Homeopathy.. what's the deal?

[ladelfina]

On the intro thread someone mentioned homeopathy. This seems to be a rather popular alternative medicine in Italy, but I have a hard time figuring out how anyone believes in it.

I can buy theories that say:
1. medicinal herbs and other natural substances have beneficial properties
2. Lower doses of active ingredients may work better for you than higher doses.. (in fact, some of the substances may be toxic in higher doses, so...)

but I can't wrap my head around #3:
.. that the lower the concentration (the higher the factor of dilution -- up to the point of it being unlikely that there be even ONE MOLECULE of the active substance in the ampule you are buying) somehow the more effective and 'powerful' the homeopathic action.. To me this sounds like a brilliant way to charge $$ for distilled water.

In a related scenario, one of my husband's colleagues here, an engineer and otherwise intelligent person (who, among other things, has built his own helicopter) is working with someone on a method to "charge" small samples of water between electrodes (without having the water come in contact with any part of the metal/electrical apparatus), the desired result being that a "patient" is "cured" in some way by drinking this (rather small amount of) water after said treatment. (!!!) Our engineer friend is positive-to-agnostic regarding this (leaning towards positive); he doesn't think there is anything weird about it at all.

I have no doubt there a wealth of material about homeopathy out there on the Internet, but I was curious to hear any stories/explanations from otherwise-acknowledgedly-rational people here on the ER board.

[Ed_The_Gypsy]

Not sure why being an engineer gives one authority in medicine.

I am an engineer and I say "horsepucky".

Now you have two opposing views from engineers.

Now let's hear what Rich has to say.

Ed

[ladelfina]

Sorry Ed. It wasn't so much "authority in medicine" I was trying to communicate.. just that this engineer (like most, I would assume) generally lives in the "reality-based" community; he's not a new-ager or hippie-type that could get easily drawn in to things that sound good but have no basis in scientific fact.

[HFWR]

Another stereotype bites the dust...

[Rich_by_the_Bay]

Like many flavors of "complementary" or "alternative" medicine, homeopathy has quite a following. And each flavor (as well as traditional medicine) has all kinds of secondary agendas, greed-mongers, and quacks. I feel that this is a fairly small percentage, but it is a harsh reality.

Everyone needs to determine some standard or criterion by which they judge the validity of their health care (not to mention other life decisions). I happen to adhere to a scientific and evidence-based philosophy though even that has its deficiencies.

If you are are satisfied with anecdotes, testimonials and charismatic supporters then you can choose from almost any school of care. If you prefer to adhere to peer-reviewed, randomized, double-blind controlled trials, case control studies, cohort trials and the like, then traditional medicine might suit you best. Lacking such evidence, you might at least insist on some type of scientific plausibility. Each approach will work sometimes and be wrong other times. It's about stacking the deck in your own favor.

To my knowledge, homeopathy generally lacks a sound evidence-based foundation. Biologic plausibility? Hard to say. This does not mean it is completely without merit. Lack of evidence does not mean lack of effectiveness, just that such effectiveness has not been reproducibly and quantitatively demonstrated.

Personally, I feel that if you've got an effective treatment, prove it rigorously. If you can't prove it, why not? And proof doesn't mean it always works, but rather that it works xx% of the time or yy% better than the alternative. Then let patients decide for themselves. Without such evidence, you proceed at your own peril.

It's a complicated issue, filled with emotion and fanaticism. I usually don't try to talk patients out of it, but rather to provide information, work with them when I can, and accept that not everyone wishes to do it "my" way. C'est la vie.

[donheff]

R-I-T didn't MDs prescribe placebos in days gone by? They probably couldn't risk it now because of malpractice suits and disclosure requirements. It seems to me that homeopaths (and maybe the engineer wit the magic - electrodes at a distance remedy) benefit by being able to leverage the placebo effect - albeit unknowingly on their own part. They can't get hammered by malpractice or disclosure requirement since they say outright that their 'essences" may have few to no molecules of the "active" substance.

I subscribe to the skeptics' assertion that extraordinary claims demand extraordinary evidence and that seems to be lacking for some of these things.

[Baxter]

Another engineer says "horse pucky."

I'm all in favor of experimenting with so-called "alternative" forms of medicine, but there's no credible evidence that homeopathic remedies work. Period.

And the notion that you can dilute a solution to the point where you are unlikely to ingest a single molecule of the original substance, and this somehow makes the solution more "potent," should be laughed at as the pseudo-science that it is. Sorry if this offends, but chemistry, physics, and other sciences have contributed a lot to our understanding of the world, and it really gets my goat when people turn their backs on the great body of knowledge we have accumulated... and pushing bogus products on sick people is near the top of my list of Bad Things Not To Do.

Wikipedia helps put the numbers in perspective:

Quote:

...there are in the order of 10^32 molecules of water in an Olympic size swimming pool; to expect to get one molecule of a 15C solution, one would need to take 1% of the volume of such a pool, or roughly 25 metric tons of water. Thus, even homeopathic remedies of a high "potency" contain, with overwhelming probability, only water. Practitioners of homeopathy believe that this water retains some 'essential property' of one of the substances that it has contacted in the past. Water will have been in contact with millions of different substances in its history. According to this molecular paradigm, any glass of water must be regarded as an extreme dilution of almost any agent you care to mention. Thus, critics argue that by drinking water one receives homeopathic treatment for every imaginable condition. Proponents of homeopathy are unable to accept the molecular paradigm as a complete account of life phenomena and therapeutics. They believe that the methodical dilution of a particular substance, beginning with a 10% solution and working downwards, produces a therapeutically active 'remedy', in contrast to regular water which is therapeutically inert. However, in terms of chemistry, a dilution of anything at 30C is identical to water.

[Rich_by_the_Bay]

Quote:

Originally Posted by donheff R-I-T didn't MDs prescribe placebos in days gone by? They probably couldn't risk it now because of malpractice suits and disclosure requirements. It seems to me that homeopaths (and maybe the engineer wit the magic - electrodes at a distance remedy) benefit by being able to leverage the placebo effect - albeit unknowingly on their own part. They can't get hammered by malpractice or disclosure requirement since they say outright that their 'essences" may have few to no molecules of the "active" substance.

Prescribing for placebo effect in an explicit way is considered to be unethical in many settings. Probably was done years ago. However, many remedies have no proven clinical benefit but are prescribed regularly, as a way of acknowledging patient deisres , legitimizing an otherwise questionable doctor visit, etc.

For example, robitussin, oral decongestants, and antibiotics for viral syndromes have little or no proven benefit. Yet patients sometimes feel more satisfied if something is given (I will not prescribe antibiotics in this setting due to their 3-6% side-effect risk). So, prescribing placebos (e.g. sugar pills), no. But near-placebos - it's been known to happen.

[Nords]

Quote:

Originally Posted by ladelfina In a related scenario, one of my husband's colleagues here, an engineer and otherwise intelligent person (who, among other things, has built his own helicopter) is working with someone on a method to "charge" small samples of water between electrodes (without having the water come in contact with any part of the metal/electrical apparatus), the desired result being that a "patient" is "cured" in some way by drinking this (rather small amount of) water after said treatment. (!!!) Our engineer friend is positive-to-agnostic regarding this (leaning towards positive); he doesn't think there is anything weird about it at all.

If this procedure happens to be related to cold fusion, they could cash in!

[ladelfina]

I think he is in it for the design challenge posed by the client.. but his wife was taking a homeopathic remedy ("arnica") for pain following a fall from a ladder, in addition to regular pain meds; a belt-and-suspenders approach, I guess.

http://www.herbmed.org/Herbs/Herb92.htm#Category1Herb92
Pretty much what you would expect, unless you are a rat with "paw oedema"!
Just a couple studies showing some positive results; the majority showing no effect whatsoever.

Don't worry about offending ME.. I am not tempted in the least by these preparations, but was just curious whether anyone had direct personal experiences to share. Rich is very diplomatic, I must say..! There seem to be a lot of people in Europe who really swear by this stuff, probably because it is "natural" and (by its nature) benign, rather than because it is effective.. I think it allows them space to be "treating" themselves and exercise/exorcise their hypochondriacal tendencies (plus it gives them extra topics of conversation) without doing any harm, except perhaps to their wallets.

[Baxter]

Quote:

Originally Posted by ladelfina I think he is in it for the design challenge posed by the client..

I am curious, though, does the person who hired him have a hypothesis for how this "charged" water is supposed to work?

And doesn't the FDA have to approve before the seller can claim that their product has a medical benefit? I notice that a lot of manufacturers of herbal and homeopathic remedies go out of their way to avoid making any claim other than the product containing what the label says.. and then the sellers "fill in the gaps" by giving verbal recommendations. Hmmm.

[Martha]

Quote:

Originally Posted by Baxter IAnd doesn't the FDA have to approve before the seller can claim that their product has a medical benefit? I notice that a lot of manufacturers of herbal and homeopathic remedies go out of their way to avoid making any claim other than the product containing what the label says.. and then the sellers "fill in the gaps" by giving verbal recommendations. Hmmm.

http://www.cfsan.fda.gov/~dms/hclaims.html

At best, they can make supported claims about reducing disease risk like "diets high in calcium may reduce the risk of osteoporosis." They won't be able to say "our pill cures osteoporosis."