George Smith continues his series with a look at this widely used alternative medicine

Homeopathy is one of the most popular and controversial of the plethora of alternative therapies available within and without the NHS. The word homeopathy is derived from two Greek words, homoios meaning 'like' and patheia meaning 'pain or suffering'. Homeopathy epitomises the strong paradox inherent in the present attitude towards so-called integrative medicine. On one hand, there is a desire to pursue clinical excellence, properly dependent upon evidence-based medicine; on the other, there is a somewhat illogical desire to embrace alternative therapies dependent on unscientific philosophies such as ch'i, life force and universal cosmic energy.

Origins

No clear ancient origins exist, although both Hippocrates (c460-370 BC) and Paracelsus (1493- 1542 AD) considered that healing might be facilitated by medicines that produce symptoms similar to those of the disease. They didn't consider using extreme dilutions, a process of shaking or potentisation and neither followed their thinking through into practical medicines.

Samuel Hahnemann (1755-1843) was the founder of homeopathy. He was born in Meissen, Saxony and studied medicine and chemistry at the universities of Leipzig, Vienna and Erlangen. He graduated with a degree in medicine in 1779 and began to practice in a variety of posts but continued his research into chemistry. He soon became disillusioned with the ineffective, painful and sometimes fatal treatments of his day that included bloodletting, leaches, purging and medicines containing dangerous chemicals such as arsenic and mercury.

He gave up his practice and turned to research and translation. After translating a treatise on Materia Medica by William Cullen, an Edinburgh physician, he became interested in Peruvian cinchona bark as a treatment for malaria.[1] Having tested it on himself, he believed that small doses produced symptoms similar to those of malaria. After testing other substances, a process called provings, he concluded that they could be used to treat diseases with similar symptoms. He formulated his first principle (sometimes known as 'law') of homeopathy: similar similibus curantor meaning 'let like be cured by like'.

Hahnemann returned to medical practice and put his newfound theory into practice but with limited success. Concerned about side effects called aggravations, he decided to dilute his original medicines or mother tinctures. One drop was diluted with nine or ninety nine drops of solvent (water and alcohol) making a dilution of one in ten (lx) or one in a hundred (lc) respectively. This process was repeated six, twelve or 30 times, eg 6c, 12c or 30c. This process of dilution is the second principle of homeopathy.

Still dissatisfied with clinical results, Hahnemann decided to shake the solutions between each dilution, a process he called succussion, which he believed potentised the resulting remedy with some form of vital force. Potentisation is the third principle of homeopathy.

In 1810 he set out his findings in the Organon of Rational Medicine, later to be called the Organon of the Rational Art of Healing.[2] He later published a six volume Homeopathic Materia Medica.[3] Despite widespread opposition, he continued to teach and practise his new system of medicine, based on these three essential principles, in his native Germany and later in Paris where he died in 1843. Although his views were generally unpopular with the medical establishment, a few doctors did accept his principles and there was a gradual worldwide spread, which we continue to witness today. It is recorded that Hahnemann was born into a Christian family but became a very active Freemason and later followed the teachings of Confucius.[4]

Homeopathy in Britain

Dr Frederick Quinn studied under Hahnemann and believed that he had been healed of cholera by a homeopathic preparation of camphor. He went on to introduce homeopathy into England in 1826, setting up a practice in London and establishing the British Homeopathic Society in 1832. The London Homeopathic Hospital was founded in 1850 and there are now similar hospitals in Bristol, Glasgow, Liverpool and Tunbridge Wells. Established in 1978, the Society of Homeopaths grants registration (RSHom) and fellowships (FSHom); medically qualified practitioners may become members of the Faculty of Homeopathy (MFHom).[5]

Today, homeopathy is the third most popular therapy (after osteopathy and chiropractic) in the United Kingdom. Queen Adelaide (wife of William IV), who came from Saxony and was a contemporary of Hahnemann, started the Royal Family's custom of using homeopathic medicines and recent monarchs have regularly appointed a homeopathic physician. Prince Charles, a strong supporter of many forms of alternative medicine, advocates homeopathy for both humans and animals.

Homeopathic diagnosis includes a full medical history, examination and special investigations although these are necessarily restricted in those without a medical qualification. Homeopaths assess appearance, constitution and personality and arrive at a symptom picture. When homeopathy is presented in New Age settings such as Mind, Body, Spirit Festivals or Psychic Fayres, diagnosis may include divination, astrology and pendulum swinging. In the United Kingdom most medically qualified homeopaths would distance themselves from such practices.

Homeopathic treatment today still depends on Hahnemann's three original principles. Having assessed the symptom picture, treatment is based on matching this with a remedy picture selected from a homeopathic pharmacopoeia.[6] The remedy may be given perhaps for six doses; if not effective, a further selection is made. If a 6c dilution does not work, a 30c strength may then be selected. 6x is the usual strength for over-the-counter preparations but 6c and 30c would be common starting strengths for trained homeopaths. It is presumed that the more extreme the dilution, the greater its efficacy.

It is commonly believed that homeopathic remedies are based only on herbs, plants and other natural substances assuming that 'natural means harmless'. However, many of the substances in the mother tincture are noxious and poisonous including anthrax poison from the spleen of an infected sheep, rattlesnake and cobra venom, discharge from a scabies blister, sulphuric acid and arsenic. But no harm results because of the extreme dilution.

Medical Checklist

1. Does it have a rational, scientific basis?

The idea that 'like may cure like' is quite contrary to orthodox medical principles. Symptoms are usually treated and respond to medicines with the opposite effect: diarrhoea responds to constipating medicines such as codeine rather than bowel irritants such as castor oil. This is termed allopathy, the opposite principle to homeopathy. Within therapeutic limits, conventional pharmacology dictates that a higher drug concentration gives a more powerful effect. Homeopathy turns this on its head: the extreme dilutions involved mean that, from the dilutions of 12c onwards, not one molecule of substance is present in the homeopathic preparation, be it liquid, powder or tablets. Homeopaths do not dispute this but believe that some form of imaging or ultra molecular action takes place in the solvent during the process of potentisation. Evidence for this is not forthcoming. The recent chance finding that molecules in solution cluster together as the solution is diluted was thought to have a possible relevance to the preparation of homeopathic remedies but this has not been progressed to a scientific conclusion.[7,8] Homeopathy is not scientifically comparable with vaccination, immunisation or allergic desensitisation. Homeopaths maintain that the process of potentisation produces a healing power in the remedy called a vital force. This term clearly equates to the ch'i of Chinese acupuncture, the prana of Ayurvedic medicine and the universal cosmic energy associated with New Age advocates of alternative therapies.

2. Does it work?

It is generally accepted that anecdotal observations are insufficient to demonstrate the validity of any therapy, be it orthodox or alternative. A considerable number of scientific investigations into homeopathy have been attempted. Results have been correlated, (particularly by meta-analysis) and subjected to clinical, scientific and statistical scrutiny in the Department of Complementary Medicine at Exeter University, directed by

Professor Edzard Ernst. Almost 50 reports have been published in their journal FACT over the past six years.[9] Methodology has been of varying standards but after excluding results due to nonspecific placebo effects no consistent or conclusive evidence of efficacy emerges. A paper published in the European Journal of Clinical Pharmacology set out to evaluate the clinical efficacy of homeopathy. It emphasised the difficulties encountered because there was no consensus as to the treatment in particular situations. Furthermore, it noted that the more rigorous the trial, the less likely it was to produce possible evidence in support of the homeopathic preparation. The authors recommended that more research be carried out but stated, 'There is simply not enough evidence to conclude that homeopathy is clinically effective'.[10]

It is generally agreed that the placebo effect is of real importance in general medical care, in the use of alternative therapies and in scientific assessment of all medical treatments undergoing clinical trials. Professor Ernst discusses this in depth in his book, Complementary Medicine - An Objective Appraisal.[11] Of course, with its present popularity and wide royal and celebrity patronage, a significant degree of placebo effect is to be anticipated from homeopathy. Patients may well feel better but whether any pathological process has been improved or cured is very much in doubt.

3. Is it safe?

Homeopathy is often considered to be safe for minor and self-limiting complaints. There are no reasonable grounds for advocating its use instead of orthodox immunisation in children. Generally, it is not considered appropriate for serious or life threatening illness. A valid criticism of homeopathy is that it can encourage serious delay before seeking proven conventional treatment. Dr Andrew Lockie's popular textbook, A Family Guide to Homeopathy, is subtitled 'A Safe Form of Medicine for the Future'. So it is somewhat disconcerting to read advice that suspected ectopic pregnancy may be treated homeopathically for two hours before seeking orthodox treatment![12] Similarly, twelve hours' homeopathic treatment for suspected deep vein thrombosis is considered acceptable before considering orthodox treatment.[13] These potentially life-threatening conditions should receive proven treatments as soon as they are diagnosed. To recommend otherwise is not safe medicine!

Christian Checklist

There are significant areas of concern. Can we, with integrity, prescribe a medicine that does not contain one molecule of effective remedy? Is it good practice to prescribe remedies that have been investigated without producing any consistent evidence of efficacy? Is it responsible to delay or withhold orthodox proven medical treatment whilst relying on an unproven alternative remedy? Is it acceptable to use a therapy that relies on the principle of vital force, clearly comparable with the Ch'i (yin and yang) of Eastern religions and the cosmic energy of New Age philosophies? Should we use a therapy that some practitioners mix with divination, astrology and pendulum swinging, which are clearly forbidden in the Bible?[14]

Miranda Castro FSHom states: 'Homeopaths believe that there is a balancing mechanism that keeps us in health, provided that the stresses on our constitution are neither too prolonged or too great. This balancing mechanism Hahnemann called 'vital force' and he believed it to be 'that energetic substance, independent of physical and chemical forces that literally gives us life and is absent at our death''[15]

Summary

It is appreciated that there are committed and zealous Christians - including past and present doctors, nurses and missionaries - who have found homeopathy acceptable and useful in their ministry. In today's climate of integrative medicine, it is particularly relevant for Christian doctors and nurses to decide whether or not they find homeopathy acceptable. Scientific evidence, biblical guidance and discernment from the Holy Spirit all play a part in making this decision. Having said this and taking into account everything discussed in this article, it is my own conviction that homeopathy clearly falls far short of being a therapy that can be acceptable to use or recommend.

Prove all things, hold fast to that which is good, abstain from all appearance of evil. (1 Thessalonians 5:21-22, King James Version)