Tuesday, October 1, 2013

Paul Offit: "I ask for people to be more skeptical"

Paul Offit is an pediatrician, the Chief of the Division of Infectious Diseases of the Children's Hospital of Philadelphia, and was the co-inventor of the rotavirus vaccine. His last book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine, is a critical analysis of alternative medicine. 

This is the second part of the interview I did with Paul Offit, which is available on Youtube. Links: first part | video on Youtube | versão em português.

With more risk of acquiring heart disease and cancer with vitamin E, do you know some hepatologists recommends vitamin E for non-alcoholic steatohepatitis*? 
I'm not familiar with those data, but if there are studies showing that vitamin E in that situation is a value, it's great. But what amazes me about the vitamin E story is that I bought a preparation of vitamin E that said "natural E 1000". If you look on the back label, it said that it had 3330% of the recommend daily allowance. This gel cap it's about the half of the size of almond. Almonds are excellent sources of vitamin E. You would have to eat about 1650 almonds to get what was the amount of vitamin E of that one gel cap. That's not a natural thing to do. And now we know: if you take large doses of vitamin E or betacarotene for prolonged period of time, you increase your risk of cancer and heart disease and potential shorten your life. Those data were clear; there are twenty studies now.

And what are the risks of taking multivitamin supplementation (vitamins supplements in a dose near to the recommend daily allowance)?
There is one study with women that took multivitamins and they did worse than the ones who didn’t take the supplements. But I would like to see this study repeated, before we can say that with confidence. The false assumption of supplementation is that the vitamins taken in a small pill are going to be processed in the same way as the vitamins of vegetables and fruits.

I think it is a preconception to assume that vitamins supplements are safe just because are natural. I don’t know where this confidence come from. What do you think? 
I give credit to the industry, which has been able to sell itself as natural. For example, you have the nutraceutical and dietary supplements industry that sell their supplements as all natural, as it can’t hurt you and it’s being made by old hippies on mountains. This is not true. Pfizer and Hoffman-LaRoche are major players in dietary supplement game. Second, it’s an unregulated industry with no obligation to support its claims and in United States they have enough political influence to keep the FDA away from regulate them.

What about other types of alternative medicine, like acupunture, do you think it's valid for any condition?
Edzard Ernst was the first one to do retractable needle studies that shown if you though that the needle are going under your skin is valuable as the needle actually going under skin. There are studies showing some people can learn to release endorphins with acupressure. I can tell you that there two pediatricians in the Children's Hospital of Philadelphia, who had been trained in acupuncture - it's like to be trained to be a psychic, as far I'm concerned - and want to bring acupuncture to the hospital. I think they want to do that because there are patients demands. Instead of what we should be doing as doctors, which is to help patients going through medical information, instead of setting a professional standard, we become waiters in a hospital. The Hospital of University of Pennsylvania offers reiki master in their oncologic clinic. I don't think that hurts anybody, and maybe some people do benefit from that, but the slippery slope is that it creates this notion that there are healing energies to manipulate.

People need to make a distinct that if a treatment works it doesn't mean it works in the way it claims. 
That's a very good point. Mehmet Oz was asked what he does when his children gets sick. He answered that his wife gives a homeopathic arnica and if the children are still sick, if they don't get better from that, she calls him. Here's the logic of that. Probably 8% of the diseases we see in the emergency department of The Children's Hospital of Philadelphia are self-limited, such as viral infections of nose and throat. So you can make the argument that the homeopathic arnica is not going to heart them and the odds are they have self-limited disease. By giving the homeopathic arnica means they are not getting antibiotics for viral infection, that's good. It means they are not getting a preparation that contains pseudoephedrine, which could be quiet damaging special to young children, and that's good, and they get better. The problem is either he or his wife believe the homeopathic arnica actually made them better. Then, the next possibly awful step is when a child has asthma, you give a homeopathic bronchodilator. Children had been given homeopathic bronchodilators and died, instead of getting real bronchodilators, which would save their lives.

What's the whole point of writting your book Do you believe in magic? 
I guess I have this fanciful notion that if you can explain something clear and compelling and in an interesting manner, you get people to take a step back to think what they are doing. That's all I ask. I ask people to be more skeptical about what they are putting into their bodies. I think you should be skeptical to anything you put on your body, including vaccines.   

People say to me often that is not a good thing to be a skeptic. Do you have problems with that? 
It’s true. When I had surgery on the knee, my surgeon recommended that in my recuperative period I take chondroitin sulfate and glucosamine. But the data say chondroitin sulfate and glucosamine do nothing to promote healing, to decrease inflammation and pain. And there are studies showing that they do nothing for the pain of arthritis. I knew those studies and I couldn’t convince myself that was something I should do. It could be argued that if I thought that was going to relieve my pain and, therefore, I wouldn’t take a non-steroid anti-inflammatory drug. It’s expensive, but was not going to hurt me. But I didn’t share this belief system. In theory, science shouldn’t be a belief system, it’s an evidence-base system and the evidence was not that for it.  

On your last book, you mentioned that we used supernatural explanations to explain disease and now we don't use it anymore, we replace them. Do you think religious or any supernatural idea creates a barrier for scientific understanding?
Yes. When I wrote this book, I got a lot of hate mail from people who I think were angry that I attacked their belief system, I attacked the church of vitamins and supplements. Religion is a belief system, science is an evidence-based system. People make what should be an evidence-based system a belief-system.

Why people don't trust modern medicine? 
I think because it can be frustrating, technological and cold. What alternative medicine offers is something that is warmer; it is built in some sort of spirituality. And the fact that modern medicine is uncertain; there are many things we don't know. I'm sure we will know more in 100 years than we know now. We are constantly generating new information, that's what science is. In science, as you generate more information, you can take a textbook and throw it out without a backward glance. That's good, it’s mutable, it’s changeable; it's always self-correcting. But I think uncertainty is disconcerting, if you get the certainty of Andrew Weil.. If you look his books, he tells you not only how to treat your hepatitis, but he tells how to be a friend, how to raise your children, it's like a bible. Then, I think people are attracted to that.

And what's the whole point of writing your book Do You Believe In Magic? 
I guess I have this fanciful notion that if you can explain something clear and compelling and in an interesting manner, you get people to take a step back to think what they are doing. That's all I ask. I ask people to be more skeptical about what they are putting into their bodies.

* This is a recommendation from the guideline for the diagnosis and management of non-alcoholic fatty liver disease published by American Association for the Study of Liver Diseases, American College of Gastroenterology and American Gastroenterological Association. This guideline is available here.

I would like to thank Paul Offit for his kidness and attention!

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