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You Asked: How can homeopathic teething “remedies” that essentially contain nothing have an adverse effect on infants?

question markThe FDA in the U.S has raised alarm about homeopathic teething pills that may have caused seizures in babies and possibly even caused some deaths. But how can homeopathic “remedies” do this, given that they contain nothing? The bizarre tenet of homeopathy is that a substance that causes symptoms in a health person can relieve those symptoms in a sick person as long as it is diluted to an extent that contains almost zero or a just a trace amount of the original substance. Homeopathic teething remedies are made by diluting a solution of belladonna in an extreme fashion.

Why belladonna is the preferred substance is bizarre since according to homeopathic doctrine, to relieve pain, it should cause pain when used at a high concentration. While atropine, the active ingredient in belladonna can cause many adverse symptoms, it doesn’t cause pain. In any case, when diluted homeopathically, it should have no effect.

Now it seems some homeopathic companies are not very adept at making dilutions and the effects on the babies were likely caused by an overdose of belladonna. Dilution is really a very simple process, so it is hard to see how they could get it so wrong. It seems homeopaths are not only incompetent when it comes to understanding chemistry and medicine, some are also incompetent at carrying out dilutions. Obviously homeopathy is not always just benign nonsense.

Joe Schwarcz PhD

A cranky homeopath

ADHDThe Toronto Star published a letter from a physician in BC who was critical of my attacks on homeopathy. Below is his letter as well as my response.

Published on Mon Mar 16 2015
Re: Scientists skeptical of study on ADHD care, March 6

As a medical doctor, I use homeopathy on a daily basis to fill in gaps or improve on the conventional therapies I also use in family practice. There is no doubt that homeopathy works – even in children and in skeptical patients that are willing to give it a try (particularly if they have tried everything else without benefit); sometime even in patients’ pets. Sure, good interaction and placebo play a role, just as in any therapeutic encounter, but that does not explain the results I observe.When a group of “top” scientists declare that there is no evidence to support homeopathy, you cannot but wonder at their agenda. In fact, there have been several meta-analyses and governmental assessments that show homeopathy is effective (BMJ 1991, Lancet 1997, Eur J. Clin Pharmacology 2000, Swiss Federal Office for Public Health 2006).

There are numerous positive trials, many of fair to high quality. Medical doctors around the world have accepted homeopathy based on sound evidence and the personal experience that confirms it. In Belgium, for example, 4000 doctors prescribe homeopathic medicines routinely. Homeopathy is inexpensive, convenient, integrates well with conventional medicine, and patient satisfaction and safety are excellent. It is included in the national health schemes of Great Britain, France, Switzerland, Brazil, Mexico, India and many other countries. The recent discovery of nanoparticles in homeopathic ultra-dilutions has undermined the “implausibility argument” or “I can’t understand how it works, therefore it can’t work.” This type of flat-earth thinking is not helpful in promoting better healthcare and has no place in medical practice or research.

The main reason pseudo-scientists become quack-busters and criticize therapies such as homeopathy is fear. Perceived as a threat to their world-view, they use the labels “unscientific” or “implausible” to defend themselves against the barbarians at the gate. It is not really an issue of evidence or science. It’s a subconscious defense mechanism that cannot be overcome, even if the research is piled up to the ceiling. It may be disguised as defending the public, but as Shakespeare says: “The lady doth protest too much.” The potential benefits of homeopathy demand research such as Dr. Heather Boon’s ADHD study at University of Toronto, and we should not let fixed thinkers get in the way of progress in medicine. In fact, the criticism here should be levelled at McGill University for permitting its Office for Science and Society to exist and Dr. Joe Schwarcz to continue to “interpret science for the public.”
Dr. Stephen Malthouse, past president, Canadian Complementary Medical Association, Denman Island, B.C.

MY RESPONSE
Dr. Stephen Malthouse’s ungracious letter requires a response. “There is no doubt that homeopathy works,” he maintains. That may be his opinion but not that of the vast majority of the scientific community. That point was effectively driven home last week by a report from Australia’ s National Health and Medical Research Council that concluded “there is no good quality evidence to support the claim that homeopathy is effective in treating health conditions.” It was the most damning analysis of homeopathy ever compiled.

Dr. Malthouse trots out the tired old refrain that a discovery of some anomalous property of water undermines the argument that homeopathy is implausible. Nobody has ever maintained that homeopathy is implausible because water cannot have anomalous properties. That is a straw man argument if there ever were one. Homeopathy is implausible because it is based on the precept of ghostly images supposedly imparted to water by sequential dilutions and succusions having a healing effect.

Dr. Malthouse goes on to suggest that “it is not really an issue of evidence or science.” It most assuredly is. The science of homeopathy is non-existent, just like the molecules it is supposedly based upon. And the evidence is in for anyone who cares to look at the 225 well-designed studies that formed the basis of the Australian report. As far as Dr. Malthouse’s boorish remark that the McGill Office for Science and Society should not exist, his letter is a shining example of why there is a continuing need to interpret science for the public in an evidence-based fashion, which is exactly why the Office was established.

Joe Schwarcz

 

 

 

When is enough, enough?

homeopathyOn the “The Current,” the CBC’s national morning show, Dr. Heather Boon, Dean of Pharmacy at the University of Toronto, and I had a chance to express our views on the proposed study she is organizing to investigate the homeopathic treatment of attention deficit hyperactivity disorder (ADHD) in conjunction with the Riverdale Homeopathic clinic. This was stimulated by a letter I had written to Dr. Boon, co-signed by some ninety physicians and scientists, asking what was to be gained by such a study and expressing surprise that someone with training in pharmacy would attach any credibility to the bizarre concept of homeopathy.

Dr. Boon got the ball rolling by stating very clearly that she does not believe that homeopathy has any scientific basis, and that the goal of the study was to explore why people believe in homeopathy and to try and understand the complex interaction between homeopath and subject. I was glad to hear her say that she does not believe in the mythical behaviour of non-existent molecules, but when I looked at the details of the study as registered, the number one purpose stated is “to determine if there are any specific effects of homeopathic medicines in the treatment of ADHD.” Also, in a previous paper in which she discusses at length the homeopathic studies recorded in the scientific literature, she opines that “physical experiments have demonstrated a variety of possible mechanisms for the transmission and preservation of therapeutic properties in highly diluted solutions.” While some experiments have shown that water has some anomalous properties, no experiment I know of has shown the transmission of any sort of therapeutic effect.

The purpose of scientific research is to advance our state of knowledge, hopefully with spinoffs that will benefit the public. But funding for scientific research is not unlimited, indeed it is becoming harder and harder to come by. So decisions have to be made on the allocation of both money and effort. Factors that need to be taken into account include previous studies of the subject as well as scientific plausibility. For example, there would be no point in studying pendants that claim to neutralize electromagnetic radiation because this makes no sense according to principles of physics. Ditto for jars that claim to magnetize water in order to turn it into a healing solution, or for hollow wax candles that claim to remove ear wax, freeing up (nonexistent) energy channels in the body. That brings us to studying the effect of absent molecules, namely homeopathy. This two hundred year old practice has been put through the mill numerous times. Literally hundreds of studies have examined the possibility that solutions diluted to the extent that they contain no remnant of the original solute can still retain some sort of memory and deliver therapeutic benefits. How such memory, should it exist, has anything to do with healing disease is never addressed.

Plausibility is an important consideration because it prevents us from wasting scarce resources on projects that do not have a reasonable chance of producing a useful outcome. The basic tenet of homeopathy, that the potency of a substance is increased by dilution, in other words, the “less is more” phenomenon, flies in the face of what is known about the mechanism of drug action, and more specifically is incompatible with chemistry’s “law of mass action” that relates the rate of a chemical reaction to the masses of the reacting substances. If the mass of a reactant is essentially zero, as it is in a homeopathic solution, its rate of reaction with any substance in the body would also be zero. Dr. Boon has commented that conventional medications are designed based on plausibility and that the research often does not produce the desired results. I think the suggestion is that therefore we should not dismiss theories based on implausibility. While it is true that scientific plausibility does not guarantee success, implausibility, such as exemplified by the “principles” of homeopathy, virtually guarantees failure.

When confronted with the weakness of their arguments, homeopaths attempt to cloak themselves in the respectability of science by searching out references in the literature that deal with the anomalies of water. Indeed, there are some mysteries about just how water molecules associate with each other, and some interesting data about patterns that they can form. But these arrangements last only picoseconds and in no way have anything to do with justifying homeopathy. Sometimes homeopaths try to buttress their claims by lassoing the concept of hormesis, the notion that some substances at very low concentration have a greater effect than at larger concentrations. This is not pertinent because the concentrations at which hormesis is observed are far, far greater than that found in any homeopathic solution. Homeopaths also like to fling about sciency words like “nano,” “quantum” and “clathrate” as they grope to rationalize the irrational.

So it is really no surprise that the vast majority of proper, randomized, controlled, double-blind trials have concluded that the effects of homeopathy can be explained by the placebo response, without any need to invoke ghostly imprints of solute molecules. Homeopaths do not accept this conclusion and counter by pointing to the few studies that show a positive effect, no matter how marginal, as well as to the numerous anecdotal accounts of patient satisfaction. But studies of homeopathy show a huge publication bias, meaning that only positive findings, likely due to chance, get published. Less than 5% of studies in alternative journals show a negative effect while mainstream medical journals feature negative results with regularity.When challenged about the lack of evidence for their arguments, unfortunately some homeopaths tend to resort to name calling and denigrating comments about conventional medicine. They also call for more research on questions that have been repeatedly answered.

Should a university answer the call for more studies? This now takes us back to the original question we posed to Dr. Boon. Obviously she feels there is something to be gained from exploring why people believe in homeopathy and whether any benefit, should there be one, can be attributed to the interaction between the subject and the homeopath. Our view is that this issue has been thoroughly investigated, and given the scientifically irrational tenets of homeopathy, little can be gained from yet another study. Dr. Boon’s reasoning that her study will put homeopathy to the test and “will search out the truth” and perhaps “provide the best evidence yet that homeopathy doesn’t work,” is less than compelling. After the plethora of studies already carried out that have failed to resolve the issue in the eyes of believers in homeopathy, this one will? Not a chance. Doing the same experiments over and over again, hoping for a different result, is not the hallmark of good science. Admittedly, Dr. Boon’s study is well designed, but if a study isn’t worth doing, it isn’t worth doing well.

There is also a potential downside to such a study. And that is the implicit legitimization of homeopathy as a consequence of a prestigious university and a highly reputable investigator being involved. That is especially bothersome when the clinic where the study will be carried out offers a number of questionable practices including homeopathic “nosodes” as alternatives to vaccination, ear candling, cupping and cranial sacral therapy.

After 200 years of often acrimonious battles between homeopaths and their critics, the only conclusion arrived at with confidence is that no study will resolve the differences. It is time to say enough is enough and dedicate funds to projects that have a better chance of a favourable outcome. Homeopaths will have to accept that the majority of the scientific community will not be swayed by the notion of nonexistent molecules producing a therapeutic effect, and we in turn have to accept that no matter what we do, homeopathy will be kept alive by a blend of bizarre ideology, a potent placebo response, scientific illiteracy, and the popular myth that anyone who opposes homeopathy is in the pocket of Big Pharma.

Dr. Joe Schwarcz

Why Yet Another Study of Homeopathy?

homeopathy ADHDThis post needs a bit of a background. A few weeks ago we noted that the Dean of Pharmacy at the University of Toronto was organizing a trial on using homeopathic preparations for the treatment of ADHD. A letter to the Dean asking how a Faculty of Pharmacy would get involved in studying something that is dismissed by the vast majority of the scientific community seemed appropriate. Eventually this letter was signed by more than ninety scientists and physicians and was sent off. There was no reply. In our view, not only is this a waste of funds, it adds an aura of respectability to a scientifically bankrupt notion. This is especially disturbing now in face of the measles outbreak since the private clinic where the study is to be carried out is a supporter of “nosodes,” the homeopathic “alternative” to vaccination. The original letter sent to Dr. Boon is reproduced below the following opinion piece that appeared in the Montreal Gazette.

Academic Freedom Comes With Academic Responsibility

Academic freedom is sacrosanct in universities. Researchers must be free to pursue their ideas, be they conventional or peculiar. But academic freedom also includes the freedom of others to question those ideas, and scholastic consideration dictates that those questions be addressed, especially when they are posed in a courteous letter signed by ninety scientists and physicians from around the world, including two Nobel Laureates.
The letter in question was sent to Dr. Heather Boon, Dean of the Leslie Dan Faculty of Pharmacy at the University of Toronto and focused on a study she was organizing to investigate the use of homeopathic preparations in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children. Those of us who signed the letter, along with the vast majority of the scientific community, believe that numerous studies have concluded that the effects of homeopathy do not extend beyond a placebo response. The letter sought Dr. Boon’s views on why a Faculty of Pharmacy was organizing a trial that legitimizes homeopathy, a practice that has no scientific plausibility.
Homeopathy is not an umbrella term for alternative modalities. It is a very specific practice that originated before the dawn of the scientific era when little was known about disease or chemistry. Samuel Hahnemann, a well-meaning German physician, concluded that a substance that causes symptoms in a healthy person cures those symptoms in a sick person if it is sufficiently diluted. His process involved thumping the solution into a leather pillow between dilutions, and finally using a drop to impregnate a sugar tablet that would then serve as a “homeopathic medicine,” the term deriving from the Latin for “similar” and “disease.”
Hahnemann could not have realized at the time that the final solution did not contain a single molecule of the original substance. Today, homeopaths have to contend with chemical knowledge and have proposed that the curative effects are to be explained by the sequential dilutions leaving an imprint on the solution, although they appear to be at a loss to explain how such an image is transferred to a sugar pill or how a molecular ghost can have healing properties.
Stymied by the implausibility of nonexistent molecules having therapeutic potential, homeopaths point to papers in the scientific literature demonstrating a larger than placebo effect, as well as to the millions around the world who use homeopathy with satisfaction. Neither of these is surprising. Toss a hundred coins into the air and count heads and tails. Maybe 45 heads, 55 tails. Maybe 48 tails 52 heads. But do this a hundred times, and one event may come out 30 heads and 70 tails. If this is the only one reported, the impression would be that the coins were not fairly weighted. So it is with studies of homeopathy. Just by chance alone, some results will indicate efficacy. That’s why we look at all the studies and come to the conclusion that we are looking at a placebo response, which of course is valuable and should not be dismissed. Indeed, couple the placebo response with the fact that homeopathic treatments are administered by caring people who spend a lot more time with patients than physicians can, and that they mostly target self-limiting conditions or diseases that have their ups and downs, and you have a formula for satisfaction.
ADHD is a serious condition that merits serious research. Apparently the University of Toronto researchers carried out a pilot study involving homeopathy that seemed to indicate benefit. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it essentially meaningless. Even if we were to attach some importance to the claimed reduction of symptoms, the effect was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior. Furthermore the proposed study would use individualized treatments for each subject as determined by a homeopathic consultation, so at best the results would be ambiguous in terms of making any recommendation.
The study is actually to be carried out at the Riverdale Homeopathic Clinic, a private institution that also offers ear candling, cranial sacral therapy and “nosodes,” which are homeopathic versions of vaccines. No public funding is involved; support comes from a foundation dedicated to alternative medicine. Nevertheless, one wonders why with various nutritional and biofeedback treatments with significant potential for helping with ADHD needing exploration, a scientifically insolvent notion is being pursued. One also wonders why a Dean of Pharmacy at a major Canadian Institution did not take the time to respond directly to repeated requests for her comments on a contrary opinion expressed by a large number of notable scientists and physicians.

ORIGINAL LETTER

Dear Dr. Boon

The following originates from the McGill University Office for Science and Society and has been signed by scientists and physicians from the international community. We are all devoted advocates of academic freedom and support the right of researchers to pursue any field of study they feel has merit. But we also feel that it is fair to ask colleagues questions about how a particular study they are engaged in may contribute to the bank of scientific knowledge. It should be emphatically stated that those who have added their name to this letter, including two Nobel Laureates, in no way wish to interfere with your research. Everyone is just interested in your response to the concerns expressed here.
Those concerns deal with the trial we understand you are organizing to investigate a homeopathic approach to the treatment of ADHD. First, let us point out that the McGill Office for Science and Society accepts no funds from any vested interest; our only allegiance is to the scientific method and to evidence-based science. It makes no difference to us whether any substance, including homeopathic products, is regulated or not, as long as the decision is arrived at through proper scientific evaluation rather than emotion, “they say” or pressure from vested interests.
Along with the majority of scientists, we find the notion of nonexistent molecules having a physiological effect through leaving some ghostly impression in water that is then transferable to a sugar pill simply untenable. Even if some sort of “memory” effect prevailed, there is no reasonable explanation for how it could affect biology. Furthermore, after all the sequential dilutions and succussions, the original impurities in the solvent would be more extensively present in the final solution than any component from the original homeopathic source. After evaluating the scientific literature, including a comparison of 110 homeopathic studies with 110 conventional studies for a number of disorders and outcomes, the most likely conclusion is that any benefit attributed to homeopathy can be ascribed to a placebo response.
Generally, scientists look askance at homeopathy, but don’t bother much with it because they consider it to be harmless folly. Unfortunately, this is not the case when homeopaths recommend “nosodes” as alternatives to vaccination, or attack the use of antibiotics for infections, or offer unproven treatments for ADHD.
The reason for this extensive email is to solicit your rationale, given your training as a pharmacist, for the study you are carrying out. Is the motivation a concern that parents are wasting money and possibly sacrificing effective treatment by resorting to homeopathy for ADHD, and that the study may clarify the situation? Or is there a belief that there may be some factor other than a placebo response involved? In that case, what mechanism may be operative?
You allude to the results of a pilot study that warranted this further research. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it highly questionable. You also note that the reduction of symptoms found in the pilot study was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior.
Basically, as you have gathered, we are curious about why, given the need to investigate natural therapies that may actually have a potential for benefit, and faced with a scarcity in funding, a Department of Pharmacy is interested in investigating a subject that has been addressed extensively in the literature and has been found wanting both in evidence and plausibility. There is also a concern that just the mounting of such a study by a highly reputable researcher at a top notch university will be used by homeopaths to justify diverse aspects of their practice, including steering patients away from evidence-based treatments.
Looking forward to your comments,
Regards
Joe Schwarcz
Director, McGill Office for Science and Society

David Harpp
Macdonald Professor of Chemistry
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How can a pharmacist believe the unbelievable?

pharmacistHow can anyone trained as a pharmacist, with courses in chemistry, biology, and physiology believe that ghostly impressions of molecules imprinted onto sugar can cure disease? Michelle Boisvert, a Quebec pharmacist, not only believes in the power of non-existent molecules, she runs HomeoCan, a company dedicated to selling “drugs” that contain no active ingredient. She has now had a run-in with the Quebec Order of Pharmacists resulting in her being fined $17,000 and being kicked out of the Order. This has a troublesome angle. She wasn’t kicked out because she is dispensing nonsense, but because she was using her position as a pharmacist to promote a commercial product.

Truth be told, you cannot be kicked out of the Order for selling homeopathic products because they are legal in Canada. But any pharmacist who dabbles in this medical oddity is either unethical or frighteningly scientifically illiterate. I know that many people defend homeopathy justifying it based on its popularity. Well, science is not a popularity contest, it is evidence-based. And the evidence is that “drugs” that contain no active ingredients cannot have any efficacy. Unfortunately many people are confused about what homeopathy is and think that it is just an umbrella term for “natural” or “alternative” practices. It is not that. Please do take a few minutes to read this excellent article that clarifies the practice of homeopathy by colleague Dr. Harriet Hall.
http://www.csicop.org/si/show/an_introduction_to_homeopathy

 

Dr. Joe Schwarcz

Interview with SETI Institute

I was interviewed for Big Picture Science. My part is at about 37 minutes in but I think the whole program is interesting!

 

Click Image to listen to Interview with SETI Institute: 

homeopathy

 

 

 

 

 

 

 

Dr. Joe Schwarcz

Oh..The Irony!

DuchyPrince Charles has properly derided global warming deniers, calling them a “headless chicken brigade.” He went onto say that it was “baffling that in our modern world we have such blind trust in science and technology that we all accept what science tells us about everything-until, that is, it comes to climate science.”

Now, this is coming from a man who believes in the ultimate absurdity that is homeopathy and through his Duchy Originals Company sells a range of herbal remedies devoid of evidence.

Charles grew up with nonsense. “When I was very small, I remember so well my grandmother having her wonderful leather pouch with all these homeopathic glass phials in it. It was such a feature of my life and as I got older I became more and more aware of the effectiveness of homeopathy and indeed of complementary medicine generally.’ And this man talks about relying on science. Why accept the science on climate change and not on homeopathy? Bizarre. Charles also promotes a ridiculous herbal “detox” remedy. Someone is in need of a mind detox.

Joe Schwarcz

Homeopathic Mosquito Repellant-Concentrated Bunk

mosquito repellantIn the view of the vast majority of scientists, and certainly mine, any claim that homeopathic preparations have an effect beyond placebo is pure bunk. Homeopathic solutions are diluted to an extent that they essentially contain nothing and then are sprayed onto sugar pills from which they evaporate leaving behind, according to homeopathic dogma, some sort of ghostly image that has therapeutic value. This is scientifically insulting. Homeopathic products contain no active ingredients, there is no plausible way in which they can work and there is no evidence that they do work. But somehow this doesn’t bother Health Canada’s Natural Health Products Directorate which has given a free ride to homeopathic preparations, even issuing specific homeopathic drug identification numbers. It is hard to understand how this has happened given that the Directorate’s stated goal is that “all Canadians have ready access to natural health products that are safe, effective and high quality, while respecting freedom of choice and philosophical and cultural diversity.” Safety is not an issue with homeopathic products because they conatin nothing. I’m not sure what “high quality” means in this context, supposedly that the pills are produced in an environment free of contaminants. But what about efficacy? There is actually no requirement that homeopathic producers demonstrate this, which is lucky for them, because there is no way to demonstrate the efficacy of homeopathic sea water, homeopathic insulin, homeopathic chloroform or homeopathic table salt.
It seems that Health Canada has taken the view that freedom of choice is paramount as long as there is no safety issue and regulators look the other way when it comes to a question of efficacy. In most cases there is no big problem here because in general consumers who use homeopathic preparations do so for mild conditions such as colds or minor aches and pains. But using homeopathic pills to deter insects from biting is potentially dangerous. Yet that is exactly what Mozi-Q marketed as a natural homeopathic deterrent claims to do. Imagine that. Swallow a sugar pill and keep mosquitoes away. Not only that, it is also supposed to reduce the itching if you do get bitten. What evidence do they provide on their website? There’s talk of how mosquitoes avoid delphinium flowers, which may or may not be true. But what does that have to do with swallowing pills sprayed with an extremely dilute extract of the plant? Are the nonexistent delphinium molecules exuding through the skin? And itching is supposedly relieved by a pill that contains a trace of stinging nettle extract? According to the perverse theory of homeopathy, a substance that causes symptoms in a healthy person will relieve those symptoms in an afflicted person upon extreme dilution. Since stinging nettle causes a stinging sensation on contact with skin, it is supposed to relieve the same sensation when diluted. Nonsense. Mozi-Q also cites a reference to some homeopath who carried out a study in the 1960s, a study that cannot be found. What else? Supposedly Mozi-Q was tested over four seasons on people. How? Was there a control group? How were the results monitored? Why weren’t they published? Pity the poor person who goes into a mosquito infected area thinking they are protected from bites by having swallowed a sugar pill. And remember that mosquito bites can be more than minor annoyances; they can transfer disease, such as that caused by the West Nile virus. And Health Canada thinks this is ok. It isn’t.
Joe Schwarcz
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