This article was published in Veterinary Times on 17th May 2004 (volume 34, issue 18, pp. 24-25.) The original typescript was considerably shortened for publication, and although some of the cuts are mere editing for length, some important passages were omitted. Presented below is the full text of the original, with the omitted passages in a brown font. Copyedits have however been preserved from the published version. |
NIALL T. TAYLOR, BVM&S, MRCVS
airs opinions on homoeopathic medicine versus veterinary medicine as part of our occasional readers' point of view series, Your Shout.
Sir Edmund Blackadder (to his grubby manservant Baldric)
Try to have a thought of your own, Baldric. Thinking is so important.
What do you think?
Baldric (after a pause)
I think thinking is so important, my Lord.
Blackadder II, Richard Curtis and Ben Elton, BBC TV, 1985
One day,
some years ago when I was in a mixed practice in Wiltshire I was asked by the boss to attend one of our farming clients. The client had been having a problem with mastitis in his dairy herd and had decided to call in a homoeopathic vet to help him sort it out. I was to be the liaison as a vet from the farmer's usual practice.I vividly remember the day, it was pleasantly warm and my duties were light, consisting mainly of introductions and following the homoeopathic vet around while he did his stuff. Watching him carefully I was struck by the arcane probing and prodding of offending animals within the herd; much information seemed to be gained from pressing spines and there was very little in the way of diving down between mucky, twitching legs in order to express milk at risk of life and limb.
I was impressed: here was someone clearly well versed in a secret art to which I was not privy which enabled him to obtain diagnostic information without recourse to risky manoeuvres or time consuming laboratory tests and what's more stay clean during the process. My respect grew.
After some time a remedy was decided upon for the mastitis problem and for ringworm in a batch of calves which the farmer had mentioned as we meandered from shed to shed. The vet produced a medicine bag (astonishingly small when compared with the voluminous contents of my car boot) and drew from it two small screw-top vials of brown glass containing a clear fluid. I looked on with due reverence, obviously this was massively strong stuff I realised, as I heard the farmer being told to empty the contents of each into the water supply for all the animals to be treated. One vial was for the calves with ringworm and the other was for the dairy herd to control the mastitis. The vials were carefully labelled and the farmer was admonished in serious tones to ensure they were not mixed up, the correct vial must be given to the correct animals. Then came the moment that has stuck in my mind to this day. The referral vet turned to me and grinned: "Still," he said "it wouldn’t matter if you did get them mixed up, after all, they’re both water!"
I was speechless. The medicine bag was snapped shut, hands were shaken, thanks were exchanged and we all went our separate ways. Needless to say that day started me thinking, and I’m afraid I have been thinking ever since.
“No testimony is sufficient to establish a miracle, unless the testimony be of such a kind, that its falsehood would be more miraculous than the fact which it endeavors to establish...." - David Hume.
Homoeopathy is a medical modality whose doctrine is based on the texts of its founder, Samuel Hahnemann a German physician born in the town of Meissen in Saxony in April of 1755. Hahnemann was a firm believer in hygiene and disinfection in medicine and in this respect was a great innovator. He also disagreed strongly with many of the medical practices of his compatriots, such as purging and bleeding, which to modern eyes would have appeared brutal. Later these practitioners would be branded by homoeopaths as "allopaths", that is to say those who treat disease by applying an "opposite remedy". So, for instance, a fever where the skin was flushed red would be treated by bleeding in order to remove what was thought to be a dangerous accumulation of blood.
Hahnemann’s application of hygiene, and reluctance to practice the extremes of what was then contemporary medicine, meant that he almost certainly saved lives which would have been lost in other, more conventional, hands. It was in an attempt to develop a more "gentle" means of treating disease that Hahnemann first began to devise what we now know as homoeopathy.
Homoeopathy has several laws which govern its use and application, and there are a number of supplementary texts by key authors such as Kent and Hering which serve to interpret and explain the original Organon and Materia Medica of the founder, giving emphasis to different areas of the work and introducing additional rules. Homoeopathy, according to Harris Coulter, writing in the Journal of the American institute of Homoeopathy 1 is "a coherent and valid approach to therapeutics", which is "more effective than scientific medicine". Coulter further states that "homoeopathic doctrine .... is a set of rules for administering drugs". Homoeopathy is described in a variety of texts as a science or as scientific. James Tyler Kent, in the opening sentence of his 37th lecture 2 describes homoeopathy as "a perfect science".
While claiming to embrace science, homoeopathy is careful to use it with reservation and according to limited definitions. The meaning of science in the context of homoeopathy is more in keeping with the archaic use of the term which is simply knowledge, especially that which is gained through experience.3
An example of this selective use of science is seen when homoeopaths talk of treating patients in terms of experimentation. It is this view of what constitutes experiment which is central to the understanding of the homoeopaths’ attitude to science and research. According to Coulter, every time a homoeopath administers a remedy to a patient he or she is conducting an experiment to test the truth of his or her hypothesis. Every time the patient recovers the experiment can be considered a success and one more piece of evidence can be chalked up in favour of the truth of homoeopathy.
No mention is made of the possibility of failure or whether each failure would detract from the truth of the homoeopathic doctrine. This difficulty with failure is further illustrated in the homoeopaths’ attitude to the most basic of all research tools, the double-blind trial. Double-blind trials in medicine are a method of testing a theory, such as the effectiveness of a drug, by administering the drug to a patient in such a way that neither the patient nor the person doing the administration knows whether it is the trial substance being given or an inactive placebo.
As the trial progresses notes are made of changes in the patient: improvements, deteriorations, unpleasant effects or the lack of them. Once the trial is over and the evidence sifted statistically, the 'blinds are lifted' so to speak, and the final results matched up with the test preparation or placebo.
Finally, a comparison is made between the substance on trial and the placebo and a conclusion drawn as to the effectiveness or otherwise of the test substance. If the patient has failed to improve in a statistically significant way it may be deemed that the compound in question is ineffective; if the undesirable effects of treatment outweigh any beneficial ones it may be deemed that the treatment, while partly effective carries more risk than is justified for the condition under treatment. Thus medical modalities such as the surgical or pharmaceutical treatment of disease are developed, scrutinised and either accepted or rejected based on the results of properly conducted trials organised by people disinterested in the outcome of those trials, in other words by people with open minds. Needless to say far more compounds are rejected than accepted such are the stringencies of clinical trials for prescription medicines.
According to Coulter, however, if a patient in a trial of homoeopathic remedies fails to improve one of only three conclusions are possible - either the remedy used was incorrect, the patient was beyond help before the trial began, or the trial was being conducted in a way that made it difficult for the homoeopath to practice his or her art.
It is inconceivable to the homoeopath that the remedy per se could have failed. This is convenient to say the least as it allows the homoeopath to accept results of any trial which appears to validate their method yet reject those which do not.
Even in individual clinical cases the homoeopath is still allowed an 'out' in situations that a conventional practitioner would regard as failure or would at least require a re-evaluation of diagnosis and treatment. This is the so called healing crisis. Homoeopathic texts state that certain symptoms are a beneficial consequence of cure and recovery, no matter how painful or undesirable they may be. For example, asthma may be an attempt to clear a lung tumour or foreign body. Skin boils, eruptions and lichenification are seen as so desirable that homoeopathy will not allow the use of topical treatments for skin disease. Urticaria and tissue oedema are desirable as an attempt by the body to dilute presumed allergenic substances, and an anaphylactic crisis is taken to be an extreme form of the protective condition represented by allergy. Antibodies are a non-specific phenomenon, rather than a protection against infection.1 Plainly when all these effects are seen as desirable it is difficult for the conventional practitioner or lay person to understand just when a homoeopath decides that a cure has been effected.
To someone prepared to think more critically science is seen not simply as knowledge or personal experience, but as a progressive system for the rational investigation of natural phenomena. Medicine is, strictly speaking, a technology, which is a way of doing something, an application of science, if you like (although as a system technology it greatly predates science 4), and as such is subject to change, development and improvement by the application of the scientific method. It is important not to confuse technology (such as medicine) with science itself, which is a method of study and investigation which, according to Michael Shermer,5 allows for "the cumulative growth of a system of knowledge over time, in which useful features are retained and nonuseful features abandoned, based on the rejection or confirmation of testable knowledge".
To a homoeopath the very feature of science that a critical thinker would regard as its strength - its ability to change and improve and develop - is the very thing that makes it so undesirable and incomprehensible. Instead of change and innovation homoeopathy has had 200 years of unchanging existence.
This stability is seen as a validation of homoeopathy. The only conclusion possible from the homoeopath's point of view is that such persistence in the face of change and confusion all around means that the original doctrine was perfect in the first place. The addition of further remedies by means of provings still continues, adding new remedies based on substances such as the Bewick swan, the Peregrine falcon and even dreams, or others unavailable in the time of Hahnemann, such as antimatter.6 This however doesn’t constitute research or any sort of development or progression on the part of homoeopathy. It merely builds higher on the original foundations that Hahnemann laid, and these remain as unchanging as ever.
Despite its rejection of conventional science and the double-blind trial, homoeopathy is quite capable of turning to science when it suits the purpose of its practitioners.
For instance, in the early days of homoeopathy it was believed by Hahnemann, based on a system of provings (from the German Prüfung, meaning test) conducted on himself and other human volunteers, that substances which caused symptoms in healthy subjects similar to those seen in diseased patients would cure that disease or symptom in sufferers. This is the first law of homoeopathy, the law of similars (like cures like).
It was very quickly realised however that in a pure form many of these substances were equally as harmful, if not more so, than the symptoms under treatment. Accordingly they were diluted to reduce side effects. This gave rise to the second law of homoeopathy, the law of infinitesimal dose, whereby it is believed remedies become more powerful the more dilute they are.
These laws may seem strange at first sight to anyone with even a passing knowledge of current thinking in chemistry and physics, but it must be borne in mind that in Hahnemann’s time there was nothing in the way of what we today would regard as true clinical trials.
Even after his time many innovators in the field of medicine still relied on testing their theories - and medicines - on themselves or their patients and simply observing what happened, assuming their subjects survived the process.
For instance. Jenner, a contemporary of Hahnemann’s, had started inoculating people with ground-up cowpox scabs in an effort to protect them from the disease smallpox.
This apparently bizarre treatment was based on the observation that dairy maids, who came into contact with a lot of cowpox, didn’t seem to get smallpox as frequently as did the rest of the population. Despite Jenner’s good intentions, he came in for much personal vilification in conventional medical circles and in the press of the day. It wasn’t until much later that Pasteur and others were able to describe a possible mechanism for the effectiveness of what we now know as vaccination.
So by the standards of the time Hahnemann’s theories did not seem that unreasonable and when compared with other current medical practices such as purging, bleeding, fasting, firing and so forth were actually benign.
Present day homoeopaths would now have us believe that scientific medicine has paralleled homoeopathy in adopting (the implication is poaching) substances with established uses in homoeopathy into conventional pharmacy. For example belladonna, used (diluted) by homoeopaths for years for treating infantile colics, was discovered by conventional medicine in the 1920s to help control signs of infantile colic (although atropine is now less often used for this purpose). Gold is used by conventional medicine for the treatment of arthritis and also in a diluted form for the same condition by homoeopaths, having demonstrated through provings that gold "yields" a series of rheumatic symptoms.
Homoeopathic tracts contain reams of similar examples where substances are used in both conventional and homoeopathic medicine, ranging from sulphur, nitroglycerine, quinine and ergot, to the use of copper as a contraceptive in the intra-uterine device and adrenaline for the treatment of asthma.
Those same tracts are also filled with examples of what homoeopathy regards as conventional medicine adopting the law of similars, or like cures like (although in a very crude form compared with homoeopathy). Vaccines using a disease-causing organism to prevent that same disease, and the use of dilute solutions of antigen to hyposensetise an allergy sufferer, are the favourite proofs that where homoeopathy has led conventional medicine has followed.
Furthermore homoeopaths would have it that the discovery of hormones and other biologically active substances such as neurotransmitters, which can have profound effects on living systems in extremely low concentrations, is a validation by conventional science of the homoeopathic law of infinitesimal dose.
This attempt to rally science and conventional medicine - albeit on strict terms and conditions - in support of homoeopathy, contains within it a fatal flaw which homoeopaths acknowledge and have been struggling for nearly 200 years to overcome.
In Hahnemann’s day it was assumed that a substance was infinitely divisible and could be diluted indefinitely while still retaining portions of the original in the solution, so the remedy would still be capable of exerting a physical or chemical effect.
Shortly after Hahnemann devised his theories however, Amedeo Avogadro devised his special number, or constant, defining the exact number of molecules contained in a specific weight (a mole) of that substance. This threw a spanner in the works of homoeopathy’s second law, in that it meant that beyond a specific point (known as Avogadro's limit) none of the original substance is likely to be present in the solution, such is the extent of the dilution.
Unfortunately for homoeopathy all but the "weakest" remedies are way beyond the dilution limit. For instance in homoeopathic jargon a 30X dilution means that the original substance has been diluted 30 times, by a factor of ten (X) each time (i.e. 1,000,000,000,000,000,000,000,000,000,000 times).
A 30X dilution is still fairly concentrated by homoeopathic standards however, and remedies such as Oscillococcinum, a 200C product "for the relief of colds and flu-like symptoms", involves "dilutions" that are even more far-fetched. It is prepared by incubating small amounts of a freshly-killed duck's liver and heart for 40 days, then filtering, freeze-drying, rehydrating and diluting it 200 times by a factor of 100 (C) each time.
If a single molecule of the duck were to survive the dilution, its concentration would be 1 in 100200. This huge number, which has 400 zeroes, is greater than the estimated number of molecules in the universe! So even if you accept the like-cures-like dogma, the argument still doesn’t hold up; there is no 'like' there to do the curing and the use of homoeopathic remedies has no similarity whatsoever to the use of conventional pharmaceuticals or the action of bio-active chemicals even at extremely low concentration. To quote Robert Park,7 there is simply no medicine in the medicine. So we can see that homoeopathic doctrine, far from being a set of rules for administering drugs, is in fact a set of rules for administering water.
So far, scientific investigation into possible mechanisms whereby homoeopathic water can effect a cure in disease has drawn a blank. The most notorious example of this type of work was carried out by the French homoeopathic researcher Jacques Benveniste, who published an experiment in Nature magazine that seemed to show a biological effect present in homoeopathic dilutions of histamine. When, however, his work was repeated under more stringent conditions at the insistence of Nature, the effect disappeared. This hasn't prevented the continued mention of Benveniste's work in support of the so called 'memory of water' theory as a mechanism for homoeopathy.
"The most common of all follies is to believe passionately in the palpably not true. It is the chief occupation of mankind." - H.L. Menken.
When proponents of conventional, traditional medicine discuss matters scientific with proponents of homoeopathic medicine, there can be no meeting of minds. While as individuals each may respect the other, their ideologies remain entirely incompatible. The homoeopath is perplexed because there is no single "theory" of conventional medicine, which instead relies on a background of science, seen by the homoeopath as ever-changing and therefore suspect when compared to the stable and unchanging doctrines and texts of Hahnemann. The traditional medical practitioner, having left behind his or her "allopathic" ancestry of purging, bleeding and other brutal treatments in the 1800s, is equally perplexed by the reluctance of homoeopathy to similarly update itself and behave as if it were a rational medical modality that will stand or fall on scientific proof alone. The homoeopath will not be bound by the double-blind trial and states with pride that he will not let any amount of scientific evidence dissuade him that homoeopathy is a valid practice. The traditional medical practitioner is then further confused when the homoeopath goes a stage further to claim superiority, using the obsolete and derogatory term "allopath" to describe him or her - as if it were the conventional practitioner who was using methods from two centuries before, rather than the homoeopath.
Coulter in his preface suggests that "allopaths" have poor powers of intellect, they are unwilling to expend time or intellectual labour towards their patients, and are motivated entirely by money and the desire to reduce their workload (this has been given as the sole reason why homoeopathy has been rejected by mainstream medicine). Furthermore, in his chapter on chronic disease, he states that allopaths use 'monochromic' drugs portrayed as 'broadspectrum', whose only consequence is either a "rebound" effect, where the drug will make the condition worse and possibly kill the patient, or mere "suppression" of symptoms eventually leading to "drug-induced chronic disease" - a term guaranteed to strike fear into the hearts of all but the most rational of patients. On top of all that, conventional practitioners are guilty of the crimes of overdosing and polypharmacy. Kent, in his second lecture, goes one step further and accuses conventional practitioners of being "simple-minded creatures .... groveling in muck and mire" and compares "old fashioned medicine" to the act of pulling a cat uphill by the tail! Hahnemann himself in paragraph 22 of his Organon 8 states that allopaths are "playing with the life of the patient irresponsibly and murderously, with massive doses of dangerously violent drugs of unknown action, chosen on mere conjecture".
After all this, as a final riposte, the homoeopath may well accuse the now quivering "allopath" in question of abuse towards him, the homoeopath, for daring to question his methods.
Thus it can be seen that each modality criticises the other for that which the other regards as its greatest strength. So what is it about the argument between homoeopathy and traditional science that makes any discussion feel like an immovable object coming up against an irresistible force?
In his book Cults, Marc Galanter 9 describes a type of belief system known as a "spiritual recovery movement". This is a healing movement which conforms to three criteria:
Homoeopathy fulfills all these criteria. It certainly claims to provide relief from disease and it operates outwith established medical mores in the ways outlined above, including the lack of evidence of efficacy and safety as understood by conventional medicine, poor performance in clinical trials and a lack of acceptance among medical and veterinary authorities.
It is the third criterion, however, that is for me the key to understanding the adherence to homoeopathy by its followers.
Modern day homoeopaths claim connections with Ayurvedic medicine,10 a belief system where different parts of the body are said to be linked by humours and a spiritual energy undetectable by any conventional science. One of Ayurvedic medicine's greatest promoters is Deepak Chopra, a self-styled guru and author of titles such as SynchroDestiny, The Spontaneous Fulfillment of Desire: Harnessing the Infinite Power of Coincidence, Quantum Healing and Golf for Enlightenment. Ayurvedic medicine has persuaded the actress Demi Moore, amongst others, that she will be able to reach 130 years of age.11
Homoeopaths also make unsubstantiated claims linking quantum physics,12 so-called vibrational medicine 13 and even magic 14 to homoeopathy.
There is no consistency to the explanations given by different homoeopaths for the mechanism whereby homoeopathy operates, since no research has ever shown such a mechanism to exist, but whatever we make of the theories we are left in no doubt that homoeopathy fulfils the third criterion of the spiritual recovery movement by ascribing its effectiveness to non-material or metaphysical effects.
These ideas - which persist despite scientific evidence to the contrary, defy common sense and mis-represent and caricature opponents - are more suggestive of a strong, unquestioning belief rather that a modern, scientific system. Homoeopathy is more faith than healing.
The spiritual recovery movement of Galanter also has religious elements, including a 'conversion-like' moment, when those suffering illnesses which they are unsure of the ability of conventional medicine to cure are more likely to adopt such a movement to satisfy their need for emotional relief. In this situation the relief from uncertainty, when a person accepts the new perspective that such a group offers, provides continuing reinforcement of that perspective. Homoeopathy too has strong overtones of religion. Coulter describes coming to homoeopathy as being "more akin to a religious conversion than to a change of views". Many individuals will describe a moment of 'seeing the light' - often at times of distress such as personal illness or illness in a pet or family member, where homoeopathy apparently 'saved the day' and provided the relief that they were seeking at that time. The question of whether that feeling is rational or credible is at best irrelevant to those concerned, and at worst met by hostility on the part of the believer towards the questioner.
In some instances the religious aspects of homoeopathy are more overt, and its leading lights are referred to in reverential tones which non-initiates may find surprising or even uncomfortable in a modern medical scientific context. Take for instance some direct quotes written in respect of the author from the 1990 re-print of James Tyler Kent's Lectures on Homoeopathic Philosophy.
"O Kent, no tribute I can pay can equal the debt I owe! You sent for me. You poured your love upon me, taught me."
"O Kent, beloved friend, elder brother, physician, master, seer, let a double portion of thy spirit rest on all thy loyal followers the World over...."
"James Tyler Kent, what memories, or rather visions, that name calls forth!"
One contributor describes Kent as fulfilling the "Homoeopathic trinity", while another has composed a poem in his honour entitled "Hail Kent!" whose first line is "Prometheus-like, thy flame so bright...."
Apart from the reverence accorded the champions of homoeopathic thinking, there is also a distinctly biblical reverence towards the texts of Hahnemann, Kent, Hering and others, and their laws are imbued with all the gravity and immutability of biblical commandments.
It was the
science fiction author Arthur C. Clarke who said that any sufficiently advanced technology would be indistinguishable from magic. Many episodes of popular science fiction films and television productions have been based on that very premise. According to Michael Shermer humans have a natural 'belief engine' which has given us an evolutionary advantage, but means we have a hard-wired tendency to look for "magical" solutions first, especially if looking for conventional solutions is difficult, complicated, expensive, or not guaranteed to yield results.Technology, including conventional medicine, can be scary. To many people, rightly or wrongly, it seems more likely to do harm than good, so they are suspicious of anything that seems "scientific" or "technical." Maybe this is why people seem more and more to turn to irrational, "magical" type beliefs – they offer a simple solution in an increasingly complicated world.
If they have faith in what they are doing, a smattering of the jargon and technical terms enough to give a scientific aura to it and they are reassured by a community of like minded believers, they will continue to turn to modalities such as homoeopathy, crystal healing and reflexology in the same way people turned to the now defunct "science" of phrenology over a hundred years ago, or the power of the gods and the medicine man before that. Often there is little or no evidence of any benefit beyond the "good feelings" that may result, but people are willing to suspend disbelief and not demand or even seek evidence because they want the "good magic" to be true. Many people seem to feel disconnected and left out because technology is so much like magic. Think of how often you've heard someone say, "That's amazing!" or "Incredible!" about some technology. Technology is not really "amazing," at all: it's straight-forward, albeit sometimes complicated. It's designed and built by generally ordinary people who happen to have the requisite knowledge, skill, and resources. Technology certainly isn't "incredible," because it is real and it works.
It's true that we are a very long way from understanding the world around us: it is the mystery of existence that makes us what we are and keeps Mankind going, pushing back the boundaries of knowledge. To hope that honesty and the scientific method will eventually reign supreme is probably somewhat optimistic even for the critical thinker.
Human nature and the belief engine are so powerful that even when homoeopathy is finally consigned to the dustbin of history there will almost certainly be something equally unlikely to take its place. In the meantime it is a matter of regret that for some, the natural world with all its miracles is just not sufficient. Surely there is enough to marvel at in the real world without having to resort to contrived, meaningless and unnecessary pseudoscience.