ALTERNATIVE MEDICINE: AN OUTLINE FOR PHYSICIANS ^^^ 4/12/94 The following is an overview of today's "unconventional" systems of diagnosis and treatment. You are certain to encounter several of these systems of thought as soon as you begin seeing patients. Each of these systems is based on the experience of its practitioners rather than on the usual methods of controlled research. Each has presented itself as satisfying a health-care need where "orthodox" medicine fails. Each system has many happy patients. Each system has also been repeatedly condemned as quackery. Which of the systems are health frauds? Which systems have merit? Only you, the practicing physician, after becoming familiar with alternative health care systems and their patients, can decide! I hope you have as much fun doing this as I have! -- Edward R. Friedlander, M.D. December, 1983 * * * CONTENTS ALTERNATIVE PRIMARY CARE . . . . . . . . . . . . . . . . . . . . . 2 HOMEOPATHY . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CHIROPRACTIC . . . . . . . . . . . . . . . . . . . . . . . . . 3 CHIROPRACTIC VARIANTS . . . . . . . . . . . . . . . . . . . . 4 Total Lesion Osteopathy . . . . . . . . . . . . . . . . . 4 Naprapathy . . . . . . . . . . . . . . . . . . . . . . . 4 Cranial osteopathy . . . . . . . . . . . . . . . . . . . 4 Dental kinesiology . . . . . . . . . . . . . . . . . . . 4 Rolfing . . . . . . . . . . . . . . . . . . . . . . . . . 4 Polarity therapy . . . . . . . . . . . . . . . . . . . . 5 NATUROPATHY . . . . . . . . . . . . . . . . . . . . . . . . . 5 ALTERNATIVE CANCER THERAPY . . . . . . . . . . . . . . . . . . . . 6 GLOVER SERUM . . . . . . . . . . . . . . . . . . . . . . . . . 6 SANDERS CURE . . . . . . . . . . . . . . . . . . . . . . . . . 6 CARICIN and NEO-CARICIN . . . . . . . . . . . . . . . . . . . 6 MUCORHICIN . . . . . . . . . . . . . . . . . . . . . . . . . . 6 JAVIRO HEAD SHRINKING COMPOUND . . . . . . . . . . . . . . . . 6 DIAMOND CARBON COMPOUND . . . . . . . . . . . . . . . . . . . 6 HETT CANCER SERUM . . . . . . . . . . . . . . . . . . . . . . 6 KOCH ANTITOXINS . . . . . . . . . . . . . . . . . . . . . . . 7 GRAPE CURE . . . . . . . . . . . . . . . . . . . . . . . . . . 7 HOXSEY TREATMENT . . . . . . . . . . . . . . . . . . . . . . . 7 ISCADOR . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 KREBIOZEN . . . . . . . . . . . . . . . . . . . . . . . . . . 7 MILLRUE . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 GERSON CURE . . . . . . . . . . . . . . . . . . . . . . . . . 8 ISSELS CURE . . . . . . . . . . . . . . . . . . . . . . . . . 8 LAETRILE . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ZEN MACROBIOTIC DIET . . . . . . . . . . . . . . . . . . . . . 10 SIMONTON MENTAL IMAGERY . . . . . . . . . . . . . . . . . . . 10 ALTERNATIVE PSYCHIATRY . . . . . . . . . . . . . . . . . . . . . . 11 REICHIAN THERAPY . . . . . . . . . . . . . . . . . . . . . . . 11 PRIMAL THERAPY . . . . . . . . . . . . . . . . . . . . . . . . 11 DIANETICS . . . . . . . . . . . . . . . . . . . . . . . . . . 12 EST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 ORTHOMOLECULAR PSYCHIATRY . . . . . . . . . . . . . . . . . . 12 ALTERNATIVE SURGERY . . . . . . . . . . . . . . . . . . . . . . . . 12 PSYCHIC SURGERY . . . . . . . . . . . . . . . . . . . . . . . 12 ALTERNATIVE CARDIOLOGY . . . . . . . . . . . . . . . . . . . . . . 13 CHELATION THERAPY . . . . . . . . . . . . . . . . . . . . . . 13 ALTERNATIVE RHEUMATOLOGY . . . . . . . . . . . . . . . . . . . . . 13 ARTHRITIS CURES . . . . . . . . . . . . . . . . . . . . . . . 13 ALTERNATIVE REHABILITATION MEDICINE . . . . . . . . . . . . . . . . 13 MOTOR PATTERNING . . . . . . . . . . . . . . . . . . . . . . . 13 ALTERNATIVE OPHTHALMOLOGY . . . . . . . . . . . . . . . . . . . . . 14 BATES METHOD . . . . . . . . . . . . . . . . . . . . . . . . . 14 ALTERNATIVE SYSTEMS OF MEDICAL DIAGNOSIS . . . . . . . . . . . . . 14 IRIDOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . 14 HAIR ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . 14 APPLIED KINESIOLOGY . . . . . . . . . . . . . . . . . . . . . 14 GRAPHOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . 15 RADIESTHESIA . . . . . . . . . . . . . . . . . . . . . . . . . 15 ALTERNATIVE THERAPEUTICS . . . . . . . . . . . . . . . . . . . . . 15 ACUPUNCTURE . . . . . . . . . . . . . . . . . . . . . . . . . 15 REFLEXOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . 16 FOOD FADDISM AND NUTRITIONAL SUPPLEMENTS . . . . . . . . . . . 16 COLONIC IRRIGATION . . . . . . . . . . . . . . . . . . . . . . 17 URINE THERAPY . . . . . . . . . . . . . . . . . . . . . . . . 17 FUN THERAPIES . . . . . . . . . . . . . . . . . . . . . . . . 17 Aroma therapy . . . . . . . . . . . . . . . . . . . . . . 17 Color therapy . . . . . . . . . . . . . . . . . . . . . . 17 Dance therapy . . . . . . . . . . . . . . . . . . . . . . 17 Flower therapy . . . . . . . . . . . . . . . . . . . . . 17 Music therapy . . . . . . . . . . . . . . . . . . . . . . 17 Nudist colonies . . . . . . . . . . . . . . . . . . . . . 17 SPIRITUAL HEALING . . . . . . . . . . . . . . . . . . . . . . 17 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 * * * ALTERNATIVE PRIMARY CARE HOMEOPATHY ("similar suffering") This is the oldest system of "alternative medicine", and is still the most popular in Europe. Samuel Christian Hahnemann (1755-1843), a German physician, "discovered" homeopathy by experimenting on himself with Peruvian bark (chincona), the remedy for malaria. The active agents of Peruvian bark are quinine and quinidine, optical isomers. Quinine is of course the anti-malarial drug, while quinidine has several different potent effects on the heart and other organs. In Hahnemann's time, malaria was a major cause of "fever", and "fever" was understood as rapid pulse rather than elevated temperature. Hahnemann discovered that when he took a small dose of Peruvian bark, his heart slowed down, but when he took a large dose, his heart began to beat very rapidly. We now recognize the characteristic cardiotoxicity of quinidine in Hahnemann's experiment. (Students: find out the mechanism!) Hahnemann concluded, however, that low doses of any substance would cause an effect opposite to that produced by high doses. Hahnemann went on to discover that the more times the substance was serially diluted, the better the medicine would work. He published his findings in 1810, as Organon of the Art of Healing. This work still forms the basis for modern homeopathy, although homeopathic practitioners continue to expand their knowledge by a distinctive kind of research. The homeopathic researcher studies books about toxicology, to identify some poison which causes the overall symptom picture most like that of the patient. Modern homeopaths explain that this is the way to "diagnose" and treat the "whole person". Thus a patient may be described as a "typical arsenic case". Homeopaths have always denied the validity of describing distinct diseases. Because diagnosis and treatment are so individualized, homeopaths regard conventional research as impossible [1]. A homeopathic physician explains holistic medicine: "I am not trained to decide whether a person's nasal discharge is caused by a cold, an allergy, or a hay-fever. However, I am trained in homeopathy to see their nasal discharge as part of their entire adaptation to life" [2]. The appropriate substance being identified, it is then serially diluted many times to produce a "potentised" remedy which contains "less than one molecule" [3] of the original substance. The medicine works by mysterious, vitalistic means: "It is this serial dilution with succussion which we believe to be vital in the production of a potency, which may not act on a material level at all, but by means of some energy source preserved in the solvent" [4]. Homeopaths generally believe that all disease is also caused by mysterious, vitalistic processes [5]. Homeopathy has as its motto Similia Similibus Curentur: "Let Likes Be Treated By Likes". Homeopathic physicians call regular medicine allopathy, or "other suffering". Later systems of alternative medicine chose similar names: "naprapathy", "naturopathy", "osteopathy". Homeopathic manuals are voluminous and baffling to non-experts. Over 2000 substances have been used by homeopathic physicians, including: alloxan (diabetes) granite opium arsenic (GI ills) hemlock oyster shells bee venom ink phosphorus camphor (chills) iron filings poison oak (arthritis) charcoal lead Spanish fly club moss lye spider webs cobra venom nightshade strychnine copper sulfate onions (colds) virgin's tears Homeopathic vaccines are being promoted as alternatives to childhood immunizations.... Every controlled study of homeopathic remedies for particular diseases has shown little or no advantage over placebo [6]. A homeopathic physician explains the spiritual life: "Homeopathy can attune, correct, and purify the human organism so that it functions with efficiency and sensitivity. This is absolutely essential. But true health is much more than this, and comes about when man has harmonized the whole of his being with his Creator" [7]. * * * CHIROPRACTIC ("done by hand") This is the most popular system of "alternative medicine" in the United States. D.D. Palmer, a "magnetic healer" in Davenport, Iowa, "discovered" chiropractic in 1885. Palmer claimed to have cured a janitor of deafness by manipulating his spine. Because of its origins, chiropractic often exhibits a conservative religious and political emphasis. Chiropractors treat disease by manipulating ("adjusting", etc.) the vertebral column. "Manipulation" moves a joint beyond its usual range of motion. A Federal District Court summarized (1965): "It is chiropractic doctrine that most, if not all, human ailments result from a slight misalignment or subluxation of contiguous vertebrae" [8]. Regular physicians and anatomists cannot see these "misalignments" or "subluxations" at autopsy or on x-rays. (Chiropractors of course claim that they can, but have never been able to demonstrate them for skeptics.) Experiments in which various torques were applied to vertebral columns of cadavers have not supported the ideas of chiropractors [9]. In any case, some chiropractors claim that success is a result of their meticulous study of anatomy and careful training, others that their skill in manipulating is spiritual and intuitive. Currently there are around 25,000 chiropractors in the US, with 2000 new graduates per year. A chiropractor's mean income, after expenses, is now around $100,000 per year. Three percent of US citizens visit a chiropractor each year. Chiropractic is gaining its long-sought recognition as an independent profession, not subject to external review by physicians. An orthopedic surgeon, for example, would probably not be able to testify at a malpractice suit against a chiropractor. Chiropractic is legal in every state, and is reimbursable through Medicare and Medicaid (since 1977). Chiropractors may take x-rays in most states. The American Medical Associated dropped its legal battles with the Federal Trade Commission and the chiropractors in 1980, and no longer says that it is unethical for a physician to associate with any chiropractor. There is currently a wide spectrum of belief and practice among U.S. chiropractors. "Straight" chiropractors only perform spinal manipulations. Some reformer "straights" do not even regard chiropractic as an independent science, and these chiropractors are likely to limit their practice to treating back and neck pain, sciatica, etc. At least one reformer has blasted his colleagues as pseudoscientific dogmatists [10]. Younger chiropractors are discovering scientific medicine, although they usually join their elders in opposing all drug therapy. "Mixer" chiropractors present their system as primary health care. While "nonalignment" of the vertebrae and pressure on the spinal nerves causes most human disease, "mixers" also dispense enemas, vitamins, and other "holistic" treatments [11]. How safe and effective is chiropractic manipulation? Results of the few studies on chiropractic therapy for back pain are mixed. Patients often cannot distinguish a trained chiropractor from a placebo thumper. Such differences as are observed have been attributed to the personality and attitude of the therapist [12-15]. Studies of chiropractic for other problems are even fewer and are mostly negative [16-17]. Manipulation appears fairly safe if the vertebral column is sound. Mishaps have included dislocation of the atlas and occlusion of the basilar or vertebral arteries [18-19]. Leading chiropractors often make claims that seem irresponsible. Current chiropractic broadsides include allegations that spinal column "subluxations" are usually the result of obstetrical intervention during delivery. The dean of one chiropractic school says, without evidence, that this is the only cause of sudden infant death syndrome [20]. If a child dies, it is because the parents didn't take him or her to a chiropractor. A chiropractor explains why he should not have to do honest research: "It is true that there are not many [sic.] unbiased studies supporting the relationship between nerve pressure and entrapment and somatic disorders. But part of the reason for this lack is that chiropractic has not had access to the heavy public funding the medical profession has received.... One should not assume, given the scarcity of solid research data, that chiropractic doesn't effectively treat some organic disorders" [21]. Another chiropractor explains health: "It is life itself which heals, or, perhaps more accurately, the unfettered expression of life. Life and its unhampered expression (health) are conditions that come from within. The scientific law of homeostasis says that every organisms in the universe has the innate ability to be whole and healthy and stable within itself and its environment. You have every potential that you'll ever need to live a balanced, coordinated existence: those potentials are not locked in cow pus, moondust, or any outward source, but rather flow from within. In order to express more of your potential, you need only keep the channels open" [22]. CHIROPRACTIC VARIANTS Total Lesion Osteopathy Osteopathy was originally a system of health care based on manipulation, founded by Dr. Andrew Taylor Still in 1870. Traditional osteopaths sought to remedy palpable "lesions", particularly along the vertebral column. "Wherever the circulation of the blood is normal, disease cannot develop because our blood is capable of manufacturing all necessary substances to maintain natural immunity against disease" [22]. Disease was attributed to upright posture and mechanical trauma, causing mechanical imbalances which interfere with blood flow and natural immunity. Today, most osteopaths (Doctors of Osteopathy, D.O.'s) practice conventional medicine. They sometimes use Still's manipulations but typically do not resort to "alternative" theories or practices. However, some osteopaths (including "total lesion osteopaths") have typical mixed holistic practices. An advocate of holistic medicine discusses osteopathy: "On reflection it is strange that many members of the medical profession did not think much of osteopathy, yet the first thing a young medical student is asked to study is a skeleton. If that isn't a step toward osteopathy I don't know what is" [24]. Naprapathy A German system of manipulation, which attributes disease to strained or contracted ligaments. Naprapaths typically have mixed holistic practices and present themselves as alternative primary care providers. Cranial osteopathy A system of health care originated by William G. Sutherland, an osteopathic student, in 1899. Sutherland was particularly interested in the sutures of the skull. His studies on living people convinced him that the brain contracts and expands rhythmically. This causes the bones of the skull to separate slightly, although it takes much practice to be able to feel this. The few existing practitioners manipulate the sutures of the skull to treat diseases. Cranial osteopathy may be learned at the Sutherland Cranial Teaching Foundation. Dental kinesiology Holistic dentistry is a new type of dental practice which seeks to identify and control the spiritual forces that affect teeth. One type of holistic dentist, the dental kinesiologist, manipulates the jaw in order to realign and balance the whole person. ("Kinesiology" of course is the word for the scientific study of body physics in athletics. The dental kinesiologists borrowed the term.) A few years ago, there was much interest among athletes in a device which was worn in the mouth to thrust the jaw forward to increase upper-body strength and general athletic performance. It failed a placebo-controlled study miserably [25]. Rolfing A system of back care developed by Ida P. Rolfe, Ph. D., a research organic chemist, in the 1940's. Rolfers push on the body to "remold the deep connective tissues" and thereby "realign the body along its natural vertical axis in order to enable it to interact with gravity to obtain a free flow of energy ... releasing both chronic physical and chronic emotional problems" [26]. However, no grandiose therapeutic claims are made for rolfing. Polarity therapy A system of health care developed by the versatile Randolph Stone (b. 1890), a naturopath, chiropractor, osteopath, phrenologist, ceremonial magician, acupuncturist, herbalist, yogi, etc. Polarity therapy is based on vitalistic ideas: "The Polarity system holds that, underlying what we call the material world, there is an infinity of universal energy. Every living organism, for example, our apple, is engaged in a constant movement of energy, a rhythmic contraction and expansion, both within itself and in its environment" [27]. The practice of polarity therapy is designed to correct emotional, dietary, and physical imbalances, and includes squatting, "gentle" manipulations, and a diet rich in bean sprouts. NATUROPATHY An alternative, eclectic system for total health care, introduced to America from Europe in 1890 by Benedict Lust, previously a medicinal bath operator. This is the holistic approach to medicine par excellence, incorporating all "natural" remedies without a dogmatic system. Naturopaths are trained to provide all the primary health care needs of their clients, including obstetrics, minor surgery, chiropractic, homeopathy, yoga instruction, etc. Naturopathy has as its motto Vis Mediatrix Naturae: "Healing Power of Nature". Such a general interest promotes rapport with scientific medicine. We learn with hope of the first Federal accreditation last year of a school for naturopaths (John Bastyr College of Naturopathy Medicine, Seattle). Naturopaths tend to attribute disease to the buildup of poisons in the body [28]. Disease is prevented or treated by: -- avoiding alcohol, meat, "suppressive drugs", tobacco, white flour, white sugar -- fasting for days or weeks (the naturopaths I have met are all skinny....) -- following various "cleansing" diets of health foods, with herbs and particularly garlic -- taking enemas (water, coffee, camomile tea, etc.) -- enjoying baths, fresh air, sunshine, "contact with the earth", etc. Naturopaths vary in their attitudes toward conventional medicine. For example, some advocate, while others oppose, childhood immunizations. (Last year I listened as one naturopath told a church audience that polio can easily be prevented by rubbing children's feet with garlic.) A naturopath explains why he should not have to do honest research: "The funds we should use for research have always been used to protect ourselves. We can't expect to charge patients, who often aren't covered by insurance, the extra money that's necessary to do these research studies" [30]. Another naturopath explains his goals "Naturopathy is therefore mainly concerned with the prevention of disease by means of education in nature cure to maintain a maximum level of health through correct living, eating and thinking; and it encourages the growth of an ever-widening awareness of the cosmic harmony" [31]. Yet another naturopath explains the spiritual life: "WHY SUFFER? I believe that there is absolutely no need for sickness. Poverty is a state of mind. Everything is a state of mind. My philosophy of life is learning to understand the laws of nature. You cannot escape these laws. When you take something away from someone else, you take it away from yourself. If this were taught in our school system, there would be absolutely no destruction of anything. All humankind would be educated as to the laws of nature. Then and only then will we have a healthy, peaceful, and prosperous world" [32]. ALTERNATIVE CANCER THERAPY The recent surge of publications about "holistic medicine" directed toward the United States public coincided in time (1978-80) with the collapse of the multi-billion dollar Laetrile fraud. Today, "holistic medicine" advocates avoid all references to Laetrile, as if the whole fiasco has never happened. Yet Laetrile was usually presented as a "natural treatment" for the "whole person", and sold in combination with enemas, vitamins, weird diets, and "spiritual" therapy. Anyone wishing to gain a better understanding of "alternative" medical practices will want to study past and present unproven cancer remedies. Only a few of the more interesting methods of diagnosing and treating cancer are listed here. Whenever one of these has been tested by the usual methods of science, it has been found totally worthless. GLOVER SERUM During the 1920's, a Joseph Glover was treating cancer by passive immunization. The serum came from horses inoculated with a "virus" obtained from cancer patients, which he observed caused "tumors" in experimental animals. The "virus" proved to be Cryptococcus fungus, and the "tumors" were granulomas. The Glover serum remained popular for decades. The idea of using hyperimmune horse serum probably provided the inspiration for "Krebiozen" (see below). SANDERS CURE This remedy, popular early in the century, consisted of warts removed from horses, ground up fine and suspended in sour milk. Sanders was a motel operator. CARICIN and NEO-CARICIN Secret preparations to prevent and cure cancer, promoted during the first six decades of this century. The originator, Jacob Pawlotzky, always refused to divulge details about manufacture or identify any of the hundred thousand patients he had cured using them. MUCORHICIN This material was stated by its developers to be an extract of two molds, Mucor and Rhizopus. It was discovered by Philip L. Drosnes (a tire salesman) and Lillian M. Lazenby (a hospital cafeteria director), who set up a cancer clinic in a church basement and treated people with it. The two also had a diagnostic slide test for cancer (everybody positive) and recommended a weird diet. Mucorhicin is still available, and has been used recently as an adjunctive therapy with Laetrile. JAVIRO HEAD SHRINKING COMPOUND ("Ferguson Plant Products") Wilburn Ferguson, a medical school dropout, claimed to have obtained his material form his friend, "chief medicine man Tangamasha" in Ecuador. The substance itself was allegedly made from plants which Ferguson never identified. It was administered intravenously, and was popular during the 1950's and '60's. Ferguson founded the World Life Research Institute (later the Ferguson Research Institute) and his work was promoted in The Saturday Evening Post [33]. DIAMOND CARBON COMPOUND This was a mixture of herbs and powdered diamonds, based on a remedy from the ancient Atharva Veda. Indian herbalist Anthubhai Vaidya promoted this material as curing all forms and stages of cancer. Vaidya cited, as support for his claims, the results of studies that had never been performed. They would have cost over $2000 per mouse. HETT CANCER SERUM John Emil Hett, M.D., treated cancer in the early 1950's with injections of a secret preparation. He would not divulge details of how it was made or allow others to administer it in tests. Patients receiving the serum would experience chills and fever. The serum proved to be loaded with Escherichia coli and Streptococcus fecalis bacteria. Dr. Hett wrote a book entitled Cancer, Arthritis, Stomach Ulcers, Goitre, and Malfunctions of All Glands, and organized the Hett Cancer Research and Treatment Foundation. KOCH ANTITOXINS William F. Koch, M.D., and his two brothers, treated cancer in the 1940's with distilled water which they claimed was one-one trillionth part glyoxylide. They also used benzoquinone and malonide, a diet, and frequent enemas. The Kochs called their operation the Christian Medical Research League. After two mistrials, Dr. Koch fled to Brazil. GRAPE CURE Johanna Brandt, N.D. (Doctor of Naturopathy), operator of the Harmony Healing Center, believed that all cancer is caused by constipation. Dr. Brandt also discovered that grapes contain a medicine which cuts through all the mucus in the intestine. This medicine, however, turns to poison when it contacts other food in the stomach. Therefore, the "grape cure" involves eating nothing but grapes until the cancer is cured. Dr. Brandt also advocated the diet for other illnesses, including high blood pressure, bad eyesight, and gray hair. HOXSEY TREATMENT Harry Hoxsey, a versatile man with an eighth grade education, mined coal and sold insurance prior to promoting his "alternative" cancer treatment around 1920. The Hoxsey remedy was based on the "pink medicine" (pepsin and potassium iodide) and the "black medicine" (cascara and herbs). There was also a weird "cleansing diet" and enemas. Hoxsey had several early criminal convictions for health fraud. Hoxsey wrote a book, You Don't Have to Die, opened various Hoxsey Cancer Clinics, and got his own radio show, soon becoming the most conspicuous figure in "alternative medicine" in the 1950's. All visitors to the Hoxsey clinic were given a perfunctory exam, told they had cancer, and were offered a cure for $400. The Hoxsey cure became linked to conservative radio ministries and with rabid anti-Semitism. When Hoxsey was prosecuted, he persuaded several religious periodicals to sponsor a "Crusade of Prayer Against the Food and Drug Administration". Hoxsey presented investigators with a list of 400 patients he had cured of cancer. It turned out that, in every case, there was no biopsy to establish the diagnosis, or the patient had been cured by conventional means, or the patient was dead or dying. ISCADOR An extract of mistletoe, publicized by the mystical Anthroposophical Society as capable of reversing an undefined "premalignant condition". The mistletoe had to be collected at times and places determined by astrology. KREBIOZEN This cancer remedy gained national attention in the 1950's. Mysteriously, it was endorsed by Dr. Andrew C. Ivy, Chairman of the Department of Physiology at U. of Illinois Medical School. The material was prepared by two brothers from Yugoslavia, Stevan and Marko Durovic (allegedly a physician and attorney respectively). The Durovics stated the Krebiozen was manufactured from the serum of horses which they had immunized against Actinomyces bovis bacteria. Nobody but the Durovics ever got to see the horses. When the Food and Drug Administration wanted to see Krebiozen being manufactured, the Durovics sued to prevent them. Even after the Durovics lost this action, the FDA still never got to look at the horses. Dr. Ivy was persuaded by the Durovics to endorse Krebiozen without ever seeing the horses, either. The Durovics dissolved their supply in mineral oil, which prevented it from being analyzed by the chemical methods in current use. In 1963, it became possible to analyze the material. All samples were either pure mineral oil or creatine dissolved in mineral oil. At the trial, it emerged that of fifty patients reported "cured" by Krebiozen, all but a few were dead. The prosecutors suggested that the whole thing had been a charade, the horses never existed, and Dr. Ivy was the victim of a cruel hoax. (One prosecutor read the jury the story of "The Emperor's New Clothes".) The trial ended in a hung jury. Later, jury tampering by the defense was discovered, and a juror went to prison for six months. MILLRUE An herbal extract, sold as a cancer cure by Roy Paxton, a "psychic" who would diagnose and treat disease after feeling a client's feet. After serving three years in prison for quackery, Paxton was made a director of the National Health Federation, an organization promoting Laetrile and other unproven cancer remedies. GERSON CURE Max B. Gerson, M.D., an Australian, achieved prominence in the 1940's for developing a cancer remedy based on a diet of fresh fruits and vegetables which had to be processed in a special chopping machine which he sold for $150. Patients also got coffee enemas, etc. ISSELS CURE Joseph Issels, M.D., a German physician, developed an eclectic cancer treatment which he called "whole body therapy", or "combination therapy". Designed to enhance natural resistance, the regimen called for removal of teeth and tonsils, administration of Neo-Caricin and various vaccines, and psychotherapy. Dr. Issels was convicted of negligent manslaughter in 1961. The decision was later reversed because the court found Issels could reasonably have believed his treatment was effective (though he was wrong). Issels was described as sincere, helpful, and fully cooperative with investigators. LAETRILE The long story of Laetrile began in 1902, when John Beard, an eccentric Scottish embryologist, noticed that the trophoblast begins to regress as the pancreas is appearing. He conjectured that pancreatic proteases digested the trophoblast, causing it to regress. Dr. Beard went on to hypothesize that, since trophoblast is locally invasive at the site of implantation, cancers are merely trophoblast and could be destroyed by pancreatic enzymes. Over the following years, Dr. Beard and his circle attempted to diagnose cancer by demonstrating human chorionic gonadotropin (hCG) in the urine of patients (the "Anthron test" and others). Beard also claimed that the urine of cancer patients causes milk to clot more rapidly than that of healthy people, etc. Ernest T. Krebs Sr. M.D., an obscure California general practitioner, launched his long career in "alternative medicine" in 1918, selling a phony "American Indian herbal syrup" (various names) to prevent and cure the influenza pandemic. (Do not confuse this Krebs or his son with the discoverer of the Krebs cycle.) Dr. Krebs Sr. soon followed the remedy with his "Mutagen", a solution of chymotrypsin which he offered as a cancer cure. He continued work in his home laboratory, and in 1920 began producing crude amygdalin (a beta-glycoside of mandelonitrile) from seeds, at first to flavor bootleg whiskey. Krebs Sr. tried this and other substances as cancer remedies over the following decade, attracting little attention. Ernest T. Krebs Jr., the son of Krebs Sr., a medical school dropout, registered the trade-name "Laetrile" in 1952. The name comes from "laevo-rotary mandelonitrile". (Krebs Jr. later obtained an honorary Ph.D. from an obscure Oklahoma Bible college, and was generally called "Dr. Krebs" by his supporters.) Krebs Jr. stated that Laetrile was a remedy for "treatment of disorders of intestinal fermentation" (i.e., cancer and everything else). The father-and-son Krebs team began manufacturing and distributing Laetrile as operators of the John Beard Memorial Foundation. Laetrile was typically manufactured from apricot pits and was hailed as a "natural cure" for cancer. Cancer was presented as a "chymotrypsin deficiency disease" and malignant cells were described as "trophoblast" in such publications as Howard H. Beard's A New Approach to the Conquest of Cancer, Rheumatic, and Heart Disease (1958). Laetrile was alleged to release its cyanide moiety within human cells. Normal cells were said to be capable of disposing of the cyanide, while it was lethal to cancer cells. This "mechanism of action" was a bold-faced lie. Laetrile does not even enter human cells. Normal cells and cancer cells do not usually differ significantly in their ability either to cleave beta-glycoside linkages, release cyanide, or dispose of cyanide [34]. The Krebs team and followers revised their explanation of the mode of action of Laetrile several times. Krebs Jr.'s publicity campaign included claims that primitive tribes enjoyed immunity to cancer because of diets rich in Laetrile. The Hunza, living in the high Himalaya mountains, supposedly ate lots of cyanogenic glycosides in seeds and enjoyed amazing good health and immunity to cancer. Health-food advocates and other "alternative" proponents continue to refer to "the healthy Hunza" today. However, in 1955, a team of Japanese explorers visited them, and reported that they suffered from many diseases, including malnutrition and plenty of cancers. The African Bantu, who eat cyanogenic glycosides in cassava root, were also alleged to be immune to cancer. This wasn't true, either. The California Medical Association tested the Krebs's Laetrile on 44 cancer patients in 1953. There was no demonstrable effect [53]. Laetrile was saved from obscurity only by the efforts of a massive propaganda campaign by the political far-right. Andrew McNaughton, a Canadian financier and right-wing political activist (Bay of Pigs, etc.) met the Krebs team in 1958, beginning a mutually-profitable association. During the following years, McNaughton distributed Laetrile for the Krebses, as "Bioenzymes International, Ltd." and later the "McNaughton Foundation of Canada". Ernesto Contreras, M.D., a Mexican pathologist, founded the Good Samaritan Clinic in Tijuana in 1963. Dr. Contreras diagnosed cancer by the urinary hCG test and other unconventional lab tests, and treated it with McNaughton's Laetrile. Fees at Dr. Contreras's clinic were low -- $10 for an office call, $10 for a day in the hospital (!), $3 for a gram of injected Laetrile. (By contrast, actor Steve McQueen paid $10,000 per month at another Mexican Laetrile clinic a few years ago.) The U.S. government soon took legal action against the Krebses and their associates. The first seizure of Laetrile by Federal agents was in 1960. The shipment was bound for the notorious Hoxsey Cancer Clinic in Dallas. Krebs Jr. was found guilty in 1962 of violating Federal law by selling "pangamic acid" to improve the performances of race horses. (This non-substance, also called "vitamin B-15" by the Krebses, has no defined chemical structure. Samples of "pangamic acid" sold a few years ago in health-food stores proved to be various simple chemicals depending on the manufacturer.) In 1963, the government managed to close the Fremont Christian Clinic in Los Angeles, where Laetrile and Hoxsey's methods were being used. Two octogenarian physicians were successfully prosecuted. Roy DeWillis, the clinic operator, escaped prosecution only because he was already on trial in Indianapolis for quackery -- over the previous ten years he had built a national chain of colonic irrigation parlors. He was found guilty and served ten years in prison. Krebs Sr. was enjoined to stop promoting and producing Laetrile in 1965. He disregarded the injunction and was fined $250. He died in 1970 at the age of 93. In 1970, Krebs Jr. and associates launched a more aggressive publicity campaign. Krebs Jr. announced that Laetrile was "vitamin B-17", and deficiency of this vitamin caused all forms of cancer. The gimmick was to avoid certain regulations by presenting Laetrile as a "vitamin" rather than as a "drug". Of course, Laetrile is not a vitamin. John Richardson, M.D., a California practitioner and active member of the patriotic John Birch Society, was arrested in 1970 for using Laetrile. His arrest was shown on national television. The John Birch Society was soon heavily involved in the promotion of Laetrile through its conservative political machinery. (Dr. Richardson is still alive, and is now practicing homeopathy.) Rhetoric emphasized a conspiracy by orthodox physicians to suppress the cure for cancer, and the right of cancer patients to "freedom of choice" of remedies. Laetrile quickly became generally available, though illegal. "Street" Laetrile was often heavily contaminated. Enormous profits were reaped by Krebs Jr., McNaughton, the smuggler Robert W. Bradford (later manager of the Robert W. Bradford Foundation), and many others. Investigators found $12,705 cash in a ceiling safe and a "huge pile of money" elsewhere in the home of Krebs Jr. in late 1976. Efforts of Laetrile proponents to legalize the substance were rewarded in 1977. Alaska became the first of 27 states to legalize Laetrile. A federal district court in Oklahoma declared Laetrile exempt from the Food and Drug Act, ruling that the Act did not apply to terminal cancer victims. The plaintiff was a Glen L. Rutherford, who had had a colonic polyp cauterized in Mexico. He was told he had cancer and that his continued survival depended on his taking Laetrile. On June 18, 1979, the U.S. Supreme Court overturned this decision. In a subsequent decision (Feb. 1980), the Supreme Court ruled that even if Laetrile is "nontoxic", cancer victims are still entitled to protection from expensive health frauds. Also in 1977, the National Cancer Institute completed its review of Laetrile [36]. Despite the utter failure of Laetrile as treatment for cancer in experimental animals, the NCI carried out this study in response to political pressure. Requests were mailed to 375,000 physicians, 70,000 other health professionals, and every Laetrile advocacy group, asking for cases in which Laetrile had appeared to be clinically effective. An estimated 5000 practitioners had used Laetrile on an estimated 70,000 cancer victims by this time. Only 93 cases were submitted for evaluation, and data was complete on only 68. Two hundred physicians volunteered that they had seen Laetrile used without benefit in any case, the total number exceeding one thousand. Of the 68 cases, only 6 were judged as possible responses by a panel of oncologists, and 1 of 24 controls (no treatment at all) was also judged as a possible response. (These were mostly cases of transient tumor shrinking.) This retrospective survey had obvious limitations, but the results seemed clear. Laetrile advocates demanded a further controlled study using Laetrile plus diet ("metabolic therapy") at public expense. Again in response to political pressure, the NCI began such a study in 1978, using patients at the Mayo Clinic and other major cancer centers. The results, made available in 1982, showed Laetrile and "metabolic therapy" as described by Laetrile proponents to be no better than placeboes [37]. A few patients receiving Laetrile by mouth showed signs of cyanide toxicity, but no one died of it. (Cyanide can be released from Laetrile by bacteria in the colon. An intravenous dose is rapidly excreted unchanged by the kidneys.) Laetrile advocates (including Dr. Linus Pauling) then complained that "metabolic therapy" was incomprehensible to those not specially trained in the use of Laetrile, etc., etc. The public now has lost confidence in Laetrile. By now, everybody knows a few cancer victims who have died despite promises of a cure through Laetrile (at a cost of thousands of dollars). The unnecessary death of three-year-old Chad Green was highly publicized and provoked widespread disgust. A victim of a curable type of childhood leukemia, Chad died in Mexico, where his parents had taken him for Laetrile treatments in defiance of a court order. ZEN MACROBIOTIC DIET This system of nutrition has no relationship to real Zen or any other type of Buddhism. It was developed by George Ohsawa (pseudonym), a Japanese eccentric whose system emphasizes brown rice and fluid restriction. Ohsawa wrote a book entitled You Are All Sanpaku, organized the Ohsawa Foundation of New York, and so forth. Readers of Ohsawa's books are instructed to examine their eyes in a mirror to determine whether they are sanpaku (Japanese for "three white"). This condition is present if one can see the sclera at either side of and below the iris. With the white showing beneath the iris as well as at the wide sides you are in the sad state of physical and spiritual imbalance [38]. Proponents have claimed that the Zen Macrobiotic Diet cures most diseases. It has also caused deaths from scurvy and deaths from dehydration. SIMONTON MENTAL IMAGERY Oscar Carl Simonton, M.D., a board-certified radiation oncologist, and his wife and colleagues established the Cancer Counselling and Research Center in Texas. In the early 1970's, Dr. Simonton urged his cancer patients to try relaxation and mental imagery techniques, including visualizations of white blood cells as white sharks eating cancer cells [39]. These seemed to help some patients. Dr. Simonton had expected to be able to provide his professional colleagues with objective, controlled evidence of the effectiveness of his approach. These have not been forthcoming. The Simontons' principal series falls far below the usual standards on which expensive patient-care decisions are based, and the slightly longer survival time of their patients could easily be explained by patient selection [40]. Dr. Simonton and colleagues charge patients $1900 plus room and board for a ten-day course centered around mental imagery techniques. Cancer patients who cannot attend are encouraged to read the Simonton books and articles and practice the techniques at home, at no risk or expense. Whether or not they take the Simonton course, patients are urged to continue regular cancer treatments. The Simontons tell their patients that their cancers are the result of their own faulty mental attitudes, and they are told they are "responsible" for their being sick. Dr. Simonton explains why he should not have to do honest research in a short essay in The Holistic Health Handbook, citing Albert Einstein as his authority [41]. The Simontons' principal book, Getting Well Again (1978), describes the imagery techniques. The case histories in Getting Well Again won't impress cancer physicians. Bob Gilley was probably cured by conventional means. James (the index case), Betty, Edith, and Ellen all had good, but not surprising, responses to conventional therapy. Glenn and the patients with malignant lymphomas had tumors that often grow very slowly. Charles probably never had cancer. The former Mrs. Simonton has also written a book, The Healing Family, full of practical self-help advice, with only a few pages on imagery. ALTERNATIVE PSYCHIATRY REICHIAN THERAPY The ideas and practices of Wilhelm Reich, M.D., are frequently cited and emulated by practitioners of many different systems of present-day "holistic medicine". Dr. Reich began his career as a promising student of Dr. Sigmund Freud. Today, psychoanalysts regard the young Reich as having made important contributions to personality theory. Reich lost favor among his fellow psychoanalysts, however, when he became a Marxist. He subsequently found himself unwelcome in Communist circles when he became known as an advocate of free sex. Reich set off on his own, developing a system he called vegetotherapy. This system of treating physical and emotional illness included massage, hyperventilation, dancing, stomping, gagging, pushing, screaming, etc., "to release the deep unconscious". Reich and his fellow vegetotherapists established a community called Orgonon, in Maine. Soon Reich developed a further theory of life based on his discovery of "cosmic orgone energy", the vital force in orgasms and in all of life. He began constructing devices to accumulate orgone energy and trap "blue bions". These were the famous "orgone boxes", resembling telephone booths with alternating lining layers of asbestos and steel wool. Reich alleged that his boxes prevented and cured cancer and most other diseases. They rented for hundreds of dollars a month. Reich also developed four blood tests to diagnose cancer ("lack of orgone energy in the red blood cells"). These mostly measured crenation of red cells, an artifact caused by clumsy preparation of the blood smears. The Food and Drug Administration had little difficulty putting Dr. Reich in prison in 1955. He died in Alcatraz two years later, comparing himself to Jesus Christ. PRIMAL THERAPY Artur Janov of Los Angeles describes an unusual theory of mind and emotional illness in his book The Primal Scream. He rejects all other forms of psychotherapy in favor of a modality of treatment which seeks to reinstate forgotten memories. After selection, patients pay $6000 or so and undergo several weeks of continuous isolation to experience the "pool of primal pain". Patients then undergo "primalling", during which they relive early traumatic experiences (childhood, intrauterine). This experience is so real that patients have been alleged to grow new teeth during "primalling". (The same claim was made for "dianetics"; see below.) Primal therapy also urges patients to abandon all feelings of responsibility toward others [42]. DIANETICS ("Church of Scientology") Lafayette Ron Hubbard, a science fiction writer whose avocations included geology and ceremonial magic, described a new theory of mind and emotional illness in a book Dianetics: The Modern Science of Mental Health (1950). Thousands of people subsequently underwent dianetic auditing by Hubbard and associates. The patient would hold a V8 can in either hand. These were wired to a device (the "E-meter") to monitor the galvanic skin response as the patient talked. Patients would be guided to relate their current problems to childhood, intrauterine life, and previous lives as creatures of unknown species. It was hoped that auditing would eventually enable patients to become "clears", free from the residue of all previous traumatic experiences ("engrams"). Patients, who typically spent thousand of dollars for dianetic auditing, were called "preclears". In order to escape a multitude of legal problems, Hubbard and associates became the "Church of Scientology", a religion. Unwelcome anywhere, Hubbard spent many years running his empire from a ship on the high seas. Later he was held captive by his cult members, while his own son denounced him as a charlatan. The "Church of Scientology" has constantly been in legal trouble, and has shown a capability for disciplined resistance (violence, burglary). EST ("Ehrard Seminars Training") Werner Ehrard (real name Jack Rosenburg), a high school graduate, offers another system of "alternative" mind-therapy. The desired result is "getting it" by undergoing "mind-boggling". Exactly what "it" is cannot be explained but is very worthwhile. Participants pay $300 for a series of lengthy and stressful group indoctrination sessions. (EST is famous for forbidding use of the bathroom.) Cognitive thinking is ridiculed. "Understanding gets the booby prize." Participants are told they have caused their own problems, the leader says he loves all of them, etc. ORTHOMOLECULAR PSYCHIATRY A system of treating mental illness by administering large doses of vitamins and other nutritional supplements. Because its practitioners can see more patients in a day, it is more profitable than conventional psychiatric practice. Despite some interesting anecdotal evidence, there are no good studies to show it is effective. * * * ALTERNATIVE SURGERY PSYCHIC SURGERY Several different types of "psychic surgery" are practiced today. In the United States, Europe, and elsewhere, trance mediums may claim to become possessed by the spirits of dead surgeons. This enables the spiritual surgeon to operate on the astral body of the patient, possibly curing a physical illness. Gaining supernatural insight into disease and treatment during trance states has been popular since ancient times. Information comes from God, the dead, etc. Modern "holistic medicine" has little to do with living psychics. However, one of the largest holistic clinics, the "Association for Research and Enlightenment" (A.R.E.) in Phoenix, bases its approach on the voluminous writings of the late Edgar Cayce, America's most famous psychic of the past. (Cayce especially favored castor oil, administered by different routes.) Better-known are the Filipino and Brazilian "psychic surgeons", living men who claim to remove diseased tissue from living patients, magically and painlessly. Despite their claims, scientific verification has not been obtainable. Psychic surgeons insist on destroying the "evil tissue" once it has been removed and shown, rather than allowing pathologic examination. Blood from one patient's clothes proved to be pig's blood [43]. A kidney stone "removed" from another patient turned out to be granite [44]. The procedures do resemble sleight-of-hand.... (For more psychic marvels, see "Radiesthesia", below.) * * * ALTERNATIVE CARDIOLOGY CHELATION THERAPY Solutions of the chelating agent EDTA (ethylene-diamine tetra-acetic acid) are given intravenously to reverse the lesions of atherosclerosis. Patients are told that the chemical removes the calcium that makes up the plaques. This just isn't true. The EDTA simply binds the free calcium ions in the blood, and passes out through the kidneys. Further, atherosclerotic plaques are really composed of cholesterol and fibrous tissue. Calcium salt deposition occurs later in the fibrous tissue, and many fatal cases of atherosclerosis show little or no calcification. EDTA is called the "chemical roto-rooter". Treatment costs $3000-$5000. Rapid administration of the EDTA is likely to cause the patient's fingers to tingle due to transient hypocalcemia. The patient may believe this is caused by "improved circulation". If chelation therapy is ever effective, it is because of the changes its patients are urged to make in diet and physical activity. Because EDTA is approved for treatment of victims of heavy metal poisoning, its use in "chelation therapy" of atherosclerosis cannot be regulated. * * * ALTERNATIVE RHEUMATOLOGY ARTHRITIS CURES Older arthritis remedies were mostly devices ("Vivicosmic disc" made of cement, mittens filled with "radioactive" gravel, copper bracelets, etc., etc., etc.) Contemporary arthritis remedies mostly come from diet books. We now know that some (but by no means all) cases of rheumatoid arthritis appear to be caused by specific food allergies. Stay tuned. The best-known "alternative" arthritis medicine is Leifcort, a mixture of prednisone, testosterone, and estrogen. Its developer, Robert E. Liefmann, M.D., produced it in Canada in the early 1960's. Dr. Liefmann was a fugitive from the U.S., where he was wanted for peddling a phony cure for baldness. Dimethyl-sulfoxide (DMSO), a solvent, probably relieves arthritis pain by temporarily disrupting the myelin in the nerve sheaths. Because DMSO is approved for use in treating interstitial cystitis, it cannot be regulated as a treatment for arthritis. * * * ALTERNATIVE REHABILITATION MEDICINE MOTOR PATTERNING A system for treating severely retarded persons, based on an unsupported "layer-cake" model of the sequential development of human abilities. Developers Glenn J. Doman and Carl H. Delcato claimed to be able to "modify the neurological organization" of the mentally handicapped. Their technique was very labor-intensive and included guided creeping, crawling, rolling, swinging, rubbing with a pot-scrubber, fluid-restriction, and carbon dioxide inhalation (to promote intracranial vasodilatation). Later, megavitamin therapy was added. The Doman-Delcato treatment has been condemned for years by the major professional organizations concerned with cerebral palsy and mental retardation victims. It is also very expensive. However, it still manages to find clients. Of course there are no controlled studies by its proponents. As a child in public school, I narrowly escaped being forced to participate in marathon "creeping and crawling" sessions to cure crossed eyes. Motor patterning is available at its birthplace (the Institutes for Achievement of Human Potential in Philadelphia), at the holistic A.R.E. (Edgar Cayce) clinic in Phoenix, and probably elsewhere. A controlled study in 1978 failed to support any of the Doman-Delcato theories or practices [46]. * * * ALTERNATIVE OPHTHALMOLOGY BATES METHOD William Bates, M.D., an ophthalmologist, devised a series of daily drills to correct faulty vision, which he believed was usually due to "bad habits of seeing". These included blinking, breath exercises, "palming" (mental imagery sessions with palms over the orbits), "sunning" (meditating with closed eyes, facing the sun), "swinging", etc. The Bates method is supposed to cure nearsightedness and farsightedness, though objective studies are not available. Aldous Huxley was impressed with the Bates system and wrote a testimonial book (The Art of Seeing). A Batesean "vision teacher" explains the spiritual life: "The most important palming meditation is this: when you are palming, begin to remember times in your life when you felt really whole, expansive, at one with yourself, when you were vibrant, relaxed, alive, and fully yourself. Invite visual memories to come to you. Cultivate this inner peace of healing wholeness" [47]. * * * ALTERNATIVE SYSTEMS OF MEDICAL DIAGNOSIS Alternative medicine uses many "unconventional" methods of detecting disease. Each of the following systems, its practitioners assure us, accurately finds diseases in their incipient stages, before the patient has any symptoms or orthodox physicians can detect any signs. The patient may then be treated by some other "alternative" remedy. When the latent disease does not develop, the patient is sure to be impressed with the effectiveness of "alternative medicine". Practitioners are also eager to point out that their systems are totally safe, pleasant, and non-invasive, unlike tests performed by regular doctors. None of these systems has ever stood up to the usual methods of scientific examination. IRIDOLOGY A method of diagnosing disease based on meticulous examination of the iris of the eye. The system's discoverer, a Dr. Ignatz von Peczely of Hungary, says he noted a new spot in an iris of his pet owl after he accidentally broke its leg. Practitioners divide the iris into tiny subdivisions, each corresponding to a different organ, and examine for abnormalities. Thus the "whole person" is reflected in the iris. In a controlled study, three prominent iridologists were unable to distinguish patients with chronic renal failure from patients with normal kidneys [48]. An iridologist explains the spiritual life: "In iridology, the macrocosm and the microcosm are linked in our eyes. The eye is the single most obvious mandala in our physical body. We may easily view it as a small world reflecting the entire person behind it...." [49]. HAIR ANALYSIS Many diagnostic claims are made by hair analysts. Typically these people receive hair specimens through the mail from individuals who have read their advertisements. The owner of the hair typically receives a prescription for some nutritional supplements a few weeks later. Hair analysis appears useful only in the study of heavy metal poisoning and a few obscure diseases [50]. APPLIED KINESIOLOGY A system for detecting early disease, based on a new claim by a number of U.S. chiropractors. Abnormalities of each organ system are associated with a different pattern of muscle weakness in different muscle groups. Its leading proponent is chiropractor George Goodheart, who has also contributed extensively to dental kinesiology. Dr. Goodheart analyzes the patterns of weakness associated with disease in terms of failure of the vital energy to flow along the appropriate acupuncture meridians. Once disease is diagnosed, it may be treated effectively by light touch at certain points on the body: "It is becoming more apparent that all disease begins with a lack of energy in a muscle, organ, or system.... Neurovascular points, mainly situated on the cranium, appear to be electrically or energy-controlled switch points for the flow of energy to all the main systems of the body. The lightest touch on these points for a short period results in a gradual realignment of energy levels" [51]. GRAPHOLOGY A method of studying character and health based on variations in handwriting. Cancer and "pre-cancerous condition" have been detected by examination of handwriting ("Kafner neuromuscular test") [52]. Most graphologists consider this irresponsible [53]. RADIESTHESIA A generic term for systems of psychic diagnosis which postulate the existence of waves as their basis. Radiesthesia practitioners generally use devices, which range from a hand-held pendulum (useful in selecting homeopathic remedies, aroma therapies, etc.) to more interesting machines. The following explanation of radiesthesia is as clear as any I have read: "Early attempts to provide instruments for radiesthesia (the simple pendulum, for example, can only convey limited information in laborious ways) sought explanation within the boundaries of formal science and inevitably failed. Many strange instruments were produced and soon many users were asking, "Why does it work without the plug in?" or "I took out the insides and it made no difference." Why, indeed?.... "From the radiesthetic side of the paraphysical fence one finds evidence to suppose that radiesthetic energy travels 200,000 times the speed of light. In hologrammic mode, all parts of a radiesthetic spectrum contain all other parts!" [54] In one device (the "Abrams oscilloclast"), the patient specimen is placed in one of the "dynamizer" (one of three empty boxes). The operator makes the diagnosis by tapping his belly and noting the various sounds made by his own intestinal gas. ALTERNATIVE THERAPEUTICS ACUPUNCTURE This fascinating system for relieving pain and treating disease has achieved worldwide popularity. Unlike most "alternative" systems, many orthodox practitioners feel comfortable experimenting with acupuncture. Most practices based around acupuncture, however, continue to draw on traditional Chinese magic and folk-medicine for their models of disease. "Traditional Chinese medicine" ignores modern empirical science in favor of a fantastic physiology based on vital force (ch'i) flowing along certain channels or meridians. There is also a theory of five transmuting "elements" which forms the basis of a doctrine similar to the Hippocratic "four humors". Positive and negative forces (yang and yin) must be kept in balance. And there is a technique for palpating each of twelve radial artery pulses (three superficial, three deep on each side), one for each organ system. Acupuncturists say these ideas are exactly as valid as "orthodox" physiology, which they regard as a Western cultural preference. Proponents of acupuncture summarize the "strengths of traditional Chinese medicine": "1. Diagnosis and treatment of diseases manifest only through symptoms, i.e., irregularities of function without demonstrable cause in organs or tissues. "2. Treatment of viral illness, especially colds and flu, for which Western medicine has not developed effective treatment. "3. Early diagnosis and prevention of organic disease, which is considered an advanced stage of disease" [55]. In other words, Chinese folk medicine is best for: 1. Functional disease 2. Trivial disease 3. Disease that is not present. An acupuncturist explains the principles of science: "There is a world view implicit in yin-yang and in the theory of the five elements. If everything exists in 'unbroken wholeness', then it makes no sense to speak of cause and effect" [56]. There have been only a few studies of acupuncture which have contrasted the effectiveness of needling the traditional Chinese acupuncture points with random needle placement. A majority of these have shown no difference in the results [57]. In any case, acupuncture appears to be remarkably safe [58]. Acupressure is a variation on acupuncture, in which finger pressure at the acupuncture points is substituted for needling. Staplepuncture involves placement of a small device in the pinna of the ear. The staple is manipulated by the patient to reduce cravings for food, alcohol, etc. This technique is not part of traditional acupuncture, and is usually performed by independent operators specializing in treating habit disorders. (NOTE: Traditional Chinese herbal remedies are widely available, both legally and illegally. Some, including "ginseng", have turned out to be such substances as indomethacin, prednisone, or testosterone.) REFLEXOLOGY ("Zone therapy") A system of treating disease based on pressure applied to "zones" of the body surface corresponding to diseased organs. It was first systematized by an American otolaryngologist, William H. Fitzgerald, M.D., in 1900. Nikolai Lenin was interested in Fitzgerald's system, and reflexology is popular in the Soviet Union. The system was elaborated in the 1930's by one Eunice D. Ingham, who was primarily concerned with the zones of the feet. Today, American reflexology mostly involves pressing on feet. A reflexologist explains disease: "What the Ingham technique effectively achieves is the clearance of congestion which has been described as "the only illness there is" -- mental or physical" [59]. The uninitiated may wonder how zone therapy differs from acupressure (see above). The body surface areas corresponding to the various organs are totally different in the two systems. There are many variations on zone therapy, including a technique in which clothespins are clamped on the ends of different fingers. FOOD FADDISM AND NUTRITIONAL SUPPLEMENTS This enormous area is beyond the scope of this review. Most systems of "treating the whole person" involve health foods and nutritional supplements. Objective evidence of the value of such things (except the financial benefit to those selling them) is scanty. The few controlled studies of multiple vitamin supplements versus placeboes do not support the concept that "subclinical vitamin deficiencies" are widespread. The government's "recommended daily allowances" for vitamins are set quite high, to allow for individual variations. One of the major popular writers on holistic medicine could find no better authority for recommending a vitamin supplement than the chairman of oral medicine at Alabama [61]. Pregnant and lactating women are likely to benefit from nutritional supplements, and in any case vitamins make good placeboes. Health food purveyors have often resorted to deceptive practices. For example: The "organic foods" popular in the late 1960's were discredited when they were found to contain quantities of insecticides, etc., comparable to their much less expensive counterparts. "Rose hip vitamin C", a popular organic vitamin, is usually synthetic ascorbic acid plus ground-up rose hips. Molasses, widely promoted as a good source of "natural" copper and iron, acquires these contaminants from the machinery in which it is processed. Kelp, lecithin, vinegar, and vitamin B-6, which are sold in combination as a miraculous substance which dissolves fat, only work if the purchaser adheres to the accompanying 800-calorie diet. The "Mayo Clinic Diet", based on grapefruit and vitamins, has never had anything to do with the Mayo Clinic. (The law allows a person to give a diet any name at all....) Adelle Davis's books and Rodale Press publications (Prevention magazine, anti-fluoridation propaganda, etc.) continue to be major sources of health misinformation for the U.S. public. The currently-popular "herbal crystallization test" requires the patient to lick a glass slide. The "lab" examines the dried spit under the microscope. Herbs are prescribed based on the resemblance of their leaves to structures observed in the dried spit. COLONIC IRRIGATION A practitioner explains this procedure: "High colonic irrigation ... demands great knowledge, skill, and the same experience as anything done by the medical profession. High colonic is done through the rectum with a 2« ft (75 cm) catheter, which is much more pleasant than most medicines given by mouth. One can see all the waste coming through -- important in case something is not in order. It is effective in completely detoxifying the intestine, getting rid of all the poisons which have accumulated over many years. After treatment the patient notices immediately the relief from wind and pressure" [62]. Another colonic irrigationist tells the cause of premature aging: "When "demagnetized" food passes through the body system with little or no benefit, eventually, experience has proved, these foods leave a coating of slime on the inner walls of the colon like plaster on a wall. In the course of time this coating may gradually increase its thickness until there is only a small hole through the center, and the matter so evacuated may contain much undigested food from which the body derives little or no benefit. The consequent result is a starvation of which we are not conscious but which causes old age and senility to race toward us with the throttle wide open" [63]. The same specialist explains the value of colonic irrigation to the "whole person": "The colon is intimately related to every cell and tissue in the body.... Knowledge and free-will determine the condition of the colon and its effect on the individual's physical, mental and spiritual health" [64]. The "zone therapy" concept applied to the colon permits this expert to derive information from x-rays of the colon, in which the other organs are mirrored in the intestinal wall. URINE THERAPY An unpopular method based on fasting and drinking one's own urine, or applying urine to the skin as compresses. As with most "alternative" remedies, evidence of its effectiveness is anecdotal: "An interesting use of the method was that of Maurice Wilson, whose courageous solo attempt to scale Mount Everest is described in the book I'll Climb Mount Everest Alone. Wilson attributed his remarkable stamina and freedom from minor ailments to his many urine fasts and urine skin frictions" [65]. FUN THERAPIES Aroma therapy: Pleasant-smelling substances are sniffed or rubbed on the skin. Color therapy: Patients sit under colored lights, etc. Dance therapy: "Movement is life and stillness is death. All different aspects of diseases are to be traced to congestion, caused by lack of movement" [66]. Flower therapy: Disease is caused by "failure to resonate with spiritual perfection" and medicines made from flowers correct this by homeovitic radiations [67]. Music therapy: Patients listen or participate. Nudist colonies: "Nudism makes for healthier, more balanced thinking. It is not the end of the world for a woman to have a caesarean scar, nor for some men to have one testicle lower than the other. You begin to see people as people...." [68]. SPIRITUAL HEALING This includes a variety of "ministries to the sick". "Spiritual healers" of all persuasions regard their acts as potential channels for healing from beyond themselves. Such "healers" may be clergy or laity from familiar denominations, or they may be occultists or people who feel themselves to have a special "gift". In contrast to other "alternative" practitioners, these people rarely appear to "do" anything except pray or lay-on-hands. Often they seem to do nothing at all. "Spiritual healers" are almost always happy to work with orthodox physicians, whom they admire and respect greatly. They have no special ideas about the physical aspects of disease, and if asked how "spiritual healing" works, they will typically admit their own perplexity. They are more likely to talk about personal morality and the importance of goodness and kindness than about "wholeness" and "integration". They will not promise results, but believe their activities to be important even where there is no physical healing. Most do not charge money for their services. Christians would regard charging a fee to share the "gifts of the Holy Spirit" as the sin of simony. "Spiritual healers" are familiar members of the health-care team in many countries, including Britain. While these people often say they can "feel" when their ministry has been effective, evidence that this ever happens remains anecdotal. * * * A helpful explanation from a proponent of holistic medicine: "If there seem to be contradictions between various systems, they arise precisely because we all differ, and what has worked for one may not work for another" [69]. REFERENCES 1. Lancet, Feb. 5, 1983, pp. 304-5. 2. The Holistic Health Handbook: A Tool for Attaining Wholeness of Body, Mind, and Spirit, Berkeley: And/Or Press, 1978, p. 396 ("HHH"). 3. The Encyclopedia of Alternative Medicine and Self-Help, New York: Schocken Books, 1979, p. 52 ("EAMSH"). 4. Boyd, H., Introduction to Homeopathic Medicine, New Canaan: Keats, 1981, p. 63. 5. EAMSH, p. 113. 6. Lancet, Jan. 15, 1983, p. 97. 7. HHH, p. 93. 8. Delaware Med. J. 51: 197, 1979. 9. American Scientist 61: 574, 1973. 10. J. Manipul. Physiol. Therap. 5: 53, 1982. 11. NEJM 307: 339, 1982. 12. Bull. N.Y. Acad. Med. 59: 660, 1983. 13. JAMA 245: 1835, 1989. 14. Br. Med. J. 2: 161, 1975. 15. Rheum. Rehab. 21: 21, 1982. 16. Aust. N.Z. J. Med. 8: 589, 1978. 17. NEJM 301: 659, 1979. 18. JAMA 244: 1450, 1980. 19. N.Z. Med. J. 88: 441, 1978. 20. HHH, p. 171. 21. Langone, J., Chiropractic: A Consumer's Guide, Reading: Addison and Wesley, 1982, p. 33. 22. HHH, p. 171. 23. EAMSH, p. 143. 24. EAMSH, p. 9. 25. JADA 103: 576, 1981. 26. EAMSH, p. 175. 27. HHH, p. 99. 28. HHH. p. 80. 29. Pediatrics 68: 407, 1981. 30. Ibid. 31. EAMSH, p. 141. 32. HHH, p. 386. 33. Nov. 1958, p. 100. 34. Cancer 45: 799, 1980. 35. NEJM 307: 118, 1982. 36. NEJM 299: 549, 1978. 37. NEJM 306: 201, 1982. 38. CA 22: 372, 1972. 39. J. Transpersonal Psychol. 8: 29, 1975. 40. Psychosomatics 21: 226, 1980. 41. p. 217. 42. Kaplan, J.E., et. al., Comprehensive Textbook of Psychiatry III, Baltimore: Williams and Wilkins, 1980. 43. Lancet, June 2, 1979, pp. 2235-6. 44. Med. J. Aust., Feb. 19, 1983, p. 153. 45. Knoxville Times, Nov. 13, 1983. 46. Pediatrics 62: 137, 1978. 47. HHH, p. 150. 48. JAMA 242: 1385, 1979. 49. HHH, pp. 155 ff. 50. Am. J. Med. 75: 489, 1983. 51. EAMSH, p. 29. 52. CA 21: 120, 1970. 53. EAMSH. p. 87. 54. EAMSH, p. 163. 55. Postgrad. Med. 74(4): 47, 1983. 56. EAMSH, p. 16. 57. Am. J. Med. 74: 49, 1983. 58. Br. Med. J. 287: 326, 1983. 59. EAMSH, p. 172. 60. Arch. Int. Med. 138: 1065, 1978. 61. Pelletrier, K., Holistic Medicine: From Stress to Optimum Health, New York: Dell, 1979, Appendix A. 62. EAMSH, p. 110. 63. Walker, M.W., Colon Health: The Key to a Vibrant Life, Phoenix: O'Sulliban Woodside, 1979, p. 7. 64. Ibid.. 65. EAMSH, p. 186. 66. HHH, p. 272. 67. EAMSH, p. 77. 68. EAMSH, p. 137. 69. HHH, p. 13 APPENDIX Dept. of Pathology Box 19540 A ETSU Johnson City, TN 37614 Dec. 31, 1986 C.W. Aakster Socioloog, Adviseur Gezondheids/welzijnszorg De Weijert 8 7991 BP Dwingeloo THE NETHERLANDS Dear Prof. Aakster, I am intrigued by your article, "Concepts in Alternative Medicine" (Soc. Sci, Med. 22: 265-73, 1986). Your final statement that the best possible health care "requires that we redefine reality" especially interested me. I am enclosing two handouts I prepared for my students on "alternative medicine" -- I hope you will find them interesting. It is always a good thing to see that sociologists and other allied professionals are becoming interested in the technical aspects of medical practice. I am sure that we would agree that, the more the patients know, the better physicians like me can serve them. I also share your lively interest in preventive medicine and self-help. My concern is that you may have been misled by unethical practitioners of "alternative medicine". In my opinion, most articles on medical metaphysics, the nature of scientific proof, and the sociology of unproven remedies are smoke screens -- alternative practitioners charge money for therapies that they know will not withstand honest examination by the usual methods of science. The vast majority of studies of acupuncture, homeopathy, etc., have shown no advantage over placebo. Acupuncture was fraudulently promoted by Mao Tse-Tung's regime so that his people would believe they were getting health care before Chinese physicians could learn Western-style medicine. Homeopathy has an even more fantastic model of disease and therapy, and essentially no controlled studies to support it. Like other holists, these people write propaganda instead of doing honest research. When I offer a treatment to a patient, or render a diagnosis for another physician, I can support my statements by the results of honest studies that follow the usual methods of science. Holists direct their efforts toward diseases scientific medicine cannot treat, or diseases that are not present (the "greater wellness" movement, etc.). There have been no great therapeutic triumphs despite the claim to understand health and the body better than conventional medicine. When a homeopath gets gonorrhea, he can get a shot of penicillin like everybody else, or he must "redefine reality". Professor Aakster, I hope that if you or one of your loved ones ever becomes seriously sick, you will not trust any practitioner who cannot defend his or her practice by the methods of objective science. If you have an ongoing interest in holistic medicine, you will probably want to own Examining Holistic Medicine, from Prometheus Books, Buffalo, New York, USA. The editor is Dr. Doug Stalker and I am one of the contributors. In any case, congratulations on an interesting article that shows much knowledge and concern for the health-care consumer. Sincerely, Edward R. Friedlander, M.D. Assistant Professor of Pathology cc: Dr. Stalker