Homeopathy, part I.

  1.  Homeopathy Today

Today, organic-food stores are thriving.  They claim to sell food that is grown in conditions that could be more healthy for consumers.  Thus, organic foods may be grown without using pesticides, and animals such as chickens may be “free-range” or “cage-free.”  In addition, these establishments have an emphasis on providing “natural products.”

Those products are likely to include “homeopathic medicines.”  Our own local food co-op has a shelf full of homeopathic remedies.  Homeopathic remedies tend to be particularly popular at organic-food stores, because of their claims to be “natural products” that are “gentle and safe.”

Here is a photo from a company that produces homeopathic “remedies.”  Note the herbs; the plants; the pestle, all emphasizing the “natural” aspects.

Advertisement for homeopathic remedies, emphasizing “natural” aspects.

Trendy grocery chains such as Whole Foods stock up on homeopathic remedies.  For example, go here to see a Whole Foods podcast about homeopathy.  This features a Q&A with an executive from the Boiron corportation, one of the leading manufacturers of homeopathic products.

You can also purchase both books and homeopathic products on Amazon.com.  Some sample comments from readers on these sites: “Homeopathy works!” and “This is my homeopathic Bible!”

As an example of a homeopathic product, you can purchase a “32 unit, Homeopathy Family Kit” from Boiron for a list price of $123.40. This consists of 32 “preparations,” each of which corresponds to a different “active ingredient” at 30C dilution.

As we will discuss in Sect. 3 below, the homeopathic community uses a logarithmic scale to describe the very high dilutions in their products.  A product described as “NC” means that the active ingredient is diluted to one part per hundred (generally with distilled water), and this dilution process is repeated N times.  Thus a “6C” dilution will consist of 1 part active ingredient to 100^6 = 10^12 parts water.  That is 1 molecule of active ingredient for every 1 trillion molecules of water.

A pharmacist in our area owns a “health and wellness” store.  He takes out ads on the radio to recommend various products.  During flu season, he stated (correctly) that there were some questions regarding the effectiveness of flu vaccines for seniors.  He recommended that seniors consider a “homeopathic flu vaccine” as a “safe and effective” alternative to a flu shot.

 Homeopathic medicines are a booming business. In 2007, the last year for which they reported numbers, the US Food & Drug Administration (FDA) estimated annual over-the-counter (OTC) sales of “homeopathic remedies” at $2.9 billion.  There are many reasons for the popularity of such products.  One is the emphasis on these remedies as “natural.”  Another is the claim that these products are “gentle.”

Are homeopathic products really “safe and effective,” as claimed by their adherents? In a word, NO.  Steven Salzberg, the Bloomberg Distinguished Professor of Biomedical Engineering, Computer Science, and Biostatistics at Johns Hopkins University had this to say about homeopathy.  “Homeopathy is the most obviously fake alternative medicine you’re likely to see in your local pharmacy.”

Our article is organized as follows.  In Sect. 2, we will review the scientific and medical basis of homeopathy.  The field of homeopathy was developed in 1796, before either the germ theory of disease or the atomic theory of matter were understood.  As a result, we can clearly demonstrate that the “laws” of homeopathy completely contradict the principles of modern science and medicine.

In Sect. 3 we discuss the extreme dilutions that characterize homeopathy.  In Sect. 4 we review the practice of homeopathy today.  Sect. 5 reviews adverse effects of homeopathy.

Although we demonstrate that the “principles” of homeopathy are in contradiction with modern science and medicine, the homeopathic community attempts to provide “scientific justification” for their remedies.  In Sect. 6, we discuss some phenomena alleged to justify homeopathy, and we show why these claims are not credible.

Section 6 will conclude part I of our review of homeopathy.  In part II, we will review some “New Age” variants on homeopathy.  These will include methods such as “electrohomeopathy” and “paper products.” We will summarize the responses of medical associations and various governments on homeopathy and homeopathic medicine.

We then review the Web site of the American Institute of Homeopathy.  How do they justify the “effectiveness” of their products, and what are their claims regarding the “scientific” basis of homeopathy?  At the end of part II, we will draw conclusions and make recommendations for dealing with the pseudo-science of homeopathy.

2.  The Historical Scientific/Medical Basis for Homeopathy

Homeopathy was developed in 1796 by Samuel Hahnemann, who is pictured below.

Samuel Hahnemann, the father of homeopathy.

Homeopathy was based on three general principles:

    1. Like cures like (similia similibus curentur), or “law of similars.” This is the notion that a substance that causes symptoms of disease in healthy people will cure similar symptoms in sick people.  Supporters of homeopathy claim that this idea may have originated with Hippocrates.  He is reputed to have prescribed small doses of mandrake root to treat mania, knowing that in large doses this produces mania.  Also, in the 16th century Paracelsus declared that small doses of “what makes a man ill also cures him.”
    2. Law of Infinitesimal Doses: This is the notion that as the “curative” substance is diluted, it becomes progressively more effective in combating disease. Thus, homeopathic medicines are created by taking an “active ingredient” (generally one that is toxic in large doses) and progressively diluting it with distilled water or some other substance.  Hahnemann’s idea was that the more dilute the substance, the more potent it becomes.  In addition, Hahnemann developed the notion that vigorous shaking of the diluted substance increased its potency.
    3. The Single Remedy: The notion is that the homeopathic physician reviews many aspects of a patient, including their symptoms, but also their habits, spiritual beliefs, and other details.  Based on a detailed workup, the homeopath supposedly chooses the single “remedy” that is most appropriate for the patient.  First, the physician consults a “repository” listing preparations that are supposed to be effective in certain circumstances.  In addition, the physician uses his/her personal experience in order to pick the ideal “remedy” to fit the condition.


Below is a photo of some pills used as homeopathic remedies.  You can see that some of the bottles have as active ingredient “Belladonna,” another name for the poisonous “deadly nightshade.”   This is an example of some of the toxic materials used in homeopathic preparations.

A selection of homeopathic “remedies.”

It should be stressed that Hahnemann’s theory was developed before either the germ theory of disease or the atomic theory were understood.  Thus, nothing in Hahnemann’s theory of homeopathy is consistent with our current understanding of the cause and treatment of disease.

Furthermore, Hahnemann imputed a spiritual character to disease.  Homeopaths believe that “all disease can be traced to some latent, deep-seated, underlying chronic, or inherited tendency.”  They also believe that direct treatment of the symptoms of disease does not remove the “infectious principles” or “miasms.”  Hahnemann believed that he had identified three miasms that together are responsible for all human diseases.  The theory is that these miasms can only be effectively treated by homeopathic methods, which correct disturbances of the “vital forces.”

Hahnemann was apparently inspired to develop his theory of homeopathy when he investigated the use of cinchona bark to treat malaria.  Hahnemann ingested some bark, and experienced a number of symptoms that were typical for victims of malaria, namely fever, shivering and joint pain.  This led him to his “law of similars.”

However, we now know why cinchona bark is effective against malaria: it contains quinine, which kills the Plasmodium falciparum parasite that causes malaria.  The effectiveness of this substance against malaria has nothing to do with Hahnemann’s theories.  So, Hahnemann’s supposedly big insight, that led him to the “principles” on which homeopathy is based, was totally incorrect.

Homeopaths try to justify the “law of similars” by comparing it to the effectiveness of vaccines, which involve giving small doses of an infectious pathogen to prevent a later infection. However, this is a seriously flawed analogy. Vaccines involve measurable doses of attenuated or killed organisms or their proteins, and operate by a known medical mechanism — they trigger an immune response. There is no analogy to homeopathy, for which there is no known physical mechanism (see Sect.  6 for “justifications” of homeopathy).

The “law of infinitesimal doses” is decidedly strange.  Since Hahnemann’s idea was to “treat” an illness using a toxic substance as “active ingredient,” it would be foolish to ingest the substance at full strength – clearly, it would harm you.  So the active ingredient would have to be diluted.  But what is the correct degree of dilution?  Hahnemann came up with the idea that the more the ingredient was diluted, the more powerful it would be as a remedy.

This argument completely contradicts the well-known “dose-response reaction.”  That is, in general one finds that the response to a dose of medication monotonically increases with the dose.  The idea that the effectiveness of a potion keeps increasing as it is successively diluted can be carried to absurd limits – one could argue that a powerful remedy would be one that was diluted until no molecules of the “active ingredient” remained.  As we will see, this is precisely the case with modern homeopathic “medications.”

3.  Homeopathic Dilutions

Homeopaths use a logarithmic scale to denote the amount of dilution.  The notation “X” denotes dilution by a factor of 10.  So, a homeopathic solution designated “5X” contains 1 part active ingredient to 10^5 parts distilled water.  Hahnemann preferred to use dilutions in parts per hundred.  Thus a homeopathic solution denoted “5C” would contain 1 part active ingredient to (100)^5 = 10^10 parts distilled water; that is, 10 billion molecules of water to every molecule of active ingredient.

Hahnemann’s preferred dilution for his potions was 30C.  That is, 1 molecule of active ingredient to 10^60 molecules of distilled water.  Now that we understand the atomic theory, we can calculate how many molecules of the “active ingredient” remain after dilutions of this magnitude.

A 2-ounce container of homeopathic medicine diluted to 30C will never contain a single molecule of the active ingredient.  Obviously, such a liquid would be incapable of producing any actual therapeutic effect, over and above the placebo effect.

The placebo effect is a well-known medical phenomenon, whereby patients experience an improvement in their medical condition when given something like a sugar pill. The improvement is a result of the patient’s expectation of a beneficial effect.

For a normal-sized containment vessel, the greatest dilution likely to contain even one molecule of the original substance is 12C.  To give an analogy, a 12C dilution is equivalent to “placing a pinch of salt in the Atlantic Ocean.”  A drop of original substance diluted with all the water on Earth would correspond to a 13C solution.

A popular homeopathic remedy recommended to “treat” the flu is a 200C dilution of duck liver, which is marketed under the name Oscillococcinum.  Note that a dilution of 1 molecule of duck liver in all the molecules in the known Universe would produce a 40C mixture.

Now that we understand the relationship between extreme dilutions and molecules of the “active ingredient,” a more honest representation of high-dilution “homeopathic remedies” is shown below.

A homeopathic solution at high dilution.

By the mid-19th century, the degree of dilution of homeopathic medicines could be understood from the atomic theory of matter.  James Young Simpson said that there was “No poison, however, strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly.”   In 1842, American physician Oliver Wendell Holmes, Sr. published a critical essay titled Homeopathy and Its Kindred Delusions.

A couple of years ago, when I felt a cold coming on, my wife urged me to try a “homeopathic zinc” over-the-counter tablet called Zicam.  She assured me that Zicam had helped her stave off a cold on several occasions.  I then launched into a critique of homeopathy; I reviewed the history of this field, discussed various dilutions, and assured her that a “20C” dilution would contain nothing but distilled water.

I eventually examined her bottle of Zicam.  To my surprise, Zicam is a “1X” dilution; that is, it is a 10% solution of some zinc compound.  Of course, at that strength Zicam might well be effective; at the same time, it seems dubious and misleading to call it “homeopathic,” since it totally contradicts the “law of infinitesimal doses.”

Note: in 2009, the FDA advised consumers to stop using three discontinued Zicam products (in particular, Zicam Cold Remedy Nasal Gel [2X]), as they could cause permanent damage to the user’s sense of smell.

Let us review: at any dilution of the order of “12C” or above, a homeopathic medicine is essentially distilled water.  One can guarantee that it will have no therapeutic value, save for the placebo effect.  However, if one takes a homeopathic treatment rather than conventional medical treatment (say, to treat a tumor, or in place of vaccination), then one is forsaking the benefits that would accrue from modern medicine.

Occasionally, products promoted as “homeopathic” have low degrees of dilution – e.g., the Zicam “1X” tablets discussed earlier.  Since these products violate the “law of infinitesimal doses,” in the remainder of this article we confine our discussion to products involving high degrees of dilution, “10C” or greater.

4.  The Practice of Homeopathy

From Sect. 3, we see that any highly-diluted “homeopathic medicine” is in fact pure distilled water.
Scientific tests run by both the BBC‘s Horizon and ABC’s 20/20 programs were unable to differentiate homeopathic dilutions from water, even when using tests suggested by homeopaths themselves.

On the one hand, ingesting such a “medicine” will be completely ineffective in treating any disease or ailment, aside from the placebo effect.  On the other hand, drinking distilled water is unlikely to produce adverse effects (unless the toxic materials in the preparation greatly exceed the specified amounts – see Sect. 5).

The failure of homeopathic remedies has been verified experimentally.
A review conducted in 2010 of all the pertinent studies of “best evidence” produced by the Cochrane Collaboration concluded that “the most reliable evidence – that produced by Cochrane reviews – fails to demonstrate that homeopathic medicines have effects beyond placebo.”

We can understand why homeopathic medicine became popular in its early days.  In those times, medical practices such as bloodletting frequently aggravated health problems.  In addition, the lack of sterile conditions at hospitals could accelerate the spread of infectious diseases.  Thus, in the 18th and early 19th century, people treated with homeopathic remedies might fare better than those admitted to unsanitary hospitals and subjected to procedures that could aggravate their illness.

Another reason for the acceptance of homeopathic medicine was that its early practitioners carried out quasi-scientific tests of the efficacy of their potions.  For example, Hahnemann administered medications to groups of volunteers for periods of months.  The volunteers were required to keep journals of their experiences, and forbidden to partake of substances such as coffee, tea, spices and wine (for some reason, beer was acceptable).

Hahnemann called his tests “provings.”  These were the predecessors to modern clinical trials.  They utilized control groups, quantitative procedures, and statistical methods.  However, the provings also differ significantly from clinical trials.  In particular, they were highly subjective  and they were not blinded.  In his essay on homeopathy, Oliver Holmes argued that the provings were impossibly vague, and their results were not repeatable.

Practitioners of homeopathy rely on “repertories” to compile their “medicines.”  A homeopathic repertory is an index of disease symptoms that list preparations supposed to be effective against those diseases.  Homeopathic medicines may be prepared from animal, plant, mineral or synthetic substances.  They are generally referred to using Latin names – when Latin names are not available, “faux-Latin” names may be generated.

Examples are natrum muriaticum (sodium chloride = table salt), or Lachesis muta (venom of the bushmaster snake).  Preparations made from healthy specimens are called “sarcodes,” whereas preparations made from diseased or pathological specimens (e.g., blood, tissue, fecal or urinary or respiratory discharges) are called “nosodes.”

5.  Adverse Effects From Homeopathy

As we have stressed, in high dilutions homeopathic remedies are indistinguishable from distilled water.  However, there are instances that have resulted in seizures or deaths.  These generally occur in two cases.  The first is when toxic substances are not sufficiently diluted; the second is where toxic substances appear at detectable levels due to improper preparation.

A recent case involved homeopathic teething gels.
On September 30, 2016 the FDA issued a safety alert to consumers warning against the use of homeopathic teething gels and tablets following reports of adverse events after their use … On October 12, Buzzfeed reported that the regulator had “examined more than 400 reports of seizures, fever and vomiting, as well as 10 deaths” over a six-year period. The investigation (including analyses of the products) is still ongoing … a previous FDA investigation in 2010, following adverse effects reported then, found that these same products were improperly diluted and contained “unsafe levels of belladonna, also known as deadly nightshade” and that the reports of serious adverse events in children using this product were “consistent with belladonna toxicity”.

 Other adverse reactions can occur if patients are convinced to substitute homeopathic alternatives for conventional medication.  Homeopaths believe that conventional medications do not cure disease but merely “push it deeper,” a condition they call “suppression.”  Because of this, some practitioners advise travelers to use homeopathic preparations instead of anti-malarial drugs.   Obviously, it is dangerous to forego meds that actually protect against malaria, in favor of a preparation of distilled water.

In another case, in 2004 a homeopath advised her patient to stop taking all medications, in particular her prescribed heart medication, stating “I feel confident if she follows the advice [to replace her heart meds with homeopathic remedies] she will regain her health.”  The patient was admitted to hospital the following day and subsequently died from “acute heart failure due to treatment discontinuation.”

In 2013, a young boy died in Calgary, Canada from a Group A streptococcus infection.  Although his condition would easily have been treated with an antibiotic such as penicillin, the parent instead treated him with homeopathic herbal remedies.  The sergeant investigating the death said, “It was a belief system in homeopathic medicine that contributed to this death … The message is simple: if your child is sick, take them to the doctor.”

6.  Bogus “Scientific” Justifications for Homeopathy

Modern science tells us that the original justifications for homeopathy — “like cures like” and “law of infinitesimal doses” – are false.  The mainstream scientific community is adamant that homeopathy is pseudoscience.  It violates fundamental principles of physics and chemistry.  There is no plausible physical mechanism that could justify homeopathy.   Furthermore, no convincing experiments have detected positive results from homeopathy that exceed the placebo effect.

The notion that higher dilutions of active ingredients produce stronger medicinal effects is completely contrary to the “dose-response relationship.”  That relationship has been confirmed in a host of experiments on different organisms.

Various New Age hucksters have tried to invoke mechanisms to explain why homeopathy “works.”  In this Section we review a few of those claims.

a. Water Memory

In this theory, the structure of water is supposedly transformed by the diluted substance, so that it “remembers” the active ingredient, despite the fact that no molecules of the active ingredient remain.  When the liquid is ingested, these lingering effects of the active ingredient are somehow transmitted to the patient.  This notion is not supported by our understanding of modern chemistry.

There is no experimentally detectable effect that could be ascribed to “water memory.”  An experiment that claimed to show such an effect was shown to be false; the supposed effect arose because the experiment was not double-blind.

Here are other arguments against “water memory.”
No evidence of stable clusters of water molecules was found when homeopathic preparations were studied using nuclear magnetic resonance, and many other physical experiments in homeopathy have been found to be of low methodological quality, which precludes any meaningful conclusion. Existence of a pharmacological effect in the absence of any true active ingredient is inconsistent with the law of mass action and the observed dose-response relationships characteristic of therapeutic drugs.

b. Nanoparticles

Another “explanation” of how biological effects could arise from ultradilute remedies invokes the effects of nanoparticles that were supposedly detected in homeopathic solutions. However, the experiments purporting to identify these particles have been poorly conducted, and were subject to contamination and other sources of error.  A telling fact is that only proponents of homeopathy believe this theory.  We know of no experiments outside the homeopathic community that observe nanoparticles in homeopathic remedies.

If nanoparticles were found in homeopathic liquids, one should ask how they got there.  They might have been introduced in the dilution and shaking processes.  The nanoparticles could have been present in vessels used in manufacturing homeopathic liquids, and could have leached into the liquids.

Even if we assume that such nanoparticles appear in a homeopathic remedy, they would be present in infinitesimal quantities that cannot possibly have a therapeutic effect.

c. Quantum Non-Locality

A number of experiments have demonstrated that quantum physics is inherently non-local.  In certain special quantum systems, events that occur at one space-time point place restrictions on results occurring at a distant point.  These restrictions are inconsistent with simple “local” assumptions regarding space and time.

What does this have to do with homeopathy?  Simply put, nothing.  “Applications” of quantum non-locality to homeopathy are generally made by non-specialists.  Essentially, they amount to the assumption that the existence of non-intuitive events in certain physical systems justifies the assumption of completely unrelated weird possibilities in totally different physical, chemical, or biological systems.

“Applications” of quantum non-locality to other fields generally involve using terms and definitions from quantum physics in unrelated areas, where those terms are not applicable.

A related area is that of “quantum entanglement.”  In modern terminology, physicists describe systems that experience non-local behavior as being “entangled.”  The notion of entanglement is sometimes mis-applied to homeopathic “solutions.”  The claim is that the “effectiveness” of homeopathy is explained by quantum entanglement.

However, legitimate quantum entanglement is observed only in highly unique systems, where stability and isolation are achieved with the most sophisticated electronic equipment.  And even in these systems, entanglement can only be maintained for a fraction of a second.

To be continued in Part II