Serial delusions

   The results of my poll about homeopathic medicine were very close to an even split between those who think there might be something to it, and those who think it's nonsense. It was pretty much as I expected, with the only difference being that I thought more people would weigh in on the side of homeopathy than against it.
   The purpose of the poll was to test a theory of mine. Well, it's not really a theory, as theories are defined. More like a hypothesis. Well, really, it's just a supposition.

   I suspect that many people who are willing to allow that there might be something to the claims of efficacy of homeopathic remedies have never really heard a good, clear explanation of exactly what homeopathic remedies are.

I would like to attempt to make this that clear explanation.

   The page explaining Homeopathic medicine that I linked to from my previous entry was that of the Toronto School of Homeopathy. They provide a basic explanation of the practice they teach:

...there [are] two ways of treating ill health, the way of opposites and the way of similars.

Take, for example, a case of insomnia. The way of opposites is to treat this by giving a drug to bring on an artificial sleep. This frequently involves the use of large or regular doses of drugs which can sometimes cause side-effects or addiction.

The way of similars - the homeopathic way - is to give the patient a minute dose of a substance which in large doses caused sleeplessness in a healthy person. Surprisingly this will enable the patient to sleep naturally. Because of the minute dosage no side-effects or addiction will result...

   This explanation is a little light on detail, but it does mention the two most important foundations of homeopathic medicine. The theory of similars, and the concept of minute doses. Remember those two things as our story moves along.

OK, here we go.

   Once upon a time, in a far off land, there lived a man named Samuel Hahnemann. Well, actually, the time was the end of the eighteenth century, and the land was Germany. Mr Hahnemann was a doctor, and he had a problem. His patients kept dying.
   Now don't think I'm trying in any way to impugn Dr. Hahnemann's reputation as a physician. He was an unfortunate victim of his era. People who got sick in the eighteenth century died. A lot. We are talking about a time when one of a doctor's most sophisticated treatments consisted of making a big cut in his patient, and letting the blood run out for a while.
   In fact, I believe that Dr. Hahnemann deserves a lot of credit. Unhappy with his lot...well, the lot of his patients, anyway, he was searching for more effective ways of treating them. One day, while he was working on a little side job he had picked up translating English medical papers to German, he came across a description of a native Peruvian remedy that was being used, with some success, in the treatment of malaria. The treatment consisted of an infusion brewed from the bark of a tree common to South America, called Cinchona.
   Now, you might think of malaria as being a disease of the tropics, but at that time in Europe, it was a considerable problem. Hahnemann was eager to learn more about a potential new way to help his community. He undertook to experiment with this new remedy he had read about.
   Uncomfortable with the idea of experimenting on his patients, Sam tried taking doses of the concoction himself, and found he suffered drowsiness, heart palpitations, trembling, weakness, thirst, and redness of his cheeks. The symptoms would last for several hours, and then subside. 
   Hahnemann believed that he was experiencing malarial symptoms, and made a sudden, intuitive leap. He came to the conclusion that substances that cure a disease in someone who is ill, would cause symptoms of that disease in someone who is healthy. Conversely, he thought, if he could discover substances that caused the symptoms of other diseases in healthy people, those substances would cure people who were afflicted with those diseases. The idea was that "like cures like." This is his law of similars.

   How the concept of minute doses came about is less clear. One article I read suggested that Hahnemann was dismayed to find that his homeopathic remedies did, indeed, cause unwanted, harmful reactions in his patients, and so diluted those remedies until the harmful effects stopped presenting, but I was unable to verify that account elsewhere, and it may be apocryphal.
   Whatever the reason, the fact is that Hahnemann began diluting his remedies in extreme ways. The following account of his dilution practices is from an article written by Oliver Wendell Holmes, in 1842.

A grain of the substance, if it is solid, a drop if it is liquid, is to be added to about a third part of one hundred grains of sugar of milk in an unglazed porcelain capsule which has had the polish removed from the lower part of its cavity by rubbing it with wet sand; they are to be mingled for an instant with a bone or horn spatula, and then rubbed together for six minutes; then the mass is to be scraped together from the mortar and pestle, which is to take four minutes; then to be again rubbed for six minutes. Four minutes are then to be devoted to scraping the powder into a heap, and the second third of the hundred grains of sugar of milk to be added. Then they are to be stirred an instant and rubbed six minutes, again to be scraped together four minutes and forcibly rubbed six; once more scraped together for four minutes, when the last third of the hundred grains of sugar of milk is to be added and mingled by stirring with the spatula; six minutes of forcible rubbing, four of scraping together, and six more (positively the last six) of rubbing, finish this part of the process.

Every grain of this powder contains the hundredth of a grain of the medicinal substance mingled with the sugar of milk. If, therefore, a grain of the powder just prepared is mingled with another hundred grains of sugar of milk, and the process just described repeated, we shall have a powder of which every grain contains the hundredth of the hundredth, or the ten thousandth part of a' grain of the medicinal substance. Repeat the same process with the same quantity of fresh sugar of milk, and every grain of your powder will contain the millionth of a grain of the medicinal substance. When the powder is of this strength, it is ready to employ in the further solutions and dilutions to be made use of in practice.

A grain of the powder is to be taken, a hundred drops of alcohol are to be poured on it, the vial is to be slowly turned for a few minutes, until the powder is dissolved, and two shakes are to be given to it. On this point I will quote Hahnemann's own words. "A long experience and multiplied observations upon the sick lead me within the last few years to prefer giving only two shakes to medicinal liquids, whereas I formerly used to give ten." The process of dilution is carried on in the same way as the attenuation of the powder was done; each successive dilution with alcohol reducing the medicine to a hundredth part of the quantity of that which preceded it. In this way the dilution of the original millionth of a grain of medicine contained in the grain of powder operated on is carried successively to the billionth, trillionth, quadrillionth, quintillionth, and very often much higher fractional divisions...

   I see, at this point, that you are skeptical. You are asking, "do you really want me to believe that homeopathic remedies have been diluted out to concentrations as low as one part per million, or more?"
   Well, yes, I do. Those are the facts of the matter. This afternoon, I took a little jaunt over to our local monster-mega-ultra-super-store, and had a look at their homeopathic medicine section. It took me a while to find it, as it was nowhere near the pharmacy. They had an impressive selection of remedies, all of them available in 6C and 30C dilutions.
   Let me explain those terms. Levels of dilution in homeopathy are represented by a number, and a letter. The number represent the number of serial dilutions a substance has undergone, and the letter represents the amount of each dilution. The letter 'X' represent a dilution in which one part of a solution is combined with nine parts of solvent, for a one-in-ten dilution. The letter 'C' a one-in-one hundred dilution.
   So, in the case of the above mentioned remedies, the term 6C means that one part of an original substance, or 'mother tincture' was diluted into 99 parts of solvent (either water or an alcohol solution). One part of the resulting mixture is then diluted into another 99 parts of solvent, creating a solution in which the original substance is present at a concentration of one part per ten thousand. This is a 2C solution. The same process is then repeated four more times, to produce a 6C dilution, in which the original substance now represents a mere one part per trillion.

   Let's pause for a minute, and think about what that means. How big is one milliliter of a liquid? Say about the size of a cube of sugar. How big is one trillion milliliters? Take a football field. Extend its width until it is as wide as it is long. Build walls around it that are as high as it is wide and long. You now have a huge cube measuring approximately one hundred meters a side. Fill it with water.  Add your sugar cube of the original substance. Stir. That is the equivalent of a 6C dilution.
   Now, take a bottle of simple sugar pills. Touch each pill with the merest fraction of a drop of that solution, and you have homeopathic medicine.
   Remember I said the remedies were also available in a 30C dilution? That represents a concentration of the original mother tincture of 1 part per 1x10 raised to the 59th power. That's a one followed by sixty zeros. To use a similar analogy as we did for the 6C dilution, picture...um, picture... No, I can't picture it.



   Sorry, I had to take a break there. I was having difficulty wrapping my head around the numbers involved in these serial dilutions. Unable to come up with an analogy to describe the 30C dilution, I went to my friend, fv, for help. Vinny, who has a university science degree sent me back this:

Ok...

Take a grain of rice. Cut it in half. Cut it in half again. That is the amount of your original solution.

Now, take the distance from where you live to the south pole. Now think about the distance around the earth. Now think about the distance from the earth to the sun. Ok, now think about the distance from the sun to Pluto. Pretty big, huh? Ok, now think about the distance from here to the nearest star. It takes light 4.3 years (light that came from our sun when Bush was re-elected will reach that star 4 months after he leaves office) to reach that star, Proxima Centauri.

Got that? Ok now imagine a cube with each side the length of that distance. I am going to hide that crumb of rice in that cube. Try to find it...

   Wow. Big concepts. Hard to really imagine numbers that big. Here's another interesting fact. At about the 12C point in the dilution process, it becomes extremely unlikely that even one single molecule of the original medicinal ingredient still remains in the solution. At 30C it is a virtual certainty that the remedy is now comprised of 100% solvent. And yet, homeopathic practitioners maintain that it retains it's efficacy due to something they call potentisation.
   Scroll back up to that quote from Oliver Wendell Holmes. Yes, I know. It's a long way back. This is the part I want you to remember:

the powder is dissolved, and two shakes are to be given to it.

   Those shakes are important. They are what is referred to as succussion. In between each step of the dilution process, Hahnemann would succuss the solution by shaking the vial, or tapping it upon a hard but elastic surface, like the leather cover of a book. He believed that this process of succussion 'potentised' or energised the solution, counteracting the effects of the dilution. Nowhere can I find an explanation of why the succussion would retain the beneficial properties of a remedy, but not the harmful ones the dilutions were undertaken to remove.
   This web page has a series of quotations referring to the practice of succussion as Hahnemann conceived of it. An example:

In the Organon, however, he stated that trituration and succussion release the ‘spirit-like power’ of the medicine - which is compatible with his assumption that medicines act through their spiritual (geistlich) or dynamic impact upon the organism.

   Here we have the basic underlying concept behind the origin of homeopathy. Samuel Hahnemann believed there was some kind of magic force acting upon the remedies he was preparing keeping them potent even after he had diluted any trace of the original ingredient out of them.
   At this point, I have to pause once more and ask you a question. Does any of this make any sense whatsoever? If you are a die hard adherent to the practice of homeopathic medicine, your answer is that is doesn't matter if it makes sense, as long as it works. Right? What do you have to say about that? Huh?
   <Best John Wayne Drawl>Well, I'll tell ya.</John Wayne> I don't have to say much at all. I'll simply let the headlines speak for me. Here is a news report detailing the results of the latest and largest clinical study of homeopathy: Homeopathy no better then placebo, says study. So, beyond the fact that it sounds silly, it just plain doesn't work.
   This is the end of my story. If you would be so good as to vote again in a poll, I would like to know how many of you, whether you believe(d) in homeopathic medicine or not, knew exactly what it was before you read this entry, and whether your opinion has changed at all.





And once more, if you would be so kind...




tags:Skepticism, Polls,