I work at Glasgow Homeopathic Hospital. I’m a medical doctor, used to be a GP (Family Physician), but I became gradually disenchanted with prescribing only antis (anti-biotics, anti-depressants, anti-inflammatories, anti-histamines, anti-hypertensives……..you get the picture) and only having the time to focus on little bits of people instead of the people themselves (we call those little bits diseases by the way). I had perhaps strangely had a notion that being a doctor would be about being involved in healing (ever tried looking up “health” or “healing” in a medical textbook? Don’t bother. No such index items!) so just suppressing bits of people didn’t feel like what a proper doctor should be doing. On top of that there were situations every day where I just didn’t have anything good to offer (everything from infant colic, to night cramps, restless legs, sports injuries, PMT…….blah, blah, blah – believe me, there are LOTS of problems your doctor doesn’t have answers for!)
I happened upon a course in “Homeopathy” at Glasgow Homeopathic Hospital back in 1983 – didn’t know there was such a hospital and had no idea what “homeopathy” was anyway, but something about the ad caught my attention – wish I could remember what it was! – I think it was something that mentioned “healing”! Well, I signed up. I learned there about homeopathic medicines, how safe they were, and what their indications were and they gave us a wee box of 10 remedies to go and try out in our practices. Well, from the first try I was amazed at how good these treatments were. They could deliver improvements in conditions I hadn’t other answers for and that was VERY useful. Patients would stop me in the street and thank me for the prescription because it had helped so much – that NEVER happened when I prescribed an anti-something!
To cut a long story short, the patient demand for homeopathic treatment drove my learning and after I passed the Membership exam of the Faculty of Homeopathy I started working at the Glasgow Homeopathic Hospital in the Outpatient Dept every wednesday. Well, my wednesdays soon got an awful lot more satisfying than the mondays, tuesdays, thursdays and fridays, so I had a crisis. All my life I’d wanted to be a doctor, no, not just a doctor, but a GP, and here I was thinking I don’t want to be a GP anymore. So I stopped being a GP and for a few months did a weekly radio show on ScotFM, wrote a textbook of homeopathy for GPs, and did my wednesday clinics. After a few months my friend and colleague, David Reilly at the Homeopathic Hospital suggested we make a bid for the creation of full-time position for me at the hospital. I started there full-time in 1995 and I’m still there. I love it! Every single day, every single clinic, every single patient. I look forward to every day of work. How many people can say that?
So what do I do there? What’s this homeopathy?
Everyone I see there has been referred by another doctor or nurse. Everyone I see has a chronic problem – everything from chronic pain, to allergies, skin problems, cancer, multiple sclerosis, psychiatric problems like depression, bipolar disorders, you name it. I see a lot of kids. Almost half my practice is treating children. The thing most of these people have in common is that they’ve already tried the drugs, surgery and so on recommended by other doctors but they’re still not well, still suffering. Amazingly, our in-house audits consistently show that across the board, after receiving homeopathic treatment, around two-thirds of these patients claim a benefit which makes a difference to their daily lives.
So, no wonder it’s such a treat to work there. Most of the patients get benefits from the treatments which they didn’t find elsewhere. That’s hugely satisfying if your goal in life as a doctor is to try and relieve suffering.
Ok, enough, you’re probably thinking, what on earth is this homeopathy thing anyway?
Dr Samuel Hanhemann, was a German doctor who lived from 1755 – 1843 As a young doctor he soon grew disenchanted with the practice of medicine of his day – he thought that blood-letting, cupping, leeching, purging and poisoning patients was pretty brutal and didn’t seem to actually heal anyone. So he stopped being a doctor and to earn some money he translated textbooks into German. One day he was translating Cullen’s Pharmacopoeia from English into German and he read about the treatment of swamp fever with Peruvian Tree Bark. Cullen said this drug worked by being an “astringent” ie it dried the body up. Hahnemann, wondered if that was right, so to test it out, he took some. Much to his surprise, he found that he got all the symptoms of swamp fever. How interesting! The drug which can cure the disease can produce the same disease when given to a healthy patient (that’s not exactly true but it’s how he saw it). He then tested a bunch of other common drugs of the time and found the same phenomenon. He called this “the treatment of like cures like” – “homeopathy”.
Does this make sense? Well, yes it does. There’s a phenomenon we know called “hormesis” – where a drug which has one effect at a high dose, has an opposite effect at a low dose. Think of aspirin. In high doses it makes the body temperature rise, yet in low doses it can lower a fever. Professor Bond, pharmacologist in Houston coined the term “paradoxical pharmacology” to describe this phenomenon and even created a receptor theory model to explain it. Nothing really controversial here. Let’s move on.
Hahnemann thought that doctors shouldn’t be poisoning their patients so he decided to find out what was the smallest possible dose of a medicine which would bring about a healing effect (when prescribed on the basis of this like treats like idea). There weren’t any drug companies in those days so doctors had to prepare their own medicines. Hahnemann used a method of serial dilutions and succussions to make his medicines (that’s a stepwise series of dilution of the original substance with vigorous shaking of the test tube between each dilution). He got another surprise. Not only did the smaller doses cause less harm, they actually seemed to cure quicker! The more dilute preparations had a more powerful effect! OK, I hear you say, enough’s enough. This is crazy thinking! Well, it gets worse. Cos he pushed this dilution theory way up to 1 in 10 to the power 30 and beyond – trust me, I’m a doctor – that means there are NONE of the original molecules left! Now THAT is controversial! In fact, its at this point where some people start to say homeopathy is sheer nonsense and can’t possibly work!
Would it surprise you to know I disagree with that view?
You might want to go check out the scientific research in homeopathy. I recommend you start here. In short, there are many clinical trials of homeopathy and many have shown effects of homeopathic treatments that cannot be dismissed as placebo. Something seems to be happening and its probably not placebo. In fact the clinical trial evidence in homeopathy is not very strong and doesn’t really answer any of the questions about this treatment so we need to look elsewhere. Elsewhere includes what are known as outcome studies. These are studies of what actually happens to patients who have homeopathic treatment (not comparing this to placebo medicines). Consistently such studies show around two out of every three patients get benefits from homeopathic treatments. So, however you explain it, for most people it does exactly what it says on the tin – it helps. What about the idea that such ultra-high dilutions can have a consistent biological effect? Is that nonsense? Well, interestingly, there have been a number of laboratory studies in recent years which show that water does indeed have the capacity to communicate specific effects of substances which have been diluted in it many times. This is early work but it shouldn’t be dismissed.
But what IS homeopathy?
Homeopathic medicines are prepared from natural substances – plants, minerals, substances of animal origin – all of which are serially diluted and succussed many, many times to prepare the actual medicines. Every single medicine has its own unique picture of symptoms as described in homeopathic materia medicae – these are reference books based on clinical trials (called “provings”), clinical experience and toxicological information about the substances. The idea is that the picture of the remedy should match, as closely as possible, the picture of the patient’s illness (actually I prefer the concept of the “narrative” as opposed to the “picture”).
The narrative of the patient’s illness reveals their unique experience (no two people with the same diagnosis have the same narrative) and it reveals their patterns of coping (and failing to cope) – this is what we are looking for in selecting a specific homeopathic medicine – the narrative of the experience and the patterns of coping. When the patient takes the homeopathic medicine the intention is to stimulate their processes of self-repair, self-recovery and self-healing. The intention is NOT to suppress but to heal. The medicines themselves are non-toxic – they have no significant side-effects, a record over 200 years of absolutely NO fatalities, and can be safely taken in conjunction with other prescribed medication.
I’m a math teacher and I was wondering if you could enlighten your readers as to how many atoms of the active ingredient are in a “typical” dilution.
Perhaps you could mathematically show if there is a single atom in a litre of water, an olympic size swimming pool, or even a volume of water the size of Earth’s oceans, or even a sphere of water the size of our solar system. I realize that homeopathic belief is that even without single atoms of active ingredient, there is still the magical “essence” left, but then every drop of water on the planet would have the same essence.
I’m also curious that you are proud about the fact that homeopathy has been around for about 200 years, yet it has not evolved like other evidence-based medical practices. Mainstream medicine has drastically changed in the last 200 years in every imaginable field based on many trials and the concensus of the medical community.
I do not expect that there could be any difference in the LD-50 (lethal dose for 50% of the population) of homeopahtic remedies and water itself. Hyponatremia with homeopathic remedies would just cost a lot more.
such great information, and it stimulates me to want to find out more. Thanks!
Hello Jeff,
I detect a certain “tone” in your comment. I suspect you don’t approve! However, if you seriously want to engage in a positive and rational debate I’m up for it. If you don’t then let’s just agree we don’t share the same values in the world and go our different ways.
Let me say first of all that I’m not a math teacher, I’m a doctor. My daily challenge is to do my best to understand the patients who consult me so I can hopefully help them find both some relief from their suffering, be that pain, depression, itch, breathlessness or whatever AND see if I can help them to have a better experience of health. (you can see what I mean by health elsewhere on this blog – you’ll see it means more to me than the mere absence of disease). What that means is that my priority each day is to do my best for each individual patient I see. I’ve been in clinical practice since 1978 and with the passing of the years and the challenges I’ve faced I’ve been confronted with the fact that human beings are complex – they don’t do well with one-size-fits-all medical interventions. I’ve also recognised that the symptoms which matter to people (like pain for example) are subjective and ONLY the patient can tell whether or not a particular treatment has worked for them. The patient is the one with the expert knowledge about their illness and their life, not the doctor. What I’m trying to say is that life is messy. It’s not like math. And medicine is messy and complicated. There is way more any of us don’t know than we do know about life! If my patients tell me they get relief from the treatments I give them that means a lot to me. I wouldn’t presume to say they are wrong.
So this is my starting point – the human one. I practice the particular form of medicine I do every day because it works. The patients are the judges.
However, I’m not saying all doctors should do what I do! I am grateful for the skills of my colleagues who have specialised in other treatment modalities. We need them too.
You think that the treatment modality I employ hasn’t evolved in 200 years? You think I am not a reflective doctor who doesn’t keep my knowledge up to date? That I don’t develop my skills over the years? You are wrong. On all these counts. So please don’t assume what you don’t know.
Yes I am proud of my practice. Very. But I believe I can improve it. All the time.
Before you get carried away with thinking that all other medical practices are evidence based maybe you should go check that out. Have a look at http://www.clinicalevidence.org and you’ll see that even with the 2500 treatments covered there, 46% are of “unknown effectiveness”. And that really doesn’t include surgical treatments, physiotherapy and talking treatments like counselling and psychotherapy, none of which lend themselves well to analysis by the EBM methods used to assess drugs.
I don’t have all the answers.
I don’t claim to.
But I am a rational, reflective and considerate doctor. The patients I see matter to me. I want the best for them and I’ll do what I can to help them make informed decisions about their care.
Let me now address your initial query. The homeopathic medicines have NONE of the original molecules of the starting substances present. NONE. Does that mean I think they cannot convey useful information to the patient? No. That’s where this so-called “memory of water” idea comes in. Have a look at http://www.trusthomeopathy.org for a great summary of the research evidence in homeopathy – clinical and laboratory. Oh, and one final thing – one of the strange things about the placebo controlled trials in homeopathy is that they frequently show DIFFERENT responses in the two groups (yes, most trials are underpowered so these differences don’t reach statistical significance) but the two groups are often NOT the same. I think you are wrong to assume that water and a homeopathic medicine are the same. To understand even water better we need to know about the behaviours of the molecules not just their identity. I don’t think it’s got anything to do with “magic”.
Sorry.
This has been a rather lengthy reply to your comment but I think your challenge deserves that.
I would genuinely appreciate your reasoned response.
Hello again. I do find your blog engaging, and this post particularly.
I think Jeff’s trying to say why has mainstream medicine left alternative (or accurately, original) medicine in the dust? The truth is money.
I have a considerable amount of respect for mainstream medicine as a number of drugs I’ve taken have worked for me, and I believe there’s no suitable solution in nature for some of them – not all.
But, the thing about drugs is patents – ingredients which often contain a synthetic portion which can be be profited from. This is why I believe animal testing has become essential because safe ingredients aren’t tested first, and of course physiologically we aren’t always the same as other animals.
Mainstream medicine therefore has the financial muscle to influence the health industry. It’s like saying McDonald’s must be better than a health food shop because they sell more.
It would probably be sane in cases where a natural remedy exists for the natural remedy to be tried first to save money and save side effects. What’s the harm?
But there’s more money in making an alternative to air than selling air!
I used to be very sceptical of natural medicine/homeopathy, and although I still nod at mainstream achievements, I do believe that it’s business first and patient second. And it makes me wonder just how many accepted treatments are best replaced by natural ones.
It’s not so hard to swallow that if nature can start certain diseases that nature too can cure them. The placebo effect to me is simply an additional factor to all medicines, that a positive mood is a healing glow for the body.
Thanks a lot for this post. I asked you for it, and glad you responded.
mo79uk, thank you for this comment. Eloquently written and spot on. I really do think Hippocrates was right when he said “First do no harm” and I think that particular instruction is often forgotten (see my post on drug harms and deaths). Doctors should always put the interests of the patients first and that includes helping patients to make informed decisions about treatments in terms of potential harms and potential benefits.
You know, medical treatments don’t actually cure – only nature does! (As Franklin said “God heals and the doctor takes the fee) Medical treatments at best support this phenomenon. We doctors often forget that.
Finally thank you for reminding us that the placebo effect is an integral part of ALL therapeutic interventions – its not an alternative. We don’t understand it as a phenomenon and I suspect there is so little research into it because it can’t be patented.
Sugarmouse…….you’re welcome.
I am actually at a loss as to how we could have a rational debate. When you accepted that there are NONE of the original active ingredients remaining in the medication, the theory of homeopathy has lost any remaining plausibility. I’m not interested in debating placebo effects – I accept it has a strong influence on self-limiting afflictions.
A student of mine once asked me how you could tell two homeopathic remedies apart if the lablels fell off. I replied that since there are no molecules of the active ingredient left, it would be impossible to do any sort of scientific investigation to test for things that are not present.
If the premise of an alternative medical modality is not based on the natural world, but relies on the paranormal (water memory that is outside of the nature of atomic physics), then it cannot rationally be debated.
Debates on things that are not based on science, reason and logic are possible, but I leave those to debates to things like “Who is faster – Superman or Santa?”
One final thought, homeopathy cannot harm people because it does not actually do anything to the patient. Where it can potentially cause harm, is where a patient will choose homeopathy as a first course of treatment instead of seeking proper medical treatment. For example, Methicillin-resistant Staphylococcus aureus needs to be effectively treated with science based medicine.
Ah well, Jeff, we just have to differ. I wish you well in the world of maths.
You choose to take the attitude that if its not explainable on your terms it can’t exist.
The patients I see every day tell me what takes their pain away. THEY tell ME whether or not they are still depressed. THEY tell ME whether or not their lives are better. I don’t presume to tell them they’re wrong because I can’t explain how a treatment works.
Thank you for your final thought. All doctors should do their best. Doctors need to know what treatments are best indicated for each individual patient. We don’t differ there.
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Thanks a lot for providing research links for homeopathy !
You are most welcome Dr Tandon
Thanks alot sir, i think few technologies or part of science has still to come to prove homoeopathy scientifically….till now we see d differences in patients which is surely much much more important 4 us rather than 2 prove….homoeopathy is “one patient one medicine show” so why people expect it to be proved on mass level….keep posting sir….wish u all the very best.
Admittedly, I’ve just scanned your post here, but I like your attitude — your dislike of the “anti’s” and I admire that you found something better — more aligned with nature. I’ve tried a wide variety of natural or alternative therapies, supplements, diets, etc. since the 70’s…can’t say that I’ve given homeopathy that much of a chance, although I have tried it. I just didn’t see any noticeable effect, perhaps I was impatient.
I also would like to interject my take regarding the placebo effect. I believe it’s much more than just a positive attitude. Much more. The mind-body connection, prayer, wishful thinking, whatever ya’ wanna call it, I truly believe and have come to observe in my on experiences that if we can convince the body with our mind and heart (the combination is crucial) that something is the truth, then is becomes the truth 🙂 I’ll spare you the biblical quote 😉 I haven’t the slightest doubt that we have this power within us. And there are many little hints to the truth of it (the placebo effect, the mind-body connection, studies showing that “prayer” works). It’s all the same thing, not about religion or “God,” it’s simply the literal energetic power of “belief.”
Excellent Sir. Every Homoeopath as well as all those Allopaths with Lancets should read this. Especially all those Homoeopaths who are practising Allopathy for various reasons.
Please keep up the good work Sir.
Thank you Drs Ahmad and Patel. Dr Ahmad, I completely agree with your lovely phrase “one patient one medicine show”! Nicely captures our daily work and our priorities – every single unique individual person every single day! Dr Patel, I suspect a lot of Lancet readers wouldn’t approve! However, I’m happy to share that learning homeopathy allowed me to become the kind of doctor I always dreamed of being, and even if they never, ever practiced homeopathy, I think every doctor could learn something useful for their practice from the challenges the method presents.
Thanks for your thoughtful comments dovelove. I so agree about the so-called placebo effect. It’s terribly misunderstood and very, very poorly researched. Such a shame really. Many people dismiss it as inconsequential or even “not real” but it’s actually incredibly powerful and I’m sure is a manifestion of our capacity to self-heal.
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