The Bottom Line
Dec. 11, 2000 -- When Judy Waters began sniffling and sneezing around her cat, an allergist prescribed a hydrocortisone nasal spray that made her ill during a trip to Japan. Waters, now a 40-year-old actor living in Los Angeles, recalls that she couldn't digest food and was constantly exhausted.
That dismal experience motivated Waters to try a form of alternative medicine known as homeopathy. Like many homeopathic products, what she began taking -- an extract of red onions called Allium sepa -- had been diluted so many times, it contained no active ingredients. But after the first dose, "within 20 minutes, I felt better than I had in a month," she says.
More than a decade later, Waters still relies on homeopathic remedies to stifle her allergies, though she occasionally resorts to an herbal treatment or a medicine like Claritin for severe symptoms. Her evaluation of homeopathy: "I think it's fabulous."
Stephen Barrett, MD, a retired psychiatrist and operator of the consumer-advocacy web site Quackwatch, disagrees vehemently. "Homeopathy is the ultimate nonsense," he says. "If you use a homeopathic product and it seems to help you, you've been mentally damaged if you believe that."
Few kinds of alternative medicine arouse such passionate and clashing reactions. While many patients, homeopaths, and even some doctors swear by it, many other physicians and scientists blast it as quackery. The government of Israel has even banned it.
The skeptics and supporters agree on one thing: Homeopathy is booming. U.S. sales of homeopathic remedies have exploded in the last decade, rising from $170 million in 1995 to $400 million in 1999.
Like Waters, many of the patients flocking to homeopaths' offices are refugees from mainstream medicine, seeking what they believe is benign, natural relief for stubborn chronic conditions. But are they getting what they seek? For two centuries, homeopathy and mainstream medicine have seemed incompatible, and most doctors have dismissed any improvements from treatment as due to the placebo effect. But now, say some researchers, a growing body of careful studies bolsters the view that homeopathy works beyond the placebo effect -- a conclusion fiercely disputed by critics.
Homeopathy dates back 200 years to the work of Samuel Hahnemann, a German doctor seeking a kinder, gentler alternative to the often brutal treatments of the day. Hahnemann argued that any substance that produces a symptom in a healthy person can cure that symptom in a sick person. Today, the homeopathic medicine cabinet contains products derived from sulfur, snake venom, duck liver, squid ink, mercury, arsenic, belladonna, crude oil, and a host of other natural compounds -- many of them identified by Hahnemann.
Hahnemann also believed that even minute doses could cure, and he diluted his preparations multiple times before giving them to patients. Modern homeopathic mixtures can be diluted a millionfold or more -- often so many times that no active ingredients are left.
So why is this 200-year-old field booming now? Dana Ullman, MPH, president of Homeopathic Educational Services in Berkeley, Calif., and a leading expert on homeopathy, sees several reasons behind its rising popularity. In part, people are seeking safer therapies for themselves and their children and are frustrated with conventional medicine's inability to control symptoms over the long term, he says. Homeopathy is an attractive option, he says, because it sees symptoms as the body's adaptive responses to disease or injury.
"Symptoms just don't represent breakdown and infection," he says. "They represent the organism's best effort to respond to stress and change," and they should be aided rather than suppressed in order to speed healing, he says. For instance, Ullman explains, conventional treatments for colds try to stop nasal discharge. But homeopathic remedies enhance nasal discharge because it's part of the body's defense against cold viruses.
Another attraction may be the amount of care and attention patients receive during office visits, especially if they're used to the harried pace of managed care. Initial examinations may last more than an hour, during which the homeopath tries to build up a profile of the "physical, emotional, and mental characteristics of the patient" in order to select the correct treatment, says Ullman.
When strategy analyst Jonah Staw first went to a homeopath for allergies, for example, he was startled to be asked questions like, "What do you love and what do you hate?" and "Do you crave sugar?"
"It's like going to the therapist," says Staw, 25, who lives in San Francisco and has used homeopathic treatments since the age of 8.
Hahnemann challenged the medical establishment of his time, starting a running battle that continues today. Many skeptics dismiss homeopathy outright because it doesn't square with the principles of biochemistry, which state that molecules must be present in a solution to produce an effect. They argue that since most homeopathic mixtures don't contain active ingredients, any benefits must derive from the placebo effect, and thus buyers are falling prey to hucksters.
Homeopaths counter that this view -- they see it as blind prejudice -- doesn't jibe with the positive results from several recent studies. One of these, published last summer, created a stir by suggesting that homeopathic treatment might work against mild allergies. Physician David Reilly of the Glasgow Homeopathic Hospital in Scotland and his colleagues determined what substance caused the allergies of 51 patients, then had a supplier create pills with these substances diluted to infinitesimal levels. Compared to a placebo group, the patients who got the homeopathic treatment had significantly less nasal congestion. However, the patients' subjective evaluations of their condition did not differ between the groups.
Combined with the results from the team's three previous trials -- which used a similar regimen against hay fever and allergies -- the work suggests that homeopathy is more than a placebo, Reilly and colleagues conclude in the August 19-26 issue of the British Medical Journal.
A large "meta-analysis," pooling 89 studies on conditions as disparate as warts and seasickness, in the Sept. 20 issue of The Lancet reached a similar conclusion. However, the authors also cautioned that there wasn't enough evidence to determine whether homeopathy is effective for any particular complaint.
Summing up the research on homeopathy, Ullman says, "I think we are beyond the question 'Does it work?' Yes, it works." And now we need to start asking how to refine homeopathy to make it more effective and precise, he says.
The skeptics remain unconvinced. Wallace Sampson, MD, editor of the Scientific Review of Alternative Medicine, criticizes the meta-analysis for including what he says are low-quality papers. Sampson also takes issue with the series of studies by Reilly and colleagues. In the team's previous paper on asthma, Sampson points out, two out of three objective measures of the patients' condition didn't differ significantly, but the patient's subjective evaluations did. Given these contradictions, he says the two studies "do not confirm each other," as Reilly and colleagues suggest.
According to Andrew Vickers, DPhil, a researcher at the Royal London Homeopathic Hospital in England, who considers himself an open-minded skeptic, the weight of the evidence supports the notion that homeopathy is more than a placebo, but there isn't enough solid data to draw a final conclusion. Most of the research so far consists of small, isolated trials that have not been repeated, he says.
And since most scientists see homeopathy as a challenge to 200 years of accumulated knowledge about chemistry, you need an enormous amount of evidence to "really blow the old view out of the water," he says.
But these scientific scuffles don't worry homeopathy users like Staw. He acknowledges that his improvement could be due to the placebo effect, but says he doesn't care. "Whether or not there is any truth to this," he says, "it works for me."
Mitch Leslie writes about science and medicine from Albuquerque, N.M. His work has appeared in Science, Science Now, and Modern Drug Discovery.
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