Sunday, November 03, 2013

Homeopathy: Much ado about nothing

I visited a doctor a little while ago and he suggested three different treatments for me. The first was expensive and not covered by insurance. The second was a strong drug that could be hard on the liver, and given my medical history he said it was not a good idea for me. The third was what he called a "homeopathic" remedy. The description did not sound remotely homeopathic, so I questioned him on it. He admitted it was actually a naturopathic remedy, and that he didn't know the difference between "naturopathic" and "homeopathic". I informed him.

For what it's worth, I chose the natural remedy and it is working nicely, thank you.

Homeopathy is one of the most hilariously silly alternative medicine systems. I decided to write this article because it seems that many people don't know what homeopathy is, and confuse it with herbal remedies or naturopathic medicine in general (as the doctor did). Herbal remedies and homeopathic remedies are quite different. While some herbal remedies are pseudoscientific, having no evidence of their efficacy, many others really do work and many of the drugs and medicines we all use are based on herbal remedies. Homeopathy, on the other hand, is based on outdated knowledge, bad science, and magic.

What is homeopathy?

A homeopathic remedy is one in which you take something that may cause an illness and make a strongly diluted solution of it in order to cure the illness. The idea is termed "like cures like", meaning that the thing that makes you sick can also cure you. This is not the outrageous part – that's (kind of) the idea that vaccines are based on. The outrageous part is the dilution.

It's very easy to make a homeopathic solution. Take 1 mL of whatever the original substance is and mix it in 100 mL of water. In an actual homeopathic remedy, you'd need to shake or bang the container a few times after each dilution. Then take 1 mL of the resulting solution (not all of it, just 1 mL – you can throw the rest away) and mix it in a different 100 mL of water. Then take 1 mL of that  solution and mix it in a different 100 mL of water. We've now diluted the original substance in a ratio of 1:100 three times. This is the same as 1:1003, or 1:1,000,000, termed 3C. It should be obvious that there isn't much of the original substance in the resulting mixture.

Now repeat that procedure twenty-seven more times. This is now 30C, which is what's typically used in homeopathic remedies. (Note that some homeopathic remedies use a dilution of up to 200C.) The odds of there being a single molecule of the original substance in the final mixture are infinitesimal. Here's a frequently-used comparison. If the entire Atlantic Ocean was fresh water and you added a pinch of salt and mixed it up, the resulting solution would be about 12C. Each number you go up (i.e. from 12C to 13C) results in a solution 100 times weaker than the previous one. You have to do this 18 times to get from 12C to 30C, so the solution is 10018 times weaker. A standard homeopathic solution is a billion billion billion billion billion billion times weaker than that pinch of salt in the ocean. When you pay $10 for a little vial of a homeopathic remedy, that's what you're spending your money on. Pure water. Homeopaths will confirm this.

(Note that sometimes it's not a liquid solution that you're buying, it's sometimes a sugar pill that has been treated with the 30C solution. Homeopaths will also confirm that the pill itself does nothing, it's just a delivery mechanism for the solution.)

One other rule of homeopathy: the more the substance is diluted, the stronger it is. You want an extra-strength version? Mix it in more water. This leads to all kinds of homeopathy jokes:

I accidentally overdosed on my homeopathic medicine the other day. I didn't take it.

Why would anyone ever buy a homeopathic remedy twice? When you're about to run out, just dilute it some more.

There's even a homeopathic webcomic.

So if the stuff you're buying doesn't have any of the original substance left in it, how do homeopaths claim it works? This is where it gets really silly. The water remembers. Homeopathy posits that you can dilute the solution to the point that there isn't any of the original substance left and the water contains some memory of the substance and that is what cures the disease. Actually it's not – that's what triggers your body's "vital life force" to cure the disease. Note that this "life force" is the same one that chiropractors claim to influence when they make spinal adjustments, and it's the same one acupuncturists claim to influence when they insert their needles. There is no evidence that such a force exists.

Not only is water memory implausible, scientific tests have shown that any artificial ordering of water molecules (i.e. what might pass for "memory") breaks down after roughly 50 femtoseconds, which is 50 millionths of a nanosecond. And I'm not talking about a nanosecond meaning "a very small amount of time", I'm talking about an actual nanosecond, i.e. a billionth of a second.

None of this matters

Having said all that, none of it matters. When it's all said and done, who cares how something works as long as it works? There are lots of different types of medicines out there, and I have no idea how most of them work. There are even some that modern medical science can't fully explain. But that doesn't mean they don't work.

Homeopaths will argue that "you can't say homeopathy doesn't work just because you think it's silly." They're absolutely right. They'll say "you can't say homeopathy doesn't work just because you don't know how it could work" and they're right again. The reason we know it doesn't work is from the thousands of studies and trials that have been done over the past hundred years that show it doesn't work. There's no need to explain why it doesn't work, and there's no need to come up with an explanation of how it could work if it did. The studies prove that it just doesn't.

Full disclosure: while researching this article, I ran across lots of published studies that concluded that homeopathic remedies worked better than placebo. Some of them didn't have proper blinding or randomization or things like that, and so they can be dismissed out of hand. But many cannot. I am not a scientist so I cannot look at a study and determine whether it was done properly or whether the data supports the conclusions, so I must read other people's interpretations and decide if I trust them. Scientists and skeptics believe the data is clear – homeopathy doesn't work. Homeopaths believe the data is clear – homeopathy works. I could simply trust the skeptics because I'm a skeptic, but that could be looked at as a personal bias. But I do trust the skeptics, and here's why.

Homeopaths point to certain trials that show homeopathy's effectiveness as proof that it works. But they also say "It has been established beyond doubt and accepted by many researchers, that the placebo-controlled randomised controlled trial is not a fitting research tool with which to test homeopathy." So they use the studies that show their results as proof, and dismiss the ones that show different results as "these types of tests aren't appropriate". Note that they're not claiming that there was a problem with the studies themselves, it's the entire concept of the randomized trial that they disagree with. There are two logical fallacies here: cherry picking (picking only data that agrees with you) and special pleading (saying that it's impossible to test this claim but not saying why). There's also no reasoning for why the generally accepted science of a randomized trial is not "fitting".

Conclusion

Homeopathy was invented in the early 1800's, during a time when almost everything known about healthcare and the human body was wrong. Medical science has changed almost entirely in that time, with innumerable advances and breakthroughs over the decades. And yet homeopaths have clung to the same concepts despite there being no non-anecdotal evidence that it works and no theoretical way that it could. There have been no advancements in homeopathy in 200 years – all of the original theories are still in use today. Homeopaths have had 200 years to prove to everyone that it's effective and they've utterly failed. If it was truly effective, there'd be no need to convince anyone of anything and it wouldn't be alternative medicine, it would just be medicine.

But what if it did work? What if water actually did retain a memory of a substance diluted in it, and could be used to cure some illness caused by that substance? How would the water know which substance to remember – the one you just diluted beyond existence, or other substances the water has been in contact with? As I read on one site, "One wonders in vain how water remembers only the molecules the homeopath has introduced at some point in the water's history and forgets all those trips down the toilet".

If water truly had memory, there would be no need to mix anything. All the water on Earth would have some memory of all the substances it's been in contact with over however many millions of years, and since it's been diluted many thousands of times, it'd be pretty potent. All the water on Earth would be a homeopathic remedy for everything. Every time you drink water, you'd be triggering your body's immune reaction against every disease, even if you didn't have it. Everyone would be healthy all the time.

And we'd all be drinking dinosaur pee.

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