28 January 2014

Regulating Homeopathy

'Outdated Fraudulent Healing?: Homeopathy on Trial - The Homeopathic “Pill Scandal” in the 1950s and Modernisation of Health Care in Sweden' by Motzi Eklöf in (2007) 6(2) Hygiea Internationalis: An Interdisciplinary Journal For the History of Public Health [PDF] comments that
In July 1951, news spread that certain manufacturers of homeopathic remedies in the Stockholm area had skipped part of the potentization process and had sold pure sugar pills under the false claim that they were homeopathic medicines. After extraordinarily time- and money-consuming investigations and legal proceedings, directors and others from Pharma-Drog AB and Drogon AB who were responsible for producing and selling the pills were charged with, convicted of and sentenced for fraud and tax evasion. 
In court, the prosecutor maintained that homeopathy as such was a big fraud, since even correctly potentiated homeopathic remedies above D5 could not possibly haveanytherapeuticeffectbeyondthatofsuggestion. This was a position also held by the Swedish Royal Medical Board, although homeopathic remedies above were sold at pharmacies. Accordingly, manufacturing and marketing of homeopathic remedies was to be considered fraudulent. 
Perhaps somewhat surprisingly, most of the accused individuals joined in this stance. As part of their defence in court, they claimed that it could not be consid-ered criminal to sell pills already commonly known to be of no benefit. On the contrary, they contended, it had been their praiseworthy intention to disclose the humbug of homeopathy by this large-scale experiment with unpotentiated pills, used by homeopaths and patients for years without any noteworthy complaints of absent therapeutic effects. The accused manufacturers referred to rumours that conventional pharmacies also cheated in the production of homeopathic remedies, and that medical authorities were aware of this and in any case, potentization above D6 was unnecessary, as the contents above this potency could not be checked out chemically. 
The one person taking a different position was the most prominent representative of lay homeopathy at the time. To the very last, he denied accusations of complicity in fraud and claimed that he still believed in homeopathy, although he was sceptical toward high dilutions. In the homeopathic journal he edited, he published a declaration swearing to God and all people that he had not known of the fraudulent activities. 
The courts chose not to take a stance on homeopathy as therapy. Instead they confined themselves to declaring that it was fraudulent to sell packages the contents of which did not correspond to the labelling. People would not have paid the prices they had paid if they had known the packages contained only pure sugar. The lay homeopath who claimed that he was innocent of the charges never had to serve his sentence – it was suspended in April 1954 by the Minister of Justice, a decision commented on acidly in the press. In early May of the same year, a huge bonfire in a dump outside of Stockholm comprising tons of confiscated pills and homeopathic handbooks represented the spectacular end of years of legal proceedings. 
This so-called homeopathic “pill scandal” raises many questions on a number of different levels. The first – and for homeopathy as such the most precarious – being how it was possible for manufacturers of homeopathic remedies to sell pure sugar pills for years without, so it seemed, homeopaths and their patients noticing. Not all the pills that were sold were unpotentiated – it turned out that the number was definitely smaller than initially claimed by the prosecutor – but there were enough to have made a difference (and in fact, some homeopaths had complained about not getting the expected therapeutic effect from some remedies). 
According to medical authorities, homeopathy had finally unmasked itself and had been revealed as the self-evident quackery they had always declared it to be. Medical doctors regarded homeopathy as pharmacologically useless – the “pill scandal” being a gigantic disclosure experiment with blinded tablets – and hopelessly outdated. Any therapeutic effects were to be regarded as the result of self-healing or suggestion, functioning especially well in “the often somewhat childish and immature types of persons who, with their disposition for blind faith, miracles and mysticism, constitute the quack’s most rewarding clientele and best propagandists”. 
However, all of that had been said many times before. What was new in the early 1950s was that the trials of fraudulent manufacturers of homeopathic remedies were not solely considered embarrassing for homeopathy as such. Additionally, the “pill scandal” was turned into a matter of great societal importance and received a great deal of attention in the media. Politicians of different persuasions, the prosecutor, medical and pharmaceutical authorities, the media, as well as some of the prosecuted swindlers collaborated in the greater task of slandering and – hopefully – wiping out homeopathy from the Swedish medical marketplace. What will be discussed here are issues regarding why the homeopathic “pill scandal” got to be such a public affair, why it was considered so important to use this convenient opportunity to try to wipe out the most commonly used alternative therapy of the time, and how that was to be achieved. Homeopathic practice was not eradicated after the pill trials, but homeopathy was no longer to be discussed as a therapeutic alternative, and the topic vanished from the discursive level. 
In this article, some general developments in society will be presented that I propose both directly and indirectly changed the prerequisites for homeopathic practice in Sweden. Discussions in the Swedish media – daily newspapers, journals, radio – concerning homeopathy in the middle of the twentieth century display some recurring themes that need to be discussed and analysed. Factors of importance include the processes of secularisation and modernisation, in parallel with an increased confidence in science. Growing State responsibility for the health of Swedish citizens, rapid expansion of hospital-based health care, and efforts to achieve political consensus for development of the welfare state were also significant factors. In addition, campaigns against sectarianism and fraudulent behaviour, especially economic fraud, in all areas of society played a central role regarding the fate of homeopathy in Sweden. With growing focus on consumers’ rights, good value was demanded for the money spent on health care. 
But this article does not deal only with the history of homeopathy in Sweden; the story can be told from another viewpoint. The history of alternative medicine is also closely linked to the history of conventional health care in Sweden. Homeopathy has played a central role for political decisions on legislation con- cerning health care and pharmaceutical products. Ninety years ago it contributed to the abolishment of the medical profession’s monopoly on the practice of medicine, and has instead paved the way for the permission of lay healing that is still in force as a complement to state-supported health care. In the public debate, homeopathy incarnated the concept of “quackery”, thereby meaning unauthorised practice of medicine. Homeopathy has thus played an important role in the efforts of conventional medicine and the state to define what separates modern scientific medicine from popular healing.
Eklöf concludes
Homeopathy, as practised both within and outside conventional medicine, had been under attack from the organised medical profession and the Medical Board since the nineteenth century. The relatively new and evolving scientific arguments and changing legal tactics in the 1950s were effective. Increasing societal support for medical science and reformed health care, in combination with a desire to get rid of reminders of old times were important factors regarding the almost complete extinction of homeopathy from the discursive level. In the rapid process of modernisation of Swedish society, official support for “old” medicine could not be retained. 
The social and cultural associations connected to homeopathy at this time – not only belief and religious faith, but also deviant, fraudulent and criminal activities – facilitated the pronouncement of the end of this kind of healing. Homeopathy was designated an outdated dogmatic healing system based on belief and suggestion. It was considered unnecessary in modern society, where the whole population had sufficient access to rational medicine that was based on the results of scientific research. Claiming a “belief” in homeopathy in order to prove one’s innocence in the pill trials – as was done by a prominent lay homeopath – was an argument with absolutely no persuasive power at a time when scientific proof in terms of chemical analysis or clinical trials had become all that mattered. 
In Sweden, there were no homeopathic physicians left to discuss homeopathy on an academic level, and no prerequisites for homeopathic practice to adhere to some extent to scientific standards, as was the case in other countries such as the US. Nor was conventional medicine open to the assimilation or integration of any part of homeopathy into mainstream medicine. Articles critical of homeopathy were given much space in the press, whereas voices favourable to this healing system were published – if at all – only as short letters to the editor. For decades after the homeopathic trials, the Swedish Medical Journal did not even mention homeopathy. The “pill scandal” was a symbolic event with great impact on the public debate. Homeopathy was eradicated from the discursive level in society. 
Nevertheless, despite the fact that homeopathy was heavily discredited in public arena, it did not vanish from the scene. People relied on their own experiences of homeopathic treatment. The press reported on persons bursting into tears in phar- macies when they realised they could no longer get the remedies from the fraudulent firms. In the northern region of Jämtland, pharmacies reported no decrease in the sales of homeopathic products. Sales figures for these remedies decreased only marginally for a year or so; the best economic results were attained in the 1980s. As in many other Western countries at that later time, “alternative medicine” had become an issue in the public debate. Homeopathy has continued to exist, but in Sweden it has not recovered the more widespread and publicly defended position it held during the initial decades of the twentieth century. The number of medical doctors daring to articulate a positive interest in homeopathy can easily be counted. The Swedish Medical Board has not changed its judgement of homeopathy as being of no therapeutic use beyond a placebo effect. As a consequence of political efforts to achieve a harmonisation of laws and regulations within the European Union, starting in May 2006 homeopathic products are – once again – to be classified as pharmaceutical products (although they are not to be sold at pharmacies). Continental medicine, with physicians openly practising homeopathy, has been criticised as being more “esoteric” as compared to supposedly more scientific Swedish medicine. That homeopathy is more widely used by physicians within conventional health care in many other countries has never been an impressive argument in the Swedish debate. 
The “pill scandal” of the 1950s is unknown to contemporary international manufacturers of homeopathic remedies, who are also represented in Sweden. Connecting the concepts of “fraud” or “quackery” with homeopathy is an unthinkable association for them. 
The fraudulent activities of the1950s may be forgotten, unknown or hushed up by homeopaths in Sweden today, but the effects of those associations with homeopathy at the time – with or without factual basis – remain. This emphasises the need for further studies in a wider socio-cultural context in order to enhance our understanding of what factors facilitate or counteract the existence or relative non-existence of alternative medical cultures in different countries.