Saul Green, a cancer researcher, wrote poignantly about why people turn to purveyors of quackery when faced with serious illness. Why do some people find “Lyme literate” practitioners so appealing, even when the Lyme literate demonstrate appalling incompetency and almost always lack recognized credentials in infectious disease?
The Realities of Alternative Medicine for Serious Illness:
A Guide for Laymen
By Saul Green, Ph.D.
Many serious diseases are not detectable in their early stages. When symptoms do appear, the attempted cures may be painful, disabling or mutilating and most certainly will be costly. If the patient endures the toxicity of chemotherapy, or the disfigurement of surgery and radiation and the treatment fails, then he and his family are left with the terrible anxiety attendent to the continued presence and possible progression of a devastating disease.
In this circumstance, the need for hope is all-powerful. It understandably drives the patient and his family to seek some sort of “alternatives”. These desperate and vulnerable people become fair game to the medical charlatans who offer “all natural, safe treatments that heal.”
To the fearful patient, healing and curing are one and the same. A high level of intelligence does not guarantee that the patient will recognize the false promise implied by the use of the word “heal”. In most cases, questioning of the practitioner will reveal that the word “heal” is used in a spiritual or metaphorical sense rather than a physical one. Charlatans often claim that their therapy stimulates either the “immune system” or some “innate” ability of the body to heal itself. Thus, the charlatan avoids responsibility when the treatment fails by shifting responsibility for the failure onto the patient – a despicable thing to do to someone already facing the trauma of a devastating illness.
Alternative medical treatments flourish because cures for many diseases do not exist and because responsible physicians will not offer false hope of medical miracles. The widespread popularity of alternative treatments is directly related to the inadequacy of many standard treatments; the impatient physician who answers questions brusquely, evasively or not at all; the scientific illiteracy of the public; the desperation of patients; and most significantly, the willingness of sociopaths in our society to take advantage of vulnerable patients.
Alternative treatments encompass a broad spectrum of remedies whose effectiveness has never been proven. Remedies can involve ancient mystical rites from the Far East, the invoking the help of various Gods, the purging of “poisons” with enemas and the injection of extracts from human body fluids, live animal cells, animal tissues, industrial chemicals, raw herbs, escharotics, and gaseous ozone. Homeopaths administer water which they say they have treated to make it “remember the vital essence of some active substance” it once contained but no longer does.
One hallmark of quackery is that practitioners treat patients according to the particular system they favor rather than the distinct clinical conditions of the patient. Proponents will claim their treatment heals everything from cancer to AIDS. Although they will defend the practices of others, rarely if ever will one practitioner recommend some other form of treatment as more efficacious for a particular patient’s condition.
The alternative practitioner projects a variety of appealing images of himself to win the confidence of medical consumers. For example,
- As the “Healer”, he plays the role of a selfless, caring physician who has no interest in making money. His “grateful patients” then eagerly follow his script whenever there is a legal challenge to his practices. They ignore questions about his credentials and his inept pseudoscience. They swear that their “regular” doctors said, “there was no hope” but still recommended the “cutting, burning or poisoning” treatments of orthodox medicine. They state that these recommendations were all proven wrong when they were “healed” by the treatment of the alternative practitioner.
- As the “Scientist”, he poses as a superior researcher whose “medical success” is based on his understanding of the healing arts of the “ancients” coupled with his knowledge of modern medical science. To blunt the impact of the rebuttals he knows his claims will provoke, he assures his “flock” that his concepts are so advanced that, like those of all great scientists in the past, they are not understood by orthodox scientists and so are repudiated.
- As the “Concerned Citizen” he recruits a cadre of wealthy and prominent laymen (industrialists and Congressmen) as supporters. Regardless of why they mistrust established science and medicine, these people forcefully promote their “protege’s” interests by lobbying government agencies, raising money, publishing “Newsletters” advertising his treatment and instigating letter writing campaigns that characterize his critics as being against Freedom of Choice and therefore un-American.
No one characteristic signals the presence of fraud in medical treatment, but anyone who reviews the bases for the claims can detect it if they understand a few basic principles about evaluating evidence.
Alternative remedies fall into two categories:
- Substances which are said to affect cellular functions like the immune system (e.g., Laetrile, 714-X, Antineoplastons, Hydrogen peroxide, Ozone, Hydrazine sulfate). The mechanisms by which these treatments supposedly work have been published, and can be scientifically evaluated.
- Mystical practices which are used “to call up the patients latent healing powers” (e.g, Chi, homeopathy, accupuncture, chiropraxis, visualization, meditation, faith healing, Kirlian auras, numerology, gem therapy and Kabalah). There is no way to prove that these powers exist and can cause healing, so their acceptance depends entirely on the patients’ willingness to blindly believe testimonials.
Charlatans depend heavily on patient testimonials as “proof” that their therapies work. However, they know that just offering a new treatment will boost a patient’s spirits, cause an increase in appetite and even reduce the perception of pain. These subjective improvements are not proof that a treatment works.
Proof comes with supporting and concommitant evidence. It is the consistency and predictability with which patients respond to a treatment that is significant. Any unpredictable improvement that occurs sporadically may not be due to the treatment itself and therefore cannot be claimed as proof of its efficacy.
Every scientist lives with the challenge,” PROVE IT!” To do so, he knows he must present data that supports his conclusions and can be independently reproduced by other scientists. What is relevant in proving the curative value of any treatment is not the reputation of its proponent, the persuasiveness of his theory, the eminence of his political supporters, the anecdotes of his patients or the lack of confidence that layman may have in the medical establishment. It is whether the treatment can be shown to work in rigorously controlled, objectively interpreted independent clinical trials.
The design of a valid clinical trial must include knowledge of the biology of normal tissue, the cause of the disease, the variations of the disease process in different tissues, the biochemical changes which mirror the diseases progress and the means by which investigators can evaluate the effect of the treatment. Clinical researchers must know the chemical composition, tissue specificity, metabolism, toxicity and excretion rates of each of the substances being used so he can integrate this into the patients clinical history and experiences with other medications. Finally each patient must be closely followed for a significant period of time after the treatment ends, so all the significant after effects can be noted. Only after all these conditions are fullfilled can a valid conclusion be reached about the efficacy of the treatment.
In September 1990, the NIH Office of Technology Assessment published a review of the wide variety of alternative medical treatments offered in the U.S. for a disease like cancer (ie. Burzynski, Gold, Gerson, Burton, Gonzalez, Revici and others). Although these treatments were entirely different from each other, proponents claimed they evoked the same degree of “healing” in patients. What was of great significance in this was the fact that nowhere in all their claims of support for these treatments, was there mention of their having personally tested and verified the efficacy of any of the treatments they endorsed.
In 1992, “true believers” in Congress created the Office of Alternative Medicine at the NIH. Its mandate, they said, was the verification of the effectiveness of alternative treatments. As was pointed out earlier, any appropriately designed clinical trial must contain the means to show that a given treatment might be worthless. Perhaps this is why no attempt has as yet been made by the OAM to clinically evaluate the effectiveness of any alternative treatment.
But independent investigators here and abroad have done so. In well-designed and controlled trials of various alternative remedies (hydrazine sulfate, chelation therapy, laetrile and others) researchers obtained results which clearly demonstrated that those treatments were worthless. Predictably, those conclusions were rejected by those who used these treatments. They charged that the test substances were given incorrectly, that antagonistic drugs were given to negate the effectiveness of the treatment and that the clinical data was incorrectly interpreted. All this, they charged, proved that the Medical, Pharmaceutical and Insurance establishments were engaged in a conspiracy to keep their “safe, effective and inexpensive” new treatments from reaching the public.
Most people are outraged when they discover that they have been victims of fraud. Strangely, this is not the case with those who have been duped into spending huge sums for worthless alternative treatments. They are either too embarrassed by their gullibility to admit it, either to others or to themselves, or they rationalize “gratitude” for the brief respite that the treatment seemed to provide their deceased loved ones. Often they remain among the most adamant proponents of the failed cure.
An examination of medical history illustrates the price patients are willing to pay for hope, even when the hope is false. In his “Medical Essays” (Boston 1883) Oliver Wendell Holmes wrote:
There is nothing that men will not do to recover their health and save their lives. They have submitted to being half drowned in water, choked with gases, buried to their chins in earth, seared with hot irons, crimped with knives, had needles thrust into their flesh, had fires kindled on their skin, and swallowed all sorts of abominations. Then they pay for all this as if scalding were a privilege, blisters a blessing and leeches a luxury. What more can be asked for as proof of their sincerity?
To expose the fraud in the sale of “hope”, health care professionals must learn about the claims being made for alternative medical treatments. With that knowledge they can teach the truth to patients that ask. Having the assurance that they are getting the best care possible from a knowledgeable professional who understands their needs and is honestly trying to to solve their clinical problems is the only way to keep patients out of the hands of medical charlatans.
Patients considering alternative therapies for serious medical illness must demand evidence. They must ask the practitioners exactly what they are promising. They must ask what recourse they have if the promised “healing” doesn’t occur, and must insist on accountability from the practitioner. If patients could be persuaded to demand evidence and accountability for the effectiveness of an alternative treatment, there would be fewer victims of medical fraud.
This article is copyright 1998 by Dr. Saul Green. It may be reprinted with proper attribution and notification to the author.
Bernard VW. Why people become the victims of medical quackery. Am J Public Health Nations Health. 1965;55:1142-7.