Friday, August 20, 2010

Homeopathy: Part 2

Guinea pigs and “provings”

The Homeopathic Pharmacopoeia, at least the classical homeopathic remedies, derives from homeopathic “provings.”  A proving is research, homeopathy-style.  It sounds very scientific, couched in the jargon of science, but what exactly is a proving?  Homeopathic experimenters conduct provings by studying a potential ingredient‘s effects on healthy individuals.  The human guinea pig consumes a quantifiable amount of the substance, then takes copious notes on symptoms he or she experiences, including physical symptoms, state of mind, and feeling warm or cold, etc.  Hahnemann, himself, took cynchona extract, the source of quinine, to which he had a profound reaction:

I took by way of experiment, twice a day, four drams of good China (Cinchona).  My feet, finger ends, etc., at first became cold; I grew languid and drowsy, then my heart began to palpitate, and my pulse grew hard and small; intolerable anxiety, trembling, prostration, throughout all my limbs; then pulsation in the head, redness of my cheeks, thirst, and in short, all these symptoms which are ordinarily characteristic of intermittent fever, made their appearance, one after the other, yet without the peculiar chilly, shivering rigor, briefly, even those symptoms which are of regular occurrence and especially characteristic - as the dullness of mind, the kind of rigidity in all the limbs, but above all the numb, disagreeable sensation, which seems to have its seed in the periosteum, over every bone in the body - all these made their appearance. This paroxysm lasted two or three hours each time, and recurred if I repeated this dose, not otherwise; I discontinued it, and was in good health.[i]

In Dharma’s case, with her back and hip pain, I asked why and how she takes Arnica.  She didn’t directly answer that question.  Instead, she made a blanket statement about wanting something to treat the cause of her disease, not just the symptoms.  She boldly declared that homeopathic remedies do that, implying that traditional medications ignore the cause of a disease.  Homeopathic practitioners often echo this belief, criticizing traditional physicians for “just treating symptoms.”  They accuse traditional doctors of ignoring the underlying cause of an illness, and of not treating the “whole patient.”  In contrast, they claim their own approach is more holistic, which, in this context, means all encompassing.

This really couldn’t be further from the truth.  Homeopathy centers precisely on treating symptoms, with complete disregard for the underlying causes of those symptoms. The “proving“ process described above focuses solely on symptoms.  The Law of Similars guides the choice of remedy for the practitioner based only upon the extensive history of the patient’s symptoms, regardless of the cause. 

For example, a study from 1998, published in the prestigious Archives of Otolaryngology—Head & Neck Surgery reviewed a commercially available homeopathic remedy for vertigo.[ii]  Vertigo is the subjective sensation of spinning when no spinning actually exists.  It has literally dozens of potential causes, including stroke, brain tumor, ear infection, and migraine.  The study designers chose one homeopathic remedy to treat all vertigo, without regard for the cause.  Unfortunately for the authors, the study suffered from weaknesses common in the literature supporting alternative and complementary treatments: it had a small population size, and had no placebo control.  Instead, the authors compared the performance of the homeopathic formulation against the performance of beta-histine, a drug marginally effective in treating a few specific types of vertigo, but not nearly the variety of causes for vertigo included in this study.  The authors also excluded from the study anyone with vertigo lasting longer than six months, and patients rating their vertigo as a five-out-of-five on a severity scale.  Apparently, even homeopathic researchers believe homeopathy only works for moderate symptoms, that don’t last very long.

Ducks and quacks

Homeopathy’s second commandment is Hahnemann’s Law of Infinitesimals.  This law, which homeopaths summarize as “less is more,” is even more absurd than “like cures like.”  While the concept of “like cures like” might occasionally stumble upon a useful remedy by chance, “less is more” is just plain idiocy.  It turns out that Dharma’s homeopathic remedy consist of an extremely dilute potion of the ingredient listed on the bottle. The remedy, in fact, is so dilute that not even one molecule of the original ingredient remains in the remedy--more magic.  Dharma gaped at me disbelievingly when I explained this.

Arnica Montana is an herb commonly used by homeopaths to treat inflammation and pain, such as Dharma’s backache.[iii]  The homeopathic formulation I encountered most frequently while researching arnica bears the label: “30 C.”  The instructions state: “Take 2 pellets by mouth every 4 hours as needed.”  What does “30 C” represent?  Well, hold on to your calculators!  Astonishingly, it means that the remedy has been through thirty serial dilutions, each dilution being 1-in-100. 

Let’s take a closer look at what this means.  Starting with one milliliter (a milliliter is abbreviated “ml,” and equals about fifteen drops, or about one-fifth of a teaspoon) of pure arnica extract, I would dilute that with ninety-nine ml of water to get my first dilution.  I would then remove one ml of the resulting solution, place it in a new bottle, and add ninety-nine ml more water to the solution.  Yet again, I would remove one ml of the newest solution, again placing it in a new container, and again adding ninety-nine ml of water.

At the end of just three dilutions, I would have a solution that is now only one-millionth (1/1,000,000th) the concentration of the original extract.  To get the final desired concentration of “30 C” as indicated on the bottle, I must repeat this diluting process twenty-seven more times.  That is not a trivial fact.  Each dilution adds two more zeroes to the denominator.  The final, miniscule concentration is 10-60.  How dilute is this? 

Assume, for the sake of argument, that I began with one milliliter of the pure arnica extract and desired to make the same “30 C” dilution without throwing any of the extract or water away.  In order to end up with a “30 C” solution I would have to add my one ml of extract to 1057 liters of water.

Proxima Centauri, the nearest star to our Sun, lies only four light-years away.  It takes light just over four years to reach us from that distance.  If you filled that entire distance with an enormous sphere of water that touched Earth on one edge and Proxima Centauri on the other, it would only contain 2.84 x 1052 liters of water.  My solution would have to contain 100,000 times that much water to reach the “30 C” dilution!  Such extraordinary amounts of water being unavailable in this end of the known universe, the manufacturers of homeopathic remedies concoct their “30 C” remedies by throwing out 99% of the extract and solvent at each of the thirty steps in the process.

When I discuss this subject with people, I can’t help but think of Mr. Gould, the gray-haired, tired looking man with slightly pink-tinted glasses who taught me high school chemistry in California.  Picture Jackie Gleason on a grumpy day, standing in front of a periodic table of elements.  Though he seemed bereft of a sense of humor, I have no doubt these remedies would have wrested a chuckle from him.  It turns out that these dilutions to concentrations less than 10-23 are meaningless.  At that concentration, there is only a fifty percent chance that any of the original substance, even one molecule, persists in the solution. 

Imagine, for a moment, that I give you 100 marbles and 100 small boxes.  After I instruct you to divide the marbles evenly among the boxes, you end up with 100 boxes, each containing a marble.  Now, I hand you a huge pile of additional boxes, giving you 1,000 boxes.  I ask you to divide your one hundred marbles evenly among the thousand boxes.  Clearly, you cannot do this while keeping the marbles whole.  You’ll end up with one hundred boxes, each containing a marble, and nine hundred empty boxes. 

The same thing happens with molecules.  There comes a point in serial dilutions when the number of medicine bottles being filled vastly exceeds the number of molecules of the original medicine.  Most of the bottles are empty.  The “30 C” dilution of Arnica far exceeds that point, as do the dilutions of many homeopathic remedies.

How do homeopaths respond to this seemingly irrefutable point, when confronted with it?  Well, to quote George Carlin, “…it was heavy mystery time.”  Homeopaths who actually understand the math agree that the original ingredient no longer exists in the remedy.  In other words, they know the bottle of arnica contains no arnica.  Incredibly, they claim that the solvent has some kind of magical memory that remembers what had been dissolved in it, and that this memory constitutes the active ingredient in the remedy.  Now, that is magic.  It also explains the complete lack of side effects attributable to homeopathic remedies: there’s nothing in them.  Imagine if oil companies could make gasoline this way.

Another remedy, called Oscillococcinum, comes from freeze-dried duck liver and heart.  The product bears a label touting an astounding 200 C dilution.  That equals one part duck out of a number with 400 zeroes behind it.  At this dilution, it would be harder to find a molecule of this duck’s liver in the remedy than finding one molecule of this duck’s liver in the rest of the entire universe!  At the time of this writing, six doses of lactose pellets carrying a fond, but extremely distant memory of duck liver and heart could be purchased on-line for a mere $24.95.  An article in the February 17, 1997 issue of U.S. News and World Report referred to the single miserable duck whose organs comprise the entire world supply of this remedy as “the  $20 million duck,” when it was learned that the sales of this product for 1996 approximated that amount.[iv]

Much more to come...

[i] Cullen, W.: 'Abhandlung uber die Materia Medica. Ubersetzt und mit Anmerkungen versehen von Samuel Hahnemann.' 2 Bande. Im Schwickertschen Verlag. Leipzig 1790.
[ii] Wieser M, Strosser W, Klein P; Homeopathic vs Conventional Treatment of Vertigo; Arch Otolaryngol Head Neck Surg. 1998 Aug; 124(8): 879-85
[iii] Vickers AJ, Fisher P, Smith C Wyllie SE, Rees R; Homeopathic Arnica 30X is Ineffective for Muscle Soreness After Long-Distance Running: A Randomized, Double Blind, Placebo-Controlled Study; Clinical Journal Pain;1998 Apr 15; 14(3): 227-31
[iv] Barrett S; Homeopathy: The Ultimate Fake;


Amy said...

hi there, I love your blog. You always pick such interesting topic's.


Mike said...

Great article, Rich! Seems as if every single homeopathic "medicine" of dilution great enough is exactly the same: water (or whatever the solvent is). Oh, yea...except for the magic memory of the solvent!

Sisyphus said...


I liked the tone of this post better. More information, and logic, less mockery and judgment, makes the medicine go down, as it were. As always I'm curious if you are skeptical of your own skepticism? You privilege a certain kind of inquiry, a certain set of databases, yet, most of us are skeptical of, or confused by those studies (you yourself have pointed out the weakness of certain methodologies, even in your favored d-bases, also, the press is fond of showing us conflicting results)yet, beyond that "medicine" is not a pure science, and as such it has a politics an economics and an hegemony -- most of us find that suspicious too. QuackWatch has a feeble, even pathetic, essay on "'Postmodern' Attacks on Science" and I think this issue is at the heart of my concerns about the limits of your skepticism. In any case keep writing keep wrangling with the issues.

Rich Charlebois said...

Sisyphus, I'm partial to ridicule as a way of addressing nonsense. It's hard to use logic and reason regarding claims that are by their nature unconstrained by objective reality. The weaknesses in modern medicine--and as you pointed out, there are plenty--do not justify invoking magic as a reasonable substitute.