Update April 2010 Homeopathy a systematic review finds no evidence that homeopathy has effects beyond placebo. Dr. Steven Barnett's article, Homeopathy: The Ultimate Fake reviews the status of homeopathy in the United States. Homeopathy lists the critiques published of homeopathy in April, 2010. homeopathyThere's Nothing In It, the 10:23 campaign.
What is Fraud and Quackery?
Dr. Steven Barret, over at, Quackwatch offers the following definition:
"Quackery" derives from the word quacksalver (someone who boasts about his salves). Dictionaries define quack as "a pretender to medical skill; a charlatan" and "one who talks pretentiously without sound knowledge of the subject discussed." These definitions suggest that the promotion of quackery involves deliberate deception, but many promoters sincerely believe in what they are doing. The FDA defines health fraud as "the promotion, for profit, of a medical remedy known to be false or unproven." This also can cause confusion because in ordinary usage -- and in the courts -- the word "fraud" connotes deliberate deception. Quackery's paramount characteristic is promotion ("Quacks quack!") rather than fraud, greed, or misinformation.
Are homeopaths, and the big homeopathic remedy companies, quacks or medical frauds? This is sincerely a difficult question for me to answer. I believe that most persons who provide or promote homeopathic remedies sincerely believe in what they are doing. I am less sure about the large companies in Europe and the United States. In this essay I propose to examine the philosophical and economic aspects of homeopathy.
What Do I Mean By Homeopathy?
Homeopathy is not now a monolithic entity, as it was at the time of the founder's life (1755-1843). Hahnemann, the founder, was trained as a physician, but became disillusioned with the dominant paradigm of his time: that illness is due to a due to an overabundance of one of the body's fluids or "liquors" and that treatment consisted of draining these excesses. Blood is of course the most avaible fluid, and a great many treatments consisted of bleeding, but other "purges" of various kinds were practiced. It is not surprising that Hahnemann, who by all accounts had a keen intelligence, began looking for other, more effective remedies . Nor is it practised today (2003) as it was in the nineteenth century, when remedies were only available through a homeopathic practitioner, often a man trained as a physician. The practitioner would interview the patient for an hour or more, and based on the patient's physical, mental, and emotional condition, prescribe a single remedy. Today, homeopathy is most visible in the supermarket, where "remedies" that are self-identified as "homeopathic" are available over-the-counter, even in giant retailers such as Safeway. The second highest visibilty point is on the Internet.
Homeopathy is a belief system with the following features:
- The Vital Force Homeopaths believe that the essential nature of a living being is not to be found in the physical tissues and organs of the body. Homeopaths perceive an intelligence, variously called "the dynamic principle" or "vital principle," "the dynamis" or "vital force," which was responsible for the coordination and activities of life.
- Like cures Like (Law of Similars) The theory is that a substance, which produces symptoms of illness in a well person when administered in large doses, will cure the condition in a sick person, if administered in minute quantities.
- Law of Infinitesimals Homeopaths believe that there is a paradoxical effect to dilution. Let us take two aspirin dissolved in a cup of water as an example. Starting from the conventional dose, as we decrease the concentration (or increase the dilution), the medicine become less and less efficient. Homeopaths believe that there is a dilution threshold, below which the medicine starts getting potent again. This principle states that extreme dilution enhances the curative properties of a substance.
- Succussion Homeopaths believe that in the course of preparing a remedy, the process of shaking and tapping (succussion) makes the remedy more powerful. Together, the principles of dilution and succussion are called potentiation
- Whole Person Prescribing Homeopaths believe that characteristics such as temperament, personality, emotional and physical responses when prescribing a remedy, etc. determine how a given remedy may work. So, for example, two persons exhibiting flu like symptoms may get two different medications from the homeopath based on the appraisal of the mind/body constitution
- The Constitutional Remedy Homeopaths believe that one specific remedy can cure all the ills of a particular "constitional type"
- The Use of Natural Materials . There are several classes of remedies: those based on plants; those based on elements; those based on chemical compounds; those based on the effluvia of disease (nosodes); those based on preparations from healthy organs and tissues (sarcodes) and further.
Don't Call Conventional Medicine Allopathy
Allopathy is what homeopathic believers call conventional Western medicine. In this belief system, allopathy has taken a turn away from true healing because the physician
- does not take time to understand the patient
- does not fully understand the patient's disease, relying on information from biased sources such as the drug companies
- relies on synthetic drugs rather than natural remedies
- is too expensive for most people.
How Does All That Make Homeopathy Hard To Think About?
First off, homeopathy's use of natural herbs and elements can get mixed up with folk remedies, herbalism, and ethonobotany All three of these of these elements are of interest to CWM, because one of the hallmarks of CWM is seeking to refine the practice of medicine, to heal more completely and with lower cost (not just financial cost, but also cost in terms of side effects). Certainly, most educated people are aware that folk and indigenous medicine has supplied foundations to healing drugs such as aspirin (from willow bark), digitalis (from garden foxglove) and of course, the queen of medicine, the pain-eliminator, opium. So a person not thinking carefully might equate homeopathy with herbalism, and not notice that homeopathy includes more magical or mystical elements.
Another element is that CWM has several dark sides. We have all heard of surgical errors, such as where surgical equipment has been left inside the patient resulting in long term illness, or cases where plastic surgery has resulted in disastrous consequences. Many of us have had friends or family members undergo treatment that seemed to be worse than the disease, such as long-term chemotherapy. In the United States, our medical insurance system seems to be headed for complete disarray. Homeopathy, again and again, positions itself as a safe and effective alternative to CWM, as the following mendatious quotes show:
Since the early nineteenth century homeopathy has proved effective for many millions of people worldwide and it has often been used successfully where other forms of medicine have failed.
Homeopathy is a natural system of medicine that works by using a small dose of a substance to help stimulate the body's healing forces. Homeopathy is an effective safe treatment that is gentle yet extremely effective when used properly. The principle of homeopathy is based on the "law of similars." In other words, a substance that could cause symptoms in large amounts can heal you in minute homeopathic doses.
More studies have appeared in the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NJEM) showing homeopathy's effectiveness against ailments such as arthritis and allergies than for any other type of natural healing modality. The best news is that homeopathy is completely safe. The FDA has given full approval to these medicines. Because the remedies are so diluted, there is virtually nothing left in them except water. That's partly why it's so difficult to believe they work. Yet the energy of the original plant or mineral is still contained in the diluted remedy.
I believe that, as a citizen of the United States, I am entitled to protection from unsafe or unproven medical treatments, under the umbrella of consumer protection law. I believe I have the intelligence and wisdom to make truly informed choices about my own health care, given (a) adequate disclosure in labeling and other warranties; (b) that the Food and Drug Administration has adequate proof of safety and effectiveness for products and services claimed to prevent, alleviate, or cure any health problem, before such products and services are presented to me (or any other consumer).
Homeopathy is a special case in the United States. While homeopathy has been presented to generations of health care consumers as safe and effective, it has never passed adequate trials of safety and effectiveness for its remedies and philosophical approach. American consumers are being taken advantage with both over the counter remedies (OTC) and by prescribed medications.
Some of it is (as always) about the money. At the end of the nineteenth century, in the previous hey-day of homeopathy, many if not all of the practitioners compounded their own remedies. Also, as the following quote from the Homeopathic Pharmacopia of the United States shows, there were roadblocks to homeopathy becoming big business, whichwere removed by the FDA's adoption of a Compliance Policy Guide that favored homeopathy over conventional Western medicine: [the emphasis added is mine]
For many years (from 1938-1988) homeopathic drugs were sold in a regulatory vacuum. FDA action was based on institutional understanding and informal agreements between agency officials and industry members. This caused the FDA to regulate in an unpredictable manner that made the homeopathic industry unsafe from a regulatory and investment standpoint; and the practice of homeopathy open to the whims of local regulators. During the period, the FDA viewed all homeopathic remedies as prescription drugs. From 1982-1988, the industry, professional and consumer members of the community through the American Homeopathic Pharmacists Association (AHPhA) worked with the FDA in the development of a regulatory framework called a Compliance Policy Guide (CPG). Although the community didn’t get every provision that it sought, it is argued that the community obtained about 80% of its requests. The new CPG strengthened the definition of the homeopathic drug, set forth guidelines for the prescription and nonprescription drugs and made clear packaging and labeling guidelines.
Rx and Homeopathic Medicines
The most important element was that the CPG established that homeopathic drugs could be OTC; setting guidelines for an OTC homeopathic drug by saying that an OTC homeopathic was a homeopathic drug claimed for a self limiting condition which did not require medical diagnosis or monitoring and was non-toxic. Further, such drugs, whether sold on an active or reactive basis, needed to be fully labeled with at least one indication for use (and a package insert if Rx.) At one time, the industry was required to drop all Latin labeling but was able to get the regulation rescinded. The industry was not pleased with these restrictions, but they were better than the worst case scenario of all homeopathic drugs having the status of prescription products.
Why would that be the worst- case senario? Because the real money is in OTC.
Today, homeopathy world-wide is big business, as the following quotes from a huge homeopathic company shows:
Boiron Q1 Sales Reach US$83.3m
Milena Izmirlieva, April 25, 2003
"French herbal and homeopathic drug manufacturer Boiron SA posted consolidated sales of 75.5m euro (US$83.3m) in Q1 2003, up from US$78.6m in Q1 2002. Sales outside France totaled US$28.2m with North American subsidiaries reporting sales of US$6.6m, slightly lower than in Q1 2002. Sales of European subsidiaries excluding France went up to US$13.7m. Direct exports and sales in metropolitan France, including sales of Boiron's production unit Herbaxt, increased to US$7.8m and US$55.1m respectively."
Economic Realities of Homeopathy
Sales of homeopathic medicines represent more than a billion Euros worldwide, or approximately 0.5% of the entire pharmaceuticals market. (SNPH 2000)
Nearly 70% of this activity is in Europe, led by France and Germany, the countries from which homeopathy has expanded during the past century. (SNPH 2000)
France, at 230 million Euros, is the world's largest homeopathy market, followed by Germany, then by countries such as India, Brazil, Italy and the Netherlands.
This demonstrates the vast resources of homeopathy
The FDA and Homeopathy
In the United States, due to an accident of history, homeopathic "remedies" are recognized by the Food and Drug Administration. (1) as drugs and (2) as safe and effective. However, to the best of my knowledge, no homeopathic remedy has ever been tested to the level of proof required for any other class of drug. How did this come about? There are four short answers:
- The original FDA-establishing legislation was written at a time, 1938, when conventional Western medicine was not much more sophisticated than homeopathy, in terms of diagnosis and treatment of most diseases and injuries.
- The senator, Royal Copeland, who chaperoned the 1938 legislation was a physician who believed in homeopathy. Under his aegis, the law was so phrased that all substances included in the Homeopathic Pharmacopeia of the United States are recognized as drugs.
- Prior to 1988, homeopathic products occupied a very small niche in the entire over the counter (OTC) and prescription marketplace. The FDA more or less expected homeopathy to wither away. But the profound social changes of the 1970s--"nature" and "wellness" gave homeopathy, especially OTC homeopathy, into big business--$230 million in 1996. Homeopathic companies have a tremendous economic advantage over conventional drug companies: they don't have to show that the products they sell are effective.
- The FDA even now in the early 21st century has more assignments than budget. Homeopathy, although useless, is not actively dangerous the way other deceptive treatments may be. For most remedies, you can't overdose. Therefore, the FDA has bigger fish to fry.
Some Background On The FDA
One essential basis of the FDA we have today is the 1938 Federal Food, Drug, and Cosmetic Act. (It was a vital necessity--to learn how far we have come in protecting ourselves from harmful products, read this history: The Story Of The Laws Behind The Labels.) In the early 1930s, the first pass at creating stronger Federal control of the safety of foods and drugs, the "Tugwell bill" was a legislative disaster. The opposition of industry and advertising interests to this proposed legislation was total and overwhelming. Nonetheless, something had to be done--people were dying from adulterated products and unregulated, deadly drugs. The senate sponsor of the Tugwell bill was Royal S. Copeland, a physician-turned-politician, who was entirely educated in Michigan. Copeland was trained and practiced at a time when Western medicine had barely recognized the germ theory of disease. Penicillin, the first antibiotic, was not in wide use until the 1940s.
Medicine in The United States
Homeopathy was introduced into the United States in 1820s, when "mainstream" medicine included such treatments as bleeding, the administration of large doses of toxic substances (such as mercury to treat sexual diseases) and the like. In this setting, the homeopath look appealing. By 1900, more than 14,000 homeopaths had been trained, and 22 schools taught the theory in the United States.
At the end of the nineteenth century, the American Medical Association (AMA) led a campaign to improve the quality of medical education and bring quality controls to curricula. This campaign ultimately led to the landmark report by Flexner in 1910. Among other outcomes, the resulting changes in medical education led to the acceptance of the biological, disease-oriented models that dominate medicine in the United States today. State licensing boards, influenced by the AMA, limited the practice of medicine to graduates of accredited institutions, and research funding became the domain of the major teaching centers.
All these factors put great pressure on smaller schools (and their graduates, many of whom were homeopaths) that could not meet the emerging requirements for medical education and practice. As a result, many schools that taught practices such as homeopathy were closed, homeopaths were shunned and stigmatized, and their therapies became the "alternatives" to the standards that evolved after acceptance of the Flexner reports. In contrast, Osteopathic schools like followed the lead of conventional medical schools, and developed rigorous standards and practices.
July 5 2010 Stephen Barrett is the doctor behind QuackWatch a wonderful resource for exposing bogus medical claims. Among the many subjects of common charlatanry he's taken apart, one is the use of invalid tests to justify useless treatments, like chelation for autism, which is a goldmine for quacks.
One of the labs providing the urine tests "proving" the need for chelation is Doctor's Data. They have sued Dr. Barrett.