View metadata, citation and similar papers at core.ac.uk brought to you by CORE bs_bs_banner provided by ZENODO Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/j.1467-8519.2010.01876.x Volume 26 Number 8 2012 pp 398–409 ARTICLES AGAINST HOMEOPATHY – A UTILITARIAN PERSPECTIVE KEVIN SMITH Keywords homeopathy, ABSTRACT alternative medicine, I examine the positive and negative features of homeopathy from an ethical complementary medicine, perspective. I consider: (a) several potentially beneficial features of home- CAM opathy, including non-invasiveness, cost-effectiveness, holism, placebo benefits and agent autonomy; and (b) several potentially negative features of homeopathy, including failure to seek effective healthcare, wastage of resources, promulgation of false beliefs and a weakening of commitment to scientific medicine. A utilitarian analysis of the utilities and disutilities leads to the conclusion that homeopathy is ethically unacceptable and ought to be actively rejected by healthcare professionals. What is the moral status of homeopathy? I shall address BACKGROUND TO HOMEOPATHY this question by exploring and weighing the benefits (or utilities) of homeopathy with its disutilities. From this The basic principles of homeopathy were formulated by a analysis it will be concluded that a strong rejection of German physician named Samuel Hahnemann in the homeopathy is morally required, with implications for early 19th century.1 Homeopathy is based on two central the ethical behaviour of a range of agents involved in principles: the ‘law of similars’ and the ‘law of infinitesi- healthcare. mals’. The former principle holds that a substance able to cause a symptom in healthy subjects can also be used to cure that symptom. The latter principle holds that a HOMEOPATHY: A PARADOX therapeutic substance becomes more potent as it is diluted, provided that the process of dilution is accompa- Homeopathy as a claimed therapeutic modality occupies nied by a special form of vigorous shaking (‘succussion’). a paradoxical position in modern medicine and health- Hahnemann and his followers assembled a body of care: the plausibility of homeopathy is entirely untenable literature based on observations of the apparent effects on logico-scientific grounds, and no quality evidence of administration of a range of diluted substances on exists to support claims of efficacy; despite this, home- various subjects (including themselves).2 opathy is manifestly popular amongst many laypeople The fundamental principles and knowledge-base of and a significant number of medical professionals. homeopathy remain essentially unchanged since the 19th Because this paradox exists in the context of medicine century, and form the basis of current homeopathic prac- and healthcare, with concomitant implications (good or tice. But these principles are highly problematic, as dis- bad) for human welfare, the moral content of homeo- cussed below. pathic theory and practice demands analysis. Such an evaluation is of prima facie relevance for a wide range of 1 S. Hahnemann & C. Hering. 1849. Organon of Homoeopathic medi- disparate agents, including public healthcare purchasers, cine. New York: W. Radde. medical practitioners, university educators and private 2 O.W. Holmes ed. 1892. Homeopathy. New York: Prometheus Books: individuals. 221–243. Address for correspondence: Dr. Kevin Smith, Abertay University – Contemporary Sciences, Baxter Building, Dundee, Tayside DD1 1HG, United Kingdom. Tel: 01382308664, Email: [email protected] Conflict of interest statement: No conflicts declared © 2011 Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. Against Homeopathy – a Utilitarian Perspective 399 Law of similars evening in bed as if intoxicated, and feeling as if the head were floating in the air’ (Juglans regia), and ‘singing, Hahnemann derived this law from a single observation tinkling, and buzzing in ears’ (Oleum animale).4 Further, involving himself. In an attempt to discover why quinine it is likely, given the lack of blinding, that suggestibility relieves the symptoms of malaria, he took some cinchona played an important role in the reporting of such effects. bark (the source of quinine) and developed a fever and Thus, the process by which the ‘materia medica’ of other symptoms common to malaria. From this experi- homeopathy were established is of extremely poor quality ence, he concluded that a substance that produces par- by the standards of modern clinical trials, to the extent that ticular symptoms in healthy individuals can be effective it is impossible to know whether the recorded symptoms against a disease that has the same symptoms. Subse- were causally related to the administered substances. Thus, quently, Hahnemann and his early followers conducted no worthwhile knowledge upon which to base medical ‘provings’ in which they administered various substances practice may reliably be taken from these ‘provings’. (of botanical, animal or mineral origin) to themselves and More fundamentally, there is simply no plausible or other healthy people, keeping detailed records of the rational basis for supposing that substances that produce associated symptoms observed. These observations have particular symptoms can cure the same symptoms. The been compiled into reference works or ‘Homeopathic assumption that ‘like cures like’ places the onus on pro- Materia Medica’, which form the basis of current homeo- ponents of homeopathy to elucidate the special logic 3 pathic practice. involved: to the knowledge of the present author, a sat- To determine whether a given substance actually isfactory account of this logic has not been made. causes a symptom, it would be necessary to conduct a clinical trial in which people who receive the substance are compared with people who receive a control sub- Law of infinitesimals stance. To minimise the risk of false results through random effects, a fairly large number of people would Homeopathic preparations are produced by taking a have to be enrolled on such a trial, since it is common- quantity of a substance associated with disease symptoms place and entirely natural for healthy people to experi- (from the ‘provings’ information referred to above) and ence occasional unpleasant bodily feelings. Finally, to subjecting this to a simple process known in science as avoid bias, the trial would have to be ‘double-blinded’ ‘serial dilution’. In this process, 1 part of the substance is (i.e. neither the experimenters nor the test subjects should diluted in 9 or more parts of diluent (usually water or be aware of which people receive the test substance or the alcohol); 1 part of this diluted preparation is then diluted in the same way, with this procedure being repeated control substance). 5 The ‘provings’ of Hahnemann et al. were conducted in several times. Each stage of dilution is prepared by a the early 19th century, an era in which the fundamental special form of shaking (‘succussion’) that is believed by proponents to increase the potency of the product (the principles of clinical trials (as outlined above) had not 6 been established. Thus, the observations that form the resultant preparation is said to be ‘potentized’). Final dilution factors vary, but are typically in the range of 1 basis of current homeopathic practice were not con- 6 60 ducted in a reliable fashion. Specifically, participants part in 1 ¥ 10 to 1 part in 1 ¥ 10 , although some prepa- rations are as high as 1 part in 1 ¥ 10400 (that is, 1 part in were observed on an individual (rather than group trial) 7† basis; there were no controls; wide variations occurred in 1 followed by 400 zeros). The high dilution factors the treatment regimes (in terms of quantities of substance inherent in homeopathic preparations present a funda- administered, source and preparation of substances, and mental problem, because straightforward mathematics length of study); blinding was not used; and the ‘data’ shows that, in most cases, it is statistically unlikely that were recorded in a non-rigorous manner. Moreover, even a single molecule of the original substance will be many of the symptoms recorded are highly subjective. † Note: Correction added on 16 August 2012 after first publication For example, ‘griping pains followed by passing offensive online on 14 February 2011. The dilution factor has been corrected flatus, or a loose yellowish stool, which always produced from 1 ¥ 10200 to 1 ¥ 10400 to match the description in the text. The error great exhaustion’ (Echinacea angustifolia), ‘excited in has been corrected in this version of the article. 4 Ibid. 3 Hahnemann himself published several volumes of ‘Materia Medica 5 The precise methods used vary according to the substance in question. Pura’ during the early 19th Century. These volumes have been trans- Insoluble substances are typically ground-up and mixed (diluted) with lated and remain in use today. Also available are various Homeopathic milk sugar. Final preparations may be in liquid form or impregnated Materia Medica works presented on websites as searchable compendi- onto sugar pills. ums, for example W. Boericke. 1927. Homoeopathic Materia Medica. 6 S. Hahnemann. 1846. The Chronic Diseases their Specific Nature and 9th edn. Médi-T. Available at: http://www.homeoint.org/books/ Homeopathic Treatment. Toronto: Bastian Books. boericmm/index.htm [Accessed 21 June 2010]; J.H. Clarke. 1901. A 7 S. Barrett. 2002. Homeopathy’s ‘Law of Infinitesimals’. Homeowatch. Dictionary