Semmelweis, Hahnemann and alt.med.-nonsense
People arguing for various alternative medical approaches being valid, or at least possible, often use the example of Ignaz Semmelweis, either directly or by using the completely valid limitations of the real world execution of science that the Semmelweis case raises. Unfortunately they only do so in a limited way and as a rhetorical device. They already know what is true, much like Semmelweis’ opponents, and fail to see that their favourite theory, while ridiculed like Semmelweis’ hypothesis, lacks the solid scientific backing Semmelweis presented. In this post I’ll examine this in more detail and contrast the case of Semmelweis with that of Samuel Hahnemann, creator of homeopathy, since they have overlapping life spans and together allow for some interesting comparisons between science based medicine and alt.med.
For those unfamiliar with the story of Ignaz Semmelweis, he was a Hungarian physician and early pioneer in antiseptic procedures. (If you know the story, you can skip this paragraph, but anyone would benefit from reading the wikipedia entry Ignaz Semmelweis as a refresher) He noted the difference in mortality rates from puerperal fever between two maternity wards in the hospital in Vienna where he worked, examined the differences between the two wards and determined that the main factor distinguishing them was that one was used to train medical interns and one was used to train midwives. He then hypothesized that the medical interns were picking up some sort of cadaverous particles from the corpses in autopsy (an activity not included in midwife training) and that this was the cause of the fever. To prevent this and to test his hypothesis he instituted the practice of hand washing with cholorinated lime before touching patients. This reduced mortality significantly both in this hospital and in other hospitals where it was used.
To someone living today, Semmelweis’ discovery seems obvious, and its opposition ridiculous, but it’s important to try to realise that germ theory was yet to be formulated, that medical science was still in its infancy and that Semmelweis wasn’t the first to consider contagion and cleanliness. Still, some of the arguments directed against Semmelweis are easily recognisable to someone defending alt.med. “Correlation does not equal causation”, “Your suggested mechanism is incompatible with established science”, “suggesting a single mechanism here is ridiculous” and “Where is your peer reviewed paper published” are not uncommon when dismissing some alt.med.-approach. Okay, I don’t know that the last one was used against Semmelweis, and probably not, but part of the baffling resistance to Semmelweis methods may be ascribed to lack of efficient publication and emanation of the findings.
So far so good for alt.med. Scientists, and therefore the real world of science, is resistant to change, and, although true in general, arguments such as “Correlation does not equal causation” and “parts of what you’re saying are obviously wrong” can be used as rhetorical devices to supress and ignore new ideas. And if Semmelweis eventually was vindicated and recognised as a pioneer, despite his “corpse particle” idea beeing inaccurate, isn’t it possible some alt.med.-heroes might one day be vindicated too? Of course it’s possible! All that is necessary is for them to have the solid data Semmelweis had and wait for science to catch up. But here’s what Semmelweis had, and alt.med. keeps failing to bring to the table.
- Solid scientific data to base his hypothesis on. There was a clear difference between the two wards, and Semmeweis could also show that the increased mortality from puerperal fever coincided with the start of patholocical anatomy at the hospital in 1823.
- Solid scientific results from testing his hypothesis. Mortality decreased significantly everywhere handwashing was mandated.
- He was fighting an establishment built on barely scientific ideas.
Twenty years ago alt.med. had excuses for not living up to the ideal of Semmelweis. Little research had been done and resistance to alt.med. was largely based on resistance to new things that conflict with current knowledge, but even back then there was the important difference that “current knowledge” in 1993 was vastly more scientific than “current knowledge” in the 1840s and 50s. Still, “How can you dismiss homeopathy/acupuncture/healing without proper medical trials?”, was not a cry completely without merit. Today however we have 20 years of research showing little or no effect of most alt.med. approaches and increasing knowledge of the quirks of human psychology that keep the belief alive in face of this. Today it is the homeopaths who refuse to accept the scientific data because it goes against their established “knowledge”.
Now what about Samuel Hahnemann, why is he interesting? Well for one thing, he invented the treatment that currently has the highest combined ridiculousness-popularity-misunderstanding level. There are dafter ideas out there, there are more popular treatments out there and there are ideas people know less about, but none combine all three in the way homeopathy does.
Unlike his modern day fans Hahnemann had perfectly good excuses for coming up with this ridiculous idea and sticking with it. He was 63 years older than Semmelweis and the state of medical science was quite a lot worse. He correctly observed that popular treatments of the day did more harm than good and actually quit practising medicine for a while and worked as a writer and translator while trying to investigate medicine scientifically.
Skeptical of the newly suggested effects of cinchona-bark as a malaria remedy he tested it out on himself and experienced similar symptoms to those of malaria. From this he incorrectly concluded that “like cures like”, substances affecting the body will cure illnesses with similar symptoms. Unlike Semmelweis he did no rigorous scientific examination of this hypothesis, instead he introduced more principles without testing them properly, the most important that diluting the substance doesn’t reduce the curative effect. Although some modern homeopathic remedies uses low dilutions, most uses dilutions so extreme that it’s unlikely for the single pill or drop you take to contain a single molecule of the original substance.
Being less harmful than popular treatments of the day, homeopathy rose to be a significant player on the field of medicine, but it was always attacked as being scientifically ridiculous, and as directly harmful treatments were weeded out by maturing medical science, homeopathy went into decline.
With the increased focus on alternative medicine at the end of the 20th century homeopathy had a second chance to prove itself, and failed. What’s interesting is that this failure has done little to reduce homeopathy’s resurgence. Medicine’s great successes in the 20th century are forgotten by the fortunate with access to modern medicine, we move the goalposts and demand to be completely healthy all the time and will accept no uncertain diagnoses and limits to knowledge, and alt.med. offers that certainty, ufettered by reality and demands for documentation.
Homeopaths and other alt.med.-proponents still see themselves as Semmelweises, unfairly ignored, and uninformed patients and politicians are still propping them up, ignorant that what they’re dealing with are Hahnemanns, successful only because they rarely do direct harm. Openness to new, untested ideas, was a virtue lacking in Semmelweis’ opponents and important to strive for even today, since it doesn’t come naturally. Openness to old, disproven ideas, is asinine, and alt.med. proponents should stop asking for it.