The Sugar Pill That Doesn’t Work

How the Indian government wastes valuable public money by promoting homeopathy for healthcare.

If homeopathy works, then obviously the less you use it, the stronger it gets. So the best way to apply homeopathy is to not use it at all —Phil Plait

Recently, a minor scandal erupted in the UK when the public came to know the National Health Service had spent £10 million or about Rs 80 crore on homeopathy in 2008. In contrast, the National Capital Territory of Delhi alone spent Rs 77 crore—or 7 per cent of its Rs 1,100 crore health budget—on homeopathy without a question being asked. And Delhi is no exception. Almost all states in India fund, control and regulate the use of homeopathy. An Act of Parliament governs its practice in India, and a significant part of the budget for alternative systems of medicine in the country goes towards it.

No other country in the world has institutionalised homeopathy quite so. The contrast with the UK, therefore, is telling: a country that can afford indulgences gets worked up about this waste of public funds; yet, in a country like ours where inefficient healthcare spending can raise fatality rates, just one city throws away as much money without even a whimper, dispensing sugar and water in the name of a system that provides no health benefits whatsoever. The misuse of public resources and what it says about our commitment to public health is alarming. But then, so is the easy acceptance of homeopathy in recent history and what it says about the Indian mind.

Consider the history. ‘Travellers, missionaries and military personnel from the West brought Homoeopathy to India as early as 1810,’ according to the website of the Indian Government’s Central Council of Research in Homeopathy (CCRH), ‘The credit of receiving official patronage goes to Dr John Martin Honigberger who was called to the Court of Maharaja Ranjeet Singh in 1839 for his treatment.’ What the website fails to mention, conveniently, is that Ranjeet Singh died shortly after—on 27 July 1839. So much for the treatment. After this singular success, ‘Dr Honigberger settled in Calcutta. This paved the road map of development of Homoeopathy in this country. It was the state of Bengal, which nurtured Homoeopathy in its early period through certain training institutions and treatment centres.’ In the form that is practised today, it became something of an obsession in that state, so much so that Rabindranath Tagore was moved to declare, “I have long been an ardent believer in the science of homeopathy, and I feel happy that it has got now a greater hold in India than even in the land of its origin. It is not merely a collection of a few medicines, but a real science with a rational philosophy as its base.”

From its beach-head in Bengal, homeopathy fanned its way across the country with the spread of British officers and Bengali practitioners who followed in their wake. Bengal was also the first province to constitute a Homeopathic State Faculty in 1943. After the formation of India’s National Government on 17 February 1948, Shri Satis Chandra Samanta, MP (West Bengal) moved a resolution for consideration by the Constituent Assembly of India: ‘This Assembly is of the opinion that [the] homoeopathic system of treatment be recognised by the Indian Union and that a General Council and a State Faculty of Homoeopathic Medicine be established at once.’ The Homoeopathic Central Council Bill was passed by both Houses of Parliament and the President signed it on 17 December 1973.

The efficacy of homeopathy and the evidence in its favour does not seem to have been examined at any point before its adoption as a system of medicine by Parliament. Of course, Parliamentarians are not scientists, but Tagore should have known better. Consider the ‘rational’ basis of homeopathy presented at the CCRH website: ‘As per the primary principle of Homoeopathy, ‘Similia Similibus Curentur’ or the ‘Law of Similars’ which is the ‘natural law of healing’, diseases are treated by medicines, which are capable of producing in healthy persons symptoms similar to those of the disease, which it can treat in a sick person. The term ‘homoeopathy’ was coined by Christian Friedrich Samuel Hahnemann and first appeared in print in 1807.’

Note the terminology. It is a ‘natural law’ by declaration, with no basis offered. Nor has any been offered in the intervening 200 years that have seen the discovery of molecules, atoms, bacteria and viruses. None of these discoveries provide any mechanism that can make such a principle, conjured entirely out of thin air, work. But an even bigger problem is the manner in which the principle is applied. Here is the website again: ‘The most characteristic and unique principle of Homoeopathy is ‘Drug Dynamization’. Homoeopathic medicines are prepared in a special way known as Drug Dynamization or Potentization. The crude drug substance is diluted and triturated or succussed to increase its potency, by virtue of which, only the medicinal power of the substance is retained and drug related side effects are eliminated. In medium and higher potencies of the medicines, the original drug substance does not exist, yet the medicinal power of the substance is retained and drug related side effects are eliminated [emphasis, Open’s]. It is believed that this process of preparing Homoeopathic medicines liberates an intrinsic power within them, which makes them safer while retaining [their] disease curing power. The potentized medicine acts as a triggering or a catalytic agent to stimulate and strengthen the defence mechanisms of the body. The potencies differ from simple dilutions, in the mechanical process involved in their preparation.’

Read the italicised sentence again. Many homeopathic drugs have no single molecule of the substance that’s supposed to heal. In effect, the medicine is just water which has somehow retained ‘the medicinal power of the substance’, as the claim goes. So, the treatment is done not by any substance, but the memory of a substance. And this has been achieved by the simple mechanism of diluting and shaking. If this were to work, we would all be in big trouble.

The water we drink is water that comes to us recycled; in that sense, it’s the very water that goes gushing down a flushed toilet, and if homeopathy is to be believed, all the dilution and shaking along the way only gives it the potency of shit—an apt summation of this field.

If the tone here is derisive, it is because hogwash is hogwash. There is no way to engage with principles of medicine here because there are none. Nor does ‘potentization’ make scientific sense. Indeed, if any of this were to make sense, much of modern science—which is being tested and re-examined every day—would have to be overturned, and not overturned in any easily redeemable way, but overturned in a manner that would junk the molecular theory of matter. It is perhaps worth remembering that evidence of the existence of molecules is now before our own eyes through microscopes.

Nor does homeopathy have any space for organisms such as bacteria or viruses. Instead, what it does believe in is, ‘The existence of an invisible dynamic force in the living organism, i.e. the Vital Force, which regulates all the functions of the body and maintains life. By virtue of harmony of this Dynamic Force, health is maintained. When this force is deranged the healthy person becomes ill. The Homoeopathic medicine, when given to the patient, stimulates this Vital Force and restores health. It is apparent that, Hahnemann wished to impress upon his followers that it is the disorder in the internal being, a lack of harmony and balance, which gives forth the signs and symptoms, identified as disease. Health can be achieved, when this harmony is restored.’

That’s what it is, an invisible ‘vital force’ that maintains our health. You cannot see it. You cannot look for it. You might as well believe in magic.

Despite the lack of evidence, millions of Indians display great faith in homeopathy, which explains why there is so much anecdotage on its efficacy. Any conversation about homeopathy will bring forth a story of how it worked for someone in some particular instance. Given that it is no more than sugar doused in water, these stories are never accompanied by any harm homeopathy has inflicted. Even a diabetic would have to overdose very substantially on these tiny pills to register deterioration. This eases selective memory, susceptibility to which is an everyday human folly. Very few remember homeopathy not working, though like many others growing up in this country, I can cite several instances of swallowing tiny pills from glass vials to no avail. It is typically the remarkable that gets recalled, the reason why coincidences linger in the mind longer than the dozens of events that are not coincidental.

Then, there is the placebo effect. As modern medicine has tried to bring rigour to the process of drug testing, every new drug is tested against the performance of a placebo, which is a tablet with no physiological effect at all. Such tests have revealed that the power of belief itself has huge curative potential, and trials show a small but significant number of people making health gains under placebo ‘treatment’. Homeopathy has never been able to demonstrate that its pills work any better than a placebo.

The placebo effect itself is poorly understood, and has come under scientific scrutiny only now. Much to the chagrin of pharmaceutical companies the world over, recent studies have shown that the placebo effect is growing stronger with time. A recent study reports that the number of new drugs rejected after being tested against placebos has risen 20 per cent. Not only that, repeat clinical trials of drugs such as Prozac are showing that the placebo effect is actually growing stronger in a measurable way. No one is sure why this is so, but increasing faith in the power of modern medicine could have a role in it. The very belief that a medicine works seems to reinforce some form of psychological self-healing. This has led to recent research focusing on that possibility. In this context, then, homeopathy should actually benefit from the belief people have in its efficacy. And if so, there should be little reason to question its use. Even if there is no rationale for it, if people benefit from believing it works, why should anyone go about challenging this belief?

The Indian Government has set up a department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (Ayush), under the Ministry of Health and Family Welfare. Of the Rs 600 crore 2008-09 budget for research in this area, Rs 54.4 crore is for homeopathy. The differences between systems such as ayurveda and homeopathy are instructive. While the principle behind ayurveda, which examines bodily ‘humours’ of three types, stands up to scrutiny no better than homeopathy, ayurvedic medicine works in the same way as modern medicine. Ayurveda does not subscribe to the homeopathic procedure of dilution and shaking. As a result, the vast pharmacology that has been established in ayurveda through observation and repetition is worthy of serious research, and is likely to throw up many potential candidates for effective drugs. In contrast, research in homeopathy leads nowhere and diverts precious funds from the study of other Indian systems of medicine that could prove useful.

But Ayush is not the only way India publicly funds homeopathy. The Delhi government alone has 98 public health dispensaries for homeopathy. Across the country, there are 230 hospitals and 5,836 homeopathic dispensaries. As long as homeopathy is practiced by private practitioners and people seek their services of their own free will, it should be no one else’s concern. But when the Government invests in public health infrastructure with funds that could be better used for conventional healthcare, already in such short supply, we ought to protest.

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