The UCB Wellness Letter (August, 1995) examined several dietary supplements containing dehydrated vegetable products. The results are what anyone knowledgeable about nutrition and food processing would expect.
Tiny to very small amounts of processed vegetables are being huckstered as alternatives to eating real food. The article includes critiques of Twin Lab's Vital Veggies, Nature's Plus Mixed Vegetables, Solgar's Broccoli Extract, and Orchard Blend Juice Plus+. The article provides useful information that can be used to show consumers that such products are not likely to be beneficial.
It also points to three important unanswered questions about all such products. Which substance from among the thousands of phyto-chemicals does a product contain? Are these beneficial in the various pill forms? What are the effects of processing suc h substances? Who is supposed to take these pills? Some companies say that these pills are not supposed to take the place of eating fruits and vegetables, while others say that they are "for people who don't enjoy eating vegetables."
Comment: The supplement pushers have been following a strategy that takes the government recommendation of 5 servings a day of fruits and vegetables and makes it seem like this amount is too large to obtain by food alone. Five servings a day sounds like a lot. A supplement trade group representative has claimed that the fresh produce industry has stated that it does not supply enough products to meet the 5-a-day recommendation.
The reality is that the 5-a-day includes more than fresh produce. In practical terms, one serving is only one-half cup of cooked, or one cup of raw, food. A banana, glass of orange juice, and a salad cover more than half of the recommended intake. It doesn't take a great deal to fill in the remainder.
Consumers' Research (July, 1995) presented a cover feature entitled "The trouble with HMOs" detailing consumer problems with health maintenance organizations and managed care in general. The problem wit h HMOs is that they are structured in a way that encourages physicians to defer or withhold care that is seen as being too expensive. The system pits the financial self-interests of doctors against the medical interests of patients.
In its September issue, CR presents reports selected from government studies and newspapers around the country which document the horrors of this misguided system. CR also reveals questionable methods sometimes used to recruit senior citizens into managed care programs.
Comment: When discussing the nature of standard medicine I always distinguish the business aspects of health care, which operate according to business law and ethics, from patient care per se. Clinical practices and the scientific aspects of medicine have a higher set of ethics than do businesses.
The law of the marketplace has little room for compassion. A Newsweek cartoon showing a maternity ward redefined "HMO" as "Heave Mom Out." HMO marketing practices resemble those employed by unscrupulous health spas--the emphasis is on signing up new people to contracts and then neglecting them. (Look to the north, America--there is much to learn from the Canadian experience!)
Herbs of Choice (Haworth, 1994) by Varro Tyler, PhD, ScD, is a useful guide to the proper therapeutic use of phytomedicinals. As he does in The Honest Herbal, Tyler begins the book by instructing readers in basic principles that serve as useful guides to judging the use of any medicinal products. Tyler also discusses "the herbal regulatory dilemma" (chap 2). Tyler does what few other writers of self-help books have done. In chapter 3, "Contents and The Use of Subsequent Chapters," he explains how readers should approach the information in his book. Subsequent chapters focus upon the potential usefulness of herbal remedies for various organ system problems. Included are: digestive; kidney, urinary, prostate; respiratory; cardiovascular; nervous system; metabolic, endocrine; arthritic, musculoskeletal; skin, mucous membrane, gingiva; performance, immune deficiencies.
Consumer Reports (Nov, 1995) reviews the herbal marketplace in an article entitled most appropriately, "Herbal roulette."
After describing the current dismal regulatory situation brought about by Senator Hatch and his cronies (unfortunately, the article does not tell Americans who they have to thank for stripping them of the consumer protection they have come to expect--only that Congress did it), the article shows that even pharmacists are confused.
One is quoted as wrongly stating, "If it is sold over the counter, it's FDA approved." Herbs are divided into those that "might help" and those that "can harm." The article addresses the poor standards of quality of herbal manufacturers, false claims, the promulgation of misinformation and much more.
Although focused upon herbs, the article does not limit itself to botanical products. Shark cartilage, melatonin, chromium picolinate, Coenzyme Q10, anti-oxidants, RNA-DNA supplements, and other dietary supplements are included. An insert provides the best critique seen to date on ginseng. Information on Ginsana, the leading ginseng product, is included with the interesting information that the company will not release its "evidence" on the effectiveness of its product (hello!).
In the last issue it was reported that a number of drug store chains were selling homeopathic remedies. Time (9/25/95:48) quoted Jerry Zlotnik, a pharmacist who is vice-president of Ohio's Medic Discount Drug chain, as seeing no need to defend the health benefits of the products he sells. Zlotnik said, "I also carry candy, cigarettes, beer and wine." No one thought to ask if he could differentiate between these items and products sold as medicines.
Canadians are being duped by the rhetoric of novoquackery (ie, "alternative" and "complementary" medicine) at about the same pace as Americans. Nova Scotia has led the retreat into the medical dark ages by setting up a section on alternative medicine within the province's medical society (see NCAHF Newsletter Jul-Aug '94).
Chief proponent of nonstandard medicine is medical maverick William LaValley, a glib young physician who spouts the usual litany and disinformation of his ilk. Writers who have been educated by empty-headed academicians who teach uncritical thinking accept without evidence that "alternative" medicine has merit, and that resistance to its methods is a result of failure to acknowledge a different "paradigm." One such writer wrote an opinion piece entitled "medical establishment needs to expand belief systems" for the Halifax Mail Star, regurgitating LaValley's standard line that quackbusters like Herbert malign any alternative medical practices, don't understand the value of vitamin supplements, and so forth.
The writer was so ill-informed that she even accused Herbert of not recognizing the value of folic acid. In fact, Herbert is an internationally known expert on folic acid, and for many years has been recommending appropriate dietary supplementation. The writer also falsely claimed that LaValley was on some kind of "hit list" maintained by Herbert. The Mail-Star issued a public apology and retracted its misinformation in a statement published on Nov 7.
NCAHF president William Jarvis believes that this type of journalism represents more fallout from the illusion that quack remedies have merit, or at the least are misunderstood esoterica, an idea that has been fostered by the creation of the NIH Office of Alternative Medicine. NCAHF believes that there are standards of conduct that all health care providers should meet, and that these should assure that patients will receive nothing that detracts from evidence-based health care.
LaValley, like his American counterparts, wants changes in the law that would exempt alternative practitioners from the accountability inherent in the privilege of having been granted a license to practice medicine, and forces third party payers to pay for non-standard medicine.
Last issue it was stated that the National Cancer Institute was to test Cat's Claw. The Natural Products Branch states that the activity of Cat's Claw was not sufficient to warrant further testing when put through the cancer and AIDS screens. [Investigational Drugs Branch fax 11/08/95]
Kurt Butler provides a detailed look at a serious aspect of the problem of health misinformation within society. In 1992, Prometheus published his book Consumer's Guide to "Alternative Medicine." Hundreds of media outlets were notified of the book.
Shows that open their platforms to all sorts of quacks expressed little interest in presenting a critical point of view. Large chain bookstores don't stock antiquackery books (traditionally, this is because antiquackery books rarely sell well, but the catch-22 of this type of thinking is that such books cannot sell well if they are not given the opportunity).
Most disturbing is Butler's account of how his book was handled by Academic Library Book Reviews. The reviewer stated that Butler's book was "extremely biased and one-sided" and rated it "not recommended." Revealing extreme personal bias, the reviewer recommended The Encyclopedia of Alternative Health Care for "balance." The latter is a pro-quackery tome that presents pseudomedicine without criticism. Its author, Kristen Gottschalk Olsen, has a master's degree in "holistic health education" from John F. Kennedy University, an accredited non-traditional school in Orinda, California. JFKU is clearly off-beat if Olsen is representative of its educational products.
Butler followed up and discovered that the reviewer was Janet M. Coggan, MLS, a librarian at the University of Florida Health Science Center Library! Butler reports that personal contacts with Coggan were fruitless.
Comment: Butler has uncovered a serious problem. Librarians have a great deal of power to make or break books. Librarians generally have liberal arts, not medicine or science, backgrounds.
Even the American Medical Association librarians found themselves unable to evaluate the "alternative medicine" literature when assembling a reader's guide. Recognizing their limitations, they asked for help from Stephen Barrett, MD, and William Jarvis, PhD. The result was the 1993 publication Reader's Guide to "Alternative" Health Methods. Further, this problem may be rooted much deeper in the uncritical empty-mindedness that salutes politically-correct cultural diversity.
A Florida man, Brian Dussalt, began seeing Dr. James McKee in 1990 for an irritating rash. McKee over-prescribed prednisone resulting in destruction of tendons and ligaments. Dussalt, a carpenter and mechanic, is now disabled at age 48.
Because McKee's "ND" was written in cursive, it looked like "MD", and Brian Dussalt had no idea he was being treated by a naturopath. Dussalt sued Mckee and won a $250,000 judgment, but hasn't been able to collect a penny. Why? Because naturopaths are not bound by the state's financial responsibility law as are nearly all other health service providers.
How did such a dismal situation for health service consumers come about? Here's the history. Florida naturopaths persuaded lawmakers in the 1920s to allow them to prescribe drugs. Citing a statute that allowed them to use plants in healing, they went to court in 1927 and won their case on the basis that nearly all drugs were of botanical origin. Florida stopped licensing naturopaths in 1959, but grand-fathered about 200 who were already in practice. McKee, 72, is one of 14 remaining NDs.
[Orlando Sentinel, July, 1995]
Beach volleyball player Scott Friederichsen bought herb pills at a health food store that were for increasing one's "energy." He was pleased with the zip that they provided and passed them along to his fellow player Mike Whitmarsh. Both he and Whitmarsh were selected for drug testing at a Hermosa Beach qualifying event for the Olympics in July. Both tested positive for pseudoephedrine, a banned stimulant.
Whitmarsh says that the label indicated that the pills contained "roots, willow bark, ginseng, and a bunch of other things," but that it did not indicate that the product contained ephedrine (note: this may have been due to the use of vague terms such as Ma Huang or epitonin). Both were suspended for three-months.
Whitmarsh's suspension was lifted because certain testing formalities were not observed, but the repercussions of the episode still have been a personal disaster for him. He forfeited his $20,000 winner's check and his Olympic qualifying points from the Hermosa Beach event. He lost his partner who chose another after Whitmarsh was initially suspended.
Whitmarsh is struggling to earn enough points to qualify for the Olympics despite his setback. He is also concerned about his reputation. Athletes who have been stigmatized by having flunked drug tests are not as likely to be contracted to advertise sports products. [San Diego Union-Tribune 10/25/95]
Forbes magazine (10/9/95) profiles Tony Robbins (President Clinton's self-help guru; see Jan-Feb '95 NCAHF Newsletter), Stephen Covey, Deepak Chopra, Susan Powter, Jack Canfield, and Mark Victor Hansen in "The happiness hucksters." The by-line says, "Mark Twain wrote about them in Huckleberry Finn, but he never dreamed that modern technology would turn riverboat hustlers into big-scale entrepreneurs."
Comment: This article provides insight into what has been called "the American sweet dream of success." This is a dimension of human vulnerability exploited by mental health quackery, multilevel marketing schemes, diploma mills, and health career training that appeal to adults who take up potentially lucrative careers later in life (eg, chiropractors).
The FDA proposes a program to give consumers more and better information about the prescription drugs that they use. The first goal of the proposal is that by the year 2000, at least 75% of consumers will receive understandable written information that will follow quality standards in terms of content and format. By 2006, 95% of consumers will have such information.
According to a new FDA survey, the proportion of consumers who received substantial written information about their prescription drugs rose from 23% in 1992 to 55% in 1994, but the quality of the information varies greatly. (FDA News Release, 8/23/95)
Comment: The FDA's announced effort at improving labeling information for consumers is laudable. One of NCAHF's major emphases involves the accurate, understandable, and complete labeling of health products and services. Hopefully, the FDA's emphasis upon improving consumer understanding of prescription drugs will spill over to nonprescription products, dietary supplements, and other such items that people use to improve their health.
The FDA's Division of Marketing Studies conducted a national telephone survey (N=1649) to find detailed information on dieting behavior.
Dieters were found to be more active readers of nutrition information than nondieters, but their choices about the type of regimen or specific products was more dependent upon word of mouth (ie, versus commercial sources, physicians, or written information). Dieters relying on written information were more likely to engage in healthy weight-loss regimens, and less likely to follow questionable practices. [Heaton AW, Levy AS. "Information sources of U.S. adults trying to lose weight," J Nutr Ed 1995;27:182-90]
Back in the 1970s the legend that ancient Chinese doctors had been paid for keeping people healthy, rather than for treating their diseases, caught the fancy of American thought leaders. People in health care financing ballyhooed the notion that this could be a model for modern Americans to emulate. The flaw in this idea was immediately apparent to people knowledgeable about the psychology of quackery, but no one was listening. Now that this idea has had time to bear bad fruit, some people may be willing to take a second look.
The flaw in this idea is revealed in an old maxim:
Quackery is more common in medicine than in other scientific endeavors because it takes credit for the work of nature--nature cannot build a railway, but she can very often cure a disease. -- Francis Shepard*
The ancient Chinese legend took this deception beyond curing and took credit for normal health! Even in primitive settings, once people survive infancy and childhood their risk of illness and death diminishes dramatically. Most of the time they will enjoy good health. When serious disease does strike, the illnesses is will last a relatively short time compared to the time a person is disease-free. In technologically advanced societies the disease-free time is even greater. The fundamental flaw in this idea is apparent in an elementary school teachers' wisecrack that says " we ought to teach growth, so we could take credit for it!"
This flawed idea became a selling point for health maintenance organizations. The idea was promoted that the incentive for keeping people well would make preventive medicine profitable. The idea has now blossomed into the horrors of managed care programs such as are described in Consumers Research (CR) cited in this issue.
There is great wisdom in Ben Franklin's famous saying, "an ounce of prevention is worth a pound of cure," but the problem is trying to apply this idea to medical practices. The provable preventive measures are dispensed in public health programs suc h as immunization, fluoridation, and food enrichment practices that eliminated nutritional deficiency diseases (goiter, scurvy, pellagra).
Private practice preventive medicine is expanding this idea through stop-smoking programs, weight control, blood pressure screening and management, cholesterol screening and management, physical fitness programs, and so forth. This is laudable and should be supported and encouraged to grow. The problem is that businesses operate on the basis of relatively short-term gains compared to the time that it takes for preventive medicine to yield results.
Stop-smoking programs are the most important provable efforts that will yield a measurable long term benefit. Unfortunately, it is very likely to take from 15 to 30 years for the effects of tobacco-use cessation to yield a financial benefit. Businesses simply are not willing to wait that long.
Juxtapose this with the profits which are immediately available through medical neglect -- as described in the CD article -- and it becomes obvious why this principle of business is incompatible with medical professionalism that is based in science and ethics.
[*Young JH. "A quota of quotations on quackery," Bull NY Acad Med, 1975;51(7):881-3.]
Critics of standard medicine are fond of quoting a 1978 OTA report which stated that "only 10 to 20 percent of procedures currently used in medical practice have been shown to be efficacious by controlled trial."  Promoters of questionable medicine used this "statistic" to justify their unproven "alternative" and "complementary" procedures.
The OTA report did not reveal how the "10 to 20%" figure had been determined, but now Kerr L. White reveals that he was its source. White was responding to a British study in which the authors stated: "For many years clinicians have had to cope with the accusation that only 10-20% of the treatments they provide have any scientific foundation" [They had found that 82% of the primary treatments given to 109 patients during April, 1995, on whom a diagnosis had been reached, were scientifically proven .
White disclosed that he based his 10-20% estimate on a 1963 paper 3 that reported on a survey of the prescribing practices of 19 family doctors in a northern British town for two weeks (one in December 1960, and another in March 1961). The survey wasn't trying to evaluate the science of medical practice. Its purpose was to look toward controlling prescribing costs in terms of "standard" (ie, "generic") versus "proprietary" drugs.
The "intent" of each prescription was analyzed according to how specific it was for the condition. These were divided into categories of "standard" or "proprietary" drugs. Intent was "specific" for the condition for which it was prescribed only about 10% of the time; "probable" in about 22%; "possible" in 26%; "hopeful" in 28%; "placebo" in 10%; and, "not stated" in 3.6%.
From these data White estimated that 10-20% of the medicine practiced was evidence-based, and that the combined placebo and Hawthorne effects accounted for another 20-40%; and the rest (which he refers to as a "mystery") accounts for 40-70%. White stated:
Some 20 years ago, as a member of the original Health Advisory Panel to the US Congressional Office of Technology Assessment I ventured the 10-20% figure again and invited anyone to provide more timely data. No one could. The figure was immortalized in OTA circles and publications for almost a decade. In countless addresses and conferences I often challenged others to provide better evidence but none was forthcoming. So the northern industrial town "armchair" assessment persisted .
Little about the survey's setting was relevant to standard American medicine in 1978, much less today. Time-wise, the 1963 survey report was coincidental with the 1962 Harris-Kefauver Amendment that for the first time mandated premarketing efficacy for medications. The survey was done in England, which has no law comparable to the US Food, Drug & Cosmetic Act. White admits to the "armchair" quality of his statement.
Why did no one challenge White's estimate? Most likely it was because no one was willing to make a statement that couldn't be substantiated scientifically. In short, they weren't as willing as he to be unscientific!
White created a myth damaging to standard medicine, and useful to the promoters of quackery. Should White be chastised for his indiscretion? The intent of the OTA Report was not to advocate an open marketplace, or that there be less science in health care. Its purpose was to find ways for improving the process through which the safety and efficacy of health care technologies are established. White merely was emphasizing deficiencies in the present system.
Nevertheless, White can be criticized for inferring in a report to Congress that the survey results were representative of standard medical practice in the USA. Legislators need valid information to act in the best interest of the nation.
Citations: (1) US Congress, Office of Technology Assessment. Assessing the Efficacy and Safety of Medical Technologies. Sept, 1978, Wash, DC; (2) Ellis et al. "Inpatient general medicine is evidence-based," The Lancet 1995;346:407-10; (3) Forsyth, G. "An inquiry into the drug bill," Medical Care 1963;1:10-16; (4) Letters to the editor, The Lancet 1995;346:838.