Respectful Insolence

With the aging of the population, one of the most feared potential manners by which more and more of us will leave this earth is through Alzheimer’s disease or other forms of dementia. And it is a scary thing, too. Having valued my intelligence all my life and in particular enjoying the intellectual stimulation that I derive from my job, not to mention from blogging and contemplating science outside my realm of expertise, like many people I fear Alzheimer’s disease at least as much as cancer or heart disease, possibly more. Imagining the slow decline in my faculties to the point where I can no longer take care of myself and no longer even recognize my loved ones terrifies me, as it does virtually anyone. Fortunately, we’re coming to understand more and more about neuroscience and how the brain works. So I at least have hope that, 20 or 30 years hence, when I’m in those dementia-prone years, there will be something medical science can do for me if I’m unfortunate enough to develop Alzheimers, in marked contrast to the situation now, in which we have nothing that can do much good for dementia.

Unfortunately, it is that very dearth of effective treatments for dementia that leads to quackery, and I’ve found a doozy of a pseudoscience-laden post at–where else?–that wretched hive of scum and quackery, The Huffington Post. It’s a post by someone whom we’ve met before, namely Dr. Mark Hyman, he of “Ultrawellness” and “functional medicine,” and it’s entitled 9 Steps to Reverse Dementia and Memory Loss As You Age. Not only doth the woo flow, but it does so with video:


Seldom have I found such a willful misapplication of the new science of genomics than here. Well, not quite. The way the Age of Autism misinterpreted the latest autism SNP study is up there, too, but that may have to wait to be a topic for another post. In the meantime, let’s see what our favorite woo-meister Dr. Hyman says:

There was a woman with mild cognitive impairment on the panel. Her condition is sort of like pre-Alzheimer’s disease. Everyone on the panel — including the Harvard neurologist — agreed that memory loss is NOT a normal part of aging. The sad part was that the panel didn’t have much to offer people in the way of prevention. Their only solution was just a very bad and pretty ineffective selection of drugs with lots of side effects.

It never ceases to amaze me how docs like Hyman can start out with a seemingly reasonable statement, namely that the drugs we have for the prevention and treatment of Alzheimer’s disease pretty much suck. They don’t work very well, and they’re chock full of side effects. Unfortunately, what separates science-based physicians from the woo are statements like the one Hyman makes next:

But there is another way to think about brain aging. The brain responds to all the same insults as the rest of the body — stress, poor diet, toxins, lack of exercise or sleep, nutritional deficiencies, and more. All we have to do is give the brain a tune-up and we can see miracles.

I have a rule of thumb. True, it’s just a rule of thumb, with no empiric evidence to back it up. I admit that. However, it does seem to hold true form an anecdotal perpective. That rule is: Whenever you see a health care professional promise “miracles,” run, don’t walk. Add to that references to “toxins” and “nutritional deficiencies,” and run harder and faster. Seriously, you’re about to be buried by woo or pseudoscience, and Hyman doesn’t disappoint:

Sometimes the practice of medicine lags behind the science, and sometimes the practice gets ahead of the science. Genetic testing puts us squarely in the middle of that dilemma. We are at a crossroads, where the old ideas we have about disease and diagnosis become less meaningful as we understand more and more about the importance of individual differences in determining illness. This a time when personalized medicine will replace medicine based on diagnosis and disease.

In fact, disease and diagnosis as we know it will soon be an obsolete concept, an artifact of medical history, like bloodletting or phrenology (the art of diagnosis based on the shape of your skull, popular in the 19th century). The reason is simply this: Naming a disease does nothing to help us identify and treat the underlying causes of the disease. We must address these causes if we have any hope of helping individuals heal.

Notice how Hyman paints current medicine as being obsolete, like bloodletting or phrenology. Truly, it’s hard to imagine more of a case of projection, given that his “functional medicine” is chock full of various forms of pseudoscience and woo. He also invokes the alt-med delusion that it, not “conventional” medicine, finds and adresses the “true causes” of disease. How I hate that lie! Does homeopathy address the “true cause” of disease? No. It bases its “provings” on symptoms. Does acupuncture address the “true cause” of disease? Of course not. It ascribes to all disease the cause of “blockages” in the flow of an imaginary “life force.” The list goes on. It’s really scientific medicine that seeks to find the cause of each disease and direct its therapies at that cause. Alt-med, on the other hand, often ascribes One True Cause to all disease.

He also misunderstands the nature of genetic diagnosis and genetic testing. I’ll tell you what I mean using the example of breast cancer. If there’s one thing we’ve learned analyzing the genetic makeup of breast cancer, it’s that breast cancer is several diseases, each with different, albeit overlapping, characteristics and behavior. Although we once divided (and still do divide) breat cancer into the broad categories of estrogen receptor-negative and estrogen receptor-positive cancers. Now, beginning with expression array profiling experiments published around the turn of the millennium, we now divide breast cancer into phenotypes known as luminal versus basal, all entirely based on gene expression profiles, not on the usual traditional characteristics that we used to use, in particular histology. These new molecular-based phenotypes have deepened our understanding of the disease known as breast cancer and allowed us to subdivide it into types based more on biology. True, we have a long way to go before this information is fully incorporated into how we diagnose and treat breast cancer, but you know what? Some of those subdivisions actually corresponded to subdivisions that we had already discovered on the basis of other characteristics.

Actually, what “personalized medicine” means to someone like Hyman is not a deeper understanding of disease that allows him to choose whatever woo he was going to choose anyway, in other words, as an excuse to make it up as he goes along. He then demonstrates this to be the case by trying to apply genetic information to a patient of his:

Even though no long-term studies have been done to look at treating dementia based on genes, there are so many scientific threads that weave together a picture of how and why our brains age and what genes are involved. This leads me back to George …

For this man, whose mind and life were evaporating, I looked deeply into his genes and the biochemistry his genes controlled and found places where we could improve things.

“I looked deeply into his genes and the biochemistry his genes controlled”? That line cracked me up, as if Hyman knew the first thing about “looking deeply” into anything, much less someone’s genes. In fact, the only thing Hyman’s good at “looking deeply” into is the woo. In fact, he “looks deeply” into the genes and biochemistry in the same way that Mark and David Geier or Andrew Wakefield “look into biochemistry.” In fact, what Hyman writes next would not be out of place on an “autism biomed” discussion board:

He had a gene called apo E4, which is a high-risk gene for Alzheimer’s disease(ii) and also made it hard for him to lower his cholesterol and detoxify mercury from his brain.(iii) He also had a version of a gene for detoxification of metals and other toxins (glutathione-S-transferase, or GST)(iv) that was very inefficient, making him accumulate more toxins over his lifetime. Having the combination of a problem with GST and apo E4 puts people at even more risk for dementia.(v),(vi) In another study, people with an absent GST gene were likely to have much higher levels of mercury.(vii)

George had another gene called MTHFR(viii) that made him require very high doses of folate to lower his blood levels of homocysteine, which is a substance very toxic to the brain. Lastly, he had a gene called CETP that caused his cholesterol to be high, which contributes to dementia. Combine this gene with the apo E4 gene and your risk of dementia goes way up.(ix)

We found that George had high levels of mercury(x) and helped him detoxify with foods such as kale, watercress, and cilantro, herbs such as milk thistle, nutrients such as selenium and zinc, and medications that helped him overcome his genetic difficulties by getting rid of toxins.

We lowered his cholesterol with diet and herbs. We lowered his homocysteine with high doses of folate and vitamins B6 and B12.

Yep, it’s all there, the obsession with mercury, glutathione, and “toxins.” In fact, if you changed the word “Alzheimer’s disease” to “autism” and left out the parts about decreasing cholesterol with diet and herbs (even I haven’t seen that on autism “biomed” boards), and Hyman’s post would be right at home on Age of Autism! I doubt any of the denizens would even notice the difference.

Of course, Dr. Hyman reports that his patient recovered spectacularly, providing the usual N=1 anecdote that is meaningless when you remember concepts such as regression to the mean and the placebo effect. he even has another anecdote about an elderly woman named Christine:

Her neurologist offered her words of comfort, but told her and her family there is no treatment truly effective to stop or reverse the progression of dementia. That’s when her daughter brought her to see me.

We discovered many subtle changes in her health that on their own wouldn’t explain dementia, but when added all together put a strain on her brain function. All we did was correct those problems — low thyroid function, mercury toxicity, inflammation, and deficiencies in vitamins B6 and D, folate, coenzyme Q10, and omega-3 fats — and improved her diet overall. I encouraged her to exercise, because exercise can help improve cognitive function and prevent dementia.

Six months later, she had the extensive memory tests repeated. Her psychologist was surprised to report that her scores got BETTER!

Note that he didn’t say how much better her report got. Was it dramatically better or just a little better? He also didn’t say if she kept getting better or if her condition stabilized. After all, dementia isn’t always a straight line decline. There are bumps along the way, times when it may slow down or even times of transient improvement. It’s quite possible that exercise and diet may have slowed Christine’s mental decline transiently. The question is: Is this just a fluke?

There’s another aspect of this article that’s interesting. One complaint I have about news articles is that they often don’t provide citations or even links to studies discussed. Dr. Hyman, to his credit, does. Unfortunately, a perusal of the reference failed to show them supporting the therapies that Hyman described. For instance, his fixation on apo E4 was overblown, as were his invocations of papers on glutathione. They’re articles that show that these may be biomarkers, but there’s one thing you have to understand about biomarkers. They only suggest the presence of disease or risk for disease. Depending on how tight the correlation is, they may or may not be reliable. More importantly, they may or may not be useful molecular targets for treatment of disease. Hyman assumes they are based on no strong evidence from interventional studies that they are. Like autism biomed “practitioners,” Hyman is extrapolating from correlational evidence that may or may not represent causation that is targetable with specific therapies.

Personal medicine, although it may well be oversold, does hold considerable promise for helping us tailor therapy to the specific characteristics of a patient’s disease, genes, and biochemistry. We’re nowhere near there yet; a lot of work remains to be done. Unfortunately, that doesn’t stop “practitioners” like Dr. Hyman from making wild leaps of speculation from correlational evidence and absent solid clinical trial evidence to guide their woo-filled therapies and then using anecdotes as evidence to declare their speculative “treatments” to be effective.

Clearly, Dr. Hyman has a different definition of “personalized medicine.”

Comments

  1. #1 purdyjim
    June 29, 2010

    Off your meds today, Orac?

    Take a deep breath and relax.

  2. #2 Ender
    June 29, 2010

    Writing pointless comments purdyjim? Step away from the keyboard. (Breathing optional)

  3. #3 Dianne
    June 29, 2010

    I never have quite understood how the woomeisters get away with claiming that they’re providing “personalized medicine”. How do they personalize their treatments? It seems to me that they always have the same prescription: diet, exercise, and various “supplements”. This regimen seems to be invarient not only from person to person but from disease to disease. How is that personalizing?

    In contrast, an oncologist seeing a patient with breast cancer for the first time will take many issues into account before deciding on treatment including but not limited to: 1. Most obviously, stage of tumor: Is it limited to the breast? Does it involve the lymph nodes? Is it anywhere else in the body? 2. Tumor characteristics: Hormone receptor status, HER-2 status, gene profile, presence or absence of DCIS, etc. 3. Patient characteristics: Is the patient past menopause? Is the patient male? What other health issues does the patient have or has she had in the past (heart problems and past treatments for other cancers are particularly important in terms of what treatments can and can’t be used.) Does she have a family history of cancer that suggest a BRCA mutation or other genetic problem? 4. Patient preferences: Would the patient prefer a mastectomy or lumpectomy and radiation (equivalent procedures in many circumstances, so that the procedure performed depends almost entirely on patient preference)? Does she want chemotherapy: some patients may decide that the decreased risk of recurrence is not worth the risk and inconvenience of chemotherapy. Depending on the details of the tumor and its biology the oncologist may or may not argue the point but ultimately, it’s the patient’s call.

    So, mainstream medicine takes multiple issues into account, not the least of which is patient preference, and tailors treatment to the situation. Yet it is accused of being “cookie cutter” medicine whereas naturopaths give the same advice and herbs no matter what the situation and get away with claiming that they’re “personalizing”. Strange.

  4. #4 Modoc
    June 29, 2010

    I couldn’t even bring myself to watch the whole video. Thanks for another insightful and cogent response to insanity, Orac.

  5. #5 Orac
    June 29, 2010

    Off your meds today, Orac?

    Clearly, that’s the best insult purdyjim can come up with. Sad, really.

  6. #6 Dangerous Bacon
    June 29, 2010

    “Notice how Hyman paints current medicine as being obsolete, like bloodletting or phrenology. Truly, it’s hard to imagine more of a case of projection, given that his “functional medicine” is chock full of various forms of pseudoscience and woo.”

    The central principles of “functional medicine” are long obsolete – starting with the obsessive focus on “detoxification”, which is reminiscent of the Kellogg days of colonic irrigation for ridding the body of “toxins”. Heavy dosage with non-evidence-based supplements (what are these “medications that helped (George) overcome his genetic difficulties”?) harks back to the glory days of patent medicines (19th and early 20th century).

    Of course, in the world of woo obsolete remedies are glorified precisely because the ancients believed in them. Woo sometimes goes a step further and revives remedies from the early days of mainstream medical practice (for instance, take the current belief among many alt med users that colloidal silver is a cure-all, as opposed to a substance with limited infection-fighting powers which can permanently discolor its users’ skin bluish-gray when taken internally over long periods).

  7. #7 Paul Browne
    June 29, 2010

    “personalized medicine” does seem to be all the rage among cranks of all sorts these days, hardly surprising since they know that a lot of people have only a vague sense of what it means and it fits their “my anecdote trumps your clinical trial” style of argument.

    I’ve noticed that animal rights activists and opponents of animal research are frequently trotting out personalized medicine as an alternative to using animals in research, as if the two are somehow incompatable. Not sure how they figure that one out, and unsurprisingly they never seem to want to explain.

    Still, personalized medicine has some distance to go before it becomes as abused as poor old stem cell medicine.

  8. #8 Denice Walter
    June 29, 2010

    I actually have a copy of his “Ultra-Prevention”(w/ Mark Liponis) that I can’t find at present- it’s probably hiding itself in shame-(FYI: my SO likes to buy gently used books from the local glitzy library for 25 cents:the travel books are much more realistic).It is a veritable treasure trove of woo,showcasing such gems as “sludge” or “rust” being health problems(BTW,they’re metaphors for “poor circulation” or “oxidative stress”or somesuch).It seems that the two Marks meet their marks at the Canyon Ranch spa,where they practice their so-called arts.The glutathione fixation and de-tox perseveration sound incredibly like Gary Null(personalized medicine in mass production?)who also has a video(which was created during his recent vitamin D episode) entitled,”Miracles can Happen”,in which he “cures”(sic) someone of Alzheimer’s.I must confess my guilty pleasure of reading these tomes as creative science fiction, which I guess they are.

  9. #9 LovleAnjel
    June 29, 2010

    Did anyone else’s brain go where mine went when I read about the “gene called MTHFR”? It sounds like someone had a bad day in the lab.

  10. #10 Jojo
    June 29, 2010

    I cringed when I heard him mention PBS. I hate when the woo-sters use PBS to both legitimize their woo and as an form of infomercial. It looks like he has appeared on Second opinion, which I don’t know anything about. I poked around the website for the show, but it didn’t give any information on Dr. Hyman’s involvement on the show.

  11. #11 clayton
    June 29, 2010

    Mmm cilantro..

    Everybody in alt-med talks about Cilantro and it’s ability to remove Hg. Unfortunately the woo on that is deep in the veins of one small “study”. Muscle testing patients to see if they had excessive mercury and then testing them again. Sad BS.

    Hey Orac,
    Thank you for this
    “He also misunderstands the nature of genetic diagnosis and genetic testing. I’ll tell you what I mean using the example of breast cancer. If there’s one thing we’ve learned analyzing the genetic makeup of breast cancer, it’s that breast cancer is several diseases, each with different, albeit overlapping, characteristics and behavior. Although we once divided (and still do divide) breat cancer into the broad categories of estrogen receptor-negative and estrogen receptor-positive cancers. Now, beginning with expression array profiling experiments published around the turn of the millennium, we now divide breast cancer into phenotypes known as luminal versus basal, all entirely based on gene expression profiles, not on the usual traditional characteristics that we used to use, in particular histology. These new molecular-based phenotypes have deepened our understanding of the disease known as breast cancer and allowed us to subdivide it into types based more on biology. True, we have a long way to go before this information is fully incorporated into how we diagnose and treat breast cancer, but you know what? Some of those subdivisions actually corresponded to subdivisions that we had already discovered on the basis of other characteristics.”

    i’m going to study that paragraph and remind myself and others just how much we don’t know, but how much progress is being made.

  12. #12 Denice Walter
    June 29, 2010

    @ clayton: and not just cilantro but cinnamon, turmeric,curcumin,”black seed”(a/k/a nigella or kalongi)which are all totally effective… if you’re trying to learn how to cook Indian food.

  13. #13 Herb
    June 29, 2010

    We have a disease with no cure, and no effective treatment. And we have a doctor who is working to improve the overall health of his patient by reducing mercury levels, insuring adequate levels of vitamins and nutrients, and is using no acupuncture, homeopathy or other implausible modalities. And he is finding that his patients are responding. And all you and the commenters have is scorn.

    Maybe some day you’ll recognize your own biases and closemindedness, and support doctors who are exploring new and safe ways to approach chronic illnesses. But i’m not holding my breath.

    And now I expect to hear the snarks and scorn that inevitably follow from a comment that does not follow medical orthodoxy.

  14. #14 Calli Arcale
    June 29, 2010

    Paul Browne @ 7

    I’ve noticed that animal rights activists and opponents of animal research are frequently trotting out personalized medicine as an alternative to using animals in research, as if the two are somehow incompatable. Not sure how they figure that one out, and unsurprisingly they never seem to want to explain.

    They’re coming at the same strategy from two directions: to achieve their particular goals (stopping animal research on the one hand, and preventing people examining particular therapies too closely on the other) they are attempting to argue that it is actually not possible to do useful medical research. That people are too unique for research on another person to matter. The alt med types who use this strategy will then blissfully go on to use something passing for research on other people to guide their treatment of patients, without so much as batting an eye at the obvious hypocrisy.

    But all in all, the strategy is the same: they are arguing, essentially, that medical research is worthless. PETA likes the argument because it suggests that animal research has no value and is therefore utterly unethical. Alt med types like it because it’s a convenient way to hand-wave away criticism. Different motives, same propaganda strategy: science is too hard, so we should give up, and anybody who says otherwise is lying.

    clayton @ 11:

    Everybody in alt-med talks about Cilantro and it’s ability to remove Hg. Unfortunately the woo on that is deep in the veins of one small “study”. Muscle testing patients to see if they had excessive mercury and then testing them again. Sad BS.

    Cilantro (aka coriander) contains some oxalic acid, which is a chelator and usually bio-available when ingested. In theory, it would indeed bind to mercury (and in the lab, it is used to recover heavy metals from solutions). However, it has much better affinity to calcium, of which there is plenty in your bloodstream. Odds are, it will never get to the mercury before killing you. And in any case, cilantro really doesn’t have enough of it to really achieve much. If it did, cilantro would be considered a poisonous plant (like the leaves of the rhubarb plant).

  15. #15 T. Bruce McNeely
    June 29, 2010

    Herb:

    Go back and read the article again. Please take note of the following sentence:

    Of course, Dr. Hyman reports that his patient recovered spectacularly, providing the usual N=1 anecdote that is meaningless when you remember concepts such as regression to the mean and the placebo effect.

    If you don’t understand it, just ask.

  16. #16 Scott
    June 29, 2010

    @ Herb:

    If he were ACTUALLY doing things in such a way that he could genuinely demonstrate improvement, there’d be a lot less of a problem. The trouble is that, as Orac described, uncontrolled experiments on one or a few patients cannot distinguish genuine improvement from the treatment vs. the natural course of the disease.

    So it’s unjustified to conclude that there are any actual benefits (other than fattening his wallet).

  17. #17 Mu
    June 29, 2010

    Herb, no one disagrees that improving general health has a chance to improve the are related loss of cognitive functions. But you have to show that it’s related to your wide regime of supplements and/or woo, and not just to getting the person off the couch and more active. Lets try lipitor and 1 h at the gym a day vs. cilantro and folate, and see who does better on average.

  18. #18 moderation
    June 29, 2010

    I don’t think he is looking as deeply in to their genes or biochemistry … and perhaps not even as deeply into woo, as he is looking deeply in to their wallets and and taking a big biopsy. I wonder if he has his own lab in addition to his books and dvds?

  19. #19 wholly father
    June 29, 2010

    Herb,

    It would be one thing if Dr Hyman was merely presenting a hypothesis. The thing that I find most disturbing and offensive about Dr Hyman’s video is his confidence. I quote his final statement.

    In reference to his recommendations:”…for most of us will prevent aging of the brain.”

    Those are some pretty arrogant words, considering the tenuous rationale, dubious interventions, and minimal to nonexistent data.

  20. #20 James Sweet
    June 29, 2010

    That rule is: Whenever you see a health care professional promise “miracles,” run, don’t walk. Add to that references to “toxins” and “nutritional deficiencies,” and run harder and faster.

    I think this can be made more specific in the criteria and more general in the applicability by phrasing it as:

    Whenever anyone suggests a simple unary cause for a perennially vexing problem, they are almost certainly wrong.

    This applies not just to health, but to public policy, social interactions, you name it. Hard problems are by definition HARD, and that usually means multiple complex and interrelated causes. Rarely does a simple single-part solution come along to a problem that has existed for a long time (otherwise, people would have thought of the simple solution a long time ago, no matter how counter-intuitive it might seem).

    “We can cure cancer just by fixing this one chemical imbalance!”
    “We can end poverty just by enacting this one simple public policy!”
    “We can end world hunger just by adopting this one simple farming technique!”
    “You can get dates all the time just by adopting this one simple pick-up technique!” (actually, this last is partially true I suppose, with the “technique” being “ask as many people as possible, all the time”…)

  21. #21 James Sweet
    June 29, 2010
    I looked deeply into his genes and the biochemistry his genes controlled and found places where we could improve things.

    “I looked deeply into his genes and the biochemistry his genes controlled”? That line cracked me up, as if Hyman knew the first thing about “looking deeply” into anything, much less someone’s genes.

    Maybe he meant to say “jeans”? “I looked deeply into his genes and found his wallet! Roxorz!”

  22. #22 Travis
    June 29, 2010

    Herb,
    And we have a doctor who is working to improve the overall health of his patient by reducing mercury levels, insuring adequate levels of vitamins and nutrients…And he is finding that his patients are responding. And all you and the commenters have is scorn.

    If he was only doing this that would be fine, eating well, making sure people have the nutrients they need is great, improving general health would be a good thing but of course that is not what he is claiming. As others have pointed out, the last part of your statement is the big problem. He has a sample with N=1, without controlled experiments yet is claiming he can help patients with Alzheimer’s. That is bunk. If he wants to claim that he would actually have to perform proper studies. So right now he is cashing in on something without any evidence it actually does as he claims.

  23. #23 Vicki
    June 29, 2010

    Herb–

    Also, vitamin D, B6, and folate supplements aren’t “personalized medicine.” If they aren’t a generic “most old people don’t get enough vitamin D, I’ll give everyone x amount a day,” a doctor can easily check levels with blood tests. That’s not “personalized medicine,” and if a random person is low on vitamin D, I’d ask about diet and whether they’re getting out in the sunlight regularly.

  24. #24 Travis
    June 29, 2010

    I also do not buy the whole “He is just trying to help” line of thinking. If you want to help you need to be intellectually honest and this guy is not, he makes supremely confident claims based on nothing at all.

  25. #25 Calli Arcale
    June 29, 2010

    When it comes down to it, this Hyman fellow doesn’t even know himself if this therapy works. He hasn’t taken the time to determine that. He used it on a patient, saw the patient improve, and made the assumption that the therapy worked. He then did not hesitate to begin using it on every patient he could find, and promoting it via other means as well. I am being charitable by describing it that way; it is also possible that his intentions are more sinister, and he really doesn’t care if it works as long as he can sell it. (And the key to that is to never publicly doubt it. Confidence will nearly always sell a lot better than facts will. Why else do people buy brand-name Tylenol when they could be getting store-brand acetominophen? Only the Tylenol is advertised with confidence. The others are just sorta there. Never mind they’re pretty much — and in some cases exactly — the same thing.)

    People accuse scientists of being arrogant, and some certainly are, but real science requires genuine humility, because you have to embrace the possibility that you are wrong about something. You have to examine it in excruciating detail to be certain that you are not wrong. Rule out all other explanations. Hyman has not done this. Either on some level he knows it is wrong and doesn’t want to jeopardize his cash flow, or he is too arrogant to believe he could ever be wrong.

    John “Jack” Horner, the famous paleontologist who discovered the Maiasaur and after whom Sam Neill’s character in the Jurassic Park movies was based, said this to one of his colleagues, a young scientist who discovered preserved red blood cells inside a femur from a Tyrannosaurus rex. That’s an extraordinary (even revolutionary) thing to find, so here’s what he told her when she first showed him the slides:

    When she first found the red-blood-cell-looking structures, I said, Yep, that’s what they look like. Now see if you can find some evidence to show that that’s not what they are.

    Good advice for anyone who thinks they’ve found the answer to a vexing problem. Before you shout it to the world, try to disprove it. Rule out the other explanations. Make sure you haven’t let your enthusiasm get the better of you.

  26. #26 JustWondering
    June 29, 2010

    and not just cilantro but cinnamon, turmeric,curcumin,”black seed”(a/k/a nigella or kalongi)which are all totally effective… if you’re trying to learn how to cook Indian food.

    You forgot coriander seed.

  27. #27 Chance Gearheart, NREMT-P/EMD
    June 29, 2010

    @5, Orac –

    I’m suprised Augustine hasn’t showed up yet to lecutre us on how no one here is really a scientist, but just pushing the atheist philosophies that alt medders are dangerous because they hurt pharma’s profit.

  28. #28 Dangerous Bacon
    June 29, 2010

    Herb: “We have a disease with no cure, and no effective treatment. And we have a doctor who is working to improve the overall health of his patient by reducing mercury levels, insuring adequate levels of vitamins and nutrients, and is using no acupuncture, homeopathy or other implausible modalities. And he is finding that his patients are responding.”

    Practitioners of all kinds (including physicians) are entirely capable of reaching conclusions based on patient anecdotes, which turn out to be wrong. It’s happened repeatedly in the case of mainstream medical therapies and surgical techniques that individuals docs swore were helpful
    but had to be discarded when they proved valueless.

    A good explanation of this phenomenon can be found in R. Barker Bausell’s book “Snake Oil Science”. I suggest reading it before going off on critics as being meanies who attack a poor healer who is just trying to help.

  29. #29 Calli Arcale
    June 29, 2010

    JustWondering @ 26:

    and not just cilantro but cinnamon, turmeric,curcumin,”black seed”(a/k/a nigella or kalongi)which are all totally effective… if you’re trying to learn how to cook Indian food.

    You forgot coriander seed.

    Coriander and cilantro are actually the same plant; English has just borrowed its name twice, from different languages. “Coriander” comes from German (which in turn got it from Latin, which got it from Greek), while “cilantro” came from Spanish (supposedly also coming from the Latin). The entire plant is actually edible, but not everybody likes it. My husband can’t stand it, but I love it.

  30. #30 Todd W.
    June 29, 2010

    @Calli Arcale

    Or, more gastronomically, coriander refers to the seed of the plant, cilantro refers to the leaves of the plant, much like nutmeg is the actual seed of Myristica fragrans, while mace is the aril of the seed.

  31. #31 Mephistopheles O'Brien
    June 29, 2010

    I thought Dr. Hyman’s snide little aside that “…match the drug to the diseasse which is the only thing doctors are trained to do … (other than surgeons actually)” was unnecessary and tainted much of the rest for me.

  32. #32 Bill in NC
    June 29, 2010

    Treating dementia is realistically limited to providing the safest environment for the patient as their disease progresses.

    Many will require secured assisted living because of their propensity to wander.

    And as their ability to perform activities of daily living declines, many more will need nursing home-level care.

  33. #33 Fleur
    June 29, 2010

    Oh, the person writing this blog is a dumb cunt who is every bit as arrogant and unknowing as the people they criticize. Natural cures have worked for thousands of years in countries like China and India. Thats why those countries are doing so much better than we are today.

    And if any of you had the brains to get out of the mainstream herd you would never fear disease again. Prevention is the word! And all diseases can be prevented.

    And of course theres a life force. What a dull monotony idiot you must be to believe elsewise. Someday you’ll all find out though.

  34. #34 Fleur
    June 29, 2010

    Oh, the person writing this blog is a dumb cunt who is every bit as arrogant and unknowing as the people they criticize. Natural cures have worked for thousands of years in countries like China and India. Thats why those countries are doing so much better than we are today.

    And if any of you had the brains to get out of the mainstream herd you would never fear disease again. Prevention is the word! And all diseases can be prevented.

    And of course theres a life force. What a dull monotony idiot you must be to believe elsewise. Someday you’ll all find out though.

    I refuse to go to hospitals or use toxic pharmaceutical drugs. Your not going to ruin my life or health. Just keep ruining your own.

  35. #35 ebohlman
    June 29, 2010

    Calli: The taste receptors for saponins (found in cilantro) are polymorphic. One variant results in saponins tasting like soap (which is how they got their name). People with that variant tend to hate cilantro with a passion (I’ve got the variant that makes it taste wonderful).

  36. #36 T. Bruce McNeely
    June 29, 2010

    Natural cures have worked for thousands of years in countries like China and India. Thats why those countries are doing so much better than we are today.

    Life expectancy in China 73.0 yr
    Life expectancy in India 64.7 yr (below the world average)
    Life expectancy in the USA 78.2 yr
    15 countries have a life expectancy of 80 yr or more. They all use science-based medicine.

    Yep, they’re doing so much better than we are.

  37. #37 clayton
    June 29, 2010

    cinnamon and diabetes
    http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=DetailsSearch&term=cinnamon+diabetes

    Curcumin is a constituent of Tumeric. It may inhibit COX-2. Som research says its good, some says not so much.
    http://www.ncbi.nlm.nih.gov/pubmed?term=curcumin%20AND%20pubmed%20pmc%20localsb%20AND%20loprovpmcsb

    But these are at least real studies, even if just in cells. Muscle testing is complete BS.

    And I do love curry! I put garam masala in my oatmeal along with dried fruit and nuts.

  38. #38 DW
    June 29, 2010

    I mentioned those spices in response to clayton’s cilantro reference because woo-world seems particularly enamored with them as be-all and end-all “cures” to just about every ill(but especially cinnamon for diabetes, curcumin/tumeric as anti-cancer,black seed for asthma) while they just sounds like a recipe to me…(garam masala in oatmeal?)

  39. #39 augustine
    June 29, 2010

    Bruce: “15 countries have a life expectancy of 80 yr or more. They all use science-based medicine.”

    That is such a fallacious use of logic. Are you saying that they live over 80 BECAUSE of science based medicine?

    Medicine is one of the many factors that improves average life expectancy. And it is certainly not THE most important factor. You should already know this.

  40. #40 Paholaisen Asianajaja
    June 29, 2010

    In other news: British Medical Association voted for banning homeopathy.

    “Homeopathy should be banned from use in the NHS, the conference agreed.

    The meeting voted overwhelmingly in favour of stopping commissioning or funding for homeopathic remedies or homeopathic hospitals in the health service.

    UK training posts in homeopathic hospitals should also be scrapped, the conference said.”

    http://web2.bma.org.uk/nrezine.nsf/wp/ESML-86VGUX?OpenDocument&C=3+July+20

  41. #41 Shay
    June 29, 2010

    Natural cures have worked for thousands of years in countries like China and India. Thats why those countries are doing so much better than we are today.

    How odd, then, that my Chinese- and Indian-born colleagues tell me everyone back home with the means to do so uses doctors trained in scientific methods. “Natural cures” are for those too poor to afford anything better.

  42. #42 Antares
    June 29, 2010

    “Biomarkers.” “Personalized Medicine.”

    I am just right now attending a conference on Metabolomics in Amsterdam, and guess what – while most talks and all posters were about teasing out the intricate interactions of the substances in our body and what they can tell us, we also had at least one cranky presentation that hailed alternative, especially traditional chinese medicine for “treating the patient and not the disease.” All alarms ringing.

    By a senior board member.

    Here, have a look:
    http://www.worldbank.org/afr/ik/GRA/van_der_greef.pdf
    He’s raising good points, but with an awful lot of, say, esoteric overhead.

  43. #43 Travis
    June 29, 2010

    Hmm, I want to look at that link Antares but I think I need to drink the beer I stuck in the fridge earlier before getting to it because I cannot handle that right now. I find it is harder and harder to deal with the crankiness.

  44. #44 Fleur
    June 29, 2010

    “When you meet a person who is taking multiple prescription drugs, they are overweight or obese, chronically fatigued, mentally depressed, sickly in appearance, mentally clouded, suffering from several blood chemistry problems, burdened with weak immune systems, suffering from low bone density, and emotionally unstable.”

    And if you ridiculously believe else-wise your just a monotonic idiosyncratic trying to push Big Pharm ideas. The only “quackery” around here is pharmaceuticals and mainstream medicine. Your a mediocre solipsism simply in line with government and your supposed “unique” ideas are just another piece of insignificant trash on the giant heap of societal faux.

    http://www.reformfda.org/FDA_Reform (told you! Don’t trust government)
    http://www.naturalcures.com
    http://www.mercola.com/
    http://www.advancedscientifichealth.com/ (scientific evidence!, for you shitholes) http://www.advancedhealthplan.com/cancerresearchfraud.html
    http://www.msgtruth.org/
    http://www.healthtalkhawaii.com/Health_Talk_Hawaii/Welcome.html (amazing guy) http://www.ginatyler.com/
    http://www.lef.org/ (the originals)
    http://www.homeopathicrevolution.com/ (see this is why all the rich people are in much better health than the herd is, they have access to information that the little guy is systematically denied) http://www.psrast.org/ (so they are concerned…)
    http://www.healthhabits.ca/ (practical knowledge without the paranoia)
    http://www.theherbprof.com/ (another amazing person)

  45. #45 T. Bruce McNeely
    June 29, 2010

    That is such a fallacious use of logic. Are you saying that they live over 80 BECAUSE of science based medicine?

    I was responding to fleur’s claim that China and India are doing “so much better” than us because they use natural cures that are 1000s of years old – you know, the same old lame bullshit that I’ve heard from alties for years.
    Please point out where I said that science-based medicine was the only reason that lifespans in these countries exceeded 80 yr.

    You seem to have a problem with reading comprehension.

  46. #46 Jack
    June 29, 2010

    Looks like this guy is mixing in some evidence-based practices with his woo which could help explain his results. Hypothyroidism can definitely look like a dementia and correcting it would improve cognition.

  47. #47 Daniel J. Andrews
    June 29, 2010

    O/T, but your post sparked some other questions. If you were diagnosed with Alzheimer’s (or a neurological disease that will leave you helpless and in pain) would you ask one of your colleagues to help you die? Would you do the same for one of your patients whom you’d known for a long time?

    Or maybe not what you’d do personally (you’re not exactly anonymous) but what the thought is among physicians about helping people die; What possible legislation might be changing to enable physicians to legally help some people die. Will insurance companies still pay out if you (or your doc) terminates your life prematurely even though the remaining few months of ‘natural’ life you’ll be a vegetable or in terrible pain and dependent on people for the smallest things.

    Don’t know if you want to tackle that kind of post, maybe it’s too cliched now…..

  48. #48 Dianne
    June 29, 2010

    @33 (and 34) Poe? Is that you?

  49. #49 English Rose
    June 29, 2010

    @42 Antares – my husband is at that conference! Also enjoying experience the orange frenzy over the world cup, too, I gather…

  50. #50 Composer99
    June 29, 2010

    augustine, which non-medical advances are more significant than medical ones in improving human lifespans?

    Unless you can come up with a reasonable list, you are still shooting blanks in the fallacy accusation game.

  51. #51 augustine
    June 29, 2010

    Composer: “augustine, which non-medical advances are more significant than medical ones in improving human lifespans?”

    “The Questionable Contribution of Medical Measures to the Decline of Mortality in
    the United States in the Twentieth Century”

    http://lingli.ccer.edu.cn/he2007/readings/n03_product_1.pdf

    “What is the evidence for a causal link
    between hygiene and infections?”

    http://deepblue.lib.umich.edu/bitstream/2027.42/55441/1/Aiello%20A,%20What%20is%20the%20evidence%20for%20a%20causal%20link%20between%20hygien%20and%20infections,%202002.pdf

  52. #52 Chance Gearheart, NREMT-P/EMD
    June 30, 2010

    So basically, Augustine, you’ve used a 33-year old thesis paper that ignores the fact that scientific investigation and study of nutrition was the main factor for the decrease in disease in a population where malnutrition was the common causitive factor in non-infectious disease, and tries to apply the same principals to a post-industrialized consumerist society who’s staple diet contributes to the main cause of death in the United States and the first world, as well as lumps these in with traumatic death (Of which, for the most part, nurtition cannot prevent pre and peri-injury), as well as discounts the prevelence prior to the data period sampled of smallpox and smallpox related morbidity/mortality during the 18th and 19th Century in the UK – as well as ignoring science and germ theory’s contribution to increased pushes for sanitation and waste control.

    The idea that nutrition, sanitation, and infection control aren’t an integral part of modern medicine is absurd.

    – And taking a paper which establishes personal hygene and infection as having a causual link and eskewing the point made in this paper as supporting the idea that medicine is only a small part of extending life expectancy is basically making a blanket statement about a very complicated topic.

  53. #53 Chris
    June 30, 2010

    Fleur, you are using the old and boring Pharma Shill Gambit. It is obvious you have not read much of this website. If you had you would have seen how Mercola, Natural News and other silliness in your list have been treated.

    You are not even an amusing troll.

  54. #54 David N. Brown
    June 30, 2010

    @44:
    “this is why all the rich people are in much better health than the herd is, they have access to information that the little guy is systematically denied”
    So, are the chelationists, homeopaths, GFCF advocates, etc. giving out their products to the poor at their own expense (the way governments do with vaccines)? And what basis do you have for saying “all the rich people” are healthier than the poor? Could you win a basketball game against a black inner city teenager, or KO a day laborer in a fair fight? But thanks for making it easier than usual to see that the anti-vaccine movement is built of rich white people who aren’t happy with receiving a medical service that is equally available to people poorer and darker than themselves.

    @51,
    As a rule, the “sanitation” gambit is the antivaxxers’ most plausible point. But it sounds like Augustine is trying to question the value of hygiene too. Do we have a germ theory denier on our hands?

  55. #55 Antares
    June 30, 2010

    @49 English Rose: The conference program leaves not much time, but yeah, we’re enjoying it here.

    Regarding that van der Greef presentation, it’s sad to see that he’s not far off the motivations and visions of the Metabolomics society, just mixing it up with way too much quackery and propagating a lot of the usual alt-med canards. (“Drugs don’t work!”, “Only side-effects!”, “Western medicine is reductionist, Chinese Medicine is holistic.” Especially that last one is a huge insult to all the colleagues at the conference who presented just how carefully they are taking “the whole individual” into consideration.

    The upside, though, is that not many of us seem to fall for his rhethoric – he was the subjects of many jokes and snarky comments later that evening… :-)

    Greetings from Amsterdam
    Daniel

  56. #56 DLC
    June 30, 2010

    As someone who fears losing his mind the most of everything, I wish there were some simple cure-all for it.
    But wishing does not make it so. Perhaps in 30 years we’ll have something. If we can figure the brain out, but that’s a fairly tall order.

  57. #57 Anon
    June 30, 2010

    This “personalized medicine” bit reminds me of something completely different, which I hope will be completely relevant. It comes from the research on Barnum Effect, and the dangers of personal validation.

    Essentially, we take three randomly-assigned groups, and get a bit of info from them in order to give them horoscope readings. One group is asked their date of birth; the second is asked their date and place of birth, to be more accurate; the third is asked date, place, and exact time of birth, to be most accurate of all (from memory here, so precise variables I cannot guarantee). They are all then given the exact same astrological report (separately, of course), and are asked to rate its accuracy. Turns out, the more information we take, the more accurate the “diagnosis” will be perceived as being, when it is demonstrably not accurate at all.

    I’ve seen the effect discussed as applicable to psychiatric intake interviews (more testing = better, yes?), where the client’s reported satisfaction is an important dependent variable (clearly confounded, as per this research, with the sheer volume and complexity of intake data-gathering). It seems to me that “personalized medicine”, as being used in this video, could easily be taking advantage of precisely this effect. By using the ultra-uber-scientific genetic testing to make sure this treatment is yours and yours alone, one thing that is being done (perhaps the only thing) is that the equivalent of the highly detailed date, place, and exact time horoscope is being generated.

    May as well be phrenology.

  58. #58 Mephistopheles O'Brien
    June 30, 2010

    @44 – I took a look at the site you said had “scientific evidence!” and have to admit not finding it just immediately. There was mention of Linus Pauling, though it was unclear whether this site’s products were based on his really good work or his work on Vitamin C which was, as I recall, largely unverified by later investigators. Did you happen to have a link to some actual evidence?

  59. #59 Bill in NC
    June 30, 2010

    @46 “Hypothyroidism can definitely look like a dementia”

    B12 deficiency can also result in dementia symptoms, but unless you’re living in the gutter with a bottle of pop-skull clutched in your hand it’s unlikely your dementia would be the result of a lack of B12.

    And if you fear dementia, there’s no need to contemplate suicide.

    Simply specify “no antibiotics” (not just “no IV antibiotics”) in your health care proxy and your first bout with pneumonia is probably going to be your last.

    My mom lived a decade after her diagnosis only because we aggressively treated the repeated infections she developed as the disease progressed.

  60. #60 Coryat
    June 30, 2010

    Ah crud, Augustine has escaped his cage again!

    Fleur sed: “And of course theres a life force.”

    Cool, is that like the Triforce? Oh wait, you were serious, let me laugh even harder. Vitalism is total bunk. That whole notion was debunked by people like Descartes and the scientists of the Royal Society. Even eighteenth century writers like Margaret Cavendish, (who held to a form of vitalism) started integrating it with the new mechanical philosophy in her fiction. How is it someone from over 250 years ago knows more than you?

  61. #61 Vicki
    June 30, 2010

    Bill in NC–

    I am making a note of that “no antibiotics” suggestion in case I need it sometime. (Based on family history, I probably have about 40 years before it might be an issue.)

  62. #62 T. Bruce McNeely
    June 30, 2010

    B12 deficiency can also result in dementia symptoms, but unless you’re living in the gutter with a bottle of pop-skull clutched in your hand it’s unlikely your dementia would be the result of a lack of B12

    Actually, B12 deficiency is not all that rare, however, the most common cause is pernicious anemia, which is caused by an inability to absorb dietary B12. It’s easily treated with B12 injections. So B12 blood levels, as well as TSH levels should be a part of every workup for dementia.

  63. #63 Calli Arcale
    June 30, 2010

    An ill-informed vegan can also wind up with B12 deficiency; vegans who know better take supplements. B12 is difficult to obtain without animal products, but bacteria have been genetically engineered to manufacture it in a manner compatible with vegan beliefs. I could see a vegan with early-stage dementia starting to forget to take the supplements, exacerbating the condition, so I agree — doctors should consider the possibility of low B12.

  64. #64 David N. Andrews M. Ed., C .P. S. E.
    June 30, 2010

    @Paholaisen_Asianajaaja (for those who don’t understand Finnish, that’s Devil’s Advocate):

    “In other news: British Medical Association voted for banning homeopathy.”

    Hieno juttu! Homeopaattinen ‘lääketiede’ ei ole (eikä ole ollut ollenkaan) tieteellistä, ja kyllä on nyt sopivaa, että BMA kieltäisi sitä loppullisesti.

    Tapasin monta vuotta sitten nuoren nainen jonka ajatus olise, että hänestä tulisi allopaattinen lääkäri, vaikka hän uskoi kovasti homeopaattiseen ‘lääketieteeseen’ (onko tuo tieteen oikea muoto tässä yhteydessä?). Hän kokeili minun kanssa jotain homeopaattista (ilman minun tietävän, kuinka se toimisi) ja näytti siltä, että paras sanottavaa siitä oli, että placebo-vaikutus ehkä tulee toimimaan tollaisessa ‘lääketieteen’yhteydessä, eikä mitään farmakologista vaikutusta ollenkaan.

    Outo juttu, sitten, että BMA on antanut luvan koulutusksessa oleville lääkäreille hakea tommosilta sairaaloilta koulutuspaikkoja. Hieno, että tämä ei ikinä tapahtuisi Suomessa.

  65. #65 Clayton
    July 1, 2010

    @fleur
    One thing, anti- government, why do you hate me, my neighbor, yourself, your family and every American here? “We the People…” Doe the government make mistakes, not keep a fair and balanced playing field? For sure. And then you are anti corporation…until you post links to businesses that exist only to make money, why is that. For example; you have provided a link to Advanced scientific Health. Lets see, from their own website.

    On their website 2 x Infinity Company Matrix
    Basically the company matrix is a pool designed to reward our members for their contribution to the growth of ASH over time. A member’s position in the company matrix is based on the entire membership and your matrix rank is based on the date you became a member. Each month all matrix qualified members are positioned into the company matrix and their position is used to calculate a profit share of the company pool.

    Mercola? Really, most of us who work in the health food business know that Mercola is just a shill for his own products. He was all about product X until Product Y offered him a better deal. Not better evidence of efficacy, just more money. How do I know, because of comments he made at a trade show to a manufacturer rep, and within 3 months was slamming us (coincidentally we didn’t give him the discount he wanted to sell our products online, his only argument, “I’m Dr Mercola”.

    Life extension foundation creates a magazine, that should be considered a marketing piece for their manufacturing side; which in all likelihood is performed by contract manufacturers. Here is a little piece of information to suck on, 93% of all supplements on the shelves or online are created by contract manufacturers. Some do a good job with quality control, some not so much. New cGMP rules that come into effect today, yes today should clean up the quality control issues (not to be confused with scientific evidence for/against the use them) that people like Gary Null have experienced.

    Kevin Trudea .. really. Are you familiar with this “…two-year stint in federal prison in the early ’90s after pleading guilty to credit card fraud, and a 1996 tangle with the Illinois attorney general, who accused him of running a pyramid scheme while working for a health-products company called Nutrition for Life. Trudeau and a co-defendant settled that case, paying $185,000 to Illinois and seven other states…”. People would walk into my store( I at one time managed a health food store) with his book, and complain about the ongoing monthly charges to their credit card, even after they had asked to cancel his monthly paper. And to make matters worse, he is like a homepathic version of the Life Extension Foundation, minus his own products.

    You come in calling people names, provide no evidence for your comments and then put up a list of profiteers who cry crocodile tears. Get a fucking grip already. no amount of colloidal silver will save you from a busted sewer pipe. How can you point a finger at pharma and not acknowledge that our side does the same thing. I am ashamed by my industry in so many ways.

  66. #66 augustine
    July 2, 2010

    Chance Gearheart: “The idea that nutrition, sanitation, and infection control aren’t an integral part of modern medicine is absurd.”

    Really? It was scientific medicine that promoted trans-fat as a healthy alternative to cholesterol. Is that really science? Scientific medicine brought us the 4 food groups, the food guide pyramid and a corn based agricultural program. Don’t forget about Nutrasweet. That stuff just doesn’t grow on trees you know. Science based medicine brought it too us. It must have saved millions of diabetics and helped billions lose countless pounds.

    Does anyone go to the doctor for “sanitation”. Is Sanitation somehow only a modern scientific concept recently developed by skeptic bloggers? No. The idea of sanitation has been around for thousands of years.

    Infection control? What on earth do you mean by that?

    “So basically, Augustine, you’ve used a 33-year old thesis paper that ignores the fact that scientific investigation and study of nutrition was the main factor for the decrease in disease in a population where malnutrition was the common causitive factor in non-infectious disease,”

    Wait a minute. I thought disease exists in those populations solely because of a lack of vaccines available. You mean nutrition has something to do with it?

    Bruce: “Please point out where I said that science-based medicine was the only reason that lifespans in these countries exceeded 80 yr.”

    In your personal opinion is it the most important? It’s the only one you purposely mentioned when noting increased avg. life expectancies. If you don’t think it’s the MOST important then why didn’t you name the most important factors? If you really truly in your heart think science based medicine is the biggest factor then you’re sadly mistaken.

  67. Hmmm. Thanks for you input on this but I think we as humans are pretty smart. Why can’t we use the best of everything we’ve had in the past and everything we have now? That means foods, supplements, detoxification, prevention and yes, sometimes even drugs! We are all individuals with different life experiences. It seems that your personality type is often associated with Alzheimer’s (and with cancer for that matter.) It’s good to research out what you are afraid of. Gets rid of FEAR (False Evidence Appearing Real.) And diatribe is good too. It’s all good actually.

  68. #68 Scottynuke
    January 16, 2012

    Hmmmmmmm…

    Haven’t looked up the stats lately, does an 18-month gap qualify Moffat for the Necromancer Top 10 list?

    And speaking of “false evidence appearing real,” Moffat owes me a new irony meter.

  69. #69 lilady
    January 16, 2012

    Denice, who communicates with the dead, has an affinity for reviving a blog that was moribund 18 months ago.

    I read your biography on your website Denice. You are today’s Respectful Insolence “all-purpose master of Reiki, cranio-sacral therapist, ND (Not a Doctor), Jesus Freak Troll”.

    Congratulations, Denice!

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.