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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?
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>
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Well done dear friend! A delicious read and nice intro to those interested in our art!
ReplyDeleteThank you, Renate. Blessings!
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