Tuesday, August 13, 2013

The Delusion of Dilution: When Pharmacists Recommend Homeopathy

You’re awakened just after midnight by a scream.  You pull on a robe, step through the darkened hallway and tiptoe into the bedroom of your three-year old.  He’s sitting up in bed, clutching his ear, sobbing.  As you try to comfort him he settles into a plaintive wail.
“It hurts, Mommy.”
That’s when you realize you’re all out of pain medication.  You pull on a pair of jeans and a sweatshirt to make a run to the 24-hour pharmacy.  When you get there, you notice a kindly-looking man in a starch-white smock behind the counter.  He doesn’t appear particularly busy, so you decide to ask him for advice. After relaying your son’s symptoms, he nods, walks around the counter and leads you down an aisle stocked with brightly colored boxes of medicine.
“Try these,” he says, as he hands you a small box of ear drops.
Not what you expected, you think.  But you’re glad.  In fact, you’re only too happy to shell out twelve bucks to relieve your child’s pain.
What you don’t know is that the drops the pharmacist gave you will not work.  In fact, they couldn’t possibly work because they contain no medicine at all.  What you don’t realize – what he didn’t tell you – is that the “medicine” he gave you is a homeopathic preparation.
Anyone who’s read my book, Suffer the Children knows that I hold no punches in holding my profession of pediatrics accountable when its practitioners stray from accepted standards of care. I’ve strongly criticized physicians for exposing children to potential harm by missing basic diagnoses, by excessively prescribing unnecessary medications and needless laboratory tests, and in some instance, by putting profit above patient care.
In this article, I will turn my attention to a non-scientific philosophy of healing created by the German physician, Samuel Hahnemann in the late 18th century. Normally I don’t fret too much about this subject, but lately I’ve noted a worrisome trend.  I see more and more families who are “prescribed” homeopathic remedies by pharmacists, often for the treatment of diarrhea or teething, and more frequently to relieve ear pain due to infection.  Almost always, the family is unaware that the medicine they purchased is homeopathic.
When I ask my patients’ parents what their understanding of homeopathy is, many answer that it’s “natural” and involves herbs and such.  Actually, that’s not true at all.  If you read the list of ingredients on homeopathic preparations, you’ll often find the names of highly toxic materials such as lead, mercury and sulfur.  But don’t worry if you’ve taken these in the past:  they don’t really contain these ingredients at all (I’ll explain in just a bit).
Actually, homeopathy is based on a couple of fundamental precepts.  The first, known as the “law of similars” holds that a substance that is able to create a particular symptom holds the key in treating a disease in which the symptom is present.  This is sometimes knows as “like treats like”.  So something that makes you sneeze, according to homeopathy, would be a good choice for the treatment of hay-fever. As long as it is prepared in accordance to the second law:  “the law of infinitesimals”.  This law holds that the more dilute a substance is, the more effective it will be.
How dilute?  Let’s take the example of the earache drops that are commonly recommended by pharmacists and advertised on the web page of the largest national franchise pharmacies.  Here’s what the box says:

Active Ingredients

Pulsatilla 30C, Chamomilla 30C, Sulphur 30C, Calcium Carbonate 30C, Belladonna 30C, Lycopodium Clavatum (Club Moss) 30C
Inactive Ingredients

Citric Acid, Water (Purified), Sodium Benzoate, Vegetable Glycerin

The “30C” following each of the active ingredients reveals their supposed dilution.  In homeopathy, an “X” represents a dilution of one part active ingredient in 10 parts of water.  A “C” is one part active ingredient in 100 parts of water.  To achieve a 30C dilution, we start with one part of the active ingredient, drop it in 100 parts water and shake real well.  Then you get an aliquot of that suspension, put in another 100 parts of water and stir well.  Repeat the operation 28 more times. 
Basic chemistry tells us just how much we can dilute a substance and still retain the original ingredient.  The prominent physicist, author and debunker of pseudo-science, Robert Park Ph.D. calculated that to retain a single molecule of the original substance, a 30C dilution would need to be dissolved in at least 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water (see the excellent article on quackwatch.com) which corresponds to a volume 30,000,000,000 times the size of our planet.
Modern practitioners of homeopathy don’t dispute these calculations. They agree that none of the active ingredient is likely to be present at such dilutions but they claim their medications are effective nonetheless because the water retains a memory or essence of the original substance.  This is sheer nonsense.

Join me in celebrating the launch of my medical suspense, The Art of Forgetting
August and September, 2013 

It may be hard to believe that pharmacists, who are educated in basic chemistry, biology, pharmacokinetics and pharmacodynamics would buy into the claims proposed by homeopathy (and most don’t), but I’ve learned that a good education and even intelligence does not necessarily render an individual immune from irrational beliefs.
A couple of years ago, I wrote a letter to the executive directors of two major pharmacy chains to ask if they endorsed the use of homeopathy and whether it was company policy for pharmacists to recommend homeopathic products.  I never received a reply, which I guess should be no surprise.  As is so often the case, the best way to protect consumers from this type of fraudulent practice is through education, and I hope I’ve done my small part with this article.
In truth, if I had been alive in 1795, I’d have gladly chosen Hahnemann’s nostrums over the leeching, purging and blood-letting that was rampant in the day – homeopathy doesn’t work, but at least it doesn’t outright kill you. But the year is 2013.  The world has changed dramatically.  Homeopathy has not.  So I’ll take the cold, objectiveness of science over the warm fuzziness of pseudoscience every time.  In the end, nothing is as soothing as rationality.