Apparently it is World Homeopathy Awareness Week (#WHAW), so I have decided to take on some social responsibility and make you aware of homeopathy and its batshit arsebackwards logic. I’m not going to post regularly on alternative medicine as it has been covered much better elsewhere. In theory, this shall be my only post on homeopathy. Unless someone proves it works…
You’ve heard of homeopathy right? It comes under Complementary and Alternative Medicine (CAM). Different from conventional medicine; different from medicines that are prescribed by doctors, different from medicines that have had to undergo trials to test whether they work, what dose they work at and what side-effects they have. Complementary and alternative medicines haven’t had to go through these before you can buy them. They may work, they may not, but to quote Tim Minchin’s Storm:
You know what they call “alternative medicine” that’s been proved to work? Medicine.
There are different sorts of CAM, homeopathy is just one branch. While herbal medicines may contain active ingredients – like St John’s Wort, which contains chemicals similar to those found in antidepressants; and plants are an invaluable source of pharmaceutically active compounds, e.g aspirin from willow bark, digoxin from foxglove, quinine, atropine from belladonna and so on, homeopathy is something altogether other. Don’t confuse homeopathy with herbal medicine.
There are two main concepts homeopathy is based on – the first is to treat “like-with-like”. This means that whatever symptoms you have, the homeopath would treat them with something that would cause the same symptoms.
OK, a semi-realistic example. I get eczema, pretty much only on my hands, and it seems to be weather dependent. It’s a mild irritation at most, but suppose I think steroid cream is a bit overkill (i have only been told to use it if the eczema is bad). I google homeopathic eczema treatments and I get this: http://www.revital.co.uk/Health_Directory/Homeo/Eczema_hm
I don’t really know what these things are. They sound scientific-y because they are in latin. One of the treatments recommended is Suphur. All chemicals bought for laboratory use come with an MSDS sheet which tells you important stuff about what the chemicals do, what happens when they burn, is it dangerous etc. It says:
SKIN CONTACT Remove affected person from source of contamination. Remove contaminated clothing. Wash the skin immediately with soap and water. Get medical attention if any discomfort continues.
(That’s pretty standard with most chemicals actually)
SKIN CONTACT Powder may irritate skin
Right, so I am going to treat my itchy irritated skin by using a preparation of something that makes your skin itchy…? It doesn’t really contain sulphur, but I’ll get onto that later.
Similarly, homeopathic treatment of hayfever is by using preparations made from red onion. See the logic: cutting onions makes your eyes water, hayfever makes your eyes water; therefore red onion should be used to treat hayfever. I could be wrong, but this is akin to me treating my headache with a piece of desk against which I have been bashing my head. Or… this:
The idea of treating “like-with-like” sort of works for vaccines; the tuberculosis jab contains a very weak form of the bacteria that cause TB. It acts like a wanted poster for the disease – your immune system has seen it before, has made the antibodies, so when it sees it again it will take it down like so many bad police movie cliches. Treating like-for-like has some success in treating allergies. Allergies, like eczema, hayfever, asthma, peanuts and so on are caused by the immune system being overly-active, responding to things it should not react to. In allergen immunotherapy a patient is initially a very small amount of what they are allergic to, so small it doesn’t cause them to react. The amount of allergen is gradually increased until the patient can tolerate it and is no longer allergic to it. This is not the same as homeopathy. Which takes me to my next point.
Dilution. This is where homeopathy really does get things arse-backwards. The process called “dynamisation” or “potentisation” involves making the preparation more “powerful” by diluting it in alcohol or water and shaking it or by grinding them up with lactose. According to wikipedia a 1 in 100 dose is at the lower end of potency that would be used (2X) , if you dilute this further (through serial diluting and shaking, remember, the shaking is important *facepalm*) you get to 6C, a fairly standard dose. 6C is, according to the homeopath school of wacky-thought, more potent than 2X, but the actually concentration is a 1 in 10000000000 dilution. When you get to a dilution of 1 in 1000000000000000000000000 (that’s 24 zeros) you are coming up to the point where there is only 1 molecule of your original thing in lots of water, be it a sulphur molecule, onion molecule or molecule of desk that I have been bashing my head against; this is 12C. The standard preparation homeopaths give is 30C – at this point there are no molecules of the original substance in the preparation. This is nicely discussed over at 1023.
And I have borrowed this from DC’s Improbable Science because it’s such a nice illustration about how ridiculous the concept of a 30C dilution is (btw David Colquhoun is an awesome skeptical blogger and professor of neuroscience – if you’re interested in science skepticism, he’s well worth a follow @david_colquhoun – he has a PIPE!)
So one molecule of sulphur in a pill that is the same diameter as the distance between the Earth and the Sun. You’re going to need more than a glass of water to swallow that one.
Pharmacology is the science of how drugs affect the body. For a drug to work, it must bind to specialised little proteins called receptors. Receptors are found on all cells in the body. There are many many different kinds of receptors, and they have different properties. Different receptors are found on different types of cells and different cells are found in different parts of the body. When a drug binds to a receptor on a cell, it has some effect on the cell, often this effect can be measured. The higher the concentration or amount of drug the more likely the drug is to bind to receptors and the more receptors can be activated. So, the more drug there is, the bigger the effect on the cell. And this is true for individual cells, groups of cells, whole organs and the entire body. Every newbie student of the biomedical sciences has had to do dose-response curves to death in pharmacology practicals. I shall endeavor to explain. If you give a dose of a drug – let’s use a 1 in 10 dilution, I’ll call it 1mM (this means there is 1 milimole of drug dissolved in 1 litre of water) you get quite a big response in your tissue (I’m going to use the textbook example of contractions of guinea pig small intestine). Now dilute 1ml of this in 9 mls of water, add it to your little setup, you get a smaller response. If you dilute your drug again, apply it to your preparation you get an even smaller effect, continue this until you get no effect.
So, wait, homeopathy’s dilution to make something more potent makes NO sense. And then you have to remember that there is a finite amount of water on Earth, and that it has had fish swimming around, been through any number of animal urinary tracts, and has jebus knows how much poo in it. Proponents for homeopathy have suggested that water has memory, there is much hand-waving and mumbling of quantum. W.T.F? Water memory? This is what the journal Nature has to say on the subject.
Still, it’s not doing any harm you say? Not strictly true. http://whatstheharm.net/homeopathy.html has an ongoing tally of consequences of homeopathy. Those being treated with homeopathy often fail to seek medical attention from a doctor. Homeopaths have provided ineffective treatments for serious conditions such as prophylaxis against malaria – leading life-threatening disease. There are masses of saddening tales of people who have paid thousands of pounds for homeopathic cancer treatments – it is exploitative and disgusting to make money from the dying and desperate.
No one has yet proved that homeopathy works better than placebo in double-blind placebo-controlled trials. It’s not like there isn’t a motive to prove they work, Edzard Ernst and Simon Singh have put up £10,000 for anyone who can prove homeopathy works. Plus, y’know, if it is proven to work, and as it’s mostly water, it’s cheaper than conventional medicine – so it would be adopted by the NHS in a heartbeat.