Terra Sigillata

Orac’s recent post, A Real Death By Homeopathy, led me to dig through the archives at my old blog and reprint one of my first posts, this one from 6 January 2006. As a natural products researcher, I often see homeopathy associated with herbal medicines, the latter of which has often been the source of beneficial pharmaceuticals. In sharp contrast, homeopathy is based on a faulty 19th century principle that is the direct opposite of dose-response pharmacology and I intended to comment briefly on the distinction, as stimulated by a misleading picture on the cover of one of my favorite print magazines.

I love Ode Magazine – much, much more often than not.

Today, I have a bone to pick.

In the aftermath of the 2004 US presidential election, I had to cancel my subscription to The Nation just because I got so depressed about negative news coming into every conduit of my house.

Ode is a Dutch-based mag that offers original and reprinted stories describing where people and ideas are working around the world to create positive change. From their mission statement: “We publish stories that bridge the gap between thinking and doing, between rage and hope, and the painful gap between the rich and the poor. By doing so we build peace and sustainability.”

Cool. A breath of fresh air when everyone is screaming at one another. And, largely, Ode succeeds. Until this issue, when I ran screaming from my mailbox like Steve Martin in The Jerk.

In the January 2006 issue, Kim Ridley offers an overview of homeopathy as “a healing idea whose time has come – again?” The article does wisely posit, “Is homeopathy a 200-year-old hoax, or a powerful paradigm for healing?” But the cover statement (above) that homeopathic remedies produced much higher survival rates than conventional medicine during the 1918 influenza pandemic is poorly substantiated in a related article. More disturbingly, an Indian homeopath who uses these remedies to treat cancer is quoted as saying, “The only things I don’t approve of are chemo and radiation.”

Together with surgery, I know of no two other modalities that HAVE been shown conclusively to produce long-term cancer remissions (I hate to use the word ‘cure’). Yet the article irresponsibly provides further details on how to seek this ‘healer’ who claims to have cured 80 percent of cancers over the last 10 years.

Homeopathy is an late 1700s/early 1800s practice of using extremely dilute preparations, largely of plant extracts and toxic metals, to treat diseases based upon the so-called ‘law of similars’. The philosophy that ‘like cures like’ was first espoused by a German physician named Samuel Hahnemann who took high, conventional doses of plant medicines, observed the symptoms produced, and then used extremely dilute versions of the same plant to treat diseases that produced similar symptoms. For example, the vomit-inducing syrup of ipecac is offered in an extremely dilute form as a homeopathic treatment for any disorder where the patient is experiencing vomiting.

Where homeopathy is most controversial is in the claim that a remedy becomes more potent as it is diluted. Even experts quoted cannot account for how this is scientifically possible, although some invoke a sort of “quantum physics” change in the structure of water. Hmmm.

More erudite fellow bloggers have already commented more concisely on the implausibility of homeopathy. Even the British journal The Lancet, one of the most alternative medicine-friendly among high-impact conventional medical journals, published results last year of a meta-analysis demonstrating that homeopathy is no better than placebo.

But where I object further is when photographs of herbal medicines are placed within an article on homeopathy as is done throughout this issue of Ode. Herbal medicine is NOT homeopathy. Herbal medicine and the use of pure chemical constituents from plants still subscribe to dose-response pharmacology: that the biological response varies in direct proportion to the dose or concentration of the remedy. While some medicinal plants are used as a source for homeopathic treatments, the rationale for dosing in medicine vs. homeopathy are diametrically opposed. Lumping together herbal medicine with homeopathy gives the former practice the same air of impossibility and detracts from the demonstrated benefits and future promise of using plants as a source of novel therapeutic molecules.

Many would love to see homeopathy proven as an effective medical practice. What’s not to like: non-existent doses of a remedy that cure diseases without any side effects.

Anecdotes abound. Show me the data. Until then, I find homeopathy difficult to swallow.

Note added 7 Nov 2007: The Challenge to Professionalism Presented by Homeopathy (free PDF here) is superb 1996 article written by pharmacy professor, W. Steven Pray, that appeared in the American Journal of Pharmaceutical Education. While written for pharmacy students, it is an outstanding teaching resource to teach critical thinking skills to all health sciences students and can even be used for discussions with high school students.

Comments

#1 bob koepp
November 7, 2007

You’ve done well to distinguish between homeopathy and herbal medicine. Could you also do a post explaining the difference between homeopathy and allopathy? It bothers me that so few physicians understand the difference and, despite having been trained in allopathic approaches to the art, can’t articulate just what that means in terms of therapeutics.
#2 herbal remedy
November 7, 2007

This is an enlightening piece on homeopathy. I understand that herbal medicine is but a component of the more expansive scope of homeopathy. Though I wouldn’t even think of herbal remedy healing as a mere placebo considering the numerous testimonies of healing made by herbal users. – Gary
#3 bob koepp
November 7, 2007

I just finished reading the “Challenge to Professionalism” article, and have a mixed review. It provides a concise overview of Hahnemann’s speculative musings, but doesn’t do a very good job of showing where/how those speculations diverge from allopathic approaches. At times, Pray seems to suggest that the main difference between homeopathy and allopathy lies in the commitment (or not) to evidence-based methodologies. But that confuses methodological and theoretical issues.
#4 Dudley Fox
November 7, 2007

herbal remedy,

You missed the point entirely. Herbal medicine and homeopathy are two entirely different things. One does not encompass the other.
#5 HCN
November 7, 2007

bob koepp said “Could you also do a post explaining the difference between homeopathy and allopathy?”

According to Samuel Hahnemann “allopathy” is anything that is NOT homeopathy. So for the strict definition by the inventor of homeopathy then “allopathy” is a derisive term for herbal medicine, acupuncture, and even real medicine. See http://www.skepdic.com/homeo.html .

Oh, and “herbal remedy”, you would do well to read that website also. Unlike herbal tinctures, homeopathic remedies have no remaining active incredients. While one can really cause themself real damage from drinking tea made with foxglove, if you mix it homeopathically there would not be any active digitalis in the the “remedy” (a 30C mix would be about 1/2 teaspoon in enough water to fill several earth-like planets’ oceans).

Oh, and another thing… one homeopathic remedy is “Nat Mur”, that is sea salt mixed with lots and lots of water (again, for 30C something on the order of one NaCl molecule in many many oceans of fresh water), and another one is Oscillococcinum, which is from duck liver (though in reality, for the stuff in your pharmacy labeled as such no duck has been harmed in decades). Not exactly “herbal”.
#6 DuWayne
November 7, 2007

There is a phenom behind herbal medicine’s question. I had never seen this, until I moved out to Portland, OR, but a large segment of the population here uses homeopathy as an all inclusive term for alty medicine. This is prevalent enough that some of the alty med schools out here also use it thus.

I suspect that this is an attempt to put homeopathic “remedies” on an equal footing with plant medicines that actually contain active components. It certainly has had the effect of blurring the lines between a lot of different alternative treatments and to an extent, EBM treatments as well.

I am working on an article for a print paper here, about alternative medicine. Portland and Seattle are in many ways the heart of CAM country in the U.S. What I have been finding is, if anything, more disturbing than even Orac makes it out to be. Even worse than having a lot of alty woo inside EBM medical schools, the alty med schools are trying (and succeeding) at putting EBM into their programs.

The problem with this, is that the students are not taking anything remotely like the course of study to become an MD. Yet when they finish their course of study, they are “qualified” to prescribe not only alternative medicines, but also some actual pharmaceuticals. From homeopathic, to plant medicine, all the way to EBM pharmaceuticals, they are trying to create a effective by association credibility for alty meds. I would add that reiki is also thrown into the mix.

It is nothing less than an attempt to erase the lines between alty medicine and EBM medicine. Unfortunately this is not the through alty medicine having to prove itself. No, they can’t be bothered to prove or worse, disprove the utility of alty medicine, yet want to sit on equal footing with EBM pharma.
#7 HCN
November 7, 2007

bob koepp, here are some of the biggest differences between homeopathy and conventional medicine (in case you need to be reminded, the term “allopathy” is a term used as an insult to anything that is not homeopathy):

1) Conventional medicine is based on science. Homeopathy is based on “Laws” made up by Hahnemann which in reality are no more than “wild assed guesses”. The “Law of Similars” and the “Law of Infinitismals” have to basis in reality, and have never been proven by experimentation by any stretch of the imagination.

2) Conventional medicine has changed over the years as the understanding of human physiology, chemistry, biology and science in general have improved. For instance, blood transfusions can be safely given now because of blood typing, something that was not in existence 200 years ago.

BUT… in 200 years since Hahnemann wrote his Organon and other books on homeopathy, homeopathy has not changed. One of the miasms that Hahnemann wrote about was syphilis, which he claimed to cure. I sincerely doubt that homeopathy would do better for syphilis than antibiotics.

Now think about this: If you come down with strep throat, which would you prefer: A homeopathic treatment or antibiotics?

Or perhaps you have a child with a severe genetic heart anomaly like hypertrophic cardiomyopathy… would you prefer that the child be treated by a cardiologist (who orders an echocardiogram and EKG, and then prescribes generic Atenolol to reduce the pressure across the already damaged mitral valve), or by a homeopath who would just engage in a long converstation with the child and prescribes a remedy with no active ingredients?
#8 HCN
November 7, 2007

Don’t take my word on this, check out this very entertaining video that was posted on Orac’s blog:
http://www.youtube.com/watch?v=BWE1tH93G9U
#9 Abel Pharmboy
November 7, 2007

Bob Koepp and HCN raise interesting points about how the word “allopathy” is misused/misinterpreted to refer to the current practice of mainstream MDs. Dr Katherine Gundling noted in Arch Int Med (1998;158:2185-6) that, “Hahnemann coined the term allopath to describe his colleagues who used harsh and abusive therapies to cause effects different from those of the disease itself.” (Unfortunately, this paper is not available as free text despite being published nine years ago!).

As HCN points out, medicine has evolved in leaps and bounds since those days while homeopathy has remained unchanged. As a result, Gundling argues that “allopathy” should not be used to refer to today’s practice of medicine because,

“Allopathy artificially delimits the practice of medicine in the eyes of our patients and, perhaps, ultimately, of ourselves. It embodies an unnatural, inflexible philosophy of care and implies that our system of practice is merely one of many from which a discerning health care consumer may choose.”

Bob, it may be a little while before I can work up a whole post on the concept but Gundling’s paper is a great place to start if you have access at your institution’s library.
#10 bob koepp
November 7, 2007

I don’t think it’s advisable to let ‘allopathy’ be used simply as a term of abuse. The AMA, after all, featured a commitment to allopathic medicine as a reason why physicians with the right stuff should be granted the status of autonomous professionals. I’m not a proper historian of medicine, but I suspect there was more to their use of the term than a desire to distance themselves from Hahnemann.
#11 HCN
November 7, 2007

Actually, I am using the definition of “allopathy” as rendered by Samuel Hahnemann. He used it as a term to differentiate (not in a good way) his invention versus the medicine practiced in the early 19th century. This is way before the AMA, and not too long after there was an actual “American” anything (history of medicine is a fascinating subject, and it was not until about a century ago that there was even a college that taught it in the USA, one good book that gives a good overview is “The Great Influenza” by John Barry). So I’d just as soon go by the definition by Mr. Homeopath himself, a German guy who lived a couple of centuries ago.

It is often used as a term of derision for real medicine by practitioners of non-medicine. Of course, these are the same folks who try to tell us that homeopathy works better than “Western” medicine, somehow putting Germany a few virtual time zones closer to the Pacific Ocean than it has been historically.

I also just checked MedLinePlus.gov for “allopathy”, and the only hits were “External Health” sites on “alternative medicine”, and absolutely nothing on their dictionary. So perhaps you would convince me more if you have me the AMA link that defined “allopathy” to your liking (you are allowed two links here before the Spambot holds your message for moderation, though I usually try to keep it to one).

I am still not quite sure why you would insist that it is a proper term for medicine that is based on reality, science and can actually prevent or cure real ailments, when you seem to be under the illusion that homeopathy has any validity. Homeopathy is as real as the the toy doctor kits we got on Christmas morning as kids, down to the bottles of sugar pills.

Homeopathy is a fantasy. The only reason it got any kind of foothold is that it did not cause the real damage that “doctors” 200 years ago actually caused. Let’s face it, treating syphilis with shook up water instead of mercury compounds was lots safer, and the victim, er sorry PAITIENT, actually lived.

Though these days, someone who did actually get syphilis would be much better off with antibiotics than homeopathic shakened water or sugar pills (the homoepathic pills are created by putting a drop of homeopathic solution which is either pure water or pure alcohol onto a lactose pill).

Here, really… watch this video:
http://www.youtube.com/watch?v=BWE1tH93G9U
#12 HCN
November 7, 2007

Oops, let me make this ” Let’s face it, treating syphilis with shook up water instead of mercury compounds was lots safer, and the victim, er sorry PAITIENT, actually lived.” a bit more factual.

The syphilis patient lived LONGER when given Hahnemann’s special shook water than with the mercury compounds. They lived longer, but still had syphilis. So instead of a horrible death due to mercury poisoning, they died slowly after a long slow mental decline when syphilis entered its tertiary stage.

Oh, and since I am adding another comment, I’ll include a good link on History of Medicine: http://www.nlm.nih.gov/hmd/index.html
#13 Pittya
November 8, 2007

I had no idea that Homeopathy was considered to be alternative medicine in America.Here in India its quite an accepted form of medicine with Medical Schools having degree courses in the subject. I myself, have taken Homeopathic medicine on a number of occasions, though how effective it has been, I have no idea, and yet according to my mother, it was the Homeopathic medicine that prevented the tonsillectomy on me when I was a kid. Oh well, it been years since I took any homeopathic medicine, so I dont suppose it matters now.

Also, I was just wondering, how is the medicine dispensed there in America ? Out here, you have little pills of icing sugar into which the doctor used to add a couple of drops of some unknown liquid which he had in a huge number of bottle in his office. And what are the sources from which the medicine is derived ?
#14 HCN
November 8, 2007

Pittya said “Also, I was just wondering, how is the medicine dispensed there in America ? Out here, you have little pills of icing sugar into which the doctor used to add a couple of drops of some unknown liquid which he had in a huge number of bottle in his office. And what are the sources from which the medicine is derived ? ”

Usually prescribed by a real doctor for real medicine, something that has a real effect on human biology. Such thing as statins for cholestoral, insulin for diabetes or beta blockers for heart contitions. What you described sounds like homeopathic fantasy.

The sources that meds are derived are called pharmaceutical companies like Merck, Pfizer and Ely Lilly. Some of the meds they create are from plants, and others are from chemical soups.

Of course, the most important difference between what they sell (oooh, like my favorite antihistamine Benadryl!) is that they have to show to a federal agency (the Federal Drug Administration) that they actually WORK!!!

In the USA, all homeopathic meds have to do is show that they have no real active ingredients and not advertize to work for anything they didn’t work for when the law was made in the early 20th century. Something along this line:
http://www.fda.gov/ora/compliance_ref/cpg/cpgdrg/cpg400-400.html

Usually this means that homeopathic remedies can get by if they advertize to work for self-limiting conditions (like colds, or aches). But if they try to sell themselves as remedies for anthrax, smallpox or radiation sickness, then they are in a world of legal hurt (if they are caught, it seems that Internet purveyors of such remedies can get lots of money before being caught by any legal entity).
#15 Abel Pharmboy
November 8, 2007

HCN, I think that we actually do agree with one another. (Or, is it Bob Koepp with whom you disagree?). Allopathy is indeed used as a derisive term by CAM practitioners to describe physicians while, as Bob Koepp points out, some physicians use it to describe themselves without truly understanding the history of the term.

So, if allopathy means “the practice of doctors using blistering and bloodletting techniques as in the 1700s and 1800s,” then we should not use the term.

This is a truly fascinating discussion and worthy of a separate post. I’m not a physician so I don’t have any emotional ties for or against the word – I’m just trying to wrap my mind around the semantics and the history.
#16 bob koepp
November 8, 2007

HCN – You say that I “seem to be under the illusion that homeopathy has any validity.” I’m not, and I don’t see anything in my earlier posts to this thread that would suggest that. You’ve got an axe to grind, right?
#17 bob koepp
November 8, 2007

OK, I’ve managed to dig my Dorland’s out of packing boxes (I’m in the middle of a move), and find the following:

allopathy: a term applied to that system of therapeutics in which diseases are treated by producing a condition incompatible with or antagonistic to the condition to be cured or alleviated.

homeopathy: a system of therapeutics founded by Samuel Hahnemann (1755-1843), in which diseases are treated by drugs which are capable of producing in healthy persons symptoms like those of the disease to be treated, the drug being administered in minute doses.

In other words, given this usage, allopaths treat by producing conditions the opposite of the symptoms of the disease, while homeopaths treat by producing conditions that mimic the symptoms of the disease. Conceptually, this contrast is a separate issue from whatever dosages are employed.
#18 HCN
November 8, 2007

Unfortunately your wording still seems to confer a kind of validity to homeopathy. It may be an interpretation.

You should look up many of the homeopathy debates at the JREF forums, http://forums.randi.org/forumdisplay.php?f=5 (look up those that involve users Rolfe and Badly Shaved Monkey, check out Rolfe’s signiture). It is there that I learned a couple more very different ways that homeopaths and real medical professionals treat patients:

1) Homeopaths only care about the symptoms, not the reason for the disease. They treat only the symptoms. This is part of where they are stuck in the past, because 200 years ago the reasons for many conditions were unknown. There was no microbiology nor any X-rays.

2) Real medical professionals check out the whole patient. From checking blood, urine and other body tissues for infections, or other things, to looking inside the patient to see anomalies (like my son’s echocardiogram showing adnormal muscle growth, and actually showing how the blood flow — it is really cool to watch!), and then talking to the patient about diet, exercise, and family history.

Gimpy’s blog has the detailed notes on a homepath’s treatment of an autistic kid:
http://gimpyblog.wordpress.com/2007/10/27/homeopath-cures-autism-a-black-hole-of-woo-with-case-notes/

Having had a child with seizures, and subsequent developmental delays I am familiar with visits to a pediatric neurologist. The neurologist did order actual tests for metabolic levels (there is a metabolic disease that can cause my son’s symptoms and is treated through diet, fortunately it was negative), and several EEGs (awake, sleep, strobe) which were also negative. The final prescription was no more phenobarbitol after a year of no seizures (yeah!), and speech and language therapy, plus educational supports. In short, no more drugs and real treatment options.

In short, homeopathy is stuck in the early 19th century and should be relegated to the history books. While real medical professionals keep up with new studies and methods, and even equipment (like not immediately treating kids’ ear infections with antibiotics).

Check out the last paragraph in Gimpy’s blog: “People like to think of homeopathy as a gentle and healing alternative treatment for mild ailments. Homeopaths do not think like this. They exist in a world of spurious nonsense where conventional medicine is seen as a dangerous enemy and homeopathy and other forms of CAM are capable of miraculous cures. Such beliefs should be prevented from flourishing and their practitioners should have their poisonous and dangerous practices highlighted at every opportunity. Homeopaths might be nice kindly people but their nice kindly practices are dangerously ignorant and offer false hope of cure as well as fuelling ignorant fear of conventional treatments with proven efficacy. When people turn from conventional treatments they risk making poor health worse and the consequences can be tragic. We should not stand for this.”
#19 bob koepp
November 8, 2007

HCN – is it my wording or Dorland’s that you think confers a kind of validity to homeopathy? And just how could an explication of the meaning of a term manage that? Please be specific.
#20 jessica freeman
May 27, 2008

Hello

I really enjoyed reading your blog. I have been taking Herbal Health products for over a decade now. I buy and get a lot of free info. From http://www.youherbal.com . I have taken Herbal products for many health concerns that I had and they are all better� Thank you for the amazing blog. I look forward to updates. Thanks again.

Jessica