Homeopathy is a controversial 鈥渁lternative鈥� practice. In 2012,听Dr. Joe expressed his views in a series of columns in The Montreal Gazette - Homeopathy: Delusion through Dilution - which triggered a lengthy response from Ginette Beaulieu, President of the Syndicat professionnel des homeopathes du Quebec to which he, in turn, responded:
Recently I was treated to a rambling, disjointed letter from Mme Ginette Beaulieu, President of the 鈥淪yndicat professionnel des homeopathes du Quebec鈥� in response to my series of columns on homeopathy in the Montreal Gazette.听 I will ascribe the undignified and slanderous nature of the letter to the writer鈥檚 lack of familiarity with academic and professional demeanour and will overlook the crude attempt at personal defamation. It is hard to know just how to respond to Mme Beaulieu鈥檚 rant, since she presents so many inviting targets.听 She parrots the usual arguments raised by the defenders of homeopathy, apparently unaware that each one has been extensively addressed and deflated by experts around the world.听
In his article in The Lancet (1), and in a more elaborate version in the Guardian (2), Dr. Ben Goldacre deftly skewers homeopathic claims and highlights the usual pattern of alternative practitioners鈥� juvenile reaction to criticism: 鈥淲ith alternative therapists, when you point out a problem with the evidence, people don't engage with you about it, or read and reference your work. They get into a huff. They refuse to answer calls or email queries. They wave their hands and mutter sciencey words such as "quantum" and "nano". They accuse you of being a paid plant from some big pharma conspiracy. They threaten to sue you. They shout, "What about thalidomide, science boy?", they cry, they call you names, they hold lectures at their trade fairs about how you are a dangerous doctor, they contact and harass your employer, they try to dig up dirt from your personal life, or they actually threaten you with violence.鈥�
I can attest to the fact that such methods are not limited to the United Kingdom.听 Dr. Goldacre is not the only one to take on homeopathy in an elegant, rational fashion.听 Drs. Edzard Ernst and Simon Singh in their epic work 鈥淭rick or Treatment鈥� unmask the practice further (3), and in 鈥淪uckers,鈥� Rose Shapiro nimbly shreds the usual homeopathic assertions to pieces. (4) Unlike Mme. Beaulieu, I will refrain from nit-picking over inconsequential historical details, such as whether my statement that 鈥渉omeopathy is a specific practice conceived in the early nineteenth century by Samuel Hahnemann鈥� is correct.听 It is.听 While Hahnemann did publish an article about his practice in 1796, he did not coin the term 鈥渉omeopathy鈥� until 1807 when he published his essay Indications of the Homeopathic Employment of Medicines in Ordinary Practice.听 It was also Hahnemann, and not the ancient Greeks, who introduced the term 鈥渁llopathy鈥� as a pejorative term for conventional medicine.听 Beaulieu鈥檚 comment that 鈥渉omeopathy was never invented by Samuel Hahnemann,鈥� as numerous history books and I maintain, 鈥渂ut goes back to ancient Greece,鈥� is incorrect.听 While some Greek physicians did raise the notion of 鈥渓ike cures like,鈥� the idea of dilution and succession, which is the essence of homeopathy, was introduced by Hahnemann.听 I won鈥檛 quibble about whether Hahnemann experimented with belladonna for sore throat or for scarlet fever.听 Does it really matter how he arrived at his implausible conclusions?听 In any case, Hahnemann鈥檚 Materia Medica clearly states that homeopathic belladonna is a treatment for sore throat.
Let鈥檚 get down to more important matters.听 I鈥檝e already expressed my views on the published trials of homeopathy.听 The evidence, for all who care to read the scientific literature in its totality suggests that homeopathy is a placebo phenomenon.听 The definitive meta-analysis published in the Lancet (5) concludes: 鈥淏iases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.鈥� There have been numerous systematic reviews of homeopathy trials, and even systematic reviews of systematic reviews (6, 7).听 One that is often presented by homeopaths as being favourable to their practice is the Swiss report 鈥淗omeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs.鈥澨� Contrary to what is commonly claimed, this is not a report by the Swiss government, but rather a committee composed mostly of members who have a history of favouring alternative therapies.听 Dr. Edzard Ernst, one of the world鈥檚 foremost experts on homeopathy, has dissected this review and has shown that due to omissions and misrepresentations of the conclusions of individual studies, the report is 鈥渕ethodologically flawed, inaccurate and biased.鈥�(8)听 Anyone interested in a thorough discussion of how the Swiss report has been twisted can check out the comments by Rudloff and Zeno (9).听
The Cuban 鈥渟tudy鈥� that is sometimes brought up in support of homeopathy actually doesn鈥檛 provide such support, as is clearly explained by Dr. David Gorski (10). A common argument made by homeopaths is that the placebo effect cannot work in the case of animals and infants.听 This is plainly wrong as can be readily seen by carrying out a PubMed search.听 It is well known that children respond to their parents鈥� expectations and pets to that of their owners. (11). The often repeated assertion that homeopathy demonstrated its efficacy in the 19th century during cholera and typhoid epidemics by virtue of having fewer fatalities in homeopathic than conventional hospitals is often trotted out.听 The explanation is simple.听 Back then conventional physicians engaged in bloodletting, purging and other horrific treatments that did more harm than good.听 At least homeopaths subscribed to the age old dictum, 鈥渇irst do no harm.鈥澨� Apparently they no longer seem to abide by that rule given that homeopaths have been known to prescribe ineffective malaria prophylaxis and commonly advise against vaccination.听
The claim that homeopathy can be effective against AIDS is dangerous folly and recommendations to take homeopathic products as protection against radiation are absurd.听 No wonder that a parliamentary commission in the UK has advised that the National Health Service should cease the funding of homeopathy. (12) Dr. Luc Montagnier, a Nobel Laureate, has become a shining beacon for homeopaths who claim he has validated their practice.听 He has done no such thing.听 Prof. P.Z. Myers gives an excellent account of Montagnier鈥檚 bizarre experiment (13) and further insightful analysis is provided by Drs. Harriet Hall and David Gorski (14, 15). Even if this experiment, which purports to detect electromagnetic signals from a homeopathically diluted DNA solution, is ever reproduced, it says nothing about curing disease.听 This critical fact is never addressed by homeopaths.听 Even if water had some sort of memory, so what?听 How does that have anything to do with treating disease?听 Montagnier鈥檚 publication is reminiscent of Professor Jacques Benveniste鈥檚 paper in Nature describing an experiment that purported to show a homeopathic effect but could not be reproduced, as well as of Professor Madeleine Ennis鈥� experiments that suffered the same fate in the hands of experts on British television鈥檚 Horizon series (16).
鈥淐an so many people be wrong?鈥� is another lame argument often advanced to buttress the crumbling edifice of homeopathy.听 The simple answer is 鈥測es.鈥澨� Popular ideas are not necessarily right.听 After all, bloodletting went on for thousands of years, and at one time the notion that the earth was the center of the universe was quite popular.听 But science is not a popularity contest. While the tenets of homeopathy are marinated in pseudoscience, homeopaths can conceivably serve a useful function.听 They ask a plethora of caring questions and lend a sympathetic ear, both processes that can translate to a reduction in stress and anxiety.听 But problems can arise if the homeopath does not recognize a medical condition that is amenable to treatment by conventional medicine.听 There are plenty of such cases, with a classic one being the case of Penelope Dingle of Australia whose tragic death has been attributed to foregoing proper care in favour of homeopathic treatment (17).
It is edifying to consider the use of a specific homeopathic remedy such as Natrum Muriaticum.听 That鈥檚 common salt.听 Among other medical conditions, it is used in homeopathy to treat migraines, pain, weakness and unusual weight loss.听 Not necessarily benign conditions.听 The best results are said to be obtained with high potency preparations such as 30C or higher.听 One grain of salt dissolved in all the water on earth would not get you near a 30C dilution.听 In any case, using the homeopathic concept, salt is dissolved in pure water which is then sequentially diluted and succussed.听 But hasn鈥檛 that water already been in contact with salt throughout its history, as well as with millions of other substances?听 Yet, it will 鈥渞emember鈥� only the salt that the homeopath added?听 And what will it do with that memory?听 Imprint it on a sugar pill?听 And then somehow, as the water evaporates, for the final pill contains no water, that imprint is left behind, unaffected by whatever impurities the sugar may have contained, or by the sugar molecules themselves. A patient then swallows this pill with water that must harbour all kinds of molecular images with which it was stamped as it rampaged through rivers, flowed over waterfalls and was flushed down toilets, including that of salt.听 When the pill enters the stomach, the sugar dissolves, and somehow the aura of the salt it had carried is liberated.听 This aura must be different from all the other auras of salt that cruise through our body generated by the salt we eat, otherwise there would be no need for the homeopathic version.听 And then what happens?听 Does this aura multiply so that it can be carried around the bloodstream so that it can get to where the problem is?听 And once it gets there, how does it perform a therapeutic function?听 If there is to be some benefit, there must be some sort of biochemical change, since everything that happens in the body is the result of some sort of chemical activity.听 So we must therefore conclude that this baffling, mysterious aura of salt, devoid of any mass, devoid of any evidence for its existence, has engaged in a chemical reaction.听 Isn鈥檛 all that a little hard to swallow?
Homeopaths retort by saying that just because science can鈥檛 explain how homeopathy works doesn鈥檛 mean it can鈥檛 work.听 They routinely criticize the 鈥渕echanistic鈥� nature of science, yet take every opportunity to cloak themselves in its garb when it suits their purpose.听 Anytime there鈥檚 wind of some research that deals with the structure of water, as in the case of water molecules forming diverse clusters, homeopaths are quick to imply that this somehow supports 鈥渨ater memory鈥� and its healing effects.听 This is a plundering of science to support a nonsensical idea. Consider an analogy.听 Suppose you have a theory that the crowing of a rooster brings on the light of dawn.听 It flies in the face of everything known about science, but you are bent on proving you are correct.听 Then you come across a phenomenon known as sonoluminescene that can be readily reproduced in the laboratory.听 The sound of a high intensity ultrasonic horn immersed in a bubbly liquid causes some of the bubbles to burst and emit flashes of light.听 You then rationalize that since it has been demonstrated that sound can produce light, it is possible that the crowing of a rooster brings on the light of dawn.听 Obviously a preposterous conclusion.听 As preposterous as suggesting that infinitely diluted solutions have some sort of healing ability because some esoteric experiments have demonstrated that water molecules can form clusters for tiny fractions of a second before they rearrange themselves to form a new pattern.
Admittedly, one can wade through the scientific literature and find studies that support patients benefitting from homeopathic treatments, although the majority of these tend to be published in homeopathic journals.听 Curiously these journals never seem to report negative studies of homeopathy.听 Are we to conclude that every study undertaken by homeopaths produces a positive result?听 In any case, the question isn鈥檛 whether some patients benefit from homeopathy, the question is why.听 The homeopathic rationale of course is that extremely diluted and succussed solutions trigger a physiological response.听 I鈥檝e already discussed the unlikelihood of such an effect, but here鈥檚 a further question.听 Have manufacturers of homeopathic remedies carried out studies on the effectiveness of diluted but not succussed solutions?听 Or the effectiveness of different dilutions?听 If so, why have they not published the data?
I do not feel the need to deal further with Mme Beaulieu鈥檚 dubious defense of the ability of nonexistent molecules to cure disease, or with her menacing insinuations.听 But I will repeat the challenge I presented in one of my columns.听 I propose that the 鈥淪yndicat des homeopathes鈥� be given ten unlabeled vials of homeopathic remedies along with a list of what these are.听 Let the members of the Syndicat use any means they desire to identify the contents of the vials.听 If they can do this, we will entertain the possibility that homeopathic medications may have some efficacy other than the placebo effect.听 Any suggestion that homeopathic pills contain some sort of 鈥渧ital force鈥� that is not scientifically measurable is unacceptable.听 That excuse amounts to sloppy thinking sprinkled with magic dust.听 Magical thinking of course is not limited to homeopathy, most of alternative medicine is permeated with it.听 Richard Dawkins in an episode of the outstanding series 鈥淓nemy of Reason鈥� brilliantly dispels the magic with science. (18)听 A 鈥渕ust see鈥� not only for Mme Beaulieu but for everyone!
Finally, it is incumbent on those making a claim to provide the appropriate supporting evidence, and obviously homeopaths do claim that their preparations have some sort of therapeutic activity.听 Since we can assume that there is no universal homeopathic remedy, the preparations must differ from each other.听 And of course, according to their labels, they do.听 Therefore we can conclude that a failure to identify the contents of the unlabeled vials in the proposed experiment means that the medications are in contravention of Canadian labeling laws.听 Furthermore, since the label lists ingredients that cannot be shown to be present, homeopaths must be prescribing remedies that are falsely labeled.听 How does one even know whether one is getting an 鈥渁ctive鈥� homeopathic remedy or a fake?听 Then again, does it really matter? I would suggest that supporters of homeopathy reflect upon the words of Isaac Newton, perhaps the greatest scientist who has ever lived: "We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances.鈥澨� This can be rephrased as other things being equal, a simpler explanation is better than a more complex one.听 Isn鈥檛 it more reasonable to attribute the finding of a coin under the pillow to a loving parent than to the tooth fairy?听 Isn鈥檛 it more reasonable to attribute the benefits of homeopathy to the placebo effect triggered by caring practitioners than to mythical molecular auras? Perhaps Mme Beaulieu can take some time and cogitate on these matters so that next time questions are raised about the benefits of homeopathy she is less inclined to fire off discourteous letters that do no more than serve as a testimonial to a lack of scientific acumen and critical thinking.
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