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I Visited a Chickasaw Healer and All I Got Was an Elk Sinew and Buffalo Horn Bracelet

Which headline is real?

  • I Visited a Alchemist. As American alternative chemistry grows in popularity, I decided to experience an even older style of nontraditional transmutation of metals.
  • I Visited an Astrologer. As American alternative astronomy grows in popularity, I decided to experience an even older style of nontraditional stargazing.
  • I Visited a Bloodletter. As American alternative medicine grows in popularity, I decided to experience an even older style of nontraditional treatment.
  • I Visited a Chickasaw Healer. As American alternative medicine grows in popularity, I decided to experience an even older style of nontraditional treatment.

Difficult? They are similar in that alchemy, astrology, bloodletting and (as we will see) Chickasaw healing are not based on reality. Bloodletting, as best I can determine, is not offered in the US, at least based on the notion of an imbalance of the 4 humors. I have no doubts that a reader will find a practitioner, likely with Hepatitis B and C, somewhere in the US. Probably in Sunnydale.

It was the final option, from The Atlantic. Given their medical reporting in the past, I would not be surprised if any of the above headlines originated in that magazine. This gets to an issue I have with all media. There are two things about which I have expertise: infectious diseases and SCAM. So often the media get both wrong, although I probably notice more when they get it wrong in the areas of my expertise. If they get it so wrong in areas about which I know something, how can I trust the veracity of reporting in all the areas where I have no knowledge?

Still, The Atlantic is perhaps unique among major periodicals in how often they offer up blogging material for me. After setting the stage of the treatment rooms the author, well, embarrasses himself. Watch in amazement as a single paragraph contains perhaps a world record’s amount of fertilizer by a writer who evidently isn’t particularly interested in, well, let’s say completeness:

…alternative medicine has reached an all-time high among ailing Americans. And it’s not just hippies on podunk ashrams–the government, too, has taken note. U.S. taxpayers have devoted $1.5 billion to the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, a center that researches techniques like acupuncture, yoga, and tai-chi. The University of Maryland’s Center for Integrative Medicine has received $25 million from the NIH for research and offers a treatment in which a healer floats his hands over a patient’s body, as my medicine man did.

…alternative medicine has reached an all-time high among ailing Americans.” Not referenced, of course, but the only way alternative medicine gets to an all-time high is by defining interventions like diet and exercise as alternative. From 2002 to 2007, according the NCCAM, CAM use went from 36% to 38%, but what CAM was being used?

When you look at the breakdown of the 10 most used therapies it is mostly supplements and exercise. Therapies divorced from reality like energy therapy and acupuncture are not on the list, with the only wackaloon therapy being homeopathy at 1.8%. Most of the popularity in CAM is the due to broad definitions as to what constitutes ‘alternative’. But as has been pointed out CAM is a brand, not a definition.

U.S. taxpayers have devoted $1.5 billion to the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, a center that researches techniques like acupuncture, yoga, and tai-chi.

Note the $1.5 billion is money wasted. Not a single effective intervention has been found by the NCCAM.

Mielczarek and Engler[16] examined the grants and awards funded by NCCAM from 2000 to 2011, which cost a total of $1.3 billion. Their study showed no discoveries in complementary and alternative medicine that would justify the existence of this center. They argued that, after 20 years and an expenditure of $20 billion, the failure of NCCAM is evidenced by the lack of publications and the failure to report clinical trials in peer-reviewed scientific medical journals. They recommended NCCAM be defunded or abolished, and the concepts of funding alternative medicine be discontinued.

There was a link on The Atlantic site to another article, “America’s Shame: Our Ketchup Packets“. The Atlantic got it wrong again. It’s not ketchup packets, it’s the NCCAM. Note that yoga and tai chi, forms of exercise, that are somehow magically transformed into complementary and alternative medicine. Huh. Who would have suspected?

The University of Maryland’s Center for Integrative Medicine has received $25 million from the NIH for research and offers a treatment in which a healer floats his hands over a patient’s body, as my medicine man did.

That NIH grant may rank as one of the most appalling I have ever seen. They are going to use reiki and acupuncture, placebos with no plausible mechanism of action, on shock trauma patients to help with pain management. I cover ID patients in our local Level One trauma center. I see how guns and cars and falls can shred a human. To use these worthless therapies on those patients is horrible. I have to wonder if the University of Maryland uses the same IRB as the Burzynski Clinic. And as I think about it, the Grant announcement was from 2007. Shouldn’t there be results by now? Or is that another $25 million flushed down the toilet?

The “healer floats hands over a patient’s body” links to an ‘about us‘ page for a therapeutic touch clinic in Edmond, Oklahoma. Weird. Maybe the author likes the graphic or maybe The Atlantic web page editor is as facile with links as I am with spelling.

That being said, there is no human energy field. If we can pick up the Voyager broadcasting with the power of refrigerator light bulb, 23 watts, from over 10 billion miles from earth, than we should be able to find a human energy field. But pseudo-medicine proponents do not use the term energy in a way that is defined or associated with physics. As Dr. Mielczarek has pointed out at the Society for Science-Based Medicine (sfsbm.org, nice site, check it out):

The fields generated by physical processes associated with human physiology are of the order of 0.004 milligauss. There is no evidence that these fields can be manipulated or tuned to affect human biochemistry for healing purposes. Furthermore there is no evidence to support claims that certain individuals can emit fields large enough for healing purposes. The postulate of an unsubstantiated biomagnetic medically healing energy field, of 2 milligauss which can only be generated by certain individuals, (Therapeutic Touch, Reiki, Qiqong, practitioners) fails all tests of science. This misconception, that an unsubstantiated, biomagnetic energy field which eludes all science based investigation but nevertheless transmits energies large enough to create healing flies in the face of all scientific reasoning and the laws of physics. Thus the Division of Biological Physics of the American Physical Society deplores attempts to mislead the public based on claims by practitioners of Therapeutic Touch, Reiki or Qiqong that they can generate fields which are sources of healing energy. This claim has no basis in physical theory or experiment.

Then The Atlantic asks:

But is this all pure snake oil?

Well, if he had a bit of understanding of reality he could have saved himself some time and money. The answer is yes. Snake oil.

I wanted to find out if there’s some truth to a therapy that doesn’t rely on traditional biological mechanisms.

Traditional biologic mechanisms. You mean fantasy-based mechanisms since there are no human energy fields?

What then occurs is a healing ritual. And healing rituals are important and do have effects. They do not alter any important physiologic parameters but they do make you feel better. The best example is the NEJM asthma/placebo study, where placebo interactions with the medical-industrial improved subjective, but not objective, aspects of asthma.

The author relaxed while

lying on a massage table draped in Native American quilts

while being massaged.

It is a form of social grooming with a side of mysticism . Monkeys do it although they do not get charged 50 bucks for doing it.

Primates provide perhaps the best example of this activity. Primatologists have called grooming the social cement of the primate world. The trust and bonding it builds is critical to group cooperation. Among primates, social grooming plays an important role in establishing and maintaining alliances and dominance hierarchies, for building coalitions, and for reconciliation after conflicts…Primates groom socially in moments of boredom as well, and the act has been shown to reduce tension and stress. It is often associated with observed periods of relaxed behaviour, and primates have been known to fall asleep while receiving grooming.

So many of the alternative therapies appear to be a ritual of relaxation combined with touch, tarted up with spiritual or pseudo-scientific nonsense. In this case it was:

energy of an eagle (from above, with opportunity for perspective) or a bear (on my level, with greater confrontation).

and the author recognizes:

there is a certain mind-cleansing element to abandoning yourself to the motions of this ritual.

If I spend an hour relaxing on a soft table with a massage and hypnotic noise in the background, I would be the better for it, all a more likely outcome for The Atlantic author who admittedly:

come(s) from a nervous people and suffer from bouts of chronic hypochondria.

I have wondered if these rituals tend to have more effects on a fanasy-prone or suggestible person. I would be interesting to do a study of the effects of a Chickasaw medicine man on a selection of the audience at TAM and compare it to The Atlantic contributors. I suspect the latter would have a more profound response. The author, in his reaction to the experience, seems a bit suggestible:

the shaman lightly touched my feet, hitting pressure points such that I felt his touch in the grooves of my cranium…I felt extreme shivers and then, when he palmed my shoulder blades, flowing warmth…I stepped on the buffalo hide rug he had on the floor and was told to absorb the energy up through my feet into my body. I crouched and strained: it was basically like taking a reverse dump.

I can see why he is a hypochondriac; he appears excellent at paying attention to every bodily twinge. And not unsurprisingly after a relaxing ritual:

…wouldn’t you know, that night I had one of the best sleeps of my life. My ear opened up and I felt a remarkable physical and mental equilibrium.

Another Atlantic article: sloppy incomplete reporting about common experience, discussed as if it were rooted in a mystical non-traditional biological mechanism.

But I am now incensed about ketchup packets, so I too am better for the experience.

Posted in: Energy Medicine, Science and the Media

Leave a Comment (47) ↓

47 thoughts on “I Visited a Chickasaw Healer and All I Got Was an Elk Sinew and Buffalo Horn Bracelet

  1. windriven says:

    “Shouldn’t there be results by now? Or is that another 25 million flushed down the toilet?”

    In an age of trillion dollar budget deficits, $25 million doesn’t sound like much. But $25 million wasted on quackery is $25 million that cannot been used to improve the lives of the people who ponied up the money in the first place.

    $25 million could provide a year’s health insurance for 2,000 young families.
    $25 million could vaccinate a million people against influenza.
    $25 million could provide hot lunches for 40,000 school children for a year.

    NCCAM’s budget is roughly $127 million per year. $127 million could be used to do real good for real people. It is immoral to urinate that money down a rat-hole.

  2. windriven says:

    From the Atlantic article:

    “I was not in a teepee, as I half expected when I made the appointment, but instead a mansion with fine cabinetry and plush furniture. Once through the varnished front doors, I entered the healing man’s therapeutic lair.”

    Shamans have come a long way, baby.

    83 million adults spent $33.9 billion out-of-pocket on CAM in 2007.

    1. mousethatroared says:

      Umm, wasn’t this a Chicksaw medicine man? Why would one expect to be in a teepee? Historical Chicksaw housing was plaster with thatched roofs. The Teepee was used by the nomadic plains Indians.

      Anyway, most people don’t live in the same housing that their forefathers did. why does the writer think that Native Americans would be the exception?

      Sorry, I know that’s off topic. It’s just something that kinda gets under my skin.

      Also, I just had a massage the other day, birthday gift to myself. Heated table (especially appreciated since it was like -10 outside). Deep tissue massage…very nice. Really I don’t think there has to be any other medicinal quality to the process, beyond just being relaxing and pleasurable.

      1. Jon Brewer says:

        Just wanted to add, the Chickasaw healer was probably a wannabe. You don’t actually see real Indians doing this kind of thing very much. But fake Indians?

        Well, you have James Arthur Ray, charging over $9000 (Yes, the fact that he was on Oprah makes this hilarious.) for a sweat lodge which killed several people. You’d think he understood not to use a plastic tarp, and maybe to let people who are having medical issues leave?

        Then you have Harley Reagan, alias “Swift Deer”, who appeared on HBO’s Real Sex to promote his particular warped image of sexuality as traditional Cherokee teachings. (Among other things, Reagan claimed he was taught by his uncles how to masturbate, then later initiated by a “Phoenix Fire Woman” into actual intercourse. Seriously.)

        The first clue is when they self-ID as a shaman. Shaman isn’t even an Indian word, and puns (sham man, shame on, etc.) are the standard treatment of anyone asking for a shaman.

        Interestingly, traditional Lakota medical theories include the idea that disease is caused by tiny animals inside the body, too small to be seen. There are actually several monsters that are credited with creating these animals. Of course, for the alties, it’s all about ‘energy’ and other Orientalist woo. And at the time, naturally, this was the 19th century, the dawn of scientific medicine, and most American doctors were agin’ it, opting instead for reflex neurosis theory, autointoxication theory, humorism, and…energy fields.

        Tell that to the next altie who uses ‘Western medicine’ as a snarl word. ;)

        1. mousethatroared says:

          @Jon Brewer – Good points! Thanks for the info.

  3. windriven says:

    “Therapies divorced from reality like energy therapy and acupuncture are not on the list, with the only wackaloon therapy being homeopathy at 1.8%. ”

    1.8% of the $33.9 billion referenced above is $610 million on … magic water. That same year San Pelligrino, windriven’s favorite magic water, sold $137.2 million.

    As Yakov Smirnoff used to say, “what a country.”

  4. DevoutCatalyst says:

    You say monkeys don’t charge $50. I live in one of the poorest counties in my state and say humans don’t charge $50. Once massage became state licensed therapists quit monkeying around and jacked up their rates.

  5. Andrey Pavlov says:

    Well, this puts the lie to the NCCAM’s claim that it does not falsely lend an imprimatur of legitimacy to ridiculous CAM claims. Something that Jack Killen himself said to me when we were having some back-and-forths over at the NCCAM blog. I have a feeling I may be referencing this in a future post I may make over there.

    Also, I wholeheartedly agree with the ketchup packet thing. I lived in Australia for 2 years and my fiance and I have commented many times how much incredibly better those packets were. What was not shown in that video is how you can dole at small portions multiple times; so you can put a few drops on each fry independently or, in the case of eating fish and chips, you can put a little tartar sauce on each bite of cod. Truly civilized.

    Of course that may be because they call it “tuh-mah-toe sauce” and not ketchup.

    1. windriven says:

      “you can put a little tartar sauce on each bite of cod. Truly civilized.”

      Halibut. To be truly civilized, fish and chips must be done with halibut.

      1. Andrey Pavlov says:

        I’m partial to the common and classic cod, though barramundi is indeed a lovely substitute. I’ve had halibut and it is also quite excellent.

        http://en.wikipedia.org/wiki/Fish_and_chips#Choice_of_fish

        1. windriven says:

          Here in the PNW it is not unusual to find salmon and chips. Batter dipped salmon frankly doesn’t work for me.

          1. Kov says:

            As a Pacific NW resident, I’m fairly certain that decrying salmon in any form is a type of heresy punishable by law. Please rectify your wayward views immediately, with a nice IPA.

            1. Andrey Pavlov says:

              Here, here! Salmon and IPA for everyone! Of course, being Russian, this is also a close approximation of heaven for me.

  6. goodnightirene says:

    You could just laugh all day if it weren’t all so sad and pathetic–and spreading beyond the realm of misfits, and the gullible into major regional medical centers.

    But how do you talk to people who think they are truly drinking the blood of Jesus (who was raised from the dead and born of a virgin) about the nonexistence of “energy” fields?

  7. daedalus2u says:

    There are potential physiological mechanisms by which blood letting could be therapeutic for some disorders. There is no excretion mechanism for excess iron, except for blood loss. Excess iron does make people more susceptible to infections.

    I suspect that a degree of blood loss while giving birth may be a “feature”, to reduce the possibility (and fatality) of infections which commonly follow.

    Hemoglobin is the sink for nitric oxide, so a reduced hemoglobin level results in higher NO levels at the vessel wall. During sepsis, the problem is too high a NO level, but the level needs to be high enough to block bacteria from forming a biofilm on the vessel wall, which is a couple orders of magnitude worse than bacteria floating around in the blood stream.

    What prevents bacteria from forming a biofilm is the NO chemical potential at the vessel wall. If the hemoglobin level is reduced, the same NO production rate will produce a higher NO level at the vessel wall. Or, a lower NO production rate can produce the same level. The problems of high NO during sepsis come from the shut-down of mitochondria in tissues like the liver and kidneys which causes multiple organ failure. That depends on the whole-body rate of NO production more than it does on the concentration at the vessel wall.

    I suspect that some degree of hemoglobin concentration lowering might be therapeutic during sepsis. Dilution via volume expansion is just as good (maybe even better) from a nitric oxide perspective.

    1. Andrey Pavlov says:

      Except that data show us that over dilution with saline has worse outcomes. We do, however, know that the HGB levels can fall very low with no adverse outcomes and in fact, outside of patients with CAD transfusing at anything above 7 is overall more harmful. I don’t think that the data can suss out how much initial volume resuscitation can be attributed to your hypothesis vs maintaining CO and peripheral perfusion, but too much saline is in and of itself a negative.

      1. daedalus2u says:

        I wouldn’t doubt that dilution with saline would be worse. There are other things in blood that are important other than hemoglobin.

        I suspect a more “natural” diluent, closer to plasma during sepsis would be better. Something with nitrite and something with lactate dehydrogenase to convert the lactate back into pyruvate.

        1. Andrey Pavlov says:

          Data shows us once again that there is not really much difference between any fluids used – crystalloid or colloid. I couldn’t find anything look at FFP directly, but there have been numerous trials of various colloids and fluids, including blood products, and none of them pan out. No benefit of colloids of any kind over plain saline and no real detectable difference between colloids.

          That said, the data doesn’t answer the question for FFP directly as the only resuscitation fluid so it could have a unique benefit. It would, necessarily, not be a huge benefit and the same negatives associated with positive fluid balance will likely be there. It is also very expensive and in relatively short supply, so I doubt we will ever actually see a robust study to directly answer that question, at least in part because it would almost certainly not be able to be implemented in real practice.

          I’d still say that the prior is not particularly high.

    2. MTDoc says:

      Just when I was going to give up bloodletting.

    3. irenegoodnight says:

      “I suspect that a degree of blood loss while giving birth may be a “feature”, to reduce the possibility (and fatality) of infections which commonly follow.”

      Where and when did YOU give birth? I lost no blood with four births and unless you’re talking about the third world, I don’t think infections are “common”.

      None of your extremely pedantic reasoning has any bearing on the reasons bloodletting as a therapy was performed, so what’s your point?

      1. Harriet Hall says:

        “I lost no blood”
        I think you are mistaken. The average blood loss at delivery is 500cc, about a pint.

        1. Andrey Pavlov says:

          My experience is (thankfully) very limited, but yes, there is always some bleeding during childbirth. The placenta must detach from the uterus and there is always some blood there which is lost. It can be reasonably minimal, but never zero.

          1. Calli Arcale says:

            I, too, have to question as the definition of “no” in this case. While you may not have lost enough blood to qualify for a transfusion, you surely lost some blood. It is common to bleed for a couple of weeks after giving birth, with the first couple of days being quite heavy, like the menstrual period from hell.

            1. Andrey Pavlov says:

              Ah yes, lochia. I’m sorry that evolution saddled us with such a just-barely-good-enough means by which to procreate.

    4. Angora Rabbit says:

      As an iron researcher, where do I begin? The only people blood-letting would be helpful to is those with hemachromatosis. And maybe alcoholic males. This is because the iron overload can cause significant tissue damage especially to liver. I’m unaware that excessive iron increases risk for infections; rather the opposite. This is a distortion of the well-described finding that inflammatory factors tend to mobilize serum iron into storage; the teleological thinking (can’t ask “why” in biology) is that it sequesters iron away from the pathogen. Hence low-grade infection is the second-most common cause of iron-dependent anemia.

      I very much doubt that blood loss during pregnancy is meant to reduce infection risk, especially since iron deficiency is the most common micronutrient deficiency in child-bearing age women including in the U.S. There’s an evolutionary advantage for women to store iron, not waste it during childbirth. The real goal is to enhance the neonate’s iron endowment during third trimester, since breast milk iron levels don’t meet postnatal growth needs.

      You know, sometimes biological events have nothing to do with NO. Just sayin’.

      1. MadisonMD says:

        Thanks, Angora. Again I’ve learned something about iron stores. One small suggested edit,.. in addition to iron overload, bloodletting is useful for Polycythemia vera.

  8. Frederick says:

    just a comment on the first Part of your article. Media do get it wrong often.
    just last week with Hawking new paper. the headline were suggesting that He was saying that black hole does not exist, ( no he meant that he is suggesting that, they are not exactly as we once thought) or you see ghost stories without any critical thinking side. They talk about a new Device/robot/phones, but it turns out the device is decades away.

    mainstream media and alternate media are both terrible.

  9. Denise says:

    And I thought that Therapeutic Touch was one of the practices that had been thoroughly and conclusively debunked.

  10. Kiiri says:

    I second Harriet, I actually bled a lot in the delivery of my small child. I tore very early in the deliver process and the OB actually sat there holding the tear together the whole time. I got two suture kits worth of stitches (I am going to remind small child of this later in life) and tested anemic on the post birth blood screening. Bounced back fortunately without having to endure disgusting iron pills I needed for anemia a couple of years ago. Scared the crap out of my poor husband who was sure I was going to bleed to death.
    I will take the social grooming aspect of a good massage over this any day. Of course you feel better you just spent an hour on a comfy heated table while all of the knots were kneaded out of your muscles. Awesome way to relax. But you don’t need to slap energy field labels on it to enjoy and benefit from it.

  11. RobLL says:

    IIRC it was Atlantic that proposed the the HIV virus was not the cause of AIDS. Later some of their articles on software, aviation, and economics persuaded me that I benefited only if I knew more than the author. Beings I don’t know more than most authors I quit subscribing and reading Atlantic.

    I donate blood, in the gallons at this time, and have read that it may be helpful to males. Don’t know about that, but the blood bank does do blood draws and discard the blood for those whose doctors want blood withdrawn, and who are not eligible to donate.

    1. Sawyer says:

      “IIRC it was Atlantic that proposed the the HIV virus was not the cause of AIDS”

      Okay, that’s something I’d like to see a reference for. The Atlantic has pushed crappy alt med research for a decade but I’m having a hard time believing they’d stoop that low.

      Are you sure you aren’t thinking of another magazine?

      1. Anna says:

        I assume that RobLL is thinking of the AIDS denialist story Harper’s published by author Celia Farber. As far as I can tell, it’s not available online, but here’s a story about it in The Advocate: http://www.advocate.com/health/health-news/2006/03/14/harper%E2%80%99s-magazine-publishes-controversial-aids-story

        1. Sawyer says:

          Thanks Anna. I didn’t know it was Harper’s but my magazine clairvoyance told me it didn’t quite fit with the type of mistakes the Atlantic usually makes.

        2. lilady says:

          Celia Farber’s article on AIDS which appeared in Harper’s Magazine, is available on the internet.

          Just copy and paste this on your search engine and it will come up, just under Wikipedia’s entry on Farber:

          Out Of Control
          AIDS and the corruption of medical science
          CELIA FARBER / Harper’s Magazine 1mar2006

    2. Andrey Pavlov says:

      I don’t know a huge amount on it, but there is data to show that donating blood improves all cause outcomes in individuals, even when controlling for confounding factors like the idea that those who donate blood might also be likely to lead more healthy lives in general. That study was rather recent and I don’t know if anything following up to suss out the difference exists.

      Speculation is fun though (so long as we all recognize it is speculation).

  12. daedalus2u says:

    One of the reason hemachromatosis is bad is because it increases the severity of infections. For example; plague.

    http://www.ncbi.nlm.nih.gov/pubmed/21714673

    For virtually all of human evolution, all humans lived in the undeveloped world. It is only recently that modern medicine has reduced the maternal death rate in childbirth to below ~1% per pregnancy.

    Major causes of maternal death during childbirth (in the absence of medical care) are blood loss, infection, and cephalopelvic disproportion.

    The whole point of sepsis is to prevent bacteria floating in the blood stream from attaching to the vasculature and forming a biofilm. That is why sepsis is such a vigorous action by the immune system. Evolution has minimized the sum of deaths from too weak an immune response (dying from the infection) and from too strong an immune response (dying from the immune response). To minimize the sum, there have to be deaths in both categories.

    Of course the iron and hemoglobin levels are a compromise. All of evolution is a series of compromise, many that we don’t appreciate. When hemoglobin levels are raised via epo in end stage kidney failure, if they are raised back to “normal” (what would be observed in people without kidney failure), the death rate is higher than if the level is only raised to something less than normal.

    It may be that by the time sepsis is already ongoing, that it is too late for lower the hemoglobin level to have any benefit. In sepsis the NO comes from iNOS, which isn’t feedback regulated (so much), it is feed forward regulated with the NO level during NFkB activation regulating iNOS expression. Low NO before leads to higher NFkB and higher NO via iNOS later.

    1. Angora Rabbit says:

      Hemoglobin is about the last thing to change when a person is anemic and isn’t going to change in acute infection. Serum iron and Hb are not the same thing nor the same compartment. With all respect, when we treat and think about hemochromatosis, infection risk is not the first thing we think of, nor is it what usually precipitates a diagnosis. Iron metabolism is fairly nuanced.

      Fever / infection response is a lot more than just biofilm prevention; for starters, not all pathogens make biofilms.There are major changes in energy utilization, nutrient metabolism, and fuel choices to elevate BMI, for starters.

      1. daedalus2u says:

        I agree that infection risk is not the first thing thought about in hemochromatosis. However, over evolutionary time infection was a leading (if not the leading) cause of death, usually before age 5. Now there are vaccinations, antibiotics and ID specialists like Dr Crislip who make a living out of killing bacteria before they kill the patient. People don’t need a “strong” immune system to kill bacteria, they can rely on technology if the infection is caught soon enough. A “strong” immune system isn’t a panacea, it can cause things like autoimmune disorders.

        When antibiotics become useless through over use and widespread antibiotic resistance, other things (that don’t work as well) will have to be substituted.

        Hemoglobin level is difficult to change, except by bleeding. The growth of many bacteria is iron-limited in vivo.

        You are correct, hemoglobin levels are not the same as blood iron levels. However “anemia” is pretty much defined as a blood hemoglobin below a certain level. Anemia can be caused by insufficient dietary iron, it can also be caused by certain disease states, end stage kidney failure for example. A portion of the anemia of end stage kidney failure is adaptive, because when blood hemoglobin levels are raised to “normal”, the death rate is higher then if the level is raised somewhat less. How much, we don’t know because it is likely idiosyncratic and depends on the details of that particular patient.

        There is no one “ideal” blood hemoglobin level. The “ideal” level changes depending on the physiological state of the organism. The “ideal” level in a modern society where ID specialists like Dr Crislip can be relied upon to kill pathogens is probably somewhat higher than in “the wild” where there are no ID specialists.

        Regarding teleologic explanations. Yes, such “explanations” are speculative, but the whole premise of treating “anemia” is that “hemoglobin in the blood” is there for a “teleologic reason”, and that “fixing” a “bad” level (as in anemia or hemochromatosis) is “better” than no intervention. My own perspective is that every level is a compromise that physiology has arrived at over evolutionary time, and we don’t know what the trade-offs for different levels are until we have measured them.

        You are correct, not all pathogens make biofilms. Those that do are much harder to deal with once they have formed a biofilm. Some, such as malaria, don’t form a biofilm, but when they become attached in one spot are many times more dangerous. NO does prevent malaria infected red blood cells from sticking in one spot. When the infected cell sticks in one spot, it receives glucose by the convection of blood past it, and not by diffusion while it is freely floating in the blood stream. Preventing malaria infected cells from sticking in one spot is a very important aspect of treating malaria.

        1. Andrey Pavlov says:

          However “anemia” is pretty much defined as a blood hemoglobin below a certain level.

          For the most part. It is defined as a decreased absolute number of circulating RBCs. This not the operational definition, however, and is typically defined as a decreased hematocrit, count, or HgB concentration. Ultimately the point is that it is a diminished oxygen carrying capacity of the blood related to available HgB.

          Hemoglobin level is difficult to change, except by bleeding

          Iron deficiency will do it just as well.

          A portion of the anemia of end stage kidney failure is adaptive, because when blood hemoglobin levels are raised to “normal”, the death rate is higher then if the level is raised somewhat less.

          Unless you have further evidence that I am unaware of (very possible) your conclusion does not follow from the premise. We know that artificially increasing crit/HgB in ESRD leads to increased mortality. But you cannot from that infer that the anemia is adaptive simply because correcting it leads to increased mortality. There are many confounds in the pathologic state of ESRD along with the fact that you are using artificial means to stimulate RBC production with EPO. It is a much more likely conclusion that there is no adaptive role to anemia of ESRD but that aggressive treatment has its own negatives which outweigh the positives of not being anemic.

          There is no one “ideal” blood hemoglobin level.

          Agreed.

          The “ideal” level changes depending on the physiological state of the organism.

          I’m not fully comfortable with this statement, but it is probably close enough to not quibble. My key issue is that in most disease states where increasing crit/HgB increases mortality it is a reflection of either the mechanism by which we are doing it (transfusion has its own significant hazards and should never be taken lightly, even though many physicians do) or because of physical forces involved. The viscosity of blood is basically driven entirely by the crit (RBC fraction). As you well know, even small increases in crit lead to significant increases in viscosity. In cases where the physiologic strain on the cardiovascular system are significant, this can be extremely detrimental to the patient’s health. The exception is in known CAD, because the diminished oxygen carrying capacity significantly outweighs the increased viscosity in terms of negatives. But even that doesn’t hold true beyond an HgB of 10.

          So it isn’t so much the HgB itself, or the iron in it, but the actual physical processes involved with changing the viscosity of the blood in these states. There are enzymatic/catalytic function of both HgB and RBCs directly, which is why I hedged my comment earlier. But I do not think this is a huge role – the oxygen carrying capacity vs viscosity seems to be the predominant driver of outcomes in these cases.

          The “ideal” level in a modern society where ID specialists like Dr Crislip can be relied upon to kill pathogens is probably somewhat higher than in “the wild” where there are no ID specialists.

          I’m with Angora on this one. Bacteria do not use iron in HgB in RBCs for metabolism. Unless you’ve got something that demonstrates otherwise. Perhaps some of the acutely hemolytic strains do, but in that case trying to sequester iron through “adaptive anemia” makes no sense – each RBC has copious iron that these hemolytic strains could make use of such that you’d have to be basically dead from lack of O2 carrying capacity to have that strategy do anything meaningful.

          Yes, such “explanations” are speculative, but the whole premise of treating “anemia” is that “hemoglobin in the blood” is there for a “teleologic reason”, and that “fixing” a “bad” level (as in anemia or hemochromatosis) is “better” than no intervention. My own perspective is that every level is a compromise that physiology has arrived at over evolutionary time, and we don’t know what the trade-offs for different levels are until we have measured them.

          Yes…. but I believe that transfusion (which is by far the most common “treating of anemia” you’ll find) is often very poorly executed by physicians. This is an example of reflexive “treating the number” predominating over understanding physiology and looking at your patient. HgB of 6? Transfuse. Patient has an O2 sat of 93% on 2L and is a little short of breath? Transfuse.

          So yes, we act in that manner, but I believe that to be wrong and for exactly the reason that there is no teleology involved. We like to have all our numbers back in the normal because that makes us feel better. Often, but far from always, this also actually makes the patient better.

          So I agree with the latter half of your comment above.

          1. daedalus2u says:

            I had four links, so I divided this into two comments.

            The viscosity of blood is important for pressure drop, but equally important is the cross section available for flow. The cross section is acutely changed by nitric oxide generated by shear-mediated activation of eNOS in the endothelium.

            During severe, acute isovolemic anemia, there doesn’t appear to be any deficit in either O2 delivery (the SvO2 doesn’t fall very much until below 60 g Hb/L see figure 4) or O2 consumption (figure 5). There is a slight increase at lower Hb levels, I suspect due to the faster heart rate.

            http://www.ncbi.nlm.nih.gov/pubmed/9438742

            There is no increase in lactate, suggesting that all tissues remain fully aerobic.

            If acute, severe, isovolemic anemia doesn’t produce peripheral hypoxia, what basis is there for suggesting that the much milder anemia of chronic heart failure or end stage kidney failure is producing peripheral hypoxia?

            If you do the hemodilution before the sepsis happens, then low Hb levels do seem to improve things.

            http://www.ncbi.nlm.nih.gov/pubmed/11568153

            The term “oxygen extraction” is a non-physiologic term that doesn’t really mean anything. The relevant parameter for O2 diffusion is O2 chemical potential, or partial pressure O2, not O2 concentration (because the O2 concentration of blood is non-linear in O2 partial pressure.

            I am pretty sure that the effects observed here are due to reduced NO generation by iNOS due to the lower Hb levels (resulting in higher NO levels) when the endotoxin was administered. This lower NO in the peripheral tissues resulted in less inhibition of cytochrome c oxidase and O2 consumption at lower O2 levels. This increases the gradient in O2 chemical potential between the vessel wall and the peripheral mitochondria.

            1. daedalus2u says:

              We know that “normal” physiology regulates the hemoglobin concentration of blood to be “something”. We don’t know what that “something” is, or how physiology determines whether to increase it, or decrease it, but we know that there is “something” that is doing it (because hemoglobin concentration doesn’t become either zero or infinite; it is controlled to something in between non-viable extremes).

              The Hb concentration in blood changes as it passes through capillaries.

              http://www.ncbi.nlm.nih.gov/pubmed/7517645

              The viscosity of blood at certain vessel diameters is not sensitive to Hct.

              http://www.ncbi.nlm.nih.gov/pubmed/1481902

              I agree that high Hct does increase blood pressure and decrease peripheral blood flow. I suspect that these are more due to reduced NO/NOx status (at the vessel wall) associated with higher Hb levels (reducing flow-mediated dilation), than due to increased viscosity.

            2. Andrey Pavlov says:

              I think you missed my point.

              It isn’t that viscosity predominates at the capillary or vessel level. It predominates on a system level. Sepsis is a state of high-output cardiac failure. Just increasing volume without changing viscosity will lead to these effects. Increasing viscosity just does it much more sensitively. So even though you can have a net difference in pressure across the system such that flow is maintained, your overall TPR will be increased and maintaining that pressure gradient involves more work for the heart.

              I know the data on O2 delivery – which is exactly why I stated that transfusion is done too commonly. The DO2 can be steady through a very wide range of crit/HB and even down to less than 6g/dL.

              There is no increase in lactate, suggesting that all tissues remain fully aerobic.

              If acute, severe, isovolemic anemia doesn’t produce peripheral hypoxia, what basis is there for suggesting that the much milder anemia of chronic heart failure or end stage kidney failure is producing peripheral hypoxia?

              Lactate has a very good positive predictive value but a terrible NPV. Only about 1/3 of patients with outright severe sepsis and/or septic shock actually have an elevated lactate. In some cases that is undoubtedly because they are more able to maintain aerobic metabolism. But there are many confounds from lactate metabolism and excretion to lab process errors (lactate is a time and temp sensitive assay).

              So I am not saying that the issue is peripheral hypoxia – even though that can certainly exist without elevated lactate. I am saying that the burden of work on the heart is elevated in this cases and that for ESRD as the example, there are many confounds as to why normal RBC levels artificially induced would lead to increased mortality and morbidity without being evidence of an adaptive role of anemia in play.

              The term “oxygen extraction” is a non-physiologic term that doesn’t really mean anything. The relevant parameter for O2 diffusion is O2 chemical potential, or partial pressure O2, not O2 concentration (because the O2 concentration of blood is non-linear in O2 partial pressure.

              Not sure what you mean by this. O2 extraction is a sum total of processes. It takes total blood O2 content in mL and measures the difference between blood in the left ventricle and the right atrium. Of course this is rarely done in practice so we use various ways to estimate that, but it is a pretty solid metric by which to say if there is dysoxia (which is a much more relevant metric than hypoxia or hypoxemia in these sorts of scenarios). So the data I have looked at and learned from doesn’t look at O2 concentration in discussing O2 extraction and dysoxia but absolute O2 content in mL/mL.

              Hopefully everyone should know that plasma O2 concentration is not linearly related to PO2 since it saturates extremely rapidly. In fact that DO2 equation makes that quite clear – 0.003 of the O2 content of blood is plasma. But it is the sink through which it must go to diffuse back and forth.

              I am pretty sure that the effects observed here are due to reduced NO generation by iNOS due to the lower Hb levels (resulting in higher NO levels) when the endotoxin was administered

              The issue I have with this is that based on data with dysoxia and HB that you referenced yourself, I don’t see a mechanism for that. If you look at O2 extraction as an absolute quantity you find that you don’t get dysoxia until past ~50% extraction and that one would need HgB <6g/dL to get to that point. What this is telling me is that there is a very wide range of tolerance and that tissue level aerobic metabolism will continue (assuming nothing else is going on) until the diffusion/dissociation reaction becomes unfavorable enough that the offload of O2 cannot meet demand…. and that is well below a level of HgB and O2 extraction than most severely septic and shocked patients have. So where does the NO system come into play when there is not yet a demand for O2 that isn't met? Just a decrease in HgB or crit itself, without affecting O2 status at the tissue level, shouldn't be able to trigger that response on its own.

              It just seems much less likely to me that the anemia is adaptive as you are putting it.

              We know that “normal” physiology regulates the hemoglobin concentration of blood to be “something”. We don’t know what that “something” is, or how physiology determines whether to increase it, or decrease it, but we know that there is “something” that is doing it (because hemoglobin concentration doesn’t become either zero or infinite; it is controlled to something in between non-viable extremes)

              This is an interesting point. But I think too wide open to infer that there is some sort of adaptive advantage to anemia. Seems much more likely to me to but a by product of other evolutionary changes.

              1. daedalus2u says:

                A paper that illustrated the issue is this

                http://www.ncbi.nlm.nih.gov/pubmed/12388462

                Acute high altitude causes a reduction in VO2max, even after there is “compensation” due to increased hemoglobin in the blood. Hb goes from 138 g/L to 180 g/L, the O2 content of arterial blood goes from 189 cc/L in normoxia at SL at 138 g/L to 258 cc/L at 188 g/L at hyperoxia for relative work of 271 vs 277 watts.

                What limits O2 delivery to muscle mitochondria is the diffusion gradient between the vessel wall and the mitochondria. The O2 concentration (actually chemical potential) at the mitochondria depends on the local NO level. The concentration at the vessel wall is fixed by the atmosphere partial pressure.

                The delivery of O2 to mitochondria is purely passive diffusion down the chemical potential gradient. The hemoglobin content of blood doesn’t affect the diffusion of O2, other than as a sink for NO which affects the NO concentration at the mitochondria which affects the O2 chemical potential that the mitochondria can reduce O2 to water at on cytochrome c oxidase.

                More hemoglobin doesn’t increase the O2 chemical potential at the vessel wall. More hemoglobin can increase the convective transport of O2. But that has no effect on the diffusion of O2.

                In sepsis, the NO level is made very high (at the vessel wall) by iNOS (by very high, perhaps 5 or 10 nM/L). This has the effect of shutting down cytochrome c oxidase because the NO level at the mitochondria is higher (how high we don’t know because there are no measurements). That has the effect of increasing the O2 level that mitochondria need for cytochrome c oxidase to bind O2 and reduce it to water.

                In other words, during sepsis, there is plenty of O2 delivery to the mitochondria, the mitochondria can’t use it because the NO level is too high, so cytochrome c oxidase is inhibited by the NO level. That is sort of ok, as long as the ATP level can be maintained by glycolysis. If it can’t, then the ATP level falls, the mitochondria try to turn on, the respiration chain becomes reduced, electrons from the respiration chain attach to O2 and form superoxide, superoxide reacts with NO and forms peroxynitrite, the peroxynitrite nitrates MnSOD, nitration of a single tyrosine irreversibly inhibits MnSOD, the superoxide level goes up, the peroxynitrite level goes up, the respiration chain is irreversibly inhibited via nitration. If too many mitochondria become irreversibly inhibited then the cell dies. If too many cells die, you get multiple organ failure.

                It is just as much an assumption to posit that every instance of anemia is pathological.

                There is no teleology. You can’t have “normal outcomes”, you can only have “normal processes”. If the normal processes don’t have the capacity to compensate for the circumstances they experience, then they will break.

                When I look at physiology I see many instances of good control around a bad setpoint.

  13. Pareidolius says:

    I stand by my belief that fear is the main driver of the popularity of Woo. Pure, existential angst and fear of death will make a person toss their rational mind in a second. The hypervigilance of the hypochondriac is a perfect example of that. I know from experience, my years in Wooville only came to a close when I came to terms with the inevitability of death.

  14. Pareidolius says:

    I just noticed that they cut off the comments after only 2. Chickensh*ts.

  15. Calli Arcale says:

    “If we can pick up the Voyager broadcasting with the power of refrigerator light bulb, 23 watts, from over 10 billion miles from earth, than we should be able to find a human energy field.”

    Well, maybe if we take one of these faux-native healers and strap them to the feed horn of the 70-meter Mars antenna at Goldstone Deep Space Communications Complex? :-D

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