A surgical procedure widely promoted since the early 1990s to remove areas of hyper-inflated lung in patients with emphysema has been shown to do more harm than good for patients with the most severe disease characteristics. In a randomized clinical trial the 30-day mortality rate for 69 surgical patients was 16%, while for the control group of 70 medically treated patients it was 0%. Patients were monitored for three years. The overall mortality rate for the surgical group was nearly four times greater than for the medically treated group. The results were published in the October 11, 2001 issue of The New England Journal of Medicine. In an editorial in that issue, the journal's editor Jeffrey M. Drazen, MD wrote "in my opinion it does not make any sense for anyone to undergo lung-volume-reduction surgery outside a controlled trial."
Gina Kolata reported in The New York Times (8/15/01, p. A1) that a 1996 government survey showed that more than 3,000 patients at 27 medical centers had the operation. The operation costs about $60,000; the discounted Medicare price is $30,000. Medicare is no longer paying for the surgery outside of a clinical trial.
On May 16th, the World Health Organization (WHO) released a global strategy "to provide a framework for policy to assist countries to regulate traditional or complementary/alternative medicine (TM/CAM) to make its use safer, more accessible to their populations and sustainable." The report refers to TM as "a comprehensive term used to refer both to TM systems such as traditional Chinese medicineand to various forms of indigenous medicine." It states: "In countries where the dominant health care system is based on allopathic medicine, or where TM has not been incorporated into the national health care system, TM is often termed 'complementary,' 'alternative,' or 'non-conventional' medicine."
The report's definitional foundation is faulty. Allopathic medicine is extinct. Allopathy is a term coined by Samuel Hahnemann (founder of homeopathy) to designate medical practices, such as bloodletting, based on ancient Greek superstitious beliefs about four fluids of the body they called humors. The term is often used incorrectly to describe modern medicine, which, unlike traditional medicine, advances by adopting new innovations and by discarding misguided or inadequate practices in light of scientific discoveries.
Many practices promoted as "complementary," "alternative," or "non-conventional" medicine are rooted in traditions of particular cultures (and cults), and are based on prescientific notions of "like cures like" (e.g., animal horns as an aphrodisiac) and healing through methods to supposedly manipulate a transcendent force of living beings (popularized as "the force" in Star Wars and "mojo" in Austin Powers: The Spy Who Shagged Me). But other "alternative" practices that pollute the health marketplace, such as EDTA chelation treatment of cardiovascular diseases, "anti-aging" hormonal treatments, and electrical "Zappers" for killing phantom disease-causing parasites, have nothing to do with any traditional system; they are based on materialistic assertions about biology that are just plain wrong.
The stated aim for the WHO TM/CAM strategy is to assist countries to:
develop national policies on the evaluation and regulation of TM/CAM practices create a stronger evidence base on the safety, efficacy and quality of the TM/CAM products and practices ensure availability and affordability of TM/CAM, including essential herbal medicines promote therapeutically sound use of TM/CAM by providers and consumers.
"Traditional or complementary medicine is victim of both uncritical enthusiasts and uninformed skeptics," explained Dr Yasuhiro Suzuki, WHO Executive Director for Health Technology and Pharmaceuticals in a WHO press release. Dr. Suzuki left out well-informed skeptics who decry the failure of proponents to provide evidence to support their claims for treatments euphemistically promoted as CAM such as chiropractic, homeopathy, fad diets, faith healing, shamanistic trances, and most herbal products.
Considering WHO's track record of distributing educational materials misrepresenting fraudulent methods, such as "psychic surgery," as "cures" we have reason to be wary of the implementation of WHO's strategy. The strategy, a working document for adaptation and regional implementation, along with information (and misinformation) about TM/CAM can be accessed at http://www.who.int/medicines/organization/trm/orgtrmmain.shtml.
The WHO press release claims that efficacy of acupuncture in relieving pain and nausea has been well established. However, a recent review of review articles and meta-analyses on acupuncture for various health problems studied revealed favorable findings for acupuncture treatment of some types of nausea and pain, but not other types. The authors concluded about acupuncture: "Effectiveness could not be established with confidence for any condition studied." [Ramey DW, Sampson W. Review of the evidence for the clinical efficacy of human acupuncture. Sci Rev Alt Med. 2001;5,:195-201.]
On page 8 of the strategy document is an erroneous statement that "chiropractic systems were developed in Europe in the 18th century" Chiropractic actually originated in 1895 in Davenport, Iowa when grocer, spiritualist, and "magnetic healer" Daniel David Palmer dreamt up and announced "subluxations" as the cause of disease.
The strategy document cites a 2000 United Nations Conference on Trade and Development document as its source for an estimate that the world market for herbal remedies based on traditional knowledge is US$ 60 billion and steadily growing. "About 80% of the people in Africa use traditional medicine," said Ebrahim Samba, WHO's Regional Director for Africa in the WHO news release. "It is for this reason that we must act quickly to evaluate its safety, efficacy, quality and standardization to protect our heritage and to preserve our traditional knowledge. We must also institutionalize and integrate it into our national health systems." But if objective evaluations show the traditional knowledge to be based on misconceptions, why should WHO's cause be preservation? And how will it help health systems to integrate misconceptions into it?
Traditional (i.e., folk) medicine practices promoted through neighborly medical advice, and used as part of self-treatment, family home treatment, and the non-commercial activities of folk healers require neither preservation efforts from intergovernmental authorities nor regulation from governmental authorities. State laws against practicing medicine without a license are rarely enforced in the U.S. against folk healers. Practitioners of folk medicine in industrialized nations deserve no exemptions from state laws to protect children from abuse and neglect, and animals from human cruelty.
Folk beliefs may influence the willingness of some people to cooperate with licensed practitioners offering science-based treatments. It is important for scientifically oriented caregivers to respect the folk beliefs of their patients, not in order to encourage the preservation of their beliefs, but to build patient-provider relationships based on cooperation. Without showing respectful attitudes, many patients will reject science-based care and restrict themselves to using the charms, spells, and rituals ingrained in their cultures for invoking the supernatural. Some practitioners of science-based healthcare believe it is important to work closely with folk healers to gain the trust of patients whose cultural backgrounds provided them with little familiarity of modern medicine.
In the health marketplace beyond the extended self-care communities of folk medicine practice, we must require healthcare providers and health-product promoters to be accountable to their customers regarding issues of safety and effectiveness. We must ensure that sellers meet standards of manufacturing practice and professionalism. Promoters of treatments with superstitious or implausible rationales deserve no exclusion from this burden. Whenever a traditional practice is commercialized through advertising, sales promotion, or labeling with implicit or explicit medicinal claims not backed by objective supportive evidence, it is neither complementary nor alternative. It's quackery. 3
Four women visited Edgar Giovanni Gonzales, 23, after hearing his advertisements on a local Spanish-language television station for a medicinal "cure." Gonzales allegedly claimed he could heal them of various disorders by removing small animals and insects from their bodies. After one woman who took his $1,040 treatment reported to police that she found in her bowel what appeared to be a spider, police initiated an undercover investigation that revealed Gonzales was slipping foam scorpions, mice, spiders, and worms into customers' fluid intake. Police arrested Gonzales, who later received a six-year sentence. [From 2001 archives.nashvillescene.com: "Take two arachnids and call me in the morning."]
Promoters of acupuncture in the United States sometimes claim that use of acupuncture for anesthesia is common in China. But according to an anesthesiologist from a Hakujikai Memorial Hospital in Tokyo who visited 10 large hospitals in Beijing, Shanghai, and Guiyang as part of the Regional Anesthesia and Pain Medicine Delegation to the People's Republic of China: "Acupuncture anesthesia was not popular and less frequently used for clinical anesthesia ranging 0 to 10%. Many surgical cases were done by Western medicine similar to Japan and USA. General anesthesia machines were imported from Germany and USA."
[PubMed abstract of an article in Japanese: Nishimara N. Anesthesiology in People's Republic of China in the year 2001. Masui 51(3):314-317;2002.]
In China, where there are height requirements for various jobs, where personal height has become a national obsession, a huge industry has developed to increase stature through such quackery as herbal tonics and magnetic shoe insoles to stimulate growth hormone production. Also popular is the Ilizarov procedure to make longer legs. The procedure involves cutting bone and then applying leg-stretching frames to the patient. Although bone can be lengthened about an inch a month, the risks are high of developing fragile, warped bones and deformed joints; nerves may be damaged. The procedure is used in the United States mainly for therapeutic purposes rather than for cosmetic purposes as is popular in China.
[Smith CS. Risking limbs for height, and success, in China. The New York Times. May 5, 2002, p. 3.]
Is there a difference between objective reporting and "balanced" reporting?
I had an opportunity to put that burning question to a group of college newspaper editors when I spoke at a conference on "The Role of the Press in a Free Society" hosted by the Institute for Humane Studies. My argument was that "balance" and "objectivity" are two different things, though they are often lumped together. Balance, it is generally assumed, means that "both sides" in an article will be given roughly equal time and equal respect. In TV news terms, as I learned while working at ABC News for six years, it really means that you don't want either side threatening to sue you, so for practical purposes the truth, on any remotely controversial issue, is supposed to end up looking like a combination of the two (or more) sides or is presumed to fall somewhere in between them.
Unfortunately, it is often assumed to be the case that truth and the reporter's stance should be in the middle of the road even when science strongly supports the claims of one faction and rebuts the claims of another. At the conference, I showed a clip from the ABC special Tampering with Nature, hosted by John Stossel. Some of the students watching felt that the scientists defending biotech in the show came off looking good while anti-biotech activists such as Greenpeace looked ridiculous. Couldn't ABC have found anti-biotech crusaders who sounded just as reasonable as the pro-biotech scientists? Certainly, with enough effort, one could make two sides in any debate sound "equal."
But what is the virtue of balancing the two dominant perspectives if one side or both sides are demonstrably, objectively wrong? To take a hypothetical example (since the biotech issue may indeed be too controversial), if the Republicans, under pressure by the religious right, were to claim that faith-healing is the most reliable cure for cancer and the Democrats disagreed, saying there is no scientific evidence for this claim, should a responsible reporter feign indifference between the two positions? Alternatively, if the Democrats, under pressure by alternative medicine advocates, claim that quartz crystals have the magical power to heal (and want an increase in funding for the National Center for Complementary and Alternative Medicine as a result), but Republicans and scientists say otherwise, should a reporter treat the two positions as "equal"?
As a metaphor, I offered the case of a dispute in a society half composed of Nazis (with all their eugenics-theory baggage) and half composed of Gaia worshippers. Sadly, some of the students were hampered in the discussion by what they saw as my far-fetched scenario. When I gave an earlier version of the speech at a previous conference, one student said the hypothetical society sounded like something out of Star Trek (as if that's a bad thing), and this year two students voiced objections, one calling the hypothetical "unfathomable" and the other saying that he thought a scenario in which a group was advocating belief in a flat Earth would be more enlightening. For practical reasons, I may need to change the hypothetical if I give the speech in the future, though I will say in my defense that at least one country in recent memory has gone Nazi, and the Nazi/Gaia scenario is certainly more likely than widespread flat-Earthism these days, since not even everyone in the Flat Earth Society, you will disappointed (or relieved) to learn, still believes the Earth is flat (you can find hints of self-parody and some inside-joke references to the works of absurdist authors such as Alfred Jarry and Robert Anton Wilson at one Flat Earth Society website, http://www.flat-earth.org/platygaea/faq.mhtml, for instance).
The central philosophical point of my speech remains, though: It is quite often the case that there is widespread error in the public thinking and the media coverage on some topic, especially in matters of science and public health that aren't immediately deducible from "common sense." Those reporters who know the facts or can get the facts by acquainting themselves with the broad consensus of mainstream science owe it to the public to be objective and not just "balanced." That is, they should be concerned with reporting the facts, no matter how popular or unpopular, and not at all concerned about the potential for public backlash nor about how the truth will affect factional disputes in society.
The college newspaper editors who attended the conference, many of them from campuses prone to political controversy, were admirably wary of appearing to take sides in their reporting. However, if half the population becomes convinced that faith is the best cure for cancer, that quartz crystals heal, or simply that genetically-engineered tomatoes are likely to destroy the Earth, reporters owe it to the entire public to report that one half the population is dead wrong.
Todd Seavey is Editor, HealthFactsAndFears.com, webzine of the American Council on Science and Health (ACSH). This essay was published on the webzine, dated February 25, 2002. It is reprinted with permission of Mr. Seavey and the American Council on Science and Health.
Fredrick J. Stare, PhD, MD, one of the most influential and outspoken critics of nutrition quackery and misinformation died on April 4th at the age of 91. He was the founder of the Department of Nutrition at the Harvard School of Public Health and its chair for 34 years. He also founded the research journal Nutrition Reviews and co-founded the American Council on Science and Health.
A paper by Dr. Stare, "Boston Nutrition Society, Inc., Plaintiff vs. Fredrick J. Stare, Defendant," published in a 1963 issue of the Journal of the American Medical Association, described the 1959 libel suit against him in response to an article he published in McCall's magazine. Dr. Stare had written that claims by the Society that white bread was devoid of nutrients and related to the development of heart disease and cancer was "a cruel and reckless fraud." The case came to trial before a jury which ruled in Stare's favor after only 15 minutes of deliberation. The lead editorial in the JAMA issue that included Stare's paper about the lawsuit was entitled "Quackery Quakes." It commented on Dr. Stare's experience. It ended:
There are practical points that all physicians can gain from this interesting case: Speak clearly and firmly in the combat of quackery and food faddism. Speak without malice to any individual or society but with the physician's responsibility to inform his patient or society of the truth as he sees it in the important area of health where the physician has special qualifications.
In 1978 the National Nutritional Foods Association and two NNFA officers who owned health food stores initiated a $1.3 million libel suit against Dr. Stare and Elizabeth M. Whelan, ScD, MPH, charging them with "conspiracy to defame, disparage, and destroy the reputation and business of plaintiffs." The names of the plaintiffs had not even been mentioned in the publications they found objectionable. Federal Judge Abraham D. Sofaer dismissed the case in 1980. He warned that "any further suit by plaintiffs against critics of the health food industry should be scrutinized carefully to determine whether it was brought in good faith."
From 1945 to 1980, Dr. Stare wrote a nationally syndicated newspaper column called "Food and Your Health." He co-authored at least eight books for consumers about nutrition, and wrote numerous articles about nutrition in popular magazines. He frequently appeared on television to debunk myths about nutrition. His radio program "Healthline" was syndicated to about 100 stations.
Dr. Stare was a co-developer of the Basic Four Food Groups to teach about healthful diets emphasizing a variety of foods. He defended fluoridation of community drinking water and the use of food additives. His research included early experimental and clinical studies of dietary fat and serum lipids. He was truly a giant in the field of nutrition and its application to medicine and public health.
The April 2002 issue of Pharmacist's Letter told pharmacists to advise patients to avoid products containing the following "natural weight loss" ingredients, especially if they are combined with caffeine, guarana, cola nut, mate, or tea: conjugated linoleic acid (in Body Solutions, Diene-O-Lean, Tonalin), 7-keto DHEA (in PatentLEAN, 7-Keto Fuel, 7 Keto Lean)-because little is know about its long-term safety, hydroxycitrate (in Citrimaax, CitriLean, Diet Fuel, Herbalife), ephedra (recalled in Canada), and bitter orange or country mallow (heartleaf) which contains ephedrine-related compounds. Pharmacist's Letter did not mention that pharmacists can help patients avoid products of unproven safety or effectiveness for weight loss by not selling them.