Thursday, May 15, 2014

The Substance of Homeopathy: Fact or Fiction?

I am pro-homeopathy. The following paper was written as a controversy analysis for a course at the University of Arizona; in this particular context, it provided me with the opportunity to take a look at both sides of a long-standing controversy within homeopathy: placebo or not. As far as I'm concerned, homeopathic remedies are effective and are not placebo. 
Did you know that Arizona is home to a college dedicated to the study of homeopathy, a controversial medical system? To elucidate briefly, homeopathy is a two-hundred-year-old medical system, using highly diluted natural substances as its medicines. In the United States, homeopathy falls into the category of Complementary and Alternative Medicine (CAM) as designated and regulated by the National Center for Complementary and Alternative Medicine (NCCAM), which is under the governmental direction of the National Institutes of Health (NIH). Homeopathy is, however, taught and used in other parts of the world; Great Britain, Denmark, Germany (the home country of its founder), France, Cuba, and India all currently teach and use homeopathy in various forms to a much larger extent than done here in the United States. The three prime reasons for its continued use around the world are that homeopathy is nontoxic, effective, and ranges from costing little to being relatively inexpensive depending upon how it is used and by whom.
A key unique component of the homeopathic medical system is its use of highly diluted natural substances, however, these remedies are also at the heart of its controversy. The remedies are controversial because non-homeopaths see them as merely placebos, defined as “an inert drug or substance given to satisfy patients, or as the control in a research study” (Yasgur). The attacks upon homeopathy by conventional medicine are nothing new, though, because the American Medical Association (AMA) has been leading the oppositional effort since it was formed in 1847, two years after the “first national medical society in the U.S. was founded—the American Institute of Homeopathy” (Ullman 43). While the on-going argument is a complicated one, involving education, licensing, access, methodology, quality control, and remedies, this essay focuses upon the remedial aspect and presents both sides of the placebo versus active substance controversy. What is it about these remedies that creates a situation in which organizations, individuals, and carefully conducted trials can disagree so vehemently about their effectiveness or lack thereof?
Large health care organizations represent both sides of the controversy. For instance, NCCAM opposes homeopathy. Although listing homeopathy as a complementary approach under its “other” category, NCCAM takes a stance against the general use of homeopathy. On their web site, under the article titled “Homeopathy: An Introduction,” the first key point listed states that “there is little evidence to support homeopathy as an effective treatment” (NCCAM). While they provide an overview with a brief history, as well as some statistics showing that “3.9 million [American] adults” used homeopathy in 2006, the greatest portion of the article focuses upon research, side effects, risks, and regulation of this modality (NCCAM). NCCAM is a government regulated agency that resides firmly in the arena of using scientific evidence to decide whether a CAM is safe and effective for public use, and uses this evidence-based approach to dissuade the public from using homeopathy—a method unscientifically proven—without first consulting their conventional health care provider. It relies upon statements of logic such as “several key concepts of homeopathy are inconsistent with fundamental concepts of chemistry and physics” and “it is not possible to explain in scientific terms how a remedy containing little or no active ingredient can have any effect” to negate homeopathy (NCCAM). So, even though NCCAM skirts an outright statement that homeopathic remedies are placebos, the overall tone of extreme caution is one that encourages the public to put their health care in the hands of conventional medical health care providers. In the thirteen articles NCCAM listed as references, three of those (23%) are by the same author, Edzard Ernst.
Along with other individuals, Edzard Ernst is an eminent opponent of homeopathy (Baum; Stenger). Ernst, a CAM doctor trained in homeopathy in Germany who practiced as a professional homeopath early in his thirty-year career, is often cited due to his prolific papers on this topic. Somewhere along the line, he reversed his views on the efficacy of homeopathy, which places him in a unique experiential position. Two relatively recent articles from 2009 and 2010 show Ernst’s current adversarial approach to any consideration of homeopathy as an effective complementary health care modality. In the co-authored article “Should We Maintain an Open Mind about Homeopathy,” Baum and Ernst ridicule not only homeopathy but also anyone who could be deluded enough to support such “an absurd concept that denies progress in physics and chemistry” (Baum). The words they use throughout the article—“absurd,” “faith-based,” “self-delusion,” “irrational,” and “broad conjectures”—could easily evoke emotions like embarrassment and shame, not to mention concerns about potential litigation by patients, in doctors who might consider using homeopathy (Baum). The authors conclude that homeopathic remedies are placebos that are ineffective, unethical, and dangerous to the public. In the 2010 article, “Homeopathy, a ‘helpful placebo’ or an unethical intervention,” one of Ernst’s strong points of opposition to homeopathy as an unethical modality due to placebo effect is “the possibility … that this might replace effective treatments” and, therefore, result in suffering and/or loss of life through “suboptimal” treatment (Ernst). This peer-reviewed article relies upon an appeal to the reader’s sense of right and wrong, and it confronts the audience boldly with whether they are committed to “medical ethics” (Ernst). Here, Ernst’s logical comments likely hit home because the journal is one specific to pharmacology and the tangible substances of science; he doesn’t resort to ridicule but maintains a professional tone. While these two essays use different rhetorical approaches, they both represent a conventional ideology that only scientific fact and evidence-based studies are to be used in health care. Given these strict preferences, Ernst and Baum state bluntly that, “our minds are too tightly closed when asked to consider the possibility that homeopathy is anything other than placebos” (Baum).
Because the issue of placebo is a major component of those opposed to homeopathy, there are studies that review other studies and trials, and some of them conclude that homeopathic remedies are placebos (Altunc; Shang). In the paper, “Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy,” Aijing Shang and his team present their findings after analyzing and comparing the results of equal numbers of trials.  This is a comparative study that provides an intriguing view of how medical trials are conducted and supports the perception of homeopathy as placebo. The authors were attempting to rule out any bias in both groups of studies and describe how they identify various forms of bias; the methods of selection and analysis used were strictly scientific and logical. One weakness in their strategy, however, was that the authors assumed a bias of their own when they stated as background for their comparison that the “specific effects of homeopathic remedies seem implausible” (Shang). In other words, when they established their study, they were already biased against homeopathy. In spite of this, or perhaps because of it, the conclusion of Shang and his team was that most of the homeopathic studies were faulty and showed placebo effects, while conventional medicine was clearly not a placebo.
In direct contrast to the NCCAM’s opposition, one of the oldest leading proponents of homeopathy and its non-placebo effect is the American Institute of Homeopathy (AIH), which was established in 1844 and has remained firm in its dedication to this medical system. All of its members have to be medically licensed so have both the training and code of ethics of the conventional medical paradigm (they are doctors, clinicians, and nurses), yet they also adhere to the standards of practice required by the AIH. The AIH endorses courses taught by the aforementioned American College of Homeopathic Medicine (AMCH), located in Phoenix, for the education of medical professionals. The institution also provides a framework for understanding how the philosophical assumptions within the system differ from those of conventional medicine. The AIH shows in the “AIH Guide to Homeopathic Research” that it is committed to basic science research and clinical research, and it provides extensive resources for exploring these endeavors. This is an important facet to the AIH since their members are medically trained and desire to work effectively within the health care provider system without having to constantly defend themselves against the accusations of so-called placebo effects. In the article, the AIH states that, “despite the findings of statistically significant positive results in well-controlled studies, some critics of homeopathic medicine assert that positive findings are due to a placebo effect” (AIH). Its transparency regarding the skepticism of the conservative medical community requires that the institute respond with concise professionalism intended to encourage readers to use their rational minds to consider the entire system of homeopathy. Since placebo accusations are at the forefront of most concerns about the use of homeopathy, the research section makes it easy to find peer-reviewed articles—from prophylaxis to veterinary research to agrohomeopathy—for those seeking further information.
In further support of homeopathy, from the individual perspective, is Kate Chatfield, a scientific research teacher at a university in Great Britain. Chatfield published an article titled “Progress in the Placebo Debate for Homeopathy?” and, as the title states, her focus is on whether homeopathic remedies are effective. She makes the bold statement that “Homeopathy is not controversial because it doesn’t work. Homeopathy is controversial because homeopaths prescribe medicines that are highly diluted” (Chatfield). This cuts to the quick of the issue because scientific researchers have yet to understand and prove according to their methods exactly how homeopathic remedies work. Chatfield points out that the debate is far from over because “many scientists and medical researchers believe the phenomena worthy of investigation.” She takes a practical view of homeopathy and the debate, citing “observation” and “demonstration” of its effectiveness as aspects not to be tossed away simply because science has yet to catch up with a way to show how the remedies work (Chatfield). She mentions a new medical analyzer that might have potential in this area. And so, while opponents of homeopathy prefer to see the remedies as placebos, Chatfield remarks that nothing has been resolved and the subject continues to be investigated.
Along these lines of investigation and research, the intensity of the debate recently increased when a paper was published that seemed to prove beyond doubt that homeopathic remedies are not placebo. Up until now, there have always been smaller studies that pointed to the effectives of homeopathy (Banerji; Davenas; Zanasi). The large trial, however, has added a dynamic component to the variety of smaller studies because of the sheer volume of people involved: 2.3 million citizens. Gustavo Bracho led the team in Cuba and co-authored the scientific paper “Large-scale application of highly diluted bacteria for Leptospirosis epidemic control.” This report detailed how using a specific type of homeopathic remedy called a nosode worked to significantly reduce the effects of an epidemic, a “decrease of between 91.8 and 65.8%” (Bracho). The entire process was carefully monitored by the government from surveillance of the population to preparation of the nosode for mass distribution to collecting data, analyzing the results, and comparing them to trends; this paper was firmly based in scientific logic. In fact, in a separate commentary essay about this Cuban trial, Helmut Roniger makes a point of stating that the use of nosodes for homeoprophylaxis (prevention) is a good research project because it removes the individuality factor which is usually prime in one-on-one consultations and is a source of conflict in other types of studies that skeptics use as proof of placebo.
The nosode study in Cuba is a grand example that is reflected in many smaller examples of the effectiveness of homeopathy when used with babies, animals, and plants. These three categories are usually considered by the medical establishment to be immune to placebo effects and yet they respond extremely well to homeopathy (Betti; Aboutboul).
There are many articles that take a stand on one or the other side of the placebo debate, but there are also a few papers that suggest simply maintaining an open mind (Bayley; Lehmann; Wick). One such neutral view on homeopathic remedies is that presented by pharmacist Jeannette Wick in her article: “Homeopathic Remedies: Fielding Patients’ Questions.” In this article which was published in a mainstream journal, Wick posits that, due to recent advances in science, what originally appeared to be nothing but water (the highly diluted homeopathic remedies) might indeed retain cellular-level particles. For, of course, the crux of the controversy is whether the remedies contain any “active ingredients” (Wick). The ever-present reference to various studies and trials is contained in the article, landing on the side of a placebo probability. However, Wick ends by suggesting pharmacists keep an open mind and at least understand the general principles of homeopathy, stating that “many allopathic medications have unknown mechanisms of action, and some have never been proved effective.” Thus, Wick provides a rare artifact in conventional medicine literature when she writes that homeopathy may not be a placebo at all.
In conclusion, the issue of whether homeopathic remedies are active stimulants or placebos is both an embarrassing thorn in the side of the conventional medical establishment and a frustrating barrier that directly affects those trying to help patients by using homeopathy. Without scientific proof of how the remedies work, a lot of time and energy is spent on oppositional research and defense when it could be better utilized improving the entire “package of care” for patients and recipients (Relton). While there are many medical professionals, especially those in the AIH, who are as eager to prove non-placebo as there are those who seek to dismantle homeopathy on the grounds of unethical placebo practices, there is also a huge faction of lay practitioners and self-prescribers who care less about scientific proof than they do the simple fact that they’ve seen and experienced the effectiveness of homeopathy. I am one of the latter, which leads me to a final question. Why does homeopathy continue to grow in popularity, having withstood the test of time, if its remedies are merely placebo?

Aboutboul, Ronit. "Snake Remedies and Eosinophilic Granuloma Complex in Cats." Homeopathy. 95.1 (2006): 15-19. University of Arizona Libraries. Web. 30 Mar. 2014.
Altunç, Umut, Max H. Pittler, and Edzard Ernst. "Homeopathy for Childhood and Adolescence Ailments: Systematic Review of Randomized Clinical Trials." Mayo Clinic Proceedings. 82.1 (2007): 69-75. University of Arizona Libraries. Web. 30 Mar. 2014.
AIH. “AIH Guide to Homeopathic Research.” American Institute of Homeopathy. AIH, n.d. Web. 30 Mar. 2014. < >
Banerji, Prasanta, Pratip Banerji, and Donald R. Campbell. "Cancer Patients Treated with the Banerji Protocols Utilising Homoeopathic Medicine: a Best Case Series Program of the National Cancer Institute USA.” Oncology Reports. 20.1 (2008): 69-74. University of Arizona Libraries. Web. 30 Mar. 2014.
Bayley, Carol. "Homeopathy." The Journal of Medicine and Philosophy. 18.2 (1993): 129-45. University of Arizona Libraries. Web. 30 Mar. 2014.
Betti, Lucietta, M. Brizzi, D. Nani, and M. Peruzzi. "Effect of High Dilutions of Arsenicum Album on Wheat Seedlings from Seed Poisoned with the Same Substance." British Homoeopathic Journal. 86 (1997): 86-89. Print.Baum, M, and E Ernst. "Should We Maintain an Open Mind About Homeopathy?" The American Journal of Medicine. 122.11 (2009): 973-4. University of Arizona Libraries. Web. 30 Mar. 2014.
Bracho, Gustavo, Enrique Varela, Rolando Fernández, Barbara Ordaz, Natalia Marzoa, Jorge Menéndez, Luis García, Esperanza Gilling, Richard Leyva, Reynaldo Rufín, la T. R. de, Rosa L. Solis, Niurka Batista, Reinier Borrero, and Concepción Campa. "Large-scale Application of Highly-Diluted Bacteria for Leptospirosis Epidemic Control." Homeopathy. 99.3 (2010): 156-166. University of Arizona Libraries. Web. 30 Mar. 2014.
Chatfield, Kate. "Progress in the Placebo Debate for Homeopathy?" Journal of Alternative and Complementary Medicine (New York, N.Y.). 17.8 (2011): 663-4. University of Arizona Libraries. Web. 30 Mar. 2014.
Davenas, Elisabeth, F. Beauvais, J. Amara, M. Oberbaum, B. Robinzon, A. Miadonna, A. Tedeschi, B. Pomeranz, P. Fortner, P. Belon, and al et. "Human Basophil Degranulation Triggered by Very Dilute Antiserum against Ige." Nature. 333.6176 (1988): 816-8. University of Arizona Libraries. Web. 30 Mar. 2014.
Ernst, Edzard. "Homeopathy, a "helpful Placebo" or an Unethical Intervention?" Trends in Pharmacological Sciences. 31.1 (2010). University of Arizona Libraries. Web. 30 Mar. 2014.
Fisher, Peter. "Homeopathy and the Lancet." Evidence-based Complementary and Alternative Medicine. 3.1 (2006): 145-147. University of Arizona Libraries. Web. 30 Mar. 2014.
Lehmann, Bianca, Brigitte Krémer, Katrin Werwick, and Markus Herrmann. "Homeopathy As Elective in Undergraduate Medical Education - an Opportunity for Teaching Professional Core Skills." Gms Zeitschrift Für Medizinische Ausbildung. 31.1 (2014). University of Arizona Libraries. Web. 30 Mar. 2014.
NCCAM. “Homeopathy: An Introduction.” National Center for Complementary and Alternative Medicine at National Institutes of Health. NCCAM, 2009. Web. 30 Mar. 2014. < >
Relton, Clare, Alicia O'Cathain, and Kate J. Thomas. “‘Homeopathy’: Untangling the Debate." Homeopathy : the Journal of the Faculty of Homeopathy. 97.3 (2008): 152-5. University of Arizona Libraries. Web. 30 Mar. 2014.
Roniger, Helmut, and Jennifer Jacobs. "Prophylaxis against Leptospirosis Using a Nosode: Can This Large Cohort Study Serve As a Model for Future Replications?" Homeopathy : the Journal of the Faculty of Homeopathy. 99.3 (2010): 153-5. University of Arizona Libraries. Web. 30 Mar. 2014.
Shang, Aijing, Karin Huwiler-Müntener, Linda Nartey, Peter Jüni, Stephan Dörig, Jonathan A.C. Sterne, Daniel Pewsner, and Matthias Egger. "Are the Clinical Effects of Homoeopathy Placebo Effects? Comparative Study of Placebo-Controlled Trials of Homoeopathy and Allopathy." Lancet. 366.9487 (2005): 27. University of Arizona Libraries. Web. 30 Mar. 2014.
Stenger, Victor, David Ramey, Mahlon Wagner, Robert Imrie. “Homeopathy and Science: A Closer Look.” University of Colorado, n.d. Web. 20 Mar. 2014.
Ullman, Dana. The Homeopathic Revolution. Berkeley: North Atlantic Books, 2007. Print.
Wick, Jeannette. "Homeopathic Remedies: Fielding Patients' Questions." Pharmacy Times. 79.11 (2012). University of Arizona Libraries. Web. 30 Mar. 2014. 
Yasgur, Jay. Yasgur’s Homeopathic Dictionary and Holistic Health Reference. Greenville: Van Hoy, 1990. Print.

Zanasi, Alessandro, Massimiliano Mazzolini, Francesco Tursi, Antonio Maria Morselli-Labate, Alexandro Paccapelo, and Marzia Lecchi. "Homeopathic Medicine for Acute Cough in Upper Respiratory Tract Infections and Acute Bronchitis: a Randomized, Double-Blind, Placebo-Controlled Trial." Pulmonary Pharmacology & Therapeutics. 27.1 (2014): 102-8. University of Arizona Libraries. Web. 30 Mar. 2014.


  1. Well done dear friend! A delicious read and nice intro to those interested in our art!