Homeopathy: the basics

Dec 16 2009 Published by under Health Care/Medicine

I feel kind of weird doing a post on homeopathy. But it drives me crazy when people talk about homeopathy as though it is the poor unfortunate soul of modern scientific medicine. So this is an "info" post. I've read a lot of blogs out there, and many of them attack homeopathy without explaining why they think it's bunk, and many people defend homeopathy without knowing what it is they are defending. And I hate when people say things, and then look like idiots because they didn't know ANYTHING about what they were saying. Sci has done this in the past, and wants to save you all from the same embarrassment.
Ah, homeopathy. Almost everyone has an opinion, and opinions are very strong. I managed to find only one article that I could say made an effort to be unbiased, looking at various studies done and whether the studies were enough to determine effects. This article is actually a statement from the American Journal of Pharmaceutical Education by Johnson et al in 2007, and it's an article about homeopathy and how it should be covered by those in pharmaceutical practice. So I'm relying pretty heavily on that one article, with other articles as supplement. I do think this stuff is bunk, but this is not about what I think. Rather, it's about what homeopathic remedies are, and how they are purported to work.
I've tried to talk to several people about this post, and every single one of them started out saying "Ooh! Homeopathy! Can you tell me about [insert herbal remedy/ Airborne/ Zinc tablets/ aromatherapy]?!"
I wish I could, and maybe if you ask me a specific question about a specific herbal remedy, I can (hint for possible future posts). Unfortunately, homeopathy is not ABOUT that. Recently, homeopathy has come to mean pretty much anything in the way of alternative therapy, from aromatherapy and herbal remedies to pressure points and chiropractic techniques. But homeopathy itself is actually something very different. It doesn't mean that homeopathy doesn't often coincide with herbal remedies or aromatherapy, many homeopathic remedies are herbal in origin. But what I will be covering today is homeopathy in the very strictest sense.
So, for the record. Homeopathy ≠ herbal remedies. A lot of people say stuff like "you scientists hate homeopathy, but herbs can have many medical properties". Yes, herbs can have many medical properties, and many researchers are still looking at plants to isolate possible active ingredients for new drugs. We wouldn't even have aspirin if the Bayer company hadn't started questioning why people took Willow infusions for headaches (willow bark contains salisylic acid, which is a relative of acetylsalisylic acid, or asprin). But herbal remedies like those are NOT homeopathy. The difference lies in how homeopathic remedies are made and the theory behind how they work.

What is Homeopathy?

Homeopathy (taken from Greek, meaning "similar disease") is considered a form of alternative or complementary medicine. The idea of homeopathy was first described by Samuel Hahnemann in the late 1700's. The modern form of homeopathy is based on three main tenets:
The Law of Similars: The idea is this: a given thing (usually a natural product, but not always) causes a certain set of symptoms in a healthy person. If you give the thing that CAUSES the symptoms, to a sick person that already HAS the symptoms, the law of similars states that the symptoms will be cured (Johnson et al, 2007). Hahnemann, the founder of homeopathy, used the phrase "simila similibus curentur" or "like cures like". How does 'like cure like'? It is the belief of many homeopaths that the artificial symptoms that you get when you take the remedy empower your vital force (or spirit) to neutralize the original disease. For example, if someone has insomnia, and they want to take a homeopathic remedy for it, the active "ingredient" in what they take will be caffeine. The 'wakefulness' of the caffeine is suppose to neutralize the wakefulness of your body so you can sleep.
So what is this "vital force" thing? That is where the second tenet comes in.

Individualized Therapy
: Homeopaths believe that everyone has a unique personality (or vital force), and that this unique personality will carry over into your physical body. This means that everyone will get sick in a slightly different way. For instance, if you and your friend had a cold, you could have a really runny nose for ten days, while your friend could only have a slightly runny nose and much more of a cough. Homeopaths believe that these differences in symptoms are the carry-over of your personality and the environment in which you exist (Jonas et al, 2003).
This means that it is important for a homeopathic practitioner to develop a good relationship with the patient. Only by knowing as much as possible about them can a homeopath come up with the medication that most closely matches the person's symptoms. Illnesses, especially those that linger or are consistent (like allergies or asthma) are thought to result from weaknesses in your vital force affecting your physical body. So it's very important to determine what the weaknesses in your vital force ARE, so that the practitioner can prescribe the best remedy.
Use of High Dilution: As you saw up in tenet #1, remedies in homeopathy are supposed to cause the same symptoms that they ultimately cure. But you don't want to be giving this stuff in high amounts. A lot of things that cause severe physical symptoms are very toxic, many natural poisons are used in homeopathy, and anyway it's not a good idea to exacerbate symptoms the patient already has (as then the patient might complain that it's not workng). So homeopaths instead dilute the substance.
Dilution in homeopathy is actually a very specific process, called "potentisation" (McDermott et al, 1995). The remedy is diluted with alcohol or water (or sometimes saline), and then shaken. The traditional way to shake up a homeopathic remedy is to strike it very hard ten times against an "elastic body". This shaking is called "succussion" (Bellavite, 1995). Hahnemann's "elastic body" was a wooden board covered in leather, an item that is still used by homeopaths today. It is believed that the more you dilute a substance, the MORE potent it is, not less.
So how diluted are the remedies? Hahnemann recommended that the remedies be diluted to the point where no symptoms would be observed when they were taken (so as not to exacerbate a sick person's symptoms). He recommended a "C" system of measurement, where you dilute the remedy to 1:100 of the original at each stage. He recommended doing this about 30 times, or 30C (Resch, 1987). Obviously, that's a lot of dilution. Most homeopathic remedies are in fact diluted to the point that they have no chemical difference at all from pure water, alcohol, or saline.
So to make a homeopathic remedy, add one tiny drop of, say, caffeine, to a gallon of water. Shake vigorously. Pour 99% of it out (you're diluting 1:100). Add another gallon of water. Shake vigorously. Pour 99% of that out. You're now at 2C. Continue until you are at 30C. Several people have estimated that, to get one molecule of a substance in a homeopathic remedy, you would have to swallow 30 swimming pools worth of the remedy or solution.

The Memory of Water

So, if there's no chemical in there other than water, how is it more potent, and how does it work at all? This is the main sticking point for most clinicians, and it involves something called the "Memory of Water". The theory involves quantum physics, actually. Water in its liquid form is not just a bunch of little H2Os floating about. The water molecules are linked very loosely (thus the liquid), and constantly forming complexes of themselves, and of anything else that is in the water. Because water molecules are a very specific shape, they can form only a limited number of complexes.
The Memory of Water (MoW) relies on these complexes that water can form. The idea is that an amount of water that has been exposed to some compound will keep the memory of that compound. The compound will induce the water to form certain complexes MORE than it forms others. So the former presence of the compound affects the likelihood that the water will form certain complexes later. Because the compound WAS ONCE THERE, it has changed the water. It is the change in the water that causes the homeopathic remedy to be effective (Milgrom 2007). Basically, the chemical that was once there has left a hole in the shape of the chemical in the water in terms of the complexes that the water is capable of forming.
However, the MoW does not have any scientific support. There are some experiments that have shown that the memory of water DOES occur, but only on the level of picoseconds (that is one millionth of one millionth of a second) (Milgrom 2007). Proponents of the MoW believe the effect lasts for a long time, and that MoW is key to the effectiveness of homeopathic remedies. Critics believe that picoseconds are all that you're ever going to get. Critics also point out that if water really did have memory, all the water we are in contact with would be irrevocably changed by all the stuff it's gone through, and thus adversely affect our health. For example, in urban areas, we would be suffering the effects of drinking the homeopathic equivalent of each other's urine for about a century. Let alone the homeopathic effects that we'd also get from drinking homeopathic manure, radioactive waste, or any drugs that find their way into the sewer system. And if MoW REALLY lasts a while...well, that's a LOT of dinosaur crap we've been drinking.
So Does Homeopathy Work?
There have been several clinical trials for homeopathic remedies, many of which are well controlled and with good methodology, and no one has been able to confirm that homeopathic remedies work better than placebo. Of course, there is a very strong placebo effect in all the trials (as well as in most trials for clinical medicine). So homeopathic remedies work no better than placebo (Shang et al 2005). Also, homeopathic remedies, though they do fall under regulation by the FDA, are not subject to the same standards are clinical drugs. This means that you do not have to prove your remedy is effective to sell it. (As an aside, anyone seen the thing on Airborne? Airborne is a dietary supplement, not a homeopathic remedy, but both fall under the same category. So technically Airborne never had to prove it was effective to be sold. Therefore, the lawsuit had to be false advertising.)
(And for real: you want this to WORK?! Vital forces, the memory of water...diluting things to make them MORE potent...um...if your logic alarm is going off, it should be.)
Many opponents of homeopathy additionally believe that homeopathic remedies can cause HARM. Not because they are harmful by themselves (though possible additives in them can be), but because homeopathic practitioners will discourage patients from using clinical medicine, such as vaccines or blood pressure medication.
However, a placebo effect isn't always a bad thing. And homeopathic practitioners say that part of the positive effects of homeopathic treatment rely on the trusting relationship formed between a patient and practitioner. They say the benefits are a lot like that received from therapy, and no one doubts the effects of good therapy. But it still seems like lying to use a good relationship to market...a placebo.
So now you know what people are yelling about when they discuss homeopathy. Personally, I would really like to see a homeopathic treatment for dehydration. You'd have to have a compound that causes dehydration, but what would you dilute it in? you can't dilute it in water or saline, because those will rehydrate, and in homeopathy, you have to CAUSE dehydration to cure it...but you can't having anything that CAUSES dehydration because it would have to be diluted to the point where none of the dehydrating agent remains...


28 responses so far

  • Z.M. says:

    Good introduction, thanks. Do you know where Hahnemann got the idea that "like cures like"? It seems very implausible and difficult to test as a general rule, and I've always wondered where such ideas come from.
    Also, if you want suggestions for herbal "remedies" to post on, I'd be interested in hearing more about the alleged health benefits of tea. It probably wouldn't alter my tea-drinking habits either way, but I'm curious about which (if any) claims are well substantiated.

  • razib says:

    yeah, i've heard homeophiles rage against "allopathic" medicine. in third world countries homeopathy is appealing cuz it's cheap.

  • Karen says:

    A very succinct overview of the "theory" (and I do use that word loosely) behind homeopathy -- I'm bookmarking this to email to confused friends who ask me stupid questions.
    I do have an answer to your hypothetical homeopathic remedy for dehydration, though: dilute the dehydrating agent (probably salt, as that's the obvious one) in alcohol, which is also a dehydrating agent.
    We could make a fortune, if it just didn't seem so damned unethical to scam people like that.

  • Sam C says:

    It's understandable to focus on placebo effects, but it is important to remember that the perceived "effectiveness" of homeopathy is not only dependent on the placebo effect. Outside of trials, it also takes advantage of ordinary healing processes, confirmation bias and plain ordinary lying, plus the weirdest mechanism of all in this context: homeopathic remedies that actually contain ordinary effective drugs (at proper concentrations).
    And is it reasonable to ask those who are against homeopathy to take time to discuss it? When you have something so totally absurd, that has not passed a decent trial, something that is clearly 100% undiluted nonsense, why waste time giving it credibility? It's as much nonsense as creationism, and its adherents cling to their pseudo-scientific crutches in the same way.

  • P. Wormer says:

    Did you see the article:
    and if so, what is your opinion about this article?

  • Sam C says:

    Z.M. #1:

    Do you know where Hahnemann got the idea that "like cures like"? It seems very implausible and difficult to test as a general rule, and I've always wondered where such ideas come from.

    I might be wrong but I think the reasoning for that bit went along the lines of:
    (a) there's something wrong with the patient's body
    (b) the patient has a fever (for example)
    (c) the fever must be part of the body's curative response to the problem
    (d) so the fever is good and should be encouraged to speed up the response
    In effect, distinguishing between the underlying problem and the symptoms of that problem. It's got a sort of underlying sense to it. Don't cure a fever, cure what's causing the fever. Of course, it's massively simplistic, and homeopathy has failed to take onboard any new medical knowledge in its 200 or so years; medically, it's stone age.
    How Hahnemann got from there to the idiotic dilution theory, I have no idea.

  • Dagda says:

    Hahnemann got his idea 'Like cures like' while he was translating an english medical book into german.
    Because he had problems translating some sections he tested some remedies. He took quinine,an anti-malaria drug himself.
    The typical symptom of Malaria is fever. Now he developed fever himself, which then led him to the idea.

  • Howard C. Berkowitz says:

    "Like cures like" actually precedes Hahnemann; see http://en.citizendium.org/Sympathetic_magic. While homeopathic provings have enormous problems when compared with modern randomized clinical trials, his approach to them was systematic for the early 19th century.
    I don't know his inspiration for potentiation. The idea does occur in anthropological analyses of ritual magic, such as Frazier's The Golden Bough, often under the term of the principle of contagion -- essentially, amplification of undefined forces in arbitrary nearby objects.

  • Howard C. Berkowitz says:

    Correction on the link above; it picked up the period.

  • ENT-TT says:

    Actually, as I recall, "simila similibus curentur" goes back a loooong way. As Sam C said, it's pretty much stone-age. I've seen many references across several different cultures that use variants of this idea... In most cases, it had to do with temperature. There are "hot" remedies for "hot diseases", cold for cold, and even certain opposites (not sure what the logic was if any). I can remember a specific instance where glowing-hot metal rods were applied directly to the skin over areas where muscles were stressed or torn (hot for hot), and where diets match the ambient climate (eat spicy food when it's hot outside, cold bland food when it's cold outside). These seem to be pretty common folk remedies across a wide variety of cultures. They certainly don't have anything to do with modern medical science (although I could think of some physiological reasons why hot metals applied to muscles might work, once you get over the searing agony).

  • Katie says:

    I think the idea of potentisation was introduced way after Hahnemann, as a result of the fact that people experienced ill effects from homeopathic treatments. Unfortunately, I can't cite a source, just remember this from browsing through a library book a while ago... Maybe somebody out there knows what I'm talking about?

  • Tsu Dho Nimh says:

    One scary thing is that anything in the Pharmacopia of Homeopathy is automatically OK to sell. And there is no safety review process for the things in there ... it's whatever they want to call "homeopathic".

  • Katherine says:

    Additional to Dagda's comment at #7:
    I read somewhere that Hahnemann's fever from the quinine was not a typical reaction to quinine and that he was probably allergic to it, which is why he developed the fever.

  • Katherine says:

    @Sam C #4:
    I wouldn't say you HAVE to take time out to explain it, but if you never explain it a lot of people that are undecided or do not have the skills to research and evaluate the evidence themselves will either remain undecided or think that because you are being mean the homeopaths must be right (that they are just persecuted by modern medicine). As long as there are explanations periodically posted on the net people like that will be able to find them and will get the help they need to change their minds. By all means just be scathing etc. the rest of the time 😉

  • Angermeyer says:

    You'd have to have a compound that causes dehydration, but what would you dilute it in?
    Well alcohol can be very dehydrating and it's also freely miscible in ethanol.
    Homeopathy may be absurd, but that concoction will definitely make you feel better.

  • Cherie says:

    In an era when encounters with doctors and hospitals were more likely to kill than to cure, it made a lot of sense to treat via placebos. In fact, in many cases it still does.
    Homeopathy is bunk, but for mild conditions and chronic incurable ones (colds, arthritis, headaches) it may be safer and at least as effective as a lot of allopathic remedies (not all allopathic medicine is evidence-based).
    So, what is wrong with homeopathy is overcharging as well as selling it for conditions for which satisfactory allopathic treatments exist.

  • namnezia says:

    About like cures like, I have to say that I sleep better if I've just had a cup of coffee...

  • Julie says:

    Sorry, y'all, but I'm going to keep using the homeopathic teething gel they sell in the stores because it works. I'm pretty certain that neither of my babies suffered from placebo effect. I was even *still* doubtful that it was doing anything for them until I got an impacted tooth. For those who have had an impacted tooth, you know what kind of pain that is, and that you'll do pretty much anything to get it to stop (you know, like Tom Hank's character in Castaway?). I hadn't slept because of the pain, and anbesol had just about melted away my gum tissue. I'm telling you, I grabbed it randomly out of the medicine cabinet; I was not expecting it to work, but it did. I slept for 3 hours, when it wore off, put more on, and went back to sleep. I used it until I could get back to the dentist. I have tried to look at it from every angle, and I really don't think there was a placebo effect. I don't have empirical evidence to back me up, but I hear similar accounts from others who have used it, or used it on their children.
    I don't know if the concoction is technically homeopathic, given the ingredient list, but it is labeled as such.
    Oddly enough, the teething remedy comes as tablets too, but it doesn't work nearly as well. Just the gel.

  • DD says:

    Sci, most excellent post!! Huge difference between (truly ancient) herbal remedies and modern homeopathy, thanks for separating them, most anti-homeopath "big pharmers" ignore the critical difference.
    Aspirin was synthesized from the meadowsweet (spirea) plant, which contains the same salicin as in Salix (willow) and Populus (aspen) but in more consistent quantities. I wrote a quick post about natural mosquito repellent & anti-microbial herbal plants, many live at waterside in mutual symbiotic relationships with animals that daily drink water and munch the nearby herbs, evolving an acquired taste for lemony/minty/medicinally aromas/flavors which repulse blood-thirsty mosquitoes (that need protein to make their eggs).

  • Joe says:

    For the best information on quackery see http://www.ebm-first.com/ or http://www.skepdic.com For the most comprehensive, if somewhat more technical source, see http://www.quackwatch.org which has a subsidiary site devoted to homeopathy.
    As for aspirin, it is derived from salicylic acid (SA), originally found in meadowsweet. Salicin (aka saligenin) is the primary analgesic in willow bark, not spirea. DD is a tad confused; but so are many other folks including J. Vane who won a Nobel for his work on the pharmacology of aspirin. Salicin (from willow) is digested to glucose and salicyl alcohol; which is subsequently metabolized to SA. (Yes, later some SA was found in willow bark- it is commonly found in many plants.)

  • Joe says:

    If I may add, Sci cites Lionel Milgrom with appropriate disdain. LM is a bloody idiot. I teach rudimentary QM in Introductory and Organic Chemistry in college.
    He promotes a weak quantum mechanical (QM) justification for homeopathy. "Weak" QM dispenses with Plank's constant, which is the link between the pure math of QM and reality. Thus, Milgrom offers fanciful math as a justification for his notions. I say again: he is an embarrassment to my profession.
    One last thing, in particular to the homeopathetic gel user- many such products are adulterated with active drugs. Keep your eyes peeled for an article from a pharmacologist who is (informally, today) reporting that many homeo-preps contain drugs. I am not able to report his work before he publishes it. Similar adulteration is also regularly found by the FDA concerning herbs.
    Sci- great article.

  • DD says:

    Joe, thanks for the Org Chem details.

  • Scicurious says:

    Julie: What is the brand that you're using? Many remedies labeled "homeopathic" actually contain measurable amounts of active drug, and it's very possible that the teething gel contains a real amount of something like lidocaine or another topical anesthetic which would explain the effects. The scary thing then is that this is entirely unregulated, and thus ANYTHING could be in there.
    Angermeyer: alcohol! Excellent suggestion. Alcohol cures many ills, indeed.
    DD and Joe: thanks for the details! I was unaware of the actual origins of aspirin and I might have to read up on it.

  • Melissa Burch says:

    The best scientific evidence for homeopathy comes from the materials scientists including Dr. Rustum Roy and many others. Dr. Iris Bell, NIH funded, recently explained the reality that homeopathy works at http://tinyurl.com/yd5mjjj
    Someone mentioned that homeopathic remedies are unregulated which is completely untrue. The FDA regulates all homeopathic remedies. There is still the confusion between homeopathy and herbal medicine. They are completely different even though homeopathy used herbs to make homeopathic remedies the use of them and the way they are prepared is fundamentally a different type of medicine.
    Thank you for your clear explanation of homeopathy. If people knew the possibilities of what homeopathy can do for them it would change medicine forever.
    Melissa Burch, CCH, RsHom(NA)

  • Emmers says:

    @Melissa: To quote the original post: "Also, homeopathic remedies, though they do fall under regulation by the FDA, are not subject to the same standards are clinical drugs."

  • Joe says:

    @24 Melissa,
    Your citation is a joke, not science. Rustum Roy and Iris Bell are idiots whose painfully stupid article (Homeopathy (2007) 96, 175–182) was thoroughly debunked by us (doi:10.1016/j.homp.2007.10.004, available online at http://www.sciencedirect.com) in that same magazine. I could teach high school students to do better.
    So, perhaps the best "evidence" comes from Bell and Roy, but their "evidence" isn't worth the powder to blow it to hell. The bottom line, despite sincere advocates, is that homeopathy is fraud.

  • Joe says:

    Sci, presumably you have my e-mail address. If you send me an e-mail with Neurotopia on the subject line I can send you some information on the history of aspirin.

  • DuWayne says:

    Julie -
    Those are not actually homeopathic - they contain ingredients in measurable quantities that help reduce teething pain and the sugar is also rather helpful.
    Sci -
    The reason that homeopathy has been taken as an all encompassing label, is entirely advertising - a sort of efficacy by association idea. I actually interviewed folks at a few of the numerous CAM schools in the Portland and Seattle areas and while there were few who would put it outright, they all implied it. By lumping it altogether, under one label - and the label that actually describes the least evidence based, it all becomes more valid by mere virtue of association.
    I would also note that this phenom began in the PacNW - earliest use began in Portland. Though more have sprouted up in recent years, for a long time there were more schools for CAM in Portland and Seattle, than could be found collectively in the rest of the U.S. Throw in the Bay area and I suspect that is true today. I mention this because in the PacNW, CAM is a considerable industry and there is a lot of money and energy being thrown into legitimizing CAM in general. Not from any single aspect of CAM, but across the board. About the only dissent found within that community comes from some of the herbalists who object to the equation of magical thinking with a field that actually has some evidence based efficacy.

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