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?


Like the Chronicle Flask’s Facebook page for regular updates, or follow @chronicleflask on Twitter. In need of a groovy new mug for your oh-so-healthy coffee? Check out this page.


All comments are moderated. Abusive comments will be deleted, as will any comments referring to posts on this site which have had comments disabled.

But no one wants to research that; they can’t make any money from it…

A couple of my recent posts have focused on potentially dangerous ‘alternative’ treatments for medical conditions. Invariably, such posts generate comments along the lines of “I’ve been using it for years and I’m FINE” and the other favourite “ahhh but They don’t want to research it because it’s cheap and They can’t make any money from it!” (‘They’ is usually the eponymous ‘Big Pharma’).

It’s hard to argue with the first one. The friend of a friend of your uncle’s dishwasher repair main who’s smoked 40 a day for years without ever even getting a case of the sniffles doesn’t believe all that stuff about smoking being bad for you either. No one ever believes the thing they’re doing will turn out to be bad for them. Until, that is, they start getting nasty shooting pains in their left arm.

olaparib

Olaparib costs £49,000 per patient.

The other one though, well, let’s have a look at that. It’s a really common argument, especially from Americans who tend to be much more aware of the cost of medication than Brits. We on this side of the pond are somewhat shielded from the realities of specific costs by the way the National Health Service works. However, some recent decisions by NICE (The National Institute for Health and Care Excellence) have raised the issue of the price of medication in the minds of people over here as well. For example, just a few days ago it was widely reported in the press that NICE had turned down a drug called olaparib (Lynparza) – a targeted treatment for ovarian cancer – because its price tag of more than £49,000 per patient per year was considerably higher than NICE’s upper limit of of £20,000 to £30,000.

£49,000 is a lot of money, no question about it. In some places you could buy a house for that kind of money. At the very least, you could buy a big chunk of a house. For the average household it’s almost double a year’s salary. How could a year’s worth of a drug possibly be worth so much money? Surely the pharmaceutical company (AstraZeneca in this case) are having a bit of a laugh with this price tag? All the way to the bank?

Why ARE medicines so expensive?

Why ARE medicines so expensive?

Well, how much does it cost to develop a drug? A study by the Centre for the Study of Drug Development at Tufts University in Massachusetts reported that the average cost for drugs developed between 1995 and 2007 was $2.6 billion (*see update below) which, based on 2007 exchange rates, is very roughly £1.3 billion. Of course, these figures are from a few years ago – it will be more in today’s market.

Why so much? Well, it takes on average about 12 years to get a drug from the laboratory to the market (and many potential drugs fall by the wayside during the various testing processes). There are a lot of people involved, from researchers in the lab to people running clinical trials to chemical engineers who have work out how to get a small-scale lab production up to something much larger to the people who design and produce the packaging. Even if you just start adding up 12 years worth of salaries (the average salary of a chemical engineer is something like £35,000, for example), you quickly get into big numbers, and that doesn’t take the cost of offices, factories, equipment, raw materials and so on into account.

Back to olaparib and its £49,000 a year price tag. There are about 7000 ovarian cancer diagnoses in the UK each year, but it’s a very specific treatment that would probably only apply to about 450 women each year and it’s estimated to extend life by about a year so, sadly, each patient would probably only be taking it for one year. It’s difficult to get specific figures about development costs, but let’s estimate it took about £1.5 billion to develop it (probably a conservative estimate), and let’s give it 20 years to break even, since after 20 years drugs go off-patent (which means other companies can produce them), and profits immediately drop).

Are pharmaceutical companies really ripping us off?

Are pharmaceutical companies really ripping us off?

Based on those rough numbers, each year the pharmaceutical company would need to make about £75 million. Divide by 450 patients and you get (rounding up a bit) £170 thousand per patient per year – more than three times the price tag NICE was working with. To stress: this is just to cover development costs. I’m not adding any profit on here. Even if you allow for the fact that AstraZeneca are selling the drug in other countries (in the US and Europe in particular), it’s hard to see how their profit margins can be anything more than pretty small.

You might say, so what? This is someone’s life we’re talking about here. Life is priceless. Yes, of course. But unless they can break even, and in fact make some kind of profit, no pharmaceutical company is ever going to invest time in drug development. No one runs a business to deliberately make a loss. Not for long, in any case.

turpentine

Don’t let anyone convince you to swallow this stuff.

There are plenty of people out there claiming that some cheap, every-day substance can cure cancer (could be anything from a type of bleach to turpentine to baking soda, depending on the day of the week), but that ‘Big Pharma’ deliberately suppress these treatments, and/or refuse to research them, because they can’t make thousands selling them, and they would rather push their expensive (but, you know, tested) drugs.

Well no, the pharmaceutical companies can’t sell these kinds of ‘alternative’ treatments, because they’re controlled by extremely strict regulations and they can’t claim something works without rock-solid evidence. But don’t be taken in by the argument that it’s impossible to make a lot of money from selling this kind of stuff. Of course it’s possible: buy it in huge bulk, put it in small bottles with expensive-looking packaging, and the markup can be comfortably generous. Hey, if it’s possible to make money selling ‘ghost turds‘, then it’s possible to make money out of anything. And if you don’t want to actually sell it (which might upset the regulatory authorities) there are book sales, public appearances and private consultation fees. Oh yes, don’t let anyone convince you there’s not plenty of money to be made.

Besides which, it’s simply not true that medical researchers aren’t interested in ‘cheap’ substances. To quote the comedian Dara Ó Briain:

“Oh, herbal medicine’s been around for thousands of years!” Indeed it has, and then we tested it all, and the stuff that worked became ‘medicine’.

Except we shouldn’t be using the past tense; scientists continue to research this kind of thing all the time. Despite what the conspiracists might say, the people who work in these fields are genuinely interested in making people better. If they really thought baking soda could somehow cure a particular cancer, they’d be on it like a shot. Even if you don’t believe they’d do it for ‘the public good’, it’d be worth it for the prestige alone. Someone who managed to prove something like that would almost certainly be up for a Nobel Prize. The company they worked for would be using it in their marketing material forever more. You can’t buy publicity that good. (For more about this, check out this excellent article by Steven Novella.)

beetroot juice

Recent research suggests that beetroot juice could help treat high blood pressure.

Just to prove that research into simple, inexpensive stuff truly does happen, here are some examples (public health warning: I’m not advocating you experiment with any of these, I’m merely listing them to make the point. Discuss it with your doctor before you try anything):

Believe it or not, doctors like medicines that work.

Believe it or not, doctors like medicines that work.

These are just five examples. I’m certain there are many more. Researchers do look at well-known, relatively inexpensive substances if they think they might have a genuine therapeutic effect. That’s the sort of thing scientists do. The difference is that real scientists don’t rely on testimonials – the word of people who’ve “been taking it for years and never been healthier!” – they design proper, rigorous trials.

Sometimes these trials are promising, sometimes they’re not, but the substances that do turn out to be promising invariably find their way into medicine sooner or later because, essentially, doctors like medicine that works.

* Update: June 2015
After I wrote this post I came across this article on theconversation.com. It casts some doubt on the US$2.6 billion figure from The Tufts Center for the Study of Drug Development, and makes some interesting points about its calculation. In particular, it points out that more than once source has suggested the figure may be over-inflated. This could well be the case, in which case my rough estimate calculations might be off by some margin, but it’s impossible to be more accurate because pharmaceutical companies are pretty cagy about their actual costs. It is certainly the case that a number of pharmaceutical companies have existing, profitable medicines which are reaching the end of their patent lifetime and, it appears, not enough to replace them, leading to some recent mergers and acquisitions activity. A few have run into trouble: Glaxo Smith Kline issued a profit warning last year, as did the French group Sanofi SA. On the other hand, others have been doing extremely well. So are they genuinely over-charging for drugs? It’s a very difficult question, but I think it’s still safe to say that drug development is a very expensive business

Follow The Chronicle Flask on Facebook for regular updates