The journal Academic Medicine focuses on the education of physicians. The March 2001 issue included a special set of articles on "Alternative Medicine: The Importance of Evidence in Medicine and in Medical Education." In an introduction to the set, guest editor Arthur P. Grollman, MD of the SUNY at Stony Brook School of Medicine attributed clinical improvements before 1900, when virtually all medical treatments were ineffective, to the placebo effect and the self-limited nature of most diseases. He explained that methods for preparing standardized extracts of herbal agents and the knowledge to use them safely to significantly affect the course of disease were not available until the 20th century.
Donald Marcus, MD of Baylor College of Medicine called for education about "alternative medicine" that is evidenced-based, not merely the integration of unproven practices into medicine. He repudiated "alternative medicine's" antipathy to scientific testing. He refuted three common criticisms that alternativists make about regular medicine: (1) physicians ignore mind-body interactions; (2) medical treatment does not address the cause of disease; and (3) medicine ignores prevention.
Barry Beyerstein, PhD of Simon Fraser University identified reasons for the popularity of unproven therapies. He discussed seven social and cultural reasons: (1) poor scientific literacy; (2) anti-intellectualism and anti-scientific attitudes piggy-backing on New Age mysticism; (3) vigorous marketing and extravagant claims; (4) inadequate media scrutiny and attacks on critics; (5) social malaise and mistrust of traditional authority figures-the anti-doctor backlash; (6) dislike of the delivery of scientific biomedicine; and (7) the belief that "natural" remedies are necessarily safer, gentler, and more efficacious than scientific ones. He discussed three psychological reasons: (1) willingness to believe; (2) logical errors, shortcomings of judgment, and missing control groups; and (3) self-serving biases and implicit social demands.
Beyerstein discussed eight reasons why ineffective therapies may seem to work: (1) the self-limited nature of many diseases; (2) the cyclic nature of many diseases that leave patients with good days and bad days; (3) the placebo effect; (4) rare instances of spontaneous remissions; (5) physical complaints arising from psychological distress, which induce people to think they have diseases; (6) it's easy to misattribute positive results to CAM treatments when they're used in addition to evidence-based treatments; (7) patients sometimes are misdiagnosed and they receive unduly pessimistic prognoses; and (8) charismatic practitioners can provide psychological uplift.
Pamela Talalay, PhD and Paul Talalay, MD of the Johns Hopkins University School of Medicine called the 1994 Dietary Supplement and Health Education Act, which weakened regulatory authority over products such as vitamins, minerals, botanicals, and amino acids, "a disaster waiting to happen" [emphasis in original]. They support their argument with a summary of the dangers of supplement products. They also point out that plants have provided a multitude of life-saving drugs. For example, they wrote: "Fourteen of the drugs in current use in cancer chemotherapy occur naturally, and of these, five originate from plants." But they also explained how the development of useful drugs from plant chemicals requires rigorous scientific investigation to establish safety and efficacy. They called for requiring that plant products used as drugs be evaluated for safety and efficacy by methods identical to those used for novel synthetic chemicals.
Wallace Sampson, MD, clinical professor of medicine (emeritus), Stanford University School of Medicine characterized most teaching about CAM as ideologically or advocacy-based and without concern for scientific validity. Dr. Sampson described his own course at Stanford on CAM, which teaches students to think critically about claims and how to investigate them. The course addresses: (1) sources of errors in thinking, perception, and memory; (2) influences on placebo experience; (3) language distortion, myths, propaganda techniques, cult-like behavior; (4) information on specific CAM methods; and (5) recognizing misinformation in medical literature. Learning activities for students have included applying methods of critical analysis to evaluate talks by CAM promoters and visits to CAM clinics.
On September 21st Allen J. Hoffman pled guilty in federal court to two felony counts of introducing unapproved new drugs into interstate commerce. Hoffman, doing business as T-Up, Inc. in Baltimore, MD and as Astec Biologics, Inc. of Pennsylvania, promoted and sold aloe vera products under the names of T-Up and T-Plus as well as cesium chloride products for the treatment of cancer, AIDS, and other diseases. Hoffman and others charged cancer patients and their families approximately $12,000 for a two-week treatment with intravenous aloe vera. They charged approximately $75 for a 2 oz. bottle of T-Up or T-Plus. Hoffman faces 41 to 51 months in prison. Sentencing is scheduled for November 30th. If the court so orders, Hoffman will be required to pay restitution to the victims he defrauded or to their families.
Donald L. MacNay, Hoffman's codefendant in a 22-count indictment of July 1999, pled guilty to fraud and conspiracy charges on March 29, 2000 and received a 17-month sentence.
According to proponents of "repressed memory therapy" (RMT), numerous mental health problems in adults are due to subconscious damage from repressed memories of sexual or Satanic ritual abuse experienced in childhood. RMT practitioners claim to be able to help their clients recover memories of trauma and heal. Many mislead their clients into believing they have multiple personality disorder (MPD) and into accusing family members of abuse. The consequences have included divorces, family feuds, loss of employment (as charges have become public), lawsuits, and criminal convictions.
Although many naïve psychotherapists have accepted some of the premises of RMT, according to sociologist Rael Jean Isaac, PhD [writing in Priorities for Health 12(4);2000/13(1);2001.], the repressed memory movement has been on the wane since 1994. For example, the number of continuing education courses on RMT offered to clinicians has decreased considerably. Clients and falsely accused family members have initiated numerous lawsuits against RMT practitioners. Hospitals have closed MPD units. Insurers have refused to pay for RMT. Prominent RMT practitioner Bennett Braun, MD had his medical license suspended. He was expelled from the Illinois Psychiatric Society and the American Psychiatric Association. Braun's insurers had to pay a malpractice award of $10.6 million to one of his former patients.
Instead of repressing memories of traumatic events, people tend to have trouble forgetting them. Memory is a process of reconstruction prone to error. Therefore, it is not difficult for therapists to implant false memories. The failure of RMT practitioners to acknowledge this is a psychotherapy scandal. Isaac quotes False Memory Syndrome Foundation Executive Director, Pamela Freyd, PhD: "We have a whole culture that has accepted the notion that the proof that something happened is that the person forgot it."
Elizabeth Loftus, professor of psychology at the University of Washington, has been the most prominent critic of claims about "recovered memories" of child abuse. RMT fanatics have responded to Professor Loftus's research findings with threatening letters, filings of complaints, lawsuits, and defamatory falsehoods in newspapers and over the Internet. Nevertheless, in June she received the William James Fellow Award of the American Psychological Society. The award citation [published in the November/December 2001 issue of Skeptical Inquirer] states in part: "As a result of her pioneering scientific work as well as her activity within the legal system, society is gradually coming to realize that such memories, compelling though they may seem when related by a witness are often a product of recent reconstructive memory processes rather than of past objective reality."
Americans have become painfully aware of the public health threat of anthrax bioterrorism. By the time people develop clinically recognizable health problems due to anthrax infection, and particularly in cases of inhaled anthrax, it may be too late for antibiotic therapy to save them. Anthrax vaccination is neither recommended nor available for the general public. The Centers for Disease Control and Prevention recommends antibiotic therapy to prevent anthrax infection only for people whose exposure has been determined on the basis of a public health investigation. No screening test exists for people to take to determine whether they have been exposed to anthrax.
Consumers are scared. Truthful messages from public health officials about anthrax control do not and cannot at this time provide consumers with as much reassurance as they are seeking. Health hucksters have responded to consumer demand for extra protection against anthrax with deceptively promoted products that can only provide false reassurance. Some examples:
The Securities and Exchange Commission said that it ordered three publicly traded companies to stop promoting products with fraudulent claims that they kill anthrax spores and provide warnings of biological and chemical attacks. The companies are the Classica Group of Lakewood, NJ; R-Tec Technologies of Flanders, NJ; and Disease Sciences of Boca Raton, FL. [The New York Times, B9, 11/17/01.]
Five trade associations (the American Herbal Products Association, the Consumer Healthcare Products Association, the Council for Responsible Nutrition, the National Nutritional Foods Association, and the Utah Natural Products Alliance) for the dietary supplement industry issued a joint statement advising against use of dietary supplements as a cure or treatment from anthrax.
The Federal Trade Commission has sent about 40 e-mail warnings to operators of Web sites touting bogus bioterrorism defense products and therapies. The operators must discontinue express or implied claims about benefits against anthrax, smallpox, or other diseases that are not substantiated by competent and reliable scientific evidence. Those who continue to make deceptive and misleading claims face possible prosecution for violating the Federal Trade Commission Act.
The Associated Press reported that Stephen E. Strauss, MD, the director of the National Center for Complementary and Alternative Medicine, told the U.S. House Government Reform Committee that there is little reason to believe that "alternative" medicines are effective in treating anthrax or other biological agents." He said that the public should have "an unwavering trust in the currently approved drugs and vaccines" and cautioned against "pursuing unproven remedies." But at the same hearing Rep. Dan Burton (R-Indiana), the committee chairman, said that federal agencies should be encouraging "alternative" medicine in responding to bioterror attacks. [Feds: Alternative remedies no cure for anthrax. CNN.com November 15, 2001.]
Therapeutic Touch. Edited by Béla Scheiber and Carla Selby. Prometheus Books. 2000. 300 pages. ISBN 1-57392-804-6; $26.00. Reviewed by Rebecca Long.
This book combines all essential reference material on "Therapeutic Touch" (TT) in one volume for ease of reference. It is also fascinating reading. One of its strengths is that it contains reprints of some of the best research papers, not only by TT critics, but also by TT proponents. The papers by proponents reveal how poor the evidence is to support claims that TT is a useful method of healing.
Scheiber and Selby included the two most widely cited pro-TT research papers: the Pentagon-funded study of TT on burn patients conducted at University of Alabama at Birmingham and the paper by Gordon and others on TT treatment of osteoarthritis of the knee. They also included a powerful critique of these studies' methodological flaws.
The editors wisely chose a recent article by Therese C. Meehan to define TT. Meehan provides an illuminating summary and criticisms of the vague theory behind TT and the problems associated with the most frequently cited papers. Since she is a proponent of TT, the criticisms in her article are not easily dismissed.
Daniel Wirth's experiment in wound healing, often cited by TT proponents, is accompanied by Wirth's more recent article in which he states that out of five of his experiments, only two showed significant results in favor of the study group. The other three were either neutral or actually showed significant results in favor of the control group. Wirth writes: "the overall results of the series are inconclusive in establishing the efficacy of the treatment [TT] interventions examined."
The book features the most comprehensive history of TT published to date. Its coverage ranges from the physics of TT to its ethical problems. It belongs in all nursing school libraries and should be required reading for all nurses who have encountered TT.
Editor's note: Therapeutic Touch includes a chapter by the author of this review.
Varro E. Tyler, PhD, ScD, an expert on the scientific study of plant-based medicines and a member of NCAHF's Herbal Remedies Task Force, died on August 22nd. He was 74. Dr. Tyler was a distinguished professor emeritus of pharmacognosy as well as a former dean and executive vice president for academic affairs at Purdue University. He was internationally recognized for his research and education efforts related to the field of herbal medicine. He provided important input into the development of NCAHF's 1995 "Position Paper on Over-the-Counter Herbal Remedies."
The paper identifies problems in the herbal remedies marketplace related to unreliable labeling, improper preparation, failure to track harm, extravagant claims of product efficacy, and industry's claim that it is too expensive to conduct well-controlled studies to determine safety and efficacy of products that can't be patented. It recommends the creation of a special category of over-the-counter medicines called "Traditional Herbal Remedies" (THR). THRs would be subject to limitations such as being well-established in the pharmacogonosy literature as not having lethal or damaging side effects and being indicated only for the treatment of non-serious, self-limiting conditions. Marketing of THRs would be permitted without costly and lengthy trials as long as certain requirements are met related to labeling, postmarketing surveillance, and quality control. Two of Dr. Tyler's books, Herbs of Choice and The Honest Herbal are available through NCAHF Book Sales.
Senator Orrin Hatch (R-Utah) is well known as a hawk in the U.S. war against controlled substances such as stimulants and depressants. A pious Mormon, he abstains from alcohol, tobacco, and coffee. But he is also the biggest champion of the dietary supplement industry which sells pro-hormones that act like anabolic steroids, ephedrine-a chemical cousin to the stimulant methamphetamine, valerian-an herbal tranquilizer, the sedative kava, and nostrums of all sorts. Hatch was the chief architect and sponsor of the 1994 Dietary Supplement and Health Education Act (DSHEA), which deregulated the supplement industry, promoted its growth, and inaugurated a new golden age of quackery.
In "Scorin' with Orrin" (The Washington Monthly, September 2001, p. 27-35), Stephanie Mencimer provides a perspicuous exposé of the folly of DSHEA, Utah's hospitality to scammers, Hatch's hypocrisy, and his close ties to an industry with "a well-documented history of fraud that goes beyond the usual corporate shenanigans." She writes about Olympic athletes testing positive for the pro-hormone nandrolone after taking supplement products that did not provide accurate labeling. Following the Sydney Olympics, the International Olympic Committee blamed Hatch for the surge in positive tests and "warned athletes to avoid American supplements particularly those manufactured in Utah."
The 2002 Winter Olympic games will be held in Salt Lake City. Supplement companies are among the sponsors.
Washington State Attorney General Christine O. Gregoire filed a lawsuit in Thurston County Superior Court in October against the promoter of "CWAT-Treatment: BioResonance Therapy" for cancer. Gregoire's complaint accused David L. Walker of Olympia and his company, DLW Consulting, Inc. of numerous violations of the state's consumer protection act including: making unsubstantiated health claims, misrepresenting the success rate of his treatment, making an unsubstantiated testimonial to the treatment's effectiveness, offering medical advice and treatment without having the necessary qualifications, and marketing an unapproved drug.
According to the complaint, Walker's treatment-for which consumers paid between $2,436 and $5,220 for the program-uses a combination of an herbal mix known as "Indian Mud" ingested orally, coffee enemas, a variety of dietary supplements and the use of an electrical device called a "bio-resonance oscillator" or "molecular enhancer" that patients are instructed to use each day.
The lawsuit asks that the court order Walker to stop promoting his treatment immediately, and that he pay an unspecified amount of civil penalties and restitution.
On November 28th the DLW Consulting Web site continued to promote its dubious treatment program. David claims on the site that he has a PhD in physics.
On October 11th U.S. Department of Health and Human Services, US Customs, Florida state, and Hillsborough County authorities effectively stopped the Medical Center for Preventive and Nutritional Medicine clinics in Carrollwood and St. Petersburg from offering nonsensical, aloe vera-based injections as cancer treatments. They seized serum supplies and patient files from the clinics and took materials from the Largo home of clinic operator and "nutrition counselor" Joseph DiStefano. U.S. Judge Thomas McCoun III sealed the affidavits, which contain the evidence to justify the search warrants, for 120 days.
Patients treated by DiStefano have protested the raid; they are trying to raise money for an attorney and say they will take their case to members of Congress. They were charged about $1,125 for the aloe vera-based protocol, which involved a "standard series" of 30 injections of "albarin serum."
The clinics continue to provide other unproven "alternative" treatments such as chelation, bio-energetic medicine, and colonic therapy.
[St. Petersburg Times Online reports: Ripley R. Agents search therapists home, clinic. (10/12/01); Zimmer J. Patients rally for alternate therapy. (10/26/01.)]
A couple who rejected medical advice to not restrict their
diets to raw vegetables, fruits, and nuts received no prison sentence
after pleading guilty to child cruelty in the death of their nine-month
old daughter, Areni Manuelyan, from a chest infection related
to malnutrition. Garabet and Hazmik Manuelyan from Staines, Surrey
(UK) were placed under a community rehabilitation order for three
years. Areni had been seen by a pediatrician who said that she
wasn't developing properly and that the mother's breast milk was
nutritionally deficient. [Baby death parents spared jail. BBC
News Online. 9/14/01.]