Homeopathy in Cuba?

Homeopathy is among the most ridiculous of so-called “complementary and alternative medicine therapies.” I realize that I’ve made this point over and over and over again, but it bears repeating because, no matter how often homeopathy is shown to be utter and complete woo, homeopaths always seem to bounce right back, Gish galloping between the bullets of science in order to repeat the same unsupportable claims, nonsense about the “memory of water,” and comparisons of homepathy to vaccines. Another reason that homeopathy is an excellent example to discuss is because–well, let’s face it–it’s nothing but water or ethanol, depending on the diluent the homeopath decided to use to dilute his remedy into nonexistence, sometimes with some sugar if the homepath decided to put his diluted magic into pill form.

Just to review, in case you’re not a regular reader and don’t already know what homeopathy is, homeopathy operates according to a couple of main precepts: first, that “like cures like (a.k.a. the law of similars), which states that, to relieve a symptom, you choose a remedy that causes the symptom. Never mind that this concept is far more akin to sympathetic magic than anything backed up by science, which shouldn’t be surprising given that homeopathy is based on a prescientific understanding of disease. The other principle is known as the law of infinitesimals, which states that the more a remedy is diluted, the more powerful it becomes. Part of this principle is that the remedy must be vigorously shaken between dilutions or the magic doesn’t work. Homeopaths will solemnly tell me that dilution alone isn’t enough and that shaking “potentizes” the solution. It’s all nonsense, of course. There’s no scientific reason to think that the law of similars is a generally applicable law in biology and even less reason to suspect that the law of infitesimals is anything other than pure magical thinking. After all, a typical homeopathic dilution is 30C, which requires diluting the solution 1:100 thirty times, or a total of 1:1060. Given that Avagadro’s number is on the order of 6×1023, we’re talking on the order of 1037 times more dilute than what would be expected to have one molecule of original remedy left.

Thus endeth the review.

One thing that I find particularly irritating about homeopaths is that they will not infrequently claim that homeopathy is very much like vaccination because, you know, vaccination is a validation of “like cures like.” Sometimes this misunderstanding leads them to make truly dangerous claims, such as advocating homeopathy as a preventative strategy for pandemic influenza. Some even go so far as to claim that homeopaths did better treating people with influenza during the pandemic of 1918. Apparently homeopaths don’t just limit their idiotic claims of “homeopathic vaccines” to influenza. In fact, apparently, if the homeopaths are to be believed, homeopathy can prevent or treat HIV/AIDS, malaria, and a wide variety of other diseases.

Diseases like leptospirosis.

I hadn’t realized that Cuba was into homeopathy, but, if a press release sent to me by a reader is any guide, the Cuban government is seriously into homeopathy:

Homeopathic immunization against Leptospirosis in Cuba has resulted in significant reduction of disease incidence, prompting the Cuban government to focus more on homeopathy medicine in disease prophylaxis.

Leptospirosis is a zoonotic disease which is endemic in Cuba. It usually worsens during the hurricane and high rainfall seasons from October to December each year when the infection is spread via infected water, although rodent urine will also carry the disease.

The press release concludes:

Dr. Manish Bhatia, CEO of Hpathy.com, world’s leading homeopathy portal said that it is clear that the Cuban initiative in safe, effective, and low cost infectious disease prevention, making the Cubans world leaders in this area of immunization and this study will be followed with great interest by both practitioners and public health scientists around the world.

Wow! Odd that I hadn’t heard of this before! The writers of the press release were even kind enough to provide me a link to the “study” that allegedly shows the extreme efficacy of homeopathic vaccination against leptospirosis by a homeopath named Isaac Golden teamed up with a guy named Gustavo Bracho entitled Homoeopathic Immunisation Against Leptospirosis in Cuba.

Leptospirosis is a disease caused by the spirochete Leptospira (a bacteria similar to the kind that causes syphilis) that is carried by rats and other rodents. The disease resulting from infection by this bacteria can result in complications that include meningitis, extreme fatigue, hearing loss, respiratory distress, azotemia, renal failure, and often liver failure. In general the spirochete is transmitted in the urine of infected animals, most commonly rats, mice, and moles, although a wide range of other mammals can carry the disease, including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, possums, skunks, and certain marine mammals. It turns out that Cuba has a problem with leptospirosis. Every year after the summer and fall hurricanes, rats can be swept out of the sewers, and many more people come into contact with water containing the spirochete.

Leave it to Le Canard Noir to have reported on this nearly two years ago. However, the latest “publication” (if you can call it that) appears to be an update of the fevered reports from 2008 claiming that homeopathic vaccination had prevented leptospirosis outbreaks. Homeopaths had published some of this “data” (and I do use the word loosely–very, very loosely) in–surprise! surprise!–the journal Homeopathy. This study has been utterly demolished. True, the very fact that the article was published in Homeopathy should almost have been enough to scuttle it. After all, if the homeopaths had really had results that would stand up to scientific scrutiny, they could have gotten into a better journal. In any case, my university wisely does not subscribe to this journal, meaning that I don’t have access to the actual original paper; that is, unless someone wants to send it to me. I don’t want to reinvent the wheel anyway; so let’s move on to the new “study” instead.

The first thing I noticed in this article is that it is woefully lacking in description of exactly how this “study” was carried out. However, if we look at the descriptions linked to above of the previous “study” of this issue, it’s possible to determine that the homeopathic remedy used was made from four different Leptospira species, specifically L. interogans Serovar Canicola, L. interogans Serovar Copenhageni, L. kirschneri Serovar Mozdok, and L. Borgpetrsenii Serovar Ballum. Oddly enough, the homeopaths stated that the bacteria used as the “mother tincture” to make the homeopathic remedies used were inactivated. I’m not sure why they would use inactivated bacteria. After all, the inactivated bacteria wouldn’t cause the symptoms of Leptospirosis anymore, thus violating the homeopathic principle of “like cures like,” unless, perhaps, they were injected, in which case the homeopaths might be making a real vaccine. Speaking of a real vaccine, from my reading, I’ve learned that apparently Cuban doctors have managed to make an actual effective vaccine against Leptospirosis. It’s unclear why Cuban officials wouldn’t just go with that, except for a mention in one of the homeopathy studies that Cuba can’t make the vaccine in adequate quantities.

Nice. If you can’t provide sufficient real medicine for your citizens, give your people fantasy medicine instead.

And fantasy medicine it is! Remember how I talked about a typical homeopathic remedy being a 30C dilution? The homeopathic “vaccines” apparently reached truly mind-boggling levels of dilution, if the secondhand reports of the “study” I’ve read are any indication. For example, the most concentrated remedy used was apparently 200C, which is a 1:10400 dilution. but even that isn’t the most diluted remedy used. Apparently the “stronger” homeopathic remedy used was a 10 MC remedy, which is basically 10,000 C, or a 1:1020,000! How one does 10,000 serial dilutions and then administers the resulting tincture to hundreds of thousands of people, I just don’t know. It sure seems like a hell of a lot of tedious work for no gain, the proverbial long run for a short slide. If you’re going to go to that much trouble, why not just put the resources into making the real vaccine? I know, I know. That’s just me and my nasty reductionistic “Western” thinking. Wait a minute. Scratch the whole thing about “Western.” After all, homeopathy is a distinctly “Western” woo, given that it was dreamed up in Germany over 200 years ago.

In any case, the homeopaths behind this update to their “homeoprophylaxis” study claim that they have treated 2.5 million people and that the results were a dramatic decrease in the incidence of leptospirosis. The most recent update sets the stage for further claims:

The three eastern regions of Cuba, Las Tunas, Holguin and Granma (IR = Intervened Region) usually have a much greater incidence of the disease per head of population than the rest of the country (RC) as is clear from Figure 1 which shows the average weekly incidence of leptospirosis for 2003-2006 in IR (2.4 million people) and RC (8.8 million people), weighted per head of population figure for both regions (Average x population in Cuba/population in region).

In both 2007 and 2008 the RC was hit by severe hurricanes. In 2007 the Cuban Government, through the Finlay Institute which manufactures most vaccines used in Cuba, decided to homeopathically immunise the bulk of the population in IR due to a severe spike in the incidence of the disease.

This figure shows the typical incidence of leptospirosis in Cuba in the IR and RC from 2003-2008:


This next graph shows the weekly incidence in 2007, the year the homeoprophylaxis was tried out, the arrow indicating when the homeoprophylaxis began:


The claim? This:

2007 was already a worse than average year for residents of IR, and became dramatically so following the hurricanes. However the outbreak “broke” in IR in Week 47, 2 weeks following the HP intervention, although it continued in RC where there was no intervention.

My first thought was: WTF? How on earth could they say that? The patterns of incidence in IR and RC were radically different, with the IR having a spiking pattern that was highly variable. The homeopaths began their “vaccination” campaign right before the peak of the largest spike in the fluctuating pattern and then claimed credit for the “breaking” of the outbreak, even though it would be expected that there would be a drastic decline in incidence right after the peak, just based on the pattern of previous years in the recent past, yet this is what they try to do here, graphing leptospirosis incidence versus “predicted” incidence:


The modeling of the leptospirosis incidence in this graph is, as you might expect, not well explained. Even so, leptospirosis incidence is highly variable. In fact, it would be nice to see a longer timeline for leptospirosis incidence, because to me what this graph suggests is that the years 2006, 2007, and 2008 were the anomalies, with 2009 returning leptospirosis incidence back towards historical patterns. As our friend Le Canard Noir points out, it’s highly dependent upon hurricanes, rat populations, and public health measures. It’s a disease that can vary widely from year to year. Moreover, Cuban officials were undertaking other interventions to try to decrease the rate of leptospirosis infections, including real vaccination of high risk workers (such as sewage workers and others exposed to contaminated water), campaigns to eradicate rat populations that carry the bacteria, and public education efforts. Even if these efforts weren’t in effect, given the wide variation in leptospirosis infection incidence from year to year, you can’t assume that your intervention was responsible, particularly given that there was no control group and no attempt to estimate what the baseline endemic incidence of leptospirosis is other than to assume that the last three or four years are representative of long term trends. Basically, as Le Canard Noir put it almost two years ago:

So, is there evidence that the homeopathic experiment worked? Of course not. Accounts from the conference suggest that there were merely 10 infections per month and no deaths. Can this be attributed to homeopathy or the other health measure in effect? We will not know until a paper is published. But here is my prediction: it will basically say, we dished out the magic water and brandy, we saw a small amount of infection, we concluded it woz the homeopathy wot did it. No control groups. No baseline. Just assertion.

Damn that little black duck is good. He predicted it. What we have is our old friend John Benneth (whose Science of Homeopathy website is a hoot) saying just that:

I have to thank old John for one thing. He points out that it would have cost $3 million to produce enough real vaccines to immunize the population, which, it occurs to me, would be pretty damned cheap–only around $1 per person! The homeopathic “nosodes” cost a mere $200,000, which should not be surprising, given that homeopathy nothing but water. In any case, it sounds to me as though the Cuban government cheaped out, pulling a Mao, so to speak. You may remember that in the 1960s, Mao, seeing that he didn’t have the resources to provide adequate science-based medical care to his people, unleashed his “barefoot doctor” campaign, providing cheap traditional Chinese medicine to the masses, rather than science-based medicine, in order to give the appearance that he was providing needed medical care to his people, particularly out in the rural regions, which really lacked doctors. It looks to me as though, if this story is true, Cuba just did the same thing with homeopathy.

Same as it ever was.