Book review of:
Suckers: How Alternative Medicine Makes Fools of Us All, by Rose Shapiro. London: Harvill Secker, 2008. 296 pages. £12.99. ISBN: 978-1-846-55028-7/
Political correctness has emasculated our language. We walk on linguistic tiptoes for fear of offending someone. British journalist Rose Shapiro refuses to be cowed. With refreshing directness, she titled her new book Suckers: How Alternative Medicine Makes Fools of Us All. “Sucker” has a double meaning: (1) a gullible, easily deceived person and (2) someone who lives at the expense of others. The growth of alternative medicine depends on both kinds of sucker. And when she says it “makes fools of us all” she is not just talking about the deceived and the deceivers, but about all the rest of us who allow the deceit to go unchallenged, whose tolerance is allowing this blight to spread.
She points out how powerful a change of name can be. Treatments that were labeled quackery or fringe medicine as recently as 1960 are now labeled complementary and alternative medicine and are offered by half the GPs in Britain. With the support of Prince Charles, unproven and even disproven treatments and diagnostic methods are provided at taxpayer expense by the National Health Service. Britain still has several homeopathic hospitals, one of which is patronized by the Queen. (The last American homeopathic hospital closed its doors in 1950.)
Shapiro covers all the major systems of complementary and alternative medicine as well as some less well known remedies and some rare curiosities. She helps us understand why so many people are fooled into thinking ineffective treatments work. She provides insights into history and into human psychology.
She tells us how to spot a quack:
The task of spotting quackery is made easier once you know that there are large areas of medicine in which it is never found. These are the ones that involve outcomes which are easily measurable, or where there is a risk of imminent death. There is no homeopathic contraceptive, for example.
And patients who suffer major trauma or a heart attack don’t go to their acupuncturist. Complementary and Alternative Medicine (CAM) appeals to those who “feel unwell in themselves but are not ‘ill’ in the Western sense.” CAM claims to “balance” things that can’t be measured.
Among the things to look for:
- The Disclaimer: “usually the only truthful statement on the page.”
- The universal diagnosis and/or universal treatment. One size fits all.
- Ancient wisdom that has not changed or learned anything new for centuries.
- Feeling worse is a sign of getting better (it’s just the toxins coming out!).
- A powerful establishment is said to be suppressing the discovery.
- Evidence consists only of anecdotes and testimonials.
- They are flattering and appeal to your vanity.
- It sounds too good to be true.
Watch for buzz words like detoxification (the toxins are always unspecified), quantum, life force, natural, energy, miracle, balance, paradigm shift. “Rejecting ‘the biomedical paradigm’ is so much more impressive than saying you are simply not interested in evidence.”
Where CAM really becomes dangerous is when it claims to cure cancer and other life-threatening illnesses. Effective medicine is being discouraged by practitioners like the one who let a man with liver cancer die in agony by telling him to stop all his medications, even pain relief. She never even met her patient: she diagnosed and treated him by telephone.
One bogus cancer treatment was advertised as being approved by the FDA. The fine print revealed this FDA was the “Fighting Diseases Association” invented by the product’s promoters. Failures are discounted: a woman whose cat died with an alternative cancer treatment explained “I believe in your product, but the patient has to be willing to live.” It seems kitty didn’t try hard enough.
We are starting to see “advanced, untreated cancers with catastrophic symptoms that doctors have not encountered for decades.” Patients are told “whatever you want to do for your cancer is right for you.” Doctors don’t want to appear closed-minded or upset patients, so they won’t come right out and say a useless treatment is useless. They are complicit in quackery when they fail to call it quackery. They are contributing to a fuzzy kind of nonscientific thinking that tends to undermine our whole society’s understanding of science. CAM practitioners claim to heal patients, but “healing” seems to mean sustaining, calming and lifting the spirits with no effect whatsoever on disease outcome.
Some of the advertising ploys are truly laughable. A German company that sells “Hopi” ear candles bought the name Hopi from the tribe. The tribal council recently announced that ear candling “is not and never has been a practice conducted by the Hopi people.” In fact, an ENT specialist told Shapiro that the Hopi are notorious in ENT circles for having a high incidence of ear disease!
In traditional Chinese medicine (TCM), excess Qi was sometimes attributed to having had sexual intercourse with ghosts; this diagnosis is no longer popular. Shapiro speculates that the spirits may be less willing these days. In 1941, a Marxist referred to TCM as the “collected garbage of several thousand years.” Later, it was revived by Mao as a cynical ploy to provide cheap, readily available medical care to the masses, although he personally believed it was ineffective. TCM is again in decline in China (only 20-30% of Chinese use it) just as it is gaining popularity in the West.
Current laws in the UK and in the US fail to protect the consumer. Many alternative methods are poorly regulated or not regulated at all. Diet supplements and herbal remedies are not subject to the same quality controls as medications, and they are frequently contaminated. An Herb Garden store sold a slimming pill to a reporter, telling him it contained rhubarb and honeysuckle; laboratory analysis showed it contained fenfluramine, a dangerous pharmaceutical banned in most countries (it was implicated in the Fen-Phen scandal a few years ago when it was found to cause heart valve disorders).
“The End of Homeopathy” was proclaimed after a conclusive study in 2005, but it refuses to end. A quarter of Europe’s population still uses it and 85% of Belgian GPs prescribe it. Shapiro describes the unscientific “proving” process, where patients write down every symptom like “crashing pots in café area don’t put me off” and “as I get ready for work my nose looks bigger.” One homeopath revealingly reported, “the more I explored the meaning of illness, the more I found patients would tell me their whole story. It was and is surprising how ready people are to reveal themselves. It also surprised me how therapeutic patients found this and how grateful they were.”
Homeopathy researchers make excuses for why controlled experiments fail, and they really don’t care whether the effects are genuine or just elicit the placebo effect. Shapiro says “an exploration of homeopathy starts to resemble wrestling with a giant jelly.” One advocate says, “poetry is very similar to homeopathy because how does a poem work?”
The variety of offerings is unlimited. I learned from her exposé of the Bach flower remedies that the name is pronounced like match, and that some remedies amount to watered-down brandy at £399 per liter. Radium water was sold as “liquid sunshine.” The Gentle Wind Project claimed a decorated credit card sized piece of plastic was a healing instrument. Ineffective magnetic leg wraps are being provided by the NHS. A chiropractor used a bogus electrodiagnostic machine to convince a man he didn’t have AIDS, so the man passed on the virus to his wife and child before he died.
D.D. Palmer was “a red flag in human form” – the epitome of a quack. He invented chiropractic all by himself in 1895 when he supposedly cured Harvey Lillard’s deafness by replacing a subluxed vertebra in his spine. He extrapolated from this one example to conclude that 100% of illness is caused by bones being out of place and interfering with nerves. Shapiro tells Lillard’s daughter’s version of the story, which was quite different from Palmer’s and hinted at a compact to commit fraud. Palmer’s son developed chiropractic into an industry with slogans like, “the world is your cow – but you must do the milking.”
An Australian healer was filmed in a BBC documentary “on the telephone to a six-year-old girl conducting an animated but distinctly one-sided conversation with the girl’s internal organs, addressing them as ‘Captain Pituitary,’ ‘Thelma Thyroid,’ and ‘Larry Liver.’” Why do people fall for such nonsense? The wife of a deceased quackery victim said it all: “You have to walk a mile in a desperate person’s shoes and then you know how people can be so stupid.”
Placebos do not change the outcome of illness, but they may improve the experience of illness. If the goal is to elicit the placebo effect, why not find an ethical and practical way to harness that effect within an evidence-based medical system built on trust and sharing of knowledge?
Shapiro’s book is well-written, entertaining, and full of fascinating tidbits of information about the shadier side of health care. Her style is engaging and humorous:
Laboratory studies have shown that the cyanide in Laetrile can kill cancer cells but then you could also kill cancer cells with a flame thrower or a bottle of bleach.
She includes charming details like a photo of a Chinese doctor’s shop window that proclaimed, “NATURE IS YOUR HARMACY.” (The P had fallen off). She covers the world but provides special insight into the situation in Britain, where, according to the editor of Lancet, scientific medicine is “being eroded by the complicity of doctors who should know better and a prince who seems to know nothing at all.”
This article was originally published in Skeptic magazine.