[Update as of February 9: Georgian College has cancelled its homeopathy program.]
When academic institutions teach nonsense, students suffer the most – not only have they wasted their tuition, but they’ve wasted their time. Georgian College is a community college in Ontario, Canada with over 11,000 students. It recently announced plans to offer a three-year diploma program in homeopathy. This announcement has understandably raised questions from critics about Georgian College’s educational standards. That’s because homeopathy as a health practice is pseudoscience, where the “treatments” lack any medicine at all. It is the air guitar of medicine: It goes through the motions of health care, and looks a bit like medicine, but actually accomplishes nothing at all.
Science and evidence is the basis of medicine today
Evidence-based medicine is a (relatively) new model for health care delivery. Medicine was very different just 100 years ago. Formal medical education had varying standards before 1910. That changed when the American Medical Association commissioned Abraham Flexner to evaluate American and Canadian medical education and make recommendations on their improvement. Flexner was highly critical of the education standards he observed, and recommended consolidating schools, increasing education prerequisites, enhancing the scientific rigor, and embedding the role of research in education. Flexner was also highly critical of dubious “alternative medical practices” and recommended the closure of under-performing institutions that continued to offer education and training based on principles other than science.
The effects of the Flexner report on medical education and the practice of medicine (and affiliated health professions, like pharmacy) can’t be overstated. Medical education became grounded in a rigorous foundation of science, and schools abandoned unscientific practices like naturopathy, homeopathy, chiropractic, and osteopathy. The result is the medical education and the medical standards you see today. Of course, the purveyors and supporters of these now-rejected practices never fully disappeared. They retreated, regrouped, and fought back, continuing to seek the public legitimacy and credibility now offered to medicine and its related health professions. Over time, these practices became known “alternative” medicine, and eventually, “complementary and alternative” medicine (CAM). Today, CAM is often called “integrative” medicine. The branding of alternative medicine as “integrative” or “holistic” is a marketing tactic, but the reality hasn’t changed. There is still no need to adopt or accept practices into medicine that are not grounded in high-quality science, as this (still current) 1998 editorial pointed out:
There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is “Eastern” or “Western,” is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. We recognize that there are vastly different types of practitioners and proponents of the various forms of alternative medicine and conventional medicine, and that there are vast differences in the skills, capabilities, and beliefs of individuals within them and the nature of their actual practices. Moreover, the economic and political forces in these fields are large and increasingly complex and have the capability for being highly contentious. Nonetheless, as believers in science and evidence, we must focus on fundamental issues—namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy.
– Phil B. Fontanarosa & George D. Lundberd
Dilutions of grandeur: The history of homeopathy
I’ve discussed homeopathy several times before, and will refer curious reader here if you want more. Among all the forms of alternative medicine, homeopathy is possibly the most implausible of them all. Homeopathy is based on the idea that “like cures like”, in that a small dose of what causes a symptom can actually cure that symptom. Like-cures-like is simply sympathetic magic, a pre-scientific belief that was first described by anthropologist Sir James George Frazer in his 1890 book, The Golden Bough. In the book, Fraser outlined the two components of sympathetic magic:
If we analyse the principles of thought on which magic is based, they will probably be found to resolve themselves into two: first, that like produces like, or that an effect resembles its cause; and, second, that things which have once been in contact with each other continue to act on each other at a distance after the physical contact has been severed. The former principle may be called the Law of Similarity, the latter the Law of Contact or Contagion.
The so-called “Law of Contagion” underlies societal preoccupations with pseudoscientific ideas such as “detox” and “eating clean“. Sympathetic magic is the entire basis for the homeopathic belief system:
- Like-cures-like: in homeopathy, a substance that is believed to cause a symptom, is diluted to treat that same symptom. Any substance is thought to be an effective remedy if it’s diluted enough: cancer, boar testicles, crude oil, oxygen, skim milk, even vacuum cleaner dust or moonlight can be a homeopathic remedy. Deciding which substances will cure which symptoms is determined by a process called a “proving” which is equally without any scientific basis. (Here are homeopathic provings for the Berlin Wall remedy and also sunlight reflected off the planet Saturn, to give you an example of the how the remedies are created by homeopaths.)
- Water has a memory: the more you dilute the substance, the more powerful its effect. And when I say dilute, I mean dilute. The 30C “potency” is a common dilution used in homeopathy – that’s a dilution of 10-60. You would have to give two billion doses per second, to six billion people, for 4 billion years, to deliver a single molecule of the original, pre-diluted material. The result is that most homeopathic remedies are completely inert, and don’t contain a single molecule of what’s on the label. Whether bottled as a liquid or dripped onto lactose and sold as tablets, they are pure placebo.
Samuel Hahnemann invented the practice of homeopathy, based on the ideas of sympathetic magic, in the early 1800s. Hahnemann attempted to position homeopathy as a separate and more effective form of medicine compared to conventional medical practices. Given homeopathy is an elaborate placebo system, homeopathy probably was safer than medical practice at the time, which was still based around the idea of the four humors and was referred to as “heroic medicine” because of the dramatic treatments used and effects they caused. Eventually, germ theory emerged, ideas of humors disappeared, as did the elements of vitalism and magic, and medicine slowly turned towards a scientific model based on objective observations. Homeopathy, on the other hand, has never progressed or evolved based on evidence, because it was never based on evidence to begin with. Its practices today are frozen in the same beliefs from the 1800s.
Homeopathy is ineffective
Despite the implausibility of homeopathy, and its ejection from the practice of medicine, it retained some popularity over time, with a resurgence in the past few decades as an “alternative” medical system. Rigorous clinical trials confirm what basic science predicts: homeopathy’s effects are placebo effects. While there are plenty of clinical trials that show homeopathy is associated with positive clinical effects, they are always small, poorly controlled, and often biased. Two of the more recent comprehensive reviews of the evidence are the 2010 Evidence Check from the United Kingdom’s House of Commons Science and Technology Committee and the 2014 Australian National Health and Medical Research Council review, the latter of which made the following conclusion:
Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective.
Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. 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. People who are considering whether to use homeopathy should first get advice from a registered health practitioner. Those who use homeopathy should tell their health practitioner and should keep taking any prescribed treatments. The National Health and Medical Research Council expects that the Australian public will be offered treatments and therapies based on the best available evidence.
That’s not all. Edzard Ernst has compiled a list of twelve different statements on homeopathy from international or national organizations, all of which make a similar point: Homeopathy lacks plausibility, and has not been shown to be effective.
Georgian College’s homeopathy program
With this in mind, you might wonder how a post-secondary community college like Georgian College can possibly justify a three year diploma program what is essentially magical thinking. Yet it does:
The graduate has reliably demonstrated the ability to:
– practice in a professional and competent manner within the defined scope of practice and consistent with the current legislations and standards of practice;
– critically analyze and administer treatment using established homeopathic principles, theories and methodologies;
– select, formulate and dispense homeopathic medicines in accordance with homeopathic principles, practices and regulatory criteria;
– implement safe and effective client care and practice management consistent with the ethical and professional standards;
– integrate interdisciplinary knowledge for the effective provision of client care and promotion of interprofessional collaboration;
– communicate effectively in educating clients, families, the community and the broader healthcare field about the benefits and efficacy of homeopathy;
– provide respectful and culturally sensitive care to clients in the homeopathic clinical setting;
– implement and advocate environmental sustainability and best practices relevant to the profession;
– establish a plan for lifelong learning and professional development;
– apply entrepreneurial strategies to create and respond to new opportunities.
The entire three-year curriculum is posted:
BIOL1036 Human Health Systems and Biochemistry
BIOL2008 Human Pathophysiology
BUSI3007 Business Principles for the Regulated Professional
HLTH1005 Holistic Nutrition
HLTH1006 Holistic Nutrition and Lifestyle Management
HOMP1000 Foundations of Homeopathy
HOMP1001 Professional Practice and Jurisprudence
HOMP1002 Introduction to Materia Medica
HOMP1003 Introduction to Case Taking
HOMP1004 Homeopathic Repertory
HOMP2000 Materia Medica 2
HOMP2001 Physical Examination and Emergency Medicine
HOMP2002 Repertorization and Case Analysis
HOMP2003 Homeopathy Therapeutics 1
HOMP2005 Conventional and Herbal Medicines
HOMP2006 Materia Medica 3
HOMP2007 Homeopathic Dispensary
HOMP2008 Homeopathy Therapeutics 2
HOMP3000 Homeopathy Therapeutics 3
HOMP3001 Homeopathy Therapeutics 4
HOMP3002 Homeopathy Practice Management
HOMP3003 Environmental Medicine
HOMP3005 Contemporary Integrative Medicine
HOMP3006 Research Methodologies
HOMP3007 Preparation for Provincial Regulation
PSYL1001 Introduction To Psychology
HOMP1005 Clinical Observations
HOMP2004 Clinical Grand Rounds
HOMP2009 Clinical Case Management
HOMP3004 Clinical Internship
HOMP3008 Clinical Internship Advanced
The curriculum embraces homeopathy’s root principles:
HOMP1000 Foundations of Homeopathy 84.0 Hours
In this course, students are introduced to the philosophy, fundamental principles and theories of classical homeopathy. Samuel Hahnemann’s Organon of the Medical Art forms the basis of discussion and analysis. A historical overview of homeopathy highlights significant contributions by prominent figures in the profession. Foundational concepts – including the law of similars, totality of symptoms, provings, minimum doses, miasms, direction of cure and potentization – provide the framework for the remainder of the program.
It appears the curriculum will give students the impression they can use homeopathy to treat acute conditions, as well as trauma:
HOMP2003 Homeopathy Therapeutics 1 42.0 Hours
In this course, students examine the etiology, pathogenesis, symptomatology and therapeutics associated with traumatology, acute conditions, dermatology and musculoskeletal disorders. Homeopathic medicines are examined and compared in the context of their clinical application in relationship to specific diseases. Polycrests as well as smaller remedies are studied. The concept of prophylactic homeopathy is discussed. Rubrics, modalities and approaches for differential diagnoses are reviewed.
There’s that strange term, “homeopathic medicines”.
And yes, the curriculum include homeopathic nosodes, which are efficacy-free products sold as “alternatives” to vaccines but offer no protection from infection.
HOMP3001 Homeopathy Therapeutics 4 42.0 Hours
In this course, students study mental and emotional health issues, palliative care, epidemics and the emergence of modern society’s environmentally generated diseases. The role of the homeopath in interdisciplinary and complex care is examined. Special attention is given to guidelines, communication strategies and safety precautions associated with the treatment of these specialty areas. The role of nosodes is discussed.
I could easily go through the entire syllabus course-by-course, but there’s no need for a trip down that rabbit hole. It’s remarkable that it will take Georgian College three years to fully train students to be ill-equipped to deliver health care.
Conclusion: Wasted time and dollars on homeopathy
It’s disappointing to see academic institutions like Georgian College offer programs in homeopathy, where student might be led to believe homeopathy has something meaningful to offer patients and the broader community. Ignoring the evidence, it has created a three year course in what is essentially magical thinking, with a curriculum based on ideas that have no basis in fact. Every dollar spent by Georgian College students on its homeopathy diploma program will be a dollar wasted, that could have been otherwise directed towards a more meaningful and credible health career. It’s easy to ignore and even dismiss endeavors like this one as fringe activities offered by colleges putting revenue ahead of evidence. But programs like this will create graduates ill-equipped and potentially without the insight to recognize they’ve been taught nonsense. People like ex-naturopath Britt Marie Hermes, who recognized her education hadn’t prepared her to provide credible health care, are rare. Let’s hope that prospective students do their due diligence and show more critical thinking than Georgian College has.