Homeopathy revisited

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I’ve long marvelled at the success of the wonderfully unscientific concept of homeopathy. This is a double-length post pulling together two homeopathic adventures.

Just over a week ago there was a mass overdose of medication sold by responsible companies like Boots. [I'm pleased to say, since this post, Boots has stopped making homeopathic remedies, though they currently still sell a handful of products.] Across the world people took vastly more than the recommended dose. And nothing happened. The reason? They were overdosing on homeopathic medicine.

The campaign was known as 10:23. The strange numbering refers to Avogadro’s number. This is a number that delights chemists – it’s the number of atoms in a mole of a substance. The actual number is around 6×10²³, where 10²³ is 1 with 23 zeroes after it. The reason this is of relevence to homeopathic medicine becomes clear when you realize how these medications are made.

The idea of homeopathy, which has no scientific basis whatsoever, is that you treat an ailment with a poison that produces a similiar effect. But to avoid finishing off your patients, you dilute that poison with water. In fact you dilute it over and over again, so much so, that you have reduced it by more than Avagadro’s number. The chances are there is not a single molecule of the poison left – it’s all water. You then drip the water onto a sugar pill, and that’s your homeopathic remedy.

When homeopathy was first devised this wasn’t a problem, as no one knew about atoms or Avogadro’s number, but now we do, homeopaths have had to devise a reason for the medicine to work. They say it’s because during the dilution process they bash the container against a leather strap, and this, in some mysterious way, enables the water to have a memory of the poison even after it has entirely gone. (You couldn’t make this stuff up.)

So homeopathic remedies are sugar pills with no active ingredient, and all the evidence is that the positive results some people ascribe to homeopathy are down to the placebo effect. I was very careful not to say ‘only the placebo effect’, because placebos can really deliver results, particularly on the supression of pain. A good example is the internal mammary artery ligation operation. This used to be regularly performed to reduce chest pain as a result of angina.

It was an invasive procedure involving opening the chest and tying off the artery. Pain was reduced for a number of months. But in the 1950s, a surgeon tried a series of placebo operations. As far as the patients were concerned, they were undergoing the procedure, but in fact the surgeon just made an incision and closed up again. The result was exactly the same. The pain relief was not due to the operation, but to the natural painkillers released by the body when the brain assumed there would be pain relief – it was a placebo.

This same thing can happen with homeopathic remedies, to the real benefit of patients. But there is no active ingredient causing the outcome. While it’s clearly totally unacceptable for homeopathy to be used for anything life threatening in place of real medicine, there’s a difficult moral decision when it comes to, for instance, pain relief. Is it acceptable to lie to someone in order to make them feel better? We certainly do this all the time, but most would argue it’s unprofessional to do this for medical reasons. And hence the 10:23 protest.

You will almost certainly have heard people say ‘Yes, but there is scientific validation of homeopathy. It has been tested.’ I’m afraid there is some misleading information floating about. See this article on the misrepresentation of scientific evidence on homeopathy to a House of Commons committee.

The sad thing is that most homeopaths won’t accept reality and continue to insist that their medications do have a non-placebo effect. I want to leave you with a quote from a homeopathist in response to the 10:23 protest. Try not to fall off your chair.

Of course homeopaths know that one dose of however many pills taken together in one go, is the equivalent of only one dose, because it is the time frame that counts.  So if they had repeatedly taken a dose every hour for the rest of the day, the skeptics would most certainly have felt the effects.  Therefore this little stunt ‘proves’ little, although I wouldn’t be surprised if some of them sheepishly confess that they did experience some symptoms later, because after taking a homeopathic remedy, especially 30c or above, the effects can be felt for days afterwards.

‘It’s the time frame that counts.’ Oh, that’ll be okay, then. Sigh.

Five years later, I had some fascinating responses to another item I wrote:

A couple of weeks ago I put up a blog item on Huffington Post, suggesting that it would be a good idea if alternative remedies, like cigarette packets, had to carry a health warning.

In some cases this was because there were reports of a high percentage of herbal remedies not containing the requisite herb, and sometimes containing fairly dubious contents that could be harmful. And in others, such as homeopathy, it was more because there was a danger of using a homeopathic remedy, and as a result not taking medication that actually does something. So I suggested a suitable warning for a homeopathic product might be something like:

WARNING — contains no active ingredients. If taken in place of medical treatment could result in harm or death

Now it would be disingenuous of me to suggest that I didn’t expect a certain amount of negative response. I was sure it would bring the homeopathy supporters out of the woodwork and it has. I’ll go into some of the specific kinds of response in a moment, but the thing I was really quite surprised by (but probably shouldn’t have been) was how close some of these responses were to someone defending their religious faith.

In a contentious area of science, there will be arguments. So, for instance, if I were to say that I rather hope MOND (modified Newtonian dynamics) can be made to work rather than particle dark matter as an explanation of the gravitational effects blamed on dark matter (which is true), I could sensibly expect cosmologists/astrophysicists to weigh in with the scientific arguments as to why dark matter is a better bet. But that’s not what happened here at all. What I should have been seeing is a) a good explanation for the mechanism of homeopathy (as I claimed there wasn’t one) and b) a good collection of large scale, double blinded trials undertaken by experienced professionals that came out in favour of homeopathy being more than a placebo effect. Neither of these things happened.

In practice, the science isn’t contentious about homeopathy – it’s very straight forward. And so, instead, arguments fell into these broad categories:

• The report you mention only uses big studies - and this is a bad thing because? Good big studies give more statistically reliable results that good small studies – that’s inevitable. If you don’t understand this, take a statistics course, please.
• Making snide remarks - ad hominem attacks are the last resorts of those who have no good arguments. When I see things like ‘Thanx [sic] for embarrassing yourself even more’ and ‘pointing out your egregious ignorance and prejudice in regard to the topic’ I know I’ve hit a raw nerve: resorting to personal attacks means there clearly is a total inability to answer my two key points above.
• Attack allopathic [sic] medicine - there’s a technical term for ‘allopathic medicine’: it’s ‘medicine’. However the real point here is that you can’t defend something by attacking something else. (E.g. ‘Rx drugs are toxic, and RCTs have proven that 50% of the drug trials cannot explain the method of action.’) I know the huge amount of good done by modern medicine, and know plenty of people whose lives have been saved or improved by it. But even if every real doctor doing real medicine made all their patients worse, it wouldn’t make alternative remedies any better. It’s a bit like responding to a restaurant critic who says the food in your restaurant is bad by saying ‘Yes, but the food in McDonald’s is really bad.’ So?

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