IIUC refinements are module-local so they are modular and don't break anything.
Edit: the page refers to open classes, and I think the idea is that you can redefine methods on Object and have it apply to every object.
So, if I pass a String to your api and you invoke method X it will invoke the one redefined in your module, while outside it stays the same (more like scala implicits than ruby's open classes).
EDIT:
to clarify how I understand this: the authors have basically decided that the module is the element of behavior specialization, and method calls are basically static functions with syntax sugar, and a class is only a data container with some default implementations for the functions.