The false promise of false science: Homeopathy as pseudoscience

By: on January 21, 2013 |

Status where status is not due

“By granting self-regulation, we’re attesting, as elected representatives, to the public that we believe the practices that will be engaged in by professionals are safe and that they’re effective and that they meet the highest possible standard.

The above statement was made earlier this year by the Alberta Health Minister, Fred Horne, during a press conference to announce the granting of regulated status to naturopaths. The mood at the press conference, which received a good deal of coverage, appeared to be upbeat and positive. It was portrayed as a good-news story. It was, apparently, a victory for those who want more health-care options. It was a victory for patient choice, autonomy and open-mindedness.

My reaction was somewhat less than positive.

The granting of regulated status – which includes the creation of the College of Naturopathic Doctors of Alberta – may seem a relatively benign political act. It will lead to more standardization and, I guess, promote safety.

However, it may also foster a misunderstanding about the services provided by these practitioners. It may create the impression that the therapies are supported by good science. It casts a veil of legitimacy over the work of naturopaths and, one could argue, implies that all services that are offered are efficacious. Indeed, Minister Horne was explicit. He said that the granting of self-regulation demonstrates to the public that the Alberta government “believe[s] the practices … [are] effective.”

Really?

Welcome to the world of pseudoscience

Allow me to lay my admittedly love-of-science-rant-tainted cards on the table. In general, the services provided by naturopaths reside either in the realm of commonsense lifestyle advice (get lots of sleep, eat well and stay active!) or they

have little empirical evidence to support their use. In fact, many naturopathic practices are based on a semi-spiritual theory (the healing power of nature) and have no foundation in science. They reside largely in the realm of pseudoscience.

Am I being too harsh? I recently worked with a University of Alberta colleague on an analysis of the web sites for the naturopaths in Alberta and British Columbia. We wanted to get a sense of what is being offered to the public. In Alberta, the number-one most commonly advertised service is homeopathy.

Homeopathy has been around for hundreds of years. The basic philosophy behind the practice is the idea of “like cures like.” A homeopathic remedy consists of a natural substance – a bit of herb, root, mineral, you get the idea – that “corresponds” to the ailment you wish to treat. The “active” agent is placed in water and then diluted to the point where it no longer exists in any physical sense.

In fact, practitioners of homeopathy believe that the more diluted a remedy is, the more powerful it is. So, if you subscribe to this particular worldview, ironically, you want your active agents to be not just non-existent, but super non-existent.

The bottom line: For those of us who reside in the material world, where the laws of physics have relevance, a homeopathic remedy is either nothing but water or, if in capsule form, a sugar pill.

How homeopathy conflicts with the laws of physics and chemistry

Of course, “like cures like” and super dilution have absolutely no foundation in science. There is no evidence to support the idea that the active agents – the herb, root, mineral – correspond in any biologically meaningful way to the particular ailments that the homeopathic treatments are meant to treat. (One popular homeopathic web site nicely illustrates the ridiculous nature of this idea by saying, “[I]f the symptoms of your cold are similar to poisoning by mercury, then mercury would be your homeopathic remedy.”

Of course, the idea that a super-diluted solution could have some measurable impact on our bodies conflicts with the known laws of physics and chemistry. If a homeopathic solution contains no true ingredients, how can it have a physical impact on the body? (This is not the same thing as using a vaccine, where there is an actual biologically active agent present that interacts with our immune system.)

One might argue that, sure, from a scientific perspective, homeopathic remedies sound silly, but who cares if perhaps in some instances they do work?

What does the clinical evidence actually say?

Here’s why: Because despite claims to the contrary, there are hundreds of studies on homeopathy. What the good research consistently tells us is that homeopathic treatments do not work any better than placebos do.

For example, a 2002 systematic review – a rigorous analysis of all available evidence – concluded that the best available evidence “does not warrant positive recommendations for its use in clinical practice.” A 2010 review of the “best evidence” concluded that homeopathic remedies have no “effects beyond placebo.” Even the U.S. National Institutes of Health National Center for Complementary and Alternative Medicine, an entity that has a specific mission to be open-minded about unconventional treatments, concluded, “[t]here is little evidence to support homeopathy as an effective treatment for any specific condition.”

To be fair, there is observational evidence that suggests that patients who seek out homeopathic remedies often feel better, but research tells us that, as with many alternative treatments, this is likely nothing more than the placebo effect – which is, no doubt, a powerful force.

In summary: There is no evidence that homeopathy works, and given the absurd nature of the proposed mechanism of action, no scientifically plausible reason that it should work.

Some might argue it is unfair to analyze homeopathy and use that to critique naturopaths. Homeopathy is a “treatment” so obviously devoid of scientific merit that it is consistently mocked on TV shows, by comedians and, of course, by skeptics.

Welcome to bogus treatment endorsed by a pandering government

Nevertheless, for naturopaths, homeopathy is not some fringe practice utilized by a few rogue clinics that have decided to shun modern science. Homeopathy is central to naturopathic medicine. The web site for the newly formed Alberta college has a picture of an attractive naturopath dispensing what looks to be a homeopathic solution. The text under the picture proudly notes the use of homeopathy. The president of the new college reiterated this message in the speech he delivered after Minister Horne gave his speech. And, of course, it is a practice that is taught in Canada’s leading school of naturopathic medicine.

When Minister Horne tells the world that the Alberta government believes that the practices of naturopaths are effective, he is talking about homeopathy. This is not implied legitimization of a bogus treatment; this is official and overt legitimization of a bogus treatment.

Every time I speak or write about the pseudoscientific nature of homeopathy, I elicit one of three reactions. Reaction one: It is alleged that homeopathy does work (this is usually in the form of “It worked for me!”) and that I must be in the pocket of Big

Pharma. Two: It is noted that many remedies provided by conventional doctors also do not work any better than placebos do, and I must be in the pocket of Big Pharma. Three: I must be in the pocket of Big Pharma.

These arguments do not take us very far down the road of rational debate. To simply assert something works does not make it so. Moreover, personal experience is the most unreliable form of evidence. Indeed, in many ways, the scientific method was developed to fight the perverting influence of personal perceptions.

“Big Pharma” and “Big Naturopath”: Both have vested interests

The claim that many conventional therapies are ineffective is absolutely true. And pharmaceutical interests – and, for that matter, other corporate interests – have had a terrible impact on the way evidence is produced and used. Many forces and vested interests twist what we hear about biomedical research but embracing unproven therapies does not help this situation. On the contrary, it moves health-care policy in the wrong direction – further away from science and empirically provable, efficacious and safe treatments.

The public should not forget that many special interests also exist in the context of homeopathy and naturopathic medicine. The makers of homeopathic remedies want to turn a profit just as much as any pharmaceutical company. After all, homeopathic solutions are not made by water fairies and distributed free of charge. Nor do naturopaths donate their time and services.

How to puncture bias and vested interests: Return to the scientific method

There are biases and vested interests everywhere. One should be aware of these biases, but their existence does not help prove that homeopathy works. In fact, the concern with vested interests should push us toward, not away from, a reliance on the scientific method. It is the use of carefully constructed scientific studies and the dispassionate assessment of available data that will ultimately tell us what works – whether we are talking about conventional or alternative therapies.

Many caring and thoughtful alternative practitioners will likely continue to assert that homeopathy is effective, but the argument that 2+2=5 is still incorrect no matter how sincere, caring and “holistically” motivated the proponent. The values or disposition of the proponent may be relevant to questions of bias, but not, in the end, to whether a claim of efficacy is accurate.

I do not know if my arguments will convince a single person to stop using homeopathy. Homeopathy is a faith-informed practice and, as such, largely impervious to rational argumentation. No amount of evidence (and there is a mountain of it) will convince advocates that homeopathy is merely water. But I do hope that, in the future, provincial governments across Canada will take more care in the way they address these regulation issues – that is,  unless they wish to abandon evidence-based approaches to health care and embrace the supernatural and pseudoscientific.

~

Timothy Caulfield is the Canada Research Chair in Health Law and Policy; a professor in the Faculty of Law and the School of Public Health, University of Alberta; and the author of The Cure for Everything: Untangling the Twisted Messages about Health, Fitness and Happiness. Twitter: @CaulfieldTim


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About Timothy Caulfield

10 thoughts on “The false promise of false science: Homeopathy as pseudoscience”

  1. Holodoc says:

    Interesting article but I think you are using the arguement that homoeopathy has no basis in science as an attempt to discredit naturopathy and natural methods of healing.  As you can see from below I totally disagree with your arguements for the reasons stated. This was published on Canadian Healthcare Network online in 2012.

    Homeopathic Remedies Are Diluted to the Point Where They Are No More Effective Than Placebos.
    “Either homeopathy works or controlled trials don’t!”  Scottish researcher David Reilly at the 2001 Harvard Medical School Complementary and Integrative Medicine Conference.
     
    Disclaimer: I am not a homeopath, nor do I presently practice homeopathy.  In the past I have published negative research regarding homeopathy (See Chronic Fatigue Syndrome: Do Herbs or Homeopathy Help? A Report of Six Cases. Leyton ER, Pross H. Canadian Family Physician 1992; 38:2021-2026).
     
    I am taking the position against the statement because there is sufficient research to support homeopathy as a bono fide treatment modality.  The title of this article simply cannot be supported by current scientific research results.   There are countless references in the mainstream literature to show homeopathy is effective over and above placebo.  (See for example: http://www.bmj.com/content/321/7259/471.full ).  Reilly’s commentary from this BMJ article says it well and the figure below is an example of the effect:
     
    “Recent attempts to resolve the controversy surrounding homoeopathy have centred on the 180 or so controlled trials to date. A criteria based review in 1991 found that the evidence was positive but not conclusive. In a 1997 update, other workers concluded that 73% of the existing trial data supported homoeopathy being more effective than placebo, with the pooled odds ratio from a criteria based meta-analysis of 89 trials suggesting homoeopathy showed around twice the overall mean effect of placebo. The difference was significant and proved robust in sensitivity analyses that included correction for publication bias.  A third working group, independently set up by the European Commission, selected 17 comparisons in 2001 patients for a meta-analysis. The pooled P value was highly significant, and the group commented that “it is likely that among the tested homeopathic approaches some had an added effect over nothing or placebo.”
     
    Mean (SE) weekly change from baseline in nasal inspiratory peak flow in allergic rhinitis

     
     
     
     
     
     
     
     
     
     
     
     
     
    There are a couple of questions to consider when thinking about any method of treatment: The first is does the treatment work; and the second is how does it work?  In medicine the former question is often the one considered most important, and the latter often relegated to the back burner.  This is not an unreasonable ordinal, but in the case of the homeopathic model the fact that we do not know exactly how the treatment works has for some reason become a reason not to use it.  This is akin to saying that because we cannot see subatomic particles that they do not exist, and that thereforewe should not utilize quantum theory!
     
    Can a very small dose of something prevent an illness from happening?  Of course –  immunization seems to work; small doses of alcohol can prevent heart disease; small amounts of vitamins and minerals are essential for life; there is now low dose therapy for advanced cancers (Satti in Dose Response 2009 PMID:19809540), and most of us support these ideas.  Can a very small dose of something prevent or even cure in illness?  Of course – homeopathy – what??!!!  Although the same principles apply there is often a very different, frequently emotional, reaction from the scientific community.  And scientists are supposed to be rational.
     
    Homeopathy relies on the premise that “like cures like” – historically a phenomenon that was observed by Samuel Hahnemann in the 19th century.  He found that when a substance known to produce symptoms similar to a disease is diluted sufficiently, that it actually had the opposite effect of inhibiting the disease process.  This observation has been challenged, vehemently in some cases, over the last 300 years, sometimes to the point of an almost hysterical denial that such a phenomenon could even exist.  Yet, in the last 10 years the concept of hormesis has gained attention both in the world of toxicology and medicine.  Hormesis is a phenomenon in which low doses of a substance can stimulate and high doses inhibit, and is challenging the predominant dose-response laws that have dominated pharmacology for several centuries and have never really been validated.  Calabrese, the researcher credited with most of the hormesis research in the last 15 years has argued that certain types of homeopathic medicine may represent a form of hormesis. (Calabrese in Hum Exp Toxicol 2010 PMID20558600).  However, that being said, this might only explain the low dilution type of homeopathy where some of the substance in the remedy is still present, although others have published in vitro studies to show otherwise. (Ive EC in Int. J. Mol. Sci 2012)
     
    It is probably well past time to even question whether low dilution homeopathy actually works and perhaps even whether high-dilution homeopathy works.  The peer published evidence for homeopathy is considerable, and any reasonable scientist would recognize that such an effect exists based on standard procedures such as clinical trials, meta-analyses, comparing homeopathic versus conventional treatments, and the efficacious effects of homeopathic treatments for hay fever, asthma, and other illnesses.  Perhaps the most remarkable research has been done by David Reilly who has consistently shown in double-blind placebo controlled studies, published mostly in the Lancet and BMJ (see reference above), that there is a homeopathic effect beyond placebo.  By most standards if such research had been published on medication, everyone would be using it.  Such is not the case however with homeopathic research about which some people remain entirely skeptical, simply because they cannot conceive of something with lesser dose having more effect.
     
    Rational scientists must put aside, finally, the idea that homeopathy doesn’t work.  The evidence is simply overwhelmingly in favour of it, and now supported by the very conventional research of hormesis.  When it comes to high dilution where none of substance originally present remains and has been diluted below Avogadro’s number, I can certainly see how skepticism might still prevail.  However, Reilly’s work on homeopathy has used dilutions beyond Avogadro’s number and still found differences beyond placebo.  Benveniste published his findings on high dilution in the 1980s.  He was then promptly subjected to Nature Journal’s desperate and relentless invasion on his laboratory with magicians and fraud-busters.  This highly respected researcher was denigrated and ostracized as a result of finding something unusual.  This attitude is prevalent in medical circles of course.  Around the time of homeopath Samuel Hahnemann, a physician by the name of Semmelweis suggested that washing hands would be helpful in surgery to reduce puerperal infection. Despite various publications of results where hand-washing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community, simply because Louis Pasteur had not discovered bacteria!  It has always seemed strange to me that opponents of homeopathy use the argument that it is no better than placebo.  What is a placebo?  In short, at least in clinical trials, it’s a sugar pill that contains nothing and has a profound effect sometimes upwards of 30% on healing!  Pretty powerful for something that has ‘nothing’ in it!  The hubris and short-sightedness of medical doctors and scientific research is sometimes just too much to take seriously.  It has done much damage to the progress of medicine and our understanding of disease in illness.  Let rational minds prevail – let homeopathy stand!
     
    Edward Leyton MD FCFP CGPP is a Kingston ON physician practising Integrative Medicine since 1978.  He uses the placebo effect extensively in his practice.

    1. Brown says:

      Using the placebo effect effectively is good medicine.  High-dilution homeopathy is something else again– and it doesn’t help that the author  here doesn’t realize that bacteria were discovered long before Pasteur.  Given publication bias effects (see also ‘parapsychology’) this kind of meta-review of the literature is not a particularly reliable basis on which to judge effectiveness of homeopathy, especially in  the high-dilution case where not a single molecule of the ‘active’ ingredient remains.  Water with memory is a pretty scary idea, really, given how water gets around…

  2. Yet another totally poorly researched, biased, false presentation against homeopathy. 
    After years and years of hearing the same-old arguments against homeopathy, homeopaths, naturopathic doctors and other scientists got together and actually conducted many double-blind, rigorous studies with very credible scientific research establishments and have shown, repeatedly, that homeopathy does work significantly better than placebo effect. 
    please watch this debate between Dr. Andre Saine, Naturopathic Doctor and Homeopathy, vs Joe Schwarz, PhD: 
    http://www.youtube.com/watch?v=T2uBBU4XT7Y&feature=share

    Joe is a leading “quackwatch” chemist, who has hated homeopathy since his momma brought him into this world. He’s been saying, “where’s the evidence for homeopathy” for 2 decades. Dr. Saine presented to him many significant scientific results and Schwarz just dismissed it… saying “Let’s not compare papers with papers.” Why? Because, like Timothy Caulfield, he is not a true scientist. A true scientist studies his subject thoroughly before writing  about it.
    Timothy could not have done a thorough research as he missed ALL of the scientific papers out there that prove homeopathy is more than placebo. There are dozens of them. 

    With nano particles being observable in the medicines, reproducibly, we also know that homeopathy is more than just water. 
    Not to mention all the cures… countless cures of very chronic, difficult cases forsaken by the medical establishment. 
    But Caulfield isn’t interested in truth, as a true scientist would be. 
    He’s biased and using inaccurate, false arguments to forward his agenda. 
    this is not science. 

    Homeopathy is a strange medicine. it makes people look outside of the box, and challenge their model of medicine.
    It is based on scientific principles that are observable, reproducible, and perform wonderfully when applied properly in practice. 
    But if one cannot get past the dogma of Chemistry 101, they will wrestle here with Homeopathy, as Caulfield has done. 
    This is not a well written, well studied article. 
    THIS is pseudoscience in its exact form. 

    To add to Caulfield’s total lack of credibility in this topic, this article has a banner of an acupuncture doll posted from Traditional Chinese Medicine, which is about as well related to homeopathy in medicine as an emu is related to a duck. 
    That would be like writing a paper about football and using a picture of golf as a banner. 

    People, think for yourselves. Go do the research and study for yourself. 
    Homeopathy is a real medicine with real results, both in the clinic, and the scientific research. 

    Moshe Daniel Block, ND, HMC

  3. Yet another totally poorly researched, biased, false presentation against homeopathy. 
    After years and years of hearing the same-old arguments against homeopathy, homeopaths, naturopathic doctors and other scientists got together and actually conducted many double-blind, rigorous studies with very credible scientific research establishments and have shown, repeatedly, that homeopathy does work significantly better than placebo effect. 
    please watch this debate between Dr. Andre Saine, Naturopathic Doctor and Homeopathy, vs Joe Schwarz, PhD: 
    http://www.youtube.com/watch?v=T2uBBU4XT7Y&feature=share

    Joe is a leading “quackwatch” chemist, who has hated homeopathy since his momma brought him into this world. He’s been saying, “where’s the evidence for homeopathy” for 2 decades. Dr. Saine presented to him many significant scientific results and Schwarz just dismissed it… saying “Let’s not compare papers with papers.” Why? Because, like Timothy Caulfield, he is not a true scientist. A true scientist studies his subject thoroughly before writing  about it.
    Timothy could not have done a thorough research as he missed ALL of the scientific papers out there that prove homeopathy is more than placebo. There are dozens of them. 

    With nano particles being observable in the medicines, reproducibly, we also know that homeopathy is more than just water. 
    Not to mention all the cures… countless cures of very chronic, difficult cases forsaken by the medical establishment. 
    But Caulfield isn’t interested in truth, as a true scientist would be. 
    He’s biased and using inaccurate, false arguments to forward his agenda. 
    this is not science. 

    Homeopathy is a strange medicine. it makes people look outside of the box, and challenge their model of medicine.
    It is based on scientific principles that are observable, reproducible, and perform wonderfully when applied properly in practice. 
    But if one cannot get past the dogma of Chemistry 101, they will wrestle here with Homeopathy, as Caulfield has done. 
    This is not a well written, well studied article. 
    THIS is pseudoscience in its exact form. 

    To add to Caulfield’s total lack of credibility in this topic, this article has a banner of an acupuncture doll posted from Traditional Chinese Medicine, which is about as well related to homeopathy in medicine as an emu is related to a duck. 
    That would be like writing a paper about football and using a picture of golf as a banner. 

    People, think for yourselves. Go do the research and study for yourself. 
    Homeopathy is a real medicine with real results, both in the clinic, and the scientific research. 

    Moshe Daniel Block, ND, HMC

  4. Yet another totally poorly researched, biased, false presentation against homeopathy. 
    After years and years of hearing the same-old arguments against homeopathy, homeopaths, naturopathic doctors and other scientists got together and actually conducted many double-blind, rigorous studies with very credible scientific research establishments and have shown, repeatedly, that homeopathy does work significantly better than placebo effect. 
    please watch this debate between Dr. Andre Saine, Naturopathic Doctor and Homeopathy, vs Joe Schwarz, PhD: 
    http://www.youtube.com/watch?v=T2uBBU4XT7Y&feature=share

    Joe is a leading “quackwatch” chemist, who has hated homeopathy since his momma brought him into this world. He’s been saying, “where’s the evidence for homeopathy” for 2 decades. Dr. Saine presented to him many significant scientific results and Schwarz just dismissed it… saying “Let’s not compare papers with papers.” Why? Because, like Timothy Caulfield, he is not a true scientist. A true scientist studies his subject thoroughly before writing  about it.
    Timothy could not have done a thorough research as he missed ALL of the scientific papers out there that prove homeopathy is more than placebo. There are dozens of them. 

    With nano particles being observable in the medicines, reproducibly, we also know that homeopathy is more than just water. 
    Not to mention all the cures… countless cures of very chronic, difficult cases forsaken by the medical establishment. 
    But Caulfield isn’t interested in truth, as a true scientist would be. 
    He’s biased and using inaccurate, false arguments to forward his agenda. 
    this is not science. 

    Homeopathy is a strange medicine. it makes people look outside of the box, and challenge their model of medicine.
    It is based on scientific principles that are observable, reproducible, and perform wonderfully when applied properly in practice. 
    But if one cannot get past the dogma of Chemistry 101, they will wrestle here with Homeopathy, as Caulfield has done. 
    This is not a well written, well studied article. 
    THIS is pseudoscience in its exact form. 

    To add to Caulfield’s total lack of credibility in this topic, this article has a banner of an acupuncture doll posted from Traditional Chinese Medicine, which is about as well related to homeopathy in medicine as an emu is related to a duck. 
    That would be like writing a paper about football and using a picture of golf as a banner. 

    People, think for yourselves. Go do the research and study for yourself. 
    Homeopathy is a real medicine with real results, both in the clinic, and the scientific research. 

    Moshe Daniel Block, ND, HMC

    1. Brown says:

      This is pretty dubious, absent a clear explanation of how molecules that are no longer present have somehow left a trace (a causally efficacious trace) in the water or sugar pill that’s given to patients.  A real reference or two here would be the minimum price of entry for me.  List a study- or five- showing good controls, and a statistically significant difference in outcomes.  Good controls should be easy to do here, too: hand out pure distilled water and / or pure sugar pills to patients (with the ND unaware of which is which) and see if patients receiving ‘real’ homeopathic remedies really do better.  Oh– and make sure you have independent documentation of the blinding procedure (my trust wears thin when it comes to ideas so patently implausible). 

    2. Andrew Laliberte MTL says:

      There isn’t one positive controlled double blind study that has been replicated to prove that homeopathy works. Before you start lecturing intelligent people who use the scientific method, i suggest you take a class so you can learn how to read a study. Once you do, read this systematic review http://www.ncbi.nlm.nih.gov/pubmed/20402610 by Edzard Ernst. So you know this review has no bias against homeopathy, Ernst specializes in the study of complimentary and alternative medicine. Since i’m feeling generous today, ill pass along another pointer. A youtube video ins’t a proper source. Have a nice day!

  5. Adam McInnes says:

    If water has a memory, how does a homeopath clear the old memory of water in order to create their homeopathic treatment? And if homeopathy could cure, why doesn’t tap water do the same? It has been distilled, succussed over many minerals, through plants and animals, in various ecosystems, etc. and diluted in the process. And what form does this memory take? I know of no evidence, or even a theory of how water could have a memory, especially to the exclusion of other compounds, molecules or elements.

  6. Abcd Escu says:

    What about the Royal Family using homeopathy?

  7. Caitlin says:

    References should have been used to make this article more credible and reliable. One cannot deduce whether this information has grounds to it or not. The most credible articles are those developed by the unbiased- unfortunately this is not one of them.

Comments are closed.