Homeopathy - the Test

This Horizon programme, first broadcast on BBC2 in November 2002, was something of a mixed blessing.  Although the result of the "test" was comprehensively, unambiguously and predictably negative, for about 40 minutes of the 50-minute programme the presenters kept up an almost X-Files atmosphere of "there must be something in it".  Even at the end, the lasting impression was more that the mechanism of action of homoeopathy was still a mystery, rather than the obvious conclusion that there is no action there in the first place.

Surely nobody involved in the production actually imagined that the BBC's coffers were likely to be augmented by Randi's million bucks?  Surely none of them really believe that water is medicine?  But they chose to take the dramatically easier option, and so missed a golden opportunity to make a really controversial, and really useful, programme in which the lies and misinformation which lie at the heart of this long-running health fraud were properly exposed.

The most pervasive inaccuracy was the repeated assertion that if Professor Ennis's experiment with the ultra-dilute histamine could actually be reproduced (about as likely as the sun rising in the west tomorrow, but never mind), this would prove that homoeopathy is a valid therapeutic methodology.  This is of course not the case, any more than a well-conducted experiment which proved that the more you dilute a sugar solution the less sweet it becomes would prove that insulin is an effective treatment for diabetes.  All Professor Ennis claimed to have shown was that an ultra-dilute solution of histamine was still capable, to some extent, of doing what a normal physiological solution of histamine will do (degranulate basophils).  Alone, that wouldn't go very far to validate homeopathic methods, even if it were true.

Homoeopathy makes a number of startling assertions, all of which would have to be proved before the method might be considered as a valid therapy, and the 'memory' of water is a relatively small part of it.

1. The central tenet of homoeopathy isn't the memory of water, it is 'like cures like' (or similia similibus curantur, as the homoeopaths like to put it).  No homoeopath would admit that the identity of the 'mother tincture' used to start the dilution process is irrelevant - in fact they make quite a performance of the selection of the appropriate remedy.  However, they aren't using ultra-dilute insulin to treat diabetes, or ultra-dilute cortisone to treat arthritis.  They're using ultra-dilute onion to treat colds, and ultra-dilute salt to treat cancer, according to the examples given in the programme.  Where is the faintest experimental justification for that?
    
   
2. Next, homoeopathy doesn't simply assert that some effect remains in ultra-dilute solutions, it asserts that the more you dilute the solution, the more 'potent' it becomes.  Something like a dose-response curve in reverse.  Neither Professor Ennis nor Jacques Benveniste has even attempted to claim to have demonstrated this one!  Of course, they should have tested perhaps the last eight or ten dilutions, and looked to see if the effect was stronger in the more dilute preparations.  But they didn't.
    
   
3. It is also implied that the 'memory' of water is highly selective.  Only the desired therapeutic effect is potentised, while all undesirable and toxic effects disappear.  Actually, it could be argued that the basophil-degranulating property of histamine is a toxic effect - so why might the homoeopaths expect that to be maintained or amplified in an ultra-dilute solution?  (As an aside, this gives the homoeopaths a perfect explanation for the failure of the Horizon test - why have we never heard it propounded?  Maybe because actually thinking about it this clearly exposes the whole thing as complete nonsense?)  In addition, the diluent used must have come in contact with an enormous number of other substances throughout its history.  Why are the effects of these not potentised?  However, nothing in the experimental design tested the claim of selectivity.
    
   
4. We were invited to consider that some effect remained in the water in the absence of any histamine molecules.  However, homoeopathic remedies aren't usually administered in liquid form.  As demonstrated on the programme, the method is to take the 'potentised' water and immerse some lactose pellets in it.  The pellets are then removed and eventually dry out.  As there are no solute molecules left to be deposited in the lactose pill, how is the therapeutic effect transferred from the water to the lactose?
    
   
5. Finally, in what way does the potentised water / lactose actually affect cell metabolism in order to produce the often striking effects claimed by the homoeopaths?

Horizon could have examined these points rationally, but they were completely ignored.

Most of the programme was extremely biassed towards the homoeopathy proponent point of view.  Against only four sceptics (James Randi, Robert Park, Walter Stewart and John Maddox) were ranged no less than seven proponents (Madeleine Ennis, Peter Fisher, Lionel Milgrom, Jacques Benveniste, Marie Smith, Mark Elliott and David Reilly).  The proponents included three medical doctors and one vet, also one patient describing a 'miracle cure'.  However, although the vast majority of the medical and veterinary professions think homoeopathy is a sham and a delusion, and the world is awash with people who found that homoeopathic treatment did nothing at all for their illness, no medical sceptics or uncured patients were interviewed.  This inevitably allowed the impression that homoeopathic cures are a medical fact, and that the problem is simply one of explaining the mode of action.  There was no debate, and the format of the programme allowed the proponents to make extremely misleading and verifiably untrue statements without challenge.

Jacques Benveniste presented himself as an expert in allergy doing reputable research into basophil function.  He was even allowed to state that he was in line for a Nobel Prize for his contribution to this field, which is complete nonsense.  He may have imagined a Nobel Prize for the 'memory of water', if that had turned out to be true, but he was certainly nowhere close to a Nobel Prize in any mainstream discipline.  He then stated that his first encounter with the 'memory of water' principle was when a technician came to him and reported detecting an effect in a homoeopathically-diluted solution.  He feigned extreme surprise, and the belief that this was 'impossible'.

There are a number of version of this story, but the facts seem to be that Benveniste had a technician who was convinced that homoeopathy was effective, and the technician decided to try the histamine experiment currently being run, using a 30C preparation.  He then approached Benveniste, announcing that he'd found a positive result.  The reason for Benveniste's wholesale conversion to belief in this phenomenon is unclear, especially as its pursuit effectively ruined his original career.  However, why were viewers not told that Benveniste received research funding from France's largest manufacturer of homoeopathic medicines (Boiron), who had a clear vested interest in demonstrating some effect of ultra-dilute solutions?  Why was there no mention of his latest discovery, that the memory of water can be recorded digitally and transmitted over the Internet?  Possibly because that's so crackpot that the viewers would have noticed?

[As an aside, it's worth noting that both the accounts of the participants and the video footage of the event demonstrate that the first thing the sceptics did when they visited Benveniste's laboratory was to allow the group to do the experiment in the usual way.  Both James Randi and Walter Stewart agreed that the results on that occasion were clearly positive, even though the sceptics were present and observing the procedure closely.  It was only after the samples had been relabelled to conceal their identity from the technicians, at John Maddox's insistence, that the null result was demonstrated.  Why does this matter?  It matters because one of the 'explanations' for the failure of the experiment which is now floating around is that the sceptics (especially Randi) give off some kind of negative energy which nullifies the effect.  No, it works just fine when the sceptics are present.  It only stops working when they force the experimenters to stop cheating.  And if the 'negative energy' excuse isn't proof that what we're really talking about here is magic, I don't know what is.]

Madeleine Ennis seems to be a genuine scientist who genuinely found something she couldn't explain.  She published her results, but she hasn't ruined her career over it.  What happened in her laboratory?  Why hasn't she tried for Randi's prize herself, or at least invited a third party into the laboratory to see if any explanation can be found for her observations?  This was all very mysterious.

David Reilly was "a conventionally trained doctor who became intrigued by the claims of the homeopaths, and wanted to put homeopathy to the test."  Perhaps viewers were expected to deduce his affiliation from his job title (which appeared on-screen) at the Glasgow Homoeopathic Hospital?  Hardly the most unbiassed assessor.  Close examination of his methodology reveals clear bias in favour of positive effects of homoeopathy.

At this point the question arises as to why the producers chose not to invite Professor Edzard Ernst or one of his colleagues from the University of Exeter to take part in the programme.  This group has recently published a number of well-controlled clinical trials which have resoundingly failed to find any difference between homoeopathic and placebo treatment.  A particularly well-designed investigation of "individualised" homoeopathy (White et al., 2003), was published after the programme was broadcast.  The Exeter work is much more rigorous and reputable than Dr. Reilly's, but it was not even alluded to.

Mark Elliott claimed to have achieved an 80% success rate in treating equine Cushing's disease homoeopathically.  This was actually a reference to a paper he published in the British Homeopathic Journal (Elliott, 2001), which has so much wrong with it that it requires a page all of its own to critique it properly!

There are plenty of veterinary surgeons around who are quite vitriolic about the lack of efficacy of homoeopathic treatments in animals, and who can cite some well-documented facts to back up their opinions.  However, Mark was the only veterinary point of view aired, and he was allowed to assert his beliefs without even the most elementary challenge.

Marie Smith recovered from cancer fifteen years ago.  She had a wide range of scientifically-based medical and surgical procedures, but she attributes her recovery to a homoeopathic preparation of common salt.  This astounding proposition was never subjected to even the slightest scrutiny.  In addition, although many people with serious diseases have tried homoeopathic remedies and experienced no improvement, none of these were interviewed.

Millions of people are spending millions of pounds on homoeopathic consultations, and treatment which quite literally has 'nothing in it'.  When can we expect Horizon to do an honest exposé of this fraud, and allow the rational scientists and physicians to demolish the claims properly - as they so easily could given the slightest opportunity.  Such a programme would be a real public service.

Morag G. Kerr, May 2003.

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