Bittersweet: Homeopaths insist they are trained diagnosticians and study subjects such as anatomy in a bid to ensure they recognise medical conditions and provide appropriate treatment. (Madelene Cronjé)

'Magic' vs science: Matter of choice

Joan Koka
Homeopathy may now be regulated but many remedies remain untested.

If you’re feeling ill, the chances are you’re making an appointment to see your general practitioner. But not *Sandra Yates, a mother of two from Durban. She calls her homeopath first.

"I think what some people don’t understand is that a homeopath is a doctor," says Yates, who did not want to give her real name. "In the same way that your general practitioner has studied, they understand the anatomy and the physiology and the symptomatic responses."

Homeopathy, a branch of complementary and alternative medicine, has worked for Yates and her family for well over eight years. The practice is based on the theory that "like cures like", meaning that an agent that produces a particular set of symptoms in a healthy individual can be used to treat the same set of symptoms in a sick person.

Not proven
"Based on conventional science, you just can’t prove it," says Andy Gray, a pharmacologist at the University of KwaZulu-Natal.

Most homeopathic medicines have not undergone randomised controlled trials – clinical studies that can prove cause and effect – unlike conventional medicines.

But homeopathy has persisted as a popular health alternative in South Africa and abroad despite the release of multiple studies and government reviews that have found such remedies to be no more effective than a placebo.

Australia’s National Health and Medical Research Council published one such review in March. After analysing more than 200 homeopathic studies, the council found that not a single homeopathic product was effective for the treatment of any health condition – and that "people who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness".

Along with questioning their efficacy, critics also question the safety of such products, given that the global market for complementary and alternative medicine remains largely unregulated. In South Africa alone, a "significant" number of complementary and alternative medicines do not have "well-established medicinal use with recognised efficacy and an acceptable level of safety", according to the Medicines Control Council.

Although aware of the scepticism, Yates says she trusts her homeopath and the process. Her children have not taken antibiotics thanks to homeopathic alternatives that "resonate" better with her.

"There was a part of me that did do a bit of research [on homeopathy] but I don’t know if it was necessary for me to go and unpack every little scientific explanation in order for me to buy into it," she says.

Perhaps the most controversial aspect of homeopathy is the belief that the more diluted a substance is, the more potent it becomes. Homeopaths perform serial dilutions with water or alcohol combined with succussion (vigorous shaking) to produce some of their remedies.

These solutions are often diluted to the point where no single molecule of the original substance remains, but homeopaths believe they still retain information related to the original substance that causes them to have a physiological effect, according to the British Homeopathic Association.

'Belief in magic'
The belief defies all the laws of conventional science and "is a belief in magic as far as pharmacologists are concerned", according to Gray. But for Yates, it all comes down to energy.

"I think that they’ve managed to harness or captivate energy in a bottle essentially," she argues.

Yates is one of thousands of clients who frequent the 200-plus registered homeopathic practitioners, according to the Homeopathic Association of South Africa, an industry-led association. The local industry is worth R7-billion, reports the National Health Alliance, another industry representative.

Prior to November 2013, when Minister of Health Aaron Motsoaledi amended legislation, the government had no regulatory system in place to evaluate alternative health products’ safety (See "Health businesses seek 'proper' regulations").

Without regulation, there was a "mesh of confusion", says Neil Kirby, the director of Werksmans, a law firm representing the Health Products Association of South Africa. Multiple bodies, including port health authorities and the Medicines Control Council, were trying to get complementary medicines under control, he says.

But with the new amendments, complementary and associated medicines are now controlled through the council. Products must be registered with it and producers must provide proof of safety and efficacy to complete registration. In addition, manufacturers and wholesalers must be licensed and comply with new labelling requirements that inform consumers that the product is "not intended to diagnose, treat, cure or prevent any disease" because it has not been clinically tested.

But industry associations, including the Health Products Association of South Africa, describe the new changes as vague, confusing and unconstitutional.

And, adds Gray, the amendments have largely not been followed.

Although certain countries, such as India, Taiwan and South Korea, have embraced the profession and integrated homeopathy into their healthcare systems, policymakers and scholars in some countries, most notably Britain and Australia, are challenging government support for homeopathic care and education.

In South Africa, homeopathic care is privately sourced, with select medical schemes, such as Discovery Health and Bankmed, providing limited allowances for homeopathic consultations and prescriptions. Meanwhile public funds from the National Skills Fund, which could be applied to any field of research study, are available to support those who choose to study homeopathy at the tertiary level.

Qualification
The Allied Health Professions Council of South Africa requires that aspiring homeopaths complete a five-year master’s degree from the University of Johannesburg (UJ) or the Durban University of Technology and be registered with the council to operate legally.

Each year, 60 to 100 students enrol in these programmes and pay between R20 000 and R28 000 a year in course fees.

Gray says he does not believe government subsidies should be given to students studying homeopathy because of the lack of sufficient evidence of its efficacy, but he stops short of denouncing the practice.

"As long as [homeopathic] products can be proven to be safe or harmless, and they treat a condition which is self-limiting or doesn’t require effective treatment, then it’s up to people to spend the money as they see fit," he says.

But Neil Gower, a practising homeopath and lecturer at UJ, says the existence of university-level training "feeds into a system that regulates the profession and ultimately protects the public".

"If you look around the rest of the world, there’s always a need or demand from patients, whatever percentage of the population they are, to consult complementary practitioners or traditional practitioners," he says.

"What South Africa has been successfully able to do is get education standards in place such that, when [practitioners] are consulted, they are of pretty high quality."

Homeopaths are trained diagnosticians first and foremost, Gower says. At university, students receive medical training on evidence-based topics such as anatomy, physiology, chemistry and biosciences. Such training enables them to recognise conditions and identify whether they need conventional treatment or can be treated homeopathically, Gower says.

Both Gray and Gower agree that choosing to enter the field of homeopathy or using alternative products comes down to consumer choice.

But Gray says the government still has a vital intermediary role to play.

"Let people know what it is they’re buying and if they wish to spend their money, then that’s fine," he says. "But let’s not forget that the government also has an obligation to protect the public against anyone who makes claims that are dangerous or untrue."


Health businesses seek 'proper' regulations

The Health Products Association of South Africa (HPASA), which re-presents more than 100 alternative health businesses, is waiting for a response from the Pretoria high court regarding a ­petition it submitted to the court last year to protest at legislative amendments that Health Minister Aaron Motsoaledi introduced in November 2013.

According to the amendments, homeopathic medicines and other complementary and alternative medicines are now classified as "category D" medicines under the Medicines and Related Substances Act.

This means that these medicines are now subject to control by the Medicines Control Council (MCC) – previously no regulation was in place.

Some of the new rules are:

  • Complementary and alternative medicines that claim they can treat, diagnose or modify HIV, Aids, diabetes, hypertension and cancer must first be evaluated by the MCC – such medicines may have to undergo clinical trials;
  • Those classified as "anti­viral agents, oral hypoglycemic medicines, cardiac medicines, or ­cytostatic agents" should have been registered with the MCC since May 2014 – this would require manufacturers to provide proof, which could range from literature reviews to evidence from clinical trials;
  • Immune boosters and sports supplements that make medical claims and/or contain more than the recommended limit of vitamins or minerals must be evaluated by the MCC by May 2016; and
  • Products containing scheduled or "banned" substances, including yohimbine, damiana, kava kava and apiol, must be withdrawn immediately.

Neil Kirby, the director of Werksmans, the law firm re-presenting the HPASA, says the association is not altogether opposed to regulation, but rather is seeking regulation that is more "sensible, proper and constitutional".

"The HPASA argues that the regulations are unworkable and will cost the industry billions of rands," he says. 

*Not her real name.

Joan Koka is a master’s student from the University of Missouri, Columbia. She is an intern with the Mail & Guardian’s health journalism centre, Bhekisisa

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