Friday, August 26, 2016

UPDATED::Like it says, black salve is BS

UPDATE::  A good look at Black Salve from a UK perspective by Myles Power,,,

This is some of the double-dare ya stupidity that is being passed along on the inter-web.  I leave the group name as it is not private, but "closed" with any member able to add new members.  Also stated within their own description, this is a business site with 9000+ "members", and they sell "bloodroot" salve and products.  [Courtesy of BSIDQ]
Admin are managers of ZenithHerbal, who make bloodroot products, and also manage - an information site where you will find most answers.
Be forewarned, this post includes what some may consider disturbing pictures and descriptions!

As I mentioned in my previous post concerning Monika Milka, she shared the following article with commentary (7/12/2106 904AM):
While her commentary has the usual big pHARMa/pHARMa shill gambits (taken directly from the tone of the article), that is not my interest ATM.  What is at issue, she is promoting a "product" or substance that not only fails in efficacy, but causes serious harm as well.

So, began my initial posting concerning BS (also know as Cansema and various other names). After my two preceding posts, I had hemmed and hawed at continuing, as many words have been aimed directly at Monika's Entity.  But then I had a conversation with a young co-worker and I realized people don't know what BS is,
Black Salves are corrosive substances, classified as ‘escharotics’. Escharotics are substances which cause tissue to die and slough off. Black Salve proponents believe that when this escharotic destroys tissue, it is somehow targeting cancer cells – and that when scabs form and fall off, the cancer is being removed from the body.

This is sadly very wrong – there is no mechanism by which black salve can mobilise and destroy cancer cells in a targeted manner; the salve merely damages tissue, healthy or not.
and based on preliminary information gathering, there seems to be 2 or 3 products called BS. 

The other salve(s) or ointment(s) are, "Ichthammol ointment" and "Amish black drawing salve".  I believe it is the "Ichthammol ointment" we are most familiar with from our youth.  Notice that neither contains bloodroot or zinc chloride,
Bituminosulfonates are classified as local therapeutic agents with very good tolerability. Pharmacologically, Ichthammol has anti-inflammatory, bactericidal, and fungicidal properties. It is used to treat eczema, psoriasis, Acne rosacea and acne, and it decreases microorganisms in the area surrounding a skin condition. It is commonly used in 10% or 20% concentrate ointment, applied topically. [Internal citations removed.]
That is what this post will try and address, what is this product that burns off noses?

Or as the following shows, puts a hole in your head.

I am not going to touch ingestion or internal use,,, sigh, I lied a wee bit.
The “natural” escharotic treatment alternative for cervical dysplasia involves applying a solution of bloodroot (Sanguinaria canadensis) and zinc chloride. They claim that the solution selectively kills abnormal cells of the cervix while leaving healthy cells unaffected. That claim is almost certainly false, and the efficacy and safety of escharotic treatment has not been properly tested or compared to conventional treatment.
So while this is a Monika's Entity inspired post, it has nothing to do with her.  "Leaky gut" phenomenon will be another, although that is a planned topic.

First thing you will notice about the article, there are no citations to be found, but claims galore.
Black salve, hailed as the most effective, natural skin cancer remedy available today, has saved thousands of lives world wide leaving the $30 billion Australian pharmaceutical industry stewing in its wake.

Anecdotal evidence
This writer has used it and has seen the results in others where it left no scarring or had any adverse side effect.

One elderly Atherton patient was sent home from hospital to die, suffering from a huge malignant ulcer on his leg after telling the hospital he did not want his leg amputated.

A relative treated him with black salve and within two months his leg had healed and he was walking on it.
I tend to be the opposite, citations galore.  I plan on keeping it that way.

History of,,,
In a nutshell, Black salve is an alternative cancer-treating remedy that was popular in the early 1900s. The salve, burns the skin tissue, leaving behind what is called eschar (necrotic tissue and hence the name "escharotic agent").  Black salve will cause serious injury and potentially disfigure the skin. Its users believe that black salve will draw out the cancer using corrosive ingredients like zinc chloride and the extract of bloodroot, which attacks and destroys living tissue.

As Orac notes,
In brief, it’s a caustic substance. Usually, it’s derived from bloodroot, but it can also be made from zinc oxide or various herbs. The claim that you will hear from advocates of black salve make is that it somehow “draws out the cancer” if you either apply it as a paste over a tumor, such as a skin cancer, cancerous lymph nodes, or a soft tissue cancer such as a sarcoma. Most commonly, you see it used for melanoma. It can even work sometimes. Unfortunately, it’s how black salve works that is problematic.
As a comment notes, "how BS works" is important. 
Another critical issue, yes this might work, but with surgical removal of the sample you have the benefit of tissue pathology, which is lost by destructino [sic] of the skin and surrounding area. Critical information about the type of tumor and the depth of invasion will be lost that could be relevant to anything from whether or not the lesion was benign to what additional surgical or medical interventions are necessary to control the spread of disease.
You use the shit, you deserve all that is coming to you.  I know it sounds harsh but just looking at the numerous forums, the posting and the pics, why the fuck would you even consider it.

But I digress,,,

So this stuff has been around a while.  There are claims the native Americans used it, (consider the source)
What if we told you there exists a blend of herbs so powerful, effective, and safe for treating cancer that no other conventional treatment even comes close? And what if we told you this same herbal formula only targets malignant cells while leaving healthy cells and other tissue alone? The formula in question actually does exist, and it is traditionally known as Indian black salve, a "magical" cancer cure of sorts that also safely treats viruses and many other health conditions without causing harmful side effects.
or that it is part of the Amish life,
Amish are known for their strict way of life without modern technology and medicine. They live in harmony with nature and are treated exclusively with natural remedies. One of their traditional preparations is a wonderful black salve (Black Drawing Salve) used for many inflammatory conditions, and it is known that it is very effective with infections, cysts and ulcers.  Many people outside the Amish circuits used for these problems, but also for ingrown nails and hair, and cystic acne.
but as I noted above, this "bloodroot" or zinc oxide based product (as exemplified by the NN article as "Indian Black Salve", is not the same as "Ichthammol ointment" or the "drawing salves".

What makes reporting on this stuff so difficult is a point Steve Novella notes,  "The bottom line is that Black Salve is a general name for a topical ointment that is corrosive and is used to burn away skin lesions, including cancer. There are no proper scientific studies of its safety and efficacy, and the exact ingredients are formulas vary and are often not known."

So what is this stuff,,,
Some currently marketed escharotics contain bloodroot (Sanguinaria candensis), zinc chloride, or both. However, because cancer salves are not manufactured under government supervision, it may not even be possible to know what is in them.
So the issue(s) appears to be the inclusion of "bloodroot" and/or zinc chloride.  Many other resources mention this combination as being the damaging culprit(s) and is behind the numerous governmental warnings.

From the abstract,
The use of escharotic or caustic pastes to treat skin cancer is based on the centuries-old observation that selected minerals and plant extracts may be used to destroy certain skin lesions. Zinc chloride and Sanguinaria canadensis (bloodroot) are 2 agents that are used as part of the Mohs chemosurgery fixed-tissue technique. The use of escharotics without surgery has been discredited by allopathic medicine but persists and is promoted among alternative practitioners. Patients may now purchase "herbal supplements" for the primary self-treatment of skin cancer, and physicians will see patients who elect this therapy for their skin cancers.
Escharotic agents are available as herbal supplements and are being used by patients for the treatment of skin cancer. The efficacy of these agents is unproven and their content is unregulated. Serious consequences may result from their use. Conventional medicine has an excellent track record in treating skin cancer. Physicians should recommend against the use of escharotic agents for skin cancer, and the Food and Drug Administration should be given the authority to regulate their production and distribution.

The full article, then drops a bit of history, who and what is Moh's surgery,,,
Escharotics were introduced to Western medicine in the 1930s by Frederic Mohs, who was then a medical student at the University of Wisconsin, Madison, investigating tissue fixation  [preserve the tissue  without changing the structure of the cells] as part of a new surgical treatment for cancer. Mohs chose zinc chloride as a proper tissue fixative based on studies he performed on cancerous and normal rat tissues. Mohs consulted with a pharmacist to create a paste that could be applied to the skin, and the final product, Mohs paste, contained zinc chloride as a fixative, as well as antimony trisulfide for suspension and bloodroot as an organic stabilizer. Mohs proposed that this paste, applied in a carefully calculated manner that accounted for the tumor's depth and diameter, would fix tumor in tissue over a 24-hour period. This process enabled the surgeon to remove a fixed specimen and, following sectioning and staining, immediately review the histologic findings to assess tumor involvement of the surgical margin. The paste application, fixation, and excision of the tumor was repeated daily until the microscopic examination finding was negative for tumor. It should be clarified that Mohs used zinc chloride only as a fixative and Sanguinaria only as an organic stabilizer for his fixative paste. The primary procedure undertaken by Mohs was surgical excision. He coined his technique "chemosurgery," and thus began the long-storied history that has culminated in the widespread use of micrographic surgery.
See also: Mohs' 1941 paper describing his "chemosurgery".

Hoxsey Therapy?
Simultaneously, Harry Hoxsey, the lay cancer specialist responsible for the operation of one of the nation's largest private cancer treatment clinics, developed an herbal tonic and paste that were designed to treat internal and external cancers. Hoxsey based his internal tonic on a family recipe handed down from his great grandfather. It was purported to treat an imbalance of body fluids, thus making the body uninhabitable by malignancy. His paste, however, was much like Mohs', a preparation of antimony sulfide, bloodroot, and zinc chloride. Hoxsey recommended a fingertip application of paste to the affected area with a thin layer of petroleum jelly (Vaseline) to protect the surrounding healthy tissue. Over a period of days to weeks, the affected area would necrose, separate from the surrounding tissue, and fall out.

Even before Hoxsey and Mohs we have the Nichol Escharotic Method

The Nichols Escharotic Method involved the use of escharotic, or caustic, pastes to treat cancerous skin lesions. The pastes, typically arsenic and zinc chlorides, left deep burns, often requiring multiple surgeries after the treatment. It was common for cancer to return within a few years and it often metastasized quickly. The method was quickly regarded as ineffective, and it was phased out by the late 1950's.
You will note that there is some discrepancy between the meme and journal citation as to when Hoxsey's use began.  This does not take away from the overall message that 1] Mohs technique in the use of BS changed, 2] it was used in conjunction with surgery, and 3] the anti's ignore both points in their appeal to authority.

There is a BUT,,,
Hoxsey's therapy never gained ground though Mohs' did; it wasn't until the 50's that Mohs began to abandon the "fixed" tissue technique.
Unfortunately, the technique as it first existed had certain drawbacks, above all a procedure time that could span several days, and severe discomfort accompanying the zinc chloride paste application.

In 1953, Dr. Mohs tried a “fresh-tissue” version of chemosurgery. He was treating a patient with an eyelid basal cell carcinoma, and to avoid irritating the globe of the eye, he skipped the zinc chloride paste. He administered local anesthesia, and without having to wait for a fixative to set, he was able to immediately excise one thin layer of fresh tissue, section it in the usual way, map it, and examine it under the microscope. Finding tumor cells at the margins, he was again able to excise another layer of tissue immediately.

Encouraged, Dr. Mohs began to use this new technique, primarily for skin cancers around the eye. After learning of the technique and excited by the possibilities, dermatologic surgeon Theodore Tromovitch in 1963 began using the fresh-tissue technique on more and more body sites. In December, 1970 at the annual Chemosurgery Conference, he and Sam Stegman, MD , presented 104 cases of surgery “without using zinc chloride chemical fixative,” with only four recurrences. He and Dr. Stegman subsequently published landmark papers reporting high cure rates using the new form of chemosurgery, which they called “chemosurgery fresh tissue technique.” In his 8-year retrospective study, he reported a 97.2 percent cure rate for 532 lesions. [Internal citations removed.]
While I am aware that the ACMS still "advocates" the Mohs procedure, it is above my pay grade and qualification to judge whether it is proper or not, that is best left to the proper medical people.  My interest at this point is only the history of the use of BS and how it came into use and disuse.

What is at issue, the "natural fallacy"
One point to make note of before tackling the "appeal to nature fallacy".   In all the literature read, not including those that favor its use, it has been noted that self diagnosis or improper diagnosis had occurred in a majority of cases; reliance on family or friends to try the product was also prevalent. 

What is important to keep in mind in considering these bits of anecdote, the person(s) concerned may never have seen a doctor and never had a biopsy, but nonetheless is describing a "cure".  By the time proper medical care was sought, it was due to infection (sepsis being common), recurrence, or metastases.

The most oft repeated "claim" from purveyors of the crank, "Black Salve only kills the cancer cells. If you put it on a spot that is not doesn't do anything."  So, you have a very strong stomach for bad outcomes, google "black salve" and look at the photos.  Tell me again why you would do this to yourself!

As I mentioned the primary issue, besides this shit doesn't work is what is called the "Appeal to Nature" .  It goes something like this,
1 N is natural.
2 Therefore, N is good, safe or right.

1 U is unnatural.
2 Therefore, U is bad, unsafe or wrong.
Like all logical fallacies, the argument is invalid as the conclusion does not follow from the premise(s).  As noted,  "the premise(s) can be true but the conclusion can be false." 

As Orac notes concerning how established the NF has become in sCAM thinking,
If there’s one fallacy that grips the brains of proponents of “natural healing,” “holistic medicine,” or, as the vast majority of it is, quackery, it’s an appeal to nature. Basically, the idea that underlies the appeal to nature is a profane worship of nature as being, in essence, perfect, with anything humans do that is perceived as somehow being “unnatural” being viewed as, at the very least, inferior and at the very worst pure evil. We see it in the pseudoscientific stylings of cranks like The Food Babe, whose epic appeals to nature are legendary in their stupidity, particularly her demonization of any chemical perceived as synthetic to the point where she actually says thinks like, “If you can’t pronounce it, you shouldn’t eat it” and “There is just no acceptable level of any chemical to ingest, ever.”

That’s just one example. The appeal to nature undergirds so much of alternative medicine that it’s hard to think of an example of alternative medicine that doesn’t to some extent embrace the this fallacy,,,
Orac's explanation very well sums up what the problems with this fallacy is by citing the Boob, "If you can’t pronounce it, you shouldn't eat it." One example oft used is Digitalis or digoxin which comes from the foxglove plant.  Whether extracted or synthesized, at the wrong dosage it can be toxic and there is a very narrow window between therapeutic and toxic levels.  So would you rather take a well regulated dose or roll the dice.
Plants undeniably produce lots of good stuff. Today researchers are finding useful medicines in plants that have no tradition of use. Taxol, the cancer-fighting product of Pacific yew trees, was discovered by the National Cancer Institute only by screening compounds from thousands of plants.

There is a reason pharmacology abandoned whole plant extracts in favor of isolated active ingredients. The amount of active ingredient in a plant can vary with factors like the variety, the geographic location, the weather, the season, the time of harvest, soil conditions, storage conditions, and the method of preparation. Foxglove contains a mixture of digitalis-type active ingredients but it is difficult to control the dosage. The therapeutic dose of digitalis is very close to the toxic dose. Pharmacologists succeeded in preparing a synthetic version: now the dosage can be controlled, the blood levels can be measured, and an antibody is even available to reverse the drug’s effects if needed.
As Dr. Hall further notes, "that natural medicines are not regulated the way prescription drugs are, thanks to the infamous Diet Supplement and Health Education Act (DSHEA) of 1994."
When you take an herbal remedy, you are taking
  1. An active ingredient that usually has not been adequately tested,
  2. Other components that have not even been identified, much less tested,
  3. An uncertain amount, and
  4. Possible contaminants.
In other words, whereas medicinal plants contain variable and unpredictable quantities of pharmacologically active substances, drugs are precisely dosed and you always know the exact quantity of active ingredient you are getting.
This issue of what is actually in a product is not just a BS issue.

The real issue, "bad" outcomes
And that brings me to some closing thoughts of which I'm going to borrow from Black Salve is dangerous quackery.
There have been endless claims that "my doctor was OK with Black Salve" or "my doctor now recommends Black Salve".

Lets break this down.

If you doctor thinks there is ANY merit whatsoever in black salve, why don't they document your case, with pathology reports, and at least send a LETTER to the correspondence column of a medical journal. ANY medical journal? All it takes is 10 minutes and a photo, sent via email.

If your doctor is seeing consistent success from Black Salve why not put together a case study series and get it published? Its not hard! Why don't they approach their specialist college (oncology or dermatology) and propose a small scale study? These are the lowest grade forms of scientific evidence. I've published links to almost 20 papers and letters like this to journals, all negative about escharotics.
What I find telling is this observation,
The use of black (or red) salve is unproven by even any vaguely scientific measure. How about this from the website
  • "Black Salve has not been subjected to RCTs (randomized controlled trials)."
  • "...until scientific trials have been done, we remain uncertain as to exactly how it works. "
  • "It doesn’t seem to (damage healthy tissue), certainly not to the naked eye.  There may be evidence of damage at the microscopic level, but that’s about all."
  • "...based purely on clinical observations, that Black Salve appears to be very good at killing tumors."
  • "The Black Salve also appears to act as a catalyst (a “reagent”) in mediating an immune response ..."
  • "Users of Black Salve, believe that when Black Salve is applied to cancerous skin lesions, any and every cancer cell associated with that lesion, those laterally and those deep, will be destroyed!"
The italics are all mine, but that's a lot of belief, a lot of 'seems' and 'maybes' and 'appears tos'. It adds up to a lot of uncertainty. And if you look at the site, a lot of it is tied up in medical-sounding jargon, presumably to provide a veneer of  science ("serous fluid",  "leucocytes",  "macrophages", "cytokines" anyone?). It make it way easier to buy into the promise. t's exactly like women at the beauty counter wearing white lab coats. News flash: wearing a white lab coast doesn't make a  retail assistant a scientist.
While I am pleased that some user seem to have found relief or treatment to their alleged cancers.  I ask, is the risk worth it? 
"He believed he had cured his lump whatever it was and went about sharing the wonders of this miracle treatment with all and sundry. However, 18 months later Mark became quite unwell, so unwell that he eventually had to seek the advice of a doctor. Scans revealed secondary melanomas in his bowel liver and oesphagus.

The primary? Yes – it was the lump on his back he had ‘successfully’ removed with ‘black salve’ … that ‘successful removal’ had cost him his life – he was blissfully unaware of the insidious disease he had been harbouring in his body. He still refused convention interventions choosing more natural remedies and died within a month from a very aggressive melanoma! Had Mark had his original lump diagnosed when removed – the outcome may have been very different. He leaves behind a wife and 4 teenage children."
Years ago I could have chose this route to remove what turned out to be a fatty cell cyst on my leg.  I didn't.  I have a small scar from where my doc removed the cyst and the procedure was done in 5 minutes.  I couldn't fathom putting myself through days of ugliness as some "patients" have.  I does not compute.  As I mentioned, if you really want to see some nasty outcomes, just do an image search.  Some of the wounds are just horrifying.

Just as with any medication or remedy that I may consider, this is the type of literature review I partake in.  While I have been pretty lax since my stroke, hopefully I have given a good look at the science surrounding the bullshit that is "black salve".  While it may have its uses in Moh's surgery (again I am not qualified to make that determination), as a home remedy for curing cancer, I give it an F-.  Anecdote is not evidence.

For your viewing pleasure, Monika's Ghost has this to say:

And yes MG's and I are acquainted as we have similar goals though not identical.  I like her snark!!

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