Gentle remedies

Despite the huge popularity of homeopathy, many doctors remain highly sceptical about it. But now a scientific study shows that this 200-year-old practice can help patients with allergies. Luisa Dillner on the pills that 'cure like with like'

It's a form of medicine that has been around for nearly 200 years, with advocates as diverse as John D Rockefeller, Mahatma Gandhi, Tina Turner and the royal family. But even though homeopathy is used by more than 20% of people and is available on the NHS, no one knows how it works. And yet it does seem to work. A research paper in last week's British Medical Journal shows that out of 50 people with nasal allergies, 28% improved with homeopathy compared with 3% given a placebo. While symptoms of blocked, runny or itchy nose, eye irritation and sneezing got better over four weeks in both groups, those on homeopathic treatment had better nasal air flow and could therefore breathe more easily.

Dr David Reilly of the Glasgow Homeopathy Hospital, one of the paper's authors, hopes his results will encourage doctors to look again at the evidence supporting homeopathy. "Despite these findings, and the fact that there have now been more than 180 trials of homeopathy - of which 70% are positive - there will still be doctors who believe religiously that it cannot work and therefore it does not work," he says.

Homeopathy was invented by Samuel Hahnemann, a German doctor who was so horrified by the cures available in the late 18th century, such as blood letting and arsenic, that he gave up his traditional practice. Using drugs such as belladonna, he experimented on himself and announced a new medical principle (based on the practice of the ancient Greeks) of "that which makes sick shall heal".

Homeopathy, from a combination of the Greek words for similar and suffering, works on the basis that like cures like. Cutting onions, for example, makes your nose and eyes run and your throat sore. So what better treatment for a cold, in homeopathic terms, than Allium cepa, a remedy made from onion? Homeopaths cite parallels in conventional medicine to support this concept - irradiation causes cancer but also treats it, and digitalis can both cause and cure irregular heart rates. But while conventional medicine gives doses you can measure, homeopathy does not. Homeopathy believes that only a tiny amount of like cures like and uses medicines that contain minute doses of the therapeutic agent. The medicines, from plants, minerals, metals and even poisons, are serially diluted in alcohol and water, up to many thousands of times. Each time they are diluted they are vigorously shaken and each dilution is thought to make the remedy stronger.

Remedies come in various forms, often as tablets. The problem that critics have is that after the 12th centesimal dilution, no molecules of the original substance can be found in these remedies. A biochemical analysis shows only water and alcohol. How, they ask, can homeopathy work when its remedies contain no active agents?

"Many people say there is no plausible mechanism for it to work and that trials are a waste of money," says Dr Reilly. "Now if people tell you there's a unicorn at the end of your garden you can invoke plausibility and refuse to believe it. But if over 200 years people keep saying there's a unicorn in your garden then it might be at least worth having a look."

Reilly and others believe that homeopathic remedies are active because the water and alcohol remember, in some way, the original ingredient. "There may be some imprinting of information from the starting material in the first dilution," he says.

Regardless of how effective the remedies are, homeopathy's growing popularity is partly due to the consultation process. Practitioners may take over an hour seeing patients and specifically ask about emotions and life stresses. Dr Reilly says: "If a patient comes in with asthma then we ask what was going on in their life when it started. They may tell you that they had some devastating grief and their health went right down and they got asthma. Part of the prescribing may be a remedy for what we call illness from grief. Extracting the history from a patient is quite therapeutic for them - it shows we are interested not just in the diagnosis but how the disease affects them." So therapeutic is the consultation that for years it, rather than the remedies, was credited with making patients better. But a study of more than 100 homeopathy trials, published in the Lancet in 1997, found that the consultation alone could not explain homeopathy's clinical effects.

Remedies are tailored to individuals to take account of the person's experience of their disease - what time of the day or during which weather conditions their symptoms are worst. Rather than attacking the agent responsible, they are said to provoke the body's own defence mechanisms. Symptoms are matched with remedies from the homeopathic materia medica and patients may also be told to make lifestyle and dietary changes. Patients are usually reviewed between two and six weeks when their practitioner may stop treatment and monitor progress.

Homeopathy's underlying tenet, which rankles with many doctors, is that there are no incurable diseases for homeopathy, only incurable patients. But homeopathy does not claim to clear any mechanical obstructions or fractures. These, they admit, need surgical treatment. Most registered homeopaths would not treat patients with cancer without conventional help. There are more than 1,000 doctors and at least 1,500 non-doctors in the UK practising homeopathy.

Francis Truherz trained as a homeopath and has practised for 10 years, mostly in NHS clinics in London. "Sometimes patients come to see me without seeing their GP and I will strongly advise them to see a doctor. I may not always get it right, but then doctors can also miss diagnoses," he says. "If someone phoned me and said they thought they had meningitis I'd tell them to phone for an ambulance."

As with conventional medicines, homeopathy is increasingly available over the counter. "It's fine to try them - you can't overdose on them as you can with aspirin," says Truherz. "If your symptoms persist, see your doctor or registered homeopath. It's really matching the prescription to the patient that makes the remedy homeopathic." He advises people to use products from one of six licensed manufacturers (such as Helios or Ainsworths). Homeopathic medicines must be taken in a clean mouth (no eating for 20 minutes before and no toothpaste or cigarettes) and he advises no coffee for a month once treatment starts because it can neutralise remedies.

Andrew Vickers, researcher and author of the ABC of Complementary Medicine (BMJ Publishing Group), says that it's still as easy to argue against homeopathy as to argue for it. For a start, he says, there's enormous variation in remedies and practice, with some homeopaths using low dilutions and others high. Some only give one remedy at a time, others give combinations. In France they may prepare a remedy by macerating it in alcohol for two days, in Germany by leaving it in alcohol for 12 days. "We did a study where we gave two homeopaths a list of symptoms and said is it plausible to give this medicine? There was only mediocre agreement," says Vickers. "If you did an equivalent study asking doctors if it was plausible to give aspirin for headaches, they would almost all say yes."

Vickers is also concerned that so much of homeopathy's knowledge base is unvalidated. "Homeopathic repertories tell practitioners how to prescribe on the basis of patients' symptoms. But some symptoms are utterly bizarre, such as 'erections during supper' and 'dreams of writing on a dirty table and the paper becoming smeared'.

"This information is unreferenced, it's just there. It comes from 'provings' that involve healthy people being given potential homeopathic remedies and then recording and reporting everything that happens to them. The remedy and the recorded 'symptoms' are then entered into the repertory. We analysed some provings that were done and people recorded 'thoughts of hedgehogs' and 'felt bored during lectures'. There is no evidence that these potential remedies caused these symptoms."

Vickers estimates that there are around 2,000 homeopathic remedies but believes that most homeopaths use a core of 30 or 40 that they are confident work for groups of symptoms. Even so there are no studies that show how these drugs can work. "It's all highly implausible," he says. "A new cancer drug would be similar to an old cancer drug and there would be some work in animal models so you could believe it could work, and a clinical trial using patients would be part of a larger picture of evidence. With homeopathy there are no animal models. With homeopathy you need more evidence than normal to show it works because the clinical trials are all you have. But so far the data is largely positive from those clinical trials. Sceptics who try to argue against these trials can't make the positive findings go away. These are good trials."

Arnica (mountain daisy) for minor bumps and bruises.

Aconite for shock, intense fear, violent emotions, restlessness with fear of death.

Chamomilla (chamomille) for teething infants.

Coffea (coffee) for insomnia.

Colocynthis for infant colic.

Rhus tox (poison ivy) for joint pains worse with first movement and rest and then better with motion, for joint stiffness in damp weather, for back pain and stiffness.

Cuprum for leg cramps.

Comfrey relives pain from fractures after they have been treated surgically.

Calendula for cuts and grazes, helps heal wounds. Use as ointment, gel or spray.

Urtica urens (stinging nettles) for burns.

In print: Practical Homeopathy, A Complete Guide to the Whole Person by Beth MacEoin (Bloomsbury). The Complete Homeopathy Handbook, by Miranda Castro (Macmillan). On the net: - medical database - a US web site on all aspects of homeopathy. - the Faculty of Homeopathy, which has a list of registered homoeopaths. Useful contacts: The Faculty of Homeopathy (020-7566 7800). The Society of Homoeopaths, 2 Artizan Road, Northampton NN1 4HU (01604 621400).