Jun 15 2009
According to the British Homeopathic Association (does that mean the fewer members they have the more powerful the group?) June 14-21 is Homeopathy Awareness Week. I would like to do my part to increase awareness of homeopathy.
I would like people to be aware of the fact that homeopathy is a pre-scientific philosophy, that it is based entirely on magical thinking and is out of step with the last 200 years of science. People should know that typical homeopathic remedies are diluted to the point that no active ingredient remains, and that homeopaths invoke mysterious vibrations or implausible and highly fanciful water chemistry. I would further like people to know that clinical research with homeopathic remedies, when taken as a whole, show no effect for any such remedy.
In short, homeopathy is bunk. But here is a somewhat longer description of its history.
Homeopathy was founded by Samuel Christian Hahnemann (1755-1843), a German physician who had become dissatisfied with the medicine of his day. Hahnemann lived in a time before the rudiments of modern medicine had been developed, before the germ theory of infectious disease, before the first antibiotic, before systematic testing of drugs for safety and efficacy, before surgical procedures were performed with anesthesia or sterile technique. In his century, it is fairly safe to say, conventional medicine was more likely to do harm than good, and hospitals were a place people went to die, rather than get well. It is no surprise, therefore, that Hahnemann sought for an alternative to the classical approach of his day.
For many years Hahnemann’s search was unsuccessful, until he stumbled upon what he thought was an amazing observation. He took a small amount of cinchona bark, which contains quinine, the drug used to treat malaria, and developed the symptoms of malaria. From this observation he developed homeopathy’s first law, similia similibus curentur, or let likes be cured by likes. In other words, drugs which cause specific symptoms can be used to cure diseases which cause the same symptoms.
As homeopathy evolved, other laws were also discovered. The law of infinitesimal doses was actually a late development by Hahnemann, but today is often thought of as the primary characteristic of homeopathy. This law states that when drugs are diluted in either water or alcohol, they actually increase in potency. Today, serial dilutions of 1:100 repeated 6 or 30 times are commonly used. Between each dilution the substance is violently shaken, which is thought to be necessary to activate the properties of the drug.
Hahnemann also developed, as the underpinning of homeopathy, his own theory of disease, called the miasm theory. According to this theory there are three miasms which are responsible for all human disease, and homeopathic remedies are directed towards treating these offending miasms.
Homeopathy enjoyed a great deal of success in Europe and later in the U.S. in the 19th century. In the year 1900, there were 22 homeopathic colleges and 56 purely homeopathic hospitals in the U.S. During this century, however, as modern medicine came into its own, as life expectancy rose from about 40 years to 80 years, and as the modern approach to disease continuously improved the quality of life, producing a stunning revolution that homeopathy had failed to provide in the previous century, homeopathy declined steadily until it was all but gone.
It is an amazing fact of history, however, that pseudosciences rarely, if ever, die completely. Belief systems such as astrology, phrenology, and homeopathy itself survive long after their usefulness or the primitive scientific environment in which they were developed. Today, homeopathy is experiencing a resurgence, initially in Europe, but it is quickly spreading to the U.S. Homeopathic hospitals have been incorporated into the National Health Service in Britain, and early on in its history the FDA granted approval to the entire homeopathic pharmacopoeia because the remedies had already been in use for so many years.
Today, although there are several different traditions of homeopathy, the basic principles as outlined above remain unchanged. Homeopaths offer as a point of superiority of their method of treatment, that they treat the whole person, taking a “holistic” approach. They denigrate conventional physicians for “focusing narrowly on the disease.” But what does their holistic approach actually entail?
The goal of a homeopathic consultation is to “find the totality of symptoms,” physical, mental, and spiritual. They accomplish this goal by taking a “homeopathic history” which includes questions such as: do you feel sad when you hear piano music, are you excessively tidy or do you have a chilly personality. This information is combined with the patient’s symptoms and their physical “constitution,” which may depend on such facts as hair color. The homeopath then decides on what single remedy will treat the patient’s “totality.” The remedy is then prescribed, and is usually given in either a single dose or only a few doses.
There are many appealing aspects to homeopathy as it is practiced. Patients are made to feel that they are being given a remedy which is specifically designed for them personally, that the goal of treatment is complete cure, rather than just managing symptoms, and that the remedies have no side effects, toxicity, or interaction with conventional drugs. There is, however, no scientific or rational basis to the claims of homeopathy, for it falls cleanly into the realm of pseudoscience rather than true science.
Modern medicine is science-based to the extent that its treatments are based on a working model of disease which in turn is based on human physiology, anatomy, genetics, and biochemistry. All of the principles are subject to experimental scrutiny, and therefore change. They can be proven or disproved by new information. New ideas are subjected to harsh criticism by experts in the field, and must stand the test of such critical examination before they are incorporated into clinical practice. The rapid rate with which medical knowledge changes is not a weakness but a testimony to its scientific basis.
Homeopathy, on the other hand, is a pseudoscience because its underlying principles are not founded in basic research and have remained largely unchanged for almost two centuries. It shrouds itself in the trappings of science, but is devoid of the real substance. Although today there are many efforts to subject homeopathic remedies to double blind clinical trials, homeopaths do not alter their treatments based on the results of such research, they have often been shown to lack carefully controlled techniques, and their interpretation of experimental results reeks of magical thinking.
For homeopaths, the only purpose of clinical research is to validate what they already “know” – it is a statistical crap shoot of placebo vs placebo.
Let us examine homeopathy’s most basic principle, that of infinitesimal doses. Homeopaths today use dilutions of substances which essentially remove all traces of the substance from the final dilution. There is not likely to be even a single molecule of the original drug in the final remedy which is given to the patient. Homeopaths conclude from this fact that the substance is transferring its essence to the water into which it is diluted. The more it is diluted, the more potent is the water. They offer, however, no plausible explanation for how simple water molecules can contain the essence of far more complex substances. They simply call it “water memory”, but labeling is not explaining. They further have no model for how such implausible “water memory” could survive as the water is placed on a sugar pill, digested in the stomach, absorbed in the blood, and then carried to wherever it has its alleged action.
Their model of illness is similarly constructed. Hahnemann developed his ideas before the disease theory of illness was fully developed. In other words, during his time physicians did not yet understand that illnesses were caused by specific diseases; that a given disease, such as diabetes, has a common underlying pathophysiology – a specific malfunction of a specific tissue, organ, or organ system leading to a specific disorder with recognizable signs and symptoms. This modern theory of illness has led, for instance, to the treatment of diabetes with insulin replacement, vastly improving the quality and duration of life of patients suffering from this disease.
Hahnemann, and modern homeopaths, must reject this concept of medicine. Their goal is not to identify which disease afflicts a patient, in fact they criticize this approach. Rather they believe, regressively, that every patient is experiencing a unique illness, which is affected by such factors as whether or not the patient has a weepy personality, and that one remedy will treat all of the patient’s ills, curing the single cause which has displaced them from being well. They admit that the same symptoms often require different treatments in different patients. They dramatically lack any biological model underlying their concepts of illness.
Finally, there is the rule of likes treating likes. Hahnemann based this rule on a single observation. All subsequent investigation was designed to decide what substances should be used to treat which illnesses (summarized in their primary reference, the Materia Medica), but they were all based on the assumption of the rule of likes. No basic research was ever conducted to test the assumption itself, nor are there any biological models which explain why likes should treat likes. Why is it, as homeopaths claim, that and extract of onion should treat colds, which are caused by a viral infection, simply because onions irritate mucous membranes and cause tearing and secretions similar to the common cold. Hahnemann’s theories, unlike modern medicine, did not lead to or stem from any deeper understanding of human biology.
Like cures like is, in fact, an example of sympathetic magic – the primitive notion that substances have properties or mystical connections to things that they resemble. Therefore in some traditions rhino horns are thought to treat impotence, because of their physical appearance resembles an erect penis (more or less).
At this point many defenders of homeopathy would argue, “Who cares how it works, as long as it works.” This defense is used for all alternative medicines which cannot produce a rational explanation for how they work. There is a kernel of legitimacy to this argument, although it does not save homeopathy from being a pseudoscience, in that even in conventional medicine treatments are used before their mechanism of action is fully understood. In such cases, however, it is necessary to demonstrate using carefully controlled clinical trials that such treatments do in fact work.
Further, the lack of a precisely known mechanism of action is not equivalent to extreme scientific implausibility – which is the case with homeopathy.
With regard to clinical trials modern homeopaths have been somewhat self-contradictory. Many homeopaths have argued that homeopathy cannot be subjected to the same type of studies as are conventional drugs. This is because each patient, from a homeopathic perspective, is unique, and cannot be lumped into a single category. Whereas conventional medicine can compare treatments of 1000 diabetics with two different medications, homeopaths cannot produce large numbers of patients with the same totality of illness requiring the exact same treatment. In making this argument, that of untestability, such homeopaths are securing their position in the halls of pseudoscience, for if their is one single quality which separates scientific theories from nonscientific ones, it is falsifiability. If homeopathic remedies cannot be tested, then they can never be grounded in science.
However, this has led to homeopathic studies with individualized treatments – which should address this concern of homeopaths. These studies have been largely negative (when well-controlled and blinded). This lead homeopaths to complains that even these trials were not good enough. Homeopath Weatherley-Jones writes:
For clinical trials of homeopathy to be accurate representations of practice, we need modified designs that take into account the complexity of the homeopathic intervention.
This is a clear case of special pleading -finding a special excuse for negative results, but only after they are negative.
Despite this defense by some homeopaths, modern homeopathic research has focused on these very types of studies. There has been mixed results from these studies and, in conflict with the defense of untestability, homeopathic organizations are quick to site positive studies as evidence for homeopathy’s legitimacy, while simultaneously ignoring the results of negative studies.
Also important is the question of the quality of the research that is being done. Research which is not carefully constructed to eliminate any possibility of bias or fraud, or which is not large enough to produce statistical significance, or which is not reproducible by independent centers, is of little scientific value. In fact such research is harmful because it creates confusion and leads to false conclusions.
Nature magazine famously lead an investigation of the positive research coming out of the lab of Jaque Benveniste. This team, which included James Randi, learned that all the positive research created by the lab were performed by Benveniste’s assistant, Elizabeth Davenas. Benveniste had claimed that all the research was double blind, but Randi soon discovered that this was not the case. Davenas was studying the results of a homeopathic drug on the growth of cells in culture. While Randi observed, she counted the number of cells under a microscope on what she believed to be a test slide, getting a result of 40, which she dutifully recorded in her lab notebook. While removing the slide, however, she noticed that it was labeled as a control. She therefore recounted the slide, arriving this time at a result of 18, which she then corrected in the notebook. It is difficult to conceive of a more blatant breach of basic research protocol.
In short, when the Nature team next subjected Davenas to truly double blind conditions, her positive results disappeared. Benveniste insisted, however, that his lab’s results had been duplicated by four independent labs throughout the world. On investigation, however, it was learned that Elizabeth Davenas had visited each of these four labs and had performed the research herself.
Wim Betz, a physician and former homeopathic doctor who now is an outspoken critic of homeopathy, has similar criticisms of homeopathic research. He reports on one study in which a hormone prepared in homeopathic dilutions was added to a tank of tadpoles and was observed to increase the rate at which the tadpoles developed into frogs. When the hormone, however, was placed inside the tank while inside of a sealed test tube, the same results were observed. The homeopathic researchers, instead of concluding that this control revealed shortcoming of their research, concluded that the homeopathic hormone was transmitting its effect to the tadpoles via some type of rays. They later conducted research to see if such remedies can emit their healing rays over telephone lines.
Another researcher, reports Betz, was confused when the placebo control he used in his clinical trial had the same effect as the homeopathic remedy being tested. Instead of concluding that his study was negative, he instead concluded that since the placebo was stored in the same refrigerator as the remedy, that the homeopathic drug was radiating it effective quality to the placebo. Despite sealing the placebos in aluminum foil and separating them from the homeopathic remedy in different refrigerators, this homeopathic researcher could still not keep the effect of the drug from leaking over into the placebo.
Professor of complementary and alternative medicine, Edzard Ernst, reviewed the homeopathic literature and concluded that homeopathic remedies “contain no biologically active agents and are no more effective than sugar pills.”
Published systematic reviews (examples here, and here) of the literature either conclude that the evidence is equivocal or negative. There is not a single homeopathic remedy for a single condition or illness that has been clearly shown to be effective, despite decades of research. And the overall pattern in the literature is that the better designed the trial, the more likely it is to be negative – a pattern most compatible with a null effect.
Poor scientific technique, magical thinking in the interpretation of negative results, the lack of falsifiability, the absence of a cohesive biological model, and the adherence to unchanging and untested principles has marked homeopathy as a pseudoscience. And yet, it flourishes in Great Britain in particular and Europe as a whole. Also, homeopathic entrepreneurs are spreading homeopathic nonsense to the US.
I am all in favor of homeopathic awareness. The scientific community should use this week to make the public acutely aware of the fact that homeopathy is, put simply, utter rubbish. It is a classic pseudoscience and has no place in a 21st century science-based health care system.
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