Poison for pain, the homeopathic way

At my local mega-grocery store last weekend, I happened to stroll down the aisle dedicated to homeopathic treatments.  I saw shelf after shelf of brightly colored packages, all claiming health benefits.  Most of these "medicines" were not cheap.

Amazing.  To an average shopper, all of these products look like real medicine.  The packaging is similar, the claims are similar, and it's all on display at a respectable grocery store.  The difference, though, is that none of these products do what they claim to do.  Thanks to a special exception for homeopathy created all the way back in 1938, none of the claims on these medicines need to be tested.  The homeopathy aisle is an organized, state-sanctioned scam.

The 1938 law was the brain child of a U.S. senator, Royal Copeland, who happened to be a homeopath.  Sen. Copeland inserted language into a major food and drug law that declared homeopathic preparations to be drugs.  It also allowed homeopaths themselves to maintain the official list of these drugs, called the Homeopathic Pharmacopeia.  Talk about the fox guarding the henhouse!  Thanks to aggressive lobbying by homeopaths, homeopathic ingredients are not subject to the normal review required of real drugs.  Most importantly, homeopathic drug makers do not have to prove their products are effective.

Homeopathy is based on the long-discredited beliefs of Samuel Hahnemann 200 years ago.  Hahnemann thought that "like cures like," as long as you dilute the substance sufficiently.  Thus caffeine will cure sleeplessness, poison ivy extract will cure an itch, and paralyzing plant toxins will cure pain.  None of this is true.

The other key principle of homeopathy is that the more you dilute something, the stronger its effect.  This is not only wrong, but it is exactly the opposite of what really happens.  Greater dosage levels, unsurprisingly, have stronger effects.  In Hahnemann's defense, science wasn't very far along when he came up with these notions.

Real medicine moved on long ago.  But homeopathy persists, because there is money to be made - lots of money.

Back to my grocery store.  Several shelves were filled with something called Topricin(R), which claims to relieve pain. Sounds like a medicine, right? Real drugs often use "cin" or "in" in their names because the word "medicine" itself ends with that sound.  Clever!  In front of me I saw Topricin for pain, Topricin foot cream, even Topricin for children. The Topricin packages and the company's website proclaim, in big letters, "Ideal Pain Relief", and in slightly less big letters: "Safe.  Effective. Free of Side Effects."  It also claims:

"Topricin's 11 homeopathic medicines are proven to be safe and effective for the elderly, pregnant, children, pregnant women and all skin types.  Experience Topricin's relief for damaged muscle, tendon, ligament, and nerve tissue."

This is simply not true.  It even seems to go beyond the bounds of what the (very weak) FDA regulations allow.  The website specifically claims that Topricin is effective for arthritis, back pain, bruises, bursitis, fibromyalgia, minor burns, tendinitis, and more.

Well, what is it?  Let's look at just two of the homeopathic ingredients in Topricin:

• Belladonna 6X................. Treats muscles spasms, night leg cramps
• Heloderma 8X................. Relief of burning pain in the hands and feet

Belladonna for pain?  Belladonna is one of the most toxic plants known to man.  Eating just a few small berries is lethal.  And the one study I could find showed that it has no clinical effect when used in a homeopathic preparation.  That's lucky for unwitting consumers: if it wasn't so diluted, Belladonna would make them very sick indeed.

Heloderma?  That's the venom from a gila monster.  Although rarely fatal, it causes severe pain, bleeding, nausea, and vomiting.  This is not something I would take for pain - and I certainly would never give it to children.

I know that Big Pharma is often guilty of deceptive marketing, and I've criticized Pharma many times.  But CAM ("complementary and alternative") pharma is every bit as bad.  Big CAM takes advantage of generous laws to make medical claims with impunity, often skirting as close as possible to what the law permits.  And the Big CAM companies profit handsomely in the process.  Everything on the Topricin package - the name, the packaging, the claims - is designed to make the consumer think that it is an effective pain treatment.  It's not.  It's a modern package of snake oil.

Everything in this journal is wrong

Moxibustion at work.

In real science, we agonize over every detail.  When we publish a paper, we strive to get everything just right.  We qualify our findings, always allowing for the possibility that we might have missed something.

Oh, to be freed of the constraints of reality.  But fiction, alas, doesn't work in the real world.  Fantasy medicine is, well, a fantasy.  Or is it?  Let's enter the world of Complementary and Alternative Medicine.

Imagine a scientific journal in which every single article was wrong.  Not just an occasional mistake, as happens with many journals.  No, I'm talking about a publication where every single article has at least one fundamental flaw.

No, it's a real journal, published by BMJ, the publishers of the well-known journal by the same name (the British Medical Journal).  "Helping doctors make better decisions since 1840", they proclaim.  Then why, among their 40+ journals, do they publish Acupuncture in Medicine?

It appears - I can't prove this, but it seems to be so - that every single article in this journal is wrong.  Not just a little bit wrong, either.  Let's look at the "Editor's choice" article from the latest issue, which must be one of their best.  It's called "Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial".

In this study, a group of Spanish doctors looked at the use of moxibustion to correct a common problem in pregnancy known as a breech position - that's a baby that is turned the wrong way round in the mother, head up instead of down.  What, you may ask, is moxibustion?  Well, let me use the authors' explanation:

"The application of heat from the combustion of Artemisia vulgaris (moxibustion) for therapeutic purposes has long been used in China. Among other effects, it is believed to contribute to correcting the non-vertex presentation of the fetus when applied at a specific acupuncture point (BL67 Zhiyin) located at the outer corner of the little toenail."

That's right: you burn an herb (Artemisia) next to the little toenail of the pregnant mother, right next to an acupuncture point, and that's supposed to make baby flip right around so its head comes out first.

You can't make this stuff up.

These guys are serious.  They ran a study where they divided pregnant women into 3 groups, with about 135 women in each.  One group got moxibustion, another got "fake" moxibustion, where they burned the herb next to a different toe (really!), and the last group got standard care.

Amazingly, the doctors found that it works!  More of the women with moxibustion had babies born the right way round, head down, than in either of the other two groups.  To be precise, 79 babies in the moxibustion group came out the right way, versus 60 and 59 in the other two.  By the authors' own analysis, this difference was statistically significant.

Wow.  Maybe this stuff really does work.  And moxibustion is cheap and easy to administer.  Maybe this is the solution to our rising health care costs.

How to explain this result?  I see several possibilities:

1. The small effect was just a random variation, not due to the treatment.  Previous studies of exactly the same treatment (such as this one) showed that moxibustion did not work.  So either those studies are wrong, or this one is.
2. There was bias in how the women were assigned to treatment, and the effect can be explained by that.
3. The authors manipulated the data to make the numbers come out better.  (Quelle surprise! Not in a BMJ journal!)  Of course we can't prove this without much more investigation.
4. Burning an herb next to the little toe at just the right place - and nowhere else - stimulates a mystical "qi" pathway, and zaps that little baby back around the way he's supposed to be.

Hmmm, which seems the most likely?

OK, I admit it: I haven't read every single article in BMJ's acupuncture journal.  So I don't really know that they are all wrong.  But who has time to read all this bad science?  The latest issue has a disturbing number of articles about acupuncture for cancer, which I find particularly upsetting because that practice takes advantage of highly vulnerable patients.  It also includes an article on ear acupuncture, a practice invented out of whole cloth by an Army doctor in the U.S., who has been inflicting it on injured service members, as I've written about before.

Actually there is one article that seems plausible.  It reports a case of arterial hemorrhage caused by an acupuncture needle.  But we don't need to dwell on that.

Acupuncture in Medicine has all the trappings of a real journal, including an editorial board whose members work at respectable medical schools.  I know that BMJ wants us to believe it; after all, they make money on this stuff.  As for the journal itself: I can't bear to read any more.  It is just too painful.  Perhaps acupuncture would help.