Faking Sick for a Living

Lying to your doctor is encouraged in one situation: when your doctor is a student and you're an actor asked to portray a certain condition. My friend Amy Savage does this for work. In between fake symptom bouts, I asked her to write a guest post sharing what she's learned from being poked for practice.

Have you ever been asked to “please dislocate your left breast,” or if you “have noticed any hairs growing in places you normally wouldn’t have hairs"? Or maybe someone told you to “have a nice day” after your spouse just passed away or you’d received a cancer diagnosis. Not only do I hear things like this from time to time at my job, but I have grown to expect them.

I have been working for several months as a so-called standardized patient. The local medical school runs an excellent program that lets students conduct histories and physical exams in a simulated, standardized setting. This means I (and many others) pad around in rubberized socks and breezy hospital gowns and feign myriad diseases, syndromes, conditions, and (sometimes nasty) habits. It also means I overuse hand sanitizer and have many strangers listen to my heart, palpate my abdomen, and poke me with a broken wooden Q-tip to test my sensation. One time I even let someone stick their gloved hand in my mouth and squeeze my tongue a little.

As a standardized patient, I have to memorize case materials for fictional patients. This means memorizing not just a list of symptoms and how long the “patient” has had them, but also the patient’s occupation, education, diet, marital status, drinking habits, exercise, stress, family history, and past medical history. If I am supposed to experience or not experience pain when they poke me, or have a knee jerk reaction (literally), I’d better be ready with a realistic response. This involves a bit of groaning, some crying (in the case of bad news), and some bona fide reflexes.

Most often the students show concern and empathy. In the rare case, though, that they say something a patient could perceive as judgmental, we “patients” get to act grumpy and less compliant.

I am expected to give specific, memorized lines about my symptoms, but only if the students ask the right questions in the right way. For example, if a student asks if I use tobacco, that is different from asking if I use or have ever used tobacco products. Asking a woman if she has ever been pregnant is different from asking if she has any children. And, of course, those types of oversights in questioning can lead to different diagnoses.

Luckily, I am not just a living cadaver for the medical students to practice on. I also give feedback. We evaluate the students on things such as how they organize their questions; whether they display empathy; how they perform the physical exam; and how they communicate the possible diagnoses to the patient. After the exam we have time for students to ask questions and for the standardized patients to give suggestions—like how to encourage patients to change their habits, or what would be better wording to deliver bad news.

From this experience, I have learned what to expect from an ideal physician, what to ask, and what not to tolerate. For example, your doctor should not ask leading (or possibly judgmental) questions such as, “You don’t smoke, right?” Nor should they run off a list of questions such as, “Do you smoke, drink, or use drugs?” without giving you time to think. They should ask open-ended questions: “Have you noticed any other changes lately?”

I've also learned that it's important to pay attention to symptoms that may seem unrelated to your chief complaint. If you were experiencing extreme fatigue, for example, you might not think that your newly brittle hair had anything to do with your energy levels, but it could be a thyroid problem.

Even though I am trained to train medical students, this only means I know what (or how) they are supposed to ask or not ask. It did not necessarily mean I knew what to ask when I saw my own doctor.

Recently, I went to my own physician for knee pain. The doctor instructed a medical student to ask about my symptoms while she (the doctor) went out of the room, presumably to doctor someone. The medical student reviewed my complaints. What made the pain better? Worse? Did the knee make any sounds? The student said that it sounded like a very common problem; she just couldn’t remember the name exactly. (Whether she really couldn’t remember or was refraining from diagnosing me without a medical license, I will never know.)

The student left to get the doctor, and when they returned the doctor moved my knee cap around a bit and then suggested that I might have premature arthritis (I’m close to thirty) and that I may need cortisone shots and physical therapy. I refused to believe this, but said “Oh, okay,” nodding complacently. The student and the doctor left the room to give me time to get my pants on, and when they returned, the doctor admitted that the medical student had come up with another possibility: runner’s knee. I read the photocopied pamphlet they handed me, and it fit all of my activities and symptoms.

I was grateful that my physician was willing to listen to the medical student, though a bit terrified to think what I would have put myself through if she hadn’t. Though I know better now from my work as a standardized patient what the doctor could and should ask me, I am still at their mercy if they do not ask the right questions and listen carefully to the answers.

**********

How to Make Your Doctor’s Appointment Better Than Standard: Advice from a Standardized Patient

• Find a physician who will ask you many questions and listen carefully to the answers. Do not assume, if you’ve talked to a medical student or other proxy, that they have conveyed all the information to the physician.

• Your physician should give you more than one possible diagnosis. In other words, they should tell you what they are thinking, unless they are absolutely certain what is wrong. This should be like a conversation between you and your physician. Don’t be afraid to ask, “Are there any other possibilities for what this could be?”

• Pay attention to your own body. Notice when the pain started and what makes it better or worse. Does it happen at a certain time of day or after certain activities? Have you changed your diet recently? Tell your physician about everything you’ve noticed that is not normal for you, even if you don’t think those other symptoms or changes are relevant.

• As I learned with my knee problem, some medical students—because they are not overly confident and are willing to ask, not assume—are better than some doctors.


Image: Craig Breil/University of Michigan MSIS (not a picture of Amy)

Laughter Is OK Medicine, Unless It Kills You

Careful with the bedside banter, doctors. Before you put on your best Patch Adams impression, you might want to consider whether your attempts at humor will ease your patient's discomfort or give him a protruding hernia.

That's the conclusion of a review paper in the Christmas issue of BMJ that asks the jolly question of whether laughter can kill. The two authors, R. E. Ferner of the University of Birmingham and J. K. Aronson of Oxford University—no JK-ing, those are his real initials—take a tongue-in-cheek approach. They even give their research question an acronym: MIRTH (Methodical Investigation of Risibility, Therapeutic and Harmful).

Ferner and Aronson scoured medical literature for studies having to do with laughter. After "excluding papers on the Caribbean sponge Prosuberites laughlini and with authors called Laughing, Laughter, Laughton, or McLaughlin," they were left with three categories of study. One had to do with the benefits of laughter, one with its dangers, and the third with medical conditions that have laughter as a symptom.

Let's hear the bad news first. Laughter, according to various researchers, can lead to syncope (fainting), arrhythmia, and cardiac rupture. In asthmatics, laughing can trigger an attack. Laughing can even cause pneumothorax, a collapsed lung. People with cataplexy, a rare condition tied to narcolepsy, may suddenly lose all their muscle strength and collapse during a fit of laughter. An especially good laugh can make a person's hernia protrude, or dislocate someone's jaw.

Among the more pedestrian dangers, breathing in sharply when you start to laugh can make you choke. Laughing in someone's face can spread germs. And, of course, there's the danger of pee coming out when you laugh, which doctors call "giggle incontinence."

The authors also gathered a list of about three dozen medical conditions that have been reported—commonly or not—to cause laughter. These include epilepsy, brain tumors, multiple sclerosis, and kuru (a disease you are unlikely to contract unless you're a practicing cannibal).

Now for the good news. Laughter may increase your pain tolerance, reduce stiffness in the walls of your arteries, and even lower your risk of a heart attack. In patients with chronic obstructive pulmonary disease (COPD), laughter can improve lung function. Fifteen minutes of laughter reportedly burns 40 calories, which fitness-wise makes it similar to a very slow walk (or, according to Fitness magazine, barbecuing.)

Most strangely, one study used clowns to try to (indirectly) get women pregnant. Immediately after undergoing IVF, women were subjected to 12 to 15 minutes of entertainment by "a clown, dressed as a chef de cuisine." Among these women, 36 percent became pregnant, compared to just 20 percent in a control group.

Perhaps aspiring clowns themselves, the authors can't resist throwing in a few puns of their own: "Laughing fit to burst can cause cardiac rupture." "Perhaps surgical patients derive no advantage from being in stitches." "It remains to be seen whether...sick jokes make you ill, [or] dry wit causes dehydration." I'll give them the benefit of the doubt and assume that, knowing the potentially serious side effects of laughter, they chose to spare their audience the risk.


Image: Urban Combing (Ultrastar175g) (via Flickr)

R E Ferner, & J K Aronson (2013). Laughter and MIRTH (Methodical Investigation of Risibility, Therapeutic and Harmful): narrative synthesis. BMJ DOI: 10.1136/bmj.f7274

The Shambulance: Laser Lipo Only Kind of Sucks

The Shambulance is an occasional series in which I try to find the truth behind overhyped or bogus health products. With me at the reins are Steven Swoap and Daniel Lynch, both of Williams College.

People selling no-suction liposuction are not totally sure what they're offering you. "Low levels of visible red laser light...create a safe and painless bio-stimulation effect," says one center. "Transitory pores" open in the fat cells, sending their contents out for "detoxification," says another, adding that the process is "almost exactly the same as exercise." Except for the lasers.

Despite the confusion, laser lipo does—seemingly, in some ways—work. Wait! Don't panic. Put away your wallet and let's talk about it.

"This is not a weight loss therapy," says Williams College physiologist Steven Swoap. At best, it's "a redistribution of fat therapy."

Many spas offer treatment with a specific laser system called i-lipo. The FDA approved this device in 2012 "for non-invasive aesthetic treatment for the temporary reduction in circumference of the waist."

It's "non-invasive" as opposed to something called laser-assisted liposuction, where doctors blast your fat with a laser before actually cutting into you and sucking it out. What about the rest? "Aesthetic" is because this is meant to change your looks—not to address any health problems. "Temporary," because the FDA based their approval on a study lasting just a few weeks. If you want your new waist shape to last longer, they're not making any promises. And, of course, "reduction in circumference"—but not loss of weight. Something inside you may move around, but that doesn't mean it's going away.

FDA approval was based on a placebo-controlled study in which some participants had a fake laser treatment. After eight sessions over three to four weeks—each session followed by a required workout—the group getting real laser treatment had lost almost an inch and a half more from their waists than the placebo group. (If anybody finds this study itself, and not just a PR summary, I'd love to see it.)

As for how it works, the FDA approval statement says that laser energy "promotes disruption" of fat cells, making them release their contents. But a 2013 review paper says that "the mechanism of action of LLLT [low-level laser therapy] on fat remains somewhat controversial." Various scientists have suggested that the laser makes tiny pores open in the fat cells to release fats; that the cells themselves are destroyed; or that the laser stimulates your cells' machinery to start breaking down fats and discarding their components. There are challenges to the evidence in every camp.

"The use of lasers to essentially heat the fat seems a bit dubious," says Williams College biochemist Daniel Lynch. He's curious whether the results could really be coming from changes in water and salt balance in heated areas of the body. "I wonder if similar effects could be obtained simply [with] heating pads," he adds. Actually, the so-called infrared body wraps offered by some spas aren't far off—these places wrap clients in heated pads and report inches lost after all the squishing and sweating is over.

Assuming that the procedure does kick fat out of your cells, many spas recommend that you exercise immediately afterward. You need to burn up that wandering fat right away, they warn, or else it will just find its way home to your belly.

Lynch agrees that mild exercise afterward would help you use up any fats that the laser has shaken loose. Swoap points out that when we do tougher exercise, our bodies switch to using carbs as fuel instead of fats—so an intense workout right after laser treatment would be less helpful than a tame one. Either way, if fatty acids travel to your liver, it will likely send them right back into storage in your body's squishy areas.

Even if you manage to lose fat from your midsection, you may not be doing yourself any favors in the long term. "Certain types and locations of fat are beneficial, whereas others are harmful," Swoap says. The fat that's reachable by liposuction—laser or traditional—is "subcutaneous" fat, just under your skin. "Subcutaneous fat is a good fat—[it provides] insulation, cushioning, even endocrine function," Swoap says.

"Liposuction is, unfortunately, removing mainly subcutaneous 'good fat' in the name of body sculpting and body image," Lynch agrees.

The fat that's harmful to your health is "visceral" fat, the stuff wrapped around your organs. And if you suck out subcutaneous fat, your body may respond by hiding more fat where you can't reach it.

A 2011 study found that one year after surgical liposuction in their thighs and bellies, women had regained their lost fat—and stored more of it into their abdomens than originally. In 2012, a different research group found that six months after abdominal lipo, women's visceral fat had increased by 10%. This was prevented if they followed an exercise program.

So laser lipo may shrink your waist a little, if you exercise every time you do it. And fat removed surgically might not reappear to strangle your organs, as long as you keep exercising after liposuction. There's no word yet on whether laser lipo can also lead to more visceral fat, but to be safe you might just want to keep working out after it's done.

Maybe the people who called this treatment "almost exactly like exercise" were closer than they knew.


Image: NU:U Laser Lipo Centers

Compost Program Could Bring Dangerous Fungus into NYC Homes

If Mayor Bloomberg's wildest decay-related fantasies are realized, New Yorkers will soon be sparing their food scraps from the garbage. A new composting program would encourage (or possibly require) people in the city to collect their food waste in a separate container. Yet Bloomberg may want to consider whether a Manhattan apartment has the square footage to fit both its residents and their potentially harmful compost fungi.

The New York City recycling plan, as described in the New York Times this week, would start out on a voluntary basis. Participants would gather their food waste in "containers the size of picnic baskets in their homes," then dump the compost in curbside bins for regular collection. Instead of going into landfills, that waste might be turned into biogas for electricity. Eventually, the program could become mandatory.

Vidya De Gannes, a graduate student at the University of the West Indies, St. Augustine campus, in Trinidad and Tobago, has been composting too. She made three kinds of compost, each based on one type of dried plant material (agricultural wastes from the processing of rice, sugar cane, or coffee) mixed with cow or sheep manure. De Gannes and William Hickey, a soil microbiologist at the University of Wisconsin, Madison, who's the senior author of the new study, say these composts are most similar to a homeowner's compost mix of grass and yard waste.

To study the biodiversity of species living in compost, De Gannes collected fungal DNA from her compost containers and sequenced it. In total, she found 120 different species of fungus. Each kind of compost had a unique mix of species living inside it.

She also turned up 15 fungus species that can cause disease in humans. These were present in every kind of compost and ranged from Aspergillus fumigatus, a common fungus that can cause lung infections in people with compromised immune systems, to other species that can infect the skin or eyes.

Although the composts De Gannes studied weren't quite what New Yorkers would be collecting in their kitchens—unless they're keeping pet sheep too—some of the potentially dangerous fungi she found have also turned up in studies of all-plant compost.

Keeping a compost bucket in an enclosed space is "potentially risky," Hickey and De Gannes wrote in an email. Fungal spores floating on the air can cause infections, especially in people with weakened immune systems. "Compost kept in an enclosed area like a small apartment would probably not have adequate ventilation."

To get some fresh air, composters might have to leave their apartments and go around the corner for an extra-extra-large soda.


Image: Waldo Jaquith (not, as far as I know, a dangerous fungus)

De Gannes, V., Eudoxie, G., & Hickey, W. (2013). Insights into fungal communities in composts revealed by 454-pyrosequencing: implications for human health and safety Frontiers in Microbiology, 4 DOI: 10.3389/fmicb.2013.00164

Everyone Underestimates Fast-Food Calories (But Especially at Subway)

At a McDonald's shareholder meeting last week, a nine-year-old girl accused CEO Don Thompson of sneaky advertising. Stop "tricking kids into eating your food," she demanded, saying that McDonald's ads tell kids to "keep bugging their parents" until they get that Happy Meal. In the world of fast-food chains, though, the golden arches may not be the sneakiest purveyor of excess calories. Diners in all kinds of fast-food restaurants underestimate the calories they're taking in—and the most dramatic underestimation happens at Subway.

Thompson may not have been swayed, but Jason Block of Harvard Medical School and a group of other researchers writing in BMJ do care what consumers think about their fast food. Specifically, they care how many calories people think they're eating. To find out, they went into the trenches: 80 fast-food restaurants in New England cities.

Researchers stood outside their chosen dining establishments (which included McDonald's, Burger King, Subway, Wendy's, KFC, and Dunkin' Donuts) in 2010 and 2011. They asked customers on their way in whether they'd be willing to save their receipts and answer a few questions when they came back out. (Only a few restaurants kicked the researchers off the premises.) At dinnertime, they targeted adults, either eating on their own or with kids. At lunchtime and after school let out, they went to fast-food places within a mile of a school and talked to adolescents.

In all, more than 3,000 people participated. Across all the restaurant chains, the average dinnertime meal for adults was 836 calories, and the average afternoon meal for adolescents was 756 calories. Yet when asked how many calories they thought their meals held, people consistently guessed too low. And the bigger their meals were, the more severely they underestimated.

The researchers also asked subjects whether they'd noticed any calorie information indoors. "All of [the chains] provide information in some way," says Block—"on a wall poster, on napkins/cups, on sandwich wrappers and tray liners, and on 'special menus' that might present items that are below a certain number of calories."

Yet less than a quarter of adults said they'd even noticed this information. Those people didn't do any better at estimating their calories than others. Did they use the information to help them make menu choices? Only five percent of all adults said yes. Of adolescents, two percent.

Block says it's easy for diners to miss the calorie information provided by fast-food chains today. But soon, as part of the Affordable Care Act, all chain restaurants with more than 20 locations will have to post calorie information in a standard format. "The menu labeling regulation will require the calories to be up front and highly recognizable," Block says.

Even this kind of prominent labeling has had mixed results in past studies. However, Block adds, the new law will also require menus to post an "anchoring statement" pointing out that people only need about 2000 calories a day. This might make, say, the 970 calories in a Wendy's Baconator more meaningful to a customer.

Anchoring was effective in at least one small study, Block says. Other studies have looked at "traffic light" labeling (in red, yellow, or green), or listing calories in terms of how much exercise you'd need to burn them back off. "We'll be in a position to know much more after the federal law is implemented," Block says. His group is collecting data this year and next year to see how well the new labeling works.

If people do start noticing how many calories their favorite chains are offering, they may be surprised. When researchers broke down their results by restaurant chain, they found that people underestimated their calories more dramatically at some restaurants than others. At McDonald's, adults guessed too low by an average of 100 calories, and adolescents by a little more than 200. The guesses were off by a bit more, on average, at Burger King and Wendy's. At Subway, the errors were most extreme: adults underestimated their calories by an average of about 350, adolescents by close to 500.

Five hundred calories is equivalent to all the bread in a 12-inch sub (or, if you opt for multigrain, all the bread plus four American-cheese triangles). It's a lot not to know you're eating. This mistake, the authors write, may happen because people view Subway with a "health halo." After seeing TV ads featuring fresh vegetables, smiling Olympians, and Jared's old pants, consumers may think they're making a healthier choice than they are.

The new calorie labeling could help most in places like this. A fast-food chain that brands itself as healthy is even sneakier than someplace like McDonald's, which even little girls know is bad for you.


Image: by Jeremy Brooks (via Flickr)

Block, J., Condon, S., Kleinman, K., Mullen, J., Linakis, S., Rifas-Shiman, S., & Gillman, M. (2013). Consumers' estimation of calorie content at fast food restaurants: cross sectional observational study BMJ, 346 (may23 3) DOI: 10.1136/bmj.f2907

Aging Makes People Colon-Close-Parenthesis

Getting older is not a recipe for crotchetiness. Although those two cranky Muppets will always be up in their balcony, Americans in general don't become less happy with age. If anything, they get happier.

The trajectory of people's happiness over a lifetime is tricky to study, because in a given year you're capturing not only your subject's age but also the current events. You need to follow a large group of people over many years, and you need them to be all different ages when the study starts.

Angelina Sutin and her colleagues at the National Institute of Aging in Maryland had just such a dataset to work with. Called the Baltimore Longitudinal Study of Aging (BLSA), this project has been running for more than five decades and has gathered data on people born everywhere between 1885 and 1980. These subjects have answered questions about their happiness on many occasions—some as many as 19 times—throughout their lives.

Want to find your own happiness score? Answer the following questions on a scale from 0 to 3, where 0 is "rarely or never" and 3 is "most or all of the time." In the past week of your life, how frequent were these feelings?

     I enjoyed life

     I felt I was just as good as other people

     I felt hopeful about the future

     I was happy

Summing the four numbers will give you your well-being score. If you were in the BLSA, that score would be your data point for today.

When the researchers put all 2,267 subjects together and looked at how their happiness changed with age, they got a decidedly downward slope. A frowny face, if you will.

age = : ( 

It looked like aging made people less happy. But then the researchers tried a different tactic. Instead of lumping all their subjects together, they grouped them by when they were born. That frown turned upside down:

age = : \

Within each birth year, the results now looked like a somewhat more optimistic "meh?" face. Every group's well-being slightly (but significantly) improved with age.

The first set of results had sloped downward because people who were born earlier reached lower endpoints of well-being. In the graph, you can see that someone born in 1905 or 1925 is likely to reach a 9 or a 10 later in life; someone born in the 1960s might make it nearly to 12 (a perfect score).

Sutin thinks this could have to do with the biggest national frowny-face of all: the Great Depression. People who lived through this time, she writes, may have felt lasting psychological effects. Although their well-being still improved as they aged, the cloud of the Depression may have lingered.

(Sutin notes also that younger and older adults, according to previous studies, treat this set of well-being questions and the 0-to-3 scale similarly. This suggests the results aren't just happiness inflation—say, younger people reporting a 12 for the same feelings that older people would rate a 10.)

Aside from increasing economic prosperity in the United States, there are plenty of other reasons people may have felt happier in more recent decades. Sutin cites increased life expectancy, decreased infant mortality, better nutrition, less disease, and more women in the workplace as possible factors. The twentieth century also saw faster travel, the invention of the Internet, and the eradication in America of both the polio virus and gelatin-based entrées. There's a lot to be happy about.

Now that Sutin has found that the average American seems to have an upward trajectory of well-being, she's interested in people's individual paths: what makes one person's happiness increase more or less (or decrease) over time?

In this study, subjects who were white had higher well-being scores on average, as did those with more education. Sutin hopes to pick apart the social, economic, and health factors that affect how happiness changes with age. When everyone can feel as :) as they want, we'll really be living in the future.

Sutin, A., Terracciano, A., Milaneschi, Y., An, Y., Ferrucci, L., & Zonderman, A. (2013). The Effect of Birth Cohort on Well-Being: The Legacy of Economic Hard Times Psychological Science DOI: 10.1177/0956797612459658

Image: a 102-year-old woman, by Uppy Chatterjee (Flickr)

Are You Healthy Enough to Be a Space Tourist?

Space travel for regular folks is almost here. But before jumping on board the nearest spacecraft, amateur astronauts and their doctors might want to consider the health risks. Although standard air travel is more boring than spaceflight, it's also less likely to shrink your bones or deform your eyeballs.

"Practically only the healthiest people have flown in space so far," says Marlene Grenon, a vascular surgeon at UCSF who researches the effects of microgravity on the body. Government astronauts go through extensive medical testing and training. But even these extra-fit fliers have suffered ailments ranging from cardiac dysrhythmia to good old-fashioned vomiting. What's in store for the rest of us?

Grenon is the lead author of a paper in BMJ asking that question. The researchers say that doctors will have plenty to consider before sending their patients to boldly go where no civilian has gone before.

"Space motion sickness would be expected to be the most common" medical problem, Grenon says, "particularly for short-duration flights." If your inner ear is easily confused by sitting still in a moving vehicle, just imagine what happens when that vehicle has no up or down.* NASA's parabolic flights—trips on aircraft that fly in steep up-and-down waves, simulating weightlessness for astronauts in training and scientists researching low gravity—have earned the nickname "vomit comets" for a reason.

Life without gravity is hard on the bones and muscles as well as the barf reflex. NASA astronauts onboard the space station exercise for two hours every day to counteract bone loss, muscle atrophy, and a decrease in cardiovascular fitness. Grenon says she doesn't yet know how weightlessness might act on people who are less fit to begin with, or overweight.

Exercise may prevent muscle atrophy but it doesn't do much for squished eyeballs. A study last year found that after a six-month space mission, astronauts were likely to have "flattened globes" and other eye problems. The shifting of fluids inside the head, free to bounce off the walls just like the astronauts themselves, might be to blame. Even after shorter trips, many astronauts reported worsened eyesight.

The authors of the new paper name several medical conditions that might worsen in microgravity. For people with diseases of the blood vessels, fluids drifting around might be dangerous. Aneurysms could rupture during takeoff. Bone loss in space could be especially bad for people who already have osteoporosis. Acid reflux could worsen when the esophagus no longer knows which way is up. And don't forget radiation exposure.

But the most ordinary complaint that might ground you is an infection. Grenon writes that even people with simple ear or skin infections should consider postponing trips to space.

That's because the immune system changes during spaceflight, Grenon says. Although these changes are not well understood, they "could place the spaceflight participants at higher risk of infection." Additionally, she says, "Some research has also hinted [at] the fact that bacteria grow stronger in microgravity." And radiation might make people more susceptible to infection—or make bacteria mutate more quickly. Overall, the changes in space favor bacteria over your immune system. These risks would be greater on longer flights.

Still want to fly? Virgin Galactic is accepting reservations. If you're willing to put down $200,000 up front, you can still get a spot on their first round of flights. For a cool million you can reserve a private trip for yourself and five friends—that's a buy-five-spaceflights, get-one-free deal. Make sure you pack enough barf bags.


Grenon, S., Saary, J., Gray, G., Vanderploeg, J., & Hughes-Fulford, M. (2012). Can I take a space flight? Considerations for doctors BMJ, 345 (dec13 8) DOI: 10.1136/bmj.e8124

Image: U.S. Air Force

*For an exceedingly thorough discussion of space barfing, as well as other bodily functions performed in microgravity, I recommend Mary Roach's book Packing for Mars.

Malaria Makes Its Victims More Tempting to Mosquitos

Think mosquitos have a special fondness for you? Do they choose to target you over adjacent humans? No matter how badly you have it, things might be worse if you were infected with malaria. New research in birds shows that malaria parasites somehow make their victims more attractive to mosquitos. After all, the parasite needs a lift to its next destination—so it forces its sick host to flag down a ride.

Malaria, one of the top killers worldwide among infectious diseases, isn't caused by a virus or a bacterium. The culprit is a one-celled protozoan, called Plasmodium, that comes in a couple hundred disease-causing flavors. Plasmodium falciparum is the species that causes most malaria deaths in humans.

Various other Plasmodium species infect birds, reptiles, and mammals ranging from apes to anteaters. Whichever animal it prefers, the parasite needs to travel to new hosts via the belly of a mosquito. If possible, Plasmodium shouldn't just rely on chance—it should encourage mosquitos to bite its host.

In a 2005 study, researchers found hints that mosquitos are more attracted to the smell of a malarial child than a healthy one. (This was only true once the parasite had reached the right life-cycle stage for spreading to other people.) Giving malaria to kids is hard to justify ethically, though, even if you then treat them with antimalarials as those researchers did.

To pursue the question without leaving behind a trail of sick children, researchers in France turned to birds. Author Stéphane Cornet, of the Centre d'Ecologie Fonctionnelle et Evolutive, says the avian malaria parasite the team used infects more than 30 bird species around the world. For their experiments, they used canaries.

Mosquitos could prefer sick animals simply because they're easy targets. "Infection often renders hosts lethargic, as we are when we feel sick," Cornet says, "so that they are less able to defend themsleves against [mosquito] attacks." But he and his coauthors were more interested in whether malaria changes the particular bouquet of an animal to tempt to passing mosquitos. So they placed all their canaries inside PVC tubes with only their legs sticking out. This way, the birds' behavior and appearance wouldn't matter.

Fifty canaries were divided into pairs. Then the researchers released 70 hungry female mosquitos into a cage with each pair of birds (or, from the mosquitos' perspective, a cage holding four bird legs). After the mosquitos had feasted, the authors checked the DNA of the blood in their bellies to find out which bird each mosquito had chosen. Every mosquito choice test was repeated three times.

After testing mosquitos on healthy birds, the researchers infected one bird in each pair with avian malaria and repeated the tests 10-13 days later, when the birds were sickest. Two weeks after that, they tested the mosquitos and birds a final time. By then, 9 birds had died. But the surviving infected birds had entered the "chronic" stage of infection, when the parasite lies low and the victim isn't as sick.

Mosquitos weren't any more interested in acutely ill birds than in healthy birds, the researchers found. This might have been because the malaria had driven down their red blood cell counts, making their blood less delicious to mosquitos. But once the canaries entered the chronic stage of malaria, mosquitos clearly preferred to feed on the infected birds. The authors report their findings in Ecology Letters.

Cornet believes malarial birds give off some signal to attract mosquitos, such as extra carbon dioxide or a specific odor. What exactly that signal is, and how the Plasmodium parasite manipulates its host into sending the signal, remains a mystery.

A canary is of course not a person, and their malaria parasites are different from ours as well. But there are similarities in how the two parasites act on their hosts, Cornet says. Humans, like birds, might give off some mosquito-enticing perfume when infected with malaria. Finding this perfume could help prevent malaria transmission in the future. And even before that happens, Cornet says, it's useful for people who model the spread of malaria to know that mosquitos aren't choosing their victims randomly.

If you're still feeling resentful toward mosquitos, it may help to know that the malaria "perfume" is really a trap. Mosquitos that carry Plasmodium parasites are about a third less fertile than they would be otherwise, another study this year found. Drinking from infected hosts is bad for mosquitos just like it's bad for the next animal they bite. But, like us, they're helpless to Plasmodium's wiles.


Cornet, S., Nicot, A., Rivero, A., & Gandon, S. (2012). Malaria infection increases bird attractiveness to uninfected mosquitoes Ecology Letters DOI: 10.1111/ele.12041

Image: Travis S. (Flickr)

The Shambulance: Copying Roger Clemens Won't Help You Lose Holiday Pounds

The Shambulance is an occasional series in which I try to find the truth about bogus or overhyped health products. With me at the wheel of the Shambulance are Steven Swoap and Daniel Lynch.

The injections he'd been receiving in the buttocks during his major-league baseball career, pitcher Roger Clemens explained to a jury this summer, were not steroids. They were perfectly legal and innocent shots of vitamin B12. The jury acquitted him, lifting the weight of a felony perjury charge from his shoulders. You, too, can use B12 to put some spring back into your step—at least, if you believe the companies that market the injections for weight loss, energy, and general well-being. In reality, this is not a performance enhancer.

B12 is a quirky vitamin that you can't get from plants. It's manufactured by bacteria that provide their services to some animals by living in their guts. Humans mainly get B12 from meat, eggs, and dairy. Of course, this means vegan humans have to find the vitamin elsewhere, such as in fortified breakfast cereals or Flintstones chewables. (They might also ingest B12 from soil bacteria on vegetables that haven't been washed well.)

"Healthy individuals have a six-year supply of B12 stored in their liver," says Daniel Lynch, a biochemist at Williams College. So even a temporary shortage in your diet shouldn't harm you. Long-term vegans, though, can become deficient in B12. Some older adults and gastric-bypass patients who can't absorb enough B12 from their food need to get it from an outside source. And patients who suffer from a disorder called (oddly) "pernicious anemia" need B12 supplements.

B12 deficiency causes weakness and fatigue, and an injection of the vitamin reverses those symptoms. This has apparently led some people to conclude that healthy, non-deficient folks will also get stronger and more energetic by taking B12. Why settle for normal functioning when you could be a vitamin-powered superhuman?

"[Weekly] vitamin B12 injections are intended to crank up the metabolism and boost energy levels to increase daily activity and help weight loss even when the body is at rest," says one Chicago weight-loss center.  An "anti-aging" clinic asserts that "B12 injections are...an effective means of boosting the body's metabolism for those looking to lose weight."

You'll start by shedding weight in the wallet region: a 3-month course of shots from that office will relieve you of nearly $500.

It's true that vitamin B12 is involved in metabolism. However, according to the National Institutes of Health, "Vitamin B12 supplementation appears to have no beneficial effect on performance in the absence of a nutritional deficit."

In other words? "Basically, for any healthy person this is a sham," Lynch says. "Any excess B12 is peed out anyway."

Non-human animals store B12 in the liver, just as humans do. "So you could get the same effect of the injection by munching on liver," says Steven Swoap, a physiologist who's also at Williams College. "This is how they 'cured' vitamin B12 deficiency a hundred years ago."

If you still feel a craving for B12 but don't care for liver sandwiches, you can buy bottles of B12 pills—and they'll run you about five cents a tablet. "It begs the question as to why anyone would stick a needle in themselves when you can buy this stuff as a pill at the local drugstore," Swoap says. Maybe we can find a Hall-of-Fame-nominated baseball player to explain it.

Image: Craig Strachan (Flickr)

Subliminal Placebo: You Didn't See It, but It's Working

The latest additions to the placebo effect family might be the rudest. First there was placebo, which uses your body's own tools to make you feel better after you try a treatment you imagine will help you. Then there was nocebo, placebo's evil twin: it makes you feel worse only because you think you will. Now researchers have discovered that placebo and nocebo effects can be triggered subliminally, which is like finding out that the good and evil twins have both been living in your basement without you knowing it.

Usually, placebo and nocebo look like cases of our own expectations manipulating us. Someone swallows his favorite headache remedy or visits a doctor, and his body, expecting to feel better, ramps up production of its own pain-relief molecules. Someone else steps onboard a plane and begins to feel nauseous, simply because her body has learned that airplanes mean queasiness. If we were more ignorant of our circumstances, the effects wouldn't be there.

But there seem to be some cues we can take in subliminally, without noticing them. So researchers led by Karin Jensen at Harvard Medical School wondered whether visual signals that are too brief to reach our consciousness—but perhaps not too brief for certain areas of our brains to snag as they pass—can trigger placebo and nocebo effects too.

For their visual signals, the team chose photos of male faces. "We know from previous studies that faces can be detected and processed very quickly in the brain," Jensen says. Their models came from a set of photos created for use in psychology experiments.

The researchers carried out two experiments, the first of which was a classic test of placebo and nocebo. Subjects were shown pictures of two expressionless male faces over and over. Each time they saw face A, they felt a painfully hot sensation on the forearm. Face B was paired with heat that was milder, but still uncomfortable. (The A and B models alternated between different subjects—just in case one man's face really was more painful to look at.) During the conditioning part of the experiment, subjects saw each face 25 times. This taught them to expect higher pain with face A and lower pain with face B.

Then came a second series where subjects saw the same two faces as before, with a few new ones mixed in as controls. With each face they saw, subjects rated the pain they felt from the heat instrument on a 100-point scale. The twist was that in this part of the experiment, the heat level was exactly the same every time. But subjects consistently reported high pain for face A and low pain for face B. When they saw a new face, subjects reported an intermediate level of pain (which corresponded to what they were actually feeling).

This first experiment showed the researchers that pairing faces with painful heat stimuli could create both a placebo effect (when subjects rated moderate heat as less painful because they saw face B) and a nocebo effect (when subjects found moderate heat more painful, thanks to face A). So they moved on to the second experiment. In this round, the visual signals would be "nonconscious,"or subliminal.

A new group of subjects went through the same conditioning sequence as before. Then they were given a testing sequence using face A, face B, and the new (control) faces, all paired with the same moderate heat on the arm. But the faces in this sequence flashed on the screen for just 12 milliseconds, compared to 100 milliseconds in the earlier experiment.

12 milliseconds is fast. Too fast, in fact, for subjects to consciously process the faces zipping by. They reported that they couldn't tell who was who (and a separate experiment confirmed that people can't recognize faces shown this quickly).

But, as the researchers report this week in PNAS, the pain scores still matched the faces subjects said they couldn't see. Face A got significantly higher pain scores than face B, with the control faces scoring in the middle—and don't forget that, once again, subjects were actually feeling the same degree of heat every time.

Even though the pictures flashed too briefly to enter conscious awareness, they seem to have snuck in through the brain's back door. These visual cues made subjects experience more or less pain than they should have, even though they had no idea what they'd seen.

There were only 20 subjects in each experiment; it would take further studies to show how consistent or how powerful the subliminal placebo and nocebo effects are. But the fact that they found an effect at all is exciting news to the researchers. "To the best of my knowledge, there has not been an experiment [previously] where placebo/nocebo effects have been activated by nonconscious cues," Jensen says.

The common assumption, Jensen says, is that placebo and nocebo rely on the signals we're paying attention to (pills, needles, drug commercials) and the results we expect (relief, discomfort, alarming side effects). But this study "proves that we don't need to be aware of the cue to elicit a conditioned response," Jensen says.

Don't expect to start seeing mysterious images flashing at you in the doctor's office. The subjects in Jensen's study had to be trained to associate photos of faces with high or low pain. And even if there were another kind of image that automatically produced a placebo effect in a wide audience (teddy bears? puppies?), our brains might not be able to recognize it as quickly as a human face.

But the idea that placebo and nocebo effects can be triggered by cues patients don't even notice could be important for healthcare, Jensen says. Certain conditions such as asthma, depression, and irritable bowel syndrome are known to respond well to placebos. Maybe doctors' offices and hospitals in the future will tailor everything patients see—from the posters on the wall to the instruments on the counter to the fish swimming in the lobby aquarium—to encourage placebo and avoid nocebo. Or maybe we'll be able to use the same tricks at home to keep ourselves feeling our best. Let's kick those weird placebo relatives out of the basement and put them to work.

Karin B. Jensen, Ted J. Kaptchuk, Irving Kirsch, Jacqueline Raicek, Kara M. Lindstrom, Chantal Berna, Randy L. Gollub, Martin Ingvar, & and Jian Kong (2012). Nonconscious activation of placebo and nocebo pain responses PNAS : 10.1073/pnas.1202056109

Image: freya.gefn/Flickr

Blood Test Reveals the Time Inside You

Like flowers opening and closing with the sun, our bodies have a rhythm that follows the daily turning of the earth. Processes speed up and slow down; hormones rise and fall; we feel wakeful or tired. But our internal clocks aren't always in sync with the day. By finding out what time our bodies think it is, doctors can time their treatments to work better. And now, there might be a simple way to check the time on our inner clocks.

The idea of coordinating medical treatments with the ticking of patients' internal watch hands is called "chronotherapy." Hiroki Ueda, a researcher at the RIKEN Center for Developmental Biology in Kobe, Japan, says that some doctors are already using chronotherapy in treatments such as chemo for colon cancer. Checking a patient's internal schedule before delivering medicine can make a treatment both more effective and less toxic.

But doctors don't have an easy way to check the body clock. "It was labor-intensive and time-consuming for clinical researchers to measure body time using classical methods," Ueda says. One method involves keeping subjects under controlled conditions for more than a day while constantly sampling their blood to check levels of cortisol or melatonin (two hormones with a strong daily cycle). Methods like this aren't exactly practical, which has been an obstacle to chronotherapy. So Ueda and his colleagues have been working on a better technique.

The researchers took inspiration from a hypothetical garden described by 18th-century Swedish botanist Carolus Linnaeus. The Horologium Florae (Latin for "clock of flowers"), as Linnaeus imagined it, would hold a few dozen varieties of flowers that he'd chosen for the precise timing with which they opened and closed each day. By simply looking around the garden, a knowledgeable gardener could tell the time of day.

Instead of flowers, the Japanese researchers used molecules circulating in the bloodstream that wax and wane over the course of the day. They'd previously built this kind of molecular flower clock for mice; now they tried it with humans.

They recruited six healthy volunteers who were willing to pretty seriously jet-lag themselves inside a lab. First, subjects stayed awake and sitting in a chair for a day and a half while researchers fed them and took their blood every two hours.

In these blood samples, the researchers found 58 molecules that cycled over the course of the day. (Since subjects weren't sleeping, moving around, or eating normal meals, they knew these molecular rhythms were intrinsic to their bodies and not a reaction to their environment.) They created a timetable  that would predict the time of day based on the levels of all these molecules in the blood.

Next came the jet-lagging. For a week, subjects were put on a 28-hour cycle of sleeping and waking instead of the usual 24. This was to knock their internal rhythms out of alignment with the true time of day. Then subjects sat through the same day and a half of blood sampling as before.

The frequent blood samples let researchers find their subjects' internal body time the old-fashioned way, by closely plotting the rise and fall of one hormone (cortisol). This gave them a cheat sheet against which they could check the answers from their molecular flower clock.

Using the timetable they'd created in the first part of the experiment, Ueda and his team found that any pair of blood samples taken 12 hours apart could accurately tell their subjects' body time to within 2 or 3 hours. If a person's body thought it was 4:00 PM when it was really noon outside, the molecular timetable could detect the difference.

Ueda's subjects for this study were all young adult males. But he says the cycling molecules in the timetable—including steroid hormones, amino acids, and lipids—should apply to females and other age groups as well. One of the researchers' next steps will be to start testing their molecular clock in these other populations. They'd also like to hone the technique so it works with a single blood sample, rather than two.

Even when we're not trapped inside a sleep lab with manipulative researchers, our circadian rhythms can get misaligned. Jet lag or night shifts at work can push people's bodies out of sync with the sun. Genetic mutations can create whole families of extra-early risers who wake up before dawn.

If a simple blood test allows doctors to peek at patients' internal clocks, they could more easily diagnose these disorders. They could also better tailor chemotherapy and other treatments to patients' bodies. And recent research in mice suggested that high-fat foods consumed during the usual sleeping hours contribute more to obesity than the same foods eaten during waking hours. Understanding our individual clocks might keep us not just sleeping and waking well, but blooming with health.


Takeya Kasukawa, Masahiro Sugimoto, Akiko Hida, Yoichi Minami, Masayo Mori, Sato Honma, Ken-ichi Honma, Kazuo Mishima, Tomoyoshi Soga, & Hiroki R. Ueda (2012). Human blood metabolite timetable indicates internal body time. PNAS : 10.1073/pnas.1207768109

Image: Josh Greenberg/Flickr

New OCD Symptom: Tail Chasing

The comments on online forums are sometimes resigned, sometimes plaintive. One four-year-old "has always has some OCD issues," reports Brookey77, "especially when it comes to tennis balls. When he was a pup, he sucked on them as a baby would suck on a pacifier...Then he started eating them...For the last few months, he has been eating his leg."

An 8-month-old pitt bull is "a shadow chaser," says ultimatek9. "She is fine at night and when it is overcast, but when the sun comes out she goes into a trance. She locks onto the shadows and will start salivating and trembling."

Dogs with compulsion may pace, chase imaginary flies, or lick their flanks until they get sores, despite their owners' best efforts to make them stop. Certain breeds are especially vulnerable. A staple of canine compulsion is tail chasing, which frequently strikes bull terriers and German shepherds. On one forum, user MatrixsDad complains that his German shepherd "is constantly chasing and barking at her tail...She comes up and puts her backside against anyone who's standing around so she can get a better view of her tail before she starts chasing it."

Although they may seem like nothing more than cute YouTube material, dog compulsions can turn unfunny fast. A user called Fodder describes a cocker spaniel that used to chase and bite his tail whenever stressed. "Finally the day came—we pulled into the garage where he had been staying and he was cowering on the steps...as I got closer I realized that he was sitting in a puddle of his own blood. He had chewed his tail completely off."

Because of the apparent similarities between human OCD and dog compulsions, researchers led by Katriina Tiira at the University of Helsinki decided to investigate just how close the connection is. They gave detailed questionnaires to the owners of 368 German shepherds, bull terriers (standard and miniature), and Staffordshire bull terriers. Among their subjects, 218 were tail chasers.

The first clear similarity between tail chasing and human OCD is that they have a genetic component. In humans, OCD is estimated to affect 1 to 3 percent of the population in general. But the twin of a lifetime OCD sufferer has at least a 25 percent chance of OCD himself. Likewise, the fact that certain breeds of dogs chase their tails more suggests that somewhere in the breeding process, that tendency was embedded in their DNA.

The questionnaires turned up many similarities between obsessive dogs and humans. One was the early onset of the behavior: Human OCD often shows up in childhood or adolescence; tail chasing began for the greatest number of dogs in the study between 3 and 6 months old. Some dogs only tail chased occasionally, while others couldn't get enough and repeated the behavior several times a day. And some dogs also seemed to freeze or go into a trance, a symptom similar to one in human OCD patients called "obsessional slowness."

Certain factors appear to make dogs more or less likely to be tail chasers. Owners reported that tail-chasing dogs had been separated from their mothers earlier as puppies. Dogs that live with a lot of other dogs, though, don't chase their tails as often.

Dogs given vitamin and mineral supplements by their owners were less likely to tail chase, and so were females that had been neutered. This might mean that the presence of certain vitamins, or absence of certain hormones, makes tail chasing less likely. However, the authors acknowledge, it could also mean that owners who neuter their dogs or give them supplements are treating the dogs in some other way that lowers their risk of obsessive behaviors.

A subset of the dog owners in the study also filled out a questionnaire on the "personality" of their pets. Tail chasers were shyer and likely to have additional compulsions. Senior author Hannes Lohi says this resembles anxieties and behavioral inhibitions in human OCD sufferers.

"Our major aim is to identify new anxiety genes" in dogs, Lohi says. Those genes could teach us about how these conditions develop in dogs as well as in humans, who share the same environment and aren't that far off physiologically. We might even learn about new treatment avenues in humans. An earlier study found a genetic region that's linked to a flank-sucking obsession in Dobermanns—and the same region has been tied to human OCD and autism. But the new study found no connection between that genetic area and tail chasing.

It's likely, the authors write, that obsessive behaviors in dogs have many different origins and manifestations. The same seems to be true of humans. Hunting down the roots of these behaviors in our canine companions, then, might help us cure our own kinds of tail chasing.




Tiira K, Hakosalo O, Kareinen L, Thomas A, Hielm-Björkman A, Escriou C, Arnold P, & Lohi H (2012). Environmental effects on compulsive tail chasing in dogs. PloS one, 7 (7) PMID: 22844513


Image: Tim Mowrer/Flickr

How Placebo's Evil Twin Makes You Sicker

Whenever a pharmaceutical company tests a new migraine prevention drug, nearly 1 in 20 subjects will drop out because they can't stand the drug's side effects. They'd rather deal with the headaches than keep receiving treatment. But those suffering patients might be surprised to learn that the drug they've quit is only a sugar pill: the 5 percent dropout rate is from the placebo side.

Lurking in the shadows around any discussion of the placebo effect is its nefarious and lesser-known twin, the nocebo effect. Placebo is Latin for "I will please"; nocebo means "I will do harm." Just as the expectation of feeling better can make our symptoms ease, the expectation of feeling worse can make it a reality.

In a review paper published last week in the German journal Deutsches Ärzteblatt International, researchers say doctors and drug companies are unwittingly introducing patients to the demon of nocebo. Led by Winfried Häuser of the Technical University of Munich, the authors say that nocebo in the doctor's office can add unnecessary pain and distress to ordinary procedures. In clinical drug trials, it can create side effects that shouldn't be there—and perpetuate them in the patients who will take that drug in the future.

Chemically, nocebo seems to use the same toolkit that placebo does. Say you have a headache and treat it however you normally like to—maybe with an ibuprofen, or a few drops of homeopathic whatever under your tongue. If you expect to start feeling better soon, your body will use internal molecules such as dopamine and opioids to start creating its own pain relief. (Depending on what treatment you've used, you may or may not get some chemical backup once it kicks in.) It's good old-fashioned conditioning, just like Pavlov's hungry dogs salivating before food was anywhere in sight. But in nocebo, when you expect your headache to get worse, your body turns the pain-relief machinery down instead of up.

Nocebo doesn't need a doctor's help to find you. But a doctor can harness it too. The standard assumption in medicine, Häuser and his coauthors write, is that patients should be warned ahead of time about anything painful ("You're going to feel a little pinch!"). But telling a patient to expect discomfort might actually make it worse. In one study, patients getting an injection felt more anxiety and pain when their doctors used words such as "sting," "burn," or "bad," even if the doctor was only trying to express sympathy.

In another study, women receiving epidural injections felt more pain when they were warned that the "big bee sting" would be the worst part of the procedure. When women were instead reminded that the injection would numb them and make them more comfortable, they experienced less pain. The authors point out that patients in emergency situations or facing major surgery are often in a "trance state" that makes them even more suggestible than usual.

Nocebo can really throw a wrench into clinical drug trials. Placebo is well accounted for; these trials always include a large placebo group in which patients are given a sugar pill or other fake treatment. To minimize the effect of suggestion, neither doctors nor patients know which group they're in. After the trial, researchers can subtract the positive effect seen in the placebo group from that in the patients taking a real drug, and see how much good their treatment really did.

In both the real and placebo groups, subjects report any side effects they experienced. When drug companies report the results of their trials, the Food and Drug Administration asks that they only report side effects (or "adverse events") that they have some reason to believe were caused by the drug. But the FDA acknowledges that this is "a matter of judgment."

As we saw with the migraine patients, side effects can be common even with a sugar pill. In one study, 44 percent of lactose-intolerant people reported gastrointestinal problems after taking a fake lactose tablet. (Impressively, a quarter of people without lactose intolerance also reported digestive troubles after taking the tablet.) And in a somewhat cruel prostate drug study, one group of subjects was told that sexual dysfunction was a possible side effect, while the other group wasn't. The better-informed group reported sexual side effects at a rate of 44 percent, compared to only 15 percent in the blissfully ignorant group.

Whatever side effects are attributed to a new drug, doctors may increase patients' odds of feeling those effects just by mentioning them. In Germany, Häuser says, "most of the product inserts contain very many potential non-specific adverse events, raising the risks of nocebo effects." So how can doctors avoid making their patients sicker?

Häuser and his coauthors have a couple of suggestions. Patients could consent to not be informed about mild side effects, knowing that just hearing about these effects makes them more likely. And doctors can phrase their warnings more positively, emphasizing that most patients respond well to a treatment rather than focusing on potential negatives.

"Doctors can and should be trained to positively use the power of their words," Häuser says. If we know where nocebo is lurking, we may be able to keep it far away.


Winfried Häuser, Ernil Hansen, & Paul Enck (2012). Nocebo phenomena in medicine: Their relevance in everyday clinical practice. Deutsches Ärzteblatt International : 10.3238/arztebl.2012.0459

Image: takgoti/Flickr

The Shambulance: Ionic Foot Detox Baths

(The Shambulance is a brand-new, occasional series in which I try to convince you not to spend your money on bogus health products. My Shambulance copilot is Steven Swoap, a biology professor and physiology expert at Williams College.)

Regular water is so lazy. You put your feet in a warm tub and sure, it's relaxing. Maybe afterward you scrape some dead skin off your heels and put on lotion and feel a little more presentable in sandals. But don't you wish that water was doing some real work? Why isn't it, say, sucking poisons out of your whole body through the soles of your feet while curing your every ache, pain, and allergy?

If this is how you feel, you're in luck: Certain spas will happily take 50 or 75 of your dollars in exchange for half an hour of "foot detox." This warm water tub is no ordinary foot bath, but one that contains "positive and negative ions from a special generator" (an electrical current, in layman's terms).

What exactly does that current do? One Chicago spa claims that "your body will undergo a life-changing cleanse, releasing...toxins, oils, acids, fats, heavy metals, cellular debris, and waste that have accumulated over your lifetime." Removing all that bad stuff (which your body, for some reason, stubbornly clings to unless aided by electric foot baths) leads to a host of benefits. Possible health effects name-dropped by foot detox purveyors include pain relief, improvement of eczema and psoriasis, better organ functioning, increased energy, and greater muscle strength. And—because why not?—weight loss.

Just in case any skeptics are tempted to scoff, the foot bath people have proof their product is working. "It is an amazing process to watch," another Chicago spa declares, "as the presense of these cleansed toxins and waste are deposited back into the water around your feet in a murky display of residue."

Want the benefits of frequent detoxifying foot baths without having to pay for spa trips? You can buy your own machine (comes with carrying case!).

Before you pull out the MasterCard, though, you might reconsider a few points. For starters, the idea that harmful molecules can exit your body through the feet.

"We definitely have organs to rid ourselves of compounds that are not useful. You can call them toxins, but that word is so often used incorrectly that I try to avoid it," says physiologist Steven Swoap. "Those organs are the liver and kidney."

Our livers filter unwanted materials out of our blood and chemically modify them. Our kidneys send those materials into the toilet bowl. The soles of the feet are, if you can believe it, not part of the equation. "I imagine that in some alternate universe, organisms evolved an excretory organ on the bottom of their feet," Swoap says. "But not in our world."

In response to a long list of health claims from one spa's website, Swoap says, "If I report that I got sick from reading this, would that be a good scientific study?" He calls the wide-ranging promises "simply ridiculous." Increased energy? Cells get their energy from molecules such as adenosine triphosphate (ATP), not from some sort of internal housecleaning. More muscle strength? "It is not clear to me how running a small electric current in a bath can improve muscle strength," Swoap says. "Wouldn’t body builders just lie around in the stuff?"

The murky water doesn't prove much, either. "The residue is most certainly corrosion of the electrodes once you put in some salt water and a little current," Swoap says. "This is just like a corroded battery—all nasty and brown." Instead of removing metals from their bodies, users are soaking their feet in a bath of iron, nickel, or other metal from the machine's electrodes. ("Yum," Swoap says.) He points out that someone could easily demonstrate this by running the machine without any feet in it and producing the same residue.

You may remember foot gunk being used to sell another product: Kinoki foot pads, which popped up in the As-Seen-on-TV aisles a few years ago. Their makers claimed that wearing the adhesive pads on the bottoms of your feet overnight would draw out toxins from your body and, again, cure all your ills. The proof, they said, was in the gross brown material found on the pads in the morning. But a 2008 investigation aired on NPR revealed that used Kinoki pads were chemically identical to unused ones; the pads simply turned brown in the presence of moisture. In 2010, the Kinoki manufacturers were banned from marketing their foot pads after the FTC charged them with false advertising.

Any company that's selling cleansing and curing foot products may similarly be living on borrowed time. Instead of looking for miraculously hard-working water baths, why not take a moment to appreciate all the hard work your body is doing on its own? You might even thank it with a nice soak in a regular tub.

Image: healthandmed.com

Thanks to Steven Swoap for helping me kick off the Shambulance road trip. Have a suggestion for a column? Write to me or leave a comment!