Denialism (18 page)

None of that is really in dispute, but those fundamental flaws cannot possibly be overcome by a system that replaces facts with wishes. Prescribing diet and exercise to fight disease is
not
an alternative approach to medicine, as anyone who has visited a physician in the past five years would surely know. What America needs, and what the Obama administration has, for the first time, set out to do, is get a better sense of which treatments work and which don’t. That would, for instance, require placing caloric information on all fast-food menus and explaining what it means. And it will require clear economic judgments about whether many current procedures are in fact worth the cost. All that will require data, not voodoo.

Nearly a decade ago, a Stanford University professor named Wallace I. Sampson warned that institutional support for alternative medicine endangers society. “Modern medicine’s integrity is being eroded by New Age mysticism, cult-like schemes, ideologies, and classical quackery,” he wrote in an influential essay called “The Alternate Universe,” arguing that they were all misrepresented as “alternative” medicine. “Using obscure language and misleading claims, their advocates promote changes that would propel medicine back five centuries or more. They would supplant objectivity and reason with myths, feelings, hunches, and sophistry.” At the time, Sampson’s claims seemed a bit over the top to me. We were in a golden era of medicine; life expectancy grew nearly every year, and so did our knowledge of how to treat many chronic diseases. It never occurred to me that science-based medicine might be considered an obstacle to a healthy life, rather than the best chance of having one.

Those bottles of folic acid and BlueGranate from The Health Nuts were sitting on my desk. They looked so promising and appeared to offer so much: support for a healthy cardiovascular system, as well as better memory and brain function; they would promote urinary tract, eye, and skin health, boost body detoxification functions, and reduce cellular damage associated with the aging process. There was, however, a tiny asterisk next to each claim. “These statements have not been evaluated by the Food and Drug Administration,” each one said. “These products are not intended to treat, diagnose, cure or prevent any disease.” I looked at the Garlicyn, the amino acids, and the vitamin C. Same warnings. Same nearly invisible print.

The fine print on labels like that is rarely read. In the world of dietary supplements, facts have always been optional. Pharmaceuticals are strictly regulated; for supplements there is almost no oversight at all. A pill may be sold as something that contains 1000 mg of vitamin C. But how can you be sure without meaningful standards? When facts are not required anything goes, and Andrew Weil, for one, wouldn’t have it any other way. “I believe in magic and mystery,” he wrote in
Healthy Aging.
“I am also committed to scientific method and knowledge based on evidence. How can this be? I have told you that I operate from a
both-and mentality, not an either-or
one.”

Sorry, but that’s not possible. Either you believe evidence that can be tested, verified, and repeated will lead to a better understanding of reality or you don’t. There is nothing in between but the abyss. The FDA knows that, and so does the supplement industry. And so does Andrew Weil. If a product whose label promotes it as contributing to brain function, cardiovascular health, or one that can reduce cellular damage associated with aging, or improve digestion, or support a healthy immune system is “not intended to cure, treat, diagnose or even prevent” any health problem, what on earth, one has to wonder, is it supposed to do?

ALMOST 40 PERCENT of American adults made use of some form of alternative medical therapy in 2007, according to the most recent
National Health Statistics Reports.
They spent $23.7 billion on dietary supplements alone. It has become one of the America’s biggest growth industries. (And one that almost uniquely profits during times of economic distress. People are far more likely to turn to herbs and other supplements when they can’t afford genuine medical care—and when they have no access to any other health system.) There were approximately 4,000 supplements on the market in 1994, when the industry was deregulated by Congress. Today the exact number is almost impossible to gauge, but most experts say there are at least 75,000 labels and 30,000 products. Those numbers don’t include foods with added dietary ingredients like fortified cereals and energy drinks, which seem to fill half the supermarket shelves in the country.

The attraction isn’t hard to understand. For all that medicine has accomplished, millions of people still suffer the considerable aches and pains of daily life. Arthritis and chronic pain plague America, and much of that agony is no more amenable to pharmaceutical relief today than it was thirty years ago. The drugs one needs to alleviate chronic pain—aspirin, for instance—can cause their own complications when taken in high enough doses over a long enough period. The pharmaceutical industry is a monolith that often acts as if there is, or soon will be, a pill for everything that ails you. Too much cholesterol? We can melt it away. Depressed? Try one of a dozen new prescriptions. Can’t sleep? Blood pressure too high? Obese, sexually dysfunctional, or bald? No problem, the pharmaceutical industry is on the case.

Even our medical triumphs cause new kinds of problems. Reducing deaths from heart disease and cancer, for example, permits us to live longer. And
that
exposes us to a whole new set of conditions, most notably Alzheimer’s disease, a debilitating, costly, and humiliating illness for which there is no cure and few treatments of any value.

So what could it hurt to try something new? It is an era of patient empowerment. People have access to more information than ever, their expectations have changed, and they demand greater control over their own health. Supplements and herbal alternatives to conventional drugs, with their “natural” connotations and cultivated image of self-reliance, fit in perfectly. They don’t require machines or complex explanations. People can at least try to relate to an herb like echinacea, which has been around for centuries, no matter how useless it is, or a practice like qi gong, which means “cosmic breathing” and suggests that human life forces can be marshaled to flow through our body in a system of “meridians.” Homeopathy is nothing more than fraud, as any number of scientists, studies, reports, and institutions have pointed out. Yet, in a complex world simplicity offers an escape from the many moving parts of the medical machine. As with organic food, if science seems allied with corporations and conglomerates—all distant and unfathomable—well, then, nature feels just right.

Under the banner of natural and alternative treatments Americans reflexively accept what they would never tolerate from a drug company (and never should). Vioxx made that clear. Without post-marketing surveys, the unacceptable risks of Vioxx would never have been known. Maybe none of the tens of thousand of herbal supplements for sale in the United States carries any similar risk. But how would we know, since that kind of monitoring has never been required of supplements? Doctors could not have continued to prescribe Vioxx after news of its dangers was made public. Yet compare the way Vioxx was removed from the market—amid the greatest possible publicity and under threat from billions of dollars’ worth of lawsuits—to what happened in 2004 with ephedra, which was America’s most popular dietary supplement.

Ephedra, derived from the Asian herb ma huang, has been used for thousands of years; the herb’s active ingredient, ephedrine, boosts adrenaline, stresses the heart, raises blood pressure, and is associated with an increased risk of heart attack, stroke, anxiety, psychosis, and death. None of that was in question. But the FDA’s decision to pull it from the market certainly was. Many of the Americans who were outraged that Vioxx had been approved in the first place were just as outraged when ephedra was banned. It took the FDA years of legal battle to get the supplement removed from the shelves of vitamin shops. Ephedrine-containing supplements have caused deaths in many countries, not just in America. But people still want it, and what people want, the Internet provides. “We’re growing ma huang (ephedra), which has been used in Traditional Chinese Medicine for 5,000 years but is now banned in America thanks to the criminally-operated FDA,” one foreign supplier wrote in 2009. And he will be more than happy to sell it to anyone foolish enough to send money. And why would anyone do that? Because a supplement is not a drug. Its value is taken on faith and no amount of evidence will ever convince true believers to turn away.

Belief outranks effectiveness. Vitamin worship demonstrates that fundamental tenet of denialism with depressing regularity. In 2003, a study that compared the efficacy of echinacea to a placebo in treating colds received considerable attention. Researchers followed more than four hundred children over a four-month period, and found not only that a placebo worked just as well, but that children treated with echinacea were significantly more likely to develop a rash than those who took nothing at all.

Subsequent studies have been even more damning. In 2005, researchers from the Virginia School of Medicine reported in the
New England Journal of Medicine
that echinacea had no clinical impact, whether taken as a prophylactic or after exposure to a virus. Nor did it lessen the duration or intensity of any symptom. In addition, the American College of Pediatricians has urged parents to avoid echinacea mixtures for children who are less than a year old. The response? According to the latest data released by the federal government in 2008, echinacea remains the most heavily used supplement in the childhood arsenal. (It is still wildly popular with adults too, but fish oil is now in greater demand.)

Almost no restrictions were placed on the sale of supplements, vitamins, or other home remedies until 1906, when, reacting to the revelations in Upton Sinclair’s book
The Jungle
, Congress passed the Pure Food and Drug Act. The law permitted the Bureau of Chemistry, which preceded the Food and Drug Administration, to ensure that labels contained no false or misleading advertising. Since then, the pendulum has swung regularly between unregulated anarchy and restrictions that outrage many Americans. In 1922, the American Medical Association made an effort to limit the indiscriminate use of vitamins, describing their widespread promotion as “gigantic fraud.” It helped for a while. By 1966, the FDA tried to require the manufacturers of all multivitamins to carry this notice: “Vitamins and minerals are supplied in abundant amounts in the foods we eat. . . . Except for persons with special medical needs, there is no scientific basis for recommending routine use of dietary supplements.” The vitamin industry made certain that no such warning was ever issued.

The relationship between food, drugs, and supplements began to blur in the 1970s as connections between diet, food, and medicine became more fully understood. What began as a federal effort to improve nutrition and prevent confusion has ended up as a tacit endorsement of chaos and deceit. First, with a major report issued in 1977 by the Senate Select Committee on Nutrition and Human Needs, and then with studies by the National Academy of Sciences and other research groups, the government started telling Americans to alter their diets if they wanted to have long and healthy lives. That made sense, of course. Advice about ways to reduce the risk of heart disease, diabetes, many cancers, and other chronic illnesses became routine. There were food pyramids and instructions to eat less salt and fat and add fiber as well as whole grains; eat more fruits and vegetables and watch the calories. Still, it was against the law to suggest that there was a relationship between the ingredients in a commercial food and the treatment or prevention of a disease.

Then, in 1984, came the Original Sin. That year, the National Cancer Institute lent its unparalleled credibility to the Kellogg Company when together they launched a campaign in which All-Bran cereal was used to illustrate how a low-fat, high-fiber diet might reduce the risk for certain types of cancer. All-Bran was the first food permitted to carry a statement that was interpreted widely as “Eating this product will help prevent cancer.” That led to the era of product labels, and completely changed the way Americans think about not only foods but dietary supplements and ultimately about their health. Food was no longer simply food; it was a way to get healthy. Some of those changes made sense: flour was fortified with folate; juice enriched with calcium; and in 2004, in the name of health, General Mills started making every one of its breakfast cereals from whole grains.

They were exceptions. It would require Dickens’s narrative skills and Kafka’s insight into bureaucratic absurdity to decipher the meaning of most products for sale in American health food stores today. In the world of alternative medicine, words have become unmoored from their meanings. As long as a company doesn’t blatantly lie or claim to cure a specific disease such as cancer, diabetes, or AIDS, it can assert—without providing evidence of any kind—that a product is designed to support a healthy heart, or that it protects cells from damage or improves the function of a compromised immune system.

It’s still against the law to claim a product cures a disease—unless it actually does. But there is no injunction against saying that a food or supplement can affect the structure or function of the body. Such claims can appear on any food, no matter how unhealthy. You cannot advertise a product as a supplement that “reduces” cholesterol, but you can certainly mention that it “maintains healthy cholesterol levels.” It would be illegal to state that echinacea cures anything, since of course it has been shown to cure nothing. But it’s perfectly acceptable to say that echinacea is “an excellent herb for infections of all kinds,” although no such thing has been proven to be true.

Even claims that are true are often irrelevant. Vitamin A, for example, is essential for good vision—as supplements for sale in any health food store will tell you. Insufficient consumption of vitamin A causes hundreds of thousands of cases of blindness around the world each year, but not in the United States; here people don’t have vision problems arising from a lack of vitamin A. Although statements advertising vitamin A for good vision may, like many others, be legally permissible, they are meaningless. And since too much vitamin A can cause birth defects and osteoporosis, for example, its potential to harm American consumers is far greater than the likelihood that it will do good.