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EDITORIALS: Hywel C Williams Evening primrose oil for atopic dermatitis BMJ 2003; 327: 1358-1359 [Full text]

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Borage oil and Evening Primrose Oil are not the same.

Nicola J Reid   (12 December 2003)

Written communications should be available on website

Yoon K LOKE   (12 December 2003)

Blinding revelation of the obvious...

Hilary Butler   (12 December 2003)

Only borage oil was tested

Peter Lapinskas   (12 December 2003)

Evening Primrose Alone Insufficient To Treat Atopic Dermatitis

Joseph M Mercola   (12 December 2003)

Evening primrose oil is effective for benign mastalgia

Anne L. Appleton   (17 December 2003)

Conventional eczema conceptualisation: Illogical, dangerous and unscientific. Time to say goodnight to this philosophy.

Herman J Jeggels MRCP (UK)   (18 December 2003)

Pfizer Response

Olivier Brandicourt   (30 January 2004)

GLA for eczema

Linda L Hillenbrand   (7 February 2005)

Evening primrose oil, fish oils and mins and vits for eczema

Ellen C G Grant   (8 February 2005)

Borage oil and Evening Primrose Oil are not the same. 12 December 2003
Nicola J Reid, Education Services Manager Australia Send response to journal: Re: Borage oil and Evening Primrose Oil are not the same.	I fail to see how the conclusion that Evening Primrose Oil (EPO) is of no benefit in atopic dermatitis can be based on studies with Borage oil. Borage oil may contain higher levels of GLA than EPO, but it is known to be less bioavailable. In Australia, borage oil products are considered inferior to EPO in light of this fact. These studies also fail to mention that the incorporation of Omega 6 fatty acids into prostaglandin pathways requires the co-factors Zinc, Vitamin B6 and magnesium, all commonly deficient in sufferers of atopic dermatitis. It is not adequate to make such a conclusive statement about EPO without a closer look at all of the relevant factors involved in the management of atopic dermatitis and the ability of the individual to metabolise essential fatty acids. Competing interests: None declared
Written communications should be available on website 12 December 2003
Yoon K LOKE, Senior Lecturer in Clinical Pharmacology University of East Anglia, Norwich NR4 7TJ Send response to journal: Re: Written communications should be available on website	I congratulate Prof. Williams and the BMJ for lifting the veil on what has obviously been a very dark episode. I urge the BMJ to publish, as a web-extra accompanying this editorial, the two articles which have not seen the light of day - Bamford's defence of his trial, and Marsden's review article - both of which, says Prof. Williams, are now sitting on his desk. Obviously the authors' permission would be required, but release of such data into the public domain would help current systematic reviewers as well as future researchers. YK Loke Competing interests: None declared
Blinding revelation of the obvious... 12 December 2003
Hilary Butler, Freelance Journalist New Zealand 1892 Send response to journal: Re: Blinding revelation of the obvious...	Dear Sir, In your editorial you ask : "Yet many questions surrounding the story of evening primrose oil for eczema remain unanswered: how was this drug licensed in the first place and why have so few data been available in the public domain for open scientific debate? " The answer is obvious to those with eyes to see. The normal Modus Operandi of Pharmaceutical companies is to ignore everything that does not suit their purposes. They get the license, and then push the barrow for all it is worth, until either the patent runs out, or the side effects accrue to such an extent that they have no choice but to pull the drugs many years down the line. However, unlike evening primrose oil, which has an exemplary safety profile, the other pharmaceutical drugs that Allen Rogers exposes as being useless most of the time, have racked up hundreds, if not thousands of reports of deaths, maimings, and serious problems on the other side of the ledger. So, for there to be complaints about how long evening primrose oil was sold, without solid evidence, is more than a bit rich. It's actually hypocritically astounding. Perhaps the moral here, is for pharmaceutical companies, instead of pointing the finger at a very safe, albeit ineffective supplement which they see as a splinter in the eye, is to get the forest out of their own eye first. Sincerely, Hilary Butler. Competing interests: None declared
Only borage oil was tested 12 December 2003
Peter Lapinskas, Consultant 26 Deepdene Wood, Dorking, Surrey, RH5 4BQ, UK Send response to journal: Re: Only borage oil was tested	This study appears to show that high doses of borage oil (BO) are not beneficial in atopic eczema. However this does not mean that gamma- linolenic acid (GLA), or evening primrose oil (EPO) are not beneficial. At Scotia Pharmaceuticals (which produced the eczema treatment Epogam, based on EPO) we produced both evening primrose and borage in large quantities. The reason why we used EPO rather than BO in our eczema product, in spite of its higher cost and lower GLA content, was because we found from internal studies that BO didn't work. (We used the BO for the extraction of GLA as a pure compound.) Unfortunately, I am unaware of any published comparisons between BO and EPO in eczema, but some work has been published on the rat model of diabetic neuropathy which shows a clear difference between the two oils, with BO being much less effective than EPO at equivalent doses, and no more effective at high doses than at low doses (Dines et al. 1996). It is possible that the same effect is occurring here. It is interesting to speculate on why these differences should occur. One explanation may be that the GLA in EPO is primarily in the sn-3 position, and would be cleaved off the triglyceride during digestion and hence find its way into the metabolic pool. BO, on the other hand, has much more GLA at the sn-2 position, which would tend to be absorbed as the 2-monoglyceride and hence be directed into phospholipids and hence membranes. An alternative hypothesis is that the very high levels of linoleic acid in EPO compared to BO are in some way influencing the way in which the body handles the GLA. Sadly, we were never able to pinpoint the exact reason, but it is clear that it is unjustifiable to extrapolate results from one GLA-containing oil to another. Similarly, it is not justified to make statements about the efficacy of GLA unless a pure GLA preparation has been tested. The most that can be said from this study is that borage oil may not be a suitable treatment for atopic eczema. Reference Dines KC, Cotter MA and Cameron NE (1996) Effectiveness of natural oils as sources of gamma-linolenic acid to correct peripheral nerve conduction velocity abnormalities in diabetic rats: modulation by thromboxane A2 inhibition. Prostaglandins, Leukotrienes and EFAs 55(3) p159-165 Competing interests: Previously Seed Production Director for Scotia Pharmaceuticals Ltd
Evening Primrose Alone Insufficient To Treat Atopic Dermatitis 12 December 2003
Joseph M Mercola, Medical Director Optimal Wellness Center Schaumburg, IL 60194 Send response to journal: Re: Evening Primrose Alone Insufficient To Treat Atopic Dermatitis	Over the last 15 years our center has routinely provided resolution of severe cases of atopic dermatitis with inexpensive nutritional manipulations that are not addressed in this review. These dietary changes have had profound beneficial effects in the most extreme cases of atopic dermatitis we have seen. The key is balancing the omega 6:3 fat ratio. Although GLA is an omega-6 fat, it is also very important to limit other omega-6 fats from vegetable oils from the diet. The level of omega-6 fat at the turn of the last century (1900) in the diet was less than one pound per year. In 2000 the average person in the US consumed over 75 pounds of vegetable fat per year. These excessive levels of omega-6 fats will adversely affect the important omega 6:3 ratio. So one of the first steps is to severe limite the intake of n-6 fats that are converted to inflammatory archidonic acid lipoxygenase mediators. N-6 fats are common in nearly all polyunsaturated vegetable oil products (with the exclusion of olive and canola oils, which are relatively high in n-9 and n-3 fats respectively). Bakery products are particularly troublesome, as high percentages of the n-6 fats have been converted to trans isomers that further exacerbate the dermatitis. The second step would be to increase elongated n-3 fats, such as EPA and DHA that are common in fish oils. Cod liver oil is profoundly effective here as it has significant quantities of vitamin D and vitamin A that frequently provide synergistic therapeutic effects. Typical daily therapeutic quantities of n-3 fats are 300 mg per 4 kg of body weight. Supplementation with the shorter chain n-3 fat, ALA (i.e. flax) is frequently not sufficient to generate significant quantities of beneficial eicosanoids as only 10% of ALA is elongated and desaturated to the higher chain n-3 fats, EPA and DHA. If the child is breast-fed these dietary manipulations are, of course, initiated through the nursing mother. If the child is eating table foods two additional manipulations are most useful. The first is to limit most grains and fruit juices as they are rapidly converted to simple carbohydrates that increase insulin levels. The increased insulin levels inhibit delta-6 desaturase, which converts linoleic acid to gamma-linolenic acid (GLA). The elevated insulin levels also facilitate delta-5 desaturase, which further increases pro- inflammatory by products of arachidonic acid. Although GLA is an n-6 fat, we frequently find supplements of 2-3 gram quantities GLA from evening primrose oil beneficial in compensating for the impaired delta-6 desaturase activity. Additionally, restriction of all gluten and casein containing foods and regular exposure to sun provide additional valuable measures in healing this challenging problem. Mayser P, Mayer K, Mahloudjian M, A double-blind, randomized, placebo -controlled trial of n-3 versus n-6 fatty acid-based lipid infusion in atopic dermatitis. JPEN J Parenter Enteral Nutr. 2002 May-Jun;26(3):151-8. Reynolds, NJ, et. al. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet June 23, 2001; 357: 2012-16 Solvoll K, Soyland E, Sandstad B, Dietary habits among patients with atopic dermatitis. Eur J Clin Nutr. 2000 Feb;54(2):93-7. Yu G, Bjorksten B. Polyunsaturated fatty acids in school children in relation to allergy and serum IgE levels. Pediatr Allergy Immunol. 1998 Aug;9(3):133-8 Competing interests: None declared
Evening primrose oil is effective for benign mastalgia 17 December 2003
Anne L. Appleton, Médecin-Chef, Unité de Sénologie (Consultant Breast Physician) Unité de Sénologie (Breast Unit), Clinique de Genolier, 1272 Genolier, Switzerland CH-1272. Send response to journal: Re: Evening primrose oil is effective for benign mastalgia	Whilst Williams (1) may dismiss the role of evening primrose oil (EPO) in atopic dermatitis (although in common with others, I fail to see the relevance to this debate of the study by Takwale et al (2) of borage oil in atopic dermatitis, since borage oil has a different pharmacokinetic profile to EPO), it is important to remember that EPO is of considerable use in the treatment of another common condition, benign breast pain, which affects up to 70% of women, and is severe in 20% of women (3). The breast tissue of women with this condition is believed to be high in saturated fatty acids and deficient in gamma linolenic acid (GLA), which renders the breast tissue abnormally sensitive to normal hormone levels (4). With prolonged treatment at high dose (320 mg/day for 3-6 months), the GLA content of EPO restores the balance of fatty acids in the breast tissue, with high efficacy and few side effects (5), and in contrast to treatment with isoflavones such as red clover (Promensil) (6), with no concerns regarding agonistic stimulation of breast oestrogen receptors and the theoretical risk in relation to breast cancer. As a breast physician, I find this simple treatment of considerable use in this common, debilitating condition. William's dismissal of EPO for the treatment of atopic dermatitis should not detract from its efficacy in other common conditions. (1) Williams HC. Evening primrose oil for atopic dermatitis. British Medical Journal 2003; 327: 1358-1359. (2) Takwale A, Tan E, Agrawal S, et al. Efficacy and tolerability of borage oil in adults and children with atopic eczema: randomised, double blind, placebo controlled, parallel group trial. British Medical Journal 2003; 327: 1385-1387. (3) Gately CA, Miers M, Mansel RE, Hughes LE. Drug treatments for mastalgia: 17 years experience in the Cardiff Mastalgia Clinic. J Roy Soc Med 1992; 85: 12-15. (4) Horrobin DF, Manku MS. Prostaglandins Leukot Essent Fatty Acids: Reviews 1989; 37: 255-261. (5) Pye JK, Mansel RE, Hughes LE. Clinical experience of drug treatments for mastalgia. Lancet 1985; 2 (8451): 373-377. (6) Ingram DM, Hickling C, West L, Mahe LJ, Dunbar PM. A double-blind randomized controlled trial of isoflavones in the treatment of cyclical mastalgia. The Breast 2002; 11: 170-174. Competing interests: None declared
Conventional eczema conceptualisation: Illogical, dangerous and unscientific. Time to say goodnight to this philosophy. 18 December 2003
Herman J Jeggels MRCP (UK), Medical Practitioner, Homoeopath Cape Town, South Africa Send response to journal: Re: Conventional eczema conceptualisation: Illogical, dangerous and unscientific. Time to say goodnight to this philosophy.	Dear Sir, A Consultant Dermatologist recently asked me whether my alternative modality, i.e. Homoeopathy, has been shown by means of a trial, that it works for atopic eczema. My answer was detailed indeed, which I naturally have to condense for the purpose of this response to whether Primrose oil or any other treatment works for atopic eczema. What is eczema? To perform a trial on atopic eczema would imply that atopic eczema is a lone standing problem, which does not have any relationship with the rest of the body. It must therefore be a compartmentalized and cordoned off disorder. When conceptualised as such, treatment can be applied to the atopic eczema alone. This conceptualisation implies that one should be able to treat the atopic eczema without the rest of the patient being taken into consideration and the rest of the patient not influenced in any way whatsoever due to the treatment instituted for the atopic eczema. Is atopic eczema a lone standing, compartmentalized and cordoned off disorder? Has a skin ever been born without a baby? Have you ever been consulted by only a skin? No, never, and till the end of time, never! Any atopic baby is the product of two atopic families, though minimally one atopic family is needed. At conception we, and in the same way the atopic patient, inherits the Good, the Bad and the Ugly from the two families. We know that disease tendencies, predispositions and diatheses, enter the conceived baby via the sperm and ovum! This FERTILISED single cell, from which ALL CELLS of the body develops, is SICK! This single cell starts to divide, eventually forming a foetus, baby and ultimately into a unique human being. All the illnesses are therefore passed from the fertilized egg cell to the other cells being formed! EVERY CELL OF THE PERSON IS THEREFORE SICK, containing all the predispositions of the families! THE WHOLE HUMAN IS THEREFORE SICK! This is not mind-boggling information. We all know these facts. We know that an atopic patient is the product of inherited diseases and we are dealing with a sick person in totality, and not merely a sick skin! Why then does a patient develop atopic eczema? Allow me to answer this in a round about way. Firstly, what happens when something befalls us in the form of an injury or an illness? For instance, if someone breaks a bone, what heals that bone in reality? Do doctors heal the bone or the patients’ own healing potential? Naturally we know the answer! Doctors merely reduce the fracture, immobilise the fracture, splint it or perhaps perform internal fixation and provide pain relief. Nevertheless the bone heals spontaneously under the wondrous inherent spontaneous healing of the body. Furthermore if a surgeon inflicts a surgical wound to a patient, the sutures are not responsible for the healing, rather the same processes are responsible, as I have described above. In the case of an atopic baby who has inherited all these disease predispositions and diatheses from the two families present in every single cell of the body, what would the response then be of our intelligent body when faced with such a serious problem? Can our body heal these multitudes of disorders, which may lead to Asthma, Allergies, Diabetes Mellitus and Cancer etc? Is our body, in this case, faced by these multitudes of disease predispositions, really capable of healing these problems and leave the atopic individual truly healthy? Unfortunately our body is not equipped to cure such complex disorders which are present in every cell of the body, and thus in all organ systems. These organ systems may collapse under the influence of these predispositions. Are diseases and disease predispositions QUALITATIVELY NEUTRAL? DO THEY NOT INFLUENCE US AT ALL? NO, on the contrary, they are NOT QUALITATIVELY NEUTRAL! May I then quote what the Dripps classification says about the presence of diseases in the body! I am taking the following quotation from an unpublished article of mine, which I have altered to fit this discussion: “Anaethetists have a Whole-istic concept of the patient and his health in order to assess the patient’s ability to survive the anaesthetics and the operation. The Dripps classification is a classification of the physical status of the patient, used to assess the preoperative risk in relation to an individual patient. This classification naturally assesses the risk of the patient dying during or after an operation. The classification is as follows: Class Patient 1 Normal healthy patient. A patient without any organic, physiological, biochemical or psychiatric disturbance. 2 Mild to moderate systemic disease related or unrelated to the presenting complaint, e.g. diabetes, hypertension 3 Severe systemic disease but not incapacitating, e.g. heart disease with limited exercise tolerance, uncontrolled hypertension or diabetes 4 Incapacitating disease that is a threat to life with or without surgery, e.g. congestive cardiac failure, severe and persistent angina 5 Moribund, not expected to survive 24 hours with or without operation, e.g. ruptured abdominal aortic aneurysm E Any of the above done as an emergency Dripps et al state, “It seems obvious that the more ill a group of patients, the higher would be the death rate regardless of the stress under study. This may be all that our data represent. Certainly they indicate that healthy subjects compensate well for whatever challenge anaesthesia poses to them.” “ As the physical condition deteriorated, the mortality increased.” Reflecting on this classification of the ASA we perceive that Class 1 represents patients with optimum health and healing potential. Thus Class 1 has indeed no risk factors for the anaesthetics or the operation. Patients in Classes 2-5 are burdened by diseases, which rob, usurp and hijack the patient’s ability to, in the first instance survive the anaesthetics and the operation, in the second instance spontaneously heal the wounds, which the surgeon inflicts. This Classification recognizes, without implicitly stating the obvious, that the Comorbidities are destabilizing and never innocent fellow travellers. The mere presence of other diseases in a patient leads to an increased mortality due to the stresses of anaesthetics for example. These diseases are therefore never qualitatively neutral, on the contrary the diseases negatively affects the patients’ quality of life and survival abilities. Diseases furthermore cannot be viewed as if they are compartmentalized or cordoned off from firstly the patient and secondly other diseases present in the patient. In summary Anaethetists assess the healing potential of an individual patient in relation to the patient’s Comorbidities. In the light of this assessment of the Anaethetists, the question begs, what primarily heals and maintains our body? Naturally, our body’s own healing potential. Therefore Anaethetists and surgeons would at times refuse to operate if the patient’s body cannot heal itself.” After having noted the above discussion we perceive that, if nothing from a healing or curing perspective takes place, the atopic baby could face serious health consequences! Thus an atopic baby may be born prematurely without any eczema on the skin but unfortunately suffers from asthma immediately after birth. This asthma is invariable of the same nature as all other atopic patients suffering from asthma and atopic eczema. This atopic patients’ asthma would be triggered by misty weather, weather changing from warm to cold with rain, as well as from mouldiness and steam. Thus the inherited diseases are NOT QUALITATIVELY NEUTRAL to the atopic patient and the ONLY OPTION for our intelligent body is to INDUCE THE FORMATION OF ECZEMA! Our body therefore starts processes, which drives the diseases from the VITAL ORGANS ONTO THE SKIN! As a consequence we are able to perceive that atopic eczema represents the EXTERNAL MAINFESTATION of the inherited diseases, which are present in every single cell of the body! Eczema merely represents the TIP OF THE ICE BERG and NOT THE WHOLE DISEASE. How then can we perform a trial of eczema when we do not take into consideration the fact that the eczema merely represents the tip of the iceberg, and not the whole disease? I take the discussion further by stating that WHEN THE ATOPIC ECZEMA APPEARS ON THE SKIN, the internal diseases are MERELY QUIETED DOWN, NEUTRALIZED, BUT NOT CURED! It is tantamount to inducing a SLEEP MODE to the internal diseases, in the same way that a computer goes into sleep mode when not in use. Once the mouse is handled in one or other way, the computer comes back to life! In the very same way, we can perceive that as long as the eczema is on the skin, while the internal diseases are in sleep mode, the patient does not suffer from asthma or other internal disorders! Once the eczema is treated locally by applying creams, which is equivalent to handling the computer mouse, the internal diseases are aroused, and the atopic patient starts suffering from asthma or other internal diseases! This implies that TREATING THE ECZEMA LOCALLY WITH CREAMS MAKES AN ATOPIC PATIENT SICK, and for that matter treating any skin disorder would make a patient sick. I shall later quote you from the book of Hahnemann, cases that stem from the 1600’s and later, which shows exactly this point. What are the consequences to patients when employing local creams to treat their atopic eczema? I here quote a section from a pamphlet of mine, which I send to new patients to educate them about atopic eczema before they actually arrive for consultation: “If the eczema is not cured, but instead suppressed by applying ointments or creams (and even Aqueous cream can have this effect), the imbalance is driven inwards, and usually manifests itself in a definite layered fashion as follows: • First, (as is often seen in little babies) as a disturbance of the Brain, resulting in night restlessness and poor sleeping. Later the Hyperactivity and the A.D.D. Ritalin problem. Later in life, we term the mind disorder as Sex, Drugs and Rock & Roll. Consider the social consequences. • The Nose is next, with the perpetual dirty noses of these children, or Hay fever and possibly later Sinusitis. • The Lungs are next with Asthma or Whooping cough or eventually Chronic Bronchitis etc. • The next stop is the tendency to manifest itself in any of the Internal Organs as Diabetes or Arthritis or Kidney diseases, Endometriosis, Fibroids, Heart diseases, even as Cancer.” If conventionally minded colleagues especially the dermatologists would simply sit back and analyse their patients they would and should perceive these consequences as I have outlined above. The opposite is true if my honourable colleagues do not want to see the consequences of their actions. Do we never care about the consequences of our actions? Do we not care about the consequences of one more step forward when standing at the edge of a vertical 1000-meter abyss? It is therefore obvious that the conventional trials of atopic eczema, which implies the application of creams to the skin represents violence to the patients and is totally reprehensible. In the opinion of the dermatologist, trials showing the efficacy of cortisone creams is scientifically correct, however they wilfully ignore the consequences of their actions. Today we naturally have Ventolin to treat the onset of asthma, however the use and presence of Ventolin saving the life of such a patient does not take away the fact that the reason for the asthma still remains a reprehensible consequence of violence to the patient, and represents intellectual bankruptcy. In fact Hahnemann and many Homoeopathic colleagues called the local treatment of atopic eczema a criminal act. I below quote you from Aphorism 203 of the Organon of Medicine of Samuel Hahnemann, regarding what he says about eczema. This was written in 1843: “Every external treatment of such local symptoms, the object of which is to remove them from the surface of the body, while the internal miasmatic disease is left uncured, as, for instance, driving off the skin the psoric eruption by all sorts of ointments, burning away the chancre by caustics and destroying the condylomata on their seat by the knife, the ligature or the actual cautery; this pernicious external mode of treatment, hitherto so universally practised, has been the most prolific source of all the innumerable named or unnamed chronic maladies under which mankind groans; it is one of the most criminal procedures the medical world can be guilty of, and yet it has hitherto been the one generally adopted, and taught from the professional chairs as the only one.” Allow me to return to the question whether a trial, from Homoeopathic perspectives, has been performed, or can be performed on atopic eczema in the light of the above discussion employing local treatments to the skin is totally out of the question. How are we able to show that Homoeopathy works for atopic eczema? My answer to this would be that we treat Homoeopathically, the WHOLE ATOPIC PATIENT to cure firstly the internal diseases present at the time, mostly as the consequence of the local treatment of the atopic eczema. During the first consultation, marking the start of the Homoeopathic treatment, I would invariably be faced with a patient suffering from internal diseases such as asthma and the REMNANTS of the atopic eczema on the skin. This Homoeopathic treatment of the patient would naturally induce initially more eczema to appear on the surface, in the same way that the eczema surfaced spontaneously in the beginning. This phase, during which more eczema appears on the surface, coincides with the disappearance of many, but not all internal diseases. During the final stages of the treatment process the remnants of the internal diseases together with the remnants of the eczema representing the external manifestations of these remaining internal diseases, are then systematically and in a phase wise fashion cured. In the end we remain with a patient who is free from the inherited internal diseases, diseases such as asthma etc., as well as the eczema. In this sense it is unacceptable to consider the treatment of atopic eczema as the only treatment for that particular patient. I now briefly wish to discuss, in short, the Reductionistic basis of Modern Medicine, which governs the minds of most of us. Allow me to quote again from an unpublished article of mine regarding this manifestation: “Studying man as a totality-that is with multiple problems, comorbidities and in fact also the elderly, is generally ignored and avoided in most clinical studies, as Schellevis, Greenhalgh, Gurwitz and Knottnerus have shown. In essence we fail to study clinical reality and its real difficulties. How do we conceptualise, as Tudor Hart have shown, a patient suffering from rheumatic diseases and at the some time hypertension, sinusitis, colitis and anxiety neurosis? Our failure to conceptualise such a patient stems from us adhering to the paradigm of Old Fashioned Science according to Ludwig von Bertalanffy, author of the book titled General System Theory (Whole-istic biological systems theory). This Old Fashioned methodology of science is illustrated by the fact that one individual who suffers from Rheumatic Diseases and hypertension etc. as I mentioned above, is subjected to studies by totally different specialisms, each of which study only one disease entity of this unique individual, as if this one individual is composed of 5 separate individuals, each with his own disease. By studying the diseases of one individual in this manner we thus imply that this one individual would be: · Individual number 1 who is suffering from Rheumatic Diseases studied by Rheumatologists. · Individual number 2 who is suffering from Hypertension studied by Physicians. · Individual number 3 who is suffering from Sinusitis studied by ENT specialists. · Individual number 4 who is suffering from Colitis studied by Gastroenterologists. · Individual number 5 who is suffering from Anxiety Neurosis studied by Psychologists or Psychiatrists. The above methodology is utterly illogical and unscientific. When discussing the above conceptualisation with patients, some of whom are lawyers, scientist etc., they are literary dumfounded by such illogical and unscientific reductionistic conceptualisation of diseased patients by Modern Medical Scientists. The above research methodology verifies the paradigm whereby scientists “Reduce observable phenomena to an interplay of elementary units investigatable independently of each other”. In order to illustrate this reductionistic paradigm, consider what Professor James Wyngaarden, one of the editors of the famous text book of Internal Medicine, Cecil Textbook of Medicine, has been saying for years: –“Instead of reaching for the whole truth the scientist examines small, defined, and clearly separable phenomena.” This reductionistic paradigm is therefore NOT BASED ON FINDING THE TRUTH! By implication THE TRUTH would mean studying the WHOLE UNDIVIDED man with all his diseases as is. What represents the opposite of Old Fashioned Science? Ludwig von Bertalanffy described Contemporary Science as "wholeness”, defined as "problems of organization, phenomena not resolvable into local events,” in short, “systems of various orders not understandable by investigation of their respective parts in isolation.” This is what medical science should aim for. Hahnemann has been one of the few medical scientists, who in the 1800’s conceptualised these multiple Comorbidities. Allow me now to quote from “ The Chronic Diseases” by S Hahnemann (with minor editing by myself to make the text readable for conventional colleagues) the following with regard to the consequences of the local treatment of eczema. Kindly take note that Hahnemann, 1755-1843, quotes the observations of colleagues who preceded him, sometimes more than 200 years. Homoeopathy did not exist at that time: “The older physicians were more conscientious in this matter and observed with less prejudice. They saw clearly and became convinced that innumerable ailments and the most severe chronic diseases follow the destruction of the itch-eruption from the skin. And since this experience compelled them to assume the existence of an internal disease, in every case of itch they endeavored to extirpate this internal malady by means of a multitude of internal remedies, as good as their therapeutics afforded. It was, indeed, but a useless endeavor, because the true method of healing, which it could only be the prerogative of Homoeopathy to discover, was unknown to them. Nevertheless this sincere endeavor was praiseworthy, since it was founded on an appreciation of the great internal disease present together with the eruption of itch, which internal disease it was necessary to remove. This prevented their reliance on the mere local destruction of the itch from the skin, as practiced by modern physicians, who think that they cannot quickly enough drive it away as if it were a mere external disease of the skin-without regarding the great injuries attending such a course. The older physicians, on the other hand, have warningly laid these injuries before our eyes in their writings, giving thousands of examples.” Page - 17 “The observations of those honest men are too startling to be rejected contemptuously, or ignored by conscientious men. I shall here adduce some of these numerous observations handed down to us, which I might increase by an equal number of my own if the former were not already abundantly sufficient to show with what fury the internal disease manifests itself when the external local symptom which serves to assuage the internal malady is hastily removed. They also show that it must be a matter of conscience for the physician who loves his fellow-man to direct all his endeavors to cure, first of all, the internal malady, whereby the cutaneous eruption will at the same time be removed and destroyed and all the subsequent innumerable lifelong chronic sufferings springing from the internal diseases be prevented or, if they are already embittering the life of the patient, be cured. The diseases, partly acute but chiefly chronic, springing from such a one-sided destruction of the chief skin-symptom (eruption and itching) which acts vicariously and assuages the internal skin disease (which destruction is erroneously called Driving the itch into the body) are innumerable; as manifold as the peculiarities of bodily constitutions and of the outer world which modifies them. A brief survey of the manifold misfortunes resulting thence is given by the experienced and honest LUDWIG CHRISTIAN JUNCKER in his Dissertatio de Damno ex Scabie Repulsa, Halle, 1750, p. 15-18.“ Page - 18 “His experiences were frequently confirmed by the observations of others, as e.g. with reference to Asthma (edited by Jeggels): • H Lentilius Miscell. med. pract. Tom. I., P. 176. • Fr. Hoffmann Abhandlung v. d. Kinderkrankheitenn, Frft., 1741, P. 104. • Detharding in Append. ad Ephem. Nat. Cur. Dec. III., ann 5 et 6 et in obs. parallel. ad obs. 58. • Binninger, Obs. Cent. V., obs. 88. • Morgagni, de sedibus et. caus. morb. Epist. XIV., 35. Acta Nat. Cur. Tom. V obs. 47. • J. Juncker, Consp. ther. spec. tab. 31. • F. H. L. Muzell, Wahrnehm. Samml. II. Cas. 8. “Patient No. 1. A man 30 to 40 years of age had been afflicted with the itch a long time before, and it had been driven away by ointments; from which time he had become more and more asthmatic. His respiration became at last, even when not in motion, very short and extremely labored, emitting at the same time a continuous hissing sound, but attended with only little coughing. He was ordered an injection of one drachm of squills, and to take internally 3 grains of squills. But by mistake he took the drachm of squills internally. He was near losing his life with an indescribable nausea and retching. Soon after this the itch appeared again on his hands, his feet and his whole body in great abundance, and by this means the asthma was at once removed.” • J. Fr. Gmelin in Gesner's Samml. v. Beob. V. S. 21. “Patient No. 2. The violent asthma was combined with general swelling and fever.” • Hundertmark.-Zieger Dissert. de scabie artificiale, Lips. 1758, p. 32. “Patient No. 3. A man of 32 years had the itch driven away by sulphur ointment, and he suffered for eleven months from the most violent asthma until by drinking birch-juice the eruption was brought back on the twenty-third day.” Hahnemann provides 100 examples from amongst thousands, which can be read in this book. Allow me to provide you with a final few examples from the same book by Hahnemann below. Kindly note that the first case dates from the year 1615! Suffocations from Asthma (i.e. dying from Asthma), Joh. Phil. Brendel, Consila. med., Frft., 1615, Cons., 73. Ephem. Nat. Citr., Ann. II., obs. 3I3. Wilh. Fabr. V. Hilden, Obs. Cent. III., Obs. 39: “The dyspnoea of a youth, 20 years, caused by the driving away of itch was so great that he could not get any breath, and his pulse was hardly perceptible, in consequence of which he suffocated.” Amaurosis, Northof, Diss. de scabie, Gotting, I792, P.10: “From itch expelled by external application there arose amaurosis, which passed away when the eruption re-appeared on the skin.” Convulsions, Juncker, as ab. tab. 53. Hoechstetter, Eph. Nat. Cur. Dec. 8, Cas. 3. Eph. nat. cur. dec. 2, ann. obs. 35, and ann. 5, obs. 224. D. W. Triller. Welle, Diss. nullam medicinam interdum esse optimam, Viteb, 1754, §13, 14: “After an itch driven away by ointment there followed with a girl a most profound swoon and soon after the most terrible convulsions and death.” I am not attempting to avoid subjecting Homoeopathy to scientific investigations; rather I am detailing the facts, in this case of eczema, that the scientific basis of such investigations should be scientific in the first place. Viewing eczema as the disease is not scientific, rather dangerously shortsighted with severe consequences for the patient. I have not included cases from my practice to highlight the consequences of the suppression of eczema, however the above examples from the past are more important than even my own. Allow me to end this discussion with the famous litany of Sir Robert Grieve Hutchinson: “From inability to let well alone; from too much zeal for the new and contempt for the old; from putting knowledge before wisdom, science before art, and cleverness before commonsense, from treating patients as cases, and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.” Yours, H Jeggels. References: 1. Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. J Am Med Assoc 1961; 178: 261-6. 2. Hahnemann, Samuel, Organon of Medicine, 6th Edition translation by W Boericke, 1921: B Jain Publishers, New Delhi. http://homeoint.org/books/hahorgan/index.htm 3. Schellevis FG, Velden J vd, Lisdonk E vd, Eijk J ThM van, Weel C van. Comorbidity of chronic diseases in general practice. J Clin Epidemiol 1993; 46:469-73. 4. Greenhalgh T. Is my practice evidence-based? Should be answered in qualitative, as well as quantitative terms. BMJ 1996; 313:957-8. 5. Gurwitz JH, Col NF, Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction. JAMA 1992; 268:1417-22. 6. Knottnerus A, Dinant GJ. Editorials. Medicine based evidence, a prerequisite for evidence-based medicine. BMJ 1997; 315:1109-1110. 7. Tudor Hart J. Correspondence. Other diseases complicate management. BMJ 1993; 306:1337. 8. Bertalanffy L von, General System Theory, Foundations, Development. Applications (George Braziller. New York, 1969), in Lisa Chong and L. Bryan Ray, SCIENCE, Volume 295, 1 March 2002, 1661. 9. Wyngaarden J, Cecil Textbook of Medicine, 19th Edition 1992, Medicine as a Science, page 10, WB Saunders Company. 10. Hahnemann, Samuel, The Chronic Diseases, 1835. Indian Books and Periodicals Syndicate, New Delhi. http://homeoint.org/books/hahchrdi/index.htm 11. Hutchinson RG. Modern Therapy, Letter. BMJ 1953; 1:671. Competing interests: None declared
Pfizer Response 30 January 2004
Olivier Brandicourt, Managing Director Pfizer Limited, Dorking Road, Tadworth, Surrey KT20 7NS Send response to journal: Re: Pfizer Response	Dear Mr Smith We read with interest the editorial by Professor Hywel Williams regarding evening primrose oil and the suggestions that Searle had denied the opportunity for timely publications on its efficacy. As you may be aware, Pfizer acquired the Pharmacia organisation in April 2003. Searle who manufactured primrose oil at the time the original research was conducted had previously been acquired by Pharmacia in 2000. Discussion between Pharmacia and the MHRA took place concerning the apparent lack of effectiveness of evening primrose oil during 2002. The Medicines Commission finally decided that there was insufficient evidence of efficacy and the product licence was therefore suspended in October 2002. All relevant data was provided to the regulatory authorities during that process, and Pfizer is willing to provide the same data to the Cochrane review should this be planned. Pfizer is committed to ensuring that all its products are appropriately supported with evidence of efficacy and safety and works with regulatory authorities globally to ensure that this is the case. Pfizer is equally committed to providing all relevant data for assessment by health technology assessment groups, for systematic review or other analyses as required. Yours sincerely Olivier Brandicourt Managing Director Competing interests: Managing Director, Pfizer Limited
GLA for eczema 7 February 2005
Linda L Hillenbrand, staff at university 01002 Send response to journal: Re: GLA for eczema	I've been an eczema sufferer on and off my whole life. Steroids do not help when it's in your ears. I had to find something else. I had been using borage oil in a cream for my hands and feet which is the only thing that has worked. When it developed in my ears I had to find something else. Borage oil and evening primrose (about 1,200 mgs) worked and still does with quercetin for the itch. These articles I'm reading bug me. If I'd participated in the study my eczema might have cleared. There is no rhyme or reason to when it pops up. It's not connected to food, stress, PMS or anything else. It just happens when it wants to happen. If the folks doing these trials had eczema themselves they might know this. Please think about this before making these articles available on-line. Competing interests: None declared
Evening primrose oil, fish oils and mins and vits for eczema 8 February 2005
Ellen C G Grant, physicain and medicalgynaecologist Kingston-upon-Thames, KT2 7JU Send response to journal: Re: Evening primrose oil, fish oils and mins and vits for eczema	It was a mistake for the UK's Medicines Control Agency to withdraw the product licence for GLA supplementation for atopic dermatitis.1 What is needed is the increased availability of red blood cell essential fatty acid (EFA) profiles to demonstrate to doctors and patients that deficiencies of either n-6 or n-3 EFAs are extremely common. Delta- desaturase blocks caused by zinc, magnesium, copper or B vitamin deficiencies have been diagnosed in about 80% of my patients over the past 20 years. It is unscientific to rely on results of trials of evening primrose oil (EPO) or borage oil, which do not include measurements of EFA levels. No clinical benefit would be expected from supplementing with EPO if the n -6 EFA pathway was normal. Supplementing with EPO can cause n-3 pathway deficiencies and supplementing with fish oils alone can cause n-6 pathway deficiencies. As Joseph Mercola writes correctly2 avoidance of major food allergens and repletion of essential nutrient deficiencies are the most effective ways to treat and to prevent eczema, even in children with two parents affected by atopy in my experience. 1 Williams H C. Evening primrose oil for atopic dermatitis BMJ 2003;327:1358-1359(13December),doi:10.1136/bmj.327.7428.1358 2 Mercola J M. Evening Primrose Alone Insufficient To Treat Atopic Dermatitis. http://bmj.com/cgi/eletters/327/7428/1358#43298, 12 Dec 2003 Competing interests: None declared