Tag Archives: skeptic

ALS Pseudoscience: What Quacks Won’t Tell You

I have yet to hear one argument against the ALS icebucket challenge that isn’t either fundamentally flawed, or simply petty when put next to the giant sum of money that has been raised to help sufferers of one of the most brutal and relentless diseases that can befall a human being. 

This post, however, is not about the absurdity (or hypocrisy) of criticising the challenge on the basis of clean water shortage in the third world, or the fact that the uncomfortable symptoms of “FB peer-pressure” tend to dissipate naturally over a short period of time, whereas ALS causes an inexorable disabling of all the body’s faculties until the sufferer can no longer breathe on their own, and results in death, always. No, this is about medical pseudoscience at its very, very worst. And I’ve seen it shared by some pretty sensible people, which has been disturbing. To those people: 

Please be aware that most articles posted on social media that talk about health, disease or science, are BULLSHIT. A good rule of thumb is to type the author’s name into Google followed by the word ‘skeptic’. Then do the same with the word ‘rational’, ‘quack’ (or ‘quackery’), ‘debunked’ and ‘pseudoscience’. Repeat this process for the name of the website, and key words from in the article.

I was ‘inspired’ to write on the subject of ALS charlatanism by this profoundly misleading article, authored by conspiracy-mongering pseudowhistleblower and all-round crank Anthony Gucciardi. The article is first and foremost a libellous denigration of the ALSA. He couples this with a few references to some cherry-picked studies he either hasn’t read or doesn’t understand, which he uses for the purposes of implying, strongly, that  ALS is a disease which can be easily prevented or reversed through diet. Hint: it isn’t. The most flabbergasting aspect of Gucciardi’s article is how outrageously, wantonly, and shamelessly lazy (or calculatedly deceitful?) a mere couple of clicks around the ALSA’s website reveals him to have been.

I’ll be focusing mostly on what Gucciardi has actually written, though I will broaden the discussion at times. I would also point out that numerous members of the ‘alternative’ crowd, such as Joseph Mercola, have posted articles or videos encouraging members of the public not to donate to the ALSA – the whole incestuous ‘alterweb’ is buzzing with them. Take your pick – they are mostly variations on one quack theme: don’t give money to ALS charities; buy our supplements instead. 

Disclaimer

What follows is a long article, and no doubt there will be sections that for some readers will represent a case of tl;dr. That’s fine. I just wanted to be as thorough as possible, because that’s what I think this topic deserves. So I’ve said everything I think needed to be said. I could have summed the whole thing up like this: “Gucciardi and his cronies are spreading misinformation about the charity they are publicly slamming, and if you want to verify that for yourself, all you need to do is to do is visit the ALS Association’s website. None of the studies he cites say what he thinks they say and, in any case, knowing a few risk factors for a complex disease doesn’t mean the disease is preventable or reversible. Furthermore, what is he doing citing scientific studies when they come from institutions that are just as (inevitably) tied up with the pharmaceutical industry as the ALS Association is? His article and the principles upon which it is based are a mess of double standards and illogic. He’s out of his depth and I think he knows it. Next!” But if I did that, I’d only end up having to write a patchwork version of my essay in the comments thread anyway. Instead, I will now be able to refer commenters to relevant sections, if they respond in disagreement, having not read them.

Who is Anthony Gucciardi?

To give you a better idea of the kind of person we’re talking about here — and I highly recommend following some of these links if you are new to medical pseudoscience — Gucciardi is a frequent guest on Infowars (a show hosted by Alex Jones, who is quite possibly the most deluded person in the world), a writer for Natural News (known to be the Internet’s #1 anti-science website), and a specialist in grossly misrepresenting scientific studies, often with the aid of outright lies. Here is a crystal-clear demonstration of him wilfully and grossly misrepresenting a fluoride study; here is a discussion about him and Mike Adams proudly exhibiting their failure to grasp basic scientific concepts (while ‘critiquing’ a scientific paper); here is documentation of him spreading falsehoods about vaccines; and here is a report of lies he’s told about five further topics. He is the founder of naturalsociety.com and storyleak.com, where he publishes re-cycled myths and long-debunked conspiracy theories dressed up as STUNNING NEW INFO.

Who is Sayer Ji?

In his article, Gucciardi references this almost identical blog post on the ALS icebucket challenge, by Sayer Ji, founder of GreenMedInfo, another hive of quackery. Just like Natural News, GMI deals in regurgitated anti-vaccine myths, dangerous misinformation about chronic diseases like diabetes, and all things anti-science and anti-medicine. In order to legitimise his career in cherry-picking, Sayer Ji labels objections to this abuse of the scientific literature as ‘scientism’. He buys into just about every conspiracy theory on the market, compiling and proudly presenting them as  “conspiracy factualities.” He denounces evidence-based medicine, calling it nothing more than a “coin’s flip of certainty”, something for which he was rightly ridiculed by science blogger and surgical oncologist David Gorski.

Though it includes much more extensive (professional-standard!) cherry-picking, Sayer Ji’s article doesn’t add anything qualitative to Gucciardi’s, so my focus will remain mostly on that. However, this is arbitrary, resulting from the fact that I discovered Gucciardi’s first. I will comment on Sayer Ji’s misinformation campaign at the end, because I think it will be doing more damage than Gucciardi’s, and is arguably a couple of orders of magnitude more disgraceful.

To any scientifically-literate person, especially anybody with an understanding of complex disease (on which more later), it is plain as day that Gucciardi’s and Ji’s take on ALS stems from ignorance and delusion. But I dread to think how many well-meaning people without the necessary background knowledge to see this will have been roped in by their sleazy impersonations of people who know what the hell they’re talking about.

Rebutting attacks against the ALS Association

The opening section of Gucciardi’s article revolves around a pie chart published by the ALSA on their website, displaying the various ways in which their finances were allocated, and in what proportions, over the financial year ending January 2014.

Gucciardi introduces his pseudo-exposé with the heading:

“$95 Million Later: Only 27% Of Donations Actually Help ‘Research The Cure’”

fye2014But of course the pie chart tells us nothing about how the ice bucket donations will be used. It tells us how the ALSA apportioned their funds last year, when they had about $25 million to work with. There is no reason to expect the slices of this pie to increase proportionately with respect to one another in the wake of a sudden influx of over $100 million. And besides, there is a button you can press when you make your donation, if you want 100% of it to go to research. The unctuous preface for the paragraph headed by this baseless claim reads, “But don’t just take my word for it”. Well, thanks, Anthony, we won’t.

Readers should be aware that the ALSA made a correction to this pie chart. The one shown here is correct.

Since ALS is currently incurable (and care for a patient can cost upwards of $200K per year), one of the single most important resources for patients and their families is access to support, which the ALSA calls patient and community services. In his piece, Gucciardi mentions twice that even more important than supporting local communities “the spread of information.” What, you mean, like, public and professional education, Anthony? You know, that thing represented by the largest slice of the pie you just shat all over?

Just so we’re really clear on this, there absolutely is no grand secret being revealed here. If he had bothered to look, Gucciardi would have seen that the official remit of the ALSA’s charitable work is three-pronged, entailing research, patient services, and education.

So, this leaves only two slices that don’t represent one of the ALS Association’s core activities, as declared in their manifesto. These core activities, incredibly, cost money. (I know, right?) There’s a name for the systematic gathering of money. It’s called fundraising. The more you publicise your cause, the more funds you’re likely to raise. Being a businessman, Anthony, presumably you are aware of the costs associated with publicity. One slice left.

Where Gucciardi really goes to town is with administration costs, particularly via his having copied and pasted the salary figures for the ALS Association’s executives, including — gasp! — the CEO’s salary of $339,475. He has this to say on the matter:

“And let’s be clear: I am a huge proponent of prosperity and business expansion. When it comes to private business and commerce, it benefits us all to see growing numbers among a company and its members. This, however, is not the case for a ‘non-profit’ organization that is based around the concept of ‘searching for the cure’ and ‘funding research’ as its primary goal. Especially when this organization is being funded with close to 100 million dollars through a viral social media campaign in which it appears no one truly took the time to investigate the very company they are shoveling their assets into.” [Emphasis his]

Congratulations, Anthony, on finding such a convenient way to cover your back: It’s perfectly virtuous to want to earn a large salary, but if you accept one and play an instrumental role in the running of an organisation that works directly to improve the lives of other people, then you become immoral. Duh!

Good logic right there.

I fail to see how it could be the case that “when it comes to private business and commerce, it benefits us all to see growing numbers among a company and its membersbut when it comes to the non-profit sector, it doesn’t. I’d say that the downstream effects of charity CEOs having substantial financial incentives are probably much more beneficial “to us all” than are the consequences of private business CEOs having them. Gucciardi seems to be expressing a feeling, apparently shared by many, that someone who heads a charitable organisation ought to have no desire to earn a good living – that there is something hypocritical about accepting a good wage if you’re receiving that wage from the non-profit sector. Personally, I’d say that someone who earns a six-figure salary heading a furniture (or supplement) company deserves fewer ethical brownie-points than someone earning the same amount of money via activities that directly help people with a crippling disease. As devil’s advocate, I’d turn the tables and say of those working in the profit sector that not only are they not working to improve the lives of others, but they’re also accepting a large wage! Shocking!

If you object to large salaries per se, given how many people in the world live in poverty, then I’d suggest that your campaigning efforts would be better directed towards people who have hundreds of billions of dollars squirreled away in vaults, doing nothing; you know, that 1% of people who control half of the world’s ‘wealth’, in the form of little bits of paper. If you’re coming at this from a Marxist perspective (which Gucciardi clearly isn’t, since he expressly doesn’t object to “growing numbers” in the profit sector) then forgive me but you seem to be forsaking one of your own core principles: what $300K a year can buy you under our current system is within what the world could theoretically provide for every person living in it. If you’re attacking this individual CEO, you’re doing it because the opportunity to do so has been served up for you on a plate; not because you’re an activist. Every minute you spend attacking this person is a minute you could have spent campaigning against real corporate juggernauts. It’s a simple case of lazy scapegoating.

Besides, the moral status of this one person is not the relevant issue. We have to think of this from the perspective of the ALSA, which has an official moral duty to perform as well as it can. To make a large-scale charity as innovative and successful as possible, you need a leader with maximum experience, business know-how, connections, and an intimate knowledge of the sector’s infrastructure and dynamics, working full-time. In other words, you need a CEO who can command a high salary. One could just as well argue that it would be immoral for the ALSA to scrimp on such an integral component of their organisation. The ALSA do not set salary standards  – it’s not their fault that high-level CEOs are in a high wage-bracket.

In a document addressing the various accusations levied against them by misguided characters from the ‘alternative’ crowd, the ALS Association writes:

The salaries of our executive staff are in line with the job markets where they are located—and in line with those of other national charities. Salary review is part of the accreditation process for the watch dogs mentioned above and is a requirement of the National Health Council (NHC), of which we are a member. In fact, The ALS Association is the only ALS charity that has qualified for membership. Read what this journalist has to say about The ALS Association’s executive salaries: “they are all well within the range of nonprofit salaries; the compensation for ALSA’s CEO compares favorably with that of his peers, including some who run low-performing nonprofits.” [Emphasis my own.]

As his final word on the way in which the ALS Association spends its funds, Gucciardi references Sayer Ji, who he says

“points out in his breakdown of the ice bucket phenomenon [that] even the smaller portions spent on ‘research’ for ALS are actually going towards pharmaceutical interventions and the pharmaceutical industry at large.” [Emphasis my own]

So, after all that fuss about not enough money going towards research, Gucciardi reveals that he doesn’t support research anyway. Sigh.

In any case, this statement is absolute bullshit. There is no evidence that the ALSA give money to “the pharmaceutical industry at large”, much less that the money they spend goes there rather than on research.

The ALSA’s research and its links to ‘big pharma’

One of the things the ALSA do is award grants to independent scientists who can demonstrate strong scientific merit and present promising research proposals, through their Investigator-Initiated Research Grant Program. I had a look through the grants that the ALSA have awarded to past and ongoing studies as part of this initiative. Gucciardi either didn’t bother, or is simply a liar – evidenced by the fact that:

Nearly all of them have been awarded to researchers looking at care protocol and equipment. Things like how to measure respiratory impairment and assist ventilation in the best way, how best to support patients nutritionally, keep their muscles moving, support their families, and generally maximise their quality of life. In other words, NOT pharmacological interventions. Of the eighteen grants awarded over the last several years, as far as I could tell, only two have been for pharmacological studies. One of these looked at whether the substance used in botox treatments could help prevent patients drooling, and the other (prepare yourself for some truly savage irony) was on…

*drumroll*

THC.

Amazing, isn’t it? The alternative crowd devote all that time to criticising “the medical industry” for not funding research on cannabinoids, because “pharma companies aren’t interested in something they can’t profit from it”. And then they’re so blinkered in their approach, so damned lazy, and so lacking in even the measliest morsel of integrity that they end up actively dissuading people from supporting one of the very few institutions that actually happens to have done so. One of Gucciardi’s other ‘articles’ is entitled Cannabis Treatment Threatens Deadly Painkiller Industry. The THC study that the ALSA funded through their grant scheme was on whether it could reduce painful cramps in ALS sufferers. This calls for a *facepalm*. Ouch, that one’s going to bruise.

The ALSA are also currently recruiting for a clinical trial they’ve funded to ascertain whether THC helps with spasticity. I found it using this search tool (via the ALSA’s website), which can pull up a list of all the clinical trials they’ve ever funded. Again, only a small fraction of these studies are on pharmacological interventions, because, unfortunately, our understanding of ALS is still not good enough for there to be lots of potential drugs discovered and ready to test. Part of the reason for this is that ALS is a rare disease, so it’s not an attractive research area for pharmaceutical companies. Which is precisely why charities like the ALSA end up contributing towards the cost of clinical trials on the very few drugs that are worth investigating.

It is true that if a new drug were shown to be effective in treating ALS, pharmaceutical companies would manufacture it, and benefit (though on a relatively small scale). It is also true that pharmaceutical companies certainly deserve the (intelligent) criticism they have received (though things really are improving). However, all too often, a vague, hand-waving mention of “big pharma” is used as an opportunity and justification to dismiss medicine all together, which is a terrible mistake.

The two main prongs of argument against pharmaceutical companies surround 1) transparency and 2) profiteering. Regarding transparency, pharma studies that have been part-funded by an independent organisation like ALSA should garner less, not more, suspicion than those which are purely industry-funded. And with respect to profiteering, if you don’t like the fact that medicine is tied up with this, then you need to be campaigning against our political system in the large – against the privatisation of medicine, and against capitalism, at least in its current form. Campaigning against pharmaceuticals per se, like the alt-med crowd do, is bad reasoning at best, and outright hypocrisy at worst, namely when it concludes — as it usually does — with “so, buy our health products instead!”

Drug discovery requires large numbers of scientists, doing difficult science, working full-time jobs. Pharma companies do have enormous incomes, but they also have enormous expenses. Getting a drug approved costs about a billion dollars. (Even if every penny of the icebucket challenge’s $100 million were handed over to big pharma, it would represent but a teeny drop in this ocean.)

Many of the arguments used by pro-alt-med bloggers and commenters break down when you consider countries that offer universal healthcare. But wherever you’re from, and whatever you feel about the privatisation of medicine, or capitalism in general, pharmaceutical companies are currently the only organisations that are able to properly test and manufacture drugs, and drugs are what ALS sufferers desperately need because unfortunately…

ALS Cannot be Cured ‘Naturally’

We should start this section with a brief consideration of complex diseases, which can be contrasted with ‘simple’ Mendelian disorders with clear inheritance patterns like Huntington’s disease, that result from a single mutation with powerful a effect whereby if you have the gene, you will get the disease.

Heart disease is an archetypal example of a complex disease. It is weakly associated with heaps of common genes, as well as various environmental risk factors that seem, statistically-speaking, to slightly increase a person’s risk of becoming a sufferer. Like other complex diseases (such as arthritis, most cancers, and ALS), it doesn’t usually have clear, straight-forward inheritance patterns, though it does often run in families.

However, as with cancer, where some rare genes confer a greatly increased — or even 100% — risk of developing disease, there are some rare genes which are very strongly associated with ALS and, like all genes, they are heritable. Inherited forms of ALS are called ‘familial ALS’, and account for about 10% of all ALS cases. Roughly half of these cases can be explained by around 17 known genes. (Some are discussed by the ALSA on their website, and a comprehensive database of all genes which have been found to be linked to ALS can be found here.)

To give an example, depending on which population you look at, between 20% and 40% of familial ALS cases are caused by inherited mutations (in this case, repetitions) of a gene called C9ORF72. (An inherited mutation is often just called ‘a gene’, which can be confusing.) This gene was discovered recently through studies conducted by two different research groups, independently of each other. Both were funded by the ALS Association.

Importantly, however, as this twin study, and this (free) paper on ALS as a genetic disease point out, the distinction between spontaneous and familial ALS is largely artificial. This starts to make sense if you think of ALS-causing genes as sitting on a continuum of effect-size, or ‘penetrance‘. At one end are genes with complete penetrance, which are certain to manifest in ALS, like the C9ORF72 repeat expansion discussed above. As you move along the spectrum, certainty becomes likeliness, which gradually peters out, with associations becoming ever weaker. (Also, de novo mutations — occurring spontaneously during the very early stages of development, rather than being inherited from a parent — can produce the same effects as inherited ones.)

The evidence we have points towards a ‘liability threshold’ model of ALS, under which disease manifests only once a critical tipping point has been reached. Everyone is born with a pre-determined genetic liability and, over time, this liability can be modulated by the environment. The fewer environmental risk factors you are exposed to, the less likely you are to reach the tipping point, provided your initial genetic liability, or ‘genetic load’ isn’t so high in the first place as to completely flood the effects of environmental influences.

There is an enormous variety of ways in which one might reach the threshold. The ‘easiest’ way is to carry a gene from right at the top end of the effect-size spectrum. But you could also do it by carrying lots of genes from somewhere in the second quartile of the continuum, and then exposing yourself to some environmental risk factors. Or you could do it by carrying a very, very large number of genes right from the low end of the spectrum.

And here’s the thing. It is much, much, much easier to identify genes that greatly increase disease liability, compared to genes that only increase it a little bit. These big bruisers ‘stand out’ when you compare large enough samples of cases (ALS patients) with samples of controls (people without the disease). But the potentially huge number of mutations that ever-so-slightly increase ALS risk sink into the background and are virtually impossible to distinguish from random ‘noise’, since they are each found almost just as often in healthy controls as they are in ALS cases – it is their collective presence in a person’s genome that causes disease. However, these low-penetrance genes are just as heritable as genes with high or complete penetrance.

Genetic material is shuffled and split in half during reproduction. In the case of one, fully penetrant gene that is sufficient to cause ALS without the ‘help’ of others, or of environmental factors, since a sperm or egg either ends up with this gene or not, the resulting person is either destined to develop the disease, or not, manifesting in a classic Mendelian inheritance pattern (autosomal dominant, for C9ORF72 mutations). When we’re talking about a large number of low-penetrance genes, however, a sperm or egg could, by chance, end up with anything from 0% to 100% of those genes (50% on average). This can explain the fact that we often see striking familial clustering of ALS cases, despite the fact that none of the 17 big genetic players are contained within their DNA – something that is enhanced by the fact that people from the same families tend to have more shared environmental influences than two people picked at random.

You could also inherit ‘sporadic’ ALS in the absence of any family history, if the combination of genes you inherit from your parents happens to place you at or beyond that threshold, even though neither of them were particularly close to it themselves.

To make things even more unpredictable and hard to shed light on, genes modulate other genes. And they often act differently depending on which other genes they end up with. Different versions of the same gene can also interact differently with the same environment and, conversely, a single gene variant can act differently in different environments. It is feasible that the same environmental factor could increase or decrease your risk of ALS, depending on what your genome looked like.

All this ferocious complexity is part of the reason why studies looking at environmental risk factors for ALS have been inconsistent in their results, with some finding associations, and others failing to reproduce these. It is also immensely difficult to tease out causation in a world teeming with correlation, or to eliminate the numerous forms of bias which can so easily creep into observational studies (as opposed to randomised, controlled trials). Finally, publication bias skews the picture too. Some associations that have been flagged up will turn out to be spurious; others will turn out to be explained by other, unseen variables. Others won’t be found, even though they really do exist. Please keep this in mind as you read the rest of this article.

Gucciardi’s cherry-picking trip

Starts with:

“Numerous studies available through the United States National Library of Medicine have demonstrated the natural preventative effects of key substances…

Vitamin E: Shown by research to exhibit a whopping 50-60% decreased risk of developing ALS when taken alongside powerful polyunsaturated fatty acids.”

The vitamin E research Gucciardi is referring to was headed by Jan H. Veldink, who is based at the University Medical Centre, Utrecht. The UMCU is one of the partners of Euro-MOTOR: European multidisciplinary ALS network identification to cure motor neurone degeneration. Also based there are Bryan J. Traynor, who headed the ALSA-funded Netherlands study that identified the role of C9ORF72 in familial ALS, and Leonard H. van den Berg, who was awarded a $25,000 research grant by the ALSA. After telling people to shun the ALSA because of its connections to the pharmaceutical industry, Gucciardi shows that he is nonetheless happy to cite studies that are connected to the ALSA (and, of course, to the pharmaceutical industry too, in similar ways to the ALSA), so long as he reckons they can slot nicely into his ideology.

Irrespective of the quality of the vitamin E/ALS research he cites, a reduced risk does not equate to a preventative, and in any case applies at a population level, though as we’ve seen, some individuals are born with a 100% risk of developing ALS, regardless of environment. What about them? Don’t they deserve access to the drugs that might be discovered through pharmacological research?

Critically evaluating individual studies was not what I set out to do here. I mentioned earlier that there are various inherent weaknesses of observational studies, and I would have left it at that, but since this study is being flaunted so widely (it features on GreenMedInfo too, and therefore on scores of other popular alternative/conspiracy websites), I couldn’t help but feel that a brief critique was warranted.

Not that the authors claim it is, but we should be clear that this study is not a randomised trial. The researchers didn’t give one group of people vitamin E and polyunsaturates and one group a placebo and then wait to see whether either group had higher rates of ALS. They sent questionnaires to patients in clinics, both ALS and healthy, asking them to “recall their dietary habits during the period 1 year before the onset of muscle weakness or bulbar signs”. Then, amongst 15 micronutrients, they looked for associations with ALS. The authors apparently did not apply a correction for multiple comparisons, which is a serious oversight, and it makes the study seem like something of a fishing expedition, since the more things you compare, the more likely you are to get a ‘significant’ result, just by chance. This is called a ‘false discovery’. One would expect the false discovery rate (FDR) to be pretty high with this many comparisons.

There is a later vitamin E study, cited by Sayer Ji but not by Gucciardi, that pools five datasets (including the one just discussed). However, it too appears to lack statistical rigour. The researchers found that, overall, vitamin E did not reduce risk of ALS (in fact, there appeared to be a slightly higher risk of ALS in vitamin E supplement users – though to be clear, this does not provide evidence that vitamin A actually increases risk of ALS). However, when they then looked at the (very small!) datasets that included information on the duration of use, they found a significant trend. But to get their significant results, it seems that the authors had to run various different analyses on their data, reorganising it for the purpose (and apparently without making FDR adjustments). For a discussion of the problems with re-arranging and re-analysing data, see chapter 4 of Ben Goldacre’s Bad Pharma, especially the sections called Dodgy subgroup analyses and Dodgy subgroups of trials rather than patients.

From that chapter: “If your drug didn’t win overall in your trial, you can chop up the data in lots of different ways, to try and see if it won in a subgroup: maybe it works brilliantly in Chinese men between fifty-six and seventy-one. This is as stupid as playing ‘Best of three … Best of five … ‘ And yet it is commonplace.”

The most recent study on vitamin E and ALS was a randomised clinical trial conducted in Finland, and the researchers did more than just measure ALS risk – they also measured subjects’ serum vitamin E levels (how much of it people had in their blood) at the beginning of the trial. Overall, they found that vitamin E supplementation did not significantly mitigate risk for ALS. However, when the data was split in half along the mid-point (median) to produce one group of subjects who, prior to the trial, had higher vitamin E serum levels and one group who started with lower levels, they found that in the lower group, supplementation did confer a reduction in risk. But the study doesn’t tell us about the finer-grained relative-risk distribution; the data was simply cut in half along the mid-point.

The interpretation of this study most likely to be correct is that ALS is associated with vitamin E deficiency and that only the people right at the bottom of the low-serum group (people who had levels far lower than the median) benefited from vitamin E supplementation. This seems most likely for two reasons:

  • This study looked at ~ 30,000 people. The fact that their overall results weren’t significant, despite such a large sample size, suggests that there were very few people within it for whom supplementation had any effect (which is parsimonious with the fact that vitamin deficiency in 1st world countries is rare), but that in those people, since there was very a real initial risk to begin with, vitamin E had a significant enough effect to be detectable even when diluted by the rest of the group.
  • Vitamin deficiencies are bad news for the human body. We already know that vitamin E deficiency can cause neurological issues, so this observation is not surprising.

In other words, the most rigorous study we have on vitamin E and ALS does not provide any evidence that the average person will reduce their risk of ALS by increasing their vitamin E intake, despite Sayer Ji having included it in the collection of cherry-picked articles he has put together and posted on his supplement-pushing website.

Gucciardi continues:

Vitamin B12: Demonstrated by scientific study to be highly beneficial in the aid and understanding of ALS. In fact, PubMed research specifically reveals the integral usage of vitamin B12 in ALS research:”

Now, perhaps this is petty of me but I can’t resist pointing out how silly referring to a study as “PubMed research” makes Gucciardi look. PubMed is a search engine. Not a research outfit. And if that’s what he thought it was, again, what was he doing citing its research? “PubMed research” is a wellspring of industry-funded studies.

This study did not demonstrate vitamin B12 to be “highly beneficial in the aid and understanding of ALS”. What does that even mean? The idea that the study “reveals the integral usage of vitamin B12 in ALS research” came from Gucciardi’s head (or arse, depending on how you look at it). This wasn’t a study about studying ALS and how useful vitamin B12 has been for that. It was a study with a very specific remit, looking at the effect of ultrahigh-dose vitamin B12 on compound muscle action potentials (CMAP) in ALS sufferers. To achieve significant results, the investigators had to give patients roughly 17,000 times the recommended daily allowance (RDA). There is little evidence that vit B12 is toxic even at this level, but it’s all by the by really, since the authors of the study are careful to point out that “CMAP improvement, as demonstrated in this study, needs to be interpreted with caution, because it may not reflect clinical muscle wasting or weakness. Moreover, this transient effect does not necessarily lead to retardation of the disease process.”

In other words, this study does NOT provide evidence that vitamin B12 helps to reduce the risk of getting ALS, nor does it provide evidence that vitamin B12 prolongs the lives of those who have ALS. And it certainly, absolutely, totally does not suggest that vitamin B12 can cure, or will ever be able to cure, this disease.

“And the list goes on”, says Gucciardi.

(What, you mean, the list of studies that don’t say what you think they say?)

It should be pointed out that even if a ‘natural’ substance were one day found to be useful in ALS treatment, this would not make it superior to, or even meaningfully different from, man-made treatments. As neurologist Steve Novella points out, herbs are drugs. Furthermore, about 50% of all pharmaceutical medicines on the market are derived from nature.

He continues: “But what’s even more important to consider is the lack of information regarding the actual cause of ALS, which may be even more valuable to many sufferers.” [Emphasis his.]

Notice “cause”, singular. A typo? Who knows.

Let’s have a quick glance at the ALS Association’s website. Oh look. A section devoted to possible environmental causes and another to the genetic causes of ALS. Hmmm. Now let’s type ‘ALS’ into Wikipedia. Oh look. A section all about the multifactorial causes of ALS, which references a systematic review of what we know about lifestyle and its links to ALS. Let’s see what happens when we type ’causes of ALS’ into Google. Funny, that. I seem to have found an enormous list of results.

He goes on: “Looking to the research we find an extensive list of culprits that can be identified and reduced, including:

1) Pesticides: Not mentioned by the ALS Association, a number of studies have drawn links between ALS and pesticide exposure.”

It’s really, really hard not to explode with swear-words at this point, as Gucciardi flaunts, yet again, his scandalously irresponsible failure perform a few clicks around the website of the organisation he is publicly denigrating. This really is an unambiguous case of

Libel.

Pesticides ARE mentioned by the ALS Association. You know what else? The ALSA have FUNDED RESEARCH ON PESTICIDES AND ALS. 

Signs of an association between pesticides and ALS are found amongst people who, because of their occupation, are directly exposed to pesticides. For instance, farmers. There is no evidence whatsoever that normal exposure (ie, from residues on fruit and vegetables) is harmful. In fact, there is even some evidence to suggest that low exposure might be good for us. Oh, and, by the way, organic pesticides are just as toxic as synthetic ones. They are also less effective, resulting in their being used in higher quantities.

The next item on his list reads:

2) Lead: Often contaminating the food supply and foreign products, 4 studies have demonstrated a relationship between lead and ALS at large.”

In 2009, a systematic review of the evidence surrounding lead as a risk factor for ALS was published. It looked at 50 studies on lead, mercury, aluminium, cadmium, manganese and selenium, and found no evidence of a causal relationship between any of these and ALS.

Since then, some other studies have supported a link between lead and ALS, but the researchers make it clear that this excess risk could by no means be enough to account for ALS, representing just one factor amidst a sea of genetic and possible environmental influences. Indeed, if lead were a particularly powerful causative agent in ALS, we would expect this to have shown up unambiguously the 2009 review. Furthermore, lead exposure in developed countries (like the ones in which readers of Natural Society and Storyleak reside) has been greatly reduced through public policy, especially during the last few decades, as a result of lead-reduction programmes.

Intriguingly, lead exposure actually holds some promise for therapy in ALS sufferers, since it seems to reduce motor neurone loss and slow the progression of the disease in mice. Life is complicated. Much more so than Gucciardi and his posse give it credit for.

And the final thing he claims ’causes’ ALS:

3) Statin Drugs: You may already be well aware of the dangers surrounding statin drugs, in which case this may not surprise you. ALS has been identified as a possible side effect of these drugs that aim to reduce cholesterol.”

This review of all the studies looking at statins and ALS points out fundamental problems with the available studies finding an association, including several very serious limitations of the study Gucciardi links to, which the authors themselves acknowledge, conceding that their research does not provide actual quantitative support for an association between statins and ALS. The paper most certainly does not make the claim that ALS is a “side-effect” of statins. Grrrrrrr!!!

The authors of the 2009 review point out that the only rigorous study on statins and ALS to date did not find an association, which is parsimonious with the observation that, since the 90s, statin use amongst 60-to 69-year-olds has gone up from 5% to 50% in men and 33% in females, and yet, when increased life-span is taken into account, there is no evidence that rates of ALS have risen since then.

Anthony wants us all to know, in no uncertain terms, just how thoroughly bloody wonderful he is.

He writes:

“Earlier this year, I found out about a Washington native named Ben Charles whose charity had been shut down by beauracratic [sic] government officials — even going as far as to threaten Ben with arrest for feeding the homeless on the streets of Olympia. Concerned about this issue, I further reached out to Ben back in early December of 2013, documenting the government crackdown on his initiatives and others.

Later that month, I gave another church that was targeted by the government for handing out turkeys on Thanksgiving a $1,000 donation in order to purchase additional food items (specifically turkey) and distribute it among those who needed it in the area — a proverbial middle finger to the bureaucratic park rangers and officers who sought to shut them down. This was also done as an initiative to drive others to do the same.

Now, amid yet another social media donation campaign that has led to almost 100 million going ‘towards the cure’, I am inspired (and want to inspire others) to give to a charity that really gives directly to the people it seeks to serve. That’s why I am giving $2,000 to Ben Charles and his grassroots ‘Crazy Faith’ food program in Olympia, Washington in order to help feed hundreds of homeless individuals on the streets with healthful food items.”

[Emphasis his!!!]

When I read this ingratiating report of how much money Gucciardi has personally given to charity (a report that Storyleak (ie. Gucciardi himself) has made into a headline that appeared as an enormous banner on the site for a couple of weeks), I wondered whether the whole article had been a pretext to lord his magnanimity over us.

I learnt in Gucciardi’s biography (see note at end of article) that one of his favourite bible verses is Psalm 94:16: “Who will rise up for me against the evildoers? or who will stand up for me against the workers of iniquity?” [sic]

I wonder what he feels about Matthew 6:1-4: “When you give to the needy, sound no trumpet before you, as the hypocrites do in the synagogues and in the streets, that they may be praised by others. Truly, I say to you, they have received their reward. But when you give to the needy, do not let your left hand know what your right hand is doing, so that your giving may be in secret.”

Gucciardi concludes:

Whether or not you have the funds available to support your local communities, what’s even more important is the spread of information. If everyone donating to the ALS Association actually took the time to share key articles such as those highlighting the dangers of ALS-linked toxic substances, or those discussing the power of natural alternatives to ALS treatment, millions would be helped within hours.” [Emphasis his]

I hope that this article has made it clear that what Gucciardi is doing, and encouraging others to do, is hurting people, rather than helping them, because what he is spreading isn’t information but misinformation.

GreenMedInfo – Competing with Natural News for #1 spot in the World’s Worst Anti-Science Websites Hall of Shame 

Sayer Ji, whose fast-growing website has an estimated net worth of $189,000, is getting around 90K page views per day, and making around 8K per month in advertising, is running a particularly appalling ALS misinformation campaign, apparently hand-in-hand with Joseph Mercola. In this article, the headline screams “60+ Natural ALS Cures the “Ice Washing” Campaign Isn’t Funding!” (Here’s another one — the one Gucciardi links to — where he makes most of the same nonsense claims.) To support his claim that ALS can be cured in 60 ways, he refers you to a “GreenMedInfo’s free ALS research PDF”, where he has listed all the scientific papers he’s cherry-picked that sport titles seeming, superficially, to support his view that ALS is something that can be prevented/reversed ‘naturally’. It’s hard to find the words to describe just how criminally unethical this is. The research written up in these papers has been conducted by scientists who understand that ALS is a complex disease. Not one of these papers contains the claim that ALS is curable, and there is no doubt that they would be horrified to see their work being exploited in this way. Compiling them, in a catalogue, under the banner of “ALS cures”, knowing full-well that none of his subscribers will read or be able to understand them, and almost certainly having not read them himself, is a heinous abuse of science, and of the trust of his readers. It’s enough to make you weep. Because of this document, and because of their so-called “cumulative knowledge database“, a scarily sophisticated-seeming system for disguising their woefully unscientific enterprise with apparent scientific credibility, I vote GreenMedInfo for most inhumane, despicable website on the net.

I wrote this article for various reasons, summed up here. But in particular, I wrote it because…

Neurodegeneration quackery harms patients

I spoke to neurologist Jonathan Howard about the damage that this kind of charlatanism does to actual patients suffering from ALS, whom I think for Gucciardi and Ji are more like an imaginary concept than real people. Here is what he said:

Many of my patients with chronic and untreatable neurological diseases (ALS, MS, and Parkinson’s disease to name a few) embrace unproven treatments.  I get it.  These are desperate people dealing with terrible diseases. These “treatments” are usually harmless.

However, there is a subset of patients who embrace only quackery for diseases such as MS, where there are effective treatments. (And of course, those same quacks are happy to take their money.) The same will undoubtedly be true of ALS, once effective treatments are available.  Some patients spend tens of thousands of dollars on unproven treatments, enriching unethical, modern-day snake oil salesmen.  These are the most obvious harms done by charlatans like Gucciardi and Ji.

But what is less appreciated is the terrible psychological price paid by patients who feel they ’caused’ their disease, or are to be blamed for its worsening.  Some of my patients feel responsible for every downturn and berate themselves endlessly for it.  Powerlessness in the face of an unrelenting disease is inherently difficult to come to terms with. However, being told and able to accept that they did not cause their disease — and have little control over its course — can be profoundly liberating. It can allow people to enjoy themselves as much as possible without shame or guilt.

Additionally, telling patients that ‘natural’ cures exist but are are being suppressed by Big Pharma serves to make some patients paranoid and bitter.  I suspect Gucciardi and Ji know this, and it is easy for them to exploit when they are not faced with the challenge of seeing these patients face-to-face on a daily basis.  In adding fear and guilt to their already profound physical suffering and poisoning the relationship between doctors and patients, they open the door to their highly remunerative quackery.


*If you do read Gucciardi’s biography, I would like to draw your attention to sceptical literature on ‘chronic lyme disease‘. I’d also point out that normal treatment for lyme disease does not include steroids. Steroids only become appropriate if the lyme disease has caused an auto-immune response like arthritis. In general, steroids would be a bad thing to give to someone suffering from a bacterial infection, since they suppress the immune system. Make of that what you will.

With special thanks to Joseph Bundy and Jonathan Howard, for being excellent sounding boards and offering helpful suggestions. It was extremely useful to be able to discuss vitamin E research with Joseph, and to have Jonathan’s first-hand account of how quackery harms patients with neurodegenerative diseases.

Advertisements

“Dog Rocks” & Meaningless Woofle

It’s a disappointment to find Pete Wedderburn, a qualified vet, endorsing “Dog Rocks”. Here’s what he printed in the Telegraph:

“The brown patches caused by dog urine on lawns are a perennial issue (to borrow a gardening term). Some people claim that a daily dollop of tomato ketchup in the dog’s dinner stops this but evidence is lacking. Dog Rocks are the most popular product marketed to help: these are placed in dogs’ water bowls, claiming to filter out excessive nitrogen and urea from the water. A high concentration of nitrates can cause grass to turn yellow or brown: the idea is that if less nitrates go into the dog, less come out the other end. Dog Rocks claim success in 80 per cent of cases when used according to instructions; they are widely available in pet shops and online (dogrocks.co.uk).”

It is amusing that Wedderburn dismisses ketchup as a solution for lawn burns on the basis of a lack of evidence and then recommends dog rocks instead, via an appeal to popularity. One might have thought that, given his science education, he would know that popularity isn’t evidence for efficacy. In his defence, he doesn’t explicitly claim that dog rocks work – he just says that the company does. Perhaps he simply assumed on good faith that a company claiming to have conducted laboratory tests on their product must be selling something legitimate – which is of course what we really ought to be able to assume, in an ideal world. Unfortunately, this world is not ideal.

According to the the company’s website, dog rocks are “an igneous Rock with absorbing & retaining qualities” that will “stop pet urine ruining your lawn, grass, shrubs and hedging”. The site offers no evidence to back up these claims, and is home to a plethora of archetypal pseudoscience – loose ideas arranged clumsily around science jargon like “stable matrix”, “micro porous medium”, “ion exchange” and “trace elements”. The marketers print the word “PROVEN” on their product packaging in big red capital letters and, as mentioned above, claim that their product is “laboratory tested”. But they fail to offer even the vaguest insight into the nature of these tests, providing no reference whatsoever to study design, who did the testing, or whether the research was published (or even written up), let alone quantitative information  like effect sizes, standard deviation, p-values, etc. Even anti-ageing face-cream companies manage to pay enough lip-service to transparency that we can go and see that their effects are based upon the subjective reports of 20 women brought into their own lab and not peer-reviewed.

Lack of peer-reviewed studies and misuse of science words are both pseudoscience red flags. Other red flags exhibited by the website are: a page of testimonials, repetitious appeals to nature (dog rocks are “100% natural!”), appeals to pH woo (dog rocks “do not change the pH balance of dog’s urine so they should not harm your dog at all”), and a sort of variation on the appeal to ancient wisdom – I’ll call it “provincial wisdom” (dog rocks were “discovered in Australia by an Aboriginal Gardener in the 1990s”).

A quick tour around the website confirms that discerning dog-owners most certainly are not this company’s target market, and makes it clear beyond any reasonable doubt that these “lab tests” are either irrelevant to the question of whether the product actually works, or simply non-existent. Here’s the “technical blurb” (that’s their term, by the way).

Dog Rocks are a coherent Rock with a mechanically stable framework meaning no significant mineral particles are released into the pet’s drinking water, in other words, Dog Rocks do not break down or leech anything into the pet’s drinking water. Dog Rocks form a stable matrix and a micro porous medium in which active components are able to act as a water-purifying agent through ion exchange. For this reason, when placed in water, Dog Rocks will help purify the water by removing some harmful trace elements giving your dog a cleaner source of water.

Perhaps it’s crude of me to even say this, but to my mind one of the most reliable indicators of junk science and B/S is simply the quality of writing. It doesn’t take a literary connoisseur to notice that the writing style exhibited on the Dog Rocks website is cringeworthily naff and unsophisticated, and it has what I would describe as an awkwardly ingratiating, cloying tone. Although that isn’t enough to dismiss scientific claims, in my experience, this particular form of prose is a strikingly accurate predictor of pseudoscience. Fortunately for our purposes, however, we have much more to sink our teeth into than that.

You might have noticed that no explanation is offered as to how the removal of “harmful trace elements” should result in a change in urine composition such that lawn burns would be prevented. Such ambiguous conflation of terms is yet another red flag: it’s not “harmful trace elements” that cause lawn burns, it’s urea and nitrates (both nitrogen-containing substances). This irrelevant appeal to TOXINS, TOXINS, EVERYWHERE and the promise to remove them seems to have been thrown in there opportunistically as a bonus selling point. You might also have noticed that ion-exchange is a two-way street, yet according to the distributors, nothing is released from the product into Buster’s water. Which is it, Dog Rocks?

I visited the FAQ section to find out more about how the product is supposed to work. Under the heading “How do DOG ROCKS work?”, the “technical blurb” quoted above is re-printed verbatim, except with a different incarnation of woofle following the phrase, “For this reason”:

For this reason, when placed in water, Dog Rocks will help purify the water by removing some nitrates, ammonia and harmful trace elements thereby giving your dog a cleaner source of water and lowering the amount of nitrates found in their diet thereby lowering the amount that is expelled in their urine. An overload of nitrates in urine will cause lawns to burn. Dogs do produce nitrates as a by-product from the protein in their diet, but the difference between too much nitrate that will kill the grass and the amount of nitrate that will be good for the grass is very small.

Carnivores have particularly high levels of nitrogen in their urine because their diets include so much protein, and the digestion of amino acids (the building blocks of protein) creates nitrogenous waste, primarily in the form of urea. As the above quote alludes to, diluted urine can be used as a fertiliser, precisely because it contains nitrogen – one of the most important macronutrients for plants. However, at high concentrations, it causes chemical burns to roots by sapping water from them as a result of osmotic pressure. Evidence that dog rocks can transform weedkiller-wee into fertilizer, as they claim, however, is entirely absent.

On the website, the manufacturers try to gloss over the fact that the nitrogen in dogs’ urine comes overwhelmingly from the protein that they eat with their assertion (featuring in the last quote) that “the difference between too much nitrate…and the amount…that will be good for the grass is very small”. The amount of urea in canine urine is 3.5 ± 2.4 mg/dl* – like human urine, it already varies quite considerably. The manufacturers are basically admitting that the reduction in nitrogen concentration achieved by dog rocks will be “very small”, but hanging on to the case for efficacy by saying that a very small reduction is all that is needed. Their use of the phrase “very small”, without any quantification or context is entirely unscientific and misleading. Small relative to what? An infinitesimal is “very small”; so is an electron; so is an ant; so is a Falabella pony, all relative to their contexts. 

The company fails to give a threshold concentration value of urinary nitrogen beyond which urine burns plant roots, and below which it doesn’t (which is fishy in and of itself – this would have been one of the most important things to determine in those “lab tests” they say they conducted). If the change in nitrogen concentration effected by dog rocks is “very small”, then the product should only work in the subset of cases in which a dog’s initial urinary nitrogen concentration happens to be just above this undeclared value, and for owners to notice a change would require that individual dogs always produced urine with that same concentration – just a “very small” fraction above the magic value  which they don’t. In reality, urea concentration fluctuates from pee to pee – the ability to vary urine concentration is one of the most important properties of the mammalian kidney. A “very small” change would would be drowned out by the noise of this daily variation. The only way I can see dog rocks working is if they were to effect a “very big” change which, given the relatively enormous amount of protein dogs eat, is physiologically implausible. So, assuming that dog rocks do actually remove nitrates from water (the website gives us no reason to believe that they do, and plenty of red flags to suggest that they probably don’t), the idea that this would translate into prevention of lawn burns in anywhere near 80% of cases is wholly unconvincing.

To summarise, the company has failed on four levels:

1) It provides no demonstration that the nitrates in the water a dog drinks contributes significantly towards its propensity to produce lawn spots.

2) It provides no evidence that dog rocks lower nitrate concentration in drinking water, nor does it describe a plausible mechanism for how they might do so, beyond unspecified “ion exchange”. (Incidentally, if these things really could absorb nitrates, wouldn’t the company be a major seller to people who own expensive aquarium set-ups?)

3) It provides no evidence, if indeed dietary nitrates consumed in water did play a significant role, that their product could significantly reduce nitrate content in dogs’ urine, relative to the nitrates coming from other sources (particularly the meat that they eat).

4) It provides no evidence that, if indeed their product did significantly reduce the nitrate content in dog urine relative to the nitrates coming from other sources, this would translate into an impact on lawn burn.

Any evidence filling in the logical gaps in their sales pitch represented by points 1-4 above would be helpful to Dog Rocks. A demonstration of each stage, along with a functional explanation, would be most convincing. However, demonstration of point 4 alone would be a good start in making their case for efficacy. They could conduct a randomised controlled study, submitted to peer-review, in which a group of, say, a hundred volunteers used dog rocks for a few months, and a hundred used “normal” rocks instead. The outcomes could be quantified by counting the number of lawn burns at the beginning and end of the trial, and then the results statistically analysed to determine whether any significant reduction had been achieved.

Something tells me that Dog Rocks won’t rise to the challenge.

I couldn’t help quoting what one Amazon reviewer of the product said in their concluding paragraph: “The ONLY truly effective solution to brown patches on your lawn is to pour a bucket of water on the exact spot that your dog has just had a wee, as soon as they have done it. If that’s not practical, then your next best solution is to save the money you would be spending on Dog Rocks every two months, and buy 2 rolls of turf. Cut out the dead patches on your lawn, and replace them with new turf. Repeat every two months. Job done.”

*I have been unable to ascertain whether this value of 3.5 +/- 2.4 mg/dl refers to deviation across different dogs, over an individual dogs’ different pees, or a combination of the two ranges. If any vets are reading and can shed light, this would be nice for completeness. 

I flipping strongly dislike dogma

We’ve had a new round of criticism regarding the name of our FB page, so we thought we’d clarify our terminology.

Why hate

The definition of “hate” that we are using is very simple: “very strongly dislike”. And we didn’t make that definition up to suit our purposes. Check it out in the dictionary. We strongly dislike pseudoscience because it damages people, and we love and care about people. Pseudoscience even kills people, when it diverts them from medicine that works, as in the case of serious illness. See http://whatstheharm.net/ for more on this point.

Pseudoscience also damages people intellectually, in the sense that it fosters a willingness to form beliefs without first subjecting the tenets of those beliefs to critical evaluation. This, in our opinion, is a tragedy in itself, because to get maximum mileage out of the delectable brain-candy that is science, you have first to be able to identify it. Above all other things under the sun, Science is our solace. And it saddens us that so many people don’t know how it works, and are being prevented from experiencing the joy of knowing how it works by the propagation of obscuring-yet-superficially-appealing false information.

However, it is a tragedy in another, more sinister sense, too. In the absence of evidence as a proviso for taking on new beliefs, people can potentially believe anything. History gives testament to the diversity of malevolence to which such a relaxation of constraints on belief-formation can give rise. To reel off a few familiar examples: some beliefs result in hundreds of thousands of girls having their clitorises gouged out (without anaesthesia) every year. Other beliefs have resulted in people being tied up and burned alive. As we speak, some beliefs are causing people to miss out on their one shot at surviving cancer, or getting to age 40 before dying of AIDS-related illness. Some beliefs lead people to kill their own children. One of them led to Peter Andre eating so many bananas that he nearly died of a potassium overdose.*

We hate pseudoscience in a comparable way to that in which we hate poverty or racism and indeed all exploitative or otherwise harmful practises, creeds and phenomena. We feel, passionately, that making concrete claims without evidence to back those claims up is unethical, and we want it to stop.

It’s evident that some of you will have different mental representations of the lexical category “hate” from the one we do, because “strongly disliking” something is clearly a very good and quite uncontroversial place to start if you want that thing to stop. If you have no problem with strongly disliking then, under our definition, you automatically have no problem with the word “hate”. If you do have a problem with strongly disliking, then you won’t be one of those people who has expressed a strong dislike of our use of the word “hate”. Will you.

It is absolutely fine if you don’t want to be associated with a word that, in your brain, means something specifically more nasty than “strongly dislike”. Nonetheless, we are very comfortable with the term indeed, and would like it henceforth to be known that accusing us, in loud capital letters, of being guilty of anything more than “strongly disliking”, will be an example of your committing an informal logical fallacy. (Can anyone identify it?)

We could have called ourselves “I fucking strongly dislike pseudoscience”, but 1) it sounds shit, and 2) I doubt we would have been featured on “I fucking love science”, the exposure resulting from which has been instrumental in the growth of our readership over the last year.

As one final point here, we do NOT hate believers. We see believers as victims of dangerous and unsavoury yet very catchy beliefs. (The author of this note would even go so far as to say that, in a philosophical sense, she doesn’t even hate the fat-cats who make millions peddling “treatments” that they know to be ineffective. She feels deep pity for them in their tragic loss of compassion – the worst and deepest kind of impoverishment of which she can conceive.) In other words, IFHP hates pseudoscience, not pseudoscientists.

Why pseudoscience?

Every time we post about religion, we get a few people saying, “This is nothing to do with pseudoscience. What is it doing here?”, usually in much less civil terms. So, here’s our defence: as activists against pseudoscience, we feel at liberty to comment on topics related to pseudoscience. Religions (and mysticism) are very closely related to pseudoscience (indeed, the author would go as far as to argue that religion is really the mother of all pseudosciences), in that they “make concrete claims about things without evidence to back those claims up“, as per the “Why hate” section of this note. They also have a tendency to threaten eternal torment if you fail to believe these claims. Yuck!!

To be clear, the phrase in italics doesn’t represent a watertight definition of pseudoscience. Defining pseudsocience is known as the demarcation problem, and it boasts a distinguished history. There is no clear-cut rule that can determine whether something’s properties are necessary and sufficient for categorisation as pseudoscience (bear in mind that categorisation in general tends to have this property), so we use checklists, or red flags. The major monotheistic religions would fail on all 9 of Carl Sagan’s “baloney detection kit“, and fly all the major pseudoscience red flags (which are generally derived from it).

I guess we could have called the page “I fucking hate dogma”, which would have saved us having constantly to justify our discussions of religion (to people who haven’t spent two years making the page what it is…). But leaving aside our feeling that religion *is* pseudoscience, “I fucking hate pseudoscience” worked better as a mirror page for “I fucking love science”, which, as we have already alluded to (and are not ashamed to admit), we thought we’d see if we could use as a piggyback to get our page out there.

Why fucking?

Three words: “get”, “over”, and “it”.

The first edition of this note, written last year, left it at that. We still feel that three words says it all, but the author is one year older than she was last year and her more mature self tells her that she should pay at least some lip-service to the argument from vulgarity.

Swearing, for reasons I can’t quite get behind (…the author can’t get behind? Gosh, referring to oneself in third-person gets tiring) upsets some people. In her, my and our view, as long as you’re not swearing all the fucking time (whoops), in such a way that it starts to prevent you from articulating yourself properly, there really is no problem. (Incidentally, the author massively prefers compulsive, chronic swearing to compulsive, chronic use of “like”, a language virus that afflicts most young Anglophones today and whose effects require constant monitoring by the host to quash.) However, if swearing, even in small and measured doses, really does offend you (one can only imagine the toils and tribulations you must face at the cinema/in front of the TV/during life in general), then there are plenty of other “family-friendly” skeptical pages out there. Once again, and for reasons already given, we deliberately named our page using the same format as IFLS. This necessitated our embrace of that most vile and filthy of all ‘F’ words.

Bottom line? Like it or leave it, but please don’t accuse us of being hateful** people, because in actual fact this page would not exist were it not for the fact that our compassion and our concern for people veritably spilleth o’er. 


* OK, OK. So I can’t verify this rumour and perhaps it’s an urban legend. However, if it were true, it would help explain this bizarre behaviour. There’s this, too.

** Adjective

  1. Arousing, deserving of, or filled with hatred: “hateful letters of abuse”.
  2. Very unpleasant: “this hateful place”.

Confronting Cancer Quackery

Cancer quackery (along with charlatanism surrounding HIV/AIDs) has to be one of the most noxious of all pseudoscience-based enterprises and, perhaps it’s just my line of work, but I can’t help but feel that it’s on the rise. The reliably high prevalence of cancer represents immensely fertile ground for scammers, and “alternative” treatments for it are sought by millions, supporting a steady cash-flow in the direction of fakes, phoneys, and otherwise ignorant followers of charismatic nasties. As well as fostering a generalised distrust in science and burning holes in wallets, cancer pseudoscience often steers patients away from their one and only shot at survival.

The Internet is abuzz with “natural remedies” and “holistic” measures against cancer, and a quick trawl through some of the websites spouting them reveals that the nature and extent of the errors (and lies) upon which they are based are as varied as they are pernicious. However, two hallmarks crop up invariably: 1, a gross de-emphasis of the complexity and diversity of cancer, and 2, a blurring of the (extremely important) distinction between cancer prevention and cancer cure. Equipped with a basic understanding of how cancer works, cancer pseudoscientists’ lack thereof becomes painfully obvious. They chronically demonstrate ignorance of the most elementary aspects of oncology. It is this very ignorance, combined with a total lack of legal regulation (not to mention endorsement by certain celebrities), that enables them to claim, smilingly, that they have the “secret” to curing cancer. In this short essay, I offer a basic explanation of how cancer works, focussing on the not-widely-enough-appreciated role that evolution, by means of natural selection, plays in tumour-growth and -development. Above all, I aim to facilitate your feeling more confident, in any future debates you might have, that “alternative” cancer-cure pedlars, whether through malice or misguidance, are Full Of Shit.

 

Some necessary background information

I think the best place to start is to consider normal body cells. Unlike free-living cells, such as bacteria, the cells of our body do not compete with each other for their own ‘selfish’ genetic propagation. On the contrary, they co-operate on a huge scale, through a vast network of elaborate communication mechanisms, dividing and assuming designated roles in adherence to instruction and signals, and even committing suicide, on cue, for the interests of the aggregate. This non-rebellious behaviour is of course explained by the fact that body cells are a collection of clones. Co-operative behaviour contributes to the propagation of their genes.

In each somatic cell (that means all cells except sperms and eggs), there is a copy of the body’s genome. Your genome is the sum of all your body’s genetic information, which is organised into 46 chromosomes – 22 pairs of “autosomes” and one pair of sex chromosomes (“XX” or “XY”, depending on whether you are a girl or a boy). Far from being an inaccessible “blueprint”, as it is often dubbed, each cell’s genome is a dynamically active factory, churning out myriad different proteins in response to incoming demands, which are communicated via precise chemical signals that either come from within the cell itself, or originate elsewhere in the body. These signals work by selecting specific stretches of gene sequence (“written” in DNA) to be read off and converted into corresponding protein sequences (which are “written” in amino acids). The number of different proteins produced by cells in the body is estimated to be somewhere in the realms of a couple of million. Each of them coils, bends and folds into its own unique shape, according to the signature of physical interaction that occurs between its constituent amino acids, all of which have slightly different distributions of electrical charge and molecular bonds.

Some of these protein shapes act as building blocks for structures such as muscle and skin, whereas others function as tools for breaking things apart, or putting things together. Some act as vehicles, carrying important stuff around the body, while others work to neutralise germs and viruses that get into us. Yet another class of proteins works in communication, as chemical signals (like those mentioned above), to trigger the production of yet more proteins, perhaps in cells some distance away from the ones in which they themselves were put together. In some cases, a protein’s communication errand entails recognising a certain sequence on a certain chromosome, and sticking to it in order to deactivate a gene, or perhaps cause it to go into programmed hyperactivity, which would result in a concentrated outflow of another specific protein.

So, each copy of the genome (in every cell) acts like a mini factory, and The Genome, in its singlular, more abstract sense, is responsible for matching supply and demand in a vast supersystem of interconnected production, maintenance, communication, and transport subsystems.

The growth and maintenance of this supersystem depends on cells’ ability to make copies of themselves, which is itself based on DNA’s ability to self-duplicate, since every new cell needs its own copy of The Genome. As with any copying system, DNA replication has an inherent, unavoidable error-rate. In the course of a human lifetime, some 10,000,000,000,000,000, (ten thousand million million) cell divisions take place. It is estimated that the probability of an error being made is approximately 0.000001 per gene, per cell division, under normal circumstances (i.e. in the absence of mutagens – substances which promote mutation). It follows that any given gene in The Genome can be expected to have experienced mutation around one million times in one lifetime. Unsurprisingly, evolution has stumbled across a number of mechanisms to fix errors as they arise. Occasionally, however, things do slip through the net. And it is at these moments of accidental neglect that cancer has its chance to begin laying the groundwork for infiltration.

 

So, what is cancer?

Cancer is the product of a collection of genetic alterations that promote “selfish” behaviour in cells, at the expense of the body in which they live. A situation is set up in which natural selection, fuelled by a building momentum of newly-acquired mutations, works (unintentionally, of course), to cultivate an increasingly deviant population of cells that “compete” with their neighbours to proliferate their own mutant genotypes, a phenomenon which begins to manifest as a tumour. In the sense that they are subject to natural selection, tumour cells have started to look quite like unicellular organisms such as bacteria, which, as we know all-too-well, can evolve extremely quickly, thanks to the exponentiating speed with which a cell population can multiply. So, in the case of cancer, what kind of accidentally-acquired traits could flip a perfectly respectable, law-abiding body cell into the realms of cancerous activity? And what “skills” might then be “useful” for it in its selfish accrual of control?

The most obvious power that must be acquired by a somatic (body) cell, via a change in its genome, is that of overcoming restraints on cell division. Cells that begin breaking the rules like this are, in most cases, eventually detected by patrolling immune surveillance mechanisms and sentenced to death by apoptosis, which consists in a signal that commands the cell to digest itself. Thus, by the time detection occurs, for the trajectory of cancer development to continue, another “ability” must have been acquired: that of evading such a signal. A mutation conferring this ability may arise before or after uncontrolled cell division was allowed to begin, but of course one of the numerical implications of increased division is that the absolute rate of copying error is increased, so it follows that an already illegitimately dividing cell lineage has an enhanced likelihood of chancing upon a signal-evasion mutation.

Now, any additional increase in tendency toward DNA mutation represents another “advantageous” trait for a cancer cell in-the-making and, therefore, any mutation that deactivates DNA repair mechanisms, or tampers with DNA copying mechanisms themselves, become favoured. (As a quick aside, when we talk of a “favoured” mutation in this context, we mean one that boosts a cell’s probability of reproducing more prolifically, relative to cells lacking the mutation, and thus becoming increasingly over-represented as a proportion of the population, as this population grows.)

The next barrier a potential cancer cell in a growing mass must overcome is the stringy matrix of proteins that surrounds it, keeping it stationary and contained within its designated area of body tissue. Without the ability to do this, a cell can spawn a mass of abnormal offspring, but this localised tumour can be easily surgically removed. Such a tumour is considered “benign”. Conversely, a tumour whose cells have undergone mutations that allow them to invade and colonise surrounding tissues is considered malignant. Fugitive cells are said to have metastasised, escaping through blood or lymphatic vessels to form secondary tumours, or metastases, in other parts of the body. Once this has happened, it can be very difficult, and often impossible, to eradicate the disease.

 

A “Miracle Cure” for cancer?

Now, in case it hasn’t already become clear that no amount of guanabana juice or religious adherence to a macrobiotic diet could possibly cure cancer, I want to discuss this now.

Cancer is in fact not a disease, but a category of highly diverse diseases, the exact causes of which, both ultimate and proximate, are different in every patient. At this point, I want to distinguish between ultimate and proximate causes. Ultimate causes are things like smoking, drinking, exposure to radiation or UV, inherited predisposition, diet, lack of physical activity, and other things that are yet to be identified. Proximate causes are the specific mutations, conferring the specific traits discussed above, that allow cancer to begin and progress. Loosely speaking, ultimate causes get closer to answering “why”, while proximate causes are more about “how”. Everyone knows that cancers have a lot of different ultimate causes. What a lot of people don’t know is that cancers have an extraordinarily diverse set of proximate causes, too. It is thought that, in most cases, between 5 and 10 mutations, contributing towards the selfish powers outlined above, are needed to create the conditions for metastatic cancer to arise. However, (and crucial for our purposes of winning in a debate in which somebody says that cancer can be cured with megadoses of vitamin C, ginseng tea and bloodroot extract), these mutations may appear in any of thousands of candidate genes. A “favourable” cancer-enabling trait like genetic instability could be achieved through disruption of any of a huge number of possible cellular systems, at any of a huge number of potential stages along the biochemical pathway making up such a system. Since so many genes, and such an immense number of genetic interactions and systems are involved in the regulation of cell behaviour, in any given case, a unique profile of mutations (and therefore a unique set of cellular malfunctions) can give rise to the same cancerous symptoms in cells. This can be seen by looking at the genetic mutations found in tumours from different people suffering from the same form of cancer. While there are some genes that present mutations in a considerable number of cases, most mutations harboured in a cancer cell genome are ones that have never been seen before. In fact, if you compare cells taken from different areas of the same tumour, you find that there is considerable diversity in terms of what has mutated. The more genetically diverse a tumour cell population is, the better its odds, by chance, of harbouring mutations that protect it from potential treatments, so the more likely it is to survive and recoup after an attack from a course of radiotherapy, chemotherapy, or oral medication. Particularly sinister here is that, since the survivors of such an attack become the genetic founders of the subsequently regenerated tumour cell population, any mutations which played a role in allowing the surviving cells to live through such an attack will now be ubiquitous. By the time the tumour has grown back, it will thus be extra-robust: more resistant to future attacks of the same kind, and sporting a whole load of new mutations to boot. This is just one of the reasons why choosing the right treatment, at the right dosage, is absolutely critical.

At the centre of cancer are not “cancer genes”, but an interdependent and vastly complex network of biochemical pathways, all of which are potentially disturbed by mutations in any of the genes involved in making them work. An effective cancer drug therefore needs a very specific mode of action – it needs to attack individual components of a faulty biochemical pathway. In the absence of knowledge of which biochemical pathways have been mutated, there is no way in. We are far from understanding all cellular biochemical pathways, and even further from understanding the precise ways in which each gene is involved in those pathways. What we do know is that it is monstrously and mind-bogglingly convoluted. I hope it’s becoming clear by now just how impossible it is for someone who has not examined the genetic aberrations within a specific tumour, and who does not understand cell biology, to make it go away.

Even if we did have a full documentation and understanding of all the biochemistry going on in cells, the idea of a comprehensive, all-round Cure for Cancer is implausible, due to the sheer number of different genetic and chemical components involved in different different diseases from the cancer category.

Current cancer treatments take advantage of the properties that define cancer cells as distinct from normal cells. For example, some exploit their genetic instability. Ionising radiation, for instance, damages DNA. Both normal and abnormal cells get zapped, but whilst normal cells will arrest their cell cycles until they have repaired it, cancer cells, characterised by their “ability” to ignore damage to their DNA and continue dividing, dying as a result of the catastrophic DNA damage they experience when they attempt to do so with defective chromosomes.

The main defining feature of “Complementary” and “Alternative” Medicine (CAM) cancer ‘treatments’, as compared with science-based cancer treatments (apart from the simple fact that the former do not work, of course) is that, unlike science-based cancer treatments, they are not targeted. Drug targets emerge from what is known about cell biochemistry. Biochemical pathways that are observed to have been disrupted by mutation in a significant number of cancer cases represent places to look for such targets. Their various stages each represent a sort of window through which cellular behaviour might be modulated. Herceptin provides an illustration. The “HER2” gene, which mediates the HER2 pathway, is mutated in 20-30% of breast cancers, causing the over-expression (churning out of too many) HER2 receptor proteins (proteins that sit on cell membranes and act as signal receivers). These receptors receive signals that, via a cascade of cellular events, stimulate the cell to grow and proliferate. Cells with an abnormally large number of HER2 receptors on their surface can grow and proliferate too quickly and too much. Herceptin intersects this pathway by blocking – getting into and jamming – HER2 receptors. In HER2-positive breast cancers (particularly when combined with chemotherapy), this can halt tumour growth. Herceptin’s ability to do this relies upon it having exactly the right molecular shape to fit into its target receptor – just like getting into your target house depends on your having a key that is exactly the right shape to fit its lock. Success of treatment depends on perfect specificity between drug and drug target.

CAM providers’ claims that alkaline water, or coffee enemas, or dietary changes can “cure cancer”, apart from anything else, work on the erroneous assumption that cancer is a single disease, entirely overlooking the diversity that characterises cancer as a disease category, and directs research in oncology. These cancer cure claims can often be identified as phoney by virtue of their also appearing in CAM (or in some cases legitimate) advice on cancer prevention. There are indeed various sensible lifestyle changes that can be made to reduce risk of cancer onset (squirting coffee up one’s behind or daily endeavours to “alkalinise” the body not falling into this class), but once cancer has begun, none of these changes are capable of targeting an already-growing mass of cells.

Incidentally, many phoney cancer-cure claimants invoke the “power of antioxidants” to destroy tumours. This presumably stems from the suggestion that antioxidants can help reduce the risk of cancers developing in the first place. Notwithstanding the fact that the free-radical theory of ageing has been called into question, the reasoning that says “since antioxidants help prevent cancer, flooding already-present cancer with them must help to cure it too” is fallacious. Indeed, in some cases, antioxidants can actually help protect cancer cells that have broken away from their surrounding mesh of protein and would otherwise have died as a result.

While some of the big cheeses in CAM are no doubt ignorant rather than just callous, I’m not sure the distinction is particularly pertinent, since their ignorance is elective. All the information is out there, and making the active decision not to study cancer before taking cancer patients’ lives into one’s hands is shamelessly unethical. Hardly surprising though, since being an oncologist means years of training and difficult exams. CAM practitioners seem to want it all: to avoid ever putting in any effort to really understand cancer pathology, yet reap the satisfaction of being revered as experts; to take patients’ money, but circumvent academic scrutiny. To achieve this, they cheat, lie and manipulate, unconditionally dismissing all evidence against the efficacy of their methods. They demonise oncologists, radiologists and surgeons, labelling them as “Big Pharma shills” who just want to earn the Big Bucks by selling products to patients. Using cherry-picked and misleading statistics, they say that chemotherapy is “poison” – a global conspiracy that “creates customers not cures”. In making this argument, they ignore the fact that countries with national health services, like here in the UK,  offer chemotherapy for free, and that what the statistics really show is that chemotherapy has greatly improved the average cancer sufferer’s prognosis.

Cancer quacks cash in on oncologists’ deeply-held responsibility to be absolutely realistic about what can and cannot be expected from available treatment in any given case, offering failsafe cures where actual doctors could not. As Science-Based Medicine’s David Gorski puts it: “It is ironic that CAM proponents often simultaneously tout how individualized their treatment approach is, but then claim that one product or treatment can cure all cancer. Meanwhile they criticize the alleged cookie-cutter approach of mainstream medicine, which is actually producing a more and more individualized (and evidence-based) approach to such things as cancer.”

Our only weapon against CAM’s Crimes Against Humanity is education. Next time someone casually mentions that cancer can be cured “from within”, or that “acid degradation of cells” is what causes tumours, don’t let it slide!

 

johnson This 1908 advertisement offered a 125-page book of patient testimonials as proof of the value of “Dr. Johnson’s Mild Combination Treatment for Cancer.” Testimonials—genuine or fabricated—often are the most effective sales ammunition for quack products, and the easiest to obtain. Drugs that work are supported by scientific evidence obtained from carefulIy controlled tests.

(picture and accompanying blurb from cancertreatmentwatch.org)

 

Government Experiments Reveal Humans Are Capable Of Bending Physical Objects With Their Mind (…or not)

An article entitled “Government Experiments Reveal Humans Are Capable Of Bending Physical Objects With Their Mind”, hosted at colllective-evolution.com and other conspiracy and pseudoscience websites, references only two sources, neither of which live up to the promise that “this-is-something-all-humans-are-capable-of-heres-the-proof”, as laid out in the article’s URL.

ImageThe first of these sources is a truly mind-warping document, entitled “Teleportation Physics Study” which, it transpires, was funded by the US Air Force, for the price of $25,000 – a drop in the ocean compared to the millions of dollars its rather obscure author, Eric Davis, urges be spent on further research into the areas he covers therein. These include quantum teleportation, traversable wormholes, and…psychic teleportation – AKA psychokenisis (PK). Physics professor and famed sceptic Lawrence Krauss describes Davis’ report (a more fitting term than “study”) as “in large part crackpot physics,” with “some things adapted from reasonable theoretical studies, and other things from nonsensical ones.” As anybody who has read or watched “Men Who Stare at Goats” will know, the military has a well-documented pseudoscience track-record, and its penchant for quackery and mumbo-jumbo continues into the 21st century.

 In the psychokinesis section of the Teleportation Physics report, Davis cites (apparently without even a hint of irony) the notorious “PK parties'” run by Jack Houck in the 80s, in which Houck believed he could teach guests how to heat up metal with their minds to make it soft and pliable. (Michael Shermer attended one of these and was able to show, with the help of microscope analysis, despite Houk’s strong convictions to the contrary, that the bent spoons produced by the guests, allegedly using a mixture of mechanical and psychic force, had been caused purely by the former, showing no signs of structural alteration by heat.) Davis also describes “psychic Uri Geller” as “the original model for demonstrating PK metal bending” – again, apparently in total sincerity. See below for entertaining links on the denuding of Gellar’s many incidents of fraud.

Houck and Geller have both been comprehensively debunked – typing their names into Google followed by “sceptic” or “debunked” will attest bountifully to their undazzlingness. However, slightly more ruffling than reference to a known con-artist and a deluded fantasist, later in the same section on psychokenisis, Davis cites a handful of obscure Chinese studies, mostly from the early 90s, involving “gifted” people with “extraordinary PK ability” who were allegedly able to make solid objects like watches and horsflies “meld” with walls, and teleport across rooms. Davis claims, with remarkable confidence, that “the experimental results were all repeatable”, and that “the conditions for fraud and sleight of hand were totally eliminated, and multiple independent outside witnesses (technical and military-intelligence experts) were present at all times to ensure total fidelity of the experiments”. His hyperbolic expression of confidence in the openness and authenticity of these studies (particularly given their political context) seems almost fanatical. Suspiciously, three of the four Chinese studies he mentions come from issue 1 of the ‘Chinese Journal of Somatic Science’. I can’t track down any of these papers online. However, let’s just say that, apart from anything else, Davis’ extraordinary failure to notice Geller’s so richly established status as fraudster does not bode at all well for his ability to detect dodgy experimental design or the dubious interpretation/reporting of results so common in parapsychology research (see links below). Moreover, scientists are in no way impervious to the illusions of stage magic – Project Alpha, for instance, saw fake psychics dupe researchers for over four years, stringing them along for over 160 hours’ worth of experiments on their “paranormal” abilities.

Davis also spends a few paragraps talking about all the millions of dollars that the Soviet Union and its Warsaw Pack allies invested in “psi” research, including “psychotronics, human mind/behavior control, and the entire spectrum of parapsychology”. Davis never actually explains what exactly this research was able to show, and instead just assures us that it represents a “wealth of experimental data”. He also describes the Soviet Union’s “revolutionary techniques” for influencing human behaviour, which they called “controlled offensive behaviour”, in the same breath as stating that the research initiative of this era had been influenced and informed by material gained from Nazi research centres in and around Germany at the end of WWII. Ooof.

The second source referenced in the collective-evolution.com article, in case you are interested, is a document entitled “PK Party Format and Materials Required“, in which Jack Houck basically lays down the itinerary for his whacky psychokinesis workshops. He talks about (but fails to provide) electron microscopic pictures of his PK-assisted bent spoons vs control spoons bent with “only” mechanical force, explaining that he shows these pictures to his attendees, “to give some scientific credibility to the phenomena”. As mentioned above, Michael Shermer enlisted the help of a metal specialist to analyse the structure of Houk’s spoons. They fitted the profile for mechanically-bent metal, with no signs of thermal structure alteration.

Government experiments from the Cold War era may well have claimed to reveal that humans are capable of bending physical objects and getting horsflies to teleport (not fly!) across rooms, but the incentive to trust these claims is snivellingly low, and these results have not been replicated in other laboratories. If the experiments Davis cites are “all repeatable” and “rigorously controlled”, why has nobody repeated them, and collected the $1,000,000 James Randi has pledged to the first person who can demonstrate the occurence of a supernatural event under controlled conditions?

Bottom line? When you strip away the hype and outright falsities from the collective-evolution.com article, what you are left with is a picture which actually shows that despite the millions of dollars spent by the US military and the former USSR, all we have in support of psychokinesis and paranormal abilities are studies that are either debunked or so obscure as to be unavailable to your average Google-user. Since we have failed to find evidence for it in any of the places we have looked, the absolute best we can say for the paranormal it is that, if it does exist, we have no idea what it might do, how it might operate, or where to find it.

I would love you to dip into the Davis report and comment, especially if you are a physicist.

 

http://www.donotlink.com/fSM – Original article at Collective Evolution

http://www.youtube.com/watch?v=NnDHPOWXFVI – James Randi exposes Uri Geller

http://www.indian-skeptic.org/html/fey2.htm – Richard Feynman meets Gellar and is disappointed, not just with his failure to demonstrate his psychic powers, but also his failure to do any impressive magic tricks

http://rationalwiki.org/wiki/Parapsychology – Great article on the failings of parapsychology as a field

http://www.skepdic.com/parapsy.html – Skeptics’ dictionary entry on parapsychology – goes into some of the most common problems with experiments that researchers have claimed support the existence of ESP

Misinformation in anti-milk propaganda

March-24-2013-19-20-10-GotMilk

A piece of anti-milk propaganda featured on the appropriately-named website “iwastesomuchtime.com” has started cropping up here and there. Its basic message is: don’t drink milk – it’s unneeded, unnatural, and bad for you. Naturalistic fallacy aside, the author(s) bring to bear on this message that a large proportion of the world is actually lactose intolerant. But in actual fact, when you look at the evolutionary history of lactose intolerance, this fact actually starts to sound like an argument from the other side of the fence.

Lactose tolerance is overwhelmingly more common in people who have pastoral (cattle-rearing) ancestry; for example, those of north-central European descent. It is rare in people who have non-pastoral ancestry, for example the Chinese. Population genetic studies tell us that the oldest genetic mutations associated with lactase persistence (the retaining of the enzymes necessary for digestion of lactose into adulthood) only reached appreciable levels in human populations in the last ten thousand years – in some populations, the frequency of the genes conferring lactase persistence have taken only 3,000 years to increase from negligible frequency to near-ubiquity. This rapidity, seen alongside other lines of evidence point to strong selection for an ability to digest lactose, and significant survival benefits for those who could do so, compared with those who couldn’t, when milk was available, in recent human evolutionary history. Most Westerners now live in a time of consistent nutritional plenty, so for this sample of the world’s population, generally the ability to digest lactose is no longer a matter of life-or-death. But seen in the light of evolution, the idea that drinking milk is “NOT NATURAL” falls through. And it renders the bulletin’s stats about China vs. Asian-Americans silly, because they correspond exactly to what genes and ancestry predict. Please do take a moment to read about the evolution of lactase persistance, if you are unfamiliar with it. It is a lovely demonstration of gene-culture co-evolution and a striking example of “niche-construction”. See, for example: http://lalandlab.st-andrews.ac.uk/niche/HumanSciences.html

One section in the bulletin reads: “cow’s milk is also the number one cause of food allergies among infants and children.” I’ve been to the source cited as a reference for this fact, and the maker of the anti-milk poster has in my opinion been fairly sneaky in its paraphrasing. The actual stat in the referenced document reads, “eight foods account for 90 percent of all (allergic) reactions: milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish”. It doesn’t say that these foods “cause food allergies” in the sense of triggering allergies to other foods, which is what statement printed on the bulletin implies, I would say.

I’ve followed all of the cited references at the bottom of the bulletin and can’t find any source to back up their assertion that 62,200,000 Americans are drinking milk even though they can’t digest it. Perhaps I’m not looking hard enough, or perhaps they got that figure using dodgy calculations. If anyone can shed any light, please do. In any case, it sounds unlikely.

The really irresponsible feature of this meme is the clear-cut picture it presents of milk and disease. It implies that higher milk consumption is known to increase risk of ovarian cancer when in fact the picture is not clear, with some studies finding an association between high milk-(and meat- and cheese-) consumption and increased risk of some cancers, and other studies finding the opposite effect. With complex diseases involving so many variables, it is notoriously difficult to single out individual causal relationships, and it is common for different studies to find conflicting results. A meta-analysis in 2005, which looked at epidemiological studies of ovarian cancer and milk consumption, did not find an association. High milk and/or calcium consumption may increase the risk of prostate cancer, but then, it is also seems to lower the risk of colon cancer. The relationship between diet, lifestyle and cancer is a crucial area of active research. See:http://www.cancerresearchuk.org/cancer-help/about-cancer/cancer-questions/does-milk-cause-cancer

The blue and white poster also implies that high milk consumption is known to increase your risk of type 1 diabetes and heart disease. It has been proposed that early exposure (in infancy) to cow’s milk (or lack of breastfeeding) may increase a child’s risk of developing type 1 diabetes – a disease which in most cases is inherited. But it’s not clear that this extra risk accrues to people without a family history of diabetes.

Various studies have looked at dairy and its relation to heart disease and type 2 diabetes. An overview of the available evidence in 2010 found a *reduced* risk of all-cause deaths, heart disease, stroke and T2D associated with increased consumption of milk and dairy foods.  The picture is complicated, unlike the one painted in the bulletin.

Going by the allusions to maltreatment of cows, it seems that really this is an agenda-driven campaign, whose net its author(s) have sought to widen by drawing from nutritional science, being willing to give an unchecked and distorted picture of what the science actually says in the process.

Notice, also, the complete vagueness of equating the saturated fat in “one serving” of milk to “one serving” of fries. How big’s a serving? And is it really all that surprising, and all that worrying, that ounce-for-ounce, milk has “about the same calorie-load as soda”? “Saturated fat” and “calories” are not terms synonymous with “bad”. This poster doesn’t centre around a solid stance or case. Its miscellaneous and dubious contents testify to a lack of quality control in its putting-together. The author(s) have clearly scanned the web for anything that can be framed to fit the anti-milk agenda, and ignored everything else.

Just for the record, I (the UK admin), can really get behind veganism (though this is not necessarily the agenda behind the bulletin) – I think it’s a very worth cause. But the broadcasting of misinformation for promotion purposes it is something that shouldn’t be accepted.

Heal Your Dental Cavities…Naturally?

We’ve had numerous requests for a post on the idea that dental cavities can be cured through diet. It’s a popular theme at Natural News, and Wellness Mama, along with many other websites offering “wake-up calls” and extolling the virtues of living “naturally”. From what I can gather, the enthusiasm with which the notion of “healing” cavities at home is currently being promulgated seems to be owed in large part to a book with the amusingly imperative title, Cure Tooth Decay, published in 2010 by Ramiel Nagel. It is loosely based on the work of Weston A. Price (on whom more later). All of the holistically-flavoured articles I’ve come to read on this subject mention Price, and most of them also draw from studies conducted by dentists Edward and May Mellanby. IFHP has received two or three messages from readers directing us to Natural News’  take on the subject (repeated verbatim at many other online locations). The sources it cites are: itself (twice), Wellness Mama and the Weston A. Price Foundation. Incidentally, regarding ‘wellness’, John E. Dodes, D.D.S., a dentist and outspoken critic of ‘holistic dentistry’, has noted that this is “something for which quacks can get paid when there is nothing wrong with the patient.” This note deals mostly with the claims made by NN, but also touches on some of those found elsewhere, on websites of the same bent.

So, first things first: I am not a dentist. While I have done everything I can to make this as accurate and comprehensive as possible within a reasonable amount of time, I would like to make it very clear from the outset that suggestions for improvement, particularly by dentists, are very much welcomed. First, here’s a brief word on the theory of tooth decay accepted by mainstream dentistry.

Tooth enamel is a dense tissue made mostly of hydroxyapatite, a molecule comprising calcium, phosphorus, carbon, hydrogen and oxygen. Being a-cellular, it is in fact a dead tissue, as is dentin – found directly beneath the enamel – which is also a-cellular.Enamel is is 96% minerals. (Dentin is 70%.) In the mouth, enamel is subject to constant cycles of softening and hardening. After eating foods containing fermentable carbohydrates such as sucrose, glucose and fructose, residues left in the mouth are broken down by oral bacteria, which produce lactic acid as a waste product. This local reduction in pH increases the solubility of hydroxyapatite, which begins to dissolve, in a process calleddemineralisation. However, once the sugar has gone and the pH has risen again, mineral ions suspended in the saliva are reuptaken by the tooth enamel. This part of the cycle is called remineralisation. Nowadays, the remineralisation process is enhanced by water fluoridation. Here is a useful article discussing fluoride’s multifaceted role in remineralisation: http://www.accessscience.com/studycenter.aspx?main=13&questionID=4858

The more frequently teeth are exposed to fermentable carbohydrates (particularly sucrose, see later) and acidic food, the less time the teeth have for remineralisation before they are subjected to the next round of demineralisation. As such, tooth decay (also known as ‘dental caries’) occurs when the rate of the latter exceeds that of the former, and lesions of softened, pitted enamel start to form. These weak areas represent the first stages of decay, and are sometimes known as ‘microcavities’. The good news (and herein lies our kernal of truth) is that, if treated properly with remineralising pastes, the development of these lesions can be reversed. However, once tooth decay has penetrated all the way through the enamel, forming a ‘true cavity’, this is irreversible. Why? because since enamel is a-cellular, it cannot grow. It is formed early in development by the ‘enamel organ’, which recedes by the time teeth erupt. Filling a true cavity is particularly urgent because, since the dentin is less mineralised (and therefore less resistant to the acid produced by oral bacteria), the decay process typically mushrooms out rapidly once it reaches the dentin, in a way that is sometimes described by dentists as a “cavity bomb going off inside the tooth”.

It should be borne in mind, then, that there is an important, qualitative difference between microcavities and the kind of cavities shown in this very popular picture (http://www.healthy-holistic-living.com/images/healcavities.gif), which accompanies many of the online articles in question. Later in this note, we’ll investigate the (misrepresented) source that has been exploited to gloss over this difference and promote the slap-dash notion that “cavities” can be “healed” at home.

Now for some direct quotations from Natural News:

 The world is slowly waking up to the fact that, when you give the body what it needs, it can heal things we previously thought were impossible. A fine example of what is often deemed as an incurable health problem is dental cavities, but extensive research is now becoming more public about the true nature of tooth decay and the fact that there are proven remedies that can remedy it.

Starting with a sweeping statement that implies all illnesses result from not giving the body “what it needs”, is an obvious red flag. Even if it were theoretically true that all disease could be prevented by feeding the body in such a way as to match supply perfectly with demand, with the ingestion of nutrients in exactly the right measurements, at exactly the right times, not enough is known about minute-to-minute body chemistry to put such a regime into action. And that’s before considering that every human body is different. This attitude, moreover, is implicitly dismissive of congenital diseases such as cystic fibrosis, a very serious condition caused by the unlucky pairing of two dodgy mutations from mother and father, and which requires an arduous daily schedule of treatment with drugs and mechanical intervention to prevent childhood death. This opening statement is redolent of willful ignorance and unconditional distrust in medicine, and we should probably expect what follows it to be flavoured with an antiscience bias, even if it originated somewhere other than Natural News.

 The lies perpetrated about tooth decay:

According to the American Dental Association, the reason we have tooth decay is as follows:

“[Tooth decay] occurs when foods containing carbohydrates (sugars and starches) such as milk, pop, raisins, cakes or candy are frequently left on the teeth. Bacteria that live in the mouth thrive on these foods, producing acids as a result. Over a period of time, these acids destroy tooth enamel, resulting in tooth decay.”

There are a few problems with this theory, including:

  • Groups of indigenous people who had fermentable carbohydrates stuck on their teeth all the timethat did not brush or floss were mostly or completely free of tooth decay.

This is a reference to the work of Weston A. Price, a dentist who has inspired a lot of praise, particularly in ‘holistic’ circles (see http://www.westonaprice.org/) and a fair bit of criticism, too. See, for example:

The Quackwatch article is arguably a little harsh, and it is important to note that Price’s work has often been pilfered and warped by others to promote dodgy theories that actually bear little resemblance to his own research. The Wiki articles on him (and the dubious foundation inaugurated in his name) are worth a read.

In Nutrition and Physical Degeneration (1939), Price gives an account of his observations of “primitive” peoples from various indigenous populations around the world, reporting that they were remarkably free of diseases afflicting Westerners, including dental caries. One of his conclusions was that Western food preparation methods were stripping away nutrients, resulting in deficiencies which, he proposed, explained tooth decay (and other diseases). During his research, Price observed that these indigenous groups, when they moved towards more Western diets, began to develop dental caries, interpreting this as support for his theory.

Price did in fact believe that sugar was a significant cause of dental caries, but hypothesised (incorrectly) that its cariogenic (tooth decay-inducing) action was to reduce the amount of minerals absorbed by the body. It wasn’t until the 1940s and 50s that the actual role of sugar in tooth decay was discovered, so this was a valid hypothesis at the time. Full appraisal of Price’s work is far beyond the remit of this note but, in short, it seems he did some interesting research which perhaps fell short on scientific and quantitative rigour. Some quick points:

  • Malnourished people, overrepresented in Price’s subjects, get fewer dental cavities, as they experience longer periods of time without dental exposure to food.
  • The serious increases in tooth decay experienced by indigenous people who then gained access to Western foods could be explained by overindulgence, by virtue of sugary foods being a novelty to them.
  • Archaeological evidence tells us that tooth decay is not exclusive to Westernised society. For example, here is recent study finding caries in humans from more than 13,700 years ago. http://www.bbc.co.uk/news/science-environment-24332237
  • Price’s research was conducted before the time of vitamin-fortification of Western processed carbohydrates, before the time of water fluoridation, and during a time when tooth decay in the Western world was almost at its highest in history (it reached a peak during the 50s and 60s). For a full-text review of the history of dental caries, published by Nature,see http://www.nature.com/bdj/journal/v191/n9/full/4801214a.html
  • Despite the controversy surrounding Price’s work, it is actually compatible with a sugar-centric theory of tooth decay.
  • I have not been able to give the time it would take to read Price’s entire book, but after the research I’ve done around this subject, it seems unlikely that he claimed his subjects “had fermentable carbohydrates stuck to their teeth all the time”, as reported by Natural News.

Here is a link to an e-version of Price’s book, which is now in the public domain: http://gutenberg.net.au/ebooks02/0200251h.html#ch1

  • Bacteria do not consume processed sugar or flour because of the lack of nutrients in them

This is a bizarre statement, made, Naturally, without any supporting reference. There is ample evidence that sucrose, the molecule constituting refined sugar, is eaten by bacteria in the mouth. De-germed (processed) flour contains less (though not nothing) in the way of vitamins, minerals and protein, but is full of polysaccarides, which can be digested by oral bacteria. In any case, the mouth contains a multitude of essential nutrients with which bacteria can supplement their diets. Here are a few references to support the role played by sucrose in caries-formation:

Krasse B, Edwardsson S, Svensson I, Trell L. Implantation of caries-inducing streptococci in the human oral cavity. Arch Oral Biol 1967;12:231–6

Minah GE, Lovekin GB, Finney JP. Sucrose-induced ecological response of experimental dental plaques from caries-free and caries-susceptible human volunteers. Infect Immun 1981;34:662–75.

Sheiham A. Sucrose and dental caries. Nutrition Health 1987; 5: 25–29.

Van Houte J, Upeslacis VN, Jordan HV, Skobe Z, Green DB. Role of sucrose in colonization of Streptococcus mutans in conventional Sprague-Dawley rats.J Dent Res 1976;55:202–15.

Another, related angle of attack (not included in the NN article) comes from Cure Tooth Decay by Ramiel Nagen. It is repeated in various online articles similar to the one from Natural News. It goes like this:

[Mainstream theory of tooth decay] further dissolves because white sugar actually has the ability to incapacitate microorganisms since it attracts water. In a 20% sugar solution, bacteria will perish. Yes, bacteria are present as a result of the process of tooth decay, but a lot of sugar at once will destroy them. If dentistry is correct about bacteria, then a high sugar diet should eliminate them.

Nagen clearly reckons he’s delivered a real blow with this one. To somebody who has never studied biology, perhaps it sounds like the kind of simple, razor-sharp idea that seems so obvious when voiced that everyone says, “why didn’t I think of that?” Only, this idea is toosimple. It’s one thing to plonk a blob of bacterial cells into a beaker of sugar solution and leave them there, out on a limb, floating around in an abyss with nowhere to hide. As long as the percentage of solutes in the liquid contained inside the cells is lower than the percentage of solutes contained outside them in the external solution, osmosis will ensure that the cells’ watery insides are sucked out, desiccating the little blighters as molecules strive towards equilibrium from both sides of their outer membranes. (http://en.wikipedia.org/wiki/Osmosis) But this lab situation is completely different from the one going on in the human mouth, which doesn’t have smooth glassy surfaces, for one thing. The bacteria in the mouth are established residents. They’ve worked their way into all the nookiest nooks and the cranniest crannies, living in gooey bundles, all huddled up together, nice and cosy. They nuzzle between teeth and ensconce themselves under the harbourage of the gum-line. They squelch around in a caggy spread on the rough, grainy surface of the back of the tongue. Most importantly of all, to help them nuzzle and congregate thus, oral bacteria manufacture an extrapolysaccharide (EPS) slime, also known as a biofilm, using broken-down sugar. This EPS acts as a protective sheath against dessication, holds them together, and keeps them glued to their terrain. Biofilms are why dentists stress the importance of mechanical cleaning with brushes and floss – your antibacterial mouthwash might have “kills 99% of oral bacteria” printed on it, but this kill-rate is likely based on tests with bacteria unprotected by biofilms. When a host human chomps up a cake, the sugary, masticated stodge might feasibly break through some patches of bacterial biofilm, in a similar way to a toothbrush, displacing some of the unlucky bacteria on the outskirts of the huddles, and dragging them, stomach-wards, down the oesophagus. But once the cake-eating eating has stopped, the plentiful remaining bacteria will of course begin spreading over the fermentable residue, digesting it and multiplying afresh.

  • Foods that bacteria like to eat, such as milk, vegetables, meat, fish and fruit, are not commonly implicated in causes of tooth decay.

 Lactose does not appear to be as cariogenic (decay-inducing) as other mono- and di-saccarides. It also tends to be consumed in the presence of other food components such as proteins, fats, and minerals from milk and other dairy products, which act as a buffer, minimising its carious impact. Milk and other dairy products also contains calcium phosphate and casein, both of which aid in the remineralisation process. Fruit, which contains fructose, glucose and some sucrose, doesn’t seem to be a major player in tooth decay, though its acid content can be a cause of tooth erosion, particularly in juice-form, which can increase susceptibility. Something not acknowledged in the NN statement above is that people who eat lots of fruit also probably tend to eat fewer doughuts, meaning that their overall sucrose-intake may be lower. It’s worth pointing out, also, that there is a staggering diversity of bacterial species, some of which have even evolved to digest radioactive material. The phrase “bacteria like to eat” fails to acknowledge the fact that different species of bacteria have different tastes. A class of bacteria called the mutans streptococci represent the main culprits in tooth decay. Of these species, S. sobrinus and S. mutans are the most highly associated with carious lesions on the teeth. The reason sucrose (not found in high concentrations in milk, vegetables, meat, fish, or even fruit) is the biggest dietary factor in tooth decay is because these bacteria specifically rely on it to manufacture sticky, long-chain molecules called glucans, the main ingredient of EPS, discussed above. Thus, the idea that some “foods that bacteria like to eat” are not implicated in tooth decay is not at odds with the modern theory of tooth decay – none of the foods listed in this bacterial tasting menu, à la Natural News, are particularly high in sucrose. See the following papers for further reading on the cariogenicity of lactose and fruit.

http://www.nature.com/bdj/journal/v193/n10/full/4801628a.html#B18 (free full-text article)

http://www.sciencedirect.com/science/article/pii/S0958694611002482

 

So if the modern explanation of tooth decay is not accurate, what is actually the cause of tooth decay?

What actually causes tooth decay

Tooth decay, as researched by Dr. Weston Price and other dental pioneers, boiled down to three factors:

  • Not enough minerals in the diet.
  • Not enough fat-soluble vitamins (A, D, E, and K) in the diet.
  • Nutrients not being readily bioavailable, and your intestinal system not properly absorbing them.The presence of phytic acid largely influences this factor.

Over a period of time, if your diet lacks vitamins and minerals from a poor diet and/or contains high levels of phytates (from grains, seeds, nuts, and legumes), the blood chemistry and the ratio of calcium and phosphorous become out of balance, which results in minerals being pulled from bones, causing tooth and bone loss.

So, the long-standing belief that sugar causes tooth decay is true, but as a result of it depleting nutrients from the body, not because bacteria eat it and produce acid that ruins your teeth.

cavities_in_dietary_groups(2) “Other dental pioneers” appears to be a reference to Dr. May Mellanby and Dr. Edward Mellanby (who discovered vitamin D). These two doctors did a lot of work on the effect of vitamins on tooth structure and decay. The graph, which comes from (http://wholehealthsource.blogspot.co.uk/2009/03/reversing-tooth-decay.html) has been reproduced in a large number of other online articles making claims similar to those made by Natural News. I must have seen it in at least six or seven articles. It is based on the summary of Dr. May Mellanby et al’s series of experiments done on children in hospitals, and, as far as I can tell, seems to be an accurate representation. Except for one crucial ambiguity. The graph uses the word “healing” (unqualified), in the context of “cavities”, neglecting to mention the difference between microcavities (lesions of softened, demineralised enamel) and true cavities – actual holes in the enamel. While softened and weak enamel can remineralise, it cannot grow back, as explained earlier in this note. I will say it again: this crucial difference between the early and late stages of tooth decay is something that is systematically ignored by all the web pages advising readers to ditch the dentist in favour of “natural” cures for “cavities”, a term which they fail to qualify. Some points on the Mellanby studies:

  • Supplementation of vitamin D (which is needed for absorption of calcium, a major component of teeth, as discussed above) was indeed found to have an ameliorative effect on dental caries, and the recommendation is made, in the concluding summary, that sufficient vitamin D and calcium should be consumed by mothers during pregnancy and by offpring from birth.
  • But the amelioration should not be, and was not, described by Mellanby simply as the “healing” of cavities, as it is in all these over-zelous articles. The improvements seen in Mellanby’s experiments were:
  1. hardening of carious lesions on the enamel (ie. remineralisation of microcavities, something accounted for uncontroversially within mainstream dentistry) – the word “healing”, out of context, is misleading, especially when the picture presented at the top of the NN the article (and others) is one of multiple, plainly visible, gaping holes in the enamel surfaces of a set of teeth.
  2. The laying down of tertiary protective dentin (dentin being the calcified tissue just below the enamel) in cavities that had already penetrated the enamel. Again, the observation that this response can occur in teeth, arresting the development of caries, is encompassed by modern dental theory. However, there is still debate surrounding how commonly and under what circumstances this occurs. This ‘laying down’ of new dentin, when it occurs, is achieved by the living pulp (remember, dentin is dead tissue). However, this new dentin does not extend very far, and is irregular in structure and far less dense than primary or secondary dentin*, so extremely vulnerable to further decay.
  • Whereas, across all the other diets studied experimentally by Mellanby, carbohydrate content was kept constant, carbohydrate content was considerably lowered in the cereal-free (low phytic acid) diet. Now that we know about the role of fermentable carbohydrates in tooth decay, this should be flagged up as confounding factor in the experiment’s results and the author’s conclusion regarding the detrimental effect of phytic acid on teeth, an idea which is so popular in current-day articles on natural “healing” of tooth cavities, as well as in “paleo” circles. Phyates are now not considered to have a detrimental effect on teeth. (In fact, when isolated from foods, they have even been found to have an anti-caries effect, though this doesn’t carry through to when they are eaten as an intrinsic component of food.)
  • Mellanby herself was clear in pointing out that, even on a high-vitamin D diet, “caries is not arrested in all children”, saying that it “appeared that there might well be dietic factors apart from vitamin D influencing the carious process”, and recognising “that some local chemico-parasitic condition in the mouth might explain the continued activity of caries at some points”. She was right, of course – “chemico-parasitic” being a rather apt way to describe the condition imposed by the presence of lactic acid-producing bacteria.
  • Again, this work was done during a time before vitamin-fortification of cereals and processed carbohydrates, before sugar was identified as the main causal factor in tooth decay, before water fluoridation, and during a time when, accordingly, tooth decay was rife.

The full text version of the report on all four experiments conducted by Mellanby et al. on tooth decay progression in children, from which the graph is taken, can be found here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2520490/?page=3. In fact, all of the Mellanby articles are available online in full.

 The food remedies that can heal cavities and tooth decay

In order to restore the ratio of calcium and phosphorus in our blood, and to enable minerals to bond to our teeth, it is not enough to just avoid eating too many sweet or processed foods. We must also eat health-building foods, containing copious amounts of minerals and vitamins that will build a glassy hard tooth structure.

Foods to focus on are:

  • Coconut oil, grass-fed organic dairy (especially butter), grass-fed meats, seafood and bone broths.
  • Organic cooked vegetables (soups with bone broth are ideal).
  • Organ and gland meats, like liver.

Limit foods that are high in phytic acid, like grains, beans, nuts and seeds, as well as limiting processed food intake full of processed flours and sugars that upset blood sugar balance.

Supplements to consider are:

  • Fermented cod liver oil – very high in fat soluble vitamins A, D and K.
  • Magnesium – required to use calcium and phosphorous effectively.
  • Gelatin – if you don’t have time to make bone broth, this is a good alternative and is great for gums and digestion.

Now go get your pearly white smile back.

 The idea that every one of us needs to be working to “restore” the ratio of calcium and phosphorus in our blood has no basis. Aside from being the conclusion of an article deliberately based on anachronistic theory from the 1920s and 30s (and loosely, at that), in general, people who eat reasonable diets based on standard dietary recommendations have no reason to believe that they are suffering from nutritional deficiencies or inbalances. Claims that modern dentistry dismisses the importance of nutrition for healthy teeth are false. Evidence points to the importance of nutrition in the pre-eruptive stage, when teeth are forming, and deficiencies in (for example) vitamin D and A, as well as protein energy malnutrition, have all been linked with poor enamel composition (enamel hypoplasia), which increases susceptibility to tooth decay (see following reference). Furthermore, other nutrient deficiencies are recognised to interfere with saliva composition and quantity (http://ajcn.nutrition.org/content/78/4/881S.full), minimising its protective effect. But in healthy people who eat a normal, balanced diet, in the post-eruptive stage, by far the most important cause of tooth decay is sugar consumption. The authors of the articles addressed in this note offer dental advice but, in so doing, clearly demonstrate that they are neither qualified nor equipped to do so. When seeking out advice on how to maximise the health of your teeth, be sure to check for accreditation by dentists. If you think you’re at risk of being subjected to unnecessary drilling and filling, ask your dentist whether remineralisation with fluoride therapy is a possible alternative. If you still suspect him/her of ‘over-enthusiasm’, go and get a second opinion. But don’t abandon dental appointments in favour of diet regimes invented in the 1930s, before the era of food fortification, water fluoridation, or an understanding of sugar’s role in tooth decay.

For a full-text read on teeth and nutrition: http://www.nature.com/bdj/journal/v193/n10/full/4801628a.html#B18

See also: http://www.smilesbypayet.com/category/dental-philosophy-of-care/holistic-dentist/

*These experiments were conducted in the 20s and 30s. At that time, what is now called tertiary dentin was then known as secondary dentin. The new category reflects the greater understanding dentists now have of tooth structure and function. Thanks to dentist Adrian Stewart, who provided the following explanation in a comment: Secondary dentin is laid down on the inner wall of the dentin throughout the life of the pulp. Dentin is tubular in structure (diameter of approx. 1 micron) with an ondontoblast (the cell that makes dentin and secondary dentin) at the interface of the pulp and he dentin tubule, with a cell process extending into the tubule. Decay entering the dentin leads to death of this ondontoblast, which is replaced by a prto-ondontoblast from pluripotent stem cells within the dental pulp. These then lay down irregular tertiary dentin, which is nowhere near as dense as primary or secondary dentin but acts as a basic defense against the decay process.