Killing Us Softly

by Dr Paul Offit

  Desiree Jennings ultimately left Rashid Buttar, put off by the size of his bill. She shouldn’t have been so surprised. One need only look at Buttar’s autism treatments to see how he operates. During the first twelve months, children are required to use his chelating cream every other day, at a cost of $150 per small vial. Buttar makes sure that parents use his product only—no substitutes. “Many pharmacies are already trying to duplicate TD-DMPS by creating their own topically applied form of DMPS,” he writes. “These inferiorly combined substitutes are being marketed to capitalize on our research and impersonate TD-DMPS. Proceed at your own risk.”

  Although sales of Buttar’s anti-autism cream have been robust, they pale in comparison with Buttar’s biggest seller: Trans-D Tropin, another potion he invented. As with his autism cure, claims for this transdermal drug are remarkable. And as with his autism cure, these claims have never been put to the test, which is in part why the FDA has never licensed it. “After the first few days to the first two weeks on Trans-D,” writes Buttar, “most patients require less sleep and experience a better quality of sleep. … As time goes on, you’ll experience various other changes … including diminished wrinkles, thicker skin, increased muscle strength and endurance, faster recovery, stronger libido, hair regrowth, increased emotional stability, higher energy levels, body contour changes and decreased chronic pain. In many instances, decades’ worth of old aches, pains and injuries begin to disappear! You don’t need to take Trans-D, but if you’re interested in the possibility of increasing your life span, improving functionality and getting healthier, then you need to experience Trans-D firsthand.” So, according to Buttar, Trans-D makes you look better, live longer, sleep better, and have better sex—a sales pitch that harks back to Hamlin’s Wizard Oil, Squire’s Grand Elixir, Kickapoo Indian Sagwa, and other cure-alls hawked in the 1800s. Trans-D goes for about two hundred dollars a bottle. Since 1998, more than 22 million doses have been sold. Along with his anti-autism cream, Trans-D has made Rashid Buttar a very rich man.

  The final irony is that while Buttar is making a fortune selling unlicensed medical products of unproven value, he rails at Big Pharma. “The motivation of most pharmaceutical companies is to fund research where they can have a monopoly,” he writes, “where they can make a lot of money.” Michael Specter, a staff writer for The New Yorker, has commented on the contradiction. “We hate Big Pharma,” he says. “But we leap into the arms of Big Placebo.”

  Rashid Buttar asks his office staff to take an oath: “I vow to do more than my share in making the change the world is waiting for.” He asks his own children to take the same oath. Buttar believes he can chelate the world into better health. It’s not just a philosophy; it’s a mission—a mission based on the notion that doctors are evil and that mainstream medicine can’t be trusted. “Doctors often expect patients to simply believe whatever they are told,” he writes. “Herein lies your first lesson. If a doctor becomes upset because you ask for more information or becomes nervous when you don’t believe them simply because he or she ‘said so,’ you need to find yourself a new doctor. Run. Don’t walk. Remember that doctors are just human beings with a license to make life-and-death mistakes as long as they are using an approved method within the ‘standard of care.’”

  Buttar believes that he, on the other hand, should be trusted absolutely: “I want the person who comes to me and says, ‘I know what the truth is. I don’t care about anything else.’ I want you to start trusting me yesterday. That’s my ideal patient. But someone who comes to me and says, ‘I don’t know what this is, and what are the side effects of that?’ Just go your own route. I’m here for the people who already know.” Buttar demands strict compliance with his philosophies: “There’s no thinking there. I tell them I’m the general. If you want to win the race, then I have to hold the reins. And you do everything I ask you to do. If I ask you to stand on your head for four hours and chant a mantra, then you do it.”

  To firm up the appeal, Buttar caters to his followers’ sense of conspiracy, using the catchphrase “what your doctor won’t tell you.” The implication is that doctors are saving the good therapies for themselves and their friends, their patients be damned. Buttar claims that as few as one in ten doctors with cancer actually get the radiation or chemotherapy recommended for them, presumably because doctors know better than to do what they recommend. And it’s all part of a larger, far more heinous plot. “I was at a meeting at the Centers for Disease Control in early October,” says Buttar. “And behind closed doors, I was meeting with a very senior official, a scientist, and … I asked what is the number-one concern for the CDC right now. And he looks at me and very pointedly he says, ‘Rashid, we will deny this in public, you understand; nobody can admit to this. But the number-one concern is mercury.’”

  Buttar’s message is clear: Trust me. Trust me because others mean to do you harm. Trust me because I, like you, have been treated badly. Trust me absolutely and without question. Trust me because the truth will set you free. Buttar is in the company of charismatic figures from Jim Jones to David Koresh: building a following with unfounded, illogical notions that—in the end—benefit no one.

  Still, one could argue, where’s the harm? If parents want to trust Buttar’s unproven tests and magical potions, if they want to buy into his logic, if they want to believe there’s a conspiracy by the government to deny them important therapies like his anti-autism cream and Trans-D, and if they want to spend much of their hard-earned money doing it, that’s their decision. Unfortunately, Buttar’s advice is potentially quite dangerous.

  Buttar’s central premise is that the “medical establishment” offers unnatural and dangerous therapies. He claims that his therapies, on the other hand, are natural and harmless. Intravenous chelation therapy, however, is anything but harmless. Children who really do suffer from heavy-metal poisoning are given chelation therapy in the hospital, where their heart rhythms and blood chemistries are constantly monitored. Hospital monitoring is required because chelation medicines don’t bind mercury and lead only—they also bind elements like calcium, which is necessary for electrical conductivity in the heart. In March 2006, the CDC published the stories of two children and one adult who had died from intravenous chelation. At the end of their report, CDC scientists made it clear what they thought about the unapproved use of chelation: “Certain healthcare practitioners have used chelation for autism in the belief that mercury or other heavy metals are producing the symptoms. These off-label uses of chelation therapy are not supported by accepted scientific evidence.”

  There’s another dangerous aspect to Rashid Buttar’s rejection of conventional medicine. It relates to how he believed his son had become autistic. “Unbeknownst to me,” writes Buttar, “my now ex-wife had gotten Abie the regularly scheduled vaccines because she had listened to the fear-evoking propaganda fed to her by the pediatricians and the doctors at the hospital when she delivered.” Buttar believed that his son had been poisoned by thimerosal, a mercury-containing preservative in vaccines, saying, “Thimerosal was the greatest atrocity ever committed to mankind in the name of money.” As a consequence, Buttar refused to vaccinate his third child (even though by that time thimerosal had been removed from all vaccines given to young infants) and, like Jenny McCarthy, is on a crusade to prevent others from vaccinating their children. “Nobody’s giving my child any vaccine,” says Buttar. “I’ll take my chances with smallpox or polio or hepatitis B. Am I afraid that he will become a doctor or a prostitute by the age of ten?”

  Like his argument for heavy metals as the cause of seemingly all chronic diseases, Buttar’s case against vaccines is ill-founded. First, studies have clearly shown that thimerosal in vaccines not only didn’t cause autism; it didn’t even cause subtle signs of mercury toxicity. Next, Buttar says he will take his chances with smallpox. Fair enough. Smallpox vaccines haven’t been given to children since 1972—a consequence of the disease having been wiped off the face of the earth. Polio, on
the other hand, is still around, having never been eliminated from countries like Pakistan, Afghanistan, and Nigeria. People traveling from these three countries have brought the disease to twenty other countries. Given the frequency of international travel, there’s every reason to believe that the virus can spread further—especially if not enough people are immunized. Finally, Buttar underestimates the impact of hepatitis B virus in children. Before the CDC recommended a routine hepatitis B vaccine for infants in 1991, about sixteen thousand children below the age of ten got infected every year. About half caught the infection from their mothers during birth, the other half after they were born, usually from casual contact with people who didn’t know they were infected. As the roughly 1 million Americans infected with hepatitis B virus will attest, you don’t have to be a doctor or a prostitute to get the disease.

  When the United States faced a crisis in 2009, Rashid Buttar was among the first to give potentially deadly advice. “The facts are the facts,” he said. “Right now more people have died from the swine flu vaccine than have died from swine flu. Probably more people will die from the swine flu vaccine than will ever die from swine flu itself. The viral strain has lost its virulence as it has come through the Yucatan Peninsula through Mexico and into the United States. So really the big hype that they made is all smoke and mirrors. It’s all an illusion to scare people.” Buttar was right in claiming that swine flu virus had worked its way up from Mexico, entering the United States in April 2009. But he was wrong that the virus had lost its virulence. During the few months following his pronouncements, an estimated 47 million Americans were infected with swine flu, 250,000 were hospitalized, and 12,000 died. Among the dead were an estimated 1,100 children—ten times more than die during a typical influenza season. Buttar’s advice wasn’t just wrong, it was spectacularly wrong. And anyone who listened to it faced an unnecessary risk.

  Not all of Rashid Buttar’s patients are satisfied with his care. In April 2008, the North Carolina Medical Board heard their complaints. The board’s lawyer, Marcus Jimison, introduced his case. “The evidence will show that Dr. Buttar preys on people in their darkest hours, at a time when they are most desperate. He provides therapies to dying patients that have not been shown to be effective and charges them thousands of dollars a day for what he knows will not work. And he does this with a North Carolina medical license hanging on his wall.”

  Jimison summarized the allegations against Buttar.

  Buttar treated a patient with cervical cancer with intravenous hydrogen peroxide, an unproven and potentially dangerous therapy. For the initial visit, Buttar charged $12,000. During the next month, the patient received nineteen more injections, at a cost of $1,000 each, for a total of $31,000. When the patient died, Buttar’s office sent the family a refund of $2,500.

  Buttar treated a patient with ovarian cancer with intravenous vitamins, chelation, Philbert Infra Respiratory Reflex Procedure, and Ondamed biofeedback. The bill for two months of treatments was $30,000. Prior to her death, the patient paid Buttar $10,000. When her estate failed to pay the remaining $20,000, Buttar turned the matter over to a collection agency.

  Buttar charged a patient with cancer of the adrenal gland $32,000 for ineffective therapies. The patient’s wife remembered their first meeting with Buttar: “He said it didn’t matter what kind of cancer anybody had,” she recalled. “He could cure it. He kept reiterating he had a 100 percent success rate.” After her husband died, his wife canceled a check to Buttar for $6,700. Buttar turned the matter over to a collection agency, seeking the unpaid portion of the bill, interest, and a 25 percent collection fee.

  In October 2007, Buttar told a patient with colon cancer that he “would be an idiot for doing anything the conventional doctors told him to do.” Buttar advised chelation and ozone therapy, at a cost of $5,000 a week. Two months later, the patient was dead.

  Toward the end of the hearing, Jimison asked Buttar whether his therapies were below the standard of care. “It’s not the standard of care,” he said. “It’s beyond the standard of care.”

  Jimison closed by exhorting the medical board to do what was right—to suspend the license of a man who was doing harm, at the very least by diverting patients away from potentially helpful therapies. “Somewhere there is a loved one that’s going to Dr. Buttar’s office,” he said. “They’re dying, and would be looking for any glimmer of hope. And Dr. Buttar is more than willing to give them that glimmer of hope. This is the time to stand up for science-based, evidence-based medicine. … It will be the board’s finest hour.”

  It wasn’t to be. The board chose only to order Buttar to provide a consent form advising his patients that his treatments hadn’t been proven effective and hadn’t been licensed by the FDA. He could continue to treat patients with cancer and autism. Continue to treat them as if they had been poisoned by heavy metals, even though evidence refuted his claim. Continue to sell magical anti-autism creams and anti-aging medicines without any proof that they worked. Buttar still describes treatments on his website as “highly effective” and boasts of giving 200,000 chelation treatments without any side effects (which is highly unlikely). It would be surprising if the revised consent deterred desperate patients and parents from streaming to his door.

  Part VII

  WHY SOME ALTERNATIVE THERAPIES REALLY DO WORK

  11

  The Remarkably Powerful, Highly Underrated Placebo Response

  We are what we pretend to be …

  —Kurt Vonnegut, Mother Night

  So if echinacea and vitamin C don’t treat colds, and chondroitin sulfate and glucosamine don’t treat arthritis, and St. John’s wort doesn’t treat depression, and ginkgo doesn’t improve memory, and saw palmetto doesn’t shrink prostates, then why do so many people believe they do? And if the human nervous system isn’t related to rivers in China, and all diseases aren’t based on misaligned spines, and highly diluted medicines don’t contain any active ingredients, then why do acupuncturists, chiropractors, and homeopaths have such a devoted following? The answers can be found during a testy exchange between Mehmet Oz and Steven Novella.

  In April 2011, Oz discussed acupuncture on The Dr. Oz Show. Researchers have spent a lot of time and money studying acupuncture in people who claim it works. First, they compared outcomes when needles were inserted into correct or incorrect acupuncture points. No difference. Then, they used both standard and retractable needles; patients felt the sting of the needle but didn’t know whether it had entered the skin. Again, no difference. Despite these studies, Mehmet Oz continues to promote acupuncture. To his credit, however, on the day he discussed acupuncture, Oz invited Dr. Steven Novella onto his show. He couldn’t have picked a more skeptical guest.

  In addition to being a Yale neurologist, Steven Novella is founder and president of the New England Skeptical Society, director of the Science-Based Medicine project at the James Randi Educational Foundation, and host of the popular science podcast The Skeptics’ Guide to the Universe. Novella explained that acupuncture still works if needles are inserted in the wrong place or if they aren’t inserted at all. Oz was furious. “There are billions of people around the world who use acupuncture as the foundation of their health,” he argued. “I just think it’s very dismissive of you to say that because we couldn’t take this idea that exists with a different mind-set and squeeze it into the way that we think about it in the West, that it can’t possibly be effective.”

  Novella knew that acupuncture was by definition a sham, a trick, a deception; yet he never once said, “Acupuncture doesn’t work.” Rather, he questioned why it worked. “It’s the ritual surrounding a positive therapeutic interaction: a comforting, caring [clinician],” he said. “You’re relaxing for half an hour or an hour. That’s where the effect is. There’s no effect to actually sticking a needle through the skin.” In other words, the placebo effect.

  Although some dismiss the placebo effect as trivial, it’s not. One of the first demonstrations of how
powerful it can be took place on the battlefields of World War II, when a nurse ran out of morphine. Unable to tell a wounded soldier that she had nothing for his pain, she lied, saying that the salt water she used was actually morphine. To her surprise, his pain disappeared. The critical question, then, isn’t “Does the placebo effect work?” It’s “How does it work?” Do placebo therapies such as acupuncture really cause less pain, or do people simply tolerate the same pain? Is the placebo effect physiological or psychological?

  At first, doctors were unfairly dismissive of the placebo effect, arguing that it had everything to do with perception and nothing to do with reality. For example, expensive therapies are often perceived as more valuable even if they’re worthless. One therapy that falls into this category is unicorn horns. Touted for the treatment of epilepsy, impotence, worms, plague, smallpox, and rabies, and purported to prolong youth, assist memory, and fortify the spirits, powdered unicorn horns have been used for more than eight centuries. Unicorns are one-horned beasts that don’t exist—a fact that hasn’t hurt sales. Made from ground-up whales’ tusks, “unicorn horns” sell for their weight in gold: a nine-pound horn sells for $55,000. People who can’t afford unicorn horns can buy unicorn drinks.

  A more recent example is Vitamin O. In 1998, an advertisement in USA Today announced a miraculous new product: Vitamin O. Under a photograph of tensely smiling, attractive people, the ad stated, “It’s so safe you can drop it in your eyes, so natural it contains the most abundant element on earth, so effective you can spend hours reading the unsolicited testimonials of those who’ve used it with dramatic results.” One believer said, “After taking Vitamin O for several months, I find I have more energy and stamina and have become immune to colds and flu.” What was Vitamin O? The ad didn’t lie. Vitamin O was “stabilized oxygen molecules in a solution of distilled water and sodium chloride.” In other words: salt water. But promoters of Vitamin O were quick to point out that it wasn’t just salt water. It was salt water enhanced with oxygen, giving buyers the vital energy they needed. Unfortunately, Vitamin O users lacked the one thing necessary to extract oxygen from water: gills. After the ad appeared, the manufacturer sold sixty thousand vials in a month—at a cost of $20 a vial.