Tracking the idea smaller doses have bigger effects
Today conventional medicine conceives of itself as a strict science based solely on facts and clinical evidence. Homeopathy - which some 15 million Americans continue to seek out as an alternative means of healing - is one of many therapeutic loose ends that medicine has trouble neatly tying up. These often popular unconventional therapies leave medical practitioners and researchers by turns frustrated, angered, bemused, or, in a few cases, intrigued.
In "Copeland's Cure," author Natalie Robins traces the life of Royal Copeland, the most prominent American proponent of homeopathy, to follow the history and effects on society of this unconventional healing method.
The term homeopathy was coined in 1796 by a German doctor, Christian Friedrich Samuel Hahnemann, codifying ideas that had far earlier roots. One was the principle of similibus curentur, or like cures like: A small dose of what ails a patient will cure him. It was also seen as a gentle and humane alternative to the conventional medicine of the day, which routinely included practices such as bloodletting.
Followers of Hahnemann use common minerals or extracts from plants or animals, highly diluted, usually in plain water. (Many are herbs and some, such as belladonna, would be considered poisonous if taken in larger doses.) The other chief homeopathic principle concludes that the smaller the dose of the original substance the stronger the healing effect. In some cases, the drug is diluted so greatly it is unlikely that a single molecule of it remains in the solution. This solution then may be absorbed into sugar pills or tablets that can be easily stored and dispensed.
Shortly after its founding in 1847, the American Medical Association, the practitioners of conventional medicine, promptly termed homeopathy "a delusion" with no scientific basis. Nonetheless, in the late 19th century, doctors continued to receive homeopathic training at some of the nation's best medical schools, including Harvard, Columbia, and Dartmouth. Homeopathic hospitals dotted the country. Among its advocates were Henry Wadsworth Longfellow, Nathaniel Hawthorne, Daniel Webster, John D. Rockefeller, and Harriet Beecher Stowe. Mark Twain wrote favorably of it. In 1901, a leading conventional doctor declared, "No one will deny that as many patients recover under homeopathic treatment as recover under any form of treatment."
As the 20th century dawned, Royal Copeland, raised in Michigan and trained as an eye surgeon and in homeopathy, became homeopathy's most prominent spokesman in America, Robins says. The busy doctor recorded a number of his own homeopathic cures, including a patient who was experiencing acute eye inflammation and great pain. "In all my experience I never saw a remedy act more quickly," he wrote of the homeopathic drug he administered. "Had it been a narcotic, the effect could not have been more magical." Copeland also pursued a political career and became a United States senator from New York, with a young Franklin Roosevelt as one early campaign manager.
If homeopathy does work, is it because of a physical or mental effect? Even its practitioners are divided on the subject, Robins says. Some expect a biomedical effect will eventually be found - that the drug, though no longer physically present in the homeopathic solution, has somehow affected it in an as yet undetectable way. Others theorize it must be a placebo effect, based on the expectation of the patient (and, more controversially, the physician as well) that the patient will be helped by the drug. Perhaps taking a homeopathic pill somehow "releases chemical impulses in the brain that diminish symptoms," as the Mayo Clinic has suggested.
According to Robins, Copeland himself apparently recognized a mental aspect. He told one patient after cataract surgery: "I wish you would not worry over your condition. It does you no good and so depresses you that your eye, as well as the rest of your body, is unfavorably affected.... Now just take for granted that you are going to be all right, as I firmly believe you are going to be, and you will find yourself in better spirits, and as a result your eye itself will be better...."
Robins makes several mentions of Christian Science, which would take a step beyond homeopathy's highly diluted drugs to no drugs at all in treating disease. Mary Baker Eddy, the founder of this newspaper, experimented extensively with homeopathy before discovering Christian Science in 1866. She felt it gave her an insight into the mental nature of disease, which she ultimately concluded was most effectively healed through prayer to God. (Copeland said he "respected" Christian Science, Robins writes, and conceded it had "beaten to a frazzle" homeopathy with its "popular success.")
As with other alternative healing methods, homeopathy is difficult to assess through conventional clinical trials, Robins points out. Treatments are designed uniquely for each patient; what works for one doesn't for another. So a similar reaction to a certain homeopathic drug from a broad sample of test subjects wouldn't necessarily be expected.
Some homeopaths have asked why they must prove how their remedies work when many conventional drugs are approved and dispensed without understanding exactly why or how they work either. Nonetheless, Robins says, to be accepted as "scientific," homeopathy will have to submit to this kind of testing. While many such tests have shown no therapeutic effect, some do. Just last year a team led by a British researcher, an admitted skeptic of homeopathy, found that a highly diluted homeopathic solution of a histamine influenced the action of human white blood cells. "We are, however, unable to explain our findings," the befuddled researchers concluded, "and are reporting them to encourage others to investigate this phenomenon."
That's just what Copeland - and Robins - would propose: a deeper, and perhaps broader, look into the puzzle of homeopathy and the questions it poses about the nature of disease and healing.
• Gregory M. Lamb writes about healthcare and technology for the Monitor.
