The Sixth Estate

The National Post has given considerable space to a vicious attack on homeopathy which, in turn, gave rise to the publication of a spiel by a defender of homeopathy. I have to say, I’m disappointed. But the latter advocate makes her case just about as well as it can be made. Karen Wehrstein even has a high-powered medical research journal to back up her side: the impressive-sounding “International Journal of High Dilution Research.”

This particular little tempest was provoked by the printing of an article by University of Alberta professor Timothy Caulfield which, at least in its online version, appeared to label practitioners of homeopathy as “witch doctors.” This is of course quite wrong. Homeopathy is not an indigenous traditional medicine suddenly exposed to the harsh racist light of Western medicine. Homeopathy is a theory for medical treatment which has solid roots in the history of science. Just like phlogiston. And ether. And alchemy.

Unfortunately, as is so often the case, the back-and-forth style of argumentation that the media prefers is very unhelpful in actually educating its readership — which is presumably the primary objective when it comes to topics like medicine. Instead, whatever the good intentions of Dr. Caulfield, what we end up with are competing arguments from authority. Which authority do you prefer: the Ivory Tower academic from Alberta, or the executive director of the Canadian Consumers Centre for Homeopathy? How does someone without a background in medical research determine which authority is more persuasive? How does one account for the fact that both groups claim the weight of medical research is on their side? Judging from the comments at the Post, homeopathy is still an open question.

A question which the Post’s editorial board evidently doesn’t feel qualified to answer. But I thought I’d throw my hat in, too, since not merely the National Post but Health Canada currently endorses homeopathy as a suitable medical treatment for Canadians, I thought it would be helpful to see how well Caulfield’s position stands up to Wehrstein’s. So. Caulfield, or Health Canada?

My approach will be somewhat different than Caulfield’s or Wehrstein’s, though. Instead, today we’ll walk through the theory and practice behind two medications. The first one will be Oscillococcinum, a treatment for influenza which Wehrstein notes is “one of the world’s most popular over-the-counter flu medicines.” Oscillococcinum is a homeopathy remedy. It comes from natural sources and millions swear by it.

The second will be oseltamivir, better known by its brand name Tamiflu. Tamiflu is not a homeopathic remedy. It has been invented by “real” conventional medicine, aka white-labcoatted doctors, aka Big Pharma. It is produced by massive corporations and stockpiled by governments.

I’m sure you’ve guessed by now which one will be endorsed by Sixth Estate.

1. What is the flu?

We’ll begin with the competing theories of the disease itself. Big Science says that influenza is caused by a virus which enters the body, especially the lungs and respiratory tract, invades healthy cells, and corrupts them, basically turning them into factories that mass-produce more copies of the virus. Most of these copies stay in the body, seeking out more cells to invade and corrupt. Some of them get expelled and then spread via coughing, physical contact, etc., spreading to new hosts and causing similar infections. Particles of this alleged virus can be found in very high quantities in samples taken from flu sufferers.

The flu virus is a well-defined subject of study. The picture to the right is an electron microscope image of a flu virus particle, taken at the U.S. Centres for Disease Control. Its RNA has been sequenced. There are thousands of scientific articles describing the study of its genome.

Homeopathy has a different theory to account for the flu virus. The inventor of the Oscillococcinum therapy was a physician during the Spanish Flu pandemic of 1918-1920, Joseph Roy. He claimed to have found in the blood of flu sufferers an “oscillating bacteria” — not a virus. Roy went on to theorize that the same oscillating bacterium was responsible for causing a range of other diseases, from measles to cancer. (In fairness to Roy, at the time he was writing, nobody had ever isolated the virus which causes measles, or the genetic mutations which cause cancer.)

Unfortunately, there are no pictures of the Oscillococcus bacteria. Its genome has never been sequenced. In fact, it has never been isolated and identified by any other medical researcher. But Roy was convinced that outside of the sick human body there was one other source for high amounts of Ocillococcus bacteria: the heart and liver of the Muscovy duck. In homeopathic pseudo-Latin, this source is known as Anas Barbariae Hepatis et Cordis Extractum. “Barbary duck” is a culinary term sometimes used for Muscovy duck once it has been cooked and prepared for human consumption.

2. What is the medication used to treat the flu?

Tamiflu is a complex organic compound, ethyl (3R,4R,5S)-5-amino-4-acetamido-3-(pentan-3-yloxy)-cyclohex-1-ene-1-carboxylate. Like all such compounds, we can do quite a number of things with it. We can synthesize it. We can take pictures of it. We can draw diagrams of its chemical composition, like the one to the left. We can put it into the body of a test subject, either animal or human, and see what happens. 75 milligrams of the substance are contained in pill form; there are also solutions in which several milligrams of Tamiflu’s active ingredient are mixed with each millilitre of water.

Oscillococcinum has a slightly more complex method of preparation. First, a Muscovy duck is slaughtered and an extract of its heart and liver is prepared. The resulting substance is presumed to include an active ingredient — either the as-yet-to-be-confirmed Oscillococcus bacteria, or if it doesn’t exist, some other as-yet-unknown compound in duck offal which causes the same symptoms as influenza. Which of these it is doesn’t actually matter: according to homeopathic theory, as long as the medication is related to the same symptoms as the disease, it doesn’t actually matter whether it is at all related to the actual pathogen that is causing the disease.

Next, the duck offal is mixed with 100 parts water. Then, 1 part of the resulting diluted solution is removed and mixed with another 100 parts clean water. This process is repeated multiple times. The precise number of times varies in homeopathy. With respect to Oscillococcinum, usually it is done around 200 times, each time taking 1 part of the former solution and mixing it with 100 parts clean water.

This is a truly extraordinary procedure. By the end of it, statistically speaking, the resulting “solution” is so dilute that there cannot be a single atom of the original “active” ingredient left in any one dose. Indeed, the trace mineral and other impurities present in all water sources will be present at much higher concentrations than the medical ingredient itself. What’s more, it’s worth noting that for this reason any homeopathic solution is physically indistinguishable from simple water. It is, quite literally, faith-based medicine.

3. How does the medication work?

Tamiflu has a well-studied and well-defined mechanism of action based upon a sophisticated understanding of biochemistry. After being processed by the liver, it binds to and inhibits a chemical called viral neuraminidase. Viral neuraminidase is a coating found on influenza virus particles, which they use to free themselves from the cells which have manufactured them. This is part of the process, then, then allows the flu virus to spread within the body.

This process is well described and well-known enough to be described in reasonably readable English on Wikipedia; the basic chemical reactions involved can be studied both in theory and in the laboratory. It is not always fully effective in the body for various reasons, and its effects are actually more modest than many have been led to believe. Also, as with all anti-viral and antibiotic drugs, it is virtually inevitable that there will eventually be widespread strains of influenza virus which have evolved a slightly different surface coating that is immune to Tamiflu. For the moment, though, there are several moderately effective anti-influenza drugs working on these sorts of principles.

Oscillococcinum, like all homeopathic remedies, does not have any known mechanism of action. The inventor of homeopathy, Samuel Hahnemann, claimed that all diseases were the products of underlying disturbances in the body called “miasms,” and that if you took a toxin that caused the same symptoms as the miasm, the miasm itself would be defeated. But Hahnemann did his research before the rise of germ theory, and the discovery that bacteria and viruses cause contagious diseases.

In contrast, Roy’s invention of Oscillococcinum does sound a little bit like what conventional medicine calls vaccines. However, vaccines are injections of relatively high concentrations of inactivated copies of the virus that causes a disease. Oscillococcinum is an excessively diluted “solution” which is purported to contain an imprint of duck liver, which bears no relation to the influenza virus at all. At this point advocates of homeopathy typically introduce a bewildering array of sciencey terms, usually involving the term “quantum.” None of this is particularly relevant, since from the perspective of modern physics, Oscillococcinum solution is so dilute that it is mere water.

So there you have it. The thesis of homeopathy is that if you take a substance that definitely doesn’t cause influenza and dilute it down far past the point where a single dose or pill is likely to contain a single atom of the original “medicinal” ingredient, somehow it will cure the flu.

Sixth Estate would now like to remind its readers that bidding is still open for the naming rights to the planned Winnipeg-Iqaluit High Speed Rail Line, due to begin construction in 2015. Interested parties must deposit $100,000, which will be refunded to unsuccessful bidders.