Complementary and alternative medicine Medicine Quackery Skepticism/critical thinking

Homeopaths: Double-blind studies of homeopathic medicines are not ideally possible

Remind me to mark April 10 down on my calendar. I never realized it was such an important day, and, in any case, I wouldn’t want to miss it. Nor should the rest of the skeptical blogosphere. Why? It’s World Homeopathy Day, “celebrated” (or, if you’re a fan of evidence-based medicine, as I am, lamented) in “honor” of Samuel Hahnemann, the originator of homeopathy, who was born on April 10, 1755.

Oh, joy. (On the other hand, I’m sure I can think of some sort of blog fun to have next April 10.)

Homeopathy, as you may recall, is the “alternative” medical therapy in which, it is postulated, a therapeutic compound diluted to the point where chemistry would dictate that there is not a single molecule of the substance left, actually becomes more potent. Reasons put forth as an explanation for this alleged effect, which, if real, would contravene the laws of chemistry, physics, and biology, range from the claim that water somehow retains the “memory” of compounds that have been diluted in it to fallacious invocation of quantum effects, the all-purpose explanation woos like to use when their particular brand of woo clearly conflicts with the laws of nature, as homeopathy does. Moreover, according to the homeopathic “law of similars,” the substance chosen to be diluted should, in non-homeopathic doses, produce an effect similar to what the disease is producing.

It’s all bunk, of course, and no good randomized controlled trials show homeopathy to be any better than placebo, yet this woo persists. Naturally, homeopaths realize that science isn’t supporting it. Consequently, they like to make excuses, and here’s a great example. First, the article acknowledges the problems with homeopathy:

Homeopathic remedies are believed to be no better than a placebo, according to several articles in medicals journals and publications. In fact, the Lancet, which in 1997 extolled the virtues of homeopathy, has published a piece to the contrary in an August 2005 issue, although based on a small study.

Critics say that the system based on the principle of Similia Similibus Currentur, meaning `like is cured by like’, does not convincingly explain how the medicines work. Further, there have been no modern scientific testing or double blind studies to prove the efficacy of the drugs; only “provings” since Hahnemann’s time which, the critics say, do not really hold water.

Sceptics also question the rationale of “constitutional remedies” which entail labelling an individual as belonging to a specific constitution type corresponding to a certain drug, as for instance an Ignatia, Pulsatilla, Nux Vomica, etc which, in turn, are related to the temperament of the individual. Non-believers also scoff at the potency of the drugs vis-à-vis the Avogadro’s number. According to this law of chemistry, there is a limit to which a substance can be diluted while retaining its original properties. However, most homeopathic drugs are used in dilutions beyond this limit, making it “substance-less.”

That’s actually a pretty good criticism of why homeopathy is utter bunk. Too bad the writer didn’t stop there. On the other hand, his letting the homeopaths try to justify their woo brings out the magical thinking behind homeopathy:

So, how do homeopathy practitioners respond to such criticism? According to Dr Kumaresan and Dr Kanakaraj of Sugam Homeopathy Clinic in Chennai, any material can be converted into energy form by potentisation or dynamisation — a method unique to homeopathy. This energy remains stable only in alcohol or sugar base and the medicines thus stored in the form of energy do not have an expiry date. The potency of various drugs is obtained by dilution, which involves vigorous shaking if the medicine is in liquid form, through a process called succussion, or by finely grinding or pulverising if the drug is insoluble.

Dr Britto Wilbert Das of Roch Homeo Clinic concurs, saying that it is quality and not quantity that is important in homeopathy where a spark of energy is all that is needed to trigger the body’s immune system to act and effect a cure. The greater the succussion, the better the drug quality — its purity and power being enhanced. And any toxicity it may contain is simultaneously removed.

Of course! How could I have been so blind? It’s so obvious. The homeopathic medicines are converted to “energy” that can only remain stable in the alcohol or or sugar base that homeopaths use to dilute it. And they strengthen the immune system and remove toxins, too. Is there anything they can’t do? Of course, these are claims that should be testable scientifically. Or maybe not, at least not according to the homeopaths:

While conceding that double-blind studies of homeo drugs were under way in some places, Dr Das and Dr B. Anantaraman of Arudhra Homeo Clinic, Chennai, however say that such a study is ideally not possible.

Allopathic cure is based on objective symptoms unlike homeopathy, which uses both objective and subjective symptoms as felt by the patient. While allopathy has a specific drug for a specific disease condition, a single homeo drug may be used for varying conditions and also several drugs may be used for a single condition.

Individualisation is the cornerstone of homeopathy treatment. No two people with the same or similar conditions need be given identical drugs or in identical potency. In fact they may require entirely different sets of drugs based on the totality of symptoms. Hence, a double-blind study may not be possible to prove the efficacy of homeo drugs.

How convenient. How clever of them to try to make a distinction between “subjective” and “objective” symptoms. Symptoms are what the patient tells you he is feeling, what’s bothering him. Pain is a symptom. Coughing is a symptom. Some symptoms can be “objectively measured” (coughing, fast breathing, frequency of urination, etc.), but many are almost entirely subjective, pain being the most common example. Conventional medicine tries to treat both whenever possible, contrary to what the article above says. Indeed, morphine is a perfectly good drug for treating the subjective symptom of pain. So are nonsteroidal antinflammatory drugs (NSAIDs) for lesser degrees of pain–and NSAIDS also objectively decrease inflammation by a molecular mechanism that can be objectively measured. Second, the homeopaths are conveniently building right into the definition of their woo an excuse for when scientific testing fails to demonstrate any objective signs of efficacy. That’s right; if you believe the homeopaths, homeopathy is too complex to subject to double-blind, placebo-controlled trials, you see, because no two patients get exactly the same drugs at exactly the same homeopathic “potency.” Of course, it can be said for many diseases treated with conventional medicine that “a single drug may be used for varying conditions and also several drugs may be used for a single condition.” Cancer is a great example of this, where most cancers present oncologists with a choice of different chemotherapy regimens with different potencies and different side effect profiles. Certain chemotherapeutic drugs can be used for multiple tumors, and nearly all cancers are treated with more than one chemotherapy agent. Yet, we poor “allopaths” somehow manage to test our treatments in randomized studies and show them to be superior to placebo.

I wonder why homeopaths can’t do the same. Naturally, they have another layer of excuses:

More often than not, patients approach homeopathy when all other systems have failed, when their bodies have been treated to a host of drugs, thus masking their true, original condition. This compounds the task for homeopathic doctors, necessitating them to “tear down and rebuild from a state of chaos”. Needless to say, the system is often faulted for being slow or even ineffective!

Or perhaps the system is faulted for being ineffective because it is ineffective.

And what do these homeopaths offer as “evidence” of the efficacy of homeopathy? If you’ve been around this blog for a while, I suspect that you know the answer to this one. Yes, indeed, it’s anecdote time:

Dr Kumaresan and Dr Kanakaraj cite some of their successes in treating difficult conditions. One of their patients, 80-year-old M. Swamy was a diabetic and afflicted with Coronary Artery Disease (CAD).

With over 90 per cent multiple blocks in the blood vessels of his heart he was advised by-pass surgery, which he could not undergo owing to low blood pressure. Doctors gave him a few days of life; that’s when he decided to take the plunge anyway and try homeopathy. Thanks to the treatment, he says, he is much better and living well.

Parvati conceived thrice and had miscarriages each time. The reason for repeated miscarriages was loss of foetal fluid. She also tried artificial insemination, in vain. With four months of homeo treatment, Parvathi conceived and delivered a healthy baby girl in 2005.

And, of course, they claim with no evidence that homeopathy is great for curing or palliating a number of diseases, including AIDS, cancer, and heart disease.

This article does bring up a question that I’ve always wondered about, though. In attempting to conduct a clinical trial of a homeopathic remedy, what, exactly, does an investigator use as a placebo? After all, think of the logistical difficulties involved. What if a molecule of the active ingredient came in contact with the placebo somehow? In the homeopath’s world, the placebo might then be contaminated and have become an active treatment. Placebos and medications might have to be stored at a great distance from each other, to prevent the diffusion of even a molecule of the homeopathic remedy into the placebo. In either case, such a “contamination” could, a homeopath could argue, tend to decrease any treatment “effects” observed. Of course, to homeopaths, it isn’t just the substance, but it’s the preparation, the “succusation”; but, even so, given the ridiculousness of the basic concept behind homeopathy, the task of coming up with a suitable placebo control for clinical trials that will convince the homeopaths is not trivial.

So how about I throw this one open to everyone: What would be a good placebo to use as a control in randomized, double-blind trials of homeopathy that would fit in with the whole system of homeopathy?

This could be fun.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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