What end is this anyway?

The latest round of polemics involving homeopathy was triggered by the The Lancet. In its issue of 27 August 2005 it published a study conducted at the University of Bern, Switzerland the conclusion of which puts into question the effectiveness of homeopathy in some diseases.[ ¹ ] As one of the most reputed medical journals in the world, The Lancet exerts an impact on homeopathy equal or even stronger than the ‘Benveniste Affair’ of 1988.

This attack makes it urgent to develop new strategies. The crucial issue is clinical trials models, with a definite epidemiological design focused on pathology control can accurately assess the effectiveness of homeopathy. Homeopaths are ambivalent: any kind of scientific treatment of homeopathy is good, yet doubt lingers: what is the epistemological price to pay? In other and simpler words: is it really worth the trouble?

Cohort or population trials might represent a solution. Yet they demand a level of funding difficult to find. Lower-budgeted homeopathic provings suggest possible reproductibility of results, but they do not assess therapeutic results. It seems the only paths opened for homeopathy to show positive results are large-scale health-related quality of life studies or models grounded on the notion of the individual as elaborated by the human sciences. Yet such designs applicable to clinical practice remain to be developed. But, the prejudiced notion of homeopathy as the poor relative of conventional medicine ought to be dispelled. Grants for research are needed, but without a basic consensus and careful selection of priorities, it is to be feared such funding will be wasted.

A second myth that ought to be dispelled is a media-enhanced notion that some ‘crucial experiment’ will definitely ‘prove or disprove’ homeopathy or any other system of ideas once and for all. This pseudo-imperative is epistemologically groundless: Georges Canguilhem has shown that such a judgement may be attributed only decades or even centuries later.

Homeopathy would only benefit if it were to establish wider connections to post-mechanist scientific disciplines and frameworks of thought. Yet, first it needs some self-criticism. It is true that The Lancet editorial violated the limits of scientific ethics yet it may be dialectically seen as an answer to those who preach a weird and contradictory sort of homeopathic supremacy. The Lancet editor was offensive when he proclaimed ‘the end of homeopathy’, but homeopaths are no better when proclaim a fundamentalist belief in homeopathy as a medical ideology. Instead of celebrating statements concerning homeopathy ‘scientificity’ or ‘mathematical precision’, we should be looking for proofs. A healthier stance would be for homeopathy to acknowledge itself as in a process of transition, a medicine which looks for a different standard of precision, a different kind of effectiveness.

The history of mankind, as a culture or civilization, may be understood as the search for logical consensuses. As Max Planck pointed out, many scientific ideas or program, including whole systems of science and philosophy, passed away merely because their supporters disappeared. There are many different sorts of sciences: better established and developing systems, hard sciences and human sciences, completed epistemologies and others in construction. There are, thus, different forms of consensus and numberless frameworks.

Let us imagine, for a second: what would an ‘end of homeopathy’ mean? One less problem for scientificism? The solution of the endless question of placebo-effects? Would it end controversy in therapeutic arenas? Would it offer relief to the suffering of the sick? Would it inaugurate a new era, when self-criticism prevails over conviction? Would it protect the sick from a therapeutic approach that no matter what contribution it brought to the art of medicine, is charged with danger?

What does society really want? I believe it wants to be listened to. We hoped that we were at the end of an era when some were ‘more equal’ than others. When a modest ‘I don’t know’ substituted for ‘absolute certainties’. Perhaps, we idealized our time and reality came all of a sudden to challenge us. But I look around and I see people is of flesh and blood. And signals are optimistic. Dim signs, yet optimistic. What society really wants is medicine and science to cure and to give support to the sick, to be by their side, to explain things, to offer both technology and meaning. People want someone to listen to them, who really cares about what they have to say, someone who will record their stories. People wish that scientifically grounded doctors offered much more than a single point of view. The sick, especially the chronically sick, want solutions. Of course, there is not always a solution. But when there is not one, we have a trump-card, that sooner or later will be acknowledged as an asset: a disposition to care and an almost superhuman patience not to give up.

The Lancet editor does not honour the memory of Christoph W Hufeland, first director of the School of Medicine of the University of Berlin. One of the first editors of medical journals, in times as critical as our own, dared to publish Samuel Hahnemann, the founder of homeopathy, even welcoming the new perspectives he was opening up. And neither does he honour the tradition of The Lancet, which in its first edition, in 1823, published a study on acupuncture by John Elliotson.

If the editor of The Lancet had the courage to risk his position, he would have saved his dignity—he could have announced that the game had just begun and that the final outcome was as yet unpredictable. The unavoidable feeling remains that he knowingly manipulated scientific opinion, when he gave the status of ‘crucial experiment’ to a flawed paper. With this he put into question his skills to select and appraise scientific papers.

But there are positive features that may teach us something. The Lancet ought to be thanked for showing homeopaths that we need to close ranks, we need to overlook our theoretical, and practical divergences. The Lancet should be praised for having the courage to show that scientific journals are affected by bias. Finally, The Lancet deserves our acknowledgement by, indirectly, showing us the way homeopathic research must follow. Homeopathy is chronically vulnerable to demands for empirical validation. But this is precisely why homeopaths cannot insist in proclaiming a supposed mathematical precision and conventional medicine cannot impose on subject-focused homeopathy a model grounded on disease.

• Reference

• 1 Shang A., Huwiler-Müntener K., Nartey L. et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366: 726-732.