NCAHF holds that the most fundamental factor in the success of health fraud and quackery is misinformation. We have observed that the use of misinformation about sugar is a favorite practice of food quacks. The University of California, Berkeley Wellness Letter (December, 1989) presents a listing of facts and myths about sugar in "The healthy eater's guide to sugar." False negative information about sugar includes the notions that "kids have more cavities than ever because they eat so much refined sugar," "sugar is the leading cause of obesity," "eating too much sugar will cause diabetes," "sugar makes kids hyperactive," "you can become addicted to sugar," "sugar can raise blood cholesterol in most people," "eating a candy bar before exercising will give you 'quick energy'," and "it is best to eat as little sugar as possible." This 2-page piece is a valuable educational tool. NCAHF thinks that a strong relationship may exist between misbeliefs about sugar and a proneness to quackery.
Dale Alexander, the self-styled nutritionist who advocated taking cod liver oil and orange juice for arthritis has died at age 70. A promoter of dubious nutrition for four decades, Alexander was author of five books titled Arthritis and Common Sense, Good Health and Common Sense, The Common Cold and Common Sense, Healthy Hair and Common Sense, and Dry Skin and Common Sense. Alexander was one of 11 California gubernatorial candidates in 1966. (Los Angeles Times, 6/17/90).
A Bakersfield woman became paralyzed from the neck down following chiropractic manipulation for neck pain. Tamara Joerns, 27, mother of three, is described as a former cheer leader, homecoming princess and track athlete. She now spends her time in bed unable to speak or control her routine bodily functions. Mrs. Joerns went to the chiropractor on the advice of her mother who now cares for Joerns' two sons. The family has filed a $5 million lawsuit against Leonard S. Ross, DC. [The Bakersfield Californian, 9/2/90].
Comment: NCAHF is told that this is not the first case of paralysis attributed to Ross, and that he carries only minimal malpractice insurance. We are also informed that there have been at least five other cases of paralysis in the Bakersfield area attributed to chiropractic manipulation. NCAHF warned that paralysis was one of the hazards of rotary neck manipulation in its position paper on chiropractic, however, we accepted organized chiropractic's contention that such events are extremely rare. We may have been misled. We have been told that defense attorneys often are successful in preventing media coverage of these tragedies. We are investigating the risk of paralysis related to manipulation further. Any aid readers can provide will be appreciated.
APPEALS COURT REVERSES JUDGE, RAW MILK DAIRY HELD LIABLE IN DEATH
In 1987 a Pomona (Calif) Superior Court jury awarded $40,000 to the family of Paul Telford, finding that his death was the result of an infection caused by drinking Alta Dena Dairy Certified Raw Milk. However, Judge Theodore Piatt overturned the jury's verdict citing "insufficient evidence" and granted the dairy a new trial. On June 13, the California Court of Appeals overturned Piatt's ruling and reinstated the verdict against Alta Dena Dairy. (Alta Dena Dairy no longer sells raw milk; the product involved in Telford's death is now sold as "Stueve's Natural.")
Comment: In fact, Judge Piatt was very obstructive and would not permit evidence that linked the dairy's herd directly to the infection in Telford's body (see NCAHF Newsletter, July-August, 1987).
The long awaited final OTA report is now available from the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325. Ask for Unconventional Cancer Treatments, GPO stock No. 052-003-01207-3. Price: $14.00 (312 pp.)
The Oregon agency details the specific techniques used to counterfeit diplomas from the Hollywood College. They say: "In addition to listing the graduation date as the "17st day of June," the diploma copy contains several very obvious internal inconsistencies in spacing, line and calligraphy. It is not copied from an integral diploma. Instead it is, with a different name of recipient, a copy identical to one that has been determined by the Arizona Department of Public Safety to be a photocopy manipulation..." (The case of Jess Franklin Lee, No. 87001-A, June 24, 1988).
Comment: The Oregon action was prompted by reform efforts within the naturopathic community to purge itself of practitioners with fraudulent diplomas. In our view, this represents a small, but significant, step in the right direction of a very long journey.
Two New Jersey physicians, Linda Choi and Priyakant Doshi, partners in the Medical Nutrition Center, have had their medical licenses suspended for one year (sentence stayed and probation imposed) for improper medical practices. Both must cease and desist from treating vascular diseases with EDTA chelation therapy, diagnosing and treating "Candida Albicans Overgrowth Syndrome" (an unrecognized condition), utilizing hair analysis in the clinical evaluation of patients (except for lead poisoning), and stop permitting unlicensed assistants to administer intravenous solutions. (Consent orders filed 6/5/90, New Jersey State Board of Medical Examiners.)
Comment: The doctors were prosecuted in this case despite the fact that the indictment noted that the FDA has granted an Investigation New Drug (IND) permit for a clinical trial of EDTA chelation therapy for heart disease. Noting that the granting of an IND only permits a clinical trial, it does not prove the value of a therapy. Interestingly, the FDA recently dropped EDTA chelation therapy from its list of Top Ten Health Frauds (FDA Consumer, October, 1989) because of the IND issuance. It seems as if the agency is confused about the meaning of an IND, or health fraud, or both.
Janis Johnson provides an excellent critique of popular fitness videos in the health and fitness magazine Vibrant Life (July-August, 1988). Included are guidelines on how to pick a home exercise video. Routines should be well-rounded, approved by a person's physician, capable of being individualized, accompanied by useful advice, easy to follow and enjoyable, led by a qualified instructor, gradual and progressive, and available for previewing.
On September 13-14, the Dept. of Health & Human Services, U.S. Public Health Service and FDA, sponsored a Western Regional Health Fraud Conference for the Latino Community in Los Angeles. An excellent slate of speakers addressed the problem of health fraud, misinformation and quackery within the Latino community. Many myths rampant in the dominant "Anglo" culture were also addressed. The interface of folk medicine and quackery is more apparent within the Latino community, but more similarities than differences exist. NCAHF participants were William Jarvis, on folk remedies & health fraud; James Lowell on Mexican border clinics; Grace Monaco on unproven cancer remedies; and, Robin Nishiwaki on combating health fraud within the community.
A common abuse by health writers is referring to scientific health care as "traditional medicine" Webster's defines tradition as: "the handing down of information, beliefs and customs by word of mouth or by example from one generation to another without written instruction." The term is correctly applicable to folk healers, not to modern medicine. Modern medicine is iconoclastic which is anti-tradition. Iconoclasts tear down tradition. "The influence of modern science" is cited as an example of iconoclasm by Webster's 3rd New International Dictionary. Regular medicine is often referred to as "traditional medicine" implying that it is staid and closedminded. In fact, it is traditional medical systems such as ancient Chinese, Indian (Ayurvedic), astrology, and the like that cling doggedly to fanciful pre-scientific notions about energy meridians, pulse diagnoses, heavenly influences on behavior, etcetera, which are thousands of years old. Closedmindedness seems to be a virtue in these systems.
"Organic foods: consumer attitudes and use" (Food Technology, 43:(11): 60-66, 1989) reports on a survey taken in September-October, 1987 (before the alar hysteria) on California consumers' attitudes toward organic foods (OF's). 57% considered OF's better, 35% the same, 7% worse than conventional foods. 30% said that they planned to buy OF's within the next month, 28% did not; 53% had bought OF's in the past and 23% had not. People who did not buy cited availability, high price and the fact the product was no better than conventionally grown foods as reasons. The most frequently purchased type of OF's in order were fruits, vegetables, chicken, eggs, beef and pork. Food safety was the main concern of the respondents in this survey with 80.2% marking it "very important." Price was of least importance with 49.5% marking it "very important." Residues and additives were of greatest concern.
Comment. It is important to note that this survey focused upon food safety. We sense that there may be a shift away from food safety to concerns about the environmental impact of modern agriculture given the current political climate.
A British study of 741 randomly assigned patients aged 18-65 that compared chiropractic treatment with hospital outpatient care (utilizing more conservative physiotherapeutic techniques) in the treatment of low back pain without nerve root involvement found that although there was no difference in outcomes in patients with no history of back pain, those with such a history who were treated by chiropractors (DCs) fared significantly better at 6, 12 and 24 month follow-ups. Outcome was evaluated by a questionnaire (Oswestry score: a self-assessment of pain intensity, including pain while lifting and sitting) [Brit Med J, 300:1431-7, 1990].
Chiropractic propagandists are overstating the findings of this study. Its design places great limitations on its generalizability.
This was a pragmatic study meaning that the types of therapies applied in the 11 (of each) participating hospital and chiropractic clinics was not controlled. A pragmatic study does not compare one therapy (99% of the DC-treated subjects were manipulated compared to only 12% of hospital-treated) with another but compares treatment sites that consumers might select. This limits the value of the data. In fact, it is the type of design NCAHF President William Jarvis has long advocated as a starting point in testing the efficacy of chiropractic.
Second, the researchers excluded patients with contraindications (eg, nerve root involvement, weakened bones, structural abnormalities) to avoid harm. If DCs do not screen for these contraindications the pragmatic patient population of DCs would differ from this study.
Third, chiropractic care was limited to a maximum of 10 treatments. This is less than DCs are apt to do when on their own.
Fourth, the chiropractic care in this study extended over a significantly longer time period (up to 30 weeks compared to a maximum of 12 weeks at hospitals) and involved 44% more sessions.
Fifth, Chiropractic care was more expensive ($280 vs $190). This may have been compensated for by less work absenteeism following care.
Sixth, we have been unable to obtain information on the reliability and validity of the Oswestry test. We would have preferred a performance test rather than a questionnaire as a method of observation.
Lastly, researchers know that treatment groups may vary significantly even when random assignment is employed, especially when numbers are below 1600 (hence, the importance of replication of research findings by others). This reviewer finds it curious that major differences in patient performance was still apparent two years later. This suggests that a real difference may have existed in the two groups despite randomization. Given the natural history of low back pain, there is little, if any, reason to expect that treatment intervention would have such long term effects. Curiously, NCAHF has received several letters from DCs saying "I told you so!" Apparently, they have not read the NCAHF Position Paper on Chiropractic in which we state: "There is substantial evidence that manipulative therapy has value in treating back pain." Although we state that there is no evidence of long term benefits which is now questionable. We also state that: "Chiropractors probably are more skilled in the art of manipulation than other practitioners...(and)..usually the most accessible..." The fact is that NCAHF has always been supportive of chiropractic care for functional back pain. It's too bad that it took MDs to design a study that DCs should have conducted themselves. We wonder if this study will affect chiropractic services. Will DCs:
NCAHF remains dedicated to helping responsible DCs bring their manual treatment skills into the main stream of health care.
Note: The NCAHF Position Paper on Chiropractic has been described as "a milestone contribution to the knowledge and understanding of those concerned about societal and community health care issues as they relate to chiropractic. This document ...provides an updated review and objective analysis of manipulative therapy ..." [White and Punjabi. Clinical Biomechanics of the Spine, 2nd Edition. Philadelphia: Lippincott, 1990, p.434].
Robert Rodale, 60, owner of Prevention magazine and other publications was killed in a auto accident in Moscow, September 20th. Although NCAHF has long regarded Rodale's publications as unreliable sources of health information, there have been marked improvements under his leadership in recent years. We saw Mr. Rodale as a key player in producing popular publications that would reach the public with sound health information. We extend condolences to the Rodale Press family and hope that they will continue the reforms Robert Rodale evidently supported.
Wellness Lifestyle Health Plan, a new HMO-type program, is being promoted in Arizona as an alternative to regular medical insurance. Organizers say they will offer the services of herbalists, chiropractors, midwives and acupuncturists. Hal Card and chiropractor Kurt Donsbach are behind the scheme. Card is the former Operations Manager of the National Health Federation. He is billed as Chairman of the All American Consumer Cooperative Association. The plan is described in Donsbach's Wellness Lifestyle Magazine (1/90, p.53-4).
The Kentucky Board of Medical Licensure disciplined Walter W. Stoll, MD, for prescribing amphetamines for himself and another patient in Oregon whom he hadn't examined in 15 years. Stoll, 53, was placed on probation for 5 years and had his license to prescribe controlled substances suspended. He will also be required to submit to random urine testing for drug abuse and see a psychiatrist. It is reported that nearly 50 sign-waving Stoll supporters demonstrated outside the Board's Louisville offices. The demonstration was organized by Nancy Erwin, a housewife who is president of the National Health Federation's Kentucky chapter. (The Courier Journal, 8/17/90).
To understand quackery one must begin with a study of humankind's earliest notions about the nature of disease and healing. These are inseparable from fundamental beliefs about the nature of reality itself--including the physical world, humanness (life & death), and natural forces. How these have been perceived in the past by the common folk constitutes the history of folk medicine while the history of ideas traces the views of thought leaders (i.e., philosophers). The history of ideas includes the history of medicine and the development of science, including the development of medical research methodology.
Academic specialization divides these up into fields of study in ways that are not always helpful. Anthropology is the academic discipline most concerned with folk medicine and culture. Although anthropologist produce high quality papers in their own fields, they often show a lack of understanding of experimental science in general and medicine in particular. Anthropologists often use their discipline as a platform from which to attack science and modern medicine which they erroneous dub "Western" as if physical laws and the causal agents of disease operated differently in the "East." This attitude fosters cultural conflict that can seriously impact upon public health policies.
An exceptional monograph [Glaser. "Accountability of anthropologists, indigenous healers and their governments: a plea for reasonable medicine," Soc Sci Med, 27:(12):1461-1464, 1988] challenges anthropologists to be more responsible in their portrayal of modern medicine and folk healers. Anthropologists are fond of decrying the dehumanizing aspects of modern medicine and paying great tribute to the use of magic and ritual in primitive therapeutics. Shamans and witch doctors are often heralded as being superior healers because of their attention to dispelling hexes and other culturally defined evils. Although there seems to be little dispute over the idea that an effective way to get rid of an imaginary hex is through a ritual, anthropologists may exaggerate the effectiveness and the "bedside manner" of traditional healers [see side box] (ie, barefoot doctors, herbalists, bone doctors, shamans). Glaser questions the notion that traditional healers are actually effective health care providers in the same sense as are modern doctors who practice on the basis of science. He challenges anthropologists to be scientific in their analysis of the value of traditional healing.
Reference is made to the dearth of outcome studies of native medicine. The few that have been done do not show good results. A study of spiritualist healers found a cure rate of less than a 50% which was less than spontaneous healing should have done. The lack of scientific acumen by the anthropologist was revealed when she gave credit to the healer for the cures that did occur despite the absence of a control group. The article also helps explode the myth fostered by anthropologists that native healers are more generous with their time than modern doctors. A study of curanderos found that treatments often involved only 1-2 minutes of conversation.
One writer is cited who "admits that it is easy to be intimidated into advocating for traditional indigenous healing practices." The World Health Organization is accused of "pandering to nationalistic pride" by not dealing objectively with the real effectiveness of native medicine. It is noted that wealthy people in third world countries patronize modern scientific doctors and the poor use folk healers. Poor people are entitled to quality medicine as well. Giving credence to the value of folk medicine without evidence they are effective is irresponsible. The monograph is worth reading because it has implications for those who must evaluate and regulate traditional folk medicine practices in primitive settings, as well as those who must deal with folk medicine which has been converted to quackery in modern settings.
The National Health Fraud Conference (NHFC) was a splendid event that brought together quackbusters, quacks, quackophiliacs (ie, lovers of quackery) and others. The conference began with a Sunday evening show by magician Bob Steiner of how persuasive deception can be with alleged ESP feats and a demonstration of psychic surgery. Monday and Tuesday plenary sessions covered: the history of quackery and consumer protection (William Jarvis); current experiences with health fraud (Victor Herbert); the Postal Inspector's efforts against mail-order health fraud (Ass't Chief Inspector, Kenneth Hearst); current FTC initiatives against health fraud (Assoc. Director for Advertising Practices, Lee Peeler); AIDS quackery, fraud and misinformation (Jarvis, Wallace Sampson and John Renner); what needs to be done to combat quackery (Stephen Barrett); what the FDA is doing to combat health fraud (Ass't to the Assoc. FDA Commissioner William Schwemmer); and, what the HHS Inspector General is doing about health fraud (Inspector, Linda Lloyd). Workshops were held on: investigative techniques; child advocacy; techniques used in billing insurance companies; the role of state Attorneys General; chiropractic nonsense; analyzing false claims; chronic fatigue real & unreal; dental health fraud; legal aspects of health fraud; and, how New Age health fraud is marketed to the church.
As with past health fraud conferences, dissenters were present to demonstrate. This time it was ACT UP, the radical gay-activist group that effectively shut down the FDA offices in Rockville and booed HHS Secretary Louis Sullivan to inaudibility earlier this year. As is their right, ACT UP members picketed in front of the hotel. Signs they carried badly misrepresented the purposes of the conference, revealing deception by organized quackery. Consistent with their history, ACT UP members exceeded their rights by engaging in civil disobedience by blocking the hotel entrance by mass lay-downs--including the cutting open of a feather pillow--in the hotel doorway. Unlike Federal agencies, the NHFC is private and does not have to put up with these disruptive tactics. The KC police were quick to arrest and remove violators. At least 17 arrests were made.
Attempted disruption of a meeting was limited to Dr. Victor Herbert's presentation. Herbert proved to be up to the challenge and continued to present a lucid exposition of organized quackery while funny-looking people exploded into the room or popped up from within the audience doing irrational acts (for instance, two would rise, one shouting the ACT UP message while a partner made the message inaudible by simultaneously blowing a police-type whistle; it never seemed to occur to them that they were defeating their own attempts to voice their views). As sad and unfortunate as it was to see desperate, alienated patients so badly deceived by quackery, Herbert's mastery of the situation was a rare performance none will forget. It was like watching an orchestra conductor lead the 1812 Overture with cymbals, cannon-booms and all. Herbert deftly pointed out that the spectacle was consistent with the title of his presentation: "Current experiences with the world of fraud!"
ACT UP's agenda generally emphasizes the slowness of the FDA to approve experimental remedies and a lack of commitment to finding an AIDS cure. We are told that some within ACT UP are convinced that AIDS is germ warfare initiated by the CIA against gay people and that no cure will be forthcoming until the gay community is decimated. At Kansas City, ACT UP added the shouting of the familiar "freedom of choice" slogans of organized quackery. Unlike the quacks, however, ACT UP called for informed choice which placed them squarely in harmony with NCAHF and the NHFC. ACT UP representatives were invited to appear on the platform and discuss minimum standards of consumer protection for AIDS patients, but refused to enter into a dialogue. It was abundantly clear that ACT UP's only purpose was to disrupt the conference. There is good reason to believe that most of the funding to fly 35 ACT UP members to Kansas City came from key figures within organized quackery.
It was quite apparent from the propaganda handed-out at the meeting that ACT UP had been the victim of deception by organized quackery. ACT UP published false messages such as "corporate interests" are "behind NCAHF," and that the purpose of the conference was to label all alternative treatments "quackery" with "special focus on AIDS." The reality is that NCAHF has no corporate backing and is the only consumer organization founded entirely upon the precepts of consumer protection law. NCAHF is on the side of patients and has a number of AIDS sufferers who appreciate its antiquackery efforts among its membership. Further, AIDS quackery was not the focus of the NHFC until ACT UP's public actions made it so. Sadly, the ACT UP leaders' ears seemed closed to reason, but a few members appeared to grasp the concept. The episode was illustrative of a quotation cited by William Jarvis in his opening address on historical perspective of the problem of quackery: "the victim of quackery is like a man with a poor glass eye, everyone can see through it but him."
On Tuesday, the NCAHF AIDS Quackery Task Force issued a comprehensive press release containing shocking revelations on abuses of AIDS patients. Copies are available from the NCAHF Resource Center. Send business-sized, double-stamped, self-addressed envelope.