Denialism (17 page)

“The harmful effects of antioxidant supplements are not confined to vitamin A,” said the review’s coauthor, Christian Gluud, a Danish specialist in gastroenterology and internal medicine and head of the trial unit at the Centre for Clinical Intervention Research at Copenhagen University Hospital. “Our analyses also demonstrate rather convincingly that beta-carotene and vitamin E lead to increased mortality compared to placebo.” More than a quarter of all Americans over the age of fifty-five take vitamin E as a dietary supplement, yet among healthy people in the United States it would be hard to cite a single reported case of vitamin E deficiency.

It gets worse: folic acid supplements, while of unquestioned value for pregnant women, have been shown to increase the likelihood that men would develop prostate cancer. “Unfortunately, the more you look at the science the more clearly it tells you to walk away,” Kelly Brownell said. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, has for years studied the impact of nutrition on human health. “Vitamins in food are essential. And that’s the way to get them. In food.” With a couple of exceptions like folic acid for pregnant women, and in some cases vitamin D, for the vast majority of Americans dietary supplements are a complete waste of money. Often, in fact, they are worse.

That brings us back to Dr. Weil, who understands the arguments against using vitamin supplements in a country where, with rare exceptions, people have no vitamin deficiencies. He actually makes them pretty well in his book
Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being. “
Not only is there insufficient evidence that taking [antioxidants] will do you any good, some experts think they might be harmful,” he wrote. Excellent analysis, pithy and true. In fact, the evidence of harm keeps growing. In May 2009, researchers from Germany and the United States reported in the
Proceedings of the National Academy of Sciences
that antioxidants like vitamins C and E actually reduce the benefits of exercise. “If you promote health, you shouldn’t take large amounts of antioxidants,” said Michael Ristow, a nutritionist at the University of Jena, who led the international team of scientists. “Antioxidants in general . . . inhibit otherwise positive effects of exercise, dieting and other interventions.” Despite news like that, Dr. Weil still thinks you need to take his (“I continue to take a daily antioxidant formula and recommend it to others as well”).

Weil doesn’t buy into the idea that clinical evidence is more valuable than intuition. Like most practitioners of alternative medicine, he regards the scientific preoccupation with controlled studies, verifiable proof, and comparative analysis as petty and one-dimensional. The idea that accruing data is simply
one way
to think about science has become a governing tenet of the alternative belief system. The case against mainstream medicine is simple, repeated often, and, like most exaggerations, at least partially true: scientists are little more than data collectors in lab coats, people wholly lacking in human qualities. Doctors focus on disease and tissues and parts of the anatomy that seem to have failed, yet they act as if they were repairing air conditioners or replacing carburetors rather than attending to the complex needs of an individual human being. And pharmaceutical companies? They serve no interest but their own. Complementary and alternative medicine, on the other hand, is holistic. It cares. In the world of CAM, evidence matters no more than compassion or belief. Weil spells it all out in
Healthy Aging
:

To many, faith is simply unfounded belief, belief in the absence of evidence, and that is anathema to the scientific mind. There is a great movement toward “evidence-based medicine” today, an attempt to weed out ideas and practices not supported by the kind of evidence that doctors like best: results of randomized controlled trials.
This way of thinking discounts the evidence of experience.
I maintain that it is possible to look at the world scientifically and also to be aware of nonmaterial reality, and I consider it important for both doctors and patients to know how to assess spiritual health. (Italics added.)

Evidence of experience? He is referring to personal anecdotes, and allowing anecdotes to compete with, and often supplant, verifiable facts is evidence of its own kind—of the denialism at the core of nearly every alternative approach to medicine. After all, if people like Weil relied on the objective rules of science, or if their methods were known to work, there would be nothing alternative about them. If an approach to healing has a positive physical effect (other than as a placebo), then it leaves the alternative world of sentiment and enters the world of science and fact. The only attribute that alternatives share is that they do not meet the scientific standards of mainstream medicine.

Data is not warm or kind. It is also, however, not cold or cruel. Assessing data and gathering facts are the only useful tools we have to judge whether a treatment succeeds or fails. Weil understands that, and yet he mixes perfectly sensible advice with lunacy. (“I would look elsewhere than conventional medicine for help if I contracted a severe viral disease like hepatitis or polio, or a metabolic disease like diabetes,” not to mention “treatment for cancer, except for a few varieties.”)

That makes him a uniquely dangerous proponent of magical thinking. It is much easier to dismiss a complete kook—there are thousands to choose from—than a respected physician who, interspersed with disquisitions about life forces and energy fields, occasionally has something useful to say. Still, when Weil writes about a “great movement toward ‘evidence-based medicine’ ” as if that were regrettable or new, one is tempted to wonder what he is smoking. Except that we don’t need to wonder. He tells us.

Weil believes in what he calls “stoned thinking” and in intuition as a source of knowledge. This he juxtaposes with “straight” or “ordinary” thinking. You know, the type weighed down by silly rules and conventional thought. Like every alternative healer, Weil believes in the supremacy of faith and compassion. I certainly wouldn’t argue against faith (if only because for many people it provides the single form of alternative medicine that seems clearly to work, a placebo effect). And here is my definition of compassion: the desire to alleviate suffering. Nothing in the course of human history meets that definition so fully as the achievements of evidence-based, scientifically verifiable medicine.

The world of CAM is powered by theories that have almost never been tested successfully, and its proponents frequently cite that fact as proof of their unique value, as if they represent a movement that cannot be confined (or defined) by trivialities. It would be terrific if Weil were correct when he says that evidence-based medicine is now in vogue; given its astounding record of success, it certainly ought to be. There is at least one compelling reason that the scientific method has come to shape our notion of progress and of modern life. It works.

But pendulums swing in more than one direction. As Steven Novella, director of general neurology at the Yale University School of Medicine, has written, the biggest victory won by proponents of complementary and alternative medicine was the name itself. “Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery,” he wrote on Neurologica, his blog, which is devoted heavily to critical thinking. “The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all—a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberately blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.”

The integrity of our medical system is certainly subject to doubts and debate. Doctors can be smug and condescending, and they often focus on treating diseases rather than preventing them. But in the alternate universe of CAM treatment nobody has to prove what is safe, what works and what doesn’t. And that’s dangerous because Americans are desperate for doctors who can treat their overall health, not just specific illnesses. Perhaps that is why this particular universe, populated by millions of people, has been fueled by one of American history’s most unlikely coalitions—the marriage of the extreme right with the heirs of the countercultural left.

The political right has never wavered in its support for dietary supplements, and Orrin Hatch, the Utah Republican, has long been the industry’s most powerful supporter. Hatch doesn’t share a lot of political space with Tom Harkin, the populist liberal from Iowa. They don’t agree on abortion rights, gun control, or many other issues. But when it comes to the right of every American to swallow any pill he or she can find in a health food store, the two are welded by a bond of steel. “For many people, this whole thing is about much more than taking their vitamins,” Loren D. Israelsen, an architect of the 1994 legislation that deregulated the supplement industry, said. “This is really a belief system, almost a religion. Americans believe they have the right to address their health problems in the way that seems most useful to them. Often, that means supplements. When the public senses that the government is trying to limit its access to this kind of thing, it always reacts with remarkable anger—people are even willing to shoulder a rifle over it. They are ready to
believe anything
if it brings them a little hope.”

That kind of fervent belief, rather than facts, feeds disciplines like ayurvedic medicine, which argues for the presence of demonic possession in our daily life, and Reiki, the Japanese practice of laying on the hands, which is based on the notion that an unseen, life-giving source of energy flows through each of our bodies. Then there is iridology (whose practitioners believe they can divine a person’s health status by studying the patterns and colors of his iris), Healing—or Therapeutic—Touch, qi gong, magnet therapy. None of it works. Acupuncture, while effective in reducing arthritic pain and the impact of nausea, has never been demonstrated to help people quit smoking or lose weight—two of its most popular applications.

Homeopathy, perhaps the best-known alternative therapy, is also the most clearly absurd, based as it is on the notion that “like cures like.” In other words, it presumes that a disease can be treated by ingesting infinitesimally small dilutions of the substance that caused the disease in the first place. No matter what the level of dilution, homeopaths claim, the original remedy leaves some kind of imprint on the water molecules. Thus, however diluted the solution becomes, it is still imbued with the properties of the remedy. No homeopathic treatment has ever been shown to work in a large, randomized, placebo-controlled clinical trial, but nothing seems to diminish its popularity. With logic that is both ridiculous and completely sensible, the federal government has taken a distant approach to regulating homeopathy
precisely because
it contains no substance that can possibly cause harm (or good). “Homeopathic products contain little or no active ingredients,” Edward Miracco, a consumer safety officer with the FDA’s Center for Drug Evaluation and Research explained. As a result, “from a toxicity, poison-control standpoint” there was no need to worry about the chemical composition of the active ingredient or its strength.

On those rare occasions when data relating to alternative medicine does become available, it is almost invariably frightening: in 2004, for example, a large group of researchers reported in the
Journal of the American Medical Association
that more than 20 percent of the ayurvedic medicines the group purchased on the Internet contained detectable and dangerous levels of lead, mercury, and arsenic. Soon afterward, the FDA warned consumers to exercise caution when purchasing ayurvedic products.

“Who is telling people that all this stuff is good?” asked Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. “Their peers. The scientists say either we don’t know or it doesn’t work. And their response is the same thing that they’re doing with the vaccine issue. They want to feel better, they want to live forever, they want not to age. So people start going around with all of these herbs that are not proven to work and that the scientists are skeptical about. Which all the more, I think, makes them want to go after it. There’s an element of, ‘I’ll show you, you son of a bitch. The people who I hang out with think this really works.’ And then you come out with a paper, like the one in the
New England Journal of Medicine
, that shows there is absolutely no benefit from echinacea. Bingo! They don’t care. They don’t care a bit.”

The Obama administration’s laudable desire to bring medical costs under control and to make the health care system more accessible has presented leaders of the CAM community with a unique opportunity—and they have seized it. In February 2009, Weil and other famous supporters of natural healing, including Mehmet Oz, a cardiac surgeon and founder of the Complementary Medicine Program at New York Presbyterian Hospital (and, most famously, Oprah Winfrey’s health guru); and Dean Ornish, of the Preventive Medicine Research Institute in Sausa lito, California, testified before the Senate Health, Education, Labor, and Pensions Committee and correctly pointed to disease prevention as the key to crafting the new health care legislation President Obama has committed himself to so completely. In their testimony, however, each did battle with a series of straw men, arguing that the American health care system costs too much (it does), is too reliant on technology (it is), and is geared to complicated and costly treatment rather than to prevention, which is cheaper and almost always more effective (also true). A month before the summit, the group published a piece in the
Wall Street Journal
in which they wrote, “Our ‘health-care system’ is primarily a disease-care system. Last year, $2.1 trillion was spent in the U.S. on medical care, or 16.5% of the gross national product. Of these trillions, 95 cents of every dollar was spent to treat disease
after
it had already occurred. At least 75% of these costs were spent on treating chronic diseases, such as heart disease and diabetes, that are preventable or even reversible.”