The Pathogens That Came In From The Cold

Yesterday, we asked you about your climate-themed policy for avoiding respiratory infections, and got the above-depicted, below-described, set of answers:

• About 46% of respondents said “Temperature has no bearing on infection risk”
• About 31% of respondents said “It’s important to get plenty of cold, fresh air, as this kills/inactivates pathogens”
• About 22% of respondents said “It’s important to stay warm to avoid getting colds, flu, etc”

Some gave rationales, including…

For “stay warm”:

❝Childhood lessons❞

For “get cold, fresh air”:

❝I just feel that it’s healthy to get fresh air daily. Whether it kills germs, I don’t know❞

For “temperature has no bearing”:

❝If climate issue affected respiratory infections, would people in the tropics suffer more than those in colder climates? Pollutants may affect respiratory infections, but I doubt just temperature would do so.❞

So, what does the science say?

It’s important to stay warm to avoid getting colds, flu, etc: True or False?

False, simply. Cold weather does increase the infection risk, but for reasons that a hat and scarf won’t protect you from. More on this later, but for now, let’s lay to rest the idea that bodily chilling will promote infection by cold, flu, etc.

In a small-ish but statistically significant study (n=180), it was found that…

❝There was no evidence that chilling caused any acute change in symptom scores❞

Read more: Acute cooling of the feet and the onset of common cold symptoms

Note: they do mention in their conclusion that chilling the feet “causes the onset of cold symptoms in about 10% of subjects who are chilled”, but the data does not support that conclusion, and the only clear indicator is that people who are more prone to colds generally, were more prone to getting a cold after a cold water footbath.

In other words, people who were more prone to colds remained more prone to colds, just the same.

It’s important to get plenty of cold, fresh air, as this kills/inactivates pathogens: True or False?

Broadly False, though most pathogens do have an optimal operating temperature that (for obvious reasons) is around normal human body temperature.

However, given that they don’t generally have to survive outside of a host body for long to get passed on, the fact that the pathogens may be a little sluggish in the great outdoors will not change the fact that they will be delighted by the climate in your respiratory tract as soon as you get back into the warm.

With regard to the cold air not being a reliable killer/inactivator of pathogens, we call to the witness stand…

Polar Bear Dies From Bird Flu As H5N1 Spreads Across Globe

(it was found near Utqiagvik, one of the northernmost communities in Alaska)

Because pathogens like human body temperature, raising the body temperature is a way to kill/inactivate them: True or False?

True! Unfortunately, it’s also a way to kill us. Because we, too, cannot survive for long above our normal body temperature.

So, for example, bundling up warmly and cranking up the heating won’t necessarily help, because:

• if the temperature is comfortable for you, it’s comfortable for the pathogen
• if the temperature is dangerous to the pathogen, it’s dangerous to you too

This is why the fever response evolved, and/but why many people with fevers die anyway. It’s the body’s way of playing chicken with the pathogen, challenging “guess which of us can survive this for longer!”

Temperature has no bearing on infection risk: True or False?

True and/or False, circumstantially. This one’s a little complex, but let’s break it down to the essentials.

• Temperature has no direct effect, for the reasons we outlined above
• Temperature is often related to humidity, which does have an effect
• Temperature does tend to influence human behavior (more time spent in open spaces with good ventilation vs more time spent in closed quarters with poor ventilation and/or recycled air), which has an obvious effect on transmission rates

The first one we covered, and the third one is self-evident, so let’s look at the second one:

Temperature is often related to humidity, which does have an effect

When the environmental temperature is warmer, water droplets in the air will tend to be bigger, and thus drop to the ground much more quickly.

When the environmental temperature is colder, water droplets in the air will tend to be smaller, and thus stay in the air for longer (along with any pathogens those water droplets may be carrying).

Some papers on the impact of this:

• Cold temperature and low humidity are associated with increased occurrence of respiratory tract infections
• A Decrease in Temperature and Humidity Precedes Human Rhinovirus Infections in a Cold Climate

So whatever temperature you like to keep your environment, humidity is a protective factor against respiratory infections, and dry air is a risk factor.

So, for example:

• If the weather doesn’t suit having good ventilation, a humidifier is a good option
• Being in an airplane is one of the worst places to be for this, outside of a hospital

Don’t have a humidifier? Here’s an example product on Amazon, but by all means shop around.

A crock pot with hot water in and the lid off is also a very workable workaround too

Take care!

Pinpointing The Usefulness Of Acupuncture

We asked you for your opinions on acupuncture, and got the above-depicted, below-described, set of answers:

• A little under half of all respondents voted for “It’s well-backed by modern science, per neurology, cardiology, immunology, etc”
• Slightly fewer respondents voted for “We don’t understand how it works, but it works!”
• A little under a fifth of respondents voted for “It may have some limited clinical applications beyond placebo”
• One (1) respondent voted for for “It’s placebo at best”

When we did a main feature about homeopathy, a couple of subscribers wrote to say that they were confused as to what homeopathy was, so this time, we’ll start with a quick definition first.

First, what is acupuncture? For the convenience of a quick definition so that we can move on to the science, let’s borrow from Wikipedia:

❝Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine in which thin needles are inserted into the body.

Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery.❞

~ Wikipedia

Now, that’s not a promising start, but we will not be deterred! We will instead examine the science itself, rather than relying on tertiary sources like Wikipedia.

It’s worth noting before we move on, however, that there is vigorous debate behind the scenes of that article. The gist of the argument is:

• On one side: “Acupuncture is not pseudoscience/quackery! This has long been disproved and there are peer-reviewed research papers on the subject.”
• On the other: “Yes, but only in disreputable quack journals created specifically for that purpose”

The latter counterclaim is a) potentially a “no true Scotsman” rhetorical ploy b) potentially true regardless

Some counterclaims exhibit specific sinophobia, per “if the source is Chinese, don’t believe it”. That’s not helpful either.

Well, the waters sure are muddy. Where to begin? Let’s start with a relatively easy one:

It may have some clinical applications beyond placebo: True or False?

True! Admittedly, “may” is doing some of the heavy lifting here, but we’ll take what we can get to get us going.

One of the least controversial uses of acupuncture is to alleviate chronic pain. Dr. Vickers et al, in a study published under the auspices of JAMA (a very respectable journal, and based in the US, not China), found:

❝Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.

However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture❞

Source: Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis

If you’re feeling sharp today, you may be wondering how the differences are described as “significant” and “relatively modest” in the same text. That’s because these words have different meanings in academic literature:

• Significant = p<0.05, where p is the probability of the achieved results occurring randomly
• Modest = the differences between the test group and the control group were small

In other words, “significant modest differences” means “the sample sizes were large, and the test group reliably got slightly better results than placebo”

We don’t understand how it works, but it works: True or False

Broadly False. When it works, we generally have an idea how.

Placebo is, of course, the main explanation. And even in examples such as the above, how is placebo acupuncture given?

By inserting acupuncture needles off-target rather than in accord with established meridians and points (the lines and dots that, per Traditional Chinese Medicine, indicate the flow of qi, our body’s vital energy, and welling-points of such).

So, if a patient feels that needles are being inserted randomly, they may no longer have the same confidence that they aren’t in the control group receiving placebo, which could explain the “modest” difference, without there being anything “to” acupuncture beyond placebo. After all, placebo works less well if you believe you are only receiving placebo!

Indeed, a (Korean, for the record) group of researchers wrote about this—and how this confounding factor cuts both ways:

❝Given the current research evidence that sham acupuncture can exert not only the originally expected non-specific effects but also sham acupuncture-specific effects, it would be misleading to simply regard sham acupuncture as the same as placebo.

Therefore, researchers should be cautious when using the term sham acupuncture in clinical investigations.❞

Source: Sham Acupuncture Is Not Just a Placebo

It’s well-backed by modern science, per neurology, cardiology, immunology, etc: True or False?

False, for the most part.

While yes, the meridians and points of acupuncture charts broadly correspond to nerves and vasculature, there is no evidence that inserting needles into those points does anything for one’s qi, itself a concept that has not made it into Western science—as a unified concept, anyway…

Note that our bodies are indeed full of energy. Electrical energy in our nerves, chemical energy in every living cell, kinetic energy in all our moving parts. Even, to stretch the point a bit, gravitational potential energy based on our mass.

All of these things could broadly be described as qi, if we so wish. Indeed, the ki in the Japanese martial art of aikido is the latter kinds; kinetic energy and gravitational potential energy based on our mass. Same goes, therefore for the ki in kiatsu, a kind of Japanese massage, while the ki in reiki, a Japanese spiritual healing practice, is rather more mystical.

The qi in Chinese qigong is mostly about oxygen, thus indirectly chemical energy, and the electrical energy of the nerves that are receiving oxygenated blood at higher or lower levels.

On the other hand, the efficacy of the use of acupuncture for various kinds of pain is well-enough evidenced. Indeed, even the UK’s famously thrifty NHS (that certainly would not spend money on something it did not find to work) offers it as a complementary therapy for some kinds of pain:

❝Western medical acupuncture (dry needling) is the use of acupuncture following a medical diagnosis. It involves stimulating sensory nerves under the skin and in the muscles.

This results in the body producing natural substances, such as pain-relieving endorphins. It’s likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.❞

Source: NHS | Acupuncture

Meanwhile, the NIH’s National Cancer Institute recommends it… But not as a cancer treatment.

Rather, they recommend it as a complementary therapy for pain management, and also against nausea, for which there is also evidence that it can help.

Frustratingly, while they mention that there is lots of evidence for this, they don’t actually link the studies they’re citing, or give enough information to find them. Instead, they say things like “seven randomized clinical trials found that…” and provide links that look reassuring until one finds, upon clicking on them, that it’s just a link to the definition of “randomized clinical trial”:

Source: NIH | Nactional Cancer Institute | Acupuncture (PDQ®)–Patient Version

However, doing our own searches finds many studies (mostly in specialized, potentially biased, journals such as the Journal of Acupuncture and Meridian Studies) finding significant modest outperformance of [what passes for] placebo.

Sometimes, the existence of papers with promising titles, and statements of how acupuncture might work for things other than relief of pain and nausea, hides the fact that the papers themselves do not, in fact, contain any evidence to support the hypothesis. Here’s an example:

❝The underlying mechanisms behind the benefits of acupuncture may be linked with the regulation of the hypothalamic-pituitary-gonadal (adrenal) axis and activation of the Wnt/β-catenin and OPG/RANKL/RANK signaling pathways.

In summary, strong evidence may still come from prospective and well-designed clinical trials to shed light on the potential role of acupuncture in preserving bone loss❞

Source: Acupuncture for Osteoporosis: a Review of Its Clinical and Preclinical Studies

So, here they offered a very sciencey hypothesis, and to support that hypothesis, “strong evidence may still come”.

“We must keep faith” is not usually considered evidence worthy of inclusion in a paper!

PS: the above link is just to the abstract, because the “Full Text” link offered in that abstract leads to a completely unrelated article about HIV/AIDS-related cryptococcosis, in a completely different journal, nothing to do with acupuncture or osteoporosis).

Again, this is not the kind of professionalism we expect from peer-reviewed academic journals.

Bottom line:

Acupuncture reliably performs slightly better than sham acupuncture for the management of pain, and may also help against nausea.

Beyond placebo and the stimulation of endorphin release, there is no consistently reliable evidence that is has any other discernible medical effect by any mechanism known to Western science—though there are plenty of hypotheses.

That said, absence of evidence is not evidence of absence, and the logistical difficulty of testing acupuncture against placebo makes for slow research. Maybe one day we’ll know more.

For now:

• If you find it helps you: great! Enjoy
• If you think it might help you: try it! By a licensed professional with a good reputation, please.
• If you are not inclined to having needles put in you unnecessarily: skip it! Extant science suggests that at worst, you’ll be missing out on slight relief of pain/nausea.

Take care!