The Itajaí city council, along with the University of the Itajaí Valley and the Ministry of Health, are using homeopathy to treat crack addicts. They haven’t been successful, and will never be
“I am sorry that public funds are being wasted in studies about the effects of illusory molecules on any illness, including cocaine addiction.” That is how biologist Beny Spira, a professor at the Biomedical Sciences Institute (ICB) of the University of São Paulo (USP), reacted to the news that the city council of the Santa Catarina municipality of Itajaí, the University of the Itajaí Valley (UNIVALI) and the Ministry of Health decided to sponsor a study on the use of homeopathy to treat crack addicts, called CocaCrack3.
Announced originally in 2017, but launched officially at the end of last year, CocaCrack3 aims at determining if homeopathic preparations based on Coca leaves may reduce the “craving”, the addict’s intense desire for the next dose of the drug.
The problem, pointed out in Spira’s allusion to “illusory molecules”, lies in the fact that homeopathic dilutions are so extreme that it is often impossible to detect any trace of the alleged active principle in the final preparation.
CocacRack3 is based on a study that used successive “Q” dilutions, where part of the base material is diluted in 150 thousand parts of solvent. After the fourth successive “Q” dilution, the probability of the existence of a single molecule originated from Coca leaves in the liquid that will be used to produce the medications handed to patients is, for all practical effects, zero.
“I fear that CocaCrack3, if financed, will not provide elements to define the activity of the medications prepared with extreme dilutions of the drugs. And, once again, we are seeing the little funding we have available for SUS being wasted on this sort of thing,” said infectologist Jacyr Pasternak, one of the main researches in that medical area in Brazil.
The homeopathy’s absence of scientific plausibility – what is the sense of treating patients with medications that are chemically identical to clean water? – is added to several studies that have shown that homeopathic treatments are, indeed, useless, and that has been taking into account in the formulation of public policies in several parts of the world.
A great review of the scientific information available on the issue, compiled by Australian authorities in 2015, concluded that “there is no health condition for which is there is reliable evidence that homeopathy is effective.”
In the latest years, NHS, the United Kingdom’s public health system, has been canceling the financing of homeopathic treatments, considering it a waste of public resources. Spain is getting ready to follow along the same path, and, in the United States, consumer defense organisms require a specific label for these medications, which inform that they are based on principles contrary to modern science.
In Brazil, the practice has been recognized as a medical specialty by the Federal Council of Medicine (CFM) in 1980, and as a pharmaceutical specialty by the Federal Pharmacological Council (CFF) in 1993. Homeopathy is supplied by the Unified Health System (SUS), through the National Policy for Integrative and Complementary Practices (PNPIC), a public policy of the Ministry of Health to encourage alternative health practices.
This formal-bureaucratic backing by the Ministry and class entities are among the main points mentioned by the Itajaí city council and UNIVALI whenever they are questioned on their involvement with CocaCrack3.
“The Itajaí Health Secretariat believes that homeopathic treatment will be an alternative to quit addiction with a reduction of abstinence effects,” said the municipal government in a statement sent to Gazeta do Povo. The statement continues:
“Itajaí has since 2008 a Center for Integrative and Complementary Health Practices (CEPICS), in which therapeutic resources are offered for the population through SUS, like homeopathy, acupuncture, do-in and lian gong. That structure has currently 7,278 users enrolled, which shows the demand and the acceptance of the service.”
The Health secretariat continues: “Just as Brazil, through its National Policy for Integrative and Complementary Health Practices, the municipality has also encouraged the expansion of these resources, especially the Basic Attention, because it believes that it is necessary to look for new ways of promoting health, self-care, and the physical, social, and mental well-being.”
Pharmacist and UNIVALI researcher Liege Bernardo, who is part of CocaCrack3’s coordinating team, stated that “UNIVALI has been following the formation axis of the national public policies, of which homeopathy is one of the pillars. Therefore, its social role is to strengthen and assess proposed public policies and, in negative cases, propose new models. In that case, this is the purpose of the project.”
As the name indicates, CocaCrack3 represents the third stage of the study on the use of homeopathic preparations against “craving” of cocaine.
The previous stages – conducted in the São Paulo “cracolândia” and, later, in the city of São Carlos (SP) – have been described in a study signed by Noemia Bernardo and by responsible researcher Ubiratan Adler. Adler, who is also the author of the scientific paper published in the Journal of Integrative Medicine (JIM) that describes and debates the CocaCrack2 stage, conducted in São Carlos, which allegedly had encouraging results.
The JIM article called the attention of Edzard Ernst, a German doctor and scientist who lives in the UK and has occupied for 20 years the chair of Complementary Medicine at the University of Exeter. Ernst, who has published several studies and articles criticizing homeopathy, did not have a good impression of the Brazilian work. He mentions, in his criticism, the high desistance rate of the volunteers. According to him, if that factor had been taken correctly into account in the statistical analysis of the data, the results would have been negative.
The survey, sent to Gazeta do Povo by the Itajaí health secretariat and UNIVALI, recognizes the fragility of the obtained results in previous stages. “Can the results of the CocaCrack2 study be attributed to chance? Yes. The low adhesion rate may have created some bias towards homeopathy. How can we find out? Through a confirmatory study, using strategies to improve adhesion through SUS policies,” says the text, which concludes: “Will it be worth the investment of public resources? Only time will tell.”
The Itajaí authorities argue, in the statement released by the Health secretariat, that “there are huge differences regarding studies done previously” on the issue. “In CocaCrack3, the 120 crack and cocaine chemical dependents recruited for the study will be treated in five basic health institutions, which have a bigger attachment to the community and make increase the user’s adhesion to the treatment. With that, after leaving the acute stage of dependency, the user may continue his treatment in the municipal public network.”
USP’s Beny Spira has a less optimistic view. For him, it is not necessary to wait – nor to spend public money – in order to answer the question posed by the study. “The answer is a clear and sound no. How can I give such a definitive answer? It’s simple: homeopathy is as likely to work out as a perpetual motion machine. Both inventions, homeopathy and perpetual motions, defy laws of science which have been fully established. It would be like proving the Earth is flat, or that two plus two equals five.”
“Clinical research in conventional medicine has as its priority methodological and statistic rigor. In contrast, the preliminary studies mentioned in the article suffer from the recurring problem in tests of alternative therapies: low rigor and a small sample number,” he points out.
Jacyr Pasternak, while praising the integrity of those involved in the CocaCrack studies for recognizing the fragility of the results obtained so far, also doesn’t expect revolutionary advancements in this third stage.
“Some patients claim to have benefitted from the medication. That is the same as the placebo effect: when any homeopathic medication is submitted to a double randomized blind study, results are invariably the same; the results of these medications are the same ones obtained using placebos,” he points out.
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A prefeitura de Itajaí, junto com a Universidade do Vale do Itajaí e o Ministério da Saúde apostam no uso de homeopatia no tratamento de viciados em crack. Não deu e não vai dar em nada