4 questions | Applied Sciences homework help

1. The littlest patients. ABC-TV, March 9, 2009. 63. Ecenbarger W. How honest are dentists? Reader’s Digest, Feb

1997, pp 50-56. 64. Dodes J. Coverage questioned (letter to the editor). ADA News, Sept 15, 1997. Chapter Eight There cannot be two kinds of medicine—conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence. Marcia angell, M.D. JeroMe Kassirer, M.D.1 The more mysterious, ancient, traditional, spiritual and holistic an explanation is, the more pow- erful and attractive it seems to be. The fact that vitalism is unscientific and posits the existence of an ethereal force beyond the powers of science to detect, may in itself be attractive to those who can’t live with the realities of the material world, are unable to deal with a negative or uncertain diagnosis or prognosis, those who fear science and to those who are unable to understand it. Peter H. canter, PH.D.2 The reason we should defer to experts is not that the experts know everything. Of course they don’t. It’s just that they know more than non-experts do. It’s not that science has all the answers. It doesn’t. It’s just that astrologers, shamans, and natural healers have none of them. DaviD FruM3 © harley schwadron “Tell them about your psoriasis, Betty. Maybe they can cure it.” The “CAM” MoveMenT Part Two Health-Care Approaches132

• “Complementary and alternative medicine” is an ambiguous marketing term rather than a sharply defined set of practices. Thus general statements about its popularity or effectiveness should be interpreted very cautiously.
• The vast majority of methods referred to as “alternative” lack a scientifically plausible rationale.
• Calling a method “complementary” does not mean that adding it to an effective method will improve the outcome.
• Many proponents of unscientific “alternatives” hold sincere beliefs that their methods are effective or worth trying.
• Under the rules of science, the burden of proof falls on those who make the claims. Few “CAM” proponents test their claims or even keep track of their results, and many don’t feel that the rules of science are applicable to them.
• “Alternative” proponents are campaigning to abolish consumer protection laws that require products and services to be proven effective before they are marketed.

Keep These poinTs in Mind As You sTudY This ChApTer Key Concepts The phrase “complementary and alternative medicine” (“CAM”) is a euphemistic label for practices most of which are unsubstantiated and lack a scientifically plausible rationale. “CAM” is also a social movement that involves businesses, media outlets, academic institutions, health professionals, gov- ernment agencies, self-proclaimed healers, celebrities, authors, bloggers, spiritualists, legislators, and crusad- ing consumer groups. The National Institutes of Health Center for Complementary and Alternative Medicine (NCCAM)4 defines “CAM” as: A group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used to- gether with conventional medicine, and alternative medicine is used in place of conventional medicine. The above statement implies that “CAM” methods actually complement or serve as sensible alternatives to standard methods. However, the “CAM” marketplace is dominated by products and services that do neither. The dictionary definition of the noun “alternative” is a choice between mutually exclusive possibilities. Until the late 1980s, in standard medical usage, it referred to choices among effective treatments. In some cases they were equally effective (for example, the use of radiation or surgery for certain cancers); in others the expected outcome differed, but there were reasonable tradeoffs between risks and benefits. Today, however, the word “alternative” is applied to a multitude of approaches that would be more accurately classified as irrational, ineffective, or quack. Dictionaries define the adjective “complementary” as completing or combining to enhance or emphasize each other’s qualities. Thus, referring to something as “complementary medicine” implies that it completes or enhances what standard medicine does not do by itself. However, just because something is called complementary does not mean it is effective. If a treatment doesn’t add to the patient’s outcome, it doesn’t complement; it just adds to the cost.5 Despite their misleading nature, the terms “alter- native,” “complementary,” and “CAM” have become institutionalized in our culture. This book uses quotation marks to remind readers that these terms are inherently misleading. Although many of the source materials and opinions cited in this chapter originated long ago, they remain relevant to the current marketplace. Enough is known about many “CAM” practices to evaluate their worth. Some may be appropriately used as part of the art of patient care or as self-care. Relaxation techniques and massage are examples. But practices linked to belief systems that reject science itself have no place in responsible medicine. A complete listing of “CAM” methods would be a monumental task, if not an impossible one. This chapter focuses on methods that have been widely publicized. Other chapters cover additional practices related to mental health, dental care, chiropractic, nutrition, weight control, cardiovascular disease, cancer, and aging. ClAssifiCATion The NCCAM classifies “CAM therapies” into five “do- mains”: (1) whole medical systems, (2) mind-body medi- cine, (3) biologically based practices that use natural substances, (4) manipulative and body-based practices, and (5) energy medicine, which includes unusual uses of measurable electromagnetic fields as well as methods intended to influence “biofields,” the existence of which have not been demonstrated.4 Chapter Eight The “CAM” Movement 133 Whether something should be considered “alterna- tive” depends not only on the method itself but also on how it is used and what claims are made for it. Spinal ma- nipulation, for example, may be useful in properly selected cases of low-back pain. But manipulating the spine once a month for “preventive maintenance” or to promote general health—as many chiropractors recom- mend—has no plausible rationale. Relaxation techniques have a limited but acceptable role in the treatment of anxiety states. But meditation for the purpose of “balanc- ing” one’s “life energy” is another matter. Consideration of herbal products is even more complicated (see Chap- ter 11). The vast number of available “CAM” products include some that have proven usefulness, some that are toxic, and many that have no plausible medical use. Critics are concerned that “alternative” methods are promoted as equally useful or better than standard methods even though they are not. It makes more sense to classify alternatives as genuine, experimental, or questionable.6 Under this system, genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness; experimental alter- natives are unproven but have a plausible rationale and are undergoing responsible investigation; and question- able “alternatives” are groundless and lack a scientifi- cally plausible rationale. Classifying proven therapies as “alternative” is advantageous to proponents who suggest that if some work, the rest deserve equal consideration and respect. Practitioners of “integrative” medicine claim to syn- thesize standard and alternative methods, using the best of both. However, no published data indicate the quality Historical Perspective Folk (Traditional) Medicine Webster’s New Collegiate Dictionary defines folk medi- cine as “traditional medicine as practiced non-profession- ally by people isolated from modern medical services and involving especially the use of vegetable [plant-derived] remedies on an empirical basis.” Traditional medicine is largely primitive medicine, which assumes that super- natural forces are responsible for both the cause and cure of disease. Even herbal remedies may be said to harbor either good or evil spirits, so that believers can explain failures or successes in supernatural terms. Curanderas, popular among Mexican-Americans, are regarded as specialists in the folk medicine of their people. The conditions they treat include mal ojo (“evil eye”), mal aire (“bad air” due to evil spirits or other forces believed to inhabit the air), bilis (anger), susto (fright), and diseases of “hot and cold imbalance.” Their ministrations include prayers, religious objects, herbs, and dietary measures. Powwow, centered in rural Pennsylvania, combines prayer and laying on of hands. They may touch an af- flicted part lightly, rub the surrounding area vigorously, or pass their hands over the entire body while praying either quietly or aloud. Some practitioners sell charms, spells, potions, and other paraphernalia. Some prescribe and sell herbs and teas. Root doctors, found mainly in southeastern states, are consulted by people who believe they have been “hexed” or have had unduly bad luck. The “doctor” listens to their story and either prepares a token, charm, powder, or other special object (“root”) that can help them fulfill their wishes or undo the hex. Voodoo, a religion indigenous to Haiti, is also prac- ticed in southern Louisiana and elsewhere in the United States where Haitians have migrated. Derived from ances- tor worship, it invokes spirits to explain and influence the course of events. It includes an elaborate system of folk medical practices. Voodoo “queens” and “doctors” also sell charms, magical powders, and amulets promised to help cure illness and grant other desires. Folk medicine, even when known to be toxic, is not generally considered quackery so long as it is not done for financial gain. Thus self-treatment, family home treat- ment, neighborly medical advice, and the noncommercial activities of folk healers should not be labeled as quackery. State laws against practicing medicine without a license are rarely enforced against folk healers. However, folk medicine and quackery are closely connected because folk medicine often provides a basis for commercial exploitation. For example, herbs long gath- ered for personal use have been packaged and promoted by modern entrepreneurs, and practitioners who once served their neighbors voluntarily or for gratuities may market themselves outside their traditional communities. Folk beliefs may influence the ability or willingness of a patient to cooperate with or respond to scientific treatment. Some science-based programs have enlisted folk healers to help gain the trust of people who have little knowledge of medical care. De Smet7 has noted that some folk remedies have therapeutic benefits, some may provide psychosocial benefits, and others (such as azarcón powder, rattlesnake meat, and certain herbal teas) can produce serious adverse reactions. Young8 has noted that scientific medicine discards inferior therapies as science advances, but folk medicine and quackery continue to use these as long as a demand persists. Part Two Health-Care Approaches134 of such care or the extent to which they burden patients with medically useless methods. Typically these practi- tioners employ a “heads-I-win, tails-you-lose” strategy in which they claim credit for any improvement experi- enced by the patient and blame standard treatments for any negative effects. This may undermine the patient’s confidence in standard care, reducing compliance or causing the patient to abandon it altogether.9 The “integrated” concept has been further criticized by Arnold Relman, M.D., former editor of The New England Journal of Medicine10: There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of “integrative medicine.” Nor . . . are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all proposed treatments must be tested objectively. In the end, there will only be treatments that pass that test and those that do not, those that are proven worthwhile and those that are not, populAriTY Prevalence reports depend on the modalities that are included and the methods used to collect the data. Al- though this limits their usefulness in discerning trends, taken together, they indicate that many of the methods described in this chapter are widely used. A 1993 report by David Eisenberg, M.D.11 claimed that one out of three Americans was using unconven- tional care. However, this figure was inflated by counting exercise, relaxation, self-help groups, and commercial weight-loss clinics as “alternative,” even though they involve practices that are medically accepted.12 A 1999 report of practitioner use concluded that 6.5% of Americans used both unconventional and conventional practitioners, 1.8% used only unconventional services, 59.5% used only conventional care, and 32.2% used neither.13 The most comprehensive report on “CAM” use among Americans was based on data on more than 23,000 adults and 9000 children gathered during the 2007 National Health Interview Survey (NHIS). The report noted that the methods most commonly used by adults age 18 or older during the previous 12 months were nonvitamin, nonmineral natural products (17.7%), deep breathing exercises (12.7%), meditation (9.4%), chiropractic or osteopathic manipulation (7.5%), mas- sage (8.3%), and yoga (6.1%). The most commonly used modalities by children were nonvitamin, nonmineral natural products (3.9%), chiropractic or osteopathic manipulation (2.8%), deep breathing exercises (2.2%), yoga (2.1%), and homeopathic treatment (1.3%). Prayer- related practices, which are more common than any of these, were not included in this survey.14 Another NHIS report15 estimated that in 2007, adults in the United States spent $33.9 billion out of pocket on visits to CAM practitioners and purchases of CAM prod- ucts, classes, and materials and about 38 million adults made an estimated 354 million visits to the practitioners. Hyman16 has noted that popularity is not a reliable yardstick of effectiveness: Every system—be it based on the position of the stars, the pat- tern of lines in the hand, the shape of the face or skull, the fall of the cards or the dice, the accidents of nature, or the intuitions of a “psychic”—claims its quota of satisfied customers. It is often suggested that people seek “alternatives” because doctors are brusque, and that if doctors were more attentive, their patients would not look elsewhere. It is true that doctors sometimes pay insufficient atten- tion to the emotional needs of their patients. But some people’s needs exceed what scientific health care can provide. A Canadian study of children attending an outpatient clinic found that word of mouth, fear of drug side effects, and persistence of a medical problem were more significant than dissatisfaction with conventional medicine in influencing their parents’ decision to seek “alternative” care.17 A New Zealand study of 148 cancer patients using “alternative” approaches found that most were satisfied with conventional medicine and used alternative therapy only as a supplement.18 Furnham and Smith19 have suggested that “CAM” users may fall into three groups: “principalists,” who believe in “CAM,” people who are primarily frustrated with mainstream care, and “opportunists” who shop around. A study based on NHIS data found that among those who used only “alternative medicine” for treat- ment purposes, about half said they “thought it would be interesting to try,” about 20% each said they believed that standard treatments would not work, and about 20% said they were too expensive.20 Misleading publicity also plays an important role in fostering popularity. Few media outlets place “alterna- tive” methods in proper perspective; most reports feature the claims of proponents and testimonials from satisfied customers. The National Center for Homeopathy, which rates reports that mention homeopathy, has concluded that since 1999, only 12% of more than 1000 mentions of homeopathy were negative. Critical analyses of acupuncture, ayurveda, chelation therapy, chiropractic, macrobiotics, and naturopathy are even scarcer. Figure 8-1 shows an ad that promotes a “CAM” newsletter by exaggerating problems within our mainstream health care system. Chapter Eight The “CAM” Movement 135 CoMMon TheMes Public interest in “alternative medicine” is part of a general societal trend toward rejection of science as a method of determining truths.21 In line with this phi- losophy, “alternative” proponents assert that scientific medicine is but one of a vast array of health-care options worth considering. Ernst22 has countered that “Anatomy, physiology, and pathology are not ‘Western medical systems.’ They are generalizable truths that apply to all humans.” Vitalism Many “alternative” approaches are rooted in vitalism, the concept that bodily functions are due to a vital principle or “life force” distinct from the physical forces explain- able by the laws of physics and chemistry. Nonscientific health systems based on this philosophy maintain that diseases should be treated by “stimulating the body’s ability to heal itself” rather than by “treating symptoms.” Homeopaths, for example, claim that illness is due to a disturbance of the body’s “vital force,” which they can correct with special remedies, whereas acupunctur- ists claim that disease is due to imbalance in the flow of “life energy” (chi or qi), which they can balance by twirling needles in the skin. Many chiropractors claim to assist the body’s “Innate Intelligence” by adjusting the patient’s spine (see Chapter 9). Naturopaths speak of “Vis Medicatrix Naturae.” Ayurvedic physicians refer to prana. And so on. The “energies” postulated by vitalists are not objectively measurable. Although vitalists often pretend to be scientific, they really reject the scientific method with its basic assumptions of material reality, mechanisms of cause and effect, and testability of hypotheses. They regard personal experience, subjective judgment, and emotional satisfaction as preferable to objectivity and unbiased evidence. Many “CAM” advocates claim to use an individu- alized approach that “treats the patient rather than the disease.” This enables them to claim effectiveness even though the patient’s symptoms do not improve. Cor- recting “imbalances” and “strengthening” the immune system are common claims of this type. “Quantum Healing” Quantum mechanics is an extremely complex branch of physics that explains how objects at the subatomic level behave differently than objects in our ordinary experience. Proponents of “mind-body medicine” and similar endeavors claim that quantum physics supports the belief that health can be improved by manipulating forces that cannot be detected with current scientific instrumentation. They also assert that the human mind controls reality and that the universe is a connected whole that cannot be understood by the usual reduction to measurable parts. In November 2011, a Google search for “quantum healing” yielded 2,240,000 Web pages. In Ageless Body, Timeless Mind: The Quantum Alternative to Growing Old, Deepak Chopra, M.D.,23 says that our cells subtly and constantly adjust to our perception of time and that transcendental meditation can slow or reverse the aging process by “taking the mind to a reality where time does not have such a hold.” A #1 best-selling book, The Secret,24 carries wishful thinking even further by claiming that people who think good thoughts will attract like thoughts and have good things come to them. The author claims that this “law of at- traction” has enabled people with cancer, heart disease and many other problems to recover. Physicist Victor Stenger25 has noted that the popu- lar versions of quantum mechanics have nothing to do with the real thing. He states: (a) quantum fields are theoretical objects and do not describe an “aether” or other continuous medium that permeates all space; (b) the brain is wired to the body, but not to other bodies, figure 8-1. Portion of an ad for Health & Healing, a newsletter that advocates “alternative” methods. Most statements in the ad are either false or misleading. Part Two Health-Care Approaches136 (c) no evidence has ever been found for any unique fields or radiation associated with living organisms; and (d) nothing in quantum theory requires the existence of undetectable (nonmaterial) forces. “Holistic Medicine” The term “holistic” (also spelled “wholistic”) is used in both scientific and nonscientific circles. However, considerable confusion surrounds its use. Scientific practitioners regard holistic medicine as treatment of the “whole patient,” with due attention to emotional factors as well as the patient’s lifestyle. But most who label their approach holistic use methods that are nonscientific, nar- row in focus, and less likely to be individualized to fit their patients. (Whereas scientific practitioners obtain a thorough history to understand the patient’s total clinical picture, ayurvedic practitioners focus on “body-types,” chiropractors tend to focus on the spine, and so on.) Stalker and Glymour,26 who have studied the holistic movement closely, consider it “a pablum of common sense and nonsense offered by cranks and quacks and failed pedants who share an attachment to magic and an animosity to reason.” Some people espouse the holistic approach as an important modern development in the health-care field. Critics reply that good physicians have always consid- ered their patients as whole beings and that the term holistic is a dangerous banner under which practitioners of nonscientific methods rally. Many chiropractors, for example, have organized “holistic” or “wellness” centers that offer “natural” treatments and “preventive” services, but the recommended methods typically include unnec- essary vitamin supplements and spinal adjustments for everyone. In contrast, science-based wellness and health educa- tion programs emphasize (a) making rational lifestyle choices such as healthful eating and smoking cessation, (b) improving quality of life beyond simply avoiding disease development, (c) commitment to ethical values, (d) physical fitness, (e) critical thinking, (f) skills for coping with life’s challenges, and (g) capacities for in- timacy and meaningful interpersonal relationships. They do not promote non-scientifically supportable methods of healing. Because the “holistic” label is a potential source of public confusion, informed observers have urged scientific practitioners to abandon it.27 “Detoxification” Many “CAM” proponents claim that people accumulate “toxins” and need periodic “detoxification.”28 Their chosen method depends on what they wish to market and, if they have a license, the scope of their license. Naturopaths, for example, claim: Toxins damage the body in an insidious and cumulative way. Once the detoxification system becomes overloaded, toxic metabolites accumulate, and sensitivity to other chemicals, some of which are not normally toxic, becomes progressively greater. This accumulation of toxins can wreak havoc on normal metabolic processes.29 Some proponents claim that intestinal sluggishness causes intestinal contents to putrefy, toxins are absorbed, and chronic poisoning of the body results. Many also suggest that fecal material collects on the lining of the colon and causes trouble unless removed by fasting, laxatives, colonic irrigation, special diets, and/or various herbs or food supplements that “cleanse” the body. The “autointoxication” theory that underlies these claims was popular around the turn of the century but was aban- doned by the scientific community during the 1930s. No relevant “toxins” have ever been found. Individuals in good health can vary greatly in bowel habits, and direct observations of the colon during diagnostic procedures or surgery indicate that fecal material does not adhere to the intestinal lining. Chelation therapy advocates falsely claim that lead, mercury, and/or other heavy metals commonly √ Consumer Tip

Questions to Use for Evaluating “CAM” Methods

• Of what does the method consist? • Is it testable? Can its effects be measured? • Do its theories or practices clash with what is known?
• Is it based on vitalistic theory? • Is it claimed to be a complete system of diagnosis and/or treatment?
• Is its scope said to be limited or unlimited? • What evidence exists that it helps? Has scientific testing proven that it is more effective than doing nothing or using a placebo?
• What evidence exists that it harms? Has it been demonstrated that its potential benefit exceeds any potential for harm?
• Do its practitioners use standard diagnostic ter- minology? Are the conditions it claims to treat recognized by medical science?
• Are its practitioners adequately trained to make standard diagnoses and to stay within their scope?
• If you cannot answer all the above questions, how can you obtain the information needed to do so?

Chapter Eight The “CAM” Movement 137 accumulate in the body and should be removed by ad- ministering substances that cause them to be excreted (see pages 156–157). Chapter 7 describes how some dentists falsely claim that amalgam fillings cause mer- cury to accumulate and should be removed. Chapter 20 covers devices that supposedly detoxity Colonic irrigation (also called colon hydrotherapy) is intended to flush the entire length of the colon. The fluid may be plain water or contain enzymes, coffee, probiot- ics, ozone, and/or herbs. The amounts used range from a few gallons up to as much as 30 gallons, a few pints at a time. The fluid is delivered through a tube or speculum inserted into the rectum. Sessions generally last between 25 and 50 minutes and may include abdominal massage. Colonic irrigation has a few legitimate medical uses, such as preparation for surgery or radiologic endoscopy and for treating fecal incontinence, but its use for “de- toxification” is irrational—and severe complications (electrolyte imbalance, intestinal perforation, and infec- tions due to unsterile equipment) have been reported.30 In standard medical practice, the word “detoxifica- tion” refers to the management of withdrawal symptoms in people who stop abusing alcohol or controlled drugs. Such detoxification is not relevant to “CAM.” Attitudes Toward Research As noted in Chapter 2, the science-based medical com- munity is committed to testing its theories and practices and accepts the accountability required by consumer protection laws. Science-based medical practice con- tinually changes as new findings point the way, but “true believers” in “CAM” cling to implausible and ineffective practices as a matter of faith. When advocates of questionable methods are chal- lenged about their lack of supportive scientific evidence, they typically claim that they lack the money or time to do research. However, preliminary research is simple to carry out and can be incorporated into clinical practice. The principal ingredients are careful clinical observa- tions, detailed record-keeping, and long-term follow-up “to keep score.” “CAM” practitioners rarely do these things. If rigorous clinical trials are conducted and come out negative, proponents often claim that the studies were conducted improperly or that the evaluators were biased. hoMeopAThY Homeopathy originated in the late 1700s when Samuel Hahnemann (1755–1843), a German physician, began formulating its basic principles. Hahnemann was justi- fiably distressed about bloodletting, leeching, purging, and other “heroic” medical procedures of his day that did far more harm than good. He was also critical of medications like calomel (mercurous chloride), which many physicians considered a “cure-all” and prescribed in doses that caused mercury poisoning. At that time, medical practice was dominated by the ancient Greek theory that the human body was filled with four “humors” (black bile, yellow bile, phlegm, and blood) that are in balance when people are healthy and out of balance when they are ill. Standard medical practices, which Hahnemann labeled as “allopathic,” were thought to balance these humors through “op- posite” effects. In contrast, his “law of similars,” held that diseases can be cured with substances that would, if given to healthy people, cause the same symptoms as the disease. Hahnemann derived “allopathy” from the Greek words állos (different) and pathos (suffering) and the word “homeopathy” from homoios (similar) and pathos. Hahnemann and his early followers conducted “provings” in which they administered herbs, minerals, and other substances to healthy people, including them- selves, and kept detailed records of what they observed. Later these records were compiled into lengthy reference books called materia medica, which homeopaths still use to match a patient’s symptoms with a “corresponding” homeopathic remedy. Whorton31 has noted: Hahnemann seems to have overlooked the fact that people regularly experience “symptoms,” unusual physical and emo- tional sensations, whether taking drugs or other stimulants, or not—especially if they have been forewarned that the experimental pills they have been given might, nay probably will, cause symptoms and that the symptoms might be mild and take several days or weeks to manifest themselves. . . . As provings by the master and his followers accumulated, homeopathic handbooks . . . grew thick with interminable symptom lists. Hahnemann also declared that diseases represent an impairment of the body’s ability to heal itself and that only a small stimulus is needed to begin the healing process. To him, disease was chiefly a disturbance of the body’s “spirit.” At first he prescribed small doses of accepted medications. But later he used enormous dilu- tions and theorized that the smaller the dose, the more powerful the effect—a principle he called the “law of infinitesimals.” This principle is the opposite of what pharmacologists have demonstrated in dose-response studies. Novella32 has warned: Part Two Health-Care Approaches138 Homeopathy represents perhaps the greatest disconnect between the scientific community and the public and regulators. Science has definitively spoken—homeopathy is dangerous witchcraft. But most countries treat it as if it were real medicine. Far-Fetched Claims Many homeopaths maintain that certain people have a special affinity to a particular remedy (their “constitu- tional remedy”) and will respond to it for a variety of ailments. Such remedies can be prescribed according to the person’s “constitutional type”—named after the corresponding remedy in a manner resembling astrologic typing. The “Ignatia Type,” for example, is said to be nervous and often tearful, and to dislike tobacco smoke. The typical “Pulsatilla” is a young woman, with blonde or light-brown hair, blue eyes, and a delicate complexion, who is gentle, fearful, romantic, emotional, and friendly but shy. The “Nux Vomica Type” is said to be aggressive, bellicose, ambitious, and hyperactive. The “Sulfur Type” likes to be independent. And so on. Homeopathic products are derived from minerals, plant substances, and several other sources. If the original substance is soluble, one part is mixed with either 9 or 99 parts of distilled water and/or alcohol and shaken vigor- ously; if insoluble, it is finely ground and pulverized in similar proportions with powdered lactose (milk sugar). One part of the diluted preparation is diluted again at the same ratio, and the process is repeated until the desired concentration is reached. Purported dilutions of 1/10 are designated by the Roman numeral X (1X = 1/10, 3X = 1/1000, 6X = 1/1,000,000). Similarly, dilutions of 1/100 are designated by the Roman numeral C (1C = 1/100, 3C = 1/1,000,000, and so on). Most remedies today range from 6X to 30X, but products of 30C or more are marketed. (1C = 10X.) A 30X designation means that the original substance has been diluted 1030 times. Assuming that a cubic cen- timeter of water contains 15 drops, 1030 is greater than the number of drops of water that would fill a container more than 50 times the size of the Earth. Robert L. Park, Ph.D., a professor of physics at the University of Mary- land, has noted that since the least amount of a substance in a solution is one molecule, an actual 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1060 molecules of water. This would require a container more than 30 billion times the size of the Earth. Betz33 has calculated that if everyone on Earth were to ingest three doses of a 30C product each day for 200 billion years, the chance that anyone would encounter a single molecule of the original substance would be infinitesimal. According to the laws of chemistry, there is a limit to the dilution that can be made without losing the original substance altogether. This limit, which is related to Avogadro’s number (6.023 x 1023), corre- sponds to homeopathic potencies of 12C or 24X (1 part in 1024). Hahnemann himself realized there is virtually no chance that even one molecule of original substance would remain after extreme dilutions. But he believed that the vigorous shaking (“succussion”) or pulverizing with each step of dilution leaves behind a spirit-like es- sence, “no longer perceptible to the senses,” that cures by reviving the body’s “vital force.” If this were true, every substance encountered by a molecule of water might imprint an “essence” that could exert powerful and unpredictable medicinal effects when ingested. Many proponents claim that homeopathic products resemble vaccines because both provide a small stimulus that triggers an immune response. This comparison is not valid. The amounts of active ingredients in vaccines are much greater and can be measured, and potency increases with dosage. Moreover, immunizations pro- duce antibodies whose concentration in the blood can be measured, but dilute homeopathic products produce no measurable response. Hahnemann’s theories have never been accepted by scientifically oriented physicians, who charge that homeopathic remedies are placebos (inert substances). However, because homeopathic remedies were actu- ally less dangerous than those of nineteenth-century medical orthodoxy, many medical practitioners began using them. At the turn of the century homeopathy had some 14,000 practitioners and 22 schools in the United States alone. As medical science and medical education advanced, homeopathy declined sharply, particularly in America, where its schools either closed or converted to responsible methods. The last pure homeopathic school in the United States closed during the 1920s.34 Homeopathic preparations were given legal status by the 1938 Federal Food, Drug, and Cosmetic Act, which was shepherded through Congress by Senator Royal Copeland, a homeopathic physician.35 One provision of this law recognized as drugs all substances included in the Homœopathic Pharmacopœia of the United States. Now in its ninth edition, this book describes how more than 1200 substances should be prepared for homeo- pathic use.36 It states that inclusion of a substance means that it has been judged safe and effective. However, the symptoms or diseases for which it should be used are not identified; that is decided by the practitioner or manufacturer. Listing of the substances does not mean that either the law or the U.S. Food and Drug Adminis- tration (FDA) recognizes them as effective.37 Chapter Eight The “CAM” Movement 139 The basis for inclusion in the Homœopathic Pharma- copœia is not modern scientific testing, but homeopathic “provings,” many of which took place more than 100 years ago. Yet Jeremy Sherr,38 a British homeopath who wrote The Dynamics and Methodology of Provings, states that these provings had no consistency because “every homeopath had a different method.” Some used a single dose, others dosed as often as three times a day for months, and potencies ranged from the undiluted original substance to dilutions as high as 200C. (The number 100200 is vastly greater than the estimated number of molecules in the universe.) About 50 American physicians who prescribe ho- meopathic remedies practice anthroposophical medi- cine, a difficult-to-describe system based on the occult philosophy of Rudolf Steiner (1861–1925). Steiner’s teachings encompassed (a) a system of body movements termed “eurythmy”; (b) a peculiar educational approach that stresses art, drama, spiritual development, and “sci- ence” based on occult concepts; (c) a fanciful theory of medicine; and (d) “biodynamic” agriculture, a type of “organic” farming.39 Anthroposophical “remedies” are marketed in the United States through Weleda Inc. of Spring Valley, New York. According to a Weleda bro- chure, each plant used to prepare remedies is “selected for its unique ‘personality,’ revealed in form, color, pattern of growth, with consideration of its beneficial properties” and is “harvested when its growth forces are strongest.” Proponents also state that “seasonal changes” and “solar, lunar and planetary influences” are factors in determining when to harvest the plants. Electrodiagnosis Many practitioners use “electrodiagnostic” devices to help select the homeopathic remedies they prescribe. These practitioners claim they can determine the cause of any disease by detecting the “energy imbalance” caus- ing the problem. Some also claim that the devices can detect whether someone is allergic or sensitive to foods, vitamins, and/or other substances. The procedure, called electroacupuncture according to Voll (EAV), electrodiag- nosis, or electrodermal screening, was begun during the 1950s by Reinhold Voll, M.D., a West German physician who developed the original device. Subsequent models include the Vegatest, Dermatron, Interro (Figure 8-2), and Biomeridian. Proponents claim these devices measure distur- bances in the flow of “electro-magnetic energy” along the body’s “acupuncture meridians.” Actually, they are fancy galvanometers that measure electrical resistance of the patient’s skin when touched by a probe.40 Each device contains a low-voltage source. One wire from the device goes to a brass cylinder covered by moist gauze, which the patient holds in one hand. A second wire is connected to a probe, which the operator touches to “acupuncture points” on the patient’s foot or other hand. This completes a circuit, and the device registers the flow of current. The information is then relayed to a gauge that provides a numerical readout. The size of the number depends on how hard the probe is pressed against the patient’s skin. Newer versions make sounds and provide the readout on a computer screen. The treat- ment selected depends on the scope of the practitioner’s practice and may include acupuncture, dietary change, and/or vitamin supplements, as well as homeopathic products. Regulatory agencies have seized several types of electroacupuncture devices but have not made a system- atic effort to drive them from the marketplace. In 1991 the Australian College of Allergy issued a position paper stating that the use of a Vegatest device has no scientific basis and “may lead to inappropriate treatment and ex- pense to the patient and community.”41 Research Findings Edzard Ernst, M.D., Ph.D., F.R.C.P., professor of com

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