Friday, July 30, 2010

Homeopathy: Part 1

 “There are no greater liars in the world than quacks—except for their patients.”
--Ben Franklin

Potions and pellets

Dharma recently transferred to my care from another practice.  At her first appointment, Dharma complained of back and hip pain.  She had overdone it a bit during an ice skating lesson the previous day.  Dharma presented me an empty, tiny, paper envelope, and asked me to replenish her supply of Arnica. 

Arnica is a homeopathic “remedy”  That is what homeopathic physicians call their potions and pellets.  Traditional homeopathic remedies consist of supposedly therapeutic agents dissolved in a liquid such as water or alcohol, or mixed into pellets of bee’s wax or lactose (milk sugar).

The Homeopathic approach to medicine dates back to the late 1700s, when Dr. Samuel C. F. Hahnemann (1755-1843), its founder, practiced medicine in Germany.  A memorial in Washington, D.C. commemorates his life and accomplishments in bronze on marble.  Hahnemann became disenchanted with the medical practices popular in his day--leeching, purging, and treatment using mercury compounds—which seemed just as likely to harm a sick patient, as help them.  In his quest for a different path, he developed the precepts of homeopathic medicine, rooting them firmly in pseudoscience and mysticism.  Homeopathy, as I will explain, requires near-lethal doses of magical-thinking on the part of its practitioners and patients.

Homeopathy is not merely a dead limb on the evolutionary tree of medicine, like other rotting branches such as phrenology (reading lumps and boney landmarks on the head).  For several complex reasons, homeopathy and a few related treatment modalities are enjoying resurgent popularity.  The number of practicing homeopathic physicians in this country grew from 200 in the 1970s to over 3,000 in 1996.

Many of my colleagues fault homeopathy for having roots in 18th century mysticism and relying upon unscientific concepts like good and evil humors and spirits.  Those criticisms, though accurate, miss the point.  I do not criticize homeopathy for the primitive ideals it once espoused and has since discarded any more than I criticize a thirty year old man for having believed in Santa Claus as a child.  I criticize homeopathy and homeopathic providers for the misinformation they expound now.  Homeopaths spout absolute blarney right now, every day, about their practices and their remedies.

Healing magic
Dr. Hahnemann erected his edifice upon three scientifically unsound and discredited foundations.  I will discuss each concept in turn, the first being the “Law of Similars.”  Paraphrasing: “like cures like.” 

Homeopaths claim that a substance known to cause a certain symptom in a normal person can cure a sick person with similar symptoms.  For example, suppose Dharma had presented to my office on this occasion with vomiting from food poisoning.  A homeopathic-practitioner would prescribe Dharma an extract derived from a plant or animal product capable of causing vomiting in normal people.  A facet of this at first glance, seems plausible.  Eating a rancid piece of meat can certainly result in vomiting.  The act of removing that piece of meat from the stomach by vomiting, or from the intestine through diarrhea, allows the body to protect itself to some degree by ridding itself of the rancid meat before it can do serious damage.  In fact, traditional medicine often uses syrup of ipecac for this very purpose: as a cathartic, to induce vomiting after poisoning. 

When examined more closely, however, this analogy falls short of explaining the homeopathic approach.  The homeopathic remedy, though it’s derived from a chemical believed to cause vomiting, is not given with the intention of causing vomiting; it’s intended to cure vomiting without causing vomiting.  In other words, a homeopath does not intend to cure vomiting by giving a remedy to provoke vomiting and get it over with; he gives a remedy capable of causing vomiting, but expects there will be no vomiting.  This defies reason.  I have yet to find a way to reconcile this apparent paradox without relying on the supernatural or magical.

Homeopaths have built an entire system of treatment upon this implausible, paradoxical premise.  It’s like saying that I painted my room red in order to make it blue.  The homeopathic approach differs markedly from standard medical and pharmacological practice, in which a physician prescribes a medication known to cause a certain effect in order to obtain that effect, not its opposite.  Modern medications base their mechanisms of action upon the receptor model, in which a medication interacts with a specific receptor to provide some therapeutic benefit.  The medication’s ability to interact with other, untargeted receptors, accounts for some of its side effects. 

The evidence supporting the receptor model is overwhelming and very reproducible.  Many of the receptors targeted by modern medications have been specifically identified--the ability of various medications to bind to those receptors having been well demonstrated.  Credence in homeopathy, on the other hand, requires us to accept fanciful, magical concepts that come completely without credible supporting evidence, and to abandon well-established, reliable, science.

Homeopathy preaches that a remedy interacts with a body’s vital forces to affect a cure.  So far, no credible research has succeeded in demonstrating the existence of any such forces, let alone the ability of homeopathic remedies to interact with them.  The efficacy of homeopathy—and the health of those who pay good money for this preposterous treatment—rests upon an immense and untenable leap of faith.  And that's just the beginning.

More to come...

Wednesday, July 14, 2010

Kefir Mythology

Kefir is a yogurt-like product made by fermenting milk with cultures of several bacteria and yeast. Frankly, until recently, I had never heard of it (nor--to my short-lived, blissful ignorance--smelled the pungent stuff). However, fad, alternative remedies usually cross my path in exactly this manner; I initially catch a rumor of some new uber-cure, then see it spread, much like a virus among unvaccinated children, over weeks to years.  I had the privilege of smelling Kefir in the hands of a patient who was using it to treat abdominal pain she had suffered from for several months.  She noted if she stopped using the Kefir for even a day, she started feeling worse.

I did a little research and found a company called Body Ecology that markets a Kefir Culture Starter kit. The website touting the benefits of Kefir claims all the usual nonsense about "strengthening the immune system" and such, but goes on to specifically claim that Kefir helps patients with ADHD, flatulence, herpes, cancer, colon "strengthening," chronic fatigue syndrome, and "cleansing the whole body."  What exactly does that mean?

Another website, this one for Lifeway Foods, claims that Kefir helps with Crohn's disease and Ulcerative Colitis (UC) because those diseases are "similar to Irritable Bowel Syndrome."  In fact, Crohn's and UC are not related to Irritable Bowel Syndrome at all (other than the fact that they all affect the bowel).   Without descending too deeply into technical details, Crohn's disease and Ulcerative Colitis are inflammatory conditions of the gut that, when present, effectively rule out Irritable Bowel Syndrome as a cause of abdominal pain.

Two clicks more on my Mac took me to PubMed, the web portal of the National Library of Medicine, where I found absolutely no randomized, controlled trials supporting any of these claims. It appears, then, that Kefir is a yogurt-like food that may have some as yet poorly established benefits of a "probiotic" nature, now being promoted--with no reliable research support--as a cure-all for all sorts of symptoms and diseases.

What's the harm, one might ask. Well, in this case, Kefir is not being promoted simply as a nutritious food (which it might very well be), like cheese or yogurt. Purveyors are making health claims about this product. Some patients suffering from symptoms like chronic abdominal pain, Crohn's disease, ulcerative colitis, nausea, fatigue, colon cancer, herpes, and ADHD are listening in, and buying it. This can cause unsafe delays in actually working up, diagnosing, and treating potentially dangerous illnesses. It can also foster a false sense of security in a patient who believes he is adequately protecting himself or others from the effects of a serious infection when in fact it isn't true.

In summary, there is no reliable evidence that Kefir is anything more than a (moderately disgusting) food.  The patient with the Kefir turned out to have a Helicobacter pylori infection which I treated with antibiotics and an acid reducing medication.