User:Savinien2002/Homeopathy (german)

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Homöopathie ist eine Alternative Medizin, die im späten 18. Jahrhundert von dem deutschen Arzt, Samuel Hahnemann erfunden wurde. Sie baut auf zwei Ideen auf: "Ähnlichen wird von ähnlichem geheilt" ("similia similibus curentur"), was soviel heißt, wie eine Substanz, die Krankheitssymptome hervorbringt, kann eben diese Symptome auch heilen. Außerdem wird angenommen, dass Verdünnung die Wirksamkeit erhöht. Beide Ideen stehen nicht nur im krassen Gegensatz zu dem, was in der Medizin normalerweise beobachtet wird, sie widersprechen auch dem gesunden Menschenverstand.

Homöopathie unterscheidet sich fundamental von Kräutermedizin, mit dem es oft verwechselt wird. Während einige homöopatische Medikamente nur als homöopatisch umgelabelte Kräutermischungen sind, werden echte homöopathische MIttel so stark verdünnt, dass sich kein Wirkstoff mehr in ihnen befindet. Die einzig messbaren Wirkstoffe darin sind Wasser und/oder Alkohol, welches genutzt wird, um "die medizinische Kraft über eine lange Aufbewahrungszeit zu erhalten."

Der wissenschaftliche und medizinische Konsens ist, basierend auf unzähligen Studien und Meta-Studien, dass Homöopathie keine nachweisbar höheren Effekt als Plazebos hat. Während esdeutliche Hinweise gibt, dass konventionelle Medizin eine starke Wirkung in Plazebo-Studien zeigt, die die entsprechenden Hinweise für homöpatische Mizttel nur sehr schwach und die Wirkung nicht vom Plazebo Effekt zu unterscheiden. Einige Aspekte der homöopathischen Behandlung, wie ausführliche "Beweise" und eins zu eins Konsultationen, können die Erwartungen der Patienten erhöhen und somit die Homöopathie zu einen ausgesprochen "überzeugenden" Plazebo machen - aber es bleibt dennoch weiterhin nur ein Plazebo. Die Theorien hinter dieser vermeintlichen Wirksamkeit würde, wenn Sie war wäre, viele Konzepte der modernen Chemie, Biologie und Physik über den Haufen werfen.

Grundsätze und Geschichte
"Wenn Homöopathie wahr ist, dann hat das verklappen von Osama bin Ladens Leiche im Ozean die Welt gerade vom Terrorismus geheilt"

The term "homeopathy" was coined by a German physician named Christian Friedrich Samuel Hahnemann in the 1700s. He based his ideas on the "Principle of Similars," the concept that "like cures like." His reasoning was simple: if, in large doses, a substance creates symptoms, then in a lower concentration it will remove those symptoms. Hahnemann's homeopathic theory held that the more diluted a solution of such a substance is, the more effective it is at removing the symptoms it would otherwise cause. Since many of the original homeopathic compounds were based on potent toxins, this is fortunate.

"Like cures like" has no scientific basis and should not be confused with concepts of modern immunology. For instance, vaccination causes production of antibodies against the specific infectious agent, which is introduced in a less potent or disabled form and in a measurable concentration. Vaccines require an enormous amount of testing to prove efficacy and, most importantly, safety. They involve relatively large numbers of molecules or infectious agents and have a proven mechanism of action — namely, a small exposure generates a clone of memory lymphocytes that will be available to fight a real infection later. The mechanics of how vaccines work is well understood, observable, and scientifically testable. There is no similar evidence or even plausible hypothesis for "like cures like."

Homeopathy originated before medicine established germ theory, and before it had even dispatched the idea of humors. Hahnemann's patients fared better than those of his contemporaries because the pre-scientific treatments of that era carried incredible risk to patients, often more so than the diseases they were meant to treat. Thus his inert "remedies" reduced patients' risks to those of the disease itself, rather than adding even more risks from the primitive treatments of his day.

Potentization: dilution of the active ingredient
Homeopaths prepare their remedies using a ritualized technique of step-wise dilution and shaking, called potentization. First the "active" ingredient is selected, such as belladonna or a similar toxic herb, gonorrheal discharge (yes, you read that correctly ), and more recently, water. The ingredient is then repeatedly diluted, most often in the ratio of 1 part ingredient to 100 parts solvent. The most common solvent is a mix of 40% alcohol and 60% water that is claimed to act as a "preservative," although as the mixtures don't contain anything, it can't really preserve anything. Thus, liquid homeopathic remedies are most commonly about 80-proof grain alcohol, which puts them roughly equivalent to vodka. That happy feeling is not the homeopathic medicine working, it's the alcohol kicking in.

Each step in the dilution process is the equivalent of putting about half a teaspoon in something the size of a soda can, although in practice homeopaths will use something smaller so as not to waste too much of their stuff. The container is then shaken 10 times or whacked against a piece of wood 10 times, a procedure homeopaths call succussion. The finer points of the ritual don't particularly matter. What matters is that potentization isn't just simple, straight-forward dilution but contains the "magical step" of succussion that supposedly distinguishes homeopathic remedies from water. Homeopaths hate it when scientists and other rational people refer to potentization simply as "dilution," so naturally we will continue to call it dilution.

The ritual

 * Note: The following will require a decent grasp of mathematics and how to use powers and orders of magnitude. If you're not comfortable with such things, you can skip down to the subsection Conflict with Hahnemann.

Homeopaths consider the succussion step important as it is supposedly the "kinetic energy input" that increases potency. However, this makes little sense as the procedure is extremely variable depending on who is doing it, the size, shape and composition of the container, the object it is struck against, and so on. "Precisely 10 hits" is a strange metric for kinetic energy - you could have the equivalent energy of 5 or 12 or 20 hits just by doing it differently to someone else. The level of energy associated with this sort of shaking or hitting is very low and will not affect the solution at all. At most a shaking process will act to dissolve molecules present in the atmosphere, but unless the preparation is made using water that has been specifically purged of these gases the difference will be marginal. In any event the dissolved gases will return to equilibrium with the overlying air within a few minutes.

Given that the "magic whacking bit" of succussion doesn't have a mechanism to affect the solution, there remains only one obvious reason for the process – as a homeopathic escape hatch. It lets homeopaths pick holes in scientific studies of homeopathy so they can reject any negative conclusions. Was it done exactly 10 times? Was it done at the right angle? Was it in the right shaped jar? If not, then the test is flawed and magic homeopathy still works - although homeopaths are rarely this picky when it comes to positive results.

Originally this process was done by hand but now it is done by machines. While this makes the "kinetic input" more consistent it doesn't lend any credibility to the idea that "potentization" differs from simple dilution, with or without a bit of shaking.

The ritual of potentization is repeated a particular number of times to create the right level of dilution. Most homeopathic solutions call for this to be done between 30 and 1000 times, with the resulting homeopathic "strength" referred to as 30C to 1000C respectively ("C" refers to a dilution of 1/100). This quickly builds up the orders of magnitude and the size of numbers required to think about each level of dilution. After the first phase the dilution is 1 part in 100 (in scientific notation, 1 part in 102). After the second it is 1 in 100 × 100 (104). After the third it is 1 in 100 × 100 × 100 (106 or 1 million) and so on, with the exponent increasing by two with each step. Thus at the end of a 30C potentization the solution is 1 part active ingredient in 1060 - a long way from the one part per million that homeopaths claim, but of course the magic of homeopathy allows it to transcend basic arithmetic. Thus, this dilution is actually one part per novendecillion. The more diluted solutions are alleged to be stronger, in stark opposition to everything known about the real world.

Summary: If all the superscript numbers were a bit abstract we can add the zeros back in for demonstration purposes; in the least diluted homoeopathic solutions normally available (30C), the active ingredient is diluted in a ratio of: "1:1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000." Powerful stuff indeed. This is very dilute, and as we shall see, it has interesting consequences for these remedies when prepared in the real world. A 1000C solution's ratio is astronomically larger than even the number above.

No active ingredient
A finite quantity of solute cannot be infinitely divided. This is because molecules themselves cannot be divided - once we dilute to the last few molecules of solute, further dilution gives a decreasing likelihood that the resulting solution will contain even one molecule of the solute.

We can think of "1 part product to X parts water" as "1 molecule of product to X molecules of water." We can figure out the number of molecules using Avogadro's number (6.02 × 1023), which is the number of molecules contained in a mass in grams of the substance equal to its molecular mass. Since water has a molecular mass of 18, this means there are 6.02 × 1023 molecules of water in 18 grams of water. Likewise there are 6.02 × 1023 molecules in 2 grams of hydrogen (H2), 4 grams of helium, and so on. Chemists call this amount of any given substance a mole.

''It’s a miracle! Take physics and bin it! Water has memory! And while its memory of a long lost drop of onion juice is Infinite It somehow forgets all the poo it’s had in it!''

A little arithmetic tells us that even the lowest commonly used homeopathic dilutions do not contain any of the active ingredient. Let's begin with 100 ml of water, to which we add 1 ml of an active ingredient. We shall call it something nice and homeopathy-sounding, like "Mandrake's Leaf." For the sake of argument we'll assume this is about 1 gram, which would make a 1% weight/volume mixture. We'll also assume the main chemical in Mandrake's Leaf has a molecular weight similar to a largish organic compound, say 300 grams per mole. Therefore the 100 ml bottle has 1/300 of a mole of Mandrake's Leaf and the corresponding number of molecules is 1/300 of Avogadro's number, or about 2 x 1021.

After the first dilution with a ratio of 1 to 100 we will have lost 99% of our fictitious magical herb, leaving 2 x 1019 molecules in the solution. A second dilution of 1 into 100 leaves us with 2 x 1017 molecules, a third with 2 x 1015 molecules, and so on. In short, we decrease the exponent by two for each dilution. This leads to an interesting consequence between the 10th and 11th dilution step - the number of molecules present in the entire solution drops from 20 to 0.2. But there's no such thing as 0.2 of a molecule. So even at these homeopathically "weak" dilutions our 100 ml container has, in technical terms, zilch, zippo, nada Mandrake's Leaf left in it. Hahnemann didn't know this because Dalton, Avogadro, and others had not yet laid the foundations of atomic theory. Modern homeopaths don't have this excuse - and as discussed below, don't deny it and even embrace it.

Calculating the container size necessary for a homeopathic solution to contain just one molecule of active ingredient can be an entertaining and illustrative exercise, and the basic outline is shown in the table below. A 30C dilution is the equivalent of having one molecule present in a sphere of water with a diameter just short of the distance between the Earth and the Sun - and higher dilutions become even more difficult to conceptualize. The number of atoms in the observable universe is estimated at approximately 1 × 1080, and the orders of magnitude associated with the most dilute (the supposedly "strongest") homeopathic solutions - when the potentization process is carried out hundreds of times - are much greater than even this massive figure.



Purity of water
ISO 3696 is a standard for laboratory water. The purest grade of water under ISO 3696 is 10 parts per billion impurity - 10 x 10-9. That is equivalent to a homeopathic dilution of 4C. So every remedy beyond 4C prepared with water of this purity would be entirely random. Actually, homeopaths do not use water of that purity; it can't be stored in glass vessels due to leaching of surface impurities and those using it have to wash their glassware in hydrofluoric acid before use, which dissolves the partially oxidized top layer of glass. Homeopaths usually use double distilled water, which is substantially less pure.

Conflict with Hahnemann
Hahnemann's original theory held that no matter how greatly the active ingredient was diluted it was still present in some amount. Avogadro's work, which was developed after Hahnemann's invention of homeopathy, showed that this claim was false and that - even in some of the lowest dilutions offered - the active ingredient is not present in the final remedy. The recent 10:23 campaign was designed to highlight this aspect - and particularly the public's misunderstanding of it - by organizing a "mass overdose" of homeopathic remedies. In a sane world the lack of any active ingredient and the disproving of Hahnemann's theory would be a serious blow to homeopathy. But modern homeopaths claim this as an advantage because a solution can't possibly be toxic, being just water with nothing dangerous in it.

To get around this rather extreme problem, modern homeopaths invented the idea that water has a "memory." In this claim, the succussion procedure supposedly imparts the "memory" of the chemical placed in it (importantly, only the intended active ingredient) to the water. It is this memory that allegedly cures the patient - be glad sewage processing plants don't do this by accident! If true, this "memory of water" claim would overturn all of modern chemistry as well as most of physics and molecular biology. (And given the history of every drop of water we drink, probably a lot of stomachs too.)

A further complication in this "water memory" belief system is the fact that many homeopathic remedies are sold in dry pill or tablet form so there is not even the "memory of water" to vouch for the supposed efficacy of the diluted "medicine."

Conclusion to the procedure
In short, although the solution has been diluted beyond any possibility of detection, the little magic taps which comprise the "succussion" procedure change all known laws of physics and turn the substance into a "medicine." It's obvious, really.

Principle of Similars
The "Principle of Similars" - even though it can trace its roots back to ancient Greece - is completely made up with no supporting evidence. Basically, Hahnemann just decided that this was the case one day.

It may, however, have been inspired by the observation that a particular malaria cure induced malaria-like symptoms in healthy patients, and other treatments sometimes exhibit this quirk of causing symptoms while curing or providing immunity. Radiation therapy is used to treat cancer caused by radiation (although melanoma, which is commonly caused by radiation, is radio-resistant) and antivenin is derived from venom, although it should be noted that antivenin is not simply venom; it contains the antibodies produced by the immune response (of other animals) to such venom. Similarly, the original smallpox vaccine involved infecting someone with cowpox, inducing symptoms similar to - but not near as deadly as - smallpox. Despite these very specific and quite interesting observations, there is no theoretical reason or supporting evidence to conclude that this can be expanded to a general rule like the "Principle of Similars." In addition, in all of these examples, the treatments have been subject to rigorous scientific study to determine their safety and effectiveness. Oncologists don't just throw cancer patients into a nuclear reactor and hope for the best.

Water memory
Given the level of dilution of homeopathic solutions, there is no plausible scientific explanation for their effectiveness beyond the placebo effect. The idea of "water memory" has been proposed by practitioners, but it is barely even explained what it actually is, let alone demonstrated. There have been a few misinterpretations of scientific papers which study water at the molecular level, however. In this research, water dimers and clusters joined by hydrogen bonds have been observed, but only under certain conditions and they certainly don't convey the complexity required to form a "cure" of any kind. When present, active ingredients certainly do cause water to form solvent shells around the molecules; taking into account this property of water and including it in models is a fundamental part of understanding chemical reactions and their rates. Even considering these properties of water and its ability to interact with itself and other compounds, no ability for the water to "remember" what was placed in it has been observed or is considered to be possible. Certainly the known intermolecular forces between molecules of water (van der Waals forces and particularly electrostatic hydrogen bonding) are of such low energy that any apparent "structure" in bulk water would last for mere picoseconds.

If water were to retain a memory of the chemicals it has been exposed to, and if this memory were able to cause pharmacological effects, then any drinking water would be deadly (and/or a miracle cure if the Principle of Similars were also correct). It would contain the memories of all the unsavory places that it had passed through - guts, swamps, sewers, and so on. Even assuming that it is the succussion process that imparts memory to the water, at the dilutions that homeopathic remedies work at any impurities, such as salts which are found in all water, would also have their presence imprinted on the water. Even distilled and deionized water and high purity alcohol used by chemists aren't pure to these parts per nonillion levels.



Adam Jacobs, Director of Dianthus Medical Limited, said, "The laws of chemistry and physics, as we understand them, say that homoeopathy cannot possibly work any better than a placebo if a treatment has been diluted to the point where none of the original molecules remain." Furthermore, a letter in Nature shows this memory claim to be bogus science.

Further claims
Faced with a massive number of problems with homeopathy being able to act as a medicine in any way, shape or form, homeopaths and alternative medicine fans do have one, very intriguing, fallback explanation. This is a claim that most alternative medicine can rely on in the face of evidence and implausibility of their explanations: that the substance itself is not actually a medicine. The full explanation of this is sometimes dressed up in fancy New Age terminology, often using the conveniently vague concept of "energy" that New Agers are so fond of, or something authoritative in the language of cargo cult science. But it essentially comes down to the idea that "homeopathy promotes the body's natural response, helping the body make itself better," an interesting explanation at the very least most. Given the theoretical issues discussed above, and the evidence discussed below, this does seem nothing more than an outright admission that homeopathy is just a placebo.

After all, a placebo is not a medicine - great pains are taken when using a placebo-control treatment during trials to make sure that they are not pharmacologically active - but we still see some effect regardless, almost like magic. However, it is not magic. A placebo works in numerous and very complex ways, and although the saline injection or sugar pill doesn't directly "promote the body's natural response," the sense of well-being, the positive thinking and the patient's attitude to their life associated with receiving a treatment of some kind certainly can, and indeed does. Given the woo explanations, the charisma of alternative medicine poster-boys, the expense of treatment and the personal consultations with practitioners, homeopathy generates very high expectations for its success and thus is set up to be a very effective placebo, but a placebo nonetheless. This idea is not disputed by medical scientists; homeopathy can work better than nothing (at least in some cases) but given the wide variety of things that could potentially work better than nothing, this isn't particularly interesting or notable.

All a scientist or medical doctor wants to know about homeopathy is "is it better than a similarly administered placebo?" This question will be discussed in the next section.

Evidence


Given the above, we should be very suspicious of homeopathy. The concept does seem to be impossible; a priori and even by its own admission, homeopathic medicine isn't a straightforward medical treatment. However, that does not mean we should totally discount it without investigating it. If a medical treatment works, then it doesn't matter if the theory is not well understood - and many modern medical treatments are approved with rather poor knowledge of how they work.

Initially, homeopathy was very successful in apparently treating illnesses - and this fact is still trotted out quite readily today, a century or so later. In the 18th and 19th centuries, homeopathy was almost miraculous and really did have the figures to prove it. During one of the 19th century's many cholera epidemics, it was observed that the hospital practicing homeopathy in London was having a far, far lower death rate than the more conventional hospitals in the area, a staggering score against the conventional medicine of the time, indeed. This remarkable success of the practice, however, can be retroactively explained by looking at the conventional treatments of the time and what exactly was going on in the other hospitals. As medical trials always compare a new treatment to the "best available" intervention, it's best to turn the question on its head and ask not "why was homeopathy causing fewer deaths?" and ask instead "why was the conventional hospital causing more deaths?"

When homeopathy was first developed, the "best available" conventional medical treatments often involved administering what are now known to be deadly poisons, bloodletting, or many other practices that were often far more dangerous than the illness they were meant to treat. Using our current knowledge of how poor those practices were, it's quite obvious that just administering pure water or sugar and essentially doing nothing may well be the better medical intervention in the case of cholera - many people just get better on their own and recover, but they have much less chance of doing so if they receive a "treatment" that could kill them first. This is still occasionally the case today when the side-effects or risks of a medical intervention, such as risky surgery on or around a vital organ, outweigh the risks of leaving an illness alone. However, medical science has since moved on from opening up veins to balance the humeurs, and now we can compare homeopathy to proven and effective treatments or a simple placebo, which would be water without all the fancy succussion business as described above. With respect to this, homeopathy invariably fails as a treatment.

Homeopathy and the Food and Drug Administration
The 1938 Food, Drug, and Cosmetic Act established the rules for FDA regulation of drugs in the United States. Senator a practicing homeopath, wrote in a specific clause that said homeopathy was a drug and would be regulated by the FDA as such, but with many exceptions. Homeopaths do not have to apply for a New Drug Application with the FDA for new solutions nor do they have to provide any information about their efficacy or safety. They do not have to test them at all. They do not even have to display the Quack Miranda warning that dietary supplements do. The only regulation the FDA has over homeopathy is to make sure the manufacturing produces a safe product (no arsenic leaking into the bottles on the production plant floor, etc.).

Practicing homeopaths and companies that produce these products often make misleading claims about FDA approval. When a homeopathic product claims to be FDA approved for the treatment of a particular disease it only means that the FDA believes that the product will not kill you if you take it, not that it has any efficacy against that disease.

Homeopathic products are not allowed to claim that they can cure diseases that are not "transitory" in nature. Homeopathic products can only be marketed for such things as coughs, fevers, pains, etc. Any claims made about things like cancer, AIDS, asthma, STDs or other chronic or long term illnesses violate FDA standards. Several homeopathic companies have been fined in the past for making these claims, but most do not overtly make these claims. Instead, products are sold for more general ailments like "liver problems" rather than hepatitis. Another way of sneaking this in is by hired sales people making the claims in one-on-one sessions with patients, where it is usually difficult to prove such wrongdoing. One example of this is in England where homeopathic consultants were advising patients to take their products for malaria.

In June 2010, the FDA sent a warning letter to Wisconsin-based "Homeopathy for Health" saying that it was falsely advertising homeopathic products that claimed they could treat the H1N1 virus. The letter included nearly twenty products from six different manufacturers, all of which were claimed by the seller to directly treat viral infections following the 2009 swine flu outbreak. The manufacturers were also notified with the same letter, as the FDA notes that manufacturers may not necessarily make the same claims as online retailers. The FDA's list of fraudulent treatments for H1N1 infections has 185 entries.

UK Parliamentary Science and Technology Select Committee
In early 2010, the UK's Parliamentary Science and Technology Select Committee published a report into homeopathy and whether it should be funded by the government as part of the National Health Service. They concluded that, basically, "homeopathy's rubbish and should be defunded."

Overall conclusion By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products.

The following are some of the notable extracts from the report (there are 275 pages in total - Note: page numbers refer to the PDF pages, not the report pages): What is homeopathy? 9. Homeopathy is a 200-year old system of medicine that seeks to treat patients with highly diluted substances that are administered orally. Homeopathy is based on two principles: “like-cures-like” whereby a substance that causes a symptom is used in diluted form to treat the same symptom in illness and “ultra-dilution” whereby the more dilute a substance the more potent it is (this is aided by a specific method of shaking the solutions, termed “succussion”). It is claimed that homeopathy works by stimulating the body’s self-healing mechanisms.

10. Homeopathic products should not be confused with herbal remedies. Some homeopathic products are derived from herbal active ingredients, but the important distinction is that homeopathic products are extremely diluted and administered according to specific principles. 14. In June 2009 the Guardian reported that the NHS had spent £12 million on homeopathy in the period 2005–08.16 According to the Society of Homeopaths, the NHS spends £4 million on homeopathy annually. It appears that these figures do not include maintenance and running costs of the homeopathic hospitals or the £20 million spent on refurbishing the Royal London Homeopathic Hospital between 2002 and 2005. 47. Our expectations of the evidence base relevant to government policies on the provision of homeopathy are straightforward. We would expect the Government to have a view on the efficacy of homeopathy so as to inform its policy on the NHS funding and provision of homeopathy. Such a view should be based on the best available evidence, that is, rigorous randomised controlled trials and meta-analyses and systematic reviews of RCTs. If the effects of homeopathy can be primarily attributed to the placebo effect, we would expect the Government to have a view on the ethics of prescribing placebos. 49. There appear to be two main concerns. The first is the principle of like-cures-like and the second is about how ultra-dilutions could retain characteristics of the active ingredient. 54. We conclude that the principle of like-cures-like is theoretically weak. It fails to provide a credible physiological mode of action for homeopathic products. We note that this is the settled view of medical science 70. In our view, the systematic reviews and meta-analyses conclusively demonstrate that homeopathic products perform no better than placebos.

And: 77. There has been enough testing of homeopathy and plenty of evidence showing that it is not efficacious.

UK "NHS Choices"
The relevant page of the government website "NHS Choices" was radically amended after it was revealed that a (now defunct) charity set up by Prince Charles had lobbied on behalf of homeopathy. It now states:

There has been extensive investigation of the effectiveness of homeopathy. There is no good-quality evidence that homeopathy is effective as a treatment for any health condition.

Real evidence?
Are there any examples that show an effect of homeopathy? The answer to this question is a little complicated, but essentially, no. The only studies that show an effect are studies that do not use a double-blind control. This makes them worthless, but homeopathic practitioners claim it is the only way.

Here is an interesting fact: the James Randi Education Foundation has a $1 million prize for anyone who can demonstrate certain “supernatural” powers (and, make no mistake, “potentization” is definitely a supernatural claim). This prize is open to any homeopath who thinks they can demonstrate an effect. A few small-time practitioners have attempted to do this, but all have failed. What is more interesting is no major “homeopathic” producer has bothered to pursue it, despite many attempts by the foundation to get them to try. These producers would not only get the money but instant free press and fame. One should ask why they refuse to put their products to the test.

"Inactive" ingredients
Though homeopathy is pseudoscience, it is possible for certain homeopathic products to be effective. How is this possible, you ask? Well, homeopathic remedies are frequently just water, but they can also come in tablet and cream form. These tablets and creams consist of a base to which homeopathic water is added, and this base often contains actual medicinal substances, which are nevertheless listed under "nonmedicinal ingredients." A "homeopathic" cream for acne may contain tea tree oil, which is a potent antimicrobial. Homeopathic teething tablets are usually made of lactose and sucrose — when a baby stops crying after taking a teething tablet, it's because the remedy is literally made of milk and sugar, not because it has magic water in it. The practice of adding medicinal ingredients to homeopathic remedies is similar, though less dangerous, to that of adulterating herbal products with drugs to make them seem effective.

Placebo effect
It is undeniable that homeopathy works... at least for a given value of "works," and this is via the placebo effect. This is the effect by which something that is clinically inactive can still produce positive results because of various factors, from positive thinking (i.e., mind over matter) to suppressing people's symptoms mentally and making them feel better about the situation. This is known as a complex intervention because it is rarely a straightforward thing to quantify; different people will experience different effects. In the case of homeopathy, it is most effective when homeopaths give time and attention to their patients, in contrast to overworked general practitioners who may give a quick exam and write a prescription for a course of painkillers (many of which are enhanced by some form of the placebo effect anyway). This is the factor that gives homeopathy its apparent power to treat simple illnesses or maladies - but not "real" diseases like malaria or cancer. However, this is not the same as "efficacy." To justify the claims of homeopaths and alternative medicine advocates that there is more than just a placebo effect occurring, what needs to be tested is just the homeopathic remedy on its own without all the extra bells and whistles, sometimes referred to as "clinical homeopathy." In all respects, homeopathic remedies fail this.

Although the placebo workings of homeopathic treatments aren't denied, the use of the placebo effect in treating patients is considered ethically dubious due to the deceit involved, as well as potential risks to a patient should they be suffering from an illness that cannot be remedied by placebo alone. Homeopathic remedies, being just water, cannot actively harm patients, but there are many indirect risks, some of them quite considerable, such as patients' increasing distrust in conventional evidence-based medicine, or the misdirection of funds by professional organisations that promote it.

Mass production
Finally, here is the most important point for “mass production” homeopathic remedies, the kinds produced in factories. Let’s ignore all of the problems with the basic foundations of homeopathy, let’s ignore all of the mountains of evidence showing zero effect of the “cures,” let's ignore the refusal of all the major proponents to be put to the test, and let’s, for the sake of argument, assume that there is something to homeopathy.

Even if this is the case then mass-produced cures will not work. This is the absolute basic rule of homeopathy. The reason that proponents say that you can not use double-blind tests is because each and every single cure must be tailor-made to the specific person it is to be used on: each ingredient, the amount, the ratio, and the procedure is painstakingly crafted on a person-by-person basis. A way to test this claim is to switch the remedy at the very last minute without letting either the homeopath or patient know whether they are receiving a prepared remedy or tap water. This would preserve the psychology of the placebo effect — where if the doctor knows that they're giving a sugar pill, this information is subconsciously indicated to the patient, who is less susceptible to the effect — resulting in a fair trial for both sides. In the best homeopathic studies, this is what has been done, and the results have come out the same for the switch-outs as for the control group. So even by the standards of proponents of homeopathy no mass-produced cure can possibly work.

Conclusion
Legitimizing quack medicines and beliefs like homeopathy, and ignoring basic concepts such as skepticism and the scientific method, is a very dangerous thing. It encourages a culture where facts are, ultimately, relative and subsequently objective evidence is meaningless. If you wonder why 30 percent of Americans still believe that Iraq was responsible for 9/11 or why over 40 percent still believe that weapons of mass destruction were found there, the answer is in issues such as this. One cannot stand on the side of facts, truth, and legitimacy in only one area, or choose to exclude them arbitrarily from just one area. When “facts” can be abandoned because we don’t like the “feeling” they give us, and lies are swallowed because they make us feel good, the bad results should be obvious to any educated person.

Homeopaths may find criticism of their practices blunted if James Randi finally manages to overdose on homeopathic remedies. Randi commented, "I did this before a meeting of the US Congress - which if that doesn't put you to sleep, nothing will."