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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Glow sticks or sparklers: which is riskier?

by Unknown artist,print,(circa 1605)

Remember, remember the 5th of November… (Image by Unknown artist, circa 1605)

It’s fireworks night in the UK – the day when we celebrate a small group of terrorists nearly managing to blow up the Houses of Parliament in 1605 by, er, setting fire to stuff. No, it makes perfect sense, honestly, because…. look, it’s fun, all right?

Anyway, logical or not, Brits light fireworks on this day to mark the occasion. Fireworks, of course, are dangerous things, and there’s been more than one petition to ban their sale to members of the general public because of safety concerns. It hasn’t happened yet, but public firework displays, rather than private ones at home, are more and more popular.

Which brings me to this snippet from a letter a friend of mine recently received.

screen-shot-2016-11-04-at-21-51-33

In case you can’t read it, it says:

“NO SPARKLERS PLEASE – with so many children runni[ng] around, we believe it is too dangerous fro children to be [words missing] lighted sparklers around.
Last year we had a few incidents of children drinking the [words missing] glowsticks – please advise against this.”

Now there are some words missing here, but it’s fairly clear that sparklers are prohibited at this event, and it seems to be suggesting that children have managed to get into, and swallow, the contents of glowsticks. But they, by contrast, haven’t been banned. Indeed, parents are merely being asked to “advise” against it.

Hmmm.

Does this seem like an appropriate response? Well, let’s see…

1024px-sparklers_moving_slow_shutter_speedWhat are these things? Let’s begin with sparklers. They’re hand-held fireworks, usually made of a stiff metal wire, about 20 cm long, the end of which is dipped in a thick mixture of metallic particles, fuel and an oxidising agent. The metal particles are most commonly magnesium and/or iron. The fuel usually involves charcoal, and the oxidiser is likely to be potassium nitrate. Sometimes metal salts are also added to produce pretty colours.

Sparklers are designed to burn hot and fast. The chemical-dipped end can reach temperatures between 1000-1600 oC, but the bit you hold doesn’t have time to heat up before the firework goes out (although gloves are still recommended). The sparks, likewise, are extremely hot but burn out in seconds. This makes sparklers relatively safe, if they’re held well way from the face and body, and if the hot end isn’t touched.

If. Every year there are injuries. Sparkler injuries aren’t recorded separately from other firework injuries in the UK, but the data we do have suggest we might be looking at a few thousand A&E admissions each year, and probably a lot more minor injuries which are treated at home.

Sparklers are most dangerous once they've gone out.

Sparklers are most dangerous after they’ve gone out.

The biggest danger comes from people, usually children, picking up ‘spent’ sparklers. The burny end takes a long time to cool down, but once the sparkles are finished and it’s stopped glowing it’s impossible to judge how hot it is just by looking.

The burns caused by picking up hot sparklers are undoubtedly very, very nasty, but they’re also relatively easy to avoid. Supply buckets of cold water, and drill everyone to put their spent sparklers into the buckets as soon as they go out. Hazard minimised. Well, assuming everyone follows instructions of course, which isn’t always a given. Other risks are people getting poked with hot sparkers – which can be avoided by insisting sparkler-users stand in a line, facing the same way, with plenty of space in front of them – and people lighting several sparklers at once and getting a flare. Again, fairly easily avoided in a public setting, where you can threaten and nag everyone about safety and keep an eye on what they’re doing.

Although I do understand the instinct to simply ban the potentially-dangerous thing, and thus remove the risk, the idea does worry me a little bit. I was born in the 70s and I grew up with fire. I remember the coal truck delivering coal to us and our neighbours. I was taught how to light a match at an early age, and cautioned not to play with them (and then I did, obviously, because in those days it was usual for kids to spend hours and hours entirely unsupervised – but fortunately I emerged unscathed). Pretty much everyone kept a supply of candles in a drawer, in case the lights went out. And bonfires were a semi-regular event – this being long before garden waste collections.

These days things are very different. It’s not unusual to meet a child who, by age 11, has never lit a match. If their home oven and hob are electric, they may never have seen a flame outside of yearly birthday cake candles. But so what? You may be thinking. Aren’t fewer burns and house fires a good thing?

Of course they are, but people who’ve never dealt with fire tend to panic when faced with it. If the only flame you’ve ever met is a birthday cake candle, your instinct might well be to blow when faced with something bigger. This can be disastrous – it can make the fire worse, and it can spread hot embers to other nearby flammable items.

I’m personally of the opinion that children ought to be taught to handle fire safely, how to safely extinguish a small fire, when to call in the experts, and not to disintegrate into hysterics the presence of anything warmer than a cup of tea. Sparklers, I think, can be part of that. Particularly if they’re used in a well-supervised setting, with plenty of safety measures and guidance on-hand. (As opposed to, say, picking them up for the first time at university with some drunk mates, setting fire to half a dozen at once and immediately dropping them.)

Now. Onto glowsticks. They’re pretty neat, aren’t they? We’ve already established that I’m quite old, and I remember these appearing in shops for the first time, sometime in the very early 90s, and being utterly mesmerised by that eerie, cold light.

phenyl_oxalate_ester

Diphenyl oxalate (trademark name Cyalume)

They work thanks to two chemicals. Usually, these are hydrogen peroxide (H2O2 – also used to bleach hair, as a general disinfectant, and as the subject of a well-known punny joke involving two scientists in a bar) and another solution containing a phenyl oxalate ester and a fluorescent dye.

These two solutions are separated, with the hydrogen peroxide in a thin-walled, sealed glass vial which is floating in the mixture of ester and dye solution. The whole thing is then sealed in a tough, plastic coating. When you bend the glowstick the glass breaks, the chemicals mix, and a series of chemical reactions happen which ultimately produce light.

How Light Sticks work (from HowStuffWorks.com - click image for more)

How Light Sticks work (from HowStuffWorks.com – click image for more)

Which is all very well. Certainly nice and safe, you’d think. Glowsticks don’t get hot. The chemicals are all sealed in a tube. What could go wrong?

I thought that too, once. Until I gave some glowsticks to some teenagers and they, being teenagers, immediately ripped them apart. You see, it’s actually not that difficult to break the outer plastic coating, particularly on those thin glow sticks that are often used to make bracelets and necklaces. Scissors will do it easily, and teeth will also work, with a bit of determination.

How dangerous is that? Well… it’s almost impossible to get into a glowstick without activating it (the glass vial will break), so it’s less the reactants we need to worry about, more the products.

And those are? Firstly, carbon dioxide, which is no big deal. We breathe that in and out all the time. Then there’s some activated fluorescent dye. Now, these vary by colour and by manufacturer, but as a general rule they’re not something anyone should be drinking. Some fluorescent dyes are known to cause adverse reactions such as nausea and vomiting, and if someone turns out to be allergic to the dye the consequences could be serious. This is fairly unlikely, but still.

Another product of the chemical reactions is phenol, which is potentially very nasty stuff, and definitely not something anyone should be getting on their skin if they can avoid it, let alone drinking.

Inside every activated glowstick are fragments of broken glass.

Inside every activated glowstick are fragments of broken glass.

And then, of course, let’s not forget the broken glass. Inside every activated glowstick are fragments of broken glass – it’s how they’re designed to work. If you break the plastic coating, that glass is exposed. If someone drinks the solution inside a glow stick they could, potentially, swallow that glass. Do I need to spell out the fact that this would be a Bad Thing™?

The thing with hazards is that, sometimes, something that’s obviously risky actually ends up being pretty safe. Because people take care over it. They put safety precautions in place. They write risk assessments. They think.

Whereas something that everyone assumes is safe can actually be more dangerous, precisely because no one thinks about it. How many people know that glowsticks contain broken glass, for instance? Probably not the writer of that letter back there, else they might have used stronger language than “please advise against this.”

So glowsticks or sparklers? Personally, I’d have both. Light on a dark night, after all, is endlessly fascinating. But I’d make sure the sparkler users had buckets of water, cordons and someone to supervise. And glowstick users also ought to be supervised (at least by their parents), warned in the strongest terms not to attempt to break the plastic, and all efforts should be made to ensure that the pretty glowy things don’t fall into the hands of a child still young enough to immediately stuff everything into his or her mouth.

The most important thing about managing risks is not to eliminate every potentially hazardous thing, but rather to understand and plan for the dangers.


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