There's a lot to be said for homeopathy. It often makes people feel better. It's harmless. It's cheap. Its practitioners tend to be caring, conscientious and earnest. And yet it is the one topic that sends me into internal paroxysms of exasperation (well, perhaps not the one topic — creationism has a similar effect, together with a few other -isms and creeds). When any of my friends and relations cheerfully announce their latest dramatic cure at the hands of their local homeopath, why do I express my pleasure through gritted teeth and inwardly rage?
I think it's a reflection of a lifelong tension between, on the one hand, a wish to accommodate other opinions, appear open-minded and avoid dogmatism; and, on the other, an unshakeable belief in the tenets of the western scientific method. For a while in my youth I was swayed by the seductive 60s' antiscience movement, and its assertion that all explanations of reality were of equal validity, but I never really believed it.
Well, time passes, and gradually I've grown to have the courage of my rationalist convictions and to adopt Darwin and Dawkins as my lynchpins. In my professional work, evidence-based medicine — with all its limitations, and thoughtfully applied — provides a sound basis. Where does this leave homeopathy? At the risk of being roasted alive, or possibly condemned to torture through sympathetic magic, I want to attempt a brief analysis of its purported principles.
We start with a ‘remedy’, such as an extract of nicotine to treat tobacco addiction. Here's the first hurdle: what possible rational basis is there for the assertion that ‘like treats like’ — and don't give me that old chestnut about vaccination: it uses real matter to provoke a well understood immunological reaction and has nothing in common with homeopathy. An extract from the Nicotiana plant is prepared, and diluted in water. A drop of the extract is dissolved in 100 times its volume. A drop of this preparation is dissolved in another 100 times its volume, and shaken — or rather, succussed, which seems to mean shaken in a special way vouchsafed only to practitioners of the art. The process is repeated 10 times to produce a dilution of the original extract of 1 in 100 to the power of 10 (10c for short). If you want a really powerful remedy, it's better to continue the dilution process to 30 steps. Well before this time, everyone is agreed, there is unlikely to be a molecule of the supposedly effective substance left in your flask.
No matter — the remedy works not through the action of a herbal (or mineral, or animal) extract per se, but by its secondary effects on the behaviour of the water molecules that it influences. So, now a drop of this miraculously transformed water is dropped onto an inert tablet, placed in a bottle, stored for an indeterminate time, dispatched to a homeopathist's consulting room, and, one day, placed on the tongue of a suffering individual. So malleable and marvellous and memory-prone is water, with its deceptively simple little molecules of two atoms of hydrogen and one of oxygen, that, in its different forms, it can retain the imprint not of one or two, or a dozen or a score, but literally hundreds of different remedies. Each unique conformation of water can withstand the effects of saliva, digestive enzymes, hydrochloric acid, and the complex of chemical compounds sloshing around in the circulation and make its way to the seat of the problem and there effect a cure.
There is not just a pill for every ill. The homeopath must also carry out an analysis of the patient's habits and proclivities. Are they hot or cold? Do they function best in the morning or the afternoon? Is their complexion sallow or dark? Are they prone to anger or accommodation? And so on and so forth. The memory of water will allow for all these factors and more.
For a long time I was wary of questioning whether the homeopathic emperor actually had any clothes, but after ruminating on the matter once more, I decided to place the above caricature under the nose of an old medical friend. Not just any old friend, but a prominent and well respected spokesman for complementary medicine for 30 years or more, who has carried out much interesting research on the subject. He is also charismatic (it helps), and honest. To my surprise he replied to my challenge by more or less agreeing that it was all a load of tosh, and that if homeopathy worked it was only through the powerful effect of the practitioner's and the patient's convictions.
This is what really bothers me — is it acceptable to practise a form of treatment that ‘works’ by means of deception? And why does this bother me so much? Perhaps because next week I'm off to do a basic course in acupuncture …
- © British Journal of General Practice, 2005.