You’re being lied to on a regular basis by people who report on science. Sure, many of the people who are guilty of this don't actually realize that they're providing bad interpretations. They themselves have been deceived because they don't know what I'm going to talk about in this post (as well as other errors, which I may discuss at another time). That is, the inappropriate use of associations to infer a cause-and-effect relationship between two factors. I will discuss some specific examples of this type of deceit later in this post, but first, let me tell you a story.
A long, long time ago, in a state far away, on the very first day of my psychology 101 class, my teacher showed us a graph of ice cream sales vs violent crime. As it turns out, there’s a correlation between the two factors. My classmates and myself were then asked to explain this correlation. We, oblivious to how our teacher was fooling us, fell into her trap. Various people tried to explain how eating ice cream makes people more violent, or that violence makes people want ice cream. Both of these conclusions are quite ridiculous. According to my teacher, the reason for the association is that there is a third factor that drives both phenomenon: summer. You see, when it’s hot outside people buy more ice cream, but people are also more irritable and prone to violence. As a result, you can measure as association between ice cream sales and violent crime. After informing us of how she tricked us, my teacher asked us to chant, “correlation is not causation”. (In case you’re wondering, “causation” means exactly the same thing as “cause”, but it makes intellectuals feel good about themselves to use technical sounding words.)
The concept that correlation is not causation is an incredibly important one for anyone who wants to understand science. There are various reasons why you can’t determine cause-and-effect from associations. The biggest is because of the myriads of possible variables that could influence the association. I mentioned a third factor earlier, but there could literally be thousands of factors that may play into a single association.
Strength of an association
The strength of the association is important. An association is said to be strong if the two factors track very closely to one another. An association is said to be weak is the two factors only vaguely track with each other. Two factors are not associated if they cannot track in relationship to each other. One way that the strength of an association is determined is based on the “relative risk”, which is a calculation done to determine the ratio between an exposure and an outcome. Relative risk is expressed as a number. If the relative risk is 1.0, then there is no increase or decrease in the outcome. If the relative risk is less than 1.0, there is a decrease in the outcome. If the relative risk is more than 1.0, there is an increase in the outcome. Keep in mind that “An increased risk of less than 50% (RR=1.0–1.5) or a decreased risk of less than 30% (RR=0.7–1.0) is considered by many epidemiologists to be either a weak association or no association”. (1)
What does the strength of an association mean? If two factors are strongly associated, there might be a cause-and-effect relationship between the two factors. It’s not definitive, but it’s possible. If the association is weak, there is not likely a cause-and-effect relationship, though it’s still possible. If there is no association, then there is no cause-and-effect relationship.
Now that we’re done with definitions, let get down to some examples. I’m going to start with the big dogs: The World Health Organization (WHO). They listed “processed meats” as a group 1 carcinogen, meaning that, according to them, there is sufficient evidence that processed meats cause cancer. But what was this classification based on? From WHO’s website “The consumption of processed meat was associated with small increases in the risk of cancer in the studies reviewed” (emphasis added) and “In the case of processed meat, this classification is based on sufficient evidence from epidemiological studies that eating processed meat causes colorectal cancer” (emphasis added, 2) What’s the significance of the statement that it’s “epidemiological studies”? Epidemiological studies are one of the types of studies used to find associations. They do not control variables, they are not an experiment. To be fair, WHO did also consider animal studies and studies exploring possible mechanisms, but they also seem to think that a consistent association supports a cause-and-effect relationship (3). Of course, there’s the strength of the association. Looking through the paper put out by IARC (a branch of WHO), I found 54 different references to relative risk in the studies they included in their analysis related to processed meat and colorectal cancer (the kind of cancer they claim is caused by processed meats). The relative risk ranged in these papers from 0.85-2.0. Only 8 out of the 54 relative risk values was outside of the 0.7-1.5 range, meaning that most of these represent a finding of a weak or absent association. To put this in context, according to the CDC, smoking is associated with a 15-30 fold increased risk of developing cancer (in other words a relative risk of 15.0-30.0) (4). The references I found for red meat, which WHO has labeled a probable carcinogen, and colorectal cancer ranged from 0.8-1.99, with only 2 out of 24 references being outside the 0.7-1.5 range. It seems to me, that WHO has made an inappropriate conclusion from the data they’ve analyzed.
The Nutritional Recommendation Consortium did a more honest analysis. They said, “Our weak recommendation that people continue their current meat consumption highlights both the uncertainty associated with possible harmful effects and the very small magnitude of effect, even if the best estimates represent true causation, which we believe to be implausible.” (5)
For a quicker and lighter example: WebMD.com has an article from several years back, titled “The Link Between Chocolate and the Nobel Prize”, which starts out with “Eat chocolate, win a Nobel Prize? It may sound far-fetched, but a new study suggests it might not be bad advice.” (6) They go on to explain the link (another word for an association) between the chocolate consumption of a nation, and the number of Nobel Prize winners in that nation. After reading this article, hopefully you aren’t thinking that eating chocolate will make you more intelligent. There may be many reasons for this association, and the fact that there are many possible explanations should immediately make you say “correlation is not causation!”
I’ve considered giving other examples, but if you pay attention to science topics (especially those related to health) you will frequently see examples of people touting the newest association to be found, and trying to use that information to convince you that meat causes cancer, chocolate makes you smarter, or that eating ice cream will make you want to attack people, among many other claims. Don’t fall for it.
I hope after reading this post that every time someone brings up an association, correlation or link that you will have an immediate gut reaction of my voice yelling in your head: correlation is not causation! You will then pause, think, and ask a few questions. There may be a cause-and-effect relationship between the two factors, or there may not be, but don’t get pulled in by the sophisticated sounding language, which ultimately just means, “we need more research on this topic before we can draw any conclusions”.
Thanks for reading,
John Hogue, ND
Hello everyone, this is Dr. Hogue.
Last weekend I attended a course to learn Fascial Counterstrain (FCS). FCS is a manual therapy method that can be used to relax tissues of the muscles, bones, joints, ligaments, nerves, organs, lymph, veins, and even arteries. I attended the introductory course to see if the method was valid and have been using it since returning. So far I have seen some pretty impressive results.
FCS is a paradigm shift for me, allowing me to treat things with manual therapy which I never thought were possible. If you’re interested in learning more, come on in for a visit. You can also look forward to an upcoming post which explains the ideas and principles of the treatment in more detail.
While I have done my fair share of testing in the past, I have done very few in the past couple years despite it being a common request from new patients.
Any of you who have seen us here know that we are big fans of zinc for mental health, but it is extremely important for gut health as well. Not only does it heal the intestinal epithelium, but it also improves the microbial biome and digestive enzymes.
Metallothionein is a protein that lives in a bunch of places in our body, but the highest concentration is in the gastrointestinal tract. It is extremely important in the prevention or treatment of food sensitivities (not full-on anaphylaxis type allergies, that's a different issue). It helps to break down gluten, gliadin, casein, casomorphins, and other proline containing proteins. Which in layfolx terms is wheat and dairy. If you've noticed that you feel better when you avoid breads and cheeses, you may have a zinc deficiency.
It's also common to experience more sensitivities to food dyes and shellfish if your copper levels are too high. This is important because copper and zinc are paired minerals, and when the copper is very elevated, zinc is often very low.
Metallothionein also helps to kill candida and keep other yeasts at bay, so if you've noticed a sensitivity to sugar and sweet foods, feeling more bloated, foggy headed, or experiencing diarrhea or constipation, then you could have a candida overgrowth that would improve with adequate zinc supplementation and possibly some additional antifungal compounds. And I never put anyone on the candida diet because it fixes nothing and just makes life really unpleasant.
So if you think you are sensitive to wheat and dairy in particular, you may want us to evaluate and treat your zinc levels.
As a side note, I've never treated SIBO per se. I don't run the tests and I don't use the treatments, but I have extremely infrequently felt the need to send someone elsewhere to another doc who does this testing and treatment. I did find a study that stated zinc levels were the sole independent predictor of SIBO in a specific population that was tested. Correlation does not imply causation, however this is an interesting area to consider for future studies.
Out with the old and in with the new!
2017 was a fantastically tumultuous year for us here at Avalon. Buying the business, but losing Dr. Haff, and adding to my therapeutic repertoire are just a few of the biggies that happened. This year will be more changes in store, I'm sure, but we'll keep you posted as they happen.
I'm still looking for some new doctors to add to the staff, and have recently had some great applicants. Interviewing, vetting, negotiating, etc all need to happen before I commit to bringing someone into our happy home, but it's all in the works.
If you've been in the office in the past few months, you know that Sandra from Mercy Diagnostics is here with us on Fridays. So if you need a blood draw from a fantastic, patient, and fun phlebotomist, schedule any blood draws with us for Friday. She's still at another location M-Th if you need a different day (ask for details).
We also rented one of the offices to a wonderfully kind therapist by the name of John Powell. He's technically a separate business, so you need to contact him directly to schedule an appointment. And yes, he is taking new clients.
I'm loving the results I get from the Walsh Research Institute protocols I've been using. The information I learned has revolutionized my practice and my success. I've also started to immerse myself in Body-positivity and the Health At Every Size Movement, which I feel is very in-line with all of the Naturopathic Principles.
See below for some highlighted changes!
Telemedicine is here!
Technically, it has been authorized for us to do telemedicine since October 1st, but since I was in the midst of purchasing the business, I kind of dropped the ball. And as I'm writing this, schools are closed due to frigid cold temperatures. Wouldn't it be great if you could meet with me via a virtual face-to-face HIPAA-compliant website?
You'll need internet access, and a device with a camera, but that's it. And, I'm only booking 15 or 30 minute slots, so if you feel like you need more time, then I'll need you to physically come to the office. I'm sure there will be a few bugs to work out along the way, so please be patient.
We have a bunch of really great, high quality supplements that I do not tend to prescribe and, I'd like to make room for some new options. So, I'm giving you 50% off the supplements on the shelf closest to the hallway. Additional discounts do not apply, but if you see something you want, come get it. These are supplements I won't be replacing on our shelves in the future.
Click to see sale items
I will be expanding the available hours in which you can schedule with me at the end of February. Our overall schedule of 9-5 isn't changing, just how many patient-hours I have in a day.
This week is Naturopathic Medicine Week, a week in which NDs try to inform people about what it is we do and why it's different from the conventional model.
I personally wanted to point out that NDs in Vermont have it better than NDs anywhere else in America. I made a couple posts about it on Twitter, Instagram and Facebook.
The best part though, is that we get to live in Vermont, with the greatest patients in the country who already understand the importance of eating local and organic, who oftentimes are herbalists or know herbalists, who want to keep our environment clean, and who appreciate naturopathic medicine more than anywhere else from my experience.
On to more practical matters, Tori is out until next Wednesday, so if you aren't getting the same great front office experience you normally get, it's because I'm not as good at it as she is. :)
I'm also extending the supplements sale until the end of the month. Not everyone checks here and our social media accounts, so I want to make sure that as many patients as possible have an opportunity to get the extra discount.
Week one is over and things went pretty smoothly despite some behind-the-scenes hiccups. I've still been making slight adjustments to the decor and systems, so this is a summary of recent and future happenings.
NECLA conference: Literally in the middle of Dr. Haff and I closing on the business, I left to go speak at UVM Medical Center for the Northeast Community Laboratory Alliance about the benefits and challenges of working with local Naturopathic Physicians. Attendees included management, customer service and phlebotomists from UVM and other regional hospitals. I love public speaking, and my hosts and the attendees were great.
Social Media: I've started some new accounts and am trying to post in those places more often, rather than sending out infrequent emails. If you are a social media user, follow us on these platforms:
Mercy Diagnostics: If you've been in the office in the past 8 months, I may have already recommended you use this phlebotomy site and laboratory at another doctor's office. This past Friday, we welcomed Sandra, the phlebotomist for Mercy, into my recently former office. She'll only be there on Fridays, since she is still at the other location Monday through Thursday, but if we get busy enough, Mercy will consider expanding the available days.
Room changes: As I said above, Mercy Diagnostics is in my most recent office (for those of you who have been around long enough to remember that I used to be upstairs). Last weekend I moved into Dr. Haff's office, including moving around the furniture quite a bit. This weekend, I painted the red door and frame inside and out to match the new colors in the hallway and to visually cool down the office itself.
Tori will be going on vacation from the end of this week to the middle of next week, so you may not get the same quick response as she provides when she's here. I've cut down my patient load while she's gone so that I can be available for everything else.
Our supplement sale continues this week. 20% off all homeopathics, herbal tinctures and anything on the shelf closest to the hallway. If you've been holding off on getting something, now's the time to get it. If you need something that isn't on our shelves, we also have an online store through Fullscript at https://us.fullscript.com/welcome/avalonnaturalmedicine
It's been a busy week! My goal is to provide you with the same great level of care to which you are accustomed, while still continuing to improve.
I've got two pieces of big news regarding supplements:
It's official! If you are interested in Walsh's Advanced Nutrient Therapy and are in Vermont, Quebec, Upstate New York, or potentially parts of New Hampshire, I'm your doc. I've been administering the protocols since I came back from the conference at the beginning of May, but this puts me on the WRI website so that people who are looking for this type of successful therapy, they can find me.
If you're interested in William Walsh, PhD or his therapies that he developed alongside Carl Pfeiffer, MD, check out the website for the Walsh Research Institute.
We're in the home stretch here at Avalon Natural Medicine. Dr. Haff has seen her last patients and will be back next week for our final transition work.
I couldn't have asked for a better boss and its been pretty sweet being an employee only for the past 5 years. Thankfully, she's had all the systems in place for a fairly easy transition, and has been walking me through all the steps of what she does as the business owner.
There will be some changes over the next few months as I put my own spin on this place. If you've been in lately, you'll have noticed some new paint, new shelves, etc. I'll try to keep the newsletters and emails to a minimum and notify you here, and repeating the same info on other social media outlets. So if you have one you like in particular, follow us so you can get the latest.
Three years ago I was dealing with my mom dying from cancer. It was rough, to say the least, but I feel like I’m in a better spot now and able to share some things that I wrote back then. This compilation of comments I made on my personal page is edited for vulgarities (I swear!) and clarity, but since the statements still feel so very true and real to me I left all wording in the present tense.
It’s hard to say this out loud, because I may come off as callous, but if one just looked at my news feed on a regular basis, you would assume that all people with cancer are beautiful bald women and children with tons of social support. But cancer is ugly, and not everyone has a large social network to throw benefits in their honor. There aren’t organizations to help depressed old smokers to make a wish come true before they die. And it’s not that I begrudge anyone’s celebration, I just want to remind everyone that cancer is ugly and lonely, and not everyone gets to walk away with a trophy.
I think it would be fantastic if people acknowledged those battling cancer who won’t be able to hold up a sign on Facebook saying that they beat it, or that it’s their last day of chemo, etc. Not everyone with cancer is a “survivor". Some quietly fight for their lives, regardless of how brief it may be, to spend just a few more days or months on this planet. And they deserve our attention too.
My point is that we glamorize beating cancer, rewarding the “winners” with notoriety, giving preferential attention to the visible. All while many are too sick to join a 5K or have their picture spread on the internet. Cancer is ugly and it kills. It kills nice people and mean people, people who lived life to the fullest and those who didn’t, people who changed their circumstances or risk factors and some who didn’t, some who took charge and fought and some who give up early on. I think it would be far more honest if our society acknowledged the ugliness of all cancer and made a concerted effort to not glamorize it.
Like I said before, this is difficult to say publicly because it sounds like I don’t care about people like the adorable twin with fantastic dimples all over my news feed at the moment. But that couldn’t be further from the truth. I care about him, my friends who have had cancer in the past that have beaten it, a best friend who is currently battling stage 4 melanoma, my mom battling stage 4 small cell carcinoma, my patients who come in frightened about a symptom that may be cancer, and so many others.
But what I see, is that I’m one of a few who is willing to talk about the ugly side. I see this inspirational stuff and it makes me annoyed and angry. We put pretty pictures on Facebook of people beating cancer because talking about the death and destruction that cancer causes to the person and to their families is uncomfortable. I once had to rebuild 2/3rds of a man’s face because of jaw cancer that left him dead and mangled after 17 surgeries. [For those of you who didn’t know, my first profession was an Embalmer.]
And it’s partly my fault because I don’t want to talk about how in the last 1-2 months my mom was hospitalized for pancreatitis, found out all of her brain tumors are back, went through another 2 weeks of whole head radiation, suffered a pulmonary embolism on the final day of radiation, was put on warfarin, puked so hard she fell out of bed and is now covered in bruises thanks to the warfarin. But I’ve had enough of the beautifying of cancer. I’m officially done. I’ve kept quiet for far too long and I’m now going to be that outspoken jerk.
I don’t think there is an easy way to deal with it, but I can tell you that watching my mom slip away in tiny pieces, day by day is awful. She’s not my mom, but she’s not dead, and I don’t know which is worse. I see the inevitable and I don’t want it to ever come, but part of me wishes I could just rip the bandaid off quickly so I don’’t have to watch her suffer and wither into a shadow of the woman who sacrificed her whole life to make mine better.
And to bring up another ugly aspect of cancer, I feel that we sympathize less for those who don’t live a pristine life, or decide to get all holistic when diagnosed, or those who choose not to do the conventional route, or those who are older instead of kids. We get kind of judgy when it comes to the most personal of decisions. I wasn’t the least bit surprised with my mom, and I don’t blame her for choosing the conventional route over what I had to offer. And her life isn’t worth any less to me because she smoked all those years. But I definitely feel (and maybe it’s just me) like people put out a she-got-what-she-deserved vibe.
No one deserves cancer. No one’s life is more valuable than others. No one deserves to feel guilty about how they choose to live their life. No one deserves condemnation during the hardest struggle they will ever endure. They just need our support. The ugly ones, the depressed ones, the ones too weak to get out of a chair much less walk a 5k.
Spotted Jewelweed (Impatiens biflora) is an invaluable tool when out in the woods hiking. The saponins found in the stem or leaves can emulsify and diminish the damage caused by poison ivy. It's also great for bug bites, rashes from stinging nettles, burns, cuts, acne, eczema, fungal infections, or any other skin irritation.