I'm hoping it's opium

In among the supermarket flyers that fell out of today's issue of the local newspaper was this intriguing single glossy page:

Front of questionable pain-relief flyer

Note the subtle change from a promise of FREE TREATMENT for your Arthritic Pain at the top of the page, to "you may be entitled to a FREE TREATMENT", boldface mine, in smaller print further down.

Note also the invaluable diagram to remind any forgetful elderly readers of the parts of their body which they might care to concentrate on, in hopes of feeling some pain there:

Helpful diagram of bits of people that can feel pain

The reverse of the flyer:

Back of questionable pain-relief flyer

(I've put the plain text of the flyer at the end of this post, to help searchers find it.)

These people may be 100% kosher, and their promise of some undisclosed kind of pain relief that may or may not be free may be given in entirely good faith.

I am a horrible, cynical person, though, so I have my doubts.

Pain relief is the gold-standard undisputed champion of things that placebos, and woo-woo alt-med nonsense that is in truth actually just a placebo, can treat.

This is a good thing. If you believe your pain is reduced, then your pain is reduced. Hurrah!

It's not like believing a small electrical gadget is curing your cancer when it isn't. Tumours are objective things, but pain is subjective. If you think it's gone, it's gone.

This doesn't, however, mean that anyone offering quote "free" unquote asterisk double-asterisk dagger double-dagger section-sign pain treatment to arthritis sufferers should be left alone to sell whatever it is they're selling.

For one thing, someone making this sort of offer may not be selling a true placebo. The classic example in alt-med arthritis treatment is Traditional Chinese Medicine arthritis pills, often called "black pearl" pills, which have on many occasions been found to simply contain plenty of normal non-Traditional-Chinese-Anything painkillers and anti-inflammatories.

On the plus side, this makes those pills work really well. But unknowingly taking large doses of steroidal anti-inflammatories, benzodiazepines and plain old paracetamol (a compound whose sole shortcoming as a painkiller is a rather narrow therapeutic index, the difference between an effective dose and a toxic one...) is a good way to end up unexpectedly hospitalised, or dead. Especially if you're as old as the average buyer of arthritis medication.

(The sellers of such medicines usually refer to the presence of real medicines in their woo-woo pills as "contamination". It is a wonder which passeth all understanding that "contamination" of alternative medicines always seems to involve substances that do what the alternative medicine is supposed to do. Never speed in the sleeping pills, never codeine in the erectile-dysfunction pills. A mystery, indeed.)

And then there are the alt-med treatments which are actually actively harmful. Poisonous, but otherwise placebo, anti-pain medicine may actually work better against pain than a sugar-pill placebo; if it's got obvious unpleasant side effects, then it must be powerful stuff!

(See also, sellers of worthless medicines who put warnings on them that say, for instance, that they should not be taken by pregnant women. And sham surgery, the most powerful placebo there is!)

Elderly people are ideal customers for a lot of scam artists. The perfect customer is someone who's losing their marbles but unaware of it - the dottier you become, the less qualified you are to detect your dottiness, and the more likely you are to conclude that you've made a solid deal when someone more compos mentis than you can see you're being thoroughly ripped off.

If Grandad's sliding into senility but hasn't (yet) had control of his finances taken away, he will be disproportionately likely to hurl large portions of said finances at door-to-door fake home repairers, worthless investments, phone scammers pretending they're from Microsoft, and of course the world's extraordinarily large supply of cashier's-cheque overpayers and Nigerian princes.

(Just this moment I myself received a very attractive e-mail offer from "MR.ALEX GOODWILL", who appears to be quite a prolific philanthropist.)

And, of course, there are also many older people who are just desperate for something, anything, to stop everything from hurting all the time. They may be as suspicious of a "Free treatment! Honest!" flyer like this as I am, and just as sure that whatever it is, it probably won't actually be free, but they're willing to try it anyway, in pursuit of even a slim chance of making their life a little more worth living.

Personally, the second I saw this flyer I was ready to bet money I had borrowed from Jimmy the Toecutter that this offer, whatever it was, was some sort of alt-med woo-woo BS.

But again, who knows, it might be totally legit. So I did a little digging.

When I searched for chunks of text from the flyer all I found was this Word document on a server belonging to the New Zealand Advertising Standards Authority. It's a complaint about a very similar-sounding flyer, including the helpful body diagram. But that flyer actually named the provider of the alleged treatment - "Niagara Healthcare".

(Niagara's response is a pretty great piece of weaseling, and a successful one, too; the complaint was not upheld!)

Perhaps my flyer had nothing to do with Niagara, though. So I searched for "Digitalpop", the name of the company on the postage-paid response thing, and "niagara". And hey presto, DigitalPop are listed as the ad agency for Niagara here in Australia.

I don't know if that'd stand up in court, but it's good enough for me. And even if this flyer by some quirk of fate doesn't have anything to do with Niagara, I think they're still a mob worth writing about.

Niagara are, you see, in the motorized-massage-gizmo business. Here's their Australian site. They sell handheld massagers, chairs with motorized rubby things in the upholstery, and other such things, including adjustable chairs and beds that help the infirm to get up, and so on.

They don't actually list any prices, though. Not on their Australian site, not on their UK one, and not on this US site either. That last site does have this Sale page proudly offering a ten-inch-thick queen-sized memory-foam mattress for a mere $US699, down from $US1499. I'm sure it is far, far better in many very convincing ways than the superficially strangely similar memory-foam mattresses you can get for three to four hundred dollars on eBay. Doubtless those are all cheap crap that will fall apart in no time.

(I bought the cheapest memory-foam pillows I could find on eBay, more than ten years ago now. They are still in perfect working order.)

Apart from that, the Niagara sites are... priceless. If you want the price of a chair, for instance, then on the Aussie site you have to fill in this quote-request form.

That is seldom a good sign.

It would appear that you can pay 1600 New Zealand dollars (more than $US1300, as I write this) just for a handheld Niagara massager, and I don't know what the chairs cost but there's a used one on eBay Australia right now with bids starting at seven and a half thousand dollars. There's a "Niagara Platinum 6 Electric Massage Therapy Bed" on offer, too; a snip at $AU5000 Or Best Offer!

(There's also a Niagara chair on eBay.com.au for less than $200, but it's only heated, not a massager.)

Niagara's Australian "key benefits" page quotes four alleged studies supporting the usefulness of their "Cycloid Vibration Therapy". I was surprised to discover that the second and the third studies on the list actually seem to exist and be published and everything. There doesn't seem to be much in the way of replication of their results, and neither study is of pain relief, and although the Niagara page calls them "recent studies", they're actually 28 and 31 years old, respectively. But they're still well ahead of the usual "studies" that are supposed to support unconventional therapies. For whatever that's worth.

I could find no evidence of the existence of the last-mentioned study at all, though. And the closest I could find for the first one was this study, which seems to have been done by the same guy quoted on the Niagara page and to be studying much the same thing quoted on the Niagara page, but which is singing the praises of "LPG Endermologie" rather than "Niagara Therapy".

"Endermologie" buzzes your flesh around to make you look slightly younger, and actually does work, for suitably small values of "work". (I'm sure all the ladies on the Endermologie Web site are actually in late middle age and displaying the miraculous results of the therapy, because it'd be a serious insult to their customers' intelligence if they depicted their products being used by heavily Photoshopped and distinctly underweight 20-year-olds.)

For some reason, the little list of studies on the Australian Niagara site doesn't include this 2002 study, which is the only abstract I could find in the whole of MEDLINE that actually refers to "cycloid vibration therapy", which is what Niagara call their great discovery.

That study's abstract says it found that cycloidal vibration along with compression bandaging helped the healing of venous leg ulceration. Except that doesn't seem to really be what it found at all, because there was no control group, just 21 patients getting their bandaged injuries buzzed. A better study would have some patients bandaged without massage, some patients bandaged and vibrated the expensive Niagara way, and some patients bandaged and vibrated with the finest, cheapest electric massager the nearest sex shop had to offer.

What, I wondered innocently, have other people had to say about Niagara?

Well, Consumer NZ is unimpressed with them, straightforwardly calling their products "overpriced".

Ricability, a UK consumer-research charity, gives Niagara special attention in this PDF, titled "Sharp selling practices in the selling of assistive products to older people".

The UK Office of Fair Trading made them change unfair contracts.

And, interestingly, the UK Advertising Standards Authority did not uphold a complaint (in this PDF) about a "free trial" of Niagara products not lasting long enough.

In Niagara's successful response to the complaint, they said that their free trial lasted "approximately 45 minutes". It seems clear to me that this "free trial" is the "free treatment" that my flyer is offering, if you send in the form. A salesman "medically trained consultant" comes to your house and sets up a buzzy thing, you get to use it for a little while, then he tries to sell you a handheld massager that costs as much as 25 Hitachi Magic Wands, or a chair or bed that costs as much as a good used car.

(Niagara's response also says that they've sent 500 million mailings about their products in the previous 20 years. I don't have much to say about that, I'm just boggling a bit. No wonder their scientific evidence is thin on the ground, even though they proudly say they've been in business since 1949. They've been far too busy printing advertising material to ever clearly demonstrate their very expensive massage doodads do anything that far cheaper, but suspiciously similar, ones do not.)

Maybe the Niagara gadgets all work great, and are more than worth their hefty, semi-secret price tags. Maybe this flyer doesn't even have anything to do with Niagara, despite the many points of similarity. Maybe we are all actually brains in jars. Who knows?

What this looks like to me, though, is an offer of "free treatment" from a company whose products are actually so astonishingly expensive that they'll only tell you what the things cost if you consent to talk to a trained salesperson. They market these expensive products to elderly people, who may be more amenable to tricky sales techniques, or unaware of cheaper alternatives. And Niagara's products may be more effective at relieving arthritis pain than far cheaper massage devices, but they present no evidence that this is the case, despite a proud claim of having been in business for more than sixty years.

One of my personal rules of thumb is, "nothing worth buying is sold door-to-door".

I now add another one: "If a product is a secret, you probably shouldn't buy it".


And now, a transcript of the flyer, to make it easier for searchers to find this page.


Are You Living With...
Arthritic Pain?
Is Pain impacting your daily lifestyle...
Complete this application today to receive your
FREE TREATMENT
DON'T put up with it any longer!
Have you been diagnosed with?
Arthritic Pain
Tension
Poor Circulation
Fatigue
Cramps
Fluid Retention
Sciatica
Swollen Joints

Where is most of your pain?
Neck
Hips
Shoulders
Legs
Back
Knees
Arms/Hands
Feet

Thank you very much for your co-operation.
By completing and returning this form you may
be entitled to a FREE TREATMENT.

SEND NOW FOR
YOUR FREE!
TREATMENT

The other side:


FREE TREATMENT

Happiness is nothing more than good health, Mobility and Quality of Life

Delivery Address:
PO Box 1173
SPRINGWOOD QLD 4127

Digitalpop PTY LTD
Reply Paid 85427
SPRINGWOOD QLD 4127

We respect your privacy
Your privacy is important to us. We are committed to ensuring that any personal and health information you provide us is handled properly and with all due care. In addition, we comply with the National privacy principles and the Privacy Act 1988. Collecting health information is necessary to ensure we provide you with an excellent service. We will only use or disclose your health information to the extent you have consented to such use or disclosure.
Digital Pop ABN 87 136 922 551

Important If symptoms persist, sees your doctor or health care professional. Use only as directed.

TUCK IN AND POST
Simply fold along the dotted vertical line marked First Fold, make the second fold, then tuck the third fold into the back of the second fold and post.

Great sound, shame about the cancer

A reader writes:

I came across your F5 speaker article...

Kit speakers

...and was very impressed with the information provided.

Is it true that glass fibre batts in speakers can cause mesothelioma? I noticed you linked to the Wikipedia mesothelioma page when discussing polyester and glass fibre batts with the word "carcinogenic".

Bailey

A ported speaker with glass-fibre wadding inside (it's there to dampen internal resonances) will spit little bits of fibreglass out of its ports in normal use. The cancer risk from these is essentially nil, mainly because the amount of glass emitted is very small. But even larger glass-fibre exposures are generally less dangerous than asbestos exposure, and there's some debate about why this is.

Fibreglass and asbestos are mechanically, and somewhat chemically, similar. Glass-fibre, like window glass, is about three-quarters silicon dioxide (quartz), with the rest being additives, chiefly oxides of light metals, to reduce the glass's melting point and improve its strength and/or chemical properties. All forms of asbestos are essentially silicate minerals too, but with different elements mixed in with the silicon and oxygen.

The most common form of asbestos is the white "serpentine" kind, which is magnesium silicate. Blue and brown "amphibole" asbestos are closer to window-glass, being complicated sodium, magnesium and iron silicate minerals.

Asbestos is so particularly nasty (and useful) because its fibres can be very, very fine, routinely below twenty micrometres (or microns) in diameter, and even down to small fractions of a micrometre, versus around 100 micrometres for a human hair. These ultra-fine fibres are too small to even see, and bits of them can float around in the air waiting to be inhaled. This is why they tent whole buildings and put workers in moon-suits to do asbestos abatement; building materials that contain asbestos can be safe to be near, but as soon as you start busting those materials up, they can produce dangerous and invisible dust.

Fibreglass, also known as glass wool, is made in a similar way to fairy floss ("cotton candy", in the USA); extrusion of the molten material through tiny nozzles. The nozzle size determines the thickness of the filaments, so glass fibres can quite easily be made down to single-digit-micron thickness. As is the case for many other "whisker" materials, most of the desirable physical qualities of the fibres increase as the thickness drops. (This is explored in some detail in J.E. Gordon's classic "The New Science of Strong Materials, or Why You Don't Fall through the Floor", a book that I may not have mentioned on this site for as much as eight or nine minutes.)

Concrete dust and asbestos and glass fibres

This electron micrograph of dust from the wreckage of the World Trade Center (via the USGS) shows a thin glass fibre and a bundle of much thinner asbestos fibres.

(Nobody performed full asbestos abatement on the WTC towers while they were standing, because it would have been very expensive, the asbestos was largely safely bound up in building materials, and nobody expected the buildings to fall down.)

Glass fibres down in the single-digit-micron diameter range are a cancer risk, like asbestos, but glass fibre in general seems to be rather less carcinogenic than asbestos fibres of similar dimensions. Nobody's exactly sure why. Glass fibres don't seem to get stuck in the lungs like asbestos fibres do; this could be purely because of the size difference, or because they don't have the same rough, almost barbed sides...

Asbestos fibres

...as many asbestos fibres (that's another USGS picture).

Glass is also slightly soluble in water, and - it is theorised - fibres in the lungs can thus be slowly eliminated via blood or sputum. For macroscopic objects the water-solubility of glass is essentially zero; you can run water through a glass tube in a laboratory for years with no visible change, and you don't need to worry about rain wearing through your windows. But the thinner the fibres, the greater will be the surface area of those fibres relative to their volume. So even extremely slight solubility can, the theory goes, get rid of the fibres usefully quickly.

It's important to realise that we're not just talking about cancer, here. Most people with asbestos-related lung disease don't have mesothelioma; they've got "asbestosis", a non-cancerous inflammatory disease which can, nonetheless, very effectively destroy your quality of life and in extreme cases kill you. Again, it's the super-fine fibres of asbestos that make it particularly nasty here, but you can get similar syndromes by inhaling various other particulate substances that get stuck in your lungs, like coal dust, and also little bits of fibreglass.

Realistically, even someone who stuffs fibreglass into speaker boxes for a living, without so much as a face mask, isn't at a huge risk of lung disease - cancer, or "just" an asbestosis-like condition. Usually it's people like surfboard manufacturers or insulation installers who get sick, and then only if they don't use a respirator while they're sanding boards or stuffing insulation batts into unventilated roof or floor cavities.

So if you've got ported speakers with fibreglass in them, don't worry about it. Even if you open the speakers up to replace a blown crossover or something, you're in no real danger. (And if you've got un-ported, sealed "infinite baffle" speakers, there is of course even less risk.)

The loudspeaker industry switched to using cellulose acetate or polyester fluff...

Speaker kit parts

...as the normal low-cost anti-resonance speaker-lagging material...

Inside of small speaker enclosures

...some time ago, but I think the change was mainly because these fibres are easier to cut and place, and not a prickly skin irritant, rather than for health reasons.

Incidentally, white asbestos and talc, as in talcum powder and...

Sticks of French chalk and holder

..."French chalk", are chemically the same, both magnesium silicate. Asbestos can metamorphose into talc, though I'm not sure if talc can go the other way. In any case, industrial-grade talc can be expected to contain some asbestos-like filaments.

This fact caused a certain amount of panic among people who've applied talcum powder liberally to their baby, or discovered that standard children's wax crayons contained a small amount of talc, which in turn did or did not contain - depending on who you asked - a tiny amount of actual identifiable asbestos.

(Some people went so far as to allege that because they're chemically the same, talcum powder is asbestos. By this logic, it should be easy to drive nails with a Brillo pad. But have no fear, highly independent thinkers stand ready to help you remove asbestos from your spine with magnets!)

In response to this, more than a decade ago the big-brand crayon formulations were changed to contain no talc. How crayon-talc was supposed to get into kids' lungs in the first place, I'm not sure. Embedding asbestos in wax strikes me as an excellent way of rendering the stuff harmless, even when kids stick crayons up their noses. Perhaps some asbestos could lodge in the digestive tract if they ate it, but I think the normal regeneration of the gut lining would carry it away. Unless you actually lit a crayon fire, I doubt any significant exposure was even theoretically possible.

The asbestos-in-talcum-powder scare was more rational, because people unquestionably do inhale some talcum powder when they use the product in normal everyday ways. There's a difference between bulk industrial talc and the super-fine stuff used for talcum powder, though. Major talcum-powder companies hotly protested that there was no asbestos in their talc at all.

It's rational to take at least some care to prevent you or your baby from inhaling talcum powder, because, as discussed above, inhaling fine insoluble powders in general is a bad idea. But there doesn't seem to be any serious reason to boycott the product entirely.

(There's also a popular belief that laser-printer or photocopier toner is deadly poisonous if inhaled. Actually, toner is just yet another insoluble fine powder. So, once again, you should avoid inhaling it if you can, and wear an appropriate mask if you have chronic exposure to it. But there's no need to panic if you snort a little of the stuff by accident.)


Psycho Science is a regular feature here. Ask me your science questions, and I'll answer them. Probably.

And then commenters will, I hope, correct at least the most obvious flaws in my answer.

Button batteries: Threat or menace?

A reader writes:

The Register had this story; it paraphrases a study from Pediatrics but includes this paragraph:

The incidents are no laughing matter, as a swallowed button cell can generate sufficient current to burn a hole in a child's oesophagus, from the inside, without the child displaying any obvious symptoms. Acid can also injure. Even batteries that appear depleted, inasmuch as they can no longer power electrical devices, can inflict these injuries.

Is it just me, or is the claim that a mostly-depleted button cell can "burn a hole in a child's esophagus" via electrical current a complete and obvious impossibility? By leaking strongly acidic or basic electrolyte I can buy, but by electrical action?

Charles

In brief: Yes, the problem here is burning, and it can be very serious. But it's not electrical burning, it's chemical burning, specifically as a result of electrolysis of tissue fluids. And if a battery makes it to the stomach, the swallower is likely to be OK; it's only if it lodges in the oesophagus that big trouble is likely to result.

Well, that's what I learned in the course of writing the following Wall O' Text, anyway.

("I would have written a shorter letter, but I did not have the time.")

Whenever you find yourself wondering about some oddball medical news, you should proceed directly to PubMed.

(This is particularly important if you got the news from a newspaper or TV show, many of which can be relied upon to get almost all science news solidly wrong. Mass-media science reporting is sometimes good, but it's very often terrible, for surprisingly complex reasons. Whenever I hear some interesting-sounding science report on TV news, I try to remember the first five seconds of the report and expunge the rest of it from my consciousness, so I can look up what, if anything, has really been discovered, without wasting any neuron-connections on what some attractive ignoramus thinks is going on. See also, jazzed-up, dumbed-down reality shows, some of which make a real effort to get things right, and some of which don't.)

PubMed lets you search the Medline, and some other, medical research databases. You'll generally only get the abstract of each paper (and not even that, for some), and you're not tremendously likely to be able to find the whole paper for free anywhere (a situation which should change, and actually may). But a quick PubMed search will nonetheless give you a rough idea of the state of research on a subject.

If you lean on PubMed for evidence when you're having an argument with someone, the two of you are likely to end up playing what I call Duelling Abstracts, in which neither of you knows how good any of the research you're citing is, so you both just end up Bullshitting for Victory. All research is not of the same quality, and PubMed will cheerfully present you with numerous papers in support of almost any nutty idea you like. (This is largely because Medline indexes many dodgy journals along with the respectable ones.)

Assuming you're not using the science for support, rather than illumination, you need to see how well a given piece of research was done, and how often it's been reproduced by other researchers, before you should cite it in a serious discussion. (At least few bad papers are the result of outright fraud. Unfortunately, though, a paper often has to be blatantly and quite famously fraudulent before it'll actually be withdrawn, though this situation is improving.)

But if you're just trying to see whether there's any research on, say, kids swallowing batteries, and you don't need more detail than you get from paper abstracts or letters written to medical journals (PubMed doesn't only index research papers), a couple of minutes on PubMed is all you need.

I was surprised to discover that there's actually quite a bit of literature on the subject of kids eating small batteries. I suppose it's the result of more and more consumer items that run from these tiny batteries. In 1980 you might have had a lithium coin or an alkaline LR44 in your calculator or wristwatch, or a silver-oxide cell if you were fancy, or a zinc-air battery in your hearing aid and maybe a mercury battery in your camera. But plenty of people didn't have one button cell in their house.

Nowadays, small remote controls, key-ring flashlights, laser pointers and umpteen other glowing tchotchkes run from miniature batteries, and it's easy to get the batteries out of most of these items. The only other thing you need to guarantee many tiny-battery-ingestion events is firm instruction from a parent that children must most emphatically not eat said batteries.

However it happens, kids are eating batteries, and the results can be quite serious.

I initially thought some danger might be posed by lithium batteries, which really do contain metallic lithium...

...which isn't as excitable as its relatives further down the leftmost column of the Periodic Table, but which is still not something you want running around loose in your stomach. Lithium salts: Mood stabiliser. Metallic lithium: Mood ruiner.

In theory, stomach acid could eat through the casing of a battery, but in practice this doesn't seem to happen. Especially not with lithium cells, which are deliberately made very resistant to corrosion specifically to stop them from starting fires all over the place. The same goes for pretty much every other tiny battery; I don't know which of them have stainless-steel casings, but it seems they can be expected to pass through the gastrointestinal system pretty much intact, even if they do some damage on the way.

The mechanism for said damage does seem to be electrical, but not directly. Even a brand new button cell doesn't have a lot of power to deliver, and the harder you load a battery the less capacity you'll get, but swallowing a battery will give it a quite nice low-resistance pathway from one terminal to the other, and button cells all have terminals separated by only a millimetre or two. This means something close to the battery's full short-circuit current could flow through a quite small amount of tissue. The relatively large circumference of a coin cell will spread out the affected area a bit, unless the battery lodges in such a way that only part of its circumference has a good contact.

To see how much current that actually is, I threw together a battery-torturing apparatus...

Battery-torturing apparatus

...in which the twenty-amp current range of a multimeter, with about one ohm of resistance including the wires, stood in for the conductive lining of a human gut. I think one ohm is a pretty good figure to go with, here; human tissue is often not very conductive at all (put multimeter probes next to each other on your tongue and you can get a surprisingly high reading; more invasive test techniques are discouraged), but I think the internal mucous membranes, plus stomach acid or one or another salt, are both pretty conductive and pretty easy to damage.

My first victim was a tiny LR754 alkaline button cell, 7.9 by 5.4 millimetres in size, which had been sitting in my miscellaneous-battery drawer for a while but still had an open-circuit voltage above 1.5 volts. At the moment when I clicked the magnetic contacts onto the cell it produced more than 0.2 amps, but this fell to 0.1 amps after 30 seconds, 0.07 after a minute, and so on down the line until it was 0.01 amps at five minutes.

(Because I was using the super-low-resistance 20-amp range on the meter, the lowest current I could measure was 0.01 amps, and I wouldn't bet my life on the meter's accuracy either.)

Next I tried a CR2016 lithium coin cell, 20mm in diameter and 1.6mm thick. These cells are commonly used in Photon-type key-ring flashlights; red key-ring lights can run from one double-thickness CR2032, but blue, green and white LEDs need more voltage and so run from a series stack of two 2016s.

(Modern computer motherboards usually have a 20-series coin cell as their BIOS-setting backup battery. It'll probably be a CR2032, but in a pinch you can substitute a 2025 or 2016; the thinner cells should still fit the contacts. Don't stack thinner cells to fill the holder, though!)

The 2016's initial open-circuit voltage was 3.25V, but it managed less than 0.01 amps from the outset.

I thought I might have picked a defective or very old CR2016, but who cares, if the ceiling performance of shorted lithium coins isn't high enough to be a worry anyway? So I next tried to establish where that ceiling is by testing a beefy (by coin-cell standards) CR2430 (24mm wide, 3mm thick), which had also been on the shelf for rather a while and only started at 3.16 volts open-circuit, but which still should be able to easily beat any of the more common 2016s or 2032s.

The 2430's initial current was up around half an amp, but that lasted less than a second. It managed 0.16 amps after 15 seconds, 0.12 amps after a minute, 0.09 after two minutes, and kept going strongly (again, by coin-cell standards); it still managed 0.08 amps after four minutes, 0.06 after seven minutes, and was still managing 0.03A after thirty minutes, which was when I unshackled the prisoner from the wall and consigned him to eternity in the rubbish bin.

OK, so this cell managed to deliver something in the neighbourhood of a tenth of an amp for at least a few consecutive minutes. Voltage equals current times resistance, so if the current is 0.1 amps and the resistance is one ohm, there must be only 0.1V across the battery. (Voltage sag is normal in overloaded batteries.) Power equals voltage times current; 0.1 volts times 0.1 amps gives a miserable ten milliwatts of power, which even if it were concentrated in one small spot probably wouldn't, I think, directly singe even a baby's oesophagus.

My last victim was an alkaline LR44. I think this is the button battery most likely to end up inside a child, because it's both conveniently pill-shaped and very widely used. The one I chose started out at 1.57 volts open-circuit, and initially managed to deliver more than 0.3 amps into the short circuit. This, again, fell very rapidly, to 0.23 amps at 15 seconds, 0.21 at 30 seconds, 0.18 after a minute, and so on. At five minutes it was 0.12 amps, and just before ten minutes it suddenly fell from 0.07 amps to only 0.01, perhaps because of some internal failure caused by the short.

(The LR44 didn't get hot or leak, though. Modern batteries are extraordinarily good at not leaking, and only partly because we now use a lot of alkalines instead of carbon-zinc cells which corroded away their zinc casing as part of their normal operation. Un-leaking batteries are one of those things, like un-popping tyres, that now give so little trouble that people fail to even notice them any more.)

OK, let's suppose we've got a very beefy LR44 that manages to deliver 0.3 amps into one ohm for a significant amount of time. V equals IR, once again, I is 0.3, R is 1, therefore V is 0.3V, and V times I is a pathetic 0.09 watts. Again, this doesn't seem to me to be very dangerous.

And the medical literature mostly agrees.

If a button battery lodges in the oesophagus then you have a problem. A neck-lodged battery can cause a tracheo-oesophageal fistula (a hole between the trachea and the oesophagus); one did in this unfortunate one-year-old, who recovered, and in this toddler, who didn't.

One of the couple of kids who apparently managed to eat an LED throwie escaped without drama. This kid for some reason ate multiple magnets and batteries, but only the magnets then caused trouble.

Interestingly, there's a two-page guide to "Management of children who have swallowed button batteries", which was published in 1986 in Archives of Disease in Childhood, in PDF format here. It agrees with the newer papers that it's lodgement in the oesophagus that's the problem, but says thin lithium coin cells don't seem prone to lodge at all. And it also speculates that an increase in pH (an increase in alkalinity around the battery's anode) is what causes tissue burns, not simple electrical heating or leaking chemicals from inside the battery.

A swallowed battery is essentially electrolysing water wherever it comes to rest. That'll produce hydrogen bubbles on one terminal and oxygen bubbles on the other, but the salts that make saliva, gastric juices and tissue conductive will electrolyse too. Sodium chloride in water, or hydrochloric acid from the stomach, could give you chlorine bubbles along with the others, which would be bad news. Perhaps it's that, along with mechanical damage from the child trying to swallow the battery or cough it up, that causes fistulas and their life-threatening consequences.

Given the feeble numbers I got by short-circuiting miniature batteries, I agree that there really doesn't seem to be any electrical burning going on there. You'd just need more watts per conductive length than 1.5V and 3V miniature batteries can deliver. A twelve-volt A23 battery might do it; A23s have a stack of tiny button cells inside them, and used to be ubiquitous in small radio transmitters like car central-locking key-fobs and wireless doorbells, but are now being replaced by lithium coins. I bet a standard rectangular nine-volt battery could do it too, in the unlikely event that even a full-grown adult, let alone a child, somehow managed to ram one down their throat. There are rechargeable button cells as well, which like other rechargeables have a lot more current capacity than non-rechargeables of the same size, but they're rare enough that no child may ever actually have swallowed one.

There are various other individual case reports, ranging from the benign to the fatal, in the face of which one should remember that surely for every kid who ends up in hospital for battery-eating there must be a few who ate and later excreted a battery without any adult noticing. Or, at least, without any adult noticing until they changed that nappy.

Saving the best for last, here we have "an analysis of 8648 cases", the full text of which is available for free. The authors conclude, and also say in this slightly later paper (also online for free), that the severity of battery-swallowing injuries is getting worse, because of proliferation of 20mm-plus coin cells, which (in contradiction of the 1986 management guide) now seem to be the most dangerous. Misdiagnosis seems to be a major part of the problem, though, which shouldn't be too hard to fix since batteries show up loud and clear on an X-ray. Oh, and kids do manage to swallow AAA and AA batteries too; more than 5% of the 8648 cases involved "cylindrical cells".

These authors also say it's alkalinity - formation of hydroxide ions in tissue fluids next to one terminal of the battery - that "is now appreciated as the most important mechanism" in batteries damaging flesh.

So yes, swallowed batteries can "burn" the swallower, but chemically, not via resistive heating, which barely happens at all because these batteries can't deliver much power.

In the absence of complications like swallowed magnets, there only seems to be a danger if the battery lodges in the oesophagus. But 20mm and larger lithium coin cells are a good size to do exactly that, and if one does, there appears to be a good chance of very bad results. The authors of those two meta-analyses says there's a 12.6% chance that a child younger than six swallows a 20mm-plus coin cell will "experience serious complications or death", but they base that primarily on the records of the US National Poison Data System and National Battery Ingestion Hotline (who knew?), which of course don't get to hear about battery-consumption that doesn't cause any problems and passes unnoticed.

Still, in the million-item list of things for parents of young children to freak out about, this doesn't seem like a silly one. I think parents could do worse than scan their house for remote controls, kitchen scales, toys and so on that have small and easily-removed batteries.


Psycho Science is a regular feature here. Ask me your science questions, and I'll answer them. Probably.

And then commenters will, I hope, correct at least the most obvious flaws in my answer.

Those poor lemurs

A reader writes:

Thought you'd get a laugh out of this one:

http://www.ascendedhealth.com/brown-recluse/bite-treatment.htm

The best part:

Healing Frequency Resonation: These oils have been imprinted with the
universal healing frequency of 728 Hz using a modified Lakhovsky/Tesla
multi-wave generator embedded with oscillators made from large
double-tipped lemurian crystal mined from Minas Gerais, Brazil.

Eric

Dear god, the "Ascended Health" site seems to be genuine. Well, if you click on their "Buy Now" links you do at least get a PayPal page, not a "Ha! We fooled you!" message.

The danger here is subtly greater than that usually posed by using holistic universal healing frequencies, which is to say a placebo, to treat illness. The Ascended Health people claim to be able to treat the usual long list of diseases, but this one page, about treating brown recluse spider bites, is subtly pernicious in an unusual way.

It is generally known that brown recluse bites are Bad News. Especially among Internet-comic fans who know that the exceedingly grody picture on the Wikipedia article for loxoscelism - the results of a decent dose of brown-recluse venom in humans - is of the leg of Jeffrey Rowland, the Wigu/Overcompensating/TopatoCo guy. His depiction of himself in his comics has had a leg-scar for as long as he has.

(Rowland's story was, of course, recently severely beaten by what happened to Peter Watts. Oh, and anybody who at this point is thinking about complaining about links to scary spiders and nasty medical pictures should bear in mind the way in which I have responded to such complaints in the past. I got a million of 'em, kids.)

The thing is, though, that the brown recluse is not actually very dangerous, and even if one bites you, placebo treatment is likely to be effective. And it's an excellent ailment for sellers of useless woo-woo treatments in other ways, too.

Brown recluse bites, you see, often hardly hurt at all at first. It's actually quite difficult to persuade a brown recluse to bite you at all; about the only way for it to happen unless you are a lunatic doing it on purpose is if you put on clothes with a spider inside and thus press it up against your skin. Some spiders are aggressive (including a few of those for which my country, Australia, is so famous), but brown recluses really aren't.

(The Australian version of the forcing-the-spider-to-bite-you situation is redbacks in your boots, or, classically, lurking under the seat in the outside dunny. Redbacks aren't tremendously aggressive, but they're still likely to become quite cross if you sit on them.)

Even if you are bitten by a brown recluse, though, most bites inject little to no venom and do little to no harm. Treatment of such a bite with prayer or reiki or homeopathic antimatter will be entirely successful.

If a brown recluse manages to envenomate you only slightly, the bite will over days develop into a nasty sore that'll take forever to heal, but will heal. Unless you were already rather frail, or the sore gets badly infected, or some other complication develops, you'll once again be fine in due course no matter what treatment, genuine or woo-woo, you get.

If a brown recluse manages to envenomate you really effectively, though, you're in trouble. But the symptoms will still take days to develop.

So what we've got here is a bite that's hard to receive and detect, which may or may not do you any harm at all, and which will be separated from the actual illness it causes, if it causes any, by a significant amount of time.

This is immensely fertile ground for people to fail to correctly figure out what's going on, in both illness and treatment. A given "brown recluse bite" may actually be a bite from some other, less dangerous spider or insect. Or it may be an infected wound, or it may be some random mosquito bite or pimple that's grown in the worried mind of the patient into a terrifying situation, on account of how they're pretty sure they saw a spider yesterday and it may have been brown.

And even if you do have a real and highly envenomated recluse bite, it's not going to eat your entire body in an afternoon like necrotising fasciitis (which, again, is what Peter Watts was lucky enough to get). Hospital treatment for recluse-bite loxoscelism is basically supportive medicine to keep the patient as healthy and happy as possible, and removal of any particularly distasteful dead flesh. If the necrosis is serious enough to threaten a whole limb then the whole necrotising area will be surgically removed, but this is seldom necessary. Basically, you just keep the wound clean and wait for it to go away.

OK, so now let's suppose you've got genuine loxoscelism and you decide to treat it with mental telepathy and the singing of hymns.

Well, if you've got the rare kind that'll take a limb, you'll lose a limb, and possibly your life, because having your arm rot off is not good for you.

If you've got the much more common, much less dangerous form of loxoscelism, though, you'll just be in a lot more pain than if you were doped up in the hospital, and you'll probably wind up with a worse scar. You may manage to get blood poisoning or something, but most likely the disease will follow its natural course, and you'll recover. And believe that you were cured, unpleasant though the process was, by whatever pointless placebo treatment it was that you tried.

(There's also the possibility that woo-woo alternative-medicine treatment will actually be bad for you in and of itself. A significant subset of folk medicines are actively poisonous in one way or another. The Ascended Health "powerful synergistic mixture of special natural magnetic minerals and oils" doesn't sound very likely to be toxic if you're only rubbing it on a wound, but who knows.)

This is the great problem with unscientific medicine, which was all medicine up until the late 19th century. You don't know what the disease is, you don't know how it works, you don't know what the treatment does, you don't know what the confounding factors are, and in the end you may by pure chance actually manage to do some good, but that's not the way to bet.

This is why homeopathy was such a success when Hahnemann invented it in 1796. "Conventional medicine" at the time was likely to involve almost nothing that actually stood a chance of making the patient better, and several things that could kill people who weren't even sick. Compared to that, harmless homeopathic placebos were a giant leap forward.

Today, though, we've got treatments for a vast array of diseases that're much better than placebo. Even when you've got something like a recluse bite for which there is no direct treatment (antivenoms for recluse toxins do exist, but they have to be administered very soon after the bite, which almost never happens when the bite is hardly noticeable), there are still numerous evidence-based things you can do which are proved to make the disease less severe, or at least less unpleasant.

It is, once again, vitally important to take pains to avoid fooling yourself, because you are the easiest person to fool.

(I am aware, by the way, that Lemuria does not really have anything to do with lemurs. Lemuria, hypothesised to be the homeland of the lemurs which Philip Sclater knew of in Madagascar and India but not places logically in between, is yet another new-age trope for which the world can thank the regrettably-not-inimitable-at-all Madame Blavatsky.)