An analysis of 13 Web sites that were listed among the first 30 hits on at least three of eight search engines using the search terms 'complementary medicine' or 'alternative medicine' or 'complementary therapy' or 'alternative therapy' and 'cancer' concluded in part that "[t]he reliability of the advice thus provided is often poor." The researchers' findings included: (1) "three sites overtly discouraged cancer patients to employ conventional therapies," (2) "[m]ost sites recommended a multitude of treatments with little consensus between them," (3) five sites "had the potential to harm cancer patients if the advice provided was followed" including one site with the HON code seal of approval, and (4) none of the sites warned about "alternative" methods that have been demonstrated to be ineffective. [Ernst E, Schmidt K. 'Alternative' cancer cures via the Internet? British Journal of Cancer 2002;87:479-480.]
Junior Mitchell, a Baptist pastor in Brooklyn, NY, and his wife Desiree Mitchell were charged in June with first degree assault on Charlene Babb, 32, who came to them for spiritual healing. As reported in The New York Times, according to police, the Mitchells performed, without Ms. Babb's consent, a spiritual healing ritual that included "cutting [the] woman's heals with a razor, pouring hot wax and flammable liquid into the wounds and setting them on fire." Ms. Babb suffered second degree burns on her feet and faced the need to possibly have part or all of one foot amputated. [Rashbaum WK. Feet burned in ritual, police say. The New York Times 6/23/02, p. 32.]
Iris and Eliezer Fernandez were arraigned July 18th in New York City on charges of assault, performing medical treatments without a license, scheming to defraud, grand larceny, and possession of a weapon, a hypodermic needle. The couple used needles to provide injections of Hyacell, an unapproved drug in the United States, to people seeking fewer wrinkles, lip plumping, breast enlargement, and other cosmetic procedures at low financial cost. The couple's anti-wrinkle treatments allegedly left the face of Freddy Borges, 47, mottled with purple scars. Other underground providers have offered similar injection procedures resulting in at least eight people hospitalized in the city since mid-June with life-threatening infections that required drainage procedures that left their faces mutilated. Dr. Thomas R. Frieden, the city health commissioner, asked that anyone who had received unlicensed treatment or doctors who treated similar infections to call 1-800-NYC-DOH7. According to Reina M. Turcios of the CDC, most of the victims in the city were immigrants from Latin America; and similar cases in the past year were reported in Wyoming and Colorado. Promotion of the Fernandez's procedure was largely through word of mouth. [Fries JH. More illegal Botox-like injections suspected. The New York Times 7/20/02, B1, B3.]
Last year The New York Times reported that police raided
a clinic, El Centro de Estética (Spanish for Aesthetics
Center), in Corona, a working-class neighborhood in Queens, New
York. Clinic staff were accused of illegal practices and operating
under unsanitary conditions. Prior to the raid a 33-year old woman
who checked in at the St. Joseph's Campus of St. Vincent Catholic
Medical Centers complained of infection after receiving at the
clinic liposuction and silicone implants in her buttocks. Doctors
at the hospital reportedly said they had treated other patients
of the clinic who had surgical complications. Vincente Galarza,
49, and John Zurita Velasquez, 45 were accused of practicing medicine
without a license. Jennifer Gando, 30, was accused of working
as a registered nurse without a license. Patricia Bautista, 37,
was accused of practicing dentistry without a license. The clinic
promoted plastic surgery, orthodontics, manicures, pedicures,
and facial tatoos to replace the need for lipstick and other makeup.
The news report also mentioned that Ilda Medina, who had a face
lift done at the cash-only clinic for $3,500, complained of knots
and scars under her ear, and said that people at the clinic threatened
to kill her if she reported them to the police. And Alejandra
Restrepo, 18, reportedly claimed to be unable to eat solid food
for weeks after receiving braces at the clinic, and unable to
afford to have the braces removed. [Koh EL. Police raid an illegal
clinic offering cosmetic surgery. The New York Times 5/21/01,
Also last year National Post (www.nationalpost.com) reported the death of a Vietnamese woman, Thi Hanh Lan Tran, 36, who may be the first person in Canada to die from surgery for cosmetic enhancement performed by unlicensed persons. Toronto police issued a warrant for criminal negligence causing death to Minh Tam Thi Le, and arrested her partner Tu Ngoc Nguyen for the same offense. Their clinic regularly advertised in Vietnamese newspapers and magazines in the Toronto area. During a cut-rate breast augmentation procedure Thi Hanh Lan Tran reportedly went into cardiac arrest likely attributable to a "freezing agent" she was given as a sedative. Plastic surgeons interviewed for the report discussed the problem of cosmetic procedures by unqualified persons operating out of backroom clinics. Stories they told included an Asian woman whose faced likely had been injected with silicone window caulking, a penis lengthening surgery that left a man unable to have sex for five years, and festering nasal infection following injections of unknown material. [Blatchford C. The beauty butchers. 5/2/01.]
A recent story in The New York Times concerned the pervasive public-health and criminal problem of beauty salon personnel offering medically complex cosmetic procedures such as Botox injections, collagen injections, laser treatments, chemical peels, and microdermabrasion while failing to operate under medical supervision as advertised. [Siwolop S. That quest to enhance beauty can leave scars. 7/14/02, p. BU9.]
Professed surgical insertions of goat gonads into human gonads and breatharianism were among the scams and schemes described in the August 26/September 2 special issue of US News & World Report on "The Art of the Hoax."
The goat gonad transplants were promoted in the 1920s and 1930s by John Brinkley, who had a diploma mill medical degree, as a treatment for impotence and eventually a variety of ailments including epilepsy and insanity. In her article, "The Doctor's Got Your Goat," Katherine Hobson wrote that Brinkley later admitted that he knew the transplants could only work as placebos and that he tucked the tissue into the patients' abdomens (exposing his customers to unwarranted risk of infection). Brinkley earned millions of dollars promoting his "Fountain of Youth" on the radio and his mail-order prescriptions. But, following a huge back tax bill from the Internal Revenue Service, malpractice suits from customers dissatisfied with his newer prostate operation, and an indictment for mail fraud, Brinkley declared bankruptcy and lost a radio station he had started in Mexico. He died a year later in 1942.
Hobson made the point that quacks like Brinkley operate today. She noted the availability of herbal products promoted as aphrodisiacs on the Internet and she quoted NCAHF President Robert Baratz, who, she wrote, sees a growing number of popular products and practices without any scientific basis: "People want simple quick answers to complex problems. And with the technology today, they get the idea we can do just about anything like thawing out Ted Williams even though he's already dead."
In his article "Swallowing Air," David LaGesse described so-called breatharianism, the practice of giving up food and water and living off air and light as "silly" and "deadly." He interviewed breatharianism promoter Wiley Brooks, 66, who was caught many years ago eating "junk food" and who says that for him hamburgers counteract the sickening effects of electrical power lines. LaGesse wrote about Jasmuheen, an Australian woman who promotes breatharianism and claims to have stopped eating in 1993, but also admits to eating cake and chocolate. She failed to complete a test by Australia's 60 Minutes TV show of her breatharianism after a few days when doctor warned that her health was collapsing. The test came after another Australian woman died in 1999 from dehydration with a copy of Jasmuheen's book Living on Light. "Two Australian breatharians went to jail for letting another initiate starve to death in 1998, and a German death the year before is tied to the teachings," wrote LaGesse.
In the introductory article to the special issue, Thomas Hayden wrote: "In the stories that follow, we present elaborate swindles, outrageous gags, and insidious disinformation campaigns. They're all hoaxes-proof there's a sap for every scam artist, an easy mark for every mountebank, a chump for every charlatan."
Edgar Stueve, who co-founded Alta Dena Dairy in California with his brother Harold in 1945 died on August 1st of amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease. He was 86. [Los Angeles Times obituary, 8/7]
During the 1980s the dairy falsely advertised that the company's raw milk products were safe and healthier than pasteurized milk. In 1989 a California Superior Court Judge ruled in a suit filed by Consumers Union and the American Public Health Association and later joined by the Alameda County District Attorney that Alta-Dena and its affiliate Stueve's Natural that "overwhelming evidenceprovedthat Alta-Dena's raw (unpasteurized) milk frequently contains dangerous bacteria that cause serious illness," that the company must stop its false advertising, and that the company's milk containers and advertising must carry for ten years conspicuous warnings. The court order also required the dairy to pay $100,000 as restitution to a fund to fight consumer health fraud, and civil penalties of $23,000 to the Alameda County District Attorney. [Raw milk creamed in California court. Nutrition Forum 1989;6(3):21.]
KOOP AND "CAM"
Commentary by William M. London
In an editorial on "The Future of Medicine" published in the January 11th issue of the journal Science, C. Everett Koop, MD, ScD, former Surgeon General of the United States criticized the "natural health products industry" for:
keeping its distance from medical research and from clinical medical practice, focusing instead on the short-term marketing advantages derived from keeping herbal and nutritional remedies exempt from any Food and Drug Administration (FDA) review of efficacy.
Dr. Koop concluded his editorial with a much needed call for accountability to consumers:
There is a potential role for some complementary therapies and natural health products in preparing us to meet the challenges of the 21st century. But it can only be played if that industry and its proponents are prepared to meet real scientific and regulatory tests of safety and effectiveness.
Unfortunately, Dr. Koop has not spoken out about the irrationality of many methods promoted as "complementary" and "alternative" medicine (CAM). Nor has he rejected CAM as marketing doublespeak used by promoters to give an image of respectability to nonvalidated and invalidated methods.
In July 2001 drkoop.com Inc., which Dr. Koop co-chaired at the time, issued a news release announcing:
Marc Micozzi, MD, PhD has joined the company's medical advisory board as principal medical advisor in the areas of complementary and alternative medicine (CAM), demonstrating the company's promise to market only dietary supplement formulas based on scientific evidence."
The release stated that Drs. Koop and Micozzi "both believe that unreliable and inconsistent information about supplements available in a burgeoning supplement industry poses a serious public health risk." It quoted Dr. Koop:
Incorporating Dr. Micozzi's expertise is consumer advocacy at its finest. Marc is helping us to raise the bar for the industry overall by reassuring customers that we've done our homework, so they don't have to.
Dr. Micozzi is not an appropriate choice to champion the use of scientific evidence to provide accountability in the health marketplace to consumers. He is the editor of Fundamentals of Complementary and Alternative Medicine (New York: Churchill Livingstone, 1996), which has been used as a textbook in many of the U.S. medical school courses on so-called CAM that have failed to apply principles of skeptical inquiry. At the foundation of Dr. Micozzi's book are the doctrines of postmodernism and cultural relativity, which actually denigrate the value of scientific evidence. For example, on p. 11, he wrote:
The point of this discussion is that everyone has beliefs, and all realities are constructed; the facts of science are as culturally contextualized as those of law, theology, or social manners. Scientific fact is only as stable as the logic that produced it and the systems that apply it. [Emphasis in the original.]
After failing to note the clear advantages of science as a process of discovery and self-correction for learning about how the cosmos-which includes purported methods of healthcare-operates, one page later he wrote:
The practice of cultural relativity is pivotal to the study of alternative medicine, because each alternative system of medicine provides a different set of ideas about the body, disease, and medical reality. Readers will find it much easier to absorb and use this material if they can willingly-even playfully-step aside from their current beliefs and appreciations, to let in new ones.
Con artists could not ask for a better worldview for their marks to have. After reading Micozzi's chapter, a quip attributed to George Orwell comes to mind: Some ideas are so silly that only an intellectual could have thought of them.
Micozzi's book includes chapters on homeopathy, "healing touch," naturopathy, chiropractic, qigong, and other scientifically indefensible systems of care, with each chapter written by proponents. No entries for quackery or health fraud are present in the book's index. I suppose it would violate the doctrines of postmodernism and cultural relativity to judge anything as quackery or health fraud.
The foreword to Micozzi's book was written by none other than Dr. Koop. The former Surgeon General did not embrace either postmodernism or cultural relativity; he clearly stated that scientific testing is essential for advancing healthcare. But overall, his foreword revealed his naïveté about the subject matter in the book.
For example, he exaggerated the popularity of various so-called alternative therapies (just as Dean Ornish, MD did in my e-mail exchange with him published in the July/August NCAHF Newsletter). He wrote that a 1993 Harvard Medical School paper in The New England Journal of Medicine found that a third of adult Americans use "complementary and alternative treatment." But the apparent popularity of "unconventional" methods in the study depended upon inclusion of survey data on use of practices such as exercise, prayer, self-help groups, and commercial weight loss programs, which are not typically marketed as "alternative" or "complementary," and which are not addressed in Micozzi's book.
Dr. Koop wrote:
This is an opportune time for us to take a second look at such alternative treatment approaches as acupuncture, botanical medicine, homeopathy, and others; not to offer these treatment modalities blindly but to expose them to the scientific method. (p. ix)
But the Harvard Medical School data suggested that, of those surveyed, fewer than 1% used acupuncture, only 3% used herbal medicine, and 1% used homeopathy in the past twelve months. And specific claims of clinical efficacy for acupuncture, the vast majority of herbal products, and homeopathy remain, even after numerous clinical investigations, scientifically unsupported. Acupuncturists have no sound basis to promote such notions as points, meridians, and flow of chi. Unless they are adulterated, homeopathic preparations-many of which are formulated with active ingredients repeatedly diluted until no molecules remain in solution-are overpriced placebos.
In his foreword (p. x), Dr. Koop suggested that the approach to "complementary and alternative medicine" should be President Reagan's credo for foreign policy: "Trust, but verify!" Dr. Koop put the cart before the horse.
Pharmaceutical Press has published a second edition of Herbal Medicines, a 530-page guide with monographs on 148 herbs. Each monograph covers identifying features, constituents, food use, herbal use, dosage, pharmacologic action, adverse effects, contraindications, warnings, references, and comments that reflect the authors' analysis and advice. The authors note that "clinical efficacy has not been established for the majority of the herbal ingredients described in this handbook and, in some instances, there is lack of documentation for chemical constituents and for pharmacologic actions." They also note that although some toxic herbs have been eliminated from products manufactured in developed countries, "safety continues to be a matter of concern." Nevertheless, they have done their best to determine what ingredients may be suitable for medicinal use. The book is intended primarily for health professionals but its main points are understandable by laypersons. For additional information, a sample monograph, and a discount order form, see Quackwatch.