Does Homeopathy Really Work?

Science has a clear answer. But the matter is still not simple.

Let's start with two observations about homeopathy that contradict each other at first glance. They make up the appeal of the old healing doctrine - and are at the same time the reason why homeopathy is the subject of heated discussions in society, in families and among friends.

First, millions of people in Germany turn to homeopathic remedies when they have ailments, i.e., to preparations in which an active ingredient has been diluted to such an extent according to fixed rules that it is no longer detectable on a molecular level. Many of them say they feel better afterwards. Probably everyone has heard of allegedly positive experiences with homeopathy. Be it the kindergarten child whose allergic rash is said to have receded after administration of homeopathic remedies, the student who takes globules with "Nux Vomica" the same night during long, boisterous parties in order to wake up the next morning without a hangover, or the 53-year-old woman who finally wants to get her menopausal symptoms under control.

The second truth: Homeopathic remedies alone are not effective against the complaints for which they are recommended. This has been scientifically proven for decades. As early as 1997, a meta-analysis on the subject was published in the renowned scientific journal "Lancet". Meta-analysis means that the results of many larger and relevant studies are examined and then a kind of conclusion is drawn that is supposed to reflect the current state of research. The authors concluded: There is insufficient evidence in the available studies that homeopathy is effective for any physical complaint. But these facts could not shake the belief in homeopathy. In 2017, another meta-study appeared in the journal Sytematic Reviews. This time, in the flood of new studies, the researchers focused on the so-called double-blind studies. They are considered to be particularly reliable and informative. In double-blind studies, neither the doctor nor the patient knows whether or not the active ingredient is currently being treated, hence the name. The result was the same: There was no disease against which an effect could be proven, the authors write.

"An active ingredient that is no longer there can no longer work".

This is also the conclusion of J.Windeler, head of the Institute for Quality and Efficiency in Health Care (IQWiG) and professor of medical biometry and clinical epidemiology. For him, this is not surprising: "The concept of homeopathy contradicts our knowledge of how the world is constructed: what is diluted no longer becomes. And an active ingredient that is no longer there can no longer work." 

Samuel Hahnemann was a German physician who lived in the 18th and 19th centuries. In 1796 and thereafter, he published the basic ideas on which homeopathy is built today: let similar things be cured by similar things (similia similibuscurentur). According to Hahnemann, medicinal substances that cause similarities to the disease should be administered in highly diluted form, in globules, small white balls that taste sweet. However, the dilution of the active substance in the globules is so high that there are practically no substances left at the molecular level. Hahnemann believed that the medicinal substances "finally dissolve entirely into their individual spirit-like essence".

What exactly this spirit-like being is supposed to be is unclear. "Investigating homeopathy against the background of our current knowledge is almost like trying to make sure that there is no Pumuckl hiding behind the moon," says Windeler. Science does need to get to the bottom of things, he adds. "But that has now been done sufficiently. Now it is time to finally put this question on file as answered and concentrate research capacities on other areas," says Windeler. Nevertheless, many people continue to take homeopathic remedies today. Thus, a paradox has emerged: Homeopathy seems to work, although the remedies have no effect.

It seems that homeopathy has perfected the placebo effect

"There are many reasons to get sick, but there are also many reasons to get well. It doesn't always have to have to do with what you get from the doctor," says Windeler. If a kindergarten child's skin rash subsides, it could also be because the immune system has calmed down on its own. If the student wakes up in the morning without a hangover, it might be because he drank a lot of water in addition to the globules in the evening. It is scientifically certain that the improvements have nothing to do directly with the homeopathic remedies. But perhaps with the knowledge that one was treated homeopathically?

Homeopathy does not consist only of globules. According to Hahnemann, the treatment should also take into account the "homely and spiritual character" of the patient. What is meant is: please take good care of your patients, address their concerns and treat them individually. Homeopaths have a detailed conversation with new patients, sometimes lasting more than an hour. If a patient believes in homeopathy, then the homeopath reinforces this belief through attention, through dedicated time, through the impression of systematicity and scientificity.

Possibly the best prerequisites for setting the placebo effect in motion in the patient. Windeler uses the term context effect here: "In addition to a drug, an operation or other interventions, there are many small building blocks in a treatment situation that can influence the healing process - favorably or unfavorably. The body can then set healing forces in motion. This can be anything from additional activation of the immune system to the release of messenger substances that improve wound healing," says Windeler.

It seems that homeopathy has perfected the placebo effect. From the patient's perspective, it doesn't matter how or why they are helped. It's not said for nothing: He who heals is right. For more harmless ailments like the common cold, that may be justifiable. "With serious illnesses like cancer, on the other hand, it is life-threatening to turn down established and well-tested, effective therapies and rely on homeopathy," says Windeler.

The Cancer Information Service (KID) of the German Cancer Research Center (DKFZ) in Heidelberg regularly receives inquiries from patients about homeopathy. However, Birgit Hiller of the KID also knows that "most patients who contact us do not want to use homeopathy as a remedy for cancer. They see it more as a complementary and gentle method to alleviate side effects of chemotherapy, for example." In the vast majority of cases, however, homeopathy does not seem to get in the way of important therapies.

For more harmless ailments or to reduce side effects, on the other hand, homeopathy is firmly established as an integral part of medicine among some of the population. This is also supported by health insurance companies. While they usually otherwise insist that therapies are only paid for if their effect has been proven in scientific studies, they are less strict with homeopathic treatment methods and cover many costs here. "It's simply a means of customer loyalty. Homeopathy is popular, and customers are more likely to go to the insurance company that pays for homeopathy," Windeler says. That can be seen as a scandal. Health insurers pay a lot of money for sugar pellets, even though they don't work at all. But you can also see it in a more relaxed way. With homeopathy, patients receive a sophisticated placebo effect on prescription.