One of the main topics that we’ve covered here on this blog over the last couple of years is the relatively rapid, seemingly relentless infiltration of pseudoscience into what should be bastions of science-based medicine (SBM), namely medical schools and academic medical centers promoted by academics who should, but apparently don’t, know better. From the very beginning, we’ve written numerous posts about this infiltration and how it has been facilitated by a variety of factors, including changes in the culture of medical academia and our own culture in general, not to mention a dedicated cadre of ideologues such as the Bravewell Collaboration, whose purpose is to blur the lines between science and pseudoscience and promote the “integration” of quackery into science-based medicine. Certainly promoters of what Dr. Robert W. Donnell termed “quackademic medicine” wouldn’t put it that way, but I would. Indeed, promoters of quackademic medicine scored a major victory last month, when a credulous piece of tripe about acupuncture passing as a review article managed to find its way into the New England Journal Medicine, a misstep that was promptly skewered by Mark Crislip, Steve Novella, and myself. It’s rare for more than two of us to write about the same topic, but it was earned by a mistake as dire as the editors of the NEJM allowing rank pseudoscience to sully its normally science-based pages.

Today, I want to riff a bit on one aspect of this phenomenon. As a cancer surgeon, I’ve dedicated myself to treating patients with cancer and then subspecialized even further, dedicating myself to the surgical treatment of breast cancer. Consequently, the interface of so-called “complementary and alternative medicine” (CAM) in the treatment of cancer both interests and appalls me. The reason for my horror at the application of CAM to cancer patients, as you might expect, is that cancer is a disease that is highly feared and can be highly deadly, depending upon the specific kind of cancer. Cancer patients deserve nothing less than the best science-based evidence that we have to offer, free of pseudoscience. Yet in even the most highly respected cancer centers, such as M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center, there are departments or divisions of what is increasingly called “integrative oncology.” The claim behind “integrative oncology” is that it is “integrating the best of science-based and ‘alternative’ medicine,” but in reality all too often it is “integrating” quackery with science-based medicine. I have yet to hear an explanation of how “integrating” pseudoscience or nonscience into science-based oncology benefits cancer patients, but, then, that’s probably just the nasty old reductionist in me. Let’s find out.

“Integrative oncology”

I was reminded by the level of “progress” in integrating woo into oncology last week when the July 25 issue of HemeOnc Today showed up. Right there on the front page I saw a story Integrative oncology combines conventional, CAM therapies, with a subtitle reading “This growing medical discipline incorporates methods such as yoga, acupuncture and stress management.” And so it does. But I worry that that’s just the beginning:

The National Center for Complementary and Alternative Medicine defines integrative medicine as treatment that combines conventional medicine with complementary and alternative therapies that have been reported to be safe and effective after being studied in patients.

Lorenzo Cohen, MD, PhD, of M.D. Anderson Cancer Center is conducting a phase 3 trial of the effects of yoga on women with breast cancer.

“Integrative medicine is a philosophy based on treating patients by focusing on the whole person and using both conventional and complementary therapies in a multidisciplinary care fashion,” Lorenzo Cohen, MD, PhD, director and professor of the Integrative Medicine Program at The University of Texas M.D. Anderson Cancer Center, told HemOnc Today.

“It is similar to complementary medicine, but one key difference is that there is an open communication between practitioners of the different traditions,” he said.

“Between the traditions”? Note the clever use of language that Kimball Atwood is so fond of pointing out. Note how Dr. Cohen equates “conventional” and “alternative” therapies (the latter of which he calls “complementary”) as though they had equal validity and equal efficacy. It’s just two different traditions! What’s the problem with bringing them together, and integrating one into the other? It’s the best of both worlds, right?

Also notice another thing. I’ve referred to certain aspects of CAM, sometimes called “integrative medicine” (IM) and, in this case called “integrative oncology” (IO), as a “Trojan horse” to bring woo into medical schools and academic medical centers. Most — but not all — academic medical centers do not use hard core quackery like homeopathy, although many appear to be using a modality just as bad, reiki, which happens to be Dr. Mehmet Oz’s favorite modality. In any case, whenever you see discussions of “integrative medicine” and in particular “integrative oncology,” chances are, the modalities discussed generally include yoga, various dietary modalities, exercise, and, quite frequently, acupuncture. Sometimes, they include various herbal remedies. In other words, “integrative oncology” rebrands modalities that have no reason not to be counted as part of science-based medicine as “alternative” or “integrative” and points to them as having some promise. They then lump together pseudoscience like reiki and acupuncture with the rebranded modalities, such as herbal therapies. This story demonstrates exactly what I mean in this passage:

According to Cohen, integrative medicine includes a plethora of therapies and methods but can be most easily classified into five categories: biologically based therapies, mind/body medicine, manipulative body-based practices, energy medicine and whole medical systems.

Biologically based therapies include ingestibles such as herbs and supplements, megadoses of vitamins or specialized diets. Mind/body medicine consists of techniques that typically help with stress management. These techniques include meditation, yoga, guided imagery and other forms of relaxation, according to Cohen. Manipulative body-based practices include therapies such as massage, medical acupuncture and chiropractic work.

The most controversial area of integrative medicine, according to Cohen, is energy medicine, which includes techniques such as healing touch, Reiki, a Japanese form of energy healing, or the use of magnets for healing. Healing touch techniques such as Reiki and Qigong, an ancient Chinese healing therapy, are based on the theory that human beings are energetic bodies and certain individuals with specific training can emit energy into another person for therapeutic purpose.

I realize that HemeOnc Today isn’t the NEJM, but on the other hand, given how the NEJM recently fell for the pseudoscience that is acupuncture, maybe they aren’t so different after all. In any case, this entire article is the sort of credulous treatment that drives me crazy, particularly the last paragraph quoted above. Energy medicine isn’t just “controversial”: it’s quackery, pure and simple, and Dr. Cohen should know that. The best that can be said about so-called “energy medicine” is that it is religion, not science, or that the various modalities that fall under the rubric of “energy medicine” are based on a prescientific understanding of how the human body works and how diseases attack it. Some of them are not even “ancient.” Reiki, for instance, only dates back to 1922. It was invented by a man named Mikao Usui, who wanted to find out how Jesus healed the sick. His answer, reiki, is no more than faith healing; the only difference between it and what Benny Hinn does is that reiki is based on Eastern mysticism instead of Christian faith. None of this discussion of “energetic bodies” and the claims that practitioners can either channel some form of “universal energy” or manipulate the flow of human “life energy” for therapeutic intent belongs in science-based medicine, at least until someone can characterize the claimed energy and actually show that these practitioners can actually do anything other than wave their hands over patients.

Cohen also speaks of “whole medical systems.” In other words he refers to ancient medical systems, such as traditional Chinese medicine and Ayurvedic medicine, characterizing them as having “their own methods and techniques for diagnosing patients, prescribing treatments and following patients over time.” That much is certainly true, but none of these techniques were based on science, either. They were based on much the same thoughts that early “Western” medicine was based on. After all, when you come right down to it, “balancing” or “adjusting” the flow of qi is not that different than the idea that the four humors must be balanced or that disease comes from “contamination” due to miasmas. As Ben Kavoussi has pointed out, there isn’t that much difference between the concepts used to justify blood letting as a treatment for disease. Yet, somehow “integrative medicine” and CAM love modalities based on Eastern mysticism. Where’s the love for black bile, yellow bile, phlegm, and blood, which make just as much sense, from a science-based standpoint as the concept of qi? In fact, they make more sense, because they, at least, exist and can be observed.

The Trojan horse

Time and time again, when I observe integrative oncology programs, I notice that many of them heavily emphasize modalities like diet and exercise. Indeed, in the HemeOnc Today article, the various advocates and “experts” in integrative oncology emphasized time and time modalities like yoga:

Karen Mustian, PhD, MPH, assistant professor of radiation oncology and preventive medicine at the University of Rochester Medical Center, discussed the findings of a yoga study at the 2010 ASCO Annual Meeting, held in Chicago in June.

Researchers enrolled 410 survivors of non-metastatic disease who participated in the Yoga for Cancer Survivors program. Survivors reported suffering from moderate or severe sleep disruption 2 months to 24 months after completing adjuvant therapy.

The participants were assigned to breathing exercises, 18 gentle Hatha and restorative yoga postures and meditation for 4 weeks with twice-weekly sessions.
Patients practicing yoga had greater improved sleep quality (22% vs. 12%), decreased incidence of clinically impaired sleep (31% vs. 16%) and less daytime sleepiness (29% vs. 5%) compared with those who did not practice yoga.

Adding to these findings, a study of the effects of yoga on women with breast cancer is also in the works. In April, Cohen received a $4.5 million grant to conduct a phase 3 trial in women with breast cancer to determine the improvement in physical function and quality of life during and after radiation treatment.

The results of the study presented at ASCO described above are, of course, utterly unsurprising. Would anyone expect that gentle exercise and meditation would harm quality of life and sleep quality? My guess is that substituting gentle exercise and prayer or non-yoga meditation would likely produce the same result. But yoga is “Eastern,” so it’s automatically way more cool than “Western” exercises. In any case, I bet I could save the NIH $4.5 million by predicting the results of Dr. Cohen’s study. Yes, yoga very likely will be found to improve physical functioning and quality of life, because, by and large, it is relatively gentle, low-impact flexibility exercise. In fact, in women who have undergone axillary dissection (removal of the lymph nodes under their arms), I would predict that yoga probably will decrease the incidence of impaired range of motion. The reason I make this latter prediction is because I already prescribe gentle stretching exercises to women who have undergone axillary surgery because it does decrease the incidence of impairments in range of motion. In fact, I would go so far as to predict that virtually any low impact exercise, be it yoga, Tai Chi, or simply low impact “Western” forms of exercise, such as walking and stretching, would produce the same results.

Oddly enough, I have been unaware of any investigators being awarded $4.5 million to study whether walking preceded by some gentle “limbering up” has all these effects in cancer patients. Why is that? This is the sort of stuff that is well-within the purview of science-based medicine, leading me to ask: Since when did exercise become “alternative” or “integrative”? Dr. Cohen’s study compares yoga versus “stretching/relaxation” (which is what I thought much of yoga was; so I’m not sure what the difference is) versus a wait list control group. So my being unaware of such a study is at an end, because apparently that’s just what Dr. Cohen will study. But does anyone think that the NIH would have funded such a study if it were about exercise and relaxation rather than yoga? My prediction for the outcome: the first two groups will both do better than the control group in terms of the outcome measures. I also wonder why on earth it will take $4.5 million and five years to answer this question. In any case, given the copious science already demonstrating that low impact exercise results in better quality of life outcomes for cancer patients, I would question the value, the “bang for the buck,” of spending $4.5 million in order to study an “alternative” or “complementary” therapy that is nothing more than a fancy form of stretching exercises and relaxation, the former of which is already known to be of benefit in cancer patients undergoing chemotherapy, surgery, and radiation. Surely such a study could be done for $1 million? Heck, for $4.5 million, I could start up a multi-investigator P01 with teams of investigators doing heavy duty basic science.

I know, I know. Sour apples. I really am in the wrong business.

The HemeOnc Today article, as credulous as it is, though, is merely an indication of just how far the concept of “integrative oncology” has gone. To appreciate just how far it has gone, I thought I’d peruse the websites of what are commonly accepted as two of the most respected institutions devoted to cancer in the United States, if not the world.

“Integrative oncology” invades and metastasizes

“Inspired” by the HemeOnc Today article, I decided to peruse the “integrative oncology” website of one of the two premier cancer centers in the country, that of the M.D. Anderson Cancer Center, as well as to take a peak at what the National Cancer Institute website says about various “alternative,” “complementary,” or “integrative” modalities. What many readers may not know is that the NCI has an Office of Cancer Complementary and Alternative Medicine (OCCAM, perhaps the most unfortunate acronym ever, given what it stands for). Moreover, OCCAM has a budget that is of approximately the same magnitude as that of the National Center for Complementary and Alternative Medicine (NCCAM), in the range of $121 million a year. Thus, OCCAM is potentially as large a force in studying and promoting CAM as NCCAM has ever been.

Let’s start with M.D. Anderson first. On its website, it has a webpage called Complementary/Integrative Medicine Education Resources (CIMER). On the CIMER webpage, perhaps the most telling and useful “resource” is a page on therapies. On this page are links to several review articles authored by CIMER staff and physicians in the Integrative Medicine Program of the M.D. Anderson Cancer Center.

Whenever I take a look at a cancer center’s website, I go straight for the most hard core quackery to see what it says about it. Usually, I go straight for homeopathy. If a website concludes anything other than that homeopathy is pure quackery and that there is not a single molecule of active substance in most true hemopathic remedies (the dilution and succussion process having diluted it to nothing), then I know I’m dealing with quackademic medicine. Here’s an excerpt from what the great M.D. Anderson says about homeopathy:

The practice of homeopathy is based on its “law of similars” which proposes that “like cures like”. That is, a substance that causes specific symptoms in a healthy person is believed to ultimately relieve those same symptoms in a sick person. A few homeopathic physicians treat cancer by prescribing minute doses of tumors and carcinogenic substances.

The intent of homeopathic medicine is to help the body begin the healing process. Rather than focusing on a specific diagnosis, prescriptions are tailored to an entire set of symptoms and may vary between individuals with the same disease.

Significant reduction of some side effects of cancer treatments has been reported in two randomized controlled trials justifying further research with larger trials.

Current research includes a National Cancer Institute (NCI) clinical trial of a homeopathic substance for chemotherapy induced mucositis in children.

So far, not so good. The passage above is completely credulous, without the least bit of skepticism about the very basis of homeopathy. It reports homeopathy as a homeopath would report it, which makes me wonder if it was written by a homeopath. Particularly disturbing is the “detailed scientific review” of homeopathy. I’ll give the author credit because he at least mentions Avogadro’s number, but then credulously parrots the typical homeopath claim that water has “memory.” The article also cites primarily articles from that journal of pure woo, whose editorial standards I’ve lambasted here and elsewhere time and time again, the Journal of Alternative and Complementary Medicine, as well as homeopathy journals, such as the British Homeopathic Journal. It is beyond the scope of this post to explain why such journals are generally not good sources (perhaps I’ll do a post on that someday), but they aren’t. The only “real” journal article I saw was the infamous TRAUMEEL S study from 2001 looking at whether homeopathic TRAUMEEL S can alleviate stomatitis in children undergoing treatment for lymphoma and leukemia. (I shudder at the unethical nature of testing magic water in a clinical trial with children as the subjects.) In any case, this study reported a positive effect; however, one might also note this from the study itself:

TRAUMEEL S® is a homeopathic-complex remedy that has been sold over the counter in pharmacies in Germany, Austria, and Switzerland for over 50 years. It contains extracts from the following plants and minerals, all of them highly diluted (10^?1–10^?9 of the stem solution): Arnica montana, Calendula officinalis, Achillea millefolium, Matricaria chamomilla, Symphytum officinale, Atropa belladonna, Aconitum napellus, Bellis perennis, Hypericum perforatum, chinacea angustifolia, Echinacea purpurea, Hamamelis virginica, Mercurius solubilis, and Hepar sulfuris. Information from the manufacturer indicates that TRAUMEEL S is used normally to treat trauma, inflammation, and degenerative processes.

In other words, this is an herbal remedy in which there is still ingredient, given that even a 10^-9 dilution is not enough to dilute away what’s in there. Why it’s even called homeopathic, I have a hard time figuring out, given that there are many herbs and minerals in there, with no rationale of “like curing like” obvious for them all. If TRAUMEEL S “works,” it’s not any sort of validation of homeopathy; all it shows is that maybe some of the herbs or minerals in the concoction have a beneficial effect. One also notes that this is a small study (N=30, 15 per group) and that the distribution of disease in the two groups was very different and that this study has never been replicated. Both Edzard Ernst and the Cochrane Reviews note this study but conclude that there is no evidence that homepathy is any better than placebo for cancer side effects.

But apparently not M.D. Anderson. M.D. Anderson appears to believe in magic. If you don’t believe me, just take a look at its review on reiki, including the “scientific evidence” for its efficacy in cancer patients, or its review on healing touch, which is more or less reiki shorn of explicit Eastern mysticism. Particularly nauseating is this introduction to “energy therapy” methods, which divides the very concept of energy itself into “Western” and “Eastern” notions of energy. (Silly me, I thought that energy was energy, and it was defined scientifically.) The author then postulates the “blending” of “Eastern” and “Western” concepts of energy thusly:

Modern physics has shown that light can exist as two interchangeable forms: a particle (form and structure) and a wave (movement and vibration). The rest of nature can also be experienced in the form of a particle and a wave. For example, water in the ocean is both particles of water and movement of coastal currents, thermal layers and tides. As in the ocean, the human body contains and is affected by energy that can be blocked, flow freely or vary in frequency. Various forms have been postulated:

• An all-pervasive background frequency without form that extends beyond the limits of the body structure
• Vertical energy flows that serve as conduits to external energy
• Additional currents of energy with identifiable paths and patterns

The extent to which a background field extends beyond a person reportedly varies with each individual. Some people have said that they are sensitive to these fields – seeing or hearing these projections. Heat emanating from a body is one form of energy and one expression of that person’s energy field⁸.

Notice that no evidence is presented showing that these claims are valid.

The introduction concludes:

Contemporary energy therapies are only recent manifestations of a larger and more ancient body of energetic and spiritual concepts that are beyond the scope of these reviews of a few contemporary energetic healing practices. MD Anderson recognizes that physical healing is only part of the cancer treatment process and also offers spiritual support through many different programs such as the Chaplaincy Services — representing a wide range of faiths and spiritual beliefs — and the Place … of wellness — where people touched by cancer can enhance their quality of life with activities that help to heal the mind, body and spirit.

Remember, this is the website of the M.D. Anderson Cancer Center, which is widely viewed to be one of the top two or three cancer centers in the United States, if not the world, and its Integrative Medicine Program appears to be based on magic more than anything else. Quackademic medicine, indeed.

Unfortunately, the NCI’s OCCAM website isn’t all that much better. Because I spent longer than anticipated going through the M.D. Anderson website, I’ll wrap it up fairly quickly. OCCAM has some fairly disturbing pages itself. For instance, its Categories of CAM Therapies is a simple list of CAM therapies with little discussion at all other than defining what they are in the way any woo-meister would be happy with. OCCAM is superior to M.D. Anderson’s CAM pages in that it does from time to time throw in passages like this:

Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven.

If there is no good science to show that these fields even exist, then why study trying to manipulate them? I never understood putting the cart before the horse like that. There’s a lot of that sort of stuff going on in the list of CAM therapies referenced by OCCAM, although a lot of the articles are in fact NCCAM articles. One article on a CAM therapy that is hosted by the NCI and apparently was written by NCI staff is entitled Questions and answers about acupuncture. Depressingly, it begins with a credulous discussion of qi and meridians that is credulous and full of magic. It also contains statements like:

Scientific studies on the use of acupuncture to treat cancer and side effects of cancer began only recently. Laboratory and animal studies suggest that acupuncture can reduce vomiting caused by chemotherapy and may help the immune system be stronger during chemotherapy. Animal studies support the use of electroacupuncture to relieve cancer pain.

And:

Human studies on the effect of acupuncture on the immune system of cancer patients showed that it improved immune system response.

One wonders just how critically the studies to which this article refers were evaluated. Certainly, the lists mix “electroacupuncture” (which is not acupuncture at all — as Mark says, where were those batteries in ancient China to hook up to the acupuncture needles?) with acupuncture studies. One wonders if this is another case of accepting the authors’ misinterpretation of their own results, as I discussed for one such study a couple of months ago. As for the effects of acupuncture on the immune system, the physician’s version of the review points out that all these studies were conducted in China, and, unfortunately, it’s well known that acupuncture studies from China tend to be overwhelmingly positive, in marked contrast to acupuncture studies from other countries, leading some writers of meta-analyses to question how to handle these studies. In any case, it would appear that the NCI, although its material on its website is not as credulous as that of M.D. Anderson, is not exactly a bastion of science when it comes to some “alternative” medical modalities.

Indeed, let me tell you a brief anecdote. Two years ago, at the AACR Meeting, I visited the NCI booth on the convention floor because I knew there was going to be a representative from OCCAM there. My confidence in the scientific rigor of the entire OCCAM enterprise was not boosted by the conversation I had there. In brief, after a brief (and neutral) conversation about what OCCAM does, I gently challenged the OCCAM representative regarding alternative medicine by pointing out that there really isn’t that much evidence for much of it and asking him if he could point me in the right direction. In particular, I asked him why one would think that a mixture of herbal medicines would do better than pharmaceuticals. He then began to pontificate about “royal herbs” and couldn’t provide a good rationale why anyone should conclude that impure mixtures of compounds would be more effective or reliable than pharmaceuticals. When he started going on about “emperor” herbs, “minister” herbs, and “assistant” herbs, I couldn’t take it anymore and looked for an opportunity to politely excuse myself.

“Integrative oncology”: The quackademic oncology that’s here to stay?

I first became aware of the phenomenon of quackademic medicine several years ago. Before then, I was blissfully ignorant. Over the last several years, in particular the last couple of years, I’ve become increasingly alarmed at just how much pseudoscience is finding its way into medical academia in general and into oncology in particular in the form of “integrative” oncology. When the websites of what have in the past been a bastion of science-based oncology, M.D. Anderson Cancer Center and the NCI, become infiltrated with this sort of pseudoscience, I become alarmed. But it’s far, far worse than that. I only picked two websites. There are many more out there, thanks to promoters of woo like the Bravewell Collaborative and others. I only picked on M.D. Anderson and the NCI because of their reputation for being much better than this, a reputation they are endangering by their embrace of woo. Cancer patients, as I say frequently, are among the most vulnerable of patients. Many of them are facing a very unpleasant death without treatment; seeing that they receive the most effective medicines and treatments we have, free of quackery, is a moral imperative, and I fear that we will soon be failing our patients. We now even have a Society of Integrative Oncology promoting the “integration” of pseudoscience into oncology.

The Trojan horse of herbals, diet, and exercise in the form of yoga may have breeched the walls of academia, bringing with it pseudoscience like acupuncture, reiki, and even homeopathy, but still I see reason for hope. Val Jones once coined the term “shruggie” for health care professionals who have seen the infiltration of pseudoscience into medicine and in essence shrug their shoulders, dismissing it as not being important or as not being their business if people choose quackery instead of science-based medicine. However, as the infiltration of pseudoscience reached a critical mass, it started to alarm even some of the shruggies. There has been pushback. We here at SBM like to think that we have been a significant part of that reaction, but we also know that there are many others, such as Edzard Ernst, Ben Goldacre, and Simon Singh. Even though a disturbing number of skeptics seem to have a blind spot when it comes to quackery, the broader skeptical movement appears to be taking more and more notice. I only hope that it’s not too late. When an admired and esteemed institution like M.D. Anderson goes woo, we have an uphill battle to reverse that.

I realize that the New England Journal of Medicine (NEJM) review of acupuncture has already been covered by Drs. Gorski and Novella. But my ego knows no bounds; so I thought I would add my two cents, especially since this review, more than any paper I have read, generates a deep sense on betrayal.

There was a time when I believed my betters. Then the Annals of Internal Medicine had their absolutely ghastly series on SCAMS, the publication of which was partly responsible for interest in the topic. Since that series of articles, I have doubt whenever I read an Annals article. When a previously respected journal panders completely to woo, they lose all respectability. Sure, the editors that were responsible for that travesty are long gone, but the taint remains. I tell my kids that once a trust has been violated, it is difficult to get it back. The Annals has permanently lost my trust, I am afraid.

But we will always have Paris. I mean the NEJM. The NEJM is the premier medical journal. Just because an article is published in the NEJM doesn’t mean it’s right; the results of clinical trials are always being superseded by new information. But the article has supposedly been rigorously peer reviewed. Its like Harvard and… Oops, Bad example. Harvard, as we have seen, has feet of clay, and so, evidently, does the The New England Journal of Medicine.

Goodness, gracious, great balls of fire, the editors of the NEJM have fallen into the depths of nonsense with this one.

Let’s go through it, shall we.

First up, the authors:

Brian M. Berman, M.D., Helene H. Langevin, M.D., Claudia M. Witt, M.D., M.B.A., and Ronald Dubner, D.D.S., Ph.D.

From the Center for Integrative Medicine, University of Maryland School of Medicine (B.M.B.), and the University of Maryland Dental School (R.D.) — both in Baltimore; the Department of Neurology and the Program in Integrative Health, University of Vermont College of Medicine, Burlington (H.H.L.); and the Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin (C.M.W.).

You always want acknowledged experts in a field to write your review. If you want a review of Lyme disease, you ask a Lyme expert (The Connecticut Attorney General not withstanding), and if you want a review of heart attacks, you ask a cardiologist.

So in that spirit, if you want a review of prescientific magic, you want someone well-versed in the practice of prescientific magic. Fortunately, these authors seem well qualified. Dr. Berman founded the Center for Integrative Medicine at University of Maryland and has a long history of research into acupuncture. The center has on its staff a reflexologist/reiki master. Really. And the center offers:

Physician Consultations, Acupuncture, Nutrition, Massage, Homeopathy, Mindfulness-based Stress Reduction, Shiatsu, Reflexology, Yoga, Qi Gong, Tai Chi, Osteopathic Manipulation.

The University of Maryland proudly offer both acupuncture and reiki to their trauma patients.

Reiki is a Japanese technique of relaxation that works similarly to acupuncture, in that you are releasing and moving energy,” explains Donna Audia, R.N., a nurse on Shock Trauma’s pain management team and a certified Reiki master. “By using Reiki with trauma patients, we are not only helping them to relax, we’re also making them active participants in their own healing, and that can be very empowering.

Reaction from trauma patients has been positive, with most requesting follow-up treatments. In fact, many family members ask to be a part of the Reiki session. A group of volunteers trained in Reiki now visits Shock Trauma regularly. The University of Maryland Medical Center is the only facility in the country offering Reiki to trauma patients, although it has also been used to treat people with cancer and other illnesses.

Seriously. Your body has been shattered in a car accident and your health care providers think they can improve your condition by moving and releasing your energy by waving their hands over you.

If, god forbid, you have trauma in Maryland, get transferred. Fast.

Dr. Berman has published extensively on acupuncture and Dr. Witt has published multiple articles on homeopathy, including one using homeopathy for low back pain.

So two of the authors are well grounded in magical thinking: who better to write a NEJM review on acupuncture? They found a Dumbledore, a Gandalf, to write the article, which explains the content as the editors of the NEJM were evidently hit with the confundus charm. As I think about it, that is not the best metaphor, since in the fantasy world, magic is real, but in the real world, magic is fantasy, as well as a review article in the NEJM.

The authors start with a case of chronic low back pain with mild degenerative disease but no anatomical or physiologic reason for the pain. The vignette ends with:

The patient wonders whether acupuncture would be beneficial and asks for a referral to a licensed acupuncturist.

Nope. Simple enough. Acupuncture is nonsense. Oh wait. There’s more.

They review the epidemiology, physiology and anatomy of chronic low back pain and note that the understanding of the disease is a long way from satisfactory and conclude with:

In addition, psychological and behavioral factors, including fear of movement, appear to play an important role in patients with chronic low back pain. Such patients have been shown to have altered brain-activation patterns at subcortical and cortical sites associated with emotion and postural control. Studies comparing psychosocial variables with anatomical findings have shown the former to have greater predictive value than the latter.

In other words, with low back pain there is a big psychological overlay. It is the psychological overlay of pain that makes it difficult to determine the effectiveness of a therapy meant to decrease the pain. When treating a condition in medicine, most interventions attempt to alter the underlying pathophysiology: block a receptor with a drug, alter anatomy with a procedure as examples. If the intervention has no effect on the underlying pathophysiology, then there is little reason to expect benefit beyond a placebo effect, which is almost no effect.

Then they jump into acupuncture.

Acupuncture is a therapeutic intervention…

It is an intervention, yes, but therapeutic? Therapeutic means relating to healing of disease. So they are front loading the language, saying at the beginning that acupuncture is effective rather than proving the case. I would have used ‘useless magical’ instead of ‘therapeutic,’ but that’s me.

Although a number of different techniques or schools of acupuncture practice have arisen, the approach used in traditional Chinese medicine appears to be the most widely practiced in the United States.

Why? Is Chinese acupuncture better? Or is popularity the criteria we use for determining appropriate medical care? There is Chinese and Japanese and tongue and foot and ear and the German head acupuncture. Is there any justification offered for using one over the other? Which is the correct style? As I have said before, it is a trick question, like asking which is the real astrology: European, Indian or Mayan. It makes no difference.

Then they delve into real nonsense.

Traditional Chinese medicine espouses an ancient physiological system (not based on Western scientific empiricism) in which health is seen as the result of harmony among bodily functions and between body and nature. Internal disharmony is believed to cause blockage of the body’s vital energy, known as qi, which flows along 12 primary and 8 secondary meridians. Blockage of qi is thought to be manifested as tenderness on palpation. The insertion of acupuncture needles at specific points along the meridians is supposed to restore the proper flow of qi.

I hate to point out that the physiologic system I use, based on so-called “Western scientific empiricism,” is also based on anatomy, chemistry, biochemistry, histology etc. All based on physical structures that can be isolated and examined.

Meridians and qi blockage is based on what? Nothing. Meridians and qi do not exist. Here is the NEJM offering up, complete with a picture, the idea of meridians and qi as if they are a meaningful construct. Next up in the NEJM will be:

Traditional European medicine espouses an ancient physiological system (not based on Western scientific empiricism) in which health is seen as the result of harmony among bodily functions and between body and nature. Internal disharmony is believed to cause blockage of the body’s vital energy, known as humors: black bile, yellow bile, phlegm, and blood which flows in the body. Blockage of humors is thought to be manifested as illness. Bleeding and purging is supposed to restore the proper flow of balance of humors.

If anyone sees a conceptual difference between the two paragraphs, let the editors of the NEJM know after they accept my review on therapeutic bleeding. Being published in the NEJM is the medical equivalent of being on the cover of the Rolling Stone, and I think I have my opportunity.

Efforts have been made to characterize the effects of acupuncture in terms of the established principles of medical physiology on which Western medicine is based.

Why? Isn’t an ancient physiological system enough upon which to base a therapeutic intervention?

These efforts remain inconclusive, for several reasons. First, the majority of studies have been conducted in animals, and it is difficult to relate findings from such studies to effects in humans. Second, acupuncture has been shown to activate peripheral-nerve fibers of all sizes, rendering a systematic study of responses complex. Third, the acupuncture experience is dominated by a strong psychosocial context, including expectations, beliefs, and the therapeutic milieu.

And fourth, having no basis in reality, acupuncture can’t work any more than homeopathy or reiki. It is tooth fairy science, published in the NEJM.

Then they delve into the physiology of acupuncture and the basic science studies. Fine. You stick people with needles, you will get a variety of physiologic responses, both locally and in the brain. The question is whether these effects are specific to acupuncture or nonspecific results of poking people with a sharp object. Like all acupuncture apologists, they lack a certain precision in what they consider acupuncture, and offer electroacupuncture as evidence.

In the rat, electroacupuncture has been shown to induce pituitary secretion of adrenocorticotropic hormone and cortisol, leading to systemic antiinflammatory effects.

Ah yes, electroacupuncture. I remember when they discovered those ancient Chinese Duracell’s and alligator clips that allowed the Chinese to shock their patients.

I quote from the electroacupuncture article, referenced above:

While the EA frequency was held constant, intensity was adjusted slowly over the period of approximately 2 min to the designated level of 3 mA, which is the maximum EA current intensity that a conscious animal can tolerate. Mild muscle twitching was observed… For sham treatment control, acupuncture needles were inserted bilaterally into GB30 without electrical stimulation or manual needle manipulation.

And when shocked, the rabbits released ACTH and cortisol, as any animal would if electrocuted. Release of ACTH and cortisol is part of the response to stress. I can just see the poor rat, “placed under an inverted clear plastic chamber” for observation saying,” don’t tase me bro, don’t tase me bro.” Wait. It’s not a taser. It’s a projectile electroacupuncture remote deliver system, and if I use it on you, you are going to release some cortisol and ACTH as well, bro.

Did the NEJM editors look at the references? They seriously need some new reviewers.

But I will grant them that sticking needles in people has physiologic effects and shocking a rat makes it squirt cortisol.

However, acupuncture is about putting needles in specific sites. In the animal models and human studies they attempt to needle specific sites that correlate with treating a disease. Most acupuncture studies use the traditional sites associated with whatever illness they are not really treating; acupuncture is about putting the needle just so.

The basic science concerns, as I read it, the effects of needling people. If you are going to recommend acupuncture, and they will, then you need to justify the use of needles in specific sites by people trained in acupuncture, and the literature doesn’t support that. It doesn’t matter where you put the needles, or even if you use needles at all, as we have mentioned, since twirling a toothpick has better effects on knee pain than needling. And I will ask again: whose style of acupuncture are you going to use? Ear, tongue, foot, Japanese or German or Chinese?

Then they move on to the clinical trials and my gaster is flabbered.

… real acupuncture treatments were no more effective than sham acupuncture treatments. There was nevertheless evidence that both real acupuncture and sham acupuncture were more effective than no treatment and that acupuncture can be a useful supplement to other forms of conventional therapy for low back pain.

Lets take a trip back in time.

There was procedure for the treatment of angina where they ligated the internal mammary artery. The theory was that by tying off the artery the back-pressure forced blood down the coronary arteries and relieved cardiac pain.

Angina improved and there are about 40 plus papers in the 50s and 60s on the benefit of the procedure as well as the underlying physiology of the procedure. Mammary artery ligation ‘worked’ and was popular in the early 60s. Until the procedure was compared to a sham operation. That’s right. They opened people up and did nothing.

The result?

The combined results of two RCTs comparing an earlier surgical procedure for angina — bilateral internal mammary artery ligation (BIMAL) — to a sham surgery clearly show that patients “experienced significant subjective improvement,” with both BIMAL (67% substantial improvement) and the sham procedure (82% substantial improvement). [see Moerman, Meaning, Medicine and the “Placebo Effect”, 2002]

So how would you interpret the study? If a procedure is equal sham, then I would say the procedure does not work. In the case of sham surgery, no underlying change occurred in the blood supply to the ischemic heart. This study is perhaps the classic clinical trial that demonstrates the difficulty in assessing the results of an intervention for pain. Patients had significant improvement in their angina. Much better than doing nothing (although these studies did not have a ‘usual care’ wing), 2/3 of angina patients do not get significant improvement on their own.

And guess what? Open heart surgery “has been shown to induce pituitary secretion of adrenocorticotropic hormone and cortisol, leading to systemic antiinflammatory effects.” Surgery releases endogenous opioids and I bet it actives both peripheral and central pain fibers.

Hmmmm. Looks like we have a justification for going back to treating angina with internal mammary artery ligation.

The authors of the review justify the recommendation on the two studies that demonstrate the equivalence of sham acupuncture and real acupuncture in treating low back pain, the same number of studies for mammary artery ligation.

Now being an article on back pain, they did not include the article that showed knee pain treated with sham acupuncture (in this case twirling tooth picks on the skin) is superior to real acupuncture. It matters not where the needles are placed or even if needles are used.

So far the authors provide no historical scientific plausibility, non-specific modern pathophysiology, a bit of gratuitous rabbit torture, and two clinical trials that demonstrate no efficacy of acupuncture over placebo. Their level of justification reaches that of mammary artery ligation. I start to wonder if the NEJM editors actually read the review before publishing it. The authors then move on to clinical use.

(Acupuncture) not been established to be superior to sham acupuncture for the relief of symptoms of low back pain [translation: it doesn’t work]. As a result, it is not often regarded as the first choice of therapy [translation: clinicians do not like to use ineffective therapy].

However, since extensive clinical trials [er, since when did two become extensive? Are the authors even reading the manuscript?] have suggested that acupuncture may be more effective than usual care, it is not unreasonable to consider acupuncture before [you mean as first line therapy? when it doesn’t work?] or together with conventional treatments, such as physical therapy, pain medication, and exercise [adding nothing to something does not increase the net effect].

That is some interesting sentence structure, worthy of Animal Farm: even though acupuncture doesn’t work, and isn’t first line therapy for pain, it should be used for first line therapy. Although the qualifiers ‘not been established,’ ’suggested’, ‘may be,’ and ‘not unreasonable’ muddy the water with their density.

Acupuncture is a regulated discipline, and patients should be referred only to practitioners who are licensed by the state in which they practice.

Why? It’s like Duck’s Breath Mystery Theatre’s Dr. Science. A license to practice ineffective nonsense still results in ineffective nonsense.

In the traditional practice of acupuncture, needle insertion itself may be accompanied by a variety of ancillary procedures, including palpation of the radial artery and other areas of the body, examination of the tongue, and recommendation of herbal medications. All of these steps are based on the application of principles of traditional Chinese medicine, as opposed to Western physiological and medical concepts. To what extent such procedures may contribute to the psychological milieu of acupuncture is unknown, and only a few studies have examined the context in which acupuncture treatment is delivered.

Note, it is not that radial artery palpation and tongue examination increase the diagnostic accuracy, it is to contribute to the psychological milieu. Like a psychic talking to your dead parent, it is important to make the environment conducive to fooling the patient into believing that an actual effect is occurring.

Take the pulse. In TCM they are not looking for tachycardia, but imaginary diseases based on imaginary diagnosis. An example:

Each pulse position can reflect different phenomena in different situations. For example, in a state of health, the left middle pulse (Liver) will be relatively soft and smooth, neither superficial nor deep. Therefore, we can say the liver and gall bladder energies are balanced or that the Yin and Yang within the Liver/Gall Bladder sphere are balanced. If a patient is experiencing migraine headaches and her pulse feels wiry (harder or tighter than normal) and more superficial and pounding, then we may diagnose this as Excessive Liver Fire (Yang) Rising (up the Gall Bladder channel to the head). The pulse reflects the rising energy.”

Or tongue examination, which is another example of prescientific nonsense where the body is represented on the tongue.

The editors of the NEJM seem to think this is reasonable, worthy of unqualified discussion. Of course, there is no reference to demonstrate that these additions increase diagnostic or therapeutic accuracy.

The practitioner may further stimulate the needle with electrical current (electroacupuncture), moxibustion (burning the herb artemisia vulgaris at the end of the acupuncture needle), or heat.

Why? No data given that this nonsense increases efficacy. I keep telling myself this is the NEJM, adding their imprimatur to the respectability of burning a plant on top a needle stuck in the skin to ease chronic pain. Then they note that patients need multiple treatments, a minimum of 12, with boosters, and they need to come in to prophylactically keep their spine aligned — no wait, the last is what chiropractors do. It seems, at 65 to 125 dollars a pop, that acupuncturists have recognized the financial wisdom of D.D. Palmer’s descendants. The NEJM is suggesting that people pay around 1200 bucks for what is, at best, a placebo.

The authors go on to the adverse effects. “8.6% reported at least one adverse event, and 2.2% reported one that required treatment.” Pretty impressive complication rate for an expensive, ineffective therapy! They do not mention that in the acupuncture/toothpick for knee pain study, toothpicks had the same effect as acupuncture and zero side effects, nor do they mention the well-reported cases of infection from sloppy aseptic technique.

I will ask you. If you have two procedures of equal efficacy and one has zero side effects, are you not ethically bound to suggest the procedure with no complications? If you are going to suggest acupuncture, ethically you have to offer sham acupuncture with twirled toothpicks, especially when what you offer is no better than a placebo effect.

Then, in the areas of uncertainty section of the review, they note that the effects of acupuncture are mostly explained by elaborate placebo effects. Benefit from acupuncture is

mostly attributable to contextual and psychosocial factors, such as patients’ beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient. These studies also seem to indicate that needles do not need to stimulate the traditionally identified acupuncture points or actually penetrate the skin to produce the anticipated effect.

It does nothing, and you do not need to do acupuncture to get the effect. Acupuncture has complications and ethically can one recommend and charge for an elaborate placebo? I do not think so. Not the authors.

The patient in the vignette has chronic back pain that has not responded to a number of medical treatments.

So instead, we will go with the unethical, expensive, useless placebo.

He has specifically requested a referral for acupuncture, and we would suggest a course of 10 to 12 treatments over a period of 8 weeks from a licensed acupuncturist or a physician trained in medical acupuncture.

Can you believe this? From the NEJM! Such total tripe. I rely on the NEJM to provide reviews of relevant medical topics as, outside of ID and quackery, I do not have the time to read the primary literature. If this is the best NEJM can do on a topic upon which I have some background, then I suppose I cannot trust them in the future. As I tell my kids, you can judge a person by the company they keep.

The NEJM has lost some of its credibility. I doubt they will ever get it back.

One of the strengths of modern medical education is its emphasis on basic science.  Conversely, the basic weakness of so-called alternative medicine is its profound ignorance of science and its reliance on magical thinking.  Nowhere is this more apparent than in the attempts of altmed cults to conduct and publish research.  From “quantum water memory” to “almost as good as placebo”, the altmed literature is filled with basic failures in the proper formulation and testing of hypotheses.

One of the finest examples of these failures was just published in the journal Homeopathy.  Leaving aside for the moment the absurdity of a journal devoted to magic, let’s see what they did here.

Leptospirosis, a systemic disease caused by bacteria of the genus Leptospira, is probably the most common zoonotic (spread by non-human animals) disease on the planet.  It can cause anything from a mild flu-like illness to liver failure and death.  It is spread in water contaminated by urine from infected animals.  An outbreak occurred during my internship year among triathletes swimming in a lake in Illinois, but occupational exposures are more common.  There are no widely-available vaccines for disease prevention.

Given the common and sometimes serious nature of the disease, especially in developing countries, there is a need for effective prevention of leptospirosis.  One proposed solution, published this month in Homeopathy, is “Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control.”

Methods

The authors conducted what they called an “epidemiologic cohort study”.  For the study, the designated a large area of eastern Cuba the “test” population (”intervention region (IR)”), and the rest of Cuba the “control” population.  These were assumed to be distinct geographic regions.

In the intervention region, local outbreaks were treated with vaccination and antibiotic prophylaxis which, according to the study, reached about 3% of the population, but they do not indicate whether this is 3% if the total population or a targeted, at-risk population.  The entire population of the intervention region was also targeted to receive a homeopathic  (i.e., inert*) preparation especially designed and “potentised” (i.e., shaken up) to prevent leptospirosis, as per homeopathic beliefs.

The authors state that the study complied with ethics requirements of the authoritarian regime who runs the country and presumably profits from the manufacture of the product being tested.

Data

The authors report that the control region had fewer natural disasters (and presumably were at lower risk for lepto) than the intervention region.  During one such emergency in the IR, the potion was widely used.  A drop in reports of the disease were noted afterward.

The statistical analysis section of the paper is quite long, but fails to address fundamental problems.  There was, in effect, no control group.  There was an opportunity to apply this alleged therapy on one group and placebo (chuckle) on another and compare rates of disease in each group.  This wasn’t done.  The entire population in question was treated, and rates of disease recorded.  The authors note that leptospirosis is occurs in cycles, and there is no reason to think that the drop in disease seen after the application of homeoprophylaxis is due to the intervention rather than to the natural course of the endemic.  Given that the intervention is supposed to be prophylactic rather than therapeutic, the authors’ conclusions are even more suspect.  Finally, the did end up comparing rates in the intervention region and the rest of the country, but these regions were defined as being geographically distinct, with different geography and differing rates of natural disaster.

This study has nothing to do with natural disasters.  Blame for the disaster here rests completely with the authors.  They conducted a study of questionable ethics and questionable methodology, and came up with questionable conclusions.  Most important, however, was the lack of a plausible hypothesis from the start.  There is no reason to think that ultra-diluted potions containing nary a molecule of “medicine” should affect anything.  Given this lack of plausibility, statistically significant findings should be examined with suspicion, and other explanations for any such findings should be sought aggressively.  The authors do not discuss possible alternative explanations, exacerbating the travesty that is their work.

References

Bracho, G., Varela, E., Fernández, R., Ordaz, B., Marzoa, N., Menéndez, J., García, L., Gilling, E., Leyva, R., & Rufín, R. (2010). Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control Homeopathy, 99 (3), 156-166 DOI: 10.1016/j.homp.2010.05.009
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*From the paper:

From the mother tinctures, 1/100 serial dilutions wereprepared using homeopathic pharmaco-technical methods(Korvsakovian dilutions). Between each dilution step, thesolution was succussed 100 times using an automatic dynamizerup to 200C (200 1:100 dilutions) and 10 MC(104 1:100 dilutions).

There is an interesting controversy raging in the Multiple Sclerosis (MS) world that reflects many of the issues we discuss at science-based medicine. Dr. Paolo Zamboni, and Italian vascular surgeon, has now published a series of studies claiming that patients with clinically defined MS have various patterns of chronic cerebrospinal venous insufficiency (CCSVI). Further Dr. Zamboni believes CCSVI is a major cause of MS, not just a clinical side-consequence, and is exploring treatment with venous angioplasty or stenting.

The claims have captured the attention of MS patients, many of whom have a progressive course that is only partially treated by currently available medications. There are centers popping up, many abroad (such as India), providing the “liberation procedure” and anecdotes of miraculous cures and spreading over the internet. There is even a Facebook page dedicated to CCSVI, and you can read the anecdotes for yourself. Many profess dramatic improvement immediately following the procedure, which seems unlikely even if Zamboni’s hypothesis is correct.

Zamboni is also getting attention from neurologists and MS specialists, who remain skeptical because Zamboni’s claims run contrary to years of research and thousands of studies pointing to the current model of MS as an autoimmune disease.

There are at least two stories to follow here. The first is the scientific story – the questions being proposed are answerable with scientific research, and they will be answered. MS remains a serious illness that is inadequately treated (not to downplay the important advances we have made, but we certainly are far from an adequate cure for MS). The potential of a new treatment deserves serious research attention, and CCSVI is getting it. It will probably take another ten years for the research to play itself out adequately for there to be a confident consensus on CCSVI, but eventually we will have a scientific answer.

The other story is the the reaction of the public and the MS community. This has been mixed, but already there are conspiracy theories that the neurology community, the MS society, and Big Pharma (of course) are fighting against CCSVI as part of a misguided turf war. (See the comments to my previous posts on this topic at NeuroLogica for some examples.) Anecdotes are being used to argue against published scientific evidence, and negative studies are being dismissed. If CCSVI is eventually found to be a scientific dead end, I have to wonder if it will survive as just another fringe “alternative” treatment, like Laetrile, psychomotor patterning, and other discarded ideas in medicine.

The Scientific Story

So far there is not much of a scientific story to tell. A PubMed search on CCSVI yields a total of 19 publications (a pittance), indicating how new this concept is. I suspect this number will grow into the hundreds at least before this story plays itself out. If CCSVI is proven to be legitimate then this number will grow into the thousands over the next few decades. If it is disproved, publications will trickle off.

Most of the current research is published by Zamboni’s team. He is building an impressive list of studies, exploring various aspects of CCSVI and MS, but evidence that derives entirely from a single research team is always suspect. The role of bias in research is well documented, and further most new ideas in medicine turn out ultimately to be wrong. Therefore skepticism is the proper approach to bold new claims being supported by a lone research team. Replication will be necessary for the broader scientific community to take CCSVI seriously.

The core claim made by Zamboni is that most patients with MS display 2 or more out of 5 criteria on studies of venous anatomy (using ultrasound or venography) of venous insufficiency. While control patients (healthy subjects or those with other neurological disorders) display 1 or no criteria, and never 2 or more. All other claims (benefit from angioplasty, matching patterns of venous insufficiency with types of MS) derive from this core claim.

I found four independent replications in the literature, three very recently published. The first is by Al-Omari MH, Rousan LA, who found:

“According to the described criteria, 92% of the MS patients showed abnormal findings and 84% of them showed evidence of CCSVI, however; only 24% of controls showed abnormal findings, but none of them showed evidence of CCSVI (OR=7.25, 95% CI 2.92-18.01, P<0.0001).”

These are similar numbers to Zamboni, although the 84% is a little less. This study used only ultrasound, which is a non-invasive technique and therefore good for screening, but the results are very operator dependent. There is no indication in the study that the patients were assessed in a blinded fashion.

The next study by Florian Doepp et al used the following methods:

We performed an extended extra- and transcranial color-coded sonography study including analysis of extracranial venous blood volume flow (BVF), cross-sectional areas, IJV flow analysis during valsalva manoever (VM) as well as ‘CCSVI’ criteria. 56 MS patients and 20 controls were studied.

They found no subjects met the Zamboni critieria for CCSVI – a completely negative replication.

The second was performed by Krogias at al, who found:

The authors conclude that the „chronic cerebrospinal venous insufficiency (CCSVI)“ cannot represent the exclusive pathogenetic factor in the pathogenesis of MS. In our cohort, only 20% of the patients fulfilled the required neurosonological features of CCSVI. So far, the pathogenetic relevance of these findings remains speculative. Thus, based on the current scientific position we cannot justify invasive „therapeutic“ approaches, especially if they are performed outside of clinical trials.

The third study is a Swedish study by SundstrÃm et al (“Venous and cerebrospinal fluid flow in multiple sclerosis – a case-control study.” Peter SundstrÃm, Anders WÃ¥hlin, Khalid Ambarki, Richard Birgander, Anders Eklund and Jan Malm. Annals of Neurology) – not yet available online. This study used MRI scanning to assess blood flow in the internal jugular vein in 21 MS patients and 20 controls, and found no difference.

Conclusion

One of four replications found results similar to Zamboni. A second found only 20% of MS patients met Zamboni’s criteria, while two others found that no patients with MS did. Four studies is not a lot – and is not even close to ending this controversy from a scientific point of view. But these early results are not promising and will tend to deepen skepticism within the neurological community.

Clearly there is a need for more research so that both patients and professionals can feel comfortable that CCSVI has been given a thorough investigation and we can say with confidence what role, if any, it plays in MS. The results, also, do not have to be black and white. While it seems unlikely that Zamboni has discovered the sole and ultimate cause of MS in most or all patients, it is possible he has found a significant consequence of MS. Chronic inflammation may result in venous insufficiency in some patients. This venous insufficiency may further play a role in worsening the clinical course in a subset of those patients, who may benefit from treatment. So CCSVI may ultimately play a minor but important role in the management of MS.

Or it may all turn out to be a figment of Zamboni’s imagination, spawned by the sincere hope of finding a cure for MS. Time and research will tell.

My open plea to the MS community, especially those who are going down the rabbit hole of conspiracy theories, is to keep this discussion about the scientific evidence. This is not the place for cheap conspiracy theories. I fear my plea will fall on deaf ears, but it never hurts to ask.

Alchemy is alive and well! Yes, that medieval precursor of chemistry, that chimerical search for the philosopher’s stone and the transmutation of lead to gold. Modern alchemists have found the philosopher’s stone and are selling it and teaching people how to make it themselves out of dew and Celtic sea salt.

The philosopher’s stone apparently is an elixir of life that you have to take on a regular basis. According to Nicholas Collette, it “completely eliminates the pharmaceutical industries by curing EVERY disease, and opens the mind to it’s [sic] full potential.”   It extends the life span, reverses the aging process, and opens the door to psychic power.

Instructions for making it are detailed on this website. It takes time and is complicated, but the starting ingredient is simple: morning dew. 

It allegedly turns lead into gold: one milligram of the Stone can turn 20 pounds of lead to gold. But you are warned to be careful: 

 …the alchemists warned that you must be careful not to transmute too much gold at once, or it will become radioactive and the radiation will harm you and eventually kill you. And selling gold is considered a trite waste of the Stone in alchemy. You will feel like a **** if you make all your money selling a product of alchemy and disgracing and defiling the Holy Art.

 There are apparently 3 colors of stone. The White elixir can cure all mental disorders and diseases or psychosis, and depression. It also causes receptive psychic ability to develop in the user, like mind reading and spirit contact. The green stone is like the white stone but takes more time to produce.

The Red Stone is used primarily for its regenerative abilities: it is not taught. It is an end product or manifestation that gives you godly powers and allows you to live for hundreds of years.

 And then there is the Ormus monoatomic alchemical elixir:

It has been discovered in this regard that what is being called carbon is actually not always carbon; sometimes it is something else. What is being called calcium is actually not always calcium; sometimes it is something else. What is being called silicon is actually not always silicon; sometimes it is something else. What is being called iron sometimes is actually not always iron; sometimes it is something else. And that something else is actually ORMUS. ORMUS (sometimes also referred to as ORME, monoatomic elements, and/orm-state materials) is a class of physically distinct atomic mineral substances that are unique forms of matter that appear to be closer to the state of aether or vacuum or pure energy than normal matter such as the common mineral and atomic compounds found on Mendeleyev’s  Periodic Table of the Elements.

The secrets of alchemy are no longer secret. All civilizations had understandings and mysteries of people who took the stone and were potential gods, with powers of healing and creation. These modern alchemists have reclaimed the lost knowledge.

Science can’t explain it. For instance, if you measure the powder, heat it to 1000 degrees and cool it, it weighs 25% less. Science says this is impossible, but it happens. Hundreds of investigations have proven that it doesn’t behave like normal matter.

You can buy it, but it’s better to make your own so it carries your own vibes. And making your own is cheaper. You will need to take 1 ½ gm a day. The price has been reduced from 105 to 75 euros for 3 grams. By my rough calculation, this would add up to an expense of nearly $24,000 a year.

A medical doctor turned alchemist explains that it isn’t as simple as “this cures cancer.” Patients become shinier, and their aura glows. There is a stronger presence of life energy. Illness is expressed in darkness and the stone produces light.  

Testimonials abound. One user said

With regards to noticeable effects, I can say that I was aware of more energy circulating, specifically vibrating in my palms and laogong. I practice high level internal alchemy (for immortality) and I could ‘see’ that the combination of my practices with the consumption of the Stone you produce would potentially yield exponential results.

Collette has written books explaining how to make the stone and raving about Rosicrucians, the Holy Grail, the Tarot, 3-mile-wide UFOs, a civilization of alien beings living right here on our planet that only show up in the ultraviolet range, astral projection, astrology, and other things that don’t seem to cohere with each other into any rational framework. I tried to make sense out of what he is actually claiming, but couldn’t. I don’t think it’s me; I think there’s no sense there to be found.

I don’t think the pharmaceutical industries are in any danger of being eliminated. I can’t imagine that many sick people will fall for this nonsense and try to “cure every disease” with it, but then I couldn’t imagine that anyone would still be practicing alchemy in the 21^st century. The human capacity for self-deception is truly inexhaustible.

This may be too silly to dignify with a post on a science-based website, but it shows the depth of human gullibility that science must strive to overcome.

The longer I’m in this whole science-based medicine thing, not to mention the whole skepticism thing, the more I realize that no form of science is immune to woo. To move away from medicine just for a moment, even though I lament just how many people do not accept evolution, for example, I can somewhat understand it. Although the basics of the science and evidence support the theory of evolution as the central organizing principle of all biology, much of the evidence is not readily apparent to those who don’t make it a calling to study biology, evolution, and speciation. It’s not like, for example, gravity, which everyone experiences and of which everyone has a “gut level” understanding. So, not unexpectedly, when the theory of evolution conflicts with a person’s religious beliefs, for most people it’s very easy to discount the massive quantities of evidence that undergird the theory of evolution. It’s not so easy to discount the evidence for gravity.

In many ways, medicine is similar to evolution, but the situation is possibly even worse. The reason is that much of the evidence in medicine is conflicting and not readily apparent to the average person. There’s more than that, though, in that there are a number of confounding factors that make it very easy to come to the wrong conclusion in medicine, particularly when looking at single cases. Placebo effects and regression to the mean, for example, can make it appear to individual patients that, for example, water (i.e., what the quackery that is homeopathy is) or placebo interventions (i.e., acupuncture) cures or improves various medical conditions. Add to that confirmation bias, the normal human cognitive quirk whereby all of us — and I do mean all of us — tend to remember information that reinforces our preexisting beliefs and to forget information that would tend to refute those beliefs — and, at the level of a single person or even practitioner, it’s very, very easy to be misled in medicine into thinking that quackery works. On the other hand, at the single patient/practitioner level, one can also see evidence of the efficacy of modern medicine; for example, when a person catches pneumonia, is treated with antibiotics, and recovers quickly. Regardless of whether they’re being used to demonstrate quackery or scientific medicine, because personal experience and the evidence that people observe at the level of the people they know can be very deceptive in medicine, science-based medicine, with its basic science underpinnings and clinical trial evidence, is necessary to try to tease out what actually works and what doesn’t.

Medicine does, however, have its version of a theory of evolution, at least in terms of how well-supported and integrated into the very fabric of medicine it is. That theory is the germ theory of disease, which, just as evolution is the organizing principle of biology, functions as the organizing principle of infectious disease in medicine. When I first became interested in skepticism and medical pseudoscience and quackery, I couldn’t envision how anyone could deny the germ theory of disease. It just didn’t compute to me, given how copious the evidence in favor of this particular theory is. It turns out that I was wrong about that, too.

On Friday there was a video released that provides a very clear, succinct explanation of germ theory denialism:

Germ theory denialism: History

The only thing I would disagree with is the conclusion at the end that germ theory denialists are not much of a threat. (I’d also quibble with the inclusion of doctors of osteopathy with chiropractors and naturopaths. These days, most DOs are indistinguishable from MDs in how they practice.) In fact, germ theory denialism is a major strain of “thought” driving many forms of pseudoscience, such as chiropractic and naturopathy, as is shown in the video itself.

Given the content of the video, however, I thought it might be worth considering the question: How on earth could people seriously deny the germ theory of disease, given how much success the application of this theory has demonstrated in decreasing mortality? Think about it! Antibiotics, modern hygiene and public health measures, and vaccines have been responsible for preventing more deaths and arguably for saving more lives than virtually any other intervention, preventative or treatment, that science-based medicine has ever devised.

The first thing we should clarify is just what we mean by the “germ theory of disease.” In most texts and sources that I’ve read, the germ theory of disease is stated something like, “Many diseases are caused by microorganisms.” We could argue whether viruses count as microorganisms, but for purposes of the germ theory they do. (Most biologists do not consider viruses to be true living organisms, because they consist of nothing other than genetic material wrapped in a protein coat and lack the ability to reproduce without infecting the cell of an organism.)

The funny thing about germ theory denialism is that, long before Pasteur, there were concepts about disease that resembled the germ theory. For example, it was written in the Atharvaveda, a sacred text of Hinduism, that there are living causative agents of disease, called the yatudh?nya, the kim?di, the k?imi and the dur?ama (see XIX.34.9). One of the earliest Western references to this latter theory appears in a treatise called On Agriculture by Marcus Terentius Varro in 36 BC. In it, there is a warning about locating a homestead too close to swamps:

…and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases.

That certain infectious diseases are contagious and somehow spread from person to person or from other sources is so obvious that various explanations of how this could happen held sway over many centuries. One common idea was the miasma theory of disease, which stated that diseases such as cholera, chlamydia or the Black Death were caused by a miasma, which translates into “pollution” or “bad air.” Certainly some diseases can be spread through the air. However, it’s long been recognized that other diseases could be spread through the water and in other ways. In any case, various ideas about how disease develops battled it out in various places over various times throughout the era of prescientific medicine. Many of these ideas involved, as we have seen, various concepts of mystical “life energy” such as qi, whose ebbs and flows could be manipulated for therapeutic effect (as in acupuncture, for example). Other ideas involved various concepts of “contamination,” in which miasmas or various other “poisons” somehow got into the body from the environment. Given the knowledge and religion of the time, these ideas were not unreasonable because science did not yet exist in a form that could falsify them as hypotheses, nor did the technology yet exist to identify the causative agents of disease. Given that background, attributing infectious disease to “bad air” doesn’t seem so unreasonable.

The beauty of Pasteur’s work is that it provided an explanation for many diseases that encompassed the concepts of miasma and various other ideas that preceded it. It should not be forgotten, however, that Pasteur was not the first to propose germ theory. Scientists such as Girolamo Fracastoro (who came up with the idea that fomites could harbor the seeds of contagion), Agostino Bassi (who discovered that the muscardine disease of silkworms was caused by a tiny parasitic organism, a fungus that was named Beauveria bassiana), Friedrich Henle (who developed the concepts of contagium vivum and contagium animatum), and others had proposed ideas similar to the germ theory of disease earlier. Pasteur was, however, more than anyone else, the scientist who provided the evidence to show that the germ theory of disease was valid and useful and to popularize the theory throughout Europe. Moreover, it should be noted, as it is in the video, that there were competing ideas; for example, those of Antoine Béchamp, who did indeed postulate nearly the exact opposite of what Pasteur did: that microorganisms were not the cause of disease but rather the consequence of disease, that injured or diseased tissues produced them and that it was the health of the organism that mattered, not the microorganisms.

Basically, Béchamp’s idea, known as the pleomorphic theory of disease, stated that bacteria change form (i.e., demonstrate pleomorphism) in response to disease. In other words, they arise from tissues during disease states. Béchamp further postulated that bacteria arose from structures that he called microzymas, which to him referred to a class of enzymes. Béchamp postulated that microzymas are normally present in tissues and that their effects depended upon the cellular terrain. Ultimately, Pasteur’s theory won out over that of Béchamp, based on evidence, but Béchamp was influential at the time, and, given the science and technology of the time, his hypothesis was not entirely unreasonable. It was, however, superseded by Pasteur’s germ theory of disease and Koch’s later work that resulted in Koch’s postulates. Besides not fitting with the scientific evidence, Béchamp’s idea had nowhere near the explanatory and predictive power that Pasteur’s theory did. On the other hand, there is a grain of truth in Béchamp’s ideas. Specifically, it is true that the condition of the “terrain” (the body) does matter when it comes to infectious disease. Debilitated people do not resist the invasion of microorganisms as well as strong, healthy people. Of course, another thing to remember is that the “terrain” can facilitate the harmful effect of microorganisms in unexpected ways. For example, certain strains of the flu (as in 1918 and H1N1) are more virulent in the young because the young mount a more vigorous immune response.

Béchamp is unusual, though, in that he is frequently invoked by peddlers of quackery as having been “right” while Pasteur and Koch were “wrong.” Just Google “Béchamp” AND “alternative medicine,” “Béchamp germ theory,” or “Béchamp vaccination,” and you’ll see what I mean. Right on the first page are multiple links to that one-stop shopping site for all things quackery Whale.to, as well as links to that king of “acid-base” woo, the man who thinks all diseases are due to “excess acid,” Robert O. Young. One example of how Béchamp has come to be used to justify quackery appears on this discussion of vaccination at the Arizona Center for Advanced Medicine:

He [Pasteur] is remembered for promoting vaccinations.

Béchamp had a different idea. He believed in the pleomorphic theory, that bacteria change form and are the result of disease. He said bacteria change into organisms that are increasingly detrimental to the body. The waste products of their metabolism are harmful to local body fluids, causing pain and inflammation. It is not the germs, viruses, and bacteria that make you sick, it is the waste products of the metabolism of those organisms that make you sick.

Here’s the kicker:

Germs seek their natural habitat – diseased tissue. During the Civil War, maggots were brought into hospitals to feed on the diseased tissue of the wounded because the bugs were better at cleaning it up than potions or anticeptics. Think of mosquitoes. They seek stagnant water, but do not cause the pool to become stagnant. So when the terrain is weakened and sickly, all manner of bugs want to set up house. But they come after the disease has begun; they come because the terrain is inviting.

Not surprisingly, included in this article is the myth that Pasteur “recanted” on his deathbed and said that Béchamp is correct. The article also uses poor Béchamp to justify all manner of quackery, including live blood analysis, anti-vaccine beliefs, and claims that, because of Pasteur, the pharmaceutical companies have come to rule health, all standard tropes of the alt-med movement.

Germ theory denialism now: A “softer” form of Béchamp

In 2010, as hard as it is to believe, germ theory denialism still exists. In fact, contrary to the video above, I would argue that such denialism is actually a significant threat, as it is frequently used as a justification for anti-vaccine views, as demonstrated by the article above from Arizona Advanced Medicine. Moreover, it goes beyond anti-vaccine beliefs, to the point where I’m half tempted to label it as the alt-med/pseudoscience equivalent of the theory of evolution in its importance to woo. What I mean is that, just as the evolution is the central organizing principle of biology, germ theory denialism borders on being the central organizing idea behind the alt-med approach to disease.

Right now, the predominant form of germ theory denialism appears to be a “softer” form of denialism, just as the predominant form of evolution denialism is not young earth creationism, but rather “intelligent design” (ID) creationism. True, there are still young earth creationists around, who state that the world is only 6,000 years old and that the creatures that exist now were put there by God in their current state, but most denialists of evolutionary theory now accept that the earth is several billion years old and that organisms do evolve. They simply deny that natural selection and other mechanisms encompassed in current evolutionary theory are sufficient to account for the complexity of life and instead postulate that there must be a “designer” guiding evolution. Similarly, there are still some die-hard germ theory denialists out there who cite Béchamp in much the same way young earth creationists cite the Bible and deny that germs have anything to do with disease whatsoever, claiming instead that microbes appear “because of the terrain” and are an indicator, rather than a cause, of disease (or, as they frequently call it, “dis-ease”). However, most cases of germ theory denialism are of a piece with ID creationism. Like ID promoters who admit that evolution “does” happen, this variety of germ theory denialist accepts that microbes “can” cause disease, but they argue that microbes can only cause disease if the host is already diseased or debilitated. Using such claims, they argue that the “terrain” is by far the most important determinant of whether or not I get sick. As a result, they claim that eating the right diet, doing the right exercises, and taking the right supplements will protect you against disease as well as any vaccine — better, in fact, because supposedly you’re not injecting all those “toxins” from vaccines into your body.

We see this all the time among proponents of “alt-med.” For example, as I’ve written before many times, comedian Bill Maher expresses just such views. My favorite example was when he was having a discussion with Bob Costas about the flu and the flu vaccine and stated that, because he lives right and eats a healthy diet he “never gets the flu” and wouldn’t get the flu on an airplane even if several people with the flu were on that plane, to which Bob Costas made a hilariously spot-on reply, “Oh, come on, Superman!” That’s not too far from the truth, because the modern form of germ theory denialism does seem to claim that diet, exercise, and living the “right way” will make us all super men and super women, able to resist the nastiest of infectious disease.

Germ theory denialism: An example from naturopathy

After I saw C0nc0rdance’s video on germ theory denialism, I couldn’t resist looking at some of the videos that popped up on the sidebar of the YouTube link to see what was there. Prominent among the related videos that Google served up was a video by Dr. Shawn Sieracki of the Whole Body Healing Center of Lewisville. One might expect a whole lot of dubious therapies from Dr. Shawn based on what’s on his practice’s website, which touts woo such as the “detox challenge,” which boasts “Detoxify or die!” and offers services such as the infamous woo known as the “detox foot bath”:

Dr. Shawn has produced a video that demonstrates the germ theory denialism at the heart of much of what is espoused by naturopathy. His video is entitled Naturopathic Minute: Germ Theory, and he begins by baldly stating that “germ theory is not correct”:

Dr. Shawn bases much of his argument on a straw man version of germ theory. First, he claims that germ theory is what “traditional medicine” bases “all of its studies and research” on and that the “medical model” is based on germ theory. These statements are sort of true in that science-based medicine does primarily base its studies and therapies of infectious disease on germ theory (germ theory does, after all, work), but Dr. Shawn seems to be implying that all disease is caused by “germs” according to scientific medicine. He then goes on to misstate germ theory by stating first that it says that disease is caused by bacteria, viruses, and parasites (true) but that scientific medicine also says that infectious disease is caused by “toxins” (false; that’s not what scientific medicine says–unless Dr. Shawn means something like the cholera toxin, and somehow I doubt that he does). He then boldly proclaims that germ theory is “not correct” because:

It’s not the germs that cause the disease. It’s the condition of the environment that causes the disease…I’m going to give you a layman’s terms example so that you can understand. Cockroaches are the germs. Now why do you have cockroaches in your kitchen sink and all over the kitchen counter? Is the cockroaches the problem, or is it the dirty dishes, the stinky syrup on the kitchen counter, the food crumbs all over the place? That, more than likely, is why the cockroaches are there. So, doctors treat the cockroaches as the problem. They spray the insecticides; they spray the pesticides, but they keep the dirty dishes in the kitchen sink. OK, does that make sense? A natural health practitioner is going to help you clean up that dirty kitchen sink…If you clean up the dirty kitchen sink, the cockroaches go away. They can’t feed on that environment.

Personally, having worked in a restaurant that had a cockroach infestation cockroaches before, I’d like to see Dr. Shawn get rid of cockroaches in a house by doing nothing more than cleaning up the kitchen. Once you have cockroaches, they won’t go away with such a minimal intervention. Just ask anyone who’s had them in his home. Restaurant management was already strict about proper food practice and keeping things clean. It became even more so after cockroaches were discovered. After all, cockroaches were bad for business. If a customer saw one, it’d be disastrous, and if the health inspector saw them on the next visit, it would be even more disastrous in that there would be fines and the restaurant might even be shut down. In addition to excellent food hygiene practices, it also took visits from the exterminator to get rid of the cockroaches, and we were under no illusion that the cockroaches wouldn’t be back promptly if our guard lapsed.

Dr. Shawn goes even further:

Another analogy would be a stagnant swamp, a stagnant swamp versus a river. A river is full of life. A river is healthy. It’s flowing just like the blood should be flowing in your body. Okay? You’ve got eagles floating, you’ve got cold water fish floating in a river. Now in a stagnant swamp, you’ve got mosquitos, gnats, flies. You’ve got deadly snakes swimming in that moldy, filthy water. It’s the condition of the pond that attracts that, okay, it’s the condition of the pond that attracts the mosquitos, that attracts the gnats, etc.

Of course, again, there is more than a grain of truth in the idea that the “terrain” matters. If you’re unhealthy or debilitated, your resistance to bacteria is decreased. For example, it’s well known that diabetics have difficulty fighting off infections; a whole specialty (vascular surgery) deals with the complications of that problem in the feet. This is not anything new, nor is studying the effect of nutrition and overall health on resistance to infectious disease. Scientists and physicians have been studying these questions for decades. Where naturopaths go off the deep end is in claiming that good health is enough to ward off infectious disease. You can be a perfectly healthy 20 year old and die of the flu. It happened to millions in the 1918 pandemic, which in the U.S. got its start in Army barracks, where very healthy 18-22 year old males congregated. You can be perfectly healthy, but if you are exposed to a pathogenic virus or bacteria, you can still come down with a disease that will kill you. It is also not correct to argue, as Dr. Shawn argues, that ill health “attracts” these bacteria. They’re out there. They live on your body; they’re in the environment; just by living you’re exposed to them.

It’s also not true that the flu shot “gives you the flu,” as Dr. Shawn claims in one of his more ignorant statements.

Dr. Shawn also parrots another germ theory denialist argument, frequently found on numerous websites. Specifically, he gives the example of ten people on an elevator with a person with the flu (sometimes it’s a pathogenic bacteria when repeated elsewhere), who’s coughing all over the place. He points out that, although everyone in the elevator was exposed to the flu virus, not everyone gets the flu, as if that were evidence that the germ theory is incorrect! Germ theory denialists seem to think that anything less than a 100% infection rate in people exposed to a pathogenic organism means that that organism doesn’t cause the disease. This is a particularly prominent trait among HIV/AIDS denialists because HIV only causes disease in only a relatively small percentage of people exposed to it once. It’s an example of all-or-nothing thinking that’s so prevalent in promoters of pseudoscience. For example, it’s very much akin to when anti-vaccine zealots in essence argue that if a vaccine doesn’t prevent disease 100% of the time it’s useless, as they so frequently do with, for example, the flu vaccine or the measles vaccine, the latter of which is approximately 90% effective. Sometimes, it leads to arguments like this, where it is argued that pathogenic bacteria are not only not the cause of disease, but they are there to rid the body of disease:

Germs take part in all disease phenomena because these are processes requiring the breaking down or disintegration of accumulated refuse and toxic matter within the body, which the system is endeavouring to throw off. But to assume, as our medical scientists do, that merely because germs are present and active in all disease phenomena, they are therefore the cause of the same diseases, is just as wrong as it would be to assume that because germs are present and active in the decomposition processes connected with all dead organic matter, they are the cause of the death of the organic matter in question. The analogy is absolutely just and fair! And equally ridiculous!

But no one would say that because the decaying body of a dead dog is full of bacteria, the bacteria are the cause of the dog’s death. We know they are there as a part of the natural disintegration process taking place as a result of the death of the dog. And so it is with germs and disease. Germs are a part of the results of disease, not its cause.

Germs are present in disease not as causes, but as superficial helpers brought there by Nature to rid the body of disease. They are the “scavengers” employed by Mother Nature to break up and “bring to a head” the accumulated internal filth of years of unhygienic and unwholesome living, which are clogging the tissues of the body and preventing proper functioning.

While it’s true that there are many bacteria that live as commensal organisms in the colon of each and every human, not to mention the trillions upon trillions of bacteria that live on the skin, the statement is denialist in that it refuses to acknowledge that there are both helpful and very harmful bacteria. To the author, bacteria not only don’t cause disease, but they are what’s trying to eliminate disease. While it is true that there are cases in which the native bacterial flora living on our body “crowd out” pathogenic bacteria and the elimination of that bacterial flora with antibiotics can leave a person susceptible to pathogenic bacteria that are there all along (C. difficile colitis comes to mind), to make such a blanket statement is the sheerest folly.

Still, it doesn’t take very much searching through the “alt-med” parts of the Internet to find all sorts of mind-bogglingly ignorant attacks against Pasteur, for example:

• Louis Pasteur’s germ Theory- Wrong (not surprisingly, this one is on a Homeopathy World Community)
• The Post-Antibiotic Age: Germ Theory by Tim O’Shea
• Why Louis Pasteur’s Germ Theory Is A Curse by Nancy Appleton
• A Faulty Medical Model: The Germ Theory by Judie C. Snelson
• Why the Anthrax Bacteria is No More Dangerous to You Than Any Other Germ by Judie C. Snelson
• Chapter One: That Fallacious Germ Theory, in: Handbook of Nature Cure Volume One: Nature Cure vs. Medical Science, by John L. Fielder.

One can’t help but notice that in the last example, a chapter attacking germ theory is the very first chapter in a book on “natural cures.”

Why is germ theory denialism so attractive?

There is little doubt that germ theory denialism is a strain of “thought” (again, if you can call it that) that undergirds a lot of quackery. The question is: Why? After all, despite its flaws and despite the manner in which microorganisms have become resistant to antibiotics, thanks to our overuse, the germ theory of disease arguably marked the beginning of the scientific revolution in medicine and the birth of science-based medicine. After Pasteur’s popularization of the germ theory of disease, medicine entered a period of remarkable advances that continue to this day. Before Pasteur, there was no unifying theory for infectious disease. After Pasteur, there was, and the success of Pasteur’s theory revolutionized not just medicine but food preparation, particularly the process of Pasteurization of milk and other products, which greatly decreased the chance of illness borne by dairy products and other products that could be treated. Proper surgical antisepsis led to declines in surgical mortality.

I suspect that a large part of the reason that germ theory denialism persists in a range of forms from hardcore belief that Béchamp was right and Pasteur wrong to softer forms that claim that better nutrition and health would be as effective, or more so, than vaccines or antibiotics in preventing and treating disease derives from the very worship of the “natural” that so much of “alt-med” is built upon. If nature is so benevolent, then how could it be that there are microorganisms that will harm or even kill us if they gain a foothold in our bodies? Also, there is a great deal of “Secret“-like mystical thinking in alt-med, making it unsurprising that, if Béchamp were right, that would imply that disease or lack of disease is within us. That further implies that the means of ridding ourselves of disease is also within us through diet, exercise, and whatever activities that promote health we can undertake. This is far more reassuring than the idea that there are microorganisms out there that care nothing for our hopes or activities and are just waiting for an opportunity to attack. It’s far more reassuring to believe that we can have complete control over our health than it is to think that a random twist of fate could inoculate us with microbes that care nothing for any of that.

Regardless of the motivations behind germ theory denialism, I can’t help but find it odd that a mere three days from now the director of the National Center for Complementary and Alternative Medicine (NCCAM), Dr. Josephine Briggs, will be speaking to the 25th Anniversary Convention of the American Association of Naturopathic Physicians (AANP). I wonder if Dr. Briggs knows the depths of germ theory denialism and anti-science that form the basis of so much “alternative medicine” in general and of naturopathy in particular. Perhaps Dr. Shawn will even be in the audience when she speaks. I wonder if he’ll approve of Dr. Briggs’ talk.