Posts Tagged ‘naturopathy’
some thoughts on regression to the mean and what causes what
Regression effects are ubiquitous, and so are misguided causal stories to explain them. Daniel Kahneman
Canto: So here’s an interesting thought, which in some ways is linked to the placebo effect and our attributing recovery from an illness to something we ate, drank or did, rather than to the silent and diligent work of our immune system. You know about the regression to the mean concept?
Jacinta: Of course. It’s a statistical phenomenon that we tend not to account for, because we’re always looking for or imagining causal effects when they don’t exist.
Canto: Well, they do exist but we attribute the wrong causal effects – we don’t account for ‘bad luck’, for example, which of course is caused, usually by factors we can’t easily uncover, so for convenience we give it that name. For example, a golfer might be said to have had an unlucky day with the putter because we observe that she she went incredibly close to dropping a number of difficult long putts, but none of them went in, so she made five over par instead of even. Of course every one of those failed putts was caused – one because her aim wasn’t quite true, another due to a tuft of grass, another because of a last moment gust of wind and so on…
Jacinta: And some of those causes might be deemed unlucky, because on a less windy day, or with a better maintained green, those putts might’ve gone in.
Canto: Okay okay, there is such a thing as luck. But luck, I mean real luck, like the effect of a sudden gust of wind that nobody could’ve factored in, tends to even itself out, which is part of regression to the mean. But let me get back to illness. Take an everyday illness, like a cold, a mouth ulcer (which I suffered from recently)…
Jacinta: Or a bout of food poisoning, which I suffered from recently…
Canto: Yes, something from which we tend to recover after a few days. So the pattern of the illness goes something like this – Day 1, we’re fine. Day 2, we feel a bit off-colour. Day 3 we definitely feel much worse. Day 4, much the same. Day 5, starting to feel better. Day 6, definitely a lot better. Day 7, we’re fine. So it follows a nice little bit of a sine wave – two peaks and a trough – as shown above.
Jacinta: So you’re saying that getting back up to the peak again is regression to the mean?
Canto: Well, sort of, but you’re getting ahead of me. Maybe it isn’t precisely, because a mean is the midpoint in a fluctuation between two extremes. Sort of. Anyway, let me explain. When you’re ill, you can choose to ride it out, or you can go to a doctor, or take some sort of medication, or some concoction recommended by a friend, or a reflexologist, whatever. But here’s the thing. You’re not likely to go to the doctor/acupuncturist/magus on day 2, when you’re just starting to feel queasy, you’re much more likely to go when you’re at the bottom of the trough, and then you’ll attribute your recovery to whatever treatment you’ve received, when it’s really more about regression to the mean. Sort of.
Jacinta: Hmmm. I agree that we’re unlikely to rush to the doctor or even the medicine cabinet when we’re just feeling a bit queasy, but that’s probably because experience tells us we’ll feel better soon – that maybe we’re already at the bottom of a little trough. But when we start going into a deeper trough, naturally we start getting worried – maybe it’s pneumonia, or tuberculosis…
Canto: Or diphtheria, malaria, typhoid, cholera, bubonic plague, acute myeloid leukaemia….
Jacinta: Don’t mock, I’ve had all of those. But it’s interesting to think of illness and wellness in this wave form. I’m not sure if it works as regression to the mean. Because wellness is just, well, feeling well. Feeling ‘normal’ or okay. We don’t tend to feel super-well – do we?
Canto: You mean you don’t believe in biorhythms? So you think the line pattern would be like, a straight horizontal one with a few little and big troughs here and there, and then finally off the cliff and straight down to death?
Jacinta: Well, no, isn’t it a slow decline into second childhood and mere oblivion – sans teeth, sans eyes, sans taste, sans everything?
Canto: Haha well not so much with modern medicine – though my hearing’s starting to go. But one of them-there invisible implants should fix that, at a price. But you’re probably right – what we call wellness at sixty is a lot different from the wellness we felt at twenty, but we’re probably lucky we can’t feel our way back to that twenty-something feeling. But getting back to the case of the person who applies a treatment and then gets better, there are, I suppose, three scenarios. The treatment caused the improvement, the treatment had no effect (the person improved for other reasons – such as our super-amazing immune system), or the treatment actually had a detrimental effect, but the person got better anyway, probably due to our wondrous immune system.
Jacinta: So that’s where the placebo idea comes in. And our tendency to over-determine for causality. You mention something like a cold, which is generally a viral infection, and mostly rhinoviral. The symptoms, like a runny nose and a sore throat, are actually caused by a mixture of the virus itself and the immune system fighting it, but mostly the latter….
Canto: Yeah, is that about antigens, or antibodies, I always get confused…
Jacinta: Well, it’s very very complicated, with T cells, immunoglobulin and whatnot, but essentially antigens are the baddies which trigger an antibody response, so antibodies are the goodies. So, if someone has a cold then unless they know their immune system is compromised in some way, the best thing is to let their immune system do its job, which might cause a few days’ discomfort, like extra phlegm production as the system, the antibodies or whatever, attempts to expel the invaders.
Canto: Yes, but the immune system is invisible to us, and is vastly under-estimated by many people, who tend to like to see something, like a big bright red pill, or a reflexology foot massage, or a bunch of needles needling their chi energy points, or unblocking their chakras…
Jacinta: Can they see their chakras?
Canto: No, but the magus can, with his various chakra-probing methods, and aural and oratorical senses developed over a lifetime – that’s why he’s a magus, dummy.
Jacinta: Yeah, and I’m sure we can all feel when our chakras are unblocked. It’s sort of like body plumbing.
Canto: So, getting back to reality, there is definitely something like this regression to the mean, to our own individual ‘normal’, but maybe ever-declining physical and mental state, that our wonderful immune system helps us to maintain, a system we rely on more than we realise….
Jacinta: Yes, but you know, it’s good that we don’t realise it so much, because think of all the acupuncturists, Alexander technicians, anthroposophicalists, antipharmaceuticalists, aromatherapists, auriculotherapists and ayurvedicists whose jobs might be on the line – and that’s just the A’s! Then we have the baineotherapist, the bead therapists and the bowen therapists, not to mention the chakra scalpel weaponmasters… can you imagine all those folk not being able to make a living?
Canto: Okay, that’s enough. It truly is a sad thing to think upon, but never fear, your horror scenario will never eventuate, my faith in human nature tells me….
Always chemical: how to reflect upon naturopathic remedies
most efficacious in every case
So here’s an interesting story. When I was laid up with a bronchial virus (RSV) a few weeks ago, coughing my lungs up and having difficulty breathing, with a distinct, audible wheeze, I was offered advice, as you do, by a very well-meaning person about a really effective treatment – oregano oil. This person explained that, on two occasions, he’d come down with a bad cough and oregano oil had done the trick perfectly where nothing else worked.
I didn’t try the oregano oil. I followed my doctor’s recommendation and used the symptom-relieving medications described in a previous post, and I’m much better now. What I did do was look up what the science-based medicine site had to say about the treatment (I’d never heard of oregano oil, though I’ve had many other plant-based cures suggested to me, such as echinacea, marshmallow root and slippery elm – well ok I lied, I found the last two on a herbal medicine website).
I highly recommend the science-based medicine website, which has been run by the impressively-credentialed Drs David Gorski and Steve Novella and their collaborators for years now, and which thusly has a vast database of debunked or questionable treatments to explore. It’s the best port of call when you’re offered anecdotal advice about any treatment whatsoever by well-wishers. Not that they’re the only people performing this service to the public. Quackwatch, SkepDoc, and Neurologica are just some of the websites doing great work, but they’re outnumbered vastly by sites spreading misinformation and bogus cures, unfortunately. It’s almost a catch-22 of the internet that you have to be informed enough to use it to get the best information out of it.
As to oregano oil specifically, Scott Gavura at science-based medicine proves a detailed account. I will summarise here, while also providing my own take. Firstly people need to know that when a substance, any substance – a herb or a plant, an oil extracted therefrom, or a tablet, capsule or mixture,something injectable or applied to the skin, whatever – is suggested as a treatment for a condition, they should consider this simple mantra – always chemical. That’s to say, a treatment will only work because it has the right chemistry to act against the treated condition. In other words you need to know something (or rather a lot) about the chemistry of the treating substance and the chemistry of the condition being treated. It’s no good saying ‘x is great for getting rid of coughs – it got rid of mine,’ because your cough may not have the same chemical cause as mine, and your cough in February 2007 may not have the same chemical cause as your cough in August 2017. My recent cough was caused by a virus (and perhaps I should change the mantra – always biochemical – but still it’s the chemistry of the bug that’s causing the problem), but no questions were asked about the cause before the advice was given. And you’ll notice when you look at naturopathic websites that chemistry is very rarely mentioned. And I’m not talking about toxins.
Gavura gives this five-point test for an effective treatment:
When we contemplate administering a chemical to deliver a medicinal effect, we need to ask the following:
- Is it absorbed into the body at all?
- Does enough reach the right part of the body to have an effect?
- Does it actually work for the condition?
- Does it have any hazardous, unwanted effects?
- Can it be safely eliminated from the body?
The answer to Q1 is that oregano oil contains a wide variety of chemical compounds, particularly phenolic compounds (71%). It’s these phenolic compounds that are touted as having the principal beneficial effects. However, though we know that there’s some absorption, we don’t have a chemical breakdown. We just don’t know which phenolic compounds are being absorbed or how much.
Q2 – No research on this, or on absorption generally. Topical effects (ie effects on the skin) are more likely to be beneficial than ingested effects, as the oil can maintain high concentration. This would have no effect on a cough.
Q3 – According to one manufacturer the oil has ‘scientifically proven results against almost every virus, bacteria, parasite, and fungi…’ (etc, etc, but shouldn’t that be bacterium and fungus?). In fact, no serious scientific research has ever been conducted on oregano oil and its effectiveness for any condition whatsoever. So the answer to this question is – no evidence, beyond anecdote.
Q4 – There have been reports of allergic reactions and gastro-intestinal upsets, but the naturopathy industry is more or less completely unregulated so you can never be sure what you’re getting with any bottle of pills or ‘essential oils’. As Gavura points out, the lack of research on possible adverse effects, for this and other ‘natural’ treatments, is of concern for vulnerable consumers, such as pregnant women, young or unborn children, and those with pre-existing conditions.
Q5 – At low doses, there’s surely no concern, but nobody has done any research about dosing up on carvacrol, the most prominent component of oregano oil, which gives the plant its characteristic odour. Other organic components are thymol and cymene.
So there’s no solid evidence about oregano oil, or about the mechanism for its supposed efficacy. But what if my well-wisher was correct, and something in the oregano oil cleared up his cough – twice? And did so really really well? Better than several other treatments he tried?
Well, then we might be onto something. Surely a potential billion-dollar gold-mine, considering how debilitating your common-or-garden cough can be. And how, if not cleared up, it can leading to something way more serious.
So how would a person who is sure that oregano oil has fantastic curative properties (because it sure worked for him) go about capitalising on this potential gold-mine? Well, first he would need evidence. His own circle of friends would not be enough – perhaps he could harness social media to see if there were sufficient people willing to testify to oregano oil curing their cough, where other treatments failed. Then , if he had sufficient numbers, he might try to find out the causes of these coughs. Bacterial, viral, something else, cause unknown? It’s likely he wouldn’t make much headway there (most people with common-or-garden coughs don’t go to the doctor or submit to biochemical testing, they just try to ride it out), but no matter, that might just be evidence that the manufacturer was right – it’s effective against a multitude of conditions. And yet, it seems that oregano oil is a well-kept secret, only known to naturopathic companies and health food store owners. Doctors don’t seem to be prescribing it. Why not?
Clearly it’s because Big Pharma doesn’t support the stuff. Doctors are in cahoots with Big Pharma to sell attractive pills with long pharmacological names and precise dosages and complex directions for use. Together they like to own the narrative, and a multi-billion dollar industry is unlikely to be had from an oil you can extract from a backyard plant.
Unless…
Our hero’s investment of time and energy has convinced him there’s heaps of money to be made from oregano oil’s miraculous properties, but that same investment has also convinced him that it’s the chemical properties that are key, and that if the correct chemical formula can be isolated, refined and commercialised, not only will he be able to spend the rest of his life in luxury hotels around the globe, but he will have actually saved lives and contributed handsomely to the betterment of society. So he will join Big Pharma rather than trying to beat it. Yes, there would have to be a massive upfront outlay to perform tests, presumably on rats or mice at first, to find out which chemical components or combinations thereof do the best job of curing the animals, who would have to be artificially infected with various bugs affecting the respiratory system, or any other bodily system, since there are claims that the oil, like Lily the Pink’s Medicinal Compound™, is ‘most efficacious in every case’.
But of course it would be difficult for any average bloke like our hero to scratch up the funds to build or hire labs testing and purifying a cure-all chemical extract of oregano oil. Crowdsourcing maybe, considering all the testimonials? Or just find an ambitious and forward-thinking wealthy entrepreneur?
Is that the only problem with the lack of acceptance, by the medical community, of all the much-touted naturopathic cures out there? Lack of funds to go through the painstaking process of getting a purefied product to pass through a system which ends with double-blind, randomised, placebo-controlled human studies with large sample sizes?
Permit me to be sceptical. It’s not as if the chemical components of most herbal remedies are unknown. It’s highly unlikely that pharmacologists, who are in the business of examining the chemistry of substances and their effects for good or ill on the human body, haven’t considered the claimed cornucopia of naturopathic treatments and the possibility of bringing them into the mainstream of science-based medicine to the benefit of all. Yes, it’s possible that they’ve missed something, but it’s also possible, indeed more likely, that people underestimate the capacity of our fabulous immune system, the product of millions of years of evolution, to bring us back to health when we’re struck down by the odd harmful bug. When we’re struck down like this, we either recover or we die, and if we don’t die, we tend to attribute our recovery to any treatment applied. Sometimes we might be right, but it pays to be skeptical and to do research into a treatment, and into what ails us, before making such attributions. And to do so with the help of a good science-based medical practitioner. And remember again that motto: always chemical.
kinesiology, TCM and depression
a kinesiology wheel – proof positive of profundity
Jacinta: So, Canto, the new USSR hasn’t posted recently on old Wesley Smith and his wellness treatments. I think we should post on another one of those.
Canto: Oh god, do we have to? I’d rather talk about black holes or the edge of the universe…
Jacinta: I know I know, but, you could think of Wesley’s treatment centre as a black hole of sorts…
Canto; Yes, and like the other kind, the more you look for them the more you find them, and they all have similar properties…
Jacinta: Hopefully, though, they’re not as dangerous…
Canto: Well, that depends. The real black holes are light years away, whereas there’s a black hole of a wellness centre just around the corner from me.
Jacinta: Kinesiology. That’s the subject for today. Know anything about it?
Canto: No, except that, presumably, old Wesley offers it as a treatment. And kinetic energy is energy of motion, right? So, let me guess, kinesiology is the science of getting your energy system moving so fast that it flings your toxins out of every available orifice leaving you feeling not only light-headedly well, but thoroughly exercised, and of course exorcised.
Jacinta: Well I doubt if it’s as scientific as that, but you’re on the right track. Actually there are two meanings of kinesiology. It’s the scientific study of bodily movement, in humans and other animals, which means applying anatomy, physiology, biomechanics, neuroscience, and even robotics, to the understanding of movement. And then there’s the naturopathically bullshittical meaning of kinesiology as deepily ancient chi-based treatment, much along the lines you just mentioned. And it’s this second meaning, as presented by the Australian Kinesiology Association (AKA), that we’ll be focusing on.
Canto: Chi wizz, this could be fun. Are they really into chi?
Jacinta: Oh yes. Their website gushes with it. It’s teeth-gnashing stuff actually. Apparently it combines western science with traditional Chinese medicine (TCM) to promote your spiritual well-being, among other things.
Canto: Hey, I’ve got an idea. You’ve heard about James Randi’s million-dollar challenge?
Jacinta: The one to psychics, promising a million to anyone who can provide scientific proof of their psychic abilities?
Canto: That’s the one, and I don’t know the details, and of course they all argue that it’s rigged against them, but it’s a good kind of bad publicity for psychics at least, but what if we offered a million dollars to anyone who can provide solid, or liquid, or gaseous evidence of the existence of chi?
Jacinta: Canto, we don’t have a million dollars.
Canto: But we don’t need a million dollars, we know there’s no such thing, right?
Jacinta: Uhhh I don’t think it would work that way. We’d need a rich backer, but in any case we wouldn’t get any takers. Having looked at a few forums discussing chi, its supporters usually say that, though it’s undoubtedly real, it’s not detectable or measurable by western methods, because it’s part of a wholly different mindset, a different way of knowing, a spiritual understanding that takes years to develop. They say, for example, that only by believing in chi can you unlock its healing powers.
Canto: So it’s placebo energy?
Jacinta: Okay small-minded little-faith man, let’s move on to kinesiology. The practice clearly takes advantage of the scientific cachet of kinesiology as body movement studies. Here’s what the AKA has to say about it:
Kinesiology encompasses holistic health disciplines which use the gentle art of muscle monitoring to access information about a person’s well being. Originating in the 1970’s, it combines Western techniques and Eastern wisdom to promote physical, emotional, mental and spiritual health. Kinesiology identifies the elements which inhibit the body’s natural internal energies and accessing the life enhancing potential within the individual.
Canto: aka bullshit.
Jacinta: Ha ha, but get what it has to say next:
The maturity of ‘Complementary Therapies’ is shown by some of Australia’s major health funds now paying rebates for many therapies, including Kinesiology. This acknowledges what is happening in the health sciences in the 21st Century. Australians spend over $1 billion annually on therapies not part of mainstream medicine. Kinesiology is one of the fastest growing of these and is now practised in over 100 countries.
Canto: Popularity as evidence. They’re really keen to show how legit they are.
Canto: Their choice, isn’t it? Survival of the brightest?
Jacinta: Maybe so, but I think the phenomenon’s worth pondering more deeply. How long does it take to become a qualified doctor in this country?
Canto: A GP? Well, for example, the University of Adelaide offers a six-year MBBS, that’s a Bachelor of Medicine and Bachelor of Surgery, to start off, but in order to get into that you need really good year 12 results – what they call your ATAR score (Australian Tertiary Admissions Rank) plus you have to pass a UMAT test, that’s a 3 hour multiple choice thing. UMAT stands for Undergraduate Medicine and Health Sciences Admission Test. Oh, and then you have to do well in an interview before a medical panel. So once you’ve been accepted and done your 6-year MBBS, you can apply to do Australian General Practice Training (AGPT) – or maybe you can apply while you’re doing the MBBS and integrate it into your undergraduate degree, I’m not sure. Anyway the AGPT takes another 3 0r 4 years, so it’s a pretty long journey.
Jacinta: Well, thanks for that fulsome response, it well illustrates the gap between evidence-based medicine and naturopathy. I see they’re very much into four-letter acronyms (FLAs) in that field. TLAs aren’t good enough?
Canto: Yes they like to consider themselves more lettered than others. But I should also point out that once they’ve been accepted into the ranks of GPs, or any other medical specialisation, they’ll automatically be able to access the latest medical knowledge in their field. In fact they’ll be bombarded with it, and will be expected to keep up to date. Whereas naturopaths are usually relying on ‘traditional’ techniques and ‘ancient’ herbal treatments, none of this new-fangled invasive or big pharma stuff.
Jacinta: Well I suppose there are a few properly qualified doctors who are into naturopathy, but by and large you’re right. So why is it that so many people are choosing naturopaths over these highly-trained and knowledgable practitioners of the latest evidence-based medicine?
Canto: Well, isn’t it because they aren’t getting what they want from GPs or other specialists? Whatever that might be. Holistic treatment, as they like to call it. A sense of trust. Something psychological, I suspect.
Jacinta: Yes, there’s that – some doctors are still not getting the message about how to share information with their clients, and how to see the approach to health as an interactive process. But it could be that evidence-based medicine is the victim of its own success?
Canto: How so?
Jacinta: Well these days, and WHO figures bear this out, patients are increasingly presenting with chronic conditions. That’s to say, the ratio of chronic illness to acute illness is increasing, and I’d say that’s largely due to the success of evidence-based medicine in the treatment of acute illness. Now of course chronic conditions can be serious and life-threatening – 60% of the world’s population die of them, according to the WHO – but they represent a whole gamut of complaints, from degenerative diseases to niggling backaches, neuralgia and the more difficult to pin down stuff such as chronic fatigue syndrome and fibromyalgia, or the chronic itching that some attribute to Morgellons disease. And then there’s depression…. So some of these ailments are met with skepticism or at least contradictory responses from trained medicos…
Canto: ‘Medical experts are baffled… ‘
Jacinta: Precisely, and many naturopaths see this area as their niche. They can get in and ‘listen’ to the client and treat her ‘holistically’ – that’s to say sympathetically. Much of it is feel-good treatment, so much more pleasant than what’s offered by hard-nosed, know-it-all, condescending doctors.
Canto: So it’s all perfectly harmless, then?
Jacinta: Well perhaps mostly, but there are obvious problems with giving too much legitimacy to these largely bogus treatments. An example of this is precisely what the AKA says on its website, that the ‘maturity’ of naturopathy is proven by the fact that many of their therapies are attracting health fund rebates. This is complete BS, it’s simply a populist move from the health funds, who know full well that naturopathy is here to stay, regardless of evidence. This of course gives the Wesley Smiths of the world more legitimacy and increases the chances of people with serious health issues being led to think that naturopathic shite can cure them.
Canto: Well, doesn’t that get back to survival of the brightest?
Jacinta: Maybe, but what about the scenario – and this has been played out – that a seriously sick child has been given a bogus treatment in lieu of real medicine, and has died of something perfectly curable, courtesy of her parents?
Canto: Mmm, couldn’t that be handled case by case? The parents could be up for gross neglect, and the associated naturopath could be had up for bogus claims leading to the death of a minor or something, and be barred from practising… or given some more serious penalty. Anyway we need to wind this up. Is there anything more specific about kinesiology we should be concerned about?
Jacinta: Kinesiology is generally associated with chiropractic, which is about as bad as it gets. As with naturopaths in general, some kinesiacs are more into woo than others, but the AKA website goes on about acupressure and meridians, and no credible evidence has ever been presented that acupressure points or meridional points actually exist. They’re of course part of TCM, along with vital energy and various other concepts and treatments that have no evidence or coherent mechanism of action to back them up.
Canto: You mean rhino horns and the penis bones of dogs don’t cure anything?
Jacinta: Sorry but rhinos are going extinct for an ignorant fantasy, not to mention the 12,000 or so asiatic black bears being kept on farms so that their bile can be extracted for ‘medicine’, which often drives them to suicidal frenzy. Other creatures being decimated by TCM include sharks, seahorses, tigers, turtles and saiga antelopes….
Canto: OK enough, I’m getting depressed. The final verdict on kinesiology?
Jacinta: Well it seems to be just a variant of chiropractic stuff, though probably even more unregulated, with a greater admixture of TCM woo. I have nothing more positive to say about it than that.
Canto: Whatever next…
it’s all about evidence, part 2: acupuncture and cupping
a picture of health
Okay, having been sick myself with my usual bronchial issues, I haven’t made much progress on researching the ‘alternative’ treatments offered by Wesley Smith and his colleagues at the Wellness Centre. I must admit, too, that I’ve found it a bit depressing focusing on these negatives, so I’ve been working a bit on my Solutions OK blog (a few posts still in preparation) which focuses on being positive about global issues.
So before briefly dealing with acupuncture, I’ve discovered accidentally through looking up Mr Smith that ‘wellness centres’ or ‘total wellness centres’ are everywhere around the western world, including at least one more in Canberra itself. It seems that this is a moniker agreed on by practitioners of holistic medical pseudoscience world-wide, to create a sense of medical practice while avoiding the thorny issue of medicine and what it actually means. But maybe it does partially mean treating people kindly? I’m all for that. Laughter is often quite good medicine, especially for chronic rather than acute ailments.
It’s an interesting point – ‘alternative’ medicine is on the rise in the west, and the WHO informs us that by 2020, due to its own great work and that of other science-based medical institutions, the proportion of chronic ailments to acute ones will have risen to over 3 to 1. It’s in the area of chronic conditions that naturopathy comes into its own, because psychology plays a much greater part, and vague ‘toxins’ and dubious ‘balance’ assume greater significance. That’s why education and evidence is so important. There are a lot of people out there wanting to smile and seduce you out of your money.
Acupuncture
There’s no reason to suppose acupuncture is anything other than pure placebo. It’s similar to homeopathy in that it proposes a treatment involving physical forces that, when tapped, can produce miraculous cures, and it’s also similar in that these forces have never been isolated or measured or even much researched. In the case of homeopathy, Samuel Hahnemann, its inventor, conducted ‘research’, but with no apparent rigour. See this excellent examination of his approach.
Acupuncture posits Qi (pronounced ‘chee’) as an energy force – apparently invisible and undetectable by mere science – which operates under the skin and is ‘strongest’ at certain nodes where experts insert needles to stimulate it. There’s not much agreement as to where exactly these nodes are, how many there are, or how deep under the skin they’re to be found. Is everybody’s Qi the same? Is the Qi of other mammals identical? If you haven’t enough Qi, can you have a Qi transfusion, or will you be contaminated by the wrong Qi and suffer a horrible death? Amazingly, acupuncture practitioners have no interest whatever in these life and death questions. Why has nobody thought to operate on a patient and withdraw a sample of her Qi, considering that the stuff has been known about since ancient times? It’s a puzzlement. And with that I’ll say no more about acupuncture.
Cupping
Cupping, or cupping therapy, is fairly new to me – I mean I’ve heard about it over the years but I’ve never bothered to research it. It was apparently used in Egypt 3,000 years ago, and it’s considered a part of TCM (traditional Chinese medicine). How it got from Egypt to China is anyone’s guess, but when used there, it’s associated with our old friend, the non-existent Qi. Yes, according to TCM, much disease is due to blocked Qi, and cupping is one way to fix it.
Briefly, there are two kinds of cupping, wet and dry, with wet cupping being the more ‘invasive’ and used for more acute treatments. The idea is to create a vacuum which draws the skin up in the cup and increases the blood flow. The cup, or the air inside it, is heated, and when the cup is applied to the skin and allowed to cool, the air contracts, ‘sucking up’ the skin. With wet cupping the skin is actually punctured, so that those nasty but never-quite-indentifial ‘toxins’ can ooze out. By the way, next time you go to your naturopath to get your toxins removed, ask them for a sample, and don’t forget to ask them to name those toxins. Perhaps you could look at them under a microscope together.
There’s very little in the way in the way of evidence to support the effectiveness of cupping, and as you might expect, the best ‘evidence’ comes from the most poorly controlled trials. Serious and obviously dangerous claims have been made that cupping can cure cancer. Here’s the American Cancer Society’s response:
“There is no scientific evidence that cupping leads to any health benefits….No research or clinical studies have been done on cupping. Any reports of successful treatment with cupping are anecdotal. There is no scientific evidence that cupping can cure cancer or any other disease.”
If cupping was effective, this would be easily provable. No proof has been offered in thousands of years, and there’s no credible scientific mechanism associated with the treatment. You’ve been warned. It’s your money. Why hand it over to these parasites?
it’s all about evidence – part 1
I wrote an open letter to a homeopath recently, and received an interesting response, which I’ve promised to deal with publicly. My letter was sent by email at the same time that it was posted on this blog, and this was followed by another couple of emails back and forth. Here they are.
Wesley Smith to myself, April 13 2015
Hi Stewart
I thank you for the courtesy of bringing your article to my attention.
Can you please publish the following corrections to your blog:
To the best of my knowledge, Wesley Smith has never made any claim to be a medical practitioner and I wish to correct any inference in my article “An open letter to a Homeopath” that Wesley Smith misrepresented his qualifications or is not suitably qualified under Australian law to practice or write about complementary medicine. At the time of publishing I was unaware that Wesley Smith is a AHPRA registered Chinese Medicine practitioner (CMR0001709253). Furthermore I withdraw any implication that the phrase “the depth of crazy in which our Wesley is mired” may suggest that Wesley is not of sound mind, or is not fit to either educate people about or practice complementary medicine. Furthermore I acknowledge that I have no knowledge of the appropriateness or otherwise of the qualifications of any of the practitioners at the Live Well Spa & Wellness Centre and therefore I withdraw any inference that any of Live Well’s practitioners may be practicing in their chosen fields without appropriate qualifications.Stewart I have absolutely no interest in debating you, please advise me when you have published the corrections.
Kind regards
Wesley
Myself to Wesley Smith, April 18 2015
Hello Wesley
At no place in my blog post did I write that you claimed to be a medical practitioner, I simply pointed out that you were not one, as far as I could ascertain. Whether you (or your colleagues) are permitted under law to practise complementary medicine is neither here nor there, and I didn’t address that matter in my article. My concern is to point out that homeopathy is not a valid treatment, a view with which the NHMRC concurs. Nor are the other treatments I mentioned in my piece, none of which have scientific evidence to support them. I will of course not be making any changes to my article. Of course it doesn’t surprise me that you absolutely don’t want to debate me, as it would absolutely not be in your interest to do so.
Regards
Stewart Henderson
Wesley Smith to myself, April 20 2015
Hi Stewart
I would have had absolutely no concern if you kept your criticism focused on homeopathy or acupuncture. I don’t agree with you but I’m hardly going to loose sleep over that.
My concern is that you were lazy with your research and published your opinions as if they were fact. You also weakened your argument when you made it personal by disparaging me, Live Well and it’s practitioners. Not only is that sloppy writing and a lazy way to make an argument it is also defamation. I have given you the opportunity to make the appropriate corrections which you have rejected, therefore I will pursue the matter via legal action.
Stewart, my research into your background tells me that you have an arts degree, it’s interesting that you choose to write about a topic for which you seem to have no qualifications. Apparently you work, or have worked at Centacare in Adelaide? Their website homepage states “we believe that everyone has the right to be treated with respect and dignity.” Sounds like great advice and perhaps a tenet you personally would do well to reflect upon especially when dealing with people with whom you disagree.
Kind regards
Wesley
Myself to Wesley Smith, April 23 2015
Dear Wesley
Thanks for your response, which I will be posting in toto on my blog in the near future, together with my response. Your complete lack of interest in addressing the matter of evidence, which was clearly the issue of my blog post, is well noted. I don’t wish to have a private email correspondence with you, as I’m interested in complete transparency and openness. I’ll address all your ‘concerns’ on my blog, with my usual gusto and good humour.
Thanks
Stewart
So now we’re up to date, and I’ll try to suppress the sense of disgust and contempt I feel for this individual, and deal with the issues.
Firstly, let’s look at Wesley’s email number 1. It is, of course, intended to be threatening – ‘make these corrections to your blog, or else…’. The first ‘correction’ is to my ‘inference’ (it looks like old Wesley has been consulting a lawyer) that Wesley has been claiming to be a doctor when he isn’t. As I pointed out in my response, I made no such inference. The point is, when someone heads up an institution called the ‘Live Well Spa and Wellness Centre’, any reasonable soul might expect that individual to be a medical practitioner, working with a staff of medical practitioners. In fact that was exactly what I expected (oh and I think a court of law would agree, Wesley). Imagine my surprise when I found that there were no MDs on the premises!
The second ‘correction’ he wanted was the removal of the phrase ‘the depth of crazy in which our Wesley is mired’, because it suggested he wasn’t of sound mind. I’ll look more closely at that ‘depth of crazy’ shortly, but first I’ll make the obvious point that people believe all sorts of crazy things (though they don’t usually make their living out of them) – that the moon landing was a fake, that September 11 was an inside job, that vaccines cause all sorts of diseases, etc, but we don’t think they should be committed, we just try to get them (usually unsuccessfully) to think more reasonably. I’ve tried to do this with Wesley by pointing out the absurdity of homeopathy from a scientific perspective – again unsuccessfully, because he’s completely unwilling to even discuss the matter.
When I wrote of the ‘depth of crazy’, I really meant it, and this is not my opinion. My opinion isn’t worth a pinch of shit, actually, and nor is Wesley’s. All that matters is EVIDENCE.
EVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCEEVIDENCE
Get it, Wesley?
So let’s do a review of the treatments Wesley’s clinic, or whatever he calls it, offers.
Homeopathy
I gave a fairly full account of homeopathy here, where I referenced Dr Ben Goldacre’s Bad Science, Chapter 4 of which gives an even more comprehensive account of the pseudoscience. I’ve also written more recently about it here, and of course in my criticism of Wesley Smith. I’ve also referenced Wikipedia’s excellent article on Homeopathy, and while I’m at it I’d like to defend Wikipedia as an excellent, and well-referenced source of reliable scientific information. If you feel unsure about what it presents, you can always check the references for original sources. I should remind readers, too, that Wikipedia has been put under pressure by practitioners of ‘holistic medicine’ to give more credence to their methods, and its founders and gatekeepers have heroically refused. I won’t go into detail here, but the story is well-presented by Orac on his Respectful Insolence blog.
So I’m not going to rehash the absurdity of homeopathy here, but since Wesley makes the claim that I was ‘lazy with my research’ and ‘published my opinions as if they were fact’ (when in fact I focused entirely on the NHMRC’s comprehensive and negative findings regarding the practice), I will give here a list of just some of the books, academic papers, scientific articles and government and medical society factsheets that report negatively on the multi-million dollar homeopathy industry, and pseudoscience in general, as well as the major figures in debunking medical pseudoscience. They’re in no particular order.
Dr Ben Goldacre, Bad Science, esp Chapter 4 ‘Homeopathy’ – Dr Goldsworthy works for the NHS in Britain and is a broadcaster, blogger and writer on science-based medicine
Raimo Tuomela, ‘Science, protoscience and pseudoscience’, in Rational changes in science.
Stephen Barrett, M.D, ‘Homeopathy, the ultimate fake’, on Quackwatch – a well-referenced site, but note the hilarious-sad reader responses!
Orac, aka Dr David Gorski – Gorski is a surgeon and scientist, and writer of the Respectful Insolence blog, which deals mostly with the health claims of pseudo-scientists. His posts on homeopathy are too numerous to mention here, just type in homeopathy on his blog.
Edzard Ernst, “A systematic review of systematic reviews of homeopathy”, and “Homeopathy: what does the ‘best’ evidence tell us?’ – Ernst, a former professor of complementary medicine, has published innumerable articles on the subject in academic journals. He co-wrote Trick or treatment? with Simon Singh, which deals critically with homeopathy, acupuncture and various other pseudoscientific treatments. His emphasis on scientific evidence has made him many enemies among the CAM (Complementary and Alternative Medicine) camp.
The Cochrane Collaboration – an independent, non-profit NGO – partnered since 2011 with the WHO – in which over 30,000 volunteers work together to provide the best healthcare evidence.
Shang et al, ”Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy”, The Lancet 366 (9487): 726–732 – This study, conducted by a number of scientific collaborators, is regarded as one of the best and most relevant studies available for proof of homeopathy’s lack of efficacy. To quote from its conclusion: ‘Biases are present in placebo-controlled trials of both homoeopathy and conventional medicine. When account was taken for these biases in the analysis, there was weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects’.
World Health Organisation – the WHO has warned against the use of homeopathy for major diseases, though, generally speaking it has taken a softly, softly approach to the pseudoscience, presumably for political reasons. Here and here are reports about the WHO’s warnings.
NHMRC – Australia’s National Health and Medical Research Council. It has conducted a comprehensive review of homeopathy, which I reported on in my criticism of Mr Smith’s ‘wellness centre’.
Science-based medicine and the FDA (the US Food and Drug administration). The Science-based medicine blog, contributed to by a number of writers, is dedicated to expose as quackery everything that Mr Smith and his ilk are promoting. The report linked to above criticises the FDA for abdication of responsibility in dealing with homeopathy. It also points out that American pharmacists are calling for tighter regulations. Homeopaths have had it too easy for too long. The FDA is finally beginning its own investigation into the pseudoscience.
I could go on – there are many many more articles and sites I could mention, but you get the point. Homeopathy is a joke, and there are many videos poking fun at its ‘science’ – for example, here, here and here. A movement designed to expose its fraudulence, the 10:23 campaign, had people ‘overdosing’ on homeopathic pills, which usually have warnings about dosage levels on the bottles(!) And yet we still have people buying into this shite – quite possibly in increasing numbers.
I don’t know Mr Smith personally. It might be that he’s a very nice if deluded fellow who treats his clients very well, adding to the placebo effect of his ‘remedies’. The placebo effect appears to be very real and we’ve only just begun to investigate its power. On the other hand, Mr Smith may be a charlatan who is cynically exploiting the vulnerability of his rich but deluded patients – his ‘wellness centre’ is in a leafy suburb of Canberra, not exactly the poorest region of Australia. Of course it’s more likely that he’s a bit of both – we deceive others best when we’ve already deceived ourselves.
However, to judge by his email responses, Wesley isn’t as much of a sincere believer as he should be, because he’s far far more concerned with protecting his reputation and with making threats, than with exploring the evidence, and thence, the further application of these homeopathic treatments (I mean, if the ‘like cures like, in infinitesimal doses’ system works, then why couldn’t it cure every cancer known to humans?). In my earlier post I suggested to him an exciting project of getting his fellow homeopaths and their satisfied clients together to ‘crowd fund’ research which would prove homeopathy to be true once and for all. And yet Wesley doesn’t even effing mention the idea. AMAZING!!!!
Well, not, actually. Mention this idea to any homeopath, and the response would be the same. They’re totally uninterested in any real research. Testimonials and anecdotes are enough for them. They just want the evidence to be less rigorous – less real and more ‘imaginary’.
Wesley has made threats about defamation, presumably because I wrote that he’s mired in crazy – which he is. This post is already too long, so I’ll investigate the other crazy treatments he and his team offer in later posts, starting with acupuncture. But as to his threats, the man must be living on another planet if he’s not aware of the many websites, some of which are mentioned above, dedicated to exposing the pseudoscience practiced by people like himself, for financial gain. They generally use far harsher language than I have. If you’re going to set up a practice devoted to procedures which seem to share only one feature – that none of them are accepted as established science – then you’ll need to develop a thicker skin, even if you can’t develop any sensible arguments to support them.
And one more thing – Wesley has tried to cast aspersions on me as a mere English graduate. I think on my ‘about’ page I describe myself as a dilettante, which most certainly and proudly is what I am. However, as a blogger, I suppose my official position is that of a journalist. Freelance of course, with the emphasis on ‘free’, as I’ve never earned a cent from it. No defamation action could ever succeed against a journalist who’s trying to expose ‘sharp practice’ through the investigation of evidence, but perhaps Wesley thinks he can intimidate ‘small fry’ like me with his threats and arrogance. I don’t get much traffic here because I’m hopeless at and positively resistant to networking. But I do know how tight-knit and supportive the sceptical community is when anyone tries to threaten it as Wesley has, because I’ve been observing it for years, and if Wesley tries any further intimidation, I suppose I’ll have to pull my finger out and start letting people know what’s happening. It’ll probably do me a power of good.
Anyway, in later posts I’ll be looking at acupuncture (briefly, as I’ve already dealt with this one before), cupping, kinesiology, bowen therapy and other treatments offered by Wesley and his team.
a plague of mysteries
Well, maybe not quite
I’m writing this because of some remarks made in the workplace which – well, let’s just say they set my sceptical antennae working overtime. They were claims made about the bubonic plague, of all things.
Bubonic plague, dubbed the Black Death throughout European history, is a zoonotic disease, which means it spreads from species to species – in this case from rodents to humans via fleas. Actually there are three types of ‘black death’ plagues, all caused by the enterobacterium Yersinia pestis, the others being the septicemic plague and the pneumonic plague. Other zoonotic diseases include ebola and influenza. Flea-borne infections generally attack the lymphatic system, as does bubonic plague. The term ‘bubonic’ comes from Greek, meaning groin, and the most well-known symptom of the disease were ‘buboes’, grotesque swellings of the glands in the groin and armpit.
It wasn’t called the Black Death for nothing (the blackness was necrotising flesh). It’s estimated that half the European population was wiped out by it in the 14th century. If untreated, up to two-thirds of those infected will be dead within four days. With modern antibiotic treatments, the mortality rate is of course greatly reduced. The broad-based antibiotic, streptomycin has proved very effective. Of course treatment should be immediate if possible, and prophylactic antibiotics should be given to anyone in contact with the infected.
The plague is first known to have stuck Europe in the sixth century, at the time of Justinian. The Emperor actually caught the disease but recovered after treatment. It’s believed that the death toll was very high, but little detail has been recorded. The fourteenth century outbreak appears to have originated in Mongolia, from where it spread through Mongol incursions into the Crimea. An estimated 25 million died in this outbreak from 1347 to 1352. More limited outbreaks occurred in later centuries, and the last serious occurrences in Europe were in Marseille in 1720, Messina (Sicily) in 1743, and Moscow in 1770. However it emerged again in Asia in the nineteenth century. Limited for some time to south-west China, it slowly spread from Hong-Kong to India, where it killed millions of people in the early twentieth century. Infected rats were inadvertently transported to other countries by trading vessels, resulting in outbreaks in Hawaii and Australia. By 1959, when worldwide casualties dropped to under 200 annually, the World Health Organisation was able to declare the disease under control, but there was another outbreak in India in 1994, causing widespread panic and over 50 deaths.
So that’s a v brief history of the rise and fall of bubonic plague, but I’m interested in looking at early treatments and the discovery of its cause. For the fact is that, even in 1900, when the plague first came to Australia, there was no clear consensus among the experts as to its means of transmission, with many believing that it was as a result of contact with the infected. However, a growing body of evidence was showing a connection with epizootic infection in rats, and as it happened, work done by Australian bacteriologists Frank Tidswell, William Armstrong and Robert Dick, working for a new public health department in Sydney under Chief Medical Officer John Ashburton Thompson, established as a direct result of the plague outbreaks in Sydney from 1900 to 1925, contributed substantially to the modern understanding of Yersinia pestis and its spread from rats to humans. This Australian work was another step forward in the germ theory of disease, first suggested by the French physician Nicolas Andry in 1700, and built upon by many experimental and speculative savants over the next 150 years. The great practical success of John Snow’s work on cholera, followed by the researches of Louis Pasteur and Robert Koch, established the theory as mainstream science, but zoonotic infections, especially indirect ones where the infection passes from one species to another by means of a vector, have always been tricky to work out.
In fact it was in Hong Kong that the Yersinia pestis bacterium was identified as the culprit. A breakout of plague occurred there in the 1890s, and Alexandre Yersin, a bacteriologist who had worked under both Pasteur and Bloch, was invited to research the disease. He identified the bacterium in June 1894, at about the same time as a Japanese researcher, Kitasato Shibasaburo. The cognoscenti recognise that both men should share the honour of discovery.
What is fascinating, though, is that the spread of plague from Asia in the 1890s to various ports of the world in the earlier 20th century was very different from the spread of earlier pandemics. Did this have anything to do with science or human practices? Well, what follows is drawn from by far the most comprehensive analysis of the disease I’ve found online, Samuel Cohn’s ‘Epidemiology of the Black Death and successive waves of plague’, in the Cambridge Journal of Medical History.
Cohn’s research and analysis casts credible doubt on the whole plague story, specifically the assumption that we’re dealing with one disease, from the sixth century through to modern outbreaks. He recounts the standard story of three separate pandemics, in the sixth century with a number of recurrences, ditto in the fourteenth century, and in the nineteenth. However, the epidemiology of the most recent pandemic, definitely attributed to Y Pestis and its carrier the Oriental rat flea, Xenopsylla cheopis, is substantially different from that of pandemics one and two, a fact which, according to Cohn, has been obscured by inaccurate analysis of the records. Cohn’s own analysis, it must be said, is fulsome, with 30 pages of references in a 68-page online essay. He doesn’t have a solution as to what caused the earlier pandemics, but he asks some cogent questions. For my own understanding’s sake, I’ll try to summarise the issues in sections.
speed of transmission
Pandemic 3, if we can call it that, was a much slower mover than the previous two. It seems to have sprung up in China’s Yunnan province from where it reached Hong Kong in 1894. It was noted in the early 20th century that Y pestis was travelling overland at a speed of only 12 to 15 kilometres a year. This can be explained by the fact that Y pestis is a disease mainly of rats, though other rodents can also be infected, and rats don’t move far from their home territories. At this rate pandemic 3, even in a world of railways, cars, and dense human populations, would have taken some 25 years to cover the distance that pandemic 1 covered in 3 months. Pandemic 1 made its first appearance in an Egyptian port in 541 and quickly spread around the Mediterranean from Iberia to Anatolia. Within two years of first occurrence it had reached to the wastelands of Ireland and eastern Persia. Pandemic 2, believed to have originated in India, China or the Russian steppes, made its first European appearance in Messina, Sicily in 1347. Within three years it had impacted most of continental Europe, and had even reached Greenland. The fastest overland travel recorded for plague occurred in 664 (pandemic 1), when it took only ninety-one days to travel 385 kilometres from Dover to Lastingham (4.23 km a day)— far faster than anything seen from Y pestis since its discovery in 1894. Pandemic 2’s speed was similar, as Cohn details it:
like the early medieval plague, the “second pandemic” was a fast mover, travelling in places almost as quickly per diem as modern plague spreads per annum. George Christakos and his co-researchers have recently employed sophisticated stochastic and mapping tools to calculate the varying speeds of dissemination and areas afflicted by the Black Death, 1347–51, through different parts of Europe at different seasons. They have compared these results to the overland transmission speeds of the twentieth-century bubonic plague and have found that the Black Death travelled at 1.5 to 6 kilometres per day—much faster than any spread of Yersinia pestis in the twentieth century. The area of Europe covered over time by the Black Death in the five years 1347 to 1351 was even more impressive. Christakos and his colleagues maintain that no human epidemic has ever shown such a propensity to cover space so swiftly (even including the 1918 influenza epidemic). By contrast to the spread of plague in the late nineteenth and twentieth centuries the difference is colossal: while the area of Europe covered by the Black Death was to the 4th power of time between 1347 and 1351, that of the bubonic plague in India between 1897 and 1907 was to the 2nd power of time, a difference of two orders of magnitude.
All of which raises the question – why was pandemic 3 so much slower than the others? Could it be that Y pestis wasn’t the cause of the earlier pandemics?
mode of transmission
We know that Y pestis is a disease of rats, and we know that the Black Death was all about rats, so that’s an obvious connection, no? Well, according to Cohn, what we think we know is just wrong. ‘… no scholar has found any evidence, archaeological or narrative, of a mass death of rodents that preceded or accompanied any wave of plague from the first or second pandemic.’ I must say I found this incredible when I first read it, yet Cohn seems to have investigated the sources thoroughly.
Cohn notes that:
while plague doctors of “the third pandemic” discovered to their surprise that the bubonic plague of the late nineteenth and twentieth centuries was rarely contagious, contemporaries of the first suggest a highly contagious person-to-person disease. Procopius, Evagrius, John of Ephesus, and Gregory of Tours characterized the disease as contagious and, in keeping with this trait, described it as clustering tightly within households and families; the evidence from burial sites supports their claims.
Pandemic 2 made the word contagium popular among the general public, and the incredible speed of transmission became one of the principle signs of the Black Death, differentiating it, for example, from smallpox, which had some similar physical characteristics. This contagion suggests person to person contact, more typical of pneumonic plague, which is highly infectious and can be transmitted through coughing and sneezing. A later chronicler of pandemic 2, Richard Mead, writing in the 1700s, advised against crowding plague sufferers in hospitals, as it ‘will promote and spread the Contagion’. However, those treating pandemic 3 noted, to their surprise, that plague wards were the safest places to be, and that this particular plague rarely took on the pneumonic form.
Cohn notes that the earlier pandemics were often associated with famine. For example in Alexandria and Constantinople in 618 and 619 famine preceded the plague and appeared to spark it into life. However, pandemic 3, definitely caused by Y Pestis, tended not to thrive in situations of dearth and was instead fed by increased yields. Such yields lead to higher rat populations, and higher rates of possibly infected rat fleas and so higher rates of transmission to humans.
death rates
According to contemporary accounts the first pandemic wiped out entire regions, decimating the inhabitants of cities and the countryside through which it so swiftly passed. These accounts are backed up by archaeological and other evidence. It’s pretty clear that millions died in the second pandemic too. Compare this to the third pandemic, which spread so slowly and was limited to coastal areas and even just shipping docks. Restricted to temperate zones, this last pandemic resulted in deaths in the hundreds, with never more than 3% of an affected population dying.
symptoms
Although few quantitative records describe the signs or symptoms of plague for pandemic one, those that do (and Cohn cites 6 different ancient authors) are in general agreement in their descriptions of ‘swellings in the groin, armpits, or on the neck just below the ear’, the classic symptoms of bubonic plague. Procopius of Caesaria also observed that victims’ bodies were covered in black pustules or lenticulae. Pandemic 2, which begins with the Black Death of 1347-52, is marked, on the other hand, by extensive records, both professional and popular – writings about it were amongst the first forms of popular literature.
range and seasonality
Another problem for the view that this has all been the doing of Y pestis, is that pandemics 1 and 2 could strike all year round, but generally settled into a pattern of prevailing in summer in the southern Mediterranean and the Near East, which is not the best season for the flea vector X cheopis. The seasonal cycle of modern plague is quite different, and the range is much more limited.
So all this opens up a mystery. Scientists are agreed that we don’t have a clear-cut story of Y pestis causing horrific disease through rats and fleas over millennia (archaeological and other evidence suggests that rats were scarce in 14th century Europe) , but they’re much in disagreement about what the real story might be. If not Y pestis, then maybe a hemorrhagic virus (one of which causes ebola). Such viruses are notorious for their rapid transmission, their resurgences and their high mortality rates. Pneumonic plague, the more infectious, lung-infecting form of plague may also be implicated, but this doesn’t appear to agree with most of the described symptoms of pandemics 1 and 2. Other types of fleas, not associated with rats, as well as lice, are also being considered as possible vectors. Some geneticists believe that a variant of Y pestis may have been responsible. It looks as if genetic analysis is the most likely pathway to finding a solution.
This article got started, as I wrote at the beginning, because someone keen on naturopathy said something about bubonic plague in our staff room. Some plant she brought in, which had great anti-oxidant properties (she clearly hasn’t kept up with the latest findings on anti-oxidants) was also a cure for bubonic plague, or maybe it was a variant of the plant, and the person who discovered the secret of its healing properties died suddenly (presumably not from plague) and the secret was lost to us for centuries…
acupuncture promotion in australia
I tried to find a picture of the chi energy system online, but guess what, nothing to be found. Here’s a chi-reflexology map instead – from the Australian College of Chi-Reflexology, no less!
On the ever-reliable US-based NeuroLogica blog, Steven Novella reports on an interesting case of acupuncture promotion here in Oz, via Rachel Dunlop. As Novella reports, acupuncture has been studied many times before, and Cosmos, our premier science mag, did a story on the procedure a while back, reporting no evidence of any benefits except in the notoriously vague areas of back pain and headaches.
Not surprisingly, lower back pain was one of the conditions that supposedly benefited from acupuncture, according to media hype about the latest study. The trouble is, this study was being reported on before being published and peer reviewed, which, to put it mildly, is highly irregular and raises obvious questions. The Sydney Morning Herald is the offending news outlet, and Dr Michael Ben-Meir the over-enthusiastic researcher. As the article points out, Ben-Meir is already a ‘convert’ to acupuncture, having used it for some time in acute cases at two Melbourne hospitals. That’s fine, if a bit unorthodox, but it doesn’t accord with other findings, and there are therefore bound to be questions about methodology.
One of the obvious difficulties is that acupuncture can hardly be applied to patients without them knowing it. It’s a much more hands-on and ‘invasive’ experience than swallowing a tablet, and this will undoubtedly have a psychological effect. It seems to me, just off the top of my head, that acupuncture, with its associated rituals, its aura of antiquity and its oriental cultural cachet, would carry greater weight as a placebo than, say, a homeopathic pill. But in fact I don’t have to speculate here, as there is much clinical evidence that injections have a greater placebo effect than pills, and big pills have a greater placebo effect than small ones. So it doesn’t greatly surprise me that people will report a lessening, and even a dramatic lessening, of acute pain, after an acupuncture treatment, however illegitimate. I presume there are illegitimate treatments, because the ‘key meridional points’ where the needles are applied are precisely know by legitimate acupuncturists, and they apply their treatments with rigorous accuracy.
Well, actually there’s a big question as to whether or not there are any legitimate acupuncturists, because acupuncture is based on an energy system known as ‘chi’, which supposedly has meridional points at which needles can be inserted quite deeply into the skin, but there’s no evidence whatever that such an energy system exists, let alone about how such a system might function – for example, its mode of energy transmission (whatever ‘energy’ might mean in this case). Considering that we know a great deal about the autoimmune system and the central and peripheral nervous systems, it seems astonishing that this other bodily system has gone undetected by scientists for so long, and especially in recent times, with our ultra-sophisticated monitoring devices. When you look up ‘chi, sometimes spelt ‘qi’ or with other variants, you’ll find nothing more specific than ‘energy’, ‘life force’ or something similar – nothing corpuscular or in any sense measurable by modern medicine. Even so, researchers into acupuncture have come up with an attempt to measure its efficacy by comparing it to ‘sham acupuncture’ in clinical trials. Sham acupuncture uses the ‘wrong’ meridians and the ‘wrong’ depths to which the needle goes.
But herein lies an obvious problem. Sham acupuncturists insert needles only millimetres deep, while real acupuncturists put their needles between one and three or four centimetres deep: ‘Depth of insertion will depend on nature of the condition being treated, the patients’ size, age, and constitution, and upon the acupuncturists’ style or school’, according to an acupuncture site I visited at random. These are rather wide parameters, but the point that interests me is this. If you don’t put your needle in deep enough, you won’t make contact with the chi that needs to be stimulated or other wise modified to heal the patient. So goes the rationale, surely. It’s like, if you don’t put the needle for a standard vaccination in the right place, you’ll miss the vein. But veins are clearly real. If you go dissecting, you’ll find veins and arteries and nerves and muscle and fat and so on. But you won’t find chi. Yet, apparently it does have real existence. It’s between one and four centimetres down, according to real acupuncturists, depending on the above-mentioned variables (and no doubt many others).
So we can’t actually see it, or find it on dissection, but it’s locatable in space, vaguely. Or is it that chi is everywhere in the body but the right kind of chi, the bit that’s causing the pain and needs to be treated with needles at certain precise meridional points, is at a certain distance from the surface of the skin?
It all begins to sound a bit like theology, doesn’t it?
Here’s the ‘take-home’ for me. If you read about treatments that ‘work’ but you get virtually nothing about the mechanism of action, as is the case, for example, with homeopathy and acupuncture, be very skeptical. In the end I’m not impressed with clinical trials that show a ‘real effect’, even a startling one, because I know about regression to the mean, and I particularly know about the placebo effect. I want ‘proof of concept’. In this case proof of the concept of chi and of meridians. I’ve heard homeopaths defend their pills on TV recently by claiming that, ‘whatever the mechanism, clinical trials consistently prove that this treatment works’, and I can’t be bothered chasing up those clinical trials and testing their legitimacy, I go straight to the concepts and processes behind the treatment – the law of similars, the law of infinitesimals, and don’t forget succussion. These concepts are so intrinsically absurd that we needn’t bother looking at the clinical data. If there are positive results, they haven’t been produced by homeopathy. The fact that homeopaths themselves are largely uninterested in the mechanisms is a dead giveaway. You’d think that the law of infinitesimals and the law of similars would surely have myriad applications far beyond their current ones. They would revolutionise science and technology, if only they were real (and they’d also render obsolete much that we currently know).
The same goes for acupuncture, and chi. If this bodily system were real, and chi could be captured in a test tube, and its constituents examined and isolated under a microscope, how revolutionary that would be. How transformative. Chi pills, chi soap, chi breakfast cereal…
Ah but I’m thinking like one of those limited westerners, so modern, so smug, so lacking in the insight of the ancients…
natural remedies, bogus cures, regulation and government – a mish-mash of preliminary observations
aka quackology monthly
Well, having just completed the onerous task of ‘debating’ William Lane Craig, it’s time to refresh with something new, and local – or at least national. Or perhaps local, because one of the leading writers behind this story is Tory Shepherd, who writes for Adelaide’s Advertiser and The Punch, and who is always excellent on pseudo-science, religion and many other issues, as well as being a far more entertaining writer than myself, as for example in this enjoyable but thought-provoking article on alcohol and anti-social behaviour (but don’t bother reading the comments, they’re mostly depressing, and give me the distinct impression that most people who comment on news articles are rather sad, angry souls who nobody else would want to talk to after five minutes).
Shepherd has recently written this piece on proposed new federal laws to deregister bogus medical treatments with the Australian Register of Therapeutic Goods. The opposition has provided in-principle support, which is great, as it might allow a smooth path to legislation in late June. However, if the opposition sniffs a vote in opposing it, there could be trouble. I’d like to keep an eye on this one. She also wrote this interesting piece in early February, about setting up a quackometer-style website to expose medical frauds, though I felt a bit confused about how it might work, funding-wise, and I can’t quite believe that quack peddlers would fall into the trap of getting listed on such a site. They’re pretty canny operators.
Let’s look, though, at the proposed legislation and why the government’s trying to act. Shepherd quotes Dr Ken Harvey, of LaTrobe Uni, a public health advocate and campaigner against bogus treatments, as welcoming the move, but with warnings about loopholes and various ways and means for the companies pedalling these products to dodge regulators (and there’s considerable concern about the rise of ‘fatblaster’ products, where big money can be made, and where the claims made are pretty extraordinary). I haven’t kept up with these issues, but a bit of research into Dr Harvey reveals these treatment peddlars to be more than just sneaky. The director of a company called Sensaslim Australia Pty Ltd, manufacturers of a completely bogus ‘slimming spray’, tried to bring a lawsuit against Harvey for defamation, citing a ridiculous amount of money. The whole thing eventually collapsed as more of the company’s shonkiness was revealed, but not before having caused much distress to the doctor. Shades of the Simon Singh case. But this case and others have highlighted weaknesses in the way the Therapeutic Goods Administration deals with the ever-increasing number of dodgy cures in the market-place.
The Australian Register of Therapeutic Goods (ARTG), which comes under the Therapeutic Goods Administration (TGA), which in turn comes under the federal government’s Department of Health and Ageing, is a compulsory register for anyone wanting to sell therapeutic goods (defined on the TGA website) within Australia or for export. A click on the website tells me that some 25 products were registered yesterday (March 28), and if that’s an average day, that’s an awful lot of products – thousands per year. There’s a lot of info on the TGA website relating to counterfeit medicines and complementary medicines, a lot to get my little head around, but I note they have a two-tiered system in which a medicine or device has to be either registered or listed. Heavy-hitting stuff, including all prescription medicine, has to be registered, which means going through an assessment process for quality, safety and efficacy. Most OTC medicines have to be registered, as well as some complementary medicines, but within the registration process is another two-tiered system, ‘high risk’ and ‘low risk’. Clearly the more low-risk the treatment, the less it will be scrutinised, but this means that treatments which are ineffectual but without evident risk, such as homeopathy, irridology, reflexology and the like, get through the system with minimum if any scrutiny largely due to their inefficacy. They do no harm, so they’re ‘okay’. What needs to be strengthened is the scrutiny of goods that just don’t do what they claim to do. There also needs to be an active recognition that dodgy products are harmful precisely because of their false claims, so that unsuspecting consumers buy them instead of more genuine products. The new legislation will provide stiff penalties for false and misleading information, as well as deregistration, which in effect would be an official ban on sale. Does this mean homeopathy might be banned in Australia soon? Don’t hold your breath on that one. One way that the homeopathy industry flies under the radar is by avoiding claims on its labels, and relying on word-of-mouth and its reputation, especially among the ‘new age’ and generally disaffected-with-mainstream-medicine crowd, to maintain sales. My (minimal) research suggests that this ‘medicin douce’ is listed rather than registered, and the TGA probably doesn’t have the resources or teeth to verify low-risk listed products for efficacy.
However, there are other government agencies such as the ACCC (Australian Competition and Consumer Commission) and the NHMRC (National Health and Medical Research Council) ready to do their bit in protecting consumers. The NHMRC is currently reviewing the effectiveness of homeopathy in a systematic ‘review of reviews’, and will be asking for public feedback in mid 2013. This will be part of an overview of various CAM modalities, with a view to possible changes to the government rebate on private health insurance for natural therapies. Interesting, but with the slowness of this process, and the likely demise of this government come September, we can’t expect too much.
on appetite suppressants
just add water and you get stuffed, apparently
The ‘obesity epidemic’ has been big news in the west for some time now. Increasing affluence, increased food production, the popularity of junk food and sugar-laden soft drinks, the pressure of advertising, not to mention the popularity of computer games and activities that exercise only the finger muscles, all have contributed to the rise and rise of western flab, and associated health problems.
Naturally, all sorts of solutions, of varying quality, are being offered, from lap banding to any number of diets, from crash fads to the more or less scientific. Clearly there’s the potential for a lot of money to be made in this area. Crisis can always be spelt as ‘opportunity’.
So it was with some interest that I noted an ad on TV the other day, from the company Swisse. From memory [that very unreliable source] it featured an attractive thirty-something woman, telling us of her busy day and how it was important to stay in trim, and recommending the use of Swisse ‘appetite suppressant’ pills. She also mentioned that the pills, or their active ingredients, were derived from a cactus plant which was used for this purpose for thousands of years by the natives of wherever the cactus grew. I don’t think the location was specified.
Well, I fell to wondering. A pill that suppresses your appetite, so that you’re less hungry and therefore eat less on a daily basis. Isn’t this the solution to the obesity crisis? Well, maybe not the solution, as there’s still the matter of what you eat, and how active you are, but certainly a general purpose appetite suppressant would be a great weapon in the fight against flab, and probably the primary weapon. Surely this is nothing short of sensational. Worthy of headline news at least.
So let’s see what I can learn about this appetite suppressant and how it works. As a seasoned researcher, I accessed that unmatchable research tool, google, and clicked the first link to come up in the list under ‘Swisse appetite suppressant’. It took me, of course, to the Swisse website, where I found a useful summary, from their perspective:
Swisse Ultiboost Appetite Suppressant contains Slimaluma®, a premium quality ingredient to help reduce hunger levels. Slimaluma® is a naturally derived extract of the cactus plant which has been used for centuries in India for its appetite suppressant qualities when food was scarce. Swisse Ultiboost Appetite Suppressant can be used to help control hunger levels and is best combined with healthy eating and as part of a regular exercise regime.
The advice at the end is admirable, though I do wonder whether people who engage in healthy eating and regular exercise are in need of an appetite suppressant. Healthy eating presumably already excludes over-eating. I was also interested in, and on reflection, slightly disturbed by the offhand remark ‘when food was scarce’. After all, to take away or reduce the pangs of hunger when you’re hungry, or even starving, is a bit like giving a painkiller. It reduces the symptoms but doesn’t solve the problem. It could even exacerbate it, when you consider that feeling hungry is nature’s or evolution’s way of telling you that you need to eat. I wondered how such a product could translate to use in an over-indulgent food-abundant society.
In any case we now find that the cactus plant hails from India and that the active ingredient extracted from it is called ‘Slimaluma’. So how effective is Slimaluma and how does it work?
My search took me to the website of Gencor Pacific, the makers of Slimaluma, and here’s what they have to say:
SLIMALUMA™ is a proprietary standardized extract of Caralluma Fimbriata, an edible plant used for centuries in India as a famine food and appetite suppressant. Gencor Pacific has developed a unique patented process to extract the essential constituents of the whole herb without chemical alteration to any of the key constituents, ensuring that the full benefits of the herb are delivered in concentrated form.
Caralluma fimbriata
Sounds impressive, and there’s more. They describe the results of clinical testing of the product, which is a great sign at least:
SLIMALUMA™ has undergone two double blind, randomized, placebo controlled human clinical trials, one in India and the other in California, USA. Many participants experienced significant loss in appetite and some lost inches off their waist and hips. Participants also experienced reduction in body weight and body fat.
They then link to a more detailed description of the studies and their findings, which again is excellent, and much more than we’ve learned to expect from the sellers of ‘natural’ health products. However, for obvious reasons it would be unwise to simply accept the description and interpretation of the studies of a health product by the makers of that product. So we need to look at more than one, possibly multiple descriptions and interpretations of the studies, and at whether other studies have been conducted.
So let’s look at clinical trial number one. It was conducted at the Division of Nutrition, St John’s National Academy of Health Sciences, Bangalore India during January to August 2003, and it involved 50 subjects. The Wikipedia article on Caralluma fimbriata [and I find Wikipedia quire reliable on these matters in spite of its reputation in some circles] reports on this trial rather differently:
In a small clinical trial conducted in India, modest benefits of Caralluma fimbriata extracts were observed. In the study, 50 overweight individuals were given either a placebo or one gram of extract each day for 60 days. Compared to the placebo group, individuals receiving the extract showed no significant change in body weight, body mass index, hip circumference, body fat or energy intake; however, both appetite and waist circumference were reduced
The difference in these descriptions of the same trial naturally demands that we examine those descriptions more closely. In Slimaluma’s description we’re told that ‘many’ participants experienced ‘significant loss in appetite’. Two questions here – first, how many is many? Fifteen, thirty-five? What about a percentage? And second, how do you measure ‘significant loss of appetite’? Weight loss and BMI are easy to measure objectively, but not appetite loss. I can only imagine that it’s measured through reporting, which, however unreliable, can at least be measured against the reporting of the placebo group. So, while the term ‘significant’ here is a bit tricksy, let’s accept that there was discernible appetite loss. Fine, but the findings were that this change did not lead to reduction in ‘energy intake’, meaning that the Slimaluma consumers didn’t eat less, in spite of having reduced appetite. An odd finding. Not only that, they didn’t reduce body weight or BMI, though there was a reduction in waist circumference. In other words the results seem to be all over the place, and of course the Slimaluma manufacturers only reported, and hyped, the positive findings.
The Indian study was quite small, and its results were hardly definitive. Shannon Moffett, in her book about the brain, The Three-Pound Enigma, which I just happened to be reading today, makes a general statement about research which fits nicely here:
..when you make a generalisation from the sample you study to the population at large, there is a chance – bigger or smaller depending on factors like the size of your sample compared to the size of the population as a whole, how well you controlled for other variables, and so forth – that the trend or trait you observed is characteristic only of that sample and not of the population at large
I seem to remember Steven Novella saying that 50 was an okay number for a study of this kind, if a bit on the small side. It would certainly be useful if it was backed up by further research, but really the initial findings are so underwhelming that further funding might be hard to find. One might expect that there would be some weight loss for the whole group over the six-month research period, as they were all obese and knew they were being studied for weight loss. They were advised not to change their diets, but it’s likely they would have. I haven’t been able to find the precise data on the study, as it’s behind a paywall [why?], but there was a further study done. However, it involved only 26 subjects, only 7 of whom were given placebos. This study only lasted for four weeks [an absurdly short period, it seems to me, given the notorious ‘rebound effects’ of people on diets]. As presented in this Gencor gloss on both studies, it produced ‘excellent’ results, but the sample was too small and the research period too short to produce reliable data.
The gloss mentioned above does attempt some science on the action of Caralluma fimbriata’s phytochemical constituents – pregnane glycosides, fIavone glycosides, megastigmane glycosides and saponins – in suppressing appetite, but I can find very little in the mainstream literature on these specific phytochemicals. The fact is, there’s very little scientific evidence for the efficacy of this product, and the Wikipedia article mentioned above makes this very important point.
Various diet pills claiming to contain Caralluma fimbriata extracts are marketed for weight loss. However there is no independent evidence to suggest that the amount of extract found in these products is sufficient to obtain the same results as the clinical trial. The FTC cautions against the use of “miracle diet” products.
This is a major problem with all so-called allopathic products. There is no control or oversight to their manufacture, as there is with all prescription medication. And, let’s face it, if these appetite suppressants really were efficacious, they would become prescription treatments. That’s what happens with evidence-based medicine. So chuck out those pills, eat less, eat healthily, and make sure you get plenty of exercise. There really is no alternative.
What is reflexology?
I have to say I began to write this piece without the slightest inkling of what reflexology might be.
So now I know it’s about feet, and other bodily parts – mostly extremities – and how they have zones which correspond to internal organs. Presumably applying pressure to these zones cures things. Very big in Denmark, apparently. It’s generally promoted by its adherents and practitioners as an ancient healing system, but little seems to be known of its origins, though this quote from one Aulus Cornelius Celsus, a follower of Hippocrates, is suggestive:
Much more often, however, some other part is to be rubbed than that which is the seat of the pain; and especially when we want to withdraw material from the head or trunk, and therefore rub the arms and legs.
So how can rubbing these zones have an effect on ‘corresponding’ organs? Well it seems there’s a lot of dissension and just plain vagueness about all that, but one common theme is that qi, the Chinese life force, provides the connection. As to the existence of qi, that’s another question, but needless to say it’s an empirical question, for it could only exist in a real sense, not in some supernatural, unlocatable and unmeasurable sense.
However, we needn’t worry about any dodginess, because the Reflexology Association of Australia [RAoA] has a website, with a link to the independent research done to prove its bona fides as a treatment.
Well actually, no, the link only takes you to the email address of the same RAoA. The website also has a left sidebar of links, including one to research, but that one’s greyed out, and doesn’t link to anything. Interesting. You’d think reflexologists would want to be promoting research into their practice, considering how effective they claim it to be. One of the other links is to ‘reflexology articles’, and it takes us to seven linked essay titles. The first is a very brief piece called ‘Importance of A&P [Anatomy & Physiology] and Clinical Medicine for Reflexologists’. Here’s how it begins:
As with any evolving profession, in the beginning, there were very few practitioners who had much knowledge of how the human body worked as the ‘hands on’ practise of working the feet was passed on by family members and anyone else who was interested in learning for their own benefit. As long as they knew where the points were on the feet for specific parts of the body this was considered sufficient at the time. Besides, there were very few avenues and incentives available for people to learn Anatomy & Physiology for their own continuing knowledge.
So we learn that reflexology, in spite of claims to its antiquity, is ‘an evolving profession’, though presumably we could say the same about medicine generally, so there’s not much meaning n the phrase. The Biblical phrase ‘in the beginning’ doesn’t cast much light either. Could be a generation ago, or several thousand years ago. What we do learn is that family knowledge has been passed down as to ‘where the points are on the feet for specific parts of the body’, though sadly we get no details as to these points. Why not throw in an example or two. I mean, it’s not a secret – is it?
In any case, nowadays, there’s a clear avenue for the study of anatomy and physiology. It’s called a medical degree. But that’s not what this article’s author has in mind. She simply claims that it would be a good idea for reflexologists to be up on modern clinical terminology, and even writes about a high standard of knowledge, but nowhere does she explain how this standard is to be achieved. The ‘Certificate of Clinical Reflexology’, unit descriptors of which are downloadable from this website, is made up of some 20 units, of which only three or four actually deal with reflexology as an application of medical knowledge. The others deal with business and admin matters, or such general subjects as ‘Personal Wellness and Self-care’ or ‘Work effectively in the health industry’. I’ve carefully perused those few essential units, and they provide no training in general anatomy and physiology whatsoever. Considering that the central claim of reflexology – that certain pressure points in the foot and elsewhere correspond to the organs of the body – is a clear claim about physiology, this omission is more than slightly disturbing.
But let me return to the article quoted above, to seek enlightenment. Here’s another little quote:
Even though, in most circles, Reflexology is considered to be working with body energy, it is extremely important to have a very sound knowledge of the human body to improve the practitioner’s ability to understand client problems and therefore fit the pattern of working to fit the problem.
Now do you get it? What we have here is an enunciation of the principal of complementarity. You see, another term for naturopathy is complementary medicine. That’s because these alternative treatments are complementary to mainstream treatments. It’s essential to understand mainstream anatomy and physiology so that you can ‘fit your pattern of working to fit the problem’ as defined by mainstream medicine. Not that reflexologists are riding on the coat-tails of mainstream medical practitioners – heaven forfend. After all, they’re working with ‘body energy’, not with just bodies, as anatomists and physiologists do.
So what is this body energy? Well, that may depend on the philosophical approach that guides your reflexological practice. And there are plenty of approaches to choose from. The unit entitled ‘Reflexology framework practice’ has this:
Philosophies relating to reflexology may include:
• TCM Five Element Theory
• Yin / Yang
• Indian chakra system
• Interaction of mind-body systems
• Holographic Theory
• Quantum Mechanics of Healing
• Polarity
And presumably they may also include much else. Clearly reflexology is deeply philosophical, possibly impenetrably so. In fact, I really feel too over-awed to continue.