Transmission electron micrograph of Variola, the virus that causes smallpox. Recent threats of bioterrorism, combined with concerns over potential adverse effects of the standard vaccinia vaccine have prompted some clinicians to reconsider prophylaxis with homeopathic preparations of variola. Image courtesy of CDC, Drs. Fred Murphy & Sylvia Whitfield, from the Public Health Image Library (www.phil.cdc.gov).

The recent threats of bioterrorism coupled with concerns over potential side-effects of the smallpox vaccine has prompted some health care professionals to reconsider an almost forgotten form of medicine: homeopathic prophylaxis.

There is a long history of homeopathic prophylaxis and treatment for infectious diseases using nosodes—homeopathic preparations of disease-producing organisms like anthrax and variola. The literature goes back to Samuel Hahnemann, the founder of homeopathy, who treated outbreaks of Scarlet Fever with homeopathic preparations of belladonna in 1801. Over the last 200 years, some of the greatest successes in homeopathy have been in infectious epidemics, including cholera, influenza, and smallpox.

Leonard Torok, MD, an orthopedic surgeon and homeopath practicing in Wadsworth, OH, believes the approach warrants renewed investigation in light of the possibility that infectious agents like variola (smallpox), anthrax, and tularemia might be used as bio-weapons. If it can be proven efficacious in modern clinical trials, homeopathic immunization could potentially have widespread application, he told Holistic Primary Care. It would be less expensive, less invasive, and potentially less fraught with adverse effects than conventional live or attenuated virus shots. It has the added advantage of self-administration.

According to the Centers for Disease Control and Prevention (CDC-P) only 21,698 of an expected 450,000 health care workers have been vaccinated for smallpox as of March. The lackluster response suggests health professionals are not convinced that the benefits of vaccination outweigh the risks or the hassles.

Dr. Torok believes homeoprophylaxis could serve as an alternative. He advocates the use of homeopathically prepared variolinum (smallpox) instead of conventional vaccines, and he believes this approach warrants serious scientific investigation, especially in light of recent concerns about the safety of conventional smallpox vaccines.

In March, CDC-P made a provisional recommendation that individuals at risk for cardiovascular disease not get the smallpox vaccine, following three heart attacks—two of them fatal—and 4 additional episodes of cardiovascular symptoms in 7 health care workers shortly after vaccination. All 7 affected individuals were in their 50s and all had CV risk factors including diabetes, hypertension, obesity, and tobacco use. CDC is convening an expert panel to review the cases and determine whether the vaccine is, in fact, triggering CV problems.

Historically, homeoprophylaxis with variolinum has been shown to be both safe and highly effective for prevention and treatment of smallpox. The earliest record is from the New York Homeopathic Hospital, which faced repeated onslaughts of smallpox in its largely indigent patient population in the mid-1800s. Dr. Torok said the hospital kept meticulous records on 10,247 individuals immunized with homeopathic variolinum over a 21-year period. There were no recorded cases of smallpox transmission in any immunized individuals. One patient developed symptoms of smallpox 3 days after homeoprophylaxis, and 3 had troublesome symptoms, though none was life threatening.

The same institution also had records on 18,554 cases of smallpox treated with variolinum. In this cohort, there were only 138 deaths, giving a better than 99% survival rate over the 21-year period. Dr. Torok stressed that there is nothing in allopathic medicine then or now that gives a 99% survival rate for smallpox.

A second case series was published in 1907, from the Iowa Health Department. Variolinum was used widely for prophylaxis during an outbreak of smallpox in that state. Records on 2,806 individuals immunized with a 30× preparation of variolinum show only 14 of them ever contracted smallpox. The cohort included 547 people who were in direct, prolonged contact with infected individuals.

“I read these reports and I started to feel I had to be able to offer something else in light of the new policy of mandatory and coercive vaccination of health care workers,” said Dr. Torok, who still practices orthopedic surgery as well as homeopathy at the Wadsworth-Rittman Hospital, Wadsworth, OH.

His interest in homeopathy arose when he was studying electroacupuncture as an adjunct to his orthopedic practice. In Germany, where he studied the system developed by Helmut Voll, electroacupuncture is used in conjunction with homeopathy, and he observed therapeutic responses in a wide variety of conditions that impressed him and ultimately prompted him to undertake in-depth homeopathic training, including several years in a fellowship with Dr. Andre Saine, one of the world’s foremost classical homeopaths. It has been part of his orthopedic practice ever since.

The efficacy of his homeopathic adjuncts to surgery—objectively demonstrated in terms of speedier recoveries, reduced blood loss, decreased need for pain medication, less pre- and post-op nausea—was enough to convince the administration of his hospital to establish a full-scale homeopathic formulary. Wadsworth Rittman is the only conventional hospital in the country with an on-site homeopathic pharmacy and routine use of homeopathic medications.

In the end, said Dr. Torok, it was old-fashioned midwestern thriftiness that led the hospital administration to accept homeopathy, not any sudden paradigm shift. “They looked at my clinical experience and found that homeopathy could save them money. Homeopathy is cheap, it reduces surgical complications, and improves outcomes.”

Though he has yet to put it widely into practice, Dr. Torok suggested that for healthy individuals wishing to be immunized against smallpox, a 30C preparation of variolinum should be sufficient to stimulate the requisite immune response. As with conventional vaccines, a homeoprophylactic dose may generate some malaise. However, he emphasized that there are no records in the homeopathic literature of any serious or life-threatening post-immunization side effects.

One pellet of a 30C variolinum preparation has 10^–60 grams of viral particles, as compared with a standard vaccine, which contains 100 million pox-forming units of vaccinia per milliliter. As with all homeopathic agents, nosodes contain energetic information rather than biochemical material. Dr. Torok acknowledged that this idea of “energy” is difficult for many clinicians to accept. But he said his colleagues at the hospital have largely come around to the possibility. “They’ve seen the effects right in front of their faces.”

Basing a serious clinical recommendation on principles that have not been studied in close to 100 years is not something Dr. Torok does lightly. He acknowledged that homeoprophylaxis for diseases like smallpox has not been evaluated in a randomized trial setting, adding that there is a crying need for such studies. But he also pointed out that the literature supporting the current recommendations for smallpox vaccination is not exactly fresh. The studies were done in the 1950s and early 60s, largely in children and young adults. There is scant data on the effects of immunizing middle-aged individuals with vaccinia.

None of this diminishes the controversial nature of Dr. Torok’s position. Though he is not alone in thinking there is value to the approach, he is definitely among the most outspoken. Homeoprophylaxis is not considered standard practice by most modern homeopaths, and while major homeopathic associations like the National Center for Homeopathy are calling for research on the topic, they are not advocating widespread homeoprophylaxis as a response to bioterror.

The Food and Drug Administration recognizes homeopathy as a form of medicine and sets standards for homeopathic drug preparation. But FDA does not formally recognize homeoprophylaxis on the ground that the classical definition of homeopathy is as a mode of treating a pre-existing disease with a highly diluted agent that would produce similar symptoms in a healthy individual. It does not include preventive dosing of healthy people under that rubric.

But there is clearly a lot of word-of-mouth buzz, not to mention marketing hype, reaching lay people interested in alternative medicine. During the post-September 11 anthrax scares, homeopathic organizations and practitioners were bombarded with questions regarding the safety and efficacy of anthracinum, the homeopathic preparation of anthrax, for treatment or prevention of the disease.

The National Center for Homeopathy has established a Crisis Intervention Team to compile the best available information regarding homeopathic treatment of infectious agents, particularly those that might be used as bioweapons. They and other professional groups are working jointly with the American Red Cross and the Federal Emergency Management Agency to try and determine if homeopathy has a role to play in responding to the threat of bioterrorism. NCH’s website contains a number of worthwhile review articles on homeoprophylaxis and homeopathic treatment of infectious disease. Visit at <www.homeopathic.org>.