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Woo's On First
Regarding "alternative" medicine (aka "woo," or as I like to call it,"quackhockey"), I'm with former New England Journal Of Medicine editor-in-chief Marcia Angell, who, with Jerome Kassirer, wrote:

It is time for the scientific community to stop giving alternative medicine a free ride... There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work.

Homeopathy -- remedies with so little actual remedy in them they seem like a practical joke -- is one of those medicines that has not been proven to work. In fact, Quackwatch's Steven Barrett calls it "the ultimate fake":

A 30X dilution means that the original substance has been diluted 1,000,000,000,000,000,000,000,000,000,000 times. Assuming that a cubic centimeter of water contains 15 drops, this number is greater than the number of drops of water that would fill a container more than 50 times the size of the Earth. Imagine placing a drop of red dye into such a container so that it disperses evenly. Homeopathy's "law of infinitesimals" is the equivalent of saying that any drop of water subsequently removed from that container will possess an essence of redness. Robert L. Park, Ph.D., a prominent physicist who is executive director of The American Physical Society, has noted that since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.

Oscillococcinum, a 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. The resultant solution is then filtered, freeze-dried, rehydrated, repeatedly diluted, and impregnated into sugar granules. If a single molecule of the duck's heart or liver were to survive the dilution, its concentration would be 1 in 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). In its February 17, 1997, issue, U.S. News & World Report noted 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."

Actually, the laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether. This limit, which is related to Avogadro's number, corresponds to homeopathic potencies of 12C or 24X (1 part in 1024). Hahnemann himself realized that there is virtually no chance that even one molecule of original substance would remain after extreme dilutions. But he believed that the vigorous shaking or pulverizing with each step of dilution leaves behind a "spirit-like" essence—"no longer perceptible to the senses"—which cures by reviving the body's "vital force." Modern proponents assert that even when the last molecule is gone, a "memory" of the substance is retained. This notion is unsubstantiated. Moreover, if it were true, every substance encountered by a molecule of water might imprint an "essence" that could exert powerful (and unpredictable) medicinal effects when ingested by a person.

Many proponents claim that homeopathic products resemble vaccines because both provide a small stimulus that triggers an immune response. This comparison is not valid. The amounts of active ingredients in vaccines are much greater and can be measured. Moreover, immunizations produce antibodies whose concentration in the blood can be measured, but high-dilution homeopathic products produce no measurable response.

Except on the condition of your wallet. Oh, and then, the complications, suffering and death they lead to if you take them in hopes of curing a serious disease. I would never go to any doctor who believes in homeopathy -- whether or not they try to use it on me. The fact that a doctor is even the slightest bit woo-based in his or her practice should be enough to make any patient who understands evidence-based medicine run. Unfortunately, the next guy's cancer got him before his kids could advise him to put on his track shoes.

Jaclyn O'Malley writes in the Reno Gazette-Journal of serious malpractice by an "anti-aging" homeopath with a medical degree. The patient is an elderly man, but there's more tragic woo-woo malpractice at the link:

In February 2000, Horton complained to Shallenberger of rectal bleeding and abdominal pain -- symptoms of colon cancer. But the medical board complaint said Shallenberger told Horton, formerly of Carson City, that he suffered from hemorrhoids and advised him to use suppositories and take baths in witch hazel.

"At no time from the initial presentation of (Horton's) medical symptoms did he examine the patient, order a test or record in the medical records why those actions weren't taken," Cousineau said.

"If you ask a beginning medical school class what is at the top of your list for a 75-year-old man with rectal bleeding and abdominal pain, it's colon cancer," said Horton's daughter-in-law, Dr. Katherine Gundling, an internist who heads the allergy and immunology clinic at the University of California, San Francisco.

"You rule that out first and worry about the rest later," she said. "Shallenberger's treatment was unbelievable."

Horton had been Shallenberger's patient for more than a decade, and seven months after emergency room doctors diagnosed Horton with stage-four colon cancer and said he had six months to live, Horton, 76, returned to Shallenberger for homeopathic cancer treatments. Those treatments included injections of insulin and laetrile, which, according to the National Cancer Institute, has shown little anti-cancer effect in laboratory, animal or human studies. Horton died in October 2003.

...Although Horton's son, Robert, is a biomedical scientist in the San Francisco Bay area and his daughter and daughter-in-law are medical doctors, Horton was an advocate of homeopathic medicine, his son said.

"It is ironic, though, that my dad kept going back to (Shallenberger)," Robert Horton said. "But you talk to any medical doctor about this case and they will have trouble believing it because it's so wacky."

"If my dad would have gone to a real doctor, he would still be alive," he said. "They would have caught it before it spread."

Thanks, Smurfy

Posted by aalkon at September 25, 2007 1:22 PM

Comments

Ah, it's a problem. You see, homeopathy does work! It works exactly as well as any other placebo, and placebos have been proven over and over again.

The problem is: it is quite important that the patient believe in the treatment - otherwise the placebo effect cannot happen.

So it's a dilemma. If one discredits homeopathy in the interest of doing honest science, it will lose effectiveness in the eyes of the patient. If one tolerates it for the benefits it creates through the placebo effect, then one accredits quacks and snake-oil salesmen.

I am of the opinion that homeopathy does more good than harm. It is, however, all too easy to use it as the opening wedge to truly harmful varieties of alternative medicine. There is no easy answer...

Posted by: bradley13 at September 25, 2007 1:39 AM

Posted by: Amy Alkon at September 25, 2007 4:15 AM

And here, to debate your opinion that homeopathy does more good than harm, is a page on homeopathy for cancer:

http://www.cancure.org/homeopathy.htm#Homeopathic%20Remedies%20for%20Cancer

Posted by: Amy Alkon at September 25, 2007 4:20 AM

Hi Amy,

Placebos for cancer are not much use. There are diseases where they do help. The problem is, of course, that it takes a real doctor to tell the difference, and a real doctor is unlikely to prescribe homeopathic remedies in any case.

In the reference you give, I just love one of the arguments used to support homeopathy: "there is much anecdotal evidence..." Of course, one can find anecdotal evidence to support the idea that the moon is made of green cheese...

You may be interested in this article about homeopathy

Posted by: bradley13 at September 25, 2007 6:56 AM

Placebos treat hypochondria.

Any genuine medical malady treated with a placebo is not evidence of mind over matter, but of the immune system fighting its way through.

Posted by: brian at September 25, 2007 7:29 AM

You make interesting points Bradley. The placebo effect certainly is real and even beneficial in some situations. It seems to me, though, that it's very dangerous to base one's hopes for health on substances which can be effective only if we believe they are effective. It would be like the cartoon characters who run off the edge of a cliff and continue to hover there in mid air until they look down and discover there's no longer anything supporting them.

Posted by: Kirk at September 25, 2007 7:30 AM

Great analogy, Kirk.

Posted by: Amy Alkon at September 25, 2007 7:33 AM

Marcia Angell really is a gem -- she has a go at "alternative" medicine and "mainstream" medicine with equally devastating logic. If I could vote to put her in charge of US health service reform, I would.


Posted by: Stu "El Inglés" Harris at September 25, 2007 8:14 AM

What would you say if I told you she and I had shared an espresso or two at Café Flore? (We haven't, just wondering!)

On a less jokey note, I concur on putting her in charge of health-care reform.

Posted by: Amy Alkon at September 25, 2007 8:23 AM

A placebo can be a wonderful thing. A security blanket if you will. I would say it doesn't do any harm if it's used along with proven/tested medical treatment. If it's done INSTEAD of proven/tested medical treatment, it's doing as much harm as not doing anything.

If I'm hungry for a steak, do I cure that craving by eating a steak? Sounds like the most logical conclusion, and is easily tested and proven. Using homeopathy to cure my craving for steak would lead me to do something like take a tiny bit of steak juice that has been diluted a ridiculous number of times. I might make myself feel a little better because I think I did something about it (placebo), but it doesn't really address the actual issue.

Excuse me, I think I will have a steak now, or maybe just chew the parsley garnish and see if it gets rid of my cravings.

Posted by: Jamie at September 25, 2007 8:41 AM

Bob Park is always a fun read for me. He has a short weekly email called "What's New" that I've subscribed to for years. It's at http://www.bobpark.org/ .

Points of interest:

It's obvious only someone who hasn't learned to think critically will believe in this crap. So, I like to pay attention to how much of this stuff is around and use it as my own sort of anecdotal "evidence" of the critical thinking skills in the general population. That's one positive about this story; at least the younger generation in this family is less gullible.

I don't think they should be able to sue in this case either. He was a consenting adult who got what he asked for. As long as my insurance company, hospital or government isn't paying for it, it's his business and not mine.

Posted by: Shawn at September 25, 2007 11:52 AM

> What would you say if I told you she and I had shared an espresso or two at Café Flore?


Ha-ha, you're funny. Of course I'd say "What? You ran into another American in the Flore? How amazing..... NOT!!!"

Posted by: Stu "El Inglés" Harris at September 25, 2007 1:43 PM

An acquaintance of mine was diagnosed with a rather aggressive form of breast cancer at age 41. She underwent surgery but instead of chemo, she and her friends were emailing everyone they knew soliciting donations for some VERY EXPENSIVE "herbal" treatments.

I thought it was the dumbest thing I had ever heard. Now her cancer is back... she did go thru chemo this time around.

Posted by: Red Ree at September 25, 2007 3:44 PM

You need look no further than poor Kathy Acker for a cautionary tale of alternative medicine. Dead at 50.

Posted by: Stu "El Inglés" Harris at September 25, 2007 4:00 PM

Don't these anecdotes prove that neither conventional nor alternative medicine actually cure cancer? There is no cure, and the best that conventional medicine can do is hold it off, perhaps permanently, perhaps not. Why does it come back after chemo and surgery?

Posted by: Chrissy at September 26, 2007 6:51 AM

Brian says: "Placebos treat hypochondria."

Hey, I've just been reading about hypochondria, and you know what? I'm afraid I may have it.

So I'm going to make an appointment with my doctor, and if he diagnoses hypochondria, I plan to ask him for the most powerful placebo he's got. Definitely not some wimpy homeopathic treatment.

I will ask him if hot lemon toddies are right for me.

Posted by: Axman at September 26, 2007 7:29 AM

Chrissy - Medicine can cure cancer but it's hit and miss. If you start with a lumpectomy, and manage to remove all the tumour cells, then it's cured. But if you leave even one cell, it'll multiply. Same with radiotherapy, chemotherapy etc. One you've got secondaries it's pretty much a holding operation, as we can't kill off cancer cells without killing the person. I think lumpectomy is your main chance, so don't delay.

Posted by: Norman at September 26, 2007 9:23 AM

The people who have no chance against cancer are those who eschew modern medicine for plant farts.

Posted by: Amy Alkon at September 26, 2007 10:21 AM

But if they don't know why the cells mutated in the first place (which is what cancer is-cell mutation), how do the doctors know that it won't happen again?

And if you chop parts of your body out with the offending cells, how do you know you haven't missed a cell here and there?

Posted by: Chrissy at September 27, 2007 9:32 AM

Chrissy - as far as I understand it, your cells are mutating all the time. But most of these mutants die or get mopped up by your immune system. Some survive but are benign so you never know about them. It's only the malignant tumours that cause enough of a problem to impinge on your consciousness, so the only news you get is bad news. But that's misleading, as you can now see.

And if you chop parts of your body out with the offending cells, how do you know you haven't missed a cell here and there? You don't know. You trust your surgeon to do the best he/she can, and hope. If you've no signs after a few years (and believe me it's tiring hoping for that long) then you can begin to believe you are free. Of course, another one can start up, and it may be that having the first one means you are predisposed to it, or there's something in your environment that is causing it.

It's a nasty business. There's nothing good about it.

Posted by: Norman at September 28, 2007 7:03 AM

PS Surgery is often followed by radio- or chemo-therapy, or both, in an attempt to kill any remaining cells. But I don't see how it can be more effective then than it is later, when it is just an attempt to delay the inevitable. Perhaps it kills some % of the cells, and if the total number of cells is small, there's a better chance you can reach 100%.

Posted by: Norman at September 28, 2007 7:06 AM

Thanks Norman. It is a messy business, and I'm glad that the 'treatment' is somewhat successful these days. It's still not a cure, but I guess that's what all the research money is supposed to discover.

Everything must still pass the test of the scientific method, nomatter what it is and who is pushing it.

Posted by: Chrissy at September 28, 2007 8:43 AM

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