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Posts Tagged ‘samuel hahnemann’

Yep, it’s the big homeopathy rant. I’ve been feeling curiously medicinal of late, so let’s see how this turns out.

All good bullshit needs an exciting origins story

In 1796, a German doctor called Samuel Hahnemann first published a description of a thing he’d made up called the “Law of Similars”. He’d taken a popular malaria treatment while he was healthy, in the name of science, and noticed that it seemed to give him symptoms of malaria. From this, he generalised that stuff normally taken as a cure, if taken while healthy, could actually give you the symptoms of whatever it usually cured. And it therefore followed, by reasoning I am yet to fathom, that the converse was also true: something which would normally make a healthy person ill could also be used to treat the illness which it induced.

So, if you’ve got insomnia, you need some homeopathic coffee. If hay fever’s your problem, get some homeopathic pollen in you. Vomiting? Homeopathic ipecac. (Even if it doesn’t work, it’s fun to say.) These are apparently among the most common homeopathic remedies available today, all based on this principle that “like cures like”.

For reasons that also remain unclear (to me and, unless my research is severely lacking, to everyone else on the planet as well), Hahnemann also declared that homeopathic treatments were more effective the more dilute they were. Ideally, you’d keep on watering your mixture down and down and down, until there was practically nothing left of the coffee, or pollen, or ipecac, or whatever, in your solution. This, by means unknown, would make it much more potent.

These days, this is exactly what they do when they make homeopathic treatments, but without the “practically”. In a lot of cases, it’s literally watered down to nothing. Homeopathy is really just water.

Water, water, everywhere, but not a drop to pharmacologically affect your biochemistry

The dilutions in homeopathic treatments are generally given labels like “10X” or “30C”, to indicate how much dilution has taken place. In “10X”, the active ingredient (that is, the bit that’s actually supposed to be medicine) has been diluted to one part in ten (that’s the “X”, the Roman numeral for 10), ten times over (that’s the “10” in front of the “X”). 30C means that it’s been diluted to one part in a hundred (“C” being the Roman numeral for 100), thirty times over. That means that only one part in 10030 of what you’re drinking – or one million billion billion billion billion billion billionth – is actual medicine. In practice, this means you’d need vast lakes, oceans, or solar system-sized doses to expect to find even a single molecule’s worth of active ingredient. Every 30C homeopathic treatment out there (and they often come even more dilute than that) can be virtually guaranteed to be pure water.

But that’s okay, because it’s magic water. Admittedly that’s not a word homeopaths tend to use to describe the mysterious process by which water which used to have some stuff in it demonstrates medicinal properties dubiously attributed to the stuff it used to have. But they might as well. Hahnemann thought that the way the treatments were prepared “spiritualizes the material substance itself“. These days, it’s more commonly claimed that water has memory.

A short list of things to remember about water having a memory

1. It doesn’t.
2. It really doesn’t.
3. Grow up.

To suggest that molecules of dihydrogen monoxide can maintain some sort of internal arrangement, which “remembers” the chemical properties of stuff that’s been diluted out of it, is to laugh in the face of every law of physics we understand. And if you do that, the laws of physics will laugh back, louder, and harder, and then punch you in the neck, because they’re bigger than you, and they’ve been around a lot longer than you have, and you’re an idiot.

If you’re trying to do scientific research that isn’t an exercise in futile bullshit, you shouldn’t really be positing explanations that completely overthrow well established branches of science just so that your pet theory makes sense. The whole water memory (or “spiritual essence”) idea is something that was plucked out of thin air to rationalise how homeopathy could possibly work, when all its patients are doing is drinking water. There’s never been any direct evidence to actually suggest that this is what’s going on; it just has to be blindly assumed to explain the results of their tests the way they want to explain them.

Now, sometimes this isn’t a totally ridiculous thing to do. A large part of science involves coming up with totally new ideas to explain things. But crucial to this is that there needs to be something unexplained in the first place. And the more outrageously wacky the new idea you’re introducing, the more of an unbelievable stretch it must be to just explain it through normal means.

So there would have to be a huge, massive, staggeringly vast, astonishingly overwhelming amount of evidence that the magic water actually does something, before we can be justified in following Tim Minchin’s advice:

Take physics and bin it! Water has memory, and whilst its memory of a long-lost drop of onion juice seems infinite, it somehow forgets all the poo it’s had in it!

So, as is so often the case when you insist on being all rational about stuff, it all comes down to the evidence. Maybe those crazy water-shakers really have discovered a new and unfathomable set of physical laws, which have eluded every actual physicist throughout history, and which are entirely incompatible with the consensus built up over millennia of research. But that’s a lot that you’re asking us to believe, and the evidence is gonna have to be both big and honkin’.

Unfortunately, but unsurprisingly, homeopathy is distinctly lacking in any kind of proof. Over and over, clinical trials show that people respond to homeopathic treatments exactly like they respond to plain water. Some of them get better. Some don’t. There’s the occasional miracle cure completely out of the blue. In general, they do slightly better than people not taking anything at all, who don’t get the associated placebo effect. But if you’re taking tap-water and just think it’s homeopathy, then you actually get every single drop of benefit that can be squeezed from the treatment itself.

And no direct observations, of any kind, have ever been able to distinguish homeopathic treatments from standard H2O, either. There’s absolutely no discernible difference between regular water and magic homeopathy. Nothing in its effects on patients, or the way it appears under close examination, has ever shown any noticeable distinction between the two.

Oh, wait. There’s that Benveniste guy.

The curious case of Jack Benny Jacques Benveniste

After Hahnemann, Jacques Benveniste is the name most associated with homeopathy. In 1988, he had a paper published in the journal Nature (an achievement which tends to carry a good chunk of scientific credibility with it), which provided the most famous evidence to date of homeopathy having any basis in reality. As one of the conditions for publication, though, Nature’s editor John Maddox and renowned skeptical rogue James Randi supervised a repeat of the experiment in Benveniste’s lab.

As they watched Benveniste’s team going through the procedure again, it all seemed to be working – there was a definite difference in the results, between the plain water and the homeopathic water. Modern science stated they should have been identical, but these results seemed to support Benveniste’s assertion, that the homeopathic concoction possessed special qualities related to whatever had been ultra-diluted in it. But it was clear to the investigators that what was being done was not a double-blinded trial. The assessment of the two types of water involved a subjective evaluation by a researcher – and the researchers knew which was the plain water, and which the homeopathic.

This is really important. Whether or not an experiment is blinded makes a huge difference to how meaningful its results are. If I want to impress you with how my spirit guide can tell me what card you picked from a deck, it’d be a lot more impressive if you’re not also showing me the card while I guess. “Look, it’s the seven of hearts! Just like he told me!” It’d be like claiming that you knew what the lottery numbers were going to be, right after watching the draw on TV, but you didn’t buy a ticket.

Much more impressive would be to do something in advance – use the hypothesis in contention (“Water has memory”) to actually predict something that you couldn’t possibly know otherwise. And if the hypothesis is right, then doing this ahead of time should be just as easy. If my spirit guide’s any good, then he should be able to peer at the card where you’ve hidden it behind your back, and tell me what I can’t see. If homeopathy’s real, there should be noticeable differences between plain water and magic water, even if you don’t know which is which.

But if the effect disappears whenever you don’t know which way you want the results to turn out (thus shutting out any possible subconscious biases that might otherwise sneak in), then the homeopathy hypothesis doesn’t explain your results, and is rendered pointless.

So, once they’d tightened up the protocols to meet basic scientific standards, the paradigm-shattering effect went away. Benveniste bitched about how unfairly he was being treated, which is pretty typical when someone’s idea is so totally blown out of the water by such a conclusive, cut-and-dry result. Boo hoo, the nasty mean rationalists actually checked your facts and found you couldn’t do what you said you could, call the fricken waahmbulance. (Sorry, I haven’t quite kicked the habit of slipping into personal mockery from time to time. It’s not logically sound, but it is funny, which is nearly as good.)

Another condition of Nature agreeing to publish Benveniste’s paper was that other labs around the world would try and replicate his results using the same protocols. They couldn’t. Presumably because they were already double-blinding their experiments as a matter of general practice. Y’know, like scientists.

Fiddler with the proof

So, homeopathy doesn’t have proof. What it does have is provings. And don’t they sound just as good?

These “provings” are homeopathy’s own standard of determining whether or not treatments work – but, ingeniously, they do it by measuring something completely different, and totally ignoring whether or not the treatments work. It involves giving a treatment to somebody healthy, and seeing what symptoms present over the following weeks.

Yep, they determine how well their magic water can cure sick people, not by giving it to sick people and seeing how well it cures them, but by giving it to perfectly healthy people instead. That’s a very helpful shortcut. By that reasoning, I’d like to offer proof that I can read anybody’s mind and tell what number they’re thinking of: if I tell them what number I’m thinking of, then ask them if they’re now thinking of it too, they almost invariably say yes.

This could only possibly work if this homeopathic “law of similars” idea was completely reliable, utterly inviolate, and a link between the two ideas could be absolutely guaranteed. But… no. If you wanted to test my mind-reading skills, you’d probably want to see how well I actually read minds, not just look at how well I do something else that’s the complete opposite of reading minds and assume that there’s a link. And if homeopathy’s going to have any value as a medicine, you should really be looking at whether it makes people better.

There’s a good reason why homeopaths are hoping you won’t do that.

But the Medicines and Healthcare products Regulatory Agency in the UK don’t seem to mind. They decided in 2006 to let homeopaths make claims for their products based on these provings, on the labels they slap on their bottles of magic water. Which seems kinda like if they gave me a license to practise medicine because I’d watched a few people recovering from surgery and said “Yep, that guy definitely needed his appendix out.”

Refuting a bad argument that nobody’s really making anyway

Here’s one more misunderstanding which I’ve heard a few times. A common form of vaccination works by introducing a small amount of a virus into the body, intended to immunise you against later catching the disease caused by this virus. I don’t think homeopaths tend to claim that their remedies are in any way comparable to this, but it seems to be how some people rationalise it.

However, in the case of vaccines, doctors aren’t relying on some nebulous concept that “like cures like” simply because it feels like it makes sense. There’s an actual physical mechanism at work. Normally when you get infected by a virus, bacteria, or something else that shouldn’t be there, your immune system will notice that there’s something wrong, and set about trying to fight whatever intruders it can identify. But this is sometimes tricky, because often these intruders have replicated, spread, or evolved and adapted into new and different versions by the time your natural defences have had a chance to respond.

When you get immunised, say by a vaccine, it’s like lobbing your immune system a few soft balls so that it can get some practice in. (As ever, I apologise for the poor quality and likely incoherent nature of my sporting analogies.) There’s no significant risk of infection from the (generally inactive) virus being introduced, but your body gets a chance to recognise it and respond. Then, if you later inadvertently scarf down a mouthful of smallpox or polio, your body will already be prepared for it, and be able to respond faster to stop you from becoming ill.

So this is clearly distinct from the way homeopathy “works”, both in that it actually makes some goddamn sense, and that there’s actual evidence showing that it does something.

Asking the big question

So if homeopathy is such obvious bollocks, why do people think it works?

Well, there’s all the usual reasons that alternative medicine is often so convincing, which I’ll cover in a separate article in due course. But there are some specifics worth noting about homeopathy. Although I’ve been liberal with my use of terms like “bullshit” throughout this piece, there have been times when opting for homeopathy over conventional medicine has actually been a good idea.

At the London Homeopathic Hospital in 1854, the rates of survival for cholera sufferers during the epidemic were significantly higher than at the nearby Middlesex Hospital, where there was more conventional stuff going on. People seemed to do better with the magic water treatment than with the supposed non-quackery of actual doctors.

Sadly, this doesn’t lead to the inevitable conclusion that homeopathy cures cholera. For one thing, there’s no way this counts as good scientific data, because there was no way to control for numerous other variables – many other things might have been different about the patients at the Homeopathic Hospital and the way they were treated, as well as just the magic water – but the simplest point is that conventional medicine at that time was a complete disaster. People were often much better off having absolutely nothing happen (for instance, taking homeopathic remedies) than letting mainstream doctors start hacking away at them.

Mainstream medicine at the time was also composed primarily of stuff which had basically been made up because it sounded good, and “tested” unscientifically and with no concern for the cognitive biases and errors in reasoning which can lead people to faulty conclusions. (Opening a vein and draining some blood was used as a cure for pretty much everything. When people got worse from having half of their blood taken away, this was taken as a sign that the doctors had better bleed them faster before it was too late.) But people thought it worked, because of exactly the kind of unscientific observations that are used to support homeopathy these days.

And it’s not like being prescribed a homeopathic treatment has literally zero benefit whatever. It’s entirely possible to get something worthwhile out of having a doctor in a reassuring lab coat sit down with you and listen caringly to your problems for an hour, and even taking a medicine that doesn’t do anything can trick your body into making an effort on its own (more on the placebo effect later, i.e. when I get around to writing it).

Homeopathy has been built on a foundation of wishful thinking and unicorn farts since its inception, but it can require some careful critical thinking to really uncover this. The notion that “like cures like” is a nonsense, and it’s now thought by some that Hahnemann’s onset of malaria-like symptoms – which prompted the whole idea in the first place – might have been due to an allergic reaction to quinine, the malaria treatment he took (in the form of cinchona bark).

Now, this might seem like an unscientific post hoc rationalisation, which the brainwashed followers of science-based medicine have had to concoct, to explain things to their satisfaction, blindly maintain the status quo, and protect their fragile ideology.

“…and so when he noticed his malaria-like symptoms, that’s what first set him thinking about the law of similars, which he’d write about formally years later, laying down the foundations for homeopathy.”
“You don’t think maybe he was just allergic to quinine?”
“Oh, come on, there’s no evidence of that, you’re just plucking ideas out of the air so you don’t have to admit that alternative medicine works.”

But is this really the right way to look at things? Are we really choosing the right one to dismiss as unreasonable? What if the conversation happened the other way around?

“…and so, given his reaction of drowsiness, palpitations, trembling, fever, and so forth, we conclude that Samuel Hahnemann was probably allergic to quinine.”
“You don’t think maybe he’d discovered a new and completely unknown medical principle, with staggering implications in numerous fields of study, not least rewriting every law of physics since Newton, but which is so elusive and mysterious that it’s still yet to be reliably observed in any rigorously controlled tests?”
“Um. Wow, you’re really reaching.”

There is a much, much simpler explanation available than the fanciful notions homeopathy requires you to believe in, and which explains the complete lack of supporting evidence admirably. It’s bunk.

More reliable (but often less delightfully droll) info can be found at SkepticWiki, RationalWiki, the other wiki, The Skeptic’s Dictionary, and in Trick or Treatment?, Simon Singh and Edzard Ernst’s thorough analysis of all the actual evidence of the efficacy (or lack thereof) for various alternative treatments. Gosh, did I just properly cite some sources? How charmingly academic.

[Edited 28/7/09: In response to this comment, I’ve yammered on about this some more in this post.]

[Edited 15/3/10: This is an excellent metaphor for the different approaches to reality taken by homeopaths and actual scientists.]

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