Jaggy Splinters (2 page)

The placebo response and the phenomenon of self-healing triggers is an area of medicine that begs extensive research and study. Homeopathists like to make out that they’re in the vanguard of exploring this field. Problem is, they want to have their cake and eat it. You can’t claim to be peddling a therapeutic pill
and
claim to be engaging the psychosomatic self-healing process. It’s a medicine or it’s a placebo: it can’t be both. And until they admit their sugar pills
are
merely placebos, homeopathy is not in the vanguard: it’s just in the way.

As the NHS’s own homeopathy website puts it: ‘Around 200 randomised controlled trials evaluating homeopathy have been conducted, and there are also several reviews of these trials. Despite the available research, it has proven difficult to produce clear clinical evidence that homeopathy works.’ Or, to put it more succinctly,
it clearly doesn’t
.

The British Homeopathic Association has, unsurprisingly, a different take on these results. Firstly they claim that they merely indicate that ‘further research is required’, by which they mean that if they wait long enough, then statistical probability will eventually throw them a set of results from the flattering end of the bell-curve, and they’ll trumpet those as ‘definitive’. But just in case Godot doesn’t show up any time soon, they’ve got their excuses prepared, with ‘many Complimentary and Alternative Medicine (CAM) practitioners believing that conventional research methods are not suitable tools with which to investigate CAM’. Thus for all the BHA say further research is required, they remain rather resistant to further research employing that same stuffy old scientific methodology that keeps delivering bad news.

Timothy’s point is that the whole homeopathic doctor-patient loveliness is an inextricable part of a holistic process, hence not only can’t you isolate the ‘medicine’ itself for testing, but nor can you ask homeopathic practitioners to participate in randomised double-blind placebo testing. The homeopathist knowing it’s even a randomised possibility that he’s prescribing a placebo could, apparently, somehow interfere with the magic. And as sceptics are wont to point out, how indeed do you get a placebo control group when the medicine in question (a sucrose tablet) is indistinguishable from a placebo (also, usually, a sucrose tablet)?

Something of an impasse, I’m sure you’d agree. So how come I’m calling myself Charles Litton and seeing patients at the shiny new ‘place b.’ alternative medicine clinic? Well, some time back I happened upon an extremely valuable piece of information, and hit upon a means of constructing a genuinely double-blind experiment: one in which not only neither the patient nor the homeopath knows whether placebos are being prescribed, but in which neither even knows they are part of the trial.

The key to it all is a small company called Sucrosanto. I read about them briefly in the local evening paper, in a piece about the regeneration of a rather run-down light-industrial estate in Corstorphine. I wasn’t even reading the piece, just skimming through the story next to it, about an archaeological find in Liberton, when my eye happened to catch the phrase ‘fought off stiff competition from several other suppliers to grab the exclusive contract to supply several key drugs to the Edinburgh and Lothian Homeopathic Hospital’. Sucrosanto, it turned out, were the ELHH’s conveniently local sole source of Bryonia, Chamomilla, Arsen, Nux Vom and Aconite, five of its most commonly prescribed remedies.

If the ELHH practices alternative medicine, then it would be fair to say that I have been known to practice what might be termed alternative journalism, and this wee nugget provided the impetus for a wee bit of just that. Before doing anything, though, I ran the idea past my wife, Sarah. Being a doctor, she was able to provide me with valuable contacts and technical assistance, as well as giving the project the ethical once-over. However, being my wife, she couldn’t allow herself to be
nothing but
helpful, and found it imperative to throw down a familiar condition.

‘You are not allowed to go breaking into this place, Jack,’ she told me, and not in a smiley, jokey, but-I-know-you-will-anyway-you-irascible-sexy-thing-you kind of way.

Busted – but not all the way back to the drawing board. Rather, Sarah’s insistence led to a fairly inspired refinement to the scheme, so I was able to give her my solemn promise. Besides, she only said
I
wasn’t allowed to go breaking into the place.

It took only a few weeks to get place b. up and running, with the choice of décor and furniture the most taxing aspect of the start-up process. Fortunately, you don’t need any kind of licence or indeed any authorised credentials whatsoever in order to set yourself up as an alternative therapist. As of this year, you’re not allowed to make specific claims about your practice without proof of therapeutic effectiveness, but nobody in this business is dumb enough to do that. Keep it vague, that’s the key. Never tell them what you’re trying to achieve and the punters can never claim you didn’t deliver. Look at Boots – they’re flogging packets of homeopathic pills bearing the keys-up, cannae-catch-us phrase: ‘without approved therapeutic indications’. It tells you on the fucking box that it doesn’t work, but it’s proving no impediment to sales. That’s Boots as in Boots the chemist, though perhaps it ought to now read Boots the shameless, whoring, snake-oil peddlers.

I took out some ads in local papers and a few carefully selected publications, while Sarah got some GP friends of hers to make some referrals. The patients they recommended me to were not misled about anything other than my name. They were informed that this was an experimental therapy, that I was not medically qualified, that the remedies I was likely to prescribe were not clinically proven, and that nor would any of it come cheap. All of these warnings proved as effective a disincentive as the admission on the Boots packets. The plan was that I would front this charade one day a week. In practice, I found myself opening three and could have filled the diary for five. The thought that I was in the wrong business did cross my mind a few times as I overheard my friend Laura, who was posing as my receptionist, speaking on the telephone politely turning new patients away.

Sarah’s connections allowed me to furnish myself with a generous supply – a super-abundance, in fact, despite my clinic’s popularity – of official, clinical test-standard placebo pills. However, cheap as these came, it always pays to shop around, so I also set up an account with Sucrosanto and placed orders for several of their signature products. Being an enthusiastic, new and locally based customer, I felt I ought to introduce myself personally to my new supplier, and suggested the ideal time to do so might be on a guided tour of their facility. Sucrosanto’s sales manager Sandy Gifford heartily concurred.

The operation was accommodated within a compact little two-storey compound, a brand new construction largely surrounded by Seventies-built low-rises in varying states of disrepair or demolition. On the rainy Tuesday morning when I visited, Sandy was showing the ropes to a shy but eager young trainee lab technician named Carol. I was accompanied by Laura’s boyfriend Michael, posing as a student doing work experience at the clinic. He was dressed in a suit and tie for the occasion, but this only served to make him look even more like a student because of the sheer incongruity the effect conveyed. Michael is doing a PhD in astronomy, and his normal dress sense reflects the fact that he and his peers spend a lot of time hanging about in the dark.

Sandy convened us initially in his office, where I asked him to walk me through the company’s ordering and shipping procedures. He showed me the place b. orders on his computer screen and explained the serial system that let them track precisely which pills went to which client, down to the individual packet, which bore the corresponding number.

‘It’s industry standard for British National Formulary pharmaceuticals. Homeopathic remedies aren’t required to comply with those regulations, but some of us believe it’s only a matter of time before they’re either accepted on to the BNF or just forced to toe the same line by new legislation. Either way, we prefer to be ahead of the game.’

Sandy then took us into the lab, where he talked us through the whole process, ‘With apologies to Mr Litton, who is bound to be a lot more familiar with this information than young Carol here.’

‘Don’t take anything as read on my account,’ I assured him. ‘One can always learn something new. Besides, the theory behind homeopathy is something I never tire of hearing,’ I added truthfully, though neglected to elaborate that this was because it gets funnier every time.

‘The father of homeopathy was a German physician by the name of Samuel Hahnemann. The term comes from the Greek: homos meaning similar and pathos meaning suffering, giving the principle that like cures like. This principle wasn’t Hahnemann’s, though: it was first suggested in ancient Greek times by Hippocrates, and given that he was the founder of the world’s first hospital, we can safely say that he knew what he was about.

Sandy directed his words mainly at Carol as he warmed to his theme with the alacrity of a proud father telling his kids about the family business.

‘Now, back in the 1790s, a trusted remedy for malaria was cinchona bark, which is a source of quinine. Hahnemann was intrigued by the fact that this bark, when taken by a healthy person, caused symptoms similar to malaria, and experimented by taking small doses of it himself, precipitating fever, thirst and palpitations: all associated with malaria. From this, he devised his Law of Similars, as he called it, whereby diseases can be cured by substances that precipitate the same symptoms.’

‘Such vision,’ I said, smiling and shaking my head with apparent awe, ‘to devise such a wide-reaching law on the basis of that single observation.’

Yeah, sarky me, but I had to say something to cover the fact that I was trying very hard to suppress a laugh. Hahnemann took a tiny quantity of cinchona bark – his reports state four grams, making the active ingredient utterly minute – and had a very nasty reaction to it, but it never struck the boy that he may simply have been allergic to quinine. Thus was overlooked a simple, rational explanation for the symptoms he experienced, and instead we now have an international pseudo-scientific movement whose founding principle is in fact based on one man’s misreading of his own unusual pathology.

‘Hahnemann was way ahead of his time,’ Sandy went on. ‘He understood that these substances could trigger the body’s ability to heal itself. You could say he anticipated modern immunology, though he took a different route. Immunology uses small quantities of the disease itself to stimulate the immune system, but the principle is the same, and he pioneered it. Though it’s not strictly true to say it was all on the basis of his work with cinchona bark. Hahnemann further experimented with giving people small doses of other substances known to cause disease-like symptoms: arsenic and strychnine, for instance.’

Carol’s eyes bulged at this point. ‘He gave them poison?’ she asked.

‘In small doses – ever decreasing doses, in fact, Carol, and you have actually nudged us towards the most amazing discovery at the root of homeopathy. Hahnemann’s patients experienced some understandably unpleasant side effects as a consequence of what they were taking, so he began reducing the dosage by dilution. And the astonishing, utterly counter-intuitive result was that the greater the dilution, the fewer such symptoms the patients suffered. Diluting the medicine made it more, rather than less, effective, and thus he came up with his Law of Infinitesimals.’

Michael and I nodded as soberly as we could, but Carol’s expression was one of naked incomprehension, wondering did she hear right, wondering perhaps if her faculties just weren’t up to grasping this complicated stuff. No, Carol, pet, you heard right and your expression indicates your faculties are serving you well. Break it down: Hahnemann gave people poison, which made them ill. When they took smaller doses of poison, they felt less ill. Contra-intuitive or what! Eat less poison – feel better. What were the fucking odds? And when that’s the level of observation and deduction it started from, it’s no surprise that homeopathy later progressed to frequently prescribing the same substances to treat completely conflicting maladies. Constipation and diarrhoea, for instance, are both treatable by sulphur, as we are told on Boots’ homeopathy website.

Sandy directed us to a machine housing a number of transparent cylinders filled with clear fluid.

‘Dilution enhanced the therapeutic properties of Hahnemann’s remedies, and it therefore holds that the more they are diluted, the more effective they become. You follow?’ he asked Carol.

‘Eh, yeah, okay,’ she stumbled.

‘I know, I know,’ Sandy assured her with a smile (as well as a knowing look to me). ‘We all find it hard to get our heads around at first. A lot of things in science are counter-intuitive. But as long as you follow the principle.’

‘Less is more,’ she suggested.

‘Very good. And by extrapolation, a lot less is a lot more. Following Hahnemann’s method, we take an extract of a substance, which we call the mother tincture, and we dilute it in ten parts water.’ With this, he pressed a button on the machine and we watched a small quantity of fluid siphon from one chamber into another. A second button caused the receiving chamber to suddenly vibrate, the cylinder shaken back and forth about a central vertical axis.

‘According to Hahnemann, this succession process is crucial, because it releases dynamic forces within the solution which are intensified with each further dilution.’

‘So it’s very much a case of shaken, not stirred,’ I offered.

‘Very good, Mr Bond,’ Sandy accepted with an approving chuckle. ‘And of course, we then repeat the process, taking the new solution and diluting an extract from it by the same ratio.’

‘With the therapeutic effectiveness increasing by a corresponding degree?’ Carol asked.

‘Indeed. Which is why when we talk about homeopathic solutions, we describe the degree of dilution as their “potency”, and the higher the degree of dilution, the higher the potency.’