In January 2010, hundreds of people gathered in Cathedral Square in Christchurch to simultaneously throw back bottle upon bottle of pills. The mass overdose was never intended to cause harm to the participants, nor tempt arrest. Instead it was to protest the sale of homeopathic remedies. By taking far beyond the prescribed dosage, the protesters sought to prove that homeopathic remedies – sold by pharmacies across the country – have no active ingredients beyond sugar and water.
The obvious question is that if the remedies are just water, why do people buy them? Why would a person drop $20 on sinus drops, or spend $140 for a consultation with a homeopath? For the very same reason people spend far larger sums on conventional medicine: they believe that sometimes the remedies work.
Bridgette* is a 24-year-old with a Masters in Music from the New Zealand School of Music, and currently working in human resources. She’s articulate, bright and engaging – and she’s a user of homeopathy. “From a young age, I’d experienced performance anxiety,” she explains. “If you experience a shortness of breath, shaking or anything like that, the audience can read it. I found it was getting in the way of my music and art.”
More recently, however, Bridgette had a major break-through in her health by using homeopathy. Between the ages of 19 and 24, she experienced irregular menstrual bleeding. She saw numerous doctors, took various tests, and was given only one solution: to go on the pill.
It was at this point that Bridgette turned to homeopathy. She booked an appointment at an alternative medicine retailer in Wellington. “I thought, ‘I need to do something about this, and maybe something alternative was the way to go’, because I’d exhausted the conventional way of doing it.” She was booked in for a 90-minute consultation, during which the consultant discussed everything from her alcohol intake to her family dynamic. However, as a sufferer of migraines, she could not take the pill often prescribed for irregular periods. She felt that she had reached a dead-end. “I’d be walking down the street, nowhere near when my period was due, and all of a sudden there would be all of this blood. It could last one day, maybe three days. It felt like I had my period all of the time. And I was not getting any answers as to why.”
Photo: Wiki Commons
The focus on both physical and emotional wellbeing and the sheer depth of the consultation are points where homeopathy more often than not outstrips conventional medicine. Constraints on time and resources mean establishing rapport and trust between GP and patient is no longer a luxury a GP enjoys. Instead, a visit to the GP often involves nothing more than the exchange of pleasantries, and then it’s straight down to business, only to be done and dusted in about 10 minutes. Homoeopaths actively involve the patient in discussing possible treatments, making them the centre of the solution rather than a distant bystander.
At the end of the consultation, the homeopath and Bridgette came up with about six different concoctions, made from a range of different remedies and specifically tailored to Bridgette’s symptoms. She went home and gave it a go. “I tried one thing for a while, and I noticed an improvement, but there was still a little bit of bleeding. It was the second or third remedy that hit the jackpot. The bleeding stopped about two days after taking it, and it hasn’t been back since.”
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Scepticism about homeopathy is not without basis. The branch of alternative medicine dates back to the 18th century, when it was created by German doctor Samuel Hahnemann. The ingredients used are chosen in accordance with a homeopathic belief that “like cures like” – that is, substances that cause symptoms in large doses can be used in small amounts to treat those same symptoms. Remedies exist for everything from malaria and asthma, through to anxiety and acne. The substances are highly diluted and made by taking an ingredient, repeatedly diluting it with water and vigorously shaking the mixture between dilutions.
Another tenet of homeopathy is that the more diluted a remedy, the more potent it is. It is believed the water carries with it a memory, which increases in strength with each dilution. While many users are well aware of the dilution theory, presumably most people are not familiar with the extent of the dilution that takes place. A standard homeopathic substance may have a dilution of around “30C”. What this in fact means is that the substance has been diluted 30 times by a factor of 100 each time. The end result, as Ben Goldacre gives the example in his much-acclaimed book Bad Science, is that in a swimming pool spanning the distance from the earth to the sun, there would be only one molecule of the active ingredient at a 30C dilution. Put simply, the substances are just water – and expensive water at that.
Sceptics of homeopathy generally chalk any of its perceived successes up to two explanations: she was going to get better anyway, or it was the placebo effect.
So if homeopathy is nothing more than water packaged in a fancy bottle, what was it that cured Bridgette? Sceptics of homeopathy generally chalk any of its perceived successes up to two explanations: she was going to get better anyway, or it was the placebo effect. The latter is often said derisively, as if the placebo effect, too, is junk science. But unlike homeopathy, it is well-established and accepted within the medical community that the placebo effect exists and can lead to physical and emotional healing. In other words, the placebo effect may not just make you feel better, it may actually make you better. In Bridgette’s case, regaining a sense of control over her body in formulating remedies with her homeopath may well have been what stopped what was very much a physical medical condition.
While the placebo effect is powerful, knowingly using it is considered unethical – hence doctors can’t prescribe you painkillers that are in fact just sugar pills. Patients have the right to information about what we put in our bodies and the kind of treatment to which we are subjected. However, if homeopaths truly believe that their remedies have a power to heal beyond the placebo effect, the ethical issue of consent is not such a big deal – just as it isn’t when a doctor prescribes a remedy that, in itself, does not address your ailment, but you get better because you are taking something you believe will make you better. Homeopathic remedies usually label the ingredients, but few patients – if any – realise just how minuscule the amounts of the active ingredient is. Again, though, this is often no different from remedies prescribed by a doctor, where the name, let alone active ingredients, goes over most patients’ heads.
It begs the question: what, if anything, is wrong with homeopathy from a regulatory point of view? Undoubtedly, the answer is plenty. Homeopathic remedies are marketed to suggest they are indeed more than water. KEEP OUT OF REACH OF CHILDREN, one bottle screams. DO NOT EXCEED MINIMUM DOSAGE, another. The products are sold in pharmacies, often by trained pharmacists. Often the bottles are said to be used to treat a particular ailment – for example, a common cold or aching joints. Under the Fair Trading Act 1986, it seems a person could bring a convincing claim formisleading or deceptive conduct.
On top of consumer protection laws, homeopathy also raises issues from a medical regulatory point of view. In New Zealand, any substance claiming to be for a “therapeutic purpose” is subject to the Medicines Act 1981. Substances under this act are tightly regulated in terms of licensing and retail sales. The issue is not so much in the law as in enforcement. Many natural health produces that ought to be subject to the act simply flout the law. In 2007 the Ministry of Health undertook a review of natural health websites, and found 78 per cent of the 263 websites were in breach of the law. For those homeopathic remedies that carefully word their claims so not to be subject to the Medicines Act, the Dietary Supplements Regulations 1985applies, which specifies labelling requirements and prohibits misleading statements. Again, the law exists; it’s just rarely – if ever – enforced.
While there is currently a bill winding its way through the House, that too looks like it will lack the teeth to effectively regulate the homeopathy industry. The Natural Health and Supplementary Products Bill will introduce a new “product notification” regime for natural health and supplementary products. Under this regime, a new authority would be notified of all natural health and supplementary products by the importer or manufacturer, who would also be required to make available on a website, “in respect of each health benefit claim made for the product, a summary of the evidence that the product notifier relies on to support the claim.”
It’s a provision that, on the face of it, seems to signal the end of the homeopathy trade in New Zealand. However, buried down in section added at the Committee stage is a proviso that states the above requirements as to the product notification regime does not apply to “any natural health and supplementary product in which the active ingredient to be administered is in a concentration not more than 20 parts per million”. And just like that, homeopathy falls outside the regime. While the Bill will introduce some changes to the regulation of homeopathic remedies, the exclusion carved out in section 13A means an opportunity to tighten the reins on homeopathic remedies may well have passed.
Many people who use homeopathy have been failed by conventional medicine, so seek out alternatives.
The lack of discernible harm and the many happy users of homeopathy are perhaps some of the reasons why the drafters of the Natural Health and Supplementary Products Bill have decided against stricter regulation in the area. Regulation is a constant balance between limiting harm on the one hand, and allowing citizens to live their lives as they wish without the interference of the state on the other.
Many will say that the danger in homeopathy is that people will rely on it instead of conventional medicine; however, ironically this claim, too, lacks evidence. Instead, many people who use homeopathy are like Bridgette: people who have, for whatever reason, been failed by conventional medicine, so seek out alternatives. When I ask Bridgette if she would feel misled if she was to find out there was absolutely no scientific basis to homeopathy, she pauses for a second. “No,” she says. “What I care most about is what works.”
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The vehement opposition to homeopathy, as seen in the Cathedral Square protest or the related 10:23 campaign held in the United Kingdom around the same time, itself raises questions. Are those who draw attention to the potential harm caused by marketing and selling a health product with no proven scientific benefits important guardians of vulnerable consumers, or are they a group of smug and self-satisfied busybodies with nothing better to focus protest efforts on than what people do with their own health and bodies?
Many of those who argue the former will say that people deserve to have all the necessary information to make informed choices. And while this may be true, there are far more vulnerable consumers than those using homeopathy. Mention the Credit Contracts and Consumer Finance Act 2003, an area of law that is also currently under review and seeks to tighten up on loan sharks, and you’ll be met with blank stares. There are plenty of people who desperately need legislative protection, but users of homeopathy are not – by and large – those people.
It also doesn’t explain the level of ridicule to which those who use homeopathy are subjected: the self-righteous, well-educated type casting judgment about the way other people live their life because “it just bothers them”. There are many ethical question marks around any industry profiting off uninformed consumers, but it’s questionable whether that’s what is causing the outrage, or whether it’s some deeper resentment for people who have different beliefs and practices. For those who are sitting outside pharmacies attempting to blow the homeopathy industry to pieces, or mocking those who believe in homeopathy on Twitter, maybe take a chill pill. I know just the place to get one.
(*name changed given the sensitive nature of the medical condition discussed)
Cover photo Bridget Coila via Wikimedia Commons
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