Paul Offit is a pediatrician who specializes in infectious diseases. He is the co-inventor of a rotavirus vaccine that is credited with saving the lives of hundreds of children on a daily basis. Despite significant academic and humanitarian achievements, in autism circles, Paul Offit caries the dubious distinction of being hailed both as a hero and a villain. Why?
In the United States Dr. Offit took the lead in debating the lack of science behind Andrew Wakefield’s claim (see: http://www.medscape.com/viewarticle/735439 ) regarding MMR vaccination and its causative role in autism. Those who blindly accept Dr. Wakefield’s arguments are certainly threatened by Dr. Offit’s logic (see http://www.whale.to/v/offit1.html). I still remember a pro-mercury lecturer at AutismOne several years ago who finished his PowerPoint presentation by offering an analogy between Dr. Offit and Nazi war criminals. His message was quite clear and constituted a direct physical threat to Dr. Offit’s life.
Figure: Paul Offit, M.D., chief of infectious diseases at the Children’s Hospital of Philadelphia and the Henle Professor of Immunologic and Infectious Diseases at the University of Pennsylvania School of Medicine
I usually straddle the autism divide and do my best at judging arguments, respective of origin, based on their empirical foundation. As I belong to several autism advisory boards and list servers, Paul Offit’s book has come into discussion on multiple occasions. Some people posting on the book demonized the same and thought the author’s intent at publishing was a direct attack to their own persons and ideas (this may still be the case if you are Mehmet Oz, Suzanne Sommers, or Jenny McCarthy). Others thought that by publishing the book Paul Offit was making himself rich, selling vaccinations, and/or minimizing the impact of alternative interventions in autism.
I decided to read the book in order to have an informed opinion on the same. The book was very well written in simple and easy to understand prose. I took the book with me a few weeks ago while I was traveling and was able to read through it during my airport layover (I had a 10 hour or so layover at Moscow). In the end, I found the vitriolic of negative criticisms ill-founded. By far the large majority of the book does not deal with autism nor with vaccination. It is a somewhat subdued criticism of alternative medicine that ends by saying that there is a place in current practice for both mainstream interventions and alternative medicine. However, «buyers beware», anybody entertaining pursuing alternative medicine should do well to investigate the same.
Throughout his book, Paul Offit surveys the efficacy of professionally organized alternative therapies (e.g., chiropractic medicine, homeopathy) and does not indulge in discussing many others (e.g. aromatherapy). The dichotomy between what is known about each alternative intervention and its acceptance by society is striking. Most people are cognizant of the potential harms of chiropractic interventions and the nonsensical scientific arguments used to sell the same. Dozens of people die each year as a direct consequence of chiropractic interventions. Still chiropractic procedures are part of the primary health care to a significant percentage of the population. The rise and fall of laetrile (a chemical substance found in the pits of apricots that was reputed to have anti-cancer benefits) seems so distant and absurd that most of us believe it could never happen again. Yet, absurd cures still abound. Have you heard of bleach enemas for autism? Homeopathic remedies have no scientific basis and act primarily as placebos. However, there are dozens of homeopathy schools around the USA, some of which (unsurprisingly) combine their treatment with chiropractic manipulations. Antioxidants which have been hailed as the first step in our anti-aging battle, may increase the chance for a person developing cancer. Oxidation, which is required in many important biochemical steps, is needed in order to maintain the metabolic balance of our bodies. Mess with the metabolic balance of the body and bad things may happen. Still, despite all possible warnings, the playing field is rigged for alternative interventions to do more harm than good.
Dr. Offit has proposed four ways in which alternative medicine may be hurtful:
«…by recommending against conventional therapies that are helpful.»
«…by promoting potentially harmful therapies without adequate warning.»
«…by draining patients’ bank accounts,…»
«…by promoting magical thinking,…»
Figure: Steve McQueen, also known as the King of Cool, pursued alternative treatments for his cancer in Mexico. The interventions included coffee enemas, laetrile, injections of live cells from diverse animals, etc. The interventions all proved ineffective but made him the poster child for the pros and cons of alternative medicine.
In «Do You Believe in Magic» Dr. Offit chronicles the double standard our nation has developed when judging the safety and efficacy of drugs. We have the FDA and numerous medical boards that provide data on the safety and efficacy of medications but nothing to protect us in the field of alternative medicine. In effect, politicians rather than health professionals are the ones making decisions regarding alternative medicines. Politicians equate the right to pursue alternative interventions at the same level as religious freedom. The public is therefore not protected from purveyors of alternative medicine and have little opportunity to pursue complaints against practitioners whose disciplines lack formal disciplinary codes and sanctions.
Overall, «Do You Believe in Magic» is an excellent read. The end message is to debunk the way of thinking that because something is «natural» it is also safe and probably better than synthesized drugs. This is simply not the case. In the end alternative medicine may be a misnomer. “There’s no such thing as alternative medicine. There’s only medicine that works and medicine that doesn’t” (Paul Offit).
Agree with you entirely. The development of an effective rubella vaccine and the international ban on the use of Thalidomide in obstetrics are the only, so far, effective prevention strategies.
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I think it is wrong to second guess someone’s else decision to treat their own cancer. Dr. Offit does not know all the facts of others people’s cancer or diseases, nor does he know the extent they did or did not seek traditional care.
Secondly while Offit is a good writer his data is very much cherrypicked. For an absolutely excellent read check out «Changing the Course of Autism, » by Dr. Bryan Jepson. Jepson is an ER doctor whose son developed autism and he spent years researching causation and treatment. It is dense but profoundly well researched and unbiased.
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Thank you for your comment. The same is taken in constructive fashion. The way I see it Dr. Offit’s book (and the blog) was not about the right of a person to decide his or her own treatment, but whether some treatments are worth anything. Curiously the argument as to the right of people to chose their treatment is the same approach used by the megacorporations of alternative medicine and politicians to keep that field deregulated. I think you would find several chapters in Dr. offit’s book, that deal with the history of alternative medicine and its politics, an excellent read.
I agree that a lot of what Dr. Offit focused upon was cherry picked and probably biased. On the other hand the book was not meant to be comprehensive, it was directed at the layman, and was supposed to create an impact. I am not sure that I could have done anything better myself.
I think the fact that I share some opinions with Dr. Offit (i.e., the value of chiropractic an homepathic medicine) makes me a somewhat biased observer. I admit to the fact. However, my opinions as to these fields are based on several decades of experience as a neurologist. In this regard, I consider of no scientific value the arguments promoted by these fields.
I must say that although I read a lot regarding layman neuroscience and autism in particular I have not read Dr. Bryan Jepson’s book. This is my fault. I do admire a parent and his/her quest to try to find a cure for their childrens’ ailments. The book will be on my reference list to read in the immediate future. The book has received some positive reviews and a few negative ones («…Here, he cherry picks fringe studies and mines anecdotes to support his discredited hypothesis, and ignores or distorts the mountain of evidence against. He even embraces work by Andrew Wakefield,…»). I must say that anybody that believes in the charismatic Andrew Wakefield is seriously deluded. (I have read Dr. Wakefield’s books and attended several of his presentations).
I looked up Jepson’s citation record and it appears to be nonexistant, the book itself has received some 55 citations since 2007 (less than 10 per year). I look at Dr. Offit’s citation record and his first listed publication (of many) has been cited 1,195 times. Just to say that looking at the citation record alone suggests a different level of science.
I do believe that there has been a conspiracy by big corporations that has undermined the health status of our children, but this is coming from the alternative medicine field.
Thank you again for your comment.
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And again, with great frequency we see cases where «alternative» medicine made a huge difference in the life of many autistic children. Call it «faith, placebo…» it is the healing power of the mind at work that goes beyond or concept of «data.» That is, in my humble opinion, the untapped dimension that allopathic medicine finds it «irrelevant.»
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Allopathic medicine does not find irrelevant the effects of placebo. Your comment that alternative medicine works by either faith or placebo is in close agreement with the opinion of Dr. Offit. Hopefully you have found his book a useful read.
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