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A correspondent wrote:

I hear all day long on my local radio station commercials for The Water Cure, which was created by a Dr. Batmangelli (I have no idea how to spell his name) promising wonderful cures by eliminating caffeine and alcohol and drinking water and sprinkling sea salt on your food. If you REALLY want to get cured even faster, swim in the ocean everyday.

That’s Dr. Fereydoon Batmanghelidj. His Big Idea was that dehydration is the main cause of disease. It was untenable to begin with, is supported by no evidence, was debunked on Quackwatch several years ago, and Dr. Batmanghelidj died in 2004, so I was surprised to hear it was still being vigorously promoted. But not very surprised. After all, homeopathy is still around.

The Water Cure is another in a long list of alleged miracle cures discovered by “lone geniuses” who are allegedly persecuted by a resistant medical establishment. These stories follow a pattern, and I think it is worthwhile looking at this prime example to understand something of the psychology of self-deception that is involved.

How It All Started

Dr. Batmanghelidj was imprisoned for political crimes in Tehran’s infamous Evin prison. A number of his fellow prisoners had previously been diagnosed with peptic ulcer disease (PUD). Their symptoms recurred in jail and didn’t respond to Cimetidine and antacids. Dr. Batmanghelidj gave a prisoner with unbearable pain two glasses of water. The pain disappeared completely after 8 minutes.

He treated other PUD patients with remarkable success. One patient was semiconscious from pain but after drinking water he recovered in 20 minutes. (One wonders about the wisdom of making a semiconscious patient drink, since there is a risk of aspiration). Patients were advised to continue drinking 1500cc of water daily for 6 weeks, allowing time for the average ulcer to heal. Symptoms did not recur.

During treatment, urine volume increased and patients had to get up at night to pee. Dr. Batmanghelidj assumed this meant that they were losing sodium so he added salt to their treatment regimen.

It seems logical that drinking water would dilute the stomach acid and provide some temporary relief. In a majority of patients the relief of pain was preceded by eructation of gas. Hmmm… For some reason, Batmanghelidj decided that the real problem was dehydration: dehydration was the sole cause of pain so the pain was relieved by drinking water.

Dr. Batmanghelidj eventually got out of prison and came to the US, where he developed his ideas further and wrote a series of books. His philosophy expanded. Although water alone had worked for his initial patients, he added salt (without any comparison studies to show it improved outcome) and then declared that it should be sea salt to supply trace minerals (again with no comparison studies). He recommends Himalayan or Celtic sea salt (!?) Rather than adding salt to your food or water, you should let it dissolve on your tongue (Why?). If you are urinating within 2 hours of drinking water, you should eat bagels to help keep the water in your body long enough for it to work. This is referred to as “Bagel Magic.”

He spoke out against alcohol, caffeine, and anything else that might contribute to dehydration. He expanded his thinking to include acidity and immunology:

the causes of most so-called incurable diseases are nothing but symptoms of a weak immune system caused by consuming caffeine, alcohol and/or soda and lack of water and/or salt. They create an acid pH and the more acidic it is, the weaker your immune system, the worse your health becomes and the more difficult it is for your body to repair itself.

He claims the water cure will:

Prevent and reverse premature aging Eliminate pain, including heartburn, back pain, arthritis, colitis, angina, and migraine headaches Cure asthma in a few days, naturally and forever Cure hypertension without diuretics or other medications Lose weight effortlessly and naturally, without strict dieting

He suggests that water is a no-cost solution to heart disease. But that’s not all! His websites include testimonials from patients who were allegedly cured of:

Terminal Cancer – Diabetes – Herniated Discs – Chronic Pain – Depression – Fibromyalgia – Suicidal Tendencies – Edema – Acid Reflux – Watering Eyes – Hiccups – Pet Arthritis – Asthma – Syncope – Migraines – Chronic Fatigue – Bronchitis – Vision – Raccoon Eyes – Energy – Skin Ailments – Dizziness – Allergies – Diabetes – Eye Edema – Herpies [sic] – Weight Loss – Leukemia

Where’s the Evidence?

The Water Cure website provides a list of scientific documents. Most of them are opinion pieces written by Batmanghelidj himself in a journal he established himself and self-published for three years (Science in Medicine Simplified) because he couldn’t get published in reputable journals.

Batmanghelidj claims to have done a lot of research, but he hasn’t. All he has done is theorize and speculate. He has only two listings in PubMed for articles published in peer-reviewed journals.

The first was published in 1983 in The Journal of Clinical Gastroenterology. It is not a scientific study, but an “editorial” that describes his experiences with patients in the prison. It is an anecdotal account that doesn’t even rise to the level of case reports or case series. He says he treated 3000 patients with PUD, and his account suggests that about a third of all prisoners had PUD, which seems a bit high even considering the stress of prison. These diagnoses were clinical diagnoses: in other words, completely unreliable. It is impossible to differentiate peptic ulcers from non-ulcer dyspepsia or other conditions without an endoscopy or an imaging procedure. He says he also successfully treated a few cases of “appendix pain” (whatever that means) and from that he concludes that “a site of pain other than epigastric may herald a clinical picture of duodenal ulcer disease.” This leaves me at a loss for words.

The second article, published in Anticancer Research in 1987, is a speculative rumination calling for a paradigm change in thinking about pain. It claims that pain is a signal system denoting free water deficiency of the cell. It is poorly written and doesn’t make sense to me. For instance, he says that this new paradigm does not apply to conditions with local tissue pathology, like cholecystitis. But peptic ulcers are local tissue pathology. Why should the water cure work for ulcers but not for cholecystitis? Bizarrely, he ends his article with an acknowledgement thanking the Almighty for his light and fine detailed guidance.

Batmanghelidj’s Other Weird Ideas

In an interview with Mike Adams he made a series of very questionable statements:

“thirst in the body can manifest itself in the form of abdominal pain to the level that the person can even become semi-conscious.” “water shortage is actually the background to most of the health problems in our society.” He claims that histamine regulates the water in the body and that antidepressant drugs are antihistamines, pain medications are antihistamines, and other medications are directly and indirectly antihistamines. “the whole entire existence of the pharmaceutical industry is based on presentation of false science” “we measure the level of cholesterol in the body in the blood we take out of the veins of the body, and nowhere in the history of medicine is there recorded one single case of cholesterol ever having blocked the veins of the body.” “a lot of children who drink soft drinks actually become ‘stupid’, but once you take the soft drink away from them, their grades improve tremendously — C’s and F’s become A’s and B’s.”

This kind of thing is bad enough, but he really loses it when he descends into AIDS denialism:

… everyone assumes that AIDS is actually a viral disease, which is a fraudulent statement by those people who presented it, because the human body is the product of many, many years of having fought various viral diseases, and has survived. Smallpox, polio, measles, and all the other viruses that can kill very easily, and the body has an ability to mount a defense system against these hot viruses, viruses that actually very quickly can kill. But having survived those, how is it possible that the slow virus would kill us in the name of AIDS? I can’t understand it. I have researched this topic extensively, and I have shown in fact that AIDS is a metabolic problem, when the body begins to cannibalize its own tissue because of certain missing elements in the raw materials that it receives through food or beverages, and the body of a person who gets AIDS, actually, is short of quite a number of building block amino acids. They’re short of tyrosine, they’re short of methionine, cysteine, they’re short of histidine, and they’ve got a whole lot of others in excess. So how can we expect a body that depends on the other amino acids to survive?

Elsewhere he has claimed that water is one of the main sources of energy for the brain and the entire body and that it produces “hydro-electric” energy by splitting into hydrogen and oxygen!

How Do Intelligent People Go Wrong?

Dr. Batmanghelidj follows a well-beaten path. From chiropractic to eye movement desensitization and reprocessing (EMDR), innumerable non-science-based practitioners have gone down this same slippery slope. Here is the typical progression from initial self-deception to “lone genius” woomeister status:

He witnesses an unexpected improvement after a treatment. He assumes the treatment caused the improvement. He does not test this assumption or try to rule out other possible explanations. He proceeds to treat many other patients the same way, with apparent success, and allows confirmation bias to bolster his conviction. His ego is boosted by grateful patients and by the conviction that he has special knowledge. He extends the treatment to patients with other diagnoses. He exercises his imagination and speculates about a possible physiological mechanism by which the treatment might work. He generalizes, often claiming to have found the “one cause of all disease.” He tries to convince scientists by describing his anecdotal experiences. The scientists refuse to accept his untenable explanations or to publish his scientifically unacceptable papers. He accuses the scientific establishment of persecuting him and suppressing knowledge that would undermine the status quo and help many patients. He plays the lone genius card, often comparing himself to Galileo or Semmelweis. He writes books and sells things.

For Batmanghelidj the epiphany was a glass of water that apparently relieved a stomach pain. For D. D. Palmer (chiropractic) it was a back adjustment that apparently restored a deaf janitor’s hearing. For Samuel Hahnemann (homeopathy) it was the supposedly malaria-like symptoms he experienced after taking an anti-malaria drug. For Francine Shapiro (EMDR) it was the observation during a walk in a park that moving her eyes seemed to reduce the stress of disturbing memories. For Edward Bach (Bach Flower Remedies), a walk in the country revealed his intuitive psychic connection to various plants.

The initial error was the same in all cases: they failed to consider the possibility that they might be wrong. They failed to use the scientific method to test their observations. The rest of the sequence followed naturally from human psychology. The Water Cure is nonsense, but its story provides a cautionary tale. The most important thing a scientist can say is “I could be wrong.”