Tag Archives: quacks

Homeopathy – The Placebo Effect

 

I’ve wanted to write about homeopathy for a long time. As you have probably already guessed if you frequent this website, I am somewhat of a sceptic. Questioning the truth and validity of things is in my nature. My training as a neuroscientist has only increased my disdain for pseudoscience and alternative medicine who’s growing popularity in this age of true science and discovery is nothing but woeful.

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‘Homeopathy is a pseudoscience – a belief that is incorrectly presented as scientific’

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Homeopathy, as we know it, was created by a man named Samuel Hahnemann in 1796 with the release of his book ‘Organon of Medicine’. Anything about homeopathy that you can find today is based on teachings from this book. This is where it all begin. The 6th edition of the book opens with this quote…

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‘The Organon may in time be widely recognized as one of the most important books in the entire history of medicine, because it introduces in the long story of man’s struggle against disease a successful system of medicinal therapy that contrasts radically with everything previously taught and practised.’

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Grammatical errors aside, I can assure you, that this will NOT be the case. One day homeopathy, as well as all unproven alternative medicine will fade into myth and memory as long as people continue to question it!

Homeopathy is aimed at a niche market split into two halves. One represents the naive buyers of homeopathic remedies which commonly have no active ingredient and are usually inert substances or water. These are normal people with no scientific training who have fallen for a scam or are trying something new based on a recommendation. The second half are the ignorant, ill-informed and vocal supporters of homeopathy many of whom are distrustful of empirically proven effective medicines and will stop at nothing to label anyone who speaks out against homeopathy as a brainwashed shill of the big pharmaceutical companies (we will meet some of those later).

We must do our best to question dubious pseudoscientific practices. Luckily the government is in agreement…

The United Kingdom’s House of Commons Science and Technology Committee has concluded that homeopathy is ineffective, and recommended against the practice receiving any further funding.

Read on to find out about the core beliefs of homeopathy, what the science says about the practise, and what happens when you question the hard-core believers.

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The core beliefs of homeopathy: pure magic

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The concept of homeopathy raises a number of issues before we even look at the science. The fact that homeopathic solutions are SO diluted that no active agent still persists is just one major issue that faces the homeopathic community. Others include notions of things like ‘water memory’ which state that water takes on the molecular form of any substance it comes into contact with. This is so preposterous that I just don’t know where to begin. Proponents of homeopathy are often very anti-pharmaceutical industry. If water really mimicked drugs do you think big pharmaceutical companies would spent literally billions of dollars developing drugs? No. I don’t think so.

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So what are the core principles of homeopathy? I’ve taken this mainly from www.hpathy.com as they have a good amount of detail about the different principles…

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The Law of Similia – ‘Like cures like’ :  the choice of the medicine is fundamentally based on the principle that the medicine must have the capability of producing similar symptoms of the disease to be cured in healthy persons. So backwards I don’t know where to begin. Based on this idea, in order to cure cancer a medicine must cause cancer -related symptoms in an healthy individual…makes…sense…

Law of Simplex – Only give one ‘homeopathic medicine’ at a time. This makes sense if we are testing the efficacy of a compound but many diseases require complex treatments requiring multiple drugs at once. 

Law of Minimum – Give the lowest possible dose of the medicine so that it doesn’t interfere with the vital source. This is based on the idea that small doses stimulate, medium doses paralyze and large doses kill. Dosing is VERY important in real medicine however homeopathic ‘treatments’ are often so dilute that they have no active ingredient left. Dosing is therefore entirely irrelevant. The less said about the ‘vital source’ the better. A large enough dose of pretty much anything can kill a person but that isn’t the issue. The issue is the idea that ‘infinitesimal’ doses are the most curative. Medicines usually work by targeting some sort of cellular receptor and changing a variety of signalling systems. If there is no drug (due to massive dilutions) these systems aren’t affected! 

Doctrine of Drug Proving – Recordings of drug proving give the only reliable knowledge of medicines which is very essential to cure disease homeopathicaly – drugs must be proved on animals as the symptoms of the drug and the disease are indistinguishable. We then must test on humans as mental symptoms are not seen with animals. At first glance this seems like actual planned drug testing first on animals and then scaled up to humans. Although some homeopaths do this their reasons are entirely backwards. According to Point 1 above that ‘like cures like’, effective medicines produce the same symptoms in healthy people as the diseased people experience – this is almost never the case. Taking Irritable Bowel Syndrome as an example; anti-motility medicines are often prescribed as they slow gut motility and  help relieve diarrhoea. Based on homeopathic teachings if I (a healthy person) were to take anti-motility medications, I would then suffer from diarrhoea. It just doesn’t hold up on any front.

 Theory of Chronic Disease – Chronic diseases are caused by chronic miasms. The miasms are Psora, Syphilis and Sycosis. Psora is the mother of all diseases and at least 7/8th of all the chronic maladies. You won’t see the words Psora or Miasm in the medical literature as they are only recognised by homeopaths. Lots of real research in the last few decades has shown that low-grade and often sub-clinical inflammation is a driver behind many different diseases ranging from diabetes to obesity and many chronic diseases inbetween. This was assessed through hundreds of well-designed studies. So it is true that lots of chronic diseases can have the same or similar underlying causes. However, The concepts of the miasms were invented by one man based on the observation that people had recurrence of symptoms when diseased. 

Theory of Vital Force – The human organism is a triune entity consisting of body, mind, and spirit. This spirit which is responsible for different manifestations of life was termed by Dr. Hahnemann as ‘Vital Force’. In the healthy condition, it is the vital force which maintains normal functions and sensations of the organism. The idea behind this is kind of on the right track. The body is a finely tuned machine constantly aiming to maintain balance and homoeostasis in multiple physiological symptoms. The theory of vital source believes that a misalignment of the triune entity leads to damage to the vital force which manifests as disease. You can sort of see where this idea sprang from – someone contracts a bacterial infection, the immune system kicks in to action, individual shows signs of disease as a result. To a homeopath the major points are Vital Source is compromised (somehow), disease manifests. 

Doctrine of Drug Dynamisation – Homeopathic dynamisation is a process by which the medicinal properties which are latent in natural substances while in their crude state, become awakened and developed into activity to an incredible degree. According to Dr. Stuart Close, “Homeopathic potentisation is a mathematico-mechanical process for the reduction, according to scale, of crude, inert or poisonous medicinal substances to a state of physical solubility, physiological assimilability and therapeutic activity and harmless, for use  as homeopathic healing remedies.” The quote is essentially a load of drivel, using big words to carry authority without really saying much. Dynamisation is achieved either using trituration (dilution of a potent drug powder with an inert diluent powder) or Succussion the action or process of shaking). According to homeopaths using these processes turns poisonous substances into ones of healing, increases the ‘dynamism’ of the medcine which is more important than quantity, medically inert crude subtances are transformed int powerful healing substances. Its this major point here that the medical community has so many issues with as it goes against the basics of chemistry and known biology and has never been shown to happen in any controlled study. Turning a poison into a powerful and true healing factor by shaking it or diluting it isn’t real!

 

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Well there you have it. That’s the major run down of the key principles of homeopathy. They tend to vary a little bit depending on the source. If you are interested in the original work that popularised homeopathy  in 1796 by Samuel Hahnemann, then you can find a PDF version of the 6th edition of this questionable book right here.

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What is the placebo effect?

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The placebo effect sometimes also called the placebo response is a truly remarkable medical phenomenon in which a fake treatment such as a ‘sugar pill’ can sometimes improve a patients condition simply because they expect it to. The whole core of this effect is that the patient BELIEVES what they are receiving is actual medicine, not just a fake pill or solution.

In the pharmaceutical industry, placebo treatments are commonly given alongside newly developed drugs. This is to determine whether new drugs have a therapeutic effect to a greater degree than we would see with a fake placebo drug – this helps determine the true medical benefits of a particular drug. Well-designed studies are described as ‘double-blind’. This means that neither the researcher giving the drugs or the participant taking the drugs known who is receiving the real medicine and who is receiving the placebo.  The information of who gets what drug (real or placebo) is usually held by another researcher who is not involved in the study or data analysis in any other way.

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If patients taking the real drug show significant improvement in comparison to the placebo group then this helps support the conclusion that the medicine is effective.

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The concept of positive thinking has been around for countless years – the idea that a positive outlook on situations can ultimately help said situations. The specific idea of the placebo response however is more recent and was popularised by a paper called ‘The Powerful Placebo‘ written by prominent anaesthesiologist Henry K Beecher back in 1955. This can be considered a type of meta-study in that he took a number of studies from the time which explored the placebo effect and then came to an overall conclusion based on the individual findings of these papers. In total he analysed 26 studies and found that, on average, 32% of patients respond to a placebo treatment. This has since been criticised for perhaps over-inflating the true numbers as he didn’t distinguish other factors from the placebo effect. He would later go on to write additional papers expanding on the idea of placebo-responders and non-responders. The general idea being that most people will simply not respond to a placebo treatment. Those who do however, show modest improvements in their conditions.

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It has been shown in the literature that placebos have real and measurable physiological effects…

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Athsma

Pain

Reduced anxiety

Reduction in depression symptoms

Irritable bowl syndrome

Parkinson’s disease

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Interestingly, the opposite can also occur. Placebos can actually cause negative or side effects. This is described as a nocebo effect.

These effects don’t have to be produced by a physical intervention such as a placebo drug but can also occur if someone is given a negative medical prognosis.

Although the placebo effect may seem like a good thing (especially for homeopaths as this is the only route by which homeopathy may be beneficial) it means much greater care is required when trialling new drugs. We have to control for the placebo effect. 

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The placebo effects is real but how or why does this happen?

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Proposed mechanisms

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Although the placebo effect produces real physiological responses- exactly why or how this happens is not full understood. There appear to be a number of process occurring simultaneously which may produce the observed effects.

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‘The placebo effect is part of the human potential to react positively to a healer. A patient’s distress may be relieved by something for which there is no medical basis. A familiar example is Band-Aid put on a child. It can make the child feel better by its soothing effect, though there is no medical reason it should make the child feel better’

-Medicine Net

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Expectancy and conditioning: 

The placebo effect is related to the expectations and perceptions of the patient. If they view the placebo as helpful then generally we see some kind of healing effect. Conversely, if the placebo is seen as harmful we will observe a detrimental effect – the nocebo effect. Expectation plays an additional role when we consider what the placebo looks like – bigger more colourful placebo pills often equate to a bigger health effect. Interestingly, it was thought the placebo was based on the notion that patients believe they are receiving medicine when in fact it is a ‘dud’ pill. Essentially a form of deception. However, it has been shown that even when people with Irritable Bowl Syndrome are told that they are receiving a placebo, we see a modest improvement in symptoms. Placebos can act similarly through classical conditioning, wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus. This concept was famously explored by Pavlov with his dogs and bells.  So we know that the placebo effect is based on what people expect to happen…but what about the true phyiological effects produced when taking a placebo?

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Effects on physiology:

A number of studies have shown measurable changes in physiology as a result of placebo treatment. These changes likely underlie any reduction in symptoms in health benefits observed. The effects of placebo analgesia (pain relief) on higher brain circuits have been studies in depth primarily using MRI scanning to highlight areas of activation in the brain.

Placebo responses are linked with enhanced dopamine and opiod signalling in reward and motivated behaviour pathways. Additionally, nocebo responses were associated with deactivation of these same circuits and reduced dopamine and opiod release.

Moving away from pain-related treatment, placebos have other   measurable physiological effects. I mentioned earlier that placebo can have a positive effect on Parkinson’s disease – this is down to increased dopamine secretion (Parkinson’s is typically caused by a destruction of dopaminergic neurons). When looking at depression, placebo treatment appears to affect many of the same areas activated by common anti-depressants with most emphasis being on the prefrontal cortex. In another interesting study, coffee which contained ‘placebo-caffeine’ caused an increase in dopamine secretion. The concept of placebo ergogenic aids (performance enhancers) has been debated on and off by the sporting industry as to whether they should be allowed.

We know that the placebo effect is real and that is stems from our perception of drugs and what we expect them to achieve – we also know that symptom improvement can be due measurable physiological changes such as changes in hormone secretions. However, the broader question of exactly why our bodies show physiological alterations just because we think they should is still quite baffling.

Hopefully I’ve explained fairly clearly what the placebo effect is and how it can produce modest physiological effects in placebo-responders. The placebo effect also explains why wacky interventions like homeopathy can in fact alleviate symptoms in those who believe it will.

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Nothing about the concept of homeopathy is special – it is simply the placebo effect.

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What does the science say about homeopathy? The papers I will be consulting will be non-biased, peer-reviewed papers. Not poorly conducted ‘studies’ by practitioners of homeopathy. When performing your own research, if you can, aim for well respected journals, that publish peer-reviewed papers  with no-conflict of interest from the authors. If you want to be extra careful you can also search for the authors and check the quality of the papers they have published in the past.

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Homeopathy: what does the science say?

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Below, I’ve summarised the most prominent studies into the effects of homeopathic treatment on a variety of disorders and diseases.

 

 

http://www.whillyard.com/pseudo-science/homeopathy.html

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Before we go into studies a little bit about how homeopathy is currently regarded in the scientific community…

The fact that homeopathic preparations often lack even a single molecule of the original diluted substance has been the basis about the effects of preparations for decades.  The concept of ‘water memory‘ is now thrown about by modern proponents of homeopathy. The idea being that water has the innate ability to mimic the effects of whatever it is diluted with. This goes against our current understanding of matter has never been demonstrated to be true in any way. Quite obviously, basic pharmacological research has shown that stronger biological effects come from higher doses of active ingredient, not lower.

In true medical and scientific circles (i.e. not alternative medicine), homeopathy has never been taken seriously as a treatment for anything and is often considered a sham or pseudoscience. Those who support and promote homeopathy, rightly or wrongly, are often labelled quacks. Now the reasons for this are very straight forward –

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”There is no sound statistical evidence of therapeutic effect, which is consistent with the lack of any biologically plausible pharmacological agent or mechanism”

-From: Ernst E  ‘A systematic review of systematic reviews of homeopathy‘ Clin Pharmacol. 2002;54(6):577-82.

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Some practitioners of homeopathy put forward very advanced and abstract theoretical physics concepts in order to explain why homeopathy works. These concepts include quantum entanglement, quantum non-locality as well as chaos theory. The people putting these theories forward are not even close to being experts in these fields and often explain them incorrectly. They are also not supported by any actual experiments – its all just speculation and nonsensical explanations.

Aside from a lack of any solid evidence to support the efficacy of homeopathic treatments – the key ideas of homeopathy conflict with fundamental concepts of physics and chemistry.

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Looking at systematic reviews of the literature…

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‘No individual preparation has been unambiguously shown by research to be different from placebo’

Ernst 2002

‘Studies that were explicitly randomised and were double-blind as well as studies scoring above the cut-points yielded significantly less positive results than studies not meeting the criteria’

Linde K et al 1999 – explaining that as study design has become more fair, homeopathy shows even LESS efficacy than it has in the past

“The most reliable evidence  fails to demonstrate that homeopathic medicines have effects beyond placebo.”

Cochrane Systematic Reviews 2010

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Almost all modern meta-studies  show no effect of homeopathic treatment beyond what we would expect with a placebo effect. Those meta-studies which DO show a small effect also state that this outcome is likely due to weak trial design which leads to biased results. As study sign has improved – these positive outcomes are no longer observed.

A quick look at the dilutions involved just so you have an idea of what a ‘minute or infinitesimal amount really is. In homeopathy the most commonly used dilution is called 60X or 30C. This is a 10-60 dilution of the original agent. That might not sound crazy but let this put it into perspective…

At a concentration of 60X/30C…

‘Dilution advocated by Hahnemann for most purposes: on average, this would require giving two billion doses per second to six billion people for 4 billion years to deliver a single molecule of the original material to any patient.’

-Wikipedia: Homeopathic Dilutions

For all intents and purposes, this dilution isn’t even close to containing a fraction of a single therapeutic molecule of medicine. 

The science concerning the efficacy of homeopathy is conclusive and has been or a long time. Read on for what happened when I disagreed with the NHS funding homeopathic treatments…it’s mental.

 


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The ‘Facebook Fight’

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I usually try to avoid openly arguing with certain people. In this case I simply couldn’t help myself. I was scrawling through Sky News and noticed a small story at the bottom about NHS homeopathy funding.

I thought ‘surely that can’t be right’.

But it was right. Turns out, tax payers money does fund a small homeopathic budget. I found this pretty ridiculous. I think people should be able to spend their own money on pretty much anything, but taxpayers money? On something that has been repeatedly disproved? I decided to dig a little deeper.

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I came across the British Homeopathic Association Facebook page. I had a look around the page and saw that the (very few) members were up in arms about a story detailing that health chiefs were planning to cut homeopathic funding. At this point I couldn’t help but chime in. Oh dear. What a mistake that was. Delve into the madness below…

Admittedly my opening gambit was a bit full on, perhaps poorly worded in hind sight. However, the argument/conversation that followed was very interesting.

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Zoom in on this. It’s worth a read!

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Linda Holmes was very vocal throughout the exchange and a quick peak at her Facebook page reveals someone completely absorbed in conspiracy theories and pseudoscience.

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Lovethispic.com sounds like a legitimate research source…

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I’m not sure why but in my research it seems that pseudoscience believers are so often always conspiracy theory crackpots, yelling in various Facebook groups and forums that ‘Big Pharma’ is trying to keep us sick to make money and that cancer has been cured but there’s ‘no money in cures’.

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Take off the tin foil hat Linda! Aliens aren’t reading your thoughts

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It’s all mad and it’s terrifically difficult if not impossible to convince these people that maybe, just maybe, the world isn’t trying to murder them and coffee doesn’t cure Alzheimer’s.

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‘Drugs will always drugs’

-Linda

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Our friend Katie (final comment from the large exchange above) cherry picks one particular example of a (probably), self-resolving infection (no details of the use of actual medicine but if she was a real nurse then presumably this infant would also be on some kind of antibiotics) in a new born. She has then attributed this positive outcome to the use of homeopathic medicine i.e. water. As such, no amount of real scientific evidence or research AGAINST her belief will convince her that she is wrong.

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What homeopaths and almost all other practitioners of allopathic/alternative medicine rely upon is anecdotal evidence and personal testimony both of which spit in the face of the scientific method. Quackwatch points this out rather well:

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‘Imagine if the FDA or pharmaceutical companies, like GSK, decided that large scale drug trials where too expensive and ‘pointless’ and relied on the experiences of a few patients when interviewed about a particular new drug.’

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Katie has used an ‘n’ of 1 in her observation. An ‘n’ number in a study, put simply, is an experimental unit. If you are testing the efficacy of a compound on 20 mice then that experiment has an n number of 20. We conduct a power analysis before an experiment to determine how many n number we need in order to detect a difference between experimental groups when a real difference actually exists. This is important as it limits the ‘over-use’ of precious animals and also means you don’t under-power your experiment and potentially waste your time and the lives of your animals. Katie has an n of 1 which is useless in all situations I can think of. Again, it’s anecdotal and personal experience.

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I could provide these people with multiple large scale studies (lots of n) showing the fallacy of homeopathic medicine but they wouldn’t read them and even if they did, it would still be denied. No one likes being proven wrong, including me, but sometimes you have to take a step back and really look at the evidence, or lack thereof, that support your claims.

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This sort of thinking spills over into all aspects of these peoples lives. One commentator on this post has a Facebook page almost entirely dedicated to quackery. Highlights in included:

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‘Big pharma has a cure for cancer but won’t release it’

‘The FBI created HIV’

‘Peanut butter cures Alzheimer’s’

‘Green tea cures cancer and pharma doesn’t want you to know’

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I’ve written extensively about the myths surrounding green tea before.

Looking at Alzheimer’s, even just a small amount of research on the topic of peanut butter and Alzheimer’s would show this is not true. Do these people not realise that if their claims were true then what they preach would be common place? We are seeing an increase in Alzheimer’s in this country due to an ageing population. I work alongside an Alzheimer’s research group in fact. If peanut butter really did cure the disease do you think members of that research lab would be working long hours on in vitro release study’s and in vivo models desperately trying to combat it?  No.

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Harsh but fair.

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But what about when homeopathy appears to work?

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We know that modern, well-controlled and designed studies show that overall, homeopathy is no better than a placebo. Then how do we explain all these anecdotes or personal testimonies from homeopaths about them witnessing healing miracles?

Quite simply. Science offers a number of explanations as to how homeopathy may cure diseases or alleviate symptoms despite having no true medical efficacy…

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  • The placebo effect –  expectations for the homeopathic preparations may cause the effect.
  • Therapeutic effect of the consultation – this falls under the umbrella of the placebo effect. The care and reassurance a patient experiences when talking to a caregiver can have a positive effect on the patient’s health.  Studies have shown this effect to be real.
  • Unassisted natural healing – many diseases are disorders are self resolving. ‘Homeopathic’ healing is wrongly attributed to the natural healing process over time.
  • Unrecognised treatments – changes in diet, exercise habits and lifestyle choices can have massive positive impacts on health but may not be recognised as the cause of healing at the time.
  • Regression towards the mean – lots of diseases are described as ‘cyclical’ with patients going through good and bad periods. As people are more likely to seek treatment when feeling the worst, the odds are that from that point they will start to feel better due to this cycle even without medical intervention. Mistakenly attributing healing to a homeopathic remedy during the ‘bad’ phase of the cycle is probably fairly common.
  • Medical intervention – patients may also receive standard medical care at the same time as homeopathic treatment with real medicine being responsible for health improvements.

In reality, healing effects are probably due to a combination of these occurring at once. All the anecdotes and stories you hear from homeopaths will be down to one or more of these reasons. These are actually very straight forward ideas but few people stop to consider them – especially those with no interest or knowledge in real biology or health sciences

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What to make of all this?

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Research into the placebo effect is still ongoing. As of now, the effect is known to be real but the exact mechanisms by which it works are still under investigation. In individual cases were homeopathy ‘works’, the benefit is due to the placebo effect. I have no problem with this. People genuinely recovering from mild illnesses can only be a positive thing. However I DO have a problem with the mentality of hard believers of homeopathy who will often claim their ‘water’ is more effective than modern medicine.

This is not only false but also potentially dangerous – you should NEV ER seek out alternative treatments instead of evidence based, proven medicines. 

Another area of contention are companies and individuals, who, knowing homeopathy is hocus pocus, market and sell expensive potions to willing and naive homeopathy practitioners. I just wish that in this day and age we were beyond this medieval mind set.

Modern medicine is EVIDENCE BASED. Homeopathy is not.

While homeopathy may provide beneficial effects for mild disorders (through the placebo effect) it will not in any way cure serious or life threatening diseases and it is unfair and untrue to claim that it will.

My advice?

By all means, take homeopathic remedies to combat things like anxiety if you must (try not to spend too much, it is water after all), but never EVER choose homeopathy over evidence based modern medicine for anything remotely serious.

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Thanks for reading!

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-ScienceGuy

Reach me in the comments below or at ed@scienceguysupplements.com

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References

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References can now be found linked directly in the text rather than listed in this section. Delving deeper into the research has never been easier!

If you are looking to do a bit of your own research, on any topic, PubMed and Google Scholar both have a huge literature collection.