Richard Moskowitz, MD

I’ve been practicing general and family medicine for the past 50 years, with homeopathy my principal method of treatment since 1974.  I have no doubt that pharmaceutical drugs have value; I often refer patients I haven’t been able to help to my allopathic colleagues and am more than grateful for what they do.  But I prefer homeopathy, first, because it makes sense to begin with gentler and safer methods whenever possible; and second, because homeopathic remedies are tailored to the individuality of the patient, and thus capable of a deeper and more comprehensive level of healing than is attainable with drugs that seek only to counteract a specific symptom or correct a particular abnormality by applying superior chemical force at that strategic point.

I can readily understand and sympathize with the common belief that homeopathic remedies are nothing but placebos, which was already current in Hahnemann’s time, became famous when Oliver Wendell Holmes, Sr. devoted some elegant prose to ridiculing it more than 150 years ago,¹ and has since been incorporated into the conventional wisdom. When I was in medical school, the term “homeopathic dose” was used almost affectionately to signify an amount of medicine far too small to have any noticeable effect whatsoever; and even today, as various modalities of alternative and complementary medicine enter the mainstream and many American physicians seek to broaden their outlook in order to accommodate them, most would probably still agree, at least in private, that homeopathy defies common sense, ordinary logic, and some basic laws of chemistry.  

            Indeed, even I feel a little uneasy when my patients eagerly gulp down the whole idea of homeopathy with no doubt or hesitation, blissfully untroubled by the profound mysteries at the very heart of it.  Hahnemann’s Law of Similars,”Let likes be cured by likes,” the basic principle of homeopathy, is still far from intuitively obvious, even to those of us who use it every day, and remains essentially a postulate, not yet amenable to conclusive proof or disproof as a scientific hypothesis must be.  Still less satisfactorily has anyone ever explained how medicines diluted beyond the level of Avogadro’s number could possibly have any effect on a patient, let alone a curative one. 

But the fact that homeopathy is based on a phenomenon as yet unexplained by the science we now have is far from proving that the phenomenon doesn’t exist, or that the method of treatment based on it is simply a fake.  It almost embarrasses me to have to point out that the entire argument of those who make a point of ridiculing it still boils down to the same defective syllogism that even the eminent Dr. Holmes couldn’t improve upon:    Homeopathy can’t possibly work; therefore, it doesn’t work!

Once that flagrant non sequitur is permitted, to be sure, all sorts of dire consequences can be made to follow from it.  Two recent examples are a law enacted by the House of Commons that removes homeopathic medicines from the list of treatments approved and paid for by the British National Health Service,² and a proclamation by the Spanish Ministry of Health that homeopathy is a “pseudoscience,” thereby excluding it from their health care system, abolishing all training programs based on it, and warning doctors not to practice it or face disciplinary action, in spite if not precisely because of its growing popularity there.³  In the United States, the Homeopathic Pharmacopoeia was officially recognized in the founding document of the FDA, but the agency has never stopped trying to curtail its influence on similar grounds.

            To these familiar indictments an Australian philosopher has proposed the novel addendum that homeopathy is not only ineffective, but also immoral, according to the utilitarian standard of doing the greatest good for the greatest number, mainly to the extent that it dissuades people from deploying the kind of heavy artillery that really does work.⁴ 

            With strong financial and political support from the pharmaceutical industry, a growing movement to discredit homeopathy, resorting to the same fallacious argument, has recently embraced a militant, debunking scientism, exemplified by professional ‘quackbusters’ like Wallace Sampson⁵ and Stephen Barrett,⁶ who regard homeopathy on a par with magic and the paranormal and have adopted discrediting such illusions as their life’s work. 

            In the end, however, all their impressive and learned reasoning goes for naught, because the twin premises it is based on—the implausibility of the Law of Similars, and the improbability that substances diluted past the threshold of molecular structure could be capable of biological activity—both turn out to be simply and demonstrably false.  The basic “law” of homeopathy, for example, based on the phenomenon that medicines can go both ways, that those with the power to relieve certain symptoms can elicit or provoke them as well, is widely familiar even in allopathic circles where “paradoxical” effects such as antihypertensives raising blood pressure, antidepressants making depression worse to the point of suicide, and so forth, are commonplace and well-documented in standard reference texts like the Physicians’ Desk Reference,⁷ just not yet proclaimed as a general rule. 

            As for our notorious “infinitesimal” doses, scientific experiments have repeatedly shown that these highly diluted remedies are capable of both stimulating and inhibiting colony growth in bacterial cultures,⁸ in vitro enzymatic activity in tissue culture and cell-free extracts,⁹ seed germination and growth in various plant species,¹⁰ and various global properties of higher animals.¹¹  While equally unambiguous results are perforce more difficult to attain with human subjects in clinical situations, it is nevertheless abundantly clear that even ultradilute homeopathic preparations are capable of significant biological activity.

            No matter what the correct explanation of those results may be, it is also undeniable that qualified and dedicated physicians have continued to follow the same principles and to practice medicine in accordance with them for more than two hundred years and now do so on every continent and in most countries of the world.  In the face of determined opposition, general ridicule, and the sacrifice of more prominent and lucrative careers for their sake, the mere fact that homeopathic medicine has survived intact for so long and even continued to grow and develop under such adverse conditions is already more than sufficient answer to the militant conviction of the quackbusters that it is a delusion and nothing more, and indeed suggests precisely the opposite conclusion.  For no matter what mode of treatment we prefer to use, every practicing physician knows and must live by the obvious truth that our reputations and livelihoods depend on the extent to which our patients are benefited by our efforts on their behalf. 

            I will give a few examples from the early years of my practice.  The first was an eight-pound baby girl, born covered with thick meconium, who took one gasp and then breathed no more.  After brisk suctioning produced only more of the same, the child lay limp, white, and motionless, with a heartbeat of 40 per minute, responding feebly to mouth-to-mouth resuscitation but incapable of breathing on her own.   I put a few tiny granules of Arsenicum album 200C¹² on her tongue, and almost instantaneously she awoke with a jolt, crying and flailing, her heart pounding at 140 per minute, her skin glowing pink with the flame of new life.  The whole evolution took no more than a few seconds.  After a night in the hospital to be on the safe side, mother and baby went home in the morning with no outward sign that anything untoward had happened.  Experiences like these are inscribed for life in every practitioner’s mind.¹³

            Of course, since the child was full-term, well-formed, and appeared normal in every other respect, she might just as well have recovered spontaneously on her own, without any remedies at all.  In any case, she was just one patient, a mere “anecdote,” utterly without statistical significance.  But all of us who were present, including my nurse, the baby’s mother and father, and I daresay the child herself, by now fully-grown and undoubtedly steeped in the legend of her birth, know as surely as we can know anything that the conjunction of the infinitesimal dose and her abrupt awakening was no mere coincidence. 

            Another patient was a 34-year-old registered nurse who had been plagued with severe endometriosis ever since her teens.  After four surgeries to remove large blood-filled cysts from her bladder and pelvic organs, and several courses of male hormones to suppress the condition, her periods had become dark-brown, scanty, and essentially “dead,” as she described them; she came seeking only to restore a healthy menstrual flow, having long since abandoned any hopes of childbearing. 

            After a few remedies, her periods became fuller and richer, and within six months she was pregnant.  By the next time I saw her, for a different ailment nearly eight years later, she had given birth to two healthy children after uncomplicated pregnancies and normal vaginal births and had remained in good health ever since.¹³   While no one can attribute such an outcome to a homeopathic remedy or indeed any other agency in precise, linear fashion, my patient has never stopped thanking me for it, which is reason enough to be grateful for a process that is inherently catalytic and persuasive, rather than forcible or compulsory.

            Still less can these happy endings be imputed to any unusual skill of mine since they are entirely comparable to what every competent prescriber has seen or could easily duplicate; and I might just as well have cited other patients whose conditions were far from hopeless, who believed in the remedies and in me, but whom I was nevertheless unable to help. 

            Homeopathic remedies are safe, economical, simple to use, and gentle in their action, with vanishingly few serious or prolonged ill effects.  What our critics don’t say and almost certainly don’t know is that they are also capable of acting thoroughly, deeply, and for a very long time, requiring only infrequent repetition of the dose and posing minimal risks of chronic dependence.  Patients, friends, and loved ones alike often notice a general improvement in vitality and a sense of well-being, such that recurrences seem less frightening and indeed less likely. 

            On the other hand, at least in my experienced but far from expert hands, it is by no means a panacea for all ills.   Homeopathy is a difficult and exacting art, and even after years of study and practice a skilled prescriber may need to try several remedies before obvious benefit is obtained; while in some cases, despite the most devoted efforts, there is little or no benefit at all.  But if such ultradilute remedies have worked well enough and often enough to sustain me in a general practice for more than 40 years, as they have so many others, that too is more than enough evidence to refute the conventional wisdom that they are no treatment at all.    

            To put it the other way, if it’s really true that our remedies are blanks, then we must be healing our patients by means of magic or shamanic spells that we’re casting over them unawares, which would be high praise indeed.  But I prefer to believe what my experience has taught me, that the “placebo effect,” the starved and tattered remnant of the innate self-healing capacity, is an indispensable component of all healing, even with drugs, but by no means the whole of it.        

            For medicinal substances, our reigning standard of efficacy is the random controlled trial, or RCT, in which subjects are randomized into two groups, one receiving the drug, the other only a placebo or inert imitation, with both patients and doctors kept in the dark as to who gets which.  In these experiments, the causal power of any drug against a particular symptom or abnormality equals the extent to which patients actually taking it outperform their placebo controls.  Rather than an optimal qualitative fit with the signs and symptoms of each patient as a whole, such as homeopaths aspire to, the best drugs and the ones most diligently sought after are simply the most potent ones, those with the most chemical power to compel the organism to function in whatever minutely targeted ways the profession decrees that it should. 

            Thus modern physicians are duly equipped with the latest chemical weapons to attack a vast array of diseases and abnormalities as if they were enemies on a battlefield: antibiotics to kill bacteria, antihypertensives to lower the blood pressure, anticonvulsants to control seizure activity, antimetabolites to destroy cancer cells, antihistamines to suppress the allergic response, and so forth, all developed to act as selectively as possible, but with little or no regard for the individuality of the patient.  In advanced cases, such drugs may indeed save life, give miraculous relief, buy valuable time, or do the best that can be done under adverse or extreme circumstances.

            Leaving aside for the moment the bottom-line question, whether most patients taking such drugs will actually feel better, live longer, and suffer fewer complications as a result of taking them, I am prepared to stipulate what is not always true in practice, that many of the drugs in common use do indeed have the power to accomplish at least some of what we ask and expect of them, in the hope that those more subjective and personal goals will eventually follow.   But the high and often exorbitant price that we must pay for such seemingly precise and overriding causal power comprises at least three enormous and largely hidden cost and risk centers that usually go unrecognized or are talked about only after the fact, if at all. 

            First, when a drug really works to suppress or counteract the target symptom or abnormality, the condition is likely to reappear with equal or greater intensity as soon as the drug wears off.  Using potent chemicals in this way, to force the issue, rather than simply to assist whatever self-healing processes are already under way, cannot fail to impose the threat of needing to continue using them for long periods of time, if not indefinitely, and thus of transforming what often began as an idiomatic episode in the patient’s life into an ongoing if not permanent chronic illness with the power to propagate itself through time. 

            Second, narrowly targeting drug treatment to specific chemical abnormalities and abstract pathological “entities” without rebalancing the energy dysfunction of the patient as an integrated whole naturally and inevitably leads to polypharmacy, the need for still other drugs to correct, counteract, or control whatever additional diseases and abnormalities we manage to identify in the future, with the further risk of synergistic or antagonistic interactions between them.

            And third, drugs powerful enough to do what we hope and expect them to do are capable of acting coercively on various other physiological functions as well, although these usually undesirable “side effects” tend to vary more or less infinitely, according to the unique tendencies and predispositions of each individual patient, and will therefore be much more difficult to attribute unequivocally to the action of the drug.

            In any case, the ubiquity and relative invisibility of such adverse reactions make it a lot easier to understand why homeopathy has become so popular with patients caught in the tentacles of the medical system, on the one hand, yet so easily dismissed by those who administer that system as ineffective, impossible, or unworthy of serious study on the other.  In pointed contrast to allopathic drugs, which are developed solely for their power to force the organism to do what it has no natural inclination to do, homeopathy seeks rather to assist and enhance the innate self-healing capacity that is synonymous with life, continually at work in every patient, and encompasses precisely those same individualizing tendencies, sensitivities, and predispositions that physicians are trained and expected to ignore in our diagnoses, outperform in our research, and override in our treatment.

            That is also the reason why, even when homeopathic remedies act curatively, the results are simply written off as isolated cases, perhaps “miraculous” at times, but in any case mere “anecdotal evidence” without scientific import and therefore always located on the placebo side of the ledger—because medical science as presently constituted restricts the term “cause” to those interventions that force things to happen and measures that power against the idiomatic and somewhat unpredictable tendency of every individual patient to recover without their help.

            Even in the case of well-designed RCT’s that demonstrate statistically significant benefits from homeopathic treatment, the result still “feels” unscientific and unpersuasive to most clinicians, simply because no such chemical force had to be exerted and no such resistance overcome, while to trained scientists its looser interpretation of causality and its emphasis on subjective and individual variables both disqualify it from serious consideration as a force potent, measurable, and consistent enough to count as “hard science.”

            For all of these reasons, the standard argument that homeopathic remedies are merely placebos actually cuts both ways.  In the first place, it’s simply wrong.  Over and above the evidence I’ve already presented, I can attest from my own experience that homeopathy has an impressive track record in the treatment of animals, newborn babies, like the one I mentioned, and comatose or unconscious patients, in all of whom the possibility of suggestion is negligible. 

            Second, if giving placebo, natural remedies, or nothing at all can achieve clinical results comparable to those obtainable with suppressive drugs or crippling surgery, it is difficult to understand why anyone of sound mind would not prefer the cheaper, gentler, and safer alternative, at least to begin with. 

            Third, and best of all, when homeopathic remedies do act curatively, our patients rightly feel that they have healed themselves and may therefore even wonder if they might have done so on their own, without our help.  To my mind at least, that “delicious quandary” is hardly cause for complaint, let alone ridicule. I’m hard put to imagine a better result from a medicine than one more or less indistinguishable from a gentle, spontaneous, and long-lasting cure requiring no further treatment.

            Indeed, I submit that the irony lies wholly on the other side, that this optimal response is relegated to the placebo half of the equation, while pharmaceutical drugs are valued and considered effective only to the extent that they can overpower the physiology of as many patients and for as long a time as possible.  To me it is absurd and contemptible to boast of standards that prize this kind of brute force over elegance of fit, and subordinate our timeless mission of healing the sick to the modern temptation of manipulating life functions artificially in the name of science, ambition, mastery over nature, or some equally abstract, hypothetical goal that we must accept on faith.

            That is why, for the present at least, I am thankful that our cures tend to remain snugly ensconced on the placebo side of things; because until we develop a kinder, more accurate, and inclusive model of causality, and a workable notion of the unified life energy of the patient as a whole, that is precisely where they belong.  What the nuclear physicist J. R. Oppenheimer once told a group of psychologists thus seems even more apposite for the medical community as a whole:

We inherited at the beginning of the Twentieth Century a notion of the physical world as a causal one, in which every event could be accounted for if we were ingenious, a world characterized by number, where everything interesting could be measured, and anything that went on could be broken down and analyzed. This extremely rigid picture left out a great deal of common sense which we can now understand with a complete lack of ambiguity and phenomenal technical success. One [such idea] is that the world is not completely determinate.  There are technical predictions you can make about it, but they are purely statistical.  Every event has in it the nature of a surprise, a miracle, or something you could not figure out.  Every pair of observations taking the form “we know this and can predict that” is global and cannot be broken down.  Every atomic event is individual: it is not in its essentials reproducible.¹⁴

            For all of these reasons, instead of competing with the placebo effect in order to defeat it, I have come to believe that the highest goal of medicinal treatment, whether homeopathic or otherwise, is rather to assist and enhance it by doing everything possible to promote healing in its most global sense, not just correcting abnormalities, and by cultivating a deeper and more thorough knowledge of our patients rather than ignoring, circumventing, or overriding what they have to teach us.   To that end, while admiring the ingenuity and dedication of my colleagues who design and conduct RCT’s to demonstrate the effectiveness of homeopathic treatment in the usual way, I offer an alternative model for clinical research, based on the bottom line of self-healing, which is equally relevant for allopathic medicine as well:

1. Nobody is blinded: all subjects know whether they are receiving homeopathic or allopathic treatment, having chosen it beforehand, precisely because of their interest, belief, or faith in it.
2. Nobody gets placebo: everyone gets the treatment they select, while the doctors giving it out are matched to them by their beliefs, and encouraged to use prayer, suggestion, exhortation, shamanic incantation, or whatever they or their subjects believe will most effectively assist them on their healing path. In other words, each group will serve as the control of the other.
3. Using the totality of signs and symptoms over time, including both subjective and objective criteria, and reports of family, friends, teachers, employers, etc., both homeopathic and allopathic subjects will be followed for a period of months or years, depending on the condition, and extending beyond the acute phase to include the chronic dimension.  Both groups will then be evaluated as to how well or badly they are measuring up in their own lives, by their own standards and those of their community, and also with respect to appropriate clinical and pathological criteria. 
4. Qualified judges not exclusively or doctrinally committed to either point of view will then ascertain which form of treatment proves more beneficial in which respects, and will publish the results in a friendly, fair, and unbiased journal of good repute, to be selected and agreed upon in advance.¹⁵

For myself and my colleagues, homeopathy has stood the test of time as both a method of healing the sick and a philosophy of health and disease, a coherent, logical system of thought, derived from the self-evident unity of the life force, a simple truism, and the “Law of Similars,” a bold postulate; neither of which follows logically from anything else or is as yet subject to experimental proof or disproof, like ordinary scientific hypotheses, as in Bertrand Russell’s whimsical definition: “. . . the point of philosophy is to start with something so obvious as not to seem worth stating, and to end with something so paradoxical that no one will believe it.”¹⁶

I freely admit, as I think most would agree, that homeopathy fits this description admirably.  But the authenticity of the homeopathic phenomenon, the enduring relevance of the point of view it offers, and the obvious effectiveness of its minute doses when competently used, together imply the existence of a bioenergetic science that is still in its infancy, one that will undoubtedly add to the natural laws that we already know a whole set of new rules, laws, hypotheses, and predictions as it develops in the future.   In that sense, homeopathy also looks beyond itself, to a more open and inclusive conceptual scheme that can accommodate and indeed reconcile both points of view, as well as perhaps others as yet unknown to us.  Helping to envision, identify, and elaborate this new synthesis thus becomes our highest mission, which we share with like-minded physicians and healers of all persuasions and in every part of the world.

References

1. Holmes OW. Homeopathy and Its Kindred Delusions. 1847; included in Medical Essays, Houghton Mifflin, Boston, 1895, pp. 1-102, passim.
2. British Parliamentary Debate, March 29, 2017, UK Citizens Online Democracy, mysociety.org.
3. “No More Homeopathy on the Spanish National Health Service,” Reporting the News, Spain, August 3, 2017, rtnnewspaper.com; “The Paradoxical Struggle of Homeopathy in Spain,” Association for Natural Medicine in Europe (ANME), November 14, 2016, www.anme-ngo.eu; and “And so it came to pass . . . ,” Institute for Homeopathic Medicine, January 2, 2017, instituteforhomeopathicmedicine.wordpress.com/spain.
4. Smith K. Against Homeopathy: a Utilitarian Perspective. Bioethics. February 2011;14:1-12.
5. Cf. Sampson W. The Braid of Alternative Medicine.Prometheus, New York, pp. 21-31; and Homeopathy Does Not Work. Alternative Therapies in Health and Medicine. 1995;1:48-52.  Cf. also the Health Care Reality Check website, www.hcrc.org: “Dr. Sampson is Emeritus Professor of Medicine at Stanford, Editor-in-Chief of Scientific Review of Alternative Medicine, and teaches about unscientific and aberrant medical claims.  He sits on the Board of Directors of the National Council Against Health Fraud, and is affiliated with other organizations that protect consumers from bogus healthcare claims and products.” 
6. Cf. Barrett S. “Homeopathy’s Law of Similars” and “Homeopathy’s Law of Infinitesimals,” HomeowatchHome Page, www.homeowatch.org, posted March 20, 2002; and “Homeopathy: the Ultimate Fake,” Quackwatch Home Page, www.quackwatch.org, revised August 23, 2009.
7. Physicians Desk Reference, 63rd Edition, 2009, Montvale, NJ. Cf., e.g., “Catapres, Overdosage,” p. 842: “Hypertension may develop early . . .”; and “Prozac, Warnings: Clinical Worsening and Suicide Risk,” p. 1854: “Patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior . . .”; etpassim.
8. Cf., for example, Noiret P. Activity of several dilutions of copper sulfate in different microbial species. Proceedings of the 31st Congress, International League of Homeopathic Physicians, Athens, 1976, pp. 137-147; and Brack A, et al. Effect of ultra-high dilutions of 3,5-dichlorophenol on luminescence of the bacterium Vibrio fischeri.” Biochimica et Biophysica Acta. 1621:253-260.
9. Cf., for example, Davenas E., et al. Effect on mouse peritoneal macrophages of orally-administered, very high dilutions of Silica. European Journal of Pharmacology. 135:313-319; Petit C. Effect of homeopathic dilutions on subcellular enzymatic activity. Human Toxicology. 8:125-129; and Shabir S, et al. “Effect of homeopathic drugs on in vitro activity of alpha-amylase from human saliva.” Indian Journal of Homeopathic Medicine. 31:93-98.
10. Cf., for example, Betti L, et al. Effect of high dilutions of Arsenicum album on wheat seedlings from seeds poisoned with the same substance. British Homeopathic Journal. 1997;86:86-89; and Binder M, et al. Effects of Arsenicum alb. 45X on wheat seedling growth. Forschende Komplementär-medizin und Klassische Naturheilkunde. 12:284-291.
11. Cf., for example, Banerjee P. Comparative efficacy of two dilutions of    Arsenicum album to ameliorate toxicity by repeated sublethal injections of arsenious trioxide in mice. Pathobiology. 2008;75:156; Fisher P. The influence of the homeopathic remedy Plumbum metallicum on the excretion kinetics of lead in the rat. Human Toxicology. 1987;6:321; Doutremepuich C, et al. Aspirin at ultra-low dosage in healthy volunteers: effects on bleeding time, platelet aggregation, and coagulation. Hemostasis. 20:99-105.
12. “200C,” or the 200th centesimal dilution, means a dilution on a scale of 1:100, carried out 200 times, for a concentration on the order of 10^-400!
13. Cited in Moskowitz R. Resonance: the Homeopathic Point of View. Philadelphia: Xlibris; 2001:pp. 14-15.
14. Oppenheimer J R. Analogy in Science. The American Psychologist. 2:134, March 1956.
15. Moskowitz, op. cit., p. 342.
16. Russell B. The Philosophy of Logical Atomism. Logic and Knowledge: Essays, 1901-1950. London: Allen & Unwin: 1968; p. 193.

Richard Moskowitz, MD, has practiced as a family medicine physician since 1967. Patient education and advocacy, holistic medicine, and classical homeopathy are integral to his practice. He has written numerous articles and several books, including Homeopathic Medicine for Pregnancy and Childbirth, Plain Doctoring: Selected Writings, 1983-2013, and Vaccines: A Reappraisal. He lives and practices in the Boston, Massachusetts, area.