Here’s the story so far: Medicine in the 18th
century was kind of a mess. Though people in other scientific disciplines were
discovering that the Earth moved around the Sun, that there were laws governing
how quickly an apple would fall from a tree, and that stoichiometry could be
used to punish generation upon generation of chemistry students, medicine
lagged behind this effort.
Samuel Hahnemann was a German physician who grew frustrated
at this lack of rigor, and so quit his practice. One day, when translating a
recently published medical book, he came across a passage on Cinchona bark that
didn’t make sense to him. He took it upon himself to test the effects of
Cinchona bark on himself, and discovered that it made him quite ill with
symptoms he equated to malaria.
Hahnemann’s goal was to bring to medicine the scientific
process he’d seen in other disciplines. Hahnemann believed most strongly that
medicines should be tested out before being used to treat disease. The theory
that diseases are cured by substances which cause similar symptoms was a result
of his experiments.
Dilution
For most people, this is a very difficult concept to grasp,
one that leads to a lot of skepticism, and is also the first concept most
encounter when they learn about homeopathy. I have no qualms in saying that, on
the face of it, it sounds like nonsense. Coming as we do from a society that
has made such advances in understanding how pharmaceuticals, minerals and
vitamins interact with enzymes and receptors, and using that knowledge to great
advantage, it makes no sense that a medicine that does not obey these
pharmacological principles could possibly work. To found a system of medicine
on the idea of watering down drugs or herbs would have been as ridiculous in
Hahnemann’s time as it would be now (Avogadro would publish in 1811, and though the importance of his work wasn't fully realized at the time, dilution still would have made little sense).
That said, dilution was not the principle upon which
Hahnemann founded his new practice – Hahnemann was working with the primary idea
that medicine needed to be tested, and that those tests should guide clinical
practice. So why did he start diluting?
To answer that question, we need to revisit the tests he
did. Hahnemann would only use substances that showed some sort of
‘disease-like’ effect when they were tested out. While not harmful in a small
dose, these substances might have ill effects in larger doses (after all, most
medicines can cause disease if you consume enough of them). Hahnemann found
that most of the time the patient recovered from their illness with no adverse
effects, but that in a certain number of patients, he seemed to ‘overdo’ it.
The patient would get better at a first dose, still better at a second and
third, but the fourth would make the patient sick all over again.
This happened over and over, and even though it didn’t
happen to everyone, or indeed that many people, it displeased Hahnemann’s
perfectionist tendencies. After trying out a few ways to get around this problem,
Hahnemann decided to try diluting the medicines down. To his surprise, this
seemed to work better than the other methods he’d tried – he could give a
patient multiple doses, they’d keep improving, and he wouldn’t run into that
problem of ‘over-dosing’ his patients. Hahnemann was happy, as were his
patients.
As a first concept to be presented with, the concept of
dilution is tough at best, but usually considered laughable. That said, I don’t
always think it’s presented well or framed in a way that makes sense (we’ll
revisit this in next week’s final installment of this series). Unfortunately,
framing and PR have a larger role to play in science and medicine than many
would like to admit. I often say that many life-saving medical procedures could
be made to sound like the plot of a B-grade horror movie if the person telling
the story wanted. Of course I’m not suggesting that there’s something wrong
with these procedures, I’m just calling to your attention the fact that
presentation has a lot to do with reception, and the same applies to
homeopathy. Which sounds more appealing: An alternate system of medicine that
was the first to pioneer clinical testing of medicines OR A weird system practiced by hippies that’s totally implausible?
Let’s not forget that early Christians were persecuted for cannibalism and
drinking blood (a rescripting of the Eucharist).
Skeptics often rationalize the effects of homeopathy as being placebo - that the patients have minor complaints that are psychosomatic in nature, and that dilute medicine works just fine because the complaint is in the patient's head. To this suggestion I offer the fact that Hahnemann's time was the time of epidemics and rampant infectious disease - these were his foes, not psychosomatic complaints. Hahnemann gained his reputation by treating very ill patients with gentle medicines.
Skeptics often rationalize the effects of homeopathy as being placebo - that the patients have minor complaints that are psychosomatic in nature, and that dilute medicine works just fine because the complaint is in the patient's head. To this suggestion I offer the fact that Hahnemann's time was the time of epidemics and rampant infectious disease - these were his foes, not psychosomatic complaints. Hahnemann gained his reputation by treating very ill patients with gentle medicines.
The 19th
Century
Now that we’ve talked about this difficult concept, let’s
return to history. From humble beginnings, homeopathy roared to prominence in
the 18th century. Many, many physicians practiced homeopathy in
Europe and America. Why wouldn’t they? Hahnemann had taken the disorganized
world of herbs and therapeutics and had put it in dazzling order. By advocating
for testing individual medicines and using the results to guide clinical
practice, Hahnemann had brought medicine into the age of reason, and people
flocked to it. Additionally, homeopathy offered physicians a method of
treatment that avoided the use of barbaric procedures and toxic medicines; for
a profession based on the principle of primum
non nocere, homeopathy held a lot of appeal.
In the first installment of this series, I asked the
question of whether all of these physicians were simply deluded, as opponents
of homeopathy might claim. The simple answer is that they weren’t. Homeopathy
was very much in keeping with the scientific efforts of the times, and there
was a lot of appeal to it.
The development of homeopathy didn’t stop with Hahnemann,
either. Throughout the 18th century, many physicians furthered
investigations into homeopathy, including testing out new medicines, and
working to further organize and systematize the information gathered. It’s a
little known fact that in the 1870s, the homeopathic profession in America began
developing the idea that in order to get the best results from the tests of medicines,
they ought not to tell the test subjects what medicines they were taking.
Furthermore, to get even better results, they ought not to tell the clinicians
conducting the tests what medicine they were giving. In fact, to get really,
really good results, there ought to be placebos given to certain subjects while
others received real medicine, and only the people compiling the data would
know who received medicine, and who got placebo. While not referred to as a double-blinded,
randomized control trials, these efforts clearly foreshadowed what would become
the dominant source of medical knowledge starting in the mid-20th
century.
So with all of this popularity and effort, what happened?
Why is homeopathy a relatively small profession now? Why is it derided by so
many? Our stunning conclusion will come next week. I hope you’ll read on.