The Science of MMS (part 1)

If you have absolutely no interest in the alternative therapy MMS, look away now and go out and do something less boring instead.  This is a pretty lengthy post.  As the saying goes – it would have been shorter if I’d spent more time on it...

This is all a result of someone I know well getting in touch a few months ago about concerns they had for a friend of theirs who was using (the alternative therapy formerly known as) Miracle Mineral Solution (MMS), “discovered” by Bishop Jim Humble of the Genesis II Church of Health and Healing http://jimhumble.biz/.  It appears that it’s now marketed as Master Mineral Solution.  MMS is 28% sodium chlorite solution.  Sodium chlorite is a pretty powerful bleaching agent.

On the face of it, a bleaching agent is not exactly the sort of thing you’d necessarily expect to have healing properties.  It’s certainly not the sort of thing that you’d expect to have been found to be a previously unrecognised panacea.  It is claimed that MMS can be used to successfully treat pretty much anything: cancer, HIV/AIDS, malaria, the common cold – you name it, there’s probably a claim made for the successful treatment of it with MMS.

I think it’s fair to say that as a natural scientist by nature, education and trade (some of the time), and a fan of Ben Goldacre’s book/column/blog “Bad Science”, I was naturally – erm – a little bit skeptical about these claims to say the least.  I had, perhaps somewhat naively, assumed that a quick google would elicit some key facts and figures that could be built up into a decent understanding of this stuff.  But the more I googled, beyond FDA warnings against its use http://1.usa.gov/d410UU etc.,  the less I found I really knew about it.  The online conversation was largely dominated by two highly polarised camps: staunch advocates and staunch opponents and never the twain did meet.  Except in (sometimes pretty vicious) forum flame wars.  See, for example, what happened to Rhys Morgan when he posted on a Crohn’s disease forum last year after he’d seen the FDA warning http://thewelshboyo.wordpress.com/2010/08/10/bleachgate/

Other than the spectacularly unfairly victimised (and brilliant) Rhys and a number of other questioning and thoughtful bloggers much of what I first read was basically either biased, unhelpful, or uninformative.  Where there was no flame war there was really only preaching to the converted – on both sides.  I knew that arguments like “it’s just so obviously a scam, there’s no point going into the science” (though I agreed completely with the first part of that statement) wouldn’t be enough for us.  I was just trying to garner some trustable and verifiable information and knowledge.  

To prepare MMS you mix it with citric acid which produces chlorine dioxide solution.  What I wanted to know was: what exactly is the amount of chlorine dioxide you end up taking with MMS?;  what are the known effects of drinking these amounts?; are there any studies (other than claims made by Jim Humble etc.) of the health benefits of chlorine dioxide?  Chlorine dioxide is used to treat drinking water in some places so clearly there must be “safe” levels (though obviously if MMS turned out to be no different from drinking water it would still be a scam).  I couldn’t find the answers anywhere.  I was lucky in that I wasn’t ill myself and the person we had our concerns for wasn’t particularly ill either – they were just using it to treat everyday coughs and colds etc.  But I really did feel for people who were perhaps more seriously ill and were trying to find decent information on this stuff. 

As much as it was true that arguments for MMS were built largely on unverifiable anecdotes of personal “success” with it, bold unfounded claims for its efficacy, unreferenced “studies”, conspiracy theories and pseudo-science etc. it was as frustrating, if not more so, that some of the supposedly “rational” opponents of MMS unfortunately just came across as little more than uninformed scientistic trolls.  “Scientistic” isn’t a typo by the way - if you’re unfamiliar with the term see http://en.wikipedia.org/wiki/Scientism and/or http://bit.ly/juxw00 - “scientism ... a kind of over-enthusiastic and uncritically deferential attitude towards science”.

Labelling someone “delusional”, for example, is pretty insensitive and isn’t a particularly rational thing to do (unless you just happen to enjoy meaningless conflict and wasting bandwidth) as it’s hardly likely to win anyone over to your side of any argument.  If you are concerned, as many are, because you believe (or know) MMS to be dangerous to health, then it would be much more helpful if you told us why you believe that or how you know.  Insulting users of MMS (no matter how ridiculous you might believe their position to be) is only likely to be counterproductive to your aim of stopping its use.  Those with opposite positions are only going to become entrenched against you and furthermore, the image of science and its healthily skeptical, questioning and thorough investigative nature is completely misrepresented and demeaned. 

There are many and varied reasons for people seeking alternative therapies – e.g. mistrust of big pharma, conventional treatments not having worked etc.  It’s hardly surprising that people choose to use MMS when it’s so cleverly promoted and so hard to research properly, because there is so much meaningless argument about it.  I found the whole conversation, if you can call it that, well… just a little undignified at times, lacking in perspective and inconsiderate.  It was not particularly informative and didn’t advance my own understanding or knowledge much, if it all. 

Anyway, interest was sparked, so I went on a bit of a fact finding odyssey, which included working through some chemistry for the first time in about 20 years!  The intention was to try and understand MMS as well as I could for myself and present, not an argument for or against it necessarily, but rather the facts as I understood them and as fair minded as possible a view of what was going on, so that the person we had our concerns for would be able to make as informed a decision as possible for themselves on whether they should continue to use it or not.

It took some time but it seems that our efforts came to be appreciated and this person has now stopped using MMS and is advising others, including those who recommended it in the first place, to do the same - using some of the information given here.  The text below is part of what was originally sent on to them.  I’ll follow up with the rest on another post.  I know it’s not much but I do wonder how many of the flamers and trolls, on either side of this “debate”, can claim to have influenced any change in even one person’s mind.  I’m not naturally a blogger but am posting now as I just thought this all might be useful to others too.

I’m basically a meteorologist – i.e. not a chemist, a biologist, a doctor, a toxicologist or whatever so not at all qualified in this field and this is therefore probably riddled with errors and misinterpretations.  If anyone does ever happen to read this, and is more qualified than I am and spots anything that needs correcting then I’d be glad for your comments.  This isn’t definitive by any means and though lengthy, is not comprehensive or particularly detailed either.  It’s just meant to be factual, comprehensible (digestible, dare I say it) and as fair as is possible.  I hope I’ve managed that.  I had, and continue to have, no other agenda other than helping someone make an informed choice.  If you happen to be in a similar position to that which I was in or are using MMS and want to know more about it, you might find the information here similarly useful.  Let me know if you do.

I’m really not at all interested in sparking another flame war.  Any trolls and flamers out there: that is not an invitation – I will flatly ignore you.  Genuine and relevant (this post is about MMS and nothing more…) comments and questions are welcome.

Many thanks and much credit due to Ben Goldacre for “Bad Science” – which I’d highly recommend.  A number of the facts, figures and ideas here are sourced from his work.

http://www.amazon.co.uk/Bad-Science-Ben-Goldacre/dp/0007240198

http://www.badscience.net/

@bengoldacre

Whether you like any of this or not just be sure that you avoid being too “uncritically deferential”. 

Here’s the original email:

Basically, MMS looks to me to be inadvisable.  It may not be too harmful in most circumstances if done properly.  It’s highly unlikely to do you any good - I’ve found no convincing or sufficient evidence for that - and that’s not me being biased, that’s just me applying certain criteria for “convincing” and “sufficient”.  It’s probably largely harmless at very low doses, will probably make you a bit poorly at slightly higher doses, quite poorly at higher doses than that - but really only even gets close to being potentially toxic at the very top end of the suggested doseage levels (i.e. those for treating cancer – 70 a day).

If I were to make a judgement on that I’d say that it looks like Jim Humble has been pretty canny and is exploiting the uncertain grey area that is there between what’s probably safe and what may be toxic, given currently available evidence – and is using that grey area to imply that there are previously unexplored benefits (over and above the likely side-effects) within it.  To be truly fair - he could be (though I think is highly unlikely to be) right, but he really needs to demonstrate properly that that’s likely to be the case.  Just because it might not do too much harm doesn’t mean that it might do any good.  It would be great (and not impossible – nothing’s impossible if no-one’s collected and properly analysed and presented the data...) if there were a sudden “spike” in health benefits over damaging effects somewhere between probably safe and likely harmful levels as they’re currently understood – it’s just that on the face of it looks unlikely and I think it’s safer and more reasonable to assume, for the time being, that sodium chlorite and chlorine dioxide become more harmful to you the more you take.

One slightly concerning aspect, is that the main toxic effect (of drinking chlorine dioxide – which is what you end up doing with MMS) is likely to be on child development.  A range of developmental effects are seen in rat pups, though at relatively high doses (for rats) compared to MMS (no-one’s tested relatively high doses of chlorine dioxide on pregnant women, babies or children obviously) - http://www.atsdr.cdc.gov/toxprofiles/tp160.pdf.  There is a study on chlorine dioxide in the drinking water supply that claims to have found a difference in rates of neonatal jaundice, cranial circumference and body length at birth between babies born to mothers who had been drinking water treated with chlorine dioxide and babies born to mothers who hadn’t – but things like any other chemicals in the water, dietary habits etc. weren’t taken into account so it’s meaningless, because it’s impossible to attribute these differences to chlorine dioxide with any confidence.  The minimum toxic level of chlorine dioxide for rats (if you scale up by relative bodyweight from rats to people) is, I reckon, equivalent to around about 100 or more doses of MMS a day for a small person, so loads - but no-one can really say for sure how results from rats will necessarily translate to people so I’d just say it’s advisable to make sure to stay well clear of anywhere near those sorts of levels.

For what it’s worth I reckon one dose of properly prepared MMS contains about 0.9mg of chlorine dioxide, which in a 150ml glass of water is a concentration of 6mg/l.  The U.S. recommended upper limit on chlorine dioxide in the drinking water is 0.8mg/l and the “minimal risk level” is 0.1mg per kg (of your bodyweight) per day.  Toxic effects are seen in rats beginning at around 5mg per kg (of their bodyweight) per day.

MMS could be horrible, in various ways, if you do it wrong – neat MMS is, frankly, just dangerous to have around the house.  Also, putting the drops of MMS and citric acid straight into a glass of water - i.e. not mixing the drops first and then adding water (as you should if you follow the instructions) - will multiply the amount of chlorine dioxide in the dose taken by a factor of about 8 (this should be born in mind with respect to toxic levels) so it is important to make sure that it’s always mixed according to instructions – especially if more than a few drops are being used.  Because of its known chemical properties as an oxidant and a free-radical there are reasons to suspect that chlorine dioxide could be dangerous if you used it even at low-ish doses over the long term but no-one really knows because sufficient tests haven’t been done for that either.

Whether MMS is dangerous in itself or not is only one thing though.  Even therapies that are completely harmless in themselves are obviously dangerous if they are used to replace more effective treatments.  This is what makes many people particularly bothered about this kind of thing, as it gives false hope and exploits (sometimes very) ill and vulnerable people (especially children), who are effectively persuaded to deny themselves (or are denied by others) the opportunity for more evidence based, demonstrably effective and even sometimes potentially life-saving, treatment.  I don’t think anyone likes being (or should be) hoodwinked in this way – especially where hope and health are concerned (though it’s hardly uncommon).  But, of course, it’s up to each individual to decide whether they trust this stuff (or Jim Humble over the FDA and the like, or me for that matter) or not.

You might remember, for example, that it took ages for the South African government to provide effective treatment for HIV/AIDS (one of the many things MMS is supposedly good for).  This is covered in some detail in “Bad Science”.  As I understand it the reasons were partly cultural (i.e. an understandable mistrust of “evil” white western “colonial” drugs companies), partly due to the “evil” drugs companies’ own price demands but were also due to some people successfully promoting their own cheap treatment for HIV/AIDS (vitamin supplements) right at the top level of government (which was sympathetic because it believed that “natural” was best). 

So national policy on HIV/AIDS treatment basically became eat your greens and top up with vitamin supplements.  Not bad advice in general and likely to improve general health, but maybe not so good for the treatment of a serious illness.  The Western Cape province defied national policy and provided anti-retroviral drugs.  One study, which compared what ultimately happened in the Western Cape with the rest of South Africa estimated that, had anti-retroviral drugs been provided nationwide in South Africa between 1999 and 2007, this would have prevented 343,000 deaths.  Another estimated that 330,000 deaths would have been prevented between 2000 and 2005.  This kind of thing is in part why what I see as the abuse of people, language and science, as I think I put it to you previously, tends to raise my ire...

Anyway, I hope this is all helpful!

• Mixing MMS with citric acid creates chlorine dioxide
• Chlorine dioxide is an oxidant, a free radical and a very effective industrial biocide (i.e. a powerful disinfectant)
• Sodium chlorite is used to make chlorine dioxide for use in (amongst other things) some water and food treatment in the U.S.  As far as I can tell it was banned for these and some other uses in the E.U. in 2009
• If you are going to take MMS you should follow the instructions to the letter.  Although, having said that, there would be no extra harm (in fact it would be advisable) in using more drops of citric acid than instructed.  The greater the amount of citric acid, the greater the guarantee that there will be no sodium chlorite left over after the reaction, and sodium chlorite is more toxic than chlorine dioxide.  Any less than 5 drops of citric acid per drop of MMS and there will definitely be some sodium chlorite left over
• It’s a bit uncertain what the exact dosage of chlorine dioxide you end up taking with MMS is.  The amount of chlorine dioxide in one properly prepared dose of MMS will change, depending on the size of each “drop” and the surrounding temperature.  It could be higher in colder conditions.  However:
• One “dose” probably has about the same concentration of chlorine dioxide as the water in an average sized fish tank disinfected with Sanogene: http://www.lenntech.com/sanogene.htm
• This is about 7-8 times the recommended limit (U.S.) on the concentration of chlorine dioxide in the drinking water supply
• The approximate concentration of chlorine dioxide you get from one dose is higher than the (U.S.) maximum for drinking water but the amount of chlorine dioxide in one dose (one glass) is lower than the “minimal risk level” for most people (it depends on how little you are)
• A number of doses gets well above both the drinking water limit and the “minimal risk level” but would nearly always be well below estimated toxic levels
• It would be quite hard, but not impossible, to prepare and drink so much chlorine dioxide from MMS to get to levels at which there are likely to be toxic effects
• The toxic levels have largely been established through tests on rats.  Most of the known effects (of drinking chlorine dioxide solution) are on the development of rat pups
• Preparing MMS releases chlorine dioxide gas (this is why it smells when you mix a few drops of it with citric acid) and there are also toxic risks associated with that, so it’s advisable to keep the room well ventilated when making it
• There is no selection of “good” or “bad” bacteria by chlorine dioxide (in fact, you can’t really generally define any such thing as “good” and “bad” bacteria).  Chlorine dioxide kills them all and is capable of killing all types of cells (not just bacteria), including the cells that we’re all made of
• You can expect to feel poorly when you take it because it kills all types of microbes in your gut, including those you need (and possibly the cells of your actual gut too), not because you’re “detoxing” (there’s actually no such thing as a “detox” – it’s basically a marketing invention)
• Chlorine dioxide behaves like a completely indiscriminate antibiotic in the gut.  The apparent “detox” effects of nausea, vomiting, diarrhoea, stomach cramps etc. as you increase the dose of MMS are the same side effects you can get with antibiotics, which in a very crude sense is kind of what MMS is.  MMS could leave you open to further infection, as they can
• The effect on your gut is a bit like the effect of spraying your whole garden with weed killer.  Weed killer doesn’t just kill weeds
• It’s hard to imagine a drug where the side-effects can be expected to dominate over any potential benefit more than MMS
• There’s no evidence MMS has any benefit.  At the very least there is no evidence that it is both safer and more effective than existing treatments for anything
• There are a wide range of things that could explain the apparent “success” of MMS – e.g. just getting better naturally anyway, the placebo effect etc.  These at least need to be eliminated as possible explanations of how it “works” before it can be accepted to be effective
• “Confounding” factors like these are one of the reasons it took ages for people to realise that things like leeches and blood-letting etc. didn’t actually work and for conventional, evidence based medicine to begin to develop
• Pretty much any treatment can appear to “work” (in a sense) for everyday illnesses and can confuse everybody – even the people who developed the treatment.  They may think they’re onto a good thing but until proper tests are done they can’t say so for sure
• Remind me to tell you about my “miracle toe-stubbing therapy” one day… basically if someone tells you that doing something will make you better and you do it and then you get better, naturally you associate the fact that you’re better with doing whatever it was they told you to do
• You usually take medicine when you’re feeling unwell and are generally (unless it’s serious) likely to get better naturally anyway.  It’s very difficult to distinguish for yourself the effect of your immune system from the effect of the medicine
• Your friend knows plenty of people who’ve been taking MMS for years and are fit and well - which is excellent to hear!  The pertinent question though, is not whether they are fit and well but whether they are more, the same or less fit and well than they would have been had they not taken it – and that’s impossible to answer
• The “evidence” for MMS working in serious illnesses is deeply flawed.  It’s largely anecdotal (so impossible to substantiate) but even where trials have been done they’ve been very poorly conducted and designed and the results misrepresented somewhat
• Established, “conventional”, evidence based medicine is an enormous success story, in terms of improvements in infant mortality, life expectancy, survival and recovery rates from many illnesses etc. - it plainly works
• Death and illness are natural.  Is successfully preventing death and curing illness unnatural?
• An apple a day keeps the doctor away is fundamentally true – eating at least five fresh fruit and veg a day and avoiding processed junk is a very good idea indeed – for general health
• Your immune system is pretty good at getting you better from many everyday bugs etc. so reaching straight for the medicine cabinet (full of side-effects), whatever it contains, is not necessarily the best and most natural idea – but if you’re really ill conventional medicine is plainly a very good idea
• Which is more natural: MMS or Sanogene (see above)?
• MMS could be very unsafe in a number of ways if you don’t follow the instructions
• Mixing MMS the right way releases quite a bit of chlorine dioxide gas.  If you mix sodium chlorite and citric acid drops straight into a glass of water (instead of adding the water last) then there is more than enough water present to dissolve all of the chlorine dioxide generated – so it all stays in the water rather than being released to the atmosphere
• You multiply the dose of chlorine dioxide about 8-fold just by mixing things together like this – i.e. in exactly the right amount but in slightly the wrong order.  It wouldn’t smell so bad but it would taste worse and would be worse for you
• Drinking one (or even part of a) bottle of neat MMS (without any mixing with citric acid or diluting it) might not kill you but would be very likely to lead to kidney failure at the very least (a Chinese man attempted suicide by drinking the equivalent of about a third of a bottle of neat MMS and suffered kidney failure - but didn’t die)
• If you mixed one bottle of neat MMS with citric acid (rather than just a few drops) in the proportions suggested you could release enough chlorine dioxide gas to kill you (I doubt anyone would do this on purpose but there’s always a risk of spills)
• There is no reason for neat MMS to be such a dangerously high concentration of sodium chlorite (28%) - preparing MMS as instructed produces much more chlorine dioxide than can be dissolved in a few drops of water, so most if it is released as a gas
• You’d get the same dose of chlorine dioxide solution if neat MMS was only ~4% sodium chlorite (and mixing it with citric acid would release little or no chlorine dioxide gas).
• It goes without saying that 4% sodium chlorite solution would be generally much safer to have around the house!
• It could be unsafe even if you do follow instructions but no-one really knows.  No-one knows the long term effects of the estimated MMS dosage levels on people but there are reasons to expect that they could be potentially damaging simply because of the oxidant/free-radical nature of chlorine dioxide
• Maybe big drug companies are evil – but that doesn’t lead to the conclusion that any alternatives are necessarily not
• Drug companies spend a lot of time and effort trying to get new drugs round the FDA – they certainly don’t see the FDA as friends
• That big drug companies are evil doesn’t mean established conventional medicine is evil, just that there can be (sometimes very serious) issues, especially with new, insufficiently tested and heavily promoted treatments (which is basically what MMS is too - and with MMS there’s no reason it might even be expected to work)
• The position the FDA are in (with criticism from both Jim Humble and from supporters of MMS) is very similar to the position any regulator can find itself in when a big drug company wants to get early approval for a new drug (i.e. under pressure from the drug company and from patients’ groups).  The regulator will often refuse approval because trials are not complete and there is insufficient evidence that the drug is safe and effective.  There’s no difference between Jim Humble and big drug companies in this context 
• It may not always be perfect (I don’t know) but I think the FDA are just the fall guy (and probably the good guy) in this instance.  It’s just applying the law (as it should) and the law (with respect to claims made in drug marketing) has demonstrably been broken http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm152422.htm
• Claims for the benefits of MMS are unfounded and people are, in effect, being used as lab rats in a (very poorly designed) drug trial on a potentially dangerous substance
• Until proper (“proper” includes ethical as well as scientific considerations) trials have been done anyone using MMS is doing so simply on the basis of trust in Jim Humble and not on the basis of evidence.  I don’t trust Jim Humble much myself, if at all - but that’s just a personal opinion and it’s up to each individual to decide for themselves on that
• Not having enough money to be able to disprove the hypothesis that MMS is dangerous (which is a very valid hypothesis given the oxidant, free radical properties of chlorine dioxide), or that it is not effective, is not a valid reason for encouraging people to take it, no matter what anyone thinks the benefits could be
• Much of the blurb, the explanation of “how it works”, is pseudo-science – i.e. it (mis)uses lots of scientific terms and concepts to make apparent sense but misses out key facts and details, so completely misrepresents the action of chlorine dioxide on cells in the body
• MMS has all the signs of a scam, particularly in the way the “science” is presented and distorted
• If you really don’t trust the FDA and want to look for a conspiracy you could argue (though I think this is a fairly weak way to argue) that:

a) it could be in the FDA’s interest (as chlorine dioxide is already present in U.S. water supplies and food) to promote (not challenge) the safety of chlorine dioxide

b) the FDA’s attitude to MMS could be based on knowledge that the current limits (in water etc.) are not as safe as is stated by government agencies in public (and therefore that the higher levels in most doses of MMS are more dangerous than is stated)

c) liberal laws covering the claims that can be made about a drug or treatment in any marketing would be of benefit to big drug companies.  If the FDA is in the hands of these companies then regulations are probably too loose rather than too tight.  Even then, MMS has contravened them