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."
Homeopathy for arthritis & rheumatism
Dr Peter Fisher discusses his approach to this common, painful and potentially crippling group of conditions.
Arthritis and rheumatism are among the commonest forms of chronic disease and, with an ageing population, are set to become commoner still. Strictly speaking, arthritis means disease of the joints, while rheumatism is disease of the soft connective tissues which support and move the joints. In fact, the distinction is often artificial, since many of these conditions affect both the joints and connective tissues.
Osteoarthritis, the commonest of these conditions, is basically ''wear and tear'' of the joints. The root of the problem is wearing out of the cartilage, the tough, slippery ''gristle'' which allows the ends of the bone to slide smoothly over each other and absorbs shocks. The joint becomes stiff and painful, and may creak as it is moved. As the cartilage wears down, the bones on either side of the joint may react by forming small bony outgrowths called osteophytes. One of the sites where bony nodes can easily be seen is the last joint of the fingers.
Spondylosis is a similar problem affecting the spine; here the main problem is degeneration of the disks which separate the vertebrae. As one would expect with a degenerative condition the prevalence of osteoarthritis increases with age; it affects 9% of the total population but around 70% of the over-70s. It is the commonest of all rheumatological conditions, and indeed probably the commonest of all chronic diseases, because many sufferers live with it for many years. Not surprisingly it tends to affect weight-bearing joints (e.g low back, hips and knees). Joint injuries or overuse (for instance heavy physical work or professional sport) predispose to osteoarthritis later in life. Overweight is another important factor.
The other two main groups of arthritis and rheumatism are inflammatory arthritis, of which the commonest form is rheumatoid arthritis and soft tissue rheumatism.
Rheumatoid arthritis affects about one person in a hundred; it is nearly three times commoner in women than men (for unknown reasons). Its cause, too, remains frustratingly elusive. It tends to come on at an earlier age than osteoarthritis (typically in the 30s to 50s) and is more aggressive, running a more rapid course; about a third of sufferers are seriously disabled within ten years, although it is very variable. It particularly affects the small joints, especially of the hands and feet, causing a typical hand deformity where the fingers slant sideways. But it can affect almost any joint in the body, and also cause nodules under the skin and eye problems. There are many other forms of inflammatory arthritis, some of them associated with infections.
The final group is true rheumatism, affecting the soft connective tissues rather than the joints themselves. There are many forms, some with picturesque names. They include enthesopathies which affect the point at which tendons connect to the bones — the best known of these are tennis elbow, affecting the outer side of the elbow and golfter''s elbow, which affects the inner side. Capsulitis — inflammation of the capsule of tissues that surround the joint — most commonly affects the shoulder and may lead to a stiff "frozen" shoulder. Some of the more amusing names are reserved for bursitis — inflammation of the bursae, cushioning pads which overlie many joints. These include housemaid''s knee (also known as clergyman''s knee), from too much kneeling. But my favourite is weaver''s bottom — so called because it used to affect weavers who had to shuffle up and down long benches to tend their looms!
The most common form of soft tissue rheumatism, however, is fibromyalgia (which used to be known as fibrositis). It affects about 2% of people and is much commoner in women than men. It is a controversial condition; some believe that fibromyalgia and chronic fatigue syndrome (ME) are varieties of the same condition; certainly there are similarities.
The typical features are widespread musculoskeletal pain and aching with tender points at several specific locations. It is frequently associated with poor sleep and fatigue as well as other problems including migraine and irritable bowel syndrome.
There are many problems with current conventional treatment of arthritis and rheumatism. For instance, although osteoarthritis rarely, if ever, killed anyone, a group of drugs often used in its treatment, the non-steroidal anti-inflammatory agents (NSAIDs), including aspirin, Ibuprofen and Voltarol among many others, certainly has. There are some 12,000 hospital admissions and 2,000 deaths from these drugs every year in the UK alone. Although the new generation of NSAIDs is safer, they are only glorified painkillers, which do not affect the basic disease process. Similarly for rheumatoid arthritis, a range of powerful drugs is available but all of these have long and alarming lists of side effects.
The homeopathic approach
In treating someone suffering from arthritis and rheumatism with homeopathy, just as with any other condition, I look at the person as a whole. In practice this means starting by looking at what exactly the problem is: pain, stiffness, sleep disturbance, limitation of particular activities, or what? Where is it? How long has it been a problem and what has been the evolution? ''Evolution'' means where did it start and what has happened since — has it moved, if so, in any particular pattern? Does it come and go, any pattern to that? Did anything seem to trigger it off in the first place? Then the modalities — simply any factor which makes the problem worse or better: for instance hot or cold applications, bandaging or support, the weather etc. Here it is important to know what is normal: for instance it is usual for an acutely inflamed, swollen, tender joint to be relieved by cold applications. But in homoepathy exceptions to the rule are of particular interest. I then move on to the rest of the history. I don''t take separate ''medical'' and ''homeopathic'' histories. I integrate the two. Sometimes the conventional part of the history can give a vital clue.
For instance, a woman came to consult me with extra-articular manifestations of rheumatoid arthritis. When I asked if anything seemed to have triggered the problem, she said she couldn''t think of anything. But when I enquired into the social background it turned out she had been through a messy divorce, including a court battle for custody of the children, which she eventually won. The onset of her illness coincided almost to the day with the end of the custody case. I was amazed that she did not make the connection. It was clear that this was a topic she didn''t want to discuss. Translated into the quaint nineteenth-century language of some homeopathic books this is ''aggravated by consolation''. It was this that gave me the first clue to the homeopathic medicine, sepia, to which she had an excellent response. This was an example of ''not what they say, but how they say it''. Then to complete the history, the ''mentals'' and ''generals''. The mentals include how the patient reacts to and copes (or fails to cope) with their problems and the so-called "constitutional" features: is this a strong-willed and assertive person, or the opposite? Tidy and organised or untidy? And so forth. Then the generals, for instance does this person feel the cold excessively, prefer the morning or the evening? I then examine the patient, again this is not just a matter of good medical practice, but can give important clues to possible homeopathic treatment.
Rheumatoid Arthritis
Homeopathic Remedies
Homeopathic remedies are useful in relieving the pain and stiffness associated with rheumatoid arthritis. A constitutional remedy is often the best approach for dealing with chronic conditions.
Arnica: Useful for chronic arthritis with a feeling of bruising and soreness. The painful parts feel worse from being moved or touched.
Aurum metallicum:
This remedy is often prescribed for wandering pains in the muscles and joints that are better from motion and warmth, and worse at night. The person may experience deep pain in the limbs when trying to sleep. Also may feel discomfort that may wake the person up. People who need this remedy are often serious and focused on work or career, with a tendency to feel depressed.
Bryonia:
Helpful for stiffness and inflammation with tearing or throbbing pain, made worse by motion. The condition may have developed gradually, and is worse in cold dry weather. Discomfort is aggravated by being touched or bumped, or from any movement. Relief can be had from pressure and from rest. The person may want to stay completely still and not be interfered with.
Calcarea carbonica:
Helpful for deeply aching arthritis involving node formation around the joints. Inflammation and soreness are worse from cold and dampness, and problems may be focused on the knees and hands. Common symptoms are: weakness in the muscles, easy fatigue from exertion, and a feeling of chilliness or sluggishness. The person who benefits from Calcarea is often solid and responsible, but tends to become extremely anxious and overwhelmed when ill or overworked.
Causticum:
Useful when deformities develop in the joints, in a person with a tendency toward tendon problems, muscle weakness, and contractures. The hands and fingers may be most affected, although other joints can also be involved. Stiffness and pain are worse from being cold, and relief may come with warmth. The person often feels best in rainy weather and worse when the days are clear and dry.
Calcarea fluorica:
Helpful when arthritic pains improve with heat and motion. Joints become enlarged and hard, and nodes or deformities develop. Arthritis after chronic injury to joints also responds to Calcarea fluorica.
Dulcamara:
Indicated if arthritis flares up during cold damp weather. The person gets chilled and wet. They are often stout, with a tendency toward back pain, chronic stiffness in the muscles, and allergies.
Kali bichromicum:
This is useful when arthritic pains alternate with asthma or stomach symptoms. Pains may suddenly come and go, or shift around. Discomfort and inflammation are aggravated by heat, and worse when the weather is warm.
Kali carbonicum:
Arthritis with great stiffness and stitching pains, worse in the early morning hours and worse from cold and dampness, may respond to Kali carbonicum. The joints may be becoming thickened or deformed. People who can benefit from this remedy often have a rigid moral code, and tend to feel anxiety in the stomach.
Kalmia latiflora:
Useful for intense arthritic pain that flares up suddenly. The problems start in higher joints and extend to lower ones. Pain and inflammation may begin in the elbows, spreading downward to the wrists and hands. Discomfort is worse from motion and often worse at night.
Ledum palustre:
Arthritis that starts in lower joints and extends to higher ones are candidate for this remedy. Pain and inflammation often begin in the toes and spread upward to the ankles and knees. The joints may also make cracking sounds. Ledum is strongly indicated when swelling is significant and relieved by cold applications.
Pulsatilla:
Applicable when rheumatoid arthritis pain is changeable in quality, or when the flare-ups move from place to place. The symptoms (and the person) feel worse from warmth, and better from fresh air and cold applications. Can benefit people who are emotional and affectionate, sometimes having teary moods.