The Dose Makes The Poison
April 8, 2015 10:15 AM   Subscribe

Ellie Lobel was 27 when she was bitten by a tick and contracted Lyme disease. And she was not yet 45 when she decided to give up fighting for survival. ... “Nothing was working any more, and nobody had any answers for me,” she says. “Doctors couldn’t help me. I was spending all this cash and was going broke, and when I got my last test results back and all my counts were just horrible, I knew right then and there that this was the end.” ... So she packed up everything and moved to California to die. And she almost did. Less than a week after moving, Ellie was attacked by a swarm of Africanised bees.

The Antimicrobial Agent Melittin Exhibits Powerful In Vitro Inhibitory Effects on the Lyme Disease Spirochete [PDF], Lori L. Lubke and Claude F. Garon, From the Bacterial Pathogenesis Section, Rocky Mountain Laboratories Microscopy Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana

The American Cancer Society on apitherapy

The Structure of Melittin[PDF], Terwilliger and Eisenber, The Journal of Biological Chemistry, vol 257, no 11.
Melittin: a membrane-active peptide with diverse functions, Raghuraman H, Chattopadhyay A. Biosci Rep. 2007 Oct;27(4-5):189-223.
Melittin: A lytic peptide with anticancer properties, Goran Gajski, Vera Garaj-Vrhovac. Environmental Toxicology and Pharmacology: Volume 36, Issue 2, September 2013, Pages 697–705.
Molecularly targeted nanocarriers deliver the cytolytic peptide melittin specifically to tumor cells in mice, reducing tumor growth. J Clin Invest. 2009;119(9):2830–2842. doi:10.1172/JCI38842. Neelesh R. Soman, Steven L. Baldwin, Grace Hu, Jon N. Marsh, Gregory M. Lanza, John E. Heuser, Jeffrey M. Arbeit, Samuel A. Wickline and Paul H. Schlesinger
Process of inducing pores in membranes by melittin, Ming-Tao Lee, 14243–14248, doi: 10.1073/pnas.1307010110

Cytolytic nanoparticles attenuate HIV-1 infectivity, Joshua L Hood, Andrew P Jallouk, Nancy Campbell, Lee Ratner, Samuel A Wickline. Antiviral Therapy 2013; 18:95-103
Influence of amphipathic peptides on the HIV-1 production in persistently infected T lymphoma cells, Michael Wachinger, Torben Saermark, Volker Erfle

Theraputic Potential of Venom Peptides[PDF] (PubMed, Nat Rev Drug Discov. 2003 Oct;2(10):790-802, Richard J. Lewis and Maria L. Garcia:
Venomous animals have evolved a vast array of peptide toxins for prey capture and defence.
These peptides are directed against a wide variety of pharmacological targets, making them an
invaluable source of ligands for studying the properties of these targets in different experimental
paradigms. A number of these peptides have been used in vivo for proof-of-concept studies,
with several having undergone preclinical or clinical development for the treatment of pain,
diabetes, multiple sclerosis and cardiovascular diseases. Here we survey the pharmacology of
venom peptides and assess their therapeutic prospects.

Bee Venom and HIV are we getting stung again?
Interesting? Very. Provocative? Certainly. Proof of Bee Venom generalized effectiveness? Unequivocal no. This is preliminary research only. There is a chance that a component of bee venom may be an agent that can be used to interfere with the transmission of HIV. I stress MAY here.
From Toxins to Therapeutics

previously:Cancer cells, COVERED IN BEES!, A scorpion-venom concoction that makes tumors glow sounds almost too outlandish to be true.
posted by the man of twists and turns (73 comments total) 54 users marked this as a favorite
 
Fascinating! I had heard of using snake venom, but not bee stings.

The first story at the top--what I don't understand is why she didn't die from anaphylactic shock. Even if the melittin helps destroy the Lyme bacteria, she's still allergic, isn't she?
posted by suelac at 10:27 AM on April 8, 2015 [1 favorite]


I was fairly allergic to milk products as a child, enough to raise rashes all over my body from small exposures. Then it just stopped when I was about 9. Sometimes you just grow out of allergies.
posted by howfar at 10:31 AM on April 8, 2015 [1 favorite]


Someone tell Amy Tan.

And I'm with suelac -- what happened to her "severe" allergy to bees? What would be very cool, though I suspect most unlikely, is if the Lyme disease "cured" her bee allergy so the bees could save her from the Lyme disease.
posted by bearwife at 10:32 AM on April 8, 2015 [3 favorites]


Lyme screws up your immune system (which is part of what can make testing so unreliable) - so yes, it's theoretically possible that it could affect your reaction to an allergen.
posted by girl Mark at 10:34 AM on April 8, 2015 [6 favorites]


I will describe a perfect scenario for this treatment. The particles activity is demonstrated in animal models. Next animal studies against controls show that it has a benefit and that it is reasonably safe. Next in human trials it is shown to completely safe, inhibit the transmission of HIV, and decreases the activity of the virus in the human body. Dose dependent testing shows that it is safe and allows the immune system to finally properly defeat the HIV virus. It is cleared for administration and the WHO, FDA, world health organizations institute a massive treatment campaign. HIV and AIDS as we know it is gone. Sounds great. As I said a perfect scenario.

From that HIV link. Unfortunately that writer doesn't know the reasons that HIV "cures" have been stymied thus far, and so even with all the caveats, does the disservice of making more out of this therapy than is warranted. HIV treatments (anti-retrovirals) already do a great job of killing HIV. They can essentially eradicate HIV from the blood stream. If curing HIV were just "allow[ing] the immune system to finally properly defeat the HIV virus [sic]" then ARVs would have done that. The problem is that the immune system, as one of its amazing functions, archives immune cells for later use, and HIV resides dormant in those cells. Stop the medications, and that HIV is enough to quickly reproduce in your body. The bee venom could only be a cure like modern ARVs: as long as you keep taking them, you're cured.
posted by OmieWise at 10:35 AM on April 8, 2015 [8 favorites]


HOUSE: she needs bee stings to live!
posted by poffin boffin at 10:36 AM on April 8, 2015 [87 favorites]


CUDDY: No, lawsuit bad.
posted by dr_dank at 10:38 AM on April 8, 2015 [30 favorites]


I'll wait for Vani Hari's take so I can make a more informed decision
posted by Renoroc at 10:39 AM on April 8, 2015 [14 favorites]


i hope nicolas cage has a special cameo on that episode of house, poffin boffin!
posted by raihan_ at 10:39 AM on April 8, 2015 [2 favorites]


All joking aside - ain't nature some cool shit sometimes.
posted by tzikeh at 10:42 AM on April 8, 2015 [6 favorites]




A friend of mine I was training with (she was in the Tokyo Riot Police's aikido senshusei course, I was not) really did in her knees training. She went back to her native Korea and found some pain relief via traditional apitherapy.

Sadly, lack of cartilage is lack of cartilage. Last I heard, she was walking with a cane.
posted by Dodecadermaldenticles at 10:46 AM on April 8, 2015


Yeah, it is, tzikeh, which makes me all the more annoyed when people classify stuff like TCM (traditional Chinese medicine) into "woo" category. Sometimes we might not know exactly why stuff works, but it works even if we don't know yet. Now I'm off to pop a willow pill for this headache...
posted by bitter-girl.com at 10:46 AM on April 8, 2015 [6 favorites]


I'm very, very torn between wanting to send this information to my mother - who is struggling with a mystery disease that her doctor is wavering about whether it's Lyme or fibromyalgia - and wanting to hide it from her. Not that Matercallipygos is actually likely to try (if I sent this to her, she'd be far more likely to shudder and say "ooh, no, I hope I don't have to make bees sting me"), but she's already starting to take a dim view of Western Medicine, and I'm afraid this will make her throw up her hands on the whole thing and start going all-out woo because "drinking this juice is nicer than beestings and it does make me feel a little better" or whatever.
posted by EmpressCallipygos at 10:52 AM on April 8, 2015 [3 favorites]


It’s cool that you might be able to squeeze bees and cure lyme disease. If I ever get the disease, and this treatment is viable, you can be sure I'll be signing up for it. It's great when nature provides something that is compatible with human well-being. However:

“When people ask me what’s the best way to convince people to preserve nature, your weakest argument is to talk about how beautiful and wonderful it is,” says Bryan Fry. Instead, he says, we need to emphasise the untapped potential that these species represent. “It’s a resource, it’s money. So conservation through commercialisation is really the only sane approach.”

I liked everything I read up until this paragraph. It is probably true that the best argument for people who think only in capitalistic terms is an appeal to their wallet. I would not, however, necessarily define people who think only in those terms as “sane.”

There is value in terms of dollars, and value in terms of esthetics, and value in terms of culture, and value in terms of medicine, and all sorts of other value that has absolutely nothing to do with bank notes. That guy's argument is un-nuanced and rather pessimistic IMO.
posted by tempestuoso at 10:56 AM on April 8, 2015 [4 favorites]


I remember visiting Pakistan as a kid and getting stung by a huge bee. I was told that it would help protect me against arthritis. I guess we'll find out in a few decades how that holds up.
posted by any portmanteau in a storm at 10:57 AM on April 8, 2015 [3 favorites]


Sometimes we might not know exactly why stuff works, but it works even if we don't know yet.

Correct me if I'm wrong, but I don't think most of TCM falls into the "we don't know why it works" category but rather "we don't know if it works" or even "we're pretty sure it doesn't work". Not knowing why something works is no bar to using it if it can, in fact, be shown to work. Witness general anaethesia: "It has always been believed that general anaesthetics exert their effects (analgesia, amnesia, immobility) by modulating the activity of membrane proteins in the neuronal membrane. However, the exact location and mechanism of this action are still largely unknown although much research has been done in this area."
posted by Steely-eyed Missile Man at 11:08 AM on April 8, 2015 [18 favorites]


Autoimmune diseases and things like Lyme still seem to be very poorly understood so I am not surprised that things like bee stings might turn out to help in some cases.
posted by Dip Flash at 11:16 AM on April 8, 2015 [1 favorite]


The frustrating thing about Lyme disease is that there's a vaccine for it that is apparently pretty effective, but it was driven off the market by litigation.
posted by alms at 11:20 AM on April 8, 2015 [7 favorites]


this reminds me of that guy who was selling hookworms out of his own ass to cure people's allergies.
posted by discopolo at 11:27 AM on April 8, 2015 [2 favorites]


Eh, I'd disagree with that, Steely-eyed Missile Man. A good friend of mine is a TCM practitioner and acupuncturist whose specialty is infertility. After people have been through cycle after cycle after cycle of everything Western medicine can throw at them, and failed repeatedly, she somehow manages to make it work, even with a larger than usual number of "advanced maternal age" patients among the group which should throw things off in the opposite direction, if anything. There's a huge wall full of new baby pictures in her office that say "this is more than anecdata" and she's converted more than a few doctors' thinking...the results speak for themselves.

Almost every time I get a chance to see her these days, she's got some new medical publication that shows doctors or pharma companies are finally investigating why [insert something from her side of the coin here] works.

I think we do ourselves a disservice when we assume things don't work just because they haven't (yet) been accepted by all doctors. If it doesn't actively harm (as the article said, the doctor recommended against an herb that caused greater uptake in a drug she was taking because then the effects would be TOO much), and can compliment the other treatments, then I don't see where the problem is.

When you create this hardcore either/or dichotomy you are more likely to cause someone like EmpressCallipygos' mom to say, quote "drinking this juice is nicer than beestings and it does make me feel a little better" and then walk away from the standard treatment. How does that help? More than a few doctors are already treating patients badly to start off with, as we saw in this thread. If we want to keep them inside the western medical system, it might behoove doctors to be more open to complimentary treatments.

And here, I'll drop my bias for a minute -- let's say it's all imaginary made up placebo town. Would you rather:

a. patient walks away from doctors' treatment, goes full blown thisweeksfad or

b. patient stays with doctor, also does thisweeksfad assuming it doesn't actively conflict with the treatment, and feels better about their treatment.

In (b) we have to assume the doctor is willing to explain if and how thisweeksfad will actively conflict with the existing treatment, because patients hate being treated like idiots, but I think that's asking too much of most doctors, who'd much prefer you shut up and not ask questions.
posted by bitter-girl.com at 11:37 AM on April 8, 2015 [7 favorites]


There's a huge wall full of new baby pictures in her office that say "this is more than anecdata" and she's converted more than a few doctors' thinking...the results speak for themselves.

Yes, well, without a controlled study this may be the expected result from doing absolutely nothing.

Anyway, my personal issue with TCM is less that it's "woo" - the lack of good studies come from a lack of commercial opportunity as much as anything - it's that whole thing about killing rhinos and bears to get weird animal body parts that have no proven value.

If your friend does fertility therapy with ginseng and crystals, great. Bear bile and rhino horn, not so great.

People getting themselves stung by a bajillion bees isn't going to make bees go extinct, so while it might be useless at least there's no inherent ethical argument against it.
posted by GuyZero at 11:48 AM on April 8, 2015 [9 favorites]


So - you COULD look at it like Lyme Disease being cured by melittin...
OR
You could look at it like like Lyme Disease preventing large amounts of melittin from killing you.
posted by symbioid at 11:54 AM on April 8, 2015 [6 favorites]


Rhino horn? Yeah, no. Not really a part of an American acupuncturist's practice... Honestly, a large component of it boils down to improving what the hell people are eating in their day to day lives, coupled with acupuncture and specific herbs that are chosen to support the person's individualized profile and problems.

Nutrition is, if you ask me, something should be a much larger portion of US doctor training -- a friend of mine's dad was a med school dean and if you knew just how LITTLE nutritional education your doctor gets, you wouldn't listen to a damn thing he or she had to say about food ever again. The hospital system dietitians know more, and the doctors poo poo what they say... and they wonder why no one knows who to believe any more.
posted by bitter-girl.com at 11:55 AM on April 8, 2015 [3 favorites]


From that HIV link. Unfortunately that writer doesn't know the reasons that HIV "cures" have been stymied thus far, and so even with all the caveats, does the disservice of making more out of this therapy than is warranted.

QFT. HIV is a tricky little bugger and neither vaccines nor cures have worked so far because we can't get the immune system to react the way we want it to against HIV. We can get antivirals to take care of it as long as the body is flooded with antivirals, but that's not the immune system working.

Also, that paragraph above that OmieWise quotes:

I will describe a perfect scenario for this treatment. The particles activity is demonstrated in animal models. Next animal studies against controls show that it has a benefit and that it is reasonably safe. Next in human trials it is shown to completely safe, inhibit the transmission of HIV, and decreases the activity of the virus in the human body. Dose dependent testing shows that it is safe and allows the immune system to finally properly defeat the HIV virus. It is cleared for administration and the WHO, FDA, world health organizations institute a massive treatment campaign. HIV and AIDS as we know it is gone. Sounds great. As I said a perfect scenario.

This process takes about 15 to 20 years. Minimum. Perfect scenarios are nice, but unfortunately even if everything works perfectly, it still takes a very long time.
posted by Sophie1 at 11:59 AM on April 8, 2015 [2 favorites]


So, Obama was right. Thanks, Obama! (No, seriously.)
posted by Halloween Jack at 11:59 AM on April 8, 2015 [2 favorites]


I was thinking of the TCM part and not the acupuncture part. If your friend is an acupuncturist, great. But the entire spectrum of TCM has some ethically questionable corners even if your friend doesn't participate in them. Things like bear bile are actual real parts of TCM, whetehr they're your friend's part of it or not.
posted by GuyZero at 12:00 PM on April 8, 2015 [2 favorites]


Even if you're allergic to bees, a sting will not necessarily cause shock. People who have a severe allergic reaction to a bee sting have a 30 to 60 percent chance of anaphylaxis the next time they're stung.
posted by showbiz_liz at 12:01 PM on April 8, 2015


Correct me if I'm wrong, but I don't think most of TCM falls into the "we don't know why it works" category but rather "we don't know if it works" or even "we're pretty sure it doesn't work".

You are correct. In order to be accepted into the corpus of western medicine, a treatment needs to reliably exert the effect that it purports to exert, and it needs to not do more harm than good. "Reliably" is the key part here. The distinction between anecdotes and data seems kind of trite to make, but that's what we're talking about here. Do bee stings help Lyme patients? It's totally possible. If the preliminary research pans out (as it appears to be doing), then it will eventually make it into wide-scale trials, and we'll have our answer, with n > 1. It's similarly possible that bitter-girl.com's TCM-practicing friend is on to something. Or it's possible that her p values are too high for anyone to acknowledge that what she's doing is anything other than some combination of blind chance plus the placebo effect. How should I know? All I can do is trust experts who open themselves to peer review. Those experts are the MDs and Ph.Ds responsible for evidence-based medicine.

Or, more snarkily: they call it "alternative medicine" because if it worked, they'd just call it "medicine."
posted by Mayor West at 12:02 PM on April 8, 2015 [6 favorites]


I remember visiting Pakistan as a kid and getting stung by a huge bee. I was told that it would help protect me against arthritis. I guess we'll find out in a few decades how that holds up.

Bee venom is actually a legit treatment for arthritis, but its effects are temporary and it has to be applied directly to the site of the problem, from what I understand.
posted by showbiz_liz at 12:03 PM on April 8, 2015


they call it "alternative medicine" because if it worked, they'd just call it "medicine."

I am as against non-evidence-based medicine as they come, but surely you have to acknowledge the possibility that there are effective forms of medicine practiced by traditional people that just haven't been studied enough yet?
posted by showbiz_liz at 12:04 PM on April 8, 2015 [16 favorites]


Re: arthritis: Unfortunately the 2 most recent citations are from 8 and 7 years ago, and are both meta-analyses and nothing significant since...

It is highly likely that the effectiveness of BVA for arthritis is a promising area of future research. However, there is limited evidence demonstrating the efficacy of BVA in arthritis. Rigorous trials with large sample size and adequate design are needed to define the role of BVA for these indications. In addition, studies on the optimal dosage and concentration of BVA are recommended for future trials. (Evid Based Complement Alternat Med. 2005 Mar; 2(1): 79–84.)

A meta-analysis produced suggestive evidence for the effectiveness of BVA in musculoskeletal pain management. However, primary data were scarce. Future RCTs should assess larger patient samples for longer treatment periods and include appropriate controls. (J Pain. 2008 Apr;9(4):289-97)
posted by Sophie1 at 12:10 PM on April 8, 2015


I am thoroughly skeptical of bee venom being a treatment for anything. As a beekeeper and an HIV researcher, I have seen my fair share of bee stings. If I was looking for anecdotal information, I'd have to look far outside most of the beekeepers I know, as many of the elder statespersons are hunched over and limping with arthritis.
posted by Sophie1 at 12:15 PM on April 8, 2015 [2 favorites]


when people classify stuff like TCM (traditional Chinese medicine) into "woo" category

People classify it as "woo" because it was invented largely as a ruse by the Chinese government to fool the peasants into thinking they were getting medicine when the real thing was unaffordable. It is, very largely, "woo" by any reasonable definition of the term.

The fact that there are treatments out there, the utility of which has not been recognized by the Western medical-industrial establishment and in some cases have been used traditionally, doesn't legitimize TCM as it currently exists and is practiced.
posted by Kadin2048 at 12:27 PM on April 8, 2015 [15 favorites]


wrt TCM, their remedy for Malaria (wormwood iirc) was used by the North Vietnamese and Viet Cong during the American War, giving them a tactical advantage over the American GI's who were forced to consume Larium (major side-effect: psychosis). For reasons likely including racism, it wasn't admitted until the last 10 years or so that the TCM treatment for Malaria was not only effective, but the most effective treatment for malaria, and is now WHO recommended worldwide.

Absence of proof is not proof of absence; just because it hasn't been studied doesn't mean it's not effective. It's worth remembering that Western medicine (read: big pharma) has little incentive to bless treatments that are un-patentable. Clinical studies cost money, and often they won't be done if there's no route to $$ at the end.
posted by grubby at 12:30 PM on April 8, 2015 [10 favorites]


Kadin2048 I call bullshit on that. I married in to a Vietnamese hill tribe, and their herbal medicine tradition bears strong resemblance to a lot of TCM, and also contains a lot of good stuff like antibacterial poultices, honey for burns, teas for lactation and other women's issues.

The stereotype that TCM is all about powdered Rhino horn is offensive. Only a tiny percentage of people could even afford that. In VN, for example, rhino horn occupies a place more like that of cocaine, as a rich person's "life improver".

Every culture has (or used to have) its folk remedies. Aspirin is one. It's worryingly arrogant to dismiss everything that doesn't come from a lab.
posted by grubby at 12:37 PM on April 8, 2015 [15 favorites]


www.ilovebees.com
posted by charlie don't surf at 12:37 PM on April 8, 2015


I think we do ourselves a disservice when we assume things don't work just because they haven't (yet) been accepted by all doctors.

I'm not assuming it doesn't work because it hasn't been accepted by doctors (that would be an argument from authority). I'm assuming it doesn't work because it clinical trials haven't demonstrated a consistently positive effect.

The problem with anecdotal "hey, look at all my successfully treated patients" stuff is that A) in most cases "treating" people with a glass of water or a wave of a wand will be "successful." By and large bodies get better, people who haven't successfully gotten pregnant do etc. etc. Obviously not in all cases, but in more cases than not.

We know this from Western Medicine, of course, which for centuries happily involved a great deal of "expertise" in doing things which we now know to be either ineffective or actually harmful ("hey, he looks sick--let me get my unsterilized scalpel and open up a vein!"). But doctors could get great reputations as healers with this armamentarium of harmful practices because despite what they were doing they could still all point to hundreds of "satisfied customers." "It would be absurd to say that a judiciously applied leech and some nightshade tea can't help an infertile woman conceive--why, look at all the children I've brought into the world after providing their mothers with that treatment!"

Even in "modern medicine" we've seen large numbers of cases where widely practiced interventions, which myriads of patients and doctors would swear to be efficacious--often miraculously so--turn out to be either ineffective or harmful when subjected to rigorous, large-scale, double-blind testing.

So, no, the experience of your acupuncturist friend tells us literally nothing about the effectiveness of acupuncture as a fertility treatment.

What does tell us something is proper scientific studies, like this one, for example, which shows that despite some early studies which had promising results, a metastudy of all the different studies which have been done (contrary to many people's assumptions, conventional medical science is very happy to go have a look-see and find out if the techniques of "complementary medicine" actually work) tends to show that acupuncture has no effect on increasing your chances of getting pregnant.
posted by yoink at 12:45 PM on April 8, 2015 [16 favorites]


I think we do ourselves a disservice when we assume things don't work just because they haven't (yet) been accepted by all doctors.

Acceptance by all doctors is not a standard anyone is interested in satisfying. For one thing, there are a lot of crazy doctors out there. However, in the absence of actual studies, the most truthful positive thing we can say is "we don't know". Often even after study the most truthful positive thing we can say is, "we don't know". Your friend's experience amounts to anecdata, period.

If it doesn't actively harm...then I don't see where the problem is.

People don't get these "treatments" for free. There is a measurable economic cost to them, to say nothing of the immeasurable psychological effect of the dashing of false hope.

Would you rather:

a. patient walks away from doctors' treatment, goes full blown thisweeksfad or

b. patient stays with doctor, also does thisweeksfad assuming it doesn't actively conflict with the treatment, and feels better about their treatment.


Are we just giving up on ever having option c. patient realizes thisweeksfad is probably bullshit? Obviously, in your narrowly defined scenario, I would prefer b., but let's not pretend there are no costs to b., as I mentioned above, even if it doesn't "actively conflict" with treatment.

Nutrition is, if you ask me, something should be a much larger portion of US doctor training -- a friend of mine's dad was a med school dean and if you knew just how LITTLE nutritional education your doctor gets, you wouldn't listen to a damn thing he or she had to say about food ever again.

Nutrition is an extremely complex and as yet poorly-understood field of study. I am not confident that anyone really knows much at all about it.

It's worryingly arrogant to dismiss everything that doesn't come from a lab.

Ugh, the blithe dismissal of skepticism as "arrogance" rears its ugly head yet again. It it not arrogant to be skeptical of things until they have proven themselves. No, your experience isn't proof. People are really, really bad at acting and thinking rationally. Really bad. They are also really bad at flying. We have developed prosthetics in the form of aircraft to (partially) make up for the fact that we are really bad at flying. We have developed mental prosthetics in the form of the scientific method to (partially) make up for the fact that we are really bad at thinking rationally. If anything, it is arrogant to assert that you know better than people who freely admit that they can't even begin to know things without resort to an apparatus specifically designed to make up for how bad they are at thinking.
posted by Steely-eyed Missile Man at 12:47 PM on April 8, 2015 [27 favorites]


The discussion of HIV, venom and microbiology brought up some of what Michael Pollan references in the fermentation section of his book, Cooked. The microbiology of what is consumed influences how antibodies develop, and we're likely programmed for bee stings and tick bites, but hyper-hygienic food and lifestyles have weakened some of the evolutionary infrastructure. It was an audiobook, so I didn't get to pore over any footnotes, and while there is an HIV story, more fermentation in your diet is not proposed as a cure, full stop. Feeding and developing your personal microflora is recommended (kimchi, kraut, pickling are featured)
posted by childofTethys at 12:48 PM on April 8, 2015 [1 favorite]


just because it hasn't been studied doesn't mean it's not effective.

Yes, but conversely, most folk remedies don't pan out when tested. You can easily bankrupt your heirs chasing after an infinite number of cancer cures.

and often they won't be done if there's no route to $$ at the end.

You can make a ton of money with a synthetic and easily quantified version of a natural drug versus variable doses from plants, e.g. aspirin.

It's worryingly arrogant to dismiss everything that doesn't come from a lab.

I don't care if it comes from a lab or not, as long as it has a well controlled double blind trial behind it. The placebo effect, reversion to mean, and unconscious bias make it incredibly difficult to conclude anything without control groups. The bee story this article starts with is terrible anecdata.
posted by benzenedream at 12:48 PM on April 8, 2015 [8 favorites]


conventional medical science is very happy to go have a look-see and find out if the techniques of "complementary medicine" actually work) tends to show that acupuncture has no effect on increasing your chances of getting pregnant.

As opposed to medical clowns, who are quite effective at increasing in vitro pregnancy rates.
posted by pie ninja at 12:49 PM on April 8, 2015 [1 favorite]


Every culture has (or used to have) its folk remedies.

Indeed. And we know that they killed a lot of people. Of course some things were actually effective, but it's romanticizing nonsense to suggest that without recourse to large-scale, randomized clinical tests it's possible to develop a predictably effective medical practice that can treat a wide variety of serious diseases. Most "western medicine" was essentially "folk remedies" until the late C19th, and we know that while some of what it did was helpful or basically neutral, much of it was actively dangerous.

It is quite literally the case that "alternative" or "folk" medicine simply becomes "medicine" when it is proven--scientifically--to be safe and effective. It is also the case that a great deal of "folk medicine" never makes it over that hurdle simply because when it is tested it is shown to be either "unsafe" or "ineffective" or both.
posted by yoink at 12:53 PM on April 8, 2015 [1 favorite]


Most "western medicine" was essentially "folk remedies" until the late C19th, and we know that while some of what it did was helpful or basically neutral, much of it was actively dangerous.

And there's no reason to think we won't look back at some of our currently accepted medical practices in 100 years and think "we were doing fucking what in 2015?"
posted by showbiz_liz at 12:59 PM on April 8, 2015 [2 favorites]


And there's no reason to think we won't look back at some of our currently accepted medical practices in 100 years and think "we were doing fucking what in 2015?"

Indeed. And it will be large-scale, double-blinded, scientific studies that will put us in the position to say that with confidence. Not anecdotes about how my friend's bee-pollen-and-cuckoo-spit balm is like totes curing cancer!
posted by yoink at 1:01 PM on April 8, 2015 [9 favorites]


most folk remedies don't pan out when tested - is there a cite on this? Has somebody bothered to test, eg, TCM systematically?

I found this, from the BMJ, which says "must do more, better, trials",
this, from plos one, which suggests TCM does better for diabetes control than some pharmaceutical compound,
this inconclusive, but suggestive study of a dismenorrhea remedy...

but nothing to suggest that "most folk remedies don't pan out when tested", but I may not have studied the matter in as much depth as yoink, benzenedream, and Steely-Eyed Missile Man.
posted by grubby at 1:02 PM on April 8, 2015


If there's one thing we humans do even worse than rational thought, it's accepting ideas from outside our tribe.
posted by grubby at 1:04 PM on April 8, 2015 [4 favorites]


Has somebody bothered to test, eg, TCM systematically?

sounds like a fantastic post. you should make it into its own fpp.
posted by the man of twists and turns at 1:11 PM on April 8, 2015 [1 favorite]


I found this, from the BMJ
Although methodological quality has been improving over the years, many problems remain.1 2 The method of randomisation was often inappropriately described. Blinding was used in only 15% of trials. Only a few studies had sample sizes of 300 subjects or more. Many trials used as a control another Chinese medicine treatment whose effectiveness had often not been evaluated by randomised controlled trials. Most trials focused on short term or intermediate rather than long term outcomes. Most trials did not report data on compliance and completeness of follow up. Effectiveness was rarely quantitatively expressed and reported Intention to treat analysis was never mentioned. Over half did not report data on baseline characteristics or on side effects. Many trials were published as short reports. Most trials claimed that the tested treatments were effective, indicating that publication bias may be common; a funnel plot of the 49 trials of acupuncture in the treatment of stroke confirmed selective publication of positive trials in the area, suggesting that acupuncture may not be more effective than the control treatments (figure).3
That's rather more damning than just "oh, we need more studies."

If there's one thing we humans do even worse than rational thought, it's accepting ideas from outside our tribe.

Absolutely no one in this thread is saying "none of these folk remedies are worthy of study." So far as I can see, everyone agrees that it's worth exploring them (which is already a huge bar to cross--there are finite resources available for large scale clinical studies. The reason traditional medicine is very frequently actively studied by scientists is precisely because they figure that "hey, if it's been used for that long there's a chance it does something." This is the exact opposite of refusing to "accept ideas from outside our tribe." But it's also recognizing that the 'tribe' of homo sapiens sapiens is fantastically, demonstrably and repeatedly shitty at evaluating the effectiveness of any medical treatment by the seat of the pants or the "school of experience" or whatever you want to call it. Confirmation bias is a really, really hard demon to defeat. Without rigorous, randomized clinical testing there simply is no way of deciding if any given traditional medical practice is valuable.
posted by yoink at 1:13 PM on April 8, 2015 [6 favorites]


nothing to suggest that "most folk remedies don't pan out when tested", but I may not have studied the matter in as much depth as yoink, benzenedream, and Steely-Eyed Missile Man.

Well, I never said that. I have no idea if "most" (however you are defining that) folk remedies pan out when tested. I have no idea how many have been tested. I am not even 100% sure how "folk remedies" should be defined. What I am sure of is "science doesn't know everything, so nya" is not a cogent response to, "is there any actual proof that practice X reliably has effect Y?"
posted by Steely-eyed Missile Man at 1:14 PM on April 8, 2015 [2 favorites]


The old saw about alternative medicine becoming plain old "medicine" when it's been tested and proven has already been stated, but I would suggest that your reference to artemisinin is an example of this process in action as it replaces quinine (ironically itself at one time a "folk remedy," having been isolated from Jesuit's Bark - the Cinchona tree) as the anti-malarial of first resort.
posted by Steely-eyed Missile Man at 1:20 PM on April 8, 2015 [3 favorites]


That's rather more damning than just "oh, we need more studies."

How is that damning in the sense of "most folk remedies don't pan out when tested," which is the premise grubby was addressing? It is damning to the methodology of the studies, sure, most of which come from a country heavily invested in TCM... what a huge surprise. As someone once said, "confirmation bias is a really, really hard demon to defeat."
posted by Behemoth at 1:34 PM on April 8, 2015


just because it hasn't been studied doesn't mean it's not effective.

So how would you decide whether or not to use a treatment that hasn't been studied?
posted by straight at 1:59 PM on April 8, 2015


If there's one thing we humans do even worse than rational thought, it's accepting ideas from outside our tribe.

I wonder if this is empirically verifiable. How do we define "tribe" here?
posted by clockzero at 2:15 PM on April 8, 2015 [1 favorite]


It might be worth pointing out that the "disease" claimed to be cured by bee stings (chronic Lyme disease undetectable by standard means and unresponsive to antibiotics) does not, so far as science currently knows, exist.
posted by kevinsp8 at 2:20 PM on April 8, 2015 [4 favorites]


I am anti-TCM because I am pro-pangolin. It's all very well to say that trafficking in endangered species is only a tiny part of TCM, but that tiny part is taking a disproportionately devastating toll on endangered flora and fauna.

TCM needs to be scientifically studied and documented if for no other reason than to have any hope of artificially reproducing helpful drugs from nature once TCM has driven their natural sources to extinction.
posted by nicebookrack at 2:25 PM on April 8, 2015 [2 favorites]


I found this, from the BMJ, which says "must do more, better, trials",
this, from plos one, which suggests TCM does better for diabetes control than some pharmaceutical compound,
this inconclusive, but suggestive study of a dismenorrhea remedy...


Did you even read your links?
  • yoink already extracted a fairly damning quote from the first one.
  • The second one clearly states that they found that the "Xiaoke Pill" is better than glibenclamide alone for management of a diabetic patient's glycemic index. What is this "Xiaoke Pill"? It's a combination of xiaoke plant extract and glibenclamide. So the study says nothing about Xiaoke's absolute effectiveness, nor does it say anything about glibenclamide's absolute effectiveness. It says that Xiaoke + glibenclamide is better than glibenclamide alone. This is hardly a vindication of TCM and rather just the normal process real medicine trudges through in order to attempt to grasp at what can one day be termed "knowledge".
  • The third mentioning that there are "suggestive" data is quite possibly the weakest statement one could make. In fact it's the penultimate category of p-values!
posted by Mons Veneris at 2:34 PM on April 8, 2015 [7 favorites]


Herb remedies during pregnancy: a systematic review of controlled clinical trials.

RESULTS:
Of the 511 articles identified, 14 RCTs were eligible. Ginger was the most investigated remedy and was consistently reported to ameliorate nausea and vomiting during pregnancy better than placebo; its efficacy in doing so was noted to be equal to that of vitamin B6 and dimenhydrinate. A single trial also supported the use of Hypericum perforatum for wound healing. Cranberry, however, was not efficacious in the treatment of urinary tract infections; finally, raspberry leaf did not shorten the first stage of labor, and garlic did not prevent pre-eclampsia.

CONCLUSIONS:
Despite the widespread, popular use of herbal remedies during pregnancy, too few studies have been devoted to specific clinical investigations. With the exception of ginger, there is no data to support the use of any other herbal supplement during pregnancy.

--------------

Note that there are entire branches of pharmaceutical science devoted to finding herbal medicines. If you search for "natural products" you will find all sorts of screening data looking for activity against various diseases. Most of the cell based assays have lots of false positives that don't translate well when tried in animals, e.g. dilute bleach or soap works great against cancer cells in a dish, not so much when injected into a mouse with a tumor. An interesting example is Shaman Pharmaceuticals, which tried to do exactly what some here are proposing -- talk to traditional medicine practictioners, learn their secrets, take samples of the plants, see if anything works, and if so, develop drugs based on it. They went bankrupt after spending $90 million of investors' money. If I recall the only thing that seemed to work was a latex like plant as a diarrhea remedy, for which they tried to get approval for AIDS patients. Their stock of herbal samples in freezers was sold for a few thousand bucks at auction.
posted by benzenedream at 2:35 PM on April 8, 2015 [2 favorites]


The hospital system dietitians know more, and the doctors poo poo what they say... and they wonder why no one knows who to believe any more.

How long and what hospital setting have you worked in? RDs are not generally poo-poo-ed and they are usually not the only part of a nutrition support team for patients that need it. They are respected and consulted primarily for their immense knowledge of nutrition and they work with docs, nurses, pharmacists very regularly and often as a part of a team.

And honestly, nutrition is usually mixed in with other courses in a curriculum. It's not like college where you just take a class called Intro to Nutrition.
posted by discopolo at 2:40 PM on April 8, 2015


Now I'm off to pop a willow pill for this headache...

That's placebo effect though. I was watching a documentary about pain recently, turns out the old willow bark thing is basically a myth, as salicylic acid needs the acetyl molecule bonded to it to be available for the body to use. Doesn't work without it.
posted by feckless fecal fear mongering at 2:51 PM on April 8, 2015


FFFM, I'm out of my depth here. Would acetyl molecule bonding occur in the small intestines given the many micro-organisms that inhabit it?

If this is di-hydrogen-oxide humor, just let me know what I'm missing.
posted by childofTethys at 3:39 PM on April 8, 2015


childofTethys, acetylsalicylic acid is a different compound to salicylic acid. It's salicylic acid with an acetyl group bound to it.
posted by ambrosen at 3:52 PM on April 8, 2015 [1 favorite]


A bit more info on willow/aspirin, from Trick or Treatment:

Just a few years after quinine was isolated from cinchona bark, scientists focused their attention on willow bark, which had been used to reduce pain and fevers for thousands of years. Once again, they successfully identified the active ingredient, this time naming it salicin, based on salix, the Latin word for willow. In this case, however, chemists took nature’s drug and attempted to modify and improve it, driven by the knowledge that salicin was toxic. Taken in either its pure form or in willow bark, salicin was known to cause particularly harmful gastric problems, but chemists realized that they could largely remove this side-effect by transforming salicin into another closely related molecule known as acetylsalicylic acid.

The book has a good chapter on herbal treatments. The quick version: most don't work, a few do. Many have serious side effects or interactions.
posted by kevinsp8 at 5:53 PM on April 8, 2015 [4 favorites]


Yeah, it is, tzikeh, which makes me all the more annoyed when people classify stuff like TCM (traditional Chinese medicine) into "woo" category.

My problem with alternative medicine is that practitioners have systematically failed to purge the disproved bits, (e.g. iridology, homeopathy), from their community. Instead they turn around and teach this to the next batch of students. To consider the arrogance and ignorance of teaching homeopathy to students who should be wrestling with organic chemistry and pharmacology ...

If it doesn't actively harm ... then I don't see where the problem is.

It defers the administration of procedures that diagnose or cure an illness, and sucks resources out of health care and student instruction. People are doing Non Contact Theraputic Touch when maybe they should be doing blood tests that look at Complete blood count (CBC), Blood protein testing, and Tumor marker tests.
posted by sebastienbailard at 8:13 PM on April 8, 2015 [2 favorites]


Melittin reduces depression, anxiety and psychotic/perseverative analogue behaviours in mice. Pretreatment with haloperidol reduced the effect size of Melittin. I see these symptoms as core elements of the "chronic lyme" construct. If it works similarly, I suspect Melittin is working through inhibition of Na+ and Ca2+ channels, as well as altering the intensity and coupling of the downstream 2nd messenger systems such as PCK, PKII. Dysregulations in the calmodulin-regulated downstream for neurons (usually through polygenetic copy number variation) has been associated with schizophrenia, unipolar and bipolar bipolar depression, ADHD and autism (more). This is probably also why certain Ca2+ channel blockers work quite well as mood stabilizers for bipolar depression.
posted by meehawl at 9:05 PM on April 8, 2015 [1 favorite]


childofTethys, acetylsalicylic acid is a different compound to salicylic acid. It's salicylic acid with an acetyl group bound to it.

childofTethys, why this is important isn't easy to explain to the layman. You need to understand inflammation, COX active sites and (COX) inhibition and inflammation, and a particular serine structure, and the covalent modification that serine undergoes in order to inactivate that acetylated serine to deactivate the enzyme and drawings help with visualizing the reaction, but to be honest, it's tiring to explain when it might just go over your head anyway and be more upsetting. It's not that you're missing a piece, you're missing a lot of important info necessary to understand.

Though maybe someone less tired can explain it to childoftethys.
posted by discopolo at 10:41 PM on April 8, 2015


BUT if it does help, it's not that salicylic acid has no analgesic or anti-pyretic activity at all---it's just that aspirin with the acetyl group is twice as potent as salicylic acid.
posted by discopolo at 10:57 PM on April 8, 2015


Now I'm off to pop a willow pill for this headache...

That's placebo effect though. I was watching a documentary about pain recently, turns out the old willow bark thing is basically a myth, as salicylic acid needs the acetyl molecule bonded to it to be available for the body to use. Doesn't work without it.
posted by feckless fecal fear mongering at 2:51 PM on April 8 [+] [!]


Sorry, this is not true, because the acetyl group is not necessary for "the body to be able use it", it just cuts down on the insult, increases potency. Basically, a diff salicylate, diflunisal, has the salicylic acid, no acetyl group, and a substitution in a certain position of the salicylic acid (sub beingarring)that increases its anti-inflammatory activity, makes it more potent than aspirin and has fewer side effects than aspirin.
posted by discopolo at 11:16 PM on April 8, 2015 [4 favorites]


I don't doubt the possible medical benefit of bee venom, but I highly doubt the anecdotal story of Ellie Lobel. Sounding so much like the "true-life" story of every miracle cure one sees on the internet, I was willing to partially suspend my disbelief until I read the part about her having founded Beevinity (a miracle skin cream). When you go to this site, you are told she was 24 (not 27) when she contracted Lyme disease, that she graduated from a "gifted children’s Program at University College Kensington, a subsidiary of UC London with a PhD equivalent degree in Physics and Engineering at the tender age of 18", had four children and worked with a number of Fortune 500 companies -- all the while completely debilitated to the point of suicide by Lyme Disease. Also in the story, she says her mother instilled a great fear of bees due to her allergy to them, but at another website she explains that she was taken away from her parents at age two and spent her childhood being shuttled from one foster home to another (http://www.youthhealthusa.org/Ellie-Lobel.htm). Could be true, but I don't think so.
posted by SA456 at 7:30 AM on April 9, 2015 [5 favorites]


SA456, I notice that the common thread in many (all) of these stories is that ultimately someone is selling something. And there's a community that benefits financially from the belief in a particular cure or, as in the case of Lyme disease, from the legitimizing of a particular diagnosis (see kevinsp8's interesting link above). That this effort is patently transparent doesn't seem to bother those promoting the cure. This practice is the legacy of many happy centuries of snake oil sales and shysterism, but when legislatures are considering laws to enshrine these practices on behalf of a particular cure, I fear for our public health. Like Dr. Crislip says in the Lyme disease article, "House Bill 916 is no different in that respect to attempts to legislate the value of pi." And look how well that turned out.
posted by sneebler at 8:19 AM on April 9, 2015 [2 favorites]


How is that damning in the sense of "most folk remedies don't pan out when tested,"

Which effects of TCM do you think Chinese researchers would have thrown money into studying first? The most or the least promising? The ones with the strongest anecdotal evidence of being effective or the ones with the least?

O.K., now think about the implications of the paragraph I quoted.

Now do you see why that's pretty "damning"?

The point is not that most folk remedies will kill you or have other noxious effects. One of the reasons scientists are interested in traditional medicines is because for the most part we can be reasonably confident they're not virulently toxic. "Don't pan out" includes "don't do much of anything at all." And, pretty clearly, the implication of the paragraph I quoted is that most of the most promising aspects of TCM that have been put to the test turn out to not do much of anything: in order to generate positive results you have to design bad tests and publish only the statistical outliers on the positive side.
posted by yoink at 9:28 AM on April 9, 2015


If there's one thing we humans do even worse than rational thought, it's accepting ideas from outside our tribe.

You know, I was thinking about this yesterday and it occurs to me that it's actually backwards. An awful lot of the woo-based medicine flooding Western markets sells simply on the basis that it does come from "outside our tribe." That is, you can pretty safely print money by selling any old bullshit in a tablet if you can claim that it is based on "ancient Chinese wisdom" (or "ancient American Indian wisdom" or "ancient African wisdom" or whatever). We have powerful cultural narratives (many of them dating back to the Romantic era) that frame the "modern" West as dangerously alienated from Nature--with our rationalist "science" and our planet-killing "technology"--and privilege the organic oneness-with-nature which we attribute to the "primitive" and the "traditional."

No one is going to buy some bottle of who-knows-what on Amazon because someone says "hey, in the Eighteenth Century everyone in Europe was pretty convinced that this was the best cure available for Disorders of the Spleen and we kinda sorta think that they might have meant type-2 diabetes amongst other things." But lots of people will rush to buy the same bottle if it is accompanied with something or other about unblocking your Qi.
posted by yoink at 9:41 AM on April 9, 2015 [5 favorites]


That's absolutely correct, yoink, and very well said. This came up strangely in my own life recently. I have twins and a part time mother's helper from Africa. Yolanda, the helper, had never heard of swaddling a baby and told us that she used cry-it-out to sleep train her babies. Now, anyone who has spent any time trying to figure out how to "properly" raise an infant, will be familiar with the vague hand-waves that suggest that swaddling is the "natural" way to handle babies, and that African mothers are closer to that sort of thing. Similarly with sleep training. "African babies never cry" is practically a trope.
posted by OmieWise at 11:16 AM on April 9, 2015


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