The Quackometer

It looks as if homeopaths will be making a noise about their victorious successes in Cuba against the scourge of leptospirosis. Last month, a conference was held in Havana, entitled "Nosodes 2008: International Meeting on Homeopropylaxis, Homeopathic Immunization and Nosodes against Epidemics". Homeopaths turned up to hear stories of the successes of magic water against dangerous diseases.

What is a nosode? A Nosode is "a homeopathic remedy prepared from a pathological specimen. The specimen is taken from a diseased animal or person and may consist of saliva, pus, urine, blood, or diseased tissue." This may sound a little like conventional vaccines - but there are important differences. When you wish to immunise someone against a dangerous disease, the key trick is to use something that is far less dangerous that what you are protecting against. Real vaccines protect against microorganisms by introducing the body to killed, attenuated or partial versions of the same microorganism. Nosodes do not introduce the body to anything. The dangerous "saliva, pus, urine, blood" is made safe by diluting to such extreme levels so that all that is left is water. Yes, homeopathic nosode immunisation is the same as any other homeopathic remedy - nothing. Of course, homeopaths claim that shaking the water introduces important quantum, vibrational dooda into the water - and this is what protects you.

However, even amongst homeopaths, the practice of homeoprophylaxis through nosodes is highly controversial. There are a number of reasons why.

• Firstly, you see, homeopathy in its 'classical' form is about 'like cures like'. The important word being 'like'. Homeoprophylaxis does not use 'like' but 'same'. This is heretical for many fundamentalist homeopaths. It is often called 'Isopathy', rather than homeopathy. In his later life, Hahnemann, the founder of homeopathy, denounced this heretical and deviant form of medicine. "To desire to cure thus, by a pathogenic power rigorously equal (per idem) is contrary to common sense and even to all experiences".
• Secondly, homeopathy is supposed to be 'individualised'. That is, a remedy is selected from a vast selection based on a wide range of 'symptoms'. These may not just be the symptoms of your disease, but on your state of mind, whether you were stuck in traffic that morning, your dreams about cheese last night - the list goes on. For many homeopaths, the idea that you can give the same remedy to millions of people without 'individualising' goes against the principles of homeopathy.
• Thirdly, homeopathic immunisation, or homeoprophylaxis, relies on giving the remedy before you have the symptoms that you are supposed to match against. Again, a major no-no for many homeopaths.

However, one can be pretty certain though: differences in homeopathy only really matter when discussing failures to cure. If there is a whiff of success in the air, these minor ecumenical disagreements will be dropped faster than an motion to promote the MMR vaccine at a homeopaths' conference. These differences persist over the decades in homeopathy as there is no acceptable standard of evidence to either accept or reject any belief. Homeopaths believe what they want to believe forever, no matter how absurd, dangerous and deluded.

So, what was going in Cuba? A presentation was given at the conference that suggested that an outbreak of leptospirosis had been prevented in Cuba by mass homeopathic immunisation. Leptospirosis "Weil's disease" is an endemic disease in many countries caused by bacteria in water, transmitted often by rats. In many developing countries it can account for many deaths per year. In the UK, it only manages to kill the odd canoeist once in a blue moon.

Cuba has has a problem with the disease. When the Autumn hurricanes hit, rats can be swept out of the sewers and into the paths of humans. Many more people come into contact with infected water. The prevalence of the disease is not constant though and depends on many factors. Up until the end of the eighties, the disease was under control. One factor was that the Soviet Union was supporting Cuba and supplying a vaccine that appeared to be effective. With the collapse of communism in Europe, such assistance quickly dried up and reports of leptospirosis leapt from 0.16 deaths per 100,000 in 1987 to 1.03 deaths per 100,000 in 1993.

Since then, the government of Cuba has taken action. Due to the enormous embargoes placed on them by the US, the Cuban economy has become remarkably self-sufficient in many areas and has achieved sometimes extraordinary things on minute budgets. It has a literacy rate of 99.8% (one of the highest in the world) and a life expectancy from birth of 75 for men and 79 for women (c.f. USA 75 and 80 respectively.) This is despite spending only $229 dollars per head on health compared with $6,096 in the US.

One thing that has been achieved against leptospirosis is the development of a new local vaccine. It appears that a mass vaccination programme has been underway for several years now with the locally developed vaccine Vax-Spiral ®. Also, the government has been recognising the importance of prevention:

Public health authorities are prioritizing rodent control and surveillance to prevent the disease known as leptospirosis. It’s recommended to see a doctor immediately if persistent fever appears and MINSAP is offering prophylactic medicines and including a vaccine to control leptospirosis, which is being administered in areas where there’s risk of contracting this disease.

Deaths from the disease need not happen if the public is educated about the symptoms and effective treatments are put in place. The Cuban government appears to be pretty good at ensuring there are a 'pool of community doctors on every corner' .

What did the homeopaths in Cuba do and what do they think they achieved? Details are hard to come by as there is no published 'scientific' paper yet. Reports from the conference suggest that 2.5 million people were given two doses of a homeopathic nosode (Nosolet) alongside "two Bach Flower Essences to address the typical mental and emotional effects of the disease. " This cost, apparently, $200,000. Now, seeing as the homeopathy is simply water, costing nothing, surely the bulk of the cost must have come from the imperialist dogs at Nelson's Homeopathic Pharmacy in London who make the Bach Flower Essences. Bach remedies are like homeopathic remedies except that they use brandy rather than water. The little vials you can buy in Boots are just tiny bottles of dilute Brandy - the most expensive brandy in the world. If Ernesto 'Che' Guevara were alive today, he would be turning in his grave at the thought of such decadent western nonsense being use to subvert the revolution from imperial corruption.

So, is there evidence that the homeopathic experiment worked? Of course not. Accounts from the conference suggest that there were merely 10 infections per month and no deaths. Can this be attributed to homeopathy or the other health measure in effect? We will not know until a paper is published. But here is my prediction: it will basically say, we dished out the magic water and brandy, we saw a small amount of infection, we concluded it woz the homeopathy wot did it. No control groups. No baseline. Just assertion.

Will we see UK homeopaths crowing about this? Maybe. But they may have also learnt a lesson from last year when a conference by the Society of Homeopaths flaunted nonsense about the treatment of HIV. They were crucified in the press.

I actually look forward to them trying to shout about this. It will simply highlight their inability to recognise the boundaries of what they know they can safely achieve. And this is the major criticism I have of homeopathy. If they stuck to being truly complementary and having nice chats about aches and pains I would have little to say. But they continue to persist in fantastical delusions that they are a true alternative to science and medicine. And in that role, they are a menace.

Labels: cuba, homeopathy, leptospirosis