An aromatherapist versus science

Things are getting back to normal here at Casa Orac. it’s always a come down after going to TAM and being able to mingle, argue, and party with people who share my skeptical world view. Yesterday was back to reality, though, at least as much as jet lag and sleep deprivation allowed. Fortunately, Monday is a lab day, and I don’t have an scheduled patient care responsibilities, and now I’m pretty much back to normal. Even so, I can’t do epics like yesterday’s post every day even under the best circumstances; so today I’ll take a look at a little wafer thin mint to cleanse the palate.

I’ve mentioned this before (and will probably do so again) that I have a number of Google Alerts set, the better to provide me with fodder for your daily (or at least week-daily) dose of Insolence, both Respectful and not-so-Respectful Sometimes these alerts bring me articles from newspapers and publications I would never encounter any other way. For instance, yesterday, a little nugget came across my Google Alerts that provides what I like to refer to as a “teachable moment.” Unfortunately, the man who wrote the article probably won’t learn, but perhaps I can teach others. The writer is named George Cox, and his article is entitled Alternative therapies seen as ‘prescription.’ Basically, it’s a string of bad arguments, misinformation, and logical fallacies strung together to make ridiculous charges against the FDA and basically wallow in self-pity that Cox and practitioners like him aren’t taken more seriously. Given Cox has written, he doesn’t deserve to be taken more seriously.

You see, Cox apparently owns an aromatherapy business. The vast majority of aromatherapy is, of course, nonsense without a scientific basis. Just to give you an idea, I went to the website of the National Association for Holistic Aromatherapy to find out how aromatherapists themselves define aromatherapy:

Aromatherapy can be defined as the art and science of utilizing naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit. It is an art and science which seeks to explore the physiological, psychological and spiritual realm of the individual’s response to aromatic extracts as well as to observe and enhance the individual’s innate healing process. As a holistic practice, Aromatherapy is both a preventative approach as well as an active method to employ during acute and chronic stages of illness or ‘dis’-ease.

It is a natural, non-invasive modality designed to affect the whole person not just the symptom or disease and to assist the body’s natural ability to balance, regulate, heal and maintain itself by the correct use of essential oils.

In the PowerPoint file for the talk that I gave at the Science-Based Medicine workshop on Thursday, there is a humorous (or at least the audience seemed to think so) slide that addresses what is to my mind perhaps the single most reliable indicator of quackery. (It’s at least in the top two, along with the Quack Miranda Warning.) That is the spelling of the word “disease” as “dis-ease.” In fact, this website goes even beyond that, spelling the word “‘dis’-ease.” And, as far as I’ve been able to ascertain, it’s true, too. If you see someone use the word “dis-ease” that person is almost certainly a quack. Indeed, take a look:

Dis-ease, is a hyphenated variation of the word “disease.” The term dis-ease is used by individuals and healing communities who are aligned with wellness, choosing not to empower health issues by focusing on a particular ailment. The intent is to place emphasis on the natural state of “ease” being imbalanced or disrupted.

In any case, it’s a lot of woo-speak, which, even if there weren’t copious evidence that aromatherapy, which involves the use of “essential oils” that smell to treat and cure all manner of diseases and conditions, is pseudoscience. True, the various oils used are natural products and might have pharmaceutical activity, but aromatherapists have basically the same problem as herbalists. They rarely use evidence other than testimonials and make claims for their natural products that they can’t back up (such as being able to treat depression and falling prey to the naturalistic fallacy to claim that “natural” oils are more efficacious than synthetic oils. Particularly amusing is “subtle aromatherapy.” As we know, any time a woo-meister adds the word “subtle” in front of anything, it ramps up the quackery quotient (QQ) by a power of at least 100:

When applied to the skin, the plant’s life-force is absorbed into the body’s fluid systems which eventually circulates through the organ and glandular systems of the body and eventually through all fluids and tissues of the body. The foot is the most porous of all the body’s skin. Rub a clove of garlic on the bottom of your foot and in 1-3 minutes you will taste it in your mouth and “feel” the sensation in your nose! Essential oils applied to the feet, the most porous part of the body, travel throughout the body and affect the cells, including the hair, in just 10-20 minutes.

New research suggests that because the olfactory nerves are similar to other nerves in the body, they may have the ability to form and transmit intelligent codes of information to all other parts of the body via neurotransmitter chemicals in the body. Recent research suggests that intelligence occurs not only in the brain but inside neurotransmitters.

Ah, yes. Vitalism. It’s at the heart of so many forms of quackery, isn’t it? Basically, subtle aromatherapy is a variant of aromatherapy cooked up by Patricia Davis. It’s basically a form of “vibrational” healing, which itself is of course a science-y-sounding spin on vitalism.

Leaving aromatherapy aside, though, let’s see Cox’s lament:

If my granddaughter ran into my office right now and I saw her nose was running and I said, “Honey, you’re getting a cold. Go ask Grandma to make you some chicken soup. It’ll make you feel better,” I am in violation of the law. I have diagnosed, prescribed (yes, chicken soup has become a pharmaceutical), treated and developed a prognosis. I am thereby practicing medicine without a license.

The FDA is not going to break down the door and arrest Grandma and me. But they could.

Uh, no. Just saying that something will make you feel better is not necessarily a medical claim. If Cox were to say that chicken soup will cure the cold or cure another disease like cancer, that would be another issue. Cox’s statement is akin to vague and meaningless claims favored by supplement sellers, such as “boosts the immune system” or “supports prostate health.” In other words, he could easily market chicken soup as a supplement and be in full compliance with the DSHEA of 1994. In any case, the regulation of food and medicines are different, and chicken soup is clearly, by any reasonable stretch of the imagination, a food, even to the government. In addition, there’s the little matter of commerce. Unless he’s selling or somehow advertising his chicken soup as a cure for the common cold, he’s about as likely to run afoul of the FDA over telling his granddaughter that chicken soup will make her feel better when she has a cold as there is of a single molecule of active substance being left in a 30C homeopathic remedy.

Cox then uses the “science was wrong before” gambit, using the fact that medicine changes its conclusions as new evidence comes in (unlike aromatherapists and other “alternative” practitioners), to imply that his aromatherapy has an evidence base equivalent to that of medicine. He then does what so many alt-med apologists do and confuses natural product pharmacology with his woo:

To the people who say that aromatherapy — my business — is just a bunch of hooey, I would point out that dentists still use clove bud essential oil for dry socket and root canal pain. They have access to all of the narcotics that MDs do, but they still use clove bud oil because it works. It stops the pain.

Actually, what dentists do is to use zinc oxide eugenol (ZOE), which is made by mixing zinc oxide with eugenol from clove bud oil, as a temporary filling when they have to drill close to a nerve. It’s useful because it allows the acute inflammation from the drilling to subside before a permanent filling is placed, decreasing the likelihood of the need for a root canal. In any case, the eugenol is used as used as a plasticizer. The concoction is mixed thusly. That is not like this claim that Cox wants to make:

So if it stops the pain in a tooth, wouldn’t it, shouldn’t it be helpful for arthritis pain? Both are technically bone pain.

But I can’t say clove bud is good for arthritis pain because I would be practicing medicine without a license, even though I know what I know. I can’t say that, or that you can help people sleep, stop muscle cramps, relieve restless legs or address 50 other common problems with essential oils.

Here’s a hint: There’s a big difference between being effective as a plasticizer to hold zinc oxide together in a temporary tooth filling and being effective at treating arthritis pain. If Cox can’t see the difference, I don’t know if he’s teachable, particularly given that, in addition to essential oils, he sells Ion Infrared Detox Units and Far Infrared Belts.

Also, he very much hates having to use the Quack Miranda warning when he sells his products, thinking that he should be able to make health claims because “there are small clinical studies that prove it and we have tons of anecdotal evidence.” Here’s a hint: Small clinical studies “prove” nothing. At best they can be used as preliminary data to support larger, more rigorous clinical studies. Used alone, their limitations are legion, and they can at times be profoundly misleading. Come to think of it, so can anecdotal evidence. Placebo effects, regression to the mean, confirmation bias, and all the cognitive quirks that dominate human thinking lead to a false impression that such treatments work. That’s why we need to rely on larger, better controlled clinical studies whenever possible, not small studies and anecdotal evidence. While it’s true that sometimes in medicine we do have to rely on small studies and anecdotal evidence, but this is usually for uncommon diseases for which large trials are not possible and other conditions for which treatment is urgently needed but the evidence base is not what we would like. Neither of these conditions apply to conditions treated by aromatherapy. More importantly, when anecdotal evidence and small clinical trials prone to bias are all you have as evidence for your entire system of “medicine,” perhaps you should rethink that system. At the very least, you shouldn’t use it until the evidence base is adequate.

Aromatherapy falls into that category. If you want to use it because it smells good and feels good to have oils massaged onto your body, fine. Just don’t expect it to cure anything. And realize that aromatherapy, as practiced by aromatherapists, is not medicine.