March 2004, Volume 11 Nr. 8, Issue 129
  
Tourists in Altmedland

JeanneE Hand-Boniakowski

Consumers and purveyors of alt-med (so-called alternative medicine, feel free to use the acronym SCAM) are a culture, not a field of healthcare.  The jumble of ideas and “therapies” are so diverse, the purported mechanisms by which they “work” are so multiple and often contradictory, that only a broad, vague cultural tent could contain them.  Jozef and I visited the Rutland Wellness Fair in November to immerse ourselves in this subculture for an afternoon.  Like white Americans in Europe, we were assumed to be citizens until we opened our mouths. Then we began to ask gauche questions and even bluntly call some things “nonsense”. They knew we were foreigners. 

Altmedland is a country founded by missionaries and populated by more expatriates and tourists than natives.  Most of the Altlanders are friendly, and they are eager to show you their stuff, which they proudly display as either very old or cutting-edge new.  We looked in vain for something with a record of progress and development.  The old stuff was praiseworthy because it had not changed for centuries or millennia.  This is proof that it works, since folks would not do the same thing for centuries or millennia if it wasn’t working, right?   And old stuff has the cachet of wisdom, mystery, antiquity. The new stuff was praiseworthy because it is the most modern scientific stuff, so new that the science is understood by only a few beleaguered geniuses.  But the very best stuff inhabits that exalted place where ancient and future meet, where East meets West and qi meets quantum, “where, you know, physics is coming to the same place the mystics got to long ago, and now science is proving the stuff these old wise shamans all know, you know?”  At least that is how it was explained to me by a nice young Altlander. And that is how it was explained to him, because, like the ancients he was so enamored of, his knowledge was passed down to him by oral tradition.  That is, he knows because someone told him, and that someone got it from someone who got it from someone and so on. 

Gossip and this version of the “telephone” game are the traditional way Altmedland’s precious and growing knowledge is passed.  But even this culture, with its pretense of egalitarianism, has its priests and stars, and they have always used whatever sophisticated tech they could.  In the past it included bullhorns and broadsides, now it includes multilevel marketing and the Internet.  What they don’t use, tellingly, are scientific meetings or journals, since scientific peer-review opens them to scrutiny in the marketplace of ideas.  Altlandish aristocrats love the market, the more frontier-style the better, but the intellectual  marketplace, with standards of evidence and an etiquette of critical inquiry, they avoid diligently.  This usually does not hurt their bottom line, because they can play on popular myths about scientists being a bunch of cold, clueless nerds, despicable and increasingly irrelevant.

Still, Altlanders crave the imprimatur of science.  Another tourist metaphor: young cousins from the new country, Altmedland, are visiting sophisticated Continental relatives, the Scientisti, eager to establish trade.  Their altlandish products are barely glanced at by the scientists, who, by long practice, can spot fools gold and fool ideas.  The Altlanders, crushed at the rejection, mutter that they don’t need those dull, old-fashioned, patriarchal Scientisti. The Altlanders preach “other ways of knowing”, different and more intuitive, holistic. Yet many still feel the Continentals are the height of sophistication, and they court Science like a moony, moody adolescent, alternately seeking favor and namecalling

Secrets of the Altmed Indians

What is “alternative medicine”, anyway?  Like the famous tale of the judge ruling on obscenity, “I know it when I see it.”  And so do most folks in the US.  They cannot define it, and, if asked, they will admit there are some therapies more plausible than others.  But generally, the majority has bought into the most significant of the mythologies about “alternative medicine”: that it is safe, natural and a matter of choice. 

None of these assumptions is backed by more than flimsy evidence and an avalanche of anecdote.  Yet, this is an era of smart consumers, who compare prices and kick the tires and are so sure they are savvy to commercials that the hippest trend in ads is self-parody, a nod to the consumer that “we know you are too smart to fool, we respect your intelligent artsy-ironic cool.”  I believe the same appeal to elitism fuels alt-med’s popularity.  Alt-med consumers are largely affluent, educated and white. Certainly this is about who has disposable income and is thus targeted by the pitchmen.  Also, word-of-mouth disseminates ideas, so the notions are propagated within this privileged peer group.

There is a pernicious classism and cultural imperialism common in so-called “alternative medicine”.

The elitist affluent class has long romanticized their "noble savages."  There is a colonialist desire among Altlanders which they delude themselves into calling "respect".  Respect for other cultures, in this context, seems to mean not allowing them to progress, lest any of the fascinating "native peoples" make the choice, as individuals or as groups, to partake of the 21st century. There are a lot of issues stirring here, including ideas of tribalism, community, individual rights, identity politics, individual identity, cultural imperialism, intellectual property, human citizenship...but, who am I kidding?  Altlandishness is not sold with intellectual discourse, nor will such decrease its popularity.  It is a proudly anti-intellectual tradition. Such nostrums as “Two Feathers Healing Formula” are typical. http://www.healingformula.net/ http://www.quackwatch.org/01QuackeryRelatedTopics/Cancer/twofeathers.html

Two Feathers is a prime example of a pseudo-old, pseudo-scientific, pseudo-secret recipe from the wise ancients.  Robert Roy, writes:  "It is like a time capsule sent to us from a distant past when knowledge was more of the spirit than of the intellect" and "produced in the original Native American manner, each herb is cured in smoke ovens and mixed in wooden bowls. Metal is never allowed to touch the formula as it would destabilize the electrolysis process provided by the components in the compound."  Whatever the heck those components are. Last  August, responding to a pharmacy student who inquired about the ingredients, Roy replied: “First of all, I have no respect for pharmaceutical drugs, I believe them to be poisons, secondly we do not give out information on our formula.”

What is this secret formula good for?  The usual mishmash of diseases that quacks have claimed to treat for centuries: “…has been used successfully for cancer, tumors, herpes, diabetes, Chronic Fatigue Syndrome, allergies, viral diseases, yeast and fungal infections, parasites, Lupus, moles, liver detox, vaginitis, worms and skin cancer. Also used as a powerful preventative remedy and detoxifier…”The two conditions that are honored with capitalization are 20^th century diagnoses, but the rest are old, reliable human complaints.   If you add arthritis, fibromyalgia, multiple sclerosis, erectile dysfunction, irritable bowel syndrome, migraines, depression and AIDS, you have a list of the disease conditions most popularly targeted by sellers of quack medicines.  Do most of the folks selling the stuff believe it works?  Probably.  It is still quackery.  This is a distinction that often escapes Altlanders.  Pointing out the uselessness of a nostrum is not calling into question the integrity of the person who peddles the nostrum. To err is human.  Fortunately, humans have also developed a great system to keep us from fooling ourselves: science.

Roy, on his site, tells us: "I met a Native American elder who introduced me to a complex herbal formula held secret by his family for over a hundred years and shared only with members of their family and tribe. . . .For a long period of time the original formula was kept from public view because of the respect and sacredness with which the elder and his family held this formula."

Now, if Roy were a talented charlatan, he would throw more pseudo-authentic details around, like a name of a tribe and/or the elder. He could really dress it up by telling us where the formula came from: vision quest, shamanic journey, near-death experience, snakebite hallucination...something really cool that the Altlanders will eat up.

 And just what sort of wise old noble tribal elder with the secrets the world needs is so stingy that he won't share it with needy, hurting folks for a century?  And what made him suddenly decide to give the recipe to Roy, (who never refers to himself by tribal or clan affiliation, just as “Native American”)?  On the website, Roy has pasted icons representing a jumble of distinctly different cultures which inhabited North America in pre-Columbian time.  He does not name or distinguish them. But Roy is nothing if not a tourist.  He says he has visited thirty countries, and studied macrobiotics, “oriental philosophy” (another overbroad, typically colonialist way of categorizing half the world: "oriental").  He became "engrossed" with Royal Rife's work and did research with young scientists for years on Rife tech, including making a working Rife generator, he writes.  (Rife’s is a sad, mad tale of fringe and fail.  My favorite Rife site is http://www.xenophilia.com/zb/zb0012f.htm) Since Roy disses intellectual paths to knowledge,  I don't know why he would hang with "young scientists" and do "research", nor why he would care about the "electrolysis process."  Of course, he has no citations to evidence of his “research”.

Roy finishes with a line to endear him to the patriots and colonialists everywhere: "I  pray daily for God's Healing and Blessing over this Great Nation."  What Native American people may feel about this prayer is unlikely to concern Roy, because for all his "honest injun" rhetoric, he knows that most of "his" folks, on the reservations and off, are too poor to buy his crap anyway. 

People hear what they want

Here is the sort of wording one hears from the more careful fraudsters:  "There was a study about the benefits of chiropractic treatment in colic...!"  They don't tell you that the study showed no benefit, but the enthusiastically delivered news that "there was a study!" is all most folks need to hear; they will assume the results favor, even laud, chiropractic for colic.  Folks will even remember things that were not said, in a "fill-in-the-blanks" internal game of telephone.  Soon, "there was a study" becomes "my chiropractor cures infant colic! Scientifically proven! He did a study!"

There are a couple of pediatric chiropractors in Vermont, of whom an enthusiastic acquaintance told me last summer, "The Peets wrote THE textbook on infant chiropractic!" I do not know whether the Peets make this claim or just showed her the book  they produced, "Pediatric Chiropractic Practice Management", (Jennifer B. Peet,  1995, published by Baby Adjusters).  This book states that "every time a child receives a chiropractic adjustment it should be given as if their very life depends on it, because it does." Also, that "the dangers of vaccinations to the young child are profound," and can "increase a child's preexisting chronic disease tendency."

I am all in favor of self-publishing anything from chapbooks to broadsides to tomes, but if Jennifer Peet's is "THE" definitive textbook, then it verifies my assumption that chiropractic is mostly a massive delusion massively marketed.  My point is that enthusiastic patients easily inflate information.  And the "sins of omission" are as important as the "sins of commission" in propagating ideas.

The closer I look at chiropractic, the more it slips through the grasping fingers of my mind.  It is maddening, there's “no there there".  A huge edifice built on less than sand.  So visible, so present, so vocal, that it just looks like "there must be something to it", yet, like gods and unicorns and subluxations, I can find no reason for chiropractic except as a self-perpetuating fancy.  I think the tiny minority of rational chiropractors should cut their losses and quit trying to reform this quagmire of quackery and cultism.  

Telescoping Scopes of Practice

The Vermont Senate recently passed. 25-2, bill requiring health insurance plans to cover some services provided by naturopathic physicians.  The overwhelming Senate support will carry weight in the House committee now studying the bill.  Naturopaths are increasing licensure and scope of practice nationwide.  Lobbying involves legislative and popularity efforts but not science.  There is a trend in Altland that, rather than depending on the judicial junk science favored in the past, to dispense with science altogether.  Science is denigrated as an invalid or unsophisticated way to determine value of altmed therapies.  The appeal to democracy and freedom of choice has led to a fierce trend of legislation.  Some very bad laws are passed, such as the 1994 DSHEA that gave free reign to sell “supplements” without proof of content, efficacy or even safety.  It took many years and over 100 deaths (and uncounted injuries) before ephedra was banned.  

An article in the Brattleboro Reformer, announcing the Vermont bill included assertions typical of naturopath’s misleading lobbying.  

Naturopathy has been successful in treating diseases such as diabetes, (naturopath Dr. Katherine) Virkstis said. Where a patient may need years of treatment and insulin with a conventional doctor, through a naturopath prescription of diet and life change, that same patient can find relief.

Why should physicians who think this way be part of the healthcare system? Think about it: Dr.Virkstis is, she claims, able to know when to refer, and why, yet she has an idea, rampant among her colleagues, that the medical doctors of Vermont, when they diagnose diabetes, do not follow their own medical standards of prescribing diet and life change.  Any MD who fails to provide such care is negligent.  Diet, exercise, skin care and more have been the standard of care in medical treatment of diabetes for many years Why would Virkstis perpetuate the myth that MD's do no such education and care with their patients?  If she really believes that MDs in Vermont do no such basic diabetes care, how can she ethically refer to MDs?  Doctors sometimes also prescribe sulfonylureas, biguanides or other medicines for diabetes. Virkstis’ poor understanding of medicine also shows in her glib implication that insulin is the common drug for a diabetic.  Go down to the nearest assisted living community and ask residents what the common drugs for diabetes are.  Most of them will know the names Glucophage and Micronase, for example.  Most will know that insulin is not used by most diabetics who were diagnosed as adults.

So, a naturopathic physician, with 4 years of post-grad education, either does not know, which is incompetent, or else she does know and is playing on her perception of the public's stupidity, thinking they link diabetes with icky insulin jabs.  I think a conscientious, thorough physician is very important when someone is newly diagnosed with diabetes or is at risk for developing diabetes.  I don't think Virkstis is that physician, if she really has such poor understanding of the issue and the current treatment protocols as her words imply. 

From dentists wanting to do plastic surgery, to chiropractors wanting Medicare dollars, to naturopaths and homeopaths wanting licensure, to massage therapists padding their national licensure exam with a mishmash of religious beliefs, to supplement sellers wanting to maintain the caveat emptor marketing of dubious concoctions, the Altlanders are busy in state and federal legislatures nationwide.  Decent treatments with solid scientific evidence of safe, effective use (including dental amalgam and vaccines) are being assailed, while speculative therapies of unproven safety and efficacy (including acupuncture and chiropractic cervical manipulation), and even treatments definitively disproven (including homeopathy and applied kinesiology) are being promoted as issues of health and choice.  

Is Medicine a Necessary Evil?

There is an assumption, largely unexamined, permeating the thinking of many, probably most, Americans, including a lot of those in medicine and allied health: "Medical care is a necessary evil."  Not that medicine is a very good thing with some bad side effects.  But that medicine does scary, painful, bad things to achieve some benefit for some people. That medicine does some good in spite of itself.

This is the underlying, and dangerous, assumption that drives many people. Attached to this assumption is a rather new notion that good health is a right.  Not good health care, which I think IS a basic right, but good health.  Therefore, when folks, meatpuppets that we are, are naturally assailed by illness and injury, we are indignant, because we have been taught that illness and injury are actually UNnatural.  Our choices then, when we get sick or hurt, are: "someone did this to me" (I am a victim) or "I did this to me" (I am a sinner).  In either case, the folks to whom we submit or bodies for repair are easily targeted as villains if they fail to either "make it all better" or, if they do implement a cure but "it hurts".

In the juvenile psychology I see in many patients, especially perhaps those susceptible to altmed's lure, the MD becomes the symbol of the illness. Everything unpleasant about the treatment, as well as the illness, is associated with the MD.  Especially chronic illnesses. Since the things the MD can actually cure have typically short courses and rare sequelae, the true cures, marvels of human accomplishment, are not much appreciated.  My raging bacterial pneumonia several years ago could easily have killed me, but with I.V. penicillin I was up and about in a day and discharged in two.  It is a nearly forgotten episode.  Pneumonia, one of the greatest killers in human history, is now akin to a bad cold.  That is, as long as modern medicine is available.  

I am writing this in the context of industrial nations of the global-cultural  north.  It may be noted that while the ancient and traditional “medicine” of many poor cultures are avidly practiced, it is often not because there is a choice between medicine and folkways, but because there is no modern medicine available. The romanticism and cultural imperialism of Altlanders commonly ignores that distinction.  Cluelessness is no excuse for racism.  

Unlike the pneumonia, my high blood pressure is a chronic issue.  I am grateful to have medicine and the use of my legs to pedal a bike to control it.  I could perceive my tendency to high blood pressure as demon, family curse, the wages of the sin of fatness, whatever.  I could analyze and worry and blame out and shame in.  I could be pissed at my doctor for prescribing an imperfect medicine (that, nonetheless, works damn well).  Or I could do more interesting things with my time and quit focusing on me.  Me-ism and selfishness are rampant in Altmedland.  Makes for some insufferably boring people.

Consider antibiotics: historically overprescribed, "outwitted" by bacterial evolution, and famous for upsetting your tummy a bit, these wonderful medicines have been vilified so that even as a patient takes them, they complain.  Maybe we should be prescribing a ritual with them: One tablet q.i.d. while reciting silently "This elixir is a blessed gift, that will rid the infection", p.o., with food, X 10 days.  And/or we can include a little pamphlet that shows vivid photographs of folks with similar infections to the patient's, who had no antibiotics; those forensic TV shows are all the rage, so show folks disfigurement and death and brain damage and all those things common with their infection.  Then folks can remember why they are taking the medicine, rather than focusing on a little transient diarrhea.

Yes, yes, there can be much more severe adverse effects from antibiotics, but those are not experienced by most folks, and even my son, who lost most of his hearing to gentamycin, says that it was "better than dying".  Maybe we should state the obvious more often, but, see, even I felt compelled to let you know I am aware of problems with antibiotics.  I am so used to Altlandish tactics that I am defending against them in anticipation. This is why the struggle is so exhausting.

Paternalism

I asked a nurse who coordinates pediatric orthopedic cases about how often parents ask her about chiropractic care for their children.  She said it rarely comes up. Since so many folks think of chiropractors as somehow bone-related, I wonder if a lot of her patients may have been to see a chiropractor but the parents do not tell the orthopedist.  Do the chiropractors encourage this?  Or do the parents just pick up the vibe that they are being naughty and going behind the MD's back?  

I am serious about the "naughty kid" thing, because, for all the notion, often with reason, that MDs are paternalistic, I have found altmedders exploit, consciously or not, the juvenile desires of people in distress.  

Think about it: my generation has been fed for years on suspicions of physicians, whom, we know from conventional wisdom, are paternalistic know-it-alls who spend little time with patients. Maybe we, as individuals, have been fortunate, in our rare encounters with medicine, to have had only genuine, caring doctors and nurses, but we know that such doctors are exceptions to the rule of rich, cold pill pushers that define the profession.  This is a very common attitude.  We assert that we want more say in our care, to be listened to and respected as adults, to be able to ask questions about proposed treatments, et cetera. These are the natural desires of grown ups, and importantly pursued by the baby boomers, who taught each other and the rest a lot about questioning authority. 

Along comes the chiropractor (naturopath, acupuncturist, herbalist, homeopath...) telling us she knows just how we feel, assuring us that she will take an hour or more at our first visit, that she will listen, will treat us as an adult, will care and respect us as whole person, et cetera. In other words, even though the treatments these various providers offer differ a lot, they are the same in saying they are different from the orthodoxy (medicine) in this.  They appeal to our stated desire for respect and choice, but do they actually deliver on this, perhaps their primary selling point? 

I would suggest that they simply substitute a different kind of paternalism, and one harder to fight.  Once one is cocooned in the safe place, (the altmed provider's office) where you have been assured you will be cared for, respected, listened to and treated with only "natural" therapies, it is actually all the harder to question the "healer", this kind, new friend. Unlike your MD, with whom you have a professional, dissatisfying, relationship, you have a more personal relationship with this alt doc. While it is encouraged that you question her so you may learn more about the therapy, you feel it would be impertinent to question the underlying philosophy of her profession, gauche behavior for a guest.  She has invoked the buzz words like "natural" and "gentle" and "immune-boosting" and "holistic", and you are lulled and comforted because you have found someone who understands, who will take care of you.  You submit in a manner more complete than any time you ever "followed doctor's orders", you submit to your new caregiver and her bizarre tests and her odd treatments and her prescriptions of herbs and vitamins (because you don't have enough of something) and of homeopathic pills (because too much of nothing is better than something at all).

The atmosphere is of a soft cult. There may be a wide and contradictory variety of theories and therapies, but there is behavior among altmedders that keeps them from dissing one another even as they collectively diss "modern/western/orthodox medicine".  While the boomers practice our right, even duty, to question authority, we are hesitant to question religious beliefs.  Our cultivated multicultural sensitivity (a good thing) can lead us to let absurd ideas and treatments stand without challenge because they claim a lineage.  Belief and faith and the esthetic esoterica of other cultures are common in Altmedland.  A soft cult, because there is no single guru or text, but there are social pressures to adhere to a party line. 

Some folks are crazed crusaders for the altmed cult, but most are reasonable-seeming folks who remind me of my cousins' neighbors' kids in the Finger Lakes region when I was a child.  When we visited, we would get involved in large-group games, like baseball or tag or hide-and-seek.  We were kids, about 20 all together.  But before we could play together, the Darlings (the neighbor's family name) had to get one thing clear: "Y'all are Catholics and we're Baptists, so y'all are goin' to Hell and we're going to Heaven cause we're saved.  As long as you're clear on that, we can play together."  So we Catholic kids learned early on it was better not to discuss religion with folks who weren't Catholic, as it just made folks uncomfortable and meant you couldn't play together.  We figured we were all Christians, anyway. In the same way, the chiropractors can play with the homeopaths because they're all Altlandish anyway. (I learned later that summer that the Darling boy I had a crush on did not agree about us all being Christian, but that's another story.)

It is quite striking how these practices are blended, often with no acknowledgement that, or how, they may adversely interact. In a clever bid for legitimizing the nonsense of homeopathy, I have noticed more and more OTC things, including toothpaste and lip balm, warning about natural mint flavorings interacting with homeopathic medicines, or reassuring folks that the product is compatible with homeopathic medicines. I think this is one of the nudge-winks that reveal the open secret that, for many, altmed is a game, a bunch of kids playing doctor.

Why Bother to Bail

Rarely will I engage quacks without an audience.  I know that it is unlikely I will affect the true believer or the knowing scammer, and I know their arguments as well as they themselves. I can, however, plant seeds in the onlookers.  Therefore, I usually conduct my conversations with quackery-mongers with the utmost civility and offer benefit of the doubt, just trying to plant seeds of reason, challenge thinking (and lack thereof) and asking very basic questions.  Drawing more flies with honey.  This means I am more often pitied than despised by true believers, but that just maybe I bailed some bilge water out of our collective lifeboat. 

Recently, though, the bilge water was rising faster than I could bail, and so I dropped a carefully composed e-mail to the e-water site (www.ewater.com) 

I was visiting this page on your website: ewater.com and would like to ask a question.

Do you actually believe this silliness?  Have you any elementary school education about the most basic knowledge from biology and physical science?  If you want to sell religious trinkets, why do you insist on all the science words (which you grossly misuse) in your ads?  Not to mention the pretend science: "micro-clustered, far-infrared enhanced water", your E-mug, "Bovis", the truly goofy "Haselden protocol"!  

I hope you never actually get sick or injured, Fred, with any of the conditions treatable by science-based medicine (despite its short history, and the many conditions which no ones can yet cure, it still has quite a record of success).  If you do, I hope you take advantage of the fruits of long, careful human labor in medicine. I hope your responsibility as a parent, the impetus you say got you started on this path of your "passion", does not lead to you compromising your child's health.  As you publish and practice with quacks like Yanick and Haselden, I wonder what other silliness you believe.  We all have different standards of evidence, but Yanick's article is a windy, wordy bit of non-science nonsense, and the Haselden protocol is a modern sacrament of silliness.  I don't know how you do it without giggling. 

Because there is a lot of overlap among the most absurd edges of health quackery, I am concerned that you may not vaccinate your child(ren).  So far, the results of such neglect has not been catastrophic because most of us do think vaccination is a valuable public health measure and an ethical obligation to our children and our community.  Those of us who have worked with children and adults severely disabled by measles, polio and other diseases that vaccination has so dramatically lowered, are appalled at the base stupidity and outright lying so prevalent in the anti-vax world.

While you sell your products to quacks and to the wealthy worried well and, sadly, to folks who are in true distress and can little afford to waste money on your overpriced filters and your outright snake oil devices, I don't know whether I would be more distressed to think that you actually believe in this or that you are a cynical snake out for the bucks.

JeanneE Hand-Boniakowski

He wrote back to tell me off, oddly closing with "Blessings, Fred Van Liew".  He also let me know that he was a better pacifist than I by telling me that his "technologies" prevent the violence I "hypocritically" speak out against.  My non-violence work is cancelled out by my involvement in "a failed system of poisoning, burning and cutting", and by my "responsibility" for "compromising society's immune systems to where a simple childhood immune building measles now becomes life threatening."  I did not even know he was an anti-vaxer until he replied, but his notion that measles was a benign disease and is now a sometime killer BECAUSE of vaccination is a level of nuts that is new to me. We can't bail fast enough, can we?

© 2004 JeanneE Hand-Boniakowski