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Monday, Oct. 9, 2000

NATURAL SELECTIONS

Homeopathy: really more than just a placebo?


Homeopathy has remained controversial as an alternative system of medicine since it was founded in the early 19th century, but a recent report in the British Medical Journal presents evidence that homeopathic treatments work better than placebos.

Homeopathy, from the Greek homoios (similar) and pathos (suffering), has three principles: the law of similars; the single medicine; and the minimum dose. It was developed by a German physician, Samuel Hahnemann. His idea of "like cures like" was that diseases could be cured by administering extremely small amounts of substances that cause symptoms similar to those of the disease when given in large amounts. Hahnemann also thought that a single medicine should cover all the symptoms the patient is suffering, mental and physical.

The third principle is the most controversial. Homeopathic medicines are used in extreme dilution, so extreme that the preparation contains no molecules of the original substance. Orthodox scientists therefore insist that any beneficial effect of homeopathic medicine must come from the placebo effect: an effect brought about by an inert substance. Because the placebo is inert, any effect is thought to be psychological.

The placebo hypothesis has been tested by Morag Taylor and colleagues at the Glasgow Royal Infirmary in Scotland. They report that in controlled trials homeopathic dilutions work better than placebos.

Their work in the British Medical Journal is the fourth in a series of studies. Two groups of patients with inhalant allergies (to things like house dust, cat fur, dog hair, and pollens) were given, randomly, either an oral 30c homeopathic preparation of their principal allergen or a placebo. (The "c" of 30c is the Roman numeral for 100. A 1c dilution is 1/100, 3c is 1/1,000,000, and so on. Medicine diluted to 30c is standard homeopathic practice. American physicist Robert Park has pointed out that a 30c solution is equivalent to one molecule of the substance dissolved in a container of water more than 30 billion times the size of the Earth.)

After taking the homeopathic preparation or the placebo (without knowing which one they'd been given), the patients tested themselves for allergy symptoms using a nasal inspiratory peak flow meter. This device gives an objective indication of nasal obstruction. They also kept a subjective diary of their symptoms each morning and evening. There were 50 patients in the trials, and both symptoms checks were made daily for four weeks.

Using the nasal airflow data, there was a clear objective difference between the effects of the placebo and homeopathy treatments. In the third and fourth weeks after being split into random groups, patients given the homeopathy treatments showed significantly improved symptoms compared to the placebo group.

For the subjective assessment of the symptoms, both treatments resulted in improvement. Subjective results for homeopathy were better than placebo in only four of the five centers where the trials were carried out, resulting in no statistical difference between the groups. This, say the researchers, may be because of positive expectations of the patients; a larger sample size, they say, might show stronger differences.

But when the results are combined with those of three similar studies, homeopathy treatment differs from the placebo using both subjective and objective measures. Together with the results of over 180 other studies, the authors conclude that the evidence is mounting for a therapeutic effect of homeopathy.

The paper has already sparked its own controversy, with many scientists remaining skeptical until a mechanism can be advanced explaining how ultra-dilute homeopathic medicines work.

Homeopathy has been resisted (and sometimes ridiculed) by the establishment for so long because there is no plausible biological, chemical or physical mechanism which could explain how it works. The "medicines" used are diluted to the point where there is no difference from water.

The French scientist Jacques Benveniste proposed that the diluted water contains a "memory" of the medicine which has been dissolved in it. The problem with his idea is that it requires radically new laws of chemistry and physics. This is why scientific evidence from clinical trials is so important for homeopathy: It is the only currently available method of demonstrating that homeopathy works.

Mark Savill, a retired scientist, said in a published response to the article, "I would like to see mainstream medicine get a little more excited by the results and a little less negative. After all we have the possibility here of side-effect free, very cheap treatment for allergies, and possibly many other conditions."

Homeopathic medicines certainly are cheap, and revenues can be high. One homeopathic product, Oscillococcinum, is marketed in the U.S. for the relief of colds and flu. It is prepared from a freshly killed duck's liver and heart. The magazine U.S. News & World Report said in February 1997 that because of the extreme dilutions used, only one duck per year is needed to make the product. In 1996 total sales of the product hit $20 million.

In a commentary on the British Medical Journal report, Tim Lancaster, of the Institute of Health Sciences, Oxford, and Andrew Vickers, at the Sloan-Kettering Cancer Center in New York, said that the results are "challenging to those who believe that homeopathy is always equivalent to placebo." But they emphasized that rigorous clinical trials are particularly important for the study of homeopathy. Now is the time, they said, "to do the large trials that really could change thinking."



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