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## A Budget of Anecdotes

“If you’ve done six impossible things this morning, why not round it off with breakfast at Milliway’s—the Restaurant at the End of the Universe!”–Douglas Adams

I recently finished reading the book “The Joy of Pi” by David Blatner. There is a chapter about the concept of squaring a circle, also called the quadrature of a circle. The idea is that, with just a ruler and a compass, you construct a square of equal area to a given circle.

It turns out it cannot be done. It is, in this iteration of the multiverse, impossible. Not difficult, or implausible or really hard. Impossible. You cannot square a circle in a finite number of steps given the conditions of using only a ruler and a compass.

That it is impossible does not prevent people from trying. Individuals do derive solutions to squaring the circle, and sometimes the derivation is erroneous, and sometimes they have a solution that requires a new value for pi.

Pi is the ratio of the circumference of a circle to its diameter. Take the circumference of a circle, divide it by its diameter and get the endless, or transcendental, number 3.141592654….(1) That number is part of the fabric of this universe. It is a fundamental part of how life, the universe, and everything is put together (2). It is a curious psychopathology that some people feel that all of known mathematics is wrong, and that they have a solution to an impossible problem and that they have discovered the hither to unknown, one true value of pi as a result.

Underwood Dudley (3) calls these people cranks, and one so called took umbrage at at the suggestion he was a crank and, like an English chiropractor (4), sued. And lost. The Judge in the case wrote the following as part of the judgment:

“A crank is a person inexplicably obsessed by an obviously unsound idea–a person with a bee in his bonnet. To call a person a crank is to say that because of some quirk of temperament he is wasting his time pursuing a line of thought that is plainly without merit or promise. … To call a person a crank is basically just a colorful and insulting way of expressing disagreement with his master idea, and it therefore belongs to the language of controversy rather than to the language of defamation. (5)”

This iteration of the multiverse has what appear to be be rules that cannot be broken (6). There are real impossibilities. The circle cannot be squared. The Laws of Thermodynamics cannot be circumvented, and those who try to develop perpetual motion machines are bound to fail as it is impossible. The speed of light is as fast as one can go.

There have been innumerable breakthroughs in the last 100 years, but since the advent of quantum mechanics and relativity, there have been no discoveries that have required a change in the fundamental understanding of how the universe is constructed (7). The rules may be a bit uncertain at the very large and the very small, but at the level of human beings, there are no great mysteries yet to be discovered.

Within the medical/biologic sciences, the basics of chemistry, biochemistry, anatomy, histology, physiology, embryology, pharmacology, evolution and all their derivative fields (cardiology, surgery etc) are well established. New discoveries are made at amazing rates, but within the well established frameworks of the basic sciences. H. pylori, as an example, was found in my medical lifetime to be a cause of gastritis and stomach ulcers. When I was a medical student gastritis and ulcers were thought to be due to stress. Although met with some initial skepticism (8) no new basic science had to be discovered for Helicobacter to cause gastritis. One did have to alter ideas about where bacteria could live, but extremophiles do not violate any fundamental understanding of the biologic sciences. Helicobacter or HIV or Chronic Fatigue or all the other illnesses do not require a new form of biology.

Believing in something that is impossible, not implausible or improbable but impossible, is the sine qua non of CAM. CAM is continually trying to find the quadrature of the circle and if it appears to be impossible, then CAM practitioners find a new value for pi to account for the rationale behind their diagnoses and treatments.

CAM can be classified many ways. Today the way (9) is

Possible: mostly botanicals and herbal remedies. There is nothing impossible that a given plant product will affect a given disease, although often the provenance of a given herbal treatment is suspect.

Implausible: can’t think of any at this point, although I am sure the comment section will show me the error of this particular way. The concept of prior possibility has been eruditely discussed by Dr. Atwood in this blog and he all too politely refer to CAM modalities as “implausible”. CAM by and large is not implausible, they are

Impossible: the rest of CAM. It will be equally impossible to cover every CAM practice, so I will mention a few.

Homeopathy

Homeopathy should be a synonym for impossible. The ‘Laws’ (10) of homeopathy are in complete opposition to the known universe.

“Law of Similars” : a substance causes a symptom in a normal person. Give that substance to an ill person with the same symptoms and it will cure them. Like cures like. This Law is not implausible, it is impossible. There is no anatomy or physiology that corresponds to this mechanism of therapeutics. Pick a symptom, any symptom. There are not that many. The body has a limited repertoire with which to respond to diseases. As an example, fevers can be caused by drugs, infections, cancer, cell death and collagen vascular disease (like lupus). Fever has a final common pathway in all these diseases: the thalamus is activated by cytokines to increase temperature. Unlike CAM, which seeks to treat symptoms, real medicine seeks to treat the underlying cause of fevers by understanding the underlying and reversing the causative pathophysiology. Homeopathy makes no distinction as to the underlying cause of fever, instead treating each of the following fevers differently, often with multiple therapeutic options (11).

fever; burning heat; night; after midnight;
fever; burning heat; night ;
fever; burning heat; alternating with chill;
fever; burning heat; alternating with chill; with chilliness;
fever; burning heat; with swollen blood vessels;
fever; burning heat; dry, burning heat, extending from head, and face, with thirst for cold drinks;
fever; burning heat; except head and face, which are covered with sweat;
fever; burning heat; furious, with delirium;
fever; burning heat; heat, outside, cold inside;
fever; burning heat; increased by walking in open air;
fever; burning heat; mostly internal, blood seems to burn ; in the veins;
fever; burning heat; mostly internal, blood seems to burn ; in particular parts;
fever; burning heat; interrupted with shaking chills, then internal burning heat with great thirst;
fever; burning heat; lasting all day;
fever; burning heat; parts lain on;
fever; burning heat; with pricking over the whole body;
fever; burning heat; during sleep;
fever; burning heat; sparks;
fever; burning heat; in one spot, which is cold to the touch;
fever; burning heat; in single spots;
fever; burning heat; spreading from the hands over the whole body;
fever; burning heat; with stinging sensations;
fever; burning heat; even when bathed in sweat, with red face;
fever; burning heat; with thirst for cold drinks;
fever; burning heat; with thirst for cold drinks; and desire to be covered;
fever; burning heat; with thirst for cold drinks; with unquenchable thirst;
fever; burning heat; body turning hot internally and externally;
fever; catarrh with fever;
fever; catarrh with fever; during period; .
fever; attacks changing;
fever; attacks changing; after poisoning by quinine;
fever; attacks changing; after poisoning by quinine; in minimal dosage;
fever; attacks changing; frequently;
fever; attacks changing; no two attacks are alike;
fever; fever without chill;
fever; fever without chill; morning;
fever; fever without chill; morning; 6 to 10 a.m.;
fever; fever without chill; morning; 7 a.m.; .
fever; fever without chill; morning; 9 a.m.; .
fever; fever without chill; late morning;
fever; fever without chill; late morning; 9 to 12 a.m.; .
fever; fever without chill; late morning; 10 a.m.;
fever; fever without chill; late morning; 10 a.m.; to 11 a.m.;
fever; fever without chill; late morning; 11 a.m.;
fever; fever without chill; noon;
fever; fever without chill; afternoon;
fever; fever without chill; afternoon; 12 to 1 p.m.;
fever; fever without chill; afternoon; 1 to 2 p.m.;
fever; fever without chill; afternoon; 2 p.m.; .
fever; fever without chill; afternoon; 2 p.m.; to 3 p.m.;
fever; fever without chill; afternoon; 3 p.m.;
fever; fever without chill; afternoon; 3 p.m.; to 4 p.m.;
fever; fever without chill; afternoon; 4 p.m.;
fever; fever without chill; afternoon; 4 p.m.; lasting all night;
fever; fever without chill; afternoon; 4 p.m.; to 8 p.m.;
fever; fever without chill; afternoon; 5 p.m.;
fever; fever without chill; afternoon; 5-30 p.m., with pricking in tongue;
fever; fever without chill; afternoon; 5 to 6 p.m.; .
fever; fever without chill; afternoon; 5 to 6 p.m.; very ill humoured;
fever; fever without chill; evening; at same hour, daily short of breath with fever; .
fever; fever without chill; evening; 6 p.m.;
fever; fever without chill; evening; 6 p.m.; to 12 p.m.;
fever; fever without chill; evening; 6 p.m.; lasting all night;
fever; fever without chill; evening; 6 p.m.; to 7 p.m.;
fever; fever without chill; evening; 6 p.m.; to 7 p.m.; 8 p.m.;
fever; fever without chill; evening; 7 p.m.;
fever; fever without chill; evening; 7 p.m.; to 8 p.m.;
fever; fever without chill; evening; 7 p.m.; to 8 p.m.; 12 p.m.;
fever; fever without chill; evening; 8 p.m.;
fever; fever without chill; night;
fever; fever without chill; night; midnight;
fever; fever without chill; night; before midnight;
fever; fever without chill; night; 10 p.m.;
fever; fever without chill; night; 11 p.m.;
fever; fever without chill; night; after midnight;
fever; fever without chill; night; 12 to 2 a.m.;
fever; fever without chill; night; 12 to 2 a.m.; to 3 a.m.;
fever; fever without chill; night; 1 to 2 a.m.;
fever; fever without chill; night; 2 a.m.;
fever; fever without chill; night; 2 to 4 a.m.;
fever; fever without chill; night; 3 a.m.;
fever; fever without chill; night; 4 a.m.;
fever; with chill;
fever; with chill; heat and perspiration;
fever; with chill; without subsequent perspiration;
fever; with chill; shaking;
fever; with chilliness;
fever; with chilliness; alternating with heat not perceptible to the touch;
fever; with chilliness; continues long into the heat;
fever; with chilliness; from putting the hands out of bed;
fever; after sexual intercourse (12);
fever; with external coldness;
fever; continued fever;
fever; continued fever; afternoon;
fever; continued fever; evening;
fever; continued fever; evening; 4 to 8 p.m.;
fever; continued fever; evening; 4 p.m. till midnight;
fever; continued fever; evening; 5 p.m.

That is at least 100 different kinds fever, each requiring a different therapy that does NOT treat, or even understand, the underlying disease. There is zero understanding of the pathophysiology of fever and disease in the approach of a homeopath. As a way of understanding illness, it is not only wrong, it is impossible for the body to have, in the homeopathic misunderstanding of disease, essentially an almost infinite number of causes of both symptoms and treatment. There is no place to put all these mechanisms of fever.

“The Law of Infinitesimals”

In homeopathy the practitioner doesn’t give the medication that causes the symptoms at measurable doses, but instead repeatedly dilutes the substance, with a special shaking called succussion, until there is no chance that even a single molecule of the original substance remains in the water. All homeopathic solutions are water and only water (13).

No problem that there are no residual molecules of the medication in the water and therefore it would be impossible for the water to have any effect except to quench thirst. They have their homeopathic version of redefining pi: The water, they say, remembers the original substance. How water remembers is not known, although occasionally quantum mechanics is used inappropriately and incorrectly as a solution to the problem (14). In homeopathy, the more the drug is diluted, the stronger it becomes.

Water cannot remember and the more a drug is diluted, the less potent it becomes. The increasing potency with increasing dilution and the memory of water are two examples of CAM redefining pi.

When you give a drug in the reality-based approach to disease, the drug operates on a specific site. Take penicillin. It binds to very specific proteins on the cell wall of the bacteria, called penicillin binding proteins, that are involved with the formation of the bacterial cell wall. Increasing the dose of the penicillin increases the number of sites on the bacteria bound by the penicillin until all available sites are filled, or saturated. After saturation is reached giving more antibiotic does not leads to more killing. The same approach is true of any drug one gives. The more drug, the more effect until the physiologic site of action is saturated, then there is no more effect.

Which bartender would you want to frequent: one who mixed your Cosmopolitan using the concepts of chemistry and physiology, in which case you would get a cocktail with a kick. Or would you want your drink made by a homeopathic bartender (15), who, to make your Cosmo more potent, would repeatedly dilute your drink until not a single molecule of alcohol remained?

Homeopathy theory is the total opposite of what is understood about chemistry and physiology. It is not implausible, it is impossible. The basic laws, so called, of homeopathy are a squaring of the circle with several new values of pi.

Energy therapies

Energy to CAM proponents seems to be the modern equivalent of the ether. These energies oscillate, vibrate, harmonize, flow, can be blocked, altered and manipulated, but cannot be measured or demonstrated to exist.

Energy is the ability to do work. Work is the quantity of energy transferred from one system to another without an accompanying transfer of entropy (16).

There are “different forms of energy, including kinetic, potential, thermal, gravitational, sound energy, light energy, elastic, electromagnetic, chemical, nuclear, and mass have been defined to explain all known natural phenomena (emphasis mine-17)”. The human body could participate in all these forms of energy, although causing a nuclear reaction would be a wee bit messy. All the energies mentioned above can be all can be measured and all derive their origin in the fundamental forces that govern the universe: the strong force, the weak force, electromagnetism and gravity. Physics understands energy, where it comes from and where it goes.

The qi of acupuncture, the healing energy of reiki, the energy manipulated by therapeutic touch, and any of the other innumerable energy therapies are based on forms of energy than cannot be measured and cannot exist under the current understanding of the physics of the world. What process is generating the energy of these alternative modalities? Energy has to be created from some physical process, and there is not a special, unique intracellular furnace that makes a new and undiscovered form of energy that powers the qi or the field manipulated by therapeutic touch.(18)

These energies, so called, have a subset that is some ill defined and never measurable life force, such as the ‘innate intelligence’ of chiropractic. In the world of alternative medicines, life apparently cannot be accounted for by its constituent biochemical pathways and a force is needed for life and the maintenance of health. When these forces are out of balance, or vibrating incorrectly or blocked, there is disease. Adjusting the life force back to normal results in restoration of health.

There is no life force, no innate intelligence needed to account for life, for health, for disease. They do not exist and cannot exist without a total rewrite of the textbooks of biology, chemistry and physics.

These human healing energies, forces and auras are not implausible, they are impossible as we understand the universe. The only way these energies and forces can exist is to understand fiction as reality and that pi as 3.

Mapping Modalities

There are many alternative modalities that map the body onto a single area of the body. Iridology maps the entire body on to the iris and disease is diagnosed by evaluating for changes in the iris that reflect changes in distant organs. The tongue, the ear, the hands, the feet and the skull have also been similarly mapped.

It is not trivially true that pathology in one part of the body can lead to pathologic physical findings in another part of the body. These distant changes are well understood given knowledge of anatomy and pathophysiology. The red dots in the hands, feet and eyes of patients with heart valve infections are explainable by knowing that bits of the infection break off and travel down the vascular system until they are wedged in the small vessels of the periphery.

It is trivially true, in a Kevin Bacon(19) kind of way, that all parts of the body are connected. When I was a child I thought that the Broadway in downtown Portland was part of the Broadway in New York City. It is trivially true that I could start down Broadway after seeing ‘Cats’ and end up here in Stump Town (20). The two are connected, but no event in NY, NY will directly affect the Schnitzer (21). So it is with these mapping modalities. There is no anatomical place to put these connections. If you have ever been in a body, you know it is packed with known anatomical structures. It is crowded in there. There is no pathological or physiologic mechanism that would lead to the treatment or diagnosis of disease in the liver that would manifest by changes in the ‘liver spot’ (22) on the hand or the foot or the ear or the iris of the mapping modalities.

These mapping modalities are not implausible, they are, as biology, anatomy, physiology and histology are understood, impossible. They are a squaring a circle.

Acupuncture

The classic theory of acupuncture is that impossible energy, qi, flows along meridians. We have a very good understanding of how the body is constructed, from the level of the proteins in the cell, to the cell, to the organs, to the entire structure, and soon, when the human genome project is complete, we will eventually know where all our parts originate.

I have dissected bodies, been in operating rooms, looked at CAT scans, MRI’s, angiograms and histologic sections of every part of the human body. There are no meridians. There is no undiscovered structure to carry the qi. Meridians do not exist and given the understanding of human anatomy, cannot exist. There are no genes to code for meridians, no structures that are meridians, no place in the body for a meridian to fit. Meridians are not implausible, meridians are impossible. They are another explanation of the quadrature of the circle, true only when you ignore the impossible.

Chiropractic

The classic theory behind disease in chiropractic is that the ‘innate intelligence’ that causes the body to stay ‘fit as a fiddle’ is blocked by subluxations of the spine. A subluxation is where one vertebral body is slightly out of line with another vertebral body. By manipulating the spine, these subluxations are removed, innate intelligence flows, and health returns.

While vertebral bodies can be misaligned after trauma, what happens, besides local musculoskeletal pain, is outgoing nerves get pinched, which in turn causes pain, numbness and, in severe cases, muscle weakness. There is no anatomical, physiologic or neurologic reason a subluxation of the vertebral bodies could cause or treatment of subluxations should affect any other disease from asthma to diabetes.

Chiropractic subluxations cannot be demonstrated, cannot cause disease by any known anatomy or physiology, and, as they are nonexistent, cannot be adjusted to treat any disease. Chiropractic subluxations, like innate intelligence, is impossible.

A motto of the skeptics is “Extraordinary claims require extraordinary evidence.” However, when the claim is impossible, there cannot be any evidence of proof. If it were a mathematics equation, my Drake equation, would be

e = k x (q x a)/p

where
e = evidence needed to prove a concept
k = a constant (every equation needs a fudge factor (23))
a = amount of research
q = quality of the research
p = the plausibility of the research.

Since alternative modalities mentioned above have a plausibility of zero, the needed evidence would be infinite. It takes an impossible amount of data to prove an impossible proposition.

In fiscal year 2006 appropriation for National Center for Complementary and Alternative Medicine (NCCAM) was \$122,692,000. The NCCAM often spends money on the medical equivalent of a perpetual motion machines, antigravity machines, and the squaring of a circle. They are spending money on the impossible. At least the \$220,000,000 bridge in Alaska to the island of Gravina went somewhere. The road down which the NCCAM travels goes nowhere; and impossible road to an impossible destination. A circle of impossibility that goes nowhere (24).

It may be that there are more things under heaven and earth than are dreamt of in my philosophy. Some will say my approach is closed minded and I am not a true skeptic, that I should keep an open mind to alternative modalities. I think to do so would be the equivalent of having an open mind that the circle could be squared, or that pi is 3.14. You need to have an open mind to the possible and the implausible, and even the incredible, but not to the impossible.

Perhaps someday there will be such a total revolution in medicine and the biologic sciences that CAM therapies will be validated. The impossible will be shown to be possible. For homeopathy or chiropractic or energy therapy to be validated at a basic science level would result in a transformation of understanding about the fundamental nature of the universe that would surpass the breakthroughs of quantum mechanics, relativity, evolution and understanding of DNA combined. The discoverer will be recognized as a genius on par with Newton, Einstein, Darwin, Watson, Crick, Adams, Whedon and all the other luminaries that have helped define this universe and others.

My bet: its not going to happen. We have too much knowledge and understanding of how the universe is constructed. CAM, instead, will remain the domain of cranks perpetually attempting to square the circle, trying to get their healt hcare at Milliways.

_____________________________________________________
1) I stared at the number on the calculator for eight years and so inadvertently memorized pi to 9 decimal points.
2) Even more than 42
3) Please do read his interesting books The Trisectors (MAA 1996, ISBN 0-88385-514-3), Mathematical Cranks (MAA 1992, ISBN 0-88385-507-0), and Numerology: Or, What Pythagorus Wrought (MAA 1997, ISBN 0-88385-524-0). While the topic is people who believe odd ideas about mathematics, the concepts are broadly applicable to other groups.
4) www.quackometer.net/blog/2008/08/chiropractors-try-to-silence-simon.html
5) http://en.wikipedia.org/wiki/Underwood_Dudley
6) as the bumper sticker says: Gravity: It’s not just a good idea, it’s the law
7) Here is where I am sure someone will remind of a fundamental shift that I cannot remember as I write this. At the level of my primitive understanding, String Theory is has not been confirmed experimentally and dark energy/dark matter is, well, too dark to know if it will require a rewrite of the physics textbooks.
8) One of my attendings as a fellow was a expert in gi infections. We discussed the literature on H. pylori at length, but I do not remember that the concept was dismissed out of hand. It was always lets see what the data demonstrates over time
9) As I write the sentence reference above, the Nirvana song “Something in the Way” came on as I write the word way. Just an Odd coincidence, I know, but there are some who would find meaning in meaninglessness.
10) these are not Laws derived from empiric observation, like Boyle’s Law of Gases, but made up like the Law that declared pi to be 3.0. Passed unanimously in 1897 by the  Indiana House, but the Senate tabled it, after much public ridicule.
11) http://abchomeopathy.com/listing/38101.html
12) Dr. Novella wants this blog to be proper. So many inappropriate options here. Sigh.
13) curiously, my Apple dictionary gives the following definition for homeopathic: “the treatment of disease by minute doses of natural substances that in a healthy person would produce symptoms of disease.” Minute means something. In a homeopathic remedy these is less than minute. There is nothing.
14) pun intended. If quantum mechanics are used as an explanation for anything in CAM, you know that they are full of BS. 100% specificity and sensitivity.
15) There is one at a local restaurant, I swear there is no alcohol in the drink.
16) my eldest son lacks energy when it comes to the yard. He has no ability to do work. One might say he has maximized his entropy.
17) http://en.wikipedia.org/wiki/Energy
18) Except, of course, in Clark Kent, whose cells can transform yellow solar energy into whatever the heck it is that powers Superman.
19) http://en.wikipedia.org/wiki/Six_Degrees_of_Kevin_Bacon
20) a local nickname for Portland, derived from our logging history.
21) http://www.pcpa.com/events/asch.php
22) another intended pun
23 Even Einstein needed a cosmological constant, and yes, I am comparing myself to Einstein. Same hair.
24) “I have a PhD in metaphoribleness”. Its my new tag line; thanks to Joss Whedon.

Posted in: Science and Medicine