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Clinical Review ABC of complementary medicine

Homoeopathy

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7217.1115 (Published 23 October 1999) Cite this as: BMJ 1999;319:1115

Rapid Response:

BMJ Debates Homeopathy: 1990s or 1840s?

The original article [of October 23] should be praised as a fair and
carefully-crafted account of homeopathic medicine, but some of the
responses to it are far from reasoned or well-crafted.
I have made the title of my response a question because there are
some striking parallels in relation to the ‘dialogue’ between the
medical establishment and ‘evil quackery’, in these two time periods.
In both cases, the engagement between them has been vigorous and hostile; various arguments were played out then which
are still being repeated today; and, most significantly,
alternative systems of healing were booming and diverse then just as
they are now. What is depressingly clear today is that there are few signs of much progress in the subject of mutual understanding
after the passing of 150 years.

How can it be ‘disgraceful’ that the British Medical Journal
discusses these matters? Is it too much to ask that any self-respecting
clinician should, by happy accident, also be equipped with an open
mind? Sheer pressure of public popularity, and thus patient
demand, is the driving force behind the growth of alternative
medicine, not just in the UK, but around the world. Since the early 1980s it has become something of a phenomenon. How can it therefore
be ‘disgraceful’ to examine this phenomenon more closely?
A phenomenon which is taking place in every town and city of the
world, whether doctors like it or not. It would surely be more
disgraceful, not to say foolish, to turn aside and ignore it? Doctors
should also seriously question the underlying motives of patients
who turn to ‘evil quackery’. They are clearly unhappy in some sense
with the conventional treatment they have been offered and
unless such fears and disappointments are addressed, then it seems
inevitable that more will flock to such therapists. Maybe the
‘safe and gentle’ holistic therapies are unwittingly guilty of
offering slender hopes to patients, as many doctors suspect, but patients
seem to prefer that to strong drugs, surgery and few significant
health gains after years of trying. These are the central criticisms patients repeatedly make of scientific medicine.

"Dr Burnett had left University with strictly orthodox medical views,
"having been taught by good men and true that Homoeopathy
was therapeutic nihilism." This was the current view at the time,
often expressed with a great deal more virulence. Homoeopathy in
Britain was confined to a more or less persecuted sect, actively
ridiculed in the universities and widely despised outside them. Its
followers were looked upon as quacks or cranks, its practice had
narrowly escaped being declared illegal in the 1850s and the
British Medical Association prohibited homoeopaths from joining its
ranks.

"The professor of anatomy at Glasgow in 1873 had begged his most
promising pupil not to throw his life away, for it is true that, as
Dr Burnett himself afterwards bitterly put it, 'the social value of
[surgery] is a baronetcy. The social value of [homoeopathic
remedies] is slander and contempt.' When urged not to abandon
orthodox medicine, Dr Burnett had declared that 'he could not buy
worldly honours at the cost of his conscience', but one may readily
detect behind his conscientious objection an equally keen
resentment of received authority. Perhaps because of his early
hardships, there was something about social ostracism which suited him. "


[J H Clarke, The Life and Times of Dr Burnett, 1902]

Burnett, who adopted homeopathy upon graduation, went on to establish
not one but two of the largest and most thriving medical
practices in London. Are people seriously suggesting that highly-
qualified doctors like him were fools, to follow their conscience
and adopt homeopathy? The argument is an imprudent and unreasonable
interpretation. To become a homeopath was, as stated,
simply to follow a suicidal career-path within medicine. What type of
doctor would willingly choose such a career path?

Repeatedly in the responses to this article, people refer to the
clinical unprovability of homeopathy and the ludicrous nature of
minimum doses. Because ‘it cannot work’ therefore ‘it does not work’
seems to be the argument. It is just about as stubbornly
medieval as that of the Pope saying to Galileo ‘There are no moons of
Jupiter, so I will not even look into your telescope!’. This is
essentially the same argument presented back in the 1840s. Sir John
Forbes, physician to Queen Victoria’s household, called ‘the
infinitesimal doses’ of homeopathy ‘an outrage to human reason’. But
every argument doctors presented against homeopathy
eventually backfired on their own side. One popular argument then,
has resurfaced again in this discussion: viz., self-limiting
diseases. Very few diseases do spontaneously get better if they are
left alone. This plain fact is well-known to all patients, which is
why they consult physicians in the first place. Therefore, to claim
that homeopathy ‘and its kindred delusions’ works because the
diseases it treats ‘would get better anyway’ is a highly dubious
contention. It might be a convenient philosophical nicety to argue a
case against homeopathy, but it simply does not square with human
experience.

In the last century this argument became termed ‘therapeutic
nihilism’ or more popularly the ‘doctor did nothing’. Doing nothing for
‘self-limiting diseases’ is not the reason homeopathy appears to help
patients. Indeed, if it was, then why bother with all the
expensive drugs which comprise the armamentarium of modern medicine?
We might just as well follow that witty Boston physician,
Oliver Wendell Holmes’ advice, and tip all our drugs into the sea:
‘and so much the better for man, and so much the worse for the
fishes, if we did’.

The real problem with the argument is that medicine has become
divided into two poles, both implacably opposed to the viewpoint,
knowledge and expertise of the other. The BMJ has in fact acted
gracefully by opening up a timely debate between these two
divisions within medicine and hopefully allowing some much-needed
light to fall into an area of great darkness. I shall now respond
to some specific points raised in the article.

The authors state that ‘during serial dilution the complex
interactions between the solvent [water] molecules are permanently
altered to retain a ‘memory’ of the original solute material.’. This
is not an accurate account of the theory as I understand it.
Fortunately there is a book on this subject which people can read, to
make their own minds up on the matter [Rolland Conte, Henri
Berliocchi and Yves Lasne, Theory of High Dilutions and Experimental
Aspects]. In my opinion, the theory states that water is a
very complex substance. Few scientists would dispute that. It does
not exist as H2O but a complex ‘soup’ composed of millions of
large ionic polymers, which are constantly forming and reforming, and
interacting with solute molecules. Thus these large polymers
are thought, in the serial dilution process, to become coded in some
manner, not permanently, but semi-permanently, to contain the
shape of solute molecules which were in the original solution. This
is by no means as absurd as it sounds.

Very vigorous shaking combined with serial dilution, which is the
method of preparation of all homeopathic drugs, could radically
affect the shape, size and number of these natural water polymers in
the solution, in such a way that they retain a ‘shadow’ of the
solute molecules which were intermingled with them in the original
solution in crude dose. One version of this theory also contends
that such large polymers act like microscopic ice crystals within the
water as long as it is kept at normal temperatures and away
from strong smelling substances, magnetic fields, X-rays etc - which
are precisely the things which ‘denature’ homeopathic
remedies. As the authors of this article then point out, some
therapeutic impact of such coded polymers on the organism, is then
perhaps conceivable.

I think any open mind would find this interesting material sitting on
the borders of human knowledge, rather than a ‘disgraceful’
matter or as ‘bunk, bunk and more bunk’. Such remarks only serve to
widen the distance between the two ‘implacably opposed’
camps. It adds much more heat than light. Hostility, insults and name
-calling did not move the argument forward in the 1840s and it
won’t today. Unpalatable it may be, but patient-demand for
alternative medicine is booming, and no amount of name-calling from
the ranks of established scientific medicine can change that simple
fact. Clinicians need to explain what is so fundamentally
outrageous about a healthy dialogue?

The authors point out that the homeopathic consultation is likely to
be longer than one of most general practitioners, and that the
underlying reason for a long consultation is that a very large amount
of patient data is collected during its course. This includes
modalities, likes and dislikes and many ancillary aspects about the
patient’s sense of well-being, sleep, menstruation, feelings and
general state of happiness. In general, homeopaths search for ‘the
rare, the startling and the peculiar’ in the patient’s
symptomatology, because experience dictates that this more frequently
leads them to the right drug. As the authors also, and quite
rightly reveal, such material is gathered specifically to match it
with the characteristics of homeopathic drugs in order to choose a
single drug which matches the totality of the patient’s symptoms.
Very patient and painstaking matching of patient symptoms to
drugs is certainly the central dominating activity of all homeopaths.
A great deal of search and analysis and subtle fine-tuning has to
be done, not only to find the correct remedy, but also to maintain
any therapeutic progress which is achieved. It is worth stating
that patient data is not gathered covertly, in order to please the
patient, or to elicit some placebo response by contact with a
sympathetic person for an hour, which is a criticism one occasionally
encounters.

As they also point out later, one drug is not the only approach and
it is incorrect to claim that there is a routine or rote-prescribing
approach in homeopathy, such as grass pollen for all cases of
hayfever. The authors refer to a lack of ‘evidence that homeopathy is
clearly efficacious for any single condition’. While this is probably
strictly correct it is also somehow misleading. It of course
depends on what you define as evidence. While many double blind
trials are flawed for research into such therapies, and have been
admittedly disappointing thusfar for researchers on both sides,
nevertheless the sheer weight of anecdotal evidence should give rise
to the common-sense notion that there must be some basis for such
therapies by virtue of the fact that they have lasted this long. In
the 1850s ‘medical delusions’ like homeopathy were all widely
predicted, by clinicians at the time, to fizzle out in a few years. That
they have failed to do so, but are now as popular as ever, must
surely, to open and reasonable minds, indicate that there simply must
be something in them. Here is an account of what might be seen as one
of the first double blind trials of homeopathy in 1870s
Glasgow:

"...Hughes had suggested aconite as a remedy for simple fever and Dr
Burnett determined to test the advice on his children's fever ward,
dosing all the patients down one side with Fleming's Tincture of
Aconite, and treating the others as usual. Within twenty-four hours all
the
aconite children were cured (save one, who had measles) and smartly
discharged, while the rest still languished in hospital. The experiment
was repeated with the same startling results until a truculent nurse,
impatient of the doctor's hard heart, dosed all the patients
indiscriminately from 'Dr Burnett's Fever Bottle' and emptied the
ward.

"The doctor was 'simply dumbfounded', spent his nights reading
homoeopathic literature and, having suffered a conversion which he
afterwards compared to St Paul's on the road to Damascus, instantly
resolved to 'fight the good fight of homoeopathy with all the power I
possess: were I to do less I should be afraid to die.' His MD thesis,
submitted when his year's term at Barnhill elapsed, was rejected for
heretical, homoeopathic tendencies (a second thesis was accepted in
1876).” [from Clarke’s Life of Dr Burnett]

Patients are not fools. They know whether they are getting better or
not and they would certainly not pay vast sums if there was no
progress being made. The argument that they are that rich and that
desperate [or that stupid?] to not bother, while interesting, does
not really hold much credence. Indeed, as some correspondents here
have said: there is not a lack of evidence but an abundance of
evidence that homeopathy works. Such evidence is unfortunately an
‘abundance of the wrong type’ and ‘a lack of the right type’ to
impress most openly hostile clinicians, who clearly reserve the right
to define what is ‘right’ and ‘wrong’ in such matters. Such
minds will probably never be persuaded of the efficacy of anything
other than scientific medicine.

There is a very engaging story worth telling here about Dr Jonathan
Miller [the theatre director and neurologist] in a late-night TV
discussion programme in September 1988. When asked why he felt that
alternative medicine was of no interest to him, he replied
along the lines of saying [not verbatim]: ‘Even if it were clinically
proven by numerous studies, I would still not be remotely
interested in it. Only science holds the future of medicine and this
‘other stuff’ is happening in an entirely different street. The future
of medicine is entirely with science.’ These views were then repeated
in an article in The Guardian newspaper some months later. I
am sure these perfectly understandable views could be repeated many
times throughout the medical community, but it is no use
running away from the fact that patients demand holistic therapies.
They demand natural and harmless therapies which work, and
prefer them to strong drugs and surgery. That is the central and
uncomfortable reality which medicine faces today. How it is to be
faced and dealt with is the very substance of this discussion.

Finally, I would say that the bibliography is seriously deficient in
a number of very important books on this subject which have been
published in recent years. I would have included the following:

Phillip A Nicholls, 1988, Homeopathy and the Medical Profession,
Croom Helm London

Mike Saks, 1992, Alternative Medicine in Britain, RKP

Mike Saks, 1995, Professions and the Public Interest - Altruism and
Alternative Medicine, RKP London

Ursula Sharma, 1992, Complementary Medicine Today: Patients and
Practitioners, RKP

Barbara Griggs, 1982, Green Pharmacy A History of Herbal Medicine,
Jill Norman and Hobhouse, London

Ivan Illich, 1977, Limits To Medicine, Penguin, London

And it is also useful to read those old classics by Brian Inglis:
Fringe Medicine, 1964, Faber, London, and Natural Medicine, 1979,
Collins, London. Time has hardly dated them, both in the factual
substance and in the underlying themes he discusses.

I would also recommend two other classics in the wider field of
medical sociology: Margaret Stacey, The Sociology of Health and
Healing and the brilliant Freund & McGuire, 1995, Health, Illness
And The Social Body: A Critical Sociology, Prentice Hall, USA

Peter Morrell


Hon. Research Associate History of Medicine


Staffordshire University, UK

Competing interests: No competing interests

23 November 1999
Peter Morrell
Hon. Research Associate History of Medicine
Staffordshire University, UK