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.


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  2. Medicines are prepared through a specific pharmacological process of potentisation which results in nanograms of fine nanoparticles of the original starting material in the final product (upto 200c potency) administered in treatment of any disease

    1. I appreciate the comment but respectfully disagree. There is no process of potentisation that can happen through dilution. Dilute a drop of whiskey in a bathtub of water and the resulting solution is less likely to make you inebriated no matter what process you use. Homeopathy stands the dose-response curve on its head.

      The use of the prefix "nano-" is clever but applicable to the discussion. It is impossible for nanograms (10 to the -9 grams -- a very specific measurement, not an ethereal concept) to exist in a solution of 30C dilution. There is a law that prohibits this: Avogadro's limit. When you get to a dilution of 10 to the 24th power, you are not likely to retain a single molecule of a substance. This corresponds to a dilution of 12C.

      Likewise, the idea of "nanoparticles" means nothing in this setting. The size of a molecule is not determined by its dilution but by its molecular weight. Furthermore, when we talk of organic molecules, we're already on a pretty tiny level to start with so the concept of "fine nanoparticles" doesn't change the discussion in the least.

      I greatly appreciate the fact that you took time to post a comment.

      Peter Palmieri, M.D.

    2. That should have read "not applicable to the discussion"

    3. Thank You Dr. Peter for your prompt reply.

      Respectfully I would like to add the following in respect to your post.

      Homeopathic medicines are colloidal solutions containing nanoparticles of measurable (upto 200c potency) remedy source material and glass-derived silica and silica crystals heterogeneously dispersed in water-ethanol solution prepared by a pharmacological process of potentisation in a type-2 borosilicate (96.4%) glass vial.

      Hahnemann in his paper “Cure and prevention of scarlet fever”, published in Journal of Practical Medicine in 1801, mentioned the prophylactic properties of Belladonna in scarlet fever and the method to prepare potentised Belladonna to 1/24,000,000 dilution. He recommended one drop which is equivalent to 0.0416 nanograms of belladonna (1 grain = 0.06479891 grams) and to repeat the dose every 72 hours. This is the first recorded nanodose of medicine used in treatment of any disease.


    4. Oh dear, Nancy! There you get yet again making claims which simply don't stand up to scientific scrutiny and have been disproved.
      Firstly. homeopathic "medicines" (which are not medicines as homeopathy has been proven to have no therapeutic beneficial effect beyond placebo) are not colloidal solutions. You merely expose your ignorance of what the term "colloidal" means. Try this:-
      Any particles found in any homeopathic "remedy" diluted beyond 12C are contaminants from the manufacturing process. This is what the silica crystals are - they are NOT therapeutically active, they are contaminants. Sorry, but the laws of physics, chemistry and biology are not changed by the claims you make - no matter how many times you make your claims, they are still wrong.
      Please don't try to claim that water has a memory. Something that has a maximum persistence measurable only on a femtosecond scale is not indicative of a memory. Homeopaths need to retire that particular claim as it is thoroughly and utterly disproven.
      Your standard Gish Gallop of nonsense is nothing more than that - nonsense. Thoroughly disproven by the application of science and critical thinking.
      Whether Hahnemann described the "first recorded nanodose" of medicine and used it to treat disease is completely irrelevant. The evidence from properly conducted clinical trials shows that homeopathy has no benefit beyond placebo. Hahnemann belonged to a era predating the majority of modern medicine and science. His theories are prescientific and have been disproved. His so-called "laws of homeopathy" are discredited and disproven and your repeating of them does not change that fact. Dilution and succusion does not increase potency and it is deluded thinking to believe they do.
      I don't know if you truly believe in what you claim about homeopathy or if you know it's nonsense but continue to make them anyway. If it's the former, you are deluded - i.e. you hold false beliefs in spite of overwhelming scientific evidence. If so, it's about time you cast those beliefs aside and joined the rational world. If it's the latter, then that brings into question your integrity and readers can draw their own conclusions as to what that is.

    5. Upto the end of year 2010, there have been 11 meta-analysis and 8 systematic reviews including 1 cochrane review (out of approximately 20 systematic reviews published) published in 14 medical journals in evidence of homeopathy. Out of 11 meta analysis, 5 are comprehensive, 5 on specific medical condition and 1 on super-avogadro dilution effect.

    6. Out of all the systematic reviews can a homeopathic remedy be recommended for a specific condition? The best that can be said is that their have been some positive studies. If you gather all the best studies together and look at them, what do you see? The highest quality ones with the greatest number are negative. This means the ones most likely to give the best answers show homeopathy does not work.

  3. Surprise, surprise! Not a doctor Nancy Malik just can't resist the opportunity to repeat her deluded, clueless nonsense. Nancy - how many times do you have to have it explained to you? If (and it's a MASSIVE "if") there's anything in a homeopathic remedy other than the sugar of the pills, then it's due to contamination. It's physically impossible for any "remedy" diluted beyond 12C to contain any active ingredient whatsoever. Water does not have a "memory" beyond what's measurable on a femtosecond scale. There are no "nanoparticles" of the "active" ingredient. These are simple chemical and physical facts. Your constant harping on about your wrong ideas about science does not change that.
    Nancy - you remain deluded, a holder of false beliefs.

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