Homoeopathy: relic of the past or medicine of the future? (Marking Samuel Hahnemann’s 250th anniversary)

Those who pose this question from the perspective of a ‘sceptic’ suggest that the two principles of homoeopathy, the rule of similars and the use of serially diluted and agitated (SDA) medicines, are outdated and that proof of this lies in the ‘advances of modern science’. However, on closer inspection, the contrary may be true so what do these two principles in fact mean?

The ‘similia’ rule states: a minute dose of a substance can be used to treat a patient with a pattern of symptoms if this is similar to a pattern provoked by the same substance in healthy subjects. Usually the experimental substance has a higher dose than the therapeutic one. This rule makes use of the potential of many biologically active substances to have a bipolar effect: in high doses they suppress, in low doses they stimulate biological processes.

One example of this is traditional pharmacology research, which seeks the maximal, still beneficial, not-yet-toxic dose. Allopathic drugs also have dose-dependent bipolar actions: in toxic doses, antiepileptics, digoxin, neuroleptics and others create the effect they are supposed to cure in ‘therapeutic’ doses. Recent biological research has also shown that toxically damaged cells can increase their regeneration capacity if they are stimulated afterwards by the SDA form of the same toxin.¹ Moreover, stimulation with the identical SDA form is more effective than with other toxins in the SDA form. This means in terms of complexity theory that a system out of balance is very sensitive to a minute stimulus. Correspondingly, ill patients (e.g. those with headache or fever) are extremely sensitive to certain external stimuli. This sensitivity issue therefore bridges the first homoeopathic principle with the second: the use of SDA forms of (mainly toxic) substances. They can contain minute doses compared to traditional pharmaceutic drugs as they are chosen after careful assessment of symptoms and features of the person or animal in question. A good ‘match’ means an adequate similarity of features; a small stimulus is then sufficient.

This is also in line with complexity theory, i.e. in a complex system stimulus and response have a non-linear relationship.² ‘Adequate similarity’ implies, however, that the more accurate the assessment of analogy, the higher the chance of a positive clinical effect. This is the main reason that I think the homoeopathic database or Materia Medica needs extensive validation with modern epidemiological methods; this includes analysis of both the experimental symptoms and the patterns of symptoms and features of successfully treated patients.³,⁴

From a modern, patient-oriented approach we may ask: do we really want to maintain the large morbidity and mortality due to drug interactions and side-effects? An important test for ‘modernity’ is performing a risk–benefit analysis taking individual sensitivity into account. This sensitivity is not respected if, to cite a major official of Glaxo Wellcome, ‘90% of the current drugs do not work for 30 to 50% of patients’.⁵ Since 1850, experimental trials of homoeopathy with healthy volunteers have taken individual differences into account. The mapping of DNA has clarified individual genetic differences that lead to interpatient variation in enzyme structure and clinical patterns. Clinical variation has always been key for homoeopathic differential diagnosis. A sensitive person matched well with a specific remedy simply does not need a large amount of the substance, which is in accordance with the complexity of the human organism.

There is no model that shows that receptors are only sensitive to a certain dose of a drug, and little is known of the concentrations required to stimulate a receptor. At least cytokines work in concentrations in the same range as most homoeopathic remedies.⁶ This may have important implications, for instance for chemotherapy in cancer treatment.

Finally, there is the nature of the SDA remedies themselves. It seems a chemical misunderstanding of a physical phenomenon to state that high dilutions do not contain anything. The sceptics who still consider aqueous solutions to be a collection of separate corpuscules of water with therein dissolved a certain number of separate ions may wish to (re)read the physics literature. Contemporary research has shown clearly that water molecules are constantly rearranging through hydrogen bonds, which yield a cluster structure. This structure changes the properties of the solution, such as conductivity and heat production, after serial dilution and agitation in calorimetric experiments with highly ionised fluids that destroy the hydrogen bonds.⁷ What remains to be understood is whether the changes in properties also vary with the type of dissolved substance.

In conclusion, molecular biology and non-linear physics may have arisen after homoeopathic empirical evidence but they serve now to explain the clinical effects from which patients have benefited for two centuries. History is a circular process …

References

1. Van Wijk R, Wiegant FA. The similia principle as a therapeutic strategy: a research program on stimulation of self-defense in disordered mammalian cells. Altern Ther Health Med 1997; 3(2): 33–8.
2. Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ 2001; 323: 625–8. [Abstract]
3. Brands M, Weatherley Jones E. Sense and sensibility; integration of qualitative and quantitative research in homeopathy. Proceedings of the Third Homeopathic Conference, Royal Homeopathic Hospital, London, 2001;
4. Brands M, Ainslie D, Schroyens F. Materia medica validation: health technology assessment. Focus Altern Complement Ther 2005; 10: 7. (Suppl.)
5. BBC News. Drugs don’t work on many people, http://news.bbc.co.uk/1/hi/health/3299945.stm accessed 13 January, 2004
6. Eskinazi D. Homeopathy re-revisited: is homeopathy compatible with biomedical observations? Arch Intern Med 1999; 159: 1981–7. [Abstract]
7. Elia V, Baiano S, Duro I et al. Permanent physico-chemical properties of extremely diluted aqueous solutions of homeopathic medicines. Homeopathy 2004; 93: 144–50. [Abstract]

‘The most costly of all follies is to believe passionately in the palpably not true.’

Henry Louis Mencken, 1880–1956

Since, after 200 years, there is still no convincing evidence for the effectiveness (never mind the ‘principles’) of homoeopathy, it seems pretty safe to assume it is a fraud. One can argue that the homoeopathic community has not tried very hard to find such evidence, as illustrated by the recent farce when the Department of Health gave money for projects that mostly failed to address the questions.¹ Perhaps this reluctance to look for evidence isn’t surprising. After all, the results could seriously harm the income of homoeopaths. Why then do so many people believe that it works? The answer to that question seems to lie not so much in science as in sociology and fashion.

The first thing to remember is that believing things that are not true is a very common phenomenon. The power of wishful thinking seems to be enormous. Many, perhaps most, people believe what they would like to be true and are remarkably unconcerned about whether it is actually right. It takes only a few minutes with Google to find claims that homoeopathy is a useful treatment for anything from influenza to polio to anthrax. These claims are, of course, irresponsible in the extreme but wouldn’t it be nice if they were true?

Victorians had, for the most part, a deep scepticism about homoeopathy. Ernst points out that ‘at the end of the 19th century [homoeopathy] had “no scientific recognition’ and was ‘universally condemned”’.² Perhaps the most eloquent Victorian debunking of homoeopathy was the famous essay Homoeopathy and its kindred delusions by Oliver Wendell Holmes (the Harvard physician and father of the famous Justice of the Supreme Court with the same name).³ The essay was presented as two lectures to the Boston Society for the Diffusion of Useful Knowledge in 1842. Very much pithier, and all the nicer for having come from a bishop, were the lines by Bishop William Croswell Doane (1832–1913), first Episcopal bishop of Albany, New York:

Lines on Homoeopathy

Stir the mixture well

Lest it prove inferior,

Then put half a drop

Into Lake Superior.

Every other day

Take a drop in water,

You’ll be better soon

Or at least you oughter.

So if a Victorian bishop could see through the fraud, why is it that, in 2005, the newspapers (even the good ones) still have columnists that persist in the delusion that there is something in it?

I propose that the current popularity of homoeopathy, and CAM in general, is merely a sign (and not even the most serious sign) of a reversal of enlightenment values that has been going on for 25 years or so. The enlightenment was the 17th–18th century movement that ended the dark ages. The world as we now know it was created by people like Francis Bacon, Galileo, Descartes, Isaac Newton, Voltaire, Benjamin Franklin, Thomas Jefferson and many others. Rationality was in, superstition was out. Then, in about 1979, it suddenly became quite fashionable to advocate a return to the dark ages (for an excellent account see Wheen).⁴

In 1979 Ayatollah Khomeini denounced cinema and dancing, and returned to Iran to be greeted by an ecstatic crowd who seemed to want nothing more than to turn the clock back 1300 years. Then Margaret Thatcher came to power, followed in 1980 by Ronald Reagan. The fundamentalists of the Christian Taliban in the USA soon came to look more and more like those in Iran, and business ethics took a dive that led to major crimes, such as Enron and Worldcom. It was about this time too when big pharmaceutical companies started behaving badly. This phenomenon has been documented by, among others, Marcia Angell,⁵ Richard Smith⁶ and Richard Horton.⁷ These authors are not whacko conspiratorialists, but, respectively, ex-editors of the New England Journal of Medicine, the British Medical Journal and editor of The Lancet. They chronicle in excruciating detail the extent to which Big Pharma now corrupts both government and universities.

Arguably, these are all signs of a culture in which truth matters little (but money matters a lot). Ronald Reagan had his astrologer and allegedly the Blairs took their son to a pendulum waver rather than having him immunised (not to mention some really creative delusions when it comes to interpretation of intelligence reports).⁴ We have a royal family that are devoted to homoeopathy and talking to trees. With leaders like these perhaps it is not surprising that delusional behaviour has flourished for a quarter of a century.

There is an interesting parallel with Darwin. On the whole the Victorians welcomed Darwin’s ideas about evolution as a great advance in our understanding of the world. Of course Darwinism was opposed by some religious people, but with the passage of time most religious sects in Europe have come to accept it. Even the last pope accepted it (well, sort of). Woodrow Wilson, asked in 1922 for his thoughts on evolution, replied that ‘of course like every other man of intelligence and education I do believe in organic evolution. It surprises me that at this late date such questions should be raised’.

According to a nationwide Harris Poll in June 2005, however, 54% of US citizens said no when asked ‘Do you think human beings developed from earlier species or not?’ (38% said yes). That’s another great leap backwards for mankind.⁸

There is, therefore, nothing unique about CAM when it comes to wishful thinking. It is everywhere you look. Can we expect truth to prevail in the long term? On the whole, I’m optimistic that it will, though not quickly. People are no longer hanged for stealing sheep (or, in Europe, for anything else). And even though our present prime minister favours religious discrimination in schools, that at least is illegal in universities (since 1871). The long-term historical trend for improvement is clear. With luck, the present fashion for not using your brain, in both East and West, will soon come to be seen as a brief hiccough in the course of human progress. Then homoeopathy and its kindred delusions will pass into history.

References

1. Garrow J, Glenn S, Wilson P et al. UK government funds CAM research. Focus Altern Complement Ther 2003; 8: 397–401.
2. Ernst E. The heresy of homeopathy. A brief history of 200 years of criticism. Br Homeopath J 1998; 87: 28–32. [Abstract]
3. Holmes O W. Homeopathy and its Kindred Delusions, 1842; Available at http://www.quackwatch.org/01QuackeryRelatedTopics/holmes.html
4. Wheen F. How Mumbo-Jumbo Conquered the World. A Short History of Modern Delusions. London: Perennial, 2004.
5. Angell M. The Truth About Drug Companies. New York: Random House, 2004.
6. Smith R. Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Medicine 2005; 2: e138. http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020138
7. Horton R. The Dawn of McScience. New York Review of Books 2004; 51: 7–9.
8. http://www.pollingreport.com/science.htm accessed August 2005.