ASK DR. BAUGHAN                                                         OCTOBER 17, 1997

HOMEOPATHY AND PLACEBOS

Physicians are sometimes reluctant to discuss “alternative” healing practices that have not been blessed by the conventional medical research process for a couple of reasons.  First, by doing so, they might be interpreted as condoning the use of unproven therapies.  Second, they might be stigmatized as being “unscientific” doctors.  I find both reasons presumptuous.  People are using alternative treatments without “physician approval” anyway, so we might as well talk about it.  Many of our treatments in medicine lack validation by our own “standards.” Science is the pursuit of truth, and there are many paths to that truth if we are not too attached to our biases.

The September 20 issue of The Lancet, a conventional British medical journal, contains a review of 186 homeopathic studies.  The review was conducted by German and American researchers. They concluded that their analysis could not dismiss homeopathy as placebo, but they found “insufficient evidence . . . that homeopathy is clearly efficacious for any single clinical condition.  Further research on homeopathy is warranted provided it is rigorous and systematic.”

Homeopathy is based on two principles.  First, if a patients has certain signs and symptoms, a treatment that produces those same signs and symptoms can cure the person.  Second, the substance in the treatment is diluted, sometimes so much so that none of the substance’s molecules may be present.  This is what strains traditional scientific credulity.  If I were to say penicillin will cure you and then give you a penicillin solution so diluted that there was no penicillin left, you would rightly question me.  So homeopathy works on a different, not understood process.

The difficulty in the article is that the studies involved a wide variety of conditions using a wide variety of substances.  It would be like studying whether antibiotics work.  The next question is “Which antibiotics for which infections?”  Then, “What’s the right dose?”  Other difficulties:  Studies that show a positive result are more likely to get published that ones that show something did not work.  Hence, the authors were left with the qualified conclusion they gave.

They ignored one key issue about placebos, though.  It is the same error made in most traditional research.  The idea with “placebo controlled” research is to compare the results of the medicine with something (like a sugar pill) that should have no effect.  Some people will get better (or have side effects) on the placebo.  If there is a difference, then the researchers assume the results are chemically due to the medicine.  Sometimes they will actually ask the subjects if they thought they took the medicine or the placebo to test if it was a “good placebo,” that is, they fooled the folks who took the placebo.

However, the placebo effect is a function of belief, not knowledge.  If I believe a substance may help me, then my brain and body release chemicals that can help heal me.  So the key question is not, “Who took the real medicine?”  We also need to know, “Who believed they took something that would help them?”  What were their results compared to those who did not believe it would help (whether medicine or placebo)?

The fact that a conventional journal like The Lancet will publish an article about homeopathy I see as a healthy sign that medicine is willing to suspend some of its biases to consider different concepts.  Hopefully, that will include an appreciation of the mind-body phenomenon of the placebo effect.