy. Available at http://www.medindia.net/alternativemedicine/homeopathy/dengue_remedies.htm

28.   Tuberculosis. University Maryland Medical Centre. Available at http://www.umm.edu/altmed/articles/tuberculosis-000165.htm

29.   Intermittent fever/malaria. Available at http://www.hpathy.com/diseases/intermittent-fever-symptoms-treatment-cure.asp

30.   Tridosha Principle. Available at http://library.thinkquest.org/04apr/01297/html/basic.htm

31.   Ayurveda Concepts Available at http://ayurveda.iloveindia.com/ayurveda-fundamentals/index.html

10. Unani – A System of Medicine So Close to Ayurveda Available at http://www.keralaayurvedics.com/category/other-resources/unani-medicine

11. Thas JJ. Siddha medicine–background and principles and the application for skin diseases. Clin Dermatol. 2008 Jan-Feb;26(1):62-78. Available at http://www.ncbi.nlm.nih.gov/pubmed/18280906

12. Management Of Epidemics Available at http://ccrhindia.org/epidemic.asp

13. Rejikumar R, Dinesh RS et al. A Study On The Prophylactic Efficacy Of Homoeopathic Preventive Medicine Against Chikungunya Fever. Found in the copy of the presentation provided by the Karnataka Health and Family Welfare Directorate. [Copy with the author]

14. WHO (Country Office for India). Outbreaks of Chikungunya Fever. Available at http://www.whoindia.org/LinkFiles/Chikungunya_Fever_cds-chikunguniya-outbreaks.pdf

About the author

Srinivas Kakkilaya

Physician practicing at Mangaluru, South India

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