Homeopathic products. They are safe enough, no doubt about that. Millions of people around the world swear by them. No doubt about that either. Furthermore, their label features the term “DIN-HM,” designating approval by Health Canada. So why then do I and my colleagues at the McGill Office for Science and Society support a class action lawsuit launched against Boiron Laboratories and Shoppers Drug Mart for marketing Oscillococcinum, a homeopathic medication advertised as a remedy for colds and the flu?
I have absolutely no desire to limit anyone’s freedom of choice when it comes to choosing health care products, or any company’s right to sell items that the public wants to buy, as long as these are safe. But I do have a desire to ensure that whatever choice consumers make is based on scientifically informed opinion. In the case of homeopathy, misinformation can have consequences ranging from a needless waste of money to foregoing more effective treatments. As an educator, I am also troubled by the promotion of a practice that is based on principles that cannot be supported by the established laws of chemistry, biology or physics. Hopefully, the publicity the current lawsuit will generate should help people understand the true nature of homeopathy.
Let’s begin by explaining what homeopathy is not. It is not an umbrella term for alternative or complementary practices. The use of herbal medications or acupuncture or reflexology has nothing to do with homeopathy. Homeopathy is a specific practice conceived in the early nineteenth century by Samuel Hahnemann, a conventionally trained German physician, who became disillusioned with bloodletting, leeches, suction cups, purges and arsenic powders, all standard treatments at the time. It seemed to Hahnemann that these did more harm than good. He was probably right.
One remedy that did work was an extract of the bark of the South American cinchona tree used to treat malaria. But lacking standardized preparations, there was a problem with finding the right dose. Hahnemann, interested in the maximum amount his patients could tolerate, became his own guinea pig and began to take increasing doses of cinchona bark. He was surprised to find that at a high dose he developed symptoms much like the ones he witnessed in his malaria patients. At that epic moment homeopathy was born! Hahnemann derived the term from the Greek "homoios" meaning "like," and "pathos" meaning suffering. “Like cures like,” Hahnemann concluded. A substance that causes symptoms in a healthy person will cure like symptoms in a sick person when given at a smaller dose.
Hahnemann went further and began to systematically test the effects of a large variety of natural substances on healthy people. Such "provings" led him to conclude that belladonna, for example, could be used to treat sore throats, because it caused throat constriction in healthy subjects. But belladonna is a classic poison. Was homeopathy therefore dangerous? Not at all. Hahnemann had another idea. He theorized that his medications would work by The Law of Infinitesimals. The smaller the dose, the more effective the substance would be in stimulating the body's "vital force" in warding off the disease. A totally illogical conclusion.
"Active preparations" were made by repeated dilutions of the original extract. Hahnemann was not bothered by the fact that at these dilutions none of the original substance remained; he claimed that the power of the curative solution did not come from the presence of an active ingredient, but from the fact that the original substance had in some mystical way empowered the solution with curative properties. A simple dilution, however, was not enough. The vial had to be struck against a special leather pillow a fixed number of times to be "dynamized," before adding a drop of the solution to a sugar pill.
These were bizarre ideas to be sure, but Hahnemann must have been impressed by the success of his homeopathic treatments. No surprise here. The placebo effect can indeed be very impressive. And patients certainly preferred a treatment that had no side effects to being bled or being purged. A real curiosity was that Hahnemann did not advocate a homeopathic treatment for malaria using ultra diluted cinchona bark. He must have recognized this would not work.
Hahnemann didn’t know about molecules, but today calculations readily show that homeopathic products such as Oscillococcinum 200C do not contain a single molecule of the duck organs that serve as the raw materials for the production of the final “remedy.” The designation “C” represents an initial dilution of 1 to 100, and 200C means repeating this 200 times. “C” is confusing to the consumer because a larger number actually means a smaller dose, and in any case, the term does not conform to the Canadian Weights and Measures Act. This issue, while included in the law suit, is not its essence.
The main thrust of the legal action is that Oscillococcinum is mislabeled because the product clearly states that it contains the “medicinal ingredients,” Anas Barbarie Hepatis et Cordis extractum 200C (duck liver and heart), as well as the non medicinal ingredients, sucrose and lactose. No chemical test can determine the presence of any “medicinal ingredient,” and furthermore, the label states that every one gram of product contains 0.85 grams of sucrose and 0.15 grams of lactose. For anyone, except perhaps homeopaths, 0.85 and 0.15 add up to 1, leaving no room for any other ingredient.
How can a product claim to contain a medicinal ingredient when no such substance can in any way be detected? Oscillococcinum amounts to a mislabeled sugar pill. If it is to be marketed, it should be honestly labeled. The lawsuit against Boiron and Shoppers Drug Mart aims to ensure that this happens, preventing the public from being misled.
Homeopaths of course have to admit that there is not a single molecule of the original substance in the final product, but they maintain that the dilution and shaking leaves some sort of imprint on the solution.
When I dilute my chicken soup, its taste suffers. When I take one aspirin tablet instead of two, my headache doesn’t resolve. When I use less detergent, my clothes do not come out as clean. Yet, in the topsy-turvy world of homeopathy, less is more. The more a biologically active substance is diluted, the more potent it becomes. The most powerful homeopathic drugs, the ones that according to some homeopaths have to be used the most carefully, are the ones that do not even contain a single molecule of the original substance! Oscillococcinum, the purported cold and flu remedy made from the liver of a duck falls into that category. At the declared homeopathic dose of 200C, the total mass of pills that would have to be consumed to encounter a single molecule of the original substance would be billions of times greater than the mass of the Earth. Yet the label on this product says it contains a “medicinal ingredient!” And curiously it does not warn of the danger that such a “high potency” remedy presents.
Other homeopathic preparations may be prepared from an astounding array of substances that include snake venom, fecal matter, arsenic, gold, plutonium, blister beetles and the south pole of a magnet. Even more bizarre are “light from Venus” and “Berlin wall,” a homeopathic dilution of which is supposed to help people with a lot of conflict in their lives.
Given that homeopaths have scientists breathing down their neck for an explanation of how nonexistent molecules can provide a therapeutic benefit, they have had to come up with some sort of a theory. The usual claim is that the process of dilution and “succussion” (banging the solution into a leather pillow between dilutions) “dynamizes” the remedy by leaving an “imprint” of the original substance. Chemists are prone to start pulling their hair when they hear something like that. Not to worry, though, homeopathy has a treatment for hair loss, natrium muriaticum. That’s sea salt. But going for a swim in the ocean won’t do, the salt is way too concentrated.
Can there be anything to the “water memory” idea? Water molecules do associate with each other momentarily through what any student of chemistry recognizes as “hydrogen bonds.” But these connections last only nanoseconds before the molecules rearrange themselves. In any case, past a dilution of 30C, the solution contains no water molecules that have ever come into contact with the original substance! Furthermore, that original substance, as in the case of duck liver, is composed of thousands of different compounds. Which one is the water supposed to remember? And why does it not remember any of the other compounds it has encountered as it flowed through rivers and sewage systems? This, though, is hardly the point. Even if there were such a thing as water memory, why should that have anything to do with treating a disease? Homeopaths never address that question. They are too busy coming up with various pseudoscientific explanations about imprinting the memory of substances on water.
Another point that homeopaths seem to ignore is that their pills do not even contain any water! A drop of the diluted and succussed solution is added to a pill made of sucrose and lactose, but the water soon evaporates. So does it leave behind a ghost of the memory it supposedly contained? And how exactly is that ghostly memory released when the pill is swallowed and the sugar dissolves? Of course if you are willing to abandon or misuse the laws of chemistry, physics and biology, you don’t have to concern yourself with such issues and can be satisfied by explanations that invoke “vital force” or “quantum entanglement.”
Sometimes the effectiveness of homeopathy is likened to the effectiveness of vaccination. This is a hollow argument. First of all, vaccines contain measurable amounts of active ingredients. And we know how they work. They give rise to measurable amounts of antibodies. Furthermore, the active ingredients in vaccines are similar to the disease causing agents. Homeopathic remedies contain no measurable ingredients, give rise to no measurable changes in the body, and the undiluted original “medicinal ingredient,” such as duck liver, bears no resemblance in any way to the disease causing organism, which in the case of a cold or the flu is a virus.
At a loss to explain how homeopathy works, homeopaths essentially invoke Hamlet’s musings. “There are more things in heaven and earth than are dreamt of in your philosophy.” Seems appropriate, since both Hamlet and homeopaths appear to believe in ghostly images. Basically, the homeopathic argument comes down to, “we may not know how it works, but it works.”
Homeopaths are convinced of the efficacy of their treatment because of the positive feedback they get from patients. But is this because their pills are effective, or is it because they tend to be caring people who listen to patients and spend a lot more time analyzing concerns than conventional physicians? Homeopaths will point out that there are proper randomized trials that show a benefit for homeopathy. Indeed, it would be shocking if there weren’t any. When you carry out enough trials, some will by chance alone show a positive result. If you repeatedly toss a hundred coins into the air, it won’t be long before you come up with a result that differs significantly from fifty-fifty. That’s why instead of looking at individual studies, we rely on a “meta analysis,” a study of studies.
Here the results are clear. The effects of homeopathy are indistinguishable from the placebo effect. Not surprising, since homeopathic remedies are indistinguishable from each other. Or from sugar pills. The James Randi Educational Foundation offers a million dollars to anyone who can by any means identify an unlabeled homeopathic remedy. Certainly any pharmaceutical company can readily identify any of their products. If this cannot be done for homeopathic remedies, how can a homeopath know he or she is giving the right substance? In fact how can we differentiate between a real and a fake homeopathic remedy?
Critics of homeopathy have been known to swallow entire bottles of homeopathic pills to make the point they contain nothing but sugar. But homeopaths are not disturbed by this demonstration because according to the tenets of homeopathy, increasing the dosage actually reduces the effect. So, the critics would face danger not by taking more pills, but by just licking one. Or, perhaps, they could overdose by staying away from the pills altogether.
We can safely say that homeopathic remedies pose no risk of side effects or of toxicity. Just try calling a poison control center to say that you accidentally took too many homeopathic pills. You’ll get a response along the lines of “forget it,” or “bogus product.” But does this mean that homeopathy presents no risks? Not at all. There are several concerns.
Some homeopathic remedies may not actually be homeopathic. More seriously, some homeopaths offer pills for protection against malaria or radiation exposure. Others claim that they can treat cancer, with the most outrageous ones urging their victims to give up conventional treatment. Finally, there is the matter of Health Canada issuing a DIN-HM (Drug Identification Number-Homeopathic) to homeopathic products implying to the consumer that these remedies have been shown to be safe and effective. Safe, yes. Effective, no.
Let’s amplify. Marketers sometimes use the term “homeopathic” to describe products that are not at all homeopathic. A classic case is Zicam, sold as an intranasal homeopathic cold remedy until 2009 when the Food and Drug Administration advised that the product be avoided because of a risk of damage to the sense of smell. How can a homeopathic remedy do that? Simple. It was mislabeled. Zicam actually contained a significant amount of zinc gluconate. This, though, is not nearly as serious as recommending ridiculous malaria protection pills that contain no active ingredient to people travelling to areas where the disease is endemic.
And how about “Homeopaths Without Borders?” I kid you not. Here is one of their gems: “with the onset of the rainy season in Haiti there will be a great need for remedies to treat dengue, malaria, cholera and other tropical diseases.” Claiming that homeopathy can treat these diseases is criminal. Jeremy Sherr of “Homeopathy for Health in Africa,” goes even further: “I know, as all homeopaths do, that you can just about cure AIDS in many cases.” Nonsense of course, and even disparaging to most homeopaths who draw the line at claiming cures for serious diseases.
Perhaps the most reprehensible practitioners of homeopathy are those who prey upon desperate cancer victims. The following comes from the “Wisconsin Institute of Nutrition,” whatever that may be: “The important thing to know about cancer and choosing whether to use homeopathy or not is that surgery will not remove the disease. Most people will still opt for conventional treatment, so how can homeopathy be useful to them? They can take the appropriate remedy after surgery to prevent recurrence. For strict homeopathic thinking such a procedure is not optimum.” Needless to say, there is zero evidence that sugar pills can prevent a recurrence of cancer.
Homeopaths are not ones to miss a marketing opportunity. Soon after the Fukushima nuclear power plant disaster in Japan, several offered remedies for either the treatment or prevention of radiation poisoning. Believe it or not, one of the suggested remedies was “X-ray.” What is it? A sugar pill treated with a homeopathic dose of x-rays. I wonder how one dilutes x-rays. What bunk.
Homeopathy has always been challenged by scientists, but now consumers are beginning to realize the delusion of dilution. In California, homeopathic manufacturer Boiron settled a $12 million class-action lawsuit that alleged the company had violated false advertising laws by claiming that homeopathic remedies have active ingredients. Boiron will now be adding a disclaimer to say that their claims have not been evaluated by the U.S. Food and Drug Administration as well as an explanation of how their active ingredients have been diluted. In Australia, a woman is suing a homeopath who she claims offered misleading information to convince her sister to give up conventional cancer treatment.
In Britain, The House of Commons Science and Technology Committee released a report stating that homeopathic remedies work no better than placebos and should no longer be paid for by the UK Health Service. The Committee also criticized homeopathic companies for failing to inform the public that their products are “sugar pills containing no active ingredients.” And at a British Medical Association Conference, an overwhelming vote supported a ban on any funding of homeopathic remedies, calling them “witchcraft.”
In Canada, our Natural Health Products Directorate has a mandate “to ensure that Canadians have ready access to natural health products that are safe, effective and of high quality.” Yet, it licenses homeopathic products without requiring proof of efficacy. Why should the manufacturers of these products be less accountable than those of other pharmaceuticals? Knowing this, how can pharmacists in good conscience sell sugar pills that claim to have ghostly images of molecules?
Homeopathic remedies work through the placebo effect. That of course is not negligible. Placebos can have success rates of over 30%! But if you think there’s something more to homeopathy, consider the following. How come different homeopaths prescribe different remedies to the same person for the same condition? How come drugs, other than homeopathic remedies, do not increase in potency when they are diluted? How come that trace impurities in the sugar used to make the tablets, or in the water or alcohol used for dilution, which are present at higher concentration than the supposed active ingredient, have no effect? How can remedies that are chemically indistinguishable from each other have different effects? And how come a producer of homeopathic remedies given an unidentified pill cannot determine the original substance used to make the dilution? Finally, how come there are no homeopathic pills for diabetes, hypertension or birth control?
Now I think I’ve said enough. According to homeopathic principles, if I say more and more about the irrationality of homeopathic remedies, the effectiveness of my arguments will become less and less.