Regular readers know that I like to refer to homeopathy as The One Quackery To Rule Them All. True, there are competitors for that most hallowed title of pseudoscience. Reiki and other forms of energy medicine come to mind as being just as ridiculous as, if not more so, than homeopathy in terms of claims and magical thinking, but homeopathy continues to win out because of homeopaths like British Columbia naturopath Anke Zimmermann, DN (ND=”Not-a-Doctor) and the level of bizarreness of the treatments they espouse. I first became aware of Zimmerman when I learned of her claimed use of homeopathic saliva from a rabid dog to cure growling, aggressive behavior, and a fear of werewolves in a four-year-old boy. Amazingly, this isn’t something that Zimmermann had just made up; it’s a real homeopathic remedy, based on the idea that there is such a thing as the “rabies miasm,” which can lead to aggressive behavior. Fortunately, the claimed remedy, Lyssinum, was first made many decades ago, and it’s not even clear that it ever started with actual saliva from a rabid dog. It’s also a 200C dilution, which means that it’s a 10-400 dilution of whatever C. Hering used back in 1833 to make up Lyssinum. Still, even though the actual remedy almost certainly has no rabies virus in it, the very idea is simultaneously extremely silly and extremely appalling.
In any event, it shouldn’t be surprising that Anke Zimmermann is into homeopathy. She is, after all, a naturopath, and you can’t have naturopathy without homeopathy. Homeopathy is an integral part of naturopathic education and practice. Not all homeopaths are naturopaths, but all naturopaths are homeopaths. They spend a lot of time learning it in naturopathy school, and it’s included on the naturopathic licensing examination, the NPLEX. In any event, Anke Zimmerman is also under investigation by the British Columbia College of Naturopathic Physicians for CEASE therapy for autism, part of which involves using a homeopathic dilution of the MMR vaccine, using “the 30C, 200C, 1M and 10M potencies to clear out the energetic field of the patient from the imprint of toxic substances or diseases.” Just for comparison, a 10M dilution is the same as 10,000C, which means a 10-20,000 dilution. By way of further comparison, Avogadro’s number is approximately 6 x 1023, and the number of atoms in the known universe is estimated to be around 1080. Anyone with a modicum of knowledge of chemistry and math can see how utterly ridiculous it is even to think that such a substance, diluted beyond not just Avogadro’s number, but way, way beyond even the estimated number of atoms in the known universe, could have any physiologic effect. Not that that stops homeopaths from invoking bizarre mechanisms to “explain” how homeopathy “works,” but hopefully you can see why it can’t.
It turns out that Anke Zimmermann is at it again. One of the things I used as a basis for discussing how pseudoscientific and full of magical thinking homeopathy is was the initial case report that Zimmermann posted on her website. Somehow, I missed a more recent one, posted in late May, but it’s so ridiculous that I say: Better late than never discussing it. Another reason to discuss the case report is because it demonstrates a technique much like cold reading: Just keep throwing homeopathic treatments at the patient until there appears to be an improvement, and then declare victory. In this case, Anke Zimmermann thinks that the vitamin K shot that newborns receive routinely before leaving the hospital was the cause of the baby’s problems and therefore treated her with—you guessed it!—homeopathic vitamin K. So, without further ado, here a case of chronic insomnia, restlessness, and excessive crying in a baby:
I saw a one-year-old girl I will name Erin on August 12, 2015. The parents were concerned about their daughter’s ongoing sleep issues and general emotional intensity.
“Erin screamed almost continuously for the first three months of her life, a high-pitched, blood-curdling scream, whenever she was not sleeping.”
“She continued to scream very frequently until she was 6-8 months old. Even now she easily reverts back to screaming if upset in any way.”
“She also has intense emotional swings. She can go back and forth on a dime, she gets very wound-up easily. Diaper changes are and have been a total nightmare. She fights us every time and also cries big crocodile tears. She gets very angry from restriction, hates the car seat. She is not very cuddly either.”
“She is very volatile and intense. She gets easily bored and needs constant attention from us. She can’t be still, is always moving, restless. When she nurses she constantly squirms and moves her arms and legs.”
“Erin is a horrible sleeper, very light. She wakes up right away if we step into the room. She often wakes up at night and then has trouble getting back to sleep. She is also restless in her sleep, moving all over her crib.”
“She is also very touchy, if another child touches her on the playground she flips out and yells at the top of her lungs.”
Does this sound familiar? It sounds like colic to me. Colic tends to begin at around two weeks of age, hit a peak intensity around 6 weeks of age, and then decrease until it goes away around 6 months of age. During that six month time period it can cause the parents a great deal of distress, but almost never results in any long-lasting adverse effects for the baby. The cry is often described just that way, a piercing, high-pitched scream. Here, for instance, is a description of colic from a review article:
Physicians and parents use the term colic to describe an infant with excessive crying, irritability, or fussiness. The most commonly accepted definition of colic, which originated in 1954, describes using the “rule of three”: crying for more than three hours per day, for more than three days per week, and for more than three weeks in an infant that is well-fed and otherwise healthy. This definition has been used repeatedly in clinical studies of colic. The motor behaviors of infants with colic also were first described in 1954. Colicky infants have attacks of screaming in the evening with associated motor behaviors such as flushed face, furrowed brow, and clenched fists. The legs are pulled up to the abdomen, and the infants emit a piercing, high-pitched scream.
Sure, this baby’s clinical course appears to have lasted to a bit older age than a typical case of colic, but there are outliers for everything in medicine. Be that as it may, whatever this baby’s problem was, colic or something else, you can bet that Anke Zimmermann is not going to ascribe it to something as common as colic. Indeed, the word “colic” doesn’t even feature in her “differential diagnosis” (if you can consider anything a homeopath does to be a “differential diagnosis). First, Zimmermann notes that this baby was born ten days overdue after a 40-hour labor, which was induced. She also notes that the mother received intravenous antibiotics for an infection during labor and had taken Clomid to conceive. The baby’s father had had years of antibiotic treatment for recurrent infections. Even more irrelevant, the mother’s paternal grandmother and brother had grown up in a tuberculosis sanitorium. Naturally, given that the parents were bringing this poor child to a naturopath, the baby hadn’t had any vaccines when seen by Zimmermann.
So let’s read Zimmermmann’s “analysis”:
She has a history of very light and restless sleep and was rashy as a baby, especially on her face. She was never vaccinated. There is a family history of tuberculosis, and of Clomid and antibiotic use as well as an induction for labour. We could rule out vaccine injury as she had not been vaccinated.
Imagine my relief that “vaccine injury” could be ruled out. But what else can we say. This:
As the child had difficulties from birth I carefully considered any factors around the pregnancy and birth as well as the family history. I chose the homeopathic remedy Tuberculinum as it fit the restlessness during day and night, the easy boredom, as well as the facial rashes, plus there was a confirmed family history of the disease.
Plan: Tuberculinum 200CH, one dose.
Yes, tuberculinum is exactly what it sounds like. It’s a homeopathic dilution of Mycobacterium tuberculosis, the bacteria that causes tuberculosis. Specifically, if you believe the Materia Medica, it’s a glycerine extract of a pure cultivation of tubercle bacilli (human). Homeopaths claim that it can treat tuberculosis (of course), but it’s rarely used for that much any more, given that tuberculosis is so much less common in developed countries than it used to be. Instead, it’s now used for “respiratory conditions, such as colds, asthma and allergies,” as well as to “control neurotic behavior, soothe irritability and help those with a flustered disposition.” This “natural medicine” source states:
From a homeopathic point of view, Tuberculinum (30C) is best suited to personalities who long for constant stimulation and change, often accompanied by destructive anger, disillusionment, irritability, and a strong sense of discontent.
Science? There is none to support this. If you really want to get an idea of the utterly bonkers nature of homeopathic “thinking” (and, no, diluting homeopathic thinking doesn’t make it stronger), read this entry on Tuberculinum. Supposedly the symptoms associated by this remedy (and, by the Law of Similars, treated by this remedy) include a feeling that there is “something beyond,” a deep sense of unfulfillment, teenagers who won’t do their homework, and, in a young child, irritability to a destructive degree, fussiness, mental retardation (I kid you not), restlessness, fear of strangers, monosyllabic answers, colds, headache, diarrhea, and more. This entry on Zimmerman’s blog claims that tubercuinum is good for developmental delays, restlessness, defiance, destructiveness, bedwetting, head-thumping, and allergies.
So, as bizarre as it sounds, Not-a-Doctor Zimmermann was treating this child according to precepts of homeopathy upon which most homeopaths would agree. So off she went, treating first with 200C Tuberculinum. She thought that did some good, although who knows, given placebo and expectation effects? Her first assessment was, “This report sounded promising but the remedy did not seem to hold that well.” So what did she do? Like any good homeopath, she upped the potency by increasing the dilution to 1M. Everything seemed to go well for a while, but by five weeks into treatment:
Email Sept 23, 5 weeks into treatment:
Has had four episodes of being up again at night last week. Took two hours to get resettled. Lot of screaming when trying to put her down in crib.
Plan: Repeat Tub 1M
October 1, email:
Was awake three hours at night with screaming and up again at 5:30 with screaming
Plan: Repeat Tub 1M
October 4, email:
Had two good nights, now another bad one, screaming from 2-4 am.
Assessment: May need a higher potency but I suspect that something else may be needed.
So the treatment clearly wasn’t working. The baby was still fussy and screaming at night. At this point, given that the baby was well beyond the usual age range for colic, a pediatrician would likely have started a workup to make sure there was nothing medically wrong with the child. Not Anke Zimmermann:
FU consultation Oct 13:
Reviewed history: Mom had antibiotics with delivery. Father had a lot of antibiotics in his life, years of it. She reports that overall Erin is getting happier. She has been fighting them on the change table again a bit. Better able to stay in car seat, before she was crying after 15 minutes.
Assessment: Tuberculinum always helps a bit, but I’m not convinced it’s the only remedy she needs. Overall Erin is continuing to improve, but some of that may also be due to normal development and maturation. I decided however to stick with Tuberculinum and give a 10M.
Plan: Tub 10M
Yes, you got that right! Not-a-Doctor Zimmermann doubled down on the homeopathic tuberculinum, “cranking up” the dose to 10M! There is a hint of self-awareness, there, though. She actually admitted that part of the improvement that she thought she had seen could have been due to normal development and maturation. In actuality, almost certainly all the changes she was observing were due to normal development, given that 30C, 1M, and 10M Tuberculinum is nothing but water. What happened next? Apparently nothing for nine months.
FU: July 26, 2016, almost a year into treatment:
I had not heard from the family in nine months. Erin is doing great overall but still gets upset easily: “She gets very excited before an event then when it happens she rapidly deflate. Emotions overcome her, she has rapid outbursts of anger.”
Her mother took Clomid to conceive and I decided to try a course of Clomid in homeopathic form to see if it would address the underlying and still continuing emotional volatility.
Plan: Clomid 30CH twice a week for two weeks, then Clomid 200CH twice a week for another two weeks
Yeah, because if Clomid caused the girl’s emotional problems, then Clomid diluted to nothingness would cure them, right? Of course, by this stage the child was probably nearing “terrible twos,” given that she was first seen in August 2015 at what I estimate to be close to a year old. All I could think at this point was: No one’s ever heard of a toddler who’s emotionally labile and throws temper tantrums, right?. At least Not-a-Doctor Zimmermann apparently hasn’t. At this point, I was wondering: Where was the person or health care professional who can counsel the mother that her child is behaving like a normal baby entering toddlerhood? Remember, this sounds as though it were the mother’s first child, and that she had had difficulty conceiving.
Not surprisingly, the Clomid didn’t work, although Zimmermann interpreted the patient’s difficulty sleeping and other aspects of her course as being due to Clomid bringing up some “blocked emotions.” So she gave Ignatia 200CH. Now here was a homeopathic remedy that I hadn’t heard of before. Apparently, Ignatia comes from the St Ignatius bean, which is the seed of Ignatia amaris, a climbing shrub native to China, the Philippines and Indonesia. Apparently Hahnemann himself “discovered” it and “proved” it in a homeopathic proving. Basically, it’s supposed to treat anxiety and prolonged grief. Did it work? What do you think.
But then, in a bolt out of the blue, Not-a-Doctor Zimmermann had an insight! it was based on the mother’s observation:
Her mother contacted me because I had posted a report about a baby having a reaction to a vit K shot on my facebook page. She said it sounded like Elise! They had forgotten to tell me that she had received a vitamin K shot at birth. I also had not thought about asking or even considering that a vitamin K shot could cause any problems up until that time.
Plan: Vit K clearing protocol as in CEASE therapy, 2 pellets twice a week with each potency of 30 CH, 200CH, 1M and 10M.
And what was the result? Whatever happened, you just know that an naturopath like Anke Zimmermann would attribute it to a “healing reaction.” I’m going to quote rather extensively, because I want you to see how utterly bonkers this whole “case report” has become:
“On Thursday we gave Erin her last dose of the vit K clearing (10M). That night she was restless beyond words. She often crawls on the wall with her legs while we read to her and moves in her sleep, but this was crazy. She also woke at 2 and 3:30 am to pee and we could hear her singing at various times throughout the night. Last night was even more insane. She woke after an hour and stayed up until 1:30 am. I stayed with her and she tossed and turned and moved her legs ALL night.”
I advised that is was likely an aggravation and to give her Epsom salt baths 3 times a day and Melatonin if needed.
Mom gave the bath and Erin fell asleep after “CRAZILY” moving her legs and entire body for at least half an hour. Then woke up again after a few hours. The next two night were better.
Sept 5 email:
Up again every few hours, all are getting exhausted.
Sept 6 email:
Up from 9-12:30 again. But excellent energy during the day, “like that lethargy that used to exist disappeared and she was running and jumping and doing great all day.”
Assessment: I never knew that she was lethargic until now. Good response, but aggravation.
Plan: Support detoxification, milk thistle and dandelion extract, 10 drops in water every 3-4 hours.
Support nervous system with Passionflower or Avena sativa 15 drops 30 min before bed.
Because of course she needed “detoxification.” Naturopaths always think their patients need “detoxification,” even when they can’t identify any of the “toxins.”
Sept 7 email:
Mom emailed at 3:30 am describing more of the same troubles.
Assessment: 10M has caused aggravation but the child’s system is stuck there. Use plussing of 10M in water to move her through this.
Plan: Give the 10M plussed in water, 1 tsp every hour for the entire day, shake before each dose.
Sept 8 email:
“She slept! If one single vit K shot did this to her, I truly can’t imagine what a full set of vaccines might have done!”
Sept 17 email:
Things are much better. Still much better energy, sleeping better.
FU Sep 28:
Sleep is off again. But has completely lost her lethargy, has tons of energy and is now interested in cycling!
Plan: Repeat vit K clearing but go slow, 30CH once a week for 2 weeks. Continue milk thistle and dandelion at 10 drops twice a day.
Had 30CH Vit K 2 days ago.
“Big emotional melt-down at noon with high-pitched screaming! Just like when she was a baby! We were pretty shocked, hadn’t heard that sound in so long.”
But slept a solid 12 hours for the first time since starting the clearing.
Plan: Continue clearing, on the right track finally.
So wait? Zimmermann was “on the right track” because the child started screaming again the way she did when she was a baby? Of course, in alternative medicine, getting worse is frequently represented as a “healing crisis,” just the way that Zimmermann represented the child’s behavior here.
Let’s step back a minute. Zimmermann’s treatment had taken two and a half years, from August 2015 to April 2018. During that time, the child had aged from under one year old to over three and a half years old. She had gone through the “terrible twos.” In other words, in the life of a child that young, two and a half years is a hell of a long time, nearly three quarters of the child’s entire lifetime thus far! There is nothing I saw in this case report that couldn’t be explained by normal childhood development, although if the pediatricians or other child care professionals who read this blog disagree I’m happy to reconsider if you’ll tell me where I went wrong. Just remember that nowhere throughout this course did the child get anything more than basically water mixed into sugar pills and allowed to dry, because that’s what homeopathic remedies greater than 12C “potency” are, and even those less than 12C are unlikely to have much active ingredient.
None of this stopped Not-a-Doctor Zimmermann from bragging about her clinical acumen:
The child had obviously been negatively affected by the vitamin K shot given to her at birth, as the remedy so elegantly identified. It was fortunate that she did not receive any regular vaccines or medications, so we were able to isolate her problem directly to this shot.
This led her to conclude:
After this case, I can say that we should all suspect vitamin K shot injuries in children with irritability and restlessness as well as insomnia. Considering the epidemic of ADHD and other neurological issues in children I can’t help but think that many of those cases may have been impacted by vitamin K shots. Of course the many vaccines and even ultrasound and other modern medical practices can and do also irritate and impact the developing nervous system.
Great. Now, in addition to claiming “vaccine injury” as a cause of all sorts of symptoms (including autism), now Not-a-Doctor Zimmermann has had the “revelation” that neonatal vitamin K shots cause all manner of emotional symptoms in babies and toddlers. Note the difference in thinking, though, between doctors and naturopaths. Based on one case over two-and-a-half years in which symptoms of irritability waxed and waned and most likely ultimately resolved through development and maturation, Zimmermann concludes that she’s not just going to discourage vaccinations any more but neonatal vitamin K shots. But don’t worry about brain hemorrhages! She has a solution! You can use oral vitamin K as a supplement! Of course, oral vitamin K does decrease the risk of early and late vitamin K-dependent bleeding, but it doesn’t eliminate the risk, particularly of late bleeding. When the shot is used, the risk of late vitamin K-dependent bleeding is near zero. The shot is preferred because it works a lot better in preventing bleeding in the brain than administering three doses of oral vitamin K. It’s just that simple, and the vitamin K shot is incredibly safe as well. Also, why, if the neonatal vitamin K injection really did cause this child’s symptoms, would Zimmermann think that oral vitamin K wouldn’t? I know, I know. It’s the evil needle.
I frequently refer to homeopathy as The One Quackery To Rule Them All and naturopaths, who abbreviate their degree as “ND,” as “Not-a Doctor.” If you want to know why, all you have to do is to read how Not-a-Doctor Zimmermann uses two and a half years of diddling with various nonsensical homeopathic remedies to treat a cranky child as a rationale to conclude that the neonatal vitamin K shot is potentially dangerous. That sort of thinking will kill children eventually every bit as much as antivaccine thinking. Naturopaths are quacks.