"What's the Harm?"

John Droescher

English 11000

04 May 2015

“What’s the Harm?”

               The world exists in an age where the overwhelming majority of humans, including those exploring the far reaches of our capability to sustain life, have fingertip access to the compendium of human knowledge. Access to this repository of human knowledge, this aggregate of all information and knowledge earned, discovered, and collected by mankind provides innumerable opportunities for humans to mistake opinion for scientific reality.

               Chiropractic, to most people, is a medical profession specializing in treatments of the back. This is only somewhat correct. Chiropractic medicine is founded on the concept of the body’s innate intelligence. Disruptions in this intelligence allow diseases and ailments to manifest themselves in the patient. Treatment, therefore, focuses on restoring the body’s intelligence through realignment of the patient’s musculoskeletal system, primarily the spine. Theoretically thereafter allowing the body to cure itself (Ernst 2008 545-6).

               Acupuncture is premised on the existence of a person’s energy, or qi. Acupuncture practitioners and patients then accept that disease is caused by disruption of this qi. Medical treatment for any ailment thus consists of the use of needles or pressure at specified points to realign the patient’s internal and external flows of energy allowing the body to then cure itself (Ernst 2005 125-6).

               Rather than attempting to correct the body’s energy or innate intelligence, as acupuncture and chiropractic medicine do, homeopathy is based on the “Law of Similars”. That is, the effective remedy for a disease is the drug that induces into a healthy individual symptoms similar to the symptoms being experienced by the patient (Hahnemann 48-9, Ernst 2002 577). Preparation of homeopathic remedies is a process where, in simplest terms, the active ingredient in the remedy is mixed with water then shaken or struck vigorously in a specific process, known as succession, designed to activate the “vital energy” of the ingredient (Hahnemann 290-3). This process is repeated until the desired value of dilute is achieved. According to homeopathic theory, higher levels of dilution result in higher levels of efficacy (Hahnemann 292)

               Western medicine, unlike alternative medicine, is predicated on the use of double-blind clinical studies using placebos to verify efficacy before adopting a new treatment or remedy. A double blind study is one in which neither the patient nor the practitioner know whether a specific patient is being administered the placebo, generally a sugar pill manufactured and packaged to appear exactly the same as the trial drug, or the trial medication. This is done to account for any possible changes in demeanor on the part of the practitioner as well as the possibility of false reporting of symptoms or cures. The resulting effects are recorded and the data analyzed to determine if the attempted remedy was more effective at treating the ailment than the placebo.

               The efficacy of Chiropractic medicine has been the subject many studies and meta-studies attempting to evaluate its value as treatment for a wide range of ailments. While creating a proper clinical trial for chiropractic is difficult due to the need for physical manipulation of the patient’s body, post treatment improvement in medical conditions is no greater than that of the placebo treatment, indicating that while there may be some neurological benefit to the treatment the chiropractic treatment itself is not producing the claimed benefit of disease remediation (Kaptchuk 817).

               A 2012 meta-study of 45 systematic reviews, covering medical conditions including headaches, back pain, general medical conditions, asthma, and many others, concluded that “these data fail to demonstrate conclusively that spinal manipulation is an effective intervention for any medicine” (Posadzki 55). An earlier comprehensive review of chiropractic medicine from its conception through to its current form notes “the terms ‘research’ and ‘science’ appear frequently in the chiropractic literature with a variety of meanings ‘unfamiliar to most scientists’” and “the little research that did take place during the early years of chiropractic was of remarkably low quality” (Ernst 2008 550). This less-than-rigorous approach to data collection and interpretation was characterized by many observational studies being described as controlled clinical trials (Ernst 2008 550). Chiropractic practitioners have maintained this loose connection with scientific rigorousness when promoting their treatments and conducting trials. The meta-review of chiropractic treatments notes that, due to a lack of uniformity in the results of individual chiropractic trials, use of single studies to prove or disprove efficacy is disingenuous. Assessing the combined data is therefore preferred and doing so indicates there is no significant benefit to spinal manipulation treatments (Ernst 2008 551).

               Conversely, the evidence suggests that spinal manipulation therapy is in fact unsafe, but the rate of adverse events is unknown as there is serious under-reporting (Ernst 2007 330) – estimated to as high as 100% in some instances (Ernst 2008 553). Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. A 2001 study found the most common side effects include local or radiating pain, headache, and tiredness (Ernst 2008 553). Two subsequent studies indicated that these adverse side effects occur in 61% and 30% of patients, respectively (Ernst 2008 553). The risk of stroke related to spinal manipulation or more serious adverse effects is controversially unknown given an insufficient amount of clinical data (Haynes 946). Given the preponderance of evidence against the efficacy of spinal manipulation, the existence of substantial risk of side effects, possibly including stroke, should engender caution in potential patients (Ernst 2008 553).

               Clinical trials of acupuncture often run into similar problems with designing a placebo that is useful for gauging efficacy of proper acupunctural procedure. The most accurate method for achieving useful clinical trial data is to perform "sham" forms of acupuncture where the patient, practitioner, and analyst are blinded (White 237, He 122). These same meta-studies have shown that regardless of “sham” style, the analgesic effect of both acupuncture and the placebo is generally small enough – 10 points on a 100 point scale – so as to be statistically insignificant (Colquhoun 1361). Other studies have found "acupuncture was not better than sham interventions or conventional therapy in the longer term" (Amezaga 589) and “the effects of acupuncture on postoperative pain are inconclusive and are dependent on the timing of the intervention and the patient’s level of consciousness” and that any “benefits are short-lasting” (Wang 611, He 122).

               The controversy behind acupuncture’s acceptance stems from the tendency of Asian studies to support all forms of traditional Chinese medicine. However, Asian clinical trial methods are less rigorous than Western trials whose results consistently suggest that any effect provided by acupuncture is due to placebo (Ernst 2006, Colquhoun 1361, He 122). A 2011 review comparing Western medical journals to Asian medical journals found western journals to be far more critical of traditional Chinese medicine, including acupuncture (He 2011). This same review found that traditional Chinese medical clinical trials performed in Asia were far less rigorous than those performed by western scientists and doctors indicating a decided bias in favor of traditional Chinese medicine in Asian countries (He 122). These findings were corroborated in a later review of over 3000 separate studies which found that the inability for various studies to achieve consistent results suggests any positive results is merely the result of the regression to the mean expected to be seen when studying an inert therapy (Colquhoun 1361-2).

               Negative side effects of acupuncture are extremely rare and due not to the treatment itself, but rather poor sanitary conditions at the practitioners office. The greatest health threat from acupuncture, therefore, is the patient’s reluctance or refusal to obtain proper effective treatment from other providers resulting in prolonged ailments, the development of more severe symptoms, and potentially death from untreated illness.

               Questions regarding the efficacy of homeopathy arise from the use of dilutions exceeding Avogadro’s number – that is the definitive number of molecules contained within any volume of any liquid exceeds the dilution of the recommended doses of nearly all homeopathic remedies (Ernst 2002 577). Given Avogadro’s number, , and a basic understanding of how dilutions are calculated and prescribed, it is easily determined therefore that 1 liter of a 13C dilution (1 in  cannot contain a single molecule of the original active ingredient. Simple calculations show that a 13C solution would be roughly equivalent to one pinch of salt diluted into both the Atlantic and Pacific Oceans (Emery 1086).

               Further comparison to known numbers is not uncommon. One oft referenced comparison involves the number of molecules estimated to be contained within the observable universe, that is, approximately  molecules. Compared to a 200C dilute, or  ratio, it would require  additional universes to ensure a single molecule of the original ingredient is contained (Park 145-6). Undeterred by modern scientific understanding of the molecule, modern advocates of homeopathy argue that it is not the active ingredient but rather the memory of water that contains the remedy. This concept is countered by a 2012 study wherein homeopathic claims were analyzed using the known laws of physics and chemistry and “the proposed mechanisms of homeopathy are shown to be implausible” (Grimes 149).

               Clinical studies of the efficacy of homeopathic remedies and their scientific plausibility have produced somewhat controversial results. In a 2010 review of homeopathic studies Ernst notes that “[n]umerous authors have pointed out that the assumptions of homeopathy are biologically implausible” (Ernst 2010 458). A 2005 review of published homeopathic studies found “[o]f those in conventional journals, 69% (18/26) reported negative findings compared with only 30% (6/20) of [Complimentary and Alternative Medicine] journals” (Caulfield 2). In nearly all clinical trials supporting homeopathy, methods have been lacking in rigor and the results were generally unreproducible leading to the conclusion that homeopathy is no more effective than placebo (Ernst 2010 458).

               Given the impossibility of any remaining active ingredient in any dilute beyond a 12C preparation, there are no direct side effects to homeopathic remedies. In 2010, noted skeptic James Randi collaborated with other skeptics to stage an event highlighting the ineffective nature of homeopathic remedies by attempting large scale overdoses (Jones). An estimated 300 persons from the UK, New Zealand, Australia, Canada, and the USA participated in the event. The spokesman for the campaign was quoted afterward as saying “[t]here were no casualties at all, as far as I know” and that “[n]o one was cured of anything either” (Coghlan). As with acupuncture and chiropractic, one of the greatest threats to a homeopathic patient’s health is the refusal to pursue western medicinal therapy for ailments. As of 2 May 2015, website whatstheharm.net lists over 437 people killed due to pursuit of homeopathic remedies over western medicine, with the number continuing to grow as homeopathy gains popularity. Additionally, the Food and Drug Administration has no regulatory authority over remedies marketed as homeopathic. It is worth noting that even in recent history one popular cold medicine, proven in clinical trials to be ineffective against the common cold, was remarketed as a homeopathic remedy to skirt these regulations and continue being sold over the counter (Novella).

               The vastness of the internet allows opinions to be presented as fact in arenas wherein cognitive biases are mostly free from challenge. In these echo chambers are found pseudo-scientific claims presented as clinically proven medicine. While science based medicine continues the search for new and improved treatments, these peddlers of nontraditional medicine decry scientific scrutiny of their beliefs yet continue to promote, as scientific, medical treatments which show no greater efficacy than the blood-letting of the 15th century. Practitioners of pseudo-scientific alternative medicine borrow “science” to lend credence to their practices while ignoring evidence and science that debunk their theories, promoting ineffective therapies, and skirting the legalities required of true medical doctors, threatening the lives and wellbeing of those who fall under their purview.

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