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Wednesday, June 26, 2013

Homeopathy for the beginning skeptic.

Hello everyone. I hope that you're doing well.  I know it's been a while, and I apologize. There has been a lot going on that's prevented me from developing a post for your reading enjoyment.  But now that things have settled down a bit here at the Fortress of Logic, located in the secret basement of the Skeptical Okie Headquarters, I'm back in the saddle.  For the next few posts, I'm going to be covering a general theme, basically alternative (quack) medicine.  These will include homeopathy, acupuncture, reiki, faith healing, psychic surgery, and .......  you get the idea.  Some may be over more than 1 topic if they are closely related. Now, before you go "Oh hell, he's going to get technical on me.", no I'm not.  These are going to be a general knowledge posts over the history, what proponents and opponents say about it, what the risks are, possibly some case studies, and from there I'll let you use your critical thinking skills to come to a conclusion.  That's not to say I'm not going to be the normal snarky bastard that you've come to love, or at least like enough to spot me a five at lunch.  I'll probably mouth off when discussing some of the more outrageous claims, but you don't want me to keep that kind of stuff bottled up.  It wouldn't be pretty. (Like I'm ever pretty.)  And I'm still waiting for submissions and suggestions on my project.  If you know of a pseudoscience product that you want tested, let me know.  For more details, go back to post #31, New Skeptical activism project.  And let me know if I need to alter the submissions criteria.  Back to the topic at hand, these next few posts are going to be a sort of beginners guide for people new to the Skeptical movement.  I hope that you find them helpful.

According to Wikipedia, homeopathy was started in 1796 by Samuel Hahnemann under the concept of "like cures like" also called "The Law of Similars".  Basically, if you have a condition, say sneezing, you would dilute pepper, because it causes the same condition, and take it as a medication.  This is supposed to cause the body to react, and cure itself  through your own immune system.  Since then, it has often been touted as a method to cure nearly anything from allergies to cancer.  The popularity of homeopathy has had its highs and lows over the last 200 years, but it has seen a steady increase over the last roughly 30 years.  (Like I said, this is sort of a beginners guide, so I'm not going to get too in-depth over the history) These days, you can walk into nearly any pharmacy or drug store and find something labeled "homeopathic cure".  WalGreens, CVS, Wal Mart, and most of your small mom and pop type places all carry something homeopathic.  (Sorry if I didn't list your favorite store, these are the only ones that are both well known and that I have actually been in.)  In the U.S., there is not really much regulation concerning homeopathic medicine, so I feel that any numbers I am able to find regarding the amount of homeopathy bought, the numbers of different treatments available, or even the number of practitioners are not reliable.  I do know if you open an Oklahoma City phone book (yes, I actually keep a hard copy phone book around.  Comes in handy when dealing with particularly adamant salesmen), you will find a number of listings for alternative and complimentary medicine.  4 in fact.  But, if you drive around OKC, you will see hundreds of signs promoting "all natural homeopathic cures" or some such variation of this drivel.  And you often see people entering the "place of business" (often, it's just a sign someone has stuck in their front yard) to buy something they either think or hope will help them. (I'm not going to make assumptions about the actual product or service they are purchasing, out side of they are buying something from someone in the building)

From this point on, I'll be referencing several sources, so I'm going to abbreviate the ever popular Wikipedia to Wp, and as I use other sources, I will give an abbreviation with the first use of their name.
According to Wp, the process of creating a homeopathic medication is rather complicated and labor intensive.  After determining what you ailment is and what your cure should be, (most homeopaths say that to be truly effective there needs to be a one on one consultation to provide the proper remedy.  This is why a lot of them tend to dismiss the 10-23 campaign.  Look up the Merseyside Skeptics Society for more info on this.)  After the consultation with the patient, they consult a homeopathic materia medica, a book with a list of provings and studies.  I'll talk about provings in a bit.  Then the prep work begins.  There are primarily 2 different types of preparation, depending if the initial substance is water soluble or not.  If it is, then they begin the dilution straight away.  The initial dilution rate is 1 gram of the substance in 99 milliliters of liquid, either water or alcohol to make a total of 100 mL of liquid.  Homeopaths call this process either dynamisation or potentisation. (This article is going to kill my spell check)  At this point they dilute the substance with either alcohol or distilled water.  The comes everyones favorite part, the succussion.  They mix it up by hitting the bottle or vial 10 times against an object with an elastic surface. You can find videos of this on YouTube.  Some of them are pretty funny. (Some even use a bible, maybe for added strength?)  They do this because the founder of homeopathy believed that this would activate the "vital energies" of the substances.  Kind of like cutting the corner off of a roast because your mother always did, not realizing she had a small roaster pan. And the dilutions continue.  A quick note about the dilution scale used in homeopathy.  They use what they call the "C scale" or centesimal.  You should remember from you science class that the prefix "centi" means 1/100th.  The substance is diluted by a factor of 100 at each stage.  You will often see the dilution labeled like 6C.  This means that the process has been done 6 times.  So after doing the math, this means that 1 part in one trillion is the "active" ingredient at a 6C dilution.  They have dilution rates as high as 200C to treat the flu, using duck liver.  What effects a duck liver is supposed to cause to be able to treat the flu, I have no idea.  I couldn't find any information as to how they came up with that.   To give you an idea of how dilute the duck liver treatment is consider this:
 A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name oscillococcinum. As there are only about 1080 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10320 more universes to simply have one molecule in the final substance.
You could treat the entire planet until the end of time a million times over from 1 duck.

Now if a substance is not soluble in either water or alcohol, then they use a process called "trituration"  They take the substance and mix 1 gram of it with 99 grams of usually lactose.  They grind them together, and just like the soluble substances, take 1 part and dilute it again, and again, and again, etc...  Then either way, the final product is added to a relatively inert substance that has been pressed into a pill.  The primary delivery agent used is a sugar pill.  Every site I looked at gave almost the exact same steps for preparing a homeopathic cure, and believe me, there are a lot of them out there.  There are a few differences.  Some try and stay pure to the roots and do everything by hand, others have updated the process.  A funny one is (WHN) .  You can read a description of their process here .  It's funny because of the lengths they go in terms of machinery and tech, but try and remain traditional.  So that's the quick and dirty on dilutions in homeopathic preparations.  Now to look at how they determine what treatments are effective for what conditions.

According to RationalWiki (RW), :
A proving records the experiences of the "provers", usually a dozen or so people who consume the remedy over a period of time. Their thoughts, feelings, dreams and habits are then recorded in what is often termed the "Materia Medica" (from the Latin meaning "collected body of knowledge") and analysed.

According to the New York School of Homeopathy,:
A proving is the testing of a potentized substance to find out which symptoms that substance is capable of producing, and hence curing. A proving is conducted on volunteers who are in a reasonable state of health (provers), and who do not know what substance it is they are taking. Doses are repeated until provers start to experience symptoms of a change in state. The provers record everything they experience, whether physical, emotional, mental, or even spiritual, as long as the change in state persists. At the end of the proving all the records are compared to find the physical symptoms, states of mind, feelings, and experiences that the provers have had in common, which can reasonably be attributed to the emerging signature resonance of the substance. 

Basically what this means is that, given the other fundamental of homeopathy is "like cures like", they have people take a substance they want to test, and then self report how they feel over a period of time and compare to the symptoms they want to treat.  And at this point I must unfortunately give credit to the first homeopaths for actually developing what would one day become the clinical trial.  It's like alchemists developing chemistry.  They were soooooo close.  From these provings, they take the data and determine what conditions it will treat.  (I would have loved to see the looks on peoples faces when the guy said "I think this duck liver will treat the flu")  A little backwards from a clinical trial, but I'll give them a B- for effort.  Hahnemann, in the first provings used undiluted substances and went from there.  According to Wp, most modern practitioners tend to use ultra-dilute forms.  The problem with ultra dilute homeopathy is that it is highly improbable that any of the original substance is actually in the treatment.  This is where "water memory" and the placebo and nocebo effects come into play.  There are some exceptions to this.  On occasion, the makers of homeopathic medicine have been known to actually put real medicine in their products, and then claim that because shows to have an effect, all homeopathy works.

"Water Memory", and the Placebo and Nocebo effects
According to homeopaths, water has the ability to "remember" substances that have come into contact with it, hence the reason that they use distilled water for their dilutions.  Never mind the fact that every bit of water on the planet at some point or another has passed through the urinary tract of one creature or another.  Most research on this has basically shown it to be a false assumption.  One piece of research that got a lot of media attention and had the homeopaths claiming that they were right all along is a study by Luc Montagnier, the man that helped discover the HIV virus.  In a new study, he found that he could basically replicate a strand of DNA from electromagnetic signals in diluted water.  This study is unfortunately way above my pay scale, and the newest info I could find on it was from 2011.  I believe they are still trying to replicate his results.  Returning to homeopathy, there is no reason to assume that water can "remember" the traits of a substance that it has come into contact with, especially at the dilution rates that homeopaths prefer to use. If it can, why does anyone ever get sick?  hasn't all the water come into contact with all the things?  Shouldn't it have the memory of everything?  (There is also no reason to assume that just because something makes you cough violently that it can be used to treat a similar symptom.)  The placebo effect is often heard when discussing any medicine, the nocebo effect isn't talked about as much, but it is probably just as important.  The placebo effect, which translated from Latin means "I will please" is when you feel an improvement because you think you will.  Doctors have used it for ages.  The problem is trying to separate the effects of the medication and the placebo.  This is normally accomplished by using a double blind test.  This involves blinding the test subjects and the testers.  This prevents anyone from knowing who is receiving a sugar pill and who is receiving actual medication.  Given the fact that homeopathy uses sugar pills, it is really difficult to separate the two.   Nocebo, translated from Latin means "I will harm" and it is the exact opposite of the placebo.  You feel bad because you think you will.  Both of these, placebo and nocebo involve not only psychology but anatomy also, so they are much more complicated than I am making them out to be.  In simplest terms,  you feel the way you think you should.  If you look up studies concerning homeopathy, you will often see the phrase "no better than placebo effect.

When it comes to homeopathy, very few areas of medicine have had as many studies concerning their efficacy.  Of course, when searching for study results, they can be extremely biased.  Groups like Natural News, Whole Health Now, and other groups that tend to have the words Health or Natural in their name will tell you that the results show that homeopathy is more effective than placebo, with varying results.  If you look at groups like the NIH in England, WHO, or the CDC, they say either the effects are no better than placebo or that more studies are needed.  With the CDC, they actually recommend that people not take homeopathic anti-virals for malaria.  I was unable to find any studies that either definitively prove that homeopathic medicines work beyond the placebo effect.

Just like any other medical treatment, there are risks.  Unlike others, there aren't any directly related to homeopathy, which is part of the appeal.  The practitioners claim that there are no side effects from using their products, and this is the most factual claim that they make, unless you're diabetic.  The main risk, just like with other alternative medicines with a dubious efficacy, is when people with life threatening conditions use them instead of traditional western medicine (can I just say actual medicine?)  When someone uses homeopathy to treat cancer, malaria, HIV and AIDS instead of seeing a medical doctor, then they are effectively taking their life into their own hands.  To sum it up, the biggest risk for those with truly serious issues, not just a cold or itchy skin, is death.  For anyone else, the biggest risk is a lighter wallet, and sometimes an actual reaction to something in the medicine.

Given what I know of chemistry, biology, and even the water cycle, my opinion is that when it comes to homeopathy, all you are getting is a sugar pill labeled with scientific sounding names and an overly complicated manufacturing process.  That is my personal hypothesis, and you are free to make your own conclusions.  Honestly though, if I had a serious illness and was seeking treatment, someone that is following a 217 year old recipe for a sugar cube and believes that water knows what's been put in it is the last place I would go

I hope that this introduction to one of the major pseudosciences has been as entertaining to read as it was to research.  I couldn't fit nearly everything in a simple blog post, so I suggest you look into a few aspects yourself.  If you have any questions or comments, feel free to leave them in the comment section.  Until next time, be good, be reasonable, and be a good example.

The Skeptical Okie