Search This Blog

Sunday, March 17, 2019

Quackery

From Wikipedia, the free encyclopedia

WPA poster, 1936–38
 
Quackery, often synonymous with health fraud, is the promotion of fraudulent or ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, qualification or credentials they do not possess; a charlatan or snake oil salesman". The term quack is a clipped form of the archaic term quacksalver, from Dutch: kwakzalver a "hawker of salve". In the Middle Ages the term quack meant "shouting". The quacksalvers sold their wares on the market shouting in a loud voice.

Common elements of general quackery include questionable diagnoses using questionable diagnostic tests, as well as untested or refuted treatments, especially for serious diseases such as cancer. Quackery is often described as "health fraud" with the salient characteristic of aggressive promotion.

Definition

William Hogarth's The Inspection, the third canvas in his Marriage à-la-mode (The Visit to the Quack Doctor)
 
Since it is difficult to distinguish between those who knowingly promote unproven medical therapies and those who are mistaken as to their effectiveness, United States courts have ruled in defamation cases that accusing someone of quackery or calling a practitioner a quack is not equivalent to accusing that person of committing medical fraud. To be both quackery and fraud, the quack must know they are misrepresenting the benefits and risks of the medical services offered (instead of, for example, promoting an ineffective product they honestly believe is effective).

In addition to the ethical problems of promising benefits that can not reasonably be expected to occur, quackery also includes the risk that patients may choose to forego treatments that are more likely to help them, in favor of ineffective treatments given by the "quack".

Stephen Barrett of Quackwatch defines quackery "as the promotion of unsubstantiated methods that lack a scientifically plausible rationale" and more broadly as: 

Pietro Longhi's The Charlatan (1757)
"anything involving overpromotion in the field of health." This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters. In line with this definition, the word "fraud" would be reserved only for situations in which deliberate deception is involved.
Paul Offit has proposed four ways in which alternative medicine "becomes quackery":
  1. "...by recommending against conventional therapies that are helpful."
  2. "...by promoting potentially harmful therapies without adequate warning."
  3. "...by draining patients' bank accounts,..."
  4. "...by promoting magical thinking,..."

Quacksalver

Unproven, usually ineffective, and sometimes dangerous medicines and treatments have been peddled throughout human history. Theatrical performances were sometimes given to enhance the credibility of purported medicines. Grandiose claims were made for what could be humble materials indeed: for example, in the mid-19th century revalenta arabica was advertised as having extraordinary restorative virtues as an empirical diet for invalids; despite its impressive name and many glowing testimonials it was in truth only ordinary lentil flour, sold to the gullible at many times the true cost. 

Even where no fraud was intended, quack remedies often contained no effective ingredients whatsoever. Some remedies contained substances such as opium, alcohol and honey, which would have given symptomatic relief but had no curative properties. Some would have addictive qualities to entice the buyer to return. The few effective remedies sold by quacks included emetics, laxatives and diuretics. Some ingredients did have medicinal effects: mercury, silver and arsenic compounds may have helped some infections and infestations; willow bark contained salicylic acid, chemically closely related to aspirin; and the quinine contained in Jesuit's bark was an effective treatment for malaria and other fevers. However, knowledge of appropriate uses and dosages was limited.

Criticism of quackery in academia

The science-based medicine community has criticized the infiltration of alternative medicine into mainstream academic medicine, education, and publications, accusing institutions of "diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology." R.W. Donnell coined the phrase "quackademic medicine" to describe this attention given to alternative medicine by academia. Referring to the Flexner Report, he said that medical education "needs a good Flexnerian housecleaning."

For example, David Gorski criticized Brian M. Berman, founder of the University of Maryland Center for Integrative Medicine, for writing that "There [is] evidence that both real acupuncture and sham acupuncture [are] more effective than no treatment and that acupuncture can be a useful supplement to other forms of conventional therapy for low back pain." He also castigated editors and peer reviewers at the New England Journal of Medicine for allowing it to be published, since it effectively recommended deliberately misleading patients in order to achieve a known placebo effect.

History in Europe and the United States

With little understanding of the causes and mechanisms of illnesses, widely marketed "cures" (as opposed to locally produced and locally used remedies), often referred to as patent medicines, first came to prominence during the 17th and 18th centuries in Britain and the British colonies, including those in North America. Daffy's Elixir and Turlington's Balsam were among the first products that used branding (e.g. using highly distinctive containers) and mass marketing to create and maintain markets. A similar process occurred in other countries of Europe around the same time, for example with the marketing of Eau de Cologne as a cure-all medicine by Johann Maria Farina and his imitators. Patent medicines often contained alcohol or opium, which, while presumably not curing the diseases for which they were sold as a remedy, did make the imbibers feel better and confusedly appreciative of the product. 

The number of internationally marketed quack medicines increased in the later 18th century; the majority of them originated in Britain and were exported throughout the British Empire. By 1830, British parliamentary records list over 1,300 different "proprietary medicines," the majority of which were "quack" cures by modern standards. 

A Dutch organisation that opposes quackery, Vereniging tegen de Kwakzalverij (VtdK) was founded in 1881, making it the oldest organisation of this kind in the world. It has published its magazine Nederlands Tijdschrift tegen de Kwakzalverij (Dutch Magazine against Quackery) ever since. In these early years the VtdK played a part in the professionalisation of medicine. Its efforts in the public debate helped to make the Netherlands one of the first countries with governmental drug regulation.

Dalby's Carminative, Daffy's Elixir and Turlington's Balsam of Life bottles dating to the late 18th and early 19th centuries. These "typical" patent or quack medicines were marketed in very different, and highly distinctive, bottles. Each brand retained the same basic appearance for more than 100 years.
 
In 1909, in an attempt to stop the sale of quack medicines, the British Medical Association published Secret Remedies, What They Cost And What They Contain. This publication was originally a series of articles published in the British Medical Journal between 1904 and 1909. The publication was composed of 20 chapters, organising the work by sections according to the ailments the medicines claimed to treat. Each remedy was tested thoroughly, the preface stated: "Of the accuracy of the analytical data there can be no question; the investigation has been carried out with great care by a skilled analytical chemist." The book did lead to the end of some of the quack cures, but some survived the book by several decades. For example, Beecham's Pills, which according to the British Medical Association contained in 1909 only aloes, ginger and soap, but claimed to cure 31 medical conditions, were sold until 1998. 

British patent medicines lost their dominance in the United States when they were denied access to the Thirteen Colonies markets during the American Revolution, and lost further ground for the same reason during the War of 1812. From the early 19th century "home-grown" American brands started to fill the gap, reaching their peak in the years after the American Civil War. British medicines never regained their previous dominance in North America, and the subsequent era of mass marketing of American patent medicines is usually considered to have been a "golden age" of quackery in the United States. This was mirrored by similar growth in marketing of quack medicines elsewhere in the world. 

Clark Stanley's Snake Oil
 
In the United States, false medicines in this era were often denoted by the slang term snake oil, a reference to sales pitches for the false medicines that claimed exotic ingredients provided the supposed benefits. Those who sold them were called "snake oil salesmen," and usually sold their medicines with a fervent pitch similar to a fire and brimstone religious sermon. They often accompanied other theatrical and entertainment productions that traveled as a road show from town to town, leaving quickly before the falseness of their medicine was discovered. Not all quacks were restricted to such small-time businesses however, and a number, especially in the United States, became enormously wealthy through national and international sales of their products. 

In 1875, the Pacific Medical and Surgical Journal complained:
If Satan has ever succeeded in compressing a greater amount of concentrated mendacity into one set of human bodies above every other description, it is in the advertising quacks. The coolness and deliberation with which they announce the most glaring falsehoods are really appalling. A recent arrival in San Francisco, whose name might indicate that he had his origin in the Pontine marshes of Europe, announces himself as the "Late examining physician of the Massachusetts Infirmary, Boston." This fellow has the impudence to publish that his charge to physicians in their own cases is $5.00! Another genius in Philadelphia, of the bogus diploma breed, who claims to have founded a new system of practice and who calls himself a "Professor," advertises two elixers of his own make, one of which is for "all male diseases" and the other for "all female diseases"! In the list of preparations which this wretch advertises for sale as the result of his own labors and discoveries, is ozone!
One among many examples is William Radam, a German immigrant to the USA, who, in the 1880s, started to sell his "Microbe Killer" throughout the United States and, soon afterwards, in Britain and throughout the British colonies. His concoction was widely advertised as being able to "cure all diseases", and this phrase was even embossed on the glass bottles the medicine was sold in. In fact, Radam's medicine was a therapeutically useless (and in large quantities actively poisonous) dilute solution of sulfuric acid, coloured with a little red wine. Radam's publicity material, particularly his books, provide an insight into the role that pseudoscience played in the development and marketing of "quack" medicines towards the end of the 19th century. 

Cartoon depicting a quack doctor using hypnotism (1780, France).
 
Similar advertising claims to those of Radam can be found throughout the 18th, 19th, 20th and 21st centuries. "Dr." Sibley, an English patent medicine seller of the late 18th and early 19th centuries, even went so far as to claim that his Reanimating Solar Tincture would, as the name implies, "restore life in the event of sudden death". Another English quack, "Dr. Solomon" claimed that his Cordial Balm of Gilead cured almost anything, but was particularly effective against all venereal complaints, from gonorrhoea to onanism. Although it was basically just brandy flavoured with herbs, the price of a bottle was a half guinea (£sd system) in 1800, equivalent to over £38 ($49) in 2014.

Not all patent medicines were without merit. Turlingtons Balsam of Life, first marketed in the mid-18th century, did have genuinely beneficial properties. This medicine continued to be sold under the original name into the early 20th century, and can still be found in the British and American pharmacopoeias as "Compound tincture of benzoin". In these cases, the treatments likely lacked empirical support when they were introduced to the market, and their benefits were simply a convenient coincidence discovered after the fact. 

The end of the road for the quack medicines now considered grossly fraudulent in the nations of North America and Europe came in the early 20th century. February 21, 1906 saw the passage into law of the Pure Food and Drug Act in the United States. This was the result of decades of campaigning by both government departments and the medical establishment, supported by a number of publishers and journalists (one of the most effective was Samuel Hopkins Adams, who wrote "The Great American Fraud" series in Collier's in 1905). This American Act was followed three years later by similar legislation in Britain and in other European nations. Between them, these laws began to remove the more outrageously dangerous contents from patent and proprietary medicines, and to force quack medicine proprietors to stop making some of their more blatantly dishonest claims. The Act, however, left advertising and claims of effectiveness unregulated as the Supreme Court interpreted it to mean only that ingredients on labels had to be accurate. Language in the 1912 Sherley Amendment, meant to close this loophole, was limited to regulating claims that were false and fraudulent, creating the need to show intent. Throughout the early 20th century, the American Medical Association collected material on medical quackery, and one of their members and medical editors in particular, Arthur J. Cramp, devoted his career to criticizing such products. The AMA's Department of Investigation closed in 1975, but their only archive open to non-members remains, the American Medical Association Health Fraud and Alternative Medicine Collection.

"Medical quackery and promotion of nostrums and worthless drugs were among the most prominent abuses that led to formal self-regulation in business and, in turn, to the creation of the" Better Business Bureau.

Contemporary culture

Electro-metabograph machine on display in the "Quackery Hall of Fame" in the Science Museum of Minnesota, St. Paul, Minnesota, US
 
"Tho-radia powder" box, an example of radioactive quackery.
 
Scientology's E-Meter, a quack device for measuring 'engrams'
 
The 1929 Revigator (sometimes misspelled Revigorator) was a pottery crock lined with radioactive ore that emitted radon.
 
"Quackery is the promotion of false and unproven health schemes for a profit. It is rooted in the traditions of the marketplace", with "commercialism overwhelming professionalism in the marketing of alternative medicine". Quackery is most often used to denote the peddling of the "cure-alls" described above. Quackery continues even today; it can be found in any culture and in every medical tradition. Unlike other advertising mediums, rapid advancements in communication through the Internet have opened doors for an unregulated market of quack cures and marketing campaigns rivaling the early 20th century. Most people with an e-mail account have experienced the marketing tactics of spamming – in which modern forms of quackery are touted as miraculous remedies for "weight loss" and "sexual enhancement", as well as outlets for medicines of unknown quality. 

While quackery is often aimed at the aged or chronically ill, it can be aimed at all age groups, including teens, and the FDA has mentioned some areas where potential quackery may be a problem: breast developers, weight loss, steroids and growth hormones, tanning and tanning pills, hair removal and growth, and look-alike drugs. 

In 1992, the president of The National Council Against Health Fraud, William T. Jarvis, wrote in Clinical Chemistry that:
The U.S. Congress determined quackery to be the most harmful consumer fraud against elderly people. Americans waste $27 billion annually on questionable health care, exceeding the amount spent on biomedical research. Quackery is characterized by the promotion of false and unproven health schemes for profit and does not necessarily involve imposture, fraud, or greed. The real issues in the war against quackery are the principles, including scientific rationale, encoded into consumer protection laws, primarily the U.S. Food, Drug, and Cosmetic Act. More such laws are badly needed. Regulators are failing the public by enforcing laws inadequately, applying double standards, and accrediting pseudomedicine. Non-scientific health care (e.g., acupuncture, ayurvedic medicine, chiropractic, homeopathy, naturopathy) is licensed by individual states. Practitioners use unscientific practices and deception on a public who, lacking complex health-care knowledge, must rely upon the trustworthiness of providers. Quackery not only harms people, it undermines the scientific enterprise and should be actively opposed by every scientist.
For those in the practice of any medicine, to allege quackery is to level a serious objection to a particular form of practice. Most developed countries have a governmental agency, such as the Food and Drug Administration (FDA) in the US, whose purpose is to monitor and regulate the safety of medications as well as the claims made by the manufacturers of new and existing products, including drugs and nutritional supplements or vitamins. The Federal Trade Commission (FTC) participates in some of these efforts. To better address less regulated products, in 2000, US President Clinton signed Executive Order 13147 that created the White House Commission on Complementary and Alternative Medicine. In 2002, the commission's final report made several suggestions regarding education, research, implementation, and reimbursement as ways to evaluate the risks and benefits of each. As a direct result, more public dollars have been allocated for research into some of these methods.

Individuals and non-governmental agencies are active in attempts to expose quackery. According to John C. Norcross et al. less is consensus about ineffective "compared to effective procedures" but identifying both "pseudoscientific, unvalidated, or 'quack' psychotherapies" and "assessment measures of questionable validity on psycho-metric grounds" was pursued by various authors. The evidence-based practice (EBP) movement in mental health emphasizes the consensus in psychology that psychological practice should rely on empirical research. There are also "anti-quackery" websites, such as Quackwatch, that help consumers evaluate claims. Quackwatch's information is relevant to both consumers and medical professionals.

People's Republic of China

Zhang Wuben, a quack who posed as skilled in traditional Chinese medicine in the People's Republic of China, based his operation on representations that raw eggplant and mung beans were a general cure-all. Zhang, who has escaped legal liability as he portrayed himself as a nutritionist, not a doctor, appeared on television in China and authored a best-selling book, Eat Away the Diseases You Get from Eating. Zhang, who charged the equivalent of $450 for a 10-minute examination, had a two-year waiting list when he was exposed. Investigations launched after a run on mung beans revealed that contrary to his representations, he did not come from a family of accomplished traditional practitioners (中医世家) and never had the medical degree from Beijing Medical University he claimed to have. His only education was a brief correspondence or night school course, completed after he was laid off from a textile factory. Zhang, despite negative publicity on the national level, continues to practice but has committed himself to finding a cheaper cure-all than mung beans. His clinic, Wuben Hall, adjacent to Beijing National Stadium, was torn down as an illegal structure. Much of Zhang Wuben's success was due to the efforts of Chinese entrepreneurs, including one government-owned company, who promoted him.

Hu Wanlin, who did hold himself out as a doctor, was exposed in 2000 and sentenced to 15 years in prison. He adulterated his concoctions with sodium sulfate, Glauber's salt, a poison in large doses. That case resulted in creating a system of licensing medical doctors in China.

In 1992, Li Hongzhi, a former grain clerk from Jilin introduced a new version of Falun gong exercises which soon turned into a cult with a mass following. One of its controversial tenets was its quack belief that its followers need not take any medicines for any diseases and illnesses. As a number of followers began to refuse medical treatment, fall ill and die, the government began to pay more attention to it. Falun gong was banned in China, but Li escaped to the United States, with his followers. Falun gong continued to thrive in the United states as an alternative therapy.

Presence and acceptance

Albert Anker's Der Quacksalber (1879)
 
Jan Steen's De Piskijker (c. 1633–35)
 
Jan Steen's De kwakzalver (c. 1650–60)
 
A quack selling cards with a verse from the Quran which is supposed to protect the wearer from snakebites. Tabant, Aït Bouguemez valley, Central Morocco (2009).
 
There have been several suggested reasons why quackery is accepted by patients in spite of its lack of effectiveness:
  • Ignorance
Those who perpetuate quackery may do so to take advantage of ignorance about conventional medical treatments versus alternative treatments, or may themselves be ignorant regarding their own claims. Mainstream medicine has produced many remarkable advances, so people may tend to also believe groundless claims.
Medicines or treatments known to have no pharmacological effect on a disease can still affect a person's perception of their illness, and this belief in its turn does indeed sometimes have a therapeutic effect, causing the patient's condition to improve. This is not to say that no real cure of biological illness is effected – "though we might describe a placebo effect as being 'all in the mind', we now know that there is a genuine neurobiological basis to this phenomenon." People report reduced pain, increased well-being, improvement, or even total alleviation of symptoms. For some, the presence of a caring practitioner and the dispensation of medicine is curative in itself.
Lack of understanding that health conditions change with no treatment and attributing changes in ailments to a given therapy.
Also called myside bias, is the tendency to search for, interpret, or prioritize information in a way that confirms one's beliefs or hypotheses. It is a type of cognitive bias and a systematic error of inductive reasoning.
  • Distrust of conventional medicine
Many people, for various reasons, have a distrust of conventional medicine, or of the regulating organizations such as the FDA, or the major drug corporations. For example, "CAM may represent a response to disenfranchisement [discrimination] in conventional medical settings and resulting distrust".
Anti-quackery activists ("quackbusters") are often falsely accused of being part of a huge "conspiracy" to suppress "unconventional" and/or "natural" therapies, as well as those who promote them. It is alleged that this conspiracy is backed and funded by the pharmaceutical industry and the established medical care system – represented by the AMA, FDA, ADA, CDC, WHO, etc. – for the purpose of preserving their power and increasing their profits. This idea is often held by people with Antiscience views.
A great variety of pharmaceutical medications can have very distressing side effects, and many people fear surgery and its consequences, so they may opt to shy away from these mainstream treatments.
  • Cost
There are some people who simply cannot afford conventional treatment, and seek out a cheaper alternative. Nonconventional practitioners can often dispense treatment at a much lower cost. This is compounded by reduced access to healthcare.
  • Desperation
People with a serious or terminal disease, or who have been told by their practitioner that their condition is "untreatable," may react by seeking out treatment, disregarding the lack of scientific proof for its effectiveness, or even the existence of evidence that the method is ineffective or even dangerous. Despair may be exacerbated by the lack of palliative non-curative end-of-life care. Between 2012 and 2018 appeals on UK crowdfunding sites for cancer treatment with an alternative health element have raised £8 million. This is described as "a new and lucrative revenue stream for cranks, charlatans, and conmen who prey on the vulnerable."
  • Pride
Once people have endorsed or defended a cure, or invested time and money in it, they may be reluctant or embarrassed to admit its ineffectiveness and therefore recommend a treatment that does not work.
  • Fraud
Some practitioners, fully aware of the ineffectiveness of their medicine, may intentionally produce fraudulent scientific studies and medical test results, thereby confusing any potential consumers as to the effectiveness of the medical treatment.

Persons accused of quackery

Deceased

  • Thomas Allinson (1858–1918), founder of naturopathy. His views often brought him into conflict with the Royal College of Physicians of Edinburgh and the General Medical Council, particularly his opposition to doctors' frequent use of drugs, his opposition to vaccination and his self-promotion in the press. His views and publication of them led to him being labeled a quack and being struck off by the General Medical Council for infamous conduct in a professional respect.
  • Lovisa Åhrberg (1801–1881), the first Swedish female doctor. Åhrberg was met with strong resistance from male doctors and was accused of quackery. During the formal examination she was acquitted of all charges and allowed to practice medicine in Stockholm even though it was forbidden for women in the 1820s. She later received a medal for her work.
  • Johanna Brandt (1876–1964), a South African naturopath who advocated the "Grape Cure" as a cure for cancer.
  • John R. Brinkley (1885–1942), a Kansas nonphysician and xenotransplant specialist who claimed to have discovered a method of effectively transplanting the testicles of goats into aging men. After state authorities took steps to shut down his practice, he retaliated by entering politics in 1930 and running for the office of Governor of Kansas.
  • Hulda Regehr Clark (1928–2009), was a controversial naturopath, author, and practitioner of alternative medicine who claimed to be able to cure all diseases and advocated methods that have no scientific validity.
  • Max Gerson (1881–1959), was a German-born American physician who developed a dietary-based alternative cancer treatment that he claimed could cure cancer and most chronic, degenerative diseases. His treatment was called The Gerson Therapy. Most notably, Gerson Therapy was used, unsuccessfully, to treat Jessica Ainscough. According to Quackwatch, Gerson Institute claims of cure are based not on actual documentation of survival, but on "a combination of the doctor's estimate that the departing patient has a 'reasonable chance of surviving', plus feelings that the Institute staff have about the status of people who call in". The American Cancer Society reports that "[t]here is no reliable scientific evidence that Gerson therapy is effective..."
  • Samuel Hahnemann (1755–1843), founder of homeopathy. Hahnemann believed that all diseases were caused by "miasms," which he defined as irregularities in the patient's vital force. He also said that illnesses could be treated by substances that in a healthy person produced similar symptoms to the illness, in extremely low concentrations, with the therapeutic effect increasing with dilution and repeated shaking.
  • Lawrence B. Hamlin (in 1916), was fined under the 1906 Pure Food and Drug Act for advertising that his Wizard Oil could kill cancer.
  • L. Ron Hubbard (1911–1986), was the founder of the Church of Scientology. He was an American science fiction writer, former United States Navy officer, and creator of Dianetics. He has been commonly called a quack and a con man by both critics of Scientology and by many psychiatric organizations in part for his often extreme anti-psychiatric beliefs.
  • William Donald Kelley, (1925–2005), was an orthodontist and a follower of Max Gerson who developed his own alternative cancer treatment called Nonspecific Metabolic Therapy. This treatment is based on the unsubstantiated belief that "wrong foods [cause] malignancy to grow, while proper foods [allow] natural body defenses to work". It involves, specifically, treatment with pancreatic enzymes, 50 daily vitamins and minerals (including laetrile), frequent body shampoos, coffee enemas, and a specific diet. According to Quackwatch, "not only is his therapy ineffective, but people with cancer who take it die more quickly and have a worse quality of life than those having standard treatment, and can suffer serious or fatal side-effects. Kelley's most famous patient was actor Steve McQueen.
  • John Harvey Kellogg (1852–1943), was a medical doctor in Battle Creek, Michigan, USA who ran a sanitarium using holistic methods, with a particular focus on nutrition, enemas and exercise. Kellogg was an advocate of vegetarianism and invented the corn flake breakfast cereal with his brother, Will Keith Kellogg.
  • John St. John Long (1798–1834) was an Irish artist who claimed to be able to cure tuberculosis by causing a sore or wound on the back of the patient, out of which the disease would exit. He was tried twice for manslaughter of his patients who died under this treatment.
  • Franz Anton Mesmer (1734–1815), was a German physician and astrologist, who invented what he called magnétisme animal.
  • Theodor Morell (1886–1948), a German physician best known as Adolf Hitler's personal doctor. Morell administered approximately 74 substances (in 28 different mixtures) to Hitler, including heroin, cocaine, Doktor Koster's Antigaspills, potassium bromide, papaverine, testosterone, vitamins and animal enzymes.[70] Despite Hitler's dependence on Morell, and his recommendations of him to other Nazi leaders, Hermann Göring, Heinrich Himmler, Albert Speer and others quietly dismissed Morell as a quack.
  • Daniel David Palmer (1845–1913), was a grocery store owner that claimed to have healed a janitor of deafness after adjusting the alignment of his back. He founded the field of chiropractic based on the principle that all disease and ailments could be fixed by adjusting the alignment of someone's back. His hypothesis was disregarded by medical professionals at the time and despite a considerable following has yet to be scientifically proven. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself 'doctor'. Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion that he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack."
  • Louis Pasteur (1822–1895), was a French chemist best known for his remarkable breakthroughs in microbiology. His experiments confirmed the germ theory of disease, also reducing mortality from puerperal fever (childbed), and he created the first vaccine for rabies. He is best known to the general public for showing how to stop milk and wine from going sour – this process came to be called pasteurization. His hypotheses initially met with much hostility, and he was accused of quackery on multiple occasions. However, he is now regarded as one of the three main founders of microbiology, together with Ferdinand Cohn and Robert Koch.
  • Linus Pauling (1901–1994), a Nobel Prize winner in chemistry, Pauling spent much of his later career arguing for the treatment of somatic and psychological diseases with orthomolecular medicine. Among his claims were that the common cold could be cured with massive doses of vitamin C. Together with Ewan Cameron he wrote the 1979 book "Cancer and Vitamin C", which was again more popular with the public than the medical profession, which continued to regard claims about the effectiveness of vitamin C in treating or preventing cancer as quackery. A biographer has discussed how controversial his views on megadoses of Vitamin C have been and that he was "still being called a 'fraud' and a 'quack' by opponents of his 'orthomolecular medicine'".
  • Doctor John Henry Pinkard (1866–1934) was a Roanoke, Virginia businessman and "Yarb Doctor" or "Herb Doctor" who concocted quack medicines that he sold and distributed in violation of the Food and Drugs Act and the earlier Pure Food and Drug Act. He was also known as a "...clairvoyant, herb doctor and spiritualist." Some of Pinkard's Sanguinaria Compound, made from bloodroot or bloodwort, was seized by federal officials in 1931. "Analysis by this department of a sample of the article showed that it consisted essentially of extracts of plant drugs including sanguinaria, sugar, alcohol, and water. It was alleged in the information that the article was misbranded in that certain statements, designs, and devices regarding the therapeutic and curative effects of the article, appearing on the bottle label, falsely and fraudulently represented that it would be effective as a treatment, remedy, and cure for pneumonia, coughs, weak lungs, asthma, kidney, liver, bladder, or any stomach troubles, and effective as a great blood and nerve tonic." He pleaded guilty and was fined.
  • Wilhelm Reich (1897–1957), Austrian-American Psychoanalyst. Claimed that he had discovered a primordial cosmic energy called Orgone. He developed several devices, including the Cloudbuster and the Orgone Accumulator, that he believed could use orgone to manipulate the weather, battle space aliens and cure diseases, including cancer. After an investigation, the FDA concluded that they were dealing with a "fraud of the first magnitude". On February 10, 1954, the U.S. Attorney for Maine filed a complaint seeking a permanent injunction under Sections 301 and 302 of the Federal Food, Drug, and Cosmetic Act, to prevent interstate shipment of orgone accumulators and to ban some of Reich's writing promoting and advertising the devices. Reich refused to appear in court, arguing that no court was in a position to evaluate his work. Reich was arrested for contempt of court, and convicted to 2 years in jail, a $10,000 fine, and his Orgone Accumulators and work on Orgone were ordered to be destroyed. On August 23, 1956, six tons of his books, journals, and papers were burned in the 25th Street public incinerator in New York. On March 12, 1957 he was sent to Danbury Federal Prison, where Richard C. Hubbard, a psychiatrist who admired Reich, examined him, recording paranoia manifested by delusions of grandiosity, persecution, and ideas of reference. On November 18, 1957 Reich died of a heart attack 9 months later while he was in the federal penitentiary in Lewisburg, Pennsylvania.
  • William Herbert Sheldon (1898–1977), who created the theory of somatotypes corresponding to intelligence.

Living

  • Stanislaw Burzynski conducts experimental research on and administers antineoplastons to cancer patients, which are ineffective and dangerous. Burzynski operates the Burzynski Clinic in Houston, Texas. He has been involved in numerous lawsuits and the subject of FDA warnings. Aided through aggressive legal threats to critics and an active group of patient-supporters, Burzynski continues practicing cancer quackery.
  • Ann Louise Gittleman (born 1949) published a series of fad diet books that promote pseudoscientific ideas about weight loss, "detoxification" and electromagnetic radiation. She received a PhD from the now-defunct Clayton College of Natural Health, which is known as a diploma mill that gave degrees to a number of individuals who went on to be accused of quackery.
  • Mehmet Oz (born 1960), as host of The Dr. Oz Show, has promoted pseudoscientific health treatments and supplements and faced a hearing at the United States Senate for helping companies sell fraudulent medicine.
  • Kevin Trudeau (born 1963) published several books about cures relating to maladies, weight loss and debt. He is currently in jail in Alabama for failing to pay a $37.6 million fine that he incurred as a result of claims he made in his book about weight loss cures.[93][94][95]
  • Tullio Simoncini (born 1951) has claimed that cancer is caused by, and in fact is, the yeast Candida albicans, and that it can be cured with an injection of sodium bicarbonate. He was convicted in 2006 of manslaughter due to the death of one of his patients and came under fire again in 2012 after attempting to promote his treatment in Totnes, in violation of the Cancer Act 1939.
  • Belle Gibson (born 1991) falsely claimed that she had brain cancer which was cured by alternative therapies and nutrition as outlined in her book "The Whole Pantry". She was convicted of misleading and deceptive conduct by Consumer Affairs Victoria, Australia. She was ordered to pay a fine of $410,000 AUD

Orthomolecular medicine

From Wikipedia, the free encyclopedia

Orthomolecular medicine
Alternative medicine
ClaimsHealth effects of dietary supplements, particularly vitamin megadoses.
Related fieldsNaturopathy
Original proponentsLinus Pauling (coined term)
MeSHD009974

Orthomolecular medicine, a form of alternative medicine, aims to maintain human health through nutritional supplementation. The concept builds on the idea of an optimum nutritional environment in the body and suggests that diseases reflect deficiencies in this environment. Treatment for disease, according to this view, involves attempts to correct "imbalances or deficiencies based on individual biochemistry" by use of substances such as vitamins, minerals, amino acids, trace elements and fatty acids. The notions behind orthomolecular medicine are not supported by sound medical evidence and the therapy is not effective; even the validity of calling the orthomolecular approach a form of medicine has been questioned since the 1970s.

The approach is sometimes referred to as megavitamin therapy because its practice evolved out of, and in some cases still uses, doses of vitamins and minerals many times higher than the recommended dietary intake. Orthomolecular practitioners may also incorporate a variety of other styles of treatment into their approaches, including dietary restriction, megadoses of non-vitamin nutrients and mainstream pharmaceutical drugs. Proponents argue that non-optimal levels of certain substances can cause health issues beyond simple vitamin deficiency and see balancing these substances as an integral part of health.

Linus Pauling coined the term "orthomolecular" in the 1960s to mean "the right molecules in the right amounts" (ortho- in Greek implies "correct"). Proponents of orthomolecular medicine hold that treatment must be based on each patient's individual biochemistry.

The scientific and medical consensus holds that the broad claims of efficacy advanced by advocates of orthomolecular medicine are not adequately tested as drug therapies. It has been described as a form of food faddism and as quackery. Proponents point to mainstream sources that have published research supporting the benefits of nutrient supplementation and to instances where conventional medicine uses vitamins as treatments for some diseases.

Some vitamins in large doses have been linked to increased risk of cardiovascular disease, of cancer and of death. The scientific consensus view is that for normal individuals, a balanced diet contains all necessary vitamins and minerals, and that routine supplementation is not necessary absent specific diagnosed deficiencies.

History and development

In the early 20th century, some doctors hypothesised that vitamins could cure disease, and supplements were prescribed in megadoses by the 1930s. Their effects on health were disappointing, though, and in the 1950s and 1960s, nutrition was de-emphasised in standard medical curricula. Riordon's organization cite figures from this period as founders of their movement, although the word "orthomolecular" was coined by Linus Pauling only in 1967. 

Amongst the individuals described posthumously as orthomolecularists are Max Gerson, who developed a diet that he claimed could treat diseases, which the American Medical Association's 1949 Council on Pharmacy and Chemistry found ineffective; and the Shute brothers, who attempted to treat heart disease with vitamin E. Several concepts now cited by orthomolecularists, including individual biochemical variation and inborn errors of metabolism, debuted in scientific papers early in the 20th century. 

In 1948, William McCormick theorized that vitamin C deficiency played an important role in many diseases and began to use large doses in patients. In the 1950s, Fred R. Klenner also tried vitamin C megadosage as a therapy for a wide range of illnesses, including polio. Irwin Stone stated that organisms that do not synthesise their own vitamin C due to a loss-of-function mutation have a disease he called "hypoascorbemia". This term is not used by the medical community, and the idea of an organism-wide lack of a biosynthetic pathway as a disease was not endorsed by Stone's contemporaries.

In the 1950s, some individuals believed that vitamin deficiencies caused mental illness. Psychiatrists Humphry Osmond and Abram Hoffer gave people having acute schizophrenic episodes high doses of niacin, while William Kaufman used niacinamide. While niacin has no known efficacy in psychiatric disease, the use of niacin in combination with statins and other medical therapies has become one of several medical treatments for cardiovascular disease.

In the late 1960s, Linus Pauling introduced the expression "orthomolecular" to express the idea of the right molecules in the right amounts. Since the first claims of medical breakthroughs with vitamin C by Pauling and others, findings on the health effects of vitamin C have been controversial and contradictory. Pauling's claims have been criticised as overbroad.

Later research branched out into nutrients besides niacin and vitamin C, including essential fatty acids.

Scope

According to Abram Hoffer, orthomolecular medicine does not purport to treat all diseases, nor is it "a replacement for standard treatment. A proportion of patients will require orthodox treatment, a proportion will do much better on orthomolecular treatment, and the rest will need a skillful blend of both." Nevertheless, advocates have said that the right nutrients at the optimum dose for the individual concerned can prevent, treat, and sometimes cure a wide range of medical conditions. Conditions for which orthomolecular practitioners have claimed some efficacy are: acne, alcoholism, allergies, arthritis, autism, bee stings, bipolar disorder, burns, cancer, the common cold, depression, drug addiction, drug overdose, epilepsy, heart diseases, heavy metal toxicity, acute hepatitis, herpes, hyperactivity, hypertension, hypoglycemia, influenza, learning disabilities, mental and metabolic disorders, migraine, mononucleosis, mushroom poisoning, neuropathy & polyneuritis (including multiple sclerosis), osteoporosis, polio, a hypothesised condition called "pyroluria", radiation sickness, Raynaud's disease, mental retardation, schizophrenia, shock, skin problems, snakebite, spider bite, tetanus toxin and viral pneumonia.

Orthomolecular psychiatry

Hoffer believed that particular nutrients could cure mental illness. In the 1950s, he attempted to treat schizophrenia with niacin, although proponents of orthomolecular psychiatry say that the ideas behind their approach predate Hoffer. According to Hoffer and others who called themselves "orthomolecular psychiatrists", psychiatric syndromes result from biochemical deficiencies, allergies, toxicities or several hypothetical contributing conditions which they termed pyroluria, histadelia and histapenia. These purported causes were said to be found during an "individual biochemical workup" and treated with megavitamin therapy and dietary changes including fasting. These diagnoses and treatments are not accepted by evidence-based medicine.

Principles

According to Abram Hoffer, "primitive" peoples do not consume processed foods and do not have "degenerative" diseases. In contrast, typical "Western" diets are said to be insufficient for long-term health, necessitating the use of megadose supplements of vitamins, dietary minerals, proteins, antioxidants, amino acids, ω-3 fatty acids, ω-6 fatty acids, medium-chain triglycerides, dietary fiber, short and long chain fatty acids, lipotropes, systemic and digestive enzymes, other digestive factors, and prohormones to ward off hypothetical metabolism anomalies at an early stage, before they cause disease.

Orthomolecularists say that they provide prescriptions for optimal amounts of micronutrients after individual diagnoses based on blood tests and personal histories. Lifestyle and diet changes may also be recommended. The battery of tests ordered includes many that are not considered useful by medicine.

Prevalence

Orthomolecular medicine is practiced by few medical practitioners.

A survey released in May, 2004 by the National Center for Complementary and Alternative Medicine focused on who used alternative medicine, what was used, and why it was used in the United States by adults age 18 years and over during 2003. The survey reported uses in the previous twelve months that include orthomolecular related uses: Nonvitamin, nonmineral, natural products 18.9%, Diet-based therapies 3.5%, Megavitamin therapy 2.8%.

Another recent CAM survey reported that 12% of liver disease patients used the antioxidant silymarin, more than 6% used vitamins, and that "in all, 74% of patients reported using CAM in addition to the medications prescribed by their physician, but 26% did not inform their physician of their CAM use."

Even though the health benefits are not established, the use of high doses of vitamins is also common in people who have been diagnosed with cancer. According to Cancer Research UK, cancer patients should always seek professional advice before taking such supplements, and using them as a substitute for conventional treatment "could be harmful to [their] health and greatly reduce the chance of curing or controlling [their] cancer".

Medical and scientific reception

Methodology

Orthomolecular therapies have been criticized as lacking a sufficient evidence base for clinical use: their scientific foundations are too weak, the studies that have been performed are too few and too open to interpretation, and reported positive findings in observational studies are contradicted by the results of more rigorous clinical trials. Accordingly, "there is no evidence that orthomolecular medicine is effective". Proponents of orthomolecular medicine strongly dispute this statement by citing studies demonstrating the effectiveness of treatments involving vitamins, though this ignores the belief that a normal diet will provide adequate nutrients to avoid deficiencies, and that orthomolecular treatments are not actually related to vitamin deficiency. The lack of scientifically rigorous testing of orthomolecular medicine has led to its practices being classed with other forms of alternative medicine and regarded as unscientific. It has been described as food faddism and quackery, with critics arguing that it is based upon an "exaggerated belief in the effects of nutrition upon health and disease." Orthomolecular practitioners will often use dubious diagnostic methods to define what substances are "correct"; one example is hair analysis, which produces spurious results when used in this fashion.

Proponents of orthomolecular medicine contend that, unlike some other forms of alternative medicine such as homeopathy, their ideas are at least biologically based, do not involve magical thinking, and are capable of generating testable hypotheses. Orthomolecular is not a standard medical term, and clinical use of specific nutrients is considered a form of chemoprevention (to prevent or delay development of disease) or chemotherapy (to treat an existing condition).

Despite a lack of evidence for its efficacy, interest in intravenous high dose vitamin C therapy has not been permanently extinguished, and some research groups continue to investigate whether it has an effect as a possible cancer treatment.

Views on safety and efficacy

In general, the vitamin megadoses advocated by orthomolecular medicine are unsupported by scientific consensus. Some vitamins are toxic in high doses, including niacin (B3), cholecalciferol (D) and tocopherol (E). The view of the medical community is that there is no evidence for the efficacy of Orthomolecular medicine as a treatment for cancer, and that high vitamin doses may – on the contrary – increase overall mortality. Nutritional treatments are not generally accepted as being helpful for psychological health. Its claims have been criticized by most medical organizations, including the American Cancer Society, the American Psychiatric Association, the National Institute of Mental Health, the American Academy of Pediatrics, CHAMPUS, and the Canadian Paediatric Society. The American Medical Association describes as "myths" the ideas that adequate nutrition is not readily achievable with normal food, all food grown with pesticide is poisonous, all food additives are poisonous, vitamin and mineral deficiencies are common, that the cause of most disease is poor diet, which can be prevented by nutritional supplements. 

Similarly, the American Cancer Society comments that the current scientific evidence does not "support use of orthomolecular therapy for most of the conditions for which it is promoted." Some supplements have exhibited benefits for specific conditions, while a few have been confirmed to be harmful; the consumption of nutritious foods is the best recognized method to obtain vitamins, minerals, and nutrients crucial for good health. Barrie Cassileth, an adviser on alternative medicine to the National Institutes of Health, stated that "scientific research has found no benefit from orthomolecular therapy for any disease," and medical textbooks also report that there is "no evidence that megavitamin or orthomolecular therapy is effective in treating any disease."

A 1973 task force of the American Psychiatric Association unanimously concluded:
This review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. It concludes in this regard that the credibility of the megavitamin proponents is low. Their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion. Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment," to be deplorable.
In response to claims that orthomolecular medicine could cure childhood psychoses and learning disorders, the American Academy of Pediatrics labelled orthomolecular medicine a "cult" in 1976.

Proponents of orthomolecular medicine counter that some vitamins and nutrients are now used in medicine as treatments for specific diseases, such as megadose niacin and fish oil for dyslipidemias, and megavitamin therapies for a group of rare inborn errors of metabolism. A review in the Annals of Internal Medicine concluded that while some therapies might be beneficial, others might be harmful or interfere with effective medical therapy. A recent study of over 161,000 individuals provided, in the words of the authors, "convincing evidence that multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease, or total mortality in postmenopausal women." A recent meta-analysis in JAMA suggested that supplementation with combinations of antioxidant vitamins (beta-carotene, vitamin A, and vitamin E) may increase mortality, although with respect to beta-carotene this conclusion may be due to the known harmful effect in smokers.

Safety

In the United States, pharmaceuticals must be proven safe and effective to the satisfaction of the FDA before they can be marketed, whereas dietary supplements must be proven unsafe before regulatory action can be taken. A number of orthomolecular supplements are available in the US in pharmaceutical versions that are sometimes quite similar in strength and general content, or in other countries are regulated as pharmaceuticals. The US regulations also have provisions to recognize a general level of safety for established nutrients that can forgo new drug safety tests. Proponents of orthomolecular medicine argue that supplements are less likely to cause dangerous side-effects or harm, since they are normally present in the body. Some vitamins are toxic in high doses and nearly all (with the possible exception of Vitamin C) will cause adverse effects given high levels of overdosing for prolonged periods as recommended by orthomolecular practitioners. Forgoing medical care in favor of orthomolecular treatments can lead to adverse health outcomes.

Health professionals see orthomolecular medicine as encouraging individuals to dose themselves with large amounts of vitamins and other nutrients without conventional supervision, which they worry might be damaging to health. Potential risks of inappropriate vitamin and supplement regimes include an increased risk of coronary heart disease, hypertension, thrombophlebitis, peripheral neuropathy, ataxia, neurological effects, liver toxicity, congenital abnormalities, spontaneous abortion, gouty arthritis, jaundice, kidney stones, and diarrhea. In their book Trick or Treatment?, Edzard Ernst and Simon Singh conclude that "The concepts of orthomolecular medicine are not biologically plausible and not supported by the results of rigorous clinical trials. These problems are compounded by the fact that orthomolecular medicine can cause harm and is often very expensive."

Example: vitamin E

Orthomolecular proponents claim that even large doses of vitamin E pose no risk to health and are useful for the treatment and prevention of a broad list of conditions, including heart and circulatory diseases, diabetes and nephritis. Initial hopes for the usefulness of vitamin E in orthomolecular medicine were based on epidemiological studies suggesting that people who consumed more vitamin E had lower risks of chronic disease, such as coronary heart disease. These observational studies could not distinguish between whether the higher levels of vitamin E improved health themselves, or whether confounding variables (such as other dietary factors or exercise) were responsible. To distinguish between these possibilities, a number of randomized controlled trials were performed and meta-analysis of these controlled clinical trials have not shown any clear benefit from any form of vitamin E supplementation for preventing chronic disease. Further clinical studies show no benefit of vitamin E supplements for cardiovascular disease. The current position of the American National Institutes of Health is that there is no convincing evidence that vitamin E supplements can prevent or treat any disease.

Beyond the lack of apparent benefit, a series of three meta-analyses reported that vitamin E supplementation is associated with an increased risk of death; one of the meta-analyses performed by the Cochrane Collaboration also found significantly increased mortality for the antioxidant vitamins A and beta-carotene. A subsequent meta-analysis found no mortality benefit from vitamin E, but also no increase in mortality either.

Use in AIDS

Several articles in the alternative-medicine literature have suggested that orthomolecular-related dietary supplementation might be helpful for patients with HIV/AIDS. A study using 250 mg and 1000 mg doses of vitamin C along with other antioxidants to treat people with AIDS did not find any benefit. However, these doses are far smaller than the ones used by orthomolecular physicians for treatment of AIDS.

A meta analysis in 2010 found that micronutrient supplementation decreased the risk of death and improved outcomes in pregnant women with HIV in Africa. A 2017 Cochrane review found no strong evidence to suggest that micronutrient supplementation prevents death or is effective at slowing the progression of disease for adults with HIV. It is important for people living HIV to eat a healthy adequate diet. For people with HIV that have clinically demonstrated deficiencies in micronutrients or for people who are not able to consume the recommended daily quantities of minerals and vitamins, supplementation is still encouraged. Vitamin A in children with HIV appears to be safe and beneficial. Vitamin A deficiency is found in children with HIV infection who may or may not have symptoms of AIDS. Vitamin A supplementation reduces morbidity and mortality in AIDS symptomatic children, but has no effect on asymptomatic children. It does not prevent HIV infection, cannot treat the chronic HIV infection, and will not cure AIDS.

Deaths resulting from illegal vitamin trials in South Africa

Matthias Rath has been extensively criticized for presenting his vitamin supplements as a treatment for AIDS and for testing them in illegal trials in South Africa. A former associate of Linus Pauling, Rath has promoted vitamins as a treatment for HIV infection, describing treatment with effective antiretroviral drugs as toxic and part of a global conspiracy serving the financial interests of the pharmaceutical industry. In a lawsuit that found against Rath, the South African Medical Association blamed his vitamin products for several deaths. The World Health Organization and two health agencies of the United Nations also described Rath’s advertisements as “wrong and misleading” and “an irresponsible attack on ARV (antiretroviral) therapy.” The South African Centre for Social Science Research described the trials as "state sponsored pseudo-science". Rath's trials, conducted with the aid of AIDS denialist David Rasnick, were declared unlawful by the Cape High Court; Rath, Rasnick and their foundation were barred from conducting further unauthorised clinical trials and from advertising their products.

Alleged institutional bias

Advocates of orthomolecular medicine, including Pauling, Hoffer and Ewan Cameron have claimed that their findings are actively suppressed by the medical and pharmaceutical industry. Hoffer wrote "There is no conspiracy led and directed by a single person or by a single organization. There is no Mafia in psychiatry. However, there is a conspiracy led and directed by a large number of professionals and their associations who have a common aim to protect their hard-earned orthodoxy, no matter what the cost to their opponent colleagues or to their patients.".

The Journal of Orthomolecular Medicine, founded in 1967 as the Journal of Schizophrenia, is a major publication of orthomolecular medicine. As Abram Hoffer wrote:
We had to create our own journals because it was impossible to obtain entry into the official journals of psychiatry and medicine. Before 1967 I had not found it difficult to publish reports in these journals, and by then I had about 150 articles and several books in the establishment press.
Other members of the medical community deny the existence of such an institutional prejudice. A review in the Journal of Clinical Oncology denied that physicians collude against unconventional treatments. Despite claims of conspiracy, the Linus Pauling Institute's funding comes primarily from the National Institutes of Health, and in 1995 some orthomolecular therapies were reported as being sanctioned in Japan.

Lie point symmetry

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Lie_point_symmetry     ...