Circadian Quackery

Believe me, I love the word "circadian". It is a really cool word, invented by Franz Halberg in the late 1950s, out of 'circa' (Latin - "about") and diem ("a day"), to denote daily rhythms in biochemistry, physiology and behavior generated by the internal, endogenous biological clocks within living organisms.

It's been a while since the last time I found someone mistaking the word for 'cicada' which is a really cool insect. 'Circadian' has become quite common term in the media and, these days increasingly, in popular culture. Names of some bands contain the word. A few blogs' names contain the word. I guess the word has cool modern scientific connotations, sounds like something from Star Trek, and on top of it has the ever-alluring association to the shape of the circle and the endless cycle of Time. Thus, it has the New-Agey air of a mix of scientific and mystical to it.

That does not mean that people know what the word means. I've seen quite a lot of confusion about the meaning of it on blogs and elsewhere. It was just a matter of time until the word was misappropriated by quacks. And yes, it has happened. I have recently found two examples of medical quackery with the word "circadian" prominently displayed. Let me show you why both are utterly wrong and what is the commonality between the two: [under the fold]

First up, the "new" healing method called Circadian Acupuncture. Here is the website that describes the Circadian Acupuncture Technique.

Here we see some typical quack strategies.

One is Reverence for the Past coupled with Reverence for the Ancient Wisdom of the Orient:

This technique was first recorded in the book "The Flow of Zhi Wu"(Zhi Wu Liu Zhu Zhen Jing), Written by a famous ancient Chinese physician and acupuncturist, He RuoYu, in 1153 AC. Once it was introduced into the clinic practice, it received numerous positive responses. After more than 200 years of clinical trials and refinement, in 1439, the well known Chinese physician Xu Feng, included the modified and improved method of Circadian Acupuncture in his book, "The Complete Collection of Acupuncture and Moxibustion" (Zhen Jiu Da Quan), which marked the maturity of this powerful clinical application. 100 years later, Dr. Gao Wu, further perfected this application and put it in his book, "The Glorious Anthology of Acupuncture and Moxibustion"(Zhu Jiu Ju Ying).

Older something is - the better, according to the nostalgics for the Golden Age. And if it comes from a culture older than ours - even better. Ahem, we know today so much more than anyone at any point in history. Some things are "time-tested" because they work, others are "time-tested" because of the aura of mysticism that keeps the non-effective treatments propagate over generations out of sheer reverence for the Ancestors. Guess in which category is Circadian Acupuncture?

Second is Naive Scientism:

Since the energy flow in the human body ebbs and surges according to a different time, has its own physiological rhythm, and we select the points accordingly, I call it "Circadian Acupuncture".

Since we live in the age of science and people tend to believe something more if it sounds scientific, why not give it a science-sounding name? New brand, new price, new market...same shit.

Third is Complexity:

Circadian Acupuncture is one of the most complicated and powerful forms of ancient acupuncture. It is an acupuncture technique, but far more advanced than common acupuncture practice.
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This technique combines the essence of Yin-Yang theory, Five Elements theory, philosophy of I-Ching, meridian theory and ancient Chinese astrology, in cooperation with Chinese unique Agricultural Calendar (a combination of lunar and solar calendar systems), Heavenly Stem, Earthly Branches time numbering system and Feng-Shui direction system. A series of calculations is necessary to predict that at any given time, which acu-points in human body have the most surging energy flow. By stimulating these points, one achieves the maximum balancing therapeutic result.

Just like Creationists (and yes, they have tried to appeal to circadian clocks as well!), the medical quacks also like to pile up everything that appears to bolster their view, even if some of those things cancel each other. But, just looking at the long list above, do you believe in this? Astrology? Feng-Shui? Meridians? I Ching? All mixed up? Do I really need to deconstruct each of those separately?

Fourth is Appeal to Mathematics:

Through a series complex calculations, a practitioner will be able to determine-according to the date and time the patient comes in for visit-what acupuncture points in the patient's body have the most surging energy flow, therefore, are open to receive the therapeutic treatment
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For example, if a patient comes in for the treatment for his migraine on April 23, 2002, 11:45 am, according to the Circadian Acupuncture technique, through calculation, we know among eight confluent points, Sj-8 and Gb-41 are open to receive treatment. Then these 2 points should be used in the beginning of the treatment, regardless what is the patient's diagnosis, to activate and invigorate the energy (Qi and Blood) ; then a few more points should be selected base on patient's diagnostic pattern. For instance, if the patient's diagnose is Wind Cold attacking the GB meridian, Gb-5, Gb-6 can be used as the local points to direct the activated energy (Qi and Blood) to enter the area to perform its therapeutic effect. Since the equation used in this calculation takes into consideration the interaction and affect between the patient and seasons, date, time and geographic changes, this method generates the best and most effective result.
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Since we have to predict at what time what points are open, we have to understand Chinese time marking system. Chinese use 10 Stems and 12 Branches to mark the date and time. Each year, month, day and hour is composed of a stem and a branch, Stem first and Brach behind. For example, at 3 pm on 4/7/2002 in stem and branch system, is represented as S9B7 (year), S1B5 (month), S2B6 (day) and S10B3 (time). There are many equations to convert the date and time to Stem system, but the easiest way is to refer to a "Tong Sheng", a Chinese lunar calendar. The table below gives a simplified quick look at what is "Stem" and "Branch" system.

Just because you have a formula does not mean you are actually calculating anything. Garbage in, garbage out. And of course, this unbeliavable precision that ignores the inherent messiness of biology is in itself a red flag. Just like biorhythms. And really, this whole technique sounds just like biorhythms - a silly math to calculate time. Instead of decisions about personal life, here we have decisions to poke a needle into a person. But the underlying logic is exactly the same.

Fifth is a Prosecution Complex which fosters Secrecy:

Since this application was so effective in ancient times, most doctors who possessed this knowledge would keep it as a secret and would not share it with other people. It was only passed down through a father-to-son or master-to-the-closest-disciple pattern. This application was once lost during the Chinese civil war and Japanese invasion in early and mid 19th century. Until the1950's, a few Chinese doctors unselfishly contributed their knowledge of Circadian Acupuncture to the public, reintroducing this application to the clinic practice.

So, it was lost and then found again. How was it found? I thought it was too complex and too secretive to be recoverable once it was lost.

Now, let's move to the second use of "circadian" in a medical hoax - the Organ Clock Theory:

In our daily routine, when our every act is time bound, did you know that our vital organs too are time bound..? The 12 organs in our body are owning 2 hours in a day according to the relevant time of the organ clock. In traditional Chinese medicine, diagnosis and the treatment are based on the dynamic theory of energy flow. This energy flow is continuous in our body in definite path. This vital energy is termed as 'Qi', which has three levels that is superficial, deep and intermediate. It is possible to cause changes in the body by influencing this Qi flow at the superficial level, which is called 'Acupuncture Therapy'.

OK, so both methods are Chinese, both have to do with acupuncture, and both involve timing, yet they calculate timing in very different ways. The first one has a complex set of formulae (like astrology or biorhythms do), while the second one is much simpler - it has pre-determined times of day when each organ is "active". Try to read through this list a little and see if it makes any sense (and try not to laugh at horrible spelling, punctuation, grammar and style):

3 am to 5 am - Lungs

This organ clock theory in Acupuncture therapy is used to treat many complications for better results. The energy enters the lung (organ) channel at 3 am, when a day starts originally.

Symptoms of particular organ is shown at that particular time, it is an alarm to the patient and good diagnosing point to an acupuncturist. Human body mechanism is a miracle and always it sticks to nature. The peak hour of each organ is 2 hours. The treatment according to the organ clock balances the vital energy flow in our body, so that lacking energy will gain by tonification of acupuncture points and stagnated energy is transferred by sedation of specific points.

Of course, this theory surprises anyone at first sight, but seen deeply the practical biorhythmic activity can be identified. A day always starts at 3 am which is the time for lungs, the foremost organ. Ayurvedic physicians, siddhars, rishis, naturapaths at earlier times used to wake up at 3am, which is defined as 'Brahmamuhuratha time'. Probably this time is good for breathing exercise, so that lung will gain more energy from universe and later travels continuously.

Acupuncture theory adds more, by diagnosing the patients symptoms which shows severe for lung disorders. A single point in lung channel is stimulated at this time to cure the lung disorders. So, both for diagnosis and treatment, the organ clock helps extensively. People having this disorder will have a disturbed sleep, like cough, sneezing or nasal congestion at this time.

5 am to 7 am -Large Intestine

Next to lung time is the large intestine i.e., from 5 to 7 am, when the bowl is emptied. Proper evacuation is needed, if failed, particularly large intestine points are needled to care the problem.

7 am to 9 am - Stomach

Next time is for stomach organ i.e., 7 to 9 am, so that breakfast is taken. Moreover, ulcer, gastritis, acidity, loss of appetite, headache cares are treated with relevant acupuncture points in stomach organ time.

9 am to 11 am - Spleen

Again, the next organ is spleen, its time is 9 to 11 am. It is very special, hence the persons who feel very tired and sleepy is the indication of diabetic symptoms later in life. A snoring sleep at this time is not advisable.

11 am to 1 pm - Heart

11 am to 1 pm,is a time where cardiac problems are targeted at this time. Usually cardiac patients sweat a lot and feel suffocation.

1pm to 3 pm -Small Intestine

1 to 3 pm is the time for small intestine, the organ for digestion, allergies, muscles, soft tissues, lips, mouth, genito-urinary disorders and general tonification. Symptoms of these problems may rise in this time. A complete digestion is supposed to be done to maintain the whole body health. Those who skip or don't fulfill the food intake, may suffer from insufficient food energy.

3 pm to 5 pm - Urinary Bladder

The next organ in line is the urinary bladder, timing from 3 to 5 pm, which looks after spine, sense organs, internal organs, kidney and urinary bladder disorders.

5 pm to 7 pm - Kidney

The next is for the kidney organ 5 to 7pm, which can used for treating all chronic problems in our body. Apart from this, it is also a special time for treatment of kidney disorders and hair loss.

Yes, cosmetic acupuncture is a boon to acupuncture. Patients who are suffering from Alopecia and Alopecia Areata have good results in cosmetic Acupuncture where kidney points are stimulated in this particular time.

7 pm to 9 pm - Pericardium

Likewise 7 to 9 pm is for pericardium, where the psychiatric and cardiac patients are treated.

9 pm to 11 pm - Endocrine System

And 9 to 11 pm., is the time which controls the endocrine system, reproductive organs and temperature in our body. Most of the infertility cases are treated in this time.

11 pm to 1 am - Gallbladder

Next is 11 to 1 am gallbladder, the special organ for insomnia and muscular pain. At last 1 to 3am is for liver, the store room for our body. If this is distributed, the body is terribly tired, eyes burning and leads to total weakness. These patients can be treated to have good sleep.

Again, the day starts, cyclic flow to complete the 24 hours for 12 organs. Man has to stick to nature for better living. Biological clocks govern every living thing, in motion, rest, sleep, chemical composition, excretion, regulation of tissue fluids, glands and organs.

The circulation is repeated for every twenty four hours which is called as circadian rhythm.

Where does one start? How does one untangle this mishmash of utter ignorance of human physiology? What has urinary bladder to do with spine and sense organs? And what does pericardium have to do with the psychiatric disease? Why Pericardium in the first place? How important is it in the general scheme of things? Is this the case of someone who thought, back in high school, that the word 'pericardium' was, like, waaay kewl, worth remembering and using in all sorts of unusual contexts? Yo, I really like your pink pericardium tonight - it's, like, so circadian - so, wanna fool around with me?

Jokes aside, let's take a closer look at what this guy is claming and compare that to the real world and the way human body is organized in time. As they say, a picture is worth a thousand words, so let me make a quick sketch of the "Organ Clock Theory":

According to this guy, each of the 12 major organs is active for two out of 24 hours and pretty much inactive for the remaining 22. Why not? Let's see how it really works. A few years back, several laboratories independently did a similar experiment - measuring expression of many genes in several different organs (of mice and rats) over a period of 24 hours, using DNA chips. For this finicky technique, the similarity between the results from different labs was quite large. I have to admit I was surprised at the relative repeatabilty of the data. So, what did they find? First, a very quick background:

Every cell in our body contains a circadian clock. There is a Master Clock - a pacemaker - in the suprachiasmatic nucleus (SCN) of the hypothalamus at the base of the brain. Unlike the cells of the SCN, other cells in the body have a clock that works a little differently - it cannot sustain many oscillations outside of the body (e.g., in culture), and it cannot be directly affected by light (e.g., by shining light on the skin cells). The major role of the SCN is to synchronize all the other clocks in all the other cells in the body. For that, it uses direct neural signals, as well as indirect endocrine signals (e.g,. cortisol, melatonin, arginine vasopressin).

What does a peripheral clock in a cell do? It acts as a relay - turning on and off batteries of genes in a tissue-specific way. So, for instance, in a liver cell, there will be three categories of genes:

First, genes that liver does not use (needed for muscle contraction or gas exchange, for instance, in other organs) are not expressed at all.

Second, genes involved in general cell metabolism (e.g., genes that code for proteins that are involved in transcription, translation or DNA repair) are expressed at high levels constituitively - there is no variation in levels over time.

Finally, there are genes that are expressed with a circadian pattern. Expression of these genes is under the control of the circadian clock in the liver cell. Which genes are those? Those that code for proteins which serve a liver-specific function, e.g., various enzymes used in biosynthesis, detoxification etc.

Are all those genes expressed at the same time? No! They are expressed in several "batteries" - some in the morning, some in the afternoon, some at night, etc. Thus, for instance, alcohol dehydrogenase (together with hundreds of other genes) is expressed in the late evening and early night - allowing one to drink more alcohol than in the morning. Importantly - most of the genes are not switched completely on and off - they are just expressed a little more or a little less over the 24-hour period.

What this all implies is that there is no down-time for the liver. It always does something, only that "something" changes over time. The same goes for every other cell-type in the body. If you are interested in the details, organ by organ, function by function, you can check out, for instance, The Body Clock Guide to Better Health: How to Use Your Body's Natural Clock to Fight Illness and Achieve Maximum Health by Michael Smolensky and Lynne Lamberg. That stuff is based on actual scientific research, not flights of fancy. Yes, there are subtle rhythms in body functions, but each organ works all the time and all organs' activity overlaps in time.

For instance, you can check out this (admittedly very old) graph of acrophases ("peaks") of various biochemical, physiological and psychological functions in the human body:

...or in the body of a mouse:

Notice how broad the peaks are, and how different functions overlap in time. Note also (if you can read it - I could not make the resolution any better) how many of those functions are performed by the same organ yet the peaks are not at the same time. Also note how many of those functions are performed by several different organs in cooperation. The figures are taken from this review paper (PDF) which contains much more relevant information.

While the two examples highlighted here are nonsense, and their use of the term "circadian" will confuse people as to the real meaning of the word, there is a way in which they make me happy. In a sense, they exemplify historical progress of sorts.

Centuries ago, explanations invoking gods and magic, intoned seriously by priests and shamans, were sufficient for the people to accept them unconditionally. By early 19th century, that was not enough. An explanation had to at least superficially appear scientific - witness the pentagonal classification of animals. After Darwin, every explanation about living things had to appear scientific. Early in the 20th century, it had to also have some math attached to it to be believable.

Just a century ago, the dominant models in biology were homeostasis in physiology and behaviorism in psychology. They can both be summarized as "if something gets out of whack, the body does something to fix it." Both were completeluy atemporal - it does not matter when the out-of-whackishness occurs.

Later, behaviorism gave way to ideas like Maslow's hierarchy of needs in which time first enters the picture - things go out of whack, but the body fixes the problem in a particular order. The timing was relative (to each other) and not yet absolute (in relation to the outside environment, i.e., pegged to an outside temporal marker).

Only in the last couple of decades, with the development of chronobiology, does absolute time start figuring in the models - interestingly, simultaneously in physiology and psychology. Nicholas Mrosovsky, around 1980, introduced the concept of 'rheostasis', later codified in his magnificient book. Yes, the body responds to changes in its internal and external environments, but the size and speed of response is dependent on time of day, time of year, or developmental stage of the organism. Also, what is considered "out of whack" by the body (and thus deserving of a response) changes with time of day, time of year and developmental stage.

I see the above two examples of naive quackery as a proof that the importance of temporal organization of the body has entered the popular consciousness. Thus the need for quacks to incorporate circadian-like concepts and terms into their loony theories. Many people, as youngsters, start out by reading loony theories and develop a thirst for knowledge about the phenomenon. They read everything they can get their hands on about it. Finally, they will have read so much and learned so much, many if not most, will abandon the hoaxes they initially read and focus on the real science - perhaps become scientists themselves. Hey, I have read UFO and Daniken stuff when I was a kid and believed it all and tried to get more books about it to read and finally read so much debunking and good science I realized that UFOs and Daniken were nonsense. Perhaps that will happen for the circadian biology to some youngsters who first hear about the word from peddlers of acupuncture.