Hokum Locum

Quack Aids Remedies

The Prevalence of HIV disease has continued to increase across the African continent and is a major public health concern due to cultural attitudes to sexuality and a degree of poverty which precludes effective pharmacological interventions. A quack Nigerian surgeon has been charging patients US$1000-1500 for a course of his vaccine which he claims has successfully treated 900 patients for HIV/AIDS. The Nigerian Academy of Sciences deemed the vaccine “untested and potentially dangerous”. The Surgeon’s response has been to allege that “he has been the victim of a conspiracy by transnational pharmaceutical companies, in league with the Nigerian Health Ministry, to steal his ‘wonder vaccine’….” This is the familiar paranoid conspiracy theories of the quack.

HIV/AIDS disease has continued to attract the same sort of quack attention as has terminal cancer, which is not surprising given that both progress to a fatal conclusion. Desperate people are given false hope as well as being robbed of their remaining wealth, which is siphoned away into the pockets of charlatans instead of passing to the descendants of the unfortunate victims. Using the late Petr Skrabanek’s rules (demarcation of the absurd) I would not even bother to test this AIDS “vaccine” and predict with complete confidence that should someone conduct a test the preparation will be found to be worthless.
Lancet Vol 356 August 5 2000 p 493

Acupuncture wins BMA approval

Like homeopathy practitioners, acupuncturists are irrepressible and in a neat example of Bellman’s fallacy (repetition leads to recognition) have prevailed long enough that they now have the imprimatur of none less than the British Medical Association. The full report is available at the BMA website (www.bma.org.uk) but seems to have been largely motivated by the fact that acupuncture is both widely requested and safe. I wonder if the BMA visited www.quackwatch.com or any of the other skeptical websites.

The study claimed that greater use of acupuncture could save the National Health Service “millions of pounds each year”. There was a call for minimum standards of training. As you will recall from Conference 1998, I modestly set the training standard by showing that a one hour training session was adequate for any lay audience. It may be necessary to gild the lily somewhat by devoting more time and training for a credulous medical audience. (BMJ Vol 321 1 July 2000 p11)

Perhaps this would be the time to share with you my memories of my acupuncture training course, during which the trainer demonstrated a popular alternative medical technique known as kinesthesiology. A patient with an allergy to tomatoes was shown to have reduced muscle strength when exposed to the alleged allergen. The test was an attempt by the examiner to separate the patient’s apposed index finger and thumb. The next step was to have the patient hold a packet containing a vial of depomedrol, a steroid. This was meant to show that the reduced muscle strength would be countered by the contact with this potent steroid. Unfortunately one of the other observers had mischievously removed the steroid vial from the packet and once the “patient improvement” had been triumphantly demonstrated he revealed his subterfuge. The trainer was unfazed and quick as a flash claimed that the improvement was maintained owing to “homeopathic residues on the packet”. It was at this point, as I gazed at the bovine and credulous faces of my fellow course members, that I became a confirmed skeptic.

Canadian Idyll

While recently in Canada for a military conference I suffered a recurring nightmare that I would arrive home to find a peremptory missive from our editor demanding a contribution for the next issue. (I did.) I was therefore relieved to find a supplement in the Vancouver Sun of Nov 16th 2000 outlining a “health show” and decided this must be worth a few column inches. I will summarise a few key points. Naturopathy/Naturopathic medicine diverges from allopathic medicine (translation: ordinary “scientific” medicine as practised by JC Welch) only “at that point where professionals in common possession of scientific facts conscientiously disagree on how best to use their shared knowledge in treating patients”. Before scoffing, I caution readers to be aware that “there is a common assumption that naturopathic treatments are placebos”.

Not surprisingly, there is a wealth of research carried out at Naturopathic Colleges showing that naturopathic remedies are very effective. You can choose from “Khamut”, a wheat grown from grain recovered from Tutankhamen’s tomb, Light therapy which uses biostimulation to promote efficient cell function, and “Trilovin” – the natural sex formula of the Ancient Greeks.

As a keen scientist I decided to administer some of this product to my wife and I am amazed to report that she has increased pain tolerance, enhancement of the immune system, improved mood and a sense of well being, reduced cholesterol and blood pressure and can now play tennis and ride a bike, but for some reason I’m tired and seem to have a constant headache.

Attention Deficit Hyperactivity Disorder (ADHD)

When I was at school 30 years ago I recall widespread concern that global cooling was going to lead to a new ice age. Now it’s global warming! I do not however, recall my fellow students exhibiting the behaviour alleged by those suffering from ADHD. I have long been suspicious that this is a fad disorder created by doctors in order to explain the exuberant but normal behaviour of some children. I will therefore conclude by quoting in full from the Guardian Weekly Vol 163/20 “Notes and Queries” column.

At school in the 40s I cannot remember pupils being hyperactive, disruptive or showing symptoms similar to ADHD. Is its growth due to a lack of discipline, or to pollution, radiation, junk food, etc.? There are always fashions in mental illnesses. In Freud’s day conversion hysteria was popular. Now it is rarely found. In Sydney, where I was working as an educational psychologist, any child with a behavioural or learning disability was likely to be labeled as autistic. Since then this diagnosis has come to be used much more discriminatingly.

Nowadays the psychiatric profession, supported by the drug companies, readily creates fashions in diagnosis. The committee that decides on the contents of the Diagnostic and Statistical Manual of the American Psychiatric Association needs only to ascertain that a group of psychiatrists agrees that a mental disorder exists to include this disorder in the manual. Another committee could reliably agree that the moon is made of green cheese. There have always been children who do not behave in the ways in which adults around them want. A few of these children have actual brain dysfunction. Many more, living under conditions that they find stressful, are constantly distracted by anxiety, and so are hyperactive and disruptive. Other children have parents and teachers who cannot tolerate the exuberant behaviour of ordinary children. The popularity of the recently created mental disorder ADHD means that many children are diagnosed as ADHD and prescribed Ritalin or other similarly potentially addictive drugs. These drugs’ long-term effects on a developing brain are yet to be discovered.

Hokum Locum

Colon Cleansing

Thanks to reader Alan Pickmere for drawing my attention to colon cleansing. In a radio advertisement Alan heard the claim that the average adult has up to 10kg of preservatives and toxic waste in their colon. The actor, John Wayne had 20kg removed at autopsy, doubtless dating from the time spent venting his spleen against commie actors facing Senator Joe McCarthy’s inquisition. Come to think of it, perhaps he should have “vented” more often.

These accumulations are not at all surprising to a skeptical doctor as I am frequently exposed to views espoused by people whose bodies hold far more toxic waste than this and it goes all the way up to their heads. If any readers would like to cleanse their colons please call 0800-CLYSTER.

Herbs Flunk

Although it makes sense to test herbs for therapeutic efficacy, there are few acceptable trials. An Australian study of herbal and Ayurvedic preparations found that only tumeric had any anti-inflammatory effect and 5 of 23 celery preparations had an anti-arthritic effect equivalent to 50mg of ibuprofen. Given the wide variation in the bioavailability of herbal medicines I recommend stick to ibuprofen, normally taken in a daily dose of 1600mg costing around 75 cents. I bet that herbal medicines cost a lot more than that. It’s important for any useless treatment to cost a lot because that helps people believe that it actually works. (NZ Doctor 19 Jul 2000)

Swadeshi

Third world countries such as India frequently seek pragmatic solutions to their health problems and in this case they have encouraged traditional practices such as ayurveda, sidha, unani, yoga, naturopathy, Tibetan medicine and homeopathy. I was reassured to see the addition of homeopathy and naturopathy, so much a part of mainstream New Zealand medicine. The Indian Health Minister has asked all other Ministries to ensure that its employees can be reimbursed for the cost of such treatments.

Perhaps this is where our own Health Minister got the idea for allocating a large sum of money for the evaluation of alternative medicine. The increasingly third world Wellington Hospital is reduced to waving its hands at patients. Will they soon be encouraging them to start the day with a freshly steaming glass of their own urine, perhaps followed by pills made out of lama’s faeces, a traditional Tibetan remedy. (Lancet Vol 355, p1252)

Silicon Implants

As Shakespeare so eloquently put it “God has given woman one breast and she gives herself another”. Minerva (BMJ Vol 320 p 882) reports a fourth extensive study finding no association between ill health and silicon implants. However, this will not have any effect on the millions of dollars given to litigants because the standard of proof is to have one’s personal account of suffering published in any women’s magazine. In the true spirit of the post-modern age I look forward to the first litigation for alien abduction. Those anal probes can hurt! All we need is a New Zealand Doctor brave enough to fill in the ACC forms.

This is yet another example of Welch’s law: “Claims expand to take up the amount of compensation available”.

Surgeon Amputates Healthy Legs

Since I have raised the topic of post-modernism, readers will be interested in this account from the BMJ (Vol 320 p332). Both patients reported on suffered from a rare body dysmorphic disorder known as apotemnophilia which makes them believe that they can only be normal once they have had a limb removed. The patients were delighted after each had a leg removed in a below-knee amputation. The hospital administration was quoted as saying that no more of these operations will be done.

Stokabunga

Obesity has been raised to an art form in North America and it is fitting that the American food industry has launched “Stokabunga”, a cookie containing more calories than an average meal, including 48g fat. Such excess is a fitting accompaniment to a recent announcement that for the first time the number of overweight people in the world equalled the number who were malnourished. In Britain, the average cat receives more protein per day than the average poor African. Sales of Stokabunga have been particularly strong in Belgium.

Ineffective Drugs

Of the 50,000 prescription drugs currently available in Germany, 33,000 have never been subject to clinical trials. They include homeopathic preparations, herbal remedies and in one case a useless preparation containing loess (a fine soil) used for the treatment of diarrhoea. Drug companies were able to suppress a report that gave advice on how to substitute cheaper effective drugs in place of the useless ones. During World War 2, Hitler’s doctor treated him with capsules containing faecal bacteria from “finest Bulgarian peasant” and such a product is conceivably still available. (New Scientist 4 Oct 97 p20)

As recently as 1997 it was possible to receive rejuvenating injections of fetal sheep cells. This treatment was popularised by Konrad Adenaur, the German Chancellor who remained in power until he was 87 years old. Unfortunately the Germans have a bad habit of blindly following rogue Chancellors.

It is quite clear now what has happened to their Pharmaceutical Regulatory authorities. Instead of a feral and vigorous staff dedicated to removing quack remedies, the excessive use of fetal cells has turned them all into sheep in sheep’s clothing. (New Scientist 25 Jan 1997 p6)

Finger-Licking Bad For Waist Reduction?

The herb Aristolochia gangchi was mistakenly used in weight loss pills by the Kentucky Fried medicine brigade. As well as causing kidney failure it is now thought to be responsible for cancers of the urinary tract. Staff at a Belgian weight loss clinic had prescribed the herb Stephania tetranda but the mixture also contained Aristolochia which has a similar sounding Chinese name.

Dr David Kessler, former Commissioner of the United States Food and Drug Administration (FDA) notes that there are no controls over the quality of such products or their composition. The cause of this was the passage of the Dietary Supplement Health and Education Act of 1994, which deregulated the industry by limiting the role of the FDA and opening up this $15 billion-a- year industry. This ridiculous legislation does not require that dietary supplements be shown to be safe or effective. I have no doubt that an epidemic of renal failure and cancer will soon peel the weight off those hordes of fatties seen in every US shopping mall. (New England Journal of Medicine June 8 2000, p1742; BMJ Vol 320, p1623)

Tissue Samples and Cryptopathology

When confronted with unusual lumps and swelling it is a common medical practice to get some tissue examined by a pathologist and this will often reveal the diagnosis.

As a keen hunter I feel the same exemplary approach should be taken when examining phenomena such as “Bigfoot”, the Loch Ness monster and our very own Australasian “Yowie”. The Yowie is believed to be named thus after the cries recorded when it had come into contact with hunters and been wounded. It would be a matter of some pride to me if I were the first person to bag either of these trophies. Nessie would obviously require a large harpoon but depth charges would soon bring the shy and expiring creature to the surface. Bigfoot should prove no problem for my Winchester 0.243. I was therefore disappointed to read that a county in Washington has declared it illegal to kill Bigfoot. However, fur samples have been gathered from “close encounters” and delivered to Ken Goddard at a wildlife forensic laboratory. Ken found that Bigfoot has made a remarkable adaptation to its cold environment-polyester fur. Ken is waiting for a “close encounter of the turd kind” so he can examine the creature’s diet for evidence of Stokabunga. (New Scientist 22 Jan 2000 p40)

I predict that once tissue samples have been obtained, all of these secretive creatures will be found to share a puzzling 100 percent of their DNA with humans.

Hokum Locum

John Welch started writing for the magazine in Issue 16, but a posting with UNSCOM to Iraq meant he had to relinquish responsibility for the column. He is delighted to once again have the opportunity to indulge his interest in bizarre medical beliefs and wishes to thank Dr Neil McKenzie for his efforts to date.

Craniosacral Therapy

Manipulative therapists such as osteopaths and chiropractors continue to provide a rich source of deluded ideas. Here is Clemens Franzmayr writing in NZ Doctor (10 May) on the treatment of dizziness: “Colleagues experienced in craniosacral therapy have good results by freeing tentorium cerebelli from restriction and by mobilising the temporal bone on the disturbed side, including the ear pull.” For once I am in complete agreement but I have always obtained far more impressive results from the “leg-pull.”

The good Doktor goes on to say: “with one single manipulation of the upper cervical spine the patient could be free of all complaint.” The patient could also be dead from spinal cord damage due to the wholly unnecessary and unscientific intervention.

Medical Overinvestigation

Your correspondent has been recently refreshing his medical skills in the Casualty Department of a large urban hospital where many of the patients present with trauma due to alcoholic decelerations. It is fascinating to experience the change in attitudes due to medicolegal fears and the consequent extensive use of sophisticated investigations such as radiological imaging techniques, recently satirised by one writer as the “gropagram”. However, a note of caution. When arriving at the hospital please do not ask for your NMR (Nuclear Magnetic Resonance) as I fear you could experience a nasty rectal invasion by an agency nurse from Sri Lanka. (New Scientist 17 April 99).

Fraudulent Skin Treatments

There is widespread belief and acceptance of treatment with secret mixtures by a section of the community who do not understand that such preparations are not subject to any form of scientific testing, standard or even basic tests of efficacy. A London clinic sold a 50g pot of cream that cost $2000 which was found to contain white paraffin and a small amount of the steroid fluocinolone, sold in New Zealand as Synalar and costing $5.92 for 30g. The great irony here is the use of a powerful and effective remedy secretly used within the context of quack therapy. Herbalists, not to mention Homeopaths, will no doubt join me in general indignation at this totally unethical behaviour.

This “Kentucky Fried medicine” (secret herbs and spices?) is a perfect accompaniment to the age of post-modern consumerism. One Wellington GP has even received approval from the Medical Council to sell similar products to her patients.

I wish I had patients like that when I was in General Practice. Even Dermatologists would envy me earning over $100,000 a year from the sale of one pot of cream a week. Damn that troublesome conscience; I could have been rich!

Analysis of Chinese herbal creams

Patients with chronic problematic skin conditions often resort to herbal remedies which are seen as “natural” and therefore safe and free of side effects. Since chronic skin conditions are commonly treated with potent steroids there are genuine concerns about side effects. Some researchers (BMJ 1999;318:563-4) found that eight out of eleven herbal creams contained dexamethasone, a potent topical steroid.

I know it’s fraud, but I still find it amusing that people using a “natural and safe” herbal remedy are in fact gaining relief from a potent nasty dangerous steroid, normally prescribed by nasty dangerous doctors in the pockets of multinational drug companies. Me paranoid? I know they are out to get me!

This reminds me of a very popular cough mixture in the early 1900s whose “magic” ingredient was heroin.

Chicken Soup

Two Israeli doctors are calling for the World Health Organisation to include chicken soup on its list of essential drugs. This will come as a great burden to the inhabitants of many Third World countries where the daily walk for water will now have to be extended for chickens. Since the WHO already lists a variety of conditions amenable to acupuncture, including myopia, the inclusion of chicken soup is entirely appropriate as an unspecified remedy for whatever ails you. Don’t be put off by the lack of evidence — “Chicken soup is over 2000 years older than the randomised trial.” They said the same thing about acupuncture.

I can assure readers that chicken soup will cure anything if you strongly believe that it will. Disclaimer: I have no shares in any chicken soup companies.

Dental Amalgam

Readers will be pleased to hear of the retirement of one of the worst medically qualified quacks in recent memory. This individual who cannot be identified for obvious legal reasons, used a dental amalgameter to diagnose “mercury poisoning.” This fraud was practised on countless patients who then paid to have all of their amalgam fillings removed, a practice condemned by the Dental Council as there is no link with any form of illness and the number of such fillings. I have written before on the subject of dental amalgameters which are basically a fraudulent blackbox device of the type discussed at our last conference. (See lead article – ed.)

This quack also railed against immunisation which prompted me to write a letter of complaint to the Medical Practitioners Disciplinary Committee (MPDC) who are essentially toothless when dealing with quack doctors. I was informed anecdotally by the MPDC that they had received dozens of complaints about this individual but were powerless to act unless they received a complaint from an actual patient who had been harmed. The MPDC forwarded me a copy of the doctor’s reply and if anybody would like a copy please send me a SAE. It is a fascinating, self-deluded and paranoid document from which I have deleted any identifying details.

Rudolf and Bailer, psychologists at the University of Heidelberg, looked at 40 patients who claimed health problems connected with their amalgam fillings. When compared with other people with amalgam fillings but no such complaints there was no correlation with any measurements of mercury in blood, saliva or urine. The researchers found that the complainants had histories of psychological problems, were emotionally unstable and had an obsessive attitude towards their health.

I have a mouthful of amalgam fillings and my health is perfect. I rest my case.

Buteyko and Asthma

The Buteyko breathing technique (BBT) is merely one more of a long line of quack therapies for asthma. (Try the medieval remedy – powdered fox lung.) Central to the theory is the belief that all patients with asthma hyperventilate (over-breathe). Deliberately slowing breathing increases carbon dioxide levels which could dilate restricted airways. However, the overwhelming scientific consensus is that asthma is an inflammatory disorder. Since quack treatments are seldom put up for testing, I was surprised to read of a trial of BBT reported in the Lancet (1998; 352:1993). It flunked. Although BBT patients were able to reduce their medication there was no objective change in key indicators of lung function. This is not at all surprising as patients receiving acupuncture treatment for asthma also reported marked improvement which was not confirmed by objective measurements of lung function. This is the classic placebo effect which is the cause of perceived improvement in most alternative medical treatments.

When people strongly believe in something and that belief becomes an unshakeable faith, they are immune to reason. When the above results became apparent the researcher from the BBT Clinic withdrew her authorship from the paper.

Hokum Locum

Joint Manipulation

An article in NCAHF reminded me of past activities with respect to joint manipulation. Following a one week course I embarked on a short-lived career in spinal manipulation which is very easy to learn and causes a greatly inflated belief in one’s ability to “cure” spinal ailments.

The first problem was that patients kept coming back repeatedly to have their back or neck “put back.” I soon realised that if, as the quacks claim, the spine can easily be “put back” then it can just as easily “go out” again. All I had done was create a perception with the patients that every time their back or neck hurt it required a specific manipulation. If only I was more unscrupulous…what a wonderful money-making idea!

What finally cured me of such activities was the day I manipulated a patient’s neck with the usual psychologically satisfying crack from the spine. She sat up, went pale and slumped back onto the couch. Distraught, and thinking that I had killed her I rushed through to get the assistance of my receptionist who took one look and said to me “You twit. She’s only fainted.”

As a reformed manipulator, I was therefore interested in the following which I will quote in full:

“The popping sound associated with ‘putting bones back-into-place’ (though it may be accomplished by manipulating a normal joint) is one of the cleverest and most effective forms of suggestive therapy ever devised. This has a tremendous psychological influence over the mind. While the popping sound itself is quite meaningless, this influence might possibly be used to advantage in curing psychosomatic conditions — provided the patient is informed that the bone is ‘back-in-place’ and will stay there. By the same token, however, such treatment can cause a great deal of harm; that is by perpetuating a psychosomatic condition or even creating a new psychological illness.”

Manipulative therapy is well documented as leading to spinal cord damage and paralysis. Quacks will claim that this only occurs in a few cases per 100,000 patients treated but the easy answer to this is that all of these conditions get better without the risk of paralysis from manipulation, therefore any risk of spinal cord damage is unacceptable. (NCAHF Vol 18, No 3)

Alleged Allergies

Although I don’t see many children in the course of my work, I am amazed at how often mothers allege that their children can’t have milk because of various allergies. In one study, researchers found that people who perceive that they are allergic to milk simply misinterpret ordinary abdominal feelings. From a group of 30 subjects, 21 were identified who were genuinely intolerant of lactose. They were divided into two groups and given either normal milk or lactose-free milk. There was no difference in the amount of abdominal distress reported by the two groups.

Full of Wind?

A report on a new breathing therapy for asthma initially looked quite interesting until I came across the following statement: “by learning to saturate their bodies with carbon dioxide, patients can lessen muscle tension and slow breathing to a normal rate.” After reading this I was still interested until I came to the end: “the technique is also used to treat angina, high and low blood pressure, piles, varicose veins and even cancer.” This is an absurd range of indications for any one treatment and such claims are absolutely diagnostic of quack therapies.

Carbon dioxide is one of the most potent stimuli of the respiratory centre which triggers breathing. Any attempt to saturate the body with carbon dioxide will stimulate the breathing reflex so the whole therapy concept is a contradiction in terms.

Silicon Implants

Are there any American female actors who have not had their breasts surgically enhanced? I was reading a magazine which was profiling Baywatch star Pamela Anderson. Pamela cannot stay in cold water for very long because her implants start to solidify and ruin her mammary profile.

In Skeptic 34 I outlined how women could claim for silicon disease if they had vague symptoms such as chronic fatigue, muscle weakness and memory loss. A study reported in the British Medical Journal (Vol 311, p138) found no connection between silicon breast implants and connective tissue disorders.

Gulf War Syndrome

A study of 10,020 Gulf War veterans found that the range of complaints they had was no different to the general population. I imagine that this conclusive study will not settle the matter as long as there is the prospect for compensation. There was very little actual fighting in the Gulf War and more Americans were killed in accidents than in actual combat.

Like most sensible people in the military, I am opposed to ritual combat as a means of solving disputes. In future wars, I can see soldiers going into battle followed by support companies of psychologists and counsellors, available to give emotional first-aid following the shock of finding that the enemy are firing live rounds.

The American study confirmed a British study of 45,000 soldiers which concluded “no evidence has emerged that any organic disorder has occurred more commonly in Gulf veterans than in any similar population over a similar four year period.” Hopefully this will be the last we hear of “Gulf War syndrome.” (GP Weekly 16/8/95, BMJ Vol 310, p1073)

Size Does Matter!

Before being released from prison, convicted sex offenders in the UK are being subjected to penile plethysmography (PPG). PPG detects minute changes to the penile blood supply while the prisoners are shown sexually explicit material. Sexual arousal is defined as a “deviant response”. The psychologist in charge of this program claims that the scientific literature says that the test is “valuable”. Another psychiatrist condemned it as a “gross abuse of human rights”. As a rational skeptic (after Skrabanek) I suspect that PPG is an unproven and extremely unlikely test which is likely to have a very high false positive response. Sexual arousal in males can occur at all sorts of embarrassing moments and it is likely that most males would show a degree of arousal when exposed to sexually explicit material. (Christchurch Press 1/6/95)

Berry Silly

The Auckland Sunday paper (27/8/95) carried a small article which claimed that World War Two airmen improved their night vision by eating blueberry jam. This contains “anthocyanosides” which are alleged to improve night vision and treat visual fatigue. It is no surprise that a drug company is now marketing pills containing this substance. This is another good situation for Skrabanek’s rules. Is this claim at all plausible and is there any more likely explanation for claimed improvements in night vision? Clearly, the placebo effect is at work here and no further testing is warranted.

Quackery and Chemists

If you go into the average chemist’s shop you will often see displays of homeopathic remedies along with vitamins and other dubious preparations. Most chemists derive the majority of their income from OTC sales and if they didn’t sell these things, someone else would. I draw the line, though, when chemists start promoting quack ideas and remedies.

A member handed me a newspaper clipping which quoted a chemist as saying “zinc detoxifies chemicals like alcohol, improves behavioural problems such as depression, anorexia, bulimia, fatigue and loss of libido.”

Prior to rushing off to get some zinc, readers will be pleased to know that there is a simple test for zinc deficiency. A sip of zinc septahydrate solution is held in the mouth and “from the taste the zinc level is determined.” I tried it and got a taste reminiscent of bullshit.

I forwarded this clipping to the Pharmaceutical Society of NZ and got the following reply: “whilst not every pharmacist would share these views, it is not considered that they bring the profession into disrepute. There have been many studies carried out on zinc which would appear to support the general thrust of these claims.”

Sick Building Syndrome (SBS)

Investigators have finally done the obvious and looked at buildings for which there are no complaints of SBS. Measured levels of contaminants were low and the authors found that complaints about the working environment were related to “perceptions about air movement, dryness, odours and noise.”

As I have said before, SBS, like CFS and OOS, is based on a notional but false belief that psychogenic symptoms have some exterior cause. The availability of compensation completes the picture although, in the case of SBS, compensation is not available for any occupational disease associated with air-conditioning and this is probably why there has not been a flood of claims.

Occupational health workers continue to perpetuate false ideas in their own literature because they lack a perspective on history and human behaviour. The Lancet (Vol 345, p1361) reviews such a publication which claims that SBS is due to environmental factors. It is time that this false concept of SBS was laid to rest. (Occupational Health May 1995, p174)

Other Readers Write

Thanks to Dr Graham Sharpe who wrote from Wellington and enclosed some material about interesting developments in midwifery. Homeopathy is popular with midwives who use it during childbirth. Dr Sharpe also mentions a case known to him where a child died from a brain abscess due to a delay while homeopathic remedies were administered. The other case concerned a case of poisoning when a naturopathic remedy contained aconite. Aconite is severely toxic to the heart and this example shows why naturopathic remedies should be subject to the same restrictions and controls as other drugs.

Denis Dutton forwarded two articles as well. One from Annals of Internal Medicine (Vol 121, No.10) outlined the well-known complication of liver damage which can be caused by a wide variety of Chinese herbal treatments, in this case “Jin Bu Huan” tablets. The other article, entitled “Bitter Herbs: Mainstream, Magic, and Menace”, is an editorial from the same issue as the journal above.

The FDA managed to ban the use of Jin Bu Huan, but their job will be made more difficult by the Hatch bill. This is “The Dietary Supplement Health and Education Act of 1994” which was shepherded through the US Congress by the quack-apologist Senator Hatch. Its language is so imprecise as to be a triumph for the promoters of quackery everywhere. The editorial ends with a plea for doctors to spend more time with patients exploring the “human interactions that are central to the physician-patient relationship.”

Hoxsey Cancer Quackery

Soon after I returned home from our annual conference, Bernard Howard sent me a travel guide for patients planning to go to Mexico and gift their money to a pack of criminal fraudsters who know that the Hoxsey treatment is useless. As well as the airfares to the US, the Hoxsey clinic charges are US$1250-1600. Presumably this is to cover the costs of the “tonics” or as I call them, Kentucky fried medicine. As I explained at the conference, we know what these quack formulae contain and they could be made up in New Zealand for a few dollars.

MVA Insurance Fraud

Los Angeles is the capital for staged motor vehicle accidents (MVAs) where professional criminals, unscrupulous lawyers and doctors participate in phony insurance claims. Until I read about this I was aware of a problem with “whiplash” (also known as chronic remunerative neck injury), which has been a rich source of money for litigants. Phony claims fall into several groups: personal injury, claims for accidents that never happened or actual crashes involving unsuspecting drivers and staged accidents involving previously damaged vehicles. (Christchurch Press 24/7/95)

Faking It?

Vicki Hyde passed on to me a peculiar letter from a Dr Hussein of Jordan asking us to participate in research in the paranormal immunity of fakirs to pain. The letter is the usual mixture of pseudoscience. In fact, no individuals possess any “paranormal” immunity to pain, unless of course they are lucky enough to lack the spinothalamic tracts which carry pain messages to the brain.

Humans possess widely varying responses to pain stimuli which are subject to attenuation by cultural factors, conditioning and belief. Slowly rising pain stimuli can be centrally blocked. I have seen (and discouraged!) my daughter pushing needles through her finger. I reviewed the question of pain control in my paper on acupuncture which is available from our organisation.

Hokum Locum

Sickness and Psychogenic Illness

The Canterbury ME (chronic fatigue syndrome, or CFS) are up in arms over proposed tighter controls on patients receiving both invalid and sickness benefits. CFS patients want funding for “residential detoxification services and “subsidies on natural remedies”. CFS is a classical psychogenic illness and as such it is quite improper for any affected patient to be on any long-term benefit on their own terms. Because of self-denial these patients resist any sensible suggestions on treatment and end up chronically unwell in a fulfilment of Abraham Lincoln’s statement that “most folks are as happy as they make up their mind to be.”

I managed to persuade such a patient to take anti-depressants and the improvement in well-being was amazing. This same person had paid to have all amalgam dental fillings removed and replaced with a predictable lack of improvement. A characteristic of CFS is the almost fanatical belief of the patients that their “illness” has a physical cause. Here is a report from a clinical psychologist about such a patient: “He scored nought on the depression inventory and three on the anxiety inventory. This is a person who does not wish to reveal anything about himself. During the interview he made it clear that he sees his problem in terms of recovery from a physical illness with no concomitant psychological manifestation.”

This fanatical belief in a physical cause of ME is also shared by many doctors whose therapeutic contact with their patients becomes a classic folie a deux.

Cultural variations were found in a WHO study which looked at depression worldwide. Only 5% of patients who were depressed said that they had psychological problems. Such a level of denial is compounded by the useless treatments offered by doctors. For example, antidepressants were prescribed for anxiety as often as for depression. Japan had a low incidence of depression due to the Japanese concept of jibyo signifying a mild chronic illness which a person carries through life and is not considered serious.

It should be mandatory for all patients with a diagnosis of CFS to undergo assessment by a Mental Health team. No person with CFS should be entitled to any long-term benefit unless they have had at least a six month trial of anti-depressant therapy. (Christchurch Press 18/7/95 New Scientist 25/3/95 p10)

Multiple Personality Disorder

This is a typically loony belief of New Age psychiatrists and it has received widespread acceptance in the US. This is hardly surprising in a culture where thousands of people believe that they have been abducted by aliens. Even such an august institution as Harvard Medical School has a psychiatrist who believes that extraterrestrial beings have visited this planet and abducted Earthlings! Striking a blow for academic freedom, the Dean of the Medical School “reaffirmed Dr Mack’s freedom to study what he wishes and to state his opinions without impediment.” In contrast, the British specialists have condemned the idea in scathing terms. Imagine the convenience of being able to blame an alternative personality for some misfortune such as a criminal offence. This absurd concept of MPD fits in to the prevailing “victim” philosophy of life whose adherents view themselves as being subject to forces beyond their control. (New Scientist 17 June 95, GP Weekly 23/8/95)

Continuing OOS Delusions

The occupational health professionals continue to indulge themselves over OOS. ACC is reported as being concerned about the vague nature of OOS and the fact that claims cannot be satisfactorily proved or disproved. Claims against ACC reached $4 million in the year ended 30 June 1994 and are increasing. The huge army of consultants advising on posture are doing just that — posturing.

At least I managed to get my contrary view published in Safeguard. Bernard Howard also sent me a newspaper cutting of a story concerning a musician allegedly suffering from OOS. I will quote his remarks which need no further comment: “After centuries of playing their instruments for hours per day, every day, musicians are only now developing OOS. Come back Paganini…all’s forgiven!” (Safeguard Update Nos 26, 27 1995.)

Medicine Chinoise

15,000 French doctors practise acupuncture and many also use “high-dilution” homeopathic medicines. It is not surprising then that a hospital dedicated to traditional Chinese medicine will open in Paris next year under the joint sponsorship of the Chinese and French Ministries of health. It is promoted as a measure to control spiralling health costs.

This trendy quackery will help the “worried well” but will do nothing to control spiralling health costs which are a feature of unreasonable patient expectation and over-application of medical technology. (British Medical Journal Vol 310 p1285)

Uncontrolled Medical Appetites

Magnetic resonance imaging (MRI) is a radiological technique which is valuable for examining internal organs. In NZ Doctor, an American doctor outlines what he calls MRI madness. Americans are so obsessed with MRI technology that there are 25 times as many machines in California as in Canada, which has about the same population. Patients demand MRI scans for virtually any medical condition and as a third party (ie. insurance company) is paying, they get what they want.

Just about everyone with low back pain gets an MRI scan. However, a new study found that two out of three people without back pain have evidence of a disc protrusion. The authors concluded that anatomical abnormalities are common in normal people.

A skeptical US doctor described the obsession with MRI as “MRI tiger balm”. (GP Weekly 27/7/94, NZ Doctor 23/6/95)

A Reader Writes

In Skeptic 36 I asked how long before magic mushrooms (Kombucha) arrived in New Zealand. John Turner has written from Motueka to tell me that they are here! [See also Forum] I hope I am not compromising his continued existence in Golden Bay by passing on his description of the area as being a “bloated gelatinous pancake of new Ageism.” As John describes it: “the ‘mushroom’ has a baby which is then passed on to someone else.”

One convert claimed he was cured of “toxins” which coloured his urine brown as they left his body. John quite reasonably enquired as to what colour the mushroom brew was. It was brown! Those readers contemplating a visit to Golden Bay will be pleased to know that every quack treatment is available from holistic pulsing to sound healing with “yidaki” or as it is more commonly known, didgeridoo therapy. This may all sound like a lot of didgeridoodoo but in the US a woman died and another was hospitalised due to severe acidosis after drinking Kombucha tea. (John Turner (personal communication), Nelson Evening Mail 8/7/95, NCAHF Vol 18 No.3)

Anti-Immunisation Quacks

I recently complained to the Medical Practioners Disciplinary Committee (MPDC) about a doctor who made a series of ignorant and unproven claims in respect of immunisation. The MPDC is fairly toothless when it comes to dealing with scientific incompetence in medical practitioners and the unrepentant doctor even wrote me a letter declaring he was proud to be a member of the American Quack Association (Quack = Quality, Care and Kindness). I will quote a short passage to show how impossible it is to argue with such people.

I challenged his claim that Vitamin C is an effective treatment for viral diseases (7 placebo controlled trials showed lack of effect for Vit C in the treatment of cold virus infections). Here is his reply: “There is extensive peer-reviewed literature bearing witness to the clinical effectiveness of ascorbic acid in viral diseases. You will not find reference to this in Medline or Index Medicus journals that represent only about 10% of the world’s scientific journals and are controlled by the international pharmaceutical industry.”

This one paragraph contains two of the main quack elements. Firstly the suggestion that some alternative inferior data base is an acceptable alternative to controlled trials, and secondly the familiar old conspiracy bogey that scientific journals are controlled by vested interests.

The President of the Australian Medical Association has come out a lot more strongly than the NZ MPDC, by recommending that doctors who use their scientific standing in the community to support the anti-immunisation movement should be charged with medical negligence. At the time he made this remark Australia came near the bottom of a list of industrialised nations when rates of childhood immunisations were compared.

It is sad that at time of writing Russia is in the grip of an epidemic of diptheria which has killed more than 2000 people. This was a direct result of allowing immunisation levels to drop below the 95% required to prevent epidemics. (Dr Quack (personal communication), British Medical Journal Vol 310, p760. Lancet Vol 345 p715)

Evidence Based Medicine

Although my main interest is alternative medical quackery there are many traditionally accepted medical practices which have never been critically evaluated. I mentioned counselling in Skeptic 36 and this was enlarged on by Jim Ring in the last issue.

In Britain, the BMJ is sponsoring a Journal of Evidence-Based Medicine which is aimed at critically evaluating both new and old treatments. The key element is randomised controlled trials (RCT’s) in which patients must be randomly allocated to either a new treatment group or a control group (may be the existing treatment or no treatment). A survey of RCT’s in pregnancy and childbirth found that out of 100 procedures commonly carried out by obstetricians and midwives, about 20 are actually harmful.

If you go to your doctor complaining of a cough, the chances are that you will come away with a prescription for an antibiotic. This is despite the fact that seven RCT’s have shown no benefit for such treatment. It was also difficult to carry out the trials because in one survey 60% of eligible patients refused to enter a trial because they felt that antibiotics were absolutely necessary to cure their condition. Perhaps this is a good argument for using harmless placebos in such cases? I should mention a note of caution against blindly imposing the results of RCT’s on patients and this point was well expounded by Sir John Scott at our last conference. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? (Lancet Vol 345 p665)

Fat Fraud

Aminophylline-containing cream is a popular quack remedy for reducing the size of large thighs. In a test, researchers studied women who were asked to massage either the cream or a placebo into one thigh and one side of the stomach. 11 out of the 17 women completed the study and, as anyone could have predicted, there was no fat-reducing effect. Despite measurements to the contrary, one woman was convinced that the cream worked. If it is important for people to believe in something, no amount of evidence to the contrary will convince them. (National Council Against Health Fraud (NCAHF) Vol 18 N0.3)

Civic Creche Case

Professor Michael Hill examined some of the issues behind the civic creche case in an article in the Christchurch Press 31/3/95 which I have forwarded to our editor. Hill coins the phrase “culture of complaint” in which disaffected people take little responsibility for their own lives and look instead for someone to blame. The existence of compensation through litigation completes this ‘Americanisation’ of our culture. It is incredible how quickly the false ideas behind ritual sexual abuse spread and were recreated throughout NZ.

I was disgusted with the judiciary over the civic creche case although the whole process was hijacked by the usual cohort of poorly trained quack therapists. The prosecution was able to get away with not presenting evidential material so ridiculous that it would have weakened their case. In a trial of any kind all the evidence should be available to both sides. My heart goes out to the falsely accused women whose lives have been ruined by this evil nonsense. I seriously question whether there was any chance at all of Peter Ellis getting a fair trial in an atmosphere of hysteria reminiscent of the Salem witch hunts.

Homeopathologies

A group of scientists have petitioned the FDA to place tighter restrictions on homeopathic remedies by making them reach the same standards of safety and effectiveness as other OTC drugs. There should not be any problem over safety since such remedies are the pharmacological version of the emperor’s new clothes. The drug exists in the imagination only.

Predictably there has been opposition from the National Centre for Homeopathy because “homeopathy doesn’t treat diseases but treats people who are ill.” The NCH wants a different type of evaluation. This is rather like admitting that homeopathy is scientifically inexplicable so a new science must be created to explain it.

Hokum Locum

No Medical Ghetto

In the last issue I warned of the dangers of a medical ghetto developing on the Auckland North Shore. Fifty new doctors set up practice in Auckland last year and even more overseas doctors are pouring into New Zealand. There has not been a corresponding drop in consultation fees in a local aberration of the law of supply and demand. Fortunately, the Northern Region Health Authority has moved to cap any further increases in doctor numbers which have already cost an extra $20 million in subsidy claims. (Christchurch Press 24/4/95)

Dietary Delusions

Retired British policeman Peter Bennett claims that criminal behaviour can be controlled by dietary manipulations. Following a shooting spree in the US, an offender claimed that he was temporarily insane due to excessive dietary sugar (the Twinkies defence, named after a proprietary candy bar). After a special diet, it was claimed that nine recidivist criminals showed a dramatic improvement in behaviour.

Such claims have been made before in connection with children’s behaviour and shown in placebo-controlled trials to be wrong. What Mr Bennett has overlooked is that changes in diet are associated with a change in management, and it is this that has the effect rather than the diet. (Dominion 3/4/95)

Magic Mushrooms in Fiji

Following its importation by a soldier returning from overseas, Fiji has been in the grip of mass hysteria over the magical properties of a tea made from mushrooms. As with most other quack remedies it is claimed to cure everything from baldness to diabetes.

The mushroom, which looks like a bloated, gelatinous pancake, is floated in sweetened black tea and the fermented brew is drunk a week later. The brew is also known as “kombucha” and is gaining popularity in the US and some other Asian countries, and has been touted as an AIDS remedy. (NCAHF Vol 18, No 2) It is in fact a symbiotic colony of yeast and bacteria. I wonder how long before the brew arrives in New Zealand. (Marlborough Express 10/4/95)

Naughty Children?

Attention deficit disorder (ADD) is alleged to be an organically based condition where children are impulsive, overactive and have a short attention span. ADD has previously been known as minimal brain dysfunction, hyperactivity, hyperkinesis and Strauss syndrome, to name but a few.

In fact, ADD is yet another example of the expansionist activities of health professionals who “convert” ills into illnesses. This is the very activity which Illich warned about with respect to the medical profession.

ADD is far more likely to be simply a description of badly behaved children. Instead of concentrating on the behaviour (an effective strategy), people form support groups and look for organic causes which is a waste of time and resources. (GP Weekly 14/4/95)

Occupational Health Delusions

In a landmark decision, a company was fined after admitting a charge that they failed to take steps to protect an employee against occupational overuse syndrome. The employee had been in the new job for four days. I wrote to the company urging them to defend the case but they chose to plead guilty.

After this ludicrous decision I wrote to the Dominion but they chose not to publish my letter. I have also written to the occupational health publication Safeguard but I am not confident on seeing any expression of opposition to the absurd idea that anyone can develop OOS after four days in a new job.

There are, however, some glimmerings of understanding creeping into the literature. A judge in the UK rejected the concept of OOS and in the US a court rejected a claim that computer keyboard design causes it.

Writing in Safeguard (No.30 1995) Alan Boyd lamented the fact that ergonomic changes in the workplace had not lessened the prevalence of OOS. This is not at all surprising to me as no amount of ergonomic posturing can lessen the prevalence of a psychogenic (produced as a result of psychological stresses) condition such as OOS.

In Safeguard Update (27/3/95), Chris Walls acknowledges that anxiety and depression are common in New Zealand, affecting 13% of the population. Exercise is prescribed to relieve anxiety and reduce the chance of OOS. I find it ironic that in their own literature, all the clues are there for a proper understanding of OOS but occupational health workers continue to miss the bigger picture.

When a job becomes too difficult and less socially enjoyable, people start to focus on their symptoms. Attribution to work then means that the problem is the fault of the employer and the availability of compensation validates the “illness”. OOS can only be understood by looking at the historical record of psychogenic illness. This is brilliantly examined in a new book, From Paralysis to Fatigue by Edward Shorter (The Free Press, 1992) which is supported with superb clinical examples from the medical literature.

A striking theme is the gullibility of doctors who validated such presentations as fits and paralysis. It is interesting to find that patients have always resisted the concept of psychogenic illness and have tended to find more socially accepted labels. This is why neurasthenia has been replaced with chronic fatigue syndrome, and Charcot’s hysteria with other conditions such as total allergy syndrome and multiple chemical sensitivity.

I recommend this book to all readers interested in medical history. It should be required reading for health professionals.

The (Un)laying-on of Hands

A physiotherapy technique known as cupping has been suspected of causing the deaths of five babies and brain damage in eight others. The technique involves tapping the chest with a soft latex cup in an unproven method of clearing chest secretions. Like many physiotherapy techniques, this method of treatment has never been subjected to critical analysis.

The use of the term “cupping” for the procedure is a little unfortunate. Cupping used to be a medieval practice of applying suction cups to the skin to cause localised counter-irritation to some disease process or symptom. Acupuncture and moxibustion are other examples of counter-irritation quackery. Lancet 25/2/95 Vol 345 p510

Case-management Flunks

In the US, case-management became the central tenet of the care of people with severe mental disorders. The case manager takes a full and comprehensive responsibility for the client. This concept spread to the UK because it was believed to be effective.

However, a randomised trial found virtually no difference in outcome for case-managed clients compared with a control group. The authors concluded “it is unfortunate, in view of the limited effectiveness we have shown, that social services case-management was not evaluated in randomised controlled trials before its implementation in the UK.” (Lancet 18/2/95 Vol 345 p409-412)

Once again, this article demonstrates the absolute necessity of critically evaluating new treatments. This process should be extended to evaluate many of our existing treatments across the whole health area.

Udder Nonsense?

In a form of primitive immunotherapy, Herb Saunders injected his cows with patients’ blood and then sold the bovine colostrum (“first milk”) with the claim that it would cure cancer and other serious diseases.

Saunders sold each patient a cow for US$2500, but not only kept the cow on his farm but charged the patients $35 a bottle for the worthless nostrum. He was charged with practising medicine without a licence but the jury were unable to find a majority verdict of guilty. In my opinion Saunders was definitely guilty of milking his patients!

Chelation Abuses

The California Medical Board has been attempting to prevent the use of chelation therapy for unapproved indications. At a meeting, dozens of patients gave impassioned personal testimonials claiming cures after chelation treatment. It was noted by observers that the “tense atmosphere did not lend itself to rational decision-making.” Despite several impeccable trials that showed no benefit, chelation therapy continues to be offered in New Zealand.

With respect to the dramatic improvements claimed, it is more likely that there has been a fraud rather than a miracle. When confronted with the ravages of arterial disease, people often make profound health and lifestyle changes. They quit smoking, lose weight, exercise and make substantial changes to their risk-factor profiles. These same people are also the ones most likely to seek out chelation therapy. How ironic that they end up paying out thousands of dollars for a treatment whose benefits have been produced entirely by their own effort. (NCAHF Vol 18, No.2)

Hokum Locum

ACC Decisions

The recent decision to award compensation to a lawyer who suffered depression because his bank loan was turned down is but one example of increasingly bizarre decisions by the ACC (Anything-goes Compensation Corporation). Money has also been paid out to victims for “memories” of childhood sexual abuse but in one recent case the alleged offender was aquitted and we are still waiting to see whether ACC will ask for their money back. (see Skeptic 34).

I obtained information about a court judgement involving ACC who awarded compensation to an employee of the Fire Service, one of a number of people affected by mass hysteria after the ICI Chemical Fire. Advising doctors said that his condition was not considered to be due to chemical exposure but his emotional state could be attributed to some stress surrounding attendance at the fire. The judge had no alternative under current law to do anything other than award full rights to compensation.

Not only do these decisions show a lack of common sense, they also illustrate what happens when no one is prepared to stand up and resist such claimants, who will continue to come forward as long as there is money available. This prevailing community belief that everyone is entitled to compensation for their “pain” whatever it is, is not limited to New Zealand. There is a worldwide growth in anti-medical science groups with self-denied psychiatric conditions. In the UK a sufferer from chronic fatigue syndrome (see Skeptic 21, 26) was awarded compensation because the stress of a car accident in which he received no physical injuries, made his symptoms worse!

Hoxsey Cancer Quackery

Bruno Lawrence recently went public with the fact that he is suffering from lung cancer and plans to make a TV documentary about his treatment at a Hoxsey Clinic in Mexico. About the same time, a syndicated article appeared in my local paper with the news that a Tauranga herbalist intended setting up such a clinic and applying to the local area health board for approval.

Hoxsey (1901-1973) developed a secret recipe of herbs and spices which he used to treat cancer patients. This followed an observation that a horse with cancer cured itself by grazing on certain plants. Hoxsey fought prolonged court battles with both the American Medical Association (AMA) and the FDA before taking his quack therapy to unregulated Mexico. He died from cancer despite self-treatment with his quack remedy.

His original nurse, Mildred Nelson, was still administering this quackery as recently as 1988. The American Cancer Society (ACS) has extensively investigated Hoxsey’s cancer quackery and I quote from the last paragraph of their report which I am happy to supply free to any reader as long as you send a stamped SAE: “In summary, the Hoxsey medicines for cancer have been extensively tested and found to be both useless and archaic. The ACS does not recommend their use by cancer patients.”

Quackery often follows a pattern as follows:

  • An apparently profound observation or emotional experience — in Hoxsey’s case, a sick horse, and in the case of iridology certain patterns in the iris of a sick bird. Doctors often revert to quackery following either job stress or a seemingly profound success with a new treatment such as acupuncture, homeopathy etc. (usually a placebo response).
  • An element of paranoia is useful, because this heightens the belief of the quack that the particular treatment is valuable and “everyone’s out to get me!” and leads to…
  • Conspiracy theory. In the case of Hoxsey, he developed the theme that doctors and the AMA had cornered the cancer market (is there one?). This is a very useful strategy for discrediting conventional medicine.
  • The quack remedy should be completely safe and quite expensive because patients will show improvement in proportion to money spent. Distilled water is cheaper and more convenient than homeopathic remedies and is already an accepted consumer fraud.
  • Reliance solely on testimonials and strict avoidance of clinical trials or any form of testing of the quack remedy. Testimonials are personal, entertaining and are excellent advertising, unlike the prosaic clinical trial which will show that the quack remedy is for the ducks. If a clinical trial or, in the case of Milan Brych, a court case, proves quackery, then all is not lost. Off-shore operations will ensure patients keep on coming, which is what hundreds of people did even after Brych was shown to be a complete fraud and actually in prison at the time he claimed to be at medical school. (I can think of a few doctors I would like to see in prison but that’s another story.)

Finally, the above information is subject to intellectual property rights and I expect a commission from any readers who set up successful cancer quackery clinics.

Psychopathology

An article in the BMJ (Vol 309 p883, “The dangers of good intentions”) caught my eye, as it is a devastating example of the psychopathology so evident in the helping professions. In 1939, 700 delinquents were randomly assigned to either a treatment group or a control group who received no treatment but were followed up 30 years later.

The treatment group received counselling, home help and other community assistance. After 30 years it was the treatment group who were sicker, drunker, poorer and more criminal! This shows that nothing can be taken for granted when trying to influence people’s behaviour, and often such programs create dependency. Our own welfare state is a classic illustration of this problem.

Psychobabble revisited

In Skeptic 33 I made a plea for hard data on the popular new condition of post-traumatic stress disorder (PTSD). Like any alleged medical condition it must be refutable, ie. capable of being proved wrong. A writer in the BMJ (Vol 309 p873) sharply criticised a case presentation on PTSD in a patient who was a heavy drinker. He pointed out that 40% of all patients diagnosed as having PTSD drink heavily and their symptoms (frightening ideas, nightmares) subside when they abstain. I am still cynically waiting to find out whether PTSD is described in populations which do not have compensation.

In Canada, a man was aquitted of stabbing to death his parents-in-law because a psychiatrist testified that the man was sleep-walking and therefore had not been responsible for his actions. The fact that the accused was also a gambler who had been caught embezzling money did not seem to be quite so important to the court!

Psychiatry as a specialty relies on rather soft science, and some psychiatrists are guilty of the most absurd psychobabble — eg, “Continuing success will reflect [the patient’s] ongoing committment to healing the wounded child within, which is the result of the experience of the poisonous pedagogy.”

Doctors’ signatures can certainly be very valuable. As far as patients are concerned, it means another ten paid weeks off work. Some 85,000 people have been collecting such benefits for more than one year and ACC is hoping to save $400 million by referring all cases to an independent medical panel.(GP Weekly, 22 Feb 95)

In the Australian Capital Territory (ACT) a new law allows people to use cannabis on a doctor’s prescription provided that the doctor keeps “research notes.” The ACT Health Minister described the new law as a “radical drug experiment”. I describe it as radical stupidity, as there is no evidence that cannabis is useful for the conditions proposed and I doubt the ability of individual GPs to conduct research. Here is my prediction: patients will flock to certain doctors who have found by research that their signature on a piece of paper is of considerable benefit to both the patient and the doctor’s bank manager. Buy ACT cannabis futures now! (GP Weekly, 22 Feb 95)

In the UK, a housing authority allowed preferential allocation for housing on receipt of a note from the doctor outling health reasons. However, they were able to revert to their normal process of allocation because everyone on the list had a note from their GP! All processes such as this become debased and degraded when subject to abuse.

Eau Dear!

Along with other legitimised quackery, the French government recognises a stay at a spa as a legitimate medical treatment. The National Audit Court pointed out that not only is there no proven scientific justification for spa treatment, but many carry bacterial health risks. Some spas have even been adding tap water to their natural mineral waters.

I seem to remember an investigation in New Zealand showing that certain “mineral waters” were indistinguishable from tap water. (New Scientist, 28 Jan 95)

Alternative Medical Remedies

The Medicines Act is being re-written, and already quacks are whining that the costs of licensing their remedies could force them off the market. Quacks also fear a ban on advertising that they can offer relief from various conditions. I don’t see any problem with the proposed law changes, as herbal remedies should come up to set standards of quality and safety and any claims of efficacy should be tested in randomised trials. (GP Weekly, 14/9/94)

After reading this I was intrigued to find a letter in the Lancet (Vol 344 p134) which looked at the ginseng composition of 50 commercial ginseng products. The authors found that 44 preparations ranged from 1.9% to 9.0% of ginsenosides, the active components. The remaining 6 preparations contained no ginsenosides at all. They also quoted a case of an athlete who failed a drug test. He thought he was only taking ginseng, but not only did his preparation not contain any ginseng, it consisted mainly of the banned performance-enhancing drug ephedrine.

Would anybody buy an aspirin that might contain either no aspirin at all or anywhere from 100mg to 500mg of the active drug? The authors conclude that “quality control is urgently needed for natural remedies with suspected or assumed biological activity.” I see a compelling case for continuing with a robust overhaul of our Medicines Act.

Face Lifts and Hair Growth

A Wellington plastic surgeon was critical of a recent proposal that GP’s could learn to do chemical face peels after watching a training video (Dominion, 15/9/94). GPs can buy a kit which contains enough chemicals and equipment to make a profit of $380 per patient for half an hour’s work. The process involves using glycolic acid to induce peeling and, by an unspecified process, cosmetic improvement. Just the thing for boosting the flagging profits of any North Shore Auckland medical practice where there are already so many doctors the place is in danger of turning into a ghetto.

I don’t intend watching the video, but the thought had crossed my mind that I could treat my vain patients in our RNZAF electroplating bay. A short dip in something caustic would give anyone’s face a good lift (off) or how about dermabrasion with a wire brush from the metal shop?

A much safer money-earning prospect is the exciting new treatment of electrotrichogenesis for bald men. I hope our editor can reproduce the advertisement which shows a futuristic looking chair with a hood poised to administer rejuvenating current to the recalcitrant scalp. [Unfortunately it’s a bit too dark to reproduce well — but it looks fascinating…]

Why not fill the waiting room with these chairs and invite balding males to pay for treatment while they wait to see the doctor on other matters. Even more doctors will be able to afford to go into practice on the North Shore!

Hokum Locum

NZ Qualifications Authority

An editorial in the Christchurch Press (23 Nov 94) was critical of the Universities who are seeking approval from the NZQA and argued that they should continue to set their own high standards.

The Aoraki Polytechnic has applied to the NZQA for recognition of a Bachelor Degree of Applied Science (Naturopathy). Naturopathy can mean anything from treatment with homeopathic remedies to colonic irrigation. I wrote to the NZQA and was told that the Aoraki application “involves review by a panel of peers…having a mix of professional and academic backgrounds.” I await the decision of the panel with considerable interest as the thought of a Bachelor of Applied Science (Naturopathy) holding equal weight with say a Bachelor of Applied Science (Biochemistry) is completely ludicrous.

Recovered Memory Syndrome

“ACC payments of $10,000 to three women who recalled `memories’ of rape and abuse as children are to be re-examined after aquittal of their father.” However, unbelievably, ACC’s Fred Cochram says “it is possible for people’s suffering to be deemed valid for compensation even if abuse was disproved in the courts! (Dominion Oct 5 1994)

It is absurd that at a time when ACC is making it more and more difficult for victims of genuine accidents to gain adequate compensation, they continue to provide money for the fraudulent activities of an army of counsellors who are poorly trained and following their own feminist agendas.

Sporting Excesses

I have previously commented on the insane activities of athletes who take performance enhancing drugs which in many cases do enhance phsyique but have no more than a placebo effect on performance. (Skeptic 28)

A former Russian gymnast alleged that her trainers forced her to become pregnant and then have an abortion because “the body of a pregnant woman produced more male hormones and could therefore become stronger.” (Christchurch Press 24 Nov 94)

There has been much speculation about possible illicit practices by Chinese athletes. I think we can reasonably discount anything other than a placebo effect from a secret elixir containing “turtle blood, ginseng and other spices” used by China’s track team. Why “turtle blood” for runners? Surely it would be more logical to give it to their swimmers? In fact it doesn’t really matter what the product contains because the Chinese expect to sell about 20,000 bottles of the quack tonic in Japan.

Eleven of China’s long distance runners have had their appendices removed because “they were getting sick and having toxicological problems.” Leading sports doctors were reported as being puzzled and amazed. (Marlborough Express 13 Oct 94) I am neither puzzled nor amazed as China continues to be a rich source of medieval superstition and quackery such as acupuncture. Medical history tells us that it was widely believed that “toxins” were a cause of many ailments and as a result people were purged, had all their teeth removed, tonsils extracted and any organs such as the appendix were also removed. In some cases patients had their entire large colon removed and enjoyed diarrhoea for the rest of their lives. When history is ignored it tends to get “rediscovered”.

Turbulent Priests

A rather extreme Catholic school principal and priest has refused to give his pupils a combined vaccine because it was obtained from cell culture originally obtained from an aborted foetus in the 1960’s. I have no argument with any religion provided it does not interfere with the state but the Catholic religion has an unenviable reputation for continually interfering with public health issues.

A more recent example is their attempted sabotage, along with Muslim extremists, of the recent global conference on population planning. (Marlborough Express 27 Oct 94).

Medicines

Correct me if I am wrong, but I think it was GB Shaw who said that the main distinguishing feature of humans from animals was their desire to take medicines.

Health expenditure in Switzerland reached 18 billion pounds last year of which drugs were 10.7 percent. About 60 percent of all drugs are available over the counter (OTC) and the Swiss are at the top of Europe’s self-medication league. (The Lancet Vol 344 p322).

The New Zealand drug bill shows a healthy annual growth rate and is rapidly approaching the NZ$1 billion mark. One Government attempt to control these excesses was thwarted by GP’s who simply prescribed more drugs on each prescription. If people wish to poison themselves with drugs I think we should follow the Swiss example and make them available OTC. People can then personally pay for their drugs which will not detract from the health vote. The oral contraceptive is incredibly safe for OTC availability, however there is an excellent case for requiring a prescription for cigarettes.

Prozac is a new antidepressant drug which may be safer than exisitng drugs but is also much more expensive and has been already grossly over-prescribed in the US. There is already considerable pressure to allow its unrestricted use here in New Zealand.

Christmas Shopping Blues?

A major trial has found that the drug Fluvoxamine prevented compulsive shopping in all seven patients. Fluvoxamine is frequently used to treat obsessive-compulsive disorder which causes people to repeatedly wash their hands, pull out their hair or to hoard strange objects. It could also help doctors who repeatedly over-prescribe drugs.

Over-investigation

The medical model applied when I went through medical school suggested that patients had either an accepted organic illness or something less well defined such as “conversion disorder” ie. stress producing symptoms and signs. (eg. RSI or OOS) The evolution of investigative technology means that this model has the potential to be mis-applied.

I will quote in full an item from the BMJ Vol 309 p420). Irritable bowel syndrome is a condition where people complain of abdominal pain and constipation for which no cause is found.

“Six patients with the irritable bowel syndrome between them had 29 operations and 46 investigations, says a report in the Scottish Medical Journal. It warns that other studies have shown that around one third of patients with the disorder have appendicectomies and half the women have major gynaecological operations.”

I recently saw a woman with a clear history of hyperventilation syndrome (over-breathing, similar to what happens when blowing up a balloon) which causes neurological disturbances. The patient had had a CAT scan and an electroencephalogram after which a (foreign) neurologist prescribed Tryptanol (an antidepressant), Prednisone (a steroid anti-inflammatory) and Dilantin (an anti-epileptic)! Presumably this lethal cocktail was prescribed “just in case”.

Sickness Benefit Abuses

As I outlined in a previous column (Skeptic 32), all that is needed to get extra money when unemployed is a certificate from a doctor saying that you are “sick”. Not surprisingly there has been a steady growth in the benefits industry since most doctors derive their income from signing forms. In 6 years the number of people on sickness benefits went from 20,000 to 34,000. When combined with the invalid benefit this costs nearly 1 billion dollars annually. (Evening Post 18 Nov 94)

The cause of this fraudulent activity is the discrepancy between income support and invalidity benefit. A British GP (BMJ Vol 309 p673-4) noted that 23 out of 24 of his drug addict patients were receiving invalidity benefits despite guidelines that GPs should not issue sick notes to drug users unless they have a co-exisitng medical or psychiatric condition. In New Zealand I have known of drug addicts getting both sick notes and their drugs from the same doctor!

I am pleased to see that our own Social Welfare Minister has acknowledged that the numbers on such benefits falls once a more consistent policy is taken to assess eligibility.

Breast implants

A judge in Alabama has approved a US$4.25 billion compensation deal for more than 90,000 women worldwide with silicon breast implants. Many women have suffered proven ill-health but those who have difficulty finding an excuse to get their pot of gold can claim for “silicon disease”. This only requires at least five of a range of symptoms, including rashes, chronic fatigue, muscle weakness and memory loss. These are of course very vague symptoms and could be attributable to a wide range of other conditions such as CFS and alleged chemical “poisoning”.

NHS goes bananas?

GPs in the UK National Health Service (NHS) have won a partial refund for their patients who are spending $1250 on transcendental meditation courses. TM is an invention of an Indian guru and has no legitimate place in any health system. The Beatles flirted briefly with TM but became disillusioned when the guru persisted in making sexual overtures to their girlfriends.

Smoothing away the years

Need a face-lift? Look no further than CACI (computer aided cosmetology instrument). CACI delivers a tiny current to the skin and muscles in order to “re-educate muscles”. It is allegedly FDA approved. I have written to NCAHF to check this claim and will report in due course.

Best wishes for the New year to all readers and don’t forget Fluvoxamine if you feel a Christmas shopping compulsion. If Christmas awakens repressed memories of ritual satanic abuse at the hands of Santa I recommend a $10,000 payout from ACC will also help with the shopping.

Hokum Locum

MSG Myth Laid to Rest

Another sacred cow from my medical school days has been laid to rest. A letter in the New England Journal of Medicine in 1968 triggered a rash of anecdotal reports about facial flushing allegedly caused by monosodium glutamate (MSG) in Chinese food. “Chinese restaurant syndrome” had entered the popular medical mythology. Finally, 26 years later, two Australian scientists conducted a double-blind placebo controlled trial and found that some reaction to MSG was experienced by 15% of the subjects but the same reactions were also experienced by 14% of the placebo subjects. The scientists believe that the true cause of Chinese restaurant syndrome are histamine compounds found in fermented ingredients such as soy sauce, black bean sauce and shrimp paste. New Scientist 15 Jan ’94 p15

Poppycock

A US plastic surgeon found that the majority of his patients presenting for operative penile enlargement were motivated by anxiety over the size of their privy member rather than its performance. In fact one patient’s partner reportedly phoned the surgeon before her husband’s operation and told him she would rather have a fur coat! (GP Weekly) The procedure of penile enlargement was developed in China by the appropriately named Dr Long Daochou.

This absurd operation is not at all unusual in a culture where people also have silicon inserts into their muscles in order to look good at the beach. In fact, Ken and Barbie dolls are good models for such people who prefer plastic moulding to the real thing. Speaking of which, Barbie now has her own spiritual “channeller” (Barbie:”I need respect”!) and a “Barbie Channelling Newsletter”. Sadly, Barbie’s cries for help were treated with derision by Mattel Corporation who threatened the channeller with a multi-million dollar lawsuit. Sunday Star Times 5 June ’94

Naturopathology?

I was absolutely stunned to read in the Christchurch Press (12/8/94) that the Aoraki Polytechnic in Timaru is planning to offer a three-year Bachelor of Applied Science in naturopathy. Incredibly, the Qualifications Authority (QA) will be visiting the polytechnic to assess the course. The list of “basic sciences” to be studied includes herbal medicine (Kentucky fried medicine) and homeopathy (dilutions of grandeur). Is there anyone out there with any influence on the QA? Should market forces be allowed to dictate what constitutes a “basic science”? These are serious questions.

Psychobabble?

Can anybody help me come to an understanding of post-traumatic stress disorder (PTSD)? I know it is the new term for what used to be called “shell-shock” but can anyone tell me if the condition is seen in societies which do not have compensation available and are therefore not subject to Welch’s law (see NZ Skeptic 32).

Three passengers on the cruise liner Mikhail Lermontov were awarded a total of nearly $300,000 compensation for PTSD and a further 18 plaintiffs are waiting for their pot of gold. In order for PTSD to have a valid aetiology there must be an equal incidence of cases in the NZ passengers.

I briefly mentioned similar cases related to military service (NZ Skeptic 32) and most people will have heard about “Agent Orange” and alleged links with ill-health in Vietnam vets. It proved cheaper for the manufacturer to settle out of court but this decision has now entered the popular mythology as proof of causation.

Gulf War veterans (something of a misnomer since very few saw any active service) are claiming that symptoms such as fatigue and memory loss constitute a syndrome for which they will no doubt be claiming compensation. (NZ Skeptic 31) I have been following this saga in the medical literature, and investigators are coming up with ever more fanciful theories to explain what is nothing more than mass hysteria. Christchurch Press 14/6/94

Medical News

A therapist who become famous through treating Diana, the Princess of Wales, has been ejected from his Harley St consulting rooms because his claimed medical qualifications were found to be bogus. Presumably he must have had some success with his treatments but the real Harley St doctors were offended and he had to go. What about the opposite situation — real doctors who persist in offering bogus treatments? We have plenty of these in New Zealand and a medical registration system which can do absolutely nothing about the situation!

There will be no sensible policy on smoking in Israel because the acting health minister, Prime Minister Rabin, is a chain-smoker and refuses to sign a bill prohibiting smoking in public places!

Finally, a common inclusion in 17th century Dutch paintings of women visiting the doctor is a charcoal burner and string. The string was burnt near the nose of hysterical women so the fumes can drive the “wandering uterus from the woman’s upper body back to its proper place in the pelvis.” A quaint theory which has been replaced in our time with food and multiple chemical allergy, RSI, CFS. Have we made any progress? Lancet Vol 343 p 663, BMJ Vol 308 p606, International Express 31/8/94.

Mass Hysteria

Some of you will have noted the derivation of hysteria from the Greek “hysteros” for the female uterus which was thought to wander about the body causing hysteria.

Many of you will remember two cases in the US (where else?) where “poisonous” patients caused ill-health to their medical attendants. The first case concerned a 31-year-old woman receiving chemotherapy for cervical cancer. Following the taking of a blood sample in the emergency room, a nurse noted a smell and promptly passed out followed by other emergency team members. Following exhaustive tests no toxic chemical was found and I quote “no one seems to have seriously attributed the mystery illness to hysteria”. The second case followed a similar course.

Both of these cases are in fact classical examples of mass hysteria which is an unfortunate term with connotations of misbehaviour. Mass hysteria is better described as a contagious psychogenic illness. Psychogenic refers to the production of physical symptoms under conditions of stress and should not be confused with neurosis or malingering. The classical sequence of events begins with a generalised belief about a toxic substance in the workplace followed by a precipitating event, typically, as in the above example, a smell. This perceived threat to health and safety leads to psychological arousal and typical symptoms and signs such as dizziness and fainting. There have been many examples of mass hysteria in New Zealand — the Parnell civil defence emergency 1973 (NZ Med J April 28 1982 p277 and also Australian and NZ Journal of Psychiatry 1975 9:225) and the ICI Chemical fire. Occupational overuse syndrome and sick-building syndrome are good examples of mass hysteria in the workplace.

See Scand, J., Work Environ Health 10 (1984) 501-504) for a good review on the subject.

Bioenergetic Medicine

An advertisement for a course in bioenergetic medicine in GP Weekly (25/5/94) recently caught my attention. The location was the same place where I did a week-long basic acupuncture course in 1987. I spent a week and about $1,000 in total expenses learning a practice which is totally unscientific and can be taught in about half an hour to any intelligent skeptic.

During my course the tutor introduced a market-gardener with alleged “allergy” to tomatoes. The patient was connected up to a Vega machine or equivalent and we were given a demonstration of how his muscle strength was diminished when exposed to the killer tomatoes. A container of steroid was then introduced into the circuit and the muscle “weakness” was cured.

Unfortunately one of the other skeptics in the room had actually removed the vial of steroid from the box and revealed it at the conclusion of the demonstration. Incredibly, the tutor was unfazed and attributed the “improvement” to steroid residues (presumably homeopathic) in the box! Truly a graphic demonstration of the power of belief, one which got me interested in active skepticism as a scientific philosophy highly relevant to my own chosen area of medicine.

I suspect that bioenergetic medicine is very similar to applied kinesiology (AK) where muscle strength is tested while a person is subjected to various influences such as foods, vitamins, homeopathic remedies etc. Controlled studies of AK have repeatedly shown that responses are random under conditions where both tester and test subject are unaware of the substance being tested. My own anecdote is a good example of this. NCAHF Vol 17 No 3 has a brief overview

Fraudulent Food & Drink

Yuri Tkachenko, of the resort town of Sochi, has been given permission by city authorities to “magnetise” the Sochi river and thereby lessen the flow of pollutants into the Black Sea. As the river water quality is obviously a little suspect you might like to try some of his “magnetic” vodka which is guaranteed not to cause hangovers.

On the other hand, if you are mainly worried about getting rid of heavy metals, look no further than a new Hungarian oat-bran extract guaranteed to soak up lead and radioactive strontium carried in the blood stream. The pill, Avenan, has been developed by Lajos Szakasi who needs few lessons in the marketing of quack remedies. Avenan will go on sale as a health supplement rather than a medication because “it can be approved after a simple registration procedure”. To quote Lajos again “I believe the product will be successful because…people will always spend on their health.”

More fantastic still is a report from Japan where Kazu Takeishi has been arrested for giving medical advice and medicines without being properly qualified. It all began with his “healthy” vegetable soup which can be mixed with urine to become a miracle medicine, particularly effective against AIDS and cancer. Kazu claimed to make his diagnoses by touching patients’ knees and the palms of their hands. Like all good quacks Kazu is sure of his market and it’s a good one — $30,000 a day and a two-month waiting list (must have been getting behind on the urine supply). Cancer is a taboo subject in Japanese culture and doctors are even protected in law from informing patients about such a diagnosis.

Now, if I could get the recipe for this soup, I could mix it with urine and treat cancer patients for $300 per consultation and there is nothing the medical council can do — because I’m a doctor!

Hokum Locum

A Menu of Dietary Delusions

Neither Nutrasweet nor sugar-rich diets produce any change in children’s behaviour. (New England Journal of Medicine 330:301-307, 1994)

The subjects were tested in a double-blind, placebo-controlled trial. The trial was reported in the local press and produced a predictably outraged response from local nutritional quacks who have carried on regardless. Their beliefs are based on faith and are therefore not amenable to reason. For another good New Zealand review see NZ Medical Journal 27/9/89 (Diet and Behaviour) and 23/8/89 (Children’s diets: what do parents add and avoid?).

Evening primrose oil has been touted widely as a “natural” remedy for a host of conditions such as pre-menstrual tension and menopausal symptoms. The active ingredient is gamma-linolenic acid and it was tested in a randomised, double-blind, placebo-controlled trial of 56 menopausal women experiencing episodes of sweating or flushing. It was found to be no better than a placebo.

It is worth noting the value of such studies. Randomisation means that patients have an equal chance of receiving either the “test” substance (gamma-linolenic acid) or a placebo. This ensures that both wings of the trial are identical in terms of age, sex, number of smokers, etc. Double-blind means that neither the subjects nor the investigators know who was taking the “test” substance or placebo until the study has finished. It is no wonder that quacks decry such studies which remove bias, prevent cheating and usually show that quack remedies are useless. (BMJ 308: 501-503, 1994)

Smart Drinks

These are amino acids and other precursors of neurotransmitters which are being promoted among teenagers at music and cultural festivals. Smart drinks are claimed to “fire up the brain” and give the young executive an “edge”. Could there be anything more loathsome than a hyperactive yuppie? I remember reading about the smart drinks phenomenon in the US and I am not surprised that they have arrived in New Zealand. There is no evidence that smart drinks have any effect on either memory or intelligence. (NZ Doctor 31/3/94)

Sick of Work?

All that is necessary in New Zealand to get a sickness benefit ($22 per week more than the dole for those under 25 years of age) is to persuade a doctor to sign a prescribed form from the DSW.

Over the years I have seen many flagrant abuses of the SB. The best one was a young person who had been on a SB for over two years because of a perforated ear-drum. When I refused to sign the certificate she simply went to a more compliant doctor.

The court news regularly detail the activities of professional criminals and drug addicts who are described as “sickness beneficiaries”. My attempts to find out which doctors were signing these certificates were thwarted by DSW who cited “medical confidentiality”. The great irony is that at the time they were expecting doctors to inform on beneficiaries who were fiddling the system but were not prepared to put their own administration under scrutiny.

A reporter in Germany was able to obtain 41 days sick leave from five different doctors even though he told them he was perfectly well but just wanted a few days away from the office. One visit lasted four minutes, involved no examination and was worth 12 days off! (Dominion 29/3/92, Worker highlights easy access to sick leave)

This sort of abuse arises from poor ethical standards, which also extend in Germany into drug licensing (see Skeptic 27).

Laying On of Hands

The introduction of ACC around 1972 saw a great increase in both the use of physiotherapy and private physiotherapy practices. In Skeptic 29 I commented briefly on the widespread use by physiotherapists of unproven treatment modalities such as ultrasound. Ultrasound treatments have been introduced on a basis of applied experience rather than from controlled scientific study. Dr Linda Maxwell writing in the NZ Science Monthly, March 1994, has studied cellular processes at injury sites and found that ultrasound may enhance inflammation and actually cause more injury.

Physiotherapy is also traditionally used to build up muscle strength in patients with rheumatoid arthritis. A controlled trial by physiologists (New Scientist 16 Oct 1993 p17) found that this approach tended to worsen the flexion deformities seen in this condition. Work continues in the area of electrically stimulating the extensor muscles in an effort to counteract the tendency to flexion deformity.

Most injuries recover with time and I doubt whether the laying on of hands or the use of electrical gadgets by physiotherapists accelerates this process. Many of my patients become upset if they do not receive a referral for physiotherapy and few doctors will refuse in such circumstances.

It is no surprise that costs of the ACC scheme have continued to rise each year. The burden of proving that their treatments are worthwhile rests with the physiotherapy profession. ACC should not pay for any treatments unless they can be shown to be both cost effective and scientifically valid.

Alexander Technique

The “Alexander Technique” (AT) is an extreme example of the laying on of hands. To quote a recent magazine article, “…by extending the neck and opening the back, it literally makes you taller and releases the body’s natural energy flow”.

Note the typical vague language of quackery: what does “open the back” mean and just what is this “natural energy flow” that quacks keep going on about? The usual anecdotal reports are quoted by satisfied patients: “My singing has improved tremendously…I felt lighter, taller…I’ve learnt to relax by opening and lengthening the back muscles!”

The founder, Frederick Alexander, was born in Tasmania in 1869 and longed to be an actor but suffered a mysterious loss of voice. The rest is worth quoting: “Sitting alone for nine years in a room containing only mirrors and a chair, he studied his position in every detail. It took two years for Alexander to discover only the fact that when he talked he was moving his face and chin forward and contracting the vertebrae in his neck. The muscles of his neck were becoming very tight and causing obstruction in his voicebox.”

I would have described his position as ridiculous and if he found the problem after two years what did he do for the other seven years? How does one “contract the vertebrae in the neck”?

Feeling a need to inform us further about AT the author followed up with three more anecdotal reports from satisfied customers who all described how they feel “happier, more positive, less stressed”.

Quackery has many recurrent themes. The founder of AT suffered a profound illness which was clearly psychological (nine years in a room with mirrors!) and led to him feeling that he had discovered the meaning of life.

The laying on of hands is the basis for the clinical effects (essentially placebo) of most forms of physical therapy such as chiropractic, osteopathy and AT.

Massage and postural “adjustments” are pleasant procedures for patients and it is not surprising that they go away feeling empowered and improved. Unfortunately, many become dependent on therapy and I have met many people who feel it essential to consult such therapists on a regular basis for years. This of course is encouraged by such quacks because it is great for business and they are able to take advantage of people who are incapable of taking responsibility for their own lives and health.

Ischaemic Heart Disease

Ischaemic heart disease (IHD) is a serious public health issue in New Zealand and is the leading cause of death for New Zealand adults. My own father died suddenly of a heart attack while on a golf course. He was 71 years old and had no known risk factors yet autopsy showed severe coronary artery disease.

The costs of treating IHD are considerable and surgical treatment is popular. Political pressure has seen the creation in New Zealand of an absurd number of cardiac surgical units compared to similar western countries. An American study (quoted in Lancet Vol 343 p412) of 1,252 patients showed no difference in employment status after one year between comparable patients who underwent either surgical treatment (angioplasty or bypass) or medical treatment (lifestyle modification, drug treatment).

Angioplasty involves passing a fine balloon catheter into an area of blockage and inflating it, while bypass surgery involves using lengths of vein to bypass the blocked area in the coronary artery. In a subset of 72 patients the median number of days from the start of treatment to return to work was 14 days for medical treatment, 18 days for angioplasty and 54 days for bypass surgery.

Clearly surgery is not always the best option and a lot more of our health resources could be better spent on prevention of this condition by risk factor reduction.

Death or Compensation

A court in the UK awarded a Falklands War veteran $220,000 for post-traumatic stress disorder acquired as a result of serving during that campaign.

This drew a sharp response from the defence editor of the Daily Telegraph (Dominion 10/3/94) who asks how this can be taken seriously at a time when thousands of veterans are converging on Normandy to commemorate the D-Day landings. The Falklands War veteran received his award for the stress of an action over two days! Many WWII vets saw active service for five years and returned to lead happy and successful lives.

Wars are horrible experiences from which soldiers can recover without the need or right to compensation. Post-traumatic stress disorder is simply a New Age euphemism for shell shock, and an insult to all servicemen who have done their duty and returned to civilian life. This absurd monetary award is an example of Welch’s law (after Parkinson): “Whenever compensation is available conditions will emerge to take up the compensation available”.

Deliver Us From Gynaecologists?

In Skeptic 29 I referred to abuses of gynaecology. In Florida, where 25% of deliveries are by caesarean section, the state legislature has forced doctors to change their practices, wanting the rate to be less than 20% by 1997. There is a higher rate of Caesarean delivery among patients with better health insurance and higher incomes, and the rate is lowest in teaching hospitals. (BMJ Vol 308 p432)

Failing the Sex Test

This is the headline of an article which appeared in the Dominion 17/3/94, and concerns an Indian clan which murders unwanted female children. Because of the illegal dowry system, girl children are too expensive so are murdered by being either strangled or smothered soon after birth. The tribe cannot afford amniocentesis which is also abused in order to predetermine sex so that female foetuses can be aborted.

It is important that such cultural practices are highlighted and discussed. It has been interesting to see how various other equally vicious cultural practices have fared following migration to western countries. Some doctors have been de-registered for performing female circumcision and I have even seen a reference in print defending this procedure!

The Indian authorities have taken little action over these murders since the status of women in India remains low. If there are problems over the dowry after marriage, it is a traditional practice to set fire to one’s wife and make the murder look like a kitchen accident.

How far should we go in either acknowledging or accepting traditional cultural practices? Nurses in New Zealand are judged on their “cultural safety” regarding Maori traditions and customs, which fortunately do not honour such abuses as infanticide.

Hokum Locum

Arthritis and Placebos

In Skeptic 30, John Britten outlined the tragic results which can occur when patients fall into the clutches of quacks. In this case, a man with rheumatoid arthritis was not only starved but ended up paying for expensive and useless medications. Most doctors can relate similar examples.

Uncontrolled trials claimed to show dramatic improvements in rheumatoid arthritis patients following laser treatment. However, a placebo-controlled trial showed that sham treatment (placebo) gave just as good results as the laser. (BMJ Vol 307 30 Oct 1993 p1154)

A placebo-controlled trial of diclofenac (an anti-inflammatory drug) for osteoarthritis of the knee, found that half of the patients allocated to placebo stayed on this treatment for two years without any worsening of their symptoms! (BMJ Vol 307 Aug 1993 p394)

Reports of pain relief from subcutaneous injections of water drew a sharp reply from Skrabanek writing in the Lancet (April 3 p905). He pointed out that a historical perspective of such “counter-irritation” methods can help prevent over-enthusiastic adoption of such unlikely treatments. In fact, I seem to remember that water injections were one of the scams exposed in the novel by A.J. Cronin, The Citadel, which should be required reading for any doctor of medicine.

Gulf Gas Mystery

An article in Time magazine (Nov 22 1993) outlines how 8,000 veterans of the Gulf War have claimed that they were exposed to chemical agents producing such symptoms as diarrhoea, aching joints and difficulty in breathing. It is alleged that “multiple chemical sensitivity” may be the cause but nowhere is there any mention of psychological causes such as stress. Many of the claimants have been dismissed as malingerers.

War is hell and it is a terrible experience for some soldiers. Stress-related disorders are common and resulted in shell shock and effort syndrome in WW1, anxiety neurosis after WW2 and alleged Agent Orange poisoning after the Vietnam war. History shows that such claims will continue to occur, as in this case, but I would prefer to see psychological causes included in the differential diagnosis.

Sick Building Syndrome (SBS)

Researchers have finally got around to acknowledging that SBS may be due to “a high level of job stress among individuals with symptoms” (GP Weekly 19 Jan 1994 p15). As would be expected there are now concerns about “sick plane syndrome” (SPS) reported in New Scientist (7 Aug 93 p7). Several cabin attendants reported difficulty breathing, dizziness, fatigue, nausea and headaches during a cross-country flight. “The cause was never determined.”

I wonder if they considered mass hysteria, which is the most likely scenario for both SBS and SPS. Hysteria is not the best word to use — perhaps mass conversion disorder is less pejorative. Essentially, groups of people under stress tend to develop similar symptoms in the face of a common stress. A good example which I have seen myself is mass fainting occuring in military recruits awaiting both blood tests and vaccinations.

Child Abuse

Christian “Scientists” believe that illnesses can be healed with prayer and Bible readings. The religion’s founder, Mary Baker Eddy, was described by Mark Twain as the “queen of hypocrites”. There are numerous examples of people who have died from lethal but eminently treatable conditions. I have no problem with deluded adults who want to be treated in this way but children are entitled to a standard of medical care expected by any reasonable parent.

As would be expected from common sense, there is no evidence that faith has ever produced a cure of any illness. Is it at all likely that faith can produce insulin secretion from a failed diabetic pancreas? In the US, a couple killed their diabetic son by withholding treatment for his diabetes (Lancet Vol 342 Sep 4 1993 p610). Incredibly, the parents were not criminally prosecuted because of “a state law that protects from child neglect statutes, parents who rely on prayer to heal their children”. However, the child’s estranged parent filed a civil suit and the Christian Science church has been ordered to pay US$11.3 million in damages.

The law in the UK seems more rational. A Rastafarian couple refused on religious grounds to allow their diabetic daughter to have insulin and she duly died. As any reasonable person would expect, the parents were charged with manslaughter and convicted (Lancet Vol 342 Nov 13 1993 p1189).

More on Dental Amalgam

As I have previously explained, there is no evidence to implicate mercury in amalgam with significant human illness. An article in the Marlborough Express (24/8/93) outlined an illness which caused weight loss, stomach cramps and nausea in a 34-year-old man. After paying more than $2,000 in medical bills he was no better. As a doctor I know straight away that there is only a slight chance of a significant organic illness (e.g., cancer) either occuring or being overlooked in a 34-year-old.

I have seen this combination of symptoms before in many patients and they all turned out to have depression and were cured with appropriate treatment. However, as I have mentioned many times, psychological causes for illness are seen as somehow inferior to a “physical” cause. To quote the patient: “I was getting worried that it was something psychological. The medical profession was giving me ideas that it was depression, stress, bodily changes.”

In this case, the patient received a diagnosis of “mercury poisoning” following an assessment with a quack “black box” involving electroacupuncture. He then paid $1,000 to have all his amalgam fillings replaced and is reported to be slowly improving. Truly another remarkable example of the placebo effect which is very powerful with any kind of surgical or operative treatment.

Conversion Disorders

These are symptoms or signs produced by notional beliefs (e.g., mass fainting due to a perceived chemical or environmental threat), and are the basis of occupational overuse syndrome, chronic fatigue syndrome, sick building syndrome etc.

“Retractor” is an expatriate Kiwi living in Australia who wrote an interesting article on allergy to local anaesthetic (LA) (NZ Doctor 16 Sep 1993 p7). He found that patients demonstrated their “allergic” reactions even when injected with normal saline solution.

One 12-year-old had fits after dentally administered LA and was investigated with two electroencephalograms (brain-wave recordings), a CT scan and a MRI scan. Following an injection of normal saline (which the patient believed was LA) he had a fit and was incontinent!

“Retractor” was mostly successful in helping patients deal with their subsequent embarrassment but some had trouble and went so far as to dispute the matter. Descartes was certainly completely wrong when he proposed his theory of complete separation between mind and body. Clearly the mind (belief) can have a potent effect on the body.

Pond Scum Scam?

Pro-algal quacks claim that algae harvested from a pond “may be beneficial” for the treatment of AIDS, cancer, heart disease, etc. The product has re-surfaced since the FDA shut down the marketing company, Cell Tech, in 1986.

Note the absurd range of indications of the product, in contrast to the specific use of drugs for particular diseases.

The FDA faces an uphill battle in countering this sort of quackery, as the law is vague on whether such items should be classified as drugs, foods or dietary supplements. A sensible law was passed by Congress in 1990 which prohibited any health claims about such products unless approved by the FDA. The powerful quack lobby has managed to introduce another law which dilutes scientific standards and shifts the burden of proving safety onto the FDA!

C is for Cancer

Linus Pauling’s faith in Vitamin C is undaunted by his cancer (NCAHF Vol 15, No4). Despite it being out of his field (nuclear physics), Pauling has championed the anti-cancer benefits of Vitamin C. Sadly, he has been diagnosed as having prostate cancer but, despite being poorly, his faith in Vitamin C is unshaken. “He credits his high-C regimen with delaying the disease until his present age of 91 yrs.” The physiology of Vitamin C is well described, and excessive amounts are simply excreted in the urine. Prostatic cancer occurs more often with increasing age and if men live long enough there is an almost 100% incidence.

Pauling has helped keep Vitamin C as the number two on the list of the top dietary supplements in the US. Dietary supplements are worth $1.4 billion US annually and are currently 37% of all health food sales.

Oil Strikes Out

The film Lorenzo’s Oil concerns the efforts of a family to save their son from a rare genetic disorder using a highly purified cooking oil of the same name. Thanks to the media there is now a new popular mythology that the oil is effective and that attempts to use it have been obstructed by the unreasonable medical profession.

A French team of scientists have tested the oil and found no evidence of any clinical benefit. Once again, extravagant claims are found wanting when subjected to critical scrutiny.

If You Can’t Beat ’em?

Bernard Howard first drew my attention to worrying trends towards the inclusion of unorthodox therapies into conventional medical practice.

The BMA has acknowledged that acupuncture, osteopathy, homeopathy etc. are “indeed a good thing” provided the practitioners are “properly qualified members of their crafts”. In an article in New Scientist (31 July 1993), Donald Gould comments on this Pauline conversion and accuses the medical profession of a change prompted by concern over the loss of patients to alternative medicine. A “properly qualified homeopath” is still a quack peddling water, and professional registers simply give quackery a spurious respectability.

The NCAHF has already shown how licencing of quackery is soon followed by that body actively lobbying for an expanded scope of practice. In New Mexico, the state Acupuncture Board allows acupuncturists to order tests and procedures such as MRI scans, writing prescriptions and performing bone and muscle manipulations. Chiropractors were predictably indignant and two doctors on the Board resigned in protest. (NCAHF Vol 16, No 5).

I briefly commented on this trend in Skeptic 30 (“Quackery in the US”). The Office of Alternative Medicine has been set up within the US National Institutes of Health at the instigation of a former congressman, Bedell, who claims to have been cured of a “possible recurrence” of prostate cancer by an unconventional “nitrogen enhancement” therapy (unspecified). What Bedell does not say is that he was also receiving conventional treatment for prostatic carcinoma and “possible recurrence” is an example of the meaningless terms and vague language that permeates alternative medicine.

The director of the Office holds establishment credentials and describes himself as a skeptic, yet favours simple outcome studies rather than the proven double-blind, placebo-controlled trial. Outcome studies are weak and will allow for all sorts of extravagant claims. The reason that quacks hate proper clinical trials is that they usually show that quack beliefs are a delusion.

Members of the Office of Alternative Medicine can use their affiliation to advertise their quackery because, as an ad hoc body, they are not subject to normal regulations. One of the members has already claimed to have cured AIDS using herbs. No evidence was offered to support such an extravagant claim.

In New Zealand the ACC will pay for acupuncture, which is an unproven treatment, on the referral of a doctor. I had a patient with a severe neck injury which required (on the advice of a specialist neurosurgeon) an MRI scan but ACC does not pay for this test because it is “not an approved investigation”! This is a good example of politics controlling medicine, instead of science.

Hokum Locum

Manipulation of the Colon

Some time ago I remember reading a letter in the Listener from a frustrated doctor who accused the public of being medically illiterate. Sometimes I feel this way myself but it is not a good practice to attack one’s audience. Public education cannot be achieved within the context of traditional ten-minute medical consultations compared with quacks who may spend up to an hour providing mis-information. Drug companies are on record as cynically exploiting a gullible public eg. “…neither government agencies nor industry, including the supplement industry, should be protecting people from their own stupidity”.
Letter to Hoffman-Laroche, quoted in NCAHF Vol 15 No.4

In a letter to Little Treasures, a writer who would probably prefer to remain anonymous claimed that her child’s constipation was cured by chiropractic manipulations because “one leg was slightly longer than the other and the passage to the bowel was obstructed by this”. The anatomical possibilities are intriguing! George Dunea writes a regular letter on the US medical scene for the BMJ and in an article reviewed the current activities of chiropractors in the US. Using aggressive marketing techniques they are claiming to treat an even wider range of self-limiting conditions such as colds and colic. One third of Americans use such unconventional treatments at a cost of $10 billion annually and one third of this cost is borne by public funds or private insurance. Dunea goes on to say: “Alternative treatments have also become popular for pets…one large dog, afraid to sleep because he had been beaten badly as a puppy, was described as taking his first afternoon nap after his spinal cord had been adjusted”.
Realigning the Spine. BMJ Vol 307 p71

An American doctor, posing as a concerned parent, surveyed 100 chiropractors and found that 80% of them would treat middle ear infections with cervical spine “adjustments”. Some 78% also sold vitamin supplements from their offices.
Chiros treating children. NCAHF Vol 16, No.6

Conductive Education

This is a treatment based on the teachings of the Peto Centre. Children suffering from cerebral palsy are treated with an intensive (and expensive) series of exercises aimed at developing alternative neurologic circuits to their paralysed limbs. These treatments have no scientific basis and a government financed controlled trial confirmed that the Peto system gives no better results than conventional treatment. There are frequent public appeals to raise money for this treatment but the money could be put to much better use by organisations such as the Crippled Children’s Society.
BMJ Vol 307 p812

Homeopathic Immunisation

Enough has already been said on the enduring myth of homeopathy. An Australian GP was rebuked for recording a homeopathic-type immunisation in a child’s health records and the Medical Defence Union said that such action makes the GP potentially liable if the child subsequently develops a serious illness such as whooping cough or measles.
NZ Doctor 11/11/93

Psychic Surgery revisited

Shirley MacLaine, the high priestess of new-age (rhymes with sewage) silliness has regained her health and happiness after visiting a Filipino psychic surgeon. In Shirl’s own words: “He inserted his hands into my body and withdrew clots of blood and internal matter of some kind, then withdrew his hands”. In defence of Woman’s Day they did add at the end of the article “Oh Really!”
Woman’s Day 31/8/93

Yin Yang Tiddle I Po

So went the song of the Goons (actually Yin tong..) making about as much sense as an article on Chinese medicine which appeared in NZ Doctor 22/7/93 entitled “Look to natural forces to maintain health”. It is written by a trained veterinarian (Massey 1980) who is now practising as a doctor of Chinese herbal medicine. If that isn’t a paradigm shift I don’t know what is! I would love to know what prompted him to change from scientifically based veterinary practice to this nonsense. The treatment of subclinical diseases is prompted by examination of the tongue and pulse. This is a wonderful scheme because all sorts of diseases can be treated and there is no way of disproving that they ever existed. “Iced food and drinks should be avoided like the plague, as these are discordant with the prevailing Qi of summer and will stress the body”.

In a child with eczema the Chinese diagnosis was “blood deficiency complicated with wind and damp. The prescription was designed to “nourish blood, expel wind, strengthen digestion, remove damp, and cool the emotions”. As I have mentioned before, Chinese herbs sometimes contain unexpected substances. A chronically ill man developed muscle wasting which proved to be due to triamcinolone (a potent steroid) contained in “herbal” tablets. Each “herbal” tablet contained 5.4 milligrams of triamcinolone.
GP Weekly 17/11/93

Japanese Herbal Medicine

Japanese doctors will soon be able to gain a degree in Japanese herbal medicine. Seventy percent of Japanese doctors already prescribe such remedies known as kampoyaku. In response to side-effects of modern drugs and a consumer sense of depersonalisation in western medicine, such remedies are now state funded to the tune of US$1.5 billion and increasing by 15% annually. Kampo is based on 4000-year-old medical texts and diagnosis depends on the skill and intuition of individual doctors. (Where have I heard that before?) Such clinical instincts have already been shown to be weak in Western medicine, eg. “only about 50% of gastroscopies, coronary artery grafts, and carotid endarterectomies could be justified by independent panels of experts”.
Viewpoint, The Lancet Vol 341, p878

It is interesting that the Japanese community sees fit to waste money in this area when they have a chronic shortage of trained anaesthetists, causing Japan to have a maternal mortality (during childbirth) twice as high as the UK. There is also a complete lack of information about crude surgical mortality rates because the large numbers of private hospitals are not required to report their operation numbers.

Their hospitals have also been struck by an epidemic of methicillin resistant staphylococcus aureus (MRSA) due to the widespread overprescribing of antibiotics (BMJ Vol 306, p740). MRSA is a nasty bacterium which becomes prevalent whenever antibiotics are prescribed either inappropriately or excessively. This epidemic occurred because doctors are paid a set price for drugs used, whereas the drug companies supply these at a discounted rate with the doctors pocketing the difference.
New life for old medicine, The Lancet Vol 342, p485; Health Research in Japan, Letter, The Lancet Vol 342 p500

The Cocaine and Guinea-pig Diet

Move over Jenny Craig! An entrepreneurial father and son have set up a weight loss clinic on the shores of Lake Titicaca, Bolivia, at 3810m above sea level. Obese guests are invited to chew a syrupy extract from coca leaves (cocaine in its crudest form!) and if that is not enough they can enjoy having their skin rubbed down with a live guinea pig. These attractions are hoped to restore the flagging tourist industry but it is bad news for the guinea pigs.
Economist August 31st 1992, p36

Generalised Chemical Sensitivity

This is a diagnosis beloved of quacks who validate essentially depressive symptoms that some patients develop after a real or imagined chemical exposure. Glutaraldehyde is a highly effective disinfectant which has good activity against both the hepatitis and HIV viruses, but can cause skin and other sensitivity. A nurse who used this chemical developed baffling symptoms and was seen by a number of specialists who are described as suggesting that “her illness may have had an `emotional’ component”. Note the implied suggestion that an emotional cause is somehow less honorable than a “real” illness.

Her most distressing symptoms were “mood swings, irritability, loss of judgement, poor concentration and short-term memory loss” which are classic depressive symptoms. She is described as being unable to enjoy a lengthy conversation without becoming exhausted. An occupational physician dogmatically stated “There’s no doubt in my mind that the chemical has affected her immune system, leading to a multi-system pathology”. He went on to decry the patient’s “degrading and demeaning experience in failing to have her condition acknowledged by specialists” and “they go away thinking it’s all in their minds”.

Here again is the implication that physical symptoms are either “real” or imaginary. As we know, symptoms are almost always real, but can be produced by anxiety or notional beliefs (somatisation, for example headaches with depression). The result is a person who is now chronically unwell and unemployed and who has received both the wrong treatment and the wrong diagnosis. Exposure to other foods and chemicals now “causes an immediate deterioration in her ability to think clearly”.

This is a classic case of somatisation and is clearly not an occupational disease. This patient’s illness has arisen from the notion that she has somehow been “poisoned” and the availability of compensation completes the process. Doctors who continue to deny the importance of psychological factors paradoxically encourage the abnormal illness behaviour while no doubt sincerely believing that they are acting in the patient’s best interests.

This whole area was briefly reviewed by NCAHF (Vol 16 No. 6) who coined the phrase “environmental anxiety disorder” and quoted research in which immunologic testing did not differentiate patients with chemical sensitivities from controls. Finally NCAHF says “the power of the imagination, operant conditioning, and practitioner influence can reinforce imaginary sensitivities”.
GP Weekly 17 Feb 93

Quackery in the US

The US National Institutes of Health Office (Alternative Medicine) has awarded nearly $1 million in research grants for topics which include: t’ai chi for balance disorders; massage for HIV-exposed babies; dance movement for cystic fibrosis patients; biofeedback for diabetics and acupuncture for depression. I predict that all of these trials will produce glowing reports of improvements, having failed to make any allowance for the placebo effect, natural disease variation and spontaneous improvement.