Book Review of Homeopathy: How It Really Works, by Jay Shelton, published by Prometheus in 2003
This will not be the last book written about homeopathy, but perhaps it ought to be. It says everything that needs to be said unless homeopaths can succeed in supporting their claims with better evidence than they have produced in the first two centuries of their endeavors. It covers everything from the origin of homeopathy through all the published research data to the various forms of current practice. In the process of showing that this emperor is wearing the most transparent of clothes, physicist Jay Shelton also provides a complete course in how to think critically about claims of medical effectiveness.
In the late 1700s, when conventional medicine was still pre-scientific and was more likely to harm than to cure, Samuel Hahnemann had the fanciful idea that “like cures like” – that if a substance caused toxic symptoms in healthy people, small doses of that substance ought to cure the same symptoms in sick people. Homeopathy enjoyed an early success because it offered a harmless placebo as an alternative to the toxic effects of conventional medicine. Its principles were debunked by Oliver Wendell Holmes as early as 1842[i] and as effective science-based medicine evolved, homeopathy lost its appeal. Today its popularity is again on the rise, with a 500% increase in sales of its remedies between 1987 and 1999.
Shelton describes the preparation of homeopathic remedies in detail. A substance is repeatedly diluted and “succussed” or shaken at each step. The idea of succussing originated when the originator of homeopathy, Hahnemann, noticed that remedies taken on house calls seemed to work better than remedies given in the office and attributed this to the jostling in his saddle bags en route. A 12C potency means it has been repeatedly diluted 1:100 for a total of 12 times, and calculations using Avogadro’s number show that 100,000 doses would have to be taken to have an even chance of getting just one molecule of the original substance. At the 30C potency, a volume of liquid remedy 10 billion times the volume of the Earth has a 50/50 chance of containing one molecule. Even higher dilutions are often used in practice. Shelton points out that even carefully distilled water is bound to have more molecules of contaminants than this.
Homeopaths claim that the more dilute the remedy, the more effective it is. This is contrary to science and common sense, but homeopaths try to rationalize it through vague concepts of vitalism, the memory of water, water clusters, and so on. There is no convincing evidence for any of these ideas, even though the late Jacques Benveniste claimed he could send a homeopathic “signature” over the Internet. (His data were inconsistent with homeopathic theory as well as with science, they were produced by experiments that were inadequately controlled, and they earned him the dubious distinction of being the only person to receive two lg Nobel awards.)
Homeopathic remedies are tested by “provings.” Several healthy people take a remedy and note every symptom or feeling for a variable period of time, often months. These symptoms are combined into a Materia Medica. An entry for Natrum muriaticum covers 19 body systems with entries such as:
Extremities: Pain in back, with desire for some firm support. Every movement accelerates the circulation. Palms hot and perspiring. Arms and legs, but especially knees, feel weak. Hangnails. Dryness and cracking about finger-nails. Numbness and tingling in fingers and lower extremities. Ankles weak and turn easily. Painful contraction of hamstrings. Cracking in joints on motion. Coldness ofl egs with congestion to head, chest, and stomach.
Sleep: Sleepy in forenoon. Nervous jerking during sleep. Dreams of robbers. Sleepless from grief.
This list becomes even more incredible when you realize that all these symptoms were supposedly caused by a pinch of table salt diluted in huge volumes of water. Natrum muriaticum is sodium chloride! Identification of symptoms is subjective and is bound to include symptoms that the person would have experienced if he had not taken the remedy. Control groups are nonexistent or inadequate. A symptom and its opposite may appear on the same list.
The information in the Materia Medica is then reorganized into a “repertory” of symptoms with their associated remedies. The homeopath looks up the patient’s symptoms and picks the remedy that best matches those symptoms. He may have to identify the patient’s facial expression from a list of 30 including “distressed,” “frightened,” “frightened when aroused,” “anxious,” “anxious during downward motion,” etc. Different sputum colors require different remedies, and he is expected to differentiate between brownish, bloody brown, brick dust, brownish yellow, dirty looking, liver-colored, muddy-like, prune juice and rusty in the brown range alone (there are also blue, black, green, clear, grey, white and yellow ranges). Headaches starting at 3 AM are distinguished from those starting at 2 AM.
Anything can be a remedy. Some practitioners use such things as lava from Mt. Hecla, wind, water from 20 different sources for 20 different symptom complexes, “eclipsed moonlight,” and the north pole of a magnet. Some use dowsing techniques or merely test the name of the remedy written on a piece of paper. Some rely on mental associations: scorpion is expected to produce maliciousness and antisocial behavior; hydrogen produces lightness and exhilaration (in provings; as remedies they would be expected to relieve these same symptoms).
In classical homeopathy, there is one ideal remedy that must be given alone. Today it is common for patients to self-prescribe and take mixtures of remedies. There are various schools of thought within homeopathy that violently disagree with each other and assert diametrically opposite claims. The variety of their beliefs is astonishing. It is difficult to test anything about homeopathy because it is difficult to get different practitioners to agree on what homeopathy is. Some say the appropriate remedy will relieve all symptoms, not just the target symptoms; some say it will not relieve the target symptom at all, but will fix everything else that is wrong.
If a remedy doesn’t work, homeopaths never admit failure. They explain that the patient must have done something to inactivate the response – such as drinking coffee, using a cell-phone, not getting enough sleep, being exposed to odors, or going to the dentist. They may try a series of remedies over a period of months or years. There is always an explanation for why the last remedy didn’t work but the next one will.
Shelton offers a number of factors other than the remedy itself that could explain the apparent effectiveness of homeopathy. It offers hope and comfort in cases where scientific medicine has no cure to offer. Improvement is not well defined – if the symptoms persist but the patient seems to be coping better in other areas, homeopaths consider the treatment a success. The homeopath spends a great deal of time listening to the patient and asking about all aspects of his life including his likes and dislikes. Just knowing that someone understands and cares may be helpful in itself. Other factors such as the placebo effect, regression to the mean, the natural self-limiting course of many symptoms, improvement due to lifestyle changes and concomitant medical treatment can also lead to misinterpretation of cause and effect.
Shelton describes in detail how science operates to rule out false attributions of cause and effect. He explains that a person may have an internal reality in which a remedy is effective, but science wants to know if that internal reality corresponds to the external reality that we all share. He covers the mechanisms of misperception, non-remedy healing mechanisms, the essentials of a good theory, and the pitfalls of clinical testing. He shows that so far, the better quality the trial, the weaker the evidence has been for homeopathy.
Users of alternative medicine often say they don’t care how it works or whether science can provide any evidence; all they care about is whether they feel better. Their internal reality may be good enough for them , but wouldn’t it be better to identify what works in external reality? Understanding how the real world works is a route to improving treatments. Most of us think truth matters. If nothing else, itmatters to our pocketbooks when someone else’s internal reality is imposed on society, when Britain’s NHS pays for homeopathy and the NCCAM wastes American tax dollars researching implausible ideas.
This well-written, entertaining book gives its readers more than they probably want to know about homeopathy as well as all they need to know about the scientific method and critical thinking. Shelton is objective, scrupulously fair, and makes his points without derogatory or emotional language. Homeopathy is based on a kind of magical thinking that is easy to ridicule, but even the most ardent homeopaths should not find anything insulting in this book. Shelton acknowledges that homeopathy often “works,” but he argues convincingly that it works for reasons other than the remedies themselves.
[i]Holmes OW. Homeopathy and its kindred delusions. Originally presented in 1842 as two lectures to the Boston Society for the Diffusion of Useful Knowledge. Available on the Quackwatch website at: http://www.quackwatch.org /OlQuackeryRelatedTopics/holmes.html Accessed 11/06
This article was originally published in the Scientific Review of Alternative Medicine.