Three physicians (Gladys McGarey, Bernie Siegel, and Royal Fuller) known for working on or outside of the borders of science, along with eccentric medical reformer, "Patch" Adams, MD, are profiled in "Different Drummers" (American Medical News, 8/3/90). The article gives some insight into how unorthodox practitioners view themselves. Such insights are useful to anyone who wishes to understand how well-intended, intelligent people can fall into quackery.
The editors of Obesity & Health have chosen 5 weight loss products for their 1990 Slim Chance Awards:
(Obesity & Health, Jan-Feb, 1991)
Studies of 20, 9-10 year-olds drinking aspartame or sugar- sweetened Kool Aid found that aspartame caused no harmful effects upon learning, behavior, mood, or activity levels. Consistent with other studies, sugar caused kids to become less active, not hyperactive as is commonly believed. (Pediatrics, 86:75, 1990). A second study, that measured blood glucose and insulin levels in 137 male juvenile delinquent teenagers and 41 non-delinquent controls, found that delinquent boys had slightly lower blood glucose and slightly higher blood insulin levels but there was no evidence of reactive hypoglycemia in either group. (Pediatrics, 86:254, 1990)
An edition of the International Journal of Mental Health (Vol.19, No.3, 1990) has been devoted to "Unvalidated, Fringe, and Fraudulent Treatment of Mental Disorders." The 84-page issue was guest edited by Loren Pankratz, PhD, clinical psychologist at the Portland, Oregon Veteran's Administration hospital and longtime NCAHF member. Topics covered include fallacious theories and treatment about bad blood or bad food causing mental disorders; New Age brain-wave scams; positive approaches to integrating folk and scientific medicine in a cultural setting; the abuse of amino acids in psychotherapy; misdiagnosed emotional disorders (yeast infection, environmental sensitivity, chronic fatigue syndrome); unvalidated treatment of PMS; and mental health quackery in cancer care.
Comment: This publication is a significant contribution to the literature on mental health quackery though it barely scratches the surface of this enormous field.
Allied International Corp., promoters of Fat Magnet, and one other corporate and three individual defendants, have agreed to settle charges that they made false and unsubstantiated claims for Fat Magnet diet pills. (FTC News Notes, 12/17/90)
John C. Selner, MD, reports the following incident that took place at the November meeting of the American College of Allergy and Immunology in San Francisco:
We arrived at our workshop to find a number of patients confined to wheel chairs with oxygen masks in place, or wearing filters who were identifiable as patients with so-called environmental illness. Approximately 4-hours into the workshop I was confronted by a CBS radio news reporter who interrupted my presentation to ask if I was aware of a public demonstration in front of the hotel. ..The reporter indicated that he had been informed by environmental activists that a demonstration would take place. A clinical ecologist (MD) accompanied the demonstrators as they forced their way into the workshop. When asked to leave they refused and the ecologists demanded to have access to the platform. The workshop was recessed and the speakers disbursed to reconvene after the demonstrators had been evicted by the security personnel and local police.
It appeared that the environmental activists had alerted ACT-UP members to cooperate with their demonstration. At least this would be the impression arrived at by the placards utilized by some of the demonstrators. It would appear that any programs that might address issues surrounding the effects of unproven and controversial methods of diagnosis and treatment may be targeted for such demonstrations in the future.
Irony might be found in the fact that the message the co-moderators of this workshop were attempting to highlight for psychiatrists and psychologists was the importance of taking patients very seriously who present without objective signs of disease, but with the so-called environmental illness scenario, and to recognize many of these patients may be able to be helped. Further, we were attempting to emphasize the importance of environmental chemicals in the induction of disease including psychological presentations.
Comment: It seems that organized quackery learned something about the media and the political system during the laetrile crusade. The tactics described are nearly identical to those used to legalize laetrile.
Stewart notes in her monograph "Emotional disorders misdiagnosed as physical illness: environmental hypersensitivity, candidiasis hypersensitivity, and chronic fatique syndrome" (Int J Ment Hlth, 19:56-68, 1990) that support groups not only lobby for legislation in recognition of their disabilities, and try to get the media to carry stories about people disabled by these disorders, but also threaten legal action against those who criticize the practice of clinical ecology and attempt to interfere with objective study of these disorders.
On Nov. 26, 1990 the U.S. Supreme Court refused without comment review of the Wilk vs AMA case. Although less than a victory, the court lets stand a bizarre and twisted decision that not only defies reason and justice, but inhibits professional associations from organized opposition to pseudomedicine and quackery. Chiropractic public relations promoters have had a field day with this case generally misrepresenting it as validating chiropractic care. However, there is no evidence that MDs are any more willing to expose their patients to chiropractors through referrals than before. Chiropractors are discovering that it was not the AMA any more than doctors at the grass-roots level that regard them as hazardous to their patients' well-being.
Dubious Cancer Treatment: A Report on "Alternative" Methods and the Practitioners and Patients Who Use Them, (128 pp, 1991) edited by Stephen Barrett, MD and Barrie Cassileth, PhD, was published by the American Cancer Society, Florida Division. It is based upon a two-day workshop on cancer quackery held in 1987 that featured nationally known experts in the field. Order from NCAHF Book Sales, P.O. Box 1747, Allentown, PA 18105. $10 postpaid.
The Mt. Sinai Complete Book of Nutrition (NY:St. Martin's, 1990) by Herbert & Subak-Sharp, bookstore priced at $35, is $30 at NCAHF Book Sales (NCAHF members $27), plus $2 postage ($4 to Canada).
A San Diego Judge responded to an attorney overseeing the estate of the late Virginia Livingston-Wheeler, MD, and ordered her clinic closed in early December. Concern was expressed over liability and the fact that there is no licensed physician available to head the corporation even though there are several MDs still working at the facility. According to the report, the possibility still exists that as yet unnamed individuals could take over its operation. One of VLW's stepsons, Gary Wheeler stated in an interview that "Virginia once called it (the clinic) her little gold mine." An accountant's report shows it grossed from $2.1 to $3 million per year for the past five years. (San Diego Union, 12/9/90)
A believable review of the toxicity of vitamin A appeared in the American Journal of Clinical Nutrition (52:183-202, 1990). Unlike a questionable review recently done by employees of a pharmaceutical firm known for its aggressive promotion of self- supplementation, this review is from the FDA's Center for Food Safety and Applied Nutrition. The review concludes that although the scientific information is not sufficient to definitively provide a specific minimum threshold intake for adverse effects, an intake of 25,000 IU/d is nutritionally excessive and carries some risk of toxicity. An intake of 10,000 IU/d is more than adequate and low enough to avoid toxicity in most people, but cannot be guaranteed safe for all individuals in a large population.
Bock and Atkins report (The Journal of Pediatrics, 117:561-567, 1990) on 16 years of utilizing the double-blind, placebo-controlled food challenge (DBPCFC) as a method for diagnosing food sensitivities in children. 480 children, with a history of adverse reaction to food and subsequent confirmation by DBPCFC, were studied. Egg, peanut and cow milk accounted for 73% of DBPCFC positive reactions. Skin tests were positive in 98% of DBPCFC positive cases over 3 years of age (83% below 3 years). Negative skin test is a reliable exclusionary finding researchers say. DBPCFC is the "gold standard" for both research and clinical diagnosis of food sensitivities. Bock, et al, provide a manual illustrating the proper office procedure for administering the DBPCFC in The Journal of Allergy & Clinical Immunology, 82:986-97, 1988.
Comment: One of the most troubling and abused aspects of health care is the improper diagnosis of food allergies, intolerances and sensitivities in children. Failure to properly diagnosis a food allergy can be life-threatening; false diagnoses can prevent relief, and contribute to the development of health neurosis. These articles represent a major contribution to the field of pediatric allergy diagnosis and care.
New FDA Commissioner, David Kessler, who was sworn into office on Nov. 8, 1990, stated in a letter to the Senate Labor and Human Resources Committee that "Improving enforcement at the agency will be among my highest priorities. I appreciate the fact that the heart and soul of the FDA is its nationwide field operations." Kessler co-authored a detailed study of the 1976 Medical Device Amendment and recommended many of the changes adopted by Congress. (The GMP Letter, November, 1990)
Comment: NCAHF prays that Kessler will follow through. NCAHF's only concern is that Kessler's ex-boss and mentor was Senator Orrin Hatch who has demonstrated either a naivete or tolerance toward quackery. Hatch seems to support "buccaneer entrepreneurialism" (see NCAHF Newsletter, Nov-Dec, 1990). His home state of Utah is the heartland for many herbal multilevel firms engaging in large scale quackery. According to Health Foods Business (Nov. 1990, p.6), Hatch was responsible for last minute changes in the new nutritional food labeling bill that "averted what could have been a devastating situation" for the health foods industry. Hatch's changes exempted dietary supplements from the bill's health message requirements (an admission by the health foods industry that truthful labeling is bad for business!). The bill requires the Secretary of HHS to establish a separate procedure for evaluating supplement claims. Hatch clearly is no friend of consumer health education. Let's hope that Kessler has learned from Hatch by his negative example!
People familiar with clinical tests of spinal manipulative therapy (SMT) for back pain were puzzled by the outcome of the British study by Meade, et al, (Brit Med J, 300:1431-37, 1990) which found chiropractic care to be more effective in the long term than hospital management (for chronic back pain sufferers only). Studies designed to test SMT against other modalities have consistently found that although SMT may produce more rapid relief there are no differences over the long term (for a review see Clinical Orthopaedics & Related Research, 179:62-70, 1983). The Meade study did not test SMT against other modalities but merely compared hospital with chiropractic care in which a flock of modalities were employed. It did not even equalize the number of treatment sessions nor length of time under care. The most likely answer to this anomalous finding lies in patient satisfaction.
The Ostwestry Disability Questionnaire employed by Meade is a 10-item patient self-report on the relief of symptoms during specified activities. Although the test has high reliability (.99), this matter involves its validity. Cherkin reports "there is mounting evidence that patient satisfaction is associated with desirable outcomes including self-assessed relief of symptoms" (Chiropractic Technique, 2:138-142, 1990). Parker & Tupling (Med J Aust, 2:373-376, 1976) also reported: "satisfaction at follow-up was associated with reported improvement in the condition, greater approval of chiropractic treatment, and less reporting of pain at follow-up."
DCs generally score better than MDs on patient satisfaction because of such factors as: "making the patient feel welcome"; "ability to explain problem & treatment"(1); "amount of time spent listening to my description of pain"; "seemed to believe that my pain was real"; "seemed confident that the diagnosis s/he gave was correct"; "seemed confident that the treatment s/he recommended would work"; "seemed comfortable dealing with my back pain"; "concern about my pain after the office visit" (2). The explanation that patient satisfaction rather than real differences was responsible for better long term Ostwestry scores is supported by the fact that a significantly greater portion of chiro patients reported being "satisfied or very satisfied" in the Meade Study.
Citations: 1. Lancet, 1974, June, 29, 1333-36. 2. West J Med, 150:351-355, 1989.
After a long hard struggle, the medical licensing board of North Carolina managed to delicense the only MD in the state practicing homeopathic pseudomedicine. Now the ACLU has decided to attempt to take a patient class-action case to the U.S. Supreme Court based upon a legal theory of the public's right to privacy and the practitioner's right to privacy and liberty. In other words, the ACLU will challenge the licensing board's duty to assure consumers of medical quality. Underlying this question is the fundamental that the practice of medicine is not a right but a privilege that should only be granted to competent, trustworthy individuals. The cult-like behavior of patients who will clamor on behalf of their guru should carry little weight in a matter of the state's duty to protect its citizens. It's disappointing to see the ACLU wasting its resources on the defense of pseudomedicine.
The FDA's district office in Minneapolis has halted sales of Peroxy Gel and Peroxy Spray, products made with hydrogen peroxide and aloe vera, because of false claims that they could treat AIDS, cancer, MS, heart disease, and emphysema. These were products of Vital Health Products of Minneapolis, Conrad LeBeau, President. (FDA Consumer, 12/90)
CBS's 60 Minutes has again demonstrated its inability to either thoroughly investigate or fairly report on an important public health topic. Its December broadcast "Is there poison in your mouth?" was a public disservice of immense proportions. Dental offices were flooded with calls from panicky patients asking for their amalgams to be removed. A Newsweek article (1/14/91) offered some good advice: patients are subjected to far more mercury while having fillings removed than by leaving them in, and anyone with mysterious health problems should consult a physician, not a dentist. NCAHF would add that people should be sure that the physician is not a member of the American Quack Association!
Addendum. 60 Minutes' mishandling of its report on alar has led to a $100 million lawsuit by the nation's apple growers. While the courts usually bend over backward to protect the network's freedom of speech, the tabloid-style TV show could be in for trouble.
In Sept-Oct, 1990 we reported on a tragic case of quadriplegia following chiropractic manipulation of the neck, and called for information on the risks of this procedure. A report from Canada cites an alert by the Manitoba College of Physicians and Surgeons that doctors warn patients about the risks involved in neck manipulation. The College had become alarmed after it found that six cases of brain stem injury had occurred in the province in the past 3-years. In all cases the patients suffered permanent paralysis. (The Medical Post, 1/28/86). A second report sent to NCAHF is an article from Neurology (40:611-615, 1990) describing 4 young (ages 28-41) healthy patients, who suffered strokes (Wallenberg's syndrome) following chiropractic neck manipulation over a 3-year period. All recovered with minor residual defects. NCAHF continues to be concerned about the justification for forceful neck manipulation under any circumstances. It is doubtful that the procedure could survive an objective benefit-risk assessment. We are unaware of any condition that can be helped by neck manipulation that merits the serious consequences of paralysis or stroke even if the probability of injury is slight. Neither are we reassured that the risk is only slight.
Irvine Allen Korman, MD, of Willowdale, Ontario, has lost his license for professional misconduct and incompetence. Korman's questionable practices included testing a patient for allergies by swinging a quartz ball attached to a string (ie, medical dowsing). He also advised a patient to have her metal dental fillings removed and that she was "allergic to electricity." Korman acknowledges that he has left the world of scientific medicine and practices "energy medicine." Several of his patients testified in glowing terms as to the success the doctor had in treating their "environmental illnesses." (Toronto Star, 10/19/90)
Addendum. Readers may remember Korman from a report in the May-June, 1989, NCAHF Newsletter in which his license was suspended following the near-death of child he misdiagnosed using Applied Kinesiology (muscle-testing).
On Sept. 6 and Oct. 25, FDA agents raided the Century Clinic in Reno, Nevada, seizing patient records, products and medical devices. Among the items seized was a Dermatron (a device used in the speculative field of "Energy Medicine" which alleges to measure electrical resistance on so-called "acupuncture points" from which diagnoses and prescriptions are made), homeopathic remedies, enzymes and other items. The Century Clinic is operated by Yiwen Tang, MD, who formerly practiced in San Francisco. Tang referred to the federal agents as "Nazis" (apparently he has never had any experience with real Nazis) and moaned "I thought this was a free country!"
Comment: The country sometimes seems freer than perhaps it should be, especially when it comes to the freedom allowed questionable doctors to continue practicing. For instance, Tang is permitted to practice in Nevada after the state of California placed his medical license on inactive status following an investigation into his use of laetrile as a cancer therapy and charges of negligence and incompetence (Las Vegas Review Journal, 3/4/1987). A bright note is that FDA San Francisco Regional Director Ron Johnson was quoted as saying that "these devices have been imported and manufactured in this country illegally; we regard these devices to be illegal no matter who uses them." NCAHF is pleased with Johnson's statement. Heretofore, FDA has ducked enforcing the 1976 Medical Device Act against practitioners using these devices on the basis that jurisdiction belonged to state licensing boards. The boards apparently expected FDA to enforce the federal law more vigorously than it was doing. The result was nobody did anything and unapproved devices proliferated.
The FDA sent warning letters to 6 food companies telling them to remove unsubstantiated health claims. Most were bran products. In some cases FDA complained that there was insufficient bran in a serving of the product even if evidence existed to justify a claim for bran. (FDA Consumer, 11/90)
Two Nutrition Forum articles, "The Macrobiotic Diet: no cancer cure" (March-April, 1990) and "A Kushi seminar for professionals" (May-June, 1990) provide valuable insight into the background, claims, promotion, and lack of validity of the Macrobiotic Diet. NCAHF considers Macrobiotics to be very dangerous because of needless deaths that have occurred due to applying its philosophy to cancer care. Cases of malnutrition and starvation have also been associated with the Macrobiotic Diet.
Two British doctors have been accused of offering patients an expensive AIDS treatment that offers no substantial benefit. Drs. Roger Chalmers and Leslie Davis belong to front organizations for the Transcendental Meditation cult of the Maharishi Mahesh Yogi and three herbal concoctions are called Maharishi Ayurvedic pills. The doctors regard the contents of the pills as secret and refuse to reveal their contents. They claim that the pills inhibit virus proliferation. The doctors are unable to produce evidence of effectiveness. Independent tests conducted by the National Institute for Biological Standards and Control found that the pills had a negligible effect upon the HIV virus, but were 100,000 times more toxic than AZT.
The report contains a curious story about deceased AIDS patient Steve Nixon who learned of Ayurvedic medicine through newspaper articles. Nixon was required to take part in an initiation ceremony in which he was told to bring offerings of fresh fruit and flowers and lay them on an altar in front of a picture of the Maharishi Mahesh Yogi (MMY was once the Beatles' guru). Also challenged is the claim that Ayurvedic medicines have no negative side-effects as claimed by the doctors. Warnings have been given about both TM and the Maharishi Ayurvedic Diet. (The Independent on Sunday, 8/19/90)
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 non-specific symptoms of fatigue and stress among the 5 most common reasons why they recommended supplements. (J Clin Pharm & Therap, 15:131-139, 1990)
"Today's unorthodoxy is probably going to be tomorrow's convention .." Prince Charles, 1983
The notion that many of the great medical innovators of the past were quacks who are recognized today as simply being ahead of their times, known to debunkers of pseudoscience as "The Galileo Ploy", is deeply embedded into Western folk culture. As appealing as this idea is (we all love cliches such as "I told you so!" and "They said it couldn't be done, but he went right ahead and did it anyway!"), historical facts do not support the myth that today's quacks will become tomorrow's medical heroes (its corollary that some of yesterday's medicine would be considered quackery if promoted today is more likely to be true).
In 1847, Ignaz Semmelweis (1818-65), observed that a maternity ward differed from a second with a lower mortality rate in that students came directly from the dissecting room and made vaginal exams with unclean hands. Autopsy studies revealed that fatal infections were the same. Semmelweis instituted precautions (thorough scrubbing in a chlorinated lime and sand solution) that cut the death rate by 2/3's. His university friends were convinced that Semmelweis had found the answer and urged him to publish his findings and speak before medical groups. Although sternly positive in his teaching, he refused to write and was hesitant about speaking. His medical associates spoke on his behalf.
At that time before germs had been discovered, a large number of practitioners vehemently opposed the reforms Semmelweis' supporters advocated. Opposition to Semmelweis' methods was led by his clinic director, Professor Klein, whose methods he was challenging and whom he had irritated in the past. Although opposition was strong among Viennese doctors it did not prevent him from being appointed Professor of Theoretical and Practical Midwifery at the University of Pest in 1855. In 1861, he finally published his theories and findings in a book described as "disorganized and difficult to follow" but "moving, best documented and closely reasoned." The deaths of his first two children (1862-3) depressed him and coupled with his disappointment over the failure of his book to persuade his adversaries, his mind became deranged. Semmelweis died in 1865 of the same kind of an infection, contracted during an operation, about which he had written. Ironically, the day before Semmelweis died, Joseph Lister of Glasgow, acting on Louis Pasteur's publications (Pasteur was a Professor of Chemistry, not a physician) for the first time used carbolic acid in treating a compound fracture wound. Within twenty years Semmelweis' contribution to medical science was recognized.
Semmelweis, or other innovators who met resistance, are not suitable models to be used to justify quackery. Rather, they are part of the history of science which recognizes that although people wrongly "laughed at Fulton" they rightly laughed at many, many more cranks, clowns and charlatans who were promoting nonsense. The only way to tell the difference is for proponents to produce evidence that is reproducible by others who are both skeptical and qualified to do the work. At no time did Semmelweis behave as a quack. He did not promote his methods through advertising and publicity; he demonstrated the safety and effectiveness of his methods by experimental evidence, not by anecdotes or testimonials; and, he did not seek to escape accountability by arguing for freedom of choice for his patients.