When doctors and scientists publicly denounce the viability of homeopathy, much of the resistance and confusion on the part of the general public stems from people confusing homeopathy with medicinal herbs or with simple home remedies. That is not what we are referring to. When we speak of homeopathy, we’re talking about products based on two main pre-scientific ideas which were codified and promulgated in the late 1700s and early 1800s by a man by the name of Samuel Hahnemann.
They are as follows:
2. The law of infinitesimals. (The idea that the medicine becomes more effective the lower the dosage).
That means that if someone was sick, the homeopath would find some substance believed to CAUSE symptoms similar to that which the patient is experiencing, and then dilute it repeatedly until there was little or none left.
However, this took place before modern chemistry. We now know with great mathematical precision that a given amount of a substance has a certain number of fundamental atomic or molecular units of which it is comprised. In chemistry, we use the standard of one “mole,” which is defined as 6.02*10^23 atoms (or molecules) of the substance. That’s approximately six hundred thousand million million million! And is known as Avogadro’s number. So, just as we use the term “one dozen” to refer to twelve of something, we use the term “one mole” to refer to approximately 6.02*10^23 of something. The mass and volume of one mole always depends on the substance in question, simply because different elements and molecules have different masses and densities, but for many common substances, one mole is an amount that can approximately fit in a person’s hand (though a mole of a larger and/or more complicated molecule may of course take up more space than that).
Why does this matter?
Well, supposing tacitly that the particular substances they use are even capable of treating the patient’s ailments (which is a generous assumption), the way homeopaths utilize the so-called law of infinitesimals is by diluting the substance (usually with water) over and over again. The problem is that diluting to that degree means that the probability of finding even just a single molecule of the active ingredient (or allegedly active I should say) in the amount supplied in most homeopathic products, is ostensibly zero. To have a non-trivial likelihood of finding even one molecule at that concentration, one would have to consume a homeopathic product oh, I don’t know, say maybe the size of the Continental US (for moderate dilutions), or as big as the radius of earth’s orbit around the sun in the case of really large dilutions.
This not only goes against everything we know about biology and medicine, but against everything we know about chemistry and even physics.
For example, on many commercial homeopathic products, you may see notation such as 12X or 30C. The 30C designation means to dilute the original solution to 1 part in 100, and then to repeat that 30 times. C means 100, and 30 means the number of times it’s done. We’re on an exponential scale, so that’s (10^2)^30, which equals 10^60. In other words that dilutes the original solution by 1 part in a trillion trillion trillion trillion trillion (by volume of solution: not by mass). To put that in perspective, a mol of any substance, (a standard unit of measure in chemistry for an amount of a substance), is about 6.02 x 10^23, or approximately 600 billion trillion molecules of the substance. So, just to make the arithmetic easier, supposing you were to start with about 1/6th of a mol of the purported active ingredient; that’s roughly 100 billion trillion, or 10^23 molecules diluted by a factor of 10^60, which is 1 in 10^37, or 1 part in 10 trillion trillion trillion, which works out to
NOT FUCKING MEDICINE!!!
More recent generations of homeopaths have attempted to construct theoretical reasons why it could still work, but they are regarded as pseudoscience because there’s no evidence for them, but a lot of evidence against them. These attempts at reconciling belief in homeopathy with modern physics have included things like the idea that the water “remembers” the medicine that used to be in it, and that that changes its structure and/or behavior. Other ideas include “vibrational medicine,” which attempts to borrow technical-sounding terminology from the field of quantum mechanics, but for which there is no support to be found within either modern physics or clinical medicine.
If that were indeed the case, one might be inclined to question why water would “remember” the essence of the active ingredient that was diluted out, but wouldn’t remember the Stegosaurus poo, or whatever other unsavory substances with which a given H2O molecule would likely have come into contact over billions of years of evaporation, re-condensation, freezing, thawing, splitting and reformation.
The following article goes over some of the evidence-free pseudoscientific mechanisms of action that have been proposed by various homeopathy proponents.
Yet, despite this, many people believe in it anyway, usually based off of personal anecdotes that can be understood in terms of the placebo effect (a notion which homeopathy proponents typically seem to misunderstand and/or misrepresent). Consequently, many double blind placebo clinical trials have been done which establish that the products simply don’t work. They are the equivalent of taking sugar pills, or drinking water.
If the scientific community had dismissed homeopathy purely on the grounds that it contradicts the last 300 years worth of theoretical science in chemistry, physics and biology, then proponents of homeopathy would just dismiss us as closed-minded. But the fact that so many clinical trials have been done suggests that we were open to the far fetched idea that literally everything from atomic theory and particle physics to immunology and the germ theory of disease were all incorrect. All we required was some good quality evidence that homeopathy could produce some clinically relevant effects in excess of a placebo. It just turns out that even when you judge on the basis of efficacy alone, without worrying about whether it makes theoretical sense, we see that it indeed does not work.
The studies that appear to show positive effects tend to lack one or more of the essential features of informative high quality clinical trials. These include elements such as random selection, random assignment, decent sample sizes and double blinded placebo control groups, all of which serve to minimize bias and filter out obfuscatory noise in the data in order to draw more reliable conclusions. When a large number of double blinded placebo controlled trials have accumulated, it becomes possible for scientists to perform a systematic review. Systematic reviews are among of the strongest forms of evidence one can have on the evidential hierarchy in science, because they combine a large quantity of the best quality evidence available pertaining to particular question in order to examine trends and prevalent conclusions in the data.
What follows is a paper even more inclusive than that; it’s a systematic review OF systematic reviews on the efficacy of homeopathy for various medical conditions.
The authors stated the following:
“Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, 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. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice.”
Moreover, The National Center for Complementary and Integrative Health concluded the following:
“There is little evidence to support homeopathy as an effective treatment for any specific condition.
Although people sometimes assume that all homeopathic remedies are highly diluted and therefore unlikely to cause harm, some products labeled as homeopathic can contain substantial amounts of active ingredients and therefore could cause side effects and drug interactions.
Homeopathic remedies are regulated by the U.S. Food and Drug Administration (FDA). However, FDA does not evaluate the remedies for safety or effectiveness.
Several key concepts of homeopathy are inconsistent with fundamental concepts of chemistry and physics. There are significant challenges in carrying out rigorous clinical research on homeopathic remedies.”
This conclusion was corroborated by national health review committees in both Australia and the UK as well.
Back in 2009, the WHO went on public record by stating that it does not recommend the use of homeopathy for the treatment of HIV, TB, malaria, influenza or infant diarrhea.
The following were some of their comments:
Dr Mario Raviglione, Director, Stop TB Department, WHO:
“Our evidence-based WHO TB treatment/management guidelines, as well as the International Standards of Tuberculosis Care (ISTC) do not recommend use of homeopathy.”
Dr Mukund Uplekar, TB Strategy and Health Systems, WHO:
“WHO’s evidence-based guidelines on treatment of tuberculosis…have no place for homeopathic medicines.”
Dr Teguest Guerma, Director Ad Interim, HIV/AIDS Department, WHO:
“The WHO Dept. of HIV/AIDS invests considerable human and financial resources […] to ensure access to evidence-based medical information and to clinically proven, efficacious, and safe treatment for HIV… Let me end by congratulating the young clinicians and researchers of Sense About Science for their efforts to ensure evidence-based approaches to treating and caring for people living with HIV.”
Dr Sergio Spinaci, Associate Director, Global Malaria Programme, WHO:
“Thanks for the amazing documentation and for whistle blowing on this issue. The Global Malaria programme recommends that malaria is treated following the WHO Guidelines for the Treatment of Malaria.”
Joe Martines, on behalf of Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO:
“We have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children…Homeopathy does not focus on the treatment and prevention of dehydration – in total contradiction with the scientific basis and our recommendations for the management of diarrhoea.”
Now, all of this raises a couple of questions.
Firstly, why do so many people still believe in homeopathy?
Secondly, what’s the harm in letting those beliefs go unchallenged?
There are a number of reasons that contribute to the first. As I alluded to at the beginning of this article, a lot of people simply don’t know precisely what the term refers to. Additional contributors may include the placebo effect, regression to the mean, the post hoc ergo propter hoc fallacy, a belief that it’s more natural and that natural equals better, or perhaps just a general distrust and/or dislike of mainstream medicine.
There are many people who tend to assign greater salience to their personal experiences and anecdotes than they do to rigorous scientific evidence, either because they aren’t aware of the degree to which additional variable can confound the accuracy and objectivity of their assessment of their experiences, and/or because they lack the scientific background to competently evaluate the veracity of the conclusions on which scientific studies are based.
Now, to be fair, Hahnmemann began implementing his ideas in a time during which contemporary medicine was still not very scientific. Many of the standard treatments were not merely inefficacious and based on flawed premises, but were in many cases more harmful than simply leaving a patient untreated so he or she could heal naturally. For instance, blood letting was still quite common in his time, and wasn’t even seriously questioned by science until the mid-19th century. So, people could be excused for buying into it at the time given the current state of human medicinal knowledge and methods. However, many people still believe in homeopathy anyway even though that’s no longer the case.
Additionally, people have also had bad experiences with hospitals, costly and arduous drug procedures, drug regimens and insurance plans, and experiences of mainstream medical doctors appearing cold, detached and not giving them the time, compassion and attention they felt they needed. In some cases, that may have pushed them away from science-based medicine. As a side note, I do think there may be something to learn from homeopaths and other so-called alternative medicine practitioners in that regard. Namely, what Dr. Steven Novella refers to as the “touchy feely” aspects of the alt med world which may actually be more pertinent to a patient’s overall well-being than one might initially assume. It’s not a substitute for efficacious treatment methods of course,
As for the question, “what’s the harm?”
Rather than wax hypothetical about how failing to discourage credulity might be detrimental to critical thinking and effective decision making, or about how opting for methods known to be inefficacious might prevent or delay someone from getting more scientifically supportable treatment in time, how about I just give you an already compiled list of instances in which it has led to one or the other. It’s not pretty to read, but if you’re in doubt, here it is.
In summary, homeopathy is a pre-scientific modality of medical intervention that contradicts multiple entire branches of modern science, doesn’t work any better than a placebo (because that’s what it is), but which somehow caught on and retained its popularity in the modern era despite the overwhelming evidence that it is simply pseudoscientific nonsense.