On the “The Current,” the CBC’s national morning show, Dr. Heather Boon, Dean of Pharmacy at the University of Toronto, and I had a chance to express our views on the proposed study she is organizing to investigate the homeopathic treatment of attention deficit hyperactivity disorder (ADHD) in conjunction with the Riverdale Homeopathic clinic. This was stimulated by a letter I had written to Dr. Boon, co-signed by some ninety physicians and scientists, asking what was to be gained by such a study and expressing surprise that someone with training in pharmacy would attach any credibility to the bizarre concept of homeopathy.
Dr. Boon got the ball rolling by stating very clearly that she does not believe that homeopathy has any scientific basis, and that the goal of the study was to explore why people believe in homeopathy and to try and understand the complex interaction between homeopath and subject. I was glad to hear her say that she does not believe in the mythical behaviour of non-existent molecules, but when I looked at the details of the study as registered, the number one purpose stated is “to determine if there are any specific effects of homeopathic medicines in the treatment of ADHD.” Also, in a previous paper in which she discusses at length the homeopathic studies recorded in the scientific literature, she opines that “physical experiments have demonstrated a variety of possible mechanisms for the transmission and preservation of therapeutic properties in highly diluted solutions.” While some experiments have shown that water has some anomalous properties, no experiment I know of has shown the transmission of any sort of therapeutic effect.
The purpose of scientific research is to advance our state of knowledge, hopefully with spinoffs that will benefit the public. But funding for scientific research is not unlimited, indeed it is becoming harder and harder to come by. So decisions have to be made on the allocation of both money and effort. Factors that need to be taken into account include previous studies of the subject as well as scientific plausibility. For example, there would be no point in studying pendants that claim to neutralize electromagnetic radiation because this makes no sense according to principles of physics. Ditto for jars that claim to magnetize water in order to turn it into a healing solution, or for hollow wax candles that claim to remove ear wax, freeing up (nonexistent) energy channels in the body. That brings us to studying the effect of absent molecules, namely homeopathy. This two hundred year old practice has been put through the mill numerous times. Literally hundreds of studies have examined the possibility that solutions diluted to the extent that they contain no remnant of the original solute can still retain some sort of memory and deliver therapeutic benefits. How such memory, should it exist, has anything to do with healing disease is never addressed.
Plausibility is an important consideration because it prevents us from wasting scarce resources on projects that do not have a reasonable chance of producing a useful outcome. The basic tenet of homeopathy, that the potency of a substance is increased by dilution, in other words, the “less is more” phenomenon, flies in the face of what is known about the mechanism of drug action, and more specifically is incompatible with chemistry’s “law of mass action” that relates the rate of a chemical reaction to the masses of the reacting substances. If the mass of a reactant is essentially zero, as it is in a homeopathic solution, its rate of reaction with any substance in the body would also be zero. Dr. Boon has commented that conventional medications are designed based on plausibility and that the research often does not produce the desired results. I think the suggestion is that therefore we should not dismiss theories based on implausibility. While it is true that scientific plausibility does not guarantee success, implausibility, such as exemplified by the “principles” of homeopathy, virtually guarantees failure.
When confronted with the weakness of their arguments, homeopaths attempt to cloak themselves in the respectability of science by searching out references in the literature that deal with the anomalies of water. Indeed, there are some mysteries about just how water molecules associate with each other, and some interesting data about patterns that they can form. But these arrangements last only picoseconds and in no way have anything to do with justifying homeopathy. Sometimes homeopaths try to buttress their claims by lassoing the concept of hormesis, the notion that some substances at very low concentration have a greater effect than at larger concentrations. This is not pertinent because the concentrations at which hormesis is observed are far, far greater than that found in any homeopathic solution. Homeopaths also like to fling about sciency words like “nano,” “quantum” and “clathrate” as they grope to rationalize the irrational.
So it is really no surprise that the vast majority of proper, randomized, controlled, double-blind trials have concluded that the effects of homeopathy can be explained by the placebo response, without any need to invoke ghostly imprints of solute molecules. Homeopaths do not accept this conclusion and counter by pointing to the few studies that show a positive effect, no matter how marginal, as well as to the numerous anecdotal accounts of patient satisfaction. But studies of homeopathy show a huge publication bias, meaning that only positive findings, likely due to chance, get published. Less than 5% of studies in alternative journals show a negative effect while mainstream medical journals feature negative results with regularity.When challenged about the lack of evidence for their arguments, unfortunately some homeopaths tend to resort to name calling and denigrating comments about conventional medicine. They also call for more research on questions that have been repeatedly answered.
Should a university answer the call for more studies? This now takes us back to the original question we posed to Dr. Boon. Obviously she feels there is something to be gained from exploring why people believe in homeopathy and whether any benefit, should there be one, can be attributed to the interaction between the subject and the homeopath. Our view is that this issue has been thoroughly investigated, and given the scientifically irrational tenets of homeopathy, little can be gained from yet another study. Dr. Boon’s reasoning that her study will put homeopathy to the test and “will search out the truth” and perhaps “provide the best evidence yet that homeopathy doesn’t work,” is less than compelling. After the plethora of studies already carried out that have failed to resolve the issue in the eyes of believers in homeopathy, this one will? Not a chance. Doing the same experiments over and over again, hoping for a different result, is not the hallmark of good science. Admittedly, Dr. Boon’s study is well designed, but if a study isn’t worth doing, it isn’t worth doing well.
There is also a potential downside to such a study. And that is the implicit legitimization of homeopathy as a consequence of a prestigious university and a highly reputable investigator being involved. That is especially bothersome when the clinic where the study will be carried out offers a number of questionable practices including homeopathic “nosodes” as alternatives to vaccination, ear candling, cupping and cranial sacral therapy.
After 200 years of often acrimonious battles between homeopaths and their critics, the only conclusion arrived at with confidence is that no study will resolve the differences. It is time to say enough is enough and dedicate funds to projects that have a better chance of a favourable outcome. Homeopaths will have to accept that the majority of the scientific community will not be swayed by the notion of nonexistent molecules producing a therapeutic effect, and we in turn have to accept that no matter what we do, homeopathy will be kept alive by a blend of bizarre ideology, a potent placebo response, scientific illiteracy, and the popular myth that anyone who opposes homeopathy is in the pocket of Big Pharma.