Healing Ways

A new book on alternative medicine has little to add

Last year, I wrote to the Minister of Health protesting at her plans to spend $600 000 on a Ministerial Enquiry into Complementary Medicine. Press reports quoted the Minister as saying that acupuncture was an example of an alternative technique that is now accepted as mainstream.

In my letter I said that acupuncture had never been shown to be better than placebo. Frank Haden followed up my protest with a supportive article in the Sunday Times and this is where the fun began.

A Dr Robin Kelly wrote criticising me, and accusing me of acting unethically. In my response to him I made an error of fact, which he pointed out to me. But the interesting thing about his reply was that he claimed I was losing the battle because of misinformation, a point that I will revisit.

On October 17 Dr Kelly was interviewed by Kim Hill on the National Programme in her Nine to Noon show. My name came up several times, for which I am, of course, very flattered. The interview was basically an advertisement for Dr Kelly’s new book, Healing Ways (Penguin New Zealand, 2000), but several points in the discussion intrigued me.

Kim Hill said she was sure Dr Kelly could explain to her how an anaesthetic worked. Now, I am a consultant anaesthetist with some twenty years experience, and if I could explain fully how a general anaesthetic worked I would immediately put in for a Nobel Prize. General anaesthesia is a complex process, and although many aspects are understood there are still large and fundamental gaps in our knowledge of exactly what happens during general anaesthesia. Maybe Dr Kelly can explain how an anaesthetic works, but I’ll lay a bet that he cannot.

Kim Hill then invited him to explain how acupuncture works. After several assurances that he would do so, Dr Kelly failed. He said that an acupuncture needle acts like an aerial, allowing contact from the outside to the inside. Well, in his explanation the needle sounds more like a conductor than an aerial. Is he saying that acupuncture needles must be metal, and not bamboo for instance?

Dr Kelly then told us that much research was proceeding at Monash University. Well maybe it is, but it is the results we want, not the assurance that the research is being done.

Dr Kelly stated that I would benefit from some acupuncture, though he did not state for which condition I needed it. He also said that what he was on about was enhancing the placebo effect. But hold on. Was he not criticising me for saying that acupuncture had not been shown to be any better than placebo?

You can’t have it both ways Dr Kelly!

Throughout his interview, Dr Kelly was at pains to say the material was covered in his book. I went and bought a copy of Healing Ways, much to my wife’s annoyance as she predicted it would be a total waste of money. How right she was (a very wise woman is Mrs Sharpe.)

I wish I could in all honesty say that I have read Healing Ways, but try as I did I just could not READ it. So Dr Kelly will be able to claim I have missed vital material. I was merely able to dip into it and read small sections.

To be fair, Healing Ways has some valid and potentially useful material. Dr Kelly emphasises the importance of listening to patients, and writes empathetically about dealing with dying patients and their families. I did not, however, find anything particularly new or startling in this material.

The rest of the book is a mix of many current trendy alternative claims. Acupuncture and Chinese Medicine, homoeopathy, applied kinesiology, Gaia hypothesis, healing touch, prayer therapy… you name it, it’s there!

I was particularly amused at the contention that Dr Benveniste is a leading researcher in water memory. Readers will remember the good Dr B. and his thoroughly discredited paper on water memory and homoeopathy in Nature back in 1988.

Another enjoyably silly section in the book deals with breathing. Apparently we should focus our breathing on our navels, because that is where we got our oxygen before birth. Dr Kelly advises that we watch how a baby breathes and learn from this natural breathing pattern. It is a pity that he does not revise his physiology lessons from medical school. Babies breathe the way they do for a number of reasons, but the end result is that the oxygen cost of breathing is proportionately much higher. Also, a baby does not have a functional reserve volume to the same extent that an adult does. Therefore any interruption to breathing in a baby is more likely to result in hypoxia. I do not think we want to run the same risks.

All in all, Healing Ways is an irrational collection of trendy claims, lacking any evidence of scientific validity.

What concerns me about Healing Ways is that I expect this to be typical of the “evidence” that will be presented to Annette King’s enquiry. I have told Ms King that the enquiry will be a waste of time and money. If I am correct about the material that will be presented, I will take no great pride in being proved correct.

I will however concede the final round to Dr Kelly. He said that I was losing the battle because of misinformation. Having heard his interview with Kim Hill, and read the greater part of his book, I am inclined to agree, with the proviso that we recognise that it is people like Dr Kelly who are providing that misinformation!

Pseudoscience and the Midwife

Recent issues of the Skeptic have contained expressions of puzzlement at some subjects being taught to tertiary students in New Zealand. The worst example is the Degree in Naturopathy planned for Aoraki Polytechnic. But is this really all that surprising?

Currently, health courses in polytechnics are including all manner of “alternative” medicine instruction as part of core courses. In my experience, the worst offenders are courses in midwifery.

Most midwives in New Zealand train for one year at a polytechnic, having previously completed a three-year course in nursing. There are three-year direct entry courses, but these are quite new and their first students have not yet graduated.

I teach anaesthetics in the one-year course at Wellington. The time allocated to me is one hour. The senior tutor also teaches this topic for one hour, a total of only two hours’ formal instruction in the whole course.

How relevant is anaesthetics to midwifery? I agree that the amount of knowledge needed by a midwife in this area is limited, but it is not generally recognised just how dangerous anaesthesia can be in the pregnant female. General anaesthesia is the third or fourth commonest cause of death in labouring women in the developed world. The situation is worse in Japan, where it ranks first or second. (The “or” is included because figures change from year to year. The United States has pushed anaesthesia down a slot as a cause of death in pregnant women by bringing gunshot into the top three.)

The point I am hoping to make is that anaesthesia can have a major impact in obstetrics, and I, for one, think that anyone involved in the care of pregnant women should have a sound background in the principles of anaesthesia, and why it can be so dangerous.

So is two hours enough? An open question, but homeopathy gets more than twice as much formal teaching time, and I assume the tutors are paid out of taxpayers’ money and student fees.

Midwives as a group seem to have a fascination with homeopathy. When challenged, defences range from “scientific proof” to “patient choice”. I will disregard the first of these, except to say that I have yet to be offered science or proof in any discussion of homeopathy with a midwife. (As an aside, the weakest defence I have heard is that the Queen is interested in homeopathy, so there must be something in it. These days, one would have thought that royal patronage of anything was guaranteed to ensure its failure, but I digress.)

“Patient choice” is fast becoming the defence of scoundrels. Should patient choice be the final arbiter in medical practice? It is a nice, politically correct idea, but choice is limited to what is realistically available. To defend the inclusion of something in a professional curriculum purely because the students or the patients are interested in it is lacking in sense and responsibility. I would guess that midwifery students might also be interested in skiing and wine tasting, and their potential patients may express an interest in Fascism or safe-breaking. Following along the lines of “choice” may lead to a more entertaining course, but would it advance the care of mothers and babies?

The whole question of choice leads onto the matter of informed consent. Does a midwife who uses homeopathy fully inform her patient (sorry, sorry; I should say her “client”) that she is using something that is unrecognised as a form of scientifically proven medicine, and that its use may put the patient (“client”; there I go again) beyond compensation by ACC should something go seriously wrong? Like hell she does.

Homeopathy is not the only intruder of its type in midwifery. Acupuncture is praised not only for its analgesia, but also as a means of inducing labour, stopping early labour, and turning breech babies the right way up before delivery. Aromatherapy has its advocates, and I have attended a labouring mother whose midwife insisted on having a lighted candle in the room as part of her client’s care. (Delivery rooms are oxygen-enriched environments, and she was not happy when I refused to proceed until the flame was extinguished. The hospital fire officer was even less impressed when I referred the matter to him.)

I was horrified recently to hear of the advice offered to the wife of one of my junior colleagues. She is expecting her second baby, and the baby has turned breech — i.e. bum first instead of head first. A midwife told her that she should lie flat on her back with her feet up until she felt dizzy and breathless, then walk around for a while. This was to be repeated several times a day, and would turn the baby back to present in the proper manner.

Anyone with the slightest knowledge of the physiology of pregnancy should know that if the mother is becoming breathless and dizzy, the baby is likely to be in an even worse state. In late pregnancy, lying flat can pose a significant risk to mother and baby, as the weight of the uterus can press on the aorta, reducing the blood supply to the placenta, and also on the vena cava, reducing the blood flow back to the mother’s heart.

Needless to say, the advice was ignored and the prospective parents are due to see a consultant obstetrician.

Pseudoscience is alive and well in the midwifery world, and is being taught to midwifery students.