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I am afraid that the experiments you quote, M. Pasteur, will turn against you. The world into which you wish to take us is really too fantastic.

La Presse, 1860

It’s just a theory. Not evolution. Germ theory. Just a theory, one of many that account for the etiology of diseases.

I should mention my bias up front. I am, as some of you are aware, an Infectious Disease doctor. My job is simple: me find germ, me kill germ, me go home. I think there are three causes of disease: wear and tear, genetic, and germs. Perhaps a bit of an exaggeration, but not much. My professional life for the last 22 years has been spent preventing, diagnosing, and treating the multitudinous germs that a continually trying to kill or injure us. It is a fundamentally futile job, as in the end I will be consumed by the organisms I have spend a lifetime trying to kill.

I would have though that the germ theory of disease was a concept that was so grounded in history, science and reality that there would be little opposition to the idea that germs (a broad term for viruses, bacteremia, fungi, parasite etc) cause infections and some other diseases.

Wrong. There are people who deny the validity of germ theory. Add there are people who deny gravity. And evolution.

Opponents of germ theory come in two flavors:

Germ theory deniers. Those who propose alternative mechanisms of disease.

There is great overlap between the two categories, and the division serves more as a literary device for the sake of exposition than a true description of reality.



Germ Deniers

The germ deniers put forth as their patron Saint Antoine Bechamp, a contemporary of Louis Pasteur. Bechamp lived from 1816 to 1908, the dawn of modern medicine and the beginning of microbiology. No one had a clue in the 1800’s as to the cause and treatment of diseases and there were many speculations and experiments performed in an attempt to understand and treat diseases. Most people had a life expectancy less than 50 years and the predominant cause of morbidity and morality was infectious. Since we do not die young of infections and we get to live long enough to die of cancer, heart and vascular disease. Before the 1900’s, if you could understand what caused infections, you could understand most diseases.

The foundations of microbiology and infectious diseases are based on the work of Pasteur and Robert Koch. Like Darwin, the insights of Pasteur and Koch are not the end of understanding of infectious diseases, but the beginning. The world is far more complicated and subtle than Pasteur and Koch could appreciate with the scientific tools of the time.

Pasteur, of course, performed the experiments that proved that germs existed and were a cause of some diseases. His name is well known and lives on in pasteurization, the heating of milk to kill microorganisms and prevent the spread of disease, one of many contributions he made to medical sciences. His insights, which lead to antibiotics, hygiene, and vaccines have undoubtedly prevented more morbidity and mortality than any human in history.

Another contemporary of Pasteur was Robert Koch, who, among many accomplishments formulated Koch’s postulates, conditions that were to be met to prove the infectious cause of disease:

The organism has to found in all cases of the disease The organism has to prepared and maintained in a pure culture The organism had to be capable of producing the original infection, even after several generations in culture The organism retrievable from an inoculated animal and cultured again.

Modern biochemistry and molecular techniques have refined Kochs postulates. We can’t always grow the organism but we can isolated its DNA. Given the species specificity of some germs, we cannot always infect animals to prove causation. I doubt anyone would want to prove the cause of Ebola by re-inoculating a human with cultured virus. Also, there is great variability in the ability of many germ strains to cause disease and great variability in the hosts immune system to combat diseases. Some germs are more virulent than others. Some people are some or less susceptible to disease, and the last 10 years have seen an explosion in understanding of the variability in the human immune system (polymorphism’s) that explain why some people get ill from a given pathogen and others do not.

The combination of germ theory and Koch’s postulates, improved and refined by biotechnology, are still the cornerstones of infectious diseases. Pasteur, Koch and their contemporaries began the science of infectious diseases and microbiology, a field that has lead to more benefits to mankind than perhaps any other.

What do the germ deniers offer as a alternative to Pasteur et. al.? The theory of Antoine Bechamp and others called pleomorphism (1).

CELLULAR THEORY (BECHAMP) Disease arises from micro-organisms within the cells of the body. These intracellular microorganisms normally function to build and assist in the metabolic processes of the body. The function of these organisms changes to assist in the catabolic (disintegration) processes of the host organism when that organism dies or is injured, which may be chemical as well as mechanical. Microorganisms change their shapes and colours to reflect the medium Every disease is associated with a particular condition. Microorganisms become “pathogenic” as the health of the host organism deteriorates. Hence, the condition of the host organism is the primary causal agent. Disease is built by unhealthy conditions. To prevent disease we have to create health.

Bechamp’s hypothesis was, at the time, no more or no less reasonable than other ideas. Unfortunately for him, a century and a half of research has demonstrated that there he was wrong on all the particulars of his ideas, except for 7 and 8. Postulates 1, 2, 3, 4, and 6 are all flat out false. From 1950 to November 2nd 2008 at 9:50 am PST, there were 909, 599 citations on Pubmed relating to infections. How many papers and experiments were done in the 100 years prior to 1950 I do not know, but it is a safe bet that germ theory is supported by over a million studies and experiments. A Pubmed for terms to support pleomorphism finds zero references. Germ theory is as confirmed a concept as science can offer. Cellular theory lost the battle to experiment. Reality and science supports the ideas of Pasteur, not Bechamp.

Alternative practitioners are drawn to the concepts of Bechamp because the reason for disease is that the body fails. Alternative providers are all about supporting health to allow the body to heal itself. Bechamp lends credibility to many alternative practices.

Here is where it gets weird.

Rather than look at the mountains of evidence to support germ theory and the complete lack of evidence to support pleomorphism as the reason for the dominance of germ theory, they resort to paranoid sounding conspiracy theories.

The Whale is a good source for this kind of thinking and is representative of what you will find if you browse the web:

How did Pasteur’s ideas become the foundation of organized medicine? Politics. Pharmaceutical economics. Early in his career, Pasteur was decorated by the Emperor Napoleon. His position as a scientist was thereby secured, even though he was only a chemist and had no credentials at all in medicine or physiology….. For the first time in history, things were coming into focus. Discoveries were being made about fundamental issues, but in a piecemeal fashion. It was perfect timing for an opportunist to take advantage of the general uncertainty and lack of understanding and to claim that he understood all the issues involved, and furthermore had thought of them first. Pasteur was noted for his habit of playing both sides of the fence on issues he didn’t understand, and then later, to quote the parts of his earlier writing that supported the later finding, always with the claim that he had been there first. Only the scientists understood the complexities of these emerging ideas. The royal court and the press just knew that something was going on, and though they didn’t know what, were going to act as though they did. And for them, a chameleon like Pasteur was the perfect frontman. Politics never changes. The same type of thinking that imprisoned Galileo long ago for discovering that the earth went around the sun, the rulers’ eternal attempt to control the minds of their subjects, these are the forces that cast Pasteur, an ambitious opportunist, into a position he may not have deserved – the supposed Trailblazer in the science of modern biomedicine. Funny how things often don’t really get “discovered” until the commercial aspects of that discovery have been worked out.

or

Béchamp’s research revealed that the inner condition of a person’s cellular terrain determined whether disease would manifest or spread in the body. He proved through rigorous scientific method that disease was not due to germs attacking the body from the outside as Louis Pasteur later convinced the world. What you eat, breathe, drink, and bathe in are the primary factors that determine your body’s inner condition. Instead of incorporating Béchamp’s discoveries to bring about a health revolution in the world and save countless lives, greedy, power hungry industrialists decided to ostracize his work and put their dollars behind Louis Pasteur’s “Germ Theory of Disease” because it was a way for them to build a colossal pharmaceutical/medical empire for profit. No pharmaceutical company in the world today cares one iota about curing disease. They want to control disease and focus on symptom suppression so they can make huge profits by getting you to become a lifelong user until you die from their poison. That’s why they go to war against disease with all their “anti” this and “anti” that medications instead of addressing the inner condition of a patient and re-establishing homeostasis in the body. (2)

This is weird not only because it denies over a million interrelated studies that confirm germ theory, but Pasteur’s fundamental ideas were confirmed about 60 years before the discovery of penicillin. That is just how subtle and clever big Pharma is: they suppressed a theory because they knew that 60 years in the future they would make a fortune selling antibiotics. Someone needs to send Big Pharma the JREF million dollar prize.

Then there are HIV deniers, who live in a bizarro world of their own. My medical career started with the onset of the HIV epidemic. I have seen HIV go from zero understanding about the disease and a 9 month life expectancy to amazing detail about the biochemistry and pathophysiology of HIV and an almost normal life expectancy for many AIDS patients. There are 191,000 plus articles on Pubmed concerning HIV research. The astounding accumulation of data to support HIV as a cause of AIDS and the benefits of applying that understanding to the treatment of AIDS is triumph of the modern medical-industrial complex. It is why I have one AIDS patient die this century after a decade of AIDS deaths. Application of germ theory saves lives. Millions and millions of lives.

Of course, that is just what they told me to say.

Alternative mechanisms of disease

There are a multitude of alternative mechanisms of disease: blocked chi in acupuncture, blocked innate intelligence in chiropractic, toxin build up in the colon, etc etc. What these alternative therapies share is a lack of appreciation or understanding of germ theory. Since germs cannot be seen, and since it is not germs but their alternative theory that causes disease, why would you expect alternative providers to behave as if germs exist? The result of believing that germs do not exist is infections. The germs will always win.

Acupuncture and Infections

Acupuncture is unique compared to most alternative practices in that it is invasive and because acupuncturists actually do something to accomplish nothing. Stick needles into people and you can drag in all kinds of germs. I have a healthy respect for needles and the damage they can cause by practitioners who understand germ theory. A review of adverse events associated with acupuncture demonstrated that “Infection accounted for 204 primary reports and 91 secondary reports. Over 60% of these cases were hepatitis B. The next most common infection was of the external ear, as a complication of auricular acupuncture (3).”

Cellulitis, bacteremia, endocarditis, empyema, osteomyelitis, endophthalmitis, abdominal abscesses, epidural abscesses and infected joints are well described complications of acupuncture. Blood borne pathogens such as HIV, hepatitis C and hepatitis B are associated with acupuncture. Mycobacterium abscesses and Mycobacterium chelonae outbreaks have occurred due to acupuncture. Needles are dangerous, and while the body has good defenses against infectious complications of minor trauma, the defenses fail on occasion.

One would think acupuncturists would clean the skin before needle insertion, but a review of skin disinfection for acupuncture states: “Disinfection of clean skin before injection is not generally considered necessary and observations of lack of infection following injections without prior skin disinfection support this (4).” Another review suggests that “none the less, good infection control is essential” but that assumes the practitioner understands and appreciates germ theory as a cause of infectious diseases. Infection after penetrating trauma is uncommon, a rare event under most circumstances. I would guess that many reading this have evidence of minor skin trauma right now and are not infected. It is what the immune system is for.

One of the lessons you learn in medicine is there is a difference between what one can get away and what is the best practice for all patients. Most of the time you do not need to wash your hands or prep the skin or do any of the procedures that decrease the risk of infections. Most of the time you can get away with being sloppy. But the more you practice infection control procedures, the greater the odds that the patient will avoid infection. Of course, there is the underlying assumption that you think germs cause disease. If not, why bother? There are a smattering of infections treated with acupuncture (UTI, skin infections, arthritis) in the medical literature; one can only wonder why. I suppose the acupuncture will support immune health a foster the innate healing process. I would rather kill bacteria. But then, I would.

Chiropractic and Infections

Two studies have cultured chiropractic exam tables and found pathogens, including methicillin resistant staphylococcus. Apparently chiropractors are not particularly fastidious at disinfecting their exam tables. Why would they? Germs are not necessarily the cause of disease in their world view.

I am particularly drawn to one of the conclusions: “Rudimentary behavioral changes to improve chiropractic clinic infection control are needed.” Rudimentary. Not an enthusiastic vote that the education chiropractors received in school was in infection control. I note chiropractic schools offer microbiology, and again I wonder why. It would not appear to be for the purpose of learning rudimentary infection control. But why should they feel inclined towards good infection control practices? The cause of disease is not germs, it is due to blocked innate intelligence.

It maybe less of an issue currently, but chiropractors long opposed germ theory and a google using chiropractor and germ theory as search terms finds no shortage of chiropractors who oppose the concept of germs causing disease. Given the huge variability in chiropractic practice, it is difficult to know if such lack of understanding of germ theory is typical of the field or not.

Other practices

There was an outbreak of colonic amoebiasis associated with colonic irrigation. Thirty six people developed the disease and 10 required colectomy. “Tests of the colonic-irrigation machine after routine cleaning showed heavy contamination with fecal coliform bacteria. The severity of disease in this outbreak may have been related to the route of inoculation.” Colonic irrigation is done to cleanse the colon of toxin build up that causes disease. It is an idea for the cause of diseases that has no bearing on reality and colonic irrigation is useless for removing toxins or curing diseases. Why concern yourself with germs and their transmission to others, since they are not a cause of disease. It is no surprise that the cleaning was not optimal

Moxibustion has been associated (and yes I know association is not causation) with a spinal epidural abscess and with a Pasturella abscess. The other complication of moxibustion is burn injury, which is fertile soil for infections. It is no surprise that this procedure would be associated with infection.

Naturopathic care is associated with a case of prosthetic valve endocarditis with P. acnes after unnecessary vitamin injections.

Other alternative modalities have fewer or no reported infections associated with them probably because they do not do anything. The recent 50 facts about homeopathy suggested “The chances of contracting MRSA or C. Difficile at a Homeopathic Hospital are extremely rare.” Of course it is. An intervention that does nothing cannot have an infectious complication. Doing nothing results in nothing.

What unites many alternative practitioners is their opposition to vaccines. Germs don’t cause disease, so why prevent infections with vaccines? Like many practices with alternative medicine practitioners, it is difficult to know how pervasive anti-vaccine sentiments are.

CAM also lends support to the “anti-vaccination movement. In particular, sections of the chiropractors, the (non-medically trained) homoeopaths and naturopaths tend to advise their clients against immunization. The reasons for this attitude are complex and lie, at least in part in the early philosophies which form the basis of these professions (5).” In other words belief in magic prevents understanding of infectious diseases and germ theory.

Chiropractors often advise against vaccination and do not vaccinate their own children. There is a contingent chiropractors of who are against vaccines, but to what degree they represent chiropractors as a whole I cannot say. Since Chiropractors are not required to use evidence to base their practice, there appears to be fewer standards and greater variability as to what what constitutes chiropractic practice. Attitude by health care professionals can influence decisions to vaccinate, and 27% of chiropractors in one survey advised against childhood vaccination (7). In another series where a fictitious patient asked for vaccination advice on the internet, of 93 homeopaths and chiropractors, “no homeopath and only one chiropractor advised in favor of the MMR vaccination (8).”

Advice from chiropractors, homeopaths, naturopaths and other alternative practitioners against vaccinations abounds on the web, it is difficult to tell from the published studies if this dangerous advice is the norm for these practitioners or the deviant recommendations of the more extreme of the already irrational. The studies are few and small in number, but disturbing in their implications. Chiropractors and naturopaths are pro childhood infection.

Anti-vaccination is often spun as an issue of choice “Concerning immunization information, a much higher proportion of faculty (91%) and students (80%) than practitioners (62%) felt chiropractors should provide both pro and con information to patients (6).”

It may be that the biggest source of infections from alternative medicine practitioners is not what they do but what they do not do. The only studies I can find on vaccine refusal concerns religious exemptions. I wonder how many who refuse vaccinations do so because of information obtained from chiropractors, homeopaths, naturopaths and other alternative practitioners.

I looked for, and could not find, studies that examined how compliant various alternative providers are with rudimentary hand hygiene and other infection control recommendations. In science based medicine, where germs are an accepted etiology of disease, compliance with hand hygiene has historically been poor. Rates for hand washing have typically been less than 50% in a group of people who allegedly think germs exist. Thanks to intensive education and focus this century, hand hygiene rates have gone up at all my hospitals. It has been gratifying to see as the compliance with infection control has increased, the rates of hospital acquired infections have dropped. The last 19 years that I have been the Chair of our Infection Control committee has seen the continuous and relentless decline in infections at all my hospitals. That is one of the side effects of applying evidence based medicine and germ theory to the hospital: infections decrease.

Any useless anecdotes from readers? Did your chiropractor wash her hands? Your naturopath? Your primary care doc? If not, you should perhaps seek care elsewhere.

All of the infections associated with alternative medicine modalities are unusual. I also suspect that the infectious complications associated with alternative medicine are under reported because it takes time and effort to report cases. I have seen a handful of infections (and other complications) associated with alternative therapies and have neither the time nor inclination to report them formally to a journal.

I am certain someone will mention in the comments all the morbidity and mortality us real doctors cause on a regular basis. Health care is not, unfortunately, risk free, and I know all too well the improvements that could be done to improve patient safety. I also know the enormous strides we have made in preventing hospital acquired infections during my career. I used to be able to make a living off hospital acquired infections and the last 19 years have shown a steady decrease in nosocomial infections at my hospitals to the point where some have not had a nosocomial pneumonia in over a year.

In medicine we have to weigh the risks of what we do with the benefits we hope to gain. In the world of alternative medicine, there is all risk with no benefit. See http://whatstheharm.net/ for more anecdotes (not data).

Beliefs in disease causation have consequences. Believing that germs do not cause disease doesn’t affect the germs. They are out there waiting for the opportunity to invade and try and kill you. Job security.

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(1) http://whale.to/p/bechamp.html

(2) http://www.healthtruthrevealed.com/full-page.php?page=article&&id=11421316206

http://whale.to/v/bechamp1.html

Acupuncture references:

(3) Acupunct Med. 2004 Sep;22(3):122-33. A cumulative review of the range and incidence of significant adverse events associated with acupuncture.

(4) Acupunct Med. 2001 Dec;19(2):112-6. Skin disinfection and acupuncture.

Outbreak of invasive methicillin-resistant Staphylococcus aureus infection associated with acupuncture and joint injection. Infect Control Hosp Epidemiol. 2008 Sep;29(9):859-65. PMID: 18684094.

Acupuncture-associated Listeria monocytogenes arthritis in a patient with rheumatoid arthritis. Joint Bone Spine. 2008 Jul;75(4):502-3. Epub 2008 May 2. PMID: 18455948

Outbreak of acupuncture-associated cutaneous Mycobacterium abscessus infections.J Cutan Med Surg. 2006 Jul-Aug;10(4):166-9.PMID: 17234114

[Risk of hepatitis C related to traditional medicine: a case control study in Ho Chi Minh City, Vietnam] Rev Epidemiol Sante Publique. 2007 Apr;55(2):107-12. French. PMID: 17 442516

Paraplegia caused by spinal infection after acupuncture.Spinal Cord. 2006 Apr;44(4):258-9.PMID: 16151454

Multiloculated pleural empyema following acupuncture.Infection. 2005 Aug;33(4):297-8. PMID: 16091905

HIV infection after Chinese traditional acupuncture treatment.Complement Ther Med. 2003 Dec;11(4):272. PMID: 1496979

Soft tissue abscess and osteomyelitis secondary to acupuncture.ANZ J Surg. 2003 Sep;73(9):770. PMID: 12956798

Group B Streptococcus endogenous endophthalmitis : case reports and review of the literature.Ophthalmology. 2002 Oct;109(10):1879-86. Review. PMID: 12359609

Chiropractic References

Chiropr Osteopat. 2007 Jun 7;15:8. Assessment and risk reduction of infectious pathogens on chiropractic treatment tables.

Am J Infect Control. 2006 Apr;34(3):155-7. The role of chiropractic adjusting tables as reservoirs for microbial diseases.

Chiropr Hist. 1996 Jun;16(1):72-87 Chiropractic’s tension with the germ theory of disease.

Other Practices

N Engl J Med. 1982 Aug 5;307(6):339-42.Links An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic.

Spinal epidural abscess associated with moxibustion-related infection of the finger. J Spinal Cord Med. 2008;31(3):319-23. PMID: 18795486

Pasteurella multocida infection of the calf in a patient who had moxa cautery treatment for degenerative arthritis. Yonsei Med J. 1982;23(1):65-70

Tidsskr Nor Laegeforen. 1991 Sep 20;111(22):2741-2. [Bacterial endocarditis after treatment by a natural healer]

Vaccines and alt med

(5) Vaccine. 2001 Oct 15;20 Suppl 1:S90-3; discussion S89. Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination.

(6) J Manipulative Physiol Ther. 2004 Jun;27(5):287-98. A survey of US chiropractors on clinical preventive services.

http://www.chirobase.org/06DD/chiroimmu.html

(7) Vaccine. 2004 Dec 2;23(3):372-9. here to read Beliefs and behaviours: understanding chiropractors and immunization; Association between Health Care Providers’ Influence on Parents Who Have Concerns about Vaccine Safety and Vaccination Coverage.: Smith PJ, Kennedy AM, Wooten K, Gust DA, Pickering LK.Pediatrics, November 2006; 118(5):e1287-e1292

(8) Vaccine. 2003 Mar 7;21(11-12):1044-7. MMR vaccination advice over the Internet.