An Interview with Peter Fisher

If there were such a thing as homeopathic royalty, Peter Fisher would easily fit the bill. And that’s not just because he is physician to Her Majesty Queen Elizabeth II, as well as both Clinical and Research Director of the Royal London Hospital for Integrated Medicine–the largest public sector provider of holistic medicine in Europe (formerly called the Royal London Homoeopathic Hospital).

Of at least equal importance is that for the past 25 years he has served as editor-in-chief of the journal Homeopathy, the only MEDLINE-indexed homeopathic journal. MEDLINE is the medical research database of the US National Library of Medicine at the National Institutes of Health and is considered the gold standard of published medical research. In his role as editor of the journal and author of numerous published studies, Peter brings to homeopathy what it so richly deserves–serious consideration, assessment, and refinement by the most rigorous methods of science.

Trained at elite Cambridge University, Peter is qualified in both homeopathy and rheumatology and is a Fellow of the Royal College of Physicians. (The Royal College is the oldest medical society in the world; Fellowship is a select honor bestowed by Royal College peers.) He is also a Fellow of the Faculty of Homeopathy (The Faculty, established in 1844 and incorporated by an act of British Parliament in 1950, regulates the education, training, and practice of homeopathy by the medical profession in the UK). Peter is a member of the World Health Organization’s Expert Advisory Panel on Traditional and Complementary Medicine, and he chaired the WHO’s working group on homeopathy.

Below is an interview I conducted with him in 2011.

How did you first become interested in homeopathy?

I went to China in 1972 in between my undergraduate and post-graduate medical studies, just a few months after Nixon’s visit.  China had been completely closed to foreigners during the Cultural Revolution. I remember vividly seeing a woman lying on the operating table, entire abdomen open, having half her stomach resected, conscious, with three needles in her left ear [for anesthesia]. And I thought, “Oh, well they didn’t teach us about that in Cambridge. That doesn’t happen.” But clearly it was happening. So that’s what first got me interested in unorthodox forms of medicine.

So, for a while I studied Chinese. I seriously intended to take up Traditional Chinese Medicine, but it is a huge cultural leap.

Then I became ill myself while still a medical student. I went to see various distinguished physicians who made a precise diagnosis and said, “Tough, nothing can be done.” And an American friend suggested homeopathy. The first thing [after taking the remedy], I had a terrible aggravation. It made me realize at least it did something. And then it helped, and that sort of started the ball rolling.

How did you get involved in rheumatology?

Well, it was a bit of an accident. I found a research opening in the rheumatology department at Bartholomew’s Hospital of London with an open-minded professor of rheumatology and clinical pharmacology. And we conducted one of the very first good quality studies of homeopathy published in a first line medical journal–published in BMJ [British Medical Journal] in 1989.  [1]

How did you get involved in research?

It clearly needed to be done in homeopathy. I just felt there was a desperate need for it. So I did it.

It was actually very difficult because we had a hospital and consultants but you had no way to train consultants–that was the problem at the time. So you could be appointed a consultant if you could get trained, but you couldn’t get trained in homeopathy–it was a bit of a Catch-22. And the one way you could get around it was by being a research fellow, so that’s what I did.

What do you see as the role of and the direction you want to take the journal?

The historic piece was when we got MEDLINE-listed, that was in 1998 I believe, when Wayne Jonas was the boss at the Office of Alternative Medicine [at NIH, now called the National Center for Complementary and Alternative Medicine]. He was instrumental in that. That was very important. So that means we were no longer in the so-called “grey” literature. The “black and white” literature gets cited in MEDLINE.

Homeopathy needs a specialized journal. There are a lot of the generic complementary medicine journals…but I think there is a need for a dedicated [homeopathic] journal….We put together some coherent issues. For instance we did a special issue three or four years ago on basic science. And then we did one on biological models – which ended up being 2 issues, because there was so much material two years ago. And that was important–to make it clear that there really is evidence.

We are going to do one on clinical research. We are planning a mega-series of systematic reviews and meta-analyses.

What is your opinion on randomized controlled trials versus more pragmatic observational studies? At the 2011 Joint American Homeopathic Conference in Alexandria, VA, Wayne Jonas said that it’s time to focus on the real-world, outcomes-based trials as opposed to placebo-controlled studies.

Of course he’s been saying that for a long time, and I think he is right in many ways.

One thing to remember about research is it is just a method of answering questions. It gets fetishized–people turn it into an end in itself, which it shouldn’t be. So, the question really is, “What is your question?” If your question is, “Can homeopathic dilutions really do anything?” then actually the randomized controlled trial is an expensive, difficult way of answering it. I’ve done many of them, and there is an awful lot that can go wrong. If your question is, “Is this stuff placebo or not?” then there is a strong argument that randomized trials are actually an expensive way of answering that question and you would do much better with a biological model [i.e., in vitro laboratory study].

On the other hand if your question is “Does homeopathy make a useful, cost-effective therapy or fill an effectiveness gap in health care?” then you need some kind of, observational or controlled clinical study which might be randomized or cohort. The difference being “observational” means you just watch the patients and watch what happens–it is completely uncontrolled. Cohort study means you compare it, but it is not randomized.

Claudia Witt in Germany has done some excellent cohort studies showing that patients who get homeopathy do at least as well as, in many cases better than, comparable [conventional medicine] cohorts. Although, of course, the cohorts are never quite comparable–that’s the problem. You can use clever statistical methods to try and make them comparable, but they never are. One of the things I rather like is that you find pretty consistently the cohort that chooses homeopathy has higher levels of education. That’s got to say something. The cohort studies are pretty consistently positive.  But of course the differences, such as level of education do interfere with the interpretation.

So, controlled trials are difficult and expensive, but is it something we should be doing as a community just for the sake of our advancement?

Yes of course they have an important role. But we need to think very carefully. I’m chair of a research group and we actually have some money–and you need to be very targeted to consider, “What are you going to do, and why?”

We are doing this meta-analysis of homeopathic trials. There are, I think, 240 of them. It is a huge undertaking to do them properly. And we’ll be dividing them into individualized (so-called “classical”) and non-individualized. And non-individualized further subdivides into so-called “clinical” and “complex.”

We are still concentrating on the potential of homeopathy in pandemic/epidemic disease. There was a very nice study [2] done by Gustavo Bracho in Cuba – very interesting.  I met him for the first time recently–very impressive guy, very interesting guy. So that is one area we are looking at.

But there is a need to repeat studies and concentrate on promising areas, and not just to go off and do the first thing that comes into your head

What areas are promising–influenza maybe?

Yes, influenza, dengue fever. There is one study done by Jennifer Jacobs which is negative, [3] but there are many people who think it might work in dengue. And interestingly, you’ve got countries as diverse as Brazil and Malaysia where you’ve got groups of homeopaths interested in working on dengue, so we’re trying to put those together.

What do you think about Lex Rutten’s work on the repertory? (Lex Rutten leads a team of 10 Dutch homeopaths working to assess repertory rubrics for their accuracy and reliability based on the statistical methodology of Bayesian analysis. They published their first paper, assessing 6 rubrics, in 2009.) [4]

It is very interesting. He is definitely right, but the trouble is it takes a vast amount of data collection to validate the repertory. It is alarming–the repertory just gets bigger and bigger and bigger, but less and less reliable.

I always start with my students, I pick up a copy of Synthesis Repertory and I say, “The problem with this book is that half of it is wrong–the question is, ‘Which half?’” What I mean really is that 80% of it is wrong, the question is, “Which 80%?”–but I don’t want to discourage them too much.

Lex told me it would take about 15 years working with 20 groups such as his to assess the top 600 rubrics, representing the most common keynote symptoms.

Yeah, it is a vast undertaking to do it properly. But his methodology is very good, and he is right.

How did you come about being physician to Her Majesty?

By a rather opaque process. Somebody comes up to you and says, “If you were to be asked, you wouldn’t say ‘no’, would you?” They can’t risk you possibly saying “no.” So they check you out, and then you don’t hear a thing. Then a year later you get a letter. So, I suppose it is a matter of being in the right place at the right time.

The royal family has had homeopathic physicians since…?

For a long time–since the 1840s. The founder of our hospital Dr Frederick Quinn had been homeopathic physician to Prince Leopold of the Belgians, father of Queen Victoria’s husband, Prince Albert and all the monarchs for a long time. George VI certainly, the one who was in The King’s Speech…he had homeopathic treatment for his stutter. Ambra grisea was the remedy they gave him.

And the Prince of Wales [Prince Charles] is into it. We don’t know about Princess Kate, yet. We’ll see.

Do you think the scientific community will ever embrace or even accept homeopathy?

Well, I think that is up to us. There is huge prejudice–there is prejudice and persecution which actually seems to have originated in the UK for various psycho-social-geopolitical reasons.

And one interpretation of the current situation is that it is the early stages of a scientific revolution, when you get a reaction. Homeopathy is persecuted because it is a new paradigm that is threatening the established order…a scientific revolution in the sense of Thomas Kuhn. That’s one interpretation

On the other hand I am always a bit cautious about that because we’ve had false starts before. If you read the [writings of] homeopaths from the 1890s, they talk rather pityingly of “old school” medicine, and how the “new school” [homeopathy] is about to sweep it away; but it never did happen.

So, yes I believe that eventually something, maybe descended from homeopathy, using the key techniques of homeopathy, will be accepted. I have to say I think the homeopathic community is in many ways its worst enemy, particularly in this country [UK]–we have people who make silly claims, frankly, who are not qualified and say things they really shouldn’t say, for instance, about preventing malaria.  That is potentially very dangerous and gets us a bad press.

Iris Bell said she thinks homeopathy will be accepted by the medical community, but it may be with a different name?

Yeah, well as I said, something descended from homeopathy. Maybe the name will have to change. Homeopathy has been forced into a ghetto. But one of the things we can do something about–you can’t do a lot directly about the skeptics–is to get our own house in order; not to make claims we can’t back up; to try to be scientific; and instead of larding up the repertory with anything you please, we need to think a little bit more carefully about what we put in there; be a little bit more serious about it.

Because undoubtedly homeopathy works. It is a therapeutics that has survived, that works, and that makes remarkable claims–and we need to be sure.

References

1. Fisher, et al. Effect of homoeopathic treatment on fibrositis (primary fibromyalgia). BMJ Aug 5;299(6695):365-6.
2. Bracho G, et al. Large scale application of highly-diluted bacteria for Leptospirosis epidemic control. Homeopathy 2010 Jul;99(3): 156-66.
3. Jacobs, et al. The use of homeopathic combination remedy for dengue fever symptoms–A pilot RCT in Honduras. Homeopathy. 2007 Jan;96(1):22-6.
4. Rutten AL, Stolper CF, Lugten RF, Barthels LW. Statistical analysis of six repertory rubrics after prospective assessment applying Bayes’ theorem. Homeopathy 2009 Jan;98(1):26-34.