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Homeocracy

Recent comments on homeopathy again resulted in references to the 1994 Pediatrics paper by Jacobs et al on use of homeopathic remedies for childhood diarrhrea.  The authors of that paper concluded from their blinded study that homeopathic remedies, tailored to the individual infants and children, were effective in reducing the number of diarrhea stools and thus in shortening the illness.  The paper has been widely referenced and reported to have proved  homeopathy efficacy, and the critiques have been argued by homeopaths as irrelevant, as has been done by Mr. Ullman.

In this short series I want to recount my experience with the report, its predecessor, and its two major sequellae, as well as its effect on systematic reviews of homeopathy.  I will begin with a description of the first two studies, concentrating on their methods. Then I will discuss the results of the 1994 Pediatrics report and the authors’ interpretation of the results. Then (I hope last) I will discuss the third paper which the authors claimed supported findings of the first two and the meta-analysis which combined data from all three. If you are imagining why this  series interests me, and imagining the worst, you are probably right. The sequence will  help to reveal how some of the information in “holistic” and “alternative” systems become published, and despite critiques and disproofs through a sort of systematic deconstructions, still develop wheels of their own and enter the fund of general knowledge seemingly forever. Or, at least for several decades, until a social belief switch is finally turned off.
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Posted in: Basic Science, Clinical Trials, Homeopathy

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The Dull-Man Law

Kimball Atwood is obviously trying to throw mud at Harvard and at homeopathy, but when you throw mud, you get dirty…

(Sigh) So little time, so much misinformation. Hence the Dull-Man Law:

In any discussion involving science or medicine, being Dana Ullman loses you the argument immediately…and gets you laughed out of the room.

This will be the last time that I don’t invoke that law, because it is the perfect opportunity to explain why it is such a useful shortcut. The occasion is the current series about my alma mater, Harvard Medical School (HMS), and its regrettable dalliances with quackery.† The series consists mostly of correspondence that occurred between Dean Daniel Federman and me in 2002. Some of it refers to homeopathy.*

Mr. Ullman, a self-styled expert on homeopathy who lacks any medical training, is a darling of the ‘integrative medicine’ movement, as explained here. He has posted several comments objecting to my assertions in the HMS series. Other commenters have skillfully refuted some of his arguments. Some have been left unchallenged, however, and a naive reader might therefore assume that they are valid. They are not, but explaining why takes time and a modest acquaintance with the topic. Other than to clarify the issues for the uninitiated, then, such time would be wasted. Henceforth, let it not be so: From now on, this post can be cited by anyone wanting to avoid the drudgery of refuting Mr. Ullman’s claims. (more…)

Posted in: Health Fraud, Homeopathy, Humor, Medical Academia, Science and Medicine

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This one’s for you, Dana

As you may have noticed, everybody’s “favorite” homeopath, Dana Ullman, has made a return visit to our humble little blog, where he is laying down his usual list of logical fallacies and irrelevencies (such as attacking Oliver Wendell Holmes) in defense of homeopathy. Consequently, now’s as good a time as any to unveil what is perhaps the best ready-for-a-poster criticism of homeopathy I’ve ever seen:

HN09poster1A

Clicking on the picture will lead you to a blog post where you can download a high resolution version suitable for printing up and either distributing or posting on a bulletin board or wall. I particularly like that it was made by The American Institute for the Destruction of Tooth Fairy Science. Truly, a nod to SBM blogger extraordinaire Harriet Hall!

My only objection to the poster is the use of the word “shit.” Don’t get me wrong here. Yes, it’s accurate. No, I’m not some sort of prude who never uses the word and wilts at the very sight or sound of it. My problem with it is that its inclusion on the image means that I can’t actually print up and post this beautiful (and brief) mockery of homeopathy on my lab door or on the bulletin board in my office. I can’t put something like that up in public at work. It also made me a little leery of posting it here, which led me to check with our fearless leader before doing it. So I started thinking of alternatives that get the message across but without any curse words.

Clearly, a version of the poster suitable for a G (or at least PG) audience is required.

How about something like:

If water has a memory, then homeopathy is full of crap
Homeopathy: Potentizing poo by flushing.

After all, flushing should “succuss” the remedy as well as hitting it against a Bible.

Yes, I do watch Dirty Jobs a lot, with its host, Mike Rowe, who likes to use the word “poo” a lot. Come to think of it, perhaps Mike Rowe should do a segment of Dirty Jobs segment at a manufacturer of homeopathic remedies. Why? Think of the potentized poo!

Posted in: Homeopathy, Humor

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Rhinos and tigers and bears. Oh my.

More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly.

~ Woody Allen

No good deed goes unpunished.

The website whatstheharm.net is a depressing recitation of the harm that humans do to themselves and others from participating in various forms of nonsense in the attempt to do good. It my backfire, and instead pain and death result.

I would bet that most practitioners of medical woo are true believers. They do not intend to harm people, and believe they are doing good for their patients. Certainly the consumers of alternative therapies intend to have good benefits from their use of sCAM modalities. Most want to get better, and do not intend to hurt themselves or others.

Unfortunately, actions always have unintended consequences. Sometimes the harm is directly to the patient. Sometimes the harm in indirect, with collateral damage to people or the environment. My hospital system has an extensive recycling program to handle the huge amounts of waste generated by the need to insure that all manner of materials are sterile. Patients in isolation consume large amounts of paper and plastic to keep infection confined. My hospitals actively look for ways to decrease their environmental impact and carbon footprint and still deliver high quality medical care. Legacy Health System, where I work, is an award winning leader recycling medical waste, which is a lot more difficult to dispose of than the pop cans and paper bags in your house. Hopefully the trash in your house is not covered with pus, blood and other potentially hazardous medical waste. We try to be good global citizens.

I wonder if some branches of the alternative medical industrial complex are so environmentally conscious.
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Posted in: Herbs & Supplements, Homeopathy

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CAM on campus: Homeopathy

I am quite proud of my medical school. The dedicated faculty and dynamic curriculum produce graduates of excellent clinical skill with a strong sense of service. Initially I was too focused on coursework to pay much mind to the student-run interest group in “cross-cultural and integrative medicine” and the occasional extracurricular CAM event. More recently, however, I noticed that such events had become a highly-publicized, monthly occurrence. It was still very much outside the official curriculum, but the discussion was one-sided with no public debate.

In addition to the student group on my local campus, we have a “CAM institute” that boosts CAM across the wider university. The CAM institute is a major sponsor of events organized by the student group in addition to producing its own lecture series and publications. The events hosted by either group are of two types. The first kind is an activity for med students that essentially functions as stress management: a yoga instructor leads free sessions between lectures once a week, and free herbal tea or massages are offered during final exam week. Who can complain about that? The massages are quite popular.The second kind of event is a lecture or workshop on a particular CAM modality.

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Posted in: Homeopathy

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University of the Sciences in Philadelphia Justification for Scientific Honor of Homeopathic Leader, John A. Borneman, III

To update readers, I posted last week that my alma mater was to offer a Doctor(ate) of Science degree at our Founders’ Day celebration to Mr. John A. Borneman, III, pharmacist graduate (1952),  founder of the Board Member, Homeopathic Pharmacopoeia Convention of the United States, Southeastern, PA, and Chairman, Standard Homeopathic Company, Bryn Mawr, PA

The university, known prior to 1998 as the Philadelphia College of Pharmacy and Science (PCP&S), has been led by Dr. Philip Gerbino, a gentleman whom I hold in highest regard for his leadership and dedication to pharmacy practice. As I increasingly appreciate the time demands on a university administrator, I was grateful to receive a very prompt response from Dr. Gerbino following the public posting here of my letter of objection last week:

Dear Dr. Kroll,

I would like to thank you for e-mailing myself and our provost, Dr. Russell DiGate, on Jan. 26 with your concerns regarding our Founders’ Day honoree. We most certainly respect your opinion and thoughtful correspondence.

We had no intention of eroding the honorific nature of science with our selection of John A. Borneman, III, P’52, RPh. Instead our objective was to honor a man who is a founder, innovator, and successful entrepreneur.  His selection for the Honorary Doctorate of Science degree is not about the rigors of science, nor the appropriate applications of science to homeopathic and alternative medicines, but about a founder who possesses remarkable leadership qualities and who is willing to share some of those with our students.  

Mr. Borneman’s selection as our Founders’ Day degree recipient provided a source of considerable discussion internally. I can say that in the end, it was decided that since one of our missions is to provide our students with academic and personal development through intellectual, cultural, and ethical understanding and awareness, Mr. Borneman’s honor would ultimately benefit them on their own paths to becoming future leaders and innovators. As point of emphasis, and in this context, we honor founding, not the field of homeopathic medicine. We honor a founder with entrepreneurial spirit.

Again, we appreciate your interest and comments and value your opinion. This letter is not intended to change your mind. It is provided to offer a better understanding of our decision. A good criticism is healthy and often inspiring. While it is not always necessary that we all agree, the basis of academia is to provide an environment of inquiry, debate, and critical thought where all opinions are respected.

Sincerely.

Philip P. Gerbino, PharmD

President

Again, readers, please keep in mind that I hold Dr. Gerbino in my highest regard.  He has been a university leader since I conducted my very first research project at PCP&S in 1984. Knowing what I know of him personally, even considering the unrecognized challenges of being a lead university administrator, I am led to register an even stronger objection to this honor of Mr. Borneman.

At first, I thought it might be more appropriate to acknowledge Mr. Borneman with an honorary MBA from the university.  However, even this recognition would honor leadership and entrepreneurship in the absence of ethics by promoting the sale of products with no medicinal value under the guise of health remedies.

Not to be melodramatic, but if I were to collect lawn clippings from my yard and sell them as a cure for cancer with 30% of patients claiming they were helped, would I be worthy of an Honorary Doctorate of Science from my alma mater?

And I also submit that Mr. Borneman’s grandfather, John P. Borneman (1907) was a PCP graduate and promoter of both botanical medicines *and* homeopathics at a time when dose-response pharmacology was first being realized in the United States.

My most serious point is that one cannot, as Dr. Gerbino proposes, separate the business leadership and success of Mr. Borneman from the fact that the business is one of deceptive products marketed in the name of medicine.

Whatever Mr. Borneman offers to my alma mater in terms of business acumen and leadership training, I find his honor highly deficient in ethics and an affront to the principles of authenticity and scientific rigor put forth by the founders of the Philadelphia College of Pharmacy.

Unfortunately, my compatriots are graduates of a small college with a small alumni organization. I was graduate number 17,346 since 1821 and the school has only had between 900 and 2,500 students per year in the last 20 years. I doubt seriously that a significant public objection can be mounted against the honoring of Mr. Borneman.  I’m sure he is a fine gentleman personally, and I hope to meet him at some point to discuss these issues, but I am disgusted by the imprimatur about to be given to him by the same institution whose academic endorsement hangs above my desk.

 

Posted in: Homeopathy

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Historic College of Pharmacy to Honor Homeopathy Leader

I am a graduate of the institution known formerly as the Philadelphia College of Pharmacy and Science (PCP&S) – the first college of pharmacy in North America, established in 1821.  The college, now called University of the Sciences in Philadelphia, counts among its alumni John Wyeth, Silas M. Burroughs, Sir Henry Wellcome, several members of the Eli Lilly and McNeil families, and other historical figures in pharmacy among founders of what have now become large pharmaceutical companies.

Although I was among the 35% of students in the “and Science” side of PCP&S, earning a BS in Toxicology, I was there at a time before Big Pharma had acquired much of the bad name it often carries today and we took great pride in our college’s rich history and contributions to modern medicine.  In particular PCP&S graduates were critical players in combating snake oil hucksters in the early 1900s and establishing chemical standards, safety, and efficacy guidelines for therapeutic agents.

So it is with disbelief that I learned my alma mater plans to award an Honorary Doctorate of Science to a major leader in homeopathy – on Founders’ Day, no less.  The press release is here.

I’ve just sent the following e-mail to University President, Philip P. Gerbino, Pharm.D., and Provost Russell J. DiGate, Ph.D.:

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Posted in: Homeopathy, Pharmaceuticals, Science and Medicine

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“It’s just a theory”

I am afraid that the experiments you quote, M. Pasteur, will turn against you. The world into which you wish to take us is really too fantastic.

La Presse, 1860

It’s just a theory. Not evolution. Germ theory. Just a theory, one of many that account for the etiology of diseases.

I should mention my bias up front. I am, as some of you are aware, an Infectious Disease doctor. My job is simple: me find germ, me kill germ, me go home. I think there are three causes of disease: wear and tear, genetic, and germs. Perhaps a bit of an exaggeration, but not much. My professional life for the last 22 years has been spent preventing, diagnosing, and treating the multitudinous germs that a continually trying to kill or injure us. It is a fundamentally futile job, as in the end I will be consumed by the organisms I have spend a lifetime trying to kill.

I would have though that the germ theory of disease was a concept that was so grounded in history, science and reality that there would be little opposition to the idea that germs (a broad term for viruses, bacteremia, fungi, parasite etc) cause infections and some other diseases.

Wrong. There are people who deny the validity of germ theory. Add there are people who deny gravity. And evolution.

Opponents of germ theory come in two flavors:

  1. Germ theory deniers.
  2. Those who propose alternative mechanisms of disease.

There is great overlap between the two categories, and the division serves more as a literary device for the sake of exposition than a true description of reality.
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Posted in: Acupuncture, Chiropractic, Homeopathy, Science and Medicine, Vaccines

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“Urban Zen” and homeopathy at Beth Israel Medical Center, or: Dr. Gorski destroys his chances of ever being invited to join the faculty at BIMC or the Albert Einstein College of Medicine

I guess I never really wanted to work in Manhattan anyway. At least, that’s what I keep telling myself.

I mean, why on earth would I want to? What’s the attraction? Living in the heart of it all, all those shows and all those amazing cultural activities, all those world-class restaurants? Being close to Boston, Philadelphia, and other cool East Coast cities, which are all just a quick Acela train ride away? Who cares about those things, anyway?

Apparently I don’t, because I’m about to destroy my chances of working at what has been considered one of the premiere academic hospitals in New York City, specifically Beth Israel Medical Center, an academic affiliate of the Albert Einstein College of Medicine. It’s possible for me to have been ignored when I first included the Albert Einstein College of Medicine and its affliated Continuum Center for Health & Healing in my roll call of shame as a medical center that has not just added woo to its offerings, but actively embraced it. At the time I originally discovered it, though, its offerings seemed limited to fairly mild woo, the usual stuff like acupuncture, what I like to call “gateway modalities” that centers embrace first because they’re relatively tame and commonplace. All too commonly, though, dabbling in gateway modalities leads to the “hard stuff,” outright quackery with zero scientific basis like homeopathy, reflexology, and craniosacral therapy. Such is the pathway an academic medical center follows when it degenerates from science-based medicine to what Dr. R. W. famously dubbed “quackademic medicine,” usually driven by a few famous true believers, which, alas, is exactly what happened at fearless leader Steve Novella’s institution of Yale, thanks to Dr. David Katz and his “more fluid concept of evidence.”

In any case, last week, I realized that I’ve been completely neglecting the aforementioned roll call of shame. Perusing it, I now realize that it’s been over five months since I did a significant update to it. You just know that, given the rate of infiltration of unscientific medical practices into medical academia as seemingly respectable treatment modalities that there must be at least several new additions to this roll of shame. Alas, even today, having been shamed myself by the realization of my failure to keep the list updated, I’m not going to do the full update and revamping that the Roll Call of Quackademic Medicine cries out for. However, that doesn’t mean I can’t do a piecemeal addition here and there. That doesn’t mean I can’t point out new additions as they pop up, even if it takes me a while to find the time to give the list the facelift it cries out for. It doesn’t mean I can’t call out hospitals like Beth Israel when they fall into woo, especially when they dive into quackademic medicine in a big way for cancer patients.
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Posted in: Cancer, Homeopathy, Medical Academia, Science and the Media

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Another take on those “50 Facts About Homeopathy”

You may recall that a week ago fellow SBM blogger Mark Crislip did a truly amusing takedown of an article by a homeopath purporting to provide us with 50 Facts About Homeopathy that supposedly validate the efficacy of this most amazing form of quackery. Not surprisingly, others wanted to get in on the fun, given how outrageously ridiculous and riddled with numerous logical fallacies the homeopath’s article was. Indeed, that’s why prominent Australian skeptic Peter Bowditch, whose website The Millenium Project is always an entertaining read (except that, at only once every one or two weeks, its updates are too infrequent) couldn’t resist getting in on the action with his answer to A Homeopathic Challenge.

Unfortunately, by the time he hit “Fact” #25 Peter was laughing so hard that, try as he might, he just couldn’t continue with his deconstruction. He does, however, promise to finish up the list in a future installment.

Posted in: Homeopathy, Humor

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