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NCAHF News, March/April 1997

Volume 20, Issue #2

DUBIOUS "NUTRITION" INDUSTRY SET AT $17.2 BILLION

A study by Nutrition Business International of San Diego pegs total sales of "natural" nutrition products at $17.2 billion. Vitamins & supplements make up 52% of the market ($8.9 billion); natural foods & beverages 36% ($6.2 billion), and natural personal care products 12% ($2 billion).  Products are marketed as follows: natural food stores 44%; mass market retail (eg, drug stores and supermarkets) 26%; multilevel marketing firms 22%; mail order 5%, and "medical" practitioners 3%.

[Whole Foods, February, 1997, p.12]

Comment: This is the first time we have seen data this complete on the extent of sales of the products of nutrition-related quackery. Particularly interesting is the amount sold by multilevel marketing (aka, direct selling).  According to the Direct Selling Association [Success, 9/96:20] 7.2 million people were engaged in "direct selling" in 1995 (compared to only 222,709 in 1980 [US Census Bureau]). The proportion of the number selling supplements is not known, but it must be substantial when just a single company, Cell Tech, claimed to have 185,000 distributors in 1995.  Little wonder that Congress received a lot of mail supporting the bills deregulating supplements.  Dietary supplement sales clearly is the locomotive that pulls quackery's train.

JURY NULLIFICATION THWARTS BURZYNSKI CONVICTION

The trial of Stanislaw Burzynski for cancer fraud ended in a hung jury (6-6) on March 4. CBS's 48 Hours' interviews of jurors told the tale as to why they couldn't agree.  Clearly, the jurors agreed that Burzynski was guilty as charged of violating court orders not to distribute his unapproved "Antineoplastons" in interstate commerce, but the fact that some desperate cancer patients believed Burzynski's remedy was keeping them alive (or, at least, was keeping their hope for recovery alive) made the case too emotional a matter for them to convict him of his crimes. One juror who was interviewed admitted that she had disregarded the judge's instructions to ignore such issues. 

The CBS reporter confronted Burzynski with the calculation that, based upon his fee system and patient load, his annual income would be $20 million.  Burzynski concurred but said that not all of his patients paid their bills.  Burzynski claims that his medicine is quite costly to produce.  Cancer researcher and NCAHF board member, Saul Green, PhD, pointed to prices in a catalog showing that a bottle of medicine cost Burzynski 80 cents.

The Burzynski trial was stereotypical.  Supporters paraded with placards extolling the doctor and his cure, while the media reporter focused on a few individuals who apparently do have cancer but whose survival is no more than one would expect from any group of patients.  The prosecution is shown as dealing with technical points of law, while the doctor and his patients are "real people." 

It is classical deception by illusion.  Viewers have no way of knowing if the demonstrators are really cancer patients.  A study of a laetrile rally in 1978 found having cancer did not predict participation in an anti-FDA rally; rather being against fluoridation, disliking MDs, liking chiropractors, and shopping in health food stores were the determinants.  Viewers have no way of evaluating the real medical conditions of the patients shown.  Most are not even aware of just how normal a cancer patient can look and feel even in advanced stages of the disease.  And, no one knows the proportion of failures among the large number of patients who Burzynski has treated over the two decades he has promoted his remedy.

Trial by placard waving emotion is a form of mob rule.  More and more it seems like society is letting emotion overrule the sound judgment of carefully considered law.

CHIROPRACTIC MALPRACTICE: BUYER BEWARE!

An article in the January, 1997 issue of Smart Money ("Ten things chiropractors won't tell you") reveals that only about half of chiropractors carry malpractice insurance, and many of those who do are under-insured.  This is bad news for people who are seriously injured by chiropractic "adjustments."

NCAHF recently received a heart-breaking call from a woman who had been paralyzed from the neck down by a chiropractor.  He had only $250,000 in coverage and had filed for bankruptcy to protect his other assets.  Her lawyer was discouraged because the protracted defense being mounted by the chiro promised to chisel away at all of the money they could hope to get at in a settlement. 

The Smart Money article updated us on the tragic case of Tamara Joerns of Bakersfield, California.  Back in 1990, the 27-year-old mother of three was made a quadriplegic by a chiropractic neck adjustment.  She lost her case against him because a judge ruled that the manipulation did not amount to substandard care, ie, it is something consumers can expect from chiropractic care. (This case was cited in the Sept-Oct, 1990 NCAHF Newsletter)

Comment: Information about chiropractic malpractice has been hard to come by in the past.  Chiros once boasted of their low malpractice rates, but apparently those days are over.   According to the major insurer, 5% of chiros are defendants at any given time. From 1991-5, National Chiropractic Mutual Insurance Company (NCMIC) paid over $73 million for 1,403 losses.  The most common claims were for:

Disc problems 27.6%
Fractures 13.8%
Failure to diagnose 13.1%
Prior condition aggravated 7.1%
Cerebrovascular accidents 5.4%
Burn 3.4%
Therapy 3.0%

["Most common causes of chiropractic malpractice lawsuits," JMPT, 1997;20:60-4]

CLASSIC ON HOW QUACKERY ADVANCES --
HOW THE NIH OFFICE OF ALTERNATIVE MEDICINE CAME TO BE

"Beyond the pail" by Bilger [The Sciences Nov-Dec, 1996:16-20] provides a detailed account of how a small-time Minnesota dairy farmer (Herbert Saunders) inspired a crusade that "breached the wall between conventional and 'alternative' medicine."

Bilger's play on words (ie, "pail" for "pale") is a tip-off to his interesting writing style.  Detailed in Bilger's account is both the science that semi-legitimizes Saunders' sales pitch and the layman's viewpoint of the situation.

NCAHF president William Jarvis believes that quackery wins over its allies primarily because of peoples' inability to accurately interpret their personal experiences with health and healing.  "Even honest, intelligent, experienced physicians can be fooled by subjective clinical experiences," says Jarvis, "that is why double-blinded methods of scientific testing evolved."  Physicians who have participated in such trials often tell of how they have been humbled when the codes were broken and those treated by placebo versus the real medication were revealed.

Roberts, et al,a measured the deceptiveness of clinical illusions by reviewing medical and surgical treatments that were thought to be effective at the time they were reported in the literature, but which were later found to be ineffective in double-blind, placebo-controlled studies.  A random search and analysis settled upon five therapies involving 6,931 patients.  It was concluded that nonspecific effects in healing could be expected to produce positive effects in 70% of cases in treatments that had failed under controlled conditions. 

Whether they be cranks who sincerely believe in their off-beat theories, charlatans who deliberately deceive their victims, or health hucksters who merely sell whatever fads people are buying at the time, all quacks can be fooled into believing what they promote is working for someone. When a powerful politician is converted by his personal experience, the result can affect all of society as clearly happened in the case of Saunders' milk cure. This is a classic on the social psychology of quackery.

a"The power of nonspecific effects in healing: implications for psychosocial and biological treatments," Clin Psych Review, 1993;13:375-91.

ARTHRITIS "CURE" STIRS HOPE

Media coverage of The Arthritis Cure has turned glucosamine sulfate and chondroitin sulfate into the hottest remedies for osteoarthritis sufferers.  The "wear and tear" apparent in osteo-arthritis is actually due to excess action of proteolytic enzymes that break down tissue in the normal maintenance of joints.

In a patient information statement (1/27/97), the American College of Rheumatology informs consumers that although early animal studies suggested that glucosamine could slow cartilage breakdown, and small, short-term human studies showed a modest decrease in symptoms, no convincing studies have shown a long-term benefit.  These substances still are regarded as promising, but they have not been proved safe or effective at this time.

Supplements are widely available in health food and drug stores, but consumers are warned to keep in mind that the FDA cannot regulate these products unless serious harm from their use is clear. Health professionals should ask their patients about their use of such products, and report adverse effects to the FDA MedWatch, 5600 Fishers Ln, Rockville, MD 20852-9787; 1-800-FDA-0178.

1997 SLIM CHANCE AWARDS

Worst Product

The Equinox Weight Management System is an herbal program based upon the quack theory that our bodies must be "detoxified" for proper balance and function of digestive and enzyme systems.  Included are Equi-lizer Fast Start capsules (claimed to suppress appetite, stimulate calorie consumption and burn fat), Equi-lizer Steady Burn capsules (claimed to increase thermogenesis and stabilize appetite), Equi-lizer Night Time Formula (claimed to promote weight loss while you sleep, reduce sugar's ability to produce fat, reduce toxins, and help detoxify your body), Protein Plus Chrome Mate capsules ("essential to keep calorie-burning capacity at its peak"), Equi-vites Multi-vitamin tablets, and Equi-lizer Almond Bars. Combination costs about $164 a month. Equinox is a multi-level marketing company located in Nevada.

Most Outrageous

Absorbit-ALL PLUS. Full-page ads across the country in July, 1996 touted this product in blazing headlines "Guaranteed to blast up to 49 pounds off you in only 29 days! ... Blocks up to 15 times its weight in fat, blasts up to 50% of your body fat in record time, obliterates up to 5 inches from your waistline, and zaps 3 inches from your thighs before you know it." Just more chromium picolinate mixed with mysterious ingredients like "Asian root...fat blockers" in a pill that "stimulates your metabolic rate and prevents lean muscle loss while the fat just melts away!" $49.95 + 5.95 S&H for a 30-day supply. SlimAmerica, Inc, Deerfield Beach, FL.

Worst Claim

Svelt PATCH.  A stick-on patch to be attached anywhere on the body. Purports to absorb fat, trigger fat burning, speed up metabolism, stimulate thyroid, fight water retention, prevent muscle loss, control appetite, and maintain weight loss--all of which are illegal drug claims.  "Fucus--a natural algae" (sic) is the active ingredient alleged to be absorbed from the patch.  Each patch lasts 24-hours, and a 4-week supply costs $42.95.  Svelt-PATCH International is located in Canada.

Worst Gadget

Slimming Insoles. Insoles covered with small knobs slip into your shoes and supposedly cause "weight loss with every step you take."  The knobs are claimed to stimulate foot reflex centers that control kidneys, bladder, and stomach through acupressure--"a 5,000 year-old Chinese therapy."  The theory is that weight problems are often linked to "under-performance of the dietary system."  Therefore, when these organs are primed to function efficiently through acupressure your metabolism "works normally and does not store fat!"   Testimonials claim that no dieting or exercise is needed: "I lost 74 pounds!" $19.95, Body Well USA, New York City.  The Slim Chance Awards are presented each year by the Healthy Weight Journal which is edited by Frances Berg who is Coordinator of the NCAHF Task Force on Unsound Weight Loss Practices.

[Healthy Weight Loss Journal, Jan-Feb, 1997]

JURY TAGS CANCER DOC WITH $4.7 MILLION JUDGMENT

Nicholas Gonzales, MD, New York City, has been promoting modifications of "Kelley Metabolic Therapy"* for nearly a decade. Gonzales was sued by a patient who he was treating for cancer and "monitoring" via hair analysis. Gonzales repeatedly told the patient that she was improving, based upon hair analysis. In fact, hair analysis does not provide indicators of cancer, or cancer levels, in the body.   Gonzales' program is zany enough that even a jury could see through it.  He has been ordered to pay $4.7 million in damages to Julianne Charell for malpractice, and the jury is still deliberating how much he must pay in punitive damages. [NY State Supreme Court, Manhattan, 3/26/97]

William Donald Kelley, DDS, received national attention when the popular film star Steve McQueen died while undergoing his quack cancer in 1979.  The fact that Kelley's ideas on cancer were figments of his imagination was made clear in his self-published booklet One Answer To Cancer (1969).  Kelley claimed to have "diagnosed" himself as having cancer, and also "cured" himself--in both instances using patently absurd methods.  He lost his dental license for his bizarre activities in 1972. The last we heard, Kelley was living in Pennsylvania with Carol Morrison, MD.  He says that Gonzales' program is not the same as his.

OHIO AMENDS EPHEDRINE BAN

Products containing ephedrine (aka, ma huang) will be back on the shelves of health food stores in Ohio after 3/31/97.  The amount of ephedrine that a single unit (pill or serving) may contain under the new law is 25 mg.  Products must also carry a prominent warning that improper use may be hazardous to health.  No one under 18 yrs old may buy the drug and promoters may not represent that the products cause euphoria, ecstacy, a "buzz" or "high," or an altered mental state; nor can they claim that products heighten sexual performance or increase muscle mass.  The new law resulted from grass roots lobbying by the National Nutritional Foods Association President-elect Joe Bassett, who owns two health food stores in Toledo.

[Herbalgram No.39:25]

THE IDEA vs THE REALITY OF "ALTERNATIVE" MEDICINE

William T. Jarvis, Ph.D.

The author has been tracking the use of nonstandard healthcare for 25 years.   Washington and Alaska Blue-Cross was good enough to share the unpublished results of its AlternaPath experiment in which 1,000 subscribers were enrolled on a first-come basis for one-year's coverage of alternative care (alt-care) in 1994.  The program took in $170,000 and paid out $650,000. Some of the overcosts apparently were due to subscribers stocking up on supplements.  The marketing analysis made it clear to me that there is a difference between the idea of alt-care and its realities.   Because the study found that consumers believed that alt-care coverage should include naturopaths, homeopaths, acupuncturists, nutritionists, chiropractors, massage therapists, and possibly herbalists, I will limit comments to these providers.  The ideas presented below are those expressed to market analyzers by AlternaPath consumers.

Idea:  There is a high demand for alt-care.

Reality:  This misperception is likely due to widespread misreporting of the 1993 New England Journal of Medicine (NEJM) study [1] which stated that 34% of Americans used "unconventional" (not "alternative") medicine.  The survey found that 13% used unspecified "relaxation techniques" for insomnia, headache, high blood pressure, digestive problems, anxiety, and depression; 10% used "chiropractic" for back problems and arthritis; and 7% used "massage" for back problems, sprains or strains. These 3 accounted for 30 of the 34% utilization, and only 36% of the users "saw a provider," reducing the percentage who used providers to 12%.

Among the remainder were commercial weight-loss programs (eg, Weight Watchers, Jenny Craig, NutriSystem), health spa methods, and self-help groups (eg, Alcoholics Anonymous).   The alt-care providers named by AlternaPath users constituted only 11.4 % of use, 2/3 of which was chiropractic.  The data do not support the NEJM statement that "the frequency of use of unconventional medicine in the United States is far higher than previously reported."

An earlier landmark study [2] found that 1% reported "ever having used" a naturopath in 1969, but naturopathy didn't even make a showing in 1990.   Acupuncture use was under 1%, which was substantially less than the 4% Harris reported in 1987. [3] The use of homeopaths was very low in both studies--.5% reported "ever having used" a homeopath in 1969, while .32% used a practitioner in 1990. Only two areas showed a significant increase in use: over-the-counter herbal and homeopathic remedies, both of which are clearly due to aggressive marketing in the face of lax regulation by the FDA. A major homeopathic journal acknowledged that although there has been a lot of favorable publicity about homeopathy, and sales of homeopathic medicines to consumers who use these without much knowledge of homeopathy "are way up," sales to physicians and consumers using the more traditional homeopathic medicines "are flat." [4]

Idea:  Alt-care would save money over time because of an emphasis upon prevention and wellness.

Reality:  In many instances, adding alt-care has increased costs to insurers without providing any measurable benefits. In 1983, Blue Cross of Arizona was forced by the legislature to cover chiropractic on the theory that competition would cut healthcare costs. A 3-year study found that outcomes took a different direction than lawmakers had hoped. The average chiropractic case cost was $587, which was 8% higher than surgeons, and 352% higher than general practice MDs.  From 1984 to 1986 chiropractor's claims rose much faster than hospital, or MD, costs (70% versus 23% and 33% respectively). Within 79 categories of service, DCs were the most expensive in 32.

Among the most common diagnoses for which DCs render services, their average charges were $370, versus $166 for DOs and $112 for MDs.  There was no reduction in hospital admissions for conditions within the DC scope of practice. The volume of service provided by DCs increased to the point that by mid-1986, it accounted for more than all physician providers combined within the chiropractic scope of practice [5]. A comparison of DC v hospital outpatient care in the United Kingdom found DC care more expensive, despite being limited to 10 treatments [6]. CHAMPUS, the U.S. military medical program, did an 18-month demonstration project to determine the cost-effectiveness of chiropractic. It found that chiropractic care adds costs to health care programs without providing improved health to an insured population [7]

Idea:  Alt-care providers look at the whole person.

Reality:  Alt-care providers have a narrow view of disease and its treatment.  Acupuncturists place needles on imaginary "points," chiropractors are obsessed with manipulating the spine which some believe is a panacea. Naturopaths overemphasize dietary supplements, and tend to focus on the colon. Homeopaths are supposed to pay attention to emotional complaints, but prescribe medications in the same manner as do regular physicians.

Alt-care providers focus more upon patient satisfaction than regular doctors, but much of this is contrived.  Practice management seminars teach DCs how to trick their patients into unneeded care, how to rope them for a lifetime of useless "preventive" care, and how to make them believe that chiro care is "working." Patient deception was intricately described by sociologists who worked as chiropractic assistants [8].

Idea:  Alt-care providers spend more time with you.

Reality: Some alt-care practitioners do spend a lot of time with patients, but others do not.  Homeopaths are trained to spend 30-45 minutes with patients, and to spread treatment over extended time periods, but such is inefficient and not likely to set well with managed care administrators.  Most chiropractic practice builders emphasize high-volume practices, and teach DCs to train assistants to line up patients so the "doctor" can go down the line "adjusting" spines.

Idea:  Alt-care providers focus on prevention.

Reality:  Alt-care providers make a pretense of practicing preventive medicine by prescribing lots of dubious supplements. But their methods of prevention are apt to be just as unproven as their therapeutic procedures.  In fact, many alt-care providers attack scientifically proven preventive measures (eg, immunization, fluoridation, pasteurization, food irradiation). "Diversion by a homeopath" was the most common reason for parental refusal to immunize their children in the United Kingdom.[9].  In the USA, 46% of chiropractors would support a policy opposing the American Public Health Association's policy promoting immunization [10] Naturopaths traditionally bad-mouth immunization [11].

Idea:  Alt-care providers use natural treatments and remedies.

Reality: Natural is defined in many ways (ie, 2a being in accordance with or determined by nature; 11b untouched by the influences of civilization and society; 13c having a form or appearance found in nature) [12]. Poking acupuncture needles into the skin, swallowing homeopathic concoctions elaborately prepared according to Hahnemannian principles, manipulating the spine, colonic irrigations, or swallowing handfuls of dietary supplements are no more "natural" than medical procedures.

In the case of fluoridation, alt-care providers have been against this procedure which merely adjusts the level of fluoride in water to mimic tooth decay prevention seen in nature.  Immunization also is based upon mimicking naturally.acquired immunity discovered by medical pioneers such as Jenner.  Registered Dietitians promote food rather than pills for good nutrition, but alt-care providers are notorious for pushing dietary supplements. Alt-care may be mystical or low tech, but it is not as natural as science-based medicine.

Acupuncture, chiropractic, homeopathy, naturopathy, and some types of massage therapy are rooted in vitalism, "the theory that biological activities are directed by a supernatural force; opposed to mechanism." [13] Supernaturalism is the opposite of the concept of naturalism upon which the basic sciences undergirding evidence-based medicine are based. Although most of the alt-care systems named claim to be "holistic," vitalism represents dualism, not holism. Vitalists believe in a Life Force that can exist apart from the physical body. Acupuncturists call the force chi, chiropractors The Innate, homeopaths vital energy, and naturopaths the vis medicatrix naturae.   Many vitalists go so far as to interpret herb-induced hallucinations as "out of body" experiences. Some have said that the failure of a patient to respond to treatment meant that "the spirit has decided it is time to leave the body." Modern science is truly holistic because it holds that the "mind" is a functioning brain that is inseparable from its anatomy.

I believe that alt-med succeeds because providers: (1) use buzzwords that resonate with their patients (eg, "natural," "nontoxic," "nutritional," "preventive," "holistic," "wellness") but are only vaguely understood; (2) employ "feel good" methods (herbal uppers & downers, hands-on procedures such as massage and manipulation that increase suggestibility, do "pep-talks"); (3) exploit the wishful thinking of patients; (4) exploit the symbolism of "good" vs "bad" foods, including the guilt induced by people's pursuit of pleasure; (5) exude self-confidence; and, (6) have a "never-say-die" approach that strings patients along.

Some of these tactics are not compatible with tight-fisted managed care programs. Anyone insuring alt-med should consider the nature of hard-core alt-med users. Many are health neurotics with an insatiable appetite for attention and pill-taking. Alt-care is appealing to some insurers because it is low-tech and dietary supplements are cheaper than medications.  The low cost of low tech methods may offset the propensity of alt-care providers to over-treat, but as a policy-holder, I would not want my premium dollars wasted on alt-care. Insurance carriers should limit alt-care coverage to an optional assessory strictly on a business basis.

References

  1. NEJM, 1993;328:246-52.
  2. National Analysts. A Study of Health Practices and Opinions. Wash, DC: National Technical Information Service, Dept of Commerce (distributor) PB 210 978, 340 pp. 1972.
  3. Louis Harris & Assoc. Health, Information and the Use of Questionable Treatments: A Study of the American Public, US DHHS, Sept, 1987.
  4. Resonance Jan-Feb, 1994, p.23.
  5. Financial Impact of Chiropractic Benefits on Health Care in Arizona; Blue Cross/Blue Shield Exper, 1983-86. 2/87.
  6. BMJ, 1990;431-7.
  7. CHAMPUS Chiropractic Demonstration, Aug, 1993, Task III Report MRI Project No.8533-D, 1/24/86.
  8. Cowie JB, Roebuck JB. Ethnography of a Chiropractic Clinic. Macmillan Free Press, 1975.
  9. BMJ 1995; 310:227.
  10. JMPT 1994;17:584.
  11. Pediatrics 1981;68:407-10.
  12. Webster's New Collegiate Dictionary.
  13. Dorland's Illustrated Medical Dictionary, 25th Edition. WB Saunders Co. 1974.


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