How does homeopathy work?
In the UK, today marks the start of Homeopathy Awareness Week. This is an annual event and this year’s theme is a natural approach for the symptoms of hay fever.
So how does homeopathy work exactly? The site states: “Scientifically it can not yet be explained precisely how it works, but new theories in quantum physics are going some way towards shedding light on the process.” So, basically they don’t know.
What we do know is that the substances involved contain nothing that can have any pathological effect. The site explains that: “Homeopathic remedies are a unique, potentised energy medicine, drawn from the plant, mineral and animal worlds. They are diluted to such a degree that not one molecule of the original substance can be detected.”
I’m currently reading “Bad Science” by Ben Goldacre. He devotes 35 pages to a demolition of the nonsense that is homeopathy.
Of course, like all of us, I’ve met people who are adamant that homeopathy works. Of course, for some people it does ‘work’ – but it works no better than a placebo because it is a placebo.
June 15th, 2009 at 11:24 pm
Don’t know much – but do know Arnica works for making external bruising lessen quickly and witchhazel was and still is great for cold sores. But maybe it’s because I am gullible, but as the old saying goes – if it works it works – never mind how. We are still living and learning and there is much more to be learnt. Roger you have an open mind – don’t close it.
June 17th, 2009 at 8:51 pm
Wikipedia states: “The homeopathic use of arnica, however, has been found by multiple studies to be no more effective than a placebo. The fact that homeopathic studies of Arnica have even been the subject of published clinical trials has drawn criticism on the grounds that the basic premise of high dilution used in homeopathy is inherently flawed.”
June 18th, 2009 at 5:17 am
Why should we, as Roger urges, trust scientific studies over our own experience?
Like Mavis and many other people, I suffer from occasional cold sores. They can last anywhere from a day to a week. I’ve never tried homeopathic treatments — in fact, I don’t use any treatment! — but if I did try homeopathy I’m not at all confident I’d be able to judge its effectiveness.
Suppose I’ve had a cold sore for a day. I take a homeopathic witchhazel preparation and it goes away a day or two later. Does that prove witchhazel is effective. No, because cold sores go away anyway without treatment; I should know!
OK, so maybe I need to compare witchhazel against no treatment at all. Every time I get a cold sore I’ll decide at random (e.g., by tossing a coin) whether to treat it with witchhazel or just let it heal itself. Why do I need to decide at random? Because otherwise, knowing that some cold sores will be more severe than others, and having some ability to recognise at the outset which ones might be more severe, and being keen to prove the effectiveness of witchhazel, I might unconsciously choose to treat the less severe ones with witchhazel while letting the worst ones recover on their own. Voilà — very soon witchhazel would appear to be more effective than no treatment! It’s no use saying you wouldn’t do that! It’s a human frailty. It needn’t imply conscious deception. I’m not sure I wouldn’t be biased in that way, and I don’t even believe in homeopathy! (Or I might be biased the other way — against witchhazel.) To quote the great physicist Richard Feynman, “Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool.”
So I toss a coin to decide whether to treat each cold sore. I’ll need to wait for many cold sores before I have enough data to analyse. I’m not a statistician, but I’m pretty sure you’d need at least a few dozen trials before you could decide with any degree of certainty whether witchhazel is an effective treatment. This implies I’d need to keep careful records. I need to guard against the very human tendency to remember the times when witchhazel appeared to help while conveniently forgetting or excusing or downplaying the occasions when it didn’t.
Suppose after, say, 50 trials, I analyse the data. What does it show? Very likely, it would show that homeopathic witchhazel is indeed effective at treating cold sores! Or, I should say, it would appear to show that. Alas, there are at least two confounding factors at play.
One is the well known (yet still somewhat mysterious) placebo effect. The very act of taking a pill or receiving an injection or having a bunch of needles theatrically inserted into you can have a significant healing effect for some ailments. Even the colour of the pills matters! Green pills are more effective for anxiety than red, and four sugar pills a day will clear up ulcers quicker than two sugar pills. Placebo is about the cultural meaning of a treatment, our expectation, and more.
The other confounding factor is that, of course, I was aware whether I was treating myself with witchhazel or whether I was letting the cold sores heal on their own. This is another opportunity for unconscious bias to creep in. Deciding when a cold sore is healed is not a simple yes/no question. There are gradations of uncertainty. Maybe one morning I examine my lip and it’s borderline whether it has healed yet. How tempting, if I am anxious to prove the efficacy of witchhazel, to record that — yes! — this morning the cold sore has gone. That’s only 3.5 days! Conversely, if I know I have not been treating myself, how tempting to conclude that I need to wait a little longer “just to be sure.” Maybe until 3.75 or 4 days. Again, it’s a human frailty. The history of science (and not just in medicine) is replete with examples of people falling prey to just such unconscious bias. And learning how to avoid such bias.
So, how to avoid these two confounding factors? Firstly, instead of comparing witchhazel to no treatment at all, I should compare it to a placebo treatment, such as a sugar pill. But I must not know, when I take it, which is the witchhazel and which is the placebo; if I did, the placebo might lose its effect! (If I expect the witchhazel to work, I might experience a strong placebo effect; on the other hand, not expecting a simple sugar pill to work, any placebo effect is likely to be much weaker.) (I’m assuming here that homeopathic witchhazel is taken as a sugar pill; whatever, the placebo treatment needs to be indistinguishable from the homeopathic treatment, to the patient.)
So I need a stock of witchhazel pills and simple sugar pills from which to choose at random. They must appear indistinguishable to me, but ultimately of course somebody needs to know which is which! One way to achieve this is to code the pills beforehand so that I can tell later which I took. I might have someone help me with this, but it’s important that they too don’t know which pills are which at the time; if they did, they might unconsciously convey that information to me — in their manner, in their eyes, in their expression… It’s hard to hide such knowledge completely, even when you’re trying. Just a small leakage of information could bias the results sufficiently to give a false positive; i.e., that witchhazel is effective when actually it isn’t.
The above arrangement also neatly solves the second confounding factor. If I do not know whether I have taken a witchhazel pill or a placebo pill, I cannot be biased in judging when the cold sore has healed!
All in all, this is quite a complicated arrangement just to determine whether homeopathic witchhazel is an effective treatment for cold sores! Yet each step is necessary. As I said, the history of medical trials demonstrates the need for taking the placebo effect into account, for blinding the patient (so I do not know which pill I have taken), for blinding the experimenter (neither does the experimenter, until later), and for carrying out a large number of trials. There are other confounding factors that must be taken into account, too. Medical research, at its best, is an organised way of not fooling yourself!
All of these considerations illustrate why we should trust scientific studies over our own personal experience. Even if I tried homeopathic witchhazel a dozen times for my cold sores and it appeared to work, I wouldn’t be confident it really was better than placebo. How can you be sure, Mavis?
I recommend the book Roger mentioned, Bad Science by Ben Goldacre, to explain these issues and many others much more clearly and in greater depth than I can. Goldacre also discusses the ethics of placebo — is it ethical for a doctor to prescribe a treatment knowing there is no evidence for its efficacy, relying purely on the placebo effect? Medical ethics is moving towards the position that this approach is too deceptive and paternalistic and corrosive to the doctor/patient relationship to be acceptable.
June 18th, 2009 at 8:50 am
Excellent description of evidence-based assessment of treatments and interventions, Nick.
The double-blind, randomised features that you describe are at the heart of the medical trial in which I am currently participating – see here.
June 18th, 2009 at 8:58 pm
A good article on evidence-based medicine: Barriers To Adoption of Science-Based Medicine. One interesting quote:
June 19th, 2009 at 12:38 am
Nick
I am not sure – I just know it seems to work for me. Maybe I am gullible and maybe it is mind over matter – but really I just want rid of the cold sore and bruising.
On the cardiac stent – my mate in Glasgow was offered a trial on tablet medication instead of a stent for six months. (Closely monitored).
The six months has passed and they have decided to keep him on the pills. He does not know what happened with the others who are taking part in the trial. So maybe it will not take a decade.
August 7th, 2009 at 12:03 pm
Real (homeopathic) medicine cures even when Conventional Allopathic Medicine (CAM) fails
November 28th, 2009 at 5:57 pm
Hello Nick
What would your reaction be, if after treatment with homeopathic medicine, you never get cold sores ever again?
I think you should consult a good doctor and then comment on homeopathy.
November 29th, 2009 at 2:37 pm
Hello Iqbal,
Actually, I was commenting not so much on homeopathy but on the difficulties of assessing medical treatments. The confounding factors I mention above — plus many others — are relevant to assessing any medical treatment, not just homeopathy. That is why, as Roger was urging, we should trust scientific studies over our own experience.
This feeds nicely into your hypothetical question… If I did not get a cold sore for a considerable period (say, 10 years) after homeopathic treatment, I would wonder whether that was due to the treatment or whether it might have happened anyway. Maybe recurrences tend to become less frequent with age, regardless of treatment? The best way to find out whether the homeopathic treatment was truly effective would be to set up a long-term scientific study.
December 15th, 2009 at 6:38 pm
Evidence-based modern homeopathy is the scientific revolution (fastest growing medicine in the world) in the 21st century
December 20th, 2009 at 11:49 am
Homeopathy is non-toxic system of medical science originated in Germany by Dr. Friedrich Samuel Hahnemann (1755-1843) (the founder and father of homeopathy). He was M.D. in conventional medicine. The term “homoeopathy” was coined in 1807.
The four fundamental principles of Homeopathy are: –
1. Law of similars/Like cures like (1796): Disease can be cured by a medicinal substance given in micro doses that produces similar symptoms in health people when given in large doses.
2. Law of minimum dose (1801): Since the homoeopathic medicines act at a dynamic level, only a minute quantity of the medicine is administered which is enough/sufficient to stimulate the dynamically deranged vital force/innate healing powers to bring about the necessary curative change in a patient
3. Law of simplex (1810): At any given time, only one remedy can be the exact similar to the presenting disease condition of the patient. So a single remedy (one remedy at a time) is given based upon their constitution/totality of the symptoms which includes physical, mental, and emotional aspects/symptoms.
4. Hering’s law of five directions of cure (1845): Cure progresses from above downwards, from within outwards, center to periphery, from more important organ to less important one, in reverse order of coming of the symptoms
January 25th, 2010 at 2:14 pm
Hello Nick
Do you have scientific explanation for EVERYTHING that happens around you today? Many existing theories of science would become defunct in the not so distant future as better investigative procedures get developed?
Just because the process of homeopathic medicine’s action cannot be explained by the conventional theory of chemical action does not mean the system is suspect.
For that matter can you name 2 drugs developed in the allopathic system of medicine that have an age of over 20 years? All drugs have been discontinued- not because a better drug was discovered but because the full impact of the drug made it necessary for it to be banned.
The major failure of the homeopathic system is the low cost of treatment.
1. The cost of producing medicine is small.
2. The treatment method does not require expensive investigations.
3. The cures affected are permanent and do not require repetitive medication.
Why would many doctors, corporations or lawyers (no side effects-no legal fees) be interested to be associated in an activity where money is difficult to come by? The system that does not generate money dies over a period. If the homeopathic system is alive and kicking, it is only because of the benefits it offers and the many people who cannot afford the expensive conventional system.
Frankly, does it matter to you if you are permanently cured of your cold sores by homeopathy and you continue to debate if it was because of age being on your side?
February 3rd, 2010 at 10:34 pm
Dear Dear Dear, most of the people who comment like this are people who have not personally(or seen people ) undergone through the horros of modern allopathic medicine.
It is self explanatory,if allopathy p0rovides all that is to cure, why the heck will any body go to anyone else. Nobody doubts that Sun is the greatest provider of light on this plant- if allopathy were so perfect it would be obvious,can anyone dismiss the sun. Allopathic practioners who talk these lengthy nonsense about other forms of medicine should work to improve their own medicines. Improve the quality of drugs – eliminate side effects. If you cant avoid major side effect give timeline for its usage-for some horrible problems which people get, they are okay to even wait for 5 years in allopathy if it can cure. But that is not what these goons do. They talk about all this nonsense but definately no cure for many of the chronic illness. And worse the allopathic doctor looks at the patient sternly and says till the patient weeps- well this is what happened, no mommy can save you, I will give you these regular injections and your pain will be managed, it wont be cured . And if you ask if medicine has side effects, either they say its not a concern, or give a rude look or say do what the hell you want. Leave aside these bad manners, they are clear that they must be well paid for every consultation they do. Thats secondary of course. But what irks you is when you hear that these so called benevolen drug companies make the cost of medicine so high that deserving and genuine patients who cant afford are screwed , as it is crippled by ill health, and further more not being promised of permanant cure, and furthermore warned of a 100 possible side effects and as it is without giving a start date and end date for a therapy. This is modern medicine and you wonder how much good could be done to you by people whose focus is only on making money and filling pockets. Even if you believe all this crap, take the trouble to go through allopathic therapies, many a time you come to a situation when you reach a dead end. No progress. Imagine you are one of those “dead end” patients.Imagine yourself to be a sceptic of alternative medicines as many including myself once were. Then if at the dire need for a cure, you visisted a homeopath and benefitted from him what you did not benefit from allopathy, would the bloody hell you still call it a fad, a placebo? Placebo my foot. People like James Randy have to spend more time in the laboratory working on more effective medicine. If you are medicine is so superior make it like the sun then all this wasteful talk. I feel sorry for all the people hurt by current state of modern medicine and I wish for all wasteful treatment and doctors who cannot encourage their patients to die.Randy may never ever want to try any form of homeopathy, but he denies himself all effects of even a placebo treatment that way. Imagine a patient not being cured and all day he thinks – I am gonna die, I cannot lift my hand , I am not going to be able to speak. All these fools end up exactly where they are supposed to be in the dead mans chest.Life is about positivity, about confidence, open mindedness and continous faith in the healing powers of nature. A mule or spider may be an unintelligent species, but we stand to learn by observing the way they live. Of course you could observer a lot about them after they die, but that does not provide you any insight into the wisdom of nature.
To all who have reached dead-ends do be bold in trying alternatives, why deny what comes your way.
Thanks and despite the sceptics I personally know people benefitted from homeopathy. Long live good healer and adieu to machines(stern and textbook doctors)
February 25th, 2010 at 4:11 pm
Iqbal,
You write:
That would be a good point if we actually had good evidence that homeopathy works better than placebo! Until we do, the fact that homeopathic action cannot be explained by science is not a problem.
Sure, some will be modified or rejected in the light of future discoveries. The trick is knowing which theories will be revised.
Big Pharma conspiracy theories do not evidence for homeopathy make.
harish,
The fact that conventional medicine is not perfect — a strawman argument if ever I heard one — does not constitute evidence for homeopathy.
March 1st, 2010 at 4:56 pm
Hello Nick
Of the few billion people who visit doctors every month, some million are visiting doctors to be treated with homeopathic medecines. The treatment is available at a small fraction of the cost of visiting a specialist hospital. I believe the pharma companies realise the money being lost.
The daughter of my collegue suffering from dust allergy(?) was into and out of hospital every month. Her cough would reoccur as soon as the effects of the antibiotics given to her wore off -and she was back to hospital for the next cure! Two medicines prescribed by a homeopathic doctor and medication lasting for a week – she has no reoccurance for the past 11 years? She sure crossed the age barrier in no time! She continues to stay in the same dusty environment. The cost of homeopathis medecine – less than a packet of cigarette. The cost of a week in hospital – his weeks’ salary.
The double bind tests so important to release a drug in the conventional system does not do a negative impact test? Why do drugs cleared by the double bind tests have to be pulled out of the market within a few years? What is the long term impact of these drugs? Why should these tests be necessarily valid for homeopathic medecine?
I know some homeopathic doctors who treat themselves and their children with the same medecines as they treat their patients with. This would not be so if their experience showed they were using placeboes. At least with their children, they will be honest!