Homeopathy - a cure all in the mind?

By: David Bradley

Medical News HeadlinesIn the US, relaxation, chiropractic and massage are perhaps the most popular alternative, or complementary, forms of medicines while in the UK, homeopathy, acupuncture and chiropractic have the greatest uptake. High street chemists and health food shops boast a whole range of homeopathic remedies for ailments such as hay fever, influenza and migraine. Anyone who has tackled yoga or had joint problems fixed by a chiropractor could vouch for the physical and mental benefits that go beyond the placebo effect with these. Homeopathy though seems to fall outside the realm of known chemistry, so is it anything but quackery, asks David Bradley?

In the eighteenth century, German Physician (Christian Friedrich) Samuel Hahnemann was trying to figure out why extracts from the cinchona tree (mainly quinine) could cure ague (malaria). He gave increasingly large doses to healthy volunteers and himself to see what effects they would have and found that the supposed cure actually caused feverish symptoms very similar to the ague itself.
Hahnemann thought that cinchona, by creating the symptoms itself, somehow helped stimulate the body's defenses into action and he came up with the theory that "likes are cured by likes," similia similibus curantur. He tested numerous other drugs on healthy "provers" and published his results just over 200 years ago. Building on this idea Hahnemann reasoned that if a large dose of a drug caused a disease then a small dose should cure it. The logical conclusion being that an increasingly small dose would have increasing efficacy, this so-called "potentisation of dynamisation" and this formed the basis of homeopathy.

Hahnemann's idea was not entirely new though, Paracelsus declared that if given in small doses, "what makes a man ill also cures him," as long ago as 1534. Paracelsus is said to have cured people in the plague-stricken town of Stertzing in the summer of that year by feeding them a pill made of bread containing a minute amount of the patient's excreta.

Hahnemann refined his practice to a fine art developing a "special" method for diluting the cure to its most effective concentration, which involved, bizarrely, beating the flask against his Bible. This violent agitation, he claimed, imparted the curative powers on the solution by some unknown mechanism. Modern homeopathic remedies are allegedly prepared in a similar manner although the flat of a hand has generally replaced The Bible.

Followers of homeopathy are convinced of its power and often cite the effects in veterinary homeopathy as proving it cannot simply be a placebo effect. Scientists argue, however, that the ingredients are diluted so many times, often several hundred, that the likelihood of there being just a single molecule of the original drug present in the final preparation is zero.

The Late Jacques Benveniste's INSERM laboratory at Clamart, France, was closed in late 1993 but his ideas purported to explain homeopathy in terms not of molecules present in the solution but in terms of the diluting water retaining a "memory" [see Startling Claims below] or imprint of the drug molecules. Benveniste published a controversial paper in Nature that seemed to show that dilutions as great as 1 in 10<sup>120</sup> could still affect the function of immune cells (Nature, 1988, 333, 816). Benveniste suggested that the molecular organisation of water was the key. Most recently, Shui-Yin Lo has claimed to observe organised structures, which he calls Ie crystals in water, Modern Phys. Lett. B, 10(19), 921-930.

Nature in an unprecedented move established an investigative team, of pseudoscience debunker James Randi, then Editor John Maddox and NIH organic chemist Walter Stewart, to visit Benveniste's laboratories and figure out whether his results were liable to misinterpretation. They returned to refute Benveniste's findings and in a flare of controversy <i>Nature</i> withdrew the original paper after publication.

In 1991, the British Medical Journal published a report from Paul Knipschild (Prof of Epidemiology at the University of Limberg in the Netherlands), which analysed all published controlled trials of homeopathy. The report found that 81 showed a positive result while 24 showed homeopathy had no more effect than placebo. However, many of the trials analysed were not as well controlled as scientific vigilance would like. Indeed, Knipschild's assessment has since been shown to have been inadequate as the scoring system used (i.e. what he meant by positive and negative results) was flawed. He and others, however, have made the important suggestion that proper clinical trials should be carried out into the effects of homeopathy to settle the argument once and for all. The British Medical Association is apparently open to suggestions for research.

Why should we waste resources carrying out such a trial? The mechanisms of drug activity are known and indeed have been designed at the molecular level. There is nothing in present science to explain any claimed effects of homeopathy at the molecular level. Frank Lesser writing several years ago in New Scientist famously said, "As a pharmacologist, I understand perfectly how an absent substance fails to exert toxic effects. What defies comprehension is how, not being there, it can exert beneficial ones."

It is easy to understand why, in the mid-nineteenth century, homeopathy became so popular as it provided a pleasant alternative to the likes of emetics, purgatives, leeches, opium and sulfuric acid cocktails and other such unhealthy medical practices.

Today, although medicine has moved on significantly, many people are worried by an assumed failure on the part of medical science, a growing list of side-effects and drug resistance and the concurrent growing pharmaceutical company profits and again are turning to homeopathy. One third of the UK population uses some form of complementary medicine.

Homeopathy is not entirely benign though, some studies have shown it be less effective than placebo (a negative placebo effect, perhaps?). It is, in the UK and the USA at least, rather expensive (the French and Dutch are treated free under their health services) and uses money that might better be spent on fresh fruit and vegetables which could be far more beneficial to health. More worrying though are some of the claims made by homeopaths. For instance, many disagree with the use of vaccinations. If such a notion entered the mainstream we could be exposing ourselves to the ravages of diseases we thought were conquered once again, such as polio.

The basic homeopathic recommendations of plenty of fresh air (which might euphemistically be interpreted as exercise), plenty of rest and small quantities of very dilute materials should not be sneezed at for almost any patient, however. While Hahnemann's original thoughts that a patient is a person not a collection of symptoms could advantageously be heeded by many GPs today more concerned with fund holding and using up their prescription pads than the patient.

It is worth noting before one rushes to the homeopath or the pharmacist's alternative counter that, as if to inspire confidence in cynicism, those homeopathic products launched after 1994 have to be labelled "Homeopathic Medicinal Product Without Approved Therapeutic Indications".

Startling Claims

Psychologists at the University of Arizona in Tucson have made some startling claims recently that could provide an explanation for many disparate phenomena including homeopathy. They reckon that memory is not merely a function of brain cells and computer chips but something stored by everything in nature down to the atomic scale.

Schwartz, a professor of psychology, neurology and psychiatry, and director of the Human Energy Systems Laboratory, and psychologist Linda Russek, co-director define memory as not just the conscious retrieval of information, but any kind of stored information, whether it can be retrieved, or not. Memory they say is created when the parts of a system interact with each other, sharing information and energy. They cite as a basic example two tuning forks set to the same pitch. When one is struck, its vibrations will make the other vibrate as well. But Schwartz and Russek posit that, over time, the vibrations between the two instruments circulate so what is being stored is the relationship between the two tuning forks.

They claim that such non-neural memory might help explain homeopathy following along the lines of Benveniste's notions of water's memory.

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