Academic freedom is sacrosanct in universities. Researchers must be free to pursue their ideas, be they conventional or peculiar. But academic freedom also includes the freedom of others to question those ideas. That is just what we did in a courteous letter addressed to Heather Boon, dean of the Leslie Dan Faculty of Pharmacy at the University of Toronto, which was signed by 90 scientists and physicians from around the world, including two Nobel laureates.
Boon is involved in a study of homeopathic preparations in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children. Those of us who signed the letter, along with the vast majority of the scientific community, believe that numerous studies have concluded that the effects of homeopathy can be attributed to a placebo response. The letter sought Boon’s views on why a faculty of pharmacy was organizing a trial that legitimizes homeopathy, a practice that has no scientific plausibility.
Homeopathy is not an umbrella term for alternative modalities. It is a very specific practice that originated before the dawn of the scientific era when little was known about disease or chemistry. Around the turn of the 19th century, Samuel Hahnemann, a well-meaning German physician, concluded that a substance that causes symptoms in a healthy person cures those symptoms in a sick person if it is sufficiently diluted. Hahnemann’s process involved diluting a substance by a factor of up to 1060, thumping the solution against a leather pillow between dilutions and finally using a drop to impregnate a sugar tablet. The result was a “homeopathic medicine,” the term deriving from the Latin for “similar” and “disease.”
Hahnemann could not have realized at the time that the final solution did not contain a single molecule of the original substance. Today, homeopaths have to contend with chemical knowledge and have proposed that the curative effects are to be explained by the sequential dilutions leaving an imprint on the solution, although they appear to be at a loss to explain how such an image is transferred to a sugar pill or how a molecular ghost can have healing properties.
Stymied by the implausibility of nonexistent molecules having therapeutic potential, homeopaths point to papers in the scientific literature demonstrating a larger than placebo effect, as well as to the millions around the world who use homeopathy with satisfaction. Neither of these is surprising. Toss a hundred coins into the air and count heads and tails. Maybe 45 heads, 55 tails. Maybe 48 tails, 52 heads. But do this a hundred times, and one event may come out 30 heads and 70 tails. If this is the only one reported, the impression would be that the coins were not fairly weighted. So it is with studies of homeopathy. Just by chance alone, some results will indicate efficacy. That’s why we look at all the studies and come to the conclusion that we are looking at a placebo response, which of course is valuable and should not be dismissed.
ADHD is a serious condition that merits serious research. Apparently the University of Toronto researchers carried out a pilot study involving homeopathy that seemed to indicate benefit. That study, however, was unblinded, devoid of randomization, had no control group and relied on a subjective outcome, making any data derived from it essentially meaningless. Even if we were to attach some importance to the claimed reduction of symptoms, the effect was about half of that seen with conventional medication, making the homeopathic treatment clearly inferior. Furthermore the proposed study would use individualized treatments for each subject as determined by a homeopathic consultation, so at best the results would be ambiguous in terms of making any recommendation.
The study is being carried out at a private clinic that also offers ear candling, cranial sacral therapy and “nosodes,” which are homeopathic versions of vaccines. No public funding is involved; support comes from a foundation dedicated to alternative medicine. Nevertheless, one wonders why, with various nutritional and biofeedback treatments with significant potential for helping with ADHD needing exploration, a scientifically insolvent notion is being pursued.
Joe Schwarcz is the director of McGill University’s Office for Science and Society. Read his blog at www.mcgill.ca/oss.