Treat the patients, not just the symptoms: What we can learn from homeopathy
Second-year Psychology students participating in the University Honours College follow a mini-course on Blogging Science (within the Thematic Meetings course), in which they learn to communicate science to the general public, by means of informing, giving an opinion, and relating issues in science to issues in society. This year a selection of these written blog posts is published on Mindwise. Today’s post is by Leon Többen.
A hypothetical recipe for a homeopathic remedy against insomnia:
- Take one coffee bean and throw it into a bottle of water with the size of a lake
- Stir the mixture thoroughly (you need an enormous spoon for this)
- Take a sip from the bottle whenever you cannot sleep
Would you believe that this mixture helps you fall asleep? I doubt it, but homeopaths try to make us believe that “medicines” similar to this remedy work. They do so with great success: three-fourths of Europeans know about homeopathy, and nearly one in three of them uses it; this amounts to about 100 million Europeans . Moreover, most homeopathic compounds are freely available in pharmacies and look virtually identical to medications that have been proven to be effective. Thus, chances are that even more Europeans (including you!) have used homeopathy unknowingly.
What is homeopathy?
Homeopathy is a domain of alternative medicine based on two principles . Firstly, according to the like cures like principle, one may use substances which cause symptoms of a disease in healthy people as a cure for similar symptoms in ill people. For instance, a homeopath might treat sleeplessness with compounds that prevent sleep in individuals who are not sleep-deprived. The second principle – potentiation – assumes that diluting these substances with water increases their effectiveness. Thus, homeopathic remedies consist of a possibly harmful substance which has been watered down to the extent that oftentimes no molecules remain in the mixture. In other words, there is usually nothing in it, and if there is something in it, it can have rather adverse effects. Needless to say, homeopathy flies in the face of mainstream medicine. Nevertheless, many people firmly believe in its effectiveness.
Is homeopathy effective?
While much research is devoted to homeopathy, there is no reliable evidence that the ingredients of homeopathic substances cause them to work . In contrast, there is a lot of evidence that psychological mechanisms are the only factors involved in causing their effects. The most obvious mechanism is that homeopathic compounds work because the people taking them expect them to work; this is known as the placebo effect . Further, while illnesses simply get better with time, people tend to attribute their recovery from an illness to their treatment rather than to the natural healing process . The least obvious predictor of homeopathy’s effectiveness, though, is that homeopaths are more likely to establish a relationship with their patients: compared to mainstream medical doctors, they take more time for their patients and have longer consultations with them, thereby conveying empathy and understanding . This “quasi-psychotherapy” can do wonders because it makes the patients feel cared for. Thus, homeopathy is indeed effective – but only because it utilizes psychological mechanisms, which are often outside patients’ awareness. This brings up the question whether homeopathy is ethical.
Is it ethical to prescribe homeopathic substances?
Proponents of homeopathy argue: “it helps the patients, so what is the problem?” The problem is that homeopaths seldom inform their patients sufficiently; they tend to withhold a large body of research which has brought to light that homeopathic substances have no biological effects. The next argument typically is: “Homeopathy has no side effects and does no harm”. This is only half of the story. Yes, it has no side effects – because it has no direct biological effects. But, importantly, homeopathy can do harm: patients favoring homeopathy tend to neglect mainstream medicine . This may be very dangerous when patients have life-threatening illnesses: to survive such serious conditions, they need medication that takes effect through biological factors, rather than purely involves psychological factors. Thus, practitioners (and pharmacists) should think twice about recommending homeopathy.
What can we learn from homeopathy?
The fact that so many people turn to homeopathy shows that they are missing something in mainstream medicine. Their wellbeing is influenced by psychological as well as biological mechanisms. Homeopaths utilize only the former (without letting their patients know) whereas regular physicians focus primarily on the latter. However, to treat patients optimally, both factors have to be taken into account. Therefore, mainstream medical doctors can learn much from homeopaths. For example, they can extend the time of their consultations and establish a more patient-friendly atmosphere by showing empathy and understanding. This improved physician-patient relationship may not only enhance the patients’ satisfaction with the treatment but also their clinical outcomes . Nevertheless, physicians tend to show a decline in empathy over their careers, so that it is especially relevant to increase the awareness of the big role empathy plays in treatment . In short, physicians should treat the patients, not just the symptoms.
In short, physicians should treat the patients, not just the symptoms.
Relevant links and publications
 di Sarsina, P. & Iseppato, I. (2011). Looking for a Person-Centered Medicine: Non-Conventional Medicine in the Conventional European and Italian setting. Evidence-Based Complementary and Alternative Medicine, 1-8, doi: 10.1093/ecam/nep048.
 Hahnemann, S. (1833). The Homeopathic Medical Doctrine, or “Organon of the Healing Art”. Dublin: W.F. Wakeman. pp. iii, 48–49.
 Ernst, E. (2002). A Systematic Review of Systematic Reviews of Homeopathy. British Journal of Clinical Pharmacology. 54(6), 577-582.
 National Health and Medical Research Council. 2015. NHMRC Information Paper: Evidence on the effectiveness of homeopathy for treating health conditions. Canberra: National Health and Medical Research Council; 2015.
 Brien, S., Lachance, L., Prescott, P., McDermott, C., & Lewith, G. (2011). Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial. Rheumatology (Oxford). 50(6), 1070-82.
 Malik, I.A. & Gopalan, S. (2002). Use of CAM results in delay in seeking medical advice for breast cancer, European Journal of Epidemiology 18(8): 817–22.
 Bensing, J., Derksen, F., & Lagro-Janssen, A. (2013). Effectiveness of empathy in general practice: a systematic review. The British Journal of General Practice, 63, e76-e84.
 Edelhäuser, F., Fischer, M.R., Haramati, A., Neumann, M., Scheffer, C., Tauschel, D., & Wirtz, M. (2011). Empathy decline and its reasons: a systematic review of studies with medical students and residents. Academic Medicine, 86, 996-1009.
NOTE: Image by UMHealthSystem, licenced under CC BY 2.0