A spoonful of nothing: Why homeopathic remedies are just expensive placebos

Written by Dan Landry in Health Literacy Last Updated October 12, 2021
A spoonful of nothing: Why homeopathic remedies are just expensive placebos

I always find it amusing when I explain homeopathy to people. Almost unanimously, people will assume that I’m joking or exaggerating. Let’s review the basics of homeopathy and homeopathic remedies:

What is homeopathy?

Homeopathy is often promoted as a traditional remedy, and often grouped together with things like traditional Chinese medicines. However, the truth is that homeopathy isn’t actually a “traditional remedy” at all.

When was homeopathy created?

Homeopathy was founded in 1796 by the German doctor Samuel Hahnemann. It’s said that Hahnemann had taken quinine around that time and was surprised to find that the side effects of the remedy were similar to the effects of the disease that it was used to treat (malaria). So, he then went on to hypothesize that “like cures like”.

In other words, what Hahnemann thought was that you could cure diseases by giving a remedy that would cause a slightly milder version of those symptoms in a healthy person. For example, if you suffered from headache they would aim to give you something that produces a mild headache when given to healthy people.

This theory is not based on any evidence, and has never been proven to be legitimate either.

What is in homeopathic medicine?

Homeopathic remedies are supposed to contain various substances, usually derived from plants (but not always). They can range from things like poison ivy, deadly nightshade (belladonna), stinging nettle, and even arsenic.

Wait, they’re giving people stuff like belladonna and arsenic?

While homeopathy will technically claim to be giving very small doses of these substances, luckily they probably aren’t. The reason why will be covered below…

How diluted are homeopathic medicines?

Because the goal is to give something that would only produce mild versions of the same symptoms, homeopathic medicine is diluted. On the surface, this would seem reasonable. However, the amount of dilution that is used makes it so that the substance is almost certainly not even present in the final product.

Homeopathy has a few beliefs that they claim act as a backbone to “explain” this notion:

Less is more

Homeopathy works under the unproven notion that a smaller dose would be more potent than a larger dose. This would be like claiming that non-alcoholic beer is stronger than moonshine.

Many homeopathic remedies use terms like 200C to show how “potent” they are. This represents how many times the initial substance was diluted, but using roman numerals (as a reminder C represents 100 in Roman numerals).

So, if C means 100, that means that the initial substance is diluted at a ratio of 1 to 100 in water.

For a 200C remedy, this means that the process is repeated 200 times. You then soak this ultra-diluted solution onto sugar pellets (which are the final homeopathic remedy to be taken).

At this point, homeopathic remedies have been diluted so much that it’s almost statistically impossible that a single molecule of the initial substance remains in the final “remedy”.

I know this is probably hard to visualize. So, here is a (very low budget) representation of what the 200C dilution process would look like:

At every step along the way, you are removing a small amount and then re-diluting it 1:100 in more water.

As I’ve already said, it’s essentially impossible that you have any of the substance remaining in the final product.

For an idea of what some “C values” represent, check out the following analogies:

  • A 12C dilution would mean that we’re at a final ratio of 10-24; which means 1 to 1,000,000,000,000,000,000,000,000 (i.e. 1 to 1 septillion…I had to look up what to call that number).
    • Another way to look at 12C would be if you treated a headache by:
      – Taking an ibuprofen tablet and throwing it into a volume of water equivalent to the entire Atlantic Ocean (i.e. diluting it in 323,000,000 km2 of water)
      – Letting it swish around for a while
      – Then taking a small sip of water to help your headache.
  • A 200C dilution is often used in the Oscillococcinum formulation. This popular remedy is used by some people to treat cold and flu symptoms.
    • For this “potency”, they take the initial substance, and then dilute it to a final ratio of 10-400
      Which means diluting it 1 to (1 with 400 zeroes after it)

So, if you wanted to take enough Oscillococcinum to guarantee that you ingested just one molecule of the initial substance, you would need to ingest more Oscillococcinum than there are atoms in the known universe.

As you could imagine, there’s no method that could even accurately measure this. So, you’re almost certainly just getting an expensive sugar pill (unless a manufacturing error occurs… more on those later).

Water memory

Homeopathy has a theory that water can essentially “remember” what was in it. There are some references that say original homeopaths called this a “dematerialized spiritual force” that can remain in the water.

So, how is this “dematerialized spiritual force” obtained? There are many words that are used to describe the process; among these are “potentization” or “dynamization”.

The belief behind “potentization” or “dynamization” is that, while you are diluting the substance, you are supposed to “succuss” it properly. Succussion is literally just shaking something really hard. The theory is that, at every dilution, the container must be smashed a specific number of times against a soft object like a pillow. (I swear, I’m not making this up)

When you boil it down, the belief is that you can make the water “remember” the diluted treatment, while also making sure it doesn’t “remember” all the raw sewage and other waste products that have been in it.

Does homeopathic medicine work?

There is no good quality evidence showing that homeopathic remedies have any better effect than placebo. Time after time, any meta-analysis (i.e. a study of studies) evaluating well-designed studies has come to the same conclusion that they don’t work.

The Australian National Health and Medical Research Council has thoroughly researched the subject of homeopathic medicine. In the summary of their 2015 report, they state:

Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective.

Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.

Australian National Health and Medical Research Council; March 2015

Is homeopathic medicine safe?

Since homeopathic remedies essentially have nothing in them, it’s quite easy to say that they’re safe. This safety is often used as a selling point for homeopathic remedies.

But, remember what I said about how homeopathy uses many types of plants?

Well, many of those plants are actually toxic. One example is deadly nightshade, a poisonous plant that is also sometimes referred to as belladonna. I know what you’re thinking; “I thought he said they diluted it until nothing was left“.

Unfortunately, many homeopathic remedies are not as well-regulated as the pharmaceutical industry. This can lead to substandard manufacturing practices.

This has potentially led to harm in some people. A detailed article from Scientific American reported the story of Hyland’s Teething Tablets. Sadly, some children seem to have displayed signs of belladonna poisoning after taking these homeopathic teething tablets. When the FDA reviewed the facilities where they were produced, they found that some of the tablets actually contained belladonna (and in much larger quantity than what the label indicated).

If homeopathy hasn’t been shown to work, why do so many people swear by it?

Homeopathy has many attractive elements for certain people. This is particularly true for those who are already distrustful of modern healthcare and large pharmaceutical companies.

The first reason is that the placebo effect is a real thing. For example, in placebo-controlled studies of antidepressants, there will always be patients in the placebo group that say they feel better. So it’s not surprising that many will swear that their homeopathic medicine is helping, since a good portion are probably just having a placebo effect from it.

The second reason is that many homeopathic practitioners will spend a long time (usually an hour) with a patient during a consultation. People will unsurprisingly associate this as a good thing when compared to a traditional doctor’s visit that lasts a few minutes. On top of this, homeopathic practitioners will ask many questions in a “holistic” approach; whereas many physicians will limit the discussion to one or two problems per visit. There is actually a study showing that, in rheumatoid arthritis patients, the actual consultation with the homeopathic practitioner (and not the homeopathic medication) was what was giving any benefit. So, just the act of sitting down and talking to someone for an hour is probably what is driving any potential benefit on top of the placebo effect.

The third is that some homeopathic remedies contain other ingredients. For example, some homeopathic cough remedies also contain honey in them. Because honey has been shown to potentially reduce cough, this is the most likely part of the remedy that would be giving any benefit.

The Bottom Line

Homeopathy is based on pseudoscientific concepts that have no plausible scientific mechanism to explain them. The dilutions and methods used to prepare homeopathic remedies result in a scenario where it’s almost statistically impossible that the final product contains any of the initial active ingredient. For example: in order to take enough Oscillococcinum to guarantee that you ingested one single molecule of the active ingredient, you would need to ingest more Oscillococcinum than there are atoms in the known universe.

There is no good scientific evidence to show any benefit with homeopathic remedies to treat any medical condition. While some patients may claim to benefit, it’s almost certainly due to a combination of the placebo effect and the fact that the homeopathic practitioner will spend a long time to interact with them during a consultation.

References:

Dan Landry

Daniel (Dan) Landry, founder of Rxplanation.com, is an infectious diseases pharmacist at the Dr-Georges-L.-Dumont University Hospital Centre in Moncton, NB, Canada.

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