In a recent paper, George Vithoulkas argues that “homeopathy is not a therapeutic approach suited for a modern ‘developed’ society, that it will never be widely practiced in our contemporary world, and that it will never become truly adopted by medical schools”. The reason for this according to Vithoulkas is that we live in a world of violence and aggression that is fundamentally toxic and imbalanced. Hence, the mild therapeutic approach of homeopathy is ill-suited because every time it works, as it has for millions of patients according to him, the newly “re-set” patient will return to a world that will inevitably disturb their balance.
As a general commentary on the way we live today and state of the modern world, this was a somber read. The way in which our modern society functions alienates us from the environment and from ourselves in ways that on short reflection reveal themselves toxic to our overall wellbeing on multiple fronts. The general homeopathic sentiment about the need to return to nature and maintaining balance is one we should all value and adopt if we wish to get to the root of many of our problems, health and otherwise.
But this is not really a paper about modernity per sé. It’s about why homeopathy has not been able to go mainstream. Vithoulkas finds it a “strange paradox that, despite evidence that classical homeopathy can successfully treat chronic conditions that are considered incurable with conventional medicine, homeopathy still remains an untouchable issue for the majority of medical authorities.” The framing he offers is purely ideological, presented in such a way that makes mainstream medicine as not ignorant of the evidence for homeopathy, which has benefitted millions of patients according to his account, but to be engaged in a deliberate effort at suppressing and ignoring it because it doesn’t fit the dominant mode of the modern world as he put it:
Violence, in all its forms — between states, between nations, between terrorist groups, by anyone who possesses any power over more vulnerable groups — is prevailing in today’s world. It is thus interesting that conventional medicine, with its generally invasive approach, fits so well with the mentality of today’s society and therefore dominates the contemporary health sector.
Notwithstanding the valid points raised about what dominates our modern modes of living contributing to our dis-ease, which can serve as a social commentary we should all reflect on, the leap Vithoulkas makes to equate medicine with violence is logically untenable. It’s a rhetorical tactic employed by homeopaths presenting themselves to be the victims of marginalization by the mainstream medical establishment because of what he termed a “peaceful temperament” while at the same time aggressively attacking conventional medicine with its “generally invasive approach”. That a number of easily accessible systematic reviews have examined numerous studies attempting to validate the efficacy of homeopathic treatment and showed them to be no better than placebo and more likely due to the homeopathic consultation process is peculiarly missing.
It’s important to note here that we have to rely on systematic reviews of randomized clinical trials because no single study is perfect. Science is not about “proving” anything and clinical practice is not based on one or two studies. It’s about collecting enough evidence to point in a direction that will give us a reasonable expectation of a particular outcome. Each of us can find a study to support our biases. But if we find 99 studies pointing in one direction and 1 in the opposite, the most we can say about the one study is that it needs to be dissected to identify what about it led to a different outcome. More often than not, it either doesn’t replicate in a follow-up study, or has a methodological issue that explains the result.
The ideological framing by Vithoulkas is not surprising. Since its inception by the German physician Samuel Hahnemann (1755–1843), homeopathy has been founded on extraordinary claims that fail to provide the extraordinary evidence in support of them. In Bad Science: Quacks, Hacks, and Big Pharma Flacks, Bed Goldacre describes the period in which Hanhamann came up with his theories of medicine:
At a time when mainstream medicine consisted of bloodletting, purging, and various other ineffective and dangerous evils, when new treatments were conjured up out of thin air by arbitrary authority figures who called themselves doctors, often with little evidence to support them, homeopathy would have seemed fairly reasonable.
Hahnemann’s theories differed from the competition because he decided — and there’s no better word for it — that if he could find a substance that would induce the symptoms of a disease in a healthy individual, it could be used to treat the same symptoms in a sick person…
Giving out chemicals and herbs could be a dangerous business, since they can have genuine effects on the body (they induce symptoms, as Hahnemann identified). But he solved that problem with the second great inspiration, and the key feature of homeopathy that most people would recognize today: he decided — again, that’s the only word for it — that if you diluted a substance, this would ‘potentize’ its ability to cure symptoms, ‘enhancing’ its ‘spirit-like medicinal powers,’ and at the same time, as luck would have it, also reducing its side effects. In fact, he went further than this: the more you dilute a substance, the more powerful it becomes at treating the symptoms it would otherwise induce.
Simple dilutions were not enough. Hahnemann decided that the process had to be performed in a specific way, with an on brand identity, or a sense of ritual and occasion, so he devised a process called succession.
I emphasized in this passage two things. First, Hahnemann is deciding upon something that can be empirically verified. Second, he made a metaphysical claim about the substances he’s diluting, combined with a ritual to go along with it. As for the empirically-verifiable claims, we have a method for that. All we need to do is to go and test them out. The jury has been settled on this front and it’s not in Hahnemann’s favour. As for the metaphysical claim about spirit-like medicinal powers, Muslims have a method for that. All we need is evidence from the Quran and the Sunnah to corroborate this general claim, and evidence for the specific ritualized process Hahnemann prescribed to harness those spiritual powers. To date, I’ve yet to come across those two lines of evidence.
Homeopathy faced the same resistance during the period of its inception as it does today. Long before the professionalization of medicine and standardization and licensing of its practice, contemporary challenges to Hahnemann’s ideas were penned by other physicians. One of the most notable and thorough critiques was by the American physician Oliver Wendell Holmes Sr. (1809–1894) under the title Homeopathy and Its Kindred Delusions, which included two lectures Holmes delivered before the Boston Society.
As a historical document, Holme’s writing offers clarity to a discussion of a topic the underpinnings of which may have become obscured by the passage of time and the institutionalization of medicine. He begins his second lecture, which is dedicated to examining the tenets of homeopathy, with a response to the same charge made then as today — that mainstream medicine is aggressively attacking it, pointing out that it’s a reaction to an initial attack started by the homeopaths themselves:
It may be thought that a direct attack upon pretensions of HOMŒOPATHY is an uncalled for aggression upon an unoffending doctrine and its peaceful advocates.
But a little inquiry will show that it has long assumed so hostile a position with respect to the Medical Profession, that any trouble I, or any other member of that profession may choose to bestow upon in, may be considered merely as a matter of self-defence. It began with an attempt to shew the insignificance of all existing medical knowledge. It not only laid claim to wonderful powers of its own, but it declared the common practice to be attended with the most positively injurious effects, that by it acute diseases are aggravated, and chronic diseases rendered incurable. It has at various times brought forward collections of figures having the air of statistical documents, pretending to shew a great proportional mortality among the patients of the Medical Profession, as compared with those treated according to its own rules. Not contented with choosing a name of classical origin for itself, it invented one for the whole community of innocent physicians, assuring them, to their surprise, that they were all ALLOPATHISTS, whether they knew it or not, and including all the illustrious masters of the past, from Hippocrates down to Hunter, under the same gratuitous title. The line, then, has been drawn by the champions of the new doctrine; they have lifted the lance, they have sounded the charge, and are responsible for any little skirmishing that may happen.
Prefacing his second lecture, Holmes emphasized that his objective was restricted to the rational evaluation of homeopathy:
I wish to state for the sake of any who may be interested in the subject, that I shall treat it not by ridicule, but by argument; perhaps with great freedom, but with good temper and in peaceable language; with very little hope of reclaiming converts, with no desire of making enemies, but with a firm belief that its pretensions and assertions cannot stand before a single hour of calm investigation.
Holmes offers a lengthy treatment of the principles of homeopathy, and one would be hard-pressed not to acknowledge that he didn’t misrepresent or strawman any of them. I’ll leave that part for you to read and decide for yourself, or you can read Goldacre’s Bad Science for another version of it. As far as I’m concerned, this is more of a social phenomenon than a science question. Of the questions that interest me is how advocates of homeopathy manage to convince some people. The answer to this seems to be, in part, about rhetoric.
Holmes points out a rhetorical tactic Hahnemann employs in his writing that is all too familiarly observed among many in the alternative medicine stream — the unscrupulous appeal to the authority of tradition and historical accounts to present homeopathy as “authentic”. Regarding the homeopathy principle of “like cures like” (this one is a bit long but bear with me):
It is necessary to show in the next place that medicinal substances are always capable of curing diseases most like their own symptoms. For facts relating to this question we must look to two sources; the recorded experience of the medical profession in general; and the results of trials made according to homœopathic principles, and capable of testing the truth of the doctrine.
No person, that I am aware of, has ever denied that in some cases there exists a resemblance between the effects of a remedy and the symptoms of diseases in which it is beneficial. This has been recognised, as Hahnemann himself has shown, from the time of Hippocrates. But according to the records of the medical profession, as they have been hitherto interpreted, this is true of only a very small proportion of useful remedies. Nor has it ever been considered as an established truth that the efficiency of even these few remedies was in any definite ratio to their power of producing symptoms more or less like those they cured.
Such was the state of opinion, when Hahnemann came forward with the proposition that all the cases of successful treatment found in the works of all preceding medical writers, were to be ascribed solely to the operation of the homœopathic principle, which had affected the cure, although without the physician’s knowledge that this was the real secret. And strange as it may seem, he was enabled to give such a degree of plausibility to this assertion, that any person not acquainted somewhat with medical literature, not quite familiar, I should rather say, with the relative value of medical evidence, according to the sources hence it is derived, would be almost frightened into the belief, at seeing the pages upon pages of Latin names he has summoned as his witnesses.
It has hitherto been customary, when examining the writings of authors of preceding ages, upon subjects as to which they were less enlightened than ourselves, and which they were very liable to misrepresent, to exercise some little discretion; to discriminate, in some measure, between writers deserving confidence and those not entitled to it. But there is not the least appearance of any such delicacy on the part of Hahnemann. A large majority of the names of old authors he cites are wholly unknown to science. With some of them I have been long acquainted, and I know that their accounts of diseases are no more to be trusted than their contemporary Ambrose Paré’s stories of mermen, and similar absurdities. But if my judgment is rejected, as being a prejudiced one, I can refer to Cullen, who mentioned three of Hahnemann’s authors in one sentence, as being ‘not necessarily bad authorities; but certainly such when they delivered very improbably events;’ and as this was said more than half a century ago, it could not have had any reference to Hahnemann. But although not the slightest sign of discrimination is visible in his quotations — although for him a handful of chaff from Schenck is all the same thing as a measure of wheat from Morgagni, there is a formidable display of authorities, and an abundant proof of ingenious researches to be found in each of the great works of Hahnemann with which I am familiar.
It is stated by Dr. Leo-Wolf, that Professor Joerg of Leipsic, has proved many of Hahnemann’s quotations from old authors to be adulterate and false. What particular instances he has pointed out I have no means of learning. And it is probably wholly impossible on this side of the Atlantic, and even in most of the public libraries of Europe, to find any thing more than a small fraction of the innumerable obscure publications which the neglect of grocers and trunk makers has spared to be ransacked by the all-devouring genius of Homœopathy. I have endeavored to verify such passages as my own library afforded me the means of doing. For some I have looked in vain, for want, as I am willing to believe, of more exact references. But this I am able to affirm, that out of the very small number which I have been able to trace back to their original authors, I have found two to be wrongly quoted, one of them being a gross misrepresentation.
The first is from the ancient Roman author, Cælium Aurelianus; the second from the venerable folio of Forestus. Hahnemann uses the following expression, — if he is not misrepresented in the English Translation of the Organon; ‘Asclepiades on one occasion cured an inflammation of the brain by administering a small quantity of wine.’ After correcting the erroneous reference of the Translator, I can find no such case alluded to in the chapter. But Cælius Aurelianus mentions two modes of treatment employed by Asclepiades, into both of which the use of wine entered, as being in the highest degree irrational and dangerous.
In speaking of the oil of aniseed, Hahnemann says that Forestus observed violent colic caused by its administration. But as that author tells the story, a young man took, by the counsel of a surgeon, an acrid and virulent medicine, the name of which is not given, which brought on a most cruel fit of the gripes and colic. After then another surgeon was called, who gave him oil of aniseed and wine, which increased his suffering. Now if this was the Homœopathic remedy, as Hahnemann pretends, it might be a fair question why the young man was not cured by it. But it is a much graver question why a man who has shrewdness and learning enough to go so far after his facts, should think it right to treat them with such astonishing negligence or such artful unfairness.
Even if every word he had pretended to take from his old authorities were to be found in them, even if the authority of every one of these authors were beyond question, the looseness with which they are used to prove whatever Hahnemann chooses, is beyond the bounds of credibility. Let me give one instance to illustrate the character of this man’s mind. Hahnemann asserts in a note annexed to the 100th paragraph of the Organon, that the smell of the rose will cause certain persons to faint. And he says in the text that substances which produce peculiar effects of this nature on particular constitutions, cure the same symptoms in people in general. Then in another note to the same paragraph, he quotes the following fact from one of the last sources one would have looked to for medical information, the Byzantine Historians,
‘It was by these means’ (i.e. Homœoapthically) ‘that the Princess Eudosia with rose water restored a person who had fainted!’
Is it possible that a man who is guilty of such pedantic folly as this; a man who can see confirmation of his doctrine in such a recovery as this; a recovery which is happening every day — from a breath of air — a drop or two of water — untying a bonnet string — loosening a stay-lace — and which can hardly help happening, whatever is done; is it possible that a man, of whose pages, not here and there one, but hundreds upon hundreds are loaded with such trivialities, is the Newton, the Columbus, the Harvey of the nineteenth century!
The whole process of demonstration he employs is this. An experiment is instituted with some drug upon one or more healthy persons. Every thing that happens for a number of weeks or days is, as we have see, set down as an effect of the medicine. Old volumes are then ransacked promiscuously, and every morbid sensation or change, that any body ever said was produced by the drug in question is added to the symptoms. By one or both of these methods, each of the sixty-four substances enumerated by Hahnemann is shown to produce a very large number of symptoms, the lowest in his scale being ninety-seven, and the highest fourteen hundred and ninety-one. And having made out this list respecting any drug, a catalogue, which as you may observe in any Homœopathic manual, contains various symptoms belonging to every organ of the body, what can be easier than to find alleged cures in every medical author which can at once be attributed to the Homœopathic principle; still more if the grave of extinguished credulity is called upon to give up its dead bones as living witnesses; and worst of all, if the monuments of the past are to be mutilated in favor of ‘the sole law of Nature in therapeutics?’
What Hahnemann has done is set the tone for every homeopath who walks in his footsteps:
- Decide how things are regardless of the presence or lack of evidence in support of your belief;
- Talk about mystical powers that by definition cannot lend themselves to an empirical investigation;
- Use scientific and clinical jargon to sound authoritative;
- Speak using the most general and vague terms so that like a horoscope, you sound like you’ve identified the problem for that patient who will just project their own confirmation biases onto your statements;
- Find anecdotal examples of historical and clinical accounts, and now articles you can find on PubMed, that sound like they’re talking about what you’re promoting and rely on the fact that most people won’t go through the effort of confirming the existence such accounts let alone reading them to check you haven’t misinterpreted them;
In his introductory remarks in the first lecture on homeopathy, Holmes drew an analogy:
Astrology and Alchemy, which came under our notice on a former occasion, were seen to be marked by many common character, which, if embraced in a single sentence, may stand as a general formula for the whole tribe of the pseudosciences.
A theory was gratuitously assumed; ‘FACTS’ were brought forward to sustain it, numerous, seemingly well authenticated, but untrue, or misapplied; the phenomena of nature were misinterpreted; the constant failures of honest experimenters or observers, were accounted for by a self adjusting system of subterfuges; both falsified the history of the past to gain the credit of antiquity; both violated the rules of common sense to involve their doctrines in impressive mystery; and yet volumes, alike unnumbered and unmeaning, were written upon both subjects, men of learning accepted their pretensions, shrewder, if not wiser rogues employed their artifices for a livelihood, and their coffers ran over with the rich man’s gold and the poor man’s silver; because they both held out such glittering objects, that the weakness of human nature yearned to believe them true.
Homeopathy works for some people, but not for the empirical reasons homeopaths claim it does. The clinical encounter has a number of factors that can influence the outcome, and the management plan is only one of them. Medicine is a constantly evolving field where the concern of the physicians, at least in general, is the wellbeing of the patient. The advent of lifestyle and integrative medicine is part of this ongoing development, which places the focus more on conservative management and lifestyle factors to improving health as opposed to early medical intervention. The reason medicine is moving in this direction instead of homeopathy is not that we live in a world of violence. Rather, it’s a recognition that you can’t simply decide in your mind that something works in the mechanism you say it does, claim mystical powers to it, then refuse to change your mind when all attempts to validate your claim in the real world fail.
