The Magazine

Doing Harm

The alternatives to medicine can be sickening.

Dec 2, 2013, Vol. 19, No. 12 • By TEMMA EHRENFELD
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My mother, who admired Linus Pauling, kept three rows of bottles filled with vitamins and herbs in her kitchen, as well as stacks of newsletters with advice about “natural” remedies. She maintained an admirable figure on a low-fat, low-meat diet and enjoyed a full, happy life. So when she died of a rare cancer at 78, people were especially surprised. “It was all that chlorine at the pool,” one griever surmised. 

Jenny McCarthy at war with vaccination

Jenny McCarthy at war with vaccination

associated press

Despite my mother’s wide reading, I doubt that she knew about the many studies concluding that high doses of vitamins increase the risk of cancer. More than half of all Americans take vitamins—a $28 billion industry in 2010—and even unbelievers tend to think they are harmless. 

Do You Believe in Magic?—the charming title of which comes, of course, from the 1965 Lovin’ Spoonful song—is a fun read, a fast tour through stories about villains and crackpots. Linus Pauling is among them. Author Paul Offit, chief of the Division of Infectious Diseases at the Children’s Hospital of Philadelphia, seems to subscribe to the Great Man theory of history, at least on this subject: He blames the American affection for mega-vitamins on Pauling and the craze for alternative cancer treatments on the Polish doctor Stanislaw Burzynski, aided by Gary Null. He also likes to follow the lobbyists (and the money), excoriating the supplements industry for winning exemption from regulation. 

By his lights, supplement-pushers are akin to the hucksters who sold Curry’s Cancer Cure (hydrogen peroxide, iodine, laxatives, and cocaine) or the Radio-Sulpho Cancer Cure (Epsom salts and Limburger cheese), not to mention John D. Rockefeller’s father, who sold “bogus cancer cures at county fairs with the help of magicians, hypnotists and ventriloquists.” 

Medical history is fascinating, even funny, when you’re not on the operating table. The author’s accounts of the origins and core principles of chiropractic, acupuncture, and homeopathy made me chortle; but this is serious business. The hint of agnosticism in the subtitle—nicely balancing “sense” and “nonsense”—is misleading: Offit is more like an angry atheist. Though he never sounds hostile, his true and persuasive message is that nonsense can be deadly and its purveyors need more policing. 

They feed on distrust of modern medicine, which leads even rich, clever people like the late Steve Jobs to put off, or reject, conventional medical treatments. Jobs opted for nine months of acupuncture, herbs, bowel cleansings, and fruit juice rather than early surgery for his tumor and thus “died of a treatable disease,” as Offit puts it. Distrust leads us into the arms of gurus who betray their profession while touting its credentials. 

Pauling is a sad case of brilliance succumbing to irrational belief in an ever-crazier spiral that led to his ultimate claims, despite much evidence, that high doses of vitamin C, combined with other supplements, could cure colds, treat cancer, and address just about any problem—including AIDS—without side-effects. How human it is to love cure-alls. Daniel Palmer, founder of chiropractic, believed that he had cured a man’s deafness by pushing down on the back of his neck to “realign his spine.” The nerve that conducts impulses from the ear to the brain doesn’t travel through the neck, but Palmer argued that misaligned spines cause all diseases. Bizarre as that sounds, chiropractic is covered by Obamacare. 

Dr. Offit offers six reasons for the appeal of unproven remedies. None of them is novel, but they are neatly summarized. The gurus of alternative medicine are definitive and comforting—they tell us how to live. In a world of doctors pressed for time, “healers” offer care that feels more sympathetic and individualized. Today’s gurus and healers claim to represent ancient wisdom from cultures that seem fuzzily superior to our own. (In China, for example, acupuncture “is embraced almost solely by the rural poor.”) By contrast, modern medicine is ever-changing, hence scary. Alternative medicine offers the sense that you can take control, that you don’t need scientists or doctors to tell you what to do. Finally, many Americans think that modern medicine has “rejected nature.” 

The “sense” of alternative medicine comes down to the power of the placebo effect and the attractive idea that we can use it to our advantage. My mom’s tiny white homeopathic pills for “calm” did appear to make her calmer, and if you asked her why she took them, she didn’t invoke homeopathic theory. “They work,” she said. Homeopathic remedies, Offit says, are safe because they are actually sugar or water. One popular product (I’ll confess that I’ve used it) is oscillococcinum, for colds and flu. Offit argues that it’s a better choice than cough-and-cold preparations with pseudoephedrin, which, according to the Centers for Disease Control, can cause hallucinations, seizures, and heart problems in young children. 

The best news here is a paragraph on scientific research showing that people can be taught to suppress and enhance their immune responses. We also hear from Norman Cousins, the man who told us to laugh when we’re sick. Offit concludes with Cousins’s account of his meeting with Albert Schweitzer, whose clinic in West Africa brought, in 1912, quinine for malaria, digitalis for heart disease, and salvarsan (the first antibiotic) for syphilis. Schweitzer took Cousins to a jungle clearing to see an elderly witch doctor at work. The witch doctor gave some patients herbs; for others, he gave no herbs but filled the air with incantations. For a third group, he pointed to Schweitzer.

Later, Schweitzer interpreted for Cousins what had occured. The first group had problems that could be resolved without treatment, or couldn’t be treated. People in the second group were receiving “African psychotherapy,” according to Schweitzer. And the people in the third group, the witch doctor knew, had problems that Dr. Schweitzer could treat better than he could. 

Similarly, today’s mainstream and alternative healers both have their place, Offit writes. 

The problem comes when mainstream healers dismiss the placebo response as trivial or when alternative healers offer placebos instead of lifesaving medicines or charge an exorbitant price for their remedies or promote therapies as harmless when they’re not or encourage magical thinking and scientific denialism at a time when we can least afford it. 

I would like to have heard more from Offit on how our society can humanize medicine and make better use of the placebo effect. Although he doesn’t mention this, deception and denial of scientific evidence may not be necessary. In a 2010 pilot study, a Harvard team studying the placebo effect compared two groups of people suffering from irritable-bowel syndrome, a chronic gastrointestinal disorder accompanied by pain and constipation. One group received no treatment. The patients in the other group were told they’d be taking fake, inert drugs—delivered in bottles labeled “placebo pills”—but that placebos often have healing effects. 

The results surprised everyone: Patients who knew they were taking placebos reported twice as much relief as people in the no-treatment group.

But a later study, with asthma patients, found that although people perceived improvement while on a placebo, the benefit couldn’t be measured objectively. Seeing improvement that doesn’t exist is a problem if it leads someone to not take an effective treatment. So there’s help to be had in a harmless placebo, but only when there’s no better option. 

The witch doctor had it right.

Temma Ehrenfeld is a writer in New York.