Is less really more? – homeopathy

Is less really more? – homeopathy – includes related information

Leah R. Garnett

As medicine becomes an increasingly sophisticated and high-tech enterprise, millions of Americans are seeking out low-tech alternative therapies to treat everything from hay fever to neurological disorders. One approach that has surged in popularity over the past few years is homeopathy, a 200-year-old therapy that uses minuscule doses of natural substances to treat disease.

Even as consumer advocates and scientists petition the Food and Drug Administration (FDA) to crack down on the sale of homeopathic products — which they say are worthless — demand for these remedies has never been greater. (See sidebar on page 3.)

Americans spent more than $165 million on homeopathic medicines in 1994, and sales have climbed 25% a year since the late 1.980s. Although this is good news for homeopathic drug companies, practitioners, and satisfied customers, it leaves skeptics shaking their heads in disbelief. The last time Americans embraced homeopathy with such enthusiasm was nearly 100 years ago, before the advent of antibiotics and other modern medicines. In Europe, however, homeopathy has never gone out of fashion. It is regularly used by doctors in France, Germany, and Great Britain where it is covered by national health insurance. Indeed, the Queen of England has her own homeopathic physician.

The stuff they’re made of

Homeopathic medicines consist of minute doses of natural substances that are supposed to boost the body’s immune system when ingested as tablets or drops. Tarantulas, bees, squid ink, poison ivy, chamomile, and sulphur are among the hundreds of materials used. These remedies are touted for nearly every imaginable ailment including arthritis, asthma, allergies, anxiety, depression, herpes, and migraines. Over-the-counter preparations are as close as a local Kmart or chain drug store.

Although most homeopaths do not recommend that people abandon conventional treatments for cancer, AIDs, and other life-threatening illnesses, they often advise supplementary use of homeopathic remedies to “change the underlying pattern of the immune system,” according to Edward H. Chapman, president of the American Institute of Homeopathy, a 150-member organization made up of physicians, osteopaths, and other health care professionals. Although in most states it is illegal to practice homeopathy without a license to prescribe drugs, many people with no formal training represent themselves as homeopaths.

The same, only different

Samuel Hahnemann, a German physician (1755-1843), founded homeopathy as a safer alternative to bloodletting, purging with mercury compounds, and other perilous medical practices of his day. He based his new approach on what he called the “law of similars.” According to the theory, a drug’s power to cure disease springs from its ability to bring on symptoms in a healthy person that are similar to those produced by the illness.

Today, for example, a homeopathic practitioner might prescribe extract of belladonna, derived from the poisonous plant deadly nightshade (Atropa belladonna), to treat fever or flu because this flowering plant causes fever, flushing, delirium, and other flu-like symptoms when ingested. The amount of belladonna contained in a homeopathic treatment, however, is minute. In fact, not even a molecule can be found in most preparations. That’s because medications are formulated according to Dr. Hahnemann’s “law of infinitesimals,” which states that the smaller the dose, the more potent the cure. It is this tenet of homeopathy, which defies the laws of physical science, that many people find hard to swallow.

How they work

Many homeopathic remedies are diluted with a water and alcohol mixture to 30X — the X stands for a one-in-one-tenth dilution. That means that one drop of a substance is dissolved in nine drops of liquid; then a drop of the new solution is further diluted by nine drops of liquid, and so on, 30 times. The end result is akin to putting a drop of red dye into a container more than 50 times the size of the Earth so that it disperses evenly. Almost no one, including homeopaths, quarrels with the chemical principle that says a substance can only be diluted so far before it statistically disappears altogether.

Dr. Hahnemann believed that vigorously shaking the solution each time it was diluted “potentized” it, leaving behind a “spirit-like” essence that cures the body by activating its “vital force.” As implausible as this may sound, modern homeopathic drug companies make their products this way.

One of the largest is Boiron in Lyon, France, which produces Oscillococcinum, a cold and flu remedy made from the heart and liver of wild Barbary ducks — which carry flu virus. Already the bestselling flu remedy in France, Boiron is hoping to cash in on its success in the United States where it has opened production facilities near Philadelphia and Los Angeles. TV ads for the product have appeared nationally.

Promoters of homeopathy say these products adhere to the same biological laws as vaccines and allergy treatments. However, Polly Matzinger, an immunologist at the National Institutes of Health, says the comparison to vaccines is inaccurate. “The principle of vaccination has nothing to do with giving people very tiny amounts of a substance; sometimes you do, but sometimes you give lots.” And unlike homeopathy, there’s no mystery about how the immune system responds to vaccines.

A sticky wicket

If homeopathic tinctures are nothing more than harmless water-based solutions and sugar pills, why do so many patients seem to get better after taking them? And why do some studies report that homeopathic remedies are more effective than a placebo (an inactive substance)? There are several ways to answer these questions and each stirs up a hornet’s nest.

People who believe homeopathy is valuable often point to an analysis of 107 clinical studies published in the British Medical Journal in 1991. The results of 81 of them suggested that homeopathic treatment was more effective than a placebo; the others found no difference. However, there were methodological problems with many of the studies. When the authors reviewed the 23 best trials, they concluded that 15 showed positive results. But other researchers who have examined the analysis point out that only eight of the better trials were designed to minimize bias on the part of participants or observers.

“There have been a couple of studies in recent years that do not appear to be poorly designed. But who knows what went on? What safeguards were in place to prevent fraud?” said consumer advocate Stephen Barrett, a retired psychiatrist and author who is petitioning the FDA to ban the sale of homeopathic products. “How many experiments are run and not reported because the results are unfavorable?”

Dr. Chapman of the American Institute of Homeopathy thinks Dr. Barrett’s criticisms could be applied to every scientific inquiry. “There is a built-in bias in all investigations,” said Dr. Chapman, a Boston area family physician and homeopath. “You don’t think people studying AIDS treatments have a bias? Everybody wants their treatment to work; that’s why you have a control group.”

The National Center for Homeopathy, an information clearinghouse, points to a study published in the December 10, 1994, issue of the Lancet, a British journal, as “solid evidence” for homeopathy’s effectiveness. Twenty-four people with allergic asthma (most of them sensitive to dust mites) participated in the double-blinded, randomized controlled trial. In addition to taking their conventional medications, half received a homeopathic preparation and the other half a placebo. After four weeks, one third of those receiving the homeopathic remedy reported a reduction in symptoms while 10% of the placebo group said they felt better. The Lancet’s editorial board was at a loss to explain the results and acknowledged that the study was conducted with “exceptional rigour.”

What does this prove? Nothing, according to Dr. Barrett, the consumer advocate. “The best way to get relief from dust mites is to vacuum them,” he said. But even if this study does prove that homeopathic remedies work for allergic asthma, said Dr. Barrett, “does that mean they work for everything else?”

The study’s author, internist David Reilly of the University of Glasgow in Scotland, put forth a weightier explanation of these and previous findings: “either homeopathy works, or the clinical trial does not.”

All in your head?

Herbert Benson, president of the Mind/Body Institute at Deaconess Hospital in Boston, declined to comment on the Lancet study but said that homeopathy’s clinical impact appears to be consistent with the placebo effect — a testament to the extraordinary power of the mind to heal the body.

“A very large number of conditions people suffer from have been shown to be alleviated by the placebo effect — including angina pectoris, herpes cold sores, and various forms of pain,” said Dr. Benson, a cardiologist and associate professor of medicine at Harvard best known for his books on the “relaxation response,” a form of meditation.

For the placebo effect to work, there must be “belief and expectation” that it will, both on the part of the patient and the healer, said Dr. Benson. The problem is, the placebo effect has gotten a bad rap because doctors seem to be offended by the idea that their healing powers rest in large part on belief, he said.

If homeopathy rests on faith, why can’t people get better without medications? They can and do, said Dr. Benson, through belief and positive relationships with compassionate doctors and other healers.

Then why do consumers need to spend millions of dollars a year on homeopathic products? “Because they work,” said Dr. Chapman, who has received a $30,000 grant from the National Institutes of Health Office of Alternative Medicine to study homeopathic drugs in people with mild traumatic brain injury. “We don’t know the mechanism by which these drugs act, but we don’t know how lots of drugs work.” Dr. Barrett, however, believes this argument is inconsequential. “We don’t have to know how homeopathy works; the first step is to know whether it works.”

What to do

Internist Thomas Delbanco, professor of medicine at Harvard, is frequently asked by patients if they should seek homeopathic treatment. “I tell them that a lot of people are helped by it, but that there is no good scientific evidence in the world that it’s anything other than a placebo.” However, Drs. Benson and Delbanco both agree that the placebo effect plays a major role in the success of all medical treatments — whether they’re alternative or not. “Few providers care to advertise this widely,” said Dr. Delbanco.

Meanwhile, it’s unlikely that the debate surrounding the merits of homeopathic medicines will be settled anytime soon. People who like to avoid controversy should probably smile and look the other way when the conversation turns to politics, religion … or homeopathy.

RELATED ARTICLE: Passing a Bill of Goods

More than 40 physicians, scientists, and consumer advocates have formally petitioned the Food and Drug Administration (FDA) to stop the sale of homeopathic remedies. The agency has responded that it has no immediate plans to address the issue.

Although state and federal laws ban the sale of medicines that have not been proven safe and effective for their intended purpose, such regulations have not been applied to homeopathic products. This is because the remedies were given a special exemption when the Food, Drug, and Cosmetic Act of 1938 was passed. U.S. Senator Royal Copeland, who happened to be a homeopathic doctor, authored the provision.

Nearly everyone agrees that homeopathic drugs are probably harmless. So what’s wrong with people buying them? “I don’t think our society should be structured so that a company can profit from the sale of a product if the claim is false, whether or not it causes harm,” said consumer advocate Stephen Barrett.

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