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...