Dubious Medical Alternatives

In all ages, the public has clamored for magical cures, many of which are now recognized in retrospect as irrational or even comical. Many people are unaware, however, that even in this age of effective scientific medicine they are embracing pseudo-scientific therapy that in the future will be looked back on in the same way.

Quackery became big business after the Civil War, fueled by the large scale manufacture of patent medicines and their distribution in frontier areas  by “medicine men” who traveled in horse-drawn wagons covered with ads for patent medicines. This type of distribution eventually developed into full-blown medicine shows with acrobats, elephants, and magic acts to entertain a gullible audience.

Many of the patent medicines’ claims were not encumbered by logic. The King of Pain was good for baldness or deafness, or whatever the patient had. Colder’s Liquid Beef Tonic was sold as a cure for alcoholism, even though it contained over 26% alcohol. Simmons Liver Regulator was a remedy for everything, including “disgust for food and prostration of the system.” One of the best patent medicine sellers of the nineteenth century was Dr. Miles Compound Extract of Tomato, guaranteed to reach a person’s “weak” spot. Today it is known as ketchup.

Rather than being an amusing and interesting relic of history, the “medicine man” still operates in our midst. He is spiffed up and hardly recognizable any longer. He operates out of attractive shops, offices, hospitals, and medical education facilities. What he dispenses is backed up with impressive pseudo-scientific jargon and poorly designed studies. He spreads his message widely to an eager public with advertising dispensed by the best public relation firms. The harsh designation of “quack” is hardly ever associated with him. He is now practicing “complementary and alternative medicine” (CAM).

In our culture, “alternative medicine” is any healing practice that is used in place of conventional medicine. It includes measures that lack scientific proof or that have already been disproved, such as naturopathy, chiropractic, herbalism, traditional Chinese medicine, Unani, Ayurveda, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and others. “Complementary  medicine” refers to the same measures used in addition to conventional medicine. Note carefully that for the rest of this article the unwieldy phrase “complementary and alternative medicine” will be abbreviated as CAM.

According to a large federal survey released in 2008, more than one-third of adults and nearly 12% of children use CAM. Overall, the use of CAM appears to have stabilized compared to a study done five years earlier.

The problem with the designation “alternative medicine” is that “alternative” suggests an equal status with conventional medicine and implies that “alternative medicine” would be a rational substitute.

David Eisenberg, director of the Harvard Medical School’s division for research and education in complementary and integrative medical therapies, stated that, “I think the news is complementary and alternative medicine use by the U.S. public is here to stay.” He may be right, but many in the medical field are disturbed by the trend, since most CAM therapy has not been evaluated by well-designed investigations, and those that have been evaluated  are overwhelmingly found to be ineffective.

Wallace Sampson, founding editor of the Scientific Review of Alternative Medicine, summed up the situation succinctly: “They are either unproven or disproved. Acupuncture is a placebo. Homeopathy is one step above fraud. It goes on and on. The fact that they are so widely used is evidence for how gullible large segments of our society are.” He has also stated: “Most alternative medicine is quackery by another name.”

The most frequently used form of CAM is dietary and herbal products. Currently, the only legal requirement for these products is that they cannot be promoted as preventing or treating disease. The Federal Drug Administration can intervene only when a product is shown to be harmful. The reality is that these products often are promoted for the prevention and treatment of disease, in spite of the legal requirements.

In addition to a gross misdirection of our precious healthcare dollars toward largely placebo therapy, there are other problems with dietary and herbal products:

1. Lack of standardization. When the few herbs that have active ingredients are assayed, the amount is often lower or higher than stated on the label.
2. Contaminants. Sometimes the remedies contain pesticides, heavy metals, carcinogens, and bovine products (remote risk of “mad cow disease”).
3. Occasional serious or even fatal side-effects. Ephedra products have been the most dangerous since they have produced adverse cardiac reactions, including sudden death.
4. Adverse interactions with prescribed medications. Only about one third of patients tell their physicians about alternative products.
5. Using alternative therapy in  place of proven medical treatments. This action can have serious or fatal results.

The government has played a large part in making CAM mainstream, and much of the government promotion has been by one individual, Democratic Senator Tom Harkin of Iowa. In 1992 he was a powerful member of the appropriations subcommittee in charge of the National Institute of Health (NIH) and slipped a line in the report accompanying the appropriations bill that created the NIH Office of Alternative Medicine (OAM) with one million dollars in seed money.

In 1999 President Clinton signed into law an appropriations bill that changed the name of the Office of Alternative Medicine to the National Center for Complementary and Alternative Medicine (NCCAM). The budget was pumped up to 50 million dollars a year, which enabled the organization to establish a national center at Bastyr University, a naturopathic college outside of Seattle.

Harkin is a great believer in alternative therapies. His conviction in these modalities was cemented when he concluded that his hay fever had been cured by bee pollen. There is no evidence in the scientific literature that bee pollen can cure anything, and it can cause life-threatening allergic reactions. The Federal Trade Commission fined Harkin’s bee pollen distributor $200,000 for false claims.

Harkin’s main motive in establishing the Office of Alternative Medicine appears to have been to promote the use by the public of alternative therapies. Little scientific investigation was done. Harkin criticized the “unbendable rules of randomized clinical trials” and, citing his use of bee pollen, to treat his allergies, stated: “It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies.” Harkin’s office reportedly pressured the OAM to fund studies of specific “pet theories,” including bee pollen and antineoplastons.

When the OAM became the NCCAM, one of the main goals was to evaluate alternative therapies with rigorous scientific studies.  After ten years of evaluating many herbal and other alternative health remedies and spending 2.5 billion dollars, the sad fact is that not a single one has been found effective. Popular herbal remedies such as St. John’s wort, echinacea, saw palmetto, and ginkgo biloba were no more effective than a placebo.

Despite these definitive scientific studies, NCCAM has never stated that these measures were ineffective. Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams, states: “There’s been a deliberate policy of never saying something doesn’t work. It’s as though you can only speak in one direction and say a different version or dose might give different results.” And even if negative findings do reach practitioners of CAM and its enthusiasts in the public, there often is no effect on behavior since such conclusions are based on faith rather than evidence.

The biggest waste of taxpayer money by NCCAM is repeating tests on measures that have already been disproved by good scientific studies and studying measures that have no scientific rationale for working.

An example of repeating studies on measures already disproved is a study on chelation therapy underway on 2,300 patients, even though smaller controlled trials have been negative (and scientific rationale is lacking and deaths have occurred). Examples of funding studies that violate the basic tenets of science are: therapeutic touch for wrist fractures in postmenopausal women, use of Reiki for patients with advanced AIDS, and distance healing in wound healing.

Clearly, by any objective standard, NCCAM has been a failure. Any good studies that it has done could just as easily have been done by other departments of the National Institute of Health with more scientific vigor and better public communication.

Despite its negative findings, NCCAM has continued to promote the proliferation of CAM by offering grants to money-starved medical education facilities. Sixty percent of standard medical schools, 95% of osteopathic medical schools, and 85% of nursing schools teach some form of CAM. With a few exceptions, CAM is not taught as an objective scientific appraisal but from an advocacy viewpoint.

Dr. Wallace Sampson, the CAM expert mentioned earlier, clearly appraises the significance of this spread of CAM to medical education facilities : “Teaching about alternative medicine implies acceptance of it and potentially creates more gullibility and less critical, objective thinking. This will be felt in many indirect ways, including judgment errors, misguiding people with severe diseases, and tax standards and laws.”

Instead of  the “medicine man” of the nineteenth century being relegated to his proper place as a historical relic, he still walks proudly among us enjoying great respect and adulation, sometimes even in the halls of our most prestigious medical educational institutions. Steven P. Novella, Assistant Professor of Neurology, Yale University School of Medicine is certainly right when he states we are in  “the golden age of quackery and anti-science.”

What can be done to counteract this embrace of quackery and anti-science by many in the general public? I am under no illusions that any measures will eliminate quackery and anti-science entirely, but certain ones over time can be helpful. My suggestions are these:

First, eliminate NCCAM and do any research with a reasonable chance of a positive result under already established units of the National Institute of Health. For political reasons this will be difficult since true believers in CAM in Congress strongly support the organization. Strong public pressure to accomplish this will be needed and is lacking at present.

Second, increase science education and scientific (critical) thinking in schools. These measures over time would probably be the most effective.

Third, scientists themselves must be actively involved in educating members of the general public about science and scientific thinking.

Fourth, the general public should screen candidates for Congress as to their scientific knowledge and their ability to use scientific thinking.

Sometimes I slip into a funk worrying about why some of my fellow human beings aren’t more rational. Perhaps a heavy dose of Dr. Miles Compound Extract of Tomato (ketchup) will reach my “weak spot” and lift my spirits.

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