You might be wondering why there was no fresh Insolence, Respectful or not-so-Respectful, yesterday, and, before I lay down today’s installment, I’ll tell you. Basically, I was ensconced in a meeting room of the Westin Hotel at the airport all weekend on a strategic planning retreat for my cancer center. As much as I’d love to blog about what happened there, I can’t, because what went on there is confidential. I can, however, say that it was an…unusual…experience. It was even illuminating. That being said, I realize that I also rarely write about the same topic three times in a row, but, before I move on, I feel the need to do one more post about homeopathy, thus closing (for now) a series that began on the first day of Homeopathy Awareness Week and ended up with a post showing how “integrating” homeopathy with real medicine harms the clinical care being offered. Along the way, I encountered one of the most bizarre bits of homeopathy ever, in which a naturopath named Anke Zimmermann made the news for a case report in which she treated a child with the homeopathic remedy lyssinum, which is derived from the saliva of a rabid dog. Or so homeopaths claim. This four year old child presented with behavioral problems, including aggression, pretending to be a dog, and, oddly enough, a fear of werewolves. (How a four-year-old even knows what a werewolf is would be the question I would have asked, suspecting that somehow he had seen all or part of a horror movie inappropriate for someone that young.)
The reason I’m revisiting Not-A-Doctor Zimmermann is because I noticed that she’s taken down her original post describing her case report. In its place at the same URL, she now has an impassioned and risible defense of homeopathy. Fortunately, the Internet never forgets, and, thanks to the almighty Wayback Machine at Archive.org, the original post can still be found quite easily. I’ve already discussed that in depth before, however. What I’m interested in now is Not-A-Doctor’s excuses and complaints. First, I can’t help but note that she engaged in the usual conspiracy-mongering in a followup news story published Friday:
“I’m not taking this personally,” she said. “There is a worldwide push by skeptics and organizations funded by pharmaceutical companies to eliminate homeopathy. This is nothing new.”
Funny, but she says that as though it were a bad thing. In reality, of course, this is merely the very predictable pharma shill gambit. It is now obligatory for me at this point to ask the usual questions that must be asked whenever I and other skeptics are accused of being in the pay of big pharma: Where is all the filthy lucre I’m supposed to be getting? I’m told there would be piles of money, expensive sports cars, and a yacht. Where is my damned yacht?! In fact, for no reason at all other than it is a “where” question and because I like Game of Thrones I was half tempted to put a photo of Queen Daenerys Targaryen raging, “Where are my dragons?” Oh, what the heck:
There, I feel better.
In any case, why am I doing this for free, even paying the expense of hosting my blog out of my own pocket? I mean, seriously! I don’t even get the small amount of blogging cash I used to get from ScienceBlogs when it still existed. I’m completely on my own.
Enough of that, though. What’s amusing is that Not-A-Doctor Zimmermann takes it upon herself to lecture health officials who were horrified at the thought of using saliva from a rabid dog as the starting compound for a homeopathic remedy. She’s oh-so-outraged at their ignorance about homeopathy, and she thinks that a medical doctor doesn’t know how rabies is transmitted:
It’s a sad day for Canada when a top health official, a medical doctor no less, causes alarm in the population because she expresses ‘grave concern’ that a homeopathic remedy made from rabies might somehow infect someone and should perhaps be removed from the market.
Unfortunately she is completely uninformed about homeopathy or this thought would have never crossed her mind. Neither does she seem to quite understand how rabies is transmitted, even though she is a medical doctor, which nobody in the press seems to have noticed.
As per the CDC: “Transmission of rabies virus usually begins when infected saliva of a host is passed to an uninfected animal. The most common mode of rabies virus transmission is through the bite and virus-containing saliva of an infected host. Though transmission has been rarely documented via other routes such as contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol transmission, and corneal and organ transplantations.”
Zimmermann is referring to Bonnie Henry, British Columbia’s senior health officer, who told CBC News that she had “grave concerns” about the use of lyssinum to treat the young boy. Zimmermann also didn’t quote Dr. Henry quite properly, as Dr. Henry said, “It’s hard for me to believe as a physician that anything that was made from a very serious lethal infection … would have any therapeutic benefit” and, annoyingly from my point of view, even conceded:
Henry said she believes some homeopathic remedies can be helpful under certain circumstances, but not in this case.
Oy, Dr. Henry. That’s what we call trying to be too diplomatic. Homeopathy is The One Quackery To Rule Them All. It doesn’t work any more than placebo, mainly because the vast majority of homeopathic remedies are nothing more than water.
The rest of Not-A-Doctor Zimmermann’s rejoinder to all the criticism doesn’t actually help her. In fact, she openly admits that homeopathy is water, placebo medicine, as a defense of using a homeopathic remedy supposedly based on the saliva from a rabid dog. Indeed, she explicitly says:
Homeopathic remedies don’t contain any active viruses or other pathogens and are also not administered via sharp teeth, saliva or organ transplants etc. The remedy I administered consisted of a few medicated lactose pellets.
Unfortunately the public in North America is ill-informed about homeopathy thanks to the relentless and ongoing attack on homeopathy by the mainstream media. The usual accusation is that homeopathic remedies are just water, a placebo, but now the claim suddenly is that they are somehow deadly or injurious, because the remedy in this case was made from rabid dog saliva.
I have news for you folks, homeopathy either works or it doesn’t. If it doesn’t, what does it matter what it’s made of, dog saliva, elephant’s dung or badger’s pubic hair, it’s so diluted that it’s only water after all, or a placebo, a sugar pill.
The remedies I gave in this case were of the potencies of 200CH, 1M and 10M which means they went through the dilution and succussion process 200, 1000 and 10,000 times.
After the process is repeated 12 times it is basically impossible to have even one of the original molecules left in the solution, which is ultimately often used to medicate lactose or sucrose pellets.
Therefor there is no single molecule of rabies in the remedy. Again, you can’t catch rabies from the remedy.
Zimmerman, surprisingly, is correct here. Given that Avogadro’s number is on the order of 6 x 1023 and that a single “C” dilution is a 100-fold dilution (making a 12C solution a 10-24 dilution), any homeopathic remedy of “stronger” than 12C is unlikely to have a single molecule of starting material left. For comparison, a 200C dilution is a 10-400 dilution. For further comparison, the number of atoms in the known universe is only estimated to be on the order of 1080. Of course, if you really want to get ridiculous, consider that “M” is shorthand for 1,000C, making a 1M dilution a 10-2000 dilution and a 10M dilution even more amazingly ridiculous at a 10-20,000 dilution. We’re basically talking fantasy here.
Left unsaid, of course, is how any compound diluted many, many orders of magnitude beyond nonexistence in solution can have any physiological effect. Well, not exactly unsaid. There’s the usual handwaving about “we don’t know how it works, but it does,” an infuriatingly stupid argument because it assumes that we “know” that homeopathy works when in fact we “know” nothing of the sort. As I like to say, for homeopathy to “work,” huge swaths of well-established knowledge in physics and chemistry (and biology) would have to be not just wrong, but spectacularly wrong. If we’re going to conclude that we need to radically revise our understanding of large swaths of scientific knowledge to include concepts like the “memory of water” that homeopaths sometimes invoke to “explain” homeopathy, it will take more than just the occasional clinical trial that, because of random chance and bias, gives a positive result. Not that that stops Not-A-Doctor Zimmermann from listing cherry picked studies going back to the 1980s.
She also describes how lyssinum was supposedly made and discovered:
Rabies is an infection of the central nervous system, so early homeopaths realized that it might be useful for certain neurological and mental health issues. One brave soul, somewhere around 1833, 50 years before the crude experiments of Louis Pasteur, who developed the rabies vaccine, managed to extract a little saliva from the mouth of a small pet dog who had been bitten by a rabid fox. Then he made it into a homeopathic remedy. It’s quite a riveting story, any interested parties are directed to Allan’s Materia Medica of Nosodes. The dog had puppies when it was bitten and two of her puppies were also bitten. The doctor extracted the saliva, made it into a remedy, gave it to the puppies and was able to save them, but the mother died as her state was more advanced and she had been bitten more intensely.
One of the first symptoms a person with rabies may experience is a general over-excitability; they can be more lively and talkative than usual and may have trouble sleeping. Next they might feel a sense of dread, of something terrible about to happen, as well as a fear of dogs, the dark and water. Hence the reason it was given in the case in question and similar cases I have treated of children who were overexcitable, had trouble sleeping and had various behavioural issues.
I have on numerous occasions prescribed the remedy based on an unreasonable fear of dogs in both adults and children, as long as other indications were also present.
So let me get this straight. I’m supposed to believe that someone, back in 1833, got saliva from his pet dog who had been bitten by a rabid fox and then made it into a homeopathic remedy that he used to save the dog’s puppies? Then I’m supposed to believe that this same tincture has been kept for 185 years and used as the basis for lyssinum? I call bullshit on this story. As for the indications, I discussed the nonsense that is the “rabies miasm” last time. As you might recall, basically a miasm seems to be some sort of generational contamination wherein if any of your ancestors ever had rabies or was treated for rabies, the “miasm” might have been passed down to you. It’s a delightfully silly and fluid concept, too, as, according to homeopaths, miasms don’t predict disease and have nothing to do with the diseases they’re named after. (Imagine the relief of those diagnosed with the cancer miasm.)
If you want another example of this sort of ridiculousness, consider Medorrhinum, a homeopathic remedy that Zimmermann has used to treat bedwetting and pervasive developmental disorder and epilepsy. What, you may ask, is the starting material for Medorrhinum? Gonorrhea. I kid you not. Any condition that homeopaths think to come from the Sycotic (or gonnorhea) miasm, which homeopaths attribute to “suppressed gonorrhea.” In the case of bedwetting, the rationale is to use Medorrhinum because bedwetting involves the genitourinary tract and so does gonorrhea. In the case of the child with PDD and epilepsy, Medorrhinum was used to treat a “remarkably strong feature to bite, put everything in her mouth and even bite her toenails.”
In fact, one homeopath’s website describes Medorrhinum this way:
Medorrhinum is a very important remedy to consider for Autism. It is also a magnificent remedy for hormonal problems, and affects the generative organs very strongly. It is one of the best remedies for severe menstrual cramps and other problems connected with the menstrual cycle. It is the first remedy we consider in homeopathy for recurrent urinary tract infections. The remedy also affects the musculo-skeletal and nervous systems very profoundly.
Medorrhinum is a massive remedy, which is possibly needed by a large percentage of mankind. When syphilis and gonorrhea are treated with antibiotics or other means in allopathic medicine, the genetic taint is not eradicted from the system, and it causes alterations in the genes, which are passed on to the offspring. Homeopathy offers a means of preventing this unfortunate scenario, which has generation-wide consequences.
Yes, the gonorrhea miasm persists down through the generations. If you have an ancestor who ever had gonorrhea or was treated for gonorrhea, you could well have the Sycotic or gonorrhea miasm. The very concept of miasms, in fact, reminds me why naturopaths, homeopaths, and other quacks are so enamored of epigenetics. They think epigenetics means that basically any noninherited trait or even memory can be passed down through many generations.
In the meantime, Zimmermann has been busy on social media posting gems like this:
How about a little bit of Rover with your flu vaccine? Flucelvax is grown in dog kidney cells. Cocker Spaniel to be precise. Think you're not going to get a bit of dog DNA with it? Think again. But giving a child a homeopathic… https://t.co/O8uTa4XpRJ
— Dr. Anke Zimmermann (@drzimmermann) April 23, 2018
On our next episode of, “One of these things is not like the other,” we explain to Not-A-Doctor Zimmermann that, even if there were dog DNA in the flu vaccine, it is not the same thing as concern about a whole rabies virus in a homeopathic remedy or the utter quackery and pseudoscience that underlie the idea that you can use rabies virus diluted to nonexistence in solution as a treatment for anything.
Finally, Zimmermann notes:
I’m a licensed ND but I practice mostly homeopathy. All NDs learn basic homeopathy in naturopathic college, but not all specialize in homeopathy. NDs learn many different treatment modalities, homeopathy is only one of them. Others include clinical nutrition, acupuncture, physical therapies etc. Homeopathy is an entire system of medicine in its own right, just like acupuncture, or nutrition. Homeopathic practitioners may or may not have other qualifications, including being medical doctors, chiropractors, acupuncturists etc.
As I’ve said before, you can’t have naturopathy without homeopathy, because all naturopaths learn homeopathy in naturopathy school and, in states where naturopaths are licensed, naturopaths must pass an examination that includes a section on homeopathy. Yesterday, naturopaths, organized by the American Association of Naturopathic Physicians (AANP), were in Washington, DC, lobbying lawmakers to be included with physicians assistants and advanced practice nurses (also sometimes called nurse practitioners) as health care providers authorized to prescribe controlled substances like buprenorphine to assist in combatting the opioid addiction crisis. If you want to know why the thought of naturopaths with prescription pads scare the crap out of me, just consider Not-A-Doctor Anke Zimmermann and that all naturopaths are, to some extent, homeopaths as well. Then ask yourself: Would you want someone with such massive misconceptions about basic science and medicine to be administering drugs to real patients? The answer is obvious.