Homeopathic Remedies vs. the Placebo Effect

The art of homeopathic medicine today is all but unknown to the general public; and I would venture to say that a large majority of those who have heard of it, including most of our patients, believe in their hearts that the tiny granules that taste so sweet are in fact nothing but sugar pills, and that whatever results we may achieve clinically could just as well be attributed to our own personal or shamanistic powers, or to the patient’s belief in them, or some combination of the two.


Nor does such a view necessarily imply any hostility to Homeopathy. Quite the contrary, it often reflects a deepening skepticism about all forms of treatment, especially the more aggressive modalities of conventional medicine, and even a humanistic preference for the “placebo effect”, i.e., the ancient vis medicatrix naturae, the unassisted healing effort of the patient, as a model of the healing process in general.(1)


Moreover, it is a view that Homeopathy itself has never really refuted, partly because we still do not know how our medicines act, or how our patients are cured, and partly, I suspect, because our history as a persecuted minority makes us almost not want to know, or indeed to do anything else to attract further attention to ourselves. Nor is it by any means a simple matter to demonstrate the effectiveness of the high attenuations even to someone who is prepared to examine the evidence with an open mind.


Nevertheless, while it may be quite difficult to prove that our remedies actually work, there is a very substantial body of evidence that they do so; and, to refute the argument that they are placebos, it is not necessary to prove that they act curatively, which is of course a more complicated matter, but only that they act at all, that something happens as a result of their action, rather than simply on account of the interaction between the physician and the patient. Conversely, it is could be proved that our remedies were in fact nothing but placebos, let us by all means admit it with good grace, since, quite apart from having deluded ourselves all these years, knowingly giving placebos or just saying that we don’t know would be incalculably simpler and less expensive than the elaborate rigamarole that we actually practise!


As many of you know, there have been a substantial number of experimental studies demonstrating that the homeopathic remedies in high dilution can stimulate or inhibit the growth of various bacteria, plants, molds, fruit flies, etc., as well as the enzymatic activity of some in vitro or cell-free systems. But, inasmuch as these have already been described fairly extensively in the literature, I will concentrate on the clinical data, where my own experience lies.


It seems to me that there are a considerable number of clinical situations in which we can show quite convincingly, albeit without any formal proof, that the homeopathic remedies act, or a least are capable of acting. In the remainder of this paper, I will try, first, to group these situations into categories, and, second, to give cases from my own records to illustrate them, insofar as possible.


1 . Cases where spontaneous recovery would have been highly improbable, or at least would have required a longer’ period of time than was actually observed.




CASE 1. Respiratory distress of the newborn.


8-pound baby girl, full-term, born at home in February, 1976, following a prolonged second stage. The baby was born covered with meconium, took a single gasp, and failed to breathe after that. Suctioning of the oropharynx yielded copious thick meconium; endotracheal intubation was unsuccessful (cords not visualized). Heart rate 60 per min., color pale, almost white; no movement. The baby responded somewhat to mouth-to-mouth resuscitation, but could not sustain normal respiration as soon as it was stopped. Gave ARSENICUM ALBUM 200, 1 dose, dry, on the tongue. Almost instantly, the heart began to beat strongly, at a rate of 140 per minute; the child began breathing normally, with good tonus and normal reflexes, and became pink almost immediately. The whole evolution took at most a few seconds. From that moment on, the child continued to behave perfectly normally in every way, as if nothing had happened. She was hospitalized for further observation, but was discharged after 24 hours without any further distress or evidence of aspiration, and without any further medication being required.


I should say in retrospect that, inasmuch as the child was full-term and well-formcd in every respect, she would most probably have recovered eventually, even if the remedy had not been given; but I have no doubt that it would have required at least 24 to 48 hours in thc Newborn ICU, with oxygen, some form of assisted ventilation, and possibly other drugs as well. What was so unforgettable about this case was the extreme rapidity of its evolution, from a life-threatening emergency into a completely normal, stable pattern, in the space of a few seconds. What perhaps convinced me most was the look on my nurse’s face, because she had had her ear glued to the stethoscope the whole time, and had not even seen me give the medication. Less than a second after I gave it, she looked up at me in blank amazement, handed me the stethoscope, and asked, “What happened?” These are the experiences that arc imprinted for life in every practitioner’s mind.




CASE 2. Breech presentation.


23- year old primigravida, EDC 8 January 1976. Routine prenatal visits: good health, vertex presentation.


15 December 1975. Routine checkup: complaining of increased pressure and movement in suprapubic region. FHT heard in RUQ at 138 per min Definitely breech. Gave PULSATILLA 6x ii t.i.d.


18 December. Mother noted violent movements on the night of the 16th again on the 17th. Position now definitely vertex; FHT heard in LLQ at 150 per min. No other complaints.


5 January 1976. Delivered 7 lb. 6 oz. baby girl after short labor, ROA; no problems.


This was the first breech presentation I had ever turned with PULSATILLA. I had recently read a number of accounts in the old literature recommending its use prior to engagement, or at lest prior to labor. On the other hand, a fairly high percentage of breeches will revert spontaneously in the final weeks, in spite of our best efforts. It was purely circumstantial evidence that led me (and the patient) to believe that the remedy had acted in this case. I used a low potency because the patient otherwise had no symptoms, and I was looking for what could be described as a physiologic effect.




CASE 3. Breech presentation.


24-year-old primigravida, EDC 8 February 1980. Feeling well; no complaints. 16 November 1979. Routine checkup: fundus 25cm., FHT heard in RUQ. Definitely breech. No treatment.


13 December. No complaints; baby still breech. Gave PULSATILLA 6x ii t.i.d. for 4 days. No change.


11 January 1980. Status quo: position unchanged. Discussed possibility of hospital birth. Gave PULSATILLA 30, I dose, dry t.i.d. for 4 days. No change. 17 January. Ultrasound confirmed breech presentation single fetus.


21 January. Still no change. Gave PULSATILLA 200, I dose, dry daily for 4 days.


25 January. Awoke on morning of the 25th after normal sleep, but baby “felt different.” Definitely vertex; no other complaint.


4 February. Delivered 7-pound baby boy, at home, after average labor; position LOA. No other problems.


Here again, the evidence was circumstantial, but quite convincing. I should mention that from November on the patient was also doing special exercises for converting the breech, and was receiving acupuncture treatments for the same purpose. But these measures were going on more or less continuously. It was actually the potency that appeared to make the difference in this case: both the 6 x and the 30th produced markedly increased fetal movements, but no change m position, whereas the 200th had no effect on fetal movement, but the patient awoke from a sound sleep with the abnormal position corrected.


2 . Cases where conventional medicine had been tried unsuccessfully or the pa tient had been recommended for surgery, yet were cured or at least significantly helped with homeopathic remedies.



CASE 4. Epilepsy.


4-year-old boy from Hobbs, N.M., with long history of febrile convulsions, and 7-month history of minor seizures. Parents separated when mother was 5 months pregnant, divorced shortly after the birth; mother promptly remarried. Birth was normal and uneventful. Febrile convulsions at 4 months, followed by rash (possibly roseola), and several time thereafter, in the course of acute tonsillitis, otitis media, etc. The seizures were all of the grand mal type, and treated successfully with phenobarbital. Otherwise, the child appeared to be developing normally and in good health, until March 1976, when in the course of a simple URI, with low fever, he developed persistent grand mal seizures and was hospitalized. The EEG was inconclusive. His seizures were controlled with Dilantin and phenobarbital; he was discharged on maintenance doses of both drugs. After a few weeks, he began having many brief episodes of the petit mal type, in which the body stiffened, the head was thrown back, ,the back arched, and the mind would go blank for a few seconds; about half of the time, he would fall to the ground. Zarontin was then added to the regimen, in place of the Dilantin. At the time of his first visit, he was having perhaps 15 to 20 of these episodes daily; the mother had discontinued all medications for 2 weeks at my request.


5 October 1976. First visit: child extremely hyperactive, continually interrupting; speech slurred. Physical exam normal, but twice interrupted by hyperactive episodes. Gave CALCAREA PHOSPHORICA 200, 1 dose, dry plus CALC. PHOS. 6x ii q.i.d. as needed.


25 November. Mother telephoned. Child much improved for about 2 weeks, then old symptoms returning in force for the past 3 days. Gave HYOSCYAMUS 200, 1 dose.


20 December. Mother telephoned. General condition much improved; speech, appetite, hyperactivity much less troublesome. Still fairly frequent petit mal episodes, approx. 6 per day, plus occasional generalized clonic seizures, without loss of consciousness. Gave OPIUM 200, 1 dose.


18 January 1977. Mother telephoned. Several more clonic episodes, similar to above, with continued improvement in general condition; speech “back to normal.” On 10 January, had a severe grand mal seizure, followed by long deep sleep. No seizures at all since then. No treatment.


2 April. By letter: good appetite, doing well in public school; no seizures of any kind.


26 August. By letter: moving to Florida, sent for medical records. Perfectly healthy in every respect; no seizures of any kind.


This case was noteworthy because of the suppressive effect of the anticonvulsant drugs, which abolished thegrandmalactivity but produced petit mal in its place. The treatrnent therefore had to proceed “backward” to the grand mal again, before complete cure could occur.




CASE 5. Renal calculi; obstructive uropathy.


31-year-old surveyor, with long history of kidney stones.


24 January 1976. First visit. History of stone began in 1972, passed spontaneously; intermittent flank pain since then. Complaining of severe, intermittent left CVA pain for 5 days, radiating to and from the bladder, associated with obstructed urination, and large amounts of sediment in the urine, resembling shreds of tissue. IVP showed 2 large calculi completely obstructing the left uretero-pelvic junction, with considerable hydronephrotic enlargement of the left renal pelvis and calyces. His family physician had recommended immediate surgery. Gave BERBERIS VULGARIS 200, 1 dose and 6x ii q.i.d.


26 January. Pain considerably lessened, almost gone: now merely a dull ache. Gave OCIMUM CANUM 200, I dose, followed by CALCAREA RENALIS 6x ii q.i.d.


16 February. Pain mild, now chiefly in the bladder area, with occasional stinging and dysuria at the urethral meatus. No treatment.


26 February. Much better. Still has occasional twinges of pain, but feels that the obstruction has been removed. No treatment.


25 March. Repeat IVP showed a single stone in the lower pole of the left kidney, with no further evidence of obstruction; second stone in the distal portion of the left ureter, near the uretero-vesical junction. No treatment.


15 November. Recently back on coffee; another episode of severe pain, this time in the LLQ, near the bladder. Gave NUX VOMICA 200,1 dose, and 6 x ii q.i.d.


17 November. Much improved; pain almost gone.


17 January 1977. Passed large stone, approx. 6 x 3 x 5 mm., conglomerate type. Feeling well in every respect. Refused IVP or further treatment.


The experienced homeopath will doubtless excuse the overly hasty, symptomatic type of prescribing that may well have prolonged and could have spoiled this case. I cite it merely as an example of how surgery can often be avoided, even in somewhat threatening situations.




CASE 6. Pelvic trauma.


27-year-old weaver, with documented yeast infection intermittently for the past 2 years, treated repeatedly with Mycostatin, with temporary relief.


23 June 1977. First visit. Constant burning in and around vagina, with pain on intercourse; labia flaming red, with sticky white substance clinging to the folds. No discharge. Gave SULPHUR 200, 1 dose.


1 July. Pain lessened, irritation gone. Still very dry on intercourse: “lovemaking has become an ordeal” (whereupon she wept bitterly). She stated that her symptoms had begun shortly after a car accident 2 years ago, in which she had been thrown from the car, and had landed on her buttocks. There was no fracture, but a large bruise appeared and took quite a long time to heal, during which time her present symptoms developed. Gave ARNICA 200, 1 dose, and 6x ii q.i.d.


22 December. Dryness totally gone, no other complaints; feeling well in every respect.


This case is memorable to me, first, because it shows very clearly the flaw of conventional prescribing, which is aimed purely at the microbial pore, the tissue changes, etc., without any thought being given to the unique history of this particular patient. Second, it illustrates how the homeopathic remedy can search back in time, through the life history of the patient, to locate and overcome chronic symptoms traceable, in this case, to mechanical trauma in the distant past.


3. Cases where the patient was extremely skeptical or hostile, or otherwise presumably insensitive to the placebo effect (e.g., newborn babies, animals, comatose patients, etc.), yet were cured or significantly benefited with homeopathic remedies.




CASE 7. Recurrent mastitis.


30-year-old gravida i pare i, who gave birth at home in February 1975, with the assistance of a doctor friend, who eventually performed a manual removal of retained placental fragments, after excessive traction on the cord produced sever postpartum bleeding and a placenta that was torn in several places. About 5 weeks postpartum, she developed severe mastitis, with high fever, which was treated successfully with Ampicillin, but recurred as soon as the drug was stopped. This time she was given Keflex, with the same result; even after a second course of Keflex, she developed yet a fourth episode within a few days. At this point she decided, somewhat reluctantly, to try Homeopathy.


6 May 1975. Temperature 102, pulse 120 per minute. The patient lay motionless in bed, as the slightest change of position brought on a violent headache and nausea. Even moving her eyes provoked a severe retro-orbital pain that was quite characteristic of all four episodes. Gave BRYONIA 200, I dose, plus 6 x ii q.i.d., but the patient would not hear of my leaving the house, so little faith had she either in me or my methods. I went to sleep there, it being already quite late in the evening; and, when I awoke the next morning, her temperature was normal, the breast was completely free of swelling or tenderness, and the headache and other pains greatly relieved. She was completely well within 12 hours, and her symptoms never reappeared.




CASE 8. Urethritis.


33-year-old mother of two children, complaining of vaginal discharge, itching, and constant desire to urinate.


26 July 1979. Patient appeared extremely agitated, suspicious, and hostile, especially when I told her that I was a homeopath and did not give sulfa drugs, antibiotics, etc., whereupon she became openly scornful, mainly because her symptoms were so violent, and she was in sue! hurry to be rid of them. (She had had them only for about six hours.) turned out that her illness had followed a violent, angry scene with herhusband, interspersed with several bouts of passionate lovemaking (they had until then been separated for 2 weeks), and culminating in his a nouncement that he had been exposed to gonorrhea in the course of his travels. There was considerable dysuria at the end of the stream. Cultures proved negative for VD. Gave STAPHISAGRIA 200, 1 dose, and 6 x q.i.d.


27 July. Symptoms virtually gone.


28 July. No symptoms of any kind. Needless to say, I had to call this pa- tient myself.


My only reason for reporting these two cases is to show you that the patient need not believe in you or the remedies for them to be effective. The second patient was as surly, ill-mannered, and uncooperative a patient as I have ever had The only reason she called me was that I had played volleyball with her hus- band. Neither of them had the vaguest idea about Homeopathy, or even knew that I practiced it; but she was sufficiently desperate to at least give it a try when I told her that I did not write prescriptions.


4. Cases where the patient, conversely, was cooperative, highly motivated, full of faith in me, and in Homeopathy, and presented a classic symptom picture, clearly indicating a well-known remedy (i.e., where the placebo d feet should have been maximal), yet the remedy had no effect whatsoever


This group is exactly the converse of the last, and cases of this type are, alas far too common to be particularly memorable, or toe require much elaboration I mention them simply to show that it is also possible for the remedies not to work sometimes, which could not happen unless they actually did work at other times. If the placebo effect had been the important factor, then surely these arc the patients who should have benefited from it, just as those of the last group are the ones who should not have; but in fact, just the opposite was the case.


5. Cases where the patient developed sulking new symptoms peculiar to or characteristic of the homeopathic remedy.




CASE 9. Premenstrual tension.


43-year-old lady, with long-standing history of premenstrual symptoms.


7 November 1979. First visit. Feels well 3 weeks out of 4. About 7 days prior to the onset of the period, she has painful, lumpy breasts, ravenous appetite, nervous irritability. Very haughty. Loves hot drinks; intolerant of dry, spring winds, and of dry weather generally. Most symptoms worse on waking. Gave LYCOPODIUM 200, 1 dose.


10 January 1980. Next period after meds. came on only 2 days after the onset of her symptoms, which were quite mild; and all of them were right-sided, which was unusual. Only the right breast was tender; in addition, there was aching and stiffness of the neck on the right, which was quite new, and an earache on the right side, which she had not had since she was a child. In the midst of these complaints, she felt quite well, and has remained so since.


This type of case is quite common and, to my mind, represents perhaps the most direct and convincing evidence we can have that it is the remedy, rather than simply the suggestibility or the desire of the patient to be healed, that is doing the job. The provings of LYCOPODIUM, the club-moss, show it to be a markedly right-sided medicine. When all is said and done, it is this correspondence between the experimentally proved symptoms of the remedy and the actual symptoms of the patient that distinguishes Homeopathy from all other methods of treatment. So, when you see new symptoms appearing in the course of a treatment, and these symptoms are characteristic or proved symptoms of the remedy you have given, you can be virtually certain that the remedy is acting, whether curatively or otherwise.


I have often heard it said that it is the appearance of a classic aggravation, followed by amelioration, or the curative response in accordance with Hering’s Laws of Cure, that constitute the surest proof that the remedy is acting. But I have seen typical aggravations and curative responses according to Hering’s laws following conventional drugs, surgery, acupuncture, faith healing, placebos, and even in the course of spontaneous cures without any treatment whatsoever. These are simply curative reactions, and cure is always miraculous in the sense that it can always occur or fail to occur, whatever modality we use.


6. Cases where the remedy actually did harm, or at least appeared to catalyze a destructive process in the patient.




CASE 10. Rectal fissure.


27-year-old photographer, with 4-month history of rectal pain and bleeding, diagnosed as a rectal fissure, and recommended for surgery. Past history of migraine (last episode 2 years ago); amoebic dysentery; recurrent prostatitis; and chronic irritation of the eyes, with redness, soreness, and crusting, for which he had used mercuric oxide ointment 3 times a week for the past 5years.


9 October 1975. First visit. Rectal pain most severe after prolonged sitting. Gave NITRIC ACID 200, 1 dose.


21 October. Pain, bleeding almost completely gone within a few days after the medicine; felt revitalized and full of well-being. After 1 week, the original symptoms had reappeared, and had gradually regained their former intensity Also, in the past 24 hours, the soreness of the eyes had increased, and then were occasional brown “floaters” in the field of the left eye. Gave NITRIC ACID 200, 1 dose.


22 October. Left eye totally browned out: can see only fuzzy blotches. Local ophthalmologist made tentative diagnosis of retrobulbar neuritis; patient scheduled for full neurological workup at UNM Medical Center, Albuquerque.


2 November. Returned from hospital with diagnosis of multiple sclerosis. Very large blind spot in left eye, surrounded by grey penumbra; can see some light peripherally. Also quite a lot of fuzziness now in the right eye.


20 November. Right eye almost back to normal. Left eye almost totally blind, except for a narrow, crescent-shaped arc at the periphery.


31 December. Condition unchanged.


I present this case lest you assume, as I think most of us do, that the homeopathic remedies are innocuous, which is, after all, essentially a euphemism for ‘ineffective’. To be sure, such cases are extremely rare; and the safety record of Homeopathy, compared to the conventional method, is quite extraordinary. I would also agree that the remedy in this case undoubtedly only elicited a tendency that would have come to light eventually even without it. Nevertheless, I must continue to live with the fact, as must the patient and his family, that he would have been much better off had he never consulted me in the first place.


So, if you will but take the trouble to practise Homeopathy, you will quickly see that the remedies do actually work, although we do not yet really understand how they work, which of course keeps it interesting. At the same time, we can cheerfully agree with those who say that we are using the placebo effect, if by the placebo effect we mean the simplest model of the healing process itself, the patient’s own healing effort. This is fundamentally what healing is all about. This often succeeds whatever modality is used, and whether the physician attempts to cooperate with it or not. In the words of Paracelsus


“The art of healing comes from Nature, not from the physician; for every illness is inherent in our nature, and every illness has its own remedy within itself. We could not be born alive and healthy were there not a physician already hidden in us.” *

Paracelsus, Selected Writings,

translated by N. Guterman.

Bollingen, pp. 50, 76. passim.






Notes

1) Cf. Cousins, N., The Anatomy of an Illness as Perceived by, the Patient, Norton. Chapter 2, ‘The Notorious Placebo . pp. 49-70.



The value of the service is nothing, your use is first,
and so long as you have this in mind, you will grow.


                    — J. T. Kent’s Aphorisms


Avatar Written by Richard Moskowitz MD

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