Is Homeopathy "New Science" or "New Age"?
Mahlon W. Wagner, Ph.D.
Homeopathy has existed for about 200 years, yet reports in the media have suggested that homeopathy is the medicine of the future. Today, homeopathy is found in almost every country. In Europe, 40% of French physicians use homeopathy; 40% of Dutch, 37% of British, and 20% of German physicians use homeopathy [1]. In the United States, hundreds of thousands of people take homeopathic remedies each year. Indeed, homeopathy seems to be becoming more popular.
Background History
Samuel Hahnemann, a German physician, developed homeopathy in about 1796. He was dissatisfied with the conventional medicine of his time. The accepted medical remedies at that time were often dangerous for the patient. There was a joke that more people died of medical treatment than from the disease itself.
Hahnemann laid out two principles of his homeopathy. First, he said that "like cures like" (Similia similibus curentur). This meant that a substance that produces certain symptoms in a healthy person can be used to cure similar symptoms in a sick person.
Second, Hahnemann asserted that smaller and smaller doses of the remedy would be even more effective. (In a way, perhaps this was a good idea because some of Hahnemann's remedies were poisonous.) So Hahnemann used more and more extreme dilutions of the remedies. In a process he named "potentization," Hahnemann would take an original natural substance and often dilute it 1-to-99 (called "C1"). A second dilution of 1-to-99 would be called "C2." Between each dilution, the remedy must be vigorously shaken. This shaking, or succussion, supposedly released the healing energy of the remedy. This healing energy has never been adequately defined nor measured.
Hahnemann found C30 dilutions to be quite effective. For Hahnemann, these very high dilutions presented no problem. He did not believe in atoms, and he thought that matter could be divided endlessly. Today we know that any dilution greater than C12 is unlikely to contain even one single molecule of the remedy. Sometimes Hahnemann diluted a substance 1-to-9 (called "D1"). In this case any dilution of D24 or greater would also not likely contain any molecules of the remedy.
Remedies Used
Homeopathy claims to use only "natural" substances. This is an attempt to contrast itself with conventional medicine. For example, homeopathic remedies include raw bovine testicles, crushed honey bees (Apis mellifica), Belladonna (deadly nightshade), cadmium, sulfur, poison nut (Nux vomica), hemlock (Conium), silica (Silicea), monkshood (Aconite), salt (Natrium mur), mountain daisy (Arnica), venom of the Bushmaster snake (Lachesis), arsenic (Arsenicum album), Spanish fly (Cantharis), rattlesnake venom (Crotalus horridus), Ipecac (Ipecacuahna), dog milk (Lac canidum), poison ivy (Rhus toxicodendron), and more. Some of these substances are quite harmless, but others can be toxic (especially at D4 and lower dilutions).
How did Hahnemann know that a remedy was appropriate for a particular disease (actually for a particular symptom)? Hahnemann and his students tested remedies on themselves. They would eat various plant, animal, and mineral substances and carefully observe what symptoms occurred. This is called "proving." These reactions (or symptoms) were collected together into a book Materia Medica. For example, one of the symptoms of Pulsatilla (windflower) is "An unpleasant message makes him deeply sad and depressed after 20 hours." During provings, the people knew which substance they were taking. This is a problem because one might anticipate a certain reaction or exaggerate some symptom.
Today, in modern science, we try to prevent this bias by not letting the person know what he or she is taking -- a "test-blind" procedure. When evaluating symptoms, it is also important that the researcher does not know which remedy is being tested (a double-blind procedure) because the researcher can also be biased.
One recent German study [2] did compare a remedy (Belladonna C30) to a placebo. Those who received the placebo reported even more symptoms than those who received the remedy. The symptoms reported included minor aches and pains in various parts of the body. Did the patient mistakenly assume that a normal ache or pain must be related to the remedy? It is possible that the ache or pain was the result of a confounding factor such as not enough sleep.
As we can see, homeopathy is not concerned with the disease. It concentrates on the symptoms reported by the patient. Homeopathy then matches these symptoms to those symptoms that a remedy causes in a healthy person. By contrast, scientific bio-medicine uses symptoms to identify the disease and then treats the disease itself.
Research
There are two points of view about homeopathy that are in conflict. One viewpoint says that homeopathy should not attempt to meet the rigorous requirements of scientific medicine. It is sufficient that there have been millions of satisfied patients during the last 200 years. Science is not relevant anyway because it rejects the concept of the energy of the "vital force" which is essential to homeopathy. This vital force is identical to the concept of vitalism -- a primitive concept used to explain health and disease. And, besides, scientific medicine is unfairly prejudiced and biased against homeopathy. Dana Ullman [3], a leading spokesman for American homeopathy, says that personal experience is much more convincing than any experiments. The emphasis on experience shows that most people simply do not understand that good science, based upon experiments, is essential to the development of knowledge.
The second viewpoint is that scientific research is necessary if homeopathy is to be accepted by medicine and society. In the past 15 years many experimental studies have been done to examine homeopathic remedies. Two reviews of homeopathy are perhaps the best known.
J. Kleinjen, P. Knipschild, and G. ter Riet[4] examined 107 controlled clinical trials of homeopathy. They concluded that the evidence was not sufficient to support the claims of homeopathy. C. Hill and F. Doyon [5] examined 40 other clinical studies. They also concluded that there was no acceptable evidence that homeopathy is effective. Since the above reviews were written, four more research studies have appeared.
In 1992 the homeopathic treatment of plantar warts (on the feet) was examined [6]. The homeopathic treatment was no more effective than a placebo.
A report in May 1994 examined the homeopathic treatment of diarrhea in children who lived in Nicaragua [7]. On Day 3 of treatment the homeopathic group had one less unformed stool than the control group (3.1 Vs 2.1; p <.05). However, critics [8] pointed out that not only were the sickest children excluded, but there were no significant differences on Days 1, 2, 4, or 5. This suggests that the conclusion was not valid. Further, there was no assurance that the homeopathic remedy was not adulterated (contaminated). Finally, standard remedies which halt diarrhea were not used for comparison purposes.
In November 1994 a research report examined the effects of homeopathic remedies in children with upper respiratory infections (such as a cold) [9]. Eighty-four children received the placebo, and 86 received individualized homeopathic remedies. The researchers concluded that the remedies produced no improvement in symptoms or in the infections.
In December 1994 a fourth study examined homeopathic treatment of allergic asthma in Scotland [10]. The 13 patients who received the homeopathic remedy reported feeling better and breathing easier than the 15 patients who received the placebo. Then the researchers combined these data with several earlier experiments. They concluded that, in general, homeopathy is not a placebo and that homeopathy is reproducible.
However, there were too few patients for significant analysis. Second, personal reports of feeling better are not reliable. If a patient feels better, is that proof of recovering from the ailment? There are many diseases in which the patient feels good but is actually quite sick. What is needed are several proper physiological measurements of improvement. Third, it is inappropriate to combine this small study with previous studies of a different disorder.
The latest study from Norway [11] examined relief from the pain of tooth extraction/oral surgery by homeopathic remedies or placebos. Fourteen of the 24 subjects were students of homeopathy, and 2 of the 5 authors were homeopaths. It is safe to say that motivation was high to have homeopathy succeed. However, no positive evidence was found favoring homeopathy, either in relief of pain or inflammation of tissue.
The reader may ask why so much attention has been given to the scientific research when supporters of homeopathy reject the relevance of clinical trials to establish its validity. But the same people also claim that the 1991 review, and the Nicaragua and the Scotland studies are proof that homeopathy does indeed work. It is important to realize that all of the research that seems to support homeopathy is seriously flawed. The only conclusion that is justified at this time is that research has not conclusively shown that homeopathic remedies are effective.
Homeopathic Pleading
What answer can be given to someone who says he took a remedy and it worked? Most people do not realize that in time most conditions will get better even if nothing is done. As the saying goes, "A cold will get better in 14 long days without treatment, but will get better in only two short weeks with medication." A wise medical doctor will say not to worry, that medication won't help much. (By the way, has anyone ever heard of a homeopath telling a patient that they need not worry and that the sickness will go away by itself?) When someone says the homeopathic remedy cured them, we can ask: "Would one have been cured just as quickly if nothing had been done?"
Another factor to consider is the "placebo effect." This means that if people "believe" that they are being properly treated, they will perceive themselves getting better faster. Recent research shows that up to 70% of medical/surgical patients will report good results from techniques that we know today are ineffective [12]. (At the time of the treatment, both the patient and the physician were convinced that the treatment was effective.)
Since 1842, homeopaths have argued that the placebo argument is irrelevant because children and animals are helped by homeopathic remedies. But children and animals respond to suggestion when researchers and often the parents and pet owners are aware that a remedy has been given.
Supporters also claim that there are no risks from homeopathic treatment. They say that the ultra dilute remedies are safer and cheaper than most prescription drugs. First, it has been shown that several homeopathic remedies for asthma actually were contaminated with large amounts of artificial steroids. Second, some remedies do contain measurable amounts of the critical substance. If a patient takes 4 tablets daily of mercury (D4), he would receive a potentially toxic dose. And a dose of D6 cadmium exceeds the safe limits. Finally, a D6 or less dose of Aristolochia contains significant amounts of this cancer-causing herb. Therefore, we cannot easily and quickly claim that homeopathic remedies are always safe.
There is an additional risk of seeking homeopathic treatment. If someone is ill and requires immediate medical treatment, any delay could have serious consequences. This is the risk that is present with all alternative medical care.
Advocates of homeopathy often assert that using dilute remedies is similar to vaccinations. After all, vaccinations also use very dilute substances. Once again, homeopathy is trying to obtain respectability by showing that conventional medicine uses similar procedures. This is misleading for several reasons. First, vaccinations are used to prevent disease. Once one is sick and has symptoms, a vaccination will not help. The homeopathic remedy is given only after one is already sick. Vaccinations use similar or identical weakened microorganisms, but homeopathy is concerned with similar symptoms of illness. And last, many homeopathic remedies use D24 or C12 dilutions where none of the substance remains. Vaccinations on the other hand must contain a measurable amount of the microorganism or its protein.
Strange Bedfellows
Sometimes we can learn much about a topic by examining who or what it associates with. In the first 100 years, homeopathy was closely associated with many pseudosciences including Mesmerism and phrenology. In the United States, many early homeopaths were members of the mystical cult of Swedenborgianism.
Unfortunately, this has not changed today. Especially in the United States, chiropractic (spinal manipulation therapy) and applied kinesiology use homeopathic remedies. Many homeopaths use iridology, reflexology, dowsing, and electrodiagnosis. None of these methods has scientific validity. In America, if you want to learn more about homeopathy, the best place to go is to any New Age bookstore or meeting place.
Another connection of homeopathy with the New Age movement is found in the emphasis upon some mystical energy (called the "vital force") which, though unquantifiable, supposedly permeates the universe and is responsible for healing. Fritjof Capra and Deepak Chopra claim that the mysteries of quantum physics support this "healing energy" concept. But Victor Stenger [13] has shown that all of modern physics (including quantum physics) remains materialistic and reductionistic and offers no support for the mysterious energy supposedly present in potentized homeopathic remedies at dilutions of C12 or greater.
Is Homeopathy Quackery?
In the United States, we have a motto: "If it walks like a duck, and looks like a duck, and sounds like a duck, then it probably is a duck." To what extent does homeopathy look like quackery and sound like quackery?
One clear link that homeopathy has to quackery is its supporters' use of faulty logic. The first example is known as the "test of time" argument -- the fact that homeopathy has existed for a long time shows that it is valid. But longevity does not guarantee validity. Astrology, numerology, and dowsing have been around for a long time, but they are clear examples of pseudoscience. Longevity of an idea is never a good substitute for rigorous science.
The second argument is that many people have tried homeopathic remedies and are all satisfied, so homeopathy must be legitimate. Along the same lines, we are told that the following famous and important people all supported homeopathy: The British royal family, Johann Wolfgang Goethe, Mahatma Gandhi, Mother Teresa, Mark Twain, O. J. Simpson, Yehudi Menuhin, Angela Lansbury, and Mary Baker Eddy (founder of Christian Science). The Chinese have a saying that if a thousand people say something foolish, it is still foolish. Also a majority vote is no substitute for good science. In addition, we usually hear only about the successes, but the failures are conveniently forgotten or ignored.
A third argument is the "non sequitur." Typically, the crackpot says: "They laughed at Galileo, and he was right. Today they laugh at me; therefore I must be right." (Actually Galileo was not laughed at. Rather he was persecuted because he was devoid of a proper Christian faith to accept the correct dogma.) Homeopaths say that throughout history many great geniuses have rebelled against the prevailing wisdom; many of these were ultimately recognized as correct. Paracelsus, William Harvey, Louis Pasteur, and Joseph Lister were vindicated by history. Therefore, it is argued, Samuel Hahnemann and homeopathy also will ultimately be recognized as correct. But this argument forgets that many more who claimed to be geniuses were correctly rejected.
In the spirit of fair-mindedness, one may be tempted to give homeopathy the benefit of the doubt and simply conclude "not yet proven." However, what then are we to do when many lay practitioners report that merely writing the name of the remedy on a piece of paper, and putting this on the body of the patient results in a "cure." Even two respected national spokesmen were unwilling to reject these reports, and one of them suggested that quantum physics may ultimately explain these healings as well as those reported by patients who are given the remedy over the phone.
We must conclude that homeopathy certainly sounds like quackery.
Homeopathy in the United States
Before 1920, homeopathy was extremely popular in the United States. There were many homeopathic hospitals and medical colleges. But then conventional medicine established more rigorous standards for training students. In addition, pharmacology and the discovery of many useful drugs happened at the same time. Today in the United States, only about 500 of more than 600,000 physicians use homeopathic remedies.
However, many scientists are concerned because the popularity of homeopathy is increasing. Today almost anyone can buy homeopathic remedies without a prescription. This is because in 1938 a homeopath who also was a powerful politician (Royal Copeland, MD) was able to have a law passed that made homeopathic remedies exempt from all drug regulation. So homeopathic remedies do not have to be proved effective, as all other drugs must be. In addition, many unlicensed and untrained people can give homeopathic remedies to anyone who asks for them. Both German and French homeopathic companies recognize the large potential American market for their remedies. Sales of remedies are growing by 30% a year, and most remedies are sold in New Age and related natural health-food stores. Therefore, there is no control over the quality of homeopathic treatment received by patients; nor is there control over the quality or purity of the remedies.
Why Do People Accept Homeopathy?
Perhaps there are really two different questions here. The first question relates to the New Age in general. The second question relates to many alternative medicines as well as homeopathy.
Why do people read their horoscopes? Why do people believe in good luck and bad luck? Why do people ask a dowser for help? Why do people visit fortune-tellers? People who do these things want to know about the future, to avoid uncertainty, and to take control of their lives. For many people the uncertainty in life is unbearable. These people want explanations that they can understand. Modern science has become so complex that many people turn away in frustration. It is unfortunate that most people throughout the world do not understand what science is and what science does. For example, how many people can explain why it is warmer in the summer than in the winter? (Only 2 of 23 recent Harvard graduates could mention the tilt of the earth's axis[14].) Or how many people understand the basic ideas of biological evolution? A survey by the National Science Foundation in May 1966 reported that 48% of American adults believe that humans and dinosaurs coexisted, and only 47% knew that it takes one year for the earth to go around the sun. This scientific illiteracy, due in part to the shortcomings in our education systems, makes it easy for pseudoscience and superstition to succeed.
Why do people turn to homeopathy and other "alternative" medicines? Many people are dissatisfied with conventional medicine. They distrust physicians who may prescribe expensive drugs or painful surgery. Often physicians can find nothing wrong with the patient. Or else they tell the patient that time alone will cure the ailment. And, of course, physicians often cannot spend much time talking with the patient because they have too many patients to see that day. If the physician finds nothing wrong, this may offend the patient because it suggests that the cause is psychosomatic. The patient who wants to be cured and to be cured immediately is upset when the physician says that time alone will cure the problem. The patient may also be unhappy if the physician doesn't give some medication.
An initial visit to a homeopath can often take more than one hour. Patients are encouraged to talk about all of their cares, concerns, and pains. Patients may be asked whether they like oranges or apples; what kinds of music they enjoy; whether they sleep on their back or on their side.
Later the homeopath tells a patient that because he is a unique individual, the remedy will also be individualized for that patient alone. Thus, homeopathy is seductive to both the patient and the physician. The patient and physician become partners in fighting the illness. The homeopath is seen as a concerned and sympathetic health-care giver.
Conclusions
It must be concluded that by every objective, rational, and medical standard, homeopathy has failed to establish its scientific credibility. Homeopathy has not cast off the many characteristics of pseudoscience and quackery. How can conventional medicine, science, and patients respond to this challenge?
The problem of scientific illiteracy must be acknowledged. For example, if people understood the influence of suggestion and the placebo effect more clearly, homeopathy's attraction might diminish.
Intelligent people can encourage others to think more critically. Extraordinary claims demand extraordinary evidence. A miracle means a violation of the laws of nature. A miracle cure probably is not a miracle at all. If something seems too amazing to be true, it probably isn't true. We must demand that the claims of diagnosis and cure be supported with good evidence. To paraphrase another American motto: "The only thing necessary for quackery to succeed is for intelligent people to do nothing."
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This artuicle was revised on March 1, 2002.