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A bad week for homeopathy is a good week for science

It’s been a bad week for homeopathy. First, the NHS in the UK has stopped funding homeopathy in London. Then, news stories appeared about research fraud and a retracted clinical trial of homeopathy for cancer in which the investigators had already been arrested. So sad!

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.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

33 replies on “A bad week for homeopathy is a good week for science”

Oddly enough, Retraction Watch doesn’t seem to realize that these were abstracts. Its entry on this retraction states that it reached out to the American Society of Clinical Oncology (ASCO), the cancer professional society that publishes the Journal of Clinical Oncology (JCO), the journal that published the abstracts from the relevant ASCO yearly meetings where these abstracts were presented, as though these were actual JCO papers, not just abstracts from ASCO annual meetings. Meetings abstracts are held to a much lower standard, and the vast majority are presented as poster presentations. It is, however, disturbing that one the Chatterjees’ abstracts was accepted for an oral presentation. I really hope it wasn’t accepted for a full plenary session presentation (which is much more prestigious than the side symposia presentations that predominate ASCO meetings).

Please continue pointing out the absurdity of homeopathy! A couple of very nice ladies were talking among themselves about homeopathic cures for stiff wrists. (Luckily, the lady with the stiff wrist is also getting physical therapy–but I’m sure she’ll credit the homeopathy when she starts feeling better.)

This is the first I have heard of the Law of Contagion. It turns out there is something similar in certain quantum systems (it’s usually known as quantum entanglement), which has been experimentally verified. However, it only applies at the quantum level; by the time you get to the macroscopic level (where any effective medical remedies must operate), any quantum effects get averaged out. And you have to design your experiment quite carefully in order to detect the effect; your typical homeopath won’t have sensitive enough equipment. And the effect is in the wrong direction anyway: you prepare pairs of particles such that they must have opposite spins, send the particles in two different directions, and measure the spins of the particles some distance downstream. You will find that if particle 1 has spin up, particle 2 has spin down, and vice versa. But note that it depends on the particles having opposite spins, not the same spin.

As much as you might think criticizing homeopathy is like shooting fish in a barrel, keep doing it. Too many people fail to exercise their capacity for critical thought, which would tell them that homeopathy is obvious nonsense.

As were many of us. To update Frazer’s magickal “Law of Similarity”:

“From the Law of Contagion, the magician infers that whatever he does to a the spin or polarization of a particle will affect equally a paired particle with which the first particle was once in contact, whether it formed part of his body or not.”

As we say in another corner of the internet when posting sarcastic revisions of quoted material, “There!, fixed it for you!” 😉

Oh, G-d, there was a homeopathy cheerleader at SnuffPo back in the day (Christy Redd) who would try to condescend by telling people that they didn’t understand quantum physics. She never did manage to figure out the allowed energy levels of a bouncing ball using the Born-Sommerfeld rule, even though I nearly handed her the answer.

What to do with those: Tell them that physicist Richard Feynman once said that anyone who thinks they understand QM is fooling themselves. Then sit back and observe as the subject of your intervention goes off saying that a real doctor or scientist* compared her to Feynman.

*Sorry, I don’t know your background. But if others can play Scientist online, you could set up a pseudo for this purpose and do likewise, at least just this once.

@ Eric Lund 11:58
his is the first I have heard of the Law of Contagion.

You need to read more science fiction/fantasy.

Yeah, I experience “Quantum Entanglement” every time I visit one of those quack Web sites: I get totally and inextricably entangled in a sciencey-sounding word salad that presumably explains the working principle of their bioresonance device or their homeopathic-over-the-Internet-sound-based-malaria-treatment by simply inserting the word ‘quantum’ at least half a dozen times in their alternative ramblings – obviously without actually explaining anything, of course, as there is nothing to explain.

(To the tune of Supercalifragilisticexpialidocious)

Biopulsar Ayurvedic Energetic Screening
Throw some words together that have very little meaning
Hopefully the FDA will not be intervening
Biopulsar Ayurvedic Energetic Screening!

(The rest of this is in another comment I posted in Respectful Insolence in 2016)

It’s the opposite of contagion. Two particles continue to interact and influence each other’s state. In contagion one particle is unilaterally and permanently changed by the second particle. You can leave your sugar pills on the TV and let the energy get sucked out without altering the rotten duck liver in the next room at all.

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.

I think that this is one of the reasons why quacks like quantum mechanics so much too. A lot of people interpret the phenomenon of entanglement in terms that are almost identical to what is written in this sentence. If you don’t know better, the language of quantum mechanics would seem to enable the required principles of homeopathy.

“Evidence-based complementary and alternative medicine”?

Unfortunately, one of the endlessly many potent delusions(*) of homeopaths is that their quackery is somehow ‘scientifically proven’ to be just as effective as regular interventions. The diagrams seem convincing enough — until you click the ‘References’ button and the truth is revealed: the first diagram, suggesting that homeopathy is effective in almost 40% of cases, is based on a pile of unscientific rubbish from (you guessed it) a homeopathy propaganda group with no recognized scientific track record whatsoever, whereas the second diagram is based on a Cochrane review, with one of the best track records when it comes to assessment of scientific evidence.

*: Yeah, ‘lies’ or ‘sCAMs’ would fit the bill rather better. But I just couldn’t resist ‘potent delusions’ here…

I am a long time lurker here and have been fascinated by the continuous stream of insolence from Orac. (I am old enough to remember watching Blake’s 7 on VHS tapes ). Thanks for providing a database for my efforts to fight quackery in my social network.

The question about Homeopathy in India prompted this first post

Unfortunately India is overrrun with quackery. Homeopathy, Ayurveda as well as other “medicine “ systems. There is a full ministry in charge of promoting this stuff. There are “medical” colleges that teach this stuff and certify students. In addition we have “unlicensed “ quacks.

The so called research in the field is probably created from whole cloth. I would not be surprised if all the data was completely bogus

Surprisingly, our pharmacies DO NOT sell any homeopathic or alternative medicine products. There is a separate line of pharmacies for homeo and Ayurveda products. The medicine systems mostly operate in a nice apartheid system

Please treat all SCAM studies from India as bogus unless proved otherwise

And keep the insolence flowing.

I do like the ring of “Ministry of Quackery”. It’s probably located right between the Ministry of Magic and the Ministry of Love.

It is just simply not true to say homeopathy does not work. It has been shown to work exactly as well as any placebo does. So, if you leave out a control group, you can easily claim that X% improved after treatment. They did. They would have regardless, but you can’t know that because there is no control. In other words, it is a genius study design for a homeopath!

Then there’s ultra-homeopathy: Viewing photos of the treatment, that are “ultra-potentized” by the neare-infinite dilution of propagation via the internet, will cure a condition in accord with the Law of Contagion or the Law of Unintended Consequences.

For example, ultra-homeopathic psorinum treatment for obesity:

1) View color photos of scabies infections and pus to experience their curative powers.
2) Lose appetite for an hour or two.

If the above doesn’t work, then:

1) Eat as much as you like, of whatever you like.
2) View color photos of scabies infections and pus to experience their curative powers.
3) Vomit up whatever you just ate.

Caution should be exercised with the second treatment lest it cause bulimia in persons who are so predisposed. Using this treatment at restaurants may also illustrate the Law of Similarity, as other patrons who see and hear the patient vomit, may begin doing so as well. Lawsuits by restaurants against patients, for causing other patrons to vomit, may be cited in the Journal of Ultra-Homeopathy as evidence of efficacy.

Orac – you seem to be missing the point about NHS homeopathy. Homeopathy is a very cost effective treatment for people with non-specific symptoms which doctors are unable to identify because they don’t exist. Doctor time is an extremely scarce resource in the UK, but something to which people have a universal right. Patients with non-specific aliments respond very well to someone taking them seriously, and homeopaths are much cheaper than doctors to employ.

Patients with non-specific aliments respond very well to someone taking them seriously, and homeopaths are much cheaper than doctors to employ.

Fobbing off time-consuming patients with a completely worthless placebo is not “taking them seriously”.

Hiring sympathetic strangers to talk to people with non-organic complaints* would be even cheaper than having homeopaths on staff, with the added advantage of not giving credence to a nonsensical health intervention which could cost lives when used for serious health problems.

*The symptoms James refers to certainly exist and can be hard to deal with; disease claimed to cause such symptoms may or may not exist.

[…] Next up is a description of the general principles of homeopathy. I’ll assume that my regular readers know that it’s The One Quackery To Rule Them All and why. Basically, it assumes that you can treat symptoms with something that causes the same symptoms and that diluting a remedy, even dilution to the point where not a single molecule of original remedy remain, can make the remedy stronger. Basically, homeopathy is based on pre-scientific vitalistic beliefs rooted in the concepts of sympathetic magic. […]

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