Homeopathy

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Homeopathy is a type of alternative medicine based on the idea that "like cures like", and that dilution increases potency - not only the opposite of what medicine usually observes, but the opposite of common sense too. Compared to other alternative or complementary medicines and practices which date back thousands of years, homeopathy was created only in the late 18th century by German physician Samuel Hahnemann. The current scientific and medical consensus, based on numerous studies and meta-studies, has found that homeopathy has no effect above that of a placebo. The theories behind its supposed efficacy have been completely rejected as quack medicine and pseudoscience.

[edit] Principles and history

Samuel Christian Hahnemann, founder of Homeopathy, purveyor of bollocks.

Homeopathy is fundamentally different from "herbal medicine", with which it is frequently confused. While some "homeopathic" medicines are simply standard herbal supplements labelled as homeopathic, true homeopathic remedies actually contain no active ingredients. The only measurable ingredients are water and/or alcohol,^[2] which is used to "preserve the medicinal power for a long period of time during storage".^[3]

The term "Homeopathy" was coined by a German physician named Christian Friedrich Samuel Hahnemann in the 18th century. He based his ideas on the "Principle of Similars", the concept that "like cures like". His reasoning (if you wish to call it that) was simple: if, in large doses, a product or chemical compound is observed to create symptoms, then in a lower concentration it would remove the symptoms. To treat a disease, a substance that produced similar symptoms, such as fever, would be administered. Hahnemann 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" should not be confused with the concepts used in modern immunology. For instance, when someone is vaccinated to induce immunity, antibodies are produced 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 that a small exposure will generate a clone of memory lymphocytes in a patient that will be more readily available to fight a real infection in later life.

[edit] Dilution and water memory

To demonstrate orders of magnitude, the area of the largest square in this diagram is only 5 orders greater than that of a single pixel. A square that was 10⁶ larger would be just under the size of the average computer screen. By 10¹⁵, it would be 1 square kilometer and by 10²⁰ it would be the surface area of the Earth. 10²⁸ would be a disc the area of the Earth's orbit...^[4] So imagine that one pixel on an image the size of the solar system and we're talking homeopathic dilution.

The following will require a decent grasp of maths and how to use powers and orders of magnitude.

[edit] Succussion: Dilution of the active ingredient

To make their solutions, homeopaths use a ritualized technique of step-wise dilution and shaking, called succussion. This process usually involves taking the "active" ingredient (such as belladonna or similar toxic herb) and diluting it in the ratio of 1 part ingredient and 100 parts water, alcohol or a water/alcohol mix. Mostly, the solvent used in homeopathic dilutions/extractions is a mix of 40% alcohol and 60% water where it is claimed to act as a "preservative", although as the mixtures don't contain anything, it can't really preserve anything.^[5][6]

Each step in the dilution process is the equivalent of putting a couple of drops in something the size of a cola can, although in practice homeopaths will use something smaller so as not to waste too much of their stuff.^[7] The container is then shaken 10 times or whacked against a piece of wood 10 times. The finer points of the ritual don't particularly matter much, all that matters is that succussion isn't just simple, straight-forward dilution but contains a "magical step" which can be used as a claim to separate homeopathic remedies from water - homeopaths apparently hate skeptics and scientists just calling it "dilution". The hitting or shaking process is considered important to homeopaths as it is supposedly the "kinetic energy input" that increases potency. However, this makes little sense as the kinetic input is unregulated and massively variable depending on who is doing the succussion, as well as the size, shape and composition of the container. Therefore, "precisely 10 hits" is a very odd metric for measuring "kinetic input" - you could have the equivalent energy of 8 or 12 hit just by doing it differently to someone else, and presuming you just want to add some energy, it would be just as efficient to use a microwave. The level of energy associated with this sort of shaking or hitting is, of course, very low and will not affect a solution at all - it takes much higher levels of energy to induce any sort effect, such as an increase in rotational or vibrational energy level in the solution (and even more energy to induce a chemical effect). In short, any energy "input" will dissipate almost immediately and the solution will remain unaffected. At most, a shaking process will act to dissolve the molecules present in the atmosphere (nitrogen, oxygen and argon being the most common); but unless the preparation is made using water than has been specifically purged of these gases first, the difference will be very marginal. Originally this process was done by hand, but now it is done by machines.

The ritual of succussion is repeated a particular number of times to create the right level of dilution, a drop is taken from the first container and placed into another container and the process is repeated. Most homeopathic solutions call for this to be done between 30 and 1000 times - the resulting homeopathic "strength" is referred to as 30C to 1000C respectively. Homeopaths usually state that this is the equivalent of "1 part per million"; however, this is a severe overestimate as the product is diluted 100 times for every step in the succussion. This quickly builds up the orders of magnitude and the size of numbers required to think about this for level of dilution. After the first phase, the dilution is 1 part in 100. After the second, it is 1 in 100 × 100 (100²). After the third, it is 1 in 100 × 100 × 100 (100³, or 1 million, so the strength that is guesstimated by homeopaths is reached after a mere 3 succussions!). At the end of a 30C succussion process, the solution is 1 part active ingredient in 1 × 10⁶⁰. The more diluted solutions are alleged to be stronger, in stark opposition to everything that is known about chemistry.

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 very interesting consequences for these remedies when prepared in the real world.

[edit] No active ingredient

A finite quantity of solute, however, can not be infinitely divided due to the finite size of molecules. "1 part product to x parts water" can be thought of as "1 molecule of product to x molecules of water". The finite number of molecules of water is related to Avogadro's number, which is 6.02 × 10²³. Avogadro's number is the number of actual molecules in an amount of substance when its mass in grams equal to its molecular mass, a quantity known to chemists as a mole. This may seem wordy, but it basically means that 18 g of water has the same number of molecules as 2 g of H₂ gas, which is the same number as 103 g of rhodium metal and so on. In the case of water, its molecular mass is 18, so 18 g (and by definition, 18 ml) of water will contain 6.02 × 10²³ molecules. 180 ml will contain 6.02 × 10²⁴ molecules and a litre around 3 × 10²⁵ molecules. Even though there are more molecules of H₂O in a litre of a water than there are litres of water in the Earth's oceans, it is very easy to dilute a substance down so that there should be no trace of the active compound left. Even the least diluted homeopathic solutions do not contain any of the active ingredient. There is a chance that one molecule may be present. So strictly speaking we should talk about the chances of one molecule being present. For the very least dilute homeopathic solutions, there is around a 60% or so chance of one molcule being present. This figure tails off rapidly to practically zero for even slightly higher dilutions. Even taking into account the supposed ideas of aggregation^[8] the dilutions will rid the final remedy of any active ingredient (in fact, aggregation will effectively decrease the concentration of your active ingredient, making it easier to dilute to infinity).

To show this, we imagine 100 ml of water, which contains around 3 × 10²⁴ molecules, and then 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 assume this will be around 1 gram, which would make a 1% w/v mixture. The main chemical in Mandrake's Leaf has a molecular weight similar to a large-ish organic compound, around 400 g mol^-1. Therefore the 100 ml bottle will have around 1/400 of a mole of Mandrake's Leaf - 1.5 x 10²¹ molecules, which is 1/400 of Avagadro's number. After the first dilution, we will have lost 99% of our fictitious^[9] and magical herb, and will be left with only 1.5 x 10¹⁹ molecules of Mandrake's Leaf, which is still quite a lot. A second dilution of 1 into 100 will leave our solution with 1.5 x 10¹⁷. In short, we will be dropping the exponential 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 15, to 0.15. So, at these weak dilutions, our 100 ml container has, on average fuck all of Mandrake's Leaf in 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. A 30C dilution is the equivalent of having one molecule present in a sphere of water with a radius just short of the distance between the Earth and the sun - and higher dilutions become even more difficult to conceptualise. 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 "strongest") homeopathic solutions - when the succussion process is carried out hundreds of times - are much greater than even this massive figure.

[edit] Conflict with Hahnemann

Hahnemann's original homeopathic theory held that the active ingredient was diluted greatly, but it was nonetheless still present in the homeopathic solution. Avogadro's work, which was developed after Hahnemann's invention of homeopathy, clearly 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 10:23 campaign^[10] was designed to highlight this aspect - and particularly the public's misunderstanding of it - by organising a "mass overdose" of homeopathic remedies in January 2010. The lack of any active ingredient and the disapproval of Hahnemann's theory is a blow to homeopathy, but it should be noted that modern homeopaths do not deny this. They will even specifically claim it as an advantage because a solution can't possibly be toxic, being just water with nothing dangerous in it.^[11]

To get around this rather extreme problem, modern homeopathic practitioners developed a claim that the 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, and 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, most of physics and probably a lot of molecular biology too.

[edit] 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.

[edit] Problems with the concept

[edit] 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".

[edit] Water memory

See the main article on 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, yet 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 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 this memory was able to cause pharmacological effects, then any drinking water would be deadly - or a miracle cure if the Principle of Similars was also correct. It would contain the memories of the sewage treatment plant as well as other unsavory places that it had passed through. 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.

Examples of naturally occurring water clusters that are used as "evidence" of water memory. In reality, these clusters are highly fluxional and certainly not dependent on what minerals they were associated with in the past, nor are they affected by knocking the bottle against a piece of wood (succussion), therefore water "memory" is not proved by their existence. These clusters represent small molecules of water in the gas phase, which hardly reflects a system of 10²³ molecules.

[edit] Further claims

Faced with a massive amount 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, fall back 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, or something authoritative in the language of cargo cult science,^[12] 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. Given the theoretical issues discussed above, and the evidence discussed below, this does seem nothing more than an outright admission that homeopathy is in fact 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 has very high expectations of it and is thus is set up to be a very effective placebo, but a placebo nonetheless. This idea is certainly not argued against by skeptics and mainstream medical scientists; homeopathy certainly works better than nothing (at least in some cases) but often anything can work better than nothing, and therefore it isn't particularly interesting or notable.

All a skeptic 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.

[edit] Evidence

Old homeopathic remedies in their bottles. Naturally, there is probably more of the bottle dissolved in the water than the active ingredient

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.

There have been several major investigations into homeopathy some of which include:

• The Lancet, one of the world's premier medical journals, published a meta-analysis on homeopathy in 2005.^[13] This paper examined 110 controlled studies of homeopathy and 110 studies of matched conventional medicine studies. The Lancet study showed that there was NO effect beyond that of a placebo for homeopathy. This massive undertaking examined a large amount of evidence and was systematically - i.e., fairly - constructed and carried out.
• In 2006 European Journal of Cancer showed no effect of homeopathy in a meta-analysis of 6 studies.^[14]
• Even sympathetic researchers have problems. Homeopathic practitioners published a study performed in Honduras in the Journal of Alternative Medicine that showed homeopathy to have no effect treating diarrhea.^[15]

Some published positive evidence for homeopathy does exist and these papers are often cited repeatedly by practitioners.^[16] However, these studies tend to have many methodological flaws and such flaws make the data less reliable. Ineffective blinding (where people may have been aware that they were receiving administering a placebo rather than treatment) has been known to overestimate the efficacy of a treatment under study by 17%. In addition, ineffective randomisation (where the researchers could choose, consciously or unconsciously, who received the treatment and who received the placebo) can overestimate efficacy by around 30-40%. Taking into account the methods used when analyising data is particularly important if the papers don't mention their methods; i.e., they may have something to hide.^[17][18] When taking into account data from flawed experiments and accounting for the flaws, homeopathy still comes out as no more effective than a placebo.^[19]

[edit] 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. Sen. Royal Copeland, 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 patent from 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. 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.).^[20]

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.^[21]

[edit] Additional thoughts

[edit] 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, “succussion” 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.

[edit] Mass production

Some homeopathic remedies come in "pill" form. In this case, not even claims of "water memory" help explain how they work. "Sugar memory," perhaps.

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 test is because each and every single cure must be tailor made to the specific person it is to be used on.^[22] Each ingredient, that amount, the ratio, and the procedure is painstakingly crafted on a person-by-person basis. By even the standards of proponents of homeopathy no mass cure can possibly work.

[edit] Conclusion

“Extraordinary claims require extraordinary evidence”: legitimizing things 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 relative. If you wonder why 30 percent of our society still believes that Iraq was responsible for 9/11 or that over 40 percent still believe that weapons of mass destruction were found, the answer is in issues such as this. One can not stand on the side of facts, truth, and legitimacy in only one area. When “facts” can be abandoned because we don’t like the “feeling” they give us, and lies are swallowed because it makes us feel good, the 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."^[23]

[edit] See also

• Water memory
• Oscillococcinum
• List of scientifically controlled double blind studies which have conclusively demonstrated the efficacy of homeopathy
• Wiki4CAM: Myths about homeopathy
• Purity Products

[edit] External links

• Homeopathy A&E - A quick look at what applying homeopathy to real medicine would look like.
• Scientist seeks ban on homeopathic products.
• Dara O'Briain dissects homeopathy.
• If homepathy works... I'll drink my own piss

[edit] Footnotes

1. ↑ Storm, lyrics - it's hilarious.
2. ↑ To be fair, alcohol is an active ingredient (and possibly the only one) in the cure remedy for "chronic cubicle syndrome". Source: Dilbert the animated Series, Season 1.
3. ↑ Homeopathy World Community - post by Aejaz Husain
4. ↑ Google Calculator is quite good at working this out.
5. ↑ Wiki4CAM - Myths about homeopathy
6. ↑ It should also be noted that drinking distilled water is a bad idea but it's unlikely that homeopaths would use it anyway.
7. ↑ If homepathy works ... I'll drink my own piss - the video shows the process in action and indicates the size of vials relative to the drops used in dilutions.
8. ↑ The Independent - Dilution theory may answer homeopathy riddle
9. ↑ Well, not that fictitious
10. ↑ 10:23.org.uk
11. ↑ Homeopathy at HimaylanHeritage.com - They're actually very open about this sort of thing, but usually fail to mention that this conflicts with the original theory.
12. ↑ A particularly stunning example, almost worthy of an article in itself, can be found in this video
13. ↑ Aijing Shang MDa, Karin Huwiler-Müntener MDa, Linda Nartey MDa, Peter Jüni MDa, b, Stephan Döriga, c, Jonathan AC Sterne PhDb, Daniel Pewsner MDa, d and ProfMatthias Egger MD, The Lancet, Volume 366, Issue 9487, 27 August 2005-2 September 2005, Pages 726-732
14. ↑ Milazzo S, Russell N, Ernst E Efficacy of homeopathic therapy in cancer treatment. Eur J Cancer. 2006 Feb;42(3):282-9.
15. ↑ Jacobs J, Guthrie, B, Montes G, Jacobs L, Colman N, Wilson A, DiGiacomo R. Homeopathic Combination Remedy in the Treatment of Acute Childhood Diarrhea in Honduras. The Journal of Alternative and Complementary Medicine. 2006 Oct;12(8):723-732.
16. ↑ British Homeopathic Association - Here they state that 44% of trials were positive while 7% were negative. Although true, this is misleading as it is the quality of research that is important and the research with positive conclusions tend to be very flawed. The major meta-analyses into homeopathy take this into account.
17. ↑ Kenneth F. Schulz; Iain Chalmers; Richard J. Hayes; Douglas G. Altman - Empirical Evidence of Bias: Dimensions of Methodological Quality Associated With Estimates of Treatment Effects in Controlled Trials. JAMA, Feb 1995; 273: p.408 - 412.
18. ↑ David Moher, Ba' Pham, Alison Jones, Deborah J Cook, Alejandro R Jadad, Michael Moher and others - Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?. The Lancet, Aug 1998; 352, 9128: p.609-613
19. ↑ Science Based Medicine - Fun with homeopaths and meta-analyses of homeopathy trials
20. ↑ FDA-Homeopathy: Real Medicine or Empty Promises?
21. ↑ BBC undercover report on malaria and homeopathy
22. ↑ Actually, this argument is nonsense, you can just switch the remedy at the very last minute without letting either the homeopath or patient know whether they are recieving 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 subconciously indicated to the patient, who is less susceptable to the effect - resulting in a fair trial for both sides. In the best homeopathic studies, this is what has been done.
23. ↑ BBC NEews - The Test - webchat with James Randi.