A group of feature articles by The Kansas City Star (6/10/90), "Doctors of Deceit," reveals common ways that health fraud is perpetrated by doctors, pharmacists, chiropractors, and hospitals. Some of the tactics described were unbundling: separating a procedure into several steps and billing for each; upcoding: exaggerating the services provided; ping-ponging: bouncing patients back and forth between doctors; generic drug switching by pharmacists; false billing, and double billing. Patients also cheat by faking accidents (in collusion with crooked attorneys and doctors or chiropractors) and by collecting on multiple policies. This article increases one's vocabulary on health fraud and also helps distinguish health fraud from quackery per se.
Grouped with this article is another which points out that most crooked doctors go unpunished, and still another that presents the fascinating case of Harold Hopkins who, although he already had a doctorate in biology, became a chiropractor and made a science out of ripping off the system. He and his wife (a minister's daughter) are both doing time for insurance fraud. Described as well-educated, church-going people who led Boy Scouts and taught underprivileged children to read, the Hopkins' story is a sad case of white collar crime.
Psychologist Dr. Loren Pankratz describes the evolution of magic as originally used to control and enslave people, to entertain, and eventually to perform the socially useful function of exposing fraud. The author provides a bibliography of books written by magicians for the purpose of educating and warning the public. Included are fascinating insights into the personalities and experiences of many of the world's greatest conjurers. Pankratz discusses the tension within the magician's community regarding the use of deception as entertainment versus personal influence. He states that magicians perform an important benefit to society by reminding people of their vulnerability to deception. (The Linking Ring, December, 1989).
Devices promoted by health spas called "toning tables" employ the theory that continuous assistive-passive exercise (CAPE) will achieve a significant measure of physical fitness. A test of CAPE divided 43 sedentary, postmenopausal women into three groups: (1) CAPE training (N=15); cycle ergometer (N=14); and, (3) control (N=14). The CAPE training consisted of 10 minute bouts on six CAPE tables twice per week. The CAPE group did not improve in body girth measurement and actually decreased in oxygen uptake (a most important measure of aerobic fitness in which more, not less, is better). (Martin D, Kauwell GP. Medicine & Science in Sports & Exercise, 22:(4):523-527, 1990.)
Comment: "Passive-exercise" is a contradiction of terms. Flexibility can be improved by passive stretching, but this has no effect upon strength or endurance. Claims to the contrary are extraordinary because they contradict an enormous body of research in exercise physiology. Remember that extraordinary claims demand extraordinary evidence.
ILLINOIS DC ACKNOWLEDGES CHIROPRACTIC FAILINGS
Mark Sanders, DC a practicing Illinois chiropractor, and former chiropractic school instructor, writes: "If you suspect that diagnostic shortcomings and therapeutic abuses still plague the profession, you're right!" in Medical Economics (9/17/90). Dr. Sanders says that while he believes that spinal manipulation is bona fide therapy for selected patients with back, muscle and nerve problems, "a lot of chiropractic is a sham." Sanders details typical, common abuses by DCs including inadequate diagnoses, abuse of X-rays, treating according to Palmer's original single-cause of disease concept, use of bizarre nonscientific procedures, reliance upon dubious methods taught be "practice builders" to build up business, and more.
Response from the chiropractic guild has been disappointing. Some DCs are crying-out to have Sanders' license revoked. They moan that it would be all right for him to criticize chiropractic from within but do not wish to have their dirty laundry aired in public. Others deny that his criticisms are valid, claiming they are outdated. One expressed relief that the article appeared in a medical journal rather than a popular magazine.
Comment: None of what Sanders says is news to followers of the chiropractic enterprise--these abuses are widespread and contemporary. What is commendable is that a DC will publicly acknowledge abuses. DCs have yet to learn that open criticism of one's own peers is an essential part of the scientific process. Abuses by medical doctors are exposed by other physicians in the publications of organized medicine (that's were doctor-bashers find grist for their mills). It is the public-relations minded DCs who prevent progress by stonewalling the failings of their guild. Sanders gives chiropractic more credibility by his frankness than all of his DC-critics have ever generated by their self-serving promotions.
HEALTH TEXTBOOKS FAIL TO WARN ABOUT QUACKERY
NCAHF President William Jarvis was asked by the California Textbook League (CTL) to evaluate the coverage given quackery in health textbooks used in California schools. The CTL asked Dr. Jarvis to develop a set of criteria a priori and then apply their inventory of health texts. Six textbooks were evaluated using the letter-grading system familiar to educators. Grading ranged from C+ to F. Being Healthy (1990) by Harcourt Brace Janovich received the highest grade and Addison-Wesley Health and Safety (1989) flunked for not even mentioning quackery. Jarvis not only reviewed portions of the textbooks that dealt directly with quackery but looked at sections on consumerism that may have provided useful information on self-protection even if quackery wasn't mentioned by name. ("Health texts fail to warn of quackery and its perils," The Textbook Letter, 1:(3):1+, July-August, 1990.)
Note: The publication of the textbook review was timely to be used as a handout at a presentation on the harmful impact of quackery upon children given on October 17 by Dr. Jarvis at the Annual Convention of the American School Health Association. Dr. William London, President of the Ohio Council Against Health Fraud presided.
It is estimated that more than one million Americans per day utilize tanning parlors in which they are exposed to some UVA lamps that generate more than five times the UVA radiation reaching the Earth's equator. Dermatologists are concerned about the potential for injury and long-term damage to the health of users. This is the topic of an article entitled: "Tanning Parlor Regulation: A Paradigm for Physician Involvement in Public Health Issues," (State Health Legislation Report, 18:(2):1-12. Summer, 1990).
Health Schemes, Scams & Frauds by Stephen Barrett, MD, and the editors of Consumer Reports Books, will be published in December, 1990 and ready for shipment in mid-January. It covers arthritis quackery, dubious cancer therapy, fringe medicine, "fad" diagnoses, chiropractic, the dental mercury amalgam scam, weight control fraud, real vs. bogus allergies, and many other topics. The price will be $13 plus $2 or $3 for postage. However, advance buyers can get the book for $13 postpaid from LVCAHF, Inc. P.O. Box 1747 Allentown, PA 18105.
Comment: As a reviewer of the prepublication drafts, I can assure readers that this book is the "state of the art" anti-quackery book for consumers. William Jarvis, Editor.
Virginia Livingston-Wheeler, owner and operator of infamous Livingston Clinic in San Diego, died this past June of heart failure while on a European tour. VLW purported to have discovered a bacterium which she believed to be the cause of cancer. She dubbed her pet Progenitor cyptocides (PC). Scientists who looked into her microscope merely saw a variety of common bacterium. VLW's explanation was that PC was "pleomorphic" (appearing many different forms). VLW alleged to cultivate patient's urine and develop an anti-cancer vaccine and prescribed megadoses of vitamins which were sold at her office window. VLW was ordered to cease and desist her dubious cancer treatments in February, 1990 (see NCAHF Newsletter, March-April, p.5).
The national media widely covered the book 6892 Questionable Doctors compiled by the Public Citizen Health Research Group (PCHRG) in June, 1990. NCAHF obtained a copy and checked it against its own listing of physicians guilty of serious misconduct do not appear. This limits the book's value as a reference source because some very bad actors could slip through if this were the only net used for screening. This failing is not the fault of PCHRG. It was limited to information supplied by state licensing boards. We agree with PCHRG's conclusion that there is too little discipline being done. However, rather than simply bashing the licensing boards or organized medicine for this failure, we believe that the real problem is that behind every successful quack is a shyster lawyer keeping him/her in practice. The lawyers intimidate professional critics into silence, and manipulate the legal system which has always been too lenient with white collar crime. The book includes a section on how to use it. It recommends a series of actions to take if "the doctor you are considering is listed here." Our guess is that most people will stop there. The actions recommended are too cumbersome for most people to follow through on. The section gives useful information on how to file a complaint. The book's description of the U.S. "system" of medical quality control is revealing. It is described as a "patchwork system" which is "largely uncoordinated and ineffective." Its' expose of the dismal status of consumer protection is, we believe, the book's greatest asset.
Comment: The questionable doctors book is a worthy project, but falls far short of what is needed to serve as a guide to help consumers avoid questionable doctors. Further, naturopathic, homeopathic, chiropractic licensing boards, whose practitioners have an appalling tradition of health fraud and quackery, don't even have a compulsory national registry for wrongdoers.
A survey of pharmacists and their practices in the USA vs the UK found that 40% of US vs 28.6% of UK pharmacists recommended vitamin-mineral supplements more than 5 times per week. A large number placed the non-specific symptoms of fatigue and stress in the 5 most common reasons why they recommend supplements. (J Clin Pharm & Therap, 15:131-139, 1990)
A landmark publication, The Mount Sinai School of Medicine Complete Book of Nutrition (St. Martin's Press, 1990) is hot off the press. Edited by Victor Herbert, MD, and Genell Subak-Sharp, this tome has more than three dozen contributors. Comprehensive, authoritative, and most important, easy-to-read, this book provides a resource to anyone interested in reliable nutrition information. Price: approximately $35 in hardback.
Colorado has added itself to a growing list of states that outlaw the use of diploma mill credentials to claim expertise. House Bill 90-1090 classifies as deceptive trade practices as claiming either orally or in writing to possess either an academic or honorary degree, or the title associated with said degree, unless the person has been awarded said degree from an institution that is accredited by a regional or professional accrediting agency recognized by the U.S. Department of Education or the council on post-secondary accreditation. There are other categories that qualify too lengthy to detail here, but the new law clearly outlaws the false labeling of individuals with bogus credentials.
Judge Kaye Tertzag, Wayne County (Michigan) Circuit Court ruled on August 29, 1990 that Thermography devices were not within the scope of chiropractic; do not locate subluxations; are for differential diagnosis only; and, are not scientifically valid to monitor physiology. Thermoscribe, NCM, and dermathermograph are even less reliable than infrared or liquid crystal thermography. Hofman v Auto Club Insurance Case #85-500355 CZ.
Big Green (California Proposition 128), the radical environmentalist's solution to pollution, lost big at the polls. No one knows for certain why, but the best-guessers are pointing to voter's rejection of every initiative that cost more money and everybody seemed to agree that the cost of Big Green would have been astronomical. It would be nice to be able to report that the reason Californians rejected Big Green was because they saw through the sham, but there is no evidence to support that idea.
Big Green's promoters used big lies which may reverberate around the state for some time to come. In speeches, Tom Hayden would hold up a red shiny apple and state that it had been grown without Alar. He declared that "they" (the defenders of Alar) said that apples "couldn't be raised without Alar; that apples would be little shriveled up things that no one would eat. You can see," he would add, "this is a perfectly good apple." He lied. Alar was used to help keep ripening apples on the tree and to keep them firm and red during post-harvest storage. None said that apples would change in appearance. However, there are some common food crops that may become a luxury if pesticides were regulated by the unrealistic (and unnecessary to protect health) standards that would have been imposed by Big Green.
The most appalling, despicable and cynical lie by Big Green's backers was the misuse of a child with cancer who, bald from chemotherapy, appeared in TV-spots implying that her cancer was caused by pesticide residues, whimpering "I cannot vote, but you can." A TV-news interview with the little girl's parents revealed that her mother had been an activist for an environmental group during the anti-Alar campaign. The mother stated that when her little girl came down with cancer, she offered the child to the promoters of Big Green. What exploitation! What a travesty! There is no reason whatever to connect any child's cancer to pesticide residues, but this big lie was broadcast throughout California.
Anti-Big Green TV-spots featured former Surgeon General C. Everett Koop, MD who stated that he had spent his entire life working on behalf of the health of mothers and children, and that if he believed Proposition 128 would protect their health he would be in favor of it, but that it would not and he was not. He stated that he believed that public policy should be based upon science, not scare tactics.
Koop's message was an abbreviated way of saying that public health measures, which have done so much to deliver the record longevity Americans presently enjoy, are dependent upon science and technology. Included are not only immunization, fluoridation and pasteurization, but food production methods that make an abundant, varied supply of safe, nutritious foods available the year around at low cost. Radical environmentalists have made themselves blind to the truth regarding the high health status of the nation. Good nutrition is one of the cornerstones of public health.
Our guess is that the apocalyptic environmental radicals will go back to a strategy of picking off one technology at a time, as they did with Alar, rather than attempting the shotgun approach represented by Big Green. They will capitalize upon the public distrust engendered by these big lies which undoubtedly still smolders in the minds of many Californians. A good review of Big Green's fallacies appears in the Fall, 1990 issue of Priorities.
National media reports proclaimed that a miracle had occurred at Loma Linda University Medical Center (LLUMC) in which an infant born with a hypoplastic left-heart syndrome (HLHS) and small mitral and aortic valves who was awaiting a transplant suddenly became normal. The implication was that a paranormal healing event had occurred. In fact, a remarkable event did take place, but the word "miracle" only applies in a non-paranormal sense. Doctors monitoring a 2-month-old boy awaiting a heart transplant for several weeks realized changes were taking place never seen before in dozens of infants with HLHS monitored at LLUMC, nor had any such thing appeared in the literature. In time, the heart had grown to nearly normal and the mitral valve, though small, was sufficient. Surgery still had to be performed to remove a constriction in the aorta. No one at LLUMC suggested that a paranormal event had occurred. Such an interpretation occurred in some people's minds because LLUMC is a Christian hospital. Specialists at LLUMC pointed out that the baby's HLHS had been atypical at the outset, and that this type of growth and development should not be expected in typical HLSH cases. (LLU Today, 10/24/90).
Russell S. Worrall, OD, details the bizarre cranial manipulation method, "Neural Organizational Technique", promoted by a New York chiropractor that was used on learning disabled children in Crescent City, California (see NCAHF Newsletter, p.3, March-April, 1988). NCAHF considers this case to be an outstanding example of irresponsible action on the part of school officials entrusted with the well-being of children. Dr. Worrall's article provides insight into what transpired during that sad affair. (The Skeptical Inquirer, 15:40-50, Fall, 1990).
The FTC has charged Miles, Inc. with making unsubstantiated claims in their ads for One-A-Day Vitamins. The FTC complaint cites the following claims:
Diet books are always leaders in the popular trade market, and the slant they take seems to follow trends (eg, hypoglycemia, weight loss, fiber, low cholesterol, immune system enhancement). The new trend emphasizes environmental concerns. Harvey Diamond has extended his area of non-expertise to include world food production and the environment. David Steinman, who appears to be a follower of the cult of L Ron Hubbard (Scientology) has written Diet for a Poisoned Planet that is loaded with health misinformation and scary falsehoods. Steinman advocates a "detoxification" or "purification" program which includes megadoses of niacin, saunas and exercise to purge body toxins invented by Hubbard and promoted by Health Med, a Scientology-linked agency. The FDA issued a "talk paper" on 10/19/90 which states that Steinman distorts health statistics and FDA's data in his book. The bandwagon is rolling and all manner of strange people seem to be following the adage: If you see a movement coming, get out in front and pretend to be leading it!
The Bristol Cancer Help Center (BCHC) was set up in 1979 to offer a variety of alternative therapies in the United Kingdom. Included is a stringent diet of raw and partly cooked vegetables with proteins from soya and pulses. The ideology of BCHC is that cancer patients can contribute to the healing process in an active way. BCHC offers counseling, "healing," and alternative therapies claimed to enhance quality of life and a positive attitude to cancer. The BCHC staff and patients felt a need to validate scientifically the results they felt had been achieved. They invited in a team of doctors and scientists who came up with two studies; one to compare survival and the other quality of life. The survival study ran from June, 1986 to June, 1988 and followed 334 women with breast cancer attending the BCHC for the first time between June, 1986 and October, 1987. Controls were 461 breast cancer patients attending a specialist hospital or two district general hospitals. 85% of the BCHC patients were under age 55 at diagnosis, more than half had experienced recurrence before entry. For patients metastasis-free at entry, survival was significantly (2.85 ratio) poorer in the BCHC group. Survival was also significantly poorer among relapsed patients in the BCHC group (1.81 ratio). Researchers note that substitution of the BCHC program for standard therapy is not an issue since few patients had rejected conventional treatments. It is possible that some important difference exists between patients selecting BCHC and the controls. The BCHC patients seem to exhibit a stronger commitment to healthful living since far fewer smoked than normal, and 41% were already using alternative therapies (ie, diet or "healing") upon entry to BCHC. It is possible that the radical diet actually shortened patient's lives.
(The Lancet, pp.606-610, Sept 8,1990)
Comment: The BCHC study provides some important lessons. First, the BCHC staff obviously felt that something worthwhile was happening to patients in their program. The lesson to be learned from this is that subjective observations are deceptive. People view selectively tending to accentuate the positive and eliminate the negative. Objective analysis can be heartbreaking when it fails to confirm what seems like a good thing. Second, this experience underlines the fact that many people engaged in cancer quackery are sincere. They have had experiences that reinforce their belief that something real and good is happening to patients using their remedies. The lesson here is that sincerity and good intentions are not enough; only objective, critical analysis can determine the real value of therapies. "The great tragedy of science is the slaying of a beautiful idea by an ugly fact." Huxley
Skeptic: "... taken from the Greek word skeptomai which merely meant to 'look at something carefully'" and 'examine' and 'consider' it." Funk C. Word Origins. Bell Publ Co, 1978. Cynic: A faultfinding captious* critic; one who believes that human conduct is motivated wholly by self-interest. *Marked by an often ill-natured inclination to stress faults and raise objections. Webster's New Collegiate Dictionary, 1975.
NCAHF founders rejected Ralph Nader's adversarial approach that delineates "consumers" versus "industry" as separate classes of people because it encourages cynicism rather than the much-needed skepticism, in its original meaning. True skepticism is the essence of the science that must undergird our regulatory system in our capitalistic democracy. All of us have a stake in safe and effective health care, safe food and water, and a healthful environment. The same error is made when "environmentalism" and "industry" are posited as separate classes. This message was clear in TV "sound bites" during California's recent political campaign: if industry had input into the initiative, no more need be said, it couldn't be trusted. NCAHF believes that we would all be well-advised to take a skeptical rather than a cynical approach to our ecological problems. Just as in consumerism, rational regulatory policies are needed, not extremism. We advocate skepticism in these matters. Cynically posing business as completely untrustworthy serves no useful purpose. Nevertheless, we are firm supporters of government regulation.
NCAHF founders rejected Ralph Nader's adversarial approach that delineates "consumers" versus "industry" as separate classes of people as wrongheaded in a free enterprise society such as ours. Consumerism works best by supporting regulatory policies founded in science and consumer protection law. NCAHF is not anti-business, but we deplore the business philosophy popularized by Milton Friedman in his book Free to Choose. Victor Herbert dubbed this business philosophy "buccaneer entrepreneurialism" at the 1990 National Health Fraud Conference. We think that it is a term worth remembering.
Friedman became a guru of a kind of cult of Adam Smith that asserts that a free marketplace will automatically sort the good products and services from the bad. Former President Ronald Reagan is a notable disciple. Reagan brought devotees of the cult to Washington. They were the people who put the FTC on its misguided course of threatening professional health organizations which oppose competing quack organizations with anti-trust; stopped FDA from banning raw milk in interstate commerce until forced to do so by court action; allowed health claims for foods; lowered the standards used by FCC to control abuses within broadcasting which eventually led to "infomercials" that even Reagan's own son used to sell snake-oil band-aid weight loss patches; pillaged HUD, and the S&L's. Some regulatory reforms were advised when Reagan took office, but no one had called for deregulation in health (Kennedy, Health Affairs, 2:39-51, 1983). Reagan has boasted of the new small businesses that started under his tenure. Unfortunately, a portion of those business are the multilevel health scams that advance the "freedom of choice" battle cry. The freedom the buccaneers desire is their own freedom from accountability. Buccaneer entrepreneurialism is a libertarian philosophy advocating "buyer beware" in which victims are blamed for their folly when outsmarted by shrewd entrepreneurs.
GOLDEN PRIDE PRODUCTS
Golden Pride Products is a West Palm Beach, Florida company that markets its product line by a multilevel scheme. Promotional literature contains health misinformation and obviously illegal medical claims:
NCAHF warns consumers to be alert to false and misleading health claims by dealers selling these products, and urges government agencies that oversee false claims and the unlicensed practice of medicine to take action against violators.