There are more than 1,000 different kinds of arthritis, ailments as disparate as gout and lupus and low-back pain and scleroderma.
There's probably a snake-oil remedy for each one and perhaps several hundred for the rheumatoid type, the one known as "the crippler," the one that effects more than 6 million American's, the one people usually mean when they say arthritis.
The snake-oil purveyors always promise a lot more than traditional medicine can -- as yet -- although more arthritis, even the arcane types like lupus or scleroderma, can be treated with some success. And there have been some real breakthroughs in knowledge about rheumatoid arthritis.
Delivery, of course, is the catch. Before techniques like bloodwashing and oral gold pills and lowdose radiation -- all possible therapies on the arthritis horizon -- can become standard options, they must be subjected to the kind of scientific scrutiny that will weigh effectiveness against side effects and safety.
The purveyors of snake oil don't find such consideration compelling.
Mostly they don't call it snake oil anymore -- as they did in those oldtimey medicine shows -- but there have been some dubious claims in recent years for snake venom . And medical quackery, especially when it come to arthritis, is such big business (an estimated $250 million a year in the U.S.) that the arthritis foundation had a kind of medical truth squad to head off the most dangerous before they get started, and to at least make consumers a bit more sophisticated about claims.
The arthritis people are careful about their nomenclature because some of these methods may, at some future date, prove beneficial. But until they're proven not only effective, but safe, says Dr. Michael Lockshin of the New York Hospital for Special Surgery and chairman of the Arthritihs Foundation's Committee on Unproven Methods, the foundation will continue to make skepticism its watchword.
People who have arthritis, almost any kind, are usually people in pain.
People who hurt tend to be more vulnerable to almost anything that promises relief.
Combine this with today's fashiobnable predilection to naysay the medical profession and it may come as no surpirse that in a recent survey of patients at two prominent (and very establishement) arthritis clinics, mroe than 90 percent of the patients diagnosed as having arthriis admitted they wer using, or had used, unorthodox types of treatment.
"You wouldn't believe," says Lockshin, "how many of the patients I see are wearing something made of copper."
Copper jewelry is a relatively mild unconventional teatment of course. Most of the patients interviewed (not by doctors) at the arthritis clinics at Sanford University and at the Univeristy of Alabama admitted to unorthodoxies much less benign, even downright dangerous.
Pain is susceptible to relief in a myriad of ways. People can be taught to relieve pain by themselves through such methods as biofeedback or self-hypnosis. Scientists have discovered that the body can produce its own opiate-like painkillers, endorphins, for example, and their production can be manipulated, to some extent, by conscious will. Some speculate that it is by the stimulation of there natural substances that acupuncture and acupressure techniques may work.
ythis knowledge also sheds some light on the phenomenon doctors have recognized for centuries, the thing called the placebo effect -- the unexplained, but distinct performance of a so-called sugar pill -- when the patient thinks real medicine is being taken.
The trouble with a lot of arthritis quackery is that there is a lot of placebo effect.
"We have good treatments for arthritis," says Dr. Cody Wasner, the Eugene, Ore., arthritis specialist who has been connected with both the Stanford and Alabama clinics.
"The real crime is that the quack treatments take away from real care. People in chronic pain all the time welcome symptomatic relief even when they know it doesn't treat the disease. Sometimes (legitimate) treatments can take several months to work, but that's hard to accept . . . when you are hurting right now."
"When it comes to our patients' lives," says Wasner, "we doctors are very conservative. Sometimes the quack remedies can be dangerous, even when the disease is not." (Some forms of arthritis are less dangerous than others.)
Wasner, who serves on the foundation's unproven remedies committee and participated in last year's survey's, now is trying to figure out ways to estimate the cost of quack remedies.
"We know it's a lot. Fifteen years ago the Artritis Foundation estimated that 20 times more money was spent on quack treatments than on research. We don't have a good figure right now, but it's probably much higher now."
The patients interviewed, he says, had two principal things in common. One was their ailment and the other was almost universal reluctance to discuss their use of quack remedies with their doctors. They were interviewed by non-medical personell in a "non-threatening manner."
Neither economic nor educational status seemed to matter. "Although," says Wasner, "the more affluent ones tended to take trips for cures more often than the pooer ones."
"Cures" ranged from exotic health- food preperations to witches brews, some of them made from ground-up rats tails.
Some "unproven methods" for treating arthritis being promoted these days, according to Lockshin:
Green-lipped mussel extract. Demonstrated as ineffective by two British studies, this "secret" extract from a rare New Zealand mollusk continues to be sold in some health-food stores.
Leifcort. A combination of hormones. No proof of advantage exists, says Lockshin.
Flu vaccines. No advantages have been demonstrated.
Cobra venom. Although there is a factor in cobra venom "that has strong immunologic effects," it had been removed from the product suggested recently for use in arthritis. Specialists see no advantage of cobra venom for arthritis, and some real danger.
DMSO. A powerful and potentially dangerous solvent which is rapidly absorbed through the skins and may have some pain-relieving effects, especially for sports injuries like pulled tendons. Its use in arthritis is questionable.
Bee venom. Severe bee stings are known to stimulate the production of cortisol, which does affect arthritis, but so far studies have failed to document bee venom's usefulness, says Lockshin. He believes that now that pure venom extract is approved for immunizing people allergic to bees, any real effect on arthritis will become known.
Cooper. Studies have shown that copper is absorbed through the skin from copper jewelry and that copper levels in people with rheumatoid arthritis may be low (perhaps from the use of aspirin, suggests Lockshin), but other than that no value has been demonstrated.
Diets. Nutrition may play a role in various forms of arthritis -- gout, for example -- but there is no diet around that will either cure or serve as a substitute for traditional treatment.
There is also the problem of the mis-application of incompletely tested treatments. For example, although radiation experiments are underway, it will not help victims of arthritis to go sit -- as some have actually done -- in a uranium mine. Arthritis 'Cures'
Arthritis sufferers as a general rule, says Dr. Michael Lockshin, chairman of the Arthritis Foundation's Committee on Unproven Methods, should shy away from treatments or medications when puryeyors:
Purport to CURE all (or any) kinds of arthritis. There are treatments but so far, no cures. And nothing works for all 100-plus forms.
Claim "secret," or "mysterious," or "magical properties."
Claim it "works right away," or "gives immediate relief."
Claim supression by the "medical establishment."
Questions about specific claims, treatments or practitioners may be addressed to The Arthritis Foundation, P.O. Box 19000, Atlanta, Ga. 30326.