An Introduction to Homeopathy: Part 2
In Part 1 of this article, we took a look at the origins of homeopathy and the formulation of its theories, which should have alerted almost any reader to the possibility that the theory of homeopathy just doesn’t hold water. However, a surprising number of homeopathy proponents are utterly unaware of this history, just as many of us may be unaware of the history of most of the conventional medications we take for granted. As such, homeopaths will often attempt to justify why or how their favourite remedy works, with arguments that are blind to its origins. In Part 2, we’ll take a look at some of these.
As a caveat, this is only an introduction, so I will merely be touching on some of the arguments. I would greatly encourage further reading on the topic.
Homeopathy works because I/my patients are satisfied that it does.
The most often used explanation, and the one you should trust the least, is the argument from personal experience. There are a host of reasons why the plural of anecdote is not evidence: subjectivity, the quirks of memory, cognitive dissonance and, most of all, the placebo effect. The majority of ailments that homeopathy (and indeed, most alternative medicine) treats so ‘successfully’ are either those that are highly subjective, cyclic or prone to the actions of the placebo effect – like pain or depression – or those that would clear up on their own – like the ‘flu. This leads to apparent relief that is incorrectly ascribed to whatever remedy happened to be taken at the time. Add to this the fact that both the patient and the doctor both have a vested interest in the remedy working, which is likely to blind them to all the previously listed effects, and you have a powerful recipe for false satisfaction. For more, read up on the placebo effect and the fallacies of false cause.
There have been many scientific studies published showing that homeopathy has a real clinical effect.
It is true that many positive clinical trials of homeopathy have been published, but that’s not where the story ends. It is irresponsible to merely read the conclusion of a paper and not weigh up the quality of the study itself. Did the trial make use of placebo controls? Were there enough participants to draw any reasonable statistical conclusions? Did the trial report attrition rates and were they sufficiently low? Were both the practitioners and patients blinded as to which group was the control? Has a biostatitian weighed the results for statistical significance? Are the authors even qualified to conduct clinical trials1? Have the authors made leaps in their conclusions that are not supported by the evidence… the list goes on and on. Add to that the publication bias towards positive results that affects all journals to some degree, but which apparently affects Complementary and Alternative Medicine journals even more so2, and what you have is a minefield of potential false positives.
How is anyone supposed to tell which studies are worthwhile and which are not? To our rescue comes the concept of a systematic review, or meta-analysis – a process by which a large number of available trials are weighed and considered for a consensus. Good systematic reviews take all the above questions into account before reaching their conclusions. In the history of homeopathy, there have been many systematic reviews of the available papers. One of these did not sufficiently consider the methodological quality of the papers in question, came to a cautiously positive conclusion3, but warned that further study would be required. A further six analyses were performed in response, all concluding that the original analysis had come to an erroneous conclusion by allowing poorly-controlled and -conducted trials to carry the same weight as good ones. The remainder of the analyses found no evidence for a homeopathic effect beyond the placebo effect, and this was all wrapped up very nicely by Ernst in his Systematic Review of Systematic Reviews of Homeopathy, which concluded
…there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo.
For more, read R. Barker Bausell’s Snake Oil Science. Despite the pejorative title, this is a fair and thorough look at the clinical study of CAM treatments, including homeopathy. Bausell is a research methodologist and former researcher at the National Center for Complimentary and Alternative Medicine.
Homeopathy works because of the Law of Similars and the Law of Infinitisemals.
Given what we know of the history of homeopathy, thrusting forward its made-up laws should seem like a patently absurd argument. However, bear in mind that most fans of homeopathy are introduced to these laws much as we are first introduced to the law of gravity or the laws of motion – as immutable facts which our elders and betters have discovered and now pass down to us, with little context or history to validate why these laws should be so.
However, anyone with a basic science education should immediately be suspicious of such laws. The law of similars presents no chemical or biological reason why it should work, and in normal dilutions even a homeopath would admit this to be so. It is the law of infinitisemal dilution, they say, that changes a substance from harmful to helpful. Yet the law of infinitisemals itself does not stand up to scrutiny. For a start, the dose-response mechanism (by which we respond more strongly to stronger concentrations) is an established fact, based on solid science. We all know from experience that a higher concentration of alcohol in a drink hits us harder. We all know that if we want to really knock out a headache, we should take two aspirin instead of one. It’s basic chemistry. For homeopathy to establish a law of dilution – that less of the active ingredient creates a stronger effect – it would not only have to prove this to be so, but it would also have to posit why, up until now, every other substance ever introduced into our bodies has behaved in exactly the opposite manner.
But all of this is itself a moot point, given that the dilutions normally recommended are such that there cannot be a single molecule of the original substance left in the product. An average homeopathic dilution of 30X (1 in 1030) is equivalent to a single drop of the active substance in a container 50 times the size of the earth – even without a calculator you should be able to figure that if you took a sip of the resultant mixture, your chances of getting anything but water are pretty slim. Oscillococcinum, the homeopathic remedy for influenza (made from duck’s liver), is usually prescribed at a concentration of 200C, which is 1 in 100200, or 1 in 10400. At a concentration of this kind, to be sure you had swallowed just one molecule of the active ingredient, you would have to drink more molecules of water than there are molecules of anything in the known universe.
The process of succussion imbues the dilutant with the power of the active ingredient, even after it is long gone.
Even Hahnemann realized that there was a problem with the concentrations he was suggesting, and argued that it was the shaking between each step of dilution that inferred a spirit-like quality to the dilutant (potentized it), thus allowing the power of the active ingredient to be transferred without needing any actual particles of the ingredient to remain in the solution. He obviously explained this with reference to the magical vitalist forces used to explain just about everything at the time. Today, homeopaths make exactly the same argument, but now refer to the ‘memory of water’ or assure us it’s all got to do with ‘quantum mechanics’. Same argument, different magic.
Let’s talk about quantum mechanics first. Despite what you may have heard, quantum mechanics has not proven homeopathy, nor could it even if it tried. Quantum mechanical effects do not assert themselves at classical scales i.e. at the scale of you, me and a vial of water. The only way to get a homeopathic solution to exhibit quantum mechanical behaviour of any kind would be to cool it to a few nanokelvin above absolute zero, or possibly to accelerate it to near the speed of light and smash it violently into something. Simple ‘shaking’ is not going to cut it.
Similarly, any claims that water has been proven to have a memory are absolutely false. But you do not need to understand advanced physics to see the holes in the ‘memory of water’ argument. All you need is a little common sense. A common response is this: if all that shaking about imbues the water with the essence of the ingredients it is in contact with, why is it not also imbued with the essence of the glass vial, the breath of the homeopath, or the variety of other impurities that are absolutely present in water? After all, even the purest of pure water contains foreign molecules at homeopathic solutions!
But an even more powerful common sense argument is this: if it’s all about the magical properties of water, this wonder-molecule that makes up most of our bodies, covers most of the earth, ‘resonates’ with our biofield, and is capable of altering its structure to mimic that of any substance… why then are so many homeopathic solutions dropped onto a sugar pill and allowed to evaporate before being bottled and sold? Even if the water does hold the matrix of the active ingredient, how does it transfer this to the simple sugar? And even more telling, if it’s all about the power of water, why then are some homeopathic solutions diluted in alchohol?
What’s the harm?
Even with all we know of homeopathy, we may still think to ourselves that perhaps it is not a bad thing for such a sham treatment to exist. The patients feel as though they are being treated, they are less of a burden on our already over-burdened health system, and homeopathic doctors on the whole are more attentive than regular GPs. Maybe it’s all make believe, but is it dangerous?
The answer is yes, when it comes to a certain range of homeopathic substances: vaccines and prophylactics. While it may be fine for the Queen Mother to dose herself with a homeopathic remedy when she gets a cold, it is not fine for a small child to be vaccinated against polio with water, or for tourists on their way to Africa to be prescribed same to protect them against malaria. And how about when it’s used to treat conditions much less innocuous than the common cold, such as when homeopathic solutions of infected blood are administered to AIDS sufferers?
Worse, homeopathy is not only administered to consenting adults, but also to small children and pets. Since the placebo effect is largely one of conditioning, it cannot be expected to work on babies and animals. In fact, it works on the parent or owner, leading them to convince themselves that the patient is doing better, when in fact they continue their mute suffering regardless.
There are of course many other arguments made, ranging from ‘Homeopathy is a victim of Big Pharma Propaganda’ to ‘You can’t possibly criticise homeopathy if you haven’t studied it yourself’, but I have neither the time nor the patience to try to address these obviously absurd statements. Others such as James Randi, Ben Goldacre and Stephen Barrett have done this for me already. They are known for taking strong stances against homeopathy and, to the uninitiated, their attitudes may seem unfairly scornful. However, I hope that after this brief introduction, you can at least understand why someone might be so very upset by the proliferation of such a thing. All I can do now is encourage you to read further – Quackwatch’s sister site, Homeowatch, is an excellent resource.
1Keep in mind that a medical doctor is not a scientific researcher by default, and alternative medicine practitioners even less so.
2Despite the authors’ backward conclusion, which itself supports the argument for postive bias in CAM publications.
3Linde K. et al., Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-43. Naturally this is the only meta-analysis trusted by homeopaths, despite its thorough debunking. Many homeopathy sites not only misrepresent the findings of this paper, but also ignore all the other reviews that came after it.