Respectful Insolence

I had been planning on finally getting around to writing that review of Richard DawkinsThe God Delusion that I’ve been meaning to write since I finally finished the book two weeks ago. Then a Google Alert hit my mailbox last night for a preset search that I keep active on “Abraham Cherrix,” and the article that the link in the search results lead to not only contained a a disturbing amount of credulity towards alternative medicine (in the form of he-said-she-said “balance” when two outlooks are not anywhere near equally supported) but offered a positive portrayal of Abraham Cherrix and Dr. Arnold Smith, the altie radiation oncologist who fancies himself an immunologist and happens to be treating him. Worse, it appeared in the Sunday Chicago Tribune, which was my favorite newspaper when I lived in Chicago.

You know, for me this sort of thing is kind of like the Bat signal going up. Richard Dawkins will have to wait.

You can tell right away that this is going to be a fairly credulous article from the opening paragraphs:

GREENWOOD, Miss. — Abraham Cherrix never set out to be an advocate for alternative medicine. He is just a 16-year-old with cancer who refused to undergo a second round of chemotherapy and went to court to fight for his right not to have it.

In a court-ordered compromise, the Virginia teenager landed at the North Central Mississippi Regional Cancer Center, one of a new breed of cancer facilities in the United States that integrate conventional medicine and alternative therapies.

Cherrix’s struggle to use herbs and diet supplements to fight Hodgkin’s disease, a cancer of the lymphatic system–rather than have a series of debilitating rounds of chemotherapy–has brought attention to a growing movement in the U.S. to bring alternative medicine into the mainstream.

Although Americans have been crossing the border into Mexico for more than 40 years in search of cancer treatments illegal in the United States, interest in alternative and complementary healing methods in this country is rising. The move is being fueled by the Internet’s ability to provide easy access to information and by personal testimonials of patients.

Yes, it is. And, as we all know, if it’s on the Internet, it must be true, right? Here’s the problem. As I’ve said before, testimonials, with few exceptions, do not constitute useful data regarding the efficacy of a therapy. For one thing, the types of testimonials that you see on alternative medicine websites are almost always there to sell products, not to give information. For another thing, testimonials, even honestly given, almost never provide sufficient objective data for a knowledgeable medical scientist determine if there might actually be something to the treatment being described. This problem isn’t helped by the fact that testimonials are almost always given by “true believers” who almost always have a tendency towards confirmation bias, the all-too-human tendency to give more weight to incidents and data that conform to preexisting beliefs and to forget things that do not conform to those beliefs. We’re all prone to it, including scientists. One major advantage of the scientific method is that it is pretty good at overcoming confirmation bias.

At least the reporter Dahleen Glanton does get one thing right:

Advertisements for alternative therapies are everywhere, from highway billboards to health magazines. Clinics specializing in acupuncture, dietary supplements and herbal medicines–considered unconventional a decade ago–can be found in almost every U.S. city. To remain competitive, a fifth of U.S. hospitals now offer some type of alternative or complementary therapy such as massage, yoga, homeopathy or mind-body therapy.

Indeed, few are the hospitals that can resist this trend; even mine can’t, I’m sad to say. We seem to have taken the attitude of “if you can’t beat ‘em, join ‘em.” This wouldn’t bother me if our medical schools, which supposedly serve as the seat of evidence-based medicine, would actually only incorporate alternative therapies with some sound evidence for efficacy into their armamentarium. (It would be a small number of therapies, but we do represent ourselves as the face of scientific medicine, after all.) But they don’t. They have a distressing tendency to incorporate the whole kit and kaboodle without differentiating between some therapies that might have merit (certain herbal remedies and maybe acupuncture, for instance) and those that are nothing but woo, like Reiki therapy, reflexology. (I haven’t seen the utter fraud known as homeopathy offered yet in a university medical center, but I wouldn’t be at ll surprised to see it one day. I’d be depressed, but not surprised.) Worse, as Dr. RW has documented, woo is infiltrating the medical school curriculum and medical student organizations. (Heck, it’s even infiltrating the premedical curriculum in college!) Of course, what this should remind you is that a lot of this move to so-called “alternative” medicine is just as driven by commerce as any conventional drug sold by big pharma. It may be an industry that is only around 10% of the size of big pharma right now, but big pharma’s fairly stagnant and big altie is growing.

Not surprisingly, Dr. Smith seems all for it:

“This is a patient-driven effort to access things that are approved by the FDA [Food and Drug Administration] or are outside its jurisdiction,” said Dr. Arnold Smith, medical director at the Mississippi cancer center. “The desktop computer has become a window to the world of education regarding diseases and treatment.”

It all depends son what you mean by “education.” Most of the “education” about alternative medicine out there is credulous, accepting, and markedly lacking in skepticism and the application of the scientific method. In other words, it tends to be even more credulous than Glanton’s article. Alternative medicine cloaks its woo in the guise of “educating” and “empowering” the patient, when it certainly doesn’t do the former and it’s highly debatable whether it does the latter. And what is this $36-47 billion industry telling its patients? A lot of sloppy thinking like this:

“The old mind-set is if you are not doing the conventional method, you are not doing anything,” said Barbara Sikes, a 62-year-old chiropractor from Virginia Beach, Va., who is undergoing alternative treatments in Mexico for breast cancer. “But for me, it is much scarier to get cut on or to go through chemotherapy than to just eat healthy and take vitamins.”

There’s no doubt that it’s much scarier to have surgery or to undergo chemotherapy and radiation than it is to “eat healthy and take vitamins.” It’s hard to argue with that. I’ve had “minor” surgery before, and even that minor surgery scared me. (In fact, perhaps it scared me more because I’m far more aware than nonphysicians of what can go wrong.) The obvious problem is that surgery can cure most early stage breast cancers and even many that are more advanced, as long as they haven’t started invading adjacent structures like skin or chest wall and haven’t metastasized to distant sites. Adding chemotherapy and radiation decreases the chance of a recurrence after successful surgery. Eating healthy is important, but it won’t cure your breast cancer. Neither will vitamins. But the overall message of the alternative health industry is that your doctor is the enemy and that you should be scared of effective treatments because they may be painful or uncomfortable!

A second message coming from the alternative health industry is this:

With traditional health-care costs rising to $1.9 trillion and 46.6 million people without health insurance, natural remedies have become more attractive to Americans–especially cancer patients, for example, who sometimes pay up to $50,000 a year for a single medication.

Of course most alternative medical therapies are cheaper. Of course, if they don’t work, it doesn’t matter how much cheaper they are; the patient is paying for something that doesn’t do what is claimed for it. Whether they’re paying $5 or $5,000 for it, it’s a ripoff. Moreover, not all of these “cures” are so cheap. As documented in the accompanying article, some of this woo is quite expensive, and it’s not paid for by insurance companies. In fact, check out this factoid about the Bio-Medical Clinic, which is where Abraham Cherrix went for the Hoxsey concoction:

The Bio-Medical Center’s advertised charge is $3,500 for an initial visit that includes refills of the 16-ounce bottles of Hoxsey tonic for as long as needed. But additional costs can bring the bill up to $5,000.

Fanuele, a factory worker, is thinking about selling his home to pay his bill, which after just two visitsstands at $4,300. But that is not important, he said, if his cancer is cured.

I fear that Fanuele is on the path to dying poor and in debt. One clinic in Germany reportedly demands $250,000 up front! But remember, as any altie will tell you, it’s not about the money. Really, it isn’t.

Annoyingly, one of the people Glanton interviews is altie entrepreneur Ralph Moss, who says:

Ralph Moss, president of Cancer Communications Inc., a research publication, said some U.S. drug laws do need rethinking in order to remove huge financial requirements that give large drug companies a monopoly on testing.

“The whole system by which we test drugs and reward innovation is deeply flawed. The fact that it takes hundreds of millions of dollars to test drugs means that the only ones tested are those that will make hundreds of millions when they are approved,” said Moss, who has spent more than a decade documenting the work at alternative cancer clinics. “We are in a cycle where you have to be enormously wealthy to even think of playing in that poker game.”

He may have a point, as far as it goes, but, given the high profile problems with drugs after being released, such as Vioxx, I doubt that it would be politically palatable or scientifically smart to decrease the amount of testing. That means that it will remain very expensive to develop new drugs, and, given the science involved in producing a new drug, it’s likely to become more, not less, expensive . Of course Moss has no suggestion about how to fix this problem; in reality he simply uses it as an excuse as to why data is lacking for the efficacy of so many alternative medicines. Too bad Glanton didn’t also ask Moss about homeopathy and get him to reveal his true colors:

An interesting thing is that platinum is the old homoeopathic drug for problems of the testicles or the ovaries, and Hahnemann proved that on himself 180 years ago, but Allopathic medicine takes this basic idea, without giving credit of course, ups the dose by the billions because they can’t conceive of small doses having significant biological effect, and consequently put in massive amounts of homoeopathic medicines and cause tremendous toxicity and other problems, second cancers down the road and so forth.

Moss is referring to platinum-based chemotherapy that is used for testicular and ovarian cancer. In my book, anyone who buys into homeopathy and even claims that medicine based its chemotherapy for these cancers on the same concept is not someone whose pronouncements about medicine are to be considered credible, particularly if they laden their credulity towards this most fraudulent of woo with conspiracy-mongering regarding Laetrile in the very same interview. To take a page from alties attacking big pharma: Remember that Ralph Moss makes lots of money selling woo; so take whatever he says with a big grain of salt. He really just wants to sell you his “newsletter” and get you to pay big bucks to see him speak. What’s really annoying is that Glanton refers to Moss’ company as a “watchdog group” in the accompanying article about desperate people going to Mexico for quackery and as a “research publication” in the quote above. Here’s an example of the “research” Moss publicizes:

I asked Susan what she thought explained her astounding recovery. She said that the oncologists think it was the chemotherapy that cured her (even after they told her that she had “failed” treatment) and the alternative physicians want to claim credit too. Susan told me that she is certain that, for her, the cancer had developed because of her painful marriage. She had felt trapped and now feels that developing a critical illness was her body’s way of looking for an “out.” Divorcing her husband was the turning point for healing from a cancer that Susan feels had deep emotional origins.

Susan agreed to let me tell her wonderful success story at conferences all over the world and I never fail to have people approach me afterwards with “emotional healing” cancer stories of their own. If there are painful emotions or experiences you have pushed aside in your life, perhaps it is time to seek professional support to help resolve them. We know far too little about the mind/body connection and its relationship to cancer, but stories like Susan’s remind us that for some people there does seem to be a powerful connection between emotional and physical healing.

It sounds like Dr. Moss may buy at least partially into the Iron Rule of New German Medicine from last week, doesn’t it? There are several more dubious testimonials on that very same page that show Moss to be anything but a “watchdog.” Indeed, Quackwatch has a few articles that show just how dubious his views are, and this review of Moss’ book The Cancer Industry: Unraveling the Politics is most revealing, particularly about Moss’ claims to have been a high-ranking executive at the Memorial Sloan-Kettering Cancer Center in the 1970’s.

In actuality, this article isn’t too bad compared to a lot of what I’ve read. If you leave out the credulous treatment of Ralph Moss and the even more credulous treatment of Starchild Abraham Cherrix’s case, in which Abraham was described as seeming “wise beyond his teenage years,” the seed of a halfway decent article is there. In any case, “seems” is the operative word here. As I’ve pointed out before, his thinking has been nothing but magical and not evidence-based. I don’t want to belabor that point again, given how much I’ve written about it before. The only new piece of information is that Cherrix plans on returning to Mexico for the Hoxsey treatment. Funny, but I thought that wasn’t part of the agreement that he had come to with the court, but in reality the court essentially gave up on Cherrix when it handed down its decision.

Even despite its flaws (and there are many), the one useful point that this article makes is that there is a deep and abiding mistrust of the pharmaceutical industry and conventional medicine and that it is largely this mistrust that is driving the alternative medicine industry. Most patients tend to like and trust their own primary care doctors, but many distrust medicine in general and the pharmaceutical industry in particular. Moreover, I would add, the industry itself does its best to stoke this mistrust by exaggerating side effects of known treatments and conspiracy-mongering about the motivations of physicians and big pharma, knowing that the result will be that many patients will turn to it instead. It also plays on the public’s belief that what is “natural” must be better. Finally, it offers false hope to desperate people for whom conventional medicine can offer little other than palliation who don’t have enough knowledge of medical science to recognize quackery when they see it.

Of course, a lot of the susceptibility of the public to these blandishments comes from the fact that many altie practitioners, lacking evidence-based treatments, provide the “human touch” that patients crave and that conventional doctors have such a hard time providing in these days of declining reimbursements and pressure to see more patients and more patients in a day just to break even. Unless we find a way to improve the system so that there are not such strong disincentives for spending more time with each patient, it is a perception of conventional medicine that will get worse, rather than better.

Comments

  1. #1 Paul Browne
    November 1, 2006

    Perhaps you should write a letter to the editor of the Chicago Tribune? All too often this stuff goes unrefuted by those who know better.

  2. #2 Cayte
    November 1, 2006

    In my opinion its useful to the consumer to have the more than one points of view. A savvy consumer should check both standard and qualified altie sites.American Botanical Council ( herbalgram.org ) has qualified scientists. Its not the same as the “teach the controversy”, for several reasons.
    Medicine is not as rock solid as evolution but the genome project put the nail in the coffin of creationism. The citizens are not third graders. And sometimes the same study gets such varying interpretations that it begins to seem like a Rorsasch. No double blind eliminates interpretation bias.
    Not everybody is the same. Some are magnets for side effects but studies are averages.

    Our country and industry is based on competition. When an industry acts as only one monopoly it stagnates. Medicine as much as anything else.

    False hope cannot be avoided without eliminating progress. Any lead that fails to pan out is by definition false hope.

  3. #3 familydoc
    November 1, 2006

    I have been trying to think of something appropriate and erudite to say about this article , so here goes:
    What unadulterated bullshit (a naturally occuring substance , I believe)

  4. #4 rhubarb
    November 1, 2006

    Our citizens may not be third graders, but with the likes of Cayte to speak for them, they don’t have to be.

    I, too, wish that Orac would submit his analysis to the Trib, but I also respect his choice to safeguard his anonymity.

    Thanks for your well-reasoned and erudite dissection of that article, Orac. The damned thing ruined my Sunday, but I feel better knowing that my disgust for the claims of alties is shared by a thoughtful practicing physician who cares enough to share his time and effort with anyone who has access to the ‘net.

  5. #5 Cayte
    November 1, 2006

    I’m expressing my point of view not speaking for anyone, altie or otherwise. I stand by my points. Medical science( actually an application of science ) is less solid than the theory of evolution. It is valuable to be exposed to varying points of view. Herbalgram is a scientifically respectable site. Bias does creep into interpretation of studies. And monopolies do behave like well monopolies.

  6. #6 James
    November 2, 2006

    As an economist I take issue with Cayte’s erroneous use of the term ‘monopoly’. A monopoly is a market in which there is one seller only. There are several drug companies, therefore the pharmaceutical industry is not a monopoly. I suppose one could argue it was a cartel – that being a group of producers that collaborate in such a way as to act like a monopoly. But as cartel activity is illegal in the US (and most Western countries) I would expect to see some evidence of cartel activity presented, as opposed to a mere assertion.

    Finally it is idiotic to refer to an industry as “monpolising” what that industry produces. This is a tautology as an industry is by definition all of the firms that produce the product(s) in question. And in any event an ineffective product can never truly be competition for an effective one, just as paper airplanes are not competition for airlines. What you suggest is equivalent to me declaring that the food industry monopolises food production and we should all start eating gravel just so there will be competition.

  7. #7 Cayte
    November 2, 2006

    I don’t claim it meets the academic definition of cartel. But to me its a monopoly if the consumer is out of the loop. Each year I have less and less choice. Health care is only available through employment except at an exorbitant cost and the plan offers less and less. Its an artifact of government regulation that limits consumer choice.

    During the Clinton administration medical lobbyists were able to get a law passed that limits the number of medical schools to prevent a glut. They may offer some altruistic reason for this but it still limits supply and consumer choice.

    Finally, there is enough if a range in quality in “altie” sites that the analogy to gravel or paper airplanes does not match reality.

  8. #8 HCN
    November 2, 2006

    Cayte: Complain to the department that regulates insurance in your state if you cannot get affordable health insurance. (also read the Grand Round blogs for the postings on health insurance… there are plenty of those… http://blogcarnival.com/bc/cprof_21.html )

    Actually, in my urban area there is no shortage of medical doctors or hospitals. I live within walking distance of two hospitals, several medical clinics and am a short driving distance to four other hospitals (and a slightly longer distance to three others). Granted, there are problems finding doctors for rural areas, but programs like http://depts.washington.edu/uwrhrc/ are trying to address those kinds of problems.

    There are options for those without medical insurance… including state funded health insurance for school children (though it does not go far enough).

    For instance… this family does not have health insurance, but the baby did undergo surgery to facilitate kidney dialysis:
    http://seattlepi.nwsource.com/search/pisearch.asp?rank=date&matches=250&UserQuery=riley+kidney&x=12&y=8

    Also, my son is on beta-blockers for his genetic heart condition. He gets a generic form… one that is cheaper and still effective produced by a competitor of the original company that marketed it.

    So your argument pretty much is just a bunch of hot air, that you mostly made up on the spot (or read off of a website that fabricated it to get you to either support their agenda, or buy their stuff).

    Many of the “altie” sites exist just to extract money from desperate cancer patients. They may claim to “cure cancer”, or a number of other ailments, but more often then not they fail to live up to their claims. These things include _The Cure for All Cancers_ by Hulda Clark (with a large parasite that really only exists in a far flung part of the world on center stage), Hoxsey herbs, laetrile (B-17 is NOT a vitamin, but is was a really important bomber in WWII… is there also a B-29 and B-52 vitamin for cancer?), and the infamous “vitamins, ozone therapy and chelation cures”. Just ask the “Cajun Cowboy” on how that worked: http://www.cajuncowboy.com/Dr.Buttar.htm

    (okay, so I am past the 2 weblink limit for the spam block… so I’ll just go on… and on…)

    Oh, good grief… laetrile was disproven decades ago, but folks still sell it:
    http://www.cancer.gov/cancertopics/pdq/cam/laetrile/HealthProfessional/page5

    Why is that Cayte?

    Are the folks who peddle laetrile and Hoxley herbs more admirable than any one of the several pharmaceutical companies?

    You could also ask the webmaster of http://www.sumeria.net, but you have to use the archive version of the site:
    http://www.sumeria.net/health/rectcan.html … because this is his obituary: http://obits.abqjournal.com//results?obit_id=56606

    Then there are the lovely folks at Sanoviv who spam random blogs: http://www.kevinleitch.co.uk/wp/?p=277 … Here is the webpage of one of their patients/victims: http://www.keepblairalive.com/index.htm (be sure to click on the “updates” with the links to “zapper”, “parasites”, and then the very expensive visit to Sanoviv). Enjoy.

  9. #9 valhar2000
    November 2, 2006

    “Unless we find a way to improve the system so that there are not such strong disincentives for spending more time with each patient, it is a perception of conventional medicine that will get worse, rather than better.”

    You will likely consider this excessively cynical: How about natural selection? People who are too sensitive to “uncaring doctors” will tend to die much more often than people who just want to get cured, and thus sensitivity to “an industry that has lost its human touch” will slowly disappear.

    Really, if people are so dumb that they do not want to be helped, what are you going to do? There comes a time when you have to let them crash into their own stupidity so that they will learn a sharp lesson.

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