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What if Homeopathy Really Worked?

September 22, 2014

Here is a thought experiment about what might happen if homeopathy suddenly started returning positive results in research studies.

Of course, homeopaths claim that such results already exist, but, as the only thing homeopaths have ever tested positive for is rigging or misinterpreting studies, I will ignore them. (I have already looked into Dana Ullman’s “150 positive studies”, and found it was more like zero. And in Europe, homeopaths are lobbying the EU to exempt them from normal medical testing standards yet still grant them full medical status. Anyone who wants to claim that homeopathy is indeed proven can start by convincing these lobbyists that it’s safe to stop.)

Maybe the fairest starting point for our thought experiment would be to base it on a claim made by a well recognized homeopathic organization. How about the American National Center for Homeopathy….

In regular medicine, if you, let’s say, stop taking your high blood pressure medication, at a certain point you can be sure your blood pressure is going to go up, because there’s not actually any real healing that has happened. With homeopathy you can expect your body to actually heal.

So here’s our hypothetical scenario — taken directly from the NCH:

A study on blood high pressure returns positive results for homeopathic treatment.

Let’s go through this step by step. How was our study conducted and what is the homeopathic remedy for high blood pressure?

A quick check of a few websites reveals at least one thing that is surprisingly sensible, namely that many homeopaths also recommend dietary measures, regular exercise and stress management. (At least they have learned something from the “allopathic” medicine they so despise!) So these can also be included in the study:

homeopathy + related health measures for one group, and a (non-homeopathic) placebo + related health measures for the control group.

But before we go further, there’s another complication that must be considered. Homeopathy, it is often claimed, must be individually diagnosed, case by case. Merely testing a single remedy the same way as one might test aspirin will result in a false negative for homeopathy because it “doesn’t work like that”. This is often used as an excuse for negative results, or to claim that homeopathy “can’t be tested”. But in fact this can easily be built in to the study. It just means that we need to add a step wherein patients are diagnosed and a suitable treatment prescribed.

So our study also has a diagnosis phase. Again, to be fair, we can base our imagined scenario on real descriptions of typical diagnoses and prescribed treatments for high blood pressure by a real homeopath:

The following snapshots of cases may clarify how homeopaths choose the appropriate remedy.

Argentum nitricum helped Gerry, who was a social, warm soul. She became emotional when talking about her son’s problems and she worried about him constantly. She also felt anxious about upcoming events, holidays, or flights, experiencing bouts of diarrhea. She craved sweets, though she would feel unwell after she ate them.

Aurum metallicum worked wonders for John, whose high blood pressure began after his business failed. He had a serious nature, worked to perfection, and felt like a total failure when problems arose. On occasion, his chest felt too full. He felt his worst at night and often craved alcohol.

Lachesis was the correct remedy for Maggie, a witty, passionate person whose blood pressure became a problem after menopause, when she experienced hot flashes and constriction in the chest. She preferred loose clothing, especially around the neck, and felt her worst after sleeping, avoiding afternoon naps.

Nux vomica helped de-stress Nathan, a type A workaholic whose blood pressure would rise at the least delay or potential problem in his business. He drank coffee to keep going and would settle down with a few drinks at the end of the day. He always ate on the run, which caused digestive upsets, gas, and constipation.

Plumbum metallicum was a good choice for Matthew, an elderly gentleman who suffered from hardened arteries and lightning-like neuralgic pains down his legs. His chest would feel tight and I noticed he trembled slightly. He admitted that he had, perhaps, lived a little too well and ignored his symptoms for a long time, since they began slowly.

Here we stumble upon our first problem. We need to stop for a moment and point out that if homeopathy is merely a placebo, then any one of these diagnoses will be as good (or as useless) as the next, and the placebo effect in its many forms would do all the work. But if — as in our thought experiment — the remedies really are effective, then something quite paradoxical would occur. Namely, it would make it possible for a homeopath’s diagnosis to be wrong.

So we also need to check the accuracy of the diagnosis. Let’s give our study a few dozen homeopaths to diagnose each patient using medical records, a video statement from the patient, and maybe a brief personal meeting.

However, this of course introduces an element that I don’t think homeopaths have bargained with — some practitioners would be shown up as incompetent at diagnosis. Homeopaths are unfailingly confident, even bullish, about their own abilities, but practitioner confidence would not necessarily be a good indicator of success.

But back to the study. The correct diagnoses have been settled upon according to popularity of diagnoses, and the trial is conducted. Six months after the treatments have been completed (during which patients have been monitored), the results are unblinded. Let’s imagine the following results: the placebo group has returned 30% success, the homeopathy group, as expected by the homeopaths, and as ensured by the exclusion of wrong diagnoses, shows 100% success.

The medical world is stunned, homeopaths the world over celebrate a great triumph, and await the call to dress up in lab coats and start wandering through the world’s hospitals pronouncing on illnesses and healing patients. Homeopathy legitimately enters mainstream medicine….. Doesn’t it?

Nope.

And this is the next unpleasant surprise for homeopaths. They will have assumed that the entire corpus of homeopathy — methodology, beliefs about chemistry and human physiology — has just been confirmed by this success. In fact, from the point of view of medical science, one remedy has passed one successful test.

What has been established however, is that we have a product on the market with ingredients that turn out to be active and no one knows how they work or its possible side effects. Medical authorities realize they must take it seriously. All remedies will now carry warning labels:

WARNING
Untested remedy
Unknown side effects
Practitioner competence unknown

All remedies for serious illnesses are removed from the market and anyone prescribing or selling them will be severely prosecuted.

Soon a second study begins. This time on, let’s say, hay fever.

Again, a few dozen homeopaths will be asked to diagnose the patients. But this time they will have already realized that there are risks involved. Any crappy homeopath who’s no good at diagnosis will be shown up. And even worse, none of them will know in advance how they will fare. Those homeopaths who successfully identified the consensus diagnoses in the first study start shuffling uneasily and looking at the floor. Do they really want to risk a failure this time around? This study is likely to turn into a bizarre kind of James Randi Million Dollar Challenge.

Eventually, enough homeopaths have been found, and have agreed on the diagnoses for treating the patients suffering from hay fever. Again, we can be fair and base our fantasy on some real homeopathic diagnoses.

In people with multiple sensitivities who demonstrate allergic reactions on many levels, such that their skin and breathing is affected…the practitioner may consider using a nosode….

The researchers ask what a Nosode is…

Nosodes are homeopathic preparations made from bodily tissues and fluids (including faeces, blood, pus, discharges, and saliva) taken from patients suffering from a disease (e.g. measles, anthrax, tuberculosis).

Medical researcher: “Holy heck! What???”

The ethics committee steps in at this point and refuses to allow it. All nosodes are immediately withdrawn from the market.

The next hay fever remedy:

The simplest may be with isopathic remedies, which are made from the potentisation of pollens, dusts or other substances that the person may be sensitive to.

Medical researcher: “I thought you said this stuff works by finding a substance that causes particular symptoms in a healthy person, and then giving it to someone who is suffering from those same particular symptoms. Wouldn’t this treatment be doing the opposite of that — simply finding what makes someone sick and then giving them exactly that?”

Homeopath: “Well, this is a different branch of homeopathy.”

Medical researcher: “What??? But it’s the opposite the Law of Similars. So you guys also think that a substance that causes a symptom in a sick person will also heal exactly that same symptom in a sick person?”

Homeopath: “Yes, under certain circumstances.”

Medical Researcher: “Which are???”

Homeopath: “Well, um….”

Medical researcher: “Whatever the case, we can’t use any of this isopathic stuff, until we figure out what how it works. It might be dangerous. The ethics committee won’t have it.”

Now all “isopaths” are pulled from the shelves as well.

Our medical researcher starts looking through a list of remedies and asks if practitioners really test them on themselves first.

Homeopath: “Well, that’s the magic of it. Hahnemann developed the methodology 200 years ago and since then homeopaths have been using it to research and develop their own remedies for all known illnesses.”

Medical researcher: “Really? Um, what’s this one — homeopathic wolf’s milk?”

Homeopath: “Ah yes, the essence of motherly love…”

Medical researcher: “So a homeopath drank wolf’s milk and watched what it did to him?”

Homeopath: “I guess so…”

Medical researcher: “What about this one — dog shit.”

Homeopath: “Please, it’s called exrementum caninum.”

Medical researcher: “Well, go on, what symptoms does it cause when you ingest it?”

Homeopath [flipping through a big book]: “Nausea, migraine, inflammation of the genitals — I guess if you rub it on; conjunctivitis, eating disorders. And it causes emotional problems too — feelings of guilt, hate….. And unemployment. It causes unemployment. But it it can cure it too if you take the remedy.”

Medical researcher: “What???”

Homeopath: “Yes, and it also causes hip dislocation if rubbed on… or maybe if you slip on it. I’m not sure. Anyway, it will certainly cure a dislocated hip if you already have one, so it must have caused that symptom somehow in a healthy person.”

Medical researcher: “Go on…”

Homeopath: “Um… It causes children who don’t want to leave home when they grow up. And hay fever. It causes hay fever or cures it if you’ve already got it.”

Medical researcher: “Well there’s no way the ethics committee would let us use it in this test….. And what the hell is this? Tyrannosaurus Rex? Where the hell did you get a sample of that from? Did you steal it? And what symptoms does it cause in a healthy person who eats it? And what kind of healthy person would eat Tyrannosaurus Rex material for god’s sake?”

Looking at the floor, our homeopath mumbles, “Well maybe some people have been developing their own theories about this and have gotten a bit ahead of the rest of us.”

Medical researcher: “Well okay. How about we exclude the craziest ones for now then?”

Our homeopath nods, suddenly realizing that all those people who sell these things will find their remedies subjected to testing too, eventually. But it’s too late to stop it now.

There would be massive interest among medical researchers and scientists. Any homeopath who agrees to assist in studies will have to risk being publicly exposed as a failure at diagnosis.

Eventually, it would become clear to science what caused the initial success. But what must already be clear is that the various systems and theories that homeopaths have developed for themselves over the years cannot all be true. The best that they can hope for — the best — is that maybe one version would be left standing. All other versions would be clearly demonstrated to be false. And only those homeopaths who understood the correct version (if there is one) and were competent at diagnosis would survive in business.  

Once proper accreditation procedures were in place, homeopaths would need to develop some new skills: the critical thinking skills necessary for accurate diagnosis, and of course a sufficient level of literacy to understand the course material

How would they go? Well, one homeopath from a homeopathic hospital recently left this comment for me —

Nice post,We are also same in this business….

— on a post about how the Nazis tested homeopathy on prisoners suffering from malaria.

… 

Whatever were to happen next, it’s clear that a large proportion of homeopaths would wind up dreaming about the good old days when their treatments were completely ineffective and they were protected by the ever reliable placebo effect.

Update Oct 2015: Dr Edzard Ernst has posted an article looking at the four meta-analyses of studies on homeopathy that homeopaths frequently refer to as “positive”. Unsurprisingly, they aren’t.

Posted by Yakaru

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20 comments

  1. Nice post, Yakaru. That whole idea that something caused a problem in a healthy person, therefore it will fix that same problem in a sick person is beyond wacky. (Am I understanding this correctly? What I just wrote is so weird that I hope I have it wrong!)

    I also find mind-boggling this notion of “it can’t be tested but I know it works/is true” but I probably thought that way about certain things at one time. Now that I know better, it hurts to see that.


  2. […] Of course, homeopaths claim that such results already exist, but, as the only thing homeopaths have ever tested positive for is rigging or misinterpreting studies, I will ignore them. [Read more] […]


  3. Thanks, Mariah!

    Yes, this business of “proving” is completely and utterly mad. I think it’s even crazier than the dilution business, which only needs one slight revision to the natural laws of the universe which I’m sure God could be persuaded to make if we paid him enough.

    But the Law of Similars would require large scale changes to all aspects of human physiology. This would of course require reworking the entire evolutionary history of life on earth. I actually talked to God about this while I was researching this post, and he said that he would not be prepared to undertake such a project at this time.


  4. But if the dilution claim were true it would make homeopathy easy to prove, since homeopaths themselves already take the dilution to such extremes that, according to what they claim, the effectiveness should be multiplied by factors in the millions.


  5. Yep, and if it worked for homeopathy it would work for everything else too. One asprin would cure the whole world’s headaches for a decade. The cost of medicine would plummet, but the cost of homeopathy would stay the same, making it prohibitively expensive!


  6. The point about methodology reminds me of a psi troll on Skeptico. No grasp of the philosophy of science and why the Ganzfeld experiments would just as easily be explained by clairvoyance as they would be by telepathy. The point I made was that failing to consider such possibilities undermines any trust I’d have in the competence of parapsychologists, even if their results weren’t the result of more mundane causes. They presumed they knew what was going on and thus didn’t create opportunities to learn from experiments. You’re supposed to test to fail, not to superficially verify preconceptions.


  7. Yeh, it’s a basic failure to understand what testing is all about. I don’t know how many times I’ve heard woos saying “I became a scientist in order to prove _______.” (I remember, also on Skeptico many years ago a Feng Shui master who said exactly that. It was the trump card he’d been keeping up his sleeve, and was surprised when nobody was cowed.

    And it’s an utter lack of curiosity.


  8. In regular medicine, if you, let’s say, stop taking your high blood pressure medication, at a certain point you can be sure your blood pressure is going to go up, because there’s not actually any real healing that has happened. With homeopathy you can expect your body to actually heal.

    Just thought of one of my pet peeves with homeopathy..

    There are multiple aspects of medical care: Preventive, curative, and symptomatic/palliative are the ones that spring to mind. I think it’s relatively easy (but still subject to error, hence we still need science) to figure out if a treatment is effective at cutting down on symptoms. I would expect curing and preventing health problems to be harder because it requires understanding the underlying causes and knowing how to stop them.

    In the case of blood pressure medicine, well, that doesn’t strike me as curative medicine in the first place. When the doctors tell patients with high blood pressure to cut back on fatty foods, cut down on sources of stress, and to exercise more often, they aren’t being mean or changing the subject. That’s what the real curative and preventive treatments are. Doctors know that a lot of health problems aren’t cured solely by throwing pills at them, despite what the public thinks. As I understand it, blood pressure medication is typically to ensure they don’t have a cardiac episode in the meantime, but people end up on it for longer than intended because they can’t or won’t change their lifestyle so easily.

    We know that compensating for symptoms and treating the underlying problem are very different things. If you don’t treat the cause, we expect that cutting back on symptomatic treatments will lead to the symptoms returning.

    Homeopathy’s Law of Similars, in contrast, is inherently focused on symptoms. They base their remedies on what symptoms they cause in healthy people. They treat disease by matching remedies to the patient’s symptoms, almost as if they believe ailments are cured by toggling boolean status flags on RPG characters. I suspect using the law to treat diseases with diluted causes of that disease is a more recent phenomenon in homeopathy using borrowed knowledge from real medicine in order to stay vaguely plausible. It’s much like other forms of woo borrowing terminology from quantum mechanics and epigenetics since electricity and radiation are no longer hip and new. It’s more about keeping up with modern jargon than revising their understanding in light of new evidence.

    Another irritation is that “allopathy” sometimes comes across as a jab at the long discredited four humors theory, showing that homeopathy hasn’t kept all of their jargon up to date. Either that, or it’s a form of projection, asserting that modern medicine is like an exact mirror of homeopathy, only treating symptoms with opposites instead of similars.

    If they cared about evidence more than tradition, they’d be doing something much like Yakaru’s thought experiment as part of designing real experiments.


  9. Homeopathy is entirely fixated on symptoms to the exclusion of all else. I have no idea why the claim that it’s mainstream medicine that does that.

    I think they are making a massive and very specific Naturalistic Fallacy with regards human physiology. (Actually the whole of vertebrate physiology in fact, because they use it on animals too.) They must believe in a designed universe too, with the Creator haivng structured physiology and chemistry in general so that the Law of Similars will work.


  10. One insidious enthymeme that often seems present in all sorts of quackery: The idea that health is the natural, expected state of a human being, and everything is fixed with a quick reset to factory settings. All you need is Esuna.

    The reality is that we’ve created a much healthier society with sanitation, vaccination, and modern medicine using real science. It’s only in recent history that we’ve been able to take health for granted.


  11. It’s instructive to look at the assumptions and beliefs about human physiology held by alt med people. These are often even more bizarre than the products they promote.

    –> Illness is fault of the sick person because they let themselves get “out of balance”. (As if the heathy people around the place are all perfectly “in balance”.) And healing is as easy as a simple tweak to the system, which drug companies are preventing you from knowing about.

    I had to look up Esuna, of course.
    http://finalfantasy.wikia.com/wiki/Esuna_(Ability)

    (I’ve got a post about this topic in the works, but my internet not working at home again because my internet provider is useless. I’m waiting to see if a new company will manage to get it connected next weekend.)


  12. I had to look up enthymeme too. Thanks, Bronze Dog. I’ll have to look out for opportunities to repeat the wonderful phrase “insidious enthymeme!”. Great post, Yaraku, although I don’t quite understand your issue with isopathic remedies – I mean, apart from the fact that they’re all baloney. I don’t see that as the opposite of the main principle – you’re just blurring the definition of a sick person and a healthy person, it seems to me. If we give a useless bit of water that’s had pollen in it, which someone is sensitive to in normal doses, it’s not giving a sick person something that makes them sick, since they would be well without those irritants…or have I misunderstood the point?

    I have to say I always felt the intuitive pull of the homoeopathic principle. It’s kind of echoed in the immune response, where small doses of a pathogen, which might be highly toxic in larger quantities, causes us to produce antigens against later attack. It’s there vaguely in the idea that what doesn’t kill you makes you stronger, which again has some intuitive appeal and very limited value. It’s there in the “hair of the dog”, sort of, although not as a cure for drunkenness so much as a hangover. There have been times when I thought that I responded homoeopathically to small amounts of caffein (sleepy) or painkillers (headache), etc., all very likely just placebo responses.

    Actually, I’m wondering now if a nosode could work as a vaccine and if there isn’t some history of its use that way. There is often some vague shadow of a good idea at the heart of a Great Twooth.


  13. I also did a bit of a double-take after writing the bit about isopaths. But it all hinges, hypothetically, on a subtle, but hypothetically important hypothetical distinction.

    The prefix “iso” is “equal”, as opposed to “homeo” meaning similar. The ISO- uses the supposed cause of a sick person’s symptoms, whereas the homeo- just finds a substance that causes similar symptoms in a healthy person.

    So in classical homeopathy, the CAUSE of an insomniac’s symptoms are unknown, and of utterly no interest whatsoever to a homeopath. All he looks at is the symptoms, looks in his book, and reads that if a healthy person takes caffeine, they get a little more waked-uppy. And that’s what the insomniac’s symptoms look like, so he prescribes caffeine, which then somehow cancels out the waked-upness and the person falls asleep.

    (How all this supposedly happens on a physiological level is of course utterly mysterious and of no interest whatsoever to the homeopath.)

    So, on to isopaths. Here the practitioner is suddenly very interested in the cause of the hay fever symptoms. He suspects, say, a particular pollen is the cause, and prescribes this symptom-inducing substance in homeopathic form.

    For some reason, this pollen when it’s in homeopathic form, no longer triggers an asthma attack, but relieves the symptoms instead.

    However, in the thought experiment, this would presuppose a physiological mechanism by which isopaths would work safely. But until such a mechanism could be identified and understood, it would have to be seen as highly dangerous to give a known or suspected allergen to a sufferer, especially if they were in danger of dying from an asthmatic reaction to it. In reality, the homeopathic form is inert, but hypothetically, it’s highly potent.

    (N.B. Caffeine would also be an isopathic treatment If the cause of a patient’s insomnia was believed to be caffeine.)

    Yes, vaccines do sound eerily similar to some homeopathic ideas, don’t they….. But of course, homeopaths, idiots that they are, oppose them!

    I have read of at least one case — I can’t remember any details or where I read it — of a particular substance that causes certain unpleasant symptoms and does indeed cure them again if reapplied.

    Hannemann thought he’d discovered just this — that quinine both causes malaria-like symptoms and relieves them in malaria sufferers. It is apparently true that quinine can treat malaria, but in fact Hannemann had an unusual allergic reaction to it.

    From this mistaken beginning, he went on to make several equally mistaken assumptions:

    a) that his (in fact allergic) reaction was the normal reaction for all humans;
    b) that the reason it helped in malaria is related to the symptoms it supposedly evokes in healthy people;
    c) that diluting such a substance and shaking it would increase its efficacy; and
    d) that this principle will work for all other substances and all other illnesses/symptoms.

    This is of course, enthymemetically very sound, but completely disregards chemistry and physiology.


  14. Thanks Yakaru, that’s made it all a lot clearer for me. Also useful to see those errors listed.

    Odd coincidence – I just thought I’d google to check the spelling and found Hahnemann is reported on one practitioners’ site as saying “the omission of the dipthong [œ] makes the root of the word mean ‘same’ and not ‘similar’. ‘Homoeis’ “cannot these persons feel the difference betwixt ‘identical’ and ‘similar'”. So NO difference between homeopathy and isopathy at all! ;)

    I think he was under fire at the time, as he goes on: “Are they all labouring under the same malady or stupidity? Should not anyone who ventures to step forward as a critic of the ‘spirit of the homoeopathic doctrine’ have to begin with at least some idea of the meaning of the word ‘Homoeopathy'”. Of course, ‘no’ is the answer to that; how you spell it and the etymology aren’t really that important in critiquing the ‘spirit’ of it. For that you just need the scientific method.


  15. I have a homeopath friend who claims clinical trials in homeopathy are flawed not just because they ignore individual diagnosis but because often many wrong remedies have to be tried and failed before you hit upon the right one. It can take years, and you only know you’ve found the right remedy when the disease improves. Seriously.


  16. I sometimes think homeopaths themselves might benefit from being shaken a bit and diluted!

    I stand to be corrected on this, but I’ve never seen a seen a single study designed by homeopaths that includes a diagnosis phase.


  17. Yes, but if they did it according to my friend’s advice, it might take forever, but all completed cases would be successful.

    I think you’re misunderstanding the workings of homoeopathy when you say ” it would have to be seen as highly dangerous to give a known or suspected allergen to a sufferer, especially if they were in danger of dying from an asthmatic reaction to it. In reality, the homeopathic form is inert, but hypothetically, it’s highly potent.” It’s only the *healing* effect that is potentiated by the dilution and succussion. That’s why healthy people don’t get ill when they take the sugar pills.


  18. Yeh, I deliberately didn’t mention succussion and dilution because I think that aspect gets too much coverage from skeptics, and wanted instead to emphasize their crazy beliefs about the physiology of healing. I was of assuming the hypothetical situation that the ingredients turn out to be active in some unknown way.

    So if isopaths, even when diluted, were still active, medical authorities would have to assume it could be dangerous to give a sufferer the substance they are allergic to.

    I could have worded it a bit more clearly or used more scientifically sound scenarios, but I already had to put a *lot* of thought into how to make it even hypothetically plausible that any of this stuff could work! There are so many ways it’s impossible!


  19. I just meant that I think it’s clear that what science considers active is very different from what homoeopathy considers active. :)


  20. Might be a good challenge for any scientists or MDs who read this — dream up a hypothetical explanation for how the healing effects are be potentized while the ingredients remain inert!



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