MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Samuel Hahnemann, a German physician who was frustrated with the ‘heroic’ medicine of his time, invented homeopathy about 200 years ago. Since then, his followers have applied what we might call ‘selective dogmatism’ to his invention: they have religiously adhered to certain aspects, been considerably more liberal in other respects and abandoned some concepts altogether. It is therefore not unreasonable, I think, to ask what the ‘father of homeopathy’ – if he were still with us – might think of homeopathy as it is being practised today.

TYPES OF HOMEOPATHY

We tend to consider homeopathy to be one single therapy or school of thought, but this is not quite true. There a numerous forms of homeopathy, including the following:

Auto-isopathy (treatment with remedies made from patients’ own body substances)

Classical homeopathy (doctrine based on strict Hahnemannian principles)

Clinical homeopathy (non-individualised treatment based mainly on guiding symptoms; e.g. arnica for bruises)

Complex homeopathy (treatment with combination remedies)

Homotoxicology (treatment based on Reckeweg’s concepts of detoxification)

Isopathy (use of remedies made from the causative agent, e.g. a specific allergen for an allergy)

Pluralistic homeopathy (use of more than one remedy at once)

The list could be extended, and we could discuss the characteristics as well as the pros and cons of each variant. But this would be rather futile and intensely boring; suffice to say that, from all we know about Hahnemann’s views and temper, he would have strongly condemned even the slightest deviation from the strict rules of his doctrine.

CURRENT TYPES OF HOMEOPATHS

So, what about the different ways in which homeopathy (whatever version we might select) is practised by Hahnemann’s disciples today? The way I see it, four different and fairly distinct types of homeopaths currently exist.

The purist homeopath

Samuel Hahnemann himself clearly was a purist. He was adamant that his detailed instructions must be followed to the letter. Amongst other things, this means that homeopathy must be seen as the only true medicine; mixing homeopathy with any other type of medicine is, according to its founder, strictly forbidden; Hahnemann was very explicit that this would weaken or even abolish its effects. Today’s purist homeopaths therefore follow these instructions religiously and employ homeopathy as the sole and only therapeutic option for any symptom or disease.

The liberal homeopath

Purist-homeopaths still do exist today, but they seem to be in the minority. Most homeopathic doctors mix homeopathic with conventional medicines, and most non-doctor homeopaths (they prefer the term ‘professional homeopaths’) accept or at least acknowledge that a mixed approach might often be necessary or preferable. In the words of Hahnemann, these homeopaths are ‘half-homeopaths’ who have ‘betrayed’ his gospel. He would most certainly disown them and point out that this type of approach is doomed to failure and cannot possibly work.

The occasional homeopath

In several countries – Germany is a good example – many doctors use homeopathy on just relatively rare occasions. We might speculate why this is so; my personal impression is that this group of clinicians do not really believe in the effectiveness of homeopathy at all. They employ it because some patients ask for it, or because they want to use a legally defensible and harmless placebo. There can be no doubt, Hahnemann would have not approved of this approach at all. Quite to the contrary, he would have been furious, called them ‘traitors’ or worse and insisted that this is nothing more than a placebo-therapy.

The DIY-homeopath

DIY-homeopaths is my term for patients and consumers who have no training in homeopathy but buy homeopathic remedies over the counter and self-administer them without consulting a trained homeopath. They might see it being recommended for a certain health problem and give it a try. If their symptoms subsequently disappear, they are likely to misinterpret this phenomenon and become convinced that homeopathy is effective. This group seems to be by far the largest of all types of homeopaths.

WOULD HAHNEMANN APPROVE?

What would Hahnemann, if we could ask him today, make of all this? I think he would be fuming with anger (from all we know, he was a rather short-tempered man and had no patience with ‘traitors’).

The DIY-homeopaths obviously break every rule in his book: without a long and complicated consultation, it would not be possible to identify the correct, individualised remedy. What follows is simple: according to Hahnemann’s teachings, all these millions of people across the globe are treating themselves with pure placebos. Ironically, this is where most scientists would agree Hahnemann’s verdict!

Hahnemann would certainly direct equal scorn towards the occasional homeopaths who do not even believe in homeopathy. To Hahnemann, belief in his doctrine was essential and the use of his remedies as mere placebos would have been insulting, utterly unacceptable and destined to therapeutic failure.

We do know from Hahnemann’s mouth what he thought of those clinicians he himself called “half-homeopaths”. In his view, they were ‘traitors’ who did not even deserve to be called true homeopaths. There can be no question about the fact that he would have judged their practice as a useless and ineffective abomination.

This leaves us with the purist-homeopath. This relatively small group of dogmatists turns out to be the only one which Hahnemann might have actually approved of. They tend to strictly adhere to (almost) every of the numerous therapeutic instruction he ever put to paper. Like Hahnemann, they believe that homeopathy is the only efficacious medicine and, like Hahnemann, they use it as a true alternative to ‘allopathy’, the derogatory term Hahnemann coined for conventional medicine.

CONCLUSION

If this analysis is correct, we are today faced with the situation where homeopathy is used by many people worldwide but, according to the teachings of homeopathy’s founder, it is currently badly misused – so much so that, according to Hahnemann’s most clearly and repeatedly expressed views, it cannot possibly result in clinical benefit. Considering that most of today’s homeopaths would insist that the words of Hahnemann as pure gospel, this situation is most bizarre and ironic indeed. It becomes even more ironic when we realise that the only group of clinicians who employ homeopathy in the ‘correct’ way is also the one which is the most serious danger to public health.

51 Responses to The four types of homeopaths: would Hahnemann approve?

  • Quite a lot of doctors admit to prescribing drugs as placebos so you are almost certainly right about “occaisional homeopaths” using it as a harmless placebo.

    • the trouble is that a “harmless” placebo can become life-threatening when used as an alternative therapy in severe diseases

    • How can drug with well know efficacy act as placebo? OK, one can use vitamin or, e.g. magnesium pills, but they still affect body! E.g., if you has had too little magnesium (has not been very fond veggies), magnesium pills will bring real improvement, and, if you get too much magnesium, you will get at least soft stools or very real diaorrhea.

  • I tend to categorise homeopaths into two types:

    1. Well-meaning (maybe) but thoroughly deluded

    2. Mendacious

    • it was bert brecht who wrote: “the opposite of good is not evil but well-meaning”.

      • Do you think that was the only thing Brecht got wrong?

        Pitty noone understands what Hahneman really did but then it is down to the credit of the arrogance of so called scientists not to understand and call him a fool. His concept was spot on. If they would only follow his instructions properly 🙂

        • If only you could come up with good evidence for your assertions. 🙂

          • Hope to be able to by next year. My preferred method would be to use something like the basotest as an endpoint test but I can’t afford the kit’s as I do this as a hobby. I still work on the reproducibility of the method struggling with reproducible succussion and the glassware.

        • @Marvin

          Who are the “so called scientists” you are talking about who call Hahneman a fool?
          Educated, sensible people consider Hahneman a mistaken man, not a fool. There is no reason to call him a fool. Hahneman was really smart enough to see the problems with blood letting, sulphur enemas and other murderous magical nonsense that was considered medicine in those days. Today he would have been called a fool alright but back then the problem was simply that he bet on the wrong horse and got it all wrong and did not have the help of the necessary science to guide him away from the fallacies.
          Science later evolved and fixed the problems that he failed to fix.

          I am rather curious to hear what it is that you consider the homeopaths of today are doing wrong? Are they not banging the vials of water hard enough or often enough? Or are they not thinning, sorry, potentiating the water enough? Not that I expect you to come up with anything useful, I only have a phenomenological interest in what goes on in the muddled minds of modern homeopaths.

          • I consider Hahnemann to have been a clever doctor and excellent observer; without knowing it, he made detailed observations of what we today call the placebo-effect.

          • The problem of homeopathy is not Hahnemann – he did what he could do at his time. The Problem lies with his successors. See Kent (http://en.wikipedia.org/wiki/James_Tyler_Kent) for an example. He lived from 1849 till 1916. In that time he should have known better than adding his own woo to homeopathy. He could have started to adapt homeopathy to the new scientific approach.

            Maybe there would have been nothing left in the end. But maybe they might have found something else, some remedy (not all) that acts like it would follow the law of similarity, in reasonable dosage (not diluted out of existence), in certain conditions set forth by exact measurement (not defined by comparing oral accounts of strange symptoms).

          • correct the one’s that call him a fool are the “so called scientists” as he was e very clever scientists. His approach was reasonable and I try to reproduce his method.

            If Randi would be serious about his bet I would go ahead and demonstrate the efficacy of the C32 dilution as I understand the principle but van not yet get it to work reproducibly enough.

            I would not think that Hahnemann was just observing the placebo effect but that’s a different story. The problem is indeed the modern day homeopath who are full of woo.

          • Marvin said:

            correct the one’s that call him a fool are the “so called scientists” as he was e very clever scientists. His approach was reasonable and I try to reproduce his method.

            Unfortunately, the best quality, most independent and robust experiments since show that Hahnemann was wrong.

            If Randi would be serious about his bet I would go ahead and demonstrate the efficacy of the C32 dilution as I understand the principle but van not yet get it to work reproducibly enough.

            Why do you believe Randi isn’t serious about the million dollar challenge?

            I would not think that Hahnemann was just observing the placebo effect but that’s a different story.

            Unfortunately, there is no good evidence he was observing anything else.

            The problem is indeed the modern day homeopath who are full of woo.

            Yes, they are all full of woo.

          • @ Marvin

            Seriously.
            Your statement that Randi is not serious tells me you’re chicken. Either you’re a genius who should be applying for the Noble price but to shy to come forth and save mankind… or you’re full of excrements.
            Not excrementum caninum mind you, just plain old excrementum vaccinum( incidentally also used in a homeopathic remedy)

            Prove me wrong and win a million dollars while you’re at it.

          • @Marvin:

            If Randi would be serious about his bet I would go ahead and demonstrate the efficacy of the C32 dilution as I understand the principle but van not yet get it to work reproducibly enough.

            [My emaphasis]

            There’s your problem. It doesn’t matter how well you understand the principle if it doesn’t work.

        • Those were times when physicians, who did not know any better, bled, purged and poisoned patients. But now patients have another option (in addition to being poisoned with heavy metals etc. or doing nothing): patient can use drugs that work for his benefit.

        • @Marvin
          Why don’t you start by listing the medical conditions you can think of where Hahneman’s “like cures like” principle is self-evidently valid. (I don’t mean listing the results of so-called ‘provings’!)
          It certainly doesn’t work in non-medical circumstances. If my room’s too dark I turn on the light, not draw the curtains. If my car’s going too fast I don’t push on the accelerator to correct things. If something I treasure has been damaged by wetting in the rain I don’t put it in a bowl of water to dry it out.

          • @Franko

            If you add a bit of tension to tense tissue, it will loosen. You can sometimes stop a muscle cramp by contracting the muscle. Photographing in a high contrast situation, increasing the exposure on silver gelatin film will decrease the highlight density on the negative. Conversely, when making a silver gelatin print, increasing the exposure to the printing paper will lighten shadows that are too dark. If you can’t unscrew a wood screw, tighten it slightly. Etc, etc.

          • @jm,
            Humans are not photographic film or corkscrews. It surprises me I even need to state something some obvious but alt-meds (maybe more so skin-scrapers) may not understand these things.

          • @Frank Collins
             
            In fairness to jm; it was me who first put in the non-medical examples.
             
            @jm
             
            I’m not sure I know what ‘tense tissue’ means. Any evidence to explain and support what this is about? A muscle cramp = a muscle stuck in contraction. You can’t contract it further. You might be able to send ‘contract’ nerve signals that will affect neighbouring muscles, but cramps normally respond to attempts to relieve them by further exercising only when they’ve already started to relax spontaneously.
             
            I can’t comment on your photographic analogies, but the reason why you can’t unscrew a wood screw is not necessarily or normally because it’s screwed in too tightly: it has become stuck in the surrounding milieu. Putting on clockwise pressure as well as anticlockwise is just to ‘unstick’ the screw.
             
            But never mind the non-medical examples; red herring. The fundamental principle of homeopathy is that like cures like. Please provide us examples where this principle is self-evidently valid. Remember that homeopathy claims it works for all types of diseases and symptoms.

          • Franko –

            You’re not sure what tense tissue means? Lucky you. Muscle is tissue, and most people seem to have a bit of extra tightness every now and again. A little compression generally takes care of it. For evidence, feel the muscle before and after. Easy peasy. Try the experiment on a friend – they’ll love you for it.

            “A muscle cramp = a muscle stuck in contraction. You can’t contract it further.” Do you have any evidence for this? I’ve never experienced a cramp (on myself or anyone else) where all the fibers in a particular muscle have contracted. Interesting… Even more interesting would be how that was measured. Quite the feat to determine that they were all contracted. I’d love a link.

            “…the reason why you can’t unscrew a wood screw is not necessarily or normally because it’s screwed in too tightly: it has become stuck in the surrounding milieu.” If it’s stuck in the surrounding milieu, it’s screwed in too tightly. To free it, sometimes the best course of action is to tighten a tiny bit more.

            Sorry for the photographic analogy – old school silver halide isn’t that common anymore. Modern digital imaging doesn’t work the same way.

            “But never mind the non-medical examples; red herring.” Red herring? I don’t think so – I presume you brought it up because bodies are subject to the same laws/principles as everything else. ‘Like cures like’ isn’t what I find odd about homeopathy – it’s the whole dilution thing that’s a bit curious.

            But without homeopathy, you couldn’t make the comment “This is a homeopathic gin and tonic.” in an airport bar.

  • Probably the best analysis yet of why homeopathy should be considered a religion rather than a form of medicine. I know of no form of medicine which relies on holy writ as its root of authority, and where disputes cannot be resolved by objective means, but result instead in schisms.

  • So we are facing a situation, where we have a lot of different types of homeopaths, which greatly differentiate in the way the remedy is selected: for one and the same patient the result would be a number of different remedies. In fact, when you found your treatment at homeopath #1 as useless, homeopath #2 will point out to you that #1’s treatment was complete bogus, that you would not call this real homeopathy etc. etc.

    But apparently all of these are successfully treating patients, that is, the patients believe it was the remedies they received, that proved helpful. Otherwise the unsuccessful type of homeopath would be out of business today.

    So, Watson, what can we deduct from this situation?
    Well, Holmes, I’d say it is prettey obvious, it does not make much difference what the remedy consists of. So the remedy does not contribute much to the patent’s recovery, at least not the way as thought by homeopaths.

    QED

    • or, in a nutshell, homeopaths are placebo-merchants!

    • I visited many homeopaths during three decades prior to reading “Trick or Treatment?”, which inspired me to learn critical thinking skills, and one homeopath subsequently.

      My conclusion is that the various complex procedures taught to students of homeopathy were/are designed very carefully to empower the student to totally convince themselves of their efficacy during their time as a practitioner.

      I guess very few “patients” would do something this daft: I didn’t take any of the remedies I was given on each monthly visit (for 10 months) yet was told categorically by the homeopath which previous remedy was causing my current symptoms!

      This experience helped me to fully understand and accept that my chronic illness does indeed regress to the mean after the initial positive effect from placebo and that many of its minor symptoms either fluctuate randomly or my mental tolerance of them fluctuates randomly. Randomly and widely enough for a well-trained homeopath to subconsciously cherry-pick a thoroughly convincing case for cause (remedy) and effect (symptoms).

      Homeopathy is nothing other than a very elaborate extension to belief in the myth that breaking a mirror will result in seven years of bad luck. Those who believe in the mirror myth (or Friday 13th myth) become focused on finding a causal relationship where none actually exists. Which reminds me, I have a bone to pick with the Tooth Fairy over my broken molar…

      • I would not call it belief in myths. I guess a strong case of confirmation bias is a better explanation.

        But, Pete, why did you visit a homeopath, pay for the consultations and the remedies, just to throw it away? (You could have used it in your tea or coffee instead…) Just for a good laugh?

        • Norbert, I agree that some of the (many) cognitive biases combine to form the correct explanation.

          I think the reason I continued to pay for the consultations and remedies can best be summarized as follows… At that point in time I had just come to the realization that not only had I wasted a small fortune during three decades of alternative treatments, I also had to accept the fact that if the treatments didn’t work then all of my hopes and dreams for eventually being cured of my chronic illness were smashed to pieces.

          That was a very bitter pill to swallow and certainly not cause to gain a good laugh out of it. I needed to know whether the homeopath (that I had fully trusted) was deliberately cheating me out of my money or was simply deluded/naive/indoctrinated. By continuing with the consultations I managed to discover that I was not being deliberately cheated, fortunately. However, I couldn’t understand how a person with a much better education and a great deal more experience of life than myself could also have been duped into believing that this line of treatment was efficacious. The only way for me to gain that understanding (and avoid going into a very deep depression) was by observation and analysis.

          I’m not good at writing so I hope the above makes sense.

          • Thanks Pete, this makes complete sense to me. Sometimes it is hard to find out that you were living with a dilusion for a long period of time and you need to doublecheck on your beliefs and convictions.

            I wish you all the good luck there is that you may find a treatment and a remedy that would help you with your desease.

    • They are in the business because: 1) relatives of dead patients (if he/she did have any) often does not know how to sue homeopath; 2) many of the homeo fans still use conventional drugs; 3) most health problems of the more or less developed world are chronic and it certainly takes time to die of Type II diabetes, aterosclerosis or cancer. Add people with mild autoimmune diseases and those with all kind of back problems (except the most severe) and you have clientelle.

  • Fascinating post. Interesting to see how so many homeopaths allegedly revere Hahnemann, but may not be practicing what he preached.

    However, I once wrote about a different classification of homeopaths:

    1. Responsible homeopaths (both your “liberal” and “occasional” homeopaths would be included in this category)

    2. Irresponsible but ignorant ones (a subtype of your “purists”, perhaps with a few of your “liberal” ones thrown in)

    3. Evil and dangerous ones (another subtype of your “purists”)

    • There are no responsible homeopaths, because patients tend to make generalisations and if there is choice between magic water and real drug that has created side-effect (or may create: just read package insert), he/she may chose magic water that has not created any.

  • Hmmm…I started out with Homeopathy, never having been seen, simply filling out a multi-page, in-depth, interview and returning it to the doctor by mail, and was prescribed a remedy which had immediate effect, and, over the course of the next few months, mitigated all of my complaints and more. Conversely, when I moved to the city, I was able to find a Classical Homeopath who operated strictly according to Hahnemann’s principles. I stayed with him for 5 years, saw him regularly, and never really received much relief from this subsequent complaint, despite my great belief in homeopathy. As far as DIY, I treat myself quite successfully with Apis for insect bites and stings, so out of these three — the purist, the liberal, and the DIY, I would have to say I’ve had more success with the latter two.

    • What about real ointments that have active ingredients? For example, I always keep at home one made of bee wax, thick extract of propolis and calendula extract to use it in case of herpes un the lips. And it works, at least helps to avoid bleeding during the healing process. Wax is good for any skin cracks (that is if you are not allergic) and propolis is significant for bees to avoid infections in the overcrowded hive.
      Anyway, is made of these components and not of memories.

  • The only quasi OK use of sugar pills (homeopathy), that I can think of:

    Patient: I think I have Strep throat (bacterial infection), please give me antibiotics.
    Dr: No, you have the common cold, it’s a viral infection, antibiotics are useless and lead to antibiotic resistant bacteria.
    Patient: Please, please give me something for this sore throat.
    Dr: I won’t give you antibiotics, but these sugar pills may be better than nothing. Try chicken soup too.
    Patient: Thank you!!
    Patient (6months later, visiting for another reason): Oh, by the way, those sugar pills worked!! Within a week my throat was better.

    • @Chris Upton:
      “Patient (6months later, visiting for another reason): Oh, by the way, those sugar pills worked!! Within a week my throat was better.” Absolutely typical. Patient completely overlooks the contribution of the chicken soup!

  • To all those arrogant ignorants who still don’t get the message of this article, and argue anyways about how wonderful modern, allopathic medicine is, and how much of a quackery homeopathy is, read again. Almost none of current homeopaths follow Hahnemann’s original teachings, therefore, if you add current incompetent homeopaths to the ruthless war waged against alternative medicine from the criminal, mafia like organised medical establishment, that’s what you get: A noble science reduced to nothing, despised and condemned by the manipulated masses, who like to pay huge amounts to allopathic doctors who also do very little good, and a lot of harm.

    • @Lucq
      If I understand your last sentence correctly, you at least acknowledge that homeopathy does very little good, and a lot of harm?

      • No, he doesn’t mean that. He asserts standard medicine (which homeopathy believers like to call “allopathic”) does more harm than good. Never mind that homeopathy doesn’t protect from gangrene or infectious diseases. Never mind that homeopathy will never manage to deal with a broken arm or a tumor. Never mind that standard medicine has a much larger success record in these and other issues and homeopathy goes against physics and chemistry.
        Only the quasi-religious belief in homeopathy matters.

  • The author of this article contradicts himself. He states that the purist homeopaths seem to be in a minority under the paragraph untitled “liberal homepaths”, then under the paragraph “conclusion” he states that most homeopaths would consider Hahnemann’s words as pure gospel(referring to the purists). If the purists are in the minority then how could most homeopaths view his words as gospel?

    Where are the statistics? This looks like a poorly researched article with the intention of discrediting homeopathy. Now here’s a question for him. What difference does it make to the patient if a placebo cures the illness? Placebos do have the advantage of being harmless, not an advantage of prescription drugs.

    • WELL SOPTTED, THANK YOU!
      I should of course have made clear that homeopaths SELECTIVELY consider Hahnemann’s words as gospel. They pick and chose from the Organon what fits into their type of practice and forget about the rest. Different types of homeopaths pick different concepts.
      Therefore, cherry-picking has a long tradition in homeopathy and was practised long before this term had been invented.
      What difference…? Placebo effects come with every treatment – homeopathic or otherwise. Effective therapies have specific effects in addition. This means that just giving placebos equals cheating the patient of the most important element of the therapeutic response.
      Placebos are harmless? Perhaps, but the homeopath who gives placebos for a serious condition is life-threatening.

    • @Donna,

      What a curious misreading of the post! Its main point is that most homeopaths consider Hahnemann’s words as pure gospel, yet only a minority of purists practise what they preach. As the conclusion states: “this situation is most bizarre and ironic indeed”. The contradiction is not from the author (Edzard Ernst: this is his blog, as you don’t seem to have noticed) but from from the way most homeopaths work the way they do, but still pay lip service to Hahnemann. The line about most homeopaths considering Hahnemann’s words as pure gospel is not aimed solely at the purists at all. You have misunderstood. Please read the post again.

      “What difference does it make to the patient if a placebo cures the illness?” In well conducted clinical trials, about 15-35% of patients typically show a response to placebo treatments. Please enlighten us how to pick out that minority so the majority can be given treatment that actually works.

      “Placebos do have the advantage of being harmless, not an advantage of prescription drugs.” Somewhere on this blog someone makes this comment just about every single day. What matters is not just the level of harm; it’s the level of benefit to be obtained from a treatment, too. If there is no demonstrable benefit then any level of risk is unacceptable. The worst (but by no means the only) risk of Big Snakeoil is that it persuades people who genuinely need proper medical attention not to seek it.

    • “What difference does it make to the patient if a placebo cures the illness?”
      None whatsoever… except the fact that placebos, by definition, _do not cure_.

  • You could have been a good story teller! With due respect may be you are? You could have used all this time writing this article and subsequent post responses for good in something else.

    Actually, tell us who paid you write it?

  • The Cult anti-homeopathy strikes again.. Wherever there is homeopathy you can find the same nicknames. Such miserables.

    • And you solve that by changing your nickname, right?
      It may come as a surprise to you, but homeopathy has a few cult-like features: it relies on faith, it rejects evidence against its tenets.

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