One of the things I like best about homeopathy is that when I want to illustrate how fanciful and ridiculous the theories and beliefs of homeopaths are, there is no need to exaggerate or embellish their claims in any way. All that is needed to demonstrate homeopathy is nonsense and that homeopaths are ultimately faith healers who have rejected the very foundations of conventional science-based medicine is to allow them to describe their beliefs and practices in their own words. A fairly simple comparison of what they claim to reality makes the point quite clearly.
I recently took a brief online introductory course in homeopathy offered by the British Academy of Veterinary Homeopathy (BAVH). This was a free offering intended to lure veterinarians into their full introductory training course, which will set you back £1,300 (about $2100). The course made many of the usual claims about both homeopathy and conventional medicine and illustrated the deep inconsistencies in what homeopaths say and what they really practice.
Throughout the course, the instructors repeatedly emphasize that they accept science and evidence-based medicine and do not reject established healthcare. They then repeatedly emphasize, exaggerate, or manufacture flaws in science and science-based medicine and claim that homeopathy is fundamentally different, and superior, in both theory and practice.
For example, the stated aim of the course is “To enable and encourage veterinary healthcare professionals to integrate the discipline into their clinical practice and to facilitate this within the framework of an evidence based approach.” However, the instructors repeatedly claim that homeopathy can replace conventional therapies and that homeopathy is fundamentally different, safer and more effective than conventional medicine. Here are a few examples.
Homeopathy can work where conventional treatment has failed.
These natural remedies do not have traditional side effects.
Homeopathy can, in many cases, avoid the need of using antibiotics.
[Homeopathy provides] the opportunity to cure an animal whereas with a conventional approach all you can do at best is to hope to control it with continuous medication or in the absolute worst situations to carry out euthanasia.
[Homeopathy] is an actual philosophy of health and disease, a different understanding of what health and disease actually is… than in current medicine.
This material seems more appropriate for Hogwarts than for a veterinary continuing education course. Let’s have a look at the content in a bit more detail.
An Introduction to Potion Making
The central tenets of homeopathic theory, which originated with the father of homeopathy, Samuel Hahnemann in the 18th century, are reviewed in this course. Generally, no effort is made to provide evidence that these are true, they are simply assumed or implied to be true.
- Law of Similars
I have covered this subject before, as have many other authors (e.g. Science-Based Medicine, Skeptic’s Dictionary). Basically, the homeopaths accept a version of the ancient and widespread, and completely false, theory of sympathetic magic. This is the belief that things which have some sort of superficial resemblance must have a fundamental connection such that one can be used to manipulate the other. The voodoo doll is a classic example. In this case, homeopaths claim that substances which cause certain symptoms in healthy people should be used to cure the causes of those symptoms in the ill. This is a notion that has stubbornly resisted all attempts to prove it is actually true.
2. Dilution and Succussion
The instructors acknowledge that one of the biggest stumbling blocks to acceptance of their claims is the fact that many homeopathic remedies are diluted far beyond the point at which any of the original substance could possibly be present. The instructor for this course appears to be trying to have his cake and eat it too. He claims that dilution is not necessary for homeopathic remedies, but then admits that “most of the remedies we use involve dilution way beyond Avogadro’s number.” He admits that homeopathic remedies are usually ultradilute but suggests that Avogadro’s number is no longer relevant for some mysterious reason because we now have quantum physics, which has supplanted Newtonian physics. He offers, however, no evidence for exactly how quantum physics invalidates basic chemistry, merely mumbling about “nanoparticles” and “hydrogen bonds” in a way that is supposed to imply some deep meaning but simply illustrates that he really doesn’t know and is just waving away the problem on faith alone.
If quantum physics had replaced Newtonian physics, I would expect we would be using quantum principles to magically transport airplanes instantaneously anywhere we wanted, rather than shooting them laboriously through the sky using old-fashioned Newtonian physics. Yet we are not.
Finally, the instructor claims it is not the dilution which makes a homeopathic remedy but the succussion. Unfortunately this is just a fancy word for “shaking,” and why shaking should transform water into a specific medicine with properties derived from a substance no longer present is not explained (or, I would argue, explainable). In any case, he undercuts this attempt to dodge the problem of dilution when he says, “dilution does add to the effectiveness of a remedy.”
Another instructor, in the “evidence-based” section of the course, uses almost exactly the same strategy. She begins by suggesting conventional scientific understanding of chemistry as an interaction between molecules is outdated and not applicable to homeopathy. The scientific view, “requires active substance in this old-fashioned kind of lock-and-key type mechanism.” This instructor also claims homeopathy does not require using ultradilutions, but then acknowledges that “homeopaths mostly do use high dilutions.”
She goes on to claim it is widely accepted that ultramolecular solutions do have activity despite this not being possible under the conventional understanding, and then makes a lot of vague references to various scientific-sounding phenomena like “thermoluminescense,” “NMR studies,” “epitaxy,” “nanobubbles,” “stabilized water clustering,” etc. Again, there is no attempt at explaining what, if anything, this has to do with the magic of pure water have all sorts of potent and varied therapeutic effects.
This is a classic hallmark of quackery, using a lot of vague, “sciency” language without any actual understanding of the concepts referred to or any real theoretical or data-based connection between them and the claims they are implied to be supporting. All of this is part of the typical pattern of homeopaths acting as if their theories are established, accepted science despite the reality that they are accepted by almost no one except other homeopaths.
3. Individualization of Treatment
Homeopaths like to claim that they tailor their therapies to each individual’s personal needs, while conventional medicine treats patients as so many identical units. I’ve written before about this supposed individualization, and why it is complete nonsense.
Basically, the claim to individualize treatment ignores the whole issue of relevance. Since no human doctor is capable of considering the effect of everything in the universe simultaneously throughout all time on the condition of the patient before them at the moment, all of us must decide which factors are relevant and which aren’t. In scientific medicine, we use the accumulated results of scientific research to understand the relationship between biological processes and all the things that can influence them to bring about disease or to preserve and restore health. It is impossible to perfectly account for all possible factors, but as scientific knowledge grows, we get better and better at understanding what matters and what doesn’t in the care of each patient.
A good example of this is the gradually improving understanding of the white blood cell cancer known generally as lymphoma. Rather than being a single cancer, it is a collection of related but different diseases, and the differences that matter vary from those that can be lumped into broad categories and are common to many patients, down to those that are unique to each individual. We are constantly improving our understanding of these differences, and how they influence treatment, and we are embarking on an era in which we will eventually be able to tailor cancer therapies very precisely to the needs of each individual, through detailed analysis of the genome of each person and each cancer. This is not yet a reality, but it is a plausible future we can reach by hard work and patience.
Homeopaths, on the other hand, choose which factors are relevant to the individual in a subjective, haphazard way that is essentially arbitrary. For example, one instructor in this course indicates that one way to decide whether the homeopathic remedy arsenica album is appropriate for a given patient is the time of day their symptoms seem to worsen. Specifically, “all the symptoms…whatever they may be, are much worse around or just after midnight.” Whether you have vomiting or coughing, a fever or back pain, and regardless of what scientific medicine would determine to be the cause of your disease, this remedy is for you if you think, or your doctor thinks, the symptoms are worse during this magical hour of the day. If you think your symptoms are worse at another time, you might well choose a different remedy. This criterion is based on the uncontrolled, personal anecdotal experience of some homeopath and then blindly followed by subsequent homeopaths without any rational or scientific attempt to find a sensible explanation for why this might be true.
Many other similar criteria, including the emotional experiences of patients, the color or smell of body fluids, the character of pain, and others are assumed to be relevant to the treatment based solely on subjective experiences without any rational or plausible, much less scientifically demonstrated, relationship between these factors and the cause of illness or the success or failure of treatment. This is witchcraft, not science or medicine!
Homeopaths also like to complain that clinical trials don’t provide good evidence for how to treat patients because they rely on the experiences of a group of people, and every individual is different. Yet how do they decide which symptoms indicate the need for which particular remedy? Why through a type of test they call a “proving.” This basically involves giving a remedy to a group of healthy people and having them write down everything they experience, physical, emotional, spiritual, and so on, while taking the remedy. Homeopaths then look through these subjective diaries and subjectively decide which patterns are meaningful, and they then assign specific symptoms to the remedy. In the future, other homeopaths then look at these symptoms to help decide which remedy to use. This is simply basing the choice of treatment for a given patient on the experiences of a group of other people, just as is done in clinical trials. The only difference is that in provings no attempt is made to objectively measure anything, and all the data are subjective and subject to innumerable sources of uncontrolled bias.
Of course, as I’ve discussed previously, the use of language like “scientifically proven” and “evidence-based” has great marketing value for alternative therapies. This is because people, regardless of their philosophical perspective, recognize that science has given us far more reliable knowledge about the world than any other approach, and it has brought about a tremendous and unprecedented improvement in human health and well-being. However, homeopaths use such language in a completely dishonest and disingenuous way.
As already pointed out, the instructors in this course claim to be committed to scientific evidence, yet they belabor, exaggerate, or manufacture all the flaws of scientific research and suggest that their subjective and anecdotal methods are superior. In an entire lecture of this course devoted to discussing “The Evidence Base for Homeopathy” the instructor never once suggests that any tenet of homeopathy or any basis for homeopathic practice might be proven wrong by scientific research. Science is not used by such individuals as a method to develop knowledge and test beliefs but as a marketing tool to promote their faith.
This is clear from the beginning, as the instructor describes how she began studying and using homeopathy at a time when there was no research evidence at all to support it in veterinary medicine. She chose to study it anyway, however, because she already knew it worked based on her personal experience.
The instructor then lists the number of research studies she claims exist to support veterinary homeopathy, without discussing them at all. The strategy is clearly to say that studies exist and allow the listener to suppose they show homeopathy is effective. Having reviewed the evidence base for homeopathy myself in great detail (1,2), I have learned that in fact the sheer number of studies is meaningless since the overwhelming bulk of the evidence is too biased and poorly conducted to mean anything, and the best quality evidence consistently shows homeopathy is nothing more than a placebo.
The instructor then indicates that she does not, in fact, believe scientific clinical trials are necessary or relevant to homeopathy anyway, despite having just suggested they proved homeopathy works. She lists numerous real and imagined weaknesses of clinical trials, without ever addressing their strengths or the tremendous positive impact they have had on healthcare. She then says that homeopathy is buttressed by exactly the subjective evaluation of individual cases that science has proven to be so deeply unreliable:
Case based reasoning is solving a new problem by remembering a previous similar situation and reusing the information and knowledge from that situation…200 years of homeopathic documented case reports and pathogenetic trials form the basis of every prescription choice…alongside cured case analysis…If we look at the case report, perhaps it may be the gold standard [rather than randomized clinical trials].
The approach here seems to be to say that homeopathy is validated by science, but that science isn’t all that reliable, and anyway homeopathy doesn’t need to be validated by science because we already know it works. Needless to say, this is not a logic that is in any way compatible with evidence-based medicine.
The instructor does discuss a recent systematic review of veterinary homeopathic clinical trials, which I have evaluated previously. The conclusion of the review’s authors was that additional research is needed to validate homeopathy. My conclusion is that if the best evidence committed advocates of homeopathy can come up with after 150 years consists of two clinical trials, one of which is weak and the other shows no effect, then there is no reason to think more research will be of any use.
In any case, I found it interesting that the instructor repeatedly mentioned the problem of bias when questioning the value of clinical trials on pharmaceuticals and other conventional therapies, but she neglected to mention the fact that both authors of this systematic reviews are “employed by a homeopathy charity to clarify and extend an evidence base in homeopathy.” Neither does she acknowledge that almost all of the research evidence cited in favor of homeopathy is funded and conducted by advocates for the practice, and most of it is published in journals devoted to homeopathy or other alternative therapies. The problem of investigator and publishing bias cuts in both directions, but homeopaths conveniently ignore this when discussing studies that agree with their own bias.
Integrating Magical & Muggle Medicine
The final lecture in this course was a general discussion of so-called “integrative medicine” and why veterinarians should mix science-based medicine and unproven or nonsensical alternatives like homeopathy. I’ve discussed before the misleading nature of this term (3, 4). Mark Crislip has probably most effectively characterized the integration of scientific and alternative medicine:
If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.
This lecture repeats many of the unsupported claims about the superior safety and effectiveness of alternative therapies. It conveniently ignores the fact that several of the various therapies recommended and used together are based on completely incompatible models of health and disease. The instructor claims that using this hodgepodge of approaches will:
Allow “less reliance on suppressive conventional treatment” with “no suppression of signs or symptoms for a later and much more vicious reappearance later, which is something we see with suppressive conventional therapies”
Integrative medicine “can work where conventional treatment has failed” and lead to “fewer drug side-effects, better clinical outcomes, [and] quality of life for patients and owners.”
She even goes so far as to hint at the truth homeopaths so often struggle to conceal–that homeopathy is ultimately a form of faith healing.
Hahnemann viewed the health of the body as dependant on spiritual health, and he saw disease as fundamentally not a physical abnormality but an abnormality of spirit. Curing disease, then, was a spiritual matter:
During health a spiritual power (autocracy, vital force) animates the organism and keeps it in harmonious order. Without this animating, spirit-like power, the organism is dead.
In disease the vital force is primarily morbidly deranged and expresses its sufferings (the internal change) by abnormal sensations and functions of the organism.
The affection of the diseased vital force and the disease symptoms thereby produced constitute an inseparable whole—they are one and the same. It is only by the spiritual influences of morbific noxae that our spirit-like vital force can become ill; and in like manner, only by the spirit-like (dynamic) operation of medicines that it can be again restored to health.
The instructor of this course references this spiritual orientation when she contrasts scientific medicine with homeopathy, revealing her view that they are fundamentally incompatible. The use of the word “dynamic” is intended to hide the fact that the real force referred to here, which Hahnemann also used the word dynamic to reference, is spiritual and supernatural:
Conventional thinking is based in the material world, with most current treatments and research being centered around genes and the biochemical pathways that are altered in the expression of disease.
Homeopathic thinking is based in the dynamic world with treatments based on symptom expression of the whole individual with symptoms and material changes being a consequence of dynamic disturbance and not a cause of disease.
This lecture also most dramatically paints a picture of harmful and ineffective conventional medicine contrasted with gentle and miraculous alternative medicine. Next to a picture of a dog looking sad, she describes how in conventional medicine “a failure to understand and explain the disease process often leaves the client with a pocket full of drugs, a dog that looks no better, and a feeling of deep dissatisfaction.” Clearly, science-based medicine is really Sad Dog Medicine.
Along with a photo of the same dog looking happy, the instructor explains how integrative medicine can improve client compliance and lead to fewer drug side-effects, better clinical outcomes, better quality of life for patients and owners.” Clearly, integrative medicine is Happy Dog Medicine!
The Ethics of Fairy Dust
There is nothing especially surprising or original in this course. All of the usual clichés, fairy tales, and misinformation associated with homeopathy are present. What is disturbing is that this course is offered as continuing education for practicing veterinarians. Veterinarians are legally required to update and advance their knowledge base to maintain their license to practice. This is intended to protect the public from outdated ideas and ineffective care. However, the purpose of such a requirement is defeated entirely when veterinarians can maintain their license by learning outdated ideas and ineffective care.
What is more, such courses can mislead veterinarians into believing homeopathy has some legitimate scientific basis and is something other than an 18th century pseudoscientific form of faith healing that functions only as a placebo. And the placement of the BAVH and its course alongside mainstream, reputable veterinary medical organizations and their science-based continuing education materials implies an equivalence that is entirely false. It is unethical to practice homeopathy on veterinary patients and to make false claims about it to animal owners and other veterinarians. Some veterinary and governmental organizations have recognized this and taken a principled stand in defense of the public and our patients. If only more would join them.
The BVA cannot endorse the use of homeopathic medicines, or indeed any medicine making therapeutic claims, which have no proven efficacy.
That the Board agreed that the veterinary therapies of homeopathy and homotoxicology are considered ineffective therapies in accordance with the AVA promotion of ineffective therapies Board resolution.
There is no clinical evidence to support the use of homeopathic remedies for treatment or prevention of diseases in domestic animals.
NHMRC concludes that the assessment of the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered.
In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos. We could find no support from independent experts for the idea that there is good evidence for the efficacy of homeopathy.