CURRENT BOOKS: Separating Fact and Fiction

Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine, by Paul Offit, MD, HarperCollins, 341 pages (2013).

Paul Offit, MD, is a pediatrician and infectious-disease specialist in Philadelphia who is an expert on vaccines, immunology and virology. He is the co-inventor of the rotavirus vaccine, for which he has received wide recognition. He also received death threats after publishing his previous books: Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure and Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. In his well-written and thoroughly researched new book, Do You Believe in Magic?, he examines the scientific evidence pertaining to popular complementary and alternative remedies, and he details their risks and benefits.

In the mid-18th century, the French philosopher Voltaire wrote, “The art of medicine consists in amusing the patient while nature cures the disease.” At that time, Western medicine consisted largely of bloodletting. Fortunately, the science of medicine has made significant advances in the last 250 years, yet many patients choose to forego these advances in favor of centuries-old therapies. What makes these patients so leery of modern medicine, and so willing to turn to unproven, unregulated treatments?

“There’s no such thing as alternative medicine,” writes Offit. “There’s only medicine that works and medicine that doesn’t.” He maintains that medicines touted as natural should be subject to the same rigorous testing as mainstream medicine. In the book’s introduction, he tells the story of the unfortunate Joey Hoffbauer, a child from New York who was diagnosed with lymphoma in 1977. Though radiation and chemotherapy would have given him a 95% chance of cure, Joey’s parents were concerned about potential side effects and decided instead to entrust his care to Dr. Michael Schachter, a psychiatrist with no experience in cancer treatment.

Schachter prescribed Joey a regimen of laetrile, derived from apricot pits, as well as raw milk, raw liver juice, cod liver oil, soft boiled eggs, coffee enemas, and a number of other remedies that had not been approved for use in humans. After a court battle in which the Department of Social Services tried to remove Joey from his parents so he could receive conventional therapy, the judge ruled against the cancer specialists and in favor of Joey’s parents. Though Joey succumbed to his illness three years later, Schachter declared the treatment successful, stating, “Most of his body was either free of Hodgkin’s or minimally involved.” Further studies showed that laetrile was of no substantive use in the treatment of cancer, and the FDA banned its sale in 1987. It can still be obtained from clinics in Mexico, however.

In a chapter called “Rediscovering the Past,” Offit takes on celebrity physicians--such as Drs. Mehmet Oz, Andrew Weil and Deepak Chopra--who promote traditional therapies based on the notion that supernatural forces cause diseases and maintain that acupuncture, plants, herbs, oils and spices will balance humors and restore energies. Offit also explains the theory of homeopathy, i.e., that medicines should induce the same symptoms as the disease. In order to prevent harm, however, homeopathic medicines are diluted to the point that the active ingredients are no longer detectable.

Further on, Offit tells the story of how the father of chiropractic medicine, Dr. D.D. Palmer--a mesmerist who used magnets to treat his patients--claimed that by adjusting the cervical spine to treat subluxation he was able to cure a man of deafness. (This is curious given that the eighth cranial nerve, which connects the ear to the brain, doesn’t pass through the cervical spine.)

Offit goes on to critique the vitamin industry and its powerful lobby, the National Health Federation (NHF). He describes Nobel laureate Linus Pauling’s claims that vitamin C not only prevents colds but also cures cancer and many other ailments--claims that were later disproven. Lack of scientific evidence, however, failed to deter Pauling and his followers from touting the benefits of vitamin C and other megavitamin supplements. Despite several randomized controlled studies showing that patients who take megadoses of vitamins not only don’t benefit but are actually more likely to die of cancer, most Americans are unaware that the supplements they take may be harmful.

The establishment of the FDA in 1906 was the first attempt to ensure food and medication safety, writes Offit. In 1938, the FDA began to require testing of drugs for safety prior to their sale. But the 1975 Proxmire amendment categorized vitamins and supplements as foods, thereby exempting them from FDA oversight as pharmaceuticals, in the name of freedom of choice for consumers. In 1994 the FDA’s authority over “natural” products was further eroded by the Dietary Supplement Health and Education Act, which effectively created a third class, neither food nor drug, but “dietary supplement.” The New York Times called the new law the “Snake Oil Protection Act.”

In subsequent chapters, Offit decries celebrities Suzanne Somers and Jenny McCarthy as spokespersons for anti-aging potions and autism, respectively, as well as the politics of chronic Lyme disease and alternative cancer cures.

In the chapter “Why Some Alternative Therapies Really Do Work,” Offit examines the effectiveness of therapies such as acupuncture. He attributes their success to the powerful placebo effect mediated by the release of the patient’s own endorphins in response to the intervention.

Offit cautions readers to beware of quackery, which he defines as recommending against conventional therapies that are helpful, promoting potentially harmful therapies without warning, draining patients’ financial resources, and promoting magical thinking. He ends the book with a story about Dr. Albert Schweitzer and a witch doctor in Gabon. The witch doctor has three types of patients. The first group, those with minor illnesses that will resolve on their own, he treats with herbs. The second group, those with psychological problems, he treats with incantations. The third group, those with diseases or injuries only modern medicine can treat, he refers to Dr. Schweitzer.

I recommend Do You Believe in Magic? for anyone with an interest in alternative medicine--whether you use it yourself or want to discuss pros and cons with your patients.

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Dr. deFischer, a Petaluma family physician and geriatrician, is president of MMS.

Email: irinadefischer@gmail.com