Share:
Homeopathy - critically inquired about origins, application and effectiveness
The discussion about homeopathy is sometimes heated and controversial. A contribution to the objectification in the discussion of the topic makes Dr.. Jens Behnke from the Carstens Foundation. In the interview, the expert answered some basic questions about the origins, application and effectiveness of homeopathy.
Samuel Hahnemann founded homeopathy. who was that?
Samuel was a German physician and chemist born in the mid-18th century. After successfully completing his medical studies and practicing for a short time, he closed his practice and from then on worked as a translator of textbooks. In his opinion, the medicine of his time often harmed the patient more than she used it: Many treatment regimens, for example, provided for massive bloodletting and the gift of heroic doses of highly toxic substances, such as mercury or belladonna. Hahnemann founded homeopathy after self-testing cinchona bark, a well-known remedy for malaria. She produced malaria-like symptoms. This led him to think that substances that produce certain symptoms in healthy individuals can cure similar symptoms in the event of illness (the principle of the "simile" principle). Subsequently, he systematically explored this hypothesis and applied the therapy derived from it in the treatment of the sick. In his late days Hahnemann lived in Paris. His busy practice enjoyed an international reputation.
The origins of homeopathy date back to the 18th century. To this day, heated deaf people are being led over their effects. (Image: Gerhard Seybert / fotolia.com) On which medical ideas was Hahnemann's teaching based? What do "life force", "life energy" or "miasms" mean? What is the simile principle and what is the medical tradition? What evidence for the effectiveness of his idea and method Hahnemann provided?
Homeopathy is a drug therapy that prescribed by a certain process (potentiation) and tested healthy substances individually prescribed by the law of similarity. I have already explained the simile principle in Hahnemann's sense in connection with cinchona bark. In terms of medical history, related ideas can be found, for example, in Hippocrates or Paracelsus. It is important in this context that the homeopathic similarity rule has nothing to do with medieval signatures. For example, it has been thought that bloodwort (Potentilla erecta) has anti-bleeding properties because red dye leaks out when cutting the plant.
Theories about the life force or miasms (Greek for evil "haze, pollution, defilement") are secondary to homeopathy then as now. For example, some homeopaths completely reject the idea of miasms as a cause of chronic diseases, while others consider them helpful. Originally, the observation that chronically ill are not so easy to cure permanently, Hahnemann led to the thesis that other processes have to play a role here than in acute diseases. He suggested that earlier infections and the resulting constitutional burden could play a role, which may even be hereditary. Analogous ideas can be found in today's genetics. If one wants to make further references to modern medicine, one could perhaps say that "life force" means the organism's ability to self-regulate.
Hahnemann provided evidence for the effectiveness of homeopathy by successfully treating a large number of sick people. At least this is suggested by his extensive records of the treatment of several thousand patients in the form of 37 medical journals, each containing several hundred pages, as well as the diverse reports of his contemporaries.
How could Hahnemann's ideas be reconciled with viruses and bacteria as pathogens and etiology?
Hahnemann did not have the knowledge of modern pathology. But homeopathy is a phenomenological method: the choice of drug is determined by observable symptoms. Any theory of disease causes is secondary to this background. This was true at Hahnemann's time and is still valid today.
The presence of microorganisms in the body of a patient is, of course, also relevant for the modern homeopath. In particular, any therapy that wants to be successful must ultimately make an infection disappear, including a homeopathic one. The viral or bacterial attack is in this view, but only a symptom that has information value for the indication, as well as the prognosis and follow-up. He is not the primary choice for the therapy. A direct pharmacological control of pathogens, such as in the context of antibiotics, is neither intended nor possible with homeopathic remedies. For this reason, for example, a severe sepsis is no indication for a sole homeopathic treatment: The severity of the infection requires a rapid elimination of the microbes, because the patient's body does not have enough reserves to bring about recovery on the basis of its self-regulatory ability. However, homeopathy can also be used to support this, as evidenced by a study by intensive care physician Prof. Michael Frass.
Homeopathy is naturopathy?
This depends on the definition: If you understand the "natural medicine" as the classical natural remedies for phytotherapy, hydrotherapy, nutritional therapy, exercise therapy and order therapy, the answer is no. If one wants to use the term "naturopathy" more or less synonymously with "complementary medicine", then yes. My personal opinion: Because of the central importance of the similarity rule and, secondarily, because of the potentiation of the drugs used, homeopathy is rather to be regarded as a therapy system sui generis and thus not a part of naturopathy in the narrower sense.
Unlike herbal medicine, homeopathy does not belong to natural medicine in the case of a narrow interpretation of the term. (Image: Alexander Raths / fotolia.com) Which means first aggravation?
The phenomenon of initial aggravation is sometimes observed in the administration of suitable homeopathic medicines. In the process, the patient's already existing symptoms first intensify, then quickly fade away. The subsequent marked improvement is, in addition to the short duration of the initial aggravation, a definitive feature of the initial aggravation. It must also be different from the normal course of the disease. Scientific studies suggest that initial exacerbations in the context of homeopathic treatment are rare.
Using cybernetic models, the homeopathic first aggravation can be easily explained: the organism is considered as a control loop that is in a steady state. In the event of illness, a harmful external or internal influence disturbs this balance. As a result, the body sets up control mechanisms that intend to restore it. Visible expression of these efforts are the disease symptoms, such as fever, coughing or suppuration. According to the rule of similars, the patient now receives a substance capable of producing similar symptoms in the healthy. The charm of the homeopathic remedy corresponds in this respect to the trigger of the disease. It aims to reinforce the self-regulation efforts of the organism. The already initiated control mechanisms can be "up-regulated" as it were. The first aggravation is then the obvious expression of this intensification.
Which test potencies did Hahnemann base on his dilutions of the substances used? What does an "amber essence", for example, contain??
Hahnemann experimented with healthy people with different potencies both in the treatment of patients and in his provings. While in his early days he also used mother tinctures, ie classically pharmacologically active substances, he later recommended the C30 as the standard potency for proving on the healthy. Amber essence is not a homeopathic medicine tested by Hahnemann.
Globuli are sugar globules to which the respective homeopathic active ingredient is applied. (Image: Klaus Eppele / fotolia.com) What are globuli?
Cane sugar cane, available in different sizes. In homeopathy they are used as a carrier: the medicinal solution is sprayed on.
Christiane Maute recommends globules for plants to deter pests and Dagmar Neff presents the "homeopathy for painting" as a new homeopathy. Can you explain the mechanism of action of homeopathy for plants and painting??
Numerous experiments from basic research on homeopathy show that even plant organisms react to highly potent drugs: In the three main areas of bioassays with healthy plants, intoxication models and phytopathological investigations, reviews from 2009-2011 identified a total of 167 experimental studies, of which 48 met higher quality requirements , In various studies, specific effects were also observed of potencies beyond the molecular limit (study on homeopathy application in healthy plants, homeopathy application in abiotic stressed plants and homeopathy application in field trials). The systematic use of such ultramolecular dilutions in agricultural crop protection is being tested, for example, in India.
The mechanism of action of high potencies is still unclear. Many, sometimes independently replicated, experiments, such as nuclear magnetic resonance (NMR) relaxation, UV spectroscopy, and biocrystallization, indicate that water molecule dynamics in homeopathic drugs are altered from placebo control. So far, however, the hypothesis that a drug-specific signal in stable water structures (clusters) is stored. The candidate patterns are stable only in the picosecond range (10-12).
A "homeopathy for painting" is not known to me.
Even in pest control in the garden, many people rely on homeopathy. (Image: Gina Sanders / fotolia.com) Is there a controversy between evidence-based medicine based on scientific evidence and particular forms of therapy, such as homeopathy??
The juxtaposition "Evidence-based medicine vs. Homeopathy "suggests a false picture of the actual data. I will illustrate this with the example of homeopathy:
The Homeopathic Research Institute (HRI) conducted an evaluation of 189 randomized controlled clinical homeopathy studies in 2014: 41% demonstrated the efficacy of homeopathic preparations, 5% demonstrated their ineffectiveness, and 54% of the publications did not permit a clear conclusion.
By way of comparison: In 2007, 1016 reviews of the renowned Cochrane collaboration on conventional medicine were scrutinized: 44% demonstrated the effectiveness of the studied intervention, 7% demonstrated their harmfulness, and 49% reported that no conclusion was reached Direction (overview of the Chochrane health decision-making studies).
The similarity in the distribution of positive, negative and neutral results is immediately apparent. Although the data base in homeopathy research is considerably narrower than in some areas of conventional medicine, it is nevertheless broad enough to state the following facts: a comprehensive consideration of clinical research data sufficiently substantiates a therapeutic benefit of homeopathic treatment. In addition, the results of numerous placebo-controlled studies as well as experiments in basic research speak for a specific effect of potentiated drugs.
What is the annual turnover of homeopathic remedies in Germany??
In 2015, € 100 million were transacted nationwide with prescribed homeopathic medicines (source: Statista). In the same year, the expenditures of the statutory health insurance for medicines amounted to altogether 31.84 billion € (source: Statista). Thus, homeopathic expenditures equaled 0.31% of total drug-related expenditures. In addition, there is another 495 million sales of non-formulated homeopathic remedies, which patients pay in full out of pocket.
Although the turnover of homeopathic medicines reaches around 100 million euros per year, this represents only 0.31% of total drug expenditure. (Image: pegbes / fotolia.com) With regard to the above-mentioned expenditure, one should also keep in mind that various studies document that the use of comparatively inexpensive homeopathic remedies can obviously significantly reduce the prescription of sometimes significantly more expensive drugs:
Regarding upper respiratory illness, the EPI3 cohort study found that in comparable homeopathic medical practices, only about half of antibiotics, anti-inflammatories and antipyretics are prescribed compared to conventional ones.
The same is true in the field of musculoskeletal diseases, such as rheumatism: Patients who are treated homeopathically require only about half of non-steroidal anti-inflammatory drugs (eg ibuprofen) for the same therapeutic success, according to a study from 2012. Also in relation In a study from 2015, it could be demonstrated on mental illness that for patients who visit a homeopathic doctor, the probability of being prescribed psychotropic drugs is four times lower than for conventional medical practice.
Due to the overuse of antibiotics resulting multidrug-resistant germs cause an estimated number of deaths per year - according to a study from the year 2015 alone in the US 99,000 per year. Nonsteroidal anti-inflammatory drugs represent the group of drugs for which the highest number of serious adverse events are observed (e.g., at least 15,000 deaths per year in the US, see American Nutrition Association). According to the director of the Nordic Cochrane Center, Peter Götzsche, psychotropic drugs are responsible for approximately 500,000 deaths per year in Europe and the US in the over-65 age group.
All in all, these facts give reason to assume that the nationwide use of homeopathy would lead to considerable potential savings for the health care system. Because not only the consumption of conventional drugs would be reduced, even the significantly higher follow-up costs due to their side effects sink.
Furthermore, there is a systematic review from 2014 on the topic of cost-effectiveness of homeopathy. It summarizes the results of 14 health-economic analyzes on homeopathy with more than 3,500 patients. In 8 out of 14 studies, improvements in health and cost savings compared to those treated conventionally were documented. In 4 studies, treatment outcomes were similar to conventional control and cost was equivalent. In two studies comparable treatment successes but higher costs compared to conventional therapy were found.
What is the relationship between homeopathy and natural science??
The efficacy of ultramolecular dilutions is certainly an anomaly, that is, a phenomenon that can not or only insufficiently be explained by reference to common theories and models. Enlightened and self-critical scientists see challenges in anomalies. As a rule, an advance in knowledge is based on the investigation of such anomalies:
What did not fit in with our picture of the world because our explanatory models were too short forces us to question our theories. The subsequent modification of the conceptual system that we use to make the world understandable is progress. Opposite the scientific attitude of mind is the dogmatic. Here empirically ascertainable phenomena are denied because they can not be explained by recourse to a certain set of cherished theories.
The scholasticism of the Middle Ages did not want to accept anything that is not found in Aristotle or in the Bible. Similarly, some critics of homeopathy consider the effect of high potencies to be impossible in principle because it can not be explained by the model "molecule acts on the cell".
Some even go so far as to admit that the available data from clinical studies and basic research tend to speak in favor of homeopathy. The conclusion for these "skeptics", however, is that unknown errors in the experimental setups would have to be because an effect without molecules violates natural laws (see Scientability - a concept for dealing with EbM with homeopathic medicines). Here, as it were, the legal concept of law is impermissibly transferred to the natural sciences: laws of nature do not prescribe to the world how it should behave. They describe rather general relationships of our observations.
The philosopher of science Karl Popper postulated as a necessary criterion for a theory that can be described as "scientific" that in principle it must be possible to disprove it. Exactly this is not the case if phenomena are indeed determined using recognized methods, but nevertheless not taken seriously, because they can not be completely deduced by reference to certain models, here the laws of nature. Against which laws of nature the effect of highly potentized medicines should violate at all, is at least in need of explanation. Physics regularly observes effects without direct contact with molecules in the case of electromagnetism, gravitation, etc. For these forces of nature, only explanations are available that attribute them to already known quantities and mathematical formalisms by means of which their effects can be predicted. Both of these are not or not sufficiently the case for homeopathy. The rejection of homeopathy without prior examination of the numerous positive findings from clinical and basic research does not correspond to the scientific method of gaining knowledge. Because here is an immunization compared to the experience, similar to the Middle Ages.
The exact knowledge of the causes of the specific diseases and the processes in the body are based on the meaning and course of homeopathic therapies?
Homeopathy is a stimulus regulation therapy. Their goal is to give the body an impulse to stimulate the self-healing powers. Disease causes in the sense of a classical pathology are important for them only insofar as they can be election-indicating indications for a similar drug. In addition, they are of course important for indication, prognosis and follow-up. Homeopathy is based on perceptible symptoms, including laboratory parameters or diagnostic data from imaging techniques and the like. can count. However, it dispenses with the choice of drug to a theoretically based causal relationship between certain symptoms and their supposed causes. This is certainly one of the great advantages of homeopathy to see: It requires no therapy for the therapy theory of disease, but adheres to the directly observable.
How did today's homeopathy develop since Hahnemann??
The pillars of homeopathy, 1. the principle of the simile, 2. the drug proving on the healthy and 3. the special drug manufacturing process, are more or less unchanged by Hahnemann until today. Different schools of homeopathy are constantly developing their own approaches to one or another of these fundamentals, sometimes more or less successful.
After a flourishing never to be surpassed in Western countries, homeopathy reached the threshold of the 19th to the 20th century in the USA. This upturn was brought to a sudden halt by the efforts of the conventional medical profession, financially strong interest groups and the so-called "skeptic movement", according to a retrospective analysis from 1993.
Homeopathy is still fully established in the healthcare system in India today: the number of people treated there daily should easily be in the millions.
Homeopathy is used globally in more than 80 countries worldwide. Three out of four Europeans have heard of homeopathy before, and about a third use it themselves. Here, homeopathy is the most commonly used complementary therapy for children at all. According to a representative survey by the Allensbach Institute for Demoscopy, 60% of the population in Germany have taken homeopathic medicines themselves, and the trend is rising.
In many cases, homeopathy is accused of lack of scientific evidence, but many studies have shown an effect significantly above the placebo effect. (Image: Sonja Birkelbach / fotolia.com) Which meta-studies of the last years are there, which evaluated a large amount of individual homeopathy studies, and to which results came the?
Currently there are 5 indication-independent systematic reviews of placebo-controlled homeopathy studies with statistical analysis (meta-analysis) covering a period from 1991 to 2014: Four of these studies (clinical application of homeopathy, are the clinical effects of homeopathy placebo effects ?, proof of clinical efficacy of the Homeopathy, Randomized placebo-controlled studies on individualized homeopathic treatment) conclude that the effects of homeopathic medicines can not be explained by placebo effects alone.
A meta-analysis concludes that homeopathic medicines are probably placebo. Due to scientifically incomprehensible criteria, this one negative work evaluated only 8 out of 110 homeopathy studies included. A statistical reanalysis revealed that in this publication too the result for the 21 clinical trials attested to a high methodological quality was significantly positive in favor of homeopathy.
Great media coverage was further reviewed in 2015 without a meta-analysis commissioned by the Australian National Health and Medical Research Council (NHMRC). For this reason too, 171 out of 176 studies were not evaluated for methodologically untenable reasons: The authors excluded all clinical trials with fewer than 150 participants as unreliable from the analysis and came to a negative result for homeopathy. Such a selection criterion was not used in any medical review published before or after the NHMRC report (except Shang et al., 2005, supra), as it is a methodologically unjustifiable arbitrary setting. In fact, even the NHMRC itself conducts studies with fewer than 150 participants because this number of subjects has nothing to do with methodological quality, according to the Homeopathy Research Institute.
In homeopathic research, the evaluation of data seems to play an important role due to (in-) compatibility with certain theoretical assumptions. This phenomenon is discussed theoretically under the concept of plausibility bias (plausibility bias). For example, in a 2013 study, epidemiologist Robert Hahn analyzed the inclusion and exclusion criteria for meta-analysis studies on homeopathy with a negative or indifferent bias, showing, inter alia, statistical considerations that they were likely to be postulated. He suggests that this approach is ideologically motivated, which would be diametrically opposed to the scientific claim of evidence-based medicine.
The Social Security Code demands: "The quality and effectiveness of the services must conform to the generally accepted state of medical knowledge and take account of medical progress." To what extent does this apply to Hahnemann's teaching and the derivations of today's homeopaths??
Data from clinical studies on homeopathy show that patients regularly benefit to a considerable extent from homeopathic treatment. The effects are similar to those that can be achieved with conventional measures, but are associated with fewer side effects. In addition, many patients who use homeopathy are already unsuccessful or have conventionally pretreated with inadequate results, as a joint study by researchers from the Charité - Universitätsmedizin Berlin and the Karl and Veronica Carstens Foundation shows. Quality and efficacy therefore seem to be sufficiently given in terms of scientific evidence. Medical progress has so far not led to the fact that especially many chronic diseases can be permanently cured or at least adequately alleviated. Here, homeopathy has great potential, according to data from clinical research. Unfortunately, this promising therapy is still far too little integrated into the healthcare system. Here there is an urgent need to catch up with politicians.
Interviewee:
Dr. Jens Behnke
Homeopathy in research and teaching
Karl and Veronica Carstens Foundation
Note: This article is intended as a technical contribution to the ongoing debate around the topic of homeopathy, in which we give both critics and advocates room for a presentation of their positions. Further contributions to the topic can be found here:
Homeopathy: myths and facts about globuli
Homeopathy - Popular with users, proven by studies!