Repeat after me: Sham = placebo

Yesterday I mentioned Linde et al.'s 2009 Cochrane review and how the authors noted that having needles  anywhere on the skin is as effective as sticking them in the "official" acupuncture points. Here's a recent news item on their eureka discovery:

The researchers conducted two sets of tests on patients with chronic migraine pain. In one test, acupuncture needles were applied in strict adherence with established practice. But in the other test, the needles were inserted either in the wrong positions or else the needles did not penetrate the skin at all.

And as the authors concluded: "Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists."

Lead author Klaus Linde explains these results:

Much of the clinical benefit of acupuncture might be due to non- specific needling effects and powerful placebo effects, meaning selection of specific needle points may be less important than many practitioners have traditionally argued.

Well that's a clarification/qualification I'm more comfortable with. Noting that the observed reduction in headaches are due to "non-specific needling effects" and "powerful placebo effects" calms me down.

Let's be clear that the placebo group is there for comparison. If and when the experimental group does not perform any better than the control group then the conclusion ought to be: the modality under test isn't effective. If acupuncturists tell us that the needles should break the skin and that certain points need to be manipulated instead of others in the the treatment of condition X, and if the sham procedure does not meet these criteria, and if there is no statistically significant difference in the results between the two procedures then the conclusion is simple: acupuncture doesn't work.

Sure, we can do a comparative test of placebos and find out which are comparable to placebo X and which elicit placebo effects better than others. But let's keep in mind that they're placebos.

The picture that's coming out of acupuncture studies is that needling anywhere and even jabbing without penetrating the skin (unbeknownst to the particpants of course) all elicit similar or the same effects. One wonders then whether touching, pinching, fondling, scratching, spanking, "hickey-ing," licking, tapping, ... would likewise trigger the same. The only problem is blinding the participants as to which procedure they're receiving. I would guess, however, that being kissed, licked, and fondled by persons the participant finds "interesting" would have much greater, uhh, clinical benefit than being poked with needles.

A journalist for science

Michael Specter of the New Yorker talks about how science is essential, how the antiscience sentiment is misplaced.

Best line: We run away from Big Pharma and leap into the arms of Big Placebo.

Chinese studies now to be taken with a ton of salt

It's worse than I thought. The problem of publication bias in China is nothing compared to this. 

Ghostwriting, plagiarizing or faking results is so rampant in Chinese academia that some experts worry it could hinder China's efforts to become a leader in science.

...

"Academic fraud, misconduct and ethical violations are very common in China," said professor Rao Yi, dean of the life sciences school at Peking University in the capital. "It is a big problem."

...

Fang Shimin, an independent investigator of fraud, said he and his volunteers expose about a hundred cases every year, publicizing them on a Web site titled "New Threads." "The most common ones are plagiarism and exaggerating academic achievement," Fang said.

WHO not to be trusted with review of CAM

In Pricks I posted a list of diseases that according to Chinese herbalist and acupuncturist Shenrong Liu are some of the conditions which the World Health Organization (WHO) says are treatable by acupuncture. Here's the complete list from the WHO website. WHO lists the diseases/symptoms/conditions under four categories: 1.those for which acupuncture has been proved to be effective. 2. those for which the therapeutic effect of acupuncture has been shown but for which further proof is needed. 3. those for which there are only individual controlled trials reporting some therapeutic effects. 4. those for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment. 

1. Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment:

    Adverse reactions to radiotherapy and/or chemotherapy
    Allergic rhinitis (including hay fever)
    Biliary colic
    Depression (including depressive neurosis and depression following stroke)
    Dysentery, acute bacillary
    Dysmenorrhoea, primary
    Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
    Facial pain (including craniomandibular disorders)
    Headache
    Hypertension, essential
    Hypotension, primary
    Induction of labour
    Knee pain
    Leukopenia
    Low back pain
    Malposition of fetus, correction of
    Morning sickness
    Nausea and vomiting
    Neck pain
    Pain in dentistry (including dental pain and temporomandibular dysfunction)
    Periarthritis of shoulder
    Postoperative pain
    Renal colic
    Rheumatoid arthritis
    Sciatica
    Sprain
    Stroke
    Tennis elbow


2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:

    Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
    Acne vulgaris
    Alcohol dependence and detoxification
    Bell’s palsy
    Bronchial asthma
    Cancer pain
    Cardiac neurosis
    Cholecystitis, chronic, with acute exacerbation
    Cholelithiasis
    Competition stress syndrome
    Craniocerebral injury, closed
    Diabetes mellitus, non-insulin-dependent
    Earache
    Epidemic haemorrhagic fever
    Epistaxis, simple (without generalized or local disease)
    Eye pain due to subconjunctival injection
    Female infertility
    Facial spasm
    Female urethral syndrome
    Fibromyalgia and fasciitis
    Gastrokinetic disturbance
    Gouty arthritis
    Hepatitis B virus carrier status
    Herpes zoster (human (alpha) herpesvirus 3)
    Hyperlipaemia
    Hypo-ovarianism
    Insomnia
    Labour pain
    Lactation, deficiency
    Male sexual dysfunction, non-organic
    Ménière disease
    Neuralgia, post-herpetic
    Neurodermatitis
    Obesity
    Opium, cocaine and heroin dependence
    Osteoarthritis
    Pain due to endoscopic examination
    Pain in thromboangiitis obliterans
    Polycystic ovary syndrome (Stein-Leventhal syndrome)
    Postextubation in children
    Postoperative convalescence
    Premenstrual syndrome
    Prostatitis, chronic
    Pruritus
    Radicular and pseudoradicular pain syndrome
    Raynaud syndrome, primary
    Recurrent lower urinary-tract infection
    Reflex sympathetic dystrophy
    Retention of urine, traumatic
    Schizophrenia
    Sialism, drug-induced
    Sjögren syndrome
    Sore throat (including tonsillitis)
    Spine pain, acute
    Stiff neck
    Temporomandibular joint dysfunction
    Tietze syndrome
    Tobacco dependence
    Tourette syndrome
    Ulcerative colitis, chronic
    Urolithiasis
    Vascular dementia
    Whooping cough (pertussis)


3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:

    Chloasma
    Choroidopathy, central serous
    Colour blindness
    Deafness
    Hypophrenia
    Irritable colon syndrome
    Neuropathic bladder in spinal cord injury
    Pulmonary heart disease, chronic
    Small airway obstruction


4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:

    Breathlessness in chronic obstructive pulmonary disease
    Coma
    Convulsions in infants
    Coronary heart disease (angina pectoris)
    Diarrhoea in infants and young children
    Encephalitis, viral, in children, late stage
    Paralysis, progressive bulbar and pseudobulbar

Just counting those in categories 1 & 2 there are a total of 91 conditions that WHO claims to be treatable by acupuncture. That by merely sticking needles in various points on the skin can treat such a wide range of diseases and conditions is already suspect. So we shouldn't be surprised that the WHO review is rather flawed. According to Singh & Ernst the WHO committed two major errors in their review. First, WHO set the bar too low for clinical trials it admitted as evidence. "[T]he WHO had taken into consideration almost every trial ever conducted, because it had set a relatively low quality threshold." And so low quality trials (which are more prone to producing positive findings) skewed the review. Secondly, WHO included a large number of studies from China. This wouldn't be a problem if not for the fact that "careful statistical analyses of all the Chinese results ... demonstrate beyond all reasonable doubt that Chinese researchers are guilty of so-called publication bias." We saw the evidence for this bias in our survey of the studies by Vickers et al., Pan et al., and Tang et al. Given the low admission threshhold and the fact that published Chinese studies are more biased against negative results, the WHO review cannot but come to a very positive conclusion of acupuncture. Garbage in, garbage out. As if that's not enough to weaken the review, the report was "drafted and revised by Dr Zhu-Fan Xie, who was Honorary Director of the Institute of Integrated Medicines in Beijing, which fully endorses the use of acupuncture for a range of disorders." This conflict of interest is more reason to be suspicious of the WHO's glowing findings. [Singh & Ernst p.71-73]

Let's now compare the WHO report with the studies by the Cochrane Collaboration. Why Cochrane? Well, because it's committed to "adhering to the principles of evidence-based medicine" [Singh & Ernst p.74].

The Cochrane Collaboration is practically obsessed with producing high quality, unbiased reviews, given that quality and the avoidance of bias are as important in conducting reviews of trials as they are in conducting the trials themselves. In fact, the organization will not add a review to its database that does not comply with its voluminous set of regulations and safeguards, the most important of which from our perspective is that the quality of the trials must be factored into a succinct, bottom-line conclusion. [W]hile organized medicine might be susceptible to accusations of bias toward CAM, the Cochrane Collaboration is not. The entire reason for the organization's existence is to provide the public and the medical profession with unbiased assessments of what works and what does not work, and it takes this mission very seriously. [Bausell p.202]

The comparative analysis is pretty straightforward. I first searched for all Cochrane reviews with "acupuncture" in the title. I then culled those reviews which had matching diseases/conditions in the WHO report. The results are summarized in the table below. Note that I did not include any findings for electroacupuncture or other forms other than manual needling. And I was tendential toward results for real versus sham acupuncture rather than other types of controls. To my mind the only way to know whether acupuncture is in fact not merely a placebo is to compare it with the results of blinded sham needling.

Disease/Condition	WHO category	Cochrane Collaboration review
Depression	1	"We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria." [source]
Headache	1	"[T]he available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache." [source]  Note: this review is for tension-type headache.
Induction of labor	1	"There is insufficient evidence describing the efficacy of acupuncture to induce labour." [source]
Low back pain	1	"The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only." [source]
Nausea and vomiting	1	Acupuncture did not reduce the proportion of acute vomiting from chemotherapy. [source]  Note: this review is for chemotherapy-induced nausea or vomiting "Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea ...; vomiting ..., and the need for rescue antiemetics." [source]  Note: this review is for post-operative nausea and vomiting.
Neck pain	1	"There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment ."[source]
Rheumatoid arthritis	1	"From the little evidence that there is, acupuncture does not appear to improve the symptoms of rheumatoid arthritis." [source]
Stroke	1	"There is no clear evidence of benefit from acupuncture in acute stroke." [source] "There is no clear evidence of the effects of acupuncture on stroke rehabilitation." [source] "There is not enough evidence to make any conclusion about the therapeutic effect of acupuncture for dysphagia after acute stroke." [source]
Tennis elbow (lateral elbow pain)	1	"There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain." [source]
Bell's palsy	2	"The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture [source]
Bronchial asthma	2	"There is not enough evidence to make recommendations about the value of acupuncture in asthma treatment." [source] Note: this review is for chronic asthma.
Cocaine dependence	2	"There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence." [source]
Female infertility	2	"The data from this meta-analysis suggests that acupuncture does increase the live birth rate with in vitro fertilisation (IVF) treatment when performed around the time of embryo transfer. However, this could be attributed to placebo effect and the small number of trials included in the review." [source]
Insomnia	2	"The small number of randomised controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia." [source]
Osteoarthritis	2	"Sham-controlled trials show statistically significant benefits; however, these benefits are small, do not meet our pre-defined thresholds for clinical relevance, and are probably due at least partially to placebo effects from incomplete blinding." [source]
Schizophrenia	2	"We found insufficient evidence to recommend the use of acupuncture for people with schizophrenia." [source]
Tobacco dependence	2	"Acupuncture and related therapies do not appear to help smokers who are trying to quit." [source]
Vascular dementia	2	"There is no evidence from randomized controlled trials to determine whether acupuncture provides any effect when treating people with vascular dementia." [source]
Irritable bowel/colon syndrome	3	"There is no evidence to support the use of acupuncture for the treatment of irritable bowel syndrome." [source]

In the above table the only conditions for which Cochrane reviews found evidence of efficacy are tension-type headache, neck pain, short term relief of chronic low back pain, and nausea and vomiting (but not those that are chemotherapy-induced). Of the nine conditions in the table above which according to the WHO are most certainly treatable by acupuncture (category 1), only four are supported by Cochrane reviews and even then the evidence is far from overwhelming.

While the Cochrane review for acupuncture for IVF does say there is evidence in its favor, the authors are cautious given the small number of trials. More importantly that 2007 review has to be tempered by the large RCT by So et al. (2009) employing 370 participants, which found that "placebo acupuncture was associated with a significantly higher overall pregnancy rate when compared with real acupuncture." In other words, real acupuncture is no better than sham. Moreover, a meta-analysis of 14 clinical trials having a total of 2670 subjects published in 2010 by Cheong et al. found "no evidence of benefit in the use of acupuncture during assisted conception." Thus, none of the category 2 conditions listed in the table have any good evidence in their favor.

Although only a minority of the diseases/conditions in the WHO report have corresponding Cochrane reviews the trend is apparent--Cochrane reviews paint a much sober picture of acupuncture's effectiveness. Except for some four conditions, there is currently a dearth of good evidence for the efficacy of acupuncture. This is further drummed in when we consider the fact that the findings of other Cochrane reviews of acupuncture which have no matching conditions in the WHO report are all negative:

Uterine fibroids: "There is no reliable proof of effectiveness of acupuncture for uterine fibroids due to lack of randomized controlled trials up to now."
Migraine prophylaxis: "There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance."
Epilepsy: "The current evidence does not support acupuncture as a treatment for epilepsy."
Glaucoma: "At this time, it is impossible to draw reliable conclusions from the available data to support the use of acupuncture for the treatment of glaucoma."
Shoulder pain: "There is not enough evidence to say whether acupuncture works to treat shoulder pain or whether it is harmful."
Restless legs syndrome: "There is insufficient evidence to determine whether acupuncture is an efficacious and safe treatment for RLS."


One would think that this blunder by the WHO is an isolated case. Unfortunately, it seems that CAM has a special place in its heart. In 2005 the British medical journal Lancet reported that

a draft report on homoeopathy by the World Health Organization says the majority of peer-reviewed scientific papers published over the past 40 years have demonstrated that homeopathy is superior to placebo in placebo-controlled trials. Furthermore, it says that homoeopathy is equivalent to conventional medicines in the treatment of illnesses, both in humans and animals.

Looks as if the WHO yet again made no effort to separate chaff from grain and instead admitted any Tom, Dick and Harry study into their review of homeopathy.

We're talking about the World Health Organization here. This is suppose to be an organization which has the health of the human population in mind. Needless to say, it ought to promote and suggest treatments that work, treatments that are backed up by good science and good evidence. Patently, there is no good scientific rationale undergirding acupuncture and homeopathy. And the best evidence at hand refutes them.

There may be hope, however. In 2009 as a response to an open letter by the Voice of Young Science network WHO officials came out stating that WHO does not recommend homeopathy for the treatment of AIDS, tuberculosis, malaria, and diarrhea in infants. While laudable, I'd rather hear them announcing that the WHO does not recommend homeopathy for any and all conditions.


An interesting aside:

In the above Cochrane review of acupuncture for migraine prophylaxis, Linde et al. posit a strange hypothesis. Given that there was no statistically significant difference between real and sham acupuncture the authors muse that the "exact point location could be of limited importance," that "correct placement of needles seems to be less relevant than is usually thought by acupuncturists." What they seem to be saying is that sham acupuncture is as therapeutic and efficacious as real acupuncture. In the above study by So et al. the authors also make a similar a comment after finding that sham performed significantly better than real needling: "Placebo acupuncture may not be inert." Dr. Steven Novella has this to say:

It is just a form of special pleading to argue after a negative trial that placebos work also. In this study the authors are left trying to justify the conclusion that placing the needles in the “correct” locations had a disadvantage over placing them in random locations, which would also mean that expertise in acupuncture is a disadvantage.

One wonders how Linde, So, and their team members would react if after a new drug fails to perform any better than the placebo control the authors of the trial hypothesize that the placebo they employed may not be inert.


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References:

R. Barker Bausell. Snake Oil Science: The Truth About Complementary and Alternative Medicine. Oxford Press, 2007.
Simon Singh & Edzard Ernst. Trick or Treatment: Alternative Medicine on Trial. Bantam, 2008.

Pricks

What do you call a treatment modality that is effective against a gamut of human diseases including Bell's palsy, arthritis, post stroke paralysis, sciatic pain, neuralgia, migraine headaches, insomnia, dizziness, neck and shoulder and back pain, anxiety disorders, depression, mood swings, asthma, colds, flu, allergies, bronchitis, sinusitis, hypertension, angina pectoris, arteriosclerosis, anemia, acute/chronic diarrhea, constipation, indigestion, gastritis, ulcers, irregular/painful menstruation, PMS, hormonal imbalance, infertility in men and women, menopausal symptoms, UTI, prostatitis, bladder/kidney dysfunction, sexual dysfunction, fatigue, tinnitus, diabetes, immune deficiency, debilitating disorders, bed-wetting, seizures, tobacco and alcohol addiction?*

It's called a panacea. Some, including myself, would describe it as snake oil.

Now think of a tested and proved treatment, whose biological/biochemical mechanism is supported by, among others, in vitro studies, which is able to address all of the above conditions. If there is one, I'm all ears.

Let's look at some of the most common proven treatments. Because of their "wonder drug" nature antibiotics immediately spring to mind. But even they are only effective against bacterial infections not viral, and each antibiotic has its limits as to which species it can lick. Worse, antibiotics are limited by the fact that evolution favors those freaking bugs eventually outsmarting our weapon of mass decimation. The sheer number of bacteria and their extremely fast reproductive cycles means selection forces can act within years instead of millennia and longer. So as life-saving and indispensable as antibiotics are, they still cannot address anything beyond bacterial infection.

Of course there's a slew of other drugs such as statins, NSAIDs/analgesics/antipyretics, SSRIs, H2 blockers and proton pump inhibitors, beta blockers, calcium channel blockers, anticoagulant/antiplatelet drugs, insulins, ... Yet none of them claim to be able to treat the above encyclopedia of diseases. (Even SSRIs whose efficacy is controversial aren't claimed to be effective against infections, asthma, diarrhea, etc.; in fact they may have adverse side effects)

What about surgery? Well, obviously there is a whole range of surgical procedures depending on the disease/condition one is addressing. Heart surgery obviously is not going to cure a fractured tibia nor will any doctor in his right mind even suggest it. Kidney transplant does nothing if one has healthy kidneys and a brain tumor. Angioplasty certainly isn't called for if one has appendicitis or diabetes or anxiety disorders or infertility or anything in the above litany except for (certain) blockages in arteries.


Now mull over whether drugs and surgery are sensible and how plausible they are. Penicillin for instance was discovered by accident in one experiment--where a mold gate-crashed and screwed up a bacterial party. Further in vitro experiments confirmed the action of penicillin. And you can do such petri dish experiments for the current trove of antibiotics and show how they can in fact mess up the colony. Of course just having a chemical kill a dishful of bacteria tells us nothing about how it will do in the human body. Isopropyl alcohol will kill a multitude of microbial species too. But there are good reasons doctors don't prescribe isopropanol for internal use. And so you perform animal studies and clinical trials to ascertain both efficacy and, more importantly, safety at the effective dosages.


All drugs including antibiotics are chemicals. So are food, water, and air. So are hemlock, ricin, botox, and poison ivy. The body is a chemical factory. So it stands to reason that ingesting a chemical or getting it intravenously can and may have an effect on the body.

The action of a host of surgical procedures is common sense. If you place a stent in a blocked carotid artery which restores the diameter of that pipe then obviously you address the constriction and improve blood flow. You can even measure the before and after flow rate using ultrasound. Transplants are just as common sense. They're a direct analogue of parts replacement in machines. Excision of tumors also makes sense, particularly when that tumor is putting pressure on surrounding tissues. Removal of that feckless appendix specially when it's become a bloated home for a million pathogens is just as sensible.

So at least with these common treatment modalities, none of them claim to address a broad sweep of unrelated disorders. And all of them have a physical/biological/biochemical even common sensical basis for how they work and how they are suppose to treat disease.


But there is (at least) one modality that boasts of actually being able treat that long roster of conditions above. And that's acupuncture. A short introduction to the theory behind acupuncture:

In TCM (traditional Chinese medicine), the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. The concept of two opposing yet complementary forces described in traditional Chinese medicine. Yin represents cold, slow, or passive aspects of the person, while yang represents hot, excited, or active aspects. A major theory is that health is achieved through balancing yin and yang and disease is caused by an imbalance leading to a blockage in the flow of qi. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. According to TCM, health is achieved by maintaining the body in a "balanced state"; disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi. In traditional Chinese medicine, the vital energy or life force proposed to regulate a person's spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang. (vital energy) along pathways known as meridians. Qi can be unblocked, according to TCM, by using acupuncture at certain points on the body that connect with these meridians. Sources vary on the number of meridians, with numbers ranging from 14 to 20. One commonly cited source describes meridians as 14 main channels "connecting the body in a weblike interconnecting matrix" of at least 2,000 acupuncture points.

For illustrations of these meridians go here, here and here among others.

Could "meridians" be just a fancy name for the network of blood/lymph vessels or the nervous system or muscle groups or some other system within the body? Apparently not. Meridians are a completely different phenomenon from anything we currently know of human anatomy. Thus, if we dissect a cadaver and look for meridians, we can mince the whole corpse, but neither we nor acupuncturists will be able to find these channels. You can take a microscope or any other instrument and examine every square micron of the body internally and externally and you won't see these meridians nor will you discover what they're made of. They're not made of nerves, vessels, muscles, or any tissue. We can't see them via dissection or fMRI, X-ray, ultrasound, CAT scan, PET scan, etc.

Dissecting human cadavers was taboo in ancient China [Shapiro p.50, Ernst & Singh p.52]. Needless to say back then they didn't have anything remotely close to any of our imaging technology. So how did the Chinese "know" of the existence of meridians thousands of years ago? They didn't. They merely came up with the idea of a network of energy or vital force conduits and happily took it for granted and passed on the "therapeutic" tradition and its supposed mechanism of operation down the generations.

And what about the vaunted energy form called qi? What kind of energy is this: chemical, mechanical, thermal, electromagnetic, nuclear? Or is it some new form which the ancients knew about but which scientists have been unable to discover? How do you measure this energy? What instruments can be used to detect it? Energy has to come from somewhere. What produces qi? And since energy dissipates where does qi go? We know human biochemistry pretty well. Our energy comes from chemical reactions made possible through the food, water and oxygen we take in. What metabolic processes are involved? It seems these questions can't be answered. Qi is some "energy" that can't be detected, or perhaps can be detected but only subjectively--not unlike the "human energy field" which touch therapists claim to be able to detect. But then 9-yr old Emily Rosa's study--published in the prestigious Journal of the American Medical Association--effectively debunked the claim of practitioners--mostly nurses--that they can sense this energy field. So is qi yet another imagined phenomenon which would be equally debunked if subjected to a blinded test of detection? Will another 9-year old to put an end to thousands of years of nonsense?

There are meridians which can't be seen, qi which can't be objectively detected or quantified. And then there are postulated mechanisms of cure which make little sense: Disease is said to be caused by blocked or unbalanced qi, and acupuncture is the method by which the flow of qi is unblocked or rebalanced. What does unblocking and rebalancing qi mean biologically, physiologically, etc.? What are the physical, physiological, biochemical processes involved? What happens at the cellular level? Can this unblocking, rebalancing of the undetectable qi be detected and measured?

The onus of proof is of course upon those who make the claim for the existence of new postulated phenomena. But no evidence has been provided. On the other hand, we've been looking inside the human body for centuries. And since the last century we've been scanning it too.We've also measured signals coming from it. But meridians and qi are nowhere to be found. Which naturally leads to the question: How then do today's acupuncture proponents know that meridians and qi are not just human constructs, that they in fact have empirical reality? What's the difference, for instance, between unseen channels that conduct some force or energy (poorly and vaguely defined as they are) and unblocking and rebalancing that energy and the claim that all human disorders are caused by undetectable gremlins in the brain and that realigning gremlin aura in a particular way cures the person of their disease? Neither meridians nor gremlins can be found, neither qi nor auras are detectable much less measurable, neither unblocking/rebalancing qi nor realigning auras have been shown to actually occur. These phenomena have no existence beyond the crania of their proponents. Acupuncture (as is our gremlin theory of disease) is pseudoscientific from the git go.

Even some acupuncturists have already given up providing tangibility to these concepts. A brochure by the China Acupuncture Health Center in Westford, Massachusetts, for instance, admits, "you can't look at [qi] under a microscope, you can't detect it with any scientific instrument. You cannot isolate it in any form or substrate" [Shapiro, p.48]. Just like invisible gremlins and their aura. Felix Mann, founder and president from 1959 to 1980 of the (British) Medical Acupuncture Society, is most explicit and forceful about the nature of these ancient concepts:

Acupuncture points, in the traditional sense, do not exist.... Meridians, in the traditional sense, likewise do not exist. [Mann p.3-4]

Some [researchers] have tried to find acupuncture points or meridians by measurement of the electrical skin resistance. Those with a microscope have tried to find specialised structures in the skin or subjacent tissue. Those who have the use of infra-red photography, Kirlian photography or ultrasound have all diligently searched for the elusive acupuncture point. Some have been "successful" and have described their findings in journals.

If only these researchers had realised that the traditional acupuncture point does not exist! [Mann, p.5]

The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in meridians. [Mann p.31]

Given how 1. there is not a shred of evidence for the existence of meridians and qi, 2. there is hardly any scientific rationale for how needling the skin can produce the plethora of claimed therapeutic effects, and 3. acupuncture is claimed to be a panacea, with the ability of treat infectious diseases, psychiatric, reproductive,  gastroenterological, musculo-skeletal, respiratory, ... disorders, the prior probability that it is an efficacious therapy is extremely low. Even prior to testing and conducting trials there is no good reason to believe that acupuncture should work, anymore than chiropractic manipulation of the spine or pinching various points on the butt will cure the said litany of diseases.

In fact acupuncture can be likened to that other pseudoscience--chiropractic. It postulates a phenomenon of subluxation or misalignment of the spine. As with blocked qi, subluxations are said to be the cause of diseases. And while needling can unblock and rebalance qi, spinal manipulation can correct subluxations and cure the patient of his ailment. Just a needling is a panacea, realignment of the backbone is touted to be a cure-all.

So can pin pricks treat the host of disorders mentioned above? We should be most skeptical that they can. 


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* This list of diseases comes from a pamphlet by Shenrong Liu, an acupuncturist who has a master's degree in Traditional Chinese Medicine from the Academy of Chinese Culture & Health Sciences in Oakland, California. She is (or was) a Chinese Medicine Physician in China and has been in practice for 20 years. She's currently practising TCM in the Philippines. In her pamphlet she writes, "According to the United Nation's World Health Organization, over seventy diseases can be treated effectively with acupuncture, including the following:" The above list of diseases then follows.


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References:

Edzard Ernst & Simon Singh. Trick or Treatment: Alternative Medicine on Trial. Bantam, 2008.
Felix Mann. Reinventing Acupuncture: A New Concept of Ancient Medicine, 2ed., Butterworth-Heinemann, 2000.
Rose Shapiro. Suckers: How Alternative Medicine Makes Fools of Us All. Harvill Secker, 2008.

The lighter side of science

Watch science comedian Brian Malow here and here. Just an example from his repertoire of bar jokes:

Some helium gas drifts into a bar. The bartender says, "We don't serve noble gases in this bar." The helium doesn't react.

What a gas! Malow's jokes I mean.

And to add to his wonderful collection here's my own contribution:

A DNA molecule walks into a bar. The bartender says, "We don't serve double helices in this bar." The DNA  immediately turns around and splits.

Why studies from China should be taken with a sack of salt

Nothing new in what follows. Actually the studies I cite below are all over five years old. Just that of late I've been in a discussion with a doctor (an MD) who's also an acupuncturist and the topic of publication bias came up. We both agree that Chinese studies are suspect. But then he makes the simplistic claim that studies in the West are also guilty of the same bias. True enough that those in English-speaking countries are also afflicted with publication bias. But just as corruption is more prevalent in some countries than in others so too is publication bias. There is a difference in degree. And this isn't just a prejudice. There is evidence showing that this is a bigger problem among Chinese studies.

For instance, a 1998 systematic review by Andrew Vickers et al. ("Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials") showed that 100% of acupuncture studies from China, Taiwan, Hong Kong, Japan, Vietnam were positive while of those from English-speaking countries 60% from the UK, 53% from the USA, and 30% from Canada, Australia, and New Zealand were positive [Bausell p.170]. Furthermore,

when Vickers and his colleagues repeated the analyses with a much larger sample of trials involving treatments other than acupuncture (most of which involved conventional medical treatments), they basically came up with the same results: 98 percent of conventional Chinese trials produced positive results, as did 97 percent of Russian trials [Bausell p.169]

In their 1999 "Review of randomised controlled trials of traditional Chinese medicine" Jin Ling Tang et al. noted that besides reporting inadequacies, small trial sizes, limited use of blinding, inappropriate controls (use of a control treatment which in itself has not been shown to be efficacious), etc., there was a preponderance of positive findings among the RCTs which may be attributable to publication bias:

Most trials claimed that the tested treatments were effective, indicating that publication bias may be common; a funnel plot of the 49 trials of acupuncture in the treatment of stroke confirmed selective publication of positive trials in the area, suggesting that acupuncture may not be more effective than the control treatments.

Zhenglun Pan et al. in "Local Literature Bias in Genetic Epidemiology: An Empirical Evaluation of the Chinese Literature" have this to say:

Chinese studies typically suggest much stronger genetic effects than non-Chinese studies, and this may be even more prominent for the few studies that reach PubMed. Although Chinese studies are smaller than non-Chinese studies and thus even more underpowered, surprisingly half of them reach formal statistical significance for the evaluated gene-disease association. This exaggeration is seen across very diverse topics.

The larger genetic effects in Chinese studies are unlikely to reflect genuine heterogeneity in the effects of genetic risk factors across various "racial" descent populations. Heterogeneity due to ancestry should not have led always to larger effect sizes in all probed gene-disease associations. Therefore, the most likely explanation is publication bias against "negative" results or other selection biases in the chase for statistically significant findings. This explanation is further supported by our analysis of the expected number of statistically significant findings. Even if the average genetic effects in the Chinese studies were indeed as large as those observed, one would expect far fewer Chinese studies to have reached formal statistical significance on their own, given their small sample sizes. The alternative explanation that Chinese investigators may be targeting high-risk populations with particularly strong genetic effects is unlikely given these data.

In his November 22, 2005 PLoS article "Selection Bias in Meta-Analyses of Gene-Disease Associations" JL Tang comments on the above study by Pan et al:

In their study published in this issue of PLoS Medicine, Pan and colleagues compared genetic studies conducted in mainland China with those from other places. The researchers identified 12 gene-disease associations and compared a total of 161 Chinese studies and 309 non-Chinese studies. The Chinese studies were on average smaller in sample size than non-Chinese studies and appeared in the literature a few years after the first non-Chinese studies. Chinese studies in general reported a stronger gene-disease association and more frequently a statistically significant result. These two characteristics were more likely to occur in Chinese studies identified through PubMed than in those accessible only locally.

These findings suggest a variation or heterogeneity in the strength of the gene-disease association (often expressed in an odds ratio) observed between Chinese and non-Chinese studies. These studies are primarily case-control studies. Many factors may contribute to the variation in the estimate of odds ratio across such studies, such as the genetic make-up of the population studied, the type of patients included, the selection of controls, the quality of the study design, and the quality of the laboratory work. These factors could lead to either over- or under-estimation of the true odds ratio. However, it is difficult to conceive that any single factor, or combination of these factors, could consistently cause the exaggerated odds ratio in Chinese studies in all the topics (gene-disease associations) examined by Pan and colleagues. Selective publication is therefore a very likely and worrying explanation for their findings.

Selective publication can cause publication bias, which in turn could lead to false gene-disease associations in meta-analyses. It would be a disaster if a genetic screening program (in which healthy people are tested for a gene and offered a treatment if they test positive) were based on such a false association. Even if such a false gene-disease association were only subjected to further related investigations, this would be a waste of valuable resources for medical research.

Selective publication of positive studies in China and a few other Asian countries has been observed in clinical trials of acupuncture. However, selective publication by no means exists in only the Chinese literature. It is probably a common phenomenon in the entire field of biomedical research. Given the fact that positive studies are more likely to be published than negative ones, and given the pressure on researchers worldwide to publish in indexed journals (especially in international journals with high impact factors), selective publication is likely to continue in the foreseeable future. As compared with English-speaking countries, selective publication is perhaps more likely to occur in non-English-speaking countries where there are a small number of indexed journals to publish local studies.

That last line bears repeating: "As compared with English-speaking countries, selective publication is perhaps more likely to occur in non-English-speaking countries where there are a small number of indexed journals to publish local studies."



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Reference:

R. Barker Bausell. Snake Oil Science: The Truth About Complementary and Alternative Medicine. New York: Oxford University Press, 2007.

A dozen apples a day will likely not banish cancer risk away

Just in: An analysis by Paolo Boffetta et al., (Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition) concludes that there is "a very small inverse association between intake of total fruits and vegetables and cancer risk." The study used data from over 142,000 men and 335,000 women who had a high intake of fruits and vegetables.

Apparently, this mega prospective analysis supports the findings of previous studies:

In an accompanying editorial, Walter C. Willett, M.D., Dr.P.H., of the Harvard School of Public Health, notes that "this study strongly confirms" the findings of other prospective studies that high intake of fruits and vegetables has little or no effect in reducing the incidence of cancer, although it has been shown to affect the risk of cardiovascular disease.

That last point has to be emphasized. Just because eating more fruits and vegies has negligible impact on cancer risk doesn't necessarily imply it's worthless or doesn't have significant consequences for other conditions.

Courts of science vs courts of law

Just learned from Andy Lewis of Quackometer that General Electric had sued Danish radiologist Henrik Thomsen for supposed inuendo concerning GE's MRI contrast drug Omniscan. Apparently GE did not like what Thomsen had to say about their product even if he was merely expressing safety concerns given that there was reasonable evidence to be wary of Omniscan. GE had a taste of its own medicine when Thomsen countersued. The giant probably didn't expect that. Well, last February GE had a change of heart and change of mind and dropped its libel suit. What the heck was it thinking in the first place when it tried to silence Thomsen?!

As you may know, journalist and author Simon Singh had also been sued for libel by the British Chiropractic Association (BCA) over his use of "bogus" in  the April 19 2008 edition of the Guardian.

The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

The judge who heard the case sided with the BCA. Singh appealed and after a costly battle a celebration is in order. Yesterday, the judges presiding over the appeal dealt a coup de grace to BCA's breathtaking inanity.

Among other things in their decision is this: 

We would respectfully adopt what Judge Easterbrook, now Chief Judge of the US Seventh Circuit Court of Appeals, said in a libel action over a scientific controversy, Underwager v Salter22 Fed. 3d 730 (1994):

"[Plaintiffs] cannot, by simply filing suit and crying 'character assassination!', silence those who hold divergent views, no matter how adverse those views may be to plaintiffs' interests. Scientific controversies must be settled by the methods of science rather than by the methods of litigation. … More papers, more discussion, better data, and more satisfactory models – not larger awards of damages – mark the path towards superior understanding of the world around us."

So we've had both quacks and Big Pharma try to stifle critique by enlisting the courts. But as Easterbrook says scientific matters are not settled through litigation. Science has its own courts for arriving at the truth.

A god who can do anything is nothing

From Massimo Pigliucci, biologist and philosopher:

[Can God make a mountain so heavy he can't move it?] If you answer “yes,” it looks like god can do something that he cannot undo, which means that he is not, after all, omnipotent. If you respond “no” then you are immediately acknowledging a limit to what god can do, so again it turns out that he is not omnipotent. Try getting out of it, you’ll either laugh all the way to your logic class (if you are an atheist) or get a really bad headache (if you are a theist). (The funniest variation of the paradox is due to that immortal philosopher, Homer Simpson: “Could Jesus microwave a burrito so hot that he himself could not eat it?”)

It would seem, then, that an omnipotent god is a logical impossibility. Since logical impossibilities are stronger than physical and contingent impossibilities, it follows that there cannot be such a thing as an omnipotent god. Oops. So the next time someone says something as inane as “anything is possible,” ask them about the paradox of omnipotence: you will kill two birds with one stone, showing both that not anything is possible and that the most common type of god worshiped nowadays is a contradiction in terms. Then go out for a drink to congratulate yourself on a job well done.

Of Batmen and Supermen

In Batman whenever the help of the caped crusader is needed the commissioner or chief of police would switch on a huge searchlight which illuminated the clouds with the bat symbol. In minutes the hooded man in black would be at the scene giving likewise hooded men a taste of his knuckles. Superman, without contest a far superior bloke, on the other hand has no walkie talkie or cell phone or anything with which he could be reached. As luck would have it, he's there at just the right moment to foil bank robbers or save the citizens of his city and the world.

There is a need for superheros of course. Just look at the number of criminals who're able to get away with their dastardly deeds. Think of the number of lives that needn't be lost or wouldn't be traumatized if we had Batmen and Supermen. Imagine the wars we won't need to fight because a flying human, impervious to bullets and bombs, and with the strength of a thousand bulldozers could nip a greedy general's ambitions. Imagine how oppressive regimes would be a thing of the past given the deterrent factor that superheros would bring to the world. It's a kind of deterrence that no ICBM can offer.

Humans are prone to fantasizing. We all daydream. We all run imaginary scenarios in our heads. We visualize. We all have hopes. While these are abilities which distinguish as from other species and have allowed wondrous works and discoveries to be made, it is not without its drawbacks. Often we are unable to distinguish reality from fiction. We go overboard and begin wholeheartedly believing in the reality of ideas that we have drenched our minds with or ideas that have been handed down to us via family and culture. We can fail to apprehend that human constructs such as superheros are just that--imagined beings born out of our fervent hopes for Justice and Freedom and Liberty and Peace, hopes for a utopian society.

Yet more than such lofty yearnings, there are more immediate needs that Batman and Superman serve. They swoop down and catch  the child who accidentally plunges down Niagara Falls. They rescue the passengers of a plane that's been sabotaged by terrorists. They divert missiles headed for the heart of the city. Saving lives is the primary job of a superhero. We need them to keep us from harm. The survival instinct is so strong in us that during those times when the end is imminent, when we are powerless to change our fate, we call upon and implore them to yank us out of the jaws of death.

One such crisis:

[H]eavy rains and zero cloud visibility forced the landing of the chopper carrying Legarda and five others in Sariaya, Quezon yesterday.

...

Legarda's chopper was forced to land at a vacant lot at the Avalon Subdivision, Barangay Sto. Cristo, Sariaya, at around 12:30 p.m. after hovering around Sariaya for several minutes because of dark clouds and heavy rains.

Legarda started praying the rosary, given by healing priest Fr. Fernando Suarez, when they spotted the open field.

"We were battered by the heavy rains and strong winds. It's fortunate we found the spot," she said. "Thank God that he spared us from danger and I thank the people here in Barangay Sto. Cristo who went to our rescue. Inaamin ko na nagkaroon ako ng kaba. (I admit I got nervous)."

In desperate situations, fearing death, sensing doom, the likes of Loren Legarda reach out to their superheros. No cell phone required. No searchlight need be turned on. A whisper uttered or mere thought addressed to the savior is all that's needed: "Help me." The supernature of her hero guarantees the missive will be received instantly.

Humans are fallible, most fallible. Humans are weak--feeble minded and psychologically fragile. The desire for superheros is an order of magnitude far stronger than the imperative to face reality at all costs.

For the Legardas of the world supersaviors are not mythological. They are very real--not because they've seen their heroes, not because they are as tangible as the ground into which the chopper will smash, but because these superbeings without question exist in their minds. Existence in the head is all the Legardas, Ratzingers, Suarezes need in order to feel and know that their superhero is out there somewhere ready at their beck and call to come to their rescue.

And if Superman fails to appear? There are a thousand and one reasons for his absence, but certainly not because he is a figment.

And so God the superhero is real. He's alive and lives in the billions and billions of neurons that orbit a star in a galaxy called the Milky Way.

A multi-reincarnated bad-energy busting hypnotherapist

Alice McCall is a psychologist who I think you may agree needs to have her head examined before she merrily goes off examining others'.

McCall said she discovered her own past lives in 2000 and used her knowledge when diagnosed with breast cancer. Through regression therapy, McCall says she learned of her past lives, dealt with unresolved issues and was healed of her cancer.

Since then she has gone on to help others discover their own past lives and facilitate healing of physical and mental maladies.

“I don’t go looking for them, they just come up during hypnotherapy,” she said.

As for her own lives, McCall knows of more than 15, possibly more than 20. She says she once was a high priestess and leader of a mystic school in Egypt during the time of the pyramids.

Hey, if she was a priestess, then I was King Tut. Just to make it very clear, Dr. Hawass, I own that pyramid in the desert, ok?

McCall is one heck a woowoo. Apart from her two dozen or so former lives, she talks of "negative energy" which she claims makes us "malfunction." She practises "holistic" healing--which usually translates to "a mish mash of treatment options, however wacky, ridiculous, untested, or disproved they may really be."

In her website she talks more about this bad energy.

The basic premise behind Alice McCall's energy healing is that when you hold on to a strong negative thought or emotion, it can be buried in your body. The memory of it is held in your cell as a negative, dark dense energy.

Whoa! Dark, dense energy trapped in our cells. She must talking about mitochondria, right? And "negative" ATP in those power plants, right? (A type of energy which the hundreds of thousands of biologists and biochemists have somehow missed in the last hundred years of study). Or could she be alluding to dark energy in the cosmos? Or ultra high gravity black holes perhaps?

So how do you counter cytologically-entrenched evil energy? Why you turn to sky daddy of course. Thus, McCall uses "God-based" energy healing to "remove blocks of dense, negative energy at the cellular level."

I didn't even bother checking out everything on Alice's site. It's a Wonderland and the rabbit hole I can tell is pretty deep.

Another quack, another crank. Isn't there an agency in Florida that can restrain this nutcase from treating the sick?

One of the best ads I've seen

Off topic. But just have to share this.

This medicine doesn't work unless...

I just received a free sample of a new super antibiotic in liquid form called Panbiocin. According to the person handing it out it is effective against every known pathogen--bacterial and viral. This is astounding to say the least since conventional antibiotics are effective only against certain bacteria and antibiotics are useless against viral infections. So I took home the sample bottle and read the label more carefully. Well, I got the surprise of my life. Right there below the brand name it states:

ATTENTION: THIS ANTIBIOTIC DOES NOT REALLY TREAT INFECTIONS. IT IS YOUR FAITH IN ITS CURATIVE POWERS THAT WILL INACTIVATE MICROBES. WITHOUT FIRMLY BELIEVING IN ITS EFFICACY, PANBIOCIN IS USELESS.

You are encouraged to make a trip to the heart of the Amazon rainforest where the active ingredients for this incredible medication is made from. Being in the midst of Mother Nature and the very flora that go into this antibiotic promotes faster healing. Chanting "I am getting cured, I am getting cured!" when taking Panbiocin has also been shown to increase its effectiveness.

What's even more amazing is that Panbiocin is said to be effective in any concentration, such that it can be endlessly diluted and still possess the same potency. Thus, the manufacturer suggests:

Should you wish to share Panbiocin with friends and family simply add a drop to a gallon of clean, boiled water and mix thoroughly. Bottle the resulting dilution and distribute freely. Tell the recipients that they too can do the same and produce more of the product. Remember, it is not the antibiotic that cures, it is your unwavering belief in its healing powers.

At the back of the bottle users are encouraged to send in their success stories:

If you or someone you know is satisfied with this product please send your story to the email or postal address below. We broadcast positive testimonials to those who suffer from all kinds of infections to give them hope and show them that Panbiocin can cure all manner of bacterial and viral diseases.

A most incredible product indeed. And unlike homeopathic remedies, concentration/dilution does not affect its potency. The one thing that the label fails to mention, however, are the side effects. It's a heuristic in medicine that the more powerful the drug, the more powerful its side effects are as well.


On another front I need to mention that I had heart surgery last month. Before going under the knife the surgeon explained to me the nature of the operation in complete detail including how effective it is, what he and his team will be doing, what my chances were, and possible post-op complications. He then asked me to sign a waiver. Among other things, the 500-word document included the following clause:

I, the undersigned, fully understand that the coronary surgical procedure I am about to undergo is COMPLETELY USELESS, that it has been shown to have NO therapeutic benefit over and above sham heart surgery, and that only my belief in its efficacy confers it any chance of effectiveness. I hereby expressly agree that any failure or lack of complete success of the procedure to cure my condition shall be attributed to dearth or paucity of faith (belief) on my part, and that neither doctors nor staff nor this hospital shall be accountable for such failure.

Yeah, I signed it of course given how I had and still have complete, absolute trust in my surgeon and in his procedure of choice. Hey, look, I'm alive today, right? Time to mail in my success story.


I don't think anyone is gullible to the point that they would believe either of the treatment claims above. Well, I should hope not. Both are fictitious, of course. The point of churning out such ludicrous therapeutic claims is that the one coming right up isn't made up at all. Journalist Bernardo V. Lopez wholeheartedly believes it. Hermie Santos believes it. The nuns of the Religious of the Virgin Mary (RVM) believe it too. And those who flock to the Mother Ignacia Healing Ministry compound in Novaliches in search of miracle healings blissfully join the bandwagon.

Couple of weeks back I found out that the Mother Ignacia Healing Ministry is giving away free healing oil via snail mail. Peachy! How could I resist. Today I received the oil endowed with supernatural curative powers. The cloth inside the ziplock bag is 1.5 x 1.25 inches in size and is soaked in some odorless oil. (My camera has been on the blink so the image quality is poor.)

From what I've read, the Ministry claims the oil mysteriously appeared on the floor of their chapel late last year. They couldn't explain how it got there. In one video (6:45min into it), a nun speculated that the ceiling might have a leak but then cursory ocular inspection ruled this out. Happening in the chapel, the nuns couldn't help looking for significance in the drops and puddles of oil. It happened in a place of worship and a healing center so the sisters mused that the oil could be for healing. Sure enough when Sister Raquel Reodica, the resident miracle healer, applied it on the sick some claim to be healed.

What I'd dearly want to do is to be able to get hold of her bottle of healing oil (without anyone knowing of course) and replace it with canola, hydraulic, or some other oil. Bet we'll get the same "healing" results statistically.

Early this year the Ministry began making the healing oil available for free upon request. Which of course made me wonder how they can possibly have enough of the oil from the floor to accommodate the, I imagine, hundreds if not thousands of requests.

When I requested for the oil my plan was to send it to a laboratory for analysis to find out what it's made of. Could it be some compound unknown to 21st century chemistry? Some exotic chemical which destabilizes and decomposes at room temperature but miraculously doesn't in this case? Or would it be discovered to be extra virgin olive oil for salads?


A computer printed letter accompanied the oil-drench cloth. Here are images of that document.

Here's the full transcript.

HEALING OIL GUIDELINES

Dear recipient of healing oil,

PLEASE UNDERSTAND THAT THIS "HEALING" OIL DOES NOT REALLY HEAL. IT IS JESUS HEALING PEOPLE THROUGH THIS BLEST OIL, A MATERIAL OR PHYSICAL MEDIUM SIMILAR TO THE SACRAMENTS, I.E. WATER FOR BAPTISM OR SALT FOR CONFIRMATION. WITHOUT PRAYER OR FAITH, THE OIL IS USELESS. IT CANNOT HEAL.

YOU ARE ENCOURAGED TO MAKE A PILGRIMAGE TO THE HEALING CENTER, IF YOU CAN, WHERE THE OIL MYSTERIOUSLY APPEARED. YOU CAN ACHIEVE HEALING BETTER THIS WAY. YOUR PILGRIMAGE IS A FORM OF POWERFUL PRAYER AND SACRIFICE. YOU ARE ALSO ASKED TO SHARE THE OIL WITH OTHERS, ESPECIALLY THE TERMINALLY SICK AS YOUR PARTICIPATION IN THE HEALING MINISTRY. FOR DIRECTIONS AND SCHEDULES, GO TO - www.sisterraquel.com

First step is to read the background and history about the oil so you understand the healing process. go to the link http://www.sisterraquel.com/2010/02/announcement3-%E2%80%93-blogsite-library-links/

Put emphasis in praying and strengthening your faith rather than just thinking the oil will heal you. As soon as you receive the oil, before you apply it on yourself or the sick, all present must pray together to Jesus the healer while touching the oil container. Put yourselves in the presence of Jesus and thank Him for bringing the oil to you. Then ask Him for healing. Ask for the intercession of the Blessed Virgin Mary and Mother Ignacia del Espiritu Santo, foundress [sic] of the congregation of the Religious of the Virgin Mary or RVM, of which Sister Raquel Reodica is a member. Sister Raquel invokes Mother Ignacia in her healing prayer. DO NOT APPLY THE OIL WITHOUT PRAYING. Only after praying should you apply the cloth with oil on the part of the body which is sick, breast, forehead, abdomen, etc., preferably while saying "Jesus, Jesus" and "Mary, Mary" continuously. For non-Catholics who do not pray to Mary, pray to Jesus directly. Again, without prayer, the oil is useless. It cannot heal. Only Jesus heals.

There are only 14 drops of oil on the cloth you received, to avoid leaks in the mail. So that you do not run out of oil and you can share with others, Sister Raquel suggests you wash and dry a small empty perfume bottle, put the healing oil cloth you received by mail in it, and mix it with ordinary baby oil until it is full. Optional but recommended, have your local priest bless it. If you distribute the oil to friends, do the same thing, put oil on a small woolen cloth in a small zip lock bag or small bottle and let the recipient add baby oil into it and have it blessed. Make a photocopy of this document and give to all you give the oil to.

The oil you receive comes from the tabernacle lamp of the adoration chapel, which is constantly replenished as many pilgrims are allowed to take some. This lamp, which has an eternal flame, mysteriously overflowed and created a large pool of oil on the floor on November 6, 2009, a First Friday. On that day, nine lines of oil appeared in an orderly equidistant line on the floor from the back of the chapel to the altar. The oil was wiped over by a towel and applied to the sick, many of whom were healed, some instantly. To view or download photos of the healing oil, go to the link http://www.sisterraquel.com/2009/12/poster37-40-mysterious-oil-and-cloud-at-healing-center/

The oil you received was blessed by Fr. Teo[filo], healing center chaplain, and by Sister Raquel. It was offered at the healing fountain of the same adoration chapel where many have been healed. It was offered to the Blessed Sacrament, Holy Child, Sacred Heart, Blessed Virgin, Mother Ignacia, St. Therese of the Flower, Padre Pio, and St. Michael the Archangel at the healing center before it ready [sic] to be given away.

If you or someone is healed by the oil, please report this to the email address below, so that it is included in the ministry archives. These testimonials are broadcasted to desperate terminally-sick [sic] people to give them hope and to make them understand that nothing is impossible for Jesus the Healer. eastwind@motherignaciahealingministry.com

The healing oil you receive is given free. The ministry spends for postage cost. There is no need to give a donation. However, if you still wish to make a donation, no matter how small, and participate in the healing ministry, please send by postal mail any amount 1) outside the Philippines, international money order in dollars pay to HERMIE SANTOS, 8 Dockery Drive, West Orange, NJ 07052, U.S.A.; 2) in the Philippines, deposit cheque or cash at the nearest Bank of the Philippines Islands branch to BPI Savings Account No. 0086-3992-84 in the name of BERNARDO V. LOPEZ. In both cases, email Mr. Santos at hermie.santos@verizon.net or Mr. Lopez at the eastwind email address above that you have sent or deposited your donation. You will get a reply once the donation is received.

Please visit our website www.sisterraquel.com/ and subscribe as member if you are interested in 1) asking for prayers for the sick sent to our prayer warrior group with worldwide members; 2) receiving regular notices of the ministry's healing guides and inspirational materials, such as youtubes, powerpoints, prayer-poems, testimonials.

Given the above text I now believe having the oil analyzed is unnecessary. The "healing oil" I received is most probably lamp oil, either spilled or fresh from the dealer, and "blessed by Fr. Teo[filo], healing center chaplain, and by Sister Raquel." The Ministry admits the oil did not actually have miraculous origins--it didn't even condense out of thin air. Instead the oil comes from the tabernacle lamp. You gotta give them a thumbs up for honesty. The oil reservoir they say "mysteriously overflowed and created a large pool of oil on the floor." "Mysteriously"? Wonder if they bothered checking for a cracked or leaky container. I'd also like to have a word with the guy who tops up the lamp's fuel tank. And since visitors are allowed to take oil home, a video of what happened the day before the pools of oil appeared may be revealing. Here is a screenshot of what may be the oil lamp (9:37min into the video) in question.

Apparently, oil has been seen on the floor on at least two occasions--September 25 and November 6, 2009*. Though I haven't found an admission, the Sept. 25 oil spill probably has something to do with the tabernacle lamp oil as well.

As with the makers of Panbiocin, the Ministry is adamant that "THIS 'HEALING' OIL DOES NOT REALLY HEAL." Rather it's a 2000-year old corpse that actually makes you well: "IT IS JESUS HEALING PEOPLE THROUGH THIS BLEST OIL." So how do we get the zombie to cure us through the nonhealing oil? Beseeching and believing: "WITHOUT PRAYER OR FAITH, THE OIL IS USELESS. IT CANNOT HEAL." So the oil by itself does not possess curative powers. But if one prays and has faith that can move the whole Himalayan mountain range, do we still need the oil? Can't we just pray and believe till we're blue? Can't Jesus heal directly without the use of chemicals? You can bet that miracle healer Benny Hinn et al. would belt out a Yeah, baby, yeah! Then again, if Jesus can heal directly, who needs Hinn & Co.?

And as in the case of Panbiocin, the oil can be also diluted--in this case with baby oil--and still retain its full potency, not least because as they warn the oil does not really heal. Chances are--and the Ministry might cautiously agree--you can use sunflower oil, peanut oil, motor oil, ... instead of mineral oil and it shouldn't make a difference. The Ministry may even approve of a Vitamin E enriched healing oil. Or what about a rose scented oil to please Doctor Jesus? We can even use that famed panacea--virgin coconut oil (VCO)--and in teaming up with the supernatural endow it with even more magical powers. I'm sure Doc Jesus will bless the Philippines for using indigenous products.

As for claims of healing, need it be said that all the Ministry can show are testimonials? One story is not proof. A thousand anecdotes ain't evidence. Certainly not when the cherry picker shamelessly tells us to send in only happy stories:

If you or someone is healed by the oil, please report this to the email address below, so that it is included in the ministry archives. These testimonials are broadcasted to desperate terminally-sick [sic] people to give them hope and to make them understand that nothing is impossible for Jesus the Healer.

Well, if I count only my hits and ignore my failures, then I'm an A student in all subjects from kindergarten to university, a genuine psychic, a top marksman, numero uno in the diagnosis of illnesses and electronic faults, ....

Finally, having watched Bernardo Lopez's videos and having corresponded with him, I can only say that he is utterly deluded and has not a single critical bone in his frame. For instance, in his latest videos (12A and 12B) he totally believes in the power of prayer. His reason? Post hockery. He recalls and makes known only those instances when a desired outcome came after the nuns prayed and ignores those instances when prayer was not followed by a desirable outcome (we know this because the nuns pray everyday). Yes, Lopez is the Ministry's resident cherry picker. And then of course there are the testimonials he features. On the flimsiest and hyper unreliable kind of evidence he is persuaded that indeed the people in his videos have been cured of their ailments and that the oil or Sister Reodica or prayer or a zombie or what have you is what cured them. Non causa pro causa. Amen.

Lopez is older than I am. He's probably in his 50s or 60s. And yet there is something rather intellectually sophomoric about him. I don't know if he knows this but he shared a tidbit that might shed light on his mental/intellectual constitution:

i have a very strong faith
which is from the heart
you are arguing from the mind
intellectual plain
i am not there

And that segues onto the matter of his writing style in our correspondences which both irked and puzzled me at first. In each of the seven emails I received each line is less than 10 words. I initially thought the short lines was a quirk of his email software, that it was adding a carriage return (yeah I'm from the typewriter days) automatically. Only later did it dawn on me that he was deliberately writing in verse form. Duh! Artistic? I say crank. The obsessively, fanatically religious all are.



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* In this video, Bernardo Lopez says oil appeared on November 26, 2009 which according to him is a First Friday, which can't be since Nov. 26 was a Thursday. Furthermore the photos he shows are those of the Nov. 6 oil appearance. In all probability he just made a booboo and actually meant to say Nov. 6. In an earlier video Lopez claims oil also appeared on the floor on October 16, 2009. Strangely he does not mention this in his Inquirer article.

Falsehood in advertising pays

I was at the drugstore today and while waiting for the pharmacist to bring out the medicines I saw on one of shelves behind the counter a dark green box labeled "Coldease." Well, that caught my attention because I remember a Coldease in the US that's being sold as a homeopathic cure for, well, colds. Unfortunately, it isn't homeopathic, meaning that the amount of active ingredients in the preparation is nowhere close to infinitesimal. In fact there's enough of the zinc compound to cause adverse effects, loss of smell being one of the more notorious ones.

When the pharmacist returned I asked if I could take a look at the green box. Closer examination revealed this Coldease probably isn't homeopathic at all. The pharmacist told me it's actually an herbal remedy--meaning there is an appreciable amount of the active ingredient in it and the ingredient is of course plant-based. And sure enough it is. The description said it contains, among other things, Echinacea, a plant touted, for Zeus knows how many centuries, as a treatment for colds.

I googled Coldease the moment I got home and turns out my memory was--as is usually the case--on the blink. The American "homeopathic" remedy is "Cold-Eeze," and it was through James Randi that I first heard of it. Coldease on the other hand is a brand by the Philippine pharmaceutical company United Laboratories (Unilab). I couldn't find this product on their website. Instead I found the following Coldease TV ad uploaded by Unilab on their Youtube channel. According to the info they provide the ad was produced in late 2009. In the video Unilab boasts Coldease can "help stop a cold before it starts." But can Echinacea--presumably the major active ingredient in Coldease--in fact stop a cold before it occurs?

Studies, systematic reviews and meta-analyes of trials have come to conflicting conclusions. The National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) tells us:

Study results are mixed on whether echinacea effectively treats colds or flu. For example, two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults. However, other studies have shown that echinacea may be beneficial in treating upper respiratory infections.

Most studies to date indicate that echinacea does not appear to prevent colds or other infections.

On the other hand, a 2007 meta-analysis by Shah et al. published in the British medical journal Lancet found that "Echinacea decreased the odds of developing the common cold by 58% and the duration of a cold by 1.4 days."  However, in June 2008, Craig Coleman, one of the authors of the meta-analysis, in reply to a letter, wrote in the Lancet:

I agree with Andreas von Maxen and Peter Schoenhoefer that the studies on echinacea included in our meta-analysis are heterogeneous in their methodological quality. We attempted to cast a broad net to see whether or not a difference in the incidence or duration of cold was evident when the whole of the literature on echinacea was summarised, but as described in our paper's conclusions, we too suggest caution in over-emphasising the results before they can be confirmed with more rigorous, larger randomised controlled trials.

Meanwhile, a 2007 Cochrane Collaboration systematic review by Barrett el al. concluded,

Echinacea preparations tested in clinical trials differ greatly. There is some evidence that preparations based on the aerial parts of E. purpurea might be effective for the early treatment of colds in adults but the results are not fully consistent. Beneficial effects of other Echinacea preparations, and Echinacea used for preventative purposes might exist but have not been shown in independently replicated, rigorous RCTs.

That such large studies and reviews come out with contradictory and cautionary results may imply that the effect size of echinacea is very small or nonexistent--that is, its therapeutic efficacy over placebo may be zero to minimal. Whatever the reason for the differences in conclusions, however, it is inadvisable to tout echinacea as effective against colds or in preventing it when the jury is still out on the matter and no definitive evidence is at hand to support a claim to efficacy.

Unilab and others who promote and market echinacea as a cold remedy are, to say the least, jumping the gun. Why not wait until there is firm, conclusive evidence that it is effective? Because when it comes to profit the end justifies the means.

The asylum known as the Vatican

85-year old Father Gabriele Amorth has been the Vatican's chief exorcist for the last 25 years. He's come across some 70,000 demonic possessions. Amorth says the sex abuse scandals that have rocked the Church lately is evidence that the Devil is within the Vatican itself.

Amorth also claims that a number of the possessed he's encountered "spat out nails or pieces of glass." "Anything can come out of their mouths – finger-length pieces of iron, but also rose petals," he says.
Well this is most interesting. If humans--whose mouths and guts are devoid of the said materials--actually can be shown to produce nails, cullet, bolts?, bullets?, lava?, flowers and what have you, then this would be a truly incredible phenomenon meriting study and investigation from a host of disciplines. Hell, this would mean that Hell might actually be real!

To kickstart the investigation I've got a suggestion. The next time Amorth rushes to exorcise a human Gatling gun, I urge him to bring along two conjurers/magicians. No need for scientists. They'll just be a hindrance. A couple of seasoned illusionists will do just fine. Let them stick around, poke around, and check out the (purportedly) possessed and the (supposed) projectiles shooting out of them. I bet you a thousand dollars they'll come back home yawning. While Amorth will continue to insist that demons and possession are as real as the brew of delusions his brain is marinated in.