The Health Robbers: A Close Look at Quackery in America (Prometheus) rolled off the presses in September. The book has 544 pages, a detailed index, and foreword by Ann Landers.
Edited by quackery experts Stephen Barrett, MD and William Jarvis, PhD, the book is the most important antiquackery publication since the 1930s during the heyday of Morris Fishbein.
Dr. Robert Atkins' New York medical license was suspended on August 10 as a result of serious injuries to patients with ozone gas therapy. One week later, State Supreme Court Justice Edward Greenfield reinstated Atkins' license to practice as long as he doesn't use ozone gas treatments. He was due back in court on September 15.
Atkins is a host on radio station WOR in New York. He took over the spot vacated by the death of the late Carleton Fredericks. The show is said to be a magnet for commercials by vitamin suppliers and other sponsors in the health field. Atkins advertises his services on the show. (Newsday, 8/18/93)
Hippocrates Lantern, published by attorney Stephen C. McAliley, is dedicated to "casting light on unnecessary medical services." This quarterly publication will be of special interest to anyone interested in medical quality assurance. Back issues are available.
Write: P.O. Box 2439, West Palm Beach, FL 33401. Some NCAHF members may be able to contribute articles to this laudable publication.
Attorney Loren Isrealson, past president of Nature's Way, a Utah-based herbal company, has paid $30,000 to Dr. Victor Herbert in an out-of-court settlement for defamation. Isrealson repeated a false story before a large audience at the Natural Products Expo in Anaheim in 1992.
Isrealson alleged that Dr. Herbert had been arrested for assaulting and stealing an audio-tape from Frank Wiewel (promoter of dubious cancer remedies) during a lecture at the University of Iowa. This false story has become folklore among "health freedom" advocates, but this outcome reveals that repeating such lies can be costly.
New Hope Communications, which taped and distributed Isrealson's comments also settled with Dr. Herbert for $2,500. Isrealson will also pay Drs. Barrett, Renner and Jarvis a settlement for falsely describing them as "vicious, pathological and will stop at nothing" in their efforts against the health food industry.
Comment: Isrealson's comments may be seen as a furtherance of the character assassination effort began by Vegetarian Times in 1991. Although VT also paid for defaming Drs. Barrett, Herbert, Jarvis, Renner and NCAHF, the practice of repeating the "big lie" often enough as a way of undermining the credibility of one's critics can be effective in our sound-bite society. With this in mind, antagonists will find that the future price of repeating lies will increase.
The Arizona Department of Insurance is investigating the American Western Life Insurance (AWLI) company of Foster City, California. AWLI is unique in its coverage of "alternative" healt h care (in Arizona, most providers are naturo-paths). The state's investigation does not involve the validity of the services covered by the high level of complaints received from policyholders which ran about 10 times the level the Insurance Dept. considers acceptable. A curious feature of AWLI is its herbal resale business which supplies customers with herbal remedies so they don't have to search them out in health food stores. (Arizona Daily Star, 5/16/93)
A 3-yr-old child with a posterior fossa ependymoma (tumor of the lining of the brain and central spinal chord canal) was treated for neck pain by a chiropractor. MRI by a medical doctor determined the existence of the tumor. Reporters state that they have records of four other children with cancer who underwent chiropractic treatment before medical diagnosis found their real problems. In addition, 13 other children with a variety of conditions were seen by chiropractors, x-rayed and received inappropriate care (manipulative or dietary). (Nickerson, et al. "Chiropractic manipulation and children," J of Pediatr., July, 1992, p.172)
Comment: A recognized danger posed by primary care health care providers with limited training or a sectarian ideology is the failure to properly diagnose. This can result in delay or diversion from care. If the condition causes irreversible damage or death, the results can be disastrous. We hear of such cases frequently, but few are well-documented.
A report from a Marshfield, Minnesota clinic documents many such cases involving chiropractors making a significant contribution to the literature on this aspect of nonscientific health care. Hopefully, more physicians will follow their example and keep track of this kind of harm.
The American Cancer Society describes questionable "nutritional" cancer therapies in CA--A Cancer Journal for Clinicians (1993;43:309-19). Included are: vitamin C, pau d'arco tea, Hoxsey herbal treatment, macrobiotic diets, the Gerson diet, Kelley Metabolic Therapy, and Manner Metabolic Therapy. The ACS says that while dietary measures may be helpful in preventing certain cancers, there is no scientific evidence that any nutrition-related regimen is useful as a primary treatment for cancer.
The media has spread the word that folic acid supplementation is a good idea for pregnant women (or who may become pregnant) to help reduce the risk of neural tube defects. Some have presented these recommendations with a preamble which implies that agencies such as NCAHF have regarded folic acid supplementation as unnecessary.
This is untrue. In the May-June, 1987, NCAHF Newsletter we stated guidelines by NCAHF--in conjunction with the American Dietetic Association, American Institute of Nutrition and the American Society of Clinical Nutrition--that (among other things) "pregnant ...women may require extra iron, folic acid and calcium." NCAHF board member, Victor Herbert, MD, is a world expert on folic acid and was not taken by surprise by the neural tube defect prevention studies. Consistent with good public health practice, Dr. Herbert now recommends that staple foods be fortified with 0.4 mg folic acid per day and 0.1 mg per portion.
Warning labels should advise against use by fertile African-Americans, people over 50, epileptics and people in endemic malaria zones without a physician's approval, says Dr. Herbert. NCAHF and the supplement hucksters do not differ on the value of folic acid supplementation, but whether it should be done in an economically-efficient, more sweeping public health manner with appropriate warnings, or done by entrepreneurs who tend to oversell their products and underwarn about dangers.
Three Colorado children, ages 13-months to 2.5 years, suffered life-threatening toxicity after ingesting Chinese herbal pills purchased at health food stores. Emergency room treatment was life-saving and the tots fully recovered. It is noteworthy that the pills made medical claims but were not accurately labeled, nor tested for safety or efficacy. A toxic alkaloid natural to the herbal product was responsible. (Horowitz RS, et al. "Jin Bu Huan toxicity in children--Colorado, 1993," Morbidity & Mortality Weekly Report, 1993;42::633-6.)
Comment: This case is a timely example of the hazards posed by the current unregulated marketing of herbal products by the health food industry. The Hatch-Richardson Bills (S 784-HR 1709) would institutionalize these hazards. The industry is orchestrating an aggressive write-in campaign to Congress to pass this irresponsible legislation. If it does pass, we predict a backlash once consumers become aware that they have been betrayed by their representatives.
Two medical doctors on the New Mexico Acupuncture Board have resigned in protest because the board's new rules permit acupuncturists to do tests and procedures most are not trained to do. Included are ordering MRIs, performing neurological tests, writing certain prescriptions, counseling patients, and performing bone and muscle manipulations. MDs, DOs and chiropractors oppose the new rules. (Albuquerque Journal, 7/23/93)
Comment: This is a demonstration of what can happen when a group achieves licensure. Its board soon stops being a consumer protection advocate and becomes a lobbying agency for expanded scope of practice. This is a problem even when the health care system is science-based. It is a public disservice when the system is not founded in science as in the case of acupuncture.
Despite increasing evidence that acupuncture is at best a placebo that may have clinical usefulness for pain relief, or a psychological aid that may be employed in behavioral medicine, claims are still being made for the procedure as an appropriate treatment for medical conditions.
A Wilmington, Delaware Doctor of Oriental Medicine says that acupuncture can be used to treat "pathologies such as paralysis, gastrointestinal disorders, indigestion, asthma, sinus problems, hives, menstrual disorders, substance abuse and mental agitation." (Advance for Occupational Therapists, 6/14/93, p.12)
The National Research Council stated in a 8/18/93 press release that concerns are unwarranted that fluoridated drinking water poses a health risk. Specifically mentioned are cancer, kidney disease, stomach and intestinal problems, infertility and birth defects, and genetic mutations. Health Effects of Ingested Fluoride is available from the National Academy Press, 2101 Constitution Ave, N.W., Wash., DC 20418; $35+$4 p&h.
A 2-yr-old child died after ingesting 4-6 ounces of 35% hydrogen peroxide stored in the family refrigerator. The solution was being used as an antimicrobial agent to prolong the shelf life of raw milk. (Christensen, et al. Fatal oxygen embolization after hydrogen peroxide ingestion, Crit Care Med, 1992;20:543-4). [AACT Clinical Toxicology Update, 1992;3:(4):2]
Comment: 35% hydrogen peroxide is marketed through health food stores as a health promoting agent, disease fighter. There is no evidence that it is useful for any of these purposes. At least one other child has died in similar fashion (NCAHF Newsletter May-June, 1989). There are different ways of looking at such a tragedy. A fatalist might say: "The child's number was up, if it hadn't died this way, something else would have killed it." An apologist might say, "Children also die from ingesting approved prescription drugs left around in an unguarded fashion, so why pick on 35% hydrogen peroxide just because it's unorthodox." A rationalist might say, "This child was needlessly exposed to a risk which offers no benefit; it was in the house because of quackery." NCAHF takes the rationalist's point of view.
The father of Ian Lundman, the 11-yr-old Minnesota diabetic boy who died when his Christian Science mother and step-father relied upon spiritual healing rather than insulin treatment, was awarded $5.2 million in damages by a Minnesota jury. Neither Ian nor his father were Christian Scientists. Lundman objected to irrational spiritual healing but was unable to control what his former wife did with their child. Manslaughter charges against those responsible for the boy's death were dismissed by the court, but Ian's father sought civil action and prevailed in this lawsuit. This case outlines a new course of action against the needless death of children by anti-medicine sects. (Star Tribune (Mpls-St. Paul), 8/19/93)
A booklet by Rita Swan (Cry, the Beloved Children, 1993) reviews recent deaths and injuries to children by faith healing sects. Order from: CHILD, Box 2604, Sioux City, IA 51106.
The House of Representatives Subcommittee on Crime and Criminal Justice held an oversight hearing on health care fraud entitled AIDS Fraud - Deceit, Dollars and Despair on May 27, 1993. Testimony provides case reports of victims and how their desperation was exploited by various practitioners. These are heart-rending stories, told by those closely involved. They are useful as educational materials that reveal the human suffering caused by quackery.
In June, NCAHF obtained drafts of the submitted testimony from the subcommittee, but was told that the hearing book will not be available for some time.
(Those who would like to obtain a copy of the hearing book should contact their local congressional delegation for a free copy.) NCAHF will supply a set (85 pages) for $11 to members, $20 to non-members, to cover copying and handling.
Interstitial renal fibrosis found in two young women taking a slimming regimen including Chinese herbs led researchers to conduct an epidemiological survey of dialysis units in Brussels, Belgium. Findings: From Jan. 1, 1989 to June 30, 1992, 624 patients in terminal or preterminal renal failure were started on maintenance dialysis. Among them were 14 women under 50-yrs old with a diagnosis of chronic interstitial nephritis.
In 1989 and 1990 there was only one patient per year of this type. In 1991, there were 3 such patients, and 9 patients in the first half of 1991; 7 of these had followed the slimming regimen making a total of 9 including the two cases which led to this investigation. By Feb 1, 1993, a total of 48 women had been identified with variable degrees of renal failure after Chinese herb therapy.
Renal biopsy confirmed extensive interstitial fibrosis in 24 women of whom 18 are in terminal renal failure and are being given renal replacement therapy. (Vanherweghem J-L, et al. "Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs," Lancet, 1993;341:387-91)
Promoters of nonscientific health care sometimes try to intimidate their critics by creating the illusion that differences between scientists and nonscientists are merely cultural, and that to assert that one way is superior to another is akin to racism.
A better case can be made against the myth of an east-west dichotomy as ethnocentrism that denigrates easterners as being incapable of conducting quality science. The reality is that physical laws, anatomy, physiology, biochemistry and what it takes to determine clinical safety and effectiveness are not bound by east-west dichotomies.
Further, fanciful metaphysical healing systems are not limited to eastern cultures. Homeopathy's vital force, herbalism's Doctrine of Signatures, and chiropractic's Innate life force, all of which arose in the west, are as mystical as ayurveda's prana or Chinese medicine's chi. Those who use the "western" versus "eastern" science or medicine dichotomy are usually comparing prescientific cosmologically-based medicine (aka, "folk medicine") with modern science-based medicine. Here again, prescientific cultures of the west differed little from those of the east in their fanciful cosmologies and magical medical beliefs. Faith healing in the west may be broadcast by television and performed by stylish people in 3-piece suits instead of more primitive garb, but the practices are no less irrational than those seen in the east.
It is also demeaning to imply that eastern cultures have made no contribution to the scientific process. Mesopotamia, India and China have long been acknowledged by historians to have made significant contributions to the development of medical science. Nor do westerners have special claim on scientific methodology per se. Controlled studies have been done by easterners prior to the present. Benham describes how a Japanese medical officer solved the riddle of beri beri more than a dozen years before Casmir Funk cured his pigeons with rice polishings. After hypothesizing that diet was responsible for the condition, he set up an experiment. Two naval ships, with crews of 276 and 287 men, on an extended voyage served as laboratories. The customary naval ration was used on one and an experimental ration on the other. The first ship had 160 cases of beri beri and 25 deaths; the second had 10 cases of beri beri—all among sailors who would not eat their entire ration—and no deaths. By 1882, the Japanese navy had solved its beri beri problem. The experiment was published in Japanese in 1885 but was overlooked by European workers (1).
The idea of comparative studies also appears to be very old. The Biblical Book of Daniel (2) describes a test in which Hebrew whiz-kids were given one type of diet and compared to the performance of others who were served the Babylonian king's standard ration (circa 600 BC). The evaluative criteria is not described very well, but the concept of a controlled test is clear.
Sound scientific methodology is universal and enduring. It may not be as emotionally satisfying as mysticism but it is infinitely better at controlling the plagues of mankind. Anti-science promoters are using the east-west myth to send a message that the popularity of "alternative" medicine is due to a growing disaffection with mainstream medicine with the implication that health care is too scientific and would be better (and cheaper) if it were less so. Medicine may need to be more humane, but indications are that it needs to be more scientific (3,4) and medical discipline of maverick physicians needs to be strengthened (5)
Citations: (1) Benham H. Man's Struggle for Food. New York: Univ Press of America, 1981, pp.470-1. (2) Daniel 1:3-20. (3) Congress of the U.S., Office of Technology Assessment. Assessing the Efficacy and Safety of Medical Technologies, Sept. 1978. (4) Smith R. "Where is the wisdom?" Brit Med J, 1992;303:798- 9. (5) Public Citizen Health Research Group. 6,892 Questionable Doctors. 1990.
Dr. Shekelle says that what can be concluded from RAND's research is: There is enough scientific evidence to justify the use of spinal manipulation for some patients with low-back pain. It is the judgment of a multi-disciplinary group of back pain experts, based on the scientific literature and their clinical experience, that spinal manipulation is a appropriate treatment for some patients with low back pain. Additional criticism on the abuse of scientific information for public relations purposes by chiropractors themselves appears in the article.