Evolutionary selection on alternative medicine

(Orac note: I was away at Skepticon over the weekend, where I gave a talk entitled The Central Dogma of Alternative Medicine. (When the talk’s up on YouTube, I’ll provide a link, of course.) Because of all the fun and travel delays I didn’t get a chance to turn my slides and notes into a blog post yet. Also, I’m on vacation this week. However, this gives me the opportunity to resurrect a blog post from 2007, because I think the concept is interesting. I even use it in a slide that shows up in many of my talks (above). I’ve updated dead links and added some text to include relevant links to post written since. Enjoy, and I’ll definitely be back next tomorrow with original content. Besides, if you haven’t been reading since 2007, it’s new to you!)

I wish I had thought of this one, but I didn’t. However, I never let a little thing like not having thought of an idea first to stop me from discussing it (even if Steve Novella’s also discussed it), and this particular idea is definitely worth expanding upon because (1) it’s interesting and (2) it combines two of my interests, alternative medicine and evolution. I agree with parts of the idea, but it’s not without its shortcomings. Indeed, I’d very much welcome any of the evolutionary biologists who read this blog to chime in with their own ideas.

A colleague of mine, Martin Rundkvist over at Aardvarchaeology, has proposed a rather fascinating idea regarding the evolution of alternative medicine in which he argues that alternative medicine evolves according to certain selective pressures. As you may or may not know, evolution is not just for biology, but has been proposed as a mechanism in cultural memes, for example. Since alternative medicine is a cultural phenomenon, it is not unreasonable to look at such non-evidence-based medicine and hypothesize what might be the selective pressures that shape its popularity and evolution. After all, if we’re going to discourage the use of non-evidence-based medicine or even quackery, it’s helpful to understand it. We already know that alt-med terminology has evolved considerably into the current preferred term, “integrative medicine.”

Martin primarily considers what the selective pressures are on various alternative medicine modalities and comes to a startling conclusion: Namely, that the selective pressure on such modalities is primarily to select for ineffective treatments. He bases this on two primary forms of negative selection. First, he hypothesizes, there will be selective pressure against modalities that cause obvious harm. According to this concept, such modalities will tend to be eventually recognized as harmful and shied away from by alternative medical practitioners due to fear of lawsuits and government regulations. The second form of selective pressure will come from conventional medicine. In essence, alternative medical therapies that can be shown to have a reasonable degree of efficacy will risk being co-opted by us “conventional” practitioners of evidence-based medicine and thus taken out of the armamentarium of alternative practitioners, whose setting themselves apart from mainstream medicine is very important to their livelihood. This leads Martin to observe that homeopathy is the ultimate CAM therapy:

So, there is evolutionary pressure on alternative therapies to achieve near-zero effect. This is why homeopathy is still around: its main method being the administration to patients of small amounts of clean water, it’s uniquely suited to surviving indefinitely in the alternative-therapy biotope. Homeopathic remedies can neither harm nor benefit patients.

This is a fascinating and lucid insight. Clearly it has some merit. However, it is incomplete. The reason, I would argue, is that the negative selective pressures Martin identified are almost certainly not as potent as he thinks they are, as evidenced by how rare it is for an alternative medical therapy to actually go “extinct.” Indeed, I would argue that selection against harmful or potentially harmful remedies is actually fairly weak and perhaps even nonexistent. After all, black salve is still around after many decades, if not hundreds of years, and it can produce some truly horrifying complications (not for the squeamish). Even though the FDA banned importation of black salve products and they can be demonstrably harmful, they are still around and show no sign of disappearing. Another example is Laetrile. Multiple well-designed clinical trials demonstrated that Laetrile is ineffective against cancer, and it has the well-known potential complication of cyanide toxicity. It, too, shows no signs of disappearing. Of course, perhaps the most popular ineffective CAM therapy that has potentially deadly complications is chelation therapy, which remains widely used among CAM practitioners to treat cardiovascular disease and autism, despite of the extreme biological implausibility of the argument that it should work for either condition and despite there being no good evidence that it does. Indeed, back in 2006 there was even a well-publicized case of an autistic boy who died as a result of hypocalcemia as a result of chelation therapy for autism causing a fatal cardiac arrhythmia.

No, there are lots of potentially harmful CAM modalities out there that show no signs of going away.

Let’s look at the flip side of the negative selection, co-optation of “effective” alternative therapies into mainstream medicine. Once again, this is probably a weaker negative selective force than it might seem. Herbal medicines, for example, are probably the most common of the CAM-type modalities to show some evidence of efficacy in randomized clinical trials. This is mainly because they are drugs. Impure and dirty drugs with widely varying levels of active ingredient from lot to lot, but drugs nonetheless. The problem for the co-optation of these drugs by conventional medicine is that practitioners of scientific medicine do not like unpredictability in their drugs. They like drugs with a predictable effect; herbal medicines “in the raw,” so to speak, do not fit the bill, particularly when pure pharmaceutical alternatives that lack the contamination and unpredictability of herbs exist. Even if conventional medicine co-opts an herb, for example, it is usually in the form of the pure active ingredient purified from that herb. For example, if you have breast cancer, you could try to chew on the bark of the Pacific Yew tree for its anticancer properties, but you’d be a whole lot more likely to do better if you took pure Taxol derived from that bark–and took it intravenously. The example of Taxol also suggests that once conventional medicine co-opts an herbal or plant-based remedy, it usually does not supplant the original alternative therapy. After all, all of the “natural goodness” has been extracted from it during the purficiation of the active ingredient! CAM mavens would often rather take the raw herb or the herb chopped up and compressed into an herbal pill because it’s more “natural.”

As for other non-herbal CAM therapies, even when they’re co-opted by modern medicine (although it’s often arguable whether conventional medicine or CAM did the co-opting), often an “alternative” version remains. The scientific version will be stripped of all the woo, while the “alternative” version will retain it. Think massage therapy and perhaps even chiropractic, which, as I’ve said before, stripped of its woo is nothing more than physical therapy with delusions of grandeur in the form of claims of being able to cure all manner of illnesses that have nothing to do with the spine or the musculoskeletal system.

Finally, there is one last aspect of Martin’s concept that argues against it. Martin states:

Evidence-based medicine, alternative medicine and weaponry change through time because of selection pressure. This means that they evolve and produce a fossil record of discontinued methods and therapies.

Here’s the problem: There actually is no “fossil record” of discontinued CAM methods and therapies. The reason is simple: CAM does not abandon its methods, regardless of evidence and, to a large degree, regardless of harm. Yes, individual treatment modalities may wax and wane in popularity, but they never go away completely. They never go extinct. Think about it a bit. Can you think of a single “alternative medicine” treatment modality that’s ever been completely abandoned because it either doesn’t work, is too harmful, or has been co-opted by conventional medicine. I can’t. CAM is, in the words of James Randi, an “unsinkable rubber duck.” It just won’t disappear. Martin is quite correct that homeopathy, for example, has persisted 200 years despite no evidence for its efficacy. Aryuvedic medicine has persisted at least a couple of millennia, despite a similar lack of evidence. Ditto most of traditional Chinese medicine, whose real history has been conveniently retconned over the last several decades, making it more popular even outside of China than it’s ever been. Never mind that these systems were developed in a time when very little was known about how the body actually works and are infused with spiritual and religious beliefs. They are still used my many millions, if not billions, of people worldwide. They have left no “fossils.” Of course, as in evolution in biology, this selection, applied over long periods of time, may ultimately eliminate such modalities, but if I were somehow able to call the Doctor to give me a ride in his TARDIS a couple of hundred years in the future, I bet that virtually all of these CAM modalities would still be in use. Part of the reason, I suspect, is that, as Martin pointed out, most CAM modalities do little; there is usually no CAM modality that can supplant existing modalities.

In any discussion of the evolution of CAM, I would be remiss not to look at its primary competition for resources (i.e., patients) in the ecosystem of medicine, namely scientific, evidence-based medicine. EBM has been hugely successful in many areas. Indeed, it can be said to have driven back CAM to a much smaller “ecological” niche than it once occupied. These days, relatively few people rely on CAM modalities when faced with a truly life-threatening illness, such as cancer. The Katie Werneckes, Abraham Cherrixes, and the Chad Jessops of the world (if the latter even had cancer), who treat life threatening cancers with high dose vitamin C, the Hoxsey concoction, or nasty, burning goo like the infamous “black salve,” respectively, are pretty uncommon. The main ecological niches for CAM these days have contracted to two areas. First are “diseases of living.” In other words, CAM has been for the most part relegated to the treatment of what are generally vague complaints that are not exactly diseases or to self-limited conditions. Indeed, one could argue that the strongest positive selective pressure for CAM modalities is how well each one gives the appearance of doing something therapeutic for such conditions, whether it actually does anything or not. In other words, how good of a placebo is it? Or is its timing or method of administration optimally adapted to correlate with the patient’s improvement anyway, allowing the confusion of correlation with causation? The better the adaptation, the more likely a CAM modality will thrive and expand.

The other remaining ecological niche for CAM, I would argue, is in serious diseases for which conventional medicine does not have much to offer. These conditions include diseases such as terminal cancer that has passed beyond our ability to treat it, as well as any manner of chronic diseases for which conventional medicine does not have a cure, such as Parkinson’s disease, chronic pain syndromes, multiple sclerosis, etc. Conventional medicine can treat and often palliate such conditions, but it cannot cure them. In this latter niche, I would argue that the primary positive selective pressure would be how well the CAM modality can inspire belief in its practitioners and hope in its users. The two are related, of course; the more the practitioner believes in the modality the more he or she can sell the patient on it.

Of course, applying evolutionary principles to CAM only goes so far. It’s a highly complex situation, and there are a number of positive and negative selection pressures that one could postulate. Certainly, the marketplace and how much of a feel-good aspect there is to CAM therapies are important. Finally, no doubt, like evolution, there are aspects to CAM proliferation that do not depend upon selection, a CAM equivalent of genetic drift, for example. Indeed, there was a fascinating paper five years ago why quackery persists which argues for a similar hypothesis of selection for more ineffective therapies but also added a twist: That even in self-medicating or use of alternative medicine effective remedies can can be lost due to stochasticity, in other words, due to random chance. Indeed, the authors point out that most highly efficacious innovations would be predicted to be lost due to stochasticity. Indeed, my reading of this study would suggest that one reason why highly effective treatments actually do persist in our society is because scientists, physicians, and science-based medicine validate what treatments are efficacious, retaining the treatments that are and trying (but not always succeeding) in discarding the ones that aren’t. For people self-medicating, such a mechanism is not operative.

Since were using evolutionary principles now, one might also look at CAM this way with respect to its “competitors.” Perhaps CAM is adopting an evolutionary strategy not unlike that of dogs or cats. In other words, it was subsuming itself to its more successful competitor, conventional medicine, in much the same way that ancient wolves were domesticated by humans and ultimately started to speciate into dogs. The problem with that analogy, of course, is that both human and dog gain benefits from their relationship. Humans gain companionship and work from dogs; dogs gain protection and a reliable source of food and shelter. It could be argued which species gains more, human or dog (probably humans early on and dogs now), but there is little doubt that both species benefit. So, in the relationship between CAM and conventional, who benefits?

The answer is obvious: CAM. Scientific medicine does not need CAM, but these days CAM appears to need scientific medicine. Indeed, the very name CAM was adopted to allow alternative medicine to seem more palatable to practitioners of conventional medicine and ease its ability to insinuate itself into academic medicine, which, as I’ve documented extensively, is having increasing success in doing so, even to the point of finding its way into the curriculum of various medical schools.

What this tells me is that we’re looking at a “speciation” event in alternative medicine. There is a strain of alternative medicine that fits in with the whole movement towards CAM in medical schools, and there is a strain of alternative medicine that does not. Now here’s where Martin’s idea of selective pressures favoring placeboes in alternative medicine comes in. The strain of alternative medicine that either excessively credulous or cynical academicians embrace falls under exactly the sort of selection pressure that Martin discussed that favors minimal effects. The reason is simple. The two most common justifications used for including CAM in academic medical centers are (1) the patients want it and (2) the perception among academic physicians that it won’t do any harm anyway and seems to make patients feel better. Consequently, the most common varieties of CAM in such settings are massage therapy, meditation, acupuncture, yoga, and nutrition-based therapies. Oddly enough, arguing against Martin’s idea is that seldom will you see homeopathy in academic medical centers, at least in the U.S. I speculate that that is because in such settings, there is also a negative selective pressure against extreme scientific implausibility–at least upon the initial incursion. On the other hand, perhaps it’s just an odd quirk of history, culture, or whatever that makes homeopathy use less common in the US. After all, reiki is just as ridiculous as homeopathy, if not more so (my talk this weekend prominently featured reiki, for instance), but it’s everywhere these days in academic and community medical centers.

So what term best describes the relationship between CAM and academic medicine? Certainly CAM advocates would argue that it’s a symbiotic relationship. I would counter that it’s a parasitic relationship, and here’s why. Parasitism is defined as a relationship where one organism benefits and the other is harmed. CAM is indeed parasitic. It benefits from its association with academic scientific medicine by obtaining a level of plausibility and respectability that it could never obtain on its own, while it arguably harms academic medicine in the process. True evidence-based medicine is what academic medical centers are ostensibly built to promote, applying the scientific method to medical therapies in order to find more effective treatments. What academic medical centers should be doing is to educate the new generation of physicians in the scientific method, to better prepare them to be able to evaluate claims for treatment, whether they come from conventional medicine or elsewhere. This is how medicine has advanced so rapidly over the last 60 years. Blurring the line between science and non-science, evidence-based medicine and woo, through the enthusiastic promotion of CAM in medical school curricula, harms that endeavor, both by degrading the ability of physicians to think critically (thus preparing them to accept even more implausible treatments) and by wasting money and resources to study obviously highly implausible gobbledygook before there’s any good evidence that it does anything at all beyond the placebo effect that could be better used to study more promising science-based modalities. It would be one thing if CAM were being studied from a truly scientific perspective. I don’t object to that; indeed, I encourage it. A true scientific examination of the vast majority of CAM will likely find it useless, while a few gems might be pulled out of the dirt. Unfortunately, though, as I’ve mentioned before, that’s not what usually happens. What almost invariably happens is that CAM is used as a marketing tool.

Although I often disagreed with him (mainly politics) Panda Bear, MD (whose blog seems to have been hacked and has become a spam site) gets it right in describing this parasitic relationship:

Suppose I were to actually build a house. Along with a foundation it would require framing of the walls and floors, siding, wiring, glazing, plumbing and a dozen other skilled trades coordinating their efforts. The practioners of Complementary and Alternative Medicine would be like your Aunt Mildred telling you how to hang the toilet paper in the finished bathrooms and then trying to claim credit as an essential part in the construction. Complementary and alternative medicine only exists because real medicine does all of the heavy lifting leaving a risk-free enviroment in which it may ply its patent remedies. At best it’s an afterthought, something that legitimate hospitals add to their services to attract the kook money. At worst it’s a cynical ploy to fleece a little extra from the desperate, many of whom are dying and will gladly pay for another straw to grasp. In no way is it an essential part of medical therapy except that it provides entertainment to the patients and their families while medicine and nature run their courses.

He’s not quite right, at least now. These days, CAM is like Aunt Mildred claiming that the house was built by magic.

Conventional medicine fights the real battles and faces the real danger of failure, while increasingly CAM attaches itself to conventional medicine, much as the parasitic roundworm Ascaris lumbricoide finds its way into the small intestine of its host. CAM benefits from its association, but its host, conventional medicine, most definitely does not. At best it is not harmed; at worst, grave harm to scientific medicine becomes possible.

All this speculation leads me to believe that the form of CAM that increasingly thrives in academic medical centers is indeed developing into a new “species” of woo, so to speak. It’s wraps itself in scientific-sounding terminology and, for the most part, discards the more outrageously silly religious and supernatural elements that it can, all in order to become seemingly inoffensive enough that academic physicians, although they may not approve of it, remain insufficiently sufficiently alarmed by it to rise up and purge the system of this parasite. Meanwhile, the parasite grows in number and strength, continually weakening the body of academic medicine the longer it stays. Eventually, like the roundworm, it spreads its eggs where more and more academic medical centers can pick it up until it is so entrenched and self-perpetuating that it can’t be dislodged without resulting in severe injury or death to the host.

Comments

  1. #1 Eric Lund
    November 24, 2014

    You are right that alt-med techniques rarely if ever die out. I’d like to think that people don’t use leeches for bloodletting anymore, but I wouldn’t put money on that view, and it’s even more likely that bloodletting by other means occurs. And then there’s MMS, also known as bleach. How does anybody with a microgram of sense think for even a millisecond that this might be a good idea? (I have heard some people, only half in jest, urge Obama to take a stand against drinking bleach, but that’s because the people who might be thus incited to drink bleach are suspected of lacking that microgram of sense.)

    Oddly enough, science- and evidence-based medicine do evolve. The guy who invented the lobotomy got a Nobel Prize for his efforts. Since then, the lobotomy has been found to do more harm than good, so surgeons don’t perform lobotomies anymore. I could come up with about a dozen more examples without too much effort, and I don’t have a background in medicine.

  2. #2 Denice Walter
    November 24, 2014

    Well, that makes sense – inefficacy is selected to perpetuate ineffectiveness.

    Peripherally related ( evolution and woo):
    the other day I heard a guy present about how changing diet transformed how hominids- humans appeared facially- when they began eating meat- especially *cooked* meat- they no longer required powerful musculature/ bonier skulls to facilitate chewing; also they spent less time chewing- freeing uptime for more sophisticated activities. The streamlined face was more suitable for subtle expression and recognition.

    So sorry, vegans/ vegetarians: meat helped advance human development. Lots more too but I can’t go into it here.

  3. #3 Panacea
    November 24, 2014

    CAM is working its way into nursing education as well. It’s part of the Concept Based Curriculum in North Carolina. It’s only taught in one course, which at my school happens to be MY course. I’ve ignored it. I don’t teach it, and I don’t test on it.

    That’s been a mistake. Last semester, one of my students did a presentation on a quack diagnosis as if it were a real medical diagnosis. It created quite a mess.

    So I added a discussion of pseudoscience to an APA power point I made, which helped a bit with the following class. But in the semester I’m just finishing up, I had another student propose a presentation based on quackery. I had to tell her no.

    I’m going to have to take CAM by the horns and actually explain to students what it is, and why it really can’t be considered medicine. It’s bound to be controversial.

  4. #4 Andreas Johansson
    November 24, 2014

    @Denice Walter:

    A related idea is that a meat-rich diet left our ancestors with enough energy to grow big brains, neural tissue being very expensive energetically.

    (There should be a fad “diet” about literally thinking the fat away. Unfortunately it doesn’t work that way – your brain burns about as unreasonably much energy irrespectively of how hard you think.)

  5. #5 Denice Walter
    November 24, 2014

    @ Andreas Johansson:

    That was discussed as well.

    It never fails to amuse me how alties continuously advocate meatless/ vegan diets as being more *advanced* and *natural* not to mention, more ethical and less contributory towards AGW. Supposedly, becoming vegan will save the earth and halt the rising seas ( see PRN).

  6. #6 palindrom
    November 24, 2014

    Eric @1 – I seem to remember that there are a few modern uses for leeches when excess blood needs to be drained from an extremity. This NY Times article starts with an anecdote about a homeopathic drugstore in Germany that sells leeches, but then gives instances of more legit uses.

  7. #7 Eric Lund
    November 24, 2014

    meatless/ vegan diets as being … less contributory towards AGW

    That one actually does have some basis in reality. To raise meat, you have to provide your livestock with food, much of which could otherwise feed people. And of course the conversion is less than 100% efficient, so you need more agricultural land (and therefore less forested land) to provide a given amount of calories, as well as additional costs (and carbon) to transport livestock feed. The worst offender in this regard is grass-fed beef (with feedlot beef a close second, only because you are concentrating the cattle in one location, reducing transportation costs and allowing forests to grow on what would otherwise be pasture land). Cattle also produce a fair amount of methane as a byproduct, which is an additional contributor to global warming. Pork and chicken aren’t nearly as bad; the cost isn’t zero, but at least it is low enough that you can make the case for using these animals as protein sources (especially if you use all of the animal, as, e.g., Cantonese cuisine does with chicken).

    Ethics is another matter. I can understand people being squeamish about factory farming; I would definitely prefer not to live the life of a feedlot animal. And some religions (particularly certain forms of Buddhism and Hinduism) require their adherents to follow vegetarian or vegan lifestyles. More “advanced” or “natural”? Definitely not compared to being an omnivore.

  8. #8 BA
    Quacklandia
    November 24, 2014

    Such zombie-like qualities are not limited to “medical” treatments. I frequently encounter children (mostly) with autism being placed on facilitated communication systems when the overwhelming evidence base (dating back into the early 1990s) showing that facilitators control the communicative content. If only this zombie would take the stake to the heart/silver bullet/pure water through the remains that empirical evidence provides and finally die, then more kids with communicative impairment would be better served.

  9. #9 herr doktor bimler
    November 24, 2014

    The streamlined face was more suitable for subtle expression and recognition.

    I call shenanigans, and suspect that your informant was telling Just-So stories. I cannot see how having smaller masseter muscles has any effect on how we contort our facial integument to send emotion messages.
    Is the idea that with larger masseters for raw-food chewing, we would be less able to make those facial twitches, or be restricted to a smaller gamut of expressions? If that were so then we’d just evolve more sensitivity to those twitches we *could* make.

  10. #10 Denice Walter
    November 24, 2014

    @ Eric Lund:

    I know about the feasible part ( raising animals uses more resources etc) HOWEVER…
    what isn’t feasible or very likely is getting hundreds of millions of meat eaters to drastically change their diets to or towards veganism in short order.
    YET that’s what I’m told is the next new thing and youngsters will lead the way. Expect films, articles, marches, protests and facebook/ twitter extravaganzas soon.

  11. #11 Narad
    November 24, 2014

    The worst offender in this regard is grass-fed beef (with feedlot beef a close second, only because you are concentrating the cattle in one location, reducing transportation costs and allowing forests to grow on what would otherwise be pasture land).

    All cattle are grass-fed; they still have to be transported to the feedlot for finishing. It’s also thoroughly unclear to me that the bulk of the acreage used for grazing would turn into woodlands were there no cattle around.

    CAFOs themselves have come up before.

  12. #12 Denice Walter
    November 24, 2014

    @ herr doctor:

    Altho’ I’m not at liberty to disclose my source ( thus near locus) , let’s just say that he represented a major internationally recognized museum and research facility in the natural sciences ( paleo, anthro, bio etc) _ you’ve heard of them.

  13. #13 herr doktor bimler
    November 24, 2014

    he represented a major internationally recognized museum and research facility in the natural sciences

    Alas, that is not incompatible with telling Just-So stories.

  14. #14 Kiiri
    November 24, 2014

    Denice Walter – I doubt the youth will lead the charge at least in great numbers. For example, my 17 year old nephew announced about 6 months ago that he was going to be a vegetarian now. My sister freaked out about it, I told her not to worry so much. Sure enough, after subsisting on a diet of mostly cheese pizza, macaroni and cheese, and peanut butter he quietly started eating everything he had eaten before. I have seen many children of that age decide to go vegetarian and switch back once the dietary restrictions really begin to add up. I have no problem with vegetarians or vegans but the commitment to stay with that diet and to actually be healthy is a real commitment. All of the vegetarians/vegans I have met spend a lot of time shopping for food (and it’s all deeply expensive), preparing their own food, and being very careful while eating out. They also almost always have a handful of restaurants that are suitable for them to eat out at (if they are lucky and in a fairly large urban or suburban area) and insist on those places exclusively. It puts a crimp in the socialization of Americans over food. I also personally detest most vegan cuisine, which attempts to substitute certain animal derived ingredients. Its mostly just nasty. I have embraced my own hypocrisy with meat, if I had to kill it I would be a vegetarian. But because it comes wrapped in plastic at the store I am good with eating it. I know its hypocritical but I like meat. I just can’t bring myself to actually kill anything. If I were vegetarian I would definitely never give up cheese, eggs, or butter. they make life worth living.

  15. #15 Denice Walter
    November 24, 2014

    @ Kiiri:

    I include the tale for the hilarity factor.

  16. #16 Tim
    November 24, 2014

    @Eric Lund #1

    You are right that alt-med techniques rarely if ever die out. I’d like to think that people don’t use leeches for bloodletting anymore

    Well, not so much for ‘bloodletting’ but they’re great for stopping a ‘black eye’:

    Maggots and leeches are so effective that the FDA last year classified them as the first live medical devices

    http://livescience.com/203-maggots-leeches-medicine.html

    Widespread antibiotic resistance, however, rekindled interest in the use of medical maggots, and in 2004 the fda approved them as a valid “medical device.” Today maggot providers raise the larvae from sterilized fly eggs and place them in tea bag–like packages that physicians apply directly to wounds.

    http://www.scientificamerican.com/article/news-science-shows-how-maggots-heal-wounds/

  17. #17 Arcanyn
    November 24, 2014

    One form of quackery which I think it is pretty safe to say has died out is the radium cures which were popular in the 1920s. The notion of radioactivity as a miraculous natural cure has pretty much completely given way to the opposite extreme; namely that anything even slightly radioactive is apocalyptically scary, far more so than vastly more dangerous non-radioactive things. As such quacks these days will scare-monger about radioactivity and offer bogus cures against it, rather than promote radioactivity as a cure.

  18. #18 palindrom
    November 24, 2014

    Arcanyn @16 — A-yup.

    High levels of radioactivity are certainly not good for you, but somehow I don’t think the west coast is doomed because there’s a just-detectable level of Fukushima cesium-137 has finally turned up in the Pacific off California.

  19. #19 Helianthus
    November 25, 2014

    @ Narad

    It’s also thoroughly unclear to me that the bulk of the acreage used for grazing would turn into woodlands were there no cattle around.

    Some website I read pointed out that cattle is much more efficient than us omnivore at extracting food from grass and other plants (in short, we don’t digest cellulose, but they do).
    So while going vegetarian will cut the middlebeef, we will have to replace the culture of cattle food by more edible vegetables, so we may not save as much as we think.

  20. #20 ProgJohn
    UK
    November 25, 2014

    @Narad: Feedlot cattle are fed on grain, not grass, while they are there. They may eat grass before being sent to the lot but I suspect that forms a very small part of their lifetime diet.
    @Tim: The uses of leeches and maggots described appear to be part of EBM, not CAM, so are not evidence that leeches remain a CAM modality.
    @Helianthus: The climate in the west of the UK is too wet to be suitable for most arable crops so land used for rearing animals on grass cannot be transferred to creating vegetarian or vegan foods. It is in that scenario that ruminants ability to digest grass comes into its own.

  21. #21 squirrelelite
    November 25, 2014

    @arcanym (16),

    Radium cures are no longer touted, but the nutritional healing crowd can conveniently ignore it when it’s convenient.

    For instance, lists of healthy nuts like this one often include Brazil nuts for the cancer fighting power of selenium.

    http://www.everydayhealth.com/diet-and-nutrition/0406/why-you-should-go-nuts-for-nuts.aspx#06

    But, they don’t bother to mention that Brazil nuts have the highest concentration of radium of any nut.

    Radium Content

    As might be expected, the reported concentration of Ra-226 and Ra-228 vary, but overall, the radium concentrations in Brazil nuts are 1000 times higher than those in other foods. The following are representative of some of the measurements that have been performed:

    Turner et al (1958): approximately 1.8 pCi/g Ra-226.

    Penna-Franca (1959): approximately 2 pCi/g Ra-228

    Penna-Franca et al (1968):

    0.075-3.6 pCi/g Ra-226 in the nut (3.1-113.5 pCi/g in ash of nut)

    0.16- 3.6 pCi/g Ra-228 in the nut (5.3-114.5 pCi/g in ash of nut)

    Smith (1971): up to 6.6 pCi/g Ra-226 in the nut.

    Gabay and Sax (1969) determined that most of the radium of ingested Brazil nuts was not retained by the body.

    @Helianthus and ProgJohn,
    For information about feedlots from the cattleman’s mouth, I found this.

    http://www.beefusa.org/uDocs/Feedlot%20finishing%20fact%20sheet%20FINAL_4%2026%2006.pdf

    My experience driving by feedlots in western Texas suggests that their odor mitigation strategies are only marginally effective. And, as I recall from my side glances from the moving car, there is a fair amount of hay added to the grain in the diet.

    I had a short job many years ago loading hay that was harvested from grasslands around our city lake and delivering it to a big feedlot in Wichita, Kansas. The city has stopped doing this and now lets the grass grow as a habitat for wildlife.

  22. #22 ProgJohn
    UK
    November 25, 2014

    @Narad & @squirrelelite: I was wrong about overall mix of grain to grass. The doc squirrelelite linked to is interesting, although is clearly written mainly from a PR perspective and needs to bead with several grains of salt.

  23. #23 ProgJohn
    November 25, 2014

    #21 make that “… read with several grains of salt”.

  24. #24 Quark
    November 25, 2014

    This a fun post to read.
    But I would say that the main factor of alt med selection is : money making. If it doesn’t sell the practice is lost, that’s all you need to know. And it’s true for a whole lot of thing…

    By the way, to add to the speculation, if i remember, evolution state that mutation are random and then selection occur, I would not say that alt med are designed at random. Usually they come from false/biased observation or from ancestral practice. So, from wrong people into full Dunning-Kruger which then develop a very strong cognitive dissonance to protect themself. You can add to this the fear mongering around pharma and you got a strong cocktail.
    Other people know that alt med are bogus, but know there is money, so it’s not random too, it’s truely calculated (they are the worse, the pure quack).

  25. #25 Krebiozen
    November 25, 2014

    Arcanyn,

    One form of quackery which I think it is pretty safe to say has died out is the radium cures which were popular in the 1920s.

    Nope, it’s still with us, with these people offering ‘healing’ radioactive stones and mud, and radon spas offering people the opportunity to expose themselves to ‘healing’ radiation.

  26. #26 Jenora Feuer
    November 25, 2014

    Re: Bloodletting
    My grandfather had haemochromatosis, which is one of the few conditions for which bloodletting is actually still the scientifically indicated treatment; especially during the early stages when you need to bring the blood iron levels down to safe ranges quickly. My grandfather was having a pint of blood removed a week for a while.

    Re: Radiation
    Aren’t bananas actually one of the more radioactive foods out there, due to their high potassium content?

    Hmm… according to http://en.wikipedia.org/wiki/Banana_equivalent_dose Brazil nuts tend to be fairly high in potassium-40 as well as radium.

  27. #27 Mephistopheles O'Brien
    November 25, 2014

    Radon spas? And to think that people around here pay good money to get radon pumped out of their basements. Apparently we don’t see the opportunities just beneath our feet.

  28. #28 Renate
    November 25, 2014

    @ Krebiozen and MOB
    In June we were in Bad Kreuznach, which is also famous for its radon spa and also for other ‘therapies’:
    http://www.bad-kreuznach-tourist.de/spa-breaks/
    Our guide took us to the Saltwork Valley, where he lectured us about the dangers of ordinary kitchensalt, wich according to him contained all kinds of dangerous stuff.
    I tended to take his words with more than a grain of salt.

  29. #29 Mephistopheles O'Brien
    November 25, 2014

    Renate – It’s true – table salt is made of a poison gas and a flammable metal. It’s surprising that it doesn’t spontaneously combust and isn’t sold in a pressure container.

    I plan to name my next dog “Kreuznach”. However, he will be a good dog.

  30. #30 Narad
    November 25, 2014

    And, as I recall from my side glances from the moving car, there is a fair amount of hay added to the grain in the diet.

    Right; you can’t feed cattle exclusively grain without (usually corn, I think) silage. It’s been a while since I’ve looked at this – the CAFO link above, specifically.

  31. #31 Denice Walter
    November 25, 2014

    @ Renate:

    Oh, I know about the salt thing ( and we’ve discussed it here); some woo-meisters tout Himalayan pink salt and its multiple magical minerals included some radioactive ones in minute doses. One of my gentlemen insists upon Celtic salt but is otherwise not too woo-entranced. I actually have some here from Espana.

  32. #32 Narad
    November 25, 2014

    The doc squirrelelite linked to is interesting, although is clearly written mainly from a PR perspective and needs to bead with several grains of salt.

    There are both calf and yearling feedlot approaches, but this at least suggests that longer grazing times are more economical.

  33. #33 Mrs Woo
    chilly Missouri
    November 25, 2014

    Cows, horses, goats… all need lots of roughage with any grain or their intestines can twist. Mr Woo and his family farm cattle, and we in our own little subgroup have accidentally accumulated three and a half (probably shouldn’t count that foal… chickens hatching and all) registered Arabians. A big deal is being sure to move plenty of round bales to our little place from the big place before snow gets too bad.

  34. #34 Mrs Woo
    November 25, 2014

    I have been told grass fed beef are preferable from a health perspective, but not as appealing in regards to taste and tenderness. Say the people growing them.

  35. #35 Mrs Woo
    November 25, 2014

    @Denice – I almost bought some pink salt at Aldi the other day, but then reason exceeded curiosity, and I put it back.

  36. #36 Narad
    November 25, 2014

    I have been told grass fed beef are preferable from a health perspective, but not as appealing in regards to taste and tenderness

    I have more experience with heritage turkey breeds, which also require adjusting one’s cooking approach but have proved to be outstanding for me. With grass-finished beef, you’re basically looking at muscle that is less marbled. Roasts are going to benefit from long, low-heat cooking (as well as braising, of course), and steaks are going to have to be cooked very quickly. It’s not as though cattle have always been grain-finished.

    I’m not a fan of fork-tender, “buttery” cuts such as the tenderloin, though, which can be just plain insipid.

  37. #37 Denice Walter
    November 25, 2014

    @ Mrs Woo:

    If you look at Mikey’s store ( Natural News) , you’ll find his own select brand.
    I do find that the Celtic or French or Spanish sea salts taste better although ordinarily, I hardly ever use salt.

    Alties believe all sorts of nonsense about it. e.g.. Natural News articles.

  38. #38 Shay
    November 25, 2014

    Denice@#36 —

    Not even on margaritas?

  39. #39 Denice Walter
    November 25, 2014

    @ Shay:

    No. Tequila** is not my friend. I get incredibly awful headaches.
    I need to stick with gin, vodka and dry white wine. Not together obviously.

    ** also Bourbon, Scotch and rum.

  40. #40 Mrs Woo
    November 25, 2014

    I avoid salt for the most part. In my younger days it was shots of tequila with margarita chasers…

    @Narad – sounds a lot like cooking venison, which makes sense on a lot of levels

  41. #41 Mrs Woo
    November 25, 2014

    I do get the Natural News updates. Sometimes I am impressed that Orac doesn’t cover Mikey more often.

  42. #42 Narad
    November 25, 2014

    sounds a lot like cooking venison, which makes sense on a lot of levels

    Ah! That should have occurred to me, but I had something of a bad experience with somebody’s dad’s homemade venison sausage… a while ago. There was a worse one involving a Valencian restaurant in Madrid, rabbit, some sort of red anise liqueur, and a taxi driver repeateddly asking my girlfriend if she was sure that I shouldn’t just go to the hospital, but I suppose I could get over these ancient memories given the right opportunity.

    I wouldn’t be like trying to “forget” the odor of mildew, after all.

  43. #43 Scottynuke
    November 26, 2014

    @ palindrom #17 — There’s a troll who seems to have a Google alert for “Fukushima west coast” and will show up on most any blog or news article with tons of fearmongering to try and sell “zeolite.” *SIGH*

  44. #44 Mrs Woo
    Where holidays and dates rarely match
    November 26, 2014

    @Narad – cringe thinking about it. Nothing turns you against a taste worse than getting violently ill from eating it. Still won’t touch creamed potatoes, and they were probably innocent.

  45. #45 Denice Walter
    November 26, 2014

    Interestingly enough, I was almost done in by an under-refrigerated treacle-laden Spanish dessert that consisted of crème fraiche, coconut and a liquer.
    Fortunately for me- I ate only a very small- but deadly- portion.
    -btw- I’m still tussling with Mr Asus, editor.

  46. #46 Andreas Johansson
    November 26, 2014

    Re altie salt beliefs, I’m unreliably informed that regular table salt is bad for you because all the healthy trace substances have been refined away and lots of nasty additives have been added. Quite why manufacturers go to such lengths making the product worse is never explained.

  47. #47 Denice Walter
    November 26, 2014

    But ohhhh, lookee, he gave me an accent grave!

  48. #48 Julian
    Surrey
    November 27, 2014

    How would the evolutionary argument apply to yoga and tai chi?
    Like homeopathy those are applied to many (too many?) conditions. Unlike homeopathy they can actually produce benefits (the most common outcome) and can produce problems (rare).
    So why is they still here? Could it be that yoga and tai chi are not alternative medicine?

  49. #49 Old Rockin' Dave
    Here, for just a moment...
    November 27, 2014

    (I didn’t have time to read all the comments, so forgive me if what I say has already been covered.)
    Two points about vegans:
    My daughter is vegan because she doesn’t want to bring any harm to animals of any kind, and it’s not religious. The pressure of her beliefs turned her from a liability in the kitchen to a first-rate cook and baker. She’s as healthy as can be, very athletic, and a world traveler. So yes, you can flourish on a vegan diet.
    As for inefficiency of raising meat animals, much of the world’s grazing land is unsuitable for any other kind of agriculture. Go out west and see some of the places where sheep, goats, and cattle are grazed. Many traditional hunting and herding societies would disappear or become impoverished and dependent if forced to give up their animal protein – Inuit, Sami, many sub-Saharan and North African peoples, many of the peoples of Papua New Guinea, and others. To find the additional food for them to live a more “developed” lifestyle would mean more land turned to the plow, more irrigation, more fertilizers and agricultural chemicals. It’s a much more complex issue than one of efficiency or greenhouse gases.

  50. #50 Dangerous Bacon
    November 27, 2014

    Please, PLEASE people: When cooking today (or any other day), do not use conventional allopathic table salt.

    You MUST use only Organic, Natural, Non-GMO, Halal & Kosher Gourmet Himalayan pink table salt for all your cooking and healing needs:

    http://www.amazon.com/Salt-Himalayan-Gourmet-Chemicals-Non-gmo/dp/B007PR93EU

  51. #51 LIz Ditz
    United States
    November 27, 2014

    Re grass-raised beef, etc.

    1. I have some of my grandmother’s cookbooks, pre 1920 (MOL). Many of the beef roast recipes recommend larding and/or barding: illustrated. Back when I was regularly eating home-raised beef, I got pretty good at larding.

    2. If you want to try grass-fed beef, I suggest getting your hands on some Piedmontese beef. It is naturally tender and very flavorful. The link is to one source; there are others.

  52. #52 LIz Ditz
    November 27, 2014

    Denice at #2: the notion of “cooking made us human” was the subject of Richard Wrangham’s book, Catching Fire, which I read. I don’t have a complete recollection but it wasn’t just the meat hypothesis, also had to do with grains and nuts. Worth getting from the library.

  53. #53 Denice Walter
    November 27, 2014

    @ Liz:

    I’m somewhat familiar with him.
    I’d have to add that besides the physical/ nutritional benefits of cooked food, the process and product may contribute to increased opportunities for social interaction rather than solitary gathering berries et al.

  54. #54 sadmar
    Animal Farm
    November 27, 2014

    IIRC, the beef about AGW doesn’t have to do with the grazing land in Red State USA, but rather that world love for Royales with Cheese is so insatiable that large tracts of rainforest in South America have been cleared to produce more moo-la for Mickey-D’s.

    I don’t know about methane, but as a ham and Swiss on pumpernickel is as good as food gets, so I shan’t make a big issue of the fact the most productive farm land in the U.S. is almost entirely devoted to producing feed corn used to fatten hogs.

  55. #55 squirrelelite
    November 27, 2014

    @sadmar,

    I once read a statement that we tried to transform the ecosystem of the state of Iowa into just 3 species, humans, pigs and corn.

    But, more seriously, a big problem there now is that because of supports for producing ethanol as an alternative fuel, a lot of the marginal farmland that would have been left fallow for grazing is now being plowed up to plant corn. One result is increased soil runoff and general degradation of the land.

  56. #56 Mrs Woo
    November 28, 2014

    This year corn is trading so low that you barely break even on the crop, suggesting that supply has far outstripped demand. I have heard murmurs of something killing off pig populations, though, which would account for part of the excess.

    I prefer to believe that only stupid/inexperienced farmers exploit the land rather than take care of it. The investment required for successful family-size farming makes it impractical to ruin crop land. We rent our crop acreage to a young man who is carrying on his family tradition, and he has treated it very well so far. Next year we are taking part back to put into alfalfa for the horses and cattle.

  57. #57 Old Rockin' Dave
    Back for another moment...
    November 29, 2014

    @Dangerous Bacon (and aren’t you concerned about the love expressed here for ham sandwiches?):
    What I really want to know about that Himalayan salt is if it was raised without growth hormones and is gluten-free? And is it a superfood?
    BTW, my vegan daughter, not sufficiently immunized against woo by her old dad, brought home a box of quinoa that declared it was the “superfood of the Inca warriors.” I wanted to know how, if it was so super, some three hundred disease-ridden, ill-nourished Spanish soldiers managed to defeat eighty thousand of those superfood-munching Inca warriors in one battle.

  58. #58 sadmar
    The Fayette County Corn maze
    November 30, 2014

    squirrelelite:

    It’s not all corn. They also grow soybeans. Or as a land-use activist I met once derisively put it: “just tall stuff and short stuff, nothing else.” My mom’s family is from Iowa City, so I spent a Lot of time there as a kid in the late 50s/early 60s. I can remember the days of independent family farms, crop rotation, crop variety… It was pretty much all gone by the time I finished up grad school at UI in 1992… **sigh**

  59. #59 P. J.
    Colorado
    December 3, 2014

    It seems that medicine is patient-driven instead of doctor-driven in today’s world. So, if a patient is wanting to try a complementary medicine, medical doctors seem to allow this so as to make the patient “happy”. However, for this to be effective, the medical doctor needs to have 100% confidence in the complementary/alternative medicine being offered or it could be considered quackery. Now, let’s define complementary vs. alternative. Complementary is used along with conventional medicine, whereas alternative replaces conventional medicine and this is where the controversy may lie. It is not always safe to replace alternative medicines such as herbs or “zone” therapy with conventional medicine, in fact, down-right dangerous. Also, at times, the physician may not even be aware their patient is partaking in CAMs, which is dangerous for the patient as well as the physician. This brings up a discussion for another time and that would be patient-doctor relationships and how much patients really trust their doctors in this day and age.

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