In “Homeopathy, part I” we reviewed the principles of homeopathy. We showed that there was absolutely no scientific or medical justification for these principles, which were formulated before modern theories of disease were known, and before the atomic theory of matter was understood.
In part I, we discussed how the high dilutions that characterize many homeopathic remedies result in no molecules of the “active ingredient” remaining. We also reviewed, and debunked, attempts to provide “scientific” justification for homeopathy. In this part, we will review a few variants of homeopathy. We will also summarize responses to homeopathy from various medical groups, and also from different governments.
We will next look at the American Institute for Homeopathy, and discuss how they attempt to justify their practices. Finally, we will draw some conclusions regarding homeopathy and make some recommendations.
7. Some Unusual Practices of Homeopathy
Here are some practices that differ from “classical homeopathy.” These practices are generally utilized by people outside the “standard” homeopathic community. All of these appear to be ‘New Age’ variants of homeopathy.
Isopathy is a branch of homeopathy that specializes in the use of “nosodes” as active ingredients. Nosodes are preparations that utilize diseased or pathological specimens (e.g., blood, tissue, fecal or urinary or respiratory discharges). One application of isopathy is “homeopathic vaccines,” recommended by some New Age practitioners as alternatives to vaccines.
At high dilutions, “homeopathic vaccines” cannot possibly be effective. One is being “treated” with distilled water! There is no mechanism for such a vaccine to stimulate the immune system to develop and evolve effective antibodies to destroy the disease pathogens. It is seriously risky to substitute these products for vaccination. There is no way that one can achieve resistance to any infectious disease through a “homeopathic vaccine.” Homeopathic vaccines administered to children are particularly dangerous, since they will not receive the immunity from disease provided by conventional vaccines. It is also risky for senior citizens to substitute “homeopathic flu vaccines” for legitimate vaccines.
“Imponderables” are not actual substances. This generally involves exposing water, alcohol or lactose to some form of radiation (the most common are sunlight and X-rays). Presumably some of the “essence” of the radiation is captured by the liquid. There is no evidence that such preparations have any therapeutic value. It is conceivable that high levels of X-rays could cause chemical reactions in water, but we know of no therapeutic benefits that would arise from these reactions.
A related field is called Electrohomeopathy. This was introduced by Count Cesare Mattei in the late 19th century. Mattei proposed that different “colours” of electricity could be used to treat cancer. There is no relation between electrohomeopathy and conventional radiation treatments for cancer. Above is an advertisement for an electrohomeopathy practitioner in India. Note that the “treatments” are recommended for everything from asthma and infertility to cardiac disease, AIDS, and cancer!
c. Paper Preparations
With “paper preparations,” the “active ingredient” and degree of dilution are written on a piece of paper. The paper can be “activated” in various ways: the paper can be pinned to the patient’s clothing; it can be placed in the patient’s pocket; or the paper can be placed underneath a glass of water that is given to the patient, as shown in the photo below. This seems like a genuinely crazy way to “administer” medication; but when one thinks about it, it is arguably no wackier than classical homeopathy.
8. Official Statements on Homeopathy
Until about 1970, Homeopathy was common in some European countries, but was much less popular in the U.S. All this changed with the introduction of New Age thought in America. This has led to a much greater acceptance of New Age medicine, and homeopathy is one of the quasi-medical practices that have increased in popularity.
Health organizations such as the National Health Service (U.K.), American Medical Association, the Federation of American Societies for Experimental Biology (FASEB), and the National Health and Medical Research Council of Australia have concluded that “there is no good-quality evidence that homeopathy is effective as a treatment for any health condition.”
The American College of Medical Toxicology and the American Academy of Clinical Toxology recommend that no one use homeopathic treatment for disease or as a preventive health measure.
The Russian Academy of Sciences claims that homeopathy is “a dangerous pseudoscience that does not work.” The acting director of the U.S. National Center for Complementary and Alternative Medicine (NCCAM) says “there is no condition for which homeopathy has been proven to be an effective treatment.” The NCCAM has issued a statement on homeopathy: “It is not possible to explain in scientific terms how a preparation containing little or no active ingredient can have any effect. This, in turn, creates major challenges to the rigorous clinical investigation of homeopathic preparations.”
The British House of Commons Science and Technology Committee states “In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos.”
The U.K. National Health Service has taken the following actions regarding homeopathy.
They recommended that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims, that homeopathic products should no longer be licensed by the MHRA, as they are not medicines, and that further clinical trials of homeopathy could not be justified … funding of homeopathic hospitals should not continue, and NHS doctors should not refer patients to homeopaths. … In July 2017 the NHS announced that it would no longer provide homeopathic medicines.
The Australian National Health and Medical Research Council concluded that there were no health conditions with reliable evidence that homeopathy was effective. No reliable studies existed that showed homeopathy with better results than placebos, or that gave an improvement in health equal to another treatment.
In some European countries, certain types of homeopathic treatment are covered by national health services. This includes France, Luxembourg and Switzerland. In other countries such as Belgium and Austria, homeopathy is not reimbursable. Just this month, the U.K. has announced that homeopathy will no longer be covered by the National Health.
On the other hand, India recognizes homeopathy as part of a group of traditional medicines; it is represented by a department (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) in the Ministry of Health & Family Welfare. In 1975 India established a National Institute of Homeopathy. One can get a degree in homeopathy, which is necessary to “practice” homeopathy.
Based on complaints from the Center For Inquiry (CFI) organization, in 2016 the U.S. Federal Trade Commission (FTC) required that homeopathic products cannot include claims of effectiveness without “competent and reliable scientific evidence.” CFI and the Committee for Skeptical Inquiry (CSI) asked the Food and Drug Administration (FDA) to issue warnings to Boiron for marketing tactics associated with their product Oscillococcinum, a “homeopathic flu vaccine.” In March 2012, Boiron agreed to spend up to $12 million to settle claims of false advertisement for its homeopathic preparations.
In Nov. 2016, The FTC issued an Enforcement Policy Statement on homeopathy. It stated that the Federal Trade Act “does not exempt homeopathic products from the general requirement that objective product claims be truthful and substantiated.”
The FTC summary policy statement regarding claims for homeopathic drugs concludes:
The FTC will hold efficacy and safety claims for OTC homeopathic drugs to the same standard as other products making similar claims. That is, companies must have competent and reliable scientific evidence for health-related claims, including claims that a product can treat specific conditions …. For the vast majority of OTC homeopathic drugs … the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product’s efficacy. As such, the marketing claims for these products are likely misleading, in violation of the FTC Act.
Homeopaths make much of the fact that their field is “recognized by the U.S. FDA.” Indeed, in 1988 the FDA struck a deal with the homeopathic drug industry, where homeopaths could be self-regulating, provided that they included a disclaimer that their claims hadn’t been evaluated by the FDA. As Steven Salzberg described it, “the FDA’s agreement is basically a license to lie.”
9. Homeopaths Defend Themselves
In an attempt to understand current thinking on homeopathy, we went to the Web page for the American Institute of Homeopathy (AIH), an organization that has apparently existed since 1844. How did they defend their beliefs and practices?
First off, they trot out the two major principles of homeopathy, which we summarized in Sect. 2. These are “like cures like,” and the “principle of the minimum dose,” which we called “law of infinitesimal doses.”
As we pointed out earlier, the medieval notion of “like cures like” is in conflict with everything we know from the modern theory of disease. Furthermore, there is no evidence that infinitesimal amounts of poisons such as arsenic will cure diseases.
The notion that an active ingredient becomes progressively more potent as it is diluted conflicts with experiments that verify the dose-response relationship. This notion is not supported by any principles from physics, chemistry or biology.
So how are these principles justified? According to the AIH, by “provings, toxicological data, and clinical experience.” Unfortunately, since the only people who believe this “data” are homeopaths, one has to take this “experience” on faith. And most of the “justification” for homeopathy boils down to personal testimonials such as “it works for me (or my family),” or claims that “homeopathy has been effective for centuries.”
Since the AIH takes the position that “potency” of their active ingredients increases with the amount of dilution, presumably they are talking about high-dilution preparations. In that case, as we have shown, all homeopathic potions are simply distilled water, with perhaps microscopic traces of impurities that might be found in the liquid as a result of the preparation process.
The homeopathic literature places great stress on the arguments that their process is “natural, gentle and holistic.” As far as “natural” and “gentle” go, indeed distilled water satisfies both conditions. It is unlikely to harm you. Since homeopathic remedies have been shown to be no more effective than placebos, people taking these preparations may experience positive results courtesy of the placebo effect. This is particularly true if a “homeopathic remedy” is taken for a cold or other self-correcting temporary ailment.
As for the “holistic” part, indeed consultation with a homeopathic physician will involve the whole person. Questions asked of their patients cover a very wide range, and the homeopath makes a concerted effort to prescribe “just the right preparation” for a given individual. All of that would be impressive and comforting, were it not for the fact that every remedy is identical – it’s all distilled water!
Next, we examined the “scientific justifications” as listed by AIH. First, there is a reference to “nanoparticles” in high-dilution systems (Chikramane et al., Homeopathy 99, 231 (2000)). Note that this is in the journal Homeopathy, and not a recognized peer-reviewed scientific journal. The authors carried out this research at IIT Bombay. They look at high-diluted liquids where the “active ingredient” is a metal. They find tiny amounts of nanoparticles of the metal components, despite incredible dilutions.
Presumably the nano-particles remain in the system because of defects in the “dilution and shaking” process by which the liquid is prepared; or possibly some molecules of the metal remain on the surface of the vessel used to prepare the substance.
The authors conclude that “how this translates into change in biological activity with increasing potency needs further study.” That is to say, they cannot imagine any physical mechanism that would be consistent with homeopathic lore.
Perhaps the most vigorous defense of homeopathic theory is given by Iris Bell (American Journal of Homeopathic Medicine 105, 116 (2012)). Her argument is that nanoparticles in homeopathic remedies combat disease through a process called hormesis. Hormesis is a non-linear process that differs from the normal dose-response relationship. Reactions involving hormesis are believed to have beneficial effects at some small dose, while at larger doses the substance is toxic. The prevalence, mechanism of action, and effects of hormesis are all controversial.
Bell justifies her theory by presenting the above figure. The argument is that nanoparticles will display a dose-response relationship that peaks at a certain dose, then declines thereafter.
One should remain highly skeptical of these arguments. One first needs to produce evidence that homeopathic remedies actually contain nanoparticles. Next, the nanoparticles would have to demonstrate hormesis, with the concentration of nanoparticles corresponding to their maximum response. And finally, the nanoparticles would have to produce the desired therapeutic effects for a particular condition.
The one positive thing we can say about Ms. Bell’s hypothesis is that it is susceptible to experimental testing. So if there is anything to her hypotheses, they could be tested by scientific experiments.
The next “justification” is that of “water memory.” The AIH references a paper on water memory (Elia et al., Homeopathy 96, 163 (2007)). Regarding this paper, note that there are no confirmations in reputable peer-reviewed scientific journals. Belief in the phenomenon of “water memory” appears to be strictly limited to the homeopathic community. We reviewed “water memory” in Sect. 6.
The AIH also provides a series of papers “demonstrating” outcomes of studies where results differ from those with placebos. There are several reasons that experiments with “homeopathic remedies” might differ from controls with placebos. The first is poorly designed experiments. A second could be errors in the statistical analysis.
Assuming that experiments were well-designed and well-analyzed, there are always random statistical fluctuations. Such fluctuations could cause a certain number of experimental results to show deviations from the placebo effect.
Interesting results are obtained using meta-analyses, that include data from a large number of different clinical trials. Generally speaking, the larger the meta-analyses, the closer the outcomes converge toward identical results between homeopathic remedies and controls with placebos. This argues against the effectiveness of homeopathic treatments.
Homeopathic remedies are a big business, particularly in the organic-food industry. Homeopathic products are popular because of their association with “New Age” health notions. They place considerable reliance on “traditional medicine” methods, even when those methods conflict with our understanding of modern science. Devotees of New Age practices might be impressed by claims that these methods are “holistic.” Also, homeopathic “physicians” provide a high degree of personal attention to their patients.
As scientists, we are disturbed that “remedies” consisting of distilled water are being sold at our supermarkets. We see them at grocery chains such as Whole Foods, and find homeopathic products available on Amazon.com.
We mentioned earlier a “32 unit, Homeopathy Family Kit” from Boiron, shown below.
Since each of the 32 “preparations” is sold at 30C dilution, and the price is greater than $100, the consumer will be paying an exorbitant price for 32 identical flasks of distilled water, devoid of a single molecule of the active ingredient.
Children who take “homeopathic vaccines” to guard against infectious diseases (measles, mumps, rubella, polio, etc) are being cheated of the opportunity to obtain immunity from these dangerous diseases. Anyone who takes a “homeopathic remedy” instead of an anti-malarial med, or a “homeopathic flu vaccine” instead of a flu shot, is putting their health in jeopardy.
What can be done to prevent the public from being fleeced by these useless potions? Our FTC has taken the first step; manufacturers of homeopathic remedies can no longer claim that they are effective against, or are recommended for treatment of, any disease or condition. Another step would be to refuse reimbursement from insurance plans for medical “treatment” by homeopathic physicians.
In our opinion, the FDA should require that homeopathic remedies cannot be sold until they can show reliable scientific evidence that proves their effectiveness against a particular disease. Manufacturers of “homeopathic vaccines” should be required to show that they actually provide immunity against communicable diseases. In fact, in their 2016 report, the FTC recommended that the FDA “subject homeopathic drugs to the same regulatory requirements as other drug products.”
The FTC now requires that promotion of homeopathic OTC remedies “effectively communicate to customers that (1) There is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most medical experts.”
Our un-scientific study (looking at homeopathic products on the shelves of our co-op and CVS pharmacy) suggests that makers of homeopathic remedies are not displaying this disclaimer. We would hope that retailers would refuse to stock homeopathic products until they provide such a disclaimer on their packages. Apparently the CFI has requested that the FTC undertake proceedings against CVS, for not enforcing the requirement that homeopathic products display a disclaimer.
At the very least, we hope that pharmacies would place homeopathic products in a separate section (labeled “New Age Mumbo-Jumbo”?), instead of the “Cold and Flu” area, adjacent to legitimate products.
We realize that this is contradictory to the current practice that one can freely sell any “natural products;” but we believe that the public would be well served by requiring that companies produce scientific evidence that their products are effective.
We are posting this article in the hope that people might be convinced that homeopathy is a waste of money, and that the “principles” of homeopathy have absolutely no basis in modern science or medicine.
WebMD, Homeopathy – Topic Overview
NIH – National Center for Complementary and Integrative Health: Homeopathy
Science-Based Medicine: Homeopathy
American Institute of Homeopathy: Homeopathy
FTC Steps In Where FDA Fears to Tread: On Homeopathy, Steven Salzberg, Forbes Magazine, Nov. 21, 2016.