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Homeopathy - critically asked about origins, application and effectiveness

Homeopathy - critically asked about origins, application and effectiveness



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Interview with the Dr. Jens Behnke on homeopathy
The discussion about homeopathy is sometimes heated and controversial. Dr. makes a contribution to objectification when dealing with the subject 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 doctor and chemist who was born in the mid-18th century. After successfully completing his medical studies and practicing for a short time, he closed his practice and began working as a translator of specialist books. In his view, the medicine of his time often harmed the patient more than it was used: Many therapy regimes, for example, provided massive bloodletting and the administration of heroic doses of highly toxic substances such as mercury or deadly cherry. Hahnemann founded homeopathy after self-experimenting with Chinese bark, a well-known cure for malaria. It produced malaria-like symptoms in him. This gave him the idea that substances that can produce certain symptoms in healthy people can cure similar symptoms in the event of illness (simile principle). Subsequently, he systematically researched this hypothesis and applied the derived form of therapy in the treatment of the sick. Hahnemann lived in Paris in his late years. His busy practice enjoyed an international reputation.

What medical ideas was Hahnemann's teaching based on? What do "life force", "life energy" or "miasms" mean? What is the Simile principle and what medical tradition does it come from? What evidence did Hahnemann show for the effectiveness of his idea and method?

Homeopathy is a drug therapy that prescribes substances manufactured according to a certain procedure (potentiation) and tested on healthy individuals individually on the basis of the Law of Similarity. I have already explained the simile principle in Hahnemann’s sense above in connection with Chinese bark. From a medical history perspective, related ideas can be found at Hippocrates or Paracelsus. It is important in this context that the homeopathic rule of similarity has nothing to do with medieval signature theory. This assumed, for example, that bloodroot (Potentilla erecta) had anti-bleeding properties because a red dye escaped when the plant was cut.

Theories about life force or miasms (Greek for evil "haze, contamination, defilement") are secondary to homeopathy then and now. For example, some homeopaths completely reject the idea of ​​miasms as the cause of chronic diseases, while others consider it helpful. Originally, the observation that chronically ill people are not so easy to cure permanently led Hahnemann to the thesis that other processes have to play a role here than in acute illnesses. He assumed that previous infections and the resulting constitutional burdens could play a role, which may even be hereditary. Analogous ideas can be found in today's genetics. If one wants to establish further references to modern medicine, it could perhaps be said that “vital force” means the ability of the organism to self-regulate.
Hahnemann provided evidence of 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 with a few hundred pages, and the diverse reports of his contemporaries.

How can Hahnemann's ideas be reconciled with viruses and bacteria as pathogens and the 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. Against this background, any theory about causes of illness is of secondary importance. This was true in Hahnemann's time and still applies today.
The presence of microorganisms in a patient's body is of course also relevant for modern homeopaths. In particular, any therapy that wants to be successful must ultimately make an infection disappear, including a homeopathic one. From this point of view, the virus or bacterial attack is only a symptom that has informational value for the indication and the prognosis and progress monitoring. It is not the primary indicator of therapy. A direct pharmacological control of pathogens, such as takes place in the context of antibiosis, is neither intended nor possible with homeopathic drugs. For this reason, severe sepsis, for example, is not an indication for homeopathic treatment alone: ​​the severity of the infection requires the microbes to be removed quickly because the patient's body does not have enough reserves to bring about recovery based solely on its self-regulating ability. However, homeopathy can also be used to support this, as a study by intensive care doctor Prof. Michael Frass shows.

Is Homeopathy Naturopathy?

That depends on the definition: If the term “naturopathy” means the classic naturopathic methods phytotherapy, hydrotherapy, nutritional therapy, exercise therapy and order therapy, the answer is no. If you want 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, secondly, because of the potentiation of the medicinal products used, homeopathy should rather be regarded as a sui generis therapy system and therefore not part of naturopathy in the narrower sense.

What does initial aggravation mean?

The phenomenon of initial worsening is sometimes observed when appropriate homeopathic medicines are administered. The patient's existing symptoms initially intensify, but then quickly subside. The subsequent significant improvement is, in addition to the short duration of the initial worsening, a defining characteristic of the initial worsening. It must also be differentiated from the normal course of the disease. Scientific studies indicate that initial worsening as part of homeopathic treatment is rare.

The use of cybernetic models can easily explain the homeopathic worsening: the organism is viewed 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 in motion control mechanisms that intend to restore it. Symptoms such as fever, coughing, or suppuration are a visible expression of these efforts. According to the similarity rule, the patient now receives a substance that is capable of producing similar symptoms in the healthy. The appeal of homeopathic remedies thus corresponds to the trigger of the disease. It aims to strengthen the organism's self-regulatory efforts. In this way, the control mechanisms that have already been started can be “adjusted” to a certain extent. The initial worsening is the obvious expression of this intensification.

What test potencies did Hahnemann base on his dilutions of the substances used? For example, what does an "amber essence" contain?

Hahnemann experimented both in the treatment of the sick and in his drug tests on healthy people with different potencies. While in his early days he also used mother tinctures, i.e. classic pharmacologically active substances, he later recommended the C30 as the standard potency for drug testing on healthy people. Amber essence is not a homeopathic medicine tested by Hahnemann.

What are globules?

Pellets of cane sugar, available in different sizes. In homeopathy, they are used as carriers: the medicinal solution is sprayed on.

Christiane Maute recommends globules for plants to keep pests away and Dagmar Neff presents “homeopathy for painting” as a new homeopathy. Can you explain the mechanism of action of homeopathy for plants and for painting?

Numerous experiments from basic research on homeopathy prove that plant organisms also react to highly potent drugs: In the three main areas of bioassays with healthy plants, intoxication models and phytopathological examinations, a total of 167 experimental studies identified from 2009-2011, 48 of which 48 met the higher quality requirements . In various studies, specific effects of potencies beyond the molecular limit were observed (study of homeopathy use in healthy plants, homeopathy use in abiotic stressed plants and homeopathy use in field trials). The systematic use of such ultramolecular thinners in agricultural crop protection is being tested in India, for example.
The mechanism of action of high potencies has not yet been clarified. Many experiments, some of which are independently replicated, for example with NMR relaxation time measurements (nuclear magnetic resonance), UV spectroscopy and biocrystallization indicate that water molecule dynamics in homeopathic medicinal products have changed compared to placebo control. However, the hypothesis that a drug-specific signal is stored in stable water structures (clusters) has so far not been substantiated. The patterns in question are only stable in the picosecond range (10−12).
I am not aware of a “homeopathy to paint on”.

Is there a controversy between evidence-based medicine based on scientific evidence and special forms of therapy such as homeopathy?

The comparison “Evidence-based Medicine vs. Homeopathy ”suggests a wrong picture of the actual data situation. I want to illustrate this using the example of homeopathy:
The Homeopathic Research Institute (HRI) evaluated 189 randomized controlled clinical homeopathy studies in 2014: 41% confirmed the effectiveness of homeopathic preparations, 5% confirmed their ineffectiveness, and 54% of the publications did not allow a clear conclusion.

For comparison: In 2007, 1016 reviews of the renowned Cochrane collaboration on conventional medicine were examined: 44% confirmed the effectiveness of the intervention examined, 7% confirmed its harmfulness, and 49% reported that no conclusions were reached in one way or the other Direction can be drawn (overview of Chochrane studies on decision making in healthcare).
The similarity in the distribution of positive, negative and neutral results is immediately apparent. Even though the database in homeopathy research is considerably narrower than in some areas of conventional medicine, it is broad enough to confirm the following facts: A summary of clinical research data sufficiently demonstrates the therapeutic benefit of homeopathic treatment. The results of numerous placebo-controlled studies and experiments from basic research also speak for a specific effect of potentiated drugs.

What is the annual turnover of homeopathic remedies in Germany?

In 2015, € 100 million was implemented nationwide with prescribed homeopathic medicinal products (source: Statista). In the same year, the expenditures of the statutory health insurance for pharmaceuticals totaled € 31.84 billion (source: Statista). Thus, the expenses for homeopathics corresponded to 0.31% of the total drug-related expenses. In addition, there is another 495 million turnover with non-prescription homeopathic remedies, which the patients pay out of their own pocket.

With regard to the expenditure mentioned, it should also be borne in mind that various studies document that the use of comparatively inexpensive homeopathic drugs can obviously significantly reduce the prescription of medicines, some of which are significantly more expensive:
With regard to diseases of the upper respiratory tract, the EPI3 cohort study found that with comparable treatment results in homeopathic doctor's offices, only about half of antibiotics, anti-inflammatories and antipyretic are prescribed compared to conventional ones.

The same applies to the area of ​​musculoskeletal diseases, such as rheumatism: Patients who are treated with homeopathy require only about half of non-steroidal anti-inflammatory drugs (e.g. ibuprofen) for the same therapeutic success, according to the result of a study from 2012. Also in relation A study from 2015 on mental illnesses demonstrated that patients who see a homeopathic doctor are four times less likely to be prescribed psychotropic drugs than conventional medical practice.

Multi-resistant germs that result from overuse of antibiotics cause an almost undeterminable number of deaths annually - according to a study from 2015 in the United States alone, 99,000 a year. Nonsteroidal anti-inflammatory drugs are the group of drugs for which the highest number of cases of serious side effects are observed (e.g. at least 15,000 deaths per year in the USA, see American Nutrition Association). According to the director of the Nordic Cochrane Center, Peter Götzsche, psychotropic drugs are responsible for around 500,000 deaths per year in Europe and the USA in the age group of over 65-year-olds.

Taken together, these facts give reason to believe that the widespread use of homeopathy could realize considerable savings potential for the health system. This would not only reduce the consumption of conventional medicinal products, but would also lower the considerably higher follow-up costs due to their side effects.

There is also a systematic review from the year 2014 on the topic of cost efficiency of homeopathy. It summarizes the results from 14 health economic analyzes of homeopathy with over 3,500 patients. In 8 out of 14 studies, improvements in the health situation and cost savings compared to only conventionally treated patients were documented. In 4 studies, treatment outcomes were conventional and the costs were equivalent. Comparable therapy successes were found in two studies, but higher costs compared to conventional therapy.

What is the relationship between homeopathy and natural science?

The effectiveness of ultramolecular dilutions is certainly an anomaly, i.e. a phenomenon that cannot be explained, or can only be explained inadequately, using common theories and models. Enlightened and self-critical scientists see challenges in anomalies. An advance in knowledge usually starts from the research of such anomalies:
What so far did not fit into 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. The scientific mindset is the dogmatic one. Here, phenomena that can be determined empirically are denied because they cannot be explained using a certain set of popular theories.
The scholasticism of the Middle Ages did not want to accept anything that cannot be found in Aristotle or in the Bible. Similarly, some critics of homeopathy consider the effects of high potencies to be impossible in principle because they cannot be explained using the “molecule acts on cell” model.

Some even go so far as to admit that the available data from clinical studies and basic research tend to speak for homeopathy. The conclusion for these “skeptics”, however, is that there should be unknown errors in the experimental set-up 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 inadmissibly transferred to the natural sciences: natural laws do not dictate how the world may behave. Rather, they describe the general context of our observations.

The theoretician Karl Popper postulated as a necessary criterion for a theory that can be described as “scientific” that it must in principle be possible to refute it. Exactly this is not the case if phenomena are identified using recognized methods, but are not taken seriously because they cannot be completely derived using specific models, here the laws of nature. The natural laws against which the effect of highly potent drugs should violate are also at least in need of explanation. Physics regularly observes effects without direct contact with molecules in the case of electromagnetism, gravitation, etc. For these natural forces there are only explanations available that can be traced back to known quantities, as well as mathematical formalisms that can be used to predict their effects. Both of these are not yet 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 an immunization against experience takes place, similar to the Middle Ages.

On what precise knowledge of the causes of the specific diseases and the processes in the body are the meaning and course of homeopathic therapies based?

Homeopathy is a stimulus regulation therapy. Your goal is to give the body an impulse to stimulate self-healing powers. Causes of illness in the sense of a classic pathology are only of importance to them insofar as they can be indicative of the choice of a similar drug. In addition, they are of course important for the indication, the forecast and the follow-up. Homeopathy is based on perceptible symptoms, which also include laboratory parameters or diagnostic data from imaging processes and the like. can count. However, it does not use a theoretically supported causal relationship between certain symptoms and their supposed causes for the choice of medication. This is certainly a major advantage of homeopathy: it does not require a theory of disease development for therapy, but adheres to what can be directly observed.

How has today's homeopathy developed since Hahnemann?

The pillars of homeopathy, 1. the simile principle, 2. drug testing on healthy people, and 3. the special drug manufacturing process, have remained unchanged from Hahnemann to this day. Various schools of homeopathy repeatedly develop their own approaches to one or the other of these basics, which are sometimes more and sometimes less successful.
Homeopathy in the United States on the threshold from the 19th to the 20th century reached a flowering that was never surpassed in Western countries. This upswing was brought to an abrupt end by the efforts of conventional doctors, financially strong interest groups and the so-called "skeptic movement", according to the result of a retrospective analysis from 1993.

Homeopathy is still fully established in the health care system in India today: The number of people treated there every day is likely to be in the millions.
Globally, homeopathy is used in more than 80 countries today. Three out of four Europeans have heard of homeopathy and around a third use it themselves. Homeopathy is the most commonly used complementary therapy for children. In Germany, according to a representative survey by the Institute for Demoscopy Allensbach, 60% of the population have already taken homeopathic medicines themselves, and the trend is rising.

What meta studies in recent years have evaluated a large number of individual homeopathy studies and what were the results?

There are currently 5 indication-independent systematic reviews of placebo-controlled homeopathy studies with statistical calculation (meta-analysis) that cover a period from 1991 - 2014: Four of these papers (clinical application of homeopathy, are the clinical effects of homeopathy placebo effects?, Proof of the clinical effectiveness of the Homeopathy, randomized placebo-controlled studies on individualized homeopathic treatment) conclude that the effects of homeopathic medicines cannot be explained solely by placebo effects.

A meta-analysis concludes that homeopathic medicines are believed to be placebos. This negative work evaluated only 8 out of 110 initially included homeopathy studies due to scientifically incomprehensible criteria. A statistical reanalysis revealed that the results for the 21 clinical trials, which were certified to be of high methodological quality, were also significantly positive in favor of homeopathy in this publication.

Another media review from 2015 was commissioned by the Australian National Health and Medical Research Council (NHMRC) and received a lot of media attention. Also in this work 171 out of 176 studies were not evaluated for methodologically unsustainable 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 never used in any medical review published before or after the NHMRC report (exception: Shang et al. 2005; see above), since it is a method that cannot be justified in terms of method. In fact, even the NHMRC itself conducts studies with fewer than 150 participants because this number of subjects has nothing to do with the methodological quality, according to the criticism of the Homeopathy Research Institute.

In homeopathy research, the evaluation of data seems to play an important role due to the (inc) compatibility with certain theoretical assumptions. This phenomenon is discussed in the theory of science under the concept of plausibility bias. In a study from 2013, epidemiologist Robert Hahn, for example, analyzed the inclusion and exclusion criteria for studies in the context of meta-analyzes on homeopathy with a negative or indifferent tendency and shows, among other things, based on statistical considerations that they were probably formulated retrospectively. He suspects that this approach is ideologically motivated, which would be diametrically opposed to the scientific claim of evidence-based medicine.

The Social Code demands: "The quality and effectiveness of the services must correspond to the generally recognized state of medical knowledge and take medical progress into account." To what extent does this apply to Hahnemann's teaching and the derivations of today's homeopaths?

The data from clinical studies on homeopathy show that patients regularly benefit considerably from homeopathic treatment. The effects are comparable 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 received conventional treatment with insufficient results, as a joint study by researchers from the Charité - Universitätsmedizin Berlin and the Karl and Veronica Carstens Foundation shows. As far as the scientific findings are concerned, quality and effectiveness seem to be sufficient. To date, medical progress has not led to many chronic diseases, in particular, being permanently cured or at least adequately alleviated. Here, according to data from clinical research, homeopathy has great potential. Unfortunately, this promising therapeutic method is still far too little integrated into the health system. There is an urgent need for politicians to catch up.

Interview partner:
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 on the topic of homeopathy, in which we give both critics and advocates space to present their positions. You can find more articles on this topic here:
Homeopathy: Myths and Facts About Globules
Homeopathy - Popular with users, proven by studies!

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