Trick or Treatment 713
brothke writes "The recent collapse of financial companies occurred in part because their operations were
run like a black box. For
many years, alternative medicine has similarly operated in the shadows with
its own set of black boxes. In Trick or Treatment: The
Undeniable Facts about Alternative Medicine, Simon Singh and
Edzard Ernst, MD, break open that box, and show with devastating clarity and
accuracy, that the box is for the most part empty." Keep reading for the rest of Ben's review.
I first encountered co-author Simon Singh at the
2005 RSA
Conference. In his
presentation, he included a demonstration of the human brains unique
capability for pattern matching when specific patterns are expected, and used
Led Zeppelins Stairway to Heaven as an
example. Stairway has long been rumored to have
subliminal satanic messages. When played backwards,
it is impossible to decipher any message. But when
the message is known in advance, one can then hear
the message imploring the listener to go to Satans tool shed.
Once Singh put the subliminal lyrics on the overhead, the
subliminal message was now clear, not due to a subliminal message, rather via
pattern matching.
| Trick or Treatment: The Undeniable Facts about Alternative Medicine | |
| author | Simon Singh and Edzard Ernst |
| pages | 352 |
| publisher | W. W. Norton |
| rating | 9 |
| reviewer | Ben Rothke |
| ISBN | 978-0393066616 |
| summary | Peels away the fallacies of acupuncture, homeopathy, chiropractic and herbal medicine |
While no reasonable person can believe in Stairways subliminal lyrics, far too many people do believe in equally implausible things in the realm of alternative medicine. In the book, the authors tackle four main areas: acupuncture, homeopathy, chiropractic and herbal medicine. The books conclusion is that acupuncture, homeopathy, chiropractic are essentially worthless, while herbal medicine has limited value.
Chapter 1 starts with an overview of evidence-based medicine (EBM), of which the authors are staunch believers. EBM applies evidence gained via the scientific method and assesses the quality of the evidence relevant to the risks and benefits of the treatments. The foundation of EBM is the systematic review of evidence for particular treatments via mainly randomized controlled trials. In the chapter, the authors reiterate the concept that the plural of anecdote is not data. Acupuncture, homeopathy, chiropractic have plenty of first-person anecdotes, but a lack of controlled studies with real data to back up their spurious claims.
EBM shows that homeopathy and other bogus cures are of no value, yet the public is oblivious to those facts. In a piece I wrote on this topic, New York News Radio" The voice of bad science, its shows that cheap radio advertising (with its mishmash of pseudo-scientific claims) combined with a public that is ignorant of basic scientific facts, creates a perfect storm for the continuation of homeopathy and other bogus cures.
A recurring theme the book stresses is that acupuncture, homeopathy, chiropractic and other alternative therapies are scientifically impossible, and often will violate fundamental scientific principles. A perfect example of this implausibility is with homeopathy. Contrary to what common sense and basic science, in homeopathy, a solution that is more diluted is considered stronger and as having a higher potency. The issue is that the end result is a product that is so diluted, that its contents when in solid form is pure sugar, and when in liquid form; 100% H20. When a homeopathic liquid is in its most diluted state, there is not a single molecule of the active ingredient. Therein lays the scientific implausibility of homeopathy.
Chapter 1 also asks one of the books fundamental questions: how do you determine the truth? The authors answer that it is via the scientific method. This is determined only after strict and careful analysis of a clinical study, of which the most effective is double-blind and randomized.
In chapter 3, the book jokingly notes that since homeopathic liquid remedies are so diluted that they contain only water; their only use would be for dehydration. And since homeopathy is based on the fact that the strength of a remedy is based on its dilution, one could conceivably overdose on a homeopathic remedy by forgetting to take a dose.
The chapter concludes with perhaps the strongest indictment against homeopathy; namely its content. If one looks at the content of oscillococcinum, a homeopathic alternative marketed to relieve influenza-like symptoms, the packaging states that each gram of medication contains 0.85 grams of sucrose and 0.15 grams of lactose. Sucrose and lactose are simply forms of sugar, of which oscillococcinum is nothing more than am expensive sugar pill.
In chapter 4, the authors write that while homeopathy is nothing more than a placebo, the added danger with it is that patients will often forgo real medications to take a homeopathic one. It reports of a study in Britain, which demonstrated that the most benign alternative medicine can become dangerous if the therapist who administers it advises a patient not to follow an effective conventional medical treatment. The study demonstrated that alternative medical practitioners often recommend homeopathic remedies for malaria, and ignore proven conventional medicines. Such an approach can often mean a death sentence for the person taking the homeopathic remedy.
Chapter 5 deals with herbal medicine. The chapter is somewhat different in that the previous chapters about acupuncture, homeopathy and chiropractic showed them to be useless, herbal medicine does have value. The book notes that herbal medicine has been embraced by science to a far greater extent than acupuncture, homeopathy and chiropractics. The chapter lists over 30 herbal medicines and their levels of efficacy. An irony of herbal medicine is that some exotic ones, such as those with tiger bone or rhino horn are pushing the species to the brink of extinction, due to their level of popularity in certain parts of the world.
Chapter 5 concludes with on why smart people believe such odd things? Alternative medicine has failed to deliver the health benefits that it claims, so why are millions of patients wasting their money and risking their lives by turning towards a snake-oil industry? The authors provide numerous reasons for this, from the concepts such as natural, traditional and holistic, to attacks on the scientific method by the alternative medical community and more.
The appendix is a rapid guide to alternative therapies and lists over 30 new treatments with their benefits and potential dangers. The appendix gives single page summaries of the plethora other alternative therapies, from ear candles, colonic irrigation, reiki, to leech therapy and more. The authors write that most of these are bogus, many violate fundamental laws of sciences, and but a few have real, but limited value.
Alternative medicine operates in the shadows, blithely touting that their products have not been evaluated by the Food and Drug Administration, and that they are not intended to diagnose, treat, cure or prevent any disease. While these products are not intended to diagnose, treat, cure or prevent any disease; consumers nonetheless spends billions of dollars per year on unproven supplements. Consumers can be quite fickle. On one side they are furious at the SEC for their lack of oversight around Madoff Investments Securities. Yet when the FDA requires products use their disclaimer of how ineffective the item is, consumers will throw billions of dollars on ineffective products.
Trick or Treatment: The Undeniable Facts about Alternative Medicine is an incredibly important and eye-opening book. While Singh is a physicist and Ernst a medical doctor, the book is written in a clear and compelling style, avoids technical jargon, and sticks to the facts. In the spirit of the scientific method, the authors scrutinize alternative and complementary cures and the results show that the snake oil is still selling.
Ben Rothke is the author of Computer Security: 20 Things Every Employee Should Know.
You can purchase Trick or Treatment: The Undeniable Facts about Alternative Medicine from amazon.com. Slashdot welcomes readers' book reviews — to see your own review here, read the book review guidelines, then visit the submission page.
Minor correction (Score:5, Informative)
"the plural of data is not anecdote"
should be
"the plural of anecdote is not data"
you can thank Patron Saint Orrin Hatch for this (Score:5, Informative)
it was our good ol' boy Hatch who called in chits to get a law passed that puts the not-medicine hawkers beyond the reach of scientific proof and tests for safety and efficacy of their nostrums.
The author is wrong about accupuncture (Score:5, Informative)
And likely many of his other claims as well. Here's what PubMed says:
http://www.ncbi.nlm.nih.gov/pubmed/17568299?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum [nih.gov]
"Accupuncture may be an efficacious and acceptable nonexposure treatment option for PTSD. Larger trials with additional controls and methods are warranted to replicate and extend these findings."
http://www.ncbi.nlm.nih.gov/pubmed/6289567?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum [nih.gov]
"A brief characterisation is maccccde of the working principles underlying neural therapy under local anaesthesia or accupuncture. Common approaches to therapy are offered by disorders of autonomous regulation, including inflammatory processes, and by purely functional disorders.--There are many applications in gynaecology and obstetrics. A brief statistical information on lumbosacral pain is quoted as an example. Optimum performance can be expected from them, when used in combination with proven therapeutic methods. They provide a low-cost approach to reducing both the consumption of antibiotics and other pharmaceuticals as well as time of morbidity."
There are many others outside of PubMed. And that is but one of the author's claims that actual published studies in the medical literature refute. This side-swipe skepticism is not science, it is marketing in order to sell a bullshit book. Ignore idiots like him and read peer reviewed journals and abstracts before basing your own judgment.
Chiropractic treatment worked for me (Score:4, Informative)
I had a serious fall when skiing in february. A muscle in my back was so sore that I could not tie my own shoelaces or sit down without severe pain.
After having consulted three different medical doctors who all told me to just go home and lie down and just wait for the pain to go away I consulted a chiropractic. He was able to make some of the pain disappear immediately.
So I have to say that for me at least it worked. YMMV.
Grammar Nazi (Score:2, Informative)
From someone who's a published author, I expect better grammar in a book review.
The aphorism is mis-stated (it's "the plural of anecdote is not data"), and directly contradicts the next sentence. I actually read it over several times because I thought it might be deliberately reversed to make a point. Nope, it's just wrong.
Either the third word, "what", shouldn't be there, or there's some missing word(s) after "basic science", such as "assert" or "claim" or "would say".
Either "on" is not supposed to be there, or should be something like "the question of".
Overall, it reads like a high school student's book review. Get a proofreader.
although I agree (Score:5, Informative)
A lot of standard medicine doesn't really pass the test of evidence-based medicine either, in the sense that specific advocated treatments have been validated experimentally when applied to specific, observable conditions. That's one reason EBM is still relatively controversial: many standard surgical and medical practices are based on rational inferences from facts we're pretty sure of, but have never themselves been validated.
To take a really simple example, look at how dermatologists treat moles. There isn't very good experimental data on mole prognosis. An EBM approach would say something like: given specific observed features of this mole, data tells us it has an x% chance of turning into a melanoma within Y years. You would probably need computer models to aggregate the various features that could contribute to or against it being at risk. Dermatologists don't generally have this information at hand (if it exists at all), but instead make more subjective judgment calls, based on some high-level knowledge of risk factors (which may or may not have ever been validated experimentally themselves).
oscillococcinum (Score:3, Informative)
Um, it does contain both .85 grams of sucrose and .15 grams of lactose, but those are only the "inactive" ingredients. The supposedly active ingredients are "200CK Anas barbariae hepatis," or heart and liver of the Muscovy duck. Whatever that is. I'm not saying I think it works (though they do have clinical data showing some benefit over placebo), but that the reviewer is wrong that it's ONLY a sugar pill.
I should add that it is improving (Score:3, Informative)
Especially in areas where there's some specific push to use evidence-based medicine, its adoption is increasing and leading slowly to changes in clinical practice, as long-established assumptions have turned out not to be supportable by evidence.
One of the more notable examples is the significant decrease in use of antibiotics for many bacterial maladies, which has been driven by an initiative to experimentally validate allegedly positive uses of antibiotics, and stop prescribing them if evidence of positive effect can't be found.
It used to be assumed that, because broad-spectrum antibiotics kill bacteria, they are therefore useful to prescribe for maladies caused by bacteria. However in many cases they turn out to have little effect at all; for example, controlled studies of antibiotic prescription for ear infections have generally shown no improvement in recovery speed or likelihood with antibiotics as compared to without. Therefore the previous, non-evidence-based standard medical practice ("you should prescribe antibiotics for ear infections") has turned out not to be experimentally supportable.
Re:It isn't all a trick (Score:4, Informative)
The military also invested millions in remote viewing.
Re:oscillococcinum (Score:3, Informative)
Except that there is none of this ingredient physically present in the medicine. At some point (supposedly), some small quantity of this ingredient was mixed with greater and greater and greater quantities of inactive dilutants until you'd be lucky to find a single molecule of it in a swimming pool full of the stuff.
That's how homeopathy is supposed to work. By the memory of the water or whatever was in contact with the "active" ingredient.
Re:It isn't all a trick (Score:2, Informative)
Re:We already knew this (Score:4, Informative)
I'd be much more interested in some of the evidence-based medicine exposes of mainstream medicine.
Then you might be interested in reading the article The Wholesale Sedation of America's Youth [csicop.org] in the Nov/Dec '08 issue of Skeptical Inquirer [csicop.org].
Re:The author is wrong about accupuncture (Score:3, Informative)
But the main point about researching any medical articles is that picking out limited data points is a terrible, terrible way to draw conclusions. Holding up a couple of papers as proof is a rather dubious method of calling "bullshit" on a position. Appraoching things that way, we have to assume that MMR undoubtably causes autism, for example, since there are published articles which express support of this claim. Cherry-picking abstracts does no good, particularly without a critcal eye - the obvious observation on the first article is that it lacks a placebo control, which is a common criticism of many accupunture trials, I believe.
A more comprehensive examination of this field (and indeed, most medical fields) typically shows there is actually disagreement in the field with published articles supporting both positions, and it must be evaluated as a whole to determine the validity of a given statement. Perhaps the author has actually performed such an experiment and reached this sort of conclusion? That's the sort of thing which needs to be investigated before dismissing the work out of hand.
Baby and the Bathwater (Score:2, Informative)
Two examples: my mother was told by the doctors that her thyroid deficiency was untreatable and that she would need supplements for the rest of her life. A local alternative medicine doctor claimed otherwise, he explained that back in the 60's chickens were fed with chemicals that were not safe for humans. Humans ate these chickens and that was what had caused her thyroid to start malfunctioning. He treated her, and she hasn't needed the supplements for several years now.
More recently, I have had serious eye/head pain. The eye doctors didn't know what it was. Out of a whim I visited a chiropractor, and a day later I was totally fine. And that was after living off of pain killers for an entire week.
So yes, this stuff works. Nothing is a cure all, and there's just as much snake oil as there ever was. But I have been cured more times by alternative medicine than I ever have been by doctors.
Re:oscillococcinum (Score:5, Informative)
The key point you've glossed over is the measurement "200CK". How much is 200CK? It means that the substance has undergone 200 100-to-1 dilutions. That means that the concentration has been reduced from full strength by a factor of 100^200. Yes, that's right---10^400. According to this article [wikipedia.org] in Wikipedia, the number of observable atoms in the observable universe is approximately 10^80. Clearly, you will be the luckiest person alive, 10^40 or so times over, if even one atom of the active ingredient is left in your sugar pill.
Re:The author is wrong about accupuncture (Score:2, Informative)
I don't have to do a study, they have been done several times. And they have been published in peer reviewed journals. I am not just making a claim.
They showed clearly that it doesn't matter were you put the needle, as long as the patient thinks you are putting it in a special accupuncture place it works.
If you followed your own advice you would already know that.
Re:Herbal medicine has limited value (Score:5, Informative)
Cognitive behavior therapy and gradual exposure to social situations actually helps much more. Finding an environment you can trust, especially a group environment, goes a long way.
I think a lot of psychological "disorders" are BS... but as someone who is 31, stays at home all the time (including blowing off what few friends I do have), refuses to go to stores and whatnot during hours typical people do, still gets so anxious that I shake when talking to an interesting woman, and can't even call up a utility company to make changes to my account because I'm afraid of the rejection that I'm "certain" to face, yeah... all encompassing anxiety is a real issue and I can trace it's development and growing prevalence in my life going back to when I was 7. I spent almost two years in a constant state of suicidal depression and if you think alcohol is going to make that better, you're very mistaken. I refuse to take pills for it because they just seem to delay dealing with the problems rather than actually solve them.
Anyways, I realize you were trying to be glib... but for people with real underlying problems, alcohol isn't the answer. For someone fairly normal with just a bit of stage fright, sure, but not for the person that can't deal with life as it is.
Re:Acupuncure? (Score:2, Informative)
Re:Exploitations? (Score:3, Informative)
Maybe that's the case in a profit-oriented system like in the USA. Other countries have evil socialist healthcare systems that mean that doctors have no incentive whatsoever to prescribe the most expensive treatment or to prolong your treatment unnecessarily, so they concentrate on doing their job properly instead.
Re:Painting with a very broad brush (Score:3, Informative)
Re:you can thank Patron Saint Orrin Hatch for this (Score:4, Informative)
It's called the Dietary Supplement Health and Education Act of 1994, or DSHEA. You can search for that on Google or Wikipedia. It's harder to find info linking Hatch to the law, but if you search for DSHEA and Hatch together, you'll find it.
Heavy lobbying by Congress and the makers of these drugs caused Clinton to sign the bill into law.
Re:you can thank Patron Saint Orrin Hatch for this (Score:4, Informative)
This is a bit of cynicism speaking, but also decades of career in the pharmaceutical industry.
Even if tongue of newt cured the flu, tongue of newt isn't easily patentable, being that there's millennia of prior art by newts in creating it. So there's not as much of a motive for an FDA-regulated company to go through the testing and approval process (which costs, when all the accounting is done, on the order of magnitude of a billion dollars for each novel molecule that actually becomes a commercially available product; it costs a LOT more money than you probably think to get 100 people and run a controlled study,... which in reality involves usually thousands of animals, several phases of toxicology testing, piloting production processes, and many et ceteras before those human trials even get approved,...).
Of course, if you call it a "dietary supplement" and are cagey about what claims you make for it, you aren't subject to FDA requirements for testing for purity, safety, identity or quality, let alone effectiveness and controlling for dosage, and it is many orders of magnitude cheaper to bring it to market with those considerations out of the way.
One could be much sloppier, in terms of real-world meaning, than equating "medicine vs. alternative medicine" to FDA-approved vs not FDA-approved, provided you get the implications of that FDA approval process.
it's not so much that there are blind spots (Score:3, Informative)
It's that the entire premise this book's authors are coming from---that standard medicine is about evidence-based medicine---is not really universally accepted in standard medicine. Its acceptance is growing, but EBM as an explicit aim was only introduced in the early 1990s, and was initially seen as basically a crusade by a bunch of ivory-tower lab scientists who didn't understand the subjective complexity of real-world clinical practice. It's only from the late 1990s or so seen increasing acceptance in affecting clinical practice.
So to some extent, saying "homeopathy is wrong because it doesn't follow EBM principles" is a bit off target, because it's not the primary thing that distinguishes standard from alternative medicine.
Re:Herbal medicine has limited value (Score:1, Informative)
Alcohol will take away the social awkwardness for otherwise normal people. It becomes a trap that can easily turn into a dependency and full blown addiction for someone who has bigger problems than a little shyness. It's rather irresponsible to encourage such people to self-medicate (which is what alcohol is to them).
If you get a splinter in the tip of your finger, it's fine for you to pull it out with a pair of tweezers or nail clippers. If you get a puncture wound through your lung, you need to see a real doctor. While the vast majority of people will just get a splinter, it's dangerous to tell the puncture victim to take care of himself using the same methods just because it works for everyone else.
Re:We already knew this (Score:3, Informative)
Re:The author is wrong about accupuncture (Score:3, Informative)
Some of the things chiropractors do help, but those things are also done by western trained physical therapists. Chiropracty is unfortunately encumbered with a pseudoscientific theory of 'subluxations'. They use this theory to justify chiropracty for anything from a bad back to allergies. Next time you meet a chiropractor, ask him what exactly a subluxation is and how they measure them.
While a chiropractor may be effective for your bad back, I'd rather get the same treatment from someone who actually knows why the treatment works.
Re:We already knew this (Score:3, Informative)
Tryptophan is no longer illegal in the US. You can order it online from many US-based companies. I've got some in my cupboard right now.
Re:Minor correction (Score:4, Informative)
"the plural of anecdote is not data"
Then what are the results of a survey? You understand that the scientific method allows for using surveys as data, correct?
This actually illustrates the point nicely. Surveys are NOT just a collection of anecdotes. Since each person who fills out the survey has to answer the same questions, you get (roughly) the same information from each person. In a collection of anecdotes, who knows what each person is choosing to include in his/her story and what the person is leaving out. By putting a carefully selected structure onto the information collection, you are making a "collection of anecdotes" into useful data that can be used for scientific reasoning.
Re:Herbal medicine has limited value (Score:2, Informative)
This is actually a well-documented phenomenon.
I believe the theory that seeks to explain it is that, especially during the early stages of treatment, and especially for younger patients, when they start taking the medication they literally become more motivated to do something about their situation and kill themselves.
Re:Herbal medicine has limited value (Score:3, Informative)
Repeat after me: The plural of anecdote is NOT data.
I love quacks (Score:5, Informative)
This will be fun. I love quackery!
If proof == "medicine" and no proof == "alternative treatment", then why is massage [miami.edu] or acupressure [google.com] or dietary changes [webmd.com] considered alternative treatment?
How about 2+2 = chocolate milk? That's a redefinition which makes about as much sense as yours. Alternative [wikipedia.org] mean an option. You might have several alternatives that are effective treatments though one might be preferred. Alternative has nothing to do with proof or the lack thereof. You can try treatments that are not proven to work. Happens all the time and that is how medicine advances. The first time we tried penicillin there was no certainty that it would work. But the doctors did have a credible theory as to why it might work. Most drugs we try are abject failures.
Now you are using "alternative treatment" in a different sense meaning something different than the standard of care [wikipedia.org]. Massage has its uses but it doesn't cure brain cancer. Dietary changes are helpful for many things but won't set a broken bone. Suggesting that they will is quackery and anyone who promotes them as cures for problems they clearly cannot help is a criminal who should be in jail.
I do shiatsu acupressure, and I can cite studies on its effectiveness
How about citing some double blind studies from actually reputable journals ("Journal of Alternative and Complementary Medicine"? You HAVE to be kidding me) or even some studies that I can't shoot holes in by reading the abstracts?
And why is surgery considered "medicine"?
Because it works and actually cures people of serious problems would be my guess. Call me crazy but I'm pretty sure some smart folks might have looked into this.
Every placebo controlled study of a surgical technique has found it no better than a placebo operation.
That might just be the most ludicrous thing I've ever read on Slashdot. And that is really saying something. Apparently you'll believe anything you read no matter the source unless that source has a hint of being credible.
Re:Chiropractic treatment worked for me (Score:3, Informative)
Right, one of them is much more likely to kill you on the spot [quackwatch.org].
Wait, were you suggesting the muscle relaxants were the more dangerous approach? That's not right at all.
Re:Herbal medicine has limited value (Score:3, Informative)
But the concept that if something is toxic in large doses that a small dose might have medicinal effects is not crazy at all.
The author of TFR (in addition to apparently having run out of apostrophes) forgot to mention the other lynchpin that marks homeopathy as a fraud.
It's not just the dilution aspect. It's that the substances are chosen based on their ability to cause similar symptoms to what they're supposed to treat. Because the less you use of the substance, the less it causes those symptoms. Therefore, the "reasoning" goes, the less of it you use, the more it will remove those symptoms when they already exist due to a different cause.
Re:Herbal medicine has limited value (Score:2, Informative)
No. It wasn't folk wisdom. It was the observation that sailors on ships who ate citrus fruit didn't get scurvy, and those who didn't eat citrus fruit did get scurvy.
Re:Herbal medicine has limited value (Score:3, Informative)
Except that observation was only made in hindsight, and long before then it was conventional wisdom that scurvy was caused by a lack of acid in the diet, where -any- acid including vinegar and sulphuric acid would do. That's why Lind included all of these things in his trial.
Re:Chiropractic treatment worked for me (Score:3, Informative)
Sure. Massage and stretching is great for muscle pain.
BUT, I very much doubt that misalignment of your spine interfered with your "innate intelligence" and caused your body to not be able to heal itself. I'd also suggest you not seek chiropractic treatment for, say, food poisoning.
Chiropracters are fairly harmless so long as you treat them like massage therapists and don't let them touch your neck. That's very different from them being right, however.
Western modern model for Accupuncture (Score:3, Informative)
There's a well known model in modern Medicine called "Gate Control [wikipedia.org]", which could be employed to explain why at least Acupuncture might work in some specific circumstances.
In short, the perception of pain is an information which results from the processing of 2 different and competing information :
- actual noci-ceptors (pain detection pathways)
- and other receptors (other body senses)
The whole system has evolved in a way where pain is useful for giving a general alert, but non-pain perception may over-ride it, because a precise information about the environment is much more useful to evade the source of pain.
In every day situation that's why we tend to rub body parts when hurt : the sensory information (rub) over-rides the pain information through the gate-control mechanism.
TENS (transcutaneous electric nerve stimulation) is also well documented and recognized to be able to shut down pain and help some patients with chronic pains (whereas the usage about burning calories as advertised sometimes on TV is contested)
The possible scientific explanation for Acupuncture is that this is simply more of the same, but with a fancy name, weird tools and a whole mysticism wrapped around it.
(To draw a parallel to humoral medicine : picking up "blood" humor for someone who is easily aroused isn't completely wrong - being angry release a couple of hormones [like adrenaline] some of which alter and increase blood flow [adrenaline make the heart pump more]. So indeed blood and angry are associated, except that medieval humoral medicine got the whole model completely wrong)