Trick or Treatment

There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance.

-Hippocrates of Cos

I just finished reading a book by Dr. Edzard Ernst and Simon Singh. Dr. Ernst began his career practicing in a homeopathic hospital in Munich. He is the first professor of alternative medicine in the world, and the only one in the UK. And, he chose to begin his book with this quote. The rest of the book continues in this spirit. Throughout the book, in (mostly) engaging prose, he examines various “alternative” approaches to health. He wishes to dismiss nothing out of hand, and sees value in some areas of alternative medicine. Repeatedly, however, he asks (and answers) several basic questions:

• How is an approach claimed to work?
• What is the evidence for a therapy’s efficacy? What is the quality of the evidence?
• What risks are involved in a therapy?

Along the way and throughout the book, he provides numerous anecdotes to illustrate his point. He talks of James Lind, who conducted one of the first documented clinical trials and determined an effective cure for scurvy. He tells of various “mavericks” in medical history, such as the man who lost a libel case when he criticized bloodletting, a process which eminent doctor Benjamin Rush used freely. (He also notes that many mavericks were not “ahead of their time”, but simply wrong.) He describes the methods that exist for determining a treatment’s efficacy, leads his readers through the reasoning behind these methods, and examines numerous “complementary and alternative” therapies through the lens of evidence. Though it can get a little long, it’s written engagingly, and with an open-minded, inquiring, but thoroughly evidence-based approach. I enjoyed the book, and I’m guessing some of my acquaintances would enjoy it as well–even those who like alternative medicine much more than I.

From an initial chapter titled “How Do You Determine The Truth?”, the book proceeds through chapters on acupuncture, homeopathy, chiropractic therapy (the history of the field is fascinating!), and herbal medicine. A number of other therapies, including aromatherapy, “energy” treatments, and others, are treated much more concisely in an appendix. After finishing this book, you’ll be much better equipped than before to evaluate existing or new kinds of “alternative” medicine.

Highly recommended: Trick or Treatment: The Undeniable Facts About Alternative Medicine, by Simon Singh and Edzard Ernst. It’s available via Amazon or the alternate bookstore of your choice.

For further reading, see this article about Ernst.

More on sugar alternatives

Originally posted 2007-09-29:

In an earlier post, I provided links to some credible sources of information on the physiological effects of artificial sweeteners. I recently gleaned a couple more relevant links from a list to which I subscribe.

One: yet another meta-review that, based on numerous studies, found aspartame to be safe. Note that, apparently unlike some other cases, the study does follow best practices of disclosing funding.

Two: The FDA sent a warning letter to Celestial Seasonings about using the “unsafe food additive” stevia–a plant-based sweetener which many promote as a “safe” alternative to oh-so-toxic synthetic sweeteners. MSNBC talks about the letter:

It also said “literature reports have raised safety concerns,” including those “about control of blood sugar, and the effects on the reproductive, cardiovascular and renal systems.”

The original letter may be found here, and the resolution here–apparently, it’s fine to sell stuff with these safety concerns, as long as it’s labeled appropriately. Oh well…I suppose you can’t blame the company too much for supplying what the market demands.

Health Effects of Artificial Sweeteners

Originally posted 2007-09-02:

I’ve had a number of encounters over time with horror stories about the ill effects of aspartame, saccharin, sucralose, and other artificial sweeteners. I’ve done some searching for hard facts regarding such sweeteners, and came up with a few links that seem fairly helpful.

First, an excellent speech on “Poisons of the Mind”, a good “backgrounder” in evaluating claims such as those above.

First, here’s a review of reports that aspartame becomes toxic when stored at temperatures exceeding 85 degrees Fahrenheit (conclusion: the reports are false). The list of references at the bottom may be helpful.

Next, a couple of seemingly fairly authoritative publications: a position paper from the American Dietetic Association, and the “Sugar Substitutes and your Health” booklet from the American Council on Science and Health (click on “View PDF Version” below the image of the book to access the free online version). (Update 2008-09-19: Although it doesn’t necessarily invalidate the ACSH booklet, it seems that there may be reason to question their commitment to sound science; see the update at the end of this post.)

Next, the FDA’s evaluation of “the Ramazzini Study”, a study often held forth by anti-aspartame advocates as evidence of aspartame’s deleterious effects (for the “mental antidote” to citation of this study, see the papers listed above). Also, the European Food Safety Authority’s evaluation of same.

Finally, a guide to “deconstructing Web pages” to determine their credibility; this is probably unnecessary for most readers of this blog, but is interesting nonetheless in providing a bit of a “critical thinking” checklist for readers.

2008-09-19: Since posting this, I’ve come across a couple of links regarding the American Council on Science and Health (ACSH) that concern me. If the assertions in the links are true (note that I haven’t “fact-checked” them at this point), this would be reason to read the ACSH booklet very critically, and to check the cited studies to ensure that they are credible and support the conclusions being drawn. Also, of course, links to the critics shouldn’t be taken as implying that I fully endorse their agenda or credibility either. Mainly, since I quoted ACSH as a source and found somewhat-credible articles questioning ACSH’s credibility, I thought it would be fair to include links to the critiques for aid in a fair evaluation.

(I’m not unaware of the irony of, in a post encouraging critical thinking, referencing a questionable source as a supporting document. However, it does provide a great opportunity to develop critical-reading skills! Also, it seems that quite a bit of independent corroborating information exists. It’s true as well that in this case, as well as others, true information can be presented by people whose motives one has reason to question.)

The critical pieces are:
“Confronting Pseudoscience and Threats from a Corporate Front Group: The American Council on Science and Health”
“Corporate Front Groups and the Abuse of Science: The American Council on Science and Health (ACSH)”

Mannatech

Originally posted 2007-07-09:

It appears that the Texas Attorney General is no more a fan of Mannatech, a purveyor of glyconutrients, than I am. The linked WSJ article begins, “The Texas attorney general has asked a state court to bar Mannatech Inc. from allegedly illegal sales and marketing practices, saying the dietary supplement seller is falsely claiming its products cure, mitigate, treat or prevent diseases such as cancer, autism and Down’s syndrome, in violation of state and federal laws.”

The suit makes rather interesting reading, discussing the web Mannatech–their charity, their research institutes, their partners and associates–has allegedly woven to promote their system (I’ve refrained from over-using quotation marks in this sentence). It also includes other interesting tidbits: I’ve often heard the fact that several recent Nobel prizes have been related to glycobiology cited in support of the purported scientific basis for Mannatech’s products. For some reason, I haven’t heard quite as much from promoters about the cease-and-desist letter that Dr. Gunter Blobel (one of said laureates) sent them, or the complaint that Drs. Blobel, Paul Greengard, and Paul Nurse (two other laureates) filed with the NY State Attorney General against Mannatech over its use of their names. This information is included in the Texas AG’s suit.

Further reading here, among other sources.

Plain Prey

Originally posted 2005-10-15

Many thanks to the Kansas City Star for their “Plain Prey” series, describing many of the ways in which “plain people” (Amish and conservative Mennonites) fall prey to “miracle cures”, medical fraud, and even “Amish voodoo!” This treasure was written in 1996, but I only found out about it today.

Death By Snake Oil

Originally posted 2005-10-01

Here’s a question for consideration: why aren’t willful practitioners of quack medicine civilly and criminally liable for injuries caused by their actions?

In a recent business law exam, one of the questions involved a coach who decided to make his players “tough” and have them practice in the heat w/o water, even after some began showing symptoms of heat exhaustion/stroke. When one of the players collapsed and died on the way to the locker room after practice, the question was posed: what liability did this coach have? The gist of the answer, of course, was that he was liable for the tort of wrongful death, having caused the player’s death by his negligence. He was also criminally liable, having so grossly violated his duty of care toward this player that he faced prosecution, probably for involuntary manslaughter.

Now, compare that with a real-life “alternative medicine” case involving an acquaintance of mine. Probably around a year ago by now, his wife began experiencing some weird symptoms–extreme weakness, shortness of breath, and I don’t remember what all else. They began a series of tests, but soon decided to stop, though she wasn’t significantly better off. They knew what was wrong–their doctor, actually an MD if my information is correct, had determined that she was suffering from mercury poisoning, and had her amalgam fillings drilled out (again, this is based on recollections of 2nd/3rd-hand relations of events). After these events transpired, I didn’t hear much about the situation for a while, although I knew that Mrs. M. was still unable to perform many of the activities of daily life.

Recently, around a year later, Mrs. M. went back to our local small-town hospital. From there, she was flown to a hospital in a larger city nearby, where she entered the ICU. A week later, I heard that she’d been diagnosed with some sort of treatable, though not entirely curable, autoimmune disease. During her hospital stay, she’d gained about 16 pounds–apparently not an unwelcome development in this case.

So…what, my dear students of morality, what should the “mercury poisoning” doctor’s liability be for causing a year of being an invalid? And, had Mrs. M. died from lack of treatment of her actual problem, based on (reprehensible, IMO) exclusive reliance on this “doctor’s” diagnosis, what would it be in that case? How does the fact that this snake-oil salesman has the letters “MD” after his name, and thus presents himself as worthy of consultation, as an expert in matters of health, affect the case?

In my opinion, such a person should be held to have willfully, with premeditation, caused the death of another person, should that person indeed die. (Does that definition sound at all familiar to you?) The public places great trust in members of the medical profession. When a “medical doctor” not only grossly breaches that trust by diagnosing a serious problem as being caused by something he knows (or, if he doesn’t know, by his training and by his representation should have known) to be highly unlikely, knowing that this false diagnosis will keep his patients from looking elsewhere for the cause of problems, it seems reasonable to assume that he has consciously chosen between fraudulently gained money and a human life, and has chosen to destroy that life in preference for the money.

OK, so I’m not a legal scholar. On moral grounds, though, this kind of behavior seems worthy of the most severe penalties that the legal system has to offer. As to innocent purveyors of quackery…I might write about this later.

Anon commented:

This sounds like a troubling, and very serious situation you are describing. I would also take your observations one step further. I was diagnosed with cancer a number of years ago, and with the wisdom God gave the medical field, I have been healed. BUT during the years I was battling the illness, and the side affects of the treatment, I was inundated with advice, and coercion to use this or that , with fabulous sounding testimonials. One question none of these people could ever answer me satisfactorily;”Why is your product so expensive if the purpose is to help people who are sick?” People who are ill have enough stress, without the added stress of “Christian” friends hounding them to try this or that miracle cure.