Part of Issue #7 of The Highlight, our home for ambitious stories that explain our world.
Natalie Grams once believed in homeopathy. She believed that sugar pastilles, distilled and diluted as the praxis of homeopathy prescribes, could treat ailments from colds and flus to depression and anxiety, to allergies, asthma, chronic pain, immune dysfunction, and digestive disorders — you name it.
As a medical student in her native Germany, she’d become increasingly frustrated with the limitations of conventional medicine. There was no time, the 41-year-old physician says, to really care about patients; treating symptoms was the bottom line. Then, in the midst of her studies, she survived a horrific car accident. She escaped mostly unscathed, but soon suffered repeated fainting spells. Doctors could find nothing wrong. A friend suggested she try a naturopath, a practitioner of alternative medicine, who diagnosed Grams with PTSD, and prescribed a homeopathic remedy — specifically, Belladonna C200, tiny, white pills featuring a diluted form of the poisonous plant by the same name.
“And then I felt better,” says Grams. “So I thought, ‘Oh, it was homeopathy that healed me, that cured my symptoms.’”
Homeopathy is a school of alternative medicine based on the principles that “like cures like,” that less is more, that a detailed patient intake is necessary to get to the root of a medical issue. After she recovered, Grams devoted herself to it, not only as a patient, but as a practitioner. She first completed her medical training, and then, after seven years of homeopathic training, including 300 hours of coursework that cost her a not-insignificant sum (weekend trainings were as much as 300 euros, or more than $300), Grams became a licensed medical homeopath. And she opened her own practice.
Much of her homeopathic training ran counter to what she’d studied in med school. Instructors taught that vaccinations contained chemical ingredients like aluminum, and that antibiotics can’t cure disease, recalls Grams. One supervisor stripped away all conventional remedies for most patients he saw, even those with chronic illnesses requiring medication, like high blood pressure, diabetes, and asthma. Grams, though, was all in.
And, as is something of a time-honored tradition in homeopathy, she contended with skeptics and critics. To prove them wrong, she began writing a book in defense of homeopathy.
Instead, she found that the facts and research didn’t support the field she’d built her career on. She read up on clinical trial after clinical trial that could find no hard evidence that homeopathic remedies worked; she consulted chemists and physicists, who explained why quantum physics can’t support homeopathy’s claim that water retains “the memory” of any substance it comes into contact with; she turned to psychologists, who talked in-depth about the placebo effect. The result was a very different book that she titled Homeopathy Reconsidered.
“I was convinced [I was] doing something good, really good,” she says of her homeopathic practice over FaceTime while on vacation with her family at an undisclosed location. (She’s lived “hidden,” as she puts it, since she became a public critic of homeopathy and the death threats began.) “Even perhaps the best form of medicine.”
Homeopathic remedies contain no discernible molecules of their “active” ingredients. And yet, proponents claim they retain the properties of what isn’t there. “It’s like smoke,” says Grams, “like something that if you want to grab it, if you want to get ahold of it, it just vanishes. It’s just a big illusion.”
Homeopathy is a $1.2 billion industry in the US alone, used by an estimated 5 million adults and 1 million kids. It’s become such a staple of America’s wellness industry that leading brands such as Boiron and Hyland’s are readily available at high-end health-focused chains like Whole Foods and Sprouts, supermarkets like Ralphs, and superstores such as Walmart. Analysts project that the global homeopathic market will grow 12.5 percent by 2023.
Once considered fringe, homeopathy is now bundled by conventional medicine under the banner of “complementary and alternative medicine,” with the other usual suspects of the West’s modern wellness movement, a health wave that swelled in the 1970s and crested twenty years later: acupuncture, massage, meditation, yoga, reiki, Ayurveda, etc. “Back in the 1990s,” writes Jennie Rothenberg Gritz at the Atlantic, “the word ‘alternative’ was a synonym for hip and forward-thinking.” Today, about half of adults in the US say they’ve tried alternative medicine.
For those who buy into it, homeopathy is synonymous with holistic health. Surely there are more answers out there, more remedies, homeopaths argue, than ibuprofen, antacids, statins, SSRIs, and surgery. Its rise has been in tandem with a growing sense of perceived failures in medicine, particularly that doctors fail to take “whole health” into consideration. To its followers, homeopathy does.
But these products are not FDA-approved. In 2016, the Federal Trade Commission began a crackdown on the homeopathic remedies that were filling grocery shelves, mandating that they clearly state that they are not, in fact, medicine. Boiron’s website now bears that legally required disclaimer: “Claims based on traditional homeopathic practice, not accepted medical evidence.”
Consumers are beginning to feel “scammed and cheated,” the nonprofit Center for Inquiry argued, in a lawsuit filed last month against Walmart and CVS over the sale of what it called “homeopathic fake medicine.” A consumer survey conducted by the nonprofit found that 41 percent of respondents felt negatively about homeopathic remedies “[o]nce [they] were told the essential facts about homeopathy’s pseudoscientific claims.”
In a statement provided to Vox, Boiron’s chief executive and president Janick Boudazin wrote, “We do not comment on ongoing cases or cases of others. It should be clarified, however, that homeopathic drug products are legally marketed in the United States, ensuring consumers have access to safe and clearly identified homeopathic products from which to choose for their healthcare needs.”
Peter Gold, a spokesperson for the American Institute of Homeopathy, cited several studies, including a controversial one from the Swiss government, that he said proved homeopathy’s efficacy. “Ninety percent of available clinical studies would have to be ignored in order to conclude that homeopathy has no effects,” he said in an emailed statement. “Homeopathy is an important element of an Integrative Medicine, combining the best from conventional medicine and medical homeopathy for the benefit of patients.”
Requests for comment from another leading homeopathy organization — the National Center for Homeopathy — went unanswered by the time of publication.
A history of homeopathy, distilled
Many misidentify homeopathy as “natural” and describe it as plant-based or herbal medicine. It’s not. In his 2016 book, Homeopathy: The Undiluted Facts, Edzard Ernst, a physician, homeopathy researcher, and noted skeptic, classified the “natural” qualifier as one of the many myths about homeopathy disseminated by both believers and skeptics. But there’s “nothing natural” about it, he wrote: Homeopathic remedies include alcohol exposed to x-rays to minimize the effects of radiation therapy, and fragments of the original Berlin Wall to “cure a patient’s communication problems,” Ernst wrote.
Homeopathy isn’t Eastern medicine either. It’s slightly more than 200 years old, and it was born in Germany.
Samuel Hahnemann, an 18th-century physician described by Ernst as a “deeply religious and spiritual man as well as an eccentric, innovator, maverick, and polymath,” first published a new school of medical thought that he named homeopathy in 1790. He’d become disillusioned with the medical model of the time, but was fascinated by cinchona bark powder, then used to treat malaria (and later found to contain the alkaloid quinine, which is still used to treat malaria today). He dosed himself with large quantities of cinchona bark, ingesting it repeatedly to document the fever, sweats, and nausea that set in. His aim: to test whether the remedy for malaria produced the symptoms of malaria in a healthy person. It did.
Hahnemann declared this the first of what would come to be known as “homeopathic provings.” (The etymology of the word “homeopathy” is “like disease.”) He conducted more experiments and reached more provings. Soon, he defined several so-called laws; two are guiding principles of homeopathy today:
- Like cures like: Homeopathy posits that a substance that produces a disease’s symptoms in a healthy person is a cure for that disease. (In the case of the aforementioned 20th-century remedy known simply as “Berlin Wall,” conditions caused by communication problems are said to be cured by tablets made from finely ground, diluted shards of the actual Berlin Wall, because it was once a concrete barrier to communication.)
- Law of minimum dose: The lower the dose, say homeopathic practitioners, the more potent the remedy. To that end, homeopathic remedies are extremely diluted. Many are so diluted, in fact, that they contain no detectable molecules of the “mother tincture.” Hahnemann intended to avoid poisoning, as many of the substances that he introduced as remedies were toxic. But soon his rationale became less, well, rational: “Vital energy” was transmitted during dilution, Hahnemann believed, so none of the original substance needed to remain.
Hahnemann’s theories represented a sea change in medical philosophy, a rejection of what he coined “allopathy” — remedies that produce a disease’s opposite symptoms — and derisively dubbed “school medicine.” Hahnemann thought that doctors of his day harmed patients, and he wasn’t wrong. Late 18th century medicine revolved around balancing the four humors, most frequently through bloodletting. Homeopathy’s less-invasive approach attracted followers, who in turn spread Hahnemann’s gospel across Europe, India, and the US. The American Institute of Homeopathy, founded in 1844, even arrived three years before the American Medical Association.
Conventional medicine eventually became increasingly science-oriented, discarding bloodletting and the like for more effective (and drastically less dangerous) treatments. Homeopathy, by contrast, maintained its original dogma, one that hinged on individualized treatment and made it nearly impossible to conduct clinical trials that adhered to the scientific method.
By the 1900s, homeopathy was even recognized by the US government. Royal Copeland, a surgeon, New York City commissioner of health, storied US senator, and homeopath, used his medical authority to lend credibility to homeopathy and his political influence to ensure its recognition by the law. The Food, Drug, and Cosmetics Act of 1938 oversees homeopathy to this day.
From “alternative medicine” to complementary medicine
In the world of homeopathy, there are believers, and there are skeptics. There are also passive participants who seek over-the-counter remedies as supplements, believing in these pastilles (and ointments, tinctures, tablets, creams) enough to buy them, if not necessarily to stake their health on them entirely. There are those who believe in invisible forces, in energies, in spirits; there are those who don’t, who dismiss homeopathic remedies as alcoholic sugar water. And some perspectives, like Grams’s, fluctuate over time.
Boiron was the homeopathic brand of choice for my Southern California family in the 1990s and early 2000s. I grew up in the suburbs, my dad is a doctor, and my parents fully vaccinated me, but there was something about “natural medicine,” and homeopathy in particular, that spoke to them. Whenever I had the flu, my mom gave me a pinky-sized vial of Oscillococcinum, sweet “flu crystals,” as we called them, that I dissolved happily under my tongue. Whenever I had a cold, she gave me something called ColdCalm, which I took, but begrudged for its chalky taste and easily crumpled blister packs.
I know now that the active ingredient in Oscillococcinum is Anas barbariae, extract of duck heart and liver. (The Center for Inquiry asked consumers about their knowledge base of Anas barbariae as part of their aforementioned survey; 46 percent of respondents “viewed the product less favorably” once they learned about this duck stuff.) I don’t know if it worked. My symptoms would eventually abate, but I don’t know that my conditions improved any quicker with the remedy than without. I do know, however, that my parents searched beyond the confines of conventional medicine for ways to improve our health that were more “natural” than prescription drugs and standard over-the-counters, or that seemed more natural anyway — and they’re not alone.
As alternative treatments become immersed in mainstream consumer culture (see again: Whole Foods, worth $13.7 billion as of 2017), there’s been a semantics shift, away from “alternative” to “integrated.” To wit, the National Institutes of Health renamed its alternative health-focused department the National Center for Complementary and Integrative Health in 2015.
“The name change really reflects our deep-seated interest in studying complementary and integrative health as part of conventional care, and not as an alternative to conventional care,” says NCCIH Deputy Director David Shurtleff. He uses cancer as an example: There is no known alternative cancer treatment that’s proven effective, but the research supports that alternative treatments can ease common cancer symptoms, such as yoga for anxiety and depression or mindfulness for insomnia.
For supplemental users, homeopathy is an alternative medicine, another option in the medicine cabinet. Critics see all homeopathic use as an alternative to medicine. It’s a subtle, but important, distinction. To the critics’ point, consider this statistic from Pew Research Center: One in five adults in the US uses alternative medicine instead of conventional medicine.
For Grams, this is the biggest risk — that people will forgo conventional, proven treatments in favor of homeopathic remedies which, she says, are nothing more than sugar pills. “You might think, ‘Oh, if that remedy doesn’t help me, I’ll use another, I’ll use another.’ And you lose time. If you have cancer, time is life.”
In the shadows of mainstream medicine’s failures
Doug Brown was happy in his practice as a family nurse practitioner, for a time. Eventually, however, ambivalence about modern medicine set in. “As I became more aware that so many of my chronically ill patients were not really getting better,” says Brown, 62, “that I was managing their illnesses, often by ordering lots of lab tests and adding more and more medications, I began to question what I was doing.”
His path to homeopathy followed a familiar script: disillusionment with conventional medicine, a sense of desperation and yearning for what Brown describes as “something ‘more.’” After his 2-year-old son’s ear infection resisted two courses of antibiotics, Brown — who had spent over a decade prescribing pharmaceutical drugs to his patients — turned to homeopathy. The belladonna remedy, says Brown, cured his son’s infection.
“It seemed to me like a miracle,” Brown says from his office in Portland, Oregon, where he’s practiced homeopathic healing for almost 20 years. “And then when I saw it work on other people, I began to realize that homeopathy held the key to this missing link that I was intuitively searching for in all my years of doing conventional medicine.”
The people who turn to homeopathy are a subset of a larger wellness-focused demographic that tend to be female, young to middle age, non-smokers, with lower body mass indexes, who make healthy lifestyle decisions (diet, exercise, supplements, you get it). “People who use homeopathy have that same profile, but even more so,” says Michelle Dossett, an assistant professor of medicine at Harvard Medical School who has studied homeopathy usage and published on her national survey findings in the American Journal of Public Health in 2015.
At the same time, there’s a subset of this population of homeopathy seekers that holds a low perception of mainstream medicine. Conventional medicine, they feel, is failing.
“I think there’s a big disconnect between what conventional medicine aspires to do and what actually happens sometimes in the consultation room,” says Dossett. “Because physicians face incredible pressures these days.” A 2017 study found that doctors in the US spend around 20 minutes with their patients, reports Reuters. (Even worse: Primary care consultations last just 5 minutes for half the world’s population.) It’s not for lack of trying. Doctors’ schedules are typically stacked, and wait times are typically long, with the Physician Foundation’s 2017 Patient Survey Report finding that only 11 percent of patients and 14 percent of primary care physicians feel “that they have all the time they need together.”
Most attitudes toward modern medicine are positive. Pew Research Center found in 2017 that more than two-thirds of Americans visited a health care provider in the previous year, with nearly 90 percent of that cohort feeling that they were listened to and 84 percent feeling that their provider “really cared” about their health. But the remainder, albeit a comparatively small sliver of the pie, shouldn’t be overlooked. Misdiagnoses and missed diagnoses may be one reason for their dissatisfaction: According to health care journal BMJ Quality & Safety, 12 million American adults — around 5 percent of the US adult population — are misdiagnosed every year.
“We have sort of an industrial medical system that really isn’t serving patients, and isn’t serving the health care professionals who are trying to serve patients,” says Dossett, who adds that many homeopathic practitioners, on the other hand, tend to spend more time with their patients.
They also spend more time exploring aspects of a patient’s health that might not be immediately tied to the reason they’ve made an appointment, the “chief complaint” or “presenting problem” in medicalese. Homeopathy is decidedly more comprehensive, exhaustive even, in its tack, from the inside out, and top to bottom. “Homeopathy is holistic because it treats the person as a whole, rather than focusing on a diseased part or a labeled sickness,” reads AIH’s description of homeopathic medicine, adding that the practice “stimulates the person’s own healing power” — a.k.a., invisible energy within every individual that Hahnemann termed “vital force.”
In homeopathy’s doctrine, mental, emotional, and social considerations are just as important as what X-rays, imaging, and lab tests can reveal, explains Brown: “What the mind expresses, the body expresses.” This is not to suggest that illnesses are psychosomatic, he adds, but more an issue of trusting patients at their word.
The trouble with homeopathic self-medicating
Buying homeopathic remedies at Walmart and the like, homeopaths would like you to know, isn’t real homeopathy. Dossett’s research found that most people in the US who use homeopathy self-prescribe OTC remedies, as my family did with Oscillococcinum and ColdCalm; only 19 percent of American homeopathic users see a homeopathic provider.
“It’s very unlikely that the remedies at a Whole Foods dispensary [are] going to be what the patient needs,” says Brown. There are more than 4,000 remedies available today, he adds, while at any given store, there may be about 10 on the shelves (none of them “Berlin Wall”). “I’m certainly not in favor of restricting that, but I want people to understand that homeopathy isn’t just the remedies, or just taking remedies,” continues Brown. “It is a process of becoming conscious of one’s experiences.”
Hahnemann believed homeopathy to be the only true medicine. He called the homeopath who combined his teachings and practices with conventional medicine “an apostate and a traitor,” according to Ernst. (Gold, of the American Institute of Homeopathy, dismissed Ernst, writing that “his work lacks the rigor one should expect from serious research.”) He would hate the supporting role that homeopathy’s been cast under the complementary and integrated health umbrella.
Today’s homeopathic practitioners often train in conventional medicine as MDs (like Grams) or nurse practitioners (like Brown), and largely recommend seeing general practitioners and primary care physicians concurrently, and getting X-rays and imaging and lab tests done. “Nothing can be a substitute for what modern medicine can offer in critical, life-threatening situations,” says Brown. “That’s not to say that homeopathy doesn’t have a role.”
When asked whether its line of homeopathic remedies should be considered supplements to conventional medicine, or substitutes, Boiron’s CEO Boudazin wrote to Vox: “Homeopathic medicines are one of the safest choices for self-treatment of everyday conditions like cold and flu symptoms, allergies, and muscle pain. They are often a first line of treatment that can offer relief with a low risk of side effects when used as directed. There are no known interactions with conventional medications or herbal supplements, allowing users to complement other treatments as well.”
Can “harmless” homeopathy become harmful to society?
There’s not going to be a meeting of the minds on this one. Devotees say that homeopathy works. Critics say that any perceived benefit is the work of the placebo effect. Devotees counter with success stories among animals and kids. (Ernst reported that Prince Charles wrote of his homeopathically treated animals: “[Homeopathy] is not the quackery they claim it to be. Or if it is, then I have some very clever cows in my shed!”) Critics counter that counter, asking, well, what about placebo by proxy?
“So much of conventional medicine actually could be legitimately criticized as exercises in the nocebo effect,” Brown says. The nocebo effect is the phenomenon where a diagnosis, pill, or treatment provokes negative symptoms associated with that diagnosis, pill, or treatment in the patient. Tell someone they have three months to live, and kill their hope, and the prophecy may very well come true. Brown adds, “Our conscious attitude and our conscious expectations do have a profound effect on our patients.”
The old evidence versus feelings debate can be a dangerous one, though, particularly when taken to its extreme. (See: Trump supporters.) And to that end, with more than 1,090 people in the US contracting measles this year alone, with the US at risk to lose its measles-free status after the measles vaccine eliminated measles just 19 years ago, and with the number of unvaccinated kids in the US quadrupling since 2001, we need to talk about anti-vaxxers.
Vaccinations might appear to follow the same “like cures like” logic as homeopathic remedies, and they do, to a degree; vaccinations, however, contain measurable quantities of their active ingredients. And to be clear, anti-vaxxer ideology is by no means intrinsically part of homeopathic philosophy, or prescribed by homeopathy dogma. “You will find some homeopathic providers who will recommend modifications to [the] vaccination schedule, but it’s not something that becomes part and parcel of homeopathy,” says Dossett.
Still, there is some overlap between individuals who eschew conventional treatments in favor of homeopathic remedies and individuals who forgo vaccinations in favor of homeopathic substitutes.
“Immunizations are a controversial subject,” reads a 2004 blog post from the National Center for Homeopathy, which appears at the top of the site’s search results for ‘vaccinations’ and ‘immunizations.’ “Before making decisions about them, it’s best to arm yourself with information from many different sources.” Four of the five homeopaths interviewed in the post appear to condone the “choice” to not vaccinate, though not necessarily the decision itself.
Concern about this potential overlap is great enough that NCCIH includes a warning box on its homeopathy info page titled, “No Evidence To Support Homeopathic Immunizations.”
What homeopathy can teach conventional medicine
There is a swath of middle ground in the great believers/skeptics debate swirling around homeopathy, and it’s this: empathy.
“There’s so much scorn, and so much ridicule, that it creates a tremendous block,” reflects Brown of negative attitudes toward homeopathy. “And to me that is very, very sad.” He’s sick of seeing homeopathy labeled as “pseudoscience,” or “quackery,” or a “scam.” His lived experience, and his homeopathic practice, tells him otherwise.
“What is it about homeopathy that patients value?” asks a German study published in 2013 in Quality in Primary Care. “And what can family medicine learn from this?” The study singles out empathy as key to establishing positive patient-physician relationships, and to achieving positive patient outcomes. Homeopaths listen to their patients. They believe their patients. Individualization is the most basic driver of their medical philosophy.
Conventional medicine, this argument contends, could stand to take a page from homeopathy’s book, and trust more in what their patients feel to be true. Doing so could be the key to bridging the gap between conventional and alternative, for medicine that is truly holistic and integrated.
Grams left homeopathy behind her, but she still believes in one of its tenets: the power of self-healing. “Our self-healing powers are enormous,” she says. “The patients I treated in my [homeopathy practice], many of them got better. It was not due to homeopathy, but because of their self-healing. And I think we can have more awareness for that power, that it’s really in us.”
This story has been updated.
Stephie Grob Plante is an Austin-based features writer and essayist. Her work has appeared at The Goods by Vox, The Atlantic, Smithsonian Magazine, The Verge, Curbed, Southwest: The Magazine, Playboy, and elsewhere.