Junkfood Science: <i>Junkfood Science Special:</i> Healing water

December 19, 2006

Junkfood Science Special: Healing water

© Sandy Szwarc 2006

Should the popularity, political expediency or profit potential of a medicine determine our support of it? That’s how a surprising number of our public health guidelines, regulations, health benefits, and even curriculums in medical and nursing schools are decided. Do we want to go to a healthcare provider whose advise and prescriptions for us are based on their popularity and ability to make extra money for them? Or do we want to trust that our provider is giving us honest advice and therapies with proven efficacy?

And as medical professionals, is it ethical to endorse and put credentials behind modalities that lack reproducible, clinical and scientific evidence — or even plausible, rational explanations in proven biophysical science — simply because patients may want them or offering them can bring in extra revenue? Or would that be taking advantage of people and betraying their trust?

These are dicey questions and confront all of us daily in mainstream medicine and public health. But complementary alternative medicines may most challenge us to think about them.

A recent story from Switzerland highlighted how we’re often led by popular beliefs rather than science when it comes to making health decisions. Homeopathy has been a hot button issue there, as supporters of alternative preparations try to force officials to pay for them under their country’s compulsory health insurance. Last year, after investigating the evidence, the interior ministry found homeopathy therapies “failed to meet the criteria on efficacy, suitability and cost-effectiveness” under their law. But the science proved no deterrent and supporters gathered signatures and petitions to force it to a popular vote giving, as SwissInfo reported, “rational voters a headache.” Health agencies around the world, from Ontario to Scotland are considering including homeopathy and other alternative modalities among recognized medical professional services.

Homeopathic products have become popular here in America, too, as sales have reached $400 million a year, according to Grant Ferrier, editor of Nutrition Business Journal. But a surprising number of people, both professionals and consumers, don’t understand what they are and only know what they’ve heard from friends or advertisements. The most common situation I encounter is that many people think they’re natural, holistic medications, and confuse them with herbs and supplements that may have some active ingredient. Even if you think you understand homeopathic preparations, the following information may come as a surprise.

What are homeopathic products?

Homeopathic preparations are made from a mineral or botanical, chosen based on the "law of similars,” which maintains that symptoms of a disease can be cured by exposures to something that causes similar symptoms in healthy people. [So, if caffeine causes a healthy person to keep wide awake, then someone having difficulty sleeping would be given caffeine.]

This substance is then diluted in 10 parts of water or alcohol, then diluted again, then again, and again.... Most homeopathic products sold today are one drop that’s been diluted 1,000,000,000,000,000,000,000,000,000,000 times. And some are such large numbers, the dilutions have 1500 zeros!

At that dilution, it is the equivalent of one grain of rice crushed and diluted in a sphere of water the size of the solar system and repeating that process 2 billion times, said James Randi at a 2001 lecture at Princeton.

The liquid has not even a molecule of the original substance left and no measurable active ingredient. “Even the most carefully distilled water is likely to have more molecules of contaminants than a homeopathic remedy has of its ingredient,” said Dr. Harriet Hall, M.D., medical advisor with the National Council Against Health Fraud.

Homeopaths claim, however, that the more dilute the remedy, the more powerful it is. It is believed to have a memory of the substance, which leaves a spirit-like essence that cures by reviving the body’s “vital force.”

While the core of homeopathy defies biological plausibility, belief in it is analogous to today’s popular beliefs over the dangers from infinitesimal traces of “chemicals” — in parts per BILLION — in our foods and environment. Organic foods have also grown in popularity over the past decade and by 2003 accounted for $20 billion in sales, according to the USDA Economic Research Service.

What leads us to believe that we can be healed and harmed in such implausible ways? Both are spurred by being bombarded by scares of our modern life and medicine. When faced with so much seeming uncertainty, it’s natural for people to want to take control over their lives and embrace the comfort that simple explanations provide, said Mahlon W. Wagner, Ph.D., psychology professor at State University of New York, Oswego.

Are homeopathic products regulated?

Homeopathic products are not regulated like mainstream (allopathic) medicines, nor do they have to undergo clinical trials and be shown safe or effective and meet U.S. Food and Drug Administration (FDA) approval. The FDA can, however, take action on illegal marketing claims and has found homeopathic products being illegally marketed for heart disease, kidney disorders, cancer and other serious conditions.

Weight loss is common promise of homeopathics. During 1988, the FDA took action against companies marketing diet patches with false claims that they could suppress appetite. The largest such company, Meditrend International of San Diego, instructed users to place 1 or 2 drops of a “homeopathic appetite control solution” on a patch and wear it all day affixed to an “acupuncture point” on the wrist to “bioelectrically” suppress the appetite control center of the brain.

The FDA forced Biological Homeopathic Industries (BHI) of Albuquerque, New Mexico to stop claiming homeopathics cure serious diseases including cancer and strokes, as they’d published in catalogs sent to 200,000 doctors nationwide. But, according to Dr. Stephen Barrett, M.D, its Physician’s Reference continued to recommend products to treat about 450 conditions, including heart failure, syphilis, kidney failure, blurred vision, cancer, angina, bacterial infections and paralysis. The FDA again issued warnings to BHI, this time for making claims its homeopathic cold product was “effective for mumps, whooping cough, chronic respiratory diseases, herpes zoster, all viral infections, and measles.” BHI also claimed that when combined with their other remedies, it was “effective against otitis, pleurisy, bronchitis or pneumonia, conjunctivitis and tracheitis,” said Dr. Barrett.

Do homeopathic products work?

Homeopathic followers often assert that these preparations defy modern testing or that there have been few tests on them. Both are false.

“Many providers of complementary and alternative medicine are convinced that their therapy defies the ‘straightjacket’ of reductionist research,” said a recent panel report from the Conference on Complementary and Alternative Medicine Research Methodology, National Institutes of Health. Supporters argue that alternative modalities are individualized, holistic, intuitive, etc, and call for a ‘paradigm shift’ in research.” However, the Panel concluded that these arguments are based on a series of misunderstandings and concerns can be resolved by properly designing the research, and that “if the aim is to test the effectiveness of complementary and alternative medicine, randomized controlled trials usually provide the least biased method for finding a reliable answer.”

As Steven Bratman, M.D., a national expert on the scientific evidence on alternative medicine and principle author of The Natural Pharmacist and other books, said:

I once took alternative medicine on faith. For decades, I practiced it on patients and myself and my family, and assumed that pretty much all of it worked. Then I learned about double-blind studies, and it was like a tornado blowing down a house of cards. I discovered that I, like most people who love alternative medicine, had made a huge (though understandable) mistake.

I had thought it was possible to know whether a treatment worked by trying it. I had also thought I could trust tradition, anecdote, and authority. I now see otherwise. The insights of the double-blind trial have cut through my wishful thinking and idealism, and turned me into a hard-nosed skeptic. Show me the double-blind studies, and I'll pay attention. Otherwise, so far as I'm concerned, it's little more than hot air.

It doesn’t matter if the treatment has a long history of traditional use — in medicine, tradition is very often dead wrong. It doesn’t matter if doctors or patients think it works — doctors and patients are almost sure to observe benefits even if the treatment used is fake.

But such awareness isn’t common. When presented with the evidence that contradicts something they believe, as did a recent 20/20 episode debunking homeopathic preparations, many people didn’t care. They’d seen good effects with their own eyes and believed they must work if millions of people swear by them.

Homeopathy has undergone more than 150 clinical trials and all of the careful, quality studies have failed to show that homeopathy has any value over a placebo. There are, of course, efforts to make findings appear controversial, and systematic reviewers often differ considerably, as German researchers noted in a 2003 Journal of the Royal Society of Medicine. But, “well-conducted clinical trials consistently yield the least promising results,” they concluded. Every careful examination of the few studies being used to claim homeopathy is effective reveals major flaws in the design such as nonrandomized and selected study groups, no placebo groups and nonblinding, insignificant relative risks, evaluations based on subjective symptoms, etc.

Dr. Matthias Egger and other researchers at the University of Bern conducted the largest study ever done on homeopathy which was published last year in Lancet. After carefully analyzing 110 clinical trials, they found that the effects from homeopathic treatments were due to placebo. “We’re not saying that homeopathy doesn’t work,” Egger told SwissInfo. “We’re just saying that the effects that people clearly experience are perhaps not due to the little white pills.”

Researchers at the Institut Gustave Roussy, Villejuif, France, reviewed 40 randomized trials that compared homeopathic treatments to standard treatments and concluded there is no evidence that homeopathic treatment has any more value than a placebo. More than a dozen similar analyses have come to the same conclusion: homeopathy does not perform any better than placebos.

“There is little doubt that some conditions are quite responsive to placebo treatment, such as menopausal hot flashes, symptoms of prostate enlargement, and many types of pain, said Dr. Bratman. “While it’s often reported that only 30% of people respond to placebo, this number has no foundation, and, in fact the response rate seen in some of the conditions I just listed reaches as high as 70%.”

Much of the perceived benefits of homeopathy, like many alternative modalities, are due to homeopaths spending time with patients, listening and giving assurances. “The homeopath is seen as a concerned and sympathetic health-care giver,” said Dr. Wagner. And with the dissatisfaction and distrust some consumers have developed of conventional medicine, or when patients are told that there is nothing wrong with them and they believe otherwise, they are drawn to the reassurance of a cure that homeopathy offers, he said.

As singer Karen Louise told the Daily Record today, she believes alternatives are essential for her chronic fatigue syndrome:

Doctors told me I was depressed and had a virus and to rest and that other than that I was fine. But I felt my life was awful and I couldn't live like that....She booked me an appointment at a homeopathic centre. I went with my mum and had a full on assessment and was told I had ME. It was an amazing moment to find out I really was ill. There was a relief at knowing there was something wrong with me, but also a horror....I know there is controversy surrounding [homeopathy], but if you have been there and they help you, you don’t care what people think.

Are homeopathic products safe and cost effect?

These statements have appeared on homeopathic labels:

“No side effects”

“Non-habit forming”

“In case of overdose, call your poison control center”

While the first two are certainly true, the third bit of advice is of doubtful necessity. :)

While the placebo effect can be powerful and clearly the remedies themselves are not likely to hurt people, the potential benefit of relieving short-term symptoms with placebos have to be weighed against the harm that can result from relying upon — and wasting money on — ineffective products.

The actual costs of these products are rarely a concern for most current users because repeated studies have shown that homeopathic products are most popular among those who are affluent, white, younger and elite in our society. These are the same groups more apt to seek remedies for subjective symptoms and able to spend more for foods and products perceived as healthy, noted a critical overview of the evidence on homeopathy in the 2003 Complementary and Alternative Medicine Series published by the Annals of Internal Medicine. Never mind that “there is a lack of conclusive evidence on the effectiveness of homeopathy for most conditions.”

But when the moneys come from limited healthcare resources that could be directed to medications that are proven to help, then the risks become more critical. One of the most serious potential side effects rarely mentioned when balancing risks and benefits is the delay in seeking care while pursuing modalities that don’t actually treat an organic disease.

Some of the most popular homeopathic products, which soared 44% in sales last year, are for infants to treat teething and colic. One study of two million people in Scotland, for example, found that children under 12 months were the most likely to be given homeopathic or herbal remedies, nearly 1 in 10 babies. Parents might waste critically important time while a serious medical reason for their baby’s crying and pain is overlooked.

It is also a concern when homeopaths lead people to believe they are sick or something is wrong with them, or give them medical diagnoses that can be treated with a natural remedy, of course. Especially worrisome is that “most homeopathic leaders preach against immunization,” said Dr. Steven Barrett. “Equally bad, a report on the National Center for Homeopathy’s 1997 Conference described how a homeopathic physician had suggested using homeopathic products to help prevent and treat coronary artery disease,” he said.

One of the most frighten and poignant examples of why healthcare professionals worry about homeopathics and what can happen when people fall prey to believing unsound modalities was illustrated in a recent article in the Kelowna Capital News (British Columbia). It recommended packing a homeopathic travel kit before traveling where risks of Botulism, Hepatitis, Norwalk virus and E-coli loom. The kit included “30 to 40 homeopathic remedies to protect against food poisoning, traumas, insect bites and fevers.” The homeopath advised readers of “some excellent homeopathic remedies also for Malaria...I would consider taking that before taking the pharmaceutical medicine Quinine which has some side effects that include rash, nausea, low blood glucose level, severe swelling of lips face or tongue and flushing to name a few. If you have made an appointment to have your travel vaccinations you may want to cancel it and do some more research before you commit...”

This is really not a frivolous issue. Science and medicine may not have all of the answers, but it can help us protect ourselves and others from beliefs and quackery that can prove costly, misleading and hurt people... when we take the time to understand and care.

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