The Era of Echinacea - Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives - Michael Specter

Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives - Michael Specter (2009)

Chapter 4. The Era of Echinacea

Not long ago, for reasons I still don’t understand, I began to feel unfocused and lethargic. Work was no more stressful than it had ever been, and neither was the rest of my life. The bulk of my savings had been sucked into the vortex of the newly recognized black hole called the economy. But whose had not? I try to eat properly, exercise regularly, sleep peacefully, and generally adhere to the standard conventions of fitness. It didn’t seem to be working. My doctor found nothing wrong and my blood tests were fine. Still, I felt strange, as if I were lacking in energy—or in something. So I did what millions of Americans do every day. I sought salvation in vitamins.

First, though, I had to figure out what variety of salvation to seek. There are many thousands of pills, potions, powders, gels, elixirs, and other packaged promises of improved vitality for sale within just a few blocks of my home. I walked to the closest store, a place called The Health Nuts, and told the proprietor I was feeling sluggish. He nodded gravely and took me straight to the amino acid section. To counteract my deficit of energy, he recommended a supplement of glutamine, which is one of the few amino acids that passes the blood-brain barrier. When people are under stress—physical or psychological—they begin to draw down on their stores of glutamine. “This stuff repairs brain cells and it’s good for depression, too,” he told me. A leaflet attached to the bottle described the amino acid as a magical aid for mental acuity. (“It is helpful with focus, concentration, memory, intellectual performance, alertness, attentiveness, improving mood, and eliminating brain fog & cloudiness”). I dropped it into my basket.

The store also had a garlic section—not actual garlic, but various pills with names like Kyolic and Garlicin, GarliMax and Gar lique, all of which claimed to possess the healing properties of garlic, which for centuries has been thought to help ward off the common cold, clear up respiratory infections, and soothe sore throats. Garlic, its advocates claim, is also effective in treating heart problems, lowering cholesterol, and keeping arteries free of blood clots. I grabbed a bottle and moved on to the main supplement section, where multivitamins in every conceivable size, shape, dosage, strength, and formulation were lined up in rows. (There were vitamins for vegans, and for people allergic to gluten, for those who don’t need iron and those who do; and there were specific pills for every age group, from the fetus right through to the “well derly.”) Antioxidants were next to them, all seemingly fueled by the “natural” power of prickly pear, goji, and açaí, the intensely popular Brazilian berry that supposedly offers benefits such as rejuvenation, skin toning, and weight loss, not to mention prevention of various illnesses like heart disease. There was also something called “BlueGranate,” a combination of blueberries and pomegranates, both of which “possess wondrous health properties,” as the bottle put it. “A synergistic blend of powerful and potent phy tonutrient antioxidants.” Into the basket it went.

Almost everything advertised itself as an antioxidant. Oxidation is a natural result of metabolic processes that can cause harmful chain reactions and significant cellular damage. Those broken cells in turn release unstable molecules called free radicals, which are thought to be the cause of many chronic diseases. Set loose, free radicals can turn into scavengers, ransacking essential proteins and DNA by grabbing their electrons for spare parts. Antioxidants prevent those reactions, but standing there, it was impossible to know how, or if, they worked. The collection of pills was so enormous, the choice so vast, and the information so humbling that while I may not have been depressed when I arrived at The Health Nuts, spending half an hour there did the trick.

I went home and consulted the Internet, which was even more intimidating: there are millions of pages devoted to vitamins and dietary supplements. You could spend your life combing through them and then another life trying them all out. Fortunately, my eye was drawn immediately to the Vitamin Advisor, a free recommendation service created by Dr. Andrew Weil, the ubiquitous healer, whose domed head and bearded countenance are so profoundly soothing that with a mere glance at his picture I felt my blood pressure begin to drop.

Dr. Weil is America’s most famous and influential practitioner of complementary medicine—he prefers to call it integrative—which seeks to combine the best elements of conventional treatment with the increasingly popular armamentarium of alternatives, everything from supplements to colonic irrigation, spiritual healing, and homeopathy.

The public’s hunger for novel remedies (and alternatives to expensive drugs) has transformed the integrative approach into one of the more potent commercial and social forces in American society. Nearly every major medical school and hospital in the country now has a department of integrative or complementary medicine. (A few years ago the Harvard Medical School even tussled with its affiliate, the Dana Farber Cancer Institute, over which would win the right to house such a program. Harvard prevailed.) While the movement has grown immensely since he opened his Center for Integrative Medicine in Arizona in 1994, Weil remains at its heart. Educated at Harvard University, both as an undergraduate and at its medical school, Weil embraces herbal therapies, New Age mysticism, and “spontaneous healing,” which is the title of one of his books. But he also understands science and at times even seems to approve of it.

Weil offers sound advice in his many books—calling refined foods, excess starches, corn sweeteners, and trans fats dangerous, for example, and noting that exercise and a proper diet are far more beneficial even than the vitamins and supplements he recommends. His influence is immense, and in a country embarking on an urgent debate about how to make its health care system more affordable, rational, and responsive, that influence has never been felt more powerfully. Weil is in great demand as a public speaker, testifies before Congress, and has twice appeared on the cover of Time magazine. For advocating the many health benefits of mushrooms, Weil is a hero to mycologists the world over. (He is one of the rare Americans to have had a mushroom named after him, Psilocybe weilii.)

Andrew Weil seemed like just the man to lead me out of the forest of nutritional darkness into which I had inadvertently wandered. His Vitamin Advisor Web site assured me that, after answering a few brief questions, I would receive “a personalized comprehensive list of supplements based on my lifestyle, diet, medications, and health concerns”—all at no cost, without obligation, and prepared specially to meet my “unique nutritional needs.” In addition, if I so chose, I could order the “premium quality, evidence-based” supplements in the proper doses that would “exactly match the recommendations from Dr. Weil.” The supplements would be “custom packed in a convenient dispenser box and shipped directly to [me] each month.” The only thing Dr. Weil doesn’t do for you is swallow the pills.

I filled out the form, answering questions about my health and providing a brief medical history of my family. Two minutes after I pressed “submit,” Dr. Weil responded, recommending a large number of dietary supplements to address my “specific health concerns.” In all, the Vitamin Advisor recommended a daily roster of twelve pills, including an antioxidant and multivitamin, each of which is “recommended automatically for everyone as the basic foundation for insurance against nutritional gaps in the diet.” Since, as he points out on the Web site, finding the proper doses can be a “challenge,” Dr. Weil offered to “take out the guesswork” by calculating the size of every pack, which, over the previous ninety seconds, had been customized just for me. That would take care of one challenge; another would be coming up with the $1,836 a year (plus shipping and tax) my new plan would cost. Still, what is worth more than our health? If that was how much it would cost to improve mine, then that was how much I was willing to spend.

Also on my list: milk thistle, “for those who drink regularly or have frequent chemical exposure,” neither of which applies to me; ashwagandha, an herb used in ayurvedic medicine to help the body deal with stress and used traditionally as an energy enhancer; cordyceps, a Chinese fungus that for centuries has been “well known” to increase aerobic capacity and alleviate fatigue; and eleuthero, also known as Siberian ginseng, often employed to treat “lethargy, fatigue and low stamina.” In addition, there was 1000 milligrams of vitamin C (high doses of which, the information said, may provide additional protection against the oxidative stress of air pollution and acute or chronic illness); saw palmetto complex, mixed with stinging nettle root to “support prostate health”; an omega-3 pill (which may help reduce the symptoms of a variety of disorders); Saint-John’s-wort (to support healthy mood); folic acid (which in addition to offering pregnant women proven protection against neural tube defects, may have a role to play in heart health, and may also help protect against cancers of the lung and colon, and even may slow the memory decline associated with aging); and finally another ayurvedic herb, triphala (a mixture of three fruits that help tone the muscles in the digestive tract).

Dr. Weil, who argues that we need to reject the prevailing impersonal approach to medicine, reached out from cyberspace to recommend each of these pills wholeheartedly and specifically, just for me. Before sending off a check, however, I collected some of the information on nutrition and dietary health offered by the National Institutes of Health, the Harvard School of Public Health, and the Memorial Sloan-Kettering Cancer Center. It turned out that my pills fell essentially into three categories: some, like cordyceps and triphala, seemed to do no harm but have never been shown in any major, placebo-controlled study to do any particular good; others, like Saint-John’s-wort, may possibly do some good in some cases for some people, but can also easily interfere with and negate the effects of a large number of prescribed medicines, particularly the protease inhibitors taken by many people with AIDS. Most of the pills, however, including the multivitamin and antioxidant, seemed just plain dangerous.

Despite Dr. Weil’s electronic assurances that his selections were “evidence-based,” not one of those twelve supplements could be seen to hold anything more than theoretical value for me. At best. One study, completed in 2008, of the omega-3 fatty acids so beneficial when eaten in fish, found that in pill form they had no discernible impact on levels of cholesterol or any other blood lipids. The study was not large enough to be definitive; other trials are needed (and already under way). But it would be hard to argue with Jeffrey L. Saver, vice chairman of the American Heart Association’s Stroke Council, professor of neurology at UCLA, and the director of its department of Stroke and Vascular Neurology, who called the findings “disappointing.”

Others agreed. “You know, most of that stuff just comes right out at the other end,” former surgeon general C. Everett Koop told me. The ninety-four-year-old Koop is congenitally incapable of ignoring facts or pretending they shouldn’t matter. “Selling snake oil has always been one of America’s greatest con games. But the more we know about our bodies, the more people seem to buy these pills. That part I never did understand; you would have hoped it would be the other way around. But every day it becomes clearer: we need to eat properly and get exercise. And every day more people seem to ignore the truth.”

New data keeps streaming in, and almost all of it confirms that assessment. In 2009, researchers from the Women’s Health Initiative, working at dozens of major medical centers under the direction of the National Heart, Lung, and Blood Institute, concluded a fifteen-year study that focused on strategies for preventing heart disease, various cancers, and bone fractures in postmenopausal women. After following 161,808 women for eight years, the team found no evidence of any benefit from multivitamin use in any of ten conditions they examined. There were no differences in the rate of breast or colon cancer, heart attack, stroke, or blood clots. Most important, perhaps, vitamins did nothing to lower the death rate.

Another recent study, this time involving eleven thousand people, produced similar results. In 2008, yet another major trial, of men, had shown that the risk for developing advanced prostate cancer, and of dying from it, was in some cases actually twice as high for people who took a daily multivitamin as it was for those who never took them at all. There are hundreds of studies to demonstrate that people who exercise regularly reduce their risk of coronary artery disease by about 40 percent, as well as their risk of stroke, hypertension, and diabetes, also by significant amounts. Studies of vitamin supplements, however, have never produced any similar outcome.

Antioxidants, often described in the press as possessing wondrous powers, and recommended to every American by Dr. Weil, among others, are taken each day by millions. That should stop as soon as possible. While a diet rich in antioxidants has been associated with lower rates of chronic disease, those associations have never been reflected in trials in which people took antioxidants in supplement form. In 2007, for example, the Journal of the American Medical Association published the results of the most exhaustive review yet of research on such supplements. After examining sixty-eight trials that had been conducted during the previous seventeen years, researchers found that the 180,000 participants received no benefits whatsoever. In fact, vitamin A and vitamin E, each immensely popular, actually increased the likelihood of death by 5 percent. Vitamin C and selenium had no significant effect on mortality. (Vitamin C has long been controversial. Linus Pauling, the twentieth century’s greatest chemist, was convinced it would cure cancer. He was wrong. In fact, too much vitamin C actually seems to help cancer cells withstand some kinds of treatment.)

“The harmful effects of antioxidant supplements are not confined to vitamin A,” said the review’s coauthor, Christian Gluud, a Danish specialist in gastroenterology and internal medicine and head of the trial unit at the Centre for Clinical Intervention Research at Copenhagen University Hospital. “Our analyses also demonstrate rather convincingly that beta-carotene and vitamin E lead to increased mortality compared to placebo.” More than a quarter of all Americans over the age of fifty-five take vitamin E as a dietary supplement, yet among healthy people in the United States it would be hard to cite a single reported case of vitamin E deficiency.

It gets worse: folic acid supplements, while of unquestioned value for pregnant women, have been shown to increase the likelihood that men would develop prostate cancer. “Unfortunately, the more you look at the science the more clearly it tells you to walk away,” Kelly Brownell said. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, has for years studied the impact of nutrition on human health. “Vitamins in food are essential. And that’s the way to get them. In food.” With a couple of exceptions like folic acid for pregnant women, and in some cases vitamin D, for the vast majority of Americans dietary supplements are a complete waste of money. Often, in fact, they are worse.

That brings us back to Dr. Weil, who understands the arguments against using vitamin supplements in a country where, with rare exceptions, people have no vitamin deficiencies. He actually makes them pretty well in his book Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being. “ Not only is there insufficient evidence that taking [antioxidants] will do you any good, some experts think they might be harmful,” he wrote. Excellent analysis, pithy and true. In fact, the evidence of harm keeps growing. In May 2009, researchers from Germany and the United States reported in the Proceedings of the National Academy of Sciences that antioxidants like vitamins C and E actually reduce the benefits of exercise. “If you promote health, you shouldn’t take large amounts of antioxidants,” said Michael Ristow, a nutritionist at the University of Jena, who led the international team of scientists. “Antioxidants in general … inhibit otherwise positive effects of exercise, dieting and other interventions.” Despite news like that, Dr. Weil still thinks you need to take his (“I continue to take a daily antioxidant formula and recommend it to others as well”).

Weil doesn’t buy into the idea that clinical evidence is more valuable than intuition. Like most practitioners of alternative medicine, he regards the scientific preoccupation with controlled studies, verifiable proof, and comparative analysis as petty and one-dimensional. The idea that accruing data is simply one way to think about science has become a governing tenet of the alternative belief system. The case against mainstream medicine is simple, repeated often, and, like most exaggerations, at least partially true: scientists are little more than data collectors in lab coats, people wholly lacking in human qualities. Doctors focus on disease and tissues and parts of the anatomy that seem to have failed, yet they act as if they were repairing air conditioners or replacing carburetors rather than attending to the complex needs of an individual human being. And pharmaceutical companies? They serve no interest but their own. Complementary and alternative medicine, on the other hand, is holistic. It cares. In the world of CAM, evidence matters no more than compassion or belief. Weil spells it all out in Healthy Aging:

To many, faith is simply unfounded belief, belief in the absence of evidence, and that is anathema to the scientific mind. There is a great movement toward “evidence-based medicine” today, an attempt to weed out ideas and practices not supported by the kind of evidence that doctors like best: results of randomized controlled trials. This way of thinking discounts the evidence of experience. I maintain that it is possible to look at the world scientifically and also to be aware of nonmaterial reality, and I consider it important for both doctors and patients to know how to assess spiritual health. (Italics added.)

Evidence of experience? He is referring to personal anecdotes, and allowing anecdotes to compete with, and often supplant, verifiable facts is evidence of its own kind—of the denialism at the core of nearly every alternative approach to medicine. After all, if people like Weil relied on the objective rules of science, or if their methods were known to work, there would be nothing alternative about them. If an approach to healing has a positive physical effect (other than as a placebo), then it leaves the alternative world of sentiment and enters the world of science and fact. The only attribute that alternatives share is that they do not meet the scientific standards of mainstream medicine.

Data is not warm or kind. It is also, however, not cold or cruel. Assessing data and gathering facts are the only useful tools we have to judge whether a treatment succeeds or fails. Weil understands that, and yet he mixes perfectly sensible advice with lunacy. (“I would look elsewhere than conventional medicine for help if I contracted a severe viral disease like hepatitis or polio, or a metabolic disease like diabetes,” not to mention “treatment for cancer, except for a few varieties.”)

That makes him a uniquely dangerous proponent of magical thinking. It is much easier to dismiss a complete kook—there are thousands to choose from—than a respected physician who, interspersed with disquisitions about life forces and energy fields, occasionally has something useful to say. Still, when Weil writes about a “great movement toward ‘evidence-based medicine’ ” as if that were regrettable or new, one is tempted to wonder what he is smoking. Except that we don’t need to wonder. He tells us.

Weil believes in what he calls “stoned thinking” and in intuition as a source of knowledge. This he juxtaposes with “straight” or “ordinary” thinking. You know, the type weighed down by silly rules and conventional thought. Like every alternative healer, Weil believes in the supremacy of faith and compassion. I certainly wouldn’t argue against faith (if only because for many people it provides the single form of alternative medicine that seems clearly to work, a placebo effect). And here is my definition of compassion: the desire to alleviate suffering. Nothing in the course of human history meets that definition so fully as the achievements of evidence-based, scientifically verifiable medicine.

The world of CAM is powered by theories that have almost never been tested successfully, and its proponents frequently cite that fact as proof of their unique value, as if they represent a movement that cannot be confined (or defined) by trivialities. It would be terrific if Weil were correct when he says that evidence-based medicine is now in vogue; given its astounding record of success, it certainly ought to be. There is at least one compelling reason that the scientific method has come to shape our notion of progress and of modern life. It works.

But pendulums swing in more than one direction. As Steven Novella, director of general neurology at the Yale University School of Medicine, has written, the biggest victory won by proponents of complementary and alternative medicine was the name itself. “Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery,” he wrote on Neurologica, his blog, which is devoted heavily to critical thinking. “The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all—a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberately blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.”

The integrity of our medical system is certainly subject to doubts and debate. Doctors can be smug and condescending, and they often focus on treating diseases rather than preventing them. But in the alternate universe of CAM treatment nobody has to prove what is safe, what works and what doesn’t. And that’s dangerous because Americans are desperate for doctors who can treat their overall health, not just specific illnesses. Perhaps that is why this particular universe, populated by millions of people, has been fueled by one of American history’s most unlikely coalitions—the marriage of the extreme right with the heirs of the countercultural left.

The political right has never wavered in its support for dietary supplements, and Orrin Hatch, the Utah Republican, has long been the industry’s most powerful supporter. Hatch doesn’t share a lot of political space with Tom Harkin, the populist liberal from Iowa. They don’t agree on abortion rights, gun control, or many other issues. But when it comes to the right of every American to swallow any pill he or she can find in a health food store, the two are welded by a bond of steel. “For many people, this whole thing is about much more than taking their vitamins,” Loren D. Israelsen, an architect of the 1994 legislation that deregulated the supplement industry, said. “This is really a belief system, almost a religion. Americans believe they have the right to address their health problems in the way that seems most useful to them. Often, that means supplements. When the public senses that the government is trying to limit its access to this kind of thing, it always reacts with remarkable anger—people are even willing to shoulder a rifle over it. They are ready to believe anything if it brings them a little hope.”

That kind of fervent belief, rather than facts, feeds disciplines like ayurvedic medicine, which argues for the presence of demonic possession in our daily life, and Reiki, the Japanese practice of laying on the hands, which is based on the notion that an unseen, life-giving source of energy flows through each of our bodies. Then there is iridology (whose practitioners believe they can divine a person’s health status by studying the patterns and colors of his iris), Healing—or Therapeutic—Touch, qi gong, magnet therapy. None of it works. Acupuncture, while effective in reducing arthritic pain and the impact of nausea, has never been demonstrated to help people quit smoking or lose weight—two of its most popular applications.

Homeopathy, perhaps the best-known alternative therapy, is also the most clearly absurd, based as it is on the notion that “like cures like.” In other words, it presumes that a disease can be treated by ingesting infinitesimally small dilutions of the substance that caused the disease in the first place. No matter what the level of dilution, homeopaths claim, the original remedy leaves some kind of imprint on the water molecules. Thus, however diluted the solution becomes, it is still imbued with the properties of the remedy. No homeopathic treatment has ever been shown to work in a large, randomized, placebo-controlled clinical trial, but nothing seems to diminish its popularity. With logic that is both ridiculous and completely sensible, the federal government has taken a distant approach to regulating homeopathy precisely because it contains no substance that can possibly cause harm (or good). “Homeopathic products contain little or no active ingredients,” Edward Miracco, a consumer safety officer with the FDA’s Center for Drug Evaluation and Research explained. As a result, “from a toxicity, poison-control standpoint” there was no need to worry about the chemical composition of the active ingredient or its strength.

On those rare occasions when data relating to alternative medicine does become available, it is almost invariably frightening: in 2004, for example, a large group of researchers reported in the Journal of the American Medical Association that more than 20 percent of the ayurvedic medicines the group purchased on the Internet contained detectable and dangerous levels of lead, mercury, and arsenic. Soon afterward, the FDA warned consumers to exercise caution when purchasing ayurvedic products.

“Who is telling people that all this stuff is good?” asked Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. “Their peers. The scientists say either we don’t know or it doesn’t work. And their response is the same thing that they’re doing with the vaccine issue. They want to feel better, they want to live forever, they want not to age. So people start going around with all of these herbs that are not proven to work and that the scientists are skeptical about. Which all the more, I think, makes them want to go after it. There’s an element of, ‘I’ll show you, you son of a bitch. The people who I hang out with think this really works.’ And then you come out with a paper, like the one in the New England Journal of Medicine, that shows there is absolutely no benefit from echinacea. Bingo! They don’t care. They don’t care a bit.”

The Obama administration’s laudable desire to bring medical costs under control and to make the health care system more accessible has presented leaders of the CAM community with a unique opportunity—and they have seized it. In February 2009, Weil and other famous supporters of natural healing, including Mehmet Oz, a cardiac surgeon and founder of the Complementary Medicine Program at New York Presbyterian Hospital (and, most famously, Oprah Winfrey’s health guru); and Dean Ornish, of the Preventive Medicine Research Institute in Sausa lito, California, testified before the Senate Health, Education, Labor, and Pensions Committee and correctly pointed to disease prevention as the key to crafting the new health care legislation President Obama has committed himself to so completely. In their testimony, however, each did battle with a series of straw men, arguing that the American health care system costs too much (it does), is too reliant on technology (it is), and is geared to complicated and costly treatment rather than to prevention, which is cheaper and almost always more effective (also true). A month before the summit, the group published a piece in the Wall Street Journal in which they wrote, “Our ‘health-care system’ is primarily a disease-care system. Last year, $2.1 trillion was spent in the U.S. on medical care, or 16.5% of the gross national product. Of these trillions, 95 cents of every dollar was spent to treat disease after it had already occurred. At least 75% of these costs were spent on treating chronic diseases, such as heart disease and diabetes, that are preventable or even reversible.”

None of that is really in dispute, but those fundamental flaws cannot possibly be overcome by a system that replaces facts with wishes. Prescribing diet and exercise to fight disease is not an alternative approach to medicine, as anyone who has visited a physician in the past five years would surely know. What America needs, and what the Obama administration has, for the first time, set out to do, is get a better sense of which treatments work and which don’t. That would, for instance, require placing caloric information on all fast-food menus and explaining what it means. And it will require clear economic judgments about whether many current procedures are in fact worth the cost. All that will require data, not voodoo.

Nearly a decade ago, a Stanford University professor named Wallace I. Sampson warned that institutional support for alternative medicine endangers society. “Modern medicine’s integrity is being eroded by New Age mysticism, cult-like schemes, ideologies, and classical quackery,” he wrote in an influential essay called “The Alternate Universe,” arguing that they were all misrepresented as “alternative” medicine. “Using obscure language and misleading claims, their advocates promote changes that would propel medicine back five centuries or more. They would supplant objectivity and reason with myths, feelings, hunches, and sophistry.” At the time, Sampson’s claims seemed a bit over the top to me. We were in a golden era of medicine; life expectancy grew nearly every year, and so did our knowledge of how to treat many chronic diseases. It never occurred to me that science-based medicine might be considered an obstacle to a healthy life, rather than the best chance of having one.

Those bottles of folic acid and BlueGranate from The Health Nuts were sitting on my desk. They looked so promising and appeared to offer so much: support for a healthy cardiovascular system, as well as better memory and brain function; they would promote urinary tract, eye, and skin health, boost body detoxification functions, and reduce cellular damage associated with the aging process. There was, however, a tiny asterisk next to each claim. “These statements have not been evaluated by the Food and Drug Administration,” each one said. “These products are not intended to treat, diagnose, cure or prevent any disease.” I looked at the Garlicyn, the amino acids, and the vitamin C. Same warnings. Same nearly invisible print.

The fine print on labels like that is rarely read. In the world of dietary supplements, facts have always been optional. Pharmaceuticals are strictly regulated; for supplements there is almost no oversight at all. A pill may be sold as something that contains 1000 mg of vitamin C. But how can you be sure without meaningful standards? When facts are not required anything goes, and Andrew Weil, for one, wouldn’t have it any other way. “I believe in magic and mystery,” he wrote in Healthy Aging. “I am also committed to scientific method and knowledge based on evidence. How can this be? I have told you that I operate from a both-and mentality, not an either-or one.”

Sorry, but that’s not possible. Either you believe evidence that can be tested, verified, and repeated will lead to a better understanding of reality or you don’t. There is nothing in between but the abyss. The FDA knows that, and so does the supplement industry. And so does Andrew Weil. If a product whose label promotes it as contributing to brain function, cardiovascular health, or one that can reduce cellular damage associated with aging, or improve digestion, or support a healthy immune system is “not intended to cure, treat, diagnose or even prevent” any health problem, what on earth, one has to wonder, is it supposed to do?

ALMOST 40 PERCENT of American adults made use of some form of alternative medical therapy in 2007, according to the most recent National Health Statistics Reports. They spent $23.7 billion on dietary supplements alone. It has become one of the America’s biggest growth industries. (And one that almost uniquely profits during times of economic distress. People are far more likely to turn to herbs and other supplements when they can’t afford genuine medical care—and when they have no access to any other health system.) There were approximately 4,000 supplements on the market in 1994, when the industry was deregulated by Congress. Today the exact number is almost impossible to gauge, but most experts say there are at least 75,000 labels and 30,000 products. Those numbers don’t include foods with added dietary ingredients like fortified cereals and energy drinks, which seem to fill half the supermarket shelves in the country.

The attraction isn’t hard to understand. For all that medicine has accomplished, millions of people still suffer the considerable aches and pains of daily life. Arthritis and chronic pain plague America, and much of that agony is no more amenable to pharmaceutical relief today than it was thirty years ago. The drugs one needs to alleviate chronic pain—aspirin, for instance—can cause their own complications when taken in high enough doses over a long enough period. The pharmaceutical industry is a monolith that often acts as if there is, or soon will be, a pill for everything that ails you. Too much cholesterol? We can melt it away. Depressed? Try one of a dozen new prescriptions. Can’t sleep? Blood pressure too high? Obese, sexually dysfunctional, or bald? No problem, the pharmaceutical industry is on the case.

Even our medical triumphs cause new kinds of problems. Reducing deaths from heart disease and cancer, for example, permits us to live longer. And that exposes us to a whole new set of conditions, most notably Alzheimer’s disease, a debilitating, costly, and humiliating illness for which there is no cure and few treatments of any value.

So what could it hurt to try something new? It is an era of patient empowerment. People have access to more information than ever, their expectations have changed, and they demand greater control over their own health. Supplements and herbal alternatives to conventional drugs, with their “natural” connotations and cultivated image of self-reliance, fit in perfectly. They don’t require machines or complex explanations. People can at least try to relate to an herb like echinacea, which has been around for centuries, no matter how useless it is, or a practice like qi gong, which means “cosmic breathing” and suggests that human life forces can be marshaled to flow through our body in a system of “meridians.” Homeopathy is nothing more than fraud, as any number of scientists, studies, reports, and institutions have pointed out. Yet, in a complex world simplicity offers an escape from the many moving parts of the medical machine. As with organic food, if science seems allied with corporations and conglomerates—all distant and unfathomable—well, then, nature feels just right.

Under the banner of natural and alternative treatments Americans reflexively accept what they would never tolerate from a drug company (and never should). Vioxx made that clear. Without post-marketing surveys, the unacceptable risks of Vioxx would never have been known. Maybe none of the tens of thousand of herbal supplements for sale in the United States carries any similar risk. But how would we know, since that kind of monitoring has never been required of supplements? Doctors could not have continued to prescribe Vioxx after news of its dangers was made public. Yet compare the way Vioxx was removed from the market—amid the greatest possible publicity and under threat from billions of dollars’ worth of lawsuits—to what happened in 2004 with ephedra, which was America’s most popular dietary supplement.

Ephedra, derived from the Asian herb ma huang, has been used for thousands of years; the herb’s active ingredient, ephedrine, boosts adrenaline, stresses the heart, raises blood pressure, and is associated with an increased risk of heart attack, stroke, anxiety, psychosis, and death. None of that was in question. But the FDA’s decision to pull it from the market certainly was. Many of the Americans who were outraged that Vioxx had been approved in the first place were just as outraged when ephedra was banned. It took the FDA years of legal battle to get the supplement removed from the shelves of vitamin shops. Ephedrine-containing supplements have caused deaths in many countries, not just in America. But people still want it, and what people want, the Internet provides. “We’re growing ma huang (ephedra), which has been used in Traditional Chinese Medicine for 5,000 years but is now banned in America thanks to the criminally-operated FDA,” one foreign supplier wrote in 2009. And he will be more than happy to sell it to anyone foolish enough to send money. And why would anyone do that? Because a supplement is not a drug. Its value is taken on faith and no amount of evidence will ever convince true believers to turn away.

Belief outranks effectiveness. Vitamin worship demonstrates that fundamental tenet of denialism with depressing regularity. In 2003, a study that compared the efficacy of echinacea to a placebo in treating colds received considerable attention. Researchers followed more than four hundred children over a four-month period, and found not only that a placebo worked just as well, but that children treated with echinacea were significantly more likely to develop a rash than those who took nothing at all.

Subsequent studies have been even more damning. In 2005, researchers from the Virginia School of Medicine reported in the New England Journal of Medicine that echinacea had no clinical impact, whether taken as a prophylactic or after exposure to a virus. Nor did it lessen the duration or intensity of any symptom. In addition, the American College of Pediatricians has urged parents to avoid echinacea mixtures for children who are less than a year old. The response? According to the latest data released by the federal government in 2008, echinacea remains the most heavily used supplement in the childhood arsenal. (It is still wildly popular with adults too, but fish oil is now in greater demand.)

Almost no restrictions were placed on the sale of supplements, vitamins, or other home remedies until 1906, when, reacting to the revelations in Upton Sinclair’s book The Jungle, Congress passed the Pure Food and Drug Act. The law permitted the Bureau of Chemistry, which preceded the Food and Drug Administration, to ensure that labels contained no false or misleading advertising. Since then, the pendulum has swung regularly between unregulated anarchy and restrictions that outrage many Americans. In 1922, the American Medical Association made an effort to limit the indiscriminate use of vitamins, describing their widespread promotion as “gigantic fraud.” It helped for a while. By 1966, the FDA tried to require the manufacturers of all multivitamins to carry this notice: “Vitamins and minerals are supplied in abundant amounts in the foods we eat… . Except for persons with special medical needs, there is no scientific basis for recommending routine use of dietary supplements.” The vitamin industry made certain that no such warning was ever issued.

The relationship between food, drugs, and supplements began to blur in the 1970s as connections between diet, food, and medicine became more fully understood. What began as a federal effort to improve nutrition and prevent confusion has ended up as a tacit endorsement of chaos and deceit. First, with a major report issued in 1977 by the Senate Select Committee on Nutrition and Human Needs, and then with studies by the National Academy of Sciences and other research groups, the government started telling Americans to alter their diets if they wanted to have long and healthy lives. That made sense, of course. Advice about ways to reduce the risk of heart disease, diabetes, many cancers, and other chronic illnesses became routine. There were food pyramids and instructions to eat less salt and fat and add fiber as well as whole grains; eat more fruits and vegetables and watch the calories. Still, it was against the law to suggest that there was a relationship between the ingredients in a commercial food and the treatment or prevention of a disease.

Then, in 1984, came the Original Sin. That year, the National Cancer Institute lent its unparalleled credibility to the Kellogg Company when together they launched a campaign in which All-Bran cereal was used to illustrate how a low-fat, high-fiber diet might reduce the risk for certain types of cancer. All-Bran was the first food permitted to carry a statement that was interpreted widely as “Eating this product will help prevent cancer.” That led to the era of product labels, and completely changed the way Americans think about not only foods but dietary supplements and ultimately about their health. Food was no longer simply food; it was a way to get healthy. Some of those changes made sense: flour was fortified with folate; juice enriched with calcium; and in 2004, in the name of health, General Mills started making every one of its breakfast cereals from whole grains.

They were exceptions. It would require Dickens’s narrative skills and Kafka’s insight into bureaucratic absurdity to decipher the meaning of most products for sale in American health food stores today. In the world of alternative medicine, words have become unmoored from their meanings. As long as a company doesn’t blatantly lie or claim to cure a specific disease such as cancer, diabetes, or AIDS, it can assert—without providing evidence of any kind—that a product is designed to support a healthy heart, or that it protects cells from damage or improves the function of a compromised immune system.

It’s still against the law to claim a product cures a disease—unless it actually does. But there is no injunction against saying that a food or supplement can affect the structure or function of the body. Such claims can appear on any food, no matter how unhealthy. You cannot advertise a product as a supplement that “reduces” cholesterol, but you can certainly mention that it “maintains healthy cholesterol levels.” It would be illegal to state that echinacea cures anything, since of course it has been shown to cure nothing. But it’s perfectly acceptable to say that echinacea is “an excellent herb for infections of all kinds,” although no such thing has been proven to be true.

Even claims that are true are often irrelevant. Vitamin A, for example, is essential for good vision—as supplements for sale in any health food store will tell you. Insufficient consumption of vitamin A causes hundreds of thousands of cases of blindness around the world each year, but not in the United States; here people don’t have vision problems arising from a lack of vitamin A. Although statements advertising vitamin A for good vision may, like many others, be legally permissible, they are meaningless. And since too much vitamin A can cause birth defects and osteoporosis, for example, its potential to harm American consumers is far greater than the likelihood that it will do good.

Not long ago, I was given a free bottle of Lifewater at my gym. “It’s the perfect energy drink,” the woman handing it out said, “because it’s an antioxidant and nutritious. And of course, it’s water.” Except that Lifewater is not really any of those things. Water has no calories. My “Agave Lemonade Vitamin Enhanced Beverage” with natural flavors contained 40 calories per eight-ounce serving. That’s five calories per fluid ounce, a little less than half the calorie count of regular Pepsi, the signature product of the corporation that sells Lifewater. Even that number, of course, is misleading. Nobody drinks eight ounces; Lifewater comes in a twenty-ounce bottle, which brings the calorie count to 100.

Okay, 100 calories is not that big a deal. But the main ingredient in the drink is sugar: 32 grams in what many people assume to be vitamin-enriched water. And that is not the kind of water we need to be drinking in a country where one-third of adults are obese, 8 percent are diabetics, and both of those numbers are rising rapidly. Lifewater contains no meaningful amount of agave, lemonade, yerba maté, or taurine, all of which are listed invitingly on the bottle.

Lifewater is hardly the only beverage created, named, or designed to dupe people into buying the opposite of what they are looking for; it’s probably not even the worst offender. In January 2009, the Center for Science in the Public Interest sued the Coca-Cola Company in federal district court, saying that the company’s Glacéau division relied on deceptive advertising and unsubstantiated claims when promoting VitaminWater as a “Nutrient-E nhanced Water Beverage” and by employing the motto “vitamins + water = all you need,” for a product that has almost as much sugar in it as a similarly sized can of Coke. “VitaminWater is Coke’s attempt to dress up soda in a physician’s white coat,” the CSPI litigation director Steve Gardner said when he filed the law-suit. “Underneath, it’s still sugar water, albeit sugar water that costs about ten bucks a gallon.”

IT WOULD BE sufficiently distressing to know that the federal government permits unproven therapies to flourish in the United States. Through the National Center for Complementary and Alternative Medicine, however, it actually encourages them. Josephine Briggs is an internationally renowned nephrologist who has published scores of scientific articles in prestigious journals. She served for nearly a decade as head of the Division of Kidney, Urologic, and Hematologic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases before moving, in 2006, to the Howard Hughes Medical Institute, where she had been named senior scientific officer. Briggs is agreeable personally, scientifically accomplished, and widely considered a talented administrator. It would be hard to imagine a less controversial choice to lead a branch of the National Institutes of Health.

Her appointment as director of the National Center for Complementary and Alternative Medicine in 2007, however, was not exactly greeted with hosannas. Many of her scientific peers regard the center as a distraction and a waste of money—or worse. (Indeed, NCCAM has been opposed since the day it was created, in part because of the way the center came to be: NCCAM is the brainchild of Iowa senator Tom Harkin, who was inspired by his conviction that taking bee pollen cured his allergies—a belief he has stated publicly before Congress. There is no evidence that bee pollen cures allergies or lessens their symptoms. For some people, however, it can cause life-threatening allergic reactions.)

Traditional scientists expressed hesitation about Dr. Briggs’s appointment, but those were doubts about the center itself, not about her ability to do her job. The CAM community, on the other hand, saw themselves saddled once again with a “conventional” scientist as its leader. “New NIH NCCAM Director Wanted: No Experience or Interest in Field Required” ran the headline of one influential health blog, The Integrator, when word of the Briggs appointment surfaced in 2007. (The previous director, Stephen Straus, a renowned clinical virologist, died of brain cancer. He had also been criticized for his lifelong commitment to science-based medicine.) After Briggs was appointed, The Integrator was even more direct: “Oops, They Did It Again,” the publisher, John Weeks, wrote early in 2008. In an open letter to Briggs he continued: “Director Zerhouni appointed you, despite the fact that you too have no visible professional experience in the field that you were selected to lead. Of your 125 publications, none appear to touch on the kind of interventions which will be on your desk at your new job… . Perhaps you can explain why the NIH would choose a novice, for the second time—it’s officially 2 for 2 on this count—to run one of its domains? The answers that come to mind, and which I have heard from colleagues in the last 24 hours, range from fear to ignorance to suppression.”

Briggs says she was prepared for opposition from both sides. It started the moment she told colleagues at the Howard Hughes Medical Institute about her new position. “Some of the criticism from conventional medicine arises from the usual sort of turf wars, and some of it arises from areas where there is genuinely some quackery,” she said. “However, I think that we can steer this portfolio to the more mainstream practices, and the things that arouse the alarm of people who have been my colleagues all my scientific life are mostly things that are not being used by very many people.” In her laboratory, Briggs has studied the effect of antioxidants on kidney disease, but she has never used alternative medicine, personally or in her practice. “I myself am not a supplement user,” she said. “Vitamin D and calcium is my read of the literature”—by which she meant that those two supplements have proven their efficacy.

That’s a sensible, fact-based approach to the current state of knowledge about dietary supplements. It is not, however, the “read” of the people who care passionately about CAM, including Senator Harkin, who established the center’s precursor, the Office of Unconventional Medicine, in 1992 with $2 million in discretionary congressional funds. The word “unconventional” didn’t sit well with the healing community, however, so the name was soon changed to Office of Alternative Medicine. Its mandate was simple: investigate treatments that other scientists considered a waste of time and money.

The first director, Joseph Jacobs, resigned under pressure from Harkin after he objected to including some nominees for the center’s governing council. One of Harkin’s choices had even endorsed the use of laetrile—perhaps the definitive quack treatment for cancer. (The laetrile movement, founded in the early 1950s by Ernst T. Krebs Sr., was based on the idea that a chemical found naturally in the pits of apricots could fight tumors. It couldn’t, yet many desperate people spent the last days of their lives believing it would.) By 1998, the NIH director, Harold Varmus, a Nobel laureate who combined unimpeachable scientific credentials with a sophisticated understanding of Washington bureaucracy, wanted to place the Office of Alternative Medicine under more rigorous NIH scientific control. But Harkin wasn’t about to let that happen; in a deft bit of administrative jujitsu, he managed to elevate the office into an independent research center within NIH.

That made the center even more suspect among scientists than it had been before. Briggs, like her predecessor, finds herself in an intellectually precarious position. In effect, she is like an attorney who argues that the guilt or innocence of her client is beside the point because everyone has the right to a defense. The defense most commonly offered in support of CAM is its stunning popularity—and popularity can easily be confused with reality. It happens every day on the Internet. Confusing popularity with authority is one of the hallmarks of denialism. People take comfort in becoming part of a crowd. The sense that complex issues can be resolved by a kind of majority vote, as if it was an election, helps explain the widespread support for CAM. It is also a reason the anti-vaccine movement has been so successful. Democracy rules. Millions of people take antioxidant supplements. That’s unlikely to change. So the argument for NCCAM suggests that whatever we think of supplements, their popularity requires NIH to face reality and understand how they work.

Science doesn’t operate by rules of consensus, however, and the NIH exists in order to discover scientific solutions to the health problems of Americans. Briggs understands that. “I think that there is a tension in this area, and I feel this as a practitioner—that while I’m comfortable in trying to reassure people, I’m not comfortable in fooling them. And you know, I think any physician is aware that some of the confidence you build in someone is part of helping them get better, and when is that being a confidence man? That tension is kind of inherent in healing practices. It’s interesting; it’s not easily solvable.”

Briggs has become fascinated with the causes of the placebo effect—how it works on a biochemical level, and why. That the mind can affect the chemistry of the human body is not in doubt, and researchers have shown direct relationships between what a patient expects from a drug and its therapeutic results. In one experiment, Fabrizio Benedetti, professor of clinical and applied physiology at the University of Turin Medical School in Italy, demonstrated that a saline solution works just as well as conventional medicine to reduce tremors and muscle stiffness in people with Parkinson’s disease. Benedetti is also a consultant for the Placebo Project at NIH and a member of the Mind-Brain-Behavior Initiative at Harvard University. In the Parkinson’s study, he and his team found that neurons in patients’ brains responded rapidly to saline. In another experiment, Benedetti has shown that for people who have no idea that a switch has been made, a shot of saline can provide as much pain relief as one of morphine.

Briggs smiled but declined politely when I tried to steer the conversation toward the potential merits of homeopathy. Based on her scientific credentials, I have to assume that’s because she couldn’t have had much good to say about the practice, but neither can she afford to enrage her advisory council, some of whose members believe in it wholeheartedly. Briggs has begun to push NCCAM, and the studies it funds, to focus more seriously on chronic pain. It’s an excellent idea, since pain remains such a pervasive problem and conventional approaches at controlling it have shown only limited success.

Yet when an arm of the federal government devotes more than $100 million a year to a particular kind of research it makes a statement about the nation’s health priorities. NCCAM has spent its money looking into everything from the use of qi gong as a way to treat cocaine addiction to Therapeutic Touch for bone cancer. “NCCAM is presented as a scientific vehicle to study alternative medicine’s anomalous methods,” Wallace Sampson wrote in “Why the NCCAM Should Be Defunded,” the first of many appeals to close the center. “But it actually promotes the movement by assuming that false and implausible claims are legitimate things to study.” As Sampson and many others have pointed out, while the center has demonstrated the “ineffectiveness of some methods that we knew did not work before NCCAM was formed,” it has not proven the effectiveness of a single alternative approach to medical treatment.

That is because, uniquely among NIH centers, most of the research has been driven by faith rather than by science. D. Allan Bromley, a physicist who was science adviser to President George H. W. Bush, once said that NCCAM lent prestige to “highly dubious practices” that “more clearly resemble witchcraft than medicine.” Paul Berg, a Stanford professor and Nobel laureate in chemistry, wrote that “quackery will always prey on the gullible and uninformed, but we should not provide it with cover from the N.I.H.” And Ezekiel Emanuel, long the head of the department of bioethics at NIH, and brother of Rahm Emanuel, President Obama’s chief of staff, has published widely on the ethics of placebo trials and the use of alternatives. Highly implausible or impossible methods, such as homeopathy, “psychic (distant) healing,” Therapeutic—or Healing—Touch, and many other CAM claims are what Emanuel and colleagues have referred to as “trifling hypotheses,” and the ethics of pursuing them are shaky at best. “Comparing relative value is integral to determinations of funding priorities when allocating limited funds among alternative research proposals,” he wrote in the Journal of the American Medical Association.

Josephine Briggs and others at NCCAM may rely on the scientific method when assessing alternative therapies, but the man who founded the center certainly does not. In Senate testimony in March 2009, Harkin said that he was disappointed in the work of the center because it had disproved too many alternative therapies. “One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short,” Harkin said. The senator pointed out that since its inception in 1998, the focus of NCCAM has been “disproving things rather than seeking out and approving things.”

That’s a remarkable comment coming from a man who has spent years focusing on public health. In the opening sentence of the NIH mission statement, the agency is described as “the steward of medical and behavioral research for the Nation.” It is not the steward for “validating” treatments that don’t work. No wonder skeptics have complained from the beginning that Harkin created the center to promote alternative therapies, rather than to weigh their merit through rigorous testing. Afterward, I asked Briggs to comment on Harkin’s statement. “I certainly understand the desire to see positive results,” she said. “Rigorous, objective, scientific research often yields results other than what we would hope for, but our goal must remain one of building the evidence base regarding CAM practices.”

Senator Harkin wasn’t done. The next day, he traveled across town to the Institute of Medicine to address hundreds of people attending a “summit” on integrative medicine there. “Clearly, the time has come to ‘think anew’ and to ‘disenthrall ourselves’ from the dogmas and biases that have made our current health care system—based overwhelmingly on conventional medicine—in so many ways wasteful and dysfunctional,” Harkin said. “It is time to end the discrimination against alternative health care practices.”

Discrimination? The budget for NCCAM was $121 million in 2008, and it has disbursed more than $1 billion since Harkin first forced the Office of Alternative Medicine on the NIH leadership. By comparison, the NIH funding for autism research in 2008 totaled $118 million. Moreover, if a study is good enough to be funded, surely it can be funded by one of the other twenty-six institutes at the NIH. Physicians and other contributors to the relentless and insightful blog Science-Based Medicine have made this case many times. They have also examined in excruciating detail how NCCAM money is actually spent.

“Perusing the list of projects is truly depressing,” wrote David Gorski of the Wayne State University School of Medicine. “True, a lot of the projects seem to be yet another study of Ginkgo Bi loba, cranberry juice, or soy in various diseases. That’s all well and good, but why is the study of natural products considered ‘alterna tive’ or ‘complementary’? It’s the same sort of stuff that pharma cologists have been doing for decades when they study most botanical products.”

Gorski describes some of the weaker grants, including one funding a study called Polysomnography in Homeopathic Remedy Effects. “Yes, you have it right. Your tax dollars are going to fund at least a study this year on homeopathic remedies (a.k.a. water). But it’s even worse than that. [One grant was] actually awarded to study homeopathic dilution and succussion”—the act of shaking liquid each time it is diluted—“and how they affect the dose-response curve of homeopathic remedies. I kid you not. I just about spit out my tea onto my laptop keyboard when I read it. Naturally, it’s at the Integrative Medicine Program at the University of Arizona” (which is run by Andrew Weil).

A FEW YEARS AGO I wrote an article for the New Yorker about a man named Nicholas Gonzalez. He was a highly credentialed physician, trained at Cornell University Medical School and at Memorial Sloan-Kettering Cancer Institute. Gonzalez worked out of an office in midtown Manhattan, where he was treating pancreatic cancer patients using some of the most amazingly bizarre methods in modern medical history. He prescribed twice-daily coffee enemas, for example, and a pill regime for most of his patients that ran to four single-spaced pages. (It included, in part, sixty freeze-dried porcine-pancreatic enzymes, capsules of adrenal medulla, amino acids, bone marrow, selenium 50, thyroid, vitamin A 10,000, and vitamin E succinate. And many, many more.)

The prognosis for pancreatic cancer patients, then and now, is particularly bleak, and it seemed to me at least that if one were going to roll the dice, it might make more sense with that particular disease than with another. Gonzalez was reviled by members of his profession. But unlike virtually any other alternative healer, he always insisted that he wanted his method to be tested in the most rigorous possible way by the NIH, and in 2000 he received a $1.4 million grant to do just that.

Most people in the medical world thought the trial was a waste of time and money. I didn’t agree at the time, but I do now. Studies like that just make the ridiculous seem worth investigating. Wallace Sampson was right—we cannot afford to fund research that has no reasonable chance of success. It wastes money and steals time that could be devoted to more promising work. More than that, though, it makes the denial of reality acceptable. If you believe that coffee enemas and energy fields offer hope, you can believe anything. We have seen where that can lead.

Since the beginning of the AIDS epidemic, a small band of committed activists led by Peter Duesberg, a microbiologist at the University of California at Berkeley, have denied that the epidemic is caused by the human immunodeficiency virus. Thousands of molecular studies (and millions of deaths) have made it clear that there is no possibility they are right, but with the help of the Internet, the impact of that denialism has been felt throughout the world. People want to be told that everything is going to be all right. That’s normal. (“What mattered to me as a person living with HIV was to be told that HIV did not cause AIDS. That was nice,” Winstone Zulu, a Zambian AIDS activist and former denialist, has written. “Of course, it was like printing money when the economy is not doing well. Or pissing in your pants when the weather is too cold. Comforting for a while but disastrous in the long run.”)

AIDS denialism doesn’t die, even in America. In the United States the group the Foo Fighters recorded the soundtrack for a documentary called The Other Side of AIDS, which was directed by the husband of Christine Maggiore, one of America’s more prominent AIDS denialists (who, in 2008, died of AIDS). And in 2009, House of Numbers, a film made by another AIDS denialist, Brent W. Leung, provoked new outrage (and letters from nearly every prominent scientist featured in the film saying they were misled and quoted out of context).

It is of course in South Africa that the denial of fact-based medicine has had its most deadly effect. South Africa has the world’s largest population of people infected with HIV. Instead of treating those people with the antiretroviral drugs necessary to save their lives, former president Thabo Mbeki denied for years that the virus caused the disease. Like the Zambian leaders who refused to accept genetically engineered food to feed their starving people, and the northern Nigerian mullahs who campaigned against polio vaccinations, Mbeki suspected a Western plot. In this case, he believed that Western pharmaceutical companies had banded together to threaten the future of Africans; and he was convinced that a natural, local solution would be far more effective than the “poison” offered by such organizations as the World Heath Organization and UNAIDS.

Instead, he and his longtime health minister Manto Tshabalala-Msimang recommended herbs, garlic, and lemon. I have seen the effect of those herbs, and of the vitamin regimens peddled by people like the German health entrepreneur Matthias Rath with the tacit support of Mbeki and Tshabalala-Msimang. Rath urged people to substitute remarkably high doses of multivitamins for proven AIDS therapies like AZT. People who did that, rather than relying on the antiviral medicines they needed, died. In 2008, a group of researchers from the Harvard School of Public Health concluded that the South African government would have prevented the premature deaths of as many as 365,000 people between 2000 and 2005 had it provided antiretroviral drugs to AIDS patients. The study also concluded that the drugs were largely withheld due to “Mbeki’s denial of the well-established scientific consensus about the viral cause of AIDS and the essential role of antiretroviral drugs in treating it.”

Taking megadoses of vitamins or craniofacial massage for the flu may seem comforting. At worst, many have argued, such actions are self-inflicted wounds—like the self-inflicted wound of refusing to vaccinate a child. There comes a point, though, when individual actions become part of something bigger. Progress is never guaranteed. It can vanish if reality ceases to make more sense than magic. Denialism is a virus, and viruses are contagious.