Saturday, January 19, 2019

Expanded Food Storage--Pressure Canning Pork

In my family the first Saturday in December is Tamale Day.  My mom and aunts began this tradition over thirty years ago as a way of celebrating our Mexican heritage and keeping connected with the family.  We continue the tradition, but because my family is some distance away from the others and because my family is rather large by today's standards, we celebrate and make tamales on our own.  And we do it in a prepping kind of way.

Everyone else in the world slow roasts and shreds the pork for filling tamales the day before.  I do it the year before, but without roasting.  I can the pork.  It makes getting ready for Tamale Day so much less stressful.  The pork is perfectly cooked and shreds so easily.  Of course, canned pork is not just for tamales.  We also use it for making super speedy pulled pork sandwiches, quesadillas, and tacos.  It's a major convenience.

And it's so easy.

Cut up the raw pork into one-inch cubes.  Try to remove as much fat as possible to reduce chances of seal failure.  Pack into canning jars.  I use quart jars for the pork that will be used to make tamales, about one quart per dozen tamales, and we usually make twelve to fifteen dozen tamales and then freeze them.  I use pint jars for pulled pork sandwiches, quesadillas, and tacos.

Fill jars to one inch below the rim and add salt--one teaspoon per quart, one-half teaspoon per pint.  Do not add any liquid.  Liquid is never added when canning raw meats.  The meat produces its own juice.  Wipe rims very carefully with vinegar.  Most say to just use hot water, but when dealing with foods that may have fat on them, vinegar will cut that fat and make for a better seal.  Put on lids and bands and process per instructions for your particular canner and your altitude and jar size.  Typically pints are processed for 75 minutes and quarts for 90 minutes.

That's all there is to it.

When you open a jar for making tamales, drain off and reserve the liquid.  It is used in making the masa.  For all other recipes, you can save the broth for using in soup, or you can do what we do and pour it over the dogs' food.

If we're making pulled pork sandwiches, we just heat the meat with some barbecue sauce.  For tacos, add your own seasonings to taste.

When times get really interesting, and when cooking fuel becomes expensive either in terms of money or of time spent gathering, and time for preparing food becomes even more scarce than it already is, being able to preserve foods and having those foods ready to eat will be really invaluable. 

And even more invaluable will be having learned how to do this before the crisis hits.

Friday, January 18, 2019

Basic Food Storage--Salt

Well, this is going to be a rather short post.  It will be tempting for many to skip it; after all, how much is there to say about salt?

There's not a lot to say, but what there is, is pretty important to know.

First off, the minimum amount to store is ten pounds per person, per year.  Note, that is the minimum.  It does not allow for any canning, brining, pickling, drying, or other means of preserving.  That deer that crossed your path out in the woods, or that unbranded cow that wandered into your camp?  No, that ten pounds of salt does not include salt for preserving any game you take.  Remember, when times get really interesting, you may not have a freezer to rely upon.  Everything will have to be preserved as it was 150 years ago.  It would not be unwise or excessive to store an additional thirty to forty pounds per person.

You have several options for salt, some better than others.

Iodized salt, also known as table salt, has potassium iodide, dextrose to stabilize the iodide, and calcium silicate, which keeps the salt from clumping or becoming solid.  Iodine, in the form of potassium iodide, has been added to salt since the 1920s, to reduce the incidence of dietary iodine deficiency.  Shortly thereafter it was noted that the average intelligence of children increased up to 15 points in some areas of the United States known to be deficient in iodine.  As noted in the post on iodine deficiency (16 January 2019) the amount of iodine in the American diet has decreased over the past five or so years.  Iodized salt is not recommended for canning; the calcium silicate is not water soluble.  So is iodized salt safe for canning?  Yes, it is perfectly safe and acceptable. Unless you are entering the county fair.  Because calcium silicate will make your food look a little cloudy.  And the canning police judges will know.  And they will probably tell everyone in the county what you did.

Iodized salt has a shelf life of about five years.  Of course, the salt does not go bad, but the iodine dissipates and then you have plain salt.

Canning and pickling salt is nothing but salt.  No potassium iodide, no dextrose, no calcium silicate.  Just salt.  Perfect for canning and pickling, in case you couldn't tell from the name.  But because it has no anti-caking agents, it may become clumpy if you have any humidity in your air.

Ice cream salt should not be eaten.  It may contain rocks.

Plain salt contains calcium silicate, but no potassium iodide.  You can purchase this for about $5 for 25 pounds at restaurant supply stores.

Kosher salt can be used in cooking and as table salt, but should not be used in baking except as a garnish for breads.

If you live in an area with moderate to high humidity, you'll probably want to store your salt in plastic buckets or other containers.  Even here in the desert I store my salt in buckets to protect it from getting wet.  However, keep in mind that salt is very heavy.  Unless you are fairly strong, and the handle on your bucket is pretty durable, you do not want to fill a five-gallon bucket with salt.  Go with a 2.5 gallon bucket for salt.  You'll be glad you did.

For further information:

Thursday, January 17, 2019

Food Storage and Learning from History

One of the most challenging aspects of preparing for the exciting times ahead is the fact that none of us have experience.  We've lived in a world of plenty for our entire lives and for the most part we've never seen or experienced true want.  When it comes to preparing for famine, war, or societal collapse, we have to learn from history.  A lot of readers will be familiar with Selco's writings about the Balkan War and FerFAL's experience in the socio-economic collapse of Argentina.  There is so much to learn from their experiences.

Below I have pasted in several lengthy excerpts from an article written by F. Enzio Busche, a German who experienced World War II and the aftermath as a child.  There is a link for the complete article at the end of this blog; I encourage you to read it.  However, for purposes of this post I have excerpted what I think will be of most interest to those striving to prepare as best as possible, especially with regard to food.

"May I share with you some experiences that I, along with millions of other Europeans, had in the days of devastation, total destruction, and starvation that became a reality for so many survivors of World War II. These experiences helped me to recognize and appreciate the basic necessities of life and to separate true needs from false wants....

"Frequently I am asked, “What were the most valuable items in the days of starvation in Germany?” The answer is difficult to believe, because some of the experiences we had seem to be totally illogical and contrary to human nature. The items of highest value were tobacco and alcohol, because people who live in fear and despair, who have not learned principles of self-control, tend to need in times of panic some drug to escape the dreadful awareness of reality. I have seen people give their last loaf of bread and their last meager supply of potatoes just to obtain a bottle of brandy....

"As for what we needed, the food item we relied on most was vegetable oil. With a bottle of vegetable oil, one could acquire nearly every other desirable item. It had such value that with a quart of vegetable oil one could probably trade for three bushels of apples or three hundred pounds of potatoes. Vegetable oil has a high calorie content, is easy to transport, and in cooking can give a tasty flavor to all kinds of food items that one would not normally consider as food—wild flowers, wild plants, and roots from shrubs and trees. For me and my family, a high-quality vegetable oil has the highest priority in our food storage, both in times of daily use and for emergency usage. When vegetable oil is well-packed and stored appropriately, it has a long storage life without the necessity of refrigeration. We found ours to be in very good condition after twenty years of storage, but circumstances may vary in different countries and with different supplies....

"A third priority item is honey. Its value in daily usage is immeasurable. My family prefers honey rather than sugar because our experience supports some of the research findings regarding the preeminence of honey. Another reason I prefer honey is because during the starvation period in postwar Germany, honey could be traded for three times as much as sugar; its value was considered that much greater....

"These four basic items—oil, wheat, honey, and milk (or their equivalents in other cultures)—together with water, salt, and renewable basic foods such as potatoes and other vegetables, can satisfy nutritional requirements in times of emergency and also are valuable and usable in normal daily life.

"You might ask, 'What about the many other food items and desserts that play an important role in our eating habits?' I shall always treasure the great experience I had in those hard times, when I learned to appreciate food with the most balanced nutrients. When a person is very hungry, the taste of food will change for him. In times of emergency, the Lord seems to provide a way to help our bodies adapt. For instance, I remember well that when I was a child I did not like to eat bacon. I argued with my mother whenever she prepared potatoes fried with bacon instead of fried with vegetable oil or butter, not recognizing in my youth that sometimes this was the only way she could provide fat in our diet. Several years later when we were suffering from the severe food shortage, I remember that after days of being without food, the first edible item I could obtain, ironically, was a piece of bacon. I looked upon it as the best treasure I had ever achieved. I placed the pieces of the bacon between my teeth and my cheek and did not dare to chew it, simply because I wanted to savor and appreciate longer the wonderful taste of bacon. At that moment I could not understand how I could have ever disliked bacon.

"In times of real hunger the human body seems to develop a natural craving for the things it needs most. An athlete who is preparing for a marathon has the same experience as he daily runs his ten miles in training. He will eventually develop a feeling for the real needs of his body; he will develop an appetite for the food that his body requires, and he will be repulsed by food items that do not add to his body’s strength.... It might also be of interest to know that there seemed to be much less sickness during those hard times. 

"When we think in terms of our own year’s supply of those foods and materials we use on a regular basis, we may feel that every family will have to store everything. This, of course, is not easy and seems to make storage difficult. However, let me offer this comforting idea based on past experience. We need to take into consideration that in difficult times, so long as there survives more than one family, there will be trading of valuable items. A free market will begin immediately to satisfy the needs of people, and items in greatest demand will set the price, bypassing the use of money. The ingeniousness of mankind becomes evident in times of need. When man is presented with a problem or challenge, if he is in a healthy spirit—which hopefully we are—he will find solutions that he never dreamed of. When a person has a good, healthy spirit, is able to adjust and is not afraid to use his imagination, he will find ways to survive.

"There is a long way from the point of hunger to actual starvation, and there is much that one can do to stay alive in hard times, especially when one is mentally and physically prepared. A garden, even as small as a window box, is of great value, as is the skill to be able to plant and to grow things. Following the war, in addition to having a small garden, my family was able to obtain the milk we needed by keeping a milk sheep, which gave enough milk for our family for the greater part of the year.... Besides milk, our sheep supplied us with wool to trade or to use for knitting items. During the spring of the year it would give birth to one or two lambs which could also be used for food or trade. Some of our neighbors had goats, but we preferred the sheep because of the wool and because sheep seemed easier to tolerate and to work with. They required very little extra care and were easy to satisfy. Also, all over the country, even the large cities, people began to keep rabbits in small pens, and children had the task of looking for grass, dandelions, and leaves in order to feed their rabbits. In addition, people kept hens, and chicken coops were prevalent in all places. Because grain was too valuable to feed to chickens, other sources of chicken feed had to be found. Children found ways of breeding worms, beetles, and flies to be used for this purpose. People also built small, wooden handcarts which could be used to transport items used for trading, which took place wherever people met."

For further reading, click on the links below.  Be advised that Ferfal's and Selco's writings are not for the faint of heart.  Also, I am not endorsing any of the products they sell.  I just found their experiences really eye-opening.

Wednesday, January 16, 2019

Disease and Illness--Iodine Deficiency

Iodine deficiency, like many nutritional deficiencies, is not something we generally give much thought to.  We don't see it personally; we don't hear about it.   And that's because the deficiency has been eliminated in most western countries.  However, it does remain a problem in Australia, New Zealand, and several European countries.  Iodine deficiency is most common in areas where the soil is deficient in iodine, especially islands and mountainous regions.  Statistics vary; somewhere between 33% and 70% of the world's population is deficient in iodine to some extent. 

Here in the US, iodine deficiency hasn't been an issue since the introduction of iodized salt in 1924.  However, change is in the air.  According to WebMD, until about five years ago (whenever that was--there was no date on the article) Americans got sufficient iodine in their diets from bread, dairy, and meat.  But when manufacturing companies stopped using iodine disinfectant on their machinery, iodine levels started dropping.  In addition, as a whole, we're also consuming about thirty-three percent less salt that we used to.  Most food processors--the manufacturers of frozen, canned, and boxed foods--do not use iodized salt.  Many individuals are limiting their salt intake to prevent cardiovascular disease.

So iodine deficiency is a common worldwide problem, on the verge of becoming a possible problem in this country, and people in general don't know much about it.  Why should we care?  What does iodine deficiency cause?

First, it gives rise to hypothyroidism, symptoms of which include extreme fatigue, goiter, mental slowing, depression, and weight gain.  In pregnant and nursing women it can cause mental retardation, stunted growth, and deafness in their children.  Iodine deficiency has been correlated to a 12 point loss on the IQ scale, while iodine supplementation in the diet in the US has been found to increase the IQ of children 15 points.  But note that this is in the diet of pregnant and nursing women; there is nothing you can do to reverse the mental retardation that occurs in children who lack sufficient iodine for proper brain development.

Risk factors for iodine deficiency include low dietary iodine, pregnancy, exposure to radiation, gender (women), smoking, alcohol consumption, and oral contraceptives. 

Adults need to consume 150 micrograms of iodine per day.  Women of childbearing age should have 200-300 micrograms per day.  Iodine is found in iodized salt (shocker), seafood, milk, eggs, baked potatoes, navy beans, and cranberries.

So what's this mean for the average prepper?  Clearly, the best prevention of iodine deficiency is to use iodized salt.  But keep in mind this little tidbit of info:  According to Morton Salt, the shelf life of iodized salt is about five years.  After that, the iodine breaks down and you have plain salt.  So even the salt that we thought we didn't have to worry about rotating has to be rotated.  Bummer.

Of course, achieving a definitive laboratory diagnosis of iodine deficiency is going to be difficult post-collapse.  Laboratory facilities will likely be limited.  However, there is a simple, if crude, test you can do on your own if you suspect iodine deficiency.  Paint a 3x3 inch square of iodine solution on the inner arm, inner thigh, or abdomen.  Let dry completely before replacing clothing.  Check the iodine patch 24 hours later.  Is it still the same color?  Lighter? Gone?  If it's gone, that suggests a serious deficiency.  If it's lighter, there is a mild to moderate deficiency.  And if it's the same color, keep doing what you're doing.  Unfortunately, this test will be difficult to perform on people with darker skin.

Note.  Some people suggest that iodized salt retards yeast fermentation in bread, but I have not been able to find any definitive references for this.  And in an effort to reduce iodine deficiency in their countries, some countries are mandating the use of iodized salt in their bread.  Iodized salt is not to be used in fermenting vegetables, like in making sauerkraut.

Tuesday, January 15, 2019

Traditional Medicine--Advanced Medical Kit

Previous posts covered boo-boo kits, IFAKs, and family medical kits.  Today's post will cover the items suggested for an advanced medical kit.  Even if you do not have the training to use these items, they're still a good idea to have available for someone who can use them to help your family.  You never know--there were a few doctors who lived in Paradise, California, who escaped the fire with only their families and their lives. They still had their skills, but no medical kits to work with.

In additional to needing a larger bag for an advanced medical kit, you'll want to include the following items:

blood pressure cuff
more light sticks
N-99 mask, the AZ Mask, 2.5
oxygen tank wrench and gasket
chest seal
cricothoracotomy kit (remember, this is for trained personnel to use)
chest tube kit (same, for trained personnel to use)
pressurized water bladder (to irrigate wounds)
iodoform gauze (to treat infections of the skin or drain fluid out of the body)
SOAP notes
folding clipboard
triage tape
triage cards
administrative satchel

medications (again, for advanced kit, for use by licensed medical personnel, and beyond what is stocked in a family medical kit)
lidocaine 1%, 1 vial
lidocaine 2% with epinephrine, 1 vial
rocephine 1 gm, 2 vials
normal saline for injection, 25 ml, 2 vials
tranexamic acid, 100 mg, 2 vials
epinephrine 1:1000, 1 ml, 2 vials
triamcinolone, 10 ml, 1 vial
nubain, 10 mg/ml, 10 ml, 1 vial
narcan, 4 mg/ml, 10 ml, 1 vial
toradol, 30 mg/ml, 10 ml, 1 vial
valium, 5 mg/ml, 10 ml, 1 vial
augmentin, 875 mg, 60 doses, 1 bottle
zithromax, 500 mg, 20 doses, 1 bottle
bactrim DS, 30 doses, 1 bottle
levaquin, 750 mg, 30 doses, 1 bottle
clindamycin, 300 mg, 14 doses, 1 bottle
doxycycline, 100 mg, 30 doses, 1 bottle
diflucan, 150 mg, 10 doses, 1 bottle
albuterol MDI, 1 MDI
assorted syringes and needles
sharps container
envelops, small, dispensing, 12

minor surgery kit  (all quantities are one, unless otherwise indicated)
folding pouch
scalpel handle, #3
needle driver, smooth carbide tips
scissors, 1 point sharp
scissors, Metzenbaum, curved, fine, 5.5"
forceps, splinter, fine point
forceps, dressing
forceps, tissue, adson 1x2
forceps, Debakey, 6"
forceps, curved mosquito (four)
forceps, kelly, straight (two)
probe, straight
retractors, simm's retract, sm (two)
retractors, gelpi, 5"
forceps, allis 2x3
towel clamps, small (three)
skin stapler, #10, (two)
staple remover
medicine cup
blue towels, sterile (four)
scalpel blades #11 (six)
scalpel blades #10 (two)
scalpel blades #15 (two)
scalpel blades #12 (two)
suture, assorted, armed (six)
suture, silk, 4-0, 4', sterile (three)
suture needles, assortment of six
syringe, glass 5ml, sterile (two)
hypodermic needles, assortment of 12
gloves, sterile, operating (two pairs)

*Dr. Steve, who taught two of my classes, recommended the Littman Lite.  Unfortunately, as I look at Amazon right now, I don't see anything for Littman "Lite."  There are loads of options for a Littman stethoscope, however, and they are very, very good.  Obviously, I can't review them all here.  I can say that my daughter and I bought the same very low-end stethoscopes before our first class.  She still uses hers, but I have difficulty hearing anything with mine.  After my husband took the class, he went all-out and got a very nice, about $300, Littman stethoscope.  It included software for learning to listen to heart and chest tones and had a longer tube.  One reason for getting this particular stethoscope was so that it could be used for speaking to hearing-impaired individuals--they put the stethoscope on and you speak into the diaphragm (the piece that is placed on the chest for listening).  That might not be a consideration for some, but my mother-in-law is hearing-impaired, and my husband wants to be able to better care for her.

Monday, January 14, 2019

Herbal Medicine--Japanese Barberry

Disclaimer. I am not a licensed health practitioner.  This is just another post on an item you might wish to have available if needed so that a physician can treat you and your family as best as possible.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care.  A qualified, licensed physician or other medical provider should be consulted before beginning any herbal or conventional treatment.

This post is going to be exclusively about Japanese barberry.  However, it should be noted that just about everything written here about the medicinal uses of Japanese barberry also applies to Oregon grape (Mahonia aquifolium), Phellodendron amurense (not phylodendron, an entirely different plant), American goldenseal (Hydrastis canadensis), and Nandina domestica, which are all members of the berberine family.  There is absolutely nothing wrong with any of these other plants; the medicine obtained from them is equally effective.  In the case of Phellodendron amurense it's actually easier to obtain because you don't have to dig up the roots.  Most of these plants are considered invasives and are easily located, especially in the eastern United States.

I don't live there.  If I did, I'd plant a Phellodendron amurense tree or two in my yard and perhaps some of the others.  But the way things are going in this country, there might not be sufficient time for it to grow and for me to be able to start harvesting for medicine.  I really want to be able to find what I need for medicine now.

So that's where Japanese barberry (Berberis thunbergii) comes in.  While it is particularly invasive in the eastern part of the country and should be easy for folks living there to locate, it's not at all invasive in the West.  It gets planted and it stays there.  It does not spread at all.  With its small, shrubby size, bright red berries, and foliage that turns purple in the fall, it's a very popular ornamental out here.  It's used in landscaping everywhere.  Shopping centers, commercial developments, churches, residential landscaping.

Guide on Invasive Plant Species | Greencare Landscapes
Japanese barberry

Here's one picture of it.  Google for a few other images and then pay attention when you are out and about.  Maybe consider getting some plants in the spring and planting them in your yard.

The medicine, berberine, can be found in the lower branches (scratch off the outer bark--if it's yellow underneath, it's got berberine), but the roots contain up to ten-fold more medicine.  That's why it's nice to find invasive plants growing in the wild.  No one cares if you dig them up.  But in shopping centers and church parking lots people might not be so understanding.

Why do you want to learn about using Japanese barberry as medicine?  What's it good for, as far as preppers are concerned?  Acute dysentery and diarrhea, as encountered in cholera and enterotoxogenic E. coli infections, giardia, infected wounds, conjunctivitis and other eye infections, and infections of the mucous membranes of the mouth, throat, and vagina. 

In places where it is considered invasive, Japanese barberry spreads like raspberries and blackberries do:  by seeds eaten by animals and excreted, root spread, root and branch cuttings, and live branches touching the ground.  Roots left in the ground will resprout.  In arid areas and poorer soils barberry is much more well-behaved.

The barberry wood is really tough and must be cut into very small, one inch or less, pieces while fresh.  Scrape off the bark of sections you have targeted for harvesting.  The inner bark must be yellow; if not, it is not medicinal and there's no point to harvesting it.  Move on to another plant.  The outer bark is the most medicinally powerful part of the plant, but most people use the entire root.  Harvest in the fall.  Cut and dry well and store in plastic bags in plastic totes, and keep it dark and dry.  (If you have access to Oregon grape, you could use it instead; the roots aren't as difficult to harvest and process.)

Tincture:  Tincture the dried root in a 1:5 ratio in 50 percent alcohol (i.e., one ounce dried root by weight to five ounces of 100-proof alcohol).  The dosage is 10-60 drops, three times per day, or more in acute gastrointestinal conditions. 

Very little information is provided on dosages to treat various conditions.  A clinical trial in India showed that berberine in a dosage of 10 mg/kg/day was as effective as metronidazole in treating giardia.  It controls enterotoxigenic E. coli completely, and works to some degree in treating cholera.  (However, when combined with pomegranate bark or peel or geranium root, berberine is completely effective in eliminating cholera.)

Vaginal yeast infections:  two teaspoons in one pint of water; douche once or twice per day.

Wash:  one tablespoon per pint of water and wash affected area twice per day.  Useful for infected wounds and acne.

And an aqueous extract (which has been shown to be less potent than alcohol extracts) was shown to be slightly less effective than sulfacetamide in treating eyes infected with Chlamydia trachomatis

Berberine is synergistic with fluconazole, ampicillin, and oxacillin.

Other uses:  The barberry fruits are edible and were historically used to make jam. Common barberry (Berberis vulgaris) when used in place of antibiotics in chicken feed was shown to increase the birds' weight gain.

For more information:  (This link contains the exact text from Stephen Buhner's Herbal Antibiotics book.  It is totally and completely plagiarized, word for word, except for "purposes of this book" was changed to "purposes of this post."  But you can get another idea of Stephen Buhner's research and writing before committing to purchase.

Saturday, January 12, 2019

Expanded Food Storage: Chocolate

Chocolate.  You know it's truly going to be TEOTWAWKI if you don't have it.

You already know why you want it in your preps.  You probably don't need a whole lot of help with recipes, either, though I'll provide a few later in this post.  What you are looking for, most likely, is how to store it best.

Chocolate chips (semi-sweet).  For maximum long term storage, up to five years, they should be put into canning jars and vacuum sealed.  Unfortunately, I have no personal experience with this, that is, with the part about five years.  The max I've been able to store chocolate chips here is three years.  We are so good at rotating our chocolate chips.  And while I firmly believe that storing chocolate chips in canning jars is truly the best way to go, I have to admit, it is not what I practice here.  It's partly because I'm a little lazy, but also partly because I know we will be rotating through these chocolate chips.  There is no doubt.  So I'm not concerned about longer term storage.  And because I'm not concerned about storing for the long haul, I have taken to putting the bags of chocolate chips into four-gallon buckets.  The buckets go into the crawl space with much of our other long-term food storage, where the temperature is cooler and more consistent.  If I were storing for longer term, I'd definitely do it as I did in the beginning--vacuum-sealed in canning jars.

Milk chocolate.  The higher milk content contributes to a shorter shelf life than for semi-sweet, definitely in the range of months and not years.  Were I to store it, it would be vacuum-sealed in canning jars.

White chocolate.  I rarely use it; certainly not enough to store it.  But my husband brought some Baker's semi-sweet and white chocolate baking bars home a couple of years ago because they were on clearance.  Those half-dozen or so bars went up on a high shelf in the laundry room/pantry and were kind of forgotten.  (OK, so they were totally forgotten.)  I came across them as I was tidying.  I couldn't find a date on them anywhere, but I know they came home post-Christmas one year, so they're somewhere between two and four years old.  First, I carefully opened the white chocolate.  It was no longer white, but rather caramel-colored.  I think I probably sniffed it first, but I'm not sure.  And besides, the true test would be to taste it.  Nasty!  It probably erased whatever memory of the smell I may have had.  So, so nasty.  Into the trash.  The semi-sweet  bars were just fine.

Cocoa powder.  Stored in a cool, dry place, it keeps pretty much indefinitely.

Hot cocoa mix.   The Home Storage Center states that their hot cocoa mix has a shelf life of two years.  In my supply here it looks like the last time I bought hot cocoa mix there was five years ago, because the best-by date on the pouch says February 2016.  So I'm testing cocoa that's almost three years past it's best-by date.  Three children with discriminating palates and I all say it tastes just fine.  What I would not trust, however, is the "cut here" dotted line, so that the bag can be resealed.  That was a total fail this time. 

DIY hot cocoa mix.  Cocoa powder stores almost indefinitely.  Sugar stores indefinitely.  Powdered milk has a 20-year shelf life.  So all three of these, the main ingredients in cocoa mix, ought to be able to be combined to make your own mix, right?  I searched the 'net for quite some time last night and came up with the recipe to try.

2 cups powdered sugar
1 cup cocoa powder
2 1/2 cups powdered milk
2 teaspoons cornstarch
1 teaspoon salt
pinch cayenne

Now the recipes were all pretty much the same.  Some called for sifting the powdered sugar and cocoa to make sure there weren't any lumps.  One used brown sugar instead of powdered.  Most omitted the cayenne; in 5 1/2 cups of mix, it's only going to make a difference to the most sensitive of taste buds.  I didn't notice it.  What I did notice was that it was truly, truly awful.  I followed the recipe exactly and then mixed it up to make some hot cocoa without paying attention to the mixing directions.  Yes, it was so, so bad.  So I very irritatedly (yes, I know that's not a word, but it's how I felt) threw it all out.   Then I glanced at the mixing directions.  OK, so I was only supposed to use two tablespoons.  So I got back into the trash and carefully removed two tablespoons of mix that were not contaminated in any way.  I added two ounces of water and stirred well.  I then added milk and heated it in the microwave.

Nope, it was no better.  Still very, very awful. 

(Note:  In the above recipe I used non-instant nonfat dry milk from the Home Storage Center.  Results may be better using a higher-end instant dry milk.)

So why exactly did I include that recipe if it doesn't work?  Because you need to know that just because someone somewhere on the 'net says something works, doesn't make it true!!  And then there can also be honest differences in taste buds.  I like fresh mushrooms; most of my children don't.  Trader Joe's peanut butter cups are the only way to go for me, but it seems most people are happy to eat Reese's.  Store brands are just fine for most things, but my crackers better be Honey Maid and Krispy or Premium.  You have to try recipes out yourself now so you don't waste precious food later.

Nesquik.  Nesquik (remember when it used to be just "Quik"?) can make a bad day a whole lot better.  It can also make powdered milk taste a whole lot better, especially if you didn't have time to get it thoroughly chilled.  Per the customer service representative at Nestle, "after it is produced our regular Nesquik Powder has a recommended shelf life of 24 months while the No Sugar Added has a recommended shelf life of 18 months. After opening either of those, the recommended shelf life is 3 to 6 months."

DIY Nesquik.  There were no where near as many options as there were for hot cocoa.  It's basically a 1:2 ratio of cocoa powder to sugar, with a pinch or two of salt.  

And it also tastes like barf.  Well, maybe just really bad.  But notice there is only one really.   Not two very's or two truly's, like the hot cocoa mix above.  If your kids have anywhere near the average number of brain cells or taste buds, they will not be fooled by this poor attempt at a copycat recipe.

A final note.  Chocolate can be stored in the freezer.  I supposed if I had unlimited space I would do this as well, but I really need the room for meat and some veggies.  Chocolate that is stored in the freezer will develop "bloom," a whitish, tannish, grayish cast to it.  It is the cocoa butter separating from the cocoa and does not affect the taste in the least, only the appearance. 

Friday, January 11, 2019

Basic Food Storage: Baking with Beans

If you didn't store enough oil, or you just want to be a little healthier when you have some treats, here's a substitute for baking.  Or, if your neighbor says, oops, I ran out of oil, may I have some of yours, you can offer them beans to use in their baking.  If they object that their food won't taste so good, say neither will your own when you run out of oil because you gave it to your neighbor who didn't prepare.  Smile, and offer them the beans again.  Besides it's for their own good.  It's healthier this way.

Bean puree is also advocated as a substitute for oil in baking and boosting the nutritional value of sweets. I’ve read rave reviews from people praising the use of bean puree in chocolate chip cookies and cakes. In the interest of research and providing my classes with samples, I have made some of these recipes. Using the full amount of bean puree recommended results in a very heavy product. Small children might be fooled; I don’t know, as I didn’t have any around at the time to offer samples to. My older children and teens were not fooled. When I used half of the recommended amounts of bean puree or mashed beans, most people said the result was tolerable but not desirable. Basically, they’d rather just do without.

If you want to give this a try, here are the suggestions on how to go about this. For bean puree to substitute for oil in baking, mash beans with enough water to make a puree. To substitute for butter in baking, mash cooked, drained beans into a paste. Substitute in a 1:1 ratio, meaning that if your recipe calls for one cup of oil or butter, use one cup of pureed or mashed beans instead. White beans are recommended as being the best to substitute in baking.

I'm going to post several recipes below for you to check out, as well as general reviews of friends and family.  That way you can compare them to your own recipes and decide whether you want to give them a try.  If you do decide to try any of them, do it before TEOTWAWKI.  You don't want to risk wasting good food when it really matters. 

Black Bean Brownies

1/4 cup black bean puree
1/4 cup oil
2 teaspoons vanilla
3/4 cup sugar
2 eggs
1/2 cup flour
1/2 cup cocoa
1/2 teaspoon salt
1/2 c nuts (optional)

Mix it all up, pour it into a 9x9 pan, and bake at 350 for 30 minutes.
Review:  Hugely disappointing.  Nobody wanted more after the first bite.  However, I should be fair and note that no one who tried these likes cake-like brownies.  We all favor fudgy brownies.  Beans will only make cake-like brownies.

Carrot Bread

1 cup brown sugar
1/2 cup white bean puree
1 extra large egg, or two small eggs, or equivalent amount of egg powder
1 cup grated carrots (or substitute dehydrated carrots that have been rehydrated--about 1/2 cup dehydrated carrots and 1/2 cup water)
1/2 cup crushed pineapple, drained
1 1/2 cups wheat flour
1/2 teaspoon salt
1/2 teaspoon baking soda
1/2 teaspoon cinnamon
1 teaspoon vanilla extract
1/2 cup raisins, boiled for a few minutes to rehydrate a little
1/2 cup chopped walnuts

Combine sugar, bean puree, and egg(s), and then stir in carrots and pineapple.  In a separate bowl, combine flour, salt, soda, and cinnamon thoroughly, and then stir in carrot/pineapple mixture and vanilla, raisins, and walnuts.  Pour into greased bread pan and bake at 350 for 45 minutes.
Review:  Most adults liked it.  I absolutely loathe raisins.  I felt this carrot bread definitely had too many raisins.  I think it would be better if the raisins were omitted and more carrots and/or pineapple were added instead.  And I kept eating it anyway.  I'm kind of embarrassed about it.  I mean, it had raisins in it.  A lot of them.  And it's even better with butter on it.

Pumpkin Bars

1 16 oz can pumpkin
4 eggs
3/4 cup white bean puree
2 teaspoons vanilla extract
2 cups whole wheat flour
2 cups sugar
1 tablespoon pumpkin pie spice
2 teaspoons cinnamon
2 teaspoons baking powder
1/2 teaspoon salt

Mix wet ingredients, then stir in dry ingredients.  Pour batter into a 9x13 pan and bake at 350 degrees for 25-30 minutes.
Review:  Of all the recipes we taste-tested, this was the absolute overall favorite. 

Pumpkin Bread

1 cup canned pumpkin
1 cup sugar
1/2 cup packed brown sugar
3 egg whites
1/2 cup milk
1/4 cup bean puree (white or pinto)
2 cups whole wheat flour
2 1/2 teaspoons baking powder
2 teaspoons pumpkin pie spice
1/4 teaspoon salt

Mix first six ingredients in a large bowl.  Stir in remaining ingredients.  Pour batter into a greased bread loaf pan.  Bake at 350 for 60-65 minutes, or until bread tests done.  Cool on wire rack for ten minutes, then remove bread from pan and cool completely. 
Reviews:  This was okay, acceptable, not to die for.  But when chocolate chips were added, it was way better.

Oatmeal Raisin Cookies

1 cup cooked white beans, drained and mashed
3/4 cup brown sugar
3/4 cup white sugar
2 eggs
1 teaspoon vanilla extract
1 1/2 cups whole wheat flour
1 teaspoon salt
1 teaspoon soda
3 cups oats
2 teaspoons cinnamon
2 cups raisins (boiled and drained)

Cream together first five ingredients.  Combine dry ingredients and stir into wet ingredients.  Drop tablespoonfuls of dough onto cookie sheet.  Bake at 350 degrees for 10 minutes.
Reviews:  These were okay.  Again, I thought there were way too many raisins.  I substituted cranberries for just a few cookies' worth of dough, and I liked the cranberry ones much better.    

Conclusions and observations.  The general consensus seems to be that using bean mash or puree in a recipe that is more of  a bread works better than in using it in a recipe that is more of a dessert.  When we are having a treat, we want all the fat, all the flavor.

Thursday, January 10, 2019

Compressed Toilet Paper and Washcloths

I'm always on the lookout for items that will make my life easier post-collapse or in a disaster.  And sometime in the past couple of months I came across compressed washcloths.

I was intrigued.  They were tiny.  And when they arrived, they were indeed about the size of a Life Saver.  In my backpack I usually carried a pack of baby wipes, but even the smallest packages can take up a bit of space.  Especially when I didn't use them all that often.  And then they start to looking kinda cruddy after a while, and you're embarrassed to be seen carrying or using them. 

Paper Hand Towel Roll Reviews - Online Shopping Paper Hand ...
I got mine from Survival General, but I couldn't copy their image here.  But this is pretty much what mine (and all the others sold online) look like.
Enter the compressed washcloth.  They're so small, you can put them anywhere.  And they're so cheap that you can buy a lot so that you can put them anywhere and everywhere.  So they have gone into all the emergency packs and camp kits.  These compressed washcloths are about the size of a regular baby wipe, and I would guess they would be about as durable.  They take about 10 seconds to re-hydrate and then it takes about a minute to unfold, maybe less. 

A month or so later on Amazon, I happened upon something very similar, marketed and sold by Hi-Qual as compressed toilet paper.  Of course, I had to have some.  After all, it might be better than using a compressed washcloth.

Nope.  Exactly the same materials (which I could have read online before purchase).  Same size.  However, and this could be critical, it took only two to three seconds to re-hydrate.  Same minute or less to unfold.
There are a lot of companies on Amazon selling these washcloths/toilet paper/camping towels, whatever you want to call them, ranging from about eight dollars per hundred up to ridiculous prices.  I prefer getting the ones that are individually packaged so that I can put just one or two in a backpack and they'll remain clean until needed.

The next item is an actual real washcloth like you use in your bathroom every day.  These are 12"x12" 100% cotton washcloths that can be machine washed and dried and used again and again.  And they also come in a larger compressed brick that is a 12"x27" hand towel if that suits your needs better.  
Jonny & Lora compressed towels.  Somehow I think that towel laid out above is not the washcloth advertised.
Of course, these are real towels, so they cost more, about a dollar each.  I'm not sure that they are that much more desirable to have in an emergency than the smaller, cheaper washcloths at the expense of space for other necessary items.  But I throw them in the bags for now.

Wednesday, January 9, 2019

Disease and Illness--Thiamine Deficiency and Beri-Beri

Food manufacturers routinely add vitamin B1, also known as thiamine, to enrich breakfast cereals and breads.  But what happens when Kraft and Nabisco and Kellogg's aren't working for us anymore?

Due to the fortification of foods, cases of nutritional thiamine deficiency in the United States are extremely rare.  However, it remains common in parts of Africa and outbreaks occur in refugee camps.  While thiamine deficiency has been described in historical records for thousands of years, it only became common in the late nineteenth century with the increased processing of grains, particularly rice in the eastern hemisphere and wheat in the western hemisphere.  As researchers observed increasing incidences of disease in populations that consumed more white rice and white flour, governments mandated the addition of essential vitamins back into these foods that processing had stripped away. 

Mild to moderate thiamine deficiency is marked by malaise, weight loss, irritability, and confusion.  Risk factors for thiamine deficiency in a functioning society include dialysis, bariatric surgery, diabetes, large numbers of diuretics, and alcoholism.

But what happens when our society is no longer functioning?  What are the risk factors?  How quickly will thiamine deficiency and beriberi (Sinhalese phrase meaning “I can’t, I can’t”), return when our society collapses?

Ten days.  The human body doesn't store thiamine.  Symptoms of mild to moderate deficiency may occur in just ten days.

Diagnosis of beriberi in a collapsed society without access to laboratory blood tests is going to be based on symptoms and improvement with good nutrition, specifically whole grain bread, because conventional treatment with thiamine administered intravenously also won't likely be an option.

Unfortunately for caretakers, beriberi is expressed in different forms, which could make diagnosis difficult.  Common symptoms include impaired reflexes, droopy eyelids, lack of coordination, and difficulty walking.

Wet beriberi affects the cardiovascular system and is marked by an increased heart rate, shortness of breath, and swelling of the legs due to vasodilation.

Dry beriberi affects the nervous system and is exhibited by confusion, numbness in the limbs, trouble moving the feet, and pain.

Gastrointestinal beriberi causes abdominal pain, nausea, vomiting, and lactic acidosis.

Infantile beriberi occurs primarily in infants two to six months in age whose mothers are deficient in thiamine as well.  It may present in either the wet or dry forms, and in addition to an increased heart rate, edema, and vomiting, the infant may also have diarrhea and pale skin.  Shortness of breath and convulsions are noted in the terminal stages.

There are also some genetic conditions that make thiamine absorption from food difficult, but they're beyond the scope of this post and the ability to treat post-collapse.

So how to we ensure that we are getting enough thiamine in our diet on a daily basis?  Building up a generous supply of supplemental vitamins is one way, but when that supply is exhausted, what next?  What foods are high in thiamine?  
  • Whole grains, especially brown rice (which doesn't have a long shelf-life)
  • Beef, pork, fish, liver, eggs, dairy (food from animal sources is only a good source of thiamine if their diet has adequate thiamine)
  • Legumes
  • Vegetables such as acorn squash, asparagus, spinach, beet greens, and Brussels sprouts
As I attempt to finish writing this post, my husband is asking me about where to find Christmas wrap and tape and bows and playing Christmas music.  (I write posts about a month before they appear online.  It gives me time to make revisions and lets me take a break if I need to.) My daughter's trying to keep the one remaining kitten from the litter from hiding behind the piano, or anywhere else, before someone shows up to claim him.  My son is studying for his last final.  I love my life.  I don't want things to change.  I'm sure it's the same for you.

Tuesday, January 8, 2019

Traditional Medicine--Skin Preps and Washes

A lot of what I write about on Tuesdays is the supplies you want to have on hand to let a licensed professional care for your family should the need arise.  We see what has happened in the past when economies collapse or war breaks out, and we see what is happening in Venezuela right now.  They still have some physicians who haven't left the country, but supplies are virtually non-existent.

However, because we Americans have been taught that only physicians and nurses should be providing care for anything more serious than simple scrapes and common colds, many don't have a clear understanding of various supplies and their uses.  Today I want to focus on the different solutions used for cleaning skin and wounds.

Isopropyl (rubbing) alcohol is used to disinfect and sterilize and to make liniments.  It is commonly available in 50%, 70%, and 91% solutions. You must have a minimum of 70% for sterilization and disinfection.  And of course, 91% is dual purpose since it can also be used as a cooking fuel.  However, and it seems counterintuitive, a 70% solution is more effective at disinfecting than the 91% solution.  Water is needed to carry the alcohol into the bacteria to kill the bacteria.  A 91% solution of alcohol evaporates faster and has less water to carry the alcohol to the bacteria.  (And it's much more expensive.)  Alcohol does not inactivate some viruses (hydrophilic viruses like polio and coxsackie).   Alcohol pads and hand sanitizer are generally 60-70% alcohol.

Rubbing alcohol should never be used in a wound, only around a wound for cleaning.  Using alcohol in a wound can delay or prevent healing.    Dr. Cynthia Koelker, author of Armageddon Medicine, recommends storing two 16-oz bottles of rubbing alcohol for a family. Store one box of 200 pads as well.

Hydrogen peroxide is commonly available in a 3% solution.  It is always in a brown bottle because it is degraded by light.  Even with being in a brown bottle, it still only has a six month shelf life once it's opened.  Hydrogen peroxide can be used to sterilize surgical tools and is effective against viruses, bacteria, and yeasts.  It is environmentally safe as it degrades to form oxygen and water.  It has historically been used for disinfecting wounds; it's been a staple of home first aid cabinets for years, and is still used in developing countries because it is cheap and readily available.  But it kills newly formed tissue and induces scarring.  It should never be used in a wound, only around a wound for cleaning.  For family medical purposes, Dr. Koelker advises storing one 16-oz bottle. 

Chlorhexidine (Hibiclens) is a disinfectant and antiseptic used to sterilize surgical tools and disinfect the skin before surgery.  It is on WHO's List of Essential Medicines and is available over-the-counter.  More effective than povidone iodine, and certainly more expensive, it is not effective against poliovirus or adenovirus.  It has recently started being used in poor countries for cleaning umbilical cords in newborns and shown to reduce neonatal death rate by 12%.  Do not allow chlorhexidine to get into the ears as it can damage hearing.  One 16-oz bottle should be sufficient for family medical needs in a long-term collapse of society.

Povidone iodine (or iodopovidone, Betadine), most commonly available in a 10% solution, is used to disinfect the skin of the patient and the providers' hands prior to surgeries or procedures, and is also used to clean umbilical cords.  Like chlorhexidine, it is also on WHO's List of Essential Medicines and available over the counter.  It is used to disinfect and clean around minor wounds, never in.    When diluted to 2.5% (one part of the 10% solution to three parts water), it can be used to disinfect medical instruments.  Instruments should soak for 15 minutes.  Some evidence suggests that alcohol and chlorhexidine are better than povidone iodine for pre-operative skin cleaning.

Povidone iodine is not to be used on burns or puncture wounds, nor is it to be used with people allergic to iodine or seafood.  In an emergency, an iodine wipe can be dropped into a bottle of water and used to make a disinfecting solution.  Store one 16-oz bottle per family or a box of 100 prep pads.

Benzalkonium chloride (BZK, BAK, BAC) is active against bacteria, some viruses, fungi, and, unlike all the other solutions, protozoa.  It is more effective than alcohol, doesn't dry out the skin like alcohol, and isn't messy like povidone iodine.  It's one of the active ingredients of Bactine.  Like all the other disinfecting solutions above, it is used for cleaning around a wound, never in.  It is ideal for prepping before inserting a catheter and the safest for using around the eyes, but should not be allowed to get into eyes.  It is available in wipes and is the skin prep of choice for wounds received in water because it will kill protozoa.  Larger groups may include a box of BZK wipes in their supplies.  In our family, we all carry two BZK wipes in our boo-boo kits; more in the larger kits.

Clean water is actually one of the best things for irrigating a wound and removing debris.  However, irrigating does not mean pouring water over or swishing in a basin.  Irrigating a wound is done with decent water pressure that is achieved using a needle-less syringe, a water bladder, or a peri bottle (like those the hospital sends home with new mothers).

Sterile saline is used for irrigating debris out of the eyes and irrigating and washing wounds around the eyes.

Dakin's solution.  Dakin's solution was developed during WWI as a wound antiseptic.  It is used to kill germs and prevent growth of germs in wounds.  It is an excellent solution for irrigating wounds without killing healthy tissue.  It is very inexpensive and easy to make, and thus ideally suited for the difficult circumstances a collapsed society will present. 

To make your own, you will need:
Sterile equipment--pan and lid, glass jar(s) and tight-fitting lid(s), measuring cups and spoons
32 oz clean water
1/2 teaspoon baking soda
Regular, unscented, not concentrated or ultra, just regular bleach in one of the following concentrations:

full strength--3 ounces (95 ml) bleach--for sterilizing instruments
1/2 strength--3 tablespoons plus 1 teaspoon (48 ml) bleach--for debridement of necrotized wounds
1/4 strength--1 tablespoon plus 2 teaspoons (24 ml) bleach--for irrigating wounds
1/8 strength--2 1/2 teaspoons (12 ml) bleach

Boil water for 15 minutes with the lid on the pan.  Remove from heat.  Add the baking soda to the boiled water.  Measure bleach according to desired strength and add to water.  Cover tightly in a glass jar and wrap jar in aluminum foil to shield it from light.  (Do not store Dakin's solution in metal containers.)  Once opened for use it is good only for 48 hours.  Discard unused portion.  Unopened and protected from light, the solution can be stored for one month at room temperature.

Label the jar with the date and time you made the solution, as well as the date to discard it.

The full-strength solution is used only on stainless steel medical instruments.  Dakin's solution will corrode nickel, chromium steel, iron, and other metals.  Because of its corrosive nature, instruments should not be in the bath solution for longer than 30 minutes. 

Use only 1/4 strength solution for acute wound irrigation.  Always irrigate very generously with plain water following irrigation with Dakin's solution.  If the solution is used for mouth wash, do not swallow it. Do not use in individuals allergic to any of the ingredients.

For further reading:

Monday, January 7, 2019

Herbal Medicine--Activated Charcoal

Disclaimer.  I am not a licensed health practitioner.  This is just another post on an item you might wish to have available if needed so that a physician can treat you and your family as best as possible.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care.  A qualified, licensed physician or other medical provider should be consulted before beginning any herbal or conventional treatment, especially anything related to poisoning or overdose.

OK, I know this isn't an herb, but it is natural, so this is where I'm putting it.

Activated charcoal, also known as activated carbon, is not barbecue charcoal.  If someone's wanting to make that substitution, give that person something else to do.  Perhaps chopping onions.

Aside from its most common usage in water filters, activated charcoal is used in emergency rooms the world over for treating some kinds of poisoning and drug overdoses.  It has application for both internal and external use.

Internally, physicians use activated charcoal to cleanse toxins such as bacteria and most organic poisons from the gastrointestinal tract.  Research shows that it will bind enterohemorrhagic Escherichia coli strains O157:H7 while not affecting the beneficial E. coli normally found in the body.  (And researchers still don't know why that is.)  It is specifically used in emergency rooms for treating overdoses of aspirin, acetaminophen, opium, and morphine.  Activated charcoal is used in doses of 1 gram per kilogram of body weight, so 50-100 grams for adults, and 10-25 grams for children.  It must be administered within 1-2 hours of the time the toxin was ingested to be effective.  Plenty of water must be consumed at the same time.  To use it internally, mix the powder with clean water and drink it, or use capsules (you're going to need a lot).  Activated charcoal may cause constipation and definitely will turn the stool black.  It does not enter the bloodstream and so is of no efficacy in dealing with toxins ingested more than 2-3 hours before treatment is sought.  And it cannot be used internally to treat snakebites.

Activated charcoal is effective only for some poisons.  It does not work against petroleum, alcohol, acid, lye, or corrosive poisons.

Externally, activated charcoal is used to clean out wounds by binding dead tissue, bacteria, and toxins.  For more superficial wounds, mix activated charcoal with clean water into a paste and apply to the affected area.  For deeper, penetrating wounds, like with a snakebite, mix activated charcoal with more water into a thick juice/thin smoothie consistency and soak the affected area in this.  The activated charcoal has to get into direct contact with the tissue and toxin to be effective.  Leave the plaster on, or let the affected area soak for an hour or two, then wash off the skin and check the wound (it's gonna be black, so this may be a little difficult).  Then repeat the above procedure to draw out more toxin.  After about four hours, clean off, and start working with herbs to promote further healing.  Charcoal only cleans; it does not help tissue grow and heal.

To treat poison ivy, poison oak, insect bites and stings:  1/4 teaspoon or one capsule activated charcoal with 1/2 tablespoon water, apply to affected area, bandage.  Repeat every thirty minutes.

To treat poisonous spiders:  same as above, but 1/2 teaspoon activated charcoal, and apply to a wider area surrounding the bite, cover with a bandage to prevent staining, and change every two hours, rinse well between bandage changes.

Other uses:  to alleviate gas and bloating associated with foods that normally cause flatulence, take activated charcoal capsule one hour prior to a meal with one to two full glasses of water.

For further reading:
Sam Coffman, The Herbal Medic, p 323-325.

Copyright 2019, Jennifer Rader,

Saturday, January 5, 2019

Expanded Food Storage--Pressure Canning Chicken

All right, this is going to be a pretty short post because canning chicken is so very easy. 

Raw pack:  Canning raw chicken is almost brainless.  Fill jars loosely with raw meat pieces "in suitable sizes for canning."  I aim for 1/2-inch to 1-inch cubes.  Allow 1-1/4" headspace.  Add salt, if desired, 1 teaspoon per quart, 1/2 teaspoon per pint.  Do not add any liquid.

Hot pack:  Boil, steam, or bake chicken until it is about 2/3 cooked.  Fill jars with pieces and hot broth.  Allow 1-1/4" headspace.  Add salt, if desired, 1 teaspoon per quart, 1/2 teaspoon per pint. 

To process the jars, follow the directions that came with your pressure canner.  Meats and other low-acid foods must be preserved using a pressure canner, not a pressure cooker, and not a water-bath canner.  Directions vary slightly but significantly among pressure canners, and so you must use the directions that came with your canner.

Now for just a few notes.

Something one of my physiology professors shared--super high-level stuff:  "A pint's a pound the world around."  What this means for you is that about one pound of chicken will fit in a pint jar.  But loosely packed, it will be a little less chicken.  If I were canning ten pounds of chicken, I'd plan on using twelve pint jars.  

Chicken (and rabbit, by the way) are the only meats that require 1-1/4" headspace.  They expand more than other meats during the canning process.  

If you are canning chickens that your raised and freshly butchered yourself, chill those chickens for six to twelve hours before canning.  Trust me on this.  If you don't, you'll be sorry.

You may can chicken with or without the bones.  Processing times with the bones are less than without the bones.  No, that's not what one would normally expect, but it is true.  The USDA says so.

If you have cats, you might wish to can the chicken bones to make food for them.  To do this, cram as many bones as you can into the jar and then add boiling water.  Process with your other jars of chicken.  To feed the cat, pour canned bones into a bowl and mash them with a fork.  That's all it takes.  Do not feed this to dogs.  The protein content is too high for dogs and will harm their kidneys. 

For further reading:
Ball Blue Book:  The Guide to Home Canning and Freezing
The USDA Complete Guide to Home Canning  (super-detailed, complete, blow-by-blow report on how to can chicken with lots of pictures for the super-nervous first-timer who can't believe it's as easy as I've described above)

Friday, January 4, 2019

Basic Food Storage: Beans

"Beans, beans, the magical fruit;  the more you eat, the more you toot."

That's what a lot of people think of beans, even preppers.  It makes me sad.  Because beans are so versatile and can be used in so many ways, they really are magical!  So first off, let's take care of the primary (and legitimate) objection to beans.  "[T]hey make you toot."  Beans make people who are not accustomed to eating beans regularly toot because they lack the proper intestinal flora to digest beans properly.  Once you incorporate beans into your diet, problems with gas should disappear entirely. 

It's recommended that you store sixty pounds of dry beans (not green beans, not commercially canned beans) per person per year.  Beans are an ideal storage food because they are high in protein and low in fat, and are a good source of many trace minerals.  And it does not matter what kinds of beans you store—white, pinto, red, kidney, black, lima, lentils, et cetera. Store what you eat!  The chief cook and bottle washer here is of Mexican descent, so we have a lot of pinto beans. We also store some black beans, some white, and a few pink. I have no idea why I bought pink beans.  I never use them.  Maybe they were cheap.

While most of us think of soup and chili as the main ways of eating beans, they can actually be used in a wide variety of recipes. Beans can be sprouted; mung beans are what's used to produce the beans sprouts used in Asian cooking.  If you have old beans that will not soften no matter what you do, they can be ground into flour using a grain mill.  Use this flour instead of wheat flour or cornstarch for thickening soup.

In the course of your own research into the deep, dark mysteries of food storage and beans, you will find those who advocate using bean puree in baking to substitute for oil or butter and to boost the nutritional value of sweets.  Proceed with caution!  (Just kidding.)

OK, actually, I'm only half joking about that.  I've tried a few of those beans-for-butter recipes and was not impressed.  But using bean puree in baking is worthy of its own post and will be addressed in the future.

Beans are almost as sensitive to heat as oil and milk and should be kept in conditions as cool as possible.  When exposed to higher temperatures beans become tough and require more time for soaking and cooking.  Unfortunately, people occasionally find themselves with beans that won’t soften with cooking. There are several ways to address this problem. First, add acidic foods such as tomatoes, vinegar, and molasses near the end of the cooking time because these ingredients tend to toughen beans. For the same reason, salt also should not be added until just before serving. Second, hard water may result in hard beans. If your cooked beans refuse to soften, try adding ¼ teaspoon baking soda to soften the beans.  (Keep in mind that adding baking soda to beans reduces the nutritional value.)  If none of those attempts work, there is yet another remedy to try, but it won’t be in time for tonight’s dinner. Try freezing the beans. As the water in the beans freezes, it will break down the cell walls to soften the beans. If that still doesn’t work, pressure cooking or canning the beans almost always will.  Finally, if all else has failed, the beans can still be ground in a mill and the resulting flour used in soups. However, bear in mind that the increasing toughness in the beans suggests a corresponding decrease in nutritional value.

Because dry beans require a long time to cook (and will thus require a lot of fuel in a grid-down situation), I always keep a good supply of beans that I have pressure canned at home. Dry beans are among the easiest foods to can.  In fact, if I were brand new to pressure canning, I would start with canning dry beans.  They're easy, cheap, and almost fool-proof.  Consult your Ball Blue Book  (the exact title has changed over the years, and the current edition is no longer blue, but usually the title includes Ball Blue Book, and that is how it will be referred to here) for exact directions. Basically you soak the beans overnight, rinse in the morning, add the appropriate amount to your jar, add salt and boiling water, and process according to instructions that came with your pressure canner.  In the course of researching the pressure canning of dry beans, you may come across information advocating the canning of beans that have not been presoaked.  (Dry beans are put into the jar, salt and boiling water are added, and then the beans are canned under pressure.) This method is not USDA-approved, which may not matter to you; I have never seen any reasons offered as to why this is the case. However, people, including me, who have experimented with this method have noted a much higher seal failure rate, like about 25%, that we can only attribute to the beans being unsoaked.

The Home Storage Center sells a few varieties of beans (white, pinto, and black) as well as dehydrated refried beans in #10 cans.  The whole beans have a thirty-year shelf life, when stored properly.  The refried beans have a five-year shelf life.  While I know of a few people who have been happy with the dehydrated refried beans, I have not, and therefore I cannot recommend them. Perhaps it is my heritage coming through, and I’m too picky about the consistency, or perhaps my beans were old and tough.  And, to be fair, I haven't tried them in about 20 or 25 years.  Maybe they're better now. 

Thursday, January 3, 2019

Tips and Tricks--The Placebo Effect

Do you remember that episode on M*A*S*H where the 4077th, as they are treating the casualties of a recent battle, runs out of morphine?  Hawkeye and BJ have patients in excruciating pain, and nothing to give them, and no prospects of supplies coming in anytime soon.  As caring physicians desiring to alleviate their pain, in response to this crisis they resort to the unthinkable.  Quackery.  They give them sugar pills.  And miraculously, the placebo works on everybody, even Klinger, who is merely bothered by the heat.

When the first physician I took an off-grid medicine course from mentioned that the placebo effect is real, and that placebos can work in some patients, my curiosity was piqued.  When Dr. Steve also mentioned it, I became even more interested.  But that didn't matter too much, because there is precious little research on placebos.  Most physicians know it exists, but they don't like to talk about it.  Kind of like that crazy uncle.  Everyone knows him, but no one wants to admit he's there.  Better to talk about something else.

On November 7, 2018, a rather lengthy article on the placebo effect appeared in the New York Times Magazine.  Now, the NYT is not something I've ever considered citing for anything, but this topic is too intriguing to ignore, and the NYT is where the article appeared.  I've copied the link at the end of this post, but also pasted in the whole article just in case the link goes bad.  In a previous life I abstracted life sciences articles.  For the first time in about twenty-five years, I'll be writing another abstract for those who want to decide whether to read the whole article.

"What if the Placebo Effect Isn't a Trick?"


Placebos work best in individuals with chronic, stress-related conditions, especially if administered by someone they trust.  Though the placebo effect is real, many physicians do not acknowledge it or utilize it because they do not understand it and do not know which patients are likely to benefit.  Placebos have been shown to be effective in migraines, irritable bowel syndrome, PTSD, depression, Parkinson's, and back pain.    Researchers are beginning to study why the placebo effect works better for some people and some disorders than others.  The placebo is part of every clinical trial, but is not studied itself because there is no money in it.  The doctor-patient relationship is fundamental to understanding how placebos work and in helping them to be effective.  There is some evidence to suggest that the placebo effect is a biological response to the act of caring--and the more caring the better the response.  An enzyme called COMT  affects the body's response to pain and painkillers.  COMT levels are also significant in individuals with Parkinson's, depression, and schizophrenia, people who have also exhibited a strong response to the placebo effect.  MRI studies demonstrate a consistent pattern of brain activation in response to a placebo.

So why did I choose to post this article here?  A placebo is a tool, and as supplies are exhausted, it may become a very valuable tool.  But the most important take-away is that in difficult situations, a truly caring caregiver may be the very best medicine on the path to recovery.

(Update 16 January 2019)  Another MSM article on the placebo effect appeared online this morning. (Accessed 16 January 2019)

The Chain of Office of the Dutch city of Leiden is a broad and colorful ceremonial necklace that, draped around the shoulders of Mayor Henri Lenferink, lends a magisterial air to official proceedings in this ancient university town. But whatever gravitas it provided Lenferink as he welcomed a group of researchers to his city, he was quick to undercut it. “I am just a humble historian,” he told the 300 members of the Society for Interdisciplinary Placebo Studies who had gathered in Leiden’s ornate municipal concert hall, “so I don’t know anything about your topic.” He was being a little disingenuous. He knew enough about the topic that these psychologists and neuroscientists and physicians and anthropologists and philosophers had come to his city to talk about — the placebo effect, the phenomenon whereby suffering people get better from treatments that have no discernible reason to work — to call it “fake medicine,” and to add that it probably works because “people like to be cheated.” He took a beat. “But in the end, I believe that honesty will prevail.”

Lenferink might not have been so glib had he attended the previous day’s meeting on the other side of town, at which two dozen of the leading lights of placebo science spent a preconference day agonizing over their reputation — as purveyors of sham medicine who prey on the desperate and, if they are lucky, fool people into feeling better — and strategizing about how to improve it. It’s an urgent subject for them, and only in part because, like all apostate professionals, they crave mainstream acceptance. More important, they are motivated by a conviction that the placebo is a powerful medical treatment that is ignored by doctors only at their patients’ expense.
And after a quarter-century of hard work, they have abundant evidence to prove it. Give people a sugar pill, they have shown, and those patients — especially if they have one of the chronic, stress-related conditions that register the strongest placebo effects and if the treatment is delivered by someone in whom they have confidence — will improve. Tell someone a normal milkshake is a diet beverage, and his gut will respond as if the drink were low fat. Take athletes to the top of the Alps, put them on exercise machines and hook them to an oxygen tank, and they will perform better than when they are breathing room air — even if room air is all that’s in the tank. Wake a patient from surgery and tell him you’ve done an arthroscopic repair, and his knee gets better even if all you did was knock him out and put a couple of incisions in his skin. Give a drug a fancy name, and it works better than if you don’t.
You don’t even have to deceive the patients. You can hand a patient with irritable bowel syndrome a sugar pill, identify it as such and tell her that sugar pills are known to be effective when used as placebos, and she will get better, especially if you take the time to deliver that message with warmth and close attention. Depression, back pain, chemotherapy-related malaise, migraine, post-traumatic stress disorder: The list of conditions that respond to placebos — as well as they do to drugs, with some patients — is long and growing.

But as ubiquitous as the phenomenon is, and as plentiful the studies that demonstrate it, the placebo effect has yet to become part of the doctor’s standard armamentarium — and not only because it has a reputation as “fake medicine” doled out by the unscrupulous to the credulous. It also has, so far, resisted a full understanding, its mechanisms shrouded in mystery. Without a clear knowledge of how it works, doctors can’t know when to deploy it, or how.
Not that the researchers are without explanations. But most of these have traditionally been psychological in nature, focusing on mechanisms like expectancy — the set of beliefs that a person brings into treatment — and the kind of conditioning that Ivan Pavlov first described more than a century ago. These theories, which posit that the mind acts upon the body to bring about physical responses, tend to strike doctors and researchers steeped in the scientific tradition as insufficiently scientific to lend credibility to the placebo effect. “What makes our research believable to doctors?” asks Ted Kaptchuk, head of Harvard Medical School’s Program in Placebo Studies and the Therapeutic Encounter. “It’s the molecules. They love that stuff.” As of now, there are no molecules for conditioning or expectancy — or, indeed, for Kaptchuk’s own pet theory, which holds that the placebo effect is a result of the complex conscious and nonconscious processes embedded in the practitioner-patient relationship — and without them, placebo researchers are hard-pressed to gain purchase in mainstream medicine.

But as many of the talks at the conference indicated, this might be about to change. Aided by functional magnetic resonance imaging (f.M.R.I.) and other precise surveillance techniques, Kaptchuk and his colleagues have begun to elucidate an ensemble of biochemical processes that may finally account for how placebos work and why they are more effective for some people, and some disorders, than others. The molecules, in other words, appear to be emerging. And their emergence may reveal fundamental flaws in the way we understand the body’s healing mechanisms, and the way we evaluate whether more standard medical interventions in those processes work, or don’t. Long a useful foil for medical science, the placebo effect might soon represent a more fundamental challenge to it.
In a way, the placebo effect owes its poor reputation to the same man who cast aspersions on going to bed late and sleeping in. Benjamin Franklin was, in 1784, the ambassador of the fledgling United States to King Louis XVI’s court. Also in Paris at the time was a Viennese physician named Franz Anton Mesmer. Mesmer fled Vienna a few years earlier when the local medical establishment determined that his claim to have cured a young woman’s blindness by putting her into a trance was false, and that, even worse, there was something unseemly about his relationship with her. By the time he arrived in Paris and hung out his shingle, Mesmer had acquired what he lacked in Vienna: a theory to account for his ability to use trance states to heal people. There was, he claimed, a force pervading the universe called animal magnetism that could cause illness when perturbed. Conveniently enough for Mesmer, the magnetism could be perceived and de-perturbed only by him and people he had trained.
Mesmer’s method was strange, even in a day when doctors routinely prescribed bloodletting and poison to cure the common cold. A group of people complaining of maladies like fatigue, numbness, paralysis and chronic pain would gather in his office, take seats around an oak cask filled with water and grab on to metal rods immersed in the water. Mesmer would alternately chant, play a glass harmonium and wave his hands at the afflicted patients, who would twitch and cry out and sometimes even lose consciousness, whereupon they would be carried to a recovery room. Enough people reported good results that patients were continually lined up at Mesmer’s door waiting for the next session.
It was the kind of success likely to arouse envy among doctors, but more was at stake than professional turf. Mesmer’s claim that a force existed that could only be perceived and manipulated by the elect few was a direct challenge to an idea central to the Enlightenment: that the truth could be determined by anyone with senses informed by skepticism, that Scripture could be supplanted by facts and priests by a democracy of people who possessed them. So, when the complaints about Mesmer came to Louis, it was to the scientists that the king — at pains to show himself an enlightened man — turned. He appointed, among others, Lavoisier the chemist, Bailly the astronomer and Guillotin the physician to investigate Mesmer’s claims, and he installed Franklin at the head of their commission.
To the Franklin commission, the question wasn’t whether Mesmer was a fraud and his patients were dupes. Everyone could be acting in good faith, but belief alone did not prove that the magnetism was at work. To settle this question, they designed a series of trials that ruled out possible causes of the observed effects other than animal magnetism. The most likely confounding variable, they thought, was some faculty of mind that made people behave as they did under Mesmer’s ministrations. To rule this out, the panel settled upon a simple method: a blindfold. Over a period of a few months, they ran a series of experiments that tested whether people experienced the effects of animal magnetism even when they couldn’t see.
One of Mesmer’s disciples, Charles d’Eslon, conducted the tests. The panel instructed him to wave his hands at a part of a patient’s body, and then asked the patient where the effect was felt. They took him to a copse to magnetize a tree — Mesmer claimed that a patient could be treated by touching one — and then asked the patient to find it. They told patients d’Eslon was in the room when he was not, and vice versa, or that he was doing something that he was not. In trial after trial, the patients responded as if the doctor were doing what they thought he was doing, not what he was actually doing.
It was possibly the first-ever blinded experiment, and it soundly proved what scientists today call the null hypothesis: There was no causal connection between the behavior of the doctor and the response of the patients, which meant, as Franklin’s panel put it in their report, that “this agent, this fluid, has no existence.” That didn’t imply that people were pretending to twitch or cry out, or lying when they said they felt better; only that their behavior wasn’t a result of this nonexistent force. Rather, the panel wrote, “the imagination singly produces all the effects attributed to the magnetism.”
When the panel gave d’Eslon a preview of its findings, he took it with equanimity. Given the results of the treatment (as opposed to the experiment), he opined, the imagination, “directed to the relief of suffering humanity, would be a most valuable means in the hands of the medical profession” — a subject to which these august scientists might wish to apply their methods. But events intervened. Franklin was called back to America in 1785; Louis XVI had bigger trouble on his hands and, along with Lavoisier and Bailly, eventually met with the short, sharp shock of the device named for Guillotin.
The panel’s report was soon translated into English by William Godwin, the father of Mary Shelley. The story spread fast — not because of the healing potential that d’Eslon had suggested, but because of the implications for science as a whole. The panel had demonstrated that by putting imagination out of play, science could find the truth about our suffering bodies, in the same way it had found the truth about heavenly bodies. Hiving off subjectivity from the rest of medical practice, the Franklin commission had laid the conceptual foundation for the brilliant discoveries of modern medicine, the antibiotics and vaccines and other drugs that can be dispensed by whoever happens to possess the prescription pad, and to whoever happens to have the disease. Without meaning to, they had created an epistemology for the healing arts — and, in the process, inadvertently conjured the placebo effect, and established it as that to which doctors must remain blind.

CreditPhoto illustration by Paul Sahre

It wouldn’t be the last time science would turn its focus to the placebo effect only to quarantine it. At a 1955 meeting of the American Medical Association, the Harvard surgeon Henry Beecher pointed out to his colleagues that while they might have thought that placebos were fake medicine — even the name, which means “I shall please” in Latin, carries more than a hint of contempt — they couldn’t deny that the results were real. Beecher had been looking at the subject systematically, and he determined that placebos could relieve anxiety and postoperative pain, change the blood chemistry of patients in a way similar to drugs and even cause side effects. In general, he told them, more than one-third of patients would get better when given a treatment that was, pharmacologically speaking, inert.

If the placebo was as powerful as Beecher said, and if doctors wanted to know whether their drugs actually worked, it was not sufficient simply to give patients the drugs and see whether they did better than patients who didn’t interact with the doctor at all. Instead, researchers needed to assume that the placebo effect was part of every drug effect, and that drugs could be said to work only to the extent that they worked better than placebos. An accurate measure of drug efficacy would require comparing the response of patients taking it with that of patients taking placebos; the drug effect could then be calculated by subtracting the placebo response from the overall response, much as a deli-counter worker subtracts the weight of the container to determine how much lobster salad you’re getting.
In the last half of the 1950s, this calculus gave rise to a new way to evaluate drugs: the double-blind, placebo-controlled clinical trial, in which neither patient nor clinician knew who was getting the active drug and who the placebo. In 1962, when the Food and Drug Administration began to require pharmaceutical companies to prove their new drugs were effective before they came to market, they increasingly turned to the new method; today, virtually every prospective new drug has to outperform placebos on two independent studies in order to gain F.D.A. approval.
Like Franklin’s commission, the F.D.A. had determined that the only way to sort out the real from the fake in medicine was to isolate the imagination. It also echoed the royal panel by taking note of the placebo effect only long enough to dismiss it, giving it a strange dual nature: It’s included in clinical trials because it is recognized as an important part of every treatment, but it is treated as if it were not important in itself. As a result, although virtually every clinical trial is a study of the placebo effect, it remains underexplored — an outcome that reflects the fact that there is no money in sugar pills and thus no industry interest in the topic as anything other than a hurdle it needs to overcome.
When Ted Kaptchuk was asked to give the opening keynote address at the conference in Leiden, he contemplated committing the gravest heresy imaginable: kicking off the inaugural gathering of the Society for Interdisciplinary Placebo Studies by declaring that there was no such thing as the placebo effect. When he broached this provocation in conversation with me not long before the conference, it became clear that his point harked directly back to Franklin: that the topic he and his colleagues studied was created by the scientific establishment, and only in order to exclude it — which means that they are always playing on hostile terrain. Science is “designed to get rid of the husks and find the kernels,” he told me. Much can be lost in the threshing — in particular, Kaptchuk sometimes worries, the rituals embedded in the doctor-patient encounter that he thinks are fundamental to the placebo effect, and that he believes embody an aspect of medicine that has disappeared as scientists and doctors pursue the course laid by Franklin’s commission. “Medical care is a moral act,” he says, in which a suffering person puts his or her fate in the hands of a trusted healer.
“I don’t love science,” Kaptchuk told me. “I want to know what heals people.” Science may not be the only way to understand illness and healing, but it is the established way. “That’s where the power is,” Kaptchuk says. That instinct is why he left his position as director of a pain clinic in 1990 to join Harvard — and it’s why he was delighted when, in 2010, he was contacted by Kathryn Hall, a molecular biologist. Here was someone with an interest in his topic who was also an expert in molecules, and who might serve as an emissary to help usher the placebo into the medical establishment.
Hall’s own journey into placebo studies began 15 years before her meeting with Kaptchuk, when she developed a bad case of carpal tunnel syndrome. Wearing a wrist brace didn’t help, and neither did over-the-counter drugs or the codeine her doctor prescribed. When a friend suggested she visit an acupuncturist, Hall balked at the idea of such an unscientific approach. But faced with the alternative, surgery, she decided to make an appointment. “I was there for maybe 10 minutes,” she recalls, “when she stuck a needle here” — Hall points to a spot on her forearm — “and this awful pain just shot through my arm.” But then the pain receded and her symptoms disappeared, as if they had been carried away on the tide. She received a few more treatments, during which the acupuncturist taught her how to manipulate a spot near her elbow if the pain recurred. Hall needed the fix from time to time, but the problem mostly just went away.

“I couldn’t believe it,” she told me. “Two years of gross drugs, and then just one treatment.” All these years later, she’s still wonder-struck. “What was that?” she asks. “Rub the spot, and the pain just goes away?”
Hall was working for a drug company at the time, but she soon left to get a master’s degree in visual arts, after which she started a documentary-production company. She was telling her carpal-tunnel story to a friend one day and recounted how the acupuncturist had climbed up on the table with her. (“I was like, ‘Oh, my God, what is this woman doing?’ ” she told me. “It was very dramatic.”) She’d never been able to understand how the treatment worked, and this memory led her to wonder out loud if maybe the drama itself had something to do with the outcome.
Her friend suggested she might find some answers in Ted Kaptchuk’s work. She picked up his book about Chinese medicine, “The Web that Has No Weaver,” in which he mentioned the possibility that placebo effects figure strongly in acupuncture, and then she read a study he had conducted that put that question to the test.
Kaptchuk had divided people with irritable bowel syndrome into three groups. In one, acupuncturists went through all the motions of treatment, but used a device that only appeared to insert a needle. Subjects in a second group also got sham acupuncture, but delivered with more elaborate doctor-patient interaction than the first group received. A third group was given no treatment at all. At the end of the trial, both treatment groups improved more than the no-treatment group, and the “high interaction” group did best of all.
Kaptchuk, who before joining Harvard had been an acupuncturist in private practice, wasn’t particularly disturbed by the finding that his own profession worked even when needles were not actually inserted; he’d never thought that placebo treatments were fake medicine. He was more interested in how the strength of the treatment varied with the quality and quantity of interaction between the healer and the patient — the drama, in other words. Hall reached out to him shortly after she read the paper.
The findings of the I.B.S. study were in keeping with a hypothesis Kaptchuk had formed over the years: that the placebo effect is a biological response to an act of caring; that somehow the encounter itself calls forth healing and that the more intense and focused it is, the more healing it evokes. He elaborated on this idea in a comparative study of conventional medicine, acupuncture and Navajo “chantway rituals,” in which healers lead storytelling ceremonies for the sick. He argued that all three approaches unfold in a space set aside for the purpose and proceed as if according to a script, with prescribed roles for every participant. Each modality, in other words, is its own kind of ritual, and Kaptchuk suggested that the ritual itself is part of what makes the procedure effective, as if the combined experiences of the healer and the patient, reinforced by the special-but-familiar surroundings, evoke a healing response that operates independently of the treatment’s specifics. “Rituals trigger specific neurobiological pathways that specifically modulate bodily sensations, symptoms and emotions,” he wrote. “It seems that if the mind can be persuaded, the body can sometimes act accordingly.” He ended that paper with a call for further scientific study of the nexus between ritual and healing.
When Hall contacted him, she seemed like a perfect addition to the team he was assembling to do just that. He even had an idea of exactly how she could help. In the course of conducting the study, Kaptchuk had taken DNA samples from subjects in hopes of finding some molecular pattern among the responses. This was an investigation tailor-made to Hall’s expertise, and she agreed to take it on. Of course, the genome is vast, and it was hard to know where to begin — until, she says, she and Kaptchuk attended a talk in which a colleague presented evidence that an enzyme called COMT affected people’s response to pain and painkillers. Levels of that enzyme, Hall already knew, were also correlated with Parkinson’s disease, depression and schizophrenia, and in clinical trials people with those conditions had shown a strong placebo response. When they heard that COMT was also correlated with pain response — another area with significant placebo effects — Hall recalls, “Ted and I looked at each other and were like: ‘That’s it! That’s it!’ ”

It is not possible to assay levels of COMT directly in a living brain, but there is a snippet of the genome called rs4680 that governs the production of the enzyme, and that varies from one person to another: One variant predicts low levels of COMT, while another predicts high levels. When Hall analyzed the I.B.S. patients’ DNA, she found a distinct trend. Those with the high-COMT variant had the weakest placebo responses, and those with the opposite variant had the strongest. These effects were compounded by the amount of interaction each patient got: For instance, low-COMT, high-interaction patients fared best of all, but the low-COMT subjects who were placed in the no-treatment group did worse than the other genotypes in that group. They were, in other words, more sensitive to the impact of the relationship with the healer.
The discovery of this genetic correlation to placebo response set Hall off on a continuing effort to identify the biochemical ensemble she calls the placebome — the term reflecting her belief that it will one day take its place among the other important “-omes” of medical science, from the genome to the microbiome. The rs4680 gene snippet is one of a group that governs the production of COMT, and COMT is one of a number of enzymes that determine levels of catecholamines, a group of brain chemicals that includes dopamine and epinephrine. (Low COMT tends to mean higher levels of dopamine, and vice versa.) Hall points out that the catecholamines are associated with stress, as well as with reward and good feeling, which bolsters the possibility that the placebome plays an important role in illness and health, especially in the chronic, stress-related conditions that are most susceptible to placebo effects.

CreditPhoto illustration by Paul Sahre

Her findings take their place among other results from neuroscientists that strengthen the placebo’s claim to a place at the medical table, in particular studies using f.M.R.I. machines that have found consistent patterns of brain activation in placebo responders. “For years, we thought of the placebo effect as the work of imagination,” Hall says. “Now through imaging you can literally see the brain lighting up when you give someone a sugar pill.”
One group with a particularly keen interest in those brain images, as Hall well knows, is her former employers in the pharmaceutical industry. The placebo effect has been plaguing their business for more than a half-century — since the placebo-controlled study became the clinical-trial gold standard, requiring a new drug to demonstrate a significant therapeutic benefit over placebo to gain F.D.A. approval.
That’s a bar that is becoming ever more difficult to surmount, because the placebo effect seems to be becoming stronger as time goes on. A 2015 study published in the journal Pain analyzed 84 clinical trials of pain medication conducted between 1990 and 2013 and found that in some cases the efficacy of placebo had grown sharply, narrowing the gap with the drugs’ effect from 27 percent on average to just 9 percent. The only studies in which this increase was detected were conducted in the United States, which has spawned a variety of theories to explain the phenomenon: that patients in the United States, one of only two countries where medications are allowed to be marketed directly to consumers, have been conditioned to expect greater benefit from drugs; or that the larger and longer-duration trials more common in America have led to their often being farmed out to contract organizations whose nurses’ only job is to conduct the trial, perhaps fostering a more placebo-triggering therapeutic interaction.
Whatever the reason, a result is that drugs that pass the first couple of stages of the F.D.A. approval process founder more and more frequently in the larger late-stage trials; more than 90 percent of pain medications now fail at this stage. The industry would be delighted if it were able to identify placebo responders — say, by their genome — and exclude them from clinical trials.

That may seem like putting a thumb on the scale for drugs, but under the logic of the drug-approval regime, to eliminate placebo effects is not to cheat; it merely reduces the noise in order for the drug’s signal to be heard more clearly. That simple logic, however, may not hold up as Hall continues her research into the genetic basis of the placebo. Indeed, that research may have deeper implications for clinical drug trials, and for the drugs themselves, than pharma companies might expect.
Since 2013, Hall has been involved with the Women’s Health Study, which has tracked the cardiovascular health of nearly 40,000 women over more than 20 years. The subjects were randomly divided into four groups, following standard clinical-trial protocol, and received a daily dose of either vitamin E, aspirin, vitamin E with aspirin or a placebo. A subset also had their DNA sampled — which, Hall realized, offered her a vastly larger genetic database to plumb for markers correlated to placebo response. Analyzing the data amassed during the first 10 years of the study, Hall found that the women with the low-COMT gene variant had significantly higher rates of heart disease than women with the high-COMT variant, and that the risk was reduced for those low-COMT women who received the active treatments but not in those given placebos. Among high-COMT people, the results were the inverse: Women taking placebos had the lowest rates of disease; people in the treatment arms had an increased risk.
These findings in some ways seem to confound the results of the I.B.S. study, in which it was the low-COMT patients who benefited most from the placebo. But, Hall argues, what’s important isn’t the direction of the effect, but rather that there is an effect, one that varies depending on genotype — and that the same gene variant also seems to determine the relative effectiveness of the drug. This outcome contradicts the logic underlying clinical trials. It suggests that placebo and drug do not involve separate processes, one psychological and the other physical, that add up to the overall effectiveness of the treatment; rather, they may both operate on the same biochemical pathway — the one governed in part by the COMT gene.
Hall has begun to think that the placebome will wind up essentially being a chemical pathway along which healing signals travel — and not only to the mind, as an experience of feeling better, but also to the body. This pathway may be where the brain translates the act of caring into physical healing, turning on the biological processes that relieve pain, reduce inflammation and promote health, especially in chronic and stress-related illnesses — like irritable bowel syndrome and some heart diseases. If the brain employs this same pathway in response to drugs and placebos, then of course it is possible that they might work together, like convoys of drafting trucks, to traverse the territory. But it is also possible that they will encroach on one another, that there will be traffic jams in the pathway.
What if, Hall wonders, a treatment fails to work not because the drug and the individual are biochemically incompatible, but rather because in some people the drug interferes with the placebo response, which if properly used might reduce disease? Or conversely, what if the placebo response is, in people with a different variant, working against drug treatments, which would mean that a change in the psychosocial context could make the drug more effective? Everyone may respond to the clinical setting, but there is no reason to think that the response is always positive. According to Hall’s new way of thinking, the placebo effect is not just some constant to be subtracted from the drug effect but an intrinsic part of a complex interaction among genes, drugs and mind. And if she’s right, then one of the cornerstones of modern medicine — the placebo-controlled clinical trial — is deeply flawed.
When Kathryn Hall told Ted Kaptchuk what she was finding as she explored the relationship of COMT to the placebo response, he was galvanized. “Get this molecule on the map!” he urged her. It’s not hard to understand his excitement. More than two centuries after d’Eslon suggested that scientists turn their attention directly to the placebo effect, she did exactly that and came up with a finding that might have persuaded even Ben Franklin.
But Kaptchuk also has a deeper unease about Hall’s discovery. The placebo effect can’t be totally reduced to its molecules, he feels certain — and while research like Hall’s will surely enhance its credibility, he also sees a risk in playing his game on scientific turf. “Once you start measuring the placebo effect in a quantitative way,” he says, “you’re transforming it to be something other than what it is. You suck out what was previously there and turn it into science.” Reduced to its molecules, he fears, the placebo effect may become “yet another thing on the conveyor belt of routinized care.”

“We’re dancing with the devil here,” Kaptchuk once told me, by way of demonstrating that he was aware of the risks he’s taking in using science to investigate a phenomenon it defined only to exclude. Kaptchuk, an observant Jew who is a student of both the Torah and the Talmud, later modified his comment. It’s more like Jacob wrestling with the angel, he said — a battle that Jacob won, but only at the expense of a hip injury that left him lame for the rest of his life.
Indeed, Kaptchuk seems wounded when he complains about the pervasiveness of research that uses healthy volunteers in academic settings, as if the response to mild pain inflicted on an undergraduate participating in an on-campus experiment is somehow comparable to the despair often suffered by people with chronic, intractable pain. He becomes annoyed when he talks about how quickly some of his colleagues want to move from these studies to clinical recommendations. And he can even be disparaging of his own work, wondering, for instance, whether the study in which placebos were openly given to irritable bowel syndrome patients succeeded only because it convinced the subjects that the sugar was really a drug. But it’s the prospect of what will become of his findings, and of the placebo, as they make their way into clinical practice, that really seems to torment him.
Kaptchuk may wish “to help reconfigure biomedicine by rejecting the idea that healing is only the application of mechanical tools.” He may believe that healing is a moral act in which “caring in the context of hope qualitatively changes clinical outcomes.” He may be convinced that the relationship kindled by the encounter between a suffering person and a healer is a central, and almost entirely overlooked, component of medical treatment. And he may have dedicated the last 20 years of his life to persuading the medical establishment to listen to him. But he may also come to regret the outcome.
After all, if Hall is right that clinician warmth is especially effective with a certain genotype, then, as she wrote in the paper presenting her findings from the I.B.S./sham-acupuncture study, it is also true that a different group will “derive minimum benefit” from “empathic attentions.” Should medical rituals be doled out according to genotype, with warmth and caring withheld in order to clear the way for the drugs? And if she is correct that a certain ensemble of neurochemical events underlies the placebo effect, then what is to stop a drug company from manufacturing a drug — a real drug, that is — that activates the same process pharmacologically? Welcomed back into the medical fold, the placebo effect may raise enough mischief to make Kaptchuk rue its return, and bewilder patients when they discover that their doctor’s bedside manner is tailored to their genes.
For the most part, most days, Kaptchuk manages to keep his qualms to himself, to carry on as if he were fully confident that scientific inquiry can restore the moral dimension to medicine. But the precariousness of his endeavors is never far from his mind. “Will this work destroy the stuff that actually has to do with wisdom, preciousness, imagination, the things that are actually critical to who we are as human beings?” he asks. His answer: “I don’t know, but I have to believe there is an infinite reserve of wisdom and imagination that will resist being reduced to simple materialistic explanations.”
The ability to hold two contradictory thoughts in mind at the same time seems to come naturally to Kaptchuk, but he may overestimate its prevalence in the rest of us. Even if his optimism is well placed, however, there’s nothing like being sick to make a person toss that kind of intelligence aside in favor of the certainties offered by modern medicine. Indeed, it’s exactly that yearning that sickness seems to awaken and that our healers, imbued with the power of science, purport to provide, no imagination required. Armed with our confidence in them, we’re pleased to give ourselves over to their ministrations, and pleased to believe that it’s the molecules, and the molecules alone, that are healing us. People do like to be cheated, after all.

Gary Greenberg is the author, most recently, of “The Book of Woe: The DSM and the Unmaking of Psychiatry.” He is a contributing editor for Harper’s Magazine. This is his first article for the magazine.