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Bengaluru: When cases of coronavirus, the virus that has killed more than 3,000 people in China, were first reported in India, the AYUSH Ministry advised citizens to use homoeopathy to prevent infection.

A system of alternative medicine, homoeopathy courts deep popularity in India, so much so that many are known to believe that it’s an Indian system. According to the government, it’s the second most popular form of medicine in the country with as much as 10 per cent of the population relying on it.

It claims to treat diseases for which allopathy, or Western medicine, currently offers no cure — from diabetes and psoriasis to polycystic ovary syndrome (PCOS).

Among followers, it is seen as a form of natural therapy, invoking a sense of Eastern mysticism with its promise of painless treatment.

However, homoeopathy is neither all-natural, nor Indian. It’s not even Eastern — it was created in 1796 by a German physician named Samuel Hahnemann, who reportedly coined the term “allopathy” as a pejorative for modern medicine.

One of the two basic tenets of the system is “like cures like” — that is, if something causes acidity, the same thing will also ease it.

The other is the law of minimum dosage — Taking a core ingredient and diluting it to such an extent that there isn’t even a single molecule of the original substance left.

Despite its popularity, the system remains controversial. Most health experts — from the World Health Organisation (WHO), to the US Department of Health and Human Services and Britain’s National Health Service — cite research and express scepticism. They discourage its use as an alternative to conventional medicine for life-threatening diseases, and see it as a harmless placebo at best and a purveyor of potentially lethal concoctions at worst.

Several countries like Britain and France do not allow government funding in the field, while Australia conducted a thorough review and declared it pseudoscience. Spain has proposed banning it for being dangerous.

Even so, there is no dearth of people who testify to its potential as a cure for a laundry list of conditions. In India, it’s the subject of a degree course that allows students to become registered practitioners and is overseen by a dedicated government department.

This contradiction is precisely the reason why the AYUSH Ministry’s coronavirus advisory seemed to set the cat among the pigeons, leading several people to question the “unproven advice” in the face of a health crisis. But backers of the system were equally vocal.

the government of India (as usual) is peddling unscientific crap ayurveda, homeopathy and unani are NOT legitimate branches of medicine and have no material proof in curing or preventing such diseases please don't swallow placebo-inducing sugar pills thinking you'll be safe. https://t.co/u9vV2n8itD — v̴̢͉̙͙̜̘̣̓͑̽̾̓͘͝ͅo̸̯̮͂̽̉̓̃͝͠͝i̸͎͍͕̭̩̊͆̇̃̅̽̄d̷̿̈́̀̄͑ (@bismillahcamus) January 29, 2020

#Coronavirus breaks out, China embarks on building a 1000 bed hospital in 6 days

India: ye lo homeopathy, 4 goli subah 4 raat ko khaali pet. No onion no garlic. OK? — Raghav Chopra (@RaghavChopra_) January 29, 2020

3.02.20 to conduct Coronavirus Awerness and Distributed Homeopathy Preventive Medicine, in Govt MPP School in Ramanujapalli villege, Tirupati Rural, Andhrapradesh,India. Homeopathy Doctor Balaji Deekshitulu P V, was free distributed medicines in 100 poor children's. pic.twitter.com/Q8VBF6N1rN — drsribalaji@gmail.com (@drsribalajigma1) February 3, 2020

Discussion with Honorable AYUSH Minister Mr Shripad Yesso Naik ji, about the preventive aspect of Homeopathy for Coronavirus Disease,he has assured his valuable support in this matter .

Indian AYUSH Ministry will be pioneer in working for preventing this deadly virus.

Thank you. pic.twitter.com/6gjiVQoWES — Dr. Naval Kumar Verma (@dr_naval) January 28, 2020

So, what does a layperson make of it?

Also Read: Homoeopathy for coronavirus: Is AYUSH commitment to alt meds healthy or promoting quackery?

What is homoeopathy?

Hahnemann, the homoeopathy creator, believed there were only three kinds of illnesses, syphilis, psychosis (or fig-wart disease), and the itch (where the skin itches), which he thought were symptomatic of other diseases like cancer, deafness and epilepsy.

This theory is contentious even within homoeopathic communities today.

Hahnemann’s basic premise rejects the theory that a disease or infection is through an outside cause and states that every illness is from within one’s own body.

The homoeopathic premise of “like cures like” derives from an experiment Hahnemann conducted where he reportedly ingested large amounts of cinchona bark (it contains quinine, used to treat malaria even today). Hahnemann is believed to have concluded that the symptoms produced by overconsumption mirrored those for malaria, and thus the bark could treat the disease.

While it’s often believed to be plant-based and natural, the core ingredients involved in homoeopathic remedies can be animal- or plant-based, mineral or synthetic, designated with Latin or Latin-sounding names.

The creation of remedies involves diluting the core ingredient to such an extent with water, alcohol or sugar that there isn’t even a single molecule of the original substance left.

Arsenic oxide, known as arsenicum album in homoeopathy, was what the AYUSH Ministry prescribed for coronavirus prevention. It has traditionally been used by homoeopaths as treatment for conditions such as digestive disorders, allergies and even anxiety and insomnia.

Other core ingredients include natrum muriaticum (sodium chloride or common salt), the poisonous belladonna flower, opium, and even products from a diseased person, like blood, urine, faeces, pus and mucus discharge.

Some preparations use “captured” ingredients such as x-rays and sunlight. “Sol” or sunlight is particularly common, and is “obtained” by exposing lactose (natural sugar occurring in milk) to the Sun.

To reduce the effects of radiation therapy, alcohol exposed to x-rays is used (which isn’t “natural”). Often, insoluble substances like granite are ground to pieces with lactose and then diluted. For example, it was reported last year that a British homoeopath, who also caters to the royal family, was offering a remedy devised from pieces of the Berlin Wall as a “cure” for depression and asthma.

The dilution takes place in a form of logarithmic scales (where each step is a multiple of the previous one). The two used most commonly are X potency, where each scale represents a dilution by a factor of 10, and centesimal (C), by a factor of 100.

A 2X (unit of potency) scale would mean that a substance is diluted one part in 9, and then one part of the resulting solution again diluted in 9 parts of the solvent.

For example, one millilitre of a core ingredient first diluted in 9 millilitres of water, and one part of the resulting solution again diluted in 9 millilitres of water.

So, a 10X potency would repeat the process 10 times, and a 15X, 15 times.

This is the same for C, but by a factor of 100: One part diluted with 99 parts.

Common potencies used are 30X or 300C, but beyond 12C or 24X, there is no presence of even a single molecule of the core substance.

Homoeopathy believes that the more diluted a remedy is, the more potent it is. A potency of 100X, for example, is considered to be higher than 10X — a fact chemists see as counterintuitive.

This is based on the controversial notion that water has “memory” and retains information about the substances it comes in contact with (and thus cures the body).

The final solution is poured over sugar tablets and left to evaporate.

Homoeopathic remedies are thus as good as harmless to the human body, but only when mixed correctly. There have been cases of arsenic poisoning in India because of poorly concocted homoeopathic remedies.

Evolution and spread of homoeopathy

Homoeopathy was widely adopted in the 1800s as modern medicine was just evolving and included several painful practices. New diseases were infecting the human population, and medical science hadn’t caught up yet.

Homoeopathy held the promise of painless “treatment” and gained popularity.

Homoeopathic schools opened in the US and Europe throughout the late 19th century, spurred by ineffective treatments for outbreaks like cholera, which killed hundreds of thousands of people at the time.

Medical practitioners investigated the system for assessing efficacy, and this is thought to have encouraged rigour in modern medicine as well.

However, leading homoeopaths rapidly started abandoning the practice in the mid-20th century as modern medicine showed real results. The last homoeopathic school in the US was shut down in 1920.

Later, Nazi interest in homoeopathy led to its resurgence in public consciousness in the 1930s and 40s — but they abandoned the system quickly too.

It then gained favour with the New Age Movement, a Western phenomenon that spawned a variety of spiritual and religious beliefs in the 70s, and incorporated “natural” remedies for the mind, body, and spirit as their central tenet for health.

The movement has been known to adopt pseudoscientific beliefs such as astrology as a reaction against institutional establishment structures, and is credited with the rising popularity of homoeopathy today.

In India, homoeopathy was introduced in the early 19th century and was quickly adopted across the country, via Bengal.

The Calcutta Homoeopathic Medical College, the first Indian homoeopathic institute, was established in 1881.

In 1973, the Union government recognised homoeopathy as one of the national systems of medicine and set up the Central Council of Homoeopathy (CCH, now overseen by AYUSH Ministry) to regulate its education and practice.

Also Read: Homoeopathy as ideology

Scientific consensus

Homoeopathic training involves a number of beliefs that run counter to well-established science. The system rejects germ theory, believing that all illnesses come from within. Future practitioners are reportedly taught that vaccines are poisonous and antibiotics a sham.

Right from the time it took hold, homoeopathy has been criticised by physicians. Evidence for its efficacy is said to have been established by Hahnemann by having patients simply write down their symptoms in detail after consumption of a remedy, a process that lacked rigour.

Scientific studies into homoeopathy have consistently shown it to be ineffective in treating illnesses or their symptoms — or occasionally just as effective as placebos.

Analyses of existing studies show that research suggesting positive results was either not conducted as rigorously as necessary or was backed by insufficient evidence.

A 2002 study conducted by a British researcher — a systematic review of other systematic reviews on homoeopathy — found that no study was able to determine positive outcomes. It concluded that the “best clinical evidence for homoeopathy available to date does not warrant positive recommendations for its use in clinical practice”.

Many other such studies have followed in the two decades since.

Most recently, an extensive 2015 study in Australia, conducted by the country’s top funding body for medical research, the National Health and Medical Research Council, assessed over 1,800 other studies and the results yet again weren’t in favour of homoeopathy.

The basic foundation of homoeopathy, that water holds the memory of substances it has been in contact with, has been widely discredited but remains controversial.

Following large-scale denunciations of homoeopathy by scientists, many medical bodies and health services have conducted independent research and issued advisories against the use of homoeopathy.

The health agencies of the US and Britain — the Department of Health and Human Services and Britain’s National Health Service, respectively — both state clearly on their websites that the purported effectiveness of homoeopathy is not backed by research. The WHO has discouraged its use for treatment of serious diseases, and called for quality control and regulation of homoeopathy to avoid lethal consequences.

National medical and health bodies in Russia, Australia, and Europe have warned against homoeopathy. Countries like Britain and France have forbidden reimbursement for homoeopathic treatments, while Spain is pushing for a ban on the entire system for being dangerous and unethical.

“Many countries have conducted comprehensive research and have ultimately decided that it doesn’t work,” said Amalorpavanathan Joseph, a vascular surgeon at Chennai’s Vijaya Hospital.

Speaking about the recent government advisory against coronavirus, he added, “Even if it was issued as a preventive measure to build up immunity and not a cure, it can’t work. Building up immunity takes years, it can’t happen in a matter of a few days.”

‘A cure for everything’

Supporters of homoeopathy claim it can cure almost anything, including conditions such as polycystic ovary syndrome (PCOS), psoriasis and diabetes that Western medicine is yet to find a cure for.

“Homoeopathy has medicines for everything, including thyroid, PCOD, psoriasis, diabetes, hair-fall, osteoarthritis, and even cancer,” said Josy Joy, a homoeopath practising at the Bengaluru-based Care N Cure Health Clinic.

According to Joy, his patients have seen improvements in all these illnesses without modern medicine.

Asked about the criticism directed at the medicine system, he said, “Western science looks for material content in homoeopathic medicines, but homoeopathy acts in a dynamic way. If the medicines are used, results can be seen.

“Our patients have seen their goiters dissolve through homoeopathy but allopathy has only surgery for most of these.”

Medical experts disagree.

“Any claims made should be backed by data and evidence. There has been no documented evidence that homoeopathy works and can cure people of illnesses,” said Joseph of Chennai’s Vijaya Hospital.

“If there’s evidence that homoeopathy works, doctors would be the first to adopt it. We want our patients to be cured and healthy after all.”

Sumaiya Shaikh, a Sweden-based neuroscientist who serves as science editor of the fact-checking portal Alt News, has done extensive research on homoeopathy and academic homeopathic publications as a part of her reportage.

“The studies (that prove homoeopathy to be effective) have faulty statistics at the outset,” she said.

“A mechanical explanation of the drug dynamics is never attempted in the discussion, even as a hypothesis, as the authors never know how exactly they think the drug is working. Often the conclusions are far-fetched in the abstract but when the study is carefully examined, the data doesn’t reflect the assertion of the conclusions,” Shaikh added.

Additionally, critics claim, processes that induce scientific rigour, such as blinding, are rarely used. Blinding is when the patient doesn’t know if they’re being given a homoeopathic medicine or an allopathic one. A similar system is double-blinding, when doctors themselves don’t know either.

Such systems are important to establish the effectiveness of a treatment without bias.

Shaikh explained how ‘citation value’ of research — a measure of credibility — is enhanced by the authors or other homoeopaths by repeatedly citing faulty studies that discard other variables.

Backers, however, are quick to reject the argument about the lack of credible research, saying it was consequence of the West’s indifference towards the alternative medicine system.

“The accessibility of homoeopathic system is very limited in the Western world and did not receive much attention in development as compared to allopathy,” said Dr Anil Khurana, director general at the Central Council For Research in Homoeopathy, an institute under the AYUSH Ministry.

“Because of the low cost of medicines, it did not get investment from sponsors either. Even governments in Western countries did not invest funds in alternative medicine, including homoeopathy,” he added. “Their support towards allopathy has prevented them from investing in further research and studies to prove the efficacy of homoeopathy.”

“However, there are countries like Brazil, Cuba and Mexico where the government supports this system of medicine… The therapy has started growing in the US, where seven states have allowed legal practice of homoeopathy. In Europe, acceptance is at an all-time high in most countries, including Italy, Germany, France and Switzerland.”

While as much as 60 per cent of the French population reportedly uses homoeopathy, come 2021, the government will end public support for medicines under the system. In Switzerland, meanwhile, homoeopathy has been given the same status as conventional medicine.

According to Khurana, students seeking training in homoeopathy are subjected to a rigorous 5.5-year curriculum, which includes a year-long internship and “is equivalent to MBBS where lessons don’t only deal with homoeopathy but also other subjects, as happens at allopathic medical colleges”.

“India has the largest infrastructure of homoeopathy because of increased demand from the public who have experienced the benefits of homoeopathy,” he said.

There are nearly 3 lakh registered homoeopaths in India today. An estimated 32,000 students enrol each year in AYUSH colleges, of which over 13,000 students opt for homoeopathy.

But this curriculum has a potentially dark underbelly.

“Homoeopathy degrees are an easy gateway into medical practice for students who didn’t obtain good enough scores to enter an MBBS programme,” said Shantanu Abhyankar, a trained homoeopath who switched to modern medicine after “being convinced that homeopathy is humbug”.

Abhyankar himself did the same — entered a homeopathy course as he couldn’t score well enough for MBBS.

But during the course of his training, he realised that they were just taught theory, and research papers published in the field offered no proof that homoeopathy worked.

“Homoeopaths are legitimised by the prefix ‘Dr’ against their name, and thus set up a practice,” he said.

Abhyankar eventually went back and obtained an MBBS degree, and has been a practising gynaecologist for 20 years now.

Also Read: PM Modi’s acupressure roller could work for some, but mostly it is pseudoscience

How placebos work

There are many reasons why critics believe homoeopathy seems to work for people.

Primary among these is called “regression to the mean”.

Nearly every illness has a natural growth curve before it tapers and dies (or kills). Typically, the moment illness sets in, patients go to doctors. Antibiotics or other modern drugs are prescribed — and might not always work. A homoeopath then prescribes a long course of remedies. So, just as the patient consumes them, the disease in its natural course starts to decline, and eventually the patient is cured.

The regression to the mean has been cited as a factor behind faulty results in placebo experiments on multiple occasions. This is also believed to be the reason why many patients who have survived dangerous illnesses like cancer report feeling better when they follow up medical treatment with a trip to the homoeopath.

“We have treated many cancer patients who have suffered from all kinds of cancer such as lung cancer and breast cancer,” said homoeopath Joy.

“Homoeopathy prolongs life. With chemotherapy, the problem is that there is increased chances of cancer recurrence [there is no proof for this claim], but people still always go to chemotherapy and then come to homoeopathy. We have successfully avoided recurrence for many kinds of cancers.”

“Different patients have different needs, so we use different remedies made of arsenic, belladonna etc.,” he added.

He did, however, concede that he hadn’t seen cancer patients who came to homoeopathy directly before chemotherapy.

A similar effect as regression to the mean is also seen in unassisted natural healing, where the body’s system builds up immunity over time to fight off an illness, and this often coincides with a homoeopathic course.

It is also possible that the patient feels better on account of a completely different aspect of their life that is inducing a pharmacological change in the body and treating the illness, such as a new meditation practice.

Patients also often use homoeopathy as a complementary treatment to a medicine course.

There is also the therapeutic effect of physician consultation. A homeopathic consultation could typically last for two hours, and a 2010 study published in the peer-reviewed British journal Rheumatology attributed to clinical benefits in homoeopathy patients could be attributed to the consultations.

Homoeopathy is also considered a placebo — it works because the people who take it think it does. But this requires strong belief and doesn’t hold true for all consumers. The placebo effect is a subject of active research, especially in light of the knowledge that patients respond even when they’re aware they might have been given a placebo.

But placebo effects are mostly known to work for symptoms of illnesses and pain management, not the actual disease. For a cancerous tumour, for example, someone under the placebo effect can feel less pain, but the tumour still eats away at the body.

Khurana, however, said it was a myth that homoeopathy worked as a placebo.

“The top research institutes of India for modern medicine, including AIIMS, School of Tropical Medicine, Kolkata, and Bose Institute, Kolkata and others have conducted pre-clinical trials (those preceding clinical trials on humans) to dispel the myth that these medicines are mere placebo,” he said.

“Such trials have been adequately documented to validate the claims. The studies have been published in international peer-reviewed journals.”

Some of the studies, however, seem to say nothing about the efficacy of homeopathy. Instead, a study by West Bengal researchers, including from Bose Institute, spoke about “vibrational and electric properties” of the medicines.

ThePrint reached the heads of AIIMS and the Indian Council for Medical Research (ICMR) for comment but they did not respond.

“Homoeopathy treats symptoms while modern medicine treats causes,” said Abhyankar. “Modern medicine can even predict and prevent (a disease). But homoeopathy can only treat symptoms after they manifest.”

Homoeopathic remedies might seem like a harmless placebo, but they cause significant indirect harm, said Edzard Ernst, a German academic physician who is considered an authority on complementary and alternative medicine (CAM).

“If a severely ill person is treated with ineffective homoeopathy and thus forfeits effective treatments, her illness will not be adequately treated and thus (she will be caused) unnecessary suffering,” he added. “If a homoeopath advises a patient against vaccinations — as many homoeopaths do — he endangers public health. If a homoeopath charges for useless treatments, he causes harm to his patient’s finances.”

Homoeopaths, however, fulfil a key role in India’s healthcare pyramid — informal community care.

“We have nurses, super speciality nurses, ward officers, doctors, but very few physiotherapists or trained counsellors,” said Abhyankar. “Because they (homoeopaths) are considered doctors, they often end up fulfilling this need.”

Under the AYUSH Ministry, homoeopathy is the second most highly funded system of medicine after ayurveda, but Ernst said it didn’t warrant such attention.

“Homoeopathy is both biologically implausible and, according to the best available evidence, not clinically effective. Therefore, funding research into homoeopathy should not be on the agenda of reputable funding organisations, let alone governments,” he added.

“Research funds are notoriously scarce. Therefore, governments and other funding bodies have an ethical, moral and legal duty to spend them on projects with a high prior probability of generating a productive result,” he said.

“Alternative medicine should be open to scrutiny and peer review by everyone and should be subjected to the same principles of research as evidence-based medicine,” added Shaikh. “By the sheer exclusivity and inability to bite bitter bullets, alternative medicine has become what it has become. There could be immense value in finding mechanisms and biochemical pathways at which the anti-inflammatory herbs are targeted but the research is always focused on quick translation and marketing before due research, as the belief takes over its evidence.”

With inputs from Himani Chandna in New Delhi

Edited by Sunanda Ranjan

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