By Ananya Prasana
Medicine is a constantly evolving field of study- many revered theories have been later disputed and replaced by more modern ideas. Yet, almost 230 years after it was first discovered, regardless of many trials shunning its efficacy, homeopathy remains used as a treatment in modern medicine. Why has homeopathy remained as a pillar in the treatment of disease, and is there any fact behind its ideology?
Homeopathy, developed by German physician Samuel Hahnemann in the 1790s, is the idea that highly diluted versions of a disease-causing substance can be used to treat the same disease.Influenced by the principles of similarity (like cures like), which seemed logical at a time when removing diseased blood (bloodletting) was a preferred treatment, Hahnemann conducted an experiment. He ingested Cinchona bark (containing quinine, the drug used to treat malaria) and experienced symptoms which he described as those of Malaria; scientists have later theorised that these symptoms may have merely been an idiosyncratic adverse reaction. Regardless, he published his theory of homeopathy, concluding that the quinine drug eased malarial symptoms because it supposedly caused Malaria in a healthy individual, his own experience being the evidence. His theory is still used to this day- a theory which was possibly based entirely on a misinterpreted experiment.
Part of the theory discusses how diluting a substance increases its effectiveness in treating disease- a process which he called potentiation. This is backed by no scientific evidence, and more significantly, the levels to which substances are diluted means that there is often no pharmacalogically effective amount of the primary substance. The process involves diluting in steps of 100, in what Hahnemann called the centismal or ‘C’ scale, which quickly leads to dilutions of the primary substance in the ratio of 1:1060 (or 30C), a common dilution level in classical homeopathy. To put this level of dilution into context, a common analogy used for a 12C dilution (which contains more of the primary substance than a 30C dilution) is it being equivalent to a pinch of salt in both the North and South Atlantic Oceans. The process of potentiation contradicts both the pharmacological dose-effect relationship, and the law of mass action.
Furthermore, the treatments involve ritualistic processes such as succussion, where the solution is given ten firm shakes, which add no scientific value. Although Hahnemann had good intentions, the continued use of homeopathy has meant that ailing patients delay scientifically accurate treatments in lieu of homeopathy, which means that diseases worsen and ultimatelly, patients die.
In a plea to avoid these complications, many scientists have conducted clinical trials to dispute the efficacy of homeopathy. However, many of these trials have not been admissible- from not being double-blind, to lacking a comparative placebo; yet, homeopaths have cherry-picked in order to publish this data in support of their craft. The comparison of the methodological accuracy of a homeopathy trial with the result it provides has been thoroughly studied- by completing a Jadad score, a method used to evaluate the methods of a trial, it has shown the fairest trials (highest Jadad score) show homeopathy performing no better than a placebo. In an article published in the Lancet in 2005, Shang et al completed a meta-analysis of the fairest published data, and again supported the conclusion that homeopathy performs no better than placebo.
With all of this evidence against the medicine, why is it still used and appreciated by patients? Homeopaths and patients often see remarkable improvement in symptoms as a result of using these alternative medicines. As proven, this is definitely not because of the clinical efficacy of the medicines- rather, some amelioration may be due to a phenomenon called ‘Regression to the Mean’- patients seek treatments when they are feeling at their worst, and in many cases, this pain gets slightly better regardless of treatment- if patients have taken alternative medicines, they feel that these have caused the alleviation of symptoms rather than just regression to the mean. Another reason may be the creation of a placebo effect- in speaking to a compassionate physician and having someone listen to them, patients gain hope and feel that their symptoms will get better and as a result feel better.
Many have experienced homeopathy to be effective, due to the reasons outlined above. However, the otherwise detrimental effects of delaying treatment, and using dangerous substances can be extremely harmful. A Croatian study found notable concentrations of heavy metals in some homeopathic treatments; although the risk of bioaccumulation was concluded to be low, it was stated that a risk is still present and should be considered. It is important to note that although homeopathy forms part of the complementary and alternative medicine (CAM) market, its inefficacy is not a representation of the entire market; some CAM products do perform better than placebo.
For the large part of a century, the UK Government and aristocracy supported homeopathy, the British Monarchy having been patrons for and assigning the prefix ‘Royal’ to the London Homeopathic Hospital. A 1999 BBC study found that 17% of 1204 candidates had used homeopathic treatments (including over-the-counter remedies) in the preceding year, these treatments being used to treat chronic pains, depression/anxiety and common conditions such as asthma and arthritis. More recently, in response to the overwhelming evidence, the NHS stopped funding homeopathy in 2017 after concluding that it had no clinical benefit in 2010. However, an international clampdown may be necessary when considering that countries such as Germany, Hahnemann’s homeland, still support the treatment under insurance policies, contributing to its possibly dangerous consequences.
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