posted June 30, 2010 04:41 PM
Prince Charles and "Alternative" Medicine
While I was in Ireland, the Prince of Wales--a longtime advocate of "alternative" medicine--caused quite a stir with an anecdote he told in a speech to some 200 healthcare professionals. Prince Charles is the president of the Foundation for Integrated Health, an outfit devoted to promoting the use of therapies considered quackery by many skeptics..
"'I know of one patient who turned to Gerson Therapy," said the Prince, "having been told she was suffering from terminal cancer and would not survive another course of chemotherapy. Happily, seven years later, she is alive and well. So it is vital that, rather than dismissing such experiences, we should further investigate the beneficial nature of these treatments."
Gerson Therapy was developed by Dr. Max Gerson (1881-1959) and is based on the belief that "toxins" cause diseases such as diabetes and cancer and that these "toxins" can be eliminated from the body by a diet rich in fruits, vegetables, and coffee enemas. He believed that "cancer was a symptom of a diseased, polluted body in which tumors form when the liver, pancreas and other organs are out of balance, and reasoned that animal and dairy products and other chemicals must be banned. The coffee enemas are used to strip the gut of harmful bacteria and pollutants, but specialists argue they often lead to other problems such as dehydration."* Most scientists today agree that eating fruits and vegetables is good for you. Few recommend the large quantities of juices used in Gerson Therapy.
Enemas have been used in body purification and cleansing rites for thousands of years by many cultures. "The coffee enema appeared at least as early as 1917 and was found in the prestigious Merck Manual until 1972. In the 1920s German scientists found that a caffeine solution could open the bile ducts and stimulate the production of bile in the liver of experimental animals. "* Gerson believed that caffeine would act as a detoxifier by stimulating the liver. He first used coffee enemas to treat tuberculosis, a bacterial infection. In the 1930s he began treating cancer patients with coffee enemas.
The conventional view of cancer does not find any evidence for the view that removing "toxins" is effective for treating cancer. Those who say that Gerson Therapy is scientific tend to focus on such evidence as "substances found in coffee—kahweol and cafestol palmitate—promote the activity of a key enzyme system, glutathione S-transferase, above the norm." They note the evidence, accepted by the medical establishment, that certain substances in fruits and vegetables can neutralize free radicals. However, the notion is unsubstantiated that once cancer has been established, detoxification by diet and enemas is effective in fighting the disease. Whatever benefit Gerson Therapy might have for preventing disease does not translate into effective treatment for those who have cancer. This point is lost on Prince Charles and his supporters, however.
For a skeptic, which Charles is not, several questions regarding his anecdote should be asked: Who is this phantom person that was saved by juices and enemas? and what evidence is there that she really was suffering from terminal cancer? Who told her she would not survive chemotherapy? And, what evidence is there that Gerson Therapy had anything to do with her being alive and well seven years after her alleged bout with "terminal" cancer?
Of course, it would be rude to ask the Prince for such details. His point, in any case, is probably not that cancer patients should give up chemotherapy and turn to Gerson Therapy. (A spokesman for Prince Charles said that the Prince had never suggested people should abandon their orthodox treatments for alternatives – rather that alternatives can be useful.*) Even if that were his point, there is little likelihood that there would be a mass exodus from scientifically-based clinics to an outpost in Tijuana (The Baja Nutri Care Clinic). (The treatment is illegal in the U.S.) The cost--about $15,000 for three weeks of treatment--is prohibitive for most folks. Yet, dying people can be desperate and an anecdote from Prince Charles might provide just the shred of hope they need to take the risk.
His point, however, may have been that treatments with satisfied customers, no matter how ridiculous, useless, or unlikely to prove effective should be subjected to scientific trials. This notion is apparently attractive to many people, yet it is not very logical and there are good reasons why scientists--real scientists--don't use the satisfied customer criteria as a guide to what should be subjected to a clinical trial. It is important to know why the customers are satisfied. Are they satisfied because they have objective, unbiased evidence that the therapy is effective? Good. Then it may be worth testing. Are they satisfied because they feel better or because they think the therapy cured them of a deadly disease? Sorry, such subjective evidence isn't sufficient to warrant an investigation. Steve McQueen said he felt much better after his Laetrile treatments right before he died. Many people think they've been cured of deadly diseases when they didn't have a deadly disease in the first place.
I first heard of Gerson Therapy when a local TV newswoman, Pat Davis, announced that she had breast cancer and was not going to submit to chemotherapy, opting instead for Gerson Therapy. In my entry on alternative health practices, I write
Pat Davis followed a rigorous 13-hour-a-day regimen of diet (green vegetables and green juices), exercise, and coffee enemas (four a day) developed by Dr. Max Gerson. Davis’ mother had had breast cancer twice, undergoing chemotherapy and a mastectomy. Davis knew the dangers of chemotherapy and the effects of breast surgery. She refused to accept that there were no alternatives. Gerson therapy gave her hope. When it was clear that the Gerson treatment was ineffective, Davis agreed to undergo chemotherapy. She died four months later on March 20, 1999, at the age of 39, after two and one half years of fighting her cancer. Could chemotherapy have saved her had she sought the treatment earlier? Maybe. The odds may have been against her, but the slim hope offered by scientific medicine was at least a real hope. The hope offered by Gerson is a false hope through and through.
Davis's mother is still alive. I tell this anecdote not to prove that Gerson therapy doesn't work but to remind those who, like the Prince, know of someone or of someone who knows of someone who survived a death sentence by using vitamin C or Laetrile or bile of ogre, that there are untold anecdotes that nobody tells because the patients are dead. Dead men, women, and children don't tell anecdotes.
Who was Max Gerson and why would anyone follow his advice of massive quantities of vegetable juice and daily coffee enemas? According to Croft Woodruff, "Max Gerson was the personal physician and friend of Albert Einstein and the philanthropist and missionary, Albert Schweitzer...Albert Schatz was also a friend of Dr. Gerson, Dr. Einstein, and the Schweitzers." (Many consider Schatz to be the true discoverer of streptomycin.)* Schweitzer believed that Gerson's diet therapy cured him of adult onset diabetes and cured his wife of TB. Schweitzer said of Gerson
...I see in him one of the most eminent geniuses in the history of medicine. Many of his basic ideas have been adopted without having his name connected with them. Yet, he has achieved more than seemed possible under adverse conditions. He leaves a legacy which commands attention and which will assure him his due place. Those whom he has cured will now attest to the truth of his ideas.
What Gerson did was try to cure himself of "migraines" by diet.* Apparently, his migraines went away after he went on his strict diet. He concluded that the diet cured him of the migraines. Gerson and others seem to have reasoned similarly when various ailments or symptoms, including cancer, were apparently removed or alleviated after going on the diet. As far as I can tell, Gerson never used a control group and thus was never justified in concluding that the effects he observed were due to the diet. He also did not report on the failures, only the apparent successes. There are no Pat Davises in the literature, but there are many in the graveyard. In short, not only is there no scientific basis for Gerson Therapy, there is little or no reason for doing clinical trials, as suggested by Prince Charles.
Prince Charles's speech inspired Dr. Michael Baum to respond with a scathing letter published in the online version of the British Medical Journal. "I have much time for complementary therapy that offers improvements in quality of life or spiritual solace, providing that it is truly integrated with modern medicine, but I have no time at all for alternative therapy that places itself above the laws of evidence and practices in a metaphysical domain that harks back to the dark days of Galen," wrote Dr. Baum.
Baum's letter and the dozens of responses it elicited are well worth reading. On one side is the notion that Prince Charles's longstanding position of advocating alternative medicine qualifies him as a dunce who might well read the entrails of birds for guidance. On the other side are the scientists with their evidence-based medicine, who follow reason and rationality, logic and empirical evidence. Then there are the anecdotes. Some tell of how conventional medicine saved lives; some tell of how alternative medicine saved lives. This raises the question: why do we give more weight to some anecdotes and dismiss others? If we are already convinced of the uselessness of alternative remedies, we might not question the efficacy of a conventional treatment, while we readily dismiss the efficacy of an alternative therapy. We also tend to ignore the cases of those who underwent the conventional treatment but died. Why? Conventional medicine has a better track record and the probabilities are on its side.
Many of the letters remind us of the fallibility of conventional medicine. Because of the great advances in medicine, we have come to expect miracles as the standard. One area where the miracles are glaringly small in comparison to, say, the treatment of infectious diseases, is in the area of cancer treatment. This may be why so much quackery focuses on bogus treatments for cancer.
There is also the untidy fact that conventional medicine sometimes kills by various kinds of malpractice. While nobody will ever die because a classical homeopath prescribed the wrong medication. But these issues, much on the minds of some of the respondents, are irrelevant to whether therapies like Gerson Therapy should be administered much less put to the test.
Several of the letter writers claim either to have successfully treated cancer with food or to have successfully treated themselves with food. As far as I know, there is good evidence that diet plays a role in the prevention of cancer (and other diseases) but there is no strong evidence that diet can reverse cancer. It should be obvious that just because a cancer goes into remission after one goes on a special diet, it does not follow that the diet had anything to do with the remission.
I think one letter writer captured the feeling of many of the defenders of Prince Charles when he wrote:
As one who has cured himself of cancer using holistic methods, without going to a doctor, I know whereof I speak. Conventional medicine has nothing to offer for cancer except surgery, radiation, and chemotherapy--otherwise known as slash, burn, and poison--and more and more people are catching on that the mutilation, burning, and toxic chemicals are completely unnecessary.
Modern medicine, in thrall to the pharmaceutical industry, fails utterly to understand that cancer itself arises from toxicity and that a cure depends on righting the body's internal energy balance. Gerson's diet works well, and so do many other techniques. The fact that large numbers of people are trying them and succeeding is a reproach to medicine's many failures. The holistic way typically offers superior results with fewer or no side effects and much lower cost--not to mention that patients aren't sent through an assembly line and get a practitioner who actually has the time to listen and respond.
I wonder if this fellow also diagnosed himself with cancer. In any case, New Age beliefs abound: that "energy" balance, harmony, and the like are relevant to disease; that one can take control of one's health and disease by manipulating "energy" through diet, exercise, and happy thoughts; that "toxins" are the cause of illness and can be removed by diet and enemas; and that doctor's are unnecessary or even dangerous. This may be a very distorted and erroneous view of both conventional medicine and the nature of disease, but it is widespread and warrants concern. Far from seeing Prince Charles as a dunce, some people see him as a knight in shining armor. This is worrisome, although some cynical skeptics welcome such leadership and see it as natural selection at work and believe it will eventually lead to a healthier species.
One of the more interesting letters in response to Baum's criticism of Prince Charles is from Hilary Butler, self-described as a freelance journalist, who calls into question the standard P-values used in clinical trials for significance. Butler writes
Could it be that this standard "scientific" baseline is a load of hogwash decided by an arbitrary standard chosen from the crystal ball from the er.. um... well... "I don't know" domain?
Could it be that the results of any research using this arbitrary standard is thereby subject to critical flaws?
Flaws which have been written about in great detail in the 80's by Professor James Berger of Purdue University, who published an entire series of papers alerting researchers to the tendency of the standard tests to be very wrong.
Oh and Professor Leonard Savage, who said that P-values were able to boost the apparent significant of implausible results by a factor of 10 or more.
Both warned that P-values were very prone to attribute significance to fluke results.
Both were ignored. But then, such is the way of medical history.
Butler seems to suggest that there is no point in testing Gerson Therapy because the methods used to evaluate the data of double-blind, controlled experiments have been misused.
All this and more from one little anecdote, indicating what? A skeptic's work is never done.
Why do we bother? Let me relate an anecdote.
A young woman who has been a "fan" of the Skeptic's Dictionary for several years wrote me:
I never thought that I would have to be looking up the Skeptic's Dictionary for anything but fun and interest.
But my father has just been diagnosed with terminal cancer (pancreas and liver) and has less than 6 months to live. He is now vulnerable prey to the snake oil salesmen.
Two weeks after diagnosis (inoperable/no western treatment possible) he is already on the Chinese herbalist quack medicine. For a couple of hundred dollars he has some capsules and a foul liquid. My attempts to find out what is in the formula have been thwarted, as the writing on the box is in Chinese characters. No chance of deciphering. A book accompanied these medications and if what is in the book is what is in the capsules/liquid (Tiang Xiang remedy no. 1, 2, 3 and 6) then it includes such wonderful ingredients as essence of pearl, essence of poisonous toad (doesn't specify which species), ginseng, natural indigo, essence of male animal bile, etc.
So what? you might ask. The stuff can't do him any harm, can it? Yes, it can.
* It causes dad PAIN when he takes it.
* He has to take it 3 times a day. He cannot eat for an hour before or after. He has to schedule his pain-relief medication around it. In short, it is ruling his life. He cannot enjoy himself because whether he goes to a restaurant or to the beach or to the races is dictated by his Chinese herbal medicine times. He forgot to take his "medicine" with him the other day and we had to race home from the museum in stress.
* It could be causing dad PHYSICAL DAMAGE as his liver isn't working properly, it cannot strain out the toxins in this "medication".
In short, the HARM herbal medicine can do in a terminal case where Western medicine can not help is this:
* increase stress
* increase discomfort
* shorten the already pitifully short amount of time left
* waste money
* raise false hopes that will inevitably be dashed.
Worse, as soon as this medication is disproved, a well-meaning uncle has another 10 different herbal remedies lined up for Dad to try.
No doubt the uncle is well-meaning. It seems to be a natural instinct in some people to rush to the aid of someone in distress and offer "cures" and "remedies" they know nothing about in the misguided belief that hope can cure all. In some families where everyone is a New Ager or postmodernist, this may not be much of a problem. But, if there is just one skeptical, logical, empirically minded family member who objects to making a dying person's last days, weeks, or months more miserable or full of false hope, or who objects to wasting money and precious time on useless remedies, then there will be increased stress among family and loved ones.
The young woman recently sent me an update:
Dad's bloodtest did in fact show that he was still declining despite that Tiang Xiang mixture, and thankfully he has given it away.
He is now on proper pain-relief medication from a palliative care doctor and is enjoying a much better quality of life than previously.
I am driving home to look after Dad now, after being in another city and I intend to make his last days as full of fun and love as possible.
I'm sure that the Prince and many of the defenders of alternative cancer treatments think they are contributing to the well-being of people. Not all are unscrupulous crooks taking advantage of desperate people. But, as Fr. Becker told me many years ago, the road to Hell is paved with good intentions.
I'll conclude by noting that in his speech the Prince of Wales defended alternative therapies because they offer care and hope, making the patient feel better. The implication is that conventional medical doctors are uncaring stiffs who are indifferent to their patients' fate. While it is certainly true that there are uncaring stiffs in most professions, it is not true that most medical doctors are unfeeling robots. The Prince also claimed "it has been demonstrated that in a variety of cancers, such as breast cancer, that attitude of mind can not only raise the quality of life but in some cases can even prolong life." I don't know what study the Prince had in mind but a 1989 study led by Dr. Pamela J. Goodwin of the University of Toronto and published in the New England Journal of Medicine found that attitude can make patients feel better but it doesn't help them live longer.
Questionable Cancer Therapies by Stephen Barrett, M.D. Victor Herbert, M.D., J.D.
"Why Bogus Therapies Often Seem to Work" by Barry L. Beyerstein, Ph.D.
The Scientific Review of Alternative Medicine and Aberrant Medical Practices
Now Charles backs coffee cure for cancer
Dr. Max by Giuliano Dego by Ralph Moss (Skeptics will especially like the part about Gerson's son-in-law and EVP. Dego claims Gerson spoke to him from the dead via radio and told him that he didn't die of pneumonia (as his death certificate stated) but that he was poisoned with arsenic. Gerson's widow is said to have verified the claim that high levels of arsenic were found in Gerson's body and that he was in perfect health when he died. Hmmm. Arsenic-laced coffee?)
The Gerson Institute
Skeptic's Dictionary entries on communal reinforcement, confirmation bias, control study, Occam's razor, the placebo effect, the post hoc fallacy, the regressive fallacy, selective thinking, self-deception, subjective validation, testimonials, and wishful thinking.