I have been writing a bit about homeopathy lately, which may not seem like the most important CAM method to focus on since it is not widely practice and since the remedies, being only water after all, are themselves usually harmless. However, I have found that wherever there is a pseudoscientific theory of veterinary medicine, and wherever there is vehement opposition to vaccination, commercial pet food, and many science-based medical interventions, there is often a practitioner of homeopathy behind it. Homeopathy is, ideologically, a parallel universe where the rules that govern the physics, chemistry, and biology of our universe do not apply. Though it is sometimes marketed as compatible with a scientific outlook, or even as a legitimate science itself, it is truly an alternative approach to health and deeply, fundamentally incompatible with science.

The homeopathic community themselves know this, though they often try to avoid acknowledging it outside of their ranks. And while I’m sure there are the kind of internal disputes within homeopathy that plague every profession, those voices that present themselves as the mainstream, authoritative guardians of standards for veterinary homeopathy also indicate quite clearly that they do not consider it compatible with scientific medicine, which they view as at best good for crises only and at worst the cause of many of the problems they believe they are treating. Vets or pet owners considering homeopathy should understand that they are dabbling in an approach which views all of mainstream science, and especially scientific medicine, as mistaken and often malign.

The following are excerpts from the Standards of Practice published by the Academy of Veterinary Homeopathy, which certifies veterinarians to practice homeopathy (though as I’ve mentioned before this organization is not recognized by the American Board of Veterinary Specialties, so this certification is only recognized in Homeopathy Land). These are mostly taken directly from the original writings of Samuel Hahnemann, the inventor of homeopathy and a figure often cited and revered even by those “mixers” among homeopaths who incorporate other treatment approaches into their practice.

The most important directive from these sources is that the purpose and goal of homeopathic treatment is the cure of the patient. Cure is not left vague, but is carefully defined by Hahnemann to be the rapid and gentle restoration of health with disappearance of the whole pattern of the signs of illness. Not only is health restored, but it is also permanent, not requiring continued treatment with medication.

Homeopathy by definition intends to cure every patient treated. Of course, the meaning of “cure” is not the standard one of eliminating the underlying cause of a disease since homeopaths often do not believe that what science identifies as a cause is really the source of the problem. Homeopaths would claim that a bacterial infection, for example, is itself only a symptom of a deeper imbalance or defect in the patient’s underlying “vital force,” a mysterious spiritual energy that Hahnemann proposed was the ultimate source of health and “dis-ease.” Since this vital force cannot be detected or measured in any way, treating it is all guesswork based on symptoms, of course, so it is a bit bizarre to claim it is conventional medicine treats symptoms and homeopathy treats the “true cause” of disease.

Though all of the instructions in the Organon of Medicine are a guide to practice, the following guidelines are stated for their value as detailing the method of curative homeopathic treatment:

1. Only the remedy that is homeopathic to the patient is to be used.

2. Drugs and methods of treatment which are not homeopathic to the case are to be avoided because of the possibility of interference with the progress of cure. [the footnote reads,” Organon of Medicine, 6th edition, paragraphs 23, 25-45, 69, and 291. Here discussion of the curative effect of similar medicines and the harmful effects of non-similar medicines is made clear. Drugs, herbs and other forms of treatment prevent cure and cause ultimate harm to the patient. Hahnemann states that only the medicine homeopathic to the patient’s condition is to be used in treatment.”]

3. Use of acupuncture and moxa is not compatible with homeopathic treatment because of its effect on the vital force of the patient.

4. Treatment of symptoms by electrical or electromagnetic application is to be avoided because of its tendency to suppress symptoms in the patient. Use of electricity and effects of magnets are suitable in treatment when administered according to homeopathic indications only.

5. Only one homeopathic medicine is to be given at one time.

 6. Medicines are most suitably given by mouth. [This one is especially interesting since the magic “water memory” that supposedly makes homeopathy medicine is often claimed to be transmissible via electromagnetic apparati but apparently loses it’s potency when not given orally]

7. The patient should receive nutritious food which does not, in itself, have medicinal effects.

8. Symptoms on the skin or surface of the body that have expressed as a localized lesion are not to be treated in a vigorous way with the intent to cause their disappearance or by surgery to remove them. These are to be treated primarily by internal homeopathic treatment.

Clearly, many homeopaths do not follow these “classical” guidelines. Giving multiple homeopathic remedies and combining homeopathy with acupuncture, TCM remedies, herbal medications, and even conventional treatments is common. Such “mixers” might argue that their practices are the result of development in the knowledge available to homeopaths since Hahnemann’s time. This misses the point that such development is merely the adding of guesswork and intuitions to Hahnemann’s original guesswork an intuition. All the development in mainstream science, which demonstrates the uselessness of homeopathy, are generally ignored. And given that the justifications given for using homeopathy are primarily based on Hahnemann’s original theories, it is quite inconsistent to pick and choose those dicta you want to follow and those you want to ignore. This is the hallmark of a religious faith, not a scientific healthcare approach.

The AVH recognizes that these rules are often breached and has some rather stern things to say about this.

In spite of the careful elucidation by Dr. Samuel Hahnemann of the essentials of homeopathic practice based on his 50 years of clinical experience, many people have chosen to develop different forms of practice. Most often, the deviations consist of dropping one or more of the methods of practice elicited above.

For example:
1. Giving more than one remedy at a time.
2. Not keeping detailed records of symptoms.
3. Mixing therapies so that the homeopathic remedy is counter-acted by use of non-similar methods of treatment or so that the patient’s response to homeopathic treatment is confused and proper evaluation is not possible.
4. Eradicating or suppressing a localized lesion.
5. Injecting remedies into the body rather than administering by mouth.

These few examples convey the ways in which practices can differ. The difficulty is that those homeopathic physicians who have successfully followed Hahnemann confirm that only careful adherence to the details of his method will result in consistent cure of patients. It therefore becomes a problem when practitioners, on their own, decide that certain parts of practice are not necessary (as outlined above). This leads to confusion among clients (who expect a consistency of treatment) and division among practitioners who cannot agree about an approach to treatment.

A further difficulty is that the Academy of Veterinary Homeopathy will be a representative organization in the sense that if a homeopathic practitioner is challenged, this organization will be asked to evaluate the situation. If a practitioner has not adhered to Hahnemann’s method, then it will be very difficult, if not impossible, to make a favorable evaluation.

For these reasons, it is necessary to establish standards of practice, e.g., state what the essentials of practice are. In establishing the Academy of Veterinary Homeopathy it was decided that the best standard is that given by Hahnemann’s writings, as described above.

So the AVH says very clearly that not following the original guidelines of the founding guru is less effective and that the organization cannot vouch for any practitioner that deviates if they are accused of malpractice. However, the organization does allow for a few exceptions.

1. A patient is taken on for treatment who is already on allopathic medication that cannot be immediately stopped.
2. A case becomes critical yet not responsive to homeopathic treatment.[In other words, if it is so obvious the treatment is not working that this cannot be covered up with nonsense about a “healing crisis” then real therapy may be necessary]
3. There is an acute illness or injury that is an immediate threat to life and the practitioner either does not know how to resolve the situation or does not have the physical facility required.[Again, critical illness requires real medical care. Only conditions that are less serious and for which response is harder to define and measure are appropriate for fake therapy]
4. There is failure of a body function, for example bladder paralysis that cannot be repaired and may necessitate the use of antibiotics to control recurrent infection. [Again, real disease requires real medicine, at least when it is obvious and undeniable]

While it is fairly clear that homeopathy is scientifically unsound theoretically and that the balance of the evidence is heavily against any meaningful clinical effects, it is sometimes easy to take the approach that it is at least benign and “might help” so why not try it. Perhaps this impulse can be opposed by a clearer understanding that “trying” it means, according to the leadership of the veterinary homeopathic community, giving up all mainstream scientific reasoning and practice.

Promoters of alternative medicine, especially the more wacky fringe varieties, have a love/hate relationship with science. On the one hand, science often fails to support their theories or claims of clinical effect, so they are inclined to dismiss it. “Allopathic” or “Western” medicine is caricatured as a mere point of view with no right to claim it is more accurate in its understanding of the world than ancient folk traditions or the individual epiphanies of folks like Hahnemann and Palmer. Or it is described rather patronizingly as ok for acute, life-threatening illness but merely treatment of symptoms whereas [insert CAM of choice] treats the one true cause of all disease. At worst, CAM proponents accuse science and science-based medicine of actually being a major cause of illness, with the demonization of vaccines, obsession with “toxins,” and wailing about the “cancer industry.”

On the other hand, people aren’t stupid, and most consumers of medical products and services understand that scientific medicine has done more to improve the quality and length of life in a couple of centuries than all other approaches achieved in the rest of human history. So science as a branding and marketing tool is powerful, and CAM practitioners crave both the validation of scientific evidence and the aura of legitimacy it can provide.

This conflict can generate an Orwellian doublethink in which CAM advocates simultaneously deride and dismiss science as a method for seeking knowledge and also claim that it proves them right. Of course, consistency is not the hallmark of CAM in general, since it is really an ideological umbrella term to associate various unrelated and often incompatible approaches to healthcare. But the mental gymnastics necessary to both claim their methods are scientifically valid and dismiss the same scientific method because it does not support their claims are sometimes dazzling.

The most recent example that I have run across is the list of offerings for the Academy of Veterinary Homeopathy (AVH) 2011 annual conference. The AVH certifies veterinarians as homeopaths and serves as an advocacy group for veterinary homeopathy. (It is important to note here that homeopathy and the AVH are not recognized as a legitimate specialty by the American Board of Veterinary Specialties, and so any “board certification” in homeopathy is a meaningless marketing label, not an indicator of meaningful advanced training or high quality care).

The title of the conference is The Science of Homeopathy. Of course, homeopathy is more properly described as a pseudoscience, an unscientific idea promoted as if it were scientifically legitimate, but I’ll get to that in a bit. Clearly, the title is intended to create an impression of scientific validation, though an impression of truthiness would be more accurate.

Some of the offerings presented as if they were scientifically validated are blatant nonsense founded on theories as antithetical to science as it is possible to be. Others are cleverly disguised in language that appears scientific but is mere obfuscation and gibberish. And a couple manage to be very articulate and rational on the surface while concealing deeply antiscientific thinking. All, however, illustrate the paradoxical process of CAM advocates seeking the appearance of scientific legitimacy while operating within a fundamentally anti-science view of the world.

Patricia Jordan- “Vaccinosis and its cure by thuja by J. Compton Burnett Revisited”

J. Compton Burnett in his work Vaccinosis and its cure by thuja presented an important work describing the subdivision of sycosis from vaccinations.  The recognition of this consideration as a utility in the consulting room or at the patient’s side is critical as the number of vaccines has increased in quantity and frequency of administration. Research into the vaccine issues will update and confirm the information Burnett already knew in the 1800’s. This presentation will offer the audience further insight into vaccinosis, the use of thuja and to the prophecy of Burnett and what he understood of the Pasteur’s vaccine “sailing right down this rock towards shipwreck”. Cases of vaccinosis with use of thuja will be presented. Also, emerging public health problems due to use of veterinary vaccines will be explored.

This session refers to a work by a homeopath published in 1884 that discusses supposed deleterious chronic illness associated with vaccination, called “vaccinosis,” and the benefits of a particular homeopathic nostrum in preventing and treating it. Vaccinosis is, like “allopathic,” a buzzword for the alternative medical community that instantly signals an anti-scientific stance. While I’ve discussed the risks and benefits of vaccination in detail,  and vaccines can undoubtedly cause unwanted illnesses, the concept of vaccinosis is completely without any scientific legitimacy. It is a polemical term used by anti-vaccination activists to generate irrational fear, and it is not grounded in any actual research of evidence. Many anecdotes are presented to “prove” vaccinosis exists, but these are all mere anecdotes and the link between symptoms described and vaccines is always assumed, never demonstrated.

The original work was, not surprisingly, wrong on many counts as it was written well before any real scientific understanding of the immune system was developed. The reverence shown to it illustrates the reliance of homeopathy on tradition and historical “visionaries” and the inability of practitioners to accept the advances in medical knowledge that have occurred since Hahnemann. Since homeopathy is fundamentally a vitalist belief system, not a scientific approach to healthcare, it is a classic example of the all-too common faith-based approach to medicine, which will seize on any scientific evidence that appears to support its ideas while ignoring the overwhelming majority of scientific knowledge which does not.

I did find a quote in the preface to Burnett’s book that I thought especially apt as it relates to the fuzzy thinking and elastic concept of “truth” that is embedded in homeopathy.

Truth is not Truth save only to the Infinite; to the mind of mortal man Truth is not necessarily Truth, but only that which appears to be true.

The speaker for this session is a rabid anti-vaccine activist who makes no attempt to hide the faith-based and unscientific philosophy that underlies her approach. Dr. Jordan is the owner and author of the web site and book Mark of the Beast Hidden in Plain Sight: The Case Against Vaccination. Here is a sample of the rhetoric from her site.

WE SHOULD REWRITE THE BOOKS OF MEDICINE TO REFLECT THE UNDERSTANDING THAT DISEASE HAS EVOLVED FROM THE VERY USE OF VACCINES.

NEVER SHOULD WE HAVE ALLOWED THE INNOCULATION OF POISON, THE GRAFTING OF MAN AND BEAST. NOW WE ALL CARRY THE SCAR, OF MEDICAL SUPERSTITION THE GENETIC PLAGUE OF INQUITY

The purpose of putting the Mark of the Beast together was to provide education for the reader or listener to a very important quest that apparently has been going on from the beginning of the illusion of time….conventional medicine [is] not the direct path to true healing and wellness…true health and wellness comes from a very natural setting and one from the relationship of the individual in balance with the earth and all of the treasures a healthy ecosystem has to offer…The important ingredient everyone also needs is right relationship with the other living organisms of the environment we share, respect for each other and the most holy relationship that of the one with the intelligence that designed this most wonderful system. Our fall from right relationship is as much responsible for disharmony and disease as is the turmoil the daily disturbance this imbalance maintains…Vaccines and drugs are at odds with the intelligence of the almighty design and getting back to the garden means getting back to the natural form…

If this kind of thinking, tracing all illness back to the Fall of Man and characterizing vaccines as inimical to God’s plan, is part of the “science” of homeopathy, then clearly the word “science” is not being used in anything like the usual sense. In fact, such a use is outright dishonest.

Richard Pitcairn –“Why Medicine Is Not Scientific: The impact of Quantum Physics“

We learn in homeopathy that there can be obstacles to cure, influences on the patient that interfere with their optimal response to the remedy. Usually they are factors like foods eaten, stimulants used, drugs taken, emotional upset. Another angle, not usually considered, are the obstacles to cure that come from two other directions — the client’s psychological state which subtly resists progress and also the interferences of emotional reaction in the practitioner. We will explore some of the most common patterns we will see in progress and consider how best to deal with them.

This presentation is at least a bit more straightforward in its rejection of science, though of course that adds to the overall inconsistency of including it in a program called “The Science of Homeopathy.” Quantum physics is much beloved of proponents of unscientific or pseudoscientific theories. So much so that the invocation of it is one of the key warning signs that one is peddling nonsense. For one thing, it is counterintuitive, seeming to invalidate the well-established laws that govern the behavior of time and matter and which we have evolved to intuitively understand. The implication is that if an established, legitimate science such as quantum physics has found exceptions to the rules of basic logic and the established laws of pre-quantum physics and chemistry, then any counterintuitive theory no matter how wacky must be at least possible.

The flaw in this reasoning arises from another characteristic of quantum physics which also makes it much beloved of CAM advocates; it is difficult to understand. Quantum physics is a hard science in both senses of the word: objective and quantitative and also difficult. It is inherently mathematical, and those of us without advanced degrees in the appropriate domains of physics or mathematic can only understand it in a superficial, metaphorical way. This allows us to promote almost any mystical concept and justify it as “scientific” under the umbrella of quantum physics.

Unfortunately for homeopathy, the oddities of quantum physics, such as entanglement or “spooky action at a distance” only apply at subatomic scales, not at the macroscopic level of ordinary life. They do not validate mystical theories about life force and energy, and they certainly do not support notions of “water memory” and other pseudoscientific attempts to justify selling pure water as if it were medicine.

I’m not sure exactly what Dr. Pitcairn will say in his talk, but the supposed relationship between legitimate quantum physics and vitalistic homeopathic theory has examined been comprehensively debunked many times (here, for example). I would suspect Dr. Pitcairn’s arguments, and the problems with the, to be similar, though of course I can’t be sure.

Sara Fox Chapman – “Hyperthyroidism:  Efficacy, Safety and Pitfalls of Homeopathic Therapy – Six Cases”

Wendy Jensen -“Homeopathy and Feline Urinary Tract Disease”

Wendy Jensen -“Building our Veterinary Homeopathy Literature Base”

These presentations illustrate another superficial resemblance between authentic science and what groups like the AVH present as science. From their brief descriptions, they all rely on case series as their primary, or only form of evidence.

A case series is essentially a collection of individual anecdotes. When used in conventional medicine, a case report or series is intended to illustrate something unusual or unexpected. This may be merely a curiosity, as in most cases, or it may suggest a new idea to be pursued. Case reports and series do not prove anything. They are subjective descriptions of cases that grab a clinician’s interest, not planned controlled, objective research. Another word for case reports is, of course, anecdotes, and as the old cliché goes, the plural of anecdote is anecdotes, not data.

Of course CAM proponents love case reports because they can select those stories that seem consistent with their ideas and present those particular facts that support their argument. Unfortunately, there is no guarding against ignoring those cases or facts that contradict their ideas, and confirmation bias virtually guarantees this will happen with case reports, which is one of the reasons they are not considered proof of anything in real medical science.

Homeopaths in particular rely on case reports because it fits their notions of individuals as snowflakes so unique that no population-based research could ever tell us anything useful about how to care for an individual. The fact that population level research, despite its undeniable limitations, has led to all the medical advances of the last 200 years, including saving billions of people from death and disease, doesn’t seem to register with people making this argument.

So while presenting case reports and case series as if they represented legitimate scientific validation of their ideas, these speakers are simply dressing up the old fashioned anecdote in a white coat and illustrating their fundamentally unscientific approach.

Shelley Epstein – “Evidence Based Homeopathic Veterinary Medicine”

Research supporting the basic science and clinical efficacy of homeopathy is vast and growing. We will review selected studies in basic sciences like biology and physics that show activity in infinitesimal doses. We’ll then discuss noteworthy clinical trials, predominantly from the human side. We’ll look at provings from a 2011clinical trial meets Samuel Hahnemann perspective, the case report, randomized clinical trial (RCT), and politically-charged meta-analysis from perspectives unique to homeopathy. By the end of this lecture, you’ll be able to cite numerous reasons why the statement “There are no studies showing homeopathy works” is false; and you’ll see what it takes to write a case report or design a RCT for publication.

The most sophisticated of these attempts to present homeopathy as based on solid science is this presentation, which the speaker also gave in January, 2011 at the North American Veterinary Conference. Dr. Epstein provides an articulate review of the theoretical foundations of homeopathy and then tries to present a comprehensive refutation of objections on multiple levels, including basic theory, in vitro and laboratory animal research, caser reports, and clinical trials. I respect both the thoroughness of her presentation and the attempt to systematically apply an evidence-based medicine frame to homeopathy.

I think it is clear, however, that the factual details of her defense are mistaken and her conclusions incorrect. She selectively chooses research, and elements of individual studies, that appear to support the claims of homeopathy, assumes the truth of many debatable propositions, and ignores the much larger quantity of evidence against her claims. It is, as I said, a sophisticated defense of homeopathy as a legitimate science, but not a persuasive one.

I will try to go through her presentation in some detail to show why the evidence does not actually support her conclusions. Most of the specifics have been addressed elsewhere many times, so I don’t intend to rewrite the book but simply to point out the major flaws in reasoning or fact. For a more thorough treatment of the problems with Dr. Epstein’s approach, see the resources below.*

Principles of Homeopathy

1. Like Cures Like (or in fancy Latin similia similibus curentur):
This “discovery” on the part of Hahnemann is nothing more than a restatement of the principle of sympathetic magic, the idea that things which resemble one another in some superficial way must be meaningfully related and that one can influence the other. It is the basis for the notion that ground up rhino horn can provide virility, because the horn has some resemblance to a penis. Hahnemann’s version of the idea was that if you take a substance and it causes certain symptoms, then it can be used as a cure for these symptoms once processed in specified ways.

It’s a childish conception of the world, and really quite arrogant in its assumption that how things appear to humans must represent some deep truth about reality. In any case, there is no legitimate evidence that it is true, though of course some accidental correspondences can sometimes be found to perpetuate the myth. Which is likely how the whole idea started, through so-called “provings.”

2. Drug Provings or Pathogenetic Trials:
The concept of provings is another of Hahnemann’s inventions, elaborating on the principle of sympathetic magic. He (or later other volunteers) would take an unspecified amount of a substance and record in detail every experience, sensation, or symptom they experienced afterwards. Subjectively perceived patterns in these reports were then used to define what symptoms the substance could be expected to cause, and thus what it could be used to treat. For the late 19th century, this was reasonably systematic observation compared to many other contemporary medical practices. Today, it is a crude, unreliable practice that deserves to be abandoned.

Attempts to demonstrate the accuracy of traditional symptoms attributed to homeopathic remedies have not generally been successful, and there is great inconsistency between the evaluation of symptoms reported in supposed provings. Since homeopaths revere historical figures, I shall defer to Oliver Wendall Holmes, who described quite clearly the ridiculous logic of “pathogenetic trials” in 1842.

…the common accidents of sensation, the little bodily inconveniences to which all of us are subject, are seriously and systematically ascribed to whatever medicine may have been exhibited, even in the minute doses I have mentioned, whole days or weeks previously.

To these are added all the symptoms ever said by anybody, whether deserving confidence or not, as I shall hereafter illustrate, to be produced by the substance in question.

3.  Potentization Via Dilution and Succusation:
Another of Hahnemann’s counterintuitive epiphanies was the idea that diluting a substance extremely, often to the point where none of the original substance can be detected at all, and then agitating it makes it an effective medicine. While the original substance on which a homeopathic remedy is based might cause symptoms in a proving, if it is sufficiently diluted it will no longer cause these symptoms in healthy people. Up to this point, the idea is rational, and in the early days of homeopathy patients treated with such remedies may often have done better than conventionally treated patients, who were bled and given all sorts of random toxic remedies. Pure water is not medicine, but it isn’t harmful either.

But Hahnemann goes off the rails with the idea that dilution not only made the remedies safer but more potent. Only if, of course, they were agitated in the proper way. As the speaker says, ” In making these dilutions, Hahnemann rigorously pounded the solution on a leather-bound book. His thinking was to evenly distribute the material throughout the solution. This evolved into the process of dynamization, or potentization.”

Dr. Epstein, to her credit, directly addresses the issue of homeopathic dilutions that are so extreme that it is impossible by all established laws of physics and chemistry, “no material substance is expected to be found in a solution.” Her answer to this objection is to refer to a body of research on the subject of “water structure.” She cites many complex tests done on homeopathic solutions, such as thermoluminescence, nuclear magnetic resonance, electron microscopy, and so on to show that the water in these solutions has measurably different structural properties than ordinary water. I’ve written about the subject of magic water before, and while like Dr. Epstein I am a veterinarian, not a physicist or chemist, I am convinced that all these fancy tests fail to add up to a consistent, repeatable, measurable difference between homeopathic solutions and regular water that could possibly be imagined to have biological relevance. These claims have been addressed by others (for example here and here) and in general the physics and chemistry research has demonstrated only that the structure of water at the molecular level is complex and interesting. It has not demonstrated that ultradiluting and shaking water generates stable, biologically relevant  changes in water molecules that turn the water into medicine.

4. In vitro Studies:
A number of studies have been conducted, usually by dedicated believers in homeopathy, to see if homeopathic preparations have measurable effects on cells in test tubes. This would not, of course, prove clinical benefit, but it would at least suggest something other than mere water was present. Most of these studies are published in journals like Homeopathy and The Journal of Complementary and Alternative Medicine, which exist solely to generate the appearance of scientific legitimacy for CAM research that cannot meet the standards of mainstream journals. Thes journals rarely publish any negative results of tests of homeopathy.

But some studies have seemed convincing enough to make it into high-quality journals, including the notorious article in Nature by Jacques Benveniste. Dr. Epstein mentions Benveniste’s study, but apart from a vague reference to a “pseudo-scientific highly political affair” associated with it, ignores the fact that a thorough investigation showed the results to be due to uncontrolled bias and sloppy methodology.

Since then, most such studies have been published in dedicated CAM journals such as those mentioned above and have not been subjected to the kind of rigorous independent review that identified the fatal flaws in the Benveniste study. So while the research mentioned has many of the trappings of legitimate science, it exists largely in a parallel homeopathic universe where it does not have to face skeptical scrutiny.

Despite decades of research that has generated substantial evidence against the claims of homeopathy, I cannot say with absolute certainty that this research may not one day turn up something meaningful, but I think the reasons for doubt are greater than the reasons for hope. And any gems of truth these studies do uncover must still survive the same gauntlet of attempts by skeptics and independent researchers to validate them before they deserve to be accepted as legitimate. As of now, this has not happened, and these claims do not merit this acceptance.

5. Hormesis:
Dr. Epstein epitomizes the bizarre joining of claims to scientific legitimacy with an utter rejection of scientific method and philosophy in her section on hormesis and the mechanism of action of homeopathy. She quotes Hahnemann reverentially and extensively, apparently to make the point that understanding the scientific mechanisms of hoeopathy’s supposed clinical effects isn’t really necessary, but that as it happens Hahnemann’s mystical metaphorical explanations were a prescient vision of what science has since discovered anyway.

In the latter part of the 20th century, conventional medicine has emphasized understanding the mechanism of action of medicines before clinically utilizing a therapy. Complementary/Alternative therapies often suffer from a lack of this understanding, a deficit that has been cited as a reason for avoiding such therapies…In the Organon of the Medical Art, Hahnemann laid out all the rules necessary for successful prescribing in homeopathic practice. The symptoms of the sick patient gave all the clues needed to prescribe, and all that was needed to understand in the drug was discovered in the provings. Hahnemann said:

“This natural law of cure has authenticated itself to the world in all pure experiments and all genuine experiences; therefore it exists as fact. Scientific explanations for how it takes place do not matter very much and I do not attach much importance to attempts made to explain it.”

Regarding the method of action of remedies, Hahnemann said, “Eachmedicine, alters the life force more or less and arouses a certain alteration of a person’s condition for a longer or shorter time. This is termed the initial action. While the initial action is a product of both the medicinal energy and the life force, it belongs more to the impinging potence [of the medicine]. Our life force strives to oppose this impinging action with its own energy. This back-action belongs to our sustentive power of life and is an automatic function of it, called the after-action or counter-action.”

These brilliant observations by Hahnemann almost two centuries ago are being verified by scientific studies today.

The supposed verification of Hahnemann’s vitalistic theories of mystical life forces is the concept of hormesis. In brief, hormesis is the notion that a high dose of radiation or a toxin may generate the opposite response as a low dose. The notion is controversial in that while such a dose response relationship in laboratory settings can be shown for a variety of toxins, it is not clear that it is a real or biologically meaningful phenomenon. Extensive research on the concept of hormesis applied to radiation has generated little convincing evidence to support claims that low doses of radiation can have beneficial health effects. Homeopaths love the idea of hormesis because it seems to align with their belief that something poisonous in high doses can be beneficial in low doses.

One problem here is that hormesis is not generally accepted as a true and meaningful phenomenon that predictably affects the health of living organisms, so using the concept to justify homeopathy is simple taking a questionable idea and using it to support an even more doubtful one. However, even if hormesis turns out to have some real biological relevance, it doesn’t really translate in “homeopathy works.” The low doses of toxins in studies on hormesis are at least measurable doses, unlike the complete absence of any “material substance” in homeopathic preparations, so the whole notion of magic water memory would still have to be true for homeopathy to work.

Another problem is that the relationship between specific substances and the symptoms they are used to treat is only based on the subjective and unsystematic observations of “provings,” so even if solutions that had once contained some of these substances could somehow have medicinal effects, we don’t have a consistent and reliable way to select specific remedies for specific problems, just homeopathic intuition.

And finally, the symptoms a patient reports and the process by which the homeopath decides which are important and which aren’t and which remedies to use are thoroughly subjective and inconsistent. Like chiropractors, homeopaths do not reliably and consistently identify the same problems or the same treatments for individual patients.

So even if there were something to hormesis, which seems doubtful, the use of homeopathic remedies to treat disease still fails multiple other tests of logic and consistency. Of course, when faced with these challenges to their claims, homeopaths usually fall back on the claim that, “Well, I don’t know how it works, but it works.” So is there anything to this claim? Despite all its implausibility and lack of a clear, logical theory, does homeopathy actually work reliably in clinical studies?

6. Claims of Clinical Benefit:
Dr. Epstein presents many claims and arguments that homeopathy has a real, measurable benefit despite all the problems with its theory and methods. The first of these are claims that homeopathic “vaccines,” called nosodes, and homeopathic remedies have been effective in preventing or treating infectious disease epidemics. Claims are for regarding successful use of homeopathy to reduce mortality during the 1918 flu pandemic and to combat leptospirosis associated with flooding in Cuba in 2007, and for other epidemics. The specifics of the studies and claims have been discussed by others (Cuba 2007, Cuba 2007, 1918 Flu Epidemic), but there are several obvious problems with them.

For one thing, they are often based on uncontrolled reporting and case selection by proponents of homeopathy. Undoubtedly, homeopaths in 1918 claimed a very low mortality from the flu, without objective statistics (which are, shockingly, not available from 100years ago), there is no way to verify these claims. And subsequent studies have, as usual, been conducted by homeopaths, published in journals dedicated to alternative medicine, and not replicated or rigorously reviewed by anyone not already a believer in homeopathy. This lowers the reliability of these reports significantly and justifies significant skepticism of them. Also, nosodes as a preventative for infectious disease have been studied and have failed to demonstrate their effectiveness under controlled conditions. So the impression of effectiveness here is, once again, highly dependent on uncontrolled clinical observations and self-reporting by homeopaths.

Dr. Epstein then goes through a lengthy discussion of randomized clinical trials (RCTs) versus case reports to make the point that RCTs are not appropriate for homeopathy and aren’t all that reliable anyway. This is a form of special pleading that essentially says “Because conventional methods of study don’t support my approach, the methods must be inappropriate.” The same claim is made for why scientific studies haven’t confirmed ESP and other psychic phenomena, the effectiveness of prayer as a medical therapy, and essentially any implausible idea that conventional scientific methods don’t validate.

There is no question that RCTs have many limitations and flaws, and some of those that Dr. Epstein points out are true problems. This does not, however, have any bearing on the fact that overall as a method they work better than the subjective, anecdotal methods homeopaths prefer and have revolutionized health and health care to an unprecedented degree. It is a philosophical point, of course, but I hold the view that reality is as it is regardless of how we see it or wish it to be. Our ability to know it is limited by the flaws in our own perception, memory, and reasoning. Science has many weaknesses but, to paraphrase Winston Churchill, it is the worst possible system except for all the others that have been tried. Anecdote (dressed up as case reports or “case-based reasoning” though it may be) has led to many varieties of error and little real progress in medical care throughout human history, so to argue that it is as good as or better than the scientific method is to deny the manifest reality illustrated by this history. It is, ultimately, a weak excuse to claim that homeopathy, which has failed by the standards science applies to conventional medicine, deserves to be judged y what she calls “special considerations,” a code for weaker standards of evidence..  

All of that said, there have been many clinical trials involving homeopathy, and homeopaths in general cite them freely as validating their methods when they appear positive. Many have methodological flaws that call into question their conclusions (for example, this arthritis study and this study of bovine mastitis). Of course, the same is true of studies of conventional therapies, but the point is that no single study definitively proves or disproves a single clinical hypothesis, much less an entire therapeutic approach. The balance of the clinical trial evidence over decades is clearly, and definitively against any meaningful benefit from homeopathic treatment. The references below discuss many of the systematic reviews, meta-analyses, and other large-scale analyses of the sum total of the evidence.

The trends in the clinical trial evidence are the same as is often seen for implausible or dubious therapies. Smaller, poorly designed trials, trials published in journals dedicated to promoting homeopathy or alternative medicine are more likely to report positive results (even, sometimes, when a close look at the data and statistical analysis doesn’t support these conclusions). Larger studies with better quality in mainstream journals and not conducted or funded primarily by homeopaths tend to show negative results. When looked at in total, the evidence clearly does not support claims that homeopathy is a proven beneficial clinical therapy.

So while Dr. Epstein is correct to say that the claim “There are no studies showing homeopathy works” is false, she is incorrect in her conclusion that the evidence, from the theoretical and basic science level, trough the in vitro level, and including the clinical research level shows homeopathy does work. The evidence on all of these levels fails to support the theoretical or practical claims of homeopathy, and it does not justify presenting this essentially faith-based treatment as if it were “science.”

Conclusions
This one conference seems, from the presentations being offered and the information available by and about the presenters, to illustrate clearly the love/hate relationship homeopathy has with science. Homeopaths disdain the scientific methods that have failed to support their claims for decades, and they make many arguments that these methods are inappropriate, that homeopathy can only be judged by its own standards, or that the whole enterprise of understanding health and disease through scientific methods is too flawed to be relied on. Yet they simultaneously crave the legitimacy that comes from being perceived as practicing a legitimately science-based form of medicine, and they go to great lengths to adopt the trappings of true science and claim science validates their approach. Some of the arguments are bizarre and seem out of touch with reality, others are mere confused New Age mysticism cloaked in the language of science, and a few, like those of Dr. Epstein, are articulate, informed and thoughtful (though ultimately still self-serving and false). Taken as a whole, they present a picture of a confused and conflicted attempt to be both special and different and yet accepted and respected by the mainstream. Ultimately, what matters is what the evidence tells us about the theories and clinical claims of homeopathy, and this evidence is still solidly, consistently against these these theories and claims.

* The Homeopathy Series:

Homeopathy and Evidence-Based Medicine: Back to the Future – Part I

Homeopathy and Evidence-Based Medicine: Back to the Future – Part II

Homeopathy and Evidence-Based Medicine: Back to the Future–Part III

Homeopathy and Evidence-Based Medicine: Back to the Future Part IV

Homeopathy and Evidence-Based Medicine: Back to the Future Part V

UK House of Commons Science and Technology Committee Report on Homeopathy 

Snake Oil Science by R. Barker Bausell

Trick or Treatment: The Undeniable Facts about Alternative Medicine by S. Singh and E. Ernst