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Should medical students be taught alternative medicine?

BMJ 2014; 348 doi: (Published 28 March 2014) Cite this as: BMJ 2014;348:g2417

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In a recent paper, Robert Jutte wrote that Samuel Hahnemann (1755–1843), the acknowledged founder of homoeopathy, was the first physician who administrated a sham medicine as placebo to many of the patients coming to his practice on a systematic and regular basis, at least as far as we know from historical documents in the Archives of the Institute for the History of Medicine of the Robert Bosch Foundation in Stuttgart1.

Jutte gives some explanation about why Hahnemann prescribed placebos to his patients and henceforth placebo quite immediately was associated with a “medical deception”1. the meantime, until the second medicament is given, one can soothe the patient’s mind and desire for medicine with something inconspicuous such as a few teaspoons a day of raspberry juice or sugar of milk...2.(cit. ref 5 page 210)

and moreover: Patients who have firm confidence in the honesty and skill of their physician, will have no hesitation to be satisfied with a dose of sugar of milk, which may be exhibited every two, four, or seven days, agreeably to the wishes of the patient; such a course will never lessen their confidence...3 (cit. ref 5, page 210). It does not matter if prescription is potentially noxious or ineffective, the main thing is that the patient goes on with trusting the physician and his prescription.

While most general practitioners at the end of the XVIII century came across with the concept of placebo, as in Cullen’s Clinical Lectures, placebo medicine was replaced by Hahnemann by sham medicine, mostly represented by milk sugar. In this perspective, it is arguable that this sham medicine, used as placebo, was a fundamental issue in medical practice and probably the utmost target of medical therapy in times where medicine lacked most current weapons against epidemics, toxicology, acute illness and particularly infectious diseases. Furthermore, medicines as potentially noxious substances, whose activity was often presumptive as it came quite exclusively from trusting the valuable expertise of colleagues rather than the experimental evidence, were diluted to ensure patients a harmless action and fundamentally a placebo effect.

Students who are addressing EBM and alternative medicine have to face many controversial opinions still existing about whether homeopathy has built up an exclusively placebo-based tenet4-7. The fact is that the similia principle has never been demonstrated on a scientific ground, though many theoretical attempts sprout from authors elsewhere8,9. On the other hand, lack of evidence exists even for placebo in homeopathy, as no single report, as far as we know, has demonstrated the neuro-psycho-endocrine source of a homeopathy-driven healing in any clinical trial. Furthermore, if Hahnemann used placebo very frequently in many of his patients, one has to ask why homeopaths grieve for building up awkward, puzzling and poorly evidenced theories on liquid water to explain the presumptive efficacy of their remedies, when Hahnemann frequently used milk sugar.

Therefore, I am afraid we are talking about a fake.

Homeopathy came to the light as a pragmatic and empirical medicine, based on the increasing people approval on practitioners’ bona fide and on its consequent enhanced diffusion. Yet, surprisingly, most current homeopaths are justifying homeopathy as an ethically correct medicine because of the many people still resorting to it.

1. Jütte R. Hahnemann and placebo. Homeopathy. 2014 Jul;103(3):208-12
2. Hahnemann S. Heilart des jetzt herrschenden Nerven- oder Spitalfiebers (1814). In: Schmidt JM, Kaiser D (eds). Kleine Medizinische Schriften. Stuttgart: Karl F. Haug Verlag, 2001, pp 648e650.
3. Hahnemann S. Transl. by Hempel CJ. The Chronic Diseases, Vol 1. New York: Wm. Radde, 1845. 165 note.
4. Fisher P. What is homeopathy? An introduction. Front Biosci (Elite Ed). 2012 Jan 1;4:1669-82
5. Garattini S, Bertele' V, Banzi R. Homeopathy cannot even be used to replace placebo. Eur J Intern Med. 2014 Jun;25(5):e68
6. Garattini S, Bertelé V, Banzi R. Placebo? no thanks, it might be bad for me! Eur J Clin Pharmacol. 2013 Mar;69(3):711-4
7. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32
8. Bellavite P, Olioso D, Marzotto M, Moratti E, Conforti A. A dynamic network model of the similia principle. Complement Ther Med. 2013 Dec;21(6):750-61
9. Van Wijk R, Wiegant FA. Postconditioning hormesis and the similia principle. Front Biosci (Elite Ed). 2011 Jun 1;3:1128-38

Competing interests: No competing interests

21 August 2014
Salvatore Chirumbolo
Head of the Laboratory of Physiopathology of Obesity
Department of Medicine-University of Verona
LURM Est Policlinico GB Rossi piazzale AL Scuro 10 37134 Verona-Italy