The Dull-Man Law

Kimball Atwood is obviously trying to throw mud at Harvard and at homeopathy, but when you throw mud, you get dirty…

(Sigh) So little time, so much misinformation. Hence the Dull-Man Law:

In any discussion involving science or medicine, being Dana Ullman loses you the argument immediately…and gets you laughed out of the room.

This will be the last time that I don’t invoke that law, because it is the perfect opportunity to explain why it is such a useful shortcut. The occasion is the current series about my alma mater, Harvard Medical School (HMS), and its regrettable dalliances with quackery.† The series consists mostly of correspondence that occurred between Dean Daniel Federman and me in 2002. Some of it refers to homeopathy.*

Mr. Ullman, a self-styled expert on homeopathy who lacks any medical training, is a darling of the ‘integrative medicine’ movement, as explained here. He has posted several comments objecting to my assertions in the HMS series. Other commenters have skillfully refuted some of his arguments. Some have been left unchallenged, however, and a naive reader might therefore assume that they are valid. They are not, but explaining why takes time and a modest acquaintance with the topic. Other than to clarify the issues for the uninitiated, then, such time would be wasted. Henceforth, let it not be so: From now on, this post can be cited by anyone wanting to avoid the drudgery of refuting Mr. Ullman’s claims.

First, this comment by Mr. Ullman:

One cannot help but notice how little research is referenced.

Ullman then cited Linde, Clausius, Ramirez, Jonas et al., (1997), Jonas, Kaptchuk, Linde (2003), Jacobs, Jonas et al (2003), and later the David Reilly series on allergic rhinitis, implying that I’d missed the boat by failing to cite these wonderful papers. Regarding the Linde/Jonas 1997 review, whose conclusion had been, “The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo,” Mr. Ullman wrote:

Even a leading skeptic who wrote an editorial in this issue of the Lancet referred to this meta-analysis as “completely state of the art.” No other meta-analysis on homeopathy has been acclaimed by both sides of the fence.

Ullman must have overlooked this statement in my post:

Much of the content of [the homeopathy] treatise has been covered by the series on homeopathy with which I began my stint here on SBM, so here I’ll post only the parts relevant to promotions by academic physicians, including those at Harvard.

That series (and my entire essay for Dr. Federman) covered, among other reports, the Linde/Jonas 1997 meta-analysis, the 1994 Jacobs childhood diarrhea paper, and the Reilly allergic rhinitis series. It showed that each of these projects has not survived methodologic scrutiny. Several re-analyses of the Linde/Jonas 1997 data, in particular, have demonstrated that they were, well, compatible with the clinical effects of homeopathy being completely due to placebo. Two of those re-analyses were done by Linde and Jonas themselves (!), a point that Mr. Ullman failed to make. Either he knows this (in which case his comment was dishonest) or he does not (in which case he relinquishes his claim to being an expert on the topic).

But wait a minute: Ullman must know these things, because this was only one of several times that he has graced the comments of this blog with his sophistry, including responses to my previous citings of…Linde/Jonas 1997, Jacobs 1994, and Reilly’s allergic rhinitis series. I answered him there in some detail, as did other commenters, and I enlarged on that answer in the post that followed. Mr. Ullman might also consider that in 2002, when I wrote to Dr. Federman at HMS, I could not have cited papers published in 2003—not that it matters, for reasons previously explained.

Atwood considers any comparison between homeopathy and vaccination to be inappropriate. And yet, it was none other than Emil Adolf von Behring (1854–1917) who was one of the early scientists to make this assertion. Behring broke from orthodox medical tradition by recognizing the value of the homeopathic law of similars:

And by what technical term could we more appropriately speak of this influence [ie, smallpox vaccination], exerted by a similar virus than by Hahnemann’s word “homeopathy”?

What I wrote was: “the vaccine analogy is erroneous.” That is correct: the active ingredient in a vaccine is real, measurable, and works because its antigenicity, ie, its ability to elicit a specific immune response, is similar to that of the infectious agent that causes the disease in question—but not because of some fanciful ‘similarity’ of ‘symptom’ production. A vaccine’s dose, moreover, is determined by rational dose-reponse trials, and every competent physician and biologist knows that if it were diluted into non-existence its effect would also become non-existent.

The word “similar” above gives homeopaths an irresistible urge to claim some profound insight into immunology and pharmacology, but it does nothing of the sort. Even looked at solely from Ullman’s superficial, linguistic point of view, where his hero Behring also apparently stood—ignoring, that is, the molecular basis for the immune response and the absurdity of infinitesimals—the technical term most applicable to immunization is isopathy, not “Hahnemann’s word ‘homeopathy’.” But then Ullman, in his Heinous Hyping of the Hogwash that is Homeopathy, regularly Appeals to Irrelevant Authority, including the Holy See itself.

Hahnemann, of course, knew nothing of the immune system (nor did anyone else at the time), and famously railed against anything that could have suggested even the possibility of infectious vectors. For Hahnemann, diseases were “purely dynamic deranging irritations of the vital force,” and “to regard those diseases that are not surgical as a peculiar distinct thing residing in the human frame is an absurdity which has rendered allopathy so pernicious.”

Ullman again:

Even the British Medical Journal (BMJ) named my website their “website of the week” on August 19-26, 2000.

Too bad for the British Medical Journal and for the level of scientific discourse in what now passes for academic medicine. That is the whole point of the HMS series and of Science-Based Medicine in general.

I was, however, surprised that you chose to make reference to a popular magazine (the Utne Reader) as some type of unimpeachable source…are you next going to quote the National Enquirer without fact-checking?…Ironically, the editor of FASEB also chose to use this same error of fact that was printed in this magazine…When I was granted the right of reply, I chose to reply to sustentative [sic] issues on homeopathy rather than specious personal attacks against me. I will simply say that the Utne Reader mis-reported and has appropriately withdrawn that story from their website.

Hmmm. The article in question appeared during the anthrax scare of 2001 that followed closely on the heels of ‘9/11’. Its every statement is consistent with other claims by Ullman; several are direct quotations. That Ullman offered “homeopathic anthrax treatments” for sale on his website is corroborated here. What, then, is the “error of fact,” and how might I have “fact-checked” if, as he admits, he failed to explain it at the time? Does Ullman not really believe that homeopathic ‘nosodes’ can prevent or treat anthrax? If so, we’d love to hear it.

In a sidebar to the Utne Reader article is this:

Dosage

The pills used in homeopathic medicines can vary in size from an aspirin down to the size of poppy seeds. While Dana Ullman says it is generally recommended to take one to five pills per dose, the amount of dose changes depending on the size of pellets. If the pills are aspirin-sized, one or two should be taken per dose. If the pellets are poppy seed-sized, five pills should be taken per dose.–Kate Garsombke

Ah, perhaps that is the ‘error of fact’: surely, according to ‘potentization,’ Dana Ullman must have told Ms. Garsombke that the smaller the pill, the fewer should be taken. Otherwise the patient would risk an overdose.

Also, for the record, I was the [Utne Reader] health book reviewer about 15 years ago and have not held that position since then. It would be nice if you made a little effort in your own fact-checking.

OK, here was my fact-checking. I went to Mr. Ullman’s website, archived in 2002 (when I wrote what I wrote); I clicked on About Dana Ullman, MPH; I scrolled down to the very last paragraph, where I read:

Dana Ullman is the health book reviewer for the Utne Reader.

It must depend on what your definition of “is” is.

Atwood also made reference to Edward Chapman, MD, a homeopath who formerly was an instructor at Harvard. It might have been nice for you to have completed a little homework, for you would have discovered a trial that he conducted at a Harvard-affiliated hospital…

I am well aware of Chapman’s report on “Homeopathic Treatment of Mild Traumatic Brain Injury,” yet another example of a silly, small clinical trial being incompatible with how the universe works, and thus another embarrassment to Harvard Medical School and to academic medicine in general.

Regarding homework, if Mr. Ullman had done his own he might have discovered this entry in a 2003 press release from the Massachusetts Board of Medicine:

In the first matter, in a Final Decision and Order, the Board revoked the medical license of Dr. Edward H. Chapman, a board-certified family practitioner from Newton. The Board found that Dr. Chapman had engaged in numerous boundary violations with two patients and had engaged in conduct that calls into question his competence to practice medicine. The Board also concluded that Dr. Chapman was guilty of malpractice and of conduct that undermines public confidence in the integrity of the medical profession. The revocation will go into effect on August 15, 2003, to allow for appropriate termination and transfer of patients. Prior to that date, Dr. Chapman’s practice will be subject to the terms of a monitoring agreement.

Ouch. (Funny: Harvard Medical School didn’t mention that, either.)

Finally, I am forever amazed that Atwood uses O.W. Holmes as his hero. My comments about his unscientific attitude towards homeopathy and his questionable ethics were previously provided in Part II of your recent series on Harvard.

Oliver Wendell Holmes, Sr. (the father of the Supreme Court Justice) is a hero of the Harvard Medical School, of American medicine, and of the human race as a whole, for numerous reasons. The most important is that he proposed, even prior to Ignaz Semmelweis, that puerperal fever was contagious. He published his paper on the topic in 1843 when, according to Mr. Ullman, he shouldn’t have been taken seriously because “he was a medical ‘adolescent’.” His public lecture of the prior year, “Homeopathy and its Kindred Delusions,” was a systematic dismantling of the tenets of homeopathy (as promulgated by Hahnemann himself), and was as scientific as current knowledge allowed in its criticism of the utterly unscientific homeopathy. It still stands as an eloquent, learned criticism, although it was composed prior to an understanding of Avagadro’s number, modern biochemistry, physiology, pharmacology, microbiology, genetics, diagnostics, and everything else that would propel medicine into the modern era.

In the just-linked comment, Ullman repeatedly referred to the “errors” in Holmes’s homeopathy lecture, but the only example he gave was this:

Dr. Holmes got his calculations confused, and he incorrectly assumed that the homeopathic manufacturer had to have 10 times or 100 times more water than in the previous dilution. Dr. Holmes estimated that the ninth dilution would require ten billion gallons of water and the seventeenth dilution required a quantity equal to 10,000 Adriatic Seas.

Well, OK, let’s see exactly what Holmes wrote (emphasis added):

So much ridicule has been thrown upon the pretended powers of the minute doses that I shall only touch upon this point for the purpose of conveying, by illustrations, some shadow of ideas far transcending the powers of the imagination to realize. It must be remembered that these comparisons are not matters susceptible of dispute, being founded on simple arithmetical computations, level to the capacity of any intelligent schoolboy. A person who once wrote a very small pamphlet made some show of objecting to calculations of this kind, on the ground that the highest dilutions could easily be made with a few ounces of alcohol. But he should have remembered that at every successive dilution he lays aside or throws away ninety-nine hundredths of the fluid on which he is operating, and that, although he begins with a drop, he only prepares a millionth, billionth, trillionth, and similar fractions of it, all of which, added together, would constitute but a vastly minute portion of the drop with which he began. But now let us suppose we take one single drop of the Tincture of Camomile, and that the whole of this were to be carried through the common series of dilutions.

A calculation nearly like the following was made by Dr. Panvini, and may be readily followed in its essential particulars by any one who chooses.

For the first dilution it would take 100 drops of alcohol.

For the second dilution it would take 10,000 drops, or about a pint.

For the third dilution it would take 100 pints.

For the fourth dilution it would take 10,000 pints, or more than 1,000 gallons, and so on to the ninth dilution, which would take ten billion gallons, which he computed would fill the basin of Lake Agnano, a body of water two miles in circumference. The twelfth dilution would of course fill a million such lakes. By the time the seventeenth degree of dilution should be reached, the alcohol required would equal in quantity the waters of ten thousand Adriatic seas. Trifling errors must be expected, but they are as likely to be on one side as the other, and any little matter like Lake Superior or the Caspian would be but a drop in the bucket.

Swallowers of globules, one of your little pellets, moistened in the mingled waves of one million lakes of alcohol, each two miles in circumference, with which had been blended that one drop of Tincture of Camomile, would be of precisely the strength recommended for that medicine in your favorite Jahr’s Manual, against the most sudden, frightful, and fatal diseases!

Does Ullman not know the meaning of “let us suppose,” or that the subjunctive “were” refers to something that is not, in fact, the case? Ullman, unwittingly, is playing the same fool for us as the “person who once wrote a very small pamphlet” played for Holmes. Holmes, of course, used the exercise to illustrate how implausible the ‘law of infinitesimals’ was, considering the vast improbability that the original, “active” ingredient could exert any effect, much less a ‘potentized’ one, when the “seventeenth degree of dilution” was the equivalent of it having been dropped into a quantity of water the volume of “ten thousand Adriatic seas.” In the years before Avagadro’s number was known, this was about as rational and rigorous a critique of homeopathic ‘infinitesimals’ as one could hope to find. It is Ullman who has made incorrect assumptions, and in so doing has betrayed his inability to decipher well-written English.

Ullman’s claim that Holmes was a racist (at a time when nearly all white Americans were), whether true or not, is obviously irrelevant to Holmes’s or anyone else’s arguments against homeopathy, as are Ullman’s implications that 19th century homeopaths were somehow politically progressive in the late 20th century sense.

The above is more than enough to justify the Dull-Man Law, but here’s the dessert:

I don’t know why my name would be a part of any writing you may do on Harvard. If you are getting your information from wikipedia, you are not standing on firm ground (wikipedia is notorious for not having reliable information). If veritas is your goal, my name should not have any role in an article about Harvard because I have no affiliation with them, and the one short affiliation that I had was one which can be described as extremely tangenial at best.

I didn’t get my information from Wikipedia; I got it from Mr. Ullman himself:

Dana Ullman has served as an instructor in a course on homeopathy at the University of California at San Francisco for three years. He will also be a member of the Advisory Council of the Alternative Medicine Center at Columbia University’s College of Physicians and Surgeons and is a consultant to Harvard Medical School’s Center to Assess Alternative Therapy for Chronic Illness.

There’s that old ‘is’ word again. Is Mr. Ullman now confessing that he, er, exaggerated his affiliation with Man’s Best Medical School?

Ergo,

In any discussion involving science or medicine, being Dana Ullman loses you the argument immediately…and gets you laughed out of the room.

Q.E.D.

……………………..

†The Harvard Medical School series:

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* The Homeopathy Series:

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Kimball Atwood

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