Real or Just a Placebo—
a Sometimes Dangerous Placebo?
Complementary medicine is an unregulated jungle of therapies, supplements, and theories. And like any jungle, it’s a storehouse of peril as well as promise.
By David Nayor
with Mark Frankel
Illustration by David Pohl
Sam D. is a calm and rational guy. So when the 51-year-old father of three (who asked that his name and address not be revealed) was diagnosed with Non-Hodgkin’s Lymphoma six years ago, he didn’t panic. Instead, he set out to find the best and latest available treatment options. “I saw a half-dozen oncologists, none of whom said they could cure my cancer,” he says. “I knew about the side effects of conventional cancer therapy and tried everything I could to avoid it.” His search for a cure led him to try many “non-conventional” treatments, including intravenous vitamin therapy—administered at the Schachter Center for Complementary Medicine in Suffern, New York, in addition to medical centers in Manhattan and Long Island. He even went so far as to fly to Germany to try a popular but unproven treatment recommended, he says, by the
The only problem: Sam nearly died. His cancer, which conventional doctors thought was treatable, spread to such an extent that tumors began pressing against his spinal cord, paralyzing him from the waist down. “I couldn’t do anything by myself,” he says. “It took two people just to turn me over.” Sam, then still in Germany, knew he needed conventional treatment, but his case looked so hopeless that he couldn’t find any hospital in the U.S. that would agree to treat him. Then, finally, the Sinai Hospital in Baltimore agreed to admit him. “U.S. hospitals didn’t want to admit me because I needed treatment immediately,” Sam says. “Often, you need a biopsy before you start treatment, and the results take about ten days. They didn’t think I had ten days left. Sinai was the only hospital that would admit me.”
Fortunately for Sam, he was able to afford state-of-the-art medical treatment. He immediately rented a private plane to fly him to Baltimore. After several intensive rounds of radiation treatments and chemotherapy, Sam’s condition began to improve. Today, his cancer is in remission and, though he’s no longer paralyzed, he walks with a cane. Interestingly, Sam holds no ill will towards the doctors who tried—in unconventional ways—to rid his body of cancer. “I blame myself for not going the more conventional route.”
Michael Schachter, MD, of the Schachter Center, who treated Sam with intravenous vitamin C, is familiar with Sam’s case. “It didn’t work for him, but we see many, many other patients who regularly get high-dose vitamin C and it seems to help,” says Dr. Schachter, who is a psychiatrist. “Most patients use the therapy as an adjunct to conventional treatments. But even with the patients who don’t get conventional treatments, we see results, including low recurrence rates and very few side effects.” He cites a study done by Dr. Mark Levine, chief of molecular and clinical nutrition at the National Institute of Diabetes & Digestive & Kidney Diseases that seems to support the high-dose vitamin C treatments. The study was performed on isolated cells in a laboratory.
Sam was not alone in his willingness to utilize alternative treatment. An increasing number of Americans are heading down similar roads and choosing non-conventional treatments for their medical problems, whether they’re for cancer, diabetes, asthma, heart problems, obesity, or merely to put some zip back into their flagging libidos. According to a 2004 survey by the National Center for Complementary and Alternative Medicine (CAM), a part of the Federal National Institutes of Health, more than a third of the U.S. population—some 36 percent—over the age of 18 had used some form of CAM, which the center defined as “a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional [allopathic] medicine.”
CAM covers a vast area, seemingly everything from acupuncture to herbal, vitamin, and mineral supplements, to vitamin therapies, to unconventional therapies such as colonic hydrotherapy and chelation therapy. It’s estimated that some two million American men, to give but one example, regularly dose themselves with saw palmetto, a popular herbal product that is said by proponents of CAM, including the Cochran Collaboration, a nonprofit organization that reviews medical literature, to treat enlarged prostate glands. More than $100 million a year is spent on the herb. Overall, the financial stakes are huge: U.S. consumers spent an estimated $34 billion on CAM-related therapies in 2004 (the last year for which statistics are available), which works out to about two percent of the nation’s overall healthcare spending.
Unfortunately, many claims for CAM are questionable. A number of popular alternative medical therapies are, experts say, at best, useless, and at worst harmful to the very patients who put their trust in them.
“Before patients come to see me, I ask them to bring a list of the supplements and medications they’re taking,” says Shelley Mesznik, a Mount Kisco-based registered dietician and adjunct professor at Columbia University’s Teacher’s College. “Sometimes, I’m shocked at what they’re bringing in.” She says that, while less than half of her patients use supplements, including multivitamins, fish oil, and pills that are supposed to aid weight loss, too many of her prospective patients regard CAM supplements as a veritable panacea, using them without proper guidance and in lieu of making real or substantive changes in their behavior.
“I had a 22-year-old patient with pre-diabetes who knew he needed to do something because of a family history of diabetes, and his weight was interfering with his job as an electrician,” she explains. “The sad thing is that he’s spent hundreds—if not thousands—on supplements, including six hundred dollars at one sitting, and he’s still gaining weight. Clearly, they’re not making the difference he expected.” And that saw palmetto on which men are spending beaucoup bucks? According to a recent Wall Street Journal article, saw palmetto was found to be no better than a placebo at treating enlarged prostates.
Marcia Angell, MD, senior lecturer in the Department of Social Medicine at Harvard Medical School and one of the nation’s most persistent and outspoken critics of alternative medicine, says: “The biggest problem with CAM is that it’s not scientifically proven. Often it is wrongly claimed that it cannot be tested by the usual scientific methods. That is nonsense. Medical history is filled with instances of treatments that were accepted on the basis of testimonials and tradition that later turned out to be ineffective—or worse.” She adds: “There is no substitute for scientific testing, and all the mystical claptrap in the world does not change that.”
In fact, recent scientific studies have demonstrated that even some of the most widely embraced alternative herbal remedies are little more than old wives’ tales. Take the example of Echinacea, a plant genus native to the Midwest that’s been touted for its medical benefits for centuries, starting with Native Americans. In recent years, it has been widely promoted and accepted by many throughout America and Europe for its supposed ability to boost the immune system and as a prophylactic treatment for upper respiratory infections.
But there’s little hard scientific evidence that Echinacea is good for anybody (except the people who sell it, that is). In one study published in the June 2000 issue of Antimicrobial Agents and Chemotherapy, researchers gave 117 people either Echinacea or a placebo for two weeks, and then exposed them to cold viruses. Those who took the Echinacea were just as likely to develop colds as those who took a placebo. Another study, published in the journal Clinical Infectious Diseases, found that when 48 volunteers were given either Echinacea or a placebo before being exposed to a cold virus, nine out of 10 volunteers in both groups came down with colds. Other research suggests that taking Echinacea for too long might actually weaken one’s resistance to cold viruses.
But such hard facts have done little to dampen CAM’s growing appeal. There are literally hundreds of unregulated herbs and supplements on the market, many of which have been embraced by the public to treat a variety of real (and imagined) illnesses and complaints. Many of these supplements benefit from some medical consumers’ deeply-held-but-knee-jerk belief that any nostrum that is labeled “natural” is somehow good and beneficial while, conversely, any manufactured pharmaceutical has got to be destructive to human health. (By this line of reasoning, naturally occurring substances like lead and arsenic should be good for you, too.) In reality, bee pollen, bitter orange, blue green algae, comfrey, germanium, licorice, pennyroyal, and yohimbe are just a few of the many supplements that have been linked to numerous side effects, some even to delirium and liver damage.
Many alternative therapies have benefited from praise or discussion by the likes of popular figures like broadcaster Larry King, advice maven Dr. Phil McGraw, and even alternative health guru Dr. Andrew Weil.
“I see it every day. People come to my office with bags of supplements and/or herbal remedies,” says gastroenterologist and internist Maxwell Chait, MD, of the Hartsdale Medical Group, and an assistant professor of medicine at the College of Physicians and Surgeons at Columbia University Medical School. “It’s a very common problem.” The problem, as Dr. Chait sees it, is not that people are trying alternative remedies, but that they’re doing so without rhyme or reason. “I’m not necessarily opposed to these things.
In fact, I use non-conventional treatments in my office, including folic acid to lower blood homocysteine levels [which are associated with cardiovascular disease] and probiotics [dietary supplements containing bacteria] such as Acidophilus and Bifidus to treat irritable bowel syndrome,” he says. “The problem is that a variety of these remedies have side effects and can even exacerbate certain conditions. For example, many popular herbal remedies for constipation contain Senna [a flowering plant], which can actually cause dehydration and worsen the condition or cause melanosis coli, a darkening of the intestine.”
And in some cases, like that of Sam’s, patients become so enamored with unproven alternative remedies that they avoid proven medical treatments that can actually help them.
New York City-based Morton Coleman, MD, Sam’s oncologist, couldn’t agree more. Sam “was treatable,” he says. “Had he come in earlier, he would have avoided some of the long-term effects he now suffers from.”
“I worry that patients are potentially putting themselves at risk by abandoning traditional therapies,” says Dr. Chait. “I’ve actually seen patients miss the opportunity to treat a malignancy because they opted for less traditional and unproven therapies. In each case, the consequence was a further spread of the disease, and in some cases the result was even death.”
He sadly reports of one woman, a patient at his practice, who, after being diagnosed with breast cancer and told of her treatment options, decided to go the non-traditional route, which included the use of vitamin supplements. When she came back and Dr. Chait saw her again, it was too late. “The tumor had spread,” he says, and the woman died. “That’s why I say that, though I’m not against non-conventional treatments, they should be used in conjunction with traditional medicine and under the supervision of a medical doctor.”
Nobody knows how many patients have actually been harmed by CAM. “There’s no way to put that number together. You can’t quantify the mental harm or the financial harm that results from patients relying upon CAM,” says Stephen Barrett, MD, a Pennsylvania-based retired psychiatrist who founded Quackwatch.org, a non-profit organization that combats health-related frauds, myths, fads, and fallacies. No comprehensive studies of the adverse impact of CAM have been done, Dr. Barrett says, partly because of the high cost of funding such a broad-based study and partly because of the vague definition of CAM itself. “CAM is a marketing term that can be slapped on anything the proponents damn please,” he says.
For many Americans, using various CAM therapies is considered no more wacky or off-kilter than doing daily exercise or watching their diets. When Desiree Ferguson, a Peekskill mother of two, entered her thirties, she began making monthly appointments for colonic hydrotherapy. “Honestly, I had an epiphany and felt like I needed to clean the slate both physically and mentally,” says Ferguson, now in her late thirties. Asked how she knows the treatment is working, Ferguson says, “I have more energy, and my skin looks better. I just feel much healthier.”
Colonic hydrotherapy, which is basically a supersized enema that cleanses the large intestine through the administration of water, herbal solutions, enzymes, and other substances such as coffee, has become an increasingly popular treatment. In some quarters, it’s considered almost a social ritual. (Remember the scene from the 1991 film comedy L.A. Story, in which Steve Martin’s lascivious weatherman and his spacey young date SanDeE*, played by Sarah Jessica Parker, receive high colonics to get their date off to a rousing start?) For those who are truly “full of it,” colonic hydrotherapy may offer some physical relief. However, proponents claim it is much more than a quick fix for constipation. They insist that it detoxifies the body by ridding it of ancient fecal matter, thereby promoting wellness and energy.
Ferguson’s colonic therapist, Jacquelyn Darling of Peekskill, says that her case is similar to many she sees in her Cortlandt Manor office. “Most of my clients have tried other methods—including sodium docusate—but they’re just Band-Aids. They don’t feel cleaned out.” In fact, colonics are used to alleviate seemingly everything from asthma, arthritis, sinus problems, and chronic fatigue, to acne, bad breath, PMS, and constipation.
That all sounds great. Unfortunately, the only “proof” of the benefits of colonics is purely anecdotal. An extensive search through the usual medical indexes, including the Journal of the American Medical Association and the New England Journal of Medicine, yielded no medical research substantiating any actual medical benefit. There’s no mention of the practice on the website of the American College of Gastroenterology. “It’s not something I use in my practice,” says Mount Kisco-based gastroenterologist Elie Abemayor, MD, who sees no benefit of colonic hydrotherapy. “I’ve never seen a controlled study that showed any positive efficacy and my gut feeling is that it’s not useful for most people,” he says.
Ferguson remains a believer despite Dr. Abemayor’s stance. “I like going by what I feel, not by what other people say I should feel. I feel good and that’s what matters.”
But in the wrong or ill-trained hands, colonic hydrotherapy can be hazardous. As long ago as 1985, the California Department of Health Services listed some of the potential hazards of the treatment, including infection and death from contaminated equipment, and death from electrolyte depletion and perforation of the intestinal wall. In Colorado between 1978 and 1980, there were 36 cases of amebiasis, a parasitic infection, spread by a colonic therapist who failed to maintain sanitary conditions, which resulted in six deaths. The Food and Drug Administration considers colonic-irrigation machines to be Class III devices that cannot be legally marketed except for medically necessary procedures such as cleansing before a colonoscopy. To date, no machine has been approved for regular use, yet they’re widely available for sale on the web. There are even do-it-yourself colonic hydrotherapy kits available.
Too often bizarre therapies and unproven cure-alls are promoted by the media without any hint of skepticism as significant medical advances. One such remedy, chelation therapy, which is employed by allopathic physicians for removing heavy metals like lead from the body, has been embraced by some CAM practitioners as a way to reverse the course of everything from cancer to macular degeneration. Advocates of chelation therapy claim that intravenous infusions of EDTA, or ethylenediamine tetra-acetic acid, combine with unwanted compounds in the blood, such as calcium or heavy metals, to render them harmless. Some advocates—including Generation Rescue, a national parent-founded and funded nonprofit organization that believes autism, Asberger’s Syndrome, and other developmental delays and neurological disorders, are actually mercury poisoning that has been misdiagnosed—claim that some disorders might even be ameliorated by chelation therapy. Unfortunately for its proponents, there are virtually no reliable statistics to endorse their claims.
There is, however, evidence that it can be harmful. The problem with using chelation therapy for atherosclerosis, for example, is that EDTA cannot penetrate the cell walls of arteries and cannot access the calcium that is causing the problem. The other issue is that EDTA binds indiscriminately to calcium and magnesium, thereby removing necessary minerals from vital organs. Problems associated with chelation therapy have included hypocalcaemia (abnormally low calcium levels), decreased blood coagulation ability, and the leaching of vital trace minerals. In 2005, an autistic boy in Pittsburgh went into cardiac arrest less than an hour after receiving chelation therapy (a coroner’s report found the therapy to be the cause). “I think people doing it for autism and heart disease are dishonest,” says Dr. Barrett.
Why are so many Americans willing to turn their backs on conventional medicine, which is the product of what is inarguably the world’s most technologically sophisticated medical system? True, modern conventional medicine has left many Americans dissatisfied despite its undeniable cascade of breakthroughs. Our expectations have probably grown higher. Conflicting studies and changing advice—carbohydrates good, carbohydrates bad, carbohydrates good again—have left many frustrated and skeptical.
Sky-high pharmaceutical prices have pushed some drugs out of the financial reach of many patients, while overscheduled and overworked physicians seem to have lost any hint of a Marcus Welby-like bedside manner. “There’s definitely a perception that modern medicine is not up to par in taking care of everyone’s needs,” says Dr. Gilbert Ross, the medical and executive director of the American Council on Science and Health, a Manhattan-based not-for-profit consumer education and advocacy group.
Dr. Ross contends that the real appeal of complementary and alternative medicine is not scientific but emotional. Too many CAM practitioners, he says, substitute pseudoscientific postulating, testimonials, and biased observation for “serious scientific inquiry and research.”
Echoes Harvard’s Dr. Angell: “It’s a form of secular religion. With its emphasis on the almost limitless capacity of the mind to control the body and ward off illness, CAM provides a sense of transcendence over the often frightening specter of disease and death.”
Whatever the case, the CAM movement shows no sign of receding anytime soon. Presently, of the nation’s 215 accredited medical schools, 117 offer courses in CAM. CAM guru Dr. Weil recently appeared on the cover of Time under the headline “Living Better Longer,” timed to the release of his latest best-selling book. Not to mention the billions of dollars that Americans spend on CAM each year. “There’s a lot of deception out there, and it’s getting worse,” concludes Dr. Barrett. “A lot of people are being fooled.”
David Nayor is a freelance writer based in Briarcliff Manor.