Wednesday, October 1, 2008

Homeopathy Is Antiscience (Part 1)

Homeopathy is simply an elaborate placebo. It is certainly not scientific, but it is worse than mere non-science: it is anti-science, and so should have no place in a University. In this series of posts I will explain why. In the first instalment I will describe the dilution problem, and the bizarre range of substances that homeopaths claim to have medicinal properties. In later posts I will consider the research evidence and evaluate the counterarguments that homeopaths use against their critics. But let's start with the basics...

The Dilution Problem

The probability that a homeopathic substance could have any effect (other than placebo) is vanishingly small. We can say this with some confidence because homeopathy contradicts at least two of the most solidly-established principles in biology and chemistry. The first is that larger amounts of a drug or toxin have larger effects. This is called the dose-response relationship, and it is an iron law of biomedicine. Ten paracetomols are more dangerous than two, just as ten pints of ale will get you drunker than two. There are no exceptions, except in the topsy-turvy world of the homeopath, where lower dilutions such as 3X can be bought over the counter and given to babies (e.g. for teething) whereas extremely high dilutions such as 200C are thought to be far too dangerous for this, and should only be prescribed by a trained practitioner.

For readers unfamiliar with homeopathic notation I will explain these dilutions. The "X" means that the original essence has been diluted one part in ten, and the number tells you how many times the dilution has been repeated. So 3X means that a one in ten dilution has been repeated three times, leaving a final concentration of one in a thousand, or 1x10E3. A "C" dilution is one in a hundred, so a 200C preparation would have a concentration of one in 1x10E400 (forgive me for not writing out the full number: a one followed by 400 zeroes). This brings me to the second basic principle that homeopathy flaunts: the Avogadro limit. Once the dilution process has passed 24X or 12C we can be pretty sure that no molecules of the original substance remain. According to the standard molecular model of Chemistry it is impossible for these dilutions to have any effect. At the lower dilutions yes, a 3X dilution will still contain a fair dose of the original essence, but most homeopathic preparations are taken way beyond the Avogadro limit: 30X and 30C are probably the most commonly used. To visualise a 30C dilution, imagine one molecule of an active ingredient being added to 10E60 molecules of diluent. What would this look like? We are not talking drop-in-a-swimming-pool or even drop-in-the-ocean here. 10E60 water molecules would make a sphere twenty-eight billion times larger than planet Earth.

Homeopaths are aware of the dilution problem, of course. However, they contend that it is irrelevant because of the way the dilutions are carried out. Between each step in the dilution process, the preparation is vigorously shaken (or "succussed") in order to transfer the "healing energies" of the solute into the diluent. This is obvious nonsense, and we will see later on that there is absolutely no evidence that succussion has any effect. But first, let's look in more detail at the range of substances homeopaths use to create these strange solutions.

Animal, Vegetable, Mineral?

At dilution levels beyond the Avogadro limit it makes no difference what the original essence was, but it is still worth spending a few moments considering the range of ingredients that homeopaths use. This provides another reason to be sceptical about the claims of homeopathy: the jaw-dropping silliness of the so-called remedies.

One common misconception about homeopathy is that it uses only natural substances, such as herbal essences and plant products like coffee or onions. Indeed, there are homeopaths who choose to specialise in such remedies, but for most practitioners the herbals are only a small part of their armoury. Another very important group of remedies are based on minerals, especially salts such as sodium chloride, magnesium phosphate and silicon dioxide, which you can buy in combination as a hayfever remedy. A third group of remedies are based on animal parts or products, such as duck liver, snake venom and even dog excrement. Fourthly, there are remedies known as “nosodes”, which are made from human disease products, such as pus, mucus, blood, faeces and scraps of tissue. Finally, there is a group of remedies known as “imponderables”, made from such things as electricity, thunderstorms or sunlight. There is even a remedy made from fragments of the Berlin Wall, used for those who feel oppressed, or who find themselves having to mediate between warring factions. I am not joking: homeopath Charles Wansbrough reports using Berlin Wall for patients who have “decided that their surrounding environment was hostile and suppressive and chose to create a ‘wall’ of fury that encircled their way of being”. Kees Dam was sceptical but decided to try a proving and was convinced:

“My ‘Berlin Wall’ was broken down when I trusted and believed my eyes seeing the effects of Berlin Wall as a homeopathic remedy”.
Dam admits that the proving was not done blind, but does not think that to be a problem:
“I must honestly say that I never saw any difference in the quality of the proving depending on if the prover knew the remedy or not”.
I hope it is clear that such thinking is closer to sympathetic magic or voodoo than it is to science. Some homeopaths agree, and remedies like Berlin Wall have proved divisive. George Vithoulkas launched a stinging attack in a speech in, appropriately, Berlin:
“If we teach our students to do or apply ridiculous things we will only reach the 'ridiculous', if we potentize the Berlin wall, or the National Anthem of France and we encourage our students to follow such nonsensical ideas, homeopathy will be identified with the ridiculous.”
Quite.

Homeopaths select these "remedies" according to a principle known as the “Law of Similars”, or “Like cures like”. In 1790, the German physician Samuel Hahnemann noticed that cinchona bark, which contains quinine and had long been used as a malaria remedy, actually produced some of the symptoms of malaria when taken by a healthy person (namely himself). Unfortunately for homeopaths, it may be that Hahnemann’s reaction to the cinchona was in fact simply the result of an undiagnosed allergy. Nevertheless, it led him to wonder if a general principle of similarity could be used to discover new remedies, and to classify the chaotic muddle of herbal and mineral preparations that constituted the materia medica of the day. He therefore embarked on a series of experiments upon himself and others, to test for the pathological effects of various substances, including mercury, belladonna, tobacco and nux vomica. Family, friends, students and colleagues submitted themselves to these “provings”, and by 1796 he was convinced that homeopathy (“similar suffering”) was indeed the answer: a substance that causes particular symptoms in a healthy person can be used to cure those symptoms in a sick person. A few examples of the current uses of well-known substances should suffice to give the general idea: onions irritate the eyes and nose, and so may be given as a treatment for colds; coffee is a stimulant, and so can be used to treat insomnia; arsenic causes sickness and diarrhoea, and so is used for food poisoning, and so on.

Hahnemann intended his work on similars to be a refutation of the doctrine of signatures, which provided the basis for much of the medicine of the time. For Hahnemann, similarity was solely a matter of the effects a substance had, not (as in the doctrine of signatures) anything to do with its physical appearance or provenance. However, it is immediately clear from considering the range of substances described above that the doctrine of signatures quickly re-asserted itself, and that a major flaw in the method used in Hahnemann’s provings allowed this to happen (and has been perpetuated in almost all subsequent provings by others): his experiments were not done blind. In other words, he always knew exactly what his guinea pigs were taking, and probably they knew it too, and so his and their perceptions of any symptoms would inevitably have been coloured by the nature of the test and their existing knowledge of the substance. It is not therefore surprising that many ancient herbals resurfaced in homeopathy with similar functions based on appearance. Euphrasia, for example, re-appears as a homeopathic remedy for eye problems, just as it did under the doctrine of signatures owing to its supposed resemblance to a bloodshot eye. So as we have seen, nowadays virtually anything can be (and is) used as a homeopathic remedy, often based on nothing more that superficial resemblances or associations.

Conclusion

In this post I have explained three reasons to be highly sceptical of homeopathy: it defies the dose-response relationship, it ignores the Avogadro limit, and it uses a bizarre range of ingredients. Despite this, many homeopaths claim that there is good evidence that homeopathy does work. In the next instalment I will consider this evidence in more detail.

18 comments:

Rob a said...

Great start to the blog, Mike.

DT said...

As you say, the mind-numbingly ridiculous sources of "mother tinctures" used as the essence of the homeopathic remedies should make anyone with any common sense dismiss the whole concept.

Apart from the ones you mention, like "Berlin Wall", the homeopaths have foisted such gems as dilutions of the "light of venus", AIDS and positronium (antimatter) to name a few.
http://www.homeopathyschool.com/provings.html

Dr* T said...

Hi Mike,

Welcome to the world of blogging - and what a great start!

Remember to take your homeopathic owl malarial blood tabletsd (not sure what they're for though)

Cheers

T

Mike Eslea said...

@ DrT

Owl blood? What a hoot! Reminds me of the falcon blood proving at http://www.hominf.org/proving.htm

This is one of my favourite websites, filled with gems of purest stupid: how about some house-sparrow head? Unbelievable!

David Colquhoun said...

Welcome to the blogosphere

Polonium 210 is another favourite of mine. Utterly batty

canonical_view said...

Oh, good start :)

Glad to see you are finally doing this! And oh, how I wished you were joking about that link to dog excrement, but no, apparently not ...

jdc325 said...

"... the mind-numbingly ridiculous sources of "mother tinctures" used as the essence of the homeopathic remedies should make anyone with any common sense dismiss the whole concept"
Yes, I'm a bit cynical as to whether these mother tinctures really are used as the essence of remedies anyway. Someone on an internet forum calling themselves Anna of Arnica claims to have spoken to Helios and received an assurance that no ducks are killed in the making of their remedies - which is odd, because the last time I checked they were selling oscillococcinum (duck's liver). I'm not sure how you could obtain duck's liver without slaughtering ducks, but someone on the Bad Science forum did suggest that perhaps Helios wait for ducks to die from natural causes.

SVETLANA PERTSOVICH said...

Hello, Mike!
Good blog.

However, I think that blogging can be useful only if it is supplemented by real fight against quackery in universities. REAL ACTIONS are necessary! Besides, these actions MUST be successful. Or else blogging turns into idle blabbing. I hope that you will be capable to escape this danger in your activity.

Good luck!

What about UCLan's quackery courses? What is the news? Does Dr. McVicar intend to close them at last?

apgaylard said...

A very enjoyable post Mike - I look forward to the rest of the series!

My favorite 'provings' of the moment are Mobile Phone (Eriksson GH337 and Nokia 5.1) (pdf)and Chlamydia Trachomatis (word doc) from the acolytes of Jeremy Sherr at the South Downs School of Homeopathy.

Miraculous Molecule said...

Mike,
You're far too negative!

Homeopathic priciples can sometimes be used to very good effect. For example, the more Punk Rock music is diluted the better it sounds (and the later the onset of deafness in the listener). And just to be on the safe side, it is best to take it well below the auditory threshold and thereby ensure that it is beyond further improvement. [Please forgive me for the slight departure from Homeopathic orthodoxy which, as I understand it, admits of no limit to the power of dilution.]

Miraculous Molecule said...

Rather than resorting to exotic indices of dilution such as the volume of the earth, the dilution issue is better explored as follows. Consider the very powerful dilution of 200C. This would entail a procedure along the following lines: 1) take a sample of, say, 10 grams of the ‘active substance’; 2) add water so that the total volume was one litre; 3) ‘succuss’ it; 4) retain a 10ml sample and throw away the remaining 990ml; 5) repeat steps 2, 3, 4, & 5, 199 times. Now, because the reduction in the number of molecules in a sample is directly proportional to the number of prior dilutions – a 2C dilution, for example, would result in a sample that contained 10,000 times fewer molecules than were in the initial sample - we know when we have reached a stage when there are likely to be no molecules left. A 10gr sample of glucose, which contains 10E22 molecules, provides a convenient example. At the end of an 11C dilution series it would have been diluted the same number of times as the number of molecules of glucose in the initial sample. Assuming that the diluting and sampling had been perfectly executed, this final sample would therefore contain just one glucose molecule. After a 12C series there would be only a one in a hundred chance that a glucose molecule remains; after a 13C series a one in 10,000 chance; after a 14C series a one in a million chance; … after 200C series there is no chance (or, to be pedantic, a chance of one in million multiplied by a billion raised to the power 31).

At this point one might think that common sense dictates that homeopathy cannot be effective, at least where dilutions exceed about 11C. However, to their credit, homeopaths share Oscar Wilde’s (and the Miraculous Molecule’s) view that the application of common sense is brutal and brutish. It is, He said, “like hitting below the intellect” thus denying access to the creative imagination. And this applies not just to art but to science and (alternative) medicine too. What’s more, it is following in a respectable tradition; for example, Copernicus proposed the heliocentric hypothesis at a time when the balance of evidence (and common sense) still favoured the geocentric position, or so it is commonly claimed. He kept the faith and of course was in the end vindicated.

Homeopaths, again to their credit, have also been keeping faith. Their initial solution to the dilution problem was to relocate the presumed site of the ‘healing molecules’. They were no longer said to reside in the ‘active substance’; now they resided in the diluting agent, the water. The succussion procedure was at the bottom of it. In the more modest dilutions it caused the water molecules and the ‘active substance’ molecules to bang up against each other. This effected a permanent change in the former. In essence this meant that the water molecules had become antidotes to the sorts of condition that macro doses of the active substance normally mimicked. Whether this curious curative property derived directly from the aggregate actions of the individual molecules or from a change in the way they interacted that altered the structure of the water was a question that initially divided homeopaths. Either way, they have talked of the water containing a ‘memory’. However, both sides conceded defeat when it was drawn to their attention that just as there will not be a molecule of the original substance left after a 12C dilution then neither will there be a ‘memory molecule’ left after a further 12C dilution.

This revelation was explosive. The homeopaths were shell-shocked. To their rescue rode a brilliant Irishman, Sean Omar Reason, who had begun his intellectual life as a distinguished Jesuit scholar, before turning to Islam, and then immersing himself in the science of complementary medicine. His feat was to combine Sheldrake with Lovelock - morphic resonance with Gaia theory - to create an account, at once powerful and elegant, that explained how the water comes to have a memory AND the trickier business of how that memory gets passed on in increasingly augmented [‘potentised’] form with each successive dilution. In this latter case, it is the (morphic) resonance that is coming from all the molecules discarded at the end of each step in the dilution procedure that lies behind it – the greater the number of dilutions the greater the number of molecules and therefore the more powerful the effect.

Arghhhh - The Miraculous Molecule [MM] has just this minute returned from a Google search that revealed that ‘homeopathy’ has already been frequently linked with ‘morphic resonance’, with ‘Gaia theory’, and occasionally with both. First impressions are that little or none of it is satirical. MM is now very uncomfortably exercised by the possibility that many readers will interpret his posting as an endorsement of homeopathy. He needs time to calm down and re-group; his electrons are in danger of spinning out of their orbits.


Two days (and a 200C dose or two of adrenaline) later…

MM has decided not to write an alternative spoof but instead will refer the reader to one he has found on the internet. It has been done extremely professionally but contains enough contradictions and amusing absurdities to make it obvious to even the most inattentive or gullible reader that it is a spoof. The website (http://www.homeopathy-soh.org/) is entitled ‘The Society of Homeopaths’.

Concentrating first on dilution: In a subsection headed ‘Are homeopathic remedies safe?’ the reader is told “Homeopathic remedies are a unique, potentised energy medicine, drawn from the plant, mineral and animal worlds. They are diluted to such a degree that not one molecule of the original substance can be detected (after the 12c potency).”

Then, under the subheading ‘How are the remedies made?’, the reader is told “…
the 30c [dilution] represents an infinitessimal part of the original substance.”

This is quite clever. The contradiction is clearly designed to highlight the difficulty homeopaths have in coming to terms the ‘Avogadro limit’, a constraint that their founder was unaware of and therefore couldn’t take into account. Moreover, the second extract entails the extraordinary implicit assumption that there is a form of matter which is additional to that contained within molecules and which is infinitely divisible. But at least the idea of memory encoded in the water seems to have been dispensed with – perhaps because it is too plausible to be satirised. But wait a minute… no, MM spoke to soon:

Under the subheading ‘If they are so dilute, how can they work?’ the reader learns: “After each dilution the mixture is vigorously agitated in a machine that delivers a calibrated amount of shaking. This is called succussion. It is thought that this process imprints the healing energy of the medicinal substance throughout the body of water (the diluent) as if a message is passed on. The message contains the healing energy. Even in ultra-molecular dilutions, information specific to the original dissolved substance remains and can be detected.”

Here we have a marvellously vacuous account of something called “healing energy” that is “thought” to be passed from “the medicinal substance” to the body of the water along with a wholly unrealistic claim that “information specific to the original dissolved substance remains and can be detected”.

Unfortunately, the authors of the spoof did not rise to the task of explaining what
‘healing energy’ is. But at least they made it clear that they were not speaking metaphorically when they warned that the healing energy was not to be exposed to such hazards as strong smells and mobile phones:
“If you are given homeopathic remedies to take at a later date, be sure to store them in a cool dark place, away from anything with a strong smell and try to avoid placing them near your mobile phone. If you travel abroad, where possible, try to avoid putting the remedies through the X-ray scanner.”

MM will end this post with what is perhaps the funniest and most outlandish part of the Society of Homeopaths’ spoof:
To explain one of the three ways in which the clinical indications of our medicines are discovered they write: “The ‘signature’ of the medicine, an ancient medical idea based on the ‘affinities’ of certain substances (eg. Deadly Nightshade, Atropa belladonna has large shiny black berries that resemble the dilated pupils of the eyes in high fever).”
Beat that!

Mike Eslea said...

Nice one MM. Shame you changed your mind about carrying on the spoof, but unfortunately it is impossible to satirise religion (yes, homeopathy is a religion). Check out Poe's Law...

Anonymous said...

hi mike
although i agree with many many many of your comments i have a problem with your initial statements concerning the 'anti-science' of homeopathy, and therefore it has no place in a university.
english lit is not a science and does not pretend to be, as paul rogers would say 'it's writing is too flowery', so does that mean it should not be taught at uni? also art, fashion design, etc.
i myself have never used such ludricrous remedies and to be honest will avoid the doctor as much as i can as i have little faith in the medical profession. i do however feel that for thousands of years people used natural remedies to attempt to cure ills and were successful to some extent, i believe this is largely due to the power of suggestion, but hey, if it worked it worked.
nice blog though

Mike Eslea said...

@ Anonymous

I think you've missed my distinction between "non-science" and "anti-science". The former is fine, but the latter - things that are directly contradicted by the scientific evidence - is not. I don't think a University should teach homeopathy any more than they should teach astrology or witchcraft.

NW said...

Actually, I have not come across any scientific studies disproving astrology and witchcraft. It would be hard to do so; the best you can do is show that specific practitioners or systems are bogus, one by one.

As for what a university should teach, do you mean a publicly funded university? I would be willing to use the word "university" to refer to a center of learning and research of a certain size and scope -- with that definition, I have no problem including fields that don't agree with the current scientific models for how things work. Just as genetic diversity is an important resource for when conditions change, I think it's great that we let many systems of thought develop. If you mean that you don't want taxpayers to fund something that mainstream science rejects, I can see that.

Mike Eslea said...

@NW

I don't think it makes any difference who funds a University. The name "University" is legally protected, and in order to call yourself a University you have to meet certain standards. Sadly, in the modern world this seems to mean little more than mastery of edubabble, but in a sensible system it would also mean intellectual honesty and respect for evidence. The problem with homeopathy is not just that it "doesn't agree" with mainstream science, it is explicitly contradicted by the scientific evidence. It is not a "system of thought", it is an absence of thought.

Anonymous said...

utter foolishness mr.... think u don't know the principle less quantity more quality.please read the articles about molecular chemistry and homoeopathy.hope all of u who mocked homoeopathy will once recognise the wonders of that system.

Kiron Ahmed said...

Homeopathy is a great science of noble man Hahnemann. But I feel that there is necessary huge research. So we can get it strongly and powerfully.
thuja homeopathic