I get the occasional email. Very little hate mail, unfortunately, since hate mail is often more amusing. I read what little email I receive, and usually do not respond, mostly as I do not have the time. I am a slow writer and a slower typist, and there are just so many hours in the day, and the older you get, the shorter those hours become.

Recently, over at the center of the growing Mark Crislip multimedia empire, I had the following in the feedback section:

Just thought you’d like to know:

My kids watch the PBS show “Curious George” which usually does a good job with introductory Physics, Astronomy, scientific method, etc. Interspersed with the cartoons they have scenes with real children that do a real-life parallel investigation of what happened on Curious George.

Today’s episode involved the Man with the Yellow Hat catching a cold, and Curious George going to the pharmacy and picking up various drugs to assist in making the guy feel better, mainly to have him sleep and be comfortable.

The interspersed skit, however, had the children visit a naturopath, where they learned:
* Oregano cures infections
* Various pressure points that correspond to energy lines
* And that taping magnets to these points is really effective.

I sat here simply amazed.

Me, not so much. Alternative medicine has always been a blind spot for PBS. While PBS would not show perpetual motion machines, suggest that astrology is legitimate, or give credence to a flat earth, alternative medicine, as it is for many otherwise thoughtful people, is exempt from even cursory critical thinking. PBS has broadcast Drs. Chopra and North, so its track record with science based medicine is not so good. My children are long past the Curious George part of their lives, but I read them the books when they were kids. Not my favorite (I like the Madeleine books better; 6 weeks in hospital for an acute appendix never failed to amuse me) but they were a quick read when the kids wanted a story at bedtime and I was too tired for a longer exposition.George couldn’t go to a naturopath, could he? Well, he is curious, and he does have a brain about a fifth the size of a human, so it is a potentially bad combination. And is his first name Curious? It is capitalized, so perhaps I should call him Mr. George, although I can find no information on the proper honorifics for an ape. Perhaps “Mr. Speaker”?

The episode is called Monkey Fever, and the episode summary is:

The Man with the Yellow Hat always takes such good care of George, so when the Man with the Yellow Hat comes down with a terrible case of the sniffles, George wants to return the favor. But how? He decides to try his own brand of monkey medicine to nurse the Man with the Yellow Hat back to health, including setting up the bedroom like a real hospital, feeding the Man with the Yellow Hat’s cold and starving his fever, and even playing an impromptu game of charades with the pharmacist to get the proper cold medicine. But as George plays doctor for a day, he notices that the Man with the Yellow Hat’s symptoms are peculiarly close to those of Betsy’s cat, the new mother of five kittens. Could the Man with the Yellow Hat’s illness mean he’s anticipating feline fatherhood?

Educational Objective (Science): To illustrate what it’s like to be sick with a cold and some ways to take care of yourself when you are sick; get rest, drink fluids, eat healthy food and, if needed, take medicine. Also to introduce some doctor’s tools like thermometers and stethoscopes.

Live Action Segment
The kids visit Dr. Shiva Barton, a naturopathic doctor and learn about alternative healing therapies. The doctor shows them pressure points on their bodies and the importance of staying healthy and eating right.

Sounds mostly innocuous and staying healthy and eating right is a good idea. I went looking on the interwebs for a torrent, er, I mean, YouTube video, but none are available. So I plunked down 2.99 on iTunes and the transcript of the show is also available. I have to wonder at the interwebs, where someone took the time to transcribe the whole show. It is not the real Curious George. The art is not right, but I am a traditionalist about these things. They should try and recreate the style or the original, but that is the crabby old fart in me. Lets see the show has to offer.

The episode begins with something concerning chickens. I was hopeful that George would get bird flu or Salmonella, but no. So the first part of the show is of little interest. The second half starts with a cartoon where the Man with the Yellow Hat (or very bad jaundice) has a cold. As a white-coated scientist says, “It doesn’t take a scientist to see you caught a cold.” True enough, and they set the scene for the rest of the program: they definitely avoided scientists and science when researching large parts of the episode.

Most of the show concerns George’s escapades, unrelated to education. When George answers the phone, George is mistaken for the Man with the Yellow Hat, who has taken to bed with a cold. Mistaken identity is a classic source of humor, and people with colds often sound like apes, so it is a plausible scenario.

The white-coated scientists finish by telling George/Man with the Yellow Hat, “Drink lots of water and fruit juice, it will help you beat a cold.” The Man with the Yellow Hat agrees, saying “drinking lots of fluids will help cure a cold.”

Fluid intake has no impact on the course of a cold, homeopathic claims notwithstanding, although it is important not to get dehydrated (yes, I know. People get volume short, food is dehydrated) which is a common complication if one is not careful when one has a fever.

Of course, no recommendation, however much is part common lore, is immune from the meta-analysis. And fluids for respiratory tract infections are no exception:

We found no randomised controlled trials comparing increased and restricted fluid regimens in patients with respiratory infections. Two prospective prevalence studies reported hyponatraemia at rates of 31% and 45% for children with moderate to severe pneumonia (see table).1 2 None of these children showed clinical signs of dehydration. Symptoms associated with hyponatraemia were not reported, but four children with a serum sodium below 125 mmol/l died during one study.

We also found several case series in which patients with respiratory infections developed hyponatraemia, of which some were symptomatic. These patients were all successfully treated with fluid restriction.

We found data to suggest that giving increased fluids to patients with respiratory infections may cause harm. To date there are no randomised controlled trials to provide definitive evidence, and these need to be done. Until we have this evidence, we should be cautious about universally recommending increased fluids to patients, especially those with infections of the lower respiratory tract.


There is currently no evidence from RCTs for or against the recommendation to increase fluids in acute respiratory infections. The implications for fluid management of acute respiratory infections in the outpatient or primary care setting have not been studied in any RCTs to date. Some non-experimental (observational) studies report that increasing fluid intake in acute respiratory infections of the lower respiratory tract may cause harm.

Although these evaluations are not specifically concerning colds.

Nor do fruit juices affect the course of a cold, although there is no harm in both the fluids and the nutrition provided by fruit juice. If one were inclined, one could argue it is the vitamin C in the fruit juices that are of benefit, but I have been less than convinced by the antiviral/anticold efficacy of vitamin C. And perhaps the lack of research in the area is hampered by fear of patent infringement.

Then, after watching a soap, George tries to get the Man with the Yellow Hat better faster by treating turning the apartment into a faux hospital. More hilarity endues as the room is turned into an ersatz hospital by George. Unlike my hospital, George does not understand the importance of hand hygiene, and fails to wash his hands, perhaps the one important message you could give the demographic that watches Curious George: kids and their parents.

Later, when George is again mistaken as the Man with the Yellow Hat on the phone, the white-coated scientists tell George to “Feed a Cold and Starve a Fever.” The scientists must be from the University of Old Wives Tales. The origin of the advice, as best as can be determined, is

the ancient belief that cold symptoms were caused by a drop in bodily temperature and that stoking your internal furnace with fuel would restore health.

There is almost no clinical data, or basic physiologic principals, to support the concept of feeding a cold or starving a fever. Of course, Medical Hypotheses has an answer:

We hypothesize that anorexia may represent a prehistoric behavioral adaptation to fight infection by maintaining T helper (Th)2 bias, which is particularly vital in fighting bacterial pathogens. Specifically, we propose that anorexia may avert the reduction of Th2/Th1 ratio by preventing feeding-induced neurohormonal and vagal output from the gut. Emerging evidence suggests that the vagal and neurohormonal output of the gut during feeding promotes Th1 function, which is desirable in fighting viral infections. Since fever may be an adaptation to fight bacteria and “colds” are generally viral in origin, the adage “starve a fever and feed a cold” may reflect a sensible behavioral strategy to tilt autonomic and Th balance in directions that are optimal for fighting the particular type of infection…Hydration and sleep, unexplained but widely accepted recommendations for flu patients, may also work by promoting vagal and Th1 functions. Modulating feeding, hydration, and sleep may prove beneficial in treating other conditions associated with abnormal autonomic and Th balance.

Who knows. For some odd reason I have developed Pavlovian avoidance to Th2/Th1. I enjoy the wild ass speculation often found in Medical Hypotheses, but I rarely take them seriously. Perhaps it is a just so story to explain why people get a decreased appetite when ill with an infection. My just so story as to why patients get anorexic and have diarrhea with fevers is that through most of history much of our illness came from eating and drinking contaminated food and water and nausea/anorexia prevented consuming more of the bad material. I like my explanation better, but then, I would. Otherwise, there is little to support the concept of the popular approach to colds and fevers.

Later the Man with the Yellow Hat notes “Normal (temperature) is 98.6, so I have a very slight fever at 99.2 degrees.”

I can, and have, pontificated for hours on normal temperature. 98.6 is not the normal/average temperature and is the result of measurement errors in the 19th century by Wunderlich. Modern temperature measurements in normal people are slightly less (or humans are cooling as the earth warms), but more importantly temperature varies over a 24 hour period, lowest in the am, highest in the early afternoon.

Our findings conflicted with Wunderlich’s in that 36.8 degrees C (98.2 degrees F) rather than 37.0 degrees C (98.6 degrees F) was the mean oral temperature of our subjects; 37.7 degrees C (99.9 degrees F) rather than 38.0 degrees C (100.4 degrees F) was the upper limit of the normal temperature range; maximum temperatures, like mean temperatures, varied with time of day; and men and women exhibited comparable thermal variability. Our data corroborated Wunderlich’s in that mean temperature varied diurnally, with a 6 AM nadir, a 4 to 6 PM zenith, and a mean amplitude of variability of 0.5 degrees C (0.9 degrees F); women had slightly higher normal temperatures than men; and there was a trend toward higher temperatures among black than among white subjects.
Thirty-seven degrees centigrade (98.6 degrees F) should be abandoned as a concept relevant to clinical thermometry; 37.2 degrees C (98.9 degrees F) in the early morning and 37.7 degrees C (99.9 degrees F) overall should be regarded as the upper limit of the normal oral temperature range in healthy adults aged 40 years or younger, and several of Wunderlich’s other cherished dictums should be revised.

The Man with the Yellow Hat does not have a fever and does not need starvation, although George proceeds to take all his food. George, like many alt med providers, accepts everything he hears at face value. Maybe George is a metaphor for a Naturopath, playing at doctor with none of the understanding or real tools? I am probably giving the producers of the program too much credit.

Then there is more humor as George is lead to believe the cold symptoms of the Man with the Yellow Hat really mean he is soon to have kittens. No more unbelievable than water helps cure a cold or that the place for health advice is a naturopath.

The video doesn’t include the live action section ($2.99 thrown away) and the videos have been taken down due to copyright issues, but the transcript lives on, as in the live action sequence children visit the ND. Evidently, even a small brained ape know better than to go to the ND, curious or not.

And here is the transcript. As is often the case, it is what is not said that is more important, but what kind of critical thinking can you expect in a minute and a half. None. So instead they offer propaganda and nonsense.

00:25:44 Today, we are visiting Dr. Shiva Barton.
00:25:48 He’s a naturopathic doctor.
00:25:50 Barton: Instead of using medicines, we use natural therapies.

Yes, instead of effective therapies, they use worthless nonsense.

00:25:53 Girl: Naturopathy is another way to help you feel better.

Like homeopathy, acupuncture, and avoiding vaccines. Not the road to wellness I would suggest.

00:25:57 Barton: See if you guys can tell me what it is.
00:26:01 It smells like rosemary or something.
00:26:04 Very good, it’s very close to that.
00:26:06 It’s oregano.
00:26:07 Oregano is a spice that you find in spaghetti sauce and pizza.
00:26:11 Oregano seems to be helpful for fighting germs.

Really? Pubmed finds 11 references, a few of which show that extracts of various herbs have, in the test tube, effects on some bacteria. This is no surprise, since plants have evolved mechanisms to resist being consumed by microorganisms. Oregano is not the only herb with this characteristic:

To investigate the bactericidal and anti-adhesive properties of 25 plants against Helicobacter pylori (H. pylori).
Twenty-five plants were boiled in water to produce aqueous extracts that simulate the effect of cooking. The bactericidal activity of the extracts was assessed by a standard kill-curve with seven strains of H. pylori. The anti-adhesive property was assessed by the inhibition of binding of four strains of FITC-labeled H. pylori to stomach sections.
Of all the plants tested, eight plants, including Bengal quince, nightshade, garlic, dill, black pepper, coriander, fenugreek and black tea, were found to have no bactericidal effect on any of the isolates. Columbo weed, long pepper, parsley, tarragon, nutmeg, yellow-berried nightshade, threadstem carpetweed, sage and cinnamon had bactericidal activities against H. pylori, but total inhibition of growth was not achieved in this study. Among the plants that killed H. pylori, turmeric was the most efficient, followed by cumin, ginger, chilli, borage, black caraway, oregano and liquorice. Moreover, extracts of turmeric, borage and parsley were able to inhibit the adhesion of H. pylori strains to the stomach sections.
Several plants that were tested in our study had bactericidal and/or anti-adhesive effects on H. pylori. Ingestion of the plants with anti-adhesive properties could therefore provide a potent alternative therapy for H. pylori infection, which overcomes the problem of resistance associated with current antibiotic treatment.

Clinical relevance is nonexistent and probably unimportant. You could get the same effect from my favorite natural yeast metabolite, alcohol.

00:26:15 He showed us a chart of the pressure points on our body.

Which are nonexistent. He also had them drink unicorn tears.

00:26:18 Barton: So this is a pressure point if you have a tummy ache or for seasickness, and you can just rub that.

Jeeze. Everyone knows the correct point for seasickness is P6, on the wrist. They can’t even get their nonsense correct on this show.

00:26:26 Sometimes it helps.

And sometimes it doesn’t. Can you say confirmation bias? I thought you could. But time is insufficient to note the difficulties with anecdotes about antidotes.

00:26:27 Girl: He showed us little bandages with magnets on the back of them.
00:26:31 He put them on a pressure point on our forehead.
00:26:34 Barton: That pressure point is helpful for people who need to relax.

Now useless magnets on a nonexistent pressure point. How much nonsense can they cram into a minute and a half? It must be a record, even for PBS. I have, after all, watched the Dr. North specials.

00:26:40 Nico was so calm he fell asleep.
00:26:42 Naturopathic doctors also help people to stay well.
00:26:46 That’s called prevention.
00:26:48 We should eat right, exercise, sleep well and have fun.

It is called bait and switch kids. Put the reasonable together with the nonsense, and if you are not careful, you will forget to differentiate the good from the bad from the ugly.

00:26:52 Barton: A good choice when you go to the ice cream shop is to get a fruit smoothie, because it has a lot of good things in it that keep you healthy. “

That evil chocolate malt, the root of all evil. What a spoilsport.

I realize the purpose of TV programs is to get people to watch the TV. I have the discussion at home every time, usually as part of the yearly fund-raising drive, PBS puts on some sort medical nonsense to raise money. I have family members who think PBS should have a commitment to scientific truth. I disagree. It’s TV. Their only commitment is to the bottom line.

That a kids show like Curious George promotes rank nonsense, well, I expect nothing less from PBS. If that is what they want to produce and promote, that is their privilege. But I quit sending PBS my money years ago. The best I can do is vote with my checkbook. And, for a parent who is paying attention, the show represents an opportunity to teach your children a little about critical thinking. Fortunately, as best I can tell from my kids, they never learned a single thing from the shows they watched on PBS as children. Pokémon? That is a different matter. If Pikachu had received an oregano magnet on his pressure point I would have been upset. They are older now. Their favorite show currently is Breaking Bad, so I will have bigger worries than alternative cold treatments if I start to see pseudoephedrine boxes in the trash.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at edgydoc.com.