A perfect crystal. Just not of ‘duh’.

Das ist nicht nur nicht richtig; es ist nicht einmal falsch!”

German sounds so sharp and final, perhaps due to all the consonants pronounced at the end of words. Neunundneunzig Luftballons is so much better than the English version.

I get all sorts of articles in my feeds and there are some, well, let’s say interesting, understandings of disease.

Acupuncture Today is an online newspaper promoting acupuncture and traditional Chinese pseudo-medicine. It is a rich vein to be mined if you want to know how acupuncturists think. Well, not so much how as what. They have over 2,500 articles and I thought I would take a quick look at one covering the treatment of sinusitis.

A view from a different universe

It is a hodgepodge of alternative understandings of physiology and disease. Let’s see what they have to offer.

The dominant medical belief that was strengthened by Pasteur’s findings purported that disease was caused by pathogens that, if eliminated, would cure the infection and its resultant symptoms.

Believe is what you do when you have no evidence. It is pretty clear as an infectious disease doctor that infections, as opposed to disease, are caused by germs and if you remove the germs then patients get better. Unlike pseudo-medicine, I can cure serious infections. There is a good reason “endocarditis treated with acupuncture” and “meningitis treated with acupuncture” have zero hits on Google. When it comes to infection, germ theory is like gravitational theory. You ignore it at your peril. And I would bet that no LAc (Licensed Acupuncturist pronounced, oddly enough, lack) would rely solely on her theatrical placebo for the treatment of any infection I take care of on a daily basis.

But forget that Germ Theory is just a theory, a myth that I discussed way back in 2008. And judging from the picture of the author at work, with a LAc of gloves while manipulating needles, a typical TCPM germ theory fan. Let’s continue with a simplistic false dichotomy that demonstrates a complete lack of understanding of the complex relationship between pathogens, commensal organisms, and the host immune system:

Pasteur’s critics argued that virulence of the microbe was not as important as resistance of the body, known at that time as the biological terrain or “milieu intérieur” (internal milieu), a concept developed by Bernard.

Pseudo-medical providers seem to think of germs and microbes, as interchangeable objects. Pseudo-medical providers also tend to act like the immune system is a monolithic thing, like a bicep, that can somehow be strengthened, as we shall see. And, as we shall also see, pseudo-medical providers seem to not understand that many organisms have evolved to infect us as their mechanism of reproduction that no amount of immunity can resist.

No one would argue that the host immune system, aka the terrain, is not important, but the interactions with germs are subtle and often beyond either clinical intervention or diagnosis. Organisms have variable virulence between genus (MRSA is more virulent than P. acnes) and within genuses (genii?) (MRSA is more virulent than MSSA) and even within strains (some MRSA are more virulent than others).

This comes as no surprise to practitioners of traditional Chinese medicine, who have long understood the concepts of “wei qi” and the transmission of pathogenic factors from the exterior of the body toward the interior.

I am glad they understand wei qi, as I sure as hell don’t.

According to one site:

In Traditional Chinese medicine (TCM), the Wei Qi circulates on the surface of the body, protecting the body from pathogens such as bacteria and viruses; this concept is loosely related to how modern medicine views the immune system and is thousands of years old. In western medicine, only viruses can cause viral infections. In Chinese medicine, viruses and other pathogens are ever present and do not generally pose a threat to health unless the Wei Qi is weak and cannot protect the body.

See? As is so often the case in pseudo-medicine, the fault lies in ourselves. As confirmed in:

holistic medicine practitioners stuck to their roots (both metaphorically and medicinally) by employing herbal therapies that lower populations of microbes while at the same time strengthening the body’s immune system. The latter strategy is also used preventively with the idea that if the body is sufficiently bolstered, a healthy individual should withstand all but the most virulent infectious diseases.

Which is just not true. No matter how bolstered, if you get exposed to measles or norovirus you WILL get infected if you have no pre-existing antibody. As to the Wei Qi? No wei.

I wonder just what is meant by lowering populations of microbes? Wiping out the normal microbiome? Knocking down the mystical ever present viruses and other pathogens? Using herbs like broad-spectrum antibiotics? If it were possible, and fortunately it isn’t, herbs would be a bad idea.

And the concept of ‘strengthening the immune system’ is as non-specific as it is futile. What are they going to do? Increase antibody levels? Improve WBC function? Get rid of dangerous polymorphisms in Toll-like receptors? Increasing cytokines? Activating platelet-derived cationic proteins? Puh-leaze.

None of that is likely. Probably just going to make the nonexistent wei qi work better. As I have said before, if a pseudo-medicine could really boost the immune system they would be inducing an inflammatory response, which could be dangerous as well, perhaps leading to stroke, heart attack, and pulmonary embolism. Don’t mess with the immune system. It will bite back.

…there is always a portion of the population exposed to a pathogenic factor that does not contract the expected illness. We see patients who catch every cold that comes along and others who seem miraculously immune.

Such a simplistic understanding of disease. Not everyone is exposed to contagion, or at the right inoculum, some have preexisting immunity, and some have polymorphisms that render them resistant. They are many reasons people may not get an infection but I suppose if you LAc understanding of medicine it would seem a miracle. As Arthur C. Clark said (kind of), “Any sufficiently advanced physiology is indistinguishable from magic”.

The author doesn’t seem to recognize, at least with clear language, the difference between chronic and recurrent sinusitis and the different reasons people get symptomatic sinusitis.

They suggest two approaches. The first is boosting the immune system.

…we can provide acupuncture and herbal therapy. Yu Ping Feng San and high-potency Echinacea angustifolia root are an excellent combination for long-term immune support.

Yu Ping Feng San, based on what few articles I could find is, if anything, an anti-inflammatory, which in the real world, is considered immunosuppressive and the only clinical trial is in allergic, not infectious, rhinitis. There is no reason by prior plausibility to think an herbal concoction couldn’t have anti-inflammatory effects, especially given the habit of the herbal preparations to be adulterated with real medications. But only in the world of pseudo-medicine would an immune suppressant anti-inflammatory perhaps useful for allergic rhinitis be touted as an immune booster for infection. Another LAc of understanding. Yes, I can beat a pun to death. I LAc the self-control. But I am avoiding all the ‘point’ and ‘needle’ and ‘stick’ puns so beloved by headline writers.

And the data is clear. Echinacea LAcs efficacy.

Echinacea products have not here been shown to provide benefits for treating colds, although, it is possible there is a weak benefit from some Echinacea products: the results of individual prophylaxis trials consistently show positive (if non-significant) trends, although potential effects are of questionable clinical relevance.

But the LAc of understanding continues.

A biofilm is a colony of microbes banded together and adhered to the lining of epithelial tissue, the formation of which may persist along the sinus passages in a patient suffering from chronic infections.

Not quite. Biofilms are a notorious virulence factor, but important in biofilms is the extracellular matrix made by the organisms. Key phrase there. Made by the organism. Not:

Stubborn biofilms are often the result of lifestyle factors that predispose a person to their growth. One of the most common in the ear, nose, and throat area is the consumption of dairy, especially pasteurized dairy, in individuals who tend to accumulate phlegm from eating cheese or drinking milk.

Phlegm is not biofilm. Oh, and milk/dairy LAcs the ability to increase mucous, much less make biofilm:

Milk and dairy product intake was not associated with an increase in upper or lower respiratory tract symptoms of congestion or nasal secretion weight. A trend was observed for cough, when present, to be loose with increasing milk and dairy product intake; however, this effect was not statistically significant at the 5% level. Those who believe “milk makes mucus” or reduce milk intake with colds reported significantly more cough and congestion symptoms, but they did not produce higher levels of nasal secretions. We conclude that no statistically significant overall association can be detected between milk and dairy product intake and symptoms of mucus production in healthy adults, either asymptomatic or symptomatic, with rhinovirus infection.

The author LAcs the understanding that mucous production is not the reason for biofilm.

The second part of treatment is targeted herbal therapy to lower populations of pathogenic microbes that are overwhelming the body. Antibiotic therapy will do this but at a cost.

Yeah. The cost of efficacy.

Antibiotics pose a risk to our gut microbiome, predisposing us to a buildup of pathogenic yeasts that are unaffected by antibiotics.

The author evidently believes in the fictional yeast connection, a disease that has the same support as phone tapping. While there are many potential downsides to antibiotics, the idea of the Candida syndrome LAcs a connection with reality (and yes, I know about thrush etc.)

If antibiotics are prescribed without confirming the nature of the infection by culturing a swab test

I think he means

If antibiotics are prescribed without confirming the nature of the infection by culture with a swab

aAthough perhaps not given the preceding LAc of clear understanding. Or it was just LAckadaisical editing.

We can never fully eliminate these bugs from our system

Well, actually we can. Pathogens are usually eradicated once the infection has resolved.

Then he finishes with the Kellyanne alternative fact:

Looking back, we come to an interesting twist of fate at the end of their story as on Pasteur’s deathbed he came to finally admit that Bernard was right by stating, “The microbe is nothing, the terrain is everything.”

Dude. There is an internet. You can look it up. If you are in the job of having evidence.

Louis Pasteur died on Sept. 28, 1895. His last words were, “One must work; one must work, I have done what I could.”

A LAcluster article from Acupuncture Today. A pure crystal.

Like, if you just take all of the stupid and just cook it down, and then scrape just the pure ignorance. Like crystal “duh.” It’s like crystal “duh.” —Jon Stewart, The Daily Show

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