Thursday, June 28, 2012

Putting Homeopathy in Historical Context: Part 3

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.


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.

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.