Classical homeopathy originated in the 19th century with Samuel Christian Friedrich Hahnemann (1755-1843) as an alternative to the standard medical practices of the day, such as phlebotomy or bloodletting। Opening veins to bleed patients, force disease out of the body, and restore the humors to a proper balance was a popular medical practice until the late19th century (Williams 2000: 265). Hahnemann rejected the notion that disease should be treated by letting out the offensive matter causing the illness. Instead, he argued that disease should be treated by helping the vital force restore the body to harmony and balance. He rejected other common medical practices of his day such as purgatives and emetics "with opium and mercury-based calomel" (ibid.: 145). In retrospect, Hahnemann's alternative medicine was more humane and less likely to cause harm than many of the conventional practices of his day.
Scientific medicine was developing in Hahnemann's time but homeopathy would not be part of that development. Scientific medicine is essentially materialistic. It is based on such disciplines as anatomy, physiology, and chemistry. While Hahnemann's methods involve empirical observation, his theory of disease and cure is essentially non-empirical and involves the appeal to metaphysical entities and processes.
Hahnemann put forth his ideas of disease and treatment in The Organon of Homeopathic Medicine (1810) and Theory of Chronic Diseases (1821). The term 'homeopathy' is derived from two Greek words: homeo (similar) and pathos (suffering). Hahnemann meant to contrast his method with the convention of his day of trying to balance "humors" by treating a disorder with its opposite (allos). He referred to conventional practice as allopathy. Even though modern scientific medicine bears no resemblance to the theory of balancing humors or treating disease with its opposite, modern homeopaths and other advocates of "alternative" medicine misleadingly refer to today's conventional physicians as allopaths (Jarvis 1994).
Classical homeopathy is generally defined as a system of medical treatment based on the use of minute quantities of remedies that in larger doses produce effects similar to those of the disease being treated. Hahnemann believed that very small doses of a medication could have very powerful healing effects because their potency could be affected by vigorous and methodical shaking (succussion). Hahnemann referred to this alleged increase in potency by vigorous shaking as dynamization. Hahnemann thought succussion could release "immaterial and spiritual powers," thereby making substances more active. "Tapping on a leather pad or the heel of the hand was alleged to double the dilution" (ibid.).
Dynamization was for Hahnemann a process of releasing an energy that he regarded as essentially immaterial and spiritual. As time went on he became more and more impressed with the power of the technique he had discovered and he issued dire warnings about the perils of dynamizing medicines too much. This might have serious or even fatal consequences, and he advised homeopaths not to carry medicines about in their waistcoat pockets lest they inadvertently make them too powerful. Eventually he even claimed that there was no need for patients to swallow the medicines at all; it was enough if they merely smelt them. (Campbell)
Two potency scales are in common use: the decimal, which proceeds by 1:10 steps, and the centesimal (1:100). Starting from the original "mother tincture" (in the case of a plant this is an alcoholic extract) a 1:10 or 1:100 dilution is made. This is succussed and the resulting solution is known as the first potency. This now serves as the starting point for the next step in dilution and succussion, which results in the second potency, and so on. The 1:10 potencies are usually indicated by x and the 1:100 by c; thus Pulsatilla 6c means the 6th centesimal potency of Pulsatilla, which has received six succussions and has a concentration of one part in a thousand billion. (Campbell)
Like most of his contemporaries, Hahnemann believed that health was a matter of balance and harmony, but for him it was the vital force, the spirit in the body, that did the balancing and harmonizing, that is, the healing.
Hahnemann claimed that most chronic diseases were caused by miasms and the worst of these miasms were the 'psora.' The evidence for the miasm theory, however, is completely absent and seems to have been the result of some sort of divine revelation (Campbell). The word 'miasm'
derives from the Greek and means something like "taint" or "contamination". Hahnemann supposed that chronic disease results from invasion of the body by one of the miasms through the skin. The first sign of disease is thus always a skin disorder of some kind (Campbell).
His method of treatment might seem very modern: Find the right drug for the illness. However, his medicines were not designed to help the body fight off infection or rebuild tissue, but to help the vital spirit work its magic. In fact, Hahnemann believed it is "inherently impossible to know the inner nature of disease processes and it was therefore fruitless to speculate about them or to base treatment on theories" (Campbell). His remedies were determined by the patient's symptoms, not by the supposed disease causing those symptoms.
homeopathic "laws"
Homeopaths refer to "the Law of Infinitesimals" and the "Law of Similars" as grounds for using minute substances and for believing that like heals like, but these are not natural laws of science. If they are laws at all, they are metaphysical laws, i.e., beliefs about the nature of reality that would be impossible to test by empirical means. Hahnemann's ideas did originate in experience. That he drew metaphysical conclusions from empirical events does not, however, make his ideas empirically testable. The law of infinitesimals seems to have been partly derived from his notion that any remedy would cause the patient to get worse before getting better and that one could minimize this negative effect by significantly reducing the size of the dose. Most critics of homeopathy balk at this "law" because it leads to remedies that have been so diluted as to have nary a single molecule of the substance one starts with.
Hahnemann came upon his Law of Similars (like cures like) in 1790 while translating William Cullen's Materia Medica into German (Loudon 1997: 94). He began experimenting on himself with various substances, starting with cinchona.
Daily for several days, he wrote, he had been taking four drams of the drug. Each time he had repeated the dose, his feet and finger tips had become cold, and other symptoms had followed which were typical of malaria. Each time he had stopped taking the cinchona, he had returned rapidly to a state of good health. (Williams 1981: 184)
Hahnemann experimented on himself with various drugs over several years and concluded that "a doctor should use only those remedies which would have the power to create, in a healthy body, symptoms similar to those that might be seen in the sick person being treated (ibid.)." Medicines should be given in single doses, he claimed, not in complex mixtures. His conclusions seem to have been based upon intuition or revelation. He did not experiment with patients by giving them drugs to discover which remedies worked with which illnesses or that only unmixed substances were effective. Indeed, he couldn't experiment on sick people because he assumed the remedy must produce an effect similar to the disease and he'd never be able to tell what remedies to use because the symptoms of the disease would be difficult to distinguish from those of the remedy in a sick person. Instead, he assumed that whatever caused the symptoms in a healthy person would be a remedy for a disease with similar symptoms.
Hahnemann's called this method of finding what symptoms a drug caused in a healthy person "proving."
Hahnemann did not leave us any details of the doses he used or the manner of giving the drugs, but from chance remarks elsewhere in his writings and from the accounts of his provers we have a pretty fair idea of what went on. All the provings at this time were carried out with tinctures (extracts) of herbs or, in the case of insoluble substances, with 'first triturations' (one part of substance ground up with nine parts of sugar or milk)....
His usual practice seems to have been to give repeated doses until some effect was produced; the actual amount was calculated on the basis of his own previous experience. The provers were expected to record their symptoms with the utmost care, and on presenting their notebooks to Hahnemann they had to offer him their hands - the customary way of taking an oath at German universities at that time - and swear that what they had reported was the truth. Hahnemann would then question them closely about their symptoms to elicit the details of time, factors that made them better or worse, and so on. Coffee, tea, wine, brandy and spices were forbidden to provers and so was chess (which Hahnemann considered too exciting), but beer was allowed and moderate exercise was encouraged. (Campbell)
Working on the principle of similarities, Hahnemann created remedies for various disorders that had symptoms similar to those of the substances his provers had taken. However, "....methods of proving are highly personalised and of individual relevance to the homoeopath or experimenter."* In other words, one hundred homeopaths preparing a remedy for one patient might well come up with one hundred different remedies.
Hahnemann may be praised for empirically testing his medicines, but his method of testing is obviously flawed. He wasn't actually testing the medicines for effectiveness on sick people but for their effects on healthy people. In any case, he had to rely upon the subjective evaluations of his provers, all of whom were his disciples or family members and all of whom were interrogated by the master himself. (Later investigators would use more controlled methods of proving.*) But even if his data weren't tainted by the possibility of his suggesting symptoms to his provers or their reporting symptoms to impress or gain the approval of the master, it is a belief in magic that connects this list of symptoms with the cure of a disease with similar symptoms. In logic, this kind of leap of reasoning is called a non sequitur: It does not follow from the fact that drug A produces symptoms similar to disease B that taking A will relieve the symptoms of B. However, homeopaths take customer satisfaction with A as evidence that A works.
There is some evidence that Hahnemann did not use healthy subjects to prove any of the remedies he recommended for most disorders: sulfur, cuttlefish ink, salt, and sand.
What appears to have happened is that Hahnemann based his new provings largely on symptoms supposed to have been produced in his chronic patients. By his own rules this procedure was inadmissible, and in fact it undoubtedly led him to attribute to the effect of the medicines a number of symptoms that were really due to the diseases the patients were suffering from. (Campbell)
While we might excuse Hahnemann for not doing properly controlled experiments, we shouldn't be so generous toward modern homeopaths for not understanding the nature of anecdotes and testimonial evidence. However, we can't accuse them of not doing any properly designed controlled experiments. But we can blame them for not understanding some fundamental principles of evaluating the results of controlled experiments that involve giving drugs or even inert substances to humans.
Today's homeopaths should know that because of the complexity of each individual human body, fifty different people may react in fifty different ways to the same substance. This makes doing clinical trials on potential medicines a procedure that should rarely claim dramatic results on the basis of one set of trials. Finding a statistically significant difference, positive or negative, between an experimental (drug therapy) group and a control group in one trial of a drug should usually be taken with a grain of salt. So should not finding anything statistically significant. It is not uncommon for twenty trials of a drug to result in several with positive, several with negative, and several with mixed or inconclusive results.
Yet, despite the fact that of the hundreds of studies that have been done on homeopathic remedies the vast majority have found no value in the remedies, some defenders of homeopathy insist not only that homeopathic remedies work but they claim they know how they work. It seems, however, that scientists like Jacques Benveniste, who claim to know how homeopathy works, have put the cart before the horse. Benveniste claims to have proven that homeopathic remedies work by altering the structure of water, thereby allowing the water to retain a "memory" of the structure of the homeopathic substance that has been diluted out of existence (Nature Vol. 333, No. 6176, pp. 816-818, 30th June, 1988).* (Benveniste even claims that a homeopathic solution's biological activity can be digitally recorded, stored on a hard drive, sent over the Internet, and transferred to water at the receiving end. He was a successful biologist working in a state-run lab until he started making such claims, which have cost him his status and reputation as a reputable scientist. He is now considered by his critics (such as James Randi) to be another Blondlot.) Since homeopathic remedies don't work, there is no need for a theory as to how they work. What there is need of is an explanation for why so many people are satisfied with their homeopath despite all the evidence that homeopathic remedies are ineffective.
Why does anyone believe homeopathy works?
Before attempting to explain why so many people believe homeopathy works, let me first defend the claim that homeopathic remedies are ineffective. There have been several reviews of various studies of the effectiveness of homeopathic treatments and not one of these reviews concludes that there is good evidence for any homeopathic remedy (HR) being effective. Homeopaths have had over 200 years to demonstrate their wares and have failed to do so. Sure, there are single studies that have found statistically significant differences between groups treated with an HR and control groups, but none of these have been replicated or they have been marred by methodological faults. Two hundred years and we're still waiting for proof! Having an open mind is one thing; waiting forever for evidence is more akin to wishful thinking.
A review of the reviews of homeopathic studies has been done by Terence Hines (2003: 360-362). He reviewed Taylor et al. (2000), Wagner (1997), Sampson and London (1995), Kleijen, Knipschild, and ter Riet (1991), and Hill and Doyon (1990). More than 100 studies have failed to come to any definitive positive conclusions about homeopathic potions. Ramey (2000) notes that
Homeopathy has been the subject of at least 12 scientific reviews, including meta-analytic studies, published since the mid-1980s....[And] the findings are remarkably consistent:....homeopathic "remedies" are not effective.
Nevertheless, homeopathy will always have its advocates, despite the lack of proof that its remedies are effective. Why? One reason is the prevalence of a misunderstanding of the causes of disease and how the human body deals with disease. Hahnemann was able to attract followers because he appeared to be a healer compared to those who were cutting veins or using poisonous purgatives to balance humors. More of his patients may have survived and recovered not because he healed them but because he didn't infect them or kill them by draining out needed blood or weaken them with strong poisons. Hahnemann's medicines were essentially nothing more than common liquids and were unlikely to cause harm in themselves. He didn't have to have too many patients survive and get better to look impressive compared to his competitors. If there is any positive effect on health it is not due to the homeopathic remedy, which is inert, but to the body's own natural curative mechanisms or to the belief of the patient (the placebo effect) or to the effect the manner of the homeopath has on the patient.
Stress can enhance and even cause illness. If a practitioner has a calming effect on the patient, that alone might result in a significant change in the feeling of well-being of the patient. And that feeling might well translate into beneficial physiological effects. The homeopathic method involves spending a lot of time with each patient to get a complete list of symptoms. It's possible this has a significant calming effect on some patients. This effect could enhance the body's own healing mechanisms in some cases. As homeopath Anthony Campbell puts it: "A homeopathic consultation affords the patient an opportunity to talk at length about her or his problems to an attentive and sympathetic listener in a structured environment, and this in itself is therapeutic."* In other words, homeopathy is a form of psychotherapy.
....most homeopaths like to allow at least 45 minutes for a first consultation and many prefer an hour or more. Second, patients feel that they are being treated "as an individual". They are asked a lot of questions about their lives and their likes and dislikes in food, weather, and so on, much of which has no obvious connection with the problem that has led to the consultation. Then the homeopath will quite probably refer to an impressively large and imposing source of information to help with choosing the right "remedy". (Campbell)
We know that there is virtually no scientific evidence that homeopathic remedies are effective. This does not mean that patients don't feel better or actually get better after seeing a homeopath. That is quite another matter, although it is clearly the reason for the satisfied customers. (Here the reader might consult the entries on the placebo effect, the post hoc fallacy and the regressive fallacy.)
Wendy Kaminer, a critic of various irrational behaviors, is one of those satisfied customers. Even so, she told her homeopath that her greatest fear "was that someone would find out I'd consulted a homeopath" (1999; p. 3), which is obviously not her greatest fear or she wouldn't have announced it to the world in her book.
When I go to my homeopath maybe I'm following one of the precepts of the recovery movement that I've always derided: I'm thinking with my heart and not my head. Or maybe I'm acting rationally after all. Believing in homeopathy may be irrational, but not using homeopathy if it works would be even more irrational. I care only if medicine works, not why. (I have the vaguest understanding of antibiotics.)
So I don't listen to scientists eager to tell me why homeopathic remedies can't possibly work, because they violate the laws of chemistry. Assuming that the scientists are right, and the remedies I've taken are mere placebos, why would I want to start doubting - and diminishing - their effectiveness? Why not be susceptible to placebos? (ibid.)
Here we have a rational person who decries irrational behavior admitting that she does something that many rational people would consider irrational. It is interesting how she has dealt with this cognitive dissonance. She has made the irrational rational (or at least less irrational than the alternative) by focusing on her belief that homeopathy works. But we know the potions don't work, so what is Kaminer talking about? She is not talking about scientific studies that show homeopathic remedies are effective, because such studies point in the opposite direction. In fact, she doesn't seem concerned whether such studies even exist. She means that she believes "homeopathy has helped me" (p. 4). Her caveat to the reader is don't take my word for it, try it yourself, which seems to imply that if I go to a homeopath and think it's helped me, then I'd be irrational not to continue seeing the homeopath. But what does help or helps mean? These are weasel words; they have no cognitive content though they are full of emotive meaning. Her only concession to the idea that perhaps she is acting irrationally is in her musing
....maybe I'm imagining that homeopathy has helped me. Maybe I'm confusing correlation with causation: perhaps I began feeling better coincidentally, for some unknown reason, at about the time I turned to homeopathy (ibid., p. 4).
She advises us not to take her word for it and tells us that we should ask her to substantiate her claim. She even advises us to try to duplicate her experience. Perhaps this is her notion of what a rational, scientifically-minded person should do. But there is no way I or anyone else can substantiate her claim by trying to duplicate it. We don't have a clear enough idea about her claim to know what we would be trying to substantiate. Her claim that something helped her is too vague to be of any value in trying to duplicate. Is she really saying that if I go to a homeopath and feel better afterward then I have substantiated and duplicated her claim? I think she is. And I think she is mistaken.
Yet, I think I understand what she is saying. If I, for example, went to a homeopath and found that under treatment the pain in my knees went away completely, the pain that I have been having for several years and which my physician tells me is due to bursitis, then I would be irrational not to continue with the homeopathic remedy. Furthermore, it would be irrational not to consult my homeopath should I begin suffering pain, say, in my elbow or shoulder or back. If I could start jogging again, I would be irrational not to continue seeing my homeopath. I might agree. But, if I consulted a homeopath about a new pain that my physician had been unable to relieve me of with conventional therapy and after the homeopathic treatment the pain went away, I would not consider it irrational to not continue going to the homeopath. I would consider it likely that the pain would have gone away had I not consulted the homeopath. (If you are wondering why, consult my entry on the regressive fallacy.)
Furthermore, if a homeopathic remedy did cure me of my knee pain, I would want to investigate what was in the remedy. Even though most homeopathic remedies in the U.S. and the UK are little more than water or alcohol, there are a number of products on the market that are labeled homeopathic that have active ingredients in them (see complex homeopathy, isopathy, and nosodes). However, if I did find that my remedy was one of those that had been diluted so many times that there weren't any molecules remaining of the original active substance, I would rather believe that my pain had suddenly gone away than that the homeopathic remedy had cured me of my pain. Why? Because the known laws of physics and chemistry would have to be completely revamped if a tonic from which nearly every molecule of the active ingredient were removed could be shown to be effective. But if I could yo-yo the pain by stopping and starting the homeopathic remedy under double-blind conditions, I would have to conclude that the potion was having the effect and would have to become an advocate of that homeopathic remedy. This is just to say that homeopathic remedies can be empirically tested. That no remedy has yet been shown to have the effect I have outlined is strong evidence against homeopathic remedies.
Even though homeopathic remedies are ineffective, homeopathy itself is very effective or it wouldn't have lasted and grown for the past 200 years. It is very popular in Europe, especially among the royal family of Britain. There are schools of homeopathy all over the world. Homeopathy is said to be $200 million a year industry in the United States. "The fact that it is condemned as unscientific by some orthodox doctors is for many people a positive merit, not a criticism" (Campbell).
The main harm from classical homeopathy is not likely to come from its remedies, which are probably safe but ineffective, though this is changing as homeopathy becomes indiscernible from herbalism in some places. One potential danger is in the encouragement to self-diagnosis and treatment. Another danger lurks in not getting proper treatment by a conventional medical doctor in those cases where the patient could be helped by such treatment, such as for a bladder or yeast infection, or for cancer. Homeopathy might work in the sense of helping some people feel better some of the time. Homeopathy does not work, however, in the sense of explaining pathologies or their cures in a way which not only conforms with the data but which promises to lead us to a greater understanding of the nature of health and disease.
