Arsenicum album 30C (Aa30C) is a homeopathic drug that India’s Ministry of AYUSH prescribed through an advisory on March 6, in the context of the COVID-19 pandemic. In section “i. Preventive and prophylactic” and sub-section “Homoeopathy”, the ministry advised the recommended dose thus: “Arsenicum album 30, daily once in empty stomach for three days”.
To make the drug, a “mother tincture” of the medicine is first made by dissolving by arsenic trioxide in a mixture of glycerine, alcohol and water or sometimes by “heating arsenic with water”. One millilitre of this tincture is diluted with 99 ml of water plus ethyl alcohol, and given a few machine-operated, “moderate, equal and successive jerks”, called “succussions”. This leads to a 100-fold dilution. The process is repeated 30-times to produce the final product, of 30C potency. A few drops of this, loaded on sugar pills, is administered to an individual. Apparently, each dilution plus succussion step makes the formulation more potent, and the process is called “potentisation”.
Starting with a “mother tincture” that has 200 grams of arsenic trioxide in 1 litre of liquid, the 30C potency medicine has one molecule of the active material present in a volume equivalent to that of 1 million Suns. In terms of the active material, an individual is consuming zero molecules.
However, this should not surprise us. Homeopathy was first proposed in Germany by Samuel Hahnemann (1755-1843) as an alternate medicinal strategy, more than 200 years ago. This was a time when the chemistry to show the above effect was not known (now it is in school textbooks). This was also an era where orthodox medicine was crude, often involving blood-letting. Compared to this, homeopathy seemed safe and humane. But today, when science has since made numerous strides, it is problematic that homeopathic principles still evade the rigours of scientific questioning.
From nothingness to water memory
Homeopathy takes recourse in the notion that water, when it comes in contact with the active material, develops “molecular memory”. In the absence of this active material in the final formulation, it is this ‘memory-laden’ water that triggers an “immune” response in the human body. Note that the active material – arsenic, in this case – is chosen based on the homeopathic “law of similars”, i.e. a substance that induces the symptoms of a disease.
Unfortunately, there is no evidence of water having any kind of memory. Even the journal Nature was touched by this controversy. It should also strike us that if water “remembered” what it touched, it would have lots of memories of anything it touched.
Any scientific response to such lack of evidence should be rigorous experimentation to demonstrate effects, or the lack of it. However, the actual response to any critique of homeopathy has often been that “science does not know everything yet”.
The quest to explain how homeopathy works has also led to hypotheses that suggest the active material somehow survives in even the most dilute homeopathic medicines. Here, the original active material finds its way into the final drug via interaction of the drug and bubbles formed during “succussions”. However, the methods used in the study are not standard for “potentisation”. The physics of bubbles catching the active material is unclear, and control experiments like checking for contaminants were not performed.
More importantly, even if traces of active material are present, how do they trigger physiology to act against an external agent (like the novel coronavirus)? We don’t know. For a chemical to be accepted as a drug, it takes years of experimentation, involving laboratory experiments, animal trials and human trials over multiple phases. But proponents of homeopathy have claimed that it cannot be subjected to such trials because it provides “highly individualised” doses. However, the mass distribution of Aa30C is anything but “individualised”.
Most popular narratives on homeopathy consist of anecdotes and scientific-sounding terms like “vital force” or “biphasic actions”. Hahnemann himself “explained” that homeopathy worked through a “dematerialised spiritual force”.
We also hear things like “a thousand people were given this medicine and then 95% did not get the disease, so it works”. This is not what a trial is and these ‘experiments’ are worthless unless compared with 1,000 people who are given placebos (i.e. blank doses).
The fact that homeopathy thrives is not proof of its efficacy – just like the existence of tarot readers and astrologers does not prove that these practices have any scientific basis.
Homeopathy puts on an aura of respectability thanks to ‘scientific’ journals from major publishers that cater to it.
Many reputed institutions have looked at the available literature and their conclusions are unequivocal. The US National Institutes of Health say, “There’s little evidence to support homeopathy as an effective treatment for any specific health condition.” The UK’s National Health Services (NHS) state, “There’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.”
A report prepared by a committee appointed by the UK parliament in 2010 called the British government’s position on homeopathy confused and recommended that the government stop funding homeopathy on the NHS. The report argued that homeopathy “undermines the relationship between NHS doctors and their patients, reduces real patient choice and puts patients’ health at risk”. Since 2017, the NHS has severely restricted access to homeopathy.
After an extensive literature survey, Australia’s National Health and Medical Research Council concluded in 2015 that “there was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered: no good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment.”
A false shield
A much-quoted statement by the WHO – sometimes distorted – during the Ebola outbreak in 2014 said, “In the particular context of the current Ebola outbreak in West Africa, it is ethically acceptable to offer unproven interventions that have shown promising results in the laboratory and in animal models but have not yet been evaluated for safety and efficacy in humans as potential treatment or prevention” (emphasis added). However, the words in bold are often omitted in public statements, such as in the AYUSH ministry advisory.
All the hype and publicity surrounding Aa30C have set the stage for people to desperately chase what they think is a wonder drug. Clarifications of the type issued by the AYUSH ministry, stating that their recommendation is only “in the general context” or that it is only for “add-on preventive care”, is like water off a duck’s back. Panic-buying of Aa30C has already been reported. News of random, untracked distributions by various agencies and buyers flocking to pharmacies to buy the concoction at inflated prices continue to pour in.
The problem is significant because people are likely to believe that by imbibing this “medicine”, they have just acquired a shield against the COVID-19. A corporator in Mumbai mentioned that some people, when questioned about their being out during a lockdown, said that they had taken Arsenicum album. They believed that they would now be immune to the disease.
Anurag Mehra, Supreet Saini and Mahesh Tirumkudulu teach in IIT Bombay.