(As published in the Business Day’s Health News: October 31, 2007)
Is homeopathy just the placebo effect dressed up? Some people swear by homeopathy, giving it cult-like status. Are these suggestible patients paying a high price in order to access their own healing abilities?
Imagine the scenario: you visit a physician who seems like a regular doctor. Despite the fact that this physician checked your blood pressure, had blood tests done, auscultated your heart and lungs and handed you a prescription, this is not a regular doctor’s visit. Something is amiss. The consultation alone took half an hour where every detail of every sensation you were experiencing was extracted; the prescription is not for a drug, but for a tailor-made ‘remedy’.
For some, the word homeopath conjures up images of a pendulum-swinging-hippie. And in some countries, the imagery is justified. However, in South Africa, in order to register as a homeopath you need to banish your crystal ball and face the science. At the University of Johannesburg, a five year full-time course is offered, followed by a year’s internship during which time a dissertation is completed in order to graduate with a Masters Degree in Technology. On completion of the Master’s Degree (which is the minimum standard to practise) a compounding and dispensing course run by the Pharmaceutical Society is completed before homeopaths can dispense their medicines.
The course is heavily bent towards the medical sciences with anatomical dissection, biochemistry, physiology, microbiology and diagnostics all forming part of the repertoire of subjects. The nitty-gritty of homeopathy is only taught from the third year onwards, alongside systemic pathology, diagnostic radiography and research methodology.
On graduating, the Allied Health Professions Council of South Africa, the statutory body regulating homeopaths awards graduates the title “Doctor”. In terms of practising, homeopaths are well within their scope of competence if they inject (unscheduled) substances, have blood and urine analysed and interpret blood reports or x-rays. Diagnosis is an important part of the homeopathic consultation, as all invoices and prescriptions must include ICD-10 codes to be legally valid. Private medical insurance companies clearly have a great deal of faith in homeopaths as they reimburse their consultations and their medicines.
Despite speaking the lingua franca of the medical fraternity, homeopaths remain on the fringe. They do not work in state hospitals and there is little interaction between doctors and homeopaths. Most doctors are sceptical of homeopathic medicine presuming their action to be tantamount to the positive effect that is witnessed when patients are given inert substances believing them to be medicinal.
The most fervent argument against homeopathy is that its action is thanks to the placebo effect working its magic on suggestible minds. The reason that homeopathy has been stacked on the “pseudoscience” pile is due to the lack of statistical significance in controlled experiments. In such trials, half the population are given the placebo and the other half are given a remedy which is not necessarily indicated for them. Homeopathy only works when the specific remedy that is indicated is administered. By giving a large group of people the same homeopathic remedy, which is not indicated, researchers are in essence, giving the experimental group the equivalent of a placebo, and the result is, not surprisingly, a placebo effect. The fact that fifty patients all with the ‘flu could each be prescribed a different remedy especially suited to their symptoms, is proving to be a statistical nightmare for those who wish to prove scientifically that homeopathy works in the paradigm of a randomised double-blind controlled trial.
Aside from the hard science approach, there are a number of counter-arguments to the placebo-effect explanation of how homeopathic remedies work. The first is that homeopathic remedies work on animals. Veterinary homeopathy is a well-established and practised modality of veterinary science, which has yet to explain how animals might be conscious of a placebo effect. Homeopathic remedies also work on babies, comatose patients and the unconscious, who are unlikely to engage in the social constructs that are involved in getting better because you believe you are supposed to.
The argument against homeopathy continues by explaining that it only works in those who have unwavering blind faith in it and that its efficacy is proportional to belief that it will work (If this were true, homeopaths would have no male converts). Many patients come to homeopathy as a last resort, once the high-tech probing (which is placebo-enhancing in itself) has yielded no result. Some would argue that their misplaced hope provides an impetus for healing to take place. They might not be wrong. But is this impetus strong enough to do more than create a “feeling of well-being” and move into the realm of objective improvement?
The questions implicated in how homeopathy might work extend far beyond the question of how the body turns hope into health. There are touchy-feely questions around mind over matter and mind-body links. However, the true mystery is how do some very brainy people (including medical doctors who practise homoeopathy) reconcile their scientific education with their “placebo practice”?
{Dr. Marilena Deroukakis is a homeopath practising at the Paediatricks Centre where she treats children}
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