Wednesday, April 9, 2014


What is homeopathy?

Homeopathy is a bit like the old "hair of the dog that bit you". If I have a headache, I should be treated with something that gives me a headache. That something will be highly diluted, so as not to kill me - which is a good thing. This sort of treatment will muster my body's own resources to combat whatever is ailing me.

Homeopathic cure for a hangover?

Homeopathetic claims

Here are some of the claims about homeopathy that I found on the internet:

Homeopathy is a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health.

Homeopathy is extremely effective. ...
Homeopathy is completely safe. ...
Homeopathy is natural...
Homeopathy works in harmony with your immune system, unlike some conventional medicines which suppress the immune system...
Homeopathic remedies are not addictive...
Homeopathy is holistic...

One of the ways homeopathy works is by helping to balance your body’s energy, or chi as it’s called in traditional Chinese medicine. This energy is circulated through your body along specific meridians, and when this circulation gets disrupted -- something you can test for using electrodermal screening -- illness can result.

Homeopathy is holistic because it treats the person as a whole, rather than focusing on a diseased part or a labeled sickness.  Homeopathy is natural because its remedies are produced according to the U.S. FDA-recognized Homeopathic Pharmacopoeia of the United States from natural sources, whether vegetable, mineral, or animal in nature.

Homeopathy is probably the most difficult medical discipline to master because it is based on the pure observation of nature, and the strict application of a natural law.  All symptoms (physical, mental or emotional) need to be considered for an accurate prescription to be given. The goal of the homeopath is to recognize, through the unique expression of their patients’ symptoms, the pattern of disturbed energy and identify the correct homeopathic medicine (remedy) that is most ‘similar’ to them.

I noticed a funny thing on these sites. These websites never come right out and make specific claims about which ailments might be best treated by homeopathy. They tell a bit about what homeopathy is, and maybe some of the history. But they are very reluctant to say "good for a sore throat", or "if your doctor has diagnosed you with..."

The British Homeopathic Association is one of the few sites that makes claims, albeit indirect claims. They provide a list of 75 papers where homeopathy has been tested on various conditions. These are valid research papers in respected journals According to this web page, homeopathy is effective at treating brain injuries, bronchitis, childhood diarrhea, the common cold, depression, fatigue, fibromyalgia, hay fever, post-operative ileus, immune function, influenza, insomnia, low back pain, post-operative oedema, otis media, perennial allergic rhinitis, plantar fasciitis, post-operative wound healing, postpartum bleeding, premenstrual syndrome, psoriasis, radiodermatitis, renal failure, rheumatic diseases, seborrhoeic dermatitis, sepsis, sinusitis, snoring, sports injury, stomatitis, tracheal secretions, upper respiratory tract infections, uraemic pruritus, varicose veins, and vertigo.

Wow! How could anyone possibly be skeptical after that?

What is Science?

Medical treatment is a tricky thing. Symptoms are not always clear cut, so diagnosis is not simple. People sometimes fail to respond to proper treatment, and sometime spontaneously recover despite lack of treatment. Measuring the effects of medications is a statistical thing, and as we know, seven out of five people have difficulty with statistics.

Science is not hearsay or anecdotal. Testimonials are appropriate for revival meetings, but not for science. Good medical research relies on the idea of randomized, controlled trials.

The typical design of a medical experiment starts by recruiting a bunch of volunteers who have all been diagnosed with a certain condition, the more the merrier. Ten is not such a big group. A hundred? Not bad. A thousand? Yeah... that would be good. If you have too few, then you run the chance of falling into the "maybe it worked, but it might just be the roll of the die" zone.

Some studies will administer the same test treatment to all the volunteers and then see how they fare. These studies have a name. They are called "inconclusive". As compelling as the results may seem, you can never tell whether the volunteers got better because of the treatment or in spite of the treatment.

It is important, therefor, to run studies that compare one potential treatment against another treatment. Half of the volunteers get treatment A, while the other half get treatment B. Often times, the "other treatment" is "no treatment", but humans are tough to work with. They generally have some belief in medicine, and their brain and body can team up to enhance recovery even when the pill is nothing more than a placebo (sugar pill). To make for a level playing field of "treatment A" versus "no treatment", the volunteers are not allowed to know whether they are getting a real medicine or a sugar pill. This is one half of the double blind.

The other half of a double blind experiment is that the people doing the caregiving -- the ones administering the medicines, taking in the volunteer's data, or otherwise interacting with the volunteers -- must also be kept in the dark about who is taking a medicine and who is taking a placebo.

Assigning volunteers to treatment groups is another delicate matter. When I have run randomized trials, I generally try to get all the attractive young brunette ladies in whatever group I will be involved with. For some reason, I don't get invited to run all that many drug trials. Volunteers are generally assigned to the groups at random, although the significance of a trial can be improved by selecting treatments in a quasi-random manner. For example, the computer may be told to randomize in such a way that the treatment groups all have roughly the same number of people between the ages of 60 and 70.

At the end, we wind up with a statistical question: How statistically significant is the difference between the results in the two groups? Even if the treatment being tested has absolutely no effect on the body, there is a 50% chance that it will outperform the placebo. But if the treatment way outperforms the placebo, then we can be pretty sure that there is something going on. Statistics allows us to put a number on "way outperforms".

Here comes the tough part. Human bodies, illness, treatment... these things have a lot of variability. If you run a drug trial with just a handful of people, the luck of the draw could easily tell you that the same drug is fabulous, ineffective, or lethal. So, to be effective, we need large studies before we can be confident that a treatment is effective.

Sometimes, it is possible to bring together a large number of smaller studies and form a firm conclusion. If one study with ten people says the drug is helpful, well, that's not that exciting. If there are ten studies out there that all came to that conclusion, then the evidence is a bit more convincing. They call this meta-analysis.

Meta-analysis is a bit tricky, though. First, it's complicated by the fact the the ten studies were probably all run just a little different, so it's hard to combine the results. More importantly, however, is publication bias. If a researcher does a small study and the results are kinda blah, there is a tendency for no one to get all that excited about publishing it. So, the studies that actually make it into the journals are biased toward optimism.

Those are the rules for doing science.

How does homeopathy hold up?

I took a look at the list of research papers provided by the British Homeopathic Association. For almost all of them, they gave links to the Pubmed abstracts. I consider this good scholarship. Good for you guys. Below I have quotes from the "Conclusion" sections of the four studies that investigated the effectiveness of homeopathy for treating childhood diarrhea.  (I added the bold type.)
Study 1The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power.

Study 2: The statistically significant decrease in the duration of diarrhea in the treatment group suggests that homeopathic treatment might be useful in acute childhood diarrhea. Further study of this treatment deserves consideration.

Study 3These results are consistent with the finding from the previous study that individualized homeopathic treatment decreases the duration of diarrhea and number of stools in children with acute childhood diarrhea.

Study 4The homeopathic combination therapy tested in this study did not significantly reduce the duration or severity of acute diarrhea in Honduran children.

My summary: One provided negative results. Three provided positive results, with two of these clearly saying that the question is still open. Overall, this is favorable, but please bear two things in mind. First, these are the four studies that actually got published. Who knows how many studies were performed and subsequently discarded because the results were uninteresting?

The second thing to bear in mind... I will add one additional quote from Study 3, which was the most positive of the four: "The mean number of stools per day over the entire 5-day treatment period was 3.2 for the treatment group and 4.5 for the placebo group." Hmmmm... If I were to stop at Walgreen's to pick up some loperamide for my ummm... unappealing symptoms, and if the ummm... frequency of unpopular symptoms dropped from 4.5 occurrences a day all the way down to 3.2, would I recommend loperamide to a friend? I think not. There is a difference between "statistical significance" and "practical significance".

I did a little study of my own, wandering around Pubmed looking for meta-studies on homeopathy. I found six such studies.

Overall, the literature concerning a total of 83 original studies suggests that homeopathy may have significant effects in some conditions, ... A larger number of observational studies and of clinical trials -- conducted in a methodologically correct manner without altering the treatment setting-- are needed before sure conclusions concerning the application of homeopathy for specific diseases can be drawn.

The evidence demonstrates that in some conditions homeopathy shows significant promise, ... A general weakness of evidence derives from lack of independent confirmation of reported trials and from presence of conflicting results, ...

When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.

There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to confirm these results.

The central question of whether homeopathic medicines in high dilutions can provoke effects in healthy volunteers has not yet been definitively answered, because of methodological weaknesses of the reports.

Placebo effects in RCTs [Randomized Clinical Trials] on classical homeopathy did not appear to be larger than placebo effects in conventional medicine.

Based on this, I am inclined to go along with what the National Center for Complementary and Alternative Medicine has to say about homeopathy:
Most rigorous clinical trials and systematic analyses of the research on homeopathy have concluded that there is little evidence to support homeopathy as an effective treatment for any specific condition... A number of the key concepts of homeopathy are not consistent with fundamental concepts of chemistry and physics.

But, but, but...

It worked for my cousin's neighbor

I'm glad to hear that your cousin's neighbor improved. But, there is a possibility that your cousin's neighbor might have recovered without the treatment. And what about your other cousin's boss who got the same treatment and grew a third foot?

It's not a chemical, it's natural

Hydrogen dioxide, sodium chloride, l-trytophan, and disaccharides are all chemicals, so therefor, they are harmful. These are are better known as water, table salt, that protein in turkey that supposedly makes you sleepy, and certain sugars, like sucrose. All matter is a chemical. Rather than tell me again that homeopathic remedies re not chemicals, please just paste a sign on your forehead that says "I don't understand chemistry".

By the way, rattlesnake venom, arsenic, stinging nettles, radon gas... these are all natural, so they must be good for you?

It's holistic, so it's better

There is something appealing about a doctor who considers your whole condition, rather than primarily looking at a biopsy of your liver. But I will repeat a quote from one of the homeopathy sites mentioned above: "Homeopathy is probably the most difficult medical discipline to master because it is based on the pure observation of nature, and the strict application of a natural law."

"Science has been wrong on a lot of things"

I have heard this argument quite a bit. It is used to prove that there are martians, that aluminum foil hats keep the CIA from reading your brain, and that dinosaurs roamed the Earth just a few years before Ronald Reagan was born.

Let me flesh out the argument a bit. I think the complete train of through goes something like this: "Science has said that homeopathy is ineffective, but Science has been wrong in the past. That means that there is a chance that Science could be wrong on it's condemnation of homeopathy. Therefor, it is certain that homeopathy works."

I followed that argument right up until the last little bit. And I might add,, one of the wonderful things about science is that it does evolve. When reality disagrees with Science, Science is adapted to resolve the conflict.

Conspiracy theory

Homeopathy would be proven if the major drug companies weren't colluding to squash all funding, and if medical journals would allow the research to be published.

The second part of this is just plain not true. A Pubmed search on the word "homeopathy" gets 4,850 hits.

As to the first part, homeopathy is currently big business. I could not find a single consistent number, but according to one source, there are 4,000 businesses accounting for $360M in annual income. Another source says that “U.S consumer sales of Homeopathic treatments reached $870 million in 2009, growing 10% over the previous year.” A third source gives a much larger number for the worldwide market: "In dollars the world homoeopathy market according to ASSOCHAM is $5.35 billion."

I'm not going to quibble about hundreds of millions versus billions of dollars. The important thing is that, by all accounts, there is a huge market potential. If the technique could be proven to the point where it was accepted by insurance companies, then the potential is astronomical. I am probably not the first person to ponder the fact that investment in some good science could make someone a lot of money. Well, if it panned out.

"Not consistent with fundamental concepts of chemistry and physics"

I'm going to go back to a comment from the National Center for Complementary and Alternative Medicine. Where does homeopathy run afoul of established science?

The difficulty comes from the fact that homeopathic remedies are highly diluted dilutions of highly diluted dilutions, which are then highly diluted by highly diluting them again and again. The active ingredient is first diluted in water or alcohol to one part in a hundred. The result of this is then diluted again to one part in a hundred, and then again, and again, and yet again. This dilution may be performed as few as 6 times, but preferably 30 times.

Excuse me... We start out with a finite number of molecules. After one dilution we have 100 times fewer. After two dilutions, that number goes down to 10,000. After three dilutions, the number of molecules is reduced by a factor of a million. After somewhere around 12 dilutions, we have about one molecule left.

After a few more dilutions - for good measure - it would be awfully hard for a lab with 18 million dollars worth of analytical equipment, a staff of 43 PhDs, and a couple of cages of lab rats to tell the difference between a tablet for angina and a tablet for morning sickness. So... how is my body is gonna be able to tell the difference?

The homeopathicists have heard this one before, so they have a ready response. There may not be any molecules of belladonna extract left, but the belladonna has left it's "memory" in the water.

Ok. Sorry. I just got off the bus. Homeopathic memories in the water are able to cause a profound effect on the human body, but to date we have not been able to invent an instrument of test procedure that is sensitive enough to see these "memories"?

Even in the unlikely event that there is something like a memory that gets imprinted in the distilled water, any drop of distilled water must also have the imprint of the millions of different molecules that it has come into contact with.

One can certainly argue that many medications work for reasons that we don't understand. But homeopathy goes a step beyond just benign ignorance. Any scientific explanation of homeopathy must start by inventing a new branch of physics that has a powerful effect on the body, but for some reason has evaded our detection up until this point. 

My assessment

Send me a check for $100 and I will send you my remedy for whatever ails you. Just to warn you, my cure will likely involve painting your toenails orange and dancing naked around a spruce true under a full moon while singing a certain Van Morrison song. For $1000, you might coerce me to join you. I'll bring along the KFC to sacrifice.

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