Posts Tagged Pseudomedicine

Is your vagina depressed?

Are you femme presenting? Do you sometimes wish more people would have more of an opinion on how you have sex? How often you have sex? How you should behave when you don’t want to have sex? How often you should want sex? How your body behaves when you do/don’t have sex? Whether your experience of sex is real? What ‘real’ sex is and who ‘real’ sex happens with?

Well, you’re in luck! Because over the last year and a half the British media have been telling us all about a “study” which says if you’re not having “enough” sex, your vagina (if you have one) will get depressed and “atrophy”.

Woman's head and shoulders from behind, in grayscale. Her head is dropped down.

As far as I can tell, this all started a little over a year ago when The Sun wrote this headline:

SORE POINT Do you have a ‘depressed’ vagina? This could be why sex is SO painful (and it’s nothing to do with an STI)”. The story resurfaced just a few weeks ago when Higher Perspectives said “New Research Says Lack Of Sex Makes Your Vagina Depressed

The Higher Perspectives article begins “We all know that a healthy sex life keeps our immune system humming, lessens pain and relieves stress. It makes for a happier life. But what happens when we don’t have a sex?”. The article goes on to explain that “research” shows that “Sexual abstinence can make our vagina depressed and this can also lead to vaginal atrophy.”

Do they link to this research? Well, no. And having a look on Pubmed shows no sign of any such research in existence. But they said their claims were “backed in science” it so it must be true, right?

Digging a little deeper, it becomes clear that the media – including The Sun, Maxim, The New York Post and Women’s Health Magazine seem to think a diagnosis of vulvodynia is a synonym for vaginal depression. The Sun even claims that vaginal atrophy is “The horrifying thing that can happen to your vagina if you don’t have enough sex” – again, this begs the question of where they get this claim that a lack of sex can cause vaginal atrophy – and again, this news outlet does not link a reliable source to support the claim.

Two stormtrooper lego figures holding hands stood in front of a sunset over water

They do however, mention that Louise Mazanti, a “sex therapist” from London, has just released a book…More on Louise Mazanti later.

Vulvodynia ≠ vaginal depression

The idea that vulvodynia and vaginal depression are equivalent terms, seems to come from an episode of Sex and the City where Charlotte is diagnosed with the condition (the real one, not the media hyperbole one). She remarks that her doctor prescribed her antidepressants and it’s “hilariously” questioned if her vagina is depressed.

Nearly ten years after Sex and the City finished broadcasting, we collectively know so little about vulvodynia that this misnomer seems to have stuck.

And yet vulvodynia is a significant diagnosis that affects a huge proportion of people with vaginas at some point in their lives.a stethoscope and sphygmomanometer on a white surface

Simply put, vulvodynia is chronic pain (lasting 3 months or more) of the vulvar area. Vulvodynia is a tricky condition to treat, as with many chronic pain conditions, and requires collaboration between doctor and patient to find the right treatment.

One treatment option is a tricyclic antidepressant.

This is where the confusion starts – but antidepressants used in this way are prescribed in far lower doses than required for an antidepressant effect. These drugs are actually used because in low doses they act as pain modifiers. The comparison of vulvodynia to depression is completely inaccurate.

Having “enough” sex?

For some people with vulvodynia, penetrative sex is not possible. Suggesting women have more sex to solve all their medical problems, can actually cause harm far more than it helps. We know that our society tends to view penis in vagina sex as the only “real” sex. The consequences of this are significant – sex between two women is dismissed, oral and digital forms of sex are considered “foreplay” and there is a huge pressure placed onto the idea of “virginity”. And for people with the forms of vulvodynia that make penetration very difficult, this idea can have a damaging effect on their mental health. Across our society “women” are expected to “provide” for their “men” and this includes having sex frequently (but not too frequently). It is easy for people with vulval pain to feel dysfunctional and that can be damaging to their mental wellbeing – not helped when a lack of libido is often termed “female sexual dysfunction” but that’s a rant for another day.

two women holding hands in a field

Vaginal atrophy

These latest stories are particularly keen to mention frequency of (penetrative) sex being a preventative for vaginal atrophy (a thinning of the vaginal walls which the NHS website refers to as vaginal dryness). They claim this is founded in science but give no supporting evidence of this. Vaginal atrophy does happen – but it is scientifically understood to be a response to changes in hormone levels, and therefore is most common during and after the menopause. There is very little a person can do to control it and it is not as “horrifying” as The Sun claims – sexual frequency might enhance blood flow to the area to help delay or prevent this but that is not dependent on penis in vagina penetration. Using dilators, dildos, vibrators or manual penetration and stimulation will help just as well.

Louise Mazanti

So, if there’s no obvious “new” study which triggers this year’s media interest in our sexual habits, why else might this be “newsworthy”?

Perhaps it’s all to do with a new book that Louise Mazanti published earlier this year titled “Real Sex: Why Everything you Learned about Sex is Wrong” alongside her husband Mike Lousada.

Mike was an investment banker before his spiritual awakening led him to retrain as a counsellor and “sexologist” while Louise was a Professor in art and design before her own spiritual awakening and retraining in sex therapy. They both see clients in London and give talks and write books together and separately.

Louise is touted as an expert sex therapist in a number of articles discussing vulvodynia. On her webpage about her “expertise” is the claim that “Louise holds a strong energetic field for you to start exploring your own inner truth, and she can guide you into states of expansion that will give you a new direction in life.”. Louise is “trained in energy psychology [and] esoteric wisdom”.

And apparently that’s good enough to be an expert on the medical health of the vagina, or at least that seems to be the opinion of the media who think vaginal depression is a synonym for vulvodynia.

Read more about vulvodynia:

 

Dr Alice Howarth, PhD

Alice is a cell biologist and cancer researcher who works in the Institute of Translational Medicine at the University of Liverpool. She is the Treasurer of the Merseyside Skeptics Society and co-hosts the popular sceptical podcast Skeptics with a K. In her free time she Instagrams photos of her ridiculous dog, Lupin and watches Buffy the Vampire Slayer ad infinitum. Find her at DrAlice.blog or @AliceEmmaLouise on social media.

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Arsenic cures cancer!

Last week The Daily Mail boldly asked “Could arsenic be a miracle cure for cancer? Scientists say it had astonishing results when added to a leukemia drug”. It’s worth pointing out here, that even in the subheading bullet points the Mail Online downplayed their excitement a little, de-escalating from arsenic being a potential “miracle cure” to “makes chemotherapy more effective”.

Headline from the Mail Online reading "Could arsenic be a miracle cure for cancer? Scientists say it had astonishing results when added to a leukemia drug"

The Mail Online wasn’t the only one to cover this story. Medical News Today headlined “Poison or cure? Arsenic can help treat cancer, study finds” while Science Daily said “Arsenic in combination with an existing drug could combat cancer – An ancient medicine shows new promise” and Harvard Magazine asked “Is Arsenic a Key Ingredient in the Battle Against Cancer?”. So, the Mail Online seem to be in good company in reporting this apparently exciting news.

New use for a traditional medicine?

One thing all of these stories had in common was the detailing of arsenic in traditional Chinese medicine. Harvard Magazine quoted study author Kun Ping Lu: “In Chinese traditional medicine, “Arsenic has been used for thousands of years,” said Lu. “Its oxidized form is the active ingredient” for a concoction the Chinese called “magic bullet,” which was used to treat a specific kind of leukemia, APL”.

Arsenic, in fact, has been claimed to treat a whole range of diseases throughout history – in Ancient Greek times it was used to treat ulcers and in Chinese Traditional Medicine it’s been used for over 2000 years. Arsenic was once added to Indian Ayurvedic herbal remedies and when Paracelsus, an Italian Professor of Medicine from the 1500s was skeptical of the old methods of balancing humours to treat disease, he introduced arsenic as an alternative. Paracelsus, in fact, stumbled across a genuine therapeutic action of arsenic in its ability to treat syphilis – an indication for which arsenic was used well into the 20th Century until antibiotics came along.

an open brown medicine bottle laying on its side containing a white powder and labelled "acid arsenic"

But arsenic has not only been a persistent element in traditional medicine, it has also been used to treat cancer – first, to treat chronic myeloid leukaemia in the 1930s and later to treat acute promyelocytic leukaemia (APL). Arsenic trioxide (ATO) has been used to treat APL since its approval in 1995.

The study

The study the Mail Online et al. referenced was summarised in Nature Communications earlier this year in an article titled “Arsenic targets Pin1 and cooperates with retinoic acid to inhibit cancer-driving pathways and tumor-initiating cells”. The study is apparently based on three things:

  • A protein called Pin1 is important in cancer
  • Arsenic trioxide (ATO) is a treatment for cancer
  • All-trans-retinoic acid (ATRA) inhibits Pin1

A good introduction to any peer-reviewed article will use scientific literature to convince you that the question the researchers have asked is a valid one and set their work within the context of what is known in the field. At first glance, this article is particularly industrious in the effort to convince the reader on the three areas above. They strongly stress that “Pin1 is a critical “driver” and a unique drug target in cancer. Pin1 is hyperactivated in most human cancers and correlates with poor clinical outcome”.

ATO and leukaemia

ATO has been approved for use in a certain kind of leukaemia called acute promyelocytic leukaemia (APL) for many years and is successfully used in combination with ATRA in patients with APL. There are very few alternative treatments for this form of leukaemia and ATO combined with ATRA has low toxicity.

The underlying mechanism of this treatment is down to the existence of a protein called PML-RARα which causes APL. PML-RARα doesn’t exist in normal conditions however patients with APL have a genetic mutation which produces this fusion of the genes for two individual proteins PML and RARα – this generates the fusion protein, PML-RARα. It doesn’t really matter what PML-RARα does, only that it drives APL and it doesn’t exist outside of disease. Studies have shown that ATO binds to the PML part of this fusion protein and degrades it.

an image taken from one of the study figures showing the chemical structure of Pin1 and the chemical structure of ATO - the two are shown overlapping to indicate where ATO binds in Pin1

The chemical structure of Pin1 is shown with ATO (I) sitting within in apparent binding pocket on the protein. This image is adapted from the paper.

ATO and Pin1

But the authors of this study were interested in the effect of arsenic on a completely different protein – Pin1.

They don’t really explain why they thought arsenic might remove Pin1 in cancer cells. They used a technique to identify ATRA as a drug of interest, but it seems like they only looked at ATO because it’s already used in combination with ATRA.

In their study the authors find that treating cancer cells with arsenic in the lab reduces the levels of Pin1. They also show that ATO and ATRA combined, reduce cancer cell growth and reduce tumour size in mice. And they go some way towards explaining the mechanism behind these interactions and discounting alternative explanations for their findings.

In many ways, it’s a solid paper.

So why am I skeptical?

There are a few reasons, though, to be wary of the findings in this paper and the way it has been presented. Firstly, it’s the particularly hyped up nature of the story – arsenic has been used to treat leukaemia since the mid-1990s, this isn’t really news. But it does make me wonder if there’s a particular reason this article might be so strongly endorsed.

The authors also don’t really explain why they picked arsenic in the first place other than they’re interested in ATRA and Pin1… In fact they’re very, very interested in Pin1.

They argue “that Pin1 is a critical “driver” and a unique drug target in cancer” – which is particularly interesting because as a cancer researcher with a PhD in cancer cell biology, I’ve never even heard of this protein. They reference three papers to support their claim but two of them are from the group’s own lab – the final paper they reference, an article titled “Pin1 in cancer” is from a separate source. This unrelated (and therefore, unbiased to some degree) article argues that Pin1 is hyperactivated in around 10% of all cancers. That number is pretty high, but it is certainly not enough to say that Pin1 is a “critical driver” in “most human cancers”.

So why are the authors so keen on Pin1? The suggestion that it’s a “unique drug target” might give us a clue.

five stacks of silver coins increasing in height from left to right

At the end of the article is the heading “Competing interests” under which is stated “K.P.L. and X.Z.Z. are inventors of Pin1 technology, which was licensed by BIDMC to Pinteon Therapeutics. Both Dr. Lu and Dr. Zhou own equity in, and consult for, Pinteon. Their interests were reviewed and are managed by BIDMC in accordance with its conflict of interest policy. The remaining authors declare no competing interests.”

Pinteon Therapeutics is a “private venture backed biotechnology company focused on the discovery and development of breakthrough therapeutics targeting Pin1” and we can therefore assume that this company will make money from the generation of Pin1 inhibitors that can be used to treat cancer.

Of course, Pin1 inhibition might well make for an interesting cancer target – there’s no disputing that – but its promise might well be overstated both in this article and in the media coverage of the article.

Me? I’m suspending judgement until we see more compelling evidence.

 

Dr Alice Howarth, PhD

Alice is a cell biologist and cancer researcher who works in the Institute of Translational Medicine at the University of Liverpool. She is the Treasurer of the Merseyside Skeptics Society and co-hosts the popular sceptical podcast Skeptics with a K. In her free time she Instagrams photos of her ridiculous dog, Lupin and watches Buffy the Vampire Slayer ad infinitum. Find her at DrAlice.blog or @AliceEmmaLouise on social media.

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Green is Good?

You may have heard that exposure to nature can improve your health*. There are also many trends floating around the Internet that claim to leverage the benefits of nature to improve your physical and mental health. While proponents claim to be driven by evidence, is there really evidence that nature can improve your health? And if so, is it really necessary to reorganise your daily life, drive out to the wilderness, and/or buy expensive accoutrements in order to leverage the benefits?

Popular Claims

Among the most prominent trends is earthing or grounding, a practice popularised by a variety of holistic health devotees, from nature-loving vegans and Ayurvedic enthusiasts to paleo and primal dieters and Silicon valley biohackers. The trend is based on the idea that the earth has a negative charge; but that modern life bombards us with positive charges, creating an imbalance and reducing our ability to combat free radicals. The benefits of grounding touted by advocates are vast, from reducing jetlag to balancing hormones and normalising blood pressure.

A large field under a blue almost cloudless sky

At its most basic, grounding advocates suggest we simply spend more time walking outside on soil and grass in bare feet; but many advocates also promote grounding mats, blankets, shoes, sheets, bags, and a variety of other devices to counteract modern life and provide ready (and overnight!) access to the benefits of the earth through an electrical charge. Most of these sites enthusiastically link to studies, but any effects seen in these small studies are miniscule and potentially the results of design flaws, as described in a recent segment of Skeptics with a K.

Forest bathing is an older cousin of grounding, referring to the Japanese practice of using your senses to soak in the forest atmosphere. Increasingly popular outside of Japan, it has a small number of researchers who suggest it is not only a way to combat the psychological stresses of increasingly urban life but also a way to combat cancer, lower blood pressure, and boost immune function. Although one would think this is a fairly solitary endeavour, as with many holistic practices, its Western reinterpretation includes guided group visits and sometimes even hugging and speaking to trees.People walking along a footpath surrounded by trees

Understanding the connections between exposure to nature and human health

For most people, the idea of sleeping on a specially designed electrical mat and wandering around barefoot in forests are beyond what they are willing to do for health. Access to nature can also be challenging for city dwellers, and in most developed countries, more than 75% of the population lives in urban areas. In the UK that number is over 90%. While cities offer many benefits, urbanisation increases the incidence of a host of health problems and associated socio-economic costs. For these reasons, it’s perhaps more helpful to investigate what we actually know about urban green space and human health, to see if there are measurable benefits.

A tarmac road lined with trees

The evidence

A considerable body of research is developing, suggesting positive impacts of being in, and leaving near, green space. The amount of green space seems more important for perceived health than the amount of urbanisation, although certain groups may benefit more.

The benefits

Exposure to green spaces has been shown to relieve stress and promote relaxation, and has positive impacts on affect and reducing sadness, which improve cardiovascular disease outcomes and all-cause mortality. The effect may be amplified by the fact that people prefer green spaces for physical activity, making exercise and active forms of transport more attractive. Some studies have shown decreases in salivary cortisol and reduced blood pressure, with women potentially more negatively affected by lack of green space. Although some reviews have noted this effect is not consistent across studies.

Increasingly studies are looking at the dose of nature that we actually need to experience these benefits.  Most studies suggest that the required dose is likely relatively small (perhaps only 5-10 minutes on a given day). Benefits are evident whether you are merely looking at nature or exercising in it, although the latter, perhaps understandably, offers benefits more quickly. Lower rates of blood pressure and depression have been documented from just 30 minutes in green space per week. The shape of the dose-response curve is still in question.

A footpath beneath lots of trees with sunlight shining through

Countering harm

It is also worth noting that green space can contribute to reducing air pollution, which is a major contributor to poor human health outcomes. This effect is direct, in that vegetation can reduce greenhouse gas emissions and reduce pollutants such as particulates (PM10), carbon monoxide (CO), ozone (O3), and nitrogen and sulphur oxides (NOx and SOx). Green space makes walking and cycling more attractive. This contributes not only to improving air quality via reduced vehicle use, but the increased physical activity has associated health benefits.

Green space can also reduce the urban heat island (UHI) effect, wherein cities are hotter than surrounding areas because of the prevalence of dark surfaces such as asphalt and concrete. UHI also contributes to poor air and water quality. By lessening this effect, green spaces can improve the urban environment, decrease health impacts of heat and even reduce mortality from heat waves.

Caveats within the literature

There is a lot of academic literature focusing on the connections between human health and urban green space**. This literature is both theoretical and empirical, and methods are a mixed bag. For example:

  • Self-reported data from individuals on perceived improvements in health (usually gathered via questionnaires)
  • Correlations between access to green space and population-level data
  • Direct measurements of key indicators (e.g. blood pressure, heart rate, salivary cortisol) either linked to exposure or accessibility of green space.

What constitutes health varies across studies, with the first two categories often adopting a fairly broad definition that includes physical health as well as mental health (especially anxiety and depression) and broader indicators such as happiness, life satisfaction, and social cohesion.

A body of water with a bridge in the background and trees on either side

As with all social and health research in the “real world”, teasing out causal relationships is difficult. Confounding factors are controlled for, to an extent, but there are so many causal factors that complicate the issue. For example, people prefer to exercise in green space, but green space tends to be more scarce and of lower quality in areas with multiple social, economic, and health deprivations. However increasing green space (and improving its quality, addressing personal safety issues, etc.) can also improve these indicators.

Conclusion

Spending more time in green areas, whether forests urban parks, is likely to offer you some health benefits and encourage you to be more active. The great news is that it needn’t take much of your time, and no special mats, shoes, blankets, or spiritual guides are required. Green spaces also address some of the environmental problems in urban areas, providing benefits for both people and nature.

Dr Sarah Clement standing in front of a wall and smilingDr Sarah Clement

Sarah is a faculty member in the Department of Geography and Planning within the School of Environmental Science at the University of Liverpool. Her research focuses on environmental governance, science-based policy, and nature-based solutions. She is particularly interested in how reforming policy and practice can enable better ecological, socio-economic, and democratic outcomes, particularly during periods of rapid environmental and social change.  Sarah has worked in the field of environmental science and policy for 16 years as an environmental consultant, researcher, and environmental policy advisor in Australia, the UK, and the USA. She is also on the board of the Merseyside Skeptics Society. She spends most of her spare time hiking in nature, travelling, lifting heavy things, adoring her cat, and documenting all of these in pictures. She tweets as @DrSarahClement, and posts said pictures on IG @umsfromumbridge.

 

Footnotes:

* The most widely used definition of ‘health’ is from the World Health Organisation: ‘physical, mental and social well-being, not merely the absence of disease or infirmity’. Operationalising and measuring this concept is a major challenge that leads to the variety of measures discussed here.

** Also called “green infrastructure” and “nature based solutions” in the literature and public policy. To complicate matters, “blue infrastructure” (i.e. water) is often, but not always, embedded in these terms.

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Happy Homeopathy Awareness Week!

In celebration of Homeopathy Awareness Week – and in recognition of the fact that genuine awareness is the biggest threat to belief in homeopathy – our friends* at the Good Thinking Society have released their own awareness-raising site, with 12 key points to be aware of when it comes to homeopathy.

Homeopathy Awareness Week takes place internationally from April 10th-16th and is aimed at raising awareness of homeopathic remedies. Each year, homeopaths from around the world use this week to promote their practice and gain publicity – yet public awareness of the realities of homeopathy remains low.

For example, many people mistakenly believe homeopathic products are a form of herbal product – not realising that homeopathic products typically contain no active ingredients at all. Over two centuries ago, the first homeopaths perversely decided that diluting an active medicinal ingredient makes it more potent, with the vast majority of remedies containing nothing at all! Modern homeopathic tablets are generally 100% sugar, containing no active ingredient whatsoever.

As part of World Homeopathy Awareness Week, we would like to raise awareness of twelve key points about homeopathy.

Head over to homeopathyawarenessweek.org to read the twelve points in full!

*full disclosure – Vice President of the MSS, Michael Marshall, is the Project Director of the Good Thinking Society.

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New Diploma in Old Wives’ Traditional Medicine

QED: Question. Explore. Discover.

Get your QED ticket now!

Here at the Merseyside Skeptics Society, we heartily endorse awareness-raising publicity stunts. Obviously. After all, we organised for nearly 500 people worldwide to ‘overdose’ on homeopathic products. Pretty hard to deny our love of a good publicity stunt, then. Plus, on September 14th our BBC documentary involving the creation and distribution of homeopathic ‘QED Vodka’ will be screened. So, yeah, publicity stunts are our thing, really.

So when I saw that the Voice of Young Science are to take to the streets of London to hand out qualifications in Old Wives’ Traditional Medicine, I was very interested indeed. Unfortunately, I can’t make it along to the event, so my practice of traditional old-wives-tale remedies will have to remain strictly that of an unlicensed amateur, but if you’re around and free, why not pop along and get yourself a qualification? It beats spending 5 years learning to be a ‘Doctor’ of homeopathy, and leaves you just as qualified to treat people. Details of the event are below, and you can RSVP on Facebook too (if you do, tell them we sent you!).

New Diploma in Old Wives’ Traditional Medicine

Do you remember how your grandmother thought burns should be treated?  What happens to your hair if you don’t eat your crusts?  If you think you can answer questions like these and your hands are clean, why not become a registered practitioner of Old Wives’ Traditional Medicine?

The Voice of Young Science School of Old Wives’ Traditional Medicine will hit the streets of London on Wednesday, handing out diplomas for people to practice Old Wives’ Traditional Medicine. Young medics and researchers in lab coats will be registering members of the public who can correctly answer questions about traditional advice and cures.

Find out if you qualify for a diploma at the Department of Health, Richmond House, Whitehall, SW1A 2NS, on Wednesday 8th September 11.30 – 12.30.

The VoYS Network is launching its Old Wives’ Traditional Medicine Accreditation Scheme to draw attention to the Department of Health’s proposed professional registration scheme for practitioners of traditional medicine, which will regulate everything except whether a practitioner has medical training or is practicing an evidence-based discipline. Read the rest of this entry »

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Skeptics with a K: Episode #027

More homeopathy (!), treating impotence, victimising Bosnians and permanent gastric fistulas. Diagnosed by passages from the Koran, it’s Skeptics with a K.

Play

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