A few weeks ago, I found myself in an increasingly common situation: I decided to go grocery shopping at Whole Foods (sale items only please, I’m a grad student). As usual, I had to follow up my trip with a second stop at a “regular” grocery store to fill in the gaps on my grocery list; specifically, I needed to buy a few over-the-counter medications. As you probably know, Whole Foods and similar organic grocery chains only sell alternative health remedies in the form of vitamins, supplements, and homeopathic medicines. So while you can’t buy ibuprofen at Whole Foods, you can buy a homeopathic flu remedy and hope for the best.

Ever since the emergence of the “natural is best” philosophy in the 1970s, an increasing number of Americans have turned to alternative therapies in order to alleviate both superficial and serious medical conditions. In 1993 Harvard researcher David Eisenberg published a landmark study showing that 1/3 of Americans had used some form of alternative therapy in 1990. When he repeated the study in 1997, that ﬁgure jumped to more than 40 percent. With the “organic revolution” and the omnipresence of internet medical advice, this trend has continued to grow in popularity.

One of the more popular, yet controversial forms of alternative medicine is, of course, homeopathy. While you used to have to seek out the most über-crunchy alternative health food store in order to find homeopathic remedies, now you only need to travel to the nearest Whole Foods or CVS Pharmacy to find those alluring little blue bottles. And whether you are a fan of homeopathy or an ardent skeptic, most people have no idea what homeopathy exactly is, where it came from, and how it came to be so popular.

Hahnemann and the Rise of Homeopathy

Believe it or not, homeopathy used to be really, really popular in the mid-to-late nineteenth century. The practice grew out of the work of German physician, Samuel Christian Hahnemann (1755-1843). Hahnemann experimented with cinchona bark, a common treatment for malaria at the time, and soon realized that if he ingested enough of the stuff, he would experience symptoms similar to malaria: nausea, a rapid heart rate, etc. Hahnemann theorized that substances that caused symptoms in healthy people would alternatively relieve the same symptoms in sick people. In other words, people who were healthy and took cinchona would feel sick, but people who had malaria and took cinchona would feel better. This concept would form the fundamental law of homeopathy — similia, similibus, curantur (let likes be cured by likes).

Hahnemann continued to experiment with various substances, first on himself, then on other people. However, he soon realized a major problem with his theory: the substances he gave to his patients were often toxic. Subsequently, he began experimenting with diluting his formulas. Hahnemann eventually came to believe that the more he diluted a substance, the more effective it became. This became the second fundamental component of homeopathy, the “law of infinitesimals.” Even though it seems counterintuitive, practitioners of homeopathy indeed claim that a substance becomes more potent the more it becomes diluted and shaken, a process they call potentization. As Larry Schwartz over at Salon writes,

Most homeopathic remedies are diluted between 6X (1 part per 1,000,000) and 30X (1 part per 1,000,000,000,000,000,000,000,000,000,000) … To put it in perspective, a 30X dilution would be the equivalent of one drop of medicine placed into a container of water the size of the Earth.

So … that sounds kind of hard to believe, right? A bit like quack medicine? Why then, did so many patients and practitioners in the nineteenth century buy into homeopathic medicine?

Homeopathy in Nineteenth-Century America

The simple answer is that in the mid-nineteenth century, “regular” medicine was terrible.

At the time, germ theory was still in its infancy and not well understood. Even those researchers who did theorize on the matter had yet to have any practical means to employ it (no vaccinations, no antibiotics, etc.). Many everyday physicians adhered to medical theories that dated back to antiquity (think humors), and most employed “heroic” medical treatments that often included heavy bloodletting, purges, and large doses of poisonous concoctions of mercury or arsenic. In short, it was very dangerous, very painful, and often deadly to be a patient back in the olden days.

Homeopathy, on the other hand, was a promising new development because of its use of small doses, its emphasis on the curative power of nature, and its holistic treatment of the body. It’s actually not hard to understand why a mother might choose to treat her ailing child with small vials of a painless liquid rather than cutting their flesh to drain blood or giving them poison to induce heavy vomiting. As Paul Starr has pointed out, a big part of the allure of homeopathy went beyond the comfort of non-threatening potions. Homeopathy developed into a practice that dictated its physicians observe the whole patient, and this attention often fostered a more sympathetic relationship between doctor and patient.

While homeopathic medicine originated in Germany, by the 1840s the practice was flourishing in the United States. Homeopathy was just one of several sects of alternative medicine that emerged during this period, including hydropathy, osteopathy, eclectic medicine, Thomsonain medicine, and Christian Science. There were many reasons why Jacksonian America became a hotbed of alternative medical practices; chief among them, an inherent distrust of elitism; the subsequent repeal of medical licensing laws; and the “wild west” ethos of for-profit medical schools. And while each sect enjoyed varying degrees of popularity, it was homeopathy that became regular medicine’s biggest rival. At its height, there were over 14,000 homeopathic physicians and 22 homeopathic medical schools in the United States.

The Regulars vs. The Homeopaths

As wacky as homeopathic remedies might seem from our twenty-first century perspective, at the turn of the century, regular physicians perceived the practice of homeopathy as a legitimate threat. In fact, it would be a mistake to draw a straight line from nineteenth-century regular medicine to modern-day scientific medicine. As sociologist Owen Whooley argues, it was never “predetermined” who would be the apostles of modern medicine — it was anybody’s game at that point.

And it was a high-stakes game. Who ultimately had access to hospitals, the battlefield, and university medical schools was largely tied up with the question of who had the most legitimate claim to medical knowledge and authority.

Of course, we know now that in the battle of the regulars vs. the homeopaths, the regulars came out on top. But what happened? In 1847, the American Medical Association was founded, largely as an effort to expel homeopaths from the profession. The federal government also played an important role in curbing the expansion of sectarian medical schools, while corporate interests increasingly favored the funding of orthodox medical schools by the early twentieth century. Some historians argue, however, that the fatal blow to homeopathic medicine occurred when, somewhat ironically, regular physicians decided to simply stop fighting them. In 1903, the AMA reversed their policy against admitting homeopaths, and oddly enough, this inclusion spelled their demise. As Starr argues, “When homeopathic … doctors were shunned and denounced by the regulars, they thrived. But the more they gained in access to the privileges of regular physicians, the more their numbers declined.” Their numbers continued to dwindle well into the twentieth century, and the last traditional homeopathic college closed its doors in the 1920s.

Homeopathy Today

If homeopathy died a slow death, why do you pass that aisle of little blue mysteries every time you venture into a Whole Foods store? It turns out that while traditional homeopathic practice largely faded away by midcentury, the sketchiest part of homeopathy — those vials of diluted nothingness — survived. In 1938 the FDA passed the Federal Food, Drug, and Cosmetic Act (FD&C Act), which included a section that recognized homeopathic medicines and appointed a non-governmental body, the Homeopathic Pharmacopeia Convention of the United States (HPCUS), responsible for establishing safety and manufacturing guidelines. Because of this bureaucratic structure, the FDA doesn’t routinely investigate homeopathic remedies for safety and efficacy the way they do with conventional pharmaceuticals. This may not be problematic on its own since homeopathic remedies are pretty much weakened down to nothing.

Except many are not.

Some of today’s most popular homeopathic remedies actually contain measurable amounts of medicines. For example, homeopathic products like Cold-Eeze and Zicam contain zinc, which can have toxic effects if not regulated properly. In fact, in 2009 the FDA issued a warning to consumers about Zicam nasal spray after 130 people reportedly lost their sense of smell. In 2010 the FDA issued a warning about Hyland’s Teething Tablets because the product had inconsistent levels of belladonna — a substance that can be lethal. In 2014, the FDA warned consumers about Pleo homeopathic drugs because they found samples that contained penicillin (some people are deathly allergic to penicillin). Recognizing a potential problem, the FDA finally began holding hearings last April to find out whether some manufacturers have exploited the HPUCS loophole by producing medicines that contain biologically active doses of certain chemicals.

While it’s unclear whether the FDA will step in and begin to strictly regulate these medicines, there is still more trouble in Mudville for companies that manufacture homeopathic remedies. Last Spring, the Australian National Health and Medical Research Council (NHMRC) conducted the most thorough and independent evaluation of homeopathy in its 200-year-long history. The organization reviewed 225 research papers and concluded, “ … There are no health conditions for which there is reliable evidence that homeopathy is effective.” As The Guardian reports, “The Chair of the NHMRC Homeopathy Working Committee, Professor Paul Glasziou, said he hoped the findings would lead private health insurers to stop offering rebates on homeopathic treatments, and force pharmacists to reconsider stocking them.”

This brings us back to Whole Foods. The problem with homeopathic remedies is that they either contain unregulated amounts of medicine or they contain nothing at all. This inconsistency, which I think is ultimately the fault of the FDA, seems to go against the Whole Foods “the more you know” ethos. Their own website has pages and pages devoted to their stance on GMO labeling, and their position on irradiation of food, sustainable and fair trade practices, animal welfare, and organic food standards. They proudly boast, “There are 50 ingredients common in conventional body care products that are not allowed in any body care products we sell.” Yet, it is difficult to find any in-depth information on the homeopathic remedies they sell. The best I could come up with is a blog post on their site that gives a weird explanation of the history of homeopathy and how it supposedly works. No critical eye, no in-depth analysis — just a cheery anecdote about cutting onions and the power of fresh air.

And yet we buy into it. I would like to say that the same misinformed, anti-vaccination, Jenny McCarthy crowd are solely responsible for making the homeopathic drug industry profitable to the tune of more than 2.9 billion annually in the U.S., but that’s just not true. I know lots of perfectly rational, pro-vaccination folks who dabble in homeopathy. I also know that there are plenty of alternative therapies that have proven their merit and made their way into mainstream medicine. I am also a big believer in the power of placebo effect — if it works for you, fantastic!

But as the FDA hearings so clearly demonstrate, we need to think critically and regulate accordingly for everyone’s safety.

If places like Whole Foods put as much energy into investigating homeopathy as they did animal welfare, then perhaps the aisle of blue bottles would cease to exist. Or at least they might have a little more room on the shelf for some Tylenol.