To the Editor:
Samuel McCracken must have had fun tossing all alternative therapies into the same pot and declaring the whole stew unpalatable [“The New Snake Oil: A Field Guide,” June]. But my own alternative doctors and medical nutritionists draw upon whatever has proved useful in any serious school of medical thought, including allopathic—or conventional—medicine. In chronic cases, they give priority to mild, preventive natural remedies, avoiding the harsh measures and surgery that may be needed in more acute cases. They do not fit Mr. McCracken’s depiction of extremist alternative therapists who reject all allopathic treatment at all times.
Were there anything to these alternative therapies, Mr. McCracken suggests, they would have been tested scientifically. His standard is valid, but his notion of what gets tested is unrealistic. Testing for approval by the Food and Drug Administration (FDA) requires about $100 million. Drug companies channel most of their funds into the conventional rut. New medical uses for non-patentable vitamins do not interest them: without a patent, they have no hope of amortizing their costs.
Nevertheless, there have been studies of vitamins, minerals, and other nutrients. Over the years, the medical establishment has had to admit that more and more nutritional supplements work as claimed and that larger doses are needed for therapeutic use. In the meantime, untold numbers of people have suffered from the establishment’s resistance to new ideas.
One might also turn around Mr. McCracken’s warning that seriously ill patients can lose valuable time by trying untested alternative treatments. In fact, by the time many patients realize they have gotten nothing but torturesome side effects from, say, orthodox oncologists, their cancers have advanced too far for them to get relief from alternative therapies that have achieved some clinical success.
Richard H. Shulman
New York City
To the Editor:
In his article, Samuel McCracken makes great sport of a number of the more ridiculous “cures” that have been on the market over the last hundred years, but he overlooks some arguments for the other side. The mainstream medical community has looked down its collective nose at a number of treatments that are now known to be extremely beneficial. Vitamin therapy, for example, was considered useless at best for many years. Now there is a rush to acknowledge the value of folic acid during pregnancy, vitamins C and E for cardiovascular problems, etc. At the same time, a number of drugs approved by the FDA have turned out to be worse than the diseases they were designed to cure.
Without coming out and saying as much, Mr. McCracken seems to believe that the way to protect the public from unscrupulous hucksters like Andrew Weil, M.D., is for the FDA to clamp down a Big Brotherly hand on the entire alternative-medicine industry. In mainstream medicine, he states, the tradition is that “the arena of testing not be tainted by prejudice.” Mr. McCracken is either naive or disingenuous. The idea that the FDA and mainstream medicine are somehow above bias is simply ludicrous. Now that the approval of new treatments and drugs is limited to governmental or quasi-governmental bodies, politics plays the lead role. The major drug and medical-device manufacturers spend enormous sums lobbying for approval of their products. The winners are typically those with the deepest pockets.
To suggest that we would all be better off if the FDA or some other government body were regulating every substance that we eat or consume sounds suspiciously like the rhetoric of the far Left. One of the freedoms that this country once guaranteed was the freedom to make choices about things that affect our own lives, even if those choices are the wrong ones.
To the Editor:
Samuel McCracken fails even to attempt a serious analysis of why so many Americans have sought help outside the mainstream of Western medicine. There are good and bad practitioners of both Western medicine and the major forms of alternative medicine. But there is a fundamental difference in attitude that prepares these disciplines to deal effectively with different kinds of situations.
Central to the Western approach is the idea that pain and sickness are the enemy and must be vanquished. The alternative view is that symptoms are vital signals of a more general disorder and the body should be helped to set that disorder right. Sometimes the Western approach is warranted, as when pain is truly unbearable or when acute injuries result in shock or hemorrhage. But with a variety of chronic conditions, the alternative approach is sometimes more suitable. The very power of Western medicine to suppress specific symptoms can stand in the way of achieving the long-term health of the individual.
Western medicine has a strong theoretical base, following in the tradition of physical science, and classifies ailments in broad categories. Alternative medicine is empirically based and relies on observation of the individual. Many Americans are dissatisfied with the pigeonholing of Western medicine and seek individualized alternatives. They are willing, for example, to explore Chinese herbal medicine, which draws upon an ancient, continuously evolving tradition of observation and prescription. I may not know the precise mechanism by which such practices work, but, properly applied, they often do.
Americans can be viewed as carrying out a large-scale clinical experiment to find out for themselves what works. In doing so, they are providing all of us with a wider range of alternatives to choose from. It is fair to say of critics like Mr. McCracken that ridicule may amuse, but it does not promote health.
To the Editor:
I have no problem with the argument that all medical hypotheses need to be scrutinized in the critical light of scientific investigation. But we must also acknowledge that there are some matters that do not lend themselves to such analysis. Let us take, for instance, the existential questions that arise in medicine: why do some people get sick while others do not, even when exposed to the same pathogen? Why are some people healed while others, who are equally afflicted, die?
Unfortunately, in his devotion to science and its “double-blind” standard of research, Samuel McCracken is guilty of scientism, the belief that if you cannot measure something, it does not exist. Most of us who treat patients struggle to make clinical judgments based on imperfect knowledge. We use whatever means inspire hope and allow us to touch our patients in healing ways. The modalities of alternative medicine—touch, empathy, loving-kindness, belief—are used by most clinicians. We integrate these things into our therapeutic repertoire to help our patients become agents in their own healing.
Mr. McCracken, who, I suspect, has never treated a patient, denigrates Andrew Weil, M.D., who has treated many, as a shrewd manipulator whose irrational ideas are perpetrated by snake oil, charm, and a memorable beard. Weil has never minimized the genius and technology of scientific medicine. Instead, he has opened patients and practitioners to expanding the ways in which people are healed.
Since Mr. McCracken’s ninety-year-old grandmother swore by her homeopathic doctor, I would have thought that it might have opened him to how many ways there are to help people heal.
Carl A. Hammerschlag,
To the Editor:
Samuel McCracken argues that there is no evidence homeopathy works. This is simply false. Go to any homeopathic study group—there are hundreds scattered across the country—and you will find individuals like me who were sick or dying, went to a homeopathic practitioner, and were cured. Any honest examination of homeopathy needs to explain this phenomenon. Saying that those of us who believe in and utilize homeopathy are delusional is not enough.
True, there is very little scientific evidence that homeopathy works. But this is because the scientific model that orthodox medicine has created does not work when applied to homeopathy. This model requires that a substance be given to a large number of patients and then cure a statistically significant number of them. Homeopathy cannot be validated in this way because, according to homeopathic theory, each patient is unique and must be treated individually. If a homeopathic physician is treating a paranoid-schizophrenic who has a pathological fear of snakes, he will use one medicine. A paranoid-schizophrenic who dreams he is flying every night will get another medicine.
It should be clear that orthodox medicine simply does not work very well. Hundreds of thousands of the mentally ill wander our streets, and epidemics of cancer and other maladies terrify the populace. In the face of this, we pour billions of dollars into a medical system that, at best, is capable only of repressing the symptoms of disease. Should we be surprised that a significant portion of the population turns to alternative forms of medicine?
Los Angeles, California
To the Editor:
I would add to Samuel McCracken’s very lucid article that it was political pressure from “believers” in alternative medicine that forced the National Institutes of Health to create an office on alternative medicine. I use the term “believers” deliberately because of its religious connotation; those involved in promulgating alternative medicine claim that they have a different paradigm of what constitutes knowledge and can see a different reality in the workings of living systems, especially the human body. They do not depend on rational, evidence-based, scientific studies. The fact that medical schools have nonetheless been quick to jump on the bandwagon to do alternative-medicine research is not surprising. Administrators are prostitutes, and will go where the money is, even if it means giving legitimacy to outright quackery.
Sheldon F. Gottlieb
Boynton Beach, Florida
To the Editor:
I greatly appreciated Samuel McCracken’s “field guide” to what is now termed “alternative medicine.” Sadly, nothing on this subject that has appeared in any of the medical journals has even come close to the clarity of Mr. McCracken’s article.
As a member of the faculty at Northwestern University Medical School, having graduated from the University of Iowa Medical School and completed specialty training at the University of California’s San Francisco Medical School, I agree with Mr. McCracken when he says that “whenever medical schools accommodate new programs in alternative medicine, they also accommodate the severely relaxed standards of evidence that disfigure it, . . . which cannot but weaken the standards applied in mainstream medicine itself.”
The alumni publications of all three schools have featured major articles on alternative medicine within the past few years, none of which has exhibited anything approaching the objectivity of Mr. McCracken’s article. Moreover, Northwestern now offers first-year medical students a seminar on “Alternative Medicine in Chicago.” Next year, it plans to offer fourth-year students the opportunity to work with a group that “blends allopathic medicine with more alternative modalities.” David J. Zeiger, D.O., serves as preceptor for the students at the American Whole Health center, where all sorts of alternative therapies are offered. It is my impression that the University of Iowa is even less objective in this area, as Mr. McCracken has noted.
There is no question that he is correct in concluding that the growing respectability of alternative medicine will have “deeply disturbing consequences to the national health”
Carol K. Tharp, M.D.
To the Editor:
In his amusing and comprehensive article, Samuel McCracken states that “there are a great many alternatives out there.” There are indeed. If we define alternative medicine as any health-related method or practice for which scientific evidence concerning safety and efficacy is lacking or largely contradictory, the numbers are even higher than most health professionals know. Two years ago, American Medial News, published by the American Medical Association, stated that “alternative modalities” numbered about 200. By then, however, I had already come across about 1,200 nonbiomedical health-related methods. The latest on-line version of The Expanded Dictionary of Metaphysical Healthcare (http://www.hcrc.org/diction/dict.html) names well over 1,300 such methods (most of them mystical, supernaturalistic, or vitalistic). Scores of others are in use, including, for example, 40 forms, variations, or hybrids of Qigong (Chinese yoga) alone. There is no end in sight.
American Council on Science
New York City
Samuel McCracken writes:
It is hard to believe that Richard H. Shulman read my article very closely. He claims that I treat all alternative therapies as part of the same unpalatable stew, not noticing, for example, that I cite persuasive evidence that both hypnosis and biofeedback work. Nor do I find fault with alternative therapists, as Mr. Shulman claims, for failing to embrace some aspects of allopathy.
My problem is with their embrace of quackery. Mr. Shulman’s medical advisers may show respect for diversity by utilizing some allopathic methods; one hopes that in doing so they do not contravene the medical-licensing laws. His account of their practice is suffused with the usual polemical rhetoric: they eschew “harsh” methods and prefer “natural” ones. The quack ever promises the painless cure, and “natural” is either a meaningless term or one that denies man his place in nature. This ideological approach to healing is common in alternative medicine: the efficacy of a therapy is deduced from its “naturalness” or some other meaningless shibboleth. Harry Rubin’s letter pursues a similar tack, with his criticism of mainstream medicine for treating disease as an “enemy.”
In discussing the dearth of research validation for various alternative nostrums, Mr. Shulman confuses two kinds of medical research. The testing for an FDA license is indeed expensive—although it is not routinely as expensive as he claims—but any pharmaceutical that makes it through to clinical tests on humans has already shown promise through in-vitro and animal tests. If researchers in alternative medicine have been able to induce therapeutic effects in rats, they are keeping quiet about it.
In any event, the cost of FDA approval is a red herring: the alternative pharmacoepia is not subject to FDA rules. And, indeed, a substantial part of the alternative armamentarium is not even pharmaceutical: chiropractic and other forms of body work could demonstrate efficacy in controlled tests while thumbing their noses at the FDA.
Mr. Shulman’s claim that patients waste their time on orthodox oncology and thus deny themselves the benefits of alternative therapies would be stronger if he cited the studies in which he says these therapies have “achieved some clinical success.” But he does not even tell us what the therapies are, let alone the evidence for their success.
Several of my correspondents rely on the notion that, since alternative medicine is not subject to the tests applicable to mainstream medicine, I am by definition asking the wrong questions. Susan Jordan, for example, says that homeopathy, by treating each patient as literally and absolutely sui generis, is, in effect, immune from statistical analysis. This is nice work if you can get it. But of course—to use Miss Jordan’s own example—it would be possible to compare the success of homeopathic treatments for schizophrenia against allopathic treatments for schizophrenia without pitting particular homeopathic medications against particular allopathic ones.
Chris Steincamp uses one of the hoariest tactics of those who have no evidence to refute what an opponent says: he takes me to task for not coming out and saying what I really believe. In this case, Mr. Steincamp makes the bizarre claim that I advocate giving the FDA total control over everything we ingest. This is nonsense: nothing I say implies this. There is a tremendous difference between arguing (for example) that homeopathy is a foolish quackery and urging that homeopathy should be banned by law. Mr. Steincamp’s position is equivalent to my asserting that he believes (“without actually coming out and saying as much”) that because my views on alternative medicine are wrong-headed, I have no right to publish them.
When Mr. Steincamp portrays me as claiming that mainstream medicine is “above bias,” he is, to use his own terms, being either naive or disingenuous. I do claim, and rightly so, that mainstream medicine tries to minimize bias. I also note that it is, like all human endeavors, fallible. Mr. Steincamp’s riposte—that the FDA’s drug-approval process is controlled by extra-scientific lobbying—is conspicuously lacking in specificity or documentation.
Susan Jordan cites multiple study groups as proof of homeopathy’s efficacy. This begs two crucial questions: whether these believers have been properly diagnosed to begin with, and whether they have in fact been cured. To agree with her would thus require an act of faith. But a study that detailed cases in which patients were determined by allopathy to suffer from particular illnesses and also determined by allopathy to have been cured by homeopathy—now, that would compel assent not through faith but through reason. We are still waiting for such a study. None of my correspondents cites one.
Carl A. Hammerschlag is perfectly right to take issue with the notion that if something cannot be measured, it does not exist But that is certainly not my position, nor is it that of mainstream medicine, which could accurately be summarized as “if something cannot be perceived, there can be no evidence that it exists.” Dr. Hammerschlag appears to believe that by labeling certain questions—for example, why some persons exposed to a pathogen become ill and others do not—as “existential,” he has removed them from the arena of scientific study. This is a distinctly odd notion, since the particular issue he raises is intimately tied up with immunology.
That Dr. Hammerschlag’s remarks are just as infused with assertion and vagueness as those by some of my correspondents who do not hold M.D.’s is further evidence of the penetration of snake oil into orthodox medicine, as is indeed his website, where one can learn about his specialty of “Psychoneuroimmunology,” which replaces what he regards as the outdated germ theory.
I am grateful to Sheldon F. Gottlieb, Carol K. Tharp, and Jack Raso for their kind words, even though Mr. Raso (whose own website is a remarkable and useful place) brings the kind of news that among the Persians would have led to unfortunate consequences for the messenger.