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Below is Dr. Harry Zeil's delightful article on "How to Evaluate Medical Discoveries" followed by an article by Dr. Barrett on Quackery, and then more commentary by jk. 

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  BY   Jk

It was back in the early 70s when I read a medical article on high fiber diet, which I found convincing.  It concluded that the reported health benefits of a high fiber diet were the result of the contravening variables; to wit, eating less-meats and other foods that contribute to cancer and the living of a healthful lifestyle.  In other words, the average person in the high-fiber group had a lower cancer incidence because of the contravening variables, and once the two groups were matched for these variables, then the rates of colon cancer were about equal.  The failure to institute proper controls vitiates the claims for fiber being prophylactic. 


The issue of contravening variable goes to the heart of most health studies. If there is no known reason as to why a certain substance is healthful, then one must look to the contravening variable.  And even when such mechanism is proposed, that doesn’t prove the case.  Most of such claims are made for to sell the product, and have not been subject to critical testing.  The industry pursues profits first and the putative mechanisms, as with VIOXX, are illusory. 


There is something very suspect of claiming that carbohydrates which we can't digest somehow ward off colon cancer.  First what is the fate of those carbohydrates that pass through us undigested? Or do they feed intestinal bacteria?  (These bacteria might pose a health risk through their products of metabolism).  Second, how would a bit of additional bulk in the stool function to prevent cancer?  Third, are the answers to these questions substantiated by research?  Fourth, if so, how much?  And finally was the study published in one of the better peer-review journals?  I have not come across research at the molecular and or cellular level on high carbohydrate diets.  Answers at these levels do not prove the issue.  Just because a possible mechanism exists, does not entail that it is significant.  Those of faith often in naturalistic health will provide answers on a molecular or cellular level.  This is effective in persuading an audience with a scientific background.  Often the purveyor of the information is himself lacks a background to evaluate the technical claim he is making.


My sold understanding of health science has helped me recognize most of the dubious claims.  For example, that bovine growth hormones pass through the milk and are still biologically active in quantities sufficient to have an impact upon health.  If they were they would need to inject them into the cows.  Hormones are proteins, and thus are broken up into the individual amino-acid blocks which they are made of.  There are many ideas in the natural health movement which are simply bad science.  


Equally bad are their usage of anecdotal evidence.  False reporting and atypical cases are touted as the norm; so too are their studies lacking proper controls.   Finally, they publish in journal that requires the proper point of view rather than proper scientific controls.  


 If one does not bring to the table a deep knowledge of the bio-molecular foundation of life, then one should look to peer review articles in journals of high reputation.  Beware of evidence presented by those of faith or those who are part of the sales team.  Such people regularly use publications that cater to alternative medical treatments. 


Below is an article illustrating the merit of skepticism when it comes to population research about what is healthful.

Below that is a short article/definition of QUACKERY.








By Harry K. Ziel, M.D.

Of late, the internet represents a great potential for transmission of medical misinformation to an unwary public. As the use of the internet geometrically increases, web surfers intent on learning the most up to date information on disease treatment are exposed to a vast array of unproved therapies. All the traditional safeguards are lost when usually well intentioned authors, enthusiastic to announce their discoveries, pass along their latest findings over the convenient computer network.


A patient with an unusual medical condition like pulmonary interstitial fibrosis or dermatomyositis may surf the web to find any number of sites which discuss his condition. That unsophisticated patient may download, read, and believe that medical researchers have found that a particular diet or herbal medicine is effective in treating his disorder. Desperate with an uncommon disease that is showing no or slow response to traditional allopathic medicine (TAM), the patient is prone to look for and to utilize a number of complementary alternative medical (CAM) nostrums of no value or even a substance that causes harm. These computer web sites are the equivalent of Tijuana locations touting falsely advertised miracle cures that are falsely advertised, like laetrile.*


Excluding internet reporting, transmission of responsible scientific information today falls into the venue of a huge number of scientific journals. A hierarchy of scientific journals exists in each specialty area. Specialty organizations support the publication of most journals in their fields. For instance, the American Chemical Society's publication division supports publication of 27 different journals. In all, publication companies in United States print approximately 16,000 various peer-reviewed journals.

In each specialty area of medicine, a hierarchy of journals has developed over time. The most prestigious and selective medical journal is The New England Journal of Medicine (NEJM), published since 1812 by the Massachusetts Medical Society. Only one out of 10 articles submitted survives the NEJM peer review process. NEJM editors send articles submitted to anonymous reviewers, experts in the fields covered by the articles to be considered for publication. These highly responsible referees must reject, accept with recommended revision, or rarely accept without revision all articles that clear the editors' primary review.

A close second to the NEJM is the Journal of the American Medical Association (JAMA). The American Medical Association has published the JAMA since 1883. The JAMA also accepts about one in 10 articles submitted. For the fields of general medicine, these two journals have attained the first tier status in the hierarchy of medical journal reporting.

Journal editors today virtually require that all the authors have subjected their data to sophisticated statistical evaluation. One of the referees evaluating the article is a statistician who must peruse and agree with the testing of the data. First tiered medical journals require that authors follow set formats. Editors insist on pertinent references supporting views the authors present. Authors must disclose their sources of financial support. Purposals to perform research must first clear investigational review boards (IRBs). Before the research protocol starts, IRBs insist on meaningful studies, check on adequate size of patient cohorts to attain statistically significant conclusions, require patient consents which enumerate all patient risks as well as provision for study termination should patient injury become manifest.

Lower tiered journals tend to accept articles which meet with ever lower standards of quality review. The lowest tiered journals may accept and publish nearly all articles submitted. Obviously, one needs to scrutinize and be more wary of conclusions tabulated in the lower tiered journals. Unpublished internet findings have the least degree of peer review and accordingly should bear the greatest skepticism. Without any ability to review the material and methods, the statistical evaluation of the data, the quality of internet study conclusions are highly problematic.


High quality peer reviewed reports can not be accepted fully, even if data appear to be statistically valid. Unrecognized biases often contaminate data. Statistical validation simply suggests truth. Only multiple studies, all statistically valid, each concluding similar findings, biologically plausible, with increasing exposure correlating with increasing effect will point to a causal rather than a casual association between cause and effect. The best studies are prospective in which patients are randomly assigned to a study group or a control group. Both the researchers and the patients are unaware (blinded) into which study or control group patients are enlisted. Study medications and placebos look alike. Researchers check compliance in taking medication by inspecting patient logs and remaining medication during each visit. Prospective studies are long and expensive.

As an alternative to prospective studies, researchers often choose to perform retrospective case control studies which are far faster and less expensive to conduct than prospective studies. Selection of control patients randomly chosen and matched by age, ethnicity, parity, Ponderal index, socioeconomic status etc. are paramount to avoid bias in retrospective case control studies. Simple observational studies, sometimes matched with historical controls, provide information of a far lessor quality on which physicians must sometime decide therapy when no better information is available.

To illustrate why multiple studies, each coming to the similar conclusions, must be the gold standard for scientific decision making, one needs only to point to the recent NEJM article which refutes the long held belief that a high fiber diet was protective against colon cancer. In 1971, Denis Burkitt first reported that Africans who ate a high fiber diet had a low incidence of colon cancer. A 1992 meta-analysis done by Howe et al of 13 case control studies documented both a protective effect of fiber against colon cancer as well as a dose-response relationship (greater fiber use resulted in less colon cancer incidence). Thun et al in 1992 and Steinmetz et al in 1994 both showed an inverse relationship between high fiber intake and colon cancer occurrence indicating protection from colon cancer from fiber intake. Because of other associated benefits of high fiber intake, i.e., reduced incidence of diverticulosis, less coronary artery atherosclerosis, lower incidence of hypertension, and less frequent type 2 - non insulin dependent diabetes, high fiber became a highly encouraged prophylactic disease intervention. The fiber bandwagon was rolling along!

Hints that fiber was ineffective in colon cancer prevention however arose from four publications. Responsible were DeCosse et al in 1989, McKeown-Eyssen et al in 1994, MacLennan et al in 1995, and Platz et al in 1997.

Fuchs et al in the January 21, 1999 issue of the NEJM reported from the Nurses' Health Study begun in 1976 that no protective association existed secondary to the use of high fiber diets from colon cancer or from premalignant adenomas known to precede colon cancer development. Their meticulous study refuted a belief held for the past 28 years. The Nurses' Health Study is an ongoing prospective study of 88,757 women conducted by a highly regarded research team at Harvard, one member of which team, Walter Willett, has made dietary influence on disease development his life's work.

Shari Roan, writing in the January 25, 1999 Los Angeles Times, was quick to jump both on and off the Nurse's Health Band Wagon saying that the report shows that one can not trust a "lone study". Her assessment of where we stand in understanding the causes and prevention of colon adenomas and cancer is just what the public needs to hear.

A true skeptic must say, "I still see no gold standard met. The story of colon cancer prevention is complicated by too many other factors than fiber ingestion. The skeptic requires many more studies involving complex carbohydrates and sugars, carcinogens derived from high temperature cooking , ingestion of smoked fish and meats, camplobacter and other enteric pathogens, genetic predilection, as well as pesticides and other contaminants from foodstuffs and water to begin to find the solution to the colon cancer causes and prevention's. It's not a crime to admit one does not know.


The skeptic who steps outside the parade to await the final float before he steps back into line will experience the fewest upsets. The cocky drum major who heads a parade is most conspicuous if he leads followers who are all out of step. Scientific proof may take generations before discovery.

*Laetrile is a good point of example for there is nothing peculiar about the chemical contents of peach kernels that support strongly a medicinal claim.  The traces of cyanide are not medicinal and the other substances are found in the common almondto which the peach is a member of the family.  Speculation as to some natural curative effect of a chemical without a demonstration of its biochemical mechanism is mere product hype.  When a credentials is added to a name, this does not entail that the experts knowledge is in fact scientifically sound.  There are a few who have earned such initials attached to a name how have a religious belief in quackery, and there are many more who have obtained such letters from institutions that do not qualify them to practice medicine or be employed at a university as a research scientist.  Their articles have an odor like that of laetrile, rotten almonds, and the results can be as deadly as cyanide.  For the failure to obtain proper treatment of a medical condition has accounted for many early deaths.     




1.Burkitt D P. Epidemiology of cancer of the colon and rectum. Cancer 1971; 28:3-13.
2. DeCosse J J, Miller H H, Lesser M L. Effect of wheat fiber and vitamins C and E on rectal polyps in patients with familial adenomatous polyposis. J Natl Cancer Inst 1989; 81, 1290-1297.
3. Fuchs C S, Gioannucci E L, Colditz B A, Hunter J H, Stampfer M J, Rosner B, Speizer F E, Willett W C. Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women. N Engl. J Med 1999; 340: 169-176.
4. Howe G R, Benito E, Castelleto R, et al. Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis if 13 case-control studies, J Natl Cancer Inst 1992;84:1887-1896.
5. MacLennan R, Macrae F, Bain C, et al. Randomized trial of intake of fat, fiber, and beta carotene to prevent colorectal adenomas: the Australian Polyp Prevention Project. J Natl Cancer Inst 1995, 87:1760-1766.
6. McKeown-Eyssen G E, Bright-See E, Bruce W R, Jazmaji V. A randomized trial of a low fat high fibre diet in the recurrence of colorectal polyps: Toronto Polyp Prevention Group. J Clin Epidemol. 1994; 47:525-536.
7. Platz E A, Giovannucci E, Rimm E B, et al. Dietary fiber and distal colorectal adenoma in men. Cancer Epidemiol Biomarkers Prev 1997; 6: 661-670.
8. Steinmetz K A, Kushi L H, Bostick R M, Folsom A R, Potter J D. Vegetables, fruit, and colon cancer in the Iowa Woman's Health Study. Am J Epidemiol 1994; 139: 1-15.
9. Thun M J, Calle E E, Namboodiri M M, et al. Risk factors for fatal colon cancer in a large prospective study. J Natl Cancer Inst !992; 84: 1491-1500


Quackery: How Should It Be Defined?

Stephen Barrett, M.D.

"Quackery" derives from the word quacksalver (someone who boasts about his salves). Dictionaries define quack as "a pretender to medical skill; a charlatan" and "one who talks pretentiously without sound knowledge of the subject discussed." These definitions suggest that the promotion of quackery involves deliberate deception, but many promoters sincerely believe in what they are doing. The FDA defines health fraud as "the promotion, for profit, of a medical remedy known to be false or unproven." This also can cause confusion because in ordinary usage -- and in the courts -- the word "fraud" connotes deliberate deception. Quackery's paramount characteristic is promotion ("Quacks quack!") rather than fraud, greed, or misinformation.

Most people think of quackery as promoted by charlatans who deliberately exploit their victims. Actually, most promoters are unwitting victims who share misinformation and personal experiences with others. Customers of multilevel companies that sell health-related products typically have been persuaded by friends, relatives, and neighbors who use the products because they believe them effective. Pharmacists also profit from the sale of nutrition supplements that few customers need. In most cases pharmacists do not champion the products but simply profit from the misleading promotions of others. Much quackery is involved in telling people something is bad for them (such as food additives) and selling a substitute (such as "organic" or "natural" food). Quackery is also involved in misleading advertising of dietary supplements, homeopathic products, and some nonprescription drugs. In many such instances no individual "quack" is involved -- just deception by manufacturers and their advertising agencies.

Quackery is not an all-or-nothing phenomenon. A practitioner may be scientific in many respects and only minimally involved in unscientific practices. Also, products can be useful for some purposes but worthless for others. For example, vitamin B12 shots are lifesaving in cases of pernicious anemia, but giving them frequently to "pep you up" is a form of medical fraud.

Quackery and poor medical care overlap but are not identical. Quackery entails the use of methods that are not scientifically accepted. Malpractice involves failure by a health professional to meet accepted standards of diagnosis and treatment. It includes situations in which the practitioner was negligent while using standard methods of care. Leaving a surgical instrument in a patient's abdomen or operating on the wrong part of the body are examples of malpractice unrelated to quackery.

To avoid semantic problems, quackery could be broadly defined as "anything involving overpromotion in the field of health." This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters. In line with this definition, the word "fraud" would be reserved only for situations in which deliberate deception is involved.

Unproven methods are not necessarily quackery. Those consistent with established scientific concepts may be considered experimental. Legitimate researchers and practitioners do not promote unproven procedures in the marketplace but engage in responsible, properly-designed studies. Methods not compatible with established scientific concepts should be classified as nonsensical or disproven rather than experimental


quack issues easily exposed--jk


1.  There is no reasonable health science modus operandi. 


2.  Failure to find widespread application by physicians.  Market place forces assure that a wonder treatment will find acceptance. 


3.  Failure to be published in a major peer-review medical journal.  The lack of funding for rigorous scientific study of an alternative medical treatment reflects the reasoned conclusion that the treatment will at best be only marginally better, and most like perform no better than the placebo control. 


4.  Reliance upon testimonials.  .


5.  The results are contrary to a large body of experimental, published results.


6.  The source is from the alternative health group.


1.  Reasonable entails a method of operation that is supported by known and documented biological pathways.  There is no known mechanism in the cells of the body designed to be influenced by a magnet—that strong magnetism might well over prolonged periods of time prove disruptive of biochemical reactions.  (People are routinely subjected to a strong field for nearly an hour when having an MRI).  Since magnets are not used to influence in the laboratory chemical reactions, a reasonable conclusion is that they don’t in the body as well.  Secondly the effects are much more likely to be disruptive rather than therapeutic.  For vitamin C, for example, has special receptors in the body, but for magnetic fields there aren’t. 


2.  This is very telling for other the centuries there are tens of thousands of purported wonder treatments that either fail to be demonstrated as effective or have vanish.  A clearly superior medical treatments will have a body of published results supporting their use, and thus gain wide-spread acceptance.  Controversies are generally over which alternative is best. Unfortunately treatments that are only marginally better often languish for want of aggressive marketing (see, e.g., my articles on aspirin). 


3.  Any treatment worth its salt will be tested and the results submitted to a medical journal.  If magnet on the wrist cured liver dysfunction, then the manufacturer of that product ought to advance its marketing by having a study done and then published in an important medical journal.  Being published does not prove the case:  there are trade publications for alternative treatments and their review of the submitted work is scant at best. 


4.  True believers are as much a proof of angels dancing on the head of pins as they are of the curative property of the magnet.  And just as there are scientists who profess to believe in a young world, so too are there physicians and researchers whose beliefs are equally absurd.  The issue isn’t proven because some person with a MD or PhD believes in a treatment, but rather the consensus of his peers. 


5.  Reproducibility is part of the gold standard.  A result that stands in conflict to a large body of evidence is much more like to be in error. 


6.  The overall track record of alternative health is dismal.  There isn’t one wonder cure.  Sure a few herbal sources have yielded useful medications, such as willow back and fox glove; however, in each case both I have been greatly improved by medical science.  The failure of ginkgo extract, wheat-grass juice or golden seal to pass the tests of medical science is because upon scientific examination they don’t work


The overall track record is the best marker, for often in the market place forces are less than honest about the evidence—as Dr. Barrett illustrates below


http://quackwatch.org/04ConsumerEducation/QA/magnet.html)by Stephen Barrett, MD. 

The main basis for the claims is a double-blind test study, conducted at Baylor College of Medicine in Houston, which compared the effects of magnets and sham magnets on knee pain. The study involved 50 adult patients with pain related to having been infected with the polio virus when they were children. A static magnetic device or a placebo device was applied to the patient's skin for 45 minutes. The patients were asked to rate how much pain they experienced when a "trigger point was touched." The researchers reported that the 29 patients exposed to the magnetic device achieved lower pain scores than did the 21 who were exposed to the placebo device [3} Although this study is cited by nearly everyone selling magnets, it provides no legitimate basis for concluding that magnets offer any health-related benefit:

  • Although the groups were said to be selected randomly, the ratio of women to men in the experimental group was twice that of the control group. If women happen to be more responsive to placebos than men, a surplus of women in the "treatment" group would tend to improve that group's score.
  • The age of the placebo group was four years higher than that of the control group. If advanced age makes a person more difficult to treat, the "treatment" group would again have a scoring advantage.
  • The investigators did not measure the exact pressure exerted by the blunt object at the trigger point before and after the study.
  • Even if the above considerations have no significance, the study should not be extrapolated to suggest that other types of pain can be relieved by magnets.
  • There was just one brief exposure and no systematic follow-up of patients. Thus there was no way to tell whether any improvement would be more than temporary.
  • The authors themselves acknowledge that the study was a "pilot study." Pilot studies are done to determine whether it makes sense to invest in a larger more definitive study. They never provide a legitimate basis for marketing any product as effective against any symptom or health problem.

Two better-designed, longer-lasting pain studies have been negative:

  • Researchers at the New York College of Podiatric Medicine have reported negative results in a study of patients with heel pain. Over a 4-week period, 19 patients wore a molded insole containing a magnetic foil, while 15 patients wore the same type of insole with no magnetic foil. In both groups, 60% reported improvement, which suggests that the magnetic foil conveyed no benefit [4].
  • More recently, researchers at the VA Medical Center in Prescott, Arizona conducted a randomized, double-blind, placebo-controlled, crossover study involving 20 patients with chronic back pain. Each patient was exposed to real and sham bipolar permanent magnets during alternate weeks, for 6 hours per day, 3 days per week for a week, with a 1-week period between the treatment weeks. No difference in pain or mobility was found between the treatment and sham-treatment periods [5].