Articles

Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3

The “Science” and Ethics of “Natural Medicines”

This and the next entry in the current “Naturopathic Medicine” series* deal with the cult’s claim of expertise in “natural medicines” or “natural remedies.” These include herbs (“botanicals”), glandular extracts, vitamins, and minerals. A large fraction of the Textbook of Natural Medicine (TNM), “the most thoroughly researched and carefully referenced text on natural medicine,” is devoted to these agents.[1] They are keys to the practice of naturopathy and to a core claim of “naturopathic physicians” that legislators tend to swallow: that NDs offer something that most MDs do not.

During the deliberations of the Massachusetts Special Commission, NDs produced Dr. Alan Trachtenberg, a fresh-faced ingenue who had briefly been Acting Director of the federal Office of Alternative Medicine, to testify on their behalf. He suggested to the Commission that naturopaths could be the “learned intermediaries” that the public needed to help make sense of the myriad “natural remedies” that became freely available in the wake of the Dietary and Supplement Health and Education Act of 1994 (DSHEA). This is from his written testimony:

Another advantage of state licensure, is that the holder of a professional license who provides or recommends a product, then becomes responsible for the quality and safety of a product. In an unregulated marketplace, such a learned intermediary can be invaluable to the consumer. Since naturopaths do often provide dietary supplements and herbal products directly to their patients, it is vital that they have an enforceable code of professional ethics. Such a code of ethics becomes enforceable with State licensure.

It is also beneficial for the patient to have a practitioner who knows enough about biochemistry, physiology, pharmacology, and physical diagnosis to adequately assess a patient’s clinical response to a product. These products are essentially complicated but unregulated drug mixtures. My understanding is that licensable naturopathic doctors have all taken these courses during their four years of training and passed standardized exams that test their mastery. There is no such quality assurance for the other kind of naturopathic practitioner.

Instead of relying on Dr. Trachtenberg’s “understanding,” let’s submit his two assertions—that of a “code of ethics” and that of “mastery” of the topic of “natural medicines”—to real scrutiny. In doing so I confess that I have plagiarized, to some extent, pieces that I’ve written elsewhere.

The Ethics of “Naturopathic Physicians” Selling Drugs

Shortly before the Special Commission was convened, a “supplements” company called MotherNature.com issued the following press release (emphasis added):

FOR IMMEDIATE RELEASE
Contact: Aliza Schlifkin Sharon Rice
Ruder Finn MotherNature.com
212-583-2732 978-929-2008
schlifkina@ruderfinn.com sharon.rice@mothernature.com

MOTHERNATURE.COM ANNOUNCES STRATEGIC ALLIANCES
WITH TWO HEALTHCARE ORGANIZATIONS

Agreements with Landmark Healthcare and the AANP Offer Marketing of
MotherNature.com Products & Information to Millions of Patients

CONCORD FARMS, MA (January 6, 2000) – MotherNature.com (Nasdaq: MTHR), a leading online information source and e-tailer of vitamins, supplements, minerals, and other natural and healthy living products, today announced partnerships with two leading alternative care health organizations to provide natural health products and information to their members. The agreements with Landmark Healthcare and the American Association of Naturopathic Physicians (AANP) will promote MotherNature.com to millions of patients and healthcare practitioners of the two organizations.

AANP

The American Association of Naturopathic Physicians is the leading organization for Naturopaths, representing about 650 active physicians. A licensed naturopathic physician (N.D.) attends a four-year graduate-level naturopathic medical school and is educated in all of the same basic sciences as an M.D. but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness.

With this new alliance, an AANP doctor can set up a personal dispensary on MotherNature.com and become part of MotherNature.com’s Wellness Advisor Network, an online, interactive forum to improve patient care and extend the relationship between patient and practitioner beyond the office walls. The N.D. can then send a patient to their personal site to learn about and purchase the natural products they find efficacious in treatment.

“It is an excellent added value for our N.D.’s to provide their patients with easy access to a trustworthy source for the broad array of natural health products and information they recommend every day in clinical practice,” added Sheila Quinn, Executive Director of the AANP. “We look forward to growing this partnership with MotherNature.com and finding new and innovative ways to work together.”

About MotherNature.com, Inc.
MotherNature.com, Inc. (Nasdaq: MTHR) established an Internet site in 1995. It is a leading online retailer of a vast array of vitamins, supplements, minerals, and other natural and healthy living products. MotherNature.com is also a leading provider of health information on the Internet, with contributions from a panel of health and medical professionals. The company maintains its corporate office in Concord, MA, a distribution center in Springfield, MA, and a customer support center in Acton, MA.

This profit-seeking arrangement was entirely consistent with the AANP’s “Sales of Medications by Physicians” position paper:

SALE OF MEDICATIONS BY PHYSICIANS

I. The AANP is a strong proponent of Preventive Medicine and considers adequate nutrition to be of primary importance in the maintenance of health and the prevention of disease.

II. There are numerous references in the medical literature that document the existence of subclinical disease and the fact that the chances of anyone consuming a diet that meets the RDA for all nutrients is extremely unlikely.

III. There are numerous citations in the medical literature about the efficacy of homeopathic, botanical and other natural substances as medications to be used in the treatment of disease. It is common knowledge that many of the medications prescribed by Naturopathic Physicians (such as homeopathic and botanical medications as well as certain nutrient supplements) are not available elsewhere.

IV. Certain medications, although available through retailers, exist in these markets as different formulations than the physician determines most effective for his patients. These “optimal formulations” may only be available through companies that sell exclusively to physicians.

V. Certain formulations are classified as “legend drugs” (even through they may be natural origin). These medications may be obtainable via a prescription yet are not readily available through retail pharmacies.

VI. In general, the companies that supply products to physicians are under strict scrutiny by the FDA. This ensures certain standards of quality control. While true for the majority of companies that supply health food stores, certain companies may avoid FDA regulation.

VII. Any selling of medications within a doctor’s office must be based on addressing the needs of the patient. The making of profit is always viewed as a secondary consideration. This is an extension of the code of ethics of the state and national associations governing the conduct of Naturopathic Physicians.

VIII. While the retail selling of medications could be construed as a conflict of interest on the part of the physician; as long as the underlying intention remains the patient’s best interest and not to make profit, and no other source for the formulation and quality of the medication that the physician feels is adequate exists, this remains a legitimate and viable service.

IX. The AANP expects that its members act conscientiously and within accepted codes of ethics concerning these and all professional matters. Any breach of this should be reported to the AANP if writing as identified.

Principal Authors: Martin Milner, ND, Konrad Kail, ND
Adopted at the 1990 Annual Convention.

Regarding the AANP and MotherNature.com, here was the deal:

1. Can I keep my in-office dispensary and benefit from MotherNature.com’s Wellness Advisor Network? Yes. You can maintain business as usual, using the Wellness Advisor Network to order professional line products at wholesale for your dispensary.

5. How does the AANP benefit when I join the Wellness Advisor Network? The AANP receives 1% of all the retail transactions made by your patients through your Web site. By integrating the Wellness Advisor Network into your practice, you generate revenues that will help maintain and build our organization.

6. What is the benefit to AANP members? The AANP has negotiated a 24% referral fee structure for our members – 4% more than the 20% received by other providers. The referral fee is paid on the retail sales from your patients through your website.

That pact was not surprising for organized “naturopathic medicine.” Consider the means by which it achieved licensure in Utah in 1996, as reported by the National Council Against Health Fraud (NCAHF):

HEALTH FOODS INDUSTRY GROUP GETS
NATUROPATHIC PRACTICE ACT IN UTAH

The sweetheart relationship between naturopaths and the health food industry became more transparent with the passage of a naturopathic licensure act in Utah. Health Forum, the lobbying organization that pulled off the action, was led by Rae Howard, President of the National Nutritional Foods Association (NNFA), and President of Good Earth Natural Foods at Orem, Utah. In NNFA Today (5/96, p.9) Howard boasts that: “every state legislator received a visit by representatives from Health Forum and other constituents. Grassroots meetings and training sessions were held throughout the state beginning last September, to explain the bill to consumers, train them in the political process and organize support.”

Such boosting has continued. Here is a partial list of Corporate Sponsors of the recently successful ND licensing effort in California:

CANP is the California Association of Naturopathic Physicians. California ANP Sponsors are generously helping in the licensing effort in California.

California Association of Naturopathic Physicians 2002-2003 Natural Partners Program

The CANP wishes to thank the following companies for their generous financial support in 2002-2003:

CANP Corporate Leader

  • Metagenics

CANP Corporate Partner

  • American Specialty Health Plans

CANP Corporate Donor

  • Thorne

CANP Corporate Sponsor

  • Biogenesis
  • Capsugel
  • Douglas Labs
  • Integrative Therapeutics Incorporated
  • New Hope Natural Media
  • Pure Encapsulations
  • Specturm Organic
  • Whole Foods Market

The AANP itself touts its sponsorship by a host of “supplement” companies, dubious “laboratories,” and other companies making a buck off of organized quackery.

The naturopathic “medical schools,” which one might expect to be pristine, are not immune to the same temptation. This item appeared in the 1995 summer edition of the NCAHF news:

HEALTH FOODS INDUSTRY INFLUENCES
NATUROPATHIC EDUCATION

Bastyr University, a naturopathic college in Seattle, has added several board members who are associated with the natural products industry. Included are Past President of the National Nutritional Foods Association Martie Whittekin, Sandy Gooch, founder of Mrs. Gooch’s Natural Foods Markets, Michael Murray, ND, Director of Research and Product Development at Enzymatic Therapy, and Jerry Schlesser, ND,DC, President and CEO of IsoChem Corporation. [Natural Health Advocate Winter, 1995 (a publication of Bastyr University as "an update for the natural products industry.")]
Comment: The symbiotic relationship between naturopathic education and the health food industry (natural foods, herbal remedies, dietary supplements, and homeopathic remedies) is scandalous. If drug companies were wielding comparable influence on a medical school there would be a national outcry. It makes naturopathic education appear to be a conspiracy between the health food industry and pseudomedicine.

No kidding. In 1988 Bastyr had been the happy recipient of $20,000 worth of money and equipment from American Biologics, the major Laetrile pusher. That was at a time when Bastyr was poor and $20,000 was real money.

And finally:

ENZYMATIC THERAPY, INC.

Ira Milner, RD, reports (Nutrition Forum, Nov-Dec, 1990) on his experience of attending a New Jersey seminar along with “more than 100 retailers and a few chiropractors” put on by Enzymatic Therapy, Inc. of Green Bay, Wisconsin. Before the program began, participants were asked to sign a “guarantee” that they were not agents of the FDA, Better Business Bureau, or any other consumer protection agency; and, that they would not tape the seminar for use against the company by any government agency. The seminar lasted from 9 am to 6 pm, and featured company president Terence J. Lemerond, ND, BS, CNC, Kenneth R. Daub, DC, and Michael T. Murray, ND, who practices naturopathy in Bellevue, Washington and teaches “therapeutic nutrition” at John Bastyr College, a naturopathic school in Seattle. Milner details how these promoters work to circumvent the law in the promotion of unapproved drugs disguised as nutritional products. Milner says, “rather than seek FDA approval, Lemerond and his associates have been using subterfuge to ‘distance’ illegal claims from their product labels. The fact that this effort has prospered is not the result of its cleverness but of FDA sluggishness. As should be obvious from this report, evidence of wrongdoing is not difficult to obtain.”

Does Michael T. Murray sound familiar? He’s the co-author/co-editor of the Textbook of Natural Medicine and a member of the Board of Regents of Bastyr University, the most conspicuous of naturopathic “medical schools.” Murray continues to capitalize on his apparent academic stature by shilling for such enterprises as “Natural Factors,” a purveyor of herbs and vitamins, and “BodyBalance,” a company that hawks dubious laboratory tests directly to unwary consumers.

So much for a “code of ethics.”

Next week: the “mastery” of the topic.

…………

*The Naturopathy Series:

  1. “CAL”: a Medico-Legal Parable
  2. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1
  3. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2
  4. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3
  5. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 4
  6. Colorado is Nearer to Promoting Naturopathic Pseudomedicine—Aided by the Colorado Medical Society
  7. Naturopathy and Liberal Politics: Strange Bedfellows
  8. Open Letter to Dr. Josephine Briggs
  9. Smallpox and Pseudomedicine

 

 

Posted in: Health Fraud, Herbs & Supplements, Medical Ethics, Politics and Regulation

Leave a Comment (77) ↓

77 thoughts on “Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3

  1. vinny says:

    Although I agree that the statement made by Alan Trachtenberg was disingenuous, naturopaths are not the only distributors of worthless vitamins. I often see these supplements being displayed prominently in physician’s offices. In my hospital’s cancer center they proudly offer acupuncture for pain control to patients. Although “alternative medicine” are probably the loudest promoters of quack therapies, those of us with medical degrees are also guilty of misinforming the public. Actually a considerable driving force for the legitimizing naturopathy in California, Washington, and most recently Minnessotta was the support naturopaths received and flaunted from the MD’s in those states. Although in this forum we are putting up a fight against these outside charlatans, the medical community must do a better job of informing our own colleagues about their irresponsible and naive behavior.

  2. vinny says:

    I was just reading some of the warning letters FDA sends out to vitamin supplement manufacturers. Essentially they inform them that promoting their product as a potential treatment for cancer is illegal. I wonder if there is a mechanism by which we could inform our colleagues who display and sell such remedies at their office, that these activities may bring their medical license under review. Furthermore, in states where naturopathy has achieved a regulated licensure, this could be used to force alternatives to medicine to issue disclaimers about their offered services.

  3. Hermano says:

    Thank you so much!
    I’ve been really looking forward to this installment.

    Naturopathic organizations seek and accept donations to promote their goals, some naturopaths work for supplement companies.
    Sounds like everyday grind, I would expect something more dramatic from a ‘pseudo-scientific cult’.
    Otherwise, it’s just an industry having a cozy relationship with practitioners who utilize its products. Not an ideal situation, but business as usual until something changes, f.e. increased public scrutiny, legislation, etc…
    Here is, tu quoque or not, a nice article “Doctors’ Ties to Drug Makers Are Put on Close View” http://www.nytimes.com/2007/03/21/us/21drug.html. This information is courtesy of the Minnesota law requiring that drug companies report their payments to doctors, I hope it will equally apply to the NDs registered in Minnesota and the supplement companies.

  4. Hermano says:

    The dollar amount has to increase to make alleged wrongdoings more interesting on the ND side, from both the public and the law enforcement points of view.
    $20,000 from a Laetrile “pusher” does not command as much interest as this story about the pre-1960 AMA and its major sources of revenue, the tobacco industry http://www.alternet.org/healthwellness/81659.
    Perhaps one day we will hear about Bastyr investigating its researchers for not reporting millions of dollars in payments from supplement companies, as Harvard recently did vis-à-vis Biederman and friends http://www.nytimes.com/2008/06/08/us/08conflict.html.

  5. vinny says:

    Hermano, you seem to take delight in pointing out that there is a monetary relationship between various doctors and pharmaceutical companies. This relationship cannot be denied as pharmaceuticals are our main tool for treating illness. Similarly one cannot deny a financial relationship between naturopaths and various vitamin and supplement manufacturers. The difference is that one group offers a treatment supported by rigorous scientific studies, and the other group offers confused views based largely on religious consepts: vital force, bio-energy, potentiation of subtances by dillution, bizarre theories of allergies, and unsupported vitamin claims. I do want to commend you on your writing ability and perhaps this means that you have the ability to improve your flawed knowledge base; in other words, if you can learn to write, maybe you can learn something else as well.

  6. Hermano says:

    Bravo, Vinny!
    Your bombastic style is just what this thread needs.
    What kind of benefits have you been receiving from the
    drug industry?
    It sounds like you guys are pretty close.

  7. There is a large body of evidence showing that many of us have gotten very great benefits from approved drugs. They have saved some of us from early deaths and enabled others of us to live useful lives with chronic diseases.

    There is no objective, much less scientific, evidence that any of the “drugs” and “therapies” used and sold by naturopaths has every benefited anyone other than those who have benefited financially from the sale of such products.

    That being said relationships between any health care provider and any third party that that offer an incentive to take advantage of patients should be at the very least disclosed and in many cases exposed and prevented.

    However, I will repeat again that I believe that the sale of drugs or remedies by health care providers to patients they treat should be illegal. Not only does it tempt greedy practitioners to over prescribe it also violates the trust that I hope exists between practitioners and their patients and takes advantage of sick people at a time when they are most vulnerable.

  8. weing says:

    Hermano,
    What kind of benefits have you been receiving from the naturopathic industry? It sounds like you guys are pretty close.

  9. oderb says:

    vinny and others.

    Your world is a manchiean one; where pharmaceuticals are safe and effective – Vioxx and a dozen other drugs that were the subject of ‘rigorous scientific studies’ just so happened to have killed tens of thousands..whoops and yet vitamins have “no objective scientific evidence to support them”. What blindness.

    Simply review the vitamin study abstracts at
    http://www.vitasearch.com/CP/weeklyupdates/
    and look at the dozens of studies reported WEEKLY- most of which show benefit. The most recent weekly summary has studies done by such fringe entities as Johns Hopkins and M.D. Anderson, so I guess they can be easily dismissed as pseudo science.

    N.D.’s and other open minded doctors actually read these studies. They choose not to rely solely on the NEJM.

  10. vinny says:

    Hermano, there are several illnesses which have resulted from vitamin deficiencies, scurvy is probably most famous and was caused by lack of vit c on long ocean voyages. When someone has an extraordinarily lousy diet, he might develop vit b12 deficiency. If you just drink vodka without eating anything you might develop vit b1 deficiency. I challenge you to show me any benefit to any man eating a normal diet, that resulted from taking vitamin supplements.

  11. vinny says:

    oderb, I looked at your dumb page link “brought to you by quack-naturals makers of dishonest-q.” Please do not make any further referrals to vitamin commercials.

  12. Hermano says:

    weing,
    What naturopathic industry?
    I thought naturopathy was a pseudo-scientific cult.
    A friendly cult sounds much more congenial than a mercenary corporation, e.g. Apple vs Microsoft.
    I might have something here,
    Naturopathic Medicine, the Apple of Health Care.
    Think Differently, Think Naturopathic.

  13. Hermano says:

    oderb,
    Thank you for the link.
    It is edifying to know that the leading medical school, including Johns Hopkins and UC Davis are conducting research into the efficacy of nutritional supplements and vitamins.

  14. weing says:

    Hermano and oderb,
    Research on vitamins and nutritional supplements is nothing new. Vitamins supplements mainly benefit to naturopathic supplement industry. And it looks like you guys are shills for that industry. If you follow a balanced diet, you don’t need any supplements unless you have an underlying illness that affects absorption. Thankfully, most of the vitamins are benign and you end up having expensive urine and thinner wallet, but if you overdose on some of them, they are not so benign. You guys remind me of the little kid who discovers a novel use for his penis and then tries to inform the adults of his great discovery.

  15. oderb says:

    weing and vinny,

    Your comments sadly simply confirm my initial post. Neither of you would care to actually read the abstracts and debate the science behind them. Instead one of you concludes that the site is worthless because it’s sponsored by a vitamin company and the other asserts without any evidence that vitamins are unnecessary unless one cannot absorb food properly.

    It really is a tragedy that your views are held by most who determine medical orthodoxy. I naively thought this site was about science based medicine. Apparently it only is when the research topic or paradigm accords with the bias that only synthetic drugs can advance human health.

    Just one example of many of the studies showing substantial if not unheard of benefits of vitamins is the following: (and yes heavens it’s an article about the study rather than the study itself so in your eyes that might invalidate even reading the article!)

    http://www.msnbc.msn.com/id/19098606/

    I guess reducing cancer cases in women by as much as 75% in just several years simply cannot be true, as vitamins – by definition – are worthless unless obtained by food, and no further trials, with larger or different populations should be undertaken. Am I correct that that is your position?

  16. weing says:

    oderb,
    Didn’t I say a balanced diet? Again, it’s been known for some time that sunlight, while increasing melanomas and other skin cancers, does decrease the incidence of other malignancies. That Vitamin D is playing a role is not surprising. Does it mean you have to take supplements? Why not eat salmon and other fish that have high content of Vitamin D? If you want, cod liver oil is great. How fondly I remember those teaspoons in childhood.

  17. weing says:

    BTW, While rickets is rare in children in the US, the adult american does tend to be deficient in vitamin D. I’m pretty certain the food industry will take care of this deficiency like they took care of beriberi.

  18. Harriet Hall says:

    oderb,

    Medical science never goes by the results of one study. We have to look at all the published research and consider the quality of the evidence and whether it is compatible with other things we know about science. Groups of unbiased doctors and scientists have evaluated all the evidence for vitamin supplements and they do NOT recommend them for the general population of people who eat a nutritious diet. There are specific indications for certain vitamins in certain groups of people.

    Vitamin D is recommended for those who are not getting enough from sunshine and fortified foods, especially the elderly. It may eventually be recommended for everyone, but not until we have more conclusive evidence.

    The Medical Letter’s recent review of vitamin supplements concluded, “Supplements are necessary to
    assure adequate intake of folic acid in young women
    and possibly of vitamins D and B12 in the elderly.
    There is no convincing evidence that taking supplements
    of vitamin C prevents any disease except scurvy. Women
    should not take vitamin A supplements during pregnancy
    or after menopause. No one should take highdose
    beta carotene supplements. A balanced diet
    rich in fruits and vegetables may be safer than taking
    vitamin supplements. No biologically active substance
    taken for a long term can be assumed to be
    free of risk.”

  19. oderb says:

    I don’t disagree that science should not rely on one study of anything.

    I was critiquing the comments of an earlier poster Weing that a balanced diet makes supplements never advisable, and used the Vitamin D study as one example ( even the Medical Letter refers to the possible benefits of D supplementation), suggesting that additional studies should be undertaken asap, given the potential magnitude of benefit and limited toxicity of Vitamin D at relatively low doses.

    I would disagree with your implied conclusion however that the scientific community or indeed the general public should rely on any one set of recommendations as to whether a particular substance should be supplemented. However sterling the reputation of the Medical Letter may be it is and cannot by definition be a definitive final word, particular on a subject like vitamins, where as far as I can see the advisory board has no one as a member with an intimate knowledge of vitamins as opposed to drugs.

    Given the hostility towards vitamins in the mainstream medical community I would be surprised if the Medical Letter were able to remain consciously or unconsciously unbiased on this issue.

    That isn’t to say that they are wrong in the statement you quote (though I believe they are), simply that multiple sources of recommendations from reputable sources should be considered by health care providers, including one’s own clinical experience using the substances being evaluated.

    I would also say that when the toxicity of a substance is minimal or non existent, and some evidence exists for its efficacy it should be seriously considered, particularly if the supposed benefits are life saving or otherwise substantial.

    I use as an example a RCT published in a reputable journal (Annals of Surgery 2002) that showed that the administration of Vitamin C and E in an ICU unit reduced multiple organ failure by 57%, mortality by 44% and length of stay by 17%.

    http://findarticles.com/p/articles/mi_m0ISW/is_2003_April/ai_99164827

    Is there any reason to wait for such a study to be replicated when thousands of lives could be saved by administering substances with no known toxicity at these levels?? Or if the consensus of the scientific and medical community is that further study should be done, isn’t it the moral obligation of the medical community to organize such a study asap, so that a positive result would lead to the routine administration of C and E in ICU wards, thus reducing morbidity and mortality for thousands of people, while saving hospitals millions of dollars.

    Do you seriously believe that if a drug were shown to have a similarly spectacular impact, it wouldn’t be sped to approval immediately and the results trumpeted to every doctor and hospital. But because vitamins are believed to be worthless at high doses, and no monopoly profits can be made off them, this study appears to remain an obscure curiosity despite its publication in a reputable journal.

    It is this bias which I find morally offensive. I hope I am wrong and that further studies have been done to confirm or refute the one referenced above. If they have not, and these vitamins are not being used, I can only label the result large scale medical malpractice.

  20. Harriet Hall says:

    oderb said,

    “I was critiquing the comments of an earlier poster Weing that a balanced diet makes supplements never advisable.”
    That’s not what he said. They are “sometimes” advisable for specific patients. There is just no good evidence that they are advisable for the general population.

    “additional studies should be undertaken” [on vitamin D].
    Yes, and such studies have been undertaken and are ongoing. This is a subject of great interest to researchers today.

    “I would disagree with your implied conclusion however that the scientific community or indeed the general public should rely on any one set of recommendations.”
    I certainly didn’t intend to imply any such thing. My point was that various reviews of the evidence (not just the Medical Letter’s) have agreed that there is no good evidence on which to base a blanket recommendation for vitamin supplements for all.

    “cannot by definition be a definitive final word”
    Well of course not! Nothing in science is ever the definitive final word.

    “the advisory board has no one as a member with an intimate knowledge of vitamins as opposed to drugs.”
    I don’t know what you mean by “an intimate knowledge.” These people are all scientists and clinicians who are well aware of the importance of vitamins to human physiology, and who are capable of following the evidence wherever it leads.

    “Given the hostility towards vitamins in the mainstream medical community I would be surprised if the Medical Letter were able to remain consciously or unconsciously unbiased on this issue.”
    I don’t think there is any hostility towards vitamins in the medical community, although there is disapproval of premature treatment recommendations based on preliminary or poor quality evidence. If there is any bias amongst Medical Letter consultants, it is a bias in favor of rigorous science.

    “multiple sources of recommendations from reputable sources should be considered by health care providers, including one’s own clinical experience using the substances being evaluated.”
    Now here I must disagree with you. We have learned how unreliable one’s own clinical experience can be: that’s why we need good science.

    The study you cite is of trauma patients in the ICU. It may justify using vitamins in that particular setting, but it is irrelevant to the question of supplementation in the general population. And every vitamin is toxic in large amounts. More and more studies are showing that adding supplemental antioxidant vitamins either makes no difference in outcome or makes the outcome worse for various conditions such as preventing heart attacks. We DON’T know that supplemental vitamins are safe.

    “vitamins are believed to be worthless at high doses”
    No, it’s not a matter of belief. It’s just that there is no good evidence that high doses (or any doses) of vitamins are beneficial to the general population. And there is evidence that high doses of some vitamins are harmful (beta carotene, for instance).

    “no monopoly profits can be made off them.”
    That’s not an issue. There is no monopoly on aspirin or exercise, and doctors recommend both for heart attack prevention.

    This boils down to a philosophical stance where some people are cautious and are unwilling to recommend a treatment without good evidence, and others rush in to use everything that seems reasonable and “might” be helpful. We can’t agree on risk-taking philosophy, but we ought to be able to agree on the state of the evidence.

  21. weing says:

    oderb,
    You are straw manning. Where do you get that physicians are anti-vitamin? We use vitamins in therapy whenever they are needed. Do not compare someone who is going about his daily life eating a healthy balanced diet to someone in a hypercatabolic state in an SICU. Not being a surgeon, I cannot tell you what the current practice is. Many moons ago, when I was still a resident writing hyperalimentation orders, vitamins were part of the regimen. That is totally different from selling vitamins to people who do not need them. BTW, when patients don’t listen to me and do not eat well, I tell them to use supplements.

  22. Hermano says:

    oderb,

    You might find it refreshing to learn the views of Dr. Nortin Hadler, professor of medicine at the UNC.
    He is critical of the supplement industry’s claims: “enormous North American vitamin scam.”
    http://www.nytimes.com/2008/06/24/health/24book.html,
    AND the profiteering on a huge scale by the drug companies
    promoting new drugs without real benefits and medical specialists pushing unnecessary medical procedures of all sorts:
    “I am unwilling to prescribe a drug that has no important benefits over the old standbys and has no long-term track record for safety.
    I spend much more time explaining my philosophy to my patients than the seconds required to fill out the prescription, or to give a sample. By the way, neither drug company sales people (detail representatives) nor drug samples are allowed in my clinic — and never have been allowed. I’ll take the time to explain my philosophy or stop practicing medicine.
    However, I am a “senior” clinician; if my students, and there are many out there, practiced the way I taught them, they’d starve. There is something horribly rotten in the United States, not in Denmark. ” http://mqup.typepad.com/mcgill_queens_university_/nortin_m_hadler_the_last_well_person/index.html

    Hadler is very critical of unnecessary surgeries performed in the millions:
    “I think bypass surgery belongs in the medical archives. There are only two reasons you’d ever want to do it: one, to save lives, the other to improve symptoms. But there’s only one subset of the population that’s been proved to derive a meaningful benefit from the surgery, and that’s people with a critical defect of the left main coronary artery who also have angina. If you take 100 60-year-old men with angina, only 3 of them will have that defect, and there’s no way to know without a coronary arteriogram. So you give that test to 100 people to find 3 solid candidates—but that procedure is not without complications. Chances are you’re going to do harm to at least one in that sample of 100. So you have to say, “I’m going to do this procedure with a 1 percent risk of catastrophe to find the 3 percent I know I can help a little.” That’s a very interesting trade-off.”
    “If the data are not prompting so much interventional cardiology, what is?

    H: Money. Interventional cardiology is what supports almost every hospital in America—it’s an enormous part of our gross domestic product. Every year in this country we do about half a million bypass grafts and 650,000 coronary angioplasties, with the mean cost of the procedures ranging from $28,000 to $60,000. There are a lot of people involved in this transfer of wealth. But no Western European nation has such a high rate of those procedures—and their longevity is higher than ours.
    http://discovermagazine.com/2005/jun/discover-dialogue/.”
    Considering his condemnation of these surgical procedures, perhaps chelation is a safer, more effective alternative for treating angina. Probably not.

    There is no way conventional medicine will give up its cash cows.
    I don’t know if Hadler has a prescription for fixing its sorry state.

    Naturopathic medicine would best not emulate the conventional health care system’s rotten example.
    I hope NDs embrace statistical analysis and experimental design methods, as Hadler recommends, to discover which practices are truly effective and practice a kind of “slow medicine”.

    And the question remains, how would naturopathic doctors manage financially without having to rely on selling supplements to make a living?

  23. Hermano, I think almost everyone reading this advocates the use of medicine which is based on strong scientific evidence of safety and efficacy. They are also trying very hard to expose the use of drugs and therapies that have insufficient scientific evidence to support their use and to stop the use of those which are not based on solid scientific use. I for one hold everyone to the same standards and suspect that that is true of almost everyone else here.

    The link you gave to the NYTs is inactive so I did not read what Hadler reportedly said. But you appear to be saying that you hope naturopaths objectively evaluate the drugs and therapies they use and only use those that good evidence shows work. If that is what you mean, Amen Hermano. I agree. But I’ll go another step. I hope that naturopahts stop using each and every one of their drugs and therapies for which they do not have solid, scientific evidence of safety and efficacy and I further hope that governments make it illegal for practitioners to sell patients the products that they prescribe. I for one would never trust a doctor who sold drugs or remedies and hope that most consumers would feel the same way and recognize the huge conflict of interest and the very real possibility of abuse inherent in such a practice.

  24. Michelle B says:

    The Orthomolecular approach of individualizing nutritional intake via supplements is a joke. The practitioners have no expertise and no paradigm that is measurable, testable, and applicable. They are mostly full of hot air.

    However, science-based medicine, with its recent advances in metabolomics, is on the right road to any real achievements in personalized medicine.

    It is not enough to realize a problem (treatment is not particular enough for each one of us), one must have an method to pull off a solution.

    One other possible use for vitamin megadosing (and I have not kept up on this research, so it possible that some aspects have been updated), is trying to jump start partially defective enzyme systems (as minerals and vitamins are just co-enzymes).

  25. AntiVax says:

    “The practitioners have no expertise and no paradigm that is measurable, testable, and applicable. They are mostly full of hot air. ”

    The only hot air is Pharma med. There are 1,200 medical citations showing Vitamin C is a cure for most infections, some 58 years old for measles http://whale.to/m/klenner.html. All collated by Dr Levy MD in his book http://whale.to/a/levy_h.html

    So just that information completely busts the lie that Allopathy is science based medicine, it isn’t, it is money based medicine mostly. And that info would also bust the vaccination racket as it would cure all infections like measles, meningitis, hepatitis and polio making it unecessary, and also eliminate the huge amount of vaccine injury, now $1 Billion paid out in the USA which is only a fraction of the true amount.

    “Amazingly, vitamin C has actually already been documented in the medical literature to have readily and consistently cured both acute polio and acute hepatitis, two viral diseases still considered by modern medicine to be incurable.” – Thomas E. Levy, MD, JD

  26. AntiVax says:

    As to naturopathy being a cult, see yourself in others. Herbal naturopathy is ten times better than Allopathy, and then some http://whale.to/c/shulze.html

    “80% of my patients were well just after doing my thorough bowel cleansing program.”–Richard Shulze, ND., MH

  27. Hermano says:

    rjstan,
    Here again is the link to the recent Hadler book review
    http://www.nytimes.com/2008/06/24/health/24book.html
    My earlier comment had a comma immediately after this link which broke it.
    And here is ‘Weighing the Costs of a CT Scan’s Look Inside the Heart’, currently one of the most popular articles at the NYT
    http://www.nytimes.com/2008/06/29/business/29scan.html .
    It is from a series titled “The Evidence Gap” about
    “medical treatments used despite scant proof they work”.
    From the article
    “Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care.
    No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments.”
    Read it and weep.
    Naturopathic doctors are not who perpetrate this trillion dollar scam on the American public.
    Nice work deflecting attention to naturopaths and their “evil” supplements.

  28. Fifi says:

    Hermano – This blog regularly critiques medicine and medical organizations, particularly non-evidence based practices but it also quite often discusses EBM and research and how to improve them. Apparently YOU’RE the one trying to deflect valid criticisms of naturopaths, the supplement industry and the financial by pretending no critique of medicine or medical organizations takes place on this blog. Of course, you completely ignore that taking supplements are entirely unnatural and synthesized, as are most herbal remedies (a tincture or homeopathic pill are hardly a substance in its natural form, not that something being “natural” ensures that it is healthy or safe to consume to begin with). It appears your anti-medicine agenda is showing.

  29. Michelle B says:

    Antivax, metabolomics is not hot air.

    For me, there is only good or bad medicine. I have taken drugs that have helped, I have been prescribed physical therapy, nutrition supplements (iron in particular for my particular condition), exercise, and diet which also helped.

    Pharma med is what exactly? If you don’t take the drugs they kill you on the spot?

    I don’t take the prescription of drugs lightly, I grill my doctor, and if I am not satisfied with her responses, I add my own research plus I will consider seeing other doctors. There have been times that I have rejected taking a drug prescription and I have explained my reasoning. My doctor knows she can work with me to effect life style changes and she does; she knows that I want to prevent illness. She practices science-based medicine, that is, medicine that works and is effective, even if there are negative side effects and the reason why it works is not always known.

    Effective drugs do exist. And I am glad they do. As far as fine-tuning medical treatment, at this stage, metabolomics is promising as it is framed within an working paradigm–drug dosage can be tailor-made for each one of us as diet can be also.

  30. AntiVax says:

    Good point rjstan. The way they foist radiation on people is criminal especially when you know heart disease can be reversed with Vitamin C http://whale.to/a/fonorow.html

    all they have is some surgery and a few useless drugs.

    Mammography is a good, similar, example of a useless harmful treatment http://whale.to/a/mammography_h.html

    no wonder we are going bust in the NHS. 90% of its £60 billion cost is pointless, and £4 billion goes on litigation.

  31. David Gorski says:

    Please note that “AntiVax” is in reality John Scudamore, the creator and maintainer of one of the largest repositories of pseudoscience, quackery, and conspiracy theories on the entire Internet, namely the Whale.to site. Peruse it for yourself and see what I mean.

    Whale.to has it all, HIV/AIDS denialism, rabid antivaccinationism, claims for alternative cancer “cures,” New World Order conspiracy-mongering, and more. Here’s a small taste:

    1. Cloudbusters and black lines
    2. 6 TBs in a circle (Healing Black lines)
    3. Ghostly resident in Crieff shop
    4. Noxious earth energies and their influence on human beings
    5. Mind control hardware (Did you know that CPR equipment is part of the plot?)
    6. The vaccination hoax and Holocaust
    7. Genocide via vaccination
    8. Holy Hand Grenade (not of Antioch, I hasten to add).
    9. Crystal & water charging
    10. Cell phone/GSM/PCS (aka DEATH TOWERS), TETRA, HAARP, GWEN, & Power lines
    11. Asian tsunami was nuke
    12. Medical (Allopathic) Mind Control
    13. Mammography Hoax
    14. Atheism, Forbidden Archeology & The Darwinian Evolution Hoax

    Readers should be able to judge for themselves.

  32. Michelle B says:

    The harshest criticism I have towards medicine is that it is not personalized (and that individual doctors can be aholes). Well, until quite recently, the means to do that was just not available. The Orthomolecular folks grasped some important points, but their paradigm unfortunately just will not permit their advancing into actually accomplishing their goals.

    Lots of dissatisfaction from the public stems from that reality. I remember arguing vehemently with a supporter of medicine for the masses–she said, but we must do that, we must tried to reach the biggest number of people.

    Stay tuned, I think that dismal perspective will be eventually replaced by one that will fix many problems–negative side effects of drugs, wrong diagnosis, and failure to prevent diseases in time.

  33. Michelle B says:

    Oh my, Scudamore is one of the folks that knows everything!!!

  34. Michelle B says:

    Whizzed through those linke, David–apparently as there are liars for Jesus, there are liars for nature.

  35. Harriet Hall says:

    Antivax says,

    “There are 1,200 medical citations showing Vitamin C is a cure for most infections”

    That isn’t true; it’s a warped interpretation of the positive studies on vitamin C and it disregards the more numerous and convincing negative studies. The links Antivax cites are all to his own website. It’s easy to see that Antivax gets his information from biased activists rather than from a fair evaluation of the entire body of medical literature.

    Polio and vitamin C? Nothing in PubMed.
    Heart disease and vitamin C? Articles in PubMed show it doesn’t work and may make things worse.

    He cites this as “evidence:” “80% of my patients were well just after doing my thorough bowel cleansing program.”–Richard Shulze, ND., MH” – an unsubstantiated testimonial with no attempt at a control group.

    He accuses medicine of not being based on science, but he doesn’t appear to have any understanding of what good science entails.

  36. Hermano says:

    Fifi,
    NO, you ARE deflecting!
    Let’s look at some numbers.
    Let’s say ALL supplements sold by the NDs are fraudulent.
    There are 2,500 ‘educated’ NDs.
    Let’s be generous and say they earn $80,000 per annum, and that
    half of their income comes from selling these worthless supplements, $40,000 per ND per year, for a grand total of
    $100,000,000 a year.
    $100,000,000 is how much the Americans paid for the CT scans last year, the amount expected to grow dramatically.
    Let’s say NDs markup their supplements 100%, so the American public was defrauded to the tune of $200,000,000 by the “naturopathic industry”.
    Let’s compare this number with “one-third or more of the care that patients in this country receive could be of little value” out of $2,2 trillion dollars a year, according to the NYT article.
    740,000,000,000 versus 200,000,000.
    The factor is 3,700 to 1!
    There is an elephant in the OR and you are too busy pointing fingers at the NDs to see it.

  37. Harriet Hall says:

    Hermano,

    Did you read my article on “Death by Medicine?”

    Comparing supplements sold by NDs to CT scans is absurd.
    And your quotation from the NYT article only says “could” be of little value.

    You are comparing mostly untested remedies to a valuable diagnostic test to a wild guess about how much care “could” be of little value. You can’t get 3,700 to 1 out of that; you can only get apples to oranges.

    The elephant that you are not seeing is the risk/benefit ratio.

  38. AntiVax says:

    “He accuses medicine of not being based on science, but he doesn’t appear to have any understanding of what good science entails.”

    LOL. Clue here: The Journal of Orthomolecular Medicine, although in publication for 38 years, has never been listed on the government database MEDLINE. http://whale.to/v/jom.html

    Plenty here http://www.seanet.com/~alexs/ascorbate/index.htm

    and there are some Klenner in there, believe it or not

    KLENNER FR.

    The vitamin and massage treatment for acute poliomyelitis.
    South Med Surg. 1952 Aug;114(8):194-7. No abstract available.
    PMID: 12984224 [PubMed - indexed for MEDLINE]3: Related Articles, LinksKLENNER FR.

    Massive doses of vitamin C and the virus diseases.
    South Med Surg. 1951 Apr;113(4):101-7. No abstract available.
    PMID: 14855098 [PubMed - indexed for MEDLINE]4: Related Articles, LinksKLENNER FR.

    Fatigue, normal and pathological, with special consideration of myasthenia gravis and multiple sclerosis.
    South Med Surg. 1949 Sep;111(9):273-7. No abstract available.
    PMID: 18140958 [PubMed - indexed for MEDLINE]5: Related Articles, LinksKLENNER FR.

    The treatment of poliomyelitis and other virus diseases with vitamin C.
    South Med Surg. 1949 Jul;111(7):209-14. No abstract available.
    PMID: 18147027 [PubMed – OLDMEDLINE

    “Polio and vitamin C? Nothing in PubMed.”

    Looks like you can’t search it properly which doesn’t say much for your comment: “That isn’t true; it’s a warped interpretation of the positive studies on vitamin C and it disregards the more numerous and convincing negative studies. ”

    and Medline Obsolescence http://www.doctoryourself.com/obsolescence.html

    Robert F. Cathcart, III, M.D. Key Articles, 1975-1994
    (Dr. Cathcart has successfully treated over 20,000 patients with very large doses of vitamin C, sometimes administering over 150,000 mg per day. http://doctoryourself.com/biblio_cathcart.html

    and so on

  39. David Gorski says:

    Oh, well, at least Mr. Scudamore didn’t cite JPANDS or Medical Veritas.

    There’s a reason the Journal of Orthomolecular Medicine isn’t listed on PUBMED. It’s a journal every bit as dubious as JPANDS or Medical Veritas, although for different reasons. Whereas JPANDS goes for the far right wing political craziness that leads it to pseudoscience reflecting those views, Medical Veritas is pure, hardcore antivaccinationist. Indeed, its most recent issue, as are most of its issues, chock full of nothing but antivaccinationist pseudoscience. One issue in particular MV shares with JPANDS, though, is its support for the lie that shaken baby syndrome is a misdiagnosis for vaccine injury. Oh, and there’s a whole lot of HIV/AIDS denialism in there as well.

    In any case, it’s not for nothing that so-called “orthomolecular medicine” has been called the dark side of Linus Pauling’s legacy. You see, Dr. Pauling became quite the crank in his later years, believing that high dose vitamin C could cure cancer and numerous other illnesses.

    Finally, you really should find some references more recent than 56 years old. A lot of science has been done since 1952, and most of the literature of that time has been supplanted by newer and better studies.

  40. Hermano says:

    H. Hall,
    Either we read different articles in the NYT, or you did not read one at all.
    “Could be of little value” is a polite way of saying “it is utter bunk”.
    Here is an interesting quote from the article, a cardiologist with a shiny new CT scanner criticizing another cardiologist who thinks these toys are worse than useless :“It’s incumbent on the community to dispense with the need for evidence-based medicine.”
    After all, “Fees from imaging have become a significant part of cardiologists’ income — accounting for half or more of the $400,000 or so that cardiologists typically make in this country”, as the article asserts.

  41. Michelle B says:

    David Gorski wrote: Finally, you really should find some references more recent than 56 years old.
    ________

    Why should they? They have an intuitive hot-line to the unchanging and absolute truth. A several decades lapse in research only proves they got it right the first time, and there is no need for further research.

    I am beginning to think that Scudamore has not heard of metabolomics yet.

  42. weing says:

    Hermano and Antivax are just shills for the NDs and homeopaths. Studies? They don’t need no freaking studies. Why, they were done over 50 years ago. The TRUTH is to be found by studying the works of the Ancients, not research. One thing strikes me about these cranks. We acknowledge that there is room for improvement in medicine and are constantly evaluating the risks and benefits of treatments and new testing. They, on the other hand, see no need for improvement in their pet theories (delusions). Like missionaries, the only improvement is to get more victims into the fold. Who does this benefit? Follow the money.

  43. Harriet Hall says:

    Hermano and AntiVax,

    I don’t think you understood the points in my comments. I’ll try again.

    1. Please read my article on Death by Medicine.
    2. There is evidence that vitamin C works but there is more evidence that it doesn’t work.
    3. In science, we go by the entire body of published evidence and we will not be persuaded by testimonials, popular books, or a selective list of studies that support a claim and excludes studies that don’t support it.
    4. We will not be persuaded by arguments about the risks or costs of anything unless they are put into context with the benefits.

    You quoted someone as saying:“It’s incumbent on the community to dispense with the need for evidence-based medicine.” You obviously don’t believe that yourself, because you are trying in your own misguided way to offer us evidence, without understanding what constitutes acceptable evidence.

  44. oderb says:

    I’m still waiting for someone to explain – as i posted above – why a protocol shown to reduce mortality and mortality in the iCU with no known toxicity and at a cost of pennies a day hasn’t been adopted as a standard of care, or at least been the subject of further trials.

    An RCT published in a reputable journal (Annals of Surgery 2002) showed that the administration of Vitamin C and E in an ICU unit reduced multiple organ failure by 57%, mortality by 44% and length of stay by 17%.

    http://findarticles.com/p/articles/mi_m0ISW/is_2003_April/ai_99164827

    What possible reason could there to ignore this study except for a bias against a therapy that would acknowledge the powerful benefits of vitamins in high doses, while simultaneously reducing the profits of the drug industry.

    It is downright immoral. I would like to ask everyone on this site who might possibly be able to influence the decision to use this protocol to do what they can..so that thousands of lives and millions of dollars can be saved.

    If a drug were shown to have this effect you all know that it would be front page news, and it would be sold to every hospital in the world.

    I personally wrote to five hospitals in my area with reprints of the study and asked why it was or wasn’t being used in their ICU’s.

    Not one hospital gave me a straight answer, and not one hospital is using it.

  45. Fifi says:

    No Hermano, you’re missing the point. This blog routinely questions non-evidence based practices (such as unnecessary tests and operations) and ethical and practical failings in medical institutions and the practice of medicine. Just because there are questionable practices going on in medicine (which this blog never pretends doesn’t happen) – which are brought to public attention by doctors it should be noted – doesn’t mean that questionable practices by naturopaths are somehow okay, which is what you seem to be suggesting by constantly trying to divert attention away from the topic of how incredibly corrupt the relationship between those who make and those who sell supplements actually is. Personally I’m coming to the conclusion that it’s this very for-profit model (the nexis of health insurance/pharma/supplements/CAM/institutions) that’s corrupted medicine in America so much that all kinds of woo is being accepted (it’s long been accepted by health insurance companies, who are as tied into CAM as they are medicine, since it’s become about servicing clients not treating patients. It’s much cheaper to sell people woo or a pill than it is a complex or new treatment that takes time to work (which is why insurance covers psychiatric drugs but not talk therapy, for instance). Like the people who contribute to this blog, it’s usually doctors who blow the whistle on practices that aren’t evidence based. You see very, very little whistle blowing, self criticism or even evaluation from those who promote naturopathy and supplements.

  46. Hermano says:

    H. Hall,

    The article I quote does not aim to to satisfy what you might
    consider acceptable evidence.
    It discusses something called “reality”, where the U.S. spends over $2 trillion/year on health care, double per capita of what other comparable western societies do, without providing as good quality care.
    Much of excessive costs due to expensive unnecessary procedures, tests, and drugs that while scientifically “correct” do not provide any benefit other than lining the pockets of those who sell them.

  47. weing says:

    oderb,
    As I noted previously, when I used to write hyperalimentation orders, vitamins were in the bag, so to speak. That was many years ago. I do not know what the current protocols are. I am sure if you paid an intensivist in the SICU for their time, they could tell you after work. Otherwise, they are just too busy taking care of the sick to be able to stop and waste the time satisfying your curiosity.

  48. Harriet Hall says:

    oderb,

    You ask “What possible reason could there to ignore this study?”

    It’s been a long time since I worked in an ICU. I don’t know whether it IS being ignored or not; do you? I did find this article with guidelines for nutritional support of such patients; it was published 5 months before the article you cite. http://www.ncbi.nlm.nih.gov/pubmed/12971736?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    IF IT IS being ignored, there are many possible reasons that do not involve an unreasonable prejudice against vitamins. Most published studies are wrong, and we have learned by hard experience not to jump on the bandwagon and implement treatment changes based on one study. There are literally thousands of initial studies as apparently promising as the one you cite, both for vitamins and for pharmaceuticals; and in the majority of cases further study shows that the treatment wasn’t as good as they initially thought, had unexpected adverse effects, or did more harm than good.

    Just one example: many years ago cardiologists followed initial studies and put all their cardiac patients on high-dose vitamin E thinking it was entirely safe. Then they started seeing side effects and lowered the dose. Now we have studies showing that high doses of vitamin E do not improve outcome for these patients.

    The dose of vitamin E in the study you cite is twice the recommended upper limit for human intake. There is concern that doses above the accepted UL have an anticoagulant effect that may cause bleeding complications (something that was not addressed in the study cited).

    If vitamins C and E are not being routinely used in the ICU, it is not because of any prejudice against vitamins or natural medicines, but because careful clinicians have considered the evidence and have not found it compelling for one or more of many possible reasons.

  49. weing says:

    Hermano,
    There are many reasons the US spends more than other countries on health care. Unnecessary and futile tests, procedures, and drugs are just some of them. The point you are missing is that those countries use the same expensive tests, procedures, and drugs. So, what makes them unnecessary here?

  50. Harriet Hall says:

    Hermano wrote,

    “The article I quote does not aim to to satisfy what you might
    consider acceptable evidence.
    It discusses something called “reality”, where the U.S. spends over $2 trillion/year on health care, double per capita of what other comparable western societies do, without providing as good quality care.
    Much of excessive costs due to expensive unnecessary procedures, tests, and drugs that while scientifically “correct” do not provide any benefit other than lining the pockets of those who sell them.”

    If you don’t have acceptable evidence, why should I even listen to you?

    I agree that we spend too much money on health care, but that is a political/social problem, not a question of the validity of evidence-based medicine. If a drug or procedure is supported by good scientific evidence, by definition it provides benefit to patients when used appropriately. Inappropriate use and over-use are problems that we all admit and are working to decrease.

    You either did not read or did not understand my article or my comments about putting things into context. Please read it carefully and try to understand what I said. Discussing the harm is meaningless without discussing the benefit. With all its faults, scientific medicine has no real competitors. Where is your data showing that non-evidence-based systems produce better results?

  51. AntiVax says:

    “If vitamins C and E are not being routinely used in the ICU, it is not because of any prejudice against vitamins or natural medicines, but because careful clinicians have considered the evidence and have not found it compelling for one or more of many possible reasons.”

    LOL. Nutritional medicine would send Pharma medicine (Allopathy) into orbit.

    “For every drug that benefits a patient, there is a natural substance that can achieve the same effect.” — Pfeiffer’s Law

    Robert F. Cathcart, III, M.D. Key Articles, 1975-1994
    (Dr. Cathcart has successfully treated over 20,000 patients with very large doses of vitamin C, sometimes administering over 150,000 mg per day. http://doctoryourself.com/biblio_cathcart.html

    and all that is just Appeal to Increduity, Gorski http://whale.to/b/appeal_to_incredulity.html and ad hominem conspiracy http://whale.to/a/conspiracy.html

    Logical fallacy is the cornerstone of Allopathy defence, just like the hoax vaccination is the foundation stone.

  52. Harriet Hall says:

    Antivax said,

    “Nutritional medicine would send Pharma medicine (Allopathy) into orbit.” So why hasn’t it? Maybe because “Pfeiffer’s Law” is really “Pfeiffer’s Myth.” It certainly isn’t a scientific proposition that can be falsified, because you could always say there must be some other plant we haven’t tested yet.

    Isn’t it interesting how he fails to understand my points about what constitutes adequate evidence, and he keeps offering the same kind of unacceptable evidence? And keeps making ridiculous unsupported statements like vaccination is a hoax? And he accuses others of logical fallacies while he commits them himself. It fascinates me how the unscientific mind works.

  53. weing says:

    Anitavax,
    What did Dr Crashcart treat in those 20,000? Do you mean he gave them large doses without killing them? We need documentation. I mean, I could say, and publish, in Hypothesis that I treated 20,000 patients successfully with camembert cheese.

  54. Hermano says:

    H. Hall,
    I’ve read your ‘Death by Medicine’, again.
    It’s OK, just not that great.
    Keep at it!

  55. AntiVax, “The way they foist radiation on people is criminal…”

    AntiVax, what is the problem with radiation? I had it for breast cancer in 1984. Everyone was amazed at how well I tolerated it and because of that I realized I was getting the maximum dose. I asked the radiation therapist, a Korean MD practicing scientific rather than oriental medicine, what evidence he had that it would benefit me and what evidence he had that it wouldn’t harm me in the future. He didn’t reply. I told him that I would be back for the next scheduled treatment but that I would not take it or any others till he answered my questions.

    When I arrived everyone, and I mean everyone, the nurse, receptionist and technicians came into the treatment room to hear his reply. He was very uncomfortable but by then I’d investigated and thought I knew the answers. I said, “You don’t know. It hasn’t been done long enough. The evidence isn’t in yet.”

    He responded, “That’s right.”

    I started to laugh and said, “That’s all I wanted to know. I’ll finish the course your recommend and ten or twenty years from now find out if I’ve been lucky with my ability to tolerate the treatment so well.”

    So far I’ve been lucky. Of course, without very good data on a lot of cases, I don’t know if I would still be alive and disease free if I hadn’t had any radiation and I don’t know if eventually it will harm me. I do suspect that if I hadn’t had at least the lumpectomy that my disease would have progressed to the point where the cancer ate through my skin like the picture of the lady Dr. G linked to and the one Vinny told us about. Right before I was treated I met a lady so scared of the lump she found in her breast that she didn’t go to an MD till it ate through her skin. She had seen her mother die a terrible death from breast cancer which ran in the family. Unfortunately, I don’t know what happened to the lady herself.

  56. Hermano says:

    It appears that there is an ongoing debate among naturopathic doctors regarding the ethics of selling supplements to the patients
    http://thevirtualjim.livejournal.com/361575.html .

  57. Fifi says:

    The example of discussion between homeopaths given by Hermano just highlights the fact that if supplements were properly regulated – required to contain what was advertised and only allowed to make evidence based health claims – the consumer would know exactly what they were buying. It seems even more unethical to me for naturopaths to set themselves up as middlemen to sell supplements that are often more expensive than those available retail (and that also don’t necessarily contain what they’re supposed to either).

  58. Hermano says:

    Thank you, Fifi
    That’s good information

  59. Fifi says:

    You’re welcome Hermano. I’d thought you were going to link to a debate amongst professional naturpaths about the ethics of selling supplements and was quite reading the thoughts of naturopaths who are genuine, caring and not interested in engaging in practices that lack integrity. Sadly it was just an assertion that there was debate and then some discussion by people who seem to be clients of naturopaths. I can see how some in the supplement and naturopathy industry might want to see “quality control” of supplements as the role of a naturopath since it gives naturopaths an exclusivity (and faux expertize) around the selling and dispensing of supplements and vitamins, which don’t require prescriptions and are generally quite cheap to manufacture (though most supplement makers buy their ingredients pre-prepared from other manufacturers, sometimes from China and other countries that have food and drug safety issues associated with their exports). Of course, those who disparage EBM obviously don’t know or care about well conducted studies and, well, evidence! Since studies and evidence don’t count to those opposed to EBM, it seems obvious that these naturopaths get their information (their “expertize”) from the salesmen who assure them that the more expensive and exclusive supplements are better and higher quality even though there’s no real evidence of this (not available in stores! Order now! typical MLM and tv infomercial marketing techniques). If naturopaths were genuinely interested in ensuring that their clients weren’t exposed to dangerous or substandard supplements, they’d support the efforts to change regulations in Canada and the US. No doubt there are one or two who DO support regulation but clearly the majority of both naturopaths and the supplement industry have been campaigning AGAINST regulation of supplements (by fear mongering and spreading disinformation). In light of this and the example of discussion provided, proposing that naturopaths are somehow in conflict with the supplement industry is a bit of a red herring and attempt to distance naturopaths from the very industry they support and that supports them.

  60. Fifi says:

    Heh, that should read “…was quite looking forward to reading the thoughts of naturopaths….”

  61. AntiVax says:

    “I said, “You don’t know. It hasn’t been done long enough. The evidence isn’t in yet.”

    Radiation therapy for the breast? I have asked one for studies showing benefit but never get any reply. It does seem odd to give a therapy that actually can cause cancer, along with mammography, but that is what you get when you have a monopoly. There are plenty of therapies that have been suppressed over 100 years, such as Gerson http://curezone.com/diseases/cancer/cancer_dr_lorriane_day.html

    Cue some allopathic propaganda against gerson. And that is just one non-allopathic cancer med. One of the best.

    But that information is kept from the cancer patient even when they are given a terminal prognosis.

  62. AntiVax says:

    “It appears that there is an ongoing debate among naturopathic doctors regarding the ethics of selling supplements to the patients.”

    Many of the naturopaths are no better than the allopaths, they had a go at Dr Christopher, a naturopathic herbalist, for curing his patients too fast, and he and Dr Shulze were never invited to speak at their conference after they said the only nutrition you should give patients is natural stuff like herbs and fruit.

    “Anitavax, What did Dr Crashcart treat in those 20,000? Do you mean he gave them large doses without killing them? We need documentation. I mean, I could say, and publish, in Hypothesis that I treated 20,000 patients successfully with camembert cheese.”

    Go and get it then, he has a website. As I said there are 1,200 citations on treating infections. Its not my job to convince people who aren’t listening. Go and buy the Levy book, for starters. Unlikely an MD would risk the lives of 20,000 patients and his career using vitamin C if it didn’t work, after he was raised on pharma med, don’t you think? Motive?

    “HALL: Isn’t it interesting how he fails to understand my points about what constitutes adequate evidence, and he keeps offering the same kind of unacceptable evidence? And keeps making ridiculous unsupported statements like vaccination is a hoax? And he accuses others of logical fallacies while he commits them himself. It fascinates me how the unscientific mind works.”

    I am fascinated as you how your mind works. As you can’t allow yourself to read whale then how can you know I have no evidence against vaccination??? Remember Scopie’s Law? I have listed numerous statistics that take apart smallpox vaccination completely, just for starters. Care to point out the fallacy of that?

  63. David Gorski says:

    Let’s see, there’s the NSABP B-06 trial, the NSABP B-17 trial, the NSABP B-21 trial, and those are just three huge multi-institutional trials that I could think of off the top of my head. They all showed significant benefit due to post-operative radiation therapy in the form of reducing local recurrence rates.

    As for Dr. Lorraine Day, I’m sorry, but the woman’s a complete loon:

    http://www.sciencebasedmedicine.org/?p=10

    http://scienceblogs.com/insolence/2007/01/dr_lorraine_day_purveyor_of_woo_and_anti.php

    http://scienceblogs.com/insolence/2007/03/dr_lorraine_days_at_it_again.php

    Conspiracy theories, Holocaust denial, antivaccinationism, religious fanaticism, support for outright quackery, it’s all there.

    As a fellow academic surgeon, I find what’s become of her to be very, very sad, actually. 25 years ago, Dr. Day was a very talented and well-respected academic orthopedic surgeon. Now she’s a crank.

  64. David Gorski says:

    I have listed numerous statistics that take apart smallpox vaccination completely, just for starters.

    No you didn’t. Saying you did doesn’t make it so.

  65. AntiVax, You haven’t answered my question. I asked, “What is the problem with radiation?” I also explained that I had radiation for breast cancer in 1984 and am not aware of it having caused me any problems.

  66. Fifi says:

    antivax – If Dr Christopher doesn’t believe in supplements, why does he recommend and link from his to a site that sells supplements that he created?

  67. Harriet Hall says:

    Antivax,

    “As you can’t allow yourself to read whale then how can you know I have no evidence against vaccination???”

    I read as much of it as I could stand. I got tired of seeing the same old arguments I’ve seen on other anti-vaccine websites: ancient history, outdated references, outright lies, distortions, omission of crucial information, misrepresentations, things that have been thoroughly debunked elsewhere.

    There is something you’re just not getting. Let me try again:

    You find lots of evidence for X and ignore all the evidence against X. I could find all the evidence against X and ignore all the evidence for X. We could argue till the cows came home. That wouldn’t get us anywhere nearer the truth.

    The scientific method takes ALL the evidence FOR AND AGAINST X, assesses its quality, weighs it carefully and tries to make sense out of the whole.

    The kind of stuff you put on your website is not news to us. We’ve examined it before and have rejected it for reasons that you are unable or unwilling to understand.

    We are playing in the scientific ballpark and you’re throwing tomatoes in from outside the fence. If you want to come in and play by the rules, you’ll always be welcome. If you want to learn the rules, we’ll try to educate you. But if you refuse to learn the rules, you might as well go home.

  68. Fifi says:

    Heh, my mistake. Apparently it was another naturopath’s site I found when I googled Dr Christopher.

  69. Dr. Gorski, I rather suspect that according to AntiVax’s rules of evidence (N=1) my case shows that radiation therapy for breast CA is at least not harmful. Well that would be the case if he applied his rules consistently to scientific and unscientific medicine.

  70. Fifi says:

    “Dr.” Christopher Jr does seem to be in the business of selling diplomas via a mail order school for “naturopaths” (which includes diplomas in homeopathy, reflexology, iridology and aromatherapy from their respective “Colleges”). To be fair, there is a one week residency in the form of a Master Herbalist Seminar and only two of his many websites sell herbs and products such as fizzy bath bombs and capsule machines. Personally I like a good floral/herbal bath bomb. Though I still smell the stink of a less than innocent convergence of interests whereby John and David Christopher are directly profiting from what they prescribe and promote (in the form of “education”).

  71. weing says:

    Antivax clearly illustrates the arrogance of ignorance. He is also absolutely certain of his knowledge. This, again, illustrates that certainty and knowledge do not go hand in hand. I wonder if they may, in fact, be negatively correlated?

Comments are closed.