Members were informed of the passing of NCRHI president, Dr John Renner, in the Bulletin Board, but subscribers to this publication do not receive that publication. Dr Renner died on Sept 2 following surgery for an aneurism. Dr Renner graduated from Dartmouth College in Hanover, NH, and completed medical school at George Washington University. He practiced in rural Virginia for a decade before taking a teaching position at the University of Wisconsin where he helped found the Department of Family Medicine and served as a Professor and Chairman. In 1980, he moved to Kansas City and started the Family Practice Residency at St. Mary's Hospital--now Trinity-Midwest. He also was a co-founder of the National Patient Education in Primary Care Conferences that are now in their 22nd year of service. At the time of his death, Dr. Renner was a Clinical Professor at the University of Missouri-Kansas City Medical School, Chief Medical Officer of HealthScout.com, an Internet health information service. He had been president of NCRHI since 1998.
Due to Dr. Renner's passing, the Council is undergoing substantial reorganization. One of the side-effects of this situation is that there will be no issue of the NCRHI Bulletin Board for September/October. Instead, members will receive a ballot for the election of officers and board of directors for the 2001-2 term of office.
It was announced last July that the New York State University at Stony Brook would be closing its Center for Complementary / Alternative Medicine. because of money problems. Interviews with various medical faculty members were revealing as to why the clinic was opened in the first place. Dr. Fred Miller, chairman of the department of pathology, bemoaned the "great waste of money" involved in establishing the center. He noted that although he believed it was appropriate to do research on complementary medicine, the purpose of the Stony Brook operation was a business venture intended to cash in on the alleged popularity of alternative and complementary medicine. The Newsday (7/27/00) report stated that "Despite its popularity with patients, alternative medicine has not been a money-maker for many universities or large medical centers, and many programs have scaled back or remain essentially academic centers with small clinics."
One reason given for the failure of alt/comp med clinics is a lack of insurance coverage. To remedy this, Dr Samuel Benjamin, the center's director, talked to some health insurers about providing coverage, but the idea ran into strong opposition because it meant the appearance of endorsing therapies that were of unproved validity.
The popularity of so-called "alternative" (etc) medicine is largely an illusion created by dubious data reported in medical journals which has been amplified by lazy journalists. The catalyst was the 1993 New England Journal of Medicine article by Eisenberg, et al, which claimed that their survey of the use of "unconventional" medicine in 1990 "was far higher than previously reported." There were at least two major errors with this statement. First, it was false on its face; and second, the survey was so different that its results could not be compared with previous studies.
The fact that this assertion was false was clear from merely reviewing the data from the studies cited by the authors. For instance, the authors cited the 1987 Harris and Associates study of the use of questionable health treatments. Harris found that 21% of American adults had used one or more unproven treatments for at least one of 15 different conditions (the list did not include weight loss per se, only "to remove cellulite") in the past year (1986). Far more used vitamins and herbs than were reported by Eisenberg. Less than 1% of Eisenberg respondents reported using folk remedies while 73% of the subjects in the study cited (Cook & Baisden, South Med J, 1986:79:1098+) used folk remedies. Further, Eisenberg studied the US population but cited data from the United Kingdom for comparison. These errors can only be attributed to shoddy oversight by the study's reviewers.
The second point, that Eisenberg, et al could not legitimately compare their data with others because they did not categorize the kind of things people were doing in the same manner is very significant. Eisenberg's categories not only differed from what others have used when surveying the use of unorthodox health care methods, but did not accurately reflect what is generally thought to be "medicine," unconventional or otherwise. According to Eisenberg, the most frequently used type "unconventional therapy" was undefined "relaxation techniques." Third was "massage." Neither of these qualify as medicine. Chiropractic use, which was second, was consistent with other studies, including reports by the main chiropractic trade association. I have been interviewed scores of times by the media on the alleged popularity of alternative medicine. I have asked numerous reporters about their source of the data on the extent of the use of alt/comp med. Without exception, they cited secondary sources (ie, other media reports). Not one had even read the original Eisenberg report, much less critically analyzed it to check out its validity. Thus, the media blitz on the alleged popularity of unconventional (aka "unorthodox," "alternative," "complementary," "non-traditional") medicine has been largely an illusion. The reality is that patients with real or imagined health problems tend to try a wide variety of products, services, or lifestyle practices. The more long-term the problem, the greater variety will be the speculative remedies. This is simply self-care.
The data on questionable health behavior (ie, the use of unproven methods by consumers) is quite consistent. People are willing to try new techniques if someone they trust speaks well of them. Thus, there it is no surprise that most recent surveys have found an increased use of methods that have been highly touted in the media. But, it doesn't take long for consumers with real health problems to make up their minds as to whether or not they are being helped. The reports of satisfaction by users have not been supportive of unconventional methods. The failure of alt/comp and integrative medicine clinics is an indication that some administrators did not do their homework before investing in such clinics. A regrettable aspect of this modern day fiasco is that it is nearly impossible to fund a nonprofit program such as that of NCRHI that could have saved millions of dollars that have been squandered on these misguided clinics.
In 1998 researchers at the University of Toronto reported that adverse drug reactions affected an estimated 2.2 million hospitalized patients, and 106,000 of these were fatal. Earlier this year, the National Academy of Sciences' Institute of Medicine reported that between 44,000 and 100,000 Americans die each year as the result of medical errors. In September, a Chicago Tribune report stated that "registered nurses have long been responsible for more patient deaths and injuries each year than any other health care professional." To track nursing errors, the Tribune analyzed computer records from the FDA, Dept of HHS, federal and state files of hospital records, complaint investigations, court and private health care files, and nurse disciplinary records.
It was found that since 1995 at least 415 patients have been killed, and 1,356 injured by RNs operating infusion pumps. At least 216 patient deaths and 429 injuries occurred when RNs failed to hear warning alarms built into life-saving equipment. Another 119 patients have been killed and 564 others injured by unlicensed, unregulated nurse aides, some of whom were low-wage earners used to augment or supplant high-paid RNs as cost cutting measures. Further, nationally the number of reported nursing errors have increased in each of the last five years coinciding with cutbacks due to economic crises that has left one in every four hospitals operating in the red.
The thrust of this report is aimed at the pursuit of profit by the managed care system that supplanted medical professionalism in the mid-1990s. However, these data have not been lost on the promoters of alternative medicine who happily proclaim that no such data exist to indicate that their methods are as risky. But, NCRHI doesn't believe that it is fair to compare the risks of standard medicine with those of nonstandard methods for two reasons: differing standards of conduct and differing patient populations. Nonstandard practitioners and clinics do not keep records of the harm they do. On the contrary, NCRHI has documentation that such entities work hard at covering up and denying clinical wrongs. They have to because using nonstandard methods automatically puts them at risk of legal sanctions.
The populations served by standard and nonstandard health care differ markedly. Hospitalized patients suffer from serious diseases and are extremely fragile. Patients who use nonstandard remedies come from the general population and are much healthier. As consumer advocates we are not naive or uncritical of the hazards of standard medicine, but we have learned to differentiate between the inadvertent harm done by medical errors and harms which occur when off-beat health care is done according to plan. Every procedure must be justified on the basis of a benefit-risk equation. A chiropractor who paralyzes a patient by manipulative therapy for neck pain cannot justify the risk because the benefit is so small by comparison. Nonstandard practices do not circumvent the risks of medicine, the add to such risks by introducing useless methods (including substitutes for immunization) that enable diseases to progress unchecked, involving therapies that have their own potential problems (manipulation can cause trauma, herbs or megavitamins can be toxic, acupuncture needles can injure, enema devices can puncture the colon or transmit pathogens, colonic irrigation can deplete electrolytes, and more).
Publicity about the failings of standard medicine coupled with the favorable reports usually given to alternative medicine can combine to distort the public's perception of risks. Obviously, we need to know about the problems associated with standard health care so they can be addressed. But, the failure of the media to carefully examine the realities of the alternative medicine marketplace do a great public disservice.
Mark Blumenthal reviewed the possible interactions between 47 different herbs and conventional drugs in the current HerbalGram 49, 2000, pp.52-63. Blumenthal is an herbal advocate who defends botanicals at every opportunity (aka an "apologist"). To be fair, Mark's defensiveness is sometimes justified when media reports sensationalize the risks of using certain herbal substances. Unlike some other herbal proponents, he is willing to acknowledge real problems. In other words, if Blumenthal admits to there being a potential problem with an herbal substance, there is good reason to take notice. His article is revised and reprinted from Interactions Between Herbs and Conventional Drugs: Introductory Considerations, in Herbs--Everyday Reference for Health Professionals published by the Canadian Pharmacists Association and the Canadian Medical Association, 2000.
Early in 1999, sales of herbal products began to slip in the mainstream stores. By the end of the year, the drop in sales was close to 3% after many years of gains. Biggest losers were multi-herb combinations which were down 35%, St John's wort down 26%, ginseng down 14%, and garlic down 9%. Sales in natural food stores and multilevel marketing channels continued to grow but at a lower rate. The continued growth in these markets is thought to reflect a stronger commitment on the part of patrons of these markets. Several herbal products showed substantial gains. Soy supplements led with a 340% increase in sales, followed by flax with a 177% increase, black cohosh increased 143%, milk thistle sales were up 49%, and saw palmetto had a 34% gain. [Market Report, HerbalGram 49, p.68]
About the author. Dan Labriola was once a licensed mechanical and aerospace engineer, commercial and experimental pilot and flight instructor, and president of two aviation-related companies. When the Boeing layoffs hit hard a few back, Dan went looking for a new career in health care. He chose naturopathy because it was a shorter route to becoming a practitioner--a serious factor for an older adult. Dan got his ND degree from what is now Bastyr University, and worked directly with its namesake, John Bastyr. He was the first Special Advisor to the Secretary of the Department of Health for Alternative and Complementary Medicine, and Chair of the Naturopathic Advisory Committee for the State of Washington's Department of Health--and more. Through all of his education and practice, Dan has been true to his scientific principles and has found a niche within the standard medical community. He also has the intellectual capacity to understand complex medical science and technology--which is not usually true of people who choose naturopathy for a career. Dan has been a force trying to turn naturopathy into a legitimate form of "low-tech" health care that emphasizes healthy lifestyles, preventive medicine, and has the good sense and skill to refer patients to medical specialists when serious illness strikes. Dan is located in Seattle, an area with more than its fair share of "greens" and New Age types who are suspicious of anything that smacks of science and technology. Thus, Dan sees a substantial number of patients who fit into the category of those alienated from standard medicine. In several instances, he has been able to convince the parents of children with cancer to use effective standard therapies--along with the "natural" ones that they prefer. This is not simply a mixing of remedies, but involves a scheduling of therapies in such a way as to avoid potential negative interactions between diet and herb remedies and standard medications. In November, 1999, he and oncologist Robert Livingston, MD, Chief of Oncology at the University of Washington Medical Center, published an article in Oncology that discussed the problems that may arise when cancer patients mix potent antioxidants with cancer treatments that rely upon free radical formations to do their work. This work was not well received by some clinics that load patients up on anti-oxidants based upon the simplistic notion that the benefits will be additive instead of contradictory. Now Dan has published a book that truly combines, as its title declares, Complementary Cancer Therapies with so-called "alternative" approaches for, ...well, the hypesters in the marketing department say "for the best possible outcomes," but Dan would never make such a glowing promise. However, his advice could certainly avoid harm that can come from misapplying combinations of questionable and standard approaches. In addition to advice on avoiding such harms, Dan educates patients about issues they will face as they undergo treatment for, and work and living with their predicament. This is a book worth having for any physician with patients who are vulnerable to the siren call of so-called "natural remedies." The book is published by Prima Health, a division of Prima Publishing, 3000 Lava Ridge Court, Roseville, CA 95661; tel: 800-632-8676; Internet: www.primahealth.com.
The American Cancer Society (ACS) has been the best single source of information on questionable cancer methods for many years. Beginning in 1915, the ACS gathered information on quackery by what came to be called the Ad Hoc Committee on Quackery. In 1954, the name was changed to the Committee on New and Unproven Methods of Treatment. In 1970, the word "treatment" was replaced with "management" to include dubious methods of diagnosis and prevention: The Committee on Unproven Methods of Cancer Management. In 1989, the name was changed to the Committee on Questionable Methods of Cancer Management in order to differentiate between unproven methods that were not seen as promising and experimental methods that were moving through the scientific system. In 1995, the name was changed again to the Subcommittee on Alternative and Complementary Methods of Cancer Management. Through all of these name changes, the work of the committee has remained the same--to examine unapproved, unpromising methods of cancer management and to warn patients not to use them.
Its new guide, in my view, reflects the ACS's new approach to reaching the public on a populist level. Instead of the hard scientific facts and strong condemnation of medical nonsense, the intent seems to be to reach people where they are (ie, misinformed, confused, frightened and wary), at to provide them with information that will avoid serious harm. Combined with the book by Dan Labriola, ND, reviewed in another part of this issue of the NCRHI Newsletter, the guide contains on several hundred substances, healing philosophies, therapies, techniques, resources, and so forth; and, is a useful addition to the armamentarium of those who much face patients in today's "real world." The guide is available from the ACS, Health Content Products, 1599 Clifton Rd, NE, Atlanta, GA 30329; 800-ACS-2345.
Politicians are easy targets for quacks. They have to pretty much be nice to everyone, and are always happy to receive donations to their campaigns. Some may recall a story about a New York Chinese Medicine huckster (she was hawking a secret remedy that turned out to be a cheap bottle of aspirin being sold for $60 a pop) who attended a fundraiser for Bill Clinton and used a photo of herself and the President to legitimize what she was doing. Well, a similar thing has happened to GOP candidate George Bush, Jr. Glen Braswell, a convicted felon, donated $175,000 to the Republican Party and $100,000 directly to the Bush Campaign. After discovering the source, both returned the money, but the gestures paid off for Braswell in the form of a article published in his promotional literature that carried Florida Governor Jeb Bush's name as author. The article promoted dubious dietary supplements by attributing statements to Bush that had been added without his permission or knowledge.
Readers have no doubt seen Glen Braswell's slick, four-color promotional literature. More of his publications are sent to the NCRHI office by consumers suspicious of quackery than any other. Braswell's marketing is done under the name of Gero Vita International, and appear under a variety of names, including Gero Vita Laboratories, Life Force Laboratories, Vita Industries, Health Quest Publications, and under the name of a numerous MDs and/or PhDs. Some are renegades with a clear history of quackery, others are obscure, made famous by Braswell's proliferate activities. Braswell has called some of his promotions "journals," (eg, Journal of Longevity Research, Journal of Longevity). These publications are clearly (and cleverly) aimed at aging baby-boomers.
The promotions are very much like the ones that got Braswell in legal trouble in the past. In the late 1970s and early 80s, Braswell marketed baldness remedies, breast enlargers, anti-aging and weight-loss products through a magazine, Body Forum, that disguised advertising hype as editorial articles. In 1984, an official said that the Postal Service had received 138 false representation complaints against 50 different products marketed by Braswell, Inc. Braswell was convicted of mail fraud and was sentenced to 5 years probation. In addition, he was sentenced to a 3-year prison term for income tax evasion (Ed. Is the court's message that cheating consumers is less egregious than cheating the IRS of its share of the gains? Hmmm.)
The link to the Bush brothers caught the fancy of Newsweek, whose reporter interviewed former NCAHF president and founder, William Jarvis. Jarvis told the reporter that in his view, Braswell is an artist who does the best at what he does, which is to create the illusion of that super health can be gained through buying the pills he peddles. I don't see that he is any worse than those slick ads by major pharmaceutical companies which huckster dietary supplements and tell people that in addition to vitamins they need garlic, gingko, ginseng, CoEnzyme Q10, and other speculative ingredients. When it comes to quackery, no political party is any worse than the other. Both quackery and politics are fertile fields for well-heeled hucksters, populists, and demagogues.