Wiener Medizinische Wochenschrift

Printed in Austria

Homöopathie und „Mainstream“-Medizin: Ein Dialog unter Schwerhörigen?

Zusammenfassung. Es existieren verschiedensteDefinitionen für komplementäre und alternative Medizin.Homöopathie ist unter diesen Therapien einzigartig durchihren Ursprung im Gedankengut der Europäischen Aufklä-rung. Sie ist kontroversiell und wissenschaftlich nicht plau-sibel, dabei aber populär, weit verbreitet und langlebig.Das führt zu einem seit langem anhaltenden „Dialog un-ter Schwerhörigen“ mit wenig Fortschritt oder eigentlicherDiskussion.

Klinische Zusammenarbeit und ernsthafter wissen-schaftlicher Diskurs über Homöopathie ist möglich undsollte verfolgt werden. Die Alternative wäre nicht, dass dieHomöopathie verschwände, sondern dass sie in eine ab-gelehnte medizinische Subkultur aufginge mit ungünsti-gen Konsequenzen, insbesondere für Patienten. Das Ro-yal London Homoeopathic Hospital entwickelt die klini-sche Integration und wissenschaftliche Zusammenarbeitim Rahmen eines großen akademischen Medizinzentrumsin London.

Schlüsselwörter: Homöopathie, Rationalismus, In-tegration.

Summary. Various definitions of complementary andalternative medicine have been proposed. Homeopathy isunique among CAM therapies in originating in EuropeanEnlightenment thought. It is controversial and scientificallyimplausible yet popular, widespread and durable. The re-sult has been a longstanding ‘dialogue of the deaf’, withlittle progress or genuine discussion.

Clinical collaboration and serious and scientific dis-course concerning homeopathy is possible and should bepursued. The alternative is not that homeopathy disap-pears but that it is absorbed into a disaffected medicalcounterculture with adverse consequences, particularly forpatients. The Royal London Homoeopathic Hospital is de-

veloping clinical integration and scientific collaborationwith a major academic medical centre in London.

Key words: Homeopathy, rationalism, integration.

Complementary and alternative medicine (CAM) is anheterogeneous group of therapies, several lists of CAMtherapies exist, including those of the US National Cen-ter for Complementary and Alternative Medicine(NCCAM) [1], and of the British House of Lords [2].Such lists broadly agree on which therapies constituteCAM, however the question of what it is that unites thesevery disparate therapies is much more difficult. A prag-matic and easy to operationalise definition is that of Ei-senberg et al: ‘Interventions neither taught widely inmedical schools nor generally available in US hospitals’[3]. But this definition is unsatisfactory, apart from beingspecific to the USA (although easily adapted), applyingit does not generate a list which corresponds to the listsof CAM therapies mentioned above. For instance, acu-puncture, universally classified as a CAM therapy, iswidely used in hospital pain clinics throughout Europe.

A less helpful definition is given by Dawkins, a dis-tinguished evolutionary biologist who is particularly hos-tile to homeopathy, who defines alternative medicine as‘that set of practices which cannot be tested, refuse to betested, or consistently fail tests’ [4]. But by this criterionmany surgical, psychotherapeutic, physiotherapy andother procedures would count as ‘alternative’ while sig-nificant components of what is generally agreed to beCAM, would not.

The most satisfactory definition is that of the Co-chrane Collaboration ‘A broad domain of healing resour-ces that encompasses all health systems, modalities, andpractices and their accompanying theories and beliefs,other than those intrinsic to the politically dominanthealth systems of a particular society or culture in a givenhistorical period.’ Although clumsy, this is the best defi-nition, since its application yields a list which closely ap-proximates to those identified as CAM by NCCAM, TheHouse of Lords and other bodies.

It is illuminating to consider homeopathy in the lightof this definition. CAM practices may be ‘outsiders’ to

Homeopathy and mainstream medicine: a dialogue of the deaf?

Peter Fisher

Royal London Homoeopathic Hospital, London, United Kingdom

Received August 31, 2005; accepted September 22, 2005© Springer-Verlag 2005

Wien Med Wochenschr (2005) 155/21–22: 474–478DOI 10.1007/s10354-005-0226-9

Correspondence: Peter Fisher, Clinical Director and Directorof Research, Royal London Homoeopathic Hospital, GreatOrmond Street, London WC1N 3HR, U.K.Fax: +44-20-739118829E-mail: peter.fisher@uclh.nhs.uk

Fisher, Homeopathy and mainstream medicine

the dominant health systems for various reasons: someoriginate in cultures other than that which currently pre-vails in the West – these include Traditional ChineseMedicine, Acupuncture and related methods, and Ayurv-eda. Others originate in different times: there are manydifferent local traditions of phytotherapy or herbal med-icine rooted in their respective regional floras, but all arehistorically embedded in folk culture. From the perspec-tive of the modern Western scientific paradigm they areprescientific. Osteopathy and chiropractic both originatedin late 19th century North America, and are based on spe-cific anatomical concepts.

But homeopathy is enigmatic, uniquely, it traces itsintellectual ancestry to the European enlightenment – thesame intellectual source as modern western scientificmedicine. Its founder, Samuel Hahnemann was steepedin enlightenment values, even to the extent of writing thehighest ideal of Enlightenment thought, rationalism, intothe title of his magnum opus the Organon der rationellenHeilkunde. He strongly held the enlightenment view thatknowledge is not innate, but comes only from observa-tion guided by reason, insisting that: ‘The pure, charac-teristic, curative virtues of medicines cannot be appre-hended by specious a priori sophistry, or from the smell,taste or appearance of the medicine, or from chemicalanalysis.’ [5].

He went on to develop ‘provings’, an infelicitoustranslation of the German Prüfung, more accuratelyknown as homoeopathic pathogenetic trials (HPT) [6]. Inan HPT a substance of interest is given to healthy volun-teers and their symptoms recorded. Homeopathy was theearliest example of a form of medicine which aspired tobase its practice on clinical trials; although Hahnemann’soriginal HPTs were uncontrolled, the first double blindplacebo controlled homeopathic proving was conductedin 1835, and was one of the first double blind placebocontrolled trials in the history of medicine [7]. The ho-meopathic literature contains some of the earliest exam-ples of multi-centric clinical trials [8]. Apart from ration-alism Hahnemann also shared other enlightenment valuesincluding anti-clericalism (he was a Freemason) and hu-manism: a contemporary of Pinel he strongly condemnedthe chaining and beating of ‘lunatics’, advocating instead‘humanity combined with firmness’ [9].

Yet this common intellectual ancestry has certainlynot lead to an acceptance of homeopathy by those whoregard themselves as the guardians of the Enlighten-ment’s intellectual heritage. Homeopathy has recentlybeen denounced as the ‘pons asinorum of attitudes tocomplementary medicine’ (meaning, apparently, that any-one who does not reject it a priori is an ass), the epitomeof ‘unreason’ in medicine, and generally the antithesis ofEnlightenment values [10]. The paradox is most clearlyseen in the homeland of the Enlightenment, France,where lifetime use of homeopathy among the generalpopulation is about 40 % (the highest in the world) [11],and some 25,000 of 200,000 doctors use homeopathicmedicines [12], but where homeopathy is excluded fromsecondary care and the Academie de Medicine has re-cently (but unsuccessfully) demanded that its reimburse-ment by social security cease.

The pattern is similar elsewhere, public popularity inseveral European countries is not much lower than inFrance [13], elsewhere there has been a rapid growth inits popularity: in the USA public use of homeopathy roseby 500 % in a seven year period in the 1990’s [14]. Yetin all these countries homeopathy is in various ways andto different degrees marginalised. It is worth noting thathomeopathy is also very popular in countries which donot share the European intellectual tradition: there areover 120,000 homeopathic practitioners in India, and it ispopular throughout the subcontinent.

It is not the purpose of this article to review the pri-mary research evidence on homeopathy: this has beensystematically reviewed and meta-analysed [15–17], dis-cussed and criticised of elsewhere [18–20]. Reports ofhigh-quality basic research [21, 22]; and debates concern-ing its mode of action [23, 24] have also been published.Some recent clinical trials have not so far been includedin meta-analyses, one of particular interest was conduct-ed in an intensive care unit in Vienna, on critically ill pa-tients, with a positive result [25], another examined theeffect of homeopathy in attention-deficit hyperactivitydisorder [26]. A recently published large scale primarycare outcome study conducted in Germany suggested thatpatients seeking homoeopathic treatment had a better out-come overall compared with patients on conventionaltreatment, for similar costs [27].

On the other side a meta-analysis recently publishedin The Lancet [28], was accompanied by an editorial pro-claiming the ‘end of homeopathy’ and calling for the ces-sation of research investment in research on homeopathy[29]. The meta-analysis found eight trials of homoeopa-thy for acute infections of the upper respiratory tract, thepooled effect indicated a substantial beneficial effect andthere was no convincing evidence of bias. However, theauthors do not accept these findings because ‘the biasesthat are prevalent in these publications, as shown by ourstudy, might promote the conclusion that the results can-not be trusted’.

The references cited are not comprehensive or sys-tematic, but are intended to give a flavour of the debate.They demonstrate that serious scientific discourse on ho-meopathy is possible, yet this discourse is frequently in-audible above a dialogue of the deaf, in which proponentsand opponents of homeopathy shout at each other, but donot listen.

My intent is to examine the origins, consequencesand possible solutions to the sharp polarisation of opin-ion concerning homeopathy. This debate is not new,Hahnemann himself fired one of the opening shots whenhe accused his medical contemporaries of ‘killing gradu-ally more millions than Napoleon ever slew in battle’[30]. Contemporary conventional doctors retaliated, al-though on grounds which now seem surprising, accusingthe homeopaths of empiricism [31].

The root of much of the disagreement is the use, byhomeopaths, of extremely dilute medications, including‘ultramolecular’ dilutions (diluted beyond the point atwhich they contain any molecule of the starting sub-stance). From time to time, the allegation is made that forsuch preparations to have any activity would violate fun-damental scientific principles, although to my knowledge

475

Fisher, Homeopathy and mainstream medicine

the violation of only one specific natural law (the Law ofMass Action) has ever been proposed in a peer-reviewedjournal [32], this claim was made only once and neverrepeated. In fact if the leading hypothesis on the actionof homeopathic medicines, the so-called information hy-pothesis [33] is correct, the claimed activity of thesemedicines no more violates any fundamental natural lawthan does the storage of information by a video tape orfloppy disk! This is not the only hypothesis concerningthe actions of high dilutions, and all the hypotheses arecurrently largely speculative. Nevertheless it is clear thatbasic scientific principles do not preclude the possibilitythat these preparations could have activity.

Safety is an important factor motivating patients toseek homeopathy, in a survey of 500 patients attendingour hospital, 40 % reported that safety considerationswere an important factor in their decision to seek home-opathic treatment, satisfaction ratings were high [34]. Pa-tient confidence in the safety of homeopathy seems jus-tified, while there are challenges relating to under-report-ing and mistaken identity (herbal medicines identified ashomeopathic), direct risks resulting from the use of ho-meopathic medicinal products seem to be extremely low[35].

A national ‘snapshot’ study of homeopathic practicein Belgium showed a similar pattern, but highlighted amore disturbing aspect: it appears that many patientsseeking homeopathic treatment were deeply disillusionedwith previous conventional treatment, much more satis-fied with homeopathic treatment. It has often beenclaimed that the effects of homeopathic treatment are at-tributable to longer consultations, but according to thissurvey only a small part of the dissatisfaction was attrib-utable to length of consultation [36]. An influential book,written by a doctor, which paints a pessimistic picture ofthe future of medicine seems to be alluding to the sameproblem: “these alternatives are more than just ‘feel-good therapeutics’…following the discovery of cortisoneand other anti-inflammatory agents, the skills of rheuma-tologists devolved around juggling various toxic regimesof drugs in the hope that the benefits might outweigh thesometimes grievous side-effects. Meanwhile all the othertherapies for rheumatological disorders…were aban-doned virtually wholesale only to be rediscovered by al-ternative practitioners in the 1980s” [37].

Many patients and homeopathic practitioners (in-cluding some doctors) are convinced that ‘school’ medi-cine and science is irreversibly prejudiced against home-opathy. This has lead them to abandon the rationalist ap-proach entirely, in favour of metaphysics, in an extremecase, for instance advocating the use of Berlin Wall andeven Saddam Hussein palace (!) as remedies for ‘life ex-periences of oppression, depression, repression or sup-pression’ [38].

The tension between generally favourable public at-titudes and high levels of use and generally scepticalmedical and scientific attitudes has resulted in homeopa-thy becoming increasingly absorbed into a disaffectedand disenfranchised medical counter-culture, with signif-icant adverse consequences. The most important is on im-munisation; homeopathy is the reason most frequentlycited by British parents who refuse immunisation for

their children [39]. Some practitioners of homoeopathyattribute a wide range of adverse effects to childhood im-munisation [40]. Ironically Hahnemann was unequivocaland forceful in his support of vaccination: ‘...the remark-able and salutary result of the widespread use of Jenner’scowpox vaccination. The smallpox has not since then ap-peared among us with such widespread virulence. Fortyor fifty years ago, when a city was stricken, it lost at leasthalf, often three-quarters of its children [41]. This prob-lem appears to be particularly acute in the UK, as a con-sequence of two main factors: the British health care sys-tem is state-controlled and relatively centralised, as a re-sult the public demand for homeopathy is underprovided.The practice of homeopathy is unregulated in the UK:anyone may style themselves a homeopath, there is nomandatory requirement for training, registration etc, andsuch practitioners meet the demand. As a result, in theUK homeopathic practitioners who are not members of aregistered profession now considerably outnumber thoseare. The UK Faculty of Homeopathy, which admits onlylegally recognised health professionals, firmly supportschildhood immunisation [42].

Homeopathy is geographically widespread, popularand remarkably durable; it is also scientifically implausi-ble and continues to attract fierce attacks from the med-ical and scientific community, as it has throughout its his-tory. There is a dialogue of the deaf, in which both sidesshout, but neither listens, resulting in a deadlock whosebasic form has been remarkably stable for 150 years, de-spite the dramatic changes in medicine and society sur-rounding it. There are significant adverse consequencesfor public health; and for patients who are obliged to in-vidious choices between therapies, or to conceal fromtheir doctors that they are receiving homeopathic treat-ment (as many do). There are also adverse consequencesfor doctors who wish to practice homeopathy or considerdoing so. There are also dangers for homeopathy itself,including the risk of being swept from its rationalistmoorings.

There is no doubt that many people in many parts ofthe world believe homeopathy to be helpful for theirhealth needs. The question of whether such effects aremediated through specific or non-specific or evenwhether such concepts are meaningful in the context re-mains open, and scientific investigation is at an earlystage. However there has been a significant amount ofgood quality scientific work, with positive results. ifthese results are confirmed, they pose fascinating scien-tific questions. The often-repeated claim that homeopa-thy is ‘only a placebo response’ is not supported by meta-analyses. Homeopathy would be unique in persisting forsuch a long period, spreading so widely, and achieving acomplex but stable form if it were based only on manip-ulation of non-specific effects of treatment.

Progress will be achieved by recognition on the sci-entific and medical side that science is not a set of con-clusions, but a method of investigating natural phenom-ena, based on observation; the fact that we do not cur-rently understand how it could work, does not precludethe possibility that it does. On the side of homeopathy areaffirmation of its rational and humanistic roots is re-quired. Only in this way can the longstanding dialogue

476

Fisher, Homeopathy and mainstream medicine

of the deaf be replaced by a genuine dialogue in whichboth sides listen as well as express themselves. The al-ternative is not that homeopathy disappears, it has shownlittle inclination do so for the last 200 years despite fiercecriticism, but that it becomes part of a disaffected, disen-franchised medical counterculture to the detriment, aboveall, of patients.

The Royal London Homoeopathic Hospital (RLHH)is pursuing clinical integration and scientific collabora-tion, it is part of the National Health Service (i.e. a pub-lic hospital), and since 2002 has been part of UniversityCollege London Hospitals (UCLH). UCLH is a large ac-ademic medical centre with a medical school, and closelinks to a university and several major specialist medicalinstitutes. Despite its title the RLHH provides a range ofCAM therapies, not only homeopathy. Services are or-ganised in terms of groups of conditions and patients themain clinical services include: complementary cancertherapy, allergy and environmental medicine, stress andmood disorder, musculoskeletal and rheumatology, der-matology, general medical, women’s and children’s clin-ics. In each of these clinics a range of therapies likely tobe appropriate to the conditions encountered, is provided.Therapies include homeopathy, acupuncture, spinal ma-nipulation, Iscador and nutritional medicine. We are cur-rently developing a range of integrated services bringingtogether conventional physicians and therapists with phy-sicians and therapists using CAM techniques: these in-clude an integrated pain, antenatal and allergy services.

References1. www.nccam.nih.gov/health/whatiscam accessed 7 July

20052. House of Lords Select Committee on Science and Tech-

nology 6th report Complementary and Alternative Medi-cine 2000. www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm

3. Eisenberg DM, Kessler RC, Foster C, et al (1993) Uncon-ventional medicine in the United States. N Engl J Med328: 246–252

4. Dawkins R (2003) A Devil’s Chaplain. London, Weiden-feld and Nicholson, p 180

5. Hahnemann SC (1982) Organon of Medicine 6th edition,para 110. Kunzli J, Naude A, Pendleton P (translators).Los Angeles, Tarcher

6. Dantas F (1996) How can we get more reliable informa-tion from homoeopathic pathogenetic trials? Br Hom J 85:230–236

7. Stolberg M (1996) Die Homöopathie auf dem Prüfstein.Der erste Doppelblindversuch der Medizingeschichte imJahr 1835. MMW Munch Med Wochenschr 138: 364–366

8. Bellows HP (1906) The Test Drug Proving of the O. O.and L. Society: A Reproving of Belladonna. The Ameri-can Homeopathic Ophthalmological, Otological, andLaryngological Society. Boston

9. Hahnemann SC (1851) Description of Klockenbring in hisinsanity. In: Lesser Writings of Samuel Hahnemann. Dud-geon RE (translator). London, pp 287–294

10. Taverne D (2005) The March of Unreason. Oxford Uni-versity Press, pp 43–46

11. IPSOS survey 200412. IMAGO (2003) Etude auprès de 985 médecins général-

istes

13. Fisher P, Ward A (1994) Complementary medicine inEurope. Br Med J 309: 107–111

14. Eisenberg DM, Davis RB, Ettner SL, Appel S, et al (1998)Trends in alternative medicine use in the United States,1990–1997: Results of a follow-up national survey.JAMA 280: 1569–1576

15. Kleijnen J, Knipschild P, ter Riet G (1991) Clinical trialsof homoeopathy. Br Med J 302: 316–323

16. Linde K, Clausius N, Ramirez G, et al (1997) Are the clin-ical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 350: 834–843

17. Cucherat M, Haugh MC, Gooch M, Boissel J-P (2000)Evidence of clinical efficacy of homeopathy A meta-analysis of clinical trials. Eur J Clin Pharmacol 56: 27–33

18. Ernst E, Hahn E (eds) (1998) Homoeopathy: a criticalappraisal. London, Butterworth Heinemann

19. Vandenbroucke JP (1997) Homoeopathy trials: Goingnowhere. Lancet 350: 824

20. Jonas WB, Kaptchuk TJ, Linde K (2003) A criticaloverview of homeopathy. Ann Intern Med 138: 393–399

21. Belon P, Cumps J, Ennis M, Mannaioni PF, Roberfroid M,Sainte-Laudy J, Wiegant FAC (2004) Histamine dilutionsmodulate basophil activation. Inflamm Res 53: 181–188

22. Rey L (2003)Thermoluminescence of ultra-high dilutionsof lithium chloride and sodium chloride Physica A 323:67–74

23. Schulte J (1999) Effects of potentization in aqueous solu-tions. Br Homeopath J 88: 155–160

24. Fisher P (2004) Entangled, or tied in knots? Homeopathy93: 171–172

25. Frass M, Linkesch M, Banyai S et al (2005) Adjunctivehomeopathic treatment in patients with severe sepsis: arandomized, double-blind, placebo-controlled trial in anintensive care unit. Homeopathy 94: 75–80

26. Frei H, Everts R, von Ammon K, Kaufmann F, WaltherD, Hsu-Schmitz SF, Collenberg M, Fuhrer K, Hassink R,Steinlin M, Thurnseysen A (2005) Homeopathic treatmentof children with attention deficit hyperactivity disorder: arandomised, double blind, placebo controlled crossovertrial. Eur J Pediatr [Epub ahead of print] online first DOI:10.1007/s00431-005-1735-7

27. Witt C, Keil T, Selim D, Roll S, Vance W, WegscheiderK, Willich SN (2005) Outcome and costs of homoeopath-ic and conventional treatment strategies: A comparativecohort study in patients with chronic disorders. CompTher Med 13: 79–86

28. Shang A, Huwiler-Müntener K, Nartey L, et al (2005) Arethe clinical effects of homoeopathy placebo effects? Com-parative study of placebo-controlled trials of homoeopa-thy and allopathy. Lancet 366: 726–732

29. Editorial (2005) The end of homoeopathy. Lancet 366:69030. Hahnemann SC (1982) Organon of Medicine 6th ed, para

60. Kunzli J, Naude A, Pendleton P (translators). LosAngeles, Tarcher

31. Return of an address of the Honourable House of Com-mons. 17 May 1855. Parliamentary Papers 1854–1855;(255) 45, 189

32. Editorial (1988) When to believe the unbelievable. Nature333: 787

33. Fisher P (1998) The Information Medicine Hypothesis. In:Schulte J, Endler PC (eds) Fundamental Reseearch inUltra high dilution and homeopathy. Dordrecht, KluwerAcademic, pp xi–xiv

477

Fisher, Homeopathy and mainstream medicine

34. Sharples F, Van Haselen R, Fisher P (2003) NHS patients’perspective on complementary medicine. Comp Ther Med11: 243–248

35. Dantas F, Rampes H (2000) Do homeopathic medicinesprovoke adverse effects? A systematic review. Br Home-opath J 89 (Suppl 1) :35–38

36. Van Wassenhoven M, Ives G (2004) An observationalstudy of patients receiving homeopathic treatment. Home-pathy 93: 3–11

37. LeFanu J (1999) The rise and fall of modern medicine.London, Little, Brown & Co, p 400

38. Sharma Y (2004) Spiritual bioenergetics of homeopathicmateria medica. London, Academy of Light

39. Simpson N, Lenton S, Randall R (1995) Parental refusalto have children immunised: extent and reasons. Br MedJ 310: 227

40. Coulter HL (1990) Vaccination, social violence and crim-inality: the medical assault on the American brain. Berke-ley, California, North Atlantic Books

41. Hahnemann SC (1982) Organon of Medicine 6th ed, foot-note to Para 46. Kunzli J, Naude A, Pendleton P (transla-tors). Los Angeles, Tarcher

42. Immunisation against Infectious Disease. London,Department of Health, p 27. www.dh.gov.uk/assetRoot/04/07/29/84/04072984.pdf

478