Science is a philosophy, a technology, and an institution. It is a human endeavor- our collective attempt to understand the world around us, not something that exists solely in the abstract. All of these aspects of science have be progressing over the past decades and centuries, as we refine our concepts of what science is and how it works, as we develop better techniques, and organize and police scientific activities more effectively. The practice of science is not relentlessly progressive, however, and there are many regressive forces causing pockets of backsliding, and even aggressive campaigns against scientific progress.
So-called complementary and alternative medicine (CAM) is one such regressive force. It seeks to undermine the concepts, execution, and institutions of medical science in order to promote sectarian practices and ideological beliefs. Examples of this are legion, exposed within the pages of this blog alone. I would like to add another example to the pile – the recent defense of homeopathy by Dana Ullman in the Huffington Post (names which are already infamous among supporters of SBM).
In a piece titled: , Ullman demonstrates yet again the pseudoscientific aspects of homeopathy and its proponents. The primary principle that is abused by Ullman this time is the need for scientists to carefully define their terms and concepts. Scientific concepts should be defined as carefully, precisely, and consistently as possible. Squishy concepts are very difficult to deal with in science – but are the bread and butter of pseudoscience.
The fuzzy concept is particularly useful to the pseudoscientist (someone pretending to do real science, but whose activity is devoid of genuine scientific exploration or rigor). Pseudoscientists generally start with a desired answer and then work backwards to their logic and evidence. Whereas genuine science endeavors to follow logic and evidence wherever it leads. Having a poorly defined term or concept allows pseudoscientists to better shoehorn in evidence and logic – to create the appearance of support for their beliefs where none exists.
Ullman’s article is typically full of anecdotes, cherry picked evidence, and tortured logic. There is far too much there to pick apart in detail, so I want to focus on his exploitation of poorly defined concepts. He writes:
Grubbe got the idea of using radiation as a treatment for Lee’s breast cancer from Reuben Ludlam, M.D., a professor at the homeopathic medical school. Ludlam knew that Grubbe had previously experimented with X-ray as a diagnostic procedure so much that he developed blisters and tumors on his hand and neck as a result of overexposure to this new technology.
Because one of the basic premises of homeopathic medicine is that small doses of a treatment can help to heal those symptoms that large doses are known to cause, Ludlam suggested to Grubbe that radiation may be a treatment for conditions such as tumors because it also causes them.
The toxicity and medical uses of radiation have absolutely nothing to do with any concept that can reasonably be considered part of homeopathy. But Ullman exploits superficial similarities to twist it into support for the deliberately squishy concept of homeopathy. Radiation is toxic to cells – high energy particles impart their energy to cell structures, breaking chemical bonds, killing cells outright in some cases or damaging their DNA. Radioactivity has greater toxicity to cells that rapidly reproduce, because they are more sensitive to DNA damage (partly because they have less time to repair DNA damage).
Low levels of radiation exposure carry a low risk because the repair mechanisms of cells can largely handle any damage done, and the number of lost cells is insignificant. It is not clear if low levels of radiation (such as the background radiation in which we all live) conveys zero risk or simply a very low risk – that type of distinction is inherently difficult to make with empirical studies.
But at all levels of exposure the effect of radiation is a toxic one – to do damage to cell structures. In this way radiation is very much like a drug. All drugs cause biological changes to the body. But those used as pharmaceutical agents have a dose range in which their effects can be exploited while the risk of negative effects is minimal. There are threshold at which certain toxic effects become significant, but at lower doses they are still present, just tolerable or insignificant. Some effects may display a threshold effect because of compensatory mechanisms, or because there are certain levels at which metabolic processes are overwhelmed.
Radiation damages and kills cells. Rapidly dividing cells are more susceptible to damage. There is therefore a dose range in which radioactivity can kill rapidly dividing tumor cells significantly more than surrounding healthy tissue. But in order to exploit this effect techniques must be use to focus the radiation on the tumor while minimizing exposure to surrounding tissue. And a certain level of damage to surrounding tissue is unavoidable. There is even the risk of later damage, and even cancer, from therapeutic radiation exposure. The use of radiation, like the use of drugs, is about risk vs benefit, or beneficial effects vs side effects. Given that the condition being treated is a potentially fatal cancer, a high level of side effects and risk are considered reasonable.
Ullman, however, would have you believe that what I described above is analogous to homeopathy, in which tiny or (more commonly) non-existent doses of a substance that causes certain symptoms in a healthy individual will treat those symptoms in an unhealthy person. This is not analogous to exploiting different levels of toxicity for a therapeutic effect. There is a superficial similarity in that different doses cause different effects – but with drugs and radiation there are specific mechanisms for this dose-response effect. Homeopathy does not display a dose-response effect – even as homeopaths understand it.
Science and evidence dictates that homeopathy shows no effect at all, but even within the belief system of homeopaths there is no consistent dose-response curve for their potions. There is, if anything, a mysterious and inconsistent relationship between dose and effect, without any plausible mechanism at all. This bizarre relationship between dose and effect claimed by homeopaths is such that dilutions where not even a single molecule of original ingredient is likely to remain behind are often claimed by homeopaths to be the most potent.
Further, while there are specific mechanisms for toxicity and therapeutic effects for interventions like radiation and drugs (although certainly we do not fully understand the precise mechanisms of every drug), there is no plausible mechanism behind the claims of homeopathy. The best that they can come up with is false analogies to vaccines, the speculative concept of hormesis, and now the dose-response effect of standard treatments. When pushed they speak vaguely about the “essence” of the drug, and restoring “balance”. But this is no closer to an actual explanation of how homeopathy might work than saying that it is “magic”, “witchcraft”, or “faith healing.”
The exploitation of poorly defined concepts is a hallmark of CAM. We see it in homeopathy, as above, with strained analogies and fallacious logic. We see it with acupuncture, for example, when “placebo acupuncture” (where there is no needle penetration and no acupuncture points) and electroacupuncture (where electrical stimulation is given) are used as support for acupuncture. This leads to the question – what is acupuncture? What is it that is specific an unique to acupuncture? Nothing, apparently – but this allows for a wide range of non-specific and other effects to be used as support for the vague concept of “acupuncture.”
And we can ask – what is homeopathy? What scientific concept that has been validated by experimentation constitutes the body of knowledge that is homeopathy? The answer is – nothing. There is no law of similars, nor a law of infinitessimals. There is no plausible mechanism to explain homeopathic potions. So instead we are given invalid analogies, innuendo, and a desperate attempt to confuse the public as to what homeopathy actually is.