Quack Patrol at Your Service

TIMES STAFF WRITER

Dr. Stephen Barrett bought a little green box that plugs into the wall and pumps out miracles. When a sick person grips an electrode, the gizmo figures out which organ is failing and which homeopathic potion will fix it.

That is, at least, the general idea.

"I've wanted a device like this for 10 years," said Barrett, chortling as he showed off the machine in his basement office. "It's a total fake."

The Vegatest I, built in Canada but banned for import into the United States, is the latest and perhaps kookiest addition to the massive archive of alternative medicine that Barrett has spent the past three decades stuffing into the cellar of his suburban home.

Barrett, a 65-year-old retired psychiatrist, is part of a small posse of traditionalist doctors fighting the relentless march of alternative medicine into the mainstream. Once seen as essential warriors against medical fraud, they now find themselves struggling for attention as one new therapy after another--whether it's eating an herb to ward off a cold or taking shark cartilage to survive cancer--gains popular acceptance.

These skeptics, who operate out of offices and homes and universities from here to Loma Linda, argue that nothing should be marketed as a treatment or cure until it has withstood the rigors of conventional clinical research.

While they believe that taking a vitamin under a doctor's orders can be a good thing, they also believe Americans have been duped into megadosing and medicating themselves.

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Many physicians hail the skeptics as heroes. But increasing numbers of doctors are adopting alternative therapies that may not offer a cure but may make the patient feel a little better about being sick.

In an attempt to keep a voice in the debate, Barrett and his colleagues in the past year have begun publishing a medical journal devoted to the skeptical study of offbeat medicine and have unleashed a huge World Wide Web site--dubbed Quackwatch--that is a clearinghouse of criticism of popular but unproven therapies. They also are involved in several lawsuits against people they accuse of making misleading medical claims.

Inside a maze of file cabinets in Barrett's basement is much of the ammunition for Quackwatch. This is the research Barrett used for 44 books, hundreds of articles, and scores of complaints and court cases in his crusade against what he considers the misleading marketing of everything from aromatherapy to Zen macrobiotics. He's even gone after granola.

Homeopathy? "There's nothing stupider on the planet."

Acupuncture? "The majority of acupuncturists are loony."

Herbal remedies? Don't get him started.

"Most of the people who prescribe them are screwballs," he said. "Most of the products don't have the ingredients listed so you can see what's in them. Most of the books that are written for the general public are not reliable."

Yet they usually sell better than his own. His fight has been made harder by alternative medicine's recently acquired aura of legitimacy.

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In the past six years, Congress has compelled the National Institutes of Health to add an Office of Alternative Medicine and lifted regulations on alternative medicinal products as long as they are labeled as foods and dietary supplements. The American Cancer Society has approved some of what it classifies as "complementary" medicine. Medical schools have added alternative medicine curricula and more insurers are reimbursing fees for unconventional remedies such as acupuncture.

Perhaps even more significantly, the Internet has turned into a cyber-souk of New Age healers, old-fashioned hucksters, practicing MDs and giant mail-order businesses all shilling elixirs and remedies through eye-catching Web sites.

"I think we've got a serious challenge. The Internet has made it very easy to distribute inaccurate health information," said Dr. John Renner, a University of Missouri professor of family medicine and one of the 100-plus doctors on the Quackwatch board.

Barrett hopes Quackwatch establishes itself as a scientific antidote to what he calls the virtual medicine being practiced in cyberspace. Search for advice on acupuncture, and Web browsers just may come up with a Barrett article criticizing both the practice and an NIH study suggesting there may be merit to it.

"I'm looking at probably the most powerful thing I've ever done," Barrett said of Quackwatch.

The site suggests which books not to read and which therapies and products to avoid. The site also sells books and articles by Barrett and others, as well as Internet guides written by his son. It offers old chiropractic and health-food publications that it calls "examples of the misinformation." And a Los Angeles lawyer who files false-advertising suits on behalf of debunkers has even hung out a shingle there.

Barrett said Quackwatch (http://www.quackwatch.com) also plans to evaluate other Web sites, field consumer complaints and even dispense medical advice.

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The American Medical Assn.'s stand on alternative medicine is essentially Barrett's credo: "There is little evidence to confirm the safety or efficacy of most alternative therapies."

Yet others caution against throwing out--or blindly accepting--anything that doesn't fit currently conventional criteria.

"I think [the debunkers] provide a valuable service," said Barrie R. Cassileth, a psychologist and medical sociologist who has just published a book on alternative medicine, "The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies" (W.W. Norton), and previously co-authored a book with Barrett, "Dubious Cancer Treatment" (American Cancer Society, Florida division, 1991).

"However, they address fraudulent activities, quackery and so on that would generally be classified as alternative medicine. Unfortunately, included under that rubric are many positive therapies which are usually called complementary treatment."

But Barrett said "complementary" medicine is another word for "baloney.

"There's no such thing as complementary medicine," he said. "Most of the people who are doing it are practicing low-quality, substandard medicine."

Cassileth, a member of the American Cancer Society's complementary medicine committee, disagreed. She endorses herbal teas for digestive problems, ginger for nausea and acupuncture for some types of pain. Meditation, yoga and the use of certain aromas to promote relaxation "are well-documented and extremely helpful in reducing stress generally, and particularly among patients with serious illnesses," she said.

Though he questioned their usefulness, Barrett said he's not waging war on herbal teas or aromatherapy, but rather that people are making money by promoting them as cures. Under a Quackwatch report entitled "Aromatherapy: Making Dollars Out of Scents," he lists nine such manufacturers.

Aromatherapy is listed, along with angelic healing and astrology, in a dictionary of more than a thousand alternative therapies that Barrett has posted under the Quackwatch category "Questionable Practices and Services." He conceded that he hadn't read the whole list, but denied critics' claims that the skeptics take a blunderbuss approach to denouncing trendy therapies.

Despite their differences, Cassileth said she sympathizes with the skeptics.

"It must be incredibly frustrating for them," she said. "There's almost a mindless acceptance out there. People assume that alternative medicine is automatically natural and safe, and that's wrong."

Dr. Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics, said the debunkers are missing an important point. The reason the mainstream is co-opting alternative therapies is not because they've been scientifically proven to work, but because patients--the customers--like the attention they get from a more holistic approach to health care.

"It may be that there isn't good evidence about these things like ginseng and garlic," Caplan said. "But what alternative and complementary [practitioners] understand is that it's important to listen to the patient. I have very few people say they are dissatisfied with their visit to the chiropractor.

"While I am a complete supporter of efforts to attack elements of alternative medicine that are 'quacky,' what really isn't discussed by those out there debunking is why it is so attractive."

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The current debate is a reprise of one that took place a century ago, when the precursors of today's orthodox doctors denounced things such as homeopathy, which was flourishing, as unscientific nonsense practiced by crackpots, said Paul Root Wolpe, a sociologist at the Penn Bioethics Center who studies alternative medicine.

Conservative medical societies were forced to momentarily stop fighting therapies that proved too popular with the paying public, Wolpe said. Then, after co-opting them, they regulated them out of existence. "Once they stopped fighting them, homeopathy disappeared," he said.

Now, he said, it's happening again.

"You have Harvard Medical School teaching alternative medicine," he said. "It is really a remarkable sea change in the way orthodox medicine is referring to alternative medicine now.

"That's what's upsetting the critics these days," he said. "They've lost. Now they're the ones screaming in the dark."

The debunkers insist that alternative medicine isn't as popular as the media make it out to be, and that if it is popular, it's because of the marketing acumen of people promoting unproven panaceas.

A central organization of these skeptics is the National Council Against Health Fraud, which consists of "a bunch of people who fight health fraud as a hobby," said president William T. Jarvis, a consumer health education specialist at Loma Linda University.

Jarvis and Barrett co-authored "The Health Robbers," published by Prometheus Press in 1993, of which Barrett is medical editor. Prometheus Press also publishes a new journal, the Scientific Review of Alternative Medicine, which is edited by Dr. Wallace Sampson, a Stanford cancer specialist who is on the Quackwatch board.

Barrett has been a contributor to Consumer Reports and health advisor for an organization that debunks paranormal phenomena. He's friends with famous skeptic James Randi, "The Amazing Randi," who says he often uses Barrett's research.

"He is the man, as far as I'm concerned," Randi said.

They have all been in this demystifying business even before the days when laetrile--apricot pits and arsenic--was first touted as a cancer cure and pyramids were places to recharge psychic batteries. And, needless to say, they have made enemies.

"They are what I call medical chauvinists," said longtime foe Dana Ullman, head of a Berkeley mail-order company that sells homeopathic books, tapes and medicine kits. "They assume there is only one way to do proper medicine."

Strictly speaking, homeopathy is based on the notion of treating people with infinitesimal doses of substances that are supposed to trigger the body's natural defenses.

Ullman, who once debated Barrett at New York University, said "quackbusters" like Barrett aren't interested in learning enough about homeopathy to even properly debunk it. He said he once tried to join one of the anti-quackery groups but was refused.

"They criticize the [NIH] Office of Alternative Medicine for not having skeptics, yet their own boards are entirely skeptics with no advocates," he said.

That NIH office, Barrett believes, has given a false legitimacy to every "crackbrain" medicinal scheme on the planet. He said he and some friends tried to join its advisory board but were rejected.

"The biggest thing it's done is spread misinformation," he said. "If you ask for information about chiropractic, they tell you to go to the chiropractors' association."

The office's director, Dr. Wayne Jonas, wouldn't comment. But spokeswoman Anita Greene said Jonas tried to work with the skeptics and even wrote a letter seeking Quackwatch board member Renner's help. "They're really extremists in not even wanting alternative medicine researched," she said.

Renner said he couldn't recall details of the letter, but said he was leery about letting some of his research fall into the hands of an office whose advisory board includes "rascals."

His list of dubious healers--which Renner called his "duck list"--was stolen from his office a few years ago. It turned up in the hands of alternative medicine activists, including a lawyer who tried to enter it as evidence in a case in which Renner was an expert witness for the other side.

Such infighting is not uncommon in the small world of alternative medicine proponents and skeptics.

Barrett believes that his biggest impact came in the late 1970s, when he and his colleagues took on the burgeoning vitamin industry. He did a study of the many dubious claims the supplement manufacturers made in magazine ads, which led to a Consumer Reports story and then tougher federal rules on mail fraud in 1983. He believes that his clique's relentless offensive on the dietary supplement industry was responsible for the flattening of vitamin sales in the 1980s.

Even today, Barrett barely hides a contempt for what he calls the "fundamentally dishonest" vitamin business. In their 1994 book "The Vitamin Pushers," he and coauthor Victor Herbert wrote about vitamin manufacturers that made millions by duping Americans into believing that they needed vitamins to ease stress, add pep and provide nutrients not found in three square meals a day.

This all makes it strange to discover that Barrett himself gobbles fistfuls of vitamins. Ten years ago, he had open-heart surgery. To control his cholesterol and homocysteine--a protein byproduct found in blood--he takes niacin, folic acid, B-12 and B-6. And a mineral pill every week.

"But when people say, 'Oh, you're against everything that isn't a drug,' I say, 'Well, I take 100.5 vitamins a week,' " he said. "And I'm using them properly."

Barrett may boast about the responsible way he medicates himself, but he's glum about his impact on this era: Too many people want to believe in a medical miracle. And too many merchants are willing to sell them on the healing powers of pixie dust.

"People are interested in magic," he said. "Editors, station managers, producers all believe that if you can offer magic you get a greater audience than if you throw cold water."

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