We are heading into cold and flu season, so Time magazine decided to helpfully tell us what the science says about echinacea and the common cold. Unfortunately, they completely bungled their report, getting the bottom line wrong. Exactly where they go wrong, however, is extremely common and instructive.

The terrible article is partly not the fault of the author. They spoke to experts and tried to do a balanced piece. Unfortunately, there are experts out there who are biased and just wrong. The author was not able to make sense of the evidence themselves, and so they helplessly just passed along whatever nonsense they were told. This is another manifestation of the infiltration of “alternative” medicine into our system – there are always going to be “experts” out there who are just alternative cranks, but they will get quoted along side more serious scientists.

For example, they write:

Other experts say there is evidence that echinacea can be helpful. “Echinacea is popular because it does work for at least some people,” says Kelly Kindscher, a professor of environmental studies at the University of Kansas who has written a textbook on echinacea. While some clinical trials have not shown echinacea to be effective, Kindscher says others have found benefits.

I understand listening to someone who wrote a textbook on the topic, but this conclusion flies in the face of published reviews. The next statement shows where they go wrong:

A 2010 study published in the Annals of Internal Medicine compared echinacea to a placebo and to no treatment at all. It found evidence that echinacea outperformed both when it came to reducing the duration of the common cold — but these benefits were too small to be considered statistically significant.

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A new report looking at vaccine confidence in the EU shows some troubling trends. Belief in the safety and effectiveness of vaccines seems to be very regional. We see this in the US as well as Europe. In this survey they found:

The results of the survey suggest that a number of member states – including France, Greece, Italy, and Slovenia – have become more confident in the safety of vaccines since 2015; while Czech Republic, Finland, Poland, and Sweden have become less confident over the same period.

In some countries anti-vaxxers have a stronger foothold, and are actually decreasing acceptance of vaccines. But there are two other trends that are more disturbing. First, in the countries with decreasing vaccine acceptance there is high levels of vaccine skepticism among general practitioners.

While GPs generally hold higher levels of vaccine confidence than the public, the survey found that 36% of GPs surveyed in Czech Republic and 25% in Slovakia do not agree that the MMR vaccine is safe and 29% and 19% (respectively) do not believe it is important.

Those are shockingly high numbers for physicians. This is one of my greatest fears about the advance of alternative medicine and anti-scientific medical views – that they will affect the medical profession itself. Once unscientific ideas creep into the culture of medicine, the game is all but lost. This is why teaching pseudoscience in medical school is such an alarming problem. In this survey, the countries with higher levels of GP vaccine skepticism, had higher levels of public skepticism and lower levels of vaccine compliance.

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I am what is known as a mild protan. That means that the cones of my retina that perceive red and green wavelengths are not as separated in their frequency response as they should be. This overlap causes some shades of red and green to look similar. As far as I am aware, the only deficit this has caused in my life is the inability to see some of those numbers in the circles of colored dots used to test color vision. Although some color combinations, such as the orange and green of the Miami Dolphins jerseys, are uncomfortable to look at.

But other people have more severe forms of color blindness that can actually affect their lives, such as the ability to distinguish red and green traffic lights.

I was therefore intrigued on a personal as well as scientific level when I first heard the claims for glasses that can compensate for some forms of color blindness. To me the claims sounded only semiplausible. The problem with partial color-blindness is in the cones – the retinal cells that perceive color – so how could you correct this by simply filtering the frequency of light? But I left open the possibility that by specifically altering some colors you could enhance their separation, making them easier to distinguish.

I never had the opportunity to test the glasses (they are expensive) but fortunately there is now an independent study of their effectiveness. Specifically researchers at the University of Granada tested the EnChroma® glasses.  As the researchers note, the company that makes the EnChroma glasses has been watering down their claims in the typical way that supplement manufacturers often do, which for me is a huge red flag. They now state on their website:

“EnChroma glasses are an optical assistive device for enhancement of color discrimination in persons with color blindness; they are not a cure for color blindness. Results vary depending on the type and extent of color vision deficiency per individual.”

Sounds an awful lot like the “structure function” claims of supplements, which cannot claim to treat or cure any disease. I could not find more specific claims made by the manufacturer on their website. They also say things like:

“EnChroma color blindness glasses can have a profound impact on how people see their world.”

Yeah – so do sunglasses. This is a clever implied claim here, without actually making a specific claim. They also present reviews on their site, quoting other people who make more profound claims. This is the common “testimonials” approach – let other people make the claims so you don’t have to.

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I see this all the time. In fact, this kind of thing is now the rule rather than the exception. Someone wants to stay healthy, or get more healthy, and generally take responsibility for their health, so they engage in a list of healthful lifestyles. Unfortunately, some or most of the stuff they are doing is either worthless or even counterproductive. It seems the more motivated they are to engage in healthy lifestyles, the more they fall victim to pseudoscience and nonsense.

Welcome to the “Wellness” industry, which is really an industry of lies, nonsense, pseudoscience, and exploitation. If you are lucky, you will come away from your encounter with the Orwellian-named wellness industry with the only harm being financial. If you are unlucky, your health will be harmed as well.

Jim McCants is now the latest poster child for being a victim of snake oil. At 50 he decided to get more healthy, so that he would avoid his father’s fate, who died at 59 of a heart attack. As part of his regimen, he started taking green tea extract. Why? Because it was marketed with all the usual claims built up by the snake oil industry – it’s “natural”, it has anti-oxidants, it helps detox – all utter nonsense.

But it’s a good story, and Jim bought it. Why not – the vast majority of the public buys it, because it has been endlessly marketed to them. Gurus like Dr. Oz support this pseudoscience with apparent authority. Doctors, scientists, and academics pay far too little attention to it, and so the claims largely go unchallenged. The regulatory bodies have also been rendered largely powerless against these cons, partly by design. The supplement industry, through their generously compensated representatives like Orin Hatch, have gutted the FDA’s ability to protect the public from snake oil.

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In China, don’t criticize traditional Chinese medicine, that is, if you want to stay out of jail.

Tan Qindong, an anaesthesiologist in Guangzhou, did what I and a lot of my SBM colleagues do – he wrote an article explaining to the public that a popular snake oil cure-all was – snake oil. For his troubles, he was jailed for almost 100 days, and forced to apologize. He had to admit that he was “not thinking clearly” when he defended science and the health of his patients against pseudoscience.

The company, Hongmao, not only filed the legal complaint but sued him in civil court. They then dropped their suit after Tan Qindong apologized.

Tan was jailed on an apparently seldom used law against damaging a company’s reputation. That would make consumer protection a little difficult in China. The government, however, is increasing its crackdown on any criticism, or expression of civil rights.

For example, Zhou Shifeng, director of Beijing’s Fengrui law firm, was jailed for 7 years for his part in exposing the baby formula scandal. Two people were executed as scapegoats for the practice of adding melamine to baby formula to fool tests assessing the amount of protein in the formula. But the Chinese government doesn’t like activists, and is doing a thorough job of squelching any criticism, no matter how legitimate.

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Apple recently announced two new health features of their Apple Watch – fall detection and heart monitoring. These are being sold as useful health measures, but there are concerns that this new technology may be more gimmicky than useful, and might actually be counterproductive.

The first feature detects possibly dangerous falls. If the motion detector senses that the wearer has fallen to the ground, and then they don’t move for one minute, the watch will automatically call 911. This superficially sounds reasonable, but the concern is that the tech company has not adequately tested this feature in coordination with medical professionals.

Specifically – what is the sensitivity and specificity of this algorithm? How often will it detect an event that reasonably requires a call to 911, and how many false positives will it generate? How much will this overwhelm emergency services?

What is naive about this feature is the lack of appreciation for the fact that medical interventions need to be evaluated. Why, for example, one minute? That is a round number, but is that really the threshold where the true-positive to false-positive ratio is optimal, while avoiding dangerous delays if someone is really injured?

Also, what will be the net effect of this? Will the drain on resources actually cause more harm than benefit to the users? How will 911 call centers handle these calls? Will they be able to interpret them?

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A new detailed study of the effects of probiotics on the gastrointestinal microbiome shows how complex this subject is. Unfortunately, the reporting is significantly oversimplifying the results. The BBC reports:

A group of scientists in Israel claim foods that are packed with good bacteria – called probiotics – are almost useless.

That’s not actually what they said, at least according to my read.

Probiotics are pills or foods that contain live friendly bacteria, which are meant to support the beneficial bacteria that live in our guts. This basic idea is not pseudoscience. It is quite reasonable – however, the science of probiotics is very immature. We are still in a phase where we are discovering more and more complexity, and struggling to find any clear therapeutic gains. Meanwhile, the marketplace is making claims that go way beyond the science, and is based on very simplistic notions of how the microbiome works.

In the last decade or so we have demonstrated that the microbiome is an ecosystem at homeostasis. People have about 100 bacterial species in their gut microbiome, which not only colonize their mucous membranes, they keep out other bacterial species. This is an important part of our immune defense – the microbiome prevents infection by harmful bacteria. Further, you can’t just throw one or a few species into an ecosystem and expect to change it.

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France is the world’s biggest consumer of homeopathic potions. According to a study by Edzard Ernst:

The results show that a total of 6,705,420 patients received at least one reimbursement for a homeopathic preparation during the 12-month period. This number equates to 10.2% of the French population, with a predominance in females (68%) and a peak frequency observed in children aged 0-4 years (18%).

This is unfortunate, because homeopathy is pure pseudoscience, costing French taxpayers €279 million in one year. But there is some good news – homeopathy has been in retreat around the world, at least in terms of official recognition and reimbursement. Homeopathy hospitals are closing in the UK, the FDA has decided to finally start regulating at least the worst homeopathic offenders, and now a French university, Lille, has decided to suspend its homeopathy degree for the 2018-19 academic year.

Further (and here is the big lesson here, in my opinion) this is mostly in response to scientists taking the time to review homeopathy and declare that it is not based in science and does not work.

So what happened in France, where homeopathy is very popular? Well, in March 2018, 124 French doctors signed a statement taking a strong stand not only against homeopathy, but all kinds of pseudoscience in medicine. The entire statement is worth a read, but here are some highlights:

The obligation of honesty is enshrined in the Codes of ethics of the medical professions and the Code of public health (article 39 of the Code of ethics and article R.4127-39 of the Code of public health). The codes forbid charlatanism and deception, impose to prescribe and distribute only proven treatments. The codes also proscribe the use of secret remedies or not clearly mentioning the substances they contain. The Council of the Order of Physicians is responsible for ensuring that its members do not use their title to promote practices whose science has never proven useful or even dangerous. The Council must ensure that doctors do not become trade representatives of unscrupulous industries.

Homeopathy, like other practices called “alternative medicine”, is in no way scientific. These practices are based on beliefs that promise a miraculous and safe recovery.

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“It’s dressed-up quackery isn’t it?” magistrate Daniel Reiss said.

“That’s one view, your honour,” the prosecutor replied.

That is a good summary of pretty much all alternative medicine. Practitioners have gotten very good at dressing it up, enough to even fool academics who aren’t paying close attention. But in the end, it’s all quackery.

The quote above refers to a recent case of a Sydney Chinese herbalist, Yun Sen Luo, who was arrested and charged with manslaughter in the death of 56 year old client he was treating. He advised the diabetic woman to go off her diabetes medication, ultimately resulting in her death. The charge is gross negligence.

The success of alternative medicine over the last few decades has been in convincing the world that what they offer is a genuine alternative to real medicine. They have rebranded it as complementary, and the integrative, but it’s all the same – using unproven, fanciful, or even disproven treatments instead of real medicine. They justify the substitution by appealing to nature, distracting with hand-waving pseudoscientific jargon, appealing to antiquity, or straight-up lying. In the extreme they weave complex conspiracy theories about the medical establishment to scare people away from real medicine.

This case is just one example, but it’s not atypical. The core problem is that we have a practitioner who is practicing medicine without a license, and without the requisite medical knowledge, training, and experience. The con is that if you simply call what you do “alternative” you can get away with it (until you kill someone – and even then, sometimes).

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One of the persistent themes of this blog is that expertise matters. This is not to say the experts are always right (sometimes they disagree with each-other), and there is also a range of expertise, and different kinds of experts can have different biases and blind spots. But all things considered, someone who has formal expertise on a specific topic is likely to know much more about that topic than someone who has read about it on the internet.

Further, most people underestimate the amount of knowledge that exists on a topic, and therefore the vast gulf of knowledge that exists between them and the experts. In fact, the more someone knows about a topic the more they understand how much is known, and the more humble they tend to be with respect to their own knowledge. The flip side of this – people who know little tend to overestimate their relative knowledge – is an established psychological phenomenon known as the Dunning-Kruger effect.

Operationally Dunning and Kruger found in their study that the lower someone performed on a test of knowledge, the greater the gap between their perceived knowledge and performance and their actual performance. At around the 80th percentile and above, people tend to underestimate their relative knowledge. Below that point they tend to increasingly overestimate it, and everyone thinks they are above 50%.

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