Dr. Stephen Barrett – Watching Out for Quackery

January 04, 2008

Stephen Barrett, M.D. has achieved national renown as an author, editor, and consumer advocate. In addition to heading Quackwatch, he is vice-president of the National Council Against Health Fraud, a scientific advisor to the American Council on Science and Health, and a Fellow of the Center for Inquiry’s Committee for Skeptical Inquiry (CSI). The recipient of a number of awards, including the FDA Commissioner’s Special Citation Award for Public Service in fighting nutrition quackery and the Distinguished Service to Health Education Award from the American Association for Health Education, he is the author of 50 books, including The Health Robbers: A Close Look at Quackery in America and seven editions of the college textbook Consumer Health: A Guide to Intelligent Decisions.

In this discussion with D.J. Grothe, Dr. Barrett defines complementary and alternative medicine (CAM), the responsibilities of the healthcare consumer, whether or not CAM is growing in mainstream healthcare, and the types of people who are susceptible to CAM claims. He also explores various CAM therapies including Therapeutic Touch, Chiropractic and myths about water fluoridization, and how a skeptic might most effectively confront family members who are consumers of complementary and alternative medicine.

Also in this episode, Lauren Becker shares some thoughts on secular activism and science advocacy for 2008.

Links Mentioned in this Episode

This is point of inquiry for Friday, January 4th, 2008. 

Welcome to Point of inquiry, I’m DJ Grothe a point of inquiries, the radio show and the podcast of the Center for Inquiry, a think tank advancing reason, science and secular values in public affairs. Before we get to this week’s guest, I’d like to mention a couple of things. One, there’s a new point of inquiry Web site with a lot more going on there. Please do check it out at point of inquiry dot org. Now, before my conversation with Dr. Stephen Barrett of Quackwatch dot com. Here is a blast from the past. One of my favorite elements of point of inquiry, Lauren Becker, with some thoughts about 2008. 

And so it begins. It’s finally 2008. Finally, the light at the end of the tunnel is no longer the light of an oncoming train. But the opportunity to end the long national nightmare that has weighed so heavily upon us these past seven years. As many of you know, I grew up right outside of Washington, D.C., and it’s had a profound effect on my views of government and politics. But what you don’t know is that the initial effect was entirely negative. Early on, I despised politics and thought the government was the source of all of our problems. After all, that’s all I ever heard. The daily paper spoke of nothing but corrupt congressmen and the arcane and inefficient bureaucracy of federal power. TV and radio programs constantly featured meaningless interviews with meaningless politicians spouting off about meaningless issues that seem to have no bearing on anyone who lived outside the Beltway. So when it came time to go to college, there was a part of me that couldn’t wait to get away far away from D.C., out into the real world, where people actually had to work for a living and could think about things besides budgets and backroom deals. I quickly discovered that the rest of the country felt the same way about politics and government that I did so much so, in fact, that I learned it was better for me to say I was from a lesser known town in Virginia than to use the more familiar but more scorned reference point of Washington, D.C.. And so it went. For many years. Then one day I found myself working as a park ranger, teaching conservation and environmental science. In the months leading up to the 2000 election, I guess you could say it was the best of times. It was the worst of times. Now, mountain mountaintops are known for inducing epiphanies, but they’re usually spiritual in nature. Mine, however, was political. All good rangers strive to extend the lessons of their parks into the lives of the visitors. But at that point, I realized it wasn’t enough to talk about the beauty of this lake or the importance of those trees. It became clear that most Americans saw nature, science and the environment as treats they saved for vacation rather than concepts that would save their lives. Soon, it became evident that there’s a devaluation of scientific knowledge. This tendency to separate science and nature from everyday life was causing we, the people, to make some very bad decisions. And then something else became clear to me. It was possible to move away from Washington, D.C., but it would never again be possible to separate government and politics from my life or the lives of anyone else, for that matter. It might be fun to slam politicians and complain about bureaucracy. But here’s the thing. We live in a representative democracy, a democratic republic. That means the government is us. We the people are responsible for it. We are responsible for what our government is doing. Crap. I don’t like what my government is doing. And ever since then, I’ve been doing what I can to educate myself, my fellow citizens and my representatives about scientific thinking and the importance of applying scientific methods to all the problems, not just environmental problems that we will have to confront in this new modern century. Don’t get me wrong, I still hate politics and I’m already tired and a little disheartened by the current campaigns. I’m also not so naive. I understand that much of the system is rigged and we have a terribly long row to hoe. But I also have Thomas Paine yelling at me in the back of my head. Those who expect to reap the blessings of freedom must undergo the fatigue of supporting it. And then I have to get up and get busy. And I’m hoping you’ll get busy, too. There is much to be done. But as a start, you can join CFI in the call for a presidential debate about science and technology issues. Thousands of people have already signed on, including Nobel laureates, university presidents, representatives from both major political parties, business leaders, religious leaders and the editors of America’s major science journals. Then I hope you’ll join us in Washington this February for CFI is civics days where you’ll receive briefings about First Amendment rights, church state separation and science policy legislation. After the briefings will go to the Capitol building, where you’ll be able to attend a congressional briefing or a hearing and meet with your legislator to discuss these important issues. As always, of course, you can learn more about these events from the point of inquiry Web site w w w dot point of inquiry dot org. All of us here at point of inquiry and the Center for Inquiry spend a lot of time talking among ourselves about the importance of science and science education, the separation of church and state, and the values of skepticism and humanism. But this year, that won’t be enough if we really care about these values. 2008 offers us an important opportunity to act on them, to promote them to our fellow citizens, to put them back into our government and our society. What better way to make this a truly happy New Year? 

Where can you turn to find others like yourself who appreciate critical thinking, turned to Skeptical Inquirer, the magazine that separates fact from media myth. It’s published by the Committee for Skeptical Inquiry. Find out what genuine science has to say about the extraordinary and the unexplained. You’ll be surprised. Subscribe to skeptical inquiry today. One year, six challenging issues for nineteen ninety nine. To subscribe a request, a sample issue, just call one 800 six three four one six one zero or visit the point of inquiry. Website point of inquiry dot org. 

I’m happy to finally have Stephen Barrett on point of inquiry. He’s a retired psychiatrist who resides near Chapel Hill, North Carolina, and he’s achieved national renown as an author, editor and as a consumer advocate. In addition to heading Quackwatch, he’s vice president of the National Council Against Health Fraud and a scientific adviser to the American Council on Science and Health. He’s a fellow of CSI here at the Center for Inquiry and a recipient of the FDA Commissioner’s Special Citation Award for Public Service in Fighting Nutrition Quackery. He runs over 20 Web sites. The main Web site is Quackwatch dot com, and he’s also a recipient of the Distinguished Service to Health Education Award from the American Association for Health Education, Dr. Steven Barrett. Welcome to Point of Inquiry. I’m glad to be here. Dr. Barrett, I want to start off by admitting to you that having a good back and forth with you is going to be a challenge for me, because playing devil’s advocate on an issue like all med, for me, it’s like pretending it’s an OK thing to murder someone, since that’s what some of this quackery amounts to. It seems to me. OK, so first off, let’s define our terms that we got that out of the way with what is alternative medicine, complementary and alternative medicine, what they call cam. 

Those are marketing terms. They really don’t represent a definable group of methods. The only way to only good way to look at what’s referred to as complementary and alternative is to look at each method one of at a time and sometimes even to look at each claim individually. Because one of the things that the cam folks do is to try to include things that are really part of standard. Treatment or standard prevention and claim them as their own, and then they can turn around and say, well, some of what we do is has been accepted. 

Mm hmm. How is Cam different than experimental medicine or is one a subset of the other? If you’re saying there’s not one whole category called all med, well, what are the old med practitioners doing? 

They’re doing a lot of unscientific things. What makes it different from what would be legitimately experimental is that when you do legitimate experiments, you pose a legitimate question and then you set up this study or studies to try to test it. That simply does not happen with the kinds of unscientific things that are promoted by the camp folks. 

Before we get to some of the specific unscientific claims that all med practitioners make. Let’s just imagine for sake of conversation that I’m not a skeptic. I’m just a normal guy in the U.S. I’m dissatisfied with our health care system. A lot of people are. Isn’t it responsible for me as a consumer of health care, to look for cures everywhere that I might be able to find them to take charge of my own health care, not just rely on what the doctors are saying on blind faith, but to really get in there and examine the issues and all these opposing points of view, in other words. Isn’t it in my best interest to look into the claims of all meds since on the off shoot chance that they might be able help me? 

Well, I can understand how somebody might feel that way. But the answer is no, it’s not a good idea. The dissatisfaction with our health care delivery system has to do with inconvenience sometimes in personal care. High cost. Sometimes difficulty in. Getting in to see a doctor when you need to. I mean, these are really serious problems that are part of our health care system. It takes a great deal of of intelligence and energy and sometimes a great deal of money to get the best care available. What might be called complementary and alternative medicine is likely to offer very little that that’s useful. If you want to get the best out of the health care system, what you ought to do is learn how to get the best, not simply look elsewhere. There is no elsewhere. 

So alternative medicine. They’re saying it’s an alternative to medical science. But you’re saying there is no alternative. There is no elsewhere. 

That’s right. There’s no legitimate elsewhere. One of the things, for example, that the camp folks will say is that many people still die from cancer. Yeah, cancer is a tough problem. Only a certain percentage of people have a five year survival, which is one of the ways in which it’s measured. But if you look closely, you’ll see that the five year survival rates for most cancers have been slowly increasing and that for a few cancers, the research community has done extremely well. There are a few cancers that were 100 percent fatal when I went to medical school some 50 years ago. And that are nearly 100 percent curable now. Some of the childhood leukemia is Hodgkin’s disease. The treatment there has improved tremendously. 

But isn’t it true that a lot of what doctors say? Well, some of it turns out to be wrong. This seems to be the first argument that can practitioners make. Medical science is bad for you. They say it’s actually bad for your health that we need to get back to more natural things. Stop relying on all these chemicals that people put in them on a daily basis. Add to that their criticism about all the money that’s involved in the pharmaceutical industry, the drug reps that are pushing doctors to prescribe drugs that patients might not actually need. Don’t they have a legitimate point in that criticism? 

You’ve just given me a laundry list that taken one at a time would probably take a half an hour, two to discuss. There are problems inherent in the delivery of scientific health care. That doesn’t mean that methods outside of science, space health care are effective. It may discourage people. But it doesn’t make. Worthless methods are effective. It doesn’t work that way. 

The other big argument that complementary and alternative medicine people make is the opposite of what you just said. It’s that their stuff does actually work and that it’s better than all these inputs, poisons you’ll get from the medical doctor. 

Well, that’s what they say. And believe me, they can deliver these kinds of criticism faster than anybody can possibly form a rebuttal. The question is, what are the specifics? You know, identify. What are the things that you say work that we say don’t work, and what’s the evidence? There’s a very long list of things that have been said to work, but when you look at them one at a time, there are relatively few that do two. Very good example. One that’s about as clear cut as you can get is the idea that in therapeutic touch or in Reiki. You manipulate a human energy field and therefore help the person. Well, how do you look at this? Well, first of all, the scientists will say, how do you demonstrate the existence of a human energy field? Secondly, how do you demonstrate you can manipulate it? And third, where’s the evidence that doing whatever it is you say you do is helpful? 

Well, it took a kid, Emily Rosa, not very long to line up 21 practitioners who put their hands through a screen. They couldn’t see her. She would then put her hand over one of their hands and say, where’s my hand over your right hand or your left hand? They had to tell her by supposedly feeling her field. Well, turns out that when the data were in, they didn’t do any better than would be expected by guessing. Now, that demonstrated that they couldn’t detect her body. So what’s the evidence that something works based on a theory that you manipulate something you feel when you can’t even feel it? Second thing is Emily’s parents did a massive search of what’s been published. Did an analysis of hundreds and hundreds and hundreds of articles and papers. Didn’t find any evidence that the practice is effective. And there’s been no study that’s ever shown effectiveness. 

And yet healing touch is a growing practice among nurses. It’s kind of a growing movement and therapeutic movement. I’d like to let our listeners know that you can learn more about Stephen Barrett’s work at Quackwatch dot org. There’s also a free weekly newsletter available, Dr. Barrett. Let me ask you, in kind of a general way, do most people who are gung ho about all mad, do you. Do you think, given your experience, are they really trying to solve health problems that they really have, or are they just a gullible audience for all mad marketers who are convincing them that they have problems they don’t actually have in the first place? 

On Quackwatch, I think we talk about something like six types of vulnerability. You have some people who have no particular leaning one way or another, and they simply respond to what they hear about. They don’t look critically. And what people really ought to do is to have the right level of skepticism. If you don’t have enough, you simply go whichever way the wind blows and you’re going to get quacked repeatedly. If you have too much, it means that you’re putting yourself in a position where you want to try to judge the underlying science of every claim you see. And if you’re not a scientist, if you don’t have extensive training, you’re not going to be able to do that. So what do you base it on? What do you base your judgment on? Who who makes the best argument? Who looks the best, who smiles the best? That’s what people are deciding on. 

So be open minded, but not so open minded. Your noggin falls out. Be an open minded skeptic. 

That’s right. Now, there are other things as well. Desperation sometimes drives people to try things that they wouldn’t normally do. There are some people who are alienated from science and government and and who have such a distrust that. Well, they pay no attention to it or actually they’ll move in the opposite direction. Some people are true believers. Other people are simply dishonest when they promote it. And it’s not always easy to tell whether somebody believes in what he’s doing when when promoting something outlandish. Once in a while, you can get inside someone’s head and figure out what they’re thinking. But most of the time, you really can’t tell. And that makes it more difficult. 

Is there room for some middle ground here or are you kind of a skeptical purist? Medical science is a relatively new thing. You look at the history of medicine, the history of science in the West, but people have been taking cures for their ailments throughout all of human history. And medical science, in fact, has learned from that kind of folk wisdom. You look where Tylenol came from, the bark or something. Is it? Do you think an appropriate middle ground in being open minded and skeptical at the same time, like you were just talking about, to seek a medical doctor who is also open minded about some of these old med remedies? Even at my local doctor’s office across the street from the Centers for Inquiry here, they offer some Aultman interventions like acupuncture. They do massage. And I don’t I don’t know if energy work is included in that. 

It makes a big difference. If you’re talking about energy work, you’re talking about someone who has a muddled mind. If you’re talking about acupuncture, I would be uncomfortable depending upon what the claims are. Massage is a is not properly classified as an alternative procedure. 

It’s been part of standard treatment. It’s a feel good treatment. It’s not really a treatment. It’s something that makes people feel good. Whether it affects the course of an illness is is another matter, but it’s part of standard treatment for forever. 

But the question was about middle ground at at clinics and hospitals and doctors offices all over the country. You have doctors and nurses trained in medical science who are increasingly because people are willing to pay for it, offering these other kinds of, if you don’t want, call them alternative medicine. They’re just not medical science. They’re kind of complementary to medical science, like massage. 

What you’ve described simply is not happening the way you described it there. You’re correct that at a number of medical facilities and medical centers, there are entities that have been created and called integrative clinics or complementary clinics and so on. If you look at what they actually do, most of them are simply selling slogans. They may do a couple of things, including some feelgood things which may or may not be classified as alternative. And they may do a few others. They don’t do most of the things and they adopt the name for marketing purposes. Look, if you take a proven treatment and you add to it something that doesn’t work, you don’t improve the treatment outcome. You raise the cost. And what’s happened is that some facilities that have tried to do this have closed because people were not willing to pay for it. They may be willing to have their insurance companies pay for it, but whether they’re personally willing is another matter. And I don’t think these clinics have started because these things are popular or effective. They’re started because some marketing genius at the facility thinks that it might be a way for them to make money or because there are some true believers on the staff who persuade the administration that it would be a good idea and the rest of the staff that may be uncomfortable. Somebody doesn’t want to get into a nasty battle. It doesn’t take a lot to get one of these facilities affiliated with a medical school. I remember at my own school at Columbia, they put out a big press release about how they got a grant to start a center. I went to visit the center and I said, where is it? Well, they didn’t want to show it to me. They finally took me into an alcove in a hallway with a couple of boxes, and that was their center from the press release. You think they have a building or an office or a suite? It was a couple of boxes in the corner of an alcove. And eventually they managed to attract some more money. Maybe by now they have some rooms. I don’t know. But it was basically fluff. 

It sounds like you’re suggesting that if there are corporate interests behind big medicine and there are criticisms people make about that. There’s also big money behind alternative medicine. And it’s an avenue some people even in within the medical field pursue because of the potential money that, you know, marketing gurus imagined there could be there. 

I would not like to imply that at the primary driving force is money. I think that the primary driving force is misbelief. And that money is a reinforcer. But I don’t think it’s the primary driving force in most cases. In some cases. Economics do play a role. 

Dr. Barrett, I want to zero in with you on what you think the biggest issues in AlterNet are. If you could change the public’s mind about just one widespread all mad belief, one now. 

You keep talking. It just occurred to me, you know, here we are talking about Wal-Mart. What happened to the good ol word quackery? You know, quackery is the promotion of of unsubstantiated methods for profit. We’re using the wrong language. We should be talking about quackery. That is message that don’t work, that are that are being promoted as though they do work. You asked me what, though, what the worst forms are. But I want to call them quackery, I don’t want to call them all mad. They’re quackery. That puts them in perspective. These are not debatable subjects anymore. I wouldn’t want to call rape sexual experimentation or alternative sex. Right. Rape is violent. It’s not a two sided issue either. It’s quackery. 

I’ll follow your lead of devil’s advocacy. Be damned. Let’s call it quackery and then answer the question if you could change the public’s mind about one element of quackery, the one that, you know, brings the most harm to the consuming public, what would it be? 

Do you measure harm with economics? Number of people hurt by the severity of damage per person? If you’re talking about economics and the number of people hurt per idea, I would say it’s the idea that putting fluoride in the water is harmful. That is to say, water fluoridation is a great thing. It can help millions and millions of people have stronger teeth in the fight against fluoridation is a form of quackery. And if there were one thing that I think could be wiped out magically, I would wipe out anti fluoridation because that affects the largest number of people. 

So in terms of the most number of people believing quackery, it’s fluoridation. But what about personal harm? Regarding an individual who takes this or that quackery intervention, that’s also very easy. 

But I ought to point out that that most people who are harmed are harmed financially or emotionally and made more vulnerable to more serious harm. But in terms of. Physical harm, the largest percentage of people. It’s not necessarily a tremendous amount of physical harm. And that’s the idea that amalgam fillings are the silver fillings in your teeth are dangerous and should be removed and replaced by other materials. There are several hundred dentists who are. Spreading this idea, and I’m perfectly happy to take out a perfectly good amalgam, fillings from the teeth of everyone who enters their office in the physical danger. Is that when you take out a filling? And put in a new one, you have to make the hole bigger and settle. If you have a filling that’s fairly large, you risk the integrity of a tooth. And so you may wind up weakening or even breaking teeth when you take out the amalgam fillings to replace them. 

Do people die from quackery or is it just that good ideas die, that people are deceived, made more gullible? 

Well, direct, yes, is not terribly common because you don’t want to be killing off your customers. Indirect death does happen in a number of ways. There are no statistics, but you can die indirectly if you have a condition that is potentially fatal. 

If you have cancer and you take shark cartilage rather than then chemotherapy. 

Yes. If you have a curable disease and you do something that’s not effective. Instead, that can be fatal. There are also occasional examples of fatalities that are directly with colon arrogation. There have been people that died from infections with colation therapy. There have been a few people that died from the intravenous. Injections. There are herbal products that have destroyed people’s kidneys and so on. And they contain toxic substances. There’s no reason why people should have taken them in the first place. There’s not a lot of quality control in production. And there’s also herbs that are coming in from China that have been tainted. Mm hmm. 

Doctor, your really pilloried in the all mad. You’d call it the quackery community, more so than any other skeptic is by any other kind of credulous community, more so than a skeptic of ghosts is attacked by those who believe in ghosts or. Or a skeptic of the Loch Ness Monster or Bigfoot is by cryptozoologist. Right. Why are you hated by people who are not skeptical more than other skeptics are? 

Well, I don’t know if I’m hated. I, I don’t detect too much of that. 

I’ve been. I’ll send you some Web sites. 

I mean, if you don’t if you can’t engage in an argument on a rational basis, then maybe what’s left is you attack the person. Most of the rivals that have been circulated about me stemming from a single source, that is somebody who is promoting a quack cancer cure. Hired somebody to do it. I’m suing him for libel and the case is pending. But he’s been putting out a steady stream of false information and then other people pick it up. Mm hmm. 

Well, they may hate you even if if you’re unaware. But we certainly don’t hate you at point of inquiry. 

I’d love to have you back on to talk about some some of these topics is specifically at last question for this conversation, Dr. Barrett. I know from our forums online and even talking with skeptical friends that many skeptics are confronted with the same situation I’ve been in with with my family, where a loved one is buying into complementary and alternative medicine. And what do you do? What’s your advice to the skeptic who’s not a professional science communicator, but just kind of living his life with his family, her life? Is it just a matter of shaking people and arguing with them until they see our point of view? It’s like, how would I help convince my grandma that going to a chiropractor is dangerous when she’s been going for decades? 

It’s helpful to know the facts. I’m not so sure that it is dangerous for her who one would have to look at what was taking place. The problem with chiropractors is not a high degree of physical danger. It’s really economic and occasionally has to do with absorbing false ideas about yourself. The problem is chiropractors that you’re really touching on is unnecessary treatment. And the way I would approach someone who’s been going regularly for a long time is to try to find out why they’re going and what they hope it would accomplish. And if I think that they’re wasting their money, I would might suggest they try going less often. 

That’s about as hard as convincing someone who regularly goes to church and tithes or gives offerings why they do that and suggesting that they not go as often. 

Well, yes and no. I’ve seen some people who have reached that level of true belief, but I’ve also seen other people who go because they were frightened. And when they get reassured, they stop. And that’s one of the reasons that chiropractors are upset with me, is that I’m very bad for business, because I tell people that that I’m going on a regular basis over a long period of time is not usually a good idea that they’re actually not there are actually no outcome studies that suggest that it’s helpful. I don’t doubt that some people are helped, but there are no studies that have defined who should go and who who doesn’t. And a very high percentage of chiropractors encourage people to come four times a year or once a month or or even once a week for a life. And that has no justification. 

Mm hmm. Thank you very much for joining me on point of inquiry, Dr. Stephen Barrett. I’m glad to be here. 

You’ve seen the headlines, Bill seeks to protect students from liberal bias. The right time for an Islamic reformation. Kansas School Board redefined science. These stories sum up the immense challenge facing those of us who defend rational thinking, science and secular values. One adviser to the Bush administration dismissed as the reality based community who could have imagined that reality would need defenders. The educational and advocacy work of the Center for Inquiry is more essential than ever. And your support is more essential than ever. Show your commitment to science, reason and secular values by becoming a friend of the center today. Whether you are interested in the work of psychology and skeptical Inquirer magazine, the Council for Secular Humanism and Free Inquiry magazine, the Commission for Scientific Medicine or Center for Inquiry on Campus. By becoming a friend of the center, you’ll help strengthen our impact. If you’re just learning about CFI, take a look at our Web site. W w w dot center for inquiry dot net. We hosted regional and international conferences, college courses and nationwide campus outreach. You’ll also find out about our new representation at the United Nations, an important national media appearances. We cannot pursue these projects without your help. Please become a friend of the center today by calling one 800 eight one eight seven zero seven one or visiting WW w dot center for inquiry dot net. We look forward to working with you to enlarge the reality based community. 

Thank you for listening to this episode of Points of Inquiry. To get involved with an online conversation about today’s episode, go to our Web site Point of Inquiry dot org. Views expressed on point of inquiry don’t necessarily reflect the views of the Center for Inquiry, nor its affiliated organizations. Questions and comments on today’s show can be sent to feedback at point of inquiry dot org or by visiting our Web site. Point of inquiry dot org. 

Point of is produced by Thomas Donnelly and recorded at the Center for Inquiry in Amherst, New York. Executive producer Paul Cook’s point of inquiry’s music is composed for us by Emmy Award winning Michael. 

Contributors to today’s show included Debbie Goddard and Sarah Jordan. And I’m your host DJ Grothe. 

DJ Grothe

D.J. Grothe is on the Board of Directors for the Institute for Science and Human Values, and is a speaker on various topics that touch on the intersection of education, science and belief. He was once the president of the James Randi Educational Foundation and was former Director of Outreach Programs for the Center for Inquiry and associate editor of Free Inquiry magazine. He previously hosted the weekly radio show and podcast Point of Inquiry, exploring the implications of the scientific outlook with leading thinkers.