Although I write the definitive entries on topics in this blog, new information trickles in after publication.  The new studies are often not worth an entire entry, recapitulating prior essays, but the new information is still worth a mention.  What follows are updates on topics covered in  prior SBM posts.

Raw Milk

In Oregon we are having a small outbreak of infections from consumption of raw milk.  Not a surprise, since milk is a wonderful culture media and the udder is just down the gravity well from the cows anus.  Raw milk violates the classic dictum “Don’t shit where you eat” although I understand the saying concerned dating in its original conception.

Although the sale of raw milk is illegal in muchof the US,  the law can be bypassed by owning the cow rather than buying the milk,  a reverse of dating advice.  Such is the case in Oregon, where 48 people are time sharing the cows responsible for the current outbreak.  There has been the spread of pathogenic E. coli to at least 5 people, mostly  children, and has lead to the hospitalization of at least 3 children.

Of course, it is hard to get infected. Humans have lived in Filth and Squalor (like Minneapolis and St. Paul or Buda and Pest) for centuries, drinking and eating contaminated food and enough survived perpetuate the species.  Most infections in the past would have been from consuming contaminated food and drink.  I have wondered if the reason fevers are often associated with diarrhea and/or vomiting is that it an evolved response for removing infected material as soon as possible.

The CDC has reported multiple  outbreaks of infection traced to consuming raw milk, not that anyone is paying any attention.  The results were recently summarized:

The study included 121 dairy–related disease outbreaks, which caused 4,413 illnesses, 239 hospitalizations and three deaths. In 60 percent of the outbreaks (73 outbreaks) state health officials determined raw milk products were the cause. Nearly all of the hospitalizations (200 of 239) were in those sickened in the raw milk outbreaks.  These dairy-related outbreaks occurred in 30 states, and 75 percent (55 outbreaks) of the raw milk outbreaks occurred in the 21 states where it was legal to sell raw milk products at the time. The study also reported that seven states changed their laws during the study period.

Consumers can’t tell if raw milk is safe to drink by looking at, smelling, or tasting it. Even under ideal conditions of cleanliness, collecting milk introduces some bacteria.  Unless the milk is pasteurized, these bacteria can multiply and grow in the milk and cause illness. Pasteurization involves heating milk to kill disease-causing bacteria.

It is rare to get infections from milk:  it is estimated that 1% of milk is consumed raw, about 27 billion pounds.  Lets see. A pint is a pound the world a round, so that’s 54,000,000,000 cups drunk drank drunken consumed for 4400 illnesses.  Not a huge risk, although children were disproportionately affected (60%) and E. coli 0157 mediated hemolytic uremic syndrome (HUS), with kidney failure and occasional deaths are reported.

Not that it makes any difference to those who believe in the unproven benefits of raw milk over safe food:

…people who drink raw milk tend to be fierce advocates. One person, who posted anonymously on, said that he or she would not stop drinking milk from Foundation Farm even though it had sickened the commentator and the commentator’s 2-year-old child.

The inability to admit error boggles the mind.

Two simple words. Two simple words in the English language: “I forgot!” How many times do we let ourselves get into terrible situations because we don’t say “I forgot”? Let’s say you’re on trial for giving your kid HUS from raw milk. You say to the judge, “I forgot raw milk is contaminated with dangerous bacteria.  Let’s suppose he says back to you, “You have committed a foul crime. You killed your child by deliberately giving them milk contaminated with cow manure, and you say, ‘I forgot’?” Two simple words: Excuuuuuse me!!”

Rhinos and Tigers and Bears. Oh my.

“I would personally kill every chimpanzee on the planet with my bare hands if it meant saving one homeless crack-addict with AIDS.”
~ Penn Jillette

I don’t know. I have met some pretty nice chimps and some remarkably evil crack-addicts. I suspect he would be more protective of our evolutionary cousins if the choice were between chimps and some of his colleagues on The Apprentice, but perhaps I read body language incorrectly. But I would not kill a single animal for any Traditional Chinese Medicine (TCM) nostrum.

Several years ago I summarized the adverse effects of Traditional Chinese Medicine on the environment and other species.  It is not uncommon to grind up endangered animals and plants such as rhino horn, tigers and antelope for medicinal purposes.  Their efficacy is less than plausible; rhino horn is basically hair and will not even cure baldness.  But use of TCM is increasing, consuming plants and animals with a Galactus-ian  hunger.  There is big money to made in puree of endangered species.

The issue with many of the supplements from India, China, and the US  is quality control.  What is on the label may or may not be what is in the tablet.  But how can you tell if your TCM nostrum is filled with toxins or a melange of mammals?  Modern technology has the answer. Or magic.

Targeting both the p-loop region of the plastid trnL gene and the mitochondrial 16S ribosomal RNA gene, over 49,000 amplicon sequence reads were generated from 15 TCM samples presented in the form of powders, tablets, capsules, bile flakes, and herbal teas. Here we show that second-generation, high-throughput sequencing (HTS) of DNA represents an effective means to genetically audit organic ingredients within complex TCMs. Comparison of DNA sequence data to reference databases revealed the presence of 68 different plant families and included genera, such as Ephedra and Asarum, that are potentially toxic. Similarly, animal families were identified that include genera that are classified as vulnerable, endangered, or critically endangered, including Asiatic black bear (Ursus thibetanus) and Saiga antelope (Saiga tatarica). Bovidae, Cervidae, and Bufonidae DNA were also detected in many of the TCM samples and were rarely declared on the product packaging.

They also found toad, goat, sheep, buffalo, and cow DNA in some of the concoctions.  Listed ingredients, when they bothered to list them, included toad cake,  testis et penis callorhini, and cow and monkey bezoar. Almost makes raw milk appear palatable by comparison.

Consumers of TCMs need to be wary of honesty of food labelling , as in 78% of samples, animal DNA was identified that had not been clearly labelled on the packaging (in either English or Chinese). This adulteration of medicine occurred in the Saiga Antelope Horn powder  which claimed to be 100% pure, yet was found to also contain significant quantities of goat (Caprine) and sheep (Ovine) DNA. In some TCMs, undeclared ingredients are used to reduce the cost of manufacture of the medicine by increasing the bulk of the powder, but it is impossible to determine why Caprine and Ovine appeared in this product. Water buffalo (Bubalus bubalis), domestic cow (Bos taurus) and deer species were also not listed on the packaging of samples in which they were genetically identified. The inadvertent consumption of undeclared animal products found in 78% of the medicines, such as bovid, risk violating certain religious and/or cultural strictures.

What?  I am using adulterated quackery instead of pure quackery?  Consumers of TCM have more to worry about than honesty in food labeling, as if somehow lying about nonsense is worse than honest nonsense.

The take home is when you use TCM products, you are likely contributing to the extinction of species even when the label on the  nostrum appears safe. You are not even saving a homeless crack-addicted AIDS patient, much less helping yourself.

Like Cure Like


It has been a while since I pursued the Pubmeds on homeopathy.  Regular readers of the blog know the fantasy based premises of homeopathy.  Substances that cause symptoms, when diluted beyond any residual presence, will cure the disease.

Most of the time trying to test this fantasy  is messy.  There are a lot of diseases, but fewer symptoms.  There are a lot of potential  variations in fevers or headaches or sinusitis that result in choosing a homeopathic remedy being “individualized.”  Despite being fantasy based, the enormous variation makes it hard to test one homeopathic cure for one illness or symptom.  The wiggle room is enormous.

Testing ‘like curing like’ would be more straightforward if it were poisoning.  Lead or arsenic poisoning would seem a straightforward condition to test homeopathic validity.  You would know exactly which like would cure which like. Lead toxicity should be cured with homeopathic lead.   And, incredibly, such studies have been done.

And, at least for lead, like does not cure like:

Poisoning due to lead and its compounds has short and long-term effects primarily on the nervous, hematopoietic, gastrointestinal, cardiovascular, musculoskeletal, renal and reproductive systems. It can manifest in acute or chronic symptoms. Measuring serum concentration is the primary method for diagnosing and monitoring exposed workers. Presently, elevated lead levels are treated by drugs whose effectiveness is contested on various fronts. Experimental studies suggest that homeopathic preparations may be in controlling blood lead levels in laboratory animals, creating the need for controlled studies to evaluate the effectiveness and safety of these preparations in humans.
To evaluate the effectiveness of the homeopathic preparation Plumbum metallicum in reducing the blood lead level of workers exposed to this metal.
Double-blind randomized trial.
Workers’ clinic in the Ajax battery plant, which employs 900 workers with varying degrees of lead exposure in Bauru, São Paulo State, Brazil.
131 workers exposed to lead.
Plumbum metallicum 15 cH or placebo, orally for 35 days.
The percentage of workers who demonstrated a reduction in lead counts by a percentage greater than or equal to 25% following treatment was the same for both groups: 20.3% in the homeopathic groups versus 21% in the control group [Relative Risk (RR) = 0.95, confidential interval (CI) 95%: 0.47-1.92)]. Analysis by intention-to-treat also did not show any difference between the groups: 18.2% in the treated group versus 20% in the placebo group (RR = 0.91, CI 95%: 0.45-1.84).
The homeopathic preparation Plumbum metallicum had no effect, in this study, in terms of reducing serum lead in workers exposed to lead.”

What a surprise, although one wonders what they were thinking in the Institutional Review Board at the  Federal University of São Carlos for allowing such a study to be done.

A similar study, this time with arsenic, was done in China.  And you have to love the description of how ‘informed’ consent was obtained

Most arsenic victims were weak and anemic and therefore concerned about giving blood at regular intervals. They were in general frustrated and almost resigned to their fate. They signed informed consent on the basis of the agreement that they would provide samples of their urine and blood only twice; once on the day before they started taking the “verum” or “placebo”, and then 2 months after administration of the “verum” or “placebo”.

Half of the 28 subjects dropped out,  resulting in nine people in the treatment group and 5 in the placebo.Any conclusion would be 200C. The researchers seem to be unaware that multiple measurements in small numbers of subjects with multiple statistical analysis will find something ‘significant’ but are  are as meaningless as the underlying premise of the study.

From the results of this pilot study, it becomes obvious that the verum-fed group showed positive ameliorating effects, like that of the other potencies of centesimal dilutions, Ars Alb 30C and Ars Alb 200C reported earlier. Since Ars Alb LM 0/3 potency can be used for a long time and since this remedy also has protective abilities in subjects living in a village where arsenic-free drinking water facility was unavailable, this could be used as an interim measure, particularly in remote villages without having any other kind of medical facility. As a higher potency may actually be required for sustaining the ameliorative effects, it is recommended that the remedy be used under supervision of a practicing homeopath, who may suggest when the next higher potency ought to be used. Furthermore, change in symptoms may call for some intermittent remedy (may be a constitutional remedy) as based on severity of condition and totality of symptoms…
How the tiny globules soaked in the ultrahighly diluted remedy could bring about changes in so many parameters of study while the same could not be achieved by the Ars Alb LM 0/3 unsoaked globules (placebo) remain largely unknown. However, one working hypothesis advocated by Khuda-Bukhsh et al[17-19] is that potentized homeopathic remedies may act as a “molecular switch” to trigger specific genes that may in turn activate/deactivate a cascade of other relevant genes may be one way of explaining such inexplicable phenomenon at the state of our present understanding.”

One would think in a town with arsenic in the water, that taking homeopathic water in large quantities would be of benefit, although they were limited to 10 drops twice a day. It is a town that actually needs a massive continual overdose of homeopathy:  potable water.  Finally a real use for homeopathy.  Oddly they used an Indian homeopathic preparation and given the propensity of other Indian SCAM products to be adulterated with arsenic, I would be fatalistic as well if asked to be in the study.

CAM is placebo. Placebo  is nothing.  Therefore CAM is nothing.

Several studies out this year emphasized the concept that it is the therapeutic interaction and the patients belief that is important for the subjective (but not objective, for there are none) responses to SCAM’s,  not the specific SCAM modality.  Two nonsensical SCAM interventions had the same result.

First was homeopathy  where

Homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits for patients with active but relatively stable RA.

The other was acupuncture. It has been know that acupuncture efficacy depends in part on how strongly the patient believes it will work.  This was confirmed in a study in Pain  where patients with osteoarthritis were treated with  acupuncture, Streitberger placebo acupuncture, and mock electrical stimulation, each with empathic or nonempathic consultations. The results supported the understanding that the only thing that matters for reported outcomes with acupuncture is the patients belief in its efficacy, although one practitioner had better results than the others:

Empathic consultations did not affect pain (3.0mm, -2.2 to 8.2; P=.26) but practitioner 3 achieved greater analgesia than practitioner 2 (10.9, 3.9 to 18.0; P=.002)… The 2 placebos were equally as effective and credible as acupuncture. Needle and nonneedle placebos are equivalent. An unknown characteristic of the treating practitioner predicts outcome, as does the patient’s belief (independently).

Why do I envision a Rasputin like  practitioner getting better results?  SCAM’s, like placebo effects, are self deception by the patient and practitioner.  N-Rays all the way down.

And if it were ethical, and it is not ethical since acupuncture is nonsense, you would be able to help the undiagnosed and perhaps undiagnoseable patient with a round of supportive acupuncture:

Medically unexplained physical symptoms (MUPS) are common and difficult to treat.
To investigate the effectiveness of adding five-element acupuncture to usual care in ‘frequent attenders’ with MUPS.
Randomised controlled trial in four London general practices.
Participants were 80 adults with MUPS, consulting GPs ≥8 times/year. The intervention was individualised five-element acupuncture, ≥12 sessions, immediately (acupuncture group) and after 26 weeks (control group). The primary outcome was 26-week Measure Yourself Medical Outcome Profile (MYMOP); secondary outcomes were wellbeing (W-BQ12), EQ-5D, and GP consultation rate. Intention-to-treat analysis was used, adjusting for baseline outcomes.
Participants (80% female, mean age 50 years, mixed ethnicity) had high health-resource use. Problems were 59% musculoskeletal; 65% >1 year duration. The 26-week questionnaire response rate was 89%. Compared to baseline, the mean 26-week MYMOP improved by 1.0 (95% confidence interval [CI] = 0.4 to 1.5) in the acupuncture group and 0.6 (95% CI = 0.3 to 0.9) in the control group (adjusted mean difference: acupuncture versus control -0.6 [95% CI = -1.1 to 0] P = 0.05). Other between-group adjusted mean differences were: W-BQ12 4.4 (95% CI = 1.6 to 7.2) P = 0.002; EQ-5D index 0.03 (95% CI = -0.11 to 0.16) P = 0.70; consultation rate ratio 0.90 (95% CI = 0.70 to 1.15) P = 0.4; and number of medications 0.56 (95% CI = 0.47 to 1.6) P = 0.28. All differences favoured the acupuncture group. Imputation for missing values reduced the MYMOP adjusted mean difference to -0.4 (95% CI = -0.9 to 0.1) P = 0.12. Improvements in MYMOP and W-BQ12 were maintained at 52 weeks.
The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.”

Positive interactions with other humans is always of benefit can improve the quality of life.  As I have said before, grooming each other has salubrious effects on apes.  The benefits of SCAMs are the medical equivalent of nit picking, without the ick factor of eating the louse.

And finally, are there Florence and the Machine fans who can tell me what this study is all about?  Clinical comparative study on the influence of acupoint sticking therapy in dog days and in non-dog days to the quality of life of allergic rhinitis patients.  I thought the dog days were so over.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. 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 growing multi-media empire can be found at