Out in the ozone

If you were going to try to pick out the all-time stupidest practice from the alt-med crowd, you'd have a lot of contenders for the top prize.  You have your homeopathic water.  You have your "quantum downloadable medicines."  You have your health benefits of breathing air that bees have flown around in.  You  have your recommendations to take all your clothes off and expose your butthole to direct sunlight.

None of which, for the record, did I make up.

But I think I've found the odds-on favorite, thanks to a loyal reader of Skeptophilia who alerted me to the practice.  Today we look at:

Treating COVID-19 infections using "rectal insufflation of ozone."

If you're sitting there thinking, as I was, "Okay, that can't possibly mean what it sounds like," then yes -- it means exactly what it sounds like.  (Actually, what I said was, "You have got to be fucking kidding me.")  Doctors (I'm using the term loosely here) are trying to treat COVID and other illnesses by sticking a plastic tube up your ass and pumping your rectum full of ozone.

I read this entire article with an expression like this on my face:

Okay, brief pause to (1) give you time to stop laughing and/or retching, and (2) review a little bit of high school chemistry.

Ozone is O3 (ordinary oxygen is O2).  Elemental oxygen is, unsurprisingly, a strong oxidizer, meaning it is really good at pulling electrons away from other molecules.  In the case of organic molecules, this usually makes them fall apart.  Fire, after all, is just the energy released by rapid oxidation.

Put simply, oxygen is toxic.  We depend on it to "burn" the glucose molecules from which we get our energy, but there's good evidence that the evolution of aerobic respiration started as a detoxification pathway.  When the first photosynthetic organisms evolved (probably cyanobacteria), the oxygen they gave off as a waste product resulted in the oxidation (i.e. death) of most of the living things on Earth, at that point all single-celled microorganisms.  The ones that survived did so because they either were able to (1) avoid the oxygen altogether (these evolved into today's anaerobic bacteria), or (2) detoxify the oxygen by handing it the electrons it wanted, in most circumstances inducing it to bind to hydrogen ions and stabilize as water molecules.  This latter pathway releases a lot of energy, and the ancestors of aerobes -- in other words, most life forms on Earth -- survived because they evolved a way to hook this energy release to powering their own metabolic processes.

So oxygen is dangerous stuff, and we've just learned to live with it.  But where all this is leading is: ozone is a stronger oxidizer than elemental oxygen.  In fact, five times stronger.  It's twice as strong an oxidizer as chlorine gas, which is dissolved into pool water because it's so good at killing pathogenic microorganisms.

This is the stuff they're recommending blowing up your ass.

The "research" that the article linked above cites has the following to say, apropos of using this technique to treat COVID:

The coronavirus envelope is rich in cysteine, and viral activity depends on the conservation of these residues.  Cysteine contains a thiol or sulfhydryl group (–SH); many viruses, including coronaviruses, require these reduced sulfhydryl groups for cell entry and fusion.  Sulfhydryl groups are susceptible to oxidation, and therefore to the oxidizing effect of ozone. Peroxides created by ozone administration oxidize cysteines and show long-term antiviral effects that can further reduce viral load.  Once their capsid is removed, virions cannot survive or replicate, and the creation of dysfunctional viruses due to the action of ozone offers unique therapeutic possibilities.

Well, you could oxidize the virus's capsid by setting it on fire, too, but doing that to the viruses in someone's lungs could present a bit of an issue.

Of course, this was the thing about Donald Trump's much-quoted comments about using ultraviolet light exposure or intravenous bleach to kill coronavirus.  Sure, bleach and ultraviolet light can both destroy the virus, but something that kills the pathogens and simultaneously kills you is a little counterproductive, don't you think?

It's always the problem with showing that anything -- be it an antiviral or any other medication -- that works just fine in vitro will have the same effect, and no deleterious side effects, in vivo.  You not only have to demonstrate that the drug accomplishes what you want it to do, but (1) can efficiently get to the part of the body where it's needed, and (2) doesn't destroy healthy tissue along the way.

Rectal insufflation of ozone kind of fails on both counts, doesn't it?  Okay, it probably kills coronavirus, but they're mostly in your lungs, not your rectum, and it's highly damaging to the rest of you.

Having oxidation damage to the delicate lining of your lower gastrointestinal tract would not be fun.  Having that on top of a COVID-19 infection would be a level of misery I can only imagine.

So there we are.  What is probably the stupidest alt-med therapy I've ever heard of.  Of course, I hesitate even to say that, because the alt-med folks seem to look upon this as some sort of challenge.  Every time I think, "Okay, this is it, it can't get any more idiotic than this," they up and exceed their previous record.

As the quote attributed to Einstein so aptly put it: "The difference between genius and stupidity is that genius has its limits."

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This week's Skeptophilia book recommendation is brand new, and is as elegiac as it is inspiring -- David Attenborough's A Life on Our Planet: My Witness Statement and a Vision for the Future.

Attenborough is a familiar name, face, and (especially) voice to those of us who love nature documentaries.  Through series such as Our Planet, Life on Earth, and Planet Earth, he has brought into our homes the beauty of nature -- and its desperate fragility.

At 93, Attenborough's A Life on Our Planet is a fitting coda to his lifelong quest to spark wonder in our minds at the beauty that surrounds us, but at the same time wake us up to the perils of what we're doing to it.  His message isn't all doom and gloom; despite it all, he remains hopeful, and firm in his conviction that we can reverse our course and save what's left of the biodiversity of the Earth.  It's a poignant and evocative work -- something everyone who has been inspired by Attenborough for decades should put on their reading list.

[Note: if you purchase this book using the image/link below, part of the proceeds goes to support Skeptophilia!]

Out in the ozone

Sometimes I run across alternative health therapies that are so freakin' weird I suspect, at least for a time, that the alt-med crowd is trolling us skeptics.  The sad truth is that when I look a little harder, I find that they're almost always completely serious.  And that includes the one that I just found out about yesterday, wherein just about anything that ails you can be cured by...

... blowing ozone up your ass.

Despite the disclaimer in the first paragraph, I feel obliged to reiterate that I'm not making this up.  "Ozone therapy" is a big deal; I've found that it's recommended for sterilizing wounds, treating SARS, AIDS, Ebola (for a third time, I'm not joking), Crohn's disease, rheumatoid arthritis, and various cancers.  Some treatments (as in the wound sterilization) merely wafts ozone over the affected area.  Others involve treatment with "ozonated olive oil," the aforementioned treatment of running a tube up your ass and blowing ozone therein, and (in one case) injecting a bubble of ozone directly into your vein.

The last-mentioned made my jaw drop.  A bubble in your blood vessels is known as an "air embolism," and can kill you.  It doesn't matter what the bubble is composed of.  If it migrates around until it gets into one of the arteries in the brain, you'll have a stroke.

Which means you now have an additional concern beyond a wound, SARS, AIDS, or what-have-you.

But the blow-it-up-your-ass method (known to the alt-med community by the more genteel name of "rectal insufflation") seems to be the most popular, which raises a question; how did anyone ever think of doing this?  I can't imagine being a medical researcher and thinking, "Wow, this ear infection could easily be cured if I just pump a toxic gas up the patient's butt."  Because any way you slice it, ozone is toxic.  It's O₃ (normal oxygen is O₂) and unsurprisingly is an unstable, highly reactive strong oxidizer. It does kill bacteria -- thus the suggestion that it'd be a good wound sterilizer -- but the problem is, the same properties that make it toxic to bacteria make it toxic to healthy cells.  Hell, single malt scotch kills bacteria, and I don't hear anyone proposing single malt scotch therapy.  (Although after doing this research, I'm seriously considering it.)

In fact, ozone is produced by electrical and gas-powered equipment (including car engines), and is considered a pollutant by the EPA.  According to the fact sheet about ozone, it "can trigger a variety of health problems including chest pain, coughing, throat irritation, and airway inflammation.  It also can reduce lung function and harm lung tissue.  Ozone can worsen bronchitis, emphysema, and asthma."

So positive health effects?  Not so much.

An ozone molecule [Image is in the Public Domain]

After spending over an hour searching, I only found one legitimate-sounding paper that took the idea of rectal insufflation seriously.  Titled "The Effect of Rectal Ozone on the Portal Vein Oxygenation and Pharmacokinetics of Propranolol in Liver Cirrhosis (A Preliminary Human Study)" by Saad Zaky, Ehab Ahmad Fouad, and Hassan Ibrahim Mohamad Kotb of Assiut University in Egypt.  The study was published back in 2011, and the authors kind of disappeared from the world of research publication afterwards, which says something.  Also, I notice that the one major effect they mention is that in their fifteen patients (yes, the sample size was that small), they saw an increase in oxygenation in the hepatic portal vein.

Oh, did I mention that what they blew up their patients' asses was 40% ozone -- and 60% oxygen?  Funny how that might increase your blood's oxygen saturation.

Of course there were plenty of sites advertising ozone machines and ozone therapy clinics and equipment so you can "insufflate" your own ass.  But it's unsurprising those weren't exactly peer-reviewed research, given that these people are making a bundle from the desperate and the gullible.

On the other hand, the sites explaining the complete lack of evidence that this has any therapeutic effect were numerous and vitriolic.  Here's what Andy Lewis, over at The Quackometer, has to say:

O₂ is what we breathe and absorb in our lungs for transport to our cells.  O₃ is a highly oxidising form of oxygen that has very harmful effects on our respiratory systems.  As such, if you squirt ozone on cancer cells on a dish they will die – but then so will all cells.  Cancer therapies work, in the main, by exploiting poisons that kill cancer cells faster than non-cancer cells.  This is pretty hard in practice as cancer cells are very, very similar to normal cells.  The mere fact that a poison kills cancer cells in a test tube does not mean that it can form a therapy...  Ozone has been proclaimed as a miraculous cure for over a hundred years.  There is yet to be any meaningful evidence that it can help cancer patients.  The available good evidence so far suggests that harms will outweigh any potential benefits.

Then there's Paula Kurtzweil, at Quackwatch, who tells the story of a couple in Florida who were fined and sentenced to prison terms for claiming people with AIDS and cancer could be cured by their magic ozone machines:

Proponents of medical ozone generators believe ozone can kill viruses and bacteria in the body. While ozone is used as a germicide in the cleaning of manufacturing equipment, FDA is not aware of any scientific data that supports the safety or effectiveness of ozone generators for treating medical conditions. In fact, the agency believes that at the levels needed to work effectively as a germicide, ozone could be detrimental to human health.

"These devices keep popping up," says Bob Gatling, a biomedical engineer and director of the program operations staff in FDA's Center for Devices and Radiological Health.  "We always tell their makers, 'Show us some data,' but no one ever pursues it." 

FDA's knowledge of [alternative medicine practitioner Kenneth] Thiefault's involvement in ozone generators dates to at least 1990, when Thiefault was interviewed during an FDA criminal investigation of one of Thiefault's associates.  This associate was later prosecuted and imprisoned for, among other things, manufacturing and selling ozone generators for treating medical conditions.  After release from prison, he returned to making and distributing ozone generators for treating medical conditions but fled the country before he could be prosecuted again.

Also from Quackwatch, here's Dr. Saul Green's take on it:

In 1991, Wells et al. reported that gaseous ozone inactivated cell-free HIV-l in cell-free culture medium.  Using escalating concentrations of ozone, they showed that a l200 ppm dose delivered into the solution for two hours, reduced the number of infectious viruses... and detectable virions about 85%.  However, there was also a significant reduction in infectivity after virus exposure to nitrogen.  Other factors influencing the rate and degree of inactivation of HIV-I by ozone were protein and plasma components in the culture medium.  (HIV is known to be inactivated by a host of relatively inactive substances.)  While ozone might be useful in rendering commercial blood products free of infectious organisms, more extensive analyses of the HIV-I life cycle was needed before ozone's usefulness as an in vivo anti-retroviral agent could be defined.  Poiesz, Wells' co-author, wrote, "No further in vitro work has been done and to my knowledge no in vivo work has been done."

The alt-med monitoring site What's the Harm? lists thirteen people who sought out ozone therapy -- one of them paid $23,000 for it -- instead of legitimate treatment modalities, and found out that it is definitely not a miracle cure.

Because they died.

So anyhow.  If you have a chronic disease, and (for some reason) decide that the best treatment would be to insufflate your rectum with toxic gas, I would exhort you to reconsider.  There is no reliable peer-reviewed research that it provides any benefits whatsoever, and (cf. the word "toxic" in the previous sentence) can kill healthy tissue.  Now, y'all will have to excuse me, because I think I need some single malt scotch therapy after all.

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This week's book recommendation is a brilliant overview of cognitive biases and logical fallacies, Rolf Dobelli's The Art of Thinking Clearly.  If you're interested in critical thinking, it's a must-read; and even folks well-versed in the ins and outs of skepticism will learn something from Dobelli's crystal-clear prose.