Book Chat: Sense and Nonsense of Alternative Medicine

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.”

AABGU Sponsors Update for Israel’s Health System‏

(from left) AABGU national vice-president and Philadelphia Chapter board member Dr. Al Sutnick, AABGU Philadelphia vice-chair and Health Sciences committee co-chair Dr. Rob Zipkin, and Dr. Jay Bloch

A discussion of health and social justice in Israel was just what the doctor ordered at a reception in Jenkintown, sponsored by the American Associates, Ben-Gurion University of the Negev (AABGU). BGU Professor Nadav Davidovitch spoke about Israel’s public and private healthcare systems and compared them to proposed changes in the United States under President Obama’s new initiatives. In addition to Israel’s four major public health consortiums, there is also a growing private sector for those who can afford the cost of treatment. Joining Prof. Davidovitch on the program was Prof. Michael Yudell, director of Drexel University’s new program in Public Health ethics and a collaborator with Prof. Davidovitch on a NIH-sponsored study on autism, ethics and history. Prof. Yudell also writes the blog “The Public’s Health” for the Philadelphia Inquirer.

More details after the jump.

(from left) Drexel University Professor Michael Yudell; BGU Professor Nadav Davidovitch; AABGU Philadelphia Chapter board member and host Shirley Tauber; BGU researcher Uri Schwed; and Dr. Rob Zipkin

American Associates, Ben-Gurion University of the Negev (AABGU) aims for sustaining David Ben-Gurion’s vision, creating a world-class institution of education and research in the Israeli desert, nurturing the Negev community and sharing the University’s expertise locally and around the globe. With some 20,000 students on campuses in Beer-Sheva, Sede Boqer and Eilat in Israel’s southern desert, BGU considers itself a university with a conscience, where the highest academic standards are integrated with community involvement, committed to sustainable development of the Negev.

Ben-Gurion Univ. Prof. Wins Elkeles Prize in Medicine

— Andrew Lavin

Ben-Gurion University of the Negev (BGU) Professor Ron N. Apte has been awarded the 2010 Samuel and Paula Elkeles Prize for Outstanding Scientist in the Field of Medicine.

Professor Apte is chairman of the Shraga Segal Department of Microbiology and Immunology and vice dean of the Basic Sciences division in the BGU Faculty of Health Sciences.  He is also the Irving Sklar Chair in Endocrinology and Cancer and a member of the National Institute for Biotechnology in the Negev.
Apte’s major field of research involves inflammation in malignant processes.  Approximately 15 percent of cancers are connected to inflammation, which typically result in organs where chronic inflammation has occurred.  For example, patients with Inflammatory Bowel Disease (IBD) are more prone to cancer than the general population.

The pioneering studies of Apte’s group demonstrated the feasibility of intervening in malignant process by neutralizing inflammatory components in the “normal” microenvironment of a tumor. They also detailed the basic concepts underlying such treatment.

Inflammatory cells affect proliferation and invasiveness of malignant cells through the secretion of cytokines, which include Interleukin-1 (IL-1), the molecule that has been studied for years by Apte’s group.  The group has demonstrated the involvement of IL-1-mediated inflammation in tumor invasiveness and metastasis.  IL-1 causes tumor expansion because it suppresses the immune system and nourishes a tumor’s blood vessels.  Apte’s group treated tumor-bearing mice with a specific inhibitor of IL-1, known as the IL-1 receptor antagonist (IL-Ra), and succeeded in weakening the tumor’s invasiveness.

IL-Ra, in its generic form Anakirna, is a medication that efficiently alleviates symptoms of patients suffering from rheumatoid arthritis, a chronic inflammatory disease.

Apte joined the BGU Faculty of Sciences in 1981 and has served two full terms as vice dean, as the vice dean of Student Affairs, and as the vice dean for Graduate Studies.  Since 2008, he has been the vice dean for Basic Science Affairs.

Apte has been a member of the board of the European Cytokine Society since 1989 and has served on the board of its journal, “The European Cytokine Network”.  He was also president of the Israel Immunological Society from 1996 to 1998.

Apte has served as a charter member of the International Cancer Microenvironment Society (ICMS) and as an editorial board member of its journal “Cancer Microenvironment”.   Prof. Apte has published more than 80 papers in the fields of immunology, tumor biology and cytokine biology.

The Samuel and Paul Elkeles Prize for Outstanding Scientist in the Field of Medicine was established 23 years ago.  The Jewish National Fund (JNF) administers the endowment as the executive trustee of the will and awards the prize annually.   Apte Elkeles Info.

About American Associates, Ben-Gurion University of the Negev

American Associates, Ben-Gurion University of the Negev (AABGU) plays a vital role in sustaining David Ben-Gurion’s vision, creating a world-class institution of education and research in the Israeli desert, nurturing the Negev community and sharing the University’s expertise locally and around the globe. With some 20,000 students on campuses in Beer-Sheva, Sede Boqer and Eilat in Israel’s southern desert, BGU is a university with a conscience, where the highest academic standards are integrated with community involvement, committed to sustainable development of the Negev. For more information, please visit