Dr. Paul Offit on the Sense and Nonsense of Alternative Medicine
Ideally, we recognize things that seem too good to be true, but when it comes to alternative medicine, many people put their faith in testimonials rather than science. Dr. Paul Offit's book Do You Believe in Magic? explains why alternative products and therapies are often neither better nor safer than traditional approaches. His approach is compassionate -- he understands our cravings for guarantees, hope, and sympathy, and sees why people might seek alternative approaches if traditional medicine fails them.
I talked with Dr. Offit about all these topics -- and we also discussed whether or not alternative approaches may have some legitimate benefits.
Shannon: Many folks view the alternative medicine industry as a group of outlaw heroes, who give people safer and cheaper alternatives to the traditional medical industry. Do you think people understand that alternative medicine is itself a highly profitable industry, one which in many instances has lobbied itself into immunity from Food and Drug Administration safety regulations?
Dr. Offit: I think very few people understand that these companies are under no federal obligation to support their claims or admit their harms. I think people assume that when they go into the General Nutrition Center or they buy something from Dr. Mercola, that supplements and vitamins are regulated industries. People assume that when it says 20 milligrams of selenium on the bottle, for example, that there's 20 milligrams of selenium in that tablet and nothing else -- and that's not the case.
Ever since the Dietary Supplement and Health Education Act in 1994 (which, like much in the upside-down world of alternative medicine, means the opposite of what it actually says), those industries can make claims broadly, and they don't have to tell you if the products are found to be quite dangerous. We've been hoodwinked! I think people don't realize that.
All I ask for in this book is that alternative therapies be held to the same standard as conventional therapies. And if scientific studies haven't been done, then we should insist they are done. We just assume that when one says "alternative" or "natural" or "organic" that it's all good and can't possibly hurt us -- and that's not true.
Your book strongly condemns quackery, yet you also allow that there is a place for alternative treatments. Why is that?
The book was originally titled Quacks, but I changed it. As I researched and wrote, I learned there is something to be said for the placebo response. Acupuncture is probably the best example: There are a number of studies that show that it doesn't matter where you insert the needles, and it even doesn't matter whether you insert the needles -- studies with retractable needles show that acupuncture is of value. And so the question becomes "Why?" Why is it that some people who undergo acupuncture clearly benefit? And as you go further, you learn, for example, that people can learn to release their own endorphins, which are these chemical mediators that can relieve pain. So the whole mind-body connection is true! It's like the line that "the mind can make a heaven of hell and a hell of heaven." There's a therapeutic value to some of these non-conventional interactions.
Now, there's a big cautionary tale in this book, in that there are a number of places in which "alternative healers," if you will, cross the line into quackery -- the healer offers something that is presumed to be safe when it's not, or offers an alternative therapy in place of a conventional therapy that clearly does work, or when they take advantage of their patients financially -- which certainly I think in the autism world has been true. And then lastly there's this promotion of magical thinking. But when alternative medicine works, you don't have to look to magic or to the gods to explain why. Dr. Mehmet Oz said on his show recently that there's just some things we can't understand -- I don't think that's true! In the world of science and medicine you can understand it; the issue is you may not understand it yet. But it's not because it's not understandable.
I really appreciated the story the end of the book, in which Dr. Albert Schweitzer was living and treating patients in Gabon, Africa. He respected the local "witch doctor," because the witch doctor was fully aware of which patients he himself could treat -- those who mostly needed reassurance, those whose symptoms would resolve naturally -- and those he should send on to Dr. Schweitzer. It that the kind of line we need to be aware of in contemporary times?
That chapter really represents, to me, coming full circle. I did change my thinking in some ways in this book. I think that conventional healers, if you will, and conventional medicine brought this on themselves. There are many situations, for example, where we take care of diseases that are self-limited. We give cough and cold preparations that don't do anything but make you drowsy, and when you give them to children you can cause night terrors. So you could argue that giving something like a homeopathic remedy -- which will do nothing -- is certainly safe, certainly won't cause any problems. It's not going to make your cold get better any faster, but thinking that it might can help.
I think there's also no such thing as a mood anymore -- everyone has an affective disorder that has to be treated with a pharmaceutical product. And we certainly injudiciously use antibiotics for viral diseases, which are self-limited. So I think in some ways we therapeutize too much with drugs that can be harmful and do have side effects, and that are unnecessary. And in that case, one could argue, alternative therapies are going to be safer.
But then we have so many folks thinking anything natural or alternative is good, and anything associated with "Big Pharma" is bad. How do you think this black-and-white mindset develops? Do you think people want to be told what to do, and have decisions made for them?
I think we want to believe there's something greater than ourselves. And you may be right -- maybe we don't want to think, we want to turn this over to somebody we see as "greater." If you look at the books that really sell well, books written by Deepak Chopra, Mehmet Oz, Andrew Weil -- the position that they all take is one of guru: "I'm going to tell you what to do. I'm not necessarily going to necessarily explain why it's important that this works." They don't say, "Here are the scientific studies that support whether it works." It's like the line "If you want to feed a man for a day, give him a fish; if you want to feed him for a lifetime, teach him how to fish." I think that these books give people fish and don't tell them where they got the fish from -- that's what seems to sell the best.
There was a recent article in the New Yorker on Dr. Mehmet Oz. And what was striking about that article is that Oz is almost a Christ-like figure -- people just want to reach out and touch the hem of his coat. He's seen as this guru-like authority, and that's what people like -- they want to be told what to do by someone wise, who has been standing on top of a mountain for years -- I think that's the draw.
The kinds of books I write are never going to be like that. What I try to do is say, "Okay, how would you think about this? How would you reason through this? What kind of data would support one point of view or another?" I'm trying to engage into thinking about it, and I do it by telling a series of stories.
Your book also warns against practitioners like Rashid Buttar, who sells expensive "cures" for autism via chelation therapy and other proprietary yet non-evidence-based approaches. You relate how these people are able to rein in and hoodwink desperate parents with unproven treatments that can be truly harmful. Can you talk about the dangers of using a treatment like chelation when it's not medically necessary?
Chelation is an important medical therapy for people who have been burdened with too much in the way of heavy metals, specifically lead and mercury. Chelation generally works by binding [the heavy metals] and helping the body excrete them more quickly. But chelation doesn't only bind lead and mercury, it also binds elements like calcium which are important for the conduction of the heart, how one's heart beats.
There have been a number of people reported by the Centers for Disease Control and Prevention who, when they've received chelation therapy, have essentially had heart attacks and died. It's a dangerous therapy, and when children really do have toxicity from lead or mercury, we do use chelation therapy under strictly controlled conditions -- we're monitoring their heart rhythm, and we're monitoring blood electrolytes so we can make sure we're not going to hurt the patient.
I guess what bugs me about people who claim [chelation] cures autism -- and Rashid Buttar is one of those people -- is that if it were the case, you'd think you'd be the first one to test it, to prove that it is what you claim it to be! But that's never the way it works. It's always based on testimonials, and people will likely shy away from studies that will prove that their intentions are ill-founded.
Your book also discusses the dangers of overusing vitamins, and the hugely profitable industry of selling people vitamins they don't actually need. When can vitamins be dangerous to your health?
I'd like to make a distinction between a multivitamin and a megavitamin. Vitamins are not something our body makes, but they're something our body needs, and we need to get them from food. Doctors and nutritionists have determined the necessary amounts of vitamins you need. Given how much vitamin supplementation there is in food, people who have a reasonable diet get everything they need.
Now the biggest surprise for me in writing this book -- and that's why the first couple of chapters are devoted to this topic -- is that megavitamins, meaning those with 150 percent or more of the RDA or Recommended Daily Amount -- can be harmful. I would have never predicted that, but study after study shows it. And I actually stopped taking vitamins after I did all this reading, because I became scared.
If you take excess vitamins A, E, betacarotene, and selenium, you definitely shorten your life, increase your risk of heart disease, and increase your risk of cancer. Because what you're doing is shifting the balance of oxidation and anti-oxidation in your body. Although oxidation certainly creates free radicals that can damage cell membranes, and damage DNA, you need oxidation for certain things like recognizing and killing microbes, and recognizing and killing cancer cells. If you actually blunt your oxidation response, it makes perfect sense that you actually could decrease your ability to kill new cancer cells -- which we probably make all the time and kill in our body all the time. That was the surprise for me.
The other surprise was why people don't know that vitamins are basically an unregulated industry. So I got into the politics of that, and the hearings where basically the industry was able to remove the FDA from regulation, much as the dietary supplement industry has done. People think that this gives them their health care freedom, but all it does is give them freedom from knowing about what they're using.