Wallace Sampson Wallace Sampson is the editor of The Scientific Review of Alternative Medicine and a member of the Board of Directors of the National Council Against Health Fraud, Inc. Sampson has served as Chief of Medical Oncology at the Santa Clara Valley Medical Center, and is clinical Professor Emeritus of Medicine at Stanford University School of Medicine. Sampson studies and teaches about unscientific medical systems and anomalous medical claims, and teaches the critical analysis of alternative medicine claims at Stanford University. Sampson graduated from the University of California, Berkeley in 1952 and from the UC San Francisco School of Medicine in 1955.

Ann Thompson asks:
I would like to know about Spinology. There are people working in this field who claim to be able to lengthen a leg that is a bit shorter than the other. Does this not have to do with bones in the leg? I would really like to have some clarification on this issue. I would also like to know if there is any scientific evidence that the popular cold remedies such as zinc and echinacea actually work.
Thank you.

Sampson's response:
Yes, leg bones determine leg length, not the spine. Spinal deformities can cause the pelvis to tilt, making one leg appear to be shorter than the other, but they are the same. That is due to a real deformity, not an imaginary one, and cannot be corrected by manipulation or any other non-surgical procedure. Most "spinologists" are chiropractors. "Spinology" is not a recognized medical area of study (the word was made up.) Second, zinc is not effective against the common cold. Neither is Echinacea. The original reports on both were defective, and subsequent studies came out negative.

Charles Sullivan, D.O. asks:
It is common practice in Medicine to put patients on combinations of drugs. The vast majority of these combinations of drugs (especially where 3 or more drugs are involved) have never been studied at all, let alone in double-blind trials, yet it is frequent practice to prescribe these multiple-drug combinations.

It is well-accepted in Pharmacology that it is scientifically impossible to accurately predict the side effects or clinical effects of a combination of drugs without studying that PARTICULAR combination of drugs in TEST subjects. Knowledge of the pharmacologic profiles of the individual drugs in question does not in any way assure accurate prediction of the side effects of combinations of those drugs, especially when they have different mechanisms of action, which is very common because polypharmacy is most often prescribed to patients with "multiple illnesses".

About 180,000 patients in this country die from identified adverse drug reactions; the number who die as a consequence of polypharmacy is, to my knowledge, unknown.

The argument that the prescribing of drugs is the "Art" of Medicine is not valid in defending polypharmacy, because drugs are developed (indications, dose and administration, etc) and approved through a "scientific" process (double-blind, placebo-controlled studies). The fact that the medicines are often prescribed for "different conditions" is irrelevant (especially to the patient's physiology). The idea that " we are doing the best we can," a frequent defense of Polypharmacy, does not in any way uphold a scientific argument in favor of it. (We are, indeed, trying the best we can, with tools which do not improve at the rate we would wish!) The fact that "there is a limit to how much research can be done" in no way makes the research unnecessary in order to predict the side effects of specific combinations of drugs.

It has been said that 30% of medical practice can claim to be backed by controlled studies. Are we looking closely enough at our way of practicing Medicine? Can the use of unstudied polypharmacy really be considered evidence-based, "scientific" Medicine?

Are those of us in conventional medicine looking at our way of practicing using the same "scrutiny" with which we often condemn other "alternative" systems of medicine? Charles Sullivan, D.O. Waterville, ME .

Sampson's response:
The answer is that multiple conditions require multiple drugs to treat them. Rarely does one pharmaceutical treat more than one condition in a person. An example would be aspirin for pain in a person with rheumatoid arthritis, but that is unusual. Same for other cyclo-oxygenase inhibitors. Heart failure, cancer, and other conditions often require several different drugs that act in different ways to optimize effect. Cancer chemotherapy with multiple drugs can cure leukemias, lymphomas, testis and ovary cancers, and many others, whereas single agents cannot. Each combination has been used in thousands of patients, while physicians monitor for known side effects (those inconvenient blood tests and X-rays). Doses are well designed, then individually tailored for effect and side effects. In addition, all patients are closely monitored for unusual and unknown effects, and these are reported in the medical journals.

Objections to polypharmacy are now only theoretical, and are not realistic. Do you have an alternative for the cure and successful treatment of these diseases? If so, we will stop using multiple drugs in favor of that method.

The excuse for polypharmacy Dr. Sullivan quotes, that "we are doing the best we can," is not only irrelevant, it is unnecessary. Of course we always try to do the best we can, but that is not an excuse, it is a statement of medical ethics.

Dr. Sullivan then states that less than 30% of medical practice is supported by controlled studies. That is a medical urban legend. It is based on a statement made by epidemiologist Kerr White at an early meeting of the Cochrane Collaboration, also quoted from the OTA statement, that came from a 1962 study of prescribing habits of about 16 general practitioners one Northern English town. The UK National Health Service was checking on how much it was really getting for its outlay for medical care. At that time, controlled trials were in early methodological development - few medical scientists even knew how to do them - and there was a large number of drugs approved before trials were known, based largely on safety records and uncontrolled but accurate observations.

The NHS found about 20% of prescriptions were proved by controlled trials, but they also found the majority of prescriptions written were based on reliable observations and made physiological sense. But the punch line here is that in 1995, a report in the British Medical Journal showed that 83% of hospital orders written were supported by controlled trials and another 10-15% were supported by other reliable pharmacological knowledge. The Scientific Review of Alternative Medicine last year reported that some 15 articles now exist showing between 60% and 90% of treatments are supported by controlled trials.

Dr. Sullivan then asks if standard medicine is examined with the same scrutiny as we use for "alternatives?" The answer is that standard medicine is more closely scrutinized than sectarian, anomalous medicine. Even with the disparity in the number of trials. The reason so many have been done on "alternative" methods is that not enough of them come out positive. So they keep on trying.

Mary Praino asks:
My 78 year old mother underwent colon surgery and had a malignant tumor removed and a re-section. The entire tumor was removed, however after testing 24 lymph nodes, they found a mild case of carcinoma in one of the nodes. She is refusing chemotherapy and I have been giving her 30 mg. of Q10 enzyme daily. Will this enzyme aid in discouraging the growth of this type of cancer? Should I be giving her any other type of supplement, as well? I am very concerned about her condition and would appreciate any advice you could give me.
Thank you.

Sampson's response:
The answer is that there is no medical use for CoQ10. Nor will any supplement affect colon cancer. Yet, pharmaceutical drugs (chemotherapy) and other drugs do affect colon cancer. Fluorouracil will reduce the chance of recurrence in her case by about 30%. An investigational approach would be to use one of the modern anti-inflammatory drugs such as Celebrex or Vioxx. They cause colon pre-cancerous polyps to regress and also cause regression of colon cancer cells.
This is another case of pharmaceutical drugs working, where "natural" substances do not.

Gregg Kellogg asks:
You may recall treating me around 1989 for ITP, which had an onset just after trying an herbal remedy. While I'm sure this falls into the category of thinking that the last treatment must have caused a result that doesn't, in fact, correlate to the "treatment," I wonder if there have ever been any studies that show a negative affect to such alternative therapies.
(It was great to see you on the show. I'm glad to see you're doing well, as am I).

Sampson's response:
The answer, Gregg, is the same today as 15 years ago. ITP (immunologic thrombocytopenic purpura - a mouthful meaning low blood platelets with small bleeding spots in the skin and mucous membranes.) has few known triggers, mostly drugs - quinidine and quinine, and a few diuretics. ITP is most often acute (temporary) and full recovery occurs 90% or more of the time. The chronic form is less dramatic and also usually not fatal or drug associated. I do not know of any supplement or herb cause. The herb material could have caused it but as you stated, one case of two sequential events does not make a cause and effect. Glad you are still well.

Susan asks:
Several years ago I read a report in our local newspaper of a breakthrough study that had been performed by pediatric surgeons at the local teaching hospital. Apparently, "the experts" had assumed that infants did not feel, could not recognize, were not adversely affected by pain since there was no empirical evidence to the contrary. The study found that infants that were given anesthesia during surgery had far better outcomes that those who were not given anesthesia. As a young parent at the time, I remember being so shocked and dismayed as to be speechless. I've never looked at the medical "profession" quite the same way since. I only know a little physiology, but doesn't pain (stress, trauma) initiate a whole cascade of physiological responses. Does the baby not cry and appear to be in pain? I couldn't help wondering how many traumatized infants had become troubled children and adults as the result of their treatment as infants, of those who survived, that is.

Some things are intuitive and just plain common sense. The moral of this story is, I suppose, that it is possible that you cannot quantify everything and the absence of empirical evidence at a given time does not necessarily mean something is correct or incorrect.

Sampson's response:
First, Susan, I think there may be something missing in the report. Either the reporter got it wrong, or else it was written differently or perhaps interpreted differently by readers or your assumptions are incorrect. No one I know thinks that babies do not feel pain, or ever thought that they do not feel pain. It sounds like they wondered how the babies did days later - something not really measured before.

In addition, all major surgery is done under general anesthesia - no matter at what age, so perhaps they were talking about some minor surgery such as circumcision or a laceration repair. In those cases, administering local anesthesia can be as painful as the procedure. Sounds strange, but true in many to most cases. In the past, general anesthesia was more dangerous than it has been in the past 20 years.

Whatever the question, I recommend tracking down that report, reading it again, and maybe calling the surgeon, and making sure the story is right.

HB asks:
I was wondering what you might know and or think about "ultraviolet light blood irradiation." I know it was popular in the 30's and very effective, but seemed to die out. I know it is not herbal, but I would think it would be considered a blend of traditional and alternative medicines.

Sampson's response:
This is an example of the problem of definitions. Is this an "alternative"? Alternative to what? For what is it used? This is not to criticize the questioner, but to illuminate the hidden questions behind some simple sounding questions in this field. In order to be irradiated the blood would have to be removed, which surely does not make it "natural" or simple - sterile precautions must be used, careful handling to avoid contact with the operator, etc. Ultraviolet light is still used for some skin conditions so it is not "alternative" in that sense.

The shorter answer is, I don't know.