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?
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:
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