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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

## 41 thoughts on “A Budget of Anecdotes”

1. David Gorski says:

Homeopathy is in essence magic, the casting of a magic spell. In fact, a better example of magical thinking is hard to come by. Indeed, it’s been pointed out that homeopathy’s Principle of Similarities (“like cures like”) actually resembles Frazer’s Law of Similarity from the Golden Bough as well as the Law of Contact or Contagion (the so-called “memory of water”), some of the implicit principles of magic:

IF we analyse the principles of thought on which magic is based, they will probably be found to resolve themselves into two: first, that like produces like, or that an effect resembles its cause; and, second, that things which have once been in contact with each other continue to act on each other at a distance after the physical contact has been severed. The former principle may be called the Law of Similarity, the latter the Law of Contact or Contagion. From the first of these principles, namely the Law of Similarity, the magician infers that he can produce any effect he desires merely by imitating it: from the second he infers that whatever he does to a material object will affect equally the person with whom the object was once in contact, whether it formed part of his body or not. Charms based on the Law of Similarity may be called Homoeopathic or Imitative Magic. Charms based on the Law of Contact or Contagion may be called Contagious Magic.

Actually, homeopathy seems to use both principles, the Law of Similarity, and the Law of Contagion, given that it postulates that water somehow remains influenced by substances that it’s been in contact with even after that substance has been diluted away until not a single molecule remains. It just reverses the concept that “like produces like” (the Law of Similars”) to “like heals like” (or “like reverses like”). Moreover, it’s a concept that dates back centuries, if not millennia. The homeopathic principle of like healing like was, if I recall correctly, earlier expounded by Paracelsus, who also believed in and practiced something resembling “sympathetic magic” as part of his medical philosophy.

I would, however, quibble with your claim that prior probability can ever be zero. I don’t think that’s true. Prior probability can be a very, very tiny number approaching zero. By your amusing equation that would still produce a level of evidence required that would be a very large number approaching infinity.

2. The notion of zero prior probability is philosophically problematic. It often becomes a matter of semantics, however. Mark put in the proper qualifier – as we currently understand biology, etc. That is functionally the same as saying that the probability is not zero just close to zero.

I think a good way to look at it is that if a new proposition goes against established scientific knowledge, then the evidence required is equal to or greater than all the evidence that establishes that scientific knowledge in the first place.

3. Mojo says:

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.

However, homoeopaths will claim that it is their system that treats underlying causes, using terms like “holistic”, while all real medicine does is to address the symptoms, “suppressing” them and making matters worse. Welcome to the topsy turvy world of homoeopathy.

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.

Here, I have to disagree; this is something of a strawman. Homoeopaths frequently use potencies such as 6X which, while they are probably dilute enough not to have any meaningful effect as far as most substances are concerned, do at least have the solute physically present – it’s only at 12C/24X and above that there is literally nothing left. There is, as far as I’m aware, no principle of homoeopathy that prevents the use of potencies of less than 6X, or even undiluted remedies, if the homoeopath thinks they are somehow appropriate. Hahnemann himself, after coming up with the “law of similars”, initially used undiluted remedies before coming to the conclusion that giving patients material doses of substances that made their symptoms worse was perhaps not such a good idea. The stuff with the dilutions and the “law of infinitesimals” was basically just a fudge to get around the inconvenient fact that substances that cause symptoms, er, cause symptoms.

Hahnemann later came to the conclusion that it was also better to carry out “provings”, via which homoeopaths find out what symptoms a substance produces, using diluted remedies at the 30C potency (see The Organon, 5th ed, aphorism 128), and this is how provings are pretty much always carried out. This is something that homoeopaths seem unwilling to draw much attention to: they often seem happy to give the impression that “provings” are carried out using material doses; an example often used is the use of homoeopathic onion to treat colds, on the grounds that chopping onions makes your eyes water and your nose run. However, even the “proving symptoms” on which they base their prescriptions are generally imaginary.

4. Harriet Hall says:

I was reading excerpts from the list of homeopathic fevers to my husband, and he asked if they meant 5 p.m. local time and if it should be corrected for daylight savings time. I wonder if they’ve thought this through… no, of course they haven’t!

Reminds me of the time I asked the feng shui guy if his “north” was magnetic or geographic. He didn’t know there was a difference. I pointed out that compasses detect magnetic north, and if you lived in northern Canada just north of the current location of the (wandering) magnetic north pole, your north would be due south.

Thanks, Mark, for an excellent post. Science can’t ever say for sure that something is impossible, but it can say that the currently available evidence shows that somethiing is so improbable that it would be perverse to accept it. CAM is often quite perverse.

5. I think a good way to look at it is that if a new proposition goes against established scientific knowledge, then the evidence required is equal to or greater than all the evidence that establishes that scientific knowledge in the first place.

Agreed. Indeed, I’ve often phrased the issue in a manner very similar to that myself–and not just for CAM but for issues like creationism.

6. sandman says:

What a well-reasoned and entertaining post. It’s good you stress that many of the CAM modalities are implausible, not necessarily impossible. Seeing the world through scientific spectacles means we have to keep an open mind pending evidence and not be goaded into making claims we shouldn’t – like saying something is impossible when implausible would be more apt at a given point in time. For example, scientists frustrated by nattering IDers will take to calling evolution a “fact” – now, it’s about as close to fact as anything in science can be, but we shouldn’t adopt the language of the opposition or we risk losing the hard-won high ground.

That said, homeopathy is flat-ass goofy and deserves to be called more than impossible. How about predatory?

s.

7. Karl Withakay says:

Probability approaches zero as improbability approaches infinity.

Now if we only had a good, strong source of Brownian motion and some smart-ass scientists, we could cure all disease.

8. PalMD says:

I really, really wish I’d written this.

9. Zetetic says:

Homeopathy question… When I was a small child, I was extremely sensitive to poisonous plants common to rural Maryland – Poison Ivy in particular. I would flare up with a rash by seemingly just walking within 5 feet of the vines! My mother took me to a clinic where they prepared, weekly, small cups of something which I drank. My memory is weak (it was about 50 years ago) on this but I think it was supposed to desensitize me to the toxic nature of poison ivy. We soon moved to the west coast where I only (and often) encountered poison oak so I don’t know if it really worked for poison ivy. Was this likely a homeopathic preparation?

10. daedalus2u says:

I understand where you are coming from, and agree with you to a very high level, perhaps 99.999+. However, the example of pi is not strictly apt. In our universe the ratio of the circumference to the diameter of a circle is not the same as pi in a Euclidian universe which is completely flat. Our universe has some discreteness to it, whether that applies to physical space and so to all values of distance (and hence all ratios of distances) is unclear. Below the Planck length distances are not measurable.

There are places where pi has different values, usually smaller values because the radius of a circle surrounding a mass is stretched by the distortion of space more than the circle is. In a black hole, the radius may be stretched to infinity, so the ratio goes to zero.

I agree with you when you say:

”I think a good way to look at it is that if a new proposition goes against established scientific knowledge, then the evidence required is equal to or greater than all the evidence that establishes that scientific knowledge in the first place.”
However that is established scientific data, not necessarily established scientific models. The model that ulcers were usually caused by stress happened to be wrong. It was the data derived from the unsuccessful treatment of ulcers as if they were caused by stress that led (in part) to the development of the H. pylori hypothesis.

What constitutes “scientific data” vs. what constitutes “scientific knowledge” is debatable. The distinction is very important and is not to be minimized. Data is data, and while it may be subject to error and mistakes, it is not “knowledge” that can be overcome with evidence.

A new model that incorporates all of the old data that the old model did and then some doesn’t require extraordinary evidence. Special relativity went against Newtonian mechanics which was established scientific knowledge. Special relativity didn’t contradict any of the data that had been used to formulate Newtonian mechanics. Special relativity and Newtonian mechanics describe slow speed mechanics equally well at the levels of accuracy that were attainable at the time.
The H. pylori hypothesis didn’t contradict any of the data surrounding ulcers. It explained it better. All models that are more correct will explain more data better than models that are less correct.

There are many models that are generally accepted even though there is no real evidence that they are correct; for example the homeostasis hypothesis of physiology and the amyloid hypothesis of Alzheimer’s.

11. Shieldsm says:

According to the homeopathic “Law of Infinitesimals” the smaller the dose, the greater the effect. Does that mean if you stopped taking a homeopathic remedy you could die from an overdose?

12. teeps29 says:

Brilliant post.

13. delaneypa says:

Mark,
The best analogy of Mapping Modalities I ever heard involves your home state: “Reflexology is like predicting the weather in Portland, Oregon by seeing what the weather is in Portland, Maine, by virtue of the fact they are connected by streets and highways.”

Can’t remember to whom to attribute the analogy.

14. Karl Withakay says:

Zetetic:
If it wasn’t diluted to the point of containing only water, it wasn’t a homeopathic preparation.

My guess is what you were taking was some sort of oral allergy immunotherapy.

I think it’s important to avoid confusion with the law of similars and the concept of vaccination and immunotherapy.

FROM WIKIPEDIA:
Immunotherapy or desensitization therapy for allergies must not be confused with homeopathic treatments. Immunotherapy administered through cutaneous injections or sublingually has substantial empirical support. Numerous research articles and several meta-analytic studies support its clinical effectiveness. Conversely, homeopathy (or Rinkel immunotherapy) is not generally endorsed by the medical profession as it lacks substantial empirical support.

Wikipedia is too generous to homeopathy here, but it makes my point anyway.

15. Karl Withakay says:

It is also important to understand the distinction between a homeopathic remedy and an herbal remedy. Apparently, very few people understand that there is a difference.

I was speaking the other day with my mother, a retired RN, and she had no understanding of what the term homeopathic actually meant. She thought it was a technical term used to describe herbal medicine. she was flabbergasted when I explained the law of similars and the concept of succussion/ dilution.

The distinction is blurred when you have homeopathic remedies that also include vitamins, minerals, and herbal extracts, such that they are not purely homeopathic preparations, but are instead hybrids.

16. Karl Withakay says:

Zetetic:

Upon doing a little more research, it could also have been a homeopathic remedy such as Rhus toxicodendron.

17. overshoot says:

I think a good way to look at it is that if a new proposition goes against established scientific knowledge, then the evidence required is equal to or greater than all the evidence that establishes that scientific knowledge in the first place.

Still overstated, but only slightly. Presumably most wacked-out notions don’t contradict all parts of our current knowledge, so the amount of evidence required is only enough to outweigh that evidence that the wacked-out notion contradicts, directly or indirectly.

For instance, homeopathy doesn’t obviously contradict celestial mechanics so far as I am aware. However, it does rather massively contradict some rather fundamental aspects of solid-state electronic engineering so before I’m even remotely inclined to be charitable to it, I want to see how the “New Unified Homeopathy” explains this computer I’m typing on.

18. Charon says:

overshoot:

Homeopathy _does_ contradict celestial mechanics. Something that makes science incredibly strong is the interconnectedness of disciplines. Celestial mechanics (taking a minimal version, dealing with the motions of the stars and planets) relies on Newton’s laws (or equivalent formulations). These same laws are used to derive the laws of thermodynamics. Those laws tell you that homeopathic remedies have no active ingredients.

So a claim that homeopathy works not only contradicts all experiments in thermodynamics, but also in astronomy. And solid state physics, and particle physics, and chemistry, and…

Any one experiment is a bit unsure, but the well-verified theories (Newton’s laws, evolution, etc.) have been tested by a vast interlocking web of experiment and theory.

19. Charon says:

Mark:

A minor point, but it is good to distinguish between something rigorously proven (e.g., you can’t square the circle, given the ZFC axioms of math), something very well established but not capable of being rigorously proved (e.g., quantum electrodynamics, which succeeds everywhere we’ve looked so far), and something that we know is only an approximation (e.g., the “laws” of thermodynamics, which fail in known situations).

That said, I very much liked the article.

20. dohashi says:

There are places where pi has different values, usually smaller values because the radius of a circle surrounding a mass is stretched by the distortion of space more than the circle is. In a black hole, the radius may be stretched to infinity, so the ratio goes to zero.

This is incorrect. The value of Pi does not change based on our ability to represent a circle in “our universe”. Pi is a fixed constant defined by using a perfect circle. The fact that a perfect circle may not physical exist in our universe is irrelevant. It is a mathematical construct.

Saying that Pi’s value changes because we can’t represent a perfect circle is like saying the value of 1/2 changes because you can’t accurately cut a rod into two exactly equal length parts.

21. overshoot says:

Charon:

There’s a reason I used the weasel words “obviously” and “so far as I am aware.” Yes, all of science interconnects but you can’t necessarily go directly from thermodynamics (which is not dependent on Newton’s laws, actually, it’s pretty much pure mathematics or so I learned in University so long ago) to celestial mechanics and you can’t go directly from either one to rejecting action at a distance, else we wouldn’t have been having that discussion well into the 20th Century.

However, we’re still quibbling over the difference between mountains of evidence and mountain ranges of evidence, when homeopathy doesn’t even have milligrams.

22. okjhum says:

Excellent article and interesting comments. I particularly loved the “if you stopped taking a homeopathic remedy you could die from an overdose” concept.

A related question: If you have a 24 dilution, is it physically possible to dilute it any more? Or is e.g. 30D a double fraud?

23. Mark Crislip says:

q: If you have a 24 dilution, is it physically possible to dilute it any more? Or is e.g. 30D a double fraud?

a: yes, you are futher deluded.

24. daedalus2u says:

I wrote inarticulately. I agree that pi as an abstract mathematical quantity has all the mathematical properties attributed to it, and an abstract circle cannot be squared using an abstract compass and an abstract ruler in an abstract flat Euclidean space.

In the second paragraph of my comment when I said “pi” when I should have use the term “ratio of circumference to diameter of a circle”.

However, Mark made a “big deal” out of trying to square the circle using a ruler and compass in our universe. He said ”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.”

Einstein said it quite well:

”As far as the laws of mathematics refer to reality, they are not certain, and as far as they are certain, they do not refer to reality.”

Pi is a very important number in abstract mathematics. The value of pi is something that can (in principle) be calculated to any degree of certainty, even to 10^(10^(10^(10^(10^100)))) digits, though there isn’t enough mass in the known universe to do so. Does the value of pi actually correspond to anything in reality? Is it possible for there to be a universe where pi does not have the value that it does in our universe? As an abstract mathematical quantity, pi is not subject to any limitations of physical reality. If you are going to attribute the properties of pi to the physical structure of our universe, then you are saying that our universe is Euclidean and flat and infinitely divisible.

The ratio of a circumference of a circle to its diameter does take on different values depending on the curvature of space. That ratio only has the value of pi in a completely flat and continuous space (and hence infinitely divisible space). We know our universe is not completely flat. Our universe very likely has some level of graininess to it, that is there are no physical manifestations of “real” numbers with an infinite number of digits. What that means is that there is very likely no circle where the ratio of its circumference to its diameter equals the value of pi.

There are other analogies that don’t suffer from this problem, for sample the square root of 2 cannot be expressed as the ratio of two integers. Just as impossible as the squaring of the circle but leaves out the confusion of needing an abstract ruler, and abstract compass and an abstract flat space.

But this is disagreement on the level of quibbling.

25. Robert says:

While I agree with you on almost all your other conclusions, your conclusion in regards to chiropractic is wrong. While much of the chiropractic profession is filled with philosophically-motivated and perhaps even anti-intellectual/anti-science people, there is a strong foundation of solid science that a good deal of chiropractors base their work on, and they achieve phenomenal results every day by applying this science.

First, something must be agreed upon:

0) all the tissues in the body are under the control of the nervous system, and the nervous system communicates with the body in order to maintain homeostasis and direct recuperative processes, among other things. Therefore, proper interaction between the nervous system and the body is paramount to good health.

Then we have my argument, which needn’t be agreed upon, but which I think is self-evident:

1) all the nerves in the body, with the exception of the cranial nerves, leave the spinal cord via the intervertebral foramina, where there is the possibility of impingement, traction, or chemical irritation. This has all been researched and documented.

2) the nerves which deliver instruction and receive input from the lungs, for instance, are from the spinal cord. Therefore, if there is a subluxation of sufficient severity to disrupt the nervous system, that person’s lungs will very likely not be functioning at 100% since, indisputably, the lungs are controlled by the nervous system and therefore rely on proper and complete communication between the CNS and the lungs. A pair of lungs constantly functioning at 80%, for example, is only 80% able to resist infection and initiate repair processes successfully due to this relative lack of proper nervous system function.

3) innate intelligence, while it does come off sounding quite hokey, is really just a construct used to explain away an as-of-yet unexplainable force that certainly exists. Homeostasis does not occur on accident, it is the body’s natural proclivity to maintain a constant internal state. The inborn intelligence in our bodies that directs our tissues to repair and regenerate following injury are not conscious efforts under the command of our brains, it is all occurring outside of our consciousness.

4) in many cases, if not most cases, the body knows what to do when it is diseased do that the body can return itself to a state of homeostasis and optimal health. The goal of the chiropractor is to remove all possible nerve interference (which has been heavily researched and it has been shown that subluxations can and will cause nerve interference) so that the body can adapt to it’s ever-changing environment and remain healthy.

5) chiropractic was founded, and has been led by at various times, charlatans and anti-science figures. This has led to animosity from the established medical community, as evidenced by things like the AMA conspiring to destroy the profession of chiropractic to the extent that the Supreme Court had to demand they cease their behavior.

6) all new ideas are ridiculed, then eventually accepted as self-evident. it is practically risk-free, and is literally and undeniably safer than medications, surgery, and most everything else modern medicine has been able to offer people with chronic or acute back or neck problems.

7) the scientific explanation for chiropractic is complex and ever-evolving. to dismiss is outright in the same discussion as homeopathy is ridiculous and unfair, and while the author at this site certainly appears well-educated and well-spoken, the treatment of chiropractic in this article is unfair and belies a lack of understanding of the profession, the science behind it, and the real meaning of so-called “innate intelligence”

Sincerely, Rob Romano

26. overshoot says:

Oh, like wow, man — we’ve got a live one.

27. Harriet Hall says:

Rob Romano’s defense of chiropractic is full of holes. All the tissues of the body are not controlled by nerves; some are controlled by hormones. The lungs are innervated by a cranial nerve, the vagus, that does not pass through the spine. Despite over a century of trying, no one has ever demonstrated that chiropractic subluxations exist, that there is nerve interference, or that spinal manipulation removes that interference.

http://www.chirobase.org/
https://www.sciencebasedmedicine.org/?p=59
“Trick or Treatment”, by Edzard Ernst, the world’s first professor of complementary medicine, who reviews all the evidence for chiropractic and concludes: “Chiropractors, on the other hand, might compete with physiotherapists in terms of treating some back problems, but all their other claims are beyond belief and can carry a range of significant risks.”

28. okjhum says:

Dear Rob Romano, you are really brave to speak out like that in the (false) belief that your education has given you equivalent knowledge of the human body in health and disease as a true medical education would have given you. I think that that is representative of both those CAM practicians who happen to have “a little learning” and the public: that they really don’t know how much we scientifically educated physicians really do know, truly holistically, from the minutest detail of cell organelles to the entire psychosocial situation of our patients – and all the connections between them. So we also know whatever doesn’t exist there… Actually, that’s how we spot diseases – finding something that doesn’t belong. When we can’t find the cause of a disease we say so. We don’t invent anything. Thank you for highlighting the difference.

(The quote is from Alexander Pope: “A little learning is a dangerous thing; drink deep, or taste not the Pierian spring: there shallow draughts intoxicate the brain, and drinking largely sobers us again.”)

Olle Kjellin, MD, PhD,
Sweden

29. Diane Henry says:

“all new ideas are ridiculed, then eventually accepted as self-evident”

Sigh. I do get tired of that one.

30. Jim1138 says:

Zetetic: You were probably given ImmunOak or ImmunIvy. PG&E crews in California swore by it. It tasted like grass. Over-the-counter package with three or four vials of increasingly dark liquid. Mix with water and drink. I think the instructions said to take a few days between each vial. Made my eyes itch.

If you took ImmunOak while you had a poison oak rash, the rash would get worse and last longer. Apparently, this resulted in many lawsuits and the products being removed from the market.

31. Fifi says:

Just to point out the obvious, chiropractice isn’t “new” or some “radical innovative theory” that challenges the accumulated scientific evidence with some bold and paradigm shifting theory that’s possible. It’s actually an old idea (a very old idea) that that’s been well past its due date for ages and practitioners keep trying to dress it up in whatever is contemporary to try to pass it off as science. People who faithfully cling to the ideas promoted by chiropractice aren’t being revolutionary, they’re being reactionary.

32. Charon says:

overshoot:

I certainly understand the weasel words, I just wanted to point out that things are more interconnected than is obvious. The laws of thermodynamics do need Newton’s laws (see the derivation of the idea of pressure in any basic thermo or stat mech textbook), but probably what you remember is that they also require probability. Similar ideas can be derived in non-physics situations, such as Shannon entropy in information theory.

I think that the interconnectedness is actually quite important. Yes, there’s a lot of medical evidence that homeopathy doesn’t work, and none that it does, but that conclusion is vastly more secure within the framework of other science. This holds for the analysis of all dubious “alternative” medicine claims.

Awesome article, except for the use of the word impossible. ‘Impossibilities’ makes you look closed minded. We need to popularize the fact that scientists are the ultimate in open mindedness. Given the correct level of evidence, we will always change our mind. Nothing is impossible.

I understand what you are trying to say though. These are so implausible, and some have contradictions that cannot be reconciled, that they would need so much evidence to prove them true. Evidence that never comes. But still, we should keep these CAM modalities in the incredibly, incredibly unlikely category, which we shall treat as being false, until the evidence shows otherwise.

34. Since Mark Crislip cited me, I might as well stick in my two cents. First, I agree with everything he writes. Yeah, I even agree that there is no real “placebo effect,” even though on SBM I’ve described having experienced one or two myself! Sometime I’ll get around to explaining that.

I didn’t use “implausible” instead of “impossible” to be polite; I did it to be scrupulously correct, as other commenters have suggested. Nevertheless, I agree that homeopathy and the rest are impossible in the same sense that evolution by variation and natural selection is more than “just a theory”–even though to those who know what the word “theory” means in the context of science, it really is a theory.

One of the fundamental tools of skepticism is to weigh extraordinary (“implausible”) explanations for data against ordinary (plausible) ones, and the term lends itself to that.

Finally, as Charon somewhat suggested, not all “laws” of nature can be deduced from criteria that are self-evident. Most can’t, which means that there really is a competition, of sorts, between those who claim that their data contradict a “law” and those who believe that enough previous data has been gathered to confidently assert (induce, actually) that the consistency of those data imply that “law.” The First Law of the universe (mass is conserved) is an example. The prior probability of any claim that requires a violation of the First Law approaches zero, but can never be said to equal zero in a formal sense for the same reason that the next swan may not be white. Nevertheless, it is so close to zero that for practical purposes–such as whether to take a crackpot seriously or whether to commit public funds to “study” the question–it IS zero.

Hornblowing: the real story of the alleged ostracism of the H. pylori hypothesis is here: http://www.csicop.org/si/2004-11/bacteria.html

35. Mark Crislip says:

I am even close to being scrupulously correct.
Impossible is what I said,
Impossible is what I meant,
CAM is impossible
One hundred percent.

Sorry Horton:)

I wait for the placebo post; I hope I am not Godot’d

“Impossible is what I said,
Impossible is what I meant,”

This is a matter of definition. If you mean so implausible, it basically is impossible, then sure (That’s the impression I get form your second last paragraph), but you still shouldn’t use the word impossible because it is bad PR.

“CAM is impossible
One hundred percent.”

One hundred percent? There is nothing at all useful, even by accident, in all of naturopathy, chiropractic, herbalism, traditional Chinese medicine, Ayurveda, meditation, yoga, biofeedback, hypnosis and homeopathy? We have to treat it all false, because nothing has been proven. But there is almost certainly something true or useful in that wasteland of CAM. To say it is 100% crap, is to be closed minded. Listen to the evidence with a skeptical attitude, but don’t say it is all completely unprovable, no matter the evidence. That is a dogmatic view that is not scientific.

False till proven true – correct.
Unprovable – we will never have that answer (although, I will agree, don’t hold your breath).

37. Mark Crislip says:

I had to get the meter right, but within the context of the topics discussed in the post, 100% crap.

This is were I part companies with my colleagues; I am not able to be agnostic.

There is nothing to support the basic theories of the methodologies discusses in the post. They are not implausable, they are impossible.

I am not a scientist, I am just this guy, you know. I live in the real world. And to say these things are impossible is, in my mind, a reasonable assessment based on the available data. It is not being dogmatic or closed minded when EVERYTHING says homeopathy and acupuncture etc is crap.

The converse, that itis proved that HIV causes AIDS is, in my mind true, and I am going to be dogmatic and closed minded on the topic.

I just think that this really really implausible approach is, while intellectually true and pure, is more weaslely than not when applied to the real world.

To be intellectually fair and precise, I would have say that the existance of Santa is vanishingly small and implausible. I don’t work that way. Aint no Santa, either