“freedom of choice"
removes the focus
from quackery and
it with the principle
that people should
have the freedom
to select their own
The Rise of Alternative Medicine
|By Wallace Sampson, M.D.|
This article is based on information Dr. Wallace Sampson presented to the New York Academy of Sciences conference, Flight from Science and Reason, May 31 to June 2, 1995. The complete text of his talk, along with the talks of twenty other participants, will be published March, 1996 in the Proceedings of the NYAS. Dr. Sampson is a medical researcher and a practicing hematologist and oncologist at the Santa Clara Medical Center in San Jose, California. He is also the Board Chairman of the National Council Against Health Fraud and a CSICOP Fellow.
Propaganda, cultural relativism and deconstructionism have been woven with anti-scientific thinking into a cable of thought processes that are strangling medical science. The first two of these are responsible for medical mischief from quackery and Laetrile to the creation of an Office of Alternative Medicine in the National Institutes of Health, while the more abstract phenomenon of deconstructionism takes cultural relativism into a disorienting world devoid of standards, validity and ethics.
The term propaganda refers to the intentional, and at times cynical, manipulation of language. Its purpose is to reconstruct perceived reality, thence to alter beliefs, with intent to control behavior. It is effective, pervasive and difficult to detect.
Two hundred years ago Samuel Hahnemann coined the words “homeopathy” and “allopathy.” He described his treatment method as homeopathy. He regarded all symptoms as manifestations of the body’s resistance to disease. Under this philosophy, he used treatments he hoped would strengthen these reactions by prescribing highly diluted materials that, in larger doses, produced the same symptoms. Hahnemann defined “allopathy” as methods that countered the symptoms, and he branded the rest of medicine as allopathic, despite the fact that alleviating symptoms was only part of what physicians did.
The term allopathy, with its negative connotations, has stuck with rational medicine. Slogans such as “treating only the symptoms and not the cause” have been used by holistic and “alternative” medicine proponents since the 1970s to depict biomedicine absurdly, as, for example, treating typhoid fever with aspirin. But the propaganda effect is broad and cogent, and accomplished Hahnemann’s intent of diminishing the public’s concept of medicine and increasing the perception of homeopathy’s respectability.
In the 1960s and 70s Laetrile inventor, Ernst Krebs, Jr., began similar wordplays in his contest with the Food and Drug Administration and the courts over his two invented “vitamins,” Laetrile (B17) and Pangamic (B15). Laetrile is extracted from apricot and other fruit pits which contain cyanogenic glycosides with five to six percent cyanide by weight. These compounds occur naturally in many of the world’s staple foods such as maize, taro root and cassava; but they cause thyroid dysfunction, blindness and paralysis from chronic cyanide poisoning, and death in cases of acute poisoning. Krebs labeled these compounds “nitrilosides” (a contraction of nitrile, the cyanide containing moiety, and glycosides, the sugar moiety) - eliminating cyanogenic, which means cyanide forming. He labeled the final product “Laetrile,” an alliterative, appealing name.
When the FDA began seizing Laetrile and bringing fraud charges for false claims, Krebs renamed it Vitamin B17, with trade names such as “Bee-seventeen,” and called it a food supplement. This ploy did not work with the FDA, but did with customers and followers. Laetrile still flourishes in Tijuana clinics for gullible and desperate Americans and Canadians (native Mexicans rarely patronize those clinics). Laetrile supporters ridiculed rational medicine by describing surgery, radiation and chemotherapy as “slash, burn and poison,” while describing their ineffective methods as “metabolic therapy” (Laetrile, plus special diets and vitamins) and “nontoxic therapy.”
The Committee of Freedom and Choice pushed Laetrile under the slogan “freedom of choice.” The slogan removes the focus from quackery and ineffective cancer remedies, replacing it with the principle that people should have the freedom to select their own treatments. Supporters used the argument so successfully in fighting off federal and state challenges that 27 states legalized Laetrile, although with some restrictions. And it remains a rallying cry for the health foods industry and alternative medicine supporters.
Linus Pauling invented the word “orthomolecular” which he defined as “the right molecule in the right place at the right time.” Dr. Thomas Jukes described “orthomolecular” as a slogan, not a treatment. Dr. Victor Herbert compared Pauling’s definition to Humpty Dumpty’s remark in Through the Looking Glass: “When I choose a word, it means just what I choose it to mean, neither more or less.” Pauling had little idea which molecule should be where or when or in what concentrations, so he advocated taking massive doses of vitamins to cover all bases; he finally concentrated on vitamin C. Research on cancer, mental illness and the common cold discredited Pauling’s theories, but they are still believed by many.
A Dictionary of the Absurd has been created by alternative medicine which redefines words, using euphemisms to disguise unproven, disproved, erroneous, anomalous, ineffective or fraudulent practices. In one linguistic feat, the “holistic” movement labeled rational biomedicine as “reductionist” and rational thinking as “linear.” Unscientific thinking became “nonlinear.” The term “holistic” diminished the status of measurement and rationality and inserted spirit, mind, and consciousness into medicine. Quackery and fraud are obscured by euphemisms such as “alternative.” The dictionary definition of alternative is “a choice limited to one of two or more possibilities,” which implies either possibility will obtain the same or similar result. “Alternative” has not been clearly defined by its proponents, but one author defined “alternative medicine” as anything not taught in medical school or covered by insurance.
Accepting this kind of terminology, the Office of Technology Assessment (OTA), in its report to Congress, used “unconventional” to describe ineffective cancer therapies, which until then were considered quackery. The OTA report recommended that the most impressive therapies be reviewed by undefined evaluators to answer the question of whether an unconventional method deserved further research. The report recommended “the active participation, or at least the support, of the unconventional practitioner.” In other words, if one were unqualified, a charlatan or convicted of fraud, one could be recruited to evaluate one’s own fraudulent activity. This concept has persisted in the Office of Alternative Medicine (OAM). With one exception, its Advisory Committee is made up of quackery supporters, and the large majority of its grants have gone to promoters and unqualified researchers.
Another technique used creates a false dichotomy, intentionally apposing two contradictory terms. The word “traditional” usually refers to a society’s pre-scientific medical system. Revisionists use “traditional” to mean modem biomedicine and “non-traditional” as a milder, innocuous term for pre-scientific, ineffective methods. “Nontraditional” evades consideration of treatment effectiveness. Other pseudoscience euphemisms and their pejorative scientific counterpart include: Unorthodox / Orthodox, Unconventional / Conventional, Homeopathic / Allopathic, Holistic / Reductionist, Eastern Medicine / Western Medicine.
There is no dichotomy between “Eastern” and “Western” medicine - the real difference is between pre-scientific traditional methods, of both East and West, and scientific, rational methods. Science is the same in the East and the West. In a recent book on “alternatives,” Lerner explained that physicians cure but do not heal, “Curing is what doctors hope to do. Healing, in contrast, is an inner process through which a person becomes whole.” Most people, however, would not define the two words differently, nor does the dictionary. The result of this redefinition is the perception that “alternatives” really heal. The holistic and alternative literature is full of such redefinitions. The reader is often befuddled, not recognizing the literature makes sense only when one accepts the rewriting of dictionaries. This is excellent propaganda.
In the early twentieth century, social anthropologists developed the concept of analyzing other cultures in a value-free system. Ideally, this omitted observer prejudices, allowing the culture to be seen as a functional whole; permitted a more realistic description of the culture, its mores and its history; and produced a more tolerant political view of one culture or nation by another. Although value-free analysis has value in social anthropology, it can be the wrong tool to use in other fields. A personal anecdote illustrates the point. In the 1970s I studied people who were taking Laetrile, which I knew to be worthless for cancer and a cover business for related stock sales in Canada and the U.S. All 33 patients interviewed felt antagonistic toward their physicians and the “Medical Establishment;” all believed in a conspiracy against Laetrile by the FDA, AMA and pharmaceutical companies; and none sought out information from reputable medical organizations such as universities or the American Cancer Society. All but one continued to take Laetrile until death. The situation seemed to operate like a religious cult, with cognitive dissonance playing a major role. I asked for help in developing the Laetrile cult thesis in a presentation at a sociology seminar, only to be told that sociologists did not concern themselves with the validity of Laetrile, nor the criminal backgrounds of its proponents. They were concerned with interactions of the patients and the system: Did the patients feel satisfied? Did they have trusting relationships with the proponents? Did their chosen “medical system” function to their satisfaction? The sociologists’ “value-free” evaluation ruled out asking: Were the patients involved in a cult-like system? Was it shortening their lives? Were the Laetrile claims fraudulent? The sociologists had no more reason to believe a medical investigator than the proponents of Laetrile.
Sociologists evaluating Laetrile at the annual meeting of the American Association for the Advancement of Science in 1979 perceived taking sides on the issue as prejudicial. Thus, their comments were cloaked in terms such as “critics of Laetrile have asserted...” and “Laetrile advocates counter...” It seemed that if one were to acknowledge Laetrile was part of a swindle, its proponents had been convicted of fraud, and people had died from cyanide poisoning from apricot pits, one was branded as biased.
“If Laetrile is a fraud ... then one can hardly fault an anti-Laetrile bias. But we do not know if proponents are any more fraudulent than ... promoters of many orthodox cancer remedies...” stated one sociologist. Perhaps the sociologist could be forgiven his ignorance of medicine, but given the history of the Laetrile promoters, this “value-free” analysis stretched beyond reason. The footprints of value-free analysis can be seen in many places where the validity of information takes second place to emotion and satisfying philosophies.
Acupuncturists are petitioning the FDA to remove the investigational device classification from acupuncture needles. With drugs, FDA approval requires clear evidence of safety and efficacy. FDA officials have told me that despite reported complications and deaths from acupuncture and numerous studies demonstrating it is effective only as a placebo and that lay acupuncturists are unqualified to diagnose or treat disease, the FDA will probably agree to the acupuncturists’ petition. Validity of information is secondary to the philosophical (and economic) wishes of a significant segment of the population. The over 60 controlled studies of acupuncture on pain alone might as well not have been done.
Educating two generations of students to see scientific and social problems in a content-value-free way has left many professionals unable to distinguish fiction from fact, or to evaluate probabilities of validity.
Deconstructionism takes cross-cultural analysis one step further. Cross-cultural analysis states that science has validity within its point of view, but it is not necessarily more valid than the pseudoscientific view, since each has its own criteria.
Deconstructionism, as I understand it, would state that there is not necessarily any validity at all to the scientific view, which may represent the prejudices of a European male-dominated system. A new generation of students, inculcated with antagonism toward science, will soon be our attorneys and judges, writers and editors, and teachers and legislators. Along with propaganda and value-free analysis, deconstructionism may be responsible for the mistrust of rationality that led otherwise sensible legislators to fund the Office of Alternative Medicine.
“Alternative” medicine proponents reject or misuse most criteria for evaluating validity. Their predecessors, the “holistic” proponents, claim that a view of medicine (health and disease) must include “Mind, spirit and culture” to be complete. Since consciousness effects are not easily measurable, standard measuring and statistical techniques are irrelevant. Alternative proponents redefine biomedicine as not including psychological and social matters, then criticize it for ignoring those matters. This, despite the fact that all medical schools and most practice groups have psychological, social and even religious support personnel. The alternativists also intentionally sequester the one reductionist phase of biomedicine, research, but spin the reader to equate the word “reductionist” with the practice of medicine. The practice of medicine has always been, by its nature, holistic. Alternativists’ definitions of “reductionism” and “holism” render scientific methods as meaningless while elevating holism above analysis. Alternative supporters ignore the evidence against their own methods: Overwhelming evidence shows acupuncture has only placebo effects and homeopathy has no effect; yet proponents of both convinced Congress to fund a special office (OAM) to evaluate them. With one exception, only proponents were appointed to their two advisory boards and only supporters are on their staff.
The OAM plans to spend three million dollars a year to “investigate” the methods. All the research funds have been awarded to “alternative” proponents, most of whom have done no credible research. There is no provision for peer review or publication of the studies. The awards are, in essence, a political payoff to the well-financed forces behind the office’s creation, and will go to the promotion of the methods.
The editor of Alternative Therapies wrote, “While the double-blind methods of evaluation may be applicable to certain alternative therapies, it is inappropriate for the majority of them.... Their action is affected by factors that cannot be specified, quantified, and controlled in double-blind designs. Everything that counts cannot be counted. To subject alternative therapies to sterile, impersonal, double-blind conditions strips them of intrinsic qualities that are part of their power. New forms of evaluation will have to be developed if alternative therapies are to be fairly assessed.”
Ignored is the fact that double-blind, controlled studies are not the only form of scientific evidence. Even single case reports can lead to new discoveries, when properly used. Most cancer therapy trials are not blinded, but are valid because the patients are properly stratified and randomized, and the studies are reproducible in the hands of multiple investigators. While the above author asserts double-blind studies cannot measure “initial conditions” and effects of consciousness, he offers no substitute system for evaluation. So although studies show “alternative therapies” are ineffective, proponents claim there are ineffable qualities current research methods cannot detect or define and, therefore, alternative methods must be accepted, their practitioners licensed, and services paid for by public funds and insurance.
The problem is amplified by the press and its attempt to give balanced and objective reporting. In reality, medical pseudoscience is too often reported by quoting a proponent or satisfied patient at length, then briefly quoting a skeptical physician or scientist, followed by the proponent’s rebuttal. This formula is approved by editors and is apparently taught in journalism schools. “Balanced” reporting is similar to crosscultural analysis in its rejection of scientific facts as bias.
advocates ... have created the most effective challenge to medical orthodoxy
in American history,” wrote Markle and Petersen in 1979, describing Laetrile’s
successes. The holistic movement and its successor, the “alternative” movement,
however, have staged an even broader, all-inclusive attack on reason. Together
they have parlayed propaganda, resentments towards academic science and
philosophical speculations into the most effective assault yet on scientific
biomedicine. Its object is probably the appropriation of political power
now in the hands of scientists and physicians, and its accompanying economic
rewards. The battle will be fought in universities, and the change may
take decades to occur. Meanwhile, the science and medical communities would
be wise to learn from pseudoscience’s success.
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