I asked the same question of Arthur Caplan, PhD, the director of the Center for Bioethics at the University of Pennsylvania and probably the nation’s most respected bioethicist. “Some people go the alternative route because they feel they can’t get their regular doctor’s attention, so, for example, they’ll see the chiropractor for everything,” Caplan replied. “Now, the chiropractor’s not going to cure their prostate. But he talks to them. He returns their calls. Heck, he’s got free parking.”
For not a few health-care consumers, this manifold need to feel empowered, considered, nurtured, overwhelms the desire to be kept healthy. A December 2000 study by the Journal of Family Practice tellingly suggested that alt-med users “prefer to deal with their own problems.”
Whatever the reasons, alternative medicine’s ubiquity marks a worrisome trend in self-diagnosis and health maintenance. Consider the danger it poses to cancer patients alone. They face salmonella infections from drinking raw milk and other unprocessed foods, electrolyte imbalance caused by coffee enemas, internal bleeding from deep body massage, and brain damage from whole-body hyperthermia; all of these have caused documented deaths. At clinics providing substandard care, intravenous infusions of various concoctions have caused septicemia and malnutrition; the gratuitous, irresponsible application of corrosive chemicals to the skin has caused horrific disfigurement. The Quackwatch Web site highlights the tragic case of Ruth Conrad, an Idaho woman who, like Debbie Benson, consulted a naturopath. In the course of seeking treatment for her sore shoulder, Conrad mentioned in passing that a bump on her nose was bothering her. The naturopath mistakenly diagnosed it as cancer and gave her an herbal salve to apply. Within days her face became painful and covered with ruddy streaks. The naturopath was delighted. “The lines are a good sign,” he told her, “because they resemble a crab, and cancer is a crab.” He told her to apply more of the salve.
Three years and seventeen operations later, traditional plastic surgeons and dermatologists finally managed to reconstruct what was left of Ruth Conrad’s face.
A LICENSE TO KILL?
How, one might wonder, do alt-med practitioners manage not to run afoul of licensing boards or other regulatory bodies?
To begin with, alt-med gurus boast credentials that skate that fine line between mere silliness and provable fraud. Gary Young, who hawks his proprietary “raindrop therapy” through a multilevel company called Young Living Essential Oils, claims to have one of those notorious naturopathic degrees—from a college that’s not accredited to issue conventional medical degrees. Authentic licenses aren’t always that hard to come by. Steve Eichel, a psychologist in Philadelphia, once obtained five of them—for his cat. The documents came from some of the pillars of the hypnotherapy community, including the National Guild of Hypnotists and the American Board of Hypnotherapy.
Another effective way to skirt regulatory censure is to offer treatment for maladies that are themselves invented and for which, accordingly, no time-honored treatment protocols exist. Detoxification therapies frequently fall into this category, as do a long list of remedies for dubious emotional dysfunctions. “We all have aches and pains, or reactions to stress or hormones or the effects of aging,” says Sally Satel. “Calling these normal ups and downs symptoms of some disease allows the quack to provide his illusory treatment. It’s a huge scandal.”
Stephen Barrett explains, “These folks have chapter-and-verse knowledge of FDA and FTC regulations and guidelines and work carefully around them.” The upshot is that alt-med practitioners must climb out on some pretty long limbs before getting in trouble. “The large health-food stores and herbal interests have lobbied very effectively to block liability,” Arthur Caplan told me.
This is where you might expect the federal government to step in, and it has—just on the wrong side. Far from protecting consumers, Washington has been complicit in the spread of unproven therapies, many of which bear the tacit imprimatur of NCCAM. One of twenty-seven specialized subagencies in the National Institutes of Health, NCCAM has its roots in the Office of Alternative Medicine, created in 1992 largely at the behest of Senator Tom Harkin of Iowa. As chairman of the subcommittee that allocated funding to NIH, Harkin, a longstanding alt-med cheerleader who credits megadoses of bee pollen for curing his allergies, earmarked $2 million in discretionary funds for the new agency. Six years later, despite an annual budget that had swelled to $19.5 million, the Office of Alternative Medicine had produced no scientifically valid evidence for any alt-med treatments—not even Harkin’s beloved bee-pollen remedy. (The FTC, incidentally, later fined the primary pollen distributor $200,000 for making false claims.) The agency’s scientific impotence should have shocked no one, critics argue, since it was a highly politicized affair run more by so-called Harkinites than by scientists. Nonetheless, in 1998 the Office of Alternative Medicine was elevated in status and rechristened NCCAM, receiving votes of confidence from Harkin and other Beltway heavy hitters like Senator Orrin Hatch of Utah and Congressman Dan Burton of Indiana. The new agency, which officially opened in February 1999, received an instant budget boost to $50 million. By FY2005, NCCAM’s budget had reached a projected $121.5 million.
Federal “oversight” of alternative medicine is a striking study in conflict of interest. Dr. Sampson of the Scientific Review of Alternative Medicine points out that two members of the original NCCAM advisory board were later awarded an aggregate $9 million in research grants. Senator Hatch, who played a leading role in a 1994 law that permits so-called nutraceuticals to be marketed without prior evidence of safety or efficacy, has received six-figure campaign contributions from the supplements industry (which also paid nearly $2 million to a lobbying firm that employed Hatch’s son). In 2000 President Bill Clinton empanelled the White House Commission on Complementary and Alternative Medicine Policy to assure that public policy “maximizes the benefits to Americans of complementary and alternative medicine”; Dr. Barrett’s own investigations suggest that almost every member of that commission had a stake in the outcome. The commission’s final report in March 2002 offered a sweeping endorsement of integrating CAM (complementary and alternative medicine) into America’s medical, education, research, and insurance systems.
Still today, there is no mistaking the government bias in its support of alternative medicine. “I think there’s very little skepticism left,” Dr. Stephen E. Straus, director of NCCAM since 1999, told the Scientist magazine in May 2004, just as his organization released its report on alt-med use in the United States. “The reality is the scientific community by and large has been enormously supportive of this.” In the release accompanying the 2004 report, Straus noted that with global estimates of alt-med usage hovering at about 80 percent, the United States “lags behind” the rest of the world. This was interesting, since in the same release, Straus conceded that the survey “does not look at safety or effectiveness.” You have to wonder: If we don’t even know whether this stuff does any good, how can it be said that we’re “lagging behind”?
I wondered too, so I phoned Dr. Straus and asked.
He replied, somewhat obliquely, “We have an obligation to lead the way in innovative medical modalities.”
“But shouldn’t those modalities be proven safe and effective first?”
“That’s what we’re trying to do. Consumers are already spending billions of dollars. So you can leave them to their own devices, or you can say, ‘We’re going to look at it in the laboratory and maybe a decade or two from now we’ll get back to asking whether that investment was wise or not.’ ”
“A decade or two? And how much money is spent in the interim? How many people do we leave to their own devices, as you put it, while we’re doing our tests?”
“The amount of money as a percentage of all research is really quite small.”
“If my math is correct, your total outlay since FY1992 is $717.4 million, most of that since 1999, when you were reorganized in your current form. It’s a fact, isn’t it, that to date you
have not come up with research that validates a single CAM method you’ve tested?”
“We’ve provided important contributions to the existing body of knowledge of methods that show promise, and certainly we’ve helped dispel the aura around some methods that don’t seem to work.”
“So if I come out tomorrow with a statement that says that chanting ‘I am well’ while inhaling my special recipe for pesto sauce can cure, say, cancer, and I get some people in my neighborhood to buy in, I could conceivably get NIH to study it?”
Straus was not happy with the question, and he let me know it. He reminded me that NCCAM denies most grant applications and said he was tired of the “perception” that his office is “an easy mark” for research money.
“But,” I pressed, “you make it clear that you study things based largely on whether or not consumers are using them. That might seem ass-backwards to some, especially with life and death at stake. Given the low odds of success, wouldn’t NCCAM’s current $121 million be better spent on an ad campaign warning people about the dangers of alternative medicine?”
“The studies show that alternative and complementary medicine is deeply entrenched. It offers a great deal of promise to people, as well as offering medical promise. For us to pooh-pooh it seems arrogant and unrealistic.”
And ‘round and ‘round we went.
A decade from now, according to Wallace Sampson, Stephen Barrett, and other alt-med critics, the government’s benign involvement in alternative medicine will have cost significantly more than $1 billion and probably will not have produced any functional guidelines for responsible usage.
Sampson offers a simple remedy: Defund NCCAM. “Its very existence,” he says, “lends legitimacy to implausible methods. And it’s an insult to standard, proven medicine.”
COMING SOON TO A HOSPITAL NEAR YOU
Perhaps the most striking irony in modern health care is that many of the same major medical institutions that once went to such great lengths to discredit nonstandard treatments are now tripping over their crash carts in their rush to embrace CAM therapies. “We’re all channeling East Indian healers along with doing gallbladder removal,” says Arthur Caplan of the University of Pennsylvania, who has no illusions about what’s behind the trend. “I wish it were as noble as ‘I want to be respectful to Chinese healing arts.’ But it’s more ‘Gee, people are spending a fortune on this stuff. We could bring it inside, do this plus the regular stuff we do, and bill ’em for all of it!’ ” With stunning candor, he adds, “I have seen in my own school [the attitude that] if this stuff wasn’t billable, we wouldn’t be doing it. You are not going to convince me that most of the doctors who see the aromatherapy office down the hall say, ‘Good, yeah, this really works.’ They know they’re just capturing customers.”
All of which suggests a cloudy prognosis for health-care consumers. “You have the books, the Internet, the infomercials, the multilevel marketing,” says Barrett. “You have it in hospitals now. You have all these channels for the charlatans to communicate misinformation.”
It must be remembered that the “wellness” market has become a major target for self-help impresarios like Tony Robbins and Dr. Phil. If, as Caplan argues, even hospital administrators are getting sucked into the world of alternative medicine simply because they see the financial possibilities, it’s hard not to think that the same incentive applies when motivational speakers begin selling vitamins, nutrition bars, “nutraceuticals,” antiaging devices, and assorted other products that are supposed to maintain good health and vigor. The fact that self-help gurus with no medical credentials have styled themselves experts on how to maintain good health should be enough to give one pause when considering various nontraditional medical options.
With Americans enduring an onslaught of medical misinformation, the oldest consumer-protection advice is still the best advice, says Sampson: “Use common sense. Be an educated consumer. Do your homework. Don’t rely on testimonials from friends, because there may be a multilevel marketing thing going on. When it comes to health care, it really is a caveat emptor world out there.”
Or maybe just keep in mind that CAM rhymes with SHAM.
CONCLUSION
A SHAM SOCIETY
This is the beginning of a civil rights movement.
—The late senator Paul Wellstone, in his keynote address to two hundred representatives of “America’s community of alcoholics and addicts in recovery,” at the Faces and Voices of Recovery Summit, St. Paul, Minnesota, October 2001
Over the past thirty years, American society has largely remade itself in SHAM’s bipolar image. The movement has gone from personal to political, individual to collective. It may be impossible to reckon the full cost of this (d)evolution, taking into account both money actually spent and revenue lost to decreased productivity and other problems. But without question, SHAM’s overall societal impact resides in the trillions of dollars. Though the self-help industry raked in “just” $8.56 billion in direct revenues in 2003, we’d do well to remember, for example, a Special Report to Congress on Alcohol and Health issued in June 2000, which estimated the broader costs of alcoholism alone at $185 billion—per year. Other estimates run even higher. Clearly the nation’s nagging substance-abuse problem, which we will explore further, reflects shortcomings in the nation’s approach to solving substance abuse. Just as clearly, those shortcomings have everything to do with the abiding influence of self-help and Recovery in the structure of those programs.
In the end, then, far more problematic than Dr. Phil’s latest book, Tony Robbins’s Life Balance Pack, some expensive corporate junket to a faraway wilderness retreat, or an inspirational lecture by a “contrepreneur” is what has been wrought, widescale, by SHAM’s social ascendancy and the increasing public buy-in.
The mainstreaming of SHAM dogma did not occur by design. No government spokesperson ever called a press conference to announce, “We’ve decided to reorganize the State Department according to what Dr. Phil says in Life Strategies” or “If we want human services to work better, we need to consider what John Gray tells us in Mars and Venus in the Bedroom.”1 Nor can SHAM alone be blamed for all of the issues facing modern society. But it is a major factor in numerous societal problems. And even when it’s just one of several contributing factors, SHAM’s influence on its cofactors cannot be overlooked. To cite one obvious example, political correctness, which has played havoc with so many areas of American life, owes much to both the culture of blame, spawned by Victimization theory, and the self-esteem movement, which grew out of Empowerment.
In that regard, SHAM has become like the iceberg beneath the waterline: mostly unnoticed, but always there, and capable of exerting a life-changing effect on all who travel those seas.
SHAM dogma probably has begun to sound pretty familiar by now to any reader who works at even a midsize company. You may recognize it in your office protocols and regulations. Or your boss might be one of those true believers who invests thousands of dollars to have high-priced lecturers come motivate the staff, even though there’s no real evidence that such motivation helps employees or the company’s bottom line. If you have children in school, no doubt you’ve seen signs of today’s emphasis on self-esteem in the work they bring home, though you may not see evidence of the school’s emphasis on much else. Perhaps you’re one of those whose family, marriage, or other relationship has been damaged by SHAM’s disdain for “codependency,” and by its exhortations to put your own happiness first, coupled with its insistence on allaying any guilt people might feel about their own questionable behavior.
We have even seen how SHAM crept into “hard” realms like medicine and health care. It’s disturbing enough that some patients are deferring if not forgoing proven medical treatment to pursue fanciful (or downright fraudulent) alternative “cures.” Worse, scientific disciplines themselves have felt the pressure to incorporate elements of actualization and have yielded to it; the University of Pennsylvania’s Arthur Capl
an told us as much about his own, much-respected university hospital. Even an august body like the World Health Organization now defines health as “a state of complete physical, mental and social well being, not merely the absence of disease or infirmity.” Funds that should be earmarked for no-nonsense health programs and disease prevention are sometimes diverted to softer, “wellness-based” models that fund everything from after-school play programs to research on loneliness.
Meanwhile, public health officials have invested millions in “outreach programs” for drug abusers at the urging of advocates like Nancy Krieger, an epidemiologist at the Harvard School of Public Health. Describing women of color who contract HIV from dirty needles and unprotected sex, Krieger wrote: “In response to daily assaults of racial prejudice and denial of dignity, women may turn to readily available mind-altering substances for relief. Seeking sanctuary from racial hatred through sexual connection as a way to enhance self-esteem also may offer rewards so compelling that condom use becomes less of a priority.” This language of Victimization helped win approval for a seven-figure outreach program for addicts.
A textbook example of SHAM’s ability to turn things topsy-turvy can be found in the field of mental health, where a legitimate interest in supporting the independence of the mentally ill has also given birth to a radical form of patient advocacy. At a presentation to the National Alliance for the Mentally Ill in 1996, Dale Walsh, the vice president of Riverbend Community Mental Health, came front and center with such revisionism. He spoke of how some among the mentally ill have taken to using the term “psychiatric inmates” to “make clear their dissatisfaction” with the “power inequities” of their treatment, and how, in California and elsewhere, backlash against that “patriarchal system” had caused the mentally ill to refer to themselves as “consumers” or even “clients” of the system. The use of such terminology, said Walsh, captured their newfound “sense of empowerment and the place they feel they occupy within the hierarchy” of mental-health treatment. Of his own mental-illness history, Walsh said he used to think “there was something wrong with me,” while lamenting the fact that traditionally “people who have been labeled as mentally ill have been considered to have poor judgment.” Walsh wrapped up by asserting that modern-day consumers “who use the mental-health system” must “play a significant role in the shaping of the services, policies, and research” that affect them as part of “taking back power from the system.” Another mental-health activist, Selina Glater of Sanctuary Psychiatric Centers, has written that “empowerment,” in a mental-health setting, is about “clearly stating what it is you need in order to feel whole again.” Inmates running the asylum indeed.
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