While contemplating what to write about this week (and, unfortunately, doing so much later than usual because my entire weekend was taken up by a strategic planning retreat for my cancer center), I came across this Tweetstorm by an old friend of the Science-Based Medicine, Britt Hermes. Britt, as you might recall, is a former naturopath who realized that she had become a quack and as a result of that realization did a very difficult thing. She gave up naturopathy and started training to become a real scientist. In any case, here’s her Tweetstorm (click to see the entire ten Tweet series):
I am NOT vaccine hesitant. But as a former #naturopath I used to be afraid of vaccines. I was taught to be afraid of vaccines and not to trust the scientific consensus regarding vaccine safety (2/10)
— Britt Marie Hermes (@NaturoDiaries) April 22, 2018
What Britt is referring to later in the series of Tweets, besides the indisputable fact that the vast majority of naturopaths are antivaccine and that pro-vaccine naturopaths are rare, is something called the DC Federal Legislative Initiative (DCFLI). Basically, organized by the American Association of Naturopathic Physicians, a bunch of naturopaths and naturopathic students descended upon Washington, DC on Saturday for a “leadership” conference and plan to cap it off with a day of lobbying legislators today. They have a number of “asks” that they intend to lobby for. One example is the “Preserving Patient Access to Compounded Medications Act” (H.R. 2871), which would weaken FDA oversight over compounded medicines of the sort that naturopaths like to have mixed up for them. Also, of course, naturopaths claim that their methods are part of the solution of the opioid addiction crisis. Oddly enough, however, they want access to prescribing authority to treat opioid addiction:
PROBLEM: ENSURING PATIENT ACCESS TO MEDICATION-ASSISTED TREATMENT
Only one in 10 people in the U.S. with an addiction receive treatment. According to the Pew Charitable Trusts, that’s in large part because of a shortage of trained medical providers, especially ones who can prescribe buprenorphine.4
Section 303 of CARA was previously amended to allow physician assistants and nurse practitioners to prescribe buprenorphine under the direction of a qualified physician, and is set to sunset in 2021.
S. 2456 makes a permanent addition of nurse practitioners and physicians assistants as “Qualifying Other Practitioners” who can prescribe buprenorphine. H.R. 5311 would add a variety of other nurses as well as physicians assistants to the list of “Qualifying Other Practitioners.”
Licensed naturopathic doctors receive more training and education than both physician assistants and nurse practitioners, and several states authorize naturopathic doctors to prescribe the DEA schedules necessary for Medication-Assisted Treatment like buprenorphine.
Many naturopathic doctors treat patients with addiction involving opioid use, and should be added to H.R. 5311 and S. 2456. Otherwise patients of NDs will be denied access to this life-saving treatment option, at a time of crisis when we need all available providers to practice to the full extent of their scope and education.
So what do naturopaths want? You guessed it! They want to be included with physicians assistants and advanced practice nurses to able to administer controlled substances, specifically buprenorphine, which is not uncommonly used in medication-assisted addiction treatment. Buprenorphine is a semisynthetic opioid that acts as a partial opioid agonist and also has antagonist activity (which activity predominates depends on the specific opioid receptor and the dose). What that means is that the drug can produce typical opioid effects (and side effects), but at a lower intensity and also can block the binding of other opioids to opioid receptors. Basically, without getting into the weeds too much, I’ll just mention that buprenorphine can produce enough agonist effect to enable opioid-addicted patients to discontinue their use of opioids like morphine, fentanyl, heroin, and the like without experiencing withdrawal symptoms. The dose of buprenorphine can then be titrated downward without withdrawal symptoms as severe as going cold turkey. Of course, whenever I see naturopaths wanting access to such powerful medications, it scares the crap out of me, as well as making me wonder why, if naturopathy is so great for treating chronic pain and opioid addiction, naturopaths would even want the power to use medications like buprenorphine. Presumably, they’d also want to use other opioid partial agonists than buprenorphine or even opioid antagonists like naltrexone.
Of course, Britt has spent extensive time countering the talking points used by naturopaths to try to deceive lawmakers into thinking that they are the equivalent of MDs and fact-checking the sorts of claims naturopaths make every year at the DCFLI. The naturopaths in DC promoting more favorable legislation for their quackery are part of a larger push by naturopaths to make themselves in the eyes of the law the equivalent to MDs. For instance, in addition to today’s lobbying push in DC and the general campaign to be licensed in every state in the US by 2025, naturopaths in Alaska are lobbying for the authority to prescribe medicine. More on that later.
What I wish I could tell legislators who are listening to the blandishments of naturopaths is just how deep the quackery runs in the “profession” of naturopathy by its very nature. One way to do that is to note that you can’t have naturopathy without homeopathy. Naturopathy, by its very nature, incorporates homeopathy into its education, with many hours of homeopathy in the curricula of naturopathic schools. Homeopathy is even an integral part of the NPLEX, the licensure examination that states in which naturopaths are licensed use.
Indeed, Scott Gavura recently described an incredible example of what happens when quack naturopaths use The One Quackery To Rule Them All, homeopathy, in a post he so aptly entitled “How rabid dog saliva became an approved and endorsed remedy in Canada.” It’s about a naturopath named Anke Zimmermann, who treated behavioral problems in a four year old boy with a homeopathic remedy known as Lyssinum, which is made from, yes, saliva from a rabid dog; that is, if you believe homeopaths’ characterization of the source material that was diluted to 200C, or two hundred 100-fold dilutions, or by a factor of 10400. If you consider that the estimated number of atoms in the known universe is on the order of 1080, the chances of there being a single viral particle of rabies left is near zero. Thankfully. Of course, this is no obstacle in the mind of a homeopath, since they claim their remedies work due to the “memory of water” or some other form of magic.
I realize that Scott did his usual excellent job discussing Zimmermann and how she treated a boy with a truly bizarre homeopathic treatment (even for homeopathy). However, it’s worth giving my take (I hope) on this same case. The reason is that Scott dwelled mostly on how Health Canada could allow such nonsense, while I can’t help but discuss the case from my point of view. At least, I want to add my point of view to the discussion of the case without being too repetitive (I hope).
The rabies miasm and homeopathic rabid dog spit
Scott described the case treated by Not-A-Doctor Anke Zimmermann in depth, as well as how in Canada such a treatment (Lyssinum, which is supposedly derived from the saliva of a rabid dog) can be completely legal as a treatment in Canada. This child basically had behavioral problems that included aggression at school, pretending that he was a dog, and a fear of werewolves (I kid you not). Because she is a naturopath, Zimmerman decided to treat the boy with homeopathy, because homeopathy is a major part of the armamentarium of naturopaths. What caused the ruckus was that she posted her “case report” on her blog. The original version of that case report has been taken down, to be replaced with all sorts of defenses of her treatment and rants against big pharma. However, the Internet never forgets, and thanks to the almighty Wayback Machine the original version of the post still exists:
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 [sic] in homeopathy.
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”. 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 seemed to be loving the attention she was receiving as a result of her story having spread so far and wide, at least for a time:
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 that her son had relapsed.
As mentioned above, Zimmermann also decried the “misinformation” about homeopathy being spread. For instance, in her now revised version of her case report, she explains the rationale for using rabies in this child, as well as the supposed history of the remedy:
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.
Stop right there. This is the principle of “like cures like” taken to its most ridiculous extreme, like the use of Ebola to treat hemorrhagic conditions. Next up:
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.
The amusing thing about Zimmermann’s defense of her actions is that it doesn’t actually make her or homeopathy look any better. If anything, it lays bare the utter ridiculousness of homeopathy. She even admits that there almost certainly isn’t a single viral particle or even molecule of anything from the dog saliva in the remedy:
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.
That’s, of course, even assuming that the starting material was really saliva from a rabid dog. Zimmermann, of course, sees herself (and, by extension, naturopaths and homeopaths) as the victims here:
Pretty much all of our dogs and cats receive rabies vaccines and health officials think that’s a good thing. These vaccines contain the actual rabies virus, grown on mouse brain tissue cultures.
But if an ND or homeopath gives such a homeopathic preparation of rabies to a child and the child greatly improves, she experiments with rabid dog saliva on innocent children, obviously keeps rabid dogs chained up in her backyard, is clearly a child abuser and an animal abuser too, should go to jail, have her license pulled and deserves a baseball bat to head and these are just some of the milder comments and threats I’ve received.
I certainly do not condone threats of violence and unequivocally condemn anyone who made such threats, even if they were not serious. However, the entire passage above demonstrates a serious misunderstanding of vaccines. Of course, a rabies vaccine has to contain all or part of the rabies virus. That’s how an immune reaction against it is provoked. The point is that the entire rationale she as a naturopath using homeopathy used to treat this boy is utter nonsense with no basis in science. It is actually fortunate indeed that the homeopathic remedies given do not contain any rabies virus and that the starting material very likely never contained rabies virus. The whole point is that the claimed use of rabies virus shows just how detached from reality the principles of homeopathy are and, by extension, how pseudoscientific and downright quacky naturopathy is, given that it embraces principles of homeopathy that produce treatments like Lyssinum for childhood behavioral issues.
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 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 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.
It’s delicious that this incident occurred during Homeopathy Awareness Week, too.
Naturopathy versus science
Naturopaths like to claim that their specialty is scientific, that their training is the equivalent of that of MDs, and that they can be primary care providers. As we have documented here time and time again, none of these claims are accurate, and naturopaths embrace a high level of outright quackery in their practices. Now naturopaths are lobbying for access to opioid mixed partial agonist/antagonists used to treat opioid addiction. In Alaska, they want to be able to prescribe Ambien and testosterone. Just listen to Abby Laing, the president of the Alaska Association of Naturopathic Physicians, justify giving prescribing authority to naturopaths:
Laing said that naturopaths use drugs and medication as a “last resort,” but for the efficacy of providing care, it makes sense for naturopaths to be able to prescribe drugs.
Instead of telling someone they need to get blood pressure medication, “I want to be able to prescribe it and not refer them out and hope they go and get it,” Laing said.
I would argue that people who are trained to believe that the principles of homeopathy are valid, that like cures like and diluting a substance makes its effects stronger, and that using essence of rabies virus or gonorrhea bacteria to treat a wide variety of symptoms, shouldn’t be allowed anywhere near a prescribing pad—or a patient, for that matter. Unfortunately, in all too many states and countries, legislators do not see it that way.