Physics

Consumer Health

A Guide to Intelligent Decisions

9TH EDITION

STEPHEN BARRETT WILLIAM M. LONDON MANFRED KROGER

HARRIET HALL ROBERT S. BARATZ

9TH EDITION

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BARRETT LONDON KROGER HALL

BARATZ

Make Good Decisions about Your Health Care The most comprehensive consumer health text available, Consumer Health: A Guide to Intelligent Decisions offers a panoramic view of the health marketplace. You’ll learn how to sharpen your critical consumer skills so you can distinguish valid health claims from those that are fraudulent or misleading. By offering science-based facts and guidelines, Consumer Health provides the tools you need to make smart decisions about health care products and services for yourself and your family.

Some of the many new and revised topics include:

Updated information on health care economics, refl ecting the most recent legislation and debates regarding insurance and mandatory coverage and how it affects you.

New and expanded material on complementary and alternative medicine, including the latest on fad diseases, “energy medicine,” accreditation standards, and diploma mills.

Current research and information on nutrition and weight management, including “detox” products, the Dietary Guidelines for Americans 2010, and the newly-designed MyPlate food guide.

About the Authors

Stephen Barrett, M.D., has been investigating and writing about consumer health issues for more than 40 years. His Quackwatch website serves as a clearinghouse for information on health frauds and quackery. He serves as Vice President of the Institute for Science in Medicine, is a Fellow of the Committee for Skeptical Inquiry, edits Consumer Health Digest, and is a peer-review panelist for several top medical journals.

William M. London, Ed.D., M.P.H., is a health educator and professor in the Department of Public Health at California State University, Los Angeles. He is also the associate editor of Consumer Health Digest, co-host of the Credential Watch website, and a member of the editorial board of the journal FACT (Focus on Alternative and Complementary Therapies: An Evidence-Based Approach).

Manfred Kroger, Ph.D., is Professor Emeritus of Food Science and Professor Emeritus of Science, Technology and Society at The Pennsylvania State University, where he has won several teaching awards. He is a science communicator for the Institute of Food Technologists and is scientifi c editor of its online journal, Comprehensive Reviews in Food Science and Food Safety. He is also associate editor of the Journal of Food Science and a scientifi c advisor to the American Council on Science and Health.

Harriet Hall, M.D., a retired family physician and colonel, served 20 years in the U.S. Air Force. Her administrative positions included chief of clinic services and director of base medical services. She now devotes her time to investigating questionable health claims and writing and lecturing about pseudoscience, quackery, “alternative medicine,” and critical thinking. She is a contributing editor to both Skeptical Inquirer and Skeptic magazines and a founding member and editor of the Science-Based Medicine blog.

Robert S. Baratz, M.D., D.D.S., Ph.D., an expert on quality of care, is president and medical director of South Shore Health Care in Braintree, Massachusetts, where he practices internal, oral, and occupational medicine. He serves on the medical faculties of Boston University and Tufts University and is used as a consultant by many regulatory and law enforcement agencies.

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CONSUMER HEALTH A Guide to Intelligent

Decisions

STEpHEN BARRETT, MD Author, Editor, Consumer Advocate Webmaster, Quackwatch Network

Chapel Hill, North Carolina

WiLLiAM M. LONDON, EDD, MpH Professor, Department of Public Health

California State University Los Angeles, California

MANfRED KROgER, pHD Professor Emeritus of Food Science

Professor Emeritus of Science, Technology and Society The Pennsylvania State University

University Park, Pennsylvania

HARRiET HALL, MD Retired Family Physician

Puyallup, Washington

ROBERT S. BARATz, MD, DDS, pHD President and Medical Director, South Shore Health Care

Braintree, Massachusetts

Ninth Edition

CONSUMER HEALTH: A gUiDE TO iNTELLigENT DECiSiONS, NiNTH EDiTiON

Published by McGraw-Hill, a business unit of The McGraw-Hill Companies, Inc., 1221 Avenue of the Americas, New York, NY 10020. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved. Previous editions © 2007, 2002, 1997. Printed in the United States of America. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of The McGraw-Hill Companies, Inc., including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the United States.

RECYCLED

This book is printed on recycled, acid-free paper containing 10% postconsumer waste.

1 2 3 4 5 6 7 8 9 0 QDB/QDB 1 0 9 8 7 6 5 4 3 2

ISBN 978-0-07-802848-9 MHID 0-07-802848-5

Vice President & Editor-in-Chief: Michael Ryan Vice President & Director of Specialized Publishing: Janice M. Roerig-Blong Publisher: David Patterson Executive Editor: Christopher Johnson Marketing Coordinator: Colleen P. Havens Development Editor: Darlene Schueller Senior Project Manager: Lisa Bruflodt Cover Designer: Studio Montage, St. Louis, Missouri Design Coordinator: Brenda A. Rowles Buyer: Sue Culbertson Media Project Manager: Sridevi Palani Primary Typeface:11-point Times Composition: Stephen Barrett, M.D. Printer: Quad/Graphics

All credits appearing on page or at the end of the book are considered to be an extension of the copyright page.

Library of Congress Cataloging-in-Publication Data

Consumer health : a guide to intelligent decisions / Stephen Barrett …[et al.]. — 9th ed. p. cm. Includes bibliographical references and index. ISBN 978-0-07-802848-9 (alk. paper) 1. Medical care. 2. Health products. 3. Quacks and quackery. 4. Consumer education. I. Barrett, Stephen, 1933- RA410.5.C645 2013 362.1–dc23 2011039127

www.mhhe.com

Stephen Barrett, M.D., a retired psychiatrist who resides near Chapel Hill, North Carolina, has achieved national renown as an author, editor, and con- sumer advocate. In addition to heading Quackwatch, he is vice president of the Institute for Scientific Medicine and a Fellow of the Committee for Skeptical Inquiry (formerly called CSICOP). In 1984, he received an FDA Commissioner’s Special Citation Award for Public Service in fighting nutrition quackery. In 1986, he was awarded honorary membership in the American Dietetic Association. From 1987 through 1989, he taught health education at The Pennsylvania State University. In 2001 he received the Distinguished Service to Health Educa- tion Award from the American Association for Health Education. He has been listed in Who’s Who in America since 2001 and is also listed in Who’s Who in Science and Engineering, Who’s Who in Medicine and Health Care, and Who’s Who in the World. An expert in medical communications, Dr. Barrett operates 25 Web sites; edits Consumer Health Digest (a free weekly electronic newsletter); is medical editor of Prometheus Books; and is a peer-review panelist for several top medical journals. His 51 books include The Health Robbers: A Close Look at Quackery in America and seven of the previous editions of Consumer Health. His other major works include Dubious Cancer Treat- ment, published by the Florida Division of the American Cancer Society; Health Schemes, Scams, and Frauds, published by Consumer Reports Books; The Vitamin Pushers: How the “Health Food” Industry Is Selling America a Bill of Goods, published by Prometheus Books; and Reader’s Guide to “Alternative” Health Methods, published by the American Medical Associa- tion. His Quackwatch Web site, which serves as a clear- inghouse for information on health frauds and quackery, has won more than 70 honors and awards. Since moving to North Carolina in 2007, he has been swimming com- petitively and has won 25 state championship events.

William M. London, Ed.D., M.P.H., is a professor in the Honors College and the Department of Public Health at California State University, Los Angeles. He

is also associate editor of Consumer Health Digest, co-host of the Credential Watch Web site, a consultant to the Committee for Skeptical Inquiry, a Quackwatch advisor, an advisor to the American Council on Science and Health (ACSH), a founding fellow of the Institute of Science in Medicine, a member of the review board of the American Journal of Health Behavior, and a member of the International Editorial Board of the journal FACT (Focus on Alternative and Complementary Therapies: An Evidence-Based Approach). He was an associate professor and chair of the Department of General Studies at Charles Drew University of Medicine and Science, where he led the initiation of the Master’s Program in Urban Public Health. He has also been an associate professor of health education at Kent State University; founding president of the Ohio Council Against Health Fraud; president of the National Council Against Health Fraud; faculty mentor in public health at Walden Univer- sity; professor of Health Sciences at Touro University International; associate professor and director of the Graduate Program in Health Care Management at Col- lege of St. Elizabeth; director of public health for ACSH; director of communications at Columbia University’s Mailman School of Public Health; and executive direc- tor of RAP, Inc., a nonprofit mental health and senior citizens service agency in Genesee County, New York.

Manfred Kroger, Ph.D., is Professor Emeritus of Food Science and Professor Emeritus of Sci- ence, Technology and Society at The Pennsylvania State University, where he has won several teaching awards. He is a science communicator for the Institute of Food Technologists and is scientific editor of its online journal, Comprehensive Reviews in Food Science and Food Safety. He also serves as associate editor of the Journal of Food Science, an ACSH scientific advisor, and a technical editor for Prometheus Books. He has conducted research in analytical chemistry (pesticide residues), food composition, fermented milk products, and dairy processing technology. Even though retired, he remains professionally active at Penn State and nation- ally and internationally. His university courses included

About the Authors

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food laws and regulations, toxicology, introductory food science, dairy technology, and a very popular university- wide general education course entitled “Food Facts and Fads.” His other professional activities include lecturing at public and professional meetings, expert testimony in court and at government hearings, and translation of German writings. In 1999 he was elected as a Fellow of the Institute of Food Technologists. In 2003, he served as the editor of the Proceedings of the 12th World Congress of Food Science and Technology.

Harriet Hall, M.D., is a retired family physician who resides in Puyallup, Washington. She served for 20 years in the U.S. Air Force, from which she retired in 1989 as a full colonel. In addition to practicing family medicine and flight medicine, she held administrative positions including Chief of Aerospace Medicine and Director of Base Medical Services. Since retiring, Dr. Hall has devoted her time to investigating questionable health claims and writing and lecturing about pseudo- science, quackery, “alternative medicine,” and critical thinking. She is a contributing editor to both Skeptical Inquirer and Skeptic magazines and writes the latter’s “SkepDoc” column. She is also a founding member and editor of the Science-Based Medicine blog; an advisor to the Quackwatch network; an editorial review board member for the Natural Medicines Comprehensive Da- tabase; a Fellow of the Committee for Skeptical Inquiry; and a founding fellow and board member emerita of the Institute for Science in Medicine. Her 2008 book, Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon, describes how she became a pilot and helped bring about equality for women physicians in the Air Force. Her Web site is www.skepdoc.info.

Robert S. Baratz, M.D., D.D.S., Ph.D.,who contrib-uted mainly to the medical and dental chapters of this book, is an internist, dentist, and researcher who resides in Newton, Massachusetts. The founder of four companies, he has also served as medical director for two others in the medical device and pharmaceutical industries. He has been involved with issues regarding the safety and proper use of drugs and biomaterials since 1980. He has served on the medical and dental faculties of Northwestern and Tufts universities. Currently he serves on the faculty of Boston University School of Medicine, having initially been appointed in 1976. His broad knowledge of interactions of materials and the body has been sought by numerous licensing boards, regulatory agencies, universities, government agencies, insurance companies, and professional associations. He is also an expert in medical database applications and analyses. Dr. Baratz has worked for more than 25 years in dental and medical practice for private, public, and government entities, including the Department of Veterans Affairs, The Daughters of Charity, and Beth Israel Hospital in Boston. He has also worked for the Agency for International Development. Currently he is President and Medical Director of South Shore Health Care in Braintree, Massachusetts, where he practices internal and occupational medicine. He has also served as NCAHF President; a scientific advisor to ACSH; and President of International Medical Consultation Services, Inc., of Newton, Massachusetts. In 1992, the American Dental Association gave him a Presidential Citation for his work in advancing oral public health. He has been listed in Who’s Who in America, Who’s Who in the World, and Who’s Who in Science and Engineering.

About the Authorsiv

More is known today about achieving and maintain-ing good health than ever before. Life expectancy is at an all-time high, and although there is still much room for improvement, health-related accomplishments have exceeded the fondest dreams of past visionaries. This progress has been partly due to a safer environ- ment that includes cleaner water, safer food, and better living space. Yet we hear plenty of news about the en- vironment that concerns us. Preventive and therapeutic medical care have advanced tremendously, yet we worry about the risks associated with immunization, cancer therapies, prescription drugs, surgery, and many other methods of treatment. How can we resolve our concerns and reap the benefits of modern scientific discoveries? The key is to become well-informed. The challenges involved are enormous. The health marketplace—the world of commercial activity for health-related products and services—is complex and dynamic. The Internet offers vast amounts of informa- tion, but much of it is not trustworthy. Health concerns can be overwhelming, especially for people confronted with medical crises. Quackery is more pervasive and far trickier than most people realize. (As noted by the late James Harvey Young, Ph.D., “Quacks never sleep.”) Health-care costs continue to rise despite numerous reform efforts. The rapidly growing older adult popula- tion faces a bewildering array of choices and obstacles for obtaining and paying for appropriate health care. It can also be difficult to determine what health care actu- ally costs and to obtain the best prices. In addition, many people lack access to adequate health care because of cultural, transportation, language, and economic barriers. Government and private agencies protect consumer rights in some ways but not others. The health-care industry is accountable to consumers to some extent, but quality is often elusive and abuses persist. Some scams are even facilitated by legislation and government policies. Consumer advocacy calls for justice and fair play in the marketplace. Yet many self-appointed “consumer advocates” do not act in the public’s interest. Although some are sincere and make a contribution, others engage in irrational business bashing or act from motives of per- sonal aggrandizement. Some business trade associations even pose as “consumer groups” and seek self-serving legislation.

Consumer Health offers a panoramic view of the health marketplace. It explains and supports the scientific methods that are essential for validating claims about how products and services affect health. It can help you to: • Understand how medical facts are determined and where

to get appropriate information and advice • Avoid wasting money on unnecessary, ineffective, or unsafe

products and services • Take care of yourself and minimize your need to spend

money on health products and services • Choose appropriate health products and services to meet

your needs • Get the most value out of your health dollars • Optimize benefits from encounters with health-care provid-

ers and facilities while minimizing the potential for harm • Assert and protect your rights • Set reasonable expectations for what health care can do • Evaluate how political issues affect access to health-related

innovations and accountability of marketers

The key to intelligent decision-making is to use relevant and accurate sources of information. Consumer Health is both an introductory text and a reference book on the opportunities and pitfalls of the health market- place. The various chapters offer hundreds of practical tips; the Appendix provides a comprehensive list of trustworthy sources. You will get the most out of the book by using the detailed Index to search for information and the Glossary for definitions of terms that might be unfamiliar. We also operate many Web sites that can supplement your coursework. Consumer Health Sourcebook (www. chsourcebook.com) provides hyperlinks to dependable online sources. It also links to Consumer Health Digest, a free weekly e-mail report of relevant news. Internet Health Pilot (www.ihealthpilot.org) is a gateway to ad- ditional trustworthy information. Quackwatch (www. quackwatch.org) and its many subsidiary sites provide comprehensive articles about quackery, health fraud, and consumer health strategy. All of these sites are accessible free of charge. Visiting them is a good way to enhance your learning experience.

Stephen Barrett, M.D. William M. London, Ed.D, M.P.H. Manfred Kroger, Ph.D. Harriet Hall, M.D. Robert S. Baratz, M.D., D.D.S., Ph.D.

To the Reader

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Preface for Instructors

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As have previous editions, this ninth edition of Consumer Health emphasizes the opportunities and pitfalls in the health marketplace and aims to help students protect their health and their pocketbook.

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