Trick or Treatment (38 page)

There was already a small market in shark cartilage as a cancer treatment, but the hype generated by
60 Minutes
triggered a rush for shark-based remedies. According to Lane, there were thirty new shark-cartilage products on the shelves within two weeks of the broadcast and within two years these products were generating $30 million per year.

Yet the preliminary research did not demonstrate with any confidence that shark cartilage was effective in treating cancer. Had this been a conventional pharmaceutical, then it would have been forced to undergo years of research in order to prove that it was safe and effective, and only then would it have been available through prescription. But, because this was a natural alternative product, then no such regulation and testing were deemed necessary. Instead, shark cartilage was being distributed to health stores across America, and cancer patients were clamouring for it.

Incidentally, this took a terrible toll on the shark population. For example, Holland & Barrett, the UK’s largest chain of health-food shops, has admitted that it sourced its shark cartilage from Spiny Dogfish and the Blue Shark, both of which are classified as ‘vulnerable species’, which means that they carry a high risk of becoming extinct. In a letter to the Shark Trust, the company stated: ‘Holland & Barrett will continue to sell shark cartilage due to customer demand, until such time that the species is classed as an endangered species.’ The classification ‘endangered’ means a very high risk of extinction, as opposed to merely a high risk.

In the late 1990s, concerned that the public was being duped, scientists began submitting shark cartilage to the sort of rigorous clinical trials that it should have undergone before being widely promoted. One by one, the trials concluded that shark cartilage had no medical value. Today, we can see how
60 Minutes
had nationally promoted a treatment that in reality offered no benefit, causing thousands of people to waste millions of dollars.

Worse still, it seems that some cancer patients suffered as a direct result of being swept up in the fad. In 1997 the
New England Journal of Medicine
reported the case of a nine-year-old Canadian girl who had undergone surgery to remove a brain tumour. Doctors had recommended radiation and chemotherapy as a follow-up treatment, which would have given the girl a 50/50 chance of survival. Her parents, however, had been impressed by the publicity surrounding shark cartilage and decided to forgo the conventional treatment in favour of the alternative. This decision, according to the doctors, removed any chance of survival: ‘Four months later, marked tumor progression was documented, and the patient subsequently died…We find it difficult to understand how conventional treatments for childhood cancer can be repudiated in favour of alternative approaches for which any evidence of efficacy is lacking.’

6 The media (again)

Mass media is a powerful force for influencing the public, which is why it deserves two slots in this list of top ten culprits. In the previous section we explained that the media exaggerates the benefits of alternative medicine, but in this section we will focus on how newspapers and television also sensationalize the risks of conventional medicine.

A 1999 survey of British newspapers by Professor Edzard Ernst sampled four broadsheet newspapers on eight separate days and discovered 176 articles relating to medicine. Twenty-six of the articles concerned alternative medicine, and they were unanimously positive – it seems that alternative medicine is almost beyond criticism. By contrast, the remaining articles about mainstream medicine were roughly 60 per cent critical or negative.

Without doubt, certain aspects of mainstream medicine deserve to be criticized, but the problem here is that newspapers and broadcasters are trigger happy. They cannot resist turning minor issues into major scares or presenting tentative findings as serious threats to the nation’s health. For example, there have been numerous scare stories over the years suggesting that mercury-based dental fillings are toxic. These include a 1994 news report entitled ‘The Poison in Your Mouth’, which was part of the BBC current-affairs series
Panorama
. There was, however, no real evidence to warrant these concerns.

In fact, a major study in 2006 confirmed numerous previous investigations showing that the fears over mercury fillings were groundless. Researchers monitored the health of 1,000 children who had received either mercury fillings or mercury-free fillings. Over the course of several years there was no significant difference between the two groups in terms of their kidney function, memory, coordination, IQ and other qualities. Although this was the most important paper ever published in this field, the journalist and clinician Ben Goldacre made a very telling observation:

In this particular case, the media merely scared the public away from mercury fillings and towards more expensive, less reliable options, which then require more visits to the dentist. In other episodes of media hysteria, the consequences are far more serious. For example, the news stories concerning the measles, mumps and rubella (MMR) triple vaccine have genuinely endangered the health of thousands of children. Reports have tended to exaggerate the significance of preliminary or insubstantial research that questions the safety of MMR, while ignoring the high-quality research that demonstrates that the MMR triple jab is the safest option for children.

Irresponsible media coverage has caused a significant drop in the number of parents vaccinating their children, which in turn has already led to several measles outbreaks – the threat of a substantial epidemic still looms. Perhaps the media takes such a cavalier attitude because it has forgotten the damage caused by measles. While measles is merely an inconvenience for most families, it will cause ear infections for 1 in 20 children, respiratory problems for 1 in 25, convulsions for 1 in 200, meningitis or encephalitis for 1 in 1,000, and death for 1 in 5,000 children. In 2006 a British child died after contracting measles, the first such death in the UK for fourteen years.

In effect, poor reporting has started to undo the work of generations of researchers, who have devoted their careers to the battle against disease. Maurice Hilleman, for example, was born into a poor Montana family in 1919, living on a single meal a day and sleeping in a bunk ridden with bedbugs. He witnessed how childhood diseases had decimated his community, which later inspired him to develop eight of the fourteen vaccines routinely given to children, including MMR. He lived just long enough to witness the controversy over his life-saving vaccine. His colleague Adel Mahmoud still recalls Hilleman’s reaction:

The mass media must decide whether it wants to report medical issues responsibly in order to inform the public, or to report it luridly in order to create shocking headlines. Unfortunately, the media has a profit motive and a lack of discipline, so the latter option will probably continue to be too tempting, particularly in light of how easy it is to scaremonger. This was demonstrated by an article entitled ‘Mysterious Killer Chemical’, published in 2005, which highlighted the dangers of the chemical DiHydrogen MonOxide, sometimes called DHMO.

In fact, DHMO is just a highfalutin name for plain water (H
₂
O), and the article was written by the Australian science journalist Karl Kruszelnicki to show how easy it is to scare the public. He went on to point out: ‘You can give people this totally accurate (but emotionally laden, and sensationalist) information about water. When you then survey these people, about three-quarters of them will willingly sign a petition to ban it.’

7 Doctors

Doctors ought to be ambassadors for evidence-based medicine, combining the best information from research with their own experience and knowledge of the particular patient in order to offer the best treatment options. This should mean that they discourage alternative treatments which generally come under the headings of unproven, disproven, dangerous or expensive.

Regrettably, too many GPs seem to take an entirely different stance. The numbers vary from country to country, but a reasonable ballpark figure is that roughly half of GPs refer patients to alternative therapists, and many more will respond positively to the idea of their patients trying remedies from the alternative-health section of the local pharmacy or health-food store. This raises the question, why are so many GPs tolerating, promoting, or even using bogus treatments?

One explanation could be ignorance. Many doctors may not be aware that most homeopathic remedies contain absolutely no trace of any active ingredient. They may not realize that the latest trials for acupuncture indicate that it offers negligible or no pain relief beyond placebo. They may be oblivious to the risks associated with spinal manipulation, and uninformed about the highly variable evidence relating to herbal remedies. Therefore, doctors may be giving the benefit of the doubt to treatments that really ought to be avoided.

Another, perhaps more important, factor is that doctors are constantly dealing with patients who have coughs, colds, backaches and other conditions which are either difficult or impossible to treat. Many of these troubling ailments will disappear over the course of a few days or weeks, so doctors might advise plenty of rest, a day off work, some paracetamol pills, or simply carrying on as normal. Some patients, however, are disappointed by these sorts of suggestions, and they may pester the doctor for something more obviously medical. Hence, it might be expedient for doctors to recommend something that placates the patient and which might also help them deal with the symptoms via the placebo effect. This might mean encouraging a patient to try a herbal or homeopathic remedy from a health-food store or pharmacy, even though the doctor might be aware that there is no evidence to support the use of either option.

This approach to patients – fobbing them off with placebos – was touched upon earlier in the chapter. It is paternalistic and inevitably involves deception. It also has negative consequences, such as medicalizing minor conditions which should be simply left alone, endorsing bogus remedies and encouraging patients in the direction of acupuncturists, homeopaths, chiropractors and herbalists.

And introducing patients to alternative therapists in relation to a minor condition could act as a gateway to a longer-term reliance on alternative practitioners. In turn, this might lead to treatments that are both ineffective and expensive, and possibly even dangerous. Moreover, there is a likelihood that the alternative practitioners will go on to counsel against proven conventional interventions, such as vaccinations, or meddle with prescription drugs. This undermines the role of doctors and endangers patients’ health.

One solution is for doctors to be more honest with patients (‘In a few days you’ll be fine’). Another solution, which is something of an awkward compromise, is to offer patients a so-called
impure placebo
, which is more ethical than a
pure placebo
. Homeopathy is a good example of a pure placebo, as its only impact is via the placebo effect, and there is no justification at all for using it based on any scientific evidence. By contrast, magnesium in the treatment of anxiety is a good example of an impure placebo. This is because magnesium cannot really treat straightforward anxiety, but it can successfully treat some very rare conditions that have symptoms similar to anxiety. Hence, a doctor who treats a patient complaining of anxiety with magnesium might conceivably be giving the perfect remedy, because the patient might have one of these rare conditions. In reality, however, it is much more likely that the magnesium will only alleviate the patient’s anxiety through the placebo effect. This form of impure placebo is much more acceptable than a pure placebo, because we are avoiding complete lies. On the other hand, we are still dealing in half-truths, as opposed to complete truths.