Homeopathy and Nosodes

I've been meaning to write something about homeopathy at some point, because it's just so wretchedly stupid. But until now, I haven't sat down to actually do it, because it can seem rather like beating a dead horse: it's just so over-the-top goofy, and the goofiness of it is so well documented that I wasn't really sure what I had to add.

Then I came across something that was new to me.

As I've mentioned before, I'm a New Yorker. I live just north of the city in one of the Westchester suburbs. The anthrax attacks that happened a few years ago were a very big deal in my area - in particular, because one of my neighbors is a NYT reporter who at a desk in the room where one of the alleged anthrax letters was opened. (It turned out to be one of the faked copycat ones - an envelope full of talcum power, if I remember correctly.)

Anyway... I've been sick with a miserable sinus infection this week, and got a prescription for an antibiotic. The pharmacy that I use is, alas, rather heavy of the woo: they've got a homeopath and a naturopath providing consultations on the premises. But after trying rather a lot of different local pharmacies, I've found that it's the only one where I haven't been robbed or abused by the phramacist. (By robbed, I mean having them fill prescriptions with less pills than I'm paying for; since I use some expensive stomach medications, I've had $300 prescriptions with fully a tenth of what I was supposed to be given left out of the bottle. I'll take a woo-ish pharmacist who's honest with me, leaves me alone when I say I don't want to hear the woo, and gives me what I pay for over a lying, cheating scumbag.)

Anyway... Heading down to my pleasant but rather woo-ish pharmacy, there's a note on a bulletin board about nosodes, and how we should all be preparing safe quantities of nosodes for anthrax and smallpox attacks in order to protect our families? I'd never heard the term before. So when I got home with my non-woo medication, I hit the net to figure out what this stuff was.

According to The National Center for Homeopathy, nosodes are

homeopathic attenuations of: pathological organs or tissues; causative agents such as bacteria, fungi, ova, parasites, virus particles, and yeast; disease products; excretions or secretions

Translated: take either a sample of an infectious agent, or an infected tissue sample. Dilute it down to silly proportions using a magic shaking ritual (homeopathic attenuation, aka succussion), voila! You have a nosode.

What's going on here? And why is it bad math?

The homeopathic shaking ritual is, basically, take something like a nosode. Mix it with water, in a 100 to 1 proportion, using the special magic shake. Now, take a sample of that mixture - and mix it with water again - 100 parts water to 1 part solution, and shake. Repeat many, many times. Many homepathic remedies use a 100 to 1 dilution repeated 20 times - the so-called "20C" dilution. The more times you repeat the magic shaking ritual, the stronger the alleged medicine becomes.

Normal homeopathic remedies are based on the dilution of substances that produce the same symptoms as the illness that they're allegedly treating. So they'll take some substance - a salt, an herb extract - and dilute it this way. So in a 20C dilution, you're talking about 1 part active ingredient in 100^20 parts water - so you're talking about one part active incredient in 1x10^400 parts water. This is also known as "pure water". In a regular dose - several teaspoonsful of the diluted solution - you are almost certainly not getting a single molecule of the active ingredient in the dose.

This is the first piece of really bad math in it. The inventor of homeopathy had no idea about how many molecules were in water; it's not even clear that he really knew what molecules were. (Homeopathy was invented in the 1820; the molecular theory of matter as we understand it was proposed in 1812.) But we do now know about that - and so we know, by a combination of simple arithmetic and the number of molecules involved, that it's an undeniable fact that these dilutions are entirely eliminating the supposedly active ingredient. To insist on a magical effect from something which has been eliminated from the solution is just stupid.

The idea that somehow diluting a solution to the point where there's probably not a single molecule of the active ingredient left creates a good medicine is stupid - and that diluting it more after there's not a single molecule left is even stupider.

The claim of modern homeopathy is that there are basically magical propeties of water: that the magic shaking ritual leaves crystalline structures in the water that are based on the active ingredient, and that those magic structures somehow are the cause of the effectiveness of homeopathy. This belief is predicated on the notion that the basic particles of the homeopathic ingredient is small enough that it can leave a specific shape in the arrangement of molecules in water.

So - what about nosodes? Well, the argument for a nosode is that it's basically a kind of a vaccine: you're putting the specific infection agent into solution - either directly if you can identify and extract the agent; or indirectly by using an infected tissue sample if you can't. Then you're doing the dilution.

In particular, they claim that they can "vaccinate" you against anthrax using a nosode solution of anthrax. But anthrax isn't a molecule. It's a bacteria - and a largish one at that. The so-called "crystalline structures" of water that homeopaths propose as an active principle are at an entirely different scale: this is another error of arithmetic; something orders of magnitude larger than a water molecule is not going to interact with a water molecule in the same way as something of its own size: it's like saying that if you dip your finger into a pile of dust, take it out, and then shake the dust around, that the dust can retain the shape of your finger. The size of the structure that you claim to form is so much larger than the things it's formed from - it's a very silly idea.

What's particularly scary about this: these people are applying for homeland security funds to stockpile nosodes. They claim that they can provide "homeopathic vaccines" using nosodes for less money, and in less time than it would take to prepare real vaccines or treatments. And in the current political climate, they may very well be taken seriously, and get money that could have been used to buy or produce real remedies, rather than magic water.

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"Hundreds of orders of magnitude" is probably an exaggeration. After all, an entire mole is only 26 orders of magnitude bigger than a molecule.

:-)

Blergh. Editing error; the "hundreds of orders of magnitude" phrasing was originally several paragraphs earlier, in the discussion about the degree of dilution, where you're diluting by a factor of 10^400.

Ah well, I'm allowed a bit of hyperbole when dealing with something this stupid, aren't I? :-)

Argh. Small*pox*.

I think maybe I've been working on programming languages too much.

Good point.

If you really want to see some bad math in regards to homeopathy go look for papers on "Weak Quantum Mechanics", by such luminaries as Lionel Milgrom... meaningless drivel, really, but disguised with math symbols to look like quantum physics.

100^20 parts water - so you're talking about one part active incredient in 1x10^400

Err... that should be 10^40.

Re: homeopathy: the claims it makes are silly. It's nuts to think that they're true. But, unlike Intelligent Design, homeopathy *does* make predictions! Do you know of any clinical trials or tests on homeopathic remedies? Ultimately, in the end, the science rests on the data, and if homeopathic remedies *do* show a more-than-placebo effectiveness, then, well, I guess it's time to revisit the molecular theory of matter and a whole lot of other things on which vast quantities of science and observations are based.... But if the tests show that homeopathic remedies are no better than placebos, then there's your trump card right there. Everything you say about the notion of infinitely diluted molecules doing anything being silly remains true, but you've also got the empiricism.

-Rob

Argh! They gave you an antibiotic for a sinus infection?! Most sinus infections are viral and resolve on their own. In addition, many antibiotics act as anti-inflamatories, so often the 'curative effect' has nothing to with killing the etiological agent per se; Benadryl or a really strong antihistimine would have done the trick. I'm not blaming you Mark (really, I'm not), but your doctor helped contribute to the problem of antibiotic resistance.

Mike:

I've actually got a chronic sinus problem, and this is not a normal sinus thing. Definitely a nasty bacterial, which is something I get once every three or four years, as opposed to a viral, which I typically get once every three or four months. In the past, they've made me go through cultures to be sure it was bacterial; by now, we have enough experience with the symptoms I get to differentiate the bacterial ones from the viral.

Of course, this time, I'm lucky enough to have what looks like both :-( I stalled on getting the sinus infection treated, and managed to pick up a secondary thing on top of it because of how poorly everything was draining; now I've got the bacterial sinus thing, and a viral throat thing. I'm a miserable wreck.

I also think benadryl is intensely evil. When I take benadryl, I don't get sleepy; I get seriously, almost suicidally depressed. I'll stick with my claritin, even though it's nowhere near as strong.

There was a huge double blind study published in Lancet (I believe, could have been another major British journal) on homeopathy, found absolutely no effect -- as we would suspect.

Prince Harry decided a few years ago that homeopathy worked -- and directed some funding towards that end.

Here's a test: get a glass of bourbon, dilute it to 20C and drink it. If homeopathy works, you should get really drunk.

(Idea stolen from Terry Pratchett).

By Michael Geissler (not verified) on 20 Jun 2006 #permalink

Oy vey! And I'm not even Jewish.

I've had plenty to say about homeopathy at the old Terra Sigillata here and here.

I also need to direct you to this PDF of a great article to bring to your pharmacy. Written by Prof Steven Pray at SW Oklahoma State College of Pharmacy, it is entitled, "The Challenge to Professionalism Presented by Homeopathy." In it, he challenges students to reconcile dose-response pharmacology with this hooey. The conclusion is that you can't. I've used it in my lectures and even had the pleasure of having him come out to speak to my students.

Ok, I here are the details...

The Lancet publication was a meta-analysis of 110 different homeopathic trials.

Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.

Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy.

Shang A, Huwiler-Muntener K, Nartey L, Juni P, Dorig S, Sterne JA, Pewsner D, Egger M.

PubMed Abstract

Ah well, I'm allowed a bit of hyperbole when dealing with something this stupid, aren't I? :-)

Yes, you are indeed.

It never ceases to amaze me the dichotomy between the gullible acceptance of pseudoscience in the form of new age remedies and the almost vitriolic suspicion of and rejection of scientific medicine.

Wouldn't this make incredibly strong biological weapons, according to homeopathic logic?

By ParanoidMarvin (not verified) on 20 Jun 2006 #permalink

Thank you for writing this Mark. I included a link over to this post on my site, cause I certainly think more people should read this.

I can also sympathesize with the sinus infections. I have about 2 bad bacterial ones/year and pretty much a chronic viral one. Had about 6 surgeries to correct this and a host of other sinus issues (and I'm just 26!). Claritin changed my life. Maybe I wouldn't have to pay so much ($1/pill!!!!) if I crushed them down and diluted them 1x10^40. I mean, according to the homeoquacks it'd be more effective! :)

I'm using homeopathy, and I'm considering it as a placebo. It's a placebo that my doctor prescribes me, that I can buy in pharmacy, and that actually cures the illnesses it's supposed to. I don't care it's not better-than-placebo, because placebo effect is already better than nothing. But I think homeopathy is something else.

There is a possibility to have natural resistance in a particular person for virtually any disease (immunities to viruses, better tolerance to chemical compounds, etc). Sometimes it's some particular combination of DNA, sometimes it's some particular use of common genetic material, but it can cure the diseases without active agent. Then imagine that you can influence your own body to go that way (mind-controlled genetic mutation, probably crazy, but mood related modification of hormonal (and thus chemical) behaviours, that's quite possible).

Homeopathy just take all these diseases that are known to be possibly cured without active agent, and make you believe that if you do what your doctor says, you will be cured. It's just some positivism on top of a placebo effect.

So in the end it's not about pharmacology, it's more about psychology.

My sympathies. Same thing happens with my throat every few years (I usually have to arm wrestle the doctor though--yes, I know antibiotics don't work on viral infections; yes, I know they're overprescribed; no, the strep screen will come up negative; please, don't make me wait three more days till my throat's swollen shut with ugly white blotches that'll take five days longer to clear up than if we start now; I've done this before). It used to be every few months. The recurrence has gone way down since I had my tonsils out (unpleasant, but worth it).

My personal favourite is the one which is duck liver diluted down to 1 in 10^1500. Apparently this is the same as dissolving a grain of rice in a sphere the diameter of the solar system and repeating 2 billion times. The best part is that they only need to use 1 duck, but they still sell $20 million worth of the stuff every year.

Shelley:

I think that actually, according to homeopaths, if you diluted the claritin down, it would become an incredibly potent *cause* of allergy symptoms.

The homeopathic stuff is based on the idea, roughly, that if "X" taken in large doses causes symptom "Y", then to treat "Y", you need to take massively diluted doses of "X". It's a sort of opposite-effect thing. So if you have a headache, you don't dilute aspirin, which gets rid of headaches; you pick some substance that causes a headache similar to the one you're treating, and then dilute it.

Marvin:

See my comment to Shelley :-)

To make a powerful bioweapon a homeopathic way, I think you'd take antibiotics, and then dilute them. Diluting the bacteria themselves would create the magic cure for the weapon.

usagi:

My sympathies. I'm fortunate enough to have a really wonderful doctor who is extremely well-informed, and who's actually willing to credit me with a bit of intelligence.

So when it comes to these wretched sinus infections, she knows my history; she knows that *I* know what's going on; and I know that when I get a sinus infection, that there's no point in trying to get it treated for about a week; if it's viral,it'll clear up in 4 or 5 days, and if it's bacterial, it'll either clear up on its own, or graduate into a clear bacterial infection in the same period. So I don't bug her until I've waited it out long enough to know what's going on, and she knows that I do that.

I'm using homeopathy, and I'm considering it as a placebo. It's a placebo that my doctor prescribes me, that I can buy in pharmacy, and that actually cures the illnesses it's supposed to. I don't care it's not better-than-placebo, because placebo effect is already better than nothing. But I think homeopathy is something else.

The placebo effect pretty much means doing nothing except making yourself think you're doing something.

To Doub: Why pay for a placebo? The great thing about a placebo (other than having extremely minimal positive effects and NEVER resulting in a cure) is that it is free. If its really the "psychology" rather than "pharmacology" then there's no use paying for that. Unless somehow you think that you get what you pay for, even when you're paying for nothing.

We need to get Abel Pharmboy to weigh in here.

Hey, Mark, could you check your 'junk comments'? I pposted last night a useful (I hope) and thoughtful (at least) comment that had a few links in it of interest on homeopathy. Since it had three links or more, it is probably quietly awaiting your approval somewhere in MoveableType.

abel:

Yep, you were caught in the moderation queue. Sorry for the delay.

I am an actual scientist and mathematician. I do not believe in Homeopathy, for the reasons you summarize.

However, I suggest that you examine the recent (past year or two) scientific literature on the structure of water. Water is NOT properly understood. Based on high-luminosity neutron diffraction studies in the past couple of years, the experts are mostly in 2 competing camps on water. One holds that there are mostly short-lived rings and chains of H2O, one claims a more conventional but still very heterogeneous amorphous structure.

I'm not talking about the at least 10 isomers of ice (such as Ice X, where there is no H2O as such, but rather interpenetrating cubic lattices of oxygen atoms and hydrogen atoms). Nor the Vonnegut fiction of Ice 9 (which is thermodynamically absurd). I mean liquid water.

Mathematically, this is related to some open questions on coagulation-gellation and of crystal frustration, for which I've drafted a paper on poly-tetrahedra.

No time to list references for all of above; I'm leaving in a very few hours for 11 days of presenting or co-presenting a dozen papers at the NAACSOS in Notre Dame, and the ICCS-2006 in Boston.

But, really, your mental model of water is far too simple. I don't think there's even 1% chance that anything in this supports Homeopathy, but I demand proof OR disproof that respects the refereed literature.

Best,

professor Jonathan Vos Post

I realize that water is an extremely interesting structure. But that doesn't mean that I take something like homeopathy at all seriously.

The thing is, the problem with homeopathy isn't just that it requires some kind of magical structure to be held in the water. It requires that the dilution process somehow creates, preerves, and amplifies that structure as you continue to dilute.

But what does that mean? It means that if there is a trace of any substance in the water, than the dilution process magically knows that that substance is the one whose structure should be imposed and amplified through dilution.

But as you pointed out - water isn't simple. It's already got some structures in it; and it's always got trace impurities, because it's such a good solvent. So the water actually had hundreds or thousands of different subtances in it - but somehow it knows what substance/structure is the right one. Even after none of that substance is actually left in the solution, but there are numerous other substances that are actually there?

That's the problem for homeopathy. They can't explain why *this* 1 part in 20 billion takes precedence over *that* 1 part in 20 billion. And they need to be able to do that for any of it to make sense.

Don't you love it when people don't have to time to give references in their comments, because they simply *must* jet off to give so many important talks? Good thing he took the time to let us know THAT though. ::Sigh:: Some people just like themselves a *little* too much. I thought your explanation of water was right on target given the audience (laypeople) and the subject matter (homeopathy, not the theoretical structure of water).

Yes, Prof Batts, I've similarly jetted off, but to a federal study section meeting. Still, I have the time to reiterate that folks interested in homeopathy first read this article and then decide for themselves if homeopathy is a scam or real medicine.

Yes, we don't know the structure of water fully. We also don't know the structure of glass fully. But we still see through both. And we can still see that water and glass doesn't pick up the properties of everything they come in contact with. We can do that without a refereed literature proof.

Homeopathy is an improved nontoxic version of the old recipies based on "like cures like" or "poison gives visible effects". You are more likely to survive the remedy so you can continue pay the scam artist.

"There is a possibility to have natural resistance in a particular person for virtually any disease (immunities to viruses, better tolerance to chemical compounds, etc)."

Aaargh! The immune system, like most of the body's defense system against stress, is an evolutionary and imperfect construct.

First, we are already bags of viral and bacterial DNA. Our body mass is 1-2 kg bacterias and 50-100 kg human cells. But since viral and bacterial genes are smaller, more than 95 % of the bodys genes are nonhuman. Worse still, in our genome more than 90 000 retroviruses have inscribed about 50 % of our gene mass. This demonstrates the general ineffectiveness of the system. (Not that all retroviral genes are bad and will get loose again - evolution has used some of that material to our advantage.)

Second, antibodies work sloppy. For example, for making antibodies to small molecules like nicotine to make tobacco vaccine one has to connect the molecules to something larger to get a large enough reaction.

Third, human T-cells work sloppy. Probably due to dropping a sugar expression to allow a larger brain, human T-cells are much more agressive than apes. This gives us a lot of unnecessary autoimmune diseases. It also makes it hard for HIV virus to integrate with our germ cell genome as normal retroviruses, which is probably how apes escapes analogous SIV infections.

Fourth, our white blood cells work sloppy. The same gene shuffle mechanism that makes them flexible also makes cancer.

Fifth, inflammatory responses in our arteries and brains do secondary damages, sometimes allout killing.

See The Loom blog for references on most of this.

So no, our immune systems aren't perfect by a long shot. They are only good enough for survival. Look at the sinuses discussed - sinuses are supposed to be harmonic. :-)

By Torbjörn Larsson (not verified) on 21 Jun 2006 #permalink

"But since viral and bacterial genes are smaller"

And the viral and bacterial bodies too, obviously.

I think it is remarkable - maybe less than 1 % of our body genome are genuine eukaryote genes. And eukaryotes were also originally composites. Evolution sure makes wondrous things!

By Torbjörn Larsson (not verified) on 21 Jun 2006 #permalink

Here's a test: get a glass of bourbon, dilute it to 20C and drink it. If homeopathy works, you should get really drunk.

If I understand homeopathy, it should sober you up if you are already drunk (or perhaps protect you from getting drunk if you drink). Wonder if it will help you pass a breathalyzer test...

I remember going to a pharmacy while visiting France some years back with a bad head cold. I was looking for an alpha-adrenergic agonist spray to dry up my nose, but all they seemed to have on the shelves was homeopathic remedies. My French wasn't very good...maybe in France they keep the real stuff behind the counter?

But homeopathic medications do serve one potentially useful function. Doctors these days have an ethical dilemma with prescribing placebos. Placebos actually work for some conditions, and it may be that in some cases a placebo is the best treatment available. But if you actually tell somebody you're giving them a placebo, then it generally doesn't work as well. On the other hand, it is unethical for a doctor to lie to a patient. But he could give them the name of a homeopathic prep with an impressive-sounding name and say, quite truthfully, "Well, you might try this stuff--some people find that it helps, although nobody quite understands how it works." The nice thing about homeopathic preparations is that (assuming they used pure water to dilute it), they should be perfectly safe, which is more than you can say for herbal supplements.

Before you're all down on the placebo effect, check out Ben Goldacre's article about it and the scientific studies (from Bad Science in The Guardian): http://www.badscience.net/?p=82
The placebo surgery thing still amazes me.

I'm on a course to become a homeopath, it's fascinating stuff, total rubbish, but fascinating.

So far, the only science referenced throughout the course is "we believe a subtle energy comes into play" and "studies have shown" without citing anything!

They try and inject impressive scientific jargon into the course wherever possible, but it's becoming painfully obvious at this early stage that the straws are being clutched.

There is interesting work on the placebo effect. An abstract I read in the last year or two reported that the placebo effect is greater the more expensive the cost of the placebo.

Thus, there may be something beneficial to paying for a placebo versus whipping up a batch yourself.

By Dane Skold (not verified) on 07 Aug 2009 #permalink

There are a few problems developing here. If you don't believe that the principles of homeopathy can work, then fine - don't use it. But once you start using the logic of allopathic medicine and applying it to "homeopathy," and then pointing to it as ridiculous, it is exactly that from the homeopathic point of view: ridiculous.

George Vithoulkas, and internationally known homeopath in Greece, has a video on his website of a lecture he gave on this precise problem of "vaccinating" with a nosode. Homeopathy does NOT claim to vaccinate anyone and is not used in such a way - at least not by a reputable homeopath. To "vaccinate" someone with a nosode is to apply homeopathy according to allopathic principles, which IS just ridiculous.

Another one: the idea that Claritin would CAUSE allergies in high dilutions? (Or was it 'low dilutions'?) No. Because Claritin is not formulated according to homeopathic principles.

Another one: double-blind studies. And testing 110 homeopathic remedies in one double-blind study? Not possible. Such misguided approaches to "homeopathy" only reveal the complete failure of allopathic medicine to even try to understand the principles of homeopathy. Such speculations - whether 'double-blind' studies or the seemingly logical extension of allopathic logic to homeopathic principles - only reveals one's own ignorance of the principles of homeopathy, which it's true, are entirely different from those of allopathic medicine.

If you really want to apply your critical faculties to the misuse of homeopathy in such tests, just ask yourself: which industry makes billions of dollars? Homeopaths will never get rich from practicing their medicine, and neither will homeopathic labs.

But please, don't spread misinformation and invent "logical" scenarios based on something you don't understand. Hearing about one homeopathic principle, even if you understand that one correctly, does not mean you are informed on the subject.

(And, while I'm at it, the makers of Zicam have unwittingly done the same thing. They claim, through sheer ignorance and failure to consult the dictionary, that their medicine is "homeopathic." It is not. Doubtless they meant "naturopathic." Now people who have lost their sense of smell from using the gel think, wrongly, that homeopathy can cause lasting side-effects.)

Another thing - the "scary" idea that monies that COULD produce "real" vaccines (rather than nosodes) might be diverted in a time of emergency doesn't wash, according to what I've heard and read about, say, the swine flu vaccine. The problem is, no matter how much money is thrown at this problem this year, there is only so much vaccine the labs can make in one year. Maximum capacity has been reached. So funding the production of homeopathic remedies does not really present a "danger" here. In fact, if you want to be alert to dangers, take a look at how much testing has gone into the Swine Flu vaccines. None for me, thanks.

But this gets to the heart of the problem with criticisms of homeopathy: no one can really point to whom the use of homeopathy is supposedly hurting. Meanwhile, one doesn't even have to research the dangers of allopathic medicine. We all know someone who has battled - or even died from - staph, and then there's MERCA, to say nothing of the nasty side-effects of so many drugs - whether known or unkown.

No, I think there's plenty of room in the world for homeopathy. A lot of people are using it and experiencing results of a type that you would never even try for with allopathic medicine.

Oh -- and one more thing. I don't think homeopathy as a body is claiming anything involving the crystalline structure of water. I'm sure some homeopaths are convinced that the reason homeopathy works might finally be discovered. But this is not a claim of homeopathy in general. It is simply a new frontier that has opened up, and some of us who know homeopathy are watching with continued interest.