Homeopathy and Placebo

Homeopathy and Placebo

I ran across an interesting bit of history in my feeds, Hahnemann and placebo.

From a modern perspective, homeopathy is placebo. Most homeopathic nostrums contain no active ingredients, and potentially active molecule being diluted out of the product. A 12C dilution, as an example

Has a 60% probability of containing one molecule of original material if one mole of the original substance was used.

and 30C, the

dilution advocated by Hahnemann for most purposes: on average, this would require giving two billion doses per second to six billion people for 4 billion years to deliver a single molecule of the original material to any patient.

It is no wonder that in all the reviews, homeopathy is no different that placebo for the treatment of any disease.

It is why it is interesting that the inventor of homeopathy, Samuel Hahnemann, differentiated between a sham medication (placebo) and his homeopathic nostrums.

His goto placebo was milk sugar, although he also experimented with ground oyster shells and raspberry juice. He evidently gave more sham medication than his homeopathic nostrums

A close look at Hahnemann’s case journals reveals that the percentage for placebo prescriptions is very high. In his case journal no. 22 from 1821 85% of the medications are placebo. This is also true in regard to his later years. In the period between 1833 and 1835 more than half (54%) of Hahnemann’s prescriptions are placebo.

Pretty remarkable. Evidently it was the style of the time to give medications frequently, even hourly, and his nostrums were given far less frequently. He wanted to see the effects of his homeopathic interventions over time and did not want other medications to be given simultaneously and interfere with his observations. So

The main reason for giving placebo in homeopathy was therefore to please the impatient patient.

He also had some curious reasons for resorting to placebo:

  • Hahnemann himself was not sure whether he had found the right homeopathic drug. 

  • The patient looked in his eyes so sensitive that he wanted to find out first how this patient would react to placebo.

  • If a female patient began to menstruate during the treatment, Hahnemann stopped the verum treatment and gave placebo.

  • If a patient was used to drinking tangy beer – which Hahnemann thought might have medicinal ingredients – this person was temporarily treated with placebos.

And I suppose nothing would get in the way of a treatment more than a sensitive, menstruating, beer drinking woman.

Sham medicines were considered appropriate at the time, the ends justifying the means:

He even used the word ‘deception’ for his action. What mattered to him was the goal: “Patients who have firm confidence in the honesty and skill of their physician, will have no hesitation to be satisfied with a dose of sugar of milk, which may be exhibited every two, four, or seven days, agreeably to the wishes of the patient; such a course will never lessen their confidence.

Of note, while Hahnemann suspected that there would be a limit to his dilutions, he lived in a time before that limit was known:

BUT neither Avogadro nor Dalton knew how many molecules there were in a given mass of a substance

This is absolutely crucial because it means that, although Hahnemann realised that there was a limit to the dilutions that could be used, he had no way of knowing what that limit was,

The answer to that question was discovered only in 1865, 22 years after the death of Hahnemann. It was discovered not by Avogadro, but by Johann Josef Loschmidt (1821 – 1895). It is Loschmidt, not Avogadro, who discovered the crucial numerical value of ‘Avogadro’s number‘.

So I will cut Hahnemann some slack; he had no way to know that his homeopathic nostrums were placebo as well. As David Colquhoun said

But modern homeopaths have no excuse whatsoever for believing the impossible.

Hahnemann would have thought they were nuts, I suspect. He was too intelligent to believe that medicines that contain no medicine could be effective. In his words, “It cannot go on to infinity”.

Points of Interest 06/19/2014
Points of Interest 06/17/2014