Snake-oil or cure-all? 250 years after the birth of its founder, the scientific controversy still rages, but its sales are rising quickly. Jeremy Laurance investigates a medical phenomenon
Some call it snake oil, some believe it is the 21st century’s cure-all: 250 years after the birth of Samuel Hahnemann, the system of medicine he founded, homoeopathy, is still the focus of scientific controversy.
Yet despite being mocked and ridiculed by the scientific establishment from the start, it flourishes today as one of the leading branches of complementary medicine, with millions of adherents across the world.
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In England, an estimated 470,000 people use homoeopathic remedies every year. Walk into any high street chemist and in the complementary medicine section you will find arnica, nux vomica, pulsatilla and rhus tox on the shelves. The Queen, David Beckham and Geri Halliwell are among those said to swear by them.
The origins of the treatment lie in the dissatisfaction that the young Dr Hahnemann, a German physician who practised in the late 18th century, felt with the orthodox medicine of the time. Born in Meissen, Saxony, on 10 April 1755, to poor but middle-class parents, Hahnemann spent his childhood attaining “knowledge by every possible means” and became proficient in eight languages. By his late teens he had developed an interest in medicine and qualified at Erlangen in 1779.
His distaste for the then favoured treatments – blood-letting, purging and burning and the administration of toxic substances such as arsenic and mercury – was not difficult to understand and it led him to devote his energy to his “beloved chemistry”. He gave away his medical practice in 1790, just 11 years after qualifying, and began a new practice based on the principle that “like cures like” which underlies homoeopathy.
One of his earliest experiments involved the drug quinine, used to treat malaria. He had read that it was effective because it was bitter and astringent, but realised that, if this were the case, all bitter and astringent substances would be effective, which they clearly were not.
By testing it on himself he discovered that it produced symptoms of fever similar to those produced by the disease itself and he speculated that this could be the real secret of its curative power.
He began to test other drugs on himself, his family and friends, such as belladonna, camphor and aconitum to study the symptoms they produced. But it was not until 1796 that he “first communicated to the world by means of public print his new discovery in medicine”.
It was based on two principles. The first, called the law of similars, can be seen in the way that an effective treatment for a hangover is to have another drink in the morning. This was not the sort of treatment that Dr Hahnemann had in mind, but it demonstrates that it can work. Homoeopaths, however, believe it applies universally.
The second principle is that a treatment becomes more powerful the more it is diluted – even to the point where it is so dilute that the remedy cannot contain even a single molecule of the original substance. The process of repeatedly diluting and shaking a remedy is known as potentisation and it may be carried out so many times that it is equivalent to diluting a tiny speck of the original substance in all the world’s oceans.
This is the central difficulty that scientists have with homoeopathy. If a homoeopathic remedy does not contain a single molecule of the original substance from which it was made, how can it exert any effect?
The question did not trouble Dr Hahnemann because molecules were still awaiting discovery at the time he was writing his Organon of Ration Healing, published in 1810 and Materia Medica Pura, setting out his ideas. His remedies gained currency because they were notably kinder and less injurious than the conventional treatments handed out by his colleagues.
In 1811 he moved with his family – he had married Joanna Kuchler in 1782 and they had 11 children – to Leipzig where he began teaching a small group of students in the university. But his growing success provoked jealousy and he was eventually forbidden by the courts from dispensing his medicines.
In 1821 he moved to Ko”then and devoted himself full time to homoeopathy. People travelled hundreds of miles to consult him as his fame grew, but he was constantly attacked and persecuted by establishment colleagues. In response, he increasingly isolated himself leaving the movement leaderless and resulting in the formation of different sects.
Today there are two kinds of homoeopaths in the UK – those who trained first as doctors and those non-medically qualified homoeopaths who have studied the principles for several years. The latter far outnumber the former and there are at least 2,000 registered homoeopaths in Britain.
The NHS has since its inception backed homoeopathy. And five homoeopathic hospitals in Britain have enjoyed royal support. Peter Fisher, the clinical director of the Royal London Homoeopathic hospital signs himself Physician to the Queen. At one of the earliest debates on the NHS Act 1948 the Government pledged that homoeopathy would continue to be available on the health service as long as there were “patients wishing to receive it and doctors willing to provide it”.
When challenged about the scientific implausibility of their practice, homoeopaths reply that their remedies do not work like pharmacological drugs but that, in some way, the “energy” in the original substance is passed on to the water or other liquid in which it is diluted. The water thus retains a memory of the substance.
This theory was proposed by Jacques Benveniste, a French biologist, in the 1980s. In a paper published in Nature, one of the world’s leading science journals, in 1988 he claimed that experiments in his laboratory in Paris had shown that an ultra-dilute solution could exert a biological effect.
However, Dr Benveniste was investigated by a team appointed by the then editor of Nature, Sir John Maddox, and after they failed to repeat his experiments successfully Dr Benveniste was ridiculed in a subsequent edition and his theory consigned to history.
Last year, interest in the theory was revived by the publication of new research which appeared to lend weight to Dr Benveniste’s claim. Four teams of researchers working in four countries separately observed that a highly dilute solution of histamine, the substance produced in the skin in response to an insect bite or sting, exerted an effect on a type of white blood cell called a basophil in the test tube.
Three of the four laboratories found a statistically significant effect and the fourth found an effect which lay just outside the significant range. Writing in the journal Inflammation Research in August 2004, the authors said: “We are not yet able to propose any theoretical explanation for these findings”.
If confirmed, they may require the laws of physics to be rewritten. Critics claim it is more likely there is some error in the experiment, a charge which the scientists reject.
Philippe Belon, the lead researcher, was a former collaborator of Dr Benveniste’s, but fell out with him many years ago. He now works for the French homoeopathy company Boiron, although he claims to be interested only in discovering scientific truth. The British arm of the study was led by Professor Madeleine Ennis, an asthma specialist and sceptic on homoeopathy, at Queen’s University, Belfast, who agreed to participate only to prove the theory wrong. “I know what we tested and I cannot explain the results,” she said.
Support for homoeopathy also came from an analysis of 89 trials published in The Lancet in 1997 which appeared to show that the remedies produced an effect more than twice as great as a placebo. But the analysis was criticised on the grounds that it did not make sense to lump together highly diverse studies in this global fashion.
A much larger review encompassing 200 trials of homoeopathy by the NHS Centre for Reviews and Dissemination based at York University, which issues advice to the NHS on effective treatments, delivered a damning verdict in March 2002.
“There is currently insufficient evidence of effectiveness either to recommend homoeopathy as a treatment for any specific condition or to warrant significant changes in the current provision of homoeopathy,” it concluded.
A similar verdict was reached by the influential Academie de Medicine in Paris, an advisory body of distinguished physicians. In a report in September 2004 it upset practitioners and users of homoeopathy by concluding that they subscribed to mumbo jumbo. “Homoeopathy is a method dreamed up two centuries ago, based on prejudices that were devoid of any foundation. It has survived as a doctrine completely outside the remarkable scientific movement which has been transforming medicine for two centuries.”
Verdicts do not come much more damning than that. But it is unlikely to deter the hundreds of thousands of adherents to the philosophy in France or Britain.
The British Homeopathic Association claims that heightened public awareness of the dangers of chemicals in the food chain, growing resistance to antibiotics through over-use, and concerns about the side effects of conventional drugs, are contributing to a rethink about the way we live and how we seek to regain health.
Two hundred years after Samuel Hahnemann raised parallel concerns about the damaging effects of the medicine of the day, the public has again grown anxious about what doctors do.
Homoeopathy – with its use of natural substances in minute doses, and holistic person-centred approach – is attracting more and more converts. And it scores one big advantage over conventional medicine. Even though it may do little good, the absence of harmful side effects means that it can do little harm.
PULSATILLA – WIND FLOWER
This is prescribed for complaints that cause a profuse discharge, especially coughs and colds that produce catarrh. It is mostly given to women and may also be used for depression, varicose veins, nosebleeds, toothache, rheumatism, acne, migraines, and ear and eye complaints. Advice on its use suggests people who respond well to pulsatilla are empathic, swayed by emotion rather than reason, dependent on others and easily led. Public opinion is very important to them and they can easily feel slighted and full of self-pity. They may fear enclosed spaces, crowds, being alone and the dark. Pulsatilla people tend to be plump, fair-haired with blue eyes and can flush or blush easily.
BELLADONNA – DEADLY NIGHTSHADE
Prepared from the poisonous plant, deadly nightshade, belladonna is a first-aid remedy for headache and fever. It may alsogive relief for earache, swollen glands, sore throats, boils, anxiety and teething. Belladonna produces a headache which is more accentuated on the right side of the head so the location of the headache must be taken into account by the homoeopath. If the patient has a left-sided headache, bromium is the more likely remedy.
BACH FLOWER RESCUE REMEDY – CHERRY PLUM, ROCK ROSE, IMPATIENS, CLEMATIS STAR OF BETHLEHEM
The Bach Flower Remedies were created by a Harley Street doctor, Edward Bach, in the 1930s. He devised a system of seven major emotional groups, such as fear, uncertainty or loneliness. He categorised 38 negative states of mind and then formulated a plant or flower-based remedy to treat each one. Bach Flower Rescue Remedy is one of the most popular homoeopathic treatments. It is used by people to combat stress. Rock rose is given for terror, impatiens for impatience, clematis for dreaminess, star of Bethlehem for the after-effects of shock, and cherry plum for fear of the mind giving way.
RHUS TOX – POISON IVY
Poison ivy can cause rashes or itching if touched. In the homoeopathic dose, it is used to treat rheumatic pains and skin complaints which may be accompanied by burning, itchiness, swelling and painful blisters. People needing rhus tox are sensitive to the damp and can suffer from arthritis with aching and stitch pains. It is a remedy for backache, and for aching joints in flu. It is also useful for sprains and strains and the effects of over-exertion as well as stiff neck, sciatica, diarrhoea, swollen glands and backache.
IGNATIA – IGNATIA AMARA
Made from the seeds of the plant Ignatia amara, which contain strychnine, ignatia affects the nervous system. It is prescribed to sensitive, highly-strung people who tend to blame themselves when things go wrong. Their over-reactive and over-sensitive nature leads to rapid changes of mood. They may suffer from trembling and agitation. Often their ailments have contradictory symptoms. Ignatia is mainly given to women who tend to be thin, dark-haired and have bluish circles around their eyes. They feel the cold and dislike tobacco. It is prescribed for emotional upset or grief and can be used to treat headaches, sore throats, coughs and menstrual problems.
ARNICA – ARNICA MONTANA LEOPARDS BANE
Probably the most popular homoeopathic treatment, it is widely used as a first aid treatment for shock. It should be taken as soon after injury as possible to ease pain and speed recovery. Little attention needs be paid to detailed symptoms. It can be taken as a pill or applied externally to bruises, sprains or an injury where the skin is unbroken. It is made from a perennial herb which is native to central Europe. Care must be takenas some people are sensitive to the plant and poisoning has occurred.
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