homeopathy is enigmatic, uniquely, it traces its intellectual ancestry to the European enlightenment – the same intellectual source as modern western scientific medicine. Its founder, Samuel Hahnemann was steeped in enlightenment values, even to the extent of writing the highest ideal of Enlightenment thought, rationalism, into the title of his magnum opus the Organon der rationellen Heilkunde. He strongly held the enlightenment view that knowledge is not innate, but comes only from observation guided by reason, insisting that: ‘The pure, characteristic, curative virtues of medicines cannot be apprehended by specious a priori sophistry, or from the smell, taste or appearance of the medicine, or from chemical analysis.’

1. Wiener Medizinische Wochenschrift
Printed in Austria
Homöopathie und „Mainstream“-Medizin:
Ein Dialog unter Schwerhörigen?
Zusammenfassung. Es existieren verschiedenste
Definitionen für komplementäre und alternative Medizin.
Homöopathie ist unter diesen Therapien einzigartig durch
ihren Ursprung im Gedankengut der Europäischen Aufklä-
rung. Sie ist kontroversiell und wissenschaftlich nicht plau-
sibel, dabei aber populär, weit verbreitet und langlebig.
Das führt zu einem seit langem anhaltenden „Dialog un-
ter Schwerhörigen“ mit wenig Fortschritt oder eigentlicher
Diskussion.
Klinische Zusammenarbeit und ernsthafter wissen-
schaftlicher Diskurs über Homöopathie ist möglich und
sollte verfolgt werden. Die Alternative wäre nicht, dass die
Homöopathie verschwände, sondern dass sie in eine ab-
gelehnte medizinische Subkultur aufginge mit ungünsti-
gen Konsequenzen, insbesondere für Patienten. Das Ro-
yal London Homoeopathic Hospital entwickelt die klini-
sche Integration und wissenschaftliche Zusammenarbeit
im Rahmen eines großen akademischen Medizinzentrums
in London.
Schlüsselwörter: Homöopathie, Rationalismus, In-
tegration.
Summary. Various definitions of complementary and
alternative medicine have been proposed. Homeopathy is
unique among CAM therapies in originating in European
Enlightenment thought. It is controversial and scientifically
implausible yet popular, widespread and durable. The re-
sult has been a longstanding ‘dialogue of the deaf’, with
little progress or genuine discussion.
Clinical collaboration and serious and scientific dis-
course concerning homeopathy is possible and should be
pursued. The alternative is not that homeopathy disap-
pears but that it is absorbed into a disaffected medical
counterculture with adverse consequences, particularly for
patients. The Royal London Homoeopathic Hospital is de-
veloping clinical integration and scientific collaboration
with a major academic medical centre in London.
Key words: Homeopathy, rationalism, integration.
Complementary and alternative medicine (CAM) is an
heterogeneous group of therapies, several lists of CAM
therapies exist, including those of the US National Cen-
ter for Complementary and Alternative Medicine
(NCCAM) [1], and of the British House of Lords [2].
Such lists broadly agree on which therapies constitute
CAM, however the question of what it is that unites these
very disparate therapies is much more difficult. A prag-
matic and easy to operationalise definition is that of Ei-
senberg et al: ‘Interventions neither taught widely in
medical schools nor generally available in US hospitals’
[3]. But this definition is unsatisfactory, apart from being
specific to the USA (although easily adapted), applying
it does not generate a list which corresponds to the lists
of CAM therapies mentioned above. For instance, acu-
puncture, universally classified as a CAM therapy, is
widely used in hospital pain clinics throughout Europe.
A less helpful definition is given by Dawkins, a dis-
tinguished evolutionary biologist who is particularly hos-
tile to homeopathy, who defines alternative medicine as
‘that set of practices which cannot be tested, refuse to be
tested, or consistently fail tests’ [4]. But by this criterion
many surgical, psychotherapeutic, physiotherapy and
other procedures would count as ‘alternative’ while sig-
nificant components of what is generally agreed to be
CAM, would not.
The most satisfactory definition is that of the Co-
chrane Collaboration ‘A broad domain of healing resour-
ces that encompasses all health systems, modalities, and
practices and their accompanying theories and beliefs,
other than those intrinsic to the politically dominant
health systems of a particular society or culture in a given
historical period.’ Although clumsy, this is the best defi-
nition, since its application yields a list which closely ap-
proximates to those identified as CAM by NCCAM, The
House of Lords and other bodies.
It is illuminating to consider homeopathy in the light
of this definition. CAM practices may be ‘outsiders’ to
Homeopathy and mainstream medicine: a dialogue of the deaf?
Peter Fisher
Royal London Homoeopathic Hospital, London, United Kingdom
Received August 31, 2005; accepted September 22, 2005
© Springer-Verlag 2005
Wien Med Wochenschr (2005) 155/21–22: 474–478
DOI 10.1007/s10354-005-0226-9
Correspondence: Peter Fisher, Clinical Director and Director
of Research, Royal London Homoeopathic Hospital, Great
Ormond Street, London WC1N 3HR, U.K.
Fax: +44-20-739118829
E-mail: peter.fisher@uclh.nhs.uk

2. Fisher, Homeopathy and mainstream medicine
the dominant health systems for various reasons: some
originate in cultures other than that which currently pre-
vails in the West – these include Traditional Chinese
Medicine, Acupuncture and related methods, and Ayurv-
eda. Others originate in different times: there are many
different local traditions of phytotherapy or herbal med-
icine rooted in their respective regional floras, but all are
historically embedded in folk culture. From the perspec-
tive of the modern Western scientific paradigm they are
prescientific. Osteopathy and chiropractic both originated
in late 19th
century North America, and are based on spe-
cific anatomical concepts.
But homeopathy is enigmatic, uniquely, it traces its
intellectual ancestry to the European enlightenment – the
same intellectual source as modern western scientific
medicine. Its founder, Samuel Hahnemann was steeped
in enlightenment values, even to the extent of writing the
highest ideal of Enlightenment thought, rationalism, into
the title of his magnum opus the Organon der rationellen
Heilkunde. He strongly held the enlightenment view that
knowledge is not innate, but comes only from observa-
tion guided by reason, insisting that: ‘The pure, charac-
teristic, curative virtues of medicines cannot be appre-
hended by specious a priori sophistry, or from the smell,
taste or appearance of the medicine, or from chemical
analysis.’ [5].
He went on to develop ‘provings’, an infelicitous
translation of the German Prüfung, more accurately
known as homoeopathic pathogenetic trials (HPT) [6]. In
an HPT a substance of interest is given to healthy volun-
teers and their symptoms recorded. Homeopathy was the
earliest example of a form of medicine which aspired to
base its practice on clinical trials; although Hahnemann’s
original HPTs were uncontrolled, the first double blind
placebo controlled homeopathic proving was conducted
in 1835, and was one of the first double blind placebo
controlled trials in the history of medicine [7]. The ho-
meopathic literature contains some of the earliest exam-
ples of multi-centric clinical trials [8]. Apart from ration-
alism Hahnemann also shared other enlightenment values
including anti-clericalism (he was a Freemason) and hu-
manism: a contemporary of Pinel he strongly condemned
the chaining and beating of ‘lunatics’, advocating instead
‘humanity combined with firmness’ [9].
Yet this common intellectual ancestry has certainly
not lead to an acceptance of homeopathy by those who
regard themselves as the guardians of the Enlighten-
ment’s intellectual heritage. Homeopathy has recently
been denounced as the ‘pons asinorum of attitudes to
complementary medicine’ (meaning, apparently, that any-
one who does not reject it a priori is an ass), the epitome
of ‘unreason’ in medicine, and generally the antithesis of
Enlightenment values [10]. The paradox is most clearly
seen in the homeland of the Enlightenment, France,
where lifetime use of homeopathy among the general
population is about 40 % (the highest in the world) [11],
and some 25,000 of 200,000 doctors use homeopathic
medicines [12], but where homeopathy is excluded from
secondary care and the Academie de Medicine has re-
cently (but unsuccessfully) demanded that its reimburse-
ment by social security cease.
The pattern is similar elsewhere, public popularity in
several European countries is not much lower than in
France [13], elsewhere there has been a rapid growth in
its popularity: in the USA public use of homeopathy rose
by 500 % in a seven year period in the 1990’s [14]. Yet
in all these countries homeopathy is in various ways and
to different degrees marginalised. It is worth noting that
homeopathy is also very popular in countries which do
not share the European intellectual tradition: there are
over 120,000 homeopathic practitioners in India, and it is
popular throughout the subcontinent.
It is not the purpose of this article to review the pri-
mary research evidence on homeopathy: this has been
systematically reviewed and meta-analysed [15–17], dis-
cussed and criticised of elsewhere [18–20]. Reports of
high-quality basic research [21, 22]; and debates concern-
ing its mode of action [23, 24] have also been published.
Some recent clinical trials have not so far been included
in meta-analyses, one of particular interest was conduct-
ed in an intensive care unit in Vienna, on critically ill pa-
tients, with a positive result [25], another examined the
effect of homeopathy in attention-deficit hyperactivity
disorder [26]. A recently published large scale primary
care outcome study conducted in Germany suggested that
patients seeking homoeopathic treatment had a better out-
come overall compared with patients on conventional
treatment, for similar costs [27].
On the other side a meta-analysis recently published
in The Lancet [28], was accompanied by an editorial pro-
claiming the ‘end of homeopathy’ and calling for the ces-
sation of research investment in research on homeopathy
[29]. The meta-analysis found eight trials of homoeopa-
thy for acute infections of the upper respiratory tract, the
pooled effect indicated a substantial beneficial effect and
there was no convincing evidence of bias. However, the
authors do not accept these findings because ‘the biases
that are prevalent in these publications, as shown by our
study, might promote the conclusion that the results can-
not be trusted’.
The references cited are not comprehensive or sys-
tematic, but are intended to give a flavour of the debate.
They demonstrate that serious scientific discourse on ho-
meopathy is possible, yet this discourse is frequently in-
audible above a dialogue of the deaf, in which proponents
and opponents of homeopathy shout at each other, but do
not listen.
My intent is to examine the origins, consequences
and possible solutions to the sharp polarisation of opin-
ion concerning homeopathy. This debate is not new,
Hahnemann himself fired one of the opening shots when
he accused his medical contemporaries of ‘killing gradu-
ally more millions than Napoleon ever slew in battle’
[30]. Contemporary conventional doctors retaliated, al-
though on grounds which now seem surprising, accusing
the homeopaths of empiricism [31].
The root of much of the disagreement is the use, by
homeopaths, of extremely dilute medications, including
‘ultramolecular’ dilutions (diluted beyond the point at
which they contain any molecule of the starting sub-
stance). From time to time, the allegation is made that for
such preparations to have any activity would violate fun-
damental scientific principles, although to my knowledge
475

3. Fisher, Homeopathy and mainstream medicine
the violation of only one specific natural law (the Law of
Mass Action) has ever been proposed in a peer-reviewed
journal [32], this claim was made only once and never
repeated. In fact if the leading hypothesis on the action
of homeopathic medicines, the so-called information hy-
pothesis [33] is correct, the claimed activity of these
medicines no more violates any fundamental natural law
than does the storage of information by a video tape or
floppy disk! This is not the only hypothesis concerning
the actions of high dilutions, and all the hypotheses are
currently largely speculative. Nevertheless it is clear that
basic scientific principles do not preclude the possibility
that these preparations could have activity.
Safety is an important factor motivating patients to
seek homeopathy, in a survey of 500 patients attending
our hospital, 40 % reported that safety considerations
were an important factor in their decision to seek home-
opathic treatment, satisfaction ratings were high [34]. Pa-
tient confidence in the safety of homeopathy seems jus-
tified, while there are challenges relating to under-report-
ing and mistaken identity (herbal medicines identified as
homeopathic), direct risks resulting from the use of ho-
meopathic medicinal products seem to be extremely low
[35].
A national ‘snapshot’ study of homeopathic practice
in Belgium showed a similar pattern, but highlighted a
more disturbing aspect: it appears that many patients
seeking homeopathic treatment were deeply disillusioned
with previous conventional treatment, much more satis-
fied with homeopathic treatment. It has often been
claimed that the effects of homeopathic treatment are at-
tributable to longer consultations, but according to this
survey only a small part of the dissatisfaction was attrib-
utable to length of consultation [36]. An influential book,
written by a doctor, which paints a pessimistic picture of
the future of medicine seems to be alluding to the same
problem: “these alternatives are more than just ‘feel-
good therapeutics’…following the discovery of cortisone
and other anti-inflammatory agents, the skills of rheuma-
tologists devolved around juggling various toxic regimes
of drugs in the hope that the benefits might outweigh the
sometimes grievous side-effects. Meanwhile all the other
therapies for rheumatological disorders…were aban-
doned virtually wholesale only to be rediscovered by al-
ternative practitioners in the 1980s” [37].
Many patients and homeopathic practitioners (in-
cluding some doctors) are convinced that ‘school’ medi-
cine and science is irreversibly prejudiced against home-
opathy. This has lead them to abandon the rationalist ap-
proach entirely, in favour of metaphysics, in an extreme
case, for instance advocating the use of Berlin Wall and
even Saddam Hussein palace (!) as remedies for ‘life ex-
periences of oppression, depression, repression or sup-
pression’ [38].
The tension between generally favourable public at-
titudes and high levels of use and generally sceptical
medical and scientific attitudes has resulted in homeopa-
thy becoming increasingly absorbed into a disaffected
and disenfranchised medical counter-culture, with signif-
icant adverse consequences. The most important is on im-
munisation; homeopathy is the reason most frequently
cited by British parents who refuse immunisation for
their children [39]. Some practitioners of homoeopathy
attribute a wide range of adverse effects to childhood im-
munisation [40]. Ironically Hahnemann was unequivocal
and forceful in his support of vaccination: ‘...the remark-
able and salutary result of the widespread use of Jenner’s
cowpox vaccination. The smallpox has not since then ap-
peared among us with such widespread virulence. Forty
or fifty years ago, when a city was stricken, it lost at least
half, often three-quarters of its children [41]. This prob-
lem appears to be particularly acute in the UK, as a con-
sequence of two main factors: the British health care sys-
tem is state-controlled and relatively centralised, as a re-
sult the public demand for homeopathy is underprovided.
The practice of homeopathy is unregulated in the UK:
anyone may style themselves a homeopath, there is no
mandatory requirement for training, registration etc, and
such practitioners meet the demand. As a result, in the
UK homeopathic practitioners who are not members of a
registered profession now considerably outnumber those
are. The UK Faculty of Homeopathy, which admits only
legally recognised health professionals, firmly supports
childhood immunisation [42].
Homeopathy is geographically widespread, popular
and remarkably durable; it is also scientifically implausi-
ble and continues to attract fierce attacks from the med-
ical and scientific community, as it has throughout its his-
tory. There is a dialogue of the deaf, in which both sides
shout, but neither listens, resulting in a deadlock whose
basic form has been remarkably stable for 150 years, de-
spite the dramatic changes in medicine and society sur-
rounding it. There are significant adverse consequences
for public health; and for patients who are obliged to in-
vidious choices between therapies, or to conceal from
their doctors that they are receiving homeopathic treat-
ment (as many do). There are also adverse consequences
for doctors who wish to practice homeopathy or consider
doing so. There are also dangers for homeopathy itself,
including the risk of being swept from its rationalist
moorings.
There is no doubt that many people in many parts of
the world believe homeopathy to be helpful for their
health needs. The question of whether such effects are
mediated through specific or non-specific or even
whether such concepts are meaningful in the context re-
mains open, and scientific investigation is at an early
stage. However there has been a significant amount of
good quality scientific work, with positive results. if
these results are confirmed, they pose fascinating scien-
tific questions. The often-repeated claim that homeopa-
thy is ‘only a placebo response’ is not supported by meta-
analyses. Homeopathy would be unique in persisting for
such a long period, spreading so widely, and achieving a
complex but stable form if it were based only on manip-
ulation of non-specific effects of treatment.
Progress will be achieved by recognition on the sci-
entific and medical side that science is not a set of con-
clusions, but a method of investigating natural phenom-
ena, based on observation; the fact that we do not cur-
rently understand how it could work, does not preclude
the possibility that it does. On the side of homeopathy a
reaffirmation of its rational and humanistic roots is re-
quired. Only in this way can the longstanding dialogue
476

4. Fisher, Homeopathy and mainstream medicine
of the deaf be replaced by a genuine dialogue in which
both sides listen as well as express themselves. The al-
ternative is not that homeopathy disappears, it has shown
little inclination do so for the last 200 years despite fierce
criticism, but that it becomes part of a disaffected, disen-
franchised medical counterculture to the detriment, above
all, of patients.
The Royal London Homoeopathic Hospital (RLHH)
is pursuing clinical integration and scientific collabora-
tion, it is part of the National Health Service (i.e. a pub-
lic hospital), and since 2002 has been part of University
College London Hospitals (UCLH). UCLH is a large ac-
ademic medical centre with a medical school, and close
links to a university and several major specialist medical
institutes. Despite its title the RLHH provides a range of
CAM therapies, not only homeopathy. Services are or-
ganised in terms of groups of conditions and patients the
main clinical services include: complementary cancer
therapy, allergy and environmental medicine, stress and
mood disorder, musculoskeletal and rheumatology, der-
matology, general medical, women’s and children’s clin-
ics. In each of these clinics a range of therapies likely to
be appropriate to the conditions encountered, is provided.
Therapies include homeopathy, acupuncture, spinal ma-
nipulation, Iscador and nutritional medicine. We are cur-
rently developing a range of integrated services bringing
together conventional physicians and therapists with phy-
sicians and therapists using CAM techniques: these in-
clude an integrated pain, antenatal and allergy services.
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