The longer I’m in this whole science-based medicine thing, not to mention the whole skepticism thing, the more I realize that no form of science is immune to woo. To move away from medicine just for a moment, even though I lament just how many people do not accept evolution, for example, I can somewhat understand it. Although the basics of the science and evidence support the theory of evolution as the central organizing principle of all biology, much of the evidence is not readily apparent to those who don’t make it a calling to study biology, evolution, and speciation. It’s not like, for example, gravity, which everyone experiences and of which everyone has a “gut level” understanding. So, not unexpectedly, when the theory of evolution conflicts with a person’s religious beliefs, for most people it’s very easy to discount the massive quantities of evidence that undergird the theory of evolution. It’s not so easy to discount the evidence for gravity.

In many ways, medicine is similar to evolution, but the situation is possibly even worse. The reason is that much of the evidence in medicine is conflicting and not readily apparent to the average person. There’s more than that, though, in that there are a number of confounding factors that make it very easy to come to the wrong conclusion in medicine, particularly when looking at single cases. Placebo effects and regression to the mean, for example, can make it appear to individual patients that, for example, water (i.e., what the quackery that is homeopathy is) or placebo interventions (i.e., acupuncture) cures or improves various medical conditions. Add to that confirmation bias, the normal human cognitive quirk whereby all of us — and I do mean all of us — tend to remember information that reinforces our preexisting beliefs and to forget information that would tend to refute those beliefs — and, at the level of a single person or even practitioner, it’s very, very easy to be misled in medicine into thinking that quackery works. On the other hand, at the single patient/practitioner level, one can also see evidence of the efficacy of modern medicine; for example, when a person catches pneumonia, is treated with antibiotics, and recovers quickly. Regardless of whether they’re being used to demonstrate quackery or scientific medicine, because personal experience and the evidence that people observe at the level of the people they know can be very deceptive in medicine, science-based medicine, with its basic science underpinnings and clinical trial evidence, is necessary to try to tease out what actually works and what doesn’t.

Medicine does, however, have its version of a theory of evolution, at least in terms of how well-supported and integrated into the very fabric of medicine it is. That theory is the germ theory of disease, which, just as evolution is the organizing principle of biology, functions as the organizing principle of infectious disease in medicine. When I first became interested in skepticism and medical pseudoscience and quackery, I couldn’t envision how anyone could deny the germ theory of disease. It just didn’t compute to me, given how copious the evidence in favor of this particular theory is. It turns out that I was wrong about that, too.

On Friday there was a video released that provides a very clear, succinct explanation of germ theory denialism:

Germ theory denialism: History

The only thing I would disagree with is the conclusion at the end that germ theory denialists are not much of a threat. (I’d also quibble with the inclusion of doctors of osteopathy with chiropractors and naturopaths. These days, most DOs are indistinguishable from MDs in how they practice.) In fact, germ theory denialism is a major strain of “thought” driving many forms of pseudoscience, such as chiropractic and naturopathy, as is shown in the video itself.

Given the content of the video, however, I thought it might be worth considering the question: How on earth could people seriously deny the germ theory of disease, given how much success the application of this theory has demonstrated in decreasing mortality? Think about it! Antibiotics, modern hygiene and public health measures, and vaccines have been responsible for preventing more deaths and arguably for saving more lives than virtually any other intervention, preventative or treatment, that science-based medicine has ever devised.

The first thing we should clarify is just what we mean by the “germ theory of disease.” In most texts and sources that I’ve read, the germ theory of disease is stated something like, “Many diseases are caused by microorganisms.” We could argue whether viruses count as microorganisms, but for purposes of the germ theory they do. (Most biologists do not consider viruses to be true living organisms, because they consist of nothing other than genetic material wrapped in a protein coat and lack the ability to reproduce without infecting the cell of an organism.)

The funny thing about germ theory denialism is that, long before Pasteur, there were concepts about disease that resembled the germ theory. For example, it was written in the Atharvaveda, a sacred text of Hinduism, that there are living causative agents of disease, called the yatudhānya, the kimīdi, the kṛimi and the durṇama (see XIX.34.9). One of the earliest Western references to this latter theory appears in a treatise called On Agriculture by Marcus Terentius Varro in 36 BC. In it, there is a warning about locating a homestead too close to swamps:

…and because there are bred certain minute creatures which cannot be seen by the eyes, which float in the air and enter the body through the mouth and nose and there cause serious diseases.

That certain infectious diseases are contagious and somehow spread from person to person or from other sources is so obvious that various explanations of how this could happen held sway over many centuries. One common idea was the miasma theory of disease, which stated that diseases such as cholera, chlamydia or the Black Death were caused by a miasma, which translates into “pollution” or “bad air.” Certainly some diseases can be spread through the air. However, it’s long been recognized that other diseases could be spread through the water and in other ways. In any case, various ideas about how disease develops battled it out in various places over various times throughout the era of prescientific medicine. Many of these ideas involved, as we have seen, various concepts of mystical “life energy” such as qi, whose ebbs and flows could be manipulated for therapeutic effect (as in acupuncture, for example). Other ideas involved various concepts of “contamination,” in which miasmas or various other “poisons” somehow got into the body from the environment. Given the knowledge and religion of the time, these ideas were not unreasonable because science did not yet exist in a form that could falsify them as hypotheses, nor did the technology yet exist to identify the causative agents of disease. Given that background, attributing infectious disease to “bad air” doesn’t seem so unreasonable.

The beauty of Pasteur’s work is that it provided an explanation for many diseases that encompassed the concepts of miasma and various other ideas that preceded it. It should not be forgotten, however, that Pasteur was not the first to propose germ theory. Scientists such as Girolamo Fracastoro (who came up with the idea that fomites could harbor the seeds of contagion), Agostino Bassi (who discovered that the muscardine disease of silkworms was caused by a tiny parasitic organism, a fungus that was named Beauveria bassiana), Friedrich Henle (who developed the concepts of contagium vivum and contagium animatum), and others had proposed ideas similar to the germ theory of disease earlier. Pasteur was, however, more than anyone else, the scientist who provided the evidence to show that the germ theory of disease was valid and useful and to popularize the theory throughout Europe. Moreover, it should be noted, as it is in the video, that there were competing ideas; for example, those of Antoine Béchamp, who did indeed postulate nearly the exact opposite of what Pasteur did: that microorganisms were not the cause of disease but rather the consequence of disease, that injured or diseased tissues produced them and that it was the health of the organism that mattered, not the microorganisms.

Basically, Béchamp’s idea, known as the pleomorphic theory of disease, stated that bacteria change form (i.e., demonstrate pleomorphism) in response to disease. In other words, they arise from tissues during disease states. Béchamp further postulated that bacteria arose from structures that he called microzymas, which to him referred to a class of enzymes. Béchamp postulated that microzymas are normally present in tissues and that their effects depended upon the cellular terrain. Ultimately, Pasteur’s theory won out over that of Béchamp, based on evidence, but Béchamp was influential at the time, and, given the science and technology of the time, his hypothesis was not entirely unreasonable. It was, however, superseded by Pasteur’s germ theory of disease and Koch’s later work that resulted in Koch’s postulates. Besides not fitting with the scientific evidence, Béchamp’s idea had nowhere near the explanatory and predictive power that Pasteur’s theory did. On the other hand, there is a grain of truth in Béchamp’s ideas. Specifically, it is true that the condition of the “terrain” (the body) does matter when it comes to infectious disease. Debilitated people do not resist the invasion of microorganisms as well as strong, healthy people. Of course, another thing to remember is that the “terrain” can facilitate the harmful effect of microorganisms in unexpected ways. For example, certain strains of the flu (as in 1918 and H1N1) are more virulent in the young because the young mount a more vigorous immune response.

Béchamp is unusual, though, in that he is frequently invoked by peddlers of quackery as having been “right” while Pasteur and Koch were “wrong.” Just Google “Béchamp” AND “alternative medicine,”Béchamp germ theory,” or “Béchamp vaccination,” and you’ll see what I mean. Right on the first page are multiple links to that one-stop shopping site for all things quackery, as well as links to that king of “acid-base” woo, the man who thinks all diseases are due to “excess acid,” Robert O. Young. One example of how Béchamp has come to be used to justify quackery appears on this discussion of vaccination at the Arizona Center for Advanced Medicine:

He [Pasteur] is remembered for promoting vaccinations.

Béchamp had a different idea. He believed in the pleomorphic theory, that bacteria change form and are the result of disease. He said bacteria change into organisms that are increasingly detrimental to the body. The waste products of their metabolism are harmful to local body fluids, causing pain and inflammation. It is not the germs, viruses, and bacteria that make you sick, it is the waste products of the metabolism of those organisms that make you sick.

Here’s the kicker:

Germs seek their natural habitat – diseased tissue. During the Civil War, maggots were brought into hospitals to feed on the diseased tissue of the wounded because the bugs were better at cleaning it up than potions or anticeptics. Think of mosquitoes. They seek stagnant water, but do not cause the pool to become stagnant. So when the terrain is weakened and sickly, all manner of bugs want to set up house. But they come after the disease has begun; they come because the terrain is inviting.

Not surprisingly, included in this article is the myth that Pasteur “recanted” on his deathbed and said that Béchamp is correct. The article also uses poor Béchamp to justify all manner of quackery, including live blood analysis, anti-vaccine beliefs, and claims that, because of Pasteur, the pharmaceutical companies have come to rule health, all standard tropes of the alt-med movement.

Germ theory denialism now: A “softer” form of Béchamp

In 2010, as hard as it is to believe, germ theory denialism still exists. In fact, contrary to the video above, I would argue that such denialism is actually a significant threat, as it is frequently used as a justification for anti-vaccine views, as demonstrated by the article above from Arizona Advanced Medicine. Moreover, it goes beyond anti-vaccine beliefs, to the point where I’m half tempted to label it as the alt-med/pseudoscience equivalent of the theory of evolution in its importance to woo. What I mean is that, just as the evolution is the central organizing principle of biology, germ theory denialism borders on being the central organizing idea behind the alt-med approach to disease.

Right now, the predominant form of germ theory denialism appears to be a “softer” form of denialism, just as the predominant form of evolution denialism is not young earth creationism, but rather “intelligent design” (ID) creationism. True, there are still young earth creationists around, who state that the world is only 6,000 years old and that the creatures that exist now were put there by God in their current state, but most denialists of evolutionary theory now accept that the earth is several billion years old and that organisms do evolve. They simply deny that natural selection and other mechanisms encompassed in current evolutionary theory are sufficient to account for the complexity of life and instead postulate that there must be a “designer” guiding evolution. Similarly, there are still some die-hard germ theory denialists out there who cite Béchamp in much the same way young earth creationists cite the Bible and deny that germs have anything to do with disease whatsoever, claiming instead that microbes appear “because of the terrain” and are an indicator, rather than a cause, of disease (or, as they frequently call it, “dis-ease”). However, most cases of germ theory denialism are of a piece with ID creationism. Like ID promoters who admit that evolution “does” happen, this variety of germ theory denialist accepts that microbes “can” cause disease, but they argue that microbes can only cause disease if the host is already diseased or debilitated. Using such claims, they argue that the “terrain” is by far the most important determinant of whether or not I get sick. As a result, they claim that eating the right diet, doing the right exercises, and taking the right supplements will protect you against disease as well as any vaccine — better, in fact, because supposedly you’re not injecting all those “toxins” from vaccines into your body.

We see this all the time among proponents of “alt-med.” For example, as I’ve written before many times, comedian Bill Maher expresses just such views. My favorite example was when he was having a discussion with Bob Costas about the flu and the flu vaccine and stated that, because he lives right and eats a healthy diet he “never gets the flu” and wouldn’t get the flu on an airplane even if several people with the flu were on that plane, to which Bob Costas made a hilariously spot-on reply, “Oh, come on, Superman!” That’s not too far from the truth, because the modern form of germ theory denialism does seem to claim that diet, exercise, and living the “right way” will make us all super men and super women, able to resist the nastiest of infectious disease.

Germ theory denialism: An example from naturopathy

After I saw C0nc0rdance’s video on germ theory denialism, I couldn’t resist looking at some of the videos that popped up on the sidebar of the YouTube link to see what was there. Prominent among the related videos that Google served up was a video by Dr. Shawn Sieracki of the Whole Body Healing Center of Lewisville. One might expect a whole lot of dubious therapies from Dr. Shawn based on what’s on his practice’s website, which touts woo such as the “detox challenge,” which boasts “Detoxify or die!” and offers services such as the infamous woo known as the “detox foot bath”:

Dr. Shawn has produced a video that demonstrates the germ theory denialism at the heart of much of what is espoused by naturopathy. His video is entitled Naturopathic Minute: Germ Theory, and he begins by baldly stating that “germ theory is not correct”:

Dr. Shawn bases much of his argument on a straw man version of germ theory. First, he claims that germ theory is what “traditional medicine” bases “all of its studies and research” on and that the “medical model” is based on germ theory. These statements are sort of true in that science-based medicine does primarily base its studies and therapies of infectious disease on germ theory (germ theory does, after all, work), but Dr. Shawn seems to be implying that all disease is caused by “germs” according to scientific medicine. He then goes on to misstate germ theory by stating first that it says that disease is caused by bacteria, viruses, and parasites (true) but that scientific medicine also says that infectious disease is caused by “toxins” (false; that’s not what scientific medicine says–unless Dr. Shawn means something like the cholera toxin, and somehow I doubt that he does). He then boldly proclaims that germ theory is “not correct” because:

It’s not the germs that cause the disease. It’s the condition of the environment that causes the disease…I’m going to give you a layman’s terms example so that you can understand. Cockroaches are the germs. Now why do you have cockroaches in your kitchen sink and all over the kitchen counter? Is the cockroaches the problem, or is it the dirty dishes, the stinky syrup on the kitchen counter, the food crumbs all over the place? That, more than likely, is why the cockroaches are there. So, doctors treat the cockroaches as the problem. They spray the insecticides; they spray the pesticides, but they keep the dirty dishes in the kitchen sink. OK, does that make sense? A natural health practitioner is going to help you clean up that dirty kitchen sink…If you clean up the dirty kitchen sink, the cockroaches go away. They can’t feed on that environment.

Personally, having worked in a restaurant that had a cockroach infestation cockroaches before, I’d like to see Dr. Shawn get rid of cockroaches in a house by doing nothing more than cleaning up the kitchen. Once you have cockroaches, they won’t go away with such a minimal intervention. Just ask anyone who’s had them in his home. Restaurant management was already strict about proper food practice and keeping things clean. It became even more so after cockroaches were discovered. After all, cockroaches were bad for business. If a customer saw one, it’d be disastrous, and if the health inspector saw them on the next visit, it would be even more disastrous in that there would be fines and the restaurant might even be shut down. In addition to excellent food hygiene practices, it also took visits from the exterminator to get rid of the cockroaches, and we were under no illusion that the cockroaches wouldn’t be back promptly if our guard lapsed.

Dr. Shawn goes even further:

Another analogy would be a stagnant swamp, a stagnant swamp versus a river. A river is full of life. A river is healthy. It’s flowing just like the blood should be flowing in your body. Okay? You’ve got eagles floating, you’ve got cold water fish floating in a river. Now in a stagnant swamp, you’ve got mosquitos, gnats, flies. You’ve got deadly snakes swimming in that moldy, filthy water. It’s the condition of the pond that attracts that, okay, it’s the condition of the pond that attracts the mosquitos, that attracts the gnats, etc.

Of course, again, there is more than a grain of truth in the idea that the “terrain” matters. If you’re unhealthy or debilitated, your resistance to bacteria is decreased. For example, it’s well known that diabetics have difficulty fighting off infections; a whole specialty (vascular surgery) deals with the complications of that problem in the feet. This is not anything new, nor is studying the effect of nutrition and overall health on resistance to infectious disease. Scientists and physicians have been studying these questions for decades. Where naturopaths go off the deep end is in claiming that good health is enough to ward off infectious disease. You can be a perfectly healthy 20 year old and die of the flu. It happened to millions in the 1918 pandemic, which in the U.S. got its start in Army barracks, where very healthy 18-22 year old males congregated. You can be perfectly healthy, but if you are exposed to a pathogenic virus or bacteria, you can still come down with a disease that will kill you. It is also not correct to argue, as Dr. Shawn argues, that ill health “attracts” these bacteria. They’re out there. They live on your body; they’re in the environment; just by living you’re exposed to them.

It’s also not true that the flu shot “gives you the flu,” as Dr. Shawn claims in one of his more ignorant statements.

Dr. Shawn also parrots another germ theory denialist argument, frequently found on numerous websites. Specifically, he gives the example of ten people on an elevator with a person with the flu (sometimes it’s a pathogenic bacteria when repeated elsewhere), who’s coughing all over the place. He points out that, although everyone in the elevator was exposed to the flu virus, not everyone gets the flu, as if that were evidence that the germ theory is incorrect! Germ theory denialists seem to think that anything less than a 100% infection rate in people exposed to a pathogenic organism means that that organism doesn’t cause the disease. This is a particularly prominent trait among HIV/AIDS denialists because HIV only causes disease in only a relatively small percentage of people exposed to it once. It’s an example of all-or-nothing thinking that’s so prevalent in promoters of pseudoscience. For example, it’s very much akin to when anti-vaccine zealots in essence argue that if a vaccine doesn’t prevent disease 100% of the time it’s useless, as they so frequently do with, for example, the flu vaccine or the measles vaccine, the latter of which is approximately 90% effective. Sometimes, it leads to arguments like this, where it is argued that pathogenic bacteria are not only not the cause of disease, but they are there to rid the body of disease:

Germs take part in all disease phenomena because these are processes requiring the breaking down or disintegration of accumulated refuse and toxic matter within the body, which the system is endeavouring to throw off. But to assume, as our medical scientists do, that merely because germs are present and active in all disease phenomena, they are therefore the cause of the same diseases, is just as wrong as it would be to assume that because germs are present and active in the decomposition processes connected with all dead organic matter, they are the cause of the death of the organic matter in question. The analogy is absolutely just and fair! And equally ridiculous!

But no one would say that because the decaying body of a dead dog is full of bacteria, the bacteria are the cause of the dog’s death. We know they are there as a part of the natural disintegration process taking place as a result of the death of the dog. And so it is with germs and disease. Germs are a part of the results of disease, not its cause.

Germs are present in disease not as causes, but as superficial helpers brought there by Nature to rid the body of disease. They are the “scavengers” employed by Mother Nature to break up and “bring to a head” the accumulated internal filth of years of unhygienic and unwholesome living, which are clogging the tissues of the body and preventing proper functioning.

While it’s true that there are many bacteria that live as commensal organisms in the colon of each and every human, not to mention the trillions upon trillions of bacteria that live on the skin, the statement is denialist in that it refuses to acknowledge that there are both helpful and very harmful bacteria. To the author, bacteria not only don’t cause disease, but they are what’s trying to eliminate disease. While it is true that there are cases in which the native bacterial flora living on our body “crowd out” pathogenic bacteria and the elimination of that bacterial flora with antibiotics can leave a person susceptible to pathogenic bacteria that are there all along (C. difficile colitis comes to mind), to make such a blanket statement is the sheerest folly.

Still, it doesn’t take very much searching through the “alt-med” parts of the Internet to find all sorts of mind-bogglingly ignorant attacks against Pasteur, for example:

One can’t help but notice that in the last example, a chapter attacking germ theory is the very first chapter in a book on “natural cures.”

Why is germ theory denialism so attractive?

There is little doubt that germ theory denialism is a strain of “thought” (again, if you can call it that) that undergirds a lot of quackery. The question is: Why? After all, despite its flaws and despite the manner in which microorganisms have become resistant to antibiotics, thanks to our overuse, the germ theory of disease arguably marked the beginning of the scientific revolution in medicine and the birth of science-based medicine. After Pasteur’s popularization of the germ theory of disease, medicine entered a period of remarkable advances that continue to this day. Before Pasteur, there was no unifying theory for infectious disease. After Pasteur, there was, and the success of Pasteur’s theory revolutionized not just medicine but food preparation, particularly the process of Pasteurization of milk and other products, which greatly decreased the chance of illness borne by dairy products and other products that could be treated. Proper surgical antisepsis led to declines in surgical mortality.

I suspect that a large part of the reason that germ theory denialism persists in a range of forms from hardcore belief that Béchamp was right and Pasteur wrong to softer forms that claim that better nutrition and health would be as effective, or more so, than vaccines or antibiotics in preventing and treating disease derives from the very worship of the “natural” that so much of “alt-med” is built upon. If nature is so benevolent, then how could it be that there are microorganisms that will harm or even kill us if they gain a foothold in our bodies? Also, there is a great deal of “Secret“-like mystical thinking in alt-med, making it unsurprising that, if Béchamp were right, that would imply that disease or lack of disease is within us. That further implies that the means of ridding ourselves of disease is also within us through diet, exercise, and whatever activities that promote health we can undertake. This is far more reassuring than the idea that there are microorganisms out there that care nothing for our hopes or activities and are just waiting for an opportunity to attack. It’s far more reassuring to believe that we can have complete control over our health than it is to think that a random twist of fate could inoculate us with microbes that care nothing for any of that.

Regardless of the motivations behind germ theory denialism, I can’t help but find it odd that a mere three days from now the director of the National Center for Complementary and Alternative Medicine (NCCAM), Dr. Josephine Briggs, will be speaking to the 25th Anniversary Convention of the American Association of Naturopathic Physicians (AANP). I wonder if Dr. Briggs knows the depths of germ theory denialism and anti-science that form the basis of so much “alternative medicine” in general and of naturopathy in particular. Perhaps Dr. Shawn will even be in the audience when she speaks. I wonder if he’ll approve of Dr. Briggs’ talk.



Posted by David Gorski

Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.