Hokum on the Rise: The Seventy Percent Solution
Julian Howell, the family doctor who cared for me during my childhood in Selma, Alabama, had an impish smile and a garrulous, back-slapping charm that soothed the most anxious patient...
A few years after my graduation from medical school, when Julian was approaching retirement, I stopped by his home for a visit. We sat on his back patio, a broad expanse of terra cotta tiles shaded by a canopy of oaks and sycamores. A fountain fed by an artesian well gurgled nearby. In the purple twilight of a summer evening, as doctors are so often wont to do, we drifted through a long, pleasant swapping of medical tales.
I strutted my stuff by citing the triumph of my internship, a patient whose chronic blood loss I had diagnosed within five minutes of his admission to Santa Clara Valley Medical Center by testing his stool for occult blood. Months of seepage from a gastric ulcer had left the poor man profoundly anemic. He was deathly pale.
When Julian’s turn came, he sipped his bourbon on the rocks, set it down on the table between us, then swore that the palest creature the world had ever seen was Amantha Hargood, a ten-year-old patient he had examined many years before.
“I spun down her blood right then and there,” Julian said. “The haematocrit was twelve. I wanted to put her in the hospital, but her parents didn’t have a pot to piss in, couldn’t come near affording the twenty dollars a day it cost back then. They sharecropped a little plot out by Marion Junction, fed her mostly corn – corn mush, corn bread, a scrap of fatback every now and then. Her skin was so pale, you could almost see her bones.”
But Amantha suffered from more than anemia. She was cachectic, short for her age, with swollen joints and thin, frail limbs. Her gums bled all the time, tinting her saliva pink. A mass of bruises ran all the way up her bony spine. The father told a disturbing story.
“Well, Amantha’s been doing right poorly for more’n a year, so a while back we got hold of this preacher over in Uniontown. He came to the house, charged a dollar an hour to read the New Testament while he sat by Amantha’s bed resting his hand on her head. Cost us four dollars to get through Mathew and Mark, but halfway through Luke, we decided Amantha wasn’t getting much better, so we took her to Doc Jensen.” (Jensen, a Selma chiropractor, lived in an antebellum mansion famous for the cannonball hole blasted through one of its Greek Revival columns during the Civil War.) “Jensen told us Amantha had a collapsed colon and told us we had to sign up for five treatments, charged six dollars on the spot, but that first treatment raised all them bruises up and down her back. When the time come for her next treatment, she squalled so loud we just give up. Finally, things got so bad, we decided we’d best get us a real doctor.”
Julian diagnosed scurvy, a deficiency of vitamin C that stunts growth, impairs healing, and causes patients to bruise and bleed easily. He also diagnosed anemia and protein deficiency. For treatment, Amantha received injections of vitamin C and ferrous sulfate. The parents were told to supplement her daily diet with one pork chop, the juice of a fresh orange, and over-the-counter iron tablets. When they brought her back a month later, the bleeding and bruising were gone. She had gained twelve pounds. Julian claims – I tend to doubt this, despite his famous veracity – she had already grown a head taller.
He charged the Hargoods a dollar for each of the two visits.
“Thank you, doctor,” the father said. “We’re glad we came.”
* * *
Julian Howell, god rest his sweet soul, was the gentlest man I ever knew, but he loathed chiropractors. When anyone mentioned the subject, his impish smile vanished, and his face grew dark with rage. It does something to a doctor when a farmer with metastatic bone cancer limps into his office carrying a basket of fresh-picked corn in lieu of payment because his savings have been drained by a high-school graduate with six months of training at the Alabama Chiropractic College. Indeed, chiropractors have inflicted upon modern medicine some of its most humiliating defeats.
The debacle began in 1895, when Daniel David Palmer, the founder of America’s first school of chiropractic, claimed to have cured a patient’s deafness by manipulating his spine. Since the auditory nerve remains entirely within the skull throughout its path from ear to brain, such an outcome would have been a singular achievement. Though no scientific evidence supports Mr. Palmer’s various theories of disease, the soothing effects of spinal manipulation won chiropractors millions of enthusiastic patients, while a lobbying campaign forced Medicare to reimburse chiropractors and physicians on an equal basis. The most devastating blow came in 1992, when the Supreme Court awarded chiropractors a judgment for restraint of trade against the American Medical Association.
Julian’s long life ended two decades ago, just before the rising onslaught of what is now called CAM – Complementary and Alternative Medicine. Since then, unorthodox therapies have gained a wider audience with each passing day, even in such exalted institutions as Harvard and Johns Hopkins. From Maine to California, in shopping malls and store-front boutiques, CAM practitioners offer yoga, acupuncture, iridology, naturopathy, massage therapy, aroma therapy, and colonic infusions of coffee extracted from organically grown, high-caffeine beans. In some of the more eclectic venues, the shaman who reads your palm will also sooth your irritable bowel with whiffs of lavender and patchouli oil.
In theory, CAM and modern medicine remain very much at war. Of the various remedies popular across the tides of human history, only a tiny faction have been incorporated into the discipline we call “modern,” “mainstream,” or “scientific” medicine. This is not to say that only science can relieve suffering. Indeed, all popular treatments “work” – i.e., they make patients feel better. Otherwise, they wouldn’t be popular. The scientists who rail against CAM often overlook this crucial point: if something makes a profit in the open market, be it a pill or a Barbie Doll, then by definition it works. Medical purists grumble about placebos and implausible biologic mechanisms, while CAM practitioners laugh all the way to the bank. What patient gives a hoot for biologic mechanisms so long as those tingly acupuncture needles relieve a backache that has tormented him for weeks?
* * *
In the annals of medicine, 1960 became a landmark year when David Sabiston and Alfred Blalock, distinguished professors at Johns Hopkins University, published the results of a controversial clinical trial. Especially disturbing was the fact that anyone dared to conduct such a trial, since the procedure it tested – ligation of the internal mammary artery (LIMA) – had already been performed on hundreds of patients with coronary artery disease, and respected surgeons had reported an improvement rate that approached seventy percent. Most victims obtained at least partial relief from chest pain, and some even showed objective signs of benefit, such as changes toward normal in their electrocardiogram.
Undeterred by these results, Sabiston and Blalock conducted what many regarded as a horrific experiment: thirty-four patients were randomly divided into two groups, and, while the first group received a standard LIMA, the second group was subjected to a sham procedure that left them with the same surgical scar, so neither the patients nor their cardiologists knew who had received the real operation. The first group showed the expected results: chest pain was relieved in seventy percent, exercised tolerance increased, many were able to return to work, and some showed objective improvement in their EKG. Sabiston and Blalock were saved from the academic equivalent of a lynch mob only because the sham-operated group displayed the same benefit, revealing for all to see the staggering power of the placebo effect.
Subsequent research has proved this study more the rule than the exception. When surgeries and medicines are tested in an informal setting – i.e., a setting that does not control for psychological factors or statistical bias – the great majority seem to be effective. Yet, tragically, when proper scientific scrutiny is finally brought to bear, these same treatments are often shown to be worthless, or even harmful. Sometimes this scrutiny comes too late to save thousands from unnecessary suffering, disfigurement, or death.
The history of secretin, a natural hormone that stimulates digestion, offers a poignant example. Shortly after injecting secretin into the vein of an autistic child with digestive problems, a pediatrician thought he noted a dramatic remission in the symptoms of autism and decided this might be a cause-and-effect relationship. His enthusiastic report led many of his colleagues to try the drug on their autistic patients. The news was especially exciting because autism, among the most heartbreaking of all childhood afflictions, had long resisted anything resembling a cure.
Interest abounded when the pediatrician presented this case on NBC’s Dateline in October of 1998. The following year, doctors administered secretin to an estimated 2,500 autistic children, with seventy percent of their caregivers reporting positive results. In response to such widespread interest, the National Institutes of Health sponsored a controlled clinical trial – a trial in which neither the patient, the family, nor the treating physician knows whether the coded injections contained secretin or sterile salt water.
A wave of optimism swept through America as parent after parent reported dramatic benefits. Even the treating physicians were impressed, but unfortunately, when the codes were finally released, the benefit derived from secretin was found to be no better than that derived from injections of sterile water. Subsequent trials showed similar results, yet many parents and physicians remain doggedly loyal to secretin, citing the seventy-percent improvement rate and chastising the naysayers for trying to steal their only hope. How is it possible, they argue, that such a powerful benefit could come from nothing but the placebo effects?
How indeed. Fifty years after the landmark paper of Sabiston and Blalock, this conundrum still haunts not only CAM practitioners, but the very halls of academic medicine, where professors and patients alike are loath to surrender a beloved treatment just because it falls flat on its face in a clinical trial. Why does the mind play such deceitful tricks? In fact, there is more than the mind at work here: placebos enjoy a huge statistical boost – the random waxing and waning of symptoms that occur over time in the course of most diseases. By chance alone, treatment is often administered just hours or days before a spontaneous improvement, and in such cases, both the patient and doctor are inclined to credit the treatment, even if it has no true biologic effect.
Placebos receive an additional boost from a statistical phenomenon known as regression to the mean. Patients are most likely to seek treatment after they have suffered an especially bad day or an especially bad week, and regression to the mean assures that, on average, the following day or week will bring less severe symptoms – again, by random chance alone, even if the treatment is a sugar pill or a sham operation. Most important of all, studies performed during the last decade have shown that the expectations aroused by a placebo may stimulate the body’s own defenses against pain and muscular spasms.
The inclination to credit treatment for what are in truth random remissions, plus the subconscious power of inert potions and sham procedures, gives alternative medicine an “improvement rate” that trumps some of the most effective scientific regimens. This spurious advantage is especially marked when the results of a controlled clinical trial, an experiment designed to eliminate both random and psychological factors, are compared with the day-to-day results of alternative medicine, whose practitioners remain free to employ every psychoactive trick in the book. Thus oncologists struggle to enhance survival from breast cancer by twenty percent, while acupuncturists – twirling their needles into “meridian” points based on historical legend, adding the exotic sizzle of moxibustion or electrostimulation – dispense a level of satisfaction that rivals the seventy percent shown by Sabiston and Blalock.
However much ground physicians have lost to alternative medicine on the battlefield of treatment, they face an even more daunting challenge when forced to name the disease that causes the patient’s suffering. For the complaints that bring most patients to their family doctor, science restricts us to an uninspiring array of diagnoses: viral illnesses, the depredations of aging and lifestyle, and modern terms – stress, fibromyalgia, multiple chemical sensitivity – for psychosomatic disorders once diagnosed as neurasthenia or hypochondria. This restriction puts the modern physician at a huge disadvantage, since no patient likes to be told that his symptoms are due to gluttony, sloth, or old age. Or, worse yet, to a “stress-related” illness, which even the most unsophisticated patient will translate as “It’s all in your head.”
At the core of modern medicine there lurks a terrible truth: most orthodox remedies offer little benefit for the average patient. Of the viral illnesses amenable to antiviral agents, only a few justify the risk of treatment, leaving millions to suffer the cold and flu agonies of winter with nothing more potent than over-the-counter remedies. The prognosis for obesity and sloth remains grim, rivaling the prognosis for advanced malignancies. If the typical family doctor filled his waiting room with all the patients who had sustained a regimen of diet and exercise for five years, he would have many empty chairs. Indeed, studies of weight-loss programs have shown that from eighty to ninety-five percent of the participants eventually regain every pound lost. Even more discouraging is the cure rate for old age, which to this day remains at zero percent.
These common disorders pose a dilemma for physicians schooled in the rigors of science: should they tell patients the terrible truth, or should they hedge their bets? Which is to say, should the doctor admit there is no effective treatment – except, in certain cases, lifestyle changes which the patient will almost certainly reject – or should the doctor prescribe a medication that offers no more benefit than a placebo? This question brings us to a crucial juncture, for it is here that much harm can be done: the complications brought on by unnecessary drugs wreak havoc on thousands of patients every year, rivaling the harm done by the misdiagnoses and mistreatments of alternative practitioners.
Every drug poses risks. Sugar pills are harmless enough, but they represent a bald-faced scam that might backfire if discovered. And, we might reason, if the patient needs a placebo, why not give one with the cachet of feverfew or Ginkgo biloba, or the psychological boost provided by moxibustion, aroma therapy, or spinal adjustment? Ah, but we forget – such measures are forbidden to the scientific physician, even if they offer the only hope for sending the patient home a happy man.
In contrast to these dilemmas, the “holistic” practitioner can give free reign to her imagination when it comes to diagnosis and treatment. The patient’s yin has succumbed to his yang, an imbalance that calls for a concoction of fenugreek, cardamom, and origanum oil. Ingested animal fats have depleted the patient’s chi, leading to dyspepsia and varicose veins; iridology or a whiff of patchouli oil will set things right. A dried herb known as pill-bearing spurge is said to cure asthma. Shamans of every stripe reshape their patients’ karma by manipulating their muscles or vertebrae or spiritual auras.
The list of alternative therapies rolls off the tongue in a litany of claptrap humor, providing a large, slow-moving target for satire, but two nostrums offer special appeal by harkening back to the excretory obsessions of childhood: colonic infusion, in which sometimes astounding quantities of tap water or other liquids are infused through the rectum; and urophagia, the drinking of ones own urine, a remedy advocates claim will cure a host of ills. When the craving to be healed joins with the need to believe, science has little hope of victory.
* * *
Every workday morning, eighty-three thousand professionals stride into doctors’ offices all across America. Each carries a briefcase, wears a stylish but sober suit, and shows those qualities of face, figure, and manner that most appeal to the opposite sex. These are the Drug Reps. Once predominately female, in recent years their distribution has shifted toward the masculine gender in order to complement the ever-increasing proportion of female doctors. The Drug Rep’s job is simple: urge physicians to prescribe large quantities of the drugs manufactured by her employer.
This salesmanship has contributed to the thousands of injurious side effects caused every year by medications that offer the patient no more benefit than a sugar pill. Physicians argue in their defense that many patients refuse to leave their office without a prescription in hand, a trend aided and abetted by the millions of dollars drug companies now spend on direct-to-patient advertising. This argument is correct, of course, but it does nothing to remove the physicians’ moral burden. These are the same doctors who rail indignantly when an occasional patient suffers paralysis at the hands of a chiropractor or develops life-threatening complications from an unproven herbal remedy.
However great the havoc wrought nowadays by inappropriate drugs and surgery, things used to be much worse. For untold generations, mainstream doctors dosed their patients with strychnine and arsenic, bled them with leaches and lances, purged their bowels and blistered their skin. Worse yet, they removed thousands of perfectly normal organs. We now know that these treatments almost always caused more harm than benefit – on occasion, a great deal more harm. The bacterial epiglottitis that killed George Washington was sped along its fatal course by repeated purges and blood-lettings, while Lincoln’s prognosis after his gunshot wound to the head – poor under the best of circumstances – was worsened by the trochar doctors thrust into his brain in a misguided attempt to remove the bullet.
According to Lawrence Henderson, an eminent medical historian, the predominance of harm over benefit from mainstream medical treatments did not reverse itself until about 1910, when science finally began to hold sway over centuries of superstition, misinformation, and downright quackery. Even after this reversal, hideous theories persisted. Of these, the most pernicious were autointoxication and visceroptosis, spurious diagnoses that, though concocted in the very halls of academic medicine, wrought more harm than any of the nonsense promoted by contemporary shamans. Well into the 1930’s, eminent professors insisted that poisons seep into our bloodstream from retained intestinal waste (autointoxication), a process enhanced, or so they insisted, by the pathologic sagging of our internal organs (visceroptosis). Practicing doctors believed this idiocy, and as a result thousands of patients were purged with laxatives or enemas, while others fell victim to an array of needless surgeries, including nephropexy (fixation of a “floating” kidney) and uterine suspension (attaching the uterus to the abdominal wall). Most unfortunate of all were those subjected to hemi-colectomy or total colectomy (removing half or all of the colon), procedures that sometimes inflicted on its victim a lifetime of fecal incontinence.
Disturbing insight into this quagmire is provided by homeopathy, a rival to mainstream medicine that arose early in the 19th century. Its founder, a German physician named Samuel Hahnemann, advocated a novel regimen – diet, exercise, fresh air, and minimal doses of natural medications – as an alternative to mainstream treatments. This regimen was based on three principles: the law of similars (diseases are cured by medicines that cause the same symptoms as the disease itself), the single medicine (one medicine will suffice to cure all the symptoms of a given malady), and the law of infinitesimals (medicines work best when diluted to the point of non-existence).
Since Hahnemann’s minimal doses rarely contained a single molecule of active ingredient, his patients, in effect, received nothing but tap water – a vast improvement over the toxic compounds and torturous surgeries administered by his mainstream colleagues. Thus it comes as no surprise that homeopathy enjoyed a meteoric rise in popularity throughout Europe and North American. Nor is it surprising to find homeopathy warmly embraced by modern-day CAM, even though the three principles Hahnemann expounded have been proven as absurdly wrong as visceroptosis and autointoxication.
Where, one must ask, did all this idiocy come from? Why did medicine remain so misguided long after associated disciplines such as chemistry and biology had advanced to dramatic new levels of insight? William Harvey correctly described the mammalian circulatory system in 1628, and by 1900, the basic aspects of human anatomy and physiology were thoroughly understood. In 1905, Robert Koch won the Nobel Prize for showing doctors how to diagnose infectious diseases. In 1915, Albert Einstein published his landmark paper on general relativity, a concept of far greater intellectual subtlety than anything related to clinical medicine. How could it be that well into the 20th century, the most respected physicians in America and Europe continued to advocate treatments as harmful and unscientific as those administered by barbers during the Middle Ages?
If anyone doubts the archaic cruelties that persisted in Western medicine as recently as 1929, he need only read George Orwell’s classic memoir, “How the Poor Die.” Even at the dawn of the 21st Century, the battlements of science still groan under attacks from alternative medicine, attacks during which an ever-increasing number of physicians surrender to the Philistines, or at least steal away in the night to learn their secrets.
* * *
Nothing taught in the laboratory or lecture hall gives a doctor the strength of character she needs to wrestle successfully with the placebo effect. Only the most rigorous physician can resist a pill, an injection, or a surgical procedure that offers “relief” to seventy percent of her patients. Theories be damned – this stuff works! Until his death in 1943, Sir William Arbuthnot-Lane, Senior Surgeon at both Guys Hospital and the Hospital for Sick Children in London, continued to prescribe purgatives, enemas, and colonic resection for the treatment of autointoxication, even though these remedies tormented his patients while offering no hope of a true physiologic benefit. Why did he do it? Because, more often than not, his patients said the treatment worked, and what more compelling evidence could any man ask, even the preeminent surgeon in all of England?
As shown by this example, the conflict between scientific and alternative medicine contains at its core a marvelous irony. Until recent decades, mainstream physicians such as Abuthnot-Lane measured truth by the same flawed criteria used today by naturopaths, chiropractors, acupuncturists, and aroma therapists. Though physicians in bygone eras based their therapies on what was thought to be scientific evidence, conclusions as to whether these remedies actually worked were based on that magical moment when the patient told the doctor how he felt after the treatment. And this moment, as has been amply shown, falls easy prey to bias, random noise, regression to the mean, and a variety of psychological factors.
On occasion, a useless or harmful therapy persists for decades because the biologic principles that support its use seem so obvious, no proof of benefit is needed. For example, generations of ophthalmologists treated traumatic hyphema (a hemorrhage within the eye) by patching both eyes and putting the patient at absolute bed rest (no ambulation whatsoever) for as long as a week. On the face of it, this gruesome regimen seemed to make sense: by restricting the patient’s eye movements, patching and bed rest should reduce the risk of further hemorrhage, which could lead to blinding complications.
In 1973, eye doctors around the world were shocked when investigators at a South African hospital dared to perform a controlled clinical trial. Half the patients suffering a traumatic hyphema were treated with patching plus bed rest, while the other half were allowed to lead normal lives. Since this radical experiment denied half the patients a treatment considered ophthalmology’s Holy Grail, a cry of alarm went up, but the villains became heroes when the two treatment groups showed identical outcomes. By discrediting an ineffective therapy, these bold investigators saved thousands of future patients from needless torment – a torment that including the indignity of using a bedpan for all bodily functions.
Even more disturbing is the history of episiotomy, a surgical incision that many obstetricians made to enlarge the mother’s birth canal during every routine delivery. Here again, the benefit seemed obvious: a single clean incision would prevent the jagged spontaneous tears that sometimes occurred during labor and delivery. Advocates also insisted the procedure helped women avoid incontinence and improved their sexual response, though no scientific evidence supported either conclusion. Hundreds of thousands of women were subjected to this operation before an extensive review published in 2005 by the Journal of the American Medical Association showed the opposite effect: routine episiotomy increases the risk of pain, injury, and delayed healing following childbirth.
From such alarming histories, it becomes clear that alternative and mainstream practitioners once followed parallel paths, basing their tenets on the biased impressions of therapists and patients rather than on objective evidence. The parting of ways came only when medical scientists discovered the true magnitude of the placebo effect and other sources of bias. In response, they formulated three important principles. First, in every large-scale clinical trial, those patients receiving a new treatment (known collectively as the “treatment” group) must be compared to a “control” group that receives either a placebo or an earlier form of treatment. Second, the assignment of patients to the two groups must done on a random basis. Third, neither the patients nor the physicians who evaluate their progress can know what treatment is being administered.
These three guidelines define what is termed a randomized, double-blind, controlled clinical trial – an experiment designed to strip away all the confounding factors and focus exclusively on the biologic effects produced by the treatments. As a result of such rigor, with depressing and ever-growing frequency, controlled trials have rung down the curtain on countless cherished remedies, including secretin, ligation of the internal mammary artery, and a host of others.
On the positive side, medicine can now focus its resources on truly effective therapies, therapies that have vastly improved the prognosis for numerous crippling and life-threatening diseases. Such diseases, however, affect only a small fraction of the patients who flood into doctors’ offices every day, and those whom science cannot cure often seek help elsewhere. At the moment, thanks to liberal state laws, little can be done to keep patients away from quackery. Perhaps we should not try. Many will suffer injury at the hands of a shaman who can’t distinguish a tibia from a femur, but against such failings we must set two important factors: the often compelling psychological benefit of the shaman’s placebos, versus the complications a doctor might cause by prescribing unneeded drugs or surgeries in an effort to please his patient.
In 1991, the National Institutes of Health entered this fray by founding the Office of Alternative Medicine, an organization devoted to the study of unconventional therapies. Seven stormy years later, the OAM was supplanted by the National Center for Complementary and Alternative Medicine, but even this restructured body continues to draw fire from both sides of the battlefield. Much of the conflict arises from the fact that NCCAM’s two governing councils are composed largely of naturopaths, homeopaths, chiropractors, and other alternative practitioners who have no background in or commitment to scientific methodology.
Even on the rare occasion when NCCAM sponsors a properly controlled trial, the results do little to calm the furor. For example, in 2005, the World Journal of Gastroenterology published a study of the irritable bowel syndrome. During this study, patients were treated with either “real” or “sham” acupuncture. For the sham treatments, needles were inserted into points on the body that are traditionally thought to have no therapeutic value. When the results were analyzed, the improvement rate in both treatment groups came close to the seventy-percent benefit from sham heart surgery reported by Sabiston and Blalock.
However clear-cut this finding may appear, both treatments made patients feel better, and thus acupuncturists around the world can boast that their procedure was proven effective by rigorous scientific methods. Skeptics will argue the opposite – that these results smack strongly of the placebo effect – but I suspect few patients or alternative practitioners will listen. Two-thirds of the patients improved. What more could anyone ask?
* * *
Powerful indeed are the ties that bind CAM to the fallible traditions of mainstream medicine. Only in the past few decades have medical curricula expanded to include the rigorous standards of controlled clinical trials. Furthermore, many practicing physicians ignore or reject these standards, leaving themselves vulnerable to the placebo’s seductive lure. Deepak Chopra, arguably the most successful of America’s CAM practitioners, began his career well within the bounds of traditional medicine by serving as Chief of Staff at Boston Regional Medical Center and by teaching at Tufts University and Boston University Schools of Medicine. Now a multi-millionaire thoroughly seduced by the placebo effect, he is the author of 35 books plus 100 audio, video and CD-ROM titles that advocate virtually every form of alternative therapy.
Despite these non-standard credentials, Chopra remains an instructor at the University of California School of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center. It seems appropriate that Chopra and legions of his ilk should now populate the halls of academic medicine, since they carry on the placebo-dominated traditions long ago established in those very halls by their progenitors – respected professors whose measure of success differed not one jot from the measure used nowadays by CAM practitioners of every stripe.
Purists rage and splutter, arguing that science, not the archaic mumbo jumbo of voodoo and witchcraft, has given us immunizations, antibiotics, antisepsis, anesthesia, modern surgery – a panoply of benefits that over the last century has increased the life expectancy of Americans from 47 to 77 years. This argument is sound. Whatever psychological comfort patients may derive from herbal nostrums or touchy-feely therapies, only a few properly controlled trials have demonstrated an unequivocal medical benefit from the hundreds of alternative treatments offered around the globe. Thus while CAM has moved backward by promoting remedies that are ancient and unproven – or, in many cases, ancient and proven to be worthless – modern medicine has saved hundreds of thousands of patients, many of them children, from an agonizing premature death.
* * *
Despite their sound logic and noble ambitions, I suspect that scientists will fail in their efforts to expunge CAM from the landscape of American medicine. The cause of this failure is rooted in human nature, as I discovered some years ago while attending a convention in Portland, Oregon, $$$ sponsored by the Committee for Scientific Investigation of Claims of the Paranormal. CSICOP was founded by a panel of scientists, magicians, and psychologists who devote their lives to defending science against pseudoscientific nonsense. As one might expect, my fellow attendees were a skeptical lot, but they remained vulnerable to a human and all too common frailty. I explored this frailty by conducting an informal clinical trial of my own during the dinners and cocktail parties that followed each day’s lectures.
Several times each evening, after striking up a conversation with a randomly selected male, I asked my subject whether or not he was married. If he answered in the affirmative, and if his wife was not within earshot, I posed this question: “Is your wife more attractive than the average woman?” The question invariably brought forth a blush, a smile, and laughter, as the subject recalled Garrison Kielor’s famous benediction on The Prairie Home Companion: “ . . . and that’s the news from Lake Woebegone, where all the women are strong, all the men are good-looking, and all the children are above average.”
But I pursued the issue, and, after a prelude of blushing and stammering, every subject – to the last man – admitted that he, like the unskeptical masses, did indeed consider his wife more attractive than average. A similar experiment conducted in my home town of Louisville, Kentucky, revealed that every parent I questioned considered his or her kids more intelligent than average – for the majority, MUCH more intelligent. Even those whose offspring scored toward the bottom of their class blamed this failing on a lack of motivation or on untalented teachers. In fact, I have yet to meet a man – myself included – who confesses to an ugly spouse or a stupid child. This irrational certainty, I would argue, is nothing more than the placebo effect with its white coat removed.
We live in a chimerical world, a world that allows a statistically impossible distribution of personal qualities. To survive, it seems, we all must cherish blatant falsehoods. In his innermost heart, no man considers himself an ordinary human, breeding and forging for food on a planet as mortal and doomed as the creatures inhabiting it. Astronomers assure us that the universe will someday end in a Big Crunch or a Big Freeze, destroying all record of human existence, but we set about our lives each morning as though an eternity of fruitful days lay before us. Indeed, I could argue that we all live in Lake Woebegone, a psycho-spiritual community where the meaning of our lives – and of our fragile, cherished affections – derives in large measure from the placebo effect.
We admire scientists. We turn to them for those needs that can be served only by the cold fires of reason, but the nonsense we preach to ourselves is cut from the same cloth as the nonsense preached by shamans throughout human history.