Placebo: How a sugar pill became a poison pill. Part 1 of a continuing saga...

In the nearly six years I've been running SHAMblog, I've taken a fair amount of flak for my withering criticism of alternative medicine (and, for the record, I stand by that criticism). In the interest of honesty and fairness, however, this blog in the coming months will tell the story of placebo medicine: how during the past century, multiple precincts of traditional medical practice, from your local GP to the largest university hospitals, began trading in sugar pills: bogus drugs, bogus therapy, even bogus heart surgery. The dimensions of the problem are staggering and, as you will see, alarming. I will keep up with it as I'm able. I hope you get something out of it.

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IN THE EARLY 1940s, two major wars were being fought in multiple theaters. One war—the more familiar of the two—took place entirely overseas, as Allied forces prepared for what they hoped would be a decisive sweep through Europe and the Pacific Islands, vanquishing Hitler, Mussolini and Tojo.

The other, less publicized war was occurring in laboratories in both Europe and the United States, as researchers sought to vanquish the unseen pathogens that made battlefield wounds so lethal (and, in civilian life, spawned terrifying epidemic scourges like tuberculosis and pneumonia). Although Scottish biologist Alexander Fleming had made his famously inadvertent discovery of penicillin in 1928, ongoing research into the substance's medicinal possibilities soon stalled. As Fleming saw it, the process of extracting the antibiotic agent from mold was so cumbersome and inefficient as to render its widespread use impractical. He also questioned whether penicillin—once isolated—would be the blanket cure that he heard some of his contemporaries describe in such extravagant terms. In Fleming's view, penicillin's efficacy depended on fairly precise, bacteria-specific dosing; absent that precision, he felt, the antibiotic might prove futile, or could even backfire. (His concerns were prescient, as it turned out.) For such reasons, surprisingly little had been done to commercialize the drug in the decade after its momentous discovery.

That changed after Hitler began crossing borders. British biochemists Ernest Chain and Howard Florey recognized the antibiotic's potential as a game-changer in this terrible new conflict. In 1940, with the backing of U.S. and British governments, Chain and Florey set about establishing a laboratory platform for mass-producing Fleming's so-called miracle mold. (In 1945, the three men would share the Nobel Prize in Medicine.) Leading U.S. pharmaceutical firms were conscripted into the endeavor. In much the same way that World War II transformed the face of Europe, this behind-the-scenes war on bacteria would have a transforming effect on the practice of medicine—if not necessarily the effect well-meaning researchers envisioned.

The two wars dovetailed on June 6, 1944, amid the blood-soaked sand of Omaha Beach. Late the previous year, after swiftly done clinical trials, penicillin production had been ramped up in order to be available to the large numbers of troops sure to be wounded in the looming invasion. The drug was a stunning success, saving countless lives at Normandy and in the bitter village-by-village firefights that ensued. Penicillin fast became a staple on all battle fronts.

From this point forward, the story unfolds against the backdrop of one of the most folkloric, heavily scrutinized and socially significant periods in American history: post-war Suburban Sprawl. Returning GIs quickly set about the business of finding wives, putting down roots and starting families. Domestic America shifted into high gear: Hospitals soon bulged with women who themselves bulged with child. Housing tracts sprouted on erstwhile cornfields faster than the corn once had. Fueled by the post-war ambitions of the incipient Baby Boom generation as well as a new revolution of rising expectations, the U.S. economy obligingly took off. Between 1940 and 1960, the GNP (precursor to the GDP) nearly tripled. Unemployment lolled at under 2 percent. Increasing numbers of women—when they weren't having babies—took their cue from Rosie the Riveter, opting to remain in the workforce or join it anew. The phrase “upward mobility,” coined in 1949, fast become a staple in the lexicon. Everyone was busy, busy, busy. Americans—husbands and wives alike—simply had no time to be sick; no time even for such mundane a malady as the common cold. Further, having set themselves on a flower-rimmed path to Happiness And Prosperity, these husbands and especially wives were bent on taking every possible step to protect their (demographically correct) two or three kids, fencing them off from loathsome microbial stalkers. They went to their family doctor and explained as much.

And all across the land, doctors nodded sympathetically and wrote prescriptions for this new miracle drug everyone was talking about: the one that had worked such wonders overseas, in the closing months of the Great War.

Between 1944 and 1947 mass production of penicillin dropped the unit price from $20 to less than a half-dollar per dose, thus making the drug universally affordable. In 1950 family doctors wrote some 48 million “scripts” for penicillin and the other antibiotics coming on-stream—representing an estimated 2.2 billion individual pills, or the rough equivalent of a two-week dosing regimen for each of the 157 million men, women and children then living in the United States. That does not include antibiotics given through injection. A 2008 World Health Organization (WHO) review of antibiotic abuse poses that most of those scripts were for illnesses that “were likely viral in origin [for example, the common cold] or where the prescribed antibiotic was not the antibiotic of choice for the agent responsible for the patient's illness.” (To this day, the CDC reports, “almost half of patients with upper-respiratory-tract infections in the U.S. receive antibiotics from their doctor,” even though “90 percent of upper- respiratory infections...are viral.”

Of course, family doctors knew from the outset that prescribing penicillin for colds made about as much sense as putting air in a car's tires when the radiator overheats. But they were developing a wider lens on “healing.” They were giving America peace of mind as it went about its proper business, the business of booming. So they kept right on writing prescriptions, and for almost every health complaint imaginable.

To be continued...

Dr. Oz has left the building.

I would love to comment at greater length on this, but (a) I'm pressed for time of late, what with working 12-hour days, and (b) I really don't think I can say it any better than the folks at "Science-Based Medicine" do. Broad-brush, the piece assesses Dr. Mehmet Oz's decision not just to have as a guest noted "psychic" John Edward, but to essentially vouch for Edward's line of work.

Following is one of my favorite observations from the piece (though there are many), because it highlights the "argument" that is, in fact, the foundation for the entire New Age movement:

So, let’s see. Just because the great and powerful Dr. Oz can’t explain it, he assumes that talking to the dead must be real and that science can’t study it.

And to think, when I wrote my controversial piece on America's Oz-fest for The New York Daily News, people told me I was "too hard on the guy."

Please don't simply skim the piece linked in my first line. Read it. Think about it. Send it to your woo-obsessed friends. They may not thank you, at least not right away, but you owe it to them.

Guest column: Beware the cancer quack.

The following piece was contributed by Samantha Harris, a young woman who recently earned her bachelor's degree in journalism and communications. She titles it "Problems with Alternative Cancer Therapies." As many of you probably realize, we could write a book on that topic alone, but I think Samantha's piece provides a nice overview and is in "the SHAMblog spirit."

With that, I give the floor to Ms. Harris:

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Unfortunately, wherever there are people who are desperate and looking for answers, there will be others who swoop in to take advantage of them. This phenomenon is seen commonly with cancer patients.

Cancer is the second-leading cause of death in the United States. Though most cancers are treatable, the prognosis for some types is dire indeed: mesothelioma life expectancy, for example, averages less than a year from diagnosis. The fear of cancer is such that people too often seek answers in strange places. Some of these places may be hazardous in their own right, especially for patients whose cancers can be successfully treated through standard means. Following are a few common alternative cancer therapies–and the reasons they don’t work.

Vitamin C Megadose
This treatment, in which patients are injected with large amounts of vitamin C, was thought promising after a study published in 1976 appeared to show that such dosing increased the longevity of cancer victims. However, problems were found with the study's methodology, and further research has not been able to replicate the 1976 results.

Alkaline Diet
This school of thought insists that lowering the body's pH will pay a variety of health dividends, including the death of cancer cells. Again, this treatment has a very slim basis in scientific fact: In a test tube, cancer cells do grow slightly faster in an acidic environment. However, the body is an extremely complex system, and it's impossible to simply alter one aspect and expect to obtain one specific, isolated result.

Here, the potential downside is clearer than with Vitamin C: The body works hard to maintain a constant pH, and attempting to tweak it with an extreme diet can result in the depletion of important nutrients.

Magnet Therapy
There is simply no science behind the notion that magnets offer any health benefits, let alone have the ability to cure cancer. In a biophysical sense, the most plausible claim about magnets is that they improve blood flow or tissue oxygenation–although neither effect has ever been observed in a scientific, properly controlled setting. For one thing, there are problems creating double-blind tests, since patients can often tell whether the ring (or other device) they are wearing is magnetic. In any case, only non-specific placebo effects have been reported.

Sadly, magnet therapy is big business, pulling in $1 billion worldwide and $300 million in America alone.

Anti-Cancer Psychotherapy
There is no question that being diagnosed with a terminal illness greatly increases the risk of depression and anxiety disorders; it follows that psychological therapy can help the patient deal with these disorders. However, self-help gurus including Bernie Siegel and Deepak Chopra have attempted to advance the notion that there is a “cancer personality,” rife with resentment or grief, that can worsen life expectancy or even cause cancer in the first place. They contend that psychotherapy can help remove these negative emotions, allowing the patient to overcome his or her disease.

There is no scientific evidence to that effect. Moreover, these claims create another form of victim blaming, implying that if the patient fails to recover, it's because he or she didn't try hard enough. [ED. NOTE: Barbara Ehrenreich has written persuasively of this syndrome. Try here and here.] Maintaining a positive attitude and healthy social connections has been shown to be of some help in dealing with illness, but that's a far cry from claiming that one can simply wish cancer away.

Make no mistake, there are alternative ("complementary") therapies that, when used alongside standard cancer treatment, can help reduce the unpleasantness of symptoms and side effects. The danger arises when people believe that these alternative therapies alone represent a cure. Fatal cancers will not simply disappear after a patient eliminates a certain food from his or her diet or talks with a therapist. Although medical science may not have all the answers, it does offer the most comprehensive and reliable information on human health available.

© Copyright 2011 by Samantha Harris. All rights reserved

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For more on questionable cancer therapies, try this column from Quackwatch.

A loving ode to my grandson.

Just thought I'd post this essay, which is now up on Grandparents.com.

There was a period when I made 75% of my living—and a very good living, at that—from such memoirs. But that was a long time ago, when my industry was very different from what it is today.