World Homeopathy Awareness Week
April 10th to 16th is World Homeopathy Awareness Week. The Saskatoon Skeptics are getting in on the celebrations, as far too few people are aware of just how completely unscientific homeopathy actually is.
The principle behind homeopathy is that “like cures like”, meaning that if an illness caused a runny nose, then giving the patient a remedy which also caused a runny nose would cure the original illness. Homeopathy was invented by physician Samuel Hahnemann (1755-1843) in the late 1700’s. Hahnemann was experimenting with quinine which was known to treat malaria. He experimented with the remedy using himself as a test subject. He ingested a concoction derived from tree bark containing quinine and became ill with chills, palpitations, thirst, redness of the eyes, in other words similar symptoms to a malarial fever. Hahnemann thought he saw a pattern; he reasoned the body would not allow two substances causing the same symptom to exist in the same place. Before we tear homeopathy apart, it is worth mentioning that Hahnemann did some very commendable things. He was one of the first physicians to actually test his remedies, and was one of the first to realize that the medicine of the time was doing more harm then good. Hahnemann worked during a time when diseases were thought to be caused by miasms, which needed to be leeched, bleed or purged out; the germ theory of disease was still a century off. Hahnemann did what he could long before science as we know it now existed. Hahnemann, who lived in the 1700’s, can be excused for not knowing what knowing about atomic theory, germ theory, or even the scientific method. Present day homeopaths do not have that excuse.
Principles of Homeopathy
The first principle of homeopathy is what Hahnemann referred to as the “Principle of Similarities” – the fore-mentioned “like cures like”. Quinine may treat malaria, but there were many other illnesses whose remedies were unknown. Hahnemann set out to find the substances that produced the same symptoms in patients as the conditions he was attempting to treat. Hahnemann called this process “proving” and it was likely one of the first examples of a drug efficacy test. The protocol involved repeatedly administering a substance to a healthy volunteer until they experienced a symptom. The volunteers were then instructed to record their symptom in as much detail as possible. As radical as this was for Hahnemann’s time, it is a terrible experimental protocol. The concept of a control group was still a century away, and Hahnemann was testing his remedies on healthy patients – not the ones suffering from illness. If exploring a new allergy treatment, an experiment with patients not afflicted with allergies is not going to return a meaningful result. Hahnemann’s law of similarities had one other practical problem; the remedies would make the patient worse. Hahnemann then proposed the “Law of Infinitesimals” and diluted his remedies.
The Law of Infinitesimals consists of the counter-intuitive claim that the more the homeopathic remedy is diluted, the stronger the effect. Hahnemann did much more then just adding water. Homeopathic preparations are dissolved in water or alcohol in ratios of 1 to 10, or 1 to 100. The concoction is then vigourously shaken or “successed” in the parlance of the homeopaths. A dilution of 1 part in 10 is known a 1X solution; a dilution of 1 part in 100 would be known as a 1C solution. For a 2X or 2C dilution the procedure is repeated. These dilutions according to the law of infinitesimals are far too concentrated to be effective. Hahnemann argued for the use of a 30X solution or a dilution of 1 part in 1,000,000,000,000,000,000,000,000,000,000. What Hahnemann did not know was that matter can not be infinitely divided; the smallest part of matter, the atom, is the natural terminus to the process. In order to find one molecule of the original substance, Hahnemann would require a volume of water greater then that of the Earth. Hahnemann had diluted his carefully chosen remedies into nothing.
An interesting question is why Hahnemann thought his remedies worked at all considering there was no active ingredient. Remember Hahnemann lived during a time when conventional medical practice was dominated by the equally stupid idea that sickness was something that could be purged from the body. A patient with a fever will likely recover no matter what remedy the physician uses. Unfortunately, a 18th century physician might attempt to bleed out the fever; making incisions into the body in a time before antibiotics and proper sanitation was a recipe for disaster. In such a situation the patient would be better off if the physician did nothing, which is exactly what Hahnemann’s remedies did: nothing.
Allopathy, Homeopathy, and Modern Medicine
So impressed with homeopathy, Hahnemann wanted to distinguish what he did from the conventional wisdom of his time, so he coined the word allopathy. An allopath did not embrace the “like cures like” vision of medicine; instead, they prescribed remedies that produce the opposite symptoms to the disease, or so Hahnemann thought. My computer dictionary defines “allopathy” as the treatment of disease through conventional means, i.e. with drugs having opposite effects to the symptoms. What my dictionary fails to mention is that allopathy is word 200 years out of its time and has absolutely nothing to do with 21st Century medicine.
While homeopaths battled it out with allopaths in the 19th century, science was about to make two important discoveries that would bury Hahnemann’s ideas for good: these were the germ theory of disease, and atomic theory.
The germ theory of disease was the idea that many diseases were caused by micro-organisms and not bad smells, or miasms according to earlier ideas. Germ theory was extremely controversial when it was first proposed; the burden of proof was on the proponents of germ theory to prove their case. Oddly enough, the first studies of microbiology were done before Hahnemann, by Dutch scientist Antonie Philips van Leeuwenhoek (1632-1723), yet no one made the connection between the “animalcules” seen under Antonie’s microscope and disease until the 1800’s. In 1843, Hungarian obstetrician Ignaz Semmelweis noticed that women at his hospital were more likely to die from puerperal fever when they were attended by doctors or medical students. These doctors had been performing autopsies before being called in to deliver babies. Semmelweis reasoned that something had passed from the corpse to the doctor’s hands and then to the women. He insisted that all doctors wash their hands before attending to deliveries. Maternal mortality dropped dramatically, yet Semmelweis has ridiculed by the medical establishment of the day for his contributions. In 1854, John Snow traced a cholera outbreak to one particular well, and was able to show that the outbreak pattern was inconsistent with the idea of miasms. In 1890, Robert Koch designed rigourous experiments to isolate the particular micro-organism and to establish it as the cause of disease. He used this method to demonstrate that the baterium Bacillus anthracis was the cause of anthrax. At the dawn of the 20th century, medicine had left the term “allopathy” in the dust. By embracing the germ theory of disease, new advances such as antibiotics, vaccines, and better surgical practices were possible. Where was homeopathy during this revolution? It was still clinging to the notion of “like cures like”. We know in detail how drugs work. Antibiotics cures disease, not by producing symptoms opposite to those of a bacterial infection, but by killing the invading organism. Modern medicine addresses the underlying cause of disease instead of treating the symptoms as homeopaths do.
Quantum Theory: Or why homeopathy is implausible
We know now that matter is made up of atoms and molecules, and there is a finite amount of these tiny particles. When Hahnemann kept removing more and more of the original substance in his remedies, he eventually had not even a single molecule left. Modern homeopaths realized this and instead of abandoning homeopathy as a pre-scientific notion, they attempted to rescue homeopathy using the recent discoveries of quantum physics. Quantum physics was born out of the discovery that energy was not a continuous variable; rather, it occurs in discrete packets or quanta. In quantum mechanics, matter is not the discrete clumps we are familiar with, rather particles are described mathematically as a probability function. These probability functions can interfere with each other, producing the famous wave-like behaviour of what common sense tells us should be solid matter.
Homeopaths use quantum mechanics to try to convince us that water has a “memory”. Modern homeopaths point to a feature known as quantum entanglement. In quantum entanglement, the states of two or more particles are linked together. If you can learn the state of one particle, you can fully describe the other particle regardless of its spatial separation. Strange as it sounds, quantum entanglement has been demonstrated in laboratories under carefully controlled conditions. Therein lies the problem: even if homeopaths could show that the molecules of their active substance have become entangled with the water (which they have not done to date), the system would be unstable. This is because the slightest disturbance would destroy the entangled particles; a disturbance like the homeopath shaking the bottle, or even the patient drinking the remedy. Quantum entanglement does not rescue homeopathy from clutches of pseudo-science. So, what else could the homeopaths come up with?
Here is a newsletter from a Homeopathic “Research” Institute describing something called Quantum Coherence Domains. Quantum coherence domains when a solid or liquid will act as a single entity. This sounds an awful lot like quantum entanglement to me. What else do they say?
“Each atom, molecule, or even complex set of molecules, has a range of associated electromagnetic frequencies characteristic of that substance. Actually this signature is so precise that it can be used to detect very small concentrations of pollutants in chemical processes.”
This is spectroscopy, and just like on Star Trek, they got the science wrong. When light passes through a colder material, the photons can raise the electrons into a higher energy state. Since the energy is used in discrete packets (i.e. the quanta in quantum mechanics), when you spread the light out using a prism you will see distinct dark bands where photons were used to raise the atoms into higher energy state. The pattern of dark bands, or absorption lines, is unique to each substance. This is a fascinating physical process which has been used to determine the chemical makeup of the sun and distant stars. This process can also work in reverse: when atoms return the ground, or lowest energy state, it will emit a photon of the same precise energy as the one it used to get to higher energy state. This is all very interesting, but how does any of this process make homeopathy plausible? Even if the quantum coherence domain does lock in the photons emitted by our active ingredients, so what? Acetaminophen does not reduce fever by changing energy states. Once again quantum mechanics can not rescue homeopathy. I have tried in vain to find coherent theory of homeopathy; this video tries to explain to the physics of homeopathy, and well …. see for yourself.
I’ll let the Doctor summarize that video.
What if we forget everything we know about medicine and physics, and go ahead and do the clinical trials as presented above, despite their lack of basic plausibility? Would we get some meaningful data? First of all, it is not a good idea to ignore basic science when designing an experiment. Since there is no theory on how homeopathy should work, we have no idea of what to look for. What are the effects of the homeopathic remedy on the body? Again, we do not know. Much of homeopathic research seems to consists waiting for something to jump out of the data then claiming that is what they were looking for in the first place.
The gold standard for evidence in medicine is the randomized, double-blind, placebo-controlled trial. Patients are assigned randomly into the treatment arm or the placebo arm where neither the patient nor the practitioner evaluating the patient, know who got the treatment, or who got the placebo. This is a very good way to eliminate bias that is inherent in human beings. Patients want to get better so they will report that they are better, and doctors want to see the therapy work; both are biased.
I have here the results of a meta-analysis for homeopathic remedies for the treatment of pain and nausea of chemotherapy patients. No effect was found, but then again we had no reason to expect one.
Here is a another meta-analysis with barely significant results in childhood diarrhea, that the author concluded was a success. There were three trials: two in Nicaragua one in Nepal. Think about that. Diarrhea is a common killer of children in the third world, and these doctors from the first world come in and give a remedy, with no prior plausibility that it would even work, to treat a potentially fatal disease. Clearly the ethics board was sleeping. Thankfully no one died.
Science-based Medicine blogger Mark Crislip tears into this study of homeopathic treatment in sepsis. Sepsis is extremely dangerous: bacteria invade the organs and bloodstream, causing a massive inflammatory response that can shut down organs. Without treatment, sepsis is universally fatal. Homeopathic remedies were not the main treatment: apparently the ethics board is not in a coma. Rather they were an adjunct therapy. Patients were given a 200C dilution of the remedy or placebo. They followed both patients for 30 days and noted the survival rate. The small number of patients made it impossible to determine any significant differences between the two groups. Already the study is a wash: however, the authors did a followup with the patients after 180 days. According to Dr. Crislip, an infectious disease specialist, sepsis will kill quickly (in first couple of weeks), thus if the patient is alive after 30 days then they have survived their ordeal. In other words, sepsis does not wait six months to finish the job. Including this endpoint was bizarre and not consistent with the progress of sepsis under treatment with antibiotics. The authors did find a difference between the two patient populations at six months. Why? No one knows. With the small patient populations, the authors can not rule out chance. I think the only purpose of this study was to generate noise in medical literature.
These studies are terrible, and some are ethically questionable. What else have homeopaths wrought? Homeopaths working in the third world have been pushing remedies for AIDS, malaria, and tuberculosis. They may be well intentioned, but pushing worthless treatments for deadly illnesses will only add to the suffering of those they are trying to treat. This has prompted the World Health Organization (WHO) to issue a statement condemning the practice of homeopathy for those conditions. The WHO has also had to issue another statement when homeopaths decided their nostrums were better then the H1N1 vaccine for pregnant woman. The recent H1N1 influenza hit pregnant women hard: the homeopaths’ advice was simply dangerous. And what was the homeopathic position on the vaccine based on? I think again of that YouTube video and shudder. All I could find was an article containing a single anecdote in Vancouver-based North Shore News. If you think cutting edge medical research the New England Journal of Medicine is so passé, try the North Shore News instead and see how bad it can get.
What is truly mysterious is why anyone would believe homeopathy works. Because of modern medicine, we live in world where we recover from most of our illnesses no matter what treatment is used. If you found that homeopathy worked for you, then chances are you would have recovered if you had done nothing at all.
Eur J Cancer. 2006 Feb;42(3):282-9. Epub 2006 Jan 11.
Efficacy of homeopathic therapy in cancer treatment.
The Pediatric Infectious Disease Journal:
March 2003 – Volume 22 – Issue 3 – pp 229-234
Homeopathy for childhood diarrhea: combined results and meta-analysis from three randomized, controlled clinical trials
JACOBS, JENNIFER MD, MPH; JONAS, WAYNE B. MD; JIMÉNEZ-PÉREZ, MARGARITA MD, PhD; CROTHERS, DEAN MD
FRASS, M., LINKESCH, M., BANYAI, S., RESCH, G., DIELACHER, C., LOBL, T., ENDLER, C., HAIDVOGL, M., MUCHITSCH, I., & SCHUSTER, E. (2005). Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit Homeopathy, 94 (2), 75-80 DOI: 10.1016/j.homp.2005.01.002