What is homoeopathy?
Homoeopathy's founder was a German physician, Christian Friedrich Samuel Hahnemann (1755-1843). He based his treatments on simple remedies such as exercise, good nutrition and pure air, and two fundamental principles. The first was the Law of Similars. He believed that diseases could be cured by substances which in a healthy person would cause similar symptoms to those the medicine is prescribed to treat. The second was the Law of Infinitesimals. This held that the smaller the dose, the more efficacious the medicine. A method of mixing, dilution and shaking was called 'succussion' and the resulting preparation a 'potency'. The process of dilution and succussion is still claimed by some to release a therapeutic 'immaterial and vital' force.
Two organisations currently represent homoeopathy in the UK.[1] One is the Faculty of Homoeopathy, with over 700 members, whose purpose is to teach homoeopathy to qualified medical practitioners, veterinary surgeons and dentists. Short introductory and six month full-time courses are offered, with teaching given by qualified doctors. Based at the Royal London Homoeopathic Hospital, it carries out research and publishes the British Homoeopathic Journal.
The other is the Society of Homoeopaths, with over 500 members. This trains homoeopathic practitioners, entry qualifications usually being a minimum of 5 GCSE and 2 'A' levels. The Society offers a three year full-time course equivalent to an undergraduate degree, or a four year part-time course. The curriculum includes tuition in medical sciences given by qualified doctors. The Society also aims to develop and maintain high standards of practice, promote society's awareness of homoeopathy and ensure continuing access to homoeopathy for the public. It also performs research and has its own journal. Both organisations promote homoeopathic remedies for the treatment of a wide variety of acute and chronic, physical, mental and emotional conditions.
The medical controversy
Homoeopathy is based on principles which conflict fundamentally with those currently known to underlie orthodox medicine. The basic mechanisms by which orthodox pharmaceutical agents exert their effects are generally known. Drugs may stimulate or antagonise specific receptors (eg B-adrenoceptor agonists and antagonists), modify cellular transport processes (eg probenecid, which blocks active reabsorption of uric acid), act as enzyme inhibitors (eg allopurinol which inhibits xanthine oxidase), replace missing endogenous components (eg hydroxocobalamin given for pernicious anaemia) or chelate toxins, such as pencillamine used to chelate copper in Wilson's disease.
The implication of all these mechanisms of action is that the pharmacological effects of drugs are related to their concentration at the site of action. Within certain limits, the higher the concentration, the greater is the resulting pharmacological effect. This 'dose-response relationship' is well established for drugs currently on the market.
Homoeopathic practice is based on altogether different principles. The active ingredient is heavily diluted in an inactive vehicle, usually water or alcohol, until no molecule of the original agent remains. According to the approach described above there is no reason to suppose that the active ingredient can be effective, because it is no longer physically present. However, homoeopathic practitioners believe that by subjecting this solution to a series of shakes, termed succussions, it becomes more potent. Such claims run contrary to the principles underlying twentieth century drug therapy, and the two treatment systems cannot be reconciled in the light of our present understanding.
There is controversy amongst doctors as to whether homoeopathy has proven effectiveness. This is evident from such titles as 'Is homoeopathy a placebo?'[2] and 'Homoeopathy: medicine or magic?'[3] There have been relatively few well-conducted trials evaluating it. Homoeopathic practitioners have sometimes been reluctant to pursue clinical trials on the grounds that their remedies are individual for each patient and therefore cannot be assessed in this way. Those which have been performed have yielded inconclusive results, as the following summary illustrates.
In 1986 a randomised, double-blind placebo-controlled trial of a homoeopathic preparation of mixed grass pollens was performed in 144 patients with hayfever.[4] Patients receiving homoeopathic treatment showed a significant reduction in symptoms (scored by patients and doctors) compared with the placebo-treated group, and improvement was associated with a halving of antihistamine requirements. The authors concluded that the evidence from this trial did not support the hypothesis that the effectiveness of homoeopathy is due to a placebo effect.
A French review of forty previously published randomised trials in which a homoeopathic remedy was compared to an orthodox medical treatment, to a placebo or to no treatment at all was published four years later.[5]
Conditions treated were wide-ranging. The authors considered most of the trials to be flawed by the use of subjective and/or multiple end-points. The median number of patients in each group was also relatively small at 28. The authors concluded that these trials did not provide sufficient evidence of the effectiveness of homoeopathic remedies.
In 1991 an analysis of 107 trials was published in this country.[6] The authors scored these studies according to predefined criteria of good methodology, and used as the main outcome measure the results of those trials with the best methodological quality. Of 105 with interpretable results, 81 trials were felt to indicate a beneficial effect of homoeopathy while 24 trials did not. Nevertheless, the authors concluded that most trials had been poorly designed and conducted, so that the evidence at present was insufficient to allow definite conclusions to be drawn. They recommended that further well-performed studies should be carried out.
A German paper in 1992 concluded that, while there may be some evidence suggesting that homoeopathy is effective, the methodological quality of trials was then too poor to allow definite conclusions to be drawn.[7] They recommended that further collaborative studies between physicians and homoeopathic practitioners should be planned. They also noted that trial design may have to take account of the individual prescription of remedies by homoeopaths.
In 1994, a study performed at the Glasgow Royal Infirmary[8] tested the reproducibility of evidence from two previous trials that homoeopathy differs from placebo. Twenty-eight patients with atopy and asthma were randomised to receive homoeopathic treatment or placebo in addition to their usual medication. The outcome measure was a daily visual analogue scale. Significant improvement with homoeopathy was noted within one week of starting treatment and persisted for up to eight weeks. Similar trends were noted in respiratory function and bronchial reactivity tests, but the changes were only statistically significant for forced vital capacity. Meta-analysis of all three trials showed homoeopathy to be significantly more effective than placebo (p=0.0004). The authors concluded that there is 'evidence that homoeopathy does more than placebo'. In their view the principles stated as underlying homoeopathy are irreconcilable with those of modern pharmacology. They hypothesised that electromagnetic or nuclear magnetic resonance changes may occur at high dilution and in some way underlie a biological activity. The above suggestions are obviously purely speculative.
This study provoked six letters in the Lancet,[9] five of which were critical of its methods, outcome measures or conclusions. It was pointed out that neither daily peak flow readings (the most objective measurement of asthma severity), night-time symptoms nor requirement for other medications altered following homoeopathic treatment. Two correspondents highlighted the fact that patients and doctors alike guessed treatment allocation correctly more often than predicted from chance alone, which might influence the self-assessment score. The first author is allegedly a proponent of homoeopathy whose work has been supported by commercial homoeopathic organisations. The debate looks set to continue.
To date there is therefore little evidence that homoeopathy is effective. Proponents have claimed that the process of dilution and shaking release a therapeutic force. Thus, if homoeopathy were in future shown to be effective, it might be the methodology which was important.
The Christian controversy
Many Christians in the UK today are concerned that homoeopathy may involve the occult. Hahnemann was a freemason and a hypnotist, but was reportedly a well-educated and empathetic practitioner. However, the answer to the question of whether homoeopathy involves the occult is not immediately evident. It depends on where the 'immaterial and vital' force is thought to originate from. This will follow to some extent, but not necessarily wholly, from the therapist's world-view. There is certainly evidence from continental Europe of a link between homoeopathy and the occult, where it has been alleged that homoeopathic practitioners carry out research during seances and use occult practices such as the pendulum.[10] This is probably less common in Britain, but anecdotal reports are of concern. Christian homoeopathic practitioners should obviously not use these practices.
A Christian medical response
It seems that at present there is insufficient scientific evidence for homoeopathy for it to be a convincing form of treatment. Whether it will gain scientific credibility in the future remains to be seen. Doctors may wish to keep an open mind until the evidence is clearer, since history teaches us that orthodox medicine is not always superior to practical contemporary wisdom.
The solution to this debate lies in ensuring that further well-conducted clinical trials are performed, involving collaboration between homoeopathic practitioners and physicians. It could be argued that such physicians should be those with no interest in promoting the practice of homoeopathy, precluding undue claims of bias.
Christians are forbidden to have any association with witchcraft or the occult.[11] Given the isolated reports of an association with occult practices, Christians considering homoeopathic treatment would be well-advised to be careful and prayerful, and to make exhaustive enquiries before embarking on therapy.
Despite these reports, and the lack of good evidence for homoeopathy's effectiveness, some Christian doctors remain enthusiastic homoeopathic practitioners. Christian medical students or doctors considering receiving training in homoeopathy should firstly, as in all other areas of their lives, be absolutely clear that this is the Lord's will for them. Secondly, they should use the knowledge and skills acquired during their medical training to evaluate homoeopathy objectively.
The debate amongst Christians can become divisive. As in all areas where Christians disagree on non-doctrinal issues, we should remember that none of us has a monopoly of the truth. We are to be gracious[12] and humble.[13] It is important to pursue truth as far as possible, but we may have to wait for heaven before knowing it in full. If we then discover we were wrong, it may be easier to face Jesus Christ if we were courteous on earth.
