 Welcome back. I'm Dr. Harriet Hall and this is lecture 5 in a series of 10 lectures on science-based medicine. The topic of this lecture is homeopathy. Many of the people who use homeopathy don't have any understanding of what it is. I've run across highly educated medical professionals who thought homeopathy was just some kind of herbal medicine. When they found out what it really was, boy, it was their face red. Homeopathy is actually incredibly silly. Here's a simple explanation of homeopathy that illustrates just how ridiculous it is. If coffee keeps you awake, dilute coffee will put you to sleep. The more dilute, the stronger the effect. Dilute coffee acts as a sleeping pill and more dilute coffee acts as an even stronger sleeping pill. If you dilute all of the coffee molecules out of the water, the water will remember them and the effect will be even stronger and the water's memory of coffee can be transferred to a sugar pill by dripping the water onto a sugar pill and allowing it to evaporate. Quackwatch calls homeopathy the ultimate fake and it's also been called delusions about delusions. In lecture three I explained how a single individual, D. D. Palmer, invented chiropractic all by himself on a single day in 1895. In lecture four I explained how a single individual, Dr. Nogier, invented ear acupuncture all by himself in 1957. A single individual, Samuel Hahnemann, invented homeopathy all by himself too in 1796. To set the scene, let's think about the state of medicine in Hahnemann's lifetime. Science-based medicine was far in the future. Diseases weren't well defined. They thought malaria was caused by bad air. There was no germ theory, no antibiotics, no anesthesia, no sterile techniques, no systematic testing of treatments. Doctors of his time did more harm than good. They were treating patients on the basis of a false theory of the four humors. In an attempt to balance those humors, they were bleeding patients, emptying their colons with purgatives and emptying their stomachs with a medics. They were poisoning them with medicines like mercury. They were killing people. Hahnemann was right to criticize his colleagues, but he was wrong about homeopathy. He intended homeopathy to be a kinder, gentler, more effective treatment system that would replace allopathy. That was the word he coined to disparage doctors, saying that they only treated the symptoms, not the disease itself, and that they treated with opposites instead of similars. That wasn't even an accurate characterization of what doctors were doing in his day, and it certainly doesn't describe what doctors do today. Most of us subject strenuously to being called allopathic doctors. The term is used as an insult, and it has no legitimate meaning. Just as one personal experience with a deaf janitor led DD Palmyry to invent chiropractic, a personal experience with tree bark led Hahnemann to invent homeopathy, and in both cases, they misinterpreted a single experience and extrapolated wildly from it. Sincona is a tree that grows in South America. The bark of the tree was used to treat fevers. If the fever happened to be from malaria, Sincona worked because it contained quinine, an effective malaria treatment. Hahnemann was skeptical, and he was experimenting on himself with large doses of Sincona. He developed symptoms that he thought were typical of malaria. He was wrong. His symptoms weren't typical of malaria, and today we think he probably had some unusual reaction to something in the bark. Anyway, his experience led him to deduce that the same remedy that caused a symptom could relieve it. So he tried treating with similars. He found that some people got worse before they got better. To reduce the side effects, he kept lowering the dose by diluting the remedy. Here are the two basic principles of homeopathy. First, the law of similars. Like cures like. A remedy will cure a disease in a sick person if it causes the same symptoms as the disease when given to a healthy person. If Ipocac makes a healthy person vomit, it ought to cure vomiting in sick people. Now the idea that like cures like is really just a form of sympathetic magic. Second, the law of infinitesimals. The smaller the dose, the larger the effect. That would mean the less sugar you put in your coffee, the sweeter it tastes. This law is obviously false, and it's contrary to everything we know about chemistry, pharmacology, and physics. Hanuman had another revelation. Seccussion. When he made a home visit, the patient was more likely to improve than if he saw the patient in his office. Now it's easy to see how a home visit might make more of an impression on the patient and might enhance the contextual effects of the doctor-patient encounter. But Hanuman thought up his own explanation. The remedies got jostled in his saddlebags as he rode his horse to the patient's home. He imagined that the jostling increased the potency of the remedy. He never thought to test this idea by comparing jostled and non-jostled remedies because he didn't think like a scientist. He just assumed he was right, and he recommended that when remedies were prepared, the solution should be potentized after every step of dilution by pounding the bottle repeatedly against something. He used a leather-bound book. Today some prepare is succust the remedies by hand against a leather pad, and some use machines. The remedies may be sold as a liquid or as a tiny pill. When the dilution is complete, the solution can be dripped onto tiny sugar pills and allowed to evaporate. Some remedies like granite, diamond, and platinum are not soluble in water or alcohol, so they're prepared by trituration. They grind them up with a mortar and pestle and then dilute them with lactose, milk, sugar. One triturated remedy is Berlin Wall. They take a tiny bit of ground-up concrete from the Berlin Wall and they mix it with 100 parts of sugar, lactose. Then they take one part of the resultant mixture and mix it with 100 parts of lactose. They repeat that process 200 times. One homeopath said it was such a powerful remedy that she had to store it away from her other remedies. She kept it out of the garden shed. It is used to treat feelings of confinement and oppression, shifty eyes, terror, asthma, and headaches. According to a homeopathy journal, the Wall in Berlin seems to have been immersed with the psychological emotions and thoughts of mankind. Again, magical thinking. The dilutions are where it really boggles the mind. They're labeled as X for 10 and C for 100. A 6x dilution means one part of remedy was diluted with 10 parts of water or alcohol and one part of the resulting mixture was diluted with another 10 parts of water and so on for a total of six times. In the seed dilutions, one part of the remedy is mixed with 100 parts of water at each step. 6x amounts to a solution of one part in a million. 6c amounts to one part in 10 trillion. The process is exponential. By the time you get to the 13c or the 26x level, there isn't a single molecule of the original remedy left. A 13c dilution is equivalent to diluting one third of a drop of the original substance in all the water on earth. A typical homeopathic remedy is 30c. At the 30c level, it would take a container 30 million times the size of the earth to hold enough water to make sure you were getting at least one molecule of the original substance. Another way of looking at it is that for one patient to get one molecule, you would have to give 2 billion doses per second to 6 billion people for 4 billion years. It gets worse. The most popular flu remedy is sold as a dilution of 200c. That's 10 to the 400th power. The number of atoms in the observable universe is 10 to the 80th power. My brain froze when I tried to figure out how many universes it would take to find one molecule. And 200c isn't the limit. There are remedies that are diluted far more. Above the 1000c level, they are designated as M. 1M equals 1000c. We're able to make those calculations thanks to Avogadro. Avogadro's number allows us to calculate the number of atoms or molecules in a volume of a chemical substance based on the molecular mass. The first calculations were done in 1865, 22 years after Hahnemann's death. Now we know that remedies of 13c and above are nothing but water. Hahnemann didn't have any way of knowing that. When his followers found out, they had three choices. One, they could abandon the dilute remedies. Two, they could accept metaphysical explanations, assuming that the water somehow remembers molecules that are no longer there. Or three, they could look for a scientific explanation. Most of them accepted option two, that water somehow absorbs the vitalistic essence of the remedy and remembers it. Some of them are still working on option three, trying to find an explanation that scientists could accept. Homeopaths try to justify their remedies by comparing them to vaccines. That's a false analogy. Vaccines contain measurable amounts of antigens and they work by a known mechanism. Homeopathic remedies contain no active molecules and they work by magic. They invoke hormesis. Now that's a phenomenon where a low dose of a chemical may trigger the opposite response to a high dose. But hormesis is only known to apply in certain cases. It's not a universal phenomenon by any means and it describes a response to a low dose, not to no dose. They invoke water clusters. Clusters of water molecules do form, but they only last for trillions of a second. There's no way they could register or transmit information. There's been wild speculation about quantum entanglement. That's the kind of thing that leaves quantum physicists rolling on the floor laughing. They keep doing ridiculous flawed experiments trying to prove that water can remember. One of the most famous experiments was the Benveniste affair. Jacques Benveniste claimed that he could detect biological activity of antibodies after the antibodies had been diluted out and were no longer there. The study was published in Nature with the condition that his lab would be inspected. A team including the journal's editor in chief and James Randy visited the lab and found a number of problems. The researchers were true believers who bordered on religious fervor. Their blinding procedures and controls were inadequate. The positive results were from a single technician. And when the team instituted more rigorous controls, the results couldn't be reproduced. Other labs tried to reproduce their findings and failed. And the results weren't even compatible with homeopathic theory. The effect went up and down with subsequent delusions instead of steadily upwards. Benveniste is the only person to have won two Ig Nobel awards, both for his work on homeopathy. His second Ig Nobel award was for his alleged discovery that not only does water have a memory but the information can be transmitted over telephone lines in the internet. Drugs are tested with randomized placebo control trials. Homeopathic remedies are tested with Provings. These were originally done with an undiluted remedy and later with a 30 C dilution. Healthy volunteers take it and they keep a detailed diary of every symptom they experience for an unspecified, unspecified length of time as long as they feel like doing it, sometimes for months. They write down everything. I felt angry. I burped. My big toe itched at 11 PM. I dreamed about my dog. There's no attempt to compare those symptoms to a control group. Then they're interrogated to elicit even more symptoms. Instead of looking for commonalities, they just pull all the different reports from different Provers and the whole mishmash of reported symptoms is used to guide treatments for that remedy. People mean different things by homeopathy. In classic homeopathy, only a single remedy is used at a time. In combination homeopathy, a mixture of remedies for the same symptoms is used. Today, homeopathic remedies are sold over the counter for self prescription. Something that I don't think Hanuman would ever have condoned. When homeopaths take a patient's history, they spend as much as an hour interviewing the patient. They go into excruciating detail about the chief complaint. They try to pin down the time of onset and its possible relation to life events. They ask about concomitants, seemingly unrelated symptoms like weak ankles or unusual sleeping positions. They ask about general symptoms like sluggishness, feelings of hot or cold, restless sleep, changes in appetite. They ask about family history. Did anything stressful happen to the patient's mother during her pregnancy? They ask seemingly off the wall questions like what do you love most about life? What bothers you the most about other people? What are you teased the most about? Here's a typical history that a homeopath obtained from a patient with uterine fibroids. That's a benign tumor of the uterus. He wrote down that she was loquacious, loud, anxious, doesn't want to live, desperate, feels humiliated, ashamed, used, rejected, angry, offended, lonely, religious affections, relationship problems, workaholic, absence of nurturing and childhood, parents fighting, uterine fibroids, constipated, retains fluid. The fibroids themselves are near the end of the list and the homeopath may interpret other things in the history as more important. After eliciting all these relevant and irrelevant symptoms, the homeopath looks up the symptoms in a repertory book. It lists symptoms by parts of the body. Here's an excerpt from a section on facial expression. The patient with fibroids was anxious. For anxious, 66 different remedies are listed. There are other facial expressions like anxious when child is lifted from cradle, anxious during downward movement, astonished, besotted, bewildered, changed, childish, cold, distant, and that's just the ABCs. It continues right on down the alphabet for 20 more categories, including happy, intoxicated, old-looking, and stupid. For each of these categories of facial expression, there is a different list of corresponding remedies. The homeopath looks up the symptoms he imagines are the most important and he selects the remedy that best matches those. The repertory is organized by symptoms. The next step is to use another book, The Homeopathic Materia Medica, that's organized by remedy. It lists all the symptoms that provings have associated with each remedy. Here's an example for a remedy called natrium muriaticum. The entry for natrium muriaticum lists symptoms in all of these areas. Mind, head, eyes, ears, nose, face, stomach, abdomen, rectum, urine, male, female, respiratory, heart, extremities, sleep, skin, fever, and modalities. Some of the examples from these areas include eyelids heavy, anemic headache of school girls, constipation and diarrhea, yes both of those, sensation of coldness of heart, palms hot and perspiring, hangnails, dreams of robbers, oily skin, warts on palms of hands, chill between 9 and 11 a.m. The list goes on and on for several pages. What is natrium muriaticum? It's common table salt. How can anyone seriously believe that table salt causes all those symptoms and can cure them? Hanuman listed 67 remedies. Today there are over 2,000 with over 1,300 officially recognized by the HP US, the homeopathic pharmacopoeia of the US. Here are some examples. Berlin Wall, eclipsed moonlight, south pole of a magnet, dog's ear wax, tears from a weeping young girl, fossilized dinosaur bone, rattlesnake venom, arsenic, poison ivy. The homeopath follows the patient's progress and if the patient is not getting better, he assumes that the first remedy was correct but that the situation has changed. So he reevaluates and prescribes a different remedy. The homeopath is constantly reevaluating and there's always another remedy to try. Aggravations are a good sign. If the symptoms get worse it means the remedy is working. If the symptoms get better it means the remedy is working too so you can't lose. If the remedy isn't working the homeopath can blame the patient for having inadvertently used antidotes that prevented the remedy from working. For instance, he drank coffee. He didn't get enough sleep. He used a cell phone. He ate spicy foods. Why did some patients fail to respond? Hanuman developed his theory of myasms to explain the failures of homeopathy. He decided that all disease was caused by three myasms. syphilis, psychosis or gonorrhea, and saura, scabies or itch. He decided that myasms had to be cleared before the remedy could work. He thought this led to an improved approach to selecting remedies. This all sounds so silly but scientists don't reject something just because it sounds silly. We still need to test whether it works. Homeopaths cite epidemics and early successes where patients treated with homeopaths did better than patients treated with conventional medicine but those successes were because doctors of that era were doing more harm than good. Homeopathy did nothing so the results were better. Homeopaths point to high levels of patient satisfaction but that doesn't mean it works. Remember all the ways that patients can be satisfied by bogus remedies and a charismatic provider. Remember medicine's beautiful idea. No matter how convinced you are you still need to test every treatment. And homeopathy was tested as early as 1832 in a hospital in Russia. One ward got conventional treatment. One ward got homeopathic treatment and one ward got no treatment but was given fake pills made of breadcrumbs and cocoa to make them think they were being treated. The no treatment ward had the best outcomes. That means that homeopathy did no good and the conventional treatments of the day didn't do any good either. In those days before science-based medicine it was better for patients to steer clear of both conventional doctors and homeopaths and just let nature take its course with no treatment. It's a wonder they didn't conclude that breadcrumbs and cocoa were an effective treatment. Homeopathy has been tested over and over since that time. Modern clinical trials have not shown that homeopathy was effective. David Reilly said either homeopathy works or control trials don't. In a sense he was right. Control trials don't work very well for studying homeopathy and other implausible health claims. As my colleague Kimball Atwood put it, trials of ineffective claims championed by impassioned advocates will appear to yield equivocal rather than merely negative outcomes. The inevitable continual citations of dubious reports will lead some to judge that the aggregate data are weakly positive or that the treatment is better than placebo. So they just call for more studies. Dr. Atwood also pointed out that homeopathy can't possibly work as claimed is the sort of basic science that can reasonably be called established knowledge. Is it realistic to assume that this level of evidence can be overthrown by ambiguous clinical trials of dubious design? The evidence against homeopathy is as strong as the evidence that the earth is spheroid rather than flat, that the planets orbit the sun rather than the earth, that mass and energy are conserved, that the earth is several billion years old, and that species evolved by a process of variation in natural selection. Jay Shelton wrote a book about homeopathy, homeopathy, how it really works. It's listed in the course guide. He concluded that homeopathy often helps people, but the remedies don't contribute. It helps through non-remedy factors like unassisted natural healing, attention, suggestion, contextual effects of the treatment encounter, regression to the mean, cessation of harmful or unpleasant treatments, lifestyle-assisted healing, and different perceptions of internal reality versus external reality. When results of clinical trials disagree with each other, we can try to resolve the disagreements with systematic analyses of all the data. Of 11 systematic reviews of homeopathy, only two were positive. When those two were re-analyzed with the low-quality trials omitted, they were negative too. The most favorable systematic review said that overall, homeopathy worked better than placebo, but it didn't work better than placebo for any specific condition. That doesn't compute. It's like saying broccoli is good for everyone, but it's not good for men or women or children. Homeopathy is a good example of changing attitudes about CAM. In 1900, there were 10,000 homeopathic physicians in the U.S. along with 79 homeopathic hospitals and 22 homeopathic medical schools. As scientific medicine gained ground, homeopathy lost ground. The last U.S. homeopathic medical school closed in 1920. By 1950, the last homeopathic hospital closed, and by 1970, there were only 75 homeopaths still practicing in the U.S. But today, homeopathy's having a revival, and remedies are sold over the counter in pharmacies. Oscilocoxinum can be found on the shelves of any local pharmacy. It's the most popular homeopathic remedy, and perhaps the funniest one ever. During the Spanish flu epidemic of 1918, a French doctor named Joseph Roy looked at the blood of flu victims under a microscope, and he thought he had observed an oscillating bacterium. He named it Oscilococcus. No one else ever saw it. He was probably confused by Brownian motion. He was probably seeing tiny particles of dust or whatever that were being jostled by the constant movement of water molecules. But he thought he'd discovered a new pathologic organisms, and when he thought he'd spotted the same organism in the liver of a duckling, he assumed that a homeopathic flu remedy could be made from the duck liver. Today, it's manufactured from the heart and liver of the Muscovy duck, diluted by 1 in 100 to the 200th power. To get one molecule of the original extract, a patient would have to consume an amount of the remedy, many orders of magnitude greater than the number of atoms in the observable universe. Oscilocoxinum is one of the 10 top-selling drugs in France, and it brings in $15 million a year in the U.S., but it's an impossibly dilute solution of something that never even existed in the first place. Here's my version of the recipe for Oscilocoxinum. Take a bit of duck liver, dilute the duck out of it, hope the water remembers the duck, and hope the memory of duck cures cold. In reality, all it remains is the quack. Would you believe there are homeopathic vaccines? They're prepared with nozodes, material taken from the saliva, blood, pus, urine, or disease tissue from victims of the disease. Health Canada has officially licensed homeopathic remedies to prevent flu, polio, measles, and pertussis. I reported one homeopath to Homeland Security because I figured they'd like to find out where he got his smallpox and anthrax nozodes, because if he could get them so could terrorists. Do you believe in magic? A well-known homeopath described how a car was fixed homeopathically. It appeared to be having electrical problems, so they wrote electricitus 200C on a piece of paper, and they placed it near the engine, and the problem was resolved. Sometimes dowsing is used to select remedies. The customer takes a pendulum to the store and holds it over each remedy until it swings the right way. Provings are done where the subject doesn't actually take the substance, but meditates about it, or dreams with it under the pillow, or prepares it by trituration, or writes it on a piece of paper and keeps the paper close to his body. Homeopaths have treated patients by telephone or telepathy. In grafting, one potentized sugar pill is added to a bottle of inert pills, and it converts them all to remedies. There are even homeopathy first aid kits for accidents and emergencies. You can buy one of these for $54.99 on amazon.com. It contains 18 vials of sugar pills labeled 200C. They're recommended for accidents, injury, infections, GI problems, burns, muscle pain, etc. For certain illnesses they advise depending on severity seek medical care. The list includes anaphylaxis, animal bites, bone injuries, third-degree burns, carbon monoxide poisoning, drug overdose, electrocution, eye injuries, poisoning, puncture wounds, and shock. It's appalling to think that patients are left to their own assessment and might think that these conditions were not severe enough to merit medical care. There's a hilarious YouTube video making fun of these kits. A young man goes out to save the world. He drops a pill from each bottle into a local stream that runs to the ocean. So the remedies will eventually reach everyone on earth in an even more dilute form. This will eliminate all the diseases the kit instructions cover from heart attacks and strokes to throttling and drowning. People say even if homeopathy is only a placebo, what's the harm in using it? It can't cause any side effects so it's safer than other treatments and patients seem to like it. But it can be very dangerous if it's used in place of effective treatments. Yanez Podgorsek was harmed in Slovenia. A homeopath named Darja Erzen treated him with homeopathic drops to prevent malaria. He got malaria anyway and then the homeopath treated him with homeopathic remedies for the malaria. He died in 1996 at the age of 42. The homeopath's license was revoked and he got two years probation. Jacqueline Alder Slade was harmed. She was a 55 year old woman who lived in Ireland. Her homeopath told her to stop taking her asthma medication and she died of an asthma attack. And little Isabella Dinley was harmed. She was a 13 month old baby in Australia and her epilepsy was treated with homeopathy and she died. And the remedies are not always benign. Sometimes remedies sold over the counter as homeopathic are low delusions like one in a hundred that may actually contain an effective ingredient to harm patients. A teething remedy, Hyland's baby teething tablets, was recalled because babies developed symptoms of Belladonna toxicity. Zycam caused adults to lose their sense of smell. Manufacturing standards were lax and the amount of active ingredient in the products varied. A skeptic group in the UK did an experiment. They sent a young woman to various homeopaths for advice about malaria prophylaxis for a trip to Africa. 10 out of 10 advised homeopathic protection instead of standard prophylaxis. One explained, they make it so your energy, your living energy doesn't have a kind of malaria shaped hole in it. The malaria mosquitoes won't come along and fill that in. The remedies sorted out. There was a case reported in the British medical journal where a woman relied on homeopathic vaccines during a trip to Togo. She developed a severe case of malaria, spent two months in intensive care, and had multiple organ failure. Water passes through the oceans in the water cycle and it gets succused by the waves. If it can remember, why wouldn't it remember fish poop? There's no such thing as absolutely pure water or absolutely clean glassware. Tiny amounts of contaminants are always present and dust and pollen grains fall out of the air into open containers of water. There are far more molecules of contaminant in a homeopathic dilution than there are molecules of the original substance. So how could the water know which substance it's supposed to remember? This poster pretty much says it all. If water has a memory then homeopathy is full of shit, shit and sugar. To end with, here's a t-shirt that says homeopathy making fuck all difference since 1796. In the next lecture I'll talk about naturopathy.