The following article, written by UK homeopath Noam Bar RS Hom in 2011, discusses how attitudes in the homeopathic profession may have strayed from being rational and rigorous, adding to the scepticism against homeopathy.
‘Homeopathy in the age of evidence-based medicine
Homeopathy is a medical profession. As such, it is part of the zeitgeist of the medical world. While the philosophical fundamentals of allopathy and of homeopathy have not changed in the last 200 years, the way allopathy is practised has changed dramatically. I believe that we are failing to perceive these changes, and to react to them accordingly. Below, I look at what these changes mean to us, and how we can adjust to the new reality.
The evolution of the allopathic practice has shifted the goal-posts in the allopathy-homeopathy debate. While it is possible to perceive the recent attacks on homeopathy as an attempt from the medical establishment to cement its control of the market, and undoubtedly this element exists, it is also important to consider the possibility that the recent attacks are so successful because they are hitting the right spot. I believe that they are pointing to areas of weakness in the way we practice homeopathy in the UK.
Two hundred years ago, Hahnemann developed homeopathy because he was exasperated by the inaccurate claims of his contemporaries, who treated diseases according to untested theories and fashions. He wanted to establish a system that is based on “principles that are at once plain and intelligible”. This enabled him to claim that homeopathy is scientific, but allopathy, on the other hand, is not.
It may sound provocative, but watching the recent Newsnight report, in which homeopaths told patients that taking homeopathic remedies can prevent malaria, made me think that the tables have turned. It is now the homeopaths who give unfounded advice, while it is the doctors who are scientific in their approach.
The simple fact is that there is no evidence to prove that Malaria nososde, China-s, or any other remedy, can prevent malaria. Such advice is based on hearsay and on fads. Some homeopaths tell each other that “China-s is a good prophylaxis for malaria”, and somehow it becomes a fact. If a homeopath gives such advice, he is no different than the 19th century doctor who advised mercury because that’s what his colleagues were doing, not because there was any evidence that this medication actually improved health. Like the 19th century doctor, some 21st century homeopaths are reliant on unproven facts, on anecdotal evidence.
Two ways to practice rationally
Hahnemann wanted rational medicine, and had his answer – a practice based on the universal principles of health and disease, as presented in the Organon. But is it possible that homeopathy is not the only rational system in the 21st century? Modern medicine developed Evidence-Based Medicine (EBM) out of the same frustration felt by Hahnemann – doctors wanted a system that would ground the medical practice on facts rather than anecdotal evidence. They decided that every treatment has to go through rigorous empirical tests in order to prove that it is reliably treating the condition it’s prescribed for. This has been a massively important development. It gives doctors a definite tool to measure whether the treatments that they offer work or not.
This means that when one tries to compare EBM with homeopathy in the early 21st century, the stakes are much higher. Doctors can confidently claim that they have an efficient tool to treat named diseases, eg, that they can prevent malaria (with caveats – in most cases, and at the expense of side-effects – but, importantly, in a statistically significant manner). We, unfortunately, don’t have such a tool – we do not have a proven, researched remedy, or a reliable protocol, that can prevent malaria.
Naturally, EBM is still highly inadequate. It still looks at the symptom and not the person, and it still ignores the simple fact that diseases are a part of a greater imbalance of the body. But it is far superior to 19th century medicine, because it makes sure that the prescribed medicine actually reduces the symptom it is meant to reduce.
The drawbacks of EBM send us back to Hahnemann and his universal principles, first and foremost of which is prescribing according to the totality of the symptoms. But where are these principles when homeopaths recommend Malaria nosode as a prophylaxis for malaria? Prescribing in such a way is not only empirically unsound, it is also bad homeopathy.
Theoretically, homeopathy might be able to provide a prophylaxis for malaria. Hahnemann used Belladona successfully to prevent scarlet fever after treating very large numbers of people, running his own version of empirical trials. Similarly, we might in the future be able to find the genus epidemicus to malaria. But if we venture to do that we are out of the realm of universal principles and holistic medicine; we are in the allopathic-like realm of named drugs for named diseases. Such a claim can only be verified through the same tool used by allopaths – the randomized controlled trial. Prove it – or else remain silent.
The need to respond
The combination of relying on anecdotal evidence and drifting away from what makes homeopathy unique has brought us to a crisis. If we don’t acknowledge that, it is not impossible that in the near future lay homeopaths will be banned from practising on the grounds that they risk people’s lives. We need to react swiftly and forcefully.
I believe that, as a profession, we need to do a few things:
Firstly, we must go back to Hahnemann’s principles – treat the person and not the disease, treat holistically, and treat according to principles and not according to fads. When this is not possible, eg, when asked for a prophylaxis for malaria, we need to acknowledge that we cannot, ethically or reliably, offer a definitive solution.
Secondly, we need to be much more conservative and careful about what we tell others, and ourselves, about homeopathy. In the brave new world of randomized control trials and meta-analyses, no-one, including doctors, can get away with statements that are not based on hard facts. We should bear this in mind and refrain from unverified statements. It is exactly because homeopathy is so complex, immaterial and spiritual that we need to be extra careful about how we describe it.
Thirdly, we need to be realistic about what we can achieve and what we can’t; we need to be realistic about the power of homeopathy, about our skills, and about the potential risks to the patient if misused. We need to work in much closer collaboration with doctors, and learn to appreciate and embrace the incredible progress that they have made in recent decades. Even after allowing for these three caveats, there is still a vast space for homeopathy to work in and to succeed. EBM, for all its confidence and its success, is far from finding an answer to most people’s disease, and is creating a host of iatrogenic conditions. But, quick to criticize it, we haven’t taken in the changes it brought with it. I think that homeopathy is, at the moment, dangerously out of touch with the outside world. I think that until we put our house in order we cannot expect the attacks on us to lessen.
Most homeopaths are now indignant. They blame the media, the pharmaceuticals, and the NHS. This is a wrong use of energy. There’s an opportunity in every crisis, and the recent attacks on our profession are no different. It would be much better to look in, find what we can learn from these attacks, examine why they are so successful, and clean up our act. In this, our professional organisations and our colleges have a crucial role to play. They must produce much clearer guidelines and enforce them convincingly.
Only then – knowing that are flanks are secure – can we go to the public arena and ask the difficult questions that the doctors have no answers to. To win this argument we need to concentrate the discussion on our agenda. More importantly, to win we must admit that we are largely responsible for the state we are in – and draw the right conclusions.
With a Nobel prize laureate now saying that ultra-dilutions work, 2011 can potentially be a great year for homeopathy. Whether this happens is up to us, and to how honest we are with ourselves.’
12.1.2011, Noam Bar RSHom