AS SOON as his best friend moved away, the eight-year-old boy started
complaining of pains in his legs. The family doctor couldn鈥檛 work it out, so he
referred the case to the hospital. The neurologists checked him out and couldn鈥檛
find anything. And so the boy was referred to yet another specialist.
This time the doctor was less interested in the boy鈥檚 legs than in what he
liked to eat and drink, how he slept and so on. Did he have any unusual habits?
鈥淗e hates buttons,鈥� his mother said. 鈥淓ver since he was a baby he鈥檚 refused to
wear clothes with buttons.鈥� The doctor consulted his texts then prescribed some
medicine. It worked. At the next appointment the boy walked into the clinic
without any pain in his legs, and he was wearing a cardigan with buttons.
The magic potion was a homeopathic remedy, jalapa, based on the root of the
Mexican shrub Exogonium purga. And it was prescribed by Bob Leckridge,
associate specialist at Glasgow Homeopathic Hospital. In common with all
homeopaths, he has a rather different approach from the majority of the medical
profession.
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Leckridge starts a consultation by making a study of a patient鈥檚 habits,
character, likes and dislikes. He uses this information to put together a
鈥減icture鈥� of the patient. He then looks up possible remedies in a
鈥渞epertory鈥濃�攁 list of symptoms and their associated remedies. All these
remedies have been tested in a process called proving, in which homeopaths
record the symptoms they produce in healthy people. Leckridge then cross-checks
the possible remedies in a homeopathic formulary to find out which one produces
a picture closest to the patient鈥檚. This is what is prescribed.
Homeopaths believe their remedies have a similar effect to vaccination. By
using a substance that produces symptoms similar to the ones they鈥檙e trying to
cure, they trigger a healing response in the body. As laid down at the end of
the 18th century by homeopathy鈥檚 founder, German physician Samuel Hahnemann,
鈥渓ike cures like鈥�.
Hahnemann came up with his theory after noticing that the malaria drug
quinine actually produced symptoms very similar to malaria when given to a
healthy person. He then started testing other drugs to see what symptoms they
produced. In the hope of making the drugs safer, he started diluting them. To
his surprise, he found that the effects produced grew stronger the more he
diluted the solution.
Today, homeopathic remedies are dissolved in ethanol to produce the 鈥渕other
tincture鈥�. This is then repeatedly diluted, starting with 1 part tincture to 99
parts of a mixture of water and ethanol, then 1 part of the resulting solution
to another 99 parts, and so on. Solutions are usually diluted six or 30 times,
but up to 200 dilutions can be performed. Each time the remedy is diluted it is
vigorously shaken, or 鈥渟uccussed鈥�.
The original ingredients are usually natural substances. Some, called
nosodes, come from matter produced by the disease itself, such as tissue from an
infected gland. Some are straight from the 鈥渆ye of newt鈥� recipe book鈥攂lack
Cuban spider, anal gland of skunk鈥攂ut others are more familiar. Red onion
has a 鈥渞emedy picture鈥� that includes watery eyes and sneezing. Homeopaths
prescribe it for some allergies. Nux vomica, the poison nut, causes
irritability, aversion to noise, bad breath and nausea. Not surprisingly, it鈥檚 a
popular hangover remedy.
So are homeopaths quacks? If so, millions of people have been taken in and
Britain鈥檚 National Health Service supports them in their credulity. There are
five NHS homeopathic centres. Glasgow鈥檚 alone sees 2500 new patients a year.
Between them, British consumers spend more than 拢20 million a year on
over-the-counter homeopathic remedies. It鈥檚 difficult to say how many
practitioners there are in Britain, as anyone can call themselves a homeopath,
but a recent University of Exeter report found that 2696 people were members of
homeopathic practitioner organisations.
Yet despite the popularity of homeopathy, practitioners have yet to convince
the majority of scientists that there is anything in it other than the placebo
effect.
Because homeopathy really shouldn鈥檛 work. There are two big problems. First,
the key ingredient in any homeopathic remedy is diluted to such an extent that
the chance of finding even a single molecule of the original substance in a dose
is vanishingly small. Secondly, the dose-response relationship鈥攖hat is,
the more you take, the more powerful the response鈥攊s apparently reversed
in homeopathy. The more dilute the remedy, the stronger the effect.
Being asked to believe two impossible things before breakfast can make people
angry. Even with the general public stampeding to their doors, homeopaths are
fighting a rearguard action against those who say they鈥檙e charlatans. Although
happy to continue practising as long as their patients keep coming, homeopaths
would dearly love a scientific explanation of their art.
So it was with some enthusiasm that the homeopathic community greeted a 1988
paper in Nature (vol 333, p 816) by immunologist Jacques Benveniste, then based
at INSERM, the French national institute for medical research. He suggested that
anti-immunoglobulin E serum diluted way past the point at which it鈥檚 reasonable
to expect a single molecule of the original substance to be present still
produces a biological effect. From this came the idea that water has
memory鈥攖hat it could somehow 鈥渞emember鈥� molecules that had once been
dissolved in it and act as if they were still there.
Unfortunately, his results could not be replicated despite the efforts of
several teams鈥攎ost famously a team assembled by Nature which
included magician and arch-sceptic James Randi. Randi鈥檚 foundation has since
offered a $1 million prize for anyone who can invent a reproducible test
that can tell the difference between a homeopathic preparation and a control. It
remains unclaimed.
Since what has come to be known as the Benveniste affair, scientific
attention has concentrated on statistical reviews of reputable clinical trials.
Most notably, Klaus Linde of the Centre for Complementary Medicine Research at
the Technical University of Munich led an analysis of 89 homeopathic trials.
Published in The Lancet in 1997 (vol 350, p 834), the study concluded
that the trial results were 鈥渘ot compatible with the hypothesis that the
clinical effects of homeopathy are completely due to placebo鈥�. A follow-up paper
in 1998 in The Journal of Alternative and Complementary Medicine (vol
4, p 371) went further, concluding that 鈥渋ndividualised homeopathy has an effect
over placebo鈥�. Not quite a ringing endorsement鈥攂ut not a dismissal
either.
Of course, some people think grown-ups shouldn鈥檛 be wasting their time
looking for something that shouldn鈥檛 be there. Jan Vandenbroucke, professor of
clinical epidemiology at the University of Leiden in the Netherlands, says
reviews of trials are pointless as any positive results can鈥檛 be interpreted
within our current understanding. 鈥淣othing can be ruled out in principle, but it
seems quite a remote possibility that an infinite dilution may have chemical
activity,鈥� he says. 鈥淓mpirical data do not necessarily overrule
theory鈥攚hen data are totally incompatible with accepted scientific theory
that has been shown to work, theory overrules empirical data.鈥�
Telling homeopaths not to be so silly was also, until recently, a pastime of
Madeleine Ennis, professor of immunopharmacology at Queen鈥檚 University, Belfast.
She did it so often that she was asked to join a multi-centre European study
to look at the effects of 鈥渉ighly dilute鈥� solutions鈥攚ell into the
homeopathic range鈥攐f histamine on human basophils.
Basophils are white blood cells involved in inflammation. They make many
biologically active substances, including histamine, which they release in
response to an attack. Once histamine has been released, it has a
negative-feedback effect on basophils, stopping them from releasing any
more.
Four separate research centres were sent some test tubes of pure water and
some of histamine at homeopathic dilutions. They weren鈥檛 told which contained
pure water and which the homeopathically prepared solution. The results? All
four centres found that the ultra-dilute solutions inhibited histamine release
from basophils, just like histamine itself, and the results were statistically
significant at three of the centres.
Ennis was not best pleased. She had set out to destroy the central tenet of
homeopathy but had ended up shoring it up. Her reluctant conclusion? 鈥淒espite my
fundamental reservations against the science of homeopathy, the results compel
me to suspend my disbelief and start searching for a rational explanation for
our findings.鈥� The Belfast team鈥檚 results are due to be published in
Inflammation Research this summer.
Ennis says that if her results are real we may have to rewrite physics and
chemistry. But Peter Fisher, director of research at the Royal London
Homoeopathic Hospital, proffers a less radical explanation. 鈥淚 think it鈥檚 to do
with changes in the structure of the water,鈥� he says. 鈥淪omehow information is
stored in water.鈥� He says the act of preparing a homeopathic remedy imprints
this information on the water. Ordinary, untreated water has no structure.
鈥淭he reason why people find [homeopathy] so challenging is that we are used
to thinking about pharmacology in molecular terms,鈥� Fisher continues. 鈥淚f you
take homeopathic medicine to be analysed, a pharmacologist would say it鈥檚 water
and ethanol and sugar, and that鈥檚 true. But if you take a floppy disc to a
chemist he will say it is ferric oxide and vinyl. The information is stored in
physical form: the alignment of the dipoles of ferric oxide.鈥� We shouldn鈥檛 write
off homeopathy simply because the dose-response relationship is reversed, he
adds鈥攚e just don鈥檛 know enough about ultra-dilute solutions.
Although resigned to practising without an accepted explanation, a scientific
model would at last enable homeopaths to discover what works best. At the
moment, there鈥檚 a distinct lack of agreement about best practice. Different
homeopathy schools, countries and practitioners perform their art in different
ways. Many homeopaths tell you not to eat or drink strong flavours when taking
their remedies. Others think that鈥檚 ludicrous. Some favour combination remedies.
Others prefer a single one. Who鈥檚 right? No one knows. Clearly, some more robust
trials are needed if scientists are to stop shouting 鈥渞ubbish!鈥� whenever the 鈥渉
word鈥� is mentioned.
But then, as a scientifically trained friend commented after taking an
irritatingly successful homeopathic treatment for hayfever: 鈥淚t鈥檚 witchcraft.
But it鈥檚 bloody effective witchcraft.鈥�