Jun 17 2013

A Homeopathy Debate

On two occasions I was invited to UCONN to debate the scientific legitimacy of homeopathy – in 2007, and again in March of this year. I often directly confront or debate those who hold an unscientific belief. Sometimes this is criticized as being pointless, but that claim is premised on the assumption that the only point to such a debate is convincing the person on the other side, but that is not the case.

I have several goals in direct confrontation: to better understand the claims and logic of those holding that view, to explore my own position and improve my ability to explain it, and to demonstrate scientific and critical thinking with respect to this issue to the audience.

The more recent homeopathy debate was between me an Andre Saine, a Canadian naturopath and homeopath. During the debate we barely scratched the surface of this complex topic, so we both agreed to continue our discussion in writing, moderated by Peter Gold who organized the debate.

Here is Andre’s first question to me, and my answer.

Question from Andre Saine

It is quite common for homeopathy to be grossly misrepresented in the professional and popular literature. You wrote, “In order for an argument to be sound all of its premises must be true. Often, different people come to different conclusions because they are starting with different premises. So examining all the premises of each argument is a good place to start.”1

Let’s start with two of the basic premises you stated that they belong to homeopathy, namely the law of infinitesimals and the law of chronic diseases. First, you wrote, “The second law, the law of infinitesimals, says that as you dilute the substance it becomes more potent—in direct violation of the very real laws of physics and chemistry,”2 as well as, “I want the public to be aware of the fact that most homeopathic solutions are diluted far past the point where there is likely to be a single molecule of active ingredient left—and therefore claims for the homeopathic ‘law of infinitesimals’ violates the law of mass action and the laws of thermodynamics.”3

Now let’s turn to the official definition of genuine homeopathy and its fundamental principles. Forgive me for this very long definition that Hahnemann wrote in the preface of the last edition of his Organon but it is the most complete and most unequivocal one: “Hence homeopathy avoids everything in the slightest degree enfeebling,* and as much as possible every excitation of pain, for pain also diminishes the strength, and hence it employs for the cure ONLY those medicines whose power for altering and deranging (dynamically) the health it knows accurately, and from these it selects one whose pathogenetic power (its medicinal disease) is capable of removing the natural disease in question by similarity (similia similibus), and this it administers to the patient in simple form, but in rare and minute doses so small that, without occasioning pain or weakening, they just suffice to remove the natural malady whence this result: that without weakening, injuring or torturing him in the very least, the natural disease is extinguished, and the patient, even whilst he is getting better, gains in strength and thus is cured—an apparently easy but actually troublesome and difficult business, and one requiring much thought, but which restores the patient without suffering in a short time to perfect health,—and thus it is a salutary and blessed business.

“Thus homeopathy is a perfectly simple system of medicine, remaining always fixed in its principles as in its practice, which, like the doctrine whereon it is based, if rightly apprehended will be found to be complete (and therefore serviceable). What is clearly pure in doctrine and practice should be self-evident, and all backward sliding to the pernicious routinism of the old school that is as much its antithesis as night is to day, should cease to vaunt itself with the honorable name of homeopathy.”4

You will notice that in this detailed definition, Hahnemann answers the question that you asked me during the debate regarding the use of compounded5 versus “accurately” known, simple medicines, and that such a practice, as well any other form of practice that don’t abide to the just-cited fundamental principles “should cease to vaunt itself with the honorable name of homeopathy.” However, you will not find in this definition of homeopathy and its fundamental principles, or in any other of Hahnemann’s works or writings, any reference to a law of infinitesimals or a law of chronic diseases that you mentioned during the debate.

Returning to what you have written, “in order for an argument to be sound all of its premises be true,” and given that these two basic premises you claimed for homeopathy unequivocally don’t exist or apply to genuine homeopathy, and are therefore false, aren’t all their subsequent arguments unsound or completely false, such as “ ‘the law of infinitesimals’ violates the law of mass action and the laws of thermodynamics“ and “the very real laws of physics and chemistry”?

As a responsible man of science, what steps are you going to take to correct these gross and completely unscientific misrepresentations of the fundamental aspects of homeopathy and any of their subsequent logical fallacies, which you have repeated for many years in numerous articles and presentations, and that can currently be found on numerous websites ? 6 Also can you precisely describe what laws of chemistry or physics, homeopathy violates, if any at all, once these two completely fabricated laws of homeopathy are eliminated from the equation?

References:

[1] Steven Novella. How to argue. Neurologicablog. March 19, 2009

[2] Steven Novella. Homeopathy at the Huffpo. Skepticblog. Oct. 19, 2009.

[3] Steven Novella. Quietus and homeopathy awareness week. Neurologicablog. April 13, 2010.

[4] Samuel Hahnemann. Organon of Medicine. Sixth edition. Translated by William Boericke. Philadelphia: Boericke and Tafel, 1922: 18-19.

[5] Unproved compounded medicines or combination remedies sold under the name of homeopathy are clearly not part of homeopathy. However, they could be sold under the name of homeotherapeutics.

[6] Such as theness.com/neurologicablog, sciencebasedmedicine.org, skepticblog.org, randi.org, csicop.org, friendofreason.wordpress.com, skeptico.blogs.com, startleddisbelief.com, illuminutti.com, lizditz.typepad.com, lippard.blogspot.ca, skepticalteacher.wordpress.com, trusted.md, skepdic.com, etc.

* Homeopathy sheds not a drop of blood, administers no emetics, purgatives, laxatives or diaphoretics, drives off no external affection by external means, prescribes no hot or unknown mineral baths or medicated clysters, applies no Spanish flies or mustard plasters, no setons, no issues, excites no ptyalism, burns not with moxa or red-hot iron to the very bone, and so forth, but gives with its own hand its own preparations of simple uncompounded medicines, which it is accurately acquainted with, never subdues pain by opium, etc.

 

Dr. Novella’s Response:

I find the claim that Samuel Hahnemann did not endorse a “law of infinitesimals” to be misleading in many respects.

First, it is a “No True Scotsman” logical fallacy – arguing that examples of infinitesimals within homeopathy do not demonstrate that homeopathy follows such rules, because such examples are a-priori “not true homeopathy.”

The undeniable fact is, that homeopathy, as it is widely practiced today, including the many homeopathic products sold on the market, do follow the basic concept that ingredients are diluted to extreme degrees. While the exact extent of dilution varies considerably, very common dilutions include those that exceed the point at which any original ingredient is likely to remain.

I further find it either an example of intellectual dishonesty or extremely poor and selective scholarship to claim that Hahnemann did not endorse extreme dilutions. He may not have written the words “law of infinitesimals” himself, but he certainly endorsed the principles that are captured in that phrase.

A review of his writings documents quite thoroughly that Hahnemann began with a belief in using the smallest dose possible in order to treat a patient, but that this belief evolved over his career until he was recommending extreme dilutions (what would now be called 30C, or 1/100 dilutions repeated 30 times).

From the Organon fifth edition he writes:

“The doctrine of the divisibility of matter teaches us that we cannot make a part so small that it shall cease to be something, and that it shall not share all the properties of the whole.

If now the smallest possible part is powerful enough for the purpose for which you require it, would you employ a greater quantity than you require, in order not to run counter to traditional custom, and out of deference to the prejudices of those whose standard of measurement is imperfect ?

And what is the use of larger doses of medicines if the smallest possible quantities given on the Homoeopathic principle suffice for the cure of diseases in the most rapid and permanent manner ?

The effect of the dose increases the greater the quantity of liquid it is dissolved in when given to the patient.”

That sounds pretty clear to me – you can dilute something without limit, and the more you dilute it the greater the effect. Is that not the law of infinitesimals as it is understood today?

I will also note that this violates the laws of chemistry – a molecule is the smallest part of a substance that retains its chemical properties. It cannot be divided further and still “share all the properties of the whole.”

Here he specifically endorses 30C as a common dilution (again from Organon fifth edition).

“Two drops of the fresh vegetable juice mingled with equal parts of alcohol, are diluted with ninety-eight drops of Alcohol and potentized by means of two succussions whereby the first development of power is formed, and this process is repeated through twenty-nine more vials, each of which is filled three-quarters full with ninety-nine drops of Alcohol, and each succeeding vial is to be provided with one drop from the preceding vial (which has already been shaken twice) and is in its turn twice shaken, and in the same manner at last the thirtieth development of power (potentized decillionth dilution X) which is the one most generally used.”

Further, Hahnemann clearly supported the notion that homeopathic remedies worked through their “spiritual” power. In the “Spirit of the Homoeopathic Doctrine,” published in 1813, he says :

“The spiritual power of medicine does not accomplish its object by means of quantity, but by quality or dynamic firmness.”

This next section is from a letter in which Hahnemann was defending himself from critics, published in Samuel Hahnemann, His Life and Work, page 116.

This infinitesimal size of the dose of a simple medicinal substance, in this new art of healing, removes all possible suspicion of harmful strength in the simple dose dispensed to the patient.

The apothecaries, who are incapable of acquainting themselves with the fact that the beneficial results shown in the strong curative power of such small doses of simple medications, consist of a hitherto unknown peculiar choice of the suitable remedy for the disease in question, so far undreamt of by the ordinary medical science, smile at these small doses which contain nothing, because the senses as well as chemical analysis cannot detect anything in the vehicle (sugar of milk and diluted spirits of wine).

That seems pretty clear too. The “infinitesimal size of the dose” contain “nothing” and cannot be detected by “chemical analysis,” and yet has its effect because of his new art of healing – the peculiar choice of remedy.

Regarding Hahnemann’s theory of disease, his own quotes again clearly make the case that he was using his own peculiar theory of illness. From The Life and Letters of Dr Samuel Hahnemann Chapter 13:

“Psora is the oldest, most universal and most pernicious, yet, withal, the most misunderstood chronic miasmatic disease, which for thousands of years has disfigured and tortured mankind.

“In the thousands of years since it first visited mankind (the most ancient history of the oldest nations does not reach its origin) it has increased its manifestations to such a degree that its secondary symptoms can scarcely be numbered.

“The most ancient historical writings which we possess describe psora very fully. Several varieties thereof were described by Moses 3,400 years ago. At that time, however, and ever since, among the Israelites, psora appears to have affected more especially the external parts of the body.

“The same holds true among the early barbaric Greeks ; later, in like manner, among the Arabians, and finally in the uncivilized Europe of the middle ages. It is not my object to detail the different names by which the various nations have designated the more or less severe forms of disease through which leprosy marred the external parts of the body (external symptoms of psora). Such names have no bearing upon the subject, as the essence of this miasmatic itch disease remains always the same.

“In Europe during several centuries of the middle ages psora manifested itself in the form of a malignant erysipelas (St. Anthony’s Fire). In the 13th century it again assumed the form of leprosy, brought by the returning Crusaders from the East. Leprosy was thus more than ever before spread through Europe (in the year 1226 there were in France about 2,000 leper-houses) ; nevertheless some alleviation of its horrible cutaneous symptoms was found through the means of cleanliness which the Crusaders also brought from the East ; aids to cleanliness theretofore unknown in Europe, (cotton, linen), shirts, as well as the frequent use of warm baths.

I maintain that the historical record, as well as modern implementation, support the following premises:

– Homeopathy is based upon the notion that solutions can be diluted beyond the point that any active ingredient remains, while retaining (and even enhancing) its potency.

– Effectiveness of remedies is not based upon any scientific notion (chemical or biological) but rather on the notion of the spiritual action of preparations which contain the essence of what was diluted in them.

– Shaking preparations transfers essence and adds potency

– Effectiveness of homeopathic remedies are based upon the peculiar and completely unscientific notions of similars

– Hahnemann based much of his thinking on peculiar notions of chronic illness (psora) that are completely unscientific.

There are many more examples in the references I gave, and in many more. The samples I provide, however, clearly establish the points I outline above.

In short – Hahnemann absolutely endorsed the principles captured in the phrase “law of infinitesimals” and these principles remain the core of modern homeopathy. All of my further criticisms that derives from this premise are both valid and sound.

Conclusion

The above exchange is a good example of why I find it so useful to directly confront believers – I never would have guessed that a contingent of homeopathy deny the Law of Infinitesimals.

I am still not sure what to fully make of it. During the debate Andre defended extreme “ultramolecular dilutions,” yet he also says this is not part of true homeopathy. Am I missing something, or is this just an absurd version of the kettle defense (I strongly suspect the latter). Or is Andre making a nitpicky distinction between “infinitesimals” and some other concept of extreme dilutions? Such a distinction is of no consequence – once you get below the dilutional limit, there is simply nothing left.

The ploy is also very common among defenders of unscientific belief systems. Legitimate criticism or evidence against a belief is often deflected by saying that what it targets is not “true” (fill in the blank). They then accuse the skeptic of attacking a straw man or being dishonest.

However we are often responding directly to claims that are being made. Go to any website about homeopathy and you are very likely to encounter some endorsement of infinitesimals or extreme dilutions. Most homeopathic products on the shelves also have extreme dilutions.

In any case, the historical record here is clear. Hahnemann’s homeopathy is based upon extreme dilutions, which are premised on unscientific notions, as described above.

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