Tactics used by modern megacorporations to inhibit the delivery of effective health care: deceptive marketing, product design to maximize side effects, influence over educational bureaucracies, legislators, regulatory agencies, and international trade organizations. Effects on the TCM (Traditional Chinese Medicine) herbal profession are examined as a special case, as these illustrate problems afflicting both conventional and alternative health care. (The author has several decades experience in clinical Chinese herbology and the politics and regulatory issues affecting it.)
Originally presented at Conference on Plants, Medicine, and Power: Emerging Social and Medical Relations; 2003 March 14, UC Berkeley.
- Shareholder value vs. the public good - the modern megacorporation
- Marketing and product-design abuses
- Encourage maximum consumption with over-general product claims.
- Emphasize invisible benefits.
- Beat the drum of single-parameter double-blind testing to distract patients and practitioners from more sophisticated research paradigms.
- Utilize religion to enhance the placebo effect and further suppress self-awareness.
- Acquire testimonials from true believers.
- Maximize side-effects and create new markets.
- Lobbying public officials and non-profit institutions
- Encourage expensive regulatory schemes to put smaller competitors out of business.
- Maintain double standards for pharmaceuticals vs. herbs.
- Promote adoption of regulatory standardization of biochemical profiles for herbal products.
- Choke off accurate information at its source - the educational institutions.
- Choke off competing health care options with mandatory state licensure.
- Choke off accurate information by controlling the media, and punish independent media sources by withholding advertising dollars.
- Choke off the most tenacious critics with food and product defamation statutes.
- International tactics
- Expand the venue of expensive and restrictive regulatory schemes via international trade organizations and international treaties.
- Pretend to protect indigenous health care practices and native plant sources with toothless regulations and promises.
- Suggested counter-strategies
To create effective national and international strategies for protecting inexpensive, indigenous modes of health care (such as herbal medicine) first requires an honest examination of current industry and institutional abuses in the domain of health care and how such abuses have damaged people's health and violated their right to choose health care options. To maximize corporate profit at the expense of the public good, specific tactics and strategies are outlined that are potentially available to modern corporations with the complicity of professional organizations and regulatory and licensing agencies. These tactics involve deceptive marketing, product design with the goal of creating long-term dependencies for "managing" chronic illness, controlling the flow of grant money to researchers with intent to influence reported results, manipulating the public with scare stories to influence regulatory agencies and legislators, and influencing and controlling health care education to produce professionals indoctrinated in techniques and modes of thought that will maximize corporate profits. Tactics formerly seen primarily in the pharmaceutical industry are now being seen with greater frequency in the so-called health food industry and alternative health professions. Such an evolution of business practices should not be surprising, given the current trend of global megacorporations absorbing, amoeba-like, smaller entities in their path of conquest.
Specifically discussed are the damaging effects of corporate and institutional strategies on the traditional Chinese (TCM) herbal profession. These effects are typical of problems now afflicting both conventional and alternative modes of health care.
While many well-meaning individuals and professional groups have waged political and regulatory battles to address single issues affecting freedom of choice in health care, few see the entire nature of the beast that manipulates sickness and death for the profit of a few. Hopefully, armed with an understanding of all the beast's tactics and strategies, well-intentioned individuals and organizations will be more effective in championing human health and potential.
Note: The tactics discussed here include progressively egregious examples of deception, dishonesty, and potentially unlawful behavior that are possible in today's political, economic, and regulatory environment. Just as in the board game "Monopoly", such tactics are the moves available to a company if the dice of fate makes them available and if they are then chosen by the board of directors. They are presented for theoretical discussion only, and no claims are made that individual companies or individuals are engaging in these tactics. The reader must decide if and when these tactics are evident in real situations.
It is the author's observation that individual herbalists, physicians, and small companies that have a more personal relationship with their clients and customers are much less likely to consciously engage in deception and dishonesty; more likely, they are often the victims of such tactics as well as their customers. As has been observed by many throughout American and European history, the larger the company and the greater its political and economic power, the greater is the potential for abuse. During the past several decades, there has been a disturbing trend of mergers and acquisitions in the international business world that has affected the health product industry as well. The consequent concentration of power and wealth, the tenuous and remote relationship between corporate boards and product end users, and the overwhelming emphasis on shareholder value at the expense of the public good has reached a crisis point.
In the following outline of tactics, the term "health products" includes pharmaceuticals, herbs and herb products, dietary supplements, and foods with claimed health benefits. Practices formerly seen primarily in the pharmaceutical industry are now being seen with greater frequency in the so-called health food industry. Such an evolution should not be surprising, given the current trend of global megacorporations absorbing, amoeba-like, smaller entities in their path of conquest.
Tactic: Make the claimed benefits as broad as possible to induce the consumer to conclude that the product will benefit almost any disease. If the consumer is able to choose the correct, effective remedy too quickly, this may result in lower total product sales. Instead, by promoting a range of products as being potentially beneficial and by making very general claims for each product, maximum consumption is encouraged. Enough consumers may eventually stumble onto a remedy that works for their own health problems to encourage others. See tactic below, "Testimonials".
A crucial principle of TCM herbology is that each herb or herbal formula has a very specific and limited range of action; if the pattern of symptoms and clinical signs falls outside this range, it may be inappropriate or contraindicated. Frequently, biomedical indications are too general, and the health condition must be further differentiated to determine an appropriate herbal strategy. [a3] For example, consider the apparently simple question: what herbs (medications, diet, etc.) would help restore health in specific conditions such as pneumonia, influenza, or insomnia? Many people assume that these medical terms represent accurate and complete descriptions of specific health problems, and that they definitively lead to appropriate choices of herbs or medications. They do not. A person with pneumonia has a condition of viral or bacterial infection in his lungs; this term says nothing about behavior patterns or the condition of other internal organs. Likewise, influenza is a condition in which a species of influenza virus has proliferated within an individual's body. It does not specify how the person's body is responding to the infection. Different individuals may respond in different ways to the same infectious organism, and the response pattern is important in determining an appropriate herbal strategy. For example, the initial low-fever stages of the onset of an infectious feverish illness must be handled very differently from an epidemic illness in which high fever, delirium, and hemorrhage are occurring; the systemic conditions are completely different and different strategies are required. Insomnia refers only to a person's inability to sleep soundly; temperature sensations, vitality levels, appetite, bowel patterns, and thirst may vary considerably among a group of people suffering from insomnia.
The human body is a complex creation, with all of its component parts functioning together, each organ having direct and indirect effects on every other part of the body. In practice, it is seldom possible to ingest a food or herb that affects only one organ or body tissue without simultaneously affecting many other organs and tissues. This fact is the central reason why the potential side-effects of improperly chosen herbs, foods, and medications (natural as well as synthetic) are such a significant problem.
The financial pressures of herbal marketing have led some distributors of Chinese herbs to promote simplified and simplistic biomedical indications for their products (influenza, insomnia, hypertension, etc.), effectively broadening the potential market relative to the more restrictive TCM indications. Such a strategy will help to expand the initial market for a product, but will also result in lower success rates among consumers. Since most of these consumers will have few guidelines to help them determine whether a product is beneficial and how long to take it before expecting specific results, they will guess or switch to other products in a type of shotgun approach. While this tactic may increase product sales, it ultimately reduces the credibility of TCM as a profession. I have heard certain people claim that Chinese herbs do not work, because they personally tried them without results. However, such people probably would not make the same assumptions about pharmaceutical drugs, if they had gone to a physician who prescribed by consulting a random-number generator or by throwing darts at a medications chart. How many people are quick to blame the herbs rather than their own lack of knowledge and discrimination in choosing them correctly?
The reputations of many useful herbs have been tarnished by over-hyped marketing campaigns that emphasize expanding sales to the detriment of educating the public in their effective use. There seems to be a commonly followed protocol for the introduction of new herbal products into the market:
- Prepare and collect scientific research on the target herb that seems to support very general and often vague claims for health improvement or disease prevention.
- Collaborate with and fund both popular and professional herbal journals and magazines to widely publicize the scientific research, to stimulate product interest among consumers and health professionals; arrange to have product advertisements appear side-by-side with the journal articles.
- Initiate blitzkrieg-style marketing campaigns, often using multi-level marketing strategies which are notorious for their exponential speed in expanding the market for a formerly unknown product.
- As product consumption begins to plateau, terminate the multi-level marketing structure and switch to conventional distribution to established health food stores and clinics.
- After a large number of people try the product with disappointing results, shift the marketing resources toward step 1 for a new product and start the process once again.
Most popular magazines that include coverage of herbal medicine tend to shy away from covering products with a TCM-style description of indicated and contraindicated patterns of symptoms and clinical signs, as such an approach would increase consumers' knowledge and might decrease potential sales of the specific product, at least initially. The favored format for articles is to present as much scientific-sounding evidence as possible, most of which will fall into the category of invisible benefits. In other words, avoid discussing criteria by which a consumer will clearly know if the product is benefiting them, having no result, or is contraindicated or resulting in side effects.
Tactic: Emphasize claimed benefits of health products that cannot be easily verified by the individual consumer, such as biochemical effects. Avoid being too specific about contraindicated and indicated symptom patterns and about typical symptom changes that one should expect if product works as claimed. This would allow the product user to easily decide whether the product is or is not improving one's health and may result in decreased product sales. Instead, steer all discussion toward the effects on hormone levels, blood chemistry, immune system changes, nutritional and physiological effects, antibiotic effects, etc., each of which would require expensive laboratory analysis to verify in individual cases.
All forms of indigenous, pre-industrial health care, regardless of ethnic or cultural origin, are based on the ability to recognize patterns of illness comprising the symptoms, clinical signs, and associated circumstantial evidence of such illness. In other words, the data immediately available to the senses and the intuitions induced by these sense impressions provide the basis for deciding appropriate action: administering herbs, special diets, steam baths, massage, bone-setting and simple surgical techniques, etc. Much in the same way that a skilled animal tracker observes subtle changes in the forest after an animal's passing, the traditional health care provider relies on acute perception and wits to comprehend the nature of an illness and appropriate actions.
Traditional Chinese medicine (TCM) is one of the most sophisticated and detailed forms of indigenous pre-industrial health care, likely because Chinese scholars, for at least several thousand years, recorded their methods in detail and passed them on to future generations for continual refinement. Patterns of symptom complaints were classified into categories and subcategories based upon the treatment methods observed to be effective for such patterns. Classification of abnormal tongue features (tissue color, moisture, shape, tissue thickness and color) and palpated radial pulse qualities provide additional data to help verify the presence of specific patterns of illness. [a1, a2, a3]
With the advent of the industrial era, medical diagnostic technology, and the sciences of chemistry, biochemistry, and physics, modern medicine chose to focus heavily on the microscopic and submicroscopic world of cells, microbes, molecules, and atoms. While there is no logical reason why the world of immediate sense impressions need be left behind, the inevitable trend of industrial culture has been to desensitize humans to their environment, because such desensitization is often an advantage in creating a work force unconscious of the toxic horrors inflicted upon their bodies. Health care workers, being members of the desensitized culture, come to rely heavily upon instrumentation and lab tests for a version of "truth" that fits into their mental model of the world, and which they have been carefully educated to believe is the only valid way of determining such truth.
The final deadly assault on the human organism is made possible when the individual has reached a stage of total trust in, or capitulation to, the industrial culture and has allowed his or her physician to declare that miscellaneous symptoms not accounted for by lab tests or diagnostic equipment are meaningless, of no consequence, and perhaps even imaginary. After a period of such negative reinforcement by authority figures, such individuals learn to suppress conscious perception of their bodies. Such semi-conscious people are ripe candidates for marketing based on a plethora of purported invisible benefits, such as improved biochemistry, enhanced brain waves, balanced etheric fields, and neutralized karmic nebulosities.
Even supposedly health-minded individuals sometimes persist in the consumption of various herbs, supplements, and diets, in spite of obvious side effects. Encapsulated herb products are especially prone to this problem, as they slide down the gullet without taste or fuss but may result in unpleasant side effects hours later. In some cases this may continue for years before the individual recognizes that there may be a problem. As an example, cayenne pepper is relatively safe when consumed with food, as its acrid-fiery quality will tend to limit consumption. However, in capsule form, several hours may pass before the individual experiences burning sensation in the abdomen, when the cause has been forgotten. I know of individuals who have contracted severe ulcerative colitis from such misadventures, persisting because some perceived authority figure told them it would be "good for disease X", or would provide some other form of invisible biochemical benefit. Any competent TCM herbalist would be able to quickly spot the pattern of symptoms and clinical signs for which cayenne is contraindicated: reddish tongue, yellow tongue coat, or tongue with fissuring patterns and absent coating; rapid-thready or rapid-full pulse; feverishness or aversion to heat, burning pains in the abdomen or trunk of body; thirst; insomnia; agitated or aggressive behavior; and other symptoms.
Biochemical knowledge of herbs can be useful information clinically only if carefully integrated within the context of practical symptomology. However, to avoid misleading interpretations that may lead to side effects, this integration should adhere to specific guidelines. Symptom indications, known biochemical constituents, comparison of effects of herbs with similar biochemical profile, and physiological modes of action of constituents must all be correlated for logical consistency, and alternative explanations for observed effects considered. [a4] Too often glib explanations are provided for observed clinical effects based on a few biochemical and physiological facts connected by a rickety chain of logic.
While such mishaps are much more common with pharmaceutical products (iatrogenic illness), it would not be fair to let herbalists and herbal marketers off the hook. Statistically, while the annual fatalities from herbal products (excluding coca, opium poppy, alcohol, and other legal or illegal potent-addictive drugs) are minuscule compared to those from pharmaceutical products [a5, a6], similar types of marketing tactics are increasingly seen in all types of health product marketing.
Tactic: While traditional Chinese herbology and other styles of holistic-type clinical assessment may be undesirable for maximizing product sales, these methods are useful tools for clinical research to complement biochemical methods in helping to tailor products that are effective in providing symptomatic relief, but result in predictable long-term side effects for which additional profitable product lines may be created. Multifactorial statistical analysis is common in psychological and industrial research, and health-care companies must take advantage of state-of-the-art statistical methods. However, it would be wise not to publicize this; instead, continue to issue press releases and research reports for public consumption that only discuss the old-fashioned single-parameter double-blind tests.
A central principle in designing individual TCM herbal formulas is that one must counteract or relieve the chief complaint so as to improve overall health and resolve those factors contributing to the chief complaint. Side effects result primarily when this rule is violated. [a1, a2, a3] It is much easier to find many ways that merely suppress the chief symptom complaint, while ignoring all considerations of systemic effects. See discussion above under "Encourage maximum consumption with over-general product claims".
A somewhat more sinister corollary of the preceding principle is that it is also possible to suppress symptom complaints while failing to resolve the underlying problem and even chronically aggravating systemic factors. A common and relatively obvious example of this would be addictive pain-relief medications. That this type of treatment is essentially suppressive, with serious side effects including addiction, is widely recognized, and is why such treatments are strictly controlled legally and ethically.
It requires only a slight stretch of imagination to speculate that it is possible to suppress symptom complaints while inducing chronic systemic illness whose onset manifests slowly and subtly enough to "fly under the radar" of regulators and fall within the range of what is tolerated by society. That such suppressive products successfully alleviate the chief complaint while failing to resolve underlying problems generally means that as soon as the consumer stops using the product, the chief symptom or symptoms will recur, creating a classic addictive pattern. Refined sugar, caffeine, and nicotine are examples of addictive substances that society tolerates and that many people demand on a daily basis because they provide immediate, though temporary, relief of such symptoms as fatigue and mental exhaustion in the case of caffeine and sugar, and anxiety and emotional stress in the case of nicotine. Herbal weight-loss products that contain ephedra likewise may provide temporary increase in metabolism without resolving the underlying chronic metabolic and dietary problems and leading to a cycle of addiction.
TCM herbalists recognize the maxim that one man's poison may be another man's food or medicine. Individual differences in metabolism, body type, ancestry, genetics, and life circumstances account for such variations. It is possible that herbs that are non-addictive and beneficial for individual A's overall health may be merely suppressive of individual B's symptom complaints and deleterious to B's overall health.
While pharmaceutical companies like to make a big fuss about how their drugs are tested using double-blind single-parameter controlled experiments, the reality is that such single-parameter tests are quite crude. Professions as diverse as psychology, operations research, engineering, and ecology have for many decades recognized the value of modeling natural processes as a coordinated interplay of multiple variables for which the mathematics of multivariate statistics, control theory, and vector algebra are important tools of analysis and experimental design. That pharmaceutical companies are somehow wholly ignorant of these areas of science and mathematics stretches the limits of credibility. Yet why do medical journals that publish results of drug safety tests continue to publish and publicize these single-parameter tests as being the "gold standard" of medical research, when scientists in other fields know quite well that such experiments may fail to reveal many significant interactions?
To illustrate how the seriously flawed single-parameter research designs are commonly mimicked even by TCM herbal researchers [b6], consider the standard two-part experiment where the effectiveness of a particular formula or herb in relieving high blood pressure is being tested. In such an experiment, half of the subjects are given a placebo and the other half the intended test substance in a double blind setup (subjects and researchers who administer the remedies do not know which are the placebos). All subjects' blood pressure is measured at specific times throughout the testing period. After the data is collected, the averages and standard deviations are compared to determine whether the difference is statistically significant. The conclusion is either that the test substance "works" or that it "doesn't work". If it does work, then some clever researcher attempts to track down the "active" chemical constituent responsible for the effect. These types of articles appear in TCM research journals constantly.
Unfortunately, even many TCM clinical herbalists see nothing wrong with such a study; after all, this is how respected medical research is done every day all over the world. However, its design violates the very philosophy of traditional Chinese herbal science and is deeply flawed logically. TCM herbal science is founded on the assumption that matching herbal formulas to the whole pattern of a person's disharmony (entire pattern of symptoms) is superior to choosing remedies for individual symptoms, independently of the context of the total symptom pattern. The experiment just described blithely assumes that the Western biomedical model is just fine for answering questions of a TCM nature and proving its efficacy.
TCM herbology differentiates at least four basic pattern manifestations of high blood pressure:
- Liver Fire
- Deficiency of Kidney and Liver Yin with Ascension of Yang
- Depletion of both Yin and Yang
- Phlegm-Dampness Accumulation
Each symptom pattern requires different herbal formulas, and for which some of the herbal formulas are contraindicated in the other patterns, and may actually aggravate the hypertension. The single-parameter double-blind experiment decribed above fails to distinguish possible differences in effects that may occur in the various types of high blood pressure. The Western biomedical model is not capable, in spite of its seeming sophistication, of providing precise solutions to vague questions. To choose herbs for an individual with high blood pressure, one requires considerably more information.
Health care providers and patients may be misled by deceptive and incomplete research results to believe that a product will be beneficial, when it may merely suppress symptom complaints at the cost of creating chronic illness or dependency. Proper TCM research must account for multiple symptom variables (patterns of disharmony) when testing the effects of remedies, or it will often be useless to clinicians. The solution to this problem is not the subject of this article and has been outlined elsewhere [f1].
Tactic: Utilize religious faith to overcome reason, logic, and self-awareness and to enhance the placebo effect. For believers of the modern day religion of materialistic scientism, provide testimonials from scientific experts regarding the claimed benefits. For believers of more ancient faiths, provide evidence of blessings from ancient masters and gurus.
Wilhelm Reich, a physician who published a series of books [b1] about the psychological basis of authoritarian control strategies, revealed that fascist societies (broadly defined, include most "civilized" nations) gain control over their subjects by inducing them to suppress bodily instincts (including natural sexual function), which constitute the first line of defense of any living being against harm, and by using religious dogma and mysticism to justify and maintain such suppression. With a whole population of such semi-conscious people who have learned to suppress their own natural instincts and body sensations for fear of ridicule by authority figures, all obstacles have been removed for inflicting iatrogenic medical care, an ersatz food supply lacking nutrients, and a toxic environment that is unpleasant and ultimately deadly. The inevitable bottled-up emotional outrage that the population would ordinarily express toward the perpetrators of such misery is instead channeled into consumerism, mindless entertainments, and contrived warfare and environmental destruction of such magnitude as to endanger not only the health but the lives of a majority of the world's inhabitants. [b2]
The politically correct religion of the day is a hybridized beast comprising a belief in science and technology as the gods of the future, with mammon and a bland New-Age belief in positive thinking following in close competition, the latter manifesting as a Prozac-facilitated ability to ignore reality with good cheer. This religion conducts its rituals primarily upon the altar of television, the Spanish-Inquisition style of religion no longer being necessary as a tool of population control. Modern psychologists have discovered that it is so much easier to create a religion that we all demand, which is addicting, and with which we "amuse ourselves to death". [b3]
As with televisions, other modern-day altars of worship must be equipped with control panels of flashing LEDs and stylish chrome dials if they are to adhere to orthodoxy. I've witnessed numerous sales presentations for health devices that awe the audience with flashing lights and hushed electronic bleepings. More than a few observers have commented with sincerity, "It costs so much money, it must do something." A sure marketing winner is a product that is "scientifically proven", conveys this impression with a suitable control panel, and promises unlimited prosperity and blissful thoughts.
The practice of TCM is now under assault by demands to replace its reliance on directly perceived sensory data with high-tech gadgetry that produces numerical "disease" indicators, in an attempt to mimic the pseudo-scientific popularity of lists of numbers. While some of these gadgets may indeed measure variables correlated with important physiological phenomena, such as the electrical impedance of acupuncture points, some of these devices are no more than expensive electronic dowsing machines, containing electrical circuitry of no greater sophistication than a 10-dollar hardware-store multimeter. Such devices are similar in principle and function to the pendulums carried by some dowsers, or Ouija boards, which rely upon minute movements and tremors of the hand to reflect back to the person or persons their subconscious impressions or desires. The scientific and clinical validity, or lack thereof, of such devices is not at issue here; I've personally investigated acupuncture-point impedance measurements and believe this subject worthy of study. [b4] It would also be improper to dismiss the realm of parapsychological influences without further investigation. What is of concern is that many practitioners use such devices with religious-like devotion, as if consulting the Oracle at Delphi, and with little understanding of scientific issues of repeatability, accuracy, statistical variation, and susceptibility to subjective influences. For example, I've witnessed a number of devices that measure the conductance value of acupuncture points, and which purport to indicate relative degree of "inflammation vs. sub-functioning" of the organ represented by the point; when it is pointed out that such measurements may be highly variable due to small changes in applied pressure of the hand-held electrode probe, the practitioners often become indignant that one would question the integrity of such expensive devices. Flashing LED's, hushed technoid bleepings, and glowing numerical displays do seem to bestow magical powers, especially if purchased at awe-inspiring prices.
The TCM profession has also suffered from its tendency to attract westerners searching for some religious-like belief system upon which to anchor their lives. According to the historian Arnold Toynbee, the forces of disintegration and chaos experienced during the declining phases of empire invariably lead to specific types of dysfunctional responses; the archaist or fundamentalist response is characterized by a desire to return to the "good old days" and a refusal to cope with the reality of current events. [b5] TCM attracts a disproportionate number of students who are seeking certainty in the wisdom of ancient masters. While TCM indeed possesses wisdom that can benefit us today, it is not perfect or omniscient in its wisdom, and certain practices, such as the use of heavy metal compounds, would be considered unacceptable today.
The historical and cultural context of heavy metal usage as a drug helps us to understand why it had been used and, moreover, why there may be better options available today. During the Middle Ages and Renaissance period of Europe, as well as in China during the same time, physicians used heavy metals to treat a variety of pernicious illnesses such as syphilis and severe acute febrile conditions. [b6] On average, people did not live nearly as long as they do now in modern industrialized countries, and the concern over long-term side effects was either not recognized or was ignored because of generally short life spans. In addition, safer methods, such as penicillin injections for syphilis, had not been discovered. For a modern TCM herbalist to administer arsenic to a client with syphilis would be unforgivable considering the serious long term side effects, yet heavy metal (mercury, arsenic, lead, etc.) preparations are listed in many books of Chinese materia medica. Many of these books fail to emphasize that these preparations are included for historical interest and completeness, and should no longer be used in all but the most exceptional circumstances.
Certain dogmatically inclined traditional Chinese herbalists may insist that these heavy-metal preparations are OK simply because the ancient masters list them in their texts. Such attitudes are striking for their simple-minded faith in ancient masters and lack of historical perspective. Rather than perceive science and medicine as an evolution and devolution of ideas, the archaist-fundamentalist grasps for that indeterminate past time where great masters were all-knowing and the world was tidy. Periods of overall cultural decline are reflected in the scientific world by an increasingly slavish devotion to ancient dogmas, whereas periods of cultural advancement promote scientific and intellectual expansion by means of vigorous and often heated debates. In such periods, the old masters are admired for their wisdom, but their theories are improved and modified without apology.
In summary, regardless of whether one's religious biases fall within the realm of politically correct materialistic scientism, or adhere to more ancient forms and dogmas, such beliefs can be potent marketing tools, robbing people of their common sense, their pocketbooks, and sometimes their health.
Tactic: Seek out testimonials from individual users. Even if a product is relatively inactive, the placebo effect and the workings of probability among a large group will usually yield a few people who achieve "miraculous" effects.
Testimonials of product effectiveness are a time-tested method for extending the marketing life of a product whose benefits are questionable or are overly general. This method is an extension of the tactic to utilize religion - the true believer is more certain of his beliefs when surrounded by fellow true believers.
Testimonials are an important counterbalancing influence to the negative impact that overly generalized claims have on consumer satisfaction. A significant percentage of consumers who otherwise might give up in frustration of not finding what they need, will be motivated to continue buying and searching after hearing inspiring testimonials.
Tactic: Design products that barely pass FDA or USDA standards and that result in a predictable array of side effects; subsequently, an entire line of new products can be designed and marketed to counteract these side effects.
While this is a tactic that one can only speculate upon, the amount of circumstantial evidence has led several authors to comment upon this possibility. [e1, e2, e3] Without doubt, the numerous side effects of many pharmaceutical drugs often lead to chronic iatrogenic illnesses unrelated to the initial complaint that brought the patient in for a medical consultation. The rapid-fire listing of potential side effects on television drug commercials has become a source of black humor. It is also undeniable that such side effects create future opportunities for profit if yet more drugs are designed to alleviate these side effects, ad nauseum. Whether this results from a planned strategy can only be the subject of speculation, but the devastating effects to naive and trusting patients are the same, regardless. I've been informed privately by hospital pharmacists and other medical personnel that many hospitals maintain their own private formularies of acceptable drugs, because, among other reasons, it is also recognized that the FDA approval process often fails to screen out unacceptably toxic and ineffective medications.
Those familiar with the writings of Macchiavelli and Sun Tzu [e4, e5] understand that in former times, deception, venality, corruption, and sabotage were considered standard practices of business and of warfare; the average citizen understood and accepted this with resignation. These tactics are just as important to modern business and warfare, but the difference lies in the trusting and gullible natures of the modern public in believing that corporations and government exist solely to make healthful products for them to consume; the typical modern citizen reacts with patriotic indignation if one questions the veracity of television talking heads.
Producing toxic and dangerous products is no monopoly of the pharmaceutical industry. Certain TCM herbal product manufacturers in China have not had a clean track-record regarding product safety or contamination issues either. Certain patent (proprietary pill or capsule) herbal products from China have in the past been found by the California Health Department and other organizations to contain a range of adulterants and contaminants, including heavy metals (especially arsenic and mercury, intentionally added because of a traditional belief that these would enhance the action of the product) and pharmaceutical drugs such as analgesics, antihistamines, antibiotics, aspirin, acetaminophen, caffeine, phenfluramine, and a range of other drugs for arthritis, insomnia, and hypertension; in many cases these adulterants were not listed on the product label. [e6, e7] I know of individuals who have acquired heavy metal toxicity from herbal products from both India and China, where heavy metal compounds have been traditionally included in certain herbal formulas [e8, e9], and of individuals who suffered from symptoms of corticosteroid withdrawal after stopping certain patent formulas for arthritis. During the late 1990's many American distributors became aware of these problems, and acted responsibly to remove these products from the American market; many distributors now routinely test for a wide range of contaminants, including pesticides, heavy metals, adulterant drugs, and molds and bacteria. Whole dried Chinese herbs, in contrast to the Chinese patent medicines, have had a much better track record, and are known for their purity and quality. [e6]
In Belgium in 1993, persistent misuse of the herb aristolochia at a medical weight loss clinic resulted in a major worldwide scandal leading to prohibitions or warnings regarding herbs that were either suspected of containing aristolochia or one of its constituent chemicals, aristolochic acid, or were similar in name. [e10, e11, e12] Aristolochic acid is a known nephrotoxin, which is also known to induce kidney cancer in some cases. The clinic attempted to create a weight loss protocol which included potent diuretic herbs as well as stimulants and the now banned drug phenfluramine. The resulting deaths and injuries from kidney failure were blamed on the Aristolochia rather than on the use of the drug phenfluramine or any of the other numerous questionable factors in this incident [e13]:
- The overall weight-loss program was not designed or administered according to traditional standards of Chinese herbology and ignored traditional cautionary warnings.
- The aristolochia was administered orally in the form of a powder rather than the traditional method of decocting (cooking) in water: it is known that aristolochic acid is insoluble in water, which is possibly one reason why there have never been reported problems with this herb until this incident.
- Aristolochia (guang fang ji) was chosen instead of Stephania tetranda (han fang ji), an herb traditionally preferred to Aristolochia for its greater safety.
- Aristolochia was used for long periods of time in large doses, which violates traditional Chinese herbal protocol.
- Aristolochia and Stephania tetranda are strong diuretic herbs, not especially appropriate for weight loss unless the individual is also suffering from severe edema, and then only for short periods of time - a few days or weeks at most.
As it is widely known that a good portion of many overweight patients' mass is stored as water weight, an impressive amount of weight can be lost in a short time by diuresis. Even though this procedure does little to promote lasting results, such procedures are often used as a marketing gimmick to create dramatic results for promotional reasons. However, the medical costs to certain patients in this unfortunate incident included kidney failure and death. This tragedy resulted because a group of physicians, who were unfamiliar with TCM principles, used a potent and dangerous herb in a context for which it was never intended in standard TCM practice. Aristolochia is traditionally indicated for certain types of severe and possibly life-threatening cases of edema, such as congestive heart failure, which could conceivably justify its use. Its use as a weight loss aid by the European physicians was a misappropriation of a foreign therapy for which they should have had greater respect and caution. Standard TCM materia medica include very specific indications and contraindications that the user ignores at his or her peril.
Even common foods and culinary herbs are not immune to abuse. Green and black tea and processed soya foods are being heavily promoted by the health food industry, though, unfortunately for many people, these products may result in chronic side effects in the amounts that many people are encouraged to consume. Health journals commonly focus on the supposed benefits of drinking tea based on its containing a class of antioxidants called polyphenols; often ignored, however, are the extremely high concentrations of fluoride that many modern tea harvests contain due to ubiquitous use of fluorine-containing pesticides and from other air and water pollutants. [e14, e15] Soya food products such as tofu were developed in China after many centuries of using the soybean plant solely as a soil nitrogen-fixer; soybeans themselves were known to be an inferior food, unfit for regular consumption. [e14] Due to periodic famines, there was great incentive to transform almost anything into an edible form, and thus tofu and fermented types of soya foods such as miso, natto, and tempeh were developed. In America, however, soya foods are promoted as a "health" food, in spite of known problems including thyroid toxicity, indigestion and abdominal bloating, hormone disruption, and cancer. [e16] I've known many individuals who experience significant symptom relief upon stopping consumption of green and black tea and most soya products. One cannot assume that just because something is sold in a health-food store, that it is healthy.
Most of the herbs and foods in the TCM materia medica have been safely used for hundreds of years. However, such safe practice is dependent upon adherence to traditional rules of common sense, preparing the herbs according to traditional procedures, and attention to whether symptoms are improving or not. For example, tapioca, a commonly available food product long used throughout the Pacific region, contains cyanide that must be reduced by special preparation. An herb that may be safe when consumed as a tea (water decoction), may not necessarily be safe as an alcohol tincture or orally consumed powder. Even cayenne pepper and tofu can be abused with consequent side effects, and it is debatable whether government regulation is always the solution to compensate for lack of common sense, as discussed under "Lobbying public officials and non-profit institutions", below.
The problems that occur when health-care professions and industries recognize the tremendous profit potential of iatrogenic illness are not new ones. Ancient cultures had evolved various traditions for keeping their health professionals and medicine men from temptation. In certain American Indian tribes, medicine men possessed an honored status within their tribe but were discouraged from charging for their services. "Beware of IRAB (I Read A Book) Medicine Men who charge money [and] make you suffer while they laugh all the way to the bank..." [e17] Instead, they were supported by the tribe in exchange for their ongoing role as spiritual leaders and were expected to refrain from profiting by tribal members' illnesses. In ancient China, the wisest doctors were said to treat their patients before illness occurred. Consequently, doctors who had many ill patients were considered inferior; during the Zhou Dynasty doctors were paid annually in proportion to their cure rates. [e18] In earlier periods, doctors received payment for their services only while the patients remained healthy. The doctor was required by law and custom to treat the patient for free until he or she recovered. Each doctor was also required to display one red lantern outside their clinic for each patient who died of disease while under the doctor's care; according to traditional Chinese history, the death penalty applied to violators of this law. [e19] While such measures may seem extreme, and regardless of whether such reports are wholly accurate, they do illustrate the concerns that ancient civilizations had regarding potential abuses by the medical profession and clearly demonstrate that such concerns are not merely the rantings of modern-day conspiracy theorists. That tobacco companies added chemicals to tobacco to intentionally increase its addictive potential should remind us that corporations may succumb to temptation to maximize their profits at the cost of consumers' health by knowing, intentional, and highly coordinated schemes spanning decades. [e20, e21, e22]
As global megacorporations acquire and absorb pharmaceutical companies, health food businesses and manufacturers, food product manufacturers and distributors, and biotech companies, the clear distinctions between drugs and health foods will become blurred, and the profit motivations of the parent company should lead consumers to question every product, taking nothing for granted. No product is safe from tampering or from being promoted in ways that lead to increased illness and debility and increased profits for corporations.
(As the following tactics require more time and resources to execute, only mid- to large corporations can afford to employ them.)
Tactic: As the company becomes larger and gains near-monopoly status, or becomes part of an industry cartel, encourage public lawmakers to pass regulations of the health product industry requiring expensive compliance procedures. This will affect most severely the company's smaller competitors and will allow the company to aggressively acquire and absorb the smaller companies at attractive purchase prices.
This tactic has been notoriously employed by the pharmaceutical cartel. While publicly bemoaning the high costs of drug development and testing to obtain FDA approval, the major pharmaceutical companies know that the high costs of FDA approval as well as occasional litigation costs from drug mishaps will disadvantage their smaller competitors the most. Estimated costs in 1990 dollars for total development and approval costs to bring a new drug to market are somewhere between $230 and $359 million. [g1] Small companies with a promising product simply cannot afford these staggering costs nor wait 12 years for the labyrinthine FDA approval process to take its course.
According to FDA regulations, herbal products or nutritional supplements cannot make any claims to be curative or beneficial for specific diseases without FDA approval. This, combined with the fact that naturally occurring chemical compounds cannot be patented, means that any herb company that might miraculously obtain FDA approval for a specific product would not be able to protect its investment. Many experienced consumers of alternative and complementary health products and services have become accustomed to seeing disclaimers such as "not for the treatment of any medical condition", "no health claims are made for this product", and "not for medicinal use only" (sic), seen printed on certain packages of imported Chinese herbs. Most consumers routinely ignore these boiler-plate disclaimers because the machinations of FDA politics and corruption are common knowledge. (Some consumers have even taken the bold leap of illogic to assume anything the FDA disapproves must be worth trying, which demonstrates how when the public trust is broken, it cannot be easily regained.)
As discussed previous sections of this article, herbs and even common foods and spices are not immune from abuse, adulteration, and deceptive marketing, but government regulation of such abuses is not always a wise solution. [g2] In some cases, the regulatory scheme may provide even more opportunities for abuse, this time available only to the big players who can afford the monetary investment, the legal expertise to exploit loopholes, and the political connections to execute their designs on the public health. The most abusive of these schemes involve using government agencies, such as the FDA, as quasi-legal hit squads to ruthlessly crush business competitors, critics, and other threats to corporate profits. [g3,g1]
California's recently enacted Proposition 65, while on its face seeming to provide important health protections and legal remedies to consumers, is an example of legislation whose intended purpose may play out differently in the real world. Proposition 65 (Safe Drinking Water and Toxic Enforcement Act of 1986) requires that products that may contain certain hazardous chemicals, including heavy metals, include a warning label "WARNING: This product contains chemicals known to the State of California to cause cancer and/or birth defects or other reproductive harm." [g4] Unless the chemical is present at such low levels as to pose no significant risk, it must include the warning label. For purposes of the law, "no significant risk level" is generally interpreted to be that which would result in no more than one excess case of cancer in 100,000 individuals exposed over a 70-year lifetime. [g5] With one of every four people now statistically expected to die of cancer [g6], the implied goal of 1 in 100,000 seems like a pipe dream. Such standards are so strict that a majority of consumer products may be drawn into the jurisdiction of this statute, giving consumers no sense of priority or intuition as to the relative toxicity of alternative choices. According to the American Council on Science and Health, the statute also does nothing to require lowered levels of contaminants, nor does it require safety standards for specific industries, nor does it require educating the public on relative risks; it merely requires one-size-fits-all warning labels. [g7] The likely result of this legislation is that most businesses, to protect themselves legally, may automatically stamp all of their products with the warning if there is the slightest doubt, providing consumers not with a realistic assessment of risks, but rather a barometer of business paranoia over potential lawsuits; a number of Chinese herb distributors have begun to stamp all of their products with the Proposition 65 warning. Consumers, as with the disclaimer "not for medicinal use only", may soon learn to ignore them. Law firms, however, should expect brisk business from this legislation.
For an exposé of serious sources of heavy-metal contamination in food products, the book Fateful Harvest by Duff Wilson [g8] reveals how toxic industries lobbied state legislatures to allow the recycling of industrial heavy-metal waste by blending them into agricultural fertilizers, without requiring any special warning on the labels. This was done with the tacit approval of state legislatures who designed loopholes in the laws to allow this. Wilson reveals the venality and cynicism with which the public health is auctioned to the highest corporate bidder. While Proposition 65 may have been enacted to appease public outrage, its inadequacies should become evident as major industries continue polluting as usual, while small businesses are besieged by an army of lawyers and bureaucrats over the issue of labels having very little information value to consumers.
Government regulatory schemes, especially when involving the practices of powerful industries, often are enacted belatedly, reluctantly, and in such a manner as to inflict the greatest burdens on smaller companies and businesses who are often not the guilty parties.
Tactic: Ensure that each mishap or presumed toxic reaction from unregulated herbal or health product receives maximum media coverage, followed up by vociferous demands for regulation to protect the public safety, while avoiding all discussion of the millions of toxic and iatrogenic reactions from FDA-approved drugs each year.
While the annual fatalities from herbal products are minuscule compared to those from pharmaceutical products [a5, a6], the media provides generous coverage to incidents of herbal and supplement toxicity or suspected toxicity. In recent years, ephedra, kava, St. Johnswort, and aristolochia and related herbs have come under fire, as well as the nutritional supplement tryptophan.
Government regulatory agencies often use such public hysteria to tarnish the reputation of herbs only tenuously related to the offending product. The concern over the hazards of tryptophan were likely due to a contaminant present in one batch of tryptophan pills, rather than the tryptophan itself, which is an essential amino acid present in all meat and protein products. Yet the FDA banned all forms of tryptophan supplements. [a5] When certain aristolochia-containing products were suspected of toxicity, an international paranoia ensued regarding even products with similar-sounding names. [e11, e12] Yet deaths from prescription medications barely merit an eye blink in the media, even though non-error, adverse effects of medications are the fourth leading cause of death (106,000 deaths/year). [h1, h2]
Tactic: Promote the regulatory standardization of herbal products by requiring that each batch of product meet or exceed the requirements of a standardized biochemical profile based on a few presumed "active" ingredients. Such a requirement may seem on its face to prevent cheap or ersatz raw material substitutions, but it also conveniently ignores the complexity of many plant products (i.e., ginseng) and dramatically increases the expense of production, effectively shutting down many small herbal wildcrafters and herbalists. Moreover, this scheme creates new opportunities for profit by synthesizing counterfeits of the "herb" that meet the biochemical profile regulatory standards but are significantly cheaper to produce. Only the larger companies, of course, have the resources to take advantage of this exciting opportunity.
There are many reasons why determining standardized biochemical profiles may be useful. Batches of harvested and processed herbal products may vary in quality and chemical constituents due to a range of factors including soil quality, local climate and weather, time of year harvested, and proximity of other specific plants. Misidentification and substitution with similar plant species, either accidental or intentional, are additional problems in the herbal industry. Whole raw or dried herbs may be inspected visually to glean some clues as to botanical identity and quality, but consumers who purchase pills, capsules, liquid extracts, or powdered herbs must largely trust the product manufacturer's ingredient label.
An independent laboratory that certifies herbal quality, much like Underwriter's Laboratory for household electrical equipment, would provide a valuable service by developing objective, verifiable reference standards for specific herbal products. Consumers who preferred certified products could decide to purchase only products with the seal of approval of the independent laboratory.
Pharmaprint, a U.S. company, has created a proprietary technology for standardizing constituent chemical profiles of herbal medicines, and has already developed such profile standards for saw palmetto, St. Johnswort, echinacea, garlic, goldenseal, ginseng, ginkgo biloba, saw palmetto, aloe, ma huang, ephedra, siberian ginseng, and cranberry. [i1, i2, i3] Pharmaprint states that such standardization for these products is a first step in the process necessary for clinical testing and eventual FDA approval. Companies understandably strive to patent the procedure for preparing the chemical profile on an herbal product, so that the investment in research and development would be protected from infringement by other companies. (Note that while individual naturally occurring chemicals cannot be patented, the process by which a biochemical profile is determined apparently has been determined by the U.S. Patent Office to be patentable.)
If the certification process remains voluntary, and if consumers could still freely purchase the raw unprocessed herbal product, the added competition might help to improve overall industry standards and quality. Pharmaprint's technology has already been used to detect the presence of the dangerous pesticide quintozene in shipments of ginseng. [i4]
However, all these advantages may be overwhelmed by the following risks if such standardization becomes mandatory and results in the removal of non-standardized products from the marketplace [i5]:
- Mandatory certification of biochemical profiles would transform the herbal industry into a high-tech operation for which large corporations would have the distinct advantage of finances and resources.
- Mandatory certification would likely increase the costs of herbal products.
- Once a company obtained FDA approval for a standardized version of an herbal product, the company would have a clear financial self-interest in lobbying for regulations and legislation to make such product available only in standardized form and only with a physician's prescription, regardless of public denials of such intent.
- The biochemical complexity of many herbal products, such as ginseng, makes developing realistic chemical profiles that include all important constituents a challenging task, and it is questionable whether such standardized profiles will guarantee all the important effects obtained from the whole herb.
- The regulatory standardization of biochemical profiles may tempt enterprising companies to cut costs by creating an ersatz concoction of chemicals that satisfies the regulatory profile, but that is not necessarily derived from the more expensive original plant material.
In Norway, which has some of the most restrictive supplement laws in the world, only patented biochemically-profiled preparations of certain herbs are available, and sales of the corresponding whole herb have been banned. The pharmaceutical companies have made them illegal to force consumers to purchase their patented products. With the proposed Codex Alimentarius standards (see below, "International tactics"), there is a significant risk that this situation may be imposed on the entire world, or at least all countries party to the GATT (General Agreement on Tariffs and Trade) treaties. [p2]
In America, the trend toward greater standardization and regulation is being countered by an opposite trend toward less intrusive regulation, as citizens recognize that regulation is only as trustworthy as the regulators. The current period of economic crisis and scandal, with corporate executives under scrutiny for accounting fraud and other forms of dishonesty, should lead us to demand that careful and thoughtful measures be taken to prevent such corruption, while at the same time, preserving freedom of choice which is the last defense against corruption resulting from collusion between corporations and government agencies. Voluntary, not mandatory, certification of biochemical profiles of herbal products is the most acceptable option in today's legal and political environment.
Tactic: As an intelligent, informed population of consumers and health care practitioners is undesirable to maximize product sales, choke off the information at its source - the educational institutions that train effective herbal clinicians. Achieve this goal by approaching schools and professional groups with offers of endowments for professorships, scholarships, research grants, and funding of professional accrediting bodies. After the schools and professional organizations become dependent on such funding, gradually begin to attach stipulations to these financial grants that limit the ways the money can be spent. By such means, encourage the schools to gradually diminish the most effective core clinical courses (such as traditional Chinese herbology) and to increase curriculum requirements in the sciences and in allopathic medicine; this can be easily achieved by appealing to a desire by many alternative practitioners to remedy their self-perceived second-class status relative to medical doctors. (For example, the Flexner Commission of 1909-1910 achieved excellent results in removing the study of plant medicines and pharmacognosy from accredited medical school curricula; physicians knowing too much about cheaper substitutes for pharmaceutical drugs may severely damage profits.)
While science education, in the larger sense of instilling in students the desire to probe the secrets of nature, is a crucial basis for material and social progress, the rote memorization of science factoids, as is common in many medical sciences courses, does nothing to enhance students' abilities in reasoning and creative problem solving. Moreover, when a program of study purporting to teach clinical skills in Chinese herbology gradually diminishes core clinical courses and substitutes them with abstract science courses, this serves no one. I'm reminded of dorm-mates at my graduate school who were involved in advanced scientific research, but needed basic advice in such kitchen skills as cooking an egg, how to make chicken soup, and why the dish soap needs to be rinsed off of the top and the bottom of the plates. When we train a generation of people in abstract mathematical skills, but with little ability to survive in the world, this will inevitably lead to disaster. Scientists whose theories seem brilliant on paper, but lead to havoc in the real world, are more the rule than the exception. Engineered genes that have spread far beyond their designers' original intent, the derivative-trading schemes of Nobel-prize winners that led to the collapse of billion-dollar companies, nuclear power that once promised to be so clean and inexpensive, but which has contaminated large areas of the earth's surface, are only a few examples.
Traditional Chinese herbology developed over a period of thousands of years, having been gradually refined and improved. Crises such as the period of world-wide epidemics of the Middle Ages led in China to the development of new theories and herbal formulas for understanding and dealing with epidemic illnesses. Rather than an analytic-reductionist science, it is a synthetic-inductive science that emphasizes skills of observation, pattern recognition, and gradual adaptation to new circumstances. It is neither less nor more useful than the analytic-reductionist techniques of western science, but complementary to them. In the same way that a knowledge of food chemistry does not guarantee success as a chef, a knowledge of physiology and biochemistry does not guarantee success as an herbalist. While chemistry and biochemistry are undeniably useful disciplines, I know good cooks and herbalists who have little knowledge of either. I also know of herbalists who have extensive knowledge of both biochemistry and physiology whose clinical skills leave much to be desired - in other words, they do not get good results.
Many alternative health care professionals perceive themselves as being second-class doctors and may grasp at opportunities to increase their social and economic status. Perhaps the greatest weakness of the alternative health professions is this susceptibility to influence by the medical industry via the promise of greater status and financial rewards. Licensing, insurance and other third-party reimbursement schemes, and academic recognition are all valued perquisites that may become the currency of negotiation when the medical industry wishes to impose certain restrictions on their competitors.
The history of medicine reveals how educational institutions that train health professionals are often the first target of forces who wish to gain control of health care for political, financial, or ideological reasons. [j1] During the 12th century, the Catholic Church perceived the medical professions as a coveted base of political power, which it proceeded to absorb by first threatening with persecution, and then offering protection with the sanction of the Church by official licensure. Formal university programs in medicine were then altered with increased emphasis on theory, rhetoric, and philosophical speculations; at that time practical skills were associated with a lower status, and this attitude allowed the subjects of surgery and pharmacy to be excluded from the curriculum of many schools without much protest.
Centuries later, in the year 1910, the Flexner Commission in the U.S. employed a similar strategy in attacking botanical medicines by establishing a standard curriculum for medical schools prohibiting the study of botany and botanical medicines. [g2] U.S. medical schools that continued to emphasize plant pharmacology and natural remedies were blackballed by the Flexner Commission, leading to a cutoff of funding from the Rockefeller and Carnegie Foundations, which heavily funded the Regular (allopathic) medical schools. Botanically-oriented medical schools were forced to close their doors. As botanical physicians and homeopathic practitioners died, none took their place, effectively destroying these professions until the recent resurgence of herbal knowledge among both health professionals and lay people.
Currently, many TCM colleges, flush with enthusiasm over the successful acceptance and licensure of acupuncture in many states, have fallen for the lure of even greater status for their profession by more closely mimicking the curriculum at medical schools, forgetting why it is that people dissatisfied with medical care originally sought them out. The curricula at many TCM colleges have expanded course requirements in pathology and western sciences while slowly shrinking the core curriculum in traditional Chinese herbology. [j2] Many graduates of such schools are not prepared to use herbs safely and effectively in a clinical setting, either because they have knowledge of herbs obtained primarily through rote memorization rather than understanding and experience, or because they have little herbal knowledge since only a few brief courses were included in the curriculum.
Another mode of influencing TCM colleges and other schools of alternative health is to dangle the possibility of research grants for herbal studies. Of course, the favored research proposals will be heavily biased toward the western biomedical model of disease, not the TCM perspective. If enough money is at stake, it is amazing how quickly ancient traditions can be swept away in an eye-blink. During the past decade, investigating the potential for herbs in the treatment of AIDS/HIV has become a popular topic of research proposals and funding, even though there is still much controversy over whether the "HIV causes AIDS" model is even correct. Peter Duesberg, a Nobel-prize winning virologist, has written extensively on this debate [j3, j4], yet many alternative health institutions trip over themselves in haste to grab the research money and the status that attaches to it, willingly adhering to current medical orthodoxy to do so.
If key TCM professionals do not sound the alarm, they will wake up one day to discover that their profession has become a modified version of the physicians' assistant rather than an independent tradition with a unique and valuable perspective on human health, because they have discarded its wisdom in their pursuit of status.
Tactic: Under the guise of protecting the public health, safety, and welfare, encourage the alternative health professions to lobby for mandatory state licensure. The increased economic power (de facto monopoly) that such licensure provides will seem very attractive to members of these professions, greatly facilitating the exercise of corporate power and control via political lobbyists. Regardless of the regulatory agenda, loudly and righteously beat the health-safety-welfare drum if anyone begins to suspect corporate self-interest.
During the 1930's and 1940's, before the takeover of China by the Communists, the Nationalist government under Chiang Kai Shek sought to restrict and eventually eliminate the use of traditional Chinese herbs. [g2, k1] The first step taken by the Nationalist government was to require registration of all practicing Chinese herbalists. They were then required to study and pass examinations in the use of Western medicine, and just before 1949, these doctors were increasingly restricted from using Chinese herbs in their practices. Fortunately, the strong extended family tradition in China provided a safe haven for herbalists continuing to practice; most rural herbalists ignored the official government restrictions. During the Communist Revolution, Mao Ze Dong himself was treated by traditional Chinese doctors. After the revolution, he restored traditional herbal practice and established it as the major health care system of China, to be supplemented by Western methods when herbs and acupuncture were inadequate. In spite of the atrocities committed by Mao during the revolution, his health reforms to restore traditional practices were widely supported; in addition, he realized that Western-style health care would quickly bankrupt the fragile Chinese economy.
In the U.S., traditional Chinese medicine was popularized primarily due to media publicity which acupuncture received after Nixon's trips to China. Unfortunately, the herbal tradition rode into this country on the tails of acupuncture, and has taken a back seat ever since. In China, acupuncture and herbal medicine are often practiced separately. There is no logical reason why one must learn acupuncture to use herbs, or vice versa, yet the licensing laws in most states include Chinese herbs within the scope of acupuncture practice even though many acupuncturists have had little or no specific training in herbs. After somewhat heated professional turf battles, Chinese herbology remains under the yoke of the acupuncture profession. This, combined with the gradual deterioration of the core traditional curriculum in TCM colleges, has led to a situation in which Chinese herbology has experienced an enforced decline in the quality and extent to which it is taught.
Many people assume that licensing of the health care professions is the best way to assure standards of quality. However, licensure is only one of several options in achieving this goal. Private non-governmental certification of herbalists and other health professionals is one option that avoids the problems and corruption that may occur with mandatory licensure, which is a form of state-sanctioned economic monopoly. As discussed previously in this article, collusion of corporate influence with the power of the state is often a recipe for despotic forms of corruption.
In considering appropriateness tests which that be applied to licensing of a profession, mere economic convenience to the profession should not be a factor. The New Jersey Professional and Occupational Licensing Study Commission, which according to the U.S. Department of Health, Education and Welfare, "may provide a useful model for State licensing studies," used the following guidelines for deciding the merits of licensing particular groups [k2]:
"Their unregulated practice can clearly harm or endanger the health, safety and welfare of the public and when the potential for harm is easily recognizable and not remote or dependent upon tenuous arguments; and, The public needs, and will benefit by, an assurance of initial and continuing professional and occupational ability; and, The public is not effectively protected by other means; and, It can be demonstrated that licensing would be the most appropriate form of regulation."
The disadvantages and dangers of restricting the practice of herbology to a privileged special interest group far outweigh any possible benefits to the public. To control and restrict access to a wide variety of plant products that have long enjoyed traditional usage and are well tested by experience would violate the common sense and historical experience of herbal traditions around the world. The English people during the rule of King Henry VIII felt so strongly about their right to freely use herbal remedies that the King was moved to make a declaration that lay herbal practice should remain free from restriction or licensure throughout the kingdom. [k3] The text of this document vividly describes the attempts of the medical profession to monopolize health care for economic gain and prevent poor people from obtaining inexpensive herbal remedies. King Henry's decree stands in striking contrast to the centuries of repression of herbal traditions by the Catholic Church.
Tactic: Provide well-publicized awards, grants, and endowments to medical and public health researchers who study the biochemical effects of health products. This will help to train the population to think in terms of the unseen and difficult-to-verify world of biochemistry inside their own bodies and to place greater trust in the pronouncements of public health officials and scientists. Reward loyal media sources with advertising contracts and inside tips of "cutting-edge" scientific breakthroughs; punish disloyal media sources who continue to truly educate the public to think and decide for themselves by withholding advertising contracts and other forms of economic blackmail.
This tactic is a corollary of the basic marketing tactics, but with an emphasis on controlling the media. Conflicts of interest have been recognized to be serious on-going problems among medical journals and in scientific reporting generally. [m1, m2, m3] Drug companies that fund researchers to "prove" and then report the safety of the drugs they are being paid to test is a major source of controversy. Medical journals have policies that require authors to state any conflicts of interest, but such rules are frequently disregarded. Advertising dollars from pharmaceutical companies are a lucrative source of income, and offending one's advertisers can be costly.
Media bias in favor of pharmaceutical products has recently been replaced by a subtler form of media control. With the large amounts of money spent by the public on alternative therapies at stake, and with mergers and acquisitions of health product manufacturers blurring the boundaries between the pharmaceutical, herb, and food industries, the new media bias has been to reinforce the consumer focus on the biomedical model of disease, regardless of the type of product being promoted. As discussed previously under "Marketing abuses", consumers have been trained to ask for products that will provide them with the invisible benefits promoted by the media or which provide suppressive relief of symptoms without necessarily resolving underlying metabolic or systemic problems. Such consumers buy more, sometimes over their entire lifetime, because their problems are rarely resolved, only alleviated temporarily.
Many health professionals have entered their chosen field because of a desire to help others, and they are decent, caring people. However, it is often these types of people who are most reluctant to admit the depths of malice, corruption, and deviousness to which some of their fellow human beings will sink to make a profit and to gain unfair advantages over others. In the interest of providing such individuals with a quick how-to manual in recognizing dirty tricks, see the article "Overcoming the Trickster: media wars of the 21st century". [m4]
Tactic: If and when a significant portion of the public begins to recognize the self-serving tactics of the health product industry, influence and prepare politicians to vote for "food defamation" statutes that apply criminal and civil penalties to the criticism of government-approved industry practices. Freedom of speech in this realm will damage corporate profits, and financial rewards to cooperative legislators will have been for naught if this tactic is not ready as a last desperate measure to protect investments. (Although Oprah Winfrey eventually won her case after being accused by the beef industry of food defamation for daring to discuss E. coli in hamburgers, she had to pay millions of dollars of legal expenses. This should discourage any lesser mortals from daring to criticize the products corporations have worked so hard to manufacture.)
Of all the tactics mentioned thus far, food and product defamation statutes are perhaps among the most flagrant assaults on freedom of speech. Some industries are apparently not satisfied with inflicting sub-standard and unhealthy practices on the public, but they wish to place a de facto gag order on the public as well, preventing such abuses from being reported and discussed in the media.
The widely publicized Texas Cattlemen's case against Oprah Winfrey, in which she was accused of violating Texas food defamation statute by criticizing the sanitation of hamburgers on national television, was resolved in Oprah's favor. [n2, n3, n4, n6] However, the Texas court did not rule upon the constitutionality of the statute itself, leaving open the possibility of other actions in Texas under the statute. Thirteen other states had such statutes at the time of this lawsuit. [n1, n5] In the majority of states with such food-disparagement statutes, food critics may be held liable if they fail to substantiate their claims by "reliable scientific inquiry, facts, or data".
There are several serious constitutional issues that remain to be decided by future courts. The common-law standard prior to these statutes was that to establish libel or slander, the plaintiff must establish that the defendant made false statements knowingly and with intent to defame. A person who sincerely believed what he said was the truth, especially regarding matters of public concern, was protected under the First Amendment's freedom of speech clause and under equivalent state constitutional requirements protecting the same. [n7] These food defamation statutes establish a lower standard for civil liability and allow for punitive damages to the plaintiffs if the defendant can be shown to fall short of the standards for "scientific inquiry". For most people, this is an impossible standard to meet unless they have professional training in microbiology and food science; the effect on public debate is chilling. Moreover, the statutes' allowance for both punitive damages and attorneys' fees for the plaintiffs alone, but not for defendants in the case of judgment in their favor, sets the stage for abusive litigation by food industry groups and corporations. Such statutes clearly favor food industries with preferential treatment and should be ruled unconstitutional.
Even though such laws are on the books in a minority of states, according to some legal opinions, a person could be held in violation of the statutes even if speaking or writing in another state, if such communications reach the state in which the statute applies. So effectively, these statutes have spread a nationwide pall on the freedom of consumers to express concern about specific products.
The food industry's desperation in lobbying state legislatures to pass food defamation statutes suggests they are truly afraid of public knowledge regarding the abuses inflicted on public health in the name of profit. After reading the book Fateful Harvest, which carefully documents the intentional contamination of agricultural fertilizer with heavy metal wastes, one cannot avoid reacting with outrage that not only have we been systematically, knowingly, and intentionally poisoned, but that corporate powers are demanding we suffer in silence!
Consumer, health, environmental, civil rights, and media groups should coordinate their activities to repeal these laws in every state while exposing the shameless and self-serving tactics of the food industry. Such laws have been repeatedly defeated in many states, after repeated attempts by the food industry to lobby for their adoption. A federal version of the statute has also been defeated.
Tactic: Under the guise of protecting the public health, safety, and welfare and promoting international trade, establish international non-governmental organizations (NGO's) to "study" the advisability of international standards and regulations for agricultural products, herbs, dietary supplements, and pharmaceuticals. Emphasize the potential benefits in such standardization for international trade and conceal the self-serving advantages that such regulation would provide to a few international megacorporations.
International corporations have found the myriad customs and commercial regulations in the world's nations to be an obstacle to greater profits and ease of trade. There are currently tremendous pressures on governments worldwide to adopt treaties and international trade agreements that attempt to standardize specifications for products, including foods, drugs, and nutritional supplements. Such negotiations have been occurring for many years under the designation "Codex Alimentarius", often referred to as Codex. However, such negotiations receive scant coverage in the American media, in spite of the serious ramifications of Codex.
International legal battles for control of Internet content provide us with a glimmer of what may likely happen in the realm of commercial trade. Several countries, including France, have initiated lawsuits in their courts to impose French legal standards for acceptable Internet content on Yahoo! [p1a, p1b], a major Internet portal. Because most websites, such as Yahoo's, are readily viewable anywhere in the world, other countries are claiming that their own more restrictive laws must apply to such content. The net result of this, if such court cases are upheld, is that the most restrictive nation's laws will effectively censor the content of the Internet worldwide. Such a result is being widely protested by civil libertarians in many countries.
Codex Alimentarius is an attempt to prevent such disputes in the realm of ingestible products (food, herbs, drugs, nutritional supplements), by preemptively deciding what is acceptable in international trade. The overwhelming majority of delegates to the Codex meetings, at least initially, have been representatives of the largest multinational pharmaceutical corporations, including Hoechst, Bayer, and BASF, the daughter companies formed in the breakup of IG Farben after the Nuremberg Trials. Unfortunately, the experiences of international Internet censorship are being replayed in the realm of food and drug products. The most restrictive nations are attempting to impose their standards upon the rest of the world. [p2, p3, p4] Germany and Norway have some of the most draconian prohibitions and restrictions on vitamin and supplements. Norway has outlawed many nutritional supplements, and the few it still allows are available only in levels at or below the RDA standards, which many scientists believe are set too low for many individuals' needs. [p5] Not only would the more restrictive German proposals apply to goods sold in international trade, but such restrictions would also apply to any goods sold within nations who are signatories of Codex trade agreements. GATT (General Agreement on Tariffs and Trade) nations who do not accept the new Codex standards may be fined heavily and have trade sanctions imposed upon them. [p3]
It is imperative that organizations concerned about freedom of choice in health care demand to be represented by delegates at the international Codex meetings. While mandatory restrictions play into the hands of the pharmaceutical cartels, to protect consumer choice it is necessary to steer the regulatory discussions toward a concensus on what constitutes honest disclosure and labeling of ingredients and quality. Moreover, imposing international standards on products that are manufactured and consumed within the same country is a violation of national sovereignty and serves no valid purpose other than to provide a backdoor for world government, a shaky and unproven idea. That such internal matters should even be on the table for discussion by an international regulatory body is arrogant and presumptuous; furthermore, it violates numerous aspects of our own state and federal constitutions.
Tactic: Enhance the appeal of such international regulation and overcome resistance by including high-sounding, though toothless, provisions for protecting the rights of indigenous populations, local herbalists, and health care providers. Once the international regulatory agency is securely in power, these empty promises may be ignored insofar as such groups lack political and economic influence.
Pharmaceutical companies have routinely appropriated the herbal knowledge of indigenous peoples worldwide; such activity has become known as biopiracy. Biopiracy has been defined as "the use of intellectual property laws (patents, plant breeders' rights) to gain exclusive monopoly control over genetic resources that are based on the knowledge and innovation of indigenous peoples." [q1] The sequence of events constituting biopiracy is typically as follows:
- Compiling interviews with local medicine men and shamans and screening for promising herbs to investigate.
- Gathering additional interview information regarding promising herbs, their history of use, mode of preparation, and medicinal uses.
- Determining biochemical profiles of active constituents by the use of proprietary methods which can then be patented.
- Developing genetically engineered, hybridized, or selectively bred varieties of the plant, which are then patented.
- Developing synthetically modified forms of active constituent chemicals for which patents are obtained.
- Lobbying governments and international trade organizations for restrictive regulations that provide the patented product a competitive advantage in world markets.
- Countering criticism of biopiracy operations by sponsoring noble-sounding conferences and agencies to "study" the problem, but that offer no practical mechanisms for implementing change.
The endpoint of this process is the disenfranchisement of the native population from the potential economic benefits of growing or wildcrafting the herb for sale in international markets.
Pharmaceutical companies often entice tribal medicine men to reveal their secrets by small monetary inducements. Consistent with international contract law and intellectual property law, ideas and information cannot be patented or copyrighted, and the corporations proceed to create patentable products from which they benefit enormously at the expense of indigenous peoples. The practice has become so widespread that many local healers and medicine men have become outraged by their fellow "sell-outs", who, in many cases, were members of a society of medicine men who had agreed to not reveal such secrets to outsiders.
National governments should be taking greater action to protect the cultural resources of their people by scrutinizing the actions of international biopiracy operations more closely. Too many third world nations have eagerly accepted grant money from outside agencies, corporations, and governments to support the biopiracy operations, while, at the same time, neglecting the role of traditional medicine men in their national health care systems. The World Health Organization (WHO) has been guilty of promoting and participating in biopiracy operations, and national governments should insist that they receive more equitable treatment for their people. While organizations have met to address these problems (such as the Convention on Biological Diversity, 1993 December), too often the outcome has been to give lip service to the ideals of biodiversity and conservation, but provide no practical multilateral mechanisms to implement these ideas. By default, what remains in play are the same old bilateral contract negotiations between corporations, international agencies, and nations that have resulted in indigenous peoples cultural traditions being sold to the highest bidder and then gradually replaced with the patented biomedical alternative in that nation's own health care system.
A key issue in the debate over biopiracy is whether anyone should have the right to patent a living organism or process. [q2] Such patents have often been challenged by groups claiming that the key principles are based on processes which were formerly known by indigenous cultures, and which were effectively appropriated wholesale by corporations with little alteration or creative added value. [q5] In such cases, the awarding of patents seems clearly unjustified. One major problem with this approach is that it may only prolong the pharmaceutical companies' strategy of inflicting purely synthetic drugs upon the public and of avoiding research validating the direct use of phytochemicals. There are instances in which the use of natural plant products is combined with truly creative and unique processes that have resulted from expensive and time-consuming research, and companies understandably wish to protect their investments in such research. Another approach, described by Michael Gollin [q3], is based on further refinements of contract law to promote and enforce the equitable international sharing of the benefits of plant research. Such contracts have become known as Access and Benefit Sharing Agreements (ABAs), which would provide access to natural botanical and genetic resources in exchange for a share of the benefits, including access to any resulting biotechnology and would result in motivation by the country possessing the botanical resource to conserve its biodiversity for future economic benefits to its people. Companies that violate the provisions of such contracts, or that continue to take plant resources without permission may find that any resulting patents may be legally challenged on the basis of fraud, violation of sovereign nations' laws, and the patent having been obtained from "forbidden fruits".
Even with the protections provided by Access and Benefit Sharing Agreements, there still remain thorny problems to be resolved regarding the patenting of living organisms and processes. One such problem is the potential uncontrolled spread of patented genetic material into the environment, other varieties of the same species, and even other species. To allow one company to have the potential to interfere and initiate lawsuits regarding all possible venues into which such genetic material may spread has already created legal nightmares for many individuals and businesses, one example being the spread of Roundup-Ready genes from soybeans and corn into other commercial crops and even weeds. [q4] Such concerns are properly the subject of on-going international discussions, as the consequences are experienced by the entire world community.
Many of the abuses outlined in this article involve collusion between corporations, government, and powerful non-governmental institutions such as media, universities, and professional associations. Such abuses will likely not cease without persistent public efforts to expose them and to resist their effects, such as consciously changing individual habits in purchasing health care products and services. Group and organizational efforts may also have a significant impact on such schemes, in contrast to individuals acting separately. Finally, both individuals and organizations need to become aware of the myriad ways that propaganda, corporate advertising, and disinformation are deployed to confuse the public. [m4]
While human behavior will never be perfect, there will always be those who believe that perfection can be attained by government decrees and regulations that require mandatory actions. In practice, because of corruption and collusion between industry and government, such regulations often have the opposite effect and provide a potent tool for increasing corporate profits at the cost of public health, welfare, and freedom of choice. Enforcing a good idea by making it mandatory often transforms it into a bad one.
Restrictive licensing and certification are often assumed to be the primary ways to improve quality in health care products or services, yet voluntary private certification has often been successful in improving standards. There are several advantages to private, voluntary certification:
- The public is free to choose whether to patronize certified practitioners or to purchase certified products.
- As long as the public perceives the private certification agency to be honest and to have reasonable standards of quality, products and services so certified will likely be in demand.
- If, for some reason, the certifying agency becomes corrupted or more interested in the economic well-being of its industrial and professional members, the public has the freedom to avoid such products or services.
- Competing certification organizations may find a market for their services if existing certifications have become untrustworthy.
Another problem area has been the increasing legal status of corporations over several centuries of American history. At the time of the American Revolution, Americans were painfully aware of the abuses inflicted on colonists by the British Crown chartered corporations [r4], such as the Virginia Company, the Carolina Company, and the Maryland Company, which controlled all aspects of life within their dominion. As a consequence, the U.S. Constitution and common law tradition later placed corporations under strict regulation: corporations, being created by the state, could be terminated by the state if judged to be no longer in the public interest. Operating a corporation was not a right, but theoretically a privilege to be regulated at the pleasure of the state, in contrast to the rights of private individuals, which were recognized in principle to preexist independently of government decree.
After the Civil War, corporations took advantage of technical provisions of the 14th Amendment to increase their status as legal "persons". The landmark case of Santa Clara County v. Southern Pacific Railroad decreed that corporations were persons, overturning previous decisions to the contrary. [r1] Most 14th Amendment court cases concerned the expansion of corporate privileges, rather than anything to do with the rights of former slaves. The result has been a gradual expansion of corporate privilege to an unprecedented level in American history, with a concomitant decrease in individual rights via contract law, which binds individuals to specific performance of contracts they may have signed to obtain corporate services and benefits. [r1, r2, r3] According to Ralph Nader, corporations should be declared to not be persons, to undo over a century of court rulings that have gradually given to corporations almost all of the rights of natural persons in addition to such privileges as an unlimited lifetime and limited liability.
Whereas formerly corporations were commonly understood to exist solely for the public benefit and at the pleasure of state legislatures, now many people assume that a corporate board's highest duty is to maximize profit for its shareholders. However, this was not always so, and is a modern distortion of basic principles of law. It is still, in principle and in law, possible for a state legislature to terminate a corporate charter if it judges that such corporation's abuses outweigh any possible public benefit. Corporate officers and lawyers know this and ensure cooperation from legislators by hefty contributions to political parties and campaign finances.
The educational institutions that train physicians and other health care providers are another vulnerable target for corporations. If future generations of health providers are indoctrinated in ideas and modes of thinking that are conducive to corporate profits, patients can no longer expect unbiased, honest advice. To avoid such an outcome and to protect indigenous forms of health care such as traditional Chinese herbology, the following suggestions are proposed:
- The indigenous population and its health care givers must be educated in the possible modes of attack that they can expect from medical and pharmaceutical powers in the industrialized nations.
- In collaboration with, and with the concensus of, indigenous health care providers and their people, prepare a written summary of important features of their health care system and the education of its practitioners. (The article "Modest proposals for improving traditional Chinese herbology education" [b6] is an example of such a description for the practice of traditional Chinese herbalism.)
- The summary of key features of the health care system should be considered as a de facto charter of freedom of choice in health care, distributed worldwide, posted on Internet websites, and called to the attention of special non-governmental watchdog groups formed for the purpose of advocating the rights to freedom of choice in health care world-wide. Such charters should be periodically reviewed to monitor potential violations by governmental regulatory bodies, and such violations widely publicized.
- Encourage the continuation of apprenticeships as a form of education, as they are less susceptible to institutional forms of corruption and subversion.
State, national, and international Health Freedom organizations have mushroomed in the past few years, and have been successful in introducing legislation protecting unlicensed alternative health providers from malicious prosecution and upholding common-sense standards of honesty in disclosure of educational background and training. [r5, r6] In addition, the U.S. Dietary Supplement Health and Education Act of 1994 (DSHEA) [r7] provides additional protection to consumer freedom of choice. These types of legislation are good first steps in countering corporate abuse of the legislative process, but much remains to be achieved in the realm of public education.
I know of no safe depository of the ultimate powers of the society but the people themselves: and if we think them not enlightened enough to exercise their control with a wholesome discretion, the remedy is not to take it from them, but to inform them.
-- Thomas Jefferson