The bottom line

Homeopathy is a very divisive topic. One group thinks that it’s a cool type of alternative medicine that doesn’t have side effects, and can potentially cure all kinds of stuff. The other group thinks that it’s quack medicine that can only lead to a dent in your wallet. People get riled up about this stuff, like religion or politics.

If you try to be as neutral as possible, you’ll notice that homeopathy doesn’t pass several important tests of causality. Trial evidence is mixed, with good quality trials generally not showing benefit, and less rigorous trials showing benefit.

Homeopathy originated in Germany

Homeopathy was founded in the late 1700s by a German physician named Samuel Hahnemann. Let’s call him Sam for short. Sam tested a bunch of substances on himself and noted what effects they produced. He started theorizing on the basic homeopathic principles that are outlined below, and compiled the first list of homeopathic remedies based on his observations. Many of these are still in use. Of note, Sam also had a theory that coffee caused many diseases, and chocolate was very unhealthy for you when it had spices in it, but is okay without spices. Interesting. Keep in mind that Sam was in practice before germ theory got off the ground.

Homeopathic principles

The homeopathic principles are very simple. Maybe even too simple. The “law of similars” is the most important one, and it declares that “like cures like”. Or more specifically, a substance that causes symptoms in a healthy person can be given to a sick person in small amounts to cure them. I’m not sure if Sam meant this literally as a law, as there are clear violations. A little bit of Ebola virus will not cure your Ebola-like symptoms, I’m guessing. Another principle is using individualized therapy, meaning that each patient has a unique situation and the practitioner must address unique variation. That, I can get on board with, but it should really apply to any healthcare situation. The final major principle is the use of small doses, which is supposed to eliminate the toxicity of the original substance and increase the efficacy. Extreme dilution is performed, and vigorous shaking of the substance with alcohol or water activates the substance.

Lots of stuff is mislabeled “homeopathy”

Homeopathy is mislabeled in the drug store about 90% of the time, in my experience. Zinc lozenges for the common cold, otherwise known as “Cold-Eeze” are labeled as homeopathic. They are not. To get a homeopathic remedy, you dilute a substance in water or alcohol, and then you dilute that sample ten times, and then you dilute that sample ten times, etc etc. The final product is so diluted that there is none of the original substance left in it. This is not the case with something like Cold-Eeze, which has plenty of zinc in it. In fact, if you take too much Cold-Eeze, expect the very real amount of zinc in it to give you a very real bout of diarrhea.

The market is big

The market for homepathic mediations is huge, and at least $200 million in the US alone. Something that massive deserves as much study as pharmaceutical drugs, even if there are no side effects. Why? Healthcare dollars should go towards the most effective treatments for given conditions. The cost-effectiveness equation includes measurable benefits, not just measurable costs and side effects.

The explanation is…physics?

A small number of scientists have attempted to explain homeopathy in terms of physics and biology. I’m not a physicist, but the theories don’t quite make sense to me. For the most part, they try to explain why the water might keep some properties of the active ingredient long after it is gone. The most popular theory at the moment might be one that involves clathrates (small water clusters) that can form like crystals during dilutions. Another theory is that the active ingredient particles can clump together more than we’d expect, although that doesn’t really explain how typically high dilutions would have any activity. These may all be true, but they seem to explain hypotheses about water activity at a microscopic level, not anything about disease and treatments for disease. As an analogy, if physicists found a new sub-atomic particle, it would be really cool. But it would not really explain anything to do with disease. The causal chain has to include more than one link.

The substances

The end result of a homeopathy dilution is expressed in units of “C”. 1C is a 1:100 ratio and anything over 12C likely has no molecules left of the original substance. At 30C, which is a common preparation, there are no molecules left of the substance, or of anything that touched the original substance. Homeopaths usually say that the more dilute the solution is, the stronger it is. So the reason we care about the substance originally used is only because it can somehow affect the water, which can somehow affect our bodies. The substance used can quite literally be anything, from a piece of tumor to a common herb.

The other substances

But what about other substances that have been diluted in water? There is a little bit of tons of different things in our water supply, much of which has been vigorously shaken and diluted many times over. Arsenic, gold, sugar, plastic, oregano, and really anything that exists in this world. So I’d venture to guess that these substances should also affect you in a homeopathic manner, if the principles of homeopathy are true.

Systematic review findings

In preparation for this article, I read the existing reviews of homeopathy. Let me just tell you…they suck. My day job is synthesizing study information for medical reviews, and judging the quality of studies. I don’t have that much experience at my job, maybe about three years. But these homeopathy reviews are extremely biased and arbitrary in the way they include studies and judge their quality, and you don’t have to be an expert to become suspicious. The positive reviews are all in alternative medicine journals, and the negative reviews are all in traditional medical journals. Not very surprising.

The most widely-cited review essentially found homeopathy to be a placebo. But this review was very controversial, especially among alternative medicine practitioners, for excluding too many studies. Earlier systematic reviews had more positive, but still cautious findings, such as this one that found insufficient evidence for any single medical condition but some inconclusive evidence for seasonal allergy.

Some really bad studies

There are also a ton of just really really poorly conducted studies out there. So let me first address the two higher quality studies for pain conditions. One study used a 3C dilution, and found that it performed better than placebo for fibromyalgia. But…3C is supposed to be not diluted enough, right? Maybe I’m misunderstanding the homeopathic principles here. Even the popular homeopathic medicine “Traumeel” that is used for pain creams and injections uses relatively high doses, and I would not really view it as homeopathic. Anyways, the above author later found no evidence for homeopathy helping arthritis. Almost every other trial I read involving pain was poor quality, and I have my suspicions of what is going on with the evidence. That being said, I can’t ignore the positive evidence that does exist–it just isn’t enough in quantity to draw conclusions from. Studies often don’t report the number of patients screened or number of patients that dropped out, among other major problems. The evidence isn’t going to be able to tell you much on this subject.

Make sure not to take studies at their word without reading carefully. Otherwise you might believe studies reporting cures of HIV infection from homeopathy. Other pro-homeopathy authors strangely advocate not doing trials comparing homeopathy to placebo for reasons I cannot comprehend and which seem totally illogical. Even stranger, one author says that because homeopathy trials show better results when they are reported in alternative medicine journals than traditional journals, this suggests that that traditional journals are biased against homeopathy. Huh? Might that be the other way around? I won’t even get into the poorly done animal homeopathy studies, or the basic research into how homeopathy affects plants instead of humans. My opinion is this: take all the money spent on these low quality studies and spend them on high quality trials for specific conditions in humans, and then try to replicate the results.

Let’s talk placebos

The possibility of feeling something after taking a homeopathic remedy is very high. Natural medicine doctors are very nice and friendly compared to most MDs. They are open-minded and interested in your condition, for the most part. Almost no one who gets a homeopathic remedy has done a full review of all the trials done, so expectations may be quite high. And you typically don’t use homeopathy for conditions that obviously need allopathic medicine, like an aneurysm or cystic fibrosis. So for your mild to moderate condition, chances are very high that your body and brain will react well to receiving a homeopathic remedy. But that does not mean that it is reacting well to the remedy itself. Placebo effects are very real and very useful, but just keep in mind that everything works by some mechanism, if it works.

Let’s talk money

Homeopathy is expensive. There’s no two ways about it. I’ve seen charges in the Boston area of around $250 for the first visit. That is a lot of money for a remedy that contains no active ingredients. On the other hand, if it works, you could be saving tons of money on chronic conditions that you might be trying to address, such as heart disease, depression, etc. You are paying for the time and expertise of the homeopath, so grill them with any questions you have. The “intake form” takes up to a couple hours to fill out, and costs are steep, so talk to your potential homeopath a bit first before hiring them.

Let’s talk alternative medicine options

People sometimes talk about alternative medicine as if it was the same as homeopathy. It is not–homeopathy is one type of alternative medicine, and not all practitioners provide it. There exist many other types of “alternative” medicine that are options to try instead of having your doctor pump you full of drugs or perform surgery. Nutrition, meditation, yoga, and other modalities have fairly good evidence for certain conditions. Consider these cheaper alternatives before shelling out too much cash.