Thursday, February 23, 2012

In Defense of Homeopathy

Of all forms of complementary and alternative medicine, homeopathy is one of the most, if not the most controversial. Indeed, to bring up homeopathy with many medical doctors is to invite an argument. However, an English translation of an interesting Swiss government report on homeopathy was just released, and I’m feeling punchy. This report, which has been about 10 years in the making, found that homeopathy is indeed both a clinically effective and cost-effective treatment for many conditions, which subsequently paved the way for the Swiss government to include homeopathic treatment in its publicly-funded national healthcare system. Homeopathy, dismissed here in the United States, and currently under attack in the United Kingdom, may have just scored a considerable victory.

While I could probably talk about homeopathy at length, today I’m going to address a specific misconception about homeopathic practice. Many of the most vocal opponents of homeopathy suggest that its use discourages people from seeking ‘real’ medical care, and that the public is at risk of serious disease and debility as a result. I’ve heard it suggested that homeopaths allow massive infections to ravage their patients completely unchecked, and that they also discourage patients from seeking care in cases of advanced cancers.

Let me be the first to say that, as a naturopathic physician who practices homeopathy regularly, I believe that these practices would be completely irresponsible, and are anathema to my beliefs as a healthcare practitioner. Far from an ‘either/or’ dichotomy in the practice of medicine, naturopathic physicians embrace a ‘both/and’ philosophy. The naturopathic approach is pragmatic, outcomes-oriented, and above all, patient-centered. The mode of practice falsely ascribed to homeopathy is not the practice of medicine, it’s the practice of dogmatism, and as I love to point out, ‘There’s no room for dogma in medicine’.

In addition to my clinical practice, I’m actively involved in the effort to pass a law that would license and regulate naturopathic physicians in Maryland. One of the main arguments that we’ve been making in our efforts is that licensing naturopathic physicians helps to increase access to complementary healthcare practitioners that are trained in appropriate usage of natural treatments. Properly trained naturopathic physicians understand both the potential and limits of homeopathic medicine, and use homeopathic medicines judiciously. If anything, the argument that some people practicing homeopathy are irresponsible in their treatment is an argument in favor of establishing licensing boards for naturopathic physicians, so that consumers are better able to access care from well-trained practitioners.

Without going into an extensive discussion of homeopathy, here are some of my thoughts on when homeopathy can be effective and when it can’t.

Here are some situations in which homeopathy can be very effective:
- Symptomatic chronic disease – When a patient has a clear diagnosis and they are suffering greatly as a result of their symptoms, homeopathy can be very effective in alleviating symptoms. It’s effect on labs and imaging studies depends significantly from patient to patient, but the symptoms can usually be alleviated.
- Functional problems – By this I primarily mean situations in which the patient is symptomatic, but pathological changes that would lead to a clear diagnosis haven’t occurred yet. Laboratory findings may be absent or vague, but symptoms are clear and troubling to the patient. Homeopathy can help alleviate these symptoms.
- Acute illness – When the body is acutely ill, it’s actively trying to fight a virus or bacteria, but in the process, creates symptoms, like fever, sore throat, cough, etc. Homeopathy allows the body to fight more effectively, and above all, alleviates the suffering of the patient. As always, this is subject to appropriate usage, and a well-trained naturopathic physician knows when a patient just needs relief of symptoms to get over an illness, and when the illness is more threatening.

There are two main categories of disease that homeopathy is generally not effective against, but I’ll include three just to make the point:
- Asymptomatic chronic disease – Examples include high cholesterol and atherosclerosis, diseases that are clearly present, but are often completely silent until it’s too late. I’m going to say here that I don’t think homeopathy is effective against these types of conditions – it may provide relief from the angina that results from atherosclerosis, but it won’t stop the narrowing of the arteries themselves. Fortunately, however, naturopathic physicians are well-trained in a whole host of effective natural treatments that can help manage things like high blood pressure, high cholesterol, diabetes, etc.
- Cancer – I could make the argument that cancer fits into the above category, but I’m listing it separately for emphasis. As with atherosclerosis, homeopathy can’t cure the cancer itself. Homeopathy may alleviate some of the symptoms associated with cancer, but cannot cure the cancer itself. Cancer is a prime example of a condition that, no matter what complementary treatments are being pursued, should be primarily managed by conventional medicine.
- Anatomic or chromosomal anomalies – These are very rare, but they encapsulate the point I’ve been making. Homeopathy can improve function around the defect, but can’t fix the anatomic or chromosomal problem itself – if you look at the previous examples, you’ll see that the thread running through it all is that homeopathy can help the body function with the pathologic anatomy, but can’t fix the anatomy itself.

If you’re a consumer and you made it this far, I congratulate you, as this was somewhat more directed towards practitioners, and want to give you consumers a take-home message. Let’s sum it up like this: homeopathy is remarkably effective for a lot of conditions, but not everything, and I gave some examples of some diseases where homeopathy can help and some diseases it can’t. As with all acute and chronic diseases, it’s important to seek out a licensed naturopathic physician, who can determine if homeopathy is an appropriate treatment in your case.

I’m looking forward to reading the Swiss government report, and when I’m able to get my hands on a copy, I’ll write a more complete reaction. Stay tuned.