MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

THIS POST IS DEDICATED TO HRH, THE PRINCE OF WALES WHO CELEBRATES HIS 66TH BIRTHDAY TODAY AND HAS SUPPORTED HOMEOPATHY ALL HIS LIFE

Like Charles, many people are fond of homeopathy; it is particularly popular in India, Germany, France and parts of South America. With all types of health care, it is important to make therapeutic decisions in the knowledge of the crucial facts. In order to aid evidence-based decision-making, I will summarise a few things you might want to consider before you try homeopathy – either by buying homeopathic remedies over the counter, or by consulting a homeopath.

  1. Homeopathy was invented by Samuel Hahnemann, a charismatic German doctor, about 200 years ago. At the time, our understanding of the laws of nature was woefully incomplete, and therefore Hahnemann’s ideas seemed far less implausible than they actually are. Moreover, the conventional treatments of this period were often more dangerous than the disease they were supposed to cure; consequently homeopathy was repeatedly shown to be better than ‘allopathy’ (a term coined by Hahnemann to insult conventional medicine). Thus Hahnemann’s treatments were an almost instant worldwide success. When, about 100 years later, more and more effective conventional therapies were discovered, homeopathy all but disappeared, only to be re-discovered in developed countries as the baby-boomers started their recent love-affair with alternative medicine.
  2. Many consumers confuse homeopathy with herbal medicine; yet the two are fundamentally different. Herbal medicines are plant extracts with potentially active ingredients. Homeopathic remedies may be based on plants (or any other material as well) but are typically so dilute that they contain absolutely nothing. The most frequently used dilution (homeopaths call them ‘potencies’) is a ‘C30’; a C30-potency has been diluted 30 times at a ratio of 1:100. This means that one drop of the staring material is dissolved in 1 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 drops of diluent – and that equates to one molecule of the original substance per all the molecules of many thousand universes.
  3. Homeopaths know all of this, of course, and they thus claim that their remedies do not work via pharmacological effects but via some ‘energy’ or ‘vital force’. They are convinced that the process of preparing the homeopathic dilutions (they shake the mixtures at each dilution step) transfers some ‘vital energy’ from one to the next dilution. They cite all sorts of fancy theories to explain how this ‘energy transfer’ might come about, however, none of them has ever been accepted by mainstream scientists.
  4. Homeopathic remedies are usually prescribed according to the ‘like cures like’ principle. For instance, if you suffer from runny eyes, a homeopath might prescribe a remedy made of onion, because onion make our eyes water. This and all other basic assumptions of homeopathy contradict the known laws of nature. In other words, we do not just fail to understand how homeopathy works, but we understand that it cannot work unless the known laws of nature are wrong.
  5. The clinical trials of homeopathy are broadly in agreement with these insights from basic science. Today, more than 200 such studies have been published; if we look at the totality of this evidence, we have to conclude that it fails to show that homeopathic remedies are anything other than placebos.
  6. This is, of course, in stark contrast to what many enthusiasts of homeopathy insist upon; they swear by homeopathy and claim that it has helped them (or their pet, aunt, child etc.) repeatedly. Nobody doubts their accounts; in fact, it is indisputable that many patients do get better after taking homeopathic remedies. The best evidence available today clearly shows, however, that this improvement is unrelated to the homeopathic remedy per se. It is the result of an empathetic, compassionate encounter with a homeopath, a placebo-response or other factors which experts often call ‘context effects’.
  7. The wide-spread notion that homeopathy is completely free of risks is not correct. The remedy itself might be harmless (except, of course, for the damage it creates to your finances, and the fact that irrational nonsense about ‘vital energy’ etc. undermines rationality in general) but this does not necessarily apply to the homeopath. Whenever homeopaths advise their patients, as they often do, to forgo effective conventional treatments for a serious condition, they endanger lives. This phenomenon is documented, for instance, in relation to the advice of many homeopaths against immunisations. Any treatment that has no proven benefit, while carrying a finite risk, cannot generate more good than harm.

26 Responses to Seven things to remember when you are tempted to try homeopathy

  • I have written to the PoW asking him to provide the evidence on which he bases his understanding homeopathy is better than (and is therefore, not) a placebo.
    He has none he is prepared to share.

    Therefore either he has the information, but is deliberately hiding this vital knowledge and information from the public (which would be perverse and to be deprecated), or he does not have any plausible evidence.
    If the latter, his endorsement expresses a faith, and he should be honest enough to admit this.

    He should not expect others to share his faith, nor to indulge it by the allocation of public funds to it.
    Faith is a private matter, possibly driven by psychological determinants into which we need not inquire further.
    They are private, providing the subject remains private about them.

    If the subject enters into even partial public discussion about them (say, by lobbying), then a proper open and transparent debate should be held with all cards on the table.
    Including the ‘Seven Considerations of Ernst.’

    • Could Richard tell us what sort of reply he got from the PoW? I am asking because I have considered writing to him myself, but would like to know whether this is likely to be a waste of postage. Were you told perhaps not to share the reply?

  • Charles will one day be king, and it is an unshakeable principle of English law that the King is ALWAYS RIGHT. ‘Rex Non Potest Peccare’, as the lawyers say.

    .’. homeopathy is true. End of argument.

  • I heard the PoW was a shape shifting alien lizard… does this have anything to do with his belief in homeopathy?

  • “The best evidence available today clearly shows, however, that this improvement is unrelated to the homeopathic remedy per se. It is the result of an empathetic, compassionate encounter with a homeopath, a placebo-response or other factors which experts often call ‘context effects’.”

    If that’s true, why aren’t allopathic docs utilizing empathy and compassion? I’d love to go a whole week without hearing a patient complain about the rude, arrogant, ____ (fill in the blank with your favorite nasty adjective) that barely makes eye contact, won’t listen to details, never palpates, looks for the first excuse to write a prescription and get them out the door. Seems that a bit of empathy and compassion would go a long way toward changing patient opinion.

    Up until a few years ago, patients were actively pissed off. Now the norm seems to be acceptance that an MD is someone you go to when you need potent pharmaceuticals…no questions asked (often literally). More and more, people are relying on Chinese med docs, chiros, naturopaths, etc for healthcare and the allopathic MD is becoming alternative, emergency medicine. Not that that’s necessarily a bad thing. But it does seem to be a waste of potential. When I was a kid, our family doc (MD) actually practiced medicine – healthcare as well as emergency med, research supporting common sense (rather than the other way around, as it is now), digging for clues by actually listening to the patient. He also understood that all meds are toxic – and knew when a toxin was needed to strategically alter a disease process and when it was best to support the body doing its thing. It would be nice to return to that.

    • Your account does not match my experience of MDs in general. But of course some are like that.

      But I’d point out that I don’t know of the existence of any “allopathic”doctors. An allopathic doctor , as defined by Hahnemann, would be one who prescribes medicine intended to counter the symptoms. If a child came in with soreness and swelling in and around the ears, an “allopathic” would prescribe anti-inflammatories and/or analgesics and be done. An MD, on the other hand, will examine the child, do tests, determine the cause of symptoms (relying on actual scientific *knowledge* of how infections progress) and, if warranted, prescribe an antibiotic which will actually treat the underlying condition. Usually with great and immediate effect.

      And a homeopath will act with the same lack of knowledge as the hypothetical “allopathic” but will prescribe a placebo.

      When homeopaths claim that “homeopathy treats the underlying cause and not just the symptoms” they fail to note that (1) their notion of “underlying causes” is all based on 200 year old disproven conjecture (2) they are comparing themselves not to doctors but to “allopathy” which doesn’t actually exist; (3) somehow they manage to do this by prescribing based primarily on symptoms, and secondarily on observations unrelated to the condition.

      • @ Greg – I was using the dictionary definition of allopathic “treating of disease by conventional means”. But your definition of allopathic accurately describes the majority of stories I hear from patients. Glad to hear your experience is different.

        • Did you cherry pick the dictionary? In a survey of about 10 major sources I wasn’t able to find that definition. But it’s common homeopathic propoganda to confuse the two. Is it part of homeopathic “training” to become deluded that conventional practice (like homeopathy) incorporates as little knowledge about actual disease processes as was known in Hahnemann’s time, and works entirety from symptoms? That would explain a lot. Including the acceptance of this utterly false equivalence.

          “The majority of stories you hear from patients” – is that a well rounded sample, fairly reported by them, and represented without bias by you? Or are you applying homeopathic methodology in making conclusions about medicine as a whole? Things to consider.

          • @Greg – “is that a well rounded sample, fairly reported by them, and represented without bias by you?”

            Simply asking everyone I run into: “Do you have a doctor you like? I’m in the market for one.” Not sure what homeopathic methodology is – other than what I’ve read on this site. I’ve never had a need (that I know of) for a homeopath, the theory seems a bit strange to me, never seen one as a patient, never talked to one about their practice, etc. Just seems like if there’s evidence that compassion and empathy get results, MDs should be making use. Seems pretty straightforward, since compassion and empathy don’t take extra time or money.

    • Who are these “allopathic doctors” of whom you speak? Allopathy was Hahnemann’s term of art for heroic medicine, which sought to balance the humours by opposition (thus bloodletting for an excess of sanguinity). Those practices died out over a century ago.

      As to why real doctors don’t spend an hour listening to their patients recounting every tiny itch and twinge, that would be because it’s a waste of a scarce resource, the doctor’s time. You can go private if you want this, or buy a cat.

      • I was using the dictionary definition of allopathic “treating of disease by conventional means”.

        Real doctors don’t have time to listen to patients? In other words, ‘real doctors’ don’t have time to practice medicine. Maybe they should get a new job. Perhaps selling cats?

  • A short while ago, HRH the PoW was reported as supporting the scientific stance on climate change, saying that the science was proven and that we should not argue with science.

    I am curious as to why he does not apply this same logic to homeopathy, and can only agree with Richard Rawlins that he must be treating it as a faith issue. Under such circumstance I believe he should come clean on this, and stop misleading others, since it is because of his lead on homeopathy that many think it must be a good thing.

  • Shop around until you do get an empathic rational doctor. They’re hardly as rare as anecdote would indicate. Actually usually when I see enquiries on community noticeboards there are plenty of recommendations for such doctors from happy patients.

    • @Mike – Good to hear that’s your experience (of course that’s anecdote itself, yes?). Good doctors here are pretty difficult to get into – their practices fill quickly once the word gets out. In addition to stories I hear from patients at our clinic, I spent some time asking everyone I ran into (at the market, restaurants, etc). My informal survey included hundreds of people (I really wanted good docs to refer people to). The vast majority was actively pissed. The happiest people were seeing Nurse Practitioners.

      Shopping around isn’t that easy, as it’s quite expensive and most of our patients can’t afford $200-$350 per visit to interview docs. I got pretty lucky, in that a patient told me about a good doc who had openings and my wife was able to get in. Unfortunately, our doc seems to be the exception, not the rule. Glad to hear it’s different where you are.

      • The US healthcare funding model is broken, everyone knows that except our own government.

        That does not, of course, excuse the practice of a bunch of untrained amateur counsellors who think they actually have some profound insight into health through their use of magic sugar pills, but this much is obvious.

        • Like someone said (I think it was David Gorski?), If the apple pie is missing some ingredients, if you mix cow pie into the apple pie it does not make the apple pie better.

        • “That does not, of course, excuse the practice of a bunch of untrained amateur counsellors who think they actually have some profound insight into health through their use of magic sugar pills,”
          What in the world are you talking about?

  • For the ethically concerned, I would add an 8th caveat: homeopathy is not bothered about where the original “ingredients” come from – apart from sheer silliness, such as “Berlin wall”, a list of provings will include animal body parts of many descriptions including pig embryo – and, of course the famous ‘flu remedy is based on duck organs. Even when diluted to extinction, the fact remains that these wretched practitioners do not care who has to render up vital bits, making the whole business just one more frantic scrabble round to stave off human death at the cost of others’.

  • A past Colleague of mine, in his personal website (www.paolobellavite.it) has taken the occasion to inform common people about the existence of purpoted bias in some comments published elsewhere, which criticizes several aspects of his excellent work. It is very difficult to trust the fact about a misleading from readers of the scientific journals , i.e. purpoted bias, if several colleagues peer reviewed any comment about. Purpoted is homeopathy and the attempt to a biased interpretation of data in order to put Gelsemium 30CH on the market…..

    https://www.youtube.com/watch?v=1eXUsj9zjMc&feature=youtu.be

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