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Homeoprophylaxis: An idea whose time has come—and gone

One of the strengths of modern medical education is its emphasis on basic science.  Conversely, the basic weakness of so-called alternative medicine is its profound ignorance of science and its reliance on magical thinking.  Nowhere is this more apparent than in the attempts of altmed cults to conduct and publish research.  From “quantum water memory” to “almost as good as placebo”, the altmed literature is filled with basic failures in the proper formulation and testing of hypotheses.

One of the finest examples of these failures was just published in the journal Homeopathy.  Leaving aside for the moment the absurdity of a journal devoted to magic, let’s see what they did here.

Leptospirosis, a systemic disease caused by bacteria of the genus Leptospira, is probably the most common zoonotic (spread by non-human animals) disease on the planet.  It can cause anything from a mild flu-like illness to liver failure and death.  It is spread in water contaminated by urine from infected animals.  An outbreak occurred during my internship year among triathletes swimming in a lake in Illinois, but occupational exposures are more common.  There are no widely-available vaccines for disease prevention.

Given the common and sometimes serious nature of the disease, especially in developing countries, there is a need for effective prevention of leptospirosis.  One proposed solution, published this month in Homeopathy, isLarge-scale application of highly-diluted bacteria for Leptospirosis epidemic control.”

Methods

The authors conducted what they called an “epidemiologic cohort study”.  For the study, the designated a large area of eastern Cuba the “test” population (“intervention region (IR)”), and the rest of Cuba the “control” population.  These were assumed to be distinct geographic regions.

In the intervention region, local outbreaks were treated with vaccination and antibiotic prophylaxis which, according to the study, reached about 3% of the population, but they do not indicate whether this is 3% if the total population or a targeted, at-risk population.  The entire population of the intervention region was also targeted to receive a homeopathic  (i.e., inert*) preparation especially designed and “potentised” (i.e., shaken up) to prevent leptospirosis, as per homeopathic beliefs.

The authors state that the study complied with ethics requirements of the authoritarian regime who runs the country and presumably profits from the manufacture of the product being tested.

Data

The authors report that the control region had fewer natural disasters (and presumably were at lower risk for lepto) than the intervention region.  During one such emergency in the IR, the potion was widely used.  A drop in reports of the disease were noted afterward.

The statistical analysis section of the paper is quite long, but fails to address fundamental problems.  There was, in effect, no control group.  There was an opportunity to apply this alleged therapy on one group and placebo (chuckle) on another and compare rates of disease in each group.  This wasn’t done.  The entire population in question was treated, and rates of disease recorded.  The authors note that leptospirosis is occurs in cycles, and there is no reason to think that the drop in disease seen after the application of homeoprophylaxis is due to the intervention rather than to the natural course of the endemic.  Given that the intervention is supposed to be prophylactic rather than therapeutic, the authors’ conclusions are even more suspect.  Finally, the did end up comparing rates in the intervention region and the rest of the country, but these regions were defined as being geographically distinct, with different geography and differing rates of natural disaster.

This study has nothing to do with natural disasters.  Blame for the disaster here rests completely with the authors.  They conducted a study of questionable ethics and questionable methodology, and came up with questionable conclusions.  Most important, however, was the lack of a plausible hypothesis from the start.  There is no reason to think that ultra-diluted potions containing nary a molecule of “medicine” should affect anything.  Given this lack of plausibility, statistically significant findings should be examined with suspicion, and other explanations for any such findings should be sought aggressively.  The authors do not discuss possible alternative explanations, exacerbating the travesty that is their work.

References

Bracho, G., Varela, E., Fernández, R., Ordaz, B., Marzoa, N., Menéndez, J., García, L., Gilling, E., Leyva, R., & Rufín, R. (2010). Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control Homeopathy, 99 (3), 156-166 DOI: 10.1016/j.homp.2010.05.009
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*From the paper:

From the mother tinctures, 1/100 serial dilutions wereprepared using homeopathic pharmaco-technical methods(Korvsakovian dilutions). Between each dilution step, thesolution was succussed 100 times using an automatic dynamizerup to 200C (200 1:100 dilutions) and 10 MC(104 1:100 dilutions).

Posted in: Science and Medicine

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18 thoughts on “Homeoprophylaxis: An idea whose time has come—and gone

  1. Mojo says:

    There’s another discussion of this paper here: Much ado about nothing.

  2. WilliamLawrenceUtridge says:

    DanaUllman in 3…2…1…

    Though I’m sure the practitioners would love to do no science at all, it frustrates me that when they try to do actual research (so they can co-opt its social capital to sell their nostroms.) and end up doing it this badly. As Ben Goldacre has said repeatedly – it’s not hard to do basic research like this. Two groups, randomized, low drop-out rates, double- or triple-blinding, large N. Have I missed something? It’s not rocket science, it’s barely math. Analysis can be tricky, but with these basic parameters, known for decades, you can at least say something meaningful.

    Not that they want to.

  3. phayes says:

    “it’s not hard to do basic research like this. … Analysis can be tricky”

    Except that in the case of homeopathy it’s not basic research – or research of any kind – and analysis couldn’t be simpler: a homeopathy CT simply isn’t capable of yielding meaningful results.

  4. windriven says:

    Where does one acquire a copy of the journal Homeopathy? Does it come as an insert in Mad Magazine?

    I was going to contribute $1,000,000 to homeopathic research. So I performed 10 serial dilutions of the money at 1/100, manually succussing between each dilution. Now I’m nearly blind from all that manual succussing so I can’t address the envelope to send the $1^-13 to them.

    Haven’t the Cuban people been through enough?

  5. Jann Bellamy says:

    I suppose that, based on this “research,” the NDs will start prescribing/selling this product to their patients as a precaution against Leptospirosis. On the other hand, wouldn’t this homeopathic “remedy” introduce a “toxin” into the body? In which case the ND would have to turn right around and “detoxify” the patient with a colon cleanse or some other nostrum.

  6. windriven says:

    @Jann Bellamy

    When can we expect to start seeing your posts here?

  7. cervantes says:

    Why do you even bother with this crap? They’re only talking to each other anyway and they don’t give a FFOARD if you debunk them, it’s just a circle jerk.

    Best ignored I think. Concentrate on legitimate controversies, efforts to put medicine on a sounder evidence base, proposals to make the design and interpretation of clinical trials more relevant to practical clinical care, common misconceptions about statistics (most physicians don’t understand Bayes Theorem, that’s well worth a whole series of posts) — stuff with meat, that matters. Science based medicine is an ideal that isn’t yet real even in academic medical centers (such as the one in which I am sitting at this moment).

    Enough with the pathetically easy targets.

  8. Peter Lipson says:

    Given that several million people were subjected to this experiment, and that it has the potential to affect public policy, I think I’ll continue the “circle jerk”.

  9. Mojo says:

    @Jann Bellamy:

    On the other hand, wouldn’t this homeopathic “remedy” introduce a “toxin” into the body?

    Only if water is considered to be a toxin. Well, the dose makes the poison, I suppose, so if they took enough of it…

  10. Mojo says:

    @cervantes:

    Why do you even bother with this crap?

    As long as the homoeopaths think it is worth putting out press releases about this crap, it is worth debunking it.

  11. Maz says:

    The brave scientists (I consider the MDs here scientists in addition to being doctors) at SBM should continue to write about all major “events” in pseudoscience.

    Why? Because there is bound to be some rational (but perhaps undereducated in the sciences) person who has a crazy friend that tells him or her about some crazy new study that PROVES homeopathy/magnetotherapy/acupuncture/vaccine-induced-autism/some other BS.

    When this rational person (with understandable incredulity) googles said study, it makes me happy to know that science based medicine will be there, waiting to tell them the study is a crock, the laws of nature still apply and that science is worth learning about.

    We’ll never convince the authors of these studies that they have dedicated their lives to nonsense, but perhaps we can save some people who haven’t yet taken the plunge.

  12. TsuDhoNimh says:

    http://www.medicc.org/publications/medicc_review/I/premier/html/lepto.htm discusses leptospirosis in Cuba.

    It is VERY weather-dependent, so if the hurricane seasons brought storms at different times, or not at all, there would be a strikingly lower incidence and lower mortality. Also, did they withhold the real vaccine from all of those people? That’s unethical!

    http://www.ncbi.nlm.nih.gov/pubmed/15193180 Discussion of the real vaccine – Cuban-made and quite good.

  13. Jann Bellamy says:

    @windriven

    I’ve done two posts and I am waiting to hear from the editors on a third. Thanks for your interest.

  14. KODAK says:

    “but they do not indicate whether this is 3% if the total population or a targeted, at-risk population”
    The editorial of this issue says: “Conventional prophylactic measures like vaccination and chemoprophylaxis were evenly distributed over all provinces of Cuba and it was estimated that only 3% of the TOTAL population was vaccinated or treated with chemoprophylaxis.”

  15. BillyJoe says:

    “Why do you even bother with this crap?”

    Did you read it?
    If no, how do you know it’s crap?
    It yes, why did you bother?

    :D

  16. DavidCT says:

    “Why do you even bother with this crap?”

    If you tell a lie often enough it becomes the truth in many peoples minds. The technique works well for Fox News. It worked well for the tobacco industry for a long time. The oil funded “climate skeptics” have been effective enough to make even a hardened skeptic like James Randi have doubts.

    Once you start allowing nonsense and pseudoscience to go unchallenged it becomes acceptable. The next thing you know states will start licensing naturopaths. Oops — I forgot some already do.

  17. The Blind Watchmaker says:

    Why don’t they just put one drop of the magic water into the water supply. The more dilute the magic water is, the larger an effect it has. We could cure the world of leptospirosis.

    Come to think of it, we could cure the world of all disease by putting one drop of all homeopathic preparations into the world’s water supplies.

    Turns out, it is all thanks to Clathrate Compounds.

    http://www.youtube.com/watch?v=lpC8BvHyorg

  18. apgaylard says:

    @KODAK

    To quote from the paper:

    The individuals treated with either vaccination or chemoprophylaxis in the IR amounted to about 3% of the population. Individuals within risk groups were vaccinated when identified with two intramuscular doses (6 – 8 weeks apart) of vaxSpiral following manufacture’s instructions (Finlay Institute, Havana, Cuba). [...] Chemoprophylaxis was applied mainly for focal treatment and outbreak control to high-risk groups when identified and consisted of a weekly oral dose of Doxicycline 100 mg.”

    Despite the impression given in the editorial (and some parts of the paper), it seems that the conventional measures were focussed on risk groups and outbreaks. This, if true, should have driven more conventional intervention in the “treated” region, given its higher rate of incidence.

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