Published articles
Myths and Misconceptions
This page was inspired by the responses to the question " Do homeopathic remedies work?" on the BBC's "Have Your Say" page in the wake of the much-publicised Lancet meta-analysis, published August 2005, which claimed to be the "last word" on the subject of whether homeopathic remedies have any effect beyond what might be expected from placebo. Amongst all the responses on the subject, there were a lot of misconceptions about homeopathy so it seemed worth addressing a few of them here.
For a more general introduction to the subject, see the Beginner's Guide, and for a perspective on how it is that scientists can become so divided over a question like homeopathy, see the essay Unscientific Attachment.
The Lancet article itself was the biggest myth of the lot, and very far from being the last word on the subject. Aside from the highly irregular context out of which this study was published, its quality has been widely condemned on its own merits (see below), along with the motivation of the Lancet in publishing it. Mikel Aickin PhD, Research Professor at the University of Arizona commented: “The Lancet article appears to be part of a recent trend, in which medical journals are publishing articles of exceedingly low quality to justify attacks on controversial therapies.”
If you have a question about homeopathy that isn't covered on this page or the Beginner's Guide, send it to me and I'll do my best to answer it and, if appropriate, include it below.
"... I think that we should all remember
that it takes 4 or 5 years to be a doctor, I could be a homoeopathist
in 5 minutes."
Chris, London
In the UK, homeopathic training is not a legal requirement so it is technically possible for anyone to call themselves a homeopath and start advertising for patients. However, in practice these days you'd be highly unlikely to find anyone doing so. And as for learning homeopathy in 5 minutes, forget it! Non-medically qualified (professional) homeopaths in the UK typically go through a 3-4 year college training (commonly including modules in anatomy, physiology, pathology, psychology, practitioner development and ethics as well as homeopathic theory, philosophy and materia medica) before starting supervised practice. Some courses are accredited by universities and have degree status. Qualified medical doctors wanting to use homeopathy used to take much shorter courses, but these are now becoming much more thorough and approaching the depth and extent of the courses undertaken by professional homeopaths.
It's no easy discipline and the learning never stops. Many practitioners devote their lives to it.
"I worked for a well known homeopathy company
for many years and was able to sample products on regular basis. In doing
so, I found the lavender, citrus and rosemary oils very good for their
particular uses such as tiredness, rejuvenating etc."
Baz, London
"Yes, actually. I sometimes have liquorice
when I have an upset stomach. I chew on peppermint when I have a headache.
I take cayenne pepper in broth when I have a headache as well. They all
usually work and I try them first before subjecting my body to drugs and
chemicals."
Beth, Bristow, Virginia USA
Lavender, citrus and rosemary oils are essential oils and liquorice, peppermint and cayenne pepper are herbal remedies. They are not homeopathy. Although there are essential oils, herbal remedies and homeopathic remedies prepared from the same substances, their method of preparation is quite different and they are used in different ways according to different principles.
See the Beginner's Guide for a more detailed explanation.
"Anybody with even the most basic knowledge
of chemistry or pharmacology will know that homoeopathy cannot possibly
work any better than placebo, so these results are no surprise."
Adam, London
The extreme dilutions of homeopathic remedies to a point where there's no likelihood of a single molecule of the original substance remaining mean that the mechanism of action can't be based on a reaction to the material substance itself. That's perfectly obvious. However, to assume that implies there can be no possible mechanism of action and that therefore homeopathic remedies can't work is mistaking the map for the territory. Such an assumption
" ... relies on a quaint old idea from the nineteenth
century that the ONLY way that the property of water can be affected or
changed is by incorporating foreign molecules. This is the Avogadro-limit
high-school level chemistry argument. To a materials scientist this notion
is absurd, since the fundamental paradigm of materials-science is that
the structure-property relationship is the basic determinant of everything.
It is a fact that the structure of water and therefore the informational
content of water can be altered in infinite ways"
Prof
Rustum Roy PhD, Evan Pugh Professor of the Solid State Emeritus; Professor
of Science, Technology and Society Emeritus; Professor of Geochemistry
Emeritus, Pennsylvania State University
So it doesn't mean that there isn't a mechanism of action, only that one hasn't been discovered. There's an awful lot we don't know about the world yet. The mechanism of action of many modern drugs isn't understood either. Nobody knew how aspirin works until just a few years ago, for instance, yet it hasn't stopped people using it for decades.
"Many people forget that medical illnesses can
improve spontaneously without any treatment or vary in severity over time.
When homeopathy seems to cure an illness it is probably mere coincidence.
Furthermore, the reason that homeopathy seems successful is due to the
pseudo religious 'believe and thee shall be healed' ethos."
Dr Richard Campbell, London
If homeopathic cures are mere coincidence, then there's an awful lot of coincidences in 200 years' worth of documented case history. Take the 1854 London cholera epidemic for instance. The results from homeopathic treatment were so positive that they were deliberately withheld from parliament. The House of Lords asked for an explanation and it was admitted that if the homeopathic figures were to be included in the report, it would "skew the results." The suppressed report revealed that mortality under homeopathic care was just 9%. Under conventional care it was over 59%. This is a matter of public record. Some sceptics have recently conjectured that the conventional treatment of the time would have exacerbated the disease rather than helping, and that homeopathy's results are consequently still no better than placebo. This is unsupportable. Mortality rates in untreated cases of cholera are generally in the region of 50-60%. Neither is it the sort of condition where placebo would be likely to have much effect.
More up to date evidence is provided in a recent study of 6544 patients over a 6-year period in a hospital outpatient unit within an acute National Health Service (NHS) Teaching Trust in the United Kingdom. 70.7% of patients receiving homeopathic treatment reported positive health changes. An even more recent study in Germany analysed outcomes for 493 patients, and concluded that patients seeking homeopathic treatment had a better outcome overall compared with patients on conventional treatment. This seems rather more than can be passed off as "mere coincidence".
Belief does play a part in healing, and the placebo effect is very real. It seems somewhat overplayed as an argument here though, not to mention singularly failing to address how it is that homeopathic patients come by their belief in the first place. A lot of people come to homeopathy as a last resort after conventional care has failed them. (TEETH – tried-evertything-else-try-homeopathy.) They're often far from convinced, but willing to give it a try. That doesn't argue for a very strong belief effect. That only tends to kick in after they've experienced successful treatment, which may occur only after several different remedies have been tried. Conversely, conventional medicine is accepted by most people as simply the way it is, so the belief/placebo effect operating there is likely to be considerably stronger than it is in homeopathy. And if those patients experiencing successful cures under homeopathy are deemed particularly susceptible to the placebo effect, then it seems strange that so many should have experienced so many failures with conventional therapy beforehand.
And as a few respondents pointed out, babies and animals don't have any belief in homeopathy yet it's been shown to be just as effective in treating them too.
"I have no objection to people using homeopathic
medicines if they want to, but if these medicines cannot be shown to work
under the same rigorous conditions used to test standard medicines, they
should not be prescribed on the NHS."
Colin, UK
"So the Society of Homeopaths thinks that
"the placebo-controlled, randomised controlled trial is not a fitting
research tool with which to test homeopathy"? Would that be because
it always shows that homeopathy doesn't work?!"
Norman MacLeod, Edinburgh, Scotland
Modern medicine presumes that its perspective on how the body functions is the only one with any validity. It assumes that one human body is very much like another and that they all work in exactly the same way. These being the ground rules, individual variation is regarded as insignificant and irrelevant. In any given condition, the assumption is that the same thing must be going wrong with the physical "machinery" so all you need to do is to find out what that is and discover a medicine that biochemically interferes with the process. To test for effectiveness, you give the same medicine to a lot of people suffering from the same condition and see how they all react. And if you want to test the effectiveness of remedies used by other therapies, you do the same thing.
Homeopathy places as much importance on individual variation in physiology, physiognomy and illness as the common features – after all, variation is just as evident and ubiquitous as what is common; why should it be any less significant? – and takes the view that although there's a level at which bodies all appear to function in much the same way, and you can treat people at that level, it's not very effective. You end up having to continually repeat the treatment in order to keep the symptoms at bay and often they come back as soon as treatment is stopped. You're also limiting yourself to looking for the common and the physical amongst potential causative mechanisms in disease, ignoring all the enormous number of other factors contributing to illness.
Homeopathy takes in a much larger picture, moving the focus from exclusive concentration on a specific condition in isolation to a view of the whole person, amongst who's various complaints is this specific condition. The most effective treatment is a remedy that matches all their complaints and even how they feel and think as well. So to test homeopathy's effectiveness in the context of any one condition, each person suffering from that condition would need to be interviewed carefully and an individual remedy selected for each of them. This could mean that out of 10 people suffering from the same problem, as many as 10 different remedies are prescribed.
This is why RCTs testing a single remedy for a single condition are not an appropriate research tool for homeopathic medicine, except in the instances in which certain remedies which have very strong affinities with superficial acute situations can show a measurable effect in a large number of people. Like Arnica for bruising.
You cannot test one system in terms of the assumptions of another when the two are not the same. To test homeopathy properly, its principles as well as its medicines need to be taken into account. Otherwise you are not replicating the real-world prescribing situation in the trial of the therapy's effectiveness. If you don't do that, then you're not testing the therapy.
"The vast majority of illnesses 'cured' by
homeopathy are episodic or self-limiting in the first place."
Cris Bates, UK
"Whilst I wouldn't countenance the prescription
of a homeopathic remedy for true organic illness, there are a number of
stress related or psychosomatic conditions for which it might well be
appropriate."
Dr Phil, Westcliff-on-Sea, Essex
It's worth noting that the vast majority of complaints have some episodic qualities and all are ultimately self-limiting – ending either in recovery or death.
The assumption that homeopathy is only applicable to minor and acute illnesses is, however, a common one. It's no doubt fostered by the fact that remedies for first aid situations and minor complaints are sold in many pharmacies and health stores, and these are the ones that tend to be featured in the media. The wide availablility of remedies for these types of complaints is because these are conditions for which self-prescription can be safe and to some degree successful. Minor injuries such as cuts, bruises, burns and shock are not so much the product of an individual's make-up as a situation, and the remedies that have affinities for these traumas can provide at least some symptomatic relief for most people. The same comment applies to common acute complaints such as colds and flu, although the chances of a good cure are slimmer. (For that it would need to be the correct remedy for the person's overall state.) Being as this is the most visible but often least effective aspect of homeopathy, the assumption that its effect is of only marginal benefit in conditions that will resolve of their own accord is consequently perfectly understandable. However, it's a mistake to suppose that this is all there is to it, or that this is representative of the therapy's potential.
Homeopathy treats individuals with "true organic illness" in the same way as those with illnesses without evident physical pathology and can be just as effective. There is extensive case history showing well-documented cures of people with organic illness, from cholera to cancer, under homeopathic treatment over a period of 150 years. Recent large-scale studies, such as the Bristol study mentioned above, involve predominantly chronic cases of illness. In another recent German study, a total of 3,981 patients were studied including 2,851 adults and 1,130 children. Ninety-seven percent of all diagnoses were chronic with an average duration of 8.8 years. Almost all patients had received conventional treatment (95%) prior to the start of the study. Disease severity was found to have decreased significantly (p<0.001) between baseline and 24 months under homeopathic treatment.
"About time – as an NHS professional I find
it scandalous that we waste millions of pounds of taxpayers' money on
such useless interventions."
Jonathan Mason, London, UK
An extensive, high-quality 5-year study of complementary medicine in Switzerland, initially widely hailed as an exemplar for all future CAM research, was starting to report considerable economic benefits arising from complementary medicine's integration into national healthcare before the entire study was derailed by political interference. (This is the program which spawned the Shang et al meta-analysis published in the Lancet. If you're at all interested in discovering what's really going on in complementary medical research behind the spin, then read all about what happened here, as well as the critique of the meta-analysis below.)
The cost of homeopathic medicines is absolutely miniscule in comparison to the cost of conventional drugs (and it's the cost of conventional drugs which is bankrupting the NHS). The same remedies that were used 150-200 years ago are still in use today and the research and development of new remedies is mostly undertaken by unpaid homeopathic practitioners and students. No prohibitively expensive technology or resources are required in the production process, and homeopathic remedies don't exploit the environment since only the minutest amount of the source material is required.
In contrast, it's estimated that up to one fifth of all new prescription drugs may ultimately be recalled or produce potentially harmful side effects (Journal of the American Medical Association 2002;287:2215-2220, 2273-2275) and that the annual death toll from reactions to correctly prescribed drugs amounts to some 106,000 in the US alone which, together with other iatrogenic (physician-induced) causes, makes conventional medicine the third leading cause of death in the US (Journal of the American Medical Association 2000;284:483-485). By the pharmaceutical industry's own admission, 90% of prescription drugs are effective in only 30-50% of cases. Only 13% of 2,500 commonly used treatments have clear evidence of benefit.
The companies producing conventional medications are some of the largest, richest and most powerful in the world, practicing some of the most dubious of marketing and business ethics.
"In our view, disease mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. It is exemplified most explicitly by many pharmaceutical industry–funded disease-awareness campaigns—more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health.” (Moynihan, Ray and Henry, David. The Fight against Disease Mongering: Generating Knowledge for Action. Public Library of Science, vol 3, issue 4, April 2006)
“The coming years will bear greater witness to the corporate sponsored creation of disease” (Coe, J. 2003. Healthcare: The lifestyle drugs outlook to 2008, unlocking new value in well-being. London: Reuters Business Insight, quoted in Moynihan and Henry above.)
At the very least, taxpayers deserve the freedom to be able to make informed choices about their healthcare and there have been extensive studies indicating that homeopathic interventions employed under the umbrella of the UK's NHS have been far from useless, and a more recent German study concluded from a analysis of outcomes for 493 patients that patients seeking homeopathic treatment had a better outcome overall compared with patients on conventional treatment. (Note too that an analysis of the statistics published in the Lancet meta-analysis actually shows no statistically significant difference between conventional and homeopathic interventions in the selected trials.)
"Some people are happy to believe in alternative
health, astrology, ghosts, quackery and other fanciful things."
Ronald, London
Indeed they are. Usually because they've had direct of experience of them and discovered for themselves that there's something there worth investigating. We are all scientists in our own way. As Sir John Weir (1879-1971), Royal Homœopathic Physician serving George V, Edward VIII, George VI and Elizabeth II, once said, “I suppose not one of us has approached homeopathy otherwise than with doubt and mistrust; but facts have been too much for us.”
A lot of homeopathic practitioners are people who have worked in conventional medicine – nurses, doctors – or in other scientific disciplines, and who were open-minded and curious enough to start studying it having discovered its effectiveness for themselves. It does defy our present models of how the body interacts with medicines in illness, but for many people that makes for an exciting subject of research rather than something to reject and deny.
As Dr Rakan Sankaran, Vice-Chairman for Asia, International Council of Classical Homeopathy comments, "Nothing sustains a form of medicine for 150 years unless it is effective. Homeopaths today successfully use the same remedies that were used 150 years ago, in addition to adding new ones to their material medica. In contrast, modern medicine keeps discarding many of its wonder drugs once their side effects become known. Homeopathy is based on a definite philosophy, backed by precise observations of remedy effects and a very well recorded register of remedies. It has been a very consistent system and several modern medical practitioners who seriously looked into it with an open mind became homeopaths themselves, never to turn back."
None of the comments from respondents above are based on an actual experience of homeopathy. Only on second-hand opinion and supposition. For those that have tried homeopathy, there can be a different set of misconceptions.
"I tried a homeopathic remedy for my problem once. It didn't do anything at all. Homeopathy doesn't work."
Homeopathic treatment is highly specific to the individual. With self-selected remedies available over-the-counter you may get lucky and find that the most common remedies associated with the condition help. Or you may not. And with all the experience and the best will in the world, no homeopathic practitioner selects the best possible remedy first time every time, particularly if the features that allow them to distinguish one remedy state from another are not readily apparent from your description of your condition. (See the Consultation check-list for more details.)
Assuming homeopathy doesn't work because one remedy didn't help is no different to assuming conventional medicine doesn't work because an aspirin didn't cure your headache.
The way homeopathy acts can also mean that you're simply not aware of its action (see blog entry Curative AmnEASYa). Often someone will come back and say nothing happened, but when the symptoms they described on their previous visit are read back to them, they realise that they've all gone. As improbable as it may sound, most homeopathic practitioners will have at least one instance of it in their records.
