A good case of smallpox may rid the system of more scrofulous, tubercular, syphilitic and other poisons than could otherwise be eliminated in a lifetime. Therefore, smallpox is certainly to be preferred to vaccination. The one means elimination of chronic disease, the other the making of it.

Naturopaths do not believe in artificial immunization . . .

—Harry Riley Spitler, Basic Naturopathy: a textbook (American Naturopathic Association, Inc., 1948). Quoted here.

Here’s what a good case of smallpox will do for you:

If you’re lucky enough to beat the reaper (20-60%; 80% or higher in infants) or blindness (up to 30%), those blisters will leave you scarred for life. Oh, and the next time a good smallpox epidemic comes around, your children born since the last one will catch it and contribute their fair share to the death rate. But not you because you’ll be immune, so you’ll have the “preferred” experience of watching your children die well before you do.

Variolation and Vaccination

Except that none of this will happen, because the disease has been eradicated from the world—thanks, of course, to vaccination, which Napoleon reasonably called “the greatest gift to mankind.”

Smallpox was “the most terrible of the ministers of death.” It began at least several thousand years ago and rapidly spread wherever its human carriers traveled, eventually to the entire populated world. In endemic regions, it wiped out 1/4 to 1/3 of children in epidemics that occurred every few years. In epidemics among people who had not previously seen it, such as the natives of the Western Hemisphere during the early years of European explorations, it wiped out as many as 90% of everyone. It brought down armies and empires. Monarchs dropped like flies; it spared no socioeconomic class. Gods were invented in its name. There was never an effective treatment for it once it had begun.

Prior to the advent of vaccination, there was a heroic method that proved useful in reducing the severity of the disease. This was inoculation (‘variolation’): crude matter from a pustule of someone with the disease was etched into the skin of an uninfected person. This resulted in somewhat more indolent clinical cases, with death rates of ‘only’ around 2%, but the disease remained terrible and those so infected could still transmit it to others by means other than inoculation.

Vaccination, as many readers already know, was introduced near the end of the 18th century in England by the physician Edward Jenner. Jenner neither discovered it—it seems to have been discovered by milkmaids (and their close associates) who had noticed that after experiencing a cowpox blister, they never caught smallpox—nor was he the first to use it purposefully or even to write about it. He was the first, however, to conduct and report a series of convincing experiments demonstrating that people previously infected with cowpox could not subsequently be infected with smallpox (by variolation). He also showed that cowpox could be transferred from person to person by inoculation of matter from the cowpox blister, thus offering the first method for widespread use. Jenner is thus given credit not only for having introduced vaccination for smallpox, but for having introduced the concept of vaccination in general, although he would not live to see another example.

The Antivax Movement is Born

Opposition to smallpox vaccination (the name comes from the Latin for “cow”) began almost immediately after Jenner’s reports and remained substantial for more than 100 years. Some opposition was explicitly religious; some was based on disbelief in the method or, later, in the Germ Theory; some objectors claimed that vaccination caused terrible diseases, including smallpox itself; some voiced a political objection to state mandated vaccination programs. An early cartoon suggested that if Jenner had his way, people would start to look like cows:

Two antivax organizations in 19th century Britain were the National Anti-Vaccination League and the Society for the Abolition of Compulsory Vaccination. They sought to discredit Jenner’s reports and to argue, in keeping with the popular “hygiene” and “sanitation” movements of the day, that “cleanliness is more likely to prevent smallpox than [is] introducing filthy matter into the body.”

The Holy Trinity of American Quackery

These were, in the late 19th and early 20th centuries, homeopathy, chiropractic/osteopathy, and naturopathy. Hahnemann himself had approved of his contemporary Jenner’s assertion, believing that it confirmed “like cures like” (ably refuted by Oliver Wendell Holmes, Sr.). Constantine Hering, however, the “Father of American Homeopathy,” was the first homeopath to declare his opposition to vaccination. He called it “always a poisoning” and asserted, “we learn from year to year a more certain and better way of curing small-pox homeopathically.” He nevertheless admitted in 1883, near the time of his death, that this ‘better way’ had not achieved the certainty of prevention by vaccination.

In 1918, Benedict Lust, the “Father of American Naturopathy,” wrote this:

Like the alchemist of old who circulated the false belief that he could transmute the baser metals into gold, in like manner the vivisector claims that he can coin the agony of animals into cures for human disease. He insists on cursing animals that he may bless mankind with such curses.

To understand how revolting these products are, let us just refer to the vaccine matter which is supposed to be an efficient preventive of smallpox. Who would be fool enough to swallow the putrid pus and corruption scraped from the foulest sores of smallpox that has been implanted in the body of a calf? Even if any one would be fool enough to drink so atrocious a substance, its danger might be neutralized by the digestive juices of the intestinal tract. But it is a far greater danger to the organism when inoculated into the blood and tissues direct, where no digestive substances can possibly neutralize its poison.

The natural system for curing disease is based on a return to nature in regulating the diet, breathing, exercising, bathing, and the employment of various forces to eliminate the poisonous products in the system, and so raise the vitality of the patient to a proper standard of health.

Official medicine has in all ages simply attacked the symptoms of the disease without paying any attention to the causes thereof, but natural healing is concerned far more with removing the causes of disease…

In those words we find several of the recurring themes in quackery that were evident in the 19th century and remain so today. We know that naturopaths continued to espouse this view of vaccination at least until 1968, when the quotation at the top of this essay was among the materials they submitted to the Department of HEW in an unsuccessful attempt to be covered by Medicare. They’ve since learned to be somewhat more subtle about the issue, possibly because of the 1968 failure, but their distaste for vaccinations in general persists, as explained here.

An Aside: the “Cause of Disease,” Naturopathy-style

I’m sure you’ve been wondering, so here it is, right from the pen of Harry Riley Spitler, the author of the quotation that began this piece (courtesy of the 1968 HEW report):

The primary cause of disease is reaction to unnatural environment . . . When the body is weighted down by toxins in excess of the amount with which the vital force is able to cope, then enervation… supervenes and there is a lag in the body’s power to expel the “ashes” of metabolism… Enervation leads to the secondary cause of so-called disease — toxemia. Toxemia is the state of auto-intoxication resulting from the accumulation ot poisons in the body – poisons taken in from without in the form of incorrect food, impure water, vitiated air, etc., and which are not thrown off by the body because of its enervated state, and in addition thereto the poisons formed within the body itself by the processes of metabolism. . . The presence of these poisons within the blood stream and tissues causes the vital force to make efforts to eradicate toxemia, and these efforts are what is called “diseased crises.” . . . Disease, therefore, is not a hostile entity to be attacked, but is rather a manifestation of vital force in its efforts to continue to live and to remove anti-vital conditions caused by man’s deliberate, or ignorant, breaking of the laws of health and life … Disease, then, is the result of stagnation and accumulation of filth in the blood stream and in the tissues.

And the cure? Back to Lust:

The Program of Naturopathic Cure

 1. ELIMINATION OF EVIL HABITS, or the weeds of life, such as over-eating, alcoholic drinks, drugs, the use of tea, coffee and cocoa that contain poisons, meat-eating, improper hours of living, waste of vital forces, lowered vitality, sexual and social aberrations, worry, etc.

2. CORRECTIVE HABITS. Correct breathing, correct exercise, right mental attitude. Moderation in the pursuit of health and wealth.

3. NEW PRINCIPLES OF LIVING. Proper fasting, selection of food, hydropathy, light and air baths, mud baths, osteopathy, chiropractic, and other forms of mechano-therapy, mineral salts obtained in organic form, electropathy, heliopathy, steam or Turkish baths, sitz baths, etc.

And, of course, enemas.

Natural healing is the most desirable factor in the regeneration of the race.

 Wow. It’s all kind of fascistic, no? But I’m digressing.

More on the Holy Trinity

You probably noticed Lust’s approval of chiropractic, another field with a rich tradition of antivax fervor. Some chiropractors have learned to be a bit more subtle; others have not (and not all contemporary chiropractors are opposed to vaccinations). If you’ve perused the 1968 HEW report, you also know that the American naturopathic schools of the mid-20th century were mostly spawned by chiropractors, and that for some time there was little distinction between naturopaths and “mixer” chiropractors. Many “NDs” of that time also had “DC” after their names.

You may also know that contemporary naturopaths love homeopathy. Lust didn’t include it in his NEW PRINCIPLES OF LIVING, probably because of his emphasis on “drugless healing.” Nevertheless, he praised Hahnemann for having shown “the physicians of his day…that just as good results could be brought about by means so gentle that even a delicate child could be treated, without the slightest particle of danger.” It seems to have been left to the next generation of American naturopaths to fully embrace homeopathy, and this was done most conspicuously by a man who himself embodied the Holy Trinity of Quackery: John Bastyr, N.D., D.C. (1912-1995), the “Father of Modern Naturopathic Medicine.”

Bastyr was also described as a

…third-generation homeopath from Dr. Adolph von Lippe. His teacher was Dr. C. P. Bryant (who had been, in 1939, president of the International Hahnemannian Association). C. P. Bryant had been taught by Walter Bushrod James who had been one of Lippe’s closest students. He received doctorate degrees in naturopathy and chiropractic from Northwest Drugless Institute and Seattle Chiropractic College, respectively. He became licensed to practice naturopathic medicine in 1936. He is also credited with being the Father of Modern Naturopathic Medicine. Because of Bastyr’s influence naturopaths have been at the forefront of the rebirth of homeopathy in this country. He made sure that homeopathy shared equal emphasis with nutrition, hydrotherapy and botanical medicine in naturopathic education. Dr. Bastyr considered manipulation the most important therapy in his practice.

So there you have it: the mystical unity of three seemingly incompatible True Causes (Psora, Subluxations, Toxemia), and of three seemingly incompatible True Cures (similia similibus curentur, spinal manipulation, enemas). No wonder that John Bastyr the chiropractor is credited with having been the Saviour of naturopathy and homeopathy in the United States.

Another Aside: Early Vaccinations really were Dangerous

It’s ironic to consider that many of the early objections to smallpox vaccinations were somewhat justified, far more so than are contemporary objections to contemporary vaccinations. Material gathered from cowpox blisters, transferred from human to human, was invariably contaminated. Diseases plausibly attributed to such “arm to arm” vaccinations, in the era before the Germ Theory elucidated such risks in advance, included syphilis, hepatitis, and even smallpox itself, due to contamination from variolations occurring within the same hospitals or clinics. The advent of exclusively animal sources of cowpox didn’t occur until the mid-19th century, and “arm to arm” vaccinations weren’t outlawed in Britain until 1898. Preparations of pure virus—vaccinia—were introduced only in the mid-20th century.

The political objection to mandatory vaccinations also had more clout in the early days, when the concept of “herd immunity” had yet to be introduced.

“All this has happened before, and all this will happen again.”

This is from a meeting of the Connecticut Homeopathic Medical Examining Board, March 12, 2003:

TREATMENT OF SMALLPOX

The Board reviewed the following procedures for the prevention and treatment of smallpox as submitted by Dr. Mullen:

PREVENTION

Malandrinum

It is recommended to administer it at a potency of 30 CH twice a day for up to 5 days as a preventive. This remedy is also very useful to combat the ill effects of Allopathic small pox vaccination, as well as to control the disease that happens when a person gets unwillingly infested by the vaccine received from another.

Sarracenia

It is recommended to administer this remedy at potencies of up to 9 CH. I believe a good dosage schedule would be once a week for 2 or 3 weeks. It is recommended to administer this remedy at a potency of 6 CH every 8 days. Also useful in recent and distant ill effects of Allopathic vaccination.

Vaccininum

An indication for the use of vaccininum would be a patient’s fear of contracting smallpox.

Variolinum

Both Drs. Allen and Vosin enthusiastically endorse this remedy for the prevention of small pox. I would advice to administer it at potencies of 30 CH or 200 CH weekly for 3 or 4 weeks.

TREATMENT

Malandrinum

It is recommended to administer it at a potency of 30 CH. This remedy is particularly useful in patients whose symptoms are more evident in the lower half of the body. I would recommend daily administration for 5 consecutive days and then re-evaluate the patient.

Mercurius 200 CH every other day alternating with Thuja 200 CH.

I would recommend to use this combination up to 10 consecutive days and then re-evaluate the patient.

Sarracenia

It is recommended to administer this remedy at a potency of 9 CH. I would recommend to use it for 5 consecutive days and then re-evaluate the patient. This remedy can stop the disease in its earliest stages, including the development of pustules. The patient may be very sensitive to light, weak in the shoulder area and have shooting pains in zigzag from the lumbar region to the middle of the scapula.

Variolinum

It is recommended to administer it at any potency. I would recommend using it for up to 5 consecutive days, depending on the potency, and then re-evaluate. Variolinum is useful in patients with mild and uncomplicated small pox. Also when pustules are surrounded by a red halo and are often very itchy. Every other day for up to 10 consecutive days and then reevaluate the patient.

Thuja 200 CH

Every other day for up to 10 consecutive days and then re-evaluate the patient.

Wow. What exquisite, quaint, balderdash. Here’s a fun exercise that readers might enjoy: see what contradictions you can find between what you’ve just read and other efforts of the Connecticut Department of Public Health. Hint: start here. Then look at some of the practice acts, such as those for homeopathy, naturopathy, and chiropractic. Does one hand know what the other is doing?

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Paradoxically, the less evidence that exists to support the use of of a treatment, the more passionate its supporters seem to be. I learned this early in my career as a pharmacist. One pharmacy I worked at did a steady business in essential oils. And king of the oils was oil of oregano. Not only were there several different brands of the basic oil, they were different forms, including capsules, creams and even nasal sprays. Not aware of any therapeutic benefits, I would ask customers what they were using it for. I rarely heard the same condition described: skin infections, athlete’s foot, head lice, colds, sore throats, “parasites”, “yeasts”, diabetes, allergies and ringworm were apparently no match against the judicious use of oregano oil. Intrigued, I took a closer look.

Long before our scientific understanding of bacteria and antimicrobials, infected wounds were packed with different products in an attempt to minimize the odour, and hopefully speed healing. It’s likely that someone happened upon a fragrant herb and discovered that it seemed to help treat wounds (or at least, cover some of the smell). Given there have been some amazing drugs with powerful effects that have emerged from natural products, it’s certainly plausible that oil of oregano could have biological and therapeutic effects. Oregano (Origanum vulgare) leaves contain a wide variety of chemical compounds, including leanolic acids, ursolic acids, and phenolic glycosides. Phenolic compounds make up to 71% of the oil. Carvacrol, thymol, cymene, and terpinine and are found in oregano leaves and do appear to have biological effects. It’s these chemicals that are proposed to be the parts with beneficial effects.

The claims made by one manufacturer are unambiguous:

Oreganol P73 is the most powerful germ killer with scientifically proven results against almost every virus, bacteria, parasite, and fungi. The complexity of the phytochemical matrix in Oreganol P73 possesses a broad spectrum of antimicrobial properties that are safe for prolonged use. The oil can be used topically and internally. Oreganol P73 is the medicine chest in a bottle, especially since it is proven never to harm the internal organs, even when used daily for health maintenance.

So if we accept the manufacturer’s claims at face value, there should be evidence demonstrating oregano oil is both safe and effective when used internally and externally. There is apparently also adequate long-term safety data to demonstrate that it can be safely used on a daily basis.

Effectiveness

When we contemplate administering a chemical to deliver a medicinal effect, we need to ask the following:

1. Is it absorbed into the body at all?
2. Does enough reach the right part of the body to have an effect?
3. Does it actually work for the condition?
4. Does it have any hazardous, unwanted effects?
5. Can it be safely eliminated from the body?

These questions are usually answered through a series of investigations, starting with preclinical (test-tube) studies, and moving into to animal trials, and then to human clinical trials that start with validating safety, and then progress to investigating efficacy and safety.

The short answer is that there’s little beyond animal studies to demonstrate that the ingredients in oregano oil have any effects. One of the best reviews seems to come from the McCormick Science Institute (yes, the spice company).  They commissioned a paper on oregano by Keith Singletary that appeared in the journal Nutrition Today in 2010. Happily, though the journal is paywalled, McCormick is hosting the paper on its own website.

1. Is oil of oregano absorbed? Some parts of the oregano do appear to be absorbed but the bioavailability of its different chemical constituents has not been verified. So we can’t be certain which components are reaching the circulation.

2. Does enough reach the right part of the body to have any beneficial effect? It’s not clear where the chemicals in oil of oregano act in the body, as no research has been done to show that it is adequately absorbed. However, there is some evidence to suggest that oregano may be implicated in inducing abortions in mice, so some parts of the herb must be absorbed, if this a causal effect. When applied to body surfaces or skin for topical effect, oil of oregano is more likely to reach high concentrations, at least locally, and then possibly deliver a medicinal effect. This makes topical effects seem much more plausible than ones that require ingestion.

3. Does it actually work for the condition? There is no published evidence to demonstrate that that oil of oregano is effective for any medical condition or illness. The McCormick review notes that that data for every condition evaluated is “preliminary, inconclusive.”  There is some very limited evidence to suggest that it might be useful for parasite infections — but given the evidence consists of only one study with 14 patients, and no placebo comparison, we really have no idea if the oregano oil itself was effective.

Let’s consider how oil of oregano might treat an infection. Bacteria are killed by antimicrobials based on a specific dose-response relationship. The minimum inhibitory concentration (MIC) must be reached at the site of an infection. Then there’s a concentration range where the bacteria (or viruses, or fungi, or parasites, depending on what you’re treating) are killed, typically in rough proportion to the dose. Keep increasing the dose, and the effect plateaus. If you can hit the MIC without causing side effects or toxicity, congratulations: you have a potential therapeutic agent.

There’s some evidence out there demonstrating that oil of oregano will kill different species of bacteria, etc in the test tube or Petri dish ( in vitro).  If I pour a pile of salt, lime juice, Cointreau, or tequila on a Petri dish, it will likely kill most bacteria too — but that doesn’t mean margaritas can treat pneumonia. It’s not difficult to kill bacteria if you change the conditions enough that it cannot live. So while it’s easy to get high concentrations of oregano in a test tube and subsequent positive effects, these effects are meaningless in the human body unless we can achieve similar concentrations, without any toxicity. And this has not been demonstrated with oil of oregano, or its individual chemical ingredients.

4. Does oil of oregano have any hazardous, unwanted effects? Natural does not mean safe. There are some reports of gastrointestinal upset with oil of oregano. There are also reports of allergic reactions. There is no evidence to suggest that oil of oregano, used at high (medicinal) amounts, may be used safely in pregnant or breast feeding women. However, when used in cooking, and as part of a regular diet, there is also no evidence that causes harm in pregnancy or breastfeeding. Animal studies show that if you give enough carvacrol, it will kill, though.

5. Can oil of oregano be safely eliminated from the body? So little published research exists on oil of oregano there is no way to determine if oregano oil is non-toxic. Certainly, at low doses, when used as a food, there is no reason to have any concerns. But at higher doses, and particularly with regular use, there is no data to sugges it’s safe to consume all that carvacrol, thymol, cymene, and terpinine. As we have no idea if and how oregano oil works, we have no information to estimate what a proper dose might be. Doses published by manufacturers are not based on any published evidence.

Conclusion

Oil of oregano, and the claims attached to it, is a great example of how interesting laboratory findings can be wildly exaggerated to imply meaningful effects in humans. A few small studies have been conducted, mainly in the lab, and advocates argue this is evidence of effectiveness. The rest is all anecdotes.

Despite the hype, there is no persuasive evidence to demonstrate that oil of oregano does anything useful in or on our bodies. And while it is popular, there is no science to support the use of oil of oregano for any medical condition. Suggesting that this herb is can effectively treat serious medical conditions like diabetes, asthma, and cancer is foolish and dangerous. If you’re ill, stick to the proven science, and save your oregano for cooking.

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This year The Amazing Meeting 9 (designated TAM9 From Outer Space) will be held in Las Vegas from July 14-17. If you have not registered, do it fast – this year the conference will likely sell out.

Among the many incredible speakers and events at TAM9 there will be a Science-Based Medicine workshop and an SBM panel discussion. The prominence of SBM at TAM9 partly reflects the new collaboration between SBM and the James Randi Educational Foundation (JREF), who organizes TAM.

The SBM website is now a joint project of the New England Skeptical Society (who founded SBM) and the JREF – two non-profit educational organizations dedicated to promoting the public understanding of science. I am delighted that the JREF is making SBM a priority, and we all look forward to working closely with them in promoting high standards of science in medicine and improved public understanding of the relationship between science and the practice of medicine.

As part of this new relationship I have accepted a position at the JREF of Senior Fellow and Director of their Science-Based Medicine project.

The SBM Workshop at TAM9 (which must be registered for separately) will include names familiar to our readers: David Gorski, Kimball Atwood, Mark Crislip, Harriet Hall, and yours truly. Because it is a workshop we want to focus on practical information for the professional and non-professional alike. The title of this year’s workshop is, “Oh, no. Not Again!: Recurring Themes in Medical Mythology.” After examining unscientific and sectarian health claims for years it becomes clear that the same basic concepts are being repackaged over and over again. Even looking back over the centuries and millennia at the history of medicine we see the same recurring concepts.

We will discuss the most common recurring themes in sectarian medicine and give examples of how they have evolved over the years. We will demonstrate that many of the “new” treatments and claims that are being marketed today are in reality nothing new, but just a reworking of themes that have been dissected and discarded by previous generations.

The goal of the workshop is to give attendees a working knowledge of how sectarian medical beliefs originate and are typically formulated. There is and endless succession of new dubious health claims out there – too many to address every single one individually. But by understanding the common themes underlying these claims, and the flawed science and logic used to promote them, one can recognize the flaws in “new” claims as they occur. Before long you too will be saying in response to the latest “new” health claim, “Oh, no. Not again!”

The SBM panel will take place during the TAM9 main program. I will moderate the panel, which will also include the workshop presenters as well as Rachel Dunlop and Ginger Campbell. The title of the panel discussion is, “Placebo Medicine: The Mechanisms and Misunderstanding of the Mysterious Placebo.”

The nature of placebo effects is more complex than most realize, and I find that even among otherwise savvy scientists and skeptics there remain a great deal of misconceptions about how placebos work, and don’t work. We will explore not only the nature of placebos but the ethics of their use in medicine, and their role in clinical trials.

We hope to meet many of our regular readers there (it’s good to put faces to pseudonyms), so please come up and introduce yourself to us, or just to say hi if we have met you at previous meetings.

Thanks again to the JREF for their support of SBM. We are all looking forward to the conference and collaborating with the JREF in the future to make the practice of medicine a little bit more scientific.

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People tend to limit their reading to sources that agree with their beliefs. We find ourselves mostly preaching to the choir; our message usually doesn’t reach those who most need to hear it. I recently received an inquiry from a science-based medical doctor asking how to approach others in building a bridge to clarify so much misinformation.

My first thought was that you can build a bridge but the real challenge is persuading people to cross that bridge. Like leading a horse to water…

How to approach others? That’s a tough question. The best approach varies with the individual and with where he is in his journey. Confrontation seldom works: it just makes people angry. It is counterproductive: it only serves to make them invent more rationalizations to defend their beliefs. Although sometimes anger can be a good thing. I got an e-mail from an acupuncturist who was incensed by an article I wrote saying that acupuncture was not based on good evidence. He set out to prove me wrong by looking up the evidence behind what he had been taught by his teachers about acupuncture’s efficacy for specific conditions, and when he couldn’t find any, he realized that his teachers and his textbooks had misled him with lies. He gave up acupuncture and went back to school to learn a science-based health profession.

If someone has never had his belief challenged and thinks it a universally accepted truth, it might do some good to show him otherwise. When I was in the dentist’s office earlier this week he asked me what I thought about detoxification. I told him I thought it was a pseudoscientific concept with no scientific validity, that proponents couldn’t even tell you what those “toxins” were, much less measure how much had been removed, and that there was no evidence that detox objectively benefitted patients. He had me repeat this to his assistant who was currently doing a detox. She looked at me very strangely and I may have created an enemy for life. But just possibly I may have started a small crack in her certainty that might someday widen to let accurate information seep in.

Some people respond to accurate information. I belong to the Healthfraud discussion list on Quackwatch and we have had several people thank us for providing accurate information, debunking false information, showing the fallacies in arguments for claims, and helping them learn about the scientific process. They tell us they have discarded their previous false beliefs because of what they read there.

When I spoke at a local college I mentioned that diet supplements are not regulated like FDA approved drugs and have been found contaminated with everything from insect parts to prescription drugs, and that dosages sometimes vary wildly from what the label says. One older student got very upset and said she was going right home to clean out her cabinet and throw all those products away.

I have gotten e-mails from people who decided not to waste their money at the Amen Clinics or on treatments with the DRX-9000 spinal decompression machine after reading my articles.

Unfortunately, many people do not respond to accurate information. Some people choose to form strong beliefs on hearsay or personal perceptions or ideological grounds without any input from science. Scientific information is irrelevant to them so they are not likely to change their minds no matter how much evidence from scientific studies you throw at them. It is useful to ask people what evidence it would take to change their minds. True believers frequently say nothing would change their minds: they know they are right and they are sure that testing would only serve to demonstrate the truth of their beliefs. It’s a waste of time to talk to these people.

I met a believer in dowsing and I gave him a book explaining the ideomotor effect, showing that dowsers had never been able to pass controlled tests, and debunking dowsing in detail. We held a public debate afterwards, and what he said was as if he had never read the book. He managed to just ignore everything in it: his “pro” side of the argument boiled down to two points: he’d personally seen it work and lots of people believed in it. That was enough for him.

Then there are people who are capable of responding to new information but don’t want to hear it. Don’t confuse me with the facts; my mind’s made up. It’s more comforting to have a belief and stick to it than to deal with uncertainty.

Something I haven’t tried yet but want to: ask them if they know of something that doesn’t work but that some other people believe in. Once you find something they reject, you might be able to argue that logical consistency requires that their pet remedy be rejected on the same grounds. For instance, if they reject bloodletting to balance the humors but accept reflexology, you might point out that during the many centuries bloodletting was used, there were far more testimonials from patients and doctors than there are for reflexology today. So if they accept reflexology on the basis of testimonials, they should logically accept bloodletting on the same basis. If they reject bloodletting because science showed it didn’t work, they should look more closely at what science says about reflexology.

Humor can be effective in making a point, like the comedian who said “Of course science doesn’t know everything; it KNOWS it doesn’t know everything, otherwise it would stop.” And like Mark Crislip’s “Alternative Flight.”

The best strategy would be to guide people to discover the truth for themselves and claim it as their own, but I’m afraid I don’t have the patience or the psychological acumen to carry that out. It’s too bad Socrates isn’t around to help.

I am not foolish enough to think I could ever influence true believers; but even for them, it might be possible to plant a tiny seed of doubt that might be reinforced by future experiences and might eventually grow into a plant. Dripping water can wear away the hardest stone over time. But realistically, I can only hope to reach the fence-sitters: those who have not yet irrevocably made up their mind.

I hope readers will share their own success stories and bridge-building ideas in the comments section.

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It’s the toxins.

Toujours les toxines.

How many times have I read or heard from believers in “alternative” medicine that some disease or other is caused by “toxins”? I honestly can’t remember, but in alt-world, no matter what the disease or condition under discussion is, there’s a good chance that sooner or later it will be linked to “toxins.” It doesn’t matter if it’s cancer, autism, heart disease, diabetes, hypertension, or that general malaise that comes over people who, as British comedians Mitchell and Webb put it, have more money than sense; somehow, some way, someone will invoke “toxins.”

I was reminded of this obsession among believers in unscientific medicine last Friday when I came across an article by Guy Trebay in the New York Times entitled The Age of Purification. The article appeared, appropriately enough, in the Fashion section and was festooned with photos of cupping, surely one of the silliest of the many “detoxification” modalities that alternative medicine practitioners use to claim to draw the “toxins” out of their clients through the application of, well, cups or various other containers in which the air had been heated in order to generate negative pressure when sealed to the skin and presumably thus bring them to a greater level of purification and health. Indeed, the only “detoxification” rituals sillier than cupping that I can think of off the top of my head are detoxifying footpads and “detox foot baths.”

Oh, wait. Scratch that. I forgot about ear candling, which must surely be the undisputed silliest “detox” treatment of all time—until someone thinks of an even sillier one. Or not. There are just so many silly “detox” procedures that it’s hard to select a “winner.”

Be that as it may, Trebay mixes sarcasm with exposition throughout his article in a rather amusing way that’s worth quoting:

My friend, like everyone else around, seemed to believe that mysterious, amorphous sludge had lodged in the anatomical crannies of half the local adult population. Unseen toxins were lurking, like Communists during the Red Scare.

The “toxins” required elimination, somehow, and thus at lunches, at cocktails, at dinner parties, normal conversations turned abruptly from the day’s news to progress reports on juice fasts, energy alignments, radical purging. From painful sessions with traditional healers to toxin-leaching treatments designed, it might seem, to clean out not just body but wallet, a surprising number of New Yorkers (not all of them well-to-do neurotics) are caught up in a new New Age, the Age of Purification.

How had it happened, I wondered, that so many otherwise sensible, urban people found themselves in the grip of a dreadful feeling that systems are down? “I just bought five pounds of carrots, ginger and kale and put it all in my Breville juicer and pounded that all day,” said a corporate adviser of my acquaintance, far from a credulous woo-woo type.

Of course, as we have noted so many times before, hard-nosed skepticism in one area of one’s life does not necessarily translate to other areas. Many are the people who would never ever fall prey to scams in business, for example, but happily fork over money for scams such as “detox footpads”—or fall for anti-vaccine quackery, like J.B. Handley. Whatever the case, why this fascination with “detoxification” in alternative medicine? Why do so many of its treatments, be they dietary, chelation therapy, purges, colon cleanses, or whatever, claim to eliminate “toxins”? Why is it that, if you Google “alternative medicine” and “detoxification,” you find so many references, some of which claim external toxins need to be eliminated, some of which claim that internal toxins need to be purged, and still more of which blame various “parasites” for all manner of health distress? In this post, I’ll try to explain, but first a little history—self-history that is.

“You’re poisoning yourself from within”

My first encounter with the concept of “detoxification” (at least, as it is described in alternative medicine terms) occurred perhaps 10 or 15 years ago, after I had been out of medical school several years and completed my surgery education. Basically, a acquaintance of mine had on her bookshelf on “body cleansing.” Given how much I’ve delved into “alternative” medical practices in the last several years, it’s truly amazing to realize that for the majority of my adult life I had no clue what “detoxification” was or what “colon cleanses” were. My ignorance at the time aside, I don’t remember the title, and I don’t remember the author, but I do remember that, as I leafed through the book, it became rapidly clear to me that “body cleansing” had nothing to do with taking a shower or a bath, at least not in this book. In particular, my attention was riveted to a chapter entitled “Death begins in the colon.”

It turns out that the admonition to beware of your colon trying to kill you came from a chiropractor named Dr. Bernard Jensen, DC, who is apparently known as the “father of colonics.” Personally, that would not be a name or title that I’d be particularly interested in having ascribed to me, but then I’m not a chiropractor. My avoidance of icky titles aside, this was my first ever real encounter with the nitty-gritty (much of the grit within the stool) of colon cleansing. What followed were two chapters, the first telling readers how supposedly up to 20 lbs. of fecal waste lurks in their colons, producing “toxins” that slowly poison them, the symptoms of which manifest themselves as lethargy and a sense of not feeling well, coupled with any or all of a huge number of potential conditions, including diabetes, hypertension, asthma, rheumatoid arthritis, and many others. What’s the solution?

Guess.

Yes, the solution, as I wrote about long ago, is colon cleansing, and this was my first encounter, up close and personal, so to speak, with the concept. What followed were long and rather lovingly limned descriptions of the vast quantities of feces, along with—dare I say it?—almost pornographic-seeming photos of what people fish out of their toilet after colon cleanses. (For examples of the sorts of photos that I encountered, click here, but only if you have a strong stomach.) In the text were passages like this:

It is no longer possible to ignore the importance of alimentary toxemia or autointoxication as a fact in the production of disease. To no other cause is it possible to attribute one-tenth as many various and widely diverse disorders. It may be said that almost every chronic disease known is directly or indirectly due to the influence of bacterial poisons absorbed from the intestine. The colon may be justly looked upon as veritable Pandora’s Box, out of which come more human misery and suffering, mental and moral, as well as physical than from any other known source.

The colon is a sewage system, but by neglect and abuse it becomes a cesspool. When it is clean and normal we are well and happy; let it stagnate, and it will distill the poisons of decay, fermentation and putrefaction into the blood, poisoning the brain and nervous system so that we become mentally depressed and irritable; it will poison the heart so that we are weak and listless; poisons the lungs so the breath is foul; poisons the digestive organs so that we are distressed and bloated; and poisons the blood so that the skin is sallow and unhealthy. In short, every organ of the body is poisoned, and we age prematurely, look and feel old, the joints are stiff and painful, neuritis, dull eyes and a sluggish brain overtake us; the pleasure of living is gone.

Even back then, having recently finished my general surgery residency, I knew this to be utter nonsense. The reason, of course, is that I was still doing abdominal surgery back then, and I had done a lot of colectomies in urgent situations, where there was no time to prep the colon using GoLytely or something similar. Never once had I seen anything resembling the sorts of horrors delineated in this book. While that didn’t rule out that some patients might be as described in the passage above, it certainly indicates that having 20 lbs of fecal waste clogging up one’s insides is not nearly as common as the colon cleansers seem to believe. Similarly, I had done a number of colonoscopies in patients with unprepped colons, and, similarly, had never seen anything like this. None of this means such a thing is not possible, but in reality if a person’s colon has 20+ lbs of impacted fecal matter that person is going to be suffering not from chronic illness or a vague sense of illness. That person is likely to be, to use a scientific term beloved among the surgeons under whom I trained as a resident, sick as snot. In other words, while it is true that the fecal matter in our colons can make us sick, it’s quite uncommon that it does make us sick. Becoming ill from our own fecal waste matter usually only happens when something bad happens to break down the protective barrier of the colon and allow wee beasties that normally reside there to translocate into the bloodstream. For example, common causes of such breakdowns in mucosal barrier function usually involve severe physiological insults resulting in too little blood getting to the colon; i.e., sepsis, shock due to massive bleeding, or acute cardiac failure. These are usually not subtle things.

I told my acquaintance that whoever had written that book was full of…well, never mind. My experience, however, had been, if you’ll excuse the term, indelibly stained. I also came quickly to realize that the concept of autointoxication seems to have a lot more to do with religious concepts than science:

“The body as hotbed of festering sin was first examined by St. Augustine,” said Caroline Weber, a professor of French literature at Barnard College and Columbia University and a writer who often explores the weird byways of shifting cultural mores. “It was adopted later by monastic orders in the form of practices like self-flagellation, the wearing of hair-shirts, ritual fasting and the mortifications of the flesh.”

What is “detoxification” but ritual purification in another guise?

Attack of the toxins

If we are to believe the “detox” cult, our bodies are a pestilent sea of toxins, arising both from internal sources (the colon being but one example) and external sources. That’s why it’s useful to divide our “toxic exposure” from an alt-med perspective into two general kinds: External and internal, the latter of which is often referred to as “autointoxication.” External toxins are easy to understand and consist of pretty much anything that is viewed as toxic that enters the body from the environment. This term thus encompasses diet, pollution, and, of course, the ever-favorite bugaboo, “toxic chemicals.” Don’t get me wrong; there is no doubt that certain chemicals can be toxic. Further, there is no doubt that some environmental exposures can make us sick. Even further still, I do not deny that there have been times when chemical companies have behaved, to put it mildly, less than admirably when it comes to chemical spills and their consequences (Love Canal, anyone?)

That’s why I want to make it absolutely clear that these sorts of demonstrated, defined adverse health events are not what’s meant most of the time when when alt-med believers discuss “toxins.”

As for “internal” toxins, there is the aforementioned belief in “autointoxication” due to massive build up of fecal matter, and then there is—well, let me allow naturopath Robert Groves explain, given how heavily naturopathy emphasizes “detoxification”:

Autointoxication is poisoning by toxic substances generated within the body. In this process the body breaks down the parts that have served their function and attempts to, but fails to fully (or in the proper amount of time) neutralize their poisons and transports them out of the body. When these substances are not properly neutralized and/or eliminated, they damage our other cells causing dysfunction and disease. This continual cycle of destroying and eliminating the old worn out materials and cells happens in a time frame from split seconds to many years depending upon the type of cells and the substances. As an example of this regenerative process, your liver regenerates itself in about 3 weeks. The old cells are now waste to breakdown and move out. The body does this in a number of ways with the help of a few friends such as antioxidants, minerals, vitamins, viruses, bacteria, etc.

Anyone who has a basic understanding of human physiology should immediately recognize how poor an understanding of bodily function the article by Groves represents. Indeed, while the above passage is superficially correct about how the body is continually renewing itself, the conclusions Groves draws from this knowledge are so wrong they’re not even wrong, particularly his answer to the question of why detoxification is necessary:

If you don’t detoxify, you’ll blow up! It sounds like I’m kidding and in some ways I am and other ways I’m not. If there is intake and metabolism, but not elimination of the substances ingested or byproducts produced, an increase in size will occur. This is a matter of physics, the old saying “if you eat more calories than you burn you will gain weight” routine. Without proper elimination of unnecessary substances, obesity will be a problem at the very least. Bacterial and yeast overgrowth will increase bloating and create rotting of the entire digestive system. The cells of your body will no longer have room to take in nutrients and burn them (metabolism) resulting in fatigue. Consequently, the cells will fill with waste within and also in the interstitial space or area surrounding them (toxemia). In this state they will starve, as they are unable to absorb nutrients (malnutrition), and/or be denied oxygen causing cells to suffocate (hypoxia), and finally will die (necrosis). When enough tissues die, your organs die, and when enough organs die, you die.

Again, this is utter nonsense, too. First of all, there is no reason why the amount of waste must necessarily precisely equal the amount of food ingested. After all, what happens to the part of the food that we actually use for energy? How on earth is it that Groves thinks that if we take in too many nutrients we will “run out of room” to use any more, resulting in fatigue? After all, one might well argue part of the problem with our physiology is that it is too efficient in using calories far beyond what our bodies need, happily storing them as fat. Be that as it may, the body has very finely tuned and efficient mechanisms for disposing of waste material or recycling it into other molecules that the body needs, such as proteins, nucleic acids, and lipids. The liver is incredibly adept at getting rid of various waste products, as are the colon, lung, and kidneys. Except when these organs fail, help is rarely necessary; the body can “detoxify” itself just fine, thank you very much. Groves makes an analogy to an automobile in which the owner rarely changes the oil, rarely replaces the filters, and uses bad gasoline. Of course, an automobile is not capable of self-renewal the way that the human body is, which is why, although this analogy may seem attractive, it is too off-base to have even a whiff of a hint of any validity.

In all fairness, it should be noted that the very concept of “autointoxication” was not an alternative medicine concept per se, at least not 100 years ago. True, it is an ancient concept that dates back to the ancient Egyptians, who believed that a putrefactive principle associated with feces was somehow absorbed by the body, where it acted to produce fever and pus, and the ancient Greeks, who extended the idea beyond digestive waste in the colon to include the four humors and incorporate the concept into the humoral theory of medicine. Even so, it was also a concept promulgated by proponents of scientific medicine in the late 1800s and early 1900s. The concept was very much like what I’ve described so far, namely that putrefactive products of digestion remained in the colon, there to leech into the bloodstream and sicken patients due to autointoxication. Indeed, some surgeons, chief among them Sir W. Arbuthnot Lane, advocated total colectomy for the autointoxication that was thought to be the cause of diseases ranging from lassitude to epilepsy. Given that there were no antibiotics effective against colonic flora back then, intestinal surgery was still fraught with peril due to the high rate of sepsis and death, making this approach reckless indeed, even by the standards of the time. Eventually, even Sir Arbuthnot Lane came to the same conclusion and by the 1920s had changed his mind, deciding that diet was the answer. In any case, also by the 1920s, science had shown that the various symptoms observed in patients with chronic constipation were largely due to distension of the bowel and were not due to autointoxication. As is its wont, scientific medicine moved on from a failed hypothesis.

In marked contrast, as is their wont, alternative medicine practitioners clung all the more tightly to this failed hypothesis, an embrace that continues to this day.

What are these “toxin” things, anyway?

The first thing you need to understand when trying to figure out what toxins are is to realize that what an alt-med practitioner means when he or she mentions toxins resemble what a physician, scientist, or toxicologist means when he or she mentions toxins only by coincidence. In science, the formal definition of a “toxin” is actually quite narrow. Basically, a toxin is a poisonous substance produced by living cells or organisms. Man-made substances that are poisonous are not considered, strictly speaking, “toxins” by this definition. Rather, they are called toxicants. In marked contrast, alt-med practitioners do not distinguish between “toxin” and “toxicant,” lumping them all together as “toxins,” be they the products of autointoxication, heavy metals, pesticides, or industrial chemicals. To the alt-med practitioner, they are all “toxins,” which is why at this point I tend to make like Gunnery Sergeant Hartman and proclaim that I do not discriminate based on toxins, toxicants, or heavy metals. To me, in alt-med usage, they are all equally worthless.

Nomenclature aside, however, perhaps the most important differences in how science views toxins versus how alt-med views toxins is in demonstrating an understanding of (1) identity and (2) how the dose makes the poison. When toxicologists speak of toxins or toxicants, they tend to be very specific about the identity of the toxin or toxicant; they do their best to identify the specific compound or chemical that is causing illness, regardless of its source. This is often not an easy task, because there are frequently many confounders. Rarely are we fortunate enough to have a smoking gun like Minamata disease for mercury poisoning or the syndrome associated with Thalidomide dosing. This is particularly true for chronic disease as opposed to acute poisoning. In marked contrast, alt-med aficionados are almost intentionally vague when discussing toxins. To them, it seems, toxins are either all-purpose nasty substances without specific identities or substances whose toxicity appears not to depend upon dose. In the former case, toxins might as well be miasmas. If you’ll recall, the miasma theory of disease stated that infectious diseases were caused by a “miasma”; i.e., “bad air.” This was not an unreasonable concept before the germ theory of disease, because before germ theory the agents through which infectious disease was transmitted were unknown, but it’s not so reasonable now. Alternatively, “toxins” often seem to function like evil humors in the humoral theory of disease. Either way, alt-med toxins do not correspond to anything resembling toxins or toxicants in science.

My favorite example of this comes from the anti-vaccine movement. Remember our old friend Dr. Jay Gordon, pediatrician to the children of the stars and anti-vaccine apologist? A couple of years ago, “Dr. Jay” (as he likes to call himself) asserted that formaldehyde is a horrible toxin in vaccines. Yet, formaldehyde is a normal product of metabolism and ubiquitous in the environment. As I pointed out at the time, Dr. Jay breathes far more formaldehyde sitting in L.A. traffic jams than is in the entire vaccine scheduled, and human infants have many times more formaldehyde circulating in their bloodstream than would be contained in any vaccine. Believe it or not, I personally engaged in a long exchange with Dr. Jay trying to get him to understand why the “formaldehyde” gambit makes no sense from a medical or scientific standpoint. I’m still not sure whether I got through, because periodically he pulls in essence the “toxins” gambit, in which ingredients in vaccines are listed, along with all sorts of scary potential adverse effects, with no mention given as to the dose required to result in those toxic effects.

When it comes right down to it, alt-med “toxins” are as fantastical as the sympathetic magic that is the basis of homeopathy.

But how do you get rid of toxins?

Given that these magical, mystical “toxins” are ubiquitous, the methods proposed to eliminate them are legion. Still, they tend to break down into five main methods. Often two or more of these methods are combined in order to flush out those evil humors toxins:

• Diet. Key to many “detox” regimens is diet. These can range from all juice diets such as the “Master Cleanse” diet, which consists of lemonade, maple syrup, and Cayenne peppers (I kid you not) to raw food diets such as the ones I’ve discussed (cooking food apparently loads it up with toxins) to any number of other bizarre diets.
• Colon cleansing. Discussed in depth by yours truly three years ago and better known as regularity über alles.
• Heavy metals. This is where “chelation” therapy comes in. In essence, the claim is that we are all overloaded with “toxic” heavy metals. The treatment is, of course, chelation therapy. Unfortunately for quacks (and fortunately for us), genuine heavy metal poisoning is increasingly uncommon. Removing lead from paint has made it less and less common for babies to be poisoned when they put paint chips in their mouth, and removing lead from gasoline has decreased the amount of lead people breathe in. Moreover, there are specific criteria for the diagnosis of poisoning due to specific metals, and chelation is only useful for some metals. It’s also important to remember that, for all the claims of anti-vaccine activists that mercury in the thimerosal preservative that used to be in some childhood vaccines causes autism, not only is there no evidence to support this claim, but there is a lot of evidence against it. Worse, often the diagnosis of “heavy metal toxicity” made by alt-med practitioners is based on “provoked” urine levels, a methodology that has no validity.
• Skin detoxification methods. These methods claim to purge the “toxins” by eliminating them through the skin. They include modalities such as “cupping”, pads like the infamous Kinoki footpads whose manufacturers claim they can draw toxins out through the soles of the feet, and the even more infamous “detox foot bath,” where the water turns colors regardless of whether your feet are in there or not.
• Manipulative methods. These tend to break down into methods like massage therapy and “lymphatic drainage,” basically manual methods that claim to “improve lymph flow” and thus “detoxify” the tissues. Examples include rolfing and lymphatic drainage massage (which, while feeling good, doesn’t remove any toxins that anyone can show).

The bottom line is that in medicine, “detoxification” has a specific meaning, and alt-med “detox” believers have appropriated the term for something that has little or nothing to do with its real medical meaning. Basically, in real medicine “detoxification” means removing a real and specific toxin or toxicant (or set of toxins and/or toxicants). In the case of real heavy metal poisoning, chelation therapy is real detoxification. Similarly, using lactulose to decrease the production absorption of ammonia by the gut is an example of detoxification. In contrast, alt-med “detoxification” is far more akin to the exorcism of evil spirits, the removal of evil humors, or the driving away of miasmas.

Fashionable nonsense

It’s not clear to me what’s behind this latest wave of detox faddism, but it’s clear that the concept that we are somehow being “contaminated” or poisoned is nothing new. Perhaps my favorite pop culture example is from a movie that’s nearly 50 years old, Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb. In this blackest of black comedies, U.S. Air Force Brigadier General Jack D. Ripper has a paranoid delusion that fluoridation of water is a Communist plot that will lead to the contamination of the “precious bodily fluids” of every American. Acting on this belief, General Ripper initiates an all out first strike nuclear attack on the Soviet Union, and the rest of the movie involves the increasingly darkly funny efforts of the U.S. government to recall the bombers and abort the attack in order to prevent global Armageddon. The idea “contamination” and the need for “purification” goes back much farther than that, though, as Trebay notes:

The idea of toxicity is a constant in Western culture, said Noah Guynn, director of the humanities program at the University of California, Davis, and a researcher into the cultural meanings of ritual cleansing. “We’re obsessed with the idea that our environments have turned against us, that they are poisoning us and we have no choice in the matter,” Dr. Guynn added. “We’ve been contaminated by something that you cannot eradicate, you can only treat.”

Whatever the reason for the resurgence of belief in various “detox” modalities, one thing’s for sure. Unnamed, unknown, undefined “toxins” are the new evil humors and miasmas, and detoxification is the newest fashionable form of ritual purification.

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