When I got back to the car, I looked closer. In tiny letters, the box said “Homeopathic”! I guess I should have expected that in a heath food store, there would be homeopathic remedies, but I didn’t realize that they would ONLY have quack medicines. Readers of this blog are probably familiar with the problem with homeopathy. Most homeopathic medicines are diluted down so much that they contain few or no molecules of the active ingredient, and so they are literally just drinking water. In the case of these pills I bought, there is a long list of inactive ingredients, and just a tiny amount of the Pelargonium sidoides plant, a South African herb that MIGHT have some effect on reducing cold symptoms—although the medical studies are inconclusive, and most colds go away as our immune systems take care of the viral infection.

The claims of homeopathy have been tested over and over again, and none has passed muster. In 2005, the premier British medical journal The Lancet published an analysis of 220 studies about homeopathy, half of them conventional studies of medicines, and half of them of controlled homeopathic experiments. They found no evidence that homeopathy had any real value except as a placebo. In 2006, the European Journal of Cancer surveyed 6 studies, and found homeopathy had no effect (Milazzo et al., 2006). Even studies by homeopaths themselves often show that their products have no significant effect, despite their biases to prove otherwise.

In January 2010, a group of British skeptics decided to stage an event to show the uselessness of homeopathic remedies. They planned a “homeopathic overdose” day on Jan. 30, where they would take hundreds of times the recommended dose of homeopathic remedies to “commit suicide”. If homeopathic remedies were real drugs, such overdoses would indeed have made these people sick, or killed them. Of course, nothing adverse happened to them—except that some of them had to go to the bathroom more often from consuming so much water. Their protest was an effort to expose the fraudulent nature of  homeopathic remedies sold in British drugstores to the tune of £12 million worth of these worthless “remedies” between 2005 and 2008. Since the original stunt, groups in America and Australia have staged similar events to publicize the worthlessness of homeopathy.

In the United States, there is no national medical system fully in place yet, but homeopathy is not covered by most private medical insurance providers. About $3.1 billion were spent on homeopathic medicines in 2007, and about 2% of the U.S.  population seeks homeopathic treatment each year. Homeopathic remedies are still regulated as drugs for purity by the FDA, although the FDA does not endorse their medicinal qualities. However, the FDA considers most of homeopathic drugs harmless, because they are so diluted that they have no real active ingredients left. (The FDA is not empowered to tell consumers whether the drugs are worthless or a waste of money, just whether they are safe or not).

I should not have been surprised that an organic food store would have expensive but worthless homeopathic products on their shelves. Unfortunately, there are many mainstream grocery stores and drugstores that carry both homeopathic “medicines” next to legitimate medicines—and the consumer needs to look the packaging over carefully to make sure that it is really an FDA-approved drug based on scientific research, and not the product of some homeopathic con game. Caveat emptor!

As a coda to the story, I went to a conventional drug store immediately after I realized the health food store “medicine” was homeopathic—and bought 20 tablets of a real antihistamine-decongestant-pain reliever (for just $6), and took some of those. I felt fine the rest of the afternoon. And I saved the receipt from the health food chain, so I got my $17 back.

Radiation Sickness and Poisoning

Guidelines for Homeopathic Prevention and Treatment

In the wake of the major earthquake and tsunami that hit Japan on Friday, an explosion has just occurred at the Fukushima nuclear power plant.

It was reported that radiation had already leaked from the plant prior to the explosion and Japanese officials now fear a meltdown with further contamination has now taken place.

People are being evacuated from surrounding areas as engineers scramble to contain the damage.

Should the situation worsen, radioactive material carried by wind and air currents may spread contaminated material to neighbouring islands and countries.

For all concerned, there are protective steps that can be taken with homeopathy.

Key remedies that have been used either in research or historically to prevent  or treat radiation poisoning include the following:

• Cadmium iodide
• Cadmium-sulph
• Phosphorus
• Strontium-carbonicum
• X-ray

If at risk of radiation exposure, any one of the above remedies may be taken as an emergency response, three times a day in a 30C potency. Do not exceed 6 doses without guidance from your homeopath. If radiation sickness has developed, your homeopath can also advise on treatment dosages.

More Information

The following was written for the treatment and prevention of radiotherapy and chemotherapy side-effects but the information and references it contains are just as useful and relevant to accidental radiation exposure.

May be taken as an emergency response. They are actually telling people that hocus-pocus is helpful in the face of an actual medical emergency. I like the “Do not exceed 6 doses without guidance from your homeopath” as if the stupid sugar pills are so powerful that they require professional guidance. And if radiation sickness has developed? If you’ve actually absorbed more than one full sievert of radiation? Take a sugar pill; that’s sure to reverse the extensive chromosomal damage and organ shutdown.

This newsletter is bursting at the seams with claims that are untrue and illegal — and moreover, morally reprehensible in the face of the tens of thousands of Japanese killed in the tsunami that caused the Fukushima Daiichi mess. Australia’s law enforcement does not take kindly to this, and neither should any other decent human being.

If anyone from “Homeopathy Plus” would care to defend any of the illegal and immoral claims in this newsletter, I invite you to do so. I will be glad to address your points. In the meantime, I encourage Australians, Japanese, other hominids, and Australian regulators to send the contents of this newsletter to the Australian HCCC (Health Care Complaints Commission). You can do so here.

Yes, exploiting the deaths of thousands of innocents for financial gain pisses me off.

Update: A reader did contact the HCCC and was referred to the Office of Fair Trading as the appropriate place to report this type of violation. They are at:
NSW Fair Trading
PO Box 972
Parramatta NSW 2124
Phone: 98950111
Fax: 98950222

Oscillococcinum, also known by its shortened and more familiar name Oscillo, is a homeopathic cold remedy. Its maker, Boiron USA, has been advertising it on TV pretty aggressively lately, and it keeps popping up in daily life, so I felt it was worth a skeptical treatment.

According to their website, Oscillo is a 200C dilution of “Anas barbariae hepatis et cordis extractum”, duck liver and heart. If that sounds gross, don’t fret: A 200C dilution means that the water with which the pills were infused contained only one molecule of duck per 100²⁰⁰ molecules of water. Considering that there are only about 100⁴⁰ atoms in the entire universe, it’s clear that the Oscillo dilution is pure water (chemical purity is considered to be 1 part per 6 × 10²³) with no duck molecules whatsoever; in fact it’s many trillions and trillions  and googols (10¹⁰⁰) of times purer than pure water.

Nevertheless, Boiron calls this a “therapeutically active micro-dose“. It’s not. It is a non-dose. Boiron is being consciously deceptive, either when they call it a micro-dose of anything, or when they label it 200C meaning that it contains no active ingredients. The two are mutually exclusive. It can’t be both a micro-dose and a non-dose.

Like most homeopathic products on the market, Oscillo’s “inactive ingredients” (in fact its only ingredients) are sucrose (85%) and lactose (15%), from which the small sugar pills are made. The “dilution” of pure water is said to be infused into these sugar pills; the principles of homeopathy dictating that the water retains a “spiritual imprint” or “essence” of whatever was once dissolved in it. Homeopaths call this “water memory”.

However, here’s the real kicker: The sugar pills are dry. Whatever water they are alleged to have been infused with — with its claimed cargo of spiritual essence — has evaporated out. Not even the pseudoscience of homeopathy puts forth any postulate that there is any such thing as sugar memory. Thus, not even the faith-based “active ingredient” of homeopathy, this so called spiritual essence, is present in Boiron’s product. The sugar pills contain no water. The water contained no molecules of duck. Molecules of duck have no plausible history of treating colds or any other illness.

Nevertheless, they assert the following on their web site:

Temporarily relieves flu-like symptoms such as feeling run down, headache, body aches, chills and fever.

This is an untrue medical claim. The product has no ability to do any such thing. Usually, promoters claim that homeopathy, and other alternative medicine products that have no therapeutic value, attribute reported effects to the placebo effect. This is all well and good; the placebo effect can indeed improve your perception of your symptoms when it works. You can get a placebo effect from anything that you believe works. However I tend to attribute such effects more to confirmation bias. When something happens that matches our preconceived notions, our beliefs are reinforced. We recover from colds naturally, and feel better in a few days; confirmation bias makes us attribute this improvement to whatever pill we took, even though that pill may have had nothing to do with the natural recovery.

Let’s take a look at Boiron’s main paragraph on their Facts About Oscillococcum page:

Manufactured by Boiron, Oscillococcinum has a long history of efficacy and safety.

Safety? Sure; a sugar pill never hurt anyone. Efficacy? Implausible and unproven (they do claim that clinical trials support their claims, and we’ll look at those in a moment).

Oscillo is used by millions of patients in more than 60 countries.

Millions of people smoke cigarettes too. Wide usage does not prove something is good for you.

In France, where Oscillo has been used for more than 65 years, it is the first flu medicine recommended by pharmacists.

I would like to see the evidence of this. Even if it’s true, pharmacists are not doctors. Pharmacies are retail outlets that make money selling stuff (anything). Colds are not otherwise treatable, so why not sell something that at least does no harm.

It has a remarkable record of safety and can be recommended to patients over age 2 and those who are following other treatments or suffering from chronic conditions. Oscillo will not cause drug interactions or side effects.

Of course. Air will also not cause drug interactions, and smiles have remarkable safety records too.

Four clinical studies, including two which have been published in peer-reviewed journals, show that Oscillo reduces the severity and duration of flu-like symptoms such as feeling run down, headache, body aches, chills and fever.

Is that so? Sounds compelling to the layperson, doesn’t it? Let’s take a look at these four “clinical studies”. They provide no information at all about two of them, so we have no idea what these might have consisted of, who performed them, or what the results were. The third (Papp R, Schuback G, Beck E, et al. Oscillococcinum in patients with influenza-like syndromes: a placebo-controlled, double-blind evaluation. Br Homeopath J. 1998;87:69-76) was published in the British Homeopathic Journal. This is a publication dedicated to the promotion of homeopathy; by no conceivable argument can it be considered a scientific journal. It’s essentially a place for the marketers of homeopathic products to send their press releases in order to be able to say that their research is “published”. The fourth study (Ferley JP, Zmirou D, D’Adhemar D, Balducci F. A controlled evaluation of a homeopathic preparation in the treatment of influenza-like syndromes. Br J Clin Pharmacol. 1989;27:329-335) is from the British Journal of Clinical Pharmacology, a legitimate journal. This study, which is 22 years old, is one of a minority of a few scattered studies that did find a small statistical improvement in symptoms among homeopathy users compared to a control group who took an identical placebo. It concluded “The result cannot be explained given our present state of knowledge, but it calls for further rigorously designed clinical studies.” Well, further rigorous studies of homeopathy have been performed in the intervening decades, dozens of them. Almost all (well-designed trials published in legitimate journals) show no value in homeopathy. There is always noise in the results of trials. You can’t just look at one; you have to look at many. Again, for Boiron to have cherrypicked this one study, and to have neglected to report the many others that contradict their desired result, which they would have had to dig past, shows conscious deception.

As with all Boiron homeopathic medicines, Oscillo complies with a well-established framework of guidelines, regulations, and quality standards enforced by the FDA through routine pharmaceutical manufacturing site inspections and surveillance on marketed products.

If this is true now, it certainly wasn’t as recently as 2009. Look at this warning letter Boiron received from the FDA for FAILING to comply with the law. The warning letter charges them with numerous violations, and shows that they attempted to capitalize on public fear of the H1N1 virus to sell their product, claiming it could treat it. It can’t.

If you’ve purchased Oscillococcum and feel that you were victimized by deceptive marketing, get your money back. This Boiron page will tell you how.

Ullman’s recent blog post is typical of his style – it is the braggadocio of homeopathy. I am sure others will skeptically dissect his piece so I won’t go into every point here. I want to focus on Ullman’s claim that the clinical and basic science research supports homeopathy. Here is the paragraph on which I want to focus:

Most clinical research conducted on homeopathic medicines that has been published in peer-review journals have shown positive clinical results,(3, 4) especially in the treatment of respiratory allergies (5, 6), influenza, (7) fibromyalgia, (8, 9) rheumatoid arthritis, (10) childhood diarrhea, (11) post-surgical abdominal surgery recovery, (12) attention deficit disorder, (13) and reduction in the side effects of conventional cancer treatments. (14) In addition to clinical trials, several hundred basic science studies have confirmed the biological activity of homeopathic medicines. One type of basic science trials, called in vitro studies, found 67 experiments (1/3 of them replications) and nearly 3/4 of all replications were positive. (15, 16)

Those numbers are references that allegedly support his claims – 14 papers (they are not all studies, some are reviews) that allegedly make the case that homeopathy works. Most reader do not independently check references to see if they say what the author claims. Some may foolishly assume that the editors at the HuffPo have done that already.

First, Ullman is a notorious cherry picker. Any large and complex body of research will have enough noise that you could support just about any claim you wish regarding the research in you cherry pick only results that support your conclusions. The way to get to the essence of a body of research is through a systematic review – a review that looks at all the research and examines each piece for quality. You need to examine the relationship between quality of research and outcome. Ullman, rather, prefers to simply count studies.

I don’t know if his claim that most homeopathy studies show positive results if true, but I am willing to concede that this is probably true – because this is true of most research areas, even into therapies that we now know do not work. We know from the work of John Ioannidis that most published studies, in retrospect, are wrong. This is because there is a large amount of preliminary and poorly controlled research leading up to the large definitive trials that finally answer questions. Preliminary research is unreliable and biased – most of it is wrong. But we can still get to reliable answers in the end. Meanwhile, there is also researcher bias, publication bias, and the various placebo effects that conspire to make medical research look positive, even when there is no effect.

Ullman’s first reference to support his claim, however, is this meta-analysis: Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. This study does not show that most published homeopathy studies are positive – that’s not what a meta-analysis is for. Here is what they concluded:

The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

This is hardly a ringing endorsement of homeopathy – and that’s the best reference Ullman could come up with. I disagree with the authors that the evidence is not compatible with placebo – I think it is, even by their own data. The authors should read John Ioaniddis. These results are perfectly compatible with just the expected noise of clinical research. But they were on the money with their second sentence – you cannot conclude from the evidence that homeopathy actually works for any specific indication. This is a good clue in itself that we are dealing with noise – when you focus on any one indication, the evidence is not there. Yet Ullman includes this as a reference in a paragraph in which he claims the opposite.

His second reference to back this point does not even address his point. It was a re-analysis of the Shang study that showed that homeopathic treatments are placebos, and the analysis concluded that “The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials.” Well, of course they do. That’s why systematic reviews are better than meta-analysis. What do the systematic reviews of homeopathy show? Edzard Ernst did a systematic review of systematic reviews of homeopathy – that’s about as thorough as you can get. He found:

The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.

Ullman then goes on to claim that there is evidence for homeopathy for specific conditions – despite the conclusions of his own references that he neglected to mention. I have to note at this point that Ullman takes on the skeptics in his article, writing:

It is remarkable enough that many skeptics of homeopathy actually say that there is “no research” that has shows that homeopathic medicines work. Such statements are clearly false, and yet, such assertions are common on the Internet and even in some peer-review articles.

This is a typical Ullman strawman. Skeptics don’t say there is “no research” – what we say is that there is “no good research” – meaning large, blinded, placebo controlled trials that show a replicably positive effect. What we do see is the positively-biased noise of placebo vs placebo research. The better controlled the study, the smaller the effect and greater the chance of no effect. Systematic reviews reveal this pattern – Ullman’s cherry picking does not.

Ullman references one study and his own review for the next claim dealing with rhinitis. But an independent review, which Ullman did not reference, found:

Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed.

Next up is homeopathy for influenza. He chose a Cochrane review of Oscillococcinum for influenza. There are two big problems with this reference. The first is the conclusion:

Though promising, the data were not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndromes. Further research is warranted but the required sample sizes are large. Current evidence does not support a preventative effect of Oscillococcinum-like homeopathic medicines in influenza and influenza-like syndromes.

It seems Ullman saw the word “promising” and his eyes glazed over with such joy that he could not read the rest of the conclusion. He also missed the other major problem with this reference – it has been WITHDRAWN (in big capital letters at the beginning of the title). So even the wishy-washy support for this treatment was thought to be not up to the Cochrane’s usual standards (which, in my opinion, have slipped recently). If you want to see how silly Oscillococcinum is (beyond the generic homeopathic silliness) read this article by Mark Crislip.

I could go on in detail, but it will get tedious. Suffice it to say that the rest of Ullman’s references show the same pattern – they are to small or unblinded studies with weak evidence, or reviews of the same. Most are unblinded, which in this context means they are worthless. The one blinded study he directly references is for homeopathy in ADHD – which was a small study with barely significant results. Again – I prefer systematic reviews, like this one, which concludes:

There is currently little evidence for the efficacy of homeopathy for the treatment of ADHD. Development of optimal treatment protocols is recommended prior to further randomised controlled trials being undertaken.

Conclusion

Again – there is no good evidence for homeopathy, but there is low-grade evidence that apologists like Ullman can cherry pick and misrepresent. Ullman’s references do not support the claims he is making – sometimes directly contradicting them. But most readers will just see lots of reference numbers after Ullman’s claims and be impressed – and that’s probably what he is counting on.

The goal of the apologist is to provide cover, not to make a fair and scholarly assessment of the evidence. I think we can see what Ullman is doing here.

Today I have some good news to report. The Canadian program, Marketplace, did an excellent piece on homeopathy. (You view it on YouTube in two parts: part I and part II.) Usually such mainstream media attention to homeopathy and similar topics falls into the trap of false balance – telling both sides and letting the audience decide. This is a reasonable journalistic default for political and social topics, but not for science. In science there is a level of objectivity and the logic and evidence is not always balanced on two sides of an issue. We don’t need to “balance” the opinions of an astronomer with the illogical ravings of an astrologer.

Fortunately, the Marketplace program did not default to the false balance mode.  Rather they took the far more appropriate consumer protection angle – which is the format of this particular show. I was especially happy about this because I have been saying for years that consumer protection advocates need to realize that fake medicine (so-called complementary and alternative medicine or CAM) is a huge consumer protection issue. Regulations meant to protect consumers from fraud and harm are being systematically weakened in the favor of product manufacturers and distributors and practitioners. It is a scandal worse than anything Ralph Nader has taken on in the past, and yet he seems to be nowhere on this topic.

My sense is that consumer protection advocates have been successfully put to sleep on the issue of CAM because of the successful propaganda of CAM proponents – selling it in the context of “health care freedom” and “patient-centered medicine” and other rhetoric that is essentially  nothing but a bait and switch. The Jedi-mind trick has worked, and consumer protection advocates are asleep. Well now it’s time for the sleeper to awaken (if I may mix my sci-fi metaphors).

The Marketplace episode was hopefully the stirring of this sleeping giant. Watch the show for yourself – they do an excellent job of explaining just how silly the underlying claims of homeopathy are. While they leave much out, it was a decent primer for those who have no idea that homeopathy is not simply “natural” medicine, but literal sugar pills with nothing on them. They also point out that relying upon sugar pills as if it were medicine can be very dangerous.

My favorite scenes are ones in which the reporter confronts homeopaths, the head of Boiron, a French company that makes homeopathic products, and a regulator pushing for licensure of homeopaths in Ontario. Their fumbling reply to very simple and straightforward questions is very telling. Their obsfuscations are reminiscent of con artists. At one point, when asked how homeopathy can work, the Boiron executive retreats to – your science cannot yet detect how homeopathy works, and then “it’s a mystery.” The politician promised evidence to back his claim that homeopathy works, but then never came forward with that evidence.

The show also did a great sting – they simply called a homeopath in Canada, the investigator saying she had breast cancer, and the homeopath (who did not realize, apparently, that she was being recorded for television) confidently proclaimed that her homeopathic concoctions can cure breast cancer, and would start working in 15 days. There was no hedging or uncertainty – just a simple, “homeopathy works” – for cancer. Another practitioner was confident it would work to prevent polio – so no need to take the vaccine.These scenes effectively destroyed the “shruggie” response of “what’s the harm.”

Marketplace also used the local skeptics, CFI Vancouver (I recognized some familiar faces from our recent SGU appearance in Vancouver) as a resource. Their influence on the content of the show was obvious, but also they were featured in a mass homeopathy overdose – a stunt meant to show how ineffective homeopathy is. Well done, guys.

Homeopaths knew this show was coming, and they were already preparing their counter-offensive. In a communication to fellow homeopaths and supporters they encouraged spamming the Marketplace website with pro-homeopathy comments. The comments are indeed full of the usual pro-homeopathy, pro CAM propaganda – anecdotes, false statements about the evidence, appeals to conspiracies and “Big Pharma”, appeals to authority, and exhortations to “keep and open mind.” It’s the same recycled nonsense over and over. The comments certainly need a non-homeopathic dose of skepticism.

Homeopaths have also responded with a full frontal assault against skeptics. They apparently have figured out that organized skeptics are about the task of revealing their con to the public, and the best defense is always a good offense. Get a load of this characterization of skeptics from this blog supported by the National United Professional Association of Trained Homeopaths and other Canadian homeopathic professional organizations:

The skeptical movement is an offshoot of the Communist Party. (Really: see the top two links below.) Its top organizers were hired by pharmaceutical company and medical industry representatives to recruit malcontents in bars to spread hate propaganda against non-conventional medical systems. One of the first such skeptic groups referred to itself as “Skeptics in the Pub”. Not surprisingly, their rants against Homeopathy sound like the drunken cacophony of soccer hooligans.

The entire blog post is an attempt at poisoning the well – skeptics are mean, and their motives are suspect. It’s interesting how the author feels they can just make up whatever libel they wish, based upon the flimsiest of justifications. Skeptics are communists? Really? I bet most skeptics would be very surprised to hear that, especially the libertarians. And of course the pharma shill gambit – hired by pharmaceutical companies. How about naming names, unnamed author of this hit blog? Who, exactly, in organized skepticism received money from a pharmaceutical company? I can tell you that this blog, and also Science-Based Medicine, receive no money from any company or industry group. We are completely independent. We just have the sense and scientific background to recognize that homeopathy is a scam.

It is no surprise that homeopaths are using the same sloppy scholarship and utter disregard for intellectual integrity to attack their critics that characterize homeopathy itself. But still the utter contempt for the truth and the sheer stones of these charlatans is something to behold.

Conclusion

The CBC Marketplace episode on homeopathy was well-done and presented the correct overall impression -homeopathy is a scam, it is a con on consumers, who are being sold a bill-of-goods with misdirection. In response homeopathy are desperately trying to attack their critics and defend their nonsense, but in so doing are just revealing themselves to the be charlatans that they are.

To those anonymous authors of the “Extraordinary Medicine: the truth about homeopathy” website that seems intent on attacking skeptics – here is an open challenge. Put aside the vague innuendo. If you have any evidence that organized skeptics are an arm of a political party or are hired guns by industry, then name names and show the evidence. Otherwise put up or shut up -  remove those libelous and ridiculous claims from your website.

As well, Bill, your comments about not wanting to “trust the government” to inject us with a potentially deadly virus, along with many comments you have made about “big pharma” being in cahoots with the AMA and the CDC to keep us sick in the name of corporate profits is, in every way that matters, indistinguishable from 9/11 conspiracy mongering.

But these brief incursions of reason aside, the HuffPo has been in continual free fall into medical woo since its inception. Although in retrospect it has been hopeless for a long time, for me it crossed the veil into complete an utter advocacy of woo when it hired Dana Ullman as a regular blogger.

Ullman is notorious as a homeopath and internet lurker, spreading undiluted nonsense as far and wide as his typing fingers can manage.  I will have to resist the urge to deconstruct every bit of medical misdirection he will spread with his new forum – that would be a full time job for one blogger. But as I have already received numerous requests to take a look at his latest post, I will give him some deserved skeptical attention.

Some Background on Homeopathy

First, some obligatory background on homeopathy. If you’ve already heard this one, you can skip to the next section. There is also a more thorough overview of homeopathy at sciencebasedmedicine.org.

Homeopathy is a two hundred year old belief system invented out of whole cloth by Samuel Christian Hahnemann- it never was a legitimate science in its methods or ideas. It is based upon several magical pre-scientific ideas (wrongly called “laws” by proponents). The first is a manifestation of sympathetic magic – the law of similars, or the notion that like cures like. This is a common superstitious belief, but not based upon scientific reality.

So the first law of homeopathy says that you use small doses of a substance to treat symptoms created by that substance. The second law of homeopathy says that you don’t do that. (This is actually one of my favorite quips of James Randi from his lecture on homeopathy.) The second law, the law of infinitessimals, says that as you dilute the substance it becomes more potent – in direct violation of the very real laws of physics and chemistry. Homeopathic remedies are often diluted beyond the point where there is even a single molecule of active ingredient left (or basically, there is the background chemicals that are already present in the water being used).

Homeopathic remedies are therefore nothing but water, and no one has been able to demonstrate the ability to reliably distinguish ordinary water from a heavily diluted homeopathic “remedy.” Modern homeopaths try to rescue their outdated nonsense by saying that water has “memory.” Of course, you can’t rescue nonsense with more nonsense. No one has demonstrated that water can retain complex chemical information for any significant duration – certainly nothing close to what would need to happen for the information to be retained all the way through ingestion and transport through the blood to the site of action.

In short, from an historical and basic science point of view, homeopathy is bunk. From a clinical science point of view, it does not work. But there is a lot of noise in the clinical literature, and this is where Ullman performs his best legerdemain.

Homeopathy is not equivalent to allergy shots

One of the mental misdirections that homeopaths like Ullman like to use to confuse the public is to make an analogy between homeopathy and allergy shots. Ullman writes:

Allergy is the medical specialty that commonly uses small doses of an allergen in order to desensitize a person to that allergen.  This concept of using small doses of what might cause a problem in order to help prevent or heal the person is an ancient observation of healers/physicians all over the world, and it is the basis for a type of natural medicine called homeopathy.

I take down this claim more thoroughly here. Allergy shots exploit a very specific biological function. An allergic reaction occurs when a specific kind of antibody, IgE, binds to an allergen and triggers an allergic immune response. Allergy shots expose the patient to an initially very small (but not homeopathic) dose of allergen so that the body will form a different kind of antibody, IgG, that does not trigger an immune response. Then the doses slowly increase, forming more and more so-called blocking antibodies of IgG. Eventually the patient can receive a full exposure to the allergen, and the circulating IgG antibodies they built up will bind to the allergen, blocking the allergy causing IgE.

This is a very specific mechanism that derives from our basic science understanding of the immune system. Homeopathic remedies do not work by this mechanism (they don’t work at all) – they do not provoke the production of IgG, or any other physiological response that we can tell. There is therefore no legitimate analogy between homeopathy and allergy shots – except in the most superficial and intellectually lazy manner.

The allergy shot analogy is nothing but a hand-waving misdirection to give a false sense of legitimacy to discredited magic.

The Cherry Picker 2000

Ullman’s well-known modus operandi is to cherry pick those studies that seem to support the use of homeopathy, and to ignore or dismiss those that show that homeopathy does not work. Again – this is just intellectually lazy and biased. As I teach my medical students – you cannot come to any sort of reliable conclusion based upon a single study. And further, there is enough noise in the clinical literature that if you allow yourself to cherry pick only certain studies, you could support just about any conclusion you wish.

It is only meaningful to interpret the literature as a whole, with a sophisticated understanding of the nature of the literature. The literature, for example, has some meta-structure, such as the file-drawer effect – the tendency to publish positive studies more than negative studies.

And, I and others contend, that the clinical literature needs to be put into the context of the basic science literature as well, so that all available scientific information is brought to bear on any medical question (and this is precisely where science-based medicine differs from evidence-based medicine).

Ullman writes:

Respiratory allergies represent the condition for which there is a relatively strong research base for efficacious treatment with homeopathic medicines. A group of researchers at the University of Glasgow published four studies, three of which were published in the BMJ (British Medical Journal) and the Lancet, two highly respected medical journals. Each study was randomized, double-blind, and placebo-controlled. Each trial used an oral 30C homeopathic preparation. The first two trials involved patients with hay fever, [4] [5] where patients were either give a placebo or homeopathic doses of 12 common flowers to which people are allergic.

The emphasis is in the original – Ullman is trying to impress his audience with the prestige of the journals in which these results were published. Journal prestige does matter, and these are legitimate journals. But Ullman is using them as shiny objects to beguile his audience.

First, Ullman glosses over the messy results of these trials, focusing the most positive results. Here is the actual results and conclusion from the study:

Fifty patients completed the study. The homoeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min, 95% confidence interval 10.4 to 29.1, P=0.0001). Both groups reported improvement in symptoms, with patients taking homoeopathy reporting more improvement in all but one of the centres, which had more patients with aggravations. On average no significant difference between the groups was seen on visual analogue scale scores. Initial aggravations of rhinitis symptoms were more common with homoeopathy than placebo (7 (30%) v 2 (7%), P=0.04). Addition of these results to those of three previous trials (n=253) showed a mean symptom reduction on visual analogue scores of 28% (10.9 mm) for homoeopathy compared with 3% (1.1 mm) for placebo (95% confidence interval 4.2 to 15.4, P=0.0007).
Conclusion: The objective results reinforce earlier evidence that homoeopathic dilutions differ from placebo.

The conclusion is odd – “homeopathic dilutions differ from placebo.” The authors did not conclude that homeopathy was superior to placebo – perhaps because some of the outcome measures were worse, such as initial aggravations. The authors seemed desperate just to conclude that the homeopathic “remedy” was different from placebo, to argue against the counter claim that homeopathic remedies are nothing but placebo.

But the parsimonious conclusion from these four trials is that they involved a small number of overall subjects (253 – that is small for four trials) and the results were predictably mixed. And it must also be realized that what gets published is often a very sanitized version of what actually happened during a study. That is why independent replication is needed – there are just so many ways for subtle biases to creep into these studies, especially when subjective outcomes (like the visual analogue score) are being used. Even nasal airflow is very tricky, as the measurement is very technique and effort dependent.

Ullman calls this a “relatively strong research base.” Rather, this is extremely thin, especially for such an implausible treatment.

But it gets worse, because these were the best studies that Ullman could cherry pick. A 2006 systematic review concluded:

Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed.

Hmmm – a number of negative studies. Ullman did not happen to mention those. Also, here is a tip on reading such reviews – “further trials are needed” is a polite way of saying that the evidence is negative or equivocal. These authors looked at the evidence and found it too wanting to make any firm conclusions. Ullman looked at the evidence and found it to be a relatively strong research base. Maybe he meant “for homeopathy,” in which case he would be correct. This is the best homeopathy can do – equivocal.

Incidentally, the same is true of homeopathy and other respiratory illnesses. Here is a recent review of homeopathy and asthma:

There is not enough evidence to reliably assess the possible role of homeopathy in the treatment of asthma. Further studies could assess whether individuals respond to a “package of care” rather than the homeopathic intervention alone.

I love the reference to the “package of care” – that is code for all the non-specific and placebo effects that go along with getting therapeutic attention. It’s like saying that this jelly doughnut is “part of this complete breakfast.” Of course, the breakfast is already complete without the doughnut. But in this case is more like saying a drawing of a doughnut is part of this complete breakfast – you don’t actually get to eat a doughnut.

In other words – homeopathic remedies add nothing to the treatment of respiratory illness.

Conclusion

A fair and scientific assessment of homeopathy for allergic rhinitis can only lead to the conclusion that homeopathy is extremely implausible, and the evidence for efficacy is weak and inconclusive. Dana Ullman, however, is telling his readers that homeopathy is on the forefront of science and there is a stong evidence base for its effectiveness.

That is the kind of responsible reporting that the Huffington Post was apparently looking for.

That Mitchell and Webb Look: Homeopathic A&E

I would like people to be aware of the fact that homeopathy is a pre-scientific philosophy, that it is based entirely on magical thinking and is out of step with the last 200 years of science. People should know that typical homeopathic remedies are diluted to the point that no active ingredient remains, and that homeopaths invoke mysterious vibrations or implausible and highly fanciful water chemistry.  I would further like people to know that clinical research with homeopathic remedies, when taken as a whole, show no effect for any such remedy.

In short, homeopathy is bunk. But here is a somewhat longer description of its history.Homeopathy was founded by Samuel Christian Hahnemann (1755-1843), a German physician who had become dissatisfied with the medicine of his day. Hahnemann lived in a time before the rudiments of modern medicine had been developed, before the germ theory of infectious disease, before the first antibiotic, before systematic testing of drugs for safety and efficacy, before surgical procedures were performed with anesthesia or sterile technique. In his century, it is fairly safe to say, conventional medicine was more likely to do harm than good, and hospitals were a place people went to die, rather than get well. It is no surprise, therefore, that Hahnemann sought for an alternative to the classical approach of his day.

For many years Hahnemann’s search was unsuccessful, until he stumbled upon what he thought was an amazing observation. He took a small amount of cinchona bark, which contains quinine, the drug used to treat malaria, and developed the symptoms of malaria. From this observation he developed homeopathy’s first law, similia similibus curentur, or let likes be cured by likes. In other words, drugs which cause specific symptoms can be used to cure diseases which cause the same symptoms.

As homeopathy evolved, other laws were also discovered. The law of infinitesimal doses was actually a late development by Hahnemann, but today is often thought of as the primary characteristic of homeopathy. This law states that when drugs are diluted in either water or alcohol, they actually increase in potency. Today, serial dilutions of 1:100 repeated 6 or 30 times are commonly used. Between each dilution the substance is violently shaken, which is thought to be necessary to activate the properties of the drug.

Hahnemann also developed, as the underpinning of homeopathy, his own theory of disease, called the miasm theory. According to this theory there are three miasms which are responsible for all human disease, and homeopathic remedies are directed towards treating these offending miasms.

Homeopathy enjoyed a great deal of success in Europe and later in the U.S. in the 19th century. In the year 1900, there were 22 homeopathic colleges and 56 purely homeopathic hospitals in the U.S. During this century, however, as modern medicine came into its own, as life expectancy rose from about 40 years to 80 years, and as the modern approach to disease continuously improved the quality of life, producing a stunning revolution that homeopathy had failed to provide in the previous century, homeopathy declined steadily until it was all but gone.

It is an amazing fact of history, however, that pseudosciences rarely, if ever, die completely. Belief systems such as astrology, phrenology, and homeopathy itself survive long after their usefulness or the primitive scientific environment in which they were developed. Today, homeopathy is experiencing a resurgence, initially in Europe, but it is quickly spreading to the U.S. Homeopathic hospitals have been incorporated into the National Health Service in Britain, and early on in its history the FDA granted approval to the entire homeopathic pharmacopoeia because the remedies had already been in use for so many years.

Today, although there are several different traditions of homeopathy, the basic principles as outlined above remain unchanged. Homeopaths offer as a point of superiority of their method of treatment, that they treat the whole person, taking a “holistic” approach. They denigrate conventional physicians for “focusing narrowly on the disease.” But what does their holistic approach actually entail?

The goal of a homeopathic consultation is to “find the totality of symptoms,” physical, mental, and spiritual. They accomplish this goal by taking a “homeopathic history” which includes questions such as: do you feel sad when you hear piano music, are you excessively tidy or do you have a chilly personality. This information is combined with the patient’s symptoms and their physical “constitution,” which may depend on such facts as hair color. The homeopath then decides on what single remedy will treat the patient’s “totality.” The remedy is then prescribed, and is usually given in either a single dose or only a few doses.

There are many appealing aspects to homeopathy as it is practiced. Patients are made to feel that they are being given a remedy which is specifically designed for them personally, that the goal of treatment is complete cure, rather than just managing symptoms, and that the remedies have no side effects, toxicity, or interaction with conventional drugs. There is, however, no scientific or rational basis to the claims of homeopathy, for it falls cleanly into the realm of pseudoscience rather than true science.

Modern medicine is science-based to the extent that its treatments are based on a working model of disease which in turn is based on human physiology, anatomy, genetics, and biochemistry. All of the principles are subject to experimental scrutiny, and therefore change. They can be proven or disproved by new information. New ideas are subjected to harsh criticism by experts in the field, and must stand the test of such critical examination before they are incorporated into clinical practice. The rapid rate with which medical knowledge changes is not a weakness but a testimony to its scientific basis.

Homeopathy, on the other hand, is a pseudoscience because its underlying principles are not founded in basic research and have remained largely unchanged for almost two centuries. It shrouds itself in the trappings of science, but is devoid of the real substance. Although today there are many efforts to subject homeopathic remedies to double blind clinical trials, homeopaths do not alter their treatments based on the results of such research, they have often been shown to lack carefully controlled techniques, and their interpretation of experimental results reeks of magical thinking.

For homeopaths, the only purpose of clinical research is to validate what they already “know” – it is a statistical crap shoot of placebo vs placebo.

Let us examine homeopathy’s most basic principle, that of infinitesimal doses. Homeopaths today use dilutions of substances which essentially remove all traces of the substance from the final dilution. There is not likely to be even a single molecule of the original drug in the final remedy which is given to the patient. Homeopaths conclude from this fact that the substance is transferring its essence to the water into which it is diluted. The more it is diluted, the more potent is the water. They offer, however, no plausible explanation for how simple water molecules can contain the essence of far more complex substances. They simply call it “water memory”, but labeling is not explaining. They further have no model for how such implausible “water memory” could survive as the water is placed on a sugar pill, digested in the stomach, absorbed in the blood, and then carried to wherever it has its alleged action.

Their model of illness is similarly constructed. Hahnemann developed his ideas before the disease theory of illness was fully developed. In other words, during his time physicians did not yet understand that illnesses were caused by specific diseases; that a given disease, such as diabetes, has a common underlying pathophysiology – a specific malfunction of a specific tissue, organ, or organ system leading to a specific disorder with recognizable signs and symptoms. This modern theory of illness has lead, for instance, to the treatment of diabetes with insulin replacement, vastly improving the quality and duration of life of patients suffering from this disease.

Hahnemann, and modern homeopaths, must reject this concept of medicine. Their goal is not to identify which disease afflicts a patient, in fact they criticize this approach. Rather they believe, regressively, that every patient is experiencing a unique illness, which is affected by such factors as whether or not the patient has a weepy personality, and that one remedy will treat all of the patient’s ills, curing the single cause which has displaced them from being well. They admit that the same symptoms often require different treatments in different patients. They dramatically lack any biological model underlying their concepts of illness.

Finally, there is the rule of likes treating likes. Hahnemann based this rule on a single observation. All subsequent investigation was designed to decide what substances should be used to treat which illnesses (summarized in their primary reference, the Materia Medica), but they were all based on the assumption of the rule of likes. No basic research was ever conducted to test the assumption itself, nor are there any biological models which explain why likes should treat likes. Why is it, as homeopaths claim, that and extract of onion should treat colds, which are caused by a viral infection, simply because onions irritate mucous membranes and cause tearing and secretions similar to the common cold. Hahnemann’s theories, unlike modern medicine, did not lead to or stem from any deeper understanding of human biology.
Like cures like is, in fact, an example of sympathetic magic – the primitive notion that substances have properties or mystical connections to things that they resemble. Therefore in some traditions rhino horns are thought to treat impotence, because of their physical appearance resembles an erect penis (more or less).

At this point many defenders of homeopathy would argue, “Who cares how it works, as long as it works.” This defense is used for all alternative medicines which cannot produce a rational explanation for how they work. There is a kernel of legitimacy to this argument, although it does not save homeopathy from being a pseudoscience, in that even in conventional medicine treatments are used before their mechanism of action is fully understood. In such cases, however, it is necessary to demonstrate using carefully controlled clinical trials that such treatments do in fact work.

Further, the lack of a precisely known mechanism of action is not equivalent to extreme scientific implausibility – which is the case with homeopathy.

With regard to clinical trials modern homeopaths have been somewhat self-contradictory. Many homeopaths have argued that homeopathy cannot be subjected to the same type of studies as are conventional drugs. This is because each patient, from a homeopathic perspective, is unique, and cannot be lumped into a single category. Whereas conventional medicine can compare treatments of 1000 diabetics with two different medications, homeopaths cannot produce large numbers of patients with the same totality of illness requiring the exact same treatment. In making this argument, that of untestability, such homeopaths are securing their position in the halls of pseudoscience, for if their is one single quality which separates scientific theories from nonscientific ones, it is falsifiability. If homeopathic remedies cannot be tested, then they can never be grounded in science.

However, this has lead to homeopathic studies with individualized treatments – which should address this concern of homeopaths. These studies have been largely negative (when well-controlled and blinded). This lead homeopaths to complains that even these trials were not good enough. Homeopath Weatherley-Jones writes:

For clinical trials of homeopathy to be accurate representations of practice, we need modified designs that take into account the complexity of the homeopathic intervention.

This is a clear case of special pleading -finding a special excuse for negative results, but only after they are negative.

Despite this defense by some homeopaths, modern homeopathic research has focused on these very types of studies. There has been mixed results from these studies and, in conflict with the defense of untestability, homeopathic organizations are quick to site positive studies as evidence for homeopathy’s legitimacy, while simultaneously ignoring the results of negative studies.

Also important is the question of the quality of the research that is being done. Research which is not carefully constructed to eliminate any possibility of bias or fraud, or which is not large enough to produce statistical significance, or which is not reproducible by independent centers, is of little scientific value. In fact such research is harmful because it creates confusion and leads to false conclusions.

Nature magazine famously lead an investigation of the positive research coming out of the lab of Jaque Benveniste. This team, which included James Randi, learned that all the positive research created by the lab were performed by Benveniste’s assistant, Elizabeth Davenas. Benveniste had claimed that all the research was double blind, but Randi soon discovered that this was not the case. Davenas was studying the results of a homeopathic drug on the growth of cells in culture. While Randi observed, she counted the number of cells under a microscope on what she believed to be a test slide, getting a result of 40, which she dutifully recorded in her lab notebook. While removing the slide, however, she noticed that it was labeled as a control. She therefore recounted the slide, arriving this time at a result of 18, which she then corrected in the notebook. It is difficult to conceive of a more blatant breach of basic research protocol.

In short, when the Nature team next subjected Davenas to truly double blind conditions, her positive results disappeared. Benveniste insisted, however, that his lab’s results had been duplicated by four independent labs throughout the world. On investigation, however, it was learned that Elizabeth Davenas had visited each of these four labs and had performed the research herself.

Wim Betz, a physician and former homeopathic doctor who now is an outspoken critic of homeopathy, has similar criticisms of homeopathic research. He reports on one study in which a hormone prepared in homeopathic dilutions was added to a tank of tadpoles and was observed to increase the rate at which the tadpoles developed into frogs. When the hormone, however, was placed inside the tank while inside of a sealed test tube, the same results were observed. The homeopathic researchers, instead of concluding that this control revealed shortcoming of their research, concluded that the homeopathic hormone was transmitting its effect to the tadpoles via some type of rays. They later conducted research to see if such remedies can emit their healing rays over telephone lines.

Another researcher, reports Betz, was confused when the placebo control he used in his clinical trial had the same effect as the homeopathic remedy being tested. Instead of concluding that his study was negative, he instead concluded that since the placebo was stored in the same refrigerator as the remedy, that the homeopathic drug was radiating it effective quality to the placebo. Despite sealing the placebos in aluminum foil and separating them from the homeopathic remedy in different refrigerators, this homeopathic researcher could still not keep the effect of the drug from leaking over into the placebo.

Professor of complementary and alternative medicine, Edzard Ernst, reviewed the homeopathic literature and concluded that homeopathic remedies “contain no biologically active agents and are no more effective than sugar pills.”

Published systematic reviews (examples here,  and here) of the literature either conclude that the evidence is equivocal or negative.  There is not a single homeopathic remedy for a single condition or illness that has been clearly shown to be effective, despite decades of research. And the overall pattern in the literature is that the better designed the trial, the more likely it is to be negative – a pattern most compatible with a null effect.

Poor scientific technique, magical thinking in the interpretation of negative results, the lack of falsifiability, the absence of a cohesive biological model, and the adherence to unchanging and untested principles has marked homeopathy as a pseudoscience. And yet, it flourishes in Great Britain in particular and Europe as a whole. Also, homeopathic entrepreneurs are spreading homeopathic nonsense to the US.

I am all in favor of homeopathic awareness. The scientific community should use this week to make the public acutely aware of the fact that homeopathy is, put simply, utter rubbish. It is a classic pseudoscience and has no place in a 21st century science-based health care system.

In the third world, however, unscientific treatments for serious public health threats is a real problem. Malaria, HIV, TB, influenza, and childhood diarrhea are all epidemic in Africa and other locations, all exacerbated by the lack of adequate health care resources. The impact of this lack of resources is worsened by reliance on ineffective pseudoscience treatments, and sometimes (as with HIV) the denial of scientific treatments.

The World Health Organization (WHO) whose very purpose is to serve the public health worldwide, especially in developing and struggling nations, has failed to adequately address the problem of unscientific medicine. The WHO, unfortunately, is an imperfect political organization and as such is vulnerable to sectarian interests. It has a poor record on combating unscientific medicine, and in fact promotes it.

Their stance on “traditional medicine”, which is the term they seem to prefer, is that their role is to facilitate the “integration” of traditional medicine into “allopathic” medicine. Their use of the term “allopathic”, which is a derogatory term for scientific medicine, is very telling. The WHO policy appears to have been written by proponents of unscientific medicine.

A group of young scientists and doctors in training, The Voice of Young Science Network, have decided to prod the WHO into a more reasonable stance toward unscientific medicine. Specifically, they are publicly calling on the WHO to oppose the use of homeopathy to treat malaria, HIV, TB, influenza, and childhood diarrhea. In their open letter they state:

We are calling on the WHO to condemn the promotion of homeopathy for treating TB, infant diarrhoea, influenza, malaria and HIV. Homeopathy does not protect people from, or treat, these diseases. Those of us working with the most rural and impoverished people of the world already struggle to deliver the medical help that is needed. When homeopathy stands in place of effective treatment, lives are lost.

Many people in developing countries urgently need access to evidence-based medical information and to the most effective means of treating these dangerous diseases. The promotion of homeopathy as effective or cheaper makes this difficult task even harder. It puts lives at risk, undermines conventional medicine and spreads misinformation.

We are sure that you will recognise these dangers and ask that you issue a clear international communication condemning the promotion of homeopathy for treating TB, infant diarrhoea, influenza, malaria and HIV. We are sure, too, that you will recognise the urgency of our request, and look forward to your response.

They also give some specific examples of clinics in Africa pushing homeopathy instead of conventional medicine:

In Tanzania, Jeremy Sherr and Sigsbert Rwegasira run three homeopathic clinics and claim to have government support to establish a school of homeopathy. Rwegasira claims to treat “no less than 100 malaria patients per day.” According to Sherr’s promotional material, “conventional medicine only supplies temporary relief, often at a great cost financially, and with many severe side effects”.

For those who think that CAM is benign (which is never true, in my opinion) consider the impact of promoting  worthless snakeoil instead of effective scientific treatments for a serious infectious disease like TB.

I applaud these young scientists for taking a stab at the WHO – they absolutely should be called out for their promotion of quackery as legitimate health care. In my opinion, however, the statement does not go far enough. The WHO should be called upon to condemn all homeopathy for any indication. Homeopathy is pure pseudoscience and homeopathic “remedies” are nothing but placebos. The only ethical and scientific stance for the WHO or any such organization to have toward homeopathy is its eradication.

But I understand that the perfect is often the enemy of the good. I see the strategy in starting with the use of homeopathy for serious diseases that represent large public health risks in vulnerable populations. This is certainly the low-hanging fruit.

I will be very interested to see the WHO response, if any. Since it is clear that the foxes are already in charge of the hen house when it comes to CAM, I doubt the WHO will be moved by this open letter. Hopefully, however, it will spark some public discussion on the topic, and raise awareness of the utterly worthless and unscientific nature of homeopathy.

What this letter also highlights is that the entire scientific community needs to be called out on the subject of CAM. Being a “shruggie” (someone who recognizes the unscientific nature of CAM but does not feel it is worth any of their time or attention) is no longer ethically defensible. Scientistst and health-care professionals have a contract with society which includes defending the public from the threats of pseudoscience. Nowhere today is this more necessary than the infiltration and erosion of science-based medicine by unscientific sectarian interests.