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Homeopathy - medicine and belief in miracles: Dr. Norbert Aust
Debates on homeopathy are reminiscent of wars of faith. Homeopathy means giving the patient, in a strong dilution, the substances that, according to homeopaths, cause the disease. Scientists have published numerous studies that show that this concept contradicts all established medical concepts. This does not affect the followers of this teaching: Not everything could be explained scientifically, and they would see how their sugar globules heal with substances that are no longer chemically detectable. The fronts are usually clear, and followers and opponents of homeopathy do not leave their positions.
Anders Dr. Natalie Grams. She practiced for a long time as a doctor with homeopathic methods. Then she researched for a book that was originally intended to defend homeopathy. Instead, she came to the conclusion that it was a heresy. Dr. Norbert Aust founded the Network Homeopathy, in which they provide critical information about homeopathy and medicine, science and religion. Utz Anhalt interviewed the two for Heilpraxisnet.
Ms. Grams, you are a doctor and run a homeopathic practice. Then you wrote a critical book on homeopathy ("Homeopathy Rethought - What Really Helps Patients", Springer Spectrum) and closed your practice. How did that happen?
Dr. Natalie Grams (NG): I originally wanted to write a positive book about homeopathy based on the supposedly perceived success of my homeopathic activity. To show critics how great homeopathy is and why criticism is inappropriate. But in the course of my research, I got a completely new picture of homeopathy. I had to acknowledge that I was seriously mistaken, had a false belief, and that the success of homeopathy can be explained more by psychology than by Hahnemann's 200-year-old ideas. After this knowledge, I no longer wanted and could not meet my patients with unsustainable promises of salvation and consequently I closed my practice.
2) Ms. Grams, that a substance has a “spiritual” effect if it is diluted until it can no longer be chemically proven is contrary to the laws of nature, but is the basis of homeopathy. In their own practice, despite globules, they have been very successful and former patients shower them with praise. How did the actual cures come about?
In times of homeopathy, of course, I was convinced that there really was such an “energy” - that it just wasn't scientifically fathomable. I saw - like all homeopaths - the mistake on the part of science and not on the part of Hahnemann or homeopathy. Today I know that natural laws are valid and that potentiation does not produce energy but only a dilution. The improvements that patients experience with homeopathic treatment can be explained by psychological effects, such as the placebo effect and come more from the setting and the therapist-patient relationship than from a specific medicinal effect of the globules. In addition, with intensive self-observation and after a certain past time, changes always occur - of course also positive ones. Today I like to say: Under homeopathy, cures do occur - but not through homeopathy.
Mr. Aust, you and Ms. Grams are among the initiators of the “Network Homeopathy”, which takes a critical look at homeopathy and on a website netzwerk-homoeopathie.eu. Why did you set up this network, what do you want to achieve with it and what do you see as a need?
NA: Homeopathy is an outdated doctrine of salvation from pre-scientific times, the basic assumptions of which completely contradict scientific and medical knowledge. However, the patient has hardly any opportunity to get an accurate picture of it. In the relevant media, a positively oversubscribed picture is drawn, the effectiveness is based on logical errors and incorrect analogies. All possible institutions, e.g. Adult education centers, church sponsors, chambers of agriculture offer courses and recommend their use. Even pharmacies and doctors can relax in front of the carts. Homeopathy is laid down in the health care system by the law on medicinal products, but piquantly, however, without requiring a burden of proof, which otherwise every food manufacturer would otherwise have to follow if he advertises his products with health-related statements. Medical associations offer further training in homeopathy, homeopathy is introduced as a subject in the license to practice medicine and subsequently at universities, and health insurance companies cover the costs.
So how should a patient who wants to get information get accurate, objective information that is not based on obvious economic interests? Already in my book and on my blog I tried to remedy this shortcoming. Our network is the continuation of these activities on a broader basis. This seems very important to me, because the health care institutions that are supposed to protect us from quackery and charlatanism have so far failed miserably. The G-BA initiative is a first step in the right direction.
NG: For me personally, the motivation is that, even as a doctor, I was so wrong in the melodious claims of homeopathy. I would like to help prevent others from doing the same, or at least provide them with the right information that can help them reassess homeopathy. I see that both therapists and patients believe that they know a lot about homeopathy, but they do not question it critically enough whether this is true. Here, the INH would like to help to clarify and to carry out bitterly necessary educational work.
Ms. Grams, you are a medical doctor, so you know the difference between empirical science and hocus-pocus as well as the effect of placebos and also the difference between medically effective substances and psychotherapy. How do you explain, also from your own experience, that scientifically trained doctors use homeopathy?
NG: I am sure that most colleagues only know homeopathy from hearsay and associate it with false associations such as “natural” and “gentle”. Since you are not very knowledgeable, you want to be tolerant, and hardly anyone has really dealt with the basics of homeopathy. In addition, doctors are not particularly scientifically trained. The natural sciences occur naturally in pre-clinical studies, but scientific thinking is hardly taught. As a doctor, you decide after completing your studies to pursue a scientific career or a practical one.
Ms. Grams, Mr. Aust, wherever naturopathy is popular, homeopathy also swims. Naturopathy in the narrow sense means, for example, medicinal plants, the effect of which is usually also scientifically proven. If seafarers ate fresh fruit and thus prevented scurvy, this does not contradict natural science. Is homeopathy naturopathy, that is, medicine with the means of nature?
NA: From my point of view, the problem with homeopathy is not based on the word 'nature' but in 'medicine', even if you can ask yourself whether electricity, vacuum or the Berlin Wall are actually natural substances. Every medicine is associated with an effect on the patient that starts from something that is effective. These do not necessarily have to be active ingredients, also warmth, physical influence (massages), or conversations are known to have a positive or negative effect. This is precisely not the case in homeopathy, which sees itself as drug therapy. In medium potencies, the active ingredient is contained in hardly measurable quantities, in high potencies it is no longer at all, even though these preparations are said to have an increased effectiveness. Homeopathy is therefore a doctrine of salvation that assumes that evaporation residues from shaken water on sugar have a specific effectiveness that is due to the absence of the mother tincture. These can be as natural as you want: it is not real medicine.
NG: You are addressing one of the main fallacies of homeopathy and homeopathy perception. We at INH therefore want to finally make a clear distinction here: Naturopathy can have specific effects and is the basis of many of our normal medications (e.g. penicillin, digitalis), homeopathy is a humbug from times long past and has nothing to do with medicine and nature in a double sense to do.
Ms. Grams, Mr. Aust. The doctor Samuel Hahnemann (1755-1843) came up with homeopathy. He adhered to an idea of the medicine of the Middle Ages: the deadly cherry helps against rabies, our ancestors thought, because both make "great", and Hahnemann recommended it against confusion and fever (madness). He looked for substances that caused symbols similar to those of the patient, but diluted them so that the substance no longer existed chemically. A 1: 1,000,000 dilution is dropped onto sugar globules. It is about the “spirit”, the “information” of the substance. Such "secret" information is very popular in the esoteric scene - sometimes it comes from angels, then from spirits, then from the cosmos. So is homeopathy religion rather than scientific medicine?
NA: Despite all the criticism of homeopathy, we see Hahnemann as someone who used the methods of his time to gain new insights. He had no way of knowing his mistakes, because falsification as an essential scientific principle was only introduced into scientific theory long after his death. He could not have known that he was completely diluting the active ingredient out of his preparations. The problem is his successors. Instead of adapting the teaching bit by bit to the increasing knowledge of medicine - which would have meant recognizing large parts as errors - they have been maintained and new reasons have always been sought that are naturally outside of science.
In the course of time, a structure emerged that is not unlike a religion. A charismatic, infallible founder, sacrosanct books that go back to this founder and are considered correct per se, the division into believers and unbelievers and, last but not least, the handling of apostates of pure teaching already point in this direction.
NG: Absolutely. However, religions are clearly stated beliefs, but homeopathy pretends to be science and medicine. Homeopathy is so steadfast in the middle of our society because therapists and patients believe in it. Even the most logical and stringent arguments cannot convince a believer. We notice that in every discussion with supporters of homeopathy.
Ms. Grams, Mr. Aust. Patients often report an improved state through homeopathic treatment. On the one hand, this is probably due to the placebo effect, on the other hand, homeopaths usually deal intensively with their patients. So do physicians or naturopaths and patients actually carry out a conversation therapy in which the sugar balls have symbolic meaning, comparable to the animal spirits in shamanism?
NG: In my book, I describe in great detail what happens between homeopath and patient or even with self-treatment with homeopathy. The therapeutic treatment setting of homeopathy offers time, individual responsiveness and simple solutions to very complex questions. Having some kind of control over the disease and not feeling so exposed may also play a role. There's a bit of magic in there too, and that creates fiction that can sometimes be helpful. However, fiction is never able to replace concrete, specific therapy, and homeopaths do not want to see this limit. And unlike psychotherapy talk therapy, homeopaths do not blame conversation and human interaction or a kind of self-awareness for changes, but only the globules. In fact, this makes it similar to a shamanic suggestion practice.
Ms. Grams, wouldn't such psychosomatic treatment, ie psychotherapy, work without sugar balls?
NG: After realizing that homeopathy only works as an unstructured conversation therapy, I also thought about talking to my patients, accompanying them and not giving them any globules. Or to give globules, but to explain to the patient that these are placebos or a suggestion ("This will help you"). That would be homeopathy without homeopathy - do we really need it? I think no. Because we have medicine. And we have psychotherapy. And: Whoever believes can go to a church.
Ms. Grams, Mr. Aust. How do you explain the growing need for "alternative medicine"? Does this indicate needs that are neglected in evidence-based medicine? Or do people want to believe in miracles?
NG: A very clear yes to the phrase “people want to believe in miracles”. And it is not the case that miracles do not happen - this is also possible in medicine. But a healing method based on the belief in miracles is just as up-to-date and helpful as a picture of a saint in a car instead of a seat belt.
I agree that people often feel that they are not seen enough in everyday medical life, and I regret that very much. Here at the INH we propose that doctors should be given more opportunities to devote time to talking to their patients - and that they will be able to do this better again. This would surely also avoid many unnecessary examinations - and thus costs. The best thing would be if there were no gap in which patients could yearn for alternatives!
NA: I think Ms. Grams said the essentials, I can only agree here.
Ms. Grams, you are a doctor and practiced homeopathy yourself. Then they became skeptical. But I also know the reverse case: A successful psychiatrist who painfully ascertained that mental disorders can only be cured to a very limited extent suddenly says that everything you wish will be fulfilled if you only believe in it. The doctor now “enlightens” his reputation because he thinks he can fix all diseases by tapping on parts of the body.
NG: People are not necessarily prone to rationality. We like to believe in miracles, we find great promises more appealing than critical thinking and consistent questioning - we all. Mr. Kahnemann worked it out very well for me in his book "Fast Thinking, Slow Thinking". So I can understand that it is easy to fall on the side of "intuitive belief in miracles" - after all, it is much less effort.
Analytical work as a psychiatrist over many years costs an enormous amount of mental energy and consumes psychological resources. The suggestions of innate quick thinking to make sense instead of continuing the tiring work, the results of which are not very successful, are now becoming ever stronger.
Is this urge to think intuitively and find quick solutions perhaps an explanation for the boom in pseudomedicine? If so, how could this be counteracted?
NG: That's exactly how I would phrase it. I see one approach in making people more aware that there are two different types of thinking - and which one we should use and when.
Mr. Aust, Mrs. Grams. How is it that homeopathy enjoys a special position in pharmaceutical law? Every medicinal plant that indigenous peoples in the Amazon have been using as medicine for centuries must first be scientifically proven before it is recognized as a medicine.
NA: From today's perspective, it is no longer understandable why homeopathy was then included in pharmaceutical law. Apparently, this goes back to Veronika Carstens, the wife of the former Federal President Karl Carstens. She was a supporter of homeopathy and used her position to create a foundation for the promotion of homeopathy and naturopathy in 1982 together with her husband. This foundation has done its job very well. The introduction of the internal consensus in 1997 also goes back to the influence of interested parties on the legislation. In 2001 a European regulation was adopted, which established a simplified registration instead of an approval linked to a proof of effectiveness. Of course, the European regulation probably goes back to similar activities.
It all sounds more or less like conspiracy theory, but it's the only conceivable explanation.
NG: In the 80s and 90s people practiced supposed tolerance and the belief that medicine was also experiential medicine. In a way, that's true. However, we have just invented clinical studies for this and developed them further in order to draw objective conclusions from individual experiences. If you look at the studies on homeopathy, the better and more comprehensive they are, they show that the experience with homeopathy corresponds to a sham therapy. A special legal position is therefore no longer tenable today.
Followers of homeopathy, healing by hand, Catholic devotees of Mary or people who believe in mysterious rays of the earth often say: "I don't know exactly why it helps, but it is crucial that it helps."
NG: As a homeopath, I always retreated to this sentence that seemed pragmatic to me at the time. But we do not see in independent reviews (clinical studies, systematic reviews) that homeopathy works better than placebo therapy. There are a number of normal medications where we still don't know exactly why and how they work - but we can prove there that they work. Homeopathy cannot do this and the sentence is simply wrong. Individual observations are a great thing and if you are the one who thinks he has experienced a “miracle”, then that is almost impossible to eliminate. But if we check whether such miracles occur regularly in homeopathy, the result is: No.
Mr. Aust, Mrs. Grams. What is the response to your website?
NA: Surprisingly, the positive feedback, i.e. inquiries about how to support us, outweighs. We are particularly pleased when university professors and medical doctors confirm our views. Of course, there are statements to the contrary, but, unlike those in Internet forums, they remain largely in a factual framework. However, the same standard arguments are always used.NG: We have had a great response, especially from the press. It is as if the door has finally been opened to a factual yet friendly, appreciative education about homeopathy. We want to continue working on this consistently.
We thank you for the interview! In Part II we will be interviewing supporters. (Dr. Utz Anhalt)