Whyfore art thou “side effect”: A [side effect] by any other name would smell as sweet
In the US, drug commercials on TV consist of 30 seconds of an announcer talking about how this new drug will improve your life in every possible way, followed by a minute and a half of side effects, which usually include death. While the announcer tells you about these painful, grisly effect, you watch happy images of women doing yoga or kids playing pass by and the message is clear: pay no attention to words, because really, this drug will make you just as happy, innocent and content as the people you see in front of you. The ads must work, since they keep being played, but they are pretty laughable if you ask me.
But have you ever stopped to ask, why are there so many side effects? What creates a side effect? And why do some people claim homeopathy has side effects, and others claim it doesn’t?
All drugs have mechanisms of action or set of effects on the body. In “conventional” (for lack of a more descriptive term) medicine, a medicine is prescribed based on one symptom and one set of effects that the drug creates. For example, we know that aspirin blocks pain, thins blood and can cause ulcers. But it’s only prescribed for either its pain blocking effects or blood thinning effects. No one prescribes aspirin because it causes stomach ulcers. To denote the difference between the “wanted” and “unwanted” effect, one effect is called an “indication” and the other is called a “side effect”. In reality though, a side effect is just an effect that the prescriber happens to wish were not there.
So in the pharmaceutical ads, really the ad has a 30 seconds of “wanted” effects, and 2 minutes of unfortunate tag-along effects.
When you look at side effects through this light, it is clear that any therapeutic agent can potentially have “side” effects. Herbal medicines are prescribed based on a set of actions, but the herb can have many more actions than what the prescription is based on, and therefore there could be “side effects”. Supplements similarly are prescribed for a small set of their actions, and can therefore create side effects. Some people may argue that these more natural prescriptions don’t have side effects, but when I used to routinely prescribe these products, I witnessed many patients get side effects from herbal products or supplements.
I know that many people believe that things that are “natural” usually don’t have serious side effects either, but I knew quite a few NDs at the clinic where I was that had patients go to the hospital with life threatening side effects from herbs or supplements. This should not be too shocking, however; as Paracelsus said the dose makes the poison. In other words, if herbs and supplements have any impact on the body, then they can become dangerous at a certain dose.
Does homeopathy have side effects?
Potentially.
Homeopathic prescriptions are based on more indications than any other medicine I know. If someone comes in with head pain worse from stooping forwards, better lying on the right side, has a history of eczema that’s better in summer and worse from rubbing, then they will be prescribed a remedy based on all of these symptoms. That’s six symptoms that will be covered by one remedy, meaning a homeopathic prescription takes into account more symptoms than a conventional prescription would (which might just be advil for head pain or topical steroids for the eczema, for example). This, theoretically, should lower the likelihood of side effects because a larger sphere of action of the remedy has been accounted for. However there are literally hundreds, sometimes thousands, of symptoms listed for our homeopathic remedies, which means there’s still great potential for side effects.
In practice, I see fewer of these effects than when I used herbs or supplements regularly. And if I were to hazard an explanation as to why, it would be because we all have susceptibility to certain symptoms.
Homeopaths discover the action of a medicine by testing it on healthy people. Then the symptoms the people experience are recorded and compiled into lists of hundreds of symptoms. A homeopath will then consult these lists of symptoms for the indication they want. However, note that no one person will experience the entire list of symptoms; we all seem to be “susceptible” to a small group of symptoms. That is why homeopaths have to test a remedy on a group of people, and not just a couple of individuals.
Sometimes in this list of symptoms, there will even be contradictory symptoms. This has been noted since the beginning of these homeopathic drug trials. In the 1800s, the founder of the homeopathic profession, Dr. Samuel Hahnemann wrote “in some…medicines, we meet with symptoms which seem to be completely or partially antagonistic to one another, alternating actions, which at the same time are primary actions, and which make [the medicine] very applicable and efficacious for a number of morbid states” (quote from the introduction to Nux Vomica in Materia Medica Pura). In other words, some remedies can have a symptom like “better after vomiting” AND the symptom “worse after vomiting”, but because they are opposite, one person cannot have both. So automatically, a person can only have a certain number of symptoms in a remedy.
Because of our susceptibility to only a certain set of symptoms, the potential contradictory nature of some indications, and because homeopathic prescriptions are based on all of our symptoms of a disease, the likelihood of getting a side effect from homeopathic treatment is low. Homeopaths do use dosing strategies that lower the risk of side effects as well (although I think that’s probably true in all forms of medicine). In homeopathy, the side effects are usually called “accessory symptoms”. In the language, you can see again how these unintended, damaging effects of the prescription are dismissed: “accessory” as opposed “unwanted” or “unfortunate” or “adverse” effects.
So just as Juliet noted that she would love Romeo regardless of what name he was called by, that what she loved was him as a person and not the constructs thrust upon him[1], we should remember that side effects should be weighed and judged not by the name they are given (accessory, side or adverse effect), nor by what caused them (drug, pharmaceutical, supplement, herb, homeopathic), but by their frequency and severity.
[1] We will ignore the fact that they were 13 and had met once, which makes it a bit less likely that Juliet had fallen in love with Romeo’s entire “person”. She more likely fell in love with some gorgeous physical attribute…