Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Sunday, May 15, 2005

The story of homoeopathy and how it has flourished

The story of homoeopathy and how it has flourished

The Independent

April 11, 2005

By Jeremy Laurance

System of medicine invented by a physician who believed that like cures like is still controversial, writes Jeremy Laurance

Some call it snake oil, some believe it is the 21st century's cure-all: 250 years after the birth of Samuel Hahnemann, the system of medicine he founded, homeopathy, is still the focus of scientific controversy.

Yet despite being mocked and ridiculed by the scientific establishment from the start, it flourishes today as one of the leading branches of complementary medicine, with millions of adherents across the world.

Chemists in many countries stock arnica, nux vomica, pulsatilla and rhus tox on the shelves.

The origins of the treatment lie in the dissatisfaction that the young Hahnemann, a German physician who practised in the late 18th century, felt with the orthodox medicine of the time. Born in Meissen, Saxony, on April 10 1755, to poor but middle-class parents, Hahnemann spent his childhood attaining "knowledge by every possible means" and became proficient in eight languages. By his late teens he had developed an interest in medicine and qualified at Erlangen in 1779.

His distaste for the then favoured treatments - blood-letting, purging and burning and the administration of toxic substances such as arsenic and mercury - was not difficult to understand and it led him to devote his energy to his "beloved chemistry". He gave away his medical practice in 1790, just 11 years after qualifying, and began a new practice based on the principle that "like cures like", which underlies homeopathy.

One of his earliest experiments involved the drug quinine, used to treat malaria. He had read that it was effective because it was bitter and astringent, but realised that, if this were the case, all bitter and astringent substances would be effective, which they clearly were not.

By testing it on himself he discovered that it produced symptoms of fever similar to those produced by the disease itself and he speculated that this could be the real secret of its curative power.
He began to test other drugs on himself, his family and friends, such as belladonna, camphor and aconitum, to study the symptoms they produced. But it was not until 1796 that he "first communicated to the world by means of public print his new discovery in medicine".

It was based on two principles. The first, called the law of similars, can be seen in the way that an effective treatment for a hangover is to have another drink in the morning. This was not the sort of treatment that Hahnemann had in mind, but it demonstrates that it can work. Homeopaths, however, believe it applies universally.

The second principle is that a treatment becomes more powerful the more it is diluted - even to the point where it is so dilute that the remedy cannot contain even a single molecule of the original substance. The process of repeatedly diluting and shaking a remedy is known as potentisation and it may be carried out so many times that it is equivalent to diluting a tiny speck of the original substance in all the world's oceans.

This is the central difficulty that scientists have with homeopathy. If a homeopathic remedy does not contain a single molecule of the original substance from which it was made, how can it exert any effect?

The question did not trouble Hahnemann because molecules were still awaiting discovery at the time he was writing his Organon of Ration Healing, published in 1810, and Materia Medica Pura, setting out his ideas. His remedies gained currency because they were notably kinder and less injurious than the conventional treatments handed out by his colleagues.

In 1811 he moved with his family - he had married Joanna Kuchler in 1782 and they had 11 children - to Leipzig, where he began teaching a small group of students in the university. But his growing success provoked jealousy and he was eventually forbidden by the courts from dispensing his medicines.

In 1821 he moved to KĖ†then and devoted himself full-time to homeopathy. People travelled hundreds of kilometres to consult him as his fame grew, but he was constantly attacked and persecuted by establishment colleagues. In response, he increasingly isolated himself, leaving the movement leaderless and resulting in the formation of different sects.

Today there are two kinds of homeopaths - those who trained first as doctors and those non-medically qualified homeopaths who have studied the principles for several years.

When challenged about the scientific implausibility of their practice, homeopaths reply that their remedies do not work like pharmacological drugs but that, in some way, the "energy" in the original substance is passed on to the water or other liquid in which it is diluted. The water thus retains a memory of the substance.

This theory was proposed by Jacques Benveniste, a French biologist, in the 1980s. In a paper published in Nature, one of the world's leading science journals, in 1988 he claimed that experiments in his laboratory in Paris had shown that an ultra-dilute solution could exert a biological effect.

However, Dr Benveniste was investigated by a team appointed by the then editor of Nature, Sir John Maddox, and after they failed to repeat his experiments successfully, Benveniste was ridiculed in a subsequent edition and his theory consigned to history.

Last year, interest in the theory was revived by the publication of new research which appeared to lend weight to Benveniste's claim. Four teams of researchers working in four countries separately observed that a highly dilute solution of histamine, the substance produced in the skin in response to an insect bite or sting, exerted an effect on a type of white blood cell called a basophil in the test tube.

Three of the four laboratories found a statistically significant effect and the fourth found an effect which lay just outside the significant range. Writing in the journal Inflammation Research in August 2004, the authors said: "We are not yet able to propose any theoretical explanation for these findings."

If confirmed, they may require the laws of physics to be rewritten. Critics claim it is more likely there is some error in the experiment, a charge which the scientists reject.

Support for homeopathy also came from an analysis of 89 trials published in The Lancet in 1997 which appeared to show that the remedies produced an effect more than twice as great as a placebo. But the analysis was criticised on the grounds that it did not make sense to lump together highly diverse studies in this global fashion.

A much larger review encompassing 200 trials of homeopathy by the British National Health Service Centre for Reviews and Dissemination based at York University, which issues advice to the NHS on effective treatments, delivered a damning verdict in March 2002.

"There is currently insufficient evidence of effectiveness either to recommend homeopathy as a treatment for any specific condition or to warrant significant changes in the current provision of homeopathy," it concluded.

A similar verdict was reached by the influential Academie de Medicine in Paris, an advisory body of distinguished physicians. In a report in September last year it upset practitioners and users of homeopathy by concluding that they subscribed to mumbo jumbo. "Homeopathy is a method dreamed up two centuries ago, based on prejudices that were devoid of any foundation. It has survived as a doctrine completely outside the remarkable scientific movement which has been transforming medicine for two centuries."

Verdicts do not come much more damning than that. But it is unlikely to deter adherents to the philosophy.

The British Homeopathic Association claims that heightened public awareness of the dangers of chemicals in the food chain, growing resistance to antibiotics through over-use, and concerns about the side effects of conventional drugs are contributing to a rethink about the way we live and how we seek to regain health.

Two hundred years after Samuel Hahnemann raised parallel concerns about the damaging effects of the medicine of the day, the public has again grown anxious about what doctors do.

Homeopathy is attracting more and more converts. And it scores one big advantage over conventional medicine - the absence of harmful side effects means that it can do little harm.