A Reader's Guide to "Alternative Medicine," written by Kurt Butler and edited by NCAHF board member Stephen Barrett, MD, is a treasure trove of information on scores of dubious products and practices. Two chapters take on leading "diet gurus" and "experts to be wary of." Another deals with chiropractic, which the author calls a "cancer of the health care system." Another blasts acupuncture, naturopathy, ayurveda, multilevel marketers, and other medical "wanna-bes." Another attacks scores of modern "snake oil" products. A chapter on "tabloid journalism" summarizes the author's two-year study of TV talk shows in which he recorded or obtained a transcript of almost every one that promoted dubious health ideas. The final chapter provides a road map with novel ideas for antiquackery activists. This 110,000-word book, published by Prometheus, is available for $20 postpaid from NCAHF Books, P.O. Box 1747, Allentown, PA 18105. The price to NCAHF members is $18 postpaid ($19 US to Canadian members).
A Finnish study that found that serum iron was a stronger predictor of heart attack than LDL cholesterol has led to extensive media coverage. Dr. Victor Herbert has been pointing this out for several years, and discussed the problem in the May-June 1992 (pp.1&3) issue of this newsletter. (Also see Herbert V. "Iron disorders can mimic anything, so always test for them," Blood Reviews 3:1-8., 1992.) What hasn't been reported by the media is that vitamin C enhances iron absorption and also acts as a redox agent producing catalytic iron which converts harmless LDL cholesterol into coronary artery-damaging oxidized LDL cholesterol. Dietary vitamin C is far less likely to cause problems than supplementation because it only occurs in modest amounts in foods. Supplements are the main sources of danger to the roughly ten percent of Americans with the iron-overload gene. This is further evidence that vitamin/mineral self-dosing is not benign or necessarily healthful, and that dietary supplements should not be given privileges from FDA regulation.
A comprehensive article on the size and nature of the problem of quackery in America today written by NCAHF president, William Jarvis, was published in the August, 1992, issue of Clinical Chemistry (38:1574-1586). The article focuses upon the real issues in the war against quackery, the most fundamental of which involves how much regulation of health products and services are needed in a free-enterprise society. The basic concepts of consumer protection law (buyer beware versus seller beware) are explained, and quackery's response to these described. "How the regulators are failing the public," focuses attention on the failure of the government to provide adequate consumer protection with effective laws and proper enforcement, double standards used in regulatory policies, and the accreditation of pseudomedicine. It is pointed out that nonscientific health care is legalized in every jurisdiction, and consumers are largely unprotected from unscientific health care practices and deception. The article notes that the cornerstone of consumer protection law is the U.S. Food, Drug & Cosmetic Act (FDCA), which is a splendid piece of legislation because it encodes key principles of science into law. However, the FDCA is flawed by three inclusions (the recognition of the Homeopathic Pharmacopeia, the Delaney Clause, and the Proxmire Amendment) each of which came about through the personal influence of politicians who themselves were devotees of pseudomedicine. The article presents the rational basis of science and consumer protection law and reveals how political meddling undermines the public interest.
Aggressive advertising by the Cancer Treatment Centers of America (CTCA) attracted the attention of reporter Jeffrey Weiss, staff writer of the Dallas Morning News. What is touted as a new "powerful and relentless enemy" of cancer is about 60 beds in the American International Hospital (AIH) at Zion, Illinois, and 50 beds in the Cancer Treatment Center of Tulsa, formerly Oral Robert's City of Faith Hospital. Although the CTCA has its share of satisfied patients--as do all cancer treatment clinics -- critics give a different picture than that of a superior, state-of-the-art cancer treatment center. AIH has a past history of promoting questionable and worthless procedures*, but today is fairly standard in its therapies. A major complaint is that its advertising makes it sound as if it is superior to other treatment centers, when it is not. The Illinois facility is old and crowded. CTCA promotes itself by an 800 number. Callers are screened by telemarketers who determine their type of cancer and amount of insurance. Patients are treated quite well as customers. Airfares are paid by CTCA and a limousine meets them at the airport. Many patients praise the attention they receive. The June 21, 1992 story provides useful insight into this rather unusual facility.
*In the past, AIH promoted laetrile, wheat grass, whole body hyperthermia, chelation therapy, hair analysis and other dubious methods; the hospital was cited (p.150-1) in the 1984 Pepper report identified as Clinic B.
People with prosthetic heart valves are at special risk for endocarditis. Norwegian physicians report a case in which a 59-yr-old woman got endocarditis following acupuncture treatment by a natural healer (JAMA, 1992;267:56)
"A nightmare that lives on" (New York Daily News 6/5/92) tells the story of 23-year-old Virginia Good and the cold indifference of "so-called doctors" who discarded her like "some soiled rag" after failing to cure her breast cancer as they promised. The worst, she says was Emanuel Revici, a 96-year-old Park Avenue "quack" who treated her for several months. She nearly died from Revici's treatment, and now will likely die from her disease. Her story is follows a familiar pattern. A disfiguring breast biopsy frightened Good of surgery, so she turned to self-styled "nutritionists" for help. When it was apparent that she was worsening, one referred her to the notorious Revici, who told her that he could cure her disease. After 16 months under Revici's bizarre care, her condition became so bad that he advised her to go to an emergency room. Her prognosis is now considered terminal. She says that Revici never told her that his treatments were not government approved, but his attorney, Richard Jaffe, says that all of Revici's patients sign numerous forms that make it clear that his treatment is not government approved, and that they assume the responsibilities of such treatments. The article briefly describes Revici's sordid history including why he is still practicing in spite of it. The article provides a case study against the concept of "medical freedom" advocated by health care libertarians.
Ever since a chemistry professor from Minnesota reported that chromium picolinate supplements would improve the lean body mass of athletes, the product has been a hot item. With the warnings and enforcement of rules against the use of anabolic steroids, all kinds of products are trying to fill the market demand for anabolic action (ie, muscle mass increase with attendant strength gain) Lefavi, et al, discuss the anabolic efficacy of chromium supplementation in athletes in the International Journal of Sports Nutrition (1992;2:111-122). The authors note that chromium is the biologically active component of glucose tolerance factor (GTF), and that supplementation could be helpful to anyone who is deficient. However, they note that the potential anabolic effects of enhanced insulin function would likely be marginal, and that short term anabolic increases alleged to result from organic chromium supplementation need to be confirmed. This is a useful article to anyone investigating the effects of chromium supplementation.
A double-blind, randomized multicenter study of the value of chelation therapy in patients with intermittent claudication (painful legs when walking) has been completed in Denmark. 153 patients received 20 infusions of either EDTA or placebo during a period of 9-weeks. Measurements of pain-free walking distances where done on a treadmill. During 3-month and 6 month follow-ups, no differences were found. (Journal of Internal Medicine, 1992;231:261-267)
Jack Raso, MS,RD, exposes Nature's Sunshine subterfuge of practicing medicine and pharmacy without licensing as they employ invalid methods of assessment such as "applied kinesiology" and iridology to diagnose and prescribe herbal products for various diseases and conditions. Practitioners are taught to ostensibly evade the law by "teaching" rather than diagnosing. Raso's article, "The shady business of Nature's Sunshine," appeared in the May/June, 1992 Nutrition Forum. Nature's Sunshine is headquartered in Spanish Fork, Utah.
Transcendental meditation devotees have established the Natural Law Party headquartered at Fairfield, IA. The group's presidential candidate is John Hagelin, PhD, a physicist who is a follower of the Maharishi Mehesh Yogi, and a member of the faculty at Maharishi International University (MIU). His veep, Mike Tompkins, received a PhD from Maharishi European Research University (MERU), and the party chairman, Bevan Morris, who also has a doctorate from MERU is President and Board Chairman of MIU. Hagelin is a respected physicist but has a side that worries many colleagues. He has been accused of distorting science to the ideas of his guru, MM Yogi (see Nature (9/10/92)
One of the most disturbing features of chiropractic entrepreneurialism is the targeting of infants and children for chiropractic care. An ever-increasing barrage of chiropediatric promotions are coming to our attention. Chiropractors have not done any research that suggests that they are qualified to treat children or that children benefit from their care. The subluxation zealots believe that infants should have their spines adjusted right after birth, and that children should be adjusted regularly for preventive purposes. The most radical would substitute spinal manipulations for immunizations.
Tragedy: We are saddened by a report that a four-month old infant boy, who was thought to be developing normally, was made quadriplegic by chiropractic neck manipulation that was aimed at correcting congenital torticollis (tilt of the head) which had occurred during birth. The parents were told that the condition would resolve itself in a few months, but turned to chiropractic care when the tilt had fluctuated but not disappeared completely. Surgery restored sensory and motor function to the T-4 level, and 18 months later the boy has full use of his upper extremities and sensory function to the T-9 level, but still suffers from paraplegia. (Journal of Pediatrics, 1992;120:266-269)
Comment: Chiropractic's defenders are always quick to point out that medicine also has harmed children. We contend that powerful difference exists between tragedies which occur from procedures for which benefit-risk has been established and those which have no scientific justification, such as was true in the case above.
The American Council on Science & Health report Quackery By Mail by Stephen Barrett describes the nature of the mail order health marketplace, its problems and what can be done about them. The 15-page report may be ordered from ACSH, 1995 Broadway, 16th Floor, New York, NY 10023-5860; $3.85
FDA agents seized all stock of Efamol,
Nature's Way brand of evening primrose oil (EPO) on July 2, charging
is an unapproved food additive. This followed a court ruling on April 8 that EPO products were not generally recognized as safe (GRAS). (Health Foods Business, August, 1992)
The health foods trade groups are scared stiff of the FDA enforcement bill H.R. 3642/2135 which will give the agency the tools it needs to put a dent in nutrition-related quackery. The bill would permit FDA to temporarily detain products; subpoena documents from the industry in conjunction with civil penalty investigations; increase penalties up to $250,000 for individuals and $1 million for corporate violators; and, take photographs and use them in court proceedings. It became clear during the Pepper hearing that such reforms are badly needed to stem the current epidemic of quackery.
The General Accounting Office's (GAO) May, 1992, report: Health Insurance: Vulnerable Payers Lose Billions to Fraud and Abuse captured enough attention to make the covers of at least one national news magazine and Consumer Reports (7/92). The report acknowledges (p.8) that "no one knows for sure," it estimates that fraud and abuse accounts "some 10 percent" of the $700-plus billion in U.S. health care spending. As to what constitutes "fraud and abuse" the GOA lists (not all-inclusive) overcharging, billing for services not rendered, rendering unnecessary or inappropriate services, kickbacks for referrals, and waving copayments or deductibles.
The simple facts are that body weight is the effect. The causes are genetics (body type and metabolism) and lifestyle (diet and physical activity). Unsound weight loss programs focus upon the effects, rather than the causes. That's why the weight doesn't stay off after weight loss. Only those who focus on the alterable causes (diet and physical activity) can be expected to succeed in the long run. They have to examine the psychology of eating patterns, learn new feeding habits that will fulfill their individual needs without causing feelings of deprivation, and discover physical activities that they are willing to adopt as permanent lifestyle changes. All efforts should be aimed at these letting the natural weight find its level. The result may not be the svelte image in the health spa commercials--often posed for by models more dependent upon genetics and metabolism than lifestyle. This has been the message of sensible living for years. Now the message has a name: the no-dieting movement. A new book, Living Without Dieting (Houston: Harrison, 1992) by two leading researchers in weight management, John Foreyt and Ken Goodrick, (PhDs) explains the concepts, provides worksheet for personal use, and provides a lot of practical help. Order by calling 800-945-6199; $16.95 plus p&h.
Several states have passed, or are considering, so-called "medical freedom" laws which require medical licensing boards to prove that harm has resulted from "alternative" medicine before action could be taken against maverick doctors. The purpose of consumer protection laws is to prevent harm, not simply discipline wrongdoers after the fact -- a principle of deterrence which is well established in law. Medical freedom laws bill represent a throw-back to an unacceptable standard of consumer protection law such as existed before premarketing approval of drugs was required. Prior to 1938, drugs were removed only after they had harmed consumers; likewise, prior to 1958 food additives were removed only after they had been found harmful. The direction of consumer protection has been to improve safety. Proving harm to patients means that they can only be used as bad examples after the harm has been demonstrated (not easily done) to have occurred. This ill-conceived concept employs a "lock the barn after the horse is stolen" psychology. If such reasoning were applied to drunk driving it would mean that drunk drivers could only be prosecuted if they were involved in accidents resulting in harm. Like drunk drivers, unscientific health care providers eventually cause needless, avoidable harm to their patients. Unlike drunks, physicians enjoy a high degree of privileged protection from prosecution when patients suffer and/or die under their care. Legislator's efforts would be better spent finding ways to protect constituents from quackery rather than boring loopholes in consumer protection law through which "alternative care" practitioners can pass.
The media missed the real story on the new NIH Office of Alternative Medicine!
Quacks are, first and foremost, promoters of their scams and schemes. Many are already using their NIH invitations in their promotions to dupe the public into believing that they have been legitimized. Desperate people don't need much urging to try questionable remedies. The NIH office was not established because scientists saw merit in "alternative" remedies, but because of the abuse of political office by Berkeley Bedell and Tom Harkin. Bedell, a cancer patient, patronized a notorious, longtime Canadian promoter of a dubious cancer remedy. In Canada, the government pays for health care and has more interest in the worth of unapproved remedies. Health & Welfare Canada found the remedy Bedell salutes to be worthless. Bedell's naivete caused him to accept the fallacy of post hoc, ergo propter hoc ("after it, therefore, because of it") which fools those who rely upon personal experience for proof. Scientific methodology grew out of a need to circumvent such fallacies. Bedell and Harkin have used their privileged positions to throw $2 million annually at NIH to set up a public relations benefit for quackery (for comparison, in 1984 the Pepper Report stated that FDA spent $1.8 million annually to fight quackery; presumably, this has increased with Kessler's improved enforcement, but the numbers are interesting).
The idea of having a scientific office where fringe and maverick practitioners can state their theories and obtain guidance in how these might be tested is not a bad idea, but there should be a prohibition against using the name of NIH in public relations and advertising just as there is a rule against using FDA approval in this way. Having an entity that helps design protocols to test innovative ideas takes away the so-called "Galileo ploy" (ie, they won't look at my evidence) universally used by quacks for self-justification. The problem with the NIH office is that they are making the mistake of thinking that they are a match for quackery just because they are scientists. Conjurers (such as James "The Amazing" Randi, Bob Steiner, Ray Hyman, Johnny Carson), who are masters at deception, tell us that the scientist's basic assumption that he/she is dealing with the same kind of honest and open people they are accustomed to within the scientific community, is the chink in their defenses that quackery will penetrate. Media reports about the director's "golly, gee whiz" responses to the promoters of "alternative" medicine are disturbing. Those of us who study "alternative" therapies, their promoters, patients and modus operandi could help the NIH avoid the traps and pitfalls, save them both time and money, and most importantly, keep them from becoming the unwitting allies of quackery. One thing is certain: quacks are more astute at dealing with the scientific community than vice-versa. Ultimately, it will become clear that the promoters of "alternative" medicine don't want to meet the standards of science. They want legalization so they can obtain third-party payment and escape the accountability of responsible health care. Whether the NIH office ultimately turns out to be a force for corralling quackery or aiding and abetting it remains to be seen, but so far the score is quackery 1, NIH 0.
Senator Orrin Hatch has become a champion for the health food, supplement and herbal industries opposed to consumer protection reforms of the Nutrition Labeling and Education Act of 1990 (NLEA). At the urging of his constituents, Hatch introduced S.2835 which would protect dietary supplements from rational regulation by FDA. Hatch says that he heard from both business people and consumers. No doubt he did, because Utah is the base of many aggressive multilevel marketing (MLM) firms. Those familiar with MLMs know one cannot differentiate consumers from suppliers because MLM distributors both sell and use the products. One Utah health food store reportedly has organized 15,000 customers into a response "tree" that can get hundreds to telephone legislators within 24-hours. Inside and outside of Utah, Health food stores are having employees and customers send multiple copies of preprinted letters to Congress to get the mail-count as high as possible.
S.2835 creates a special category for dietary supplements stating that vitamins, minerals or herbs shall not be considered drugs solely because of the potency of a substance they contain, or because of they contain a claim, or provides health information. Such language would exempt from responsible regulation potentially dangerous herbs, and toxic doses of vitamins and minerals. It also nullifies the well-conceived definition of what constitutes a "drug" in the Food, Drug & Cosmetic Act. S.2835 also would prevent FDA from regulating dietary supplements as unapproved food additives if their contents are not added to the supplement but are the supplement! This means items such as free amino acids such as L-tryptophan could not be banned even when unnatural and unproved for safety.
Borrowing language of the most militant pro-quackery propagandists, Hatch calls his bill the "Health Freedom Act of 1992." The bill should be called the "Health FRAUD'EM Act of 1992," because it would tie the hands of regulators in such a way as to strip consumers of the basic and reasonable standards of protection they have come to expect. S.2835 also puts legitimate businesses at a disadvantage which work at meeting real, not false, needs. Justification for the existence of the health food and supplement industries is the anti-science/technology basic fallacy that American agriculture and food technology makes our food supply deficient and unhealthful (recall that Europeans rejected U.S. beef exports because of unfounded fears over DES a few years back). Herbal supplement marketing is also anti-technology in its claim that raw herbal remedies are superior to conventional drugs, even though the latter may have botanical origins.
Note: By the time you read this, the Hatch bill may be law. The bill passed the Senate on 9/23/92 attached to another piece of legislation. This recalls that the 1976 Proxmire bill was also passed as a rider. With this bit of Congressional flim flam, Hatch has assured himself a place with others who have degraded consumer protection law in the legislator's Hall of Shame.