Friday, September 3, 2010

Homeopathy: Part 3

Homeopathy: Part 3

Magical energy

Why do homeopaths bother going through such time-consuming machinations?  What possible benefit could there be to diluting a solution billions of times beyond the “nothing’s left” point?  Fantastically, homeopaths claim that the more dilute the remedy, the more powerful it is: "less is more."  They claim that a process they call “potentizing by succussion,” transfers healing energy to the, now, non-existent ingredient.[i]  Succussion involves ritualistic tapping of the remedy with each dilution.  This “healing energy” supposedly increases in concentration with each dilution.  The more dilutions performed, the more agitated the remedy, and therefore, the more potent the cure.

I have several objections to this rubbish.  No solution or solvent has ever demonstrated any type of objectively measurable memory.  Wouldn’t this theoretical basis for potency mean that the solution would remember anything it had ever met, no matter how insanely dilute?  In fact, wouldn’t the tiniest impurities in the solvent get “potentized” to insanely powerful and unpredictable degrees?  Wouldn’t that render the remedy worthless--or perhaps even more potent?

The concept of increasing potency with lowering concentrations simply makes no sense.  It contradicts the laws of chemistry and physics.  The intended concentrations are so low that any real effect identified likely reflects a previously unknown property of the alcohol or water solvent.[ii] 

Legislated ignorance and sacred cows

In 2003, over three thousand homeopathic physicians practiced in the United States, with thousands more in Europe.  If homeopathy is such nonsense, why does this industry generate hundreds of millions of dollars in annual revenue for homeopathic practitioners and remedy manufacturers?[iii] The answer is complex.  Let’s first look at why it is legal to sell this garbage at all.  This makes for an excellent case study in American special-interests politics. 

In 1938, Royal Copeland, a Senator for the State of New York, sponsored a piece of legislation, the Food, Drug, and Cosmetic Act, to protect the American public from dangerous or worthless drugs and patent medicines.  Senator Royal Copeland also happened to be Dr. Royal Copeland, a homeopathic physician.  He managed to carve out an exemption in the new law for his homeopathic remedies by legislating that any product listed in the Homeopathic Pharmacopoeia would automatically receive full recognition as a drug without having to meet most of the rigorous standards that conventional prescription drugs must meet.  The new law exempted manufacturers of homeopathic remedies from proving their products contained the labeled ingredient, proving that the strength of the remedy as listed was accurate, and proving that the remedy effectively treats any medical condition at all.  Homeopathic products also do not have to carry expiration dates, and can legally contain far more alcohol than the ten percent usually allowed in standard medications.8 

However, homeopathic products must comply with some FDA regulations.  Over-the-counter preparations can only be marketed to treat self-limited disorders, in other words, disorders that would go away on their own if not treated at all.  As such, homeopathic remedies occupy a protected niche created by special interests. 

Drawing back the magic curtain

Some, like Dharma, ask, “Well, it must do something, right, even if they don’t understand it?”  On the contrary, the data so far shows that homeopathy works no better than placebo.[iv]  Virtually all of the studies purporting to show benefit from homeopathic treatments are fatally flawed.[v], [vi],[vii], [viii], [ix], [x]  No adequately designed, sufficiently powered study has ever demonstrated that any specific homeopathic remedy works better than a placebo for treating any specific disorder.11

In one study, the effects of homeopathic remedies on hot flash severity and frequency in menopausal women clearly revealed no statistically significant benefit for menopausal symptoms.[xi]  Unfortunately, the authors of the study went on to crunch the numbers from one angle after another until they found a way to present a positive result about the research. “If you can’t find something good to say about something, don’t say anything at all.”  In this case, they noted that the overall health of patients was better a year after initiation of the study protocol in the treated group than the placebo group.

A well-publicized and controversial analysis of 186 studies of homeopathy published in The Lancet, a well-respected medical journal, in 1997, concluded that a “trend existed for homeopathy to be more effective than placebo.”[xii]  However, a thorough review of the data conducted by the editors of the journal revealed that, of those 186 studies, not even one showed a significant benefit for any homeopathic remedy over a placebo.  The analysis also revealed a strong inverse relationship between study quality and homeopathic benefit: the better the study design, the poorer homeopathy fared.[xiii]  

I suspect any appearance of success for homeopathy is likely due to the placebo effect.  A more recent article published in the 27 August 2005 issue of The Lancet seems to confirm that notion.[xiv]  The authors matched over a hundred studies on homeopathy with comparable studies on traditional medications.  They found bias colored many of the studies.  Taking that bias out of the equation they found that traditional medications work considerably better than placebo while homeopathic remedies performed no better than placebo.

So tempting, the Ring of Power

If the benefit of homeopathy is all placebo, so what?  What’s wrong with that?  Why not prescribe homeopathic remedies with the knowledge that they are placebos?  After all, the patient feels better.  Isn’t that the final objective, anyway?  Is that not why patients seek out doctors in the first place?  This is the single most dangerous and insidious aspect of this phenomenon.  In this particular case, the ends absolutely do not justify these fraudulent means.  The ideal of patient autonomy that drives me to defend a patient’s right to choose some treatment other than what I perceive as rational, makes this choice impossible for me. 

To pass on to my patient, under false pretenses, something I know has no intrinsic therapeutic merit would be paternalistic, unethical, and personally abhorrent.  Homeopaths are not generally in the habit of informing their patients that the treatment being offered is a placebo.  To smilingly lie as I hand Dharma a bee’s wax pellet that I know contains nothing that will help her, robs her of her autonomy.  Dharma has a right to make well-informed decisions about her own care, drawn from the best possible information.  Remember, Dharma pays to get my medical advice.  Dharma has the right to expect she is getting her money’s worth in the form of my considered medical opinion, not intentional deception.  Otherwise, Dharma’s autonomy is meaningless. 

The magic mirror

The quackery that is homeopathy exists because of the quackery found in conventional medicine.  Healthcare has too many special interests feeding on the trillions of dollars in the healthcare budget.  The same defective reasoning that causes patients to accept homeopathy also causes many more patients and physicians to use questionable practices in conventional medicine.  The modern equivalents to leeching, purging and mercury poisoning still exist.  New medications and interventions get far more exposure, and aggressive direct marketing than their 19th century counterparts did.  The recent withdrawal of several high-profile drugs from the market, probably with thousands of deaths to their credit, reinforces the wary public’s opinion that medications are dangerous things.

Inherent in the use of homeopathy is the search for something safer than what modern medicine has to offer.  That being said, the problems in the current system do beg for changes, but do not justify fraud.  The trend towards science-based medicine promises slow, but steady improvement in treatment.  One could argue that not treating is better than treating with many of the medications currently in use. With homeopathy, that is precisely what patients get: nothing, in the guise of treatment.

People pay a lot of money for homeopathic therapy.  Our collective tax dollars find their way into government-funded research programs on this codswallop to the tune of tens of millions of dollars each year.  Not all claims to therapeutic benefit have equal standing. Homeopathy is based entirely on extraordinary, magical reasoning.  Extraordinary claims require extraordinary evidence. Therapeutic modalities based on extraordinary claims should meet the extraordinary evidence standard before qualifying for large research grants—and especially before they see the light of day as treatment for adults and children.

[i] Davenas E, Beauvais F, Amara J, Oberbaum M, Robinzon B, Miadonna A, Tedeschi A, Pomeranz B, Fortner P, Belon P, et al.; Human basophil degranulation triggered by very dilute antiserum against IgE.
Nature. 1988 Jun 30;333(6176):816-8.
[ii] Shealy CN, Thomlinson RP, Cox RH, Borgmeyer V; Osteoarthritic Pain: A Comparison of Homeopathy and Acetaminophen;American Journal of Pain Management; 1998 Jul; 8(3): 89-91
[iii] Stelin I; Homeopathy: Real Medicine or Empty Promises?; FDA Consumer Magazine. 1996 Dec
[iv] Shipley M, Berry H, Broster G, JenkinsM, Clover A, Williams I; Controlled Trial of Homeopathic Treatment of osteoarthritis; 1983 Jan 15; 1(83160:97-8
[v] McCarney R, Warner J, Fisher P, Van Haselen R; Homeopathy for dementia; Cochrane Database Syst Rev. 2003;(1):CD003803
[vi] Walach H, Haeusler W, Lowes T, Mussbach D, Schamell U, Springer W, Stritzl G, Gaus W, Haag G; Classical Homeopathic Treatment of Crhonic Headaches; Cephalalgia. 1997 Apr;17(2):119-26
[vii] Reilly DT, Taylor MA, McSharry C, Aitchison T; Is Homeopathy a Placebo Response?; Lancet. 1986 Oct 18; 2(8512); 881-6
[viii] Reilly D, Taylor MA, Beattie NG; Campbell JH, McSharry C, Aitchison RC, Stevenson RD; Is Homeopathy Reproducible?; Lancet.; 1994 Dec 10; 344(8937); 1601-6
[ix] Jacobs J, Jimenez M, Gloyd SS, Gale JL, Crothers D; Treatment of Acute Childhood Diarrhea with Homeopathic Medicine: A Randomized Clinical Trial in Nicaragua; Pediatrics. 1994 May; 93(5):719-25
[x] Hill C, Doyon F; Review of Randomized Trials of Homeopathy; Rev Epidemiol Sante Publique. 1990; 38(2):139-47
[xi] Jacobs J, Herman P, Heron K, Olsen S, Vaughters L; Homeopathy for Menopausal Symptoms in Breast Cancer Survivors: A Preliminary Randomized Controlled Trial; J Altern Complement Med.; 2005 Feb; 11(1):21-7
[xii] Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB; Are the Clinical Effects of Homoeopathy placebo effects? A meta-analysis of placebo-controlled tirals. Lancet. 1997 Sep 20; 350: 834-43
[xiii] Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB; J Clin Epidemiol. 1999 Jul;52(7):631-6
[xiv] Shang A, Juwiler-Muntener K, Nartney L, Juni P, Dorig S, Sterne J, Pewsner D; Are the clinical effects of homoeopathy placebo effects?  Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005 Aug 27;366(9487):726-32


Richard said...

Really like this series, Rich. I'll comment further if this gets posted. (I've had crummy luck posting.)

Richard said...

Here's my creep, Rich. If your science on this subject is sound--and I have no capability of questioning it--the conclusion is that a huge number of patients and a substantial number of practitioners of homeopathy are are deep in self-delusion and magical thinking. You (I assume) are not the only medical practitioner who knows what you have presented here. How can it be that for over a century the dupers and the dupees have not only pretended and imagined that they are being, in fact, treated by homeopathic methods but press on in the face of such evidence as you present here? I go only so far with you on the matter of 'special interests' at work--we know there's plenty of that around. But why haven't a number and a growing number of homeopathic practitioners and their patients come to the place you've come to (and others, I'm sure). This is one of the really large con games going. But your evidence on the negative is not hard to understand. Nor, I should think, would it be hard to prosecute against. Well, you see where I'm going with this. How does such a con game persist in the face of really just plain evidence that it's a con game?

Rich Charlebois said...

Hi Richard, glad to see the posting worked. Your question insightfully jabs at the center of issue for almost all "woo." Human beings are excellent at pattern recognition, but really lousy at statistics. Michael Shermer, the author of "Why People Believe Weird Things," would likely point out that one personal experience trumps volumes of scientific research. We all over estimate the reliability of our own judgement. In the Venn Diagram of life, with all its overlapping cultures, beliefs, behaviors, only a small portion represents well-reasoned, logical understanding of the world. There is certainly a place for debunking ridiculous notions like homeopathy, but a rigorous education in logic and critical thinking would make it all moot.

Mike A. said...

Great job, Rich. Glad to know our elected officials work so hard to protect their own selling of modern day snake oil.

Richard said...

I wonder, Rich, if you would or could turn the spotlight you use here on the practice of acupuncture, and with what results. Many years ago, I had a ten-session 'course' of acupuncture and it was fabulous. I'll be glad to describe it in detail if it would serve any purpose. In the meantime, I've heard moreorless gentle put-downs of the practice, which, like homeopathy, is the first line of medicine for millions of people. All deluded? The practice won't stand up to rigorous analysis? Interested in your thoughts.