FishBarrel - simple Google Chrome app to help automate quackery complaints

Shortened link for this post: http://is.gd/3VwJ1O

This morning I used @Simon_Perry's excellent FishBarrel tool to put in complaints about two ear candle treatments on sale in Blackheath. I also used it last night to put in a complaint about a homeopathy website but the ASA is already working on guidance for homeopaths (a 'profession' famous for making some ridiculous and dangerous claims) I probably won't complain about too many more of these sites for the time being.

Ear candling rarely causes problems but on occasion it can drip hot wax into your eardrum which can cause (usually temporary) damage and discomfort. I'm not too bothered about people wasting their money on rubbish or even injuring themselves in the process but what I do find annoying is the health claims accompanying this product.

Ear candles (used in 'thermo-auricular therapy') do not create a suction vacuum and therefore cannot suck out toxins, literally or figuratively. They don't do anything to lymphatic drainage either and the wax that appears inside the candle after the treatment is chemically identical to candle wax, not ear wax. By all means sell this nonsense - people have a right to stick burning candles into their ear whether I like it or not, but please don't imply that it is safe or has any health benefits at all.

With any complaint made to the Advertising Standards Authority (don't forget they're doing websites now, which they weren't previously) or Trading Standards / Consumer Direct there are some constants (your name and address) and some variables (the address of the website and the claims made). FishBarrel lets you store your constants, housed in a Google Chrome app that sits by your bookmarks bar, and with a couple of clicks you can activate the app to start capturing the variables. As you select misleading claims FishBarrel will store copies of these and the website from which they came, and will also let you take a screenshot of the area of the website on which the claims are made.

Once you've selected all the claims you want to complain about you can review the complaint and make some amendments (eg give some background about the claim made and why you're complaining about it), then you can choose where it goes - ASA or TS/CD. At this point the programme does a rather nifty thing and autocompletes the complaint form for you. I've only used it for the ASA one which has four sub-pages (you fill in first section, press next and so on) and it's nice to find all the text pre-installed. You get an opportunity to go through each section and make further amendments.

Then press 'submit' and hopefully chip away gradually at the amount of misleading claims on websites.

You might well say "oh really, what's the point - as soon as you get one claim removed another one will crop up" and I'd agree there's an element of truth to that. The world will always have homeopaths and sellers of ear candles among other crap. If sellers remove misleading claims that's a win (whether or not it was because they thought it was a good idea by themselves or because the ASA asked them to).

Where I think complaining about quackery 'adds value' is that there will be an adjudication on the ASA's website, if your complaint is upheld. These don't always show up on Google searches - even to find them on the ASA's site isn't straightforward as a site-search won't find them, you have to go into the Adjudications section and search within that. Each new adjudication is a piece of news that someone might blog about. This increases its reach across Google and other search engines and makes it marginally more likely that someone searching for information on a questionable treatment will come across one or more pieces of information that are critical of it. Well, maybe a bit.

You might also like

• Greasing the wheels of skeptical activisim: FishBarrel - by @krelnik
• What's the harm in ear candling? - also by @krelnik
• Hokey ear candles - by me, with a list of references pointing out the nonsense
• FDA sends warning letters to 15 ear candle manufacturers (via @Blue_Wode) - by me

FDA sends warning letters to 15 ear candle manufacturers (via @Blue_Wode)

Ear candles must surely now be very well known as being unable to remove ear wax as there is no suction force generated when the candle burns. Some evidence for this has been provided by an article published in 1996 which said "tympanometric measurements in an ear canal model demonstrated that ear candles do not produce negative pressure" ie, ear candles don't suck [Seely http://www.ncbi.nlm.nih.gov/pubmed/8849790].

I've not held a burning ear candle over a small pile of dust to see if it moves the dust but I hear, anecdotally at least, that it doesn't. I expect there's a YouTube video demonstrating this somewhere.

Some manufacturers have moved on from claiming that candling is about removing wax and speak in vaguer terms about 'balancing the ear' or removing toxins or the usual rubbish. While manufacturers might speak in more guarded terms the practitioners who use the candles aren't always so cautious. The idea that there is something physical, in the used candle, that has come from the person's ear seems to be fairly persistent.

The internet is full of text and videos implying that, on breaking open the used candle, the residue remaining contains human material including wax and dust from the ears. In our best Pantomime voices: "Oh... no.... it... doesn't".

The easiest way to demonstrate this is to burn a candle without putting it in an ear (using a glass jar for example) and seeing what's in the residue - very simply there appears to be no difference in the contents of the candles regardless of where they've been burned. This was done in 1995 by the people behind the Straight Dope http://www.straightdope.com/columns/read/1103/how-do-ear-candles-work
Going a step further than just looking at the residue, you can analyse the contents reasonably easily using chromatography (a method of separating the various components in a mixture) and mass spectrometry (a method of identifying the individual components by breaking the component and examining the fragmentation pattern).

"When the powder was analyzed using gas chromatography and mass spectrometry it was found to constitute multiple alkanes that are found in candle wax but not in ear wax." Rafferty 2007 quoting Seely 1996. [An example of an article about looking at alkanes in a geological context is available here].

So it's unlikely that the candles remove wax - I've no idea how to measure the removal of toxins or the rebalancing of the ears. That seems to be conveniently beyond measurement... the only way to demonstrate this in favour of the ear candling process is that many people claim to feel better after it, and return for subsequent sessions, reporting improvements in a variety of things (hearing, discomfort etc.). Unfortunately this is too subjective to count as good quality evidence.

Ear candles are also quite dangerous. There are numerous reports of candle wax being added to the ear (quite the opposite from what has been claimed), in some cases the hot wax damages the eardrum, though rarely permanently. I can't get too uptight about the dangers of ear candling for the simple reason that people do all sorts of dangerous things (skiing, crossing roads, driving, 'wonder what that button does') and they don't always come to harm but in most risks there's usually some benefit (having an exhilarating downwards snowy experience, getting somewhere, discovering something) - in ear candling the benefit seems to be set at zero.

The FDA sent these 15 letters in March - I first heard about the FDA cracking down on ear candles as general internet chatter about the FDA banning them. I don't know if that's the FDA's plan (the letter I read just wants evidence of better procedures for complaints, and clarity on what is actually being claimed so that it aligns with what can be claimed) but I thought this article, which acknowledges that ear candling is nonsense, was interesting because it points out that...

"The FDA, though, may be testing the limits of its jurisdiction. The primary purpose of ear candling is wax removal, which is not a medical process. So in theory the letters are open to challenge from anyone who has enough money to take the FDA to court.

...

Of course, most of the accused hippies didn’t stick to the simple claim that candling unclogs wax. They went further, claiming it cures sore throat, swimmer’s ear, increase circulation, and eliminate chronic ear infections in children." Source: reference 3 below.

The letters have been sent to the following manufacturers

King Cone International;
Indian Mountain Center;
Bobalee Originals Manufacturing;
International Ear Candle, LLC;
Home Remedies Solutions;
Harmony Cone; A..J.'s Candles Inc;
Wholistic Health Solutions;
Wally's Natural Products Inc.;
Body Tools;
Health, Wealth, & Happiness;
White Egret, Inc.;
Brennan & McCoy;
Amasha;
Unisource;
Herbs, Heirlooms and Homebrew.
Source: FDA orders 15 companies to stop marketing ear candles.
http://www.ncahf.org/digest10/10-20.html - thanks to @Blue_Wode for the tip

Summary:
a) Ear candles can't and don't remove ear wax
b) Any wax residue at the end of the process is from the candle
c) They sometimes add candle wax to the ears
d) They are a waste of money

Some safer methods of ear wax removal are discussed in BMJ Clinical Evidence

Further reading
1. Fire in the hole! The truth about ear candling
http://doesitwork.msnbc.msn.com/archive/2008/01/17/585352.aspx?p=2

2. Snuffing out ear candles SkepticZone
http://skepticzone.wordpress.com/2009/01/31/snuffing-out-ear-candles/

3. FDA launches jihad against hippies who stick burning ear candles into babies' ears, but may have overstepped
http://industry.bnet.com/pharma/10006983/fda-begins-jihad-against-hippies-who-stick-burning-ear-candles-into-babies-ears/

4. Hokey ear candles
http://brodiesnotes.blogspot.com/2009/10/hokey-ear-candles.html (a previous post from me, listing some of the published medical literature on ear candling).

Also known as ear cones, thermoauricular therapy 

Lewisham offers training in woo

Community Education Lewisham joins Greenwich Community College in selling courses in Hopi Ear Candles. It's also offering training in all manner of crap.

A Day with Crystals
'...how to choose, cleanse and dedicate crystals for everyday use. You will be introduced to the quartz family and master a self-healing technique."
£28, five hours (one day)

Astrology - an introduction
"Discover... how this insightful subject can be used for self discovery and personal growth."
£84, twelve hours (over four weeks)

Hopi Ear Candles
"This is a natural solution to ear syringing and is beneficial for conditions such as sinusitis, headaches and stress."
£28, five hours (there might be a lunch break in there too)

Iridology
"Your iris is unique to you just like your fingerprints. With careful study... magnifying glass... you can be shown ways of maintaining and improving your health."
£42, six hours (two Saturday mornings).

When I read the bit about fingerprints I wondered if anyone has ever offered courses in diagnosing something or other from fingerprints. If not why not? Why do some things get co-opted into being woo and some things don't?

As far as I know most people think phrenology is bunk and there don't appear to be any courses on this topic in Lewisham or Greenwich. What differentiates phrenology from ear candling? Both are equally bunk-ish but ear candling is bringing in the cash and phrenology isn't.

Hokey ear candles

Here is a selection of references (not many have abstracts as they seem to be letters or comments) that I'm after in my quest to find out more about ear candles. As far as I can tell there are now three shops local to me that are flogging this and a local community college is offering a course in it. This is a wooful state of affairs.

Edit 02: added Pubmed IDs 19958263 | 18800318 | 18077749 | 17555144 on 17 April 2010

Zackaria, M and Aymat, A. (2009)
Ear candling: a case report
Eur J Gen Pract. 2009; 15(3): 168-9.
http://www.ncbi.nlm.nih.gov/pubmed/19958263

Kutz, JW Jr and Fayad, JN (2008)
Ear candling.
Ear Nose Throat J. 2008 Sep; 87(9): 499.
http://www.ncbi.nlm.nih.gov/pubmed/18800318

Rafferty, J, Tsikoudas, A and Davis, BC (2007)
Ear candling: should general practitioners recommend it?
Can Fam Physician. 2007 Dec; 53(12): 2121-2.
http://www.ncbi.nlm.nih.gov/pubmed/18077749
Full article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231549/pdf/0532121.pdf

McCarter DF, Courtney AU, and Pollart SM (2007)
Cerumen impaction.
Am Fam Physician. 2007 May 15; 75(10): 1523-8.
http://www.ncbi.nlm.nih.gov/pubmed/17555144
"The use of cotton swabs and ear candles should be avoided"

Ernst, E. (2004)
Ear candles: a triumph of ignorance over science
Journal of Laryngology & Otology (2004), 118:1:1-2
http://journals.cambridge.org/action/displayAbstract;jsessionid=40027169FFB9FF73AF11D8F26F00690D.tomcat1?fromPage=online&aid=403194

Richard Harris, Ph.D. (1999)
Untoward otological and audiological consequences of ear candling
Brigham Young University; Provo, UT(Posted March 5, 1999)
http://www.rcsullivan.com/www/forum/harris/candle.htm

Seely DR, Langman AW (1997)
Coning candles--an alert for otolaryngologists?
Ear Nose Throat J. 1997 Jan; 76(1): 47.
No abstract available.
PMID: 9018937

Seely DR, Quigley SM, Langman AW (1996)
Ear candles--efficacy and safety.
Laryngoscope. 1996 Oct;106(10):1226-9.
http://www.ncbi.nlm.nih.gov/pubmed/8849790

Blakley BW (1996)
Coning candles--an alert for otolaryngologists?
Ear Nose Throat J. 1996 Sep; 75(9): 585, 588.
No abstract available.
PMID: 8870363

Pulec JL. (1996)
Cerumen and coning candle chicanery.
Ear Nose Throat J. 1996 Sep;75(9):574.Links
Comment on: Ear Nose Throat J. 1996 Sep;75(9):585, 588.
http://www.ncbi.nlm.nih.gov/pubmed/8870359

Seely DR, Langman AW (1995)
Ear candles.
Arch Otolaryngol Head Neck Surg. 1995 Sep;121(9):1068.
No abstract available.
PMID: 7646862

British Library reading rooms here I come :D

EDIT 01: The BBC has a fairly credulous page about the nonsense that is Hopi Ear Candles, admittedly it dates from 2006 and isn't being updated, but even so I would have expected better http://www.bbc.co.uk/wales/southeast/sites/mind/pages/hopi.shtml

Where you can waste your money learning about ear candling
Community Education Lewisham - full list of courses


Also known as thermoauricular or thermo-auricular therapy, coning, and ear candling,