Share:
Critical Discussion on Homeopathy - Effective Medicine or Placebo
Debates on homeopathy are reminiscent of religious wars. Homeopathy means to administer to patients in strong dilution the substances that cause the disease in the opinion of homeopaths. Scientists have published numerous studies, according to which this concept contradicts all established medical concepts. The followers of this doctrine do not touch this: not everything could be explained scientifically, and they would see how their sugar globules heal with chemically undetectable substances. Most of the fronts are clear, and followers and opponents of homeopathy do not leave their positions.
Anders Natalie Grams. She practiced for a long time as a doctor with homeopathic methods. Then she researched for a book that was originally intended to defend homeopathy. Instead, she came to the conclusion that this is a heresy. Dr. Natalie Grams and dr. Norbert Aust founded the network Homeopathy, in which they provide critical information on homeopathy and medicine, science and religion. Dr. Utz Anhalt interviewed the two for Heilpraxisnet.
Effectiveness, humbug or placebo? Image: Björn Wylezich - fotolia Mrs. Grams, you are a doctor and run a homeopathic practice. Then you wrote a critical book on homeopathy ("Homeopathy Rethought - What Patients Really Helps," Springer Spectrum) and concluded their practice. How did that happen?
Dr. Natalie Grams (NG): Originally I wanted to write a positive book on homeopathy based on the supposedly successful results of my homeopathic activity. To show critics how great homeopathy and why criticism is inappropriate. But in the course of the research I got a whole new picture of homeopathy. I had to acknowledge that I had been wrong, misunderstood, and that homeopathy's achievements could be explained by psychology rather than Hahnemann's 200-year-old ideas. After this realization, I could not and did not want to be able to treat my patients with unsustainable promises of salvation and, consequently, closed my practice.
2) Ms. Grams, that a substance is "spiritual" when it is diluted until it can no longer be detected chemically, contradicts the laws of nature, but is the basis of homeopathy. In their own practice they have been very successful despite Globuli and former patients shower you with praise. How did the actual healings come about??
Of course, at the time of homeopathy, I was convinced that there really was such an "energy" - that it was not scientifically unfathomable. Like all homeopaths, I saw the mistake on the part of science and not on the part of Hahnemann or homeopathy. Today I know that laws of nature are valid and that exponentiation produces no energy but only a dilution. The improvements experienced by patients undergoing homeopathic treatment can be explained by psychological effects, e.g. the placebo effect and come rather from the setting and the therapist-patient relationship than from a specific medicinal effect of the globules. In addition, there are always changes in an intensive self-observation and after a certain time past - of course, also positive. Today I like to say that under homeopathy, healings do occur - but not through homeopathy.
Mr. Aust, you and Mrs. Grams are among the initiators of the "Homeopathic Network", which deals critically with homeopathy and on a website netzwerk-homoeopathie.eu. Why did you start this network, what do you want to do with it, and what do you think of the need?
NA: Homeopathy is an outdated teaching of salvation from pre-scientific times whose basic assumptions are in complete contradiction to scientific and medical knowledge. Only the patient hardly has a chance to get a true picture of it. In the relevant media, a positively oversubscribed image is drawn, the effectiveness justified by logical errors and incorrect analogies. All possible institutions, e.g. Adult education centers, church sponsors, agricultural chambers offer courses and recommend the application. Even pharmacies and doctors can be stretched in front of the cart. According to the German Medicinal Products Act, homeopathy is stipulated in the health care system, but it is ironic that it does not require any proof that otherwise every food manufacturer would have to comply with if it promotes health-related statements for its products. Doctors' Chambers offer advanced training for homeopaths, in the licensing system and subsequently at universities, homeopathy is introduced as a subject of study, the health insurance companies pay the costs.
So how should a patient, who wants to inform himself, come up with objective information that is not supported by obvious economic interests? Already in my book and on my blog, I have tried to remedy this shortcoming. Our network is the continuation of these activities on a broader basis. This seems very important to me, because the institutions of the health service, which are supposed to protect us from quackery and charlatanry, fail so far miserably. The initiative of the G-BA is a first step in the right direction.
NG: For me personally, the motivation is that I - even as a doctor - have been so mistaken in the well-sounding claims of homeopathy. I would like to help others not to do the same, or at least get the right information that can help them reappraise homeopathy. I see both therapists and patients believe they know a lot about homeopathy, but they do not critically question whether that is true. Here the INH wants to help to create clarity and to provide much needed educational work.
Ms. Grams, you are a graduate in physics, so you know the difference between empirical science and hocus-pocus, as well as the effect of placebo and the difference between medically effective substances and psychotherapy. How do you explain, also from your own experience, that physicians trained in the natural sciences use homeopathy?
NG: I am sure that most colleagues only know homeopathy by hearsay and associate it with false associations such as "natural" and "gentle". Since one does not know well, one wants to be tolerant, and hardly anyone has really dealt with the basics of homeopathy. And in addition, doctors are not very scientifically trained. The natural sciences are natural in preclinical studies, but scientific thinking is hardly taught. After completing your studies you decide to pursue a scientific career or a practical one.
Mrs. Grams, Mr. Aust, homeopathy floats everywhere, where naturopathy is announced. Naturopathy in the narrow sense refers to, for example, medicinal plants whose effect is usually scientifically proven. If sailors ate fresh fruits and thus prevented scurvy, that does not contradict science. Homeopathy is at all natural medicine, so medicine with the means of nature?
NA: In my view, the problem with homeopathy is not the word element of 'nature' but 'medicine', even if you can already ask yourself whether electricity, vacuum or the Berlin Wall are actually natural substances. Any medicine is associated with having an effect on the patient that is based on something that is effective. These do not necessarily have to be active substances, but also heat, physical influence (massages), or conversations are known as carriers of a positive or negative effect. In homeopathy, which sees itself as a drug therapy, this is precisely not the case. In middle potencies, the drug is contained in barely measurable amounts, in high potencies no longer, although just these drugs allegedly have increased efficacy. Homeopathy is thus a doctrine of salvation, which assumes that evaporation residues of shaken water on sugar have a specific effectiveness that emanates from the non-existing mother tincture. These can be as natural as they will be: it is not real medicine.
NG: You're addressing one of the main bugs of homeopathy and homeopathy perception. We at INH therefore want to achieve that this is finally clearly separated: Naturopathy can develop specific effects and is the basis of many of our normal drugs (eg penicillin, digitalis), homeopathy is humbug from times long gone and has nothing with medicine and nature in the double sense to do.
Mrs. Grams, Mr. Aust. The physician Samuel Hahnemann (1755-1843) thought up homeopathy. He was clinging to a notion of Medieval medicine: the deadly cherrys are helping against rabies, our ancestors thought, because both are "great," and Hahnemann recommended them against confusion and fever (madness). He searched for substances that cause symbols similar to those of the patient, but diluted them so that the substance no longer existed chemically. A 1: 1,000,000 dilution is made on sugar globules, the globules are dripped. It's about the "mind", the "information" of the substance. Such "secret" information is very popular in the esoteric scene - sometimes they come from angels, then from ghosts, then from the cosmos. Thus, homeopathy is religion rather than scientific medicine?
NA: Despite criticism of homeopathy, Hahnemann is more likely to see someone who has used the methods of his time to come to new conclusions. He had no way of knowing his mistakes, for falsification as an essential scientific principle was introduced into scientific theory long after his death. He could not know that he diluted the drug completely out of his preparations. The problem is his successors. Instead of adapting the doctrine bit by bit to the increasing knowledge of medicine - which would have meant accepting large parts as errors - they have maintained these and sought new reasons that are naturally outside of science.
In the course of time, this created a structure that is not unlike a religion. A charismatic infallible founder, sacrosanct books that go back to this founder and are considered right per se, the division into believers and unbelievers, and not least the dealings with apostates of pure doctrine point in this direction.
NG: Absolutely. However, religions are clearly declared beliefs, but homeopathy acts as if it were science and medicine. Homeopathy sticks so steadfastly in the middle of our society because therapists and patients believe in them. Even the most logical and stringent arguments can not convince a believer. We notice that in every discussion with supporters of homeopathy.
Mrs. Grams, Mr. Aust. Patients often report an improved condition through homeopathic treatment. On the one hand, this is probably due to the placebo effect; on the other hand, homeopaths usually focus intensively on their patients. Doing a doctor or alternative practitioner and patient in fact a conversation therapy, in which the sugar balls have symbolic meaning, comparable to the animal spirits in shamanism?
NG: In my book, I describe in great detail what happens between homeopath and patient, or even when self-treating with homeopathy. The therapeutic treatment of homeopathy offers time, individual approach and simple solutions to very complex issues. Even having a kind of handle on the disease and not feel so at the mercy may play a role. There is also a bit of magic, and that creates a fiction that can sometimes be helpful. However, a fiction is never able to replace a concrete, specific therapy, and homoeopaths do not want to see that. And in contrast to psychotherapeutic talk therapy, homeopaths do not make conversation and human interaction or a kind of self-knowledge responsible for change, just the globules. This indeed makes it similar to a shamanic suggestion practice.
Ms. Grams, such psychosomatic treatment, that is psychotherapy, would not work without sugar balls?
NG: After realizing that homeopathy works at best as an unstructured talk therapy, I also thought about talking to my patients, accompanying them and not giving any globules. Or to give globules, but to explain to the patient that these are placebos or carriers of a suggestion ("That will help you"). That would be homeopathy without homeopathy - do we really need that? I think no. Because we have medicine. And we have psychotherapy. And: whoever believes, can go to church.
Mrs. Grams, Mr. Aust. How do you explain the growing need for alternative medicine? Does this point to needs that are neglected in evidence-based medicine? Or do people want to believe in miracles?
NG: Very clear yes to the sentence "people want to believe in miracles". And it's not that no miracles happen - it's also possible in medicine. But a healing method that is based on the belief in miracles is just as timely and helpful as holy pictures in the car instead of the seat belt.
I agree with the fact that people often do not feel that they are being seen enough in everyday medical practice, and I am very sorry for that. Here, we at the INH suggest that doctors should get back more opportunities to spend time with their patients for conversation - and that they can better settle it. This would certainly avoid many unnecessary examinations - and thus costs. The best would be if there were no gap at all, in which patients can long for alternatives!
NA: I think Mrs Grams has said the basics, I can only agree with this.
Mrs. Grams, you are a doctor and you practiced homeopathy yourself. Then they became skeptical. But I also know the opposite case: A successful psychiatrist, who painfully stated that mental disorders can be cured only to a limited extent, suddenly tells you that everything you desire comes true if you only believe in it. "Enlightened," the doctor is now gambling away his reputation, because he thinks he can fix all diseases by knocking on body parts.
NG: People are not necessarily prone to rationality in the first place. We like to believe in miracles, we find great promises more appealing than critical thinking and consistent questioning - all of us. Mr. Kahnemann has worked very well for me in his book "Fast thinking, slow thinking". So, I can already understand that one can easily fall on the side of the "intuitive miracle belief" - after all, it makes much less effort.
An analytical work as a psychiatrist over many years costs a great deal of mental energy and consumes mental resources. Now the proposals of the innate quick thinking to make sense, instead of continuing the tedious work, the results of which bring little success.
Is this urge of our intuitive thinking for meaning and quick solutions perhaps an explanation for the boom of pseudo-medicine? If so, how could that be counteracted??
NG: That's exactly how I would put it. One approach is to make people more aware that there are these two different types of thinking - and which one we should use when.
Mr. Aust, Mrs. Grams. How is it that homeopathy enjoys a special status in pharmaceutical law? For every medicinal plant used by the Indians of the Amazon for centuries as a medicine, their effect must first be scientifically proven before it is recognized as a medicine.
NA: Why then homeopathy was included in the pharmaceutical law, from today's perspective is no longer understandable. Apparently this goes back to Veronika Carstens, the wife of former Federal President Karl Carstens. She was a follower of homeopathy and has used her position to create in 1982, together with her husband, a foundation for the promotion of homeopathy and natural medicine. This foundation has done its job very well. The introduction of the internal consensus in 1997 is also based on the influence of interested parties on the legislation. In 2001, a European regulation was adopted, which established a simplified registration instead of an authorization linked to a proof of efficacy. Of course, the European regulation probably goes back to similar activities.
This all sounds more or less like conspiracy theory, but is the only conceivable explanation.
NG: One practiced in the 80-90's in alleged tolerance and the belief that medicine is also experience healing. That's true in a way. But we have just invented clinical studies and developed them to draw as objective conclusions as possible from individual experiences. If you look at the studies on homeopathy, they show, the better and more comprehensively they are made, that the experiences with homeopathy correspond to a false therapy. A special legal status is therefore no longer tenable today.
Followers of homeopathy, healing by hand, Catholic Marian devotees or people who believe in mysterious earth rays often say, "I'm not sure why it helps, but it's crucial that it helps." That's right?
NG: As a homeopath, I have always withdrawn to this pragmatic sentence. However, in independent reviews (clinical studies, systematic reviews) we just do not see homeopathy working better than placebo. There are a number of normal medications that we do not know exactly why and how they work - but we can prove that they work. Homeopathy can not do that and the sentence is simply wrong. Single observations are a great thing, and if you're the one who thinks you've experienced a "miracle," then that's almost impossible. But if we check that such miracles are common in homeopathy, then the result is no.
Mr. Aust, Mrs. Grams. What is the response to their website?
NA: Astonishingly, the positive feedback, ie inquiries about how to support us, outweighs it. We are particularly pleased when university professors and active doctors confirm our views. Of course, there are also statements to the contrary, but they remain, unlike those in Internet forums, largely in the factual context. Whereby the same standard arguments are used again and again.NG: Especially from the press side we get a great response. It is as if the door has finally been opened to an objective, yet friendly, appreciative education about homeopathy. We want to work on that consistently.
Thank you for the interview! In Part II we will interview supporters. (Dr. Utz Anhalt)