Reprinted
from
Arthritis Today, March-April 2000
Homeopathy is a mystery. Scientists can’t explain it, and neither can those who use it. But for more than 150 years, people have been saying it works. Should you give it a try?
Homeopathy is among the most popular alternative therapies in the United States, and even more popular in Europe and Canada where such "remedies" can be found side-by-side with conventional drugs in many pharmacies. It’s used worldwide not only by homeopaths, but by some medical doctors as well as naturopaths, chiropractors, herbalists, midwives and sometimes even veterinarians.
Most doctors tend to scratch their heads – or shake them in disbelief – whenever the subject of homeopathy comes up. It’s an alien concept that goes against almost everything understood in modern medicine.
While much of homeopathy’s appeal is based on hearsay and anecdotes, nevertheless, a number of studies have shown homeopathic remedies are effective for some conditions. Most doctors write that off to placebo effect – the curious but real phenomenon in which a person’s belief that a substance will make him feel better actually does make him feel better. But there may be more to homeopathy than the placebo effect can explain: Some of the studies were performed on animals and in test tubes, yet still showed positive effects.
The basic premise isn’t so strange: Homeopathy is based on the idea that "like cures like," that diluted amounts of a poison or other disease-causing substance can relieve the same symptoms that the larger dose causes. That concept resembles the desensitizing therapy used to relieve allergy symptoms, or vaccination, in which we are given a mild case of the disease to put our immune system on guard.
But the most confounding homeopathic belief of all is that the weaker the dose, the stronger the body’s response. In fact, some of the "most potent" remedies are so diluted that not a single molecule of the original material remains in the solution or tablet.
No one can explain how it works – or how it could work. One homeopathic theory is that the molecules of the remedy substance leave an energy "memory" as they disappear, somewhat like a shadow, and that the body responds to it.
To most scientists, that’s nonsense. How, they ask, can a substance that diluted possibly have any effect? And skeptics and foes aren’t the only ones baffled.
"It boggles the mind," agrees Wayne Jonas, MD, a family physician at the Uniformed Services University of the Health Sciences in Bethesda, Md., who uses homeopathy in his practice.
George Guess, MD, a family practitioner in Charlottesville, Va., says: "I don’t have the answer, but I know it works." Dr. Guess, who is president of the American Board of Homeotherapeutics and whose practice is "99 percent" homeopathy, was drawn to the field in part because of what he calls "the pleasant paradox: You can get an effect without a side effect," he says.
Corey Weinstein, MD, who practices homeopathy in San Francisco, says "There are a lot of things that we use every day and don’t understand. Homeopathy isn’t magic – it’s just a wonderful, natural tool that helps people."
A "Pharmacy" from the 18th Century
Homeopathy is a healing system developed in the 18th century by the German physician Samuel Hahnemann. Looking for a mild therapy that could stimulate the "vital energy" to restore and maintain health, he believed the substances that cause disease could, when administered in tiny amounts, provoke a healing response.
Over decades, Hahnemann built a pharmacy of thousands of "remedies" derived from natural substances such as herbs, minerals and animal products. Homeopathy quickly built a great popular appeal: By the mid 1800s, thousands of homeopathic doctors, hospitals, pharmacies and medical schools appeared worldwide.
Homeopathy faded from popularity in the United States in the 1940s with the advent of antibiotics and other effective pharmaceuticals. Today, increased interest in alternative therapies has led to a revival. Now homeopathic remedies are sold at health food and drugstores in the form of tinctures, creams, and most often as tiny tablets that dissolve under the tongue. Today’s homeopaths often use a computer to keep track of the many remedies.
Finding the Right Remedy
Homeopathy is an individualized therapy: A practitioner takes a detailed history of your health, lifestyle, preferences and symptoms and categorizes your "constitutional type." The homeopath then carefully matches this information to a vast data bank of remedies.
Among the most common homeopathic preparations is arnica, used for bruises and injuries. Some common remedies for arthritis pain are Rhus toxicodendron (from poison ivy) Bryonia (wild hops), Apis (from bee venom) and Ledum (from marsh tea). A homeopathic remedy for gout is Colchicum autumnal, the herb from which a prescription drug for gout is made.
In so-called "classical homeopathy," the practitioner seeks a single remedy that’s the perfect fit for an individual and his situation, and then prescribes one remedy at a time. If that remedy doesn’t work on all the symptoms, the practitioner may substitute – or add – another remedy. According to Dr. Weinstein, some insist this is the best way to practice homeopathy. On the other hand, many of today’s homeopaths use combination remedies of two or more ingredients at a time.
Many more people self-treat, especially for minor ailments such as muscle aches, a cold or an earache. There are many books on homeopathy that match symptoms to remedies, and remedies are usually labeled with their therapeutic uses. Anyone can buy the substances off-the-shelf in health food stores, pharmacies and even grocery stores. And homeopathic remedies are approved by the U.S. Food and Drug Administration as over-the-counter drugs, unlike herbs and dietary supplements which have not received FDA approval as medications.
But in homeopathic philosophies, self-treating isn’t as effective as a customized treatment for a chronic condition such as arthritis, says Dr. Corey Weinstein.
Practitioners say symptoms sometimes worsen briefly before they begin to get better. Acute ailments such as the flu or a stomach upset may clear up with one dose in a few hours or days, says Jennifer Jacobs, MD, who’s on the faculty at the University of Washington and who’s been using homeopathy for 23 years in her family practice. Chronic conditions such as arthritis may take several months of treatments, she says.
A Remedy for Joint Pain and Disease?
Although we couldn’t locate any rheumatologists who use homeopathy, several homeopathic family practitioners we spoke with said they treat patients with arthritis, and that there are remedies that ease symptoms.
Some said remedies may even slow or stop the progression of rheumatoid arthritis (RA) or osteoarthritis (OA). But scientific evidence doesn’t prove that. There are acceptable studies that suggest homeopathy eases conditions such as allergies, but the research on homeopathy and arthritis is mixed, says Dr. Jonas. "Many of the studies have problems."
He analyzed a group of six studies: three for rheumatoid arthritis and one each for OA, fibromyalgia and myaglia (or muscle pain). The remedies, which varied, were better than placebo for relieving some symptoms in two of the three RA studies. But the other studies had mixed results, were of poor quality or used small numbers of patients.
"Overall, the evidence for the benefit of homeopathy in arthritis is poor," says Dr. Jonas, and rheumatologists emphasized that people should not discontinue or delay taking effective prescription medications to experiment with an unproven therapy.
"I’d probably use other therapies first, or along with homeopathy," says Brian Berman, MD, director of the University of Maryland’s complementary medicine program, who is a family practitioner, a homeopath and an acupuncturist.
A caution: Homeopaths also believe substances such as coffee or prescription drugs may counteract the remedies. But no conscientious homeopath takes patients off prescription drugs abruptly or asks them to stop medications if they have a systemic type of arthritis such as lupus or RA.
"If I have someone with RA who needs methotrexate, I send them to a rheumatologist. But they could be trying homeopathy along with it," says Dr. Jonas, who describes himself as "a 99 percent conventional doctor" who also uses homeopathy.
"I have many people taking conventional medicine along with homeopathic remedies," says Dr. Jacobs. "If it’s the right homeopathic remedy, it won’t be nullified by any other medication the person may be taking, but they may need to take the homeopathic remedy more often."
Some people might find with homeopathy that they can gradually reduce their medication, she says, but this should be done under a doctor’s care.
What’s the bottom line? The half-dozen rheumatologists we consulted say there’s not enough evidence homeopathy helps any arthritis symptoms.
"We need more studies," says Arthur Weinstein, MD, director of the Division of Rheumatology at George Washington University Medical Center in Washington, DC. "It is possible to conduct good studies, and alternative remedies such as homeopathy should be subject to the same scrutiny as prescription drugs."
Meanwhile, they agreed the remedies are so diluted that treatments are unlikely to do harm, and many people say they find symptomatic relief.
"We have to stay open-minded," says Nancy Lane, MD, who’s an associate professor of medicine at San Francisco General Hospital at the University of California. "These alternatives are important, because people are using them. Therefore, we must consider them important topics to study."
Good Advice
Homeopathic remedies can be found in many pharmacies and health food stores. You can find a practitioner in your area through the National Center for Homeopathy in Alexandria, Va. (703/548-7790 or www.homeopathic. org). For a medical or osteopathic doctor who’s also a homeopath, contact the American Institute of Homeopathy, also in Alexandria (703/246-9501 or online at www.homeopathyUSA.org).
According to doctors we interviewed and the National Center for Homeopathy, fees for treatment range from $100 to $400 for the first consultation and then from $50 to $100 for follow-up visits. Remedies range from $5 to $15, and sometimes are used in one dose. The consultations may be covered by your insurance if the homeopath is also a medical doctor or osteopath.
If you decide to try homeopathic remedies, heed the advice given by the physician homeopaths we interviewed:
- Get a diagnosis from a medical doctor if you have – or even suspect you have – arthritis. There are more than 100 different types, and your diagnosis will determine the proper treatment.
- Don’t try to treat yourself if you have a systemic rheumatic disease such as rheumatoid arthritis or lupus. And don’t expect homeopathy alone to be enough. Consult your regular medical doctor as well.
- Don’t give up your prescription medications without your doctor’s OK. It can be dangerous to stop some drugs abruptly.
- Look for a homeopath with years of experience, certification from a national homeopathic organization and, preferably, medical training.
- Use only products labeled with the words "produced in accord with the U.S. Pharmacopoeia Convention" to be sure you are getting a pure homeopathic product, not one mixed with drugs or other substances.
- Read the labels if you have alcohol concerns: Some remedies are diluted with alcohol.
- Take only one remedy at a time, and keep detailed notes about what you take and any effects you feel. This will help you determine if it appears to help your symptoms or track any adverse effects.
- Don’t continue a therapy that isn’t working: Homeopaths say remedies show effects for minor ailments in a few days. For a chronic disease such as arthritis, it may take up to two months. If you don’t improve after that period, it’s probably not the right remedy – or homeopathy may not be the right treatment.
- Remember, more is not better: The whole philosophy of homeopathy is small doses. Take the remedies as directed, in tiny amounts.
- Side effects are rare, as homeopathic remedies have little (if any) active ingredients. However, if you develop new symptoms, stop taking the remedy right away and consult your doctor and a homeopath.
For more information:
Healing with Homeopathy: The Complete Guide, by Wayne B. Jonas, MD, and Jennifer Jacobs, MD, MPH. 1996. New York, Warner Books. $24.95
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