Mark Crislip received his MD from OHSU in 1983 and has been practicing Infectious Disease medicine for over 25 years. Currently he is chief of infectious diseases at the Legacy Health hospital system in Portland, Oregon. He  produces several podcasts, including QuackCast and Gobbet o'Pus, and regularly writes for medicine-related blogs. He is a co-founder of the Institute for Science in Medicine as well as a co-founder and the current president of the Society for Science-Based Medicine. He has been on the Top Docs list published by Portland Monthly magazine several times. His multimedia empire may be found at edgydoc.com, and two collections of his infectious disease case histories have been published by Bitingduck Press: Puswhisperer and Puswhisperer II.

Files in the Ointment

Bitingduck Press, LLC

My Introduction to SCAM

I originally became involved in the SCAM world in the early 1990s, my first year or two in practice, when I received a consult for a case of gangrene — not a typical cause of infection in the industrialized West.

The patient was a female in her mid-twenties. Sometime earlier she had been diagnosed with a cancerous tumor of her leg, I believe an osteosarcoma. Rather than an amputation and chemotherapy, which could have been curative, she opted for the care of a naturopath who treated her cancer with alkaline therapy, since — as the naturopath told her — cancer is due to acid.

The cancer progressed, grew and parts of it outgrew the blood supply, leading to dead, infected tissue. Her naturopath told her this was her body rejecting the tumor. By the time I saw her, most of her leg was black, ulcerated, dead and with a stink that I hope you never experience. There are few smells as foul as rotting human flesh.

The only reason she was in the hospital was that she had fainted from anemia and continued to refuse any medical or surgical interventions for her leg, which she told me was going to be cured. She believed in the pseudo-medicine she was receiving. She bet her life on it. That night the tumor eroded into a major artery and she bled to death in her sleep.

SCAMs are based on fantasy and the endless ability for people to fool themselves and others. And if you spend your time treating illness with fantasy you could end up bleeding to death in the middle of the night from what could have been a curable cancer.

Yes, I know. Medicine kills. But less so every day. Since 2006 in my hospital system we estimate that we have prevented over 2 000 infections and 200 deaths. How? By applying reality-, science-, and evidence-based medicine to the treatments of our patients. As Chair of Infection Control for my hospitals I have seen the enormous work we have done to improve care and make medicine safer. None of the infections we have prevented or the deaths we have avoided have been in any way due to any SCAM. So far as I know there has yet to be any quality improvement in any SCAM except for the use of disposable acupuncture needles.

As a doctor, I see medicine as a calling. I, and many of my colleagues, have literal responsibility for the health, life and wealth of people. We see people every day who lose all three because of bad decisions or a lack of insurance.

I am not worried about me and medicine. I am not worried about my position; I worry about the next person who may needlessly die or be injured by a treatable illness because they opted instead to treat their cancer with alkaline water or deny that HIV causes AIDS or treats their diabetic foot infection with honey.

So when people throw away their life, their health and their wealth pursuing alternative interventions that do not work, that cannot work, it tends to be a motivator. Most SCAM is based on fantasy and fantasy kills and maims and bankrupts. And that makes me angry.

My job, my responsibility, my calling as a physician is, to the best of my ability, diagnose and treat your illness. That cannot be done by applying ideas that are based on fantasy to problems that come from reality.

I do not doubt that most of those practicing pseudo-medicine have nothing but good intentions. That does not make what they do good, correct, or effective. This book exists because I care that people suffer and die and lose money and hope and time by participating in nonsense.

It's not just people who suffer and die, as discussed in the next chapter.

Rhinos and tigers and bears. Oh my.

More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly. ~ Woody Allen

The website whatstheharm.net is a depressing recitation of the harm that humans do to themselves and others from participating in various forms of nonsense in the attempt to do good. It my backfire, and instead pain and death result.

I would bet that most practitioners of medical woo are true believers. They do not intend to harm people, and believe they are doing good for their patients. Certainly the consumers of alternative therapies intend to have good benefits from their use of sCAM modalities. Most want to get better, and do not intend to hurt themselves or others.

Unfortunately, actions always have unintended consequences. Sometimes the harm is directly to the patient. Sometimes the harm in indirect, with collateral damage to people or the environment. My hospital system has an extensive recycling program to handle the huge amounts of waste generated by the need to insure that all manner of materials are sterile. Patients in isolation consume large amounts of paper and plastic to keep infection confined. My hospitals actively look for ways to decrease their environmental impact and carbon footprint and still deliver high quality medical care. Legacy Health System, where I work, is an award winning leader recycling medical waste, which is a lot more difficult to dispose of than the pop cans and paper bags in your house. Hopefully the trash in your house is not covered with pus, blood and other potentially hazardous medical waste. We try to be good global citizens.

I wonder if some branches of the alternative medical industrial complex are so environmentally conscious.

Natural products are at the greatest risk for being adversely affected by a demand for their use. If millions of people want a natural product that has limited supply, soon that product will be exhausted and the product extinct. Adverse effects from alternative therapies can come in many forms, and the alternative practice with the greatest adverse impact on the environment is probably traditional Chinese medicine (TCM). A billion or more people wanting a traditional herbal or animal product is going to have a detrimental effect on the herb or animal being consumed.

There are numerous examples of the adverse effects on the environment from traditional Chinese medicine.

Rhinos

For years the Rhinoceros was hunted not for food or sport, but for the horn. There is a form of magical thinking that derives function from the structure of a natural product like a rhino horn. It looks like a penis. I guess. I must not have been paying close attention during in my urology rotation. Because it looks like a penis, it must have efficacy on impotence. So the rhino horn was ground up to treat impotence. For centuries it was the Enzyte of the world. But Rhino horn is more than an aphrodisiac. Although the rhino horn is no more than a fingernail with extra calcium and phosphorus, the horn has been used in Chinese medicine to treat damn near anything.

I will note here that trying to determine what a given Chinese preparation is 'really' used for is an exercise in frustration and, as best as I can determine, there as many uses for each TCM preparation as there are acupuncture points: an infinite number only limited by the imagination of the practitioner.

It (rhino horn) should not be taken by pregnant women; it will kill the fetus. As an antidote to poisons (in Europe it was said to fall to pieces if poison were poured into it). To cure devil possession and keep away all evil spirits and miasmas. For gelsemium [jasmine] and snake poisoning. To remove hallucinations and bewitching nightmares. Continuous administration lightens the body and makes one very robust. For typhoid, headache, and feverish colds. For carbuncles and boils full of pus. For intermittent fevers with delirium. To expel fear and anxiety, to calm the liver and clear the vision. It is a sedative to the viscera, a tonic, antipyretic. It dissolves phlegm. It is an antidote to the evil miasma of hill streams. For infantile convulsions and dysentery. Ashed and taken with water to treat violent vomiting, food poisoning, and overdosage of poisonous drugs. For arthritis, melancholia, loss of the voice. Ground up into a paste with water it is given for hematemesis [throat hemorrhage], epistaxis [nosebleeds], rectal bleeding, heavy smallpox, etc.

I like that 'etc.' at the end. I thought Bayer aspirin was the wonder drug that works wonders, but aspirin will not calm the evil miasma of hill streams, mores the pity. With all the alleged benefits of consuming rhino horn, all with no biologic plausibility whosoever, it is no wonder that despite the advent of Viagra and its cousins, the rhino is still being hunted for its horn. A century ago, there were one million black rhinos in Africa; now there are 2,500 and the population is falling. A horn fetches $500 in a country where the average farmers makes $1.50 a day. On the international market a horn gets more than $10,000 for a kilogram. No wonder the Rhino is hunted to near extinction. The fact that they have no medicinal benefit does not prevent the harvesting of the rhino. All species eventually become extinct, but to become extinct because of medical woo is particularly depressing.

Rhinos are not the the only animal disappearing due to relentless harvesting of animal parts for worthless therapies.

Tigers

In 1900 there were 100,000 tigers in India; now there are less than 5,000. China now has under 100 tigers, as they are killed and chopped up into their constituent parts for many worthless medical therapies, including, but not limited to

a tiger's penis soaked in alcohol is said to increase virility; its nose suspended over the marriage bed is believed to increase the chance of having a boy and its whiskers are said to cure toothache.

Traditional Chinese Medicine loves the tiger bones — something that the tiger cannot live without — as a treatment for arthritis, often as a tiger bone wine. 14% of the US has some form of arthritis, and if the numbers are true for China, there are 172 million potential customers for tiger bones. There are also many people outside of China who use the therapy as well. That's a lot of tiger bones, and given declining tiger populations, it is no wonder tiger bones go for 400 dollars a kilogram, each tiger having 4.5 kilograms of bone.

The usual dosage for Tiger bone taken orally to treat rheumatic pain is three to six grams daily. At this rate, a daily user of Tiger bone would consume one to two kilos of bone per year. Extrapolated further, the world's remaining Tigers would provide, at most, a year's supply of medicine to 125 800 daily users - the equivalent of far less than even 1% of China's human population.

That would be about 1/3 a tiger per year per person.

It is not a minor problem:

More than 150,000 over-the-counter traditional Chinese medicines containing - or purporting to contain - tiger bone and parts from other critically endangered species are sold in the United States.

Support TCM, you are indirectly supporting the extinction of rhinos and tiger and more.

As tigers are harvested to extinction, traditional Chinese medicine has substituted other big cats like leopards, whose days are now probably numbered.

Bears

In traditional clinical practice, bear bile was used in fever fighting, detoxification, inflammation, swelling and pain reduction. It was also used in the cure of carbuncle of heat type, pyocutaneous diseases, hemorrhoid, overabundance of liver-fire, convulsion caused by the overabundance of heat, epilepsy, tic, and redness of eyes due to liver heat etc.

Again that pesky etc. Pick a disease, real or imagined, and bear bile may be a therapy. The one problem not treated with bear bile that I could find is impotence, the only TCM animal product not used for some sort of sexual dysfunction. The producers and consumers of TCM products seem to have a lot of sexual dysfunction. Cause or effect?

Rather than hunt bears, farmers keep bears in cages with a catheter in their gall bladder where they can drain the bile like sap from a maple tree. It is not a good life for the bear and often fatal. The Chinese have hundreds of farms with thousands of bears, as do other Southeast Asian countries.

There is an active ingredient in bear bile, ursodeoxycholic acid, that dissolves gall stones. It can be, and is, synthesized for human use. Oddly enough, the natural product is considered superior to synthesized molecule, and so the bile drainage continues and the bear population in China continues to dwindle to supply bears for the farms.

I never thought I would be agree with PETA on anything, but torturing bears for bile that does nothing or has a synthetic equivalent hardly seems like an ethical treatment of an animal. The Humane Society description of bear bile harvesting does not appear particularly pleasant for the bear, which has its bile 'milked' without the benefit of anesthesia.

An un-sterile latex or stainless steel catheter was inserted through the external fistula directly into the gall bladders of each bear to drain the fluid daily either by gravity into a tray or by suction with an un-sterile syringe. This extraction method was called the `Free-dripping Fistula Technique.' The fluid was then dried and manufactured as "Bear Bile Powder" (Bear bile extraction) . The bears were suffering extreme pain due to daily bile extractions. Many of them often die from illnesses (such as cholecystitis, cholelithiasis, polyp formation, obstruction of the cystic duct, strictures and partial herniation of the gall bladder wall, liver cancer) and chronic infections caused by the presence of foreign bodies and their open wounds.

Besides bear farms, bears are illegally hunted for their gallbladders all over the world.

The usual dose of bear bile is 0.25–2.5 g is taken as a pill or powder, and given that the average bear in a farm makes 20 to 40 ml a day of milked bile, it takes a lot of bears to provide the required bile. Prices vary, but bear bile can go for $1000 dollars for 250 cc. In beer talk, that would be about half a pint.

In 1970 one kilo of bear gall bladder cost around US $200, but by 1990 the price had risen to between US $3,000 and US $5,000 per kilo. Recent market price with legal certification has risen to between US $30,000 and US $50,000 per kilo (our experience in legal market of Hong Kong).

There is considerable financial incentive to hunt bears to extinction to provide worthless medications.

Sharks

The Chinese are not the only culture who uses nonsense to help drive animals into extinction. 100 million sharks are killed every year. Some are killed as a by product of fishing, some for food, some for sharks fin soup, and some for medication. Somewhere along the line it was mistakenly thought that sharks do not get cancer. They do get cancer, and they get cancer of cartilage, albeit not very frequently. William Lane, PhD has been the primary marketing force behind the idea that shark cartilage can prevent and treat cancer, publishing books on the topic and selling shark products. Again, there was no good reason to suggest that shark cartilage had anti-tumor effects, although some data in the lab suggests that it inhibits the formation of new blood vessels, needed to support tumor growth. The clinical trials for any efficacy of shark cartilage in the treatment of cancer have been negative, but the end result was has been to help push 126 shark species towards extinction.

A Google search reveals many organic/natural/ online pharmacies sell shark cartilage. I suppose extinction is natural and organic, and supporting and profiting from the extinction of animal species is also natural and organic. Who cares is Jaws is going extinct? Not the purveyors of shark cartilage.

Saiga antelope

These animals have been hunted for their horns, which are used to treat stroke, colds and high blood pressure, and, since rhino horn is both expensive and rare, a cheaper alternative to rhino horn. Because of the protection of the rhino combined with their tiny numbers, the practitioners of traditional Chinese medicine have had to find another species to decimate for useless medical therapy. As a result their numbers of Saiga have gone from 1 million to under 30,000 and falling.

Turtles and Tortoises

Half of the 90 turtle species in Southeast Asia are endangered, due to demand in China for turtle meat and traditional medicines. The World Conservation Fund has documented the rapid decline in just the last few years of the Chinese three-striped box turtle, whose fat, used in soup and jelly, is believed to cure cancer; only a few colonies of the once-abundant turtle now survive in the wild.