EXPLAINED: Germany's long-standing love affair with homeopathy

Perhaps this has happened to you. During a conversation with German friends about treatments for allergies or colds, you’ve made a sarcastic comment about taking a homeopathic cure only to be met with a stony silence. 

In that moment you realise that everyone who you have been talking to takes homeopathic medicine and doesn’t know how to politely respond to your sarcasm.

If you can relate to this, it’s not all that surprising.

Homeopathy as a treatment for everything from insomnia, to diarrhea, depression or headaches, is widely accepted in Germany.

A survey conducted by the polling firm Forsa last year found that over half of all Germans have tried out homeopathic cures.

Surprisingly perhaps, the more educated and wealthy Germans are, the more likely they are to turn to this controversial branch of medicine when they fall ill. Over 60 percent of university educated Germans use homeopathic medicine, while women are also more likely to favour it than men.

Meanwhile, German authorities take it seriously enough to only allow its sale through pharmacies, while also allowing health insurers to compensate people for using it. 

This wide acceptance comes despite the fact that the European Academies Science Advisory Council - the umbrella organisation for European science academies - has stated unequivocally that there is no evidence to suggest that homeopathy is “effective beyond the placebo effect.”

Critics point out that homeopathic remedies, which mainly come in the form of droplets or saturated sugar pills, contain such diluted quantities of the original agent that any physical effect is impossible.

Homeopaths for their part protest that recent 'gold standard' medical studies do show better results than a simple placebo effect, although they admit to being unable to explain what could be causing the improvement.

A cheap and plentiful treatment

The art of homeopathy can be traced back to a Saxonian physician called Samuel Hahnemann, who started practising medicine in the late 18th century, a time when it was still common to try and cure sickness with crude techniques such as bloodletting and purging.

Hahnemann wanted to create treatments that led to less suffering. So he came up with two principles.

The first was what he called the ‘law of similars’ - the idea that treatments should be based on substances that cause similar symptoms to those caused by the disease. The second was dilution. He thought that diluting the substance made its effect more potent while also reducing side effects.

His methods were controversial from the beginning. Fights with colleagues meant that Hahnemann was constantly moving from one town to the next before he finally settled in Paris, where he gained fame as a physician to celebrities of the day.

A stained-galls picture of Samuel Hahnemann in Köthen, Saxony. Photo: dpa-tmn | Daniela David

While Hahnemann could only convince a few trained doctors to adopt his techniques, homeopathy gained widespread popularity among laypeople in the mid-19 century, an era marked by the deadly spread of cholera through Europe.

“For contemporary observers homeopathy obviously seemed to be more successful than other forms of medicine during the cholera outbreaks,” Dr. Marion Baschin, Chief Archivist at the Institute for the History of Medicine at the Robert Bosch Stiftung, told The Local. 

“One of the reasons from today’s point of view was the fact that it did not impose additional stress on patients or weaken their recovery strengths.” 

Moreover, the fact that in many parts of Germany doctors were in short supply and medicine was expensive, it led laypeople to turn to homeopathy as an alternative, cheaper form of treatment.

In regions such as Württemberg and the Rhineland, do-it-yourself homeopathy clubs started sprouting up, with members paying an annual fee to gain access to cheap and plentiful homeopathic remedies.

In the clubs, laypeople would advise each other on which treatments would work best against their ailments.

By the start of the 20th century, medical boxes full of homeopathic cures were standard equipment in many German households.

But then a charismatic doctor called Robert Koch arrived on the scene and modern medicine was born.

Koch, a researcher at Berlin’s Charite hospital, was the first person to identify bacteria as the cause of cholera and other infectious diseases. His discoveries motivated cities like Hamburg to clean up their dirty drinking water systems and thus largely eradicate cholera. 

But the more optimistic pronouncements of Koch and his colleagues - that their discoveries would lead to cures for the most common diseases - failed to materialise.

After the First World War, a period marked by trauma and sickness, homeopathy and other alternative treatments enjoyed a comeback.

“When we look at the history of unconventional medicines it comes in waves. At one point acceptance is larger, then the opposite strikes back. In the 1920s there was a movement to reconcile orthodox medicine with homeopathy,” says Baschin.

The Nazi connection

The rise of homeopathy to a form of medicine with official state recognition seemed to be secured with the seizure of power by the Nazis.

Several senior Nazis were devoted followers of homeopathy and other alternative medicines. Moreover, the Nazis were attracted to the fact that it was a medicine made in Germany.

In the early 1930s, the Nazis promised to combine alternative treatments with orthodox medicine in a concept called Neue Deutsche Heilkunde. Enraptured homeopaths were promised professorships at universities.

But the Nazis never made good on their promises and by the start of the war they seem to have lost interest in the movement entirely.

In the post-WWII period orthodox medicine was in the ascendancy once again. The wide availability of antibiotics - and the development of state health insurance - meant that effective scientific treatments became available to all.

The pendulum swung back again though in the 1970s and 1980s with the rise of the ecological movement and the arrival of the Green party in the Bundestag. 

This era was defined by a suspicion of the destructive potential of science advancements. Middle class Germans took to the streets to protest what they saw as the dangers of nuclear power and the damage done by industrialisation to the environment.

Medicine wasn’t excluded from this growing anxiety.

“The euphoria over antibiotics was followed by a series of scandals in the 1960s, most prominently the use of thalidomide,” says Baschin. “That led to an increased demand for softer methods of treatment.”

Back on the defensive

After the high point of the ecological movement, which stretched into the 1990s, Baschin sees homeopathy as back on the defensive in the early 21st century.

“We are currently living in a time when there is a very strong movement against homeopathy. Despite this, the demand for homeopathic treatments has remained more or less stable,” she says.

A homeopathic pharmacy in Munich in 2020. Photo: dpa | Tabea Huser

Debate has flared in recent years over whether health insurance companies should be allowed to compensate people for the use of homeopathic remedies. After speculation that it could ban such practices, the German government decided in 2019 to continue to allow homeopathy to enjoy health insurance cover. 

Meanwhile medical councils in both Bremen and Saxony-Anhalt have recently stopped recognising homeopathy as a legitimate field of additional training.

Even in the Green party, which once swore by alternative therapies, a deep rift has emerged. Younger members of the party in particular, who call for ‘following the science’ on climate issues, are embarrassed by the party's homeopathic traditions.

At the same time, public perceptions still seem milder than in the English-speaking world. On Wikipedia, the English-language entry defines homeopathy as “a pseudoscience” whereas in German it is described as “a form of alternative medical treatment.”

Taking patients seriously

So, why do so many Germans keep turning to a form of treatment that can't work according to our current understanding of the laws of nature?

For the scientific establishment, laypeople are confusing correlation with causation.

"There are many reasons why people get sick, and there are also many reasons why they get well again. That doesn't always have to do with what the doctor gives you," says Jürgen Windeler, head of the German Institute for Quality and Efficiency in Health Care.

Other researchers are unsatisfied with the explanation that homeopathy relies on the gullibility of the masses.

Claudia Witt is Germany's only professor for alternative medicine and conducts her research at Berlin's Charite Hospital, the home of Robert Koch.

She believes that the time that homeopathic doctors give their patients is "a significant factor" in explaining some of its perceived success in helping people overcome illness.

"An initial homeopathic consultation usually lasts one to one and a half hours," she told Taz newspaper back in 2010. "Another feature is that the doctor listens to the patient and lets them talk" something normal GPs rarely have time to do.

"Time is important to fully educate a patient about their disease, and there is also research which shows that a course of treatment is more effective when patients have learned more from their doctor," she says.

Historian Baschin also believes that the enduring appeal of homeopathy hints at a value that shouldn’t be dismissed out of hand.

"A significant factor for understanding why homeopathy remains relevant to this day is the interest shown by patients. From a historical point of view, I believe that if patients hadn't seen it as 'successful' it probably would have disappeared," she says.

She notes too that some of the same attributes that made it popular in the 19th century still apply today.

"Homeopathy is very much suited to self-medication. It is supposed to have few or no side effects and in that sense isn’t ‘dangerous’. In Germany there is a big emphasis on preventative treatment, homeopathy is suited to people trying to take a light treatment before going to the doctor."