Kefir Mythology

Kefir is a yogurt-like product made by fermenting milk with cultures of several bacteria and yeast. Frankly, until recently, I had never heard of it (nor--to my short-lived, blissful ignorance--smelled the pungent stuff). However, fad, alternative remedies usually cross my path in exactly this manner; I initially catch a rumor of some new uber-cure, then see it spread, much like a virus among unvaccinated children, over weeks to years.  I had the privilege of smelling Kefir in the hands of a patient who was using it to treat abdominal pain she had suffered from for several months.  She noted if she stopped using the Kefir for even a day, she started feeling worse.

I did a little research and found a company called Body Ecology that markets a Kefir Culture Starter kit. The website touting the benefits of Kefir claims all the usual nonsense about "strengthening the immune system" and such, but goes on to specifically claim that Kefir helps patients with ADHD, flatulence, herpes, cancer, colon "strengthening," chronic fatigue syndrome, and "cleansing the whole body."  What exactly does that mean?

Another website, this one for Lifeway Foods, claims that Kefir helps with Crohn's disease and Ulcerative Colitis (UC) because those diseases are "similar to Irritable Bowel Syndrome."  In fact, Crohn's and UC are not related to Irritable Bowel Syndrome at all (other than the fact that they all affect the bowel).   Without descending too deeply into technical details, Crohn's disease and Ulcerative Colitis are inflammatory conditions of the gut that, when present, effectively rule out Irritable Bowel Syndrome as a cause of abdominal pain.

Two clicks more on my Mac took me to PubMed, the web portal of the National Library of Medicine, where I found absolutely no randomized, controlled trials supporting any of these claims. It appears, then, that Kefir is a yogurt-like food that may have some as yet poorly established benefits of a "probiotic" nature, now being promoted--with no reliable research support--as a cure-all for all sorts of symptoms and diseases.

What's the harm, one might ask. Well, in this case, Kefir is not being promoted simply as a nutritious food (which it might very well be), like cheese or yogurt. Purveyors are making health claims about this product. Some patients suffering from symptoms like chronic abdominal pain, Crohn's disease, ulcerative colitis, nausea, fatigue, colon cancer, herpes, and ADHD are listening in, and buying it. This can cause unsafe delays in actually working up, diagnosing, and treating potentially dangerous illnesses. It can also foster a false sense of security in a patient who believes he is adequately protecting himself or others from the effects of a serious infection when in fact it isn't true.

In summary, there is no reliable evidence that Kefir is anything more than a (moderately disgusting) food.  The patient with the Kefir turned out to have a Helicobacter pylori infection which I treated with antibiotics and an acid reducing medication.

Alternative medicine: to what, exactly is it an alternative?

I recently read an article from the February 23, 2010 edition of the journal, Depression and Anxiety, that left me pondering what, exactly, is meant by "Alternative Medicine." The study in question looked at the efficacy of therapeutic massage for treating Generalized Anxiety Disorder. Not surprisingly, it apparently works. So did several of the other types of relaxation techniques presumably used as a sort of control in the study, namely relaxing in a quiet room, and thermotherapy (the application heat to body).

Fine. So be it; to the degree that the study was performed reliably by competent researchers, using rigorous, well conceived and implemented protocols, it may be provisionally accepted. My question is this: how is massage alternative medicine? We're talking real, hands-on-the-skin, rubbing of the soft tissues here. This is not mystical energy manipulation, Reiki, chakra balancing, or psychic surgery. Soft tissue massage is a well established therapeutic modality generally accepted as treatment for certain medical problems. The notion that massage would promote relaxation is certainly plausible--perhaps even common sense. The notion that relaxation helps relieve the symptoms of generalized anxiety is also generally well established.

By definition, alternative medicine is an alternative to something else. In this case, it is an alternative to this vague concept of "established medicine." For the purposes of this post, I am defining established medicine as the practice of medicine using an evidence-based (or science-based, using the phrase coined by Dr. Steven Novella) approach to patient care. Mainstream medicine is a continuously transforming thing; it morphs to accommodate ever-increasing knowledge and understanding. As diseases, prevention, and treatment become better understood, the practice of medicine changes to reflect that understanding. In essence, modern medicine reflects the scientific method.

Sometimes, treatments that were initially considered "alternative" become mainstream by passing scientific muster. In this sense, alternative simply means unproven. Once a treatment is adequately proven to work, it becomes mainstream, not alternative. Great! That's a system that is self-correcting and always improving.

So, really, alternative medicine is just an alternative to a scientific approach to diagnosis and treatment. If its not based on science, what is alternative medicine based on? Probably crap. Is that what you want to be treated with? Not me.

TAM 6: Just amazing!

So, I'm in my hotel room at the Imperial Palace Hotel and Casino in Las Vegas basking in the afterglow of TAM 6.  For the uninitiated, TAM 6 is the sixth full installment of The Amazing Meeting.  This is the brainchild of the extraordinary magician, and skepticism activist, James "The Amazing" Randi.  http://www.randi.org/  Its a place for all those interested in reality, skepticism, science, and public education about those subjects, to come together and learn, share, celebrate and, most importantly, plan to take over the world!  Ha, ha, ha!  (Think evil sounding laugh, here.)  Yes, plan!  That's what we did, here.  We skeptics refueled our batteries.  We had lots of really good laughsat the expense of all the charlatans and con-artists, at all the crap and woo out there.  We made new important contacts.  We plotted and schemed about new ways to organize our thinking and activities.  Oh, what a glorious weekend!

This year's meeting was at the Flamingo Hotel, right next door.  The speakers were fantastic!  The keynote speaker, Dr. Neil deGrasse Tyson, was outstanding. He brings an energy and passion to his speaking that I would like to clone for my use, and to lend to all the science teachers in this country.

Adam Savage, of MythBusters, gave an excellent talk on his particular neuroses, and obsessive compulsive disorder, and then, he showed us a really cool video of things having the snot blown out of them.  I mean real KABOOMS!  What a rush!  My kids can't wait to get their hands on a couple of the ping pong balls used to raise a sunken ship in an episode.  If only Buster could have been there.

I bought a copy of Flim Flam, by Randi himself and asked him to sign it.  Of course, I used the moment as a photo opportunity.  I realized afterwards that ever picture of me at this thing features me grinning like a three-year old on Santa's lap.  I have to admit, I was very star-struck.

I think my favorite moment from the entire meeting, though, actually happened after 

hours.  A bunch of fans of the Skeptics' Guide to the Universe podcast (see the link in the links section) got together at a local restaurant for a wonderful evening of wine, and talk, and skepticism.  I have never felt so thoroughly a part of an extended family as I did that night.  Rebecca Watson, one of the Skeptical Rogues in the podcast, did a wonderful job setting that up.  It was so much fun to talk to Bob, and Steve, and Jay, as well.  I love to be around people who fight the good fight, and do it with passion!

So, now, I go back to Maine.  I'm already working on my list of topics for this blog...