Thursday, February 5, 2015

Is there any proof that homeopathic medicine works?

Respectable “Guardian” posted a question is there any proof that homeopathic medicine works. Here are some of the chose answers:

For two groups of people, yes. Those who have faith in it, and those that sell it (Michael Fisher, Brisbane, Australia).

You could have saved a lot of time and energy by writing. Is there any proof homeopathic medicine works? No! (Mike, Birkenhead).

Yep, homeopathy is right up there with numerology, palm reading, tea leaf reading, crystals, astrology and tarrot cards - it's all utter rubbish (Chris Carter, Christchurch, New Zealand).

No. Do you know what they call alternative medicine that works? MEDICINE! If you catch a cold and leave it alone it will take 7 days to leave, but use homeopathic pills and it will be gone in a week! Do not be so gullible that you reject the common sense you were born with (Edward Jenkinson, Darlington, United Kingdom).

Well, there were other respondents who claimed that for them personally homeopathy works just fine, the majority of answers were in the range from moderately negative to ultimately negative.

Basic Controversy

Homeopathic "remedies" enjoy a unique status in the health marketplace: They are the only category of questionable products legally marketable as drugs. This situation is the result of two circumstances. First, the 1938 Federal Food, Drug, and Cosmetic Act, which was shepherded through Congress by a homeopathic physician who was a senator, recognizes as drugs all substances included in the Homeopathic Pharmacopeia of the United States. Second, the FDA has not held homeopathic products to the same standards as other drugs. Today, they are marketed in health-food stores, in pharmacies, in practitioner offices, by multilevel distributors, through the mail, and on the Internet.

History of Basic Misbeliefs

Samuel Hahnemann (1755-1843), a German physician, began formulating homeopathy's basic principles in the late 1700s. Hahnemann was justifiably distressed about bloodletting, leeching, purging, and other medical procedures of his day that did far more harm than good. Thinking that these treatments were intended to "balance the body's 'humors' by opposite effects," he developed his "law of similars"—a notion that symptoms of disease can be cured by extremely small amounts of substances that produce similar symptoms in healthy people when administered in large amounts. The word "homeopathy" is derived from the Greek words homoios (similar) and pathos (suffering or disease).

Hahnemann and his early followers conducted "provings" in which they administered herbs, minerals, and other substances to healthy people, including themselves, and kept detailed records of what they observed. Later these records were compiled into lengthy reference books called materia medica, which are used to match a patient's symptoms with a "corresponding" drug.

Hahnemann declared that diseases represent a disturbance in the body's ability to heal itself and that only a small stimulus is needed to begin the healing process. He also claimed that chronic diseases were manifestations of a suppressed itch (psora), a kind of miasma or evil spirit. At first, he used small doses of accepted medications. However, later he used enormous dilutions and theorized that the smaller the dose, the more powerful the effect—a notion commonly referred to as the "law of infinitesimals." That, of course, is just the opposite of the dose-response relationship that pharmacologists have demonstrated.

The basis for inclusion in the Homeopathic Pharmacopeia is not modern scientific testing, but homeopathic "provings" conducted during the 1800s and early 1900s. The current (ninth) edition describes how more than a thousand substances are prepared for homeopathic use. It does not identify the symptoms or diseases for which homeopathic products should be used; that is decided by the practitioner (or manufacturer). The fact that substances listed in the Homeopathic Pharmacopeia are legally recognized as "drugs" does not mean that either the law or the FDA recognizes them as effective.

Because homeopathic remedies were actually less dangerous than those of nineteenth-century medical orthodoxy, many medical practitioners began using them. At the turn of the twentieth century, homeopathy had about 14,000 practitioners and 22 schools in the United States. However, as medical science and medical education advanced, homeopathy declined sharply in America, where its schools either closed or converted to modern methods. The last pure homeopathic school in this country closed during the 1920s.

Better than Placebo?

Homeopathic products are made from minerals, botanical substances, and several other sources. If the original substance is soluble, one part is diluted with either nine or ninety-nine parts of distilled water and/or alcohol and shaken vigorously (succussed); if insoluble, it is finely ground and pulverized in similar proportions with powdered lactose (milk sugar). One part of the diluted medicine is then further diluted, and the process is repeated until the desired concentration is reached. Dilutions of 1 to 10 are designated by the Roman numeral X (1X = 1/10, 3X = 1/1,000, 6X = 1/1,000,000). Similarly, dilutions of 1 to 100 are designated by the Roman numeral C (1C = 1/100, 3C = 1/1,000,000, and so on). Most remedies today range from 6X to 30X, but products of 30C or more are marketed.

A 30X dilution means that the original substance has been diluted 1,000,000,000,000,000,000,000,000,000,000 times. Assuming that a cubic centimeter of water contains 15 drops, this number is greater than the number of drops of water that would fill a container more than 50 times the size of the Earth. Imagine placing a drop of red dye into such a container so that it disperses evenly. Homeopathy's "law of infinitesimals" is the equivalent of saying that any drop of water subsequently removed from that container will possess an essence of redness. Robert L. Park, Ph.D., a prominent physicist who is executive director of The American Physical Society, has noted that since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.

Oscillococcinum, a 200C product "for the relief of colds and flu-like symptoms," involves "dilutions" that are even more far-fetched. Its "active ingredient" is prepared by incubating small amounts of a freshly killed duck's liver and heart for 40 days. The resultant solution is then filtered, freeze-dried, rehydrated, repeatedly diluted, and impregnated into sugar granules. If a single molecule of the duck's heart or liver were to survive the dilution, its concentration would be 1 in 100200. This huge number, which has 400 zeroes, is vastly greater than the estimated number of molecules in the universe (about one googol, which is a 1 followed by 100 zeroes). In its February 17, 1997, issue, U.S. News & World Report noted that only one duck per year is needed to manufacture the product, which had total sales of $20 million in 1996. The magazine dubbed that unlucky bird "the $20-million duck."

Actually, the laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether. This limit, which is related to Avogadro's number, corresponds to homeopathic potencies of 12C or 24X (1 part in 1024). Hahnemann himself realized that there is virtually no chance that even one molecule of original substance would remain after extreme dilutions. However, he believed that the vigorous shaking or pulverizing with each step of dilution leaves behind a "spirit-like" essence—"no longer perceptible to the senses"—, which cures by reviving the body's "vital force." Modern proponents assert that even when the last molecule is gone, a "memory" of the substance is retained. This notion is unsubstantiated. Moreover, if it were true, every substance encountered by a molecule of water might imprint an "essence" that could exert powerful (and unpredictable) medicinal effects when ingested by a person.

Many proponents claim that homeopathic products resemble vaccines because both provide a small stimulus that triggers an immune response. This comparison is not valid. The amounts of active ingredients in vaccines are much greater and can be measured. Moreover, immunizations produce antibodies whose concentration in the blood can be measured, but high-dilution homeopathic products produce no measurable response. In addition, vaccines are used preventively, not for curing symptoms.

Stan Polanski, a physician assistant working in public health near Asheville, North Carolina, has provided additional insights:

* Imagine how many compounds must be present, in quantities of a molecule or more, in every dose of a homeopathic drug. Even under the most scrupulously clean conditions, airborne dust in the manufacturing facility must carry thousands of different molecules of biological origin derived from local sources (bacteria, viruses, fungi, respiratory droplets, sloughed skin cells, insect feces) as well as distant ones (pollens, soil particles, products of combustion), along with mineral particles of terrestrial and even extraterrestrial origin (meteor dust). Similarly, the "inert" diluents used in the process must have their own library of microcontaminants.

* The dilution/potentiation process in homeopathy involves a stepwise dilution carried to fantastic extremes, with "succussion" between each dilution. Succussion involves shaking or rapping the container a certain way. During the step-by-step dilution process, how is the emerging drug preparation supposed to know which of the countless substances in the container is the One that means business? How is it that thousands (millions?) of chemical compounds know that they are required to lay low, to just stand around while the Potent One is anointed to the status of Healer? That this scenario could lead to distinct products uniquely suited to treat particular illnesses is beyond implausible.

* Thus, until homeopathy's apologists can supply a plausible (nonmagical) mechanism for the "potentiation"-through-dilution of precisely one of the many substances in each of their products, it is impossible to accept that they have correctly identified the active ingredients in their products. Any study claiming to demonstrate effectiveness of a homeopathic medication should be rejected out-of-hand unless it includes a list of all the substances present in concentrations equal to or greater than the purported active ingredient at every stage of the dilution process, along with a rationale for rejecting each of them as a suspect.
* The process of "proving" through which homeopaths decided which medicine matches which symptom is no more sensible. Provings involved taking various substances recording every twitch, sneeze, ache or itch that occurred afterward—often for several days. Homeopathy's followers take for granted that every sensation reported was caused by whatever substance was administered, and that extremely dilute doses of that substance would then be just the right thing to treat anyone with those specific symptoms.

Dr. Park has noted that to expect to get even one molecule of the "medicinal" substance allegedly present in 30X pills, it would be necessary to take some two billion of them, which would total about a thousand tons of lactose plus whatever impurities the lactose contained.

NHMRC Homeopathy Review

NHMRC (National Health and Medical Research Council), respected governmental organization in Australia, is in process of reviewing the evidence for the effectiveness of homeopathy. The assessment of the evidence comprises a systematic review of available systematic reviews (an overview) on the effectiveness of homeopathy in treating a variety of clinical conditions in humans and a report on evidence submitted to the NHMRC prior to the commencement of the review. NHMRC also considered published guidelines and other government reports.

In April 2014, the first draft of the review has been released. Based on all the evidence considered, there were no health conditions found, for which there was reliable evidence that homeopathy was effective. No good quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment.

Homeopathy is not Dead

In the eyes of the modern science, homeopathy is a total fail. It should be laid to rest and relegated to a footnote in the history of science – a pre-scientific idea that survived into modern times as pseudoscience. We can squeeze it in somewhere after healing crystals and before humoral theory and iridology.

However, here comes the enigma – why does homeopathy persist at all? It seems that after the rise of science-based medicine in the early 20th century homeopathy was marginalized, but was able to survive because it had already entrenched itself sufficiently in politics and society. It then flew under the radar until the recent rise of CAM – the successful re-branding of fraudulent and unscientific modalities as “natural” and “alternative”.

So successful was this re-branding that the scientific community was partly cowed by the incessant demands for being “open-minded” and for “academic freedom.” This caused many scientists who should have known better to forget themselves, to look the other way while advocates slowly inserted nonsense into the health care structure and academic institutions.

We are beginning to see a push back in the scientific community. Michael Baum and Edzard Ernst have recently published a commentary in The American Journal of Medicine which reflects the new found “permission” within the medical community to once again call nonsense a nonsense, and close the door on failed therapies.

Should we keep an open mind about astrology, perpetual motion, alchemy, alien abduction, and sightings of Elvis Presley? No, and we are happy to confess that our minds have closed down on homeopathy in the same way.

Main Danger of Homeopathy

Many defenders of homeopathy argue that, “Who cares how it works, as long as it works.” 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 often used before their mechanism of action is fully understood. There is a difference, however, between not fully understanding a mechanism and, as with homeopathy, violating basic laws of physics.  In such cases, it is necessary to demonstrate using carefully controlled clinical trials that such treatments do in fact work.

Indeed, there has been mixed results from clinical studies of homeopathy, but a clear trend when all the evidence is reviewed — the better designed the study the less likely there is to be any effect, and the best designed studies are negative. Homeopathy, it turns out, is no more effective than placebo (an inactive treatment).

Therefore, according to everything, we currently understand about biology, chemistry, and physics, homeopathy is highly implausible and should not work. Moreover, when we carefully study homeopathic remedies they in fact do not work.

Given that most homeopathic remedies contain little if any actual ingredients beyond water and sometimes sugar, it is unlikely that any direct harm could come from taking them. Improper preparation of remedies made from toxic or infectious material could pose some risk, and there have been reports of toxic contamination of homeopathic products.

Well, from time to time, it's understandable that a simple-to-administer placebo treatment might carry some benefit for doctors, where no medical intervention has a particular, proven effectiveness. In these scenarios, it could be argued that homeopathy might have had a role to play, providing a harm-free, effect-free placebo to help manage the otherwise unmanageable. However, homeopaths abuse this minor level of legitimacy to make claims about conditions the placebo effect could not possible treat. Cancer, HIV, malaria, yellow fever, autism, tuberculosis. They discourage people from seeking medical help when they most need it. It's time to stop lending support to quackery; time to give people the facts about this 200-year-old snake oil, before they choose to use it instead of the ever-improving and reliable interventions of modern medicine.

However, the most significant risk of homeopathy is that it often delays the use of accurate scientific diagnosis and truly effective medical treatment. Unnecessary injury, disability, and even death can result from the delusion that homeopathy is an effective treatment for any medical condition.

Sources and Additional Information:

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