Pagano’s Web Site
A review of Dr. Pagano’s book web site and its advertising.
This is a review of the web site for the book Healing Psoriasis: the Natural Alternative, by John O. A. Pagano, D.C.
Important Notice (added November 26, 2004): The vast majority of people who have commented on this article were under the mistaken impression that this is a review of Pagano’s book. It is not, and has never been, a book review. This article is a review of the web site that advertises the book. It says so, in the title above. Nasty comments from people who weren’t able to read carefully enough to make this extremely important distinction were not at all compelling. Even less interesting were the thoroughly hateful comments from people who thought that this review claims that Pagano’s method doesn’t work. If the article says anything of the sort, I would have liked to see it pointed out. Nobody did so,though.
This review is broken down into a page-by-page criticism of the entire web site, based on the advertising used and the claims made. It is meant to be a companion to a full criticism of Pagano’s book. The full criticism and cross-references between this review and the full criticism will be forthcoming, as soon as I can find a copy of the book (from here on out, the book will only be referred to as “the book”).
The Main Page
The Amazon.com and Barnesandnoble award citations: Both of these citations were awarded for having the bestselling book in the category of Cutaneous Diseases. On Amazon.com, at the time the award was given, there were twenty-four books in this category, most of which dealt with skin diseases other than psoriasis. While it is obviously a popular book, displaying this award front-and-center is simply a marketing gimmick, and has nothing to do with whether the method within the book is effective. I’m sure Michael Crichton has topped the bestseller list at one point or another, but who would go to him for serious scientific advice?
Below the image of the book, text explains that the book had been voted “BEST BOOK OF THE YEAR” in the health category by the North American Bookdealers Exchange (NABE). What isn’t shown is which year this award (or the Amazon and Barnesandnoble awards) was presented. Obviously, it can’t be every year, as the book was written in 1991, and NABE was formed in 1980 (NABE appears to be an “alternative” book marketing group — which could be appropriate for an alternative “medical” treatment). The text is simply another marketing ploy (how many pharmaceutical companies advertise like this: “Viagra — Voted the BEST DRUG of the year!”?), and NABE is not qualified to critique the book based on its scientific or medical merits, but only the merits of its sales, promotion, packaging, and similar categories.
In the main body of text on this page, psoriasis is described as “characterized by an uncontrolled shedding of the skin.” The shedding of the skin is secondary to the uncontrolled growing of the skin. Other diseases can be characterized simply by uncontrolled shedding of skin. The site also says “For centuries, psoriasis has remained elusive to all research and to this day, its cause and cure remain a mystery from the orthodox point of view.” This is true, but “orthodox” medicine and science have existed for much less than “centuries,” so the comment is misleading in that it implies that modern medicine has been around for as long as psoriasis has.
This page then goes on to claim that the book has “an answer” to psoriasis, and that there is “hope” for its victims. Offering hope without scientific evidence of efficacy (which we have yet to be offered, but is lacking as we shall see) is, in the mind of this reviewer, unethical and borders on the criminal. To give someone hope without showing (or being able to show) that you can follow through on the implied promise of relief is, in effect, a confidence game. Especially in the case of this book (and “self-help” books like it), which will be used primarily without oversight by competent medical personnel, regardless of any entreaties within the book to do so (most people will buy the book based on its cover, disregarding childhood lessons to avoid judging books this way, and so have lined Pagano’s pockets prior to any knowledge of the treatment, and without the possible recourse of a malpractice suit — one five-star review on Amazon.com of this book is from someone who had yet to try the treatment, and who gave it five stars based only on the text!).
The page then talks about the book being a “comprehensive report” (italics theirs) of the results that Pagano has given to sufferers. Without having seen the book, no one has given me any indication that there are any failures reported in the book. With psoriasis, there are always “failures,” at least in the eyes of the treated patients. To be a comprehensive report, the book must report all the negative results along with the positive. Since there have been negative reports on the psoriasis newsgroup, it is obvious that this “report” is not as “comprehensive” as it could have been.
The treatment supposedly uses “time-honored procedures.” Many procedures from long ago have been rejected by doctors of today (or even a century ago). To use a procedure simply because it has been known for centuries is naïve and dangerous (bloodletting is a good example). This page also claims that Pagano’s procedures are “drug free, without the use of tar baths, injections, or even ultraviolet treatments.” This appeals to those who have already found modern medical approaches to this disease lacking in some respect, and so are desperate for the elusive “something else.” However, many of these people are unaware of the various combinations of the established treatments that may provide renewed remission of the disease. For the most part, it seems that once a single treatment stops working, psoriatics reject that treatment forever after, yet it has been shown that “rotating” different treatments can be effective in a more long-term treatment program.
A Peek Inside the Book
On this page, we first find a blurb on the foundation of the whole diet. It’s based on “readings” from a psychic named Edgar Cayce, who died 55 years ago. At least one of these “readings” is suspect simply because the symptoms Cayce describes don’t really sound like psoriasis at all.
Right after the main paragraph, we find this one line: “This book proves the efficacy of this theory by documented case histories, patient affidavits and striking before and after photographs.” Scientifically speaking, case histories, testimonials, and before-and-after photos prove nothing. To prove efficacy means that you’ve shown that the treatment works better for most people than a placebo. To do this, you’ve got to have a matched control group, in order to compare the treatment to a non-treatment, a placebo. Case histories only show the one case, where the diet is used. Patient affidavits or testimonials will most likely be from successful treatments. Before-and-after photos, once again, will only be from success stories (or can be faked). From the anecdotal evidence of people on the newsgroup, we know that there are failures. (Beyond all that, you can’t prove the efficacy of a theory, only a treatment, so the claim is misleading on its face.)
Next, and I used to find this bizarre, the site claims Pagano’s book is 346 pages long, but both Amazon.com and Barnesandnoble.com say the book is 291 pages long (Amazon seems to sell the May, 1991 edition, while B&N sells the August, 1996 edition — both show the same ISBN). I’ve discovered, however, that the book is 346 pages long, when you include the index and appendices, and 291 pages when you don’t. Why the Internet booksellers decided against including these pages in their count is a mystery.
Finally, we get a list of chapter titles, and no truly informative “peek inside the book.” A few paragraphs out of a chapter would have been nice, just to see the style of writing, if nothing else.
Reviews and Quotes
Okay, once again, how many times do major drug companies or scientists advertise using these kinds of testimonials? That’s the biggest problem I have with this page, and similar pages from all the other people offering scientifically untested psoriasis remedies. Checking up with the “professional” people quoted on this page (and there’s not a single “review” here, really) would be a task the average psoriatic wouldn’t even attempt (but do they sway the average psoriatic?).
There is one quote I’d like to expand on, though. A dermatologist says “Dr. Pagano has provided a new perspective in the management of psoriasis — one that justifies serious consideration by the scientific community.” The number of people who write on the newsgroup about trying (or succeeding) on Pagano’s diet warrants, I think, a serious scientific study of its efficacy. Since the risks of this treatment are really unknown, and the percentage of people who will benefit from it also unknown, it can be only good for real trials to be held, which could answer these questions for all psoriatics. It should go without saying, though, that Pagano should be the one who is responsible for any such trials, since he is the one making the claims.
Remarkable Before & After Photos
Well, there’s not much to say here that I haven’t already said (see “A Peek Inside the Book,” above), except I really do find it remarkable that a five-year-old was subjected to the colonics and adjustments that I’ve been told are a part of the treatment. Also, the alternate text for the photos for the third set of pictures identify them as “girl,” even though it’s quite obvious the subject is not a girl (and the caption identifies “V.F.” as being 21).
About the Author
On this page, I expected to find some sort of curriculum vitae, or a description of the schools Pagano attended and training he has received. We find none of that at all. The thing we find here, mostly, is a list of self-serving promotional appearances that Pagano has made. To be proud of appearing on talk shows on radio and television is one thing, but to use them instead of credentials in order to appear important is quite another. Appearances like these only show that people find you interesting. They don’t help to prove that you’re correct.
The first two paragraphs of this page are not about appearances, but are already covered by other pages and my own criticism of them.
The interesting thing about the third paragraph is that it says that Pagano’s work has been presented to the National Psoriasis Foundation. Was it a good presentation or a bad one? A search of the NPF’s site lists one Web page as the sole reference to Pagano among the the NPF’s many, many pages (Update, June 8, 2009: the page has been deleted; a search of the NPF site returns no results for Pagano). Even this page is silent on the question of whether the regimen works or not.
The New Jersey Counseling Association bestowed an award on Pagano in 1995 for his “neverending research” on the “natural healing of psoriasis” (nevermind that adjustments and colonics are far from “natural”). Once again, I must ask how they are qualified to judge medical treatments.
The fifth paragraph talks about the show Unsolved Mysteries (UM). As far as I can tell from seeing the show, it’s the 1990s equivalent of In Search Of…, which was by no means an unbiased show itself, often promoting the ideas it claimed to be searching for, rather than presenting a scientific review of the questions. The UM show was about Edgar Cayce, the psychic from whom Pagano got his ideas. To appear on this show, or to have your work discussed on this show, seems to me to be less than flattering in a scientific light.
The last paragraph reiterates the awards the booksellers have given Pagano, and then speaks about his traveling to Japan in 1999 for a lecture circuit. This strikes me as odd, since the Japanese have a very low incidence of psoriasis, along with Native Americans and Eskimos. Finally, we are treated to a teaser about an upcoming “psoriasis cookbook.”
Ordering Information
This is the largest page on the site, with all sorts of order forms and shipping cost information. The truly amazing thing about this page, though, is that at the bottom of it, if you bother to scroll that far (or aren’t already off to one of the booksellers getting a cheaper price), they finally get around to providing a disclaimer:
The author emphasizes that this book is a report of results obtained in cases of Psoriasis and Eczema and the procedure by which they were accomplished. It is not to be viewed as a guide to self diagnosis or self treatment. Consultation with your personal physician is essential when embarking on a new approach to this or any other disease.
That this information is effectively hidden here (as how many people will really get this far?) shows a large desire to sell the book, rather than actually help people rid themselves of psoriasis. Really, to only put the warning that the book shouldn’t be used for self-treatment all the way down here, where few people will view it, leads to many people buying the book thinking it is a self-help sort of treatment. When they find out in the book itself that it shouldn’t be used without physician assistance, how many of them will be upset at the money spent? Conversely, how many will ignore that sage advice, and treat themselves anyway?
Placing the disclaimer in such a way does nothing to help the psoriatic, it only helps Pagano cover himself in the event of a lawsuit. In my opinion, an ethical physician would have plastered direct links to the disclaimer on every single page of the entire site, and in bold face on the main page. What harm would it do, besides having fewer people buy the book?
Links
Main Page
(The site has been redesigned since this review)
A Peek Inside the Book
Reviews and Quotes
Remarkable Before & After Photos
About the Author
Ordering Information
If you really want to order the book, get it cheaper through one of the Discount Retailers.
