Why homeopathy and what is it anyway?
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.
What motivates the critics?
There’s a campaign going on against homeopathy. It amazes me to discover the lengths that critics go to in their attacks and as a health care professional I find it especially disappointing to read, not just a lack of respect for the views of others, but the sheer contempt and even vitriol which is used in some of the language they use.
What I don’t understand is what motivates them to get so upset and active?
Nobody has ever died from the direct effects of a homeopathic remedy; the medicines are not dangerous (unlike prescribed pharmaceuticals, which are recorded being responsible for around 1,000 deaths a year in England alone – with estimates that this represents only 10% of the true figure).
The so-called risks of homeopathic practice are nothing to do with homeopathy. They are due to the practice of medicine by people who are unregulated by the state. In the UK, it’s illegal to practice medicine on cats and dogs unless the practitioner is a regulated vet. However, there’s no equivalent laws for humans. If the critics are concerned about patients being denied effective drug or surgical treatments, then they should be concerned about regulation, not homeopathy. Homeopathic practice by trained doctors, dentists, nurses, vets and other statutorily regulated practitioners who have achieved the Faculty of Homeopathy’s qualifications does not carry an increased risk of misdiagnosis, or denial of relevant treatment, over and above those risks inherent in every single practitioner (nobody is infallible)
It’s not that it’s expensive. The NHS spends around £6 million a year on homeopathy provided through the five NHS homeopathic hositals. To put that in perspective, the estimated hospital inpatient costs of dealing with patients who are experiencing severe adverse effects of drugs prescribed in England is £466 million a year. And in 2005, an estimated £320 million was paid by the NHS in England to management consultants. If the critics were genuinely concerned about the financial implications of patients being denied “proven” treatments, they really aren’t going to make much of a difference by ridding the NHS of homeopathy (£6 million out of a £7.2 billion drug bill? Isn’t that about 0.008%? Does that rate as a significant effect?). Nope, they’d be better off putting their energies elsewhere. It can’t be the economic argument that gets them up out of bed in the mornings!
So what is it?
Well, it seems that what bothers them is that they can’t explain how it works. In fact, the issue of ultra-high dilutions having biological effects is, to them, plainly ridiculous. As Michael Baum clarified in today’s Lancet, “the reason we started this campaign was out of a sense of despair over a malaise in society, a flight from rationalism.” Is that enough to make someone agitated? Goodness, philosophers have argued over the centuries about the ways we perceive the world and make sense of our lives. Rationalism’s got a lot going for it (I’m pretty keen on it myself), but it’s not the be all and end all of existence for everybody (and the alternative to rationalism, by the way, includes non-rationalism, not simply irrationalism!)
And here’s another thing I don’t understand. We all know that most “proven” medicines don’t work for most people. It was no other than Dr Allen Roses, Vice President of Glaxo SKF who stated that
“the vast majority of drugs – more than 90% – only work in 30 – 50% of people. Drugs out there on the market work, but they don’t work in everybody”
He’s absolutely right. It’s a common experience for a patient to take one tablet for, say blood pressure, only to find it doesn’t work for them, then take a second one, only to find that doesn’t work either, and so to end up on yet another. You can say that about any condition and any drug. That’s why there are so many different painkillers on the market, so many different laxatives, so many different antidepressants and so on – there isn’t a single drug on the market that works for everyone. The dilemma of health care planners should be, “what do we offer those patients who have tried everything and are still stuck with their original problem?” Most people who attend the NHS homeopathic hospitals are in this very category. Two thirds of the patients who receive homeopathic treatments at these very hospitals claim it benefits them. But the critics say that they know better than these patients. They say, oh no, you can’t really have benefited because we know homeopathy can’t work. You must be deluded! You must only think you have benefited. Well, I’m sorry but in my consulting room, the most important person is the patient. Only they can tell me of their suffering and only they can tell me, as most did this week, that since they received homeopathic treatment, their suffering is less. Two thirds? Yes. All the NHS Homeopathic hospitals have similar experiences – most of these patients get benefits from their treatment, having failed to get benefits from their previous treatments.
And isn’t that what health care is about?
Reducing suffering? Increasing health?
So, what’s all the fuss?
Why attack a therapy which apparently helps two thirds of the patients who receive it, which has never killed a single person, and which costs so little?
Jeanette Winterson, writes in the Guardian today about this –
This homeophobia is, I think, a genuine terror of what homeopathy is suggesting; which is that we think differently about the relationship between the cure and the disease. It is not enough to say Disease A is caused by B and can be cured by C. Homeopathy, in common with other holistic approaches, asks that we look at the whole picture – the person, and not just his illness. Specifically, in the case of homeopathy, the remedy picture, which is carefully drawn up after full consultation with the patient, follows the “like by like” premise – that tiny dilutions of the “problem” can prompt the body to effect its own cure. This is why the homeopathic code of practice does not talk about the medicines themselves having a simple causal effect – C cures A. Homeopathy seeks to understand everything we are, everything we do, as a web of relatedness. The reason why I have a recurring sore throat will not be the reason why you have one, and what helps me may not help you.
Is she right? Is that the problem? Because it changes the focus from the disease to the patient? I’m not so convinced by her argument. Good general practice has been taught and practised on this premise for years. That homeopathy is non-linear? Well, I’m not so sure. I think that human beings can be understood as complex adaptive systems, and one of the characteristics of such systems is non-linearity. But this isn’t a particularly homeopathic concept. It’s a scientific one.
Evidence Based Practice
Let’s look at the issue of evidence, because this is a common line of attack – that there is “no evidence” that homeopathy works. Well you know, I think the my evidence is bigger than your evidence debate is rather stale, but suffice it to say that, yes, I have read all the meta-analyses and I’ve read clear conclusions such as the results “were not compatible with the hypothesis that the effects of homoeopathy are completely due to placebo” (this was published in the Lancet in 1997 – the one meta-analysis that Ben Goldacre doesn’t reference in his column in the Lancet today) In addition there are several other systematic reviews published in peer reviewed journals which focus on particular medical conditions and which have been positive for homeopathy. A good summary of the evidence base is on the Faculty of Homeopathy’s website.
But the point about Evidence Based practice, as pointed out by David Tovey, the Editorial Director of BMJ Knowledge, is
that evidence should be only one influence on clinical decision making, alongside the expertise and perspectives of both patients and clinicians. However uncomfortable for health system planners an evidence based service should reflect expressed patient preference.
This is exactly what Professor Sackett said when he laid out the basic principles of EBM. One of the main reasons for taking into consideration the patients’ views is that only the patients can tell us whether or not a particular intervention has helped them (irrespective of the experimental research findings which have been published)
As I said at the outset, what’s the problem?
Does it really come down to a few people upset that a treatment which their beliefs tell them can’t work, apparently does (according to the real people who have actually experienced it)?
Patients have a right to choice in health care, because people are different. Even people with the same diagnosis will have very different experiences of that disease and quite different prognoses. They will frequently benefit from totally different interventions. Ousting a safe, inexpensive form of health care from the NHS will not improve the lot of patients. Promoting one-size-fits-all treatments doesn’t strike me as rational. Diversity is a healthy ecological principle. It’s time we valued human beings more highly than systems and technologies in health care. Homeopathically trained doctors are typically passionate about trying to understand patients and to relieve their suffering. They are amongst the most caring, empathic and committed doctors I’ve ever met. I don’t think the NHS would be better off without them.