Homeopathic medicine

Arsenicum album 30C (Aa30C) is a homoeopathic medicine and has been prescribed by the AYUSH ministry in India, through its advisory in the context of the Covid-19 pandemic. In section “i. Preventive and prophylactic” and sub-section “Homoeopathy”, it is advised that the recommended dose is, “Arsenicum album 30, daily once in empty stomach for three days”. And that, “The dose should be repeated after one month by following the same schedule till Corona virus infections prevalent in the community”.

Making the medicine

Let us examine for a moment what this homeopathic medicine is. A “mother tincture” of the medicine is made by dissolving by Arsenic Trioxide powder in a mixture of glycerine, alcohol, and water. Alternative methods, such as “heating Arsenic with water” also exist. 1 ml of this tincture is diluted with 99 ml of water plus ethyl alcohol, and given 10 machine-operated, “moderate, equal and successive jerks” (called  “succussions”) . This causes a 100-fold dilution. 1 ml of this resultant solution is further diluted 100-fold (with “succussion”), and when this process is repeated 30 times it produces the final medicine (30C potency). A few drops of this, loaded on sugar pills, is administered to an individual. According to homeopathic principles each dilution actually makes the medicine more potent and the dilution process is often referred to as “potentization”.  Does this make you wonder how much “active material” (Arsenic Trioxide) is available in the final medicine solution?

Medicine concentrations

Let us do a simple calculation. Assume that we added 200 grams of the compound to 1 liter of liquid to make the mother tincture. This gives a concentration of 1 mole/liter (the molecular weight of Arsenic Trioxide is 198; let us round it off to 200). If we do 100-fold dilution once the concentration will become 0.01 mole/liter. If we do this 30 times, the concentration will become 0.01 x 0.01 x 0.01 … i.e. 0.01 written 30 times and this is 1/10^60 mole/liter. Stated in an alternative manner: this 1 mole is now present in 10^60 liters. The volume of the sun is approximately 10^30 liters, so the 200g of the Arsenic Trioxide is now dispersed in a volume equal to that of 1,000,000,000,000,000,000,000,000,000,000 (1 followed by 30 zeros) suns! Alternatively, this is equivalent to 1 molecule of the active material present in a volume equal to that of 1 million suns. Thus, what is being given to an individual contains nothing in terms of the active material.

However, this should not surprise us. Homeopathy was first proposed as an alternate medicinal strategy more than 200 years ago. This was a time when chemistry was not well developed, and the concept of mole (used in above calculations, and what is now in every high school textbook) was not yet discovered. Homeopathy was founded in Germany by Samuel Hahnemann (1755-1843) in an era where orthodox medicine was crude, often involving profuse blood-letting, and medical interventions were surrounded by obtuse debates – incomprehensible to laypersons. Hahnemann explained that homeopathy worked through a “dematerialized spiritual force”. Compared to orthodox practices, it seemed safe, comprehensible, and focused on patients rather than the sickness. Homeopathy practitioners often spent hours talking to their patients about their problems, likes and dislikes, and then choosing the appropriate “medicine” which was supposed to be highly individualized. Indeed, it grew in popularity. Some people have also suggested that there were in-built elements of counselling and therapy in the interaction between the patients and the doctors.

It is hugely ironic that in the contemporary world, where physics, chemistry, physiology and immunology have made numerous strides since Hahnemann’s time, homeopathic principles still evade the rigors of scientific questioning.

From nothingness to water memory

To escape from this fact, homeopathy takes recourse in the notion that water that comes in contact with the active material develops some kind of “molecular memory”. The water that comes in contact with this memory-laden water itself possibly acquires that memory. It is also suggested that “succussion” helps the newly added water, at each dilution, to acquire the “memory”. Therefore, however diluted the “medicine” may be, the water always carries the memory of the original active material. And it is this “memory-laden” water that triggers an “immune” response in the human body. Homoeopathic treatment philosophy is based on the principle of “like cures like” i.e. a substance that induces the symptoms of a disease is what will cure it (“law of similars”). Hence, the substance will also invoke the same “immune” response as the disease does. In fact even the substance is not needed to be present; its “memory” alone, as “implanted” on the water is sufficient. Homeopathic practice also suggests that more “potentization” is because of “succussion”  – the shaking somehow imparts some “structure” to the water. So, as the solutions are diluted further, accompanied by “succussion”, the formulation becomes more “potent”. This is captured in the homoeopathic “principle” “less is more”.

Unfortunately, there is no evidence of any kind of water having any kind of memory. Even the journal “Nature” was touched by this controversy and this should have put an end to these fantastical hypotheses. Any scientific response to such lack of evidence should be rigorous experimentation to demonstrate effects or lack of. However, the actual response to critique of homeopathy often is that “science does not know everything” or “does not know yet”.

It should strike us that if water “remembered” what it touched it should have lots of memories – of all substances it may have encountered in its “life” – from metals, food, biological slime, and a million more. Tim Minchin, the famous Australian comedian, sang, “Water has memory! And while it’s memory of a long lost drop of onion juice seems Infinite; It somehow forgets all the poo it’s had in it!”

Homeopathy is nanomedicine

The quest to explain how homeopathy works has also led to hypotheses which suggest that active material somehow survives in even the most dilute homeopathic medicines. It is proposed that the original active material is present in the form of nanoparticles which cling to tiny bubbles. These bubbles always rise to the top (in between “succussions”). Because the “1 ml”- for dilution – is taken from the top layer, the active material finds its way into even the most ultradilute potency. Several issues remain though. The methodology is not standard for homeopathy “potentization” (top layer use), the physics of bubbles catching the active material is unclear, and there is no information available about control experiments (measuring contaminants in the water and alcohol used).

More importantly, going beyond this hypothesis, even if traces of active material are present, how do they trigger physiology to act against an external agent (like, Sars-CoV-2), remains unknown. It takes years of experimentation for a chemical to be accepted as a medicine. It involves laboratory experiments, animal trials, and human trials over multiple phases – some involving comparisons with control groups, and double-blind studies (in which neither the participants nor the experimenters know who is receiving a particular treatment).  Proponents of homeopathy claim that it cannot be subjected to such trials because the foundation of homeopathy is in providing “highly individualized” dosage. However, the mass spread of Aa30C is anything but individualized.

So what? It just works

Ultimately, a clinician would say, it is Ok if it just works! Most of the popular narrative on homeopathy consists of anecdotal stories and scientific sounding terms like “vital force”, or more contemporary “evoke biphasic actions on living systems via organism-dependent adaptive and endogenously amplified effects”. A layperson often finds “trials” of this type convincing: “1000 people were given medicine XYZ and then 95% did not get the disease, so it works”. They may not have got the infection anyway. So statements like these are worthless unless compared with 1000 people who are given placebos i.e. blank doses. The fact that homeopathy thrives is not proof of efficacy. Just like the existence of tarot readers and astrologers does not prove that these practices have any scientific basis.

An aura of respectability is provided to homeopathy because there are journals, from major journal publishers, that cater to it. Also, portals of the National Institutes of Health (US) and the National Health Services (UK) have some space devoted to “alternative” or “integrative” medicine articles.

No, it does not!

Many reputed institutions have looked at the available literature and their conclusions are unequivocal. Here is what they say:

• National Institutes of Health (NIH, USA): “There’s little evidence to support homeopathy as an effective treatment for any specific health condition.”
• National Health Services (NHS, UK): “There’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.” A report prepared by a committee appointed by the UK parliament called the (UK) government’s position on homeopathy confused. It said that whereas the government accepts that homeopathy is a placebo treatment, it continues to fund homeopathy on the NHS without taking a view on the ethics of providing placebo treatments. The report argued that this undermines the relationship between NHS doctors and their patients, reduces real patient choice and puts patients’ health at risk. It recommended that the government should stop allowing the funding of homeopathy on the NHS. Since 2017 the NHS has severely restricted access to homeopathy, with recent calls to generally blacklist it.
• National Health and Medical Research Council (NHMRC, Australia): After an extensive survey of the literature, in March 2015, the NHMRC concluded, “There was no reliable evidence from research in humansthat homeopathy was effective for treating the range of health conditions considered: no good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment.”

A report in the Indian Express cites the director of the Indian Council of Medical Research (ICMR) director saying, “We have issued no guidelines regarding the medicine.” And the WHO chief scientist comments, “No evidence that it works”.

The WHO (Ebola) advisory

The much quoted statement from the World Health Organization (WHO), sometimes in distorted or incomplete form, in the context of the Ebola outbreak in 2014, said, “In the particular context of the current Ebola outbreak in West Africa, it is ethically acceptable to offer unproven interventions that have shown promising results in the laboratory and in animal models but have not yet been evaluated for safety and efficacy in humans as potential treatment or prevention.” The words in bold, above, are often omitted in public statements, including in the AYUSH ministry advisory.

It was also stated in the same WHO report that, “there is a moral duty to also evaluate these interventions (for treatment or prevention) in the best possible clinical trials under the circumstances in order to definitively prove their safety and efficacy or provide evidence to stop their utilization.” Where are the trials or even tracking of large scale usage of Aa30C? What we have are random, untracked distributions of the “medicine” in various states by NGOs and state agencies.

Dangers of pseudoscience

The problems in pushing such unproven medicines for something as infectious as Covid-19 are many. All the hype and publicity surrounding Aa30C, often emanating from official state agencies themselves, have set the stage for people to desperately chase what they think is a wonder drug. “Clarifications” of the type issued by the AYUSH ministry stating that their recommendation is only “in the general context” or that it is only for “add-on preventive care” is like water off a duck’s back once the hype has been generated. Even the Press Council of India (PCI) sent out a warning asking the media not to publish AYUSH related advertisements to prevent “dissemination of misinformation”. Panic buying of  Aa30C had been reported. News of distributions by various agencies and buyers flocking to pharmacies to buy the “medicine” at inflated prices, continue to pour in.

Because this homeopathic “medicine” is essentially just water plus alcohol, a few drops will do no physical harm. The problem arises because people are likely to believe that by imbibing this “medicine” they have just acquired a shield against the Covid-19 disease. A Mumbai corporator mentions that some people when questioned about their being out during a lockdown said that they had taken Arsenicum album. They believed that they would now be immune to the disease.

Anurag Mehra, Supreet Saini, and Mahesh Tirumkudulu are faculty in the department of Chemical Engineering, IIT Bombay. Views expressed are personal.