Stuff that occurs to me

All of my 'how to' posts are tagged here. The most popular posts are about blocking and private accounts on Twitter, also the science communication jobs list. None of the science or medical information I might post to this blog should be taken as medical advice (I'm not medically trained).

Think of this blog as a sort of nursery for my half-baked ideas hence 'stuff that occurs to me'.

Contact: @JoBrodie Email: jo DOT brodie AT gmx DOT com

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Saturday, 6 July 2013

What Live Blood Analysts Can't Tell You

On 3 July 2013 the Committee of Advertising Practice (CAP), the body which determines the guidelines that the Advertising Standards Authority uses to decide if an advert is decent, legal, truthful etc, published their findings on what Live Blood Analysts may claim in their marketing materials. This is part of CAP's massive AdviceOnline database.

The last line of their guidance is significant
"CAP is yet to see any evidence for the efficacy of this therapy which, without rigorous evidence to support it, should be advertised on an availability-only platform." (emphasis added). 
This means that anyone offering live blood testing can say that it's available, but not what it's 'for' (because there's no evidence that it's 'for' anything) unless they have really good evidence.

The Live Blood Analysis (LBA) industry has been experiencing close scrutiny from bloggers and skeptics because of the persistently misleading health claims made by a number of its practitioners both in the UK and abroad.

In the UK this scrutiny has resulted in several listings on the Advertising Standards Authority's (ASA) pages for action taken against misleading claims. The action taken ranges from the minor informally resolved cases (where the practitioner / marketer agrees to remove or amend the misleading claims and a note is added to the ASA's pages about this) to the more serious adjudications (which can either be 'upheld' or 'not upheld') - in these cases the marketer has argued their case (either successfully or not) and details of the complaint(s) made, the evidence supplied and the findings of the ASA are published.

The most serious sanction is to be listed on the ASA's 'non-compliant online advertisers' page, for persistent offenders who don't amend their claims. At this point the ASA may pass details of the misleading claims onto Trading Standards and may also work with Google and other search engines to remove advertising from showing up in searches, or the ASA may take out an advert itself. There may also be negative articles written in the press and blogs.

The new CAP guidelines are not a ruling against LBA but they do mean that future complaints against people offering live blood testing will be quicker. Rather than having to go through the deliberations needed for adjudications the complaint can just be passed to the ASA's compliance team. The ASA has already done the work determining that LBA is unevidenced and doesn't need to do so again.

For more on the significance of the new CAP guidelines see

Live Blood Analysis: no health claims allowed (5 July 2013) Josephine Jones' blog
A good week for the reality-based community (5 July 2013) Guy Chapman's blahg

This next part of the post highlights some of the inaccurate claims made about live blood analysis. It's very detailed, you might want to get a cup of tea.

It's important to acknowledge that many people find live blood testing to be beneficial in helping them change their lifestyle and I'm sure plenty of them will be unconvinced by blog posts from people like me who say that live blood analysis is a bogus diagnostic tool. That's fair enough, but if you are thinking of spending money on this test, I recommend keeping your wits about you as this business is unregulated and, anecdotally at least, seems to be used to sell people vitamins and other supplements that they don't necessarily need and could probably get more cheaply from their doctor (if they actually need them).

Things to bear in mind
People selling live blood tests are unlikely to be medically trained so you should really see a doctor if you're concerned about your health. If anyone tells you to stop taking medication (or implies that you will be able to stop taking your medication) treat this advice with caution. If they use the title Doctor or Dr check that they have a proper medical degree (they may have a PhD doctorate which means they are a 'Dr' but not a medical doctor, see CAP's advice on the Use of the term "Dr" and the rulings panel on the right hand side of that page for examples).

What's live blood analysis (LBA)?
LBA involves pricking your finger, taking a small drop of blood and placing it onto a slide to view under a high powered microscope. A camera is attached to the eyepiece of the microscope and the view of the cells is displayed on a monitor letting the customer and live blood analyst see what's in the sample. While it all sounds sciencey it isn't really. The information that LBA practitioners provide in their promotional literature implies that the test will let them see certain things about someone's health, however that information is largely mistaken.

1. Healthy red blood cells
Healthy red blood cells under a microscope, played by Cheerios in a dish

A note on finger-pricking, using a lancet, to collect a drop of blood
Only a tiny drop of blood is needed but this does involve breaking the skin to access it, therefore it is best thought of as 'minimally invasive' rather than 'non-invasive'. In some US states a person who isn't properly trained in collecting blood samples isn't meant to do so and LBA practitioners will let the client use a blood collecting device instead. In the UK, as far as I'm aware, as long as consent is given for the finger to be pricked then this is perfectly fine.

A note on artifacts 
An artifact on a microscope slide of someone's blood is something that was created during the process of preparing the slide and isn't actually anything to do with the person's blood. As Wikipedia says it's "an apparent structural detail that is caused by the processing of the specimen and is thus not a legitimate feature of the specimen." Another article says "in micro­scopy, an artifact is something that looks abnormal or odd but is actually insignificant and is ignored by a trained professional."

Royal Microscopical Society
Hardly any live blood analysts claim that they are members of the RMS, but I thought I'd mention it because this advert for a distance-learning course in nutrition and live blood analysis says that
"Completion of the course the graduate gains a Diploma in Live Blood Analysis & Nutrition. Automatic membership to the British Association of Health and aesthtics and memebrship to the Royal Microscopical Society of Great Britain. "

Ordinary membership of the RMS costs £64 (2013 prices) and the PDF membership form doesn't ask about your competence as a microscopist, or even if you are one, only your areas of interest and nor does the corporate membership form.

Another advert implies that people who've done a similar course will be eligible for professional membership of the RMS although as far as I can see neither of the forms require someone to be a professional microscopist.

Things to watch out for

1. If the person doing your live blood test tells you that they can see bacteria in your blood, watch out - they are probably telling you something that isn't true.
They've been given wrong information in their training and are unwittingly passing this on to you in good faith. It's pretty unlikely that you have bacterial infection in your blood - you would probably be feeling very ill (unlikely to be well enough to want to sit in a clinic looking at your blood on a screen).

Sometimes they might tell you that your blood cells are turning into bacteria (this is simply impossible).
"If the practitioner could actually identify bacteria in the blood, the customer is in danger and should request immediate transfer to the nearest emergency room to be treated for septicemia, a potentially life-threatening infection of the bloodstream" - from this article on live blood cell analysis.
Basically you are very unlikely to have bacteria in your blood and if a live blood tester tells you that you do they are likely mistaken and you should be careful about following their advice or giving them money to 'treat' you.

3. Red blood cells showing signs of yeast
Red blood cells showing signs of a yeast infection, portrayed by Cheerios in a dish, and milk

2. If your live blood analyst tells you that you have yeast in your blood or markers for yeast, watch out - they are probably telling you something that isn't true.
Again, it's not about lying or deliberately misleading you - they are simply mistaken though well-meaning. It's extremely unlikely that you'd have yeast in your blood. You may well have a yeast infection elsewhere (eg thrush) but looking at your blood under a microscope doesn't tell you much about that.
"Some artifacts are mistakenly identified by the practitioner as yeast cells, one of the most common “findings” by alternative practitioners. Yeast cells cannot be seen in the blood of a healthy person for the simple reason that they are not there. An actual fungus (yeast) in the blood is seen in patients who are critically ill with some type of severe immune system deficiency. These individuals also will not be well enough to be wandering about at a health fair" - from this article on live blood cell analysis.

3. If your live blood tester says you have parasites in your blood they are unlikely to be correct
This one is at least slightly more believable, in that it is perfectly possible to detect some parasites in the blood (microscopy is used in detecting malaria for example). However it is unlikely that that is what your live blood analyst is looking at and they have probably confused artifacts introduced into the preparation of the slide for parasites.

A properly trained microscopist could certainly spot the presence of certain parasites in the blood and if you think you might have them (eg you've been bitten by a mosquito in an area where they're known to carry malaria) then a visit to the doctor's a good idea.

If someone says you have parasites, without telling you what they are, watch out if they offer some sort of treatment. They need to know what parasites are present (and further tests might be needed) as that will determine what type of treatment is needed. If they just offer to sell you herbal supplements or vitamins - be cautious.

4. If a practitioner tells you they can spot blood sugar (blood glucose) imbalances by looking at your blood they are going about it the wrong way
There's not very much you can tell about someone's blood glucose levels by looking at their blood under a microscope.

It's far more efficient to measure the concentration of glucose in the blood using a proper blood glucose meter, but it's best to learn about how to make sense of the results from a doctor or nurse. 

Higher levels of glucose in the blood overall does reduce the squishiness of red blood cells, a bit, but I'm not convinced this can easily be picked up under a microscope (and even if it was it could perhaps be caused by things other than blood glucose levels, for example, as the sample dries on the slide).

Although it's superficially plausible - after all you'd expect treacly blood to stick together more and behave slightly differently - it doesn't really work like that. Testing blood glucose levels requires either a blood glucose meter to find out what the levels are now or a glycated haemoglobin (HbA1c) test to give an indication of glucose levels over the past few weeks. Not a microscope.
  • Influence of D- and L-glucose on erythrocytes and blood viscosity (abstract only)
    I can't make a great deal of sense of this one as the abstract suggests that glucose both does and doesn't increase viscosity of blood but I've included it in case anyone wants to use it as a springboard to find other similar papers

  • Hemorheological Disorders in Diabetes Mellitus 
    Rheology is to do with how liquids flow and how soft materials can be compressed (squishiness) and this paper talks about the effect of high blood glucose levels on the squishiness of red blood cells. It makes them less flexible - which is a problem as red blood cells need to be able to squeeze into small spaces to get into the really small capillaries (to bring oxygen to organs). I still don't think it's something that can be seen easily picked up under a microscope, at least not without appropriate training.

    The paper also talks about high glucose levels increasing the aggregation (sticking together-ness) of red blood cells. Live blood analysts often claim that they can spot red blood cells sticking together (forming "rouleaux" - stacks of red blood cells) and undoubtedly they can however this is probably an artifact - as the blood smear on the slide dries there'll be a bit more clumping. If they try and use this as part of a diagnosis, beware.

    There's more information on rouleaux in this article on live blood cell analysis that I've already linked to umpteen times :)

2. Unhealthy red blood cells
Red blood cells under a microscope forming rouleaux, played by Cheerios that were obligingly already stuck together

5. If the live blood microscopist moves the slide around to look at different features of the blood they may be about to tell you something that isn't correct
If the live blood analyst moves the sample so that different bits of it are viewed and tells you that this refers to different organs in your body then they are mistaken. It's likely to be an artifact - the sample of blood will be slightly thicker in the middle and thinner at the edges, where it will dry more quickly.

6. If the analyst says they can spot weaknesses in your organs, eg pancreas stress, they're mistaken
It's nonsense, and there's no need to buy unnecessary supplements, special foods, alkaline water or the tools to make your own alkaline water either. Here's a recent (3 July 2013) ASA adjudication which upheld a complaint made about the claims a company made for their alkaline water product.

7. If someone selling live blood testing tells you it can be used to 'help with', 'treat' or 'cure' a wide range of diseases and conditions they are telling you something that is unlikely to be true
The ASA takes a firm line on a range of conditions that it considers serious and that need to be managed with the support of a healthcare professional. At this point it actually becomes largely irrelevant if the marketer has evidence that they can help, they're simply not allowed to imply that they can help medical conditions unless a doctor is working with them. The fact that (in all ASA adjudications so far) they also haven't been able to demonstrate that they have any evidence hasn't helped the case for live blood testing either.

OK but live blood analysis isn't that harmful is it?
Hopefully not. The procedure for a live blood test only involves a finger-prick to collect some blood - this is minimally invasive (not 'non-invasive' as of course it involves breaking the skin, but it's not really a risk as long as done cleanly and there's no reason to suspect that it isn't).

The risk comes from the poor advice that's given which can be alarming (one woman was told she had markers for cancer in her blood while she happened to be waiting for the results from a biopsy that came back clear) and plain wrong (people given advice to buy unnecessary supplements, that they will be able to come off medications). There is also the concern that people are not under the care of someone who is appropriately medically qualified. To be fair plenty of live blood analysts don't make these misleading claims however the entire concept of LBA rests on a misunderstanding of what can be seen in blood samples under a microscope.

I am certainly not aware of anyone in the UK having died after following the advice of live blood analysts and only know of one case worldwide (in Australia) where that has happened. It is undoubtedly true that plenty of people are harmed by 'real' medicine, however that is not really the issue here - live blood analysis takes money from people yet is a bogus diagnostic tool.

Bet you're paid by the pharmaceutical industry
No, I receive no money or other favours from any pharmaceutical company.

How can you complain about live blood testing when [something else bad] is happening
This seems a bit like complaining that someone who's learning how to play piano is wasting time because they're not contributing anything to curing cancer. It's not a very good argument.

The ASA adjudications against claims made about live blood testing
• ASA (13 October 2010) ASA adjudication on Live Blood Test
• ASA (1 June 2011) ASA adjudication on Fitalifestyle Ltd t/a
• ASA (7 September 2011) ASA adjudication on MyCityDeal Ltd: MyCityDeal Ltd t/a GrouponUK
• ASA (19 October 2011) ASA adjudication on Optimum Health UK
• ASA (2 November 2011) ASA adjudication on Fitalifestyle Ltd: Fitalifestyle Ltd
• ASA (16 January 2013) ASA adjudication on the Natural Health Clinic
• ASA (6 March 2013) ASA adjudication on Steps to Perfect Health
• ASA (27 February 2013) ASA adjudication on Live Blood Test
• ASA (24 April 2013) ASA adjudication on Live Blood Test

ASA Non-compliant online advertisers
• ASA (15 November 2011) Fitalifestyle (claims about blood-cleaning properties of chlorophyll)
• ASA (26 June 2012) London Natural Therapies 
• ASA (15 February 2013) The Natural Health Clinic
• ASA (12 March 2013) Live Blood Test

see Josephine Jones' post Live Blood Analysis and the ASA: a catalogue of complaints for more, including information on informally resolved cases.

CAP guidance
• CAP (3 July 2013) Therapies: Live Blood Analysis

Further reading
• Edzard Ernst (2005) A new era of scientific discovery? The Guardian
• Mark Crislip (2009) Live Blood Analysis: The modern auguries Science Based Medicine blog 
Wikipedia's article on Live blood analysis
• Thomas Patterson (2012) The Pseudoscience of Live Blood Cell Analysis Skeptical Inquirer
• Zachary Rubin (2009) Live Blood Analysis: New Diagnostic Method or Quackery? Case report and Review of the Literature UCLA Department of Medicine
• Posts tagged with Live Blood Analysis on Josephine Jones' blog 

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Comment policy: I enthusiastically welcome corrections and I entertain polite disagreement ;) Because of the nature of this blog it attracts a LOT - 5 a day at the moment - of spam comments (I write about spam practices,misleading marketing and unevidenced quackery) and so I'm more likely to post a pasted version of your comment, removing any hyperlinks.

Comments written in ALL CAPS LOCK will be deleted and I won't publish any pro-homeopathy comments, that ship has sailed I'm afraid (it's nonsense).