Without any scientific proof of their effectiveness, homeopathic remedies are highly disputed in Europe. With budgets strained, politicians are questioning whether the alternative treatments should be covered by state insurance systems.
It was the kind of humor that the British love. In several cities across the country, mostly young crowds marched into their local branches of the drug store Boots. Each purchased a small bottle of the homeopathic remedy Arsenicum album, which is used in the treatment of anxiety and food poisoning.
At 10 a.m., they all opened their bottles, full of remedy globules. One man wearing a hat shouted out that he was sacrificing himself for the sake of science. On command, the entire crowd began swallowing the globules -- not two or three of the small pills, but the entire bottles. "Mmm, delicious," some said. Others just laughed.
But nothing happened. And that was exactly what the demonstrators had hoped to prove. Not a single member of the "Overdose" Campaign documented on the website www.1023.org.uk, was poisoned or injured in any way.
The campaign had been organized by a network of British homeopathy skeptics. "We wanted to show that homeopathic globules contain absolutely nothing but sugar," said co-organizer Simon Singh, a former BBC journalist and author of the book "Trick or Treatment," which has become the standard of critical books on the use of alternative medicines.
For months now, a bitter battle has been taking shape in Great Britain between defenders of homeopathy, who are supported by no less than Prince Charles, and detractors who point to the lack of scientific evidence that the remedies offer anything more than a placebo effect. The royal family themselves have been adherents to homeopathy for generations and even Queen Elizabeth is given homeopathic remedies. After the war, her father King George VI even saw to it that Britain's National Health Service (NHS), the country's subsidized healthcare system, picked up the tab for homeopathic treatments.
Homeopathy is based on two fundamental ideas that skeptics like Singh can only shake their heads at. The first is the idea of the law of similars. The inventors of homeopathy believe that the cause of a symptom should also be treated with the cause. When treating someone, a homeopath considers which substance would cause the same symptoms in a healthy person. Arsenicum album, for example, which the activists in the campaign tried to overdose on, should in theory cause restlessness and nausea in a healthy person. But in an ill person, it is supposed to heal exactly these symptoms. If a patient has a fever, then a homeopath will look for a substance than can cause a fever in a healthy person.
Shaken and Diluted
The second principle is that of dilution: The more a medical ingredient is diluted and shaken, the stronger its effect will be -- at least that's the assumption. But most homeopathic substances are so strongly diluted that molecules of the active ingredient can no longer be traced. Homeopaths still believe in the effects because they are convinced the water has a "memory." Scientific proof for the claim is wanting.
At a time when British patients are forced to wait as long as two weeks for simple operations like appendectomies and when expensive medications are often rejected, many are asking why the government continues to pay for treatments whose effectiveness hasn't been proven.
In a comprehensive report released in February, Britain's House of Commons concluded that, "to maintain patient trust, choice and safety, the government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS." Several months later, the British Medical Association decried homeopathy as "witchcraft" in a resolution agreed to by hundreds of doctors belonging to the group, which represents the interests of more than 140,000 doctors across the country. So long as there is no scientific proof of its medical effectiveness, then homeopathy should no longer be covered, the doctors argued.
Critics don't need to dig very deep into the cannon of homeopathic literature to find fodder to feed their arguments. A quick look through the "Handbook of Materia Medica," uncovers a list of odd homeopathic agents: Aphids, ovary extract from cows, hornets, cockroaches, woodlouse, toad poison, mercury, saliva from rabid dogs or skunk secretion. You'll even find Coca-Cola, rotten beef, canine excrement, condom rubber, human testicle extract and horse hair in the lists.
The practice of homeopathy was first invented in the early 19th century by Samuel Hanemann of Germany. At a time when "traditional" medicine called for bloodletting, enemas and similarly dangerous methods that were painful to patients, did little to help them and could even lead to death, it was considered real progress. Centuries later, Hanemann's ideas would be taken up by the Nazis, with a World Congress on Homeopathy taking place in Berlin in 1937. Eventually, even the Nazis turned away from the alternative therapy, seeing it as nothing more than a placebo.
In times of economic uncertainty, austerity measures and generally tight budgets, experts in Britain and elsewhere in Europe are questioning whether national health care systems should continue to foot the bill for alternatives to traditional medicine like homeopathy if their usefulness hasn't been backed by science.
'A Speculative, Refuted Concept'
Rainer Hess, the chairman of the Federal Joint Committee, a body in Germany that determines which medications will be covered by the state health care system, says that even though homeopathy hasn't been scientifically proven, Germany's government-subsidized health care system is nevertheless required to reimburse patients who seek homeopathic treatments. Hess describes the situation as "extremely dissatisfactory." He says numerous efforts have been made to eliminate payment for visits to homeopaths, but that "influential politicians have always hindered these efforts."
Jürgen Windeler, who is to begin his role on Sept. 1 as the head of the Institute for Quality and Efficiency in Health Care, the independent scientific institute in Germany that is the country's highest medical investigator, has followed homeopathy for years. "Homeopathy is a speculative, refuted concept," he says -- no one has yet proven that it has any medical benefit. "And there isn't any need for any further research," he says. "The issue is settled."
While many medical experts dismiss the theories behind homeopathy as pure hocus pocus, it has long since become a mass movement in Germany. It is championed by a number of celebrities in the country, too. Fashion designer Karl Lagerfeld, for example, claims to have lost 42 kilograms with the help of homeopathy. Doris Schröder-Kopf, wife of former Chancellor Gerhard Schröder, served as the honarary patron of the Homeopathic World Medical Congress this year. Renate Künast, who heads the Green Party in the German parliament, promotes the treatments. And even philosopher Peter Sloterdijk praises homeopathy as "plausible and unbelievable in how mysterious and effective it is."
A recent survey by pollster Allensbach found that 57 percent of Germans have taken homeopathic remedies at some time or other, and 25 percent consider themselves to be "convinced users."
Distrust of Traditional Medicine
But contemporary Germany has become a lot less esoteric than it was in the 1970s and 1980s, when the New Age movement gained ground with academics. Nevertheless, homeopathy is well-established, and many attribute it to the coldness and technological obsession that permeates traditional medicine. Many doctors spend as little as five minutes with their patients, thinking they have done their job once they have placed a prescrition in their hands. A June survey by the German medical magazine Deutschen Ärtzeblatt found that only 34 percent of people in the country described health care here as "very good" or "excellent."
No wonder, then, that alternative healing methods are booming. It would be difficult to find a pharmacy in Germany today that isn't stocked with homeopathic remedy globules. More than 3,000 pharmacists in the country have been trained in homeopathy, according to the Federal Union of German Associations of Pharmacists. Doctors have also sought to profit from the boom: 6,712 of them now carry the official title of "homeopath." It's a figure that has tripled since 1993, says the German Medical Association.
The industry has also become firmly entrenched in the German health care system -- and it would be hard to conceive of its absence. More than half of all the public-private health insurance companies that are part of the country's national health care scheme provide coverage for homeopathy, despite of the fact that visits with homeopaths are more time consuming and expensive than those with regular doctors. Many of these insurance companies defend coverage of homeopathy even as they teeter on the verge of bankruptcy.
But German politicians are starting to openly question the expenditure. Karl Lauterbach -- a prominent voice in the German health care debate, and the parliamentary expert for the opposition Social Democrats in federal parliament -- has heavily criticized coverage of the treatments. "Many patients believe that their insurance only pays for things that have been proven to help," he says. This leads many patients to believe that serious illnesses like high blood pressure and cancer can also be treated homeopathically.
Lauterbach accuses the insurance companies of using homeopathy for marketing purposes, arguing that they don't even believe in it themselves. He argues that the science cannot be ignored and that the laws should be changed. "Public insurance companies should be banned from paying for homeopathy," he says.
The SPD politician's counterpart in Chancellor Angela Merkel's conservative Christian Democrats, Jens Spahn, approached Lauterbach this week, noting that parliament's approved homeopathic treatments in the past has been based on the express desire of the Social Democrats and Green Party, and that his party "was ready to talk immediately" if they were prepared to make a change.
'It May Begin with Homeopathy, But Where Will It End?'
However, Germany's smaller political parties have expressed their opposition to changes in the law. German Health Minister Philipp Rösler of the business-friendly Free Democratic Party, Claudia Roth of the Greens and Johannes Singhammer of the Christian Social Union (CSU), the Bavarian sister party to Merkel's Christian Democrats, are all calling for the status quo to be maintained. Singhammer argues: "It may begin with cuts in homeopathy, but where will it end?" And Roth points to the tendency of people who practice homeopathy to lead healthier lifestyles.
In these lean times, both Merkel's CDU and the SPD are looking for ways to reform an ailing and expensive health care system and areas where money can be saved by cutting unnecessary treatments.
For their part, insurers like Germany's Technischer Krankenkasse (TK) say that offering alternative treatments like homeopathy allow them to attract precisely the kind of higher-earning customers they need to make a health care system based on the principle of solidarity function.
"Around one-fiifth of our 42,500 insured customers earn enough money that they could switch to a private insurance company if they wanted," TK spokesperson Hermann Bärenfänger says. "If we want to keep these people in the public health insurance system, then we have to offer them something."
It's exactly those high earners who are most needed by the public health insurance companies. They pay in the highest monthly contributions and they get sick the least. At the same time, they also place the greatest demands on the services provided by insurers, says Bärenfänger. Among their demands: homeopathy.
It also costs TK relatively little to provide the services. Last year, Bärenfänger says, a mere 0.5 percent of those insured by TK took advantage of homeopathic treatments. He says the negative publicity the elimination of homeopathy would create would be far more expensive for his company.
A Visit with One of the Country's Leading Homeopaths
Curt Kösters is one of Germany's most well-known homeopaths. Up until a few weeks ago, he served as the head of the German Central Association of Homeopathic Doctors, making him something like Germany's leading homeopath.
A mother recently brought her six-year-old daughter for a visit to his clinic in Hamburg. Homeopathy, according to a poll by Allensbach, is most popular in Germany with women between the ages of 30 and 44 who, in states like Bavaria and Baden-Württemberg live in households with above average income. Emilie's mom fits perfectly into this group.
The shelves in Köster's office are lined with bottles of homeopathic globules. Emilie sits, seemingly bored. Her mother, a 45-year-old teacher, reports extensively to Kösters about her daughter's condition. In recent weeks, she says her daughter has been fretful and that she has also been having trouble with bloody noses. She's also been drinking little. In the morning, she has slight halitosis, and a few weeks ago she ran her head against a wall and caused bleeding. When its hot in the car, she says, Emilie is prone to get headaches. At night, she ads, her daughter is a little fearful, wound up and insists on going to sleep with the light on.
Any non-expert would likely see nothing more than a healthy little girl. But the homeopathic treatment is far from finished. A typical appointment lasts longer than an hour per patient.
Kösters asks Emilie what she dreams about and a number of other questions, jotting down extensive notes that take up several pages. In the end, he says that Emilie is slightly under the weather. He turns around, opens one of the globule bottles on the shelf and sticks them into the girl's mouth.
'Really Does Bear Fruit'
At the end of the session, everyone is happy. Emilie, because she will get a treat for coming with her mother. Her mother because she has had the opportunity to really explain her daughter's problems to someone and Kösters, who can charge 113.50 for the appointment. If Emilie's mother had gone to a normal pediatrician, she would have been whisked out the door after about five minutes without anything. "The treatment here is a lot better and I feel a lot more recognition," the mother says. "That builds trust."
Proponents of homeopathy note that the amount of time spent with patients can help to uncover or even prevent more serious health problems through the lengthy discussion of symptoms and what may be causing them. In addition, homeopaths comprehensively query patients about their lifestyles and nutritional habits -- all lines of questioning that can have positive knock-on effects. In many cases, the extensive analysis can help to prevent the need for expensive medicines and further tests. And often enough, further treatment isn't required because the consultation leads to a lifestyle change in the patient.
Köster himself admits that he doesn't have any explanation for why homeopathy works. Chemically, he says, it is implausible. But he says the sum of positive experiences he has had have convinced him that "homeopathy really does bear fruit."
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