A Spoonful of Sugar Helps the Placebo Go Down

On January 30th 2010, a mass suicide attempt occurred in many cities around the United Kingdom.  The Kool-Aid of choice, for the cult members, was a homeopathic sleeping medication.  In front of pharmacies across the nation at exactly 10:23, multitudes of people swallowed full boxes of pills or drank homeopathic liquids well over the recommended dose.  Before the attempted overdose, the cult members all shouted in unison, “There’s nothing in them!”

No members of the “cult” died or even felt sleepy after the event. In fact, the staged attempt was nothing but a publicity stunt to raise awareness about the ineffectiveness of homeopathic medicine. The cult is actually a group of skeptics better known as the 10:23 Campaign, a reference to Avogadro’s number, which is an important number in the field of chemistry and science (Merseyside Skeptics Society). The number also provides an easy way to show that most homeopathic medicine isn’t only a scam, but a scientific improbability.
Of course, throughout history, science hasn’t always been able to explain how everything works, and maybe in this case science is wrong. So what are the scientific procedures behind deciding what is or isn’t effective? Why is evidence-based medicine important for everyone’s well being? And if homeopathic medicine is found to be ineffective should the sale of it be banned? First, let’s take a look at how homeopathy came to be and why the beliefs behind it are so controversial in the fields of medicine, chemistry, and much of science.

Homeopathy: Like Cures Like According to a recent study from the National Center for Health Statistics about 38% of the American population use some form of complementary and alternative medicine (CAM) (Barnes). In America, about $34 billion a year is spent on CAM, mostly as out of pocket expenditures. Much of the medicine and treatments that fall under CAM, such as acupuncture and homeopathy, remain scientifically unproven, yet CAM accounts for 1.5% of total health care expenditures every year (NIH). One of the lesser known types of alternative medicine is homeopathy. Studies show that only 2% of the American population used homeopathy in the last year (Barnes) spending upwards of 1.5 billion dollars (Singh and Edzard 93). In Europe, the use of homeopathy is much higher with estimates between 10% and 50% in some areas (Ullman). Other alternative treatments, like acupuncture and herbal medicine, have long histories in ancient China. The roots of homeopathy can be traced back to just over 2 centuries.
In the late 18th century, a German physician named Samuel Hahnemann was unhappy with the conventional medicine of his time. He felt that the popular treatments, like bloodletting, did more harm to the patient than good (Glazer). In 1790, Dr. Hahnemann was experimenting with the malaria medication Cinchona, derived from the bark of a Peruvian tree. The healthy doctor consumed some of the medication himself and experienced symptoms associated with malaria such as fevers and shivering. From this result, and with no further testing, he concluded that medication meant to treat certain symptoms will cause those symptoms when taken by a healthy person. This would be known as the “Laws of Similars” (Singh and Edzard 94-95). By the reverse logic, Dr. Hahnemann started testing other substance and chemicals to see what effects they had on healthy volunteers. The volunteers would document all symptoms experienced and report them back to the doctor. Some of the substances Hahnemann used were highly toxic, such as spider venom, and even in low doses were known to kill. To avoid this, the doctor diluted the toxins numerous times. He soon noticed that the more he diluted the medication; better results were reported by his patients. This became the second tenant of homeopathy, the “Law of Infinitesimals.” (Glazer) Common knowledge leads most people to believe that the more dilute something is the less effective or potent is it. In homeopathy the opposite is believed to be true; they believe the more dilute the medicine, the more potent it becomes. In homeopathy this is known as potentization.

“There’s nothing in them!” The new form of medicine spread like wild fire around Europe and even around the globe. As more doctors stopped the practice of bloodletting and tried homeopathy they discovered less patients were dying. Looking back now we know this wasn’t because of how well the new form of medicine worked, but because how dangerous bloodletting and the other ancient treatments were. In the early 19th century, the same time as Hahnemann’s new found success; the Italian physicist Amedeo Avogadro would come up with a new theory that would cast some doubt on one of the “laws” behind homeopathy. Avogadro theorized that any two gasses at a set volume, at a constant temperature and pressure, would have the same amount of molecules. It wouldn’t be until 1909 that this exact value of Avogadro’s number (6*10²³⁾ would be discovered by other physicists and mathematicians, becoming an important law in the fields of chemistry and physics. But what does it have to do with homeopathy? To understand that I must first explain serial dilutions and the theory behind the “Law of Infinitesimals” As stated before, in homeopathy, potentization is achieved through serial dilution. A serial dilution is created by starting with what is known as a mother tincture (or the initial solution) and taking a small proportion of it (for example one tenth) and adding it to a new solution of water or alcohol. This process is then repeated with the new solution a certain number of times. Common proportions used in homeopathy are 10:1 (denoted by an X) or 100:1 (denoted by a C). For example, a homeopathic medication labeled with a 10X means the serial dilution was repeated ten times each time removing one tenth and adding it to a new solution. Based on the theories behind potentization, quite often homeopaths will take dilutions to the extreme.
The problem that arises for homeopathy is dilutions can only be taken so far. Based on Avogadro’s number, once the dilution is taken past 24X (or 12C), there is a slim chance that even one molecule exists in the medication. In fact, a 12C dilution would be equivalent to adding a drop of red food coloring to the Pacific Ocean and claiming the ocean would turn red (Barrett). Proponents of homeopathy claim the dilutions work because of water memory and the transference of energy between the medicine and water. This theory continues to go unexplained and unproven (Singh and Edzard 119-127).

The Bleeding of an American Hero Samuel Hahnemann was correct about one thing, bloodletting was ineffective and dangerous. In the gruesome treatment, a doctor would slice a patient open and allow them to bleed out a certain amount of blood. Observable and anecdotal evidence led many doctors to believe they were helping the patient by draining some blood. Some of the Founding Fathers of the United States even used the treatment, namely George Washington. The first President of the United States was a war hero of Colonial America. He served 8 years as our nation’s President from 1789 to 1797. A short two years after his presidency, in December of 1799, the 67 year old General rode his horse around his plantation during a cold and snowy winter day. The following day Washington complained of a sore throat. When his personal secretary Colonel Lear suggested taking medication the General said in protest, “You know I never take anything for a cold, let it go as it came (Vadakan).” After a long agonizing night the President’s condition worsened and his personal physicians were called upon to help. Throughout the 14th of December many different treatments and medications were used, namely bloodletting. It has been estimated that a total of 124 ounces of blood, nearly a gallon, was drained from the President’s veins. Based on Washington’s weight and size this would amount to around half of the blood in his body. The President didn’t survive through the day and slowly passed away around 10:00 pm surrounded by his family, friends, and his physicians (Vadakan). Looking back at bloodletting now we see an ancient and cruel form of medicine that unfortunately took the life of an American hero. So how are modern treatments, like chemotherapy or homeopathy, deemed effective in the first place? What systems do we currently have in place in society so we avoid the dangers of bloodletting? The answer is simple, medical trials.

Emergence of Evidence Based Medicine The death of George Washington sent shockwaves across the country. The physicians who drained his blood said it was absolutely necessary to save his life and most physicians around the country at the time agreed. During the late 18th century medical trials were not used to test the efficacy of medical treatments. Instead, doctors used what seemed to work for them based on past experience and anecdotal evidence. This started changing in the early 19th Century. 10 years after George Washington died from bloodletting, a Scottish military surgeon named Alexander Hamilton decided to test if bloodletting was an effective treatment. The surgeon randomly divided a group of 366 soldiers into three groups. Two of the groups were treated but without the use of bloodletting, the third group received the bloodletting treatment. The results were staggering, ten times as many soldiers died in the third group where the bloodletting treatment was used. Unfortunately, Hamilton didn’t publish his results and merely used his newly discovered knowledge on the dangers of bloodletting to improve medicine in the Scottish army (Singh and Edzard).