A Candle in the Dark

Recently, I got a mail in the official students mailing list of IIT Madras (which is moderated, btw) sent by a particular student, and which I’ve reproduced below.

to students@smail.iitm.ac.in
date Thu, Aug 13, 2009 at 11:13 AM
subject [Btech] [Students] tulsi a cure for swine flu
mailing list btech.smail.iitm.ac.in
mailed-by smail.iitm.ac.in

Ayurveda, the traditional ’science of life’, has a remedy for diseases when
every other stream of medicine fails. Now, at a time when swine flu is
spreading like wildfire across the world, Ayurveda has the remedy in the form
of the miraculous herb, the basil leaves commonly known as Tulsi.

Tulsi, the purest and most sublime plant, has been known and worshipped in
India for more than five millennia for its remarkable healing properties.
Considered as an ‘Elixir of Life’, this wonder herb has now been claimed to
keep the deadly swine flu at bay and help fast recovery in afflicted persons.
“The anti-flu property of Tulsi has been discovered by medical experts across
the world quite recently. Tulsi improves the body’s overall defence mechanism
including its ability to fight viral diseases. It was successfully used in
combating Japanese Encephalitis and the same theory applies to swine flu,” Dr
U K Tiwari, a herbal medicine practitioner says.

Apart from acting as a preventive medicine in case of swine flu, Tulsi can
help the patient recover faster.
“Even when a person has already contracted swine flu, Tulsi can help in
speeding up the recovery process and also help in strengthening the immune
system of the body,” he claims.

Dr Bhupesh Patel, a lecturer at Gujarat Ayurved University, Jamnagar is also
of the view that Tulsi can play an important role in controlling swine flu.
“Tulsi can control swine flu and it should be taken in fresh form. Juice or
paste of at least 20-25 medium sized leaves should be consumed twice a day on
an empty stomach.” This increases the resistance of the body and, thereby,
reduces the chances of inviting swine flu,” believes Patel.

As its name suggests, Tulsi has again proved to be the ‘the incomparable’
medicine – this time, in the prevention and cure of swine flu.
The symptoms of the H1N1 flu virus in people are similar to the symptoms of
seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body
aches, headache, chills and fatigue. A significant number of people who have
been infected with novel H1N1 flu virus also have reported diarrhea and
vomiting. The high risk groups for novel H1N1 flu are not known at this time,
but it’s possible that they may be the same as for seasonal influenza.
However, Please consult a practitioner in case of any such symptoms. Doctors
have strictly advised against self medication.
Source : Yahoo

This is complete bullshit, on so many levels. Spreading such misinformation to a student community is potentially catastrophic.

There is ABSOLUTELY ZERO EVIDENCE that Tulsi is a “remedy”; or can “control”, “prevent” or “cure” swine flu. There hasn’t been any scientific tests which attempts to test the efficacy of Tulsi in controlling or preventing or curing swine flu.

You’d expect that a ‘premier’ (hah!) scientific institution like IIT-M would realize the important of providing accurate and scientific information in light of the swine flu cases reported in Chennai. Instead, they circulate this silly pseudo-scientific drivel? What were the moderators drinking?

Finally, using Yahoo as a source for credibility? Please…

This is an example of the harm that can happen when alternative ‘medicine’ is tolerated as an acceptable treatment by society. In fact, I think that the whole label of ‘alternative medicine’ is silly. There’s medicine which is shown to work in controlled studies, and there’s garbage like homeopathy.

P.S Have I already told you that India has a national department which ’studies’ homeopathy?

This article was published in the Times Of India.

Homeopathy key to ovarian cysts?
…
Nisha didn’t want to take contraceptive pills. Instead, she took a three-month course of homeopathic pills and pain-relieving tablets. After three months, another scan showed the cyst had disappeared.
…

The key question is, if she had NOT taken the homeopathic pills, would the cyst have disappeared? The answer is probably yes. Indeed, as a two-line quote in the TOI article hastily mentions,

On ovarian cysts, Dr Neerja Batla, additional professor, AIIMS, says cysts less than 50 mm usually regress on their own. “I’m not sure how far homeopathy helps.”

To attempt to give some scientific credibility to this pathetic article, we get

Homeopathy’s efficacy in ovarian cysts was corroborated, says Dr C Nayak, director, Central Council for Research in Homeopathy, Ministry of Health & Family Welfare, by an article in the British Homeopathic Journal. The article, ‘Homeopathic treatment of ovarian cysts’, cited a study of 40 women with ovarian cysts. “After nine months of homeopathic treatment, the cysts disappeared in 90% cases,” the article said.

The article which Dr Nayak mentions, published in 1991,  can be found here. I don’t have access yet to the complete article, but the abstract states:

Forty women suffering from ovarian cysts, diagnosed and measured by ultrasound, were treated with a single homœopathic medicine according to their specific mental, general and local symptoms. The hormonal disorders suffered by these patients lead to several symptoms, some specifically gynaecological, others general or mental, demonstrating how the health deterioration process effects the general state of the sick person. The ultrasound examination was repeated after about nine months. Results were positive.

1. First, In my opinion, the “British Homoeopathic journal” hardly seems like a neutral or unbiased journal
2. Then, what exactly are the “general” and “mental” symptoms? (See Parts II and III in the essential reading below, which points out how loosely this term is used )
3. Importantly, how was the study conducted? Did they blind the test against placebo effects? Did they have a control group to make sure that the cysts did not regress on its own?
4. Also, are these results reproducible and replicated in other studies to ensure that it wasn’t the result of some freak error in conducting the test? Indeed, how credible are these “results”?

I’ve not yet read the study (this will be fixed soon), but I’m pretty confident that the answer to most of these questions will be ‘no’.

External Links and Essential Reading

For more regarding Homeopathy and the current (lack of) evidence, there are a series of brilliant posts by the wonderful people at Science Based Medicine, who point out why “Homeopathic ‘Remedies’ are Placebos“.

• Homeopathy and Evidence-Based Medicine: Back to the Future – Part I
• Homeopathy and Evidence-Based Medicine: Back to the Future – Part II
• Homeopathy and Evidence-Based Medicine: Back to the Future – Part III
• Homeopathy and Evidence-Based Medicine: Back to the Future – Part IV
• Homeopathy and Evidence-Based Medicine: Back to the Future – Part V

For the hardcore and mathematically inclined readers, the series is actually continued where the authors go on to explain why the results of clinical trials can be misconstrued as evidence despite the scientific implausibility of the original claim.

• Prior Probability: The Dirty Little Secret of “Evidence-Based Alternative Medicine”
• Prior Probability: the Dirty Little Secret of “Evidence-Based Alternative Medicine”—Continued Again

A week ago, it was reported by the media that a study conducted by a group of US scientists from the Boston Medical Center and published in the peer-reviewed Journal of the American Medical Association, reported that 20% of ayurvedic and herbal “medicines” sold over the internet contained dangerous amounts of toxic heavy metals ^{1 2}.

Now, this isn’t the first time that such a concern has been raised. In 2004, the same group had published a study which concluded that³

One of 5 Ayurvedic HMPs produced in South Asia and available in Boston South Asian grocery stores contains potentially harmful levels of lead, mercury, and/or arsenic. Users of Ayurvedic medicine may be at risk for heavy metal toxicity, and testing of Ayurvedic HMPs for toxic heavy metals should be mandatory.

The new study further looked at the prevalence of toxic heavy metals in ayurvedic and herbal “medicine” depending on the country of manufacture of the drug. The study found that⁴,

One hundred ninety-three of the 230 requested medicines were received and analyzed. The prevalence of metal-containing products was 20.7% (95% confidence interval [CI], 15.2%-27.1%). The prevalence of metals in US-manufactured products was 21.7% (95% CI, 14.6%-30.4%) compared with 19.5% (95% CI, 11.3%-30.1%) in Indian products (P = .86)

That is, the study found that there’s very little difference between the amount of heavy metals found in herbal “medicine” whether it was manufactured in the US or India.

You might be aware that India has a government sponsored national department of pseudoscience, known as AYUSH. In fact, the home page on their website proudly displays,

a) The Law of Similars – It is also called the Law of Cure. This law demonstrates that the selected remedy is able to produce a range of symptoms in a healthy person similar to that observed in the patient, thus leading to the principle of Similia Similibus Curentur i.e. let likes be treated by likes. To give a simple example the effects of peeling an onion are very similar to the symptoms of acute cold.

…

Psora, Syphilis and Sycosis are the three fundamental causes of all chronic diseases that afflict the human race as discovered by Dr. Hahnemann and called them miasms

Er… what year are we living in again? Is the national department of pseudoscience even vaguely familiar with the concept of viruses, bacteria or indeed, modern biology? The page then goes on to blatantly display rubbish as fact. Vital force? Miasm? It’s appalling how they attempt to display such nonsense with such seriousness.

Anyway, the aforementioned AYUSH has responded to the recent published study on heavy metals in herbal “medicines”. Their entire statement can be found here.

The press release by AYUSH makes several claims to serve as evidence that the study by the Boston Medical group was flawed. Let’s look at some of them which I found interesting.

CLAIM 1:

A project for Physico chemical characterization and toxicity studies of 8 widely used Bhasmas (Rasa Aushadhies) was also sanctioned under the Golden Triangle Project which is being carried out by various laboratories of CSIR i.e. Indian Institute of Toxicological Research (IITR), Lucknow, Indian Institute of Chemical Technology (IICT), Hyderabad. Under this project, one of the reputed manufacturers of Rasa Aushadhies was chosen for manufacturing of the selected Rasa Aushadhies as per the classical texts which were made available to CSIR laboratories for physio chemical characterization and their toxicity studies. On the basis of 28 days toxicity studies, all the 8 Rasa Aushadhies have been found to be non-toxic.

CLAIM 2:

Samples of 600 Indian medicinal plants collected from the wild as well as various medicinal plant gardens in India by the Council for Scientific Research in Ayurveda and Siddha were sent to the Indian Institute of Toxicological Research (CSIR), Lucknow, Sri Ram Institute of Industrial Toxicology, New Delhi and Centre for Research in Indian Medicine, Shastra University, Thanjavur. The test reports received from these three laboratories disclose that Lead, Mercury and Arsenic have not been found in these 600 Indian medicinal plants samples above the permissible limits laid down by WHO which is 10ppm for Lead, 1ppm for Mercury and 3ppm for Arsenic. This study clearly indicates that Indian medicinal plants collected from the wild or cultivated have been found to be free from lead, mercury and arsenic contamination contrary to the claim made by Dr. Robert Saper et al in their second article “Lead, Mercury and Arsenic in US- and Indian- Manufactured Ayurvedic Medicines sold via the Internet” published in JAMA, August 27, 2008.

CLAIM 3:

Further, some of the medicines mentioned in Table 3 of the article, namely Akangvir Ras, Agnitundi Bati, Arogyavardhini Bati are herbo metallic compounds which contain these metals as therapeutic agents after purification process. Dr. Saper has visited India and has been in touch with several Ayurveda experts and is fully aware that these herbo-metallic preparations used in Ayurvedic system of medicine contain heavy metals like lead, mercury and arsenic as therapeutic agents after proper de-toxification process and no significant adverse drug reactions have been reported regarding their use in India.

(emphasis mine)

(i) CLAIM 1: AYUSH do not mention if the results of the toxicity studies of the eight (compare this with the peer-reviewed study) herbal “medicines” have been published in a peer-reviewed scientific journal, but they go on to claim that most of the studies are “in progress” and the results will be obtained soon. If so, how do they claim to know that the results are going to prove that the herbal “medicine” will be free of toxic metals? Statements such as the one below makes one wonder if there’s a bias introduced, because they claim to know the results of the tests before they actually get them!

CSIR would be getting the results of this scientific research published to set at rest doubts regarding the safety of Rasa Aushadhies prepared properly as per classical texts.

Also, it’s important to note that we don’t know the methodology of the study and therefore can’t evaluate how credible this study is as there could be many flaws. For instance, while they claim that the 28 day toxic test showed that the herbal “medicine” was nontoxic, they do not mention the actual amounts detected. Compare this with the peer-reviewed studies.

Additionally, there’s a lot we don’t know about the methodology of the study. For example, did they ask the “reputed manufacturers” of Rasa Aushadhies to specially prepare the samples for a test? Could they have been that stupid? Or, did they randomly take samples from the market, which is more representative of the actual product that the consumer buys? You see, details like this are important before one can judge how credible a claim is. Besides, even if this claim was right, it doesn’t invalidate the study published in JAMA. It merely shows the importance for additional tests!

(ii) CLAIM 2: This is a classic straw-man argument. It has absolutely no relation to what Dr Saper’s group are claiming. Just because you tested 600 wild plants for heavy metal content DOES NOT automatically mean that the final herbal “medicine” and plants sold to the customer are free from the toxic heavy metals. What you have to do, is to test the actual ayurvedic “medicine” which is sold! This is precisely what Dr Saper’s group have done. If you’re claiming that Dr Saper’s methodology was flawed, then you need to point out precisely why. Just claiming that their results were wrong isn’t sufficient.

(iii) CLAIM 3: Perhaps, this is the worst one of the lot. It’s criminally ignorant and malicious. There’s no such thing as “detoxifying” heavy metals to make them safe. The toxicity of lead is because of its chemical action once it binds and interacts with enzymes in our human body, and interferes with essential biological activities. You can’t magically “detoxify” lead to remove it’s elemental properties. No sane person would recommend using elemental lead, mercury and arsenic as therapeutic agents. I don’t think there’s a single shred of scientific evidence which backs that claim.

When a governmental organization blindly ignores experimental evidence in a peer-reviewed journal about the dangers of a product using flimsy and non-existent reasoning, and instead states that the authors of the study “are consciously trying to malign the reputation of Ayurveda”, they are displaying the extent of irresponsibility and the unscientific and unprofessional attitude which maligns the organization.

Some Ayurvedic “medicine” may indeed work. But, what is required is stringent scientific tests and quality control to ensure the products are safe to use, and to try to understand the chemical and biological reason for their efficacy. The policy of ignoring information about potentially dangerous products, and attempting to rubbish evidence which does not agree with their viewpoint, may have disastrous consequences for the populace which buys such traditional “medicine”

External Links

[1] – Toxic metals in Ayurvedic remedies
[2] – Indian herbal medicines queried
[3] -R. B. Saper et al., Heavy Metal Content of Ayurvedic Herbal Medicine Products, vol. 292 (Am Med Assoc, 2004).
[4] – Robert B. Saper et al., “Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet,” JAMA 300, no. 8 (August 27, 2008): 915-923, doi:10.1001/jama.300.8.915.

“Does Venus have life in its atmosphere?” was the bold headline of the article in the science section of the Times of India (May 1st, 2008), and The Economic Times. From the article,

“According to latest research, the planet Venus has microbial ecology high in its atmosphere.”, Professor Chandra Wickramasinghe of Cardiff University said.
…
“Every 580 days, when the Sun, Venus and Earth are in a line, microbes from Venus can be transferred to the Earth. The planets Venus, Earth, Mars are surely interconnected biologically and life on earth represents a connected chain of being that extends to the remotest corner of the cosmos.”

I know prof Wickramasinghe is a proponent of panspermia, but this claim does seem rather extravagant, to put it very mildly.

It seems The Hindu* has the same article online. Don’t these people bother to employ a science editor to glance through whatever they copy & paste from some source?

*- The newspaper, not the religion.

A powerful message from cectic, the webcomic.

Image from cectic

On a related note, with the creationist propaganda movie Expelled crying about “oppression” in academics, Blake Stacey has a much more informative and saddening post, titled “Creation, Power and Violence”, about the actual discrimination that educators face in the United States for teaching evolution in science classes.

The Union Health minister Anbumani Ramadoss was quoted as saying¹,

Homeopathy has very good treatment effect for certain diseases which are not amenable to treatment by conventional medicine. It is effective, safe, affordable and simple to administer. It is also cost effective.

India has hundreds of proved studies confirming that homeopathy works.

Let’s consider that outrageous claim for a minute. Have any of these studies been published in peer-reviewed medical journals? Were the clinical trials placebo controlled and double-blind? Have the result of these “proved studies” been reproduced by an independent team, or have they vanished under critical inspection by those “materialistic western scientists”?

Apart from the fact that the principles of homeopathy completely contradict current scientific understanding, how’s it that almost all of the scientific studies and clinical trials which are actually published in peer-reviewed medical journals, tend to suggest that “homeopathic remedies work no better than simple placebos” ²?

Now, let’s consider a very recent claim made by the Director General of Indian Council of Medical Research (no less!), Dr N K Ganguly³. He says that,

The homeopathy compound screened in vitro at NARI(National AIDS Research Insititute) against HIV has been found to have a lot of potential in effectively killing the virus

At this point, it is prudent to point out that, if the above claim to have found a cure for AIDS is true, then it’s Nobel Prize time. However, exceptional claims require exceptional evidence. What about the evidence Mr Ganguly?

However, he refused to name the compound as there were Intellectual Property Rights issues involved. Moreover, there was an MoU with the company which had given the compound, which is already being used in treatment of some other disease, for testing against HIV so the details could not be divulged, he said.

Ah, figures. What’s the one thing which is missing from every single person who claims that homeopathy works?

Simple, it’s the actual scientific evidence.

Don’t miss this brilliant article by the Guardian’s Ben Goldacre, where he talks about the role of placebo effect, regression to the mean, randomized clinical trials, blinded tests, publication bias, cherry picking, meta-analysis, dangers of homeopathic prescriptions and analyzing statistics in medicine. It’s a classic.

Notes
[1] – Homeopathy treatment for AIDS under attack in UK
[2] – Unlike our esteemed minister, I can back this claim and direct you to a list of the actual studies.
- Clinical Trials on Homeopathy Published from 2003 to 2006
- Clinical Trials on Homeopathy Published from 1998 to 2002
[3] – Homeopathy medicine found effective in killing HIV: ICMR DG
- The end of homeopathy? (Ben Goldacre, The Guardian)

Recently, a team of scientists from the Peninsula Medical School reviewed the studies which were done on the effectiveness of individualized herbal medicines (ie, those which are uniquely prepared for individual patients). Currently, the published article is freely available on the Postgraduate Medical Journal webpage.

The study essentially found that,

• Despite an extensive search for studies on the effectiveness of individualized herbal medicine, correspondence with “experts” in the field, and even after requesting professional bodies representing practitioners, only three randomized clinical trials were found
• In two of those studies, there was no difference between placebo controls, and the individualized herbal medicine
• In the other study on the treatment of the irritable bowel syndrome, the Chineese herbal treatment seemed to work better than placebo, but not as well as standard medicine.

and concluded,

• There’s a very limited evidence base for European medical herbalism, Chinese herbal medicine and Ayurvedic herbal medicine despite widespread use
• There’s no convincing evidence that individualized herbal medicine is effective
• There’s a much greater risk associated with herbal treatment, due to adverse reactions between the constituent herbs, or adulteration with poisonous substances

The BBC has an informative article on this study,

Tailored herbal medicine ‘futile’

There is no evidence to suggest herbal medicines “tailored” to the individual work, and they may even do serious damage, according to a study.

Scientists writing in the Postgraduate Medical Journal examined what they said were the only three clinical trials to have been conducted on the treatments.

External Links
- Tailored herbal medicine ‘futile’(BBC News)
- A systematic review of randomised clinical trials of individualised herbal medicine in any indication, Postgraduate Medical Journal 2007;83:633-637; doi:10.1136/pgmj.2007.060202

As told by professor Richard Dawkins

Professor Dawkins is the host of a new TV documentary called ‘The Enemies of Reason‘, where he shows the absurdity of faith healers and astrologers (among others) in his calm, precise, witty, logical and brilliant manner.

From Channel 4¹, which hosts the series,

There are two ways of looking at the world – through faith and superstition or through the rigours of logic, observation and evidence – in other words, through reason. Reason and a respect for evidence are precious commodities, the source of human progress and our safeguard against fundamentalists and those who profit from obscuring the truth.

Part 1 of the documentary is called Slaves to Superstition and can be found here.

Notes
[1]- Enemies of Reason