| Recently the article Alternative Medicine Warning: | | | | Confounding variables |
| Some Chinese Herbs May Increase Cancer Risk came | | | | In stastical analysis, a confounding variable is |
| to my attention. The Fox News report reviews an | | | | something that relates to both the dependent and |
| academic article published by the Journal of the | | | | independent variable. Study methodologies need to |
| National Cancer Institute. Having more than a passing | | | | control for confounding variables in order to avoid |
| interest in Chinese herbal medicine, I chased down | | | | making invalid inferences about the relationship of the |
| the original article, Population-Based Case-Control | | | | variables being studied. |
| Study of Chinese Herbal Products Containing | | | | For example, suppose a study wants to determine if |
| Aristolochic Acid and Urinary Tract Cancer Risk (Lai, | | | | performing regular weight-bearing exercise is an |
| Wang, et. all). The authors conclude, "Consumption of | | | | effective way to prevent osteoporosis in |
| aristolochic acid-containing Chinese herbal products | | | | post-menopausal women. Women are selected for |
| [mu tong] is associated with an increased risk of | | | | the study and categorized as either doing the |
| cancer of the urinary tract in a dose-dependent | | | | exercise or not. But suppose also that the women in |
| manner that is independent of arsenic exposure." | | | | the weight-bearing exercise also regularly take a |
| A long time student of mathematics and a more | | | | calcium supplement, which is known to prevent |
| recent student of public health and biostatistics, I set | | | | osteoporosis. Without taking this fact into |
| about critically analyzing this paper. I have two | | | | consideration and making appropriate statistical |
| observations that cause me to personally call to | | | | adjustments, analysis might incorrectly conclude that |
| question the validity of the authors' conclusion. | | | | the weight-bearing exercise had a greater role in |
| Which herb are they talking about? | | | | preventing osteoporosis than it actually did. |
| In traditional Chinese herbal medicine, there are two | | | | In the study concerning mu tong, the authors |
| different herbs that are colloquially referred to as mu | | | | considered and accommodated for the presence of |
| tong. Guan mu tong, or aristolochia, contains | | | | significant levels of arsenic in the subjects' drinking |
| aristolochic acid, a known nephrotoxin. In modern | | | | water (arsenic is known to cause urinary tract |
| practice, this herb is rarely used and is banned from | | | | cancer). However, the authors site in their limitations |
| importation to the United States by the Food & | | | | section that smoking status was not considered |
| Drug Administration (FDA). Chuan mu tong, or caulis | | | | during analysis. Personally, I have reviewed many |
| mutong, on the other hand is not known to contain | | | | articles regarding cancer and possible causative |
| aristolochic acid. Chuan mu tong is effectively used to | | | | agents and I cannot think of one that was |
| treat urinary tract infections and promote lactation in | | | | considered authoritative in which smoking tobacco |
| cases of blocked milk ducts. | | | | products, a well established carcinogenic habit, was |
| The authors of the study make no distinction in their | | | | not considered and controlled for. |
| report if they are reviewing cases of people using | | | | Personally, I am appalled to think that a combination |
| chuan mu tong or guan mu tong, though considering | | | | of poorly designed scientific research and irresponsible |
| their interest in aristolochic acid, I would guess they | | | | journalism could lead people to the conclusion that |
| are studying the potentially carcinogenic effects of | | | | Chinese herbs cause cancer. Herbs, like all things we |
| guan mu tong. Considering that guan mu tong is | | | | ingest, need to be scrutinized for their quality and |
| neither legal nor widely available for use, I question | | | | effects, but to shut the door on all Chinese herbs is |
| why Fox news took such an interest in this | | | | a terrible mistake. |
| publication initially. | | | | |