Dr. Nagler's Tinnitus Site

Dr. Nagler’s Tinnitus Site

Tinnitus and Homeopathy - My View

The question regarding the appropriateness of homeopathic approaches to tinnitus management frequently arises. I thought I might try to shed some practical light on it from a Western medicine perspective.

First of all, it is important not to confuse homeopathic medicine with holistic medicine - an easy mistake to make because the words start and end with the same phonetic sounds. Holistic medicine is based upon the theory that an organism is not merely equal to the sum of its parts, but must be perceived or studied as a whole. This particular philosophy has a lot of appeal to me for many reasons, not the least of which is demonstrated by the general observation (and my professional experience) that if a patient has a good relationship with his/her surgeon and has a good self-concept, that patient tends to recover more quickly from a given operation than one who does not.

Homeopathy is something entirely different. It is based upon the "law" of similia (likes are cured by likes.) In practical application by homeopaths, the law of similia states that a substance which can cause certain symptoms in healthy individuals may be effective (in very dilute quantities) in treating illnesses that have symptoms similar to those produced by the undiluted substance. One might think that this approach is like that of conventional allergists, who use "extracts" to build up resistance to, for instance, various pollens. There are two differences:

The pollens from which the extracts are made elicit no symptoms in healthy individuals - only in individuals with allergies to the pollens in the first place.
The dilutions used by homeopaths are purer than distilled water. Distilled water theoretically has less than 1 part in 10⁹ impurities - or one part per billion. Homeopaths frequently use solutions as dilute as 1 part in 10¹⁰⁰ - or one part per billion billion billion billion billion billion billion billion billion billion. That dilution mathematically has been judged roughly analogous to placing a crushed grain of rice in a swimming pool of pure water the radius of which is the distance from the Sun to Pluto - then drinking a glass of the solution to get the effect of the rice. (With this in mind, whether or not homeopathic "remedies" help you, it seems highly unlikely that they can hurt you.)

The problems that many of us who practice more traditional Western medicine have with homeopathy are as follows:

The theory - likes are cured by likes - just does not make a lot of sense on its own merit. It is true, however, that many effective treatments in Western medicine do not make much initial sense either - for instance, giving a mold (penicillin) to someone with an infection.
There is unequivocally no "science" behind homeopathy. To my knowledge, no studies demonstrating the efficacy of homeopathic preparations in large enough numbers to make the results statistically relevant have ever been published in a "peer-reviewed" journal, even knowing that publication of data thus obtained would serve to simultaneously quiet the detractors of homeopathy once and for all AND would serve as a tremendous contribution towards alleviating the traumatic effects of tinnitus and other afflictions for everyone concerned.

Since I question the basis of the theory and since simple double-blind experiments have not been done to any statistical satisfaction, I find it difficult to recommend homeopathy as a treatment for tinnitus. Still, some tinnitus sufferers report that homeopathy occasionally seems to help them. This observation is termed "anecdotal evidence" - a phrase which unfortunately carries a light-hearted connotation. But there is nothing remotely light-hearted about a treatment which in certain circumstances might be beneficial in alleviating the discomfort of tinnitus. In my experience: No tinnitus sufferer who found even a small amount of relief ever cared one iota whether or not the treatment which resulted in that relief was based on "science." (Nagler's Law)

So, how does a reasonable person reconcile the above apparently conflicting positions - no scientific basis or solid evidence vs. anecdotal reports of successful treatment? And what position should a responsible health care professional take when faced with this question?

Doctors who state that they depend strictly on the results of double-blind randomized prospective studies when they make recommendations to patients are either naïve or forgetful. Most of us have tricks that "seem to work well in our hands" or remedies handed down (like chicken soup) that are apparently effective even though never tested scientifically. I am reminded of a young physician who would not administer a particular laxative to a patient absolutely miserable with constipation because the physician "hadn't seen the conclusive data" - a double-blind randomized prospective study indicating that that this universally used effective preparation really works to statistical satisfaction! Can you believe it??!!

Why might homeopathy work in some instances? If we accept - for a moment - the premise that the medicaments in and of themselves do not hold the key, then something else must be going on here. (It is my opinion that if the medicaments did indeed work on their own, then this issue would have been settled in favor of homeopathy a long time ago.) Homeopaths typically spend a considerable amount of time with their patients - analyzing the history, describing the treatment in depth, following the treatment along, modifying the treatment as indicated, and in general developing a meaningful relationship with the afflicted. This sounds like what MD's used to do years ago before some began to sacrifice time at the "bedside" for quantity of patients treated. Whether this gradual trend towards a change in posture in modern American medicine is a result of the onslaught of managed care, or economic reality, or advancing science, or just plain greed (I suspect a combination of each,) many of our patients have ultimately had to pay the price. To the homeopath's credit, no significant compromise has been made with respect to the amount of time spent with each patient. Herein might lie the answer to the homeopath's occasional anecdotal success.

The philosophy of homeopathy cannot readily be measured by traditional double-blind randomized prospective methodology, which may in part explain the reluctance of the homeopathic community to subject their treatment protocols to this type of rigorous testing. It does not, however, explain the reluctance of the homeopathic community to report even retrospectively specific success rates backed by good data.

If a tinnitus patient told me that he had experienced success with homeopathy for another ailment and wanted to include a homeopathic approach in his tinnitus management, I would be remiss if I did not encourage him to attempt some of the more "scientifically based" approaches available. However, I would be equally remiss if I tried to discourage him from seeking care from someone in whose hands he had experienced even anecdotal success in treatment of a previous malady - especially where a multifaceted condition like tinnitus is concerned. I might offer to contact the homeopath to see if together we could design a treatment plan for this particular patient that could prove more beneficial than would be the case if that patient saw us independently - a truly holistic approach!

Given that I have a biased education and come with a biased medical philosophy, I hope this information - provided in as unbiased a manner as possible - is helpful.

Stephen M. Nagler, MD, FACS

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