How Far Should the Government Go to Protect Us from Snake Oil? The Case of Homeopathy.


What to do about homeopathy? A Reason Foundation board member (who shall remain nameless) has neat parlor trick that he pulls from time to time. He will theatrically down an ENTIRE BOTTLE of homeopathic sleeping pills. Unwitting witnesses will sometimes gasp in worry, but he quickly uses the occasion to explain the quackery behind homeopathy. 

I don't know which brand of homeopathic sleeping pill he prefers, but let's take the product Quietude offered by Boiron, one of the leading purveyors homeopathic remedies. The pills contain four "active" ingredients, e.g., Hyoscyamus niger, Nux moschata, Passiflora incarnata, and Stramonium. In more prosaic English, the ingredients are from stinking nightshade (a.k.a. black henbane), nutmeg, purple passionflower, and jimson weed. 

Homeopathy was dreamed up by a German physican Samuel Hahnemann at around the turn of the 19th century. Without going into details, Hahnemann got the idea that if substance induced symptoms similar to a disease then dosing a patient with small amounts (minimum dose) of the substance would cure the patient. How small? As a proponent of homeopathy explains:

With the minimum dose, or law of infinitesimals, Hahnemann believed that a substance's strength and effectiveness increased the more it was diluted. Minuscule doses were prepared by repeatedly diluting the active ingredient by factors of 10. A "6X" preparation (the X is the Roman numeral for 10) is a 1-to-10 dilution repeated six times, leaving the active ingredient as one part per million. Essential to the process of increasing potency while decreasing the actual amount of the active ingredient is vigorous shaking after each dilution.

Some homeopathic remedies are so dilute, no molecules of the healing substance remain. Even with sophisticated technology now available, analytical chemists may find it difficult or impossible to identify any active ingredient. But the homeopathic belief is that the substance has left its imprint or a spirit-like essence that stimulates the body to heal itself.

Let's take a look at the dosages of the "active" ingredients in Quietude. It turns out that this homepathic remedy contains slighly more than one-100 mllionth of the active ingredient in henbane (even the EPA allows more arsenic in drinking water than this amount of henbane); one-ten-millionth of nutmeg; one-thousandth of passionflower; and a bit more than one-100 billionth of the active ingredient in jimson weed. 

Given those dosages, I do not fear that we will lose our board member to an overdose or even that he will get a good night's rest from downing homeopathic sleeping pills. 

Now comes a petition [PDF] from the Center for Inquiry to the Food and Drug Administration asking the agency … 

to initiate a rulemaking procedure with the proposed rule: 1. requiring all over-the-counter ("OTC") homeopathic drugs meet the standards of effectiveness applicable to non-homeopathic OTC drugs; and 2. requiring OTC homeopathic drugs not tested for effectiveness, and all advertisements for such drugs, to carry a warning label stating: WARNING: The FDA has not determined that this product is safe, effective, and not misbranded for its intended use."  

As the Center correctly points out … 

First, there is no reliable scientific evidence that the alleged active ingredients in homeopathic drugs cure the diseases and conditions for which they are indicated. Indeed, as discussed further below, homeopathic "theory" is premised on the magical notion that very small doses of substances that cause disease symptoms can alleviate those same symptoms.

Second, producers of homeopathic drugs typically dilute the drugs' alleged active ingredients in solution to the point that the solution contains, on average, not a single molecule of the alleged active ingredient. In other words, what the producers and retailers of homeopathic drugs market as "medications" are nothing more than solutions that are devoid of active ingredients (often the solutions are simply water), which then have been combined with various inactive ingredients, such as balls of ordinary sugar.

As the Center's petition notes, sales of homeopathic remedies in the U.S. reached $870 million in 2009 and were used by nearly 5 million Americans. The Center's concern is that consumers will suffer harm, perhaps even death, by being misled into taking ineffective homeopathic remedies rather than more effective medications. 

Here's the issue: Are homeopathic remedies fraudulent? The scientific evidence [PDF] strongly indicates that they are ineffective. Libertarians generally agree that government exists to protect citizens against force or fraud. As the Libertarian Party Platform puts it

Government exists to protect the rights of every individual including life, liberty and property. Criminal laws should be limited to violation of the rights of others through force or fraud, or deliberate actions that place others involuntarily at significant risk of harm. Individuals retain the right to voluntarily assume risk of harm to themselves.

Ah, but look at the last quoted sentence from the platform concerning the voluntary assumption of risk. Is choosing to take a homeopathic nostrum a voluntary assumption of risk? It would be if the consumer knows what is in homeopathic dilutions (basically nothing) and surely some consumers do know how such pills are made. One can argue that mandating an FDA warning label would not stop the sale of snake oil, but it would inform otherwise clueless consumers that based on scientific evidence their government regards homeopathic remedies as snake oil. If they proceeded to purchase and rely on the homeopathic pills after being warned, that would more clearly indicate their voluntary assumption of risk.

So what do you think? 

Disclosure: The Center for Inquiry has paid my travel expenses to participate in their conferences on two occasions. I do own stocks purchased with my own funds in drug companies that make and sell government-approved medicines that are allegedly effective.