
Dr. Edzard Ernst, who says he was once sympathetic to homeopathy, describes his growing disillusionment:
Two main axioms constitute the core principles of homeopathy. The "like cures like" principle holds that, if a substance causes a symptom (e.g. onion makes my nose run), then that substance can cure a disease that is characterised by a runny nose (e.g. hayfever or a common cold). The second principle assumes that the serial dilution process used for homeopathic remedies renders them not less but more potent (hence homeopaths call this process "potentiation").
Both of these axioms fly in the face of science. If they were true, much of what we learned in physics and chemistry would be wrong. If anyone shows the concepts of homeopathy to be correct, he or she becomes a serious contender for one or two Nobel prizes. Homeopaths often say that we simply have not yet discovered how homeopathy works. The truth is that we know there is no conceivable scientific explanation that could possibly explain it.
Yet as a clinician almost 30 years ago, I was impressed with the results achieved by homeopathy. Many of my patients seemed to improve dramatically after receiving homeopathic treatment. How was this possible?
In order to understand this apparent contradiction, we have to take a step back and consider the complexities of the therapeutic response. Whenever a patient or a group of patients receive a medical treatment and subsequently experience improvements, we automatically assume that the improvement was caused by the intervention. This logical fallacy can be very misleading and has hindered progress in medicine for hundreds of years. Of course, it could be the treatment – but there are many other possibilities as well.
For instance, the condition could have improved on its own. Or the encounter between the therapist and the patient could have been therapeutic without any meaningful contribution from the treatment itself. Or the patient could have had high expectations in the treatment that prompted a powerful placebo response. Or the patient self-administered some other treatments concomitantly that caused the improvements. In other words, it is not the effect of the remedy per se, but the non-specific effect of the context in which it is given that benefits the patient.
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About 200 clinical studies of homeopathic remedies are available to date. With that sort of number, one cannot be surprised that the results are not entirely uniform. It would be easy to cherry pick and select those findings that one happens to like (and some homeopaths do exactly that). Yet, if we want to know the truth, we need to consider the totality of this evidence and weigh it according to its scientific rigour. This approach is called a systematic review. Over a dozen systematic reviews of homeopathy have been published. Almost uniformly, they come to the conclusion that homeopathic remedies are not different from placebo.
So what's wrong with giving patients placebos?
- Placebo effects are notoriously unreliable; the patient who benefits today might not do so tomorrow. Placebo effects also tend to be small and short-lived.
- Knowingly giving a placebo to patients would be unethical in most instances. Either clinicians tell the truth (i.e. "this is a placebo"), in which case the effect is likely to disappear, or they do not, in which case they are liars.
- Giving a placebo to a patient with a serious condition that would be otherwise treatable does seriously endanger the health of that patient.
Back in the bad old days or cresting European anti-Americanism, from 2003-2006 or so, I was drawn into many tedious conversations about the supposed failings of the United States. For those times when I was unable to avoid these futile 'debates', I created a private catalog of comparable failings of German society. I still have that list somewhere, perhaps I should post it for old times' sake.
This almost always wrong-footed my conversation partner, proving the old adage that the best defense is a good offense. If I were feeling particularly didactic, I would try to conclude dialectically by observing that my goal wasn't something fatuous like proving one society generally 'better' than another, but to point out that an exclusive focus on the negative aspects of a foreign culture leads to unnecessary misunderstanding and resentments, blah blah blah.
One of the Europeans' favorite debating points was the hostility to science of 'the Americans': '40% of them don't believe in evolution, and lots of them also don't believe in global warming! What sort of religious craziness is driving this rejection of science?' My first return volley was, of course, homeopathy, a billion-dollar industry in Germany based on the crackpot theories of a nineteenth-century quack. Two-thirds (g) of Germans believe in it. As often as not, my conversation partner was a believer in homeopathy, and suddenly found himself in the unenviable position of critiquing American for its lack of faith in 'science' while simultaneously defending a theory of illness that's less scientific than the theory of humors.
I have to admit, it was sort of fun...
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