How to win an argument about homeopathy

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Jeremy Corbyn appeared to support homeopathy, five years ago.

Homeopathy has been in the news (again) lately. Someone managed to dig up a 2010 tweet by Jeremy Corbyn where he appeared to express support for it (so far he doesn’t seem to have commented again so let’s be generous: maybe he’s re-evaluated in the last five years). A few days ago The Express newspaper printed an article pointing out that in these times of austerity, the NHS is spending £5 million a year on ineffective homeopathic remedies, and then, of course, there was that really weird incident earlier in the month where a number of delegates apparently fell ill with hallucinations and cramps during a homeopathy conference in Germany (if an ‘LSD-type drug’ was involved, we can be certain of one thing: it wasn’t homeopathic).

I’m not going to go into the ‘science’ of homeopathy again, because I’ve done that before (seriously, if you don’t know what it is, follow that link back there). And besides, I’m starting to think the science angle is a bit (haha) pointless. Not because it’s wrong, but because it boils down to an un-winnable argument that goes something like this:

“Homeopathy can’t work because…. dilutions…. molecules… there’s nothing in it…. (etc)”
“AHHH but there are things science doesn’t understand… water memory… quantum (etc)”
“Ok, but many, many controlled trials have shown it doesn’t work.
“Those trials are all carried out by the Big Pharma, I don’t trust them.”
“Well, actually, not all of them….
“You can’t test homeopathy in the lab. It doesn’t work like that.”
“But it should, shouldn’t it? If it works? Legitimate pharmaceuticals have to pass those tests.”
“The tests are flawed.The whole peer-review system is corrupt.”
“Well, it may have a few problems, yes, but it’s the best thing we have right now.”
“Anyway, homeopathy cured by my brother’s milkman’s aunt’s dog’s arthritis.”
“Anecdotes really aren’t evidence.”
“Look, it doesn’t matter, I believe it works.”

And there we have it. You can’t get past that, at least, not with science. People that believe (and some of them are, worryingly, scientists and doctors) just believe. You can show them with evidence all day: they’ll tell you the science is wrong, or lacking in some way. Adding more science to that doesn’t help, it’s just – from the believer’s point of view – more science which is still wrong, or still lacking.

So recently I’ve taken another tack. I say, look for the money.

James Randi first issued his challenge in 1964.

In 1964 a stage magician and skeptic called James Randi issued a challenge, and it was this: anyone successfully demonstrating a supernatural or paranormal ability under agreed-upon scientific testing criteria would be paid a $1000 prize. Later it went up to $10,000, then $100,000 and eventually $1 million.

Since the challenge was first created by Randi over half a century ago, about a thousand people have applied, but no one has been successful. No one.

What does this have to do with homeopathy? Well, quite a lot. Because Randi has stated that homeopathy qualifies. In other words, anyone who can prove it works – under testing criteria agreed between the James Randi Educational Foundation (JREF) and the claimant – would win the $1 million. It doesn’t have to be some sort of ‘Big Pharma’ approved trial, it just has to be a trial that both JREF and the claimant agree, between them, is valid.

Big Homeopathy (well, they do it, why not us?) is unquestionably a million dollar business, perhaps the prize has never been claimed because ‘they’ don’t care about a piddly million dollars? But what about all the small-time homeopaths practising around the country? What about academics who continue to maintain that it works? Surely not all of these people are millionaires? $1 million has got to be worth having, hasn’t it?

I repeat. The prize never been claimed (despite at least one high-profile attempt).

James Randi, who is, at time of writing, 87 years old, has now retired. But fear not, JREF have said that they will continue the million dollar challengeas a means for educating the public about paranormal claims”. 

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Boots.com are selling homeopathic ‘remedies’ right now.

So this is what I say: if you believe homeopathy works, if you think you have convincing evidence that it works, go and claim the money. Then come back to me and we’ll talk. I promise to listen.

If you find yourself talking to proponent of homeopathy, suggest this to them, see what they say. One million dollars has got to be worth a bit of effort, surely?

Call me an old cynic, but I suspect at least some of these people know it doesn’t work, but selling pills that are made of nothing more than sugar, water and fancy packaging for over £5 a pop, or consultations at £30-£125 an hour, is making plenty of money anyway. Why mess with a good thing?

Forget belief, or even science. Look for the money.

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Elements, compounds and misleading mercury

Elemental mercury isn't the same as mercury in compounds.

Elemental mercury isn’t the same as mercury in compounds.

Today I read an interesting article about some recent research carried out at the University of Illinois where they demonstrated that the best way to convince parents to vaccinate their children might be to show them the results of the diseases the vaccines prevent. (This, by the way, contradicts some research published in 2014 which showed that this tactic didn’t work. For an excellent discussion of the two, see here.)

Then, because I am just one of those people who can’t resist poking at ulcers with my tongue (you know what I mean) I had a quick look at some of the comments regarding that article. Reassuringly, most people were weighing in on the “yeah, vaccinate!” side of the argument. But not surprisingly there was also a small group of people posting the traditional anti-vaccine arguments. And then, this appeared:

mercury ppm

This is thoroughly silly, and I’ll tell you why.

Well, it did make be go “hmmmmm”, but for the reason you might imagine.

No, you see, what I thought was: “hmmmmm, someone else who has, possibly deliberately, failed to understood the difference between elements and compounds, and how chemical bonding changes properties.”

Allow me to start at the beginning. If you went to a school in the UK (and I would hope it’s similar elsewhere in the world) you learned about elements, compounds and mixtures when you were about 13 years old – if not before. You might have forgotten it since, but I can absolutely, categorically guarantee you that lesson happened. In fact, it was probably a few lessons.

iron sulfide experiment

The much-loved reaction between iron and sulfur.

One experiment much beloved of chemistry teachers since year dot is to take a mixture of sulfur (a yellow powder) and some iron filings (grey) and show that they can be separated with a magnet. Then heat the mixture up so that the two react, with a rather beautiful red glow, to form iron sulfide. This is a blackish solid which is in theory not magnetic (but in practice almost always is) and demonstrate that now the two elements cannot be separated.

Thus we have demonstrated that elements (the iron and the sulfur) have different properties to the compound they formed (iron sulfide), and also that mixtures can be separated fairly easily, whereas breaking compounds up into their constituent elements is much harder. Lovely. Job done.

And yet… so many people seem to have been asleep that day. Or perhaps just didn’t grasp it well enough to continue to apply the principle to other things.

pouring mercury

Elemental mercury

For example, mercury. Mercury, the element (the runny, silvery stuff that you used to find in thermometers) is a heavy metal. Like most of its compatriots, such as cadmium, lead and arsenic, it’s toxic. It can be absorbed through the skin and mercury vapour can be inhaled, so containers need to be tightly sealed. The increasing awareness of the toxicity of mercury is why older readers might remember seeing it ‘in the flesh’, so to speak, at school, whereas younger ones will not – these days it’s rarely even used in thermometers for fear of breakages.

That said, it does occur naturally in the environment, particularly as the result of volcanic eruptions – and very low levels aren’t considered harmful. The dose, as they say, makes the poison. It also occurs as the result of industrial processes, particularly coal-fired power plants and gold production, and occupational exposure is a genuine concern. In particular, chronic exposure is known to cause cogitative impairment. It might the source of the ‘mad dentist’ myth. It’s almost certainly the origin of the phrase ‘mad as a hatter‘.

So in summary, don’t mess about with elemental mercury; it’s not good for your health.

However, as I took some pains to establish, elements and compounds are different things. So what about compounds which contain mercury?

The compound thiomersal

The compound thiomersal

This is where vaccines come in. There is a substance that used to be used as a preservative in (some) vaccines called thiomersal (or thimerosal, in the U.S). You may have heard its name; it comes up quite a lot. Incidentally, it hasn’t just been used in vaccines, but also in various other things including skin-test antigens and tattoo inks.

Now, to be clear, thiomersal IS potentially toxic, however it’s quickly metabolised in the body to ethyl mercury (C2H5Hg+) and thiosalicylate and, although ethyl mercury does, clearly, still contain atoms of mercury, it does not bioaccumulate. In other words, your body gets rid of it. At very low doses (such as those in vaccines) there is no good evidence that thiomersal is harmful.

Still, due to continuing public health concerns, thiomersal has been phased out of most U.S. and European vaccines. In the UK, thiomersal is no longer used in any of the vaccines routinely given to babies and young children in the NHS childhood immunisation programme. And at the moment, all routinely recommended vaccines for U.S. infants are available only as thimerosal-free formulations or contain only trace amounts of thimerosal (≤1 than micrograms mercury per dose).

Let me just say that again. The evidence suggests it’s safe, but it’s been removed anyway as a precaution. If you live in the UK, it’s not in your child’s vaccines, and that includes the new nasal-spray vaccine for flu which has been rolled out over the last few years. If you live in the U.S. it’s probably not, and thimerosal (thiomersal) free versions exist. It does turn up most often in flu vaccines (hence the meme image at the start) but thiomersal-free versions of those also exist in the U.S.

So chances are it’s not in your vaccines. Not in there. Got it? Ok.

ethyl vs methyl mercury

methyl mercury (left) is not the same as ethyl mercury (right)

Now, you may have heard about mercury in seafood. It is an issue, particularly for women who are pregnant, trying to become pregnant or breastfeeding, and is the reason such women are advised not to eat shark and swordfish, and to keep their tuna consumption low. But here’s the thing: it’s a different kind of mercury. In this case, it’s methyl mercury (remember, thiomersal breaks down to ethyl mercury, which is not the same).

Methyl mercury is more toxic than ethyl mercury. Methyl mercury binds to parts of amino acids much more readily than its ethyl cousin, and it’s able to pass through the blood brain barrier and into nerve cells where it causes damage. In addition, ethyl mercury is much more quickly eliminated from the body than methyl mercury. Because of all this, methyl mercury does bioaccumulate (build up in the body), and that’s why large top-of-the-food-chain fish like shark and tuna can have significant levels of it, and why certain groups of people should be careful about eating them.

The FDA’s action level (the limit at or above which FDA will take legal action) for methyl mercury in fish is 1000 ppb (1 ppm). But remember, that’s for the much more dangerous methyl mercury, not ethyl mercury. I’ve been unable to find an equivalent figure for the UK, but I’d imagine it’s similar.

So, where does the 200 ppb mercury figure in the image at the top come from? Well the Environmental Protection Agency does indeed set a ‘maximum contaminant level goal’ for inorganic mercury of 0.002 mg/L or 2 ppb in water supplies. Methyl and ethyl mercury are not inorganic mercury; compounds that fall into this category include mercuric chloride, mercuric acetate and mercuric sulfide, which largely get into water as the result of industrial contamination.

In summary, that meme image at the start is basically comparing apples and oranges. The EPA limit isn’t relevant to vaccines, because it’s for inorganic mercury, which the substance in vaccines isn’t. While we’re about it, the levels applied to fish don’t apply either, because that’s methyl mercury, not ethyl mercury. They’re not the same thing. And all that aside, it’s highly unlikely (if you live in the UK, no chance at all) that there are 50,000 ppb of ethyl mercury in your flu vaccine anyway. AND, let’s not forget, there’s no evidence that the tiny quantities of thiomersal used in vaccines are harmful in the first place.

Phew.

You may note that I’ve studiously avoided the word ‘autism’ in this post so far. But yes, that’s the big concern; that exposure to thiomersal in vaccines could cause autism. Despite multiple, huge, studies in several countries looking for possible links between vaccines and autism, none have been found. Vaccines don’t cause autism. It’s time we stopped wasting enormous amounts of time and resources on this non-link and spent it instead on finding out what does cause it. Wouldn’t that be far more useful and interesting?

Now… if you’re hardcore anti-vaccine and you’ve read this far, and you’re about to hit the comment button and tell me that all this research is just Big Pharma covering things up so they can make money from the ‘million(/billion/trillion) dollar vaccine industry’, just wait a moment.

Stop.

Think about this: how much money could the medical industry make from people actually catching measles, mumps, polio, TB, whooping cough and all the others? Just think of all the money they could make selling antivirals and antibiotics, all the money to be made from painkillers, antipyretics, drugs to treat respiratory symptoms of one kind or another, and everything else? Believe me, it would be much, much more than they make from a single 2 ml dose of vaccine. Why ‘cover up’ research that’s, if anything, reducing their profits?

All these diseases are horrible, and some can be fatal or have genuinely life-changing consequences. That’s proven. Please vaccinate your children, and yourself.

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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’.

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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.