Minus 10:23 – The little campaign that could

Also known as 'the mole man' to his friends.

On the first weekend of February this year, anti-homeopathy demonstrations were held in twenty-three cities spread across ten countries. Groups of skeptics took to the streets with a simple message for the public – there is nothing in a homeopathy remedy other than a solvent. No active compounds, no medicinal molecules. Nada.

The 10:23 campaign – so-called for the 6.02 x 10^23 particles in a mole of any substance – focused on the chemistry of homeopathy in an effort to provide the public with a grain of science with which to make a better choice. As a means of attracting interest, many participants chose to ingest quantities of homeopathic remedy in order to emphasise their claim that homeopathy was not like a conventional pill, with active components that increased with dosage.

I’ve written before on the tendency for participants to engage in activism without asking whether it is demonstrably effective. And contrary to how it might seem, I’m actually in favour of such activism, in principle. Grassroots movements have the capacity to bring about significant changes in society, and 10:23 has shown success in achieving significant output. The message is simple and consistent, and the campaign carries media appeal.

However, output is but a small factor, and often risks being a misleading one when used to denote success. Therefore the question is; what factors should activists consider in changing the public’s medical behaviour?

Target acquired

Perhaps an even more fundamental consideration is simply ‘why bother at all?’. Why make the effort to change how others see homeopathy? Why engage in activism at all?

Ethically speaking, it would be difficult to justify wanting to change another’s behaviour for any reason other than an altruistic one. Public confusion over herbal remedies and the pseudoscience of homeopathy might offend rationalist values, but unless it carries some form of public risk, it’s hard to sell as anything but bigotry.

There is a clear case for claiming that irrational behaviour can lead to poor decision-making, creating undesired consequences for those responsible. When a person wants good health and chooses medication presenting a poor risk-benefit ratio, sympathy demands some form of intervention.

In regards to homeopathy, the fact that the medication is nothing more than an innocuous solvent presents close to zero risk for a near zero benefit. Instead, the harm is claimed to lie in the possible inaction of the individual in seeking scientifically supported health treatment. Additionally, it is proposed that homeopathy is strongly associated with sociocultural beliefs that lead to further health decisions that are incompatible with scientifically supported medicine.

In other words, homeopathy is harmful when people avoid treatment that might be more helpful as a result of believing they’re already being treated.

Who’s ‘at risk’?

Identifying members of this subpopulation is tricky to do, especially for a globalised event. Use of homeopathy varies significantly between countries. A survey of the German population found just over one in ten had used it as a medication at least once[1], while in Australia it’s only one in twenty[2]. In any case, this is not necessarily the target ‘at risk’ population, but rather those who have used homeopathy for any reason.

In the United States, 4.4 per cent of the population have reported to rely on alternative medicines to the exclusion of conventional treatments[3]. While I was unable to locate the proportion of homeopathic uses in this specific instance, a report[4] by the National Center for Health Statistics (CDC) and the National Center for Complementary and Alternative Medicine concluded 3.6 per cent of alternative medicine use by individuals in the US over the age of 18 was homeopathic.

In rough terms, that amounts to a possible 500 000 people in the United States who could potentially use homeopathy and not much else to treat their ill health. Of that, it’s hard to judge how many would change their mind when treated with a serious illness.

Of course, that’s a significant number of people, and of those there’s still a real risk of serious illness or even death for some individuals. In European countries, this figure could be far higher. The point is not that such a miniscule fraction of the population is insignificant – it’s that it is an extremely narrow demographic to target, if it’s their behaviour a campaign is to change.

Fighting vitalism with science

The campaign relies on presenting a mechanism for homeopathy as unscientific. The fact that there are no chemically active ingredients in a homeopathic solution is promoted in order to demonstrate that the homeopath’s claims are ‘impossible’. While this is true, there is an unstated assumption that this fact will have an influence (either direct or indirect) on the behaviour of a target demographic.

No homeopath would argue that there are chemically active components remaining in their tinctures. There are two significant schools of ‘mechanism’ explaining why the remedy works in spite of this. One is practically materialistic – the solvent’s molecular properties change in the presence of a solute. The other is vitalistic – an essential force or property from the solute remains in the solvent. Neither is scientifically supported, however neither relies on chemistry as it is conventionally understood.

That means for an individual to accept the efficacy of homeopathy, a belief in textbook chemistry and physics must be superseded by alternative evidence. This alternative evidence appears to overwhelmingly take the form of social influences, with values in ‘holistic’ beliefs and a mistrust of conventional medicine[5].

For a person to merely try homeopathy, however, it takes nothing more than curiosity acting upon the social acceptance of the efficacy of this ‘natural’ remedy.

For the message ‘there’s nothing in it’ to create change, it must resonate with a firm appreciation of the laws of chemistry and physics, to the point that there can be no wiggle-room for the possibility of vitalistic or pseudoscientific mechanisms. In other words, the person must prioritise values in science while being ignorant of what homeopathy truly is.

There is no doubt that a sizeable percentage of the general ‘curious’ population falls into this category. And it is this group who might well be persuaded to put that bottle of diluted diluent back on the shelf.

Yet how likely is it that our target group consists of individuals who prioritise chemistry and physics over vitalism and personal, unblinded experience? Chances are slim.

Another target

Of course, it might not be important to directly target those members of the population who are at the greatest risk from their own choices. Some would patronise them by calling them ‘true believers’, claiming they would be beyond change anyway. By changing the behaviours of the ‘casual curious’ users, the culture of alternative medical use might shift, potentially even affecting the market in ways to reduce distribution and maybe even see the culture itself dissolve.

It’s a crafty idea that would work if the culture and the market were indeed supported by people who prioritised science over essentialism or social beliefs.

Unfortunately, while about half of new users of complementary or alternative medicine are those who are merely curious about trying something different, it’s unlikely that dissuading them would have an appreciable impact on alternative medicine culture or marketing. Just as a small percentage of the population are responsible for the majority of visits to conventional healthcare providers, alternative healthcare is buoyed by a minority of users. A study by the American Medical Association ‘suggests that only 8.9% of the population accounted for more than 75% of the 629 million visits estimated to have been made to CAM providers in 1997[6]’ Changing the minds of nine out of ten ‘casual’ or even potential users, in other words, is unlikely to even dent the alternative medicine culture or industry.

10:23 might have reached a lot of people, but it would be misleading to readily assume this is the same as striking at the heart of the problem. Even if it manages to polarise populations and become a popular event, success can’t be measured in nodding heads.

Is all therefore lost?

Not necessarily. The 10:23 campaign demonstrated that through social media it’s possible for passionate people who embrace scientific values to gather in great numbers for an altruistic cause. As a resource, this is a tremendous asset that could potentially save lives.

The question is, what, exactly, is it targeting? The casual user, or the at-risk population? The average casual user is more likely to misunderstand what homeopathy is and be persuaded by scientific values, but is far less likely to abstain from other forms of medical treatment, using it in a ‘complementary’ fashion. In a best-case scenario, success with this demographic could reduce the pharmacy-shelf purchases of homeopathic ‘cold and flu’ remedies who rely on the confusion between ‘herbal’ and ‘homeopathic’.

Yet to have an appreciable impact on the demographic at risk of making decisions that impact on their health, it pays to understand the cause of the problem being addressed and enact a plan in accordance with it. With few exceptions, most investigations into the reasons why people turn to homeopaths (as opposed to merely using over-the-counter remedies) conclude that some form of dissatisfaction with conventional treatments is involved[7]. Whether it is a poor personal experience with a doctor, undesired side effects from medication, failure of medicine to work or a misdiagnosis, conventional medicine is actively rebuffed for homeopathy.

The 10:23 campaign’s ‘overdose’ publicity required little spin for alternative medicine advocates to subvert to their own agenda, playing on fear of conventional medicine by arguing that homeopathy is not only remarkably effective, it is safe.

What of other indicators? Interestingly, education is positively correlated with use of alternative medicine in general, as is poor health status[8]. Far from ignorance on what medicine is, it is more often a combination of illness being combined with a personal, essentialist philosophy that leads people into alternative medical cultures. Knowing what scientists say is not the same as valuing scientific beliefs, hence repeating the facts is not synonymous with winning appeal in such instances.

Correlations also exist with compatible philosophies such as environmentalism or personal ‘spiritual’ growth, indicating that alternative medicine subcultures are far from discrete social groups. Indeed, research warns against treating the demographic as a homogeneous collective. Hence while target opportunities are indicated through certain correlations, such as attitude towards medicine and personal philosophies, it’s too easy to make generalised assumptions that aren’t strongly reflected in the population, such as education level, socioeconomics and ethnicity.

Where to from here?

For activism to be successful in changing public behaviour, it must resonate with pre existing conditions, or ‘opportunities’. The 10:23 campaign could arguably have succeeded with opportunities in the fraction of the public who act out of ignorant curiosity, and as such might affect ‘casual’ homeopathy use. Those same opportunities are unlikely to exist within populations at risk of poor health decision making, however, which is the demographic most often cited as potentially suffering harm from homeopathy.

Is there a way for activism to impact on this group at all? Are they really just ‘true believers’ beyond help, or is that a simplistic dismissal?

Given the opportunities in this case lie in attitudes towards conventional healthcare and personal ‘sympathetic’ philosophies, any effort to really reduce the harm caused by alternative medicine needs to be constructive in improving the perception of science and conventional medicine, rather than destructive and antagonistic towards irrational beliefs. Stunts that ridicule alternative medicine must give way to presentations that put scientists and medical practitioners in an affable light, that demystify medicine and demonstrate not just its effectiveness, but as a sympathetic community.

It would perhaps be a refreshing and positive angle for future campaigns to focus less on antagonistic tactics, and more on reinforcing positive attitudes towards the role of chemistry and physics in medicine. Connecting the public to the strength of science in decision making is a challenge worthy of a mass of passionate people. And just maybe it might mean homeopathy would one day join humour balance and phrenology as a historical curiosity in our medical past.

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[1] Bücker, B; Groenewold M, Schoefer Y, Schäfer T, (2008), The use of complementary alternative medicine (CAM) in 1 001 German adults: results of a population-based telephone survey”. Gesundheitswesen, 70 (8-9): e29–36.

[2] MacLennan AH, Wilson DH, Taylor AW, (1996), Prevalence and cost of alternative medicine in Australia, Lancet 347 (9001): 569–573

[3] Astin, J., (1998) Why Patients Use Alternative Medicine Results of a National Study, JAMA (19):1548-1553

[4] Barnes, P.M., Powell-Griner, E., McFann K., Nahin, R.L, (2002) Complementary and Alternative Medicine Use Among Adults: United States, Division of Health Interview Statistics and National Center for Complementary and Alternative Medicine, National Institutes of Health

[5] McIntosh C., Ogunbanjo, G.A., (2008) Why Do Patients Choose to Consult Homeopaths? South African Family Practice, Vol 50, No 3

[6] Wolsko P.M., Eisenberg, D.M., Davis, R.B., Ettner S.L., Phillips, R.S., (2002), Insurance Coverage, Medical Conditions, and Visits to Alternative Medicine Providers – Results of a National Survey, ARCH INTERN MED, Vol 162 pp 281

[7] McIntosh C., Ogunbanjo, G.A., (2008)

[8] Astin, J., (1998)