Killing Us Softly (23 page)

When the United States faced a crisis in 2009, Rashid Buttar was among the first to give potentially deadly advice. “The facts are the facts,” he said. “Right now more people have died from the swine flu vaccine than have died from swine flu. Probably more people will die from the swine flu vaccine than will ever die from swine flu itself. The viral strain has lost its virulence as it has come through the Yucatan Peninsula through Mexico and into the United States. So really the big hype that they made is all smoke and mirrors. It's all an illusion to scare people.” Buttar was right in claiming that swine flu virus had worked its way up from Mexico, entering the United States in April 2009. But he was wrong that the virus had lost its virulence. During the few months following his pronouncements, an estimated 47 million Americans were infected with swine flu, 250,000 were hospitalized, and 12,000 died. Among the dead were an estimated 1,100 children—ten times more than die during a typical influenza season. Buttar's advice wasn't just
wrong, it was spectacularly wrong. And anyone who listened to it faced an unnecessary risk.

N
ot all of Rashid Buttar's patients are satisfied with his care. In April 2008, the North Carolina Medical Board heard their complaints. The board's lawyer, Marcus Jimison, introduced his case. “The evidence will show that Dr. Buttar preys on people in their darkest hours, at a time when they are most desperate. He provides therapies to dying patients that have not been shown to be effective and charges them thousands of dollars a day for what he knows will not work. And he does this with a North Carolina medical license hanging on his wall.”

Jimison summarized the allegations against Buttar.

• Buttar treated a patient with cervical cancer with intravenous hydrogen peroxide, an unproven and potentially dangerous therapy. For the initial visit, Buttar charged $12,000. During the next month, the patient received nineteen more injections, at a cost of $1,000 each, for a total of $31,000. When the patient died, Buttar's office sent the family a refund of $2,500.
  
• Buttar treated a patient with ovarian cancer with intravenous vitamins, chelation, Philbert Infra Respiratory Reflex Procedure, and Ondamed biofeedback. The bill for two months of treatments was $30,000. Prior to her death, the patient paid Buttar $10,000. When her estate failed to pay the remaining $20,000, Buttar turned the matter over to a collection agency.
  
• Buttar charged a patient with cancer of the adrenal gland $32,000 for ineffective therapies. The patient's wife remembered their first meeting with Buttar: “He said it didn't matter what kind of cancer anybody had,” she recalled. “He could cure it. He kept reiterating he had a 100 percent success rate.” After her husband died, his wife canceled a check to Buttar for $6,700. Buttar turned the matter over to a collection agency, seeking the unpaid portion of the bill, interest, and a 25 percent collection fee.
  
• In October 2007, Buttar told a patient with colon cancer that he “would be an idiot for doing anything the conventional doctors told him to do.” Buttar advised chelation and ozone therapy, at a cost of $5,000 a week. Two months later, the patient was dead.
  

Toward the end of the hearing, Jimison asked Buttar whether his therapies were below the standard of care. “It's not the standard of care,” he said. “It's beyond the standard of care.”

Jimison closed by exhorting the medical board to do what was right—to suspend the license of a man who was doing harm, at the very least by diverting patients away from potentially helpful therapies. “Somewhere there is a loved one that's going to Dr. Buttar's office,” he said. “They're dying, and would be looking for any glimmer of hope. And Dr. Buttar is more than willing to give them that glimmer of hope. This is the time to stand up for science-based, evidence-based medicine. … It will be the board's finest hour.”

It wasn't to be. The board chose only to order Buttar to provide a consent form advising his patients that his treatments
hadn't been proven effective and hadn't been licensed by the FDA. He could continue to treat patients with cancer and autism. Continue to treat them as if they had been poisoned by heavy metals, even though evidence refuted his claim. Continue to sell magical anti-autism creams and anti-aging medicines without any proof that they worked. Buttar still describes treatments on his website as “highly effective” and boasts of giving 200,000 chelation treatments without any side effects (which is highly unlikely). It would be surprising if the revised consent deterred desperate patients and parents from streaming to his door.

We are what we pretend to be …

—Kurt Vonnegut,
Mother Night

S
o if echinacea and vitamin C don't treat colds, and chondroitin sulfate and glucosamine don't treat arthritis, and St. John's wort doesn't treat depression, and ginkgo doesn't improve memory, and saw palmetto doesn't shrink prostates, then why do so many people believe they do? And if the human nervous system isn't related to rivers in China, and all diseases aren't based on misaligned spines, and highly diluted medicines don't contain any active ingredients, then why do acupuncturists, chiropractors, and homeopaths have such a devoted following? The answers can be found during a testy exchange between Mehmet Oz and Steven Novella.

In April 2011, Oz discussed acupuncture on
The Dr. Oz Show
.
Researchers have spent a lot of time and money studying acupuncture in people who claim it works. First, they compared outcomes when needles were inserted into correct or incorrect acupuncture points. No difference. Then, they used both standard and retractable needles; patients felt the sting of the needle but didn't know whether it had entered the skin. Again, no difference. Despite these studies, Mehmet Oz continues to promote acupuncture. To his credit, however, on the day he discussed acupuncture, Oz invited Dr. Steven Novella onto his show. He couldn't have picked a more skeptical guest.

In addition to being a Yale neurologist, Steven Novella is founder and president of the New England Skeptical Society, director of the Science-Based Medicine project at the James Randi Educational Foundation, and host of the popular science podcast
The Skeptics' Guide to the Universe
. Novella explained that acupuncture still works if needles are inserted in the wrong place or if they aren't inserted at all. Oz was furious. “There are billions of people around the world who use acupuncture as the foundation of their health,” he argued. “I just think it's very dismissive of you to say that because we couldn't take this idea that exists with a different mind-set and squeeze it into the way that we think about it in the West, that it can't possibly be effective.”

Novella knew that acupuncture was by definition a sham, a trick, a deception; yet he never once said, “Acupuncture doesn't work.” Rather, he questioned
why
it worked. “It's the ritual surrounding a positive therapeutic interaction: a comforting, caring [clinician],” he said. “You're relaxing for half an hour or an hour. That's where the effect is. There's no effect to actually sticking a needle through the skin.” In other words, the placebo effect.

A
lthough some dismiss the placebo effect as trivial, it's not. One of the first demonstrations of how powerful it can be took place on the battlefields of World War II, when a nurse ran out of morphine. Unable to tell a wounded soldier that she had nothing for his pain, she lied, saying that the salt water she used was actually morphine. To her surprise, his pain disappeared. The critical question, then, isn't “Does the placebo effect work?” It's “How does it work?” Do placebo therapies such as acupuncture really cause less pain, or do people simply tolerate the same pain? Is the placebo effect physiological or psychological?

At first, doctors were unfairly dismissive of the placebo effect, arguing that it had everything to do with perception and nothing to do with reality. For example, expensive therapies are often perceived as more valuable even if they're worthless. One therapy that falls into this category is unicorn horns. Touted for the treatment of epilepsy, impotence, worms, plague, smallpox, and rabies, and purported to prolong youth, assist memory, and fortify the spirits, powdered unicorn horns have been used for more than eight centuries. Unicorns are one-horned beasts that don't exist—a fact that hasn't hurt sales. Made from ground-up whales' tusks, “unicorn horns” sell for their weight in gold: a nine-pound horn sells for $55,000. People who can't afford unicorn horns can buy unicorn drinks.

A more recent example is Vitamin O. In 1998, an advertisement in
USA Today
announced a miraculous new product: Vitamin O. Under a photograph of tensely smiling, attractive
people, the ad stated, “It's so safe you can drop it in your eyes, so natural it contains the most abundant element on earth, so effective you can spend hours reading the unsolicited testimonials of those who've used it with dramatic results.” One believer said, “After taking Vitamin O for several months, I find I have more energy and stamina and have become immune to colds and flu.” What was Vitamin O? The ad didn't lie. Vitamin O was “stabilized oxygen molecules in a solution of distilled water and sodium chloride.” In other words: salt water. But promoters of Vitamin O were quick to point out that it wasn't
just
salt water. It was salt water enhanced with oxygen, giving buyers the vital energy they needed. Unfortunately, Vitamin O users lacked the one thing necessary to extract oxygen from water: gills. After the ad appeared, the manufacturer sold sixty thousand vials in a month—at a cost of $20 a vial.

Psychologists have also argued that the placebo effect is simply an exercise in conflict resolution. People who use acupuncture are confronted with two conflicting facts: (1) acupuncture is unconventional; (2) acupuncture is expensive, costing between $65 and $120 a session, requiring frequent sessions, and often necessitating out-of-pocket payments. The conflict is best resolved by believing that acupuncture works. In his book
When Prophecy Fails
, Leon Festinger called it the “theory of cognitive dissonance,” the best example of which is Aesop's fable “The Fox and the Grapes.” A fox comes upon a bunch of grapes hanging from a tree and confronts two opposing thoughts: (1) he loves grapes; (2) he can't reach the grapes. The fox resolves the conflict by convincing himself that the grapes are sour.

Another explanation for the placebo effect is something
called “regression to the mean,” a phenomenon best exemplified by the
Sports Illustrated
cover jinx. For many years, sports fans have argued that an appearance on the cover of
Sports Illustrated
is the kiss of death for a professional athlete. The story is always the same: an athlete has a great season, gets on the cover of the magazine, then has a mediocre or poor season. But this isn't really a jinx. When an athlete has a great season, it shouldn't be surprising that the next season wouldn't be as great. That's because athletes have up and down years. The same can be said for pain, which can wax and wane. People usually go to an acupuncturist when they're experiencing the most pain. So it's possible that they feel better after their worst suffering because pain, like an athlete's career, can fluctuate.

During his face-off with Mehmet Oz, Dr. Novella alluded to yet another explanation for the placebo effect: the therapist's presentation. Many studies have shown that a therapist's clothes, demeanor, attitude, and phrasing make a difference. Therapists who say, “You will be better soon” or “These pills will help” find that patients do better than those who say, “I don't know what you have” or “I don't know if pills will help.” And the more time a therapist spends with patients, the better they do. Ted Kaptchuk, an alternative healer from Cambridge, Massachusetts, recognizes the healing power of personality. “I am a damn good healer,” he says. “That is the difficult truth. If you needed help and you came to me, you would get better. Thousands of people have. Because, in the end, it isn't really about the needles. It's about the man.” “The doctor who fails to have a placebo effect on his patients,” wrote J. N. Blau, “should become a pathologist.”

Probably the best example of a therapist's influence can be found in
The Wizard of Oz
. Because the Wizard can't give the
Scarecrow a brain, he does the next best thing: he makes him
feel
smarter. “Back where I come from, we have universities,” says the Wizard. “Seats of great learning where men go on to become great thinkers. And when they come out, they think deep thoughts—and with no more brains than you have. But! They have one thing you haven't got! A diploma!” After receiving the diploma, the Scarecrow is smarter, reciting the Pythagorean theorem. “Oh joy, rapture,” he says. “I've got a brain.”

In a sense, everyone uses the placebo effect, no one more than parents. “I have a four-year-old son,” writes John Diamond in
Snake Oil and Other Preoccupations
, “who, as is the way with four-year-old sons, climbs on things and then falls off them, losing chunks of skin and blood on the way down to the ground. And whenever this happens—about four times a week on average—and he runs to me crying and pointing to the latest graze, I apply strictly alternative remedies. I don't give him strong drugs to kill the pain or stanch the flow of blood but I clean the tiny wound, ask him what happened, sympathize with him about the fickleness of gravity and the harshness of brick, sit him on my lap with a glass of water, kiss him and rub the hurt better. And it works, every time.” Diamond tried to label his not-so-unique brand of healing. “So what do you think I should call the technique?” he writes. “Fatherotherapy? Dynamic parentesiology? Because dealing with minor problems by calm talking, sitting down quietly and rubbing it better seems to be just what much of alternative therapy is about.”