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Do you think I don’t understand the hydrostatic paradox of controversy? If you had a bent tube, one arm of which was the size of a pipe-stem and the other big enough to hold the ocean, water would stand at the same height in one as in the other. Thus discussion equalizes fools and wise men in the same way, and the fools know it. O. W. Holmes. The Autocrat of the Breakfast Table (1)
THE HYDROSTATIC PARADOX has never been so well illustrated as by current discussions of alternative medicine and its poster child, homeopathy. Hahnemann’s system, a therapeutic regimen unchanged since the Age of Mesmer, is making a comeback in the Age of Oprah. In 1810, Hahnemann (1755–1843) rebuked Enlightenment medicine in an over-ideational treatise called The Organon of the Rational Art of Healing:
The partisans of the old school of medicine flattered themselves that they could justly claim for it alone the title of ’rational medicine’, because they alone sought for and strove to remove the cause of disease ... [but] the greatest number of diseases are of dynamic (spiritual) origin and dynamic (spiritual) nature, their cause is therefore not perceptible to the senses. (2)
Not content to play the spiritual card, Hahnemann took swipes at the science of his day. Anatomy, physiology, and pathology, he argued, presented only "dim pictures of the imagination." Since disease was not caused by any discrete physical agent, but to man’s lack of harmony with the "vital force" of nature, he asked "Has any one ever succeeded in displaying to view the matter of gout or the poison of scrofula?" (2)
More than a century after crystals of monosodium urate were shown to be the matter of gout by Garrod, and the poison of scrofula was found to be M.tuberculosis by Koch, homeopaths still believe that Organon’s vital force of nature is at the root of gout and TB (2)
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A PRINCE AT WAR WITH SCIENCE
In May 2006, Prince Charles addressed the World Health Assembly in Geneva to argue for homeopathy and its kindred therapies. He urged a return to remedies "rooted in ancient traditions that intuitively understood the need to maintain balance and harmony with our minds, bodies and the natural world." He complained about modern biomedicine: "It seems to be that in our ceaseless rush to modernize, many tried and tested methods which have shown themselves be effective have been cast aside as old-fashioned or irrelevant to today’s needs." News flashed around the world: "CHARLES AT WAR WITH DOCTORS." (3)
The Prince of Wales, whose oddball habit of "talking to plants" is widely mocked (4)
, has been at war with medical science for some time. In 1985, he caused a stir by warning the British Medical Association that "the whole imposing edifice of modern medicine, for all its breathtaking successes is, like the celebrated Tower of Pisa, slightly off balance." Last year, he funded a commission headed by a bank executive as lacking in scientific credentials as the Prince himself, to "look at the effectiveness, especially from a financial point of view, of integrated healthcare." (6)
The commission claimed that up to 480 million pounds could be cut from the prescription drugs bill of Britain’s National Health Service if 10% of primary care physicians offered homeopathy as an alternative to standard drugs. Of course, had 20% of the docs offered rose water to their patients, Britain could have saved a billion pounds.
British science struck back. Anticipating Prince Charles’s sermon in Geneva, thirteen of Britain’s most eminent physicians and scientists issued a widely quoted "Open Letter: Use of ‘Alternative’ Medicine in the NHS" (7)
. The letter expressed concern over "ways in which unproven or disproved treatments are being encouraged for general use in Britain’s National Health Service." The signatories, who included three Fellows of the Royal Society, one Nobel Laureate (Sir James Black, FRS) and the son of another (Professor Gustav Born, FRS), cited the overt promotion of homeopathy by the NHS, including its official website. The Open Letter warned that "it would be highly irresponsible to embrace any medicine as though it were a matter of principle." Their position was supported by an extensive meta-analysis of the efficacy of homeopathy in The Lancet which documented that homeopathic regimens were no better than placebo for a wide variety of ailments (8)
. The Open Letter also concluded that homeopathy "is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness." They should know: Sir James’s highly effective beta-blockers and H2 antagonists have kept more humans alive than any integrated crystal therapist, and if Gustav Born hadn’t worked out platelet aggregation, we’d have missed the aspirin effect in heart disease.
As for the Prince’s "financial point of view," Professor Michael Baum, another of the signatories, noted that Britain had spent 20 million pounds refurbishing the Royal Homeopathic Hospital. Had that sum of money been spent on making available herceptin and aromatase inhibitors, it could saved 600 lives a year in one health district alone (3)
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Prince Charles was unfazed—on the day the Open Letter was published, he stopped at St Tydfil’s Hospital in South Wales to watch alterative medicine at work. He accepted a "spiritual" crystal, as if he were Albus Dumbledore, headmaster of Hogwarts School, accepting the Philosopher’s Stone. Unlike Dumbledore, however, who only professed witchcraft and wizardry, Prince Charles called up every form of "integrative therapy" against Alzheimer’s disease (9)
. One notes that when Prince Charles and other fans of unproven or disproved medical practices use terms such as "integrated therapy" or "alternative medicine," they’re following the lead of creationists who hide under the term "intelligent design"—these are all convenient slogans that permit the credulous to con the gullible.
HOGWARTS IN BETHESDA
The Prince’s activities have not been limited to the UK. In 2003, he authorized his US charity to fund a research fellowship at NIH’s National Center for Complementary and Alternative Medicine (NCCAM). This unusual gift to an agency of the US government came after a private dinner at St. James’s Palace to which the Prince and Camilla Parker Bowles had invited the clinical director of NCCAM, Marc Blackman, his wife, and like-minded guests "to discuss ideas and visions for complementary medicine." (10)
The NIH seems happy with research on homeopathy and kindred therapies. Its website replies "yes" to the question "Is NCCAM funding research on homeopathy?" while admitting that "Homeopathy is an area of complementary and alternative medicine (CAM) that has seen high levels of controversy and debate, largely because a number of its key concepts do not follow the laws of science (particularly chemistry and physics)." (11)
The Center has expended much of its 120-odd million dollar war chest to fund studies on chelation therapy, black cohosh, mushroom-induced immunopotentiation, and homeopathic dilutions of cadmium for prostate cancer. It recognizes and explains in detail therapies based on "the life force" variously called "qi," "ki," "dosha," "prana," "etheric energy," "fohat," "orgone," "Odic force," "mana," and "homeopathic resonance." (12)
Never mind the laws of chemistry and physics: this sounds like a final exam at Hogwarts!
However, when it comes to homeopathy, NCCAM is careful to issue a disclaimer: "It has been questioned whether a remedy with a very tiny amount (perhaps not even one molecule) of active ingredient could have a biological effect, beneficial or otherwise." Nevertheless, NCCAM has contributed $250,000 towards a clinical trial of "verum LM" (a homeopathic medicine diluted 1:50,000) for fibromyalgia at Dr. Andrew Weil’s Program in Integrative Medicine at the University of Arizona. Weil is the guru who in a 1986 book, Health and Healing announced that "Sickness is the manifestation of evil in the body." (13)
Hahnemann redux, one might say. Since many rheumatologists believe that "fibromyalgia" is simply a euphemism for a variety of medicalized miseries (14)
, it was not unexpected that Arizona’s integrators found useful a remedy that may or may not contain one molecule of active ingredient for a disease that may or may not exist (15)
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DILUTIONS OF GRANDEUR
In 1834, Dr. Oliver Wendell Holmes, poet, essayist, and Professor-to-be of Anatomy at the Harvard Medical school, returned to Boston from study in Paris with microscope in hand. He was convinced that French quantitative science would find a new home in the city, which he christened "the Hub" of the universe. But Boston in 1834 had permitted curious forms of the healing art to flower and Holmes was appalled. By 1842, he had had enough and wrote the definitive critique of the practice: "Homeopathy and its Kindred Delusions." He found that homeopathy was "lucrative, and so long as it continues to be will surely survive, —as surely as astrology, palmistry and other methods of getting a living out of the weakness and credulity of mankind and womankind." (16)
Holmes’s arguments hold today and are worth re-examination. Hahnemann’s Organon lays down three proposals that have become laws to his followers: the "Law of Similars," the "Principle of Minimum Dose," and "Prescription for the Individual." (17)
Individual prescription seems harmless enough and one can give Hahnemann a pass—the other two are worthy of Hogwarts.
The Law of Similars states that "The principle that like shall be cured by like, or Similia similibus curantur." If a substance produces symptoms of illness in a well person when administered in large doses; if we administer the same substance in minute quantities, it will cure the disease in a sick person. Nonsense—arsenic poisoning produces bloody diarrhea and minute amounts of arsenic (as in the drinking water of Bangladesh) don’t prevent shigellosis.
NCAAM demurs: "It is debated [sic] how something that causes illness might also cure it." (11)
Yes, but only in the sense that there is a scientific "debate" between those who hold the theory of evolution and those who believe in intelligent designs. NCCAM may be said to be "teaching the controversy" between the laws of chemistry and physics and the cult of the Organon.
Now for the Principle of Minimum Dose—it turns out that most homeopathic solutions contain nothing at all. Sad to say, the last remaining privately owned drug store in my neighborhood features dilutions of Oscillococcinum® a "200C" product. That’s a dilution number, cunningly calculated to guarantee that the original ingredient has been diluted several million times, and has surely exceeded Avrogado’s number. The magic numbers have been calculated by Dr. Stephen Barret as follows: "Dilutions of 1 to 10 are designated by the Roman numeral X (1X=1/10, 2X=1/100, 3X=1/1,000, 6X=1/1,000,000). Similarly, dilutions of 1 to 100 are designated by the Roman numeral C (1C=1/100, 2C=1/10,000, 3C=1/1,000,000, and so on). Most remedies today range from 6X to 30C, but some carry designations as high as 200C. Oscillococcinum, that 200C product "for the relief of colds and flu-like symptoms," involves dilutions that are even more far-fetched. Its "active ingredient" is prepared by incubating small amounts of a freshly killed duck’s liver and heart for 40 days (18)
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Were a single molecule of the duck’s heart or liver to survive the dilution, its concentration would be 100200. This huge number, which has 400 zeroes, is vastly greater than the estimated number of molecules in the universe (about one googol, which is a 1 followed by 100 zeroes). Quackwatch—a website well named for a duck authority—quotes the February 17, 1997, issue of U.S. News & World Report as reporting that only one duck per year is needed to manufacture the product, which had total sales of $20 million in 1996. The magazine dubbed that unlucky bird "the $20-million duck." (19)
HONORS FOR HOGWARTS
It’s been said that "if homeopathy has a leader in the United States it is Dana Ullman MPH!" (20)
Mr. Ullman has written six major texts, and Penguin, his publishers, boast that he serves on the Advisory Council of the Alternative Medicine Center at Columbia University’s College of Physicians and Surgeons and is a consultant to Harvard Medical School’s Center to Assess Alternative Therapy for Chronic Illness (21)
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Penguin does not report that in the course of the anthrax outbreak in October of 2001, Mr. Ullman advised use of the homeopathic medicine Anthracinum for the prevention and treament of anthrax. This agent, gathered from infected swine, is called a nosode and its producers reassure the public that they are "diluted to a point where no molecules of the disease product remain." (22)
Well, nosodes and Anthracinum, miasmas and the like, which dot the Hogwarts curriculum of Mr. Ullman’s site, are matched by those on the web-sites of the University Centers he has advised. Columbia’s Rosenthal Center offers "integrative medicine" for children with cancer offered by a staff experienced in Shiatsu, reflexology, aromatherapy, Reiki, Flow Alignment and Connection, So Tai, and Tui Na (23)
. Not to be outdone, Harvard Medical School’s Osher Institute offers clinical fellowships, funded by NCCAM, to study remedies that meet Prince Charles’s criteria of being "rooted in ancient traditions"—acupuncture, herbal therapies, chiropractic, relaxation techniques, therapeutic massage, and other proto-scientific measures that sidestep the laws of chemistry and physics (24)
. It is in this context that one can understand why, when Columbia’s Rosenthal Center kicked off its 10th anniversary celebration on November 20th at the St. Regis Hotel in New York, the awardees of honor were—you guessed it—Dr. Andrew Weil and Prince Charles (25)
. Is Albus Dumbledore next?
Hogwarts is certainly on the move! If the trend persists, perhaps MIT or Cal Tech will march in step with the medical schools and offer prizes for integrative alchemy or alternative engineering. But Dr. Oliver Wendell Holmes, dean of the Harvard Medical School before age of Oprah had the last word on homeopathy:
Some of you will probably be more or less troubled by that parody of medieval theology which finds its dogma in the doctrine of homeopathy, its miracle of transubstantiation in the mystery of its dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling. (26)
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REFERENCES
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  D. Colquhoun What to do about CAM? BMJ, October 13, 2007; 335(7623): 736 - 736. [Full Text] [PDF]
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 J. R. Moffett, P. Arun, and M. A. A. Namboodiri Laboratory Research in Homeopathy: Con Integr Cancer Ther, December 1, 2006; 5(4): 333 - 342. [Abstract] [PDF]
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