Toxins and tanks: could your fishtank really be deadly?

Could a deadly poison be lurking in your fish tank?

A few days ago I came across a news story: “Fish owner tells how cleaning out tank released deadly palytoxin that poisoned family and led to closure of entire street“. Now you have to admit, as titles go that’s pretty compelling.

To begin with, for some reason, I had it in my head that this happened in Australia (in my defence, that is where most of the really deadly stuff happens, right?). But no, this happened in the U.K. Not only that, but it was even in Oxfordshire, which is my neck of the woods.

The fish tank owner, a man named Chris Matthews, was actually an experienced aquarist. He knew about palytoxin – a poisonous substance which can be released by corals – and he was aware that it can be deadly if ingested. He also knew that it can cause serious skin irritation.

What he didn’t realise was that taking his pulsing xenia coral out of the tank could cause it to release the toxin into the air.

But before I talk about palytoxin, let’s just look at the word “toxin” for a moment. It has a specific meaning, and it’s often misused. As in many, many adverts. Here’s a recent one, but these easy to find – just put “toxin free” into the search engine of your choice.

In a way, this is quite funny. You see, “toxin” specifically refers to “a poison of plant or animal origin“. In other words, a naturally occurring poison*. There are lots and lots of naturally occurring poisons. Plants make them all the time, generally to ward off pests. Most essential oils can, at a high enough dose, be toxic. The hand cream in that picture contains peppermint oil. Peppermint is, of course, pretty safe – we’ve all eaten mints after all – but guess what? Take huge dose of it and it becomes a real problem. Now, I’m not for one second suggesting that hand cream is dangerous or harmful, but technically, it’s not “toxin free”.

Beauty products which contain only synthetic ingredients are, by definition, toxin-free.

Yes, the irony or this sort of marketing is that beauty products made out of entirely synthetic ingredients definitely will be toxin-free. Nothing natural = no toxins. Whereas anything made out of naturally occurring substances almost certainly isn’t, regardless of its spurious labelling.

Anyway, back to the palytoxin. It’s naturally occurring. And incredibly dangerous. More proof, as if we needed it, that natural doesn’t mean safe. Very often, in fact, quite the opposite. The human race has spent millenia working out how to protect itself from nature and all her associated nastiness (bacteria, viruses, extreme temperatures, poor food supply, predators…. the list is long and unpleasant) and yet for some reason it’s become fashionable to forget all that and imagine a utopia where mother nature knows best. Honestly, she doesn’t. Well, maybe she does – but being kind to human beings isn’t on her agenda.

Palytoxin is especially unpleasant. Indeed, it’s thought to be the second most poisonous non-protein substance known (there are some very impressive protein-based ones, though – botulinum toxin for one). The only thing which is more toxic is maitoxin – a poison which can be found in striated surgeonfish thanks to the algae they eat.

Palytoxin is a large molecule.

Palytoxin is a big molecule, technically categorised as a fatty alcohol. It has eight carbon-carbon double bonds, 40 hydroxy groups (phew) and is positively covered in chiral centres (don’t worry students: your teacher isn’t going to expect you to draw this one. Probably). Bits of it are water-soluble whilst other parts are fat soluble, meaning it can dissolve in both types of substance. Because it’s not a protein, heat doesn’t denature it, so you can’t get rid of this toxin with boiling water or by heating it. However, it does decompose and become non-toxic in acidic or alkaline solutions. Household bleach will destroy it.

It’s mostly found in the tropics, where it’s made by certain types of coral and plankton, or possibly by bacteria living on and in these organisms. It also turns up in fish, crabs and other marine organisms that feed on these things.

In fact, story time! There is a Hawaiian legend which tells that Maui villagers once caught a Shark God with a hunger for human flesh whom they believed had been killing their fishermen. They killed the Shark God and burned him, throwing the ashes into a tide pool. The ashes caused ugly brown anemones to grow. Later, the villagers discovered that blades smeared with these “limu” would cause certain death. So the anemones came to be known as “Limu Make O Hana” or Seaweed of Death from Hana. We now know that those brown ‘anemones’ are zoanthid corals, and the ‘certain death’ was due to palytoxin poisoning.

Zoanthids are a source of palytoxin.

People don’t suffer palytoxin poisoning very often. Most cases have been in people who’ve eaten seafood and, as here, aquarium hobbyists. In a few cases people have been exposed to algae blooms.

It’s really nasty though. Palytoxin can affect every type of cell in the body (yikes) and as a result the symptoms are different according to the route of exposure. Eat it and you’re likely to experience a bitter taste in your mouth, muscle spasms and abdominal cramps, nausea, lethargy, tingling and loss of sensation, slow heart rate, kidney failure and respiratory distress. It can damage your heart muscle; in the worst case scenario, it causes death by cardiac arrest.

On the other hand, if you inhale it, the symptoms are more likely to revolve around the respiratory system, such as constriction of the airways which causes wheezing and difficulty breathing. It can also cause fever and eye-infection type symptoms. Over time, though, the result is the same: muscle weakness and eventually, death from heart failure.

The respiratory symptoms from palytoxin are easily misdiagnosed: it looks like a viral or bacterial infection. In fact, our fish tank owner initially thought he had flu. It was only when everyone in the family got ill, even the dogs, that he realised that it must be poisoning. Fortunately, the emergency services took it seriously and sent both ambulance and fire crews to his house, as well as police. They closed the street and ensured that the poison was safely removed.

There is no antidote, but the symptoms can be eased by, for example, treatment with vasodilators. If the source of exposure is removed the victim is likely to recover over time. You’ll be pleased to hear that Chris Matthews, his family, and the firefighters who attended the scene, were checked over at hospital and appear to be okay.

If you’re an aquarium owner, how to you avoid getting into this kind of predicament? As Chris Matthews said, the coral he had, pulsing xenia, was “not expensive and a lot of people have it.”

Click the image to read safety guidelines from the Ornamental Aquatic Trade Association.

According to the Ornamental Aquatic Trade Association, the most important piece of safety advice is to only handle your marine creatures underwater and fully submerged. Don’t take them out of the tank unnecessarily, and if you do need to move them, use submerged plastic bags or a bucket, so that they stay underwater at all times. You should also wear strong rubber gloves, ideally gloves specifically designed for aquarium use (such as these). If you need to dispose of a rock which contains soft coral species, soak it in a bleach solution – one part household bleach to nine parts water – for several days before you intend to dispose of it. Leaving an untreated rock outside to dry will not make it safe – it could still be highly toxic. Finally, whilst activated charcoal can help to keep palytoxin out of the water, it may not be able to cope with large quantities, and it needs to be changed frequently.

Fish tank owner Chris also said: “The information is not readily available online in a way people can easily understand” and “I want to use this experience to educate people about the risks and the measures people need to take.” Hopefully this blog post (and all the associated news coverage) will help with that. Be careful with your corals!


* Note that while ‘toxin’ specifically refers to poisonous substances from plants and animals, this restriction doesn’t extend to the word “toxic”. The definition of that is “containing or being poisonous material” (regardless of whether it’s a naturally-occurring substance or not). So “non-toxic” labels are fine, if a little bit meaningless – no matter what the woo-pushing sites say, your hand cream really isn’t poisonous.


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Where did our love of dairy come from?

The popularity of the soya latte seems to be on the rise.

A little while ago botanist James Wong tweeted about the myriad types of plant ‘milk’ that are increasingly being offered in coffee shops, none of which are truly milk (in the biological sense).

This generated a huge response, probably rather larger than he was expecting from an off-hand tweet. Now, I’m not going to get into the ethics of milk production because it’s beyond the scope of this blog (and let’s keep it out of the comments? — kthxbye) but I do want to consider one fairly long thread of responses which ran the gamut from ‘humans are the only species to drink the milk of another animal’ (actually, no) to ‘there’s no benefit to dairy’ (bear with me) and ending with, in essence, ‘dairy is slowly killing us‘ (complicated, but essentially there’s very little evidence of any harm).

Humans have been consuming dairy products for thousands of years.

But wait. If dairy is so terrible for humans, and if there are no advantages to it, why do we consume it at all? Dairy is not a new thing. Humans have been consuming foods made from one type of animal milk or another for 10,000 years, give or take. That’s really quite a long time. More to the point (I don’t want to be accused of appealing to antiquity, after all), keeping animals and milking them is quite resource intensive. You have to feed them, look after them and ensure they don’t wander off or get eaten by predators, not to mention actually milk them on a daily basis. All that takes time, energy and probably currency of some sort. Why would anyone bother, if dairy were truly detrimental to our well-being?

In fact, some cultures don’t bother. The ability to digest lactose (the main sugar in milk) beyond infancy is quite low in some parts of the world, specifically Asia and most of Africa. In those areas dairy is, or at least has been historically, not a significant part of people’s diet.

But it is in European diets. Particularly northern European diets. Northern Europeans are, generally, extremely tolerant of lactose into adulthood and beyond.

Which is interesting because it suggests, if you weren’t suspicious already, that there IS some advantage to consuming dairy. The ability to digest lactose seems to be a genetic trait. And it seems it’s something to do, really quite specifically, with your geographic location.

Which brings us to vitamin D. This vitamin, which is more accurately described as a hormone, is a crucial nutrient for humans. It increases absorption of calcium, magnesium and phosphate, which are all necessary for healthy bones (not to mention lots of other processes in the body). It’s well-known that a lack of vitamin D leads to weakened bones, and specifically causes rickets in children. More recently we’ve come to understand that vitamin D also supports our immune system; deficiency has been meaningfully linked to increased risk of certain viral infections.

What’s the connection between vitamin D and geographic location? Well, humans can make vitamin D in their skin, but we need a bit of help. In particular, and this is where the chemistry comes in, we need ultraviolet light. Specifically, UVB – light with wavelengths between 280 nm to 315 nm. When our skin is exposed to UVB, a substance called 7-dehydrocholesterol (7-DHC to its friends) is converted into previtamin D3, which is then changed by our body heat to vitamin D3, or cholecalciferol – which is the really good stuff. (There’s another form, vitamin D2, but this is slightly less biologically active.) At this point the liver and kidneys take over and activate the chloecalciferol via the magic of enzymes.

We make vitamin D in our skin when we’re exposed to UVB light.

How much UVB you’re exposed to depends on where you live. If you live anywhere near the equator, no problem. You get UVB all year round. Possibly too much, in fact – it’s also linked with skin cancers. But if you live in northerly latitudes (or very southerly), you might have a problem. In the summer months, a few minutes in the sun without sunscreen (literally a few minutes, not hours!) will produce more than enough vitamin D. But people living in UK, for example, get no UVB exposure for 6 months of the year. Icelanders go without for 7, and inhabitants of Tromsø, in Norway, have to get by for a full 8 months. Since we can only store vitamin D in our bodies for something like 2-4 months (I’ve struggled to find a consistent number for this, but everyone seems to agree it’s in this ballpark), that potentially means several months with no vitamin D at all, which could lead to deficiency.

In the winter northern Europeans don’t receive enough UVB light from the sun to produce vitamin D in their skin.

In the winter, northern Europeans simply can’t make vitamin D3 in their skin (and for anyone thinking about sunbeds, that’s a bad idea for several reasons). In 2018, this is easily fixed – you just take a supplement. For example, Public Health England recommends that Brits take a daily dose of 10 mcg (400 IU) of vitamin D in autumn and winter, i.e. between about October and March. It’s worth pointing out at this point that a lot of supplements you can buy contain much more than this, and more isn’t necessarily better. Vitamin D is fat-soluble and so it will build up in the body, potentially reaching toxic levels if you really overdo things. Check your labels.

Oily fish is an excellent source of vitamin D.

But what about a few thousand years ago, before you just could pop to the supermarket and buy a bottle of small tablets? What did northern Europeans do then? The answer is simple: they had to get vitamin D from their food. Even if it’s not particularly well-absorbed, it’s better than nothing.

Of couse it helps if you have access to lots of foods which are sources of vitamin D. Which would be…  fatty fish (tuna, mackerel, salmon, etc) – suddenly that northern European love of herring makes so much more sense – red meat, certain types of liver, egg yolks and, yep, dairy products. Dairy products, in truth, contain relatively low levels of vitamin D (cheese and butter are better than plain milk), but every little helps. Plus, they’re also a good source of calcium, which works alongside vitamin D and is, of course, really important for good bone health.

A side note for vegans and vegetarians: most dietry sources of vitamin D come from animals. Certain mushrooms grown under UV can be a good source of vitamin D2, but unless you’re super-careful a plant-based diet won’t provide enough of this nutrient. So if you live in the north somewhere or you don’t, or can’t, expose your skin to the sun very often, you need a supplement (vegan supplements are available).

Fair skin likely emerged because it allows for better vitamin D production when UVB levels are lower.

One thing I haven’t mentioned of course is skin-colour. Northern Europeans are generally fair-skinned, and this is vitamin D-related, too. The paler your skin, the better UVB penetrates it. Fair-skinned people living in the north had an advantage over those with darker skin in the winter, spring and autumn months: they could produce more vitamin D. In fact, this was probably a significant factor in the evolution of fair skin (although, as Ed Yong explains in this excellent article, that’s complicated).

In summary, consuming dairy does have advantages, at least historically. There’s a good reason Europeans love their cheeses. But these days, if you want to eat a vegan or vegetarian diet for any reason (once again, let’s not get into those reasons in comments, kay?) you really should take a vitamin D supplement. In fact, Public Health England recommends that everyone in the UK take a vitamin D supplement in the autumn and winter, but only a small amount – check your dose.

By the way, if you spot any ‘diary’s let me know. I really had to battle to keep them from sneaking in…

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A Dash of Science, Social Media and VARD

Yesterday I recorded a podcast with Matthew Lee Loftus (from The Credible Hulk) and Christopher El Sergio for A Dash of Science, all about science communication and social media. It was a brilliant chat – I won’t go into lots of details of what we covered, but if you’d like to hear it (you know you do!) the direct link is: Communicating Science on Social Media. You can also pick it up on iTunes and/or Tune In.

After our conversation ended I remembered something I developed little while ago, after marking a particularly infuriating research homework where a quarter of the class wrote down that Mendeleev was awarded a Nobel prize for his work on the Periodic Table. For the record: he never received the honour. He was recommended for the prize but famously (at least, I thought it was famously!) the 1906 prize was given to Henri Moissan instead, probably due to a grudge held by Svante Arrhenius of Arrhenius Equation fame (it’s a good story, check it out).

Mendeleev was never awarded a Nobel prize.

Does it really matter if a few students believe that Mendeleev won a Nobel prize? That’s not really harming anyone, is it? Maybe not, but on the other hand, perhaps it’s part of a long and slippery slope greased with ‘alternative facts’ which is leading us to, well, shall we say, situations and decisions that may not be in our best interests as a society.

How to encourage students to do at least a little bit of fact-checking? Of course, you could produce a long list of Things That One Should Do to check information, but I reasoned that while students might read such a list, and even agree with the principles, they were unlikely to get into the habit of applying them and probably quite likely to immediately forget all about it.

Instead I tried to come up with something short, simple and memorable, and here it is (feel free to share this):

Fact-checking isn’t easy; it’s VARD

The four points I focused on spell out VARD, which stands for…

Verify

V is for verify, which means: can you find other sources saying the same thing? Now, chances are, you can always find something that agrees with a particular piece of information, if you look hard enough. There are plenty of sites out there that will tell you that lemons ‘alkalise’ the body, for example (they don’t), that it’s safe to eat apricot kernels (it’s not) and that black salve is an effective treatment for skin cancer (nope).

However, if you’re reasonably open-minded when you start, chances are good that you’ll find both sides of the ‘story’ and that will, at the very least, get you thinking about which version is more trustworthy.

Author

A is for author. I often hear swathes of content being disparaged purely based on its nature. You know the sort of thing: “that’s just a blog,” or “you can’t trust newspaper articles”. I think this is wrong-headed. What matters more is who wrote that piece and what are their qualifications? I’d argue that a blog post about medical issues written by a medical doctor (for example, virtually anything on the marvellous Science Based Medicine) is likely to be a pretty reliable source. Conversely, there’s been more than one thing that’s made it into the scientific literature which has later turned out to be flawed or even flat false (such as Wakefield’s famous 1998 paper). It’s also worth asking what someone’s background is: Stephanie Seneff, for example, is highly qualified in the fields of artificial intelligence and computer science, but does that mean we should trust her controversial opinions in biology and medicine? Probably not.

You may not always be able to tell who the author is, or have time to dig into their motivations, but it’s nevertheless a good question to keep in the back of your mind.

Reasonableness

Be honest: is that story really likely? Or is it just shocking?

R is for reasonableness. Which is a pain to spell or even say, but it’s important so I’m sticking with it. It’s a sense-check. Human beings love a good story, and the best stories have unexpected twists and turns. That’s why medical scare-stories pop up in newspapers with such depressing regularity. No, ketchup isn’t giving you cancer. No, our children really aren’t being poisoned by plastics. But the truth doesn’t always make a good headline. In fact, when it comes to science, the more some ‘exciting finding’ is plastered over news sites, the less you should probably trust it – because the chances are that the exciting version being reported bears almost no resemblance to the researchers’ original conculsions.

Be honest and ask yourself: does this really seem likely? Or would I just like it to be true because it’s a great story?

Date

If a surprising story has just appeared, give it twenty-four hours – chances are if there are major issues with the information someone else will come forward.

D is for date. The obvious situation is when information is so old that it’s been superseded by something else. This is easy: just look for something more recent. However, the other side of this coin is probably more relevant in these days of rolling news and instant sharing of articles: something can blow up at short notice, especially something topical, and it later turns out that not all the facts were known. Take, for example, the famous green swimming pools in the 2016 Olympics, which more than one writer attributed to copper salts in the pool water before the full facts were revealed a few days later. Inevitably, the ‘corrected’ version is far less interesting than the earlier speculation, and so that’s what everyone remembers.

If something controversial and shocking has just appeared, give it twenty-four hours. If there’s something terribly wrong with it, chances are someone will pick up on it in that time.

It’s not easy; it’s VARD

And that’s it: Verify, Author, Reasonableness, Date. It doesn’t cover every eventuality, but if you keep these points in the back of your mind it will definitely help you to separate the ‘probably true’ from the ‘almost certainly bollocks’.

Good luck out there!

Now why not go and listen to that podcast 🙂


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Hydrogen peroxide: another deadly alternative?

I’m sure most people have heard of hydrogen peroxide. It’s used as a disinfectant and, even if you’ve never used it for that, you probably at least know that it’s used to bleach hair. It’s where the phrase “peroxide blonde” comes from, after all. Hydrogen peroxide, and its formula, is so famous that there’s an old chemistry joke about it:

(I have no idea who to credit for the original drawing – if it’s you, leave me a message.)

To save you squinting at the text, it goes like this:
Two men walk into a bar. The first man says, “I’ll have some H2O.”
The second man says, “I’ll have some H2O, too.”
The barman brings the drinks. The second man dies horribly.

Now I think about it, it’s not a terribly funny joke.

Hydrogen peroxide has an extra oxygen atom in the middle.

Never mind. You get the idea. H2O2 (“H2O, too”) is the formula for hydrogen peroxide. Very similar to water’s formula, except with an extra oxygen atom in the middle. In fact, naturopaths – purveyors of alternative therapies – often refer to hydrogen peroxide as “water with extra oxygen”. But this is really misleading because, to torture a metaphor, that extra oxygen makes hydrogen peroxide the piranha to water’s goldfish.

Water, as we know, is pretty innocuous. You should try not to inhale it obviously, or drink more than about six litres in one go, but otherwise, its pretty harmless. Hydrogen peroxide, on the other hand, not so much. The molecule breaks apart easily, releasing oxygen. That makes it a strong oxidising agent. It works as a disinfectant because it basically blasts cells to pieces. It bleaches hair because it breaks down pigments in the hair shaft. And, as medical students will tell you, it’s also really good at cleaning up blood stains – because it oxidises the iron in haemoglobin to Fe3+, which is a pale yellow colour*.

Dilute hydrogen peroxide is readily available.

In its dilute form, hydrogen peroxide is a mild antiseptic. Three percent and even slightly more concentrated solutions are still readily available in high-street pharmacies. However, even these very dilute solutions can cause skin and eye irritation, and prolonged skin contact is not recommended. The trouble is, while it does destroy microbes, it also destroys healthy cells. There’s been a move away from using hydrogen peroxide for this reason, although it is still a popular “home” remedy.

More concentrated** solutions are potentially very dangerous, causing severe skin burns. Hydrogen peroxide is also well-known for its tendency to react violently with other chemicals, meaning that it must be stored, and handled, very carefully.

All of which makes the idea of injecting into someone’s veins particularly horrific.

But this is exactly what some naturopaths are recommending, and even doing. The idea seems to have arisen because hydrogen peroxide is known to damage cancer cells. But so will a lot of other dangerous substances – it doesn’t mean it’s a good idea to inject them. Hydrogen peroxide is produced by certain immune cells in the body, but only in a very controlled and contained way. This is definitely a case where more isn’t necessarily better.

The use of intravenous hydrogen peroxide appears to have begun in America, but it may be spreading to the UK. The website yestolife.org.uk, which claims to empower people with cancer to “make informed decisions”, states “The most common form of hydrogen peroxide therapy used by doctors calls for small amounts of 30% reagent grade hydrogen peroxide added to purified water and administered as an intravenous drip.”

30% hydrogen peroxide is really hazardous stuff. It’s terrifying that this is being recommended to vulnerable patients.

Other sites recommend inhaling or swallowing hydrogen peroxide solutions, both of which are also potentially extremely dangerous.

If anyone ever suggests a hydrogen peroxide IV, run very fast in the other direction.

In 2004 a woman called Katherine Bibeau died after receiving intravenous hydrogen peroxide treatment from James Shortt, a man from South Carolina who called himself a “longevity physician”. According to the autopsy report she died from systemic shock and DIC – the formation of blood clots in blood vessels throughout the body. When her body arrived at the morgue, she was covered in purple-black bruises.

Do I need to state the obvious? If anyone suggests injecting this stuff, run. Run very fast, in the other direction. Likewise if they suggest drinking it. It’s a really stupid idea, one that could quite literally kill you.


* As anyone who’s ever studied chemistry anywhere in my vicinity will tell you, “iron three is yellow, like wee.”


** The concentration of hydrogen peroxide is usually described in one of two ways: percentage and “vol”. Percentage works as you might expect, but vol is a little different. It came about for practical, historical reasons. As Prof. Poliakoff comments in this video, hydrogen peroxide is prone to going “flat” – leave it in the bottle for long enough and it gradually decomposes until what you actually have is a bottle of ordinary water. Particularly in the days before refrigeration (keeping it cold slows down the decomposition) a bottle might be labelled 20%, but actually contain considerably less hydrogen peroxide.

What to do? The answer was quite simple: take, say, 1 ml of hydrogen peroxide, add something which causes it to decompose really, really fast (lots of things will do this: potassium permanganate, potassium iodide, yeast, even liver) and measure the volume of oxygen given off. If your 1 ml of hydrogen peroxide produces 10 ml of oxygen, it’s 10 vol. If it produces 20, it’s 20 vol. And so on. Simple. 3% hydrogen peroxide, for the record, is about 10 vol***. Do not mix up these numbers.


*** Naturally, there are mole calculations to go with this. Of course there are. For A-level Chemists, here’s the maths (everyone else can tune out; I’m adding this little footnote because I found this information strangely hard to find):

Hydrogen peroxide decomposes as shown in this equation:
2H2O2 –> 2H2O + O2

Let’s imagine we decompose 1 ml of hydrogen peroxide and obtain 10 mls of oxygen.

Assuming the oxygen gas occupies 24 dm3 (litres), or 24000 mls, at standard temperature and pressure, 10 mls of oxygen is 10 / 24000 = 0.0004167 moles. But, according to the equation, we need two molecules of hydrogen peroxide to make one molecule of oxygen, so we need to multiply this number by two, giving us 0.0008333 moles.

To get the concentration of the hydrogen peroxide in the more familar (to chemists, anyway) mol dm-3, just divide that number of moles by the volume of hydrogen peroxide. In other words:

0.0008333 mols / 0.001 dm3 = 0.833 mol dm-3

If you really want to convert this into a percentage by mass (you can see why people stick with “vol” now, right?), then:

0.833 mol (in the litre of water) x 34 g mol-1 (the molecular mass of H2O2)
= 28.32 g (in 1000 g of water)

Finally, (28.32 / 1000) x 100 = 2.8% or, rounding up, 3%

In summary (phew):
10 vol hydrogen peroxide = 0.83 mol dm-3 = 3%


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Black Salve BS

Historically, people weren’t always careful in the sun.

Summer is fast disappearing in the Northern hemisphere and with it, the sunshine. Which is sad, as we all love a bit of sun, don’t we? Even if it doesn’t always love us, particularly those of us with fairer skin. Sunburn is no fun, but these days we also understand that it’s worse than a couple of days of painfully peeling skin: too much sun exposure can cause cancer.

Unfortunately there’s a whole generation – indeed more than one – who didn’t grow up with parents constantly slathering on the factor 50 (easy-to-use transparent sunscreens with very high SPFs didn’t appear on the market until the 1990s). For some sunburn was a regular part of summer, and those people need to be particularly vigilant for changes which might signify something nasty is going on.

On the plus side, these types of cancer are very treatable, and the outlook is hopeful. Often, the growth can be removed by surgery or even cryotherapy with very little scarring. Even the most dangerous kind of skin cancer, malignant melanoma, has a ten-year survival rate of around 90% with appropriate treatment.

But there’s the key: appropriate treatment. If you notice changes in your skin, especially a mole which is changing in colour or shape, you must see a qualified doctor as soon as you can.

What you should absolutely not do is visit the Black Salve page on Facebook (which I am not linking to for reasons which will be come obvious). This page, so Facebook tells me, is followed by nearly 17,000 users. It features a cheery cover photo of a family holding a canoe over their heads, and its profile picture is a pretty white and yellow flower.

Sanguinarine is a toxic salt extracted from the bloodroot plant. It’s infamous for its ability to destroy animal cells.

It’s all very suggestive of a homely, traditional remedy. The sort of thing your grandma had in her medicine cabinet. Very safe and “natural“. But while black salve might be a traditional remedy, it is anything but safe. Most preparations contain bloodroot, a source of the toxin sanguinarine, which kills animal cells.

Applying bloodroot to the skin destroys tissues and causes the formation of a large, black lump of dead flesh. Eventually this mass, called an eschar, falls off, leaving varying degrees of damage behind (internal use is also not recommended: consuming bloodroot can cause vomiting and loss of consciousness).

Bloodroot is easy to buy. Back in May this year the Good Thinking Society reported that eBay had removed “listings for dangerous cancer ‘cure’” following an investigation. Those listings were for black salve, and this was, of course, very positive news. Except for one thing: whilst listings for black salve were removed (and remain absent), listings for bloodroot were not. At the time of writing, a quick search reveals several bloodroot preparations still for sale.

At the time of writing, bloodroot is easy to find on eBay. The listing confirms that this is prepared from the “rhizome of certified organically grown Sanguinaria conadensis plants”.

Why is this such a bad thing? Because it’s easy to find recipes for making homemade black salve with bloodroot online, and using such mixtures can have truly horrific consequences. Last year the story of a woman who applied it to a basal cell carcinoma on her nose was widely reported. The black salve paste she used did so much damage that she ended up with a large hole in her nose through which she could actually draw air. Photos and video are available online (be warned: it’s gruesome).

Many patients turn to black salve as an alternative to what they imagine will be disfiguring surgery to treat their cancer. But, as in this woman’s case, the paste can do so much damage that far more extensive, reconstructive, surgery is ultimately needed.

Black Salve usually contains bloodroot and, sometimes, zinc chloride – another skin irritant.

It won’t surprise anyone to learn that dermatologists don’t recommend black salve. It can do enormous damage to the surface of the skin, resulting in scarring and a high risk of infection, and it does kill cancer cells along the way. But there is no guarantee that all of the cancerous cells deep within the skin will be destroyed. As a result, patients who’ve attempted to cure themselves may end up with cancerous tissue hidden, and growing, beneath a scar.

In fact, exactly this happened to an otherwise healthy 76 year-old woman in 2006. Her case is described in detail in the journal Dermatology Practical Conceptual – in summary, she refused surgery on a small melanoma on her leg. Instead, she bought black salve on the internet and applied it. A few years later the cancer had spread to her lungs, liver and lymph nodes.

Some people even recommend using black salve on breast cancers but this is, if possible, even worse. It’s highly unlikely that the salve will reach the entirety of a tumour which is beneath the skin. It is likely to do some horribly painful and disfiguring damage along the way, though.

Black salve is particularly popular in Australia, which of course has some of the highest rates of skin cancer in the world. But it’s available in the UK too. One online “herbal medicine” site is openly selling various formulations at prices ranging from £25-£100. Ironically, they describe their “Herbactive” product as “chemical free” (it isn’t, nothing is) and then go onto boast that it “now has a stronger concentration of bloodroot”. Fantastic.

They also sell a product which contains zinc chloride along with bloodroot. They claim zinc chloride is safe. It isn’t. It’s well-known to be a skin irritant, and should never be left in contact with skin.

The Black Salve Facebook page is full of anecdotes and testimonials, but light on evidence.

The Black Salve Facebook page is packed full of anecdotes and testimonials from people who claim to have used these mixtures safely. It’s all interspersed, of course, with the usual “Big Pharma” conspiracy theories. Namely, that the “truth” is being suppressed because there’s “no money in it for the pharmaceutical [industry].”

The irony is that reconstructive surgery is incredibly expensive, and the antibiotics, painkillers and other drugs that are inevitably needed to treat black salve victims aren’t free, either.

Given that Facebook’s community standards page states that: “We remove content, disable accounts and work with law enforcement when we believe that there is a genuine risk of physical harm or direct threats to public safety.” one has to wonder why the Black Salve page is still there. People are actually posting pictures of physical harm. What more does Facebook need?

Please, don’t be tempted to use black salve, or anything containing bloodroot. If you think you have a skin tumour see a properly qualified doctor and follow his or her advice.

It might literally save your life.


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Absurd alkaline ideas – history, horror and jail time

I’ve written about the absurdity of alkaline diets before, and found myself embroiled in more than one argument about the idea.

To sum up quickly, it’s the notion that our bodies are somehow “acidic”, and if only we could make them “alkaline” all our health problems – cancer included – would disappear. The way you make your body “alkaline” is, mainly, by eating lots of vegetables and some fruits (particularly citrus fruits – yes, I know, I know).

The eating fruit and vegetables bit aside (they’re good for you, you should eat them), it’s all patent nonsense. Our bodies aren’t acidic – well, other than where they’re supposed to be acidic (like our stomachs) – and absolutely nothing we eat or drink can have any sort of effect on blood pH, which is kept firmly between 7.35-7.45 by (mainly) our lungs and kidneys. And if your kidneys or lungs are failing, you need something a little stronger in terms of medical intervention than a slice of lemon.

But who first came up with this crazy idea?

Claude Bernard carried out experiments on rabbits.

Actually, we can probably blame a nineteenth century French biologist and physiologist, Claude Bernard, for kicking the whole thing off, when he noticed that if he changed the diet of rabbits from largely plant-based to largely animal-based (i.e. from herbivorous to carnivorous) their urine became more acidic.

This observation, followed by a lot of speculation by nutritionists and some really quite impressively dodgy leaps of reasoning (by others, I should stress – not Bernard himself), has lead us to where we are now: umpty-million websites and books telling anyone who will listen that humans need to cut out all animal products to avoid becoming “acidic” and thus ill.

Bernard’s rabbits were, it seems, quite hungry when he got them – quite possibly they hadn’t been fed – and he immediately gave them boiled beef and nothing else. Meat contains the amino acids cysteine and methionine, both of which can produce acid when they’re metabolised (something Bernard didn’t know at the time). The rabbits excreted this in their urine, which probably explains why it became acidic.

Now, many of you will have noticed several problems here. Firstly, rabbits are herbivores by nature (they do not usually eat meat in the wild). Humans aren’t herbivores. Humans are omnivores, and we have quite different digestive processes as a result. It’s not reasonable to extrapolate from rabbits to humans when it comes to diet. Plus, even the most ardent meat-lover probably doesn’t only eat boiled beef – at the very least people usually squeeze in a battered onion ring or a bit of coleslaw along the way. Most critically of all, urine pH has no direct relationship with blood pH. It tells us nothing about the pH of “the body” (whatever we understand that to mean).

The notion that a plant-based diet is somehow “alkaline” should really have stayed in the 19th century where it belonged, and at the very least not limped its way out of the twentieth. Unfortunately, somewhere in the early 2000s, a man called Robert O Young got hold of the idea and ran with it.

Young’s books – which are still available for sale at the time of writing – describe him as “PhD”, even though he has no accredited qualification.

Boy, did he run with it. In 2002 he published a book called The pH Miracle, followed by The pH Miracle for Diabetes (2004), The pH Miracle for Weight Loss (2005) and The pH Miracle Revised (2010).

All of these books describe him either as “Dr Robert O Young” or refer to him as “PhD”. But he has neither a medical qualification nor a PhD, other than one he bought from a diploma mill – a business that offers degrees for money.

The books all talk about “an alkaline environment” and state that so-called acidic foods and drinks (coffee, tea, dried fruit, anything made with yeast, meat and dairy, amongst other foodstuffs) should be avoided if not entirely eliminated.

Anyone paying attention will quickly note that an “alkaline” diet is basically a very restrictive vegan diet. Most carbohydrate-based foods are restricted, and lots of fruits and nuts fall into the “moderately” and “mildly” acidic categories. Whilst a vegan diet can be extremely healthy, vegans do need to be careful that they get the nutrients they need. Restricting nuts, pulses, rice and grains as well as removing meat and dairy could, potentially, lead to nutritional deficiencies.

Young also believes in something called pleomorphism, which is a whole other level of bonkers. Essentially, he thinks that viruses and bacteria aren’t the cause of illnesses – rather, the things we think are viruses and bacteria are actually our own cells which have changed in response to our “acidic environments”. In Young’s mind, we are making ourselves sick – there is one illness (acidosis) and one cure (his alkaline diet).

It’s bad enough that he’s asserting such tosh and being taken seriously by quite a lot of people. It’s even worse that he has been treating patients at his ranch in California, claiming that he could “cure” them of anything and everything, including cancer.

One of his treatments involved intravenous injections of solutions of sodium hydrogen carbonate, otherwise known as sodium bicarbonate or baking soda. This common cookery ingredient does produce an alkaline solution (about pH 8.5) when dissolved in water, but remember when I said blood pH was hard to shift?

Screenshot from a BBC article, see http://www.bbc.co.uk/news/magazine-38650739

Well, it is, and for good reason. If blood pH moves above the range of 7.35-7.45 it causes a condition called alkalosis. This can result in low blood potassium which in turn leads to muscle weakness, pain, and muscle cramps and spasms. It can also cause low blood calcium, which can ultimately result in a type of seizure. Putting an alkaline solution directly into somone’s blood is genuinely dangerous.

And this is before we even start to consider the fact that someone who was not a medical professional was recommending, and even administering, intravenous drips. Which, by the way, he was reportedly charging his patients $550 a pop to receive.

Young came to the attention of the authorities several times, but always managed to wriggle out of trouble. That is, until 2014, when he was arrested and charged with practising medicine without a license and fraud. In February last year, he was found guilty, but a hung jury caused complications when they voted 11-1 to convict on the two medical charges, but deadlocked 8-4 on fraud charges.

Finally, at the end of June 2017, he was sentenced. He was given three years, eight months in custody, but due to the time he’s already spent in custody and under house arrest, he’s likely to actually serve five months in jail.

He admitted that he illegally treated patients at his luxury Valley Center ranch without any medical or scientific training. Perhaps best of all, he was also made to publicly declare that he is not microbiologist, hematologist, medical doctor or trained scientist, and that he has no post-highschool educational degrees from any accredited school.

Prosecuting Deputy District Attorney Gina Darvas called Young the “Wizard of pHraud”, which is rather apt. Perhaps the titles on his books could be edited to read “Robert O Young, pHraud”?


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Hazardous homeopathy: ‘ingredients’ that ought to make you think twice

Would you take a medicine made with arsenic? Or deadly nightshade? Lead? Poison ivy?

You’d ask some serious questions first, at least, wouldn’t you? Is it definitely safe? Or, more accurately, are the odds better than even that it will make me better without causing horrible side-effects? Or, you know, killing me?

There ARE medicines that are legitimately made from highly toxic compounds. For example, the poison beloved of crime writers such as Agatha Christie, arsenic trioxide, is used to treat acute promyelocytic leukemia in patients who haven’t responded to other treatments. Unsurprisingly, it’s not without risks. Side-effects are unpleasant and common, affecting about a third of patients who take it. On the other hand, acute promyelocytic leukemia is fatal if untreated. A good doctor would talk this through with a patient, explain both sides, and leave the final choice in his or her properly-informed hands. As always in medicine, it’s a question of balancing risks and benefits.

Would you trust something with no proven benefit and a lot of potential risk? There are, it turns out, a swathe of entirely unregulated mixtures currently being sold in shops and online which clearly feature the substances I listed at the beginning. And more. Because they are all, supposedly, the starting materials in certain homeopathic remedies.

Homeopaths like to use unfamiliar, usually Latin-based, names which somewhat disguise the true nature of their ingredients. Here’s a short, but by no means comprehensive, list. (You might find remedies labelled differently but these are, as far as I can tell, the most common names given to these substances.)

If you haven’t heard of some of these, I do urge you to follow the links above, which will largely take you pages detailing their toxicology. Spoiler: the words “poison”, “deadly” and “fatal” feature heavily. These are nasty substances.

There are some big ironies here, and I’m not referring to the metal. For example, a common cry of anti-vaccinationists is that vaccines contain animal tissues – anything and everything from monkey DNA to dog livers. But many also seem to be keen to recommend homeopaths and courses of homeoprophylaxis – so-called “homeopathic vaccines” – which use bodily fluids such as pus and blood as starting materials.

Now, at this point I’m sure some of you are thinking, hang on a minute: aren’t you always telling us that “the dose makes the poison“? And aren’t homeopathic remedies diluted so much that none of the original substance remains, so they’re just placebos?

Yes, I am, and yes, they are.

Does anyone test homeopathic remedies to make sure there’s nothing in them….?

In THEORY. But here’s the problem: who’s testing these mixtures to make sure that the dilutions are done properly? And how exactly are they doing that (if they are)?

One technique that chemists use to identify tiny quantities of substance is gas chromatography (GC). This is essentially a high-tech version of that experiment you did at school, where you put some dots of different coloured ink on a piece of filter paper and watched them spread up the paper when you put it in some water.

GC analysis is brilliant at identifying tiny quantities of stuff. 10 parts per million is no problem for most detectors, and the most sensitive equipment can detect substances in the parts per billion range. Homeopathy dilutions are many orders of magnitude higher than this (30c, for example, means a dilution factor of 1060), but this doesn’t matter – once you get past 12c (a factor of 1024) you pass the Avogadro limit.

This is because Avogadro’s number, which describes the number of molecules in what chemists call a “mole” of a substance, is 6×1023. For example, if you had 18 ml of water in a glass, you’d have 6×1023 molecules of H2O. So you can see, if you’ve diluted a small sample by a factor of 1024 – more than the total number of molecules of water you had in the first place – the chances are very good that all you have is water. There will be none of the original substance left. (This, by the way, is of no concern to most homeopaths, who believe that larger dilutions magically produce a stronger healing effect.)

What if the sample ISN’T pure water after it’s been diluted?

If you carried out GC analysis of such a sample, you should find just pure water. Indeed, if you DIDN’T find pure water, it should be cause for concern. Potassium cyanide, for example, is toxic at very low levels. The lethal dose is is only 0.2-0.3 grams, and you’d suffer unpleasant symptoms long before you were exposed to that much.

So what if the dilutions somehow go wrong? What if some sample gets stuck in the bottle? Or on the pipette? Or a few dilution steps get skipped for some reason?

Are these largely unregulated companies rigorously quality-checking their remedies?

Well, maybe. It’s possible some producers are testing their raw materials for purity (ah yes, another question: they CLAIM they’re starting with, say, arsenic, but can we be certain?), and perhaps testing the “stability” of their products after certain periods of time (i.e. checking for bacterial growth), but are they running tests on the final product and checking that, well, there’s nothing in it?

And actually, isn’t this a bit of a conflict? If the water somehow “remembers” the chemical that was added and acquires some sort of “vibrational energy”, shouldn’t that show up somehow in GC analysis or other tests? If your tests prove it’s pure water, indistinguishable from any other sample of pure water, then… (at this point homeopaths will fall back on arguments such as “you can’t test homeopathy” and “it doesn’t work like that”. The name for this is special pleading.)

A warning was issued in the U.S. after several children became ill.

Am I scaremongering? Not really. There’s at least one published case study describing patients who suffered from arsenic poisoning after using homeopathic preparations. In January this year the U.S. Food and Drug Administration issued a warning about elevated levels of belladonna (aka deadly nightshade) in some homeopathic teething products. Yes, teething products. For babies. This warning was issued following several reports of children becoming ill after using the products. The FDA said that its “laboratory analysis found inconsistent amounts of belladonna, a toxic substance, in certain homeopathic teething tablets, sometimes far exceeding the amount claimed on the label.”

Now, admittedly, I’m based in the U.K. and these particular teething remedies were never readily available here. But let’s just type “homeopathy” into the Boots.com (the British high-street pharmacy) website and see what pops up… ah yes. Aconite Pillules, 30c, £6.25 for 84.

What happens if you search for “homeopathy” on the Boots.com website?

Have you been paying attention lovely readers? Aconite is…. yes! Monkshood! One of the most poisonous plants in the garden. Large doses cause instant death. Smaller doses cause nausea and diarrhea, followed by a burning and tingling sensation in the mouth and abdomen, possibly muscle weakness, low blood pressure and irregular heartbeat.

I must stress at this point that there is no suggestion, absolutely none whatsoever, that any of the products for sale at Boots.com has ever caused such symptoms. I’m sure the manufacturers check their preparations extremely carefully to ensure that there’s absolutely NO aconite left and that they really are just very small, very expensive, sugar pills.

Well, fairly sure.

In summary, we seem to be in a situation where people who proclaim that rigorously-tested and quality-controlled pharmaceuticals are “toxic” also seem to be happy to use unregulated homeopathic remedies made with ACTUALLY toxic starting materials.

I wonder if the new “documentary” about homeopathy, Just One Drop, which is being screened in London on the 6th of April will clarify this awkward little issue? Somehow, I doubt it. Having watched the trailer, I think it’s quite clear which way this particular piece of film is going to lean.

One last thing. Some homeopathic mixtures include large quantities of alcohol. For example, the Bach Original Flower Remedies are diluted with brandy and contain approximately 27% alcohol (in the interests of fairness, they do also make alcohol-free versions of some of their products and, as I’ve recently learned, they may not be technically homeopathic). Alcohol is a proven carcinogen. Yes, I know, lots of adults drink moderate quantities of alcohol regularly and are perfectly healthy, and the dose from a flower remedy is minuscule, but still, toxins and hypocrisy and all that.

There are cheaper ways to buy brandy than Bach Flower Remedies.

Amusingly, the alcohol in these remedies is described an “inactive” ingredient. It’s more likely to be the only ACTIVE ingredient. And since Flower Remedies retail for about £7 for 20 ml (a mighty £350 a litre, and they’re not even pure brandy) may I suggest that if you’re looking for that particular “medicine” you might more wisely spend your money on a decent bottle of Rémy Martin?


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