My first exposure to the word ‘Homœopathic’ was at Hampton House, a hall of residence at Bristol University which was an ex-homœopathic hospital (and is now the student medical centre). All I knew was that it was a magnificent building that used to be a hospital of some sort – but I never really thought about what the ‘Homœopathic’ bit meant – I just assumed it was another branch of medicine.
I’ve grown up a lot since then, most importantly I’ve learned to ask questions, so when I stumbled over the term homeopathy (the modern spelling of homœopathy) again, I made an effort to find out what it meant. Here’s a summary of what I understand by homeopathy and the thoughts I have in relation to that understanding. Remember, I am not a medic but I am trained in the scientific method.
1. Homeopathy was founded by Samuel Hahnemann in 1796 as an alternative to the established medicine of the time, which he considered to do as much harm as good. I get this, since 18th Century medicine was pretty poor stuff. It was still largely founded on Galen’s principles of the four humours, despite great leaps in medical understanding following the Enlightenment. To put the period into a broader medical context we should consider the work of Jenner and Withering, who were contemporaries of Hahnemann. Both men made remarkable headway in developing new treatments (innoculation against smallpox and use of careful doses of foxglove extracts to treat dropsy, respectively) by observation and experimentation, but neither managed to identify the underlying processes by which the treatments worked – this came much later (and is to some extent ongoing). It is worth noting that the Pasteur’s work on germ theory, which forms the foundation of modern medicine, didn’t emerge until after Hahnemann’s death in 1843. The germ theory was very much outside mainstream medicine at the time and it took until 1890 before a clear structure for application of germ theory emerged in the form of Koch’s postulates. This led to a fundamental shift in established medicine.
2. Hahnemann used experimentation to inform his theory. The first example of this came when he challenged an ill-founded idea in a text that he was translating about the way in which cinchona bark (the source of quinine) treated malaria. Rather than the bitterness of the bark bringing about a cure as was suggested, Hahnemann thought that other effects must be present (after all, other bitter substances didn’t work as a cure), so he sampled the bark himself and documented the effects it had. He then tried the same thing with other substances until he had built up his Materia Medica Pura, or list of suitable medical materials. I have my doubts about the controls in such an experiment, but nonetheless this was before controlled trials, which emerged as a concept in the 1870′s in experimental psychology and weren’t used in the currently accepted way until 1944, so we can grant Hahnemann some leeway.
However, modern homeopaths continue to use the same method of trying something (at homeopathic doses) and documenting the perceived effects. They refer to this as a “proving” and it tends to rely on a small group of people – usually not a statistically significant sample (i.e. less than 20) – describing their feelings after taking the substance. From what I can tell there is no blinding or well considered placebo control involved in this process – except in studies which find no observable effect beyond placebo.
3. ‘Homœopathy’ is based on the principle of like cures like. What Hahnemann found was that the cinchona bark caused symptoms similar to those of malaria, which led him to consider that:
The curative power of medicines, therefore, depends on their symptoms, similar to the disease but superior to it in strength(§. 22 -26), so that each individual case of disease is most surely, radically, rapidly and permanently annihilated and removed only by a medicine capable of producing (in the human system) in the most similar and complete manner the totality of its symptoms, which at the same time are stronger than the disease. [English translation of §27, 6th Edition of Organon of Medicine - See here for original German text of §27, 6th Edition of Organon der Heilkunst]
This seems like quite a bold conclusion – a method of eradicating any disease if a medicine capable of recreating the symptons can be found. So how would such a mechanism work?
4. Health is based on vital energy. Hahnemann deduced that:
In the healthy condition of man, the spiritual vital force (autocracy), the dynamis that animates the material body (organism), rules with unbounded sway, and retains all the parts of the organism in admirable, harmonious, vital operation, as regards both sensations and functions, so that our indwelling, reason-gifted mind can freely employ this living, healthy instrument for the higher purpose of our existence. [English translation of §9, 6th Edition of Organon of Medicine - See here for original German text of §9, 6th Edition of Organon der Heilkunst]
Hahnemann therefore considered that disease is caused by derangement of this vital force. As evidence for this he identifies the way in which the Moon is influenced by the Earth through invisible energy (gravity) and a needle will become magnetised when in the presence of a magnet (electromagnetism) - which is used to directly infer a cause for the method of contagion by diseases (see note 2). Obviously Hahnemann was not aware of Einstein’s work on special relativity and electromagnetism and had no concept of non-Newtonian physics, he also had no knowledge of the invisibly small viruses and bacteria – since all of these breakthroughs were yet to come. In effect, Hahnemann was accepting that invisible forces are undetectable and moreover that they should simply be accepted on faith:
How the vital force causes the organism to display morbid phenomena, that is, how it produces disease, it would be of no practical utility to the physician to know, and will forever remain concealed from him; only what it is necessary for him to know of the disease and what is fully sufficient for enabling him to cure it, has the Lord of life revealed to his senses[English translation of §12 note 1, 6th Edition of Organon of Medicine - See here for original German text of §12 note 1, 6th Edition of Organon der Heilkunst]
Is it then so utterly impossible for our age celebrated for its wealth in clear thinkers to think of dynamic energy as something non-corporeal, since we see daily phenomena which cannot be explained in any other manner? … And if one raises his arm, does it occur through a material visible instrument? a lever? Is it not solely the conceptual dynamic energy of his will which raises it?[English translation of §11 note 2, 6th Edition of Organon of Medicine - See here for original German text of §11 note 2, 6th Edition of Organon der Heilkunst]
Here we really hit a sticking point for me. Hahnemann is going directly against the most fundamental principles of science here. He is suggesting that because he doesn’t know the answer, no-one could possibly know the answer. He is establishing dogma based on his faith that “the Lord of life” has matters in hand, so mere physicians should bother trying to investigate the inexplicable. This is a clear departure from his initial experimental approach – and a clear departure from scientific principles.
I included the quote about raising the arm as a good example of the level of knowledge available to Hahnemann at the time. He asserts that the dynamic energy of a person’s will is responsible for something that a schoolchild should know the mechanism of now. We raise an arm by sending a nervous signal from the brain, it travels down the appropriate nerves and causes contractions in the appropriate muscles attached to bones, raising the arm. We understand this mechanism well enough to enable control of a robotic prosthetic arm. So if the evidence used by Hahnemann to support the concept of a vital energy is all based on observations of actions that have alternative causes, which have been subsequently established, is the concept of dynamic or essential energy still useful or valid? It is certainly still used in modern homeopathy:
Furthermore, we have found that those individuals within the group who wished to remain outside of the proving have been unable to do so; they are automatically included.
The concept of participation mystique comes to mind in order to afford a description of this phenomenon. In the case of the School, provings have become a recognised corner stone of homÏopathic training. This plus familiarity, shared endeavour and healing ideals combine to engender group consciousness and participation mystique. That those who did not ‘take’ the thing, that those who did not even know that the proving would take place within the group, had been affected demonstrates the dynamic nature of the phenomenon.
It is only matter that is bound to space and time. The immaterial essence of the thing, actuated by the intention of the proving group constellates the action field. Forgive me labouring the point: the thing that we are dealing with is essence, spirit, call it what you will, and is not bound within the constraints of space and time. Those who key into it are part of it irrespective of distance or time; they know it telepathically. [Misha Norland, 1999]
This is from a modern homeopath who is involved in provision of the most fundamental information required in homeopathic treatment development. Where drug development in other disciplines need years of computer modelling, animal research and human trials to demonstrate efficacy before product launch; homeopaths can create a new treatment on the back of a group of people having a telepathic episode. I’ll let you get my opinion on this just using telepathy – it will probably be pretty accurate thanks to the context.
5. Dealing with doses (the problem of poisons). The issue of how to redress the balance of the vital force gave rise to a problem, since many of the substances that can elicit a response similar to that of an illness are toxic. Fortunately, Hahnemann realised that it is the energy of the substance rather than its physical presence that is important in rebalancing the vital force. This means that very small doses of a substance can be used. Indeed the smaller the better:
The suitableness of a medicine for any given case of disease does not depend on its accurate homœopathic selection alone, but likewise on the proper size, or rather smallness, of the dose. If we give too strong a dose of a medicine which may have been even quite homœopathically chosen for the morbid state before us, it must, notwithstanding the inherent beneficial character of its nature, prove injurious by its mere magnitude, and by the unnecessary, too strong impression which, by virtue of its homœopathic similarity of action, it makes upon the vital force which it attacks and, through the vital force, upon those parts of the organism which are the most sensitive, and are already most affected by the natural disease. [English translation of §275, 6th Edition of Organon of Medicine - See here for original German text of §275, 6th Edition of Organon der Heilkunst]
It strikes me that this is a direct attempt to escape the contemporary view that doses of a medicine should be as large as possible. In fact throughout the Organon, Hahnemann casts homeopathy as the diametric opposite of the established medicine of the time. This is regardless of the work of Withering, who had started looking at using appropriate dosing with regard to the foxglove a few years earlier.
Hahnemann’s obsession with small doses led him to recognise that dilution was the best way to create tiny (and therefore more powerful?) doses of a substance. Obviously if the dilution became too great there would not be any of the original substance left to act on the vital force, so Hahnemann decided that a strong sharp concussion (that he called “succussion”) was required to transfer the inherent energy of the substance into the water or alcohol it was dissolved in.
How this works is beyond my grasp of physics/chemistry, but what do I know about such things compared to someone who lived 200 years ago? Using the combined technique of succussion and dilution Hahnemann managed to produce treatments that didn’t contain a single molecule of the original substance. Exactly how the various contaminants in the water used respond to succussion I am unsure – although I am sure that contaminants got in, given that even now our most advanced water purification systems still allow 1-5% of contaminants through. I suppose that the vital force contained in the active ingredient is generated by the will of the homeopath, whereas the contaminant has not been imbued with this mystic energy, so during succussion it has no vital force to impart… or something equally sensible.
6. Suiting the treatment to the patient. Here we hit the big obstacle in testing homeopathic remedies. Ideally the various inbalances in a person’s vital force need to be identifed and treated with the appropriate homeopathic remedy. There is a bit of a schism here, with some remaining with Hahnemann and insisting on seperate courses of treatment to deal with each of the different sources of imbalance, whilst other maverick homeopaths suggest that several courses of treatment can be undertaken at the same time. Either way, a person should have several sessions with their homeopath and their treatment should be based on the thorough investigation of imbalance, assessed by maintaining a diary of symptoms. This focus on the individual makes it very hard to pick apart what (if anything) works in homeopathy.
Does the fact that so much time is devoted to talking to patients play a role? Is it valid to consider the effectiveness of homeopathic remedies without the consultation stage? Is it reasonable to apply standard medical methodology to homeopathy? Is homeopathy an elaborate mechanism that stimulates increased placebo response?
I don’t have answers here, but I can make informed decisions based on what I have found out:
1. Homeopathy is over 200 years old, it was established as a direct challenge to an archaic system of conventional medicine that has long been superceded by medical advances that have been shown to work (note: eradication of smallpox, massive decrease in infant mortality, massive increase in life expectancy in those parts of the world with modern medicine). Homeopaths still base much of the defense of their art on arguments against the imperfections of evidence-based medicine (such as serious adverse-effects on patients in some treatments), yet they cannot demonstrate the efficacy of their own treatments (anecdotes aside), only that their treatments are safe. Since their treatments consist of water on a sugar pill the only foreseeable side-effect would be dental caries or perhaps increased risk of diabetes.
2. The experimental component of homeopathy has not kept pace with other disciplines. Sources of bias and error identified in numerous other areas of experimental science have been identified and new techniques developed to address and reduce these sources of error. Homeopathy does not use these methods in the investigation of their ‘proovings’ and the published research carried out by homeopaths is usually of poor methodological quality – rendering it equivocal at best. Homeopaths still rely on anedotes as data, missing the point that known errors like regression to the mean make anecdotal data unreliable.
3. The principles of homeopathy are dogmatic and resistant to change. They rely on concepts of mysticism that were based on an 18th Century understanding of observations about the world, which have not been updated irrespective of the vast progress in knowledge that has occurred since. Every other field of successful endeavour has changed considerably over a similar time-span, even religion. Quite simply, the theoretical foundation of homeopathy appears to be mystical supposition build upon misinterpretation – will it ever hold water?
4. Homeopaths believe in what they do. They have Faith. Some have allowed their children to die of treatable illnesses because they believe so strongly. Homeopathy is very much like a religion. Claims are made that have no evidence to support them, but which have vast implications, especially in places with limited conventional healthcare. Would you really consider using what is effectively magic water on a sugar pill to treat a serious disease? Yet from AIDS to swine-flu, there are homeopaths who say they can help.
Give me someone with some healthy scepticism any day. Give me a doctor who tells me what my chances are and what the side-effects of a medication are likely to be. That has to be far better than a magic-pill pusher who thinks my vital force is out of kilter – that’s just wich-doctoring, quackery and woo.