Health Studies 301 Complementary and Alternative Therapies

Study Guide: Unit 12

Homeopathy

Several commonly used homeopathic substances. Ar291, 2009 Public Domain.

Homeopathy is a therapy developed by Samuel Hahnemann in Germany in the first half of the nineteenth century. It is based on the premise that a substance that can cause symptoms in a healthy person can cure the same symptoms when they occur in a sick person. Simply put, “like cures like.” Homeopathy also subscribes to the “law of infinitesimals”: the more dilute the agent is, the greater its healing power. However, this law conflicts with a basic principle of physiology and biochemistry—that solutions lose effectiveness when highly diluted. Not surprisingly, many investigators have dismissed homeopathy because of its implausible rationale. However, a few studies have provided positive evidence in support of the effectiveness of homeopathy. As a result, homeopathy is highly controversial, and its merits are hotly debated.

Learning Objectives

Upon completion of Unit 12, you should be able to

• define homeopathy and explain the nature of homeopathy.
• determine the effectiveness of homeopathic treatment by analyzing available research.
• identify trends and issues related to homeopathic treatment.

Learning Activities

Study Questions

As you complete the activities for Unit 12, keep the following questions in mind. You may want to use the Personal Learning Space wiki on the course home page, and answer these questions as a way of keeping notes to focus your learning.

1. How could conventional research methods be applied to evaluate and improve homeopathic clinical practice?
2. What elements of the homeopathic process of interviewing patients could be applied by conventional physicians to provide patient care without using homeopathic remedies?
3. Give examples of conventional medicines applied in a homeopathic “likes cure like” manner. How is this different from homeopathic practice in terms of expected outcomes?

Unit 12 Discussion Forum

When you have completed the other activities for this unit, answer at least one of the questions in the Unit 12 Discussion Forum, and respond to at least one post by a fellow learner.

The more questions you answer, the better prepared you will be for the final exam!

Read

In addition to the notes provided here, read in the textbook:

Micozzi, M. (2019). Fundamentals of Complementary, Alternative, and Integrative Medicine. Pages 350–353, page 355 (from “Totality of Symptoms”) to page 357 (to “Homeopathic Pharmacy”), and page 364 (section headed “Case Taking”).

The reading provides an account of homeopathy, including its history, beliefs and claims. The author makes no secret of the fact that he is strongly of the opinion that homeopathy is highly effective. Homeopathy was born in the nineteenth century, when conventional physicians had few effective treatments available to them. It has always been in conflict with conventional medicine.

Homeopathy focuses on the totality of symptoms; it emphasizes the individual’s subjective symptoms and considers the physical, mental, and spiritual aspects of the patient.

Textbook pages 353–355 (section headed “The Vital Force”) propose views that are totally at odds with modern concepts in biomedical science. This includes quantum mechanics, a topic briefly discussed in Unit 5 in the context of energy medicine.

Law of Similars

Based on its theoretical foundation, homeopathy stands in marked contrast to allopathy, a conventional therapy system that uses drugs to counteract disturbances of physiology. In some ways, homeopathy can be compared with immunization and allergy desensitization, where very small doses are given to induce resistance.

Immunization is the process of creating immunity to a specific disease by giving weakened or inactivated bacteria leading to formation of antibodies and long-term memory cells. Antigens, foreign proteins, or large polysaccharides can produce a highly specific immune response. Immunization or vaccination can be viewed from a homeopathic perspective in two quite different ways. It can be seen as a homeopathic treatment by application of the law of similars. Hahnemann himself interpreted smallpox vaccination as a homeopathic protection. Or, as is often the case with modern homeopaths, prevention by vaccine can be rejected because the vaccine has not been potentized (see below).

Allergy desensitization consists of a series of dosages of the antigen injected beneath the skin to produce antibodies that will bind and neutralize the antigens. This can prevent an allergic reaction (a hypersensitized reaction of the immune system when certain antibodies combine with an antigen that it has been exposed to previously).

While superficially similar, homeopathy has major differences to immunization and allergic desensitization. Homeopathic remedies are given when a person is ill, to treat disease, whereas with immunization and allergic desensitization, the person is healthy and is given a vaccine or antigen to produce antibodies in order to prevent a health problem. It must also be stressed that immunization and allergic desensitization are effective only in the very specific circumstances where the production of antibodies is of medical benefit. Homeopathy, in marked contrast, is used for a very wide range of disorders.

Hahnemann applied the principle of minimum dose in his homeopathic practice, noting that higher doses of substances could aggravate symptoms. He believed that the administration of medications should be at the smallest dose possible: the more dilute the drug, the stronger the effect. Some therapies are so dilute that none of the original substance can be found in the dilution mix; the solvent is said to have a “memory” of the original substance. It is claimed by practitioners of homeopathy that through repeatedly diluting and shaking remedies, they become more powerful; a process called potentization.

Homeopathic Medicines

Two methods are used for potentization, depending on the nature of the initial substance:

1. Tincture preparation. The plant or part of the plant is harvested at the appropriate time and cleaned by washing. Juice of the plant or its part is added to alcohol and is referred to as a mother tincture.
2. Trituration. When the substance is insoluble, it is ground for 3 hours with powdered milk sugar (lactose). This process is said to reduce the substance to the millionth dilution, at which point the substance is soluble in water.

Homeopathic remedies are available in a variety of forms including tinctures, granules, and powders. The remedies are administered orally by placement under the tongue, sipped in water, or made into tablets with a lactose carrier. The amount or type of remedy that an individual may receive as a treatment varies depending on the individual’s response.

The potency of the solution is defined by adding the letter C or X after the identified solution (see textbook page 358, first and second paragraphs under heading “Formulation”). These scales are known as the centesimal (1C = 1/100; 3C = 1/1,000,000) or decimal scales (also indicated by Roman number X, 1X = 1/10; 3X = 1/1,000; 6X = 1,000,000). Thus, a 30X potency means that the original substance has been diluted 1,000,000,000,000,000,000,000,000,000,000 times. Most remedies range from 6X to 30X, but products of 30C are also marketed. As the textbook makes clear, at these dilutions, there is not a single molecule of the original substance present in the medicine (textbook page 358, first paragraph under heading “Higher Dilutions”).

Homeopathic medicines are classed as natural health products and come under the authority of the Natural and Non-prescription Health Products Directorate, a branch of Health Canada. In that respect, they are regulated in the same way as herbal preparations and dietary supplements.

Benefits: What Does the Research Say?

Homeopathic remedies are promoted as being safe and free of side effects. Homeopaths claim that they can achieve much success.

A carful reading of thee textbook chapter provided strongly suggests that the therapy is tailor made for generating the placebo effect. The section headed “Case Taking” (page 364) describes how practitioners of homeopathy assess their patients. They typically spend much longer with each patient than is the case with conventional physicians. The website of the Canadian Society of Homeopaths (http://www.csoh.ca) states, “An initial interview with a classical homeopath will usually take up to two hours. You will be asked for detailed information about your physical, mental, and emotional health and your personal likes and dislikes.” Such long and detailed consultations seem likely to help bring about the placebo effect after a medicine has been given.

But does homeopathy really work? There are two enormous hurdles before homeopathy can be accepted as an efficacious treatment. The first problem, and by far the larger, is that treatments are given where the medicine does not contain a single molecule of the drug. The second problem is there are more than 2000 homeopathic treatments and a great many possible conditions where they might be used. We therefore have a vast number of possible combinations.

Well over a hundred randomized controlled trials (RCTs), plus a dozen or more systematic reviews, have been carried out to investigate the efficacy of homeopathy. The majority of studies lack methodological rigour. Despite this research, the question of whether homeopathy is more effective than placebo treatment has not been settled. The following reading brings this out quite dramatically.

Learning Activity

Read

Ernst, E. (2009). Homoeopathy and I. International Journal of Clinical Practice, 63(11), 1558–1561. doi: 10.1111/j.1742-1241.2009.02169.x.

This reading demonstrates the highly controversial nature of homeopathy and the charged debate over whether the treatment is effective. The author, Edzard Ernst, traces the evolution of his views as expressed in his own papers on the subject. These are arranged in chronological order (from reference 8 in 1995 to reference 53 in 2009). Over this time period, Ernst became steadily more negative in his overall assessment. The supporters of homeopathy have vilified Ernst.

This heated debate shows no sign of being resolved. In 2011, the BMJ, a leading medical journal, published an attack on homeopathy with the dismissive title “Clothing Naked Quackery and Legitimising Pseudoscience.” Ernst was one of the 11 authors. This was followed by a letter signed by 48 defenders of homeopathy (Fisher, 2011). While the article stated that homeopathy works no better than placebos, the letter argued that “evidence from meta-analyses and systematic reviews consistently shows that homeopathy is effective in certain conditions.”

Other reports have been equally contradictory. A major report from Switzerland was very positive in its verdict on homeopathy (Bornhöft & Matthiessen, 2012). In stark contrast, a major review carried out in Australia was completely negative in its conclusion regarding the effectiveness of homeopathic treatments (NHMRC, 2015):

There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered: no good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment. For some health conditions, studies reported that homeopathy was not more effective than placebo. For other health conditions, there were poor-quality studies that reported homeopathy was more effective than placebo, or as effective as another treatment. However, based on their limitations, those studies were not reliable for making conclusions about whether homeopathy was effective. For the remaining health conditions it was not possible to make any conclusion about whether homeopathy was effective.

Not surprisingly, the author of the textbook chapter is scathing in his assessment of this report (page 363, section headed “How Air Blows from Down Under”).

There seems little doubt that this controversy is set to continue for many more years.

Practice of Homeopathy

Practitioners of homeopathy have quite divergent viewpoints, as we shall now see. In particular, two types of homeopathic practice have evolved: classical and complex. Classical homeopathic practitioners prescribe a single remedy for the totality of an individual’s symptoms. That is, patients are evaluated, taking into consideration their mental, emotional, and physical symptoms. The symptoms are graphed against the associated homeopathic remedies, a process called repertorization. A remedy is selected that addresses all of the patient’s symptoms; this remedy is called a constitutional. Other considerations in assessment include responses of the patient to temperature, biorhythms, environment, food cravings and aversions, and family history.

In contrast to this approach, complex homeopathic practitioners use multiple remedies to treat a specific condition. Combinations of homeopathic remedies have become popular over-the-counter remedies and are often self-prescribed.

The well over 2000 remedies currently in use in homeopathic practice are prepared from plants, animal products, insects, reptiles, minerals, metals, and chemical compounds. How homeopathic remedies are prescribed varies between different homeopathic schools, some prescribing on the basis of the totality of symptoms, some on acute presentations; others consider the patient’s constitutional type or essential features, while still others use the disease agent itself in a dilute form to treat the disease. Sometimes practitioners will use electroacupuncture instruments to diagnose physiologic disturbance.

It is often claimed that as the vast majority of homeopathic preparations are non-toxic and free of side effects, the remedies may be administered and used by individuals who lack medical training. However, if symptoms persist, individuals should seek professional assistance.

Homeopathy is widely used in many countries. The system is very popular in France and Germany. It has a long record of use in Britain, where homeopathic hospitals and clinics have been a part of the National Health System. However, some health authorities in Britain have decided to stop paying for homeopathic treatment due to the lack of evidence of clinical benefit.

There is no formal licensing requirement for homeopaths in most of Canada. However, since 2007, homeopaths in Ontario must be registered with the College of Homeopaths of Ontario. The Canadian Society of Homeopaths, which was set up in 2006, acts as a professional organization that homeopaths may join. The organization requires that all members follow a code of conduct and practice. There are three colleges, all based in Toronto, that train students to become a homeopath.

In Canada, treatment by a homeopath is not covered by government-funded health care but is reimbursed by several health insurance organizations, such as Blue Cross.

Summary

There is great controversy over whether homeopathy is anything more than placebo treatment. Based on the theory of homeopathy and the extremely low doses of chemicals in homeopathic medicines, it can be predicted that these medicines will have no beneficial effect. But, surprisingly, positive results have been seen in many randomized controlled trials. This has led to much debate over the interpretation of these studies. This controversy can only be settled by well-designed RCTs.

Since the 1990s, there has been a resurgence of homeopathic treatment. It is a recognized system of treatment in many countries and is widely available without restriction.

Learning Activity

Self-test Quiz

Do the self-test quiz for Unit 12 as many times as you wish to check your recall of the unit’s main points. You will get a slightly different version of the quiz each time you try it. (This quiz does not count toward your final grade).

If you have trouble understanding the material, please contact your Academic Expert.

References