f Ed's Guide to Alternative Therapies

Contents:

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This page was last modified August 23, 2011.

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I'm a board-certified anatomic and clinical pathologist and operator of the largest one-person medical information site on the web. As a pathologist, it's my job (among others) to examine tissue, tell what's the matter, and predict the behavior of the disease and response to therapy. Like most other pathologists, I'm extremely successful at this. Like most other pathologists, I take a lot of pride in this. (Call us arrogant if you like. I am an honest physician who engages in public debates. When I catch somebody deliberately deceiving the public, they never defend their cases on the facts, but almost always call me "arrogant" or "elitist" and claim I am secretly in the pay of the wicked pharmaceutical companies.) And if I screw up even once, I'm in MAJOR trouble.

Unlike many M.D.'s, I'm open-minded about what's known as "alternative medicine", i.e., therapies that are not recognized by mainstream medicine. During the 1980's, I reviewed alternative medicine and found there was little to recommend. As the alternative medical community has responded to pressure to defend its claims by the usual methods of science, some areas have improved.

This site aims to let the public know what empirical evidence is available for various alternative remedies, especially studies published in refereed journals. This will enable people who must make decisions to rely on more than anecdotes and advertising.

This site will always be under intensive construction. Only a fool pretends to know everything. I cannot buy or read a book, but I am interested in your personal experiences ("anecdotes"), and especially in real work by real scientists (i.e., people taking serious precautions against self-deception.) Unless you specify otherwise, I'll feel free to quote you.

I would be remiss without placing links to Quackwatch . The fact that I am less likely than some members to dismiss alternative claims out-of-hand probably reflects our differing life experience. Remember there are plenty of bad doctors in both "mainstream medicine" and "alternative medicine".

Here's the ranking system that this site will use:

The remedy has a plausable mechanism and has been given some basic tests, and/or has solidly passed two good, clear, controlled studies

The remedy makes sense pathophysiologically, and there is at least impressive anecdotal evidence

The anecdotal evidence seemed interesting to me, but that's all there was.

I can see why somebody might have thought of this. But if this actually works better than a placebo and a little human kindness, we are all going to have to make some major readjustments in how we think about health and disease. Don't spend too much money, or get your hopes up.

Bold indicates the remedy has passed a controlled, reasonable-sounding study for this use. Underlining means it failed. Claims that lack substantial testing are unmarked.

Here are some things that are NOT "alternative medicine".

People who believe their own claims will make every effort to do controlled studies. If their therapy works, it should pass some controlled study sooner or later. If positive results are obtained, some other scientist will always try to duplicate the work. If this succeeds, the claim is "reproduced", and you can present a truthful, honest claim to the public.People who don't believe their own claims will start complaining about "lack of funding", "the Heisenberg uncertainty principle", "placebos are valuable and ethical too", "politics in science", "social causation", "you create your own reality", "Thomas Kuhn", "closed-minded medical establishment", "persecuted geniuses", "we will NEVER treat individual whole-persons as statistics", etc., etc.

Another very popular claim by charlatans, who admit they have no placebo-controlled studies, is to observe that the vast majority of today's therapies have not been placebo-controlled. These people either don't understand or are lying about the central model of a modern medical study -- clinical equipoise. The control group isn't people receiving no treatment. It is people receiving the most popular standard treatment. To be ethical, there must also be a reason to think the treatment will be superior.

"The Beautiful Truth" / "Dying to have known": In Max Gerson's era, no child was ever cured of leukemia. To demand that in 2009 we randomize children with leukemia between the modern therapy that cures that vast majority, and a "treatment" group getting only a magic raw-liver-and-vegetable-based diet and coffee enemas, without even an animal model, would be a crime against humanity. Go ahead and call me an unspiritual corrupt brainwashed bigot if you want -- I've stopped answering my crank mail.

When lives are at stake, I don't think asking for a controlled study is asking too much. Do you?

If there are published, controlled studies, find out what they showed.

If the statistical effect is pronounced and reproducible, you can be confident we have something real. If it is not reproduced, there may have been some intentional or unintentional bias in the original lab.

CAUTION: As charlatans become more sophisticated, you occasionally find books that list refereed journal publications by the dozen. For example, somebody promoting oral superoxide dismutase to prevent aging will cite references to the substance's activities in the body, the harmful effects of free radicals, and so forth. This is the old salesman's technique of telling a bunch of truths, so you won't notice the lies... (1) Superoxide dismutase isn't going to make it from your stomach into your cells, but will be destroyed; (2) free radicals may contribute to degenerative disease, but they do not cause aging; (3) animals that produce huge amounts of superoxide dismutase age as fast as others. If you're in doubt, feel free to phone the authors of the papers that are cited in the dubious book... I've done so occasionally, and they have been VERY unhappy to learn that...

Possibility 2: Everybody knows it works. I'd like to illustrate this with an example. I like working out, and in the late 1980's, I obtained an EMS unit that I'd heard could accelerate my muscle growth. The anti-quackery literature listed this as fraudulent, but it made sense biologically, and I decided to do a pilot study, using the EMS unit only on the right side of my body. The end-point would be three people telling me (without my asking) that I was asymmetric. This took about a month. I decided to report my study in a letter to the JAMA, but first I went again to the refereed literature and I discovered an article that described EMS as generally known to be effective in accelerating muscle hypertrophy.

Possibility 3: Nobody stands to make a buck. Nowadays I really doubt it. The unpatentable alternative remedies that obviously work (melatonin, DHEA, creatine, St. John's wort, strontium for osteoporosis) are widely marketed, presumably for just a modest profit.

Any proposed mechanism of action can be wrong. For example, I was taught totally-wrong mechanisms of action for bismuth anti-ulcer remedies, dandruff shapoos, nitroglycerine for angina, and nitroprusside for hypertension. (I congratulate myself for having been skeptical as a student.) So if a proposed mechanism for an "alternative remedy" sounds wrong or even silly, don't dismiss the remedy out-of-hand.

Be skeptical about remedies that cannot work by any means presently known to science or religion. I'm open to the reality of the supernatural -- in fact, as a Christian, I'm committed to it (though not necessarily to the effectiveness of intercessory prayer or laying-on-of-hands.) Enough of this for now.

Acai Berries

The fruit of the acai palm tree, which like everything else contains some biologically active molecules, was presented as a multi-level marketing scheme in 2004. Claims included weight loss and "cleansing". The shady work of the marketers is now history, as is Oprah's successful lawsuit against them. A pilot study of acai for weight loss was a miserable and total failure (Nutr. J. 10: 45, 2011). At least the juice seems not to be toxic or carcinogenic (Toxicology 278: 46, 2010. There junk journal claims ("adding it to cigarets prevents emphysma in mice"), etc., etc.

Acupuncture

References to follow.

Many people who have experienced acupuncture treatment believe that it caused physiologic changes beyond just suggestion and relaxation. As acupuncture moves from folk medicine into real scientific therapeutics, physicians will insist on sorting out the placebo effect and the cultural overlay.

Acupuncture appears to have effects on neurally-mediated reflexes. Because the reflexes are so subtle, studies will remain empirical for a long time to come. Positive studies will need to be replicated, especially since the strong feelings that some people have in favor of acupuncture may introduce bias. This will probably happen soon, but to date, there are no findings of effectiveness (i.e., this particular acupuncture procedure works in this particular situation) that are robust after being replicated in several different series.

Serious studies of whether traditional acupuncture is actually more effective than placebo now use sham acupuncture as the control. In "sham" acupuncture, the operator deliberately needles the wrong points. This isn't double-blind, but it's a start. There are positive results (i.e., real acupuncture is significantly more effective than sham acupuncture) for nausea and vomiting after gynecologic surgery (weak), epicondylitis, anxiety in the emergency pre-hospital care setting, and even parental anxiety during anesthesia induction in a child. In one study of nausea and vomiting after tonsillectomy, the control group did better and the sham group did worse than those not treated at all.

In a few instances, acupuncture has proved superior to a standard medication. One example is an electrical technique for post-operative nausea and vomiting after cosmetic surgery. In another instance, stimulation of a particular needle-point proved as effective as a standard anti-emetic for post-operative nausea and vomiting in children. Another study obtained a similar result for children undergoing anesthesia in the dentist's office.

In the anesthetized patient, the placebo phenomenon is less likely to be operating. Electro-acupuncture is now widely used in Europe to reduce the need for anesthetic agents, and the effect was strongly significant in a US double-blind study.

There are also numerous negative studies, in which particular techniques applied to particular clinical problems showed no significant effect. This is in spite of the fact that acupuncture proponents might be reluctant to share a negative study. An electrical technique failed for low back pain. Another electrical technique failed to reduce the need for anesthetics. A major study showed no effect for asthma. Urologists were unable to obtain any benefits by needling the "kidney-ureter-bladder" meridian. "Minute sphere acupuncture" failed to help postoperative pain or morphine use. Despite an apparent effect in one study of cocaine addicts, acupuncture did not outperform relaxation or sham treatment for cocaine addiction in a second study. Unlike some other complementary therapies, acupuncture did not show an effect in a major study of chronic low back pain. Although two non-blinded studies of acupuncture for tinnitus suggested an effect, four blinded ones showed no significant effect.

Some large studies have actually not included a sham-acupuncture group when it would be easy to do so. These do help make it clear that acupuncture is relatively safe. Recent studies without a sham control but with positive results compared to no-acupuncture include one for low back pain in the elderly, another for nausea and vomiting during cyclophosphamide infusion for rheumatic disease, another for wheelchair-user's shoulder, another for childhood constipation, and another for labor pain. Two British studies found that a trip to the acupuncturist gave good results for chronic headache patients at relatively low cost to the health care system. The question was, "Is this worth the money?" rather than "Is this anything more than a placebo?" The authors characterized their own approach as "pragmatic". In turn, there are ethical questions involved in placebo treatment, even to make people feel good.

Some studies of electroacupuncture claiming to show a benefit (i.e., for low back pain, nausea and vomiting of pregnancy, nausea and vomiting of myeloablative chemotherapy) have used as controls a non-electrical apparatus, which is not really blinding.

Physiologists are starting to characterize the reflexes involved in needle insertion. One surprising finding, awaiting confirmation, is the induction of mirror-image electrical activity when a myofascial trigger point is stimulated. Controlled studies showing no clinical benefit (for example, post-stroke leg spasticity) still showed curious reflex effects from treatment. Animals have reflexes in response to acupuncture treatment that may be abolished by certain medications.

Despite the training they receive, several acupuncturists examining the same patient are likely to recommend widely different needle placements. This was demonstrated in a test using a low-back- pain patient, and perhaps this is no different from other physicians. Practice is likely to become more standardized as the scientific work continues. Acupuncturists will need to decide how much to retain of the cultural trappings and imaginative physiology. We can expect that most will regard the "theory" as something to be treasured as a bygone age's attempt to understand the riddles of the body. Instead, its practitioners will recognize that the effects are really mediated by subtle reflexes that are not fundamentally unlike the other processes by which the body maintains its health.

Acupuncture seems to be safe overall. One acupuncturist perforated the right ventricle of the heart causing hemopericardium, and there have been several instances of pneumothorax. I have been pleasantly surprised with how few other complications have been reported during the last few years. My friends in oriental medicine asked me to mention that it's now standard to use single-use, presterilized, disposable needles.

Artemisinin for cancer

The anti-malarial drug artemisinin and its relatives are being promoted by the alternative-medicine community for cancer in general. There is some interest in their possible anti-cancer properties, and a few decent papers, mostly focusing on which patterns of gene expression predict that the drug will kill cells in tissue culture (Pharmacogenetics Journal 6: 269, 2006). They're well-known to do this, because they are poisons, and the fact that they kill cancer cells (J. Med. Chem. 49: 2731, 2006, from the Hop) should come as no surprise. Especially, they may have activity as angiogenesis blockers.

The foremost proponent in the US seems to be Dr. Henry Lai, whose professional degree is in psychology and who teaches in the department of bioengineering at U. Wash. His focus on the effects of non-ionizing fields on humans seems to have led him into fringe medicine, and he has been writing papers about artemisinin as an anti-cancer agent since 1995. He notes that breast cancer cells reportedly (a few old papers in obscure journals) tend to have more surface transferrin (iron-binder) than their benign counterparts. So artemisinin (which generates toxic free radicals when exposed to iron) could induce apoptosis selectively in breast cancer. He managed to demonstrate this effect in a culture of breast cancer cells awash in iron-binder (Life Sciences 70: 49, 2001). Artemisinin alone was a dismal failure. At least he's honest. It sounds to me as if the breast cancer cells simply were more adherent for the iron-binder; the experiment does not support the claim that they have greatly increased transferrin surface levels. However, around this time, Dr. Lai speculated about how one could saturate the allegedly-increased transferrin molecules with enough iron, not mentioning that flooding the body with iron is itself dangerous. The iron-bearing pigment that accumulates in malaria is orders-of-magnitude richer in iron than one could possibly accumulate simply from having extra surface transferrin. (At least, both are ferric.)

Readers should know that there are no reports to date (despite ten years of interest, especially by Dr. Lai) of artemisinin inducing even a partial remission of any cancer in any animal system. The claim that there are 350 papers showing an effect on cancer is just another lie. The 88 that I found were mostly cell-culture studies without benign cells as controls. Conspiracy buffs who assume that the drug companies have shunned artemisinin since it's a naturally-occurring substance and therefore less profitable should note that taxol (a similar case) became part of mainstream breast cancer therapy as soon as it proved to work.

There just might be an effect. Dr. Lai actually got a chance to try it as a breast cancer preventative in mice in 2006 (Cancer Letters 231: 43, 2006). This was the only in vivo study I could find. He claimed an effect with p<0.1 (i.e., suggestive that the effect might be real). He ended his abstract "Since artemisinin is a relatively safe compound that causes no known side effects even at high oral doses, the present indicate that artemisinin may be a potent cancer-chemoprevention agent." Dr. Lai was somehow unaware that the year before the neurologists at UC-Frisco had reported a grisly case of toxic brainstem encephalopathy after artemisinin treatment for breast cancer in a lady who'd just had a cancer resected and thought it would be a good idea to add artemisinin (Ann. Neuro. 59(4): 725-6, 2006). Brainstem side-effects of artemisinin are in fact known clinically (NEJM 336: 1328, 1997). Thankfully, her illness subsided when her artemisinin was discontinued. Cause and effect? We can't prove it, but it's worrisome.

If you want to try artermisinin for cancer prevention or treatment, it's your decision.

UPDATE: 2011. The discussion continues. A correspondent who believes herself to have been cured of breast cancer entirely by artemisinin brought to my attention a very lively ongoing discussion as to whether the substance produces neurotoxicity (see Clin. Inf. Dis. 43: 1618, 2006.) This actually does not reference the index case. Dr. Lai continues to publish both on animals and cell culture and has findings that are interesting. There are still no reports of cancer regression in an animal system, but Cancer Letters 231: 43, 2006 (which is an elite journal) published the results of a model in which the treated animals got fewer / smaller tumors after treatment with a carcinogen (anti-cancer effect, altered carcinogen metabolism, or someting else?) I'm going to stand by my statement, "There just might be an effect", and wait with hope for the success of Dr.Lai, an investigator who is obviously a sincere and decent person.

Beta-mannan to reverse dysplasia of the cervix

Beta-mannans are presently being promoted by one individual as able to reverse most cases of dysplasia (pre-cancer) of the cervix. The principal promoter bases his claim on anecdotal evidence, but does claim 95% success.

Mannans are found in tomatoes and may have something to do with their empirical link to a lower rate of some cancers. They may prevent some of the mutations that accumulate to cause cancers. It's harder to see how they would reverse the mutations once they have happened. ("That'd be like reversing loss of virginity.") The promoter claims instead that beta-mannan stimulates the immune system, which is weak in Americans because of our alleged poor diet and smoking habits.

To his credit, the principal proponent has a side-note that urges women with frank cancer to get the required surgery.

People considering this "complementary remedy" need to know the facts.

Until I see a publication, I'll reserve final judgement. But I'm very much afraid this one won't work out.

The principal promoter of this complementary remedy is none other than the author of the old "Phantom Notes", which I found very helpful when I was on my surgery rotation. They were a superb resource; curiously, we had to send away for them and get them delived to us by mail. A few months later, a sheaf of "Bible Prophecy" stuff "that proved the truth of the Christian religion" was mailed to our PO boxes from "The Phantom". My Jewish friends especially did not appreciate this. "Bible Prophecy" still appears on the "beta mannan for cervical dysplasia" site. Again, you'll need to draw your own conclusions. In September 2003, a correspondent shared with me the court decision in a lawsuit against Dr. _______ for plagairism in connection with the Phantom notes. The judge had some very harsh things to say about him even back in the 1970's.

Anti-Malignin Antibody Test for Cancer

See my notes. This allegedly is an extremely sensitive and specific way of determining whether cancer is present in the body, and its proponents talk about its making pap smears, mammograms, and so forth obsolete. But after more than 20 years, only the original "discoverer" has described this substance as really existing. In a short (unrefereed) letter in "Lancet" announcing that his serum stains three different kinds of cancer cells, the discoverer failed to mention any control using any benign cells. (If the fundamental idea is correct, benign cells would be unstained.) I'm ready to draw the obvious conclusion. To the lab's credit, there is no talk of "conspiracies" or "cover-ups" or "persecution".

Botanicals for Diabetes

There is presently an online promotion of a "secret" natural remedy for both type I and type II diabetes. You'll have to find the site yourself, but the claims are obviously bogus.

A supposed scientific article is appended to the site. It is clear that this was not accepted for publication, even by a non-refereed junk journal. For starters, the composition of the remedy is not given. Second, the authors mention at least three previous studies but do not cite references. Third, there are no controls. There are also illiterate expressions. ("There is a remarkable phenotypic difference in Type 2 Diabetes. The connective importance of the genetic and environment causes of type 2 diabetes varies between people.") These people claim, in their ad, to make pancreatic islands regrow, but there are no tissue studies in the article. This is a sensational claim, and if there were any reason to think it were true, some scientific journal would have grabbed up the evidence. The shabby quality of the work is shown by the ad page, which states "The clinical study further concluded, '... treatment with _____ partially brought about a regenerative capability for the damaged endocrine tissues as evidenced by increased islet cell numbers and resulted in restoration of near normal architecture of pancreatic islet (sic.).'" Anyone who reads the fine print will see that this is simply untrue. The study cited shows nothing of the sort, but simply makes this statement about a second, unreferenced study. Even the name of the "independent lab" that supposedly did the tests is concealed from the reader.

If you want to send these people a few hundred dollars for their secret mix, that is your business.

Right now (2005), current articles in the genuine scientific literature on the use of "natural" remedies for diabetes are conspicuous by their absence. For a review of how herbalists design complementary therapy for diabetics, see Acta. Diab. 41: 91, 2004. "The ten most frequently suggested herbal remedies were gymnema, psyllium, funagreek, bilberry, garlic, Chinese ginseng, dandelion, burdock, prickly pear cactus, and bitter melon. The ten most frequently recommended dietary supplements were biotin, vanadium, chromium, vitamin B6, vitamin C, vitamin E, zinc, selenium, alpha-lipoic acid, and fructo-oligosaccharides." The reviewers felt some of these might help at least some. This is far from the grandiose claims made by the current promotion.

Bromelain / pineapple for goiter and so forth

Bromelain is an enzyme in pineapple that, as it happens, pathologists use in blood bank testing. In July 2010 I was alerted to promotion of magic pineapple juice, especially as a treatment for goiter (enlarged thyroid gland). This is very, very surprising. If enough bromelain were to get through your gut mucosa to have any effect, it would start by gravely altering your red cell antigens, like it does in lab.

Just to be sure, I ran a check of the NIH database that would find any study -- even a mouse study in a bottom-class junk journal -- on bromelain / pineapple and thyroid disease. Exactly nothing.

Various plants contain various chemicals that can enlarge thyroid glands. There may perhaps be something in some plant that has as as-yet-unknown effect on thyroid glands. The burden of proof is on the person trying to sell you the magic pineapple extract. It's your money.

If you have a goiter, the most important thing to find out is "Why?" Common nodular goiter often responds well to conventional treatment with thyroid supplementation. Medical disease of the thyroid is likely to kill if not diagnosed properly. And of course there's plenty of thyroid cancer. It's your life.

Follow-up: When I originally heard of the claim, I did not believe that any bromelain would make it through the gut mucosa. A correspondent brought to my attention Am. J. Phys. 273: G139, 1997. After taking 3 grams of bromelain a day, plasma levels reached as high as 5,000 picograms/mL. A picogram is one trillionth of a gram. I did the arithmetic and assuming a serum half-life of one day, one molecule of bromelain out of 600,000 will be absorbed. No drug company would issue an oral preparation with such a poor level of absorption. I stand corrected, and would invite the promoters of magic pineapple juice to take some of the stuff, or pure bromelain, intravenously and see how much good it does them. By the way, when I was in the blood bank, technicians were warned against inhaling bromolein powder because many people (maybe 50% of technicians) become allergic to it by this route and develop skin and lung problems.

Cesium Chloride for cancer

Cesium is an ion that cannot bond covalently with any other atom or molecule under any circumstances in a living body. Except for its ability to interact with electrical membranes, with potentially lethal results especially in the presence of kidney failure or if given by vein, it is as inert a substance as you can introduce into your body. However, taking a large dose is presently being touted as a cancer preventative or remedy, especially by a group representing itself as the "Life Science University Medical Center" or the "Life Science Universal Medical Center". (One must be a misprint, which is surprising in their own publication. I've taught in accredited medical schools for a quarter-century and I have never heard of them.) The author claims to conduct experiments in Rockville, Maryland, suggesting to the unwary that they are affiliated with the National Institues of Health. These people report an uncontrolled series of 50 end-stage cancer patients who were given cesium chloride plus other "holistic" remedies. The reported results are hard to understand:

An overall 50% recovery from cancer by the Cs. therapy was determined in the fifty patients treated. Data from the autopsy (sic.) indicated the absence of tumors in patients dying within fourteen days of the Cs-treatment.

One wonders what killed the people who died if they had no tumors. The author is a person using the pen name "Annie Appleseed" who admits to having no medical qualifications, but apparently claiming she performed and supervised these activities in 1981-2. It is hard to understand how the three patients in coma were fed whole grains and vegetables. Even harder to understand is why, if these accounts are true, there was never a publication, not even in an unrefereed junk journal. Further, why was this not noticed by the communist nations? Cancer was rampant in Russia and China, and they had an effective spy network. The supposedly-corrupt profit-driven capitalist medical establishment would have had no way of stopping the use of an effective cancer remedy which (had it worked) would have been a masterful stroke in the propaganda war against the West.

Of course, there is no refereed-journal publication on cesium chloride's anti-cancer effects. The explanation of how cesium chloride is supposed to work is obvious baloney. Supposedly, cesium in the extracellular milieu causes the pH of the cell to increase. Cesium chloride is cited as an alkaline salt, which raises the pH of the fluid itself. Cesium can supposedly enter a cancer cell but not a benign cell, and neutralize the acids that supposedly cause cancer. Finally, they claim that the pH in a cancer cell is "as low as 5.5", and that cesium in the milieu raises the pH to 8.0 which results in cell death within hours.

People considering this proposed mechanism should remember their high school biology. Simply because a cell is not dividing does not cause it to die. (Consider your healthy brain, heart, muscle, and most other cells.) Cesium chloride is not an alkalinizing agent any more than is table salt. Ask a grammar-school chemistry teacher. The claim that cesium can enter cancer cells but not benign cells is referenced only to the work of Brewer, a mid-1900's cancer charlatan with a physics background and if its own proponents believed it, they could easily test their own claim in any tissue-culture lab and publish in one of the junk journals for an honest reference. Of course they have not done so. The idea that unnamed acids cause cancer and can be neutralized is like saying the moon is made of green cheese. The claim that a cancer cell might have an internal pH of 5.5 is ridiculous. (Below 6.5 will kill any cell in a few minutes. And the dyes I use to stain cancer cells include pH indicators similar to litmus; of course no such pH change is evident.)

Of course, there are anecdotes. One patient whose cancer supposedly was observed by the author to shrivel to almost nothing within one hour after cesium administration. (Regrettably, soon afterwards she fell and broke her neck from a cancer-related hip fracture.) If this had actually happened anywhere near the National Institutes of Health, it would have been stolen by one of the research piranhas and published in a real journal. Of course there is no such publication, and "Annie Appleseed" cites a massive conspiracy.

Other sites repeat the grossly false claim that Otto Warburg's 1931 Nobel Prize was awarded for demonstrating that anaerobiasis causes cancer. He actually distinguished between aerobic and anaerobic metabolism and figured out how the cytochromes work. You can read his Nobel Prize lecture for yourself if you still don't realize that these people are trying to sucker you. Not surprisingly, these people also repeat the false claims that the Hunza people and reservation-dwelling Hopi people have a remarkably low incidence of cancer, attributed this time to abundant cesium in the diet.

Cesium chloride is a common chemical that costs almost nothing, though there might be a fee for administering it orally. If the proposed mechanism is accurate, then it should be sufficient therapy to provide a cancer cure. However, its proponents say it only works when given with other holistic remedies and a diet, typcially of uncooked foods, and under the supervision of a holistically-minded nutritionist.

Cesium in combination with aloe vera went to law in Maryland after a physician and two other people pretending to be physicians promised cures for cancer and AIDS. They went to prison. It used to be described at the Maryland Attorney General's site. At his site on coral calcium, Steve Barrett claims the regimen actually killed some people, but I couldn't find anything to support this.

Some of the cesium chloride sites accuse mainstream physicians of willful ignorance, attribute the vilest motives to them, compare them all to Hitler, etc., etc. If you still wish to become involved with the cesium chloride people, that is your business.

Citrus bergamot for dyslipidemia

The oil from the peel of an exotic orange has been used for decades by aromatherapists for various reasons. It is pungent and fragrant. The oil components also have some pharmacologic activity; it contains naringin, the bitter substance in grapefruit which is known to have a host of pharmacologic actions and especially drug-interactions.

One article from Spain in 2009 has been much-cited but I could not find it in a literature search, reports are that it has no controls, and the results seem too good to be true (which usually means they won't be verified.)

The one article in a NIH-listed journal (the obscure Fitotherapia 82: 309, 2011, from the med school in Catanzaro, Italy) gives results of oral trial on rats and people; there was a moderate cholesterol-lowering effect and some tendency to lower blood glucose in diabetics. The effects were most marked in folks with the metabolic syndrome. The authors simply called for some real, quality studies on humans because the kind of work they were doing is prone to false-positives. They did note that the oil inhibits HMG-CoA reductase just like today's statins.

That's it so far. Remedies that actually work generally get snapped up by the research piranhas and become mainstream, even when nobody stands to make a lot of money.

There's also a rat study in which the oil, injected into the blood, made the rats excited; no surprise. I eat orange peel myself sometimes, and if you want to try this out, it's your choice.

Clay Eating / Clay Therapy

Using clay as an aid to health. Special miracle clays from exotic locations (some of which supposedly concentrate cosmic energies) are sold to the "alternative and complementary community." There are probably some reasonable uses for clays in cosmetics, and I can't address the use of clay as a deodorant.

The claims are extremely diverse. Common sense would suggest that clay-eating would alter the gut flora and physical properties. For many years, a kaolin clay-based formulation has been in use in mainstream medicine as a diarrhea remedy, and some obscure journals are now looking at bentonite as well. Clay is included in some animal feeds, and some species consume certain clays selectively. Pilot studies are just now starting to appear in support of some of the more reasonable health claims for humans.

A study out of U. Az. confirmed the common-sense idea that components of clay are 'cidal for some pathogenic bacteria (J. Antimicrob. Chemo. 61: 353, 2008. Some obscure journals are looking at other clays especially for control of functional bowel syndrome, and it's not surprising that some clays adsorb and thus protect from mycotoxins. Thanks to my correspondent Kjell K. for bringing these to my attention.

Clay eating is known medically as "geophagia", a variant of pica. It's seen among the mentally ill, and in some places it's a cultural phenomenon, mostly among the poor (do we dare say "ignorant"?) See J. Roy. Soc. Med. 95: 143 and 274, 2002; South. Med. J. 95: 1228, 2002. One group in J. Exp. Bio. 207: 319, 2004 speculates how the widespread practice may have developed (trace-mineral availability, diarrhea control). Known hazards are intestinal obstruction (Archives de Pediatrie 11: 461, 2004), perforated colon (Acta Chir. Belg. 99: 130, 1999), lead poisoning (Clin. Ped. 43: 189, 2004; Amb. Ped. 3: 37, 2003), hypokalemia (a young mother-to-be's agonizing misadventure: Ob. Gyn. 102: 1169, 2003), and toxacara roundworm infection (you can get it in the US: South. Med. J. 91: 882, 1998; massive problem in Sri Lanka: Southeast Asia Journal of Tropical Medicine 34: 7, 2003; Brazil Curr. Op. Ophth. 12: 450, 2001; in Trinidad TRS Trop Med 96:139, 2002; several others).

Given that many members of the "alternative medicine community" believe that mercury in dental fillings is a terrible health hazard, it is surprising that there was no outcry after eating certain clays was found to produce clinical mercury poisoning (Conn. Med. 61: 207, 1997) or that there are no assays for mercury levels or other poisons on the clay promotion websites. If the consumers were clear thinkers, you'd think they'd demand to know.

I was able to find single hard-science study of a health claim for clay. A clay-based product was promoted for sheep to protect from locoweed toxicosis. It failed a controlled test miserably (J. Animal Science 75: 1867, 1997). As a food additive, there are two small controlled studies showing benefits for pigs and rats respectively. There may be more such in the future, with positive results.

One article that really helped me understand how people adopt their "cherished beliefs" was MMWR 47(43): 928, 1998. A lady from an anti-immunization family almost killed her baby by putting "health and beauty clay" on the umbilical stump, causing a dreadful anaerobic infection and neonatal tetanus. The clay was of course laced with tetanus spores, probably from decades of horse manure. When the baby recovered, the mother refused to have the child immunized because of "concerns about potential adverse effects".

Clay-eating is widespread and most people seem not to be harmed. Please be sure your clay comes from someone you have good reason to trust.

Colonic Irrigation for "Autointoxication"

Colonic irrigation with saline with or without phosphate is standard for a variety of diseases of the large intestine, including chronic fecal incontinence and the acute management of some mechanical and functional problems.

Presently there is a resurgence of interest in the old claim that the colon contents produce poisons that damage the rest of the body. This is actually true in liver failure, in which enemas and laxatives help appreciably with the brain malfunctions. (Octopamine and other bacterial products from the gut, if allowed to bypass the liver, act as false neutransmitters, sort-of-like "reverse prozac"). Evidence that anything like this happens when the liver is healthy hasn't been forthcoming.

I own a popular book promoting colonic irrigation. It showcases pictures of barium enema x-ray photos, and states that the areas where the colon is narrow are sites of "toxic bowel settlement", a substance (variously described as "slimy" and "cement-like") that accumulates on the wall of the colon, and that colonic irrigation removes. This is just a bold lie. The pictures represent the narrowings by which the colon propels its contents ("peristalsis"). As a pathologist, I have opened hundreds of colons and never seen anything like "toxic bowel settlement".

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Ed's Guide to Alternative Therapies - pathguy.com