I usually don't do requests, at least not very often. As selfish as it might sound, I do this blog mainly to amuse myself, which means that I choose whatever topics interest me and write about them. Believe it or not, I'd probably still be doing this even if my readership were 1/100 of what it is. After all, I did it seven years ago before anyone had ever caught on to the glory (and ego) that is Orac. I've just been fortunate in that, for the most part, the topics that interest me enough to write about them are generally interesting enough to a bunch of people every day to read them. That confluence between my interests and my readers led me to finding myself a very nice little niche in the medical/science/skeptical blogosphere. And there was much rejoicing, except among quacks and anti-vaccine loons.
Sometimes, however, my interests align with my readers' requests. Several of you actually sent me the topic to which I'm about to lay down a heapin' helpin of not-so-Respectful Insolence. Its source? Where else? It comes from that wretched hive of scum and quackery, The Huffington Post. It's by someone by the name of Dr. Robert A. Kornfeld, who bills himself as the "founder of the Institute for Integrative Podiatric Medicine." That alone at least brought me a chuckle. I know, I know, mentioning that could be construed as an ad hominem attack, and, given the content of his post, ad hominems are not necessary. Dr. Kornfeld's post is what we in the biz call a "target-rich" environment. There's so much material there that it doesn't matter who or what Dr. Kornfeld is, although it was fun to take a peak at the website for the Institute of Integrative Podiatric Medicine. It's all there: homeopathy, anthroposophic medicine, functional medicine, and homotoxicology, among others. But what really made me go beyond chuckling into uproarious laughter was the title of a conference that Dr. Kornfeld hosted a few years ago:
NUTRIGENOMICS and INFLAMMATION: A Science-Based Seminar for the Progressive Podiatric Physician
"Science-based." Dr. Kornfeld keeps using that term. I do not think it means what he thinks it means. And he proves it with his HuffPo post 6 Medical Myths Even Your Doctor May Still Believe. These six "myths" are all either overstatements, exaggerations, or straw men representations of what science-based medicine concludes. Let's start with "medical myth #1":
Myth #1- Technology has improved healthcareAsk any physician if he believes that technology has improved health care and you will get a resounding "Yes!" Advances in medical technology now enable us to look inside the human body with relative ease and with great detail. Our surgical tools allow us to operate on all parts of the body with a minimum of trauma and blood loss. Technology has helped us improve the quality of life for millions of patients every year. It has enabled us to save countless lives as well. Therefore, it is certainly a foregone conclusion that technology has, in fact, improved our health. Or has it?
While there is something to be said about whether physicians sometimes rely too much on technology, as in overusing imaging studies for diagnosis to the detriment of skills taking histories and doing physical examinations, it's hard to argue that technology hasn't improved health care in many, many ways. For example, in my field, laparoscopic and endoscopic surgical techniques have allowed surgeons to be able to do operations that used to require large incisions and many days in the hospital through tiny incisions or even using no incisions at all, allowing for faster recoveries with at least the same, or even better, results. Imaging studies allow earlier diagnosis of cancer and other diseases. True, as I've discussed, in some cases this leads to overdiagnosis and overtreatment, but finding disease earlier often allows for less invasive, less morbid treatment with fewer side effects and better outcomes. I suppose Kornfeld could be talking about overdiagnosis when he claims that there are "more cases of cancer, heart disease, arthritis, auto-immune illnesses, endocrine disorders, developmental disorders, allergies, respiratory problems, infectious diseases, neurological problems, musculo-skeletal pathology, gastro-intestinal disorders, psychological illness, etc., than ever before," but it's arguable that this is even the case. If you look at the incidence of many cancers, while there are some whose incidence has increased, the incidence of most others is either flat or decreasing. Ditto heart disease, where the incidence of heart disease and stroke have been pretty stable for the last 13 years or so. Meanwhile, mortality due to cardiovascular disease has been plummeting. Arguably, a lot of the reason for that is technology.
All of which points to Kornfeld's ignorance when he asserts:
If anything, advances in technology have fostered a narrow field of vision, focused more on early detection and intervention than on prevention. If, by definition, health care means "the maintenance of good health," then technology has failed miserably to produce any measurable improvement in the overall state of health of mankind.
Actually, I would argue that early detection and intervention can often be a form of prevention. For example, if doctors detect hypertension early, treating that hypertension goes a long way towards preventing its complications, which include stroke and myocardial infarction. Moreover, it's a false dichotomy being presented to imply that we either have technology focused on early prevention, less invasive therapy, and better diagnosis or we have prevention. We can have both, and in fact it's not always easy to tell where the boundaries are between prevention and early detection. More importantly, whether or not we have had any improvement in our state of heatlh depends a lot on how you define "health." People with chronic conditions are living longer with better quality of life than ever before.
Let's move on to "myth" number two:
Myth #2 - Inflammation is bad
Ask any doctor what to do about inflammation and the answer will be a uniform, "Take an anti-inflammatory." While it is true that taking medication to suppress inflammation can certainly lead to increased comfort, should we be doing that in the first place? Is inflammation bad? Is it something that occurs by freak accident, some physiologic aberration, that occurs and causes great distress and suffering amongst mankind? We have been conditioned to think of inflammation as something bad because it causes pain and makes us miserable, therefore it should be medicated and suppressed. Right? Wrong.
Inflammation is a directed response by the immune system designed to detoxify, repair and protect tissues under any form of functional or metabolic stress. It is important to understand the purpose of inflammation in order to see why we should not work to suppress it, but rather to support it.
First off, it's a massive straw man to claim that SBM argues that "inflammation is bad" in general. In fact, in my very first week in medical school, we were taught how inflammation is a normal homeostatic bodily response to injury or physiological derangement. Indeed, inflammation is the basis of all healing. If you cut yourself, it is the inflammatory response to that injury that ultimately leads to its healing. Truly, the body's ability to heal itself is amazing, and inflammation is what mediates that healing.
The problem is not inflammation per se. It's when, for whatever reason, inflammation somehow gets out of control, when it becomes chronic. In fact, chronic inflammatory reactions are at the heart of quite a few diseases and conditions, including atherosclerotic vascular and cardiac disease as well as many cancers. Ever hear of Marjolin's ulcer? Basically, it's skin cancer that develops in the area of an old burn injury due to--you guessed it--chronic inflammation. Then there's esophageal cancer, which frequently develops in a condition known as Barrett's esophagus, which is basically a chronic inflammatory reaction of the lower esophagus to stomach acid refluxing up and hitting the mucosa of the esophagus, and, yes, Barrett's esophagus predisposes to the development of esophageal cancer.
It's also hard not to point out that Kornfeld is a massive hypocrite on this issue. Here in his HuffPo piece he is extolling the benefits of inflammation, how it's necessary for the body to be able to "detoxify," and how we should "support it." Yet right on his website is a paean to a conference he held back in 2005. Remember what it was called? That's right, it was called NUTRIGENOMICS and INFLAMMATION, and it's all about using nutrition to suppress inflammation:
From the perspective of integrative medicine, Dr. Kornfeld will teach you how to intervene on behalf of gene expression with regard to inflammation and chronic degenerative disorders.
Yes, Dr. Korfeld himself appears to have no problem with trying to suppress and modulate inflammation. True, he's not using drugs to accomplish this. Rather, he thinks he's using diet to do it. But he's doing it all the same, or at least trying to do it. (It's arguable whether all the dietary woo promoted by "integrative" practitioners like Kornfeld actually do anything whatsoever for chronic inflammation.) Of course, Kornfeld doesn't see it this way. He thinks he's "modulating" inflammation naturally:
What makes more sense, empirically, is to treat these problems mechanistically and supportively. In other words, we want to work to help make the pathway of primary inflammation more efficient, with supportive, rather than suppressive, protocols. There are many natural medicines that can help accomplish the task of supporting our bodies, be they homeopathic, nutritional or herbal. Additionally, we want to be able to identify the reason(s) that this pathway is not functioning efficiently.
On the other hand, maybe Kornfeld is advocating letting inflammation take its course. After all, he is recommending homeopathic remedies. Nope. not really. Check out his blog, where he lists five ways to reduce inflammation "naturally." He even admits:
Unfortunately, when chronic inflammation remains for long periods of time and is not addressed adequately, it will cause the expression of genes that lead to degenerative conditions such as coronary artery disease, arthritis, cancer and others.
While in many cases, anti-inflammatory medications are prudent and potentially life saving in patients with certain conditions such as cardiovascular disease (for example aspirin has been shown to prevent heart attacks) and auto-immune inflammations (when treated with anti-inflammatory medications, these patients can experience improved quality of life), it is still very common for doctors and patients to take a rather cavalier attitude toward prescribing and consuming these medications.
It sure sounds as though Dr. Kornfeld accepts that "inflammation is bad" in many clinical situations. At least, chronic inflammation certainly is. So basically, in the name of seeming to be "smarter" than conventional medicine, Kornfeld is actually trying to do the same thing. Only he won't admit it and he's trying to do it with pseudoscience, all the while claiming without basis that he somehow understands physiology better than physicians.
Certainly he doesn't understand genetics, as the next "myth" demonstrates:
Myth #3 - Genetically coded diseases are unavoidable
This is, of course, a massive straw man argument. It's also based on an even more massive misunderstanding of genetics:
If having a gene for any illness condemns you to having that disease, then why are you not born with the disease you are coded to have? Why isn't every person who carries a gene for disease suffering at all times from that disease? The answer is that all genes do not express themselves at all times and many never do. There must be a reason why the body would call upon a gene to express itself. Otherwise, none of us would be able to survive the onslaught of genetic expression. So what is it that causes a gene to express itself? If you consider for a moment that diseases are just a complex of symptoms being incorporated by the body in an attempt to protect itself from tissue destruction and/or imminent death, you may begin to get a clearer understanding of what I am trying to say. Once we begin to pay attention to the reasons that a gene might express itself, we may be able to prevent that gene from releasing its code for illness.
First off, Kornfeld seems to keep saying "gene" when he means "allele" or "gene mutation" in referring to a "gene for any illness." If he doesn't get his basic terminology right, it's hard to take him seriously. He also seems to have no clue about what regulates gene expression if he finds it in any way amazing that alleles or mutations associated with disease don't cause disease right at birth. He's clearly unfamiliar with the astoundingly complex temporal regulations of genes controlling development, right from embryogenesis up through childhood and then into adulthood. This temporal regulation of gene expression and action occurs over years, decades even. And it's completely normal.
I also have no idea what the heck Kornfeld means when he says we "may be able to prevent that gene from releasing its code for illness." It makes no sense. Genes encode proteins. Sometimes there are heritable mutations in those genes that predispose to illness (such as various BRCA1 mutations that hugely elevate a woman's risk of breast and ovarian cancer) or outright cause illness (sickle cell trait/anemia or inborn errors of metabolism, like phenylketonuria, for example). True, many of the mutations that directly result in disease do produce the disease from birth (again, the examples of sickle cell trait (which only requires one copy of the mutated allele as compared to sickle cell anemia, which requires two) or phenylketonuria. Kornfeld seems to be assuming that, if a mutation or allele doesn't cause disease right from birth, the way that inborn errors of metabolism do, then people must have an enormous degree of control over whether whether those genes ever "release their code for illness."
Nonsense.
Take the example of BRCA1 mutations that predispose to breast and ovarian cancer. Certain of these mutations can produce up to an 80% lifetime risk of developing breast cancer, and there's very little that can be done to reduce that. Actually, that's not entirely true, but, whatever can be done to reduce the risk of breast cancer in BRCA1 mutation carriers, diet isn't going to make a significant impact; nor is exercise. Nor are any supplements that you can think of--or any of the other woo that Kornfeld touts. The only interventions that can reduce the risk by more than a small percentage are prophylactic surgery to remove the breasts or possibly Tamoxifen, no doubt in Kornfeld's eyes an evil pharmaceutical drug. In some cases, genetics really does trump everything. Just because baby girls with BRCA1 mutations don't have breast cancer when they are born doesn't mean that breast cancer can be prevented by Dr. Kornfeld's woo in women with such mutations.
The worst part of this whole bit of nonsense is that Dr. Kornfeld appears to be pulling the old "blame the victim" gambit. I've written many, many times the dark side of the "empowerment" that promoters of "alternative medicine" like to tout when they ascribe near magical powers (actually, there's no "near" about it) to lifestyle, diet, and the like is that, if you are responsible for being in perfect health, you are likewise responsible if you aren't in perfect health. It's something I've referred to as the "illusion of control," and it's very pernicious. Kornfeld is not as blatant about it as Robert O. Young has been in expressing this idea, but it's the same basic undercurrent to the same basic idea, namely that if you are sick it is your fault. You are to blame. Not nature. Not a "germ." Not genetics. You. Kornfeld even makes it explicit:
You should be beginning to see the pattern here. Are we treating cancer by cutting it out? Are we treating arthritis by suppressing the protective inflammation brought about by years of free radical damage? Does coronary artery bypass grafting cure cardiovascular disease? Of course not. Our goal should be in maximizing understanding of cause and effect and employing life affirming, nutrient-rich diets with a healthy, wholesome, natural lifestyle. This is the way to "prevent" genetically coded diseases.
Except that inflammation is not "protective" anymore after a certain point. In any case, the point is that Kornfeld apparently thinks that diet and exercise and whatever woo he is into can somehow trump biology. There's no doubt that lifestyle can have a major effect on health, sometimes even in the case of genetic predispositions, but in most cases biology will ultimately win out.
On to myth four:
Myth #4 - Medications improve health
And why? Dr. Kornfeld explains:
First of all, every medication swallowed is perceived by the immune system as a "poison," because there is nothing in nature that would ever present to the G.I. tract in that form of chemicals. This added "toxic load" places additional stress on the body. These chemicals must be detoxified and eliminated by the body. This need to detoxify causes stress in the liver and kidneys and can damage these vital organs.
Well, yes. Sort of. My very first day of pharmacology class in medical school, I remember the professor telling us that all drugs are poisons in that they interfere with a normal physiologic function or intracellular molecular signaling pathway. So what? When normal physiology is disrupted, often the way to restore homeostasis is to interfere with the signaling pathway that is overactive or to try to compensate by blocking another pathway. It's also utterly ridiculous to claim that there is "nothing in nature that would ever present to the GI tract in that form of chemicals." Do I really have to point out how many drugs that we use are derived from plants and natural products, how many drugs are actually found in nature? All pharmaceutical companies do is to purify and standardize these drugs. I suppose it all comes right back to the naturalistic fallacy. Drug found in nature = good; drug found in nature purified and placed in a pill = bad. I suppose Dr. Kornfeld would recommend that we chew on willow bark instead of using aspirin or eat foxglove leafs instead of taking digoxin.
Another thing popped out: What the hell does Dr. Kornfeld mean by saying that the "every medication is perceived by the immune system as a poison"? In most cases, exceptions being large molecules that are immunogenic, the immune system has nothing to do with whether a drug is "perceived" by the body as a "toxin" or not. Clearly, Dr. Kornfeld's ignorance about immunology rivals his ignorance about genetics and that combined ignorance leads Dr. Kornfeld to opine:
So, what am I saying here? Quite simply, if a patient has high blood pressure and is taking medication to control it, and then they cease taking it, they will see their blood pressure rise again. If they are suffering with an inflammatory problem and are taking anti-inflammatories to control their discomfort, and cease taking their meds, they will again be in pain. If they are suffering with sinus congestion and take a decongestant, they will feel congested again if the drug is withdrawn. Empirically then, we see that the medication has not at all improved their health, just their symptoms.
Except that hypertension is in most cases completely asymptomatic, which is one reason why reating hypertension is a perfect example of prevention I can think of, as I discussed above. By the time someone gets symptoms from his or her hypertension, it's often too late, because that symptom will be angina, a myocardial infarction, a stroke, or symptoms of ischemic peripheral vascular disease. Sometimes, sudden death from a heart attack is the very first symptom that anything is wrong. That's one reason why treating hypertension is improving health.
On to "myth five":
Myth #5 - Childhood immunizations protect us from serious disease
Of course. You knew it was coming: Anti-vaccine wingnuttery, which goes together with woo like peanut butter goes with jelly--or like dingle goes with berry. I'm only surprised that it took Kornfeld until the fifth myth to get to it and let his anti-vaccine freak flag fly high. Maybe he was restraining himself. Be that as it may, I don't plan on spending too much verbiage on this one. Basically, Kornfeld regurgitates many common anti-vaccine tropes that I've dealt with for the last seven years on this blog. He does concede that vaccines save lives (albeit after claiming that most children recover from most of the diseases protected against, except polio, both assertions demonstrating how little he understands). I'll give him that much though; he does accept that vaccines save lives. Many anti-vaccine prone woo-meisters refuse to admit even that. There is, of course, a "but" added, and in Dr. Kornfeld's case that "but" is the question: "But at what price?" He states:
Rather than decreasing childhood morbidity and improving the health of all subsequent generations being immunized against these diseases that have affected mankind for thousands of years, we have instead seen a dramatic rise in childhood illness in the form of ADD, ADHD, autism, allergies, learning disabilities, infectious diseases, auto-immune illnesses and, most importantly, cancer. Cancer has been on a frighteningly dramatic rise in small children over the past decades and shows no signs of letting up. Mortality rates for childhood cancers are unacceptably high although technology has slowed the course of death.
Wow. He actually one-upped a lot of anti-vaccine activists in this one. I've heard all the scientifically unsupported claims from anti-vaccine activists that vaccines cause allergies, autism, ADHD, diabetes, and the like, but I've never seen a claim that vaccines are somehow responsible for the increasing incidence of childhood cancers. Bring on the pirates again! While it is true that childhood cancer has increased in incidence since 1975, the reasons are unclear. One thing that's for sure is that there is no credible evidence that vaccines have anything to do with this increase. In any case, the increase in incidence of childhood cancers is bad, but what's good is that mortality from childhood cancers has fallen dramatically since 1975, and, conflicting with Dr. Kornfeld's "myth number one," it's been largely medical technology that's done it. Kornfeld even admits as much in the paragraph above, albeit apparently grudgingly! In fact, one wonders whether Kornfeld would prefer that those children should die, given that he uses frankly eugenicist arguments:
Have we traded off less serious illness for more devastating disease? How did mankind survive and thrive through thousands and thousands of years without being immunized? Are we interfering in a way that has created a weakening, rather than a strengthening, of the human immune system? Is it possible that we are interfering with the natural course of genetic mutation that would have rendered authentic immunity to these diseases?
In other words, it's better to let children die of vaccine-preventable diseases because it's evolution in action, culling the "weak"--naturally, of course. Think I'm being too harsh? I don't.
Finally, there's "myth six":
Myth # 6 - The double blind - placebo controlled study guarantees safety and efficacy in drug therapy
Now there's a straw man for you. No one says that the double-blind, placebo-controlled randomized clinical trial (RCT) guarantees safety and efficacy in drug therapy. No one. What scientists do say is that the best current methodology we have to evaluate the efficacy of new drugs is the RCT. If RCTs were thought to "guarantee" the safety and efficacy of new drugs, then there wouldn't be a need for post-market surveillance for adverse reactions that can't be detected in RCTs because there aren't enough subjects in them, nor would there be a need for phase IV trials, which are carried out after a drug is approved by the FDA and released into the market. Contrary to Kornfeld's characterization, real scientists and real regulatory agencies (like the FDA) recognize that RCTs can't detect all adverse reactions and drug interactions and are continually trying to find ways to identify problems that weren't detected during phase III RCTs. Is the process perfect? Of course not. Could it be improved? No doubt. Does Kornfeld suggest ways to improve the system?
Nope.
Instead, he rants about how RCTs don't detect all the uncommon side effects of drugs or interactions with other drugs as though that were a failure of the entire system. He ignores all the other forms of clinical trials, post market surveillance, and phase IV trials that look for just these problems after a drug is marketed. One wonders what Dr. Kornfeld would propose in the place of the current system; increasing the number of patients required in phase III trials in order to pick up rare adverse reactions would require a lot more money to develop each drug, and the process is very costly to begin with. No matter what system we come up with, it will never be perfectly safe and completely foolproof, which is what Dr. Kornfeld seems to demand. It will always be a compromise between safety and economics. One could certainly make an argument for reforms of the current drug approval process to tilt it more towards safety, but Dr. Kornfeld doesn't propose any. Rather, he tries to imply that the system doesn't work and that therefore you should choose his woo instead of drugs. It would be very interesting to see, in an ideal world where Dr. Kornfeld could design a drug approval system from the ground up, exactly what evidence of efficacy and safety he would require before the approval of a new drug. Certainly, given that he uses homeopathic remedies, his standards for efficacy must be very, very low indeed.
Overall, Dr. Kornfeld is just another anti-science crank attacking science-based medicine because it doesn't support the efficacy of the various forms of quackery. We've seen his like many times before. No wonder he's found a home on HuffPo.
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I'm all for progress! Excellent article Orac, hope you don't mind me hawking this petition: https://wwws.whitehouse.gov/petitions#%21/petition/fund-clinical-trial-…
Huffington Post medical reporting, the Sunday funnies for the 21st century.
Inflammation as a nearly universal explanation of illness by woo-meisters is actually kind of funny.. in that a reasonably large portion of them are germ theory denialists! So what then is leading to the inflammation? Not bacteria and virii! I venture a guess that they'll probably call upon the ubiquitous "oxidative stress" meme-which of course is treatable by ingesting large quantities of anti-oxidants in supplement, juice, and comestible form.
Several years ago, I attended a lecture/ book signing by a major league woo-meister: he invited questions from the audience about illnesses they ( or family members)suffered : many serious problems were mentioned by attendees- cancer, HIV/AIDS, CV, MS, SMI, diabetes, arthritis...
He told the audience that he had a single solution for all of their ills: all was caused by inflammation and inflammation can be conquered by a vegan diet, regular exercise, and ingesting large amounts of anti-oxidants in supplement form and green juices.
The effects of genetics are pooh-poohed and germ theory has no place: toxins and free radicals are the culprits.
All of which is hilarious: however what isn't funny is that the audience ( of more than 100 in metro NY) applauded wildly while they purchased books.
HuffPo has a large audience and I imagine that this writer's message is as enthusiastically received as the one I heard live: certainty and simplicity- even when they don't reflect reality- are attractive and soothing to many people.
Actually, in "myth" five, I think it may be unfair to impute to Kornfeld the idea that future generations will have resistance to diseases by letting those that don't have favorable genetic mutations die -- that would require too much understanding of natural selection and be not "nice" enough for a woomeister. Maybe he thinks that getting the disease causes a mutation to resist it that will then be passed down, or something.
And on point one, let me add three cheers for technological advances -- last week my cat chewed up and swallowed a plastic bottle, and the good folks at Cornell Companion Animal Hospital were able to remove it from his stomach endoscopically, no surgery required, and he went home from the hospital the same day. How does Kornfeld think that all of his dietary "preventives" could prevent animals or toddlers from swallowing things they shouldn't?
I have ankylosing spondylitis; you're damn right inflammation is bad. AS causes chronic pain, stiffness, leads to bone bridges and heart/lung problems long term. This guy is a freaking moron. Thanks for the write up Orac, long time reader here.
Dr Kornfeld - You keep using that word, "science." I do not think it means what you think it means.
The mention of podiatry and quackery in the same context inevitably brings up this classic Onion article, which will be familiar to most regular readers, and which I expect will be a treasured find for others:
http://www.theonion.com/articles/revolutionary-new-insoles-combine-five…
I heard that this actually won a science-writing award (yes, they did understand that it was satire).
I agree with Vasha above - most woomeisters don't really have an understanding of evolution, and tend to think it works by some Lamarkian process. He probably thinks that exposure to childhood illnesses causes some woo-y changes that result in 'stronger' children in the next generation.
I don't know which charge he would object to more strongly - idiot or a monster - but given the ample evidence for the former, it's a pretty safe bet.
Ah, the technology and medicine bit. A stethoscope discovered my son's heart murmur, an echocardiogram discovered that his heart muscle had enlarged and beta-blockers keep his heart beat steady. Because the genetic condition that causes the abnormal growth also screws up the heart's electrical signals.
That technology sure beats the most common way to diagnose hypertrophic cardiomyopathy: sudden death.
One of our state senators was found dead in his hotel room, turned out he had undiagnosed HCM. He was 41 years old. It have contributed to my uncle's death when he was 45.
It is a genetic condition that occurs in about one in a thousand people. Friday my daughter goes in for her once every five years or so echocardiogram just in case (which will continue into her 30s). I'd really like to catch it with technology and not sudden death.
As usual for a crank, Kornfield misses the point that even if his criticisms of real medicine were spot-on, it would not automagically validate whatever quackery he was trying to promote.
A lot of people don't realize that 'Onslaught of Genetic Expression' is the little-known B-side companion to the Pixies' 'Wave of Mutilation.' It never really caught on.
I have mentioned several times at how we WAY underestimate the significance of something like diagnostic imaging. The ability to see inside the body _without having to cut it open_ is one of the most important advances in all of the history of medicine.
Yes, with imaging we find lots of things that are ultimately benign, but jeez, the solution is not to quit imaging, it's to improve imagining to the point where we can better determine how significant some anomaly is. And believe me, people are working on this exact problem all the time, and making huge progress.
It's just that it is really hard to determine that a mass observed by MRI is benign when no one has ever had the ability to see such a mass before, and therefore has never had the opportunity to study the characteristics of said mass to determine if there are certain things that might indicate a problem.
It's very easy to imagine in the future a case where a nodule in the lung is treated with an imaging agent that will light up if it is cancerous and not if it isn't. I know we do that already with colonoscopy.
Similarly, diagnostic technology is extremely useful for invasive methods. Consider a cancer surgeon who is trying to determine if she has completely removed all the cancerous material in a biopsy. What she needs to know is how much material needs to be removed to make sure it is all gone. We have ways of doing that now, but what if it were possible for her to just wave a wand (like a tricorder) at the material that is there and say, "Yep, there's some left here in this area, but not over here"? In fact, that type of technology is being developed and being tested right now in surgical settings.
Chris hits the nail on the head, here. "Technology" is such a broad term that to dismiss it is meaningless. It's a stethoscope to listen to heartbeats, a spygomanometer (man, did I butcher the spelling) for measuring blood pressure, or even a thermometer to measure a temperature. All examples of technology that are invaluable to the medical profession.
You have got to check out this guy's twitter. He thinks he's the Deepak Chopra of the foot.
http://twitter.com/#!/holfoot153
"In the course of a lifetime, challenges become fuel for growth. Growth comes in the form of consciousness that brings us into the present."
Kornfeld is a-maizing. Come on, that's got to be a pseudonym.
This is my favorite:
They didn't, dumbass. Our ancestors rarely survived past 20 years of age due to numerous factors, some of which were disease and infection. Perhaps he wants humankind to return to that "Golden Age"?
Orac's article - "Alternative Medicine: The Illusion of Control" pretty much summed up what this nut is peddling.
One question, however, always crops up in my mind: A lot of the woo practitioners are almost sanctioned by the government - take the example of Homeopathy in the U.K. or India. If one fine day the government shuts these people down, there would be a large number of people left without any job prospects because they spent 5 (sometimes 8) years at Hogwarts Homeopath "school" plus several years working and are now totally unemployable. It would become a political issue.
So, what would be a better approach? Convert Homeopathy schools into SB Medschools or shut Homeopathy schools down so that there are no new Homeopaths being churned out after the current lot and it just fades away.
I speak of Homeopaths, but I also include the likes of chiropractors.
I'm sorry if this is off topic.
And here I was about to make a lame joke about sending quackwoo to the cornfield.... *cue Twilight Zone main theme*.
(with apologies to Bill Mumy)
-- Steve
T-reg - you do a major disservice to Hogwart's in that sentence.
That was priceless. I'm interested in his being a "podiatrist", though, if that is what he is supposed to be. How does he treat common podiatric complaints with food? Rub acai berry on the Korns...oops, I meant corns...
What do I eat to prevent ingrown toenails? Is there a supplement to prevent bunions? Oh, and plantars warts must not be viral in his book, so what crazy lifestyle must we take on to prevent them? Besides wearing flip-flops in the shower, that is.
I love this perpetual trash:
How did mankind survive and thrive through thousands and thousands of years without being immunized?
Seriously? They had lots and lots of babies. Most died. Simple as that.
First off, Dr. Kornfeld has a very...eccentric concept of disease. If disease is "a complex of symptoms", what about symptom-less diseases, such as hypertension and early type 2 diabetes? OK, so he meant to write "signs and symptoms" - let's give him that.
Still, the idea that these physical manifestations of disease are "...incorporated by the body in an attempt to protect itself from tissue destruction and/or imminent death" seems at odds with such things as the small vessel effects of hypertension and diabetes (as a podiatrist, he should have at least a passing familiarity with diabetic neuropathy and foot ulcers) and the destruction of the substantia nigra in Parkinson's disease, not to mention aspects of just about every disease I am aware of.
If the "signs and symptoms" of disease are the body's attempts to "protect itself from tissue destruction and/or imminent death", then the best that can be said is the body isn't very adept at self-preservation. Even if we limit the discussion to genetic disorders, the "signs and symptoms" are often wildly at odds with maintaining life. I think Dr. Kornfeld needs to work on this one.
OK, so Dr. Kornfeld is a bit at sea with his concept of disease. But what is he talking about when he says "...we may be able to prevent that gene from releasing its code for illness"? The "code" is inherent in the gene - something he would know about if he had paid attention in class. If he's talking about preventing gene expression, that's the problem with a large number of genetic disorders - absent or inadequate expression.
For some genetic disorders (e.g. schizophrenia), it appears that the problem is an error in a developmental program, with cell growth, differentiation or apoptosis not happening in the proper way. In others, the problem is not that the gene is improperly expressed but that the gene product is abnormal (e.g. sickle cell disease and Huntington's disease). Shutting down the abnormal β-globin production in sickle cell disease (or the huntingtin protein production in Huntington's disease) would not necessarily be an improvement.
All of these "myths" are straw men - that much is clear - but Dr. Kornfeld's "explanation" of genetic diseases reveals that he is lacking knowledge that, as a podiatrist, he should have.
Prometheus
Roadstergal beat me to it - the woo understanding of evolution tends to be rather Lamarckian, so that life threatening illness makes populations universally fitter without anyone dying, and only human intervention kills (when not based on veganism, donning hair shirts, dietary supplements and obedience to an omniscient guru, that is.) All that is needed is policing lifestyle and beliefs (think only happy thoughts, people!). Human intervention kills. It's about as consistent a mainstay of woo literature as the idea of a past Golden Age of 100% Natural Health, followed by a steady decline brought by advancing knowledge and technology.
@Anton P. Nym (#16):
It wasn't a lame joke, it was a good joke. A real good joke!
Any readers who have somehow never seen The Onion's hilarious parody of podiatric quackery and woo, might wish to type "Onion revolutionary insoles" into their search engine of choice.
Prometheus:
Quite so. I am suddenly reminded of a British actor named Nabil Shaban. He is quite limited in the roles he is offered because while he is a very talented thespian, he has osteogenesis imperfecta, a case bad enough that his growth is severely stunted and his limbs are strangely shaped. This is due to multiple bone fractures throughout life -- sometimes children with severe cases are called "glass babies" because of how easily they fracture. He also has the characteristic barrel chest. Some cases wind up being fatal; constantly breaking bones is not very healthy.
I wonder what Kornfield thinks of conditions like that?
Speaking of The Onion, I can't help but wonder if Dr. Kornfeld is related to the notorious Accountz Reeceever of the same name.
http://www.theonion.com/personalities/herbert-kornfeld,1019/
"Now there's a straw man for you. No one says that the double-blind, placebo-controlled randomized clinical trial (RCT) guarantees safety and efficacy in drug therapy. No one. What scientists do say is that the best current methodology we have to evaluate the efficacy of new drugs is the RCT."
I agree with you. As a doctor, Kornfeld should know better than to talk in absolutes where science is concerned.
The only qualm I have with your excellent debunking here is that in the case of BRCA mutations. BRCA1 and 2 deletion mutants increase the risk of breast and ovarian cancer by a mechanism that allows cells to build up mutations at a faster rate than normal and avoid apoptosis in the process. As such, a cell population can hit all the 7 hallmarks of cancer more quickly and a patient ends up with a high probability of this happening within their lifetime. Anyway, diet and exercise have been shown in many studies to decrease mutation rates in certain tissues and increase mutation rates to some degree in others. Specifically with BRCA1 and 2 mutations, at least in a few studies, diet and exercise have shown a positive impact when it comes to a decreasing a patient's risk of developing breast cancer. As far as making treatment decisions though, I don't think this effect is significant enough, certainly not in the case of BRCA1, to change a recommendation of profilactic mastectomy. You did hedge the point of diet and exercise a bit in your analysis though and the guy you're responding to is a complete quack; just wanted to get all nit-picky for fun I guess.
Once we begin to pay attention to the reasons that a gene might express itself, we may be able to prevent that gene from releasing its code for illness.
Unfortunately the "avoiding puberty" strategy for avoiding juvenile-onset conditions is not convenient for many people.
That Onion article was truly hilarious. "Converting the pain-nuclei into pleasing comfortrons" totally made my day.
Thank you I needed that hearty laugh, it's been a hellish kind of day.
Only by a small amount, which, compared to the lifetime risk due to the nastiest BRCA mutations, is relatively insignificant.
Apparently so.
Pyttan @29 -- My pleasure. Not a great day for me, either, but brilliant satire does lighten the load.
Alt med proponents luxuriate in their own myth-making as they "de-construct" SBM:
I've heard woo-advocates chastise SBM for "not being able to treat chronic illness" however even they grudgingly admit that emergency medicine is incredibly effective ( who can argue with starting stopped hearts and re-attaching severed limbs?)
As if there is some hard-and-fast dividing line that that separates two *discrete* entities whose practitioners are trained in *entirely* different ways and are guided by *distinctly* different data having patients whose chronic conditions *dare* not interfere with their current emergency condition let alone *lead* to the emergency... I re-iterate: as if.
The nonsense about inability to treat chronic illness flies in the face of data about CVD and HIV/AIDS- not that these folks would ever acknowldege these breakthroughs: actually some of them are even loathe to admit the existence of HIV.
Please excuse me; this is a bit of a detour from the subject, but I hope someone can help and there's little time. I live in Utah, and tomorrow night (Wednesday) Orrin Hatch is coming to our city for a town hall meeting. My husband and I want to confront him about DHSA and his role in the supplement industry. We are having a hard time phrasing our question in a way that will be most effective, and require him to defend his actions.
My hubby is a virologist working on flu vaccine efficacy among other things, so he will have some credibility as a scientist. He hasn't had time to follow this blog, but I keep him informed (and entertained). He had no idea of the extent that quackery has spread its tentacles into science, and would like to call Senator Hatch out. Can anyone suggest an appropriate question or two that will have firepower behind it? What would you ask Senator Hatch? In order not to hijack this post, you can email me at takeaseatupholstery@yahoo.com if you are so inclined. Thank you in advance.
Well, this is true for some genetic diseases. For instance, if you have sickle-cell anaemia, you can't solve it by turning off both copies of your haemoglobin genes (not if you want to keep living, anyways).
I get the impression that a lot of alt-med people think that since certain lifestyle changes can change the expression of some genes, that of course there must be lifestyle changes that can down regulate genes with bad alleles.
And on the subject of gene expression: is it possible for one allele of a gene in a single cell to be expressed differently than the other allele of the same gene in the same cell? That is, is it possible to "turn off" a bad allele in a person while leaving the other allele "on"? (I get the impression that many alt-med people believe this as well.) Given my limited understanding of genetics, I don't think it's possible.
Ok, so I really, really want to give Kornfield a tiny bit of credibility. Maybe, just maybe, he's just awful at communicating what he knows. Maybe, when he said "Once we begin to pay attention to the reasons that a gene might express itself, we may be able to prevent that gene from releasing its code for illness," he was referring to a paper on epigenetics that suggests the ingestion of foods that are high in methyl-donor supplements can actually change the epigenetic 'code' of an animal and this indicates there could possibly be links between diet and disease susceptibility (see Jirtle and Skinner's review in Nat Rev Gen, April 2007).
Then I realized that the first word of the abstract was 15 letters long and therefore the paper was too advanced for him to read. Maybe we commenters can all pitch in and buy him "The Everything Kids' Science Experiments Book: Boil Ice, Float Water, Measure Gravity-Challenge the World Around You!" so he can work up to it one day?
Sigh.
Also, InigoMontoya: you win the internet.
For instance, if you have sickle-cell anaemia, you can't solve it by turning off both copies of your haemoglobin genes (not if you want to keep living, anyways).
Or if you turn on your fetal hemoglobin gene to compensate. It's being worked on.
Matthew Cline (#34):
Actually, this two questions:
[1] Can alleles of the same gene in the same cell be expressed differently?
Yes. Some genes have one allele "switched off" permanently, other genes have both alleles expressed the same and still other genes have the paternally-derived allele expressed differently from the maternally-derived allele.
Some genes have the maternally-derived allele expressed under certain conditions and the paternally-derived allele under other conditions. Not all of the mechanisms are completely understood, yet.
[2] Can a "bad" allele be "turned off", leaving the other allele functional.
Sometimes. As you might guess from the answer to #1, this may or may not "fix" the problem. In Huntington's disease, turing off the abnormal gene would stop the production of huntingtin protein, which should stop the progression of the disease. Some diseases - recessive genetic diseases like sickle-cell disease, for example - have no "normal" allele to leave "on".
The "nuts and bolts" of turning mutated alleles "off" is the subject of extensive research. One of the biggest problems is targeting - all cells (with a few exceptions) in the body carry the same set of alleles, but not all of these alleles are expressed the same - or at all - in all cells.
Another problem is that the genes that are most amenable to manipulation - genes where both alleles are normally expressed and where a single allele is sufficient to maintain normal function - have both alleles regulated the same way. That means most mechanisms that would shut down one allele will shut down both.
I hope that helps.
Prometheus
Dianne (#36):
Hydroxyurea - which is a current treatment for sickle cell disease - works by increasing the production of the gamma chain (foetal haemoglobin). Turning on the gamma chain more strongly would probably be of even more benefit.
However, the problem with sickling doesn't disappear - although it gets much better - unless the production of mutant beta chains (sickle haemoglobin) is blocked. It's possible that strongly expressing the gamma chain (which is usually suppressed after birth except in significant anaemia) may, itself, suppress the beta chain by feedback.
Prometheus
Since this topic has slid to gene expression, could someone tell me something that is off topic from original post? My father and his sister both have dominant hereditary spinocerebellar ataxia (okay, my father had; he's passed). However, when I went to investigate I was told by my father's widow that my father had SCA1. His sister (stil alive) is very certain she has SCA2. Both are mutations of the in different alleles. Is there any possibility that sometimes we inherit the "ability" to have our cells mutate, rather than the mutation itself and the mutation could then show up in different places, so to speak? If there IS mutation is it "locked in" at conception or can your cells mutate much later in life?
This is something I've pondered some time, but never really felt like I was around people who might actually be able to answer the question until reading this.
Thank you, technological advances and the people behind them. Back in the early 1970's surgeons removed bone fragments from my brain and then put a plate over the spot that the bone didn't grow back. I wouldn't be here otherwise. Question: is there a membrane around the brain to protect it? Because if there is, I think that's where the fragments were.
Thank you, technological advances and the people behind them. Back in the early 1970's surgeons removed bone fragments from my brain and then put a plate over the spot that the bone didn't grow back. I wouldn't be here otherwise. Question: is there a membrane around the brain to protect it? Because if there is, I think that's where the fragments were.
this is funny to me: http://www.youtube.com/watch?v=uDYba0m6ztE&feature=related
"I would argue that early detection and intervention can often be a form of prevention. For example, if doctors detect hypertension early, treating that hypertension goes a long way towards preventing its complications, which include stroke and myocardial infarction."
I would say early diagnosis is becoming (or is going to become) quite contentious. While it seems obviously beneficial, it is not always what it appears as books like Overtreated and overdiagnosed point out. I notice an FDA panel has decided PSA does at least as much harm as good.
This if of course nothing to support the odious Dr Kornball
@ Tina S.
There are three covering membranes atop the brain...look up "meninges" on Wikepedia and see the great illustration there.
I suspect the bone fragments that you speak of had penetrated the Dura mater ("heavy mother") meningeal membrane.
I love your link to the Dara O'Briain You Tube video...thanks.
Interesting thing about Dr. Kornfeld, Holistic Podiatrist - on his website he rails against mainstream drug therapy for causing a "toxic load" in the body. Yet one of his advertised treatments is Botox foot injections (for smelly feet). Shades of Jenny McCarthy, who warns against dread vaccine "toxins" while loving the cosmetic effects of facial Botox. (I know, "natural" toxins are a-OK).
Kornfeld also promotes injection of Restylane (a wrinkle filler) into the foot to create a pad to make high-heel wearing comfortable (though Restylane's makers note that safety or effectiveness of the product for treating other than facial wrinkles has not been established in controlled studies). How this gets to be labeled "holistic" therapy puzzles me.
Mrs. Woo (#39) asks:
With reference to the SCA1 and SCA2 mutations that prompted Mrs. Woo's question - those mutations are both triplet (CAG) expansion disorders, where a region of repeated triplets (CAG in this case) in the gene are duplicated over and over. In these disorders, the triplet repeat areas keep expanding with each generation until it finally reaches the point where overt disease is caused.
Now, since SCA1 and SCA2 are similar in presentation but on completely different chromosomes, it seems unlikely that two siblings would each have different SCA types, although it's not impossible. I suspect that there has been a mixup, either in diagnosis or in relaying that diagnosis.
As for the idea of some people inheriting a higher rate of mutation, that happens, although the clinical outcome is usually a familial tendency to cancer. Mutations in the DNA repair systems, recombination, cell cycle control and replication systems (to mention just a few) can lead to more mutations. Depending on which system is affected, the resulting cancers may be localised to certain tissues or may be in almost any tissue.
Xeroderma pigmentosa (XP) is a defect in one of the nucleotide excision repair (NER) enzymes (there are several enzymes, thus several types of XP) that leads to exquisite sensitivity to UV light and a marked propensity to develop skin cancers (and other cancers). Rb and p53 are proteins that are involved in cell cycle control and apoptosis (controlled cell death), so mutations in their genes can lead to cancers almost anywhere.
This leads to the second part of Mrs. Woo's question. Cells can mutate any time they replicate their genome, which roughly corresponds to anytime they divide. A "global" mutation - one found in every cell of the body - has to happen before the first cell division, i.e. before fertilisation, although mutations in early embryo divisions will be nearly global (i.e. found in every tissue but not in every cell).
Since mutations happen at cell division (more or less - see above), tissues that divide a lot (e.g. skin, gut lining, blood-forming cells, lung lining, etc.) are more prone to mutation than cells that divide rarely (e.g. neurons). That's why skin cancer and colon cancer are more common than brain cancer.
Of course, it's also a lot more complicated than that. Skin cancer is common not only because skin cells divide rapidly but also because skin is exposed to DNA-damaging UV light, something the colon rarely (if ever) has to deal with. Also, things that cause cells to divide more rapidly (such as irritants or mechanical damage) lead to more mutations (and more cancer) because there is less time between cell divisions to repair DNA damage.
So, I hope I've answered Mrs. Woo's questions and also shown that "cancer" and genetic disorders are far more complicated (and complex) that the simple "myth and response" given by Dr. Kornfeld.
Prometheus
@ Mrs. Woo: I found Prometheus' explanation of the SCA1 and SCA2 gene mutations very informative.
You state that your father is now deceased and it was thought that he had spinocerebellar ataxia Type I caused by mutation of the SCA1 gene. Now your paternal aunt has been diagnosed spinocerebellar ataxia Type II caused by mutation of the SCA2 gene.
Is it possible Mrs. Woo, that your dad was diagnosed with his SCA1 gene disorder before the SCA2 gene disorder was discovered in 1996?
Scientists Identify Gene for Spinocerebellar Ataxia 2
NINDS News Articles
For release: Thursday, October 31, 1996
Scientists have identified the gene altered in one of the most common hereditary ataxias, spinocerebellar ataxia 2 (SCA2). The discovery allows improved genetic testing and provides new clues about how genetic mutations cause several neurological disorders, including Huntington's disease. The findings are reported by three different groups in the November issue of Nature Genetics.*
Source: NIH-National Institutes of Neurological Disorders and Strokes-Press Release
Oh man, you are so right on! I'm a family physician.
About "empowerment" one of my community preceptors in residency seemed to embody this. He takes impeccable woo-y care of himself and when people have a problem he suggests they are out of balance. He even tried at one point to suggest one of my own medical problems (bad GERD) was because my life was out of balance, when really I'd already tried all the usual stuff. I remember thinking, "geez, if I were your patient I would be offended that you think my problem here is lack of motivation!"
Also, I am so sick and tired of people not wanting to treat something with medicine so they treat it naturally, with something that is essentially a medicine. St John's wort? Totally a medicine, and not a great one compared to what else we have. If you're against medicine then why even take something "natural" when at best you're hoping it will function as a medicine? Recently I saw a "natural antibacterial" product made with thyme oil, and I thought to myself, the problem with antibacterials in consumer products isn't whether it's natural or not, it's that anything trying to kill bacteria leaves only the strongest ones standing! Sigh...
Quoted for truth. Amanda G, that is the best, most concise way of putting it that I've ever seen.
Prometheus - thank you so much for your explanation. The shorthand says "the genetic mutation like the trinucleotide expansions that cause Parksinson's and SCA must be present at birth." . I'm sorry not to share my thanks with you earlier - I somehow missed the update and only saw it now that Calli just commented and brought it back to my attention.
Those of us who haven't been to medical school but share information on the internet hear a few anecdotal stories here and there regarding families that have "other SCAs show up" outside of the originally diagnosed genetic flaw. It makes you wonder what might be happening, and if you don't know the science it ends up being conjecture until you can find a way to be certain. :)
@lilady - I'm not sure when they would have had the genetic testing. I know my father and his sister were both diagnosed before genetic testing had determined where the genetic error occurred, and later were urged to have the genetic testing by their neurologists. My aunt goes to the Johns Hopkins and had participated in some of the studies about spinocerebellar ataxia, or at least did, last I knew. Recently she's gotten to the point she cannot take care of herself so she might not be participating in them anymore.
When I began having neurological deficits myself I asked my father's widow and his sister which genetic test I should have and got conflicting answers. The testing is expensive (and moreso if you don't know which specific marker you're looking for), so I never knew for sure which one I should do.
@Lilady -
Hi Mrs. Woo: Would you believe that there is NIH-NINDS (National Institute of Neurological Disorders and Stroke) funded Consortium of Researchers studying spinocerebellar ataxias?:
Clinical Research Consortium for Spinocerebellar Ataxias
(Sorry for not linking) There are "participating centers", according to their website, throughout the United States where Physicians can evaluate you and order genetic testing to determine if a patient has an ataxia...and what type of spinocerebellar ataxia.
Wow! No, I hadn't heard about it. They'll test for all of them at this point as part of the study? I'll have to go look for that. Thank you very much for letting me know. :)
@ Mrs. Woo: Thanks not necessary. There are some very technical links at that site, but also some links for patients.
I imagine, you would need a neurologist to make the referral and provide you with his/her chart notes and the results of other tests that you have undergone.
Let us know if you are referred...we care.
@Lilady - thank you again. You can shrug off thanks, but it's sweet for you to say you care.
The last neurologist visit I had I was assured that I wanted to put off a diagnosis like that as long as possible since it makes it very difficult to get health insurance or life insurance or long-term care insurance after a diagnosis like that. They recommended I wait until there was regular falling instead of just tripping over my own feet, dropping things, etc.
I actually kind of liked that suggestion at the time. They didn't have a lot to offer for treatment, etc., so it wasn't like I was missing out on a treatment to stop or slow progression. I had originally promised myself I would keep up on the research, but after I got sick with something else I lost track of the ataxia stuff.
Since I was diagnosed with another chronic illness that has left me disabled, that argument is probably irrelevant now and I should go back to the neurology department again.
Another medical myth- the unvaccinated are always to blame for the
outbreak of disease-
http://www.nejm.org/doi/full/10.1056/NEJM199407073310104#t=abstract
Ken, that is not really what it says. Most of the cases were in infants under a year old, they do not get full protection until they complete the series at about a year old. And of the cases between a year and twelve only 74% were fully immunized, that leaves a quarter which were not.
Do read the herd immunity numbers at the end of this comment.
Funny how you decided to post a seventeen year old article, and not some more recent articles:
Pediatr Infect Dis J. 2005 May;24(5 Suppl):S58-61.
Duration of immunity against pertussis after natural infection or vaccination.
Wendelboe AM, Van Rie A, Salmaso S, Englund JA.
Impact of anti-vaccine movements on pertussis control: the untold story
Pediatrics. 2009 Jun;123(6):1446-51.
Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.
Glanz JM, McClure DL, Magid DJ, Daley MF, France EK, Salmon DA, Hambidge SJ.
Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.
Omer SB, Enger KS, Moulton LH, Halsey NA, Stokley S, Salmon DA.
JAMA. 2000 Dec 27;284(24):3145-50.
Individual and community risks of measles and pertussis associated with personal exemptions to immunization.
Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE.
Some herd immunity arithmetic:
Take 1000 people (ignoring the infants under 2 months who cannot be vaccinated, or babies under a year who can only be partially vaccinated), if 5% refuse vaccines then the numbers are:
950 vaccinated persons (assuming full schedule)
50 unvaccinated persons
The pertussis vaccine is actually only 80% effective at worse, so the numbers are:
760 protected persons
190 vaccinated but vulnerable persons
50 unvaccinated persons
There is an outbreak and it gets spread to 20% of the population, then:
760 protected persons without pertussis
38 vaccinated persons get pertussis
152 vaccinated person who may still get pertussis
10 unvaccinated persons get pertussis
40 unvaccinated persons who may still get pertussis.
This is how more vaccinated persons get the disease than unvaccinated. Even if the infection rate was at 100%, there would still be more of the vaccinated getting the diseases because there are more of them!
I must say, I was getting very bored at approximately half way into your diagnosis of Dr Kornfeld. I stumbled upon this when doing some research on health and medical myths.
What I know is this - when people are comfortable with their own life, and true to themselves, they do not need to waste unnecessary energy on trying to degrade another person who is probably doing more harm than good. I also know that more Doctors and Hospitals will not result in better health. So what this means is that you are fighting the wrong cause. Tell me about Cancer and virtually all other chronic diseases of today prior to the 19th Century? And why is it that we have so many diseases? Bad luck or bad genes is it? I did not see you mention anything about the ringleaders of the entire political bungle that the Medical system is in.
My heart goes out to the honest Medical Doctors of the past who made brilliant discoveries to serve mankind only to be banished by the corruption within Government, FDA, AMA ETC. It is disgusting and if you were a real Doctor you would have the balls to write about this and the real reasons as to why we have so much disease today.
@neil
Necro much, idiot?
Also, nice conspiracy theory and fear mongering drivel. I'm sure to get a laugh at your idiocy.
Correction above " more good than harm"
Perhaps Neil will "have the balls" to get back to that one.
Thanks for your constructive response. Is that the same kind of fear when they say" you need to be operated on now or you will die?" Or is it different?
Ah, epistemology. Do continue. Perhaps you could start with the surgical Brite Line.
@Neil:
A person who is making false claims about Medicine may turn people away from effective treatments, so your amusing misstatement is actually correct.
I recently read a news story about the body of a man being dug up by archaeologists. He lived almost 3000 years ago. His body was riddled with cancer. The name cancer derives from the Greek for "Crab". Diabetes was described by an ancient Roman physician as "a melting down of the flesh and limbs to urine". The fact that we can manage these diseases means that people with them live much longer than they would have even 100 years ago.
@novalox:
QFT.
This is going to totally suck if Neil hoists up its ponderomotive balls and trundles away.
Neil - it would appear that your research skills are sadly lacking, if they didn't turn up papers like this: http://www.ejcancer.info/article/S0959-8049(04)00416-2/abstract. The abstract is free-to-view: it would appear that the ancient Greeks were all too familiar with the ravages of cancer. Similarly diabetes & other chronic diseases were known & described -as Julian Frost pointed out - by physicians of that time.
Perhaps you should get over the conspiracy-theory mindset & see where the actual evidence takes you?
One man being dug up 3000 years ago, excellent work. Do I have to dig up the millions dead from Doctors? Prevention is far better than the cure - something that orthadox medicine is not taught are not taught but hypocritically, you actually believe. Allison - so America just got fat and full of disease for the hell of it. I have no interest in conspiracy theories , just valid scientific facts. I prefer not to be blinded by science like yourself.
This is great fun. Can you tell me what some of you eat in a given day, and I will advise you as a specialist what you should be eating - something that has never been taught to Medical Doctors. Yikes! You wake up one day and discover, gee, food is important after all, how about that! And most of the time it can prevent most diseases. Your travelling down the wrong path with 8 inch thick manuals when it is so simple.The longest living people in the world do not understand your terminology, the medical system and the abnormal unnatural world that surrounds us today - but they do know instinctively what the body needs - and they out live you. Therefore, these are the real leaders of science and health.Who is above them? You?
Tell me about Cancer and virtually all other chronic diseases of today prior to the 19th Century?
People died of them. Is that what you wanted to know?
herr doktor bimfer - well that's even more embarrassing isn't it or have I missed something here on planet Earth? So if people got all the diseases that you claim in previous centuries, and that we are much worse off today; that means, ah, let me think, we have gone completely backwards.Great stuff! Where are those people who live 'disease free' and 'disability free' lives - the real experts?
@ Neil
One man being dug up 3000 years ago, excellent work Um, no, reading comprehension fail. Died 3000 years ago... Did you actually follow & read the link I gave you?
and I will advise you as a specialist what you should be eating
o rly? And just what are your 'specialist' qualifications to provide such advice??
And most of the time it can prevent most diseases.
How much is 'most'? And which ones can't it prevent? Curious minds want to know.
I have no interest in conspiracy theories , just valid scientific facts
So far you appear to be full of the former, & have certainly provided none of the latter.
@ Neil
One man being dug up 3000 years ago, excellent work Um, no, reading comprehension fail. Died 3000 years ago... Did you actually follow & read the link I gave you?
and I will advise you as a specialist what you should be eating
o rly? And just what are your 'specialist' qualifications to provide such advice??
And most of the time it can prevent most diseases.
How much is 'most'? And which ones can't it prevent? Curious minds want to know.
I have no interest in conspiracy theories , just valid scientific facts
So far you appear to be full of the former, & have certainly provided none of the latter.
Hello Ally. It wouldn't matter what my qualifications are even though I am in the health and fitness industry.I am beneath you and nothing else matters. Oh by the way, there is a cure for cancer - It's called the Immune system. And the way you find out if something works or not is called 'practice'.Some brilliant integrative oncologists are obviously way ahead of you at the moment with 'much practice'. Or perhaps their work is also a 'conspiracy theory' along with the thousands upon thousands of people who have reversed their diseases, must also be telling lies right?
Those who know the least obey the most.
Neil, if someone says they offer specialist advice then they should expect to be asked about their qualifications to offer same.
As for the rest, if you can slow your version of the Gish Gallop down to a trot long enough to answer my other questions, we might just possibly be able to have a conversation.
Of course if this was the 60's and a Medical Doctor in USA mentioned nutrition, you would have FBI / State troopers at your home wouldn't you? (It's a conspiracy!!) The fact that I don't want to reveal my identity in itself tells you that there is something seriously wrong with the system when people can not speak freely the truth.
Your other questions - 1) eating correctly confidently reverses most diseases most of the time if one adheres to the pure bliss of healing the body naturally including chronic degenerative diseases - too many to list. It is not a miracle, it is nature at work. Can't cure Parkinsons etc for obvious reasons. And I haven't even covered anything else like stress, spirituality which is more powerful than our physical etc.
And you wanted to know about valid scientific facts. Well, you tell me? How many medical journal articles etc are not funded by pharmaceutical companies etc? I wouldn't read them because I don't trust them. I read independent research and those who actually 'walk the talk' in their field and have something to offer via 'real practice beyond the theory'.
So, Neil doesn't believe that chronic diseases didn't exist before the advent of modern medical science???
Well, given the prevelance of Gout in medieval England, particularly among the aristocracy, I'm sure that would come to some surprise to historians.....not the mention the fact that regular old diseases like Smallpox, the Plague, TB, measles, etc, etc, etc - killed many people well before they lived long enough to fall prey to more chronic afflictions.
Common sense is an uncommon virtue.....
Correction for the double negative (too damn early) - doesn't believe that chronic diseases existed......
Lawrence - Perhaps you work in the area of statistical data in Modern Medicine. I said no such thing about diseases not existing before 19th Century or point me to where I said that.Your last line is most interesting, common sense. Ah yes, if only the Medical Fraternity practiced more of it...
Neil, you appear to have missed what we have been saying. Cancer and Diabetes existed and were known to the Ancients. People died from them. They are not "modern" diseases. As for this:
We are not worse off today. People are living longer and staying able-bodied even into their 70s and 80s. Modern medicine means diseases that were once certain death sentences or destroyers of quality of life can be managed (insulin for diabetes) or even beaten. 100 years ago, the survival rate from cancer was close to zero. Today, if it's caught early enough, it can be cured in most cases.
Neil - you somehow seem to claim that people used to be healthier in the past, when this is patently untrue. If things were so bad today, why are lifespans now longer than they've ever heen - and people are now much more active at later ages?
Again, common sense is an uncommon virtue.
Comment of mine in moderation.
Neil,
It seems you have stumbled across some of the vast amount of misinformation that has clogged up the internet. Your challenge is to do some research using primary sources to find out how much of it is true, and how much is not. Don't believe what you read until you have checked it for accuracy yourself. You will be surprised at how much is simply wrong.
For example, you might research life expectancy, and how it has changed over the past 200 years. Take a look at infant mortality and child mortality, and how they have changed while you are at it. You might want to take a wander around a Victorian cemetery and take note of the age people were when they died. Then come back here and tell me that "we are much worse off today".
People get more diseases of old age because they live longer. The man in his 70s who has prostate cancer today would have died of TB in his 30s a couple of hundred years ago, if he was lucky enough to have made it through infancy.
As for
Who are these people, and how do you know how long they live? There are a number of longevity myths about people, mostly living in remote area, who are supposed to live for an unusually long time, but in every case that has been properly investigated this has been found to be a myth. The Hunza, for example, who are legendary for living well into their 100s, except the truth is they don't.
In the 50s, American geologist John Clark, who had 20 yearsâ field experience in first aid, spent 20 months among the Hunza. Running a free dispensary, he soon discovered that the natives had as much disease as any other people. Here's the book he wrote on the subject: http://goo.gl/vuW5 - of particular interest is the chapter starting on page 54 "The Healthy Hunzas Come to the Doctor". These people were not healthy by any standard I am familiar with. Even the relatively primitive medicines of the 50s made a huge difference to the Hunza (lots of merthiolate for the mercury fans out there, by the way!).
Julian Frost. Yes, people are living longer, just not necessarily better, and often financially crippled. Not sure about you, but I would rather be healthy and functional until 80 then die rather than at 55 be diagnosed with multiple diseases and my 'diseases managed' by drugs up until 80 where i passed away, with very little vitality or functionality in the last 30% of my life.
Most of the changes began since the industrial and agricultural revolution began. Again I have no interest in Mythology or conspiracy theories, just validated facts. You are speaking with someone who is in the less than one per cent bracket of health and fitness who eats what I consider to be 'normal', yet I am classified as a freak- No processed foods, alcohol, drugs, smoke, coffee, animal products; but organic fruits, veges, nuts, seeds, herbs, non dairy milks. You may also find this abnormal but it works best for humans to maintain vitality and preventing illness. If you can't see beyond the problems associated with excessive meat and dairy consumption, then there is nothing more to be said. Watch the movie Forks over knives, and there are many other documentaries.
So, you would rather not get a chronic illness at 55? I would rather NEVER have a chronic illness, have a pony that could fly, a million ounces of gold, and a time machine.
Speaking only for myself, I would rather be alive and "financially crippled" than either dead or even actually, physically crippled.
Also, where are you getting your data on life before the agricultural revolution? Not written records, since those postdate agriculture.
And thank you so much for implying that you are somehow morally superior to my disabled relatives and friends, those people who made wrong choices like having bad genes, accepting a bike ride at the wrong time, suffering concussions in childhood, or not being able to afford medication to keep their blood pressure under control.
As to financially crippled - did you ever read Dickens? Have you ever read about life in non-industrial and early industrial societies? People were either rich, mooched off their children, or worked until they died. People were routinely afflicted with diseases we never even hear about today. Sure - the people who lived to be old could be quite healthy; I know plenty of quite healthy people in their 80s.
Well, obviously since Neil is fine, it's okay to say "the hell with everyone else."
Nice attitude Neil.
Can you site a single instance of this? For that matter, where is your evidence that doctors are not trained in nutrition and do not speak of it (I don't recall a doctor ever being shy about that).
This merely seems paranoid. Can you justify your view?
[Citation Needed]
[Citation needed]
Name a few researchers you trust and let us know what peer-reviewed articles backed by independent teams who replicated the results you've read, please. Additionally, people who publish in reputable journals list their conflicts of interest, if any, so that people can take that into account when reading the article. That said, you've cut yourself off from a huge body of data - how can you consider yourself well informed on the topic?
Neil:
"Better" is of course subjective. It's easy to move the goalpost on that one. The financial issue is a very real problem, though. It's not the fault of modern medicine; it's the fault of our society. Our system in America is very efficient at delivering high-quality care but absolutely stinks at being cost effective, and the system is downright punitive for those without funds. Since there are laws requiring that no one be turned away from an ER, prices go up to compensate for the indigent -- and since ER care is the most expensive kind of care, this quickly becomes a monumental problem. Yet our politicians seem to treat the issue like kryptonite, and the idea of setting up universal health care is derided as "socialism" and presumed to feature "death panels". This despite the fact that our current system is so unfair and so messed up that it is vastly more expensive and will definitely kill more people.
But it's a separate problem. Really, it should be an easier problem to fix, but until we can break the "OMG it's SOCIALISM!!!!" mindset, we're probably stuck with it.
Well, of course! But it's foolish to pretend those are the only possibilities. Dead at 55 is also a realistic possibility. Diagnosed with chronic and treatable ailments at 55 and able to pursue an active lifestyle until 78, then move into a nursing home, then die at 80 is also a possibility.
I'm glad you're so healthy and able to pursue an active lifestyle. That's wonderful. But don't delude yourself into thinking you have prevented all the ills that could ever befall you. Tumors do not appear solely because we are eating an insufficiently noble diet. Heart disease can strike vegans. People who exercise regularly can have strokes. Eating well and exercising greatly improves your odds, but it doesn't reduce your risks to zero or even very close to zero. Thus, it is important to still get occasional physicals and such, since most problems are more easily treated if caught early.
And it's interesting you should tout your own healthy diet of organic products in the same post where you complained about people being financially crippled (presumably by the cost of medical care). The diet you eat is expensive, and you have offered no evidence (only assertion) that it's better for you. The poor (i.e. the vast majority of humanity) cannot afford such a diet, evne if it could be produced in sufficient volumes to feed them (which it can't). It would bankrupt them. Don't you dare suggest that it is therefore their fault if they become ill. Especially when you have offered no evidence whatsoever that such a diet will "maintain vitality and preventing illness".
Really? Odd, then, that you've presented no facts whatsoever.
And before I get called out on it: I realize there is a lot of really good published scientific research that shows that diet has a significant role in preventing or reversing some forms of heart disease, some forms of diabetes, hypertension, and several other chronic disorders. I just wonder how Neil knows, since he doesn't trust that kind of research. I also wonder what he means by "most of the time" and "most" in regards to diet reversing chronic diseases.
I have trouble understanding how people in the past managed to die much younger than people today yet they were apparently healthier. What kind of "health" leads to an early death?
Yay, a diet woo troll! Let me guess - when you break wind it smells like spring breezes, because your food is so CLEAANNNNN...
BTW, as noted above @87, mainstream doctors are well aware of the preventative effects of a healthy diet for certain conditions. Your error is in thinking that the more restricted your diet is, the greater the protective effect. That's just magical thinking. If you prefer a vegan diet that's your choice, but it's not going to cure you of anything.
There is a certain irony in a necromancing commenter on a post about fake health myths repeating real health myths.
There was no Golden Age in the past when everyone lived a healthy long life free of disease. There is no remote tribe of people who eat a perfect diet, drink the perfect water and routinely live disease-free into their hundreds. There is no diet and lifestyle that will guarantee you perfect health and protection from disease. Doctors are taught about nutrition and lifestyle, and many of them spend a lot of time nagging their patients to eat healthily, get more exercise, quit smoking and otherwise improve their lifestyles. Much of modern medicine is about prevention. Diet, exercise and medication to prevent heart disease is a major part of modern primary care. Management of diabetes is about preventing serious future health problems, asthma management is about preventing hospitalization and death. I could go on and on.
The myth of a healthier past doesn't bear up well under the scrutiny of history. Yes, some people lived in good health to ripe old ages going back at least as far as Ancient Greece... but you had to be healthy to make it that far. Those less healthy died young, of illnesses modern medicine can now treat or prevent, or in infancy all-too-often. Today we see infant mortality measured in single-digits (or low double-digits) per 100 000; historically it rose as high as 1 in 3, roughly a thousand times higher than today, and that very much includes pre-industrial and pre-civilized societies. (For instance, many cultures in the past did not name children at birth given the mortality rate... instead the name was granted later, once one could be reasonably sure the child would survive. I suspect that this got co-opted into Christianity's celebration of christening and baptising of infants.)
Frankly, the "healthy ancestors" myth is perpetuated by laughably bad research combined with the much lower contemporary expectations of writers of historical documents about what constituted "good health" than what is expected today, liberally spiced with nostalgia and wistful thinking. It's not a good basis for making lifestyle or clinical decisions.
-- Steve
'Well, you tell me? How many medical journal articles etc are not funded by pharmaceutical companies etc? I wouldn't read them because I don't trust them. I read independent research and those who actually 'walk the talk' in their field and have something to offer via 'real practice beyond the theory''
Neil - so, let me get this straight. Because mainstream scientific research is all so biased and unreliable; if you wanted to assess the effectiveness of, say, bloodletting as a medicinal treatment, you would look for research conducted by a practicing blood letter? Sure, that'll stop you being mislead by bias.
Anton P. Nym:
I have in my possession a copy of a genealogical book of an ancestor of mine that came from England and was one of the founders of Sudbury, MA in the 1600s. It was published in the mid 1920s, and actually has my grandfather listed, and mostly goes back down paternal lines.
What is interesting is that while all but one of my grandfather's paternal grandparents lived to age 80, there were lots of others listed that were very short lived. Many of the entries are from family bibles, obituaries, tombstones, so there are occasionally lists of names with just a birth and death year. There are many that were very short lived. And in addition there were lists of children names where where the names are repeated, evidence that a younger child was named the same as a diseased sibling.
How many medical journal articles etc are not funded by pharmaceutical companies etc? I wouldn't read them because I don't trust them.
I guess you'll never learn the answer to your question, then.
I do respect your comments and I have learnt some things out of this which is great, seriously!
A lot of you are getting carried away with the healthy ancestor subject, I have thrown you off track.
M.Obrien - Can I site any evidence of prosecutions? Yes, but I will not name anyone on here, I am not comfortable. You can do some homework if interested.
I value Dr William Howard Hay from the early 1900's, who suffered Brights disease, and had to move beyond orthodox medicine to rid himself of his disease. He did. There are several others who have made a difference along the way. I think today Dr Andrew Weil is making a difference and plenty of others moving into Integrative medicine who aren't as brainwashed.
Calli Arcale - thank you. I like Part A but Part B suggests that you think it is not possible for a human to be well without the need of a specialist by their side. I have no family Doctor, but I have the names of those who I trust and know well.
This is a massive problem now that too many people have no confidence in their own health anymore and have handed their souls over to the gods. I have no problems, my defences are in place, and I know many of you will think that is unrealistic. It is not just what you eat but also your mind. If you think you are, you are; if you think you can, you can; if you think you won't, you won't. Good health is 100% spiritual, 100% Physical, 100% Mind etc.
Calli - In the part of the world where I live organic food is not as expensive as the USA, which is a part of the reason why the USA is stuffed - a burger, chips and coke is affordable whilst healthy food is not. However where I live, there are many people who say it is too expensive, but they are people who make wonderful excuses, any excuse to be more disciplined to live a healthier life because it takes more effort to do so AND oddly enough, some people enjoy the attention of being sick.
Edith Prickley - I will out-live you and out-energise you and yes, out -FART you, a good sign of colon health.
Krebiozen - Of course there are no guarantees but we can eliminate what we know are the identified risk factors to give ourselves the best possible chance.
Smokers can live to 100, as in Jean Calment from France who died at 122, gave up smoking at 117. Every person has their own electro-chemical make up and it should up to every person to be 'their own Doctor', but we know this is not the case. The chances of me getting a chronic degenerative disease is extremely remote - believe it or not, and I am confident of living way beyond the average not only in years, but in quality of life! I have already accrued around 25 bonus years when compared to the 'norm' which is a terrible statistic, but it is an average, even though life expectancy is an anomaly.
Kate - understanding Modern Medical Science and access to medical Journals is not required at all to achieving a life of healthy longevity. It hasn't been required up until now.
Can anyone name me a community or a section of people who are living the longest in the USA?