Another point on which homeopathy is contradictory: either homeopathic remedies cannot have side effects, or homeopathic drug testing cannot work.
If you ask a homeopath how one knows which remedy to use and when, he will certainly mention the law of similarity, one of the essential pillars of all homeopathic teaching.
“A remedy cures the symptoms in a sick person when it may cause the same symptoms in a healthy person”. This is the law of similarity in the form that homeopaths like to quote. But you can also turn it around, then it says: “A remedy causes in a healthy person the symptoms that it can cure in a sick person”. It sounds more threatening that way, don’t you think?
In order to determine the problems for which a remedy helps, homeopaths do just that. Namely, they carry out homeopathic drug testing, where healthy people take the remedies and then write down which symptoms they suffer. These are then collected and form the basis for selecting the appropriate remedies. If your homeopath finds that your symptoms resemble the symptoms that the remedy has caused in healthy people, then you will be prescribed the remedy.
This homeopathic drug test does not involve taking a lot of the remedy or a high concentration, no, just as the remedies are, as the homeopath prescribes them to his sick patients. For example, in Potency C30, Hahnemann’s recommendation from later years, a few globules several times a day, perhaps for five days. Let us note: homeopathic remedies must cause symptoms in healthy people after five days at the latest, otherwise they are not effective. At least we do not know what they are effective against.
Let us see what remedies a medicine chest should contain, especially for young families and small children. Let us take any website from the Internet. There are nine ointments and drops recommended for the most diverse applications, as well as 24 different globules. There you can find for example:
Arnica montana for minor injuries, sore muscles, bruises
Hepar sulfuris for purulent skin inflammations and colds
Belladonna for sunburn, sore throat, inflammation of the middle ear, infections
Pulsatilla for irritable bladder, diarrhea and otitis media
Now, let’s imagine that your child suffers of something. You’ re thinking it’s an infection and giving belladonna, just to be safe. What if it wasn’t an infection? If belladonna helps fight infection, it must be able to cause symptoms of infection. So if you’re wrong about this, your kid can get exactly what you think you’re treating.
There’s more to it than that. These remedies are also effective – so say the homeopaths – for quite different diseases. So they can cause them, if you don’t have them.
Let us look at what the remedies help against, in other words, what the remedies must have already triggered at least once in healthy people. At least some of the symptoms associated with these complaints.
These are just a few examples. The remedies can allegedly do much more, and must therefore have caused this at some point in a homeopathic drug test. Is this a gentle medicine? Can one be take responsibility for giving one’s children such remedies, which can cause symptoms of serious illness? What happens if you make a mistake when choosing the remedy, or give a few drops or globules too much or too long?
These would be the risks one would have to reckon with if the claimed law of similarity actually existed. But this is not the case: you can swallow any amount of the supposedly most effective homeopathic remedies without anything happening. The remedies do not cause any symptoms. So they don’t cure anything either, if you follow the argumentation of homeopaths.
What can we conclude from this? There are two possibilities:
Either the law of similarity of homeopathy really exists, in which case homeopathic remedies belong in the poison cabinet, because in this case they can cause severe symptoms of illness with the slightest application error, which is usually called a “side effect”. Would there be any homeopathic therapists at all who would risk using these remedies?
Or, more probably, the law of similarity is wrong, then homeopathic remedies are harmless – but the whole homeopathic teaching lacks the foundation. Everything that homeopaths say about the effect of their remedies is wrong.
No matter how: the remedies only benefit one person – the manufacturer.
Addendum: This does not even address what we consider to be the most critical side effect of homeopathy: Whoever relies exclusively on homeopathic remedies in the case of serious illnesses such as cancer, diabetes, depression, high blood pressure, accepts his or her death; in the case of less serious diagnoses also a protraction of illness, subsequent complaints or longer periods of illness. Unclear symptoms should always be examined by a physician and, if necessary, treated medically.
The good conversation between patient and doctor is an essential part of the anamnesis, diagnostics and above all the therapy. Mutual trust between patient and doctor is of decisive importance.
Often one hears of a general patients’ unsatisfaction regarding the therapy conversation. It is almost always complained that these conversations are too short, because the doctor has too little time. This general unsatisfactoriness with the medical conversations is mentioned as an important – perhaps even the most important – reason why patients visit a non-medical practitioner or homeopath because he is said to be better trained for the conversation than the doctor and takes more time for the conversation (which is unfortunately a false assumption: non-medical practitioners have no training in conversation and above all no experience with patients if they have passed their exam). Many patients acknowledge that the remuneration of physicians does not normally allow long therapy sessions, but they also know that the remuneration of the physician’s consultations is not the responsibility of the patients. It is obviously the law of the market that you pick up the minutes for conversation where you get them, even if you have to pay for the time yourself.
Doctors who are confronted with criticism of the “inadequate” conversation situation in practices and clinics often find this criticism justified. At the same time, the poor remuneration is cited as the reason for this unsatisfactory situation. Patients and doctors can jointly blame third parties for the precarious situation: politicians and health insurance companies.
Patients, physicians and pseudomedical practitioners largely agree in public that there are deficits in medicine in the area of therapy conversations, which can even excuse and justify a change from medicine to pseudomedicine.
However, this argumentation usually remains general and nebulous. Concrete deficits are not mentioned.
However, a large discrepancy is noticeable: On the one hand the culture of conversation in the medical business is criticized and considered “bad”, on the other hand the patients are very satisfied with their own doctors. – Of course, we cannot and will not deny that there are also doctors who do not comply with medical standards and who rightly offer cause for criticism. However, this is not about the individual doctor with human and professional weaknesses, but about the “medicine” par excellence. It is “medicine” that uncovers and names errors in diagnosis and treatment. The “medicine” is to name the violations of their standards without regard to the person of the doctor as what they are: malpractice.
A study on patient satisfaction is presented in an older, but still valid article in the German Medical Journal (Deutsches Ärzteblatt) from 2005. There it says (quote):
“The key to dissatisfaction is the lack of a culture of speech. The weak point in the German healthcare system was indentified in the communication between doctors and patients, because 61 percent stated that they were not always informed by their doctors about treatment alternatives and asked about their opinions. (1)
The generally high level of patient satisfaction cannot be reconciled with this study result. In a press release of the service “Jameda” it says (quote):
“3-year trend: overall satisfaction in the practices remains at a high level. Overall satisfaction, which also includes the category “relationship of trust”, was stable with Germany’s doctors. As in the previous years 2013 and 2014, overall satisfaction in 2015 will remain at a good level of 1.87.” (2)
Perhaps this discrepancy can be better explained by going into a little more detail and becoming more concrete.
In the case of mental illness, patients are treated by psychiatrists or psychotherapists. These specialists have excellent training in medical conversation skills. Homeopaths and non-medical practitioners are far from having such a qualification in conducting conversations as the doctors in this specialist group have.
But how does it look in the field of somatic medicine? Are their specialists well trained for interviews?
The big question is, which topics should specialists discuss with their patients? What questions should they answer their patients? What do patients want to know? A few exemplary situations will be presented.
From internal medicine:
What does a patient who has just been diagnosed with diabetes mellitus want to know?
He wants to know why he got sick. How’s his life changing? Does he have to give up cake for life? What are bread units? What is insulin? What is the difference between the different types of insulin? Do I have to check my blood sugar daily? How can I protect my blood vessels?
An internist – in this case an endocrinologist – can provide excellent answers to these questions because he is trained to answer them. However, training in psychotherapeutic conversation is not required to answer these questions. Diabetologists even offer complete training courses to answer these questions in particular.
Other examples from internal medicine: hypertension (high blood pressure), asthma, COPD. All patients with these diseases have questions about their lifestyle, about the risks of possible non-treatment, about the risks of therapy. Internists and general practitioners can provide excellent answers to these questions – they know these diseases in all their facets.
Surgeons answer questions about the risks of any operation in informed consent discussions …
Anaesthetists answer questions about the risks of anaesthesia in the premedication consultation …
The list is not complete. She doesn’t have to be either: All specialists are excellently trained to answer all questions on the diseases of their specialty competently and comprehensively – and family doctors no less. And the cooperation between general practitioner and specialist must not be forgotten or underestimated. And in principle, § 8 of the German professional code of conduct stipulates that doctors must inform their patients about all alternatives before diagnostic and therapeutic interventions.
Do the attending physicians also take enough time to answer the patient’s questions?
It may be that not all questions are answered immediately during the first conversation. But that is not necessary either – yes, it does not even make sense. The length of the discussions must also depend on the nature of the disease and the receptiveness of the patients. Many questions come later. But all patients with such incisive diagnoses come to the practices for checks over and over again. At the second, third or each later consultation, there is also the possibility for the patient and the doctor to discuss open questions. Every time you pick up a repeat prescription, it can be used for a conversation – and it doesn’t even have to be long. Even short conversations can be long enough. The duration of a single conversation is not as decisive as the overall medical care. And with an overall grade of “better than good”, one can assume that the overall medical care is obviously better in each concrete case than its reputation in the undifferentiated general.
As one can see from the text, the accusation related to the lack of information about “treatment alternatives”. Among other things, patients also complain that doctors speak in a scientific language they cannot understand. However, in one study 29% of the patients could not remember it after an informative talk. (3)
The question remains why so many patients (61% in 2005 – see above) did not feel sufficiently enlightened.
I think we should differentiate here too. Every surgeon will inform his patients not only about the operation, but also about the treatment alternative “no operation”. In the case of tumour patients, a whole treatment team consisting of surgeons, internists (chemotherapists) and radiation therapists is discussing the best treatment alternative – one could say ” struggling for it”. Orthopaedists will certainly promote physiotherapy or simply “more sport in everyday life” as an alternative to surgical therapy. Cardiologists also recommend a “cardio sports group” as a supplement to drug therapy – in the best case, sport can replace drugs.
In a study, the authors Bahrs and Dingelstedt came to the conclusion that around 80% of those questioned judged the duration of the conversation with the doctor to be “exactly right”. It was necessary to distinguish between “experienced time” and “calendar time”. The greatest need for discussion exists in medically undetermined or non-clarifiable situations. (4)
How can it be explained that about 80% of patients are satisfied with the duration of the conversation, but 61% do not feel sufficiently informed about treatment alternatives?
If patients do not feel sufficiently enlightened about treatment alternatives, then in many cases they mean “treatment alternatives” from the field of pseudomedicine – in any case, medical treatment alternatives belong to the standard program of every medical consultation.
However, “treatment alternatives” from the field of pseudomedicine are not equivalent to medical treatment including all medical treatment alternatives. The main difference is that “treatment alternatives” from the field of pseudomedicine are ineffective. The desire for as many effective treatment alternatives as possible is quite understandable and comprehensible. But a desire for efficacy does not generate efficacy. No “therapist” can force succeed of his method. Effective treatment methods can only be detected – they cannot be invented. We can be happy and thankful that we found some at all. For it is by no means self-evident that there are any treatment methods at all for sick living beings in our world – the only one we have.
In a specific treatment situation, the patient must learn a lot from the doctor. This does not include detailed information on ineffective treatment procedures: Time can and must be used more sensibly. In view of the large number of ineffective pseudomedical procedures, it is not possible anyway to provide sufficient information about all of them. In this respect, homeopathy is the most important, but by no means the only pseudomedical “alternative”, which is no alternative at all due to its proven ineffectiveness. If one has to spend the same length of time for information about homeopathy, Bach flowers, Schüssler salts, bioresonance, Reiki, spiritual healing, New Germanic Medicine – the list is far from complete and it gets longer practically every day – as for an effective medical treatment method, then no patient is helped with it. The opposite is the case: valuable time for real advice is sacrificed to procedures that should be excluded from the outset because of proven ineffectiveness. In the case of serious illnesses, it must be made clear to patients that wishful thinking does not help. – One may and can talk about a good feeling during the treatment and about the “wellness factor” – there is talk about it! – but as a doctor one must leave no doubt that the effective treatment is in the foreground and “wellness” has a secondary priority. The desire for a “nice way to health” is an understandable wish that is certainly fulfilled wherever such a possibility exists. But even if there’s no nice way to health: The important thing is that there is a way to health at all. – Unfortunately, it happens often enough that there is no way to health at all. In such cases a “nice way” is very important, even if it does not lead to health. But even in such cases, modern palliative medicine certainly offers better methods than all pseudomedical procedures.
Patients’ dissatisfaction with the alleged lack of information about “treatment alternatives” is apparently a problem between “reality” and “perception of reality”. Doctors are aware of this problem. And they know that the pretence of supposed “treatment alternatives” must catch the eye sooner or later than what it is: an empty promise. And doctors also know that empty promises are ethically problematic. Sacrificing time for ethically problematic empty promises when time is scarce does not defuse the ethical problem at all.
The information about the ineffectiveness of – often desired – “treatment alternatives” only belongs to a small part into the medical practice or into the clinics. Basic information should be an essential part of general health education. It belongs in schools and universities. And because there are undeniable deficits there, there is us: the Information Network Homeopathy (INH).
We, the INH, feel obliged to provide correct information about pseudomedicine – mainly in the form of homeopathy.
Medical information about treatment procedures and effective treatment alternatives within medicine is provided by doctors – despite scarce remuneration. Every doctor knows that patients must bring a willingness to cooperate – compliance – because otherwise every therapy is doomed to failure. Correct information is not only in the interest of the patient – it is also in the very interest of the treating physicians.
With a patient satisfaction of “better than good”, one can and must confidently assume that the criticism of the quality and quantity of medical consultations is based more on a deception of perception than on a real deficit.