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Rhinos and tigers and bears. Oh my.

More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly.

~ Woody Allen

No good deed goes unpunished.

The website whatstheharm.net is a depressing recitation of the harm that humans do to themselves and others from participating in various forms of nonsense in the attempt to do good. It my backfire, and instead pain and death result.

I would bet that most practitioners of medical woo are true believers. They do not intend to harm people, and believe they are doing good for their patients. Certainly the consumers of alternative therapies intend to have good benefits from their use of sCAM modalities. Most want to get better, and do not intend to hurt themselves or others.

Unfortunately, actions always have unintended consequences. Sometimes the harm is directly to the patient. Sometimes the harm in indirect, with collateral damage to people or the environment. My hospital system has an extensive recycling program to handle the huge amounts of waste generated by the need to insure that all manner of materials are sterile. Patients in isolation consume large amounts of paper and plastic to keep infection confined. My hospitals actively look for ways to decrease their environmental impact and carbon footprint and still deliver high quality medical care. Legacy Health System, where I work, is an award winning leader recycling medical waste, which is a lot more difficult to dispose of than the pop cans and paper bags in your house. Hopefully the trash in your house is not covered with pus, blood and other potentially hazardous medical waste. We try to be good global citizens.

I wonder if some branches of the alternative medical industrial complex are so environmentally conscious.

Natural products are at the greatest risk for being adversely affected by a demand for their use. If millions of people want a natural product that has limited supply, soon that product will be exhausted and the product extinct. Adverse effects from alternative therapies can come in many forms, and the alternative practice with the greatest adverse impact on the environment is probably traditional Chinese medicine (TCM). A billion or more people wanting a traditional herbal or animal product is going to have a detrimental effect on the herb or animal being consumed. There are numerous examples of the adverse effects on the environment from traditional Chinese medicine.

For years the Rhinoceros was hunted not for food or sport, but for the horn. There is a form of magical thinking that derives function from the structure of a natural product like a rhino horn. It looks like a penis. I guess. I must not have been paying close attention during in my urology rotation. Because it looks like a penis, it must have efficacy on impotence. So the rhino horn was ground up to treat impotence. For centuries it was the Enzyte of the world. But Rhino horn is more than an aphrodisiac. Although the rhino horn is no more than a fingernail with extra calcium and phosphorus, the horn has been used in Chinese medicine to treat damn near anything.

I will note here that trying to determine what a given Chinese preparation is ‘really’ used for is an exercise in frustration and, as best as I can determine, there as many uses for each TCM preparation as there are acupuncture points: an infinite number only limited by the imagination of the practitioner.

“It (rhino horn) should not be taken by pregnant women; it will kill the fetus. As an antidote to poisons (in Europe it was said to fall to pieces if poison were poured into it). To cure devil possession and keep away all evil spirits and miasmas. For gelsemium [jasmine] and snake poisoning. To remove hallucinations and bewitching nightmares. Continuous administration lightens the body and makes one very robust. For typhoid, headache, and feverish colds. For carbuncles and boils full of pus. For intermittent fevers with delirium. To expel fear and anxiety, to calm the liver and clear the vision. It is a sedative to the viscera, a tonic, antipyretic. It dissolves phlegm. It is an antidote to the evil miasma of hill streams. For infantile convulsions and dysentery. Ashed and taken with water to treat violent vomiting, food poisoning, and overdosage of poisonous drugs. For arthritis, melancholia, loss of the voice. Ground up into a paste with water it is given for hematemesis [throat hemorrhage], epistaxis [nosebleeds], rectal bleeding, heavy smallpox, etc. (1)”

I like that ‘etc.’ at the end. I thought Bayer aspirin was the wonder drug that works wonders, but aspirin will not calm the evil miasma of hill streams, mores the pity. With all the alleged benefits of consuming rhino horn, all with no biologic plausibility whosoever, it is no wonder that despite the advent of Viagra and its cousins, the rhino is still being hunted for its horn. A century ago, there were one million black rhinos in Africa; now there are 2,500 and the population is falling (2). A horn fetches $500 in a country where the average farmers makes $1.50 a day (2a). On the international market a horns gets more than $10,000 for a kilogram. No wonder the Rhino is hunted to near extinction. The fact that they have no medicinal benefit does not prevent the harvesting of the rhino. All species eventually become extinct, but to become extinct because of medical woo is particularly depressing.

Rhinos are not the the only animal disappearing due to relentless harvesting of animal parts for worthless therapies.

Tigers

In 1900 there were 100,000 tigers in India, now there are less than 5,000. China now has under 100 tigers, as they are killed and chopped up into their constituent parts for many worthless medical therapies, including, but not limited to

” a tiger’s penis soaked in alcohol is said to increase virility; its nose suspended over the marriage bed is believed to increase the chance of having a boy and its whiskers are said to cure toothache (4).”

TCM loves the tiger bones, something that the tiger cannot live without, as a treatment for arthritis, often as a tiger bone wine. 14% of the US has some form of arthritis, and if the numbers are true for China, there are 172 million potential customers for tiger bones. There are also many people outside of China who use the therapy as well. That’s a lot of tiger bones, and given declining tiger populations, it is no wonder tiger bones go for 400 dollars a kilogram, each tiger having 4.5 kilograms of bone.

“The usual dosage for Tiger bone taken orally to treat rheumatic pain is three to six grams daily. At this rate, a daily user of Tiger bone would consume one to two kilos of bone per year. Extrapolated further, the world’s remaining Tigers would provide, at most, a year’s supply of medicine to 125 800 daily users – the equivalent of far less than even 1% of China’s human population (13).”

That would be about 1/3 a tiger per year per person.

It is not a minor problem: “More than 150,000 over-the-counter traditional Chinese medicines containing – or purporting to contain – tiger bone and parts from other critically endangered species are sold in the United States (4).” Support TCM, you are indirectly supporting the extinction of rhinos and tiger and more.

As Tigers are harvested to extinction, traditional Chinese medicine has substituted other big cats like leopards, whose days are now probably numbered.

Bears

“In traditional clinical practice, bear bile was used in fever fighting, detoxification, inflammation, swelling and pain reduction. It was also used in the cure of carbuncle of heat type, pyocutaneous diseases, hemorrhoid, overabundance of liver-fire, convulsion caused by the overabundance of heat, epilepsy, tic, and redness of eyes due to liver heat etc (15).”

Again that pesky etc. Pick a disease, real or imagined, and bear bile may be a therapy. The one problem not treated with bear bile that I could find is impotence, the only TCM animal product not used for some sort of sexual dysfunction. The producers and consumers of TCM products seem to have a lot of sexual dysfunction. Cause or effect?

Rather than hunt bears, farmers keep bears in cages with a catheter in their gall bladder where they can drain the bile like sap from a maple tree. It is not a good life for the bear and often fatal. The Chinese have hundreds of farms with thousands of bears, as do other SE Asian countries.

There is an active ingredient in bear bile, ursodeoxycholic acid, that dissolves gall stones. It can be, and is, synthesized for human use. Oddly enough, the natural product is considered superior to synthesized molecule, and so the bile drainage continues and the bear population in China continues to dwindle to supply bear for the farms.

I never thought I would be agree with PETA on anything, but torturing bears for bile that does nothing or has a synthetic equivalent hardly seems like an ethical treatment of an animal. The Humane Society description of bear bile harvesting does not appear particularly pleasant for the bear, which has its bile ‘milked’ without the benefit of anesthesia (14).

” An un-sterile latex or stainless steel catheter was inserted through the external fistula directly into the gall bladders of each bear to drain the fluid daily either by gravity into a tray or by suction with an un-sterile syringe. This extraction method was called the “Free-dripping Fistula Technique”. The fluid was then dried and manufactured as “Bear Bile Powder” (Bear bile extraction) . The bears were suffering extreme pain due to daily bile extractions. Many of them often die from illnesses (such as cholecystitis, cholelithiasis, polyp formation, obstruction of the cystic duct, strictures and partial herniation of the gall bladder wall, liver cancer) and chronic infections caused by the presence of foreign bodies and their open wounds (15).”

Besides bear farms, bears are illegally hunted for their gallbladders all over the world.

The usual dose of bear bile is 0.25–2.5 g is taken as a pill or powder (15), and given that the average bear in a farm makes 20 to 40 ml a day of milked bile, it takes a lot of bears to provide the required bile. Prices vary, but bear bile can go for $1000 dollars for 250 cc. In beer talk, that would be about half a pint.

“In 1970 one kilo of bear gall bladder cost around US $200, but by 1990 the price had risen to between US $3,000 and US $5,000 per kilo. Recent market price with legal certification has risen to between US $30,000 and US $50,000 per kilo (our experience in legal market of Hong Kong) (15).”

There is considerable financial incentive to hunt bears to extinction to provide worthless medications.

Sharks

The Chinese are not the only culture who uses nonsense to help drive animals into extinction. 100 million sharks are killed every year. Some are killed as a by product of fishing, some for food, some for sharks fin soup, and some for medication. Somewhere along the line it was mistakenly thought that sharks do not get cancer. They do get cancer, and they get cancer of cartilage, albeit not very frequently. William Lane, PhD has been the primary marketing force behind the idea that shark cartilage can prevent and treat cancer, publishing books on the topic and selling shark products. Again, there was no good reason to suggest that shark cartilage had anti-tumor effects, although some data in the lab suggests that it inhibits the formation of new blood vessels, needed to support tumor growth. The clinical trials for any efficacy of shark cartilage in the treatment of cancer have been negative, but the end result was has been to help push 126 shark species towards extinction.

A Google search reveals many organic/natural/ online pharmacies sell shark cartilage. I suppose extinction is natural and organic, and supporting and profiting from the extinction of animal species is also natural and organic. Who cares is Jaws is going extinct? Not the purveyors of shark cartilage.

Saiga antelope

These animals have been hunted for their horns, which are used to treat stroke, colds and high blood pressure, and, since rhino horn is both expensive and rare, a cheaper alternative to rhino horn. Because of the protection of the rhino combined with their tiny numbers, the practitioners of traditional Chinese medicine have had to find another species to decimate for useless medical therapy. As a result their numbers of Saiga have gone from 1 million to under 30,000 and falling.

Turtles and Tortoises (7)

Half of the 90 turtle species in Southeast Asia are endangered, due to demand in China for turtle meat and traditional medicines. “The World Conservation Fund has documented the rapid decline in just the last few years of the Chinese three-striped box turtle, whose fat, used in soup and jelly, is believed to cure cancer; only a few colonies of the once-abundant turtle now survive in the wild (9).”

Sea horses (8)

There approximately 90 health and medicine products containing sea horse are sold in China and elsewhere. As is often the case, the sea-horses are being used for, among other things, an aphrodisiac. . To meet this demand some 20,000,000 sea horses are harvested each year. All die for no valid reason, and seahorse stocks are plummeting.

Other animals consumed by traditional Chinese medicine include the slow loris, whose fur is believed to accelerate healing of wounds. Extracts from the eyeballs of the loris are turned into a love potion. The civet cat is used for its anal scent gland to induce abortions well as to treat arthritis, stimulating blood flow, and increasing libido. Again with the impotence.

As mentioned above, it is not just the Chinese that use animal parts for medicinal purposes, but the effects are the best documented due to the large population and the economic clout that allows the trade in medical animal parts to flourish. India, Brazil, and Sudan are a few of the countries with documented use of local plants and animals for medicinal purposes (16), however they have not (yet) had a documented adverse effect on the local ecosystems.
Data suggests in Brazil:

“Of the total of species recorded, 24 (71%) are not under extinction risk. On the other hand, Myrmecophaga tridactyla (Linnaeus 1758), Coendou cf. prehensilis (Linnaeus 1758), Dusicyon sp., Mazama cf. Americana (Erxleben 1777), Rhea americana (Linnaeus 1758), and Crypturellus noctivagus zabele (Spix) 1825, which are officially considered as threatened species by the Brazilian Institute of Environment and Renewable Natural Resources (1989), were found among the set of faunistic resources prescribed as medicines at the time of this research.”

There is good money in the trade of animals, even to the point where the director of the Berlin zoo was selling ‘extra’ tigers to the Chinese for medical use (10).

Plants have it worse than animals, feeding the voracious appetite for traditional Chinese medicine. Over 400 plants are at risk for extinction from medical use as 5 billion people use plants as the basis for their medical care, although not all of them from traditional Chinese medicine. Examples include, but are not limited to

Magnolia

Half of the world’s species of magnolias are under threat of extinction, which is used in traditional Chinese medicine to treat cancers and slow down the onset of heart disease (12). There are two diseases with similar pathophysiology: cancer and heart disease. I can see why they have the same treatment.

Manchurian Ginseng (13)

A popular treatment for memory function as well as cancer, COPD, diabetes, fatigue, increasing libido (where it that etc. when I need it?), Ginseng has all but been eradicated in China and Korea. As a result it is harvested in the US and sent to China. Wild ginseng is though to have better medicinal properties than farm raised, so the harvest of wild ginseng continues in the US, threatening that species with extinction in the US as well.

Dendrobium candidum

An orchid that is believed to cure hoarseness, is so rare that it now costs 12,000 times more than wheat.

Licorice

Licorice root is an Asian plant species commonly used for pain relief and to treat coughs, skin infections, food and drug poisoning. Licorice is almost wiped out in China – “largely at the hands of Chinese soldiers making some pocket money by digging up the plant while on duty in the country’s northern border region, which is called by some the “licorice zone”(6). Due to excessive harvesting and habitat destruction, licorice root is now grown in less than half its previous area; reduced from 50,000 square miles to about 19,000 square miles.”

These are just the tip of the iceberg as “of the 1,581 species of animals used as a medical resource, 1,306 are terrestrial animals and 275 are marine animals… 11,146 are of plant origin (5).

One of the complaints about natural herbal medications is that there is uncertainty as to what the concentration of active products, if any, are. It is argued that a superior way to treat disease is to isolate the active ingredient and then synthesize it. Herbalist of all stripe reply that one needs the complex formulation of the natural product for efficacy. No natural/herbal product I am aware of is superior to the synthesized pure product and none of the synthesized products lead to animal or plant extinction.

We are, perhaps, at the beginning of a mass extinction of animal and plant species for a variety of reasons. That we are wiping out ginseng and tigers and bears for the myth that they can cure or treat disease, that these plants and animals are dying out because of belief in magic, is evil.

Some Chinese practitioners object to interference and criticism of their practice, feeling it is racist for the West to put limits on Eastern practices that we do not understand.

“In addition, we would like to point out that recent campaigns against the use of some of our medical resources, for example tiger bones, bear bile and rhino horns, have led to a negative stereotyping of our practice…As part of a scheme in recent history to cast the then Chinese herbalists as ‘the other’, their use of animal material medica has been exploited in the past to devalue the yao they use, and in the process, devalue and delegitimize their medical practice (5).”

It is racist to be against unproven, implausible magic that is leading to the extinction of hundreds of animal and plant species. Special pleading to allow the pointless extinction and torture of animals for worthless medical therapies.

There is also a movement to make traditional Chinese medicine sustainable, by using alternative worthless products instead of endangered medically worthless products. There are arguments that the bear bile farms are helping prevent the bears from being hunted to extinction, a sort sort of greening TCM induced extinction. Traditional Chinese Medicines is the Hummer of the altmed world, trying to sustain the a destructive practice despite its causing more harm than good to the world. It could be an unexpected byproduct of the adoption of science based medicine that rhinos and tigers and bears would be saved from TCM induced extinction. Perhaps the rational use of science derived evidence will make the TCM therapies will go the way of acupuncture….. bad example. One would hope that if science would demonstrate that the therapies are worthless or that there are synthetic alternatives, that the march of the tiger and rhino towards oblivion would be halted.

Homeopathy

Water is an increasingly precious resource in the world, and will become even more so as the glacier melt that provides water to large numbers of people disappear with the glaciers. I have read that future wars in the mideast may be over water not oil.

It takes a lot of water to make a homeopathic concoction.

I love this quote, from the Australian Councils Against Health Care Fraud

“Homeopathic vaccines – (A) little bottle of water contains what the label describes as a homeopathic vaccine against meningococcal disease. As if that lie is not enough, the label also contains a claim which puts the product in breach of consumer protection and fair trading laws. It says that this preparation is “200C”, but if that is the case then the manufacture of this single bottle would have involved 800 manufacturing steps (excluding packaging) and would have produced 495 litres of waste water. (To produce a single year’s worth of “vaccine” doses would require 73% of the water needed to produce all of the Coca Cola consumed in Australia in a year.)”

Evidently they drink a lot of Coke down under. To make one 200C vial of meningococcal vaccine would take as much water as a 50 minute shower with a low flow shower head. That is a lot of wasted water (17). Multiply that by the hundreds of different homeopathic concoctions and you have an enormous amount of water being wasted for no purpose.

It is a moral-ethical question as to where your responsibility ends. We recycle in part because there is a sense that we are responsible for our garbage even after we have thrown it away. A similar sense of responsibility is lacking for our carbon footprint, but growing. I am old enough to remember more politically active times, when one did not eat California grapes or Nestles chocolate because to do so was to support a companies that were ‘evil’. In part I have accepted nothing, not even a piece of pizza, from a drug company in over 25 years because half of drug costs go to support advertising. My patients subsidize the cost of my ‘free’ pizza and I think it is not ethical for my patients to pay more for medications so I can get a free pen or other trash to add to the landfill. Everyone will draw the line as to where their responsibility ends at a different place.

The bumper sticker reads “Think globally, act locally”. Want to help rhinos and tigers and bears? Don’t support the practices that are driving them to extinction. Support your local traditional Chinese practitioner and you may be inadvertently supporting the extinction of numerous animal and plant species as well as doing nothing to promote your own health.

The harm of medical woo can extend beyond the damage we do to ourselves and others. It can lead to extinction. As Clint said, “Its a hell of thing to kill a species.”

Just don’t bring up the plane flight to the SBM conference.

—–

Thanks to my colleagues, esp Dr. Atwood,  who covered spot my two weeks ago when I was ill.

(1)http://209.85.173.132/search?q=cache:U648KL9qCKcJ:www.biaza.org.uk/public/images/campaigns/rhinoDocs/chinese.pdf+rhino+horn+aphrodisiac&hl=en&ct=clnk&cd=12&gl=us

(2) http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/article378490.ece

2a) http://www.american.edu/TED/rhinoblk.htm

(3) <sarcasm></sarcasm >

(4) http://news.bbc.co.uk/1/hi/special_report/1998/chinese_new_year/50218.stm

(5) http://www.environment.gov.au/biodiversity/trade-use/publications/symposium/tiger.html#materia

(6) http://www.independent.co.uk/news/science/the-bear-bile-cure-539187.html

(7) http://www.itmonline.org/arts/turtles.htm

(8) http://www.taipeitimes.com/News/feat/archives/2003/06/24/2003056592

(9) http://advocacy.britannica.com/blog/advocacy/2008/11/708/

(10) http://www.telegraph.co.uk/earth/earthnews/3336945/Berlin-Zoo-director-accused-of-selling-animals-for-Chinese-medicine.html

(11) http://bigcatrescue.blogspot.com/2007/02/clouded-leopard-parts-used-in-chinese.html

(12) http://chinesemedicinenews.com/2008/01/19/medical-plants-face-extinction-magnolia-included

(13) www.traffic.org/species-reports/traffic_species_mammals14.pdf

(14) http://www.hsus.org/wildlife/issues_facing_wildlife/wildlife_trade/the_unbearable_trade_in_bear_parts_and_bile/

(15) http://www.ethnobiomed.com/content/5/1/2

(16) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0001-37652005000100004&lng=en&nrm=iso&tlng=en

(17) It has been suggested by others that, given the vast quantities of water needed to make homeopathic concoctions, perhaps they are not really making the preparations with the dilutions like they say they are. In Portland water bills are public knowledge and every year the local paper publishes the top 10 water users. We do not have a homeopathic factory in the city, but might I suggest that if you have one in your city, get the water bill and see how much water they use and compare it to the homeopathic concoction production.

Posted in: Herbs & Supplements, Homeopathy

Leave a Comment (46) ↓

46 thoughts on “Rhinos and tigers and bears. Oh my.

  1. Jules says:

    So very true…although I do think many of the plants used in TCM do have medicinal compounds and these are worth studying, provided that a method of synthesizing them can be thought up.

    Wise stewardship is always easy in hindsight, though, and only rarely so simple in foresight. The Japanese have done it with their forests; it remains to be seen whether China and India can muster the political will to do so.

  2. Manduca says:

    Surely homeopaths use serial dilution?

    You can make a 200C dilution with by diluting 1 microliter of your concentrated stock with 99 microliters of water 200 times, which would require less than 200 mL.

    Actually, to have enough for multiple doses, you’d have to stop at 199C, then use all 200 microliters of that to make 20 mL of the final product.

    I’m not sure wasting water should be our main worry about homeopathy.

  3. David Gorski says:

    Loved the post otherwise, but I have to agree with Manduca here. I doubt the manufacture of homeopathic remedies eat up that much water. Even if you multiplied the dilution steps by ten or 100 (after all, it’s pretty darned hard to measure out 1 ul accurately 20 times), it would still still only be 200 mL or 2 L or water. In any case, I’ve never seen a 200C homeopathic remedy. The highest dilution I’ve seen routinely is 30C.

    And, yes, homeopaths do use serial dilution. Each “C” is a 100-fold dilution. So a 30 C dilution = (102)30 = 1060 dilution. (As has been pointed out, Avagaddro’s number is only on the order of 6.023 x1023, which means that the chance of a single molecule being left in a 30C homeopathic solution is slim and none. A 12C (1024) is the closest to being on the order of magnitude of Avagaddro’s number. That means a 12C dilution of a 1 M solution–a pretty darned concentrated solution–would have slightly more than a 1 in 2 chance of having a even single molecule of the original substance left.) At each dilution step, the remedy must be “succussed” (vigorously shaken) or it is useless. The succussion is claimed to imbue the homeopathic remedy with its potency; as homeopaths keep telling me it’s not just about the dilution. Unfortunately insisting that succussion is necessary to imbue the remedy with some sort of potency only makes homeopathy sound even more ridiculous.

  4. qetzal says:

    I wonder how they go about scaling up manufacture of these homeopathic remedies. I agree the total water required is unlikely to be an issue, but what about the succussion? How do they make sure they’ve succussed vigorously enough and long enough when they go to commercial batch scale?

    I found one company that claims to make their homeopathic remedies according to Good Manufacturing Practices (link), just like a real drug.

    Really? GMP requires validation studies to prove that what you make at commercial scale is reproducible and equivalent to what you make at small scale. It requires particular investigation of any claimed critical steps. In this case, it would require some demonstration that their large scale succussion is effective, as well as data showing acceptable operating ranges. I.e., they’d need to show that ‘properly’ succussed preps are effective, while improperly succussed ones are not.

    I’d sure love to see their ‘validation’ studies! Assuming they exist, I bet they’re hilarious. Maybe we’d learn the secret for quantifying ‘water memory’.

    Buffoons.

  5. hatch_xanadu says:

    I thought the bit about water was partially tongue-in-cheek.

  6. Chris says:

    I was recently directed to this very funny older post on homeopathy recently:
    http://photoninthedarkness.com/?p=6

    An example:

    That’s a lot of water! [Note: that much water, if it were collected in one place, would result in the formation of a black hole large enough to collapse the entire Universe - you might want to stand back a bit.]

  7. Calli Arcale says:

    One great example of how it *should* work is Taxol. When it was found that an extract of Pacific yew bark was beneficial against breast cancer, it was fantastic. The big drawback was that Pacific yews are a) endangered, b) grow very slowly, and c) don’t have a very good concentration of the important chemical, so you need a lot of them. So the chemical was studied, understood, and synthesized — no more Pacific yew trees need to be felled in order to satisfy demand for this drug.

    The depredations of traditional herbal medicine astound me. Black markets have grown up such that most of the suppliers really don’t care much about the supposed benefits of these products, except insofar as it increases the price they can get for the raw materials. One of the most disgusting examples is the rhino. Not mentioned in the article is what the black market is consciously trying to do, possibly with the blessing of elements of the Chinese government (though probably not the government itself). Rhino horn is extremely valuable, but there is a limit to how much a well-established organized crime boss can make off of it. The supply is limited, after all, and anyone seriously paying attention can tell that it’s probably going to go extinct in the near future if any harvesting continues. How, then, can profits be increased?

    By reducing supply. Ironically, efforts to better protect the animals and to crack down on importing rhino horns into China have actually aided the organized crime bosses, while only putting their less well-organized competitors out of business. A few years ago, China had a bonfire in Beijing where they burned a huge pile of confiscated rhino horns and other contraband animal parts. Intended to send a message that this will not be tolerated, it instead played right into the criminals’ hands by very visibly reducing the supply.

    What else are they doing to reduce supply? It appears that some of them are deliberately trying to drive the rhino into extinction, because once it is extinct, their rhino horn stockpiles will increase dramatically in value. To this end, they have been sending poachers into Africa to kill rhinos — even rhinos who have had their horns removed by well-meaning game wardens. (Game wardens have started sawing off the horns in hopes this would discourage poachers, by removing the animal’s value. But poachers will take even a hornless rhino, abandoning the body after extracting even the tiniest slivers of horn that remain.)

    The late Steve Irwin often said that the solution isn’t to be found in ranching (providing a non-wild supply) or in efforts like the South African attempt to dehorn rhinos. The real solution is not to make the supply inaccessible or provide a “green” supply — the real solution is to remove the demand.

    Banning ownership of the parts helps. But what helps more, and what Irwin was working towards, is to convince the general public not to want these things in the first place. Showing the world the fraudulent nature of Traditional Chinese Medicine will hopefully help. There is no reason to want to eat powdered rhino horn. It will do you no good. Save your money, and save a rhino too.

  8. apgaylard says:

    Some homeopaths have found they don’t need to waste their time and energy with all that dilution and succission. Using the e-Lybra they can “make” remedies at any “potency” using computer-controlled electrickery!

    For the Homeopath

    Make single or multiple remedies easily and quickly in any potency Comprehensive listing of 2,700 homeopathic remedies from the current materia medica Exclusive to e-Lybra®9: Bacterial, Viral, Hormone, Fungal, Enzyme, Protein/Peptide, & Pharmaceutical Drug Rems.

    Ability to select any potency in X, C, LM (so if you want 28c or 4x or 18LM then you’ve got it!) Buffered Interface Matrix (BIM) variable potency

    “They are equal to, if not better than serial or conventionally made remedies. They seem much cleaner and more precise.”
    Dr. Andrew Marsh, D.O., D.Hom., F.H.M.A. (UK) H.D.

  9. Skeptico says:

    It takes a lot of water to make a homeopathic concoction.

    The real problem is what they do with all that excess water.  They flush it down the sink.  Think of the dangers – all those potent homeopathic drugs just flushed down the sink.  Recent studies have shown Homeopathic Drugs found in US Drinking Water.

  10. The taxol story related by Calli Aracale is a perfect one for how to get real medicine from real ideas. Unfortunately, the CAM-pushing crowd use it as an example of how great herbal medicine is.

    Anyways, great post. I never thought about CAM in this way. And now I have to read whatstheharm.net on a regular basis.

  11. qetzal says:

    “They are equal to, if not better than serial or conventionally made remedies….”
    Dr. Andrew Marsh, D.O., D.Hom., F.H.M.A. (UK) H.D.

    That part, at least, I fully believe. ;-)

  12. Mojo says:

    David Gorski wrote, “In any case, I’ve never seen a 200C homeopathic remedy.”

    Meet Oscillococcinum:

    http://en.wikipedia.org/wiki/Oscillococcinum

    Not only is it a 200C potency, but the purported active ingredient (“Oscillococcus”) never even existed outside the imagination of its “discoverer”, a Dr. Joseph Roy.

    It is, rather suitably, made from a duck.

  13. Dacks says:

    Skeptico – sooo funny! I’ll have to save that link.

  14. Joe says:

    David Gorski on 27 Mar 2009 at 8:26 am wrote “Loved the post otherwise, but I have to agree with Manduca here.”

    Yes, the Australian Council’s calculation is clearly in error. Offhand- a commercial batch may take that much water, but it produces thousands of doses (the “little bottles” of which they write).

    I also loved the post. If there is any bright side- I saw a PBS program on this topic ca. 10 years ago. They purchased some remedies containing “tiger” and had them analyzed. They didn’t say for what (antigens, DNA … ?); but concluded that there was no actual ‘tiger’ in anything they bought. It gives one hope that, as the animals approach extinction, the fraud of their medicinal value will be supplanted by the fraud of mis-labeling. Perhaps the manufacturers will realize it is far more profitable to lie, than to buy the real thing.

  15. hatch_xanadu says:

    I’ve been wondering myself whether falsified ingredients will ultimately help to curb poaching — by either preserving the supply and/or flooding the market and therefore making the perceived product less rare and valuable — or whether they will encourage more use of the products (and more poaching) by their presence in the public consciousness. I can also imagine “authenticity wars” taking place for illegal animal/plant products — i.e., “Don’t be fooled by cheap imitations; we have your real tiger right here.”

  16. “Meet Oscillococcinum”

    Mojo, you took the words right outta my mou..er, pen. I know that Gorski knew this a few mos. ago, because we had a good laugh about it, but it feels good to catch him in a momentary brain freeze. ;-)

    Fantastic post. It also has to do with the fashionable term “cultural competence,” which is fraught with misinterpretation and potential mis-use. Maybe wunna my colleagues will tackle that topic in the future.

  17. David Gorski says:

    I had heard of Oscillococcinum; I just hadn’t remembered hearing it as a 200C homeopathic dilution. I’ve actually looked at a couple of papers using this particular homeopathic “remedy” but I think they were your garden variety 30C dilutions.

    The mind boggles, as a 200C dilution would be (102)200 = 10400!

  18. qetzal says:

    Don’t worry about those mind boggles, Dr. G. I’m sure there’s a homeopathic remedy for them!

    ;-)

  19. Mark Crislip says:

    I probably should have cut out the homeopathic part, as there was also the topic of contamination of alternative meds I also cut as it didn’t fit.

    But I spent far too much time trying to figure out how many homeopathic concoctions are made and trying to figure out how much water that represents.
    If they really are succussing, then a quart at a time, max, per dilution without some real repetitive stress injury, I would limited to a pint.

    Any one out there know how they do scale up?

    I cut a calculation that to make the US homeopathic nostrums at 30C, it would be the same amount of water 1500 families of four would use in a year, but there were far too many suppositions to make it a legit number.

    So I left it in. I could not let that much fruitless searching go for naught.

    My next post will be on homeopathic circumcision.

    I also wish I had thought of the skeptico post. My envy is undiluted.

  20. DLC says:

    Who was it who said something like : “To insure the mixture isn’t inferior, place one drop in lake superior”
    I think it was Oliver Wendel Holmes ?

    Isn’t Rhino horn essentially the same as horse hoof ?
    If so, then let them eat jello.

  21. qetzal says:

    Any one out there know how they do scale up?

    No, but I’m sure there are existing things they could attempt to use. Your local hardware store probably has a shaker that can mix, er, succuss 5 gallon cans of paint pretty vigorously. That would yield 18000+ one mL doses.

    Hey! If I put 6.4 oz of light blue paint into 100 times as much white paint and shake it up at the hardware store, will that give me 5 gal of dark blue paint? (I’d use water-based paint, of course!)

  22. Dr Benway says:

    You heard the one about the guy who forgot to take his homeopathic meds? Died of an overdose.

    Say, has anyone written to one of these pro-TCM faculty at Harvard, UCSF, etc., and asked about the poor wretched tigers and bears?

    I’d be interested in hearing either how one can claim to practice TCM while eschewing these remedies, or how one goes about justifying their use.

  23. Mojo says:

    David Gorski wrote, “The mind boggles, as a 200C dilution would be (102)200 = 10400!”

    Especially as there are, on current estimates, only about 1080 atoms in the observable universe.

  24. Mojo says:

    Sorry – my formatting didn’t work there – it should be 10 to the power 80 atoms in the universe, and a 200C dilution as 10 to the power 400.

  25. Harry says:

    Mark,

    How could you have possibly have gotten sick? You are an ID doc, don’t you have the inside track to all the cures that big pharma hides from the little people?

    -Harry

  26. People keep correcting me about the 495 litres of medical waste necessary to make a 25ml bottle of 200C homeocrapic preparation.

    25 millilitres

    99 times that discarded in each step

    200 steps.

    .025 x 99 x 200 = 495.

    I don’t believe that they do anything like that, which is why I said “the label also contains a claim which puts the product in breach of consumer protection and fair trading laws” in the passage Mark quoted. They just bottle it from the tap, filtering and antisepsis optional.

  27. Now back to the original topic.

    How much tiger bone and rhino horn sold in TCM “pharmacies” actually contains some tiger bone and rhino horn? Do the distributors do any tests? Does anyone care? I suspect that a lot more of these products are sold than are actually produced.

    The mention of large quantities of water reminded me of a battle a few years back over the supply of bottled water to offices. This wasn’t about those little bottles which, together with an iPod, are mandatory for users of public transport, but those large bottles that you see in the corner of almost every office and in the reception areas of professional practices.

    There was a very dominant market player and a challenger came along. A cash takeover offer (rumoured to be $35 million) was rejected as being only about 10% of the value of the business, so the interloper set up a bottling and distribution centre in Sydney to process the many megalitres of spring water required to service the Sydney market.

    Did I mention that this was water from a very specific spring? The problem was that the spring was in Perth, a trivial 3301 kilometres away by air, 4352 by rail or 3934 by road.

    There seemed to be five ways to get around this problem.

    1) Build a 4,000+Km pipeline from the spring to the bottling plant.

    2) Truck the water across the Nullabor Plain using about 40 tanker trucks per megalitre. (They could reduce the number of road movements across the country by using road trains, but they would have had to be broken up to smaller units to get through the Sydney suburbs.)

    3) Fly the water to Sydney in the sort of tanker planes used by the Air Force for in-air refuelling, then use the 40 trucks per megalitre for local delivery.

    4) Bring it in by train, with the same need for trucks for local delivery.

    5) Substitute water from the local Warragamba Spring and not tell anyone about it.

    I suspect that the problem solution used by the water vendors will not be too far away from the solution adopted by TCM practitioners when the supply of tiger and rhino parts dries up.

  28. Mark Crislip says:

    each dilution could be used as the basis for a growing number of subsequent dilutions.

    my brain hurts when I try and think how they do it.

    how do they do it?

  29. The Blind Watchmaker says:

    I wonder if they actually go through that many dilutions, or if they just say that they do.

  30. Joe says:

    Mark Crislip on 28 Mar 2009 at 10:19 pm “how do they do it?”

    The first step depends on the nature of the substance. For example, insoluble solids are ground under solvent in a mortar, and the solvent is then treated as though it contains the material. For Hahnemann, the solvent was likely to be (ethyl) alcohol, and he may have used it throughout, water is the cheaper alternative; however, one can purchase 30C dilutions in alcohol.

    For simplicity, consider using a soluble liquid. One unit (volume) is dissolved in nine units of solvent to furnish a 1X prep, or one unit is dissolved in 99 units to make a 1C solution. Continuing, a volume unit of 1X is diluted into nine more of solvent, providing a 2X prep (similar treatment ensues if one is making C potencies). Thus, a 24X prep has been diluted that many (24) times.

    Of course, each dilution must be succussed for success. There are at least three ways of doing that. One involves rapping the bottle against a leather-bound bible, another involves rapping the bottle on the homeopaths hand. There are machines that can be used, and I don’t know how they succuss; but I think that is cheating, just like the orgasmotron in the movie “Sleeper.”

    The Blind Watchmaker on 28 Mar 2009 at 10:55 pm “I wonder if they actually go through that many dilutions, or if they just say that they do.”

    You are right to wonder that. Considering homeopaths are selling water, their primary expense is the time spent on the product. Jay Shelton (Homeopathy Prometheus, 2004) estimates that it takes several hours to make the 100C potencies favored by many homeopaths. Cutting back on the number of dilutions enhances profitability.

    Another problem is the incorporation of active amounts of real drugs in homeopathic preps. This paper discusses both residual active ingredients and added active ingredients. http://www.ncahf.org/pp/homeop.html

  31. David Gorski says:

    People keep correcting me about the 495 litres of medical waste necessary to make a 25ml bottle of 200C homeocrapic preparation.
    25 millilitres
    99 times that discarded in each step
    200 steps.
    .025 x 99 x 200 = 495.

    Except that it’s completely unnecessary to dilute 25 mL at each step, as any chemist who’s done serial dilutions to achieve a desired low concentration will tell you. A much smaller amount could be used in the first 199 steps, and then have only the final step scale up to 25 mL, as has been pointed out.

    For example, one could dilute only 0.5 mL at each step for the first 199 steps:

    0.5 mL
    99 times that discarded in the first 199 steps:

    .0005 X 99 X 199 = 9.85 L discarded

    Then at the final step, one could take the 50 ml of the 199C solution and dilute the entire thing up to 5 L and have 5 L of the homeopathic prep., rather than a mere 25 mL.

    9.85 L + (5L – 50 mL) =14.7 L, with a heck of a lot more homeopathic remedy, 200 vials of 25 mL, somewhat less accounting for loss.

    In fact, if you then divide it:

    14.8 L / 200 vials = 74 mL discarded per 25 mL vial produced.

    Water waste is the least of the silliness when it comes to homeopathic remedies.

    Sorry, I can’t help it. I was a chemistry major, and my research now involves molecular biology. Titering virus stock involves preparing serial dilutions for standards, and that’s how we do it without wasting a ton of buffer.

  32. David Gorski says:

    Of course, each dilution must be succussed for success. There are at least three ways of doing that. One involves rapping the bottle against a leather-bound bible, another involves rapping the bottle on the homeopaths hand. There are machines that can be used, and I don’t know how they succuss; but I think that is cheating, just like the orgasmotron in the movie “Sleeper.”

    I’ve often wondered this myself. I’ve been condescendingly informed by homeopaths on many occasions (remember Dana Ullman?) that the succussation at each step is absolutely necessary to imbue the homeopathic remedy with its potency. Failure to succuss properly at each step leaves one with nothing more than a serial dilution. Or so I’ve been told time and time again by Dana Ullman and other homeopaths.

    Fortunately for us, NCCAM has funded a study to look at the very question of whether succussion is better than stirring for potentizing homeopathic remedies:

    There was actually awarded an R21 grant to study homeopathic dilution and succussion and how they affect the dose-response curve of homepathic remedies. This latter grant actually proposes to study whether succussion (the vigorous shaking done with each homeopathic dilution) that, claim homeopaths, is necessary to “potentize” their remedies affects the dose-response characteristics of homeopathic remedies up to 30C dilution (30 times 100-fold, or a dilution factor of 1 x 10-60). This is a dilution factor many orders of magnitude larger than Avagaddro’s number, which is makes a 30C homeopathic remedy nothing but water. Period. In fact, the investigators are actually going to compare stirring with succussion to see whether succussion, as homepaths claim, improves the dose-response curve.

    Truly, the mind does boggle that money is being wasted on this.

  33. Mark Crislip says:

    I was actually wondering more about the scaling up to produce large numbers of each preparation, the industrialization of the product.
    the British health service spent 600,000 pounds on homeopathic stuff in a year. that is probably the most reliable number

    25,000,000 pounds for the whole UK yearly

    the US spends 250,000,000 yearly give or take a few million
    that maybe 25 million “prescriptions”

    that translates into a lot of pills

    washington homeopathic products say they make over 1700 remedies, but their production facilities look like a large garage.
    http://www.homeopathyworks.com/jshop/

    the Boiron group in europe seems to have a ‘real’ pharmaceutical building and as I read their financial statement (incorrectly I bet) they take in 10 x what they spend

    http://www.boiron.com/en/htm/homeopathic-laboratory/financial-datas.htm

    waste water is the least of the homeopathic silliness, BUT

    there are two things may be helping kill newspapers: Craigs list is taking away their advertising and the environmental impact of newspaper: chopping down trees and the issue of disposing/recycling.

    It is perception: if products are seen as wasteful, and anti environment, it will decrease their use. Alt med is not green.

  34. qetzal says:

    the Boiron group in europe seems to have a ‘real’ pharmaceutical building

    I find that fairly amusing. Like little kids playing dress-up. They’ve got all the grown-up things, but what they’re doing with them is just silly.

  35. David Gorski says:

    It is perception: if products are seen as wasteful, and anti environment, it will decrease their use. Alt med is not green.

    Agreed, but the water argument is definitely the weakest example used to argue this. The killing of endangered species and elimination of various herbs thought to have medicinal value are far stronger arguments.

  36. Joe says:

    Mark Crislip on 29 Mar 2009 at 11:13 am “I was actually wondering more about the scaling up to produce large numbers of each preparation, the industrialization of the product.”

    Oh, I thought you wondered if they take 1 uL directly into 1 L and call it 6X (3C).

    In the case of liquid doses, that is a problem since a person can manually succuss only a pint or so at a time (on an assembly-line). Shelton estimated each dilution-succussion takes 2 minutes. If one could maintain that pace for an hour it would only yield 30 pints. As I noted, some places have mechanized the procedures, and they may have a way to succuss 5 gallons at a time in the final stage.

    For “pills” (also called globules), the solution is trivial. You see, once you have produced a 200C dilution, it remains that way. So, you only need to mix 1 drop into enough lactose to make 500 doses, and then use standard technology to punch out the pills.

  37. Sastra says:

    I think that the most interesting thing about this issue on environment vs. alt med is the cognitive dissonance it must cause in the minds of the alties, as their romantic love for nature leads to a conflict between seeing the Big Picture and trying to live in the Small one.

    I’ve noticed that many alt med enthusiasts tend to think of the world in very small terms, as if they were living back with shamans and wise elderly grandmothers who dug up roots and berries from the woods behind the tribal huts. It’s all loose and intuitive and focused on the personal, local story being played out between the sick person, the traditional healer, and Nature. In this world, nothing has changed for thousands of years. Although it’s “holistic,” it’s the holism of the spiritual connection between man and nature. The focus is narrow and the mindset is primitive or old-fashioned.

    Environmentalists, however, require science and statistics to examine the planet as a whole — and they need to recognize that everything has an impact on everything else. This is a different kind of “holism,” one which connects humans and their natural environment on the physical level. Environmentalists have to live very much in the world today, and you can’t think about human behavior as isolated stories.

    So what happens when the Little Picture runs smack dab into the Big Picture, and taking the traditional cure depletes the resources of the planet? Which world view and value wins out?

    I don’t know. But perhaps this environmentalist angle is like the move I’ve heard they use in some of the martial arts — where you use your opponents’ strength against them.

  38. daedalus2u says:

    A larger source of waste water is from the water used to wash and rinse the containers between each use. As I understand it, GMP pretty much requires clean in place or some type of cleanliness validation. Do they test the containers for purity after cleaning them?

    Or do they use disposable containers, oh the horror.

  39. Mojo says:

    “Except that it’s completely unnecessary to dilute 25 mL at each step, as any chemist who’s done serial dilutions to achieve a desired low concentration will tell you. A much smaller amount could be used in the first 199 steps, and then have only the final step scale up to 25 mL, as has been pointed out.”

    And then there’s “grafting”, of course. This is a process by which blank sugar pills, if put with homoeopathic sugar pills, are supposed to magically acquire the homoeopathic properties of those pills. A homoeopathic glossary available on the web states “Also done with liquid potencies”, which I would have thought can only mean just adding more solvent. So they could just make up a very small amount, and add as much solvent as they wanted at the end. They’d have to be careful not to shake it during the process, of course, as that would of course make it too powerful.

    The more I find out about homoeopathy…

  40. Joe says:

    Mojo on 29 Mar 2009 at 4:48 pm “And then there’s “grafting”, of course.”

    That’s an excellent point!

  41. qetzal says:

    As I understand it, GMP pretty much requires clean in place or some type of cleanliness validation.

    It does. Of course, it would be child’s play to validate that they cleaned the water out of a container that only contained water to begin with. Just stick ‘em in a drying oven.

    Oh, but I didn’t take grafting into account. That’s gonna complicate things. How many molecules of residual water in the container would be enough to immediate convert any new water to the same 200C potency as the previous batch? The next batch would end up at 400C. Someone might overdose!

    Luckily, GMP also requires performing a validated potency test on the final product, so they’d catch that if it happened. And they’re obviously being diligent about cleaning and testing – I’ve never heard of someone overdosing from a 200C product that was actually 400C.

    Once again, homeopathy is superior to evil pharmaceuticals!

    ;-)

  42. weing says:

    Why not just go for a swim at the beach?

  43. uptoeleven says:

    Firstly there is this: http://www.cites.org/

    It’s not much but it’s a start.

    Here in the UK the MHRA is going to start regulating TCM herbs 2 years from now. This will mainly be focused on the patent pills rather than the powders or decoctions but again, it is a start. It is very difficult to take TCM seriously for treating people because the herbs themselves are used in complex combinations to treat conditions that, at least in orthodox medicine, either don’t exist or are not connected. There is no standardized training and a lot of the “well regarded” institutions, particularly in the UK, teach “this is how we do it in Beijing, copy and learn by rote, you’re a westerner so you’re not really looking to do this for treating ill people, only the worried well”. The colleges and their teaching clinics (such as exist) are inspected by “The British Acupuncture Council” with a fortnight’s notice so on the day everything is shiny and good, there are no spot checks. The BAC is a self-appointed council in any case and holds no regulatory powers although some of the insurance companies require membership before they will indemnify you as a practitioner. Graduates then start treating patients who, for the most part, are indeed the worried well who will put up with a bunch of disgusting tasting herbs for a couple of months before thinking “screw this”.

    None of this would be a problem – placebos are good and have their place – except there are a small number of practitioners, some of whom are outside the “remit” of the BAC, who are getting some remarkable results. I will mention no names because I don’t need to get anyone in trouble. I have a life-threatening condition which I treat using orthodox medicine. As a consequence of this treatment I suffer some fairly unpleasant adverse effects but the treatment seems to work on the condition I have. I also have a collection of seemingly unrelated (according to the Summary of Product Characteristics) which nonetheless abate along with the adverse effects on dechallenge and resume on rechallenge. This means I stop taking meds and my condition gets worse but the side-effects get better, then I resume the treatments and the side-effects come back. As the other “orthodox” medicine treatments for my condition are more expensive, less effective and with greater adverse effects I am therefore left to put up with them.

    I have been using TCM for the last 3 years to try to alleviate some of the effects. The herbs taste of bitter and burnt and generally unpleasant but they seem to alleviate symptoms. My practitioner recently changed the formulation – it tastes the same but my side-effects kicked in – and I will get him to put back in whatever ingredient he has left out. Generally I am now tolerating both the TCM and orthodox meds well and living a relatively normal life.

    So would the active chemical component of the ingredient that “works” for me be useful to extract and market. Probably not. It’s too expensive for one. What about the 3 phases of drug trials and ongoing safety monitoring? And what exactly does it work for – my side-effects and reactions are different from other peoples’, even those with the same body type, age, cultural background as me. We are all different and we all react differently to medicines. And would it even work? Remember that the “active” component within a twig or seed might have other “active components” that either multiply, enable or entirely negate certain aspects of their pharmacology. What about the other TCM herbs one might ordinarily prescribe this herb with often for very good reasons (in their system).

    Obviously most of you think I am mad. Why would anyone potentially risk their health using lotions and potions and whatnot. All I can say in my defence, while realising how unscientific and unreasoned it is, is that I wouldn’t bother if it wasn’t working for me.

  44. Chris says:

    So you are happy contributing to the extinction of several plants and animals? Or did you just not understand why this blog posting was titled “Rhinos and Tigers and Bears, oh my!”?

    Well, my anti-ecological dyslexic friend, help is on the way! Dr. Crislip has recorded the core of this blog entry on a podcast:
    Green our SCAM.

  45. Chris says:

    Hell’s News Stand has made a couple of really good graphics to go with this:
    http://hellsnewsstand.blogspot.com/2009/04/new-poster-from-insitute-for.html

    and
    http://hellsnewsstand.blogspot.com/2009/04/new-poster-from-insitute-for_18.html

    Enjoy.

    Oh, and does anyone think that “uptoeleven” bothered to go back and actually read what Dr. Crislip wrote?

    (side note: I downloaded all of the Dr. Crislip’s quackcast podcasts. I listened to the first five as I wrestled with a huge Cecile Brunner climbing rose, trying to get it attached to the deck and not blocking the driveway. It almos made me forget the pain of the thorn stabs and being bit by a ladybug — that little bugger has a nasty bite! Fortunately, I keep my tetanus shots up to date, because I certainly do not want to be a patient of an infectious disease doctor.)

  46. I love the Quackcast. Also… ladybugs BITE??? o.O

    Yay for tetanus shots! :)

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