Psychologist Lynn McCutcheon discusses the confused, ambiguous, and unsupported claims being made by aroma therapists in the May-June, 1996, Skeptical Inquirer. McCutcheon reviewed books, articles and scientific reports on the topic.
Aroma therapy involves putting a few drops of some kind of fragrant plant oil in one's bath water, sniffing it from an inhaler, or massaging it into the skin. Claims such as putting fragrant oil into a warm bath will help insomnia, or rubbing oils on the genitals promotes sexual stimulation clearly confuses the action of the oils with the effects of a warm bath per se, or the effect of genital massaging. Aroma therapy theory eulogizes smell as "the most direct route to the brain," and therefore, superior as a route of administration.
McCutcheon notes that although smell may be nifty, it does not have any special advantages over other sensory pathways. Aroma therapists push the idea that natural oils are better than synthetic ones without any scientific justification. The idea that aroma therapy oils can help memory is also challenged if the smell wasn't part of the original experience being recalled. She also reveals that aroma therapy advocates are making an unwarranted pretense of science in their writings. McCutcheon provides the best critique of aroma therapy that we have seen.
Newsweek ("Herbal warning," May 6, 1996) exposes the modern health food movement for what it has become--the shopping place for the "natural drug culture." There are many herbs that can stimulate or depress the central nervous system, or distort sensory perception. In the past such were called "street drugs." Newsweek caught on when products such as Herbal Ecstasy, Cloud 9 and Ultimate Xphoria began to be promoted for energy highs, "inner visions," "sexual sensations," and "cosmic consciousness."
Health enthusiasts have long judged pills and potions by how they make them "feel." The belief that vitamins provide more "pep and energy" is one of the most prevalent misconceptions held by supplement users. Vitamin advertisers often exploit this myth. Selling "high energy" took on new dimensions when the health food industry increased its marketing of herbal remedies. Ephedrine, caffeine, ginseng, and other herbal uppers have become the stars of the new medicine show. Other herbs with powerful physiologic effects are laxatives, diuretics, and emetics.
Herbal promotions have regressed to the prescientific perception that did not differentiate foods from drugs. The ancients believed that anything they ate contained a vitalistic (ie, life-sustaining) element, and that some substances were magical in that they could liberate their "souls" from their bodies for a time. These were the mood-modifying and hallucinogenic drugs found in herbs (opium, marijuana, peyote, etc). Many of these were the main ingredients in the "patent medicines" that thrived before consumer protection laws were passed--dubbed "the golden age of quackery."
Thanks to Senator Hatch's 1994 Dietary Supplements Health & Education Act, the marketplace now resembles those outlaw years. The major difference between now and then is that the Harrison Narcotics Act restricts use of opiates and a few other abuse drugs. [If Milton Friedman and Thomas Szasz had their way, abuse drugs would be legalized (On Liberty and Drugs Drug Policy Foundation, 1992). Friedman also wrote Free to Choose (Avon, 1979) advocating eliminating the FDA. ]
The report includes information on several deaths associated with the use of herbal products. It was interesting to read the letters to the editor (5/27/96) that followed the original story. Herbal devotees tried to justify health food abuses by pointing to the misuse of approved medications. It seems to be lost on them that the difference is that standard medicines have information on proper use, contraindications, overdosage, and so forth. Herbal remedy labels rarely provide consumers with the information they need for proper use, and are often unwilling to even fulfill a duty to warn of possible adverse effects. The attorney for the family of a San Jose woman who died after using pennyroyal stated that the family had entered into a confidential settlement with the manufacturer and distributors, but had been unable to compel them to place a warning on pennyroyal bottles.
A 4,000-respondent telephone survey by the California Dept of Health Services of the willingness to vote for fluoridation has been conducted annually since 1984. Based upon pooled responses 1991-94, 71% of California adults would vote for fluoridation. About 15% would not, and the remainder are undecided. Althoug h variations were small, demographically, college graduates, older adults, and black people were most favorable.
[California Morbidity 9/95]
Frances Berg, editor of the Healthy Weight Journal, and Coordinator of the NCAHF Task Force on Unsound Weight Loss Practices, has put together an exceptional 32-page manual entitled Weight Loss Quackery and Fads. The manual provides guidelines for spotting weight loss fraud and quackery, describes the modus operandi of the weight loss quacks, and provides insight on different categories of products: creams, patches and aids; gadgets; and diet pills.
The section "Themes, schemes & combos" discusses persistent myths promulgated by weight loss quackery: "all natural" means safe, "cellulite" exists in the body, "spot reduction" can be achieved, and the notion of "detoxifying" the body. Schemes to sell weight loss products include illegal sales pyramids, hit and run scams, infomercials, and hypnosis seminars.
The last section lists specific products that have been given "Slim Chance Awards" as the worst weight loss products of the year from 1990 through 1995, and a list of 111 ingredients listed by the FDA as not generally recognized as safe and effective for weight control. The manual also tells consumers how to report fraud, and lists five different types of harm caused by weight loss fraud.
Weight Loss Quackery and Fads can be purchased for $11.95 plus $3 P&H. Order from Healthy Weight Journal Resources, 402 S. 14th St., Hettinger, ND 58639; tele: 701-567-2646; fax 2602.
Worst Product: Ephedrine-laced diet pills. Named are Formula One and Herbalife's Thermojetics, but there are many more. Side effects of these products include heart damage, stroke, increased blood pressure and seizures. The FDA reports some 330 adverse reactions and about a dozen deaths.
Most Outrageous: Kombucha mushroom tea (aka, Fungus, Kargasok, Manchurian, or Kvass tea) because of the plethora of outlandish claims that have been made for it. Burning body fat and weight loss are only two of more than 50 claims that include curing AIDS and cancer.
Worst Claim: By attending a single 2-hour Gorayab hypnosis seminar, "You can expect results ranging from 30-60 lbs in 3 months to 120 lbs in one year"; "No willpower, no hunger, no dieting, just success. Using the power of hypnosis."
Worst Gadget: Ninzu ear clips, a device that fits on the ear, claims to suppress appetite through acupressure.
[Healthy Weight Loss Journal, Jan-Feb, 1996]
Larry Hobbs, author of The New Diet Pills, claims that ephedrine plus caffeine is "the ideal diet pill." His arguments are elaborated in the June, 1996 Townsend Letter, a publication that provides a forum for the proponents of controversial health methods and a token number of critics.
Hobbs details the effects of ephedrine, caffeine, theophylline, aspirin, and L-tyrosine in various combinations and strengths. He does not deny the potential adverse effects of these substances, and discusses contraindications and possible drug interactions. Nevertheless, Hobbs is highly favorable to ephedra+caffeine products and we believe that his information will be used to campaign for their continued availability on a nonprescription basis. The "feel-good" effects of ephedra products are too much a part of the OTC herbal market for it to give up the privilege of selling these without a fight*. Although this is an advocacy article, it is well-referenced. Since diet pills also have potential for harm, weight loss professionals should read this article for perspective.
*Frances Berg says that Herbalife's Thermojetics alone was worth $70 million in 1995 U.S. sales.
The 84th Annual meeting of the Federation of State Medical Boards (FSMB) held in Chicago on April 12 has Arlene Brecher, a publicist for the Townsend Letter, in a tizzy. Brecher attended a session entitled "Fraudulent Medical Practice--Watch and Be Wary" that focused on increased attacks around the country on medical practice acts by the proponents and practitioners of alternative medicine--so-called "medical freedom" laws. Brecher declares that the medical boards' concerns about the erosion of these consumer protection laws is, in fact, a manifestation of the grand medical conspiracy against alternative and complementary medicine.
The focus at the meeting was upon chelation therapy for vascular disorders (Townsend Letter publisher and editor, Jonathan Collin, MD is a chelationist). Chelation therapy for vascular disorders is a big ticket item for maverick medical doctors and osteopaths. The fact that the medical procedure is approved for heavy metal detoxification, means that any doctor who wants to engage in the off-label use of EDTA infusion can do so. Most do not because the scientific evidence for efficacy for vascular problems is not there.
Off-label use per se is not illegal, and can be a route to finding new uses of medications approved for other purposes. Responsible doctors gather clinical data to determine if sufficient reason exists to conduct controlled trials. Irresponsible doctors are content with meeting the demand for services resulting from positive promotions. Once the FDA approves a medication for any reason, there is nothing but personal integrity or medical discipline to prevent physicians from using the medication for unapproved purposes.
When facing medical discipline, chelationists often rally their patients to political action. This is not difficult to do with patients who have been persuaded by the doctor that chelation therapy has saved them from both surgery and heart disease. Grateful patients willingly carry placards declaring their beliefs, and testify against the regulators who are characterized as bureaucratic dupes who do the bidding of the "medical establishment."
In addition to Brecher's article, Collin declared in his June editorial, "We're quacks now, by gum, we're quacks." He says that because chelationists practice a form of medicine based upon "junk" science they have been labeled "quacks" by the FSMB. His reference is to the publications of chelationist groups that carry articles extolling chelation therapy that could not pass muster in the scientific arena. NCAHF labels such organizations "mutual admiration societies" because despite having names that sound scientific, they avoid the skepticism and critical analytical debate that characterize scientific groups.
The American Heritage Dictionary defines conspiracy as: "Law: An agreement between to or more persons to commit a crime or to accomplish a legal purpose through illegal action." There is a conspiracy involved here, but Brecher has it backwards. The conspiracy is being perpetrated by chelationists who are out to defraud consumers, insurance companies, and Medicare by selling a procedure that not only has insufficient evidence of value, but has been repeatedly shown to be worthless. NCAHF believes that Collin has it right: those who substitute junk science for real science in order to create the illusion in the health care marketplace that their methods have value are quacks.
The sweetheart relationship between naturopaths and the healt h food industry became more transparent with the passage of a naturopathic licensure act in Utah. Health Forum, the lobbying organization that pulled off the action, was led by Rae Howard, President of the National Nutritional Foods Association (NNFA), and President of Good Earth Natural Foods at Orem, Utah. In NNFA Today (5/96, p.9)
Howard boasts that: "every state legislator received a visit by representatives from Health Forum and other constituents. Grassroots meetings and training sessions were held throughout the state beginning last September, to explain the bill to consumers, train them in the political process and organize support." It is said that this is the first time such a licensure bill was prepared and passed into law "through the efforts of health care consumers...and not from within the profession itself."
In the July-August, 1995 NCAHF Newsletter we reported on some of the health food industry leaders who sit on the board of Bastyr University, naturopathy's number one training school. Support for naturopathy by the health food industry is entirely self-serving.
Naturopaths prescribe the dietary supplements (eg, herbal remedies, homeopathic products, amino acids, "glandulars," "enzymes," etc) in the same way physicians prescribe approved medications. Naturopathy generally hold the same pseudoscientific views on health and nutrition as the health food industry. Thus, the industry is creating its own brand of "doctor" who will reinforce the delusions that sustain the health food movement.
As the influence of naturopathy on the population increases, one can expect that fewer children will be immunized, or enjoy the benefits of other public healt h advances. The negative effects of this symbiotic relationship is likely to be hard to detect because it represents a closed system with few opportunities to be observed by outside experts. Once a patient accepts the ND as a legitimate doctor, his/her fate is sealed. The ND is now in a position to define the patient's health or illness, and to interpret clinical outcomes as he/she will.
Most dangerous is the fallacious "healing crisis" theory which celebrates the adverse reactions users experience as "the poisons coming out of the body." Thus, if a person feels good it is proof that the remedy is working; or, if the person feels badly it is interpreted as the "poisons coming out." Therefore, good is good, and bad is also good. The fact that a patient freely chooses a practitioner goes far in legally absolving NDs from accountability because they are judged by naturopathic, not by medical, standards of practice.
On May 1, the Colorado State Board of Dental Examiners followed the recommendations of State Administrative Law Judge Nancy Connick and revoked the license of Colorado Springs dentist Hal Huggins. Huggins vows to continue his campaign against the use of dental fillings that contain mercury. He claims to be getting 5,000 telephone calls a month from people all over the world. Huggins says he will continue to consult with physicians and dentists. However, the dental licensing board says that it is against state law for a dentist whose license has been revoked to own a dental practice or to do consultation work with other dentists. Huggins complains that this violates his First Amendment rights of free speech. We may not have heard the last from Huggins versus the law. [Gazette-Telegraph (Colo Sprgs) 5/3/96]
Ginseng continues to be an enigma. Just when one thinks that he has found something that ginseng really does, something happens to spoil the joy. Recently we reported on the lack of proof for its value in physical performance. Now we see a report on a double-blind, placebo-controlled study that found ginseng elevated mood, improved psychophysical performance, and reduced fasting blood glucose and body weight in 36 non-insulin dependent diabetics. It is clear that ginseng exerts a pharmacological effect in these patients.
[Diabetes Care 1995;18:1373-5]
Comment: Ginseng is worth watching because it can be expected to come into wider use as plantations now maturing in Canada and the USA come of age for harvesting. Do not be surprised to see ginseng join coffee and tea as popular herbal drinks for mood elevation.
Hyperbaric oxygen (HBO) therapy involves treatment in which a patient breathes 100% pure oxygen intermittently while the pressure of the treatment chamber is increased to a point higher than sea level pressure (1 atmosphere absolute [ATA]). Treatment can be done in either a single patient monoplace, or several patient multiplace, chamber. Currently, it is held that pressurization should be 1.4 ATA or higher.
HBO research began during the 1930s as navies and universities around the world began to study ways to safely decompress deep-sea divers. In 1976, recognizing the need for meticulous scrutiny of emerging clinical applications of HBO therapy, the Undersea and Hyperbaric Medical Society (UHMS) established the Hyperbaric Oxygen Committee and charged it with the responsibility of continuously reviewing research and clinical data, and rendering recommendations on the clinical efficacy and safety of HBO therapy for various conditions. The Committee has met annually since then.
In 1976 and 1979, 28 indications were listed as approved for third party reimbursement. In the 1992 report, the number had been pared to 12. For approval, the Committee requires sound physiologic rationale, in vivo or in vitro studies that demonstrate effectiveness, controlled animal studies, prospective controlled clinical studies, and extensive clinical experience from multiple recognized hyperbaric medicine centers. The Committee requires that experimental and clinical evidence be at least as convincing as that for any other currently accepted treatment modality for the disorder involved. The Committee also reviews cost-effectiveness and has established guidelines for each entity.
Disorders Approved For Hyperbaric Oxygen Therapy:
Abuse of HBO Therapy
The most common abuses of HBO therapy that NCAHF hears about are in the treatment of patients who have suffered strokes, multiple sclerosis, and as in combination wit h chelation therapy for cardiovascular disease. In 1995, it was reported that former President Ronald Reagan had been diagnosed with Alzheimer's disease. It was later reported that he was undergoing HBO therapy for this problem. Although there is no scientific justification for treating Alzheimer's disease by HBO therapy, the publicity given to well-known personalities is likely to spawn some abuses.
The manufacturers of hyperbaric chambers cannot refuse to sell the devices to people authorized by law to use them. Refusal could be construed to be restraint of trade. NCAHF advises prudent consumers to contact the UHMS if they wish to check out the validity of claims related to HBO therapy, or to locate a qualified practitioner through the UHMS, 10531 Metropolitan Ave, Kensington, MD 20895-2627; Tele: 301-942-2980.
Michael Jackson and HBO
HBO appeared in a tabloid report showing a picture of Michael Jackson in a monoplace HBO chamber alleging that he slept in it to retard the aging process. The real story was that it was a publicity stunt. Jackson was about to embark upon a concert tour, and his publicist was looking for a good visual. Knowing Jackson had been treated with HBO therapy after the accidental burns he suffered while filming a Pepsi Cola commercial, the agent suggested that Jackson be wheeled out onto the stage in a hyperbaric chamber.
Jackson subsequently either had his picture taken in such a chamber, or had a composite photo prepared for publicity purposes. There was no truth to the claim that he slept in such a device. Experts say that breathing 100% oxygen would cause severe toxicity to the lungs. (2)
Citations: (1) Kindwall EP, "Use of hyperbaric oxygen therapy in the 1990s," Cleveland Clin J Med, 1992;59:517-28.(2) 10/20/95 letter, Eric P. Kindwall, MD to William Jarvis, PhD.
How Hatch helped thwart nutrition labeling reform. In 1983 the Senate's Special Committee on Aging determined that medical quackery was the #1 consumer fraud problem facing the nation's elderly. In 1984, Claude Pepper's Committee independently confirmed this finding. This inspired 3 national health fraud conferences in 1985, 1988, and 1990, and influenced the passage of the 1990 Nutrition Labeling and Education Act. However, when the reform efforts got around to dietary supplements, which are the locomotive that pulls quackery's train, the health food industry mustered its forces for an all-out attack on consumer protection reforms.
They created a sense of public outrage by employing a big lie trick. They told vitamin-loving Americans: "Don't let the FDA take away your vitamins!" They even enlisted Hollywood stars Bruce Willis and Whoopi Goldberg, who appeared in a propaganda film declaring that the FDA intended to put all vitamins under prescription. The lie resulted in over a million letters to Congress. Hatch championed their cause on Capitol Hill, and in 1994, Congress passed the Hatch-Richardson bill which put "dietary supplements" (construed to include potent hormones and herbal drugs) beyond the reach of FDA regulation.
Will Hatch subvert health insurance fraud reform? In 1992, the GAO estimated that health insurance fraud and abuse was costing the nation $70 billion. The FBI expanded its activities against health fraud, and in 1995, Director Louis Freeh told a Senate committee that health fraud costs the system $44 billion a year. It now appears that efforts to reform this area of abuse is again running headlong into the power of organized quackery on Capitol Hill. According to the April 18 Congressional Record, Senator Orrin Hatch expressed concerns to Senator Cohen about the establishment of a new health care fraud and abuse data collection program in Senate bill, Hatch stated:
The alternative medicine community has expressed concerns about this provision. I have received communications from, for example, the American Preventive Medical Associationa and the National Nutritional Foods Associationb. While we are all supportive of strong efforts to weed out health care fraud and abuse, I hope that the Senator from Maine will agree that we do not want to create an opportunity for those who might want to eliminate or discourage alternative treatments by threatening fraud actions under the new language of the bill.
Sen. Cohen assured Hatch that he has "long been interested in promoting alternative medical treatments and I do not have any desire to enact a new law which might treat such providers unfairly." Hatch asked Cohen if he "would... agree that the mere practice of unconventional or nonstandard therapies would not fall within the definition of fraud?" Cohen answered that "the practice of alternative medicine in itself would not constitute fraud."
Fraud is "an intentional perversion of truthc for the purpose of inducing another in reliance upon it to part wit h some valuable thing" (Black's Law Dictionary). NCAHF agrees that the USE of unproven methods per se doesn't constitute fraud; rather, it is the promotiond of false and unproven remedies that leads patients to substitute them for standard health care. How does a practitioner get a patient to submit to a procedure without instilling a degree of confidence in it? Can this be done without some degree of "perversion of truth"?
Legislators familiar with legal language can easily draft legislation with straightforward language that makes health fraud illegal. Hatch appears to be seeking to include weasel wordse that will exclude "the alternative medicine community" from accountability.
aAn organization of chelationists.
bA health food trade association.
c"a false representation of a matter of fact, whether by words or by conduct, by false or misleading allegations, or by concealment of that which should have been disclosed, whic h deceives or is intended to deceive another so that he shall act upon it."(Black's Law Dictionary)
d Promote: "to contribute to the growth or prosperity of; to present for public acceptance through advertising and publicity" (Webster's Dictionary).
e"from the weasel's habit of sucking the contents out of an egg while leaving the shell superficially intact: a word used in order to evade or retreat from a direct or forthright statement or position." (Webster's Dictionary)