Nine red flags of pseudoscience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How can we tell if our research is finding just pseudoscience rather than real science? At my friendly, local public library I recently found, and am enjoying reading, the 2024 book by Jonathan N. Stea titled Mind the Science: Saving your mental health from the wellness industry. He is a clinical psychologist in Calgary. There is a preview of it at Google Books. In a section titled Mind the Takeaways on pages 200 and 201 he describes the following Nine Red Flags of Pseudoscience:

 

Explain away negative findings (i.e., overuse of ad hoc hypotheses)

“Your horoscope didn’t work this time because you didn’t think positively enough when you read it.”

 

Absence of self-correction

“Sure – maybe Scientology hasn’t changed much since L. Ron Hubbard’s writings, but it still has undiscovered potential!”

 

Evasion of peer review

“They don’t publish their results in top-tier, peer reviewed scientific journals because Western medicine has brainwashed us to believe that randomized controlled trials (RCTs) are the only kind of evidence.”

 

Emphasis on conformation rather than refutation

“I don’t care if you think the Amazing James Randi has thoroughly debunked telekinetic spoon bending. Those people at the workshop swear it isn’t a magic trick.”

 

Reversed burden of proof

“No! YOU prove to ME that it isn’t an alien-operated UFO.”

 

Claims divorced from the broader scientific literature (i.e., absence of connectivity)

“Science doesn’t have all the answers! It can’t explain how past life regression therapy uses ideas about reincarnation to help treat posttraumatic stress disorder.”

 

Elevation of anecdotal evidence

“I received energy healing and happen to feel better afterward; therefore, it works.”

 

Use of science-y sounding language

“Once the diagnosis using quantum mechanics is completed, current treatments revert to biochemistry instead of using treatments involving the subtle energies that made the original diagnosis.” (From an actual published article on energy medicine that is now retracted)

 

Absence of boundary conditions

“Why, of course, detoxification diets can treat depression, anxiety, addiction, attention-deficit hyperactivity disorder, chronic pain, marital conflict, glaucoma, Covid-19, laziness, and heartburn – and it can do so in adults, children, infants, dogs, cats, and horses.”

 

The preceding quote is typical of homeopathy. For example, in the Homeopathic Materia Medica by William Boericke there is a web page about Natrium Muriaticum – chloride of sodium claiming that rather than just being edible salt (the shaker on your dining table) it is:

 

“A great remedy for certain forms of intermittent fever, anemia, chlorosis, many disturbances of the alimentary tract and skin.”

 

On January 4, 2016 I blogged about Will homeopathic Natrium Muriaticum reduce stage fright? How could that work?

 

An image of a red flag came from Openclipart.

 

An extremely peculiar homeopathic remedy for stage fright

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I recently found an article by Vikas Sharma at DrHomeo titled Want to get rid of stage fright? Try these homeopathic remedies. He lists the following eight:

 

Argentum Nitricum – top recommended medicine

Gelsemium – for stage fright with fear of appearing in public

Lycopodium -for fear occurring on starting stage presentation but afterwards it goes well

Silicea – for stage fright with a fear of failure

Aconite – for stage fright with marked anxiety and panic attacks

Arsenic Album – for anxiety with marked restlessness

Medorrhinum – for stage fright, anxiety with anticipation

Ambra Grisea – for shy people having fear of people

 

I have previously blogged about five of them: Argentum Nitricum, Gelsemium, Lycopodium, Silicea, and Ambra Grisea.

 

But what the heck is Medorrhinum? I had not ever seen it before. There is another article by Vikas Sharma at DrHomeo titled Medorrhinum: Homeopathic Medicine – Its Use, Indications And Dosage. He says it is recommended in high potencies but gives no specific dosage, only that this medicine should not be repeated frequently. And Sharma claims:

 

“It is magnificent medicine to manage cases of fear, anxiety, and panic attacks. Main fears that are present in those who require it include fear of dark, enclosed spaces (claustrophobia), misfortune, cancer, and sexually transmitted diseases. Those who need it are anxious, sensitive, nervous by their very nature. They are always in great hurry.”  

 

But Sharma does not say how it is prepared. There is another recent article by Dr. Mahima Rastogi at LinkedIn Pulse on November 5, 2023 titled Unlocking the healing potential of homeopathic Medorrhinum. Mr. Rastogi explains that:

 

“Medorrhinum is a nosode, which is a type of homeopathic remedy prepared from the discharge, secretions, or diseased tissue of a person or animal suffering from a particular disease. In this case, Medorrhinum is derived from the discharge of a person with gonorrhea. It is important to note that nosodes are highly diluted and succussed (shaken vigorously) in a series of steps to create a potent yet safe homeopathic remedy.”

  

There also is yet another article by Edzard Ernst on May 8, 2018 titled Medorrhinum: another surprising homeopathic remedy. He says more specifically the remedy comes from the urethral discharge of a male patient suffering from gonorrhea, and adds that none of the claims about it are supported by evidence.

 

Still another article by Vikas Sharma at DrHomeo is titled Top 5 Natural Homeopathic Remedies for Anxiety. These and their recommended dosages [in brackets] are:

 

Aconitum Napellus – top remedy for anxiety [30C]

Arsenic Album – for anxiety with chest constriction, difficult breathing and restlessness [30C]

Argentum Nitricum – for anxiety from anticipation (anticipatory anxiety) [30C]

Kali Phos – for anxiety, nervousness, fear [6X aka 3C]

Gelsemium Sempervirens – for anxiety about public appearance (social anxiety) [30C]

 

Note that the Homeopathic dilution of 3C for Kali Phos is a gigantic factor of 27C different from the 30C for the other four. C means a dilution by a factor of a hundred. At dilutions of 13C and above no molecules of the original substance remain, so any effect at 30C is purely as a placebo.  

 

The Gonorrhea cartoon was modified from this one at Wikimedia Commons.

 

Things that you should know about eye drops

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There is an article by Dan Gudgel on June 1, 2023 at the American Academy of Ophthalmology simply titled Eye Drops. Also, there is another article by Kierstan Boyd on February 9, 2022 about Lubricating Eye Drops for Dry Eyes, and yet another on April 7, 2023 about Redness-Relieving Eye Drops.

 

More recently there is an article by the U.S. Food & Drug Administration on December 12, 2023 titled What You Should Know about Eye Drops. It followed another article on November 16, 2023 titled FDA warns consumers not to purchase or use certain eye drops from several major brands due to risk of eye infection. FDA’s consumer tips on December 12 include:

 

“Do not use ophthalmic products that:

 

Are marketed as OTC [over-the-counter] products to treat serious eye conditions such as  glaucoma, retinopathy, or macular degeneration. There are no OTC treatments for these conditions.

 

Are labeled as homeopathic, as these products should not be marketed.”

 

The tip about avoiding homeopathic eyedrops was picked up three other places: by Beth Mole at Ars Technica on December 12, 2023 in an article titled Every homeopathic eye drop should be pulled off the market, FDA says; by Laura Baisas at Popular Science on December 13, 2023 in another article titled Stop using homeopathic eye drops; and by Scott Gavura at Science-Based Medicine on December 21, 2023 in still another article titled FDA: Don’t use homeopathic eye drops.

 

Naturally there was grousing by Americans for Homeopathy Choice on December 26, 2023 in an article titled Our Homeopathic Eye Drops Are Gone! which lazily whined that FDA had not cited any adverse case reports. But there were at least two such case reports. One article by Lin Chen et al. at Clinical Medicine & Research for December 2017 is titled Anisocoria secondary to anticholinergic mydriasis from homeopathic pink eye relief drops. A second abstract by Mallorie L. Huff in the America Journal of Emergency Medicine for April 2022 is titled Acute angle closure glaucoma precipitated by homeopathic eyedrops containing Atropa belladonna.

 

The more common criticism of homeopathic products is that the active ingredient is so diluted as to be insignificant. An article by Steven Salzberg at Forbes on May 22, 2016 titled Allergy sufferers beware: These eye drops are a scam cautioned:

 

“Uh oh. It turns out that these products are little more than very, very expensive bottles of sterile water. For $9.99 you get 10 ml of water that contains several extracts–in vanishingly small amounts–for which there is no evidence whatsoever that they have any effect on allergies.”

 

An NIH image of eye drops came from Wikimedia Commons.

 

 

Can homeopathic gelsemium calm nervous tension associated with public speaking? What if we pretended it could?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Boiron claims to be the world leader in homeopathic ‘medicines.’ Their BoironUSA website has an article dated December 10, 2020 that is titled Uncovering the Mystery of Yellow Jasmine. The first paragraph says:

 

“The bright blooming flowers of the yellow jasmine vine are a welcome sign of spring, but they also hide a mysterious dark side. Throughout history, this plant has held power to both heal and harm. Read on to uncover more about this intoxicating botanical and how the homeopathic preparation can help calm nervous tension associated with public speaking.”

 

The last paragraph says:

 

“You will find lots of yellow jasmine growing in southern gardens today, but it is only used medicinally in homeopathy where its toxic properties are removed. Made from the tincture of the root, homeopathic Gelsemium sempervirens is used to relieve apprehension with trembling, headaches, and dizziness.* It’s a valuable medicine for those who suffer from stage fright or fear of public speaking before a speech, event, or presentation. Five pellets can be taken twice a day before or after the event.”

 

What about that asterisk? It leads to a disclaimer at the bottom of the page:

 

“*Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.”

 

There is a more recent article by Heidi Weinhold at the BoironUSA web site on March 3, 2021 titled Homeopathy and the New Age of Communication. Her second paragraph opens by saying:

 

“The homeopathic medicine Gelsemium sempervirens 30C helps to relieve stage fright or situational stress.”

 

But at the end there is another weasel-worded sentence:

 

“Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of Boiron.”  

 

Also, there is a 37-second YouTube video from October 16, 2018 titled Gelsemium sempervirens – Homeopathic Medicine to Relieve Apprehension. The text says that:

 

“Gelsemium sempervirens helps relieve apprehension.* Learn more about its uses in this video featuring Dr. Gary Kracoff NMD, Reg Pharm.”

 

Again, the asterisk is for that first disclaimer:

 

“* Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.”

 

In that video Dr. Kracoff wears an impressive white coat. He holds up a package showing a 30C dilution and says:

 

“It’s a useful medicine for stage fright that will not affect alertness.”

 

Are they going back to traditional practice because there isn’t any medical evidence? No, it’s even worse than that. Back on December 15, 2011 I posted on this blog with the title Can homeopathic gelsemium reduce anxiety about public speaking? It does not. In that post I discussed a magazine article from 2012 in Fundamental Clinical Pharmacology titled Effect of Gelsemium 5CH and 15CH on anticipatory anxiety: a phase III, single-centre, randomized, placebo-controlled study. It found no significant difference between a placebo and the two dilutions of gelsemium.  (Anxiety was induced using the Stroop Color and Word Test). Authors of that article were Adeline Paris, Sophie Schmidlin, Sandrine Mouret, Enkelejda Hodaj, Phillipe Marijnen, Naoual Boejedaini, Mircea Polosan, and Jean-Luc Cracowski. Both Marijnen and Boejedaini are listed as being with Laboratoires BOIRON, St Foy-lès-Lyon F-69110, France.

 

The disclaimer really should have said:

“Someone once thought this works, but accepted medical evidence says it does not. Nevertheless we will continue to pretend that it works.”

 

 To paraphrase Daffy Duck, that’s just despicable.

 

Finally, what do 5C and 15C homeopathic dilutions mean? C means the the substance was diluted by a factor of 1 to 100, and 5 means that process was repeated five times. The end result is a dilution of 1 to 10 to the tenth power, or 10,000,000,000 times. For 15 C it is to the thirtieth power or  1,000,000,000,000,000,000,000,000,000,000 times.

 

And 30 C means the end result is a dilution of 1 to 10 to the sixtieth power, or an outrageously tiny factor of 1 in 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000.

 

The image of gelsemium is cropped from one by David Stang at Wikimedia Commons.

 

Will homeopathic Ambra Grisea relieve fear of public speaking?

 

 

 

 

 

 

 

 

I doubt it. It is diluted so much that any effect likely is a placebo.

 

There is a web page from Rachel Riches Homeopathy from June 28, 2020 titled Anticipatory anxiety? Homeopathy can help in which she listed Ambra Grisea second of five remedies and also listed three others I long ago have blogged about: Argentum Nitricum, Gelsemium, and Lycopodium. She says for intense emotional feelings to select a potency of 200C. Her description begins:

 

“Those needing this remedy are shy and sensitive and generally quite introverted. They feel their emotions strongly and find it very difficult to express how they feel. So any upcoming situations which require performing or speaking in front of people such as an interview, a talk, oral exam can be incredibly difficult.”  

 

A second article from Geeta Hansaria at Thrive in on May 14, 2019 titled These homeopathic remedies can help you overcome social anxiety also mentioned Ambra Grisea, as did a third article by Vikas Sharma at DRHomeo titled Best homeopathic medicines for social phobia. Neither of these articles stated what potency should be taken though. A fourth article at Anxietytesting.com titled All about homeopathy for anxiety said 6C and 30C potencies were best and most widely available for minor complaints and that Ambra Grisea was used for:

 

“Anticipatory anxiety in those who are shy and easily embarrassed. Dreads the pressure of performing in front of others – at an interview, oral exam, social event, etc.”

 

 What the heck is Ambra Grisea? It’s just a fancy Latin name for ambergris (see the Wikipedia article), which my copy of Hawley’s Condensed Chemical Dictionary more briefly describes as:

 

“A waxy, opaque mass containing 80% cholesterol formed in the intestinal tract of the sperm whale and found on beaches or afloat on the ocean.”

 

And what do those potencies of 6C, 30C and 200C mean? The Wikipedia article about Homeopathic dilutions explains that 6C potency is a miniscule ratio of ten to the minus twelfth power, or in Parts-per Notation one part-per-trillion (1 in 1,000,000,000,000). A 30C potency is a ratio of ten to the minus 60 power, and 200C is a ludicrous ten to the minus 400 power. Even at the 6C potency there would only be an absurdly tiny amount of ambergris in the remedy.

 

I looked at the Pubmed  and PubmedCentral medical databases to see if there were any articles with research to back up use of homeopathic ambra grisea or ambergris but found none. I did find mention of ambergris in an article by Paula De Vos in the Journal of Ethnopharmacology for October 28, 2010 titled European Materia Medica in Historical Texts: Longevity of a Tradition and Implications for Future Use.

 

Where did the connection of this homeopathic remedy and the symptoms come from? On the web you can find a page from the Materia Medica produced by William Boericke 1849 – 1929 (or the whole 1922 book at the Internet Archive). Under the heading of Mind it says:

 

“Dread of people, and desire to be alone. Cannot do anything in presence of others. Intensely shy, blushes easily. Music causes weeping. Despair, loathing of life. Fantastic illusions. Bashful. Loss of love of life. Restless, excited, very loquacious. Time passes slowly. Thinking difficult in the morning with old people. Dwells on unpleasant things.”

 

Under the heading of Urinary it has another truly awful set of symptoms. If you prefer a more recent (and even more bizarre) discussion of symptoms, then you can read a web page from another Materia Medica by George Vithoulkas at the International Academy of Classical Homeopathy.

 

A drawing of a sperm whale came from Pearson Scott Foresman at Wikimedia Commons.    

 

A little research finds a remedy is questionable

Many people have some skin tags, like the one shown above on my neck. Wikipedia says that a skin tag (or archrodon) is a small benign tumor found where areas of skin rub together (or form creases) like the neck, armpit, or groin.

Over at Walmart I saw a package of ProVent skin tag remover. The label said the active ingredient was Thuja Occidentalis – an essential oil present at a homeopathic concentration of 6X. You are supposed to put a few drops of the liquid on the tag every day, and after a few weeks it will be gone. But before I bought it I decided to look up reviews at Amazon (and also Walmart) to see if others found it was effective.

First for comparison I looked up a serious pain relief product -  the Salonpas Lidocaine Pain Relieving Maximum Strength Gel Patch. As shown above, 69% gave it a 5 stars and only 9 % gave it 1 star.

For ProVent the Amazon reviews were relatively poor. As shown above, just 27% gave it 5 stars, but 53% gave it 1 star. At Walmart reviews were even worse – 29% gave it 5 stars but 62% gave it 1 star.

Looking around on Google, I found a dismissive article by Harriet Hall, M.D. on June 18, 2013 at Science Based Medicine about a similar product (with the same active ingredient and concentration) called Tag Away that had been advertised on television.

As shown above, reviews of Tag Away at Amazon were even worse than for ProVent – 19% gave it 5 stars but 56% gave it 1 star.  Back on January 6, 2016 I blogged about how According to Consumer Reports, homeopathy is an emperor with no clothes.

What really works for removing skin tags? The Wikipedia article mentions ligation – tying a string around it to cut off blood flow. Wikipedia also mentions cryosurgery (freezing). At PubMed Central I found an article in  Jay E. Taylor on pages 998 and 999 of Canadian Family Physician for December 2016, titled Just a pinch - Technique for skin tag removal in sensitive areas.

Would you expect a homeopathic remedy at a potency of 30C to reduce your dog’s anxiety about loud noises like fireworks?

It’s the Fourth of July, so this evening people will be setting off lots of fireworks and scaring lots of dogs (and also cats). Would giving a homeopathic remedy help?

Heck no! It’s just magic. But I found an article from June 2015 at a web site called PrimallyInspired titled Natural Remedy If Your Dog Is Scared Of Fireworks Or Thunderstorms. It described giving your dog homeopathic Phosphorus at a potency of 30C.

When you look up Homeopathic dilutions at Wikipedia, you will find that C means diluting by a factor of 1 to 100 and 30C means repeating that process thirty times. It is also equivalent to diluting by 1 to 10 and repeating that process sixty times. That is a factor of ten to the sixtieth power, or

1,000,000,000,000,000,000,000,000,000,000,
000,000,000,000,000,000,000,000,000,000 times.

At that dilution there are no atoms of phosphorus left. It is just a placebo - the sugar pills or alcohol and water used as a carrier. By Charles Dicken’s terminology from A Christmas Carol, Phosphorus 30C should just be called The Ghost of Phosphorus Past.

I found another article from 2015 by Linda Miller at Dogs Naturally magazine titled Noise Phobia in Dogs: Homeopathic Solutions. It also recommended a potency of 30C, and along with phosphorus also mentioned:

Asarum (wild ginger)
Ferrum metallicum (metallic iron)
Theridion (from spiders)
Zincum metallicum (metallic zinc)

I would not expect iron or zinc at higher concentrations to have any effect either. That’s because they are used in piping and already should be present at parts per million levels in drinking water. For example, look at the detailed water analysis report from 2014 for New York City.

There also is a combination remedy from HomeoPet called Anxiety TFLN. (TFLN stands for thunderstorms, fireworks, and loud noises). Here in Boise it is carried by Zamzows. It contains:

Borax 6C and 30C
Chamomilla 6C and 30C
Phosphorus 6C and 30C
Rhododendron 6C and 30C
Theridion curassivicum 6C and 30C

Each of those ingredients supposedly is present at both 6C and 30C - a very peculiar idea called a potency chord. I discussed that idea back in a May 2, 2012 blog post titled  Is taking a liquid homeopathic remedy more like drinking lemonade or playing an accordion? In this case the 30C is fictitious and ten to the 48th power less than the 6 C (12X).

There actually was a double blind clinical trial of HomeoPet Anxiety TFLN. Results are in a magazine article in the Veterinary Journal from 2008 (Volume 177, pages 80 to 88) by Nina R. Cracknell and Daniel S, Mills titled A double blind placebo-controlled study into the efficacy of a homeopathic remedy for fear of firework noises in the dog (Canis familiaris). They concluded: 

“No evidence for the specific efficacy of homeopathy for the treatment of fear of noises was found in this study. However, significant improvements were reported with both the homeopathic and placebo treatments with approximately a 41–45% improvement in the behavioural signs of fear, an improvement seen in 68% of subjects and an approximate 10% complete recovery rate. Evidence from this study highlights the caution required when interpreting the results of uncontrolled treatment trials for the management of fear of noises in dogs. To find the true efficacy of a treatment it is necessary to compare results to that of a placebo under the same circumstances.”

What might really work? There is a medication called Sileo which was discussed on June 28, 2016 in New York Times article by Jan Hoffman titled A New Treatment for Dogs Scared by Thunder and Fireworks, and on June 29, 2016 in a Washington Post article by  Ben Guarino titled For dogs terrified of fireworks, new drug aims to take the edge off of the Fourth of July.

For a more general discussion, see a recent 5-minute YouTube video from the American Chemical Society titled Does Homeopathy Work?

The image of a woman with a magic wand was derived from an 1852 patent medicine label for Sybilline leaves found at the Library of Congress.

The biggest math error I’ve ever seen in an article

It was hard for me to stop laughing after reading an article on the web site for Mother Earth Living magazine by Sheila Kingsbury titled Defining Types of Natural Medicine. It is part of a longer article on The Case for Alternative Therapies that appears on pages 50 to 56 of their July/August 2016 issue. Her discussion of homeopathy says:

“Homeopathy can be difficult to make sense of: First, it can be hard to understand how its remedies could be effective as they are so incredibly diluted (for example, a “30X” homeopathic solution contains 1 part mineral or botanical substance to 1,000,000 parts water and/or alcohol); second, homeopathy’s incredibly individualized nature makes it almost impossible to study.”

Her description of that dilution as by a factor of a million is way off. If you look up Homeopathic dilutions at Wikipedia, you will find that X means by a factor of ten, and 30X means to repeat the dilution 30 times so it really is ten to the 30th power. At Quackwatch an article by Stephen Barrett, M.D. titled Homeopathy: The Ultimate Fake explains that:

“A 30X dilution means that the original substance has been diluted 1,000,000,000,000,000,000,000,000,000,000 times. Assuming that a cubic centimeter of water contains 15 drops, this number is greater than the number of drops of water that would fill a container more than 50 times the size of the Earth.”

So, Sheila was off by a factor of ten to the 24th power or 1,000,000,000,000,000,000,000,000 which is a septillion. I had to look up what that even was called in the article on Power of 10 at Wikipedia. 

According to Consumer Reports, homeopathy is an emperor with no clothes

Two days ago I blogged about Will homeopathic Natrium Muriaticum reduce stage fright? How could that work?

The 10:23 Campaign has a web page titled Why You Can’t Trust Homeopathy that briefly discusses the following ten points:

It doesn’t work.
It couldn’t work.
It’s a waste of your money.
It’s a waste of everybody’s money.
It's a waste of your time.
It’s a waste of everybody’s time.
There are alternatives to this alternative.
It’s not what it says on the label.
It detracts from medicine.
It has abused its placebo privileges.

A placebo is something inert, like plain sugar pills, that is used as a comparison in a clinical trial of a medical treatment. It is there to keep us from fooling ourselves.

On December 21, 2015 at the Washington Post web site there was an article from Consumer Reports titled Homeopathic drugs: No better than placebos? A section titled Does homeopathy work? stated:

“....Yet after reviewing 176 studies, the National Health and Medical Research Council in Australia this year found that homeopathics worked no better than placebos, concluding that ‘there are no health conditions for which there is reliable evidence that homeopathy is effective.’ ”

and then concluded:

“...after evaluating many reliable studies, including comprehensive, independent reviews of the research, Consumer Reports’ medical experts conclude that homeopathic preparations are no more effective than a placebo.”

A typical response to this gloomy news from homeopaths would be to attack the organization as shills for BIG PHARMA. That won’t work against Consumers Union, who are independent and only draw conclusions based on their own tests or other reliable evidence. (An article titled What You Should Know About Homeopathy also is at the Consumer Reports web site). 

They were not the only ones to discuss that Australian report. Two days later at the Science-Based Medicine web site Steven Novella had an article titled Continuing Battle over Homeopathy. He concluded that:

“...Homeopathy cannot work and does not work.”

On January 4, 2016 Dr. Edzard Ernst posted a web article titled The place of homeopathy...is...in the history books! He concluded that it finally was time for homeopaths to sit down and shut up:

“What place does homeopathy have in medical schools? Its place is in the history books of medicine! Even homeopathic optimists cannot reasonably doubt this answer. Systematic research in cooperation between experienced homeopaths and university-based methodologists complying with the currently accepted quality standards has filled the gaps in our knowledge, particularly in respect to the proof of homeopathy’s clinical effectiveness. Now it is up to homeopaths to demonstrate that they are sufficiently responsible to adapt to this new knowledge in the best interest of their patients. If they don’t, they cannot be considered to be members of the community of ethical health care professionals. ”

The image of an almost naked emperor was adapted from a WPA poster at the Library of Congress for a play based on the Hans Christian Andersen fairy tale The Emperor’s New Clothes.

Will homeopathic Natrium Muriaticum reduce stage fright? How could that work?

On February 15, 2015 naturopathic doctor Peter Swanz discussed Homeopathic Courage for Performing in Front of a Crowd. He listed eight remedies:

“For someone that feels timid about appearing in public consider: Carbo vegetabilis, Lycopodium, or Silicea.

For an individual that begins to feel anxiety anticipating an upcoming event or encounter consider: Arsenicum, Carbo vegetabilis, Gelsemium, Lycopodium, Natrium muriaticum, Silicea, or Thuja.
 
An individual that has fear and dread about appearing in public should consider: Carbo vegetabilis, Gelsemium, Lycopodium, or Silicea.
 
For someone suffering from stage fright consider: Gelsemium, Mercurius solubilis, Natrium muriaticum, or Silicea."

I have previously blogged about three of his eight:  Gelsemium, Lycopodium and Silicea (silica). One on Gelsemium is my all-time 10th most popular post. (Another on Argentum nitricum is my 4th most popular post).

What is Natrium muriaticum (or Natrum Muriaticum). It’s just sodium chloride (the main compound in sea salt) obscured by a Latin name. You probably have a shaker in the kitchen. At the web site for the British Homeopathic Association you can even find an article titled with the cryptic abbreviation Nat Mur.

Mr. Swanz doesn’t say what homeopathic dilution to use, but another web page titled Homeopathic Remedies for Anxiety - Natural Ways to cure Anxiety Attacks by Brendon G. Burwell says to use 30C, which means 1 in ten to the 60th power. That is:

1,000,000,000,000,000,000,000,000,000,000,
 
000,000,000,000,000,000,000,000,000,000 times.

When you think about it, there is a big problem with how salt could get into the body from the usual homeopathic remedy form of solid sugar pillules. An Frequently Asked Questions page on the Boiron web site under the heading Should I take my Boiron medicine with or without food? says:

“The most efficient route of administration for oral homeopathic medicines is sublingual absorption (under the tongue).

 ....Since the absorption takes place through the mucous membrane coating on the inside of the mouth, food in the stomach has no influence.”

But in the mouth the solid will be exposed to saliva and dissolved. Are sodium and chloride ions present there? Yes, both already are in saliva. Table 1 in an article by Silvia Chiappin et al titled Saliva specimen: A new laboratory toll for diagnostic and basic investigation that appeared in Clinica Chimica Acta in 2007 (Volume 383, pages 30 to 40) lists a sodium ion content of 5 mmol/liter and a chloride content of 15 mmol/liter  for unstimulated saliva. For stimulated saliva the sodium ion content is 20 to 80 mmol/liter and the chloride content is 30 to 100 15 mmol/liter. Homeopathic remedies will have vastly lower concentrations of sodium chloride, which will be overshadowed by the saliva that dissolves them.

The salt shaker image came from Wikimedia Commons.

How are homeopathic pillules really made?

Some homeopathic remedies are dispensed as little sugar pills  or pillules (as shown above). A few days ago I read a post on the Quackometer blog titled FDA Raises Serious Concerns About UK’s Nelsons Homeopathics.

Last November a representative of the U.S. Food and Drug Administration (FDA) inspected the Nelson’s plant in London. He observed how they were filling a batch of their trademarked Clikpak containers with Kali Phosphoricum (potassium phosphate) 30C pillules. (They also use Clikpaks for both Lycopodium and Gelsemium, which I’ve previously blogged about having been recommended for public speaking anxiety). FDA was alarmed enough to send them a warning letter pointing out significant violations of Current Good Manufacturing Practice (CGMP) regulations.

One example was that:

“a. During the inspection, the investigator observed glass fragments present during the manufacture of Kali Phos 30 c Clikpak, Batch #36659. Specifically, glass fragments were observed in the Clikpak Assembly (b)(4) enclosed area where open glass vials are inserted into the outer plastic Clikpak sheaths and move uncovered on the conveyance mechanism. Your firm failed to implement adequate measures to prevent glass contamination and had no documentation to demonstrate that appropriate line clearance and cleaning is conducted following occurrences of glass breakage, which has been a recurring problem.”

A second was, amazingly, that 1/6th of the pill containers weren’t getting anything added to the inert sugar pills at all:

“b. The investigator also observed for Batch #36659 that one out of every six bottles did not receive the dose of active homeopathic drug solution due to the wobbling and vibration of the bottle assembly during filling of the active ingredient. The active ingredient was instead seen dripping down the outside of the vial assembly. Your firm lacked controls to ensure that the active ingredient is delivered to every bottle.”

A third example was that:

“c. The dosing process has not been validated appropriately. Specifically, your surrogate validation study, “Medication of un-medicated pillules with (b)(4),” visually demonstrates the variability of the amount of (b)(4) for the pillules in one vial. Your firm lacks control of the variation for the amount of the active ingredient in the pillules.


The validation study demonstrated that pillules at the top of the bottle contain more active ingredient than pillules at the bottom. There are no controls in place to ensure that the dosing procedure is homogenous and reproducible.”

I would have expected they’d try to uniformly dose their pillules. So, I looked in Dr. Steven B. Kayne’s book Homeopathic Pharmacy: theory and practice to see how it’s usually done. On pages 103 and 104 of the second edition he said that:

“On a large scale, blank lactose tablets, granules or sucrose pills can be surface inoculated by spraying on the liquid remedy in alcoholic tincture or as syrup in a revolving pan, rather like the old method of sugar coating. The exact amount of remedy to be applied to ensure an even covering is determined using dyes.

In smaller scale production the solid dose forms are placed in glass vials and medicated by placing drops of high alcohol medicating potency on the surface, depending on the amount of solid dose form being medicated.

....It is not necessary for every tablet to be coated to the same uniform amount.”

Finding out how it’s actually being done reminded me of the old Monty Python comedy sketch about a box of chocolates called Crunchy Frog, which you can watch here on YouTube. 

Is taking a liquid homeopathic anxiety remedy more like drinking lemonade or playing an accordion?

In previous posts on this blog I have discussed both homeopathic and herbal remedies for anxiety. Recently I found the web site for a homeopathic remedy called Anxietin that added what to me was an entirely new claim in the area of complex homeopathy.


What’s in there?

First the familiar stuff. This liquid remedy has a combination of 21 distinct ingredients, so it can be a commercial brand. As is usual for homeopathy, most ingredients are made more mysterious by only giving their Latin names.  They include the following (with English translation):

Elements (2)
Aurum Metallicum (gold metal)
Phosphorus

Chemicals (9)
Argentum Nitricum (Silver Nitrate)
Arsenicum Album (Arsenic Trioxide)
Baryta Carbonica (Barium Carbonate),
Calcarea Phosphorica (Calcium Phosphate)
Glonoinum (Trinitroglycerine)
Kali Arsenicosum (Potassium Arsenite)
Kali Phosphoricum (Potassium Phosphate)
Muriaticum Acidum (Hydrochloric Acid)
Natrum Phosphoricum (Sodium Phosphate)

Plants (10)
Aconitum Napellus (Wolfsbane or Monkshood)
Alfalfa
Avena Sativa (Common Oat)
Chamomilla (German Chamomile)
Gelsemium Sempervirens (Yellow Jessamine)
Ignatia Amara (Strychnos Ignatia; contains both Strychnine and Brucine)
Lupulus Humulus (Humulus Lupulus; Common Hop)
Passiflora Incarnata (True Passionflower)
Staphysagria (Delphinium)
Stramonium (Datura Stramonium; Jimson Weed or Locoweed)


How much is in there?

Here’s where things get either interesting or silly. Their web site says that:

“Anxietin’s unique multi-potency formula contains three dilutions (10X, 30X, and LM1) of each active homeopathic ingredient, in equal amounts, in one bottle. These active ingredients are stabilized in our oligotherapeutic water base to help maximize absorption. Unlike most homeopathic medicines, Anxitetin does not contain irritating alcohol or sugar and is gluten free.” 

That formula isn’t really unique since it’s also sold as the less expensive Anxietrex Pet Anxiety Formula.

These three dilutions (or potencies) supposedly are like a musical chord (potency chord,  or accord, or homaccord), and somehow act together but distinctly from each other. That peculiar concept is about a century old. (There are other products like Aconite Plus that even contain four dilutions). This notion of potency chords throws out the idea of a chemical concentration, and I don’t buy it.

An LM1 dilution means that a substance is mixed with 50,000 parts of water and then shaken (succussed). Therefore its concentration would be 20 parts per million (ppm).

In homeopathy dilutions followed by an X mean that a substance is mixed with ten parts of water, shaken, and then diluted repeatedly. A 10X dilution thus contains 1 part in 10 to the tenth power, or 0.0001 ppm. A 30X dilution supposedly contains just 0.000000000000000000000001 ppm, but actually is completely immaterial (magic) since at 24X there wouldn’t even be one molecule left. So, the concentration of each substance would theoretically be the average of the first two, 20.0001 ppm. I doubt that the volume of the LM1 dilution could be measured so precisely that adding the 10X dilution would make any practical difference.

By the way, the label says that Anxietin also contains two preservatives - 0.1% potassium sorbate 0.1% (1000 ppm), and 0.0075% citric acid (75ppm). They are present at higher concentrations than those active ingredients. 
 

Will it help?

Who knows! I’ve previously blogged about how there wasn’t conclusive evidence that Argentum Nitricum, Gelsemium, or Passionflower would reduce anxiety in humans.

The image of a boy playing the accordion came from Wikimedia Commons.

Can homeopathic gelsemium reduce anxiety about public speaking?

Gelsemium sempervirens (yellow jessamine or jasmine) is a homeopathic remedy recommended for fear of public speaking, and many other ailments (like flu). Very small amounts of the root are used to prepare remedies, because the plant contains three toxic strychnine-related alkaloids: gelsemine, gelseminine, and sempervirine. (Just because something is completely natural doesn’t mean that it is either harmless or safe).   

In The Complete Homeopathy Handbook by Miranda Castro (St. Martin’s Press, New York, 1990) on page 91 she says that:

“Gelsemium is also one of the favorite remedies for people who become paralysed with fear prior to giving a talk or before an exam. This is not the active fear of Argentum Nitricum or Lycopodium; it is an acute anxiety which causes a person to seize up both mentally and physically.”

Similarly, in Easy Homeopathy: the 7 essential remedies you need for common illnesses and first aid by Edward Shalts (McGraw-Hill, New York, 2005) on page 139 he says that:

“Gelsemium is an excellent remedy for stage fright and test anxiety. People who need this remedy to perform better under various circumstances literally feel paralyzed, weak and dizzy. Their limbs become heavy. This is not a good bouquet of symptoms to have during performances or exams.”
For test anxiety he recommends taking three pellets of Gelsemium 30 C on the morning of the exam. He also suggests using what he calls the plussing method; dissolving three pellets of 30C in a small bottle of spring water and then sipping from it as needed. 

On Amazon.com you can find tubes of pellets from Boiron with potencies of 6C, 12C, 30C, or even 200C.

Is Gelsemium effective for relieving anticipatory anxiety? Apparently not. This year A. Paris et al. published the results of a detailed clinical study in a magazine called Fundamental and Clinical Pharmacology. You can read the abstract here. They compared the effects of Gelsemium at potencies of 5CH and 15CH with a placebo. The study began with 180 people split evenly among those three groups, but a few dropped out. Most of the co-authors are in Grenoble, France but two are with the Boiron laboratories in St Foy-le`s-Lyon (who also provided the remedies).    

What does the potency ‘5CH’ mean? (It’s the same as 10X). The material has been diluted by a factor of 1:100 five times, so the final concentration is 1 part in 10,000,000,000. Similarly, ‘15CH’ means diluted by a factor of 1:100 fifteen times, so the final concentration is 1 part in 1,000,000,000,000,000,000,000,000,000,000.

There also are some very preliminary (and curious) results from Verona, Italy with positive results for gelsemium on anxiety-related responses in mice. You can read the full texts on PubMed Central here and here. I’m not sure what to make of these, but did note that the reported response did not increase consistently with potency as was long ago hypothesized to occur for homeopathy. 

The plant image is from Wikimedia.

Will homeopathic lycopodium reduce your anxiety about public speaking?

Lycopodium clavatum (commonly known as club moss and pronounced like-o-podium) is a homeopathic remedy recommended for fear of public speaking (and many other ailments). In summer, spikes from the plant are collected and the very small spores are shaken out to produce a yellow powder (pollen dust) as shown above.

For example, in The Complete Guide to Homeopathy by Dr. Andrew Lockie and Dr. Nicola Geddes (Dorling Kindersley, London, 1995), under Emotional Problems in the tables on pages 190 and 191 they describe:

AILMENT:
Anxiety with a loss of confidence

SYMPTOMS:
Apprehension about performing in public
Inability to sleep at night with continual reviewing of what happened during the day
Appetite is disturbed
A craving for sweet foods may accompany insomnia

CAUSE & ONSET:
A forthcoming event or performance
Most likely to occur in the very ambitious who have high standards

YOU FEEL BETTER:
In cool surroundings
From hot food and drinks
After midnight
With movement

YOU FEEL WORSE:
In stuffy rooms
After overeating
Between 4 PM and 8 PM

REMEDY & DOSAGE:
Lycopodium - take 6C every 2 hours for up to 10 doses

You can find pellets of 6C lycopodium clavatum online. For example, Amazon shows Boiron has packages with tubes containing 80 pellets for less than $8.

What does the potency or dilution ‘6C’ mean? (It’s the same as 12X). The material has been diluted by a factor of 1:100 six times, so the final concentration is 1 part in 1,000,000,000,000. 

Is lycopodium effective? In 2006 Karen Pilkington and her colleagues published a long article in Homeopathy magazine titled Homeopathy for Anxiety and Anxiety Disorders: A Systematic Review of the Research. You can read the abstract and conclusion here at PubMed. They found no clear and compelling evidence that homeopathy was effective for treating anxiety. Lycopodium only was mentioned near the beginning of the article, where they referred to it being mentioned by Dr. Lockie  in another more recent book, the Encyclopedia of Homeopathy (2001).

Does lycopodium have undesirable side effects? A web article by Susan Kaye noted that:

“The book Synoptic Materia Medica I points out that Lycopodium may cause lack of self-confidence, feelings of inferiority and insecurity, and the possibility of a person developing bullying behavior which acts like a cover-up for these feelings of being ‘lesser-than.’ A person may be bossy, dominating and downright nasty to those who know him best, like family, yet act meek and fearful in public. The remedy may cause a fear of public speaking and even the inability to stand up for oneself in a conflict.”

I have not read that rather obscure book, so I’m not sure if this is a problem only with this remedy, or an example of a general problem with homeopathic remedies noted on the Dr. Lockie web site:

“The homeopathic equivalent of an overdose is when a remedy is ‘proved’ or begins to cause the symptoms that it is intended to cure. This can happen when a remedy is taken for very prolonged periods, so don’t continue with a remedy once it has worked in order to prevent a relapse, it’s quite unnecessary and actually counter-productive.”

Images of the plant and powder are both from Wikimedia.

Will homeopathic silica reduce fear of public speaking?

About a year ago Madeline Innocent posted an article on Overcoming Public Speaking Fear with Homeopathic Treatment which stated that:

“Silica is one of our top medicines for overcoming public speaking fear, for a lack of confidence, for someone who is paralysed by anxiety or fear, is indecisive or for someone with a yielding or timid disposition.”

Silica (or as homeopaths sometimes grandly describe it, silicea terra, or sil for short) just is silicon dioxide (typically found in sand). How is it supposed to help? According to this web page about silicea 6X “cell salt” tablets:

“....The key to Silica’s deepest uses is a want of grit– physical and sometimes moral. It offers the most benefit to individuals with some or all of these symptoms: nervous irritability, timidity, fear of public speaking, exam nerves, fear of needles, weak ankles, pale skin, fatigue, a lack of vital heat, and weak hair and nails.”

If you drink tap water, then I would not expect that taking these lactose tablets would have any effect. Silica already is ubiquitous in tap water (and most fresh water). Your tap water probably went through a rapid sand filter. Typically silica is present at concentrations of a few parts per million (mg/liter), or 6X in homeopathic dilution jargon. Taking a pinch of it in tablets would be an insignificant addition to the daily intake via tap water.

For example, silica is present in Cleveland water at 1.6 mg/L, New York City water at 2.5 mg/L, and Los Angeles water at 16 mg/L. Silica content is not required to be listed in water quality reports, so many water systems don’t bother to report it. But like the Prego spaghetti sauce slogan says, “it’s in there.”

Does homeopathic Argentum nitricum reduce anxiety?

Back on November 17th Madeline Innocent (who is a natural health consultant in Perth, Australia) wrote briefly at Ezine Articles about Overcoming Your Fear of Public Speaking with Ease. She claimed that:

“The homeopathic medicine Argentum nitricum, Arg nit for short, is a wonderful medicine to allay anticipation anxiety.”

That same day she also posted three other articles praising that homeopathic medicine: Anticipation Anxiety Treatment in One Easy Step, Performance Anxiety Can Be a Help or a Hindrance, and Holistic Anxiety Treatment is Most Likely to Be Permanent.

There are lots of other articles which recommend homeopathic Argentum nitricum. For example, R. Oliva’s eHow article on Homeopathic Treatment of Anxiety says that:

“Argentum nitricum is most effective when used before a big event such as an important test or a public speaking event.”

What is Argentum nitricum? It just is fancy terminology for a tiny bit of silver nitrate dissolved in a whole lot of water. Does it really work for reducing anxiety?

In 2006 Karen Pilkington and her colleagues published a long article (in Homeopathy magazine) called Homeopathy for Anxiety and Anxiety Disorders: A Systematic Review of the Research. You can read the abstract and conclusion here at PubMed. They found no clear and compelling evidence that homeopathy was effective for treating anxiety.

In the article they mention that there were two clinical trials for Argentum nitricum on test anxiety, which is one important type of anticipation anxiety. The first one, done in 1982 by Stanton, found that it helped reduce test anxiety. A second one in 2003 by Don Baker et al attempted to replicate the first one, but found no effect compared with an inert placebo. By the way, that 2003 article reported on work done in Australia! You can read the abstract here at PubMed. Both studies used a concentration of 12X. That means one part per trillion, which is equivalent to 1 drop of water diluted into 20, two-meter-deep Olympic-size swimming pools (50,000 cubic meters), or one second of time in approximately 31,700 years.

What about results from university theses? There was yet another study on Argentum nitricum for test anxiety done in 2005. Christinette Snyman’s Masters of Technology (M Tech) thesis at the University of Johannesburg also found no effect when using a lower concentration (or higher potency) of 200CH. However, an M Tech thesis in 2000 by Gabrielle Traub found that a combination of Kalium Phosphoricum, Argentum Nitricum and Gelsemium at 200CH reduced anxiety. Another M Tech thesis in 2002 by Rowena Emmeline Kathyrn Thomson did not find an effect on anxiety for a combination. An M Tech thesis in 2002 by Karin Pelser also found no effect for Gelsemium sempervirens at 200 CH. Traub has mentioned her thesis results in an interview here. The other subsequent results also are interest.

So, I think you should take any claims about the effectiveness of homeopathy against anxiety with a grain of salt (or in their terminology, many truckloads of Natrum muriaticum). You should do your own research, read the literature, and make up your own mind.

Also, as I mentioned in a previous post, homeopathic tablets often incorporate lactose (which can be a problem for some of us).

Update: On December 19, 2009 the first article I mentioned by Madeline Innocent reappeared on another web page titled Cure Your Hemorrhoids.