You might be wondering why there was no Insolence here the last couple of days. The reason is simple. I was away at the annual meeting of the American Association for Cancer Research (AACR). Given that I’m much more comfortable occasionally letting a couple of days go by without my usual pontifications and brain droppings, I simply didn’t bother to try to blog while I was gone, other than for Monday’s post. I even thought about going one more day without a post. Then I recalled that while I was away an incredible story hit the press, a story that, better than any I can remember in quite some time, illustrates just how ridiculous not just homeopathy is, but naturopathy too. Of course, given that you can’t have naturopathy without homeopathy (or antivax, for that matter) because homeopathy is an integral part of the education and practice of naturopaths, so much so that it is part of the NPLEX, the naturopathic licensing examination), it’s not surprising that a naturopath would believe what must be believed to do what this naturopath did, particularly the use of a homeopathic remedy known as Lyssinum.
Meet Not-A-Doctor Anke Zimmermann, who claims to have cured a restless, growling child with rabid dog spit:
A British Columbia homeopath who boasted of curing a child’s behavioural problems with a remedy made from the saliva of a rabid dog has prompted calls for greater oversight of alternative medicine.
Writing in the “successful clinical cases” section of her blog, Anke Zimmermann of Victoria described treating a four-year-old boy last fall who was restless, aggressive to other children, afraid of werewolves and growled at people.
After hearing the boy had been bitten by a dog at age two, Zimmermann said the prescription was clear.
Googling led to Dr. Jen Gunter, who had taken note of this case before it went international, including this Facebook post:
Yes, amazingly, Not-A-Doctor Zimmermann hasn’t taken her FB post down since she started making the news. It also led me to Zimmermann’s blog post two months ago about under—believe it or not—her “successful cases” section, in which she describes a four-year-old boy with sleep and behavioral problems, including aggression and violence towards classmates and hiding under tables and growling that “improved nicely” with a homeopathic remedy made from the saliva of a rabid dog, Lyssinum. Here’s the history:
Jonah, a nearly 5-year-old boy, was brought in because of sleep and behavioural problems on October 6, 2017.
“It takes him 2-3 hours to fall asleep at night. He is restless and irritable and thrashes around in bed. It’s a battle every night and has been for the past 3 years”, his mother reported.
“We go through the same routine every evening, bath, brushing teeth, stories, bed at 7:30 – 7:45, but he’s still up by 9:30 – 10 pm, flipping around, blankets everywhere. Then he is so tired on waking the next day.”
I ask him why he can’t sleep and he tells me: “I’m afraid there are wolves outside, werewolves.”
“Yes, he’s been complaining about this for the last six months and wants the curtains drawn real tight every night because of that.”
There are problems with his behaviour. His preschool is complaining that he hides under tables and growls at people. Apparently this can happen several times a day. The teachers think he may have Oppositional Defiant Disorder because he is defiant and also has trouble focusing. At home the parents are using de-escalation techniques to help him cope but the school is not as proficient at this.
The parents can’t take him to birthday parties or go out with him because he gets too excited and becomes hard to control.
At this point I asked his mother if Jonah had ever been bitten by a dog. Indeed, the answer was yes, he was bitten by a dog on a beach when he was two years old. The dog accidentally bit his hand because he wanted the food Jonah had. The bite broke the skin slightly.
“How do you feel about dogs now?” I ask him. “They growl”, he answers.
His mother tells me that he has been growling for about 1.5-2 years now. It has been an issue at his preschool since that time.
“How do you feel when you growl?”
“Like there is a tornado inside me. My spirit is a hurricane!”
So let’s see. What would a real doctor think if a boy with these symptoms and issues were brought into her office for evaluation? Certainly, these are potentially difficult behavioral issues that could lead to problems in the future. The child would likely benefit from counseling, therapy, and possibly pharmaceutical intervention, depending on what the workup showed. In any case, a workup would need to be done, a full history and physical examination, and possibly some diagnostic tests, after which a diagnosis would likely be made.
Of course, this is a naturopath who likes to practice homeopathy, not anything resembling a real doctor. So instead we get this:
This is a 4-year-old boy who is suffering from an inability to fall asleep at night, a fear of the dark, of wolves, werewolves, ghosts and zombies and who frequently hides under tables and growls at people. He is overly excitable and has a tendency to defiance. He was normal as a baby, not affected by sleep or temper problems.
There is a history of a dog bit which drew blood. I decided to give a homeopathic remedy made from rabies.
The dog that bit him may have recently been vaccinated with the rabies vaccine or the dog bite in and of itself may have affected the boy with the rabies miasm. Either is possible and the phenomenon is welll-known in homeopathy.
The wag in me can’t help but wonder how, given all the antivaccine nonsense I see on Not-A-Doctor Zimmermann’s website, how she would think that vaccines would do anything. On the other hand, given that she is antivaccine, I suppose it’s not surprising that she might think that the rabies vaccine would somehow imbue the dog that bit the child with rabid behavioral characteristics. It’s ridiculous, of course, but then so is homeopathy.
But what is rabies miasm? At first, I was a bit confused and assumed that Not-A-Doctor Zimmermann was referring to miasma theory. You might recall that miasma theory was an old medical notion that predated germ theory and purported to explain why diseases were communicable. After all, even before scientists knew anything about bacteria or viruses, it was obvious that certain diseases appeared to be communicated from one person to another. Miasma theory postulated that such diseases were caused by a miasma (μίασμα, ancient Greek: “pollution”), a form of “bad air.” Homeopaths, however, appear to have a different definition of “miasma,” though. For instance, this veterinary homeopathy (yes, unfortunately they exist) describes miasma as “when the body/mind/emotions of an individual manifest signs of the disease without actually having the disease.”
The National Center for Homeopathy quotes the originator of homeopathy, Samuel Hahnemann, as saying, “Chronic diseases arise from dynamic infection by a chronic miasm.” That, of course, doesn’t help, but miasms are actually a cornerstone of homeopathy:
A shorthand definition of a miasm is that it is a force within a person or an animal, creating a predisposition to certain kinds of illness. The miasm defines our susceptibility. Long before modern science identified genetically-linked diseases, Hahnemann noted that certain families tended to develop certain illnesses. Moreover, he observed that certain illnesses were related to each other, so that even if family members did not mimic each other’s diseases exactly, their illnesses shared similar characteristics and patterns. He also noticed that some diseases, even if “cured” by medicines and other treatments, left people ever after vulnerable to particular clusters of afflictions—families of ailments that, while seemingly unrelated, could be traced to a common root in that “cured” disease. These observations led to his understanding of the miasms, the forces that create particular disease characteristics.
Hahnemann described three miasms, psora, syphilis, and sycosis, and his disciples described two more, tubercular and cancer miasms. Now, here’s where it gets even more ridiculous. Miasms are named for diseases, but bear only a “loose relationship” to the diseases for which they are named. Even more bizarre, homeopaths say that miasms do not predict the disease. To show you how utterly divorced from logic, medicine, and science the concept of miasms is, I think it worth citing this rather long passage in full:
For those who are under homeopathic treatment, it is important to remember that having a particular miasm does not predict that you will develop any particular disease. It may be frightening, for instance, to be told that you harbor the cancer miasm, until you understand that this is merely a name and not a reflection of any predisposition to that disease. Miasms are named for diseases from which they originated and with which they share some characteristics, but they are not the disease itself.
Moreover, having a particular miasm does not mean that you have ever had the disease associated with it. Few people today, for instance, have had active syphilis, but the syphilitic miasm is very common in our population. This is because the miasm can be established in the ways I described above. The syphilitic miasm can appear in someone who has an ancestor who suffered from syphilis, or an ancestor who was treated for another disease in the same way as syphilis was treated at the time, or an ancestor who was married to someone with those experiences. It has no moral meaning and no implications about the individual person.
To confuse matters further, every miasm can create susceptibility to any disease. Miasms express themselves not in the identity of the disease but in its characteristics. Cancer, for instance, comes in many different forms; it can be slow-growing or aggressive, it can be combined with a vast variety of other complaints, and it can affect any part of the body. Any miasm can produce cancer, and only the individualizing characteristics of the particular case can express the miasmatic basis for the disease in that person.
Got that? Not only do miasms not predict that any given individual will develop any given disease. You can acquire them from an ancestor who had the disease or was treated for another disease in a manner similar to how that disease is treated, or an ancestor who was married to someone with the disease. Moreover, any miasm can create susceptibility to any disease! And here I had thought that the ideas that you treat symptoms by using something that causes those symptoms and that you make a homeopathic remedy stronger by serially diluting it away to nothing. Indeed, I’ve referred to how homeopathy is based on magic, citing Sir James George Frazer’s Law of Similarity as described in The Golden Bough (1922) as one of the implicit principles of magic. If anything, though, miasms are clearly representative of another law of magic, the Law of Contagion, which is basically what homeopaths are invoking when they claim that water has “memory” of what it’s been in contact with. Basically, miasms are the Law of Contagion put on massive doses of steroids, so that even ancestors who lived decades or longer ago can have bestowed on you a miasm without even having to have transmitted it through inheritance. Of course, homeopaths make miasms sound so very, very complicated, such that you can’t just learn how to treat them in a book. Amusingly, even though they can’t seem to tell you how any given miasm (if you even accept that miasms exist, which you should not) will produce any given disease, they invoke miasms as a reason why home homeopathic treatment might not work and why you should consult “an experienced professional who “can set things right by identifying the miasmatic basis of the problem and finding an appropriate remedy.”
In the case of dogs and the rabies vaccine, it’s a common claim among homeopaths who treat animals that rabies vaccines cause aggression in dogs, even though there is no evidence to support that claim, and that the rabies miasm, transmitted from the rabies vaccine, causes that aggression.
So that’s the background of Not-A-Doctor Zimmermann’s conclusion that this child must have rabies miasm:
A bite from an animal, with or without rabies vaccination has the potential to imprint an altered state in the person who was bitten, in some ways similar to a rabies infection. This can include over-excitability, difficulties sleeping, aggression and various fears, especially of dogs or wolves. This child presented a perfect picture of this type of rabies state. Most homeopaths would have easily recognized the remedy required in this case.
Plan: Lyssinum 200CH, 2 pellets. (Please note, this is a homeopathic remedy, prepared by a licensed homeopathic pharmacy in the UK, Helios Homeopathy.)
Yes, Helios does claim to make Lyssinum 200C.
Not surprisingly, what people have been focusing on in this story is whether or not the Lyssinum really did come from saliva from a rabid dog. If we’re to believe homeopaths, the first saliva obtained was in 1833 by C. Hering. Of course, a 200C dilution is the equivalent to a 10-400 dilution, and the estimated number of atoms in the known universe is only on the order of 1080, which means that it’s incredibly unlikely that, even if the starting material were saliva from a rabid dog, there would be one molecule of starting material, much less one virus particle left. But who knows? Actually, who knows what homeopaths are actually using? Maybe some homeopath decades ago managed to get some saliva from a rabid dog without getting bit and infected, or maybe the origin of the starting material used to make Lyssinum is lost in the mists of time and just assumed to have come from a rabid dog. Also, either way, even if it would be incredibly unlikely for any virus particles to survive dilution many orders of magnitude greater than the number of atoms in the known universe, if the starting material really was saliva from a rabid dog, the workers making the homeopathic remedies would be at risk for contracting a disease that is almost always fatal if not treated early. Also, homeopaths are just nutty enough to have actually used such saliva, though. After all, there were homeopaths trying to use Ebola virus as a starting material to treat bleeding.
Now here’s the amazing thing. Health Canada has approved Lyssin as a natural health product The online database entry for Lyssin even says, quite unremarkably, that the source material is the saliva of a rabid dog or, for those in Quebec, “salive d’un chien atteint de la rage.” Lest you think that you can make fun of those wacky Canadians for having approved this nonsense, be aware that the source cited by the Canadian entry is the Homeopathic Pharmacopoeia of United States. You might recall that, when Congress passed the Food, Drugs and Cosmetics Act in 1938, its principle author was Senator Royal Copeland. Copeland, it turns out, was physician who practiced homeopathy. In passing the law, he managed to include all articles monographed in the HPUS in the definition of drugs within the FDCA. As Jann Bellamy puts it, the HPUS is a “source for monographs, identity, methods of manufacture, standards and controls and potency levels of homeopathic products, both prescription and OTC” and “if the product is in the HPUS, it’s legal.” Yep, we have Lyssin in the US too, and veterinary homeopaths claim to be able use it as a nosode to protect against rabies. I kid you not.
For her part, Not-A-Doctor Zimmermann seems to be loving the attention:
So today the CBC called me at 2 pm for an interview re my dog bit story. Here is the result. Not terrible, only… https://t.co/a0Dvi1bKXV
— Dr. Anke Zimmermann (@drzimmermann) April 17, 2018
More exposure for homeopathy? I suppose so, but the exposure for homeopathy is a mix of horror at the stupidity and mockery of the stupidity. Not-A-Doctor Zimmermann also claims that the ends justify the means, that her treatment “worked.” Of course, if you read the account it’s not at all good evidence that the homeopathic Lyssinum “worked.” Basically, his growling and aggressive behavior, according to his mother, has been in essence waxing and waning. For instance, his mother reported three months after initiation of homeopathic treatment:
“There have been pretty big improvements”, his mother reported. “The fears of wolves and werewolves is completely gone, now he is complaining more about the dark and cracks in a dresser. His sleep has been great, but the last two weeks he seems a bit more unsettled. Things at school calmed down but for the past two weeks or so he is more aggressive again with kids there and is hitting and kicking. The school connected us with a special ed coordinator.”
“Not much growling at all, only once last week. Before he did it every day to alternate days and it would stay like that. We would tell him to stop growling but he would not stop. He’d also refuse to talk and just growl.”
“He stopped hiding under the tables at school, but that also has just come back a bit and the teachers are worried again.”
“He’s still pretending to be a puppy dog. Last night he wanted belly rubs. He just loves dogs. The only time I see him really give affection is when he is with a dog.”
In fairness, the most recent report was that he is doing better and is not currently aggressive. Zimmermann notes that “children usually need several doses of the correct remedy over a period of months to years to completely recover,” which is awfully convenient, given that development and maturity alone can account for much improvement. Also, any increase in the behavior would provoke another dose of Lyssinum, after which regression to the mean and confirmation bias would lead the mother to believe that the treatment worked. As for the fear of werewolves, did it ever occur to Not-A-Doctor Zimmermann to ask the child if he had seen werewolves in a movie? Seeing too scary a movie at that age can lead to nightmares and fears that can last a long time.
Hilariously, after the controversy erupted, Zimmermann added this to her blog post:
This blog post has generated some controversy and should be understood in the greater context of homeopathy and as part of my entire website. It is meant for educational purposes and not intended as advise or treatment. Interested parties should consult with a professional homeopath in their area or with another health care provider as needed.
Ah, yes, a variant of the quack Miranda warning! Of course!
I said at the beginning that this case demonstrates the utter ridiculousness of both homeopathy and naturopathy. Coming to the end of the tale, I now realize that that was an understatement. It will be of great interest to see what Health Canada does as a result of this case. Whatever it ends up doing, it won’t change the utter pseudoscience and mystical BS that is at the heart of both naturopathy and homeopathy.
It’s delicious that this incident occurred during Homeopathy Awareness Week, too.