a bonobo humanity?

one lump or two?

I didn’t think it would ever be necessary for me to write about homeopathy, which has been dealt with so many times by so many people, except maybe to clarify it for myself [for example, to get the name of its inventor fixed in my head], so that if it ever came up in conversation I could refute it comprehensively and concisely.

As I’ve said, there are many such refutations online. A P Gaylard has an excellent three-part refutation starting here, Paul Wilson has blogged extensively on the subject, as has Steven Novella, and of course Ben Goldacre does a job on it in his book Bad Science, so it seemed pointless to add my less informed analysis. However, I was alarmed some months ago when a couple of people in my housing co-op began trading info on the homeopathic pills they were popping, and how efficacious they were. I was gobsmacked, but I didn’t particularly want to ruin the happy mood of post-meeting drinkies with a douse of cold water. Besides, though I’d read up on homeopathy, including Goldacre’s book, I’d forgotten the silly details, and couldn’t trust myself to give a coolly constructed exposé of the pseudo-science right there and then. Instead I vowed to write one up on my blog and draw it to the attention of my fellow co-op members, for humanity’s sake. But my good intentions withered once more.

The recent threat by major homeopathy producers Boiron to sue an Italian blogger for criticising one of its products has been doing the rounds of the sceptical community, and this has been enough to prompt me to write about the subject at last.

I’ve never been one to use or explore alternative medicines much, and so, like many [including the users of homeopathy], I just thought ‘homeopathic’ was a synonym for ‘natural’ or ‘herbal’ remedies. Boy, was I wrong about that. Homeopathy is, in fact, a ‘theory’ about health and sickness, developed essentially by one person. A German physician, Samuel Hahnemann [1755-1843] formulated, or rather stated, the basic principle of homeopathy in 1796. He called it the law of similars, in which ‘like is cured by like’. Yes, this means what it seems to mean – that you can be cured of an illness by being given a dose of that illness. But only if it is given in a specific, regulated way. Regulated, that is, by Dr Hahnemann from beyond the grave. One of the good doctor’s essential rules is that the more you dilute the active ingredient, the more potent the remedy will be. It’s so counter-intuitive, he must be onto something. This trick is called potentization, and it’s taken to ridiculous lengths. If you buy any bottle of homeopathic pills, you’ll find a ‘dilution number’, which generally ranges from 30C to 200C or more. Remember, diluting the active ingredient renders it more potent, according to the good doctor. A 30C solution has been diluted by one drop in a hundred, thirty times over [to get an idea of how they do it, watch this funny wee video]. That’s 100 to the power of 30, so that the active ingredient is diluted to one part per 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000. To visualize this, imagine a sphere of water with a diameter equal to the distance between the earth and the sun, then imagine one molecule of our active ingredient within that sphere. That’s about the ‘potency’ of a 30C solution. Of course, a 200C solution is much much more potent. Impossibly potent, in fact, because to obtain such a dilution for any molecule of the active ingredient you would need way way more water than there are atoms in the entire universe! That doesn’t stop homeopaths putting 200C on their labels of course. And we shouldn’t blame Dr Hahnemann for this absurdity. His dilution ‘calculations’ were made long before atoms and molecules were known about, let alone the size of the universe.

Of course this rather devastatingly means that, if the dilutions recorded on the labels are accurate, then 99.9999 etc percent of every bottle of homeopathic pills you buy will contain no active ingredient whatsoever. Modern homeopaths [not to be confused with psychopaths] try to weasel out of this obvious problem by claiming that water ‘has a memory trace’ of the ingredient. The idea that H2O molecules – or any other molecules – have memories might come as a shock to anyone with any training in physics or chemistry, but even if this were true, consider the various activities of water molecules – evaporated from the ocean, perhaps, to become part of a cloud that eventually falls as rain, running down into a river, or an underground sewer, or incorporated into a keg of beer at a brewery from where it’s eventually drunk and pissed out at a party, into a toilet system, etc etc. Think of all the memories. And how does this quite simple molecule manage to retain just the right memory for a homeopathic cure? The idea is of course completely incoherent and smacks rather loudly of desperation.

Of course, there are other tricks to homeopathy besides potentization. The most vital of these, apparently, is called succussion. Each round of dilution of the active ingredient must [again, according to the good doctor] be followed by ‘ten hard strokes against an elastic body’ – such as a horse’s arse perhaps. Hahnemann may well have had something like this in mind, because for his succussions he ‘had a saddle-maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair’. Modern manufacturers of homeopathic pills apparently still ‘succuss’ their preparations, if that’s a real verb. They use robots nowadays to do the banging, which ‘activates the vital energy of the diluted substance’. Whether manufacturers really believe this is necessary, or they’re just afraid of being caught not doing it, is a moot question.

So that’s homeopathy. Needless to say, a plethora of clinical trials have been conducted, along with meta-analyses of those trials, and the findings are that it works no better than a placebo. How could it be otherwise? Homeopathy is definitely at the loopy end of ‘alternative medicine’. It has, of course, plugged into the holistic, new-age rhetoric of the past few decades, but the approach of Hahnemann was in fact diametrically opposed to a holistic approach. He recommended not taking into account any of the past history or experience of the patient, but treating the symptoms only. His ‘active ingredients’ were arbitrarily chosen as substances which, when ingested, caused symptoms more or less similar to the symptoms of a disease. For example, his first  active ingredient was cinchona bark, which at the time was being used to treat malaria, probably because it contained quinine. When Hahnemann ingested the bark, he became convinced that it gave him malaria-like symptoms, and so he was on his way to his first ‘cure’. Needless to say, this is hardly scientific by modern standards [cinchona bark doesn’t cause such symptoms in anybody else] but by the standards of his day it might well have been seen as a breakthrough. Ideas like Hahnemann’s ‘law of similars’ were in the zeitgeist, and it’s surely no coincidence that Edward Jenner began innoculating patients with cowpox to try to develop an immunity to smallpox in the very year that Hahnemann devised his ‘law’. The difference, of course, is that Jenner’s treatments worked, and it is now know why they worked. They are at the foundation of evidence-based medicine, and they involved a rigorously empirical approach rather than a dogmatic one.

So why is homeopathy still so popular today? One main reason is that there’s money to be made. The Boiron company, the one threatening legal action against an Italian blogger, is worth more than $500 million. Belief in homeopathy is in many ways similar to belief in a flat earth, except that there’s no money to be made from the latter, whereas ‘alternative medicine’ aficionados represent a large market to be tapped, and many who spend their money on these products aren’t particularly discriminating or informed about them. I myself didn’t know the ‘theory’ behind homeopathy until about five years ago, and just assumed it was an alternative term for naturopathy. In the distant past I’ve occasionally been influenced by ‘lefty’ friends to try out echinacea or some other natural remedy for my my chronic chest problems, and, who knows, I may even have bought a bottle of homeopathic pills without fully realising it. Research points to people with chronic, low-level problems like mine as the biggest consumers of these sorts of treatments, because mainstream medicine has no simple remedy available. Everybody is looking for a silver bullet, an instant cure, and sometimes there just aren’t any.

Research also reveals that a majority of consumers of homeopathic remedies are also opposed to vaccination, ‘big pharma’ and mainstream medical practice in general. They tend to be conspiracy theorists, many of them with an agenda. And this brings me to my last point, the dangers inherent in homeopathic treatments. Of course such treatments aren’t dangerous in themselves, because there is quite literally nothing in them. The danger lies, of course, in choosing homeopathic remedies instead of evidence-based ones, for ailments that are not the low-level, chronic ones just mentioned. This can be particularly tragic in the case of parents who insist on treating their seriously ill young children with homeopathy, with occasionally devastating consequences. Luckily most parents, even the homeopathically inclined, come to their senses at such times.

I’m not myself an advocate of ‘big pharma’ by any means – drug producers need to be monitored with all the rigour of modern science. However, I’ve never been inclined to conspiracy theories, and as far as modern medicine goes, we have it to thank for rates of infant mortality [in the west] lower than have ever been recorded, as well as increasing longevity, and freedom from disease, physical pain and suffering that were routine in previous times. Perhaps homeopathy’s survival is an odd unintended consequence of the very success of modern mainstream medicine. It flies largely under the radar as an apparently innocuous alternative treatment for persistent, niggling ailments that are constantly getting a little bit better or a little bit worse. Aunty Mabel and Uncle Bob swear by it, and there are all those testimonials on homeopathic websites. And it’s so natural – so simple. No side effects. And modern medicine, despite billions of dollars of research, hasn’t even been able to cure the common cold!

Never mind that we now know there’s no such thing as a common cold, we now have an expectation that modern medicine can cure just about anything [witness the huge demand for antibiotics] with a pill. In some ways these essentially empty little homeopathic sugar pills are symbolic of modern life.

This piece owes much to chapter 4 [‘Homeopathy’] of Bad Science, by Ben Goldacre, and to Wikipedia’s [very good] article on Homeopathy, linked in this post. Both highly recommended reading.