Getting High, on Homeopathy

On a cold winter night in late 2006 in Minnesota, 26-year-old “A” needed immediate medical attention. He was moribund and his blood pressure was an alarming 80/40. Revival came, but not before a heroic struggle. The doctors at the hospital toiled for over 4 hours, intravenously infusing “A” with over 6L of saline. “A” was finally back on his feet, but only just; his blood pressure rose to 100/62. Overall, this was a triumph of medical intervention. Upon further enquiry by the doctors, what had happened became clearer.

“A” had been suffering from depression and was fortunate to have been enrolled in a clinical study to receive a novel experimental drug for his condition. During the enrolment, “A” had been edified about the beneficial effects of his treatment but was also sternly warned of the potentially fatal consequences of consuming more than the prescribed doses of this drug. “A” had been taking the novel drug diligently for a month and had been delighted when he felt his mood had begun to improve substantially. Life had meaning, the sun shone well, and the mornings were welcoming. That’s when misery hit him with fury; his girlfriend walked out of their relationship. Unable to cope with this sorrow, he decided to end his life by consuming a “potentially fatal” number of 29 capsules of the drug that he had been receiving. And an “almost fatal” encounter is what he had. As responsible medical practice compliant with regulations of clinical trials, the doctors at the hospital contacted a physician involved in the clinical trial that had provided the experimental drug to “A”. Upon arriving at the hospital and being made aware of the case, this physician was stupefied. The 29 “potentially fatal” capsules that “A” had overdosed on, it turns out, were placebo capsules. They had nothing but sugar. This was a fabulous, almost fantastical case being of killed by placebo (Reeves, 2007). Let’s understand what happened to “A”, and why this understanding throws white light on a magical, side effects-free, comforting, and affordable form of treatment – Homeopathy.

Almost all of us have or know close relatives who have received homeopathic treatments for a variety of ailments. These include oeuvres as diverse as common cold to cancers of various kinds, COVID-19, and autism. Although, since it’s early days in the 1800s, homeopathic therapy has been under much scrutiny, there is no dearth of well-meaning individuals who will shout out the benefits they have received from homeopathic drugs as Arsenicas, Belladonas, Nux vomes, Rhus toxes, Sherlock Homes, Piss foxes. The last two on that list were added for alliteration and aren’t real drugs, but then, nor are the other four.

The effectiveness of homeopathy stands on shaky grounds, and the American Medical Association (AMA), the National Health Service (NHS) in the UK, and the National Health and Medical Research Council (NHMRC) in Australia have all issued statements suggesting that there is no evidence that homeopathy is effective for ANY health condition. However, budget estimates suggest that in the year 2024, research on homeopathy received funds worth 4000 Cr from the Indian Government and it continues to receive money and acceptance. ?We shall soon see why. First, let’s take a historical detour.

History of Homeopathy and Our Hero Hahnemann

Until the late 1700s, the field of medicine was a close cousin of barbarism. If you had a headache, you’d have a hole drilled into your skull. If you had constant nausea, you’d have your body drained out of all the blood. Disillusioned by the inability of the then prevalent medical practices to humanely treat and care for patients, an apprentice of medicine, Samuel Hahnemann left the field. He was not going to be party to the systematic torture of ailing individuals in the name of therapy. He was going to propose an entirely new field of medicine. This would be a revolutionary new field and very nobly place the personage of the patient at the heart of the treatment. Hahnemann was ready to take on the ogres of conventional medical practice. Hahnemann would and go on to establish the foundational principles of this revolutionary field. There would not be any more primitive, barbaric handling of people in the name of treatment. Thus, was born, Homeopathy.

Principles of Homeopathy

Vital Force

A critical notion in homeopathy is that of vital forces. According to Hahnemann, all organisms possess a “material body” and contained within the cells of this material body a “spiritual” or “spirit-like” body. This “spirit-like” body was christened “Vital Force”. The central tenet of homeopathy, and other alternative forms of medicine, is that diseases are produced by disturbances to this Vital Force. Homeopathic remedies act by displaying their effects on the body’s spirit-like vital force. This is fascinating and truly revolutionary. However, there is a problem.

Most homeopaths regard the Vital Force as something beyond the comprehension of currently measurable science. It is a special force that subsists all of life akin to the soul. Homeopathy claims that this Vital Force is intrinsic to the homeopathic substance and during the process of the preparation of the homeopathic drug, the Vital Force is transferred from the active substance to a solvent (more on this later). Unfortunately, no experiments in chemistry or physics have been able to point to the existence of this Vital Force.

Some practitioners of homeopathy explain the Vital Force within the orbit of non-spiritual science. They interpret the Vital Force to imply anything including chemical and physical bonds that support the molecular structure of compounds, the functioning of neuronal impulses, to the flow of blood (Selfridge, 1897). However, problem arises when homeopathy suggests that an imbalance of this uniform Vital Force is the only underlying cause of all diseases. We know from the pathophysiology of diseases that there is no “One” reason for all diseases. Some diseases are caused by infections, some by metabolic disturbances, and some others by impacting the nervous system or the immune system. Therefore, either the Vital Force means many things, in which case, we are better off calling it what it may in reality be – molecular bonds, neural impulses, metabolic homeostasis, immune signalling; or it means nothing. In that case, we are better off calling it nothing.

?Law of Similars

“Similia similibus curentur” or the Law of Similars suggests that compounds that trigger “symptoms” at high doses in healthy individuals cure the same symptoms at low doses in ailing individuals. The proof of this was that when Hahnemann ingested the bark of cinchona (used to treat malaria), he experienced malaria-like symptoms. This phenomenon is called “provings” and is purported to be proof of the efficacy of the homeopathic remedy. This way, compounds that cause nausea, itch, allergy, diarrhoea or mad dancing at high doses in healthy individuals are indicated as treatments for the same conditions in their dilute forms. Some practitioners of homeopathy claim that this operates on the same principle as immunization/ vaccination. The administration of small quantities of an inactive (attenuated) pathogen does prepare the body to prevent infection in the event of an encounter with a live pathogen. However, there are big differences. In immunization, the same individuals who are exposed to the attenuated pathogen or pathogen-particle are conferred the protection. Additionally, the protection is conferred against a live form of the attenuated pathogen or the pathogens that bear a molecular resemblance to the pathogen-particle. However, the Law of Similars does not function on either of these concepts. There is no mechanism in biology or chemistry that successfully explains the Law of Similars and for a medical phenomenon, the least that is needed is an explanation rooted in scientific principles.

The Law of Similars does not end with triggers and cures. It has been extolled that objects that resemble bodily organs have effects (often beneficial) on the organs because of their shapes. So, walnut, because it resembles the brain, must be good for the brain. Kidney beans, which resemble the eponymous organ, are beneficial to the kidneys because of their shape. However, both the walnut and the kidney beans evolved much before there were any mammalian brains or kidneys on this planet. And the brain and the kidney were not shaped by evolution using dry fruits and pulses as prototypes. This is a teleological and a rather anthropomorphic imagining of evolution. ?

The weirdest examples where the Law of Similars is claimed to work are also those that take the most eldritch turns. ?As a part of the “provings”, it has been reported that some compounds when given to healthy individuals cause them to start lying, stealing, and exhibiting weird behaviours. These compounds have, over time, been incorporated in the homeopaths’ arsenal as treatments for psychiatric disorders. A fascinating example of ridiculing the concepts of science in the name of therapy is a drug called - Berlin Wall. It includes, bewilderingly, crushed stones of the Berlin wall. It is an outstanding cure for depression. In another experiment (by a certain Dr Jayesh Shah), rat’s blood caused healthy individuals to start lying, stealing, twitching their moustaches, becoming jovial, and to become hypersexual. And viola! A panacea for pathological lying (mythomania), stealing (kleptomania), uncontrolled twitching (fasciculation), and hypersexuality was found. There was no need to confirm the reproducibility or generalizability of this treatment nor was there a need to follow-up on the occurrence of relapses. That there is no similarity in the twitching of moustaches and the need to be hypersexual, both encountered in response to the same intervention does not seem to be discordant to the homeopath. This is mind-numbing and sounds like witchcraft.

Law of Dilution

A third principle is that of “potentization” or the Law of Dilution, which states that dilution enhances the therapeutic potential of the original substance possessing the healing or curative powers. This thesis suggests that serial dilution and a ritualistic rapid shaking (succussion) transfers the Vital Force or the “spirit-like” healing power of the homeopathic remedy into the solvent in which the homeopathic remedy is diluted. However, there are problems with this notion. First, as we saw earlier, the concept of Vital Force is specious; so, something that does not exist cannot be passed from the homeopathic remedy into a solvent. In a less magical tone, homeopathic practitioners invoke simple chemistry and argue that even if it is not the Vital Force that is transferred from the homeopathic remedy into the solvent (often water or alcohol), there is reason to believe that the molecules of the solvent arrange themselves to suit the molecular structure of the homeopathic compound. This is called “Solvent Memory” or more popularly, “Water Memory”. The homeopaths further go on to state that as the solution is diluted, the strength of the Water Memory increases. A solution that is diluted 1000 times is more effective than the concentrated starting solution. A solution that is diluted 10,000 times is even more effective. This goes on and the “drugs” that are dispensed in practice often reach dilutions of 1:10^60.

As a primary concept in chemistry would tell us, any solution that is diluted more than 6x10^23 (Avogadro’s number) times would not have a single molecule of the active ingredient. In practice, therefore, the homeopathic drugs do not contain even a single molecule of the drug. It only has the solvent. It is this modified and ultra-dilute arrangement of the solvent molecules that contains the therapeutic benefits of the homeopathic drug. This is in direct contradiction with everything that we know about the chemistry of substances. To end up with increased efficacy with increased dilution contradicts the second law of thermodynamics, the law of mass action, and the dose-effect relationship. These three principles govern all chemical reactions that explain everything from the running of cars, burning of fires, the Big Bang, and how allopathic medicines work. So, unless the homeopathic Law of Dilutions works based on chemical laws that exist beyond the normal realms of this universe, there is no mechanism by which the ultra-dilute homeopathic remedies can work on the body. In the same logic, all water on Earth has at some point in time encountered various impurities. These impurities may be different micro-organisms, rocks, plant and animal residue, ashes of dead folks, and the excreta of live folks. The molecules of the water that we drink and the water that is used to dilute the homeopathic substance must also contain the memory of all these substances. However, homeopathy chooses to ignore the memory of all these impurities that the water molecules may have encountered and only focuses on the memory of its chosen solute. When high school chemistry fails them, homeopaths invoke concepts like quantum physics and uncertainty principle none of which explains the “Science” of homeopathy. ??

Try checking if this wonderful concept of homeopathy works the next time you order a peg of Macallan 21 or any of your favourite whiskeys. Do not order it neat but ask the whiskey Sommelier to dilute it a billion times. You’re sure to get a high that you’ve never had in your life.

Why Homeopathy has Survived

Anecdotes are strong and impactful in influencing human decisions; however, they do not constitute reproducible evidence. Homeopathic studies significantly lack the rigour required to live up to the high evidential standards of modern medicine. The invoking of arcane concepts of the spirit doesn’t make it any easier for homeopathy to be taken seriously either. At best homeopathy treats symptoms that cause discomfort; in other cases, the treatment may have nothing to do with the management of the diseases. On this, studies after studies and the cumulative synthesis of the findings of multiple studies (known as Systematic Reviews) have shown that there is no condition for which homeopathic remedies have a clinical effect in a controlled setting. Despite this, homeopathy enjoys much popularity and prominence among the general population, and real-world observations suggest that people who take homeopathy claim to be cured of their diseases; this is especially true for allergic rhinitis, psoriasis, acne, asthma, and irritable bowel disease. There is also scientific evidence that supports improvements in the quality of life of individuals who receive homeopathic remedies. One may wonder if everything about homeopathy is wrong, why has it survived for 250 years. This needs critical investigation.

Lifestyle Modification

An important attribute of homeopathy is careful case-taking. The homeopath shows extreme compassion and care and takes down minute details of the patient's daily affairs. Once that is done, the homeopath recommends a list of dos and don’ts. These involve strict adherence to lifestyle changes such as avoiding exposure to stressful triggers, psychological or otherwise. The homeopath also recommends dietary discipline, which involves many things that need to be avoided. The homeopath would often say that consumption of certain kinds of food may impede the effectiveness of the drug. However, these lifestyle changes such as avoiding caffeine, dairy products, onion, cold water, inter alia act, in essence to protect the patient from potential triggers to the symptoms of a disease. ??

Placebo Effect

Many practitioners of medicine dismiss the placebo effect as experimental artefact and something that interferes with our ability fully test the clinical effectiveness of medicines. Other practitioners of medicine frown upon it as a psychological trick, impacting the gullible. Funnily, the placebo effect is one phenomenon on which homeopathic doctors and allopathic doctors share their stances. Both scorn at it.

There is a wealth of evidence to suggest that the placebo effect is not some psychological weakness or illusion. Placebo drugs that are blue in colour have stronger responses than those that are red. Placebo drugs that are bigger have better response, and two placebo pills have stronger effects than one placebo pill. Placebo interventions where the patient can see the intervention are more effective than those in which the patients are unaware of the administration. Even informing the patients that they are receiving a placebo treatment (open-label placebos) have been shown to have clinical effects. There are also examples of placebo surgeries, in which patients have reported actual changes in their perception of their disease. ??

Given the importance and intrigue of the placebo effect in guiding the outcomes of medical interventions, this topic deserves lot more digging than is possible in a few paragraphs. I shall be covering the placebo effect as a separate topic in the next essay. For now, it suffices to know that the placebo effect is a fascinating phenomenon. It is a triumvirate of the roles of context, expectation, medicine. ?

Auto-healing or Spontaneous Remission

Many diseases have a natural history, starting with mild forms, reaching a peak point, and finally, resolving on its own. This happens because in response to any disease, the body mounts a response to restore health or maintain homeostasis. The interval between the initiation of the disease, the peak point and the remission can vary greatly between diseases; in some cases, it may be a few days and others, it may be months to years. Such conditions include colds and flu, conjunctivitis, diarrhoea, stomach aches, muscle pains, viral infections and the resulting fever, acne, pimples, psoriasis, lupus. These conditions do not need to be managed by any therapeutic interventions. No matter what one does, the condition takes the same time to resolve; however, if one does take homeopathic treatments to manage the condition, one may wrongly assume that the assuaging of the condition occurred because of the homeopathic intervention.

Regression to Mean

It is a statistical phenomenon of data distribution by which when multiple observations of the same phenomenon are made in a population or in an individual, natural fluctuations of variables influencing the observation cause extreme (very high or very low) values to appear. Over time and on repeat measurements, the extreme values naturally tend towards a mean range. In other words, when an extremely high or low value (compared to an average) is measured by chance, consecutive measurements return close to the mean range. What does this have to do with homeopathy? Most patients seek treatment when their health conditions are worse than the average level of illness that they can withstand before being impacted either physiologically or psychologically. Many diseases are fluctuating in nature, where the symptoms wax and wane between mild and severe forms. This cycle is repeated every time the patient experiences the disease. As an example, a patient with irritable bowel disease or acne may show the characteristic signs of the condition that wax and wane with time, and at one point in time, the symptoms reach their zenith. Since waxing and waning is a natural course of the disease, immediately after the time the symptoms of a condition reach their zenith, the symptoms would subside even in the absence of any intervention. If at that time, the patients were to receive a homeopathic remedy, the remission of the symptoms would be attributed to the remedy itself. In reality, the patients were a part of a statistical distribution, which naturally pulls their condition to an “average”.

Selective Reporting

Homeopathy has a poor habit of not presenting information on the success-failure ratio of their treatments. Homeopaths rarely identify any condition that is beyond their curative reach. “Cancer? No problem: they’ll treat it. AIDS? That’s no problem; they’ll treat that too. Autism? That’s the easiest; they’ll cure it before the weekend.” There is also evidence to suspect of obfuscation of data in larger homeopathic studies such that results are modified to report clinical success. One way to confirm this is to check for homeopathic studies were the definitions of treatment success and the expected outcomes are formally approved before the initiation of the study. This is known as “Trial Registration”. In an interesting analysis of several homeopathic studies, the likelihood of treatment success increased by 4 times if the trial had not been registered (Gartlehner, 2021). One cannot help but wonder, why the act of registration may have such a strong effect on the clinical outcome of the drug. Perhaps registration impacts the water memory. This lack of acknowledgement of the shortcomings of homeopathic treatment reeks of obscurantism.

The Bottom Line

The homeopathic approach is “holistic” and “patient-centred”, treating the individual and not the disease. This is indeed a noble thought. In some sense, homeopathic treatments not about the homeopathic drugs but about a complex relationship between the homeopath and the patient. There is much to learn from the general demeanour of the homeopathic practitioner’s attention to the individual needs of the patient, the careful listening of what the patient has to say, and the overall comfort afforded to the patient. These are critical components of the successful management of a disease and the spine of physician-patient relationship; however, this is where the “efficacy” of homeopathic treatment ends. Beyond this, the effects are taken over by changes to lifestyle, regression to mean, auto-healing, and the placebo effect. And no amount of vital forcing, mind-body hodgepodge, quantum healing, or water memory comes to the mechanistic rescue of this school of disease management. Unless homeopathy can convincingly show that not only is it an alternative form of medicine but also deals with a completely alternative form of extra-terrestrial science, it will continue to only remain desirous of a seat on the table of evidence-based, scientific medicine. By the way, did you hear about the boy who died of an overdose of a homeopathic pill? He had forgotten to take them.