In short, I believe it is not. The NHS needs to understand the value of the placebo response and its effectiveness in relieving symptoms. Having said this, I firmly believe that homeopathy should not be offered as a treatment for established disease or to create an immune response when given instead of vaccination. It does not work to produce an antibody response that protects against measles, mumps and rubella for instance. Homeopaths must act ethically to ensure it is never used for this purpose. But to ban something that people have found helpful over many years, for the relief of symptoms without serious pathology, is not justifiable.
A recent article in The Independent (NHS bosses bid to blacklist ‘bogus’ homeopathy amid fears of anti-vaccine misinformation) stated that recognising the Society of Homeopaths would give the public a “false impression” homeopathy had some basis in science. I agree that the health service needs to be driven by evidence – and there is no evidence that homeopathy can substitute for immunisation. There is much evidence however that homeopathy is active in enhancing the placebo response, and can be useful for the treatment of symptoms that cannot easily be explained by disease pathology.
The Placebo Effect
Norman Doidge, in his book The Brain’s Way of Healing offers a full section asking “Is it a Placebo?” (pp. 25-32). The placebo effect occurs when a patient with symptoms is given a dummy pill. The patient thinks that they are getting an active treatment, and surprisingly relief is often immediate. The placebo effect generally runs at 30% or higher in trials of antidepressants. As such, would it be better to give a pill without side effects rather than rely purely on medication?
Doidge discusses brain studies which demonstrate that when the placebo effect occurs, brain structure changes. These placebo successes are not less real than cures by medication. They are examples of the mind changing brain structure. Using PET scans of the brain, Wager has also shown that the placebo treatment turns off pain by getting key brain areas to increase the production of pain relievers / endogenous opioids. These are opium like substances that the brain produces naturally to erase pain. Certain cannabinoids like CBD may act in the same way.
Doidge quotes the research, conducted by Wager, demonstrating that the placebo response strengthens the brain’s wiring in opioid producing areas. In other words, a homeopathic remedy works because the mind is enabled to release an internal supply of natural pain relievers. Unlike the opioids in medications like morphine, these opioids are non-addictive.
My own experience of homeopathy
I am not a homeopath myself, but I did set up a cooperative enquiry looking at the effect of homeopathy, acupuncture and osteopathy in 1995 at our Group Practice in Cirencester. This was conducted by Peter Reason, Professor of Action Research in Bath. For three years we, as partners, discussed the involvement of complementary practitioners working in the practice, helping people presenting head, neck and back pain without referral to the limbs.
We monitored the effectiveness of the complementary therapies for our patients, and personally underwent a full consultation for our own understanding of what was involved. My contact with the homeopath lasted an hour and a half. During this time there was a full inquiry about my life situation and constitution, as well as exploring my presenting symptoms. At the end of the consultation, I felt fully understood. I could understand how at that point, being given a homeopathic remedy designed to help me, by someone I trusted, would likely be effective. This effectiveness would be down to my own state of mind and openness to the possibility of healing. It would also rely on the complex circumstances set up for a mind-body placebo response, in which an established relationship between client and practitioner is a key need.
Why is the placebo effect often not mentioned?
In the abstract for his study of people with chronic pain (Spiritual healing as a therapy for chronic pain: a randomized, clinical trial), Eduard Ernst does not provide full explanations for why many of his patients were helped by what he then called an “ineffective treatment”. The study was designed to investigate the efficacy of healing (distant vs. occurring in the same room as the patient), in the treatment of chronic pain. Results showed a noticeable difference (and improvement) between groups before and after they had healing treatments, whether distant or in-person.
Before we look at a total ban on homeopathic or alternative remedies, much more attention needs to be paid to the effect of trust in the therapeutic relationship. Nested within the complex human interaction between therapist and patient, there is the need to understand how the individual patient switches on an innate healing ability within their own bodies. This has been investigated in Peter Reason’s 1995 Complementary practice at Phoenix surgery: First steps in cooperative inquiry, which argues from experience that complementary practices have a place in primary health care. Time and energy need to be devoted to developing communication and understanding for a full benefit to be realized. Following the active participation and improved communication between GPs and three complementary practitioners, acupuncture and osteopathy are still offered at the Pheonix Surgery in Cirencester.
A plea for mind-body medicine
To end this blog, I would like to make a plea for mind-body medicine to be included in medical teaching. The mind can change the way the body carries discomfort. We need to show how to turn-on a placebo response in our patients, and importantly see this as science not quackery.
What is your view on homeopathic remedies and treatments? Have you found them useful for reducing your own symptoms? I would love to hear your thoughts. Please do “follow” this blog for further updates and conversation.