Scepisode #1: Homeopathy

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My interest in Homeopathy was catalysed by an experience at work.  I had heard of the practice before but had never known anything about how it claimed to work or what it claimed to treat. A colleague had been to see a homeopath whom I believe she sees regularly and explained to me what it is that her homeopath does and in a limited way how homeopathy is meant to work.

I got home and started researching.  I am not a scientific or medical expert, a trait  indeed, I seem to share with the Homeopathic community.

Homeopathy is an alternative practice of medicine established in the late 18th Century by German doctor Samuel Hahnemann.  Claiming to be able to treat a variety of problems and illnesses, its treatments work on a ‘like cures like’ basis meaning that symptoms can be remedied by ‘ultra-diluting’ materials or compounds that, at a high dose, could be the cause of the symptoms. An example commonly used is that ultra-diluted stimulants, like caffeine, would be used to cure a person of their insomnia.  It is an assertion that at first seems logical.  We know for example that all things at too higher a dose will become detrimental to health, indeed, a  House of Commons report recognises:

‘…“as the dose of a carcinogen decreases, it reaches a point where the agent actually may reduce the risk of cancer below that of the control group”. And this has been likened to the like-cures-like principle central to homeopathy’. (http://goo.gl/4dpo69)

Is it therefore fair to assume that, working retrospectively, any material at a lower dosage might serve to treat the effects it has at a higher dosage?   It is very easy to accept the basic explanation at face value and it certainly seems to satisfy the apparent requirement in human nature to find balance.  It would facile however to over-extrapolate this and feel justified in believing that because some substances act in this way that all must as a result.

I do notice a problem.  Homeopathy seems to treat symptoms based on the symptoms alone. ‘In homeopathy, sometimes revealing the cause can be useful in determining the remedy.’ This statement published on the Homeopathy WORKS website (http://goo.gl/Zfz2FT) I found particularly troubling because of the surprise with which it seems to be written. I found little information that demonstrated that particular effort was made to tailor different treatments to alleviate symptoms associated with different causes.    This outlook has the potential to be dangerous dependent on the specific illnesses people try to remedy with homeopathy. Many different things can cause a single symptom and while trial and error can prove effective, surely diagnosis of a cause should nearly always precede treatment of a symptom, especially a chronic one. The House of Commons report also comments ‘Treating the symptoms and ignoring the causes is simply not good medical practice.’

With regards to the treatments themselves The Society of Homeopaths explain that the remedies ‘are prepared by specialist pharmacies using a careful process of dilution and sucussion (a specific form of vigorous shaking).’ (http://goo.gl/0Bk5pQ).  However I discovered that this dilution was in some cases to such an extent that the substance was diluted beyond Avogadro’s number.  This, according to homeopaths is explained by their theory (a term used very loosely) of water possessing memory.  That is to say that a substance diluted in water will imprint its properties, to some extent, on the water molecules. This means that even if this substance is diluted into scientific non-existence it remains in a form that can still be used to treat people – presumably making tap water a homeopathic overdose. Furthermore I can’t help but struggle to call ‘water memory’ a theory and the fact that it is considered so by homeopathic institutions only causes their credibility to be diminished.

(I found more about the memory theory and plenty of other valuable information at The Faculty of Homeopathy (http://goo.gl/r89oWY) and The British Homeopathy Association (http://goo.gl/CCFwsa) websites.)

There is no doubt in my mind that some people benefit from homeopathy and it is the extent of this benefit that interests me.  The effectiveness of homeopathy is, by its critics, often written off to the placebo effect.   When testing a treatment it is usually desired that it fulfill 2 criteria, efficacy and effectiveness. These were, until a few weeks ago, words that meant nothing to me. I will try to explain their definitions to the best of my ability.  Efficacy measures whether a treatment works in ideal conditions.  Effectiveness, on the other hand, judges whether or not a treatment works in real world conditions.  There are some remedies that in perfect conditions work, but in real world conditions do not. Conversely there are remedies that do not work in ideal conditions, but do in real world conditions.  The latter result indicates the placebo effect.

The NHS begins to describe the placebo effect as being ‘about the power of the mind to influence the body.’ (http://goo.gl/s6K3Qv) It can be demonstrated that the effectiveness of the placebo is increased if it is administered as an injection rather than say, a pill.  It is also recognised that two placebo pills a day work better that one placebo pill.  It is clear that the effect is certainly a strong one and perhaps it is the leading factor in the apparent benefit users of homeopathy experience. It can however present dangers if as a result of the placebo effect patients then reject or ignore other medicines that might actually help them.

I found a vast amount of information that rushed to the defence of homeopathy for example an article found in The Journal of Alternative and Complimentary Medicine (http://goo.gl/d9FKWa).  It is well written and presented professionally, but I couldn’t help but notice that it was defending homeopathy as a treatment based on an observational study alone.  Such a study only proves the effectiveness of the treatment and not the efficacy, again suggesting that patients are simply experiencing the placebo effect.  This was the case for a lot of the information I unearthed.  The studies were often, in one form or another, outcome studies observing the how patients judged their own health after using homeopathy.

But who am I to deny people the right to use whatever form or branch of medicine they choose, and even if the main benefit of homeopathy is the successful administering of placebo it is medically recognised to be a strong and beneficial effect.  I can only express delight at the fact that people experiencing problems such as asthma, depression, eczema and even cancer felt better after using homeopathy. This does not mean however that homeopathy in anyway cured them of their ailments and should be used in replacement of traditional medicines regardless of how well that the patient claims to be. I would take less of an issue with this if perhaps homeopathy websites and articles made it clear that people should use homeopathy alongside orthodox medicine, but this is not the case.

To summarise, I take issue with the fact that homeopathy bases its treatment on the existence of symptoms and not on the causes of those symptoms.  Homeopathy’s theory of water memory allows substances to be diluted beyond Avogadro’s number and does not satisfy my understanding of a scientific theory.    As a result I remain unconvinced that this offers anything more than a form of placebo treatment, and I would be deeply concerned if anybody suffering for a chronic illness was completely dependent on homeopathy as a cure.

 

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