The placebo effect, say the critics; people believe they are getting a real medicine so they think themselves into feeling better. And, said William Jarvis, president of the National Council Against Health Fraud in Loma Linda, never discount the positive psychological role of a good doctor-patient relationship. He added that most people who see homeopaths have ailments that naturally improve over time. Since it can take months for the homeopath to find the "correct" remedy, the illness often gets better on its own. Also, Jarvis contended that some homeopathic remedies may be adulterated with therapeutic doses of standard drugs, since there is at least one documented case to that effect.
Homeopaths counter that people come to them because homeopathy works. A placebo would not work on unconscious people, infants or animals, they say, but homeopathic remedies do.
"If the critics believe so strongly that placebo and relationships are responsible for homeopathic cures, then why don't they use those to treat their own patients instead of continually plying them with expensive drugs that have side effects?" asked Shevin, the president of the National Center for Homeopathy. "If they applied all these criticisms to their own methods, they would find themselves at great fault as well."
Homeopaths also point to studies in which homeopathic remedies outperformed placeboes. Critics say many studies are flawed. But in a recent issue of the British Medical Journal, two initially skeptical scientists analyzed the quality of 107 studies and concluded that there is enough good evidence to at least justify continued research.
Homeopathy's recent upswing owes less to science, though, than to politics. Much to the critics' chagrin, for example, the Food and Drug Administration has never required proof of safety and efficacy for homeopathic drugs--a requirement that could well run homeopathic companies out of business in the United States. According to a 1988 FDA paper, homeopathic remedies are exempted from federal review by the 1938 Food, Drug and Cosmetic Act, which was shepherded through Congress by New York senator and homeopath Royal Copeland.
But Daniel L. Michels, director of the FDA's Office of Compliance in the Center for Drug Evaluation and Research, believes that the FDA does indeed have the authority to review homeopathic drugs.
In fact, he says, the FDA may consider an efficacy review for homeopathic, over-the-counter remedies in several years, after it completes its review of other over-the-counter medications. But even then, other priorities, such as speeding up new drug applications for AIDS drugs, will probably take precedent. Evaluating homeopathic drugs "is not on our immediate plate and I'm not certain when it will be," Michels said.
Homeopathy also faces little organized opposition from conventional doctors. The American Medical Assn., which in its early years worked staunchly to squelch homeopathy, is now resoundingly silent on the subject. Renner said that since it lost a costly antitrust case to the chiropractors, the AMA has shied away from commenting on alternative medicine.
Certainly the AMA is keeping a close watch on events in North Carolina, where the Board of Medical Examiners has moved to revoke the medical license of homeopath Dr. George Guess on the grounds that homeopathy is not an acceptable and prevailing medical practice. The move was recently upheld by the North Carolina Supreme Court, but this summer the American Civil Liberties Union filed suit against the board on behalf of Guess and his patients.
Individually, most doctors don't condone homeopathy--if they even know what it is. But some have softened their resistance and a few are testing the waters. Dr. Gershon Lesser, a Los Angeles physician and host of a radio talk show called The Health Connection on KCRW-FM and KGIL-AM, invited Dr. Ronald W. Davey, Queen Elizabeth's homeopath, to speak for 10 minutes on his show. But Lesser extended Davey's time to 1 1/2 hours because the show was swamped with calls. "There are enough people who seem interested in homeopathy for us to at least take a look," Lesser said. "I'm beginning to feel that homeopathy does play a complementary role."
It doesn't surprise Renner that some physicians are attracted to homeopathy. "I'd guess that 1% to 3% of MDs have a learning disability as far as good science is concerned," he said. But what worries him more is that maverick physicians and the public will treat homeopathy as a ticket to more extreme quackery. "If you can get someone to believe in homeopathy, the next thing they're into is crystals, coffee enemas, hair analysis and Mexican cancer clinics. . . . If homeopathy is ever going to amount to anything it's got to totally separate itself from the rest of organized quackery."