Trick or Treatment (15 page)

As if all this was not sufficiently mysterious, some homeopathic pharmacies stock 100,000C remedies, which means that the manufacturers are taking 30C remedies, already devoid of any active ingredient, and then diluting them by a factor of 100 another 99,970 times. Because of the time required to make 100,000 dilutions, each one followed by a vigorous shaking, such remedies can cost more than £1,000.

From a scientific perspective, it is impossible to explain how a remedy that is devoid of any active ingredient can have any conceivable effect on any medical condition, apart from the obvious placebo effect. Homeopaths would argue that the remedy has some memory of the original ingredient, which somehow influences the body, but this makes no scientific sense. Nevertheless, homeopaths still claim that their remedies are effective for a whole range of conditions, from temporary problems (coughs, diarrhoea and headaches) to more chronic conditions (arthritis, diabetes and asthma), and from minor ailments (bruises and colds) to more serious conditions (cancer and Parkinson’s disease).

Although we have listed various diseases, it is important to point out that Hahnemann and his descendants do not see themselves as treating diseases in a conventional sense. Instead they focus on the individual symptoms and the characteristics of the patients. This is best illustrated by describing how a homeopath typically deals with a case.

The homeopath starts by conducting a detailed interview with the patient, asking about both physical and psychological symptoms. This will result in several pages of notes detailing every symptom, including where each one occurs in the body, when they arise and any activities that affect these symptoms. For example, even if the chief complaint is earache, the notes will include meticulous descriptions of everything from the patient’s bunions to any recent constipation. Homeopathy is a highly individualized therapy, so the consultation may even ask about the patient’s personality, emotional wellbeing, apparently trivial matters from their past and preferences for food, colours and smells. This whole interview process usually lasts for more than an hour and the outcome is a complete analysis of the patient’s symptoms.

As the ultimate goal is to find a homeopathic remedy that best fits all the symptoms that have been described, the next stage is to consult the
Materia Medica
, the encyclopaedia that lists the remedies and what they should be used for. Although Hahnemann identified just a few dozen remedies in his early writings, the homeopath William Boericke included over 600 in his
Materia Medica
in 1901, and today
The Homeopathic Pharmacopoeia of the United States
recognizes over 1,000. Trawling through all these potential remedies is all the more complicated because each remedy treats numerous symptoms and so its entry can run to more than a page. For instance, Figure 3 shows the entry for
Aceticum acidum
, better known as acetic acid or the chemical associated with vinegar.

Ideally the homeopath is looking for the
simillimum
, which is to say the remedy that offers a perfect match with the patient’s symptoms. In order to find this optimal remedy, the homeopath might refer to a
repertory
, which is organized according to each symptom followed by the remedies associated with it (as opposed to a
Materia Medica
, which is organized according to each remedy followed by its associated symptoms). Poring through a repertory can still be a major task, so the homeopath will tend to focus on very special and peculiar symptoms to help narrow the search. For example, according to Boericke’s
Materia Medica
, ‘Face: distortion of mouth, trembling of jaw, facial paralysis; more left side’ coupled with ‘Stool: bloody, black, and offensive. Gelatinous, yellowish green; semi-fluid, with urinary suppression’ means that Cadmium sulphate is the ideal remedy.

Finding the correct remedy is such a complicated and subtle task that a patient who visited different homeopaths and who underwent different interviews would be likely to receive different remedies. In fact, the process of finding the correct remedy can vary so much that it has led to the emergence of distinct schools of homeopathy. For example,
clinical homeopathy
simplifies matters by focusing only on the patient’s main symptom and ignoring the more tangential aspects that would emerge during the usual homeopath’s interview. Similarly,
combination homeopathy
is interested only in the patient’s main symptom, but it relies on mixtures of different remedies that all share the ability to treat this one outstanding symptom. In other words, a patient with migraine would receive a homeopathic mixture of all the remedies that include headache as one of the symptoms that they cure. Another way to prescribe is according to the
doctrine of signatures
, which places less emphasis on the symptoms in the
Materia Medica
and instead looks for a clue, or signature, that indicates that a particular remedy is the one that should be adopted. Therefore a walnut-based remedy would be appropriate for various mind-related disorders, such as stress, because the walnut resembles a brain.

With so many approaches and so many possible remedies, some homeopaths employ specific and peculiar techniques for checking that they have found the appropriate treatment. This can include dowsing, whereby a pendulum is held above a shortlist of possible remedies. The direction of swinging should indicate the correct remedy, yet a scientific trial conducted in 2002 showed no evidence for the power of homeopathic dowsing. Six homeopaths were given twenty-six pairs of bottles; one bottle in each pair contained Bryonia remedy and the other contained a placebo, and the challenge was to use dowsing to identify the genuine remedy. Although the homeopaths generally felt that they were selecting with a high degree of confidence, they were successful only 75 times out of 156 trials, which is a success rate of just under 50 per cent: roughly what one would expect from guesswork.

All this ritual – from extreme dilutions to vigorous shaking, from prolonged provings to dubious dowsing – is performed with the ultimate goal of trying to restore a patient’s
vital force
to its usual, healthy balance. Hahnemann proposed that this vital force, something akin to the spirit, permeated the body and entirely determined a person’s well-being. Many modern homeopaths still believe in the crucial significance of the vital force, which in turn means that they tend to reject many of the principles of conventional medicine, such as the role of bacteria as agents of disease. For example, a homeopath would treat a patient with an ear problem by noting every single mental and physical symptom and then prescribing the most appropriate remedy according to the
Materia Medica
; the goal would be to rebalance the patient’s vital force. By contrast, a conventional doctor would focus on the patient’s main symptoms, perhaps diagnose a bacterial ear infection and then prescribe antibiotics to kill the bacteria.

Not surprisingly, modern science struggles to accept homeopathy. After all, there is no logical reason why like should be guaranteed to cure like; there is no known mechanism that would allow such ultra-weak dilutions (devoid of any ingredient) to impact on our body; and there is no evidence whatsoever to support the existence of a vital force. However, the sheer oddity of homeopathy’s philosophy and practice does not necessarily mean that this approach to medicine should be rejected, because the critical test is not how bizarre it is, but whether or not it is effective. This can best be decided via the ordeal of the clinical trial, that tried and trusted tool of evidence-based medicine, which is capable of separating genuine medicine from quackery.

The rise and fall and rise of homeopathy

Homeopathy spread rapidly through Europe during the first half of the nineteenth century, so much so that Hahnemann’s philosophy became well established during his own lifetime. The idea that ‘like cures like’ and the belief that diseases were ‘derangements of the spirit-like power that animates the human body’ sounded similar to some elements of the still highly respected Greek philosophy of medicine, so homeopathy was greeted with enthusiasm. Moreover, Hahnemann’s ideas were emerging before scientists had firmly established the germ theory of disease or the atomic theory of matter, so the vital force and ultra-weak dilutions did not sound quite so strange as they do today.

Signs of Hahnemann’s growing influence ranged from opening the world’s first homeopathic hospital in Leipzig in 1833 to the use of homeopathy to treat Napoleon’s pubic lice. Homeopathy became particularly fashionable in Paris in the 1830s, because Hahnemann set up home in the city after marrying a beautiful Parisian socialite named Marie Mélanie d’Herville-Gohier – he was eighty years old and she was in her early thirties. With her patronage and his reputation, they were able to run a lucrative practice for the wealthy elite, with Mrs Hahnemann assisting her husband in the afternoon and running her own clinic for the poor in the morning.