Georg Ivanovas From Autism to Humanism - systems theory in medicine
Issues of this chapter: paradox pharmacology, concept of chronic diseases with the example of atopic disease
No method of CAM is more controversially discussed than homeopathy. Critics agree that nearly all principles of homeopathy are unscientific. Homeopathy is called irrational, charlatanry, sect, cult and other (Jarvis 1994). The remedies homeopathy uses are the main obstacle for taking this method seriously. They are made of different minerals (sulphur, phosphorus, silicate), extractions of plants, animals (bee, poison of snakes) or products of pathological processes (carcinoma, tubercle). Out of these substances an alcoholic ‘mother tincture’ is produced. The mother tincture is diluted several times in a relation 1 10 (D - potency) or 1 100 (C potency). With each step of dilution the container of the tincture is vigorously shaken, traditionally tapped on a leather book. Today this is mostly done by machines. This process is called potentiation or dynamization.
The Law of Infinitesimals which is actually no law but a guide line - says that the dynamization eliminates the side effects but not the effectiveness. The process is said even to raise the therapeutic power. Homeopaths are not one opinion how often this process of dynamization should be repeated. The most commonly used potencies are C6, C12, C30, C200, C1000. The main point of critic is that a potency of C 12 with a dilution of 10-24 is identical with Avogadro's number and that potencies like C200 (10-400), C 1000 (10-2000) exceed it by far.
There is not the slightest explanation how such a diluted substance might work. A lot of models had been proposed based on energies or waves (Kratky 2003), or quantum mechanics (Walach 2003), but nothing is only partly convincing.
Some argue that by the process of dynamization the molecular structure of the water might be changed. Such an article of Beneviste in Nature (Davenas et al 1988) caused quite a stir, but was retracted later as an investigation of Beneviste’s laboratories showed irregularities and other groups were not able to confirm his experiments (Kaufmann 1994). Although further research showed recently that clusters of molecules in a solution of water clump together if water is added (Coghlan 2001b), and that hydrogen bonds in pure water are very different from that in homeopathic dilutions of salt solutions (Milgrom 2003), this does not explain how homeopathy works as also trituartions of a substance in lactulosis (mercury) are used. Even the smelling of the remedy is said to have a therapeutic effect.
Most of the other reproaches against homeopathy, however, are not as justified. A main accusation is that homeopathy rejects a linear relationship between dose and effect (Seymour 2001). But as demonstrated before, this relationship is a special case only true in a small physiological range (chap. 4.11). It is no longer true when it comes to inner regulation.
Another accusation concerns the Law of Similia. It is the basis of the homeopathic treatment and gave the name to the method: homeo (similar) and pathos (suffering). It says that a remedy is able to cure a disease with certain symptoms if it provokes the same symptoms in a healthy person. A classical example is Atropa belladonna which in poisoning provokes fever, flushed face, enlarged pupils and excitement. Such symptoms are often seen in feverish infections of early childhood. In these cases Atropa belladonna is given as a remedy. Furthermore, the rash of Belladonna poisoning resemble scarlet fever. Hahnemann (1755-1843), the founder of homeopathy, is said to have had good effects with this treatment (Haehl I 1922: 61).
The usual idea is that “the homeopathic Law of Similia … is unsupported by the basic sciences of physiology, pharmacology and pathology“ (Jarvis 1994). But there is a lot of evidence demonstrating that the principle of the Law of Similia is more prevalent than expected. Strategic systemic psychotherapy developed models for paradox reactions based on the understanding of cybernetic cycles (chap. 4.4), models representing definately clinical observations. Reactions following the homeopathic pattern are called paradoxical pharmacology (Martindale 2003). Sleeping pills (zolpidem) have activated and aroused coma patients (Clauss/Nell 2006). Beta-blockers are successfully used in congestive heart failure (Martindale 2003) or asthma (Nguyen et al. 2008), although the theory regards them as an absolute contraindication. But the best known example is the use of stimulants in hyperactivity disorder (Marcovitch 2004).
At first, these are mere individual, insular observations. The principle as such has been studied more in detail under the name hormesis, a biphasic doseresponse phenomenon characterizedby a low-dose stimulation and a high-dose inhibition (chap. 6.10). The applicability of the hormetic principle is known since the 1880s. But it had been excluded from the scientific frame then, in order to prevent homeopathy of claiming an effectiveness (Calabrese 2008). And still today, scientists doing research on hormesis are anxious not to be associated with homeopathy (Calabrese/Jonas 2010).
All this does not add anything new to the analysis of the medical method. From the theoretical point of view homeopathy is just another ‘strategic therapy’ (chap. 5.2.b). What interests here is the homeopathic concept of disease, especially of chronic diseases. It is a dynamic model with a lot of similarities to the now emerging model of chronic diseases based on recent immunological discoveries. As this model relies on the clinical observation, it is independent from the questions whether or not homeopathy is a placebo therapy.