A BRIEF WORD ABOUT COMPLIMENTARY AND ALTERNATIVE MEDICINE (CAM) AS WELL AS MEDICAL CHARLATANS:
Though typically lumped together in ordinary discussions, Complementary Medicine usually refers to treatments used together with conventional medicine, while Alternative Medicine should be used to distinguish those treatments that replace traditional medicine altogether. By some estimates, Americans spend about $30 billion a year on CAM. That's about the same as out-of-pocket expenditures for traditional doctors, so we need to take it seriously. [22]
We include this brief section on "medical charlatans" because we believe that we have a moral obligation to explain not only what we believe in, but what we do * not* believe in, thereby distinguishing ourselves from those without rigorous standards of scientific evidence. And while we ourselves make otherwise extraordinary claims, we justifiably believe that such claims must be supported by extraordinary evidence to the satisfaction of our scientific peers and other credible skeptics. Charlatans have no such compulsion.
In their recent book opposing the untoward practices of our modern health food industry, Drs. Barrett and Herbert define a quack as anyone who fraudulently pretends to medical skills they do not possess. They distinguish among three types: dumb quacks (ignorant), deluded quacks (self-righteous, true believers), and lastly dishonest quacks (genuine con artists, confidence men, swindlers, mountebanks, or grifters). They then go on to outline thirty ways to spot a quack, including (1) exclusive reliance on anecdotes and testimonials in support of extravagant claims; (2) display of unrecognized credentials; (3) claims that they are persecuted by orthodox medicine or that their work is suppressed because it is controversial; (4) intimidation of their critics due to threats of law suits or litigation; (5) encouragement of patients to use their political support to publicize their treatment methods; and (6) charismatic individuals capable of exploiting any "placebo effect" to the maximum advantage. (See Chapter 2 of Ref. [1]).
Mercenary practitioners have deceived a gullible public throughout history. There was a time in the 1930's when it was fashionable to drink radium in distilled water as a therapeutic agent! Really? See the details in Ref. [2].
Dr. Julius Wagner Von Jauregg, received the Nobel Prize in Medicine in 1927 for his attempts to cure dementia by inducing fevers. Along the way, he deliberately infected his mental disease patients with malaria as part of their treatment (sic). Perhaps, this is one of the reasons why the Nobel Committee now-a-days waits a respectable amount of time before issuing a Nobel Prize in any of its subject areas.
In the 1940's, Cellular Therapy(injections of fetal lamb tissues) was promoted by Dr. Paul Niehans, based on testimonials from the rich and famous, despite the fact that no credible scientific evidence was ever provided that it worked.
In the 1950's, Anna Aslan, a Romanian physician, evangelized the miracle drug Gerovital H3 [3], whose active ingredient was nothing more than procaine (the routine local anesthetic that dentists use to numb your jaw before drilling into a bad tooth). Their disciples continue to proselytize these frauds even today [4, 5]. For example, it has been suggested that the metabolism of procaine into its intermediate constituents (PABA [ParaAminoBenzoic Acid] and DEAE [DiEthyl-Amino Ethanol] ) may explain its alleged benefits, although DEAE, and its cousin DMAE to which it may metabolize, can hardly have all of the affects that are attributed to Gerovital.
Even today, shops in Singapore, Hong Kong, Macao, Taipei, Seoul, and elsewhere in the Orient do a brisk business in rhinoceros horns. For poachers, a pound of horn can fetch upward of $10,000. Folk tradition dating back thousands of years asserts that the horn, when ground into a fine powder, can cure a variety of ills, promote longevity, and eliminate sexual impotence. Where did this bizarre idea come from? The mystique of the rhino is based, in part, on the size of the male genitalia and the vigor with which these two-ton animals copulate, beginning with an orchestrated horn-butting ritual that appears to resemble combat.
In Houston, Dr. Stanislaw R. Burzynski, a 53 year old Polish-born physician, defends himself against the academic medical establishment, the FDA, and various medical insurance providers on the grounds that "Copernicus, Galileo, and Pasteur were persecuted by ignorant contemporaries when they challenged the traditional assumptions of their day." However, his antineoplaston theory of cancer begs the question of mechanisms when talking superficially about "biochemical microswitches that derepress cancer genes" when it is, in fact, based on a patented derivative of amino acids and small peptides, for which there is no rigorous controlled animal or clinical trials to support such claims. Although he has treated 3,000 patients over 20 years, his successes are all poignant testimonials from ardent supporters who treat him as a folk hero. There is no mention of the expected number of spontaneous remissions that should be observed in this population after no intervention whatsoever. Sometimes, for reasons not fully understood, the immune surveillance system suddenly "wakes up" after the patient's tumor mass exceeds a critical threshold and "cures" him or her, in spite of, rather than because of, the aggressive radiation and chemotherapeutic treatments provided by unwitting oncologists. Be wary also when you are told in response to this sort of objection that traditional clinical trials will be "getting under way soon." You could be finessed, as we were years ago in 1972 by the master spoon-bending prestidigitator Uri Geller [8]. The argument against the FDA that they are allegedly protecting the interests of giant international pharmaceutical companies at the expense of promising new treatments sounds familiar, and was echoed by the AIDS-patient community not too long ago. The counter argument is that "Dr. Burzynski is preying on the desperation of the terminally ill." The good doctor has grossed $40 million from 1988 to 1994 based on his proprietary treatment regimen. True to form, he claims that "if he is put out of business by the State or Federal authorities, his patients will be the ones sentenced to suffer and die-- not him." Breaking News: On July 13th it was reported in the Los Angeles Times that "Dr. Stanislaw Burzynski of Houston has been sued for fraud by the family of a patient who died. Mark and Susan Bedient of Lockport, New York are seeking unspecified damages in connection with the death of their daughter, Christina, who died of brain cancer at age ten. The Bedients sought Burzynski's treatment in December 1995. The treatment ended in May 1996, and Christina died a month later."
Another discredited cancer cure is known as laetrile, amygdaline, or sometimes vitamin B-17 and is found in apricot pits. It contains approximately six percent cyanide, an extremely toxic substance. Thus, taking excessive amounts of this compound can be dangerous, and if used improperly, fatal. The main medical criticism commonly directed at laetrile is that patients with potentially curable cancer may choose to take it while avoiding conventional treatments, waiting until it is too late to gain benefit from a more effective therapy.
Following in the tradition of spiritual healers and religious crusaders like Tilden, Swaggart, Jim and Tammy-Faye Baker, Oral Roberts, various so-called "psychic surgeons," and so on, the latest in this series of evangelical healers is The Rev. Benny Hinn of the World Outreach Center, a Ministry based in Orlando, Florida but which is really a traveling road show filling sports arenas with the faithful in all parts of the country. Visually-dramatic on-stage swooning and physical collapse on cue of those who are allegedly healed by a "touch-of-the-master" lends an aura of mystique about this religious promotion for profit.
The practitioners of homeopathy claim to use only natural substances-- raw bovine testicles, crushed honey bees, Belladonna, cadmium, sulfur, mercury, gold, poison nut ( nux vomica), hemlock, silica, monkshood, salt, mountain daisy, venom of the Bushmaster snake, arsenic, Spanish fly, rattlesnake venom, dog milk, poison ivy, and more. Some of these substances are harmless, while others obviously can be quite toxic (depending on the dose). However, the method of dilution proposed by these practitioners leaves the concentrations of all of these substances (harmless or toxic) at less than one molecule (or atom) per therapeutic dose. If there is no active ingredient remaining at the molecular level (except perhaps for the spiritual memory of the original substance) can there be a rigorous cause-and-effect relationship between therapy and symptoms? The counterargument of homeopathy is that there have been millions of satisfied patients during the last 200 years, and they should not be obliged to meet the standards of modern scientific medicine. On the other hand, extraordinary claims demand extraordinary evidence. A miracle, by definition, violates the laws of physics. A miraculous cure is probably not a miracle at all. If something seems too amazing to be true, it probably isn't. Our demand is that claims of diagnosis and cure be reproducible and supported with good empirical evidence, even if a model-based explanation for the phenomenon in question has not yet been worked out. Homeopaths [20] are seductive in their approach, but they are charlatans nevertheless, as much as astrologers, numerologists, phrenologists, palm readers, and dowsing - all clear examples of pseudoscience. [6]
Among the strongest possible treatments of all medical interventions is the "power of suggestion," especially suggestion by a white-coated charismatic evangelist surrounded by disciples and previously-cured minions with an associated "system of hocus pocus." A simple example of this is in weight-reduction treatments for the overweight. It is naive to imagine that a proposed diet, untested against external controls, really works just because a scale shows that the patient has lost weight. It turns out that all obese patients lose weight when you simply tell them that they will, at least for a few weeks before they gain it back again. So the proper delta of comparison should not be the "initial weight," but must always be with respect to a sufficient number of double-blind, placebo-controlled patients, in evaluating a hypothetical treatment scientifically.
Let us conclude this discussion by giving just a few more modern examples:
According to Forbes Magazine author/lecturer/physician Deepak Chopra, mentor to Michael Jackson and rage of the "New Age," has so far earned more than $3 million selling books, mail-order audiotapes, oils, and herbal preparations. Chopra boasts, "I'm 47 chronologically, but 25 biologically" in his in-depth course on "Quantum Healing," based on his best-selling book Ageless Body, Timeless Mind: The Quantum Alternative to Growing Old [7]. His lectures typically cost $119 for an all day seminar for 400 persons, where you will learn that "if you selectively breathe through your left nostril, you'll open up your right-brain thinking... The mind is in all the cells of our body; you cannot localize the mind in the brain." Dr. Chopra has recently persuaded the NIH to grant his new Institute for Human Potential and Mind/Body Medicine $30,000 to study "Ayurvedic Medicine."
The second example concerns Dr. Andrew Weil, M.D., a skilled and articulate leader of the New-Age Alternative-Medicine Movement and publisher of eight popular books since 1972 on natural health and healing. Dr. Arnold S. Relman, M.D., Editor-in-Chief Emeritus of the New England Journal of Medicine and Professor Emeritus of Medicine and Social Medicine at the Harvard Medical School writes in The New Republic Magazine [8] < New Republic Magazine (12/14/98) > "If Deepak Chopra is the mystical poet-laureate of the movement, then Weil is its heavy-duty theoretician and apologist. He directs a large and astonishingly successful medical marketing enterprise that might well be called Dr. Andrew Weil, Inc."
Dr. Weil, who was a student of Dr. Relman in an earlier life, chose to post a rebuttal on his own web site < drweil > which by-the-way typically records two-and-a-half million hits a month. The principal complaint by Relman against Weil is that he largely ignores the scientific method in making his recommendations, instead relying on a large collection of "proofs by testimonial." Dr. Weil rejects this claim, saying that his collections of anecdotes and case reports are merely "uncontrolled clinical observations." They are only the first step in conducting the scientific method in order to arrive at the truth, a truth, he says, that may challenge "the dominant medical paradigm." Furthermore, he fully intends to carry out a more rigorous scientific follow-up in the future. The first of these efforts will be in carried out in conjunction with the Pediatrics Department at the University of Arizona, which was just awarded a $5 million NIH Grant to study alternative approaches to children's disorders with Dr. Weil as a co-investigator. Stay tuned for the detailed results of this study.
The third example concerns the alleged relationship between Human Blood Type and dieting. Fad diet books typically present some startling theory of human biology, promoting a diet with mystical elements - eat this but never touch that, and the pounds will melt away. A case in point is Eat Right 4 Your Blood Type: The Individualized Diet Solution to Staying Healthy, Living Longer, and Achieving Your Ideal Weight by Peter J. D'Adamo and Catherine Whitney [17] who claim that your blood type determines what you should eat. This is pure fantasy. Indeed, one reviewer suggested that the book be reclassified as fiction. As a matter of human genetics, our four basic blood types - {A, B, AB, and O} -- are determined by the presence or absence of two antigens on the surface of our red blood cells. D'Adamo suggests that one's blood type controls digestion, and that people with one blood type or another have different physical and mental traits than those in other groups. This is ludicrous and has no more scientific basis than believing that your Zodiac Sign controls your digestion. Unless you're donating blood or receiving a transfusion, which is the only time that blood type matters, you don't need to worry about your red blood cell surface antigens in order to decide what to eat. If you do lose weight while following D'Adamo's diet, which is a strong possibility, it's probably because you're eating fewer total calories. And this is nearly the only thing that really matters in losing weight. Another fellow traveler is an OB/GYN from Miami, Steven M. Weissberg, M.D. [18]
The fourth example concerns the spurious invention of "Vitamin O" by Rose Creek Health Products that was recently charged with fraud by the Federal Trade Commission for bottling and selling very expensive, pure, salt water ($10 per oz) presumably for its high "stabilized" medicinal Oxygen content (by the way, much more Oxygen can be consumed for free by just taking in one breath of air). Full page ads for this "dietary supplement" appeared in USA Today. Rose Creek's price was 20 times the going rate for generic saline solution (used for cleaning contact lenses) which has just as much oxygen dissolved. All customers are now entitled to a full refund. The FTC recently settled a law suit against Rose Creek Health Products, Inc. and The Staff of Life, Inc. for $375,000 in fines. [14, 15]
Indeed, the collection of bogus vitamins grows all the time There are now a variety of B vitamins, including Vitamin B-17 (actually laetrile, the apricot-pit derivative cancer treatment mentioned above), Vitamin F (unsaturated fatty acids, falsely alleged to be a cure for Multiple Sclerosis), Vitamin P (a flavonoid sold to relieve leg cramps), Vitamin T (derived from egg yolks and sesame seeds, alleged to cure anemia), and last but not least Vitamin U (sold to relieve ulcer pain). Internet marketing personnel are busy inventing new ones as we speak (Sigh!).
Candeling (sometimes called coning) involves the insertion of a special hollow wax candle in the ear of a subject and burning it to draw out "undesirable things," like ear wax (sic). This ludicrous concept originated in India (or maybe ancient Egypt) and is now one of the hottest treatments in the US. Not only is there no proof that candeling (or any form of moxibustion for that matter) does what is being claimed for it, the journal Laryngoscope has shown that a lighted candle could never, in principle, create enough suction to draw out ear wax. The "ear debris" left in the candle's interior, assumed by aficionados to be proof that it works, is nothing more than melted wax residue from the candle itself! Futhermore, even if you could remove wax from your ear canal with something other than a cue tip, you shouldn't want to. Ear wax is known to perform a useful function! Firstly, it traps dust and dirt, and secondly, it protects the ear drum against infection with antimicrobial agents in the wax itself. The obvious hazards of candeling, like burning yourself or having your hair catch on fire are too obvious to mention. This is another example of "magical thinking" at its worst.
With respect to the Internet, the FTC (Federal Trade Commission) has just announced plans to crack down on deceptive medical salesmen in cyberspace. Investigators have identified 800 websites that are making claims for products such as shark-cartilage tablets and magnetic-therapy devices to treat a wide variety of ailments including arthritis, cancer, chronic back pain, HIV/AIDS, impotence, and obesity. As one example World Without Cancer, Inc. of Bay Harbor Island, Florida makes claims for shark cartilage and laetrile as effective anti-cancer treatments. "When administered to cancer patients, shark cartilage inhibits the growth of blood vessels, thereby restricting the vitality of the cancerous tumor," they say. Yet scientific studies have produced no evidence that shark cartilage can prevent or cure cancer in humans," says the American Cancer Society. Indeed, sharks actually do develop cancer contrary to the book Sharks Don't Get Cancer [1993]. Furthermore, a Danish clinical study in which 17 women with breast cancer were treated with shark cartilage found that only one may have "responded" to treatment; cancer progressed in 15 of the other women. One, who went into a brief spontaneous remission, had subsequent metastases to the brain. Conclusion: Shark cartilage doesn't work, it's expensive, and it may cause GI upset. Finally, from an environmental point of view, it's not great for the shark population either. Laetrile, is used in some other countries, is actually toxic and isn't approved by the FDA. While there is no Federal ban against laetrile sales, several states have declared this substance illegal [10]. The Internet is rife with companies that "prey on the vulnerable." When the FTC notifies the webmasters at these sites that they contain questionable claims that could violate Federal law, about 25 percent of them either remove the claim or delete the website entirely.
More than 20 million American look to the Internet for health advice and recommendations
- - 70 percent of them before visiting a doctor's office. The FTC recommends that patients start
with a US Government website -- such as
www.healthfinder.gov -- that provides links to reputable sources of information. Officials
said that consumer should shy away from sites that
(1) Advertise a product as a quick and effective cure-all for a range of ailments;
(2) Shout phrases like "scientific breakthrough," "exclusive method," or "secret
ingredient;"
(3) Include impressive-sounding terminology to disguise a conspicuous lack of scientific proof;
(4) Claim the Government or other groups have conspired to suppress their product;
(5) List undocumented case histories claiming amazing results.
"Separating the good, the bad, and the ugly on the Internet isn't really easy," says Dr. Mary Jo
Deering, who chairs the Steering Committee for the Health Finder site [11, 12].
San Diego authorities have just filed a criminal lawsuit against a Nevada company, called The Little Angeles, Inc., which offered to sell over the Internet for $200 an injectable hormone called Secretin as a miracle cure for Down's Syndrome or autism. Curiously, a chemical analysis of the substance being sold found no detectable level of secretin. (Secretin is approved by the FDA for use in diagnosing gastrointestinal illnesses, but not as a treatment for autism or Down's). The company is charged with "selling adulterated, misbranded, and new or unapproved drugs, improperly acting as pharmacists, and false advertising."[16]
According to The Washington Post, Federal regulators cracked down at the end of June 2000 on New Jersey-based companies that were promoting shark cartilage products as cancer treatments. The Federal Trade Commission ordered Lane Labs-USA and Cartilage Consultants to stop promoting their shark cartilage products. The agency also fined Lane Labs $1 million for false advertising. The two companies agreed to settle the FTC complaint after contending for months that the case was "groundless," urging congressional leaders to oppose it and warning that the Federal Government was seeking to "prohibit you from purchasing safe, beneficial dietary supplements." Under the agreement, Lane Labs of Allendale, NJ and Cartilage Consultants of Short Hills, NJ agreed to stop marketing BeneFin and SkinAnswer, a topical cream, as cancer treatments. Lane Labs sold 270 caplets of BeneFin for $86.95.
Here are four examples of now-discredited earlier misguided attempts by
conventional medical practitioners to help their patients:
1. The now infamous Tuskeegee, Alabama syphilis study; in which black subjects were exposed
to syphilis bacteria and/or deliberately not treated in order to allow doctors to follow
the natural course of the disease, including its secondary and tertiary sequella;
2. Human Radiation Exposure experiments conducted by the US Department of Defense to
establish minimum lethal doses during warfare;
3. Now discredited Nasopharyngeal Radium Irradiation Treatments intended to shrink adenoids
that was used on an estimated [0.5 - 2.5] million patients during the [1950 - 1960]s, mostly
children;
4. Now discredited Thymic Irradiation of children in the 1930s when it was imagined that the
thymus gland was either vestigial or potentially pathologic (sort of like tonsils are viewed today).
Finally, the only thing necessary for quackery to succeed is for the people who know better to do nothing.
1. Stephen Barrett and Victor Herbert, The Vitamin Pushers: How the "Health Food" Industry Is Selling America a Bill of Goods (Prometheus Books; Amherst, New York; 1994).
2. Roger M. Macklis, "The Great Radium Scandal," Scientific American, Vol. 269, pp. 94-99 (August 1993).
3. Herbert Bailey, GH3: Will It Keep you Young Longer? (Bantam Books, Inc., New York, New York; 1977).
4. Alex Comfort, Say Yes to Old Age: Developing a Positive Attitude Toward Aging (Crown Publishers, New York; 1990).
5. James Harvey Young, American Health Quackery (Princeton University Press, New Jersey; 1992).
6. Mahlon W. Wagner, "Is Homeopathy 'New Science' or 'New Age'," The Scientific Review of Alternative Medicine, Vol. 1, No. 1 (Fall/Winter 1997).
7. Deepak Chopra, Perfect Health: The Complete Mind/Body Guide (Harmony Books, New York; 1991). A CD-ROM title is now being planned of Dr. Chopra's work by Geismar and Groth of Culver City, California.
8. Arnold S. Relman, "A Trip to Stonesville," The New Republic (December 14, 1998).
9. John Stossel's ABC-TV News Special The Power of Belief: How Our Beliefs Can Impact Our Minds (a one-hour broadcast on October 6, 1998 at 10:00 PM) provides an excellent revelation of why otherwise rational people believe weird things. Hypothesis: It really derives from the sort of magical thinking that children employ to help them model the incomprehensible complexities of the real world. "Santa Claus," "The Easter Bunny," and "The Tooth Fairy" are harmless fantasies that adults normally outgrow. Nevertheless, fanatical belief in miraculous events is an essential ingredient in the thinking processes indulged in by religions and other groups of adults possessing a shared, frequently ritualized collection of fantasies.
In case you missed this program, a complete transcript can be found on the web at Part 1 and Part 2 .
The interviews with James Randi, Esq. are superb. Known as "The Amazing Randi" when he worked as a professional magician, James is now a full-time evangelist debunker of all peudoscientific or paranormal hocus pocus. A two-minute RealVideo clip of John Stossel imploring a voodoo priest to place a "curse" on him is also available on the ABC News' site. "Be careful what you wish for, John," says the voodoo priest, "because you might just get it!" The power of positive suggestion has been scientifically-documented (a placebo effect). But there is an equally strong power of negative suggestion (a nocebo effect, if you will) for those who believe in the underlying assumptions.
10. John Simons, "FTC to Curb Medical Sales on Web," The Wall Street Journal, Pages A2, A8 (June 24, 1999).
11. Stephen Fuzesi. "U.S. Targeting Fraudulent Medical Advice on the Net," The Los Angeles Times, Page A11 (June 25, 1999).
12. Ragnar Levi, "Assessing the Quality of Medical Websites," Vol. 24, No. 2, pp. 41-45, Skeptical Inquirer (March/April 2000).
13. Stephen Barrett, M.D. and William T. Jarvis, Ph.D., The Health Robbers: A Close Look at Quackery in America (Prometheus Books, Buffalo, NY; 1993).
14. "FTC Settles Suite Saying Firms Touted Solution as a Cure for Cancer," p. B6, The Wall Street Journal (May 2, 2000).
15. Robert L. Park, Voodoo Science: The Road from Foolishness to Fraud (Oxford University Press, New York; 2000).
16. "Company Sued Over Sale of Autism and Down Syndrome 'Miracle Cure,'" p. A36, The Los Angeles Times (June 30, 2000).
17. Peter J. D'Adamo and Catherine Whitney, Eat Right 4 Your Blood Type: The Individualized Diet Solution to Staying Healthy, Living Longer, and Achieving Your Ideal Weight (Putnam Publishing Group, New York; 1997)
18. Steven M. Weissberg and Joseph Christiano The Answer is in Your Bloodtype: Research Linking Your Blood Type to Life Span, Love and Compatibility, Your Likely Illness Profile, Diet and Exercise for Maximum Life (Personal Nutrition USA, Inc., Lake Mary, FL; 1999).
19. Wallace Sampson and Lewis Vaughn, Eds., Science Meets Alternative Medicine: What the Evidence Says about Unconventional Treatments (Prometheus Books; Amherst, NY; 2000).
20. George Vithoulkas, International Academy of Classical Homeopathy (IACH) (Alonissos, GREECE and Gardiner, New York; www.classicalhomeopathy.com).
21. Christopher Wanjek, Bad Medicine: Misconceptions and Misuses Revealed, from Distance Healing to Vitamin O (280 pp., paperback; Wiley, New York; 2003).
22. Laura Landro, "Net Benefits: Where to Find Reliable Sources on Alternative Medicine," The Wall Street Journal, p. R7 (October 21, 2003).