Washing Our Hands Of It

In Tuesdays’s newsletter, we asked you how often you wash your hands, and got the above-depicted, below-described, set of self-reported answers:

• About 54% said “More times per day than [the other options]”
• About 38% said “Whenever using the bathroom or kitchen
• About 5% said “Once or twice per day”
• Two (2) said “Only when visibly dirty”
• Two (2) said “I prefer to just use sanitizer gel”

What does the science have to say about this?

People lie about their handwashing habits: True or False?

True and False (since some people lie and some don’t), but there’s science to this too. Here’s a great study from 2021 that used various levels of confidentiality in questioning (i.e., there were ways of asking that made it either obvious or impossible to know who answered how), and found…

❝We analysed data of 1434 participants. In the direct questioning group 94.5% of the participants claimed to practice proper hand hygiene; in the indirect questioning group a significantly lower estimate of only 78.1% was observed.❞

~ Dr. Laura Mieth et al.

Source: Do they really wash their hands? Prevalence estimates for personal hygiene behaviour during the COVID-19 pandemic based on indirect questions

Note: the abstract alone doesn’t make it clear how the anonymization worked (it is explained later in the paper), and it was noted as a limitation of the study that the participants may not have understood how it works well enough to have confidence in it, meaning that the 78.1% is probably also inflated, just not as much as the 94.5% in the direct questioning group.

Here’s a pop-science article that cites a collection of studies, finding such things as for example…

❝With the use of wireless devices to record how many people entered the restroom and used the pumps of the soap dispensers, researchers were able to collect data on almost 200,000 restroom trips over a three-month period.

The found that only 31% of men and 65% of women washed their hands with soap.❞

Source: Study: Men Wash Their Hands Much Less Often Than Women (And People Lie About Washing Their Hands)

Sanitizer gel does the job of washing one’s hands with soap: True or False?

False, though it’s still not a bad option for when soap and water aren’t available or practical. Here’s an educational article about the science of why this is so:

UCI Health | Soap vs. Hand Sanitizer

There’s also some consideration of lab results vs real-world results, because while in principle the alcohol gel is very good at killing most bacteria / inactivating most viruses, it can take up to 4 minutes of alcohol gel contact to do so, as in this study with flu viruses:

Situations Leading to Reduced Effectiveness of Current Hand Hygiene against Infectious Mucus from Influenza Virus-Infected Patients

In contrast, 20 seconds of handwashing with soap will generally do the job.

Antibacterial soap is better than other soap: True or False?

False, because the main way that soap protects us is not in its antibacterial properties (although it does also destroy the surface membrane of many bacteria and for that matter viruses too, killing/inactivating them, respectively), but rather in how it causes pathogens to simply slide off during washing.

Here’s a study that found that handwashing with soap reduced disease incidence by 50–53%, and…

❝Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap.❞

~ Dr. Stephen Luby et al.

Read more: Effect of handwashing on child health: a randomised controlled trial

Want to wash your hands more than you do?

There have been many studies into motivating people to wash their hands more (often with education and/or disgust-based shaming), but an effective method you can use for yourself at home is to simply buy more luxurious hand soap, and generally do what you can to make handwashing a more pleasant experience (taking a moment to let the water run warm is another good thing to do if that’s more comfortable for you).

Take care!

Homeopathy: Evidence So Tiny That It’s Not There?

Yesterday, we asked you your opinions on homeopathy. The sample size of responses was a little lower than we usually get, but of those who did reply, there was a clear trend:

• A lot of enthusiasm for “Homeopathy works on valid principles and is effective”
• Near equal support for “It may help some people as a complementary therapy”
• Very few people voted for “Science doesn’t know how it works, but it works”; this is probably because people who considered voting for this, voted for the more flexible “It may help some people as a complementary therapy” instead.
• Very few people considered it a dangerous scam and a pseudoscience.

So, what does the science say?

Well, let us start our investigation by checking out the position of the UK’s National Health Service, an organization with a strong focus on providing the least expensive treatments that are effective.

Since homeopathy is very inexpensive to arrange, they will surely want to put it atop their list of treatments, right?

❝Homeopathy is a “treatment” based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself.

There’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.❞

The NHS actually has a lot more to say about that, and you can read their full statement here.

But that’s just one institution. Here’s what Australia’s National Health and Medical Research Council had to say:

❝There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered: no good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment❞

You can read their full statement here.

The American FDA, meanwhile, have a stronger statement:

❝Homeopathic drug products are made from a wide range of substances, including ingredients derived from plants, healthy or diseased animal or human sources, minerals and chemicals, including known poisons. These products have the potential to cause significant and even permanent harm if they are poorly manufactured, since that could lead to contaminated products or products that have potentially toxic ingredients at higher levels than are labeled and/or safe, or if they are marketed as substitute treatments for serious or life-threatening diseases and conditions, or to vulnerable populations.❞

You can read their full statement here.

Homeopathy is a dangerous scam and a pseudoscience: True or False?

False and True, respectively, mostly.

That may be a confusing answer, so let’s elaborate:

• Is it dangerous? Mostly not; it’s mostly just water. However, two possibilities for harm exist:
  • Careless preparation could result in a harmful ingredient still being present in the water—and because of the “like cures like” principle, many of the ingredients used in homeopathy are harmful, ranging from heavy metals to plant-based neurotoxins. However, the process of “ultra-dilution” usually removes these so thoroughly that they are absent or otherwise scientifically undetectable.
  • Placebo treatment has its place, but could result in “real” treatment going undelivered. This can cause harm if the “real” treatment was critically needed, especially if it was needed on a short timescale.
• Is it a scam? Probably mostly not; to be a scam requires malintent. Most practitioners probably believe in what they are practising.
• Is it a pseudoscience? With the exception that placebo effect has been highly studied and is a very valid complementary therapy… Yes, aside from that it is a pseudoscience. There is no scientific evidence to support homeopathy’s “like cures like” principle, and there is no scientific evidence to support homeopathy’s “water memory” idea. On the contrary, they go against the commonly understood physics of our world.

It may help some people as a complementary therapy: True or False?

True! Not only is placebo effect very well-studied, but best of all, it can still work as a placebo even if you know that you’re taking a placebo… Provided you also believe that!

Science doesn’t know how it works, but it works: True or False?

False, simply. At best, it performs as a placebo.

Placebo is most effective when it’s a remedy against subjective symptoms, like pain.

However, psychosomatic effect (the effect that our brain has on the rest of our body, to which it is very well-connected) can mean that placebo can also help against objective symptoms, like inflammation.

After all, our body, directed primarily by the brain, can “decide” what immunological defenses to deploy or hold back, for example. This is why placebo can help with conditions as diverse as arthritis (an inflammatory condition) or diabetes (an autoimmune condition, and/or a metabolic condition, depending on type).

Here’s how homeopathy measures up, for those conditions:

• Homeopathy for rheumatoid arthritis: does it work?
• Do homeopathic treatments for diabetes work?

(the short answer is “no better than placebo”)

Homeopathy works on valid principles and is effective: True or False?

False, except insofar as placebo is a valid principle and can be effective.

The stated principles of homeopathy—”like cures like” and “water memory”—have no scientific basis.

We’d love to show the science for this, but we cannot prove a negative.

However, the ideas were conceived in 1796, and are tantamount to alchemy. A good scientific attitude means being open-minded to new ideas and testing them. In homeopathy’s case, this has been done, extensively, and more than 200 years of testing later, homeopathy has consistently performed equal to placebo.

In summary…

• If you’re enjoying homeopathic treatment and that’s working for you, great, keep at it.
• If you’re open-minded to enjoying a placebo treatment that may benefit you, be careful, but don’t let us stop you.
• If your condition is serious, please do not delay seeking evidence-based medical treatment.