Imagine you’re hungry. Instead of making a sandwich, though, you take a piece of bread, cut it into 100 pieces, and pop it in your mouth. This probably wouldn’t do much for your hunger, right?
Well, imagine that you take one of these pieces and divide it another 100 times. Then, you divide it another 100 times. And then again, and again, and again.
Not only this, but you believe that the smaller the piece you eat, the fuller you’ll get! Doesn’t seem very logical, does it?
Well, this is the basic concept behind homeopathy, an alternative medical system that promises to cure what ails you using minute amounts of—often toxic—substances.
On the one hand, homeopathy doesn’t seem to make a whole lot of sense, but you’ve probably read about (or even met) many people who swear by these treatments. So, as a consumer, how can you decide which path to take?
Here, in part one of our series, we’ll take an evidence-based deep dive into the topic of homeopathy. Then, in part two, we’ll hop the aisle, speak with homeopathic practitioners, and find out what motivates them to do what they do.
Ready to begin? Let’s start with the basics.
What Is Homeopathy? How Does It Work?
Back in the late 1700s, a German physician named Samuel Hahnemann coined the term homeopathy, which is rooted in two Greek words; homoios, meaning “similar” and pathos, meaning “suffering.”
Why did he choose these two words?
Like Cures Like & the Law of Similars
According to Dana Ullman, one of the more prominent voices in the homeopathic community, homeopathy is based around the concept that “like cures like.” In other words, as the National Institutes of Health puts it, “the notion that a disease can be cured by a substance that produces similar symptoms in healthy people.”
Here’s an admittedly simplistic example: Imagine you’re so allergic to poison ivy that simply walking within 10 feet of a plant can lead to a moderate skin rash.
To help treat this, your homeopathic doctor prescribes a liquid solution that contains a very small amount of poison ivy—or, at least a substance that might trigger the same biological reaction.
By ingesting this and exposing your body to poison ivy-like symptoms, Samuel Hahnemann believed that you’d be able to activate your “vital energy,” which would help you overcome your extreme allergic reaction.
In fact, Hahnemann came up with this idea by experimenting on himself.
After taking repeated doses of Peruvian bark (Cinchona), he eventually encountered a toxic dose that expressed symptoms similar to malaria. Therefore, he concluded that Peruvian bark is effective for treating malaria.
Now, you might be wondering: “Wouldn’t ingesting a toxin ultimately cause more harm than good?” As it turns out, homeopathic treatments often contain very little (or none, as we’ll learn in a moment) of the original substance.
This is where the second homeopathic law comes in.
Dilutions & the Law of Minimum Dose
The second foundational principle behind homeopathy is the “law of minimum dose.” In other words, the lower the dose of these agitating substances, the more beneficial they will be.
To achieve this, homeopathic treatments undergo a process of successive dilutions, which are also referred to as dynamizations or potentizations.
Still widely in use today, Hahnemann’s dilutions were measured on a “centesimal scale,” or “C scale,” which indicates that a substance has been diluted by a factor of 100 at each stage.
So, if a treatment has a 2C solution, this means it’s been diluted to one part in one hundred, twice. A 3C solution has been diluted three times, a 6C dilution six times, and so forth.
On the other hand, you’ll find some homeopathic treatments prefer to use the decimal scale, which is represented by a D or X. These numbers indicate that a substance has been diluted by a factor of 10 at each stage (e.g. 1X, 6X, 12X, etc.).
Where Do We Go from Here?
Alright! Now that we have a basic understanding of homeopathy’s fundamentals, we can better understand whether or not it’s effective. And to determine whether or not it’s effective, we need to answer two key questions:
- Is it possible for a homeopathic dilution to meaningfully mimic an ailment’s symptoms?
- And if so, will this provide any therapeutic value?
As it turns out, we might not make it past the first question. I’ll explain why next.
Homeopathy Problem #1: Avagadro’s Number
No doubt, this is a heavy subject.
So, if you’re looking for the Cliff’s Notes version, here it is: Because of their dilution methods, homeopathic remedies often don’t contain enough of the original substance to have any measurable effect on the human body.
If you’re willing to stick with me, though, we’ll dig deeper and help make you a more informed consumer.
In Order to Work, You Must Have Molecules
Continuing with the poison ivy example above, if our imaginary treatment had a potency of 2C (100 x 100), this means it would contain one part poison ivy to 10,000 parts of the solution.
If we had a 6C solution (100 x 100 x 100 x 100 x 100 x 100), it would contain one part poison ivy to 100 trillion parts solution!
And it’s here’s where our first—and perhaps biggest—stumbling block enters the picture.
You see, back in Hahnemann’s day, the scientific community didn’t yet understand molecules, which represent “the smallest fundamental unit of a chemical compound that can take part in a chemical reaction.”
Or, for the purposes of our discussion, the smallest amount of a substance that might have some effect on the human body.
Because of this lack of understanding, Hahnemann thought his treatments could be diluted indefinitely and still deliver measurable results (remember this thought, because it’ll come up again shortly).
As it turns out, though, we now know this isn’t the case. In fact, using something called Avagadro’s constant, we can actually calculate the number of molecules of a substance that should be present in a homeopathic solution.
But before we get to that, we need to talk about one more thing: moles.
Why Talk About Moles?
In chemistry, a mole—no, not the cute, furry one—is a unit of measurement that represents “the amount of a substance that contains as many particles as there are atoms in 12 grams of pure carbon-12.”
Specifically, one mole represents 6.022×1023 elementary entities, or in the case of our discussion, molecules. This number is referred to as the Avogadro constant.
Going cross-eyed yet? The point is that, in order to know how many molecules a substance contains, we need to know how many moles it contains. And to know how many moles it contains, we need to know the substance’s weight in grams.
As a flow chart, it looks something like this:
Substance → Grams → Moles → Molecules
Now, let’s take this information and put it to use.
Bringing It All Together
Using what we’ve learned so far, here’s an excellent description from RationalWiki.org about how this all comes together (bold emphasis is ours):
“A brief survey of the internet seems to indicate a typical homeopathic remedy consists of about 20ml of water. One mole of water is approximately 18 grams. Thus a homeopathic treatment will consist of some 1.1 moles of water, or some 6.6 x 1024 molecules.
Now, take a 10C solution of the active ingredient. This means the active ingredient is diluted to one part in 1020.
If one took a straight random sampling of the molecules, one might expect there to be some 70000 molecules of the active ingredient remaining in the final solution, or ~1 x 10-18% by volume.
In comparison, the average tap water sample will contain several billion times more lead than this, without any effect at all on the drinker. Such concentrations might reasonably be approximated as ‘none’.”
Given these numbers, according to the International Journal of Pharmacotherapy, the largest dilution possible that still contains at least one molecule of the original substance is 12C.
Remember those 30C dilutions we talked about earlier? Well, based on what we just learned, they can’t contain any of the original substance. They’re all solution and no ‘active’ ingredient.
Furthermore, even among smaller dilutions that do contain some molecules of the original substance, there almost certainly aren’t enough to have a meaningful effect on the human body.
Using this as a stepping stone, we now come to the second major problem with homeopathic treatments.
Homeopathy Problem #2: Clinical Evidence
When it comes down to it, for the scientific method to work, you have to be able to test a hypothesis. And to test a hypothesis, your most essential tools are observation and measurement.
As we’ve just seen, though, the scientific community can’t directly measure the biological effects of homeopathic solutions in the lab. Why?
Because they don’t contain enough active ingredient to influence the human body. And because there’s no influence, any question of potential therapeutic value is moot.
Here’s how the NIH article puts it:
“… it is not possible to explain in scientific terms how a remedy containing little or no active ingredient can have any effect. This, in turn, creates major challenges to rigorous clinical investigation of homeopathic remedies.
“For example, one cannot confirm that an extremely dilute remedy contains what is listed on the label, or develop objective measures that show effects of extremely dilute remedies in the human body.”
Oddly enough, though, there is some clinical evidence indicating that homeopathic treatments provide measurable benefits.
In fact, after quickly searching for “homeopathy clinical trials,” I found 48 “randomized placebo-controlled trials (RCTs)” listed on the British Homeopathic Association’s website alone.
The problem? As we’ve discussed many times, including in Think That Clinical Study is Legit?, one study (or even a handful) doesn’t necessarily indicate that something is proven to work.
For this, you need an entire body of placebo-controlled, peer-reviewed studies, which could constitute hundreds or thousands of individual trials.
With this in mind, in March 2015, the Australian National Health and Medical Research Council published the most exhaustive review of the “evidence of the effectiveness of homeopathy” to date. What’d they find?
While I’d strongly recommend reading through their Information Paper to gain a full understanding of their methodology, they ultimately concluded, “there are no health conditions for which there is reliable evidence that homeopathy is effective.”
The Big Question: Why Do Homeopaths Continue Practicing? An Ongoing Discussion
Science-Based Medicine doesn’t mince words when writing:
“Homeopaths have known these facts for many decades. Anyone who is any sort of a scientist or has an understanding of science, when confronted with these simple, well-established physical laws, might—just might—start to rethink his belief in something that is so utterly implausible from a scientific standpoint.”
In fact, the Federal Trade Commission recently released a policy statement indicating that over-the-counter homeopathic treatments may have to clearly disclose, on their label, that they don’t work.
Given everything we’ve learned, it might be reasonable to conclude that it’s an open and shut case: when it comes to homeopathy, it’s a fundamentally flawed medical system that just doesn’t work.
If this is the case, though, why are there so many homeopathic practitioners in the US and around the world? In America alone, why do we spend $170 million per year visiting these practitioners and purchase $2.9+ billion worth of their treatments?
In a nutshell, because—despite the almost complete lack of reliable clinical evidence—hundreds of thousands of practitioners legitimately believe they’re providing a beneficial service to patients. Not to mention the millions of patients they’ve observed getting better while using their treatments.
What’s going on here? Is there some fundamental concept at work that can’t be measured using current technology? Is there a significant gap in our basic understanding of chemistry and physics that might allow these dilutions to deliver results?
Does absence of evidence equal evidence of absence?
While these questions are easy to ask, they’re anything but to answer. As a result, we’ll dedicate an entire article to covering the topic in our next installment on why do so many of us turn to homeopathy?