A dubious homeopathy study made its way into a scientific journal. Will it be retracted?

Homeopaths did it again–they snuck a dubious study into a respectable journal. Well, sort of. Let's quickly look at the study, and then look at the journal that published it.

The paper has a very science-y sounding title, which likely helped it sneak under the radar: "Ultra-diluted Toxicodendron pubescens attenuates pro-inflammatory cytokines and ROS-mediated neuropathic pain in rats." It seems they were studying pain in rats, but what else is hiding inside this title?

The first warning here is the phrase "ultra-diluted." In the world of homeopathy, substances are diluted until there is literally nothing left, not a single molecule. Some of the dilutions in this paper were indeed extremely dilute, down to 10-30, which means that they were just water. So they can't possibly have any therapeutic effect, at least no more effect than plain water.

You might also be wondering what Toxicodendron pubescens is. That's poison oak! Here's what homeopaths claim about poison oak: that if you dilute it down sufficiently, it reduces itching and pain. This is one of the basic principals of homeopathy, that "like cures like"–that if you want to treat a symptom, using a substance that causes the same symptom, only dilute it way down. Feeling itchy? Rub some poison oak on that! I'm not kidding–here's a link to a product you can buy that really makes this claim.

Of course this is utter nonsense, as I and many others have written before. Homeopathy doesn't work for anything at all, as a massive Australian study concluded back in 2015.

Now let's look at where this dubious study appeared: in a journal called Scientific Reports. Scientific Reports is a mega-journal that publishes 25,000 papers per year, making it the largest journal in the world. What's also interesting is that it is published by the Nature publishing group, which also publishes the highly prestigious journal Nature and many other related, high-quality journals. (Full disclosure: I've published many papers in those journals.) PLoS ONE was the first mega-journal, and it was so successful (i.e., it made so much money for its publishers) that Nature decided to imitate it. They've managed to steal a lot of the "customers" from PLoS ONE because the Nature brand is, apparently, more appealing to many authors.

It's tempting to argue that everything in Scientific Reports is just low-quality stuff, so one more bad paper doesn't mean anything. But it's not so simple. Scientific Reports is trying to be a decent journal, one that has a very high acceptance rate (59%, according to their website) but that nonetheless publishes only valid science. Last year I was involved in a kerfuffle with them over a plagiarized paper, and after lots of pressure, we did get them to retract the paper. It wasn't easy, but the Editor in Chief corresponded with me at the time, and he really does seem to be trying to enforce some decent standards.

When you publish 25,000 papers a year, though, some garbage is going to slip through. To their credit, Scientific Reports has now issued a note of concern on this homeopathy paper, as reported by the alert team at Retraction Watch. Here's the note in its entirety:
"Editors’ Note: Readers are alerted that the conclusions of this paper are subject to criticisms that are being considered by the editors. Appropriate editorial action will be taken once this matter is resolved."
The right thing to do would be to retract this paper, because its results are simply not valid. We'll see if that happens.

Meanwhile, when reading the paper, I noticed that no less than eight of its references are to a journal called Homeopathy, published by Elsevier, one of the biggest and most profitable academic publishers in the world. Unlike Scientific Reports, Homeopathy is not even trying to publish valid science; its entire existence is premised on a nonsensical set of beliefs.

The good folks over at Retraction Watch wrote about this journal two years ago, in an article called "Does a journal of homeopathy belong in science?" Spoiler alert: it doesn't. As Ivan Oransky and Adam Marcus wrote then:
"the issue is that science publishers, even legitimate global corporations like Elsevier, will accept something patently unscientific if it might make them money."
So while Nature does deserve criticism for letting bad science slip into its mega-journal, Elsevier has a lot more explaining to do. At least Nature is trying.

World Health Organization endorses TCM. Expect deaths to rise.

Mother and young rhinoceros killed for their horns.
Image credit: Wikipedia
A few days ago, a news story in the journal Nature reported that the World Health Organization, which is supposed to be devoted to improving the health and medical care of people around the globe, will for the first time endorse a belief system called "traditional Chinese medicine." I'm labeling TCM a belief system because that's what it is–but the WHO will be endorsing it as a set of medical practices.

The Nature writer, David Cyranoski, presents this news in a classic two-sides-of-the-story format, describing the "endless hours" that TCM proponents spent on such important topics as the "correct location of acupuncture points and less commonly known concepts such as ‘triple energizer meridian’ syndrome." Later in the article (but much later), he points out that scientists have argued that qi and meridians simply don't exist.

Cyranoski also falls into the trap of using the phrase "Western medicine" as if it were just an alternative point of view. An apt response is this comment from a biology Ph.D. student, who goes by @astrelaps on Twitter:
"What a weak, equivocal article from the world's preeminent scientific journal. "For those steeped in Western medicine..." is like writing "For those steeped in climate science" or "For those steeped in evolutionary biology" when reporting on climate change denial or creationism."
Well put. On the other hand, Cyranoski does point out that the major motivation for TCM is money:
"[China] has been aggressively promoting TCM on the international stage both for expanding its global influence and for a share of the estimated US$50-billion global market."
Were you thinking this was about health care? Afraid not. Cyranoski goes on to point out some serious problems with TCM, for example:
"Critics view TCM practices as unscientific, unsupported by clinical trials, and sometimes dangerous: China’s drug regulator gets more than 230,000 reports of adverse effects from TCM each year."
Actually, it's much worse than this.  Here's what TCM really looks like: the horrific slaughter of the last remaining rhinoceroses in Africa in order to hack off their horns, which are sold to become part of elixirs that some people mistakenly think confer strength or virility. Last year, National Geographic ran a heart-wrenching photo essay showing some of the awful results of rhinoceros poaching in Africa; take a look at these photos here.

TCM also looks like this: black bears kept in grotesquely cruel "farms" with a permanent tube inserted into their abdomens so that their bile can be harvested. Despite a growing movement to end this inhumane practice (see this NY Times story), it persists today, with thousands of bears kept in cages so small they can barely move. No one can view photos such as these and say that TCM is a good thing.

And TCM is behind the slaughter of the last remaining wild tigers, which are virtually extinct now in Asia, so that men can foolishly eat their bones, claws, and genitals in the mistaken belief that tiger parts will make them virile. Here too, National Geographic has details and photographs that are almost too painful to look at.

And don't get me started on pangolins, the beautiful, peaceful mammal that's now perilously endangered because TCM practitioners think its scales have some sort of medicinal value. (They don't.) For more on these gentle creatures, see the article I wrote last year.

I can almost hear the counter argument: but what about artemisinin? That's a plant extract derived from Artimisia annua, an herb that was traditionally used in China to treat malaria. Turns out that it really works, and artemisinin is now the basis of a number of modern malaria treatments.

Well, great. If an herb has the potential to treat disease, we should (and can, and do) study it, figure out what the active ingredient is, develop a controlled process for delivering effective doses, and use it. That's what happened with artemisia, and it also happened with taxol, an effective cancer chemotherapy derived from the Pacific yew tree, and common aspirin, derived from the willow tree.

But one success doesn't excuse hundreds of bogus claims that are based on little more than magical thinking.

There's no legitimate reason to use terms such as "Chinese" medicine, or American, Italian, Spanish, Indian, or [insert your favorite nationality] medicine. There's just medicine–if a treatment works, then it's medicine. If something doesn't work, then it's not medicine and we shouldn't sell it to people with false claims. The same is true for alternative, holistic, integrative, and functional medicine: these are all just marketing terms, with no scientific meaning. They merely serve to disguise sloppy, unscientific thinking at best, and in a less charitable interpretation, outright fraud.

As the Nature article points out, TCM has been a scam for decades: it was revived and heavily promoted in China by former dictator Mao Zedong, who didn't believe in it himself, but pushed it as a cheap alternative to real medicine. I won't go over that again here, but see these stories from Alan Levinovitz in Slate and David Gorski at Science-based Medicine.

Finally, why would the World Health Organization start pushing a set of unscientific practices that are likely to harm people's health? Support for TCM grew during the tenure of former WHO director Margaret Chan, who ran the WHO until 2017 and who had close ties to China. When Nature tried to contact Dr. Chan, the WHO responded that Chan "is not answering questions on matters related to the WHO."

By endorsing TCM, the WHO is taking a big step backwards. Let's hope that the current leaders of the WHO will realize that this step undermines their core mission. The WHO should not advocate treatments that not only have no evidence to support them and that can cause real harm to patients, but also are the primary reason that humans are hunting rhinoceroses, tigers, pangolins, and other animals to extinction.

Play Tennis For A Longer Life. Science Proves It.

Chris Evert and former President George H.W. Bush playing
tennis at Camp David during Bush's presidency.
Tennis might just be the best thing you can do to extend your life.

A new study from Denmark, published just last week by Peter Schnohr and colleagues, shows that playing tennis may extend your life by nearly 10 years. That's a remarkably big benefit, one that even the study authors were surprised at.

It's been well-established for a while now that exercise helps you live longer. For example, the Cardiovascular Health Study found that people over the age of 75 can expect to gain 1 to 1.5 years of healthy living by being active rather than sedentary. Others studies have looked at the effects of running or walking and found similar positive benefits.

The authors of the new study wanted to look at other sports activities, not just running. Using a large cohort of 20,000 healthy people in the Copenhagen City Heart Study, they identified 8,577 who were in the study from the early 1990s until 2017 and who met a variety of other criteria for inclusion. This gave them 25 years of followup, long enough to ask the question: how does participation in sports affect life expectancy?

In particular, they looked at tennis, badminton, soccer, jogging, cycling, calisthenics, swimming, and health club activities (which included treadmills, ellipticals, and weights).

The bottom line: compared to a sedentary lifestyle, playing tennis extends one's life expectancy by 9.7 years. The other sports all provided benefits too, though tennis was the clear winner. Here's a summary:

  • Tennis: 9.7 years gain in life expectancy
  • Badminton: 6.2 years
  • Soccer: 4.7 years
  • Cycling: 3.7 years
  • Swimming: 3.4 years
  • Jogging: 3.2 years
  • Calisthenics: 3.1 years
  • Health club activities: 1.5 years

The authors didn't expect tennis to do so well, as you can see in this quote:
"Surprisingly, we found that tennis players had the longest expected lifetime among the 8 different sports."
For those who don't read scientific papers regularly, I should point out that the word "surprisingly" rarely gets past the editors unless the result truly is surprising. One part of the surprise is that spending more time exercising did not correlate with the greatest benefits. In fact, the cohort of people who spent the longest time on their exercise was the health club group, who showed the smallest increase in longevity.

One possible reason for tennis, badminton, and soccer doing so well is that out of the 8 sports studied, these are the ones that require 2 or more people and involve social interaction. As the authors explain,
"Belonging to a group that meets regularly promotes a sense of support, trust, and commonality, which has been shown to contribute to a sense of well-being and improved long-term health."
Or it might be that the type of exercise you get in tennis – short bursts of activity rather than slow, steady plodding exercise – might be better for you. The authors noted that
"short repeated intervals of higher intensity exercise appear to be superior to continuous moderate intensity physical activity for improving health outcomes."
If you're still skeptical, the only other study similar to this one, a very large study from Britain published last year, came to the same conclusion: racquet sports had the greatest benefit on all-cause mortality, followed by swimming and aerobics.

So if you're not doing it already, take up tennis! It's easy to find clinics and teams at almost any level (in the U.S., that is), thanks to the thousands of local clubs and to the huge network of USTA leagues, with play ranging from beginners on up, and age groups up to 85 and even 90.

That's right, there are tennis leagues for the 90-and-over set. Maybe tennis players really do live longer.

(Caveats: this was an observational study, based on surveys of people's behavior over a 25-year time span. The scientists tried to take into account all the other variables that might affect life expectancy, but humans are complicated and surveys are never entirely reliable. We don't know that tennis, badminton, and the other sports were the cause of longer life–it might be that people who play sports are generally healthier, and that both leads to longer life and allows them to play more sports.)

Can fasting help you burn off those vacation pounds?

Vacation's over, and with it comes the end of the french fries, ice cream, and other delicious but fattening foods that are hard to resist. "I'm on vacation," we tell ourselves, "I can diet later."

Well, it's later now. How about fasting? Is that an effective way to take off the weight?

Fasting has been growing in popularity in recent years. One of the latest fads is intermittent fasting, in which you fast at regular intervals and then eat all you want in between. There's the 5-2 fast, where you eat for 5 days and fast for 2, every week. Or there's alternate-day fasting, where you eat one day and fast the next, for as long as you can. Or you can fast every day for 16 hours and get all your eating done in the other 8.

Here's the thing: eating is easy, and fasting is hard. If you're going to fast to lose weight, you probably will lose a bit, but the evidence is that most people gain the weight back fairly soon once the fasting diet is over. So fasting might provide a quick reward in terms of weight loss, but the loss will be fleeting.

Suprisingly, though, fasting may be a good idea. A recent review by Stephen Anton and colleagues, in the journal Obesity, found that intermittent fasting may come with a variety of health benefits, including reducing inflammation, improving the ratio of lean tissue to fat, improving cognitive function, preventing type 2 diabetes, and possibly even prolonging life span.

How does fasting produce these benefits? Professor Valter Longo of USC, one of the leading researchers on fasting and longevity, hypothesizes that fasting forces your body to recycle many of its immune cells, particularly white blood cells. Then your body works hard to replenish its white blood cells, essentially re-setting parts of your immune system. Longo is also the inventor of the fast-mimicking diet, where you eat a special diet for 5 days every month, one that makes your body think you're fasting even though you're getting adequate calories and nutrients. (See Alice Walton's story in Forbes for more about that.)

Another effect of fasting is a change in metabolism. As Anton's article explained:
"the key mechanism responsible for many of these beneficial effects appears to be flipping the metabolic switch." 
This happens when the body runs out of its normal fuel, glucose, and begins to burn fat, which means it's converting fat to fatty acids, which in turn produce ketones. The body then uses ketones instead of glucose.

So how much fasting do you need to flip the switch from glucose to ketones? Anton et al. write that
"The metabolic switch usually occurs between 12 and 36 hours after cessation of food consumption, depending on the liver glycogen content and on the amount of exercise during the fast."
This doesn't tell the whole story, because once the switch occurs, you need to burn ketones for some time to gain any benefits. Back in 2014, I wrote about new evidence (from Valter Longo's research) that a longer fast, such as 3 days or more provide significant long-term health benefits. Three days is a long time to fast, but Longo has said that you don't need to do it more than a few times per year.

If you do decide to try a fast, don't expect it to be easy: you're going to get really hungry, and fasting can also interfere with social obligations in an inconvenient way.

I should emphasize that the evidence isn't yet clear for any of these strategies, and there are multiple studies going on now that may provide a clearer picture. Nonetheless, despite the current fad of fasting strategies and diets, fasting really does seem to have some potential health benefits.

(A final caveat: fasting can be harmful, especially for people who have other health problems. If you’re seriously thinking of trying this, you should consult your doctor first.)

Conspiracy theories and snake oil, the perfect pair

Why on earth would people rely on a conspiracy theorist, someone with only a high school education, for medical or health advice? And yet, some people do.

Alex Jones, the far-right conspiracy theorist who runs the Infowars radio program and website, was temporarily suspended by Twitter this week, following bans by Apple, YouTube, and Facebook. These social media companies banned him for repeatedly violating their rules about hate speech and inciting violence. Among other notorious claims, Jones has falsely claimed that children murdered in the mass shooting in Sandy Hook were just actors and that their parents faked their deaths.

What many people don't know, though, is that Jones also runs a dietary supplement business from his Infowars site. Despite reports that Jones' supplements are little more than "overpriced, mundane vitamins," his supplement sales seem to be quite profitable–so much so, in fact, that Buzzfeed reported that the supplement business "largely funds Jones' highly controversial Infowars media empire."

I was curious to see what Jones was selling, so I looked at his Infowars web store. It features an array of products with names like:

Each of these products is marketed with breathless claims for what it can do, including testimonials from Jones himself. For example, Brain Force Plus claims to "supercharge your state of mind," and Jones plugs it with this quote:
"This is what I take before a hard-hitting show. I absolutely love it, and the crew does too. This stuff is over the top powerful!"
Well then. Never mind that Brain Force is really just a collection of herbal extracts and vitamin B-12, none of them proven to "supercharge" your mind or any other body part.

In a similar vein, Jones hypes Super Male Vitality with this claim:
"This product works so well for me that I actually had to stop taking it before I go on air or else I would want to do hours and hours of overdrive with complete focus on the topics at hand."
From the name, you might guess that Super Male Vitality has something to do with testosterone, and the website does state that it "may help support normal testosterone levels in men." What's in it? A collection of plant extracts, none of them proven to maintain or increase testosterone or to have any actual medical benefit.

Of course, if you follow the asterisks on both of these pages and read further down, you'll see that
"These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease."
This statement is the standard disclaimer that supplement manufacturers make in order to avoid FDA oversight. There's no actual scientific evidence (and Jones's Infowars pages don't attempt to cite any) that these products do what the text on the very same page says they do. You just have to take Jones' word for it.

This is pure snake oil. That shouldn't be surprising, not coming from a man who has accused grieving parents of faking their children's deaths, and who claims the U.S. government was behind the 9/11 attacks. It's hard to understand why anyone believes any of the outrageous claims this guy makes, and especially bewildering that people who trust him to advise them on health and diet. His supplements aren't even a good buy, as Buzzfeed reported a year ago. All I can say is, caveat emptor.

You Think It's Hot Now? Just Wait.

Figure from Steffen et al.: a global map of potential
tipping cascades. The individual tipping elements are
color-coded according to estimated thresholds in global
average surface temperature (tipping points).
It's getting hotter all over the planet.

This week the temperature in Bar Harbor, Maine, reached 91° F (32.8° C). In my 20 years vacationing here, this is easily the hottest weather I've ever experienced.

Up and down the U.S. east coast, cities are sweltering, and temperatures out west are even hotter, with California seeing all-time high temperatures, including the hottest July on record in some areas, which has fed damaging fires across the state. Death Valley is always hot, but this week has been crazy, with temperatures on August 7 reaching 122° F (50° C).

At the same time, Europe is baking under a "heat dome" that has brought unprecedented high temperatures, including 45° C (113° F.) in Portugal. It's so hot that people aren't even going to the beach.

Global warming is here, folks. I know we're supposed to call it "climate change," because it's much more complex than simply warming, but warming is one of the most obvious consequences.

And yes, a single heat wave doesn't prove anything, and weather is not the same as climate. I know. But a just-released study from Oxford University found that climate change made this summer's heat wave in Europe twice as likely.

And now, a new study published last week in the Proceedings of the National Academy of Sciences, says it could get much, much hotter if we don't do something about it. In this paper, an international team of climate scientists led by Will Steffen and Hans Joachim Schellnhuber explain that, thanks to human activities, the planet is well on its way to a "Hothouse Earth" scenario.

In a Hothouse Earth, global average temperatures would rise 4–5° C (7–9° F) and sea levels will rise 10–60 meters (33–200 feet) above today's levels. This would be catastrophic for many aspects of modern civilization. Many agricultural regions would become too hot and arid to sustain crops, making it impossible to feed large swaths of humanity. Low-lying coastal areas would disappear or become uninhabitable without massive engineering efforts, displacing hundreds of millions of people. As Steffen et al. put it:
"The impacts of a Hothouse Earth pathway on human societies would likely be massive, sometimes abrupt, and undoubtedly disruptive."
That's putting it mildly.

One reason this scenario is happening, as the study explains, is that we are very close to "tipping points" beyond which certain changes cannot be stopped. (We may have already passed some of them.) These include losing the Arctic ice cap in the summer, and losing the Greenland ice sheet permanently: because they are basically white, these massive expanses of ice serve as giant reflectors to send much of the sun's heat back into space. Without the ice, the darker planet surface absorbs far more heat, creating a positive feedback effect. Another example is the melting of the permafrost, land that has been frozen for thousands of years and that contains a great deal of carbon in the form of methane. Once that methane is released, it will create further warming.

We are also likely to lose the Amazon rainforest, all of our coral reefs, and huge swaths of boreal forests. (See here for a global map of these tipping points.)

If this seems grim, Steffen and colleagues point out that we still have time to avoid it. They propose that societies must act collectively to create a "Stabilized Earth" at no more than 2° C above pre-industrial levels, which is possible but not easy:
"Stabilized Earth will require deep cuts in greenhouse gas emissions, protection and enhancement of biosphere carbon sinks, efforts to remove CO2 from the atmosphere, possibly solar radiation management, and adaptation to unavoidable impacts of the warming already occurring."
None of this is beyond our abilities. We know what we need to do, but it requires large-scale, coordinated action that many governments must agree on if it's to have an impact. Unfortunately, humans (and our governments) tend to do nothing until faced with an emergency, and the tipping points leading to a Hothouse Earth may not look like emergencies, not at first. For example, Arctic sea ice has been declining steadily for 25 years or more, but because few people are aware of this (and even fewer experience it first hand), it doesn't seem urgent. Yet it is.

So perhaps this summer's heat wave can serve as a wake-up call that we need to pay more attention to our planet's health. Otherwise it's going to get a lot hotter.

European Union gets it wrong on GMOS. Again.

Teosinte on the left, modern
corn on the right, a hybrid in
the center.
A European Union court just issued a new decision about GMOs. Disappointingly, this decision is likely to confuse rather than clarify this complex and contentious issue. The court announced that plants whose genomes have been modified with CRISPR technology, a very precise form of genome editing, are subject to the EU's very strict restrictions on genetically modified crops.

More specifically, the Court of Justice of the European Union (ECJ) decided that:
"Organisms obtained by mutagenesis are GMOs."
If we take this literally, then here’s a list of all the foods that have never been subjected to mutagenesis, and are therefore NOT GMO:
  1. Salt
  2. Wild boar
  3. Wild blueberries
That’s it. (OK, maybe there are a few others.)

We have been modifying the genes of the foods we eat for millenia. Every loaf of organic, non-GMO bread is made from wheat that humans have modified since ancient times. Every glass of milk from your grass-fed, bovine-growth-hormone-free cow comes from a cow that humans have bred for centuries. All cows are genetically modified. Those delicious croissants you bought at the organic bakery? Sorry, those are GMOs, no matter how organic you think they are.

And corn? Have you seen what ancient corn, called teosinte, looks like? I encourage you to Google it (or see the image on this blog, above). Modern corn is the result of many generations of human-driven genetic modifications.

To be fair, the EU court recognized that many of our foods have been genetically modified for a long time, and that it might be impractical to remove all of them from our food supply. So they carved out an exception:
"varieties [of plants] obtained by means of mutagenesis techniques which have conventionally been used in a number of applications and have a long safety record are exempt...."
What's ironic here–though I'm confident that the EU court didn't mean this–is that by this definition, virtually all of the GMO crops in the U.S. are exempt. You see, we've been eating them for decades, and they have a phenomenal safety record.

Two years ago, the US National Academies of Sciences, Engineering, and Medicine issued a massive report that reviewed over 1,000 studies of GMOs. The bottom line: there are no health risks whatsoever from eating genetically modified foods.

Earlier gene editing technology sometimes added foreign genes to an organism, such as adding a bacterial gene to a plant. The EU court's new decision is intended to clarify that even if a foreign gene is not involved, plants bred using the newest form of gene editing (CRISPR technology) are nonetheless GMOs.

Banning GMOs doesn't make sense, and it never did. Genetic technology is just a tool, one that can be used for countless purposes, some of them highly beneficial–such as golden rice, which has the potential to prevent blindness in countries where many people depend on rice as their main staple food. If someone objects to a particular use of GM technology, such as Monsanto's use of it to create herbicide-resistant plants, that's something we can reasonably debate. But banning all GMOs is throwing out the baby with the bathwater.

Now if you'll excuse me, I've got to go out to my grill and see how my wild boar is doing. It might need a bit more salt.