By Hannah Lee
Americans are avid consumers of over-the-counter pills and capsules. Parents of patients being treated at the Children’s Hospital of Philadelphia (CHOP) often ask to continue their non-prescription regime of herbs and other dietary supplements. What most of us don’t know is that the Food and Drug Administration (FDA) has no authority to regulate them, so these products do not have to be tested for efficacy or purity before they’re marketed.
Sometimes supplements are later tested by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health, but their test results are published in scientific journals. It does not have the clout of the FDA for product recalls or warning labels. People shopping at their local supermarket or drugstore do not know if the labels are false or misleading.
In a recent groundbreaking policy ruling, CHOP took most dietary supplements off its formulary, its list of approved medications. It is the first hospital to no longer administer dietary supplements unless the manufacturer provides a third-party written guarantee that the product is made under the F.D.A.’s “good manufacturing practice” conditions, as well as a Certificate of Analysis assuring that what is written on the label is what’s in the bottle. Parents can sign a waiver, which states “Use of an agent for which there are no reliable data on toxicity and drug interactions makes it impossible to adequately monitor the patient’s acute condition or safely administer medications.”
Dr. Paul Offit, chief of the division of infectious diseases at CHOP and chair of the Therapeutic Standards Committee which approved the new policy, said that they found a few vitamins and other supplements which meet this standard. One is melatonin which has been shown to affect sleep cycles and has a record of safety, and they have identified a product that met manufacturing and labeling standards. Around 90 percent of the companies they contacted for verification never responded.
People seeking supplements on their own are advised to look for the label, “USP-verified,” meaning they meet standards set by the U.S. Pharmacopeial Convention for ensuring the strength, quality, and purity of a product. One such brand is Nature Made and it’s readily available in local stores.
In his new book, “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine,” Offit writes about man’s quest for therapeutic cures and the chicanery of individuals who fool the public with sham remedies. The term, quack, comes from the sixteenth-century Dutch term, kwakzalver, which means one who quacks like a duck while promoting salves and ointments. This became the English quacksilver, later shortened to quack. While the term implies intent, it is not necessarily so. We may laugh at the popularity of erstwhile products such as Wendell’s Ambition Pills, Hamlin’s Wizard Oil, or Becket’s Sovereign Restorative Drops for Barrenness, but we are not immune to new and contemporary marketing.
One chapter is on Linus Pauling and how he upended his stellar scientific career, including a Nobel Prize in Chemistry (and a Nobel Peace Prize for his activism leading to the Nuclear Test Ban Treaty), in his dogged endorsement of massive doses of vitamin C: 3,000 mg or about 50 times the U.S. government’s Recommended Dietary Allowance. Pauling initially proposed the use of vitamin C to treat the common cold, then as a cure for cancer, and later in conjunction with massive doses of vitamin A, vitamin E, and other “antioxidant” supplements which neutralize DNA-damaging free radicals could treat virtually every disease known to man. Since 1994, multiple large studies conducted at the National Cancer Institute, the Fred Hutchinson Cancer Research Center in Seattle, and elsewhere have found that people taking such large doses of vitamins and supplements, in fact, had higher rates of death. However, studies have not affected sales. In 2010, the vitamin industry grossed $28 billion in sales.
Other chapters report on the success of Suzanne Somers (touting biodentical hormones for menopause and an extensive anti-aging regimen), Rashid Buttar (anti-autism cream), Deepak Chopra, and Mehmet Oz. The latter two are especially prolific and vocal in advocating for alternative remedies that have not been tested in scientific trials.
A riveting chapter is on the placebo effect and the powerful ways that it is manifested, such as for acupuncture and pain relief. The book reads easily and the 36 pages of notes and extensive bibliography allow the committed reader to learn further.
Offit cites the Hippocratic oath of physicians to first do no harm. When a prominent individual endorses faith healing, how many children would come to harm because their parents choose to rely solely on prayer instead of antibiotics, insulin, or chemotherapy? Steve Jobs was diagnosed with pancreatic cancer, but it was a rare neuroendocrine tumor that was amenable to early treatment; surgery offered a good prognosis. Jobs eschewed standard therapy in favor of herbal remedies, bowel cleansings, and diet. By the time he had surgery nine months later, the cancer had spread. Ultimately, Offit writes, Jobs died of a treatable disease.
Magical thinking, writes Offit, is how alternative healers cross the line into quackery. “Encouragement of scientific illiteracy- or, beyond that, scientific denialism- can have a corrosive effect on patients’ perceptions of disease, leaving them susceptible to the worst kinds of quackery.”