MedicalPhysician Q&A

20 Questions: Paul Offit, MD

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Dr. Paul Offit, Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, recently authored a new book, Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine (HarperCollins, 2013). Dr. Offit, the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the University of Pennsylvania School of Medicine, has authored several other works, including The Cutter Incident: How America’s First Polio Vaccine Led to Today’s Growing Vaccine Crisis (Yale University Press, 2005), Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases (HarperCollins, 2007), for which he won an award from the American Medical Writers Association, Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure (Columbia University Press, 2008), and Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (Basic Books, 2011).
Dr. Offit is co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC; for this achievement Dr. Offit received the Luigi Mastroianni and William Osler Awards from the University of Pennsylvania School of Medicine, as well as the Charles Mérieux Award from the National Foundation for Infectious Diseases. In 2009, Dr. Offit received the President’s Certificate for Outstanding Service from the American Academy of Pediatrics. In 2011, Dr. Offit received the Humanitarian of the Year Award from the Biologics Industry Organization, the David E. Rogers Award from the American Association of Medical Colleges, the Odyssey Award from the Center for Medicine in the Public Interest, and was elected to the Institute of Medicine of the National Academy of Sciences. In 2012, Dr. Offit received the Distinguished Medical Achievement Award from the College of Physicians of Philadelphia and the Drexel Medicine Prize in Translational Medicine from the Drexel University College of Medicine. In 2013, Dr. Offit received the Maxwell Finland award for Outstanding Scientific Achievement from the National Foundation for Infectious Diseases and the Distinguished Alumnus award from the University of Maryland School of Medicine.
What in particular prompted you to write this book?
I had micro-fracture surgery on my knee a few years ago, and my orthopedist recommended I take chondroitin sulfate and glucosamine to increase the collagen in my knee and decrease inflammation. His advice didn’t make sense to me, because collagen is made every day by the body already. There were prospective, controlled thoughtful studies on the subject, and the result was no, they work no better than placebos. But I went to the health food store and I bought them anyway, because I wanted my doctor to like me. But that taught me something; until that point, I thought there was clear separation between conventional medicine and complementary healers, but I was wrong.
Why do you think many MDs stray from Western medicine and dabble in alternative treatments?
Medicine is progressively viewed as a marketplace, and the patient is the customer or “client.” But there are medical schools that teach naturopathy, such as Jefferson Hospital’s Center for Integrative Medicine, and Mayo. The National Center for Complimentary and Alternative Medicine is spending a lot of money to get into medical school curriculums. But there’s no such thing as alternative medicine. it either works or it doesn’t. If it works, it’s medicine, if it doesn’t, it’s not.
The alternative community could make the argument that some of their treatments have yet to be disproven by the medical community. Better use of time–disproving alternative therapies or working to find actual medical treatments? Why?
Of the 54k dietary supplements, most have not been disproven, only about 20 have been shown to work no better than placebo. I think it would be fair to ask the supplement makers to take half the money they spend on marketing and redirect that to proving whether or not the supplements do what they claim to do.
The Dietary Supplement Health and Education Act of 1994 has become a get out of jail free card. Saw palmetto claims to “support prostate health” on the label, but in the fine print it says it’s not FDA approved for the diagnosis, prevention, or treatment of any disease.

You’ve taken on a lot of (in)famous physicians in this book–what has the response been from both your colleagues and the alternative community?

My colleagues love what I’m doing. The doctors I take on in my book are industries in themselves, and they probably think what I have to say doesn’t matter and won’t reach their audience anyway.

Why do you think some alternative physicians are not losing their medical licenses after they do harm?

I think it’s for the same reason conventional physicians don’t lose their licenses–the medical community is terrible at policing itself. There is a “cowboyism” in this country that affords freedom of expression.
Why do you think vaccines have become the scapegoat for autism?
They are a universal scapegoat because everyone gets them. It’s a testable hypothesis that vaccines cause autism, and the results are not convincing. There’s also an incentive to label children as autistic as they then become eligible for services. There’s also a increased awareness about it in general.
Where do you think the anti-vaccine movement is headed? How can the medical community get ahead of it?
I think the anti-vaccine movement has lost a lot of credibility with mainstream media. Then mainstream media got burned on autism–Wakefield was not only wrong, he was and fraudulent and wrong. It won’t ever go away entirely, because it’s motivated by fear and ill-founded concerns. But the diseases we vaccinate against are slowly coming back, so there will be a cycle of outbreak, vaccines, anti-vaccines, repeat.
Do you think any amount of evidence would be enough to convince the anti-vaccine movement to change their beliefs about vaccines? Why or why not?
No, because it is just that–a belief system with the strength of a religious belief.
Do you think the government needs to intervene in the vaccine debate? Why or why not?
Vaccines will never be required, just mandated. Requiring them would just galvanize the easily fearful few.
One of the arguments in favor of holistic medicine is that practitioners take the whole patient into account. Why do you think conventional medicine falls short in this area?
In theory we’d like to believe we are taking the whole patient into account. But we have less time with our patients, and there is less hand holding in conventional medicine.
Do you think the medical community has anything to learn from alternative practitioners? If so, what?
Definitely. We can learn what exactly is therapeutic in their interaction with a patient, what the atmosphere does to help induce endorphins at the lowest risk, lowest cost and lowest burden. If people get better, there’s a reason they got better.
In a nutshell, what is your stance regarding alternative treatments?
There can be value in what we call alternative treatment–the placebo is physiologically real, and I take my hat off to those who evoke that response. But I would recommend everyone be as cynical about alternative treatments as they are about conventional medicine.
How do you go about dealing with patients who are absolutely sold on alternative methods when you know those methods are going to hurt their health? Is there a way you have found to educate patients?
If an alternative therapy could potentially hurt one of our patients we don’t let it happen at our hospital. We will try to talk them out of it if it doesn’t hurt and ask them not to take it while they’re with us, but if they insist, they have to sign a waiver form.

What would you say is the most typical response from patients who you try to educate about alternative methods?

Most people will do it your way, because they generally trust their doctor.
What advice would you give someone interested in trying alternative treatments?
Be skeptical and look for evidence.

Do you think the Internet influenced patients regarding alternative methods? Does it make them more or less likely to try them and why?

People think the Internet doesn’t lie. I noticed on Amazon, which sells my book, there are banner ads for supplements and vitamins, etc. on my page. If supplements claim to change health, they are drugs and should be regulated just like drugs.

Which alternative therapies and ideas do you think are the most harmful for patients’ health?

Chiropracty–when they try to treat all things due to a mis-aligned spine.
Are there any alternative therapies you feel might be helpful but need more research to support their use?
The placebo effect, for one. St. John’s Wort may be working, but the ingredient needs to be purified. That’s the problem–because it’s not regulated, the potency isn’t regulated.

Why do you think that no matter how technologically and educationally advanced we are as a society, alternative treatments will always have an allure?

The treatments are offered with a degree of spirituality that conventional medicine doesn’t have. That’s attractive and warm versus being distant and cold. Medicine offers a best guess, and the uncertainty can be disarming. The alternative practitioners offer a Bible, a “because I said so,” and certainty is attractive. Science is mutable and self correcting.
If there is no treatment available, for terminal cancer for example, what would you offer a patient who was willing to try anything?
I would offer the best treatment available. Certain experimental therapies are available, but if they don’t work or aren’t on the list they aren’t offered. Making the choice for a treatment that doesn’t work is a bad choice. It’s frustrating–in my book, the Billie Bainbridge story was the most upsetting to me.

You’re sick and no Western medicine can help you–would you consider alternative treatment? If so, what kind(s)?

I would not consider alternative treatments. I would go to the best of the best experts with the most experience.