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Paracelsus' poison

At the Threshold of Irrelevance: An Overly Dilute Defense of Homoeopathy

I have been reading an attempted defense of homoeopathy that was published recently. There is a lot that is wrong in this alleged defense of homoeopathy (see here for some background), but one thing that caught my eye was a list of drugs that supposedly work at homoeopathic dilution levels.

The list surprised me, as I work with some of the drugs involved. It contains at least one inaccuracy, one logical fallacy and one conceptual misunderstanding.

However, this is an opportunity to give some insight into how drugs work.

But first let me explain the supposed purpose of the table. Homoeopathy as you know operates on two priciples, the alchemical principle that “like cures like” and the use of ultradilute substances.

In principle, homoeopathy is like adding one molecule of sulfuric acid to to 10,000,000,000,000,000,000,000,000,000 molecules of hydrochloride (battery) acid and expecting to get limpid, non acidic water.

Actually, many common homoeopathic dilutions are so extreme that not one molecule of the original material will be present in the remedy.

But not all homoeopathic dilutions are that extreme, in some there is a chance that some molecules may be present.

Let’s set aside the peculiarity of an argument that says “sure most of our remedies have no molecules of the original substance left in it, but some of our weaker remedies (or accessories to the main remedy in which the main ingredient actually isn’t there) do have something in them”, let’s have a look at the table.

That concentration, it doesn’t mean what you think it means.

The table (you have to scroll down a bit) purports to show the concentrations at which several biological substances have a “threshold” effect and their equivalent homoeopathic dilutions.

The first thing that caught my eye was the entry for acetylcholine, the chemical that makes your muscles contract in response to nerve activity (like the restless tapping of your fingers as you think “where is he going with this”).

Acetylcholine is purported in this table to have a threshold effect at 0.0001 picograms per millilitre, equivalent to a homoepathic 16X dilution. Now I use acetylcholine a lot in my research and teaching. The threshold for acetylcholine is quite well known, and it is nowhere near 0.0001 pg per ml. In some sensitive preparations the sensitivity may be as low as 0.1 nanogram per ml, around a million times more concentrated than claimed, mostly it’s higher than that.

However, my overall point is not that the author got something wrong, although it reduces our confidence in his other statements. There are two important conceptual errors underlying the entire table.

One threshold does not rule them all

One is that just because some very potent hormones can have threshold effects in the realm of some of the least extreme homoeopathic dilutions it doesn’t mean that any random substance in homoeopathy will have a physiological effect.

Especially substances like silica, which has no physiological effect, or acetic acid which requires a high concentration to have a physiological effect.

For example, caffeine is present in some homoeopathic sleeping remedies at both 4C and 30C (how do they do that?). A 4C dilution is 0.00000001 gram per millilitre (using the terminology of the table) but the threshold for the action of caffeine is over a hundred times higher: 0.000002 gram per ml. So a 4C dilution of caffeine is not going to do anything, even though there will be some actual caffeine molecules in the remedy.

In some cases we should be glad that the concentrations are very low. Aconite, a potent poison, is present some homoeopathic stress remedies at 9X, which is fortunately too low to poison you. It may be even lower. It’s likely aconite is made from plant material containing aconite rather than pure aconite. So the concentration will be more on the order of 14X or 0.0000000000001 g per millilitre.

Again, the fact that some homoeopathic remedies have small amounts of material in them is no answer to the fact that the majority of remedies at 30X or 30C or greater dilutions are unlikely to have even one molecule of substance in them.

The dose is not enough.

There is another conceptual issue here as well. Remember that the concentrations listed for these hormones are “threshold” effects, the point where we can just detect an effect. These effects are important in understanding the dynamic range of a hormone system, but useless in medication, as they will not cause a therapeutically meaningful response. A “threshold” concentration of insulin which just marginally activates the insulin receptor will not control a diabetics’ glucose levels.

Furthermore, the threshold effects for hormones occur when the cell or tissue is immersed in a solution of the hormone at that concentration (or it’s the concentration in body fluids). But the concentrations of hormones are being compared to the concentrations of homoeopathic solutions in a bottle or in a pill.

Even if you were to take a millilitre of homoeopathic remedy (a very high dose), and if it were perfectly absorbed (very unlikely), and the substance only entered the blood, rather than tissue fluid generally, the concentration of substance will be around 5,000 times smaller in your body. Well below any threshold effects.

As I mentioned earlier, there is a lot wrong with this attempted defense of homoeopathy, but in this one table alone demonstrates fundamental misunderstandings of the action of hormones and the action, absorption and distribution of drugs. Which is not surprising for a system that hasn’t got out of the 19th century.

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