In this case, homeopaths from the Department of Homeopathy at the University of Johannesburg (seriously, a Department of Homeopathy?) in South Africa recently published a study that claimed a concoction of homeopathic potions, in pill form, treats tonsillitis, an infection and inflammation of a set of lymph nodes called tonsils in the back of the throat, better than a placebo. The researchers concluded that “the homeopathic complex used in this study exhibited significant anti-inflammatory and pain-relieving qualities in children with acute viral tonsillitis.”
Convincing conclusion. That’s it, next time my children have tonsillitis, I’m going to run down to my local homeopathic lotion and potion magician, and I’ll buy out the store.
Or maybe not. I’ll probably save my money from lining the pockets of that homeopathic wizard, and I’ll send the kids to a real physician who practices evidence-based medicine. And get real treatment.
Why am I so negative about a real peer-reviewed study published in a medical journal? For lots of reasons.
What is homeopathy?
The pseudoscience of homeopathy requires some explanation, but don’t be confused by a lot of science-sounding words, because all pseudoscience tries to misdirect us by using various feints, especially technical jargon. Firstly, many people, mostly Americans, conflate homeopathy with natural medicine, like herbal medicine. It isn’t.
Basically, homeopathy, known as the “law of similars”, relies on belief that “let like be cured by like”, and is a term coined by Samuel Hahnemann, a German physician who was appalled by the state of medicine at the time, the late 1700’s. And frankly, the state of medicine at that time was pretty bad, so any new idea might have been worthy of being a big improvement over medicine of that time. However, when Hanneman was alive, basic scientific knowledge was missing. Cell theory and germ theory were a few decades from becoming a part of the foundation of modern medicine.
Homeopathic potions are prepared by serially diluting the original substance (could be anything from diseased tissue to arsenic to snake venom plus mercury) with shaking by forceful striking on an elastic body, which they term succussion. Each dilution, followed by succussion, is assumed to increase the effectiveness. Homeopaths call this process potentization. So far, it’s just merely diluting and shaking, so nothing much there. But the level of dilution is such that there is only a tiny possibility of any molecule of the original substance showing up in solution.
The dilution is precisely described by Hahnemann. The first dilution is one part to 100 parts water. Then, one part of that is diluted in another 100 parts water. Each dilution is called 1C, so two dilutions would be called 2C, with one part of the similar diluted in 10,000 parts water. But it doesn’t stop there. Homeopathy uses >30C dilutions, which means that the dilution is simply water. At 30C, the dilution is now 1 part substance to 10^60 (or 10 followed by 60 zeroes) parts water. You would need to drink 10^34 (or 10 followed by 34 zeroes) gallons of water (which is about 10 billion times the amount of water on earth) just to get one molecule–one single molecule of the original substance. Now diluting substances to create a physiological response is a well known, evidence based method in medicine. For example, allergy hyposensitization uses extremely diluted antigens (say cat dander), while slowly increasing the concentration to build a tolerance to the immune response. But the dilution is substantially higher, maybe 1-2C at most–in other words, there’s billions upon billions of molecules of the antigen in solution.
So, then the homeopaths overcome this mathematical issue by stating that water has a memory. This claim is based on a long-disputed, unrepeated, and basically, disregarded experiment. Every attempt to repeat the experiment, in a double blinded manner, was a failure; so at some point, you have to say, “no it doesn’t work.” And of course, there is just no evidence that it might work.
In case this isn’t clear, there is substantial clinical evidence that homeopathy absolutely doesn’t work.
One of the most important analytical skills one should use in examining any clinical study is to ask, “is this plausible?” Can a substance, so diluted that there is no chance any of the molecules of the target substance remain in the preparation, really have a clinical effect if it’s not even there? Can water have a memory?
The former relies on simple mathematics, which tells me that there are no molecules (or so few that it would have no effect). It’s almost impossible to overcome this issue. The latter, water memory, relies on a ridiculous notion that a water molecule has some memory of the substance that induces some sort of clinical effect. If water has a memory, and let’s recall that water is simply 2 atoms of hydrogen bonded to 1 atom of oxygen, then we need to rewrite the whole quantum mechanics of molecules, Nobel Prize worthy research.
Water memory is so implausible that if you try to imagine that it happens, you’d have to discard the fact that water molecules are generally around 14 billion years old (give or take), and they have seen and been in contact with everything that ever happened in the universe, and every step of biological evolution on earth. So 3 atoms must remember being on a comet, bacteria, dinosaurs, mastodons, and everything else. It also runs across every pollutant and everything that ever existed on earth. So these magicians, I mean homeopaths, think that they can control water’s memory to only remember what they want?
Moreover, why don’t we have homeopathic fuel for our cars? That would be an easy experiment–pour homeopathic gas into my car and if it runs, I will write the longest apology ever about homeopathy. What about homeopathic food? We could solve world hunger with just a few shakes of a vial of water. Maybe I can get some homeopathic gold and pay all my bills?
Are they going to convince us that homeopathy only works on medicine? So, this is a self-limited magic?
This gets so implausible, if not outright impossible, that homeopathy is essentially on the FBI’s most wanted list for violating Occam’s razor.
If homeopathy want to establish scientific respectability, then those who “believe” in it need to stop. They need to show how every chemist, physicist, biochemist, and physical chemist is wrong about the essential nature of atoms and molecules with real research, without resorting to logical fallacies, like special pleading, that demands we ignore scientific facts and just believe them.
Back to the “clinical trial” and tonsillitis
So despite homeopathy being a true pseudoscience with nearly zero chance that it’s scientifically plausible, we do have this clinical trial that appears to show that some homeopathic potion can treat viral tonsillitis. This is so easy, I’ll type with one hand behind my back.
- This was a so called “pilot study” which included 30 children aged 6 to 12 years, with acute viral tonsillitis. That is a tiny group, smaller than what’s used in real Phase 1 or 2 clinical trials, the first steps in real medications getting real approval to sell for real diseases. But to be fair, the authors did state that “these preliminary findings are promising; however, the sample size was small and therefore a definitive conclusion cannot be reached. A larger, more inclusive research study should be undertaken to verify the findings of this study.” The one truthful thing they wrote
- The bias of the authors is extreme. They state, right at the beginning of the paper, that they believe that homeopathy is useful in treating all kinds of respiratory tract infections. So, they think this will be successful before they start the study. Admittedly, this can be an issue with any researcher, but that’s why medicine relies upon large double-blind clinical trials, a method that really reduces bias.
- The experimental design is extraordinarily poor (but typical of almost any alternative medicine study). Setting aside the size of the study, the homeopathic study group was compared to a placebo. But this isn’t as important as you would think–the study needed to be compared to standard medical care. Because you might observe better results for the experimental group, just through bias or random chance, but is it clinically significant? Only when it’s compared to the standard treatment can you conclude that it’s effective. The fact is that tonsillitis, though painful, is generally self-limiting–the infection and inflammation general resolves itself after a few days. The researchers didn’t show that.
- The study was published in the Journal of Alternative and Complementary Medicine, which, based on the hierarchy of evidence, ranks near the bottom. The impact factor for this journal is 1.518, which is ridiculously low, and that’s before I remind you that the journal is cited frequently in real journals when its published research is refuted and debunked by higher impact journals. If these researchers actually had real evidence that could stand up to scrutiny of real science, they would publish it in a real journal, like Pediatrics, because it would be the basis of a new way to treat a child with tonsillitis.
- Their statistical analysis was amateurish and worked hard to show that the magical homeopathic potion had some real effect. They claimed statistically “significant” but they didn’t show it.
As renowned homeopathy skeptic and critic, Edzard Ernst, stated:
I think that, in order to agree that a homeopathic remedy generates effects that differ from those of placebo, we need a proper (not a pilot) study, published in a journal of high standing by unbiased scientists.
I look forward to real clinical data published in a real journal by real scientists that would show that any homeopathic potion action works. But before then, I’d really want to have thorough and convincing evidence that homeopathy was plausible. Because absent plausibility and absent real clinical data, homeopathy just isn’t real medicine. It’s just a magical belief that requires the reader to suspend acceptance of all that we know about basic science to accept the homeopath’s beliefs and pleas.
And I await my homeopathic fuel. Wow, we could solve climate change, economic distress, and building a pipeline across America with homeopathic fuel. I’m sure Big Oil is just suppressing the evidence for this new fuel.
- Malapane E, Solomon EM, Pellow J. Efficacy of a Homeopathic Complex on Acute Viral Tonsillitis. J Altern Complement Med. 2014 Sep 19. [Epub ahead of print] PubMed PMID: 25238506.