Thursday, November 7, 2013

Hotel Pastis

Sometimes I just want to read something that makes me smile.  Something lightweight but not disposable, a book in which I can immerse myself and imagine that I'm not riding a commuter train in the dark both to and from work.  A book where I can feel the sunshine and taste the multi-hour meals.  When I'm in that sort of mood, I reach for Peter Mayle.  After careers in advertising and educational books (he wrote the "where did I come from?" books my grade school teachers used for introductory sex ed), Mayle moved to Provence in the late 80s and chronicled his year of renovation.  More travelogues followed, and then Hotel Pastis.  It's about a recently divorced ad man named Simon Shaw who falls in love both with Provence and a woman with whom he opens a hotel.  Oh, and there's a gang of bank robbers disguised as a cycling team doing training runs, and the son of Simon's former firm's biggest client who's not sure if he wants to win the Tour de France or earn three Michelin stars.  Add in an extremely competent assistant, an old man with a high ladder, an ex-wife who reappears every few months, avaricious fellow ad men, a disreputable relative, assorted tourists, a sour-tempered "journalist," the mayor's beautiful daughter, a commanding female chef, and a bull terrier, season with lavender, basil, and champagne, and sit back.  It's a pleasant vacation disguised as a 380-page paperback, and place to revisit every few years.

Wednesday, November 6, 2013

Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine

There cannot be two kinds of medicine.  There is only medicine that has been adequately tested and medicine that has not.
        - Marcia Angell

The above quote by the former editor of the New England Journal of Medicine sums up my attitude towards alternative medicine - either it works or it isn't medicine.  It's no coincidence that Dr. Paul Offit used Dr. Angell's quote to introduce his chapter on nutritional supplements.  As he points out, some of them may work, but because they're generally untested, we don't know which ones work, and what side effects they may cause.  Unlike Ben Goldacre whose Bad Science took on several affronts to science and sense, Offit focuses on supplements and the anti-vaccination movement, where he can focus on facts rather than outrage.  I'm not saying that Offit isn't outraged or that Goldacre didn't support his work, but the books have very different tones.  In contrast to Goldacre's slightly snarky wit, Offit writes in a more clinical voice.

Part of me understands why alternative medicine is so appealing.  It's personal, calming, and (mis)uses the word natural.  Clinical medicine is, well, clinical, dispensed by people whose demeanor usually ranges from slightly distant through cold to a combination of arrogant rudeness with a dash of God complex.  Natural remedies don't list adverse events; pharmaceutical ads include a laundry list of frightening side effects.  And many drugs originally came from plants, so supplements must be both effective and safe right?   Well, no, that's not true, and simple logic should tell you that.

Simple logic, however, can't stand up to repeated assaults by celebrities, by doctors who should know better, and by a federal law protecting supplement makers.  I was working in a testing lab and considering law school in 1994, and thoroughly horrified when I read that the 1994 Dietary Supplement Health and Education Act passed.  Basically, anything not classified as a drug can be marketed with no testing whatsoever, and cannot be withdrawn until a critical mass of dead bodies can be traced to its use.  It's perfectly legal for your supplement (which you think will improve your memory or increase your energy or just make you healthier over all) to contain no active ingredients, or to have failed every well-designed effectiveness study, or to be contaminated with known toxins (or, as the New York Times reported this week, may contain entirely different herbs than are listed on the label).  For the most part, this modern snake oil just drains the consumer's wallet, but due to the lack of testing, we just don't know which supplements are toxic or allergenic - and thanks to the DSHEA, we cannot know.  Offit tells us why this is the case - a supplement-loving Senator (Orrin Hatch) from a supplement-producing state (Utah) pushed through the law against the advise of the FDA thanks to the general weakness of scientific knowledge among the general public.

That lack of scientific knowledge explains why people are willing to believe B-list actresses rather than doctors when it comes to autism and menopause.  Jenny McCarthy now co-hosts The View, so her false claims that vaccinations cause autism are once again front-page news.  They are wrong, they are hazardous, and, as Offit explains, are just one item in a laundry list of potentially dangerous claims which charlatans use to prey on desperate parents.  Suzanne Sommers has been relegated to the infomercial circuit with her bio-identical hormones, and that probably makes her less of a threat.  Her position that bio-identical hormones (basically, the same molecule but from an herbal source) are safer and more effective than commercially produced pharmaceuticals, though, just doesn't make sense.  If it's the same molecule, it should have the same effect - and the same risk of side effects.  She's profiting from the ignorance of the general public.

Supplement producers, McCarthy, and Sommers are dangerous, but at least they're working from their own ignorance.  What about those who should know better?  Offit criticizes Dr. Oz for highlighting faith healers and therapeutic touch practitioners (therapeutic touch was disproved by a middle school student's science fair project) by providing a national platform for their unverified (and unverifiable) but deeply moving stories.  Andrew Weil - another doctor who should know better - promotes herbal cures based on small, badly designed studies.  There's no evidence they help anything other than Dr. Weil's financial well-being.

Offit also criticizes the late Dr. Linus Pauling, calling him both one of the greatest scientists and greatest quacks of the 20th Century.  A brilliant chemist and renowned peace activist, Dr. Pauling became a vitamin evangelist in the 1970s.  Clinical trials conduced in the ensuing decades, however, showed that high doses of anti-oxidant vitamins shorten life spans and increase cancer rates.  Too much of a good thing can kill you, but Pauling's earlier brilliance overshadows the hard facts put forth by faceless university academics.

Most of this is familiar territory.   Where Offit differs from other debunking doctors is that he explains how and why alternative remedies work.  Goldacre mentioned regression to the mean (we reach for remedies when we feel our worst and would feel better soon no matter what) and the placebo effect.  Offit actually explains what should really be called the placebo response.  Pain isn't all in our minds, but we can use our minds (through relaxation and trickery) to release endorphins.  These naturally produced pain killers can dull pain and cause other physiological responses.  When acupuncture or a supplement works, it's because we've fooled our brains into releasing endorphins, dulling our pain but not fixing the cause, be it a pulled muscle, an infection, or cancer.  This is why I think Do You Believe in Magic may be slightly more effective than Bad Science in convincing the public that most alternative remedies are ineffective.  Offit seems to understand why people want to believe in magic when Goldacre just snarks at their ignorance.  Goldacre is a more entertaining writer (Offit is perhaps a bit too clinical for some), but he's probably more likely to turn off those who need to hear his message.  I'm cynical enough (even when my office mate isn't expounding on health theories which only show he might not pass 4th grade science), though, to think that they're preaching to the choir.