A bad week for homeopathy is a good week for science

Whenever I write about homeopathy, I have a hard time feeling as though it’s too much like shooting fish in a barrel. After all, how often can we make the same jokes about water and dilution making various things stronger? On the other hand, homeopathy is about as close to the perfect pseudoscience as there is in that it really is nothing being represented as something, an ineffective treatment being represented as real medicine, and that makes it a perfect subject for teaching skepticism. It’s also why I have a hard time resisting commenting about homeopathy when it’s in the news.

For instance, just yesterday:

A major taxpayer-funded centre for homeopathic, herbal and alternative medicines will no longer be providing these remedies on the NHS after health service chiefs said homeopathy was “at best, a placebo”.

The Royal London Hospital for Integrated Medicine (RHLIM), formerly the Royal London Homeopathic Hospital, describes itself as the “largest public-sector provider of integrated medicine in Europe”.

Integrated medicine centres offer alternative remedies, such as acupuncture and herbal medicines, alongside more evidence-backed interventions such as cognitive behavioural therapy, for managing conditions like pain and insomnia.

Policy changes by NHS commissioners in London will now end funding for those without robust evidence, in line with national guidance.

This is, without a doubt, a victory for science. I realize that there are historical reasons for it, but even so I had a hard time understanding how the UK could waste precious NHS resources on homeopathy. After all, remember the principles of homeopathy, which as a skeptic I am obligated to explain at least briefly the two “laws” of homeopathy. The first law is the law of similars, which states that you treat a symptom using something that causes that symptom. Of course, there is no physiologic, biochemical, or medical basis for such a principle, and in fact what the first law of homeopathy resembles more than anything else is the principles of sympathetic magic, specifically Sir James George Frazer’s Law of Similarity as described in The Golden Bough (1922) as one of the implicit principles of magic. Certainly, it doesn’t resemble anything “similar”—if you’ll excuse the use of the word—science or reason. I like to demonstrate this by quoting straight from The Golden Bough, something that I haven’t done in at least three years, which makes me think it’s a good time now:

If we analyse the principles of thought on which magic is based, they will probably be found to resolve themselves into two: first, that like produces like, or that an effect resembles its cause; and, second, that things which have once been in contact with each other continue to act on each other at a distance after the physical contact has been severed. The former principle may be called the Law of Similarity, the latter the Law of Contact or Contagion. From the first of these principles, namely the Law of Similarity, the magician infers that he can produce any effect he desires merely by imitating it: from the second he infers that whatever he does to a material object will affect equally the person with whom the object was once in contact, whether it formed part of his body or not. Charms based on the Law of Similarity may be called Homoeopathic or Imitative Magic. Charms based on the Law of Contact or Contagion may be called Contagious Magic.

Actually, although it is not explicitly a law of homeopathy, the Law of Contagion is very much a part of homeopathy. The reason is the second “law” of homeopathy, the Law of Infinitesimals. This law states that homeopathic remedies become stronger with dilution. Actually, the process of making a homeopathic remedy involves serial dilution, usually 1:100. The mother tincture (or original compound) is diluted 1:100 and then shaken vigorously (succussed), the succussion step being claimed to be necessary to “potentize” the remedy. After that, it’s diluted again in the same way. Each 1:100 dilution is designated by “C,” such that a 6C dilution equals six 1:100 dilutions. The problem comes with the higher dilutions. For instance, a 12C solution is on the order of a 10^-24 dilution ((10^-2)¹² = 10^-24). Many homeopathic remedies are on the order of 30C, which is a 10^-60 dilution, or more than 10³⁶-fold greater than Avogadro’s number. Some homeopathic remedies go up to 100C or more, or 10^-200. Here’s a hint: The number of atoms in the known universe is estimated to be around 10⁷⁸ to 10⁸². The math just doesn’t work, and remedies over around 12C are basically water. “Lesser” dilutions contain so little remedy that it’s highly unlikely that they have a pharmacological effect.

Which brings us to the Law of Contagion. Homeopaths, when it is pointed out that the math doesn’t work and homeopathy is water, will claim that water has “memory” of what it has been in contact with. Of course, water does not have memory, not in the way that homeopaths claim, which is a good thing. As sarcastic skeptics like to point out: What if water had memory of all the compounds it’s ever been in contact with? There’d be a heck of a lot of poop and urine in those memories! Basically, homeopathy is a system of medicine without scientific basis, which is why it’s good that the NHS is pulling back from funding it:

A patient leaflet from University College London Hospitals Foundation Trust, which RLHIM is part of, says: “From 3 April 2018, The Royal London Hospital for Integrated Medicine (RLHIM) will no longer be providing NHS-funded homeopathic remedies for any patients as part of their routine care.”

A statement on the RLHIM website said it would also “no longer be providing NHS-funded Herbal Medicine for any patients as part of their routine care”.

“This is in line with the funding policy of Camden Clinical Commissioning Groups, the local NHS body that plans and pays for healthcare services in this area,” the statement added.

Non-evidence backed treatments can still be purchased privately.

Which is as it should be. If you want to buy quackery like homeopathy, knock yourself out! Be ripped off! But don’t force me to pay for your foolishness through my tax dollars or insurance premiums. Kudos to The Good Thinking Society for its efforts in trying to eliminate NHS funding for homeopathy. Unfortunately, its work is not quite done. Although London joins much of the UK in not funding homeopathy through the NHS, apparently the UK is still wasting money on these disproven treatments are Bristol and Glasgow.

Still, stopping NHS funding for homeopathy at the Royal London Hospital for Integrated Medicine is huge in terms of symbolism. After all, this hospital has a long history with homeopathy. It was founded as the London Homeopathic Hospital in 1849 by one of the first doctors to practise homeopathy in Britain. Indeed, as a skeptic, when I visited London in 2007 for the first time since I was a teenager, I made sure to visit the London Homeopathic Hospital (its name hadn’t changed yet then) to have myself photographed next to it. I still use these photos in talks. It’s been a long battle, largely because the royal family has long been a fan of homeopathy, particularly Prince Charles, who has even claimed that homeopathy can be used to curb the problem of overuse of antibiotics in farm animals.

Even better, the hits just keep coming:

A journal paper claiming to show the success of a homeopathic treatment for cancer has been withdrawn by the publishers following a series of awkward discoveries – including the arrest of its two lead authors.

The paper, published in the journal Evidence-Based Complementary and Alternative Medicine, was retracted in late February after readers voiced concerns and a formal investigation flagged multiple ethical problems.

“Evidence-based complementary and alternative medicine”? I question whether there is such a thing, no matter how much advocates of “complementary and alternative medicine” (CAM)—now more commonly referred to as “integrative” medicine—claim there is.

So what were the authors trying to show, and what did they do? Let’s take a look:

The subject of the paper was “psorinum therapy” and its use in treating stomach, gall bladder, pancreatic and liver cancers. Psorinum is a peculiar favourite of homeopaths, described as a substance “prepared from the fluid of blisters from scabies infested skin”.

The website Homeopathy Plus says that people who need psorinum “usually lack vitality and are prone to mental disturbances”. The site recommends its use in treating a range of skin conditions, along with a few outliers such as ulcers and insomnia – but notably not cancer.

Scabies, as you might or might not know, is a skin infestation by the mite Sarcoptes scabiei characterized by severe itchiness and a pimple-like rash. Basically, the female mite burrows into the skin to live and deposit eggs, and the symptoms of scabies are due to an allergic reaction to the mites. Scabies is very common in children, as parents out there probably know. Homeopaths claim that psorinum can be used to treat abscesses, acne, allergy, asthma, bronchitis, colds, depression, dermatitis and eczema, headaches, insomnia, middle ear infections, pharyngitis, phobia, psoriasis, scabies (of course!), and lice, ulcers.

Now here’s where things go beyond just gross (using mite-caused pimple fluid as the basis for a homeopathic remedy) and into the horrific (a grossly unethical and unscientific clinical trial):

The lead authors of the retracted paper, father and son team Aradeep and Ashim Chatterjee, clearly thought differently. In 2001, the pair set up a trial of cancer patients, administering the scabies-fluid, along with other homeopathic substances, and a complete absence of conventional cancer meds.

This situation alone prompted readers to raise ethical questions, as did the fact that the trial did not include control or placebo inclusions. According to the science monitoring site Retraction Watch, however, matters became considerably more complicated when journal publishers Hindawi launched a formal investigation.

Oddly enough, the study is still available on the journal website. (It just has the word “RETRACTED” stamped across it as a watermark.) It describes an observational single arm study in which 6X psorinum was used to treat cancers of the stomach, gall bladder, pancreas, and liver. Particularly disgusting is that this is a very “weak” homeopathic dilution. “X” means a 1:10 dilution; so this is only a 10^-6 dilution. Oh, yes, there was still pus from the scabies in the remedy! It might not have been very much, but it wasn’t diluted away to zero. And the investigators administered it orally! In any case, the authors claimed that a complete tumor response occurred in nearly 18% of their cases and partial tumor response occurred in 35% of their cases. For such nasty tumors, this is incredibly implausible, and there was no control.

The retraction notice describes the problems with the paper:

Aradeep and Ashim Chatterjee own and manage the Critical Cancer Management Research Centre and Clinic (CCMRCC), the private clinic to which they are affiliated. The methods state “The study protocol was approved by the Institutional Review Board (IRB approval Number: 2001–05) of the CCMRCC” in 2001, but a 2014 review of Psorinum therapy said CCMRCC was founded in 2008 [2]. The study states “The participants received the drug Psorinum along with allopathic and homeopathic supportive treatments without trying conventional or any other investigational cancer treatments”; withholding conventional cancer treatment raises ethical concerns.

We asked the authors and their institutions for documentation of the ethics approval, the study protocol, and a blank copy of the informed consent form. However, the corresponding author, Aradeep Chatterjee, was reported to have been arrested in June 2017 for allegedly practising medicine without the correct qualifications and his co-author and father Ashim Chatterjee was reported to have been arrested in August; the Chatterjees and their legal representative did not respond to our queries. The co-authors Syamsundar Mandal, Sudin Bhattacharya, and Bishnu Mukhopadhyay said they did not agree to be authors of the article and were not aware of its submission; co-author Jaydip Biswas did not respond.

Oops!

I’ve often wondered about homeopathy in India. It’s not infrequently that I see reports out of India claiming that homeopathy produces excellent results in treating cancer. I’ve wanted to look into them because they are so unbelievable, but there’s so rarely any objective evidence to look at or independent reports not relying on claims from the various homeopathy clinics making them. One of these days I need to try again, as this story suggests that there’s a lot of chicanery going on there.

Now, it’s easy to laugh at a crappy CAM journal like Evidence-Based Complementary and Alternative Medicine, but this story goes farther. It turns out that crappy CAM journals aren’t the only journals that have published the Chatterjees’s dubious papers on psorinum. It turns out that there are what appear to be three abstracts presented at the annual meeting for the American Society of Clinical Oncology (ASCO) claiming efficacy for psorinum.

So, yes, this has been a very bad week for homeopathy advocates. Remember, however, that the pseudoscientific quackery known as homeopathy is down, but not out. Its advocates never give up and never go away. After all, right here in the US, we have a billionaire homeopath financially supporting homeopathy at a major university.