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the fitness skeptic is a blog that takes a critical look at the health and fitness industry.

in it I'll examine the claims, products, practises and commonly held beliefs and SCRUTINISE the evidence.

My aim is to separate what is true from what is not and encourage fitness consumers and fitness professionals to become skeptics. 

I’ll take no prisoners when it comes to criticising the scam artist or highlightling the bogus but I’ll also give credit where credit is due.

Welcome to the fitness skeptic

Homeopathy for sports injuries: Treating Something with Nothing.

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In my quest to find the latest and greatest lunacy in health and fitness, which I have to be honest isn't hard, I stumbled across a web page from the British Homeopathic Association promoting homeopathic remedies for sports injuries. Before I get into the nitty-gritty of this, let's talk a little bit about homeopathy itself.

I think when most people hear the word homeopathy, in the UK at least, they think, complimentary medicine rather than alternative medicine by which I mean they give it more credence or think that it is aligned in some way to conventional medicine. One of the reasons for this is that homeopathy is available in some areas of the country on the NHS (National Health Service) and perhaps because Prince Charles is known to use it. In 2010 the Governments Science and Technology Committee issued an evidence check on homeopathy and stated that:

When the NHS funds homeopathy, it endorses it. Since the NHS Constitution explicitly gives people the right to expect that decisions on the funding of drugs and treatments are made "following a proper consideration of the evidence", patients may reasonably form the view that homeopathy is an evidence-based treatment.

As we'll find out it isn't an evidence based treatment but this explains nicely why homeopathy has credence in the eyes of many.  Some of the credibility homeopathy receives is also down to the fact that the majority have no clue as to what it really is and how it is proposed to work. So what I I'd like to do here is give a brief run down of where homeopathy comes from, how it is supposed to work and perhaps most importantly how homeopathic remedies are prepared. I promise you, if you have no idea about this you will be astonished.  

In the days before science based medicine (I'm getting a distinct feeling of deja vu here) 

In 1796 a German physician called Samuel Hahnemann created a form of medicine based on the doctrine that a substance that causes a particular symptom of a disease in healthy people could cure similar symptoms in sick people. So for example a substance that causes irritation to the eyes like onion, can be used to cure diseases whose symptoms include irritation and iching of the eyes, like hay fever and other allergies. A substance like crude oil (no I'm not joking) that causes skin irritation can be used to treat eczema or psoriasis. Other substances used in homeopathic treatments include arsenic (yep that poisonous substance you may have heard of) and anthrax (the highly dangerous and infectious bacteria!) as well as more mundane ingerdients such as stinging nettles and daisies. They are all used because contact with them causes a reaction which homeopaths believe can treat diseases with similar symptoms and this concept of 'like curing like' is used to this day as the basis of homeopathy.

Now I'm sure even at that this point those of you reading who had no idea about the basis of homeopathy are raising an eyebrow or two but it gets worse I can assure you.

Less = More?

You might be thinking that using poisonous substances as medicine doesn't sound like a good idea and you'd be right but homeopathic practitioners avoid killing their patients by diluting the substance and wouldn't you know it in the homeopathic world the more dilute a substance is the more potent it is. In the real world where conventional medicine thankfully rules, the opposite is true and a dose response relationship exists. This means that the effects of a substance depend on it's concentration or dose. The larger the dose the greater the response. This why we get very clear instructions on medicine packets telling us not to exceed the recommended dose and why if you take a whole packet of paracetamol for example you are likely at the very least, to need a trip to the hospital! 

So homeopaths dilute the substances in their medicines but the question is by how much. This is where homeopathy enters a new realm of implausibility. I want to run trough this very carefully to give you a very clear idea of what we're dealing with here so bear with me.

A quick lesson in homeopathic dilution

Homeopathic remedies come in a number of concentrations or dilutions and Hahnemann devised the centesimal scale (C scale) to denote the potency/dilution of the medicine.

To illustrate how both the scale and the dilution process works, I want you to imagine you're making a small glass of orange squash.

To do this you take 100ml of squash (concentrate, cordial or what ever you like to call it) and place it in a glass.

Next to this you have another glass with 100ml of water in it.

With a pipet you now take 1ml of the orange concentrate and drop it into the 100ml of water. This is now a 1C orange squash solution or one part orange squash to 100 parts water. I'm sure you'll agree that this would make a pretty dilute drink but this is nowhere near how dilute homeopathic solutions get. 

Dilute the solution again the same way for a 2C concentration and we have a concentration of 1 part orange squash to 10000 (ten thousand!) parts water. 

Dilute it once more the same way and we already have a solution that is 1 part orange in a million parts water! So you're getting a pretty weak glass of orange squash at 3C. 

If I was to tell you that homeopathic remedies are commonly sold with 30C dilutions you might wonder how much of the original substance is left and the answer is none?! Well there is a chance that there might be one molecule left, a small chance. However you'd need a sphere of water with the diameter of the solar system to have the chance of perhaps finding that one molecule. 

To further put this into context a 30C solution has been diluted to by a factor of

1 x 10,00000,000000,000000,000000,000000,000000,000000,000000,000000,000000 (that's 60 noughts, I counted them!!)

I'm not sure if a number this large has a name but it's big, so big in fact that it's many times larger than the number of stars in the observable universe! 

A little bit of chemistry (skip past this bit if you don't want to be reminded of boring chemistry lessons at school) 

In terms of chemistry there is a limit to the amount of times a substance can be diluted without losing the original substance. Avogadro's constant is the number of molecules in one mole of a substance. This is the same for every chemical and is 6.022 x 100000000000000000000000 (apologies, the editor I'm using doesn't allow me to write superscripts) Every time a substance is diluted this number reduces until you get to a point that not one molecule is left. In terms of homeopathy this occurs at about 12C yet as I've pointed out, homeopaths will continue to dilute their 'medicines' way past this point.

Chemistry, who cares about chemistry?

But homeopaths don't seem to be bothered about chemistry. From what I understand they are well aware of the above but are unconcerned. The reason for this? The memory of water.

Yep, you read that correctly, water apparently has a memory. Part of the process of creating homeopathic medicines involves the vigorous shaking of the solution in between dilutions and this apparently imbues the water molecules with some essence of the original substance. Assuming this was correct (and I can assure you it isn't as it defies all known laws of physics and chemistry) water would surely maintain some memory of all it had been in contact with, none of which of course the homeopath would know and some of which may, according to homeopathic theory, lead to different outcomes. But logic goes out of the window when we are talking homeopathy so none of this matters.

By now I'm sure that most of you reading this will scratching your heads wondering why homeopathy is still a thing. You are not alone.

What the science says

It goes without saying considering it's popularity that science has had a lot to say about homeopathy and not much of it makes good reading for the homeopaths. 

A 2002 review of systematic reviews in the British Journal of Clinical Pharmacology failed to find strong evidence for homeopathy and said

In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions.

It went on to say that

the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice

A 2010 review of evidence by Edzard Ernst in Medical Journal Australia also concluded that homeopathy had no clinical effect beyond placebo. 

Even studies that place homeopathy in a better light suggest caution. A 2010 meta analysis in the European Journal of Clinical Pharmacology found there was some evidence that homeopathic treatments were more effective than placebo but caveated this by saying that

the strength of this evidence is low because of the low methodological quality of the trials. 

and that

Studies of high methodological quality were more likely to be negative than the lower quality studies.

A more recent review (2014) in the journal Systematic Reviews that found some evidence in support of homeopathy again suggested the overall low quality of the evidence should prompt caution when interpreting the findings. 

Homeopathy for sports injuries

So now you know a little bit about homeopathy and the evidence that supports it lets have a quick look at the advice the British Homeopathic Association is dishing out in relation to sports injuries. I'll leave you to decide the validity of it. 

For acute injuries such as sprains and knocks when bruising is easily visible they recommend Arnica. Now before any of you say that arnica is a valid treatment for bruising, I need to remind you that we're talking about homeopathic arnica here, 30C in tablet form. So instead of recommending actual arnica they are  recommending sugar pills that will contain no trace of arnica?! Sadly such pills are readily available from your local health food store. In the UK they cost £6.50 and a quick look at the ingredients reveals they are indeed nothing but sugar pills, that have of course been soaked in a 30C potency arnica solution! The same health food shop will also sell you arnica cream which actually contains arnica. I know which one I'd use.

For deeper bruising and muscle tears they recommend a 30C preparation of Bellis Perennis. Bellis Perennis, for those of you who don't know, which is probably most of you, is the Latin name for the common daisy. Now I've no idea of the pharmacological properties of daisies but whether or not it has any medicinal value is of no consequence when we are talking about 30C homeopathic preparations because, as you should know by now, a 30C preparation of anything contains none of the original substance. 

For muscle cramps they recommend Cuprum Metallicum, which is I understand, what homeopaths call copper?! Ironically they recommend dissolving one 30C potency tablet in a small bottle of water and sipping it during the activity you are participating in!

Aside from the recommendations for 30C remedies there are a few at the much more 'concentrated' 6C potency. For example, in cases of tennis elbow they recommend a dose Ruta (a common European herb) with a 6C potency. They recommend this potency because in some cases Ruta apparently causes headaches and thus the 'more potent' 30C concoctions should be avoided. Of course the irony here is that in the real world we know that 30c preparations contain nothing while 6C preparations, which have only been diluted to one part in a million million (!!!!) might, if you're lucky, contain a molecule or two of the original substance. 

Homeopathy and doping

On a side note, laughable as it is the British Homeopathic Association has something to say about homeopathy and drug testing in sport. Thankfully however you'll be pleased to know that

The beauty of homeopathic remedies is that they are undetectable via conventional methods.

No Shit Sherlock! I wonder by which methods they are detectable? None which are available to those with a grasp of reality I suspect!

What's the Harm?

As you've probably figured out homeopathic treatments can't do any harm by virtue of them containing no active ingredients. This has been illustrated beautifully on many occasions by famous skeptic and conjurer James Randi, who at the beginning of one of his presentations consumes a whole bottle of homeopathic sleeping pills to no ill effect! However this isn't the point. To use my example of sports injuries, if you are taking homeopathic treatments that have no effect then you risk delaying recovery. Taking a homeopathic ruta tablet for tennis elbow for example may, if one takes the placebo effect at face value, make you feel subjectively better but will not aid recovery in any way. You would be much better off seeing your doctor who may advise anti-inflammatory medication and/or physiotherapy. The UK governments evidence check paper on homeopathy sum up their concerns saying:

Patients who do not seek medical advice from properly qualified doctors run the risk of missing serious underlying conditions while they have their symptoms treated with a placebo.

It goes on to defend this position by highlighting several cases where choosing homeopathy over conventional medicine lead to serious medical issues and even death!

So the fact homeopathic medicines are in themselves harmless is meaningless when the practise of homeopathy could lead to potential harm.   

 Fitness Skeptic Score

I don't think I've given an FSS of zero yet but there's a first for everything. The homeopathic treatment of sports injuries and homeopathy in general get's an FSS of:

Fitness skeptic score (1).png

To sum up; Homeopathy's premises (like cures like) make no sense, it's treatment methods (highly diluted substances) are implausible and it lacks any scientific credibility. The bottom line is homeopathy is nonsense and should be avoided like the plague.

References

Homeopathy is unscientific and unethical. Bioethics April 2012.

A systematic review of systematic reviews of Homeopathy. The British journal of Clinical Pharmacology. December 2002.

Homeopathy; What does the best evidence tell us. Medical Journal Australia 2010. 

Evidence for the efficacy of homeopathy. A meta analysis of clinical trials. The European Journal of Clinical Pharmacology. April 2000. 

Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Systematic Reviews 2014

Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial. Rheumatology June 2011. 

https://publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4504.htm

https://www.britishhomeopathic.org/charity/how-we-can-help/articles/conditions/s/sports-injuries/

https://en.wikipedia.org/wiki/Homeopathic_dilutions

www.critical-thinking.org.uk/health/alternative-medicine/homeopathy/homeopathic-dilutions.php

https://en.wikipedia.org/wiki/List_of_homeopathic_preparations

https://goodthinkingsociety.org/projects/nhs-homeopathy-legal-challenge/nhs-homeopathy-spending/

http://news.bbc.co.uk/1/hi/programmes/newsnight/5178122.stm

Functional Water: Fitness Snake Oil Personified.

Mainstream quackery or useful therapy? Chiropractic in a nutshell.