Respectful Insolence

Regularity über alles, revisited

File this under “Well, duh!”

In thinking about “alternative” medicine, occasionally I contemplate the deepest, most profound questions having to do with health and healing, the difference between science-based medicine and evidence-based medicine, and how to maximize the therapeutic effect of scientifically validated treatments. Other times, I contemplate the question of just what is, based on logic and basic science alone, the most ridiculous “alternative medicine” therapy of all time.

Certainly, there are many contenders. For example, there is homeopathy, which is basically nothing more than sympathetic magic in which water is claimed to retain the memory of whateve therapeutic substance the homepath wants to use but, at Tim Minchin puts it, to forget all the poo it’s been in contact with. Then there’s reiki, which, boiled down to its essence, is nothing more than faith healing, substituting a “universal energy” for the Christian god. Oh, and reiki isn’t “ancient,” either. It was invented in 1920. Then, of course, there are the ever-infamous Kinoki footpads or the “detox footbaths.” They’re both basically the same thing, wherein quacks claim that you can actually eliminate “toxins” through the soles of your feet. They’re also both equally scams, with only the mechanism of producing an apparently “positive” result differing. Either way, however, a credulous mark is separated from his greenbacks.

One form of alternative medicine quackery, however, that never fails to amaze me with its combination of utter nonsense and ridiculousness, coupled with the sheer disgustingness of it all, is, of course, colon cleansing. It’s something that I’ve written about periodically during the history of this blog (and even transplanted to my other blog), be it writing about how quacks falsely claim that “death begins in the colon,” that “dual action cleanse” does anything other than make you poop, or making fun of a form of colon cleansing so ludicrious that even the most credulous believer in alternative medicine can’t possibly believe it. Or maybe he could. Over the years, I’ve seen so much utter nonsense swallowed whole and regurgitated as though it were fact and science that I no longer believe there is any form of pseudoscience so nonsensical that someone, somewhere (and usually many people in many places) won’t believe it. I’m still waiting for butt reflexology to catch on, and, actually, in some places it did.

So, even though colon cleansing is one of the stupidest–yes, stupidest–forms of alternative medicine I’ve ever encountered, there is indeed a large contingent of credulous believers who also seem to have a fixation about cleanliness (not to mention their nether regions) who think that colon cleansing can “remove toxins in order to treat a wide variety of diseases and conditions. Let’s not forget, for instance, that the Gonzalez protocol for cancer is basically a radical diet, coupled with lots of supplements and lots of coffee enemas. There’s even a Guild of Colon Hydrotherapists, not to mention the International Association for Colon Hydrotherapy, both of which to me certainly strive for the title of most useless organization ever conceived, an organization that even goes so far as to claim that Jesus advocated colon cleansing. I suppose that latter claim is possible, given that colon cleansing dates back to ancient Egypt and is based on the idea that our colons can’t handle the waste and “toxins,” leading to all the poo in our colons leeching into our bloodstreams and poisoning us, a concept known as “autointoxication.”

Because I’ve written so much about just how silly a form of quackery colon cleansing is, when you, my readers, first started sending me links to this article, entitled Colon Detox Not Backed by Science, at first I resisted. After all, Orac is nothing if not a cantankerous box of multicolored blinking lights, and he hates being told what to do. On the other hand, he does, for all his alleged computer nature, feel a fierce loyalty to his readers, and, if his readers want him to blog about colon cleansing again and are deluging him with requests, well, then, damned if he won’t blog about colon cleansing again! Never let it be said of Orac that he doesn’t give his readers what they want (well, most of the time, anyway). Besides, this is actually an amazing little bit of victory for the forces of science-based medicine, as you will see. First, let’s take a look:

Colon cleansing has no evidence to support its use, and can lead to pain, vomiting, and fatal infections, according to a new report.

“A search of the literature using the terms ‘colon cleansing,’ ‘herbal colon cleanse,’ ‘colon detoxification,’ and ‘colon irrigation,’ yielded no scientifically robust studies in support of this practice,” wrote Ranit Mishori, MD, of Georgetown University in Washington, D.C., and colleagues, in the August Journal of Family Practice.

Colon cleansing has been practiced since antiquity as a means of enhancing health through ridding the body of toxins. These procedures are similar to enemas, except that volumes in excess of 60 liters sometimes are used, and the procedure may be done repeatedly.

60 liters? Those of you out there who’ve hit the age of 50 and had to undergo screening colonoscopy (or those of you who’ve needed a colonoscopy for a complaint such as rectal bleeding) have experienced the joy of drinking a mere 4 L of GoLytely, only to see it flow right through you and come out the other end. Imagine having fifteen times that volume being placed in your nether regions over time and squirting it out again. Gross? Well, of course it is. But that’s what we’re talking about here, and never let it be said, either, that Orac shies away from a topic just because it’s digusting. It never ceases to amaze me what people will subject themselves too when they think it is somehow beneficial.

So let’s take a look at the article itself. Interestingly, it was published by faculty at the Georgetown University School of Medicine. Those who’ve been longtime readers might recognize why I mention this. Yes, Georgetown is a school that is deeply entrenched in woo, so much so that it “pioneered” the “integration” of quackery in its mandatory medical curriculum. No more was it enough to offer various complementary and alternative medicine (CAM) rotations as electives for fourth year medical students. that wasn’t “integrative enough” so the powers that be at Georgetown “integrated” pseudoscience into their medical school curriculum. More recently (this year, in fact), Georgetown signed an agreement with that school of quackery naturopathy, Bastyr University, to help train the next generation of CAM practitioners. The only reason that I mention these things is that it’s a hopeful sign that faculty at Georgetown University are holding out against the tsunami of quackademic medicine that must be washing over them. And hold out they do, delivering a devastating critique (OK, debunking) of the quackery that is “colon hydrotherapy” or “colon cleansing.”

First off, not only does colon cleansing not provide the benefits claimed for it, but it is not a safe procedure. There are a number of complications that cna occur, ranging from the unpleasant to the genuinely life-threatening:

Most reports in the literature note a variety of adverse effects of colon cleansing that range from mild (eg, cramping, abdominal pain, fullness, bloating, nausea, vomiting, perianal irritation, and soreness) to severe (eg, electrolyte imbalance and renal failure). Some herbal preparations have also been associated with aplastic anemia and liver toxicity.

Case reports also have noted back and pelvic abscesses after colonic hydrotherapy, fatal aeroportia (gas accumulation in the mesenteric veins) with air emboli, rectal perforations, perineal gangrene, acute water intoxication, coffee enema-associated colitis and septicemia, and deaths due to amebiasis.

All of these are easily predictable by anyone who knows a bit about the anatomy and physiology of the colon (like a surgeon–like me). All medicine is a balancing of risks versus benefits. Unfortunately, in this case, the procedure is all risk, no benefit.

There is one curious bit in the article, though. Let’s see if you can see why I found this passage rather curious:

The preparations used for colon cleansing are considered dietary supplements, and the US Food and Drug Administration (FDA) requires that they be labeled as such; the FDA does not preapprove these substances, however. The FDA also requires that colonic hydrotherapy and irrigation system devices meet certain requirements, but the agency has never approved any system for general nonmedical purposes, such as colon cleansing.

Apparently the FDA has a different definition of “dietary supplement” than most people would have. Personally, I consider dietary supplements to be something that one ingests in the correct end of the gastrointestinal tract, not something that one shoots up the hole where things usually exit. Yes, I know what the authors are getting at, but, really, does it matter that much whether what’s put in the hydrotherapy fluid is considered a dietary supplement under FDA regulations and the DSHEA of 1994? I think not. On the other hand, what I can’t figure out is how colon cleansers get away with coming up with all these cobbled-together devices to deliver the goods, so to speak. After all, these devices have an FDA Class III designation. That means that if a device is used for purposes beyond what is medically indicated, such as preparation for radiologic and endoscopic procedures, then the manufacturer must obtain premarket approval from the FDA. Guess how many of these manufacturers bother to get such approval?

The authors conclude with four things they recommend telling patients about colon cleansing. Personally, I think that only two things are necessary. First, ask them what the hell they’re thinking and, second, point out that the colon rarely needs assistance in doing its job. OK, OK, I know. As a physician, I can’t be judgmental, and, believe me, when interacting with actual patients I do my damnedest not to be. On the other hand, if you’re not a physician or other health care professional, you’re under no such obligation. Be that as it may, in lieu of these points, then I suppose you can tell patients the more conservative things that the authors recommend:

  1. Colon irrigation is not wise–particularly if you have a history of gastrointestinal disease (including diverticulitis, Crohn’s disease, or ulcerative colitis) or a history of colon surgery, severe hemorrhoids, kidney disease, or heart disease. These conditions increase the risk of adverse effects.
  2. Side effects of colon cleansing include nausea, vomiting, diarrhea, dizziness, dehydration, electrolyte abnormalities, acute kidney insufficiency, pancreatitis, bowel perforation, heart failure, and infection.
  3. The devices that practitioners use for the procedure are not approved for colon cleansing by the US Food and Drug Administration. Inadequately disinfected or sterilized irrigation machines have been linked to bacterial contamination.
  4. Colon cleansing practitioners are not licensed by a scientifically based organization. Rather, practitioners have undergone a training process structured by an organization that is attempting to institute its own certification and licensing requirements.

All of this is good, solid, boring advice. My further advice, though, when it comes to colon cleansing would be to quote a former First Lady, who, whether you liked her or not, did come up with a most excellently pithy catchphrase that, while being an utter failure when it comes to drugs, might function quite well with respect to colon cleansing: Just say no. Your colon will thank you.

Comments

  1. #1 mikmik
    August 3, 2011

    This might not be the most extremely stupid of the woo arts, butt it is the most disgusting. I would also think that the risk of infection for the therapist would be prohibitive, butt I suppose they could just self administer the treatment for any acquired E.coli infection, sepsis, brown palm syndrome, well you know, it does happen.

    Actually, I just saw the link to candling. Blech.
    Next thing you know, they’ll be mixing up homeopathic solutions… Butt of course, all water is already imprinted in this manner

  2. #2 BlackCat
    August 3, 2011

    Here’s a blast from the bast. Michael Landon discusses his coffee enima cure on Carson May 91. One month later he was dead.

    http://www.youtube.com/watch?v=sjrowkWp3GU&feature=related\

    coffee enema on the 5:02 mark

  3. #3 John Crow
    August 3, 2011

    Hi. Thanks for the interesting article on the colon, but as an aside, who ever claims Reiki is ‘ancient’? Everyone I’ve ever met who practices this particular art tells the same story of it’s origins: invented in a meditation induced trance by a Japanese Christian monk in, as you say, the 20th century. This article is the only time I’ve ever heard someone claim antiquity for it, albeit as a straw man.
    Link to someone describing it as ancient and I’ll set them straight in their comments feed.

  4. #5 Kristen
    August 3, 2011

    Rich Scopie beat me to it. Plugging “ancient reiki” into Google gives me 4,400,000 hits. All hits on the first page conveniently trying to sell me something.

    Apparently the Egyptian kind of reiki is the ancient one. /sarcasm

  5. #6 Composer99
    August 3, 2011

    I can see the natural attraction woo-meisters would have for quackery involving the colon.

    After all, they are generally full of crap. And we all know from principles of sympathetic magic that like attracts like. Right? Right?

  6. #7 William Burroughs
    August 3, 2011

    the colon rarely needs assistance in doing its job

    “Americans have a special horror of giving up control, of letting things happen in their own way without interference. They would like to jump down into their stomachs and digest the food and shovel the shit out.”

  7. #8 stripey_cat
    August 3, 2011

    Amoebic dysentry?!? Can’t that infect the liver if it gets into the bloodstream? A procedure that’ll combine damaging your bowel with increasing your risk of nasty infections seems to be asking for gut pathogens getting into your blood.

    Also, how does the air embolism form from a liquid enema? Is it just that the pressure drives gases through small tears, or something?

  8. #9 Randy Owens
    August 3, 2011

    …leading to all the poo in our colons leeching into our bloodstreams and poisoning us, a concept known as “autointoxication.”

    Sounds like a rather high-faluting way of saying “full of crap” to me.

  9. #10 Greg Fish
    August 3, 2011

    Some people spend too much time gazing into their navels. Others firmly wedge their heads elsewhere and this is one of the results…

  10. #11 Finn
    August 3, 2011

    Not too long ago a friend of mine was wondering if there was anything to this colon cleanse business. Having had 2 abdominal surgeries, 3 abdominal & pelvic CT scans, and 1 colonoscopy (all of which required bowel prep) in the past 7 years, I was able to assure her that no, she did not have decades’ worth of crap stuck to the walls of her colon like spackle, as one of the many poowoomeisters claimed.

  11. #12 Mu
    August 3, 2011

    What happened to a prune in the morning? Or maybe some extra fiber cereal? On the plus side, if they perforate their bowels and get a good bit of it resected they will have so much less crap in them.

  12. #13 Dangerous Bacon
    August 3, 2011

    Orac: “Over the years, I’ve seen so much utter nonsense swallowed whole and regurgitated as though it were fact and science”

    Wrong end.

  13. #14 Denice Walter
    August 3, 2011

    Well, if the woo-enchanted, with their endlessly intricate diet and supplement regimes, are obsessed with what goes into one end of the GI tract of course they’d be obsessed with what comes out the other end as well. However, there are additional reasons why colon-cleansing is indeed the mother-lode** of alt med excretia.

    It’s a way to indulge in cleaned-up anal eroticism by re-naming it “health-consciousness” as well as a way to make yourself appear thin(ner)- at least temporarily. Thus, they can “purify” themselves of toxic contamination in a toned-down prurient manner and work on looking aesthetically pleasing at the same time. Multi-tasking woo. Spas often offer these services along with skin care – so does Ayurveda- -btw- Adams’ store at NaturalNews sells,uh… “apparati”.

    Intriguingly, other web woo sites provide Nature-based GoLytely- i.e. ingestible fibre and herb concoctions for the faint of heart ( or whatever). Ingedients like senna, psyllium, citrus fibre et al comprise popular products. Null advocates that his vegan followers eat 50 g of fibre daily- which can be supplemented with more fibre- which he sells, and yes, he is working on proving the old adage:” You can never be too rich or too thin”.

    Besides the weight issue, woo-meisters have understood that the idea of contamination and poisoning have importance emotional connotations and thus have a place in ad copy and sales techniques. If you think about it, wasn’t GI contamination by measles via vaccines the *piece de resistance* of Wakefield’s “theory” of autism? GI issues form the bulk of much hypothesising at AoA.

    Although I’ve read a lot of Freud- and don’t buy very much of it- he did address the issue of poop as an being an important factor in human development which wasn’t being addressed by polite Victorian society. If it affects people emotionally, woo-meisters will find a way to make a healthy profits off of it on a regular basis.

    ** or it is “load”?

  14. #15 Trish Gannon
    August 3, 2011

    What was cool about this article was it appeared in the top of the Yahoo News Feed – which is driven by reader interest.

  15. #16 Calli Arcale
    August 3, 2011

    Denice Walter:

    Null advocates that his vegan followers eat 50 g of fibre daily- which can be supplemented with more fibre- which he sells, and yes, he is working on proving the old adage:” You can never be too rich or too thin”.

    Having recently done a volunteer packing shift at Feed My Starving Children (which comes accompanied by information about specific children helped by their program), and having been reading the recent news about Somalia and donating to that effort via Doctors Without Borders, I think I can dispute that. While perhaps you can’t be too rich, you certainly can be too thin….. *shudders*

  16. #17 Edith Prickly
    August 3, 2011

    I’m still waiting for a woo-meister to explain how it is possible for the body to heal itself of serious diseases like cancer without medical assistance, and at the same time be incapable of completing a natural process like elimination without shooting massive quantities of liquid into a healthy colon.

    Dare I say it? they’ve got things ass-backwards…

  17. #18 Poodle Stomper
    August 3, 2011

    Regarding Reiki not being claimed as ancient, I had a classmate of mine tell me just last week that “Reiki is so ancient that even Jesus did it”! So yeah, there are at least some followers out there that have been told this crap, whether it is officially admitted or not. (yes, I am aware this is only an anecdote and may not be representative of the Reiki community as a whole).

  18. #19 cervantes
    August 3, 2011

    Did you hear about the dentist who switched to proctology? He was tired of people burping in his face.

    (Sort of on topic.)

  19. #20 Opus
    August 3, 2011

    I don’t know how I ever missed this! I’m going to be rich, RICH, RICH beyond my wildest dreams!! Behold, the newest way to remove toxins from the body:

    BUTT CANDLING!!

    1. Lie patient on stomach, after removing clothing.
    2. Set wallet aside for further processing.
    3. Insert candle.
    4. Light.
    5. IMPORTANT!! Extinguish candle before it burns all the way down.

    Now to find a good copywriter. . .

  20. #21 madder
    August 3, 2011

    Case reports also have noted back and pelvic abscesses after colonic hydrotherapy, fatal aeroportia (gas accumulation in the mesenteric veins) with air emboli, rectal perforations, perineal gangrene, acute water intoxication, coffee enema-associated colitis and septicemia, and deaths due to amebiasis. [emphasis added]

    Easily the most horrifying image I have ever come across, and I used to do forensic work. That, by itself, is what you tell anybody foolish enough to consider this.

  21. #22 Denice Walter
    August 3, 2011

    @ Edith Prickly:

    Oh, let’s see if I can think like a woo:

    It’s all about blockages of *qi*: serious illness can be healed if all blockages are removed and the qi( chi, ki, mana, prana, libido, life energy) can flow un-impeded vitalistically re-juvenating and en-livening the entire body, removing toxins in its wake, replacing them with purified energy and spiritual vitalism.

    So, shooting massive quantities of liquid into the colon assists in removing blockages ( like crap) that impede the flow of qi. However, these treatments cost money, hence the term, “filthy lucre”**: it’s healthy to be liberated from that too.

    ** told you I read Freud.

  22. #23 René Najera
    August 3, 2011

    Well, that’s quite the assinine way to “cleanse yourself”. How do those “colon cleanse” quacks not expect to be the butts of a lot of jokes. Glad that you’re keeping a close brown eye on them, Orac.

    It’s like they decided to play dig dug as they poked around for favorable results. I mean, what kind of a clown hole comes up with the idea to pump someone with 60 liters of saline!? This is bullsh!t. You can tell that science is not their Farte, but they still try to sneak in this pseudoscience through the back door.

    What a bunch of assh*les.

    Also, anus.

  23. #24 rob
    August 3, 2011

    i’m gonna start a new website:

    http://www.colonscleansingovernight.com

    the motto: any colon cleansed, anywhere, overnight!

    (BTW, check out http://www.petsovernight.com)

  24. #25 Silič O'Nopolitanopoulos, Färschdbischuf Beesknees aus Ulm und Klein Elguth, Elector Pharynguline.
    August 3, 2011

    It’s a way to indulge in cleaned-up anal eroticism

    Bingo!

    As sCAMs go, this is one of the easier ones to understand. It’s basically a paraphilia.

  25. #26 Elly
    August 3, 2011

    I read about this too (a press article + the actual paper) and briefly considered blogging about it, but opted to write about this CBC report on a spa-treatment “detox” death instead: http://www.cbc.ca/news/canada/montreal/story/2011/07/29/durham-farmhouse-detoxification-death.html

    While colonic irrigation wasn’t the cause, there’s a common element. Namely, if the word “detox” is associated with it, no procedure is too ridiculous, uncomfortable or even risky to undergo; particularly since detox advocates spin adverse effects as part of the “healing crisis.” When people are advised to ignore symptoms that indicate something’s wrong, it’s not surprising that some of them end up being physically harmed.

  26. #27 Ken
    August 3, 2011

    it’s a hopeful sign that faculty at Georgetown University are holding out against the tsunami of quackademic medicine that must be washing over them.

    Or (looking on the dark side, as I am wont to do) it is in competition with some other type of woo that they are trying to push. Time will tell.

  27. #28 timgueguen
    August 3, 2011

    Did anyone notice this thread has proof of there being an afterlife? Post number 7 is from William Burroughs.

  28. #29 Vasha
    August 3, 2011

    I’ve been reading this and other skeptic blogs for long enough that I thought I’d heard every nutty idea out there, but no, there are always more: here’s one from this week, luckily not disgusting. I visited the apartment of someone who had next to her computer a pot with three small cactuses. I commented “those are pretty”, and she explained that she didn’t have them for looks, but rather for health: she “had been told” that cactuses attract and neutralize bad energy (I think she used the expression “electronic waves”) coming from computers and other electronics.

    Remember that school where a parent was all upset that they had wireless? Seems the school could have reassured her by putting a cactus in every room, which would have been attractive as well as harmless. Sure, you don’t want to encourage this sort of thinking, but people don’t seem to respond to being told that their fears are groundless.

  29. #30 Clint Hanson
    August 4, 2011

    What amazes me is how close minded some people are. In this case the author of this blog. It is easy to just repeat what other pioneers have discovered, many of whom were considered quacks at the time. A classic example would be that of Ignaz Semmelweis, who even before germ theory suggested that hand disinfection could help lower mortality rates in obstetrical clinics. At the time he was called a quack, since the science was not understood. I’m not saying there is not a lot of quackery out there, I’m just saying that just because modern science doesn’t have a justification for some treatments, doesn’t mean they don’t produce results. The science of gut/intestinal flora is just in its infancy, and contrary to belief for the last while, the intestinal track is not as simple as it first seems, and changing the make up or balance of the bacterial colonies in your colon can have a huge impact on many aspects of a patients health. So to say that colon cleansing, or fecal transplant therapy, or any therapy that has an impact on the bacteria in your gastrointestinal tract shouldn’t be studied is just plain stupid. Please read up on the latest research regarding Crohn’s, or any other IBD before you make general comments about what and what is not quackery….

  30. #31 Chris
    August 4, 2011

    Clint Hanson, the ball is in your court to provide actual verifiable scientific evidence to support your statements. At least show that the benefits out weigh the risks. But remember, it has to be real science, not just you saying so.

    Also, did you notice that Orac was referring to a study on colonics? It was not just his opinion.

  31. #32 Robert M
    August 4, 2011

    @Clint Hanson

    As has already been pointed out colon cleansing has been studied and found to be a risk with no reward (at least as far as health goes, customer satisfaction is a different matter).

    You are correct that gut flora is important, which is why nondoctors tampering with it using unregulated equipment without the effects being known is bad.

  32. #33 lilady
    August 4, 2011

    @ Clint Hanson: I fail to see how the few studies you obviously perused in medical literature that show fecal transplantation for the treatment of C. difficile colitis is germane to the woo being practiced and marketed for high colonic “cleansing”.

    Clint, there is a world of difference between fecal transplantation as (last ditch) treatment for intransigent persistent overgrown of C.difficile bacteria that causes a patient to become acutely ill with extreme weight loss, malnutrition and electrolyte imbalances. Such acutely ill hospitalized patient have “failed” multiple courses of treatment with Vancomycin which most times is successful in destroying the overgrown of C. difficile to allow the delicate balance of “healthy” bacteria to recolonize the intestine.

    Again, it is a truly last ditch effort to cure a desperately ill patient. The procedure involves getting a fresh stool specimen from a (preferably) relative/household member, testing the “donor” stool for infectious bacteria and ova and parasites, mixing the stool with isotonic saline solution to “blend”, filtering the material several times and placing it in the patient’s small intestine through a NG (naso-gastric) tube and hoping that the healthy bacteria will recolonize the patient’s intestinal tract. If you have ever had an N-G tube, then you know it is no picnic and nothing that you would ever derive pleasure from.

    Orac has written a blog about CAM treatment by colonic cleansing which purports to cleanse the body of the “toxins” that cause cancer, heart trouble, body dysfunction and (insert your favorites here). Do-it-yourself colon cleansing does cause the body to lose weight (great for purgers who want to achieve that “skeleton look”), puts the body into electrolyte imbalances and in extreme instances leaves a person malnourished….this would be the comparison you are looking for? Do-it-yourself “cleansing” causes disease states and fecal transplantation, when properly done in a hospital setting, may cure diseased states.

    There is also the mentally disordered thinking processes of people who purge; they are fixated on body elimination and many derive sexual satisfaction out of purging that they do or have done to them by the local “escort” as part of the “package”

    Dr. Gorski did an article on colon “cleansing” for his blog on the Science Based Medicine website. Why not view that article and the links he provided to people who actually take pictures of their poop following “cleansing” and post them on the internet.

    BTW, if you are clueless about the digestive tract and the fine balance of bacteria that keep the tract “healthy” and also clueless about electrolyte imbalances and the functions of major organs dependent on electrolyte balance, don’t accuse Orac and posters here of being ignorant and don’t post here like you are an expert.

  33. #34 Militant Agnostic
    August 4, 2011

    @Clint Hanson

    So to say that colon cleansing, or fecal transplant therapy, or any therapy that has an impact on the bacteria in your gastrointestinal tract shouldn’t be studied is just plain stupid

    Could you please refrain from bringing in so many strawmen. It is aggravating my hay fever something fierce. Where did Orac suggest these things should not be studied? Try reading what is actually written instead of what your closed-minded view of how people who oppose CAM came to their conclusions says he must have written.

    Actually, Skeptical Medical Blogger and Podcaster Mark Crislip has blogged positively about fecal transplant therapy as treatment for C Difficile at Science Based Medicine where Orac’s “friend” also blogs.

  34. #35 lilady
    August 4, 2011

    @ Militant Agnostic: When Orac’s “friend” blogged about bowel “cleansing”, a link was provided to the actual pictures posted on the internet of the poop produced by do-it-yourself cleansing.

    I waited in vain for any postings that commented on the linked pictures…I believe I was the only poster on that blog who “admitted” to seeing the pictures…and commented about them. I found the picture of the turds in little piles laid out symmetrically on the rim of the toilet bowl to be especially “interesting”. All “normal” little kids pass that stage of fascination with their excretia after two years of age.

  35. #36 Clint Hanson
    August 4, 2011

    @lilady If it wasn’t obvious, I included fecal transplant as an example of a procedure that until a while ago was also called quackery. If you look back though its’ history you will find doctors also calling it crap science, and all associated positive results as being flukes. It also directly relates in that, just like colon cleansing, it has an effect on the intestinal flora which is why it can help people with C.Diff, but not just that, more recently it has been found to help people with Colitis and possible Crohn’s as well, though the later less so. The current understanding of IBD also led most people to call fecal transplant therapy for Colitis or Crohn’s also crap science. Now they are proven to be more effective then a lot of other conventional treatment paths.

    I remember doctors making general statements like “the colon rarely needs assistance in doing its job” in the past, and this is just not true anymore. If you look at the rising percentage of people with Crohn’s, Colitis, IBS, Coeliac disease etc you’ll find that we do need to start looking a lot more closely at why that part of our body is failing us. Also just recently Peter Bork and colleges discovered that people seem to fall into three classes of bacteria flora. They also have been finding that these different make ups of bacteria colonizations have big impacts on the way people process food in the digestive tract, and also on their defense against pathogens. Other papers are starting to find that many different factors can shift that equilibrium of bacteria flora in your intestine and that includes, fecal transplants, diet, probiotics and colon cleansing. Until recently I can’t tell you how many doctors thought that area or research was a waste of time. Obviously these are hugely significant findings, it basically means that physical and mental states can be drastically altered by what is going on in your gastrointestinal tract. If you don’t understand that then please stay away from treating people with Autism, Crohn’s disease, Coeliac’s disease, leaky gut syndrome and any other autoimmune, or gastrointestinal diseases because you will inevitable tell them to stick to conventional methods of treatment that have failed many of these people for years. Look at the advancements in those diseases to see how diets that were also considered quackery are now being found to have a huge impact on improving those people’s lives. So basically the above author spends all their time relating colon cleansing to whatever obvious crazies he can think of in order to discredit the practice in its entirety, rather then address the specifics of what the merits of such a procedure might include. By throwing insults at people doing research in areas outside of what current science theory says is correct, no real progress will ever be made. All breakthroughs in science have come from the edges, not from people who only criticize people who’s views differ drastically from their own limited perspective. I have no problems with some of the article warning about the dangers of such a procedure, I have a big problem when the procedure is, in it’s entirety, shunned.

  36. #37 Beamup
    August 4, 2011

    The procedure should be shunned in its entirety until and unless good evidence is presented that it is beneficial for some indications for some patients. Simply saying that it might be, or invoking the meaningless “science was wrong before” trope (how do we know that? more science), does not constitute such evidence.

    If you have good evidence for benefit, feel free to present it.

  37. #38 madder
    August 4, 2011

    @Clint Hanson:

    Yours is a common misunderstanding. What makes something “crap science” is not simply the topic being studied, but how the study is designed and interpreted. Just as an example, let’s take a noncontroversial and well-supported idea: water is a good treatment for simple dehydration. I could design a terrible study in support of that intervention, and it would be crap science. The idea/treatment is not crap science, but my study would be. There is often a tendency for the first studies of a novel treatment to be poorly designed. Add to that the fact that no single study should be the sole support for a major change in medical practice, and it’s obvious why new ideas can be slow to gain acceptance.

    Another example of “crap science” is clinging to a hypothesis that seems reasonable but consistently fails scientific study. I’m sure we could find an example of that, if we looked hard enough.

    But my main question to you is about your statement:

    I have no problems with some of the article warning about the dangers of such a procedure, I have a big problem when the procedure is, in it’s entirety, shunned.

    Given that the study discussed above showed that “colon cleansing” produces real danger with no discernible benefit, why shouldn’t we “shun” this procedure?

  38. #39 Clint Hanson
    August 4, 2011

    @Beamup I just love it when people who have no serious medical problems feel free to tell other people who are in serious pain or dealing with serious illness what they can and can’t do. Try living with IDB, Coeliac disease, cancer, etc, and dealing with doctors who persist on only sticking to conventional methods of treatment even when they are obvious failing. Do that and I’d like to see how quickly your views would change.
    I’ve watched people go through 10 to 15 specialists to get no f results, only then to go to alternative therapies and see dramatic changes immediately. If you are really sick that is when you are willing to go outside the box to find something that works, and when you do, and some doctor tells you it is fake science that does nothing more then anger you. I totally understand there is the danger that it goes too far in the other direction and people are told of miracle cures that cause them more harm then good, but when you are really sick, you should be allowed to try to find your own path to healing. If colon cleansing works for you, and your pain suddenly goes away, who frigin cares why it works, at that point all you care about is that someone doesn’t take your only source of treatment that works away from you.
    We know so little about what is actually happening in the body, the processes involved are frankly beyond our understanding, the number of chemical reactions going on are too complex to even count, and to put rules on what people are allowed to do with regards to their health is equivalent to forcing all people to become atheists simple because there is no significant proof of anything else.

  39. #40 Beamup
    August 4, 2011

    The trouble with that position is that, without the evidence, you have no grounds to believe that said alternative treatment will do anything useful at all! So there’s no way to determine that a colon cleansing should be done instead of (say) acupuncture.

    Without that kind of evidence, it can’t even be reliably determined that “colon cleansing works for you.” We’re all too good at seeing patterns that aren’t there.

  40. #41 Composer99
    August 4, 2011

    Clint:

    If you want people to agree with you, you will want to start providing citations to the medical literature for these papers you claim exist. At the very least, you will need to provide PubMed ID references. Even better would be links to the papers themselves. Alternatively, you could provide a link to a site which appears to accurately & honestly interpret the literature for the purposes of presenting it to a lay audience. (1)

    I do not doubt that you are entirely sincere. All the same, no one has any reason to accept what you claim on your say-so alone. Being sincere and being correct are two very different things.

    —–
    (1) If you include more than two links in a post, it will automatically get caught up in moderation.

  41. #42 Clint Hanson
    August 4, 2011

    @madder – first let me say I appreciate your comments, and appreciate the tone in which they are stated. I admit my comments have become a little more emotionally charged then is justified. So to take a step back and answer your question from a clear a place as I can.

    “Given that the study discussed above showed that “colon cleansing” produces real danger with no discernible benefit, why shouldn’t we “shun” this procedure?”-madder

    My thoughts would be that you answered the question already. My assertion would be that try as we might, a lot of times our best attempts at doing good science inevitable work out to be “crap” science once we understand more of the processes going on around that procedure/experiment/etc. For instance, the studies so far around colon cleansing might totally be missing the cases where it does work. For instance, Crohn’s disease or Colitis might turn out to have a number of different causes that we are currently lumping into one category. If one of those cases of Crohn’s say could be helped by a Colon cleansing procedure, it might not show up with enough statistically significance in a general study on the procedure. Then if we tell that small number of people who it is working for that they must be mistaken, and tell them to shun it, we are doing a great disservice to them. Just to be clear this is just a hypothetical example, but still a possible one, and I would argue no science around Crohn’s yet proves that it might not have an effect. I think there is an inherit danger in taking one or two studies and then saying that in general a procedure that some people have found to work for them should be shunned. A good example of this is around the significance the MAP bacteria plays in the role of Crohn’s disease. There have been “good” scientific studies both ways that show that it does and doesn’t play a role. Does that mean that both sides are doing crap science when they say treatments to get ride of MAP do and don’t have an effect on Crohn’s. Who is doing the crap science then? I would say keep an open mind always, just because one, or a few studies point in one direction doesn’t mean the next one won’t turn our current understanding completely around on some topic. It happens often in science and medicine, and so if someone personally finds that something works for them, even it really isn’t doing what they think, or even it is just turns out to be a placebo, who are we to judge until we have walked in their shoes, dealt with conditions they are dealing with. Again, I have no problem with someone pointing out the faults in a study, i have problem when one throws in comments about religious zealots, etc to throw a general shame on a procedure in general.

    there are many cases in science where initial studies proved some theory wrong, but people held to their guns and were eventually proved correct. Medicine isn’t the only science facing this problem, but it is particularly interesting that with medicine it can drastically effect someone’s life whether or not they have access to certain procedures or a particular medicine.

  42. #43 The Christian Cynic
    August 4, 2011

    If it wasn’t obvious, I included fecal transplant as an example of a procedure that until a while ago was also called quackery. If you look back though its’ history you will find doctors also calling it crap science

    Well, to be fair, it could accurately be called “crap science” even if it were good science. :P

  43. #44 Anton P. Nym
    August 4, 2011

    “If colon cleansing works for you, and your pain suddenly goes away, who frigin cares why it works”

    “Why” it works is indeed a secondary question. “Whether” it works is important… particularly whether it works better than “a nice cup of tea with a friend.” (aka “placebo”)

    If it does, then great; there’s a new potential treatment for an illness. If not, then it better not have greater risks than (or cost more than) a nice cup of tea with a friend.

    Careful scientific study shows that colonic flushes fail both those tests. (Particularly the safety one.) Subjectively and objectively, you’re better off having a nice cup of tea with a friend than having it sluiced up your arse by a stranger.

    — Steve

  44. #45 ebohlman
    August 4, 2011

    My hypothesis as to why people are into poo woo, practice doodoo voodoo, and believe pap about crap: they’re simply being stoolish.

  45. #46 Beamup
    August 4, 2011

    For instance, the studies so far around colon cleansing might totally be missing the cases where it does work.

    “Might” be missing the cases where it does work is not evidence, and is not a recommendation. It’s whistling in the dark. Eating a bunch of mashed potatoes “might” work.

  46. #47 Ledasmom
    August 4, 2011

    “Regarding Reiki not being claimed as ancient, I had a classmate of mine tell me just last week that “Reiki is so ancient that even Jesus did it”!” – Poodle Stomper

    Considering what happened when Jesus tried acupuncture, I wouldn’t call that much of a recommendation.

  47. #48 Clint Hanson
    August 4, 2011

    @Composer ok this is my last post, I obviously have stated my position, and don’t really have the time to keep arguing the merits of letting people find their own paths to healing.

    I’m sure there is a lot of finer points we could argue, and no doubt there is a lot I could still learn from people on this site, but I don’t have the time to go further into it. I also will not change my position after having had loved ones and friends go through this and there is no way I am going to change my beliefs about letting people find their own way to being healthy after having witnessed it first hand.

    I’ve even watched doctors advise exactly opposite treatments to each other both citing papers. In the end both with a family member and a friend, the only solutions after years of pain and suffering came from alternative treatments. And whether or not the scientific community believes in the science behind those treatments doesn’t matter. what does is that after exhausting every conventional treatment path, they both were healed only when stepping away from such paths and so rapidly that it wasn’t just relapse. I’ve enough brains to do my own conclusion, especially after watching the disease in one case return rapidly after those alternative treatments were stopped, and subsided again once that therapy was resumed. Again desperation opens ones mind much more then sitting at a desk reading papers objectively.

    I would have to include a ton to cover all the references I made, and I have been informed I can’t include all those, and really I don’t really have time to dig up all the references. I’ll include the two I found first, and refer you to do your own research regarding the effects of bacteria flora on a host of diseases…

    http://www.nytimes.com/2011/04/21/science/21gut.html
    If you follow this research area you’ll see there is a ton of new research money being poured in to finding the effects of probiotics, and other treatments to alter the make up of bacteria flora in a person’s colon. Also if you have follow Coeliac Disease, or other autoimmune related disorders it is obvious how nutritional intact plays a role in such cases
    - look up Gut_flora in wikipedia for some older references as well…
    - look up Thomas J Borody for some papers he did early on with regards to Fecal Transplants and colitis, and if you search you can find the backlash he experienced regarding some of his research. Also look through the history of MAP studies regarding its role in Crohn’s and you’ll also find that most of the science community rejected it after a few studies, but it has come back to being significant again with some more recent research including this recent paper,

    http://www.imt.ie/clinical/2011/08/map-infection-persists-in-children-with-crohns.html

    Yes this is not a complete reference to all the research i stated, but again, start there and you’ll quickly come to papers and articles that show how much more research still needs to be done before we start calling any procedure effective or ineffective….

  48. #49 Clint Hanson
    August 4, 2011

    Again to all the childish comments regarding “practice doodoo voodoo” and other comments regarding similar treatments being as effective as having a cup of tea. Try dealing with a life threatening illness, or one that causes so much pain that you can’t even function, and they try typing those same words when it is say your child that you found such therapies worked on after many desperate visits to doctors all over the world. you’d realize quickly how much your words come from a place and perspective that involve a dna code that lacks that basic thing that makes up one of the best parts of being human, mirror neurons…. my hope is mirror neurons also exhibit neuroplasticity…. such that lack of conscience hiding behind objectivity can someday be reversed…

  49. #50 Lawrence
    August 4, 2011

    Clint – is it great that more research is being done in areas where it looks like there might be promise. That is far from stating that definitively, that things like colon cleansings work.

    Huge difference there – and in this particular case, the evidence is in that this particular part of the woo-tacular doesn’t work. We’ll hold off any the others, until the evidence tells us either way – if it does work & becomes a standard treatment, or it doesn’t work & just goes to feed the charlatans out there.

  50. #51 Chris
    August 4, 2011

    Clint Hanson:

    Yes this is not a complete reference to all the research i stated, but again, start there and you’ll quickly come to papers and articles that show how much more research still needs to be done before we start calling any procedure effective or ineffective….

    Those are news articles not scientific citations. You made the claims, hence you need to provide the cites, which you have been asked for multiple times. We are not going to do your homework for you.

    It might help if you read Dr. Mishori’s article, The dangers of colon cleansing, before you give us those cites. It starts with a a case report that includes this paragraph:

    The patient had Crohn’s disease and had undergone a partial colectomy 5 years earlier. She told the ED physician that 2 days before visiting the ED she had gone to a “cleansing center” for a colonic cleansing, but was unable to complete the process because she developed cramps 15 minutes into the procedure. Less than an hour later, she developed diarrhea, nausea, and vomiting.

  51. #52 Chris
    August 4, 2011

    I have a comment in moderation, but I do wish to say to Mr. Hanson that many of the comments are politely asking for citation. News articles are not scientific citations.

  52. #53 herr doktor bimler
    August 4, 2011

    What you are forgetting, Beamup, is that over hundreds of thousands of years the human intestinal biota has co-evolved with us to expect regular high colonic enemas. Naturally our failure to irrigate our large intestines leaves the bacterial population out of balance. Colon-cleansing therapy is merely a return to natural paleolithic conditions.

  53. #54 Clint Hanson
    August 4, 2011

    @Chris if you can’t go from a news article that specifically states the researchers involved, to finding a citation to the specific paper, then I’m afraid that old saying applies quite well in this situation, which is, “if you have to ask the questions, you probably won’t understand the answer.”

  54. #55 Beamup
    August 4, 2011

    In other words, you expect others to do the work of providing evidence for your claims for you.

  55. #56 Chris
    August 4, 2011

    Clint, you are making the claim, therefore you provide the scientific citations. We will not do your homework for you.

    I also suggest you reading the MedPage link in the above article (blue letters that say “Colon Detox Not Backed by Science”), go to the bottom of the page and read Dr. Mishori’s article. Especially the first case report.

  56. #57 herr doktor bimler
    August 4, 2011

    there are many cases in science where initial studies proved some theory wrong, but people held to their guns and were eventually proved correct.

    Isn’t this basically the “They laughed at Galileo” argument? Initially receiving ridicule and opposition does not make a theory correct; otherwise Punch and Judy would have won Nobel Prizes by now.

    The trouble with the Colonic Detox quacksters of whom Orac writes is that they do not even have a theory; they have a general premise that “the bottom is dirty and must be cleansed”, which they rationalise with a mixture of magical thinking and Medieval physiology.

    They are not following the sequence “treatment based on hunch, followed by successes, followed by explanatory theory”; it is more a case of “treatment appealing to anxieties about non-existent ‘toxins’, followed by an income stream” — and there it stops, because once the quacks have their customer base, they do not bother trying to make their treatment make sense.

    All this talk of Borody’s combination-antibiotic therapy for Mycobacterium infection and his work on fecal bacteriotherapy is all very well, though I think Clint Hanson exaggerates the resistance he encountered. Borody’s 2005 paper was rapidly cited by other researchers trying poo transplants, with varying success; I couldn’t find anyone trying to shout it down; perhaps I searched in the wrong places. Though he does complain in one interview that another gastroenterologist was rude about him on the radio.

    But Borody is not sticking hoses in clients’ butts with a Shaman-like promise of ridding them of toxins of a spiritual or symbolic nature. His work simply isn’t relevant.

  57. #58 Clint Hanson
    August 4, 2011

    @Chris So you argue that I gave a news article instead of a specific citation to back my argument, and then give me a news article as proof of the opposite argument. Look at the bottom of the
    http://www.imt.ie/clinical/2011/08/map-infection-persists-in-children-with-crohns.html
    article for the specific citation.

    Again, my problem is with over generalization and demonization of procedures based on studies where the researchers frankly do not understand the processes involved and are making generalization beyond their studies findings… which in my opinion, this is the case with the above blog and referenced citation that started all this.

    Again, as the old saying goes, how many times do you have to state this, the answer is one more time. i am not making claims that colon cleanses have proven to be effective in any of the treatments I’ve mentioned, what I have stated is that it is not clear yet whether they do or do not have an effect on the bacteria flora in your digestive tract in a positive or negative way in all cases of ailments. Therefore any statement that it has nothing other then negative effects is based on “bad” science that actually is as guilty of being off base as the more obvious lies the charatans out there are making….

    Calling certain procedures quackery, comparing them to obvious religious nuts, etc, is an attempt to punish anyone who even thinks of using it, or doing more studies on such a procedure. We have enough fear based mud flinging out there that we don’t need any more of it. It does nothing to advance cures, etc.

    No one here can state a study that proves that in all cases Colon Cleanses are useless, that was my point all along. And most of my examples i don’t have to back up, because they are examples of cases where science/medicine thought it had it figured out and were wrong, if you don’t believe me look up those cases, otherwise I could care less, substitute your own examples, if you are widely read enough, I’m sure you can come up with others if you don’t believe mine. The other research I stated is clearly followable in the current medical journals regarding research on bacteria flora in the digestive tract, the many articles recently published along those lines. I have given enough info for you to quickly find that research with ease.

    If any of you have had serious illness like a IBD or an autoimmune disease where conventional scientific pathways to treatment have utterly failed, and you are still sticking to your guns to the point of becoming really ill. Then I suggest you open your mind a little. I come from this perspective from dealing with those diseases directly, and from seeing the effectiveness of treatments outside current scientific theory has provided. I like to think I am smart enough to understand the difference between coincidence and causality, and while one can never be sure in many cases, one can be statistically satisfied that something is working, whether or not it makes sense yet doesn’t matter. There are healing paths outside of western medicine that work, I know this first hand, and it offends me when studies overstep their bounds. And it offends me more when people who haven’t dealt serious illness pretend to understand it, it is like people who have never been to war who feel free to pretend to know more then those who have lived it….

    I’ve stated what I’ve wanted to, by this point I don’t see this dialogue producing any more insight into either side of the argument. If my points where unclear I apologize, there were stated with a sincere attempt to convey what I believe is the truth, that in a lot of what many people call quackery is a grain of truth, and many scientific breakthrough’s come when someone is able to shift away the hubris and find the insight within that moves us forward…. especially when it goes against conventional wisdom.

  58. #59 Chris
    August 4, 2011

    Did you read Dr. Mishori’s paper?

  59. #60 Chris
    August 4, 2011

    Also the news article said:

    In a letter in Inflammatory Bowel Diseases, they reported that MAP persisted in the gut mucosa over several years in several paediatric patients with CD, based on their analysis of mucosal biopsies and peripheral blood mononuclear cells.

    A letter is not a peer reviewed paper. It is a letter. They may present their findings, but it has not been reviewed or replicated. It is about as good as a poster.

    Again, you are asked to present actual scientific papers to support your claim.

  60. #61 Clint Hanson
    August 4, 2011

    @herr doktor bimler Your points are well taken. I still say the article above overstates the findings of the study, and demonizes many treatments that I would argue the jury is still out on…. I don’t argue there are many quacks out there. But don’t through the baby out with the bath water. Just because quacks jump upon a treatment as a cure all, doesn’t mean it might not have merit in specific cases. And it is not up to the patient who finds it works for them, to have to justify through scientific study that he should be able to use that treatment as part of his/her pathway to health. Doctors should not own that right, nor should they feel free to shame those who take that path, especially based when based on conclusions that over step the bounds of their studies findings….

  61. #62 Chris
    August 4, 2011

    Where in that article and letter do they recommend colon cleanses for children with Chrohn’s?

  62. #63 Clint Hanson
    August 4, 2011

    @all I just wanted to say up front, I totally apologize for my grammar and spelling, that I totally concede is truly unforgivable really…

    @Chris see below….
    I fail to see how it hasn’t been sufficiently peer reviewed at this point? see below, And there is enough other research out there that goes both ways on the link between MAP and Crohn’s, this set of videos gives a good overview if you care to take the time to learn about it…
    http://www.youtube.com/user/IBDvideos

    There are also other papers I’ve read that I am sorry i can’t recall which journal or when they were published that have studied this topic in detail. Again, I make no apologies for this. For those dealing with Crohn’s it is obvious changes to bacteria flora in the colon do have an effect on the disease. I would suggest that colon cleansing in those cases is not the answer. I was mostly referencing it as an example where good science can still produce non-definitive answers even on well studied topics. There is a crap load of money in finding a drug to cure Crohn’s, Remicade sales are in the billions each year, still, they are no clear answers to what is causing Crohn’s And alternative treatments like Helminth therapy have proven in some studies to be as effective as the popular treatment paths. But there is less money in that area of research so progress is slower. Although there was a recent announcement here regarding possible clinical trials in the US
    http://articles.boston.com/2011-07-25/business/29813486_1_parasite-cells-patients

    _________________
    More details citation of the study involving MAP an crohn’s in children….
    —————–
    Wagner, J., Sim, W., Bishop, R. F., Catto-Smith, A. G., Cameron, D. J. and Kirkwood, C. D. (2011), Mycobacterium avium subspecies paratuberculosis in children with early-onset crohn’s disease: A longitudinal follow-up study. Inflammatory Bowel Diseases, 17: 1825–1826. doi: 10.1002/ibd.21603
    Author Information

    1. 1

    Enteric Virus Group, Murdoch Childrens Research Institute, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
    2. 2

    Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
    3. 3

    Department of Gastroenterology & Clinical Nutrition, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia

    Publication History

    1. Issue published online: 8 JUL 2011
    2. Article first published online: 6 JAN 2011
    3. Manuscript Accepted: 8 NOV 2010
    4. Manuscript Received: 31 OCT 2010

  63. #64 Clint Hanson
    August 4, 2011

    @all I just wanted to say up front, I totally apologize for my grammar and spelling, that I totally concede is truly unforgivable really…

    @Chris see below….
    I fail to see how it hasn’t been sufficiently peer reviewed at this point? see below, And there is enough other research out there that goes both ways on the link between MAP and Crohn’s, this set of videos gives a good overview if you care to take the time to learn about it…
    http://www.youtube.com/user/IBDvideos

    There are also other papers I’ve read that I am sorry i can’t recall which journal or when they were published that have studied this topic in detail. Again, I make no apologies for this. For those dealing with Crohn’s it is obvious changes to bacteria flora in the colon do have an effect on the disease. I would suggest that colon cleansing in those cases is not the answer. I was mostly referencing it as an example where good science can still produce non-definitive answers even on well studied topics. There is a crap load of money in finding a drug to cure Crohn’s, Remicade sales are in the billions each year, still, they are no clear answers to what is causing Crohn’s And alternative treatments like Helminth therapy have proven in some studies to be as effective as the popular treatment paths. But there is less money in that area of research so progress is slower. Although there was a recent announcement here regarding possible clinical trials in the US
    http://articles.boston.com/2011-07-25/business/29813486_1_parasite-cells-patients

    _________________
    More details citation of the study involving MAP an crohn’s in children….
    —————–
    Wagner, J., Sim, W., Bishop, R. F., Catto-Smith, A. G., Cameron, D. J. and Kirkwood, C. D. (2011), Mycobacterium avium subspecies paratuberculosis in children with early-onset crohn’s disease: A longitudinal follow-up study. Inflammatory Bowel Diseases, 17: 1825–1826. doi: 10.1002/ibd.21603
    Author Information

    1. 1

    Enteric Virus Group, Murdoch Childrens Research Institute, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia
    2. 2

    Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
    3. 3

    Department of Gastroenterology & Clinical Nutrition, Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia

    Publication History

    1. Issue published online: 8 JUL 2011
    2. Article first published online: 6 JAN 2011
    3. Manuscript Accepted: 8 NOV 2010
    4. Manuscript Received: 31 OCT 2010

  64. #65 Clint Hanson
    August 4, 2011

    @Chris when and were did i state that colon cleanses for Crohn’s was advised. I would strongly advise against it actually. that wasn’t the point of that reference. Unfortunately a longer post I just sent is being held for review by the owner of the blog. Hopefully this one posts. Anyway. My points seem to be lost, so I am just restating the same thing over again. I am sorry for taking over this blog. Hope I didn’t offend anyone, just stating a different opinion then what seems to be the generally accepted one on this site. That being that it is ok to ridicule and attack any procedure to the point of burying it forever is a good and strongly upheld belief and practice. that if some quack adopts a procedure for his own gain, that the stigma attached to that practice shall be so strong, that any who attempt to legitimately look to it as having possible future value in certain cases, should be considered a loon and all right and privileges stripped from said practitioner. Ahmen

  65. #66 Chris
    August 4, 2011

    hris when and were did i state that colon cleanses for Crohn’s was advised.

    So you are admitting to taking over this thread for an off topic journey of your own issues. The article is about the fact that colon cleanses are not safe and not needed. The procedure being being discussed are colon cleanses.

    Now, did you read the article by Dr. Mishori? Did you even read the article above by Orac?

  66. #67 herr doktor bimler
    August 4, 2011

    If I’ve grasped the Mycobacterium / Crohn’s Disease business, the theory is that the bacteria have infiltrated the bowel lining, out of reach of any amount of colon cleansing, even with a stiff wire brush. The studies talk of tissue biopsies.

    Rinsing out one’s colon strikes me as the equivalent of bulemic purging, but at the other end. It’s a symbolic activity… not a medical therapeutic one. It’s never going to provide any sterility, even temporarily, what with the bacteria forming a tenacious biofilm on the gut mucosa.

  67. #68 Chris
    August 4, 2011

    herr doctor bimler, I think Clint finally figured out what the article was about. He jumped to conclusions after just reading the word “colon” and did not read the article.

  68. #69 Clint Hanson
    August 4, 2011

    @Chris – are you trying to start a fight? Obviously I read the articles involved. My point is still the same, and this is the last time I’ll make it for you. I am saying don’t through out the baby with the bath water. Just because Colon Cleansing doesn’t seem to work in one or a few studies for some certain conditions, doesn’t mean as a procedure it should be demonized. Which is clearly what the above article is doing, or are you so blinded to its prejudice that you can’t see it. Anyway, this is pointless now, my original point was on topic but the conversation has degraded and I’d rather not dig further down into the mud….

  69. #70 herr doktor bimler
    August 4, 2011

    Chris — I don’t think Clint Hanson was “taking over” the thread, so much as describing analogous cases where some silly-sounding medical treatment is now taken seriously. I don’t find the analogies particularly convincing but it was not unreasonable to suggest them.

  70. #71 Chris
    August 4, 2011

    Except he was doing it in such a way it seemed he was defending colon cleanses, especially since that was the only treatment being discussed in the article. Perhaps it was his presentation, but since he did not provide any real cites on specific articles it just seemed he was defending colon cleanses.

    He did mention fecal transplants, but I don’t think anyone here thinks that was anything but real science. Though it is something that has been taken by others as something else and turned into something horribly different to try on children:
    Bring the crazy – Fecal Transplant

    Now before you go all crazy, Mr. Hanson, actually read the article I linked to. You will agree that it is not real medical fecal transplant. It is equivalent to colon cleanses (which no medical need has been found, especially for those requiring 60 liters, and there are safer ways to prep for colonoscopy).

  71. #72 Clint Hanson
    August 4, 2011

    @herr doktor bimler – totally agree that flushing the colon with water might do nothing if Crohn’s is caused by MAP or some similar intracellular bacteria infection. It could very likely also cause damage if the walls are already badly inflamed. However, it is unclear whether there is inherent protection built into different bacteria flora colonizations within the colon that could protect from further infection. In which case flushes using maybe something slightly different than water might have a big effect on further infections forming, or spreading. Or perhaps there is even a change in the nutritional absorption in the cells in the intestinal walls that could effect those bacteria, unlikely but not impossible. Or maybe a billion other possible chemical reactions that occur in that area of the body could be changed and thus have an effect on the disease. Helminth therapy doesn’t involve those worms going past the outer wall of the intestine, but in several studies and in many patients found on message boards actively using this as a treatment it has had a pronounced effect. Maybe because of the release of unknown chemicals into the colon walls, etc. There is so much we don’t know and people suffering from Crohn’s and other autoimmune disorders suffer a great deal every day, so to dismiss possible directions for treatments, no matter how small a chance is a dis-service. helminth therapy is a great example of a fringe treatment that many have found to work for them. Yet if you ask many doctors they’ll tell you it is bogus, believe me I’ve seen it first hand work, and I’ve also followed the hundreds of people trying it on the boards from everything from MS to Crohn’s to relief from severe food alergies. there is no way the results people are seeing are not real. Yet there are a few studies that said that it didn’t work, only later to be found to be poorly carried out, and other studies that clearly show huge significant reductions in symptoms. I just have a big problem with people demonizing unconventional treatments in general, when they themselves are just pretending to really understand the complexity of the processes involved. That kind of close mindedness makes progress slower, and actually does harm. Fine point out quakes if you want, but be specific on why you think the procedure doesn’t work for specific ailments, and what the dangers are. Don’t demonize it to the point where society should banish it altogether, especially based on incomplete studies and clearly biased and ill formed conclusions….

  72. #73 lilady
    August 4, 2011

    @ Clint Hanson: Four hours ago, after receiving a butt-whupping about your theories regarding colon cleansing, you stated:

    “@Composer ok this is my last post, I obviously have stated my position, and don’t really have the time to keep arguing the merits of letting people find their own paths to healing.”

    Twelve hours ago at my posting at #33 above, I explicitly explained to you that do-it-yourself cleansing (the subject of Orac’s blog), is way different from fecal transplants…a last ditch effort to “save” acutely ill hospitalized patients who are colonized with an overgrow of C. difficile bacteria.

    So, in troll-like fashion, you continue to persist with additional postings that equate do-it-yourself cleansing/sexually aberrant colon cleansing done by hired “escorts” with an experimental “last ditch” procedure to recolonize desperately ill hospitalized patients with life threatening colon problems.

    Why don’t you just “leave it be” now, stop digging yourself in deeper…or are you just a full of poop troll?

  73. #74 marty
    August 4, 2011

    I still say the article above overstates the findings of the study, and demonizes many treatments that I would argue the jury is still out on

    Sure, if you reproduce the research and find otherwise you are welcome to publish it, along with your research methodology. This is called science. Otherwise, your opinion is just that.

    Just because quacks jump upon a treatment as a cure all, doesn’t mean it might not have merit in specific cases

    Really? Can you name any? It would have to be something incredibly popular in alt-med but also something not seen by medicine as valuable already ie don’t say “diet” or “exercise”, since those aren’t considered quack remedies.

    And it is not up to the patient who finds it works for them, to have to justify through scientific study that he should be able to use that treatment as part of his/her pathway to health

    Quite true. If a patient wants to shove a hose up their anus on the grounds that it feels good, man, then I guess that’s their right. They don’t get to say “oh, it works for everything!!!” without substantiation.

    Doctors should not own that right, nor should they feel free to shame those who take that path, especially based when based on conclusions that over step the bounds of their studies findings

    And yet it is just fine and dandy for alt-med enthusiasts to announce that a treatment cures everything without any justification at all

  74. #75 Chris
    August 4, 2011

    Clint Hanson:

    There is so much we don’t know and people suffering from Crohn’s and other autoimmune disorders suffer a great deal every day, so to dismiss possible directions for treatments, no matter how small a chance is a dis-service.

    You have still not read Dr. Mishori’s article and noticed what the first case report was about.

    Some suggestions:

    1) Actually read the article you are commenting on.

    2) Stay on topic.

    3) When asked for citations don’t ask us to do it for you, but actually go and cite real studies. You can just use the PubMed Identification Number. It helps if you find a supporting article that is not behind a pay wall.

    4) Learn to use paragraphs. White space is your friend.

  75. #76 Clint Hanson
    August 4, 2011

    @Chris funny you should mention Fecal Transplants and Autism. Autism is a funny thing, and many think it might be linked either to an autoimmune disorder, or a nutrient uptake problem. It is clear diet plays a larger role in their mental functions then was at first believed. Another case where people actually wrote off diet as a factor after a few very basic and general studies were done. Anyone who works with kids with autism sees the effects that diet has. In some cases a non gluten diet has a big effect, in others it doesn’t. But in the cases where it does have an effect, a trained therapist seeing dramatic differences in the kids cognitive ability isn’t imagining it, it is real. So if diet can effect the severity of autism, then changing the intestinal bacteria make up of a child with autism might indeed have an effect. There was a recent study, and yes I’m not going to dig it up, but it was somewhere in the US, where they did show that you can actually change the bacteria flora balance/equilibrium in the colon through probiotics. Obviously fecal transplants also do that, which is why they are effective against c.diff. So we already know that the different bacteria influence the way the digestive tract absorbs nutrients, so it is not hard to deduce that fecal transplants can change the way that child is absorbing nutrients. So no, I don’t see a parent who researches fecal transplants and has a child with Autism is crazy when he/she thinks about trying it to help their child. I think that is a positive thing. If done properly fecal transplants don’t really hold any danger, and if they help even a little bit, that could make a huge difference that child’s life. Again @chris I am not going to bother stating and referencing every article. I am not here to publish papers. I am arguing for a more open minded approach to these therapies. It is the same with developing knew drugs right. Just because some shaman says this plant works for curing this ailment because of some forest spirit, doesn’t mean that that plant doesn’t possible hold some medicine. It doesn’t mean we should demonize every person who says this plant might have value, after a few studies that only looked at its effectiveness against a small set of ailments…

  76. #77 Chris
    August 4, 2011

    Mr. Hanson, do you have some strange compulsion to post off-topic, not use paragraphs and totally miss the point?

  77. #78 lilady
    August 4, 2011

    @ Chris: Ignore the anal-retentive persevering troll. Simply not worth our efforts to “inform him”…based on science. Why doesn’t this troll go away?

  78. #79 Bronze Dog
    August 4, 2011

    Mr. Hanson, do you have some strange compulsion to post off-topic, not use paragraphs and totally miss the point?

    Of course he does. It’s a side effect of being in a thread for shits and giggles. If he were trying to convince anyone (including himself), he wouldn’t be using intentionally crappy tactics.

  79. #80 Chris
    August 4, 2011

    Bronze Dog, you win this thread for saying this is a “thread for shits and giggles.”

  80. #81 lilady
    August 4, 2011

    @ Chris: May I nominate myself for second place winner of this thread…or at the very least “honorable mention”…please.

  81. #82 Clint Hanson
    August 4, 2011

    Alright, I’m done, none of you have had to deal with serious illness and specialists who only see what they’ve been trained see. Go through fifteen different diagnosis, and finally find solutions in treatments most of you call quackery. Then see how open minded you are. Watch a kid struggle with more pain then I’m sure most of you have ever felt in your life, and see how strongly or how funny you think this topic is. Watch that kid get better with alternative treatments over night. Then stand there and quote general studies.

    I’ve posted what I believe are valid points and ideas, and thank you herr doktor bimler for actually seeming to want to have an intelligent discussion.

    Chris I would question the contribution of pointing out white space problems with my post, and my “lack” of sighting enough proper references. I am sorry I don’t have time to spend my day finding citations for you to not read.

    My point is the same, this blog demonizes a practice in its entirety, and that I find that objectionable. There isn’t one path to healing, and if you’ve dealt with serious illness you would know that.

    Cheers
    C.

  82. #83 Gray Falcon
    August 4, 2011

    Clint, we asked for evidence that “colon cleansing” was something other than risk without benefit. People have suffered serious injuries and died from this quackery! Of course we’re going to “demonize” it, we’d be monsters not to!

  83. #84 Chris
    August 4, 2011

    Mr. Hanson, many of us are here because we have had family members and some of us suffered from several different illnesses. We are tired of our loved ones being taken in by quackery. And that includes a relative of ours who is now buried a mile from here.

    Another suggestion would be for you to lurk on a blog/forum and see what the climate is. The treatment you received here is no worse than any other, but the level of evidence required is high. You should have known that.

  84. #85 lilady
    August 4, 2011

    Oh cripes, is he finally gone, with no encores…after announcing he was leaving upteen posts ago?

    This past weekend I was at Penn State, attending the wedding of some dear friends. While walking around town in the A.M. in pursuit of the forgotten tie for hubby, we came across a little shop that sold T-Shirts, baby bibs and infant “onesies” with some clever sayings. The cleverest “onesie” had the decal (in lieu of I-Pod) “I-Pood”. Too bad the replacement tie cost $ 65…I might have had enough cash to purchase an adult size “I-Pood” onesie for Clint.

  85. #86 Greenwhat
    August 5, 2011

    Our local weekend paper has an article in each edition about someone with an unusual job. A few weeks ago the subject was a Colon Cleansing Technician. She talked about how she loved being in a ‘healing profession’and how much she could tell about her customers and their lives by what was produced in their treatment. Perhaps there’s a new field of combination woo waiting to be exploited here – “Poo Reading”. Surely 60 litres of liquid crap has to contain more personal information than a teacup or a pack of cards.

  86. #87 Richard Smith
    August 5, 2011

    “Fatal aeroportia” sounds like some sort of lethal disease picked up while waiting to catch your plane.

  87. #88 Bronze Dog
    August 5, 2011

    “Fatal aeroportia” sounds like some sort of lethal disease picked up while waiting to catch your plane.

    To me, it sounds like that urban legend about kids in an ever-changing third world country using bicycle pumps in naughty ways to get high.

    …Which, now that I’ve typed it, doesn’t sound terribly far off topic.

  88. #89 Anton P. Nym
    August 5, 2011

    “My point is the same, this blog demonizes a practice in its entirety, and that I find that objectionable. ”

    That does *not* mean that we demonise other colon therapies like fecal transplants or enemas for impacted colons. Those have been shown to have real clinical benefit, demonstrably and provably helping patients.

    Yes, we demonise the colon “detox” because IT DOESN’T WORK, no better than a placebo let alone as advertised, and it’s riskier than a placebo treatment should be.

    You may think it works because of personal experience but the problem with personal experience, particularly in emotionally-loaded circumstances, is that the easiest person to fool is yourself. (Or myself, for that matter.) You *have* to take a step back and use the scientific method to at least try to catch the little signs that we are seeing what we want to see rather than what is actually happening. That may sound cold, but (in my opinion) it’s better than letting sentiment cloud judgement when lives are at stake.

    (Which is, I believe, the entire point of Orac’s article… and arguably his entire blog.)

    Science isn’t closed-minded. It just demands that people making claims show proof of those claims, and show how that proof was obtained in case there were mistakes. The real closed-minded ones are those who don’t take the same safeguards, because they’re closing their minds to the idea that they could be mistaken.

    — Steve

  89. #90 Roadstergal
    August 5, 2011

    in many patients found on message boards actively using this as a treatment it has had a pronounced effect…. believe me I’ve seen it first hand work, and I’ve also followed the hundreds of people trying it on the boards… there is no way the results people are seeing are not real

    http://www.ncbi.nlm.nih.gov/pubmed/18829392

    41% placebo response rate. There’s no way that those saline injection results aren’t real!

    (IBD is can be strikingly susceptible to short-term placebo responses…)

  90. #91 Sense MD
    August 6, 2011

    It’s so sad that so many people have fallen for this “detox” crap. Everywhere you go, the stores are filled with hundreds of these “detox” books, especially with “Dr.” Oz, Mercola, and a mile-long line of “health experts” leading the “clean” way. I’ve never believed in this sh*t, but almost half of my family and my friends do, and about 98% of the people online I see or chat with do, too. People who truly believe in this somehow have the nearly supernatural ability to ignore the basics of chemistry and biology, as well as murder society’s common sense.

    At least there is some hope: a couple of 16-year-olds I know regularly read this blog and enjoy every second of it.

    @ Bronze Dog and Dangerous Bacon: You two officially rule the Internet with your comments. I might have commented something like that later on, but I unfortunately didn’t have the guts to comment on these kinds of posts sooner, even though I have been a regular to this site for several months now.

    @ Opus: Such a delicious idea. Why don’t you register a website to see how many people fall for it?

  91. #92 Chris
    August 6, 2011

    Sense, MD, someone already has:
    http://buttcandle.com/

  92. #93 Sense MD
    August 6, 2011

    Oh my. And it looks like it has been around since 1999.

    The good news is that hardly anyone goes to it, since there aren’t any traffic statistics on alexa.com.

    The bad news is that there are lots of different domain names similar to buttcandle.com … such as bootycandle.com…

    Oh no. The horror this way comes.

  93. #94 Leslie
    August 6, 2011

    Shouldn’t CAM just be spelled CON?

  94. #95 Chris
    August 6, 2011

    Leslie, sometimes we add “Supplementary” in front and it becomes “SCAM.”

  95. #96 Timberwoof
    August 10, 2011

    The most important thing I got out of this article was seeing the phrases “science-based medicine” and “evidence-based medicine” next to each other, along with “the difference between”. This sent me off on a Google chase. I read some articles that enabled me to flush out some misconceptions and cleanse my understanding of woo. I had wondered why some bloggers had been bashing “evidence-based medicine” but now the return is all clear. It’s a subtle distinction, one that bears repeat administration and many followup visits.

  96. #97 SeeksHealth
    August 15, 2011

    Ideally we would be eating a diet rich in fruits, veggies, whole grains, lean, clean cuts of meat and other whole foods. Then we would not need a detox/cleanse. But, unfortunately, that is not the case for many. For those that want a quick fix, you could risk a day in the bathroom on a cleanse but then use it to kick off you new healthy lifestyle. http://mydiscoverhealth.com

  97. #98 Mephistopheles O'Brien
    August 15, 2011

    SeeksHealth,

    Can you point to evidence that says that people who don’t eat a diet “rich in fruits, veggies, whole grains, lean, clean cuts of meat and other whole foods” either need a “detox/cleanse” or benefit from same?

  98. #99 lilady
    August 15, 2011

    @ Mephistopheles O’Brien: Just because SeeksHealth linked to her website, you should not underestimate her qualifications to comment.

    She received certifications both before and after attaining her degree (BSc-Recreation & Sports Management) in leading group exercise classes, personal training and also a diploma and board certification in massage therapy.

    She is eminently qualified in all these disciplines…in fact she runs a “Fountain of Youth” seminar (limited to 8 participants)…enrollment available on her web page…for the bargain price of $ 429.

  99. #100 Mephistopheles O'Brien
    August 15, 2011

    lilady – well, color me impressed.

    Just to be clear, I don’t think anyone who studies the science really argues against a diet rich in fruits, veggies, whole grains, lean, clean cuts of meat and other whole foods, and her statement that people who eat that way don’t need a “detox/cleanse” is exactly in line with what Orac says. Of course, Orac goes on to say in effect that no one needs a “detox/cleanse” (though there are medical conditions that would respond to a laxative or enema), and I was wondering if SeeksHealth disagrees with that (and what evidence she has for same).

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