Bad Advice: Or Why Celebrities, Politicians, and Activists Aren't Your Best Source of Health Information

Paul Offit takes a slightly different tack with his latest book, Bad Advice.  He's still crusading against medical quackery and scientific woo, but instead of presenting new cases, he revisits the world of anti-vaxxers and supplement advocates with tips on how to properly argue for science.  There's not much new (other than the news that Andrew Wakefield has been reduced to the conspiracy theorist circuit), but this time Offit explains how he and others have effectively refuted bad science.  Offit also describes some of the dangers (lawsuits, stalking, death threats) that come with fighting for science and against public opinion and has enough of a sense of humor to dissect some of his least successful media appearances - and to admit that the most frightening audience he ever faced was his daughter's 8th grade class.

Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases

I've read two of Paul Offit's other books and mostly enjoyed his mix of righteous indignation and scientific explanation.  Vaccinated could have used a better editor.  Part history of vaccine production, part "as told to" memoir of Dr. Maurice Hilleman who developed or co-developed nine vaccines, and with a few chapters of public health warning tacked on, Offit's book never fully comes together.  I think the problem is that he's telling two stories linearly, one the life of an important but paradoxically ordinary man, the other of the diseases Hilleman's work prevents.  It's a bit jarring to move from the small, generally ordinary, glimpses into the life of a man who appeared to be fairly ordinary if driven to the history of a now-vanquished communicable disease and its horrifying consequences, to the discovery and development of a vaccine, and back to Hilleman's personal life.  Definitely worth reading, Vaccinated requires the reader to mentally shift gears each chapter and would have been a better book either without the Hilleman biography or with that thread in its own section.

Deadly Choices: How the Anti-Vaccine Movement Threatens Us All

I remember the DTP scare.  Every news magazine in the early 80s did a segment on how the pertussis part of the combination vaccine, although still safer than the disease, caused seizures and possibly brain damage.  England switched to pertussis-free DT vaccine (and faced a wave of whooping cough cases), and the pertussis vaccine was eventually reformulated.  Infectious disease expert Dr. Paul Offit starts Deadly Choices with this scare.  A scare that laid the foundation for the current anti-vaccine movement, and one that wasn't supported by the evidence.  There was no link between the pertussis vaccine and seizures once epidemiologists analyzed the data, but not until a spate of lawsuits drove most vaccine manufacturers out of the market and a combination of Congressional hearings and additional news stories planted doubts in the minds of parents.

Dr. Offit spends about half of his book discussing this false scare and the anti-vaccination groups it spawned.  An undercurrent of fear, a lack of familiarity with what were once common diseases, and the presence of a few well-organized groups meant that when Andrew Wakefield's falsified study claimed there was a link between the MMR vaccine and autism, people were ready to believe.  Most of the MMR discussion is familiar, but it bears repeating.  Multiple studies have shown that there is no link between the MMR vaccine and autism, and while no vaccine is 100% safe it is several orders of magnitude safer than any of the diseases it prevents.

Offit's style is an odd combination of ranting and plodding (he's a doctor, not a writer), but his passion comes through.  He also does a good job of explaining how low vaccination rates hurt the population in general.  Unfortunately, I suspect that his audience consists entirely of those who trust in science, not the anti-vaccine crowd who need to learn the truth.

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.