I have several goals in direct confrontation: to better understand the claims and logic of those holding that view, to explore my own position and improve my ability to explain it, and to demonstrate scientific and critical thinking with respect to this issue to the audience.

The more recent homeopathy debate was between me an Andre Saine, a Canadian naturopath and homeopath. During the debate we barely scratched the surface of this complex topic, so we both agreed to continue our discussion in writing, moderated by Peter Gold who organized the debate.

Here is Andre’s first question to me, and my answer.

Question from Andre Saine

It is quite common for homeopathy to be grossly misrepresented in the professional and popular literature. You wrote, “In order for an argument to be sound all of its premises must be true. Often, different people come to different conclusions because they are starting with different premises. So examining all the premises of each argument is a good place to start.”1

Let’s start with two of the basic premises you stated that they belong to homeopathy, namely the law of infinitesimals and the law of chronic diseases. First, you wrote, “The second law, the law of infinitesimals, says that as you dilute the substance it becomes more potent—in direct violation of the very real laws of physics and chemistry,”2 as well as, “I want the public to be aware of the fact that most homeopathic solutions are diluted far past the point where there is likely to be a single molecule of active ingredient left—and therefore claims for the homeopathic ‘law of infinitesimals’ violates the law of mass action and the laws of thermodynamics.”3

Now let’s turn to the official definition of genuine homeopathy and its fundamental principles. Forgive me for this very long definition that Hahnemann wrote in the preface of the last edition of his Organon but it is the most complete and most unequivocal one: “Hence homeopathy avoids everything in the slightest degree enfeebling,* and as much as possible every excitation of pain, for pain also diminishes the strength, and hence it employs for the cure ONLY those medicines whose power for altering and deranging (dynamically) the health it knows accurately, and from these it selects one whose pathogenetic power (its medicinal disease) is capable of removing the natural disease in question by similarity (similia similibus), and this it administers to the patient in simple form, but in rare and minute doses so small that, without occasioning pain or weakening, they just suffice to remove the natural malady whence this result: that without weakening, injuring or torturing him in the very least, the natural disease is extinguished, and the patient, even whilst he is getting better, gains in strength and thus is cured—an apparently easy but actually troublesome and difficult business, and one requiring much thought, but which restores the patient without suffering in a short time to perfect health,—and thus it is a salutary and blessed business.

“Thus homeopathy is a perfectly simple system of medicine, remaining always fixed in its principles as in its practice, which, like the doctrine whereon it is based, if rightly apprehended will be found to be complete (and therefore serviceable). What is clearly pure in doctrine and practice should be self-evident, and all backward sliding to the pernicious routinism of the old school that is as much its antithesis as night is to day, should cease to vaunt itself with the honorable name of homeopathy.”4

You will notice that in this detailed definition, Hahnemann answers the question that you asked me during the debate regarding the use of compounded5 versus “accurately” known, simple medicines, and that such a practice, as well any other form of practice that don’t abide to the just-cited fundamental principles “should cease to vaunt itself with the honorable name of homeopathy.” However, you will not find in this definition of homeopathy and its fundamental principles, or in any other of Hahnemann’s works or writings, any reference to a law of infinitesimals or a law of chronic diseases that you mentioned during the debate.

Returning to what you have written, “in order for an argument to be sound all of its premises be true,” and given that these two basic premises you claimed for homeopathy unequivocally don’t exist or apply to genuine homeopathy, and are therefore false, aren’t all their subsequent arguments unsound or completely false, such as “ ‘the law of infinitesimals’ violates the law of mass action and the laws of thermodynamics“ and “the very real laws of physics and chemistry”?

As a responsible man of science, what steps are you going to take to correct these gross and completely unscientific misrepresentations of the fundamental aspects of homeopathy and any of their subsequent logical fallacies, which you have repeated for many years in numerous articles and presentations, and that can currently be found on numerous websites ? 6 Also can you precisely describe what laws of chemistry or physics, homeopathy violates, if any at all, once these two completely fabricated laws of homeopathy are eliminated from the equation?

References:

[1] Steven Novella. How to argue. Neurologicablog. March 19, 2009

[2] Steven Novella. Homeopathy at the Huffpo. Skepticblog. Oct. 19, 2009.

[3] Steven Novella. Quietus and homeopathy awareness week. Neurologicablog. April 13, 2010.

[4] Samuel Hahnemann. Organon of Medicine. Sixth edition. Translated by William Boericke. Philadelphia: Boericke and Tafel, 1922: 18-19.

[5] Unproved compounded medicines or combination remedies sold under the name of homeopathy are clearly not part of homeopathy. However, they could be sold under the name of homeotherapeutics.

[6] Such as theness.com/neurologicablog, sciencebasedmedicine.org, skepticblog.org, randi.org, csicop.org, friendofreason.wordpress.com, skeptico.blogs.com, startleddisbelief.com, illuminutti.com, lizditz.typepad.com, lippard.blogspot.ca, skepticalteacher.wordpress.com, trusted.md, skepdic.com, etc.

* Homeopathy sheds not a drop of blood, administers no emetics, purgatives, laxatives or diaphoretics, drives off no external affection by external means, prescribes no hot or unknown mineral baths or medicated clysters, applies no Spanish flies or mustard plasters, no setons, no issues, excites no ptyalism, burns not with moxa or red-hot iron to the very bone, and so forth, but gives with its own hand its own preparations of simple uncompounded medicines, which it is accurately acquainted with, never subdues pain by opium, etc.

Dr. Novella’s Response:

I find the claim that Samuel Hahnemann did not endorse a “law of infinitesimals” to be misleading in many respects.

First, it is a “No True Scotsman” logical fallacy – arguing that examples of infinitesimals within homeopathy do not demonstrate that homeopathy follows such rules, because such examples are a-priori “not true homeopathy.”

The undeniable fact is, that homeopathy, as it is widely practiced today, including the many homeopathic products sold on the market, do follow the basic concept that ingredients are diluted to extreme degrees. While the exact extent of dilution varies considerably, very common dilutions include those that exceed the point at which any original ingredient is likely to remain.

I further find it either an example of intellectual dishonesty or extremely poor and selective scholarship to claim that Hahnemann did not endorse extreme dilutions. He may not have written the words “law of infinitesimals” himself, but he certainly endorsed the principles that are captured in that phrase.

A review of his writings documents quite thoroughly that Hahnemann began with a belief in using the smallest dose possible in order to treat a patient, but that this belief evolved over his career until he was recommending extreme dilutions (what would now be called 30C, or 1/100 dilutions repeated 30 times).

From the Organon fifth edition he writes:

“The doctrine of the divisibility of matter teaches us that we cannot make a part so small that it shall cease to be something, and that it shall not share all the properties of the whole.

If now the smallest possible part is powerful enough for the purpose for which you require it, would you employ a greater quantity than you require, in order not to run counter to traditional custom, and out of deference to the prejudices of those whose standard of measurement is imperfect ?

And what is the use of larger doses of medicines if the smallest possible quantities given on the Homoeopathic principle suffice for the cure of diseases in the most rapid and permanent manner ?

The effect of the dose increases the greater the quantity of liquid it is dissolved in when given to the patient.”

That sounds pretty clear to me – you can dilute something without limit, and the more you dilute it the greater the effect. Is that not the law of infinitesimals as it is understood today?

I will also note that this violates the laws of chemistry – a molecule is the smallest part of a substance that retains its chemical properties. It cannot be divided further and still “share all the properties of the whole.”

Here he specifically endorses 30C as a common dilution (again from Organon fifth edition).

“Two drops of the fresh vegetable juice mingled with equal parts of alcohol, are diluted with ninety-eight drops of Alcohol and potentized by means of two succussions whereby the first development of power is formed, and this process is repeated through twenty-nine more vials, each of which is filled three-quarters full with ninety-nine drops of Alcohol, and each succeeding vial is to be provided with one drop from the preceding vial (which has already been shaken twice) and is in its turn twice shaken, and in the same manner at last the thirtieth development of power (potentized decillionth dilution X) which is the one most generally used.”

Further, Hahnemann clearly supported the notion that homeopathic remedies worked through their “spiritual” power. In the “Spirit of the Homoeopathic Doctrine,” published in 1813, he says :

“The spiritual power of medicine does not accomplish its object by means of quantity, but by quality or dynamic firmness.”

This next section is from a letter in which Hahnemann was defending himself from critics, published in Samuel Hahnemann, His Life and Work, page 116.

This infinitesimal size of the dose of a simple medicinal substance, in this new art of healing, removes all possible suspicion of harmful strength in the simple dose dispensed to the patient.

The apothecaries, who are incapable of acquainting themselves with the fact that the beneficial results shown in the strong curative power of such small doses of simple medications, consist of a hitherto unknown peculiar choice of the suitable remedy for the disease in question, so far undreamt of by the ordinary medical science, smile at these small doses which contain nothing, because the senses as well as chemical analysis cannot detect anything in the vehicle (sugar of milk and diluted spirits of wine).

That seems pretty clear too. The “infinitesimal size of the dose” contain “nothing” and cannot be detected by “chemical analysis,” and yet has its effect because of his new art of healing – the peculiar choice of remedy.

Regarding Hahnemann’s theory of disease, his own quotes again clearly make the case that he was using his own peculiar theory of illness. From The Life and Letters of Dr Samuel Hahnemann Chapter 13:

“Psora is the oldest, most universal and most pernicious, yet, withal, the most misunderstood chronic miasmatic disease, which for thousands of years has disfigured and tortured mankind.

“In the thousands of years since it first visited mankind (the most ancient history of the oldest nations does not reach its origin) it has increased its manifestations to such a degree that its secondary symptoms can scarcely be numbered.

“The most ancient historical writings which we possess describe psora very fully. Several varieties thereof were described by Moses 3,400 years ago. At that time, however, and ever since, among the Israelites, psora appears to have affected more especially the external parts of the body.

“The same holds true among the early barbaric Greeks ; later, in like manner, among the Arabians, and finally in the uncivilized Europe of the middle ages. It is not my object to detail the different names by which the various nations have designated the more or less severe forms of disease through which leprosy marred the external parts of the body (external symptoms of psora). Such names have no bearing upon the subject, as the essence of this miasmatic itch disease remains always the same.

“In Europe during several centuries of the middle ages psora manifested itself in the form of a malignant erysipelas (St. Anthony’s Fire). In the 13th century it again assumed the form of leprosy, brought by the returning Crusaders from the East. Leprosy was thus more than ever before spread through Europe (in the year 1226 there were in France about 2,000 leper-houses) ; nevertheless some alleviation of its horrible cutaneous symptoms was found through the means of cleanliness which the Crusaders also brought from the East ; aids to cleanliness theretofore unknown in Europe, (cotton, linen), shirts, as well as the frequent use of warm baths.

I maintain that the historical record, as well as modern implementation, support the following premises:

- Homeopathy is based upon the notion that solutions can be diluted beyond the point that any active ingredient remains, while retaining (and even enhancing) its potency.

- Effectiveness of remedies is not based upon any scientific notion (chemical or biological) but rather on the notion of the spiritual action of preparations which contain the essence of what was diluted in them.

- Shaking preparations transfers essence and adds potency

- Effectiveness of homeopathic remedies are based upon the peculiar and completely unscientific notions of similars

- Hahnemann based much of his thinking on peculiar notions of chronic illness (psora) that are completely unscientific.

There are many more examples in the references I gave, and in many more. The samples I provide, however, clearly establish the points I outline above.

In short – Hahnemann absolutely endorsed the principles captured in the phrase “law of infinitesimals” and these principles remain the core of modern homeopathy. All of my further criticisms that derives from this premise are both valid and sound.

Conclusion

The above exchange is a good example of why I find it so useful to directly confront believers – I never would have guessed that a contingent of homeopathy deny the Law of Infinitesimals.

I am still not sure what to fully make of it. During the debate Andre defended extreme “ultramolecular dilutions,” yet he also says this is not part of true homeopathy. Am I missing something, or is this just an absurd version of the kettle defense (I strongly suspect the latter). Or is Andre making a nitpicky distinction between “infinitesimals” and some other concept of extreme dilutions? Such a distinction is of no consequence – once you get below the dilutional limit, there is simply nothing left.

The ploy is also very common among defenders of unscientific belief systems. Legitimate criticism or evidence against a belief is often deflected by saying that what it targets is not “true” (fill in the blank). They then accuse the skeptic of attacking a straw man or being dishonest.

However we are often responding directly to claims that are being made. Go to any website about homeopathy and you are very likely to encounter some endorsement of infinitesimals or extreme dilutions. Most homeopathic products on the shelves also have extreme dilutions.

In any case, the historical record here is clear. Hahnemann’s homeopathy is based upon extreme dilutions, which are premised on unscientific notions, as described above.

As was the case for the nonexistent cell phone-cancer link, there has now been a steady drip-drip-drip of bad studies touted by anti-GMO activists as “evidence” that GMOs are the work of Satan that will corrupt or kill us all (and make us fat, to boot). Not too long ago, I came across one such study, a truly execrable excuse for science by Gilles-Eric Séralini at the University of Caen purporting to demonstrate that Roundup-resistant genetically modified maize can cause horrific tumors in rats. I looked at the methods and conclusions and what I found was some of the worst science I had ever seen, every bit as bad as the quack “science” used by the antivaccine movement. It wasn’t for nothing that I made the comparison, because the anti-GMO movement is very much like the antivaccine movement and the cranks who claim that cell phone radiation causes cancer. As if to demonstrate that very point, last week I came across an article by the all-purpose crank to rule all cranks, Mike Adams, at NaturalNews.com entitled GMO feed turns pig stomachs to mush! Shocking photos reveal severe damage caused by GM soy and corn:

If you have stomach problems or gastrointestinal problems, a new study led by Dr. Judy Carman may help explain why: pigs fed a diet of genetically engineered soy and corn showed a 267% increase in severe stomach inflammation compared to those fed non-GMO diets. In males, the difference was even more pronounced: a 400% increase. (For the record, most autistic children are males, and nearly all of them have severe intestinal inflammation.)

The study was conducted on 168 young pigs on an authentic farm environment and was carried out over a 23-week period by eight researchers across Australia and the USA. The lead researcher, Dr. Judy Carman, is from the Institute of Health and Environmental Research in Kensington Park, Australia. The study has now been published in the Journal of Organic Systems, a peer-reviewed science journal.

It sounds pretty damning, doesn’t it? It sounds truly horrific, just as the Séralini study did. Adams is useful in that he takes the messages of anti-GMO activists (well, actually, he takes the messages of just about all cranks and quacks) and, as they said in This Is Spinal Tap, turns them up to 11. On the surface, it does, anyway. But what about the actual study. There was really only one thing for me to do, and that’s the same thing I did with the Séralini study: Go and see for myself. So I did.

What hath Judy Carman wrought?

Judy Carman’s study was, fortunately, published in an open access journal, and there was a direct link to the study itself. The first thing I did was to look at the journal. I had never heard of it before. The journal seems to cater to the organic crowd, being sponsored by groups like the Organic Federation of Australia and CSAFE, while the guidelines for authors state that “topics are to be consistent with current principles of organic farming and its associated industries, especially those in Australia, New Zealand, Asia, and the Pacific Islands.” The journal itself appears not to be indexed on PubMed, which tends to indicate either that it’s a new journal or not a very good journal. On the other hand, to be fair, there are plenty of CAM journals indexed in PubMed, and many of them are pure pseudoscience; so I can no longer conclude that lack of indexing in PubMed automatically means a journal is dodgy. It is, however, often an indication that it is. Moreover, if you wander over to Judy Carman’s website, gmojudycarman.org, you’ll see that it’s chock full of anti-GMO activism.

After having seen this study, I think that the editors of this open access journal have made a massive mistake and have, either wittingly or unwittingly, allowed their journal to become a tool of anti-GMO activist groups, a couple of which which gleefully announced the results of the study with press releases (for example here and here) calling the study “groundbreaking,” asserting that it was evidence of “adverse effects” due to GMO feed, and claiming that the results show “…clear evidence that regulators need to safety assess GM crops containing mixtures of GM genes, regardless of whether those genes occur in the one GM plant or in a mixture of GM plants eaten in the same meal, even if regulators have already assessed GM plants containing single GM genes in the mixture.”

Here’s a hint: It’s none of the above.

As I read the study itself, the first thing that became apparent to me is that it’s a massive fishing expedition. What do I mean by that? I mean that there’s no clear hypothesis. Basically, the only seeming hypothesis was “GMOs bad,” and the study was designed to find bad things associated with GMOs. At first glance, the design seems simple enough. The investigators used 168 just-weaned pigs at a commercial piggery in the US. The pigs were fed a standard diet, but half the pigs were fed widely used varieties of GM soy and GM corn, while the control group fed an equivalent non-GM diet. Basically, one protein made the plant resistant to a herbicide and two proteins were insecticides. The specific GM varieties used were as follows:

The corn used in this study contained 90% DK 42-88 RR YG PL (a triple stack of NK603, MON863 and MON810 genes) with the remainder being equal quantities of Pannar 5E-900RR (containing NK603), Pannar 4E-705RR/Bt (a double stack of NK603 and MON810) and Producers 5152 RR (containing NK603). Therefore, the GM corn that was used was genetically modified to produce three new proteins. Two were Bt proteins that protected the plant against insect attack, while the third protein provided the plant with tolerance to the herbicide glyphosate (Testbiotech, 2012; Monsanto, 2012). Because Roundup Ready^TM (RR) soy is predominant in the GM soy market, this was used. This crop contains a gene that provides tolerance to the herbicide glyphosate. GM DNA analysis (Genetic ID, Fairfield, Iowa, US) confirmed that the GM corn contained a combination of NK603, MON863 and MON810 genes (expressing the CP4 EPSPS, Cry 3Bb1 and Cry 1Ab proteins respectively), that the RR soy was 100% RR soy (expressing the CP4 EPSPS protein), that the non-GM feed contained a median of 0.4% GM corn and that the non-GM soy contained a median of 1.6% GM soy. Such GM contamination of apparent non-GM material is common in the US.

So the investigators fed piglets a diet of GMO grain versus non-GMO grain, let the pigs mature according to the normal methodology, and then after slaughter looked at a variety of outcomes. Worse, the authors measured these variables without any sort of control for multiple comparisons. Of course they found differences! Actually, what surprised me is how few differences they found between the groups, not how many. I’m going to hone in on the main finding of the paper first. It’s the finding that seemed the most dramatic and was the most highly publicized, the one mentioned by Mike Adams in his breathless description of he results, as though it was slam-dunk evidence that GMOs are evil. I’m referring, of course, to the claim that more stomach inflammation was observed in the pigs fed a GMO diet, specifically a 267% increase in severe stomach inflammation in the GMO group, with a whopping 400% increase in male pigs. It’s the result that produced pictures like this one in the paper (and, not surprisingly the same picture posted to many an anti-GMO website):

These images certainly look striking, but what do they mean? Well, not much. First of all, as many have pointed out, the photos chosen are deceptive in that not enough of the groups are shown, nor can we be sure that these are representative. Also, as Mark Hoofnagle points out, the assay for inflammation in the gastric mucosa of the piglets was only based on gross pathology. Basically, there was no histological study and pathological examination of the tissue to detect and quantify actual inflammation. Basically, the assay was based just on a gross visual inspection of the the tissue by a veterinarian (not even a veterinary pathologist even, as far as I can tell). Unfortunately, such inspections can be highly misleading, particularly after animals have been slaughtered in an abattoir, as described by Professor Robert Friendship, University of Guelph:

Dr. Robert Friendship, a professor in the Department of Population Medicine at the Ontario Veterinary College, University of Guelph and a swine health management specialist, reviewed the paper [see reference below]. He concluded that ‘it was incorrect for the researchers to conclude that one group had more stomach inflammation than the other group because the researchers did not examine stomach inflammation. They did a visual scoring of the colour of the lining of the stomach of pigs at the abattoir and misinterpreted redness to indicate evidence of inflammation. It does not. They would have had to take a tissue sample and prepare histological slides and examine these samples for evidence of inflammatory response such as white blood cell infiltration and other changes to determine if there was inflammation. There is no relationship between the colour of the stomach in the dead, bled-out pig at a slaughter plant and inflammation. The researchers should have included a veterinary pathologist on their team and this mistake would not have happened. They found no difference between the two experimental groups in pathology that can be determined by gross inspection.’

What I found particularly suspicious was Table 3. Notice how the level of inflammation is divided into no inflammation, mild inflammation, moderate inflammation, severe inflammation, erosions, pin-point ulcers, frank ulcers, and bleeding ulcers. This is not really a standard way of scoring inflammation. I don’t know about pigs, but in humans there are a variety of scoring systems for the endoscopic assessment of inflammation (for example, this one), particularly chronic gastritis (which is what we’re talking about, although such redness as described would, if associated with gastritis, be more associated with acute gastritis). Worse, gross visual assessment of gastric mucosa is subject to high inter-observer variability, and, although the personnel caring for the pigs and doing the autopsies were blinded to the experimental group (which is good), I don’t see any attempt to control for inter-observer variability, and, again, no control for multiple comparisons.

I also note that the difference between pin-point ulcers, frank ulcers, and bleeding ulcers is rather arbitrarily defined and not entirely clear. Also notice how twice as many pigs had no inflammation in the non-GMO group and that there was actually a lower risk of mild and moderate inflammation, as well as erosions and pin-point ulcers. Of course, the p-values are all non-significant, except for one: that for severe inflammation. In fact, on the entire table, the only “statistically significant” result is for “severe inflammation.” In fact, as Mark Lynas points out, many more pigs fed non-GMO feed had stomach inflammation than those with GMO feed.

Lynas also points out that the data are all over the place with respect to reported levels of inflammation, asking the very apt question, “If GMO feed is causing the severe inflammation, why is the non-GMO feed causing far more mild to moderate inflammation?” One also can’t help but notice that for “moderate” inflammation, there was a difference favoring the non-GMO feed, and I echo the question, “Do Carman et al perform a test for statistical significance to see if GMO feed has a protective effect on pigs stomachs? Of course not – that’s not the result they are after.” Exactly. Even worse, they used the wrong statistical analysis to analyze categorical data. When the data are analyzed more appropriately, there appears to be no statistically significant difference between the groups, just as there was no real statistically significant difference in the tumor burden of the rats in the Séralini study. Come to think of it, Carman’s study resembles the Seralini study in that it basically looks at a whole lot of outcomes in a fairly arbitrary fashion and cherry picks the inevitable “positive” result. In fact, if you take all the groups together, there actually appears to be a non-statistically significant trend towards less stomach inflammation in the GMO group. Yes, less. As Karl Haro von Mogel put it, the authors appeared to be “trying to shoe-horn individual categories that aren’t binary data into a statistical test designed for binary data is the wrong approach.” Basically, however you look at it, there’s just no “there” there. Analyzed correctly, there is no statistically significant (or, no doubt, biologically significant) difference in stomach inflammation in this study. As for the reported increase in uterus weights, as Professor David Spiegelhalter, Winton Professor of the Public Understanding of Risk at the University of Cambridge points out, “There are also 19 other reported statistical tests, which means we would expect one significant association just by chance: and so the apparent difference in uterus weight is likely to be a false positive.”

There’s another aspect of this paper that’s very troubling, and it is that these animals were all very sick. Indeed, I have to wonder how they were being cared for. Over half the animals are reported in Table 3 to have pneumonia, defined as “consolidating bronchopneumonia of the cranial ventral lung lobe(s) and/or caudal lobes.” That is just not normal, and it doesn’t sound like a minor pneumonia. True, this pneumonia wasn’t histologically verified either, as far as I can tell, although pneumonia can be viewed grossly if it’s bad enough. It is, after all, basically puss mixed with mucous in the alveolae and bronchial passages. As has been pointed out in multiple discussions of this study, such a high percentage of animals with pneumonia is an indicator of very bad animal husbandry, indeed. The bottom line is that there are many, many problems with this study, the totality of which are more than enough to render its results meaningless. There is no dose-dependent mechanism for the effects reported, no rhyme or reason consistent with a mechanism that would explain why GMOs would affect just the stomach (and then only to cause severe inflammation) and uterus size. The study was a fishing expedition and not hypothesis-driven. It’s not surprising that it found something. I’d be shocked if it hadn’t. In the end, this study abused a fairly large number of innocent pigs to produce no useful data. She might try to defend it against criticism, but she basically fails. In particular, one notes that she can’t seem to defend against the charge of a lack of hypothesis and that she didn’t even try to defend the criticism that she didn’t bother to look at stomach histology to verify that there really was inflammation in the gastric mucosa, despite Carman’s touting that the “authors have over 60 years of combined experience and expertise in medicine, animal husbandry, animal nutrition, animal health, veterinary science, biochemistry, toxicology, medical research, histology, risk assessment, epidemiology and statistics.” Sad that they didn’t use all that experience to produce a paper whose results are believable and useful.

This isn’t Judy Carman’s first time…

In reading this study, I couldn’t help but notice the corresponding author: Judy Carman. I had heard that name before. But where? Oh, yes. I remembered. I had encountered her making some truly ridiculous claims about GMOs, so ridiculous that I think it’s worth bringing up now. She didn’t write the commentary I’m about to describe, but she voiced support for its findings, providing tactical air support to its author, Jack Heineman. I had wanted to write about it at the time I came across it, but, for whatever reason, didn’t manage it. So now’s as good a time as any. In brief, Carman appears to be an anti-GMO activist who, along with another anti-GMO activist, Professor Jack Heinemann at the University of Canterbury’s Centre for Integrated Research in Biosafety, made some truly nonsensical claims about GMOs. I first encountered these nonsensical claims in the blog of a homeopath named Heidi Stevenson, who claimed that genetically modified wheat may damage human genetics permanently.

Stevenson prefaces her article with this scary paragraph:

The Australian government, in the form of its science research arm, is joining Agribusiness profiteering by designing a GM wheat that could kill people who eat it & be inherited by their children.

Scared yet? Does Stevenson have your attention? Who are these nefarious scientists, and why would they want to make genetically modified wheat that would do these things? They wouldn’t, of course, but, like the Frankenstein that anti-GMO activists think scientists are, it’s a matter of messing with nature resulting in unintended consequences. In fact, the hilarity is such that I think it’s worth quoting a decent sized chunk of the first part of Stevenson’s article:

We have not yet seen the worst damage that genetic engineering may do. Australia’s governmental agency, Commonwealth Scientific and Industrial Research Organisation (CSIRO), is developing a wheat species that is engineered to turn off genes permanently.

Professor Jack Heinemann at the University of Canterbury’s Centre for Integrated Research in Biosafety has studied the wheat’s potential. Digital Journal reports that he says¹:

What we found is that the molecules created in this wheat, intended to silence wheat genes, can match human genes, and through ingestion, these molecules can enter human beings and potentially silence our genes. The findings are absolutely assured. There is no doubt that these matches exist.

The implications are clarified by Professor Judy Carman of Flinders University:

If this silences the same gene in us that it silences in the wheat—well, children who are born with this enzyme not working tend to die by the age of about five.

Silencing the equivalent gene in humans that is silenced in this genetically modified wheat holds the potential of killing people. But it gets worse. Silenced genes are permanently silenced and can be passed down the generations.

Yes, that’s the very same Judy Carman who published this awful “stomach inflammation” study that I just discussed.

Basically, Carman’s claim here is that a variety of genetically modified wheat under development by the CSIRO will kill your children. I kid you not. And Judy Carman has not only promoted this idea but amplified it by emphasizing that she thinks children could die. Of course, Stevenson apparently doesn’t see the contradiction between saying that this GM wheat will kill your children but that its gene-silencing effects will also be passed down the generations. Neither does Carman, who continued:

As a result, there is a chain of evidence to show that there is a risk that the dsRNA from this GM wheat may survive digestion, enter the tissues of people that eat it and silence a gene or genes in those people. There is also evidence that any genetic changes so produced may be stable and become established in many cells of an organ. Furthermore, there a possibility that these changes may be passed-on to future generations.

In any case, I could recognize some amazing speculation and fear mongering right off the bat; so it’s time to explain.

Gene “silencing” means what the name implies: Shutting down the activity of a gene so that it stops making its gene product. Of course, gene silencing is not an all-or-nothing phenomenon. Like other forms of gene regulation, silencing happens on a continuum from zero to complete silencing, depending on the level and activity of the silencing agent. In this case, the silencing agent that is being turned into the bogeyman du jour is RNA. Specifically, it’s a type of RNA-mediated gene silencing called RNA interference (or RNAi), also known as post transcriptional gene silencing (PTGS). The idea is that the CSIRO is apparently engineering a strain of wheat that produces a short RNA molecule designed to silence specific genes in the wheat. Most of the time, when we talk about RNA, we talk about messenger RNA (mRNA), the RNA that is the intermediary between DNA and protein. However, back in the late 1990s, it was discovered that there are other RNA molecules that actually regulate gene expression by binding to complementary sequences on mRNAs. These molecules include classes of RNAs called microRNAs, as well as double-stranded RNA molecules known as short interfering RNA (siRNA), that can participate in cellular pathways that contribute to gene silencing, most commonly through binding to complementary sequences and inducing the degradation of different mRNAs in a sequence-specific manner. In fact, siRNAs were first discovered in plant genetics and only later was it discovered that short RNAs serve as a gene regulatory mechanism in mammalian cells as well.

An excellent video explanation of RNAi can be found, courtesy of Nature:

So what’s the problem? Heinemann and Carman are apparently worried that the siRNA that will be used to silence two genes in wheat called SEI and SEII. Heinemann apparently did an analysis based on the sequence of the SEI and SEII genes, comparing them against the human genome and looking for matches. He found them in the gene for the enzyme mentioned by Judy Carman. In humans, the equivalent gene is known as glucan (1,4‐alpha‐), branching enzyme 1, abbreviated GBE. Based on some similarities he found between SEI and GBE, Heinemann sounded an alarm through an anti-GMO activist group known as the Safe Food Foundation & Institute. Humans store carbohydrates as glycogen, and GBE makes branches in glycogen. There is a consequence to not being able to branch one’s glycogen, although not branching it in wheat could be useful for decreasing its glycemic index. There is a disease known as glycogen storage disease IV, which leads to damage to the liver over time. That’s the disease that Judy Carman was referring to.

Of course, the problem with Dr. Heinemann’s highly speculative analysis is that he didn’t know the actual siRNA sequences that were going to be used. Without that information his analysis was pretty pointless. At the very best, it was highly speculative. At the worst, it was ideologically and politically motivated.

So how could this possibly matter? After all, it’s RNA. It’s really unstable, isn’t it? Well, not exactly. Single stranded RNA is very unstable. It can’t survive long outside of the cell. However, dsRNA can be quite stable, even outside of a cell. But that still leaves the question of whether dsRNA from a plant that is eaten can have any effect. To do that, the siRNA would have to survive digestion, be absorbed into the bloodstream, enter other cells, and act on gene expression. Heinemann notes that such a phenomenon can be observed in insects and worms.

But can it happen in humans? Well, there is one paper that Heinemann latched on to because he thinks it demonstrates that the same phenomenon can happen in humans. It’s a paper by Zhang et al. published in Cell Research that showed that showed that a plant-derived microRNA (miR-168a) from rice can be found in human serum after ingesting rice and that it can actually bind to the mRNA for low-density lipoprotein receptor adapter protein 1, thus inhibiting the expression of this protein. It’s an interesting observation, but there are a number of questions. For one thing, although the microRNAs are detectable in serum they circulate at a really low concentration, namely the femtomolar range (10^-15 mole/Liter). News stories describing the study at the time were quite credulous, but a better discussion can be found at Sandwalk. In any case, the exceedingly low concentration of microRNA observed in the bloodstream leaves a huge question in that there is no known mechanism by which such a low concentration could have such an effect. When I first read the study, I thought it plausible, but the more I think about it the more I agree with the Sandwalk commenter who says it screams “artifact” to him. Or this commenter:

There is probably 10 fM of everything in the blood. Sheesh, that’s less than 4×10^9 molecules per whole body consisting of about 7×10^12 cells and containing no more than 7×10^10 hepatocytes. That’s less than 0.1 miRNA per liver cell in the best possible scenario. What are these RNAs, totally magic?

Maybe they’re homeopathic, although admittedly fM concentrations are far and away greater than the concentrations of most homeopathic remedies (i.e., zero). In any case, stoichiometry is your friend when figuring these things out. Personally, I’ll wait for some confirmation that this happens from other groups before I buy it. True, another group has reported finding miR-168a, but it also reported a huge variety of microRNAs in the serum from a variety of sources, including bacteria and fungi as well as from other species, such as various insects. Basically, we’re awash in microRNAs from other species that we come into contact with. So far, the only evidence that they have any effect whatsoever is that one study suggesting that miR-168a might regulate one gene, even though it’s hard to figure out by what mechanism it could possibly accomplish this. Add to that the utter lack of evidence that any circulating microRNA can not only silence a gene in human cells but actually induce epigenetic changes, and Professor Heinemann’s speculation becomes ever more…speculative. This is true particularly in light of the fact that we regularly eat plants that make many siRNAs and microRNAs. Why would GM wheat siRNAs be any different or more dangerous, particularly given the very low concentrations involved?

Let’s put it this way. For Heinemann and Carman’s fear mongering to be a real concern, any siRNA or microRNA from genetically modified wheat would not only have to be made in sufficient quantity at least to equal the normal concentration of miR-168a in rice, but also be stable enough to pass through stomach acid and the gut lining undigested, and get into the bloodstream at a high enough level to affect gene expression. That’s leaving aside the question of whether there is even enough sequence match that the siRNA could even target the human GBE mRNA in the first place, which is impossible to say because we don’t know the actual sequence of the siRNA being used. It’s true that Heinemann has updated his “report.” However, that update doesn’t really show anything new or contribute to the plausibility of Heinemann’s concerns. In fact, it trashes the plausibility even more because the homology (in laymen’s terms, match) to the glycogen enzyme that Heinemann was promoting pretty much disappears in this reanalysis. (In fact, if you look at it in depth, it wasn’t even there to begin with, and it’s questionable whether he even used the right wheat sequence in his BLAST analyses.) Even in the reanalysis, the only areas of match appeared in introns, which, as Biofortified put it:

However, all of the matches he highlights are either to introns – which would not matter for the mechanism of action that is the issue here. Or they are in the genome desert areas, thousands of bases away from anything that appears to be a gene.

Result: Take a deep breath. The GMO wheat that forms the basis of this claim will not kill your children or permanently alter your genome.

More interestingly, I decided to check back and see if the human GBE gene is still sticking with this sequence switcheroo. The main fear-based claim was that the GBE gene would be suppressed and children with a disorder of this can die by the age of 5. So let’s see–let’s do an analysis of this new sequence and compare it to GBE. If you perform a BLASTn at NCBI with these two sequences and default settings as Jack says he does, what do we get?

The result? No significant similarity found.

That’s right. The entire foundation of the fear–the match to GBE–is gone. Evaporated. Vanished. Nada. Zip.

No wonder Australian and New Zealand regulators have rejected the concerns.

Add to that the enormous lack of likelihood that, even if the siRNAs and microRNAs in GM wheat could actually make it into the bloodstream in concentrations sufficient to alter gene expression, it’s incredibly unlikely that such RNAs could actually induce “permanent” epigenetic changes to justify the fear mongering.

There might be questions about GMOs, but by and large they are not issues of safety. Rather, they are issues of intellectual property; i.e., how large companies developing GMOs behave. Hysteria of the like generated by the likes of Jack Heinemann and Judy Carman and parroted by useful idiots like Heidi Stevenson generate heat, but no light. Nor does the latest round of attempts to generate hysterical fear mongering based on Carman’s latest study. Both Heinemann’s speculations and Carman’s most recent bit of data mining are of a piece. They are not designed to provide a dispassionate analysis of the true potential risks and benefits of GMOs. They are designed to be propaganda to produce fear, uncertainty, and doubt about GMOs, just like Andrew Wakefield’s studies about the MMR vaccine, just like Mark and David Geier’s studies of thimerosal in vaccines, just like the studies of any variety of antivaccine cranks. It is the equivalent of shouting “fire!” in a crowded theater.

Unfortunately, the pseudoscience is metastasizing. GMO Pundit points out the next frontier of anti-GMO fear mongering.:

Yes, because a new flu vaccine Flublok is made in “insect cells” (specifically, the baculovirus system, a very common system of expressing mammalian proteins for use in genetically engineered products), it is now a “GMO product” and to be feared as much as GMO-derived foods. In actuality, Flublok should end up being safer than the old flu vaccine because it doesn’t include all those extraneous proteins, such as egg protein, just the three hemagglutinin, or HA proteins, of the most common flu strains circulating in any given year.

What’s next? Telling diabetics that they shouldn’t take insulin derived from genetic engineering because the protein is made in—gasp!—bacteria or yeast?

Sometimes, in the course of blogging, I come across a story that I don’t know what to make of. Sometimes, it’s a quack or a crank taking a seemingly science-based position. Sometimes it’s something out of the ordinary. Other times, it’s a story that’s just weird, such that I strongly suspect that something else is going on but can’t prove it. So it was a few months ago when I came across the story of Alex Spourdalakis, a 14-year-old autistic boy who became a cause célèbre of the antivaccine crank blog Age of Autism.

I first noticed the story in early March when perusing AoA and came across a post by Lisa Goes entitled Day 19: Chicago Hospital Locks Down Autistic Patient. In the post was a shocking picture of a large 14-year-old boy in a a hospital bed in four-point restraints. He was naked, except for a sheet covering his genitals. A huge gash was torn in the bedsheet, revealing the black vinyl of the hospital bed beneath. The boy’s name, we were informed, was Alex Spourdalakis. Further down in the post was another, equally shocking, picture of Alex that, according to Goes, showed severe dermatitis on Alex’s back due to the hospital sheets. The photos shocked me for two reasons. First, if the story was as advertised (something always to be doubted about any story posted at AoA), for once I thought that I might be agreeing with Goes and thinking that AoA was actually doing a good thing, as disconcerting as that possibility was to me. Second, however, I was extremely disturbed by the publication of such revealing photos of the boy. Undoubtedly, Alex’s mother must have given permission. What kind of mother posts pictures like that of her son for all the world to see? Then there appeared a Facebook page, Help Support Alex Spourdalakis, which pled for readers to help the Spourdalakis family.

As I said, something just didn’t seem right at the time.

Now I know that something most definitely wasn’t right, but I still can’t yet figure out what was wrong at that time three months ago. What is wrong now is that a little more than a week ago Alex was brutally murdered by his mother and caregiver, stabbed to death, in fact. The murder was carefully premeditated and quite gruesome:

Convinced that Alex Spourdalakis’ severe autism was growing worse, his mother and caregiver allegedly planned for at least a week to kill the River Grove teenager and themselves.

But the alleged murder plot initially went awry last weekend when the stocky 14-year-old didn’t succumb to an overdose of his prescription medications.

After waiting for several hours, Dorothy Spourdalakis, fatally stabbed her 225-pound son four times with a kitchen knife, then cut his wrist so deeply she nearly severed his hand, Cook County prosecutors said Wednesday.

His caregiver, Jolanta Agata Skrodzka, later stabbed the family cat with the same knife, then washed the utensil and put it back in a butcher’s block, prosecutors said.

Their suicide pact never succeeded: Both women took drug overdoses, then locked themselves in the bedroom with the slain teenager.

They were found semi-conscious inside the second-floor apartment on Sunday afternoon when Alex’s father and uncle came to check on the teen, prosecutors said as the women appeared in court to face first-degree murder charges.

More details are described in this Chicago Tribune story about the murder. Dorothy Spourdalakis and Alex’s caregiver Jolanta Agata Skrodzka had apparently discussed the plan to kill Alex using an overdose of prescription sleeping pills and explained why they did it in a letter. Apparently they killed the cat because they didn’t want it to end up in a shelter after they committed suicide. We also learned that police had been to the house several times to assist with transporting Alex to doctors’ appointments because “he was big and strong and unwilling to go to the doctor.”

Over the last three months, as I occasionally read articles and posts about Alex Spourdalakis, going back to March, I increasingly got the distinct impression that there was more going on that met the eye. Now, on the one hand, Lisa Goes might have been right. That has to be conceded. But while I occasionally looked at stories about Alex on AoA, they just didn’t seem to pass the “smell test” to me. Something, it seemed to me, was being left out. Neither did a lot of the claims being made about the care Alex was receiving strike me entirely credible. At the very least, it was very clear that a highly biased, one-sided version of events was being presented. For instance, Goes claimed that Alex was kept in four-point restraints 24 hours a day at two different hospitals, Gottleib Hospital and Loyola University Medical Center (LUMC), for 19 days:

According to her, at 14 years of age, Alex has a diagnosis of severe autism and cognitive impairment. He is non-verbal. In October of 2012, Alex began to suffer neurological events that prevented a healthy sleep cycle. He was awake for many hours at a time. Agitation and aggression ensued as a result of sleep deprivation. During this time, symptoms and behaviors that were indicative of severe gastrointestinal distress developed as well. A cycle of constipation, diarrhea and formed bowel movements surfaced and became a chronic problem. On February 16th at 5:00 am, with the assistance of police and paramedics, Dorothy took her inconsolable and highly-distressed non-verbal child to Gottlieb Hospital in Melrose Park, Illinois.

Because of Alex’s physical aggression, he was placed in locked restraints. At that time, Dorothy did not know the ER would be their home for the next several days, as Alex lay naked, in locked restraints, suffering bouts of violent vomiting, severe constipation and diarrhea. Neither she nor Alex bathed for the next 13 days while hospital staff and administrators attempted to devise a plan to care for Alex. “He was given Colace for his constipation and sometimes it would take security staff and nurses more than 15 minutes to arrive to help unshackle him so he could use the bathroom,” Dorothy explained. “Alex would scream as best he could when he knew he was going to have a vomiting episode, but security took several minutes to respond so Alex would lay in his own vomit, waiting to be released by a representative of security. He would be wiped down and returned to the same restraints.”

Sure, it was possible that the boy was being abused so horribly, first at Gottleib Hospital and then at LUMC, but the story as presented struck me as implausible, although at the time I had no way of refuting or confirming the increasingly lurid stories being posted at AoA about Alex. For one thing, there are very strict laws these days about patient restraint, particularly when it comes to children. The last time I ever had to order four-point restraints was over 14 years ago, back when I moonlighted as a trauma attending in, yes, the Chicago area, the same metropolitan area where Alex lived and died. Before that I sometimes had to deal with the restraint of patients when as a resident I rotated on the trauma services at the hospitals where I trained. Sometimes patients with head injuries or severe intoxication would be violent and require restraint. There was always a strict protocol that we followed, even back then. My understanding is that the protocols have only gotten more strict. Restraining a patient, particularly a minor, is not something that is undertaken lightly, nor should it be. To believe the AoA account, we have to believe that a severely autistic teenaged boy would be kept in the emergency room for several days (also very, very unlikely) and put in restraints in an abusive fashion at not just one but two different hospitals, continuing after Alex was transferred from Gottlieb Hospital to Loyola University Medical Center on February 28. Actually, it was three different hospitals, because later Alex was shown in four-point restraints at Lutheran General Hospital during his last admission in May. More on that later.

Also missing from these stories was a clear and cogent explanation of why Alex was ever admitted to Gottleib Hospital and then transferred to LUMC in the first place. It’s mentioned in some places that Alex was “inconsolable, highly-distressed and suffering bouts of violent vomiting, severe constipation and diarrhea.” I had to look for clues to explain it, and, I must admit, I still remain puzzled. Certainly, these Change.org petitions demanding that LUMC provide what Ms. Spourdalakis considers to be “standard medical treatment,” which to her included gastroenterology. Peppered through various reports were indications that Alex had multiple allergies and GI issues. Having observed a fair amount of autism quackery on the Internet, these terms were huge red flags to me that strongly suggested the possibility that Ms. Spourdalakis was heavily into “autism biomed.” Another hint as to what might have been really going on comes from reports of a care plan conference on March 12. Allegedly (we only have one side of the story given that the hospital and doctors are bound by HIPAA privacy law not to discuss the case), if Ms. Spourdalakis failed to agree completely to the care plan Alex would be placed in the care of the Illinois Division of Family and Children Services (DFCS).

Elsewhere, I found references to demands that LUMC consult with an “Autism Medical Specialist to ensure Alex’s dietary needs were met to ensure his food allergies and intolerance’s were not aggravating any underlying gastrointestinal or other medical conditions that may also cause adverse behaviors”, which sounded suspiciously like an autism biomed quack. In this post, Lisa Goes described a visit to LUMC with Jeanna Reed of Autism Is Medical, whose website if chock full of standard antivaccine and “autism biomed” tropes, such as a section on mitochondrial disorders, banners asking if autism is vaccine injury, and the like. It’s actually a pretty bare-bones website with lots of bugs, but the intent is clear. Besides, it’s obvious (to me, at least) that Lisa Goes is antivaccine, given that she has been a regular at the (Not-So) Thinking Moms’ Revolution. Indeed, in the very same post, Lisa Goes unwittingly portrayed Jeanna Reed as ranting and haranguing Alex’s doctors with pleas to read quack studies and claims that “many of these children present with bowel disease and mitochondrial dysfunction. He could have GERD, duodenitis, esophagitis, ulcers in the small intestines, colitis. How can we know if we don’t test?” This was pure autism biomed rhetoric, leavened with the arrogance of ignorance. When one of the doctors referred to autism as a “mystery,” Goes totally lost it, yelling, “No! No! It’s not. It’s a medical illness that causes bad behavior. All you have to do IS READ*!”

Such is the arrogance of ignorance that leads antivaccinationists to lecture physicians.

Based on what was in retrospect in plain sight on the antivaccine blogs, it’s hard for me not to suspect at least a little bit that Dorothy Spourdalakis was subjecting Alex to “autism biomed” treatments, that she came to know Ms. Reed and thereby spread her story to the wider autism biomed movement at large. If my suspicions are ultimately revealed to be true through police investigation of the murder and in the upcoming trial of Alex’s mother and caregiver, it would certainly explain a lot. Certainly, it would explain why Lisa Goes and AoA rallied to Alex’s cause so enthusiastically. It would also explain why the hero of the autism biomed movement himself, Andrew Wakefield, visited Alex during Autism One and posted to YouTube on the Autism Media Channel a video making an appeal for Alex:

Note that, in this incredibly creepy video (is it just me, or does Wakefield look creepier and creepier each time I see him?), Wakefield stated that Alex was scheduled to go to long term psychiatric care in 72 hours, as if that were the worst fate imaginable for him. He appealed for funds to allow Alex to be transferred to a facility where he would “get the care he needs.” What that facility is, Wakefield does not say. What also isn’t clear is why Alex was back in the hospital again. I say “back in the hospital” because on March 23 his mother published a post on AoA announcing that Alex was being discharged from LUMC. She thanked everyone at AoA, but she also revealed her antivaccine proclivities:

It is during times like this we as a family realize our full potential. We know no one will help us unless we help ourselves. The continued abuse, medical neglect, discrimination and ignorance have to stop. Vaccines have maimed too many already and there are many more to come. The CDC’s latest stats confirm that. We are not going away, nor are we giving up. My son Alex is just one of millions of children and adults who no longer will be silenced.

We as a group have been deceived and lied to long enough. Our children have paid and are continuing to pay the ultimate price because of greed. The health care system has failed terribly. It is our responsibility to continue to bring about change.

Please continue to follow Alex on his journey toward better health. Allow us to be a part of your lives. Our strength will continue to come from everyone and anyone who would like to continue with us. Alex will hopefully get the medical testing he needs but was denied until now. So much needs to happen in order for us ensure his recovery and I still need so much help! Please continue to follow my team of helpers for updates and fundraising efforts. I cannot tell you how much I appreciate and value every single one of you who have gotten us to this place. Thank God for the internet and facebook!

To me, this was the strongest suggestive evidence that Ms. Spourdalakis had likely been subjecting Alex to autism biomed treatments. The language was pure “autism recovery”-speak. The antivaccine sentiment was there. So was the conspiracy-mongering against conventional medicine and big pharma. In another story, I learned that another antivaccinationist and advocate of “autism biomed,” Polly Tommey of the Autism Media Channel, was involved with the Spourdalakis case, and Ms. Spourdalakis claimed that all Alex needed was “something simple, in the country, where he can run around, get the treatment that he needs so he can get better.” For some reason, however, in May Alex was back in the hospital. When the new reports of Alex in the hospital started coming out, even AoA denizens and supporters wondered what had happened, for instance, on the Facebook post announcing Andrew Wakefield’s appeal. The response from Jeanna Reed:

He’s back in the hospital. The sad truth is that this will be what is left, the only path…unless we start to treat the MEDICAL conditions, provide an appropriate treatment plan and support the families while doing it. A VERY TALL ORDER but one that has to become the norm. Alex does NOT belong in a psychiatric facility. Sadly, this is the only option so many face when all of the above is not available. We did our very best to try and help them, and will continue to do what we can but it’s not enough. We know so many who (if given the opportunity) could heal. So complicated…at the minimum PRAY for them and again realize this could be any one of our children.

I don’t know about you, but if I had seen this at the time it was actually published instead of now, knowing the ultimate outcome, I would have still found the language ominous. In any case, not long after Wakefield’s appeal, Alex was released from the hospital. Andrew Wakefield provided a statement to the Daily Mail after Alex’s death explaining what happened and covering his posterior in the process:

On Sunday May 26, members of the Autism Media Channel (AMC) went to the Lutheran General Hospital in Park Ridge, Illinois. There we visited the late Alex Spourdalakis, his mother Dorothy, and his Godmother. Alex was in four-point restraint and apparently refusing to eat or drink.

His mother was beyond exhaustion and despair. The main reason for her despair was the prospect of Alex being sent to a long-stay psychiatric hospital and heavily medicated with behavior-altering drugs drugs [sic] without any treatment of his underlying medical problems.

AMC issued an appeal on Alex’s behalf to protect him from this fate. We did not, at any stage, advocate for his release from the Lutheran General Hospital.

The following day Dorothy informed us that the hospital could find nowhere that would take Alex and that his insurance carrier had refused to pay for any further inpatient care at the Lutheran General Hospital.

It appears that, as a consequence, he was discharged from that hospital despite his precarious position and that of his carers. It is our opinion that Alex’s tragic death reflects the abject failings of a medical system that has no effective answer to the autism crisis.

In the interests of complete openness, I should point out right now that I used to work part time as a trauma attending at Lutheran General Hospital from 1997 to 1999. It was how I made some extra money while I was a surgical oncology fellow at the University of Chicago. (Chicago is an expensive city to live in, and I didn’t make that much as a fellow.) LGH was a fine hospital then, and I have no reason to think that anything’s changed. Be that as it may, do I detect the stench of self-justification from Wakefield? He’s desperately trying to cover his posterior, but his fetid flatus of blame-deflection leaks out anyway. It’s what he does. Even so, if what Wakefield says is true, it does point out another aspect of this tragedy, namely support for parents with children with special needs.

That being said, what’s also utterly despicable is the reaction of the denizens of AoA and other antivaccinationists to the news of the murder of Alex Spourdalakis. For instance, it is not infrequent to see antivaccinationists blame—of course!—vaccines for Alex’s death, the apparent underlying “logic” being that if he hadn’t become autistic because of vaccine injury then none of this would ever have happened. Such “logic” prevails in the comments of AoA posts about Alex’s death, such as this one and this one. For instance:

Though I can’t support the choice these two women made, it isn’t hard to imagine the desperation and hopelessness they were engulfed in. To watch your precious child suffer for so many years and then endure what this past spring brought for them. They fought and fought the beast head on and felt the hatred against them. It isn’t hard to imagine that they were exhausted. All of this happening in America no less.

No, these two women were, as far as I can tell, offered help but refused it because it was standard conventional therapy. From what I can tell from various blog and Internet articles, they appear to have subjected Alex to biomedical quackery and were unhappy that if Alex were transferred to a psychiatric hospital’s long-term care ward he would no longer be able to receive “autism biomed” treatments. Time and investigation by the authorities will tell if that was the case. Whether that is what happened or not, I nonetheless reject the “logic” of such antivaccinationists such as it is, that only makes sense only if you accept the pseudoscience claiming that vaccines cause autism. While one can sympathize with a parent facing the task of caring for a severely autistic child who is very large, very strong, and very difficult to control, as Jo Ashline says, autism is not an excuse to kill your child, ever. As one blogger put it:

So one of the reasons I’m really pissed off is because of the usual [eye rolling] “Oh, he’s in heaven now”. My favorite is the thing that one of the groups that was intended to work towards getting Alex out of the hospital was a letter to Alex in heaven suggesting that he thank his mother for stabbing him in the chest. [Sarcastic eye rolling] “Thank you so much for brutalizing me, it’s my favorite”. Because now, you see, he’s in heaven, which I don’t think exists. And he doesn’t have autism.

Harsh? Yes. But it rings true. The entire narrative of the autism biomed movement is that autism “stole” the parents’ “real child” away from them. Since the idea that vaccines cause autism is basically holy writ for the autism biomed movement, that means vaccines “stole” the real child away by making him autistic. Parents who try to “recover” that “real” child are thus viewed as heroic, rather than abusive, because they’re willing to do whatever it takes to defeat the scourge of autism (and vaccines) in order to rescue the “real” child within. One can’t help but wonder whether what was really happening was that DFCS was going to put Alex into a conventional long term care facility because his mother clearly couldn’t handle him anymore and was treating him with autism biomed. Unfortunately, it appears from what we know right now that Alex’s mother seems to have thought that he would be better-off dead than not being given access to what she viewed as “curative” treatments for autism. Events and evidence from the investigation and trial might prove that initial assessment incorrect, but for now it seems to fit with what we know. Was Alex collateral damage in this never-ending war by antivaccinationists against autism? Although what we know now suggests that this might be the case, we just don’t know yet. We’ll have to keep an eye on the results of the investigation into Alex’s murder to find out.

In the meantime, watching the denizens of the antivaccine crank blog AoA hold candlelight vigils for Alex is very hard to take, as they rant about how the medical system failed Alex. Maybe it did (that remains to be seen), but what Lisa Goes and Andrew Wakefield did themselves certainly didn’t help Alex either.

I heard Seth Shostak mention in one of the “Big Picture Science” podcasts, that we are unconscious when we sleep.

I disagree. This is an altered state of consciousness.

Then.. you go further…

What about a COMA? Still not truly unconscious. People have memories after they wake up of people talking to them. They just don’t know where they come from.

What about NDE’s?

C’mon… if you were truly unconscious (regardless of scientific unmeasurability of brainwave activity) , you are still either having thoughts or remembering the thoughts before you wake up.

I contend that TRUE unconsciousness is ACTUAL death. (not clinical death – a decision made by instruments) The inability to think AT ALL in any capacity as if you had never been born.

Please discuss this? Am I wrong?

I do not believe in dualism. I trust that as I lay dying, I may have experiences that feel like fantastic dreams… but when I actually die… I am dead.

If I were unconscious while sleeping… How did my alarm clock wake me up? How did my snoring wife rouse me from non REM sleep?

Michael Goff (Aka, Evil Eye)

Thanks for the question. In short – this is wrong, or at least overly simplistic to the point of effectively being wrong. The primary problem is in dealing with consciousness as a binary state, and therefore any flicker of consciousness is not “unconscious.”

Consciousness is more of a continuum, and there are various states of consciousness. To answer what is unconscious, however, we need to first ask what does it mean to be conscious.

We don’t fully know, because we have yet to fully identify the neuroanatomical correlates to consciousness. Phenomenologically we define being conscious as being awake and aware of one’s surrounding and oneself. This is a high energy state, and requires a certain critical amount of brain function to maintain (we’re not exactly sure how much this is, but of note one hemisphere of the brain is capable of being conscious by itself, without the other half).

There are two general types of alterations in consciousness – diminished consciousness, and altered states of consciousness. These are not mutually exclusive, and often occur together.

Diminished consciousness results when brain function is impaired. The entire brain may be functionally impaired, or pieces of the brain may be damaged and prevented from contributing to consciousness. There is also the special case of brainstem function, which is necessary to maintain wakefullness. If the brainstem is sufficiently damaged, then even if the rest of the brain is completely intact, coma may result.

Impairments in consciousness occur on a spectrum from a little drowsy all the way to brain death. “Coma” describes a condition of significant impairment in consciousness, but does not define an absolute demarcation along the spectrum. People with impaired consciousness may have some retained consciousness, may be in a minimally conscious state, or may have no discernible consciousness (let’s call this latter condition “deep coma”).

In deep coma, people do not form memories, do not have any experiences, and do not display any evidence of consciousness – even far short of brain death. This state can be induced with medication, as is often done with general anesthesia. Anyone who has had full general anesthesia is aware of how complete the absence of consciousness can be – there often isn’t even the perception of the passage of any time.

Altered states of consciousness are a bit trickier to define. Generally these emerge when the manner in which the brain constructs our perceptions of reality and our conscious selves is altered. This can occur when a part of the brain that is vital to this construction is damage or suppressed, leading to out-of-body experiences, hallucinations, feeling separated from oneself or from reality.

The e-mailer brings up sleep – sleep actually represents various different stages of consciousness, which are all part of the normal functioning of the brain. There are four recognized stages of sleep, each with deeper suppression of brain function. Stage 1 is simple drowsiness, while stages 2-4 are progressively deeper. In stage 4 sleep it can be very difficult to arouse someone.

In these stages of sleep the brain is still able to respond to external stimuli, but I don’t think it is valid to argue that the brain is therefore conscious. That argument assumes that all brain function contributes to consciousness, but we know that it doesn’t. Many brain processes are subconscious. The brain can process and even respond to stimuli without conscious awareness.

Dreaming, or REM sleep, is another stage of sleep that is perhaps better understood as altered, rather than diminished, consciousness. The brain is very active in REM sleep, and we experience dreaming in which we can feel fully conscious. However, not all brain regions are contributing to dreaming consciousness the way they are in wakeful consciousness. Reality testing, for example, is not very active while dreaming, which is why our dreaming self can accept fantastical events that would not be accepted by our waking self.

Consciousness is a very interesting phenomenon and is still an area of active research and debate. We know that it results from brain function, that it takes a lot of brain function to maintain consciousness, and that the brain also does a large amount of subconscious processing. There are various forms of diminished or altered consciousness, both normal and pathological.

Although consciousness is a continuum, there are many states short of death that can be meaningfully described as “unconscious.”

The conceptual framework I use, and that used by others in medicine, does not concern itself with the application of the Supplements, Complementary and Alternative Medicines that occupy the attention of this blog. In acute care medicine SCAMs are of virtually no importance yet the approaches we need to take with patients and medicine are, with slight changes in emphasis, as applicable to SCAMs as real medicine. You need to remember, however, that the topic is not necessarily based in known reality.

Two viewpoints in JAMA caught my attention this month, both more thoughtful and reasoned than I am probably capable of. While focused on the application of reality-based medical practice, they apply to the topics of SBM as well.

The first is Evidence-based persuasion: an ethical imperative.

Evidence-based persuasion.  At some level the raison d’être of this blog and the antithesis of the SCAM world. That it is considered an ethical imperative makes its lack of use in the SCAM world all the more damning.

The article points out in the introduction that:

There are at least 3 different types of persuasion. The first is the removal of bias. The second is recommending a particular course of action and providing evidence and reasons in favor of it; and the third is the potential creation of new bias, which could cross the line into unethical manipulation.

They go on to give examples applied to the practice of medicine. How about science-based medicine?

The first kind of persuasion, the removal bias, is the primary theme of this blog. Readers and writers of this blog are aware of all the types of bias that can warp judgment. I have long said that the three most dangerous words in medicine are “in my experience” because experience is unreliable in helping decide what works.  Experience in medicine is the worst bias.

Ignoring experience is an unnatural way for humans to behave. Everything we do is a result of experience. The best restaurant in town*? The fastest way to work? Best headphones? In every aspect of life we rely on our experience and that of our social network to decide what to do. And then we get to medicine, the attempt to heal illness and relieve suffering, and we are asked to lay aside a lifetime’s approach to the world and rely on clinical trials? Not likely.

I had a patient just a few weeks ago ask me if she could take colloidal silver for her infection and I told her it does nothing. She countered that I was wrong, that she had used it many times in the past and it had always cured what ailed her. I knew I had not a chance in hell if convincing her otherwise for as Groucho said, who are you going be believe, me or your lying eyes?

Perhaps people are able to alter their biases when presented with the evidence, but I am not sure everyone is capable. When someone suggests that the reason I recommend vaccines, or any other reality-based therapy, is because I am a paid shill of big Pharma, I know that we inhabit two radically different realities that do not overlap. Such sentiments are not uncommon:

…one in seven Americans think the pharmaceutical industry is colluding to “invent” new diseases in order to profit off them…

Weird. Sure Big Pharma, like all companies, can behave with all the ethics of a psychotic shark, but the conspiratorial nature of some biases is just nuts.

In medicine when we discuss diagnostic and therapeutic interventions we sometimes have to dissuade people of erroneous ideas that could prevent them from accepting care. It is rare in my world. Most people, when acutely infected, accept the interventions I have to offer since the alternatives are rather unpleasant. The only common interaction is the occasional new AIDS patient who refuses HAART because they are convinced the medications are toxic and kill people. After explaining the history of HIV treatment I usually convince them to give it a try. As a result I have many patients who would have died in months in the bad old days who are now alive a decade later. Very satisfying.

But what if your whole practice is based on bias, on unreality, and you cannot realize it? The only bias you can alter is to convince your patients that real medicine is fantasy and that fantasy is reality. Welcome to Natural News, the bizarro world of medicine.

How about the second? “Recommending a particular course of action and providing evidence and reasons in favor of it.”  Hard for a SCAM provider.

In my practice, hospital-based acute infectious diseases, it is reasonably simple. I know most of the pertinent literature for the common infections and if I have some weird bug in an odd place I research the problem and tell the patient the whys and wherefores of the proposed treatment. I know the science, I know literature (not always the same thing) and I know the best options.

What about a homeopath or acupuncturist or reiki practitioner? Can an Integrative Medicine Department ethically offer using these therapies after comparing them to the known world?

It is an interesting psychology: based on nonsense that is a polar opposite to the understanding of reality, the only favorable evidence that can be offered is “in my experience.’ It is a curiosity that real medicine uses what can be the least convincing arguments, those from the literature, while the homeopath has to rely of the least valid but most powerful argument, experience.

My patients often want to know what kind of experience I have. Has this worked before, how many of similar cases have I managed, and what would I suggest if it were my mother? I am always slightly unnerved with the question because I know how faulty my memory is, especially after almost 30 years of medicine. That’s maybe 25,000 cases. Like I can remember? But that is all the average SCAM provider has to offer.

The last form of persuasion, that of creating new biases, is the most interesting. It is an interesting balance. Patient autonomy is paramount in US medicine. They are the captain of their ship and it is my job to give them my best opinion as to their diagnosis and treatment. On the other hand, the process of explanation will persuade them and we all know the context of how information is given can create bias.

However all SCAM is about creating new biases that are divorced from reality.

It would interesting to get an ethics consult and ask the question of a hospital’s integrative medicine department if they can live up to the recommendations of ethical persuasion:

1) Remove bias and access the patient’s autonomous wishes
2) Provide honest, impartial, evidence-based information about prospective harms and benefits
3) Provide a rational interpretation of this information including facts about the belief set and views regarding the best decision
4) Use reason rather than emotion while sometimes appealing to the patient’s emotions to counterbalance their existing emotional responses
5) Avoid creating new biases
6) Be sensitive to the patient’s changing preferences because persuasion is likely to change the patient’s outlook and perspectives.

The heart of all SCAM is in violation of the first 5. Given they are not based on known reality, they cannot follow those recommendations and it should be unethical to offered in a real medical environments.

However, SCAMs make money, and where money is concerned, rationalizations will follow.

The other viewpoint that caught my eye in JAMA was Synthesizing evidence: shifting the focus from individual studies to the body of evidence.

The first sentence is intriguing:

The research enterprise behaves as if a single study could provide the ultimate answer to a clinical question.

The rest of the essay is an argument that more emphasis should be placed on the results of meta-analyses and not rely on single studies.

I do and do not agree with the authors, but there are always caveats.

One of the issues that has always annoyed me with meta-analyses is that often as new studies are done they are incorporated into the prior analysis but the older, often more poorly done studies are not thrown out, so the bad studies tend to pull down the good ones.

The Cochran Collaboration has a nice overview of the systamatic review process but they are done under the implicit assumption that what they are reviewing are studies that evaluate reality. The Cochrane Reviews usually fail when they apply their methods to topics such as homeopathy or acupuncture, where positive results are always due to bias.

Even though they assess the quality of the studies, they do not take into consideration the prior plausibility that renders most SCAM studies suspect.

There is an arc in the literature concerning most SCAMs. Better and better quality studies demonstrate less and less efficacy until well designed studies demonstrate no effect.

The potential for that arc, as best as I can tell, is not part of the systematic review, but would give a hint as to the validity of studies where the intervention is divorced from reality. A plot of study quality vrs efficacy over time.

Part of my job is that of data synthesizer. What is the best way to treat, say, MRSA pneumonia? It can depend on many factors, some of which are not clear cut or have no data at all. Is the flu vaccine of benefit? The answer depends on what is considered a benefit and in what population; a single meta-analysis that looks at PCR-proven influenza will not include the effects on pregnancy, heart attack and stroke or the lack of spread to populations not vaccinated.

Whether or not a single study is superior or inferior to the collected wisdom of a systematic review depends on the question being asked and the plausibility of the intervention being studied.

I am not so certain that systematic reviews on fiction are a reliable way to understand the therapeutic efficacy of that fiction, but outside that caveat I agree with the authors conclusions: “It is time to focus on the entire body of evidence.”

And the body of evidence concerning most SCAM, as this blog demonstrates repeatedly, is there is no there there.

*Castagna.

Even in the human brain there remain reward circuits that respond to thoughts and sensations by creating a good feeling, and others that respond with an emotionally negative experience. Despite our incredible neurological sophistication, humans are still powerfully motivated by this simple binary system. We seek out pleasant experiences and avoid negative ones. Psychologists have identified a number of cognitive biases, such as cognitive dissonance, that essentially follow this paradigm.

Building a nervous system around reward/aversion circuits is apparently evolutionarily successful, but comes with a significant vulnerability – what if the system can be “hacked”? What if a creature hits upon a behavior that is not advantageous to its survival or propagation, but stimulates the reward circuits? A little bit of this is probably inevitable – incidental behaviors around the edges of those that are truly adaptive. But what if such behaviors take over one’s existence?

That is essentially what addiction is. Addiction can be behavioral, such as gambling or a particular fetish. They can also bypass thoughts and behavior by directly stimulating reward circuits pharmacologically – drug addiction.

I don’t think we are evolutionarily prepared for drug addiction. Animals may encounter edible items in their environment that contain addictive substances, but are unlikely to have access to sufficient amounts that it can be a constant long term behavior. Humans, on the other hand, have figured out how to manufacture large quantities of purified drugs, tweaked to produce a maximal direct stimulation of our reward circuits.

It’s even worse than that, however. A recent study looked at cocaine addiction in a rat model. They found that not only does cocaine use activate reward circuits, driving drug-seeking behavior in the rats, after the rats become addicted the circuits involving negative emotions (involving the central amygdala) become active. Use of cocaine is then necessary to suppress the negative feelings of this circuit.

This study mirrors observations in humans. For many addictive drugs, use creates euphoria and intensely positive experiences. Users are then motivated to seek out this positive experience. Once addicted, however, withdrawal from the substance creates a powerful dysphoria, and users seek out drug use in order to reduce this extremely negative experience. This leads to not just addiction but dependence.

The question is – what are the ethical implications of this research (and yes, this does overlap with the whole free will debate). Can anyone really be blamed because their brains are vulnerable to addiction and dependence? More to the point – neuroscientific research into addiction seems like a powerful argument against legalizing recreational drugs.

At least, it seems to refute the argument that people should be free to choose for themselves if they want to use recreational drugs, because by the very nature of those drugs and brain function, they take away that freedom. Are people who are addicted to a drug really free to choose if they want to keep using that drug? Is it unfair to legalize a pharmacological trap waiting to ensnare the naive, uninformed, or unfortunate?

I know there are potentially practical arguments to be made for legalization, but that is a debate I am not addressing here. I simply don’t buy arguments for drug legalization premised on liberty and freedom, when those drugs by their very nature take away liberty and freedom.

It also seems inevitable that new ways to hack this reward/aversion system are coming. It has already been 50 years since the famous James Olds rat experiment in which an implanted wire stimulating the “pleasure center” of the brain caused the rat to seek out that stimulation to the exclusion of all else, even to the point of starvation.

Direct electrical stimulation may prove more powerful than pharmacological stimulation – and more addictive.

There are more subtle problems coming also. Video game addiction may be a harbinger of more extreme problems to come. What will happen when we can live our lives in a fully immersive virtual reality – when we can create our own reality to maximally cater to our reward centers? Will this be the ultimate trap of our neurobiology?

The deeper conflict here is between living in harsh reality, and making the best of it, vs bypassing the adaptive nature of the reward/aversion circuits in our brain in order to escape to a pharmacologically/electrically/virtually induced fantasy euphoria.