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A View to the Past

The quackery political map has changed over the last three decades. I recently took a historial look over the landscape at characteristics and forms of quackery that could yield some perspective, and understanding.

Pseudoscience and quackery were identifiable long before we were here. Mesmer was deposed by Franklin and Lavoisier & Co.  Samuel Hahnemann’s homeopathy was recognized as false by contemporaries, and by 1840s Oliver W. Holmes, Sr. had a merry time deriding the entire theory. Despite the ability of good scientists to recognize medical nonsense, much of 19th century medicine practiced was by school of thought or philosophy – sectarian practice. Some of these were homeopathic, herbal, hydropathic (water, baths) osteopathic, medicinal, surgical, empiricist, eclectic and naturopathic. Much of this was indistinguishable from quackery.

In 1911, most institutions of sectarian and ideological approaches were demolished by the Flexner recommendations, resulting in reform of medical schools. Quackery became the separate ideas of individuals – Hoxsey, Ivy, Gerson, Binkley. Some schools like homeopathy and sects like osteopathy and chiropractic continued separate from medicine.

After WW II quackery began to be promoted by political activity. Sects and schools began to lobby for licensure, recognition, and later, insurance payments. In the 1970s-80s sectarianism/quackery became recognized by political groups as vehicles for their political causes. The movement started in right wing causes. Not conservative, but high emotion, radical, scofflaw behavior. People who had to leave the country to do their things. Laetrile became a political symbol for anti-regulation and far right politics. The John Birch Society, then more prominent and radical than it is today, was one of the main support orgs. Most supporters berated regulatory agencies. They bore bumper stickers, “Go to Health, FDA.“

Left met right over the Laetrile conflicts, as both extremes considered Laetrile to be effective and wanted it available. (Laetrile was a science and commercial fraud, its biochemistry and biology made up by its creator, E. Krebs.)

The rhetoric then was near-revolutionary, paranoid, anti-government and anti-regulatory. Laetrile popularity was a product of anti-regulatory rhetoric. Steve Barrtett, Victor Herbert and a few others worked as experts for government agencies and boards against the problem. At that time, the agencies were largely free of both industry and ideological pressures. We exchanged information, we testified in court. There was general agreement regarding what constituted knowledge, good practice and quackery. Most elected officials were on the side of regulation and law enforcement.

Prime consultants were prominent academicians – from whom I learned most of my stuff. Robert Hodges MD of Berkeley and then Irvine, had determined the minimum daily requirement and intake of ascorbate, Tom Jukes PhD of Berkeley, had synthesized amethopterin and aminopterin, the folate inhibitors and first chemotherapy cures of acute lymphocytic leukemia (although the Nobel went to the docs at Farber in Boston who first used it). Robert Stockstad was Chairman of nutrition/biochemistry at Berkeley. All met at Jukes’s home, and formed what became the National Council against Health Fraud in 1976. Where are the academicians and faculty now? Accepting funding from NCCAM, Osher, Bravewell, and selling out for bucks.

I don’t recall any political differences among the scientists and physicians and the regulators, except that we all recognized the anti-science and anti-regulation propaganda of right wing and Birchers. Although we understood their political positions, we did not quite understand the depth of their fears of science and anti-fraud regulation. We considered those self-evident and part of a sane society. Neither did we have much understanding of their personal psychologies, or of the group and social dynamics that caused this first quacky-political movement.

We saw similarities to the episodes described in Extraordinary Popular Delusions and the Madness of Crowds. We were impressed by the scope and suddenness with which the Laetrile thing had developed. I called it a thing because there had never been anything like it to name it after. The economic delusions of the book, the Salem witch trials, the Nazi movement, most old-time quackery seemed different. The difference was that Laetrile had become a social, political, and economic movement besides its medical claims. Books were written. Meetings and rallies were held. An entire belief system surrounded the molecule and the apricot pit. Even the Mafia got involved in manufacture and sale.

Sen. Hatch (R Utah) had just emerged, and there was no other congressional sympathizer or advocate. Most activities were in the states. They were aided by Congr. Richardson (a MD from No. Carolina and a John Bircher,) and the Freedom of Choice in Cancer Therapy organization, all supporters of the Laetrile movement.

By 2000, a major shift had occurred. Although chiropractic seemed to adhere more to right wing principles, and right holdovers Hatch, Burton, and the old-style supplement set persisted, quackery’s advanced guard had become predominantly left-wing. It included the cultural relativism, post-modern wing that fertilizes “Integrative” medicine. The push in California for naturopaths and for loosening practice guidelines for sectarian practices came from the left. The ’90s had brought a surprising and revolutionary change – from the left, and recognizable as the outgrowth of the student rebellions of the 1960s – manifested in 40-50 year olds who bore the same anti-establishment psychologies of their youth. That part of the change was easy enough to see and understand. But what came next surprised and perplexed us, taking us another decade to figure out. It was political attack from the left.

While the anti-government freedom of choicers were easy to figure out – challenging regulation in the name of lying for profit – the force from the left was obscure and largely ideological. Its economic challenge hidden behind a new language that distorted meaning to the point where rationalists could not argue right and wrong any more. Unlike the political right, whose lines in the sand were visible, identifiable, definable and arguable, the new “holistic/alternative attacks changed descriptive language, and beyond that, managed to change the rules of the game without changing the laws.

Instead of attacking the regulatory agencies head on, they infiltrated academia – in fact used the new relativistic politic and post-modern rule bending and language distortion to confuse the traditionalists. So much so that rationalists – scientists, physicians, as well as agency officials had to re-define themselves in order to determine what they stood for. What are we, rationalists? Traditionalists? logical positivists? Obstructionists? Old farts?

In opposition were the PoMos who needed to do no such thing. They operated by stealth, infiltrating education, the press, got elected, taught in law schools, supplying judges and legislators. Thus a whole generation populated the elite of North America, thinking the way postmodernists do, reshaping laws, customs, mores, and language, using them as tools to re-form their surroundings to conform to their own specific outlooks. The mindset elevated neutrality to the highest good, demoted informed opinion to bias, and demeaned rationality to somewhere between learning the alphabet and learning to whistle. Little wonder that objective measurement yielded to “benefits” of placebo, or should be treated as equal to the effective method if it has “meaning” to the patient. or is that client?I glean several principles from this look-back. First, the social forms of pseudoscientific medicine changed in some unpredictable ways. From schools and sects to single ideas and practices, to cults with support groups, specific pseudoscientific ideation, culminating in political movements with press for legitimacy through legislation, courts, licensure, and sales forces for selling opinion to the public, then to assaults on science and medical ethics as tools for advancement.Second, the changing faces and mechanisms represent the opportunistic advances the movements make using defects in the social structure of the time. Analogies abound – epidemics, invasions, cultural terrorism being a few. Adaptable, changeable, surreptitious, audacious. That’s quite an objective to counter.

Posted in: Health Fraud, Medical Academia, Politics and Regulation

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34 thoughts on “A View to the Past

  1. overshoot says:

    Please close your bold tag.

  2. Ain’t it the truth. One might have thought, at some point in the not-too-distant past, that we rationalists could embarrass quackery pushers by calling attention to the sudden love-fest among former arch enemies:

    http://www.sciencebasedmedicine.org/?p=92#comment-2820

    That each side seems oblivious to this exquisite irony can only be explained by some combination of ignorance, arrogance, and cynical greed.

    This essay has moved me to post some related material tomorrow.

  3. David Gorski says:

    That each side seems oblivious to this exquisite irony can only be explained by some combination of ignorance, arrogance, and cynical greed.

    Not necessarily. It could simply be opportunistic in that they see themselves allied on this one issue. I’ve often said that quackery support is truly a bipartisan affair that knows no political boundaries. My suspicion is that the reason support for quackery seems more of a product of the left right now is because the Democrats are currently in power and during the Bush Administration “health freedom” was not the primary anti-scientific medicine force in the Republican Party, which was in power from 2001-2007. In health care, at least, Republicans seemed to focus their ire on stem cell research and “freedom of conscience” laws that in essence allow pharmacists and health care providers to refuse to provide services that the religious right don’t approve of. Now that the Democrats are in power, their woo brigade, which had been in no position to act on their beliefs, see an opportunity.

    These right wing “health freedom” nuts still exist and are still a force, however, particularly in the antivaccine movement. For example, General Stubblebine still runs Health Freedom USA.

  4. Dr Benway says:

    The story of how politically marginalized groups latch on to compelling healthcare narratives to reinforce their message is fascinating. Stories about sickness, healing, and dying, are emotionally gripping. Little wonder they’re used as rhetorical props in political struggles.

    The deeper problem is the need for the rhetorical prop.

    We’ve always known that logic has limited persuasive power, that the convincer is usually some appeal to emotion. I suspect that emotion simply gave faster, more reliable answers to our ancesters than rational problem solving. Most often it’s not what you know but who you know or do not know that will get you killed.

    Decades of marketing research have refined techniques for manipulating this emotional wiring. Much of it boils down to, “What fires together wires together.” Pair a model who looks like someone we’d like to be with a product often enough and we will tend to buy that product. Creating an illusion of consensus is another trick. If individuals believe that “most Americans have tried X within the past year,” they will be more likely to try X. Negation is a favorite strategy of politicians. When you say, “I don’t believe my opponent is a liar,” you’ve also said, “my opponent is a liar.” Just the way the brain works.

    I view NCCAM as Lysenkoism, the triumph of wishing over reality, of politics over science. Science ultimately will win out, but decades may be wasted first.

    Maybe the science-based need a marketing firm.

  5. John Snyder says:

    Another interesting take on this lemming phenomenon is the “hip” factor. Many parents that I encounter who are wooed by woo are what I would consider to be socioeconomically advantaged, educationally priviledged products of upwardly mobile families. But they often have distant histories that include anti-establishment, more left-leaning values, and embrace the cult of CAM in an attempt to convince themselves (and others) that they can still think outside the box – an ironic perspective for a cult follower. Shedding the orthodoxy of “conventional” medicine seems to them to be a relatively easy, risk-free way to feel tied to a value set left behind during their clinmb up the ladder. That their understanding of science is rudimentary at best, and the fact that this “outside-the-box” philosophy has actually become mainstreamed, makes it all the more easy. It’s similar the way in which people jump on to an emerging fashion style because they think it’s hip, but are really falling in line behind the rest of the fray. Unlike the latest fashion craze, however, this new trend has consequences far more dangerous than a retro new look.

  6. David,

    My term “cynical greed” was meant to include, among other things, “opportunistic in that they see themselves allied on this one issue.” It can’t be stressed enough how cynical this is. During the ’60s, the John Birch Society blamed all woes, real or otherwise, on the “international Jewish-Communist Conspiracy.” They would no more have affiliated with the radical Left, or vice versa, than Osama Bin Laden would affiliate with Salman Rushdie or Adolph Hitler with Eli Weisel. Now look at’em: it’s pigs and humans all over again. Orwell lives.

    Dr. B,

    Lysenkoism it is.

  7. Versus says:

    I’ve been waiting for an opening to throw out a question, and Dr. Sampson’s lament about the inability of science to triumph over quackery is that opportunity. Perhaps it’s time for a more forceful intervention. So here’s my question to all you science based medicine advocates (of which I count myself one): The states have the power to regulate health care practices. Thus we could do away with CAM practices through state legislation requiring that all health care practices meet a certain scientific standard. (Or, through federal legislation if the federal government chooses to preempt all state regulation, as it has with drugs.) How would you word such a standard? For example, would you say that all health care practices must have a “plausible basis in science,” “be based on generally accepted scientific principals,” “be based on generally accepted scientific principals of human anatomy, biology, biochemistry, and physiology?” Other suggestions? The standard needs to be high enough to weed out “woo,” as it is often referred to on this site, but not so high that it would eliminate medical therapies over which there is genuine scientific debate, or which have at least a basis in science but not yet evidence of efficacy. The beauty of this is that one is not attacking the quacks directly, merely establishing a standard for health care practice. What will their argument against it be? They will at least have to come out and admit there is not even minimal scientific support for what they do but they want to do it anyway. I raise the question because I am trying to draft just such a statute and drum up support for it in Florida. While I agree with Dr. Sampson that quackery is more a liberal cause now than it formerly was, I think the new administration’s emphasis on putting science back in its rightful place makes now the time to strike.

  8. Dr. Benway wrote:
    “The story of how politically marginalized groups latch on to compelling healthcare narratives to reinforce their message is fascinating.”

    I’m not at all surprised, either. I once had the brother-in-law of a next-door-neighbor try to sell me on the idea that the fact of his cancer survival meant he was right with God, and therefore I should listen to him when he told me that I was going to Hell for putting up Halloween decorations. I mentioned that lots of people in the neighborhood just liked holiday decorations and that the Christmas decor was just around the corner– and he replied, “Oh, they’re going to Hell for that, too.”

    I did not laugh in his face, but only just.

  9. David Gorski says:

    During the ’60s, the John Birch Society blamed all woes, real or otherwise, on the “international Jewish-Communist Conspiracy.” They would no more have affiliated with the radical Left, or vice versa, than Osama Bin Laden would affiliate with Salman Rushdie or Adolph Hitler with Eli Weisel. Now look at’em: it’s pigs and humans all over again.

    Funny you should mention anti-Semitic far right-wingers. I have a longtime interest in Holocaust denial and refuting it on the Internet. Indeed, I cut my teeth on Usenet back in the 1990s on alt.revisionism. One thing I’ve noticed is that there are a fair number of Holocaust deniers who are also into alternative medicine. Ernst Zündel, for instance, comes to mind, as does Dr. Lorraine Day.

  10. James Fox says:

    “One thing I’ve noticed is that there are a fair number of Holocaust deniers who are also into alternative medicine. Ernst Zündel, for instance, comes to mind, as does Dr. Lorraine Day.”

    Special knowledge, special wisdom, special insight, and special medicine. Dissonance across the board.

    ~J

  11. skrashen says:

    In my opinion Laetrile has been rejected prematurely. The case against against Laetrile rests on only two clinical studies. The first actually provides some support for Laetrile but has been inaccurately cited (Krashen, 2009). The second, a major study by the Mayo clinic, is considered definitive, but has lots of problems, including the use of terminal patients, a strong possibility that a much weaker kind of Laetrile was used (a mix of pure and synthetic), the researchers’ ignoring some signs of effectiveness, and an incorrect schedule in administering the Laetrile (I have written a paper on this and have submitted it for publication. I will be happy to send copies – write me at skrashen@yahoo.com).

    Milazzo, Ernst, Lejeune, and Schmidt (2006) is a formal meta-analysis, that is, an attempt to quantity the impact of a treatment in many studies and report an overall effect. The results are simple to state: No studies met the methodological standards set by the researchers, that is, no studies in the literature examining the effect of Laetrile were randomized clinical trials.

    The authors concluded that “The claim that Laetrile has beneficial effects for cancer patients is not supported by data from controlled clinical studies.” This phrasing is unfortunate because it can be interpreted as saying that controlled clinical studies exist and have shown that Laetrile does not have beneficial effects. What the paper really showed was that there is no evidence one way or the other from controlled studies.

    Serious Laetrile supporters do not claim it is a miracle cure-all; they claim that it is helpful and can sometimes provide a complete cure. The professional literature has a number of reports of patients who did well with Laetrile, reports written by professional physicians who report the cases carefully, and are not in the business of selling apricot pits. These cannot be ignored, and there are too many of them to attribute all to fraud, misdiagnoses or spontaneous remission.

    I hope a rational path can be followed with the use of Laetrile, a thorough investigation of its potential as a treatment for and preventative of cancer.

    Krashen, S. 2009. Inaccurate Reporting of the Effects of Laetrile: Mistreatment of Ellison, Byar and Newell (1978) in Professional Papers. The Internet Journal of Alternative Medicine. Volume 6 Number 2.
    http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijam/vol6n2/laetrile.xml

    Krashen, S. Does Laetrile work? Another look at the Mayo Clinic study (Moertel et al., 1982). Submitted for publication.

    Milazzo, S., Ernst, E. Lejeune, S., Schmidt, K. Laetrile treatment for cancer (review).
    The Cochrane Library, 2006: Issue 3.

    Moss, R. 1996. The Cancer Industry. Brooklyn: Equinox Press.

  12. HCN says:

    skrashenon said: “In my opinion Laetrile has been rejected prematurely.”

    Good grief! It is cyanide! What part of that being both dangerous and useless do you have trouble grasping?

    Oh, and in the 1970s there were several animal trials and in vitro tests. They are listed in the references here:
    http://www.cancer.gov/cancertopics/pdq/cam/laetrile/HealthProfessional/page5

    On the next page the two clinical trials are referenced. Did you look at the abstract for them? One says “No substantive benefit was observed in terms of cure, improvement or stabilization of cancer, improvement of symptoms related to cancer, or extension of life span. The hazards of amygdalin therapy were evidenced in several patients by symptoms of cyanide toxicity or by blood cyanide levels approaching the lethal range. Patients exposed to this agent should be instructed about the danger of cyanide poisoning, and their blood cyanide levels should be carefully monitored. Amygdalin (Laetrile) is a toxic drug that is not effective as a cancer treatment.” and the other abstract says “This small study indicates that amygdalin in the doses employed produces few clinical side effects. A definite hazard of cyanide toxic reaction must be assumed, however, and possible long-term side effects remain unknown.”

    Also Support Care Cancer. 2007 Jun;15(6):583-95. Epub 2006 Nov 15.
    Laetrile for cancer: a systematic review of the clinical evidence.
    Milazzo S, Lejeune S, Ernst E. … says “Therefore, the claim that laetrile has beneficial effects for cancer patients is not supported by sound clinical data.”

    You sound like you are trying to become the new Krebs, bringing up bad data and scamming people into poisoning themselves. I am an only an engineer, but I do know that ingesting poison is not a good cure!

    Are you also going to ignore all the case reports usually in Emergency Medicine journals about cyanide poisoning? Oh, like:
    Eur J Emerg Med. 2005 Oct;12(5):257-8.
    Severe cyanide toxicity from ‘vitamin supplements’.

    Ann Pharmacother. 2005 Sep;39(9):1566-9. Epub 2005 Jul 12.
    Life-threatening interaction between complementary medicines: cyanide toxicity following ingestion of amygdalin and vitamin C.

    Ann Emerg Med. 1998 Dec;32(6):742-4.
    Acute cyanide toxicity caused by apricot kernel ingestion.

  13. HCN says:

    Oh, just did a bit of a google, and as a structural engineer I believe I am more qualified and experienced in looking at data (you cannot imagine all the vibration test reports I had to read… erg!). Because this wee website:
    http://www.nontoxic.org.uk/?p=46 notes that Stephen Krashen is a PhD in Education!

    It says “The second, published in January this year, is from the “Internet Journal of Alternative Medicine”. The paper claims that evidence on laetrile is mixed between supportive and unsupportive, and that there is evidence suggesting that “condemnation of laetrile may have been premature”. The author is Stephen D. Krashen, emeritus professor at the University of Southern California’s… School of Education. His expertise is in the field of linguistics and second language acquisition. Not, as one might assume from the paper alone, in medicine or public health.”

    Woo Hoo!… edumacate us on how cyanide is good for us (which is naturally occurring in many seeds to that those will actually remain after the fruit is eaten to produce more plants — by the way, never ever feed apricot branches to hamsters, it is bad for them!).

    My dad is a linguist. He managed to learn three languages very well, and about three others kind of okay. He is very smart when it comes to languages, but not for other things that involved math. I could not explain to him in any way he could understand the logarithmic nature of the earthquake Richter Scale. I fortunately had a mother who was more mathematically gifted, she was the one who explained the different bases to me (Base 8, binary, etc). Well that was the anecdote… now on to some better evidence to my next point:

    I am about to take the Graduate Record Exam before applying to a Masters of Science program in Mechanical Engineering. The very crappy PowerPrep program by ETS has statistics on the score levels by intended majors. The GRE math testing in my view only goes through high school level mathematics (not even calculus!), but the math scores of majors in humanities, social sciences and even business was a rough mean of around 500. The scores for the engineering majors were 700, with the line still going up on the right hand side.

    I would hazard a guess, Dr. Krashen, that your grasp of mathematics and statistics is not strong or rigorous. You might try spending some time taking a few courses in statistical analysis (for the basic courses you only need basic 9th grade algebra) at your local university (my local university has a special program for retired citizens to audit classes at a reduced fee). Take note that the web page I linked to earlier also says: “Krashen’s grasp of statistical methods is as poor as his regard for bias within his sources. Oddly, he begins by stating that statistical analysis was not suitable “because of the selection process used”. He then proceeds to conduct a statistical analysis. Eh?”

    My advice, sir, is to quit while you are ahead. Spend your retirement in other persuits. Perhaps trying this:
    https://www.uclaextension.edu/extn/PLATOSociety.aspx

  14. @ skrashen,

    In addition to the links offered by HCN, we’ve discussed Laetrile at some length here on SBM:

    http://www.sciencebasedmedicine.org/?p=83

    Oh, and it’s been a moving target, as is typical for quack claims. In the ’60s and ’70s, serious Laetrile supporters DID claim it was a miracle cure-all.

  15. skrashen says:

    To HCM: I suggest you read what I wrote, not what you think I wrote or what other people say I wrote.
    And please consider changing your medication.

  16. HCN says:

    Total fail.

    And no, I will not read your stupid internet alternative med. journal paper because the premise is completely idiotic, which is to basically take ingest cyanide! I will not follow any medical advice from a linguist, and that includes my own father. Es verdad. Comprende?

    Especially since you did not respond to Dr. Atwood, nor to Dr. Sampson (who had actual patients die from laetrile, did you read what he wrote? See page 216 of “Trick or Treatment” by Ernst and Singh).

    And by the way my ‘nym is HCN: Hydrogen Carbon Nitrogen Do you know what that is? (other than my initials translated to elements)

  17. HCN says:

    By the way I take a very low dose med for cholesterol (it has something to do with being descended from a culture that ate lots of fish — it is the “N” in my initials, which is has the same roots as the real surname of Nevil Shute). This is not a medication that would make me think ingesting cyanide would be good for a person, nor would it make me forget calculus, differential equations, nor engineering statistics.

    It also would not make me not understand this posting recommended by Dr. Atwood:
    http://www.sciencebasedmedicine.org/?p=83

    If you are taking a medication that makes you think of such silly things like cyanide being better than real medicine, and that you actually understand statistics: STOP!!!

    Do not pass “Go!”, and head directly to your nearest primary medical care doctor for a complete physical and psychological work up. This may actually extend your lifespan (assuming you are presently doing a “Steve McQueen”).

    After that, head to your local library and check out the most excellent book “Trick or Treatment” by Simon Singh and Edzard Ernst.

  18. Joe says:

    I looked at Krashen’s paper “Inaccurate Reporting of the Effects of Laetrile” and the inaccurate reporting is quite clear: If one discards most of the cases that don’t show a good result for laetrile, one finds good results for laetrile.

    That’s right, Krashen starts with 68 reported cases that show no advantage for laetrile, and then discards 46 to give … statistically insignificant results. However, if one discards a further 9 cases, the magic of laetrile is manifest!

    That is so cool: overall, one starts with 68 cases and eliminates 55 that show no benefit from laetrile, and then the stuff works. Why didn’t they teach me this in school?

  19. Wallace Sampson says:

    Notes of thanks and expansion.

    First, thanks to Kim Atwood for his usually thorough and clear notes and following 3/20 entry.
    Notes on comments:
    Dave Gorski: Yes, thanks for pointing out a simple explanation for the right-left shift, which is that politically motivated people can be counted on to grab any issue which they can mold into support for their respective ideation and argument. Facts in the sciences are mostly neutral, or should be, and independent of human biases. The degree of bias freedom is related to the usual hierarchy of the sciences, mathematics at the pinnacle, social sciences at the base. We all do our best at eliminating biases and illuminating the reality. That is, if we still assume there is a reality out there we are trying to describe. I suppose even gravitation and quantum mechanics could be used for political pointing…ooops, they have been.
    Dr. Benway: Yes, to all your points, especially the Lysenko twist. Well, call me a taxi…or a Harkin.
    Dr. Gorski again: Yes, right wing contamination erupts in AIDS conspiracies, defense of certain errant physician practices -defense of hypoglycemia, candidiasis, chelation…but to the neutral observer, the right has been greatly marginalized – the present movement is only part of the general trend to social action, overthrowing convention, utopian conceptions of society and thus a utopian medical system that can cure all, naturally, and by some sort of social will. Similar conceptualization dominates academia, from which most social reformers, social commentators, and officialdom are themselves molded.
    One crucial concept here is that when paradigms do change, also does the individual’s concept of normal and the central area of vision from which one views the rest of society. That which is “embedded in the culture” is the norm, and that determines to a great extent the individual’s concept of one’s place in the norm, and the position held by others and other views. This is the discomfiting concept recognized through social science research, but the twisting of which is taught through medical anthropology, medical sociology, and is used by social engineers and utopianists to expand the definition of medicine, the relevance of science and the boundaries of acceptability.

    Skrashen: The others call for your education. My 1980s Laetrile book was not picked up by a publisher, but among the facts I found: Twenty Laetrile patients compared to matched controls – Laetrile patients had shorter survival (presented at FDA Laetrile hearings, Kansas City MO, 1977), Thirty-three Laetrile patient interviews: most resented medicine, sought multiple implausible methods. Only one lost faith in L. before death – cult behavior.
    Inventor and imaginer E. Krebs Jr. and business brain McNaughton convicted of stock swindles – McNaughton in Canada, Krebs and several others in US Dist Court, SF., all fined, some sentenced to prison.
    Laetrile was thought up by Krebs Jr. without any prior evidence. In other words, he made it up.
    Krebs invented Laetrile as a health care swindle, and as a front for their illegal stock manipulations.
    There are dishonest people out there – small time and big time.
    There are swindlers out there – pickpockets, gamblers, 3-card Monte artists, and there are big time stock swindlers. They were stock swindlers. The Laetrile people were career swindlers.
    Krebs and McNaughton stung dishonest racehorse owners, selling “B15” as a performance enhancer.
    Laetrile’s invented theory was that amygdalin yields cyanide within cancer cells through enzymatic action of beta-glycosidase; normal cells protected by rhodanese turning CN – into thiocyanate. Krebs made that up.
    Human cells contain only traces to no detectable betaglucosidase, which is found in the plants and gut flora. Thus Laetrile tabs and pits relase cyanide in the gut and produce cyanide poisoning, while injected Laetrile does nothing. It could not work. Most patients received intravenous amygdalin. There were lines of IV chairs in Tijuana clinics like the chelation lines today. Dr. Atwood’s explanation tells all.

    John Snyder: Interesting oservation – a cult type groupthink escaping from a larger social groupthink. How human.

    Versus: “Perhaps it’s time for a more forceful intervention. … The states have the power to regulate health care practices. Thus we could do away with CAM practices through state legislation requiring that all health care practices meet a certain scientific standard. … How would you word such a standard? For example, would you say that all health care practices must have a “plausible basis in science,” “be based on generally accepted scientific principals,” “be based on generally accepted scientific principals of human anatomy, biology, biochemistry, and physiology?”
    Regulation is a problem because the regulators are primarily political. One law today and an opposing one next week. The Senate to thank for NCCAM, and states to thank for chiropractic, naturopath and acupuncturist licensure. And who gets to be the regulators and administrators?
    The current system works by informal professional consensus – informed physicians’ practice patterns, insurance coverage, etc. whereas regulation is force of law. An informal system has the advantage of variation, imagination and innovation, multiple concurrent studies, rapid change, and personal freedom to decide and act. Such apparent disorganization is still probably functionally superior to regulation.
    But the idea is of course right on. In fact we have given it a lot of thought and have blogged on it before. It’s hard to devise a scale of plausibility. There is one in preparation.
    I’ll believe the Administration’s “science first” claim when I see 100 new nuclear power plants under construction, natural gas adaptability in government autos, defunding of NCCAM, and a sign of disallowing reimbursement of chiro, acup, in Medicare and the VA. I don’t see it I the current crowd .

    HCN: You did good.

  20. HCN says:

    [blush]Thank you![/blush]

    I am deeply honored, and very humbled.

    (also thanks to Joe for actually reading the paper)

  21. skrashen says:

    Wallace Sampson wrote:

    “My 1980s Laetrile book was not picked up by a publisher, but among the facts I found: Twenty Laetrile patients compared to matched controls – Laetrile patients had shorter survival (presented at FDA Laetrile hearings, Kansas City MO, 1977), Thirty-three Laetrile patient interviews: most resented medicine, sought multiple implausible methods. Only one lost faith in L. before death – cult behavior.”

    This is important information, and I wish you had found (or will find) a way to publish it. Could you somehow post it on this website with all the details? My reviews only conclude that there is a lack of clinical evidence refuting Laetrile.

  22. skrashen says:

    Two of previous posts did not make it to the website. Here they are:

    HCN refuses to read, and Joe didn’t read my paper carefully. Joe, I didn’t “discard cases that don’t show good results,” I discarded cases where evidence was lacking one way or another.
    The laetrile discussion has been clearly been hijacked by extremists and close-minded people on both sides. I was hoping for good critical discussion from this “science-based medicine” website.

    Dr. Atwood wrote:
    ” In the ’60s and ’70s, serious Laetrile supporters DID claim it was a miracle cure-all.”

    Yes, I know that some people claim laetrile is a miracle cure-all, and I am also very aware that many laetrile supporters today have bizarre political views and reject all of modern medicine. But there are those who have looked at the effect of laetrile on patients and have published calm, rational case histories, presenting cases where it has seemed to have had a good effect and cases where it hasn’t, along with interesting discussion, eg Navarro and Morrone. These are case histories, of course, not controlled studies, but they are suggestive. Some of these papers are cited in the two recent Mizzalo et. al. reviews and I will be happy to provide citations.

  23. Joe says:

    Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005476.
    Milazzo S, Ernst E, Lejeune S, Schmidt K.
    “MAIN RESULTS: No RCTs or non-RCTs were found, so no abstraction of outcome data could be performed in this systematic review AUTHORS’ CONCLUSIONS: The claim that Laetrile has beneficial effects for cancer patients is not supported by data from controlled clinical trials. This systematic review has clearly identified the need for randomised or controlled clinical trials assessing the effectiveness of Laetrile or amygdalin for cancer treatment.”

    Support Care Cancer. 2007 Jun;15(6):583-95. Epub 2006 Nov 15.
    Milazzo S, Lejeune S, Ernst E.
    “CONCLUSION: Therefore, the claim that laetrile has beneficial effects for cancer patients is not supported by sound clinical data.”

    Krashen can only be bolstered by the Cochrane review that suggests “need” for laetrile research because such studies are lacking. By the same token, there is no research on use of four-leaf clovers in cancer treatment, or fairy dust, for that matter. Should those be studied?

    No. One does not study a potential therapy just because it has not been studied. Rather, there must be some reason to think it will work, either from pilot studies or basic science. Krashen’s review slighted the 1982 article by Moertel et al in NEJM. That was a clinical, pilot study that found no evidence for efficacy; but clear evidence for toxicity.

    So, there is no clinical reason suggesting that more research is needed. Furthermore, Dr. Sampson outlined the basic science, which does not suggest the need for any research. He also explained the history that shows Krebs invented the notion out of thin air as a money-making scheme.

    Since there is no new evidence of any sort to form the basis for a research proposal, there really is no need for further study. Your “masssaging” of old data does not count (actually, throwing out 82% of the data is more like a clubbing than a massage).

    I suggest going to http://www.quackwatch.org and searching for laetrile.

  24. HCN says:

    I have a life, and really can only spend a limited time online.

    Given a choice of what laetrile literature to read, which author would be a more worthwhile use of my time?:

    1) A retired linguist… or

    2) An oncologist who has personally seen what laetrile does.

    I have also looked at the data and the papers for many years(interest started in the 1970s with a crazy aunt who was going off on laetrile, she also warned me about the illuminati and the tri-lateral commission). Usually I have found the promoters of laetrile on the Usenet are trying to sell the stuff.

    The stuff may work on killing cancer cells in a petri dish, but the problem is that it kills healthy cells in real people too. Sure, bleach kills bacteria in a petri dish — but would you drink it to cure strep throat?

    Cancer research has progressed greatly over the past forty years. Chemotherapy is not as horrible as it used to be (over twenty years ago my father’s cousin died from indirectly from the chemotherapy he had for his stomach cancer — a blood vessel rupture while he was retching). Yes, chemotherapy is used to kill fast growing cells, and the trick is to not kill the patient (and prevent the nausea!).

    That has not been shown for laetrile. Time and time again, the people who took it either died early (Steve McQueen), or started to show signes of cyanide toxicity. Definitely read Dr. Benjamin Wilson’s article on Quackwatch.

    While cancer treatment has advanced, sadly there are cancers that do not respond to treatment (I know of two people who have died from pancreatic cancer in their early 40s). Usually the best treatment is to keep them comfortable and out of pain.

    Taking laetrile is not going to make anyone feel better. Whatever you do, please do not become like Orange Man, written about here:
    http://scienceblogs.com/insolence/2006/08/the_orange_man_1.php

    More information here:
    http://www.cancer.org/docroot/ETO/content/ETO_5_3x_Laetrile.asp

  25. skrashen says:

    Joe wrote:

    ” Krashen’s review slighted the 1982 article by Moertel et al in NEJM. That was a clinical, pilot study that found no evidence for efficacy; but clear evidence for toxicity. ”

    No question that this is the big study. Time magazine in fact did an article on it when it was published, gleefully announcing the end of quackery.

    I have discussed this study in detail in a paper I have submitted for publication. In my initial post I offered to send copies of the paper. Nobody has asked for a copy. I also briefly described what the problems were in this study in that initial post.

    I am aware of the fact that laetrile supporters are hustlers and/or belong to political movements that most us find disgusting, and most have no idea of how research is done. I was put off by this also, and was surprised to find the holes in the establishment research.

    As for all the ad hominem attacks on this listserv, the only one I think is relevant is whether I am trying to make money selling apricot pits. The answer is no.

    The rest are irrelevant. But for the record, I am not a revisionist (observant Jew), not a John Bircher (Green party, voted for Obama). I am guilty of having a PhD in Linguistics. I also have a deep respect for current medicine and medical research, and, of course, the scientific method. But the scientific method has not been correctly applied by critics of Laetrile.

  26. michaelgrayer says:

    “But the scientific method has not been correctly applied by critics of Laetrile.”

    I disagree with this statement.

    On the contrary, the scientific method has been correctly applied, up to the point that medical ethics will allow. Of course, randomised control trials are the gold standard of scientific experiment which will generate the most robust clinical evidence, but because the subjects of experimentation are human, you have to be pretty sure that what you’re doing is ethically sound. Doctors, including clinical researchers, must consider the health of their patients first and foremost and not simply subject them to undue risk in the name of “science”. The extent of the medical evidence that can be gathered is limited, quite rightly, by ethical decency. Thus, before any clinical trial can take place, you have to have a damn good ethical justification for doing so.

    There is a lack of clinical evidence on the efficacy of laetrile simply because the qualitative, historical and biomedical evidence suggests that laetrile is most likely not only ineffective as a cancer treatment but also toxic to the human body. The substance was “discovered” and promoted first of all by a known fraud, as Wallace Sampson explains. The biomedical mechanism by which the treatment is supposed to work is not plausible, as the enzymes are not magically dichotomised between human and cancerous tissue as claimed. Lab evidence shows laetrile not only to attack cancer cells but also human tissue. Qualitatively, many doctors have had first hand experience of patients suffering the toxic effects of laetrile, though have wisely chosen to respect patients’ privacy rather than shout testimonies on the rooftops. It is actually quite remarkable, given all this preliminary evidence stacked up against laetrile, that the Moertel study went ahead.

    In SKrashen’s first comment, he writes:
    “The professional literature has a number of reports of patients who did well with Laetrile, reports written by professional physicians who report the cases carefully, and are not in the business of selling apricot pits. These cannot be ignored, and there are too many of them to attribute all to fraud, misdiagnoses or spontaneous remission.”

    This is another statement that I disagree with – funding for scientific research is finite and should not be distributed purely on the basis of who shouts the loudest, regardless of what it is they’re shouting. As I’m sure we’ve all heard before, the plural of anecdote is not data. Let’s pretend for a second that I happen to be a very charismatic and persuasive, yet devious and unethical person, and I started a rumour that a newly discovered extract of boot polish, called “Polyputheketlon-345″, was an effective treatment for every disease for which there was no known cure. Let’s say I hire a publicist and a good lawyer, start schmoozing a few tabloid journalists, release a conspiracy theory video and after two weeks or so a few thousand concerned and worried people have started a “Pro-poly” campaign group, and a bunch of sycophantic testimonials have started appearing. Is that a good basis for conducting a clinical trial of boot polish extract? We’re in serious trouble if it is.

    I have read your published paper and commented on it already in my blog, as HCN has already noted. I have got a hold of a copy of your other paper from http://www.laetrile.com.au and intend to write a commentary on it in my spare time over the next week or so. Perhaps nobody has asked you directly for your paper because they’ve found it from other sources.

  27. HCN says:

    For one, I do not remember accusing Dr. Krashen of selling apricot pits. I did actually think at first he was trying to sell laetrile, but I realize now he is only looking for an alternative.

    But it is an alternative built on lies and the graves of those who have tried it (as Dr. Sampson knows too well).

    Please, please, please… on the stars and galaxies that cause much wonderment in the skies — look at the real data with an open mind! Read the links I posted, listen to your real oncologists, and please do not get sucked into the fallacies that have killed so many!

    At the present I am reading the book (which I learned about from reading Jon Ronson’s “The Men Who Stare at Goats”) about the corruption and political deaths in Panama between 1968 and 1990 (“In the Time of Tyrants” by Koster and Sanchez). The goons of both Torrijos and Noriega killed many people, including my high school chemistry teacher, Ray Dragseth (I lived in the Canal Zone while I was in high school between 1971-1974).

    They treated life so cheaply… Much like Krebs did when he made up the whole “laetrile cures cancer” stock scam. It literally hurts when I read about one of their victims, please don’t become another form of a victim. Do not look at the data through the filter that rejects the truth!

    Oh, my word this hurts mi corazon! Es verdad!

    Read what Dr. Sampson, Dr. Atwood and Dr. Gorski have written (and that includes the Respectful Insolence blog on Scienceblogs). While they are mostly cancer doctors, they are decent human beings (along with the Australian retired doctor who comments as “pmoran”, whose webpage is http://www.users.on.net/~pmoran/ ) who do not wish ill on any person.

    Please, please, Stephen, do not get sucked into the lie that created the laetrile myth!

  28. Joe says:

    skrashen on 22 Mar 2009 at 5:16 pm wrote “But the scientific method has not been correctly applied by critics of Laetrile.”

    Sorry Professor- that is wishful thinking on your part. Try this, before tackling the original research, read the articles on the subject at http://www.quackwatch.org and tell us how they are wrong.

  29. weing says:

    He must be a cunning linguist to see that the scientific method hasn’t been applied.

  30. Joe says:

    Hey, I’m the master baiter in the comments.

  31. skrashen says:

    I would like to cite some of the comments made here in our lively debate about laetrile. Although these websites are public domain, I will not cite anyone if they ask me not to.
    Please let me know if you do NOT wish to be quoted or cited in my papers or books.
    Stephen Krashen

  32. HCN says:

    I have no problem.

    Also, I am very sorry about the state of your health. If you are still shilling for laetrile tell us where we can send the flowers for your funeral.

Comments are closed.