Editor’s Note: This article is available in Polish at the Racjonalista blog.
(First published in Sandhan (Journal of Centre for Studies in Civilizations), Vol. VIII, No. 1 , Jan.-June 2008, pp. 165-173 (New Delhi). )
Homeopathy is one of those things that arouse immediate reactions, indeed passions, in most people. A Google search for homoeopathy yields two million, six hundred and thirty thousand hits in fourteen-hundredths of a second. Modifying the keyword to homeopathy produces no less than twenty-three million, three hundred thousand ‘results’ in sixteen-hundredths of a second, showing that the American spelling of the word is by far the preferred version for aficionados. While this is understandably less stupendous than the Google results for sex (a staggering three billion five hundred thirty million in eighteen-hundredths of a second!), it is still quite impressive. There can be no doubt that homeopathy is quite a preoccupation of sizeable segments of the human race.
There are really two very different questions involved in any discussion of homeopathy: (i) Does it work? (ii) Is its formulation consonant with modern scientific methodology as we understand the latter phrase? These questions are only loosely related to each other. If we understand that clearly at the outset, almost all of the heat and noise that usually accompany the debate can be avoided.
A basic problem is that homeopathy has been formulated like a dogma. It is not self-correcting or inclusive like normal science is. The latter keeps expanding its boundaries, and does not hesitate to back-track and correct its earlier stance when new evidence comes in. homeopathy, on the other hand, is largely based on Hahnemann’s ‘insight’ or ‘revelation’, as laid down by him—and as amended with equal arbitrariness by several subsequent followers, when they found that some of his ‘principles’ were too patently absurd for even the most credulous adherent to swallow. It is obvious that the dilutions (‘potencies’) involved in the medicinal prescriptions of homeopathy, like one part in ten raised to the power of two hundred, are not merely preposterous, but just plain silly. There are nowhere near ten raised to the power of two hundred elementary particles in the entire known universe. So—all right, perhaps he was mistaken about that, it’s just a small error (it is by no means small), and maybe it should be just one part in two hundred, or two thousand, or twenty thousand, or something? Does it matter? With this kind of shifting goalpost and convenient alteration of interpretation, what are we talking about?
A more candid précis of homeopathy could well be something like: “Here is a more-or-less random set of compounds that seem to work in the case of some ailments. The precise active ingredients are unknown, but they’re present—or probably present, or maybe present—who knows, what does it matter—in various strange places ranging from tree bark to dried buffalo tails. So we thought we’d process them into tiny little round white sugar-coated balls and label them with Latin names so you’ll think they’re exotic and therefore powerful, and sell them to you, after patiently listening to you describing your symptoms at length. You see, we know that the other kind of doctor doesn’t let you get in a word edgewise, but only goes on prescribing more expensive tests, so you already think we’re giving you a much better deal. Now do be sure take the little sugary balls every day before dawn and after sundown so that the sun’s rays don’t make them lose their ‘power’, and you’ll feel a lot better. If you don’t, come back and tell us and we’ll just change the ‘potency’. But if you do feel better, we know you’ll automatically have this irresistible urge to tell all your friends, and that kind of purely anecdotal recommendation is the staunchest advocate and strongest advertisement we could ever have asked for!”
More seriously: the obvious phenomenon that comes to mind as the one that could be involved in many ‘successful cures’ is catalysis. Maybe even extremely small doses of heavy metals and ions could have large effects on the incredibly complicated biochemistry that goes on inside ourselves? This is not only possible, but also a demonstrable fact. And maybe the homeopathic (‘homeopathetic’ would be a low blow!) principle of viewing the symptoms as the disease, and basing the ‘cure’ on the symptoms alone, is not an altogether outlandish one— because symptoms arise when the body makes an effort to protect itself from further damage, and the immune system starts taking steps to cure the body; therefore, inducing further production of antibodies or whatever by the catalytic action of something that imitates or even exacerbates the symptoms isn’t such a bad idea after all? Maybe. But it certainly can’t be the whole story. And it’s all done by most of its practitioners in such a scientifically sloppy manner, and in such a curtly dismissive ‘I’m a seasoned adept, and I have an intuition about these things that I can’t be bothered to formulate explicitly’ fashion, that it reduces to little more than a cult, and many serious would-be investigators get turned off.
What are we to make of a ‘system’ of medicine that, till fairly recently, didn’t think that anatomy had anything to do with medicine, but only symptoms did? The grudging nod given to subjects like anatomy (let alone more advanced ones like surgery) in more recent ‘schools of homeopathy’ have more to do with the desire for acceptability as a science (by a public that is nowadays more exposed to the technological tools developed by science, and hence imagines itself to be more scientific than its predecessors), than the actual development of the subject of homeopathy as a science, if that were at all possible.
The second problem is that, contrary to what one might guess offhand, it is remarkably hard to collect significant statistical data in a scientific manner on the efficacy of fringe medicine of various kinds. This is especially so for data on comparative studies of different systems of medicine, especially vis-á-vis conventional medicine. A precise description of the problem would involve going into the details of the protocols that are required to be set up for meaningful studies of this kind. For the purposes of illustration, however, let me describe in rather naive fashion the kind of study that would be entailed in comparing conventional medical treatment of some common ailment with, say, the treatment of the same ailment by homeopathy. We would need a sufficiently large number of patients in nearly the same physical condition, to be observed over a fairly protracted period while under different treatment regimens. For example, we might start with four hundred patients all suffering from essentially the same ailment, and separate them into four groups A, B, C and D of a hundred each. (Fifty each would be too small a number, and five hundred each might be much more difficult to line up.) Group A is then treated by conventional medicines, group B by placebos for such medicines, group C by medicines prescribed by homeopathy, and group D by placebos for these medicines. Additional safeguards such as double blinds must be incorporated. Careful monitoring of all the patients and recording of the data must followed by a rigorous statistical analysis of the results. You can readily imagine how diﬃcult it will be to get everybody involved to agree upon the details, and to even set up such an elaborate study.
Unfortunately, the practitioners of conventional medicine also contribute in some measure to the difficulties just described. One cannot help getting the impression that a section of the medical fraternity itself operates in some respects like an exclusive guild, loath to expose too many of its ‘secrets’ to open and unbiased scrutiny. As a trite manifestation of this tendency, haven’t we all faced doctors who don’t really like to explain things in detail to lay persons, and who think that the rest of us are basically too dense to understand the deep mysteries of their subject? It is not unusual to get a patronising brush-off when one asks questions that are more penetrating than a meek and hoary: “Should I take this tablet before food or after food?” And the practitioners of fringe medicine are even more secretive, paranoid about being questioned, and aggressively defensive (and evasive) about their particular recipes and panaceas—perhaps with good reason! At any rate, getting together whole groups of people with such strongly divergent views, for an objective and impartial study by knowledgeable neutral observers, would probably be even more difficult than running a peaceable interfaith meeting among a gaggle of monomaniacal religious leaders. Even within the framework of conventional medicine, given the vested interests of diverse players including rival pharmaceutical firms, distributors, financiers, advertising agencies, doctors, hospitals, research funding agencies, research laboratories, and other sectors of the medical world, arranging for reliable, unbiased clinical trials of an experimental drug is difficult enough, as a long-suffering public has learnt, to its cost.
The fact is that the empirical content of medicine as a discipline is still quite high. There’s actually nothing wrong with that, per se. Sound empirical knowledge is the starting point for a sturdy science. But, unfortunately, many medical specialists themselves seem to feel, rather needlessly, that this empirical component somehow diminishes the scientific credentials of their discipline, and makes it less high-brow than it deserves to be. Therefore, in order to keep up the notion that their particular form of medicine is completely scientific, these experts feel that they must constantly remind lay persons that all but the broadest details of their speciality are too complex to be explained easily to a non-specialist. Such evasions are made easier, and more persuasive, by the fact that most people visit doctors only when they are already in a rather helpless situation and a vulnerable state of mind, which makes them psychologically less discerning than usual. What is being missed here by both parties is that empirical knowledge does not make medicine unscientific, but merely less deterministic than a subject with a more developed analytical framework. But the very hallmark of a developing science is the gradual replacement of empirical content by a methodological structure that enables greater predictability and control. In this sense there need be no misgivings about the scientific nature of modern medicine.
If this is the state of affairs even with conventional modern medicine, it is no wonder that the ambivalence of identity is much more pronounced in the case of various fringe or ‘alternative’ systems of medicine—all too many of which are no more than purported systems of medicine. Nor is it hard to understand why such systems are even more reluctant to subject themselves to serious, objective, unbiased, third-party evaluations and tests under carefully-documented and controlled conditions. Most of the claims of these systems would not withstand rigorous scientific scrutiny at even a cursory level, let alone deep and sustained probing.
We now come to the argument in favour of homeopathy that is trotted out most frequently: “But it really worked in the case of my nephew’s jaundice, or my aunt’s asthma!” No doubt it did, as far as one can tell. Or maybe something else did (naturopathy, acupuncture, …. take your pick, for the litany of sad tales of human gullibility is as fascinatingly varied as it is long). Or maybe what did it was a combination of prayer, homeopathy, bland food, the sympathy of relatives, the pleasant company of friends, calming music, and a regular regimen and plenty of fresh air and sunshine and the stoppage of antibiotic overdose. And let’s not forget the most helpful de-stressing effect of sincere belief in the efficacy of those little sugary balls in contributing to the eventual cure! The truth is that we have no sure-fire, foolproof way of knowing, or finding out, precisely what did it, notwithstanding the most sincere protestations of the patient himself and the sworn testimony of those around the patient. The veracity of the patient is not under question here, nor is the probity of the witnesses. It is just that these qualities do not suffice to yield, and cannot replace, truly objective scientific experimentation and observation. Such is the level of rigour and control demanded by the uncompromising procedure of data acquisition in science.
It is obvious that we have barely scratched the surface of the mountain of knowledge of what our body and mind can do in tandem with each other. We simply don’t know enough about what the subtle mechanisms are, where they lie, and exactly what triggers them. We haven’t even figured out how the immune system itself, a sort of mobile in situ ‘brain’ located all over our bodies, really works. When we do discover all these things, and we’ll surely do so eventually (maybe in another hundred or two hundred years), matters will look a lot less mysterious than they do now. Meanwhile, what about homeopathy to cure this ailment or that? Should one take recourse to it? Well, if it works for you, or if you think it works for you, or if you think it will work for you because it worked for a friend whose word you trust, or if you think you have nothing to lose by trying it out, why shouldn’t you do so—provided you aren’t imprudent enough to neglect a truly serious and threatening health situation for which there does exist a scientific method of treatment? But there’s no need to swallow (along with those little sugary balls) the accompanying hype about its being a scientific mode of treatment, because it just isn’t so. Caveat emptor!
The dilemma that seems to arise (at least for the small segment of the population that prides itself on being rational in all matters) is whether one is then being unscientific in practice, while professing to adhere to scientific principles. This is a more difficult question, but the answer is simple and virtuous. It is quite evident that everything we do in daily life is not necessarily scientific—often because there are as yet no satisfactory scientific underpinnings or theories for those things! As obvious examples, we have the enjoyment of fiction, of literature that speaks of purple skies and fairies in the garden, of poetry that swears that girls’ eyes look like stars. Do we really want to point out to poets that girls’ eyes can’t possibly be related to enormous aggregations of hot gas undergoing nuclear fusion? On a more serious note, we have psychology and sociology and economics and finance, and the myriad other expressions of consciousness and free will for which we haven’t even begun to frame the questions in the proper scientific manner. Does this—should this—preclude us from acknowledging their existence, experiencing their functioning, and enjoying their fruits? I should think not. But all of us can contribute to the desideratum of an ethos enhanced by a scientific and rational temper:
- We must refuse to encourage or accept ‘explanations’ that are mere mumbo-jumbo clothed in scientific jargon, as if this suffices to make them respectable, let alone correct.
- We need to recognise that the world around is a hierarchically organised progression into increasing complexity: from quarks to atoms and molecules, through biomolecules, cells and organisms, to humans and society, to … who knows what?
- We ought to allow for the fact that science as we understand it is less than four hundred years old, which is—incredibly enough—just about a dozen human generations or so, when you think about it. This is less than a blink of an eye on evolutionary time scales, let alone geological time scales, much less cosmological time scales. It is rather negligible even compared to recorded history. For all those who admonish: “Don’t think science knows everything or can answer all questions”, I say: science does not think it knows everything, and we do need to give it a little more time! We must be alive to the possibility that scientific explanations may exist (and emerge one day) for most things, perhaps even all things, rather than get into a mystic mode and declare dogmatically that ‘there are things beyond science’. They may indeed be beyond today’s science, but how can anyone be so presumptuous as to declare that something will be beyond the ken of rational enquiry forever? Science is nothing if not eclectic, in the best sense of the word.
That’s the whole point—what it doesn’t know right now, science will eventually find out, and incorporate into its accumulated body of knowledge. That’s equally true of medicine, naturally. One day we will surely find out exactly how asthama or eczema or other allergies can be controlled, and how and why little sugary balls containing a little arsenic, perhaps, and called surefirecura mysteriosa or something like that, may actually have helped trigger a cure in some cases. While not decrying the utility of this apparent magic in some instances for some individuals at some time, let’s not confuse it with science. There is no real need to do so! Likewise, there is no need to take seriously the purveyors of apparently scientific explanations of why homeopathy works—and such theories emerge out of the woodwork with tireless regularity. Recent ones include the attribution of long-lived ‘memory’ to water molecules, and the invoking of a quantum mechanical phenomenon called entanglement. (Quantum mechanics seems to hold as fatal an attraction for pseudoscientists as the proverbial flame does for moths.) Meanwhile, the most recent careful studies of the efficacy of homeopathy seem to indicate that it is essentially comparable to, and consistent with, that of placebos. The deep neurological and psychological reasons for placebo action are yet to be fully understood, but it is a real and well-documented phenomenon.
The probability of Materia Medica replacing molecular medicine texts in the year 2100 is near zero, if things go well. But should it happen, we can also be sure that our descendants of that day will be wearing rough animal hides and rubbing stone against stone to produce fire, while they discuss the relative merits of goat hair and bat droppings for relieving joint pain. In that case, none of this will matter. May that never come to pass!
(Prof.V.Balakrishnan is a theoretical physicist working in IIT, Madras. He is a popular teacher of Physics. His engaging lecture series on Classical Physics and Quantum Physics are available on youtube and are highly appreciated. )