Killing Us Softly: The Sense and Nonsense of Alternative Medicine. Dr Offit Paul

activity; it was caused by too much phlegm blocking the windpipe. Cancer wasn’t caused by an uncontrolled growth of cells but by the accumulation of black bile. Inflammation didn’t stem from a vigorous immune response; it was caused by too much blood (hence bloodletting).

      Two hundred years later, in the second century B.C., Chinese healers embraced a similar concept, reasoning that diseases were caused by an imbalance of energies. Chinese healers treated this imbalance by placing a series of thin needles under the skin (acupuncture). However, because Chinese physicians were prohibited from dissecting human bodies, they didn’t know that nerves originated in the spinal cord. In fact, they didn’t know what nerves were. Or what the spinal cord was. Or what the brain was. Rather, they interpreted events inside the body based on what they could see outside, like rivers and sunsets. Chinese physicians believed that energy flowed through a series of twelve meridians that ran in longitudinal arcs from head to toe, choosing the number twelve because there are twelve great rivers in China. To release vital energy, which they called chi, and restore normal balance between competing energies, which they called yin and yang, needles were placed under the skin along these meridian lines. The number of acupuncture points—about 360—was determined by the number of days in the year. Depending on the practitioner, needles were inserted up to four inches deep and left in place from a few seconds to a few hours.

      And that’s pretty much the way things stood until the late 1700s. Practitioners continued to offer therapies based on religious notions of divine intervention or Greek notions of balancing humors or Chinese notions of balancing energies. (Some, such as purgatives, acupuncture, aromatherapy, crystal healing, enemas, magnet therapy, hydrotherapy, and faith healing, are still around today.) But of all the therapies rooted in ancient beliefs, none was more widespread or universally embraced in the eighteenth century than bloodletting. European doctors bled their patients twice a month. Barbers, too, were perfectly willing to bleed their customers. (The red-and-white barber pole represents a white bandage wrapped around a bloody arm.) In the United States, Benjamin Rush, a well-respected Philadelphia physician and signer of the Declaration of Independence, was a big proponent of bloodletting. Rush was so influential that when George Washington suffered epiglottitis (inflammation of the flap of tissue that sits on top of the windpipe), his doctors chose bloodletting instead of the tracheotomy that might have saved his life. Five pints of blood—about half his total blood volume—were taken from Washington as he struggled to breathe. On December 14, 1799, George Washington, a man who had survived smallpox and bullet wounds, went into shock—killed by bloodletting. Sir William Osler, cofounder of Johns Hopkins Hospital, in Baltimore, delivered a fitting postscript. “Man knew little more at the end of the eighteenth century,” said Osler, “than the ancient Greeks.”

      Then medicine took a giant leap forward. Healers no longer believed that illnesses were a matter of spiritual will or humoral imbalances; rather, they defined diseases in biochemical and biophysical terms. This revolution in medical thought centered on several defining moments:

      In 1796, Edward Jenner, a country doctor working in southern England, found he could protect people from smallpox by inoculating them with cowpox, a related virus. Jenner’s vaccine eliminated smallpox—a disease that had killed as many as 500 million people—from the face of the earth. By inducing the immunity that follows natural infection without having to pay the price of natural infection, vaccines have dramatically reduced deaths from rabies, diphtheria, tetanus, polio, measles, rubella, hepatitis, chickenpox, rotavirus, influenza, yellow fever, typhoid, and meningitis.

      In 1854, John Snow, a British physician, investigated an outbreak of cholera in London that had killed more than six hundred people. Snow traced the problem to a water pump on Broad Street. After he removed the pump handle, the outbreak stopped. Snow’s observation launched the field of epidemiology and lifesaving sanitation programs.

      In 1876, Robert Koch, a German physician, isolated the bacteria that cause anthrax. Knowing that specific bacteria caused specific diseases, scientists could now find ways to treat them.

      In 1928, Alexander Fleming, a Scottish biologist, noticed that a mold (Penicillium notatum) growing in broth was excreting a substance that killed surrounding bacteria. He called it penicillin. Once-fatal diseases were now treatable.

      In 1944, Oswald Avery, an American scientist, found that DNA was the substance from which genes and chromosomes were made, allowing disorders like sickle-cell anemia and cystic fibrosis to be defined in genetic terms.

      But it was a relatively unknown Scottish surgeon who—fifty years before Jenner’s smallpox vaccine—made the single greatest contribution to medical thought. In 1746, James Lind climbed aboard the HMS Salisbury, determined to find a cure for scurvy, a disease common among sailors that caused bleeding, anemia, softening of the gums, loss of teeth, kidney failure, seizures, and occasionally death. Lind divided twelve sailors into six groups of two. One pair received a quart of cider every day; the second, twenty-five drops of sulfuric acid three times a day; the third, two spoonfuls of vinegar three times a day; the fourth, a pint of seawater; the fifth, garlic, mustard, radish root, and myrrh gum; and the sixth, two oranges and a lemon. Lind found that only fruits cured scurvy. In 1795, fifty years later, the British Admiralty ordered a daily ration of lime juice for sailors, and scurvy disappeared. (British citizens have been called limeys ever since.)

      Although Lind had proved that citrus fruits cured scurvy, he didn’t know why. It wasn’t until the early 1900s that a Hungarian biochemist named Albert Szent-Györgyi isolated the substance later called vitamin C, or ascorbic acid (literally, “an acid against scurvy”). Lind’s study was groundbreaking because it was the first prospective, controlled experiment ever performed, paving the way for evidence-based medicine. No longer did people have to believe in certain therapies; they could test them.

      Vaccines, antibiotics, sanitation, purified drinking water, and better hygiene allowed people to live longer. From the beginning to the end of the twentieth century, the life span of people living in developed world countries had increased by thirty years. None of this increase occurred because healers balanced humors, restored chi, or offered sacrifices to the gods; it occurred because we finally understood what caused diseases and how to treat or prevent them.

      In a sense, The Dr. Oz Show is a voyage back through the history of medicine, starting with our most primitive concept of what caused disease: supernatural forces.

      In February 2011, Mehmet Oz asked Dr. Issam Nemeh onto his show. Nemeh is a faith healer. He believes that people can be cured with prayer. One of Nemeh’s successes, Cathy, told her story. “I was so sick,” she recalls. “I was coughing up blood. I wasn’t breathing well. I had a mass in my left lung.” Oz showed the audience Cathy’s CT scan, which revealed a small, worrisome mass. “I went to see Dr. Nemeh,” Cathy continued. “And I had a two-hour visit where we talked and we prayed together. All of a sudden I took this deep breath of air. And I just kept taking breaths. I couldn’t believe how much air I was taking in. I felt wonderful.” Just like that, Cathy’s mass was gone. A second CT scan proved that her lungs were back to normal. No chemotherapy. No radiation. Just prayer. A miracle.

      Unfortunately, Cathy’s story contained several inconsistencies. First, Oz never mentioned a biopsy, suggesting that the diagnosis had been made by CT scan alone. This should never happen. Because infections can mimic cancer—and because infections are treated differently—a biopsy is required. Second, a closer look at Cathy’s CT scan showed that the mass had ragged edges, more consistent with inflammation (seen in bacterial infections) than cancer (where edges are typically smooth). In all likelihood, Cathy had a minor case of bacterial pneumonia that resolved without antibiotics, a common event. Oz’s viewers, however, were left with the notion that prayer alone had cured her. (George Bernard Shaw commented on the limits of faith healing after a visit to the shrine of Lourdes. “All those canes, braces, and crutches,” he wrote, “and not a single glass eye, wooden leg, or toupee.”)

      Another example of Oz’s embrace of supernatural beliefs can be seen during his surgeries, which look like those of any other surgeon with one exception: the presence of reiki masters like Pamela Miles, a practitioner of therapeutic touch whom Oz has featured on his show. Miles claims that she can detect human energy