White Coat Underground

My regular readers know that I hold the Huffington Post in the lowest possible regard when it comes to its medical writing. HuffPo offers a daily platform for the worst pseudo-science and infectious disease promotion. Apparently that was getting to hard, because now I think their down to phoning it in. Last week’s post by a “body cleanse expert” reads like a late-night infomercial, and is about as accurate.

The article, with the fanciful title of, “Antibiotics Cause Cancer?” is written by Kim Evans whose medical qualifications are apparently limited to selling books on how to cleanse your liver and colon. This “cleansing” is all part of the so-called “detoxification” cult, a fringe health movement that claims that many of our medical problems are due to the build up of fanciful “toxins” that our body somehow fails to eliminate. The entire article is basically an advertisement for her books on how to cure this non-existent problem, and I’m guessing sales are low since she used the “C-word”. Nothing scares like cancer.

I kind of get the whole infomercial thing. Sure, late-night health infomercials are deceptive, dangerous, and fraudulent, but at least they’re labeled as ads. Evans’ piece is presented as fact, making it particularly immoral.

This immorality takes some very basic biology and creates a myth which encourages people to make purchases that benefit the author and at best rob the mark. To accomplish this sales pitch the subjects science and logic to the written equivalent of involuntary sodomy. Her crime is particularly egregious because of her use of the word “cancer” to scare people, perhaps turning away from or delaying real care.

Nothing about Evans’ piece is correct (well, maybe her name, but who knows). For example, she makes the shocking pronouncement that, “many people still believe that antibiotics are helpful….” Wow. Shocking. I can’t imagine why someone would want to survive pneumonia, or cure a kidney infection. Just…wow.

Most of us (hopefully) know that antibiotics are powerful medications that need to be respected. When they are used, improperly or otherwise, they can cause antibiotic resistance, which makes further infections tough to treat, but can also interfere with normal intestinal bacteria leading to another infection called pseudomembranous colitis. This is caused by the bacterium Clostridium dificile, and the treatment for this infection is, of course, antibiotics, albeit not the same ones that led to the infection.

Now, do do a thorough fisking of this piece is would cause my head to explode from the pressure of all that stupidity, but I’d like to point out a few more low-lights:

Antibiotics kill bacteria in the body; it’s commonly known and it’s actually the reason they’re taken. But what isn’t widely known is that the body has healthy bacteria, called probiotics, lining our intestinal tract. These healthy bacteria, which should be in abundance in our guts, dine on unhealthy bacteria and yeasts in our bodies, serving to keep these problems in check for us.

Um, no. It’s not even close to that simple. The colonic flora create an environment which helps to inhibit overgrowth of harmful bacteria such as C. diff; they don’t sit there eating up bad bacteria. Bacteria have no way of knowing which of their neighbors are good or bad—the environment has evolved in a way that we are not constantly ill, but of course things can go wrong.

…these healthy bacteria form the basis of our immune system

Really? Wow. The level of ignorance is staggering. Immunology is hard, but that doesn’t mean you should just make it up.

On this fanciful foundation of excrement, she builds an argument that your good bacteria kill yeast, and that yeast is the primary cause of cancer. Really. For this gem she relies on a well-known quack who has this theory that candida causes cancer, indicating that he either has no basic knowledge of biology or he is a crook. Of course the cure for such a horrid problem is to buy her books and cleanse your innards.

The Huffington Post is very widely read, and is presented as news and opinion, not as advertisement. News outlets are certainly welcome to offer opinion with the news, but it should be clearly labeled as such. To print fake medical advice designed to sell something and make it look like news is terribly immoral. It’s time for HuffPo to clean house. I’m going to send this on to the editors and encourage them to exercise some editorial responsibility. In case you’re curious, the general email address is info@huffingtonpost.com. I’d suggest you drop them a line, and feel free to reference this post and others.

Comments

#1 Sam C
April 19, 2009

I don’t know if this applies the same in the US, but I suspect it’s similar to here in the UK. Ben Goldacre of Bad Science fame points out that quacks can use a friendly journalist to write nonsense praising the really good effects of snake oil, saying how it gave the author energy, made them feel good, did wonders for their liver, etc. etc. The quacks would not dare make those claims themselves because they’d be nailed by advertising standards requirements, drug labelling requirements, food (supplement) labelling requirements, contract law, etc.

But if they can bribe or cajole a journo, it’s much cheaper and there’s no comeback, wa-hey! result!

We should not under-estimate the role of lazy and dishonest journalists in promoting this rubbish.

Keep up the sniping at Huffington Trash!
#2 Marilyn Mann
April 19, 2009

This is just terrible.
#3 Ramel
April 19, 2009

Hmmm, speaking of ads…. We seem to have Viagra, generic meds, and penis enlargement today. WTF is going on?
#4 PalMD
April 19, 2009

Ramel…where?
#5 Ramel
April 19, 2009

The side bar and top of the blog, but the comp is acting a little odd so maybe I’ve got a virus, running as scan at the mo.
#6 Orac
April 19, 2009

Bastard. You beat me to this one.

Not that that will stop me from doing a post about it anyway. What’s really horrific is that she’s citing Dr. Simonelli.
#7 PalMD
April 19, 2009

yeah, i thought i’d better leave that one to you. I’ve had a fungal infestation lately that i’m trying to deal with.
#8 Ramel
April 19, 2009

On my laptop now, everything looks normal so definatly my end. I think it may be time to put a password on the pc…
#9 Dunbar
April 19, 2009

I didn’t know commensals could be introduced through breast milk. I always though breast milk was mostly sterile, except for stuff like transfer of HIV. I also always thought that commensal introduction happened mostly with introduction of solid foods.

Yay I learned something new today! Thanks Kim Evans!
#10 Dr Benway
April 19, 2009

Oy.

Bacteria have doubling times on the order of twenty minutes or so. That means that even if you only have ONE of a particular species left, within a short period of time you’ll get the entire lot back again.

Iz leik dis:

1
2
4
8
16
32
64
128
256
512
1024
*snip*
half a billion
billion
#11 Dr Benway
April 19, 2009

Dunbar,

It’s not so much the milk.

Remember mommy’s nipple is coated in bacterial. As are Daddy’s hands and grandma’s kisses. Then there’s the dog, the cat, the plants. And the sink, the shower, the floor.

Oh and the air we breathe. You likely inhaled a quidoodle of bacteria while you wrote that post.
#12 Dunbar
April 19, 2009

Thanks Benway, I am fairly aware of the prevalence of microbiological flora. Interestingly, I looked up commensal bacteria in breast milk and apparently they do exist in the breast milk– I apologise to Kim Evans if she were ever to read this. Anyway, I was really referring to commensals that colonise the adult gut, which are thought to be introduced by solid foods or by some weird mechanism from the mother’s gut to the fetus. In addition, the probiotics in yoghurt that Kim Evan suggested aren’t gut commensals in the truest sense because they only transiently colonise the gut. As a final note, I agree with the sentiment that the probiotics fad is somewhat overblown.
#13 Dunbar
April 19, 2009

Also some science nitpicks:
1) A 20 minute doubling time is the minimal doubling time of E. coli in a shaking liquid culture, so most other situations will have bacteria growing somewhat slower. Granted, the gut is somewhat like a continuous culture, but the commensal bacteria are in a biofilm and do not grow as fast as in the planktonic situation.
2) It is pretty standard in immunology to learn that the shape of the nasopharynx prevents most things like bacteria (or dust) to enter the respiratory tract. I probably did not inhale a quidoodle of bacteria while writing my previous post.
#14 Eric Jackson
April 20, 2009

Was going to nitpick the E. Coli doubling time, but was beaten to it.

In general the wickedness antibiotics seems to focus on their indiscriminate nature, and the absolute horror of killing off commensal bacteria. Gut bacteria are then characterized as the majority or ‘center’ or bulk of the immune system – I suppose bone marrow and all those lymphatic organs are just sort of like foam packing peanuts. While gut bacteria do play a role in the immune system, I’d say that characterizing them as the above is ridiculous paranoia.

It’s also worth noting that the overwhelming majority of the bacteria in the intestines are Bacteroides spp., despite E. Coli being the more well known one due to its aerotolerance. Bacteroides are characterized for their fairly extreme resistance to antibiotics, particularly in comparison to most pathogens and other gut flora.
#15 Dr Benway
April 20, 2009

Uh.. if the bacterial doubling time is 20 minutes or a few hours the point still stands: you’re not walking around with gut candidiasis now at the age of 30 because you were given amoxicillin for otitis when you were five.

I’m sorry to frighten you, Dunbar, but only some, not all, particulate matter in the air will stick to your nasopharynx.

And I’m afraid that you did inhale a quidoodle of bacteria. You swallowed even more. And I’m not implying that you eat your boogers.

You’re swimming in bacteria all the friggin’ time. In fact, there are more bacteria in you than are you-cells in you.

Given the sea of creepy crawlies that envelop us all, does it not seem strange to fixate upon what a baby ate in order to understand the critters living now in an adult’s gut?

The gut dysbiosis woo is orders of magnitude off in terms of what might be relevant to tummy woes. Just like our biochem friend here and his just-so post-hoc stories about enzymes. And all the hyperfocus upon diet to avoid disease.

No bloody sense of perspective. Y’alls need to work in a big city hospital ER for a while. Watch people die on a daily basis. Then you might get a feeling for what it means to be sick.
#16 Eric Jackson
April 20, 2009

Of course the point on E.Coli stands, it’s just nitpicking.

Forget the bacteria for the moment, and just think of the mold spores we’re positively swimming in.

Without a doubt the greatest professor I’ve ever had worked for twenty-some years at USC County hospital, primarily in adult psychiatry, dealing with a lot of head trauma cases. USC County is the main hospital that serves the Los Angeles area and tends to have things under the ‘obscure’ and ‘rare’ categories showing up daily.

The class was one human pharmaceutical therapy, through the class he told various stories, mostly from his years at this hospital before moving to the UCI Medical Center. One of them stuck with me. A 20 year old man who had sex with his girlfriend, who subsequently failed to get pregnant. This led him to the conclusion that she was sterile, and decided to show his support for their relationship by ‘joining her in sterility’ as he put it. So he removed his external genitalia with a set of toenail clippers. Eventually diagnosed with schizophrenia.

It’s a mental illness story – but there probably aren’t many areas out there where you get scenarios as thoroughly nasty as mental illness. But in the real world, medicine seems to be a profession that comes into some of the most unpleasant experiences.

It’s not firsthand experience, nor perspective I suppose. But it does make me somewhat grateful that I’ll never be near that end of things. I don’t think I could handle it.
#17 Dr Benway
April 20, 2009

I looked up commensal bacteria in breast milk and apparently they do exist in the breast milk.

And that means… what? That the breast secretes good bacteria into breast milk to help the baby’s tummy? Ot that nipple = skin.
#18 Toaster
April 20, 2009

…these healthy bacteria form the basis of our immune system

ZOMG! ZOMG^ELEVENTY!!!

For real!?

For really real!?

If I met her in person I’m afraid I’d have no choice by to beat her roundly about the ears with my copy of Janeway’s Immunobiology.
#19 PalMD
April 20, 2009

Please don’t…that’s one of my favorite books.
#20 Toaster
April 20, 2009

I don’t want to beat her with it. I’d rather all the present and future dog-earred-ness of my copy be due to intelligent questioning and reading. However, it’s the book I’m most likely to have on hand since it’s always in my backpack.

So I looked, actually went to her website, searching for a direct email address. Didn’t find one. Maybe she’s above criticism? I do find it disgusting how she’s engaging in ego masturbation with commentors on her article.
#21 catgirl
April 20, 2009

Maybe antibiotics cause cancer by allowing people to live long enough to get cancer. Dead people don’t get cancer, so if you die from a bacterial infection as a child, you’ll never get cancer.
#22 PalMD
April 20, 2009

@catgirl

Yes, very true. It’s up there with the starvation cure for HIV in Africa—if the little kids die of malnutrition, then it must be protective against HIV death.
#23 PB
April 20, 2009

The author of the article probably had a cold, had antibiotics prescribed because she wouldn’t stop complaining at the urgent care clinic, took the course of antibiotics and got a yeast infection.

Then she assumed that the antibiotics caused the “probiotics” to stop munching down on the bad bacteria, since they’re the backbone of our immune system and all. Or maybe someone told her that her normal flora were affected by the antibiotic and she completely misunderstood what they were trying to tell her and ran with it.

Either way, they should just stick to politics.
#24 dh
April 20, 2009

Can I steal this one for Carnival of the Elitist Bastards? I’d love to have ammunition like this aboard ship this sailing! Let me know at elitistbastardscarnival@gmail.com. Thanks!
#25 Joe Average
April 21, 2009

“Antibiotics Cause Cancer?”
– I agree this is quack science. However, I am not able to disqualify that infections cause cancer. The bacteria H. Pylori has been proven to cause cancer.

There are many known Carcinogens. This includes Aflotoxins(fungal toxins), so I can not exclude fungus as a cause of cancer either.

My opinion is that there are many causes of cancer. Some are bacterial, like H. Pylori. Some may be fungal. And some may be an interaction between the two infections(Bad Bacteria + Fungus). This is an opinion of course.

Do certain vitamain deficiencies or poor behaviors(smoking), cause one to be more vulnerable to certain infections? Perhaps. I can discuss smoking intelligently.

ps. Like this post, I will try to discriminate between fact and opinion; Unfortunately, sometime I take shortcuts, but PalMD has been quick to point them out. I will try to avoid these unsourced shortcuts in the future, though. Certainly, I have no intention of telling intentional untruths. Unfortunately, I have had a sloppy statement or two already, and I can’t guarantee a perfeft record in the future; however, I can guarantee I will do my best to correct a sloppy statement expediantly.
#26 Eric Jackson
April 21, 2009

While I don’t know that fungal toxins have been related to esophogeal or gastric cancer, H. Pylori is certainly highlighted as the major contributor to it at the moment(3), nasty little bugger that it is.

There appears to be a fairly decent body of evidence linking smoking to tuberculosis, seemingly by COPD. Based on these two reviews (1, 2). I am not finding a great deal of material relating it directly to other bacterial or systemic infections, at least material that does not involve HIV infection as a major contributing factor. It’s late however, and at face value I wouldn’t dismiss it. One of the MDs may be aware of something more concrete, as bacteriology is not an area I’ve focused in.

While the contributions of pathogens to human cancer are significant, and HPV is notable among them for being the primary culprit, this does not explain the full length and breadth of human carcinogenesis. Age, some genetic factors and long term health complications contribute as well. In some cases, no real risk factors or contributing causes are known, such as say, Inflammatory Breast Cancer (My information on this is second hand, and close to a decade out of date from one family member’s experience with it). Even laboratory mice kept free of known pathogens and carcinogens develop cancers.

1. Hassmiller KM. The association between smoking and tuberculosis. Salud Publica Mex. 2006;48 Suppl 1:S201-16.
2. Slama K, Chiang CY, Enarson DA, et al. Tobacco and tuberculosis: a qualitative systematic review and meta-analysis. Int J Tuberc Lung Dis. 2007;11(10):1049-61.
3. Brenner H, Rothenbacher D, Arndt V. Epidemiology of stomach cancer. Methods Mol Biol. 2009;472:467-77.
#27 Michael Simpson
April 21, 2009

Whenever someone uses the term, “healthy immune system”, my anti-woo radar goes into full sensitivity mode. I haven’t taken an immunology course in about 25 years, but I think I could list out 20 components of an “immune system” without breaking a sweat. Like how many different leukocytes are there? (That was rhetorical, an answer is not necessary.)

Since the components of an immune system are so many different kind of cells, leukocytes, proteins, complements, response mechanisms, and whatever else, there isn’t one way to make them all work better, and there’s not one thing that’s going to make them stop working. When I think of “immune system”, I think of a complex system. The woo-pushing crowd must have taken the woo-immunology class which says that there’s one magical substance that will make it work better.

One day, we ought to list out all the code words that make each of our woo-radars set off alarms.
#28 Dunbar
April 22, 2009

Benway, the commensal bacteria in breast milk colonise the alveoli and form biofilms. You seem to take the microbiology criticisms too seriously though.

Gawd, I sound like a troll in responding.
#29 Dr Benway
April 23, 2009

Benway, the commensal bacteria in breast milk colonise the alveoli and form biofilms.

You just made that up.

You seem to take the microbiology criticisms too seriously though.

This conversation may be a big joke to you. Not for me. Putting a child on Nystatin for NO FUCKING REASON is malpractice.

Go make stuff up about 9/11 or alien abductions. Do not indulge in medical flights of fancy.

Science-based doctors can no longer stop the well-funded pseudoscience avalanche. There just aren’t enough of us and there isn’t time.
#30 Dunbar
April 23, 2009

Asserting that I made something up is a fairly serious charge, which should only be made if you can contradict my statement with either or both a reasoned argument and evidence. I got my information from here: doi:10.1016/j.tifs.2003.09.010. On a conciliatory note the article does note the hypothesis that biofilm formation of commensal bacteria may occur on the areolae, which I missed the first time I skimmed through the review. You are correct, but that is not to say I am incorrect either.

On a related note, I find it distasteful that you’re waving your medical authority in completely the wrong context. I was talking about microbiology (which I am familiar with), and I was in no way claiming medical authority or promulgating pseudoscience or crank shit that you oddly accuse me of doing. Kindly stop being a self-righteous victim-hero when responding to statements made with reasoned argument and good faith.
#31 PalMD
April 23, 2009

wow, i so don’t know what this thread is about anymore