The 180

Why this infectious disease expert is studying nosodes

Nosodes are homeopathic preparations made from bodily tissues and fluids. And according to skeptics, they have no therapeutic value. But at least one researcher say there is simply no science to validate or reject nosodes. Mark Loeb of McMaster University is setting out to test their real utility.
Dr. Mark Loeb at McMaster University has just launched a study to research nosodes - a homeopathic treatment - on human immune response. (Melanie Glanz/CBC)

Like a lot of doctors who support the science behind vaccines, Mark Loeb, a professor of pathology and molecular medicine at McMaster University, doesn't think nosodes can prevent against infectious disease. 

Nosodes are tiny white pellets that contain ultra-diluted forms of diseased tissues and bodily fluids. They are touted as alternatives to vaccines by homeopaths and naturopaths. They have also been heavily criticized by public health experts and doctors. A position statement from the Canadian Paediatric Society in 2015 says nosodes are no replacement for vaccines. 

There is scant evidence in the medical literature for either the efficacy or safety of nosodes, which have not been well studied for the prevention of any infectious disease in humans.-Canadian Paediatric Society position statement, May 2015

Loeb is currently leading a research study on the impact of nosodes on human immune response. 

But the study has garnered criticism both in blogs and mainstream media

The 180 spoke to Mark Loeb about his study and the criticisms made of it. Below is a lightly edited and condensed version of his conversation with Jim Brown. 

Before we get to your study, let me ask you what is the current state of research on whether nosodes work? 

The current state is not very advanced. I mean the clinical studies that have been done on nosodes have been limited in terms of their rigour. So there have been studies that have showed effectiveness on certain pathogens like influenza, but they really haven't been rigorously done. There have been some studies in animals suggesting an immune response - but again not very credible studies. 

How will your study work? 

I just want to give you some context for why we're doing this. Although the majority of parents vaccinate their children, some parents are increasingly questioning the need for vaccination. And because there are these alternatives proposed by naturopaths and homeopathy, we felt there is a gap because there is no credible study that's actually looked at their impact on the immune system. Just to be clear, our hypothesis is not that these nosodes are going to have a great impact on the immune system - we think there will be no difference between these and placebo. Of course we will also have an arm of the study where there is a conventional vaccine, which we think will have a rigorous and robust response to the immune system. So the context of why we're doing this is that there are ongoing studies of using these products in populations, often published in homeopathic journals suggesting a great impact, but no one has looked at the mechanistic basis. 

So how have you designed the study?

Well we've taken a group of participants, 18-24 years old who should have had a booster and we're randomizing them. Each participant is randomized to one of three groups — either they will receive a nosode, or a placebo, or a conventional vaccine, — and we measure the immune response. At the end of the study, we offer everyone their booster — which is advised. Everything is blinded. 

Your study hasn't even concluded yet and it's already being criticized. The concern is that you're legitimizing homeopathy - something that been debunked as nothing but placebo. How do you respond to those concerns? 

Well I'd respectfully disagree. People have likened it to "studying flying carpets" but the fact of the matter is that Health Canada isn't licensing flying carpets. Health Canada is licensing nosodes. Each one of these nosodes has a DIN number and they're referenced with supports from homeopathic literature and doses provided by Health Canada. We think instead of ignoring it, we should shine a light on it and do it in an objective manner - the most rigorous of study which is a placebo blinded randomized control trial. 

What about the ethics of this? Is it ethical to study something you know doesn't work? 

First of all, we're not using these to prevent or treat an illness. What we're looking at is a mechanistic response. We've looked at the literature and if there were even one or two studies that have done this before then obviously we wouldn't be doing this. But there's a total gap, there's nothing out there. So we feel that providing the evidence for this would help substantiate the fact that people should not be doing any further clinical trials — if in fact our hypothesis is right and I think it will be.  Going backwards, it would give a context for the prior trials that some people are citing. It's not unethical at all - it is ethical to do this. We're not measuring pixie dust, we're measuring antibodies. 

If at the end of your study, you find your hypothesis is correct that nosodes don't prevent against infectious disease - how optimistic are you that people who don't vaccinate or are skeptical about vaccines will change their mind? 

To us, it goes without saying that individuals who have strong beliefs about vaccines or homeopathy will not change their minds. But that's not the target. Health Canada is licensing these products and it's really important to feed back these results to them to say this is the scientific basis for what you're licensing. And there are parents on the fence, who read anti-vaccine blogs and with this rigorously conducted study, this could help them make their minds up. 

But are you concerned at all that the very fact of your study would be circulated by the anti-vaccine bloggers and be used to prop up their argument? 

No I don't think so because if you look at it Jim, are we really doing a good job against vaccine hesitancy right now? No. The anti-vaccine lobby is actually increasing so I don't think putting this under the rug is the way to go. We want to shine a light on this. 

It almost seems like you're under fire from both sides on this. Did you imagine you'd find yourself in this situation when you decided to study nosodes? 

No, not at all.  I was surprised, specifically [by the criticism] from the debunking community, but it's a philosophical disagreement. I think it's important to show with science that there is no basis for this, rather than to just keep blogging about it — to me that causes the opposite reaction than what they're hoping to achieve.