Welcome to my blog

Hello. I am iciclehunter and this is my diary. My job title is "osteopath", and my work is hunting for clues, detective work, problem-solving. These things involve reason and science, but are not limited by them. They also involve the eye of experience, and "hunches". Thus, some would regard my activities as those of a quack, a title I assume here with irony. I am writing this blog because I like writing. I am quite opinionated, and perhaps I suffer from a repressed need for expression. I have no particular prior "agenda"; if I have any bees in my bonnet, no doubt they will make themselves apparent by their buzzing. All names and identifying details of any people featuring in these anecdotes have been changed. Thank you for reading.

Friday, 29 July 2016

Wow! How does that work?

Children are imbued with a sense of wonder. Some people maintain this for the rest of their lives. Scientists, like poets, have that sense of wonder. That's why they always want to find out how and why. Do you remember science lessons at school? Some of us found them interesting, some fascinating, few actually boring. We learned wonderful stuff about a world which was for us mysterious. I am one of those who found science lessons fascinating and who are still filled with wonder at the world. It saddens me that many people, especially people of an "alternative" inclination, have become dismissive of or cynical about science.

It is understandable. It is easy for my generation to misunderstand science because actually, in science lessons we didn't learn much about science! How so? Well, if for example you learn cool stuff like that there was a 12 m long predatory reptile called Tyrannosaurs rex that roamed the Earth 67 million years ago (Wow!), or how eye colour is determined by the genes, or the nature of water, or how one bacterium becomes a hundred million bacteria, or what a clone is, or how a drone flies... you are learning information, facts, but you are not learning science. Science is not facts, science is the process by which we find things out.

We didn't learn too much about that process during school science lessons in the 1970s, we only learned the information that has derived from it. And we didn't learn that information gained from scientific work isn't the same as facts. There were exceptions, but that was the general case. Things may have changed, but judging from what I read and hear from people around me, I think probably not. Not teaching children about the process of science in science lessons is responsible for a wholesale misunderstanding of science in the majority of people, who do not go onto study it at a higher level. And that misunderstanding is responsible for a widespread tendency to be cynical about or dismissive of science.

It is a pity because essentially the scientific process starts and ends with a sense of wonder. It starts with a "Wow... look at that!" and ends with another "Wow!", which is also another beginning. In between there is some technical stuff. It goes something like this:
  1. Wow! Look at that! I wonder how that works?
  2. Here's my theory. I think it works like this.
  3. Let's carry out some sort of test to see if my theory can explain what we observed.
  4. OK. Now we have some information from our test. Hmm... just looks like a chaotic lot of numbers to me. We need to do some kind of maths to sort it out and see if there's any meaningful pattern there.
  5. Hey! There is a meaningful pattern, and it seems consistent with my theory! Let's see if when we do the whole thing again it gives the same sort of result. But let's make the test bigger, including lots more examples of the thing we are investigating. That way we'll get more reliable information.
  6. Yeah, same result! Now let's tell people about it and wait and see if others can confirm what we seem to have found out.
  7. Yes, they can! So, let's say my theory is right unless any further information contradicts it, then we'll have to look at things again.
  8. Uh, oh. Look at that! My theory can't explain that. I wonder how that works then! We might have to change my theory, or even ditch it. Let's try to come up with a better theory.
  9. Come to think of it, think of all the possibilities this opens up. "Wow!" (Back to Nº1).
So, information isn't facts. It just informs our current understanding of the world. New information might change that. But much of the general public, the press, and politicians think that science is supposed to "discover" and "prove" absolute, unassailable, timeless facts. This is mistaken. Science does not do that and doesn't say it does that. That is not what is written on the tin. So it is not fair to be upset with science when it fails to do what it is unrealistic to expect it to do. It still does lots of other good things!

And the mistaken belief that information is the same as facts leads to disastrous results. At its most banal, it leads to the attitude that "You can never trust what scientists say, they're always changing their minds". The press is more than happy to feed such attitudes by reporting initial and partial information as "a new discovery", because fundamentally, the press sells headlines: no new headlines, no news, no sales. More seriously, it leads to potentially disastrous public policy decisions, such as the widespread public health advice to cut out dietary fats, which reigned supreme from the 1980s to the 2010s.

Unfortunately, and here the cynics have a point, this last example was all the more serious because the misunderstanding of science was aided and abetted by scientists themselves. The orthodoxy, guardians of the "scientific consensus", had achieved such an inflated view of its own importance and gravity (this happens from time to time), that it lost sight of the fact that while "we can only work on the basis of what we currently think we know", it is often wiser to not intervene in important matters when it is likely we do not know enough to do so intelligently.

There, self-importance prevailed over wisdom. This is a human trait to which scientists are just as prone as politicians and journalists. But none of this means that science, used but not abused, is anything other than a wonderful tool for improving our understanding of our wonderful world. It is not the only way to learn about our world, and it has its limitations, but it still is a wonderful tool.

I will continue to walk the world in childlike awe.

Monday, 25 July 2016

Is my diagnosis correct?

Many people come to me for second opinions about what is wrong with them. There are various reasons why they may not be confident in the diagnoses they have been given, some valid, some not. But almost universally there is confusion over what a diagnosis is and how it is or is not useful. I do not blame my patients for this, I blame the doctors who have not explained these things to them or do not know them themselves. After all, "diagnosis" is their term, it is not mine.

"Diagnosis" comes from Greek roots which mean "know apart" or "distinguish between". In medicine it means finding out or knowing the nature and cause of a disease. Medical words that do not describe a cause are not diagnoses: "sciatica" for example. This is a symptom, which could have various causes. A favourite of mine much used by Spanish doctors is "lumbago" (archaic in English). "You have lumbago", they tell their patients. What does "lumbago" mean? It means pain in the low back region. You know that already. That's why you went to the doctor! What a brilliant diagnosis! It has succeeded in "distinguishing between" low back pain, which you told the doctor you had, and, say, middle or upper back pain. Astonishing. In English speaking countries the equivalent is the slightly more sciency-sounding but equally useless "Non-specific low back pain".

The other day a nice lady came wanting to know if her diagnosis was correct. She had low back pain and her scan showed problems with the disks between the vertebra. The doctor's diagnosis was "degenerative disk disease" (degeneration of the disks). However, a massage therapist she spoke to had said she thought the pain came from some internal organ. Abdominal scans found a cyst in her abdomen and stones in her kidneys. So now she was confused about what "the" cause of her pain really was.

Let us start with the doctor's diagnosis. Degeneration of the disks happens slowly over many years. Yet her pain started only a few months ago. Therefore, she had degenerative disk disease (DDD) even when she was not in pain, so her pain is not in a one-to-one relationship with the DDD. All right, it is true that pain may occur once a certain threshold is reached, and reaching the threshold may happen slowly. Yet even so, science informs us that X-ray and scan pictures of joint or disk degeneration of the spine have only a poor correspondence with patients' pain. So the "diagnosis" of degenerative disk disease cannot confidently be said to be a statement of "cause" in her case, as in many others.

It might simply be a coincidental finding. In that case treating the disks would be barking up the wrong tree. In practice it doesn't matter, since unless the diagnosis is certain and the disk problem is very serious (when surgery might be indicated), nobody really treats the disks. The doctor would give you medication for pain, not for disk or back pain in particular, just pain in general. What was the scan for then? To rule out worse things, which might need surgery or more specific treatment.

What about the abdominal cyst? It is on the wrong side. Usually pain from the abdominal viscera radiates to the same side of the back. What about the kidney stones? The site of her pain was not typical for pain coming from the kidneys or urinary passages.

So what is the cause? The problem is with that word, "the". What if the idea of looking for one, single, simple cause were woefully mistaken? What if there is no one, single, simple cause?

Think of this. Think not of causes but of vulnerabilities. This lady has several:
  • Degenerative disk disease.
  • Abnormalities in the abdomen with the potential to irritate nerves affecting the spinal muscles.
  • An extreme sensitivity to cold. Even at 30ºC she feels cold. Cool drafts worsen her pain.
  • Stress. Before the onset of her pain she went through a long period of emotional upset.
  • Anxiety. She worries a lot about all sorts of ordinary things. Anxiety can trigger pain or make it worse.
  • Postural and mechanical strain. She has a less than optimal posture and has put considerable strain on her body.
  • Central sensitisation: her pain is disproportionately sensitive to gentle stimuli; this implies the nervous system is "sensitised". She feels disproportionately high levels of pain.
None of these are "the" cause but they are all potentially influential factors. Any one may not be enough. Put two or more together and you may have a problem.

That is what an osteopathic explanation looks like. I do not wish to borrow the doctors' word of "diagnosis", because that would force me to put things in little labelled boxes for convenience, when real life isn't like that at all.

In the field of pain, a "diagnosis" is sometimes so reductive it is next to useless. As a result, I cannot consider or treat your condition on the basis of a medical "diagnosis". If you want somebody to do that, you will need to go to your doctor.

Saturday, 23 July 2016

Do I need an X-ray?

This is a question patients ask me if they haven't improved after one treatment.

Let me leave aside for a moment the fact that sometimes, expecting to feel an improvement after one osteopathic treatment is like expecting to feel an improvement from a bacterial infection after taking just the first antibiotic pill of a ten day course of treatment; and try to answer the question.

There is a religious belief in Melanesia which has been called the cargo cult:

"It was oriented around the concept of cargo which the islanders perceived as the source of the wealth and power of the Europeans and Americans. This religion ... held that if the proper ceremonies were performed shipments of riches would be sent from some heavenly place."

"The Cargo Cult members built replicas of airports and airplanes out of twigs and branches and made the sounds associated with airplanes to try to activate the shipment of cargo." (1)

The belief in X-rays by modern western people with back pain has extraordinary similarities with the cargo cult of the South Pacific. The X-ray is the ceremony which must be performed in order that understanding and cure will be sent from some semi God-like figure (the Doctor). Like the cargo cult it is based on a misunderstanding of an alien technical system. Unlike the cargo cult, the blame for the misunderstanding can be laid squarely on somebody's doorstep: the doctors themselves, who have inculcated this belief in their patients by the overuse of X-rays.

Let me tell it to you straight: most cases I see gain nothing really useful from having X-rays taken. So let me tell you why you don't need an X-ray, before telling you some of the good reasons for having one taken (the exceptions):

You probably don't need an x-ray because:
  1.  "Abnormal" findings on X-ray often mean very little. Know this and you will know something most doctors don't know or choose to ignore. Proper scientific studies show relatively little correspondence between X-ray findings and presence/absence/severity/quality of patients' symptoms. In other words, even if some abnormality is found on X-ray, there is usually no reason to believe that that is necessarily the cause of your symptoms. It may be just coincidental, or it may be just one minor factor in the production of your symptoms.
  2. Even if we do believe that abnormalities found on X-ray are responsible for your symptoms, knowing that usually does not change the treatment and management in any way. Whether we knew your "diagnosis" or not, we would treat you in the same way. In a sense, with much musculoskeletal pain, your medical "diagnosis" is commonly irrelevant.
  3. A good clinician is usually able, without X-ray, to derive sufficient information about a patient's condition to establish (on the balance of probability) the absence of serious disease, and to plan an appropriate course of treatment.
  4. X-rays are toxic to life. One X-ray most probably won't be enough to give you cancer, but each and every X-ray does add to your cancer risk.
You might need an x-ray if your doctor or health care provider:
  1. Suspects the presence of serious underlying disease.
  2. Does not suspect the presence of serious pathology, but must advise investigations to rule it out, because you are not progressing as expected while on the prescribed treatment plan.
  3. Suspects the presence of disease that, though not serious, should be referred to another practitioner.
Good clinicians are always alert for suspect symptoms or physical signs. But we have to work on a reasonable assessment of probabilities. We cannot always be right. The answer to that, however, is not an X-ray by default. X-rays are, in any case, not appropriate for the investigation of many disease processes (they can't "see" everything), and are not sufficiently sensitive to show up the first manifestations of disease.

A note to cargo cultists: X-ray deficiency is not a cause of illness!

(1) http://www.sjsu.edu/faculty/watkins/cargocult.htm

Thursday, 21 July 2016

Getting to the bottom of the tensing response

All mammals produce some similar basic responses to threat. Two very basic emotional responses are fear and anger. One basic behavioural one is to tense the muscles of the shoulders ("raising the hackles"), neck and jaw, in readiness for defence or attack. These are not the only kinds of responses but they are very common options in a small range of basic ones. Human beings are not exempt from this.  Fear and anger are the basic foundations of what we know as anxiety. Our shoulder, neck and jaw muscles still tense in response to a perceived threat ("stress"), even though it is no longer the done thing to sink your teeth into your interlocutor or to turn tail and run away. We all tense these muscles when stressed, but some of us do it more than others.

The muscles over our shoulders have been called the "barometers of the emotions". Some of us tense them so frequently that it becomes an ingrained habit that is almost part of our very identity. Then events and circumstances which are not important threats cause an exaggerated tensing response. Often, this habit causes these muscles to remain tense the whole time. At this stage, we are no longer responding to specific events or circumstances, we are responding to the world at large and in general. It is as though we have decided that the world is a threat and we have to be constantly in a state of heightened alarm, on our guard against disaster. What was originally a specific and proportional response to specific events has become a general and permanent attitude to everything!

What has caused this attitude to develop? My belief is that it begins in our formative years of life, or even earlier, during our life in the womb. There is some evidence that an anxious mother during pregnancy bears a child predisposed to anxiety. Also, I believe that during our teenage years we are particularly susceptible to the moulding of our personalities by the events and circumstances around us. Nevertheless, the period in a child's life between zero and eight years probably provides the most fertile ground for the conditioning of the responses and attitudes that will become part of the adult person's enduring personality. Some circumstances then, in our early childhood or formative years, have set up a ready attitude of fear or anger. The most likely source is our interactions with the significant people in our lives, notably our parents, teachers, or carers.

Is their any way we can change this? I think the only real way is to go through a process of recognition and acknowledgement of the basic emotion behind our attitudes and responses, to realise where this came from, and to express in some form our thoughts and feelings about that, before making a decision to be free of its power over us. If you are affected by frequent or constant shoulder and neck muscle tension, there is a basic emotion bound up in that tension, an emotion with tethers that may go right back to your early childhood. One lady who was troubled by quite persistent inflammation of the joint where the collar bone meets the shoulder said to me, "I have this image of being a bird whose wings have been clipped". She had wanted to sing, but her aspiration had always been trodden down by dismissal or ridicule. I am guessing, but I would say it is likely that her creative urges were already being ignored, dismissed or even discouraged quite early on.

To recognise the basic emotions underlying the chronic tension in your shoulder, neck and jaw muscles requires an effort of introspection and self-awareness. Here is a snippet of conversation to illustrate this kind of introspection and self-awareness. This, by the way, is part of my own conversation with myself.

Q: Give me a word or an image to describe how you feel when your neck and shoulders are tense?
A: Pressure. A large ugly ogre is gripping my shoulders and pushing them down.
Q: Pressure to do what?
A: To be good enough, and to conform.
Q: Good enough for what? Conform to what?
A: Worthy of attention. Conform to expectations.
Q: Whose attention and whose expectations?
A: The attention of people I care about. My own expectations.
Q: Only your own?
A: No, I used to feel anxious if I stood out among others, but not now. So, there was a tension between my self perception and what I imagined others expected of me. Anybody around me who could observe me.
Q: Do you remember when you first felt that anxiety?
A: Yes, when I was a small child I hated people looking at me or talking about me.
Q: Were you afraid of being observed?
A: Yes, I suppose you could say it was fear.
Q: Fear of...?
A: Being judged negatively.
Q: Why should you have been judged badly?
A: I guess I wasn't confident in myself, somehow I didn't think I was good enough.
Q: You said you wanted to be worthy of the attention of people you care about. Can you remember when you first felt that?
A: Yes, when I was very small my brother, who was eighteen months older than me, was always being told interesting things by my dad - a scientist - who assumed that he, being older, was of a better age to understand them. I was envious of that attention.
 Q: Do you resent that?
A: I was hurt. I don't know if I was resentful. I have been angry in my adult life, but I don't think it was about that. I think it was about later injustices, mainly perpetrated by teachers. And that was because of the business of my doing things differently, against the necessity to conform to normal standards.
Q: So you felt an unjust limitation of your freedom?
A: That is correct, and the anger that comes from being punished for trying the boundaries.
Q: When did you first feel that?
A: I suppose in my early teens.
Q: Why did you feel different?
A: Perhaps I did not feel my worth was recognised, so I developed a tendency to take risks, to do things that were out of the ordinary.
Q: So, we go back to your feelings of being treated as less worthy?
A: Yes.
Q: How do you feel about that now?
A: I feel good. It was a misunderstanding on my father's part and a misconception on mine, both of which are entirely understandable. Parenting is not easy. We live and learn. I have learned from reflecting on these and other experiences and I am a better, more rounded person for it.

This recognition, confession, disclosure is therapeutic in itself. You will be amazed at how it takes the tension away. Sometimes it is not so easy, or not easy at all. My example above is relatively mild and commonplace. Nevertheless, the same applies to more traumatic experiences. The important thing is not to get stuck in an endless cycle of mulling over the same thoughts time and time again, but always to move forwards towards greater freedom. As an aid in this, I am a great believer in self-expression, and I don't mean necessarily pouring out your soul in words to another person. I mean using art: painting, writing, poetry, music, dance, sculpture, whatever; to let your inner world express itself in ways which don't necessarily require rational explanation or intellectual analysis.

Monday, 18 July 2016

How does osteopathy work?

I am assuming here that it does. Some readers may not like that assumption, but nevertheless, there it is.

I am mostly concerned with chronic (more longer lasting situations). Why? It is normal to feel unwell or to be in pain from time to time, and it is normal to recover within a certain time period. If that happens, there is nothing wrong with you, you are healthy. It may be that you choose to seek relief sooner than the natural course of the problem will allow, and that may or may not be a good idea depending on the circumstances, but the fact remains, basically you are healthy. I am more concerned with situations in which there is actually a problem, that is, when the normal return to a symptom free existence is delayed, incomplete or absent. So what follows is of special relevance to these cases.

Let's look at the big picture first. First, strain causes pain. It may be physical or psychological strain, it doesn't matter, the result is the same. Then, if normal resolution is not achieved, vicious cycles are set up. What we are trying to do is to break or rewind these vicious cycles. Here is a (highly simplified!) example of some vicious cycles:

The effects of osteopathy that, in my opinion, can help to chip away at these vicious cycles until they start to break down, are various:
  • Judiciously dosed mechanical stimulation can desensitise sensitive (painful) tissues in the short term. 
  • Mechanical stimuli set up short-term physiological responses in the body. These typically come to a peak before settling down to a baseline level. Often the baseline after this "settling" is more normal than it was previously. 
  • Mechanical stimulation can increase blood flow through damaged or sensitised tissues. Blood is healing: it brings oxygen, nutrients and immune cells, and it takes away wastes and biological debris.
  • Manual treatment can be relaxing to the mind, the nervous system, the muscles, the smooth muscle of the viscera. Relaxation opens a window of opportunity for healing.
  • Manual treatment can reduce strain in the body by ensuring that gravitational and other mechanical forces are distributed through the body in a more balanced way. This in turn feeds into the four effects listed above, making them longer term instead of short term.
  • Living tissues adapt to the physical demands placed upon them. For this reason, mechanical inputs from manual treatment, as well as appropriate changes in mechanical inputs through lifestyle changes, can help to re-model the body. This allows the reduced strain mentioned in the previous point to become a more permanent feature.

Friday, 15 July 2016

Creating a context for healing

As a health practitioner, over the past months I have shifted my therapeutic model to a slightly different perspective. There has always been much hoo-ha in alternative medical circles about dealing with causes rather than symptoms, but all too frequently this is a lot of hubris or dogma or both. Some practitioners' ideas about what it actually means to deal with root causes are laughably simplistic. In complex cases, and all chronic cases are complex, I have always preferred to think in terms of influences rather than "causes", and clouds of relationships rather than distinct straight lines with arrows. I have, hitherto, framed the problem thus: rather than seeking the name of a patient's special disease, I try to understand how and why a person has fallen from health. I got that idea from the late Professor Philip Greenman some years ago.

However, more recently I have begun to think in slightly different terms. It is a question of emphasis. Now I think: what can we do to create the best context for healing? There are two aspects to this: firstly, achieving environmental and behavioural conditions conducive to healing, and secondly, the direct therapeutic intervention in the person's physiology, if required. Achieving environmental and behavioural conditions conducive to healing means attention to such things as living and working conditions, diet and hydration, lifestyle and activities. The direct intervention in my case, as an osteopath, means attempts to achieve so far as possible an architecturally and mechanically balanced and coordinated system with a good balance between flexibility and stability in all its parts and as a whole, mediated by tissues with a certain sense of vitality to the touch (a complex of sensations in which right elasticity plays an important role).

Now, you could say this is a removal of causes (e.g. predisposing or maintaining factors), but I have found this idea to be less useful in explaining things, especially to patients, than the other idea of creating a context for healing. I think this is because since a very long time ago people in Western cultures, in explaining anything, have habitually employed the idea of distinct causes, and it is so easy to be simplistic about this and fall into flawed reasoning. On the other hand, creating a healing context is also an appealingly simple idea, but one that is less susceptible to over-simplistic interpretations.

Wednesday, 22 June 2016

So you think your cold is caused by a nasty bug?

At the beginning of June I went for my first swim of the season, foolishly stayed 45 minutes in the cool water, and got a bad cold. Then I was told by several friends, relatives and acquaintances, very sensible people all, “Oh, but you don’t get a cold from getting cold, colds are caused by viruses”. This post is for them.

I feel like banging my head repeatedly on the floor when I hear this sort of thing. Here are normal, sensible, intelligent people with some small exposure to the concepts of science, who use that knowledge to come to obviously false conclusions, largely because of a failure of common western culture to come to terms with the complex nature of the world... and even if to accept those conclusions one has to disregard the most obvious common experiences.

Our western culture seems still to be trapped in a simplistic, unreal world view that says, “Every effect has one simple cause and there is a straight line with an arrow running from the latter to the former”. That view, quite simply, is wrong. In fact it is quite bizarre that anybody should still hold it.

Let me put to all you microbe extremists what the relevance of getting cold might be to “catching” a cold:
  1. You might catch a cold if exposed to cold viruses, but on the other hand you might not.
  2. The difference depends on how many viruses are around and, crucially, how susceptible you are to them.
  3. Your susceptibility depends on many things: the status and settings of your immune system, your general health, your nutritional status, the efficiency of your circulation, and so on. Add to that all the factors we know nothing about.
  4. Among the things that influence your susceptibility are local variations in the temperature of the tissues to which the virus attaches, primarily the lining and superficial tissues of the nose and throat.
  5. Cold viruses like cool temperatures. That is why more people catch colds is the winter. Perhaps you hadn’t noticed?
  6. When you get cold, blood is shunted from surface tissues deeper into the body, so the surface tissues get slightly cooler. Therefore they are more susceptible to attack by cold viruses.
If you don’t believe me, in 2015, scientists finally caught up with this. They scratched their heads and exclaimed, “Hey… but it does actually seem that people catch more colds in cold weather. Let’s see if it’s true, and why that might be”. See here and here for their conclusions, so revolutionary that they should immediately get the Nobel prize. For finding out the bleedin' obvious.

So, you cold weather deniers, do you see now how more than one factor can combine to produce a certain result? Do you see also that the world could be a little more complex than you have been taught to believe?

Let me talk a little now about “causes”. In 1884 a fellow named Robert Koch devised some rules which must be satisfied in order for us to be able to say that such and such a bug is the “causal agent” responsible for producing such and such a disease. These rules are called Koch’s postulates. Here they are:
  1. The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy organisms.
  2. The microorganism must be isolated from a diseased organism and grown in pure culture.*
  3. The cultured microorganism should cause disease when introduced into a healthy organism.
  4. The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.
(* “in pure culture” = on a nutrient medium in a dish/tube in the laboratory).

Koch soon realised his rules didn’t work, when he discovered people could carry cholera and other bacteria without developing any symptoms of their corresponding “disease” (contrary to rule number 1), and that he could actually introduce their bacteria into healthy people without them causing disease (disobeying his third rule). How dare they disobey?! Moreover, it is now known that various microorganisms (including all viruses) isolated from animals with their corresponding “disease” cannot be grown in pure culture (rule 3).

Today, the “rules” have changed. Now the identification of so-called “causal agents” is based not on the presence of the microorganisms themselves, but on detection of a kind of chemical they contain which is involved in their reproduction: nucleic acids. Thus we have some new rules devised by two scientists called Fredricks and Relman. I have adapted them here for a general readership.
  1. The kinds of nucleic acids belonging to the microorganism should be present in most people with the disease. They should be found mostly in the parts of the body known to be diseased, and not in those organs that are not diseased.
  2. Less (or none) of these nucleic acids should be found occur in people without the disease.
  3. With resolution of the disease, these nucleic acids should decrease or become undetectable, and with relapse of the disease the opposite should occur.
  4. The organism is more likely to be the cause of the disease when its nucleic acids are found prior to the onset of the disease, or when their amount correlates with the severity of the disease.
  5. Foreign nucleic acids found in a diseased person should be consistent with the known characteristics of the kind of organism believed to be responsible.
  6. It should be able consistently to identify chemical and biological changes in the cells of diseased people which correlate to the presence of the foreign nucleic acids.
But these rules do not work either. Rule 1 is non-committal. “Most” people? What about the exceptions? And rule 2… “less” or “none”? If “less”, how did that foreign chemical get there, even if in a lesser amount, and what then, is its significance? Or shall we just ignore it and hope it goes away? Moreover, these rules rely on a definition of what constitutes “disease” which is unstated, and most probably arguable. Moreover, at a practical level, these new rules do not account for all cases of infection (e.g. diseases caused by prions such as “mad cow” disease) or diseases triggered by infection (e.g. cervical cancer resulting from papillomavirus infection).

Now, all these rules would be perfectly good and reasonable if the world worked in terms of having one cause for one effect. But when Koch’s original rules didn’t work, rather than admitting that the model of a bug “causing” a disease is an overly simplistic idea, scientists tried to move the goalposts in order that they could hang onto that delusion.

Given that (as we have explained) in real life various factors must interact in order to produce a certain result, especially in biology, why do we insist upon saying ONE thing “causes” another (ONE) thing. It is almost as unrealistic to say that colds are “caused” by viruses as is it is to say they are “caused” by getting cold.