No Free Lunch: A Critical Analysis of Homeopathy Part I
Usually, when I write one of these posts, I write a short, snappy introduction using an interesting hypothetical situation. I shall not do so for this post. In this post, I will discuss homeopathy – an “alternative” medical intervention that is entrenched or gaining traction in a number of countries around the world such as India, Germany, the UK and the United States. This is quite a serious topic and I wish to go over it in a reasonably serious way. This post of for those who have heard about homeopathy during a television commercial (flu remedies, Zicam etc.) or knows of a family member who uses it but doesn’t quite know what it is. I will go over the history, the underlying principle behind homeopathy, and a scientific examination of it. I will also discuss some of the current explanations that homeopaths provide that attempt to explain or justify the efficacy of homeopathic medicine. This is going to be a pretty detailed post – so hang in there!
The Early Days
Homeopathy was invented by Samuel Hahnemann in the late 1700s as an alternative to the then prevalent medical techniques and philosophies such as Humorism. As its central tenet, homeopathy posits an axiom known as the Law of Similars. Phrased succinctly, it states that “Like cures like”. This was Hahnemann’s idea behind curing all diseases and afflictions of the human body. Hahnemann believed that diseases were caused by a disturbance to the vital or life force of the body. This was during a time period when little was known about anatomy, pathology, immunology and science in general. Doctors would routinely perform blood-letting as a means of curing already ailing patients. They performed gruesome and often unnecessary surgery outside a proper sterile environment and routinely harmed their patients more than they helped them. Hahnemann noticed that the side-effects from the quina bark that is used to cure malaria is similar to the effects of malaria itself. He hence proposed the idea that the cure for a malady must produce the same effects as the malady itself. Hence, “like cures like” was born. As we can quickly see, this idea is quite out-dated. We now know that the quinine in the quina bark is what helps cure malaria by interfering with the reproduction of malarial cells. We currently have an immense body of scientific knowledge on how the body works. We understand the germ theory of disease propagation and immunology. We understand cells and cellular processes such as differentiation and reproduction. We understand genetics. There are many holes and gaps in our understanding, but we have come a long way from 18th century medical conjectures. None of theses modern, tested, independently verified theories of the human body posit the existence of anything that remotely resembles Hahnemann’s “life force”. We have not observed any such force throughout our endeavors in physics, chemistry, biology or medicine. Furthermore, we can readily ascertain the fact that highly effective cures for a number of diseases (e.g. vaccines) do not have side-effects that in any way resemble the disease itself. Aspirin (acetylsalicylic acid) has a number of side-effects but a primary one is not a headache. Sudafed (pseudoephedrine hydrochloride) causes a number of side-effects, but one of theses is not an increase in phlegm or increased coughing.
Less is More
Practitioners of homeopathy also believe in another law known as the Law of Dilution. This law states that the more dilute a substance, the more potent it is at curing the disease who’s symptoms resemble its side-effects. This is a very counter-intuitive law. It claims that dilute and weak substances are “stronger” cures than more concentrated solutions. Substances are usually diluted in sugar or water. Homeopaths measure dilution in the centesimal scale (C scale). A homeopathic remedy labeled 0C is undiluted (you would never see this). A 1C remedy has been diluted to a ratio of 1:100. What this means is that for every part of the original substance, there are 99 parts of solvent (either water or alcohol or some other inert substance). For a 2C remedy, one takes a 1C remedy and dilutes it 100 fold again. Hence, in a 2C solution, for every part of original substance, there are 9,999 parts of solvent. This is a logarithmic scale of dilution. A typical homeopathic remedy that is considered strong/effective is usually sold at 20C or 30C. At this dilution, for every part of original substance, there are 10^40 or 10^60 parts of solvent. Homeopaths have a number of ways of denoting the scale (using D, X, C or M for example). A discussion of this is found here. These ratios may not mean much, but you need to understand that 3 grams of water have only about 10^23 molecules of water. A drop of homeopathic remedy has almost no chance of containing even one atom or molecule of the original substance. It is entirely just water or sugar. Just to be sure, let me reiterate this point – there is not even a single molecule of the original substance left! You might as well have just drank a drop of water or eaten a dab of sugar. A popular homeopathic remedy for flu called Oscillo claims to have a dilution of 200C. According to homeopaths, this makes it a strong remedy (stronger than 100C or 50C for example). At 200C, for every part of the original substance, which the manufacturer of Oscillo claims is Anas barbariae hepatis et cordis extractum or “duck liver and heart”, there are 10^400 parts of solvent. Assume we quite graciously concede for the moment that fermented duck liver extract has anything to do with the flu. Now let us look at the amount of solvent needed to have even one molecule of the duck liver extract, and compare this to the number of atoms in the visible universe. By an approximate calculation, there are around 10^80 atoms in the observable universe which is about 46 billion light years in diameter. Just think about it for a second – this means that if we started with one molecule of the original extraction (this is dubious in and of itself as the extraction contains a plethora of chemicals), all the visible matter in the universe would be insufficient to dilute this homeopathic remedy to its required dilution by many, many orders of magnitude! I hope this allows you to appreciate the sheer scale of the numbers being used here. There is no actual active ingredient in them at all. None!
Homeopaths attempt to explain this apparent paradox through a number of different conjectures. A popular one is the Water Memory theory that has even made its way into the popular press. According to this theory, water has an uncanny ability to “remember”, or to somehow store/encode the fact that a particular chemical has been in it. The most popular suggestion is that the hydrogen bonds in water are persistent and remember the structure of the solute. Here is a popular video of a homeopathic practitioner explaining how homeopathy involves sequestering energy and vibrations inside water. Other explanations involve quantum entanglement and quantum effects. A recent proposal in attempted to use concepts such as quantum state entanglement in what they called patient-practitioner-entanglement to attempt to explain homeopathy. A number of other similar proposals have also been made. All of these explanations are rejected by the wider scientific community for contradicting a huge number of currently known laws of nature and failing to correctly predict current scientific evidence.
Teasing out the Truth
Supposing that there is some mysterious effect that seems to go against the known laws of physics and chemistry, we can still test homeopathy. After all, we don’t reject a valid observation just because we don’t understand it yet. There could very well be a positive effect due to using homeopathic remedies that we currently don’t understand and won’t understand unless we try to examine it. We should test homeopathy and see for ourselves! And scientists from all over the world did just that. They performed what are known as randomized controlled trials, one of the strongest forms of clinical trials possible. Here is an example of one kind of trial – a number of patients with measurable conditions (such as the presence of the flu) are taken and split into two groups randomly. They are both sent to homeopathic doctors who diagnose them and prescribe a remedy. One group’s prescription is then switched out and given sugar pills. These pills look, feel and are packaged in a way identical to the real homeopathy pills. The patients are then asked to come to a follow-up where their conditions are checked. If homeopathic medicine were really having an effect, the patients on them would show a clinically significant change (faster recovery, better measurable symptoms etc.). These results are tallied up. The average results between the two groups in then examined using various statistical procedures and tests (so as to weed out individual variations and chance effects) to see if we can tease out a statistically significant result that is caused due to the homeopathic treatment.
Trials such as these using numerous different techniques were tried throughout the world and rigorous double-blind studies show no significant results that occur from homeopathic interventions. A number of uncontrolled (or insufficiently controlled) studies have indeed shown some effect, but these effects promptly disappeared once the study was repeated with appropriate controls and blinding. Systematic analysis of the studies also shows no significant benefits from using homeopathy. Furthermore, it has been demonstrated that water does not maintain any stable molecular arrangements on periods of time longer than nanoseconds. Quantum entanglement does not even enter the picture as it applies only to small, isolated particles and there is no plausible mechanism withing quantum theory to explain entanglement within macroscopic entities. All in all, the results look pretty bad and damning for homeopathy.
Even though there is a mountain of easily available and reproducible scientific evidence against homeopathy, it still seems to be popular in a number of countries around the world, across various demographics. In the next post, I will discuss the issue of public perception and why homeopathy is still accepted and freely used in places around the world.