Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine (Vitamins, Supplements, and All Things Natural: A Look Behind the Curtain)

by Paul A. Offit

The reason alternative therapies are popular is simple. Mainstream doctors are perceived as uncaring and dictatorial, offering unnatural remedies with intolerable side effects. Alternative healers, on the other hand, provide natural remedies instead of artificial ones, comfort instead of distance, and individual attention instead of take-a-number-and-wait-your-turn inattention.

Instead of minor knee surgery, I had just undergone microfracture surgery, where small holes are drilled into bone. The recovery wasn’t going to be a few days—it was going to be a year. The miscalculation didn’t seem to surprise or upset the orthopedist. But it upset me.

What I learned in all of this was that, although conventional therapies can be disappointing, alternative therapies shouldn’t be given a free pass. I learned that all therapies should be held to the same high standard of proof; otherwise we’ll continue to be hoodwinked by healers who ask us to believe in them rather than in the science that fails to support their claims. And it’ll happen when we’re most vulnerable, most willing to spend whatever it takes for the promise of a cure.

Because the truth is, there’s no such thing as conventional or alternative or complementary or integrative or holistic medicine. There’s only medicine that works and medicine that doesn’t. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends.

By the end of the 1970s, laetrile wasn’t just a drug; it was a social movement.

On May 26, 1977, Franz Ingelfinger, the distinguished editor of the New England Journal of Medicine, published an editorial titled “Laetrilomania.” Ingelfinger wrote, “As a cancer patient myself, I would not take Laetrile under any circumstances. If any members of my family had cancer, I would counsel them against it. If I were still in practice, I would not recommend it to my patients.”

In retrospect, the last best chance to save Joey Hofbauer had occurred in one court and one court only: Judge Loren Brown’s family court. This was the only time that cancer specialists had testified. Lawyers working on behalf of Joey had done their homework. The doctors and scientists presented by the state had published hundreds of papers, written book chapters on Hodgkin’s disease, chaired professional societies, headed research teams showing the value of radiation and chemotherapy, performed studies in experimental animals showing that laetrile didn’t work and was dangerous, or headed the FDA’s section on cancer treatments. They were, in short, the brightest, most accomplished members of their field. The doctors and scientists offered by the Hofbauers also shared several characteristics: none were board-certified in oncology, hematology, or toxicology; none had ever published a paper in a medical journal; none had shown any reasonable evidence that their therapies worked; and most didn’t even have hospital privileges. That Brown could rule in favor of the Hofbauers’ choice to deny their son a proven, effective therapy is unconscionable. But an explanation can be found in the record of the trial. In the section titled “Findings of Fact and Conclusion of Law,” Brown wrote, “This court finds that metabolic therapy has a place in our society, and, hopefully, its proponents are on the first rung of a ladder that will rid us of all forms of cancer.” Brown believed that his sm...

There was another force working against Joey Hofbauer in Judge Brown’s courtroom that day—a force far more powerful than clinicians like Michael Schachter or laetrile promoters like Ernest Krebs Jr. or ideologues like Robert Bradford. It was revealed during an exchange between the Hofbauers’ lawyer, Kirkpatrick Dilling, and Victor Herbert, a cancer specialist. Dilling was questioning Herbert about the value of bonemeal. DILLING: Calcium, is that an essential nutrient? HERBERT: Yes. DILLING: Are you familiar with the fact that bonemeal is very high in calcium? HERBERT: I’m familiar with the fact that bonemeal is a dangerous quack remedy because of its lead content and people have died from being given bonemeal instead of calcium properly in milk and milk products. DILLING: Isn’t bonemeal widely available? HERBERT: Certainly is, your organization pushes it. Dilling froze. His organization? Herbert had revealed something that wasn’t evident to most in the courtroom that day—exactly who was paying for the Hofbauers’ defense. Recovering, Dilling went on the offensive. “I want to state for the record,” he said, “that I’m proud to represent the National Health Federation and I would appreciate it if the witness would keep his views to himself.”

Joey Hofbauer’s story, while extreme, contains much of what attracts people to alternative therapies today: a heartfelt distrust of modern medicine (John and Mary Hofbauer didn’t believe the advice of hematologists and oncologists); the notion that large doses of vitamins mean better health (Joey was given massive doses of vitamin A, which was likely to have been to his detriment); the belief that natural products are safer than conventional therapies (the Hofbauers preferred laetrile, pancreatic enzymes, coffee enemas, and raw liver juice to radiation and chemotherapy); the lure of healers whose charisma masks their lack of expertise (Michael Schachter, a psychiatrist, convinced the Hofbauers he could cure their son, even though he had no expertise treating cancer); the power of celebrity endorsements (Steve McQueen was one of the most popular movie stars of his day); and, perhaps most of all, the unseen influence of a lucrative business (Kirkpatrick Dilling’s NHF, still active today, is one of many lobbying groups that have influenced Congress to offer special protections to the fourteen hundred companies that manufacture alternative remedies in the United States).

Another example of Oz’s embrace of supernatural beliefs can be seen during his surgeries, which look like those of any other surgeon with one exception: the presence of reiki masters like Pamela Miles, a practitioner of therapeutic touch whom Oz has featured on his show. Miles claims that she can detect human energy fields and manipulate them to heal the sick. Oz has never put Miles’s claims to the test. But it wouldn’t be that hard to do. In fact, it was done a few years ago in a study designed, conducted, and analyzed by Emily Rosa. Rosa asked twenty-one therapeutic touch healers to sit behind a large partition with two holes at the bottom; she couldn’t see them and they couldn’t see her. Then she asked the healers to put their hands, palms up, through the holes. After flipping a coin, Rosa put her hand slightly above each healer’s right or left hand, asking them to pick which she had chosen. If healers could truly detect her energy field, they would have picked the correct hand 100 percent of the time; if not, about 50 percent of the time. Rosa found that healers were right 44 percent of the time—no different than chance. She concluded, “Their failure to substantiate therapeutic touch’s most fundamental claim is unrefuted evidence that [their beliefs] are groundless and that further professional use is unjustified.” In 1999, Emily Rosa published her paper in the Journal of the American Medical Association. It was titled “A Close Look at Therapeutic Touch.” Unlike Mehmet...

“One of the arguments mobilized by alternative medicine practitioners against orthodox medicine is that the latter is constantly changing while alternative medicine has remained unaltered for hundreds, even thousands of years,” wrote Raymond Tallis in Hippocratic Oaths: Medicine and Its Discontents. “The lack of development in 5,000 years can be a good thing only if 5,000 years ago alternative practitioners already knew of entirely satisfactory treatments. If they did, they have been remarkably quiet about them.”

Seven previous studies had already shown that vitamins increased the risk of cancer and heart disease and shortened lives. Still, in 2012, more than half of all Americans took some form of vitamin supplements. What few people realize, however, is that their fascination with vitamins can be traced back to one man. A man who was so spectacularly right that he won two Nobel Prizes and so spectacularly wrong that he was arguably the world’s greatest quack.

Whatever the reason, the data are clear: high doses of vitamins and supplements increase the risk of heart disease and cancer; for this reason, not a single national or international organization responsible for the public’s health recommends them.

Despite a wealth of scientific evidence, most Americans don’t know that megavitamins are unsafe. So why don’t more people know about this? And why hasn’t the FDA sounded an alarm? The answer is predictable: money and politics.

In addition to lobbying for the unrestricted sale of megavitamins, the NHF also campaigned against pasteurization, vaccination, and fluoridation.

Cohen had pointed to the vitamin industry’s Achilles’ heel: ingesting large quantities of vitamins was unnatural, the opposite of what manufacturers had been promoting.

It is remarkable, even in retrospect, that consumers not only chose not to know what they were buying; they lobbied for it.

Kessler was making an argument that had been made for centuries. The source of a chemical doesn’t matter; only the chemical matters. And whether it is synthesized by a pharmaceutical company or found in nature, the chemical is the same. And it should be regulated in the same way. Otherwise consumers will think they’re getting a guarantee of safety when they’re not.

The vitamin and supplement industry had successfully created a false dichotomy. On one side are natural products: vitamins, minerals, dietary supplements, plants, and herbs. Because they’re natural, they’re safe. On the other side are drugs. Because drugs are man-made, they’re supposedly more dangerous. However, many drugs are derived from nature, including antibiotics. Furthermore, the notion that natural products aren’t dangerous is fanciful. Fava beans (Vicia faba) can cause severe anemia; castor beans contain ricin, the most potent neurotoxin known to man; jimsonweed contains hallucinogenic alkaloids; berries from the coyotillo plant (Karwinskia humboldtiana) cause paralysis; and the ackee fruit (Blighia sapida) causes a severe lowering of blood sugar (“Jamaican vomiting sickness”). Mother Nature can kill you. “Just because something is natural it does not mean that it is good,” write Simon Singh and Edzard Ernst in Trick or Treatment, “and just because something is unnatural it does not mean that it is bad. Arsenic, cobra poison, nuclear radiation, earthquakes, and the ebola virus can all be found in nature, whereas vaccines, spectacles, and artificial hips are all man-made.”

Because the dietary supplement industry is unregulated, only 170 (0.3 percent) of the 51,000 new products brought to market since the 1994 Supplement Act have documented safety tests.

The General Nutrition Center is a wonderland of promise. If people want to burn fat, detoxify livers, shrink prostates, avoid colds, stimulate brains, boost energy, reduce stress, enhance immunity, prevent cancer, extend lives, enliven sex, or eliminate pain, all they have to do is walk in. The question, however, is which products work? And how do we know they work?

Not all the news is grim. Some dietary supplements actually might be of value. Of the 51,000 new supplements on the market, four might be of benefit for otherwise healthy people: omega-3 fatty acids to prevent heart disease, calcium and vitamin D in postmenopausal women to prevent bone thinning, and folic acid during pregnancy to prevent birth defects.

In the end, if a medicine works (like folic acid to prevent birth defects), it’s valuable, and if it doesn’t work (like saw palmetto to shrink prostates), it’s not. “There’s a name for alternative medicines that work,” says Joe Schwarcz, professor of chemistry and the director of the Office for Science and Society at McGill University. “It’s called medicine.”

“Now, repeat after me,” wrote McGill’s Joe Schwarcz. “ ‘The properties of a substance depend on molecular structure, not ancestry. When it comes to assessing effectiveness and safety, whether the substance is synthetic or natural is totally irrelevant.’”

The difference between bioidentical and conventional hormones isn’t that one is natural and the other isn’t. Or that one is safe and the other isn’t. It’s that one is the product of an unsupervised industry and the other isn’t.

Although one can only have sympathy for parents desperate to help their children, desperation can become child abuse.

The vitamins, minerals, supplements, coffee enemas, and herbs recommended by McCarthy to treat autism are the same therapies that were recommended by Michael Schachter to treat Joey Hofbauer’s Hodgkin’s disease, William Kelley to treat Steve McQueen’s mesothelioma, and Suzanne Somers to counter menopause and aging. Vastly different problems, eerily similar treatments.

Worse: McCarthy’s advice to avoid vaccines is not only useless; it’s dangerous. Parents who choose not to vaccinate aren’t lessening their children’s risk of autism; they’re only increasing their risk of suffering preventable diseases.

Singer doesn’t blame parents. “I think the culpability lies with the quacks who are preying on the desperation of families. I think that’s the worst kind of person who would take advantage of a parent or child during a time when they’re grieving. I don’t blame parents for being susceptible to this. I don’t blame them for wanting to believe. You just can’t imagine that there is someone who wants to take advantage of you.”

“The scientific process is not democratic,” they wrote. Science isn’t about who gets the most votes; it’s about the quality, strength, and reproducibility of the evidence.

In addition to being a Yale neurologist, Steven Novella is founder and president of the New England Skeptical Society, director of the Science-Based Medicine project at the James Randi Educational Foundation, and host of the popular science podcast The Skeptics’ Guide to the Universe.