Psychology Today
NOTHING AT ALL? PLACEBO? OR MIRACLE CURE/ THE STRANGE CASE
OF HOMEOPATHY
By Michael Castleman
In 1994, NASA computer scientist Amy Lansky, Ph.D., of
Portola Valley, California, began wondering about her
two-year-old son. Max knew the alphabet, beat adults
at memory games, and was an ace at several computer games.
But he barely spoke, and despite normal hearing, didn’t
seem to understand language. At preschool, he was a loner.
As the months passed, Max became increasingly withdrawn.
His main form of communication was poking people with his
finger. Eventually, school officials urged Lansky to have
him professionally evaluated. The diagnosis: Autism, an
incurable condition.
But Lansky refused to believe Max was incurable. She set
off on a quest to do the impossible, cure her son. Her
search led her to homeopathy, an 18th century healing art
now enjoying renewed popularity because of Americans’
growing interest alternative healing arts. Homeopathy
involves treating illnesses with such extreme dilutions of
herbs animal substances, and chemical compounds that
frequently not one atom of the diluted substance is left in
the solution.
Homeopathy defies the known laws of physics, chemistry, and
pharmacology, not to mention, common sense. No one has any
idea how it works, not homeopaths who swear by it, nor
critics, who swear at it. For this reason, homeopathy
is one of the most controversial alternative approaches to
healing. But many rigorous studies show that homeopathic
treatment works. Some recent examples:
* Vertigo. German researchers treated 105 sufferers of
persistent disorienting dizziness with either a standard
drug known to treat this condition successfully or a
homeopathic medicine. The homeopathic medicine worked as
well as the pharmaceutical.
* Mild traumatic brain injury. Some 750,000 Americans
suffer mild brain injury annually, and about 75,000
experience persistent disability. Harvard researchers gave
50 people with brain injury either a placebo or a
homeopathic medicine. Those taking the homeopathic medicine
showed significantly greater improvement.
* Infectious diarrhea. This illness, often the result of
impure water supplies, is a major cause of childhood death
around the world. Jennifer Jacobs, M.D., M.P.H.., an
assistant clinical professor of epidemiology at the
University of Washington School of Public Health in
Seattle, recruited 81 Nicaraguan children under age five
afflicted with infectious diarrhea. She gave half of them
the standard mainstream treatment—rehydration fluid
containing water, sugar, and salt. The other half
received the rehydration fluid plus a homeopathic
medicine. Among the children in the control group,
the diarrhea lasted an average of four days. But in
the homeopathy group, it lasted only 2.5 days, a
significantly faster recovery.
“It’s true that homeopathy defies the known laws of
science,” says Ellen Feingold, M.D.., a Wilmington,
Delaware, pediatrician who left conventional medicine eight
years ago to practice homeopathy. “But who says we know all
the laws of nature? I believe there are new laws yet to be
discovered, new science that will explain how homeopathy
works. But that research is not my concern. I want to heal
patients. As an M.D., most of what I did was suppress
symptoms. Now as a homeopath, I truly heal people.”
“Critics of homeopathy say that because its mechanism of
action can’t be explained, it can’t possibly work,” says
Michael Carlston, M.D. a Santa Rosa, California, physician
who has combined mainsteam medicine and homeopathy for 30
years and has taught a course on it at the University of
California, San Francisco, medical center. “But that’s
hypocritical. Aspirin was used for about 90 years before
its mechanism of action—its effect on prostaglandins—was
explained, and no doctors shunned it. I can’t explain how
homeopathy works. But it does.”
Edward Shalts, M.D., a psychiatrist-homeopath at Beth
Israel hospital in New York, cites another example: “No one
knows why lithium is effective as a psychiatric medication.
But it is, and psychiatrists don’t hesitate to prescribe
it. There’s a medical prejudice against homeopathy.”
Strange Medicine
Shortly after her son’s diagnosis, Lansky noticed a
magazine article on alternative treatments for childhood
behavior problems, including homeopathy. She’d heard of
homeopathy, but knew nothing about. She was intrigued.
Lansky’s acupuncturist referred her to a homeopath, John
Melnychuk. He did not perform a physical exam, nor did he
order any diagnostic tests. He just asked questions, some
about Max’s problems, but many about aspects of Max’s life
that M.D.s would consider irrelevant: his milk craving, his
love of music and dancing, his fitful sleep, the bluish
tint in the whites of his eyes, and his restlessness,
intensity, sweetness, stubbornness, and perfectionism. Then
using reference books compiled over 200 years, he looked
for the medicine that produces the same effects--or as
close as possible--in healthy people. This is the
fundamental principle of homeopathy, the Law of Similars,
the idea that illness can be cured by substances--plant or
animal material or minerals--that evoke the same symptoms
in those who are well. The term “homeopathy,” reflects the
Law of Similars—“homeo” means “treatment by similars.”
Melnychuk decided to give Max Carsinosin, a medicine made
from--of all things--an infinitessimal amount of human
cancer tissue.
“There are two types of homeopathic remedies,” Melnychuk
explains. “Some treat symptoms, for example, arnica works
well for sports injuries--sprains and muscle strains. Then
there are the ‘constitutional’ remedies, the ones that have
to be matched to the patient’s personality. Max seemed to
fit best into the carsinosin profile, which includes:
perfectionistic, restless, withdrawn, loves music and
dancing, has trouble sleeping, whites of the eyes look
blue, and craves milk, but milk aggravates symptoms. Max
seemed like a ‘carsinosin person.’”
However, Melnychuck cautions, not every autistic child
should receive Carsinosin. “I’ve treated other autistic
kids with different constitiutional remedies. You have to
tailor the remedy to the patient’s unique traits.”
Lansky mixed a little Carsinosin in water and gave Max a
teaspoon each morning. Within two days, she noticed
changes. “Max’s speech improved. He used phrases he’d never
used before. And he seemed more socially aware. It was
subtle, but something shifted.”
Over two months, the trend toward improvement continued.
Max’s pediatrician was amazed.
Maybe It’s Doing Nothing
Homeopathy developed during the late 18th century, a time
when physicians knew little about disease. They treated
most illnesses with bleeding, powerful laxatives
(cathartics), drugs that caused vomiting (emetics), and
mercury, which had been shown effective against syphilis
and had evolved into a treatment for just about everything.
These medications were called “heroic measures,” but the
heroism was entirely on the part of patients, many of whom
suffered more from these now-thoroughly discredited
treatments than from their illnesses.
One victim of heroic medicine was George Washington. In
1799, the 67-year-old ex-President developed a sore throat.
He probably had a cold or possibly strep throat, nothing
serious. Washington’s physicians bled him of two quarts of
blood, leaving him anemic, weak, and dehydrated, then gave
him cathartics and mercury. He was dead within 12 hours.
Not treating him at all would have been better.
One 18th century German doctor, Samuel Hahnemann
(1755-1843), became so disgusted with heroic medicine that
he closed his practice. Hahnemann did not reject every
conventional medicine. He was impressed with cinchona, the
South American tree bark that was the first effective
treatment for malaria. (Cinchona was the original source of
the antimalarial drug, quinine.) In 1790, Hahnemann
ingested some, and became cold, achy, anxious, thirsty, and
ill, all symptoms of malaria. That experience led him to
postulate his Law of Similars.
For the rest of his life, Hahnemann tested hundreds of
substances on himself--plants, animal parts, and chemical
compounds, for example: salt, zinc, onion, oats, coffee,
gold, and marigold flowers, and catalogued their effects.
Eventually, he reopened his practice, but prescribed only
his homeopathic medicines. Hahnemann’s approach was much
less drastic than heroic medicine’s. He attracted a large
following among both patients and physicians fed up with
heroic measures.
But homeopathy was controversial from the outset because of
Hahnemann’s other postulate, the Law of Potentization, the
idea that homeopathic medicines grow stronger as they
became more dilute. This flew in the face of a fundamental
principle of pharmacology, the “dose-response
relationship,” which says that the larger the dose, the
greater the effect. Many medicines homeopaths consider
“extremely powerful” are so dilute, they contain none of
the active ingredient. Homeopaths cannot explain why a
medicine diluted to the point where it’s nothing but water
should treat anything, except to say that the water somehow
“remembers” the medicine and retains its action.
Critics howl at the Law of Potentization. Homeopathy is
“absurd,” notes William Sampson, M.D., a clinical professor
of medicine at Stanford. “It conflicts with the entire body
of knowledge of pharmacology, chemistry, physics, and every
other field of science. It is bankrupt in theory and
practice.”
“There is simply no basis for believing that homeopathy has
any effect,” says Robert Baratz, M.D., Ph.D., president of
the The National Council Against Health Fraud, in Peabody,
Massachusetts. “It’s contradicted by common sense.
Homeopathy is a magnet for untrustworthy practitioners who
pose a threat to public safety. It’s quackery.”
Maybe homeopathy involves treatment with nothing. If true,
it would have been an improvement over 18th century
heroic medicine--even if all patients get is water. But
that doesn’t explain the salutary effects on a 21st century
child with autism.
Nor does it explain Dr. Carlston’s experience. In college,
he suffered the persistent, itchy skin rashes of eczema and
treated it with standard medication, steroid cream. “It
helped,” he recalls, “but when I stopped it, the rashes
came back, and when I used the cream, I developed swollen
glands, a sign of infection.” By chance, Dr. Carlston
attended a lecture on homeopathy. The speaker said that
conventional medicine simply suppresses symptoms, and in
the process, often creates other problems. “That seemed
like what was happening to me,” Carlston explains. “The
steroid suppressed the rash, but caused the swollen glands.
Carlston consulted a homeopath, got treated with a
microdose medicine, and soon afterward, his eczema cleared
up. It hasn’t recurred since. “Homeopathy is much more than
treatment with nothing,” he says. “It’s treatment that
heals.”
Maybe Itís a Placebo
By the late 19th century, conventional medicine had
abandoned heroic measures. As they disappeared, the medical
opposition, led by homeopaths, lost steam. The discovery of
antibiotics and other modern drugs strengthened
conventional (allopathic) medicine at homeopathy’s expense.
Conventional physicians were also more politically astute.
They successfully lobbied state legislatures to pour money
into allopathic medical schools, leaving homeopathic
programs underfunded and less attractive to aspiring
physicians. To gain funding, many homeopathic programs
converted to conventional medicine, including the medical
schools at Boston University, the University of Michigan,
and Drexel in Philadelphia, which is still called Hahnemann
Medical College. Homeopathy remained popular in Europe, But
by the early 1970s, there were fewer than 100 homeopaths
left in the U.S. Critics dismissed homeopathy as simply a
placebo.
Placebos have no medical value. But when given to treat
almost any illness--from colds to serious conditions--about
one-third of recipients report benefit. Why? Because
of the mind’s ability to affect the body, says Brown
University psychiatrist Walter Brown, M.D. Many studies
have shown that when a doctor offers any treatment, people
expect it will help, and that expectation often does the
trick. That’s why some people with headaches begin to feel
better at the mere sight of Tylenol. Placebos also reduce
recipients’ distress about their illnesses, and relaxation
is therapeutic, especially for pain. Finally, through a
mind-body mechanism not entirely understood, placebos
trigger the release of endorphins, the body’s own
feel-good, mood-elevating, pain-relieving compounds.
“Improvement in patients receiving homeopathic remedies is
simply a placebo effect,” Sampson argues. Or maybe not.
Here are three recent examples of studies showing that
homeopathy is effective beyond a placebo effect:
* Pain Relief. British researchers gave 37 people either a
placebo or a homeopathic pain medicine (Arnica) after wrist
surgery for carpal tunnel syndrome. The homeopathy group
reported significantly less pain.
* Colds, Flu, Hayfever. Thirty M.D.s at six clinics in four
countries (including the U.S.) treated 456 consecutive
patients with upper respiratory complaints using either
homeopathy (281 patients) or conventional medicine (175).
After three days, 57 percent of those treated
conventionally were improved. In the homeopathy group, the
figure was 67 percent. Conventional treatment caused more
side effects. Sixty-five percent of the conventional group
were “very satisfied” with their treatment. In the
homeopathy group, the figure was 79 percent.
* Childhood Ear Infections. To treat this common
affliction, University of Washington researchers gave 75
children (18 months to 6 years) a placebo or homeopathic
medicine. After 24 hours, parents’ symptom diaries showed
significantly faster recovery in those treated
homeopathically.
However, some studies show that homeopathy is ineffective:
* Asthma. British researchers gave either a homeopathic
medicine or a placebo to 242 asthma sufferers. After 16
weeks, there was no difference in how the two groups fared.
* Rheumatoid Arthritis. British researchers treated 58
people with either homeopathically or with a placebo. The
placebo group reported significantly greater pain relief.
* Pain. Arnica is the homeopathic medicine often prescribed
for musculoskeletal pain, for example, sprains. British
researchers analyzed the results of eight studies of arnica
vs. placebos for pain. Arnica showed no benefit over
placebo treatment.
How can we make sense of these conflicting reports?
In 1991, Dutch epidemiologists analyzed 105 studies of
homeopathic treatment from 1966 to 1990, most from French
and German medical journals unavailable in English.
Eighty-one studies revealed benefits. Twenty-four showed no
benefit--but 81 did. Many were not well designed,
prompting the researchers to state: “The evidence is
probably not sufficient for most people to decide
definitively one way or the other [about the efficacy of
homeopathy].” However, they concluded: “The evidence is to
a large extent positive. [It] would probably be sufficient
for establishing homeopathy as treatment for certain
conditions.” A 1997 German analysis of 89 studies agreed.
While finding “insufficient evidence” that homeopathy is
definitely effective, the researchers concluded that it is
often significantly more beneficial than placebo treatment.
Maybe People Just Prefer Alternative Therapies
Ambiguous as the evidence may be, in recent years
homeopathy has enjoyed renewed popularity in the U.S.,
coinciding with many Americans’ ambivalence about
mainstream medicine. Millions take the latest drugs for
depression, high cholesterol, and other conditions. But
according to a recent report, many say they dislike drugs
and prefer other treatments. Depending on the survey, half
to two-thirds of Americans have used alternative therapies.
They visit alternative practitioners more often than they
visit conventional M.D.s--some 600 million consultations a
year. They now spend $30 billion a year on alternative
therapies, according to a recent report in Newsweek, and
have as much confidence in alternative practitioners as
they do in M.D,s, according to a study in the AMA-published
journal Annals of Internal Medicine.
Are Americans losing confidence in M.D.s? No,
according to the report in Annals of Internal Medicine,
which shows that Americans continue to have faith in their
M.D.s, but have expanded their view of what’s medically
helpful to include alternative therapies. In the Annals
study, about three-quarters of the 831 respondents
consulted an M.D. first, but also consulted an alternative
practitioner, believing that the combination of mainstream
and alternative medicine provides better results than
either one by itself. “The renewed in interest in
homeopathy,” explains Dana Ullman, M.P.H., author of eight
books on it, “is part of the groundswell of interest
Americans have shown for all the alternative therapies.
People are just not satisfied with just conventional
medicine.”
Homeopathy is not the only alternative therapy that
conventional medicine considers impossible. The energy
pathways (meridians) fundamental to acupuncture don’t
correspond to any known structures in the body, so no one
knows exactly how it works. But a 1998 National Institutes
of Health report concluded, “the data in support of
acupuncture are as strong as those for many accepted
Western medical therapies.”
Nonetheless, homeopathy is nowhere near as accepted as
acupuncture. The latest Harvard report on Americans’ use of
alternative therapies shows that homeopathy accounts for
less and one-half of 1 percent of alternative practitioner
visits. Recently, University of Maryland researchers
surveyed coverage for alternative therapies by six major
managed care plans. Five covered chiropractic. Four covered
acupuncture. None covered homeopathy. “Homeopathy,” Ullman
says, “gets no respect.”
Dr. Carlston believes fervently that homeopathy deserves
more respect. Recently, he treated a 28-year-old woman with
a long history of anxiety attacks. She’d taken standard
medication, but it didn’t help much. She also had physical
symptoms--chronic indigestion and no menstrual periods for
several years. Dr. Carlston prescribed a homeopathic
medicine. “Over several months, her anxiety attacks
subsided. After a year her periods returned. “I’m still
sometimes amazed at how well homeopathy works,” Carlston
says.
About a year after September 11, a middle-aged computer
programmer consulted Dr. Shalts for anxiety, insomnia, and
when he did sleep, nightmares. He’d been in the World Trade
Center in 1993, when it was bombed, and he was standing on
the subway platform beneath it when the planes hit. Other
psychiatrists had prescribed antidepressants and
psychotherapy. They didn’t work. A friend referred the man
to Dr. Shalts, who prescribed a microdose of Stramonium
(thornapple). “After just one pill, he slept better, and
after two weeks, he was sleeping through the night without
nightmares.” But the man was still anxious. Shalts
prescribed a microdose of Aresenicum album (arsenic). “Now
he’s fine.”
As a pediatrician, Ellen Feingold treated many kids
with asthma and chronic ear infections. “But I never cured
them. They just kept coming back with more asthma attacks,
more ear infections. I became so disillusioned with
medicine that I considered quitting.” Then she heard about
homeopathy, became intrigued, and eventually trained as a
homeopath in Israel. Back in Delaware, she tried to
introduce homeopathy into her practice at Dupont Hospital
for Children in Wilmington. “No one there was receptive.”
Two years ago, she left and began practicing homeopathy on
her own. One of Dr. Feingold’s patients was a
five-year-old boy who had allergies and asthma. “He’d taken
multiple courses of inhaler medication, but it didn’t help,
and his mother became concerned about the long-term effects
of all the cortisone her son was getting.” Feingold treated
him homeopathically, with a microdose of arsenic. “He
hasn’t had an asthma attack in more than a year.” Feingold
has only one regret about homeopathy—that she didn’t switch
to it sooner.
Impossible Cure
Amy Lansky didn’t care that homeopathy is one of America’s
least accepted alternative therapies. After nine months of
homeopathic treatment, Max was a different child:
talkative, active, sociable, and popular. Under Melnychuk’s
guidance, Lansky decreased his dose of Carsinosin, and
eventually discontinued it. Max continued to improve. By
age five, he was virtually indistinguishable from any
healthy, happy kid.
In fall 1997, Max entered first grade at a new school.
Lansky did not tell the teachers of his autism history, and
none of them suspected it. They only knew Max for the boy
he’d become: happy, friendly, funny, charming, and working
at grade level. “Of course,” Lansky explains, “like any
child, Max still has his issues. He now sees Dr. Melnychuk
maybe twice a year. But as far as I’m concerned, he’s
cured.”
Max’s cure led Lansky to quit her job and study homeopathy
full-time. This was not easy. The nation’s few naturopathic
medical schools—the National College of Naturopathic
Medicine in Portland, and Bastyr University near
Seattle—offer training in homeopathy, but neither were near
her and she didn’t want to uproot her family. .So Lansky
cobbled together a program combining a correspondence
course from a school in England with attendance at weekend
seminars around the U.S. Last fall (2003, she hung out a
shingle.
Seeing is believing. Or is it? As a Ph.D.
scientist herself, she knows that homeopathy defies the
known laws of science, that it’s impossible, and shouldn’t
work. But she is also convinced it did the impossible—cured
her son of a supposedly incurable condition. Last year, she
published a book, whose title reflects her son’s experience
and her feelings about her new career: Impossible Cure.
San Francisco-based health writer Michael Castleman is the
author of 12 consumer health books, including Natureís
Cures: A Scientific Investigation of 33 Alternative
Therapies (Rodale), including homeopathy.
Resources:
Impossible Cure: The Promise of Homeopathy. By Amy Lansky,
Ph.D. (R.L.Ranch Press, Portola Valley, California, 2003).
www.impossiblecure.com
Homeopathic Educational Services. Homeopathic books,
medicines, and other resources. 2124 Kittredge St.,
Berkeley CA 94704; (510) 649-0294; www.homeopathic.com.
National Council Against Health Fraud. 119 Foster St.,
Peabody, MA 01960; (978) 532-9383; www.ncahf.org.