RESPONSE

HOMEOPATHY IS UNSCIENTIFIC AND UNETHICAL

KEVIN SMITH

Keywordshomeopathy,alternative medicine,complementary medicine,CAM

ABSTRACTIn opposition to the premises of Against Homeopathy – a Utilitarian Per-spective, all four respondents base their objections on the central claimsthat homeopathy is in fact scientifically plausible and is supported byempirical evidence. Despite ethical aspects forming the main thrust ofAgainst Homeopathy, the respondents’ focus on scientific aspects repre-sents sound strategy, since the ethical case against homeopathy would beweakened concomitant with the extent to which any plausibility for home-opathy could be demonstrated. The trouble here is that the respondents areattempting to perpetuate a sterile debate. The notion that homeopathicpreparations could have any biological effects represents a fringe view-point, one not entertained by serious scientists nor supported by reasonand evidence.

In the present article, I shall endeavour to explain why the respondentsdo not have a valid case. I will deal firstly with their general approach toscientific plausibility and evidence, and then consider some of the specificclaims they have made. Finally, I will answer the philosophical argumentssome of the respondents have raised.

HOMEOPATHIC THEORYIS IMPLAUSIBLE

In Against Homeopathy, I pointed out how astonishingit would be if homeopathic preparations had any directbiological effects, considering that the dilution processinherent in homeopathy makes it statistically unlikelythat even one single molecule of the original ‘active’substance will be present in most homeopathic doses. Todeal with this fact, two competing explanations may beemployed: either [a] homeopathic ‘medicines’ simplycannot have effects beyond placebo, and any claimedeffects therefore ought to be attributed to observationerrors or spurious ‘noise’ in experimental data; or [b]apparent homeopathic effects must be real and thereforethe logico-scientific conclusion that absent moleculescannot produce biological effects ought to be rejected.

Explanation [a] is demanded on logical grounds; it isthe simplest of the two explanations to fit the observed

data and, in contrast to explanation [b], does not requirethat fundamental rules of science and reason be over-turned. However, it is clear that all four respondentssubscribe to explanation [b], and this leads these authorsinto dubious territory.

Several of the respondents, in their letters in this issueand also in other published works, posit various com-plex models and claimed scientific phenomena to try toexplain how homeopathic preparations may exert bio-logical effects. However, these proffered explanationsamount merely to ad hoc attempts to manoeuvre aroundthe central problem: namely that it would be incredible tosuppose that absent molecules could exert any effects atall. The authors deploy complex scientific concepts andelaborate terminology, including ‘systemic networks’,‘complex information’, ‘neuro-immuno-endocrinehomeodynamics’, ‘chaotic dynamics’, ‘energy field’ and‘inductive-idiographic’; however, the posited hypothesesof homeopathic action have no scientific validity. I would

Address for correspondence: Dr. Kevin Smith, Abertay University – Contemporary Sciences, Baxter Building Dundee Tayside DD1 1HG, UK.Email: k.smith@abertay.ac.ukConflict of interest statement: No conflicts declared

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Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/j.1467-8519.2011.01956.x

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assert that such use of authoritative-sounding con-cepts and terminology, with no underlying substance,represents a form of obfuscation and locates thesehomeopathic hypotheses firmly within the domain ofpseudoscience.

THERE IS NO CREDIBLE EVIDENCEFOR HOMEOPATHY

A second approach employed by several of the respon-dents is to claim that published clinical evidence supportshomeopathy. It is true that the published literature con-tains reports of apparently successful treatments withhomeopathy. However, it is disingenuous to take suchreports out of context. Clinical trials literature, by itsinherent nature, contains a good deal of background‘noise’, in terms of contradictory or anomalous publica-tions, generated by a range of factors including chancestatistical effects, low subject numbers, poor studydesign, slipshod execution, and even fraud.1

Scientifically tenable theories generate increasinglyclear and accurate observations over time. By contrast,invalid theories, where pursued, accumulate negativeresults interspersed with rare positive results. The latterpattern is displayed by the body of published work onhomeopathy. Moreover, the isolated positive reports ofhomeopathy are generally inferior studies.2 Regrettably,the existence of a few ‘positive’ publications has allowedbiased reviewers to claim justification for homeopathy bycherry-picking isolated favourable studies, and ignoringtheir manifest weaknesses.

All of the papers cited by the respondents have pre-viously been examined seriously and found to be wanting.Space does not permit each paper to be considered,however one example (cited by Richard Moskowitz) isrepresentative:

D.S. Spence, E.A. Thompson, S.J. Barron. Home-opathic treatment for chronic disease: a 6-year,university-hospital outpatient observational study.J Altern Comp Med 2005; 11: 793–798.

This ‘study’ has no control group. It thus provides noevidence as to whether homeopathy works. This is regret-tably typical of ‘positive’ homeopathy publications, andthe fact that homeopaths cite such papers with regularityis good reason to believe that homeopaths have no inter-est in properly testing their ideas.

Some of the respondents’ claims are remarkably strongand unequivocal, given the lack of persuasive supportingevidence available. For example, Lionel Milgrom andKate Chatfield claim that ‘homeopathy is impressive inthe treatment of animals, newborn babies and comatosepatients’. In fact, aside from isolated and flawed reports,there exists no good evidence for such claimed home-opathic effects.

Citation of isolated ‘positive’ publications representsvery poor academic practice. Moreover, due to the riskof seriously misleading non-specialists (e.g. patients) asto the efficacy of homeopathy, I would argue that suchpractice is unethical.

DUBIOUS HOMEOPATHIC CLAIMS

I have no desire to appear to lend credence to a scientific‘debate’ which in fact does not exist as far as serious scien-tists are concerned. However, the respondents have com-mitted to print several specific assertions in opposition toAgainst Homeopathy that are based on serious scientificfallacies or misunderstandings. Thus, in the following sec-tions, I highlight and repudiate the key offending claims.

Misplaced appeals to pharmacology

Several of the respondents claim that the existence of‘non-linear’ dose-response relationships lends support tohomeopathy. Bell-shaped dose response curves are well-known in pharmacology: very high concentrations of adrug may block ion channels, or become toxic in someway, such that the response declines. In a few cases themechanism is well understood. However, this phenom-enon has nothing to do with homeopathy, as it occursonly with large doses. Homeopaths maintain that doseresponse curves have a negative slope, but in 200 yearsthey have failed to produce a single example of such acurve. It is pharmacologically untenable to claim that thesmaller the dose the bigger the effect.

More specifically, Irene Sebastian and Richard Mosk-owitz cite the idea of ‘hormesis’ to justify homeopathy.Hormesis refers to instances where a substance is toxic athigh dose but beneficial at low dose. (The term itself is notused in serious pharmacology, and simply describesrather trite occurrences: for example, vitamin A is essen-tial for health but overdosing on vitamin A supplementsmay lead to liver damage; similarly, water is essential forhealth but grossly excessive intake leads to water into-xication.) The fact that the homeopathic dilution processremoves all molecules of the original active substancerenders hormesis (and all non-linear pharmacologicaleffects) irrelevant to homeopathy. Regardless of thenature of the dose-response curve of the originalsubstance, no molecules equals no effect.

1 J.P.A. Ioannidis. Why Most Published Research Findings are False.PLos Med 2005; 2: 696–701.2 Reviewed in W.B. Jonas, et al. A Systematic Review of the Quality ofHomeopathic Clinical Trials. BMC Complement Altern Med 2001; 1: 12.For an example of a specific case see K.L. Overall & A.E. Dunham.Homeopathy and the Curse of the Scientific Method. Vet J 2009; 180:141–148.

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Homeopathic ‘similitude’ – an empty concept

Sebastian defends the concept of ‘similitude’, a fundamen-tal tenet of homeopathy. This concept, otherwise knownas the ‘law of similars’, maintains that substances thatproduce particular symptoms can cure the same symp-toms. The general idea appears to hold intuitive appeal formany; indeed it predates homeopathy considerably.3

However, there are no logical grounds for believing that‘like treats like’, and the concept is not supported by basicempirical research. Furthermore, the principle of homeo-pathic similitude is simply a category mistake: it cannot beapplied to modern medicine. The principle was conceived200 years ago when it was unknown that disease exists infundamentally different forms, each caused by a specificmalfunction of a tissue or an organ. In light of this know-ledge, we now know that diseases cannot be treatedaccording to a common rule such as ‘similitude’. The onlycorrect therapy for an illness is according to its veryspecific etiology and pathogenesis.

Laboratory experiments do notsupport homeopathy

Richard Moskowitz and Paolo Bellavite make referenceto various studies dealing with high dilutions showingthat the solvent exhibits unexpected physicochemicalproperties. There is no space here to deal with each of thecited publications separately. These papers appear to besingle disconnected studies, some of them having theobvious aim of giving scientific credibility to home-opathy. Extrapolating from these findings to concludethat homeopathy has a scientific basis is unwarranted andunconvincing. There is of course a parallel here betweensuch laboratory experiments and clinical trials, in termsof cherry-picking isolated positive findings.

The history of science contains many instances wheresurprising experimental results have led to establishedtheory being overturned. However, it is important torecognise the extent to which fundamental scientifictheory would have to be revised in order to accommo-date a mechanistic basis for homeopathy. Simple arith-metic shows that to receive just one molecule of thediluted agent from a fairly standard homeopathicdilution of 1x1030, the patient would have to consumeover 30,000 litres of the homeopathic solution. Andmany homeopathic medicines are diluted to even greaterextremes, ranging up to 1x10400, meaning that to receivejust one molecule of agent the patient would have toconsume more matter than is present within the entire

universe. Thus, for homeopathic dilutions to havemechanistic effects, it would appear necessary to rejectvirtually all that science has painstakingly elucidatedover the last 200 years concerning the composition ofmatter itself.

The only logical way that homeopaths have foundto deal with this epistemic problem is to employ the adhoc notion that the solvent used for dilution retains a‘molecular memory’ of the original substance. This expla-nation is implicit in many of the experiments alludedto by Moskowitz and Bellavite. However, the idea thatwater (or any other solvent, such as alcohol) has a‘memory’ is unsubstantiated by any laws or mechanismsknown to science. Claims that the special form of shaking(‘succussion’)4 employed during the dilution processsomehow ‘potentises’ the solvent to ‘memorise’ the origi-nal molecular structure are similarly unfounded. More-over, homeopathic medicines are frequently taken aspills. These sugar pills are prepared by the addition of adrop of the ultra-diluted solution, which then dries out.Thus, for homeopathic pills to have any activity, it wouldbe necessary for the ‘memory’ of the long-since-vanishedmolecules to be transferred from the water onto the sugarpill. Again, neither physics nor chemistry provides anysupport whatsoever for such a mechanism. Finally, the‘memory’ must pass into the patient’s body and exertphysiological or biochemical effects: biological scienceoffers no explanations as to how such ‘information’ couldpossibly alter bodily functions.

Fortunately, one does not have to be a physicist,chemist or biologist in order to cut through the pseudo-scientific jargon and understand the implausibility ofclaims for a homeopathic ‘memory’ effect. If it were truethat water can ‘remember’, then simple logic indicatesthen every substance ever encountered by a molecule ofwater – such as biological toxins or heavy metals – shouldbe expected to imprint a ‘memory’ that would exert pow-erful and unpredictable effects on the body. The fact thatphysiological chaos does not ensue whenever we drink aglass of water provides a simple but powerful refutationof the ‘memory’ concept in homeopathy.

PHILOSOPHICAL ARGUMENTS

As pointed out above, the respondents’ main approachhas been to claim scientific credibility for homeopathy.However, some of the respondents also make claims ofa philosophical nature, including those of direct ethicalrelevance.

3 Hippocrates mentioned the notion ‘like treats like’, and it was advo-cated by the Swiss physician and mystic Paracelsus, who predatedhomeopathy by about a century (Paracelsus was apparently influentialon Hahnemann, the 19th century founder of homeopathy).

4 The process of ‘succussion’ varies amongst homeopaths: Hahnemannrecommended that the solutions simply be rapped against a hard leatherbook between dilutions.

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Scientism?

Moskowitz claims that Against Homeopathy is anexample of ‘scientism encroaching into medicine’, defin-ing ‘scientism’ as ‘the unscientific belief that compared toother forms of knowledge, science is the absolute andonly justifiable access to truth’. In response, I suggestthat questions of medical efficacy – for all treatments,whether mainstream or ‘alternative’ – properly reside inthe domain of science. This seems axiomatically correct,and places the onus on Moskowitz to establish groundsfor rejecting the use of scientific methodology in thecontext of medicine. Moreover, this letter contradictsitself. Its initial lines defend homeopathy on grounds of‘compelling scientific evidence’, thus acknowledging thecentral importance of science in medicine. The applica-tion of scientific methodology to medical questions isentirely warranted and does not constitute ‘scientism’.

Moskowitz claims that ‘scientism’ of the sort allegedlydisplayed in Against Homeopathy may lead to certainoutcomes, including ‘the campaign to undemocraticallyrid Britain’s NHS of its homeopathy/CAM facilities’ and‘all current medical procedures being postponed whileawaiting proof of efficacy’. In the case of the formeroutcome, there is nothing ‘undemocratic’ about cam-paigning against the expenditure of scarce publicresources on unproven and implausible forms of medi-cine. While Moskowitz views such campaigning as ethi-cally problematic, I suggest that such an outcome insteadought to be welcomed, on the ethical grounds set out inAgainst Homeopathy. With regards to the alleged post-ponement of all medical procedures, I agree that thisoutcome would be extremely negative. However, such anoutcome does not flow from the proper use of scientificmethodology in medicine. Acceptance of the efficacy of adrug or procedure does not depend on absolute proof,but on general agreement that efficacy has been reason-ably well demonstrated through quality clinical trials.

More fundamentally, the notion of ‘scientism’ asemployed by Moskowitz is questionable. This isrevealed in part by certain references cited in his letter.In particular:

D. Holmes, S.J. Murray, A. Perron, G. Rail. Decon-structing the evidence-based discourse in health sci-ences: Truth, power, and fascism. Internat J Evid BasedHealthc 2006; 4: 180.

This paper makes repeated use of the term ‘fascism’ whenreferring to any rational approach to medical evidence.Such outrageous language (which led to immediate noto-riety for the paper concerned)5 reveals an approach thatappears to be extremely biased against science.

The use of ill-defined and derogatory terms suchas ‘scientism’ and ‘fascism’ only serves to lower thequality of the discussion surrounding the ethics ofhomeopathy.

Unethical users?

Irene Sebastian claims that ‘most users of homeopathicmedicines are in fact also proponents’, and from thisconcludes that I am denouncing on ethical grounds allsuch persons. These users/proponents are claimed by therespondent to number some 200 million worldwide, andspecifically to include Mahatma Gandhi.

Sebastian offers no evidence for these claims, either interms of the numbers or the notion that most users arealso proponents. Regarding the latter claim, it seemslikely that very many of those who use homeopathy willsimply be seeking improvements in their health, asopposed to behaving as ‘proponents’ of homeopathy.

In Against Homeopathy I argued that personal deci-sions in respect of homeopathy are not entirely ethicallyneutral, and concluded that there exists ‘at least a modestduty on individual citizens to reject homeopathy’ (on thegrounds that this would maximise personal health andavoid giving unwarranted credence to ineffective medi-cine). It is thus a distortion – and somewhat absurd –to suggest, as Sebastian does, that my arguments implythat users of homeopathy (including Ghandi) should belabelled as ‘unethical’ persons.

Moreover, the modest duty on individual citizens toreject homeopathy only applies where those concernedpossess reliable knowledge about homeopathy. In thisrespect, it is the prescribers and (true) proponents ofhomeopathy who carry the lion’s share of ethical respon-sibility. By prescribing ineffective medicine and promul-gating falsehoods about homeopathic efficacy, it is theseadvocates, as opposed to the users of homeopathy, whoare guilty of serious unethical behaviour.

CONCLUDING REMARKS

The respondents base the broad thrust of their objectionsto Against Homeopathy on the claims that homeopathyis scientifically plausible and supported by experimentalevidence. I suggest that they have manifestly failed tosubstantiate these claims.

Irving Langmuir used the term ‘pathological science’to describe the process of pseudoscientific investigationinto long-discredited phenomena.6 Examples include

5 http://www.dcscience.net/?p=37 [Accessed 2 Aug 2011]. 6 Langmuir I. Pathological Science. Phys Today 1989; 42(10): 36–48.

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‘research’ into astrology, extrasensory perception (ESP),and flying saucers. In pathological science, the process isdriven by self-delusion. I suggest that homeopathy fitswell with this description.

Given that homeopathy cannot work and does notwork, I suggest that my original utilitarian analysis ofhomeopathy remains valid. Homeopathy is ethicallyunacceptable and ought to be actively rejected by health-care professionals.

Acknowledgements

The author would like to thank the following for valuable comments:David Colquhoun, FRS (University College London), Maurizio Pan-dolfi, MD, David Ramey, DVM, and Wallace Sampson, MD (StanfordUniversity).

Kevin Smith, PhD, lectures at Abertay University, Dundee. His maininterests include medical ethics and the ethics of genetic modification.

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