Homeopathy, Placebo, Scientific evidence

A Naturopath’s View of Homeopathy or Psychotherapy with Props

by Dr. Douglas Lobay, BSc, ND

When I was a teenager growing up in a small town in the Pacific Northwest in the 1980s I had a voracious appetite for science books. I was particularly drawn to the style and reasoning of the renowned science fiction writer Isaac Asimov. He wrote in his book The Roving Mind:

I believe in evidence. I believe in observation, measurement, and reasoning, confirmed by independent observers. I’ll believe anything, no matter how wild and ridiculous, if there is evidence for it. The wilder and more ridiculous something is, however, the firmer and more solid the evidence will have to be.

I graduated from the University of British Columbia with a Bachelor of Science degree in biology and chemistry in 1987. I started naturopathic medical school at Bastyr College in Seattle in 1987. I loved the science classes and the blending of science with art of medicine and healing. I was amazed at homeopathy classes. I didn’t know much about homeopathy, but I learned about its history, provings and treatment remedies.

After I graduated from naturopathic school in 1991, I endeavored to experiment and use all different facets of natural medicine and find out what worked and what didn’t. I tried to use all sorts of homeopathic medicines from low potency, single remedies like arnica, to high potency ignatia and Oscillococcinum, to combination remedies like Traumeel and Lymphomyosot.

I was at the Advancing Naturopathic Medicine Conference at the Pan Pacific Hotel in Vancouver, British Columbia, in October of 2016. I went for a walk around the seawall near Stanley Park with a knowledgeable pharmacist friend after a session at the conference. We were chatting about health-related matters and somehow got on the topic of homeopathy. She concluded that homeopathy was nothing more than placebo or in her words “it was psychotherapy with props.” I nodded and agreed with her.

As a scientifically trained and practicing naturopathic physician with over 25 years of experience, I still find it hard to believe that homeopathy is nothing more than placebo. I also feel compelled to write about my experience and understanding on the rationale for the use of homeopathy in the practice of modern naturopathic medicine.

I understand that homeopathy is based on the principle of “like cures like.” In small doses a homeopathic medicine will treat symptoms that in larger doses it causes. The dilution is an integral part of the mystique about this theory. The more dilute the medicine, the more potent it becomes. Serial dilutions of a mother tincture can be based on 1/10 or “X” dilution or 1/100 or “C” dilution. A 6X dilution is a 1/10 progressive dilution of the original solution six times. A 12C dilution is a 1/100 progressive dilution of the original solution 12 times. Obviously, at low potencies or low dilutions there is a specific quantity of atoms and molecules in the dilution. However, beyond 24X or 12C dilution, there is a low probability that any atoms or molecules remain. Many homeopathic medicines have dilutions beyond these limits. 200C and 1M are common dilutions in classical homeopathy.

Avogadro’s number is the number of atoms or molecules in one mole of a substance. By definition, Avogadro’s number is 6.02 x 10 exponent 23. According to dilution, the inverse of this number is 6.02 x 10 exponent minus 23. Beyond this dilution, no actual physical atoms or molecules remain. And yet, according to homeopathic medicine, these medicines are active and stronger than lower dilutions. This is at direct odds with the current scientific theories of chemistry and biology.

Many homeopathic practitioners argue that there is “water memory” that is left after such high-dilution medicines are mixed or succussed. But according to analysis of such solutions, no memory or imprint remains, other than the random movement of atoms or molecules in solution. Graphic comparisons of such dilutions are analogous to one drop of a substance in the entire Pacific Ocean, one atom in the entire solar system and even one molecule in the entire Milky Way Galaxy. It is hard to explain from a rationale, scientific perspective that such dilutions with little or absolutely no substances can actually do something.

Over the years, I have tried to research homeopathic medicine on reliable scientific sites such as Medline, PubMed, and Cochrane databases. I have come to the conclusion that most scientific research on homeopathic medicines is limited, weak, and flawed. Poor methodology, weak study design, small sample size, and selection bias are frequently confounding factors in homeopathic studies. The gold standard of modern clinical research is the double-blind, placebo-controlled trial. After rigorous evaluation, most homeopathic studies that were double-blind placebo-controlled offer the same or a little more benefit than placebo.

A 2010 Cochrane review of homeopathy concluded that the most reliable evidence failed to demonstrate that homeopathic medicines have any effect beyond placebo.¹ A 2009 submission to the British House of Commons on homeopathy concluded that there was no compelling evidence of effect other than placebo.² A 2012 Swiss systematic review and meta-analysis of homeopathy showed most studies were flawed and biased.³ In 2015, the Australian National Health and Medical Research Council concluded that there were no health conditions for which there was reliable evidence that homeopathy was effective. Additionally, there was no good quality, well designed studies with enough participants for meaningful results.⁴ In 2005, the Lancet reported on a review of 110 placebo-controlled homeopathic trials. They concluded that the clinical effect of homeopathy was nothing more than placebo.⁵ A 2009 and 2017 systematic review and meta-analysis from the most reliable studies did not support the evidence that non-individualized homeopathy was effective.^6,7 In 1987, French immunologist Jacques Benveniste reported in the Nature journal that basophils released histamine when exposed to anti-immunoglobulin IgE from a homeopathic medicine. A 1988 re-evaluation of this research concluded that there was lack of evidence for this conclusion.⁸

Some may argue that there are scientific studies on Medline and Pubmed that show statistically significant benefits of homeopathic medicines. There are, as Dana Ullman points out in his blog for the Huffington Post.⁹ Some positive studies include the use of homeopathic medicines in treating COPD, hayfever, fibromyalgia, fibrositis, childhood diarrhea, ADD, and ADHD.^10-15 Of course it is important to realize that one study by itself does not provide conclusive evidence of scientific effectiveness. This can be true for any drug or therapy being tested. There are often questions about study design, objective measurements and how the conclusions are reached. And of course, the reproducibility of the study achieving the same results can be questionable. Homeopathy continues to be at diametrical odds to the current theories of physics and chemistry. Most mainstream scientists from universities that I have spoken to think that homeopathy is nothing more than placebo. Most reviews and meta-analyses conclude that although the study may be positive, more research is warranted to prove the effectiveness of this unproven medicine. Homeopathy remains controversial, inconclusive and unconfirmed in the face of a few equivocal studies. More rigourous research with better study design, methodology, and sample size is warranted. Homeopathy must prove itself.

Placebos are an integral part of medicine. By definition, a placebo has no active ingredient. Placebos have been shown to have clinical effects on health and healing. Personal expectation is important for a positive result. Pain relief, immune enhancement, anxiety, depression, fatigue, and fibromyalgia are just a few of the conditions that have benefitted from treatment with placebo. This underscores the importance of the brain’s role in physical health. Larger pills seem to work better than smaller pills, capsules seem to be better than tablets, colored medicine appears to be better than white, and injections seem to work slightly better than pills. Some research indicates that placebos activate serotonin-dopamine pathways and/or the endocannabinoid system in the brain. Some individuals, whether genetically based or not, are more susceptible to the action of placebos than others. The doctor-patient relationship and belief in the medicine and the result is also important in its effectiveness.

Psychotherapy with props implies that counseling and listening to the patient is the actual therapy that imparts healing, and the prop would be the inert, diluted homeopathic medicine without any actual ingredient. Homeopathic practitioners are renowned for having long, extended visits with the patient and asking a myriad of questions including likes and dislikes, aversions and unusual quirks. Spending an inordinate amount of time with the patient, listening intently, and asking questions show caring, kindness, and concern on the part of the physician. Based on this extensive office interview, the homeopath would then decide on an appropriate medicine for the patient. Healing is believed to occur because of the medicine but would in fact be due to the extended interaction between the patient and doctor. The homeopathic medicine would be a prop that helps facilitates healing.

As a practicing naturopathic physician, I will continue to use some homeopathic medicines in my clinical practice. I believe that low-dose homeopathic medicine, from mother tincture dilutions upwards, to the limit of Avogadro’s number, have atoms and molecules that can have direct physiological effects on health and healing. Beyond this number, I believe, that the effects of homeopathic medicines are comparable as placebos. One thing I have learned through naturopathic medical school is to keep an open mind in the realm of possibilities.

Several years after I graduated from naturopathic school in 1991, somebody gave me a copy of the book called The Demon-Haunted World: Science as a Candle in the Dark by the astrophysicist Carl Sagan. He directly and succinctly explains that rationale of the scientific method in evaluating phenomena around us. One quote of his made a lasting impact on me:

And, after all, some illnesses are psychogenic. Many can be at least ameliorated by a positive cast of mind. Placebos are dummy drugs, often sugar pills. Drug companies routinely compare the effectiveness of their drugs against placebos given to patients with the same disease who had no way to tell the difference between the drug and the placebo. Placebos can be astonishingly effective, especially for colds, anxiety, depression, pain, and symptoms that are plausibly generated by the mind. Conceivably, endorphins—the small brain proteins with morphine-like effects—can be elicited by belief. A placebo works only if the patient believes it’s an effective medicine. Within strict limits, hope, it seems, can be transformed into biochemistry.

This is just what I believe and have learned about homeopathy as practicing naturopathic physician and is not meant to disparage or demean anybody else who has a different opinion other than mine.

References

Ernst E. Homeopathy: what does the “best” evidence tell us? Med J Aust. April 19, 2010;192(8):458-60.

Evidence check: Homeopathy. House of Commons Science and Technology Committee, parliament.uk. October 20, 2009.

Shaw D. The Swiss report on homeopathy: a case study of research misconduct. Swiss Medical Weekly. May 2015;142: w13594.

National Health and Medical Research Council. NHMRC statement on homeopathy and NHMRC information paper. “Evidence on the effectiveness of homeopathy for treating health conditions.” Canberra: National Health and Medical Research Council. 2015.

Shang A, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. The Lancet. 2005;366 (9487): 726–732.

Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine. 2009;6 (7).

Mathie RT, et al. Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews. 2017;6(1): 63.

Maddox J, et al. “High-dilution” experiments a delusion. Nature. 1988;334 (6180): 287–291.

Ullman D. Dysfunction at Wikipedia on Homeopathic Medicine. Huffington Post. December 2014.

Frass M, et al. Influence of potassium dichromate on tracheal secretions in critically ill patients. Chest

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Taylor MA, et al. Randomised controlled trial of homoeopathy versus placebo in perennial allergic rhinitis. BMJ

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Bell IR, et al. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo. Rheumatology

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Fisher P, et al., Effect of Homoeopathic Treatment on Fibrositis (Primary Fibromyalgia. BMJ

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Jacobs J, et al. Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials. Pediatr Infect Dis J.

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Frei H, et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. Eur J Pediatr

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