In September 2002, the New York Rescue Workers Detox Project began to offer free "detoxification treatment" to firefighters, police officers, and others exposed to high levels of toxic debris in the aftermath of the World Trade Center's collapse. The detox program - based on the teachings of Scientology founder L. Ron Hubbard and detailed in his book Clear Body, Clear Mind - purports to "flush" poisons from the body's fat stores using an intensive regimen of jogging, oil ingestion, sauna, and high doses of vitamins, particularly niacin. Funded largely by private donations - most notably from celebrity Scientologist Tom Cruise, as has been widely reported - treatment is provided at a clinic on Fulton Street in Manhattan as well as at a newer clinic on Long Island. Roughly 240 rescue workers and 80 downtown residents have undergone the program; most have paid nothing, although a few non-rescue workers have been asked to contribute $5,000 apiece.
Critics contend that the regimen lacks any scientific basis. But some former participants, with whom I spoke during a daylong visit to the clinic, believe that the program has dramatically improved their health and are lobbying local officials, as well as members of Congress, to support it with public funding. (To date, at least $30,000 in city money has been allocated; this money appears in the most recent city budget, and an additional $300,000 from city sources is potentially in the offing, according to Councilwoman Margarita Lopez. The program has also received $2.3 million in funding from private donors, including Cruise.) Program advocates, including former patients, staff doctors, and spokespeople for the clinic, are also reaching out to physicians by setting up informational meetings in an effort to gain mainstream acceptance.
Is the Hubbard method medically defensible? And if not, how can we explain the compelling endorsement it receives from many who've undergone it, as well as from a handful of physicians?
To begin with, let's take a closer look at the regimen itself. The central premise - as codified by the late L. Ron Hubbard and repeated to me, almost verbatim, by Dr. A. Kwabena Nyamekye, the associate medical director of the downtown clinic - is as follows: Toxic substances (including pollutants, pesticides, and various pharmaceuticals) are stored largely in the body's fatty tissues. Detoxification is thus made possible by "mobilizing" fat reserves - that is, by releasing portions of stored fat that contain dissolved toxins - into the bloodstream, and then eliminating these toxins, mainly through sweating. In order to "unleash" fats, participants take increasing doses of niacin (up to a whopping 3,500 mg to 5,000 mg per day), along with other vitamins and minerals such as calcium and magnesium. They ingest two daily tablespoonfuls of oil (a blend of soy, walnut, peanut, safflower, and evening primrose oils) to replace the fats that have been mobilized and to maintain weight: Advocates are clear that weight-loss is not to occur. Participants also spend a half an hour jogging, followed by two-and-a-half to five hours in a sauna (while drinking ample water), to eliminate contaminants through sweat. The program generally runs seven days a week for three to four weeks, or until the patient no longer "feels the effects of past drugs or chemicals" and reports a "marked resurgence of overall sense of well-being." That is the model regimen, at least.
Some favorable articles have been written about this approach by apparently well-credentialed physicians. However, according to James Dillard, an assistant clinical professor at Columbia University College of Physicians and Surgeons and clinical director of Columbia's Rosenthal Center for Complementary and Alternative Medicine, there is a "disconnect" between the studies described in many of these articles and the conclusions presented. The studies themselves typically lack adequate sample sizes, well-matched control groups, randomization, and other basic elements of experimental design; Dillard calls them "anecdotal," at best. (And some report particularly peculiar findings; according to this study, after roughly three weeks of detox, program participants' IQ scores rose by an average of 6.7 points.)
A number of well-credentialed doctors also sharply criticize the scientific reasoning offered by Hubbard supporters. (This article focuses on Nyamekye and Hubbard's interpretation, but for other theories about how the program works.) Consider first how the regimen purports to mobilize fat reserves. While it is possible to release stored fat through weight loss, the specific emphasis on weight maintenance - and the daily spoonfuls of oil - make it unlikely that significant reserves will be broken down. The use of niacin, too, is open to significant question. Robert Knopp, professor of medicine and director of the Northwest Lipid Research Clinic at the University of Washington, says that niacin is often used clinically (in doses of 1,000 mg to 3,000 mg) to lower patients' blood-lipid levels - the very opposite of what the Hubbard method seeks to achieve. Dr. Knopp adds that at doses above 3,000 mg there is a real risk of niacin toxicity - particularly of liver damage. To prescribe such high doses for any reason is "totally irrational and dangerous," said Knopp.
Furthermore, the assumption that virtually any toxin can be eliminated effectively through sweat is also questionable. The dust at Ground Zero contained a wide array of poisons, including lead, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, dioxins, and asbestos, in addition to pulverized cement and glass. Some doctors do argue that small quantities of metals, including lead, may be released in sweat. Larger, lipid-soluble toxins such as PCBs, PAHs, and dioxins, however, are generally not eliminated this way, in part because sweat is a water-based medium. (It may be possible to detect traces of fat-soluble toxins in skin oils, though this does not mean that bulk quantities of these substances are removed by this route.) And certainly asbestos, which lodges in the delicate tissue of the lungs, cannot be removed by heavy sweating. Indeed, even Keith Miller, spokesman for the New York Rescue Workers Detox project and a long-time Scientologist, concedes that the regimen was never meant to address toxins or irritants in the lungs or to help patients with respiratory problems - the complaints most prevalent among former rescue workers.
The fact remains, however, that many participants believe that the program has helped them. Some who previously needed asthma inhalers say they no longer require them. Others say they are able to sleep again or have returned to work after long absences. How to make sense of these positive responses?
Certainly there are elements of the Hubbard method - exercising daily, drinking large quantities of water, cutting out alcohol and drugs - that would promote health. But a psychological argument, rather than a physiological one, may best explain the program's successes. There is strong resonance between the Hubbard method and other rituals of purification found in so many cultural and religious traditions, in which cleansing of the body allows for mental and spiritual renewal. There are also clear parallels between Hubbard's language and that of psychotherapy: During detox, patients are said to experience "manifestations" of old traumas or toxins; they taste or smell long-forgotten chemicals or drugs; they re-experience symptoms, allergies, and wounds that "turn off" again when toxins are "flushed" from the body. Hubbard himself was notoriously hostile to psychiatry; but what his method seems to offer is a potent physiological analogue to talk therapy. (It's worth noting that at high doses niacin can cause dilation of peripheral blood vessels, redness, and skin irritation, so patients may experience at least some "manifestations" for this reason.)
As William Michael Moore, a master sergeant with the New York Air National Guard who worked in rescue and recovery at Ground Zero and underwent the detox program in May 2004, told me, the Hubbard method wasn't designed to "hide the symptoms" (as other treatments, such as asthma inhalers, do). Instead, it allowed him to "know the full thing" - to experience his symptoms completely, and then begin to heal.
Some participants also said they were helped - and greatly relieved - by the program's forthrightness about environmental toxins. Several told me that staff members validated their concerns about Ground Zero exposure in a way that most public discourse (at least until very recently) did not. Indeed, advocates for the Hubbard method often dwell on government's sluggish response to environmental disaster - its propensity for "denial, damage control & [and] guarded disclosures of information" - and cast themselves as a frank alternative, in which public health is paramount and information on toxins is made easily available. This streak of activism reflects a humanitarian impulse in the Scientology detox campaign, however dubious the science behind it.