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The Era of Echinacea
Not long ago, for reasons I still don’t understand, I began to feel unfocused and lethargic. Work was no more stressful than it had ever been, and neither was the rest of my life. The bulk of my savings had been sucked into the vortex of the newly recognized black hole called the economy. But whose had not? I try to eat properly, exercise regularly, sleep peacefully, and generally adhere to the standard conventions of fitness. It didn’t seem to be working. My doctor found nothing wrong and my blood tests were fine. Still, I felt strange, as if I were lacking in energy—or in something. So I did what millions of Americans do every day. I sought salvation in vitamins.
First, though, I had to figure out what variety of salvation to seek. There are many thousands of pills, potions, powders, gels, elixirs, and other packaged promises of improved vitality for sale within just a few blocks of my home. I walked to the closest store, a place called The Health Nuts, and told the proprietor I was feeling sluggish. He nodded gravely and took me straight to the amino acid section. To counteract my deficit of energy, he recommended a supplement of glutamine, which is one of the few amino acids that passes the blood-brain barrier. When people are under stress—physical or psychological—they begin to draw down on their stores of glutamine. “This stuff repairs brain cells and it’s good for depression, too,” he told me. A leaflet attached to the bottle described the amino acid as a magical aid for mental acuity. (“It is helpful with focus, concentration, memory, intellectual performance, alertness, attentiveness, improving mood, and eliminating brain fog & cloudiness”). I dropped it into my basket.
The store also had a garlic section—not actual garlic, but various pills with names like Kyolic and Garlicin, GarliMax and Gar lique, all of which claimed to possess the healing properties of garlic, which for centuries has been thought to help ward off the common cold, clear up respiratory infections, and soothe sore throats. Garlic, its advocates claim, is also effective in treating heart problems, lowering cholesterol, and keeping arteries free of blood clots. I grabbed a bottle and moved on to the main supplement section, where multivitamins in every conceivable size, shape, dosage, strength, and formulation were lined up in rows. (There were vitamins for vegans, and for people allergic to gluten, for those who don’t need iron and those who do; and there were specific pills for every age group, from the fetus right through to the “well derly.”) Antioxidants were next to them, all seemingly fueled by the “natural” power of prickly pear, goji, and açaí, the intensely popular Brazilian berry that supposedly offers benefits such as rejuvenation, skin toning, and weight loss, not to mention prevention of various illnesses like heart disease. There was also something called “BlueGranate,” a combination of blueberries and pomegranates, both of which “possess wondrous health properties,” as the bottle put it. “A synergistic blend of powerful and potent phy tonutrient antioxidants.” Into the basket it went.
Almost everything advertised itself as an antioxidant. Oxidation is a natural result of metabolic processes that can cause harmful chain reactions and significant cellular damage. Those broken cells in turn release unstable molecules called free radicals, which are thought to be the cause of many chronic diseases. Set loose, free radicals can turn into scavengers, ransacking essential proteins and DNA by grabbing their electrons for spare parts. Antioxidants prevent those reactions, but standing there, it was impossible to know how, or if, they worked. The collection of pills was so enormous, the choice so vast, and the information so humbling that while I may not have been depressed when I arrived at The Health Nuts, spending half an hour there did the trick.
I went home and consulted the Internet, which was even more intimidating: there are millions of pages devoted to vitamins and dietary supplements. You could spend your life combing through them and then another life trying them all out. Fortunately, my eye was drawn immediately to the Vitamin Advisor, a free recommendation service created by Dr. Andrew Weil, the ubiquitous healer, whose domed head and bearded countenance are so profoundly soothing that with a mere glance at his picture I felt my blood pressure begin to drop.
Dr. Weil is America’s most famous and influential practitioner of complementary medicine—he prefers to call it integrative—which seeks to combine the best elements of conventional treatment with the increasingly popular armamentarium of alternatives, everything from supplements to colonic irrigation, spiritual healing, and homeopathy.
The public’s hunger for novel remedies (and alternatives to expensive drugs) has transformed the integrative approach into one of the more potent commercial and social forces in American society. Nearly every major medical school and hospital in the country now has a department of integrative or complementary medicine. (A few years ago the Harvard Medical School even tussled with its affiliate, the Dana Farber Cancer Institute, over which would win the right to house such a program. Harvard prevailed.) While the movement has grown immensely since he opened his Center for Integrative Medicine in Arizona in 1994, Weil remains at its heart. Educated at Harvard University, both as an undergraduate and at its medical school, Weil embraces herbal therapies, New Age mysticism, and “spontaneous healing,” which is the title of one of his books. But he also understands science and at times even seems to approve of it.
Weil offers sound advice in his many books—calling refined foods, excess starches, corn sweeteners, and trans fats dangerous, for example, and noting that exercise and a proper diet are far more beneficial even than the vitamins and supplements he recommends. His influence is immense, and in a country embarking on an urgent debate about how to make its health care system more affordable, rational, and responsive, that influence has never been felt more powerfully. Weil is in great demand as a public speaker, testifies before Congress, and has twice appeared on the cover of Time magazine. For advocating the many health benefits of mushrooms, Weil is a hero to mycologists the world over. (He is one of the rare Americans to have had a mushroom named after him, Psilocybe weilii.)
Andrew Weil seemed like just the man to lead me out of the forest of nutritional darkness into which I had inadvertently wandered. His Vitamin Advisor Web site assured me that, after answering a few brief questions, I would receive “a personalized comprehensive list of supplements based on my lifestyle, diet, medications, and health concerns”—all at no cost, without obligation, and prepared specially to meet my “unique nutritional needs.” In addition, if I so chose, I could order the “premium quality, evidence-based” supplements in the proper doses that would “exactly match the recommendations from Dr. Weil.” The supplements would be “custom packed in a convenient dispenser box and shipped directly to [me] each month.” The only thing Dr. Weil doesn’t do for you is swallow the pills.
I filled out the form, answering questions about my health and providing a brief medical history of my family. Two minutes after I pressed “submit,” Dr. Weil responded, recommending a large number of dietary supplements to address my “specific health concerns.” In all, the Vitamin Advisor recommended a daily roster of twelve pills, including an antioxidant and multivitamin, each of which is “recommended automatically for everyone as the basic foundation for insurance against nutritional gaps in the diet.” Since, as he points out on the Web site, finding the proper doses can be a “challenge,” Dr. Weil offered to “take out the guesswork” by calculating the size of every pack, which, over the previous ninety seconds, had been customized just for me. That would take care of one challenge; another would be coming up with the $1,836 a year (plus shipping and tax) my new plan would cost. Still, what is worth more than our health? If that was how much it would cost to improve mine, then that was how much I was willing to spend.
Also on my list: milk thistle, “for those who drink regularly or have frequent chemical exposure,” neither of which applies to me; ashwagandha, an herb used in ayurvedic medicine to help the body deal with stress and used traditionally as an energy enhancer; cordyceps, a Chinese fungus that for centuries has
been “well known” to increase aerobic capacity and alleviate fatigue; and eleuthero, also known as Siberian ginseng, often employed to treat “lethargy, fatigue and low stamina.” In addition, there was 1000 milligrams of vitamin C (high doses of which, the information said, may provide additional protection against the oxidative stress of air pollution and acute or chronic illness); saw palmetto complex, mixed with stinging nettle root to “support prostate health”; an omega-3 pill (which may help reduce the symptoms of a variety of disorders); Saint-John’s-wort (to support healthy mood); folic acid (which in addition to offering pregnant women proven protection against neural tube defects, may have a role to play in heart health, and may also help protect against cancers of the lung and colon, and even may slow the memory decline associated with aging); and finally another ayurvedic herb, triphala (a mixture of three fruits that help tone the muscles in the digestive tract).
Dr. Weil, who argues that we need to reject the prevailing impersonal approach to medicine, reached out from cyberspace to recommend each of these pills wholeheartedly and specifically, just for me. Before sending off a check, however, I collected some of the information on nutrition and dietary health offered by the National Institutes of Health, the Harvard School of Public Health, and the Memorial Sloan-Kettering Cancer Center. It turned out that my pills fell essentially into three categories: some, like cordyceps and triphala, seemed to do no harm but have never been shown in any major, placebo-controlled study to do any particular good; others, like Saint-John’s-wort, may possibly do some good in some cases for some people, but can also easily interfere with and negate the effects of a large number of prescribed medicines, particularly the protease inhibitors taken by many people with AIDS. Most of the pills, however, including the multivitamin and antioxidant, seemed just plain dangerous.
Despite Dr. Weil’s electronic assurances that his selections were “evidence-based,” not one of those twelve supplements could be seen to hold anything more than theoretical value for me. At best. One study, completed in 2008, of the omega-3 fatty acids so beneficial when eaten in fish, found that in pill form they had no discernible impact on levels of cholesterol or any other blood lipids. The study was not large enough to be definitive; other trials are needed (and already under way). But it would be hard to argue with Jeffrey L. Saver, vice chairman of the American Heart Association’s Stroke Council, professor of neurology at UCLA, and the director of its department of Stroke and Vascular Neurology, who called the findings “disappointing.”
Others agreed. “You know, most of that stuff just comes right out at the other end,” former surgeon general C. Everett Koop told me. The ninety-four-year-old Koop is congenitally incapable of ignoring facts or pretending they shouldn’t matter. “Selling snake oil has always been one of America’s greatest con games. But the more we know about our bodies, the more people seem to buy these pills. That part I never did understand; you would have hoped it would be the other way around. But every day it becomes clearer: we need to eat properly and get exercise. And every day more people seem to ignore the truth.”
New data keeps streaming in, and almost all of it confirms that assessment. In 2009, researchers from the Women’s Health Initiative, working at dozens of major medical centers under the direction of the National Heart, Lung, and Blood Institute, concluded a fifteen-year study that focused on strategies for preventing heart disease, various cancers, and bone fractures in postmenopausal women. After following 161,808 women for eight years, the team found no evidence of any benefit from multivitamin use in any of ten conditions they examined. There were no differences in the rate of breast or colon cancer, heart attack, stroke, or blood clots. Most important, perhaps, vitamins did nothing to lower the death rate.
Another recent study, this time involving eleven thousand people, produced similar results. In 2008, yet another major trial, of men, had shown that the risk for developing advanced prostate cancer, and of dying from it, was in some cases actually twice as high for people who took a daily multivitamin as it was for those who never took them at all. There are hundreds of studies to demonstrate that people who exercise regularly reduce their risk of coronary artery disease by about 40 percent, as well as their risk of stroke, hypertension, and diabetes, also by significant amounts. Studies of vitamin supplements, however, have never produced any similar outcome.
Antioxidants, often described in the press as possessing wondrous powers, and recommended to every American by Dr. Weil, among others, are taken each day by millions. That should stop as soon as possible. While a diet rich in antioxidants has been associated with lower rates of chronic disease, those associations have never been reflected in trials in which people took antioxidants in supplement form. In 2007, for example, the Journal of the American Medical Association published the results of the most exhaustive review yet of research on such supplements. After examining sixty-eight trials that had been conducted during the previous seventeen years, researchers found that the 180,000 participants received no benefits whatsoever. In fact, vitamin A and vitamin E, each immensely popular, actually increased the likelihood of death by 5 percent. Vitamin C and selenium had no significant effect on mortality. (Vitamin C has long been controversial. Linus Pauling, the twentieth century’s greatest chemist, was convinced it would cure cancer. He was wrong. In fact, too much vitamin C actually seems to help cancer cells withstand some kinds of treatment.)
“The harmful effects of antioxidant supplements are not confined to vitamin A,” said the review’s coauthor, Christian Gluud, a Danish specialist in gastroenterology and internal medicine and head of the trial unit at the Centre for Clinical Intervention Research at Copenhagen University Hospital. “Our analyses also demonstrate rather convincingly that beta-carotene and vitamin E lead to increased mortality compared to placebo.” More than a quarter of all Americans over the age of fifty-five take vitamin E as a dietary supplement, yet among healthy people in the United States it would be hard to cite a single reported case of vitamin E deficiency.
It gets worse: folic acid supplements, while of unquestioned value for pregnant women, have been shown to increase the likelihood that men would develop prostate cancer. “Unfortunately, the more you look at the science the more clearly it tells you to walk away,” Kelly Brownell said. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, has for years studied the impact of nutrition on human health. “Vitamins in food are essential. And that’s the way to get them. In food.” With a couple of exceptions like folic acid for pregnant women, and in some cases vitamin D, for the vast majority of Americans dietary supplements are a complete waste of money. Often, in fact, they are worse.
That brings us back to Dr. Weil, who understands the arguments against using vitamin supplements in a country where, with rare exceptions, people have no vitamin deficiencies. He actually makes them pretty well in his book Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being. “ Not only is there insufficient evidence that taking [antioxidants] will do you any good, some experts think they might be harmful,” he wrote. Excellent analysis, pithy and true. In fact, the evidence of harm keeps growing. In May 2009, researchers from Germany and the United States reported in the Proceedings of the National Academy of Sciences that antioxidants like vitamins C and E actually reduce the benefits of exercise. “If you promote health, you shouldn’t take large amounts of antioxidants,” said Michael Ristow, a nutritionist at the University of Jena, who led the international team of scientists. “Antioxidants in general . . . inhibit otherwise positive effects of exercise, dieting and other interventions.” Despite news like that, Dr. Weil still thinks you need to take his (“I continue to take a daily antioxidant formula and recommend it to others as well”).
Weil doesn’t buy into the idea that clinical evidence is more valuable than intuition. Like most practitioners of alternative medicine, he regards the scientific preoccupation with controlled studies, verifiable proof, and comparative analysis as p
etty and one-dimensional. The idea that accruing data is simply one way to think about science has become a governing tenet of the alternative belief system. The case against mainstream medicine is simple, repeated often, and, like most exaggerations, at least partially true: scientists are little more than data collectors in lab coats, people wholly lacking in human qualities. Doctors focus on disease and tissues and parts of the anatomy that seem to have failed, yet they act as if they were repairing air conditioners or replacing carburetors rather than attending to the complex needs of an individual human being. And pharmaceutical companies? They serve no interest but their own. Complementary and alternative medicine, on the other hand, is holistic. It cares. In the world of CAM, evidence matters no more than compassion or belief. Weil spells it all out in Healthy Aging:To many, faith is simply unfounded belief, belief in the absence of evidence, and that is anathema to the scientific mind. There is a great movement toward “evidence-based medicine” today, an attempt to weed out ideas and practices not supported by the kind of evidence that doctors like best: results of randomized controlled trials. This way of thinking discounts the evidence of experience. I maintain that it is possible to look at the world scientifically and also to be aware of nonmaterial reality, and I consider it important for both doctors and patients to know how to assess spiritual health. (Italics added.)
Evidence of experience? He is referring to personal anecdotes, and allowing anecdotes to compete with, and often supplant, verifiable facts is evidence of its own kind—of the denialism at the core of nearly every alternative approach to medicine. After all, if people like Weil relied on the objective rules of science, or if their methods were known to work, there would be nothing alternative about them. If an approach to healing has a positive physical effect (other than as a placebo), then it leaves the alternative world of sentiment and enters the world of science and fact. The only attribute that alternatives share is that they do not meet the scientific standards of mainstream medicine.
Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives Page 14