Hazardous homeopathy: ‘ingredients’ that ought to make you think twice

Would you take a medicine made with arsenic? Or deadly nightshade? Lead? Poison ivy?

You’d ask some serious questions first, at least, wouldn’t you? Is it definitely safe? Or, more accurately, are the odds better than even that it will make me better without causing horrible side-effects? Or, you know, killing me?

There ARE medicines that are legitimately made from highly toxic compounds. For example, the poison beloved of crime writers such as Agatha Christie, arsenic trioxide, is used to treat acute promyelocytic leukemia in patients who haven’t responded to other treatments. Unsurprisingly, it’s not without risks. Side-effects are unpleasant and common, affecting about a third of patients who take it. On the other hand, acute promyelocytic leukemia is fatal if untreated. A good doctor would talk this through with a patient, explain both sides, and leave the final choice in his or her properly-informed hands. As always in medicine, it’s a question of balancing risks and benefits.

Would you trust something with no proven benefit and a lot of potential risk? There are, it turns out, a swathe of entirely unregulated mixtures currently being sold in shops and online which clearly feature the substances I listed at the beginning. And more. Because they are all, supposedly, the starting materials in certain homeopathic remedies.

Homeopaths like to use unfamiliar, usually Latin-based, names which somewhat disguise the true nature of their ingredients. Here’s a short, but by no means comprehensive, list. (You might find remedies labelled differently but these are, as far as I can tell, the most common names given to these substances.)

If you haven’t heard of some of these, I do urge you to follow the links above, which will largely take you pages detailing their toxicology. Spoiler: the words “poison”, “deadly” and “fatal” feature heavily. These are nasty substances.

There are some big ironies here, and I’m not referring to the metal. For example, a common cry of anti-vaccinationists is that vaccines contain animal tissues – anything and everything from monkey DNA to dog livers. But many also seem to be keen to recommend homeopaths and courses of homeoprophylaxis – so-called “homeopathic vaccines” – which use bodily fluids such as pus and blood as starting materials.

Now, at this point I’m sure some of you are thinking, hang on a minute: aren’t you always telling us that “the dose makes the poison“? And aren’t homeopathic remedies diluted so much that none of the original substance remains, so they’re just placebos?

Yes, I am, and yes, they are.

Does anyone test homeopathic remedies to make sure there’s nothing in them….?

In THEORY. But here’s the problem: who’s testing these mixtures to make sure that the dilutions are done properly? And how exactly are they doing that (if they are)?

One technique that chemists use to identify tiny quantities of substance is gas chromatography (GC). This is essentially a high-tech version of that experiment you did at school, where you put some dots of different coloured ink on a piece of filter paper and watched them spread up the paper when you put it in some water.

GC analysis is brilliant at identifying tiny quantities of stuff. 10 parts per million is no problem for most detectors, and the most sensitive equipment can detect substances in the parts per billion range. Homeopathy dilutions are many orders of magnitude higher than this (30c, for example, means a dilution factor of 1060), but this doesn’t matter – once you get past 12c (a factor of 1024) you pass the Avogadro limit.

This is because Avogadro’s number, which describes the number of molecules in what chemists call a “mole” of a substance, is 6×1023. For example, if you had 18 ml of water in a glass, you’d have 6×1023 molecules of H2O. So you can see, if you’ve diluted a small sample by a factor of 1024 – more than the total number of molecules of water you had in the first place – the chances are very good that all you have is water. There will be none of the original substance left. (This, by the way, is of no concern to most homeopaths, who believe that larger dilutions magically produce a stronger healing effect.)

What if the sample ISN’T pure water after it’s been diluted?

If you carried out GC analysis of such a sample, you should find just pure water. Indeed, if you DIDN’T find pure water, it should be cause for concern. Potassium cyanide, for example, is toxic at very low levels. The lethal dose is is only 0.2-0.3 grams, and you’d suffer unpleasant symptoms long before you were exposed to that much.

So what if the dilutions somehow go wrong? What if some sample gets stuck in the bottle? Or on the pipette? Or a few dilution steps get skipped for some reason?

Are these largely unregulated companies rigorously quality-checking their remedies?

Well, maybe. It’s possible some producers are testing their raw materials for purity (ah yes, another question: they CLAIM they’re starting with, say, arsenic, but can we be certain?), and perhaps testing the “stability” of their products after certain periods of time (i.e. checking for bacterial growth), but are they running tests on the final product and checking that, well, there’s nothing in it?

And actually, isn’t this a bit of a conflict? If the water somehow “remembers” the chemical that was added and acquires some sort of “vibrational energy”, shouldn’t that show up somehow in GC analysis or other tests? If your tests prove it’s pure water, indistinguishable from any other sample of pure water, then… (at this point homeopaths will fall back on arguments such as “you can’t test homeopathy” and “it doesn’t work like that”. The name for this is special pleading.)

A warning was issued in the U.S. after several children became ill.

Am I scaremongering? Not really. There’s at least one published case study describing patients who suffered from arsenic poisoning after using homeopathic preparations. In January this year the U.S. Food and Drug Administration issued a warning about elevated levels of belladonna (aka deadly nightshade) in some homeopathic teething products. Yes, teething products. For babies. This warning was issued following several reports of children becoming ill after using the products. The FDA said that its “laboratory analysis found inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label.”

Now, admittedly, I’m based in the U.K. and these particular teething remedies were never readily available here. But let’s just type “homeopathy” into the Boots.com (the British high-street pharmacy) website and see what pops up… ah yes. Aconite Pillules, 30c, £6.25 for 84.

What happens if you search for “homeopathy” on the Boots.com website?

Have you been paying attention lovely readers? Aconite is…. yes! Monkshood! One of the most poisonous plants in the garden. Large doses cause instant death. Smaller doses cause nausea and diarrhea, followed by a burning and tingling sensation in the mouth and abdomen, possibly muscle weakness, low blood pressure and irregular heartbeat.

I must stress at this point that there is no suggestion, absolutely none whatsoever, that any of the products for sale at Boots.com has ever caused such symptoms. I’m sure the manufacturers check their preparations extremely carefully to ensure that there’s absolutely NO aconite left and that they really are just very small, very expensive, sugar pills.

Well, fairly sure.

In summary, we seem to be in a situation where people who proclaim that rigorously-tested and quality-controlled pharmaceuticals are “toxic” also seem to be happy to use unregulated homeopathic remedies made with ACTUALLY toxic starting materials.

I wonder if the new “documentary” about homeopathy, Just One Drop, which is being screened in London on the 6th of April will clarify this awkward little issue? Somehow, I doubt it. Having watched the trailer, I think it’s quite clear which way this particular piece of film is going to lean.

One last thing. Some homeopathic mixtures include large quantities of alcohol. For example, the Bach Original Flower Remedies are diluted with brandy and contain approximately 27% alcohol (in the interests of fairness, they do also make alcohol-free versions of some of their products and, as I’ve recently learned, they may not be technically homeopathic). Alcohol is a proven carcinogen. Yes, I know, lots of adults drink moderate quantities of alcohol regularly and are perfectly healthy, and the dose from a flower remedy is minuscule, but still, toxins and hypocrisy and all that.

There are cheaper ways to buy brandy than Bach Flower Remedies.

Amusingly, the alcohol in these remedies is described an “inactive” ingredient. It’s more likely to be the only ACTIVE ingredient. And since Flower Remedies retail for about £7 for 20 ml (a mighty £350 a litre, and they’re not even pure brandy) may I suggest that if you’re looking for that particular “medicine” you might more wisely spend your money on a decent bottle of Rémy Martin?


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Homeopathy: a drop in the ocean?

HomeopathicCartoonAs a skeptical chemist I have, until now, avoided the topic of homeopathy.  It felt a bit obvious, rather like shooting fish in a barrel.  Hasn’t everyone and his sister written an article about it at some point?  There’s the brilliant 10:23 campaign on the subject, and the comedians Mitchell and Webb even wrote a fabulously funny sketch on the topic (do watch it if you haven’t, I particularly love the idea of homeopathic lager).  How much more mainstream can you get?  Surely everyone knows it’s a load of old nonsense by now?

And yet, and yet… I still meet people that don’t know what it is, or who are a bit confused about it.  Many don’t know the difference between herbal remedies and homeopathy.  Many think they know someone who’s used it and it’s worked, or have used it themselves and felt that it helped them.

Worse, the NHS, despite admitting outright that, “homeopathic remedies perform no better than placebos, and that the principles on which homeopathy is based are ‘scientifically implausible” still spends money on it, going on to say on the very same web page that “there are several NHS homeopathic hospitals and some GP practices also offer homeopathic treatment.”  There are widely divergent figures on exactly how much the NHS spends on this treatment which they fully admit does not work, but there’s general agreement that it’s in the millions.  A fullfact.org article written in 2010 concluded that it was £12 million from 2005-8, which didn’t include the £20 million spent refurbishing the Royal London homeopathic hospital from 2002 to 2005.  More recently a Daily Mail article (yes, yes, I know) claimed it was £4 million a year.

In a way, does it matter?  It may be a tiny proportion of the NHS’s total £108.9 billion budget, but it’s still millions of pounds of public money.  For something that doesn’t work.

Ok, but what is it?  Well firstly let’s briefly talk about ‘mainstream’ medicine.  Also called conventional medicine, allopathic medicine, orthodox medicine or Western medicine, it’s the system by which trained professionals (doctors, nurses, pharmacists etc) treat diseases and their symptoms using tested drugs.  And make no mistake, mainstream drugs are tested.  Different countries have different regulations, but in the UK clinical trials involve at least three phases and take ten to fifteen years or even more.

Homeopathic treatments don’t have to go through this testing.  And unlike conventional doctors, who have to complete five years of study followed by further years of foundation training and yet more studying, there is no regulation of homeopathic practitioners in the UK.  Now, that ought to give anyone pause for thought.

Secondly, all drugs that actually work have side effects; effects that are secondary to the intended ones.  All of them.  There’s no avoiding it; there’s ‘no effect without side effects’.  You may not experience them personally, but someone somewhere almost certainly will.  Much of medicine is about balancing side effects against positive effects, and a lot of the time it comes down to how severe and life-threatening the disease being treated is.  If you have a bit of a cold, you’re probably happy to take some paracetamol which, when taken at the proper dose, has ‘as rash’ listed as its only side-effect.

But since the odds are very good that you’re going to recover from your cold whether you treat it or not you wouldn’t, on the other hand, want to take something that might have serious side effects like the anti-viral Tamiflu (headaches, nausea, cough, vomiting, sleeping problems, indigestion, pain, tiredness, vertigo… and that’s just some of them).  However, if you genuinely have flu (real flu, not “I’ve got a nasty cold but I’m calling it flu so that I sound like less of a skiver”) then Tamiflu might be appropriate, because real flu can be genuinely life-threatening.

HomeopathyWhy is this relevant to a discussion about homeopathy?  Because homeopathic treatments don’t have side-effects (at least, not any directly related to the pills and potions themselves).  Homeopaths are generally quite keen to tell you this.  But it means that the treatments are ineffective. There’s no getting around this I’m afraid.  You can’t have your cake and eat it, even if you dilute it by a factor of 1060.

Speaking of dilutions…  Now, I’m not about to go into a huge amount of detail about the history and reasoning behind homeopathy because, firstly, other people have already done an excellent job of that, secondly I always worry that it starts to sound alarmingly plausible if you’re not very careful and thirdly, a summary ought to be much more potent than a full description (this little witticism will make sense in a minute).

Certain substances, poisons generally, cause nasty symptoms.  Homeopaths believe that if you take very, very tiny amounts of those substances they’ll do the opposite and cure those symptoms when they’ve been caused by an illness.  For example, arsenic causes headaches, nausea and diarrhoea.  So logically (for a given value of ‘logic’) at homeopathic doses it’s used to treat digestive disorders and food poisoning.  These tiny amounts are achieved by successive dilutions: you add one drop of a substance to ninety-nine drops of water, and then you take one drop of that mixture and add it to ninety-nine more drops of water, and then you take one drop of that and….

…You keep going until you’ve done it at least six times.  Remember each dilution is a factor of one hundred.  The first time it’s done you get a solution of 0.01%.  By the time the procedure’s been followed six times, it’s 0.000 000 000 1%.  This is called 6C.  Homeopaths believe that more dilute solutions are more potent, that is they’ll be even better at treating the illness than something more concentrated.

0004908_nelsons-bryonia-30c-homeopathic-remedy_300In fact, quite a lot of remedies are sold as 30C.  That’s 0.000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 1%

Let’s attempt to put that in context.  Every year Cambridge University’s Chemistry department holds the Cambridge Chemistry Challenge (try saying that six times fast) and in 2012 there were some rather lovely questions involving homeopathy in the paper.  Here are a few choice morsels:

One question asked entrants to calculate the mass of arsenic oxide in 100 ml (a small amount, but still about four times greater than the volumes that are usually sold) of a 30C homeopathic remedy.  The answer was 2.06 x 10-30 grams.  That’s a thousand times less than the mass of a single proton.  A drop in the ocean isn’t the half of it.  Not only is there not even one molecule of the original substance in there, the dilutions have wiped out even the possibility of a sub-atomic particle.

6a00d83451df0c69e200e54f9413f98833-800wiThen they were asked to work out the amount of the remedy someone would need to take to experience a fatal dose, and express the answer as a fraction of the volume of the Earth.  The answer?  4500 times the volume of the Earth.  Probably no need for those “in case of accidental overdose contact a healthcare practitioner” warnings, then.

Finally, how many bottles of the solution would you need to buy to stand a chance of obtaining one atom of arsenic?  The answer: 285 million bottles.

So let’s be clear, homeopathic remedies have no active ingredient.  Nil.  Nothing,  Nada.

“Ah,” say the homeopaths, “we accept that.  That’s not the point.  The water ‘remembers’ the original chemical; the water molecules retain a ‘memory’ of that substance and it’s that memory that has the effect”.

At this point people who actually know some science start tearing their hair out (by the way, apparently fluoric acid, i.e. HF, is a recommended homeopathic treatment for hair loss – good job it is diluted else it might eat through the glass bottle).

Just think about it for a few seconds.  If it were true that water retains a memory of the substances that have been dissolved in it, and that memory was so powerful that it could have a real, physiological, effect on the body, then we would be constantly bombarded with ‘treatments’ every single time we drank a glass of water.  You know that water that comes out of your tap?  Well, sorry to be blunt about this, but it went through a few other people before it got to your tap, picking up all sorts of substances on the way.  Your local water company purified it, and in the process almost certainly added coagulants to precipitate out impurities.  These are then removed of course (that’s the point) but if what the homeopaths suggest is right (which it’s not) your water would ‘remember’ them.  Lead pipes would be the least of your worries.

From here the theories get increasingly outlandish.  Next stop, ‘transference’.  This is the idea that remedies can affect living organisms from a distance.  Yup.  Basically a practitioner can call someone on the phone and proceed to diagnose, and treat, them from miles away, without them having to actually swallow a thing.  Oh yes, and also water placed next to a homeopathic remedy (which is also just water, in case I need to say it again) can take on characteristics of the remedy.

Photo 13-06-2013 09 06 54 PMNow, if this were true the world simply wouldn’t work the way we know it does.  You’d be exposed every time you walked past the Alternative Remedy section in a shop.  Humans have really quite a lot of water in them; if anything like this actually happened, you could ‘catch’ antibiotics from your friend who happened to be taking them, just by standing too close.  You wouldn’t need to clean your toilet, just leave the bleach bottle next to it and it ought to work by transference (many students have tried this, it really doesn’t work).

The homeopaths will cry that I’m wilfully misunderstanding their methods, because I’ve forgotten to mention ‘potentization’.  Oh yes, allow me to explain: when you prepare a homeopathic remedy you have to shake or tap the preparation at each stage – sometimes with a particular object (a magic wand, perhaps) – otherwise it doesn’t work.  It’s not just the dilution, it’s the special tapping that does the trick, because it somehow allows the water molecules to remember the energy signature of the molecules of ‘active’ ingredient.

Next time someone claims homeopathy works, ask them if they believe in magic.  There really is very little difference.

At this point though homeopaths resort to a few final bits of misdirection and sleight of hand.  They claim that everyone who casts doubt over homeopathy is in the thrall of ‘Big Pharma‘.  They say that the big pharmaceutical companies – whom they imply control the world, possibly from a giant hollowed-out volcano somewhere – deliberately discredit homeopathy because they have a lot to lose if people use it instead of conventional (they tend to use the term ‘allopathic’) medicine.

This neatly sidesteps the fact that homeopaths have an awful lot to lose if people stop buying their pills and potions, and especially in the UK if the NHS stop funding it.  In fact, I suspect they have a lot more to lose since pharmaceutical companies, for all their faults, are required by law to prove that their drugs actually do something.

And finally homeopaths will tell you that allopathic medicines have killed millions of people, whereas homeopathy has never killed anyone.  Hm.  It’s true that people die from negative drug reactions.  It’s also true that sick people sometimes die.  Occasionally it’s difficult to say whether a person would have died sooner with or without drug intervention.  But for most people conventional drugs are far more likely to keep them safe and well than kill them.

sopHomeopathy on the other hand… well it’s true the remedies themselves won’t kill you.  A little bit of sugar and water never killed anyone.  But, sadly, there are people who don’t seek conventional treatment because they believe what a homeopath tells them.  Sometimes those people leave it too late, and sometimes they die when their life might have been saved.  Even worse, sometimes those people are parents, and they end up making bad decisions about their child’s treatment.  If you doubt me, there’s a whole list of tragic stories on the whatstheharm website.

Sometimes homeopathy does appear to work, but that’s been shown time and time again to be a placebo effect.  Now, I think that the placebo effect is cool.  I mean, it’s really awesome.  Basically, if you believe you’ll feel better, you do – at least sometimes.  People have even debated whether this can work in animals (probably not, although owners and vets might think it’s working).  Personally, I think lots of research should be going on in the area of placebo, because it’s utterly fascinating.  But.  Here’s the thing: I used the words “feel better” back there very deliberately.  The placebo effect is great for things that have a level of subjectivity, such as pain management.  When people carry out objective measures, such as lung function for an asthmatic for example, there’s usually little improvement.  The placebo effect is highly unlikely to effectively treat diseases such as asthma, or diabetes, or cancer.

And that means homeopathy cannot treat those things either.  And people absolutely shouldn’t be allowed to tell ill, vulnerable people that it can.

I know there are some people who don’t trust the government, and who think it’s all run by nine foot tall lizards, but regardless I’m going to return to the Science and Technology Committee’s report:

Screen Shot 2013-06-13 at 22.53.02“the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.”

and…

“The product labelling for homeopathic products under all current licensing schemes fails to inform the public that homeopathic products are sugar pills containing no active ingredients.”

Finally, ask yourself this: at a time when disabled people are facing cuts to their much-needed benefits, with many tragic stories of people being designated ‘fit for work’ when they really aren’t, is it right that millions of pounds are available for a ‘treatment’ which, at the risk of sounding like a stuck record, does not work?

And for the record, I have absolutely no affiliation whatsoever with any pharmaceutical company.  I am, however, more than happy to admit supporting campaigns such as 10:23, because there really is ‘nothing in it’.

—-

Late addendum: I have just been reminded (thank you @Sci_McInnes) that of course our Health Secretary, Jeremy Hunt (the one made famous by James Naughtie’s delightful slip of the tongue) is a supporter of homeopathy.  Yes, the person that is effectively in charge of the NHS believes that tapping water in a special way turns it into an effective medicine, despite the evidence of the Science and Technology Committee.  If you weren’t cross about it before, you really, really should be now.