Homeopathy is a form of ‘alternative medicine’ wherein patients are treated with heavily diluted preparations of an ingredient based on the concept that small doses of “what makes a man ill also cures him”. It arose during a time where other long-discarded quackery were in common use – blood letting and purging, for instance. Homeopathic dilutions are such that it would take many gallons of the preparation to ingest even one molecule of the active ingredient. As physicist Robert L. Park noted,
…since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.
Homeopaths believe that such preparations are different from ‘plain’ water, having retained a therapeutically-active memory of the active agent in the final dilution. ‘Succussion’, the stirring or striking at each dilution which increases its potency, is without any justification and seems more in line with being a substitution for the old incantation routine. Since no structure produced by intermolecular forces between water molecules exist for more than a few picoseconds, and succussion would do nothing to stop this (yes, the lack of any stable clusters generated by inner shell hydration of the now long-gone active agent has been verified using NMR spectroscopy1), it would seem that this is just so much bovine excrement. Not to mention that biologically-active molecules do not produce effects through the surrounding hydration shell but through their 3D shape or metabolism directly. Nay – I know not seems!
No homeopathic preparation has ever demonstrated efficacy beyond the placebo effect2. While most homeopathic preparations are harmless (just water usually), they are dangerous because if they are used in place of therapies shown to have efficacy, great harm can indeed result.
Recently, the FDA has issued a warning for Zicam, a cold remedy product touted as being a homeopathic medication, even though it contains significant amounts of homeopathic ingredients and zinc gluconate. Since zinc gluconate might (but probably doesn’t) directly reduce cold symtpoms, it is difficult to understand how Zicam is sold as a homeopathic medicine, but my suspicion is that if the medication actually works Matrixx can then claim that it is the homeopathic ingredients which did the trick. In other words, I think they are trying to hedge their bets by adding along with the homeopathic ingredients something that might (but again, probably doesn’t) work. The levels of zinc it contains can and has caused numerous cases of the loss of the sense of smell. In some cases of zinc toxicity, this impairment of smell can be permanent. By the way, while zinc gluconate may or may not reduce the duration of cold symptoms (the research is inconclusive on this, but a meta-analysis of studies meeting the criteria of properly-performed trials, and not published in bottom-feeder journals, failed to show any efficacy3), it interferes with the absorption of antibiotics.
In the US, federal legislation stealthily passed excludes homeopathic medical products from requiring FDA approval, effectively removing the demonstration of efficacy or even the demonstration that the product is not harmful. It places the onus of demonstrating harm on the FDA. Matrixx Initiatives, Inc., parent company of the maker of Zicam, has responded that its product causes no harm without providing any evidence that this is the case. Nor are they required to. Ridiculous!!! It will be interesting to see the FDA’s response to this harmful form of quackery. I certainly hope it comes down hard on Matrixx.
Homeopathy is just one of a number of pseudosciences which are a reaction to modern medicine just because it isn’t warm and fuzzy. Modern medicine is ‘too intellectual’ or ‘elitist’, many proponents of these unproven methods will tell you. ‘Too intellectual’? ‘Elitist’? As a member of the medical research community, I’m supposed to be apologetic about knowing my stuff? Not on your life! When my car breaks down, do I take it to a faith healer because I find mechanics ‘elitist’? Using the word ‘elitist’ in the pejorative is like saying you don’t want someone rigorously trained in evidence-based medicine (as a colleague of mine said to me, the term ‘evidence-based’ is superfulous), and ‘degrees’ for homeopathy have little or no oversight. Nor am I aware of any homeopathic ‘degree’ program which includes a residency requirement.
This is how a drug gets into use when following the process required by the FDA. First, it is rigorously tested both in vitro (in the test tube or Petri dish) and in vivo (live animal studies) to show that the drug produces the desired effect. The drug under consideration must show a dose response (that is, the effect is dependent on the dosage) against proper controls (usually the vehicle used without any drug in it), and that it is not toxic at what will be prescribed doses. Once it is shown to be efficacious and safe, it enters into several stages of clinical trials. In this way, the drug is rigorously tested to demonstrate the effects and safety predicted by the pre-clinical trials. It takes years of rigorous testing and monitoring in the four levels of clinical trials before a drug can be approved, and even afterwards deleterious effects are closely monitored using a database of information provided by physicians prescribing it. On average, 1 (count ‘em – one!) drug is approved for every 1,000 drugs going through the process!!! And you wonder why drug costs are so high?
Often, a drug is found not by ‘Big Pharma’, but by scientists studying a problem in their field of research. But only ’Big Pharma’ has the funds to finance its development, especially with such a high failure rate. Why there is such a strong distrust of so-called ‘Big Pharma’ is beyond me. Sure, the system is not perfect. No system is. But it is the best we have and it has evolved and continues to evolve in order to improve itself. But give me one example where the scenario in “The Fugitive” has happened, where histology samples were switched to hide drug-induced liver damage. What would a pharmaceutical company gain when such a fraud would be quickly exposed?
What about drugs that have been recalled due to unpredicted reactions? Do these not demonstrate that the system is broken? NO! It’s a success of the system! The original clinical trials can only be so large and done for so long. If we waited until we had data over whole lifetimes of the subjects in the study before approving drugs, we would still be using only penicillin as an antibiotic. It is the continual vigilance of post-approval monitoring by the FDA that allows us to catch long-term effects of drugs like Vioxx and remove them circulation. Without pharmacovigilance the problems with Vioxx would not have been uncovered until many years after it was discovered to increase the risk of heart attack, if ever. And without pharmacovigilance, there would be far fewer drugs developed by ‘Big Pharma’ found to cause problems to point at and unfairly accuse the system of not working. Ironic, no?
Contrast this with homeopathic medications. Testing? No. Demonstration of efficacy? No. Demonstration of safety? Under the Dietary Supplement Health and Education Act (homeopathic medicines are considered ‘dietary supplements’!!!), but not under FDA guidelines and without need for expiration dates. And believers in homeopathy have a problem with ‘elitist’ methods? Wow, now that’s faith! Matrixx, in their response to the FDA warning about their product, is essentially saying ‘Relax, guy! Trust us!’ without ever responding to the FACT that there are about 130 cases of anosmia (loss of smell) occurring after using Zicam. Isn’t that exactly what those who distrust ‘Big Pharma’ accuse (unfoundedly) ‘Big Pharma’ of doing? Austria has it right – scientific proof of efficacy must be provided for any treatment before the government recognizes it and is paid for by their healthcare system – and France, Austria and Denmark all require that anyone diagnosing illness must be licensed, and guess who they don’t give licenses to. Yet what this industry charges outrageous amounts for their products, essentially ground up dried plants with little or no quality control in terms of how much active ingredient they contain. Compare what you pay for a bottle of ginger tablets at a pharmacy (let alone a specialty store!) with what you pay for the same amount of ginger at the grocery store. If the financial situation of an industry is a source of distrust, why is the ‘natural medicine’ industry, which is in the billions in the US alone, not similarly distrusted? It makes no sense to me.
As a result of caving in to the will of those who want to see pseudosciences equated with their much more serious evidence-based counterparts, we can now turn on our televisions and be bombarded with ads shamelessly promoting potentially harmful ‘natural’ (and what, pray tell, makes properly-tested drugs unnatural?) products like Enzyte or Little Allergies Non-Drowsy Allergen Block. Even after legal action we still occasionally see Smiling Bob in commercials advocating Enzyte. Evidence of ‘male enhancement’ – excuse me, ‘natural male enhancement’ – with its use was found to be fabricated by company executives, and owner Steven Warshak was convicted of fraud, conspiracy and money laundering.
For the Little Allergies allergen block, it is applied outside the nasal passages and this is what the FAQ says about how it works:
Opposite charges attract. The Little Allergies™ Allergen Block gel carries a charge which is opposite the charge that an airborne allergen carries. Since opposite charges attract, Little Allergies™ Allergen Block acts like a magnet and helps to trap the oppositely charged allergens on contact, much like an air filtration system works.
Okay. I call bullshit here. Since when do allergens carry charges? And if they did, they could be positive or negatively charged, so that would mean that the gel would carry both charges, which would make it electrically neutral. The product contains “petrolatum [read: petroleum jelly], glycerin and other ingredients.” Ever been zapped by Vaseline? Neither have I. If petroleum jelly was charged, it would dissolve in water. And that is NOT how air filtration systems work. First, air filters have, well, a filter, for crying out loud. Second, air purifiers actively electrically charge allergens. And if this is what this stuff does, any child using it would also be breathing in some ozone…
It’s possible, I suppose, that the blocking action is achieved by the allergens simply getting stuck to the product as air is breathed in. But since the air is not passing through a filter, but the allergens are expected to magically be attracted to what is essentially Vaseline (at $15 for 1/10th oz.!!!!) as air passes over the gunk with very little air/gunk contact, I don’t expect much in the way of efficacy. But, hey! It uses “no unnecessary additives” and contains no pseudoephedrine (an antihistamine), alcohol, artificial flavors or dyes – or anything that is likely to work, either. Of course, using absolutely nothing will likely provide these same benefits and level of efficacy (or better, using a hepa filter mask).
Parents should not be concerned with giving children antihistamines for relieving symptoms of rhinitis, particularly the second-generation H1-antihistamines4. Some members of this antihistamine class, such as cetirizine, desloratadine and fexofenadine are approved for children as young as 6 mo. While I do not like over-prescribing medications, I must say (speaking as a sufferer of rhinitis) I am also no fan of refusing medication at the expense of my quality of life. Parents should be aware that the second generation of antihistamines are extremely safe. Their use to effectively relieve symptoms in their allergy-suffering children should not be overlooked (and let’s face it, it is suffering) just because someone claims to have an all-natural, yet unproven, remedy or a product that magically removes allergens from the air as they breathe by means of a mechanism that is highly suspect.
There seems to be some irrational association between something that is ‘natural’ and ‘efficacious and unharmful’. Foxglove (digitalis) is natural, useful in treating heart disease and deadly in anything but very small doses. A guy I know was surprised to find out that sugar and honey are calorically even though somehow honey is ‘natural’ and sugar is not(?). And the herbal medicine industry is not without its own Vioxx situations. Remember ephedra? It’s as natural as the heart failures it produced. There is also this strange belief that the ‘old wisdom’ of using herbs and other methods supported only by anecdotal evidence is somehow better than what modern medicine provides. Why not go whole-hog and return to animal sacrifice as part of health care? The level of evidence is the same.
I once bought some skin cream at a department store because I liked it. It wasn’t greasy and it was readily absorbed by my skin. I didn’t buy it because I bought into the sales pitch that “it’s made from olive leaves, the only type of leaf that regenerates!” Yeah, I’ll remember that when next I’m reincarnated as an olive tree. I find it rather implausible that the olive leaf extract will impart regenerative properties on my aging face just because the plant itself. If I accept this, by the same logic I must also accept that it will turn my skin green and I will start photosynthesizing. Exercise those critical thinking skills!
Because of political pressure from those who are satisfied with completely non-rigorous standards of evidence when it comes to treating their health problems (and think that this is a plus), I can walk into a pharmacy and buy all manner of unproven bric-a-brac, like herbs (conspicuously devoid of any mention of what they are used for) or copper and magnetic bracelets. As I believe it is professionally unethical to provide therapies which have not scientifically demonstrated efficacy, I call on Canadian pharmacies to do what they did with the selling of cigarettes – fully extricate themselves from the practice of selling unproven herbal and homeopathic ‘medicines’ which are ineffectual or potentially harmful.
I’m going to end this entry with a thought experiment – one which you can readily carry out, too – showing why homeopathy is nonsense that is so clear anyone can understand it, even its biggest believers. Ethanol is a drug. No two ways about it. Aside from life-long teetotalers, all of us of drinking age (legal or not) know it produces measurable effects we can readily experience by acting on GABAA receptors and changing the hydrodynamic properties of the fluid in the inner ear we use to maintain balance. It is also used to treat methanol poisoning, as it competitively inhibits the action of alcohol dehydrogenase on methanol to form formate (the toxic product which destroys the optic nerve) until the methanol is out of the system. Let’s say I’m totally soused. Not true at the moment, but just for argument’s sake. The principle behind homeopathy is that a little (or, using typical homopathic dilutions, none) will actually cure me of my inebriated state.
Now, if we believe the homeopaths, after ingesting most of a bottle of Cruzan (my favorite rum, distilled in the US Virgin Islands), I can make the effects go away. Now before believers start jumping on me that I am trying to cure myself of something that I have ingested, look at Zicam. One of the homeopathic ingredients is histamine dihydrochloride. According to homeopathic theory, a small amount of histamine will cure one of the histamine response. In other words, Zicam contains histamine to diminish the histamine response producing cold systems just as I am analogously using a small amount of alcohol to sober myself up. The problem agent does not care if it is ingested or generated in situ via an immune response. So, we create the homeopathic preparation by progressively diluting a shot of rum till on average not a molecule is left, shaking at each dilution. Which outcome do you predict after administering the preparation? You find-
- sobriety and reality have disappointingly returned; or
- that no matter how much succussion the concoction tastes exactly like water and you’re still completely soused.
Or don’t you trust me?
- Anick DJ, “High sensitivity 1H-NMR spectroscopy of homeopathic remedies made in water”, BMC Complement Altern Med 4: 15 (2004).
- Ernst E, “A systematic review of systematic reviews of homeopathy”, Br J Clin Pharmacol 54 (6): 577–582 (2002).
- Caruso TJ, Prober CG, Gwaltney JM. “Treatment of naturally acquired common colds with zinc: a structured review”, Clin. Infect. Dis. 45 (5): 569–74 (2007).
- Schad CA, Skoner DP. “Antihistamines in the pediatric population: Achieving optimal outcomes when treating seasonal allergic rhinitis and chronic urticaria”, Allergy Asthma Proc. 29:7-13 (2008).