Exacerbated antipathies

By Jack Aslanian

Ah, seductive and confounding keywords: “Allopathy”, “Homeopathy”. They surged off a headline in a recent issue of Le Parisien to snag attention and excite with the promise of a read enriching enough to make up for my effort to read in French. More attentively, on to the subhead and down to the lead, through the body of the article with diminishing expectations, and a couple of boxes, the only conclusion I could muster — one also linguistically consonant with the setting — was “Plus ça change, plus...” I had just spent time reading an opportunity snatching, biased, and goading journalistic treatment of a recently stepped-up skirmish of a battle in an ideological war whose kindling slogans and competing battle cries are rooted in pre-Hippocratic medical history. Bolstered by fundamentalistic angst, on one side of the front between the war’s provocative issues and challenging stances is the fraternal army of allopathy (also known as “heteropathy”), on the other integrative medicine, a ragtag agglomeration of multifarious theories and practices with allegedly deceivingly contrived, allegedly ineffective and even, again allegedly, dangerous therapeutic interventions. In this latter camp for over two centuries has been dug in homeopathy, the most puzzling and controversy stoking of the modalities of alternative medicine — of virtually any diagnostic and healing practice, one could add.

The similarities and differences between the two competing approaches and their stances vis a vis one another are akin to those between opposing political parties or religious beliefs. Allopathists explicitly, or merely implicitly in practice, are pledged to “science based” or “scientific” or “evidence based” medicine (which sometimes more ambiguously is also labelled as “traditional” or “established” medicine) taught in medical schools. The diversity of healing approaches bunched up as “alternative medicine” is, on the one hand, its bane. Its scope frustrates the search for a single catchword to refer to the entire field. Many different referents are in use — but none have the compact pith “allopathy” has as a designator of its domain. Among terms used are: integrative medicine, alternative medicine, complementary medicine, naturopathy, holistic health, mind-body medicine — on to other terms that are even less comprehensive and lack specificity and breadth of coverage, such as untraditional or unorthodox medicine, or ones that even are, not unintentionally, malicious and combative, like fringe medicine, pseudo medicine, or unethical medicine. For now “integrative medicine” or “alternative medicine” will by default have to serve as placeholders for an as-yet-not-coined all encompassing referent. Its multifariousness on the other hand also is the hope of integrative medicine, because if enough of its various existing modalities and those that surely will yet be devised are tried on for fit and efficacy, one or another may surprise and reward us by being on target. Even if that were not to be a panacea — for withal a more realistic projection of integrative medicine and its future is that (a) some of its modalities could be effective, (b) some of the time, in (c) some individuals. Allopathy by itself cannot explain such things as outliers in scientific studies, or account for individual differences in responses to pharmaceuticals, or reliably factor in the unavoidable variability over time of an individual’s unique physiology. When we are faced with new and uncustomary theories, we should forget neither that Columbus had expected to arrive at a destination that was not there, but ended up discovering another unimaginable one, nor forget that Galileo was prescient, but he was accused of heresy, long censured and ostracised, and punished for fielding what in fact were truths in astronomy.

Compared to some of the other modalities of integrative medicine, homeopathy is relatively young, but it has endured and now has substantial following — mainly among its professional exponents, of course, and among the lay public. Homeopathic treatment was conceived (“created”) by Samuel Hahnemann in 1796, and christened first in print in the subsequent decade or so. Not surprisingly, the allopathists of the time reacted immediately, and persistently since then have shown no little inhibition to shout the battle cry against it. Homeopathy was not the first nor last among alternative medical practices (plural intentional) to incite allopathists’ scepticism (a milder and more honest dismissive stance, than, let us say, disdain or animosity). It has, however, been an apt target, both because of its baffling theories and the fact that there is “no scientific evidence” that homeopathy works. Homeopaths espouse the theory that “like cures like” and rely on administering highly dilute concoctions to tackle illness. Homeopathy can be characterised as “minimalistic pharmacotherapy” that uses very low minitude [sic, neologism, as opposed to “high magnitude”] dilutions in water or alcohol — for example, dilutions in the order of 1 part to 10,000 or so — of purportedly malady-specific compounds.

I am not a believer in homeopathy, just an inquisitive observer with an open mind. For the sake of keeping this piece from getting too long, I have not delved deeply on the finer nuances, merits or demerits of the beliefs of either camp, or of the legal case itself. The placebo effect, for example, could explain the action of homeopathic preparations. Even if one were to discount those anti-homeopathy aspersions that are ad hominems, one is hard put to conceive of and equably accept the idea that the super-dilutions homeopaths prescribe actually work. And if they ever were to be proven to work, “How?” is the second big question, because then a lot of what we know about physics and chemistry and anatomy and physiology would have to be re-examined.

But what about the fact that the public believes otherwise? In France, over 30% of the population take recourse to homeo-therapy — more, it is said, than in any other country. And as a corollary to that: France’s national health system pays out about 55 million Euros (about $63M) for homeopathic prescriptions. These facts elucidate the impetus behind the recently exacerbated strife between allopathy and homeopathy “It is the money, stupid!” as the colloquialism would go.

As depicted in the Parisien article, the righteous guys are the allopathists. In March 2018 about 120 of them, general practitioners, published an open letter nationally to bear upon and turn the opinion of the public and therewith of the government against homeopaths — their wherewithal and incomes. The authors of the letter declared that it is implausible that homeopathy works; there is no evidence that it does. Besides it could be dangerous, they rationalised, to further disarm accusations of greed (read partisan scaremongery here) and wasteful of taxpayers’ monies. They launched a volley of epithets like “sham, quackery, unethical, illegitimate”. So far nothing new, other than perhaps resorting to an open letter timed to influence opinion — the signatories had timed its publication to coincide with the health ministry’s project to revaluate homeopathic practice and confirm or deny it coverage and reimbursement. The litany has been voiced and heard before. And the responses of homeopaths and other alternativists have been defensive and rather subdued, less lancinating than the attacks of their detractors. Except for this time. For now, a legal battle has ensued between the two camps.

Soon after the publication of the letter, a large number of its authors (in the order of 70-80 practitioners) were served with notices by registered mail informing them that legal action was being initiated against them by the society of French homeopaths who had decided that enough was enough (for them) and had chosen to grab the bull by the horn and sue for slander and defamation of character — an unprecedented tactic in the longstanding enmity. The reaction of the originators of the instigating letter was a mixture of surprise, sanctimonious denials, and unsuccessfully camouflaged appeals for sympathy and support — including protestations that they had done no wrong, had not cooked up facts, had in mind interests of patients and the public, and that the lawsuit clearly was retaliatory and aimed to restrict freedom of expression. The case is likely finally to end with a settlement with some kind of a public statement — and eventually also some kind of ministerial decision about the worthiness of homeopathy. A few aspects of the Parisien article and the polemic interested me enough to add the following as asides:
a) It is obvious from the writing style that the reporter’s sympathies are tipped towards the defendants in the suit, the allopathists.
b) The writer does not deign to make a distinction between alternative medicine and homeopathy. No self-respecting writer, medical or otherwise, would have been as consistently neglectful as the Parisien’s reporter was of the difference between “integrative medicine” and “homeopathy” — which latter is but one modality, a sub-domain, of the former.
c) And finally briefly, in a more epistemological vein: there is the biologically plausible concept known to many eastern cultures that increasingly diluting polluted water (e.g. in a stagnant pool) with clean water will progressively weaken the polluted water’s pathogenicity. It is not going too far afield to muse for the sake of debate that there is a conceptual resonance (maybe just a jumbled echo) between this belief and Hahnemann’s overarching theory of miasms and like-curing similars.

So what did I learn while I was under the spell of reading two keywords in a French headline? Sadly, that not much changes. The more it does, the more it stays the same (though perhaps with the addition of a lawsuit, in this instance). Vitriol and epithets and heartless vituperations are handy fallbacks. Science is incomplete; perhaps it will ever remain so, one step or two behind our wishes and expectations. Science is also self-proud. Intuitions are unreliable and unpredictable and very personal. Neither scientific medicine, by itself such as it is, nor alternative medicines individually or collectively will purvey the good health we all pine for. In tandem they will no doubt bring us closer to the ideal — a better understanding of the human body and health. But never complete and never unimpeachable.

A physician, medical editor, and member of EMWA and AMWA, Jack Aslanian maintains an ongoing interest in alternative medicine.