Killing Us Softly

by Dr Paul Offit

  Mercola’s products gross about $7 million a year. Ironically, when asked about criticism from mainstream physicians and warning letters from the FDA, he responded, “It’s very simple. There’s this huge collusion between government and industry.” This from a man who has become an industry. When Mehmet Oz questioned Mercola about his sales tactics on The Dr. Oz Show, Mercola said, “We only sell natural products,” which presumably justifies hefty profits based on unsupported, potentially dangerous claims.

  Sadly, mainstream physicians are also cashing in on the alternative medicine craze. Many academic institutions now have divisions of alternative, integrative, and holistic medicine, and the medical marketplace is starting to resemble an Arabian bazaar. “The more medicine nuzzles up to non-evidence-based alternative products,” says Art Caplan, “the more you damage medicine in the long run. Many doctors believe a false premise that the patient is king. It’s what I sometimes refer to as the restaurant model of medicine. Well, medicine isn’t a restaurant, and the patient is not a patron, and the doctor is not a waiter. I understand that medicine is a business and that alternative medicine is a business; but part of the difference in medicine is that we’re supposed to have professional norms, professional values, and professional commitments. If you keep telling people that it’s just a marketplace and that they’re just clients and that autonomy of the patient is what must be served to make them happy customers, then you have a collapse of professionalism in the face of consumer demand. We have this image that patients aren’t vulnerable. But they are. It’s hard to be a good patient unless you have an advocate who’s guided by professionalism to help you. Otherwise, there are plenty of healers who will rip you off.”

  The fourth way alternative healers cross the line is by promoting magical thinking, which, sadly, is everywhere you look. For example, take America’s favorite pastime.

  In addition to their uniforms, gloves, high socks, and cleats, many baseball players wear something else: titanium necklaces. Made by Phiten, a Kyoto-based company, titanium necklaces are purported to cause “longer lasting energy, less fatigue, shortened recovery time, and more relaxed muscles.” How do they work? “Everybody has electricity running through their bodies,” explains Scott McDonald, a Seattle-based sales representative. “This product stabilizes that flow of electricity if you’re stressed or tired. Pitchers are seeing that they aren’t as sore. Injured players are seeing that they recover faster from their workouts. People are always skeptical, but when they try it, they become believers.” “I think I have a little more energy with it,” said Endy Chávez, an outfielder on the Baltimore Orioles.

  Electricity is the flow of electrons. Flow in one direction is called direct current; in two directions, alternating current. For electrons to flow, they need to be displaced from atoms. Some metals, like gold, silver, and copper, give up their electrons easily (and are therefore excellent conductors of electricity). Others, like titanium, hold on to their electrons more tightly. Independent of the metal, one fact about electricity is clear: electrons cannot be displaced without force, usually in the form of chemical energy (batteries) or mechanical energy (generators). Although titanium, like most metals, can conduct electricity to some extent, it cannot generate electricity without force. Absent this force, titanium necklaces are inert, no different than wearing a necklace made of wood or garlic. Perhaps most amazing is that these same athletes routinely climb into MRI (magnetic resonance imaging) machines. The magnet in one of these machines generates sixty thousand times the energy found in the earth’s magnetic field. If titanium necklaces evoked the kind of energy athletes believe, an MRI would make their heads explode.

  Titanium necklaces can be purchased on the Internet for about $40.

  Unfortunately, magical thinking isn’t harmless. There’s a price to pay. “I don’t want people running around saying that because I waved a black cat in front of them that black cats have curative power,” says Caplan. Robert Slack, writing for the Center for Inquiry, agrees: “The gaps in medical knowledge we all dread are not likely to be filled by energy fields, meridians, and astrology but by the purposeful pursuit of knowledge under a single set of standards we call science. The way forward is through a careful and purposeful pursuit of scientific truth, even if it means leaving some of our most romantic fallacies behind.” Isn’t it enough to see that a garden is beautiful,” wrote Douglas Adams, author of The Hitchhiker’s Guide to the Galaxy, “without having to believe that there are fairies at the bottom of it, too?”

  Encouragement of scientific illiteracy—or, beyond that, scientific denialism—can have a corrosive effect on patients’ perceptions of disease, leaving them susceptible to the worst kinds of quackery.

  EPILOGUE:

  Albert Schweitzer and the Witch Doctor: A Parable

  Albert Schweitzer was a musician, philosopher, theologian, and physician. In 1912, using his own money, he established a clinic in Lambaréné, Gabon, in western Africa. Within nine months, more than two thousands natives had come to see him. Schweitzer gave them quinine for malaria, digitalis for heart disease, and salvarsan—the first antibiotic—for syphilis. When patients came to him with strangulated hernias or abdominal tumors, he anesthetized them with chloroform and treated their pain with morphine. Albert Schweitzer brought modern medicine to a small part of Africa.

  Toward the end of both of their lives, Norman Cousins, author of Anatomy of an Illness, met Albert Schweitzer. “At the dinner table of the Schweitzer Hospital at Lambaréné,” wrote Cousins, “I had ventured the remark that local people were lucky to have access to the Schweitzer clinic instead of having to depend on witch-doctor supernaturalism. Dr. Schweitzer asked me how much I knew about witch doctors. I was trapped by my ignorance. The next day the great doctor took me to a nearby jungle clearing where he introduced me to an elderly witch doctor.”

  “For the next two hours, we stood off to one side and watched,” recalled Cousins. “With some patients, the witch doctor merely put herbs in a brown paper bag and instructed the ill person in their use. With other patients, he gave no herbs but filled the air with incantations. A third category of patients he merely spoke to in a subdued voice and pointed to Dr. Schweitzer.” On the way back, Schweitzer interpreted what they had seen. The first group of patients had minor illnesses that would resolve on their own or for which modern medicine offered little. The second group had psychological problems treated with “African psychotherapy.” The third had massive hernias or extrauterine pregnancies or dislocated shoulders or tumors—diseases the witch doctor couldn’t treat—so he directed them to Dr. Schweitzer.

  Schweitzer described the value of the witch doctor. “The witch doctor succeeds for the same reason the rest of us succeed,” he said. “Each patient carries his own doctor inside him. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to go to work.”

  In Gabon, both Albert Schweitzer’s modern medicine and the witch doctor’s ancient medicine had their place. Schweitzer offered specific treatments for treatable diseases, and the witch doctor offered placebo medicine when nothing more was necessary or available. Both recognized the value of the other. Such is the case with today’s mainstream and alternative healers: both have their place. The problem comes when mainstream healers dismiss the placebo response as trivial or when alternative healers offer placebos instead of lifesaving medicines or charge an exorbitant price for their remedies or promote therapies as harmless when they’re not or encourage magical thinking and scientific denialism at a time when we can least afford it.

  As consumers, we have certain responsibilities. If we’re going to make decisions about our health, we need to make sure we’re not influenced by the wrong things—specifically, that we don’t give alternative medicine a free pass because we’re fed up with conventional medicine; or buy products because we’re seduced by marketing terms such as natural, organic, and antioxidant; or give undeserved credence to c
elebrities; or make hasty, uneducated decisions because we’re desperate to do something, anything, to save ourselves and our children; or fall prey to healers whose charisma obscures the fact that their therapies are bogus. Rather, we need to focus on the quality of scientific studies. And where scientific studies don’t exist, we should insist that they be performed. If not, we’ll continue to be deceived by therapies whose claims are fanciful.

  Making decisions about our health is an awesome responsibility. If we’re going to do it, we need to take it seriously. Otherwise we will violate the most basic principle of medicine: First, do no harm.

  Notes

  The page numbers in this note section relate to the printed version of this book; they do not match the pages of your eBook. You can use your ebook reader’s search tool to find a specific word or passage.

  PROLOGUE: TAKING A LOOK AT ALTERNATIVE MEDICINE

  1 Widespread use of alternative therapies: M. Conley, “Vitamins and Vitamin Supplements: Use Increases in America,” ABC News, April 13, 2011; A. Abdel-Rahman, N. Anyangwe, L. Carlacci, et al., “The Safety and Regulation of Natural Products Used as Foods and Food Ingredients,” Toxicological Sciences 123 (2011): 333–48.

  1 Popularity of alternative medicine in the EU: C. Pearson, “When It Comes to Integrative Medicine, Does the UK lag,” Huffington Post, July 4, 2012.

  1 Hospital survey of alternative therapies: S. Ananth, “2010 Complementary and Alternative Medicine Survey of Hospitals,” Samueli Institute, Alexandria, Va.

  2 Homeopathy in the UK: D. Ullman, “Homeopathic Medicine: Europe’s #1 Alternative for Doctors,” Huffington Post, July 4, 2012.

  2 Pfizer acquires Alacer: “Pfizer Acquires Alacer Corp., a Leading Vitamin Supplement Company,” press release, Business Wire, February 27, 2012.

  INTRODUCTION: SAVING JOEY HOFBAUER

  7 Joey Hofbauer: L. J. Lefkowitz, Attorney General, State of New York, by D. K. McGivney, Esq., Appendix on Appeal, In the Matter of Joseph Hofbauer, State of New York Supreme Court, Appellate Division, Third Judicial Department, index no. N-46-1164-77, May 17, 1978.

  8 Treatment of Hodgkin’s disease: E. C. Easson and M. H. Russell, “Cure of Hodgkin’s Disease,” British Medical Journal 1 (1963): 1704–7; V. T. Devita, A. R. Secpick, and P. P. Carbone, “Combination Chemotherapy in the Treatment of Advanced Hodgkin’s Disease,” Annals of Internal Medicine 73 (1970): 881–95; P. P. Carbone, H. S. Kaplan, K. Musshoff, et al., “Report of the Committee on Hodgkin’s Disease Staging Classification,” Cancer Research 31 (1971): 1860–61; S. A. Rosenberg, “Development of the Concept of Hodgkin’s Disease as a Curable Illness: The American Experience,” in P. M. Mauch, J. O. Armitage, V. Diehl, R. T. Hoppe, and L. M. Weiss, eds., Hodgkin’s Disease (Philadelphia: Lippincott Williams & Wilkins, 1999): 47–57; J. O. Armitage, “Current Concepts: Early Stage Hodgkin’s Lymphoma,” New England Journal of Medicine 363 (2010): 653–62.

  8 Hofbauers reject Cohn’s advice: Lefkowitz, “Hofbauer,” A49–A74; 411 N.Y.S.2d 416; 47 N.Y.2d 648.

  9 Chagnon’s letter to the Hofbauers: Lefkowitz, “Hofbauer,” A1546–A1547.

  9 States’ rights in protection of a minor: 411 N.Y.S.2d 416.

  10 Sheridan regarding visit to the Hofbauers: Lefkowitz, “Hofbauer,” A1180–A1181.

  10 Joey Hofbauer at St. Peter’s: Ibid., A1031.

  10 John Hofbauer regarding laetrile at St. Peter’s: Ibid., A1043.

  11 John Hofbauer searches for doctor: Ibid., A1028.

  11 Schachter consent form: Ibid., A1271–A1273.

  11 Judge Brown offers six-month extension: 411 N.Y.S.2d 416; 393 N.E.2d 1009.

  12 Schachter’s therapies: V. Herbert, “Laetrile: The Cult of Cyanide: Promoting Poison for Profit,” The American Journal of Clinical Nutrition 32 (1979): 1149–51; Lefkowitz, Hofbauer, A164.

  12 Deaths from coffee enemas: J. W. Eisele and D. T. Reay, “Deaths Related to Coffee Enemas,” Journal of the American Medical Association 244 (1980): 1608–9.

  12 New York State laws on human experimentation: Public Health Law, State of New York, Article 24-A, effective September 1, 1975: Protection of Human Subjects, Sections 2440–46.

  12 “Witch doctor’s diet”: Ibid., A149.

  12 Horton testimony: Ibid., A811–A872.

  13 Tartaglia testimony: Ibid., A782–A900.

  13 Schachter’s indiscretions: Herbert, “Laetrile,” 1149–51.

  13 Schachter regarding Joey’s progress: Lefkowitz, “Hofbauer,” A925–A972.

  13 Laetrile promoters testifying at Hofbauer trial: Herbert, “Laetrile,” 1149–51; L. J. Lefkowitz, Attorney General, State of New York, by D. K. McGivney, Esq., Appendix on Appeal, In the Matter of Joseph Hofbauer, State of New York Supreme Court, Appellate Division, Third Judicial Department, index no. N-46-1164-77, May 17, 1978.

  13 Judge Brown’s verdict: 411 N.Y.S.2d 416; 393 N.E.2d 1009.

  14 Influence of John Birch Society: J. H. Young, American Health Quackery (Princeton, N.J.: Princeton University Press, 1992), 218–28; Robert Johnston, The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America (New York: Routledge, 2004), 237.

  14 States legalize laetrile: I. J. Lerner, “Laetrile: A Lesson in Cancer Quackery,” CA: Cancer Journal for Clinicians 31 (1981): 91–95.

  14 Laetrile a billion-dollar business: V. Herbert, “Laetrile,” New England Journal of Medicine 307 (1982): 119.

  14 McQueen’s illness: B. Lerner, When Illness Goes Public: Celebrity Patients and How We Look at Medicine (Baltimore: Johns Hopkins University Press, 2006), 141.

  15 McQueen given no hope: Ibid., 143.

  15 Kelley early career: S. Watson and K. MacKay, “McQueen’s Holistic Medicine Man: Claims He Cured His Own Cancer with His Holistic Treatments,” People, October 20, 1980.

  15 McQueen’s treatment: Lerner, When Illness Goes Public, 147; “McQueen Treatment: Laetrile, Megavitamins, Animal Cells,” Associated Press, October 10, 1980; C. Sandford, McQueen: The Biography (New York: Taylor Trade Publishing, 2001), 427.

  15 Kelley on Tomorrow: Sandford, McQueen.

  16 McQueen on Mexican television: Ibid., 435.

  16 First Hofbauer appeal: 411 N.Y.S.2d 416.

  16 Ingelfinger regarding laetrile: F. J. Ingelfinger, “Laetrilomania,” New England Journal of Medicine 296 (1977): 1167–68.

  17 FDA approves laetrile study: “FDA OK’s Testing Laetrile on Humans,” Boston Globe, January 4, 1980; “U. S. Test of Laetrile on Humans Backed,” New York Times, January 4, 1980.

  17 Edward Kennedy hearing: Young, American Health Quackery, 220; J. H. Young, The Medical Messiahs: A Social History of Health Quackery in Twentieth-Century America (Princeton, N.J.: Princeton University Press, 1967), 454–57; Herbert, “Laetrile,” 1137; Anonymous: “Lopsided 161–58 Vote Defeats Legalizing Laetrile,” Boston Herald American, May 19, 1978.

  17 Jasen decision: 393 N.E.2d 1009.

  18 Schachter regarding Hofbauer’s death: W. Waggoner, “Boy, 10, in Laetrile Case Dies,” New York Times, July 18, 1980.

  18 Coleman visits McQueen: Sandford, McQueen, 438.

  18 McQueen dies following surgery: Ibid., 442–43.

  18 Moertel study: C. G. Moertel, T. R. Fleming, J. Rubin, et al., “A Clinical Trial of Amygdalin (Laetrile) in the Treatment of Human Cancer,” New England Journal of Medicine 306 (1982): 201–06.

  19 FDA ban on laetrile: Young, American Health Quackery, 226.

  20 Judge Brown’s Finding of Facts: Lefkowitz, “Hofbauer,” A0.17.

  21 Kirkpatrick Dilling and the NHF: Ibid., A184.

  21 Schachter brochure: Schachter Center for Complementary and Alternative Medicine, Two Executive Boulevard, Suite 202, Suffern, NY, obtained October 2009.

  CHAPTER 1: REDISCOVERING THE PAST

  25 Oprah Winfrey impact: W. Kosova, “Live Your Best Life Ever!” Newsweek, May 30, 2009; D. Gorski, “The Oprah-fication of Medicine,” Science-Based Medicine blog, www.sciencebasedmedicine.org/?p=497.

  26 W
hitworth and Oz: H. Dreher, “Medicine Goes Mental,” New York, May 11, 1998, http://nymag.com/nymetro/health/features/2664/#ixzz0fds1lbrm.

  29 Bloodletting: R. Shapiro, Suckers: How Alternative Medicine Makes Fools of Us All (London: Harvill Secker, 2008), 10–11; C. Wanjek, Bad Medicine: Misconceptions and Misuses Revealed, from Distance Healing to Vitamin O (Hoboken, N.J.: John Wiley & Sons, 2003), 7–10; Bob McCoy, Quack! Tales of Medical Fraud from the Museum of Questionable Medical Devices (Santa Monica, Calif.: Santa Monica Press, 2000), 25–27; S. Singh and E. Ernst, Trick or Treatment: The Undeniable Facts About Alternative Medicine (New York: W. W. Norton, 2008), 7–14; D. Morens, “Death of a President,” New England Journal of Medicine 341 (1999): 1845–49.

  30 Osler regarding bloodletting: J. H. Young, The Toadstool Millionaires: A Social History of Patent Medicines in America Before Federal Regulation (Princeton, N.J.: Princeton University Press, 1972), 4.

  31 James Lind and scurvy: Singh and Ernst, Trick or Treatment, 14–24.

  32 Longevity data: R. Tallis, Hippocratic Oaths: Medicine and Its Discontents (London: Atlantic Books, 2005), 22; National Center for Health Statistics, Health, United States, 2010: With Special Feature on Death and Dying (Hyattsville, Md.: CDC, National Center for Health Statistics, 2011); available at www.cdc.gov/nchs.

  32 Dr. Nemeh on Oz show: “Is This Man a Faith Healer?” The Dr. Oz Show, www.doctoroz.com/videos/man-faith-healer-pt-1.

  33 Pamela Miles: P. Miles, Reiki: A Comprehensive Guide (New York: Penguin, 2006), 32.

  34 Emily Rosa and therapeutic touch: L. Rosa, E. Rosa, L. Sarner, and S. Barrett, “A Closer Look at Therapeutic Touch,” Journal of the American Medical Association 279 (1998): 1005–10; G. Kolata, “A Child’s Paper Poses a Medical Challenge,” New York Times, April 1, 1998; M. D. Lemonick, “Emily’s Little Experiment,” Time, April 13, 1998; D. Krieger, Accepting Your Power to Heal (Rochester, Vt.: Bear & Company Publishing, 1993); Emily Rosa, Linda Rosa, and Larry Sarner, interviewed by the author, September 23, 2011.