Detox

I've been tempted to order those ridiculous detoxifying foot pads, just to see if they really do pull anything black and scary looking out of my skin the way they do on the commercials. But my general opinion mirrors Orac's:

"Detoxification."

Whenever I hear that term, I'm at least 90% certain that I'm dealing with seriously unscientific woo. The reason should be obvious to longtime readers of this blog or to anyone who has followed "alternative medicine" for a while, because "detoxification" is a mainstay of "alternative" treatments and quackery for such a wide variety of diseases and conditions. Of course, toxins are indeed a bad thing, and we close-minded reductionist "allopathic" physicians do indeed use detoxification when appropriate. What differentiates us from "alternative" medicine practitioners is that we have this extremely annoying tendency (annoying to alties, that is) to want to know exactly what toxins we are dealing with, to verify that they are present in concentrations that can cause problems or damage before instituting any sort of treatment for them, and then to tailor our therapies to remove the specific toxins causing symptoms and to verify that we are successful. Not so for the "detoxification" as practiced by so-called "complementary and alternative medicine" (CAM) practitioners. CAM "detoxification" most often does not specify which "toxins" are being "detoxified," or when it does it is intentionally vague about them. Occasionally, they will get specific (mercury as a cause for autism), but the problem with specifying a "toxin" as a cause for a disease is that doing so allows for falsification; it also allows scientists who know something about the disease to assess the specific toxin as a cause for a disease for biological plausibility. Not surprisingly, rarely is the mechanism biologically plausible.

Comments

I believe there's metal powder in the pads and it reacts with your sweat, and that's why the pads turn dark.

It's as scamtastic as ear candling or iridology.

Posted by albo | May 12, 2008 12:15 PM

My favorite detoxifying scam is the ionic foot baths that pull the "toxins" from your feet.

Posted by Klug | May 12, 2008 12:39 PM

I believe there's metal powder in the pads and it reacts with your sweat, and that's why the pads turn dark.

According to this:

http://hubpages.com/hub/foot_detox_pads

...it occurs via the rehydration of a vinegar powder. In other words, you could get the same effect by simply misting the pad.

Posted by aMouseforallSeason | May 12, 2008 1:04 PM

what, you're letting a little scientific method get in the way of commerce?

Posted by SwissArmyD | May 12, 2008 1:11 PM

I was tempted to buy a pair just to reward them for coming up with such a howler. I'll bet their sales would increase if they did the commercial with a more sarcastic slant.

Posted by j | May 12, 2008 1:27 PM

They're a scam, according to this 20/20 report:

http://abcnews.go.com/Health/Stossel/Story?id=4636224&page=1

Posted by William Spode | May 12, 2008 1:28 PM

Megan, what on earth do you mean by 'alties'? I suspect that the term is so generalised as to be essentially meaningless. You can't (or shouldn't) climb on your rationalistic high-horse while banding around such meaningless categories without sounding a tad foolish.

Perhaps I am getting a bit pedantic. For sure the largely unregulated complementary medicine market does throw up an alarming quantity of quacks, but how do we know whether you are talking about these or every practitioner of medicine other than the 'allopathic' variety.

Posted by Chris Dornan | May 12, 2008 1:47 PM

Obviously, they're removing thetans from the body.

Posted by Independent George | May 12, 2008 2:07 PM

Chris, "alties" was used by Orac, not Megan.

Posted by Derek Scruggs | May 12, 2008 2:20 PM

Chris, "alties" was used by Orac, not Megan

Forget it, he's rolling

Posted by albo | May 12, 2008 2:38 PM

Chris wrote: "how do we know whether you are talking about these or every practitioner of medicine other than the 'allopathic' variety."

This one is easy, no distinction is needed. _Every_ practitioner of medicine other than the allopathic variety is a quack.

Posted by tsiroth | May 12, 2008 3:03 PM

tsiroth - _Every_ practitioner of medicine other than the allopathic variety is a quack.

I dunno. I've seen plenty of quackery in mainstream medicine and some alternative treatments that worked quite well.

For example; look at how many mainstream doctors give out immunosuppresant drugs for auto-immune disorders which are probably caused by hidden pathogens. It temporarily relieves symptoms, sure, but does harm in the long term.

The drugs given to treat gout have many more side effects than simply eating a cup of cherries each day, though the latter is just as effective.

Or consider the tremendous resistance to the possibility that ulcers might be caused by bacteria, and the consequent longterm treatment with antacids that would often worsen the condition and the useless and possibly harmful admonition to 'stay away from spicy foods.' (Capsicum can help deaden pain receptors as well as exibiting antibacterial and anti-viral properties.)

There's a much longer list, of course. And there are a number of traditional Chinese or naturopathic treatments which work quite well.

Now granted, Chinese medicine tends to give what seems like bogus explanations for why the stuff works. But 2000 years of experiments on human beings is apparently worth something, with or without a solid, reductionist theory behind it.

Traditional medical researchers are usually quite knowledgeable about medicine, and pubmed is a wonderful resource. General practitioners tend to be a bit behind the times. And what's worse, they tend to write off those diseases they don't understand as just a figment of people's imaginations or something that they didn't have to worry about. For instance; fibromyalgia, which now seems to be an end stage of PTSD but was written off for decades as psychosomatic.

Posted by Ryan W. | May 12, 2008 3:22 PM

p.s. Yes, I know doctors treat ulcers with anti-biotics now. My issue was with how long it took for that to be accepted by the medical community.

Also, look at how resistant the FDA has been to supporting bacteriophage therapy, even though a significant portion of hospital mortality and morbidity is due to antibiotic resistant infections.

It was only in 2006 or so that one mix was recognized as GRAS.

Sometimes it helps to listen to non-mainstream theories, so long as you have the time and background to parse what they say.

Posted by Ryan W. | May 12, 2008 3:32 PM

My favorite detoxifying scam is the ionic foot baths that pull the "toxins" from your feet.

Colon cleansing is more amusing.

Posted by Peter | May 12, 2008 4:32 PM

I don't understand: In the commercials, they show the pads being really dark when you first start to use them, but later they come out clean. This is how you know your body is getting detoxed.

If there was some reaction with water, wouldn't they just keep getting dark forever? Is their plan that you keep using them, or do they later send you ones with progressivly less and less of the darkening agent?

Posted by David | May 12, 2008 4:54 PM

Argh, I hate the commercials for those pads. The part that really irritates me is when they claim that they work just like trees which "pull toxins out of the air and into the ground."

Which is why, of course, you stay away from the soil around trees which are all toxic waste dumps filled with asbestos, PCBs, and mercury.

/rolls eyes

Posted by Andrew Lias | May 12, 2008 5:30 PM

My clue that they were a scam was the results that suggesting asbestos presence in blood being removed by the pads.

Posted by anomdebus | May 12, 2008 5:32 PM

Which is why, of course, you stay away from the soil around trees

Nonsense. The taproot injects the toxins into the Earth's core, where they are destroyed by extreme heat and pressure.

My clue that they were a scam...

...was that they claim to pull toxins through the thickest, least permeable, and most calloused skin on your body.

Posted by Rob Lyman | May 12, 2008 5:43 PM

Rob,
He-he.. Agreed, but it is the difference between unlikely and impossible.

Posted by anomdebus | May 12, 2008 5:48 PM

But 2000 years of experiments on human beings is apparently worth something, with or without a solid, reductionist theory behind it.

No, it's not. See "geocentrism" and "liberal use of logical fallacies".

Posted by Cain | May 12, 2008 6:01 PM

No, it's not. See "geocentrism" and "liberal use of logical fallacies".

You're basically proving my point with geocentrism.

Geocentrism, while not the simplest view of data, is still a highly predictive theory.

Technically speaking, geocentrism isn't even wrong. It has never been disproved. Since there are no priveledged frames of reference, it is not more to say "The sun is the center of the universe." In fact, you could do any calculation you could do with a heliocentric universe using a geocentric model. You'd just need a more powerful computer. The church was right that heliocentrism was done for convenience and geocentrism hadn't been disproven. Galileo was wrong in stating an absolute(though they shouldn't have put him under house arrest.)

Even if this were not true, it would still prove my point. The underlying theory doesn't have to be perfect in order to get good, useful, predictive results.

Besids, since it takes well over five years to go from drug design to market, in the meantime I'll use drug research and herbal meds to treat myself using the latest discoveries about how people work, thanks.

Posted by Ryan W. | May 12, 2008 6:56 PM

No, it's not. See "geocentrism" and "liberal use of logical fallacies".

You're basically proving my point with geocentrism.

Geocentrism, while not the simplest view of data, is still a highly predictive theory.

Technically speaking, geocentrism isn't even wrong. It has never been disproved. Since there are no privileged frames of reference, it is not more to say "The sun is the center of the universe." In fact, you could do any calculation you could do with a heliocentric universe using a geocentric model. You'd just need a more powerful computer. The church was right that heliocentrism was done for convenience and geocentrism hadn't been disproven. Galileo was wrong in stating an absolute(though they shouldn't have put him under house arrest.)

Even if this were not true, it would still prove my point. The underlying theory doesn't have to be perfect in order to get good, useful, predictive results.

Besids, since it takes well over five years to go from drug design to market, in the meantime I'll use drug research and herbal meds to treat myself using the latest discoveries about how people work, thanks.

Posted by Ryan W. | May 12, 2008 6:56 PM

cain - p.s. , which logical fallacies were you referring to? I don't even know what you were trying to get at there.

Posted by Ryan W. | May 12, 2008 7:21 PM

Andrew Lias - some plants, do concentrate heavy metals. Artemesia frigida, for instance. Certain plants have been used in toxic waste cleanup for this reason. But they tend to take toxins from the soil rather than the air in most cases.

Some plants are good at detoxifying the air, however.

He discovered that Boston fern, chrysanthemum, dracaena and Ivy were highly effective at removing the formaldhyde, benzene and trichloroethylene from sealed chambers. link

Spider plants were taken on the space shuttle at one point for use as a filter. If they just wanted a CO2 filter they could have made one that required a lot less care than a plant.

Posted by Ryan W. | May 12, 2008 7:32 PM

I've seen plenty of quackery in mainstream medicine and some alternative treatments that worked quite well.

If the "alternative" treatments actually work, then medical science will establish this, and they will become part of the mainstream treatment arsenal.

"Alternative" medicine, on it's own, has absolutely no mechanism to prove that anything works or doesn't work.

My issue was with how long it took for that to be accepted by the medical community.

It only took as long as it took to establish, with evidence, that the treatment was efficacious.

Posted by Chet | May 13, 2008 1:29 AM

Technically speaking, geocentrism isn't even wrong. It has never been disproved.

In fact, it's easily disproved by the simple observation that the Sun is %99.8 of the mass of the entire solar system.

Which is why among educated people not a single person seriously promotes geocentrism. We don't cleave to heliocentrism because its merely convenient, we cleave to it because it's known to be correct.

Posted by Chet | May 13, 2008 1:33 AM

I don't understand: In the commercials, they show the pads being really dark when you first start to use them, but later they come out clean. This is how you know your body is getting detoxed.

If there was some reaction with water, wouldn't they just keep getting dark forever? Is their plan that you keep using them, or do they later send you ones with progressivly less and less of the darkening agent?

I'd be willing to bet that "in real life," you never get to the stage of the "clean" pad - meaning, in the logic of pad-world, your body is still chock-full of toxins, and you need to BUY MORE PADS!

I'm betting it's some compound that reacts to human perspiration, which, IIRC, is mildly acidic...so it's just some kind of simple pH indicator chemical in there.

And, anomdebus, nice catch on the asbestos. I missed that on the commercial. (I was too busy wondering over "How many people really and truly have thallium in their bodies?")

Posted by ricki | May 13, 2008 8:48 AM

Technically speaking, geocentrism isn't even wrong. It has never been disproved.

That's not exactly true. Part and parcel of the Ptolemaic cosmology widely believed in Galileo's day was that the earth was stationary at the center of the universe. This theory has been comprehensively disproved, although it's not as easy as you would think. Experimental confirmation of the earth's motion didn't come until the early 18th century, with the observation of aberration of starlight.

In fact, heliocentric cosmology had been widely accepted for many years before this experimental confirmation, and this sheds a great deal of light on our attitudes toward what constitutes "proof" in science. I used to ask my students to explain it as an extra credit question, back in my teaching days. The short version is that having a coherent theoretical explanation counts for a lot. Applying this principle to the question of alternative medicine is left as an exercise.

Since there are no privileged frames of reference,

That depends on what level of "privilege" you wish to extend. Most physicists would agree that inertial reference frames are, in some sense, privileged.

it is not more to say "The sun is the center of the universe." In fact, you could do any calculation you could do with a heliocentric universe using a geocentric model. You'd just need a more powerful computer.

I'd agree that it is no more correct to say that the sun is the center of the universe than that the earth is, but that is because both are wrong. Now, if we're talking about models rather than theories, then I'd agree that the geocentric model is still useful for some purposes. Note, however, that the Ptolemaic model was still incorrect, inasmuch as it failed to predict the positions of the planets.

The church was right that heliocentrism was done for convenience and geocentrism hadn't been disproven. Galileo was wrong in stating an absolute(though they shouldn't have put him under house arrest.)

That's a fairly naïve understanding of the struggle over heliocentrism. For one thing, the Church was every bit as strident in claiming that the earth "really" was the center of the universe as Galileo was in claiming the opposite. Furthermore, the Ptolemaic theory favored by the Church had a lot of baggage regarding crystalline spheres, perfect circular motion, Aristotelian physics, and so forth that was not defensible under any set of observations.

The conflict between heliocentrists and the Church really boiled down to three things. First, certain passages in the Bible suggested that the earth was stationary while the heavens moved. Second, to have the earth, for which the cosmos was presumed to be created, not at the center of the cosmos was theologically troubling. And third, the Church conceived of knowledge as revealed by God and regarded the idea that it could be discovered by mortals as borderline blasphemous.

Posted by rpl | May 13, 2008 9:33 AM

chet - If the "alternative" treatments actually work, then medical science will establish this, and they will become part of the mainstream treatment arsenal.

I wish what you were saying were true, but I haven't seen this. For instance theanine, an extract of green tea, and other naturally occuring GABA-ergic drugs are helpful restoring deep sleep in fibromyalgia. Do doctors recommend theanine? No, they proscribe lyrica, and ignored the issue before lyrica came out.

I already gave the example of cherries for curing gout (reducing uric acid concentrations.)

"Alternative" medicine, on it's own, has absolutely no mechanism to prove that anything works or doesn't work.

"Alternative" medicine can be tested in the same fashion that mainstream medicine can be. Naturopathic medicine in particular fits here.

It only took as long as it took to establish, with evidence, that the treatment was efficacious.

That is absolutely not true. You're welcome to support it with sources if you think you can. A new mechanism is developed and boom a drug is instantly available that supports it? You can't be serious. Even mainstream doctors complain about how the FDA doesn't trust European data and that it wants to confirm their own tests before giving approval. They complain that this CYA attitude kills more people than it saves, statistically. But you want me to believe that there's not even any lag time between an improvement in theory and drug development? Why should I believe you?

Posted by Ryan W. | May 13, 2008 11:01 AM

chet - If the "alternative" treatments actually work, then medical science will establish this, and they will become part of the mainstream treatment arsenal.

I wish what you were saying were true, but I haven't seen this. For instance theanine, an extract of green tea, and other naturally occuring GABA-ergic drugs are helpful restoring deep sleep in fibromyalgia. Do doctors recommend theanine? No, they proscribe lyrica, and ignored the issue before lyrica came out.

I already gave the example of cherries for curing gout (reducing uric acid concentrations.)

"Alternative" medicine, on it's own, has absolutely no mechanism to prove that anything works or doesn't work.

"Alternative" medicine can be tested in the same fashion that mainstream medicine can be. Naturopathic medicine in particular fits here.

It only took as long as it took to establish, with evidence, that the treatment was efficacious.

That is absolutely not true. You're welcome to support it with sources if you think you can. A new mechanism is developed and boom a drug is instantly available that exploits it? You can't be serious. Even mainstream doctors complain about how the FDA doesn't trust European data and that it wants to confirm their own tests before giving approval. They complain that this CYA attitude kills more people than it saves, statistically. But you want me to believe that there's not even any lag time between an improvement in theory and drug development? Why should I believe you?

Posted by Ryan W. | May 13, 2008 11:02 AM

Chet - to clarify

1. If a long-used foodstuff considered GRAS by the FDA is found to be useful to treat a condition, I consider that proof of efficacy, even without formal FDA approval.

2. I've known very few doctors who had a good sense of what various traditionally used herbs did, or gave useful, specific information regarding changes in diet and lifestyle.

3. Even when such herbs do work and are shown to be safer and more effective via controlled studies, they are not typically prescribed. (St. John's Wort vs Prozac)

4. There are a number of treatments which exist but are not used (such as phage therapy for diabetic ulcers and many many other infections) which have been repeatedly proven to work and dramatically improve clinical outcomes in controlled studies. Will they be eventually? Yes, of course. But not before several hundred thousand die needlessly. The delay is not due to a need to prove efficacy of the treatment. It is due to simple ignorance.

Posted by Ryan W. | May 13, 2008 11:18 AM

For instance theanine, an extract of green tea, and other naturally occuring GABA-ergic drugs are helpful restoring deep sleep in fibromyalgia. Do doctors recommend theanine?

Many do, as a result of the scientific evidence of its efficacy. Maybe your doctor doesn't, maybe because he doesn't keep up to date with the research, or maybe because he thinks lyrica works better, or something. "Doctors" aren't some monolithic group. Many doctors are little more than witch-doctors, prescribing the treatments they read about in the DSMIV without really understanding how they work.

"Alternative" medicine can be tested in the same fashion that mainstream medicine can be.

But "alternative" medicine doesn't have any ability to reject treatments that are found to lack efficiacy, so whatever testing they do - and it's not much - doesn't even matter. Study after study finds that homeopathy is no different than drinking water, for instance, but homepaths are still considered legitimate "alternative" medics.

Alternative medicine doesn't have any rigor. Thus, it simply can't be trusted.

But you want me to believe that there's not even any lag time between an improvement in theory and drug development?

Why would a company sit on an approved medication for no good reason? Once the FDA has established safety and efficacy, they go out on the market. Why would they wait?

If a long-used foodstuff considered GRAS by the FDA is found to be useful to treat a condition, I consider that proof of efficacy

"Found" by who? By what evidence? You're putting the cart before the horse, here.

Even when such herbs do work and are shown to be safer and more effective via controlled studies, they are not typically prescribed. (St. John's Wort vs Prozac)

St. John's Wort is not more effective than Prozac. In clinical trials it was no more effective than placebo for major depressive disorders. And it has a considerable number of drug interactions.

It is due to simple ignorance.

Promoting ignorant, backwoods, witch-doctor magic altee "medicine" isn't going to help with that. Sure, there's some validity to a small number of altee medicine claims. Asprin, after all, was discovered by native Americans steeping willow bark. The point is that the cream rises to the top and is skimmed by legitimate medicine, and what's left is the dross, like homeopathy, or healing hands therapy, or magnetic bracelets - all the crap that has been proven time after time to have no effect whatsoever but whose huckster practitioners continue to find refuge in the alternative "medicine" community, aided and abetted by people like yourself.

Posted by Chet | May 13, 2008 2:12 PM

Many do, [recommend theanine] as a result of the scientific evidence of its efficacy.

How do you know this?

Many doctors are little more than witch-doctors, prescribing the treatments they read about in the DSMIV without really understanding how they work.

Yes. This is a huge part of my complaint against 'mainstream medicine.' I know that doctors aren't "some monolithic group."

Study after study finds that homeopathy is no different than drinking water, for instance, but homepaths are still considered legitimate "alternative" medics.

You just told me that doctors aren't a monolithic group. ... apparently alternative medics are? I'm really not defending homeopathy here.

Why would a company sit on an approved medication for no good reason? Once the FDA has established safety and efficacy, they go out on the market. Why would they wait?

Take fibromyalgia.

1. People realize that GABAergic drugs help with fibro.

2. Naturopaths can advise patients to take naturally occuring GABAergic drugs already in existance.

3. Traditional medics wait for a pharmaceutical to be developed and approved, which costs more and requires a doctor's visit to obtain. This takes years. Even if the pharmaceutical has side effects that herbs don't and is less effective it is still proscribed. Saw palmetto extract inhibits type I and II of 5alpha reductase without inhibiting PSA excretion, for instance, while finesteride, which is still prescribed, only inhibits the type II isoform, iirc, and inhibits PSA secretion. But finesteride is still prescribed by doctors far more often than Saw Palmetto extract.

"Found" by who? By what evidence? You're putting the cart before the horse, here.

If a substance is already GRAS it's not so costly to jump straight to human studies. Published medical articles can demonstrate efficacy. Info put out by corporations is very often simply inaccurate. A Searle representative tried to convince me, for instance, that COX I was not at all involved in inflammation prior to the release of Celebrex.

St. John's Wort is not more effective than Prozac. In clinical trials it was no more effective than placebo for major depressive disorders. And it has a considerable number of drug interactions....uckster practitioners continue to find refuge in the alternative "medicine" community, aided and abetted by people like yourself.

St. John's Wort is as effective as other SSRIs, with fewer side effects. You're more than welcome to provide citations which demonstrate otherwise, or show that it has significantly more drug interactions than other SSRIs do. So far you've put forward a bunch of assertions without any kind of evidence to back them up. My mind is open, but why should I believe what you're saying?

Posted by Ryan W. | May 13, 2008 2:44 PM

The recent clinical studies on hypericum extract support the present indications for its use in mild to moderate depression and depressive episodes. The effectiveness is superior to placebo and comparable with synthetic antidepressive drugs. The rate of unwanted events is explicitly lower and their severity in general only mild. A further indication for hypericum could be somatoform disorders, but further clinical studies are recommended.

Posted by Ryan W. | May 13, 2008 2:50 PM

The blog is eating my links. grr. well, I'll just post exerpts from some studies, with no links provided. You can search on the string easy enough to find the original.

The Hypericum preparation tested in this study is therapeutically equivalent to fluoxetine and is therefore a rational alternative to synthetic antidepressants.

Posted by Ryan W. | May 13, 2008 2:53 PM

St John's wort was significantly more effective than fluoxetine and showed a trend toward superiority over placebo.

Posted by Ryan W. | May 13, 2008 2:55 PM

Why would a company sit on an approved medication for no good reason? Once the FDA has established safety and efficacy, they go out on the market. Why would they wait?

I didn't say 'approved.' I said one which had been shown to be efficacious (as per numerous human studies.)

Phage therapy is possible now, but only one mix is recognized by the FDA as GRAS. Will phage therapy happen in the US eventually and on a wide scale? Yes. Will a lot of people die needlessly before it is? Yes.

Also, acupuncture has shown some efficacy for things like pain relief. I haven't looked into it for other functions. Lack of mechanism isn't sufficient objection. People used aspirin for a long time before discovering how it worked.

And quite a few Chinese herbal cures, some of which I and my girlfriend have used to good effect, seem far from being incorporated into the western pharmacopia. It is common for people to be able to show that a treatment works before they understand why it does.

Posted by Ryan W. | May 13, 2008 3:36 PM

How do you know this?

Because that's what I'm reading in the medical journals. How do you know that they're not, Ryan?

This is a huge part of my complaint against 'mainstream medicine.'

Why, when it's precisely the same in alternative "medicine"? Like most altee medicals, you criticize establishment medicine for sins that are even more pronounced in the altee medicine world. At least in mainstream medicine, there's a research apparatus backing up the conclusions and treatments, even if individual doctors aren't always up to date with it. There's no such thing in the alternative medicine world.

I'm really not defending homeopathy here.

Is, or isn't, homeopathy "alternative medicine?" Alternative medicine is a monolith; it's a dumpster, a dumping ground for all supposed "treatments" that haven't yet been confirmed by research. That's true by definition, because when the research apparatus confirms their efficacy, they stop being "alternative medicine."

Saw palmetto extract inhibits type I and II of 5alpha reductase without inhibiting PSA excretion, for instance

Maybe it does, maybe it doesn't. The problem is that you don't have enough evidence to come to that conclusion.

And that's why it's not prescribed - the pharmaceutical has a decade of research underpinning its efficacy and safety, it's been studied from every angle; Saw palmetto research is "limited", to use the judicious words of Wilt et al.

You're more than welcome to provide citations which demonstrate otherwise

JAMA. 2002 Apr 10;287(14):1807-14: "This study fails to support the efficacy of H perforatum in moderately severe major depression. " This, from a massive study performed by the NIH.

I didn't say 'approved.' I said one which had been shown to be efficacious (as per numerous human studies.)

FDA approval proves effectiveness, because that's one of the criteria for approval. And, again, if the drug companies had a drug that worked, why would they sit around and wait? Why not push for FDA approval? Once approved, why would they wait some more?

The FDA approves effective drugs. Drug companies are in the business of selling drugs. You're asserting some kind of time delay that doesn't make any sense, and works against the interests of everybody involved. Why would that be the case?

Phage therapy is possible now

Possible, but expensive, time-consuming, and possible only in a few places around the country. Those are the major barriers to acceptance - the fact that you need essentially a "custom" bacteriophage for every single treatment regimen.

Compared to, say, wide-spectrum antibiotics that can be stockpiled and easily dispensed immediately, it's no surprise that antibiotics are a medical workhorse and phage therapy is a fringe curiosity.

And quite a few Chinese herbal cures, some of which I and my girlfriend have used to good effect

This is precisely the sort of poor reasoning that underpins your entire movement. You take the cure; your headache goes away. Your headache would have gone away regardless of what you took, but because of your confirmation bias, you see it as "proof" that the Chinese cure worked.

For 4000 years human beings fell prey to that reasoning, and the recognition that "ad hoc, ergo propter hoc" is a fallacy is one of the things responsible for human progress in the past few centuries.

And you want to roll back the clock? Why? Because you think a Chinese rice farmer in 1000 BC knew more about the human body than GlaxoSmithKline?

Posted by Chet | May 13, 2008 3:57 PM

Spider plants were taken on the space shuttle at one point for use as a filter.

Not the US Space Shuttle. The enviromental control & life support system (ECLSS) on the Shuttle is 100% chemical. They may have done some experiments with plants on a mission or two, but the system in use is 100% chemical.

Yes, I am a rocket scientist. I worked on control systems for biological ECLSS systems for NASA for a while - a prototype for a base on Mars or the Moon.

Posted by ech | May 13, 2008 5:00 PM

ech - Thanks for the catch! My bad. It seems there were just a series of experiments by NASA including some in space showing that plants could be used as air purifiers. Either one of my teachers mispoke many years ago, or I misunderstood.

www.thestar.com/comment/columnists/ article/292158

Posted by Ryan W. | May 13, 2008 6:53 PM

Chet - Because that's what I'm reading in the medical journals. How do you know that they're not, Ryan?

My girlfriend has Fibromyalgia. Because of this, I tend to talk to a lot of people about the topic. None of them have ever mentioned a doctor recommending theanine or any non-pharmaceutical supplement. What I read in journals doesn't correspond with the advice that doctors tend to give. That's my point. I've never insulted researchers. I'm talking about doctors here.

Why, when it's precisely the same in alternative "medicine"?

Because I'm discriminating enough not to have to deal with all alternative medicine in aggregate. Diversity may result in highs and lows, but I can pick the highs and leave the lows.

That's true by definition, because when the research apparatus confirms their efficacy, they stop being "alternative medicine."

It may be 'true by definition' but it's false by practice. So since acupuncture can be clinically demonstrated to relieve pain, it's now mainstream?
Most would consider that, as well as naturopathic medicine, as being 'alternative.'

Maybe it does, maybe it doesn't. The problem is that you don't have enough evidence to come to that conclusion.

There are numerous studies on this topic. How many would it take to convince you? That it can inhibit both isoforms isn't that controversial. There's nothing magical about FDA approval that makes it better than other science. As mentioned, Celebrex made it through FDA approvals and they were still telling us that COX-1 was worthless. If the trial was honest, there should have been a discernable difference between celebrex and aspirin inflammation that they'd notice.

Phage therapy is possible now

Possible, but expensive, time-consuming, and possible only in a few places around the country. Those are the major barriers to acceptance - the fact that you need essentially a "custom" bacteriophage for every single treatment regimen.

Phage cocktails can be used to give a broad-spectrum effect. They can be used as a supplement to antibiotics. Doing so improves clinical outcomes. Considering significant morbidity and mortality linked to antibiotic resistant bacteria, resolved with phage co-treatment (I'll happily document all this if it makes a difference) And widespread use bring economies of scale. That a good cure is not readily available is hardly an argument against it.

This is precisely the sort of poor reasoning that underpins your entire movement.

My girlfriend had a recurring skin rash, not a headache. So it wasn't confirmation bias.

Likewise, I don't use TCM unless I can't treat myself traditionally and the problem is long term.
The quality of herbs is often variable, which is a problem. But I've had them be effective.

So you're disproving reasoning that I didn't even use.

And you want to roll back the clock?

No. Read through my posts. Where do I say that?
But yes, I do thing that alternative treatments have some benefits that modern medicine does not. Red rice yeast, for instance, contains statins.
Considering that Chinese rice farmers were using statins centuries before modern pharmaceuticals were formed, I think it's a little inconsistent to argue that the people that developed them are utterly helpless morons. Would I prefer rational drug design if I can get it? Sure. Do I have as large and cheap a pharmacopia if I restrict myself to conventional pharmaceuticals? No. Many modern drugs used medically were traditional herbs at one point, which argues against the notion that naturopathic medicine, for instance, is incapable of generating any kind of useful knowledge.

Thanks for the St. John's Wort study. But there are quite a few other studies (the majority) which seem to contradict its findings. I'm curious what you think is different about the designs of the two that makes them get different results. Are all the other studies simply flawed or biased?

Posted by Ryan W. | May 13, 2008 7:49 PM

There have been studies suggesting that St. John's Wort is effective and ones saying it isn't (although the JAMA study Chet cites had the largest patient population). I'm up in the air, after all, didn't a recent large British study find that prozac didn't outperform placebo control for moderate depression? Depression studies tend to be hugely variable in their results.

In any case, "traditional medicines", while generally far superior to the quackery and hokum found in most alternative medicines (homeopathy, ayurveda, chelation therapy, toxin removal, colon cleansing, crystals, chiropractic, etc) is still a poor treatment option for most illness for several reasons. 1) unregulated herbs of unknown strength, since the active ingredients are unknown, the effectiveness of any given batch is also unknown. 2) Unknown pharmacologcial interactions. Since most people already are taking one or more medications, it is potentially dangerous to combine with herbs having unknown properties. St John's Wort is well studied in this regard and has serious effects on multiple other medications. 3) Co-opting by western medicine. The most effective alternative herbal treatments generally don't remain alternative for very long. Multiple active ingredients in St John's Wort and Saw Palmetto have been identified and are currently being tested for their efficacy and pharmacological mode of action. This is done to both limit potential side effects and interactions and, of course, to make drug companies obscene amounts of cash.

Your anger at doctors for suggesting drugs over herbs is rather silly. When a clinical study demonstrates an herb outperforms a drug, doctors should and will choose the herb. The fact that it almost never happens (cup of cherries for gout included) is not the fault of doctors. Of course progress is slower than it should ideally be, but that's what it takes to find out something actually works, rather than just one person saying it worked for them.

Posted by Crusty Dem | May 13, 2008 10:29 PM

Because I'm discriminating enough not to have to deal with all alternative medicine in aggregate.

Bully for you, but the community you're defending persists precisely because the majority of people don't have the training to be discriminating about health care.

Again, I'll reiterate my point - whatever good exists in altee medicine will be picked up by the mainstream community, because mainstream medicine has a mechanism for doing that. Altee medicine by itself has no mechanism for doing anything; no rigor to separate truth from fiction, which is why the movement is a haven for quackery.

So since acupuncture can be clinically demonstrated to relieve pain, it's now mainstream?

For pain relief? Absolutely it is, and I know of doctors who have recommended it.

For anything else, including the vast panoply of ailments its held to be a panacea for? It's absolute quackery.

How many would it take to convince you?

Any number higher than the zero you've shown me, so far.

That a good cure is not readily available is hardly an argument against it.

I'm not making an argument against it, Ryan; I'm explaining why phage therapy has fairly little market penetration. It's expensive, time-consuming, and narrow in application. Further, the disconcerting fact that the source of the phages in phage therapy include raw sewage, animal feces, and corpses.

There are good reasons why phage therapy isn't the hot new thing, and it has nothing to do with ideology and everything to do with medicine being a business that has to make money.

My girlfriend had a recurring skin rash, not a headache. So it wasn't confirmation bias.

LOL! Confirmation bias doesn't have anything to do with headaches, that was just an example. Rashes go away on their own, too.

Red rice yeast, for instance, contains statins.
Considering that Chinese rice farmers were using statins centuries before modern pharmaceuticals were formed, I think it's a little inconsistent to argue that the people that developed them are utterly helpless morons.

They weren't "using statins", though, they were just eating red rice yeast. And not universally, of course; some people were eating red rice yeast, and some were eating it for things that statins can't help with, and some people were drinking their own piss and licking goats or some such.

If you throw enough shit at a problem, some of it is bound to stick. There's no surprise when, over the course of 4000 years of history, trial and error has a few successes. That's not nearly enough to validate altee medicine.

But there are quite a few other studies (the majority) which seem to contradict its findings.

No, there's not. St. John's Wort has had limited effectiveness in treating minor depression, about as good as SSRI drugs; every study confirms that it is not effective for treating even moderately severe depression.

Posted by Chet | May 13, 2008 10:46 PM

Crusty Dem -
Thanks for writing, Crusty.

Depression studies tend to be hugely variable in their results.

True. And the best anti-depressant placebos are those which cause physical pain.

unregulated herbs of unknown strength, since the active ingredients are unknown, the effectiveness of any given batch is also unknown.

Very true, as you say, for unregulated herbs. Naturopathic medicines can be standardized, of course, and often at least some active ingredients are known. Some herbs are notoriously unreliable. Others have a wide therapeutic index. Dock, for instance, can act as a laxitive or cause constipation depending on the plant and season.

Unknown pharmacologcial interactions. Since most people already are taking one or more medications, it is potentially dangerous to combine with herbs having unknown properties.

I agree here as well. Though if traditional medicine worked I usually wouldn't be using an alternative.

St John's Wort is well studied in this regard and has serious effects on multiple other medications.

Especially other SSRIs. Which doesn't square with the notion that it's just a placebo, unless all SSRIs are.

Side effects, at worst, seem comparable to other SSRIs.

The most effective alternative herbal treatments generally don't remain alternative for very long.

A decade gap or so is enough for me to exploit, and the gap tends to be longer than that. Lapacho seems to have been known for much longer, and hasn't been coopted yet. There was an attempt to use a single-chemical extract as an anti-cancer therapeutic decades ago, but it was discontinued for toxicity. It has broad spectrum anti-viral properties which are dearly in need, but remain unexploited.

Your anger at doctors for suggesting drugs over herbs is rather silly.

I'm not angry. I simply think that some prescribed drugs are more expensive and less effective than natural remedies. And often, natural remedies are not prescribed even when there is no good traditional alternative. And many Doctors aren't really comparing drugs to herbs when proscribing.

When a clinical study demonstrates an herb outperforms a drug, doctors should and will choose the herb.

They should. I wish they would. But I really haven't seen that with most doctors.

but that's what it takes to find out something actually works, rather than just one person saying it worked for them.

I'm not talking about anecdotal evidence, though. I'm talking about using herbs that have been used for centuries based on multiple, published medical studies.

Posted by Ryan W. | May 14, 2008 3:38 AM

Again, I'll reiterate my point

Yes, but I'm looking more for support for your claim that lagtimes between elucidation of a physiological mechanism and development of a treatment based on that mechanism don't incur significant morbidity.

Likewise, I'm looking for support for your claim that
experimentally demonstrated benefits are rapidly adopted by the mainstream medical community. There's great evidence for use of acid-neutral ascorbate (vitamin C) in chemotherapy patients. It improves renal function as well as chance of survival of the cancer itself. It isn't used. There are dozens and dozens of examples like this, unfortunately. And perhaps there are a few doctors who have picked up on these trends, however there are not so many that their knowledge can be relied upon.

which is why the movement is a haven for quackery.

Alternative medicine can be tested the same way that any other method can be.

More than anything, I want to have the freedom to pursue these choices within the bureaucratic paradigms that determine what will and won't be funded. If that means that some people can get 'healing hands' treatments instead of antibiotics, that's their own personal choice.

You wanted support re: Saw Palmetto's efficacy.

www .ncbi.nlm.nih.gov/pubmed/15543614?dopt=Abstract

www .ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12006122&query_hl=16&itool=pubmed_docsum

www .ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11337315&query_hl=16&itool=pubmed_docsum

www .ncbi.nlm.nih.gov/pubmed/7577710

I'm not making an argument against it, Ryan; I'm explaining why phage therapy has fairly little market penetration. It's expensive, time-consuming, and narrow in application. Further, the disconcerting fact that the source of the phages in phage therapy include raw sewage, animal feces, and corpses.

I've tried to explain why it isn't time consuming, expensive, or so narrow in application that it shouldn't be used. The benefits in terms of decreases in morbidity and mortality overwhelmingly justify it. But it's slow to be adopted, and that slowness kills people. Lots of antibiotics come from mold. That shouldn't be a sane argument against them. If you're saying that the disincentive is aesthetic or irrational, I don't see that as more discerning than someone who drinks homeopathic water thinking that its medicine.

There are good reasons why phage therapy isn't the hot new thing, and it has nothing to do with ideology and everything to do with medicine being a business that has to make money.

The cost-benefit analysis of phage use, from the standpoint of the patient is overwhelmingly in its favor given the damage being caused simply by MRSA alone. Nor should a doctor's proscription be needed for phage, unlike antibiotics, given the low negatives associated with use. That alone would make treatment more available to a wide range of people. If more people knew about phage and could get good phage cocktails, phage impregnated bandages, etc. more people would and should use it.

Posted by Ryan W. | May 14, 2008 11:12 AM

p.s. "Alternative" medicine tends to group some widely divergent approaches to medicine. Trying to isolate common characteristics is a bit like trying to isolate common characteristics of 'heresy' which is defined primarily by what it is not.

Alternative medicine can be tested. Holistic medicine, naturopathic medicine and orthomolecular medicine certainly can be, yet those who draw on these traditions tend to list themselves as alternative.

As I mentioned earlier, ascorbate's utility for those undergoing chemotherapy is pretty clear. But such vitamin therapy is still not widely adopted. Which brings me back to my original point; it is worth considering certain types of 'alternative' medicine since there is significant lagtime between support for a thing and clinical adoption. Medics were worried about oxalic acid excretion and kidney stones, but history and genetics seems to play a more important role there, and creatinine clearance is actually improved by chemo patients taking large doses of c. (multi gram doses. I'd exclude any studies which doesn't test cancer patients with several grams or explicitly list the # of grams)

Posted by Ryan W. | May 14, 2008 5:36 PM

Altee medicine by itself has no mechanism for doing anything; no rigor to separate truth from fiction, which is why the movement is a haven for quackery.

Altee medicine is a catch-all catagory. Like 'heratic.' A heratic is not defined by a precisely defined belief. Rather, they are defined by their reaction to a dominant paradigm.

Posted by Ryan W. | May 15, 2008 4:02 AM