The invasion of well-meaning quacks into West Africa continues apace, part deux

quackinvasion

I realize that I risk getting repetitive by writing about this again, but it’s a rich vein that just keeps on producing and producing. It also demonstrates that, for every tragedy as huge as the ongoing Ebola outbreak that has killed over 5,000 people in West Africa thus far, there always exist well-meaning people who are into such utter quackery that they can’t help but risk making things worse. In my talk at Skepticon on Saturday I discussed how The Secret’s Law of Attraction is, to my mind, the Central Dogma of Alternative Medicine, the idea that, if you want something bad enough and wish for it hard enough, you will attract it to you and the universe will somehow provide. I gave many examples. I also pointed out that the flip side of The Secret is how, if positive thinking can cure you (hence the Central Dogma of Alternative Medicine), then that must mean failure to get better is due to negative thoughts. Heck, even getting sick in the first place must mean that you brought it on yourself.

I don’t believe the people of Liberia and Sierra Leone, for instance, brought Ebola upon themselves. Unfortunately, in a sort of “Secret”-like way, the suffering and horror of dying of a deadly infectious disease has attracted like (quacks who will cause more suffering) to themselves.

Last week, at the end of a post about homeopaths continuing to invade these countries to offer their useless watery nostrums to people suffering from a virus with a 50% case fatality rate even with the best care and an up to 90% case fatality rate in essentially untreated people, I noted that another practitioner of dubious medicine, a man by the name of Robert Rowan, was heading to Sierra Leone to ply his particular brand of quackery on hapless Africans suffering from Ebola. To recap:

We will oversee the training and treatment by our trainees. We will be teaching them everything Dr. Robins knows about the Robins Method of DIV Ozone Therapy gained over the past 23 years. I will teach them everything else about ozone and other oxidation therapies, and every other method of delivery, from rectal to joints. We will prepare them to receive ultraviolet blood irradiation therapy if that equipment follows us.

So, basically, Dr. Rowan was heading to Africa to teach African doctors how to do ozone therapy quackery. The press release announcing his trip was dated October 15. What’s happened since then. Unfortunately, over the weekend while I was away at Skepticon, I found out.

Ultraviolet blood irradiation is one of the dumber forms of alternative medicine out there, as is IV ozone therapy. They’re often combined. In any case, if you see the actual devices, you’ll understand even better why this is such a ridiculous and scientifically implausible therapy, and, in fact, the Wikipedia page on UV blood irradiation has pictures of some of these devices, which range from an IV catheter that goes in a vein on the forearm and is usually attached to a small laser, producing a nice red glow under the skin. Another version is the “intranasal” version, and, yes, it is exactly what its name implies. It’s a red laser light that is inserted into one of the nostrils and…oh, hell, I can’t resist showing you the picture because it’s so ridiculous:

633px-NoseApp2S
NoseApp2S” by HemalOwn work. Licensed under CC0 via Wikimedia Commons.

Yes, basically it’s a small laser light that you stick in your nose and use tape to hold in place. The rationale is that the light will have access to the rich vascular plexus in the nasal mucosa, where the blood vessels are close to the surface. Of course, even the relatively thin epithelial lining of the nasal cavity is enough to stop UV Sometimes, the “irradiation” occurs through the skin. Of course, one can’t help but note that the particular laser irradiation of the blood shown in the Wikipedia article is not ultraviolet at all, given that the laser shown is a 1–3 mW helium–neon laser at a wavelength operating at 632.8 nm. That’s well within the visible spectrum towards the red end, hence the color. One can understand why this must be, because UV radiation is far more energetic than radiation towards the red end of the visible spectrum. Using actual UV lasers in the nose might produce the results desired, if you know what I mean.

The variety of devices claiming to radiate the blood for therapeutic effect is huge. A Google Image search for such devices brings up a veritable cornucopia of images of questionable devices, some of which are just laser lights at the end of a catheter, but some of which involve removing blood from the body, irradiating it with a UV light, and reinfusing it. By far the most common, however, appears to be the little catheter that sits in the the cephalic vein (one of the veins near the crease of your elbow) and glows its little glowing light.

The funny thing about UV blood irradiation is that there was a bit of a craze for it in medicine a few decades back, with a bunch of papers published. Its purported mechanism of actions included bactericidal effects, which no doubt UV light can produce. It’s used to sterilize. Of course, the reason it’s not used in people is because it’s rather nonspecific; it causes tissue damage, as anyone as pasty white as I am can attest after having spent too much time in the sun. Aloe was my friend. Unfortunately, it was not enough. Yikes. Then there are the usual other “explanations” for how UV blood irradiation “works,” such as detoxification, increased oxygenation (which is the same claim as intravenous ozone therapy, or, as it usually is in practice, intravenous peroxide therapy), photosensitization, and others.

In any case, UV irradiation therapy has a long history that started out reasonable, given the science understood at the time, as Mark Crislip describes, and then descended into the nonsense we see today. After all, it was first observed over 100 years ago that cutaneous tuberculosis could be treated with UV light. Unfortunately, light being light and all that, not to mention UV light not having much penetration beyond the skin, direct exposure of the blood to UV radiation would be needed if any purported healing effects were to occur. It is also difficult to envision a mechanism by which irradiating a tube of a patient’s blood and then reinfusing that blood could produce a therapeutic effect, just as it’s difficult to come up with a plausible mechanism by which shining a light in a vein in the arm could irradiate enough blood to have an effect even if there were an effect from irradiating the blood. As Mark Crislip put it, color me skeptical that irradiating such a small amount of blood could have beneficial effects on such a wide range of diseases with such disparate pathophysiologies, particularly given that the medical literature, such as it exists out there, gives no real support to using UV blood irradiation.

As for IV ozone therapy, that is a therapy that’s even more ridiculous, but it is of a piece with UV blood irradiation in that in Rowan’s world both are “oxidative therapies,” in which the oxygen content of the blood is supposedly increased. There’s no evidence that UV radiation does that, although ozone therapy will do so, but trivially. The reason is that the vast majority of the oxygen in the blood is carried by hemoglobin, which is usually maximally saturated. Under the best of circumstances, taking all these sorts of claims at face value, all getting ozone or hydrogen peroxide into the blood would do would be to increase the concentration of dissolved oxygen in the blood. However, that wouldn’t really do much, as I explained in detail in a post from 2006 about “oxygenated” water. Same rationale, different oxygen quackery.

Yet UV blood irradiation and IV ozone therapy are the “oxidation” therapies that Dr. Rowan uses, and now he’s claimed to have cured a patient with Ebola! Science, right! Let’s see if you can figure out why this anecdote is not nearly as convincing as it’s being portrayed in a press release entitled Rapid Ebola Infection Cure, November 22, 2014. Basically, on November 14 a physician at an Ebola treatment center suffered a needle stick injury from a needle that had been used on a patient with Ebola. Now here’s the anecdote:

Dr. Rowen was informed of the needle stick on Sunday November 16, 2014, but was not advised that symptoms had yet developed. Rowen sent back instructions to treat him preventively and immediately with the protocol, believing the exposed doctor to be at great risk for symptoms to develop within 5 days. Dr. Robins, informed shortly after, concurred with the preventive protocol and urgency of treatment.

Unbeknownst to Dr. Rowen, symptoms did develop on day 2 (Sunday November 16) -the doctor reported high fever, loss of appetite, abdominal distress, and significant fatigue, which symptoms were rapidly progressing, classic signs of Ebola. Treatment began the third day after the needle-stick.

After just 2 days of treatment (November 18, 2014), all symptoms were gone.. The doctor chose not to get an Ebola blood test at the time. A positive test would have mandated forced confinement in an Ebola treatment center where he would have been denied the ozone therapy. He believed this would likely have cost him his life, as the best clinics in Sierra Leone have a 60% death rate.

Rowen and Robins did not want to wait for a positive test, which can take several days to occur, believing the earlier this life-taking viral infection is aggressively treated, the higher the chances of recovery. Active treatment will be maintained for at least 10 days with reduced frequency for 7 days thereafter.

The first thing I noticed about this testimonial is that Ebola symptoms showed up very rapidly (on day 2). Ebola symptoms can show up that rapidly, the time frame reported by the CDC generally being between 2 and 21 days, with an average of 8 to 10 days after exposure; so right away this looks a bit fast to be Ebola, but (barely) within the usually reported window. The second thing I noticed is that there is no confirming evidence that this physician ever actually had Ebola in the first place, as he refused to be tested. Reading this, I wondered: Would the authorities in Sierra Leone actually give the doctor any choice in the matter? He had a needle stick injury, followed by a fever and GI symptoms, even if those symptoms were a bit soon after the needle stick injury to be classic Ebola. Actually, come to think of it, any physician who had a needle stick from an Ebola-contaminated needle would be expected to undergo testing for the virus a few days later, just as any health care professional in the US who suffers a needle stick injury from a needle contaminated with, say, hepatitis B or C would be offered testing for those diseases.

But let’s say this doctor didn’t report the needle stick, which, reading between the lines, I suspect is what happened. Otherwise, one would think that his failure to show up for work on November 17 would have been a big red flag waved at his colleagues that he might have been infected with Ebola after his needle stick exposure. If that’s true, how freakin’ irresponsible can a physician be not to report something so critical, especially if he started feeling sick? Rowan reports that the mortality from Ebola is 60%, in the Ebola wards but untreated the mortality is more like 90%. In any case, most likely what happened is that this physician’s symptoms were a self-limited viral disease that happened to occur the day after he suffered a needle stick and lasted only a couple of days, after which he got better. That’s far more plausible an explanation than the claim that ozone therapy somehow prevented the Ebola infection from developing after exposure.

There’s another scary aspect to this story. The press release was dated November 22. That’s only eight days after the needle stick is reported to have occurred. Ebola symptoms can begin as long as 21 days later. This physician, his reliance on ozone therapy quackery notwithstanding, is anything but out of the woods yet. I haven’t (yet) been able to find an update. Heck, even on Rowan’s Facebook page, a reader of his press release noted:

It’s not good that there’s no proof he had Ebola but I’m glad he’s cured! Hopefully he’ll now have the antibodies that will make his work safer.

Another commenter simply shrugged his shoulders and wrote:

Great news! No problem getting confirmation of his infection, there is no shortage of other Ebola patients there so you can get one with a valid Ebola dx! Hoping you get one documented eventually, otherwise it will be poo-pooed.

Yes, sadly there are many Ebola patients right now for Brave Maverick Doctors like Dr. Rowan to experiment upon as they “fight” for the right to use their quackery, as Rowan describes elsewhere:

Please know that this was a JOINT mission between Dr. Howard Robins and myself. I stayed 2 extra days which were well worth it to stand up to the political turmoil that happened when government ministers obstructed treatments at the Ebola center. I sure hope the people of the world will begin to stand up to the forces of disease-maintenance evil that has taken over the world to pharm us. All of us together can change the history of the world. Please, all of you reading these pages, help us do this.

To me, it sounds as though those unnamed government ministers were the ones really fighting to help Ebola patients, by trying to keep the quacks away.