Alternative Medicine: Groucho Marx, Jin Bu Huan, and Coffee Enemas

After Ling Wang died, one of her friends said, "It was always lovely to be with her. She played the guitar and loved to play games. She was the kind of girl who was so sweet and so happy. Everybody who knows her is devastated." The death of the 25-year-old graduate student from Newcastle University was a tragedy indeed. The coroner determined the cause of death: liver failure due to jin bu huan, a Chinese herbal remedy that Ms. Wang had taken for an upset stomach and a rash.

In his book Anatomy of an Illness, Saturday Review Editor-in-Chief Norman Cousins described the sickness that put him in the hospital: “I was suffering from a serious collagen illness – a disease of the connective tissue…Collagen is the fibrous substance that binds the cells together. In a sense then, I was coming unstuck. I had considerable difficulty in moving my limbs and even in turning over in bed. Nodules appeared on my body, gravel-like substances under the skin…I asked Dr. Hitzig about my chances for full recovery. He leveled with me, admitting that one of the specialists told him I had one chance in five hundred.” Facing this poor prognosis from the practitioners of conventional medicine, Mr. Cousins devised his own treatment: laughter induced by a steady diet of Marx Brothers films and washed down with massive doses of Vitamin C. This unlikely combination cured him completely.

As these two cases illustrate, alternative medicine has an inconsistent record of success (as does conventional medicine). This topic has been in the news recently due to the last week’s publication of Knockout: Interviews with Doctors Who Are Curing Cancer by ‘70’s icon Suzanne Somers. In Knockout, Ms. Somers urges cancer patients to eschew chemotherapy in favor of, among other things, coffee enemas.

The book inspired a certain amount of commentary, much of it from outraged doctors predicting fatal consequences for patients who take Ms. Somers advice. However, a piece by the American Cancer Society’s Dr. Otis Brawley counsels a more thoughtful approach for coming to terms with alternative medicine (http://www.cnn.com/2009/HEALTH/10/23/commentary.brawley.cancer.treatment/index.html):

“I am not critical of the concept of alternative and complementary medicine. When used wisely, it can be useful. Indeed, open-mindedness to other ideas is how we advance conventional medicine. Today, conventional medicine has the extract of a tree bark called aspirin or the root of a plant called vincristine because of observations from those who practiced non-conventional medicine.

“My problem is with some and not all of the advocates of alternative and complementary medicine. My problem is with those who reject the scientific method. Some actually do not reject the scientific method. They seem not to even realize that there is such a thing to reject.

“Some well-meaning advocates for complementary and alternative therapies are against any rigorous evaluation of these therapies.”

In short, Dr. Brawley says that a rational person is an open-minded person. She is willing to believe anything, provided you prove it. Controlled, statistically significant study of new treatments is the surest way to more Norman Cousins and fewer Ling Wangs. The Logic Critic gives Dr. Brawley…

4 Blades - Flawless.

But then the White House is not much better

Yesterday I wrote about the insurance industry report that predicted large cost increases if the Senate’s health care proposal becomes law. I argued that the numbers presented in the report were of little merit because there was insufficient information to assess them independently.

The White House’s reaction to the report was also of little merit. Spokeswoman Linda Douglass denigrated it as a “self-serving analysis” that “completely ignores critical policies [that] will lower costs for those who have insurance”.

In dismissing the report on the grounds that it is self-serving, Ms. Douglass commits the Fallacy of Poisoning the Well. The fact that AHIP, the report’s sponsor, has a vested interest in its conclusion has no bearing on whether the conclusion is true.

The argument that the report ignores policies that will lower costs is incorrect on factual grounds. The only provision of the Senate proposal that is likely to lower costs is the (still unspecified) Medicare and Medicaid reductions. The AHIP analysis explicitly takes these reductions into account, but asserts that the savings are more than offset by the cost increases private insurers will face in taking up the slack.

The Logic Critic gives Linda Douglass…

2 Blades - Wrong.

Insurance Industry SWAGs

The insurance industry added fuel to the health care debate with its recent publication of the Price Waterhouse Coopers study, “Potential Impact of Health Reform on the Cost of Private Health Insurance Coverage” (http://www.ahip.org/content/default.aspx?docid=28536). The study concludes, “by 2019 the cost of single coverage is expected to increase by $1,500 more than it would under the current system and the cost of family coverage is expected to increase by $4,000 more than it would under the current system.” Three drivers underlie these cost increases:

1. The Senate proposal requires insurance companies to cover pre-existing conditions. To prevent enormous increases in premiums, this requirement must be coupled with penalties for the uninsured – otherwise there is no reason to buy insurance until you get sick. Insurance companies would be unable to spread the costs of health care among both the sick and the healthy (which is kind of the raison d’etre for health insurers). However, according to the report, the penalties aren’t big enough: “Once the penalties for lack of coverage are fully phased in, they are estimated to be less than 10 percent of the average cost of coverage resulting in a relatively low incentive for individuals who are healthy to buy insurance.”

2. The Senate proposal places a tax on “Cadillac Plans”, i.e. expensive plans that provide top-drawer coverage. (An aside – during last year’s election, the Obama campaign aired commercials ridiculing John McCain for proposing this tax and promised no new taxes on anyone making less than $250,000 a year). Although the threshold for this tax is indexed for inflation, medical costs rise faster than inflation. Each year a growing fraction of the population will learn that last year’s Chevy is this year’s Cadillac; a higher tax bill will accompany the lesson.

3. The Senate proposal reduces payments by Medicare and Medicaid. Private insurers will have to take up the slack, raising premiums for their policyholders.

Basic economics tells us that the Price Waterhouse is correct in predicting these provisions will raise premiums. But knowing how much is trickier. There is nothing in the report describing how the authors came up with their $1,500/$4,000 estimates. Without knowing the method, there is no way to independently assess the accuracy of the claims. They are merely assertions. The Logic Critic gives Price Waterhouse Coopers…

1 Blade - Not even an argument.

A Government of Men and Not of Laws

On September 23, the Massachusetts State Legislature passed a bill to permit an interim replacement for the late Senator Kennedy until special elections can be held in January. Governor Patrick quickly signed it and named Paul Kirk to fill the vacancy.

The trouble with this appointment was that it was unconstitutional.

The Massachusetts State Constitution states, “No law passed by the general court shall take effect earlier than ninety days after it has become a law, excepting laws declared to be emergency laws and laws which may not be made the subject of a referendum petition.” It goes on to lay out two procedures for declaring an emergency and skipping the 90 day waiting period:

1. The State Legislature can add an emergency preamble to the bill. The legislature attempted this, but did not get the 2/3 vote required by the Constitution.

2. If the operation of the bill has been suspended because it is the subject of a referendum, the Governor can declare an emergency to unsuspend it. The bill was not the subject of a referendum.

Bay State Republicans turned to the judiciary to obtain an injunction blocking the appointment. Judge Thomas Connolly of the Suffolk Superior Court denied the injunction on the grounds that, even though the bill was not the subject of a referendum, it could be.

In making this argument, Judge Connolly’s committed the fallacy of confusing the potential with the actual. Just because something could be it does not follow that it is. This is a fundamental concept in philosophy, going back 23 centuries to the works of Aristotle.

In ignoring the law, Judge Connolly not only overturned a fundamental concept in philosophy. He also overturned a fundamental concept in the American legal system – that it be a “government of laws and not of men”. Ironically, the document that gave us that phrase was the very law Judge Connolly ignored: the Massachusetts State Constitution.

The Logic Critic gives Thomas Connolly…

2 Blades - Wrong.