Correspondence
Health Quackery
N Engl J Med 1993; 329:1204October 14, 1993
- Article
To the Editor:
In his book review of American Health Quackery and Guide to the American Medical Association Historical Health Fraud and Alternative Medicine Collection (Dec. 17 issue),1 Herbert mistakenly equates all “alternative” medical practices with those that are clearly fraudulent. In any field, be it business, industry, or medicine, there will always be those who are eager to take advantage of unsuspecting consumers for monetary gain. To dismiss the entire spectrum of alternative medicine with a blanket indictment such as this, however, is shortsighted, uninformed, and insulting to the integrity of the many dedicated practitioners who use these therapies.
Many of the therapies included under the rubric of alternative medicine, including traditional Chinese medicine, acupuncture, ayurvedic medicine, herbalism, and homeopathic medicine, enjoy widespread acceptance by millions of people worldwide. There is a growing body of scientific literature to support the legitimacy of these therapies2-5. A recent poll by Time and Cable News Network documented that over 10 percent of people in the United States had consulted alternative practitioners and that most would do it again6.
The effort by the National Institutes of Health (NIH) to investigate and validate various alternative practices should be applauded, not considered “misguided,” as Herbert contends. Only through scientifically rigorous investigations such as those to be funded by the NIH will it be possible to determine which of these practices have a legitimate scientific basis. The amount allocated to this process, $2 million each for 1992 and 1993, is very small -- less than the rounding error of the entire NIH budget.
Like physics, biochemistry, and a multitude of other disciplines, medicine is in the process of a revolution, or paradigm shift. History has repeatedly shown that innovative ideas and unconventional ways of thinking are usually rejected by the mainstream and its institutions7. As the cost of health care continues to escalate out of control, it is clear that conventional modern medicine does not have all the answers to our health problems. It is both reasonable and timely to give careful consideration to these alternatives.
7 ReferencesJennifer Jacobs, M.D., M.P.H.
23200 Edmonds Way, Edmonds, WA 980261
Herbert V . Review of: American health quackery and Guide to the American Medical Association historical health fraud and alternative medicine collection. N Engl J Med 1992;327:1820-1821
Full Text2
Reilly DT ,Taylor MA ,McSharry C ,Aitchison T . Is homeopathy a placebo response? Controlled trial of homeopathic potency, with pollen in hayfever as model. Lancet 1986;2:881-886
CrossRef | Web of Science | Medline3
Kleijnen J ,Knipschild P ,ter Riet G . Clinical trials of homeopathy. BMJ 1991;302:316-323
CrossRef | Web of Science | Medline4
Dundee JW ,Chestnutt WN ,Ghaly RG ,Lynas AG . Traditional Chinese acupuncture: a potentially useful antiemetic? BMJ 1986;293:583-584
CrossRef | Web of Science | Medline5
Bullock ML ,Culliton PD ,Olander RT . Controlled trial of acupuncture for severe recidivist alcoholism. Lancet 1989;1:1435-1439
CrossRef | Web of Science | Medline6
Wallis C. Why new age medicine is catching on. Time. November 4, 1991:68-76.
7
Kuhn TS. The structure of scientific revolutions. 2nd ed. Chicago: University of Chicago Press, 1970.
Author/Editor Response
Dr. Herbert replies:
To the Editor: Dr. Jacobs misrepresents my book review as indicating that all alternative medical practices are fraudulent. Not so. There are three kinds of alternatives: genuine, questionable, and blatantly fraudulent1.
Genuine alternatives are those that successfully answer the basic questions of efficacy and safety1. Is a remedy better than placebo or than doing nothing? Is it as safe as placebo or as doing nothing? If there is any question about safety, does the potential benefit exceed the potential harm?
Questionable alternatives are those that have not answered these three basic questions. Questionable alternatives represented as genuine and used to make a profit are fraudulent since, by definition, fraud is deception for profit1.
Homeopaths refer to dilution as “potentization.” It is obviously fraudulent when bottles of homeopathic remedies “potentized” by having been diluted past Avogadro's number -- so that there is one molecule or less of active agent per 10 bottles -- are sold with representations of potency against dysfunction and disease2.
The Office of Alternative Medicine at the NIH lends credibility to fraudulent alternatives by impaneling as advisers people who conceal from the press that there is not even preliminary evidence of effectiveness of the “alternatives” they promote (such as homeopathy,2 immunoaugmentative therapy,1,3 and the “Revici method”1,3), but just “best cases” that are evidentiarily worthless. “Best cases” are not preliminary evidence of effectiveness, because on investigation1 they prove to be “cures that are not.” In some cases the patient never had the disease1. In others the disease was cured or a remission was induced by genuine therapy, but the quack remedy also given was credited1. In some the disease was progressing silently but was erroneously believed to be cured1. In other cases the patient died but was represented as cured1. Sometimes the patient had a spontaneous remission that was publicized as a success, but the proponents failed to keep score and publicize all the failures before and after each “success”1. The difference between promoters of quack remedies and promoters of legitimate remedies is that only the latter keep score.
3 ReferencesVictor Herbert, M.D., J.D.
Mount Sinai and Bronx Veterans Affairs Medical Centers, Bronx, NY 104681
Herbert V . Unproven (questionable) dietary and nutritional methods in cancer prevention and treatment. Cancer 1986;58:Suppl:1930-1941
CrossRef | Web of Science | Medline2
Butler KA. A consumer's guide to “alternative medicine”: a close look at homeopathy, acupuncture, faith-healing and other unconventional treatments. Buffalo, N.Y.: Prometheus Books, 1992:130-7.
3
Office of Technology Assessment. Unconventional cancer treatments. Washington, D.C.: Government Printing Office, 1990. (OTA-H-405.)
- Citing Articles (2)
Citing Articles
1
Køber, Lars, Torp-Pedersen, Christian, Carlsen, Jan E., Bagger, Henning, Eliasen, Per, Lyngborg, Kjeld, Videbæk, Jørgen, Cole, David S., Auclert, Laurent, Pauly, Nancy C., Aliot, Etienne, Persson, Stig, Camm, A. John, . (1995) A Clinical Trial of the Angiotensin-Converting–Enzyme Inhibitor Trandolapril in Patients with Left Ventricular Dysfunction after Myocardial Infarction. New England Journal of Medicine 333:25, 1670-1676
Full Text2
Victor Herbert, Spencer Shaw, Elizabeth Jayatilleke, Tracy Stopler-Kasdan. (1994) Most free-radical injury is iron-related: It is promoted by iron, hemin, holoferritin and vitamin c, and inhibited by desferoxamine and apoferritin. Stem Cells 12:3, 289-303
CrossRef
