Homeopathy is among the most ridiculous of so-called "complementary and alternative medicine therapies." I realize that I've made this point over and over and over again, but it bears repeating because, no matter how often homeopathy is shown to be utter and complete woo, homeopaths always seem to bounce right back, Gish galloping between the bullets of science in order to repeat the same unsupportable claims, nonsense about the "memory of water," and comparisons of homepathy to vaccines. Another reason that homeopathy is an excellent example to discuss is because--well, let's face it--it's nothing but water or ethanol, depending on the diluent the homeopath decided to use to dilute his remedy into nonexistence, sometimes with some sugar if the homepath decided to put his diluted magic into pill form.
Just to review, in case you're not a regular reader and don't already know what homeopathy is, homeopathy operates according to a couple of main precepts: first, that "like cures like (a.k.a. the law of similars), which states that, to relieve a symptom, you choose a remedy that causes the symptom. Never mind that this concept is far more akin to sympathetic magic than anything backed up by science, which shouldn't be surprising given that homeopathy is based on a prescientific understanding of disease. The other principle is known as the law of infinitesimals, which states that the more a remedy is diluted, the more powerful it becomes. Part of this principle is that the remedy must be vigorously shaken between dilutions or the magic doesn't work. Homeopaths will solemnly tell me that dilution alone isn't enough and that shaking "potentizes" the solution. It's all nonsense, of course. There's no scientific reason to think that the law of similars is a generally applicable law in biology and even less reason to suspect that the law of infitesimals is anything other than pure magical thinking. After all, a typical homeopathic dilution is 30C, which requires diluting the solution 1:100 thirty times, or a total of 1:1060. Given that Avagadro's number is on the order of 6x1023, we're talking on the order of 1037 times more dilute than what would be expected to have one molecule of original remedy left.
Thus endeth the review.
One thing that I find particularly irritating about homeopaths is that they will not infrequently claim that homeopathy is very much like vaccination because, you know, vaccination is a validation of "like cures like." Sometimes this misunderstanding leads them to make truly dangerous claims, such as advocating homeopathy as a preventative strategy for pandemic influenza. Some even go so far as to claim that homeopaths did better treating people with influenza during the pandemic of 1918. Apparently homeopaths don't just limit their idiotic claims of "homeopathic vaccines" to influenza. In fact, apparently, if the homeopaths are to be believed, homeopathy can prevent or treat HIV/AIDS, malaria, and a wide variety of other diseases.
Diseases like leptospirosis.
I hadn't realized that Cuba was into homeopathy, but, if a press release sent to me by a reader is any guide, the Cuban government is seriously into homeopathy:
Homeopathic immunization against Leptospirosis in Cuba has resulted in significant reduction of disease incidence, prompting the Cuban government to focus more on homeopathy medicine in disease prophylaxis.
Leptospirosis is a zoonotic disease which is endemic in Cuba. It usually worsens during the hurricane and high rainfall seasons from October to December each year when the infection is spread via infected water, although rodent urine will also carry the disease.
The press release concludes:
Dr. Manish Bhatia, CEO of Hpathy.com, world's leading homeopathy portal said that it is clear that the Cuban initiative in safe, effective, and low cost infectious disease prevention, making the Cubans world leaders in this area of immunization and this study will be followed with great interest by both practitioners and public health scientists around the world.
Wow! Odd that I hadn't heard of this before! The writers of the press release were even kind enough to provide me a link to the "study" that allegedly shows the extreme efficacy of homeopathic vaccination against leptospirosis by a homeopath named Isaac Golden teamed up with a guy named Gustavo Bracho entitled Homoeopathic Immunisation Against Leptospirosis in Cuba.
Leptospirosis is a disease caused by the spirochete Leptospira (a bacteria similar to the kind that causes syphilis) that is carried by rats and other rodents. The disease resulting from infection by this bacteria can result in complications that include meningitis, extreme fatigue, hearing loss, respiratory distress, azotemia, renal failure, and often liver failure. In general the spirochete is transmitted in the urine of infected animals, most commonly rats, mice, and moles, although a wide range of other mammals can carry the disease, including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, possums, skunks, and certain marine mammals. It turns out that Cuba has a problem with leptospirosis. Every year after the summer and fall hurricanes, rats can be swept out of the sewers, and many more people come into contact with water containing the spirochete.
Leave it to Le Canard Noir to have reported on this nearly two years ago. However, the latest "publication" (if you can call it that) appears to be an update of the fevered reports from 2008 claiming that homeopathic vaccination had prevented leptospirosis outbreaks. Homeopaths had published some of this "data" (and I do use the word loosely--very, very loosely) in--surprise! surprise!--the journal Homeopathy. This study has been utterly demolished. True, the very fact that the article was published in Homeopathy should almost have been enough to scuttle it. After all, if the homeopaths had really had results that would stand up to scientific scrutiny, they could have gotten into a better journal. In any case, my university wisely does not subscribe to this journal, meaning that I don't have access to the actual original paper; that is, unless someone wants to send it to me. I don't want to reinvent the wheel anyway; so let's move on to the new "study" instead.
The first thing I noticed in this article is that it is woefully lacking in description of exactly how this "study" was carried out. However, if we look at the descriptions linked to above of the previous "study" of this issue, it's possible to determine that the homeopathic remedy used was made from four different Leptospira species, specifically L. interogans Serovar Canicola, L. interogans Serovar Copenhageni, L. kirschneri Serovar Mozdok, and L. Borgpetrsenii Serovar Ballum. Oddly enough, the homeopaths stated that the bacteria used as the "mother tincture" to make the homeopathic remedies used were inactivated. I'm not sure why they would use inactivated bacteria. After all, the inactivated bacteria wouldn't cause the symptoms of Leptospirosis anymore, thus violating the homeopathic principle of "like cures like," unless, perhaps, they were injected, in which case the homeopaths might be making a real vaccine. Speaking of a real vaccine, from my reading, I've learned that apparently Cuban doctors have managed to make an actual effective vaccine against Leptospirosis. It's unclear why Cuban officials wouldn't just go with that, except for a mention in one of the homeopathy studies that Cuba can't make the vaccine in adequate quantities.
Nice. If you can't provide sufficient real medicine for your citizens, give your people fantasy medicine instead.
And fantasy medicine it is! Remember how I talked about a typical homeopathic remedy being a 30C dilution? The homeopathic "vaccines" apparently reached truly mind-boggling levels of dilution, if the secondhand reports of the "study" I've read are any indication. For example, the most concentrated remedy used was apparently 200C, which is a 1:10400 dilution. but even that isn't the most diluted remedy used. Apparently the "stronger" homeopathic remedy used was a 10 MC remedy, which is basically 10,000 C, or a 1:1020,000! How one does 10,000 serial dilutions and then administers the resulting tincture to hundreds of thousands of people, I just don't know. It sure seems like a hell of a lot of tedious work for no gain, the proverbial long run for a short slide. If you're going to go to that much trouble, why not just put the resources into making the real vaccine? I know, I know. That's just me and my nasty reductionistic "Western" thinking. Wait a minute. Scratch the whole thing about "Western." After all, homeopathy is a distinctly "Western" woo, given that it was dreamed up in Germany over 200 years ago.
In any case, the homeopaths behind this update to their "homeoprophylaxis" study claim that they have treated 2.5 million people and that the results were a dramatic decrease in the incidence of leptospirosis. The most recent update sets the stage for further claims:
The three eastern regions of Cuba, Las Tunas, Holguin and Granma (IR = Intervened Region) usually have a much greater incidence of the disease per head of population than the rest of the country (RC) as is clear from Figure 1 which shows the average weekly incidence of leptospirosis for 2003-2006 in IR (2.4 million people) and RC (8.8 million people), weighted per head of population figure for both regions (Average x population in Cuba/population in region).
In both 2007 and 2008 the RC was hit by severe hurricanes. In 2007 the Cuban Government, through the Finlay Institute which manufactures most vaccines used in Cuba, decided to homeopathically immunise the bulk of the population in IR due to a severe spike in the incidence of the disease.
This figure shows the typical incidence of leptospirosis in Cuba in the IR and RC from 2003-2008:
This next graph shows the weekly incidence in 2007, the year the homeoprophylaxis was tried out, the arrow indicating when the homeoprophylaxis began:
The claim? This:
2007 was already a worse than average year for residents of IR, and became dramatically so following the hurricanes. However the outbreak "broke" in IR in Week 47, 2 weeks following the HP intervention, although it continued in RC where there was no intervention.
My first thought was: WTF? How on earth could they say that? The patterns of incidence in IR and RC were radically different, with the IR having a spiking pattern that was highly variable. The homeopaths began their "vaccination" campaign right before the peak of the largest spike in the fluctuating pattern and then claimed credit for the "breaking" of the outbreak, even though it would be expected that there would be a drastic decline in incidence right after the peak, just based on the pattern of previous years in the recent past, yet this is what they try to do here, graphing leptospirosis incidence versus "predicted" incidence:
The modeling of the leptospirosis incidence in this graph is, as you might expect, not well explained. Even so, leptospirosis incidence is highly variable. In fact, it would be nice to see a longer timeline for leptospirosis incidence, because to me what this graph suggests is that the years 2006, 2007, and 2008 were the anomalies, with 2009 returning leptospirosis incidence back towards historical patterns. As our friend Le Canard Noir points out, it's highly dependent upon hurricanes, rat populations, and public health measures. It's a disease that can vary widely from year to year. Moreover, Cuban officials were undertaking other interventions to try to decrease the rate of leptospirosis infections, including real vaccination of high risk workers (such as sewage workers and others exposed to contaminated water), campaigns to eradicate rat populations that carry the bacteria, and public education efforts. Even if these efforts weren't in effect, given the wide variation in leptospirosis infection incidence from year to year, you can't assume that your intervention was responsible, particularly given that there was no control group and no attempt to estimate what the baseline endemic incidence of leptospirosis is other than to assume that the last three or four years are representative of long term trends. Basically, as Le Canard Noir put it almost two years ago:
So, is there evidence that the homeopathic experiment worked? Of course not. Accounts from the conference suggest that there were merely 10 infections per month and no deaths. Can this be attributed to homeopathy or the other health measure in effect? We will not know until a paper is published. But here is my prediction: it will basically say, we dished out the magic water and brandy, we saw a small amount of infection, we concluded it woz the homeopathy wot did it. No control groups. No baseline. Just assertion.
Damn that little black duck is good. He predicted it. What we have is our old friend John Benneth (whose Science of Homeopathy website is a hoot) saying just that:
I have to thank old John for one thing. He points out that it would have cost $3 million to produce enough real vaccines to immunize the population, which, it occurs to me, would be pretty damned cheap--only around $1 per person! The homeopathic "nosodes" cost a mere $200,000, which should not be surprising, given that homeopathy nothing but water. In any case, it sounds to me as though the Cuban government cheaped out, pulling a Mao, so to speak. You may remember that in the 1960s, Mao, seeing that he didn't have the resources to provide adequate science-based medical care to his people, unleashed his "barefoot doctor" campaign, providing cheap traditional Chinese medicine to the masses, rather than science-based medicine, in order to give the appearance that he was providing needed medical care to his people, particularly out in the rural regions, which really lacked doctors. It looks to me as though, if this story is true, Cuba just did the same thing with homeopathy.
Same as it ever was.
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By that token, I would then have evidence that my weekly flu reports cause the flu each year, since the flu appears right around the time I start publishing them... And then my report for week 10 cures it, since it starts going away around that time.
I cause and stop the yearly flu epidemic! (Tongue-in-cheek, of course.)
John Benneth (with an H at the end) creeps me out, by the way.
Like RenÃ© (above), I had no idea that post hoc, ergo propter hoc was a valid way of determining causation. I am now experiencing agaonizing guilt, as I am responsible for winter! I change my tires over to snow tires, and within a few days-to-weeks the country is blanketed in snow.
I'm sorry for the inconvenience, but I can't just stop doing it - there are so many people who like skiing and skating and building snow forts that I feel I must continue. I'll ensure that I stick to putting them on toward the end of the calendar year, and I'll try to remember to put the all-seasons back on before May hits.
Cuba went all-out on a preventive medicine campaign ... "[as of] 2001, a total of 1,730,632 people exposed to a risk of this disease had been vaccinated." ... Incidence rate decrease from 25.6 x 100,000 in 1994 to 4.7 x 100,000 in 2001. So look what vaccination of the most exposed people can do!!! Ain't medicine great?
That, and general sanitation and rat control and better water supplies.
Having each health care worker who gave the homeopathic remedy also deliver the prevention talk could account for a drastic decrease too.
The Homeopathy paper has already been used in an advertising campaign in the UK. See the New Statesman "Social care: who pays" report, published last month (go to page 15 of the pdf document):
"In Cuba an integrated approach to healthcare has led to homeopathy being used to enable 2.3 million people, including the elderly, to be cheaply and effectively protected against endemic Leptospirosis."
Readers who have encountered homoeopathic arguments before may spot a few more familiar points.
I would really like to see Cuban sources for this. I can imagine them using the "homeopathy" in order to give people some confidence, but I can't find anything about this in the big Cuban newspapers. Generally the Cubans rely heavily on vaccination.
I strongly suspect that that press release isn't any guide at all. Not having much luck searching in Spanish, but finding scientific articles (including a translated one from Steven Novella) on RebeliÃ³n.
Reminds me of the homeopathy-for-leptospirosis-in-mice study where 100% of the infected mice died, 100% of the vaccinated mice lived, but the ones who got homeopathy took, on average, slightly longer to die. This was touted as a great success for homeopathy.
It is a very strange mindset. However, it is very compatible with the sort of government they have in Cuba. I wonder if a majority of scientists there don't get so used to the need to produce propaganda (which, I'll note, doesn't actually mean "lies" -- it just means stuff that fits a desired narrative, which is much slippier than outright lies) that they gradually begin skewing their own research more and more to producing the right output, with any actual science being little more than a nice bonus.
Cuba has a very effective system of medicine/public health.
When my father (definitely not a lefty) visited Cuba several years ago he described it a as a second and a half world country with the universal health care and education being what kept it above third world status.
I suspect this homeopathic nonsense is a result of homeopaths taking advantage of a gullible government official.
Callie, I think you may be influenced by your government's and the right wing noise machine's propaganda about Cuba. They may not do well on free speech etc., but they have done a fairly good job of meeting basic needs although their infant mortality rate is almost as high as the US.
You make a good point, re: Cuba's health care quality. IIRC, their morbidity and mortality numbers are pretty similar to the U.S., overall, but total spending on health care is significantly less (mostly due, I think, to differences in tech level - simple beds vs. beds with fully integrated electronics and monitoring equipment, for example).
SC and MA, you misunderstand me. Cuba does a decent job of providing universal health care and meeting basic needs. (In many respects, better than we do.) But when it comes to doing actual science, they don't do as well. I was just speculating there could be a cultural effect going on among the academia. Funded for years by a propaganda machine, they may have begun to put results before process. It certainly would not be the first country in which such a thing happened.
To clarify: I am not commenting on their medical care, but on their science.
By the way, by taking my comment out of context, one might think "a very strange mindset" was meant to refer to Cubans. It wasn't. It was meant to refer to pseudoscientists who produce work to support homeopathy. These do also exist, in much greater numbers, outside of Cuba, so please do not take this as some sort of jingoism.
Cuba has a very effective system of medicine/public health.
Not to forget education. A large proportion of cubans are college-educated. The problem is that educated work is not well paid over there - the most lucrative work can be found in the tourist industry, which means that the guy who makes your margaritas may be an engineer - that is kind of sad.
I visited cuba last year - being canadian, I can go whenever I want. Our cuban tour guide commented that most cubans get everything they truly need, even if everything is lacking, especially luxury items like cars. Most recent cars are state-owned. Milk is a rarity because the little that is produced is reserved for children under 7.
He was too young to remember time before the revolution, but had been told by relatives that before, a large proportion of the cuban popuplation was starving, which is not the case today. In cuban schools everything is provided to all children, including uniforms. He didn't seem falsely enthusiastic or anything - he obviously knew that if he lived before the revolution he'd have a lot more than what he has now. But he was also conscious that a lot of people would have much less.
Cuba is no utopia, but it's no third world country either.
Based on what? Your comment, beginning "Reminds me of the homeopathy-for-leptospirosis-in-mice study...," was confused. What reminds you of that? Did your comment refer to Orac's post? If so, you're going by a questionable source (not Orac - the press release), which even if it were true would be decribing an anomalous program, apparently viewing it as somehow representative of medical science or science in general in Cuba, and then speculating as to the "cause."
One of the saddest articles I've read was by a Cuban historian (from years ago) about the history of anarchism in Cuba. The author was so clearly trying to convey the history accurately while conforming to the party line. But I haven't seen anything to indicate that this is a problem in Cuban medical science, or that this homeopathy nonsense, if true in the sense that the Cuban public health system was involved, is anything but an aberration in a strong system of medical science and provision with limited resources. (Note Orac: "Cuban doctors have managed to make an actual effective vaccine against Leptospirosis.")
I'm going to give up now; it is clear that you have a certain idea of what you think I meant, and I do not think I am going to be able to correct that. I have inadvertently caused offense, and it's hard to set things straight after that.
Not at all (in my case, at least)! What you're suggesting isn't unimaginable in such a political context. It's just that it's not at all what I understand to be the case with Cuban medicine, and this would be an aberration. Given that particularly but also in general, I don't trust that press release concerning the Cuban government's involvement.* If there's even a grain of truth to the claim, I suspect it's closer to what someone suggested above: they managed to get some official to let them attach themselves to some real efforts. If not and official public health agencies in Cuba were knowingly part of this, it would mark a distressing turn (as elsewhere), but I haven't yet seen good evidence of that.
*Or, of course, concerning anything else.
30C?? Let's see... Avogadro's number is 6*10^23 and there are 1.4*10^18 cc of water on Earth (1400 km^3, 97% of which is sea water). If you start with 10^20 molecules of pure "medicine", by dilution alone (and assuming you can achieve equipartion at every step and all the water is distilled), the original solution is 1 cc and a "dose" is also 1 cc, the maximum dilution achievable seems to be just over 9C, which works out to ~70 molecules per cc using all the water on Earth. The calculation is scalable to other quantities.
Therefore if a homeopathic medicine is claimed to be 10C strength or greater it must be false advertising. Or the original solution was deficient in the active ingredient, filtration other than dilution was employed during production or they've been mining the Oort cloud to increase the available water supply.
Sorry. Error in my previous calculation. Actual amount of water on Earth is 1.4*10^24 cc (missed that factor of a million somehow). Guess that gives a maximum strength of 12C, not 9C. And rather than 70 molecules per cc, you would most likely have none at all in the majority of doses, just as Orac said.
ron you don't have to dilute the entire sample. Presumably they take an aliquot of each dilution and use it for the subsequent dilution :p
Likewise, when I make 10^-7 dilutions of bacterial cultures for plating I don't take the entire 5 ml culture and add it to 495 ml of PBS then take that 500 ml sample and add it to 49.5 l of PBS etc.
The real lepto vaccine was made by the Findlay institute (named for a Cuban involved in the discovery that mosquitoes spread Yellow Fever). They followed the normal processes for testing the vaccine and published their results. Unfortunately, it was expensive to make.
Surprisingly, the homeopaths also worked at Findlay. They never properly tested their remedy, but gave it to everyone. Total cost was about $200,000. The only publication of their results was in 2010. Earlier, they had given a presentation of their work at a conference in Cuba.
I have hypothesized for some time (and may have commented here before) that when governments bear the costs of health care, they have a financial incentive to spend as little as possible, while appearing to deliver care. They may opt for homeopathy as it costs less than effective treatment, but appears to be a treatment to the populace. Effectiveness only enters into the equation when total cost (i.e. sequelae)are considered. If failing to treat a condition resulted in additional costs that exceed the cost of the effective treatment, then the government would have an incentive to spend the money on an effective treatment initially.
That's an expected concentration of 1 part per 200 googol, which is 250 orders of magnitude greater than the total number of fundamental particles in the observable universe!
How can one seriously claim such extreme dilutions have any meaning beyond magic and vitalism?
If only we could make homeopathic preparations in a googolplex dilution, we could live forever!
A new video on the making of homeopathic vodka.
JohnV, yes but I assumed that they wouldn't use your approach since they wouldn't want to discard any active ingredient. In your (very sensible) technique, you are perfectly justified in casting aside part of the culture to reach your dilution objective. However, taking that approach a homeopath would in effect be cheating since that is equivalent to not putting the active ingredient in to begin with. The poor water won't have anything to remember! Theirs is a ritual, not science.
Just to play along for a moment: Why sucuss at every 100 fold dilution? If one sucussed at every 1000 fold, would that be a stronger or weaker preparation? Conversely at every 10 fold? Should it even be a round number? Couldnt the optimum method be to sucuss at every 62.7 fold dilution? What about the strength of sucussion? We know Handelmann suggested against a bible: What about other books? Might it be simply any leather-bound book? Can one sucuss too hard? Too soft? Do sucussion methods differ if alcohol is used instead of water?
These are the sorts of questions that I would ask, if I believed in homeopathy. Yet there doesnt seem to be much discussion of them in homeopathic circles. (at least the ones I find on-line.)
ron, the video I posted shows how it is done.
That hypothesis has some appeal (which doesn't mean it's true in a specific case) any time the person/entity bearing the costs and making the decisions isn't the one benefiting.
And I can't even threaten to vote against the health insurance company selected by my employer.
Mark Crislip covered this topic as well in his last Quackcast podcast.
Mark Crislip covered this topic as well in his last Quackcast podcast.
Powerful homeopathic cure for a hangover: Vodka, serially diluted with pure ethanol in a 100C preparation. Drink 4 oz, over ice, lemon wedge optional. Can be mixed with carbonated water.
...successed, not stirred.
Whatever its correctness in other cases, it's very unlikely to be true in this specific case. Medicine and public health are immensely important in Cuba, both to the government and professionals (Cuban doctors travel to other poor countries to work, and they welcome foreign observers) and as a genuine source of national pride (and possibly loyalty). There's of course a propaganda aspect - which requires real results - but it goes beyond this, I think. There are intrinsic and external benefits to good medicine.
That's Finlay Institute, not Findlay.
Carlos Finlay was a physician well-known for his work on transmission of yellow fever.
Arthur Findlay had the "Worlds Foremost College for the Advancement of Spiritualism and Psychic Sciences"
I have been dredging various Latinamerican websites and search engines and I'm not finding anything about this homeopathic study.
Cuba's results are absolutely fantastic when you look at the resources available. They are 3 places better than the US on infant mortality, and only 4 places worse than the US on total life expectancy (per the CIA factbook).
And I've read wonderful things about their women's health programs, esp relating to breast cancer - but that was a while ago. Just shows what you can do when you set your mind to something even if you have very little money to work with.
Homeopathy. it's just frakkin water.
I get annoyed every time I go to the drug store and see homeopathic bollocks on a shelf next to the real medicines.
Re Cuba and it's medical services:
Cuba has very good rates of provision, with almost no one going untreated through oversight. They also have very good vaccine uptake records and a good preventive medicine programme otherwise. What they haven't got is a lot of first rate medical equipment.
I've visited a couple Cuba hospitals and the woo is strong there. They should us pyramids they use for pain control, magnet therapies (not the real kind), and various other silliness.
Though in the case of Cuba they simply cannot get the real drugs and equipment they need, due to the embargo. If putting a pyramid over a person gives them some level of placebo based relief, its hard to be too critical when it is basically the only thing they have.
Cuba does have a pretty good health care system, just one that suffers from chronic supply shortages thanks to an inability to import what they need.