Monday, January 25, 2016

Like Cures Like: Assessing the Claims of Homeopathy (In Rapid Succussion)

What is homeopathy?
          Homeopathy was first described in a book written by Samuel Hahneman in 1796, based on the central tenet that “like cures like.” This form of alternative medicine utilizes extreme dilutions of chemicals – usually natural – as therapeutic agents for symptoms and conditions often caused the original source of the substance (for example, arsenic as a cure for severe pain). Homeopathic solutions are prepared by diluting substances many orders of magnitude in either water or ethanol and vigorously shaken (known as succussion). Several rounds of dilution and succession are repeated until the desired dilution has been reached. This repeated process of succession and diution is known as potentisation. Homeopathic dilutions are logarithmic in scale, meaning that each round of potentisation is diluting the substance by 10-fold (Table 1). 

Homeopathic Dilutions
The most common scale used for dilution is the “C” scale, which = 10-2x. For example, 1C = 10-2 (or 1:100) and 3C = 10-6 or (1:1 million). Another common scale is “X”, which is 10-1x (1C = 1:10). If it has not already, it may become increasingly clear to the reader that these extreme scales of dilution present a problem. 
X ScaleC ScaleRatioNote
1X1:10described as low potency
2X1C1:100called higher potency than 1X by homeopaths
8X4C10−8allowable concentration of arsenic in U.S. drinking water[11]
24X12C10−24Has a 60% probability of containing one molecule of original material if one mole of the original substance was used.
26X13C10−26If pure water was used as the diluent, no molecules of the original solution remain in the water.
60X30C10−60Dilution advocated by Hahnemann for most purposes: on average, this would require giving two billion doses per second to six billion people for 4 billion years to deliver a single molecule of the original material to any patient.
400X200C10−400Dilution of popular homeopathic flu preparation Oscillococcinum
Note: the "X scale" is also called "D scale". 1X = 1D, 2X = 2D, etc.

At such extreme dilutions, it is unlikely that even a single molecule of the homeopathic agent will remain. Based on the calculations underlying the unit of measurement known as the mole and the conversion factor Avogadro’s Number, 6.02 x 1023, any dilution greater than 1023 would probably not contain even a single molecule of the original substance. While homeopathic preparations do not typically even mention the amount of starting material, an impossibly massive amount would be required in order to account for this scale of dilution.

“Water Memory”
Homeopaths use this math as evidence of homeopathy’s safety. Since homeopathic preparations are often derived from toxic substances, diluting them down to nothing would eliminate any dangerous effects. It at this point that the logic becomes murky, as it is argued that succussion actually increases the effectiveness of the remedy by extracting the “essence” of the ingredients into the diluents, a concept described as “water memory”. Potentisation therefore eliminates the negative effects of a toxic ingredient while bringing out its healing properties.

The general idea behind homeopathy does have some validity. While potentially oversimplified, the old saying holds true that “the poison is in the dose”. Medicines, vitamins, and even some toxins (such as botulism {Botox}) can all be both beneficial and extremely dangerous depending on the specific dose administered. In fact, the whole basis of adaptive immunity and vaccination involves our bodies sampling parts of a pathogen in order to prepare the immune system for defeating it in the future. Similarly, allergy shots reduce the overactive immune response to allergens by actually injecting them similar to a vaccine. This does not mean that poisons suddenly magically become curative when heavily diluted towards nothing, however, as homeopathy claims.

Homeopathic research
Homeopathy is more widespread among the medical and academic communities than one might think. There are several homeopathy research journals, and a quick internet search will find multiple physicians and clinics practicing homeopathy in your local area. Numerous research studies have been published demonstrating efficacy of various homeopathic substances, however poor methodological rigor and bias can often explain these positive results. Interestingly, despite the vast preponderance of poor quality studies in the field, statistically significant effects of homeopathy have been found to exist in small sample sizes of reliable trials by two separate meta-analyses (combined date from multiple studies).  As a major caveat however, another report found that positive results in homeopathic research are rarely independently replicated, an important feature of most widely accepted research findings. Nonetheless, while the overall quality of homeopathic research is poor, in certain select cases its treatments may potentially have some therapeutic value.

Homeopathy is sometimes seen as one and the same with other forms of alternative medicine, however this is not the case. Other forms of alternative medicine such as massage therapy and acupuncture are more broadly accepted within the medical community, with dedicated specialties at renowned institutions such as Johns Hopkins and an entire center within the National Institutions of Health. Additionally, many modern drugs and cures have originated from plants or other natural remedies.

While it is possible that some homeopathic treatments may have some positive effects, the biological mechanism of action for these is nonexistent, and accepted science does not support homeopathic claims. There should not be any risk involved with taking any substance of substantially high dilution, but since homeopathic substances are often toxic, weaker dilutions have resulted in a wide range of harmful effects, including death. Even without direct negative consequences, forgoing scientifically sound medical treatment in favor of homeopathy could be an extremely dangerous decision and should never be recommended.

(This is a parody for comedic purposes only)

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