Is Homeopathy Stupid?
World in a Leaf by Susan Evenson
Homeopaths believe and their patients believe, and that combined fantasy works great until the body can’t heal itself. Or so I believed…
One sunny fall afternoon during my second year of medical school (1976 in San Francisco), the weekly brown bag lunch talk was not given by a faculty member but rather by a rogue homeopath from that radical town across the Bay. Half my reason for attending was my fond defense of my hometown, Berkeley, actively insisting that its citizens were not all halfwit hippies. The handful of attendees behaved well, but I believe we all shared the same impression: “Homeopathy? Sounds crazy! Who made up this hocus-pocus and called it medicine?”
Our speaker was the infamous Dana Ullman, who at that moment was facing charges of practicing medicine without a license, after being the target of an undercover sting operation. Ullman was obviously a true believer in his healing practice, and I was sympathetic to that. In fact, all these years later Ullman remains a true believer. He settled the charges out of court, retaining the ability to maintain a health practice as distinct from a medical practice, and has been a practitioner and public advocate for homeopathy ever since.
At that first lunch, Ullman explained to us that a homeopathic remedy is selected for a patient’s symptoms, not her diagnosis, and it is dosed in immeasurably small amounts—that seemed to me to amount to nothing at all. The part that stuck with me, however, was the homeopathic principle: that the medication used for treatment would actually cause the same symptoms if given to a healthy person. A German MD named Samuel Hahnemann formulated this principle of homeopathy around 1800 when he observed that the symptoms of quinine poisoning were remarkably similar to those of malaria. Quinine, of course, is a cure for malaria. So Dr. Hahnemann created a list of symptoms caused by different medicines, and then tried those on his complaining patients. When they matched, he observed, the patients were cured.
But here’s one rub: By the time Dr. Hahnemann made his observations he had quit his medical practice and was working as a medical translator—because he considered so many of the standard medical treatments of his day to be barbaric. So Hahnemann had not only quit his profession, he had started a war against it. And his new practice made rapid gains because homeopathy was a lot healthier for most patients than at least one common medical treatment of the day: bloodletting. So bitter was the acrimony between the rival healing practices that a founding tenet of the American Medical Association was to forbid any contact with a homeopathic doctor. A married MD had to ask for an exemption if the spouse was in the enemy camp.
The other rub was Hahnemann’s extreme dilutions. Even today, MDs are confounded and tantalized by the contradictory results of medications such as antidepressants, which can cause suicide. But diluting a medication to the point of nonexistence seems completely ludicrous. So the standard story of homeopathy in America today is of a practice that came to prominence at a time when doing absolutely nothing was far better for many patients than standard medical treatments. In much the same way that a big red placebo pill works better than a small white placebo, homeopathy thrived because it was a particularly tantalizing and thus a powerful placebo. The homeopaths believed and their patients believed, and that shared fantasy continues to work well for homeopaths and patients who don’t know better. Of course, true believers of all kinds can be powerful healers—but they can also prove deadly by preventing sick people from seeking real medicine when the body can’t heal itself.
That’s kind of where I was at lunch in 1976.
Fast-forward through medical school, family practice residency, and into the ER and a new private practice. My left brain was functioning terrifically and medical progress was linear and inexorable. Then one day I phoned a local physical therapist to thank her for her excellent care of a mutual patient (that shocked her!), and she asked if she could bring me some cards and have five minutes of my time. She used that time to address what she perceived might be an open mind.
“My real interest is homeopathy,” she said. “Do you know what that is?”
I laughingly claimed to know all about it, but the question intrigued me so much that I ended up a few months later in the office of a homeopath, checking it out for my own amusement. My medical excuse for the appointment was hay fever and frequent minor illnesses over the previous six months. One thing I remember vividly is that my prescriber asked whether I was generally a warm or chilly person, and I replied warm, since I was indeed quite warm at the moment. She worried a little about that, having expected my answer to be “chilly.” I shrugged, took the remedy, Nux Vomica, and walked out to my car. Taking off my sweater, I realized I’d given the wrong answer: I was only warm because I was wearing long underwear, a turtleneck, and a sweater. I was impressed—the homeopath had intuited that if my proper remedy was Nux Vomica, I must be a chilly person. Or maybe she noticed my layers of clothes.
The other part I remember is that my response to that first remedy was right out of a homeopathy textbook: For the next week I awoke with transient symptoms of one of my recent acute illnesses. After about a month I had a rare and brief yeast infection. Not long after that I could report that my hay fever and acute illnesses were gone, and I noticed a new surge in energy, mood, and creativity—all of which I used to write upcoming wedding vows!
Physician, Heal Thy Dog
That healing story is an anecdote. It’s not “science,” but because I was the anecdote, I was curious and eventually found myself in formal homeopathic training at the Hahnemann College of Homeopathy. My classmates were all licensed health care practitioners, mostly physicians, and we spent weekends together from 1989 to 1992. One thing that drove me was a standard caution from my pharmacology teacher: “Every pharmaceutical has side effects, some worse than others. In general, drugs should be used as a last resort.” Only problem was, nowhere in medical school did we learn much about what to do as a “first resort.” Seven years of conventional medical training had made me highly effective in the ER but short on preventive wisdom and gentle therapies. Maybe homeopathy was it.
Nevertheless, I was skeptical—all too aware of the problems of placebos and wishful thinking. So my first homeopathic prescription was a dose of Arnica to my completely prostrate dog, exhausted from a 15-mile hike the previous day. Nothing roused her: not food, not water, not cajoling with a treat. So I placed a few pellets of homeopathic Arnica on her tongue and within seconds she was up, shaking off her lethargy, and fully energetic for hours. Her energy collapsed again that afternoon after immersion in a natural hot spring: an activity known to “antidote” or reverse the effects of homeopathic remedies.
That too was an anecdote, but once homeopathy had cured both me and my dog the pattern became hard to ignore. I was becoming a believer and thought my future would be to add to the body of homeopathic research—then and now quite small. By the time I completed my program, however, I no longer wanted to spend my time convincing the skeptical, opting instead to practice my newly learned craft on a rapidly growing waiting list.
Through the Looking Glass of Research
There are indeed a handful of recent peer-reviewed articles that have attempted to evaluate the efficacy of homeopathic remedies, including a Lancet study in which Dr. David Reilly and colleagues assessed that hay fever symptoms were better reduced by homeopathic than identically administered placebo. In other words, Dr. Reilly found that homeopathy is not a placebo; it does something. That finding, and others like it, is remarkable. To our scientific way of thinking, it simply shouldn’t happen. But a lot of things are confounding modern medicine. We could discuss for hours the challenges in subjecting reality of any sort to clinical trials. For example:
- Medical trials—even huge “gold standard” trials—are proving to be notoriously difficult to reproduce. Does that make their data invalid?
- Patients respond to multiple cues, including the placebo effect. Is that a bad thing or a good one?
- Should the health care decision of an individual be based on studies that did their best to eliminate all individual variation in their study group?
When studying homeopathy the challenges become even greater, and one reason is that a homeopathic treatment has to be individualized. My hay fever remedy is different from yours because my body and my life are different from yours. Clinical trials usually compare medications, not completely different medical approaches. By the way, just because there are homeopathic remedies at your drugstore and the clerk says, “Uh, yeah, that’s for headaches” is not good enough. Availability does not imply knowledge of applicability. It’s complicated—because you are.
Scientists have attempted to overcome these challenges through the process of systematic review and meta-analysis, such as a 2014 article by Mathie et al., that looks at studies that have compared homeopathic to placebo response and where the treatment has been individualized. A systematic review is thought to minimize statistical errors, acknowledging that it can also minimize statistical truths! Mathie’s article concluded that individualized homeopathic prescriptions might have small and specific effects and that new research is indicated.
Meanwhile, other studies from around the world suggest that homeopathic dilutions actually contain energetic information or traces of the original medication. How that information might actually do anything is anybody’s guess—but it suggests a reason for serious research.
The Bottom Line
On its face, homeopathy is not only stupid but literally incredible: There’s no “rational” way it can work. To my way of thinking, that means that if there is even a minimal confirmed response to homeopathic medications, the medical community should be clamoring for more information. Where is our collective curiosity? If this method indeed has some merit, how on earth does it work, and what more can we learn? The response is silence, though, because of the medical tradition in America and, frankly, because homeopathy is really hard. There are over 3,000 remedies, and I should consider all of them when you present to my office with your sick toddler. Interestingly, Europe doesn’t feel the same way about homeopathy. According to the British Medical Journal, more than 50 percent of Germans use homeopathic remedies, and this year Switzerland officially declared homeopathy to be a legitimate medicine.
Ultimately, though, what keeps me prescribing homeopathic treatment is not the scientific research but rather the clinical experience. I am currently working with a cancer patient and her oncologist, helping her sort out her diet and supplement choices. At her last visit she asked if I could also prescribe a homeopathic remedy. She remembers, from decades ago, how a single remedy resolved the disabling panic attacks of her then teenage son and how her daughter’s allergies resolved 95 percent with homeopathic treatment. In my most skeptical moments, I am always sustained by the knowledge that my 25 years of prescribing homeopathic remedies to children almost totally eliminated their exposure to antibiotics, antihistamines, and antidepressants. I have had great adult cases as well, but the kids without antibiotics make me smile. I feel really good about their microbiomes—and we now know how complicated that is.
Why Homeopathy Sure Seems Stupid
- Medications are prepared from animal, plant, or mineral material, diluted past the point where a molecule of the substance remains, and that dilution is coated onto a sugar pill and placed directly on the patient’s tongue.
- Evaluation of a patient consists of noting all current and past symptoms: mental, emotional, physical. And heck—even their attitude in the consultation is important to note.
- Homeopathic remedies are also categorized by a laundry list of symptoms: symptoms arising in a healthy person. A homeopathic “proving” uses a small daily dose repeated until symptoms are elicited—or symptoms are cured in another sick person.
- The more completely a patient’s total symptoms match the total symptoms associated with a remedy, the more likely the cure.
- Homeopathic practice got a lot easier when we started doing all this by computer rather than with textbooks. That was crazy.