Your Friday Dose of Woo: It's all in the shoes, or is it?

One of the favorite failings in logic and science among the woo-friendly crowd is the ever-famous one of confusing correlation with causation, also known as non causa pro causa, which means "non-cause for the cause." Examples of this are rampant, and include the antivaccinationists who confuse correlation with vaccination and the age at which autism is usually first recognized with vaccines causing autism, taking a homeopathic remedy shortly before having their symptoms resolve spontaneously and mistaking this for the efficacy of the homeopathic remedy, chelating children with autism and observing "improvement" that is in reality nothing more than natural development and concluding that the chelation therapy is "curing" autism, or even blaming global warming on the decrease in the number of pirates over the last three hundred years.

Sometimes, the confusion of correlation with causation can take an amazing extreme, and this week I've found a real doozy. Did you know that there is a simple discovery that's millennia old that is the cause of horrible diseases such as obesity, depression, fatigue, hypertension, heart disease, cancer, arthritis, diabetes, asthma, osteoporosis, and Alzheimer's disease? Naturally, doctors don't recognize this simple cause, but the correlation of the rise of these diseases with this discovery is, as you will see, indisputable. So join me, then, as we enter a site that dares to reveal this horror of horrors. Join me as we peruse Shoebusters:

The purpose of Shoebusters.com is to stimulate interest, discussion, and research about the effects of shoes and socks on major human illnesses and conditions such as obesity, depression, fatigue, hypertension, heart disease, cancer, arthritis, diabetes, asthma, osteoporosis, and even the much-dreaded Alzheimer's disease, to name but a handful.

"Shoes and disease?" you may incredulously wonder. Yes, as strange as the connection may initially appear, footwear seems to be a cause of disease in humans.

Chiropodist Dr. Simon J. Wikler first proposed this novel idea way back in 1953. (1) After treating the feet of his patients who presented with typical foot defects, Dr. Wikler noticed a wide variety of other diseases and conditions resolving on their own. Following his great insight, extensions are made to include many other illnesses, addictions, and disorders that continue to plague generations of humans.

"Chiropodist"? I wondered what that is. My first thought was that it was some sort of unholy union of a legitimate specialty (podiatrist) with a woo (chiropractor). Sadly, I was very disappointed to learn that it's just the British word for podiatrist. Oh, well. So much for a source of many jokes. That's OK, though. There's lots of other stuff there, starting with a long discussion of why our feet are not the way they should be. It starts out with pictures of the feet of native populations in the Philippines and Central America that do not wear shoes, showing widely splayed toes, which are compared to photos of the feet of people who wear shoes, which appear to have bunions and don't look at all like that. There then follows a long discussion about the evils of wearing shoes and socks, which, we are told, compress the feet, cause an abnormal gait, and lead to all sorts of other indignities to the feet (indignities which, depending on the shoe, are legitimate, as any woman whose back pain and foot pain are due to high heels or man whose feet ache after wearing dress shoes all day). Of course, few would argue that shoes designed more for looks than comfort and easy walking can cause problems, but few would claim that these problems are more than musculoskeletal.

Not Shoebusters.

Of course, doctors don't recognize the horror that we as a civilization have inflicted upon ourselves:

There are many possible reasons why shoes have been completely overlooked as a cause of disease. Perhaps the simplest explanation is that we adults are not aware of our deformed feet any more than a two-year-old is aware of theirs. We merely grow up in this way unquestioningly assuming our feet, and bodies, to be as Nature intended. Our feet are certainly "normal" in the sense that they are like the feet of everyone else, but they are abnormal, or unnatural, in another sense, because Nature was not expecting us to wear shoes from birth. Since we accept our bodies and the items on them as being "normal", we tend to look for reasons outside of ourselves when things go wrong. Without a doubt, the most popular external blame for degenerative disease is food or diet.

The crowd has been chasing the subject of diet and disease for well over a century, leaving behind nobody to consider the subject of shoes and disease. A search on the National Library of Medicine's PubMed database for "diet cancer" returns over 17,000 papers, nearly 500 per year since the 1960's. (10) For the last half-century on average, one or two papers are being published every single day about diet and cancer. However, a search for "barefoot cancer" on the PubMed database returns a negligible handful of papers concerned with other matters, absolutely none studying the effects of foot imbalance and shoes on breast, prostate, or colon cancers in humans. Actually, a search on the PubMed database for "diet" returns a voluminous 200,000 papers, greatly outnumbering a search for "shoes" by an overwhelming 60-to-1 ratio. No serious attention or research has ever focused on the foot and disease like it has on food and disease. A search for "high cholesterol shoes" on the PubMed database returned no papers at all. (10)

I did such a search myself (barefoot and cancer), and most of the articles appeared to be about plantar warts. It must be a huge conspiracy! In fact, consider these observations:

1. Multiple sclerosis: "Multiple sclerosis is one such disease that typically affects relatively young and healthy people, and there is no known cause, prevention, or cure. However, a careful glance at a map of worldwide prevalence of the autoimmune disease reveals that people in the United States and Europe have a higher chance of developing it, than those in undeveloped countries, where children go unshod more often.
   
   "Even a modern industrialized country--surely full of pollutants and chemical toxins--can have a multiple sclerosis rate lower than the United States, as evidenced by Japan, which uses footwear less often. Furthermore, northern countries have higher incidence rates of multiple sclerosis than southern latitudes. Deforming shoes are worn more often in colder climates but less often when the weather is sunny and warm. For example, winter boots can limit ankle movement, in addition to compressing the toes."
2. Lung Cancer: "Perhaps the single most famous statistical correlation with disease is cigarette smoking and lung cancer. According to the 2003 version of the American Lung Association's website on tobacco, smoking is "directly responsible for 87 percent of lung cancer cases and causes most cases of emphysema and chronic bronchitis." Extremely precise figures such as 87% raise a yellow flag, because it is unlikely that anyone in this world knows to such precision the number of lung cancer cases which stem from a specific source. That surprisingly precise figure immediately jeopardizes the validity of the conclusion. The American Lung Association's statement on lung cancer completely ignores any other possibility, and there is a big one indeed.
   
   "As 'crazy' as the notion may initially appear, does widespread lung cancer and addiction to cigarettes actually originate from wearing shoes since birth? After all, the people in those statistical studies who smoke, have worn shoes for a much more significant part of their lives, so the same statistics support a much stronger correlation. Wearing shoes since birth is a constant 24-hour-a-day, lifetime source of real physical stress, which is not relieved by attempts to quit smoking, and in many cases, any addiction is only replaced by another. Even the father of modern psychotherapy, Sigmund Freud--wearer of fashionable shoes--was himself hopelessly addicted to cigars and unable to control his addiction or remain objective in his own care, making himself believe that his addiction was actually beneficial to his disease.
   
   "The strong statistical correlation of lung cancer and shoes is backed by reasonable physical evidence. The changes to the shape and excursion of the diaphragm from a flattened chest and sagging spine can be physically measured and compared to a shoeless, cancer-free native. These physical changes are relevant for any discussion of lung cancer, emphysema, chronic bronchitis, and even the respiratory infections, such as pneumonia, that plague non-smokers as well. The delicate and expandable tissues in the lungs of any shod person, including non-smokers, are required to operate in crowded, congested conditions, leaving the organ prone to infection and disease. Thus, it is premature to conclude that cigarette smoke is "directly responsible" for lung cancer.
   
   "Statistically, there are regional differences that are not explained by smoking cigarettes: According to the Centers for Disease Control 1997 report on tobacco smoking, more cigarettes are consumed in Japan than in the United States, yet lung cancer rates are lower. There appear to be some people who can smoke a lot and never get lung cancer, and others who never smoke at all, yet get the disease anyway. Even women, smoking the same cigarettes as men, are thought to have the higher rate of lung cancer between the two genders worldwide. The statement, "Cigarette smoking is directly responsible for lung cancer", completely ignores such statistical data, but the habitual use of footwear since birth explains it precisely."
   
   [ORAC NOTE: It occurs to me that this guy could work for the tobacco industry and do quite nicely trying to cast doubt on the science that secondhand smoke is a health hazard.)
3. Alzheimer's disease: The modern shoe could actually be the only cause of Alzheimer's disease because it seems to be the only thing capable of robbing a person of the essence of their humanity, both metaphorically and physically. The foot is responsible for our unique human traits amongst Nature, and each person is born with a unique footprint. A lifetime of wearing a modern shoe over the foot significantly alters this "essence" of humanity, so could it climax in a total loss of an individual's unique personality? After all, women's footwear is more physically deforming to the feet because of higher heels, pointier toes, and smaller sizes, and Alzheimer's disease affects them disproportionately more than men.
   
   A German woman in her early 50's known as "Auguste D." was Dr. Alzheimer's first clinical case of the disease around 1901, and she presented with much general nervousness and a poor weight--symptoms that are also related to footwear use. This landmark influential case occurred only several decades after modern shoes started becoming wildly popular in America and Europe. The first Alzheimer's patient was born on May 16, 1850, during the last year that shoes were made completely by hand.
   
   [ORAC NOTE: What an amazing correlation!]
4. Breast cancer: "Dr. Wikler observed that rounding of the shoulders in humans puts tissue at a mechanical disadvantage. He explains, "The breast is slung between strong fibrous bands (fascia) that arise from the breast and collarbones. As long as the shoulders are thrust back and the chest held erect, breasts can become very heavy and sag considerably without undue strain to these fibrous bands. In the characteristic posture of unbalanced feet, however, the shoulders slump forward and, instead of the breast bone being prominent, the armpits are now more forward. It becomes mechanically impossible for the breast-and-collarbone fascia to support the breast. Weak fibers from the outer side of the chest attached to the armpits must now do the job. But these fibers are incapable. So there is a constant straining and tearing at these tissues on the upper outer part of the breast. It is exactly in this site that more than 90% of breast cancer is found, and it can be reasonably concluded that the deformation of the feet may be an important cause."
   
   [ORAC NOTE: Although it is true that breast cancer is more common in the upper outer quadrant (although it is totally incorrect to claim that 90% of cancers are found there), it is believed to be simply because there is more breast tissue there relative to the other quadrants, although it has been claimed that the use of deodorants are the One True Cause.]

Are you convinced? It sure sounded convincing to me.

Except...

Except that my skeptical antennae began twitching. This woo, as wondrously wild and wooly as it was, seemed a bit too tongue-in-cheek in some passages. Could it be that I was being punk'd again? I decided to read more deeply and peruse more of the web pages. First, there was this:

However, the ramblings in this thesis should be considered merely a collection of opinions or observations, nothing more. So, if you actually choose to continue reading its sections, as they are organized below, then please remain extremely skeptical and perform the background investigations necessary in forming your own views.

Was that a hint that perhaps this was an elaborate hoax? This stuff was simply sounding too outlandish to be for real. On the other hand, there is nothing in this entire website that is any more outlandish than what I've found on the websites of homeopaths and reiki masters. Indeed, this website certainly isn't any more outlandish than websites I've found about DNA activation, Dr. Emoto's water woo, Breatharianism, detoxifying foot pads, spiritually guided surgery, the "no plane" variety of the "9/11 Truth" movement, trepanation, the SCIO, the Healing Broom, the Tesla Purple Energy Shield, the "Dorian Gray" tonoscope, DNA reprogramming, or--hell!--just about any previous installment of Your Friday Dose of Woo. Truly, distinguishing True Woo from Punk'd! Woo is difficult; so let's look further:

At no other time in history have we developed such control over infectious and nutritional disease throughout the mass population. During this exact same period, shoes and socks became cheap, widely available, and worn by many since birth, such that few have suspected these common, everyday items to be so involved in the resulting diseases that remain to be conquered. Yet while germs on the hands can produce illness, so too can shoes on the feet. And just as nobody once thought to wash the hands to control infectious disease, so are shod people neglecting to bare the feet to control degenerative disease. But the common person of today knows much more about the prevention of infectious disease using soap, than did the top scientists and doctors of 150 years ago. So the same will hold true for future, unshod generations naturally preventing degenerative diseases that today's most eminent researchers, Nobel laureates, and specialists have failed to cure.

Now this is definitely sounding like satire. However, the best satire is that which is very hard to distinguish from the object being satirized, and this still certainly qualifies, if satire it is. Consequently, I had to keep searching for other indications. I found them here:

While some believe that too much curiosity kills cats, James P. Semmel's "vice", of asking just too many questions of doctors and surgeons, demonstrates that it can actually have the opposite effect in humans. Shoebusters.com is the result of a decade of efforts by this 32-year-old electrical engineer from Albuquerque, New Mexico, to understand the ailments and illnesses afflicting himself and those around him, yet fewer outside of the United States.

Following in the footsteps of the noble chiropodist Dr. Simon J. Wikler, James decided to jump in with both feet and get a toehold by constantly questioning the cobbled-up approaches that well-heeled researchers have stood behind for over a century. Practically running on empty with his narrow, shoestring budget, James stumbled his way down years of dead-end paths in controlling his own diseases by using the same head-over-heels methods of modern practitioners, but always getting back on his feet and putting his best foot forward. Naturally, such repeated failures had James questioning the boots he was trying to fill.

This continues for five more equally painful paragraphs of bad jokes and puns about feet and footwear. But is that enough? Maybe, but then there was the bibliography, especially reference #11:

Huff, Darrell. "How to Lie with Statistics", Originally published 1954, reissued in 1993 by W.W. Norton and Company, ISBN 0393310728. Yet another great book from the 1950's that remains in print and relevant today. An entertaining read, the classic book teaches how to sort through the unending stream of studies, polls, and advertisements all trying to get your opinion, your vote, or your money. The author writes, "In our time it is easy to show a positive correlation between any pair of things like these: number of students in college, number of inmates in mental institutions, consumption of cigarettes, incidence of heart disease, use of X-ray machines, production of false teeth, salaries of California school teachers, profits of Nevada gambling halls. To call some one of these the cause of some other is manifestly silly. But it is done every day."

Gotcha! Nice work indeed! This would be most excellent woo if it weren't a joke!

Now I know what you're thinking: If Orac figured out that this was all an elaborate put-on, then why did he feature it in Your Friday Dose of Woo? Excellent question! The reason is that there are a lot of woo-meisters out there who apparently have failed to see through the joke and take this seriously. Isn't the fact that it's such an awesomely spot-on parody of the "correlation/causation" fallacy reason enough? Or that the author has been known to troll various health discussion forums with his claims?

No, I guess you're right.

How about this? Here's a little background. There really was a Simon J. Wikler. He really did write a book called Take Off Your Shoes and Walk. There really is a Dr. William Rossi. He really did write a book entitled The Sex Life of the Foot and Shoe and articles entitled Why Shoes Make "Normal" Gait Impossible, Footwear: The Primary Cause of Foot Disorders, Fashion and Foot Deformation, and Children's Footwear: Launching Site for Adult Foot Ills. However, as far as I can tell, neither of these authors blamed badly designed shoes for anything other than musculoskeletal problems of the feet, legs, hips, and spine. The problem was, apparently Dr. Wikler was into woo and did make claims for other diseases, as recounted here:

• There is no record of foot troubles in ancient times comparable to modern foot ills.
• The seeds of foot trouble were first sown in the middle Ages.
• The introduction of the elevated heel and the pointed toe marked the beginning of modern foot disabilities.

Perfect correlation/causation fallacy, no? But then here are even more outlandish claims:

Shoes not only deform your feet over time but they often protect the feet so much that certain foot muscles get lazy because they're not being used. In contrast people who go barefoot often have:

[...]

• Improved circulatory function because the motion you get from your unrestricted foot when walking barefoot activates a host of muscles in people's foot and legs, which in turn helps to pump blood back to their hearts. This motion may not be as effective if your foot is confined in a shoe, especially if it's a poor fitting shoe. This muscle action prevents the pooling of blood in your feet and legs, reducing the stress on the entire cardiovascular system and reducing blood pressure. This is why going barefoot is recommended to prevent vein problems.
  
  [ORAC NOTE: This is pure woo, plain and simple. There's no evidence to support it.]
• A better contact to nature because life-force energy called Chi (also called Qi or Prana) can only be absorbed through the soles of the feet. Ground Chi is absorbed automatically and unconsciously when walking barefoot, which may be one of the reasons why it's so relaxing to walk without shoes on and why exercises geared toward strengthening the body and relaxing the mind (yoga, tai chi, martial arts) are also typically practiced barefoot.
  
  [ORAC NOTE: "Ground chi" that can only be absorbed through the soles of the feet? Now we're talking seriously real woo here! Does this mean that going barefoot redirects my qi to make me healthier?]

Of course, no woo would be complete without products to sell based on it, and there's lots of foot woo here. In fact, I rather suspect that Earth Shoes, something to which I subjected myself in the 1970s, were based on this woo. Now, we have things like FiveFingers:

FiveFingers enhances your natural barefoot walking motion as they provide contact to the ground, gently spreads your toes to strengthen foot muscles, increase range of motion, and improves general foot health. They also stimulate muscles in your feet and lower legs for greater balance, agility and strength and also helps straighten your spine, improve your posture, which may reduce or prevent lower back pain.

After using Fivefingers for 2 months I believe these unique "shoes" are an unrivalled alternative to conventional footwear. They are the first and only footwear to offer the exhilarating and natural feelings of going barefoot--with the protection from sharp objects and surefooted grip of a Vibram sole.

But, but...they look really funny! And what about the consequences of artificially spreading one's toes out like that? Will that affect circulation too? What about ground qi? That would still be blocked by the rubber out of which these are made.

Not surprisingly, Dr. Wikler's woo seems very much akin to the quackery known as reflexology. Whatever valid points he may have had about the effect of tight or badly made shoes on foot health, it's clear that he took it off the deep end by at least--forgive me--one footstep too many.