Alternative Medicine – Sense and Nonsense. Paul A. Offit, M.D. lecture at CSHL 6/8/2013

Alternative Medicine – Sense and Nonsense. Paul A. Offit, M.D. lecture at CSHL 6/8/2013

– Good afternoon, and welcome to Cold
Spring Harbor Laboratory on this lovely June afternoon. I think we’re all glad the
weather seems to be clearing up. My name’s David Stewart, I’m responsible of many of
the conferences and courses that are held here in this
auditorium and around the campus at Cold Spring Harbor
Laboratory each year. This is in addition to the
world class research that we do in cancer, brain science,
plant biology and genomics. The laboratory attracts scientists from all over the world to
our meetings and courses, and we currently have
scientists staying here, learning the latest in fields ranging from bacterial genetics to
single cell analysis, to autism spectrum disorders. So it’s a real pleasure
to introduce our speaker this afternoon for the
2013 Lorraine Grace Lecture on societal issues of biomedical research. This lecture is made
possible by an endowment gift from Mrs. Grace, for whom
the auditorium is named, in honor of Jim Watson’s 80th birthday. Our last speaker in the
series was Dr. Richard Leakey, who spoke about how human evolution has shaped ethics and morality. Each lecture is intended to address an area of biomedical research where ethics and science intersect. Dr. Paul Offit is an outstanding choice for the 2013 Grace Lecture. He perhaps more than anyone demonstrates the twin commitments of both doing outstanding science, and also engaging the public
about distinguishing between good science, bad science,
and even pseudo-science. To my mind, he is one of a
handful of citizen scientists, and we need many more of such individuals as the world becomes ever more complex. Dr. Offit is the chief of the division of infectious diseases, and the director of the
Vaccine Education Center at the Children’s
Hospital of Philadelphia. He has published more than 150 papers in medical and scientific journals on rota viruses immune
responses and vaccine safety. He is in fact the co-inventor
of the rotavirus vaccine, RotaTeq, recommended for
universal use in infants by the Center for Diseases Control. For this achievement,
Dr. Offit received awards from the University of Pennsylvania, the National Foundation
for Infectious Diseases, and was honored by Bill and Melinda Gates during the launch of their foundation’s Living Proof Project for Global Health. He received the American
Academy of Pediatrics’ presidential certificate
for outstanding service. Some of his other awards include the Humanitarian of the Year award from the Biologics Industry Organization. The Odyssey Award from
the Center for Medicine in the Public Interest,
and he’s in fact a member of the prestigious Institute of Medicine. He’s been a member of the
CDC Advisory Committee on immunization practices, and is on the board of the
Autism Science Foundation and the Foundation for Vaccine Research. And, relevant to this lecture, he is also the author of
five medical narratives, including Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases, which was published in 2007,
and for which he won an award from the American Medical
Writer’s Association. A second book, Autism’s False Prophets: Bad Science, Risky Medicine,
and the Search for a Cure was published in 2008. Deadly Choices: How the
Anti-Vaccine Movement Threatens Us All was published in 2011. And most recently, in fact
to be published next week, his new book on, Do You Believe in Magic, the Sense and Nonsense
of Alternative Medicine. Now this isn’t yet available, but I gather in today’s London
Guardian there was an extract and then tomorrow
there’ll be an op-ed piece that Paul may tell you
a little bit more about in the New York Times. So his lecture this afternoon reflects the title of his most recent book, and so we look forward to hearing about Alternative Medicine, Sense and Nonsense. (applause) – Thanks, thank you. Thank you very much. My expertise is actually in vaccines, but I sort of came to this,
and can you see this okay, do we need to turn down the lights more for you to see this
better, or you’re good? I’m the head of the
Therapeutic Standards Committee at Children’s Hospital Philadelphia, and we are constantly trying to deal with alternative medicine in our hospital. Specifically people who
for example bring in cancer medicines from Houston
called antineoplastines, which are purified from human urine. We have dietary supplements
that people wanna use. Recently there was a nurse
who was complaining to me that she was having
trouble getting this fluid down the nasogastric tube of one patient, and I asked her what
that fluid was, she said, you know, it was an antibody preparation that the parent had
bought off the internet. So we’re constantly dealing with this, and I thought it would be, that’s kinda actually
what got me interested in the subject of alternative medicine. Although I would argue actually there’s no such thing
as alternative medicine. There’s only medicine. If a medicine works,
it’s not an alternative, and if it doesn’t work,
it’s not an alternative. So we’ll go through some of
the science that supports, or doesn’t support, these
alternative therapies. So we’re gonna start with the nonsense, and then we’ll get to the sense later. I think the first point is that a lot of the alternative therapies that I’m gonna go through, the sort of biological or anatomical basis of those therapies are really fanciful, they’re built on sand. We’ll start with acupuncture. So this is a, something
from early acupuncture, actually acupuncture didn’t
quite start this early, it was a little later. It was born in China in
the second century BC. Now this was a culture that
not only didn’t believe in dissection, they didn’t
tolerate dissection. If you were found to have
dissected a human person, you were punished by death. So they knew really very
little about human anatomy. They didn’t know where the brain was, they didn’t know where
the spinal cord was, they certainly didn’t know about the peripheral nervous system. They believed that the body consisted of 365 separate components, because there were 365 days of the year. They also believed that
the key to good health was based on balancing yin and yang, these two competing forces, which would then allow the free flow of the body’s energy, called chi. Now in order to do that, what they did was they
placed these needles, these very thin needles,
underneath the skin. And they would be inserted
anywhere from one half to four inches, and they
would remain in place for anywhere from a few
minutes to a few hours. Now, the manner in which
they inserted those needles was along something called meridians, which were these longitudinal arcs that ranged from the head to the toe. And the reason that
they chose 12 meridians is that there are 12
great rivers in China. This is a picture of one of the meridians. So, the question then becomes,
is acupuncture accurate? Now there are people who
definitely benefit from acupuncture and so, and I’m not saying
acupuncture doesn’t work, by the way, I’m questioning why it works, and we’ll get to why it works
a little later in this talk. Because I think for some
people it clearly does work. The question is, what
does it have to do with needles being put under the skin? So if you look at people
who clearly benefit and you assign them
into one of two groups, either you insert the needles according to the acupuncture points or you just insert those needles randomly, they equally benefit. Similarly if you take the needle and just insert it
slightly under the skin, too superficial to have
tapped into what the Chinese would have considered the
meridian, it still works. And more recently, there’s a
researcher named Edzard Ernst who’s at the University
of Exeter in England who came up the brilliant idea of using a retractable needle. So you actually would feel
the prick of the needle, but it actually never went under the skin, and they, too, benefited. So it’s not to say that
acupuncture doesn’t work, it just has nothing to do with putting needles under the skin. Next is chiropracty. That was founded in the
late 1800s by this man, Daniel David Palmer, who was a mesmerist, he believed that magnets treated diseases, but his moment, or the crack
heard ’round the world, occurred in 1895 after he claimed to have
cured a man of deafness following manipulation of the spine. He believed that the man’s
spinal column was out of order, it needed to be put back in place, and so he did that, and the man then, according to Daniel Palmer,
recovered his deafness. Which is remarkable considering that the eighth cranial
nerve, which is the nerve that’s responsible for conducting impulses that one hears through the
ear then back into the brain doesn’t travel through the neck. But in any case, he then sort
of took the next logical step, which was to believe that all diseases were caused by misaligned spinal columns, what he called subluxations. So this is a picture,
if you look on the left, is a normal spinal column, on the right, you can see that one of those
vertebrae are out of line, so-called subluxation. And so if you look in a
modern chiropractic text, you can find pictures like
this, where basically, you can manipulate the
spine to treat any disease, including pneumonia, or
bronchitis, or pancreatitis, or diabetes, or gall bladder problems. Which is, of course, fanciful. Because all diseases aren’t
caused by misaligned spines, prospective studies have shown that chiropractic manipulations don’t treat the headaches they are claimed to treat, or menstrual pain, colic,
asthma, or allergies. The next and probably to
me the most outlandish of these therapies is homeopathy. That was discovered by this
man, Samuel Hahnemann, in 1790. Now here’s the thinking behind homeopathy. Hahnemann was chewing on cinchona bark when he developed a fever. Now cinchona bark contains quinine. Quinine is a treatment for malaria, and malaria is a disease
that causes fever. So he thought those two
things were related. That I’m chewing on cinchona
bark, that causes fever, and that treats a disease
that also causes fever. And thus was born the
notion of like curing like. And that’s where the word
homeopathy comes from. The word homeopathy literally
means similar suffering. So for example if you wanna treat someone who has a vomiting illness,
then you give them a emetic, which is to say a drug
that causes vomiting. If you wanna treat them for diarrhea, then you give them a purgative, which is a drug which causes diarrhea. Which brings us to the next step, ’cause it’s a little hard to sell that. What he did then was he took the, sort of the second pillar
on which homeopathy stands, which is the law of infinitesimals. Which is to say that
you dilute that emetic or that purgative out to the point that essentially it’s not there anymore. To his defense, actually,
he wrote his seminal text, the seminal text of homeopathy
was written in 1796, it was called the Organon. That was about 15 years
before Avogadro came up with the number for how many
molecules would exist in a mol, 10 to the 23rd. So he didn’t know that, this
was still 15 years before that, although homeopaths
certainly know that now. This Avogadro’s number seems to have stood the test of time for the last 200 years, so the notion that you
can dilute something out to the point that it’s not there anymore, and still have any kind of
active ingredient, is silly. The homeopaths will argue that the water will remember that it’s been there, but given that there’s a limited
amount of water on earth, you don’t want it to
remember where it’s been. It’s comforting to know that it doesn’t remember where it’s been. And I think probably of all
the alternative therapies, homeopathy has been the
easiest to make fun of, and I’ll show you that in a second. But I’ll give you a perfect
example of a homeopathic remedy, this one is called oscillococcinum,
it’s actually available at Children’s Hospital
of Philadelphia pharmacy on the first floor of our hospital. Here you can see that it is
claimed to treat the symptoms of flu, which include fever,
chills, body aches and pains. It’s three doses, you can see there on the
lower left-hand corner, those three doses sell
for nine dollars total. So it’s three dollars per dose for nature’s number one flu medicine. What is oscillococcinum
and how is it made? Here’s how it’s made. You take a barberry duck. You kill it, you remove
its liver and heart. You then take that liver
and heart and homogenize it, and then dilute it one to 100. Then you take that one to 100 dilution and you dilute it 200 more times. So it’s basically 10 to the minus 400. The duck’s gone, there’s not a single
molecule of that duck left. In fact, if you diluted it into
the volume of the universe, which is roughly three times
10 to the 80th cubic meters, you would be hard pressed to
find the duck there, either. So that’s why this is
so easy to make fun of. This is from the Center
for Inquiry in Canada. This for example would
be a homeopathic bicycle. (laughter) All though my favorite one is this one, which is, this is a
homeopathic contraception. (laughter) So. Naturopathy. So naturopathy is based on the
notion that nature is good. That all of these products
that are sold in the GNC center as dietary supplements are made by elves and sugarplum fairies on meadows that are flowered like this one. So the notion is that natural is good, and that mad made is bad. Now, this is, by the
way, I don’t agree with. I mean, natural isn’t always good. So for example, Ebola
virus, volcanic eruptions, meningitis, polio, dysentery,
Alzheimer’s disease, ticks, mosquitoes, the Black
death, fleas, cavities, lice and smallpox are
all natural phenomenon. And man-made isn’t always bad. Spectacles, antibiotics, vaccines, artificial knees, heart transplants, and the mute button on the remote control devices for television are man-made. I think the inventor of
that and the Swingomatic, whoever those people were, should definitely win
the Nobel Peace Prize. The other thing is that
small compounding pharmacies are good, and that big pharma is bad. David actually I think mentioned
that there was actually an excerpt of a book that I’ve written called Do You Believe in Magic, which was excerpted in the Guardian, which is a British newspaper,
it came out this morning. And there were like 500
comments to that article. Basically the point of view was is that by my calling into the question the fact that large dose vitamins and some of these dietary
supplements can be harmful, that I was somehow a shill for
the pharmaceutical industry which doesn’t make those products ’cause they’re made by elves in meadows. But actually, who do people
think makes these products? These products are made by
big pharmaceutical companies, this is a 34 billion
dollar a year business. So the only difference
between that and drug makers is that because the Food
and Drug Administration does not supervise, does
not license these products, they are really under no obligation to support their claims
or admit their harms. So let’s take estrogen for example, certainly women in
menopause suffer the fact that they no longer produce
estrogen and progesterone, and with that comes symptoms, and so one was interested
in preventing those symptoms or treating those symptoms with a hormone replacement therapy. Unfortunately hormone replacement
therapy ran into trouble when it was found to increase
diseases like breast cancer. But this is an example of estrogen made by a pharmaceutical company,
specifically Wyeth. There is a revolution, actually, in the treatment of menopause
called bioidentical hormones, I don’t know if you’ve heard this, but Suzanne Somers promotes this a lot. And the thinking here is that, let’s not have our pharmaceutical
companies make estrogen, let’s have small compounding
pharmacies make it. And so we’ll take wild yams,
which contains diestranin, which can be a precursor to estrogen, and then we’ll synthesize
estrogen from that. But what the FDA now
is interested in doing is really trying to regulate this because estrogen is estrogen. It doesn’t matter what the
ancestry of the molecule is, it doesn’t matter what the
source for a molecule is. The only thing that matters is the structure of that molecule, and it’s indistinguishable
whether estrogen is derived originally for wild yams, or in the case of Premarin,
from horse’s urine. Actually that’s where the word comes from, Premarin is pregnant mare’s urine. The other thing is that nature is one side and chemicals are on the other, and I’m actually glad that
there are some older people in this crowd because I think
you’re gonna appreciate this. What ever happened to the word chemical? I mean, the word chemical wasn’t always meant to be a bad thing. This is from a magazine
that was put out by Du Pont when they would say things like better living through chemistry. You could never say that
today, chemistry is a bad word. But what is this? So I’m gonna show you the picture on the next slide of what this is. The substance that I’m about
to show you contains benzene, methanol, acetaldehyde
and hydrogen sulfide. All of these substances are highly toxic in large quantities. This is chicken soup. And that doesn’t actually count the hormones from the chicken. Now remember, this is, it’s
always a matter of dose. As Paracelsus said in the 16th century, the dose makes the
poison, that’s still true. We in our bodies now have heavy metals like mercury and beryllium and thallium, and arsenic, we just have them at levels that are so low that they don’t harm us. So what’s this? This contains acetaldehyde,
benzaldehyde, benzene, benzpyrene and all the things
that you see listed there. Many of these substances
are known carcinogens or DNA altering chemicals. This would be organic coffee. So, if human anatomy isn’t
based on rivers in China or days of the year, and all diseases aren’t
caused by misaligned spines, and homeopathic remedies don’t contain any active ingredients, and the molecular
structure of natural drugs is indistinguishable from synthetic drugs, then why do so many people
swear by acupuncture, chiropractic, homeopathy and naturopathy? And I think the reason is, and this gets us to the
sense of this subject, the placebo response. Which unfortunately I
think has a bad name. I think that there is something to be said for placebo medicine, and
we’ll get to that in a second. So placebo is derived from the
Latin meaning I will please. It was actually first
described during World War II when a nurse ran out of morphine. And when she was then instructed to take care of these wounded
soldiers on the field, she simply said that the salt
water that she was giving them was morphine. And found that a number of
soldiers experienced pain relief. So this was striking. It was really the first time people had made this observation. And it brought up the question then, is the placebo response
physiological or psychological? Or said another way, were those
soldiers really experiencing the same amount of pain but
just tolerating it less, or did they actually experience less pain? So the first sort of studies on this were based on the notion
that the placebo response was simply psychological. And there are a number of
studies that have looked at this. This is one done by MIT researchers who tested the capacity of two
sugar pills to relieve pain. One group was told that
the pill cost $2.50, the other that it cost 10 cents. The group that was told
the pill was more expensive experienced less pain. There’s something to be said for spending a lot of money for something. And many studies have shown
that a doctor’s attitude, demeanor, clothes, and
phrasing make a difference. Patients do better when doctors
say you will be better soon, or these pills will help you, then if they say I don’t
know what you have, or I don’t know if pills will help. And this has been a
well-studied phenomenon. Whereas J.N. Blau said, “the doctor who fails to
have a placebo effect” “on his patients should
become a pathologist.” (laughter) And there’s another example. I don’t know if any of
you are baseball fans, I guess I’ll find out how
many of you are baseball fans. Who is that? – [Man] Hamels. – Hamels, thank you, very good. I gave this talk once to
about 40 medical students, in Philadelphia, and not one of them knew
who this person was. So what you’ll notice is
something around his neck that you’ll find actually on
about 70% of baseball players. That necklace, what is that necklace? It’s actually, it’s a titanium necklace. And it is his belief, as it is the belief of many
people who play baseball, that that titanium necklace is sort of giving him extra energy, because it’s emitting an
electromagnetic force. That would be his explanation, that’s many of their explanations. Now, titanium can conduct electricity, which is to say when an electron moves from one atom to the next. But in order for that to happen there has to be a force
generating that phenomenon. Either as a chemical force, a battery, or a mechanical force, a generator. Absent that force, this necklace is inert. It doesn’t matter whether
he wears a necklace made of titanium, or garlic, or wood, it would have the same effect. What amazes me about this actually is that these are the same athletes
that climb into MRI machines, which emit sort of an
electromagnetic force roughly 60 thousand times that of the earth’s electromagnetic force. I mean if this titanium necklace exhibited any of that sort of force that he claims, his body would explode when
he went into an MRI machine. And then I think there’s
sort of the ultimate example of a placebo response,
which was this movie, The Wizard of Oz. The scarecrow wanted a brain,
and he wanted to be smarter. The wizard couldn’t give him a brain, but he gave him the next best
thing, which was a diploma. And when he got that diploma he instantly recited the
Pythagorean Theorem and said, oh joy, oh rapture, I have a brain. He was smarter because he felt smarter. I don’t know if you remember this movie, there was one scene right around here when Dorothy says to the scarecrow, scarecrow, I think I’m
gonna miss you most of all. And when I was little I
thought that was a nice thing to say, but the tin man
and the lion were standing right there.
(laughter) Manners, maybe she should
get manners from the wizard. No, okay. Probably the best example
actually of sort of the notion that the placebo effect is psychological is a study actually that
was recently reported in the New England Journal
of Medicine by Ted Kaptchuk who’s a alternative therapist actually associated with Harvard. And what he did was he
took four groups of people, took people with asthma and
divided them into four groups. And he gave them a
series of four therapies. One was albuterol, which
is a bronchodilator, which helps people with
asthma breath easier. Or he gave them sort of the same thing, gave them an inhaler that
contained just salt water. Or he did acupuncture or
again the sham acupuncture which is when you get the needles but it never goes under the skin. What he found was that
the only thing that worked in these people, and FEV just means
forced expiratory volume, which is to say you breathe out ’til as far as you can breathe out, and then you just see how
much more you can breathe out, it’s sort of a test of air trapping. Asthmatics have a problem with air getting trapped in their lungs. And what he found was that the only people who really benefited were those who had received albuterol. But interestingly, when asked
to subjectively evaluate how they had thought they did, all of them basically
thought they had done better, in the same manner. So again, it didn’t sort of
jibe with actually what was an objective look at their
ability to breathe out. I think more recently people
have started to focus on the physiological basis
of the placebo response, which is really what I
wanna talk about now, ’cause I think that’s where
the money is, frankly, with these alternative therapies. In the 1970s two men, Rabi
Simntov and Solomon Snyder, discovered endorphins. These are endogenous opiate agonists produced in the pituitary
gland and hypothalamus, these are drugs that we make ourselves that enable us to experience less pain. They are pain relieving
drugs, endo just means, is short for endogenous
which means made in the body, and then the second part,
orphin, is just from morphine. And so there’ve been a number
of studies looking at this, probably the first one was done in 1978 by Levine, Gordon and Fields, and what they did was
they divided patients after dental surgery into two groups. After the anesthesia wore
off from that dental surgery, one group received the placebo
pill, and the other didn’t. The group receiving the placebo pill said that they experienced pain relief, and that pain relief could
be blocked by Naloxone, which is a blocker of endorphin. And that’s what they believed then was causing that pain relief, that these patients had learned to release their own endorphins. That taking a pill thinking
it’s going to help them with their pain, and that
they can actually learn to release their own endorphins. And actually, this shouldn’t
have been that surprising. There was a study done in the late 1800s of people who when they
were exposed to roses, when they were exposed
to the pollen on roses, that they would breathe in that pollen and it would cause them to
have an allergic response. Red eyes, itchy eyes, sort of hives. That response is mediated by histamine. What this researcher found,
J.N. Mackenzie, his name was. This was the late 1800s,
and what he found was that if he took these same
people and he exposed them to an artificial rose, that
they had the same symptoms, including hives, which is to say they could learn to release
their own histamine. Amazing. Although I think the most
amazing study in all of this was the famous Ader-Cohen study
that was performed in 1975, it was done experimentally, but now there are more data in people. And they took rats, and
the first group of rats they injected with sheep red blood cells, which is sort of typically
what immunologists used to do in those days to see whether the animals would have an immune response. Sheep red blood cells
or a foreign protein, a series of foreign proteins to that rat. And what they found, not surprisingly, was that the rats developed
an immune response. Then they took a second
group and they injected them with red cells at the same time that they orally inoculated them with saccharine flavored water. Well saccharine doesn’t have any effect on the immune response,
so not surprisingly, these rats then developed an immune response to the red cells. The third group was injected
with red blood cells and saccharine flavored
water, except this time, the saccharine flavored water had a drug called cyclophosphamide in it, which is an immune suppressive drug. And the animals not surprisingly didn’t develop an immune response. And they inoculated these
animals again and again with red cells and
saccharine flavored water that contained cyclophosphamide. Then what they did was they
inoculated the same animals with red cells and
saccharine flavored water, but without the cyclophosphamide, and they didn’t develop
an immune response. Which is to say they
had learned to suppress their own immune response. That was remarkable, and
actually when this was published, nobody believed it, until it was reproduced
in two other laboratories. Similarly there was a
study by John Imboden, I actually grew up in Baltimore, this study was done by a man whose son was actually in my high school class, also named John Imboden. And it was reported in the
Archives of Internal Medicine, it was done in 1957, he was at Hopkins. And he performed psychological
tests on military recruits prior to what ended up fortuitously being, at least from his standpoint, an influenza pandemic that
swept across the barracks, and this was Fort Dietrich, Maryland. What he found was that there
was a direct correlation between the level to which
a recruit was depressed, and the symptoms. That those patients
who were more depressed had symptoms that lasted
longer, were more severe, and actually shed virus for longer. So essentially mood determined illness. And this sort of, you sort
of hear this growing up, you get sick when you wanna get sick. And I think at some level then, the alternative medicine
people often call this the mind body connection,
and I think that’s fair. Our mind is not a trivial place to be. I think mood does determine illness. And then as an extension of that, research subjects have been
shown that they can be trained to release their own cortisol, which can be immune suppressive. Or gamma-interferon which
can be immune enhancing. So people can potentially
learn to up regulate or down regulate their
own immune response. There’s five books actually
on the placebo response, each of which contains
hundreds of studies, and some of which are excellent,
it’s really impressive. And there’s a division now within the National Institutes
of Health called the National Center for Complimentary
and Alternative Medicine, which is now spending a
lot of your tax dollars actually looking at trying to understand the physiological basis
of the placebo response. This from John Milton’s Paradise Lost, “the mind can make a heaven
of hell and a hell of heaven”. So I think that there’s
something to be said for placebo medicine. I think that believing that
acupuncture, chiropractor or homeopathy are working is important, and might allow for
things like the release of endogenous mediators that control pain, like endorphins or immune responses. And you could argue for
example that the common cold is a self-limited illness. We tend to do things in medicine like give cough and cold preparations which do nothing, frankly,
to make it get better faster, if you have children
it makes them drowsier which is an advantage,
but that’s about it. And certainly for young children, they can have night terrors associated with ephedrine
containing compounds, which is why the FDA has a
warning against their use. Oscillococcinum given to young
children will not hurt them because it’s just a gram of sugar. You’re paying three dollars for a dose, I guess that’s somewhat harmful, but you could make an argument then that there is a value to
alternative therapies here. But it does raise a question. When I was little, my pediatrician, whose name was Milton Markowitz, who ultimately became the dean of the University of
Connecticut’s medical school. When he used to come to the house, back in the days when
people made house calls, you may remember this, when pediatricians would
come to your house. And I remember looking
in his big black bag which had all this sort of
interesting tubing and syringes, also in there was this thing of pills, and I remember asking him about that and he said they were sugar pills. And I asked him what sugar
pills would be for and he said, because it makes people think
that they’re getting better, and so that’s the question,
is it ethical to deceive? I’d like to say by the way
that conventional therapists also engage in some deception. In our hospital, if you walk
into Children’s Hospital of Philadelphia you’ll see
doctors with white coats, with red stenciling on
them, we have nice offices. We have big machines that
make interesting noises. I think there’s a therapy in all of that. And I think arguably
deception at low risk, low burden and low cost is acceptable. We’ve sort of gotten away from this. I think my pediatrician
practiced placebo medicine where he thought it would be of value, where he thought that
if he’s taking someone who has a cold or a viral infection, what’s the point of giving
something that could be harmful when this disease is
gonna get better anyway? But, I think there are times
when alternative medicine crosses the line into quackery, and that’s what I wanna focus on now. The first I think is
the unappreciated harm that is caused by a
number of these remedies. So for example, acupuncture
needles have been found in hearts, lungs, and livers, they’ve introduced viral
infections such as hepatitis A, hepatitis B, and human
immunodeficiency virus. At least 86 people have
died of acupuncture, that probably represents actually
a fairly small percentage of those who have actually died. So you could make an argument
for using retractible needles. Now I think acupuncturists
might be slow to adopt this idea that I have because they would argue that that’s deceiving the patient, but I would argue that this
whole business about yin, yang, and bouncing chi
is a deception anyway, so why not just take the next step? At least 26 people have died
from chiropractic manipulations almost solely caused by
ripping the vertebral artery in the neck, including children. As I said before, dietary supplements are
an unregulated industry. If you look at the 54
thousand dietary supplements that are on the market, less than .3% have any sort of safety record. We have to deal with this
in our hospital all the time for patients that bring in
these kinds of medicines. Certainly it is known that blue cohosh can cause heart failure, nutmeg at high doses can
cause hallucinations, comfrey, kava, chaparral
and other agents listed here can cause hepatitis. Monkshood and plantain
can cause arrhythmias. Wormwood can cause seizures, Stevia leaves can cause
decreased fertility. Concentrated green tea extracts, which I think everyone would
always assume is natural and can never hurt you, has
been shown to cause liver damage in some patients. Milkweed seed oil and bitter
orange can cause heart damage. Thujone can cause neurological damage, concentrated garlic can cause bleeding. Actually the guy who drove my taxi today from Siasa to here was telling me about how his father took alternative remedies and had a bleeding problem, and the alternative
remedy he took actually was concentrated garlic,
which certainly can do that. And pennyroyal and capsaicin
can cause infant death. So as I said, most of these supplements have no sort of safety record
because they don’t have to. Because ever since
1994’s Dietary Supplement and Health Education Act, this
is an unregulated industry. Also, there are problems
with contamination. In 2004 researchers at
Harvard Medical School tested Ayurvedic or Indian remedies, the kind that are promoted
like people like Deepak Chopra in Boston, finding that 20% contained potentially harmful levels
of lead, mercury and arsenic. Recently in 2009 Kirkman Laboratories, which makes remedies,
and I put that in quotes, for children with autism, recalled 15 thousand bottles of Zinc because they contained
undeclared levels of antimony. Between 1983 and 2004 poison
control centers received 1.3 million reports of
adverse reactions to vitamins, and I’m talking about mega vitamins, meaning vitamins taken in vast excess of the recommended daily allowance, usually five, 10, 20 fold greater, minerals and dietary supplements. 175 thousand hospitalizations
and 136 deaths. I think David mentioned I
have an op-ed piece actually that’s coming out in
tomorrow’s New York Times that specifically talks about
the harm of mega vitamins. Vita always sounds
good, right, vita, life, how could vitamins ever be bad,
certainly we need vitamins, but you can take too much vitamins. You can take enough vitamins, actually, specifically A, E,
betacarotene and selenium, to increase your risk of heart disease, increase your risk of cancer,
and shorten your life. And so why don’t we know about this? The reason we don’t know about
this is that ever since 1975 the Food and Drug Administration, which tried to regulate
the vitamin industry, was basically turned
back by a very powerful, very financially solid
and influential industry. Second. I think the second place in
which alternative medicine crosses the line into quackery is the replacement of
conventional therapies with alternative therapies. So there are some conventional
therapies that work where an alternative therapy wouldn’t, and the poster boy for
this problem is Steve Jobs. So Steve Jobs had pancreatic cancer, but he didn’t have the
kind of pancreatic cancer that typically kills you, which
is to say an adenocarcinoma. What Steve Jobs had was
a neuroendocrine tumor. Neuroendocrine tumors with early surgery have a 95% chance of recovery. This was a completely
treatable disease he had. But for nine months, instead of getting the surgery
he was recommended to have, what he did was he did acupuncture,
he did bowel cleansings, he did mega vitamin therapy, he did fruit juices and vegetable juices, and in that time that he waited, that cancer then got out of
control, and it was too late. Similarly there are
many stories like this, I just highlight a few here. Linda Epping was a little
girl with a tumor of the eye, rhabdomyosarcoma, that was
treated by a chiropractor with vitamins, supplements and laxatives. This was a treatable tumor but
she was dead in three months. There was a nine year old girl who was treated with shark cartilage, which is actually still
popular among cancer patients, instead of radiation and chemotherapy, was dead in four months. In 2006 parents of a six
year old boy with asthma chose a homeopathic bronchodilator, which is to say no bronchodilator at all, instead of a real bronchodilator,
and the outcome was fatal. This interestingly is a problem in Canada, ’cause I know we were talking earlier there are a couple of people
who were Canadian here. The phenomenon of homeopathic vaccines, which is really a contradiction in term. So if you look at the picture on the left, it says HPV nosodes, so
nosodes is what they’re called. What you do is you take fluid from someone who is infected with HPV, you
dilute it out to the point that there’s not any virus there anymore, and you call that a vaccine. Obviously it has no chance of working, and this is actually a
big problem in Canada, hasn’t been a problem here yet. Third I think is draining
patients bank accounts. The situations in which you see this I think are the most regrettable. There are parents who are desperate because their children suffer autism, and will do anything, will pay anything, to help them get better. This shows just three books from what are the many many books on how you can cure your child’s autism. And cancer, there obviously are cancers which are more or less treatable. Those that are less treatable, people often go to these
kinds of alternative cures, which are, essentially
have no record of testing for either safety or efficacy. And if you look through these books, what you find is that the
recommendations are all the same. So autism and cancer, although they’re dramatically
different diseases, seem to have the same treatments. Which include mega vitamins, supplements, bowel cleansing, fruit
and vegetable juices, sweat lodges, hyperbaric oxygen chambers, chelation, restricted diets, chiropracty, homeopathic remedies, electrical
or magnetic stimulation, probiotics, intravenous immunoglobulins, and stem cell transplants, among others. And I think there’s a certain, to pick up the Wizard of Oz theme, I think there’s a certain
heartlessness to this. I think that when adults do these things, for the most part, for themselves, they do it with their eyes open, but I think when these alternative healers really try and capitalize on parents who are desperate to treat their children, there’s a heartlessness to this. I don’t know if you remember
the lion from this movie, but what the wizard said was, he said, so, Tin Man, you want a heart. You don’t know how lucky
you are not to have one. My favorite, though, my favorite
of the alternative medicine diseases is chronic Lyme disease, because what the alternative
healers have done here is made up a disease. I mean autism’s real, cancer’s real. Chronic Lyme disease, at least as defined by
alternative healers, isn’t. So Lyme disease is real, it’s caused by a bacteria
called Borrelia burgdorferi, that bacteria is injected into the body via the bite of a tick, and
undergoes a series of stages. Stage one is the classic bullseye rash, which can last for days or weeks. Stage two is characterized by fatigue, muscle aches, fever,
meningitis, encephalitis, facial palsies, neuritis, carditis, inflammation of the heart,
inflammation of the nerves, with resolution in stage three, what I guess MDs would
call chronic disease is arthritis, which
can occur months later. But the so-called Lyme
literate doctors argue that Lyme is far more than that, has far more in the way
of symptoms than that. So for example if you look in
the books that I just show you you get this characterization of what chronic Lyme disease could be. Read this and see whether or not you could potentially have chronic Lyme. It’s characterized by weight
change, hair loss, sore throat, menstrual irregularities,
upset stomach, constipation, diarrhea, cough, headache,
neck pain, lightheadedness, motion sickness, poor
balance, wooziness, tremor, confusion, difficulty
concentrating, forgetfulness, mood swings, disturbed sleep, or hangovers after drinking alcohol. (laughter) I mean, they just might as
well take the next step and say if you’ve ever bought a
lottery ticket and lost, that you might have Lyme disease. So that’s chronic Lyme disease. And so the therapies associated
with chronic Lyme disease, and I think these are
mostly patients, I mean, when you see this, at least
when it’s been evaluated in any sort of thoughtful way, these are often patients
who are depressed. They have chronic symptoms, and those symptoms are
those of depression, which is not an easy disorder to treat. But in any case, these Lyme literate doctors
try to convince people that what they really have
in their bodies are bacteria which just are invisible,
that they in fact, these bacteria don’t
evoke an immune response, that’s why all the Lyme
tests are negative, and so you need to be treated
with a variety of things, one of which is malaria therapy. So in 1990 the CDC investigated two cases of malaria in the United States. Both patients were quite ill, both had been infected
with the same strain, both believed that they
had chronic Lyme disease, both traveled to a clinic in Mexico to get infected with malaria,
and fortunately both survived. There’s also teasel, which
is a common roadside weed, this is in Wolf Storl’s
book, Healing Lyme Disease. “One takes time with the plant,” “sits down facing east, the
direction of the rising sun,” “opens all one’s senses regarding it.” “Before getting into this meditation” “one can burn dried sacred herbs” “prairie sage or mugwort for example” “and smudge oneself”. “After contacting the plant’s spirit” “and asking for its help,” “one can dig out the root
or harvest the leaves”. And then there’s the Rife Machine. The Rife Machine has been
around for a long time, and it’s been used for
a variety of things. I don’t know if any of
you have heard of this, but it still gets play in
newspapers occasionally. But what the Rife Machine
does is it delivers an invisible electromagnetic field that passes through the entire body and disables targeted microorganisms. That’s what it used to
look like in the 1930s, when it was invited by Raymond
Royal Rife, shown actually, if you can see that on the left there, standing next to one of his Rife machines. Dread disease germs destroyed by rays, claims of South Dakota scientist. He actually invented it
to treat tuberculosis, but turns out it has many uses, one of which is the treatment
of chronic Lyme disease. That’s what a modern day
Rife Machine looks like. There was recently a conference in Seattle that focused on the Rife Machine. You can actually get it
for as cheap as $400. They’re practically giving
it away at that price, so you may wanna get in on that. But typically it costs
about two thousand dollars, and it’s really easy. You can sit in your chair
and hold the two electrodes. You set it, see that knob there, you set it to the setting
that kills Lyme bacteria, which is pretty remarkable
when you think about it. We probably have about a
hundred trillion bacteria that’s on our skin, that
lines our nose and throat and intestines, but this
machine is actually able to just electrocute those Lyme
bacteria, that is pretty good, and I think well worth
the two thousand dollars. I think the other thing, the
last thing is that with this, one promotes magical thinking. Mehmet Oz is actually
I think a culprit here. Recently on a show he said, talking about acupuncture specifically, there’s just some things
that science can’t explain. Well I mean that’s true,
science certainly can’t explain how many angels could
dance on the head of a pin, it can’t answer theological questions, but it can answer scientific questions. If people are benefiting from acupuncture, if they are really
experiencing pain relief, you can figure out the physiological basis of that pain relief. We may not have figured it out yet, but it is figure out-able. You don’t have to look to the
gods to try and explain this. One can at least try and explain it based on the physiology that we know. This was a line from Robert Slack writing for the Center for Inquiry/. “The gaps in medical
knowledge we all dread” “are not likely to be
filled by energy fields,” “meridians, and astrology, but
by the pursuit of knowledge” “under a single set of
standards we call science.” “The way forward is through a careful” “and purposeful pursuit
of scientific truth,” “even if it means leaving some of our” “most romantic fallacies behind.” Or this from Douglas Adams, The Hitchhiker’s Guide to the Galaxy, which will sort of give you
a hint as to how old I am. “Isn’t it enough to see
that a garden is beautiful” “without having to believe
that there are fairies” “at the bottom of it, too?”. In fairness, and I’ll close
with these last few slides. I think one can also ask the question, when does conventional medicine cross the line into quackery? Because the fact is, most of the diseases we
see are self-limited, and yet we often choose to treat them. So we give a lot more
antibiotics than we need to give for viral infections,
which are self-limited, and will in no sense be
made better by antibiotics. And in fact we select
for resistant strains, antibiotics like any medicine
can have negative effects. And you could argue we’re better off using homeopathic remedies
which we know won’t hurt. There’s no such thing as
having a mood anymore, everything is an affective disorder. There’s a book out called
The Death of Sadness, which is great, right,
no one is sad anymore, everybody has to have
an affective disorder which has to be treated
with mood elevating drugs. You’re probably better off
using teasel or Rife Machines. Or crystals, or prayer. At least those aren’t harmful. And there’s an overuse of
surgery for arthritic pain. There’s a wonderful study done showing that you are no better off, this was a particular
kind of arthritic pain, if you got surgery or
if you got sham surgery. So people got better because they thought they
were gonna get better, and so you could argue chondroitin
sulfate and glucosamine, which was actually
offered by my orthopedist after I had recent microfracture
surgery on my knee. If you look at the
data, there’s clear data that this doesn’t make you any better, but it doesn’t hurt you,
and so you can argue it’s certainly better than surgery. And so this from Thomas Szasz, “When religion was
strong and science weak,” “men mistook magic for medicine.” “Now when science is
strong and religion weak,” “men mistake medicine for magic.” So I think there’s no such
thing as alternative medicine, if a medicine works
it’s not an alternative, if it doesn’t work it’s
not an alternative. There’s a name for medicine that works, and it’s called medicine. I think it’s incumbent on
healers like acupuncturists, or chiropractors, or
naturopaths, or homeopaths, to determine why a particular
alternative therapy might be working. There is a reason, and
so it’s find out-able. I think most importantly
alternative therapy shouldn’t be given a free pass. They’re always seen as
something natural and benign, and sort of cashes in on this
anti-pharmaceutical company bias, but they should be held
to the same high standards of safety and efficacy as
conventional medicines. And when they’re not, I think we should insist
that those studies be done. So, I’ll stop there, and
thank you for your attention. (applause)

8 Replies to “Alternative Medicine – Sense and Nonsense. Paul A. Offit, M.D. lecture at CSHL 6/8/2013”

  1. Conventional medicine in the USA is the number ONE cause of death, more than cancer, heart problems, sugar diabetes and any other illness.  Doctors should be charged with manslaughter and jailed right after all executives of the FDA and drug companies. Check out Doctor Yourself. com and Andrew Saul,  or go to "Fire your doctor" by Dr. Peter Glidden. It's your life and your responsibility to find out and know.

  2. He is talking to people that are his followers to begin with.
    However he still refuses to debate with Dr.s and scientist who have done independent studies regarding vaccines, who totally disagree with him.
    He has his own agenda, and as far as I am concerned, he spreads lies and mostly for his own profit. I have words for him that ladies never say ,however I can think him.

  3. Offit doesn't want health for people. He IS a walking conflict of interest and nonsense. He is against vitamins, alternative medicine and for every vaccine….moron. Please don't go to Children's Hospital of Philadelphia or support anything he does. Research his conflicts of interest

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