I would be embarrassed by this cheap and easy post about chicken soup for symptoms of cold and flu, but I have a more serious purpose. I want to ask ScienceBlogger colleagues who inveigh constantly against alternative medicine (or "woo" as orac at Respectful Insolence insists on calling it) what they think of this and why.
Here's the set-up:
The suspected benefits of chicken soup were reported centuries ago. The Egyptian Jewish physician and philosopher, Moshe ben Maimonides, recommended chicken soup for respiratory tract symptoms in his 12th century writings which were, in turn, based on earlier Greek writings. But, there's little in the literature to explain how it works.[snip]
In 1993, Stephen Rennard, M.D., conducted an informal laboratory study and submitted the results as an abstract mostly because of its amusement value. Seven years later, his chicken soup research has been officially published in the Oct. 17 issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians. It is titled, "Chicken Soup Inhibits Neutrophil Chemotaxis in vitro."
Dr. Rennard, Larson Professor of Medicine in the Pulmonary and Critical Care Medicine Section at UNMC [University of Nebraska Medical Center], had for years watched his wife, Barbara, cook her Lithuanian grandmother's chicken soup recipe when a cold was going around her family of 10.
"She told me the soup was good for colds," Dr. Rennard said. "I've heard that a zillion times. Then I started to think, "well, maybe it has some anti-inflammatory value." Everyone's heard this from their mother in many cultures. No one seems to have a monopoly on the insight of the value of chicken soup."
Three batches of soup prepared in the home of Dr. Rennard were studied in the laboratory under controlled conditions. Researchers collected neutrophils from blood donated by healthy, non-smoking volunteers.
The study focus was to find out if the movement of neutrophils - the most common white cell in the blood that defends the body against infection - would be blocked or reduced by chicken soup. Researchers suspect the reduction in movement of neutrophils may reduce activity in the upper respiratory tract that can cause symptoms associated with a cold.
Colds are the result of infection in the upper respiratory tract, which causes inflammation. Although colds are not completely understood, it is believed the inflammation contributes to cold symptoms. Dr. Rennard theorized if soup can stop or reduce inflammation, it might reduce the symptoms of a cold.
In the laboratory, UNMC scientists diluted the soup and subjected the neutrophils to several variations of the soup, including vegetables, chicken and a combination of the ingredients. The team found the movement of neutrophils were reduced. Samples taken during the initial stages of the soup with chicken broth alone were not found effective in inhibiting neutrophil movement.
The researchers were not able to identify the exact ingredient or ingredients in the soup that made it effective against fighting colds but theorize it may be a combination of ingredients in the soup that work together to have beneficial effects. "All vegetables and the soup had activity," Dr. Rennard said. "I think it's the concoction."
Known as "Grandma's Soup," the recipe includes chicken, onions, sweet potatoes, parsnips, turnips, carrots, celery stems, parsley, salt and pepper. For comparison purposes, commercial soups were obtained from a local supermarket and prepared according to the directions on the label. Many of the soups had the same inhibitory effect.
"A variety of soup preparations were evaluated and found to be variably, but generally, able to inhibit neutrophil chemotaxis," Dr. Rennard said. "The current study, therefore, presents evidence that chicken soup might have an anti-inflammatory activity, namely the inhibition of neutrophil migration."
Researchers noted that "Grandma's soup" has several unusual features. It contains strained vegetables. Dr. Rennard noted, however, that the inhibitory activity was observed with several other recipes that lack the particles from vegetables. "Thus," he said, "while the identity of the biologically active materials is unknown, it seems likely they are water-soluble or extractable. Pureed carrots or other vegetables are not recommended as a remedy while chicken soup is." (University of Nebraska Medical Center news release)
Chicken soup for flu and colds has to qualify as alternative medicine, I would think. The question I have is this. What would allow it to escape the slings and arrows of Orac's mighty pen? In perusing his posts on the subject he seems to have two complaints about alternative remedies, which he tends to conflate, often sliding from one to the other. The first is that the treatment has not been shown effective via a Randomized Clinical Trial or other acceptable study design to work. There are some variations on this theme when trials have actually been done. Sometimes critics (not Orac as far as I know) will mistakenly say that the lack of statistical significance in a trial means any effects seen are due to chance ("small numbers" are a variation of this). This, of course, is incorrect but here isn't the place to go into why. Another response is that the trial is flawed (which many are). So that's the first complaint: no convincing demonstration of efficacy. Unfortunately much the same can be said for a lot of what we conventional practitioners do. I won't single out surgeons, but they are hardly free of this millstone (lobotomy, anyone?). OK, I guess I did single out surgeons. Orac is a surgeon.
The second complaint is different: there is no theory or scientific rationale. It is this defect that the present chicken soup "study" seeks to remedy. I'd like to know what Orac and other quack-fighters think. Is this kind of showing sufficient to move chicken soup as therapy out of the alternative camp? If not, how much and what kind of evidence would it take? And what if we have showings of efficacy without any scientific theory? You want an example? We still don't know how asbestos causes cancer, but on the basis of epidemiological studies we have no doubt that it does. A variation of this is that the proposed explanation is "magical thinking." That's perfectly fair as a criticism. Unfortunately, proposed counter-explanations are also vulnerable. If one takes "the placebo effect" to mean an interaction between the mind and the body that produces an effect, that's at the level of magical thinking in my book. If you provide a neurophysiological explanation that's fine (assuming you can give one). But then the remedy is actually having a physical effect so what's the problem? It's like a psychoactive agent. Counter-irritation as an assumed mechaism is another irritating wave of the hand that seems quite magical to me. What exactly is the mechanism of counter-irritation, say, for acupuncture anesthesia? If you give me one then aren't you giving me an explanation for how acupuncture really does work? If you can't, why isn't that a "magical explanation"? Or is the complaint about some alternative therapies that they might work but have the wrong reason? In which case much of conventional medicine is probably also in big trouble.
Underneath all this are certain difficult epistemological questions, chief among them what philosophers of science call the Demarcation Problem, i.e., criteria that can be used to separate science from pseudoscience. Many scientists think this is settled. Far from it. The two criteria they are likely to give most often, confirmability and falsifiability contradict each other. Moreover both have been abandoned by most contemporary philosophers of science (if they were ever accepted; Popper ruled no philosophical roost but his own). If the criterion is simply "testability" (itself a slippery idea), then astrology is clearly science, not pseudoscience, because it makes testable claims.
I am not raising these questions to rescue any alternative remedies, none of which I use, advocate or believe in, as far as I know. Instead I am trying to bring some humility to the discussion and make a counter claim that a lack of intellectual rigor isn't confined to one side.
Consider it a gauntlet thrown down to my colleagues. Just for fun.
Oh, I almost forgot. Here's the recipe for Grandma's Chicken soup, courtesy nbc6:
Researchers at the University of Nebraska came up with the following recipe, which they say can relieve cold and flu symptoms.
1-5 lb chicken
3 large onions
1 large sweet potato
3 parsnips
2 turnips
12 large carrots
6 celery stalks
1 bunch parsley
Salt and pepper to tasteClean the chicken, put it in a large pot and cover it with cold water. Bring the water to boil. Add the chicken wings, onions, sweet potato, parsnips, turnips and carrots. Boil about 1 and a half hours. Remove fat from the surface as it accumulates. Add the parsley and celery. Cook the mixture about 45 min. longer. Remove the chicken. The chicken is not used further for the soup.
Eat two bowls and go to bed and read me in the morning.
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A reasonable stipulation, it seems to me, is that only "alternative" and/or traditional healing practices that have some possibility of a causal physiological mechanism within the realm of known biology need be given benefit of doubt and tested with an open mind. Chicken soup is full of essential amino acids and all kinds of other biomolecules, and why shouldn't some have therapeutic function? Herbs, too, are clearly worth looking at for bioactive "drugs," and there is a long list of successful examples. I'd also include acupuncture in this list of has-a-hope-in-hell-of-working-physiologically altstuff.
Everything "woo" that I've read Orac inveighing against has been solidly in the other camp--spiritual, energy fields, chi, strange waves of new kinds of energy, liquids infused with intangible etherous spirits, etc.
There's a big difference.
CCP: If I'm not mistaken (Orac will correct me I am sure), acupuncture is one where he differs with you. The questions of qi, energy fields, etc., is again one of the two arguments used against alternative medicine. The other is efficacy. What if it is effective but for the "wrong reasons"? Does that make it alternative medicine to be disregarded? Or what if it ha the reasons "right" but still doesn't really work. A lot of conventional medicine is in this category.
Orac objected on my site to some of Sam Harris's stuff because he found that he was too friendly with "woo" in his book on atheism. If that were the criterion for objecting to someone's work, we wouldn't have had Newton's physics.
It seems to me that your comfort with chicken soup as a remedy relies on pure handwaving. If that is all that is sufficient to get something out from under the alternative medicine label, then I could probably do it for almost any remedy by changing the theoretical paradigm to something you are comfortable with. That's a pretty flexible criterion, and the example of acupuncture is a good example of what can happen.
Is there any reason why chicken soup shouldn't be beneficial?
For lots of alternative medicines (crystals, reiki, homeopathy) there are many reasons to think (if not know) that they shouldn't work.
As far as I know, chicken soup obeys all the laws of physics and chemistry. Most of 'woo' doesn't.
Smith and Pell's parachute efficacy study demonstrates that double blind trials aren't the only way to know if something is going to work. Common sense and sound science play a huge role in deciding if something is woo or not.
Simon: "Is there any reason why chicken soup shouldn't be beneficial?" Hmm. That's a new criterion. You hang everything on the reason given. Suppose I said, "Chicken soup works because it's made with lots of love and my mother said it was good for me." Or suppose I said, "Asbestos can't cause cancer because it is inert and physical trauma from sharp particles doesn't cause cancer." Or that non-ionizing radiation can't cause cancer because it isn't ionizing (which is the argument physicists give). Or that forces can't act at a distance (which is what Newton's opponents said).
How about the "placebo effect," a favorite explanation of the anti-woo-ists. What's the physiological explanation? Handwaving not allowed.
My biggest concern with "woo" alternatives etc. is not that they exist, or the sheisters that have pushed them for centuries. My main concern is the absurd irresponsibility and ignorance displayed by medical research in not being more aggressive in researching and accepting proven eastern medicinal techniques.
I mean, I realize there isn't as much money to be made from having a stronger understanding of how spinach helps fight toe fungus etc., but frankly I don't want to continue along the path of having three different name brand pills that each address a subset of symptoms for every disease that might cause me discomfort.
The draw of "woo", then, is that it appears more proactive, and less reactive, which is a major black mark on the US health system right now; they give on the air of "reactive, but only we we absolutely must to avoid liabilities." Given that opinion, I suspect "woo" is very popular right now. (Now don't get me wrong, I'm not advocating reiki or anything, but there's enough solid eastern medicine that to immediately jump on the more spiritual aspects is bad form).
Hi Revere. You missed the point I made about how we must put things inside existing/tested frameworks. There is no reason for chicken soup not to work. However there are many reasons for other things not to work. Your example of forces for example goes against what is know and has been tested in science. For the other two examples you give, I probably need to add/clarify my initial comment. The reasons may not be known to science, however there is nothing in science that says they can't work. The point may be subtle? Science tells me it is impossible for me to spontaneously turn into a cheese sandwich. So anything that requires me to turn into a cheese sandwich, is impossible. Many woo practises require things to occur that we know can't.
As for placebo. Sure,placebo seems to sometimes work for a small number of diseases. I'm currently reading Dylan Evans' book 'Placebo', in which he suggests a mechanism for placebo to work. I've not got that far into the book to find out what the system is, but I doubt it will rely on anything science can't explain. No fairies, energy lines or spontaneous cheese sandwich transformations are needed. Under tests, placebo is limited in its affects and what it works on.
In short: if science can tell you why something can't work, then we have no reason to believe that it can work. (Usual caveats apply to this claim!)
One of my sons called from Seattle. Lots of flu in Seattle, and he's one of the unlucky ones. Has been eating his chicken soup, as we call it, "Chicken soup, chicken soup, rah...rah...rah..." Had the usual discussion on what mom suggests to enhance his immune system once he recovers. All the usual mommisms. If it works for me and the members of the family who really cares why. If it does make you feel better ,whether it be love or some subtle blending of the chicken broth and veggies, well "rah..rah..rah..."
Simon: What would be a claim that something can't work? Let's say, it violates the Second Law. I'm OK with that. Or that something has to happen that is so extraordinary and out of the range of human experience, let alone science, that it is extremely improbable, like you turning into a cheese sandwich. But most alternative claims aren't like that. They rely on other theoretical systems and may be highly rational within those systems. But more importantly, the fact that the reasons given are clearly at odds with what science knows or thinks it knows is different than whether the thing works or not and the two are often confused. If I tell you chicken soup works because my mother said so, but it only works if she makes it, then that's clearly not science (at least in my book). But does that mean it doesn't work? Said another way, if the explanation isn't qi, does that mean you should reject it outright or see if there is another explanation, and if it depends, then what does it depend on? Note that opponents of alternative medicine vary on this. I believe Orac is on record inveighing against the NIH's grant program to investigate alternative remedies.
Regarding placebos , there may eventually be a neurophysiological explanation for the effect but most people, including opponents of alternative medicine, have no trouble accepting it without that foundation. It is their own variety of magical thinking which doesn't bother them because they are pretty sure there is such an effect (so am I, BTW).
Alternative medicine relies on its own theoretical underpinnings. Rarely does it use science, and if it does it is even rarer to find one that is scientifically plausible.
Anyone can have a theoretical system. I'm sure the delusions of the mentally ill classify as a theoretical system. Doesn't mean they are valid.
If we don't know why something works, sure, do more research on it. However, if there is no evidence for something and we can demonstrate that the thing can't work - why waste money on it?
If your mothers chicken soup works, and can be shown to work (basic observations are enough to begin with), then there is something to be tested and poked. Your mothers chicken soup exists. We know there are things in it that will effect the body. We have some understanding of what these things are and how they will interact. When it comes to realigning my chakra, there is exactly no evidence of the existence of a chakra. We can't see it. We can't predict if from maths. We can't even predict it using common sense reasoning. We can do all of these with the things in chicken soup. Which is why it is different to alternative medicine.
So whilst science essentially says the mechanism for alternative medicine X can't exist, it says there probably exists a mechanism for chicken soup. Therefore it stops being woo, and becomes something to investigate.
I'm pretty sure there is a placebo effect. Current science says it is possible (the neurophys explanation). Therefore we have something which is worth funding research into. Science tells us the placebo effect won't be able to grow a limb back (as it is not a result of neuro/immune system interacion). So there is little point researching that, or even believing it to be true.
If there IS testing done, sure would like to see it with and without the chicken ingredient...so speaks the vegetarian.
Simon: So you're telling me that if someone showed that the neural system were important in limb regeneration you'd be willing to believe the placebo effect could make it happen? You are more of an "altie" than I am. The point of the post, really, was not to argue for alternative remedies but to do some hard thinking about what we are saying about it and about the medicine we do accept. A problem I have is that it is incredibly easy to conjure up "scientific" explanations for all sorts of things. I'll bet a chiropractic enthusiast (I have never seen one, BTW) could come up with a "scientific" explanation for chiropractry. But that seems to me independent of whether it works or not. The two seem to have gotten conflated, with people sliding from one to the other.
There really aren't too many things science "says" really can't happen. Probably violations of the Second Law are the most common and most practical application of your criterion. So I wonder about it's conceptual basis. Many of the things you say science says can't happen just sound like they are either highly improbable or involve explanations that don't use the language of conventional science. I sure you would disagree with that characterization but it sure sounds that way to me.
The point is that chicken soup did nothing at all to boost the immune system or cure the viral infection, it merely made the person feel better by toning down the action of neutrophils so that the person had less inflammatory symptoms. Sort of like an over the counter cold remedy. In which case it should require no more scientific proof of its efficacy as a "cold medine" than NiQuil, right?
This could be a case of Bird Woo v Bird Flu.
Goliath: Or a dyslexic Chinese Woo-Not Soup.
MiH: I suppose part of what makes a "cold" a "cold" are the symptoms.
In our house, 2 vegetarians 1 meat eater, we cook two batches. One has chicken for hubby and one doesn't for kid and mom. Both "work" in that all you want to do is sleep after you eat it, it replenishes your liquids, and makes you feel loved.
Other than that, it does squat to "cure" a cold. Echinacea, Airborne, some cold beer, and sleep work too. Just sayin'
Revere, clearly I'm not making myself clear! I don't believe in most alternative medicine (herbs are about the only thing I might accept, as they might actually have an active ingredient). Most of it I believe is down to placebo, confirmation bias and a whole of host of other things.
I think you're suggesting that I'm confusing scientific for "scientific". I am talking about real science, and not stuff alties peddle to be science or their corruption of real science.
My point about placebo was that I believe there are something things it can work for, and I think there is evidence to back this up. Headaches: possibly. Limb regrowth: no. Placebo can only do minor things in a few cases, and most of the time I'm sure it's just about making you feel better and ignoring the symptons.
Have you seen the parachute paper I mentioned earlier? You might enjoy reading it.
As a grad student in nutrition studying to be a registered dietician, I have to ask -- how is this "woo" and not nutrition science? RDs practice medical nutrition therapy to help manage all sorts of diseases and conditions. Chicken soup may not "cure" a cold, but it's interesting to see that there's a biochemical basis for how it can help to decrease the symptoms while providing some much needed nutrients and electrolytes to help you fight off the infection.
Revere, I understand where you're coming from on this but I'm not sure this is a valid example. Homeopathic flu remedies on the other hand? I'm with you all the way there....
Maybe I don't really understand the study (I haven't read it and it's not a journal I have access to), but I'm not sure how the methodology of the study is appropriate to apply to real life.
If neutrophils are immersed in chicken soup and show decreased ability to seek and destroy, how does that translate to the upper respiratory tract, where the neutrophils won't be immersed in chicken soup? If it's a direct contact effect, surely it would only work in the gastrointestinal tract...
I would also be interested to see if this effect were observed with other kinds of soup, eg fresh tomato soup, and with some kind of control solution, eg warm salty water, to see if the effect also existed.
"Sometimes critics (not Orac as far as I know) will mistakenly say that the lack of statistical significance in a trial means any effects seen are due to chance ("small numbers" are a variation of this). This, of course, is incorrect but here isn't the place to go into why."
It would be interesting to read a post on this topic.
Perhaps I'm missing something here, but doesn't this presented "evidence" require that this concoction, potates and all, come into contact with millions of circulating neutrophils to exert its effect? Chicken soup is not absorbed intact into the circulatory system. Pretty unconvincing, in my view.
attack rate, danb: Good points, for which I have no answer. I didn't read the Chest article (although I have reviewed for them and it is a high quality peer reviewed journal) so I can't answer you. You both seem to indicate that chicken soup is still in the woo category for you, although what I was really getting at is what makes something woo and something "medicine." Supposing these experiments met your objections, is that enough for you? If not why not? If it is, what does that say about what you think is "woo"?
I should post on "statistical significance," but the short version is that it is a test to calculate the probability that a difference could have occurred solely by chance if no other factors (real effect or bias) were operating and the data were collected under the necessary conditions for the test. So something could have a real effect but not be statistically significant if you had a small sample. An example would be flipping a coin twice and having it come up heads twice. This result is not "statistically significant" to show the coin isn't fair, but the results also don't tell you if the coin might have heads on both sides.
Statistical significance and scientific significance have nothing to do with each other. Something can be scientifically significant without being statistically significant and conversely. But that's a subject for a longer post some other time.
seary: Actually, where I'm coming from was trying to provoke Orac for a response on what he calls "woo." I wasn't staking out a position on chicken soup, vitamins, Reiki or acupuncture, much less homeopathy. I am interested in how we know things or think we know things in science, which is what this post was meant to be about.
But since we are also a flu site, to some extent, I thought chicken soup for colds and flu was in keeping with the theme.
Glad to see the point emphasized that statistical and scientific significance are not one-in-the-same...all too often the concepts are conflated.
Insofar as the woo: a concept should be identified as woo (or, woo-woo, if necessary) if it does not meet the requirements of the scientific method. This does not apply only to medicine, but any arena in which science provides direction. The method is why we don't believe in creationism or cold fusion. There are no falsifiables with the prior, and no replication of the latter.
Revere, you conflated confirmability with replicability --replicability, a part of the scientific method, simply means that the results can be arrived at again. You never can confirm, but if a replicate fails, then you can falsify.
I'm with Popper on falsifiability. And I'm with Simon on the description of woo (and the parachute paper, which highlights why good a priori hypotheses are necessary in research).
The NIH grants? That's a political question. If we want to award grant dollars based on the existence of a question that is falsifiable and through methods that permit replication, then why not? I would much rather see the Woo Health Organization (WoHO, not to be confused with WHO) fund the first round of research, and publish the results in peer-reviewed journals. Only after the initial work is accepted as solid science should we begin further research with federal funds. But that's just my opinion, and would guide my vote should the issue rise to the fore.
The Lamarkian hypothesis ( http://en.wikipedia.org/wiki/Inheritance_of_acquired_traits ) was discredited some decades past on the grounds that we inherited one gene trait from each parent, so "life experiences" could not be inherited.
Recent work in Genetics seems to show that there are multiple "parallel genes" in each parent from which the zygote can obtain it's inheritance. This provides a possible mechanism for the Lamarkian Hypothesis to be revived.
I am totally with Revere. Lamark was discarded because science (as it was then known) appeared to exclude a chain of causality. Let's not make the same arrogant mistake.
I think soups in general have beneficial and healing potential, however minute. I eat French onion soup with melted cheese and some toast after a nite out. I think of it as anti-bacterial and restorative. Cabbage soup for other reasons ,minestrone and other soups practically every day. I grew up with one soup or another always cooking on the stove, and have pretty much eaten one or another almost every day of my life. There is no longer the love of familiy involved as I get them from hospital cafeteria, deli and supermarket fast food hot bars. We have a lot of foodies around, so they are good. I dole out a dollop of this, a bit of that ,to make each days blend uniquely my own,and even carry my own small packet of seasonings.Every culture has its specialties, and I'm sure people way back when knew what they were doing, even if not why or how it helped.Its the ancient Greek physicians, "Let food be your medicine." Woo? Might be. After reading this I'm going to also carry a clove of garlic to mince into my soup blendings.If I don't wash my hands it might keep some people with colds and early flu at a distance..And cumin has been said to help prevent Alzheimers, so I'll add a dash of that too. I have a topiary rosemary in my kitchen, I'll throw in a bit of that too. I may not be scientific, and certainly don't have a grant from NIH, but we experiment on ourselves every day, at least I do.
"You both seem to indicate that chicken soup is still in the woo category for you, although what I was really getting at is what makes something woo and something "medicine." Supposing these experiments met your objections, is that enough for you? If not why not? If it is, what does that say about what you think is "woo"?"
I don't work in a clinical field any more, but I'm a recent enough graduate to have had evidence based medicine be my primary teaching all through university.
I quite like Evan's postulates to help determine when something stops being "woo" and starts being "medicine" or "science", although I acknowledge that there is a lot currently done that wouldn't meet this standard. A popular radio show in Australia (ABC's The Health Report) has recently run a few programs on this topic (the first is linked).
The reason that I am currently not convinced about chicken soup is that it fails to meet the biological plausibility requirement, in my current assumption.
I don't tend to reject anything based on my perception of it as "woo" - I am always open to seeing well designed, well conducted and well analysed, repeatable studies which provide support for the hypothesis that the treatment in question may be useful.
In this case, now that there have been supportive in vitro studies, I would like to see expansion of in vitro testing as per my original post (if this has not already been done) and then perhaps a small, randomised double blind controlled trial in patients with viral upper respiratory infections, to show any in vivo effect, although I imagine the variability associated with time to recovery due to uncertain date of infection at time of presentation could be difficult.
I take your point about asbestos, but there is repeatable evidence that there is a link, and although the biological method is not fully understood, it is biologically plausible that something could occur. I think there need to be in vivo studies correlating an exposure and an outcome, before any suggestion of causality is considered, especially in the absence of an understood biological mechanism of effect.
I'm rambling now, I've been up too late... I should go back to my dissertation and ramble there instead.
I consider myself to be a rational person, and it seems to me that the health benefits of chicken soup include the following:
1) It's a warm or hot liquid, and drinking it seems to help loosen mucus.
2) A person with a sore throat may find it easier to drink soup than eat solid food.
3) The dissolved protein, carbohydrates, and electrolytes will rapidly enter the digestive system. This is a good way to revitalise people who have felt too ill to eat or drink.
4) It was historically a prestigious food ("When a peasant eats a chicken one of them is sick") and its preparation therefore shows a comforting degree of concern for the invalid.
5) It is traditionally served to invalids, and it reminds them that they recovered from these things before.
6) Noodles, matzo balls and kreplach are symbolic representations of bacteria and virii. By cooking and eating them we unite our shaman-selves with the energy forces of the all-world and use its powers to destroy them.
7) It is palatable and attractive on both an olfactory and gustatory level. It is well established that a little of what you fancy does you good.
I think some of the comments have been troublesome. The criteria for judging something on the "edge" of medical science shouldn't be dependent on a working, known, biological mechanism.
The key for knowing if something is woo or scientific is the same as for any other science -- it must state a falsifiable claim. To move from experimental to regular usage, it should also be able to cite evidence.
1) Falsifiable claim: Chicken soup relieves symptoms of the flu. It either will or it won't (as measured by double blind studies).
2) Evidence that it helps comes from double blind studies, antecedents, case histories, etc. Evidence of safety must also be shown before moving into "accepted medicine".
A working mechanism helps us abstract to a theoretical basis so we can form additional cures; know more about the body, etc. But catapults worked before Newton told us how and why.
I don't have the references to hand, but I do recall reading that acupuncture for knee pain proved more efficaceous at reducing pain and increasing mobility than the "placebo", where pins were also applied, but not at acupuncture-specified places. Another showed improved recovery from surgery. I can't say these or other studies were well-designed, but it does seem to me that acupuncture edges out of "woo" into the territory of medicine.
I also know that I have walked into the acupuncturist's with severe upper back pain, and walked out an hour later feeling (from previous, non-acupuncture-treated experiences) days better.
How does this work? By what mechanism does the placement of pins in specific spots cause my spasming muscles to relax? I don't know. I'd be interested, because I do believe in the value of science. But just like a person with a cold doesn't particularly care why chicken soup makes her feel better, I don't particularly care, either.
I think that is what scientists find so galling about these issues... and why many non-scientists just shrug. A person who is suffering doesn't need to know how a remedy works (unless it has negative side effects). They're happy just to have their suffering alleviated or ameliorated. And that may explain the popularity of things even I consider "woo" people with a variety of illnesses, especially some of the chronic ones, don't get enough, if anything, from big-M Medicine. Naturally, they look elsewhere.
See: Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance.
K Saketkhoo et al, Chest, 1978.
http://www.chestjournal.org/cgi/content/abstract/74/4/408
Nagatsuka et al Int J Mol Med, 2006
Measurement of the radical scavenging activity of chicken jelly soup, a part of the medicated diet, 'Yakuzen', made from gelatin gel food 'Nikogori', using chemiluminescence and electron spin resonance methods.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&do…
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Ohry et al (1999) in a review article in the CMAJ conclude:
There are several reasons why we do not believe that it is possible to conduct a prospective RCT on the effectiveness of chicken soup therapy. First, the number of ailments that would have to be tested is too great. Second, there are too many formulas for the compounding of the drug, and standardization of the ingredients would be difficult. Third, depriving the control group of chicken soup would, in our opinion, be unethical. Finally, we believe it would simply be too difficult to find evidence to refute the therapeutic properties of chicken soup (if such evidence exists). ( :) ! )
http://www.cmaj.ca/cgi/content/full/161/12/1532
Caia: I know people who have fallen for the Big Woo and it can be tragic. I've seen people who are demonstrably not feeling better spend enormous amounts of money on weird Chinese medicine stuff or blood oxygenation or whatever. I think that their motivation isn't that they feel better presently, it's a sort of conspiracy theory aimed at medicine. Medicine hasn't made them feel better and holds no hope of making them feel better. The woo, on the other hand, presents a theory - they are in pain because they have a chipped chakra, and the magic auric balancer will eventually make them feel better. This is comforting, and they need comfort.
In your case I accept that you feel better after your acupuncture, and it would be foolish of me to argue otherwise. None the less, my experience has been that most alternative medicine is idiocy practiced by charlatans upon fools, and I believe that it should be outlawed. The (genuine) comfort that people get from alternative medicine would be better sourced from people who aren't out to make a buck from human misery.
All of you are missing the secret ingredient of chicken soup. Those darn turnips! We hate turnips! It's like being forced to watch daytime tv. More than enough to rally you out of bed and back to work (or school).
Joe in Australia has it with his points 1 through 3.
At present I'm getting over a rather nasty cold (virus with secondary bacterial nasal sinus infection) that has stuck around for over a week. For a few nights early on in this, I was eating chicken soup for dinner.
It did indeed loosen up the mucus and soothe the throat. And it is likely that a hot somewhat salty liquid goes a way toward making the throat a less hospitable environment for bacteria and virii, thus perhaps giving the immune system a leg up. It didn't make the cold go away. If such a liquid also smells good, we'll tend to inhale the steam through our noses, which also helps loosen up the nasal mucus. And last but not least, perhaps there's enough tryptophan in chicken, when cooked as soup, to help one get to sleep.
If there's anything going on at all, it should quickly come out in any reasonable double-blind study. What the heck, test it against Nyquil and a few of those OTC remedies.
I do tend to think some of the more dogmatic anti-woos are engaged in a turf battle for funding. Money after all is highly psychoactive and addictive, and its effectiveness at compromising objectivity has been well-known for thousands of years.
g510: Double blind studies sound easy but they aren't. Remember that each group can't know their therapy. I can think of some ways this could be done but it's cumbersome. Also remember that the difference has to be sufficiently great that you can test it with a reasonable number of people. And finally, what's the outcome measure? Days in bed? Subjective feeling? Viral titer?
When China first opened up, I was sorely tempted to go there and take in a course on Acupuncture.My husband , a physician thought it woo. I didn't do a lot of things that I now do in playing around with any of my health issues because he had very strong opinions and he was often right. Since he died, I do whatever my inner senses deems possibly beneficial and harmless. I also do a certain amount of research, and see a young internist I respect. I don't always run things past his scrutiny before I do anything. So far, everything herbal I have tried has been beneficial. Most people I know fiddle around on the side with woo. Probably even the younger physicians who might be more inclined to accept their patients vaguries.The public is tired of this is bad for you, and a year later studies show it is good for you. Or in reverse, this is good for you, and it turns out to be harmful for many. Studies are merely studies. Statistics can be turned on their heads. The general public, me, is pragmatic. We will do what we think helps us. And chicken soup, with or without turnips, (we all have our recipes) helps.
Joe in AU: I tend to believe in the well-meaningness of alternative practitioners. We all know what they say about good intentions, so I'm not saying some don't follow bogus systems and sell phony remedies... but I don't think they know they're doing it. I think the people going around giving out swag to doctors offices branded with the names of their prescription remedies also probably believe in what they're doing. It doesn't mean either is in the best interest of the patients.
To some extent that western medicine has brought the competition/disaffection on itself by being focused on treating disease rather than fostering health, by ignoring nutrition and preventive care, by looking at patients as symptoms rather than total organisms. And there's some distrust based on modern medicine also seeming to follow profit motives.
I think alternative/complementary modalities have actually positively influenced M.D.s, by showing them where they aren't as effective and suggesting where they could look closer. My PCP asked me last week if I had used acupuncture for certain symptoms presumably because she's seen it be effective for others. There's a lot to be gained from really treating some of the complementary treatments as true complements to allopathic medicine.
I think your example of people who spend too much on treatments that don't help them sums up one of the dangers. Hope, even false hope, is addictive. But you can't just ban alternative medicine. Which is why applying science to alternative remedies=good sense.
There's a Chinese herb... can't recall which... it actually proved to have some efficacy, but it took a clinical study to determine that it also slightly increased the risk of cardiac events. In that case, both sides were right. I'd love to see more testing along that line... because it seems like half the time they do studies (on garlic, ginger, curry spices, St. John's Wort, meditation...), they find a benefit in a traditional remedy. Or just something that tastes good. The other half of the time, they prove it's probably not worth wasting your money.
I think the discussion demonstrates a certain bias against (purported) woo. The problem should be separated into 2 parts as Dan R. pointed out, there are methods to test these claims (as for the fact that people may taste whether it is chicken soup or not, I think that a good test requires that none of the concoctions you give people should taste like chicken soup, just put in a powerful other taste, or say it is crocodile soup, or some other stuff that tastes like chicken:
http://improbable.com/airchives/paperair/volume4/v4i4/chicken.htm)
The bias comes in with regards to the "explanation". A lot of (all?) woo has "explanations" that to rational people range from improbable to plain silly.
The reaction scientists often have is that if the purported explanation is stupid, the purported benefit is too. (The "If it quacks like a duck, it walks like a duck it probably is a duck" reaction).
Even though with chicken soup remedy, the spontaneous regression factor may be high ( http://www.quackwatch.org/04ConsumerEducation/placebo.html ) there may be a chance it does work albeit via an unknown route.
Would it make sense to mount an expensive double blind trial? I think not.
First, define alternative medicine. There are two types of alternative medicine in my opinion. (1) alternative as in alternative to conventional medicine, but with actually observable effects; (2) alternative medicine based upon paranormal, spiritual or other unproven and unobserved effects (i.e. quack medicine). The chicken soup remedy seems to be a type (1) alternative medicine and this is the form many doctors will agree with. Nutrition is an often overlooked aspect of medicine. For instance, a Mediterranean diet can do "miracles" to prevent recurring heart failure, even compared to modern drugs, and this is a scientifically proven effect (forgive me for not diving into PubMed now). Still, doctors keep prescribing these drugs by the dozens.
Chicken soup as a remedy against flue? Possible. Do more research and we will find out. I personally have some issues with this method especially since I know how sensitive neutrophils in culture can be to even minute changes. Still, if there's a statistically proven effect this remedy would fall in category (1) of the alternative medicine and it will still be evidence based.
My end conclusion would be that what I designated as category 1 alternative medicine is true alternative medicine (or complementary medicine to use another phrase) and that all the quack medicine should just be called that, quack, in stead of using the misnomer "alternative medicine".
Chicken soup and all remedies with liguid, hot toddy, lemon and honey, etc. etc.,all make you more comfortable, they don't cure. Resting, sleep and the passage of time cure many common illnesses. Burn the candle on both ends and you end up with bronchitus or pneumonia, depending on the particular virus and the state of your immune system. Coddling of any sort when you are ill, gives you that little extra boost that Nature can't provide.
Chicken soup and all remedies with liguid, hot toddy, lemon and honey, etc. etc.,all make you more comfortable, they don't cure.
I'm sure you perceive a difference, but I would appreciate it if you could put it into words.
I once made my wife a nice bowl of "chicken soup" when she was feeling flu-like symptoms. She said "Yummy! This makes me feel so much better... Wait a minute, we don't have any chicken! What is this?" It was, in fact rattlesnake meat and not chicken meat. We were all out of chicken, but I had a couple sections of a diamondback rattler in the freezer, that I had killed in our back yard a few weeks earlier.
I don't have any placebo or chicken soup control on curing the flu symptoms, but I do find that as an anecdotal story, the rattlesnake has a bigger impact.
Brian
Brian: I always wondered what rattlesnake tasted like. Of course. I should have known.
Re/ snake vs. chicken: the definitive statement on this subject was, of course, made by the Austin Lounge Lizards.
While we're talking about anecdotal evidence, there is also a delightful anecdote in John McPhee's Rising from the Plains, a book about Wyoming geology drawn up around the life of its foremost geologist, David Love.
As I recall the story, David and his brother were both around 10 or 12 years old when their remote Wyoming household was host to a fellow named Bill, a friend of their parents and one with a hard reputation -- reputed to have killed a man, etc. The boys could hardly stand the excitement of it all, especially since they knew their mother would be serving the fried rattlesnake for which she was locally famous. They talked about rattlesnakes all through the first course, asking each other how you'd catch and prepare one, what it might taste like and so on, until Bill interrupted them.
"If anybody ever served me rattesnake, by Gawd, I'd kill 'im!
The boys were struck dumb. Finally, their mother broke the silence when she came back into the dining room with a serving plate.
"More chicken, Bill?"
"Don't mind if I do, ma'am!"
My response is here. ;-)
Orac: Thanks and saw it just as I was leaving for the airport. Read it at 30,000 feet and have started a response but it is hard to do this while traveling as I am fully occupied throughout the day and evening. I hope I'll have a response by the weekend.
Hi,
As someone who believes in alternative medicine, this debate has been illuminating. A couple of questions though:
1. If it works, for whatever reason, is it scientifically acceptable? I understand that it has to work everytime. But are the conditions for this "repeatbility" same? I am not sure it is. Therefore, in principle, something might work, it may not always turn out that way. As an example, consider my neighbour. She was treated by a large number of doctors over a long period of time for a chronic disease, but never was really cured. One doctor, however, was able to. If we think that everything in science must have a table, with the problem on the left side, the root cause and the solution in neat rows, there are going to be many empty rows.
2. Just because we haven't discovered how to test something, does it mean it doesn't exist?
While there are quacks, out to take advantage of gullible people, alternative medicine may have roots in some principles, that may not have undergone rigorous scientific examination.
P.S: I am not even stepped into a medical college, so I apologize in advance.
Sridhar: Good questions. I have been very busy so I haven't had time to respond to Orac's response to me from last week. When I do I'll try to cover some of this.
I apologize in advance if it is forbidden to post on an archived thread.
I can see how preconceived notions are influencing posters. While I do not know why the above chicken soup recipe may or may not work, I do have some idea why some recipes work. I like to do research, it keeps the neurons firing. My chosen area happens to be finding herbs that actually do have observerable results. If it hasn't been tested somewhere, either in vitro or in vivo, I'm not interested. If you consider Tamiflu, which is based on star anise, it shouldn't take more than a gentle nudge to consider other substances that may also contain antiviral or other disease fighting attributes. They may not be as concentrated as an extraction but, they may still show observable responses. There are several herbs/spices that have already been tested-some in double blind studies. So, before you toss out the idea that alternative medicine is woo perhaps a short read will open your inner eyelid (just kidding).
Add some thyme to your chicken soup recipe. http://aac.asm.org/cgi/content/full/51/5/1859
Toss in some garlic. It is showing some remarkable applications for MRSA. It couldn't hurt and it may help. Tastes good too.
http://www.annalsnyas.org/cgi/content/abstract/1056/1/234
Finally, pour yourself a nice glass of Pinot Noir to go with your soup. The resveratrol should also help you feel better and help eradicate the virus from your system. If you are still unaware of the benefits of resveratrol you need to catch up on your reading. LOL
There are other herbs with testing indicating disruption of either neuraminidase or hemagglutinin. Verbascum and bromelain are two examples.
Another interesting read.
http://www.wm-translations.com/Text_Samples/Scientific_Article.pdf
I thought we discussed foods before (sandwiches)? I do not like chicken soup, therefore it is good for all that ails you. I can't get any more scientific than that.