A Doctor tells it like it is

kw: book reviews, nonfiction, medicine, alternative medicine, hype, advice

As much as I appreciate doctors and nurses, I am rather skeptical of over-confident physicians. However, I am even more skeptical about medical claims, veiled or otherwise, for "alternative" and "non-traditional" remedies and treatments. It is ironic that, in the earlier times when physicians had few useful techniques and fewer genuine remedies, phony doctors seem to have been rather scarce. Since the modern era of "miracle drugs" and effective vaccination, starting around 1800, the "snake oil salesman" became a fixture of Western culture; ironically, genuine Chinese oil of water snake is a pretty good liniment for sore muscles and joints. But the "patent medicines" of the American West…you'd be better off drinking some clean water! . . . and rubbing fish oil or olive oil into sore joints.

Hype, medical and otherwise, got a huge boost with the invention of the World Wide Web, as a service offered over the Internet, after 1993 ushered in the first browser, Mosaic. That is 25 years of rampant self-publishing of everything imaginable. According to an old proverb, the Devil will tell you the truth seven times to prepare you to believe one lie. Many Web pundits don't bother with the seven truths; it is just lie, lie, lie, preying on the gullible. Caveat emptor was never needed more than now!

Hype: A Doctor's Guide to Medical Myths, Exaggerated Claims, and Bad Advice—How to Tell What's Real and What's Not, by Nina Shapiro, M.D. and Kristin Loberg, takes a series of bold swipes at the whole enterprise of online medical quackery, misinformation, and tomfoolery. I had high hopes when I began the book, and those hopes were largely met. Dr. Shapiro knows her stuff, and it is told well.

Do you fear Ebola more than bees? The number of people in the U.S. who die of bee stings ranges from 75 to 85 yearly. Worldwide, it is hard to determine, but it is perhaps twenty times that, maybe 1,500 or so. In the U.S., there have been 11 cases of Ebola, with 2 deaths. Total. Of course, in central Africa, there have been thousands who died of Ebola, 11,000 by one measure. Both bee stings and Ebola pale in the face of the most dangerous thing most of us do every day: ride or drive a car. Safety technology has cut the number of auto-related deaths in half during my lifetime, but in the U.S., the number is still about 40,000 each year, and worldwide, it exceeds 1.2 million. For comparison, the most dangerous insect, the Anopheles mosquito, spreads malaria, which kills nearly half a million yearly (though very few in the U.S.). So worldwide, autos are almost three times as dangerous as malaria!

Another fun subject. Juicing. It is enjoying a resurgence. About 40 years ago, some folks put all kinds of stuff in juicers, and a friend of mine broke his juicer trying to extract the juice from wheat grass. So, you cut up carrots, fruits, and other stuff and extract the juice. What do you get? Tasty (maybe!) water with some vitamins and whatever phytochemicals survive the juicer. What don't you get? Any of the fiber, which is the main benefit of the fruits and vegetables!

Turn your juicer into a museum piece, and just eat an apple, including the skin. If you peel the skin you are throwing away most of the pectin, which is a major ingredient in Kaopectate, a diarrhea medicine. The pectin is behind the proverb, "An apple a day keeps the doctor away". Eat an apple without skin and you are more likely to have a runny B.M. Eat it with the skin, and you probably won't.

More fears: Formaldehyde and Mercury in vaccines. Guess what? If, during your first 18 years you received the usual schedule of 25-30 vaccinations, you received about half the formaldehyde you would consume by eating a single pear! Also, your body makes formaldehyde all the time. In some of those vaccinations, there was also a little bit of mercury in the preservative. How much? About the amount in two tuna sandwiches, if you use Albacore tuna, or four sandwiches made from "light chunk" tuna. There's even less mercury in salmon, so if you want to avoid mercury, eat salmon instead of tuna! And there is even less than that in Tilapia!! My wife and I happen to like fish, so even though we usually go for low-mercury varieties, we probably consume more mercury each year than we received from all our vaccinations (and those we still get, such as the Flu vaccine).

There is advice about detecting hype, though it will be hard for most of us to carry it out. When we are looking for medical information, we are usually worried about something, and thus more prone to believe almost anything that sounds plausible and is presented with an air of authority. At a time that we most need our critical facilities, they are weakest. Every day we read or hear or view ads about medications, some legitimate and some that are really just nostrums. (Def: nostrum. A medicine with unrevealed components, prepared by a private party or non-professional, that is claimed to "cure" ailments that "ordinary" medicines cannot treat.) Some, such as a recent rash of "T-boosters" ("T" is the current euphemism for testosterone), can actually deliver some of the results promised, but they also deliver results that are not mentioned.

To speak of "side effects" is too mild. Boosting testosterone in a man will indeed allow him to grow bigger muscles through exercise, it will indeed make him more "passionate" (that is, lustful), and it will also greatly increase his risk for heart disease and cancer. The ads don't mention that last item or two, do they? Nor do they mention the shorter fuse of any testosterone-addled male at any age. Why are teens so impulsive? Because they have twice the "T" level that they'll have just 10-20 years later. Guess what? The reduction of hormone levels in most men is not only normal, but beneficial, helping them live longer. In fact, one big drawback of too much "T" is the tendency to be accident prone because of increased impulsiveness. And trust me, most women don't want a man who is as randy as a bull elk in rut; things get a lot better when a man learns to slow down.

Here is my take-away as the #1 hype detector: If the beginning of the pitch is selling fear or dread, stop right there. Salesmanship comes in two varieties. One variety is to say, "If you have this need, here is a solution." The other says, "You have a big problem; in fact you could have several big, big problems, but this stuff will make them all go away." And here is my personal rule of thumb: If a company can afford frequent TV ads about their product, its price is much too high. On principle, I keep track of TV-advertised medicines and avoid them. So far, I think I've only had to violate that principle once.

Doctors can come across as stodgy and not so fun. Dr. Shapiro, with the help of her co-author, keeps a smile on your face as you learn a thing or two about keeping your health and your finances intact.

The modern shamans

kw: book reviews, nonfiction, medicine, alternative medicine

TMTOWTDI – There's more than one way to do it – is the mantra of computer programmers and engineers. It applies to most things in life. We can call this "Principle 1", or P1.

There are few ways to succeed but many ways to fail. Let's call this "Principle 2", or P2.

But, a big but, TOOBWTDI – There's only one best way to do it. The trouble is, folks disagree on that one way. I'd like to call this "Principle 3" (P3), and the caveat, "3a" (P3a).

Thus we come to that nice, stealthy word "alternative". If P1 applies, you have alternatives. Therefore, suppose someone complains to you of pain. Anything from a paper cut to diabetic neuropathy to bone cancer. What are the alternatives?

1. OTC painkillers such as Aspirin, Ibuprofen, Acetaminophen, or Naproxen.
2. Prescription painkillers such as Hydrocodone, Morphine, or (in Europe) Heroin.
3. The age-old remedy of a quart of whiskey.
4. A stiff bonk on the head.
5. Death.

All these have their uses and all have side effects. Alternative #1 helps only low-level pain. For #3, a second quart may be needed to induce total unconsciousness. #5 is unethical and usually illegal, unless you are Dr. Kevorkian. #4 is also unethical, and the ensuing concussion causes pain of its own later on.

Depending on whom you ask, there are further alternatives, including acupuncture and distraction such as the "laugh therapy" that helped Norm Cousins, and me, endure chemotherapy. There are also homeopathy, coffee enemas and other kinds of "detox" procedures, and a really incredible list of nostrums promoted by everyone from your Aunt Tillie to the quack-of-the-month using back-page ads.

In America and the West generally, doctors are no longer the knights in shining armor we imagined right after WW2. Like all science, medical knowledge grows by stages, so it is necessarily limited. We are a long way from Dr. McCoy and his Tricorder, curing almost anything putting the Tricorder next to someone's forehead or over their chest and calling their name. When a doctor must admit helplessness, patients don't like it. Particularly the Boomer generation. This pampered, overindulged, self-indulgent generation simply won't take NO for an answer, so they look for "alternatives".

Practitioners of "Alternative Medicine" have stepped into the gap. In fact, they have opened the gap and driven through in a locomotive. They rely on P1 and say they have P3, but there are so many different ones, we come up against P3a. Thus the new book by Paul A. Offit, MD: Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine. He doesn't start with a definition, but gets there eventually, so I'll save you the suspense:

If a medical treatment is effective it is Medicine. If a so-called alternative—something not being done by MD's—is effective, it is also Medicine. If it is not effective, it is not medicine, alternative or otherwise. Thus there is no "alternative medicine". If it works, it is medicine.

Do note that the book's subtitle says, "Sense and Nonsense". In Chapter 4, "Fifty-One Thousand New Supplements", a number of popular treatments are discussed:

• Ginkgo for dementia.
• St. John's Wort for depression.
• Garlic to lower cholesterol.
• Saw Palmetto for enlarged prostate.
• Milk Thistle for liver problems.
• †Chondroitin and Glucosamine for joint pain.
• Echinacea for colds.

† I take these, and I'll discuss it a bit later.

None of these 7 is effective. All have been tested and none stood up. Four more items were mentioned that do have some benefit:

• Omega-3 supplements do improve heart and vascular health, and perhaps brain health. However, too much is not better, and can lead to prolonged bleeding from minor injuries, or even stroke. (†I have to find out how much "too much" is).
• Calcium for bone health in older women, and probably older men.
• Vitamin D (specifically D3) works with Calcium for bone health. Here also, too much is harmful, more than 3,000 units or so.
• Folic Acid (Vitamin B9) prevents many birth defects during pregnancy.

Medical testing is either A-B or A-P. An A-B test compares a new substance "A" against the standard substance "B". For example, a new painkiller might be tested against aspirin if its target use is headaches or sprain soreness, or against morphine if its target use is postoperative pain or terminal cancer pain management. A-P tests compare a substance to a placebo, a "sugar pill". This brings up an interesting matter, discussed in Chapter 11, "The Remarkably Powerful, Highly Underrated Placebo Response".

Placebos! The name comes from a Latin phrase meaning "I please you". Doctors and their shamanic forebears have been handing out pills or potions "to please the patient" for at least 5,000 years. They well know that if a doctor at least does something, a patient will feel better for that reason alone. This was thought to be a purely psychological trick until endorphins were discovered. The first endorphin was so named because it was called "endogenous morphine". These chemicals, produced in the brain, bind to receptors that reduce the feeling of pain, and can nearly eliminate it. Morphine binds to the same receptor, hence it reduces pain.

If you trust and like your doctor, being given a pill will in itself prime you for an endorphin release whenever you take the pill, and it will reduce pain, sometimes by quite a lot. Thus, to say that this or that "alternative remedy" is no better than a placebo can mean one of two things. Firstly, it may simply be another placebo, one that may have been a little more complicated to make than the standard coated sugar pill. Secondly, it may actually be effective, whether or not the placebo response is involved.

Medical test results are stated in a form such as "Caused a 50% reduction in symptoms for 75% of patients." If it is being compared to a placebo, and it is further stated, "…no more effective than the placebo", that means for the condition being tested (Migraine, perhaps), a placebo also had a significant effect for 75%, and not for the other 25%. At the risk of doubling testing costs, and they are already staggeringly high!, I'd recommend an A-P-P-A test, where during a second period of time, the patients were switched, and the differences noted for each patient. Then you focus on those patients who did not respond to the placebo, but did respond to the test substance. You may have found something that is genuinely effective for some 25% of the population, and it may be worth finding out why these but not the others were helped.

Not everyone is the same. Optometrists have always known this. My glasses would not work for your eyes. In Optometry, nearly every prescription differs from the others. (Actually, given the granularity in correction parameters, there are probably only about 50,000 unique eyeglass prescriptions, per eye.)

†So now I'll tell you why I still take Glucosamine and Chondroitin. I had a rotator cuff injury nearly 25 years ago. This runs in my family. My father has had both cuffs put back together with nylon straps. I decided to avoid surgery, and just babied the shoulder. Within a few months it was mostly better, but a lingering soreness remained for about 10 years. Then I began to take G+C. The response was slow. After 3 months the soreness began to get better and after a year it was much better. I tried stopping the supplement, and soreness began to return, so I returned to using it, and still do. I judge that is much too slow to be a classic placebo response. Something is doing me good.

Now for the other † symbol. I take a lot of Omega-3 supplement. Years ago a doctor prescribed Lovaza, and recommended I take at least 2 pills daily, primarily for heart health. I have very low cholesterol, around 120 for total, but also very low HDL, typically about 32. The doctor had first prescribed Tricor to raise HDL, and after a couple of years, it reached 38. I also gained 20 pounds in those years. He wanted me to reach an HDL of 40 at the very least, and 50 if possible (my wife's HDL is 60). One better thing the Tricor had done was lower my blood fats from 300 to below 150. So, the Lovaza is supposed to to keep them down also. It did, but it is very expensive. I found that I could get the same DHA and EPA found in 2 Lovaza pills by taking 5 of the 1.2g pills from Walgreen's or BJ's. That is what I do. It costs a lot less, and I don't mind occasional fishy aftertaste. Also, after I stopped taking Tricor I lost 15 pounds.

By the way, I was briefly involved with a project at DuPont to produce EPA from yeast. They market the stuff now. I'm waiting for a similar supplement for DHA. Anyway, they had some highly purified EPA. It has a strong fishy smell all by itself. If you're taking Omega-3 supplements that include EPA (and they'd better, it is the truly essential one), the fishy smell can't be removed, no matter what the manufacturer says. And if they put an "enteric coating" on it so it won't dissolve in the stomach, the pill is very likely to run right through your system unchanged, and you'll see it after a bowel movement, if you care to look. I use pills without special coatings, just ordinary gelatin. Five per day, or 6 grams.

I've skipped over a lot that the book discusses. There is a very enlightening history of quackery and medicine growing together in America. Then the history of regulation including creation of the FDA shows how certain loopholes have been built into the laws because of intense lobbying by people who make a killing from "alternative" treatments. As I wrote above, medicine is medicine, and if something is effective, doctors ought to use it. If it is not, they ought to say why.

All this quackery goes on because people won't accept limits to our knowledge. The medical profession is a work in progress. I am alive today because of 21^st Century medicine, including being poisoned with 5FU, a nerve gas from WW1 that happens to be a great chemotherapy agent against colon cancer. And, in my experience, 5FU is the most effective anti-depressant I've ever had (I don't take any AD's now, but I've tried a few). By the way, if you're ever tempted to use Laetrile, the effective agent, if there is one, is the cyanide found in the pits of all stone fruits and in other fruit seeds also. When I eat an apple, core and all, chewing the seeds, I get a bit of cyanide. There is more to "An apple a day keeps the doctor away" than just the anti-constipation properties of apple peel! But Laetrile is concentrated to the point that many folks who take it are damaged by the larger amount of cyanide. You'd do better and be safer eating a peach or apricot, cracking open the seed (use pliers not your teeth), and eating the soft pit inside. No more than one or two per day! But really, if you have cancer, see an oncologist. They aren't out to purposely harm you, really truly!

Dr. Offit's presentation is the most balanced and clear I've seen. His approach is common-sense and sensible. Whether the person who recommends a nostrum is a doctor, a "practitioner" of some alternative or other, or your cousin Joe, ask, "How do you know?" They need to know because you need to know. Had this book cited a study showing harm caused by the G+C I'm taking, I'd stop using them. We all ought to remember that MD's and DO's at least take the Hippocratic Oath, and promise to "do no harm." The purveyors of "alternatives" have not taken that oath.

Quicksilver queries

kw: medicine, alternative medicine, toxins

I saw another news article about mercury in vaccines, and was stunned to read that people are still trying to link autism in. Of course, mercury isn't the first target of anti-vaccine crusaders, it is at least the third. First it was thought that there were measles viruses in the vaccine, and they were causing blood clots that got in the brain and damaged it. When that was shown to be entirely false, the next target was "bad proteins" caused by bodily reactions to the vaccine. When no reactions other than rare allergies actually turned up, mercury, in the form of thimerosal (about 50% mercury as ethylmercury), was claimed to cause autism.

As it happens, there are only two or three vaccines that still contain thimerosal. It has been eliminated from the others (see this table from Johns Hopkins) over the past 20-30 years. Yet all that time, autism rates have continued to go up. Also, among those who decline to vaccinate their children, the autism rate is identical to the rest of the population.

In the aforementioned table from Johns Hopkins, we find that the mercury content in a dose of vaccine (only the ones for tetanus, influenza, and meningitis, and that only from certain suppliers) is 25 micrograms. So if you get a flu shot every year, and the vaccine does contain thimerosal, your mercury exposure is 25 micrograms yearly.

Digging around, I found that my own primary mercury exposure is fish. While we cook fish once in a while, we eat tuna sandwiches a bit more, perhaps every couple of weeks. In a report by Consumer Reports, there were two kinds of tuna tested, several brands each. For white tuna, the mercury content ranged from 0.2 ppm to 0.8 ppm (ppm = parts per million). For light tuna, it was 0.02 ppm to 0.2 ppm. Those sound like small numbers. But how much is a part per million?

One "serving" of canned tuna is shown on the package as 2.5 oz, which is about 70 grams. Thus one part per million would be 70 micrograms. For white tuna, the kind we get, our mercury exposure per serving is thus somewhere between 14 and 56 micrograms. At the high end, it is like getting two vaccinations in one tuna sandwich! Not only that, but 2.5 ounces is a pretty thin sandwich. I typically use about twice that much (go ahead, work out the numbers).

Things are actually better when we cook fish, because we usually have either salmon, whitefish, or tilapia. All these have mercury levels below 0.02 ppm, or 2.8 micrograms per 5-ounce serving. But if we eat cooked fish nine times yearly, our annual mercury exposure would be 25 micrograms, the same as a flu shot. We actually eat fish more often than that, perhaps twice a month.

Let's regroup. I really started talking about autism, which shows up in infants or toddlers. "Ordinary" autism is evident in a newborn. "Late" autism shows up by the third year, sometimes later, but is much less frequent. Few one- or two-year-olds have eaten a lot of tuna sandwiches, and with today's vaccines, they have had zero exposure to thimerosal. If mercury, whether injected or ingested, is causing neurological damage, it's something other than autism, but nobody has put their finger on anything it might be! At the levels mercury is getting into us, it is a cause looking for an effect that has yet to be found.

A fungus was among - me

kw: alternative medicine, cancer, fungi

A relative loaned me a DVD, a documentary about nine treatments that are purported to cure cancers. I watched it a few weeks ago, and from time to time I wonder about some of them. But there is one that I am sure is not so.

An Italian doctor claims that cancers all begin as fungus infections, and are largely composed of fungus. He has written a book about it with the title Cancer is a Fungus. I just Googled "cancer is a fungus" (including the quotation marks), and got nearly 500,000 hits. The treatment recommended is baking soda. Of course, you have to deliver the soda to the physical cancer, which is hard to do for internal tumors. But it is based on the known fact that baking soda does more damage to fungi than to our bodily tissues. How much more? Nobody is saying.

There is an easy way to test the premise. If most of the bulk of a cancerous tumor is fungus, a systemic antifungal such as Lamisil (terbinafine) or Nizoral (kenocotazole) ought to eliminate it. Fact of the matter is, lots of people take antifungals for things like toenail fungus. Some of them die of cancer. I was almost one of them.

I was treated for a nail fungus several times between 1990 and 1999. In 2000 I was found to have a large tumor in the colon. It was called a "fulminating tumor" by the pathologist, meaning it was growing fast. After an operation and a half year of chemotherapy, I was OK, and have been a "cancer survivor" now nearly twelve years. The antifungal medicines did nothing to prevent my cancer from developing or growing. The surgery and chemo did.

Furthermore, I have a good friend who is a pathologist. A few weeks after the operation I borrowed the slides from the hospital pathologist and took them to my friend. He and I went to his lab, where he had a two-headed microscope, one used for teaching. We looked over them in quite a bit of detail. Now, you need to know that I have a good microscope at home also. Cost me a pretty penny (but his is much better). Microbiology is a hobby of mine. I've looked at lots of things, including mushrooms, molds and other fungi. The cancerous tissues in my pathology slides were definitely abnormal colon tissues, but they were just as definitely nothing like fungal tissues. My friend has seen slides of tissues invaded by fungi, and he was equally clear that there was no trace of fungus in these slides.

Why did I ask him about fungus? Because I saw photos of the tumor taken by the doctor who did my colonoscopy. It was very pale, almost totally white. I said, "It looks more like a mushroom," as compared to the normal colon tissue surrounding it, which was deep pink. Yet I also saw one photo taken right after the doctor took a sample through the colonoscope. The tumor was bleeding profusely. And what I saw through the slides showed that all the tissue was well filled with normal capillaries, except in some areas where the tumor had grown too fast and outrun its blood supply, and was dying. But dying cells still don't look like fungal cells. At any rate, my pathologist friend said I had been pretty sick, but I didn't have a fungus.

Pathologists know these things, folks. Why not ask your doctor? Every doctor knows at least one pathologist. Some will give you their phone numbers and you can call to ask, "Did you ever see any fungal cells in a surgically removed cancer?"

I really, really wish something as simple as baking soda, or a round of antifungal medicine, would cure cancer. I do not know of any case in which it has.

Physicians who cannot heal, themselves or anyone

kw: book reviews, nonfiction, alternative medicine, scientific method, humor

For about seven years physician Ben Goldacre has written the column "Bad Science" for The Guardian. While one might expect his new book to be composed of past columns, it is not so. Bad Science: Quacks, Hacks, and Big Pharma Flacks draws upon his journalism but is fresh from the top down. It requires a light touch to review this book. Dr. Goldacre is a good fellow, but some of the people about whom he writes are decidedly not, and at least one has sued him, an event that cost The Guardian some $350,000, even though Goldacre won! (The litigant was required to pay legal expenses for both parties, but paid only half.)

I could take the garden path through the book's dozen chapters but that would be a distraction from the real issue at hand. The root problem of the misunderstood, mismanaged, mis-labeled, mis-reported, inept and frankly fraudulent attempts at science by various medical and "alternative medical" or "complementary medical" practitioners is the business of medicine. Medicine ought not be a business in the first place.

I remember when very few doctors were members of "clinics" or "group practices," when many made house calls, and were well enough paid to become quite well-to-do, but none became filthy rich. Our doctor employed an office manager who also answered phones and did most of the filing, and things rocked along very well for decades. Having an appendix removed used to cost about a month's pay for a tradesman. Now, if you had to pay for it yourself, it'd be a year's pay. Same appendix, same skill, but three times as many people around the operating table, and all of them being paid more, proportionately, than the 1960s doctor.

A cute side note: My oncologist, about ten years older than I, knew a few diagnostic tricks that have been forgotten. Once, checking my abdomen, he put a stethoscope over the spot where my bowels had been stitched back together and scratched nearby with a fingernail, here and there. I held my giggle as long as I could. He explained, "Poor man's ultrasound. I can hear echoes from the scar tissue." A younger doctor would use a CT scan to observe the same scar. That kind of big medicine generates big money. Just the technician's fee for running the CT machine is more than the oncologist charged to scratch my belly.

To pick a target: the pharmaceutical business grosses nearly $230 billion in the United States and $800 billion worldwide. And when you hear how drug prices need to be set high to repay the costs of research, consider this: The total amount spent on drug research in the U.S. is about $32 billion, or 14% of the whole, while advertising and administration (management "overhead") is more than twice that at 31% or more than $70 billion. This makes me wonder where the other $128 billion goes; it is not all reported as profit, and manufacturing costs are certainly only a fraction of that. Yikes!

Then there is the "CAM" or Complementary and Alternative Medicine business. This is everything from both well- and poorly-founded nutrition "therapies" to homeopathy to kinesiology to "crystal therapy". It is worth some $50 billion yearly in the U.S. With that much at stake, science really doesn't matter. These folks can afford a phalanx of well-paid lawyers who make damn certain that science doesn't matter.

This is why, in the closing chapter of Bad Science, Dr. Goldacre writes to his opponents, "You win." Quacks know what your pet dog knows: any attention is better than no attention. Simply engaging them, even when you prove them wrong, is good for business. Throughout the book, knowing we can't do much about the rampant quackery in CAM and the surprising amount of poor practice in allopathic medicine, if he can't beat them, he can at least laugh at them. Maybe there is no force that can oppose them, but perhaps we can laugh them out of town. The book gives a reader many of the mental tools needed to see just how laughably poor the "science" is in CAM and in the underbelly of the medical business.

Now, I just have to pass on this one item from the book. It was something I hadn't known. Do you take big doses of antioxidant vitamins to counteract free radicals in your body? Have you been told that those free radicals cause cancer? It occurred to some researchers to study the matter, to see if the "free radical theory" worked in practice. Using a proper double-blind, placebo-controlled study protocol, they found, firstly, that antioxidants didn't affect cancer rates, but secondly, they sure affected death rates, and in the wrong direction! More of the people who were taking the antioxidants died during the study, significantly more than those who were not taking them. They just didn't die of cancer.

Now, vitamin A is known to be toxic in large amounts. It turns out that all the antioxidants, and all vitamins, are toxic in large amounts. That goes for vitamins C and E, and for all those various "phytochemicals" with antioxidant properties. So, take your vitamins in the recommended amounts, but don't overdo it. There is a "sweet spot" if dosage, which is around 80-100 mg/day for vitamin C, for example. Troubling side effects show up at five times that amount, after which the more you take the more likely you are to shorten your life.

We need doctors. We need doctors who are knowledgeable. Some are not, not enough. We also need patients who are knowledgeable. We do not need a clamoring horde of ignorant "alternatives." A few alternative medical methods are helpful. Most are not. Some are harmful or even deadly. Read this book for some solid nuggets of knowledge that just might save your life and health.

Medicine, shmedicine

kw: book reviews, nonfiction, alternative medicine, medical studies

I visited a chiropractor a few times, when several sessions of physical therapy did nothing to alleviate neck pains. I know what the problem is: all day looking at a computer screen and lots of evening hours reading. I do various stretching and loosening exercises, but little relief results. Nothing has really worked except copious intake of ibuprofen. So I asked my family doc if he thought chiropractic would help, and he said it was worth a try.

I'd heard a talk by a chiropractor who claimed to distinguish between "manipulation" (forcible) and "adjustment" (gentler) of the spinal joints. I went to see him, and he started by using some electrical device connected to his computer to map my spine. The device seems to measure nerve impulses and muscular twitches or heat. It showed where I supposedly had nerves being pinched. I'll come back to this.

I'd heard about the risks of manipulating the neck joints, so I asked him to refrain from any but the most minor "neck work". As it turned out, part of each therapy session was five minutes of massage, and this did me more good than anything else. However, the chiropractor gradually ramped up his procedures as he thought I was tolerating them. At some sessions he did some milder "neck crack" moves that I judged within the safe zone, but I could tell he was gradually increasing them.

At my last session, he used more force than I wished, and ended with one of those wrap-arms-and-crunch-in-mid-spine moves that really hurt. It also made a loud pop. He looked so proud of himself that I was speechless. I picked up my coat and left, then phoned back that I would not be returning. The spot he crunched hurt for three days. Again, none of this alleviated my neck pains, except the massage. But my insurance program will not pay for massage-only treatments, even "therapeutic massage".

Like nearly everyone, I've had various other encounters and experiences with alternative medicine. The most bizarre was the tendency of my mother to follow the advice of Adelle Davis (main book, Let's Eat Right to Keep Fit, with almost religious intensity. Fortunately I'd moved out by the time she began to concoct a protein-vegetable juice mix my younger brothers called Lion Milk, and which they loathed. Proper nutrition is good, but I've determined that much of Ms Davis's advice is scorned by real nutritionists, such as taking lots and lots of extra calcium if you have arthritis—you need instead to do something about how your body uses the calcium it has already (maybe she mistook arthritis for osteoporosis...?). I do take some nutritional supplements, and that is fodder for later on also.

Chiropractic is one of four major alternative medical methods discussed by Simon Singh and Edzard Ernst in Trick or Treatment: The Undeniable Facts About Alternative Medicine. The other three are acupuncture, homeopathy, and herbal medicine. They also have an appendix with one-page surveys of thirty-six less prominent techniques and methods.

Their first chapter is a very good discussion and explanation of evidence-based medicine and the scientific method, introduced by a cogent quote from Hippocrates:

"There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance."

So what is evidence-based medicine? It is the application of genuinely scientific methods to the study of medical therapies. The biggest hindrances to such work are

• The placebo effect, which expresses the tendency of a treatment to cause improvement solely due to the expectation of the patient that "something is being done."
• The Hawthorne effect, which is the tendency for a person to respond positively to any attention at all, as compared to being ignored or getting little attention.

Thus, human effects can totally swamp the effect we are trying to evaluate. For this reason, a proper scientific study, called a clinical trial when it is medical, must have these elements:

• A sufficiently large group of patients that good statistics can be produced. For example, the expected scatter in numbers "helped" is about ten if 100 patients are tested, and about 30 if 1,000 are tested. Thus if you give treatment A to 100 people and treatment B to another 100 people, and the difference between those who improve is less than ten, you can't say there is a useful difference. However, had you used two groups of a thousand, and the difference is something like 100, this is much larger than the expected "error" or scatter of 30, so you can say you have a useful result.
• Proper control: One treatment is either a known treatment with known efficacy, or is a non-treatment (a sugar pill or water injection for example), while the other is the treatment being evaluated.
• None of the patients knows which treatment he or she is receiving. This means the placebo effect will be the same for both sets of patients.
  
• None of the doctors performing the treatment knows which is which either. This means the treatments must be prepared by a third party and given to the doctors in a way that doesn't clue them in. This means a treating doctor won't behave differently with one or another patient, so this negates the Hawthorne effect. These last two points are the "double blind" you might have heard of: both doctors and patients are blind to what is being done to whom.
  

There are many clinical studies of all kinds of alternative therapies. However, there are very few that fit the criteria above, and in particular, even well-controlled and blinded studies often had too few patients to produce good statistics. But a method called meta-analysis can combine the results of several studies to produce better statistics. One study with two sets of 100 patients may not yield a definitive result, but if there are ten well-done studies that total two sets of about 500 or more, the statistical power is multiplied.

So what is the result? Of the four major areas of alternative medicine, only herbal medicine has any effective treatments, and only a very few of the many herbal medicines being sold can be said to help by any measurable amount. Secondly, chiropractic treatments can help some cases of back pain, but only a little more than just resting the back for a few weeks.

The authors have bent over backward to avoid their own biases, and give credit where it is due. The one area in which no credit due can be found is homeopathy. This is the practice of taking a substance that, in some quantity, will cause the problem being observed, and using a very small amount for "like treats like" therapy. For example, ipecac causes vomiting, so the idea is that a tiny dose of ipecac might alleviate a vomiting spell. However, homeopaths take that word "tiny" to an extreme. They use successive dilutions to produce "medicines" that probably don't contain even a single molecule of the substance.

For example, to make a homeopathic ipecac tincture, put 1g of the syrup in a liter of distilled water. This is a 1/1000 dilution. Put one gram of this stuff in a liter of distilled water. The new liter's dilution is 1/1,000,000. Repeat ten times. The number below the slash now has thirty zeroes. The trouble is, the number of molecules in the original gram of ipecac is a number with 22 zeroes. That means, if you were to prepare 100,000,000 liters of the final dilution, there would only be one of them, or perhaps two, that contained a single molecule of ipecac. The rest would be pure, distilled water.

This "medicine" might be sold for $50 per liter, making that single molecule of ipecac worth billions of dollars! The primary disease that homeopathy treats is an excess of riches. This may seem to be no more than a harmless placebo, but if a person trusts only homeopathy when there is a real, but treatable, condition, an unneeded tragedy is likely.

There is a ray of hope for alternative medicine: every genuine remedy began as an "alternative", and most of our effective medicines are either plant extracts or are derived from them with a little chemistry. For example, aspirin is a chemically-modified version of salicylic acid, which has much more severe side effects. Yeah, aspirin might cause a bit of stomach bleeding in some folks, but the raw acid causes lots of stomach problems in almost everyone. So there is always a chance than a treatment now considered "alternative" will someday become "normal medicine".

However, even though some herbal medicines are effective, most have troubling side effects. Let us remember, plants have no incentive to produce chemicals which are good for humans. All the chemicals they produce are good for themselves. A few are incidentally helpful for our uses. I don't like to hear, "But this stuff is Natural!" So is nightshade, which will stop your heart; so is strychnine which will either kill you, very painfully, or just ruin your brain so your loved ones have to take care of a near-vegetable for a few decades.

The appendix summarizes 36 treatments, of which these few are at least a little effective, and their side-effects are at least not deadly:

• Aromatherapy can help you relax, but has no other benefits.
• A few techniques of Ayurvedic medicine are a little effective, but most are without value. Lotsa studies are needed to figure it all out; it is even more complex than Chinese medicine. Chinese medicine is treated in passing in the Herbal Medicine chapter, and is a similar situation; too complex to deal with as a whole.
• Some Food Supplements are helpful, but very few of those that are not known to be vitamins are any good at all. Be careful not to overdose, particularly on the B vitamins.
• Hypnotherapy and Autogenic Training (self-hypnosis) can help you relax, and that's the limit of their effectiveness.
• Massage Therapy, ditto, also as attested by my experience.
• Meditation, double ditto.
• Osteopathy, because it is not just skeletal but also takes account of the muscles, can be more effective than chiropractic for spine and joint pain. I used to see an osteopath as my primary physician, and he showed me an exercise for sciatica that is very helpful.
• Relaxation therapies...did you note that five of these items are for relaxation. Many of our aches and pains can be helped by a little relaxation and rest. To those who like Biblical examples, Jesus frequently took his disciples out to the desert to get away from the stress of dealing with crowds. It didn't always work, but he practically invented the Retreat.

Now, if you've read this far, and want to know more about my experience, I find the spine-measuring device rather fascinating, but I don't for a minute believe it does what its proponents say it does.

The chiropractor pressed a probe with two low metal buttons against each joint between vertebrae, and held down a foot pedal while watching a wavy line on the computer screen. When he let go, a number got recorded. It didn't take long for me to figure out that he was letting the waviness settle down, but usually not for long enough to get a really stable number. I have pretty good short-term memory, so I could see that his early stoppage of the reading had more to do with the final number than if he'd let the waviness really settle down, which he occasionally did. Had he done so throughout, my spine's report would have been pretty bland. A repetition of this test after several sessions seemed to show I was improving. You couldn't prove it by how I felt. The only time I felt better was the ten minutes after a bit of massage, and before any "adjustments".

I think that, at best, the device used is more like a Ouija board, producing results that arise in the doctor's imagination rather than the patient. At worst, it would be easy to produce any result you like. Just a little difference in pressure changes the range of the wavy readings quite a lot, and the timing of "release" can produce almost any result also. So I still have my neck pain, and probably will until I retire. The only thing that alleviates it is to rest with my head propped up just so. I can read in such a position, so I do more of my reading while reclining these days.

Now as to supplements.

• In addition to a multivitamin I take "just in case", I use a Glucosamine/Chondroitin pill for my joints. I had a bad shoulder for ten years until I began using these, then in a few weeks I got better. Too bad they don't do anything for my neck (or maybe it would be lots worse?!?).
  
• I also use extra calcium, at my doctor's recommendation.
  
• Finally, I use a large amount of an Omega-3 fish oil extract, also my doctor's idea. This last plus exercise seems to be making by blood chemistry better than a cholesterol medicine I took for a few years, and I weigh less now because the cholesterol medicine boosted my appetite, a lot.

Finally, a specific warning: There is a popular Chinese herb called Aristolochia or birthwort or pipevine. Don't use it. It has killed numerous folks by destroying their kidneys, over a few months' time.