The WHO's endorsement of TCM may have helped cause the coronavirus pandemic

About a year and a half ago, I wrote an article titled "WHO endorses Traditional Chinese Medicine. Expect deaths to rise." It went somewhat viral, with over 100,000 views, and then went quiet until last week, when it was revived on Twitter, which has driven thousands of new views to it. Multiple people asked me to re-visit it, in light of the coronavirus and its possible origin in a live animal market in China.

The deaths I was referring to in that title were the deaths of animals (as I'll explain below), not people. What I didn't write about–and what Twitter is buzzing about now–is the possibility that live animal markets in China, such as the one where the Covid-19 virus may have first infected humans, include bats sold for their use in traditional Chinese medicine, or TCM. We now know that the coronavirus almost certainly originated in bats. It's entirely possible–indeed, it seems very likely–that TCM is responsible for the emergence of the Covid-19 coronavirus.

The title of my article might have been more prescient than I guessed at the time.

Indeed, a just-published scientific paper pins the blame for Covid-19 squarely on TCM. The paper argues that

"a live or recently deceased infected bat species was handled by traders because of its value in TCM, and that such an infected individual, or the still infective bat or bat products, may have been the route by which the virus entered the exotic meat market in Wuhan."

Let's back up a bit and review the World Health Organization's involvement in this debacle. Just one year ago, the WHO added a chapter on TCM to its official International Classification of Diseases (ICD-11) for the first time. It apparently took this action after strong lobbying pressure from China: as a 2018 story in Nature pointed out:

"Over the past few years, [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."

This action by the WHO was the result of a long effort by its previous director (she left in 2017), Margaret Chan, who "worked closely with China" to get the WHO to endorse TCM.

Many scientists decried this action. The editors of Scientific American called it a "bad idea." Nature warned that it could "backfire," writing that it

"risks legitimizing an unfounded underlying philosophy and some unscientific practice.... Whatever its aims, the WHO’s chapter [on TCM] is unlikely to do anything other than fuel the expanding sales of largely unproven treatments."

TCM is not medicine. It's little more than a set of traditional beliefs (or a philosophy, as Nature called it) about various concoctions and their effect on one's health. Most of these beliefs have no evidence whatsoever that they provide any health benefits. Many of them derive from a pre-scientific view (which is not at all unique to China) that eating an animal gives one some of the properties of that animal. This is utter nonsense, of course.

Unfortunately, TCM is far from harmless, as I pointed out in my 2018 article. TCM has led to 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, virility, or other health benefits. Two years ago, 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 (warning: these are very graphic).

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 of cruel "tiger farms" that are almost too painful to look at.

TCM has also nearly wiped out pangolins, a completely harmless, gentle animal that has been killed in vast numbers because TCM practioners believe, wrongly, that its scale have some medicinal value. (They don't.) For more about this harmful practice, see this article I wrote in 2017.

And donkeys too: the Independent reported last November that "half the global population of donkeys could be wiped out in just five years, due to a surge in demand for their hides, which are used in traditional Chinese medicine." The world's donkey population is now in a state of crisis, according to the article, because of soaring demand in China for donkey hides, which are used to make eijao (donkey hide glue), a popular TCM product with no evidence that it has any medical benefits. Literally millions of donkeys are being slaughtered for nothing.

Before people accuse me of cultural insensitivity, let me add that 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.

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.

The WHO is under new leadership now, but I see no sign that it's revising its endorsement of TCM, which is still lauded on the WHO website. Now we see that, in addition to the pointless slaughter of thousands of animals, some of which are likely to go extinct as a result, TCM might also create conditions that lead to new human pandemic diseases.

The new scientific paper that I mentioned above–the one that explains why trading in bat species for TCM may have caused the current pandemic, concludes that "a change in these practices is highly recommended."

That would be the understatement of the year.

It's sadly ironic that the WHO, which has in many ways been leading the fight against the Covid-19 virus, may have contributed to the conditions (live animal markets trading in wild animals) that allowed the virus to jump into the human population. It's too late to prevent that, but it's not too late for the WHO to take steps to prevent the next pandemic: they can and should remove TCM from their official guidelines.

As for China, they should recognize that the profits they make from the sales of animal parts for TCM are vastly outweighed by the harm these practices cause. China should stop promoting TCM, and it should ban the killing of wild animals for spurious medical reasons.

$3.7 million to study quack medicine at a leading cancer center

Sometimes I'm not sure whether the best response to pseudoscience is to ignore it, or to patiently try to explain why it's wrong, or to get mad.

This week I'm mad.

My anger and frustration was triggered by a tweet from Memorial Sloan-Kettering's Integrative Medicine account, shown here:

For those who don't know, Memorial Sloan-Kettering Cancer Center is one of the world's leading cancer centers, both for treatment and research. If you are diagnosed with cancer, MSK is one of the best places to go.

But not everything at MSK is world class. Unfortunately, they have an "integrative medicine" center that offers a mixture of therapies ranging from helpful to benign to useless. One of their biggest activities is acupuncture, which they claim offers a wide range of benefits to cancer patients.

The MSK tweet shown here was boasting about a new, $3.7 million study funded by NIH to study the effect of acupuncture on pain that cancer patients experience from chemotherapy and bone-marrow transplants.

Here's why I'm mad: cancer patients are extremely vulnerable, often suffering the most frightening and difficult experience of their lives. They are completely dependent on medical experts to help them. When a place like MSK suggests a treatment, patients take it very seriously–as they should. But they really have no choice: a cancer patient cannot easily look for a second opinion, or switch hospitals or doctors. Even if they have the money (and cancer treatment is extremely expensive), switching hospitals might involve a long interruption with no treatment, during which they could die, and it might also involve traveling far from their home.

Offering these patients ineffective treatments based on pseudoscience–and make no mistake, that's what acupuncture is–is immoral. Now, I strongly suspect that the MSK's "integrative medicine" doctors sincerely believe that acupuncture works. Their director, Jun Mao, is clearly a true believer, as explained in this profile of him on the MSK website. But that doesn't make it okay.

I've written about acupuncture many times before (here, here, here, and here, for example), but let me explain afresh why it is nonsense.

Acupuncture is based on a pre-scientific notion, invented long before humans understood physiology, chemistry, neurology, or even basic physics, which posits that a mysterious life force, called "qi," flows through the body on energy lines called meridians. As explained in this article by MSK's Jun Mao:

"According to traditional Chinese medicine ... interruption or obstruction of qi was believed to make one vulnerable to illness. The insertion of needles at specific meridian acupoints was thought to regulate the flow of qi, thus producing therapeutic benefit."

Today we know that none of this exists. There is no qi, and there are no meridians. In that same article, Jun Mao continued by admitting that

"the ideas of qi and meridians are inconsistent with the modern understanding of human anatomy and physiology."

And yet this is what they offer to patients at MSK.

Just to be certain, I read one of the latest studies from MSK, published early this year, which claims to show that acupuncture relieves nausea, drowsiness, and lack of appetite in multiple myeloma patients who were going through stem cell transplants.

It's a mess: totally unconvincing, and a textbook case of p-hacking (or data dredging). The paper describes a very small study, with just 60 patients total, in which they measured literally dozens of possible outcomes: overall symptom score at 3 different time points, a different score at 3 time points, each of 13 symptoms individually, and more. I counted 24 different p-values, most of them not even close to significant, but they fixated on the 3 that reached statistical significance. The two groups of 30 patients weren't properly balanced: the sham acupuncture group started out with more severe symptoms according to their own scoring metric, and Figure 2 in the paper makes it pretty clear that there was no genuine difference in the effects of real versus sham acupuncture.

But they got it published (in a mediocre journal), so now they point to it as "proof" that acupuncture works for cancer patients. This study, bad as it is, appears to be the basis of the $3.7 million NIH grant that they're now going to use, they say, in "a larger study in 300 patients to confirm these previous findings."

And there you go: the goal of the new study, according to the scientists themselves, is not to see if the treatment works, but to confirm their pre-existing belief that acupuncture works. Or, as one scientist remarked on Twitter, "they already have a result in mind, the whole wording of this suggests that they EXPECT a positive outcome. How did this get funded exactly?"

Good question.

So I'm mad. I'm mad that NIH is spending millions of dollars on yet another study of a quack treatment (acupuncture) that should have been abandoned decades ago, but that persists because people make money off it. (And, as others have explained in detail, acupuncture is actually a huge scam that former Chinese dictator Mao Zedong foisted on his own people, because he couldn't afford to offer them real medicine. For a good exposé of Chairman Mao's scam, see this 2013 Slate piece.)

But I'm even more upset that doctors at one of the world's leading cancer centers are telling desperately ill patients, who trust them with their lives, that sticking needles into their bodies at bogus "acupuncture points" will relieve the pain and nausea of chemotherapy, or help them with other symptoms of cancer. I'm willing to bet that most MSK doctors don't believe any of this, but they don't want to invest the time or energy to try to stop it.

(I am somewhat reassured by the fact that MSK's Twitter account has nearly 75,000 followers, while it's integrative medicine Twitter account has just 110.)

Or perhaps they are "shruggies": doctors who don't believe in nonsense, but figure it's probably harmless so they don't really object. To them I suggest this: read Dr. Val Jones's account of how she too was a shruggie, until she realized that pseudoscience causes real harm.

And finally, let me point to this study in JAMA Oncology from last year, by doctors from Yale, which looked at the use of so-called complementary therapies among cancer patients. They found that

"Patients who received complementary medicine were more likely to refuse other conventional cancer treatment, and had a higher risk of death than no complementary medicine."

And also see this 2017 study from the Journal of the National Cancer Institute, which found that patients who used alternative medicine were 2.5 times more likely to die than patients who stuck to modern medical treatments.

That's right, Memorial Sloan-Kettering: patients who use non-traditional therapies are twice as likely to die. That's why I'm mad. This is not okay.

Why does anyone believe this works? The dangers of cupping.

Cupping therapy. If this looks painful and possibly damaging

to the skin, that's because it is.

People are easily fooled. Even smart people.

I'm not talking about voters in the U.S. and the UK, although both groups have recently demonstrated how easily they can be conned into voting against their own interests. You can read plenty of articles about that elsewhere.

No, I'm talking about the wide variety of health treatments that call themselves alternative medicine, integrative medicine, traditional Chinese medicine, energy medicine, and other names. These are all just marketing terms, but many people, including some physicians and scientists, seem captivated by them.

This week I'm going to look at "cupping," a rather bizarre treatment that, for reasons that escape me, seems to be growing in popularity.

I just returned from a scientific conference, where I happened to speak with an editor for a major scientific journal who also follows this blog. She remarked that she liked some of my articles, but she disagreed with me about cupping, which I wrote about during the 2016 Olympics, where swimmer Michael Phelps was observed to have the circular welts that are after-effects of cupping. This editor's argument boiled down to "it works for me," which left me somewhat flabbergasted.

And just two weeks ago, when I was at my physical therapist's office getting treatment for a shoulder injury, I heard her discussing cupping with another therapist. I then noticed a large box containing cupping equipment on one of the counters. Thankfully, my therapist didn't suggest cupping for me; I'm not sure how I would have replied.

What is cupping? It's a technique where you take glass cups, heat the air inside them, and then place them on the skin. Because hot air is less dense, it creates suction as it cools, which sucks your skin up into the glass. (Some cupping sets use pumps rather than heat to create this effect.) Imagine someone giving you a massive hickey, and then doing another dozen or so all over your back, or legs, or wherever the cupping therapist thinks you need it. If that sounds kind of gross, it is.

Quacktitioners Practitioners of cupping think that it somehow corrects your "qi," a mysterious life force that simply doesn't exist. When pressed, they often remark that it "improves blood flow," a catch-all explanation that has no scientific basis and that is more or less meaningless. What really happens, as the physician and blogger Orac noted, is this:

"The suction from cupping breaks capillaries, which is why not infrequently there are bruises left in the shape of the cups afterward.... If you repeatedly injure the same area of skin over time ... by placing the cups in exactly the same place over and over again, the skin there can actually die."

So maybe cupping isn't so good for you.

Cupping is ridiculous. There's no scientific or medical evidence that it provides any benefit, and it clearly carries some risk of harm. A recent review in a journal dedicated to alternative medicine–one of the friendliest possible venues for this kind of pseudoscience–concluded that

"No explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary."

Right. That's what proponents of pseudoscience always say when the evidence fails to support their bogus claims. Let us do more studies, they argue, and eventually we'll prove what we already believe. That's a recipe for bad science.

Even NCCIH, the arm of NIH dedicated to studying complementary and integrative nonsense medicine, can't bring itself to endorse cupping. Their summary states:

• There’s been some research on cupping, but most of it is of low quality.
• Cupping may help reduce pain, but the evidence for this isn’t very strong.
• There’s not enough high-quality research to allow conclusions to be reached about whether cupping is helpful for other conditions.

In other words, some bad scientists have conducted a few studies but haven't proven anything. But wait, it gets worse. NCCIH goes on to warn that:

• Cupping can cause side effects such as persistent skin discoloration, scars, burns, and infections, and may worsen eczema or psoriasis. 
• Rare cases of severe side effects have been reported, such as bleeding inside the skull (after cupping on the scalp) and anemia from blood loss (after repeated wet cupping). 

And still, otherwise intelligent people say "it works for me." I'm left speechless.

The bottom line: save your money and your skin. Don't let anyone suck it into those cups.

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.

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:

• Brain Force Plus
• Super Male Vitality
• The Real Red Pill, DNA Force, and more

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.

Here's $142M we'll be wasting on pseudoscience in the new US Budget

After much unnecessary drama and 6 months late, Congress finally passed a budget last week funding the government for the fiscal year that started in October 2017. While much of the news is good, or at least not too bad, the 2,232 page budget contains lots of goodies for special interests.

I downloaded the whole thing so you don't have to.

One of the worst pieces of wasteful spending is tucked away on page 934: $142,184,000 for the National Center for Complementary and Integrative Health. Incredibly, this is a 9% increase over the NCCIH's 2017 budget of $130.5 million. Is this because they've discovered new and effective treatments? Alas, no.

NIH has been spending money on so-called alternative medicine since 1992. Over the years, the budget has increased from just $2 million to the very hefty $142 million this year. NIH has now spent a total of $2.366 billion dollars on its alternative medicine center.

The NCCIH started as an "office," funded by a $2 million earmark by former Senator Tom Harkin, who later elevated it to a National Center called NCCAM. On Harkin's retirement in 2015, his buddies renamed it as NCCIH, adopting the buzzword "integrative" as a jazzier word than "alternative." It's a classic (and sad) example of how once something gets started by Congress, it grows relentlessly, creating its own constituency of people and industries who consume the funding and clamor incessantly for more.

What have we learned for our $2.4 billion? Have new cures been developed, new medicines been discovered? Has NIH provided good scientific evidence that any of the "alternative" methods–which include acupuncture, homeopathy, naturopathy, Ayurveda, therapeutic touch, reiki, aromatherapy, and others–actually work? The answer to all these questions is no.

On the other hand, the real work of biomedical research, funded by the rest of NIH, has yielded tremendous progress on a wide range of diseases. These include cures that we could only have dreamed about 10 or 20 years ago, such as this amazing stem cell cure of a 7-year-old boy with a devastating skin disorder, or this leukemia treatment reported in 2013.

After 26 years and $2.3 billion spent trying–and failing–to prove that alternative medicine works, it's long past time to end this nonsense and shut down NCCIH, as I and many other scientists have been saying for years. That $142 million could be used far more effectively studying real treatments for real diseases, rather than imaginary treatments that have failed, time and again, to prove their merits.

$142 million. To those who argue that it's only a small percentage of the NIH budget, I would point out that a typical NIH research grant is under $500K. This means we could fund at least 300 additional biomedical research projects every year if we got rid of this giant special-interest earmark that has utterly failed to produce anything useful.

Instead, someone in Congress managed to sneak in the largest budget increase that NCCIH has seen in 15 years. What a waste.

Gwyneth! How did you learn so much about health?

Gwyneth Paltrow has invented stickers that promote healing. Yes, stickers. Little circular stick-on thingies that you might give to your 1st-grader as a reward for doing her homework.

Gwyneth, though, has discovered something much deeper about stickers. If you make them with just the right materials, and then stick them on your body in the right places, they "rebalance the energy frequency in our bodies."

(A quick warning: if you follow the links in this article, put down your coffee first. You might laugh so hard that you'll spill it all over yourself.)

Until a day or two ago, Gwyneth Paltrow's Goop website–a "lifestyle" business that sells all things Gwyneth–advertised these stickers as using "NASA space suit material," which presumably was the source of their magic healing properties. Then Gizmodo called someone at NASA to check out this claim, and got a very clear answer.

Nope. Goop's stickers are not made of space suit material. (Not that space suit material has healing properties in the first place–it doesn't.) Gizmodo's quote from a former NASA scientist, Mark Shelhamer, sums it up nicely:

“Wow,” Shelhamer told Gizmodo. “What a load of BS this is.”   

Goop quickly updated their site, and now they don't claim anything about NASA space suits in their stickers. But they didn't dial back any of their magical healing claims. Here's what Goop says now, in an article called "Wearable Stickers that Promote Healing (Really!)":

"Human bodies operate at an ideal energetic frequency, but everyday stresses and anxiety can throw off our internal balance, depleting our energy reserves and weakening our immune systems. Body Vibes stickers come pre-programmed to an ideal frequency, allowing them to target imbalances."

Wow. What gobbledygook. I see what that NASA scientist meant. But wait, there's more! Goop tells us:

"Studies have shown that when your frequency slips, your immune system is compromised, which opens the door to getting sick."

Studies? No such studies exist. People don't have a "frequency," and there's nothing to "slip." I think it's fair to say that the Goop claims about these stickers are so ridiculous that they're not even wrong.

These stickers are powerful, though, so you must be careful. Goop warns that

"We recommend starting with 1 or 2 for sensitive people. Wearing more than 4 may cause some dilution of the individual frequencies."

Oh boy.

Paltrow sells these magic stickers (and all of her products) using pictures of beautiful models doing healthy activities while wearing stickers. This is part of Goop's appeal: Paltrow is suggesting, in essence, "I'm beautiful and healthy and I'm in my forties, so I know the medical secrets that will keep you beautiful too."

Of course, the special Goop stickers aren't cheap: they cost $60 for a 10-pack.

Not surprisingly, Goop sells lots of overpriced dietary supplements too, such as a bottle of multivitamins with fish oil for $90, which comes with claims about keeping the immune system strong. Almost no one needs these supplements, and they don't do anything for your immune system, as I've explained before.

It took me just a few seconds to find that you can get a sheet with about 50 "dreams come true" stickers at stickersgalore.com for less than $2. These don't come with any wild health claims, but they do make kids happy. I recommend trying these before you get the Goop stickers.

Goop's (and Gwyneth's) claims about their stickers are so ridiculous, so laughably nutty, that I can't really feel sorry for the people who fall for them. Anyone who can afford to waste $60 for a pack of stickers probably has too much money and not enough sense. It's just too bad that they're giving their money to a wealthy actress rather than donating it to some worthy cause.

Finally, I should note that I've always liked Paltrow as an actress, in movies such as Emma and Shakespeare in Love from the 1990s through the recent Iron Man franchise. But why would her acting skills make her an expert on human health? They don't.

Calling out fake medical journals that exist to promote acupuncture

Comic strip by Rudis Muiznecks, cectic.com

Fake news has been in the news a lot lately. Fake news proliferated wildly during the 2016 U.S. election, much of it completely fabricated, usually with an extreme partisan bias. Fake news is corrosive. It mis-informs the public, divides people against one another, leads to bad policy decisions, and can even induce people to take action against imaginary threats.

One might think that medical literature is immune from this kind of fakery, but it's not. Recent years have seen the appearance of journals from mainstream publishers that are based entirely on pseudoscience. On the surface, these publications look and act just like real scientific journals, but it's all just pretend. The publishers of these journals presumably care more about their bottom line than about scientific integrity. They know (or seem to know) that journals about pseudoscience will create a never-ending demand for fake breakthroughs and science-y sounding studies that are built on a house of cards.

I've decided to start out the new year by calling out these fake medical journals for what they are: complete and utter nonsense. First, a bit of background.

Imagine for a moment that a publisher created a Journal of Magical Medicine under the rubric of a large, respectable publisher–for example, Elsevier. After assembling an editorial board of academics from legitimate universities who believed in magical medicine, the journal started soliciting and reviewing papers. The editors would send any submissions for review to other academics who believed in magic, and over time a steady stream of peer-reviewed papers would emerge. A large network of magical medicine "experts" would develop, reviewing and citing each others' papers, and occasionally writing review articles about the state of the art in magical medicine.

Dr. Harriet Hall has accurately called this "tooth fairy science." I prefer to call it "cargo cult science," because its practitioners mimic the behavior of real scientists without actually understanding science itself.

Of course, no self-respecting scientist would want to waste his or her time reading garbage, so most scientists would simply ignore the Journal of Magical Medicine. But it would persist anyway.

This is exactly the situation we're in now, but as you might guess, the Journal of Magical Medicine doesn't exist. Instead, we have multiple journals devoted entirely to something just as fanciful and just as unbelievable: acupuncture. Here are three examples:

• The Journal of Acupuncture and Meridian Studies, published by Elsevier
• Acupuncture in Medicine, published by BMJ
• Chinese Medicine, published by BioMed Central (owned by Springer)

These aren't the only ones, but they'll do for an illustration. I can't help pointing out that the Elsevier journal has a bonus bit of magic in its name: "meridians" are a completely imaginary concept, referring to invisible lines of energy that supposedly flow through the body. This is a perfect (if unintentional) example of magical medicine. How nice that Elsevier provides a journal for people who want to study it.

Prof. Edzard Ernst has pointed out that these journals, and others like them, are a farce:

"Potential authors ... are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job.... As a result, most (I estimate around 80%) of the articles that currently get published on alternative medicine are useless rubbish."

If anything, Prof. Ernst is being overly generous.

Looking over the articles published in the latest issues of these journals is painful (if you care about good science, that is). For example, the BMJ acupuncture journal features "Needling depth at BL52 in 13 cadavers," an article about inserting needles into dead bodies. Why study this? Because (as the paper explains) acupuncture needles can damage the kidneys if they are inserted too deeply. Here's another example, from Elsevier's acupuncture journal: "Effect of Manual Acupuncture Stimulation at `Bai-Hui' (GV 20) or `Yintáng' (Ex-HN3) on Depressed Rats," a study that concludes that acupuncture helps alleviate depression (in rats, mind you!) but only if you use two acupuncture points simultaneously. Right.

There are thousands more articles like these. It's an entire ecosystem of pseudoscience.

Let's be clear: acupuncture is "a pre-scientific superstition" that has no basis in medicine, physiology, or biology, and has never had any good scientific evidence to support it. It wasn't even popular in China until Chairman Mao re-invented it as part of "traditional Chinese medicine." Mao did this because China didn't have enough real doctors to treat its large population, and he wanted to convince the masses that their local herbalist was offering something just as good. China is still pushing this today, for the same unscientific reasons.

I've been advised that I should treat acupuncturists and acupuncture believers with respect, and that I should accept that they have some legitimate claims because some patients like them. I've tried this approach, and it doesn't work: acupuncture continues to spread, in part because of very badly-done studies that often misrepresent their findings. I've read enough acupuncture studies for one lifetime, and acupuncture doesn't work for anything. It's nothing more than an elaborate, theatrical placebo, performed by quacks to convince unwitting victims patients that the acupuncturists have something real to offer. They don't.

Trying to refute the claims of acupuncture (see here and here, and again here, for example) is like playing whack-a-mole. Proponents claim it cures dozens (or hundreds) of different conditions, and each time a claim falls flat, they simply make up a new one. Acupuncture also carries small but real risks to patients, who can suffer infections and sometimes much worse, such as punctured lungs.

Elsevier, BMJ, and Biomed Central should be embarrassed to publish these fake medical journals, which serve only to promote pseudoscience. Their very existence can confuse medical students, who assume (as they've told me themselves) that if legitimate-looking journals are publishing this stuff, there must be something to it.

Despite their appearances, the Journal of Acupuncture and Meridian Studies, Acupuncture in Medicine, and Chinese Medicine are not real medical journals. They are fake journals filled with fake science, and the world would be a better place if they all disappeared.

How to treat the flu: a shopping guide

Flu season is upon us, and your local pharmacy may feature special displays with products claiming to cure or treat the flu (which is caused by the influenza virus). The array of products, and the claims featured on their packaging, can be bewildering. Which of them should you buy? Here is a quick guide. (Spoiler: if you want to know what really works, skip to the end.)

This photo from a local RiteAid shows their display of "alternative" treatments. Let's consider a few of them.

Alternative pills that claim to treat the flu. 

1. Across the top we have vitamin C drops, helpfully labelled "Defense" in large letters. You might think these would defend you against the flu virus, but you'd be wrong. Vitamin C has no effect whatsoever on the flu, and it doesn't prevent colds either. People have been taking it for decades, but popularity is no substitute for evidence.

2. The shelves include 11 different formulations of Airborne, with the phrase "helps support your immune system" prominently displayed. Does this product help your immune system fight off the flu? Not even a tiny bit. Airborne is nothing more than an overpriced vitamin supplement (including vitamin C), and it's on the shelf because of clever and misleading marketing. Back in 2008, Airborne settled a $23.3 million lawsuit over false advertising, which was filed because they called their product a "miracle cold buster." After the lawsuit, they simply re-labeled it as an "immune booster," which is vague enough that they've been getting away with this claim ever since. Save your money.
3. Several of the products here, notably Zicam, are basically sugar pills supplemented with zinc. Some time ago, there was preliminary evidence that zinc might reduce the duration of a cold, but there was never any evidence that it could work for the flu. (Aside: colds are caused by completely different viruses.) Once scientists looked at it a little harder, they discovered that zinc doesn't work for colds either, as I explained in a 2012 column. Zicam is marketed as homeopathic, a clever ploy that allows it to escape government regulation. Their marketing constantly dances around what is permitted, usually by claiming it provides "immune support." Sound familiar?

Very expensive sugar pills.

4. On the bottom shelf you might notice Oscillococcinum, a homeopathic remedy that is just a sugar pill. Oscillo's claims to treat anything are almost laughably ridiculous: its "active" ingredient is supposed to be an extract from the heart and liver of a duck, which is then diluted until even that ingredient is no longer present.  As you can see in the close-up picture here, it's not cheap: $31 for 30 pills.
The box also claims that it "reduces duration and severity of flu symptoms," a completely false claim. The FDA has issued warning letters about this before, pointing out that "These products have not been approved or otherwise authorized by FDA for use in the diagnosis, mitigation, prevention, treatment (including treatment of symptoms), or cure of the H1N1 Flu Virus." Apparently the manufacturers of Oscillo (and the numerous places that sell it) are just ignoring the FDA.

These are just the "alternative" treatments. Most pharmacies have an even larger selection of flu treatments with real medicine in them. Here's a photo from the same RiteAid, right next to the alt-med selections.  

Medicines that try to treat the flu.

The selection here includes pills and liquids in many shapes and sizes, and all of them have active ingredients that do indeed have some effects. But they don't actually treat the flu itself: instead, they treat some of the symptoms, such as pain and congestion. None of them work very well, although those that contain ibuprofen or acetaminophen do help reduce pain.

So what does work? The latest medical science offers only two options:
1. Vaccination. Get your flu shot! The flu vaccine isn't perfect, and it varies in efficacy from year to year, but it usually provides some protection. In the best years it can reduce your chance of getting the flu by 75% or more. It's far better to avoid getting the flu in the first place.

2. Oseltamavir (Tamiflu), available only by prescription, is the only anti-viral medication that has been shown to have some effectiveness against the flu. It's not great, but it can reduce the severity of symptoms and maybe shorten the duration of the illness by about 1 day. You have to see a doctor to get it, which means taking your (sick) child or self to a doctor's office and exposing other people to the flu. 

The bottom line: none of the treatments that you can buy without a prescription will cure the flu. The "alternative" treatments are completely useless, and the real medicines might help a little bit with symptom control. 

Your best choice, by far, is the flu vaccine. Unfortunately, the internet is filled with misinformation such as claims that the vaccine doesn't work, or that it can give you the flu, or (worst of all) the utterly discredited notion that preservatives in the vaccine cause autism. Some of the anti-vaccine nonsense has even been promoted by presidential candidates, namely Donald Trump, Ben Carson, and Jill Stein. By spreading these false stories, Trump and Stein are doing real harm to the public health.

Flu advice from a future doctor.

Finally, I want to give props to RiteAid for trying to get people vaccinated. In front of the same store at which I took these pictures were two large signs saying "Get your flu shot today." Inside the store, they had a special table with science-based information about the flu vaccine, which featured artwork from local children (one of them shown here) encouraging other kids to get vaccinated. Well done.

NIH will spend $37 million to study discredited treatment that may harm patients

What do you do when you've spent $30 million to study a highly controversial, possibly harmful treatment, only to learn that it doesn't work?

If you're NIH's alternative medicine center, you double down. More than double, actually: NIH's NCCIH* just announced they will spend another $37 million to study chelation as a treatment for heart disease. Or to be more specific, Mount Sinai of Florida and Duke University issued a press release this past week proudly announcing that they'd won a $37 million grant to launch TACT2, the second Trial to Assess Chelation Therapy. TACT2 will be a followup study from TACT, which ended in 2012 after largely failing, as I'll explain below.

Chelation is a harsh chemical treatment, using a chemical called disodium EDTA, that is sometimes used to treat lead poisoning, because it can help to remove heavy metals from the blood. Some people think that this can somehow remove plaques from arteries, a sort of Roto-Rooter for your circulation, which in turn might improve cardiovascular health. This turns out to be wrong.

(Chelation is also promoted, tragically, as a treatment for autism. Anti-vax doctors who think that mercury causes autism have been pushing this for years. In 2014, the FDA issued a warning for parents to beware of this dangerous and ineffective therapy.)

Let's briefly review what TACT was, and some of its problems. There are far too many to list here, but I'll refer readers to a lengthy article published in 2008 by Dr. Kimball Atwood and colleagues for details. That article, which called for a halt to TACT, explained that:

• a series of randomized trials in the 1990s found no evidence that chelation worked for coronary artery disease
• most of the early advocates of chelation (in the 1960s) were also outspoken advocates for Laetrile and other ineffective therapies
• at least 30 deaths have been report associated with EDTA, but the doctors pushing its continued usage deny that any deaths have occurred.
• the scientific literature has shown that the underlying "heavy metals" hypothesis is implausible
• the TACT study includes "nearly 100 co-investigators who, in our opinion, are unsuitable to care for human subjects or to report trial data ... several have been disciplined, for substandard practices, by state medical boards; several have been involved in insurance fraud; at least 3 are convicted felons."
• "The researchers failed to inform the subjects that one risk of the treatment was death." (from The Chicago Tribune.)

Atwood and colleagues called for a halt to the TACT study, saying it was "pointless, dangerous, unethical, and wasteful."

The TACT study was indeed halted in 2008 for these and other ethical concerns, but it was quietly resumed about a year later. Then in 2012, the final results were reported. Although the results were almost entirely negative, the lead investigator, Gervasio Lamas, claimed that there was a benefit for a sliver of patients: people with diabetes who had a prior heart attack. That's the group he plans to focus on in the new TACT2 trial.

As Forbes writer Matt Herper explained in 2012, most doctors were highly skeptical of these results. Cardiologist Steve Nissen of the Cleveland Clinic said "It would be tragic if the result of this was a widespread use of chelation." Science blogger (and cancer doctor) Orac provided a detailed analysis of the results at the time, explaining why the study essentially failed to prove any benefit for chelation. Most of the results were not statistically significant, and the best the study could claim was very marginal significance for a small benefit, a result that could easily be explained by bias, which was rampant in this study.

TACT2 is being run by the same doctor, Gervasio Lamas, who recruited questionable practitioners into the first trial. There's no reason to think the second trial will be run any better. The new trial will subject 1,200 diabetic heart attack survivors to chelation therapy in an effort to prove that chelation helps prevent a second heart attack. Not only is this extremely unlikely to provide any benefit, it also exposes the patients to serious risks that Lamas and his colleagues don't seem to acknowledge, and probably won't tell the patients about.

NIH should pull the plug on this enormous ($37 million) and dangerous trial before it begins. If potential patients are informed correctly that there is a serious risk of harm with virtually no chance of benefit, then hopefully they will simply refuse to enroll. That would be the best outcome for everyone.

*In case you're wondering what NCCIH is, it's the new acronym for the former National Center for Complementary and Alternative Medicine, NCCAM. Last year it was renamed. The new name is the National Center for Crackpot and Implausible Hypotheses, Or maybe it's the National Center for Complementary and Integrative Medicine, you decide.

Someone needs to tell Michael Phelps to stop bruising himself

It happens every four years. No, not the Olympics, though of course that happens too. I'm talking about new wackadoodle performance enhancement fads. In the 2008 and 2012 Olympics, it was magic tape, which we saw plastered across the arms and legs of many swimmers. This year it's "cupping," a crude technique that leaves nasty red or purple welts all over your body. Michael Phelps, one of the best male swimmers in Olympic history, featured these lovely welts in photos this week, and you can catch a glimpse of him getting the treatment in the UnderArmour "Rule Yourself" ad featuring Phelps (which is otherwise an excellent ad).

Phelps isn't the only one. Former Olympic swimmer Natalie Coughlin and gymnast Alex Naddour have displayed the distinctive circular welts too.

The New York Times, USA Today, and People all ran articles yesterday explaining what those nasty red bruises were all over Phelps' torso and shoulders. USA Today reported, unquestioningly, that athletes use cupping "to relieve tension in their muscles." The NY Times (from which we might expect a bit more skepticism) reported blithely that "Physiologically, cupping is thought to draw blood to the affected area, reducing soreness and speeding healing of overworked muscles." People used the same argument, and then added this bit of illogic:

"given that Phelps took home his 23rd Olympic medal last night, it's tough to argue."

No, it's not. Cupping is ridiculous. There's no scientific or medical evidence that it provides any benefit. The NY Times did express a bit of doubt (though not much), summarizing two small experiments that showed that cupping worked no better than placebo. But the Times couldn't help itself, and went back to quoting anecdotal evidence from true believers.

Rather than review the evidence here, I refer you to a thorough takedown of cupping written last month by Orac, a well-known science blogger who is also a surgeon:

"Among the silliest of alternative medicine therapies is something called cupping.... The suction from cupping breaks capillaries, which is why not infrequently there are bruises left in the shape of the cups afterward."

As Orac points out, repeated cupping in the same spot can destroy your skin and lead to dangerous infections. Another physician, Dr. Harriett Hall, in an article for Slate in 2012, made similar points.

I'm not sure who told Michael Phelps that cupping would help him swim faster, but I am sure that it's terrible advice–definitely not helpful and maybe harmful.

I know athletes are notoriously superstitious, and they get some psychological benefits from the various rituals they use to prepare for competition. There's no harm in believing that magic tape, or a lucky shirt, or always stepping onto the field with your left foot first–or whatever–will help you win. But Michael Phelps and his fellow Olympians should run as fast as possible from unproven treatments (and make no mistake, cupping is one of these) that can only cause them harm.

Allergy sufferers beware! These eyedrops are a scam.

Spring allergy season is upon us, and plants are bursting into leaf and bloom, spreading pollen everywhere. For some of us, this otherwise beautiful season is a time to stock up on antihistamines and tissues, and we try our best to stay indoors.

When pollen causes red, itchy eyes, we look for eyedrops to provide some relief. The American Academy of Allergy, Asthma, and Immunology and has a list of eyedrops here that includes products such as Zaditor®, Alaway®, and others. These eyedrops contain real medicine that can soothe itchy eyes and reduce your allergy symptoms.

So I was in the pharmacy section of my local grocery store, Giant, looking for eye relief, but they were sold out of Zaditor. Right next to the empty slot, though, I saw a row of other eyedrops from a company called Similisan®, and I took the picture shown here.

Homeopathic eye drops at Giant Foods in Baltimore.

Looks legitimate, right? Each box has a cross on it (apparently intended to resemble the logo of the Red Cross), and they are in the pharmacy section. I picked up the box labeled "Allergy Eye Relief" to take a closer look, though, and saw the word "homeopathic" near the bottom of the box.

Uh oh. It turns out that these products are little more than very, very expensive bottles of sterile water. For $9.99 you get 10 ml of water that contains several extracts–in vanishingly small amounts–for which there is no evidence whatsoever that they have any effect on allergies. Similisan's allergy relief bottle contains:

• Honeybee
• Eyebright (a plant)
• Sabadilla lily (another plant)

Yes, that's right: they grind up honeybees and put them in the eyedrops. The (wacky) idea is that because bee stings cause allergic reactions, a tiny bit of ground-up bee in solution will prevent those reactions. This flawed principle is the basis for all of homeopathy, which has stuck around for 200 years despite the complete absence of evidence that it works.

As I've written before, homeopathic drugs get a free pass on regulation, thanks to Congress. Homeopaths will tell you that their drugs are regulated by the FDA (they often make this claim in the comments on my articles - just watch), but they're not. All the FDA can do is check to see if the products contain the ingredients listed on the label. Unlike real drugs, though, the FDA does not and cannot require that these "drugs" have any effect whatsoever.

I don't think I need to say more about ground-up bees, but what about those other two ingredients? Eyebright is a plant that has "little or no evidence of efficacy" for eye infections. Its use dates back to the ancient Greeks, and has an interesting history:

"Eyebright was used as early as Theophrastus and Dioscorides, who prescribed infusions for topical application in the treatment of eye infections. This in large part was due to the similarity of the “bloodshot” petals to irritated eyes."

That's right: the flower petals look like irritated eyes, and this was enough to get the early Greeks to try them out as a treatment. Needless to say, the physical appearance of a plant has nothing to do with its efficacy as a medicine. (But try telling that to a homeopath.)

Sabadilla, the third ingredient, is a plant extract used as an insecticide, with an active ingredient called veratrine. As Laura Pottorff from Colorado State University explains, "its dust can be highly irritating to the eyes." Therein lies the homeopath's motivation for using sabadilla in eyedrops: homeopaths believe that a substance that irritates the eyes will somehow soothe the eyes if it is sufficiently diluted.

Similisan claims that their 3 homeopathic eyedrops will relieve itching, burning, watering, and redness in your eyes. The box just says it's "manufactured according to homeopathic principles," but doesn't explain that it hasn't been shown to be effective. You have to go to their website to discover that

"The uses of our products are in compliance with official Homeopathic Compendia. They were not the subject of approved applications reviewed by the Food and Drug Administration prior to marketing." 

In other words, they've never presented any evidence that these things actually work.

One can only hope that the sabadilla in Similisan's eye drops is sufficiently diluted; if not, you're putting insecticide in your eyes. The package says that all three ingredients are at 6X dilution, which in homeopathic jargon means 1 part in 1 million. The problem is that homeopathic substances have no real standards, so we don't know how much of the active ingredients were in the original mixture before dilution.

I was curious to see if Whole Foods Market sold the same stuff, and not surprisingly they do, in their special section devoted to homeopathy. (I've written about WFM and their love affair with homeopathy before.) The only difference is that Similisan costs more at Whole Foods, $11.99 to $14.99 depending on which flavor you buy (check out the photo below).

Homeopathic eye drops at Whole Foods Market. How much

money do you want to waste on a tiny water bottle?

Homeopathic eye drops are nothing more than really, really expensive water. At $10 for 10 ml, that works out to $1000 per liter. Similisan proudly states that it's sold at a wide variety of U.S. retailers and pharmacies, including CVS, Kroger, Publix, RiteAid, Safeway, Target, Walgreens, Walmart, and Wegmans. Seems like they're doing quite a good business selling their $1000/liter water.

Consumers beware: the eyedrops you're looking at, even in the Pharmacy section of the store, might be expensive, ineffective make-believe medicine. Make sure to read the package closely; the fake medicine is sometimes right next to the real stuff, and the packaging is designed to fool you.

Don't eat dirt

Don't eat dirt. It's bad for you.

This might seem like a head-slappingly obvious piece of advice, but there have been a slew of reports in recent years suggesting just the opposite.  Here are a few headlines:

• "Eating Dirt: The benefits of being (relatively) filthy" in Scientific American
• "Eating Dirt: It might be good for you" from the ABC News website
• "Eating dirt can be good for the belly, researchers find" from Science Daily, summarizing a 2011 anthropological study in the Quarterly Review of Biology
• "The old and mysterious practice of eating dirt, revealed" at NPR.org, describing a documentary film, Eat White Dirt, released last year.

And there's even a blogger who claims that dirt is "the missing superfood."

These articles describe a custom in which women, especially pregnant women are advised to eat dirt or clay, which some people claim offers health benefits. The ABC News story quotes a Georgia woman saying about the clay she eats, "The good stuff is real smooth. It's just like a piece of candy."

There's even a name for this practice: geophagy, or "earth eating." The NPR story claims this practice goes back millenia. Of course, ancient humans tended to die before they reached the age of 40, so I'm not sure I want to imitate their dietary practices.

Dirt is not the new superfood. Quite the contrary: dirt is the home of some nasty parasites, including a type of worm call toxocara, which can make you extremely ill. These worms are invisible to the naked eye–you can't see them crawling around–but they can cause devastating disease and even death.

This came to my attention last week in a case report in the New England Journal of Medicine (written by Dr. Steven Feske and colleagues) about a 38-year-old pregnant woman who was admitted to Massachusetts General Hospital with back and neck pain, vomiting, and headache. She was initially treated and released, but 11 days later,

"...she began to hyperventilate and her vision went black from the periphery to the center. The symptoms lasted for approximately 2 minutes and were followed by spots in her visual fields, headache, neck pain that radiated to her arms, nausea, and dizziness."

Mass General ran extensive tests, and her brain MRI showed lesions "suggestive of multiple strokes." Given all her symptoms, her physicians suspected that she was infected by a parasitic worm (a helminth or nematode) caused by eating dirt or clay. The patient was originally from Guatemala, where nematode infections are common, and where dirt-eating during pregnancy is encouraged in some areas. As they explain in the NEJM article:

“According to a tourist brochure from the Christian shrine in Esquipulas, Guatemala, 'In Guatemala, eating clay tablets combines healing, devotional reminders, blessings from Our Lord of Esquipulas, good fortune, and pregnancy nutrition.' ” 

Some of the tests came back positive for Toxocara, a parasite roundworm. Only then did the patient reveal that she had been eating dirt, but not from Guatemala, which she had not visited in several years. She had eaten dirt from a neighbor's yard in Massachusetts.

Fortunately, there is an effective treatment for Toxocara infection, and the patient recovered and delivered a healthy baby.

The roundworms that cause toxocariasis are commonly found in dirt in the U.S. They are transmitted by dogs, who spread them around through their feces. Pretty disgusting, right? A variety of other nasty parasites are transmitted through soil, including other kinds of roundworms, whipworms, and hookworms.

So don't eat dirt. It's not good for you. Really.