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“Toxins”: the new evil humours

They say that everything old is new again and that is certainly true in the world of “alternative” health. One of the axiomatic premises of contemporary “alternative” health puts its believers behind the times … by approximately 500 years.

A fundamental premise held by believers in “alternative” health is that we are swimming in a world of “toxins” and those “toxins” are causing disease. Like most premises in “alternative” health it has no basis in scientific fact; makes intuitive sense only if you are ignorant of medicine, science and statistics; and speaks to primitive fears and impulses.

The preoccupation with “toxins” is a direct lineal descendant of the obsession with evil humours and miasmas as causes of disease. It is hardly surprising that prior to the invention of the microscope the real causes of disease went undiscovered. The idea that disease is caused by tiny organisms that invade the body is not amenable to discovery in the absence of scientific instruments and scientific reasoning. And it goes without saying that the same people who were unaware that bacteria and viruses cause disease could not possibly imagine chromosomal defects, inborn errors of metabolism or genetic predispositions to disease.

Instead, people imagined that diseases were caused by excess evil humours, substances that were named, but never seen or identified in any way accessible to the senses. It was recognized that some diseases were contagious, and in that case, people invoked the idea of “miasmas” that somehow transmitted disease.

Even religion got into the act. Rather than attributing disease to evil humors of miasmas, religious authorities often claimed that disease was attributable to evil demons or to sin itself.

These theories shared several important features. The evil humours, miasmas, etc. were invisible, but all around us. They constantly threatened people, and those people had no way of fending off the threat. Indeed, they were often completely unaware of the threat that was actively harming them.

Evil humours, miasmas, demons, etc. were put to rest by the germ theory of disease. That was the first big breakthrough in our understanding that each disease was separate and has its own specific cause. The search for causes has taken us beyond bacteria and viruses, through errors of metabolism and chromosomal aberrations, right down to the level of the gene itself. We now understand that tiny defects in individual genes can cause disease or can increase the propensity to a specific disease.

But fear and superstition never die and the “alternative” health community has used that fear and superstition to resurrect primitive beliefs. It is axiomatic in the “alternative” health community that disease is caused by evil humours and miasmas. They just don’t call it that anymore; they call it “toxins.”

Toxins serve the same explanatory purpose as evil humours and miasmas. They are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence. They are no longer viewed as evil in themselves, but it is axiomatic that they have be released into our environment by “evil” corporations.

There’s just one problem. “Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.

Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).

Nonetheless, “alternative” health advocates persist in subscribing to primitive theories of disease. For those who have limited understanding of science, primitive theories apparently make more sense.

Hence the obsession with “toxins” in foods, in vaccines, even “toxins” arising in the body itself. The height of inanity is the belief in “detoxifying” diets and colon cleansing. The human body does not produce “toxins.” That’s just a superstition of the “alternative” health community. The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed for that purpose such as the kidneys.

“Alternative” health practitioners are nothing more than quacks and charlatans and their “remedies” are nothing more than snake oil. The fact that anyone in this day and age still believes in such crackpot theories is a tribute to the power of ignorance and superstition.

Evil humours and miasmas have not died, they’ve been reincarnated as “toxins.”

Posted in: Science and Medicine

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184 thoughts on ““Toxins”: the new evil humours

  1. DevoutCatalyst says:

    Back in the 1970s I saw a friend’s book titled Tissue Cleansing Through Bowel Management by Bernard Jensen. In it, people show off photos of their stools. Not just any stools, psyllium seeded Pythonesque wonders. Read the Amazon reviews, they’ll floor you.

    They say people waste their time on the Internet these days; in the good old days, some people stared at stools, compared notes as if wine tasting, and then took off into the stratosphere with profound new knowledge. Kick up yer heels and poop your way to heaven.

  2. rmgw says:

    I looked the Jensen book up, in a spirit of Christmas fun………rave reviews, as Devoutcatalyst mentions, but there was also an offer in the “new and used” sales section for a used volume at 99p……..why is it a used copy of Tissue Cleaning through Bowel Management doesn’t appeal?………….

  3. windriven says:

    Martin Luther King once said, “Nothing in the world is more dangerous than a sincere ignorance and conscientious stupidity.”

    I happen to know a couple of quite sincere woo practitioners, one of them a licensed MD. As I’ve probed their beliefs it has become clear that their essential distrust of scientific medicine arises from medicine’s inability to have an answer and a cure for everything.

    And it is here that their trains go off the tracks because they see these areas of ignorance not as ripe areas for scientific research, but as voids where science has failed. Unfortunately, where science has no answer woo has answers aplenty: ancient Chinese herbal remedies, acupuncture, colon cleansing (20 pounds of impacted fecal matter!), homeopathy, prayer, detoxification.

    Moreover, they are back-to-mother-earth types who loathe capitalism (though they remain interested in Louis Vuitton accouterments), fear industry, and happily sort all of the world’s evils into bins of toxins including an array of industrial and agricultural chemicals as well as gluten(?!).

    I do not suggest that all wootitioners are cut from this particular cloth as fear and superstition come in a dizzying array of colors and weaves. But the magical thinking that animates wooies seems to stem from one of two places: scientific medicine is scary (difficult to understand, sometimes impersonal, big latin words, doesn’t claim to have all the answers … yet) and scientific medicine is imperfect (Aunt Mary died and they never did figure out what was wrong with her – it was probably the 20 pounds of impacted fecal matter loaded with toxins and undigested wheat gluten).

    The question that we must face is how to bring light to the darkness. How do we replace the fear and superstition with science and reason? We have truth on our side. And we are very good at bludgeoning those on the dark side with the truth. But I question how many of them we convince? As Voltaire noted, “It is not enough to conquer; one must also know how to seduce.”

  4. windriven says:

    @DevoutCatalyst

    “Not just any stools, psyllium seeded Pythonesque wonders.”

    Well you certainly can’t accuse them of being full of …

  5. Amy, as usual, it’s not that you’re wrong, it’s that your declarations are both extreme and unfocussed.

    This article would be a much better piece of writing if it were in response to something particular: an article, a book, a television show… anything.

    If you had an editor to review your articles for internal contradictions, that might help too.

    [quote]The human body does not produce “toxins.” That’s just a superstition of the “alternative” health community.[/quote]

    Ok, the human body does not produce toxins. That’s pretty clear and unambiguous.

    [quote]The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed* for that purpose such as the kidneys.[/quote]

    Ok, so the human does produce toxins, which is why it has two organs essential to life that metabolize and excrete them. These organs are pretty good at their job so we are safe from the toxins we produce. Also clear and unambiguous.

    Except that if the human body does not produce toxins (as you state so clearly and unambiguously), then what are the kidney and liver for? Only to manage environmental toxins? Except that you deny the existence of environmental toxins too. Well, environmental toxins don’t exist unless we can name them. Then they exist, but then they aren’t “toxins,” they’re “poisons,” like nicotine, alcohol and opiates. So if we don’t smoke, drink or shoot heroin then I guess we don’t need our livers or kidneys. Right?

    Back to my point Amy — it’s not that you’re wrong, it’s that your writing is really bad. If you want to make a name for yourself in science writing, you might want to take some classes in science journalism. I’m saying this as someone who cares about communicating science.

    * I take it this is a reference to a creator god? A scientific one, of course. An intelligent designer.

  6. windriven:

    “But the magical thinking that animates wooies seems to stem from one of two places: scientific medicine is scary (difficult to understand, sometimes impersonal, big latin words, doesn’t claim to have all the answers … yet) and scientific medicine is imperfect (Aunt Mary died and they never did figure out what was wrong with her – it was probably the 20 pounds of impacted fecal matter loaded with toxins and undigested wheat gluten).”

    Or both places at the same time.

    “Toxins” have tremendous appeal as “the one true cause of all disease” because it offers a simple explanation that requires no special training to understand. It allows people to condemn the medical “establishment,” it places blame (evil corporations), it is relatively easy to treat (just remove all the toxins) and allows people that they can make sure they don’t get sick (just remove all the toxins).

    If only all disease was caused by “toxins.” It would make things a lot easier for everyone.

  7. “Except that if the human body does not produce toxins (as you state so clearly and unambiguously), then what are the kidney and liver for? ”

    When alternative health advocates invoke “toxins” they are not simply talking about anything and everything that is toxic. They are referring to environmental toxins, not naturally produced waste products. For example, you won’t hear them refer to CO2 as a toxin, although it is a toxic waste product; they’re not talking about urea in urine either. Medicine recognizes that waste products can be toxic, hence dialysis for kidney failure. The alternative health advocates are not talking about complex treatments like dialysis.

    “Toxins” as invoked by the alternative health community are almost always environmental toxins, put into food, water or air for sinister reasons, easily “leached out” by bogus “therapies” that happen to be very simple and can be sold by lay people (preferably over the internet).

  8. windriven says:

    @Alison Cummins

    I was not aware that toxins and waste products are the same thing. I’m not sure why you conflated them.

    And Dr. Tuteur did not state that there are no environmental toxins: “Poisons exist, of course, but their existence is hardly a secret, and their actions are well known.” Her point is that toxins, like subluxations, are not the one true cause of all evil in the universe.

    I’m not quite sure what your issue with Dr. Tuteur is but your comment seems to be a willful misrepresentation of her argument. What specifically are you trying to say? Is it that you have no particular disagreement with her position but that you dislike her style of expository prose?

  9. MS, MT(ASCP) says:

    Alison,

    Your confusion over what is and isn’t a toxin is exactly what Amy is writing about. The Alt Med definition is that a toxin is whatever the practitioner wants it to be; ask a toxicologist or an industrial hygenist, and they will tell you exactly what is a toxin and at what level it harms an individual. Even Paracelsus understood what a toxin was 500+ years ago based on dose and effect.

    Human cells have many regeneration and reclamation pathways that recycle molecules and put them back into biochemical pathways that need them. There are a few pathways that lead to a chemical dead-end, producing molecules that can’t be recycled. It is those molecules that are acted on by the liver and kidneys and eliminated in urine and feces. These are not toxins, despite the amorphous claims of Alt Med practitioners.

    As with any molecule, too much can lead to a toxic condition, which is different than saying that that molecule is a toxin. Glucose is absolutely essential to life. No glucose, no life, but too much glucose (as in Diabetes Type I or II) can cause blindness, cardiovascular disease, limb rot and fatal imbalances in salts and acids. So going by a strict evaluation by the Alt Med definition of a toxin, glucose is a toxin, but biochemically the role of glucose is much more complicated. Which view is closer to the truth?

    There is a family of enzymes in the liver called the P450 CYP enzymes that oxidize molecules that can (and do) disrupt the normal biochemical function of a cell. The P450 CYP family is very old and can be found in many animals, plants and bacteria. These enzymes have been protecting us for millions of years against thousands of naturally occurring toxic molecules in our environment by 1) altering the chemical properties that makes the molecule disruptive and 2) making the molecule more water soluble, thus more likely to be cleared out of the body by the liver and kidneys. This has been going on without our knowledge or understanding until very recently when we started making artificial chemicals and studying how they are dealt with in our cells.

    My thesis involved exposing cancer cells to the drug digoxin (Lanoxin). Digoxin comes from the Foxglove plant, and has been used for at least 300 years to treat congestive heart failure and arrhythmia. At higher concentrations, digoxin killed the lung cancer cells I was working on. But at low concentrations, it actually induced the cells to grow faster. This effect is called hormesis, and complicates the answer of what molecules are toxic and when.

    So, is digoxin a toxin or not? The answer is a lot more complicated than being answered with colon cleansers, herbal treatments or diets that make you feel that you have control over what goes on in your body. This kind of critical thinking about toxins is what Amy is writing about, and one that is an anathema to the Alt Med practitioners who make a profit off of their products.

  10. Zoe237 says:

    Amy, as usual, it’s not that you’re wrong, it’s that your declarations are both extreme and unfocussed.”

    Yep. The problem with people promoting toxins isn’t that they claim toxins (besides nicotine, alcohol, CO2, heroin) exist in the first place. They do, and not just animal and plant based, sorry it’s not black and white.

    The problem is that they don’t understand that the dose equals the response, and that these toxins also occur in nature. IOW, the risks are overblown. But I get the feeling that environmental scientists and toxicologists are despised around here.

    http://www.epa.gov/riskassessment/
    PCBs, mercury (like in lightbulbs), lead, radon, DEET, ddt, greenhouse gases, lawn pesticides, CO, asbestos, dioxins, diesel. I’m sure that some of these are overblown, but I would like to see a discussion of their potential harm to humans and what medicine does for prevention. Or if the consensus in medicine is that environmental toxins (besides nicotine, alcohol) don’t exist or are very rare or are mostly plant and animal based??

    What an us vs them mentality. While I’m sympathetic to the cause myself, painting anybody who uses a chiropractor or eats organic as stupid (or whatever) hardly is going to convince anybody. No wonder mainstream medicine is rapidly going the way of integrative ( as one component.)

    It also annoys me that people like Dr. Oz and Oprah and Dr. Mercola capitalize on people’s fears and sensationalize the toxin debate.

    But I fully admit I’m a hippy dippy recycling, lead testing, DEET avoiding liberal, ftmp. ;-)

  11. “PCBs, mercury (like in lightbulbs), lead, radon, DEET, ddt, greenhouse gases, lawn pesticides, CO, asbestos, dioxins, diesel. I’m sure that some of these are overblown, but I would like to see a discussion of their potential harm to humans and what medicine does for prevention.”

    This is what I mean about the way that ‘toxins” are invoked. A tremendous number of substances are toxic. But when alternative health advocates refer to toxins, they mean environmental toxins, produced by industry (evil?) for profit (horrors!). Like evil humours, they are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence.

    And “discussion of potential harm” is a variation of the fallacy of appeal to ignorance. The implication is that “we don’t know” what harms these toxins can cause and because we haven’t proven that they don’t cause all manner of disease (preferably diseases with unexplained causation like cancer or autism), we haven’t taken the threat seriously.

  12. “painting anybody who uses a chiropractor or eats organic as stupid”

    Belief in quackery has nothing to do with native intelligence. People who lack a basic fund of knowledge of science, statistics and medicine are prey to quacks. Their lack of knowledge makes them gullible.

    In contrast to “stupidity,” gullibility is easily remedied with education.

  13. montos says:

    Zoe237 beat me to my point exactly. The article as written definitely implies that with very few exceptions (alcohol, nicotine) that “toxin” is a fictitious construct of alternative medicine. This is simply not so. Often times the negative aspects of these toxins are not known for years until birds start laying eggs with thin shells or cancer rates significantly jump.

    Where the woo aspect comes in to play is that alternative medical practitioners claim to associate specific (or non-specific) conditions to toxin ingestion in the absence of scientific evidence. Moreover they claim they can then cure you of the condition by “detoxifying” the body through various methods.

    For example, does industrial airborne toxin X potentially lead to increased asthma rates in children? Just because no link has been conclusively proven in the literature at this point in time should we all buy houses across the street from refinery row because the real estate is cheaper? I think it is wise to err on the side of caution and not unnecessarily expose ourselves to compounds about which we have little idea of the long-term effects on the human body.

    What we do know is that if your child has developed asthma, linked to environmental toxins or not, giving them a colon cleansing or a chiropractic adjustment is not going to make it better.

    I fully agree with the points made on alternative medical practitioners, however the article does imply that there are very few toxins out there, those that exist seem to be ingested wilfully and that we must assume that man-made chemicals are safe until proven unsafe by science.

  14. David Gorski says:

    This article would be a much better piece of writing if it were in response to something particular: an article, a book, a television show… anything.

    Why?

    Seriously. Why would that make a difference? I can see some merit in your criticism that Amy contradicted herself (or at least was not as clear as perhaps would have been advisable) in discussing the differences between alt-med “toxins” and real toxins; I noticed it myself and her attempt to distinguish “toxins” from “poisons” struck me as a distinction without a real difference, at least as explained. It left me scratching my head and saying WTF? However, why would her post be “a much better piece of writing” if it were in response to anything? Quite frankly, from my perspective that’s irrelevant to whether it’s a good piece of writing or not. More importantly, why is her post not good because it wasn’t written in direct response to anything?

    Let’s put it this way: The post topic that I’m probably going to publish on Monday is not really in response to anything in particular, at least not anything recent. Does that mean it’s going to be a piece of crap automatically or that it won’t be as good as it could be? If so, you’d better prepare that same criticism for me for Monday.

  15. David Gorski says:

    When alternative health advocates invoke “toxins” they are not simply talking about anything and everything that is toxic. They are referring to environmental toxins, not naturally produced waste products.

    Actually, that’s not quite true. The key claim of the colon cleanse fad, for example, is that waste products from your body accumulate in the colon and lead to “toxins” leeching out from all the the proverbial “20 lbs” of your own poo supposedly stick to the insides of your colon.= and poisoning you. Supposedly these “toxins” from the poo caked to your colon lining are what make you sick, causing all sorts of diseases, as I wrote about:

    http://www.sciencebasedmedicine.org/?p=88

    You’re correct that alt-med people don’t generally mean the same thing as physicians when they cry “toxin!” but it’s not true that alt-med promoters limit their toxins to just environmental or ingested toxins. I’ve pointed this out time and time again, as well as how alt-med promoters can never specifically identify which “toxin” or “toxins” they are referring to when they blame disease on “toxins.”

  16. Zoe237 says:

    “This is what I mean about the way that ‘toxins” are invoked. A tremendous number of substances are toxic. But when alternative health advocates refer to toxins, they mean environmental toxins,”

    I purposefully chose environmental toxins, not plant or animal based toxins, because you seem to be either completely denying their existence or claiming that we know all toxins already and all of their harms.

    “And “discussion of potential harm” is a variation of the fallacy of appeal to ignorance. The implication is that “we don’t know” what harms these toxins can cause and because we haven’t proven that they don’t cause all manner of disease (preferably diseases ”

    I didn’t claim that toxins are the one true cause of disease, clearly a ridiculous claim. And my use of the words “potential harm” was under the assumption that some of my list had indeed been shown to be harmful to humans and some had not (I used ‘potential’ harm rathe than ‘actual’ harm iow). Apparently you are claiming that none of them are harmful to humans.

    My understanding based on reviewing literature and expert consensus was that there are basically three groups. Lead is indeed an environmental toxin, as is mercury in lightbulbs, asbestos, CO, and toxins in cigarrettes. That there are certain chemicals that are up in the air as to their toxicity, particularly in small doses (radon?). And a third group that has shown not to be toxic, particularly in small doses (mercury in vaccines). Yes, we don’t know, and no. And dose equals response.

    I think you are oversimplifying, as usual, but if I’m wrong, and there are no iffy, partially unknown environmental health hazards produced by industry, then I’ll admit it.

  17. “Tell that to someone in renal failure or acute hepatic failure.”

    As MS, MT(ASCP) points out above, when the body cannot appropriately handle a substance (metabolize it, store it or excrete it), that substance can be toxic, but that doesn’t make it a toxin. For example, in diabetes, glucose accumulates in toxic levels, but that does not make it a toxin. Consider all the inborn inherited metabolic disorders. Babies with phenylketonuria cannot metabolize phenylalanine, but that doesn’t make phenylalanine a toxin. Even water in excess can kill, but that doesn’t mean water is a toxin, either.

  18. ” Just because no link has been conclusively proven in the literature at this point in time should we all buy houses across the street from refinery row because the real estate is cheaper?”

    This is the fallacy known as the appeal to ignorance, the idea that if we haven’t proven something to be false, we can assume that it is true.

    Advocates of alternative health commonly resort to the appeal to ignorance for two reasons:

    1. They have a bedrock assumption that they wish to promote. In the case of toxins, the assumption is that something in our environment is making us sick. Often the assumption is more specific: something in our environment causes cancer or causes autism.

    2. They are trying to paper over a lack of evidence for their own claims.

  19. Zoe237:

    ” purposefully chose environmental toxins, not plant or animal based toxins, because you seem to be either completely denying their existence or claiming that we know all toxins already and all of their harms.”

    I did no such thing. I certainly am not denying that toxic substances exist.

    My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.” However, those who lack basic knowledge of science and medicine are very attracted to theories that invoke “toxins” because they provide the same explanatory power, and they capture the same fears, as evil humours once did.

  20. Joe says:

    Zoe237 on 24 Dec 2009 at 12:47 pm “I purposefully chose environmental toxins, not plant or animal based toxins, because you seem to be either completely denying their existence or claiming that we know all toxins already and all of their harms.”

    You overlook two things: A) Quacks don’t specify what they mean. Certainly one can be exposed to an environmental pollutant which may be adequately described as toxic; but quacks don’t do real analyses for them. They use quack “analyses” or simply make assertions. B) Quacks don’t perform research to prove that any particular, real toxin is removed by their procedures. Certainly, as Amy Tuteur has written, “The height of inanity is the belief in “detoxifying” diets and colon cleansing.”

    Medical professionals do have proven ways of detecting many, truly toxic substances and ways of enhancing the removal of some of said materials.

  21. There’s a difference between the appeal to ignorance of “I don’t know why my child is autistic therefore it must be toxins,” and the precautionary principle of “toxic substances exist, and industry has the theoretical ability to produce high concentrations of novel substances that my body has not evolved to eliminate safely, therefore I prefer not to live in an industrial park (where concentrations of novel substances are likely to be particularly high) until it has been proven safe.”

    The reason this piece would be better writing if it were in response to something specific is that by referencing a quote to the effect that “poo and mercury are the One True Cause of all disease and my widget can fix it,” Amy could make her point clearly about “toxin” in this situation merely being used as a modern word for “miasm” and we wouldn’t be getting derailed into discussions of whether Amy thinks we should buy land across from an oil refinery. If Amy wanted to talk about the difference between oil refineries and the possibilities of imaginary toxic poo then a good piece of writing would have — at the least — framed that discussion instead of leaving it to be brought up in the comments.

    Yes, the point of my comment really was that I dislike “Amy’s style of expository prose.” I find it unfocussed, excessively general, and generating unclear discussion. If Amy doesn’t explicitly state what she’s talking about then I have to guess, and so does everyone else, and then we guess differently from one another, and then we get into arguments that don’t advance anything.

    I fully agree with the concluding statement that “Evil humours and miasmas have not died, they’ve been reincarnated as ‘toxins.’” It’s quite perfect. But I can’t forward this post to all my toxin-obsessed friends because the essay as a whole is so sloppily written.

  22. MS, MT(ASCP) says:

    The term “environmental toxin” is meaningless. Anything in the air, soil or water, regardless of its source that causes a toxic reaction is an environmental toxin. If you’re referring to manufacturing byproducts then “industrial pollution” is a more precise term. I don’t go out of my way to be a buzzkill, but the current buzzwords need to be killed, because they are vague, misleading, misrepresentative and sometimes flat-out wrong. If you want to have a science based discussion, then use terms and concepts that actually mean something and are backed up by hard data. Alt-Med does a wonderful job of marketing a concept by using the latest buzzword(s), because that’s all they can offer. As much as they want you to believe, it doesn’t make that concept right or wrong; it makes the concept meaningless.

  23. Jeff says:

    My claim is it’s a big (and unjustified leap from acknowledging the existence of toxic substances and claiming that they cause “disease”.

    There is some evidence that industry-produced toxins may cause disease. Researchers have long believed pesticides may cause Parkinson’s.

    Acetaminophen can be liver-toxic when taken too often or in too high a dose. The most important antioxidant used by the liver during Phase 1 detoxification is glutathione peroxidase. A common antidote to acute acetaminophen poisoning is the dietary supplement N-Acetyl-Cysteine (NAC). NAC is effective precisely because it raises liver levels of glutathione peroxidase. A simple way to reduce the incidence of liver damage would be to include some NAC in each pill containing acetaminophen.

    Maybe taking some NAC on a regular basis could help the body detoxify drugs, alcohol and other chemicals, especially for those whose livers might be deficient in glutathione peroxidase.

  24. MS, MT(ASCP),

    I used the phrase “environmental toxin.” Are you responding to me in the following?

    *** *** ***
    The term “environmental toxin” is meaningless. Anything in the air, soil or water, regardless of its source that causes a toxic reaction is an environmental toxin. If you’re referring to manufacturing byproducts then “industrial pollution” is a more precise term.
    *** *** ***

    I used the phrase “environmental toxin” to mean exactly “anything in the air, soil or water, regardless of its source that causes a toxic reaction.” That is exactly what I meant. Amy said that nothing produced by or in the human body could produce a toxic reaction. (No, I understand, that’s not what she meant. But it is what she said. Hence the complaint about unclear writing.) So I wanted to discuss the possibility that something produced outside the human body might produce a toxic reaction, given that we have a liver and kidneys and all.

    You’re right that phrase may be overused in certain circles. Would it be better if I used the term “exogenous poisons”? (I’m asking seriously here. If “environmental toxin” is no longer a technically neutral term, what is the preferred alternative?)

  25. Zoe237 says:

    My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.”

    Take lead then. Recently there has been testing and recalls of lead in children toys. Medical organizations have recommended testing of children. They ask about lead based paint in homes built before 1970. This is a toxic byproduct of industrial processes. The health effects are still being explored. One effect seems to be possible mental retardation, and it was a toxin that previously was unknown. Does lead really not cause ill effects?

    Joe, I am totally with you on colon cleansing and chelation therapy. I’m just skeptical that there are no disease causing toxins produced by industry. IME, the extremists on both sides of this issue are just plain wrong. But I remain open to the possibility that my logic is flawed.

  26. Amy, in the comments you say
    “My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause ‘disease.’”

    And yet, in the body of your post you say,
    “Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).”

    So in the body of the post you say that poisons cause diseases, and in the comments you say you said that claiming that toxins cause disease is an unjustified leap.

    But in your post, you never said that claiming that toxins cause disease is an unjustified leap. You said the something that sounds very like the opposite: you said that poisons cause diseases. (Yes, I note the crucial difference between “disease” and “diseases.” Important but subtle. You still didn’t say what you think you did.)

    In your post you explain that the reasons that people worry about toxins are irrational and pre-scientific. True. But it’s not irrational or pre-scientific to suppose that if some poisons cause some diseases that other poisons might cause other diseases, and you did not in fact address that hypothesis in the body of your post.

  27. windriven says:

    Oxygen is a toxin. Our very lives may depend on it diluted in nitrogen and other gases. But at elevated partial pressures chronic exposure is toxic.

    It really seems as if we have veered into the weeds in response to this blog. Dr. Tuteur was making a fairly simple statement about a tactic of some in the alternative medicine ‘movement’ to prescribe detoxification as the cure to mankind’s ills.

    Her second paragraph says:

    “A fundamental premise held by believers in “alternative” health is that we are swimming in a world of “toxins” and those “toxins” are causing disease. Like most premises in “alternative” health it has no basis in scientific fact; makes intuitive sense only if you are ignorant of medicine, science and statistics; and speaks to primitive fears and impulses.”

    One might quibble that “held by believers…” should rightly have been phrased “held by (some/a portion of/many) believers…” but the basic point remains: a preoccupation with unnamed toxins is a central theme among some of the woo crowd. These toxins are often referred to generally so that the reader can fill in the blanks with his or her own fears. And when a toxin actually is named it is often portrayed as responsible for all manner of death, disease and indignity.

    Have we all forgotten the alar panic of the late ’80s?

    Go here:

    http://www.acsh.org/publications/pubid.865/pub_detail.asp

    to refresh your memories.

    The question is: how does the scientific community separate the very real dangers of very real toxins from the toxic pipedreams of alt.med types in the minds of the general public? Aren’t issues like these more important than semantic and stylistic disagreements?

  28. “The question is: how does the scientific community separate the very real dangers of very real toxins from the toxic pipedreams of alt.med types in the minds of the general public? Aren’t issues like these more important than semantic and stylistic disagreements?”

    Yep, and Amy could have written about that. Could have been a great post generating great discussion. She only wrote half of it though. And now we’re trying to fill in the other half in the comments, but in a very confused and antagonistic way.

    My stylistic concerns are not purely esthetic. I want to have a good discussion but the original post does not lay a solid foundation for one. I wish it did, and I wish Amy would take her posts more seriously. If I didn’t think she had the potential to write better posts I would just unsubscribe.

  29. MS, MT(ASCP) says:

    Alison,

    I’m sorry I wasn’t clear: I was responding to Zoe237 and her use of “environmental toxins.” My point still stands, and when I took a class on molecular toxicology the term used was xenobiotics. Whether or not a xenobiotic was toxic or not and how it acted depends on a lot of factors unique to person, place and length of exposure.

    Zoe237,

    As I pointed out above, anything can be a toxin and and above a certain level and what we consider to be toxic may not be at very low levels because of hormesis. The effects of lead in the body have been well known for some time, and it is now considered a carcinogen. From what I have seen, the debate actually centers on what the lower limit of toxicity is. Some people are completely wigged out over the presence, at all, of lead (or some other toxin-de-jour), ignoring the fact that lead has been around for a long time (remember the anti-knock compound in gasoline up to the early 80s?). Unless you live in a remote location well away from urban/farm areas, you live in an environment with low levels of lead. We have two ways to view the effect of lead in our environment: assign effects to the presence of lead because we know lead is toxic, or look for the mechanism of toxicity at background levels we live in. Which is the more sound approach?

    I keep pounding on hormesis, not because its a pet I adopted in my lab work, but because it is a demonstrable phenomenon that is not taken into account when studies involving trace amounts of lead (or the toxin-de-jour) are performed. At such low levels, the body has adequate resources to eliminate atoms and molecules through CYP enzymes as well as glutathione, and hormesis is seen as a beneficial over-reaction of such systems. At some point, *any* atom or molecule can overwhelm and deplete the system (cf. acetaminophen conversion to toxic NAPQI when glutathione stores are all use up), which is a function of concentration. This idea is completely lost or wasted on the Alt-Med followers.

  30. pmoran says:

    The four HUMORS were spelt thus.

    They were also observable entities, especially in the ill: yellow bile, black bile, phlegm, and blood, unlike the airy-fairy “toxins” of alternative medicine, .which have never been identified in, or correlated with the numerous illnesses attributed to them.

    The humors were also not regarded as evil or toxic in themselves, but merely out of balance in the ill.

    Since Hippocrates, Galen and others probably had similar intellectual resources to ours, the humoral theory of illness was possibly as reasonable a scientific hypothesis as any other for the times.

    We very privileged modern physicians should not be too self-satisfied — we are still learning how to best perform and assess the clinical studies that are neeeed to resolve some questions.

  31. David Gorski says:

    As MS, MT(ASCP) points out above, when the body cannot appropriately handle a substance (metabolize it, store it or excrete it), that substance can be toxic, but that doesn’t make it a toxin. For example, in diabetes, glucose accumulates in toxic levels, but that does not make it a toxin. Consider all the inborn inherited metabolic disorders. Babies with phenylketonuria cannot metabolize phenylalanine, but that doesn’t make phenylalanine a toxin. Even water in excess can kill, but that doesn’t mean water is a toxin, either.

    All these substances are toxic at the right concentration, and the body makes them. As Paracelsus said hundreds of years ago, the dose makes the poison, and our bodies do make toxic substances but the toxicity does depend upon the concentration and the physiology.

    But since in this post you seem to be harping on the difference between “toxins” and “poisons,” if you really want me to get pedantic (and why the heck not at this point?), technically by definition toxins are biologically produced poisons. Look it up in Dorland’s Medical Dictionary if you don’t believe me, and Wikipedia has several links to sources that state that toxins are defined as biologically-produced poisons. Indeed, according to a International Committee of the Red Cross review of the Biological Weapons Convention, “Toxins are poisonous products of organisms; unlike biological agents, they are inanimate and not capable of reproducing themselves.”

    So when you say:

    Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).

    you are in fact referring to toxins by definition, because naturally based poisons produced by living organisms are toxins by definition. And, in fact, by the official definition, you are probably as incorrect to do so as I may have been to label certain substances produced by the human bodies as, because another part of the definition of toxins is that they cause a characteristic disease or toxic condition.

    Be that as it may, exactly the same thing you said about water, glucose, etc, could be said about…yes, alcohol! The body has very efficient mechanisms to metabolize ethyl alcohol; it is a biological product; and it’s toxic when the body’s ability to metabolize it is overwhelmed. So why do you call alcohol a “toxin” in your post? By your own definition it is not. The same is true of nicotine, which you also label as a “toxin” in your post. We have a whole class of receptors in our body known as nicotinic acetylcholine receptors, or nAChRs. Of course, the primary ligand for these receptors is acetylcholine and they only happen also to bind nicotine (hence the term nicotinic and the effect of nicotine on the CNS), but nicotine at low levels is not toxic, except after prolonged exposure (decades). Again, the dose makes the poison. And don’t even get me started on opiates, which our bodies make and which are critical for pain regulation and all manner of other functions in the CNS. They are not toxic at the usual concentrations present in the body–or even at concentrations quite a bit higher than what is normally found. So, by your own definition above for glucose, water, etc., opiates should not be considered toxins either. Yet you label them as such in your post.

    Look, I totally understand the woo that blames “toxins” for everything and I totally agree that the word “toxin” serves the same purpose as “miasma” in alt-med. I’ve written at length myself about this very tendency over the several years I’ve been writing about such things, although I look at the fear of “toxins” to be more on the order of a religion (which much of alt-med is based on) where there are beliefs that warn against “contamination.” However, I must admit that the criticism that you yourself weren’t all too clear on the concept of toxins is not entirely baseless. I realize that most people use the terms “toxin” and “poison” interchangeably, but that’s rather the point, isn’t it? They’re wrong to do that.

    In fact, MS, MT(ASCP) is correct in that the concept of “toxins” is far more complicated, and different substances can be (or not be) toxic under different circumstances and at different concentrations. Woo-peddlers don’t even consider these distinctions, and they do appeal to unnamed “toxins” with more or less magical properties.

  32. Plonit says:

    Surely the humours were actually spelt χυμός – translate into British or American English as you wish.

  33. JerryM says:

    “Alternative” health practitioners are nothing more than quacks and charlatans and their “remedies” are nothing more than snake oil. The fact that anyone in this day and age still believes in such crackpot theories is a tribute to the power of ignorance and superstition.

    Come on Amy, don’t hold back, tell us what you really think :-)

    Nice article, though would’ve thought you’d learned from your previous articles that people will pounce on any perceived or real ambiguity here.
    Happy Holidays

  34. David Gorski says:

    We very privileged modern physicians should not be too self-satisfied — we are still learning how to best perform and assess the clinical studies that are neeeed to resolve some questions.

    Actually, I think the point is that, whatever the deficiencies of science-based medicine, we now have the tools and the science to know so much more about the cause of disease. That is not in any way to denigrate the ancients; we didn’t have the tools to discover, for example, germ theory until the 19th century. However, the point is that today, in the 21st century, there is no excuse to be invoking vague concepts like “toxins,” which , as Amy correctly points out, resemble ancient concepts of contamination and miasma (for imbalances in the four humors, traditional Chinese medicine and the “unblocking of qi” to cure disease represent probably a better analogy). In other words, whatever ignorance still remains in medicine, there is no excuse to be invoking the ignorance of the past in a time when we now know why such concepts were not operative.

    At least that’s the way I see it. I don’t see it as being “self-satisfied.” I see it as wondering why, in this day and age, people cling to prescientific concepts of disease.

  35. Dave Ruddell says:

    Hey, if we want to get really pedantic, a toxin is a poisonous substance produced by a biological process. So, all toxins are poisons, but not all poisons are toxins. Although all poisons are toxic. Stupid English language.

  36. “My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.”
    Take lead then. Recently there has been testing and recalls of lead in children toys.”

    “Toxins” don’t “cause” “disease.” Specific chemicals can interfere with biological processes in specific ways.

    Lead, for example, does not cause “disease.” It interferes with the incorporation of iron into the protoporphyrin molecule; the result is a decrease in heme production. Heme deficiency can have a wide variety of effects.

    No one, least of all me, is denying that people can be poisoned. However, being poisoned is not a disease.

  37. “I don’t see it as being “self-satisfied.” I see it as wondering why, in this day and age, people cling to prescientific concepts of disease.”

    Amen!

  38. windriven says:

    “We very privileged modern physicians should not be too self-satisfied — we are still learning how to best perform and assess the clinical studies that are needed to resolve some questions.”

    I would argue that it is the woo crowd that is self-satisfied. One difference between SBM and ‘alternative’ medicine is that SBM is extremely sensitive to the limits of its knowledge while ‘alternative’ medicine wallows in its ignorance and wears self-satisfaction like a cloak. Medical scientists work constantly to expand the borders of knowledge while wootitioners rehash the same tired bromides. SBM is dynamic. Woo is not.

  39. Amy,

    From your original post:

    “Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).” Emphasis mine.

    From your most recent comment:

    “‘Toxins’ don’t ‘cause’ ‘disease.’”

    Fuzzy thinking leads to careless writing. You say a bunch of stuff and then you say that wasn’t what you really meant. You meant something else which should be obvious.

  40. trrll says:

    The problem with the use of the term “toxin,” as commonly employed by alternative medicine advocates, is that it carries the implication that certain substances have some kind of evil “essence,” whereas to the toxicologist, virtually all substances, including nutrients essential to life, have the ability to produce toxicity at sufficiently high dose. The implication that toxicity is somehow inherent in the nature of a substance, rather than a property of the amount of a substance present, is thus misleading at a very fundamental level.

    Biologists reserve the term “toxin” for biological substances whose presumed function is to cause injury to other organisms. Many of these substances also are highly potent, meaning that they are able to cause harm at remarkably low doses. Contrary to widespread belief, the most toxic substances known to man are all of biological origin.

  41. woofighter says:

    quoting Alison Cummins:
    “Amy,
    From your original post:
    “Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).” Emphasis mine.
    From your most recent comment:
    “‘Toxins’ don’t ‘cause’ ‘disease.’”
    Fuzzy thinking leads to careless writing. You say a bunch of stuff and then you say that wasn’t what you really meant. You meant something else which should be obvious.”

    Why didn’t you finish her quote?:

    ““Toxins” don’t “cause” “disease.” Specific chemicals can interfere with biological processes in specific ways.”

    I don’t believe Dr. Amy ever calls those chemicals “toxins”.

    You seem to have a personal beef with Dr. Amy. Are you deliberating misunderstanding and twisting her words?

  42. Zoe237 says:

    @MS, MT(ASCP)

    “The term “environmental toxin” is meaningless. Anything in the air, soil or water, regardless of its source that causes a toxic reaction is an environmental toxin. If you’re referring to manufacturing byproducts then “industrial pollution” is a more precise term.”

    That sounds fair enough. Does industrial pollution ever cause disease, given a sufficient dose?

    The digoxin and hormesis research sound fascinating.

    “The Alt Med definition is that a toxin is whatever the practitioner wants it to be; ask a toxicologist or an industrial hygenist, and they will tell you exactly what is a toxin and at what level it harms an individual. ”

    My impression was that there is much debate among scientists what exact doses are considered safe. Particularly considering lowering the assumed safe level for exposure to lead in children.

    “We have two ways to view the effect of lead in our environment: assign effects to the presence of lead because we know lead is toxic, or look for the mechanism of toxicity at background levels we live in. Which is the more sound approach?”

    Absolutely, the latter. This is an argument that involves critical thinking skills and the ability to discern layers of evidence, rather than one handed denials. What do you call an extreme skeptic? A denialist? What do you call somebody who not only goes after alt.med types (rightly so) but goes so far as to deny that toxic substances cause disease at all?

    @Amy Tuteur MD:

    “Toxins” don’t “cause” “disease.” Specific chemicals can interfere with biological processes in specific ways.

    Lead, for example, does not cause “disease.” It interferes with the incorporation of iron into the protoporphyrin molecule; the result is a decrease in heme production. Heme deficiency can have a wide variety of effects.”

    Could you define disease then? I thought that lead poisoning was a disease. And I thought that asbestos (one example I asked about wrt to environmental toxins (or poisons if you prefer)) cause/ is correlated with cancer. Is there no such thing then as an industry produced carcinogen then? Is lead not a carcinogen?

    Long list of ill effects of lead, including it’s B2 classification as a “probable” human carcinogen.

    http://www.epa.gov/ttn/atw/hlthef/lead.html

    http://adam.about.com/encyclopedia/001653.htm

    http://en.mimi.hu/disease/lead_poisoning.html

    “No one, least of all me, is denying that people can be poisoned. However, being poisoned is not a disease.”

    No, I guess impaired neurocognitive function (among other effects) caused by lead poisoning is not a disease. Nor is cancer.

    Thanks, Dr. Gorski, for the clarification about the definition of a toxin.

    I read the original post as conflating toxin, chemical, and poison by this quote:

    “Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.

    Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).”

    And then there was this gem:

    “I did no such thing. I certainly am not denying that toxic substances exist. ”

    “My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.” ”

    Toxic substances do not cause disease? Ever? Really? I must be nuts, because it goes against every EPA study or environmental journal review I’ve read in 15 years. With this exception: the ones linked to from Exxon and junk science.com. And these are the exception. Scientists don’t seem to be arguing about whether toxic substances cause disease. The debate is over how much exposure is necessary and which substances and mechanisms and cures.

    I’d really honestly like somebody to resolve the serious cognitive dissonance I have going on here. I have stated at least three times that the dose makes the poison. How on earth can toxic substances never produce disease? And then Dr. Amy mentions tobacco causing cancer in the OP. Yeah, that’s a direct contradiction, and not the first one by a long shot.

    @woofighter:

    “I don’t believe Dr. Amy ever calls those chemicals “toxins”. ”

    You seem to have a personal beef with Dr. Amy. ”

    Any personal beef is irrelevant. There were four or five people who were confused about Dr. Tuteur’s original point. If it’s that alt.med types tend to overblow/ in some cases fabricate the risks of industrial pollution/ biological byproducts/ environmental “toxins” I’m 100% on board. If the point is that toxic substances never cause disease, only interfere with biological processes, with no nod to “dose=poison,” I’m not buying it. Even Dr. Gorski was unclear what Dr. Tuteur meant in her original post:

    “So why do you call alcohol a “toxin” in your post?”

    The precautionary principle as an appeal to ignorance is an interesting argument as well. I can see the logic in that. My question would be should public policy lay the burden of proof on industry to prove the safety of their product (as much as is possible using inductive logic) or on toxicologists who believe that such product (or part of) could be poisonous?

    @windriven:

    “The question is: how does the scientific community separate the very real dangers of very real toxins from the toxic pipedreams of alt.med types in the minds of the general public? Aren’t issues like these more important than semantic and stylistic disagreements?”

    This is an excellent question. I think that it’s *just as* risky to deny the possibility (and historical fact) that toxic substances cause disease as it is to claim that every disease is caused by toxic substances. I hope that makes sense.

    As I said above, this requires an ability for critical thinking, more specifically, the ability to see subtle nuances in situations. And it must be taught.

    How do I put quotes in italics?

  43. This post has appeared on my own blog and in several other places. It has been read by thousands of people, and I’ve answered many questions about it. Curiously, no one failed to understand what I meant by toxins, not because my definition was ironclad, but because they could understand what I was trying to say.

    Moreover, the few who failed to understand my intent on the SBM version initially have had it explained to them by me and by others. At this point, it is not a question of failing to understand, it is an attempt to derail the discussion.

    Either way, no post is perfect and there are always people who fail to understand even after multiple explanations. There’s not much to do at that point except to move on with a discussion about the principles of the post, as opposed to allowing the discussion to be derailed by repeated demands for clarification.

  44. “The problem with the use of the term “toxin,” as commonly employed by alternative medicine advocates, is that it carries the implication that certain substances have some kind of evil “essence,” whereas to the toxicologist, virtually all substances, including nutrients essential to life, have the ability to produce toxicity at sufficiently high dose.”

    Exactly.

    The evil “essence” point speaks to the purpose of a “toxin” within alternative health. It is meant to invoke fear by implying that we are surrounded by harmful substances, belched out into the environment by nefarious corporations, and that these substances are responsible for diseases, particularly diseases whose cause has not yet been identified.

  45. MS, MT(ASCP) says:

    Zoe237,

    I think what’s missing here is a distinction between acute and chronic disease, and how they fit into exposure to a potentially toxic compound. For instance, our friend lead (Pb) can cause acute toxicity symptoms of porphyria, colic, ataxia (unsteady gait) headache and anorexia, among others. If detected in time, chelation can reduce the body lead burden and the symptoms subsequently resolve. On the other hand, people can be exposed to levels of lead and have very mild or no accompanying symptoms who later develop permanent chronic symptoms such as nephrotoxicity (kidney failure) and neural damage leading to retardation, aggression and developmental regression (these rarely seen in adults). Unwittingly, people with a high heavy metal burden, but who are otherwise asymptomatic, risk suffering permanent damage during chelation because sequestered heavy metals are liberated.

    Toxicity from exposure, then, to a compound is at least a four dimensional problem. It depends on dose, dose duration, rate of elimination and bioavailability (or Vd for the pharmacologists out there). There is an area defined by all four parameters where toxicity occurs, but that area may not always be obvious. There are many documented instances where exposure to industrial pollution has placed a person or a defined population within that four-dimensional space (mercury in Miamata Bay, Japan being the most notorious). Some toxicity data in MSDS sheets has, unfortunately, come from documented human morbidity and mortality caused by the chemical covered by the MSDS sheet.

    As far as determining the highest safe exposure level and rate, well that’s really complicated, hence the debate. It depends on

    - an individual’s ability to clear a given compound (look up CYP2C9*2 as an example of reduced clearance of certain drugs),

    -the form in which the toxin in encountered (e.g. methylmercury vs. ethylmercury),

    -general health (e.g. obese people are at risk of retaining fat-soluble compounds such as dioxin; chronic alcoholics are susceptible to toxins because of impaired liver function),

    -and the above mentioned four dimensional model of exposure.

    Add to that the ethical constraints of deliberately exposing people to a toxic compound to find that highest safe exposure level. The best we can do is to use animal models, but even then it’s an imperfect extrapolation to humans. Examining such low levels also puts us close to the lower limit of detection, where it’s hard to discern the true signal (i.e. concentration of a compound) from random thermal noise that is always present in any measurement system.

  46. daedalus2u says:

    I suspect that some of the disagreement in the comments is due to cognitive dissonance. The “organic” food movement is tied up with the idea that chemical fertilizers are bad and their use produces food that is less healthy. The only plausible mechanism could be via the types of “toxins” that Dr Amy is talking about in her post. We know that well prepared (i.e. most) chemical fertilizers don’t have toxic substances in them. We also know that because of how plants take up nutrients (for example nitrogen is only taken up as ammonia or as nitrate), organic fertilizers can only be taken up by plants after soil bacteria have broken them down into the inorganic chemicals that are used in chemical fertilizers.

    I think that some of the push-back that Dr Amy is getting is from people who buy and eat organic foods, and who think they are getting something of higher value for the higher prices they are paying. The higher price is to avoid the evil essence of chemical fertilizers; an evil essence that chemical analysis cannot find because it is not present.

    There isn’t the time or space to go into the problems of the organic food industry, but the most zealous proponents of organic food are treating non-organic food as having the taint of toxins; the same with genetically modified food. GM foods have a “taint” which cannot be removed. Anti-GM zealots use the same techniques as the quacks in alternative medicine to “prove” that there is unacceptable risk to GM varieties while non-GM varieties pose zero risk. The definitions of what is “organic” food are not science based, they are magical thinking based. Urea from urine is a good fertilizer and is acceptable; urea synthesized in a factory is unacceptable even when it is purer.

  47. Plonit says:

    This post has appeared on my own blog and in several other places. It has been read by thousands of people, and I’ve answered many questions about it. Curiously, no one failed to understand what I meant by toxins, not because my definition was ironclad, but because they could understand what I was trying to say.

    +++++++++++++

    That’s not the case. Commenting on your article when it appeared on skepticalob, Katie asked

    “Can you define “toxins?” Are you talking about chemicals added to food, about chemicals emitted by cleaning products, glues, paint and the like, or what? Lead is a “toxin” which apparently causes such bad effects on developing minds that paint (and now most electronic devices) can no longer contain it. Does this mean I don’t have to worry about those labels that say a product is known to cause cancer in California, or does that only matter if I’m in California? Antibacterial cleaning products for self and home get rid of “toxins” (bacteria), but may be leading to the rise in more dangerous/powerful bacteria.”

    In short, very similar questions that have been raised in relation to this post. Of course, it is your perogative not to make any amendments to further clarify your article before reposting it here. But don’t be surprised if the same questions then arise.

  48. Emanuel says:

    Indeed. Why “disease” becomes a moving target after “toxins” (the latter not causing the former, rather interfering “with biological processes in specific ways”) is simply perplexing. As sympathetic as I am to observing that TOXINNNS are a preposterous joker in the alt-med deck, it’s hard to get excited about a jab that the concept is 500 years behind the times when the associated rhetoric and its defenses seem to be pre-Socratic.

  49. rosemary says:

    Point 1 – Communicating
    Okay. I looked through the comments and then glanced at Amy’s article. No. I didn’t read the comments or the article carefully, but I think I understood the point of the article and agree with Amy.

    I also expect that many others who read it will have the same reaction that I had. However, not everyone will. People vary a great deal in how they learn which is why it is a good idea to use different methods in our efforts to teach and communicate or to have different people with different methods present the same topics.

    As many of you probably know, Skeptics drive me up the wall even though my BA is in philosophy, or maybe because my BA is in philosophy, and I know I have the same effect on most Skeptics as they do on me. However, I am not alone. I know many people, including scientists, who are driven up the wall by Skeptics. Knowing how sincere, intelligent and well educated so many Skeptics are and knowing what important information they have and want to get out, I hope they will enlist others who have a different style of communicating than they do to help.

    Point 2 – Fear Tactics Used by Quacks
    Frightening people is one of the major sales tactics used by quacks to sell snake oil. There are two components to their marketing game. One is trying to make people chemophobic, something they actually do quite well. It is gotten to the point where many very rational people ignorant about science will say, “Oh, I don’t want to use any chemicals,” by which they usually mean anything synthetic or “man made”. I have many responses to this but won’t bother you with them here.

    The other thing quacks use to scar people with are “toxins” in their bodies which of course require detoxification. And guess who ya have to give ya money to folks to buy the remedies to detox with. The word toxin is used because of the evil association it carries for most people. Quacks often use it vaguely but sometimes they do use it very specifically although not necessarily correctly in that it may refer to something that isn’t really in your body at all or something there that isn’t really harmful. (Yes. I know I haven’t expressed that very well, but writing is not my forte. Speaking is.)

    I don’t know if any of your were lucky enough to know John Renner. He once looked at me and said, “Rosemary, aren’t they trying to detox you?” To which I responded, “Why Dr. Renner you are psychic! How did you know?” Again I won’t bother you with the details of quack detoxification here.

  50. Zoe237 says:

    MS, MT(ASCP), thanks.

  51. Zoe237 says:

    “In short, very similar questions that have been raised in relation to this post. Of course, it is your perogative not to make any amendments to further clarify your article before reposting it here.”

    Yikes, I didn’t realize these were reposts… are all or most SBM posts taken from elsewhere? A brief google search showed many commenters wondering about lead as a toxic substance causing disease in response to “Toxins: the new evil humours.” Oh well.

  52. Plonit says:

    are all or most SBM posts taken from elsewhere?

    ++++++++++++

    As far as I can tell all Amy Tuteur’s posts here have all been published in one form or another at

    http://skepticalob.blogspot.com/ or

    http://open.salon.com/blog/amytuteurmd or

    http://homebirthdebate.blogspot.com/

    and sometimes all three.

  53. I might be flattered by all the attention to me, my words, my writing style, but I’m well acquainted with the tactic of focusing on the author as a way to derail a discussion about an idea.

    I find it to be a variation of the ad hominem attack, try to prejudice readers by disparaging the person, instead of addressing the topic.

  54. Plonit says:

    It is surely not disparaging to direct readers to your other blogs.

  55. nitpicking says:

    OK, I read Doctor Tuteur’s last comment as an ad hominem against Alison, to be honest.

    I might have been more … ostentatiously courteous in my response than Alison (I came in late and read dozens of comments before writing this) but her point is in my professional opinion as a writer, valid.

    That point: that Doctor Tuteur’s original essay could be improved. Not that it’s factually wrong–as Alison repeatedly said, it is not. That it could be more effective.

    My own reaction was that this essay is enormously too abstract and too general. It reads like a summary of the introduction to a book on the subject, not a stand-alone essay. There isn’t a single reference to a particular person (e.g. “Dr. Oz”) and that person’s specific doctrines. There isn’t a specific reference to web site that spouts “toxin” gibberish. There isn’t even a named (but fictional) toxin. It’s just very general statements disconnected from anything concrete that they can be related to.

    It’s not that it’s wrong–it’s quite correct in the position advocated. It just isn’t structured in such a way as to convince anyone.

    Answering a question from upthread:

    How do I put quotes in italics?

    I put that between [blockquote] and [/blockquote] tags–replace the “[]” with “”. Italics can be typed using [i] and [/i]. Again, replace the square brackets with angle brackets.

  56. nitpicking says:

    OK, the blog software removed the angle brackets between the empty quotes in my comment above. Those are “>” and <".

  57. I daresay that if it wasn’t effective, it would have been ignored. The comments about style, word use, etc. are not charitable efforts to improve my writing; they are attempts to divert attention from the substance of the post.

    “Toxins” have become a very effective meme for “alternative” health practitioners. They invoke the same subconscious fears as evil humours: they are insidious, all around us and evil (or at least produced by evil corporations).

    Whereas evil humours were understandable given the technical limitations of the time (no one could see bacteria or viruses), “toxins” as a meme are understandable only in light of the educational deficiencies of large parts of the population. “Toxins” as a meme resonates with those who lack basic understanding of science, statistics and medicine.

    The idea of “toxins” is used to separate the gullible from their hard earned money, because “toxins” are invoked by those who are peddling products that supposedly remove or protect against “toxins.” Anyone who has bought an product designed to “detoxify” has fallen for a scam.

  58. nitpicking says:

    I daresay that if it wasn’t effective, it would have been ignored. The comments about style, word use, etc. are not charitable efforts to improve my writing; they are attempts to divert attention from the substance of the post.

    From people who agree with you? Including David Gorski?

  59. I daresay that if it wasn’t effective, it would have been ignored. The comments about style, word use, etc. are not charitable efforts to improve my writing; they are attempts to divert attention from the substance of the post.

    You have it exactly wrong. I want SBM to be a place I can refer people for thoughtful and convincing content-driven essays. If some of the contributors do not meet the standard I have come to expect of SBM, I am disappointed. I don’t want to refer someone to SBM and have them come back to me saying that scientists write insufficiently-thought-through essays full of obvious straw men and gaping holes in logic. You attract my attention because I believe you are not as effective as I need you to be. I believe you are letting down the side.

    You are correct with respect to my lack of charity. I don’t care if you are a poor writer for your sake. Keep your own blog and let it sink or swim on its own reputation. I care because I believe you are letting down the side and lowering the standard for SBM. I care because I care about science journalism and science education. You are correct that I do not care about you.

    I’m fine with the substance of the post. As I said, your summary statement, “Evil humours and miasmas have not died, they’ve been reincarnated as ‘toxins’” is exactly perfect. But the way you got there is not convincing to any but the converted who can fill in the many blanks and mentally substitute what you probably mean for what you actually say.

    Finally, your use of the word “effective” in the quote above. Effective at what? Attracting attention or changing minds? You’re attracting the attention of people who agree with you in the substance. If sellers of detoxifying widgets were complaining that you aren’t sufficiently clear, that would be a different story.

    If anything, you seem to be trying to divert attention by claiming that the only reason you are receiving criticism is that people are threatened by your insights. We have heard that kind of defence before, and it’s not usually from scientists.

    If you’re a real scientist I expect better of you.

  60. wales says:

    Amy’s superficial essay lumps “toxins and poisons” into a broad and somewhat vague category. Where does one draw the line between “toxins and poisons” and “hazardous substances and contaminants”? This NYT article on contaminated tap water poses some important questions.

    http://www.nytimes.com/2009/12/17/us/17water.html?pagewanted=1&_r=1&sq=toxic tap water&st=cse&scp=1

    There is a great deal of uncertainty among scientists as to what qualifies as toxicity regarding tap water contaminants. Scientists are finding that many substances are harmful at much smaller doses than originally thought. “These chemicals accumulate in body tissue. They affect developmental and hormonal systems in ways we don’t understand, ” said Linda S. Birnbaum, who as director of the National Institute of Environmental Health Sciences is the government’s top official for evaluating environmental health effects.” Dr. Birnbaum’s cv indicates she knows a little something about the science of toxicology, but her statement could be displayed on any alternative health website, couldn’t it? About toxins accumulating in body tissues…..

    And scientists trying to discern more about what constitutes toxicity are faced with animosity from industry and the military about their findings. “Earlier this decade, scientists at the E.P.A. began telling top agency officials that more needed to be done. Dr. Peter W. Preuss, who in 2004 became head of the E.P.A.’s division analyzing environmental risks, was particularly concerned. So his department started assessing a variety of contaminants often found in drinking water, including perchlorate, an unregulated rocket fuel additive, as well as two regulated compounds, trichloroethylene, a degreaser used in manufacturing, and perchloroethylene or perc, a dry-cleaning solvent. Research indicated that those chemicals posed risks at smaller concentrations than previously known. “It’s hard for me to describe the level of anger and animosity directed at us for trying to publish sound, scientific research that met the highest standards,” Dr. Preuss said. “It went way beyond what would be considered professional behavior.” So yes, apparently corporations do object strenuously to science based fact that even minute amounts of the chemical waste substances they release are harmful to humans. Not exactly “evil”, but…….distinctly disquieting.

    “Dr. Preuss said “It is our job to follow the science, and when a preponderance of evidence indicates there is a risk, we should say so,” he said.” Follow the science, that sounds familiar

  61. wales says:

    For those interested in the science behind “toxic” tap water this links to a series of NYT articles on the subject.

    http://projects.nytimes.com/toxic-waters

    The resources section at the bottom of this link includes a section listing links to “Studies Regarding Illnesses and Drinking Water” as well as links to other scientific papers on arsenic, perc, perchlorate, trichloroethylene and herbicides in drinking water.

    The NYT article cited previously states “Independent studies in such journals as Reviews of Environmental Contamination and Toxicology; Environmental Health Perspectives; American Journal of Public Health; and Archives of Environmental and Occupational Health, as well as reports published by the National Academy of Sciences, suggest that millions of Americans become sick each year from drinking contaminated water, with maladies from upset stomachs to cancer and birth defects. “ Granted “suggest” does not equal “prove”, but uncertainty abounds. Certainly enough to generate concern in individuals who base their decisions upon science and not fearful beliefs about miasmas.

  62. rosemary says:

    Wales, “Amy’s superficial essay lumps “toxins and poisons” into a broad and somewhat vague category.”

    I think that was Amy’s point. Quacks lump toxins and poisons into broad, vague categories and claim that they are all around and inside of us causing diseases which they can prevent and cure if we pay them for their goods and services.

    Wales, “For those interested in the science behind “toxic” tap water this links to a series of NYT articles on the subject.
    http://projects.nytimes.com/toxic-waters

    I saw there what is usually considered “good journalism”, articles well structured and well written, but I didn’t see science. I saw broad generalizations and quotes from scientists. (Actually, I’d love to see a critique of the articles by Dr. Novella, who I believe has done a wonderful job with similar articles in the past.)

    One example from the other link you provided, “But regulatory records show that fewer than 6 percent of the water systems that broke the law were ever fined or punished…”

    In context of the well written article this gave the impression that huge numbers of people are regularly put at risk or made sick by frequently occurring water contamination that the government isn’t concerned about. As a water and sewer commissioner in my very tiny municipality who is not a scientist or even very knowledgeable about the subject, I can tell you the other side. In my state, Vermont, there are many ancient water systems. The government would rather get municipalities to use any money they can cough up to update or fix problems rather than use it to pay fines so often when they find a violation they work very hard with the municipality to get them to do just that, only fining as a last resort.

    Also, at least as far as I know, no one is seeing or at least not recognizing, any diseases here in humans that are being caused by the contaminants, not even from the many private wells which are not regulated anywhere near the degree that municipal systems are. (And I can assure you there would be a revolt of the populace if anyone attempted that kind of regulation.)

    Wales, “Granted ‘suggest’ does not equal “prove”, but uncertainty abounds.”

    You are correct. Suggest most certainly doesn’t equal prove. Epidemiological studies are highly unreliable as are toxicology studies in animals when extrapolated to other species. It takes toxicology studies in humans to get the real answers and they obviously can’t be done for ethical reasons.

    There is a great deal of evidence showing that in order to accurately evaluate a drug a great many very good clinical studies are required. Bench studies and epidemiological ones alone usually are not sufficient to come up with anything close to a conclusion offering a high probability of accuracy. I believe the same is true with toxicology. Certainly broad generalizations without citations in articles by the NYT just won’t cut it. Unfortunately though they will probably influence public policy.

  63. Zoe237 says:

    Okay, we’ll see if this works for italics- thanks nitpicking.

    Rosemary-

    “I think that was Amy’s point. Quacks lump toxins and poisons into broad, vague categories and claim that they are all around and inside of us causing diseases which they can prevent and cure if we pay them for their goods and services..

    Except she makes the opposite mistake. Quacks are making that mistake, I agree- lumping toxins and poisons into broad, vague categories, as you say. Very true. Industry apologists, like Tuteur’s post seems to be, otoh, lump toxins and poisons into broad, vague categories, only that they are never or rarely harmful.

    And they usually say that environmentalists are chanting “evil corporations” when many understand that corporations are just protecting their bottom line, but that there needs to be a governmental protection against the pure profit motive (i.e. FDA and EPA, among others).

    The water argument cited above is a good example of the complicated issues here. I saw a Dr. Oz teaser the other day for a show about contaminated water and how we should never drink it. It was fear based and, although, I didn’t watch the show, probably waaaay exagerrated. Did anyone see Penn and Teller’s bottled water show? Now there’s a big waste of money. OTOH, we can leap to the other extreme and not be watchful for contaminants in our water supply. It does happen, just not nearly on the scale that CAM promoters would have you believe. But people like to be on one “side” or another because it makes for more simplistic thinking.

    AmyTuteurMD:

    I daresay that if it wasn’t effective, it would have been ignored. The comments about style, word use, etc. are not charitable efforts to improve my writing; they are attempts to divert attention from the substance of the post.

    Now this is a demonstrative piece of “logic”: my posts are effective because they garner lots of comments…

  64. “my posts are effective because they garner lots of comments…”

    … and readers, and tweets, etc. That’s how effectiveness is measured in the blogosphere.

    Of course some comments or tweets are better than others. For example, Ricki Lake tweeted about me this morning, referring to the post on her website, “Amy Tuteur, aka “The Skeptical OB,” Has a Blatant Issue With Home Birth,” and the comment thread that extended for several weeks and 152 entries thus far.

    I’m mystified that Ms. Lake is proudly pointing to the discussion since I presented the scientific evidence on a number of aspects of homebirth and no one had an effective response.

  65. Lawrence C. says:

    Two things come to mind while reading this post and the comments.

    First, why all the fuss over style vs. content in a blog post? The author readily acknowledges that this is a blog post in the greater “blogosphere” and thus not a professionally edited and peer-reviewed article published elsewhere. Perhaps the words “science” and “medicine” in the title of this blogging forum lead people to think it will contain only rigorously edited writings? Difficult to say, but there seems to be an inordinate amount of complaining about how things were said instead of what was said. Surely those who care deeply about the quality of writing would serve everyone better by emailing the author directly, or is the public flogging of a writer’s style part of the brave new blog world?

    Second, Dr. Tuteur concluded in part:

    “The fact that anyone in this day and age still believes in such crackpot theories is a tribute to the power of ignorance and superstition.”

    This is an accurate statement from the point of view of one with a medical degree but should not be confused with the mindset of patients that still see out those peddling “crackpot theories” in search of relief from various ailments. Many people who cannot find relief in science-based medicine turn to just about anything else in search of -something- that will work. Desperation is a powerful motivator and can easily override logic and reason when one is greatly suffering. Every effort should be made to expose the purveyors of toxin-cleansing snake oils while understanding that many people who buy such miasma-removers are in need of compassion.

  66. rosemary says:

    Zoe, “Industry apologists, like Tuteur’s post seems to be, otoh, lump toxins and poisons into broad, vague categories, only that they are never or rarely harmful.”

    I did not get that impression at all from the article.

    The article stated:
    “There’s just one problem. ‘Toxins’ are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.”

    From the context, that, at least to me, quite clearly referred to the way alt. medders use the word “toxin”.

    The article further stated:
    “Poisons exist, of course, but their existence is hardly a secret, and their actions are well known.”

    From context, at least to me, that clearly referred to the way science views toxins and it does not indicate that they are “never or rarely harmful”.

    The article ended with:
    “Hence the obsession with ‘toxins’ in foods, in vaccines, even ‘toxins’ arising in the body itself. The height of inanity is the belief in ‘detoxifying’ diets and colon cleansing. The human body does not produce ‘toxins.’ That’s just a superstition of the ‘alternative’ health community. The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed for that purpose such as the kidneys.”

    IMO, that very clearly states the way alt med uses the term “toxin” to scar the public as well as the insanity of their claims about toxins.

    I do agree with Allison who, I believe without checking, mentioned that without a link people she sent to the site would not understand the problem Dr. Tetuer was addressing. People who have not waded through the muck of alt. med. would have no idea how that crowd uses the word “toxin”. However, I hope that if they read the article and wondered they’d google it. No, I haven’t done it myself but suspect that that get a lot of quack hits that would clearly illustrate the insanity.

    Regarding the number of responses Dr. Teteur’s articles receive here and elsewhere, I think that PR professionals believe that “any attention is good” and that the more generated, the better for the product, cause or whatever. Whether or not they have solid evidence to substantiate this, I don’t know.

    When it comes to giving a voice to someone, both the broadcast and print media generally gobble up those who draw a big audience and usually they don’t care if the audience idolizes or hates the person or topic that is getting the attention.

    I find the reactions to Dr. Teteur very interesting and wish that there was a psychologist who would analyze them in an effort to discover what provokes them. I suspect that there are several reasons which include things like a style of writing that doesn’t conform to the rules of what is often considered “good journalism” as well as the fact that she takes on very emotional issues and is not afraid to show her own emotions, something I find all too rare in scientists who try communicating with the general public.

    Just my thoughts if anyone is interested.

  67. RE effectiveness: well, that certainly clears things up. Your goal is not to educate or communicate but to collect eyeballs. Why you care only about eyeballs on SBM which doesn’t have advertising I still don’t fully understand, but that’s fine. If eyeballs are your only metric, then being temptingly easy to argue with is a good thing. Cool. Don’t change a thing.

  68. wales says:

    To Rosemary, who missed the “science”. As I noted, you must scroll down to the bottom of the page where there is a list of resources containing links to papers from the Environmental Protection Agency, National Academy of Sciences, National Center for Biotechnology Information, USGS and various other scientific and health journals such as the American Journal of Public Health, International Journal of Epidemiology, etc. Why is it that the important details are always in the fine print at the bottom of the page?

    http://projects.nytimes.com/toxic-waters

  69. wales says:

    Alison, perhaps the problem is that Amy’s pieces were originally written for different website venues which are/were not as stringent about the science, and then pasted here. Perhaps she should re-write or tailor her old essays before publishing them on this science based venue in order to satisfy her more demanding audience.

  70. Zoe237 says:

    Rush Limbaugh also has a lot of listeners, as do a lot of extremists. That doesn’t make him smart, clear, logical, or effective. It makes him entertaining, and even though I disagree with him 95% of the time, I have to give him that. Same with Michael Moore (if you’re a conservative!)

    False cause fallacy, anyone?

    As for Dr. Tuteur confusing toxin, poison, chemical substances, etc, using vague, broad usages, I say that because she one, never gave a clear definition in the post, and because, two, Dr. Gorski clarified the use of the word toxin and that alcohol, tobacco, etc, do not technically fall into that definition either, despite the OP. IOW, it was an extremist post intended to demonize and confuse rather than elucidate.

    I have never responded to any of Dr. Tuteur’s other blogs, even I’ve read them a few times, because there was nothing about “science” in the title. I respond here because I think that SBM is an otherwise good website. But perhaps I am expecting too much from a random blog post.

  71. rosemary says:

    Sorry Wales, I checked again, and I still missed the science. I did see the links, most of which are to the EPA, but I didn’t see citations for each specific claim made in the articles, which to me is required in science writing but not in journalism.

    A few clicks on at an EPA link, brought this up:
    “The report concludes that most Americans received drinking water from public water systems that recorded no significant violations in 2006. Ninety-three percent of America’s public water systems did not have any reported violations of health-based standards, and 73% of the population is served by public water systems which did not have any reported significant violations in 2006.”

    Admitting that I only gave the NYTs articles a cursory glance, that statement from the EPA appears to me to show the opposite of what the articles said about the safety of drinking water in the US. Of course, when giving links to anything producing the volume of material that the EPA does, I would guess one could go through the site and find statements supporting either side of the argument which is exactly the reason that I don’t find listing links to things like an agency, institution or large organization to support specific claims as being scientific.

    Also in my mind, which is very uneducated compared to most others here, I see a clear distinction between the EPA, a government agency, and toxicology which is a science. That is based specifically on my knowledge of silver, something I do know quite a bit about. I have actually lectured toxicologists on the subject although lecture is probably too strong a word. I suspect the main reason I was invited to speak at their conference was so that they could see me, the specimen, in person.

    The EPAs estimates about the amount of silver toxic to a human are fairly useless, based on exceedingly old studies and lack of knowledge about current levels of exposure. The only way to find out what the real toxic amount of silver is for the average person is to have someone do good toxicology studies on humans. Ironically, toxicology studies are being done on silver all over the world as we speak, but they are virtually useless because they are uncontrolled.

  72. wales says:

    Rosemary I am impressed. If you read all 25+ papers, including the National Academy of Science’s 400+ page book on trichloroethylene, you are to be commended on your speed reading skills. That does explain how you may have missed something, reading so quickly.

  73. Zoe237 says:

    Rush Limbaugh also has a lot of listeners, but that doesn’t make him smart, logical, clear, or effective in communicating. Extremists usually garner a lot of attention.

    They may be right or wrong or effective or not, but this doesn’t depend on the amount of attention. I suppose Alison is right though, if your definition of effective is that you get a lot of attention.

    False cause fallacy anyone?

    As for the reason I call Dr. Tutuer’s OP as having vague and broad definitions of toxin, poison, chemical substance, etc, is because she doesn’t specifically define any of the terms scientifically in the OP, because the only poisons she mentions are alcohol, tobacco, etc, and because of Dr. Gorski’s real clarification of the term toxin and the non application of tobacco and alcohol.

    I have never responded to any of Dr. Tuteur’s blogs in the past, although I’ve read them a handful of times. These blog addresses didn’t have anything about science in the title, and I figured she was entitled to her extremist opinion. When she calls them science, and starts bringing them to an otherwise good website, I’m going to question. But perhaps I am expecting too much from a random blog post.

    Okay, I’ll stop belaboring the point.

  74. pmoran says:

    Amy may have been forthright and simplistic but where is she wrong and the “Detox” merchants right? For Detox is what her post is really about.

    These nice, concerned folk are not interested in identifying any toxic chemicals that are really causing human illness so that specific ones can be avoided.

    They are not interested in finding out if their methods actually remove worthwhile amounts of anything from the body, or that this is uniquely associated with the amelioration of any illness, or that it is of any long-term benefit for human health.

    All that is in the received wisdom — in Detox dogma

    Do they even know how much of any Detox activity is necessary for any medical purpose? Have they ever tried to find out? Of course not.

    There are in fact strong grounds for believing that the most prevalent DEtox methods are an utter waste of time in terms of human physiology or toxicology. Some are frankly harmful.

    The above does not preclude the reality of the intense euphoria some subjects experience after “Detox”, arising form the belief that they are now “clean”, and also from that DYI sense of achievement at completing often arduous Detox programs.
    It also does not preclude placebo responses in other illnesses.

    But here be science. It is our job to understand what is really going on.

  75. nitpicking says:

    pmoran, nobody said that Dr. Tuteur was wrong that I saw. Unclear, unpersuasive, yes, but not wrong.

  76. Zoe237 says:

    Amy may have been forthright and simplistic but where is she wrong and the “Detox” merchants right? For Detox is what her post is really about.

    These nice, concerned folk are not interested in identifying any toxic chemicals that are really causing human illness so that specific ones can be avoided.

    I can agree with this. Although I don’t know about nice. ;-)

    Sorry about the basically double post earlier. I don’t know if one went into moderation.

  77. lkw says:

    A question for SBM editors:

    As Alison points out, Amy’s writing/thinking is sloppy and bears an eerie resemblance to the extremist writing of the woo’ers. Her avowed goal is clicks/comments and she appears to believe that this is a sufficient contribution to SBM. Calls for more effective communication are ignored and even mocked by Amy.

    Are these the goals of SBM? If so, could you recommend some other sources of good SBM material that would enlighten me, rather than simply generate clicks/comments?

  78. rosemary says:

    Wales, “Rosemary I am impressed. If you read all 25+ papers, including the National Academy of Science’s 400+ page book on trichloroethylene, you are to be commended on your speed reading skills. That does explain how you may have missed something, reading so quickly.”

    Oh, Wales, you have so greatly underestimated me. I read everything at all the EPA links that the NYTs so graciously provided and just like the Times did my own little analysis. While the good journalists and editors at the paper didn’t say how long it took them to do theirs, I’ll bet I did mine much faster. Yikes, I even found my own little water company there and checked what the agency reported about us, something I’ll bet the Times didn’t do.

    And guess what, after my impressive “research”, I still conclude that the NYTs articles were examples of great writing, wonderful structure and all that stuff, but no science. It was kind of like writing an article about God and giving links to online sites that post the Bible as a reference. Just a tad, general, hazy and vague.

    Alison, it seems as if your vision of what the SBM site should be is not the same as that of the founders and editors of the blog. As I’ve said before, different people learn and communicate differently. Perhaps you should start your own site. They might compliment each other.

  79. David Gorski says:

    …Industry apologists, like Tuteur’s post seems to be…

    You do realize, don’t you, that this comes mighty close to being an example of the pharma shlll gambit. My post today was quite timely.

  80. Harriet Hall says:

    Rosemary said,

    “I find the reactions to Dr. Tuteur very interesting and wish that there was a psychologist who would analyze them in an effort to discover what provokes them.”

    I agree. I just went back and re-read the post and it reads well and makes sense to me. The whole point was that “toxins” are undefined in CAM; scientists know what the word really means, and Amy made that clear. There is no “science” to be cited about these vague toxins, because the concept is not based on science.

    I suspect that if another blogger’s name were on this post, the comments would have been less critical. It seems to me some of our readers are more interested in Amy-bashing than in the substance of what she writes. I find that incomprehensible and very disturbing.

  81. Zoe237 says:

    You do realize, don’t you, that this comes mighty close to being an example of the pharma shlll gambit. My post today was quite timely…

    You yourself accused Stephen Milloy, of junkscience.com, of being an industry apologist, if not an outright shill. (comments, Endocrine disruptors, 7:54 am, dec. 8). I didn’t realize it was *never* true or allowed in any circumstances, if not specifically using it to discredit an argument. It’s liking people saying that “appeal to authority” is a logical fallacy when it’s actually “appeal to *unqualified* authority.”

    No, it doesn’t discredit Dr. Tuteur’s argument, nor did I accuse *her* of being this (I rather doubt it). But I can’t think of another reason why someone would deny that *any* toxic substances cause disease then talk about “evil corporations” and denigrate environmentalists and entire fields of science. I never would have even brought it up except for the “evil corporation” remark. Take it as a side note if you will, but I appreciate the even handedness.

  82. David Gorski says:

    You yourself accused Stephen Milloy, of junkscience.com, of being an industry apologist, if not an outright shill.

    That’s because there is copious evidence that he has been (and probably still is) a shill for industry. I do not make that charge lightly. I never do. Unlike the alt-med promoters who use the “pharma shill” gambit. And, even though Milloy is an industry apologist, sometimes he’s right about certain topics (i.e., vaccines and autism). However, his history as an industry apologist does make me look at his arguments more skeptically when it comes to certain issues, and I see nothing wrong with that.

    No, it doesn’t discredit Dr. Tuteur’s argument, nor did I accuse *her* of being this (I rather doubt it). But I can’t think of another reason why someone would deny that *any* toxic substances cause disease then talk about “evil corporations” and denigrate environmentalists and entire fields of science.

    Where, pray tell, did Amy denigrate entire fields of science? I’ve been critical of some of Amy’s comments in this thread (of that there is no doubt), but I don’t recall seeing her do anything like denigrating entire fields of science.

  83. David Gorski says:

    RE effectiveness: well, that certainly clears things up. Your goal is not to educate or communicate but to collect eyeballs. Why you care only about eyeballs on SBM which doesn’t have advertising I still don’t fully understand, but that’s fine.

    I assure you, our primary measurement of effectiveness at SBM is not collecting eyeballs or comments. Traffic is, of course, essential for getting our message across, and I’d be lying if I said we don’t want more traffic. After all, the more people there are reading us, the more influence we can have. Yes, we like comments, too, just as we like traffic, but we these two things do not necessarily correlate with quality and effective communication. Having been in the blogosphere for five years, I know this to be true. What we hope to do here is to educate in a way that is engaging enough to result in traffic and comments without sacrificing scientific rigor.

  84. Plonit says:

    “For Detox is what her post is really about.”

    +++++++++++

    Actually, I’m not sure this is obviously the case. In the entire article, “detox” merits only one line “The height of inanity is the belief in “detoxifying” diets and colon cleansing.” But nowhere does Dr Amy actually take on or nail the ‘detox merchants’ – preferring to spend her time asserting that there are ‘no such things as toxins’.

    The more tackling of chelation therapy, colonic irrigation and detox in Singh & Ernst _Trick of Treatment_ is more effective because they are have a more accurate aim on their target. These are not just questions of stylistic preference.

  85. wales says:

    Rosemary you may have read all the EPA links, but you left out many others. I did not find the International Journal of Epidemiology paper, nor the American Journal of Public Health paper, nor the Epidemiology paper, nor the National Academy of Sciences papers to be vague or even remotely lacking in science. I guess it’s just a matter of semantics, to which even science is not immune. I cannot tell if your primary gripe is that the NYT article should have specific citations as in a medical journal paper (not standard practice for newspaper articles) or if you are denying that there is any scientific evidence that tap water contamination is harmful to health. The NYT article has documented its sources in a very thorough manner in the resources section. The fact that you draw conclusions that differ from the article’s does not negate the science.

    It is disturbing that a water/sewer commissioner seems to be denying the evidence for drinking water contamination, which is illustrative of why we need the EPA to protect public interests. You repeatedly say there is no science, perhaps bias plays a role in blurring your vision. You will see what you wish to see. I am finished with my comments on this topic.

  86. Harriet Hall says:

    Zoe237 said,

    “I can’t think of another reason why someone would deny that *any* toxic substances cause disease then talk about “evil corporations” and denigrate environmentalists and entire fields of science.”

    I went back and read the article again and I couldn’t find where Amy had said any of those things.

  87. wales says:

    Actually Amy did make reference to “evil” corporations. See paragraph 9, last sentence of Amy’s essay for the comment.

    It doesn’t much matter, but since I also made reference to Amy’s comment about “evil” corporations I thought I’d point it out.

  88. wales says:

    I agree with Plonit regarding the “detox” topic. It wasn’t clear to me that detox was the topic. In fact if one is to judge the topic by the number of times a word is repeated in Amy’s essay it’s interesting to note that the word “evil” is repeated even more often than the word “toxin”. Go figure.

  89. David Gorski says:

    Funny, but I thought you said you were “finished with your comments on this topic.”

  90. wales says:

    I was referring to the NYT articles. Sorry to disappoint you.

  91. Harriet Hall says:

    wales said,

    “Actually Amy did make reference to “evil” corporations.”

    She wasn’t saying corporations were evil, she was citing the arguments of believers in unspecified “toxins.” She even put “evil” in quotation marks. It was clear from the context that she did not agree.

  92. Zoe237 says:

    Harriet Hall:

    “I can’t think of another reason why someone would deny that *any* toxic substances cause disease then talk about “evil corporations” and denigrate environmentalists and entire fields of science.”

    The following quote (at the end) is where I got the idea. She posted that toxins were the new evil humors. I asked about lead, radon, asbestos, ddt, and other chemicals/toxic substances/industrial pollution. The response I got was that these don’t cause disease (specifically lead). Then I posted specific reliable medical websites that call lead poisoning a disease.

    Toxins and environmental pollution are the entire reason for some fields of science. If I’m wrong somewhere, I’d love to hear where, because I admit I’m confused. Other knowledgeable commenters have posted that of course toxins exist, some are caused by industry, and some cause disease. Dr. Tuteur said that alcohol and nicotine were toxins, but I guess they don’t fit under the true scientific definition (that toxins are the results of biological processes and cause disease BY DEFINITION.)

    This doesn’t seem to be a bias by solely Dr. Tuteur either, but toxicologists, epidemiologists, and environmental scientists don’t seem to be respected on this website. Pseudoscientists, iow. I hope I’m wrong. But I’ll let it go.

    Amy Tuteur MD (comments):
    “I did no such thing. I certainly am not denying that toxic substances exist.

    My claim is it’s a big (and unjustified) leap from acknowledging the existence of toxic substances and claiming that they cause “disease.” “

  93. rosemary says:

    Wales, “Rosemary…I cannot tell…if you are denying that there is any scientific evidence that tap water contamination is harmful to health.”

    Wales, that statement hits the nail on the head. It is so general it is silly. I am not saying this to insult you. I realize that I often don’t express myself well and that you may really wonder if I thought that. So let me try to be very clear. Of course I’m not denying that there is scientific evidence that tap water contamination is harmful to health. What I am saying is that science doesn’t pose such broad, general questions as that. It poses specific questions. Such as: Is arsenic dangerous to human health: if so what amount of each specific arsenic compound commonly found in drinking water is safe. (If we are speaking about drinking water, the route of administration doesn’t vary.)

    Wales, “The NYT article has documented its sources in a very thorough manner in the resources section.”

    The NYTs has listed links to the sites that it used in its study. To know if its conclusions are supported by the evidence, you would have to look through all the material on the subject to pull out what is relevant and review it yourself. That means the whole body of evidence, not simply a few dozen studies, and until you have done that, you cannot conclude that the NYTs had documented its sources. I can give you many examples of quacks giving long lists of citations which they claim document their statements, but if you actually read the articles, you find that they are either on an entirely different subject or say the opposite of what the quack is claiming.

    The headlines at the NYT site you sent: http://projects.nytimes.com/toxic-waters
    give me the impression that huge numbers of people are regularly put at risk or made sick by frequently occurring water contamination that the government isn’t concerned about.
    Just 2 headlines as examples:
    “Tap Water Can Be Unhealthy but Still Legal”
    “Millions in US Drink Contaminated Water, Records Show”
    Those are emotionally charged words that scar the general public and give them the impression that tap water is dangerous for their health.

    What I am saying is that I am not aware of diseases in humans caused by drinking contaminated water that indicate that people, in general, should be scared about drinking water or afraid that the government is not sufficiently regulating it. Please do not read into that more than what I’ve said because I am definitely not saying that the EPA should not continue to monitor water to see if there are contaminants in it that they have previously failed to identify. Neither am I saying that contaminants never get into water and that drinking water never makes people sick. But if you want to call it science, you have to be specific. The Times was not. It was general.

    I am also saying that bench studies, animal studies and epidemiological studies alone usually are not sufficient to come up with anything close to a conclusion offering a high probability of accuracy regarding a toxin. For that human toxicology studies are required and they cannot be ethically done. Which means that the NYTs has not found any human toxicology studies at any of the resource sites that it used to substantiate its claims. That doesn’t mean that they aren’t accurate, but it does mean that the level of evidence isn’t high.

    Which I think brings us to the emotional problem. Americans really want to believe that we can make life risk free, discover all the causes of disease and eliminate them. That just isn’t possible and sometimes in trying to do that you create problems where there weren’t any.

  94. rosemary says:

    I think perhaps I’ve found the language to express my thought regarding my inability to see any science on the NYT site above: http://projects.nytimes.com/toxic-waters.

    If I were to write an article about the danger of drugs and include links to the FDA and NIH websites under the heading of “resources” and throw in a few epidemiological studies, the reader would have no way of telling from that if in fact there was a body of convincing evidence that supported whatever my conclusions were mainly because the topic, the danger of drugs, is too broad but also because the sites are too exhaustive to locate all the specific information they have pro and con.

    Quite possibly no one is reading at this point. But if anyone is, it is a very important point since a great many people jump to the erroneous conclusion that whenever an author lists scientific sites or citations from scientific journals that his work is scientific and that the science supports his conclusions. If you have spent any time investigating the claims of quacks and the naive people who repeat them because they take the quacks at their word without ever trying to independently verify what they say, you know how very wrong that assumption is.

    I have almost all the English literature on silver drugs, but there was one pharmacology book over 50 years old that I had never been able to locate which is cited as showing that ingesting silver offers benefits. I just located and paid over $200 for a used copy. And guess what, just as I suspected, it states no such thing.

  95. Harriet Hall says:

    “toxicologists, epidemiologists, and environmental scientists don’t seem to be respected on this website”

    They are respected. I think your perception may come from the fact that epidemiologic studies have many pitfalls and are not as reliable a source of evidence as RCTs (which also have pitfalls). Shaky epidemiologic correlations are frequently offered with overblown claims of causation. Recent posts on cell phones/brain cancer and Bisphenol A are examples.

    We do not reject epidemiologic evidence nor do we disregard the possibility of environmental toxins affecting human health. We simply require the same rigorous standards of evidence as for any other claim. Epidemiologic and toxicologic evidence was crucial in the recognition that tobacco causes lung cancer, but in that case there was strong, high quality evidence, a dose-response relationship, consistency, plausibility, coherence from all areas of research and all of Hill’s criteria of causation were fulfilled.

  96. lkw says:

    Now, there’s an interesting point regarding the effective communication of scientific knowledge: the use of epidemiologic studies where RCTs are either absent or impossible. The woo’ers love to cite these studies and the non-woo’ers love to disparage them.

    However, in doing so, the non-woo’ers often appear to paint with a very broad brush and seem to be disparaging epidemiology and statistics in general. Finding a less broad (and bombastic) means for communicating the weaknesses of these studies might help the public better understand the scientific process and the manner in which both accurate and precise conclusions can be drawn from data.

    Sometimes it appears that the non-woo’ers want to have their cake and eat it, too. For example, some “studies” are sponsored by advocacy organizations; the non-woo’ers would have us scrutinize their results carefully (and I would agree). But to extend that skepticism to the motives of chemical-producing corporations is to label them “evil” and be positively medieval in our thinking. Really?

    Between the woo’ers and the non-woo’ers, it is the use of the sweeping broad brush that makes the communication so blurry, even if the underlying data is not.

  97. David, you say:

    “I assure you, our primary measurement of effectiveness at SBM is not collecting eyeballs or comments.”

    “Yes, we like comments, too, just as we like traffic, but we these two things do not necessarily correlate with quality and effective communication. Having been in the blogosphere for five years, I know this to be true.”

    However, Amy says:

    “’my posts are effective because they garner lots of comments…
    … and readers, and tweets, etc. That’s how effectiveness is measured in the blogosphere.”

    Amy is quite clear. Traffic is the only measure of effectiveness for a blog post. While you may recognize a more complex set of measures that include traffic, Amy says she does not.

    … either that, or Amy meant to say what you said, but said something else instead. If it is the latter, and I am supposed to divine what she really meant even though she doesn’t say it, then she is not writing clearly.

  98. Amy,

    “Of course some comments or tweets are better than others. For example, Ricki Lake tweeted about me this morning, referring to the post on her website, “Amy Tuteur, aka “The Skeptical OB,” Has a Blatant Issue With Home Birth,” and the comment thread that extended for several weeks and 152 entries thus far.

    I’m mystified that Ms. Lake is proudly pointing to the discussion since I presented the scientific evidence on a number of aspects of homebirth and no one had an effective response.”

    This seems to be the discussion in question: http://www.mybestbirth.com/profiles/blogs/amy-tuteur-aka-the-skeptical

    If effectiveness is measured in traffic and comments, then 152 comments means the mybestbirth post was very effective and of course Ms. Lake is proud.

    I suspect that Ms. Lake has no qualms about reposting your posts to her site because she does not find your writing persuasive and does not believe her readers will be persuaded either. If effectiveness is measured in persuasiveness, Ms. Lake believes your writing to be ineffective.

    I hesitate to refer people to you for exactly the same reason Ms. Lake refers people to you eagerly. I do not find you persuasive. While your unconvincing writing plays right into Ms. Lake’s hands, it frustrates me.

  99. Zoe237 says:

    I believe Revere on scienceblogs referred to the worship of the RCT “methodolatry.” That’s why I asked a few days ago on another SBM blog post how many prospective cohort studies or other epidemiological studies = RCT (knowing of course that the answer is complicated, but unsure how to resolve these complex issues). Of course in carcinogen research (toxins!), RCTs are impossible for the reason Rosemary mentions, so the lesser studies are all we got.

    Thanks Dr. Hall.

  100. lkw:

    “Sometimes it appears that the non-woo’ers want to have their cake and eat it, too. For example, some “studies” are sponsored by advocacy organizations; the non-woo’ers would have us scrutinize their results carefully (and I would agree). But to extend that skepticism to the motives of chemical-producing corporations is to label them “evil” and be positively medieval in our thinking. Really?”

    No. Science based medicine should involve disclosure of the competing interests of the researchers and sponsors. However, the fact that competing interests exist does not invalidate the research.

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