There’s very little that makes me angrier than the unnecessary deaths of babies. That’s why homebirth often makes me very angry indeed.

In the US, most doctors and certified nurse midwives refuse to attend homebirths because of the danger. Therefore, most US homebirths are attended by “direct entry” midwives (DEM), aka certified professional midwives (CPM). These are just fancy names for midwives with no medical training. The statistics on neonatal death at homebirth are so appalling, that Midwives Alliance of North America (MANA), the trade union for homebirth midwives, refuses to release the death statistics to the public; they are available “friends” of midwifery.

American homebirth midwives are grossly undereducated, grossly undertrained, and downright dangerous. The national and state statistics bear this out, but nothing illustrates it better than a real life example. This tragedy was brought to my attention by a commenter who had been following the story on the mother’s website.

Carri, a mother of 8, had been planning an unassisted homebirth. I recently wrote about this appalling stunt and its high death rate (Stuntbirth). Carri had had 4 successful unassisted deliveries and was planning a 5th. As the due date approached, even Carri, as deluded as she was about the safety of unassisted childbirth, could not deny that her uterus was much larger than expected, and she sought the “advice” of Brandi, a CPM, at Central Indiana Home Birth Midwives.

Brandi diagnosed twins (without the aid of ultrasound), and noted elevated blood pressure. She advised the typical homebirth midwives quack “treatment,” a high protein diet, which, not surprisingly, accomplished nothing. As the pregnancy advanced, first one week beyond the due date, then two weeks, then almost three, Brandi counseled waiting for nature to take its course.

And nature did take its course. Carri’s baby is dead, and she is now fighting for her life in an ICU. The presumed cause is an amniotic fluid embolus.

There was only one baby, not two. That’s at the top of the long and horrifying list of mistakes. It is unheard of for a responsible practitioner to diagnose twins when only one baby is present on ultrasound, but Brandi assured Carri that one baby was “hiding” behind the other.

Even more appalling, if possible, is Brandi’s reaction when she heard only one heartbeat. According to Carri (posting on MotheringdotCommune):

One time the midwife gets two heart beats and the last time she just could not find the other and felt okay to let it be because there was active movement …

It would be laughable, were it not deadly. The homebirth midwife “diagnosed” twins, then clung to that delusion even though there was only one baby on ultrasound, and only one heartbeat.

Not surprisingly, someone deluded enough to believe that there were twins when only one baby could be seen was also deluded enough to believe that a clearly pathological pregnancy was normal. Carri measured much larger than expected even though there was only one baby. Almost certainly, there was a massive excess of amniotic fluid (polyhydramnios), both a sign of problems, and a risk factor for future complications (including amniotic fluid embolus). Carri’s abnormally elevated blood pressure was untreated by the quack remedy that was “prescribed.” Pregnancies over 2 weeks past the due date have a dramatically increased risk of stillbirth, as well as life threatening birth complications. The midwife pretended that this was not so.

So now Carri’s baby is dead, and Carri is fighting for her life.

People need to understand American homebirth midwives are a second class of midwives with less education and training than other American and European midwives. The standards for direct entry midwives, in terms of educational requirements and clinical training, are far below those of any other midwives in the industrialized world. American homebirth midwives are, by and large, quacks, and babies are dying as a result.

Addendum: One of the things I find most interesting is how everyone involved understands that the refusal to seek real medical care led to this tragedy. Carri’s family has removed the posts detailing her actions in the weeks leading up to the catastrophe, and MotheringdotCommune has removed the posts by Carri and those responding to her. The baby died possibly because of unassisted birth/homebirth, and now supporters and the family want to remove the evidence.

Jon and Kate Gosselin have announced that they will issue a “life-changing decision” on June 22 during their hit reality TV show, Jon and Kate Plus Eight. The Boston Herald described the commercial airing in advance of the one hour special episode:

“Recently, we’ve made some life-changing decisions – decisions that will affect every member of our family, ones that we hope will bring each of us some peace,” Kate says in the spot.

The promo features giant graphics with phrases like “A family in turmoil” and “A relationship at a crossroads” flashing across the screen.

Here’s what they ought to say, although I know that’s never going to happen. They ought to say:

After deep and soul-searching reflection, and with the aid of our pastor and strong religious faith, we have come to the conclusion that we can no longer continue appearing on television. We have been married for 10 years and recently renewed our vows. We take those vows seriously.

Marriage is a promise to stay together through good and bad. No one needs to promise to stay together when things are good, so in essence, marriage is a promise to stay together and stand by each other when things are not good. As the public is aware, each of us has gone through a period of sadness and confusion. It seems like it might be easier to separate, but marriage is not about taking the easy course.

To honor the unbreakable commitment that we made to each other before our family, friends, and before God, we have regretfully come to the conclusion that we need time and privacy to repair our relationship. We need to concentrate on each other and our family, and a TV show and publicity tours are simply not compatible with what our family needs now.

We love our children more than life itself, and we know that more than anything, more than money or fame, our children need to grow up sheltered under the umbrella of the strong relationship of their father and mother. We want to show our children the true meaning of marriage and commitment. We are willing to forgo the temporary rewards of money and fame for the more lasting rewards that come from putting marriage and family before anything else.

We thank the public for being guests in our home and lives, but there comes a time when the guests must leave. We appreciate the love and concern that so many have show to us, and we hope that everyone will respect our need for privacy at this time. There will be no more TV show, no more books, and no more publicity tours for the foreseeable future.

In truth, this is a financial and emotional sacrifice for us, but marriage and children often require sacrifices of both partners. Although it is a sacrifice, we expect profound rewards: the deepening of our commitment to each other as spouses, friends and parents of eight precious children.

That’s not what they are going to say, of course. They are going to announce a separation, or even a divorce. And they are going to continue to capitalize on the boost in popularity that a troubled marriage has brought them. That’s why they put out press releases, why they are staging a “special episode” and why they are running commercial spots to promote it. They are no longer a family, but merely a business, and business is booming even as their family falls apart.

Surgeons can do amazing things. They can remove an appendix that is about to burst, bypass blocked arteries in the heart, or even carefully excise a tumor from the brain. But surgeons never work alone. They always depend on the human body’s intrinsic abilities, the ability to clot blood, the ability to combat bacteria, and the ability to heal.

A surgeon knows that if he removes a gangrenous appendix the patient will get better, but it isn’t the removal that makes him better. The surgeon assumes that the stitches will stop the bleeding at the site where the appendix was removed, the immune system will clear away the residual infection, and the skin and deeper tissues will heal themselves together again.

I always assumed that, too, until I met the man who wouldn’t stop bleeding.

Met is probably the wrong word, since my first encounter with him occurred while he was under general anesthesia on the operating table. It was early in my internship year and I was called to the operating room to provide assistance during a disaster of major proportions. A young man undergoing a surgical repair of a damaged artery would not stop bleeding. I was called merely to hold the retractors that kept the surgical wound open so that the surgeons could see the area in question. Another intern had been holding them for many hours and I was sent to relieve him.

The surgery, which had been scheduled to last 2-3 hours, had been going on for more than 12 hours with no end in sight. On the wall of the operating room hung the empty plastic bags that had contained the 40 units of blood that had been given to the patient thus far. As I stepped to the table, having gowned and gloved, I could see that the wound was filling with blood as fast as the surgeons could suction it away. One of the surgeons noticed my presence and explained what was going on.

The young man, in his late twenties, had been diagnosed an aneurysm of the main artery feeding one of his legs. An aneurysm is a weakening and ballooning out of a blood vessel wall that will ultimately rupture (and kill the patient) unless surgically repaired. It usually occurs in people over age 60, generally smokers. While the surgeon who had planned the operation had recognized that an aneurysm in a young person is quite unusual, he hadn’t fully considered why this unusual event had occurred. Unfortunately, he quickly found out when he attempted to repair the artery.

The artery in question, indeed all the patient’s arteries, were unusually weak. We later learned that the patient suffered from a rare genetic disease that made his artery walls abnormally thin and weak. At the time, all we could see was that the artery would not hold stitches.

The aneurysm had been excised during the first hour of the surgery. In the subsequent 11 hours, the surgeon, ultimately aided by two colleagues, struggled to close the residual hole in the artery. Yet every time they successfully stitched it closed, one or more of the sutures tore through and a torrent of blood poured from the artery. The situation was truly desperate, and desperate situations call for desperate measures.

It was impossible to close the blood vessel perfectly, as would have been required in any other patient. The decision was made to close the artery as completely as possible and to control the residual bleeding with pressure. Just like you or I might stop the bleeding from a cut by applying pressure, we would try to do the same, except that the pressure would need to be applied inside the body, not outside.

The wound was packed with as much sponge and gauze material as could fit inside, and the incision was left often. The patient was transferred to the intensive care unit with the recognition that either the bleeding would gradually stop or the patient would die. The patient left the operating room 16 hours after he had entered it and the vigil began.

Amazingly, and against all odds, the bleeding slowed and eventually stopped. Although the artery itself was defective, the patient retained the ability to clot blood, and the combination of blood clot and pressure ended the bleeding. No one dared to risk further bleeding by removing the packing, so it was decided that the wound would be left often to heal itself from the bottom up.

And that is precisely what happened. Within several days, the artery healed itself, and we began gently changing the packing each day. It took 3 months for the wound to heal completely, with progress measure by the gradually decreasing amount of gauze sponges that could be fit inside the wound. Initially I would arrive at his bedside each day with a seemingly inexhaustible supply of gauze to replace the old packing. After 3 months, I needed to bring only a large surgical bandage to cover the wound.

Ultimately the patient walked out of the hospital alive, a tribute to the body’s ability to withstand tremendous trauma and to heal itself, even under less than ideal conditions. Unfortunately, the story does not have a happy ending. There was no way to treat underlying genetic defect in his arteries and several years later another aneurysm developed in a different artery. This time the surgeons could not get the bleeding under control no matter what they tried, and the young man eventually bled to death.

You’ve got to hand it to the folks at Matrixx Initiatives. They managed to convince millions of Americans to paint the inside of their noses and throats with a toxic heavy metal that is ineffective in its stated benefit and destroys the nerves responsible for the sense of smell.

Matrixx marketed Zicam as a cold remedy. There is no evidence that Zicam has any effect on colds, but there is decades of data showing that zinc, the purported active ingredient, can damage the sense of smell. Indeed, since 2006, Matrixx Initiatives has been forced to pay $12 million dollars to 340 people who claimed that Zicam destroyed their sense of smell. Hundreds more lawsuits are still pending.

So how did Matrixx manage to convince Americans to apply a toxic heavy metal to sensitive internal tissues? They called it a homeopathic remedy and that allowed them to avoid having to prove that Zicam was effective or even safe. And, they relied on the gullibility of the American public and its current love affair with all things “natural.”

The Obama Administration is working to close the legal loophole that allows companies to market “natural” remedies without proving that they are effective or even safe. In the meantime consumers can become less gullible. The first step is to understand how we know whether a substance works. Answering the question goes far beyond giving the substance to individuals and asking them about their perceptions.

The study of drug efficacy and safety is pharmacology. Pharmacology can be roughly divided into two areas: pharmacodynamics, how the substance acts on the body and pharmacokinetics, how the body acts on the substance.

Here are some basic questions that must be answered to find out how the drug works on the body:

How does the drug work? What is the active ingredient? What effect does the active ingredient have on the body?

What is the dose-response? In other words, as the dose of drug increases, does the response increase?

What is the ED50, the dose that produces a response in 50% of subjects, also known as the median effective dose?

What is the maximum effect that can be produced by the drug, also known as efficacy?

What is the therapeutic window? For every drug, there exists some concentration which is just barely effective and some dose which is just barely toxic. Between them is the therapeutic window where safe and effective treatment will occur.

In addition, we need to know how the body interacts with the substance.

How does it enter the body?

How is it removed from the body?

Does it have effects on other parts of the body besides its stated therapeutic effect?

What did the makers of Zicam know about their product before they put it on the market? The only thing that they knew is that the active ingredient is zinc. They did no testing that would tell them the mechanism of action, the dose response or even the effect of the zinc on other tissues of the body. Therefore, at no time did they have evidence that the drug was either safe or effective, yet they sold it anyway.

Determining drug efficacy and safety is complex. It is absolutely imperative to study the pharmacodynamics and pharmacokinetics of a substance before anyone can claim that it is effective or safe. As the case of Zicam illustrates, when it comes to “natural” remedies, these questions have not even been asked, let alone answered.

In an industry noted for greed, sharp tactics and lack of social conscience, the drug company Genzyme has managed to set a new standard for depravity.

Yes, depravity. Genzyme’s latest strategy for amassing outsize profits, proudly described by company executives in today’s Boston Globe, is, in my judgment, nothing short of morally depraved.

Genzyme, as its name implies, has pioneered the use of genetic engineering techniques to create and manufacture drug treatments. The greatest potential of genetically engineered drugs lies in treatment for so called “orphan” diseases, those they afflict very few people, not nearly enough to form support groups, charities and public advocacy groups that pay for treatment. Although many companies have had success in creating novel, highly effective treatments for orphan diseases, they find it hard to profit from such treatments, because demand is very low.

Orphan diseases, by their very nature, are often difficult to diagnose and require sophisticated medical equipment and training to even identify. The chances of an orphan disease being diagnosed in the third world, let alone being treated, are extremely remote. Genzyme’s new corporate strategy is to search the third world for children suffering rare diseases, provide the technology and equipment to make the diagnosis and then attempt to force the government of the third world country into paying for the extraordinarily expensive treatment by diverting money that would otherwise be used to provide basic medical care for large numbers of people.

The idea is pure genius. By identifying a specific child who will die without treatment, by informing the child’s family that a lifesaving treatment exists, but will be withheld without full payment the drug company is able to exert far more pressure on the specific government than they could by a simple announcement that 1 or 2 children in any given third world country might benefit from the treatment.

The Globe details how this technique works in practice. Consider Tania, the Costa Rican girl, who is dying of the rare genetic disease Gaucher’s. Tania’s family did not know what was killing her, and they would never have known, if it were not for Genzyme’s efforts to find and identify Tania, and inform her family of the treatment that could save her life, the drug Cerezyme, at the cost of $160,000 per year:

Genzyme created divisions within the company to find overseas patients …

Costa Rica was part of this plan, a nearby country whose government, though poor, dedicates much of its budget to healthcare. Company executives began flying to the region and meeting with the person most likely to diagnose a Gaucher patient: Dr. Manuel Saborio Rocafort, who runs the only medical genetics department in Costa Rica. So when Saborio heard about Tania, not only did he know that he should test her for Gaucher disease, but he had the testing kit ready: Genzyme had provided it.

But Genzyme did not go to the trouble and expense of finding and diagnosing Tania in order to save her life. Their avowed corporate strategy involves letting her die, unless Costa Rica will pay the full $160,000 per year for Cerazyme. Absolutely no discount is allowed.

Lest anyone doubt that this is a deliberate corporate strategy, consider:

In Genzyme’s new glass Kendall Square headquarters, the president of the firm’s international group, Sanford Smith, keeps a brass gong outside his office. Every time a foreign government agrees to pay for one of the company’s drugs, he takes out a mallet and rings it.

Presumably, they rang the gong for Tania when Costa Rica agreed to pay the full price, the only price at which Cerezyme can be obtained. Yet the Costa Rican government is not without misgivings:

The Costa Rican healthcare system has survived paying for Tania’s medicine. What worries its leaders is the precedent. Energized by Genzyme’s success, more companies have developed high-tech drugs for other rare diseases. Genzyme’s pricing approach has become the standard for similar drugs…

It is difficult to imagine a corporate practice that is more ethically and morally depraved: deliberately identifying third world children whose lives can be saved by extraordinarily expensive drugs, refusing to provide those drugs at a discount or for free, and then ringing a brass gong to announce that another third world country has been blackmailed into diverting a large share of its healthcare budget to one child, and away from simpler medications and strategies that could save thousands of lives.

The executives responsible for this strategy should be ashamed.

There’s nothing worse than doctors who refuse to learn from their own mistakes.

The latest pronouncement from the American Medical Association opposing publicly funded healthcare (single payer) is foolish on its face, but it unforgivable when turns out that it is merely a recapitulation of a thoroughly discredited policy of the past. The fact that it is not in line with the views of the vast majority of American physicians makes it worse, and goes a long way toward explaining the increasing irrelevance of the organization.

The support for reform of the healthcare system has never been greater. The AMA, in a move supremely out of step with the majority of Americans, not to mention the majority of American physicians, has declared their opposition. According to The New York Times:

…[I]n comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

The wording is rather ironic. Forty years ago, the AMA declared its opposition to creating a public health insurance option people over age 65, complete with dire predictions of the destruction of American medicine. That public health insurance option is known as Medicare, and far from destroying American medicine, it ushered in a golden age for American physicians.

The current opposition to healthcare reform, like the opposition to Medicare, is consistent with the AMA’s sad and sordid history of vociferous opposition to any attempt at healthcare reform. Truman first proposed universal compulsory health insurance in 1948. As Robert Ball explains:

The AMA’s opposition approached hysteria. Members were assessed dues for the first time to create a $3.5 million war chest-very big money for the times-with which the association conducted an unparalleled campaign of vituperation against the advocates of national health insurance. The AMA also exerted strict discipline over the few of its members who took an “unethical” position favoring the government program.

But AMA is no longer the force in American medicine that it was in the past. In the 1960’s, at the height of opposition to Medicare, the AMA claimed at least 70 percent of American doctors as members. Today, the AMA represents only a third of American doctors, most of them elderly. Almost 90 percent of doctors over age of 70 are members, but fewer than 35 percent of those aged 30 to 49 belong to the AMA

Its decline in membership and influence can be traced to its political positions and financial arrangements. Indeed, the majority of American physicians favor a national healthcare plan:

Of more than 2,000 doctors surveyed, 59 percent said they support legislation to establish a national health insurance program, while 32 percent said they opposed it …

“Many claim to speak for physicians and represent their views. We asked doctors directly and found that, contrary to conventional wisdom, most doctors support national health insurance,” said Dr. Aaron Carroll of the Indiana University School of Medicine, who led the study…

The Indiana survey found that 83 percent of psychiatrists, 69 percent of emergency medicine specialists, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians and 55 percent of general surgeons favor a national health insurance plan.

The AMA is opposed to healthcare reform? Who cares? They don’t represent American physicians and they don’t represent the American people. The represent the worst of American medicine, a dying breed that deserves to fade into ignominy.

From MSNBC:

Ten years ago the government set out to test herbal and other alternative health remedies to find the ones that work. After spending $2.5 billion, the disappointing answer seems to be that almost none of them do.

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine…

Imagine how many people could have received real medical treatment with that money. Imagine how much real medical treatment we could buy with the tens of billions of dollars that American waste each year on alternative health mumbo jumbo.

Blogger and alternative health advocate Catherine Morgan has attempted to address my claim that alternative health is pseudoscience. She writes:

Not surprisingly, Dr. Amy takes a hard line against alternative health practices, but is alternative medicine just pseudoscience? I don’t think so. Just because something can not be “scientifically” proven today, doesn’t mean it won’t be proven in the future. For example, most people believe that when they die they will go to heaven, but there is no “scientific” proof of heaven. Does that mean heaven doesn’t exist? And at one time, before there was proof that the world was round, everyone believed it was flat. Was it flat just because the science wasn’t available to prove it wasn’t? No. Science may not be able to prove that Reiki or Acupuncture (or any other alternative modality) actually works, but that isn’t proof that it doesn’t work either. Let’s face it, even when things are scientifically proven one day, they are often scientifically dis-proven the next. … Even Einstein was wrong sometimes. The only thing we know for sure, is that no one knows everything.

That paragraph is a “greatest hits” of faulty reasoning, including basic flaws in logic, invocations of religious faith, and, my personal favorite, grandiose comparions with Galileo or Einstein (for some reason it is always Galileo or Einstein), while failing to realize that Galileo and Einstein always supplied scientific proof for their claims while their persecutors and detractors were the ones who insisted that scientific proof wasn’t necessary.

Here’s the comment that I left:

“Just because something can not be “scientifically” proven today, doesn’t mean it won’t be proven in the future.”

1. That statement reflects a very serious misunderstanding about the state of knowledge of alternative remedies. It’s not simply that alternative remedies have not yet been scientifically proven to work; the reality is that alternative remedies have been scientifically proven NOT to work…

2. It is the MORAL obligation of advocates of alternative health to be SURE that an alternative treatment is safe and effective before they recommend it. It is morally wrong to advocate a treatment, and to accept money for the treatment if you don’t have proof that it works.

“And at one time, before there was proof that the world was round,
everyone believed it was flat. Was it flat just because the science
wasn’t available to prove it wasn’t? No.”

That statement offers more support for my view, not yours. Simply put, that statement means that what people “believe” about something is completely unrelated to reality. So the fact that alternative health advocates “believe” that alternative health works tells us absolutely nothing about whether it works.

“Let’s face it, even when things are scientifically proven one day, they are often scientifically dis-proven the next.”

That’s not true, either. What is reported (often erroneously) in the media changes from day to day, but what the scientific literature shows does not change in that way. That’s why it is absolutely critical to read scientific papers if you want to know about scientific phenomena.

Alternative health is the medical equivalent of astrology. Just like astrology, it is nothing more than pseudoscience.

Ms. Morgan replies:

…Even though I’m not a scientist, I don’t believe my post reflects a “serious misunderstanding” of alternative remedies.

I’m interested in how you reconcile your strong belief in scientific fact with the placebo effect? If science has proven that a mind/body connection exists in medicine…Is it really that far fetched that alternative medicine might have some benefits as well?

And my response:

I’d like to ask you some ethical questions, and I hope you will take the time to reply.

May I ask why you have not reviewed the scientific literature on alternative health remedies? Isn’t that like writing a book review recommending a new book without having read it?

Don’t you think you have a moral obligation to read all possible evidence on something that has the power to seriously harm people before suggesting that they should risk their health and wellbeing by believing in it?

Let me try to address the question you asked me.

“I’m interested in how you reconcile your strong belief in scientific fact with the placebo effect?”

Why should I have any difficulty reconciling scientific fact with the placebo effect? The placebo effect IS a scientific fact. It was discovered, described and measured by scientists.

Contrary to what alternative health advocates like to claim, scientists are very much aware of the mind-body connection. (Think psychosomatic illness, for example.) Scientists know that it is absolutely imperative to subtract the placebo effect from any evidence that a substance works.

The placebo effect is “psychosomatic.” You can evoke the placebo effect by feeding someone dirt and claiming it is medicine. So when alternative health advocates invoke the placebo effect to show that an alternative treatment “works” they are essentially saying that the alternative treatment is equally effective as feeding someone dirt.

How can alternative health practitioners ethically justify charging people money for a treatment that is no more effective than dirt?

I’ll let you know if there is a further response.

Alternative health is nothing more than a giant scam to separate the scientifically illiterate from their money. The best and simplest example of this phenomenon is the use of herbs and supplements.

Devotees of alternative health like to pretend that herbs and supplements are better because they are “natural,” because they are pure, and because they are not produced by Big Pharma. Nothing could be further from the truth.

First, “natural” is hardly synonymous with beneficial or even harmless. Earthquake, hurricanes and lightening strikes are all “natural” and quite harmful. More to the point, some of the most toxic substances known to man, like the paralytic poisons tetradotoxin and curare, are natural animal and plant products. Anyone who wonders whether “natural” equals beneficial need only contemplate tobacco, opium and cocaine.

Second, even if the active ingredient of an herb or supplement is harmless, it is mixed with contaminants in its natural state. As MSNBC explains:

Lead in ginkgo pills. Arsenic in herbals. Bugs in a baby’s colic and teething syrup. Toxic metals and parasites are part of nature, and all of these have been found in “natural” products and dietary supplements in recent years.

The risks are not simply theoretical:

Millions of Americans take vitamin, herbal or other dietary supplements. Annual sales exceed $23 billion, and more than 40,000 products are on the market. Tens of thousands of supplement-related health problems are handled by U.S. poison control centers each year, according to a report in the New England Journal of Medicine in 2002.

Until last year, supplement makers were not required to report problems to the FDA, and even now they must report only serious ones. The agency estimates that more than 50,000 safety problems a year are related to supplement use.

Because of vigorous lobbying efforts by supplement manufacturers, herbs and supplements are exempted from the rules that apply to medication. Therefore, there is no way for a consumer to be sure that a given herb or supplement contains any active ingredient, or contains too much or too little of the active ingredient. There is no testing to be sure that harmful contaminants are not present. Manufacturers simply grind up leaves and sell them to gullible people, and neither the manufacturers nor the consumers have any idea what’s in them.

Third, and most ironic, the herb and supplement industry is a financial bonanza for … Big Pharma. Sure, the labels on the products are decorated with butterflies and rainbows, but the producers are none other than Bayer, GlaxoSmithKline and Wyeth.

Little herbal stores are only “what the consumer sees when they’re shopping,” while the large companies that supply them are mostly invisible, Silverglade said.

The industry’s little-guy, granola image has been a great marketing asset, allowing it to tap into Americans’ frustration with big medicine, big prices and big risks. Supplement makers are dwarfed by leading pharmaceutical firms, whose drugs command sales in the tens of billions of dollars. Yet the reality is that natural remedy makers constitute a sizable business that doesn’t have to play by the same rules as companies that make prescription or over-the-counter medicines.

In the final analysis, herbs and supplements represent the trifecta of the gullibility of lay people. The active ingredients themselves don’t actually work, the herbs and supplements often don’t contain the active ingredient or contain poisons, and the consumer is paying Big Pharma for the privilege of being scammed.

Herbs and supplements, like all of alternative health, depend on scientific illiteracy. The executives of Big Pharma are laughing all the way to the bank. Not only do they profit from legitimate pharmaceuticals, all of which require major financial investments to develop and assure safety and quality, but they are raking in money from herbs and supplements, without any research, without any quality control, and without any evidence that they work.