Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives

by Michael Specter

  Data is not warm or kind. It is also, however, not cold or cruel. Assessing data and gathering facts are the only useful tools we have to judge whether a treatment succeeds or fails. Weil understands that, and yet he mixes perfectly sensible advice with lunacy. (“I would look elsewhere than conventional medicine for help if I contracted a severe viral disease like hepatitis or polio, or a metabolic disease like diabetes,” not to mention “treatment for cancer, except for a few varieties.”)

  That makes him a uniquely dangerous proponent of magical thinking. It is much easier to dismiss a complete kook—there are thousands to choose from—than a respected physician who, interspersed with disquisitions about life forces and energy fields, occasionally has something useful to say. Still, when Weil writes about a “great movement toward ‘evidence-based medicine’ ” as if that were regrettable or new, one is tempted to wonder what he is smoking. Except that we don’t need to wonder. He tells us.

  Weil believes in what he calls “stoned thinking” and in intuition as a source of knowledge. This he juxtaposes with “straight” or “ordinary” thinking. You know, the type weighed down by silly rules and conventional thought. Like every alternative healer, Weil believes in the supremacy of faith and compassion. I certainly wouldn’t argue against faith (if only because for many people it provides the single form of alternative medicine that seems clearly to work, a placebo effect). And here is my definition of compassion: the desire to alleviate suffering. Nothing in the course of human history meets that definition so fully as the achievements of evidence-based, scientifically verifiable medicine.

  The world of CAM is powered by theories that have almost never been tested successfully, and its proponents frequently cite that fact as proof of their unique value, as if they represent a movement that cannot be confined (or defined) by trivialities. It would be terrific if Weil were correct when he says that evidence-based medicine is now in vogue; given its astounding record of success, it certainly ought to be. There is at least one compelling reason that the scientific method has come to shape our notion of progress and of modern life. It works.

  But pendulums swing in more than one direction. As Steven Novella, director of general neurology at the Yale University School of Medicine, has written, the biggest victory won by proponents of complementary and alternative medicine was the name itself. “Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery,” he wrote on Neurologica, his blog, which is devoted heavily to critical thinking. “The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all—a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberately blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.”

  The integrity of our medical system is certainly subject to doubts and debate. Doctors can be smug and condescending, and they often focus on treating diseases rather than preventing them. But in the alternate universe of CAM treatment nobody has to prove what is safe, what works and what doesn’t. And that’s dangerous because Americans are desperate for doctors who can treat their overall health, not just specific illnesses. Perhaps that is why this particular universe, populated by millions of people, has been fueled by one of American history’s most unlikely coalitions—the marriage of the extreme right with the heirs of the countercultural left.

  The political right has never wavered in its support for dietary supplements, and Orrin Hatch, the Utah Republican, has long been the industry’s most powerful supporter. Hatch doesn’t share a lot of political space with Tom Harkin, the populist liberal from Iowa. They don’t agree on abortion rights, gun control, or many other issues. But when it comes to the right of every American to swallow any pill he or she can find in a health food store, the two are welded by a bond of steel. “For many people, this whole thing is about much more than taking their vitamins,” Loren D. Israelsen, an architect of the 1994 legislation that deregulated the supplement industry, said. “This is really a belief system, almost a religion. Americans believe they have the right to address their health problems in the way that seems most useful to them. Often, that means supplements. When the public senses that the government is trying to limit its access to this kind of thing, it always reacts with remarkable anger—people are even willing to shoulder a rifle over it. They are ready to believe anything if it brings them a little hope.”

  That kind of fervent belief, rather than facts, feeds disciplines like ayurvedic medicine, which argues for the presence of demonic possession in our daily life, and Reiki, the Japanese practice of laying on the hands, which is based on the notion that an unseen, life-giving source of energy flows through each of our bodies. Then there is iridology (whose practitioners believe they can divine a person’s health status by studying the patterns and colors of his iris), Healing—or Therapeutic—Touch, qi gong, magnet therapy. None of it works. Acupuncture, while effective in reducing arthritic pain and the impact of nausea, has never been demonstrated to help people quit smoking or lose weight—two of its most popular applications.

  Homeopathy, perhaps the best-known alternative therapy, is also the most clearly absurd, based as it is on the notion that “like cures like.” In other words, it presumes that a disease can be treated by ingesting infinitesimally small dilutions of the substance that caused the disease in the first place. No matter what the level of dilution, homeopaths claim, the original remedy leaves some kind of imprint on the water molecules. Thus, however diluted the solution becomes, it is still imbued with the properties of the remedy. No homeopathic treatment has ever been shown to work in a large, randomized, placebo-controlled clinical trial, but nothing seems to diminish its popularity. With logic that is both ridiculous and completely sensible, the federal government has taken a distant approach to regulating homeopathy precisely because it contains no substance that can possibly cause harm (or good). “Homeopathic products contain little or no active ingredients,” Edward Miracco, a consumer safety officer with the FDA’s Center for Drug Evaluation and Research explained. As a result, “from a toxicity, poison-control standpoint” there was no need to worry about the chemical composition of the active ingredient or its strength.

  On those rare occasions when data relating to alternative medicine does become available, it is almost invariably frightening: in 2004, for example, a large group of researchers reported in the Journal of the American Medical Association that more than 20 percent of the ayurvedic medicines the group purchased on the Internet contained detectable and dangerous levels of lead, mercury, and arsenic. Soon afterward, the FDA warned consumers to exercise caution when purchasing ayurvedic products.

  “Who is telling people that all this stuff is good?” asked Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. “Their peers. The scientists say either we don’t know or it doesn’t work. And their response is the same thing that they’re doing with the vaccine issue. They want to feel better, they want to live forever, they want not to age. So people start going around with all of these herbs that are not proven to work and that the scientists are skeptical about. Which all the more, I think, makes them want to go after it. There’s an element of, ‘I’ll show you, you son of a bitch. The people who I hang out with think this really works.’ And then you come out with a paper, like the one in the New England Journal of Medicine, that shows there is absolutely no benefit from echinacea. Bingo! They don’t care. They don’t care a bit.”

  The Obama administration’s laudable desire to bring medical costs under control and to make the health care system more accessible has presented leaders of the CAM community with a unique opportunity—and they have seized it. In February 2009, Weil and other famous supporters of natural healing, including Mehmet Oz, a cardiac surgeon and founder of the Comple
mentary Medicine Program at New York Presbyterian Hospital (and, most famously, Oprah Winfrey’s health guru); and Dean Ornish, of the Preventive Medicine Research Institute in Sausa lito, California, testified before the Senate Health, Education, Labor, and Pensions Committee and correctly pointed to disease prevention as the key to crafting the new health care legislation President Obama has committed himself to so completely. In their testimony, however, each did battle with a series of straw men, arguing that the American health care system costs too much (it does), is too reliant on technology (it is), and is geared to complicated and costly treatment rather than to prevention, which is cheaper and almost always more effective (also true). A month before the summit, the group published a piece in the Wall Street Journal in which they wrote, “Our ‘health-care system’ is primarily a disease-care system. Last year, $2.1 trillion was spent in the U.S. on medical care, or 16.5% of the gross national product. Of these trillions, 95 cents of every dollar was spent to treat disease after it had already occurred. At least 75% of these costs were spent on treating chronic diseases, such as heart disease and diabetes, that are preventable or even reversible.”

  None of that is really in dispute, but those fundamental flaws cannot possibly be overcome by a system that replaces facts with wishes. Prescribing diet and exercise to fight disease is not an alternative approach to medicine, as anyone who has visited a physician in the past five years would surely know. What America needs, and what the Obama administration has, for the first time, set out to do, is get a better sense of which treatments work and which don’t. That would, for instance, require placing caloric information on all fast-food menus and explaining what it means. And it will require clear economic judgments about whether many current procedures are in fact worth the cost. All that will require data, not voodoo.

  Nearly a decade ago, a Stanford University professor named Wallace I. Sampson warned that institutional support for alternative medicine endangers society. “Modern medicine’s integrity is being eroded by New Age mysticism, cult-like schemes, ideologies, and classical quackery,” he wrote in an influential essay called “The Alternate Universe,” arguing that they were all misrepresented as “alternative” medicine. “Using obscure language and misleading claims, their advocates promote changes that would propel medicine back five centuries or more. They would supplant objectivity and reason with myths, feelings, hunches, and sophistry.” At the time, Sampson’s claims seemed a bit over the top to me. We were in a golden era of medicine; life expectancy grew nearly every year, and so did our knowledge of how to treat many chronic diseases. It never occurred to me that science-based medicine might be considered an obstacle to a healthy life, rather than the best chance of having one.

  Those bottles of folic acid and BlueGranate from The Health Nuts were sitting on my desk. They looked so promising and appeared to offer so much: support for a healthy cardiovascular system, as well as better memory and brain function; they would promote urinary tract, eye, and skin health, boost body detoxification functions, and reduce cellular damage associated with the aging process. There was, however, a tiny asterisk next to each claim. “These statements have not been evaluated by the Food and Drug Administration,” each one said. “These products are not intended to treat, diagnose, cure or prevent any disease.” I looked at the Garlicyn, the amino acids, and the vitamin C. Same warnings. Same nearly invisible print.

  The fine print on labels like that is rarely read. In the world of dietary supplements, facts have always been optional. Pharmaceuticals are strictly regulated; for supplements there is almost no oversight at all. A pill may be sold as something that contains 1000 mg of vitamin C. But how can you be sure without meaningful standards? When facts are not required anything goes, and Andrew Weil, for one, wouldn’t have it any other way. “I believe in magic and mystery,” he wrote in Healthy Aging. “I am also committed to scientific method and knowledge based on evidence. How can this be? I have told you that I operate from a both-and mentality, not an either-or one.”

  Sorry, but that’s not possible. Either you believe evidence that can be tested, verified, and repeated will lead to a better understanding of reality or you don’t. There is nothing in between but the abyss. The FDA knows that, and so does the supplement industry. And so does Andrew Weil. If a product whose label promotes it as contributing to brain function, cardiovascular health, or one that can reduce cellular damage associated with aging, or improve digestion, or support a healthy immune system is “not intended to cure, treat, diagnose or even prevent” any health problem, what on earth, one has to wonder, is it supposed to do?

  ALMOST 40 PERCENT of American adults made use of some form of alternative medical therapy in 2007, according to the most recent National Health Statistics Reports. They spent $23.7 billion on dietary supplements alone. It has become one of the America’s biggest growth industries. (And one that almost uniquely profits during times of economic distress. People are far more likely to turn to herbs and other supplements when they can’t afford genuine medical care—and when they have no access to any other health system.) There were approximately 4,000 supplements on the market in 1994, when the industry was deregulated by Congress. Today the exact number is almost impossible to gauge, but most experts say there are at least 75,000 labels and 30,000 products. Those numbers don’t include foods with added dietary ingredients like fortified cereals and energy drinks, which seem to fill half the supermarket shelves in the country.

  The attraction isn’t hard to understand. For all that medicine has accomplished, millions of people still suffer the considerable aches and pains of daily life. Arthritis and chronic pain plague America, and much of that agony is no more amenable to pharmaceutical relief today than it was thirty years ago. The drugs one needs to alleviate chronic pain—aspirin, for instance—can cause their own complications when taken in high enough doses over a long enough period. The pharmaceutical industry is a monolith that often acts as if there is, or soon will be, a pill for everything that ails you. Too much cholesterol? We can melt it away. Depressed? Try one of a dozen new prescriptions. Can’t sleep? Blood pressure too high? Obese, sexually dysfunctional, or bald? No problem, the pharmaceutical industry is on the case.

  Even our medical triumphs cause new kinds of problems. Reducing deaths from heart disease and cancer, for example, permits us to live longer. And that exposes us to a whole new set of conditions, most notably Alzheimer’s disease, a debilitating, costly, and humiliating illness for which there is no cure and few treatments of any value.

  So what could it hurt to try something new? It is an era of patient empowerment. People have access to more information than ever, their expectations have changed, and they demand greater control over their own health. Supplements and herbal alternatives to conventional drugs, with their “natural” connotations and cultivated image of self-reliance, fit in perfectly. They don’t require machines or complex explanations. People can at least try to relate to an herb like echinacea, which has been around for centuries, no matter how useless it is, or a practice like qi gong, which means “cosmic breathing” and suggests that human life forces can be marshaled to flow through our body in a system of “meridians.” Homeopathy is nothing more than fraud, as any number of scientists, studies, reports, and institutions have pointed out. Yet, in a complex world simplicity offers an escape from the many moving parts of the medical machine. As with organic food, if science seems allied with corporations and conglomerates—all distant and unfathomable—well, then, nature feels just right.

  Under the banner of natural and alternative treatments Americans reflexively accept what they would never tolerate from a drug company (and never should). Vioxx made that clear. Without post-marketing surveys, the unacceptable risks of Vioxx would never have been known. Maybe none of the tens of thousand of herbal supplements for sale in the United States carries any similar risk. But how would we know, since that kind of monitoring has never been required of supplements? Doctors could not have c
ontinued to prescribe Vioxx after news of its dangers was made public. Yet compare the way Vioxx was removed from the market—amid the greatest possible publicity and under threat from billions of dollars’ worth of lawsuits—to what happened in 2004 with ephedra, which was America’s most popular dietary supplement.

  Ephedra, derived from the Asian herb ma huang, has been used for thousands of years; the herb’s active ingredient, ephedrine, boosts adrenaline, stresses the heart, raises blood pressure, and is associated with an increased risk of heart attack, stroke, anxiety, psychosis, and death. None of that was in question. But the FDA’s decision to pull it from the market certainly was. Many of the Americans who were outraged that Vioxx had been approved in the first place were just as outraged when ephedra was banned. It took the FDA years of legal battle to get the supplement removed from the shelves of vitamin shops. Ephedrine-containing supplements have caused deaths in many countries, not just in America. But people still want it, and what people want, the Internet provides. “We’re growing ma huang (ephedra), which has been used in Traditional Chinese Medicine for 5,000 years but is now banned in America thanks to the criminally-operated FDA,” one foreign supplier wrote in 2009. And he will be more than happy to sell it to anyone foolish enough to send money. And why would anyone do that? Because a supplement is not a drug. Its value is taken on faith and no amount of evidence will ever convince true believers to turn away.

  Belief outranks effectiveness. Vitamin worship demonstrates that fundamental tenet of denialism with depressing regularity. In 2003, a study that compared the efficacy of echinacea to a placebo in treating colds received considerable attention. Researchers followed more than four hundred children over a four-month period, and found not only that a placebo worked just as well, but that children treated with echinacea were significantly more likely to develop a rash than those who took nothing at all.