Homeopathy—A lively relic of the prescientific era

Homeopathy is an alternative healing method of German origin. The method was postulated by the German physician and pharmacist Samuel Hahnemann (1755–1843) at the end of the eighteenth century. In Hufeland’s Journal of Practical Medicines [3] Hahnemann 1796 presented his leading idea, the principle of similarity (Similia similibus curentur) for the first time. He invented this principle as the central point of his construct in the first edition of his Organon in 1810.

However, the basic assumptions on which homeopathy rests are either refuted or implausible. The method is based on two basic principles, the similarity principle and the dilution principle.

Today, homeopathy is one of the most popular therapeutic methods worldwide. An estimated 500,000 physicians worldwide have additional homeopathic training, 45,000 of them in Europe alone [5]. Despite these benefits and its popularity with patients, homeopathy is more than controversial. This is mainly as to date there has been no proof that homeopathy is effective [6]. Yet the criticism of homeopathy is not new. Homeopathy was criticised from the beginning in the slowly dawning era of scientific questioning. In 1825, the physician Johann Christian Heinroth published his work Anti-Organon oder das Irrige der Hahnemannischen Lehre im Organon der Heilkunst (Anti-organon or the erroneous nature of the Hahnemanian doctrine in the organon of the art of healing), in which he anticipated many of today’s arguments of science-based criticism of homeopathy. In America, as early as 1853, the physician P. Dyer wrote in the Boston Medical and Surgical Journal (today known as The New England Journal of Medicine) [7]:

Among the various systems of medicine now prevalent in the community, none seems to be so utterly absurd or so supremely ridiculous as that termed “homoeopathy”.

Unlike many other methods from the prescientific era, homeopathy still holds its own today. The reasons for this are manifold and largely sociocultural rather than medical. In view of its medical scientific invalidity, however, it should not do so under the label of medicine and especially not with the seal of public health systems. Because of this, the scientifically oriented critique of homeopathy has succeeded more and more in recent years in attracting public attention to the problem of homeopathy [8]. These demands are also increasingly reaching the nonscientific mainstream, especially via the media [9].

Samuel Hahnemann’s (1755–1843) invention of homeopathy was intended to serve as a counter-concept to classical medicine at that time. Medicine was then based on the so-called humoral pathology, which attributed diseases to an imbalance of the four humours, following the ancient physician Galenus (born 129 AC, date of death unknown). Hahnemann saw these therapies, with some justification, as a method that did more harm than good and often weakened patients to the point that they died from the therapy rather than from their disease. He referred to these methods as allopathy, a deliberately delimiting and pejorative term that has incomprehensibly survived to this day as an occasional name for scientific medicine. Important discoveries of modern medicine, such as the discovery of cellular pathology or the discovery of disease-causing microbes (pathogens) took place in part centuries after Hahnemann’s death in 1843 [10].

Hahnemann was born in Meissen, Saxony and studied medicine in Leipzig. During his studies, he also made translations of medical and physiological works into German. In 1777 he became a Freemason. Also in 1777, he accompanied the Freiherr Samuel von Brukenthal to Hermannstadt (Transylvania, Romania) as a tutor and personal physician. He stayed there for 2 years and apparently observed numerous cases of malaria. In 1779 he completed his medical studies with a doctorate at the Friedrich-Alexander-Universität in Erlangen, Bavaria. His concept of homeopathy probably dates back to his time in Hermannstadt. Here he had the experience that was to lead him to his thoughts on homeopathy. He took cinchona bark in a self-experiment and describes the symptoms as follows: Die Füße, die Fingerspitzen, u. s. w. wurden mir erst kalt, ich ward matt und schläfrig, dann fing mir das Herz an zu klopfen, mein Puls ward hart und geschwind, eine unleidliche Ängstlichkeit, ein Zittern (aber ohne Schauder), eine Abgeschlagenheit durch alle Glieder; dann ein Klopfen im Kopfe, Röthe der Wangen, Durst, kurz alle mir sonst beim Wechselfieber gewöhnlichen Symptome erschienen nacheinander; doch ohne eigentlichen Fieberschauder (My feet, fingertips, etc., first became cold, I became dull and sleepy, then my heart began to beat, my pulse became hard and rapid, an unpleasant anxiety, a trembling (but without shivering), a lassitude through all the limbs; then a throbbing in the head, redness of the cheeks, thirst, in short, all the symptoms otherwise usual to me in changeable fever appeared one after the other but without an actual shivering fever) [4]. This description is considered today as the first step in the development of homeopathy. According to this teaching, cinchona bark will be a possible medicine against malaria. He subsequently transferred his apparent experience of the simile from the cinchona experiment to other substances. When used on the sick, he attributed healing powers to them against the symptoms that these substances were supposed to trigger in healthy people. He believed that he found a divine law through this healing with the like. The entire homeopathic teaching is based on this law.

To this day, it has not been possible to reproduce this experiment of Hahnemann. In Hahnemann’s time, the cause of malaria was still unknown. It was not until 1880 that Plasmodium was discovered as the causative agent of malaria by Alphonse Laveran. In 1897, Ronald Ross found that Plasmodium was transmitted by mosquitoes of the genus Anopheles. Both received the Nobel Prize in Medicine or Physiology for their work (Ross in 1902, Laveran in 1907). Homeopathy on the other hand is still without a Nobel Prize today.

A general principle of similarity is still unknown to science today and has not been necessary for any explanation of a natural phenomenon so far. As already mentioned above, it is a reminiscence of old, partly esoteric ideas of the prescientific era and cannot claim any validity, which is fatal for homeopathy, because it loses its cornerstone.

Despite the complete implausibility of its basic assumptions and the negative results of empirical studies and systematic reviews, homeopathy claims a role in medicine and especially in medical science. The fact that it continues to be given credit in many ways, and that it enjoys a public reputation not least for this reason, is an untenable state of affairs from the point of view of rationally based science. Criticism of homeopathy can therefore not be limited to informing patients/consumers but must also clearly show how much pseudo-medicine has infiltrated the medical sphere in the case of homeopathy and that this can no longer be justified. This brief report is intended to contribute to this.

Several scientific journals practice in particular repeatedly panders to homeopathy by publishing studies on homeopathy, preferably with positive results, despite its claim to scientific integrity. One may ask how this is possible (as long as it does not concern journals that are to be assigned to the homeopathic sphere from the outset).

On the one hand, it may be that articles on homeopathy are peer-reviewed by homeopaths because journals wrongly assume that they are the “experts” for homeopathic studies. That this will only exponentially increase the confirmation bias that is apparently overlooked. The tendency to want to publish sensational results as a priority may also play a role.

Furthermore, the obvious disinterest of the professional community in publications on homeopathy is an understandable but very regrettable circumstance. Of course, there is a broad consensus in the scientific world that homeopathy is medically irrelevant; however, scientists and researchers understandably rarely take the time and trouble to counter this to the necessary extent, especially in public.

Last but not least, it is also a problem that the research results of homeopathy rarely if ever have any influence on the therapeutic practice of this bogus method. Homeopathy does not “need” empirical studies. Everything that is necessary has been established by Hahnemann: the suitability of substances as homeopathic remedies is determined by the principle of similarity and the chosen remedy by the individual symptom picture of the patient. The correct application in individual cases is a matter for the “true healing artist” who is convinced of the method. The “studies”, be they clinical investigations or so-called basic research, which above all seek to prove specifics in highly diluted solutions, serve far more the self-assurance of homeopathic circles, the impressing of the inclined public and the urge to advance to scientific reputation.

One may ask oneself what this has to do with medical science. It is therefore not only a contribution to active patient protection and health literacy but also in the own interest of medical science and practice not to tolerate such tendencies any longer and to give them a clear public rejection.

Medical topics have always been transported by the media and made accessible to the public. Over time, similar to scientific medicine, a contrast developed between popular, pseudo and purely scientific positions and publications. The implementation of modern German drug legislation in 1978 endowed homeopathy with a special role that not only allowed easy (market) accessibility (as a drug without proof of efficacy) but also gave it massive public credibility that was unique among alternative healing methods [14]. Until the 2010s, the German medical profession still spoke of a pluralism of medicine. The goal of this pluralism was to put the former understanding of a mere empirical medicine (based mainly on the experience of the unique therapist) on an equal level with evidence-based modern medicine (based on clinical trials). Logically, these efforts also influenced the reporting media landscape [15].

Today, more realistic points of view have emerged in the media landscapes. Orientation to scientific evidence concepts has become the standard for adequate medical reporting for quite some time. This may have been overlooked by the mainstream of homeopathy-friendly reporting in the past. One can occasionally get the impression from the media coverage that it is about a feuilletonistic rather than a medical topic, all the more so as it is scientifically closed [15].

A major factor in the change in the media landscape regarding homeopathy is the public discourse that has intensified in recent years, leading to much stronger criticism and its public perception. Coverage of homeopathy has changed noticeably since then, and the criticisms of science-based homeopathy sceptics began to find entrance. Nevertheless, we are still far from a consistent evidence-based account of homeopathy as a whole. A cause that should not be underestimated is also the still powerful influence of the homeopathic advocacy group, which still succeeds in constructing and presenting a mimicry of science, not to say denialism [13]. According to this, the appearance is maintained that there is still an unresolved scientific dissent to the evidence base. The stakes of politics should also not be underestimated. For example, politicians first in Bavaria and later in Switzerland voted in favor of studies to explore homeopathics as a possible antibiotic alternative [13].

Antibiotic-resistant bacteria and germs are emerging as serious medical problems. For example, the WHO estimates that the probability of dying from resistant germs is 64% higher than from non-resistant germs [13]. To solve this problem, researchers are looking for new therapeutic approaches and antibiotic alternatives. As homeopathy was also recently brought increasingly and specifically into focus as an antibiotic alternative, this point will be discussed in more detail here. The fact that representatives of homeopathy are promoting it under the banner of the antibiotic resistance problem is not a new development, however. It should be mentioned here that the first discovery of a pathogen as the cause of a disease (Bacillus anthracis, anthrax, discovered by Robert Koch in 1876) occurred well after the postulation of homeopathy (1796). The work of Robert Koch, as well as that of Ignaz Semmelweis and Louis Pasteur, is now considered a scientific refutation of Hahnemannian homeopathy [16]. Currently, no valid scientific studies exist that justify homeopathy as an alternative to antibiotics.

When investigated by scientifically sound approaches, homeopathy does not have any effect beyond a placebo [2, 4, 17]. The placebo effect is irrelevant in serious bacterial infections. Studies that at first glance attribute a positive effect to homeopathy (currently around 4000 studies [10]) show clear deficits and bias on closer examination. Nevertheless, the unbroken social reputation of homeopathy is a worrying problem. The best example of this reputation is the aforementioned decision by the Bavarian parliament to commission a study to explore the potential of homeopathy as an alternative to antibiotics. This decision is not compatible with the overall negative evidence for homeopathy and consequently has been strongly criticized several times [13, 16].