By HJ Hornbeck
Outside of standard science-based medicine, there is the field of complementary and alternative medicine, which are unconventional treatments. One of the major players in complementary and alternative medicine, alongside acupuncture, chiropractic and herbal remedies, is homeopathy. As with any treatment, individuals must make informed decisions based on the best available information. Yet without knowing the core principles of homeopathy, the latest evidence from scientific studies and the potential ethical issues regarding homeopathy, patients can’t determine the best course of action. Overall, evidence reveals that homeopathy is no more effective than a placebo treatment, which means people are spending money on sugar pills and water and might suffer adverse health effects from not using standard medicine.
People still find the claims of complementary and alternative medicine appealing though. When patients become disgruntled with their current medical services because of long waits at the clinics, the periodic controversies surrounding large pharmaceutical companies and life-threatening treatments and surgeries for deadly illnesses, they begin to look for alternatives.
Mendel Perkins, a third-year University of Calgary botany student notes that homeopathy “sometimes sounds better than what your conventional doctor might tell you. When your doctor says ‘it might be this,’ ‘I don’t know,’ ‘there are side effects,’ the alternative of there being ‘no side effects,’ ‘it’s totally non-toxic’ and ‘it will probably cure you,’ becomes very attractive.”
However, if patients stop taking conventional medicine and rely solely on pseudoscience, serious medical complications may arise. This potential danger is another reason why the public needs to be aware of and understand the available evidence regarding homeopathy — like any medical treatment on the market. People need to be aware of sham treatments so they can make informed choices.
So what is homeopathy and why is it flawed? Samuel Hahnemann founded homeopathy in 1796 when he published his first paper discussing his experiments to find new methods to treat patients. Hahnemann searched for better treatments than the medical practices of the era, such as bloodletting and purging, as these practices often did more harm than good. Though his quest to improve the health care standards of his time was noble, homeopathy unfortunately doesn’t hold up to scientific scrutiny today. Hahnemann’s observations gave rise to three proposed laws of homeopathy, which are still core to the field now. However, these laws are scientifically flawed.
The first law of homeopathy is the ‘law of similars,’ or how drugs that cause specific symptoms in healthy individuals can be used to treat illnesses presenting those same symptoms. Hahnemann created this theory when he observed that ingesting cinchona bark — a common treatment for malaria at the time — caused malaria-like symptoms in healthy patients. Unfortunately for Hahnemann, the foundations of scientific methodology for adequately testing this theory didn’t exist in the early 19th century. Modern pharmaceutical knowledge shows that the medicinal compound quinine in the cinchona bark is what treats malaria. However, overdosing on quinine results in cinchonism, which has malaria-like symptoms, but is a completely different pathological condition. To help reinforce the absurdness of this law, it wouldn’t be sensible to suggest that caffeine can be used to treat insomnia because drinking a cup of coffee before bed keeps most people awake. The ‘like-cures-like’ postulation is an over-extrapolation of the principle that high doses of a harmful substance may instead be beneficial at lower doses.
Second, there is the ‘law of potentization,’ or how a remedy becomes more potent the more dilute it is. Hahnemann recommended a substance be diluted 30 times by a ratio of 1:100. To help conceptualize, that would mean 1 millilitre of a solute would be found in a sphere of water just a bit over 131 light years in diameter. The nearest known star to the Sun is just over four light years away. The ingredient becomes inactive or not even present in a solution when it is so heavily diluted. All that remains is a vial of water or sugar pills that are marketed as a remedy.
The homeopathic field attempts to explain how these remedies could still work, even though there is a lack of active ingredient, by claiming that water is capable of retaining the memory of the original substance. The United Kingdom’s House of Commons science and technology committee’s 2010 review of homeopathy concluded that, “the notion that ultra-dilutions can maintain an imprint of substances previously dissolved in them [is]scientifically implausible.”
Finally, the ‘law of vitalism’ is the third tenet of homeopathy. It is an ancient theory revolving around the idea that living matter is fundamentally different than non-living matter due to the presence of a vital energy or some kind of immaterial aspect. Vital energy is a common principle to many holistic practices under the umbrella of complementary and alternative medicine. Essentially, holistic medicine is the treatment of spiritual derangements in addition to any physical symptoms. Though this may be an appealing idea, from a medical standpoint there is no such thing as vital energy that is directly linked to the condition of one’s health.
According to the Canadian Society of Homeopaths, the practice of homeopathy is a “natural system of medicine that uses highly diluted doses of substances to stimulate the body’s own healing mechanisms to promote health.” Taken at face value, this may seem to be an innocent statement. It plays into the mainstream value of ‘natural’ processes while being simple to follow. However, it is essential to address the various claims made in this definition of homeopathy.
The Canadian Society of Homepaths claims to practice natural medicine. Perkins said, “things are natural and unnatural, that doesn’t assign them any value.” This entire notion of natural things being inherently good is not logically sound and is known as the naturalistic fallacy. As put by philosopher Julian Baggini, “there is no factual reason to suppose that what is natural is good (or at least better) and what is unnatural is bad (or at least worse).”
The Canadian Society of Homepaths uses highly dilute substances. Perkins said, “it flies in the face of anything that should work in chemistry.” The UK’s Evidence Check program run by the House of Commons’s science and technology committee, which reviews spending on health policies, determined that the effectiveness of highly diluted substances is implausible.
The Canadian Society of Homeopaths claims to stimulate the body’s own healing mechanisms. These ‘healing mechanism’ are not explained in detail, which results in the claim being ambiguous and difficult to verify. However, the lack of substantial evidence supporting homeopathic theories does not necessarily mean that there aren’t any beneficial healing effects. In order to analyze these healing effects, scientists must perform clinical trials. In addition, to properly analyze any beneficial effects, a distinction between efficacy and effectiveness has to be made. In simple terms, efficacy determines if a treatment has any therapeutic use — determined through properly controlled studies — while effectiveness determines if a patient responds to a treatment. However, effectiveness is subject to the phenomenon known as the placebo effect, which can result in a treatment being effective even though it is not efficacious.
In his article “Placebos and the Philosophy of Medicine,” Dr. Howard Brody, director of the Institute of Medical Humanities at the University of Texas Medical Branch, defines the placebo effect as “a change in a patient’s illness attributable to the symbolic import of a treatment rather than a specific pharmacologic or physiologic property.” Essentially, it is the idea that because a patient receives a treatment — even if that treatment has no drug or active substance in it — they will experience an improvement in any subjective symptoms, such as pain or general wellness. Therefore, homeopathy won’t pass efficacy tests due to the placebo effect being controlled for, but individuals taking these remedies may report that they are effective, even though they are simply benefitting from a psychological effect.
The 2010 review from England’s Peninsula Medical School titled “Homeopathy: what does the ‘best’ evidence tell us?” concluded, “the findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.” This conclusion shows that homeopathic treatments are no more effective than administering sugar pills — a common placebo — for treatment of relatively minor ailments. These kinds of remedies do not treat pathological conditions, such as cancer or heart disease since the underlying condition doesn’t simply improve because one ‘feels better.’
Since homeopathic remedies are simply placebos, there are ethical issues in misleading individuals by claiming it a medical treatment. The doctor-patient relationship is a cornerstone of modern medicine. Bioethics has emerged in the 20th century to examine the ramifications of this relationship. This emergence has caused the founding of various ethical research institutes. Dr. Raanan Gillon, professor of Medical Ethics at Imperial College London, wrote an article in 1994 titled “Medical ethics: four principles plus attention to scope” covering the shift from the paternalistic role of the doctor in deciding what is best for their patient, to a more egalitarian relationship focused on fully-informed decision-making by the patient. Since the power of a deliberate placebo treatment essentially requires the practitioner to deceive the patient, it is considered unethical in the medical profession. Homeopathic physicians undermine the doctor-patient relationship when they prescribe placebos.
In addition to placebo medications being unethical, Professor Edzard Ernst, director of the Complementary Medicine Group at the Peninsula Medical School, explained in an interview with the UK’s Science Committee how prescribing placebos is unnecessary: “If I give my patient an aspirin for his or her headache and I do it with empathy, time and understanding this patient will benefit from the pharmacological effect of the aspirin and she will also benefit from the placebo effect through the encounter with her clinician.” The doctor-patient relationship itself serves as an placebo as the attention they give to their patients helps them feel better.
Ernst also said, “there is lots of data to show that placebo effects are notoriously unreliable — somebody who responds today may not respond tomorrow.” Therefore, in addition to the homeopathic treatment being no better than a placebo treatment, there is no guarantee the money spent will yield even that.
Even though the effectiveness of homeopathy is highly implausibly, homeopathic nostrums are still available in the market. Perhaps it is due to a lack of awareness that consumers still buy these remedies.
The public needs accurate information from trusted sources. Without this information being commonplace, individuals are spending their income on exorbitantly priced water or sugar pills, due to deceptive marketing strategies. Although a patient relies on a doctor to understand the intricacies of medical problems and treatments, there also needs to be prominent and factual information about different treatments so patients aren’t tricked by marketing and spend their money on ineffective treatments. Government involvement through health policy may be a valid medium for providing more information on complementary and alternative treatments. Regardless, it is important that the individual, within reason, ultimately makes an informed decision when it comes to personal health.