Magical Thinking

Joey Hofbauer was seven when he was diagnosed with Hodgkin’s lymphoma in 1977. With proper treatment, his doctors told his parents, he would have an excellent chance of survival. However, his parents didn’t like the sound of chemotherapy and radiation and decided to go another route: large doses of vitamins, coffee enemas, vegetarian diets, and injections of laetrile, an unapproved remedy made from apricot pits.

Hofbauer’s story opens the book, “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine.” The author is Paul A. Offit, chief of the Division of Infectious Diseases and director of the Vaccine Education Center at Children’s Hospital of Philadelphia. The book explores the history, policy, efficacy, and ethics surrounding the $34 billion-per-year alternative medicine industry.

There were many legal battles over Hofbauer’s care, but his unconventional treatment continued. The cancer spread uninhibited, and his condition worsened. Laetrile became popular in the media and was championed by the iconic actor Steve McQueen, who used laetrile himself after traditional treatments for his lung cancer had failed. The advocacy led the Food & Drug Administration to investigate the drug, but the results came too late. Hofbauer died at 10 years of age, and four months later McQueen died at the age of 50.

Not only did Hofbauer’s treatment not help him, it likely harmed him. FDA found that laetrile was not an effective treatment and that it caused cyanide toxicity; consequently, it banned the drug. Additionally, the large doses of vitamin A Hofbauer received damaged his liver and hastened his death. Nevertheless, the practitioners who treated him continued to have successful businesses.

“Do You Believe in Magic?” contains a significant amount of history about various unproven health claims that have been made throughout time, including those made about patent medicines such as Paine’s Celery Compound (which were often mostly alcohol, prompting Offit to say the hucksters of said products were really in the liquor business), faith healing, and acupuncture.

Some herbs and remedies have been found to be effective over time, and scientists have created medicines with the active ingredients from those sources. For example, the bark of the willow tree contains salicylic acid, which has analgesic and antipyretic properties. However, it can cause upset stomach, which is why aspirin, a drug based on salicylic acid, is more often used. “There’s no such thing as alternative medicine,” Offit says. “There’s only medicine that works and medicine that doesn’t.”

“Do You Believe in Magic?” is not a hit piece on alternative treatment methods and those who use them; Offit believes alternative medicine has its place in society.

Many people who use alternative medicine may actually feel better as a result, Offit says, albeit not for the reasons they might think—the mind has a significant effect on the body. He dedicates a chapter to the placebo response, which he calls “remarkably powerful, highly underrated.” Some remedies are inert and benign. The concern is that in an increasing number of cases, false belief in the efficacy and composition of such treatments has reached a potentially dangerous point, sickening and sometimes killing patients rather than helping them.

The health problems of the late Apple CEO Steve Jobs, Offit writes, are a good example in which overestimation of the efficacy of alternative medicines and underestimation of conventional methods caused harm, in this case fatal. Jobs had been diagnosed with pancreatic cancer, albeit a treatable variety. Doctors said he would have a great shot at surviving the cancer if he began treatment as soon as possible. Jobs did begin treatment, but not the recommended kind. Instead, he focused on alternative remedies—fruit diets, bowel cleansings, and herbal supplements—in lieu of conventional care. By the time he realized his mistake, it was too late, and he died from the illness.

That false belief of efficacy, Offit says, is propagated by many factors. Lack of regulation in the nutritional supplement industry brought about by the Dietary Supplement Health & Education Act of 1994 has opened the door for the dietary supplement industry to provide untested substances to the public with little to no accountability or oversight, Offit says.

Practitioners often claim a conspiracy against alternative medicine by pharmaceutical companies, the government, or both to avoid or deflect criticism of their products. (Offit doesn’t allow the irony to be lost that the dietary supplement firms are basically big pharma themselves.) Appeals to individual freedom and attacks on government regulation have also been used to release the dietary supplement firms from the burden of proving that their products work and are safe, Offit maintains.

Distrust of government agencies and pharmaceutical companies, although sometimes warranted, the book says, can cause the disillusioned to adopt alternative medicine out of sheer contrarianism. The deeper problem arises when the claims of practitioners—who may have only their own best interests in mind—are taken at face value and embraced wholeheartedly, without healthy skepticism. Even those who practice the scientific method themselves can fall prey to claims lacking any empirical evidence.

Offit dedicates a significant portion of the book to a tough piece on Linus Pauling, the Nobel Prize-winning chemist who also had an unhealthy obsession with vitamin C. Even after clinical study after clinical study refuted his claims that massive doses of vitamins were positive for health, Pauling stuck to his guns, propagating the megavitamin narrative that still persists today. Offit focuses on Pauling’s history to drive home the point that even the best scientific minds can fall victim to the sort of magical thinking that perpetuates ineffective or sham treatments.

Offit also ties Pauling’s story to the power of celebrity in the world of medicine. Citing figures such as actresses Suzanne Somers and Jenny McCarthy, “Do You Believe in Magic” details the various ways a celebrity endorsement can trump a consensus medical opinion in the public’s eye.

He holds up McCarthy, who popularized the false link between vaccines and autism, as one of the prime examples. There is little medical understanding of the causes of or treatment for autism, so treatments are speculative and parents are desperate. However, there is decisive medical evidence that vaccines do not cause autism. That doesn’t stop the narrative of the antivaccine movement, however, and some diseases that had been all but eradicated have resurfaced as parents fail to vaccinate their children out of fear caused by antivaccine activists’ claims.

Many preventable deaths have been the result of the substitution of alternative therapies for conventional ones. However, Offit makes it clear that he is not saying fault lies with the people who take alternative medicine out of fear or uncertainty; rather, the fault is with those who are willing to exploit desperation for profit. Snake oil salesmen have been around since the dawn of time, Offit says, and he cites instances in history in which a patent medicine turned out to be little more than alcohol, sugar, or water. Even worse than selling an ineffective treatment, though, is a practitioner of alternative medicine who either convinces or coerces the patient to avoid conventional treatment altogether.

The medical field does not get off scot-free, however. Offit critiques conventional medicine as well, recalling his own experience with nerve-wracking false diagnoses and painful surgery. He lived in fear for two years following a misdiagnosed metastatic malignant melanoma, which he calls a death sentence. The dark spot on his nose that caused the hubbub turned out to be benign. Later, a misdiagnosis of a pain in his left knee caused Offit to have surgery that drilled into his bone, leaving him in recovery for a year rather than the orthopedist’s previously promised few days. Offit did not have a torn meniscus, his orthopedist later said, but rather had lost cartilage behind his knee. The orthopedist wasn’t upset, but Offit was.

Sometimes, especially in the case of minor diseases or injuries that heal on their own, naive intervention can be more harmful than inaction. The book has a few examples of doctors who treat minor things that would heal on their own with alternative medicines (in order to take advantage of the placebo effect) and reach for conventional treatment for other maladies that need intervention. The author insists, however, that the flaws of mainstream medicine do not justify a complete rejection of centuries of scientific achievement, and they especially do not justify canonization of practitioners who use treatments that haven’t been backed by science.

“Do You Believe in Magic?” performs its function well. Offit builds a cohesive narrative, and the structure of the book allows a smooth transition between the chapters. The subject is a polarizing one, but Offit argues his points in a reasonable tone and cites clinical studies throughout the book to bolster his position.

In the end, the book does not call for blanket bans on alternative medicine, but rather it calls for more information to be made available to consumers so they can make better decisions about their health. Offit calls for more government regulation to establish that alternative remedies contain what they are advertised to contain and ensure that such treatments are safe. Without adequate data and testing, he says, it’s difficult for patients to avoid treatments that may be ineffective or harmful.

Until then, caveat emptor.