Moa Mania

Some Skeptics have been surprised that our organisation has been so restrained in its response to the purported moa sighting near Cragieburn. As we see it, the whole issue is fraught with difficulty.

The notion of a colony of large moas escaping detection till now, despite its location in the Southern Alps accessible to Christchurch, almost defies the imagination. Almost, but not entirely: there is a lot of dense country out there, and the notion of a surviving moa — or two, or twenty — cannot be classed with Bigfoot or UFO abductions.

To this, we have to add the perceived credibility of the witnesses. The Press reporter who broke the story, Dave Wilson, is a previous winner of one of the Skeptics’ “excellence in journalism” awards. He’s an intelligent, persistent, hard-headed bloke who has spent a lot of time interviewing the trio who saw the beast, and he’s strongly inclined to the view that they are at least sincere. Wilson is a world away, for instance, from the cynical, exploitative Australian journalists who a few years ago got their hands on a family that had seen a blinding light on sky over the Nullarbor desert. Wilson has, to the contrary, been careful and measured in his approach.

The New Zealand Skeptics, it seems to me, cannot simply disregard Wilson’s convictions on this issue. If the trio is lying, it’s a particularly skillful and cruel hoax on Wilson personally, not to mention the rest of us. Still, for my part, I found the watery “footprint” of the beast, a photograph of which the three trampers produced at the very beginning of the flap, cause for the most skepticism. It was all wrong for a print left by a running bird, or a standing moa. The fuzzy photograph of the bird itself was plausible; the footprint looked outright fake.

If the sighting is not a hoax, then something like a loose emu still is far more likely than a moa. Nevertheless, hope springs eternal in the hearts of most skeptics that something as wondrous as the recovery of the moa might just turn out to be true. Wouldn’t we all cheer?

When I was musing on this the other day, Vicki Hyde brought me back down to earth with a stern lecture on the real, numerical probabilities of there being large, undetected moas in one of our more accessible parks. She was right, of course. But then I never claimed to have a skeptic’s soul. If anything, I more-and-more consider myself temperamentally gullible, and in need of occasional dressings-down by more tough-minded types like Vicki. Nevertheless, if the Skeptics are to err in this case or any other, better perhaps to be slightly on the side of a splendid possibility, than to dismiss without any consideration some extraordinary claim.

One of the highlights of our upcoming conference will be a symposium on cryptozoology. Dave Wilson will be there, and we may even be able to bring along the moa spotters themselves. Meanwhile, Vicki is organising a “fuzzy-photo” contest for Skeptics who can produce evidence demonstrating the existence of some extinct or extraterrestrial beast. Or perhaps a tossed hubcap, a floating log, or a chicken-wire moa.

Hokum Locum

Quackery

In the last issue I discussed how quackery can be practised by New Zealand doctors with impunity, “if they do so honestly and in good faith.” Alaska has a similar clause which only disciplines maverick doctors if they harm their patients. In fact, the latest NCAF newsletter outlines how a Dr Rowen has been appointed to the state medical board after “curing” the governor’s wife of lumbago by extracting one of her teeth. The link between the tooth and the back was made by an electro-acupuncture circuit using a Vega machine.

Dr Rowan also practises chelation, homeopathy and is described as “anti-fluoridation, anti-aluminium cookware, and anti-dental amalgam.” The Alaskan State Medical Association has strongly protested and one medical board member has resigned.

More on Bands of Hope

Sea Bands are available from NZ Pharmacies as well as Elekiban which is another form used for musculoskeletal complaints. As outlined in Skeptic 26, these are acupressure devices which have no scientific effect other than placebo. I was interested to read that the Institute of Naval Medicine (INM) had tested Sea Bands because on my recent overseas trip I spent a day a day at INM having a look at their research programs on Hypothermia and Diving Medicine.

Acupressure is an equally false derivative of acupuncture which works through a combination of the placebo effect and suggestion. Having written a truth kit on acupuncture I was alarmed to read that the Medical Acupuncture Society of NZ (MASNZ) is setting up a register of medical acupuncturists (150 hours training minimum)(NZ Doctor 21/1/93). Since acupuncture has no proven basis this is totally unnecessary, rather like setting up an appreciation society for the emperor’s new clothes.

As a former acupuncturist, I can teach anyone to be a safe and confident acupuncturist in about one hour. Perhaps I should give a demonstration at our next conference in the style of Dr Bill Morris and his vivid demonstration of homeopathy.

Pharmaceuticals Around the World

I have long held the belief that NZ doctors tend to overprescribe drugs. While working in general practice myself, I was often aware of pressure from patients to prescribe drugs. However, until now I haven’t come across any comparative data from other western countries. A survey of 495 randomly chosen Australian GPs (Patient Management Nov 1992) found that a prescription item was issued for every consultation (a reduction from 1974 when 136 prescription items were issued per 100 consultations!)

In NZ our annual drug bill is about $600 million, or $185 per head, per annum. My family of four definitely does not consume $740 worth of drugs in a year! Some people must be consuming a lot of drugs. British doctors are described as “low prescribers of medicines” yet their costs were roughly the same at $165 per head per annum.(The Lancet Vol 340 August 8, 1992 page 364). Patients expect drugs, and doctors want to help their patients, so it is not surprising that prescription rates are high. The writing of a prescription is often a convenient way to end a consultation.

One of the major problems for third world countries is getting cheap, effective drugs which are truly necessary. Multinational drug companies continue to cynically exploit these countries by marketing both dangerous and useless drugs. In a letter to The Lancet (Vol 339: Feb 22, 1992 page 498), a Pakistani doctor explained how a child died after being given drops containing an anticholinergic drug and phenobarbitone. Such a preparation has no scientific medical indication and its use in NZ would not be allowed.

A survey from Peshawar (reported in The Lancet Vol 338:August 17, 1991 p438) found that 90% of general practitioners were using antibiotics and anti-diarrhoeals to treat diarrhoea instead of using the correct treatment of oral rehydration therapy.

In Bangladesh, (GP Weekly International 2/12/92), hundreds of children have been injured or killed by cheap brands of paracetamol containing toxic ethylene glycol.

Datura is a drug which is commonly abused by drug addicts. It contains atropine, which in high doses causes hyperactivity and hallucinations. Incredibly, cigarettes containing datura are licenced for the treatment of asthma in France because “many old people rely on the treatment because they don’t believe modern methods help them.” This is a classic example of the need to have a rational, scientifically-based pharmaceutical industry. Datura-containing cigarettes would not be allowed here (we used to have cannabis cigarettes on prescription up until the 1920s!) and their persistence in France is based on delusion, placebo effect and anecdotal reports of efficacy. (New Scientist 22 August 1992).

Drug treatment can also be irrational when it is used for a condition which has no clinical basis. On the European continent there is a widely held belief that low blood pressure is associated with specific symptoms and is a pathological state requiring treatment. There is no basis for this belief, because complaints of faintness and fatigue are made as often by patients with a normal blood pressure.

Blunderbuss Treatment

A doctor whose daughter fainted on a hot day (BMJ Vol 299, 18 Nov 1989, p1284) reported that a French doctor prescribed a proprietary preparation called Tensophoril which contains the following ingredients: dopamine hydrochloride 15 mg, boric acid 15 mg, amylobarbitone 15 mg, and ascorbic acid 250 mg.

This sort of combination has been rightly criticised as “blunderbuss” drug treatment. Dopamine is inactive when given by mouth; boric acid is toxic and should not be taken by mouth; amylobarbitone is a long acting barbiturate sedative and the ascorbic acid dose is that which would be found in about 5 oranges. Fortunately the doctor’s daughter elected not to take the treatment and recovered fully.

Drug Licensing

I was much more impressed with a letter (The Lancet Vol 340: August 15 1992, p432) which detailed how Israel dealt with homeopathy. Drug registration required proof of efficacy and this was still not forthcoming after three years. Unfortunately the new legislation did not apply to raw materials and homeopathic preparations were able to be imported as such. The author regretted that “the compromise is not entirely satisfactory in that scientific assessment of efficacy cannot be applied.”

The situation in Germany is hardly credible. Drug licencing does not depend on clinical trials, but on anecdotal evidence supplied by medical practitioners, many of whom are paid by the same companies whose products they are endorsing. This is hardly surprising when 7 out of 10 general practitioners practise alternative medicine.

For example, the Federal Health Office (BGA) was forced to licence a totally useless product containing “1 g loess soil” for the treatment of diarrhoea, because “German law does not define the term efficacy.”

Another useless drug is Arteparon, an extract of bovine lung used for the treatment of osteoarthritis when given by injection. The drug is licenced because the courts have determined that “the efficacy of old drugs must not be judged by modern scientific standards.” Arteparon causes severe allergic reactions, a fact not recognized by the courts because “proof of causality beyond any doubt was needed for each case of adverse reaction.” The judges obviously overlooked the irony of demanding a higher standard of proof of side effects than of efficacy. The cost of these crazy decisions is a huge drain on the German health system. One quarter of the DM20.7 billion spent annually on pharmaceuticals is for useless drugs.

I have no idea whether our own drug lists contain either questionable or useless drugs and these reports have prompted me to have a browse through the GP’s pharmacopoeia New Ethicals. Watch this space!

Thalassotherapie

While overseas I collected a number of articles worthy of skeptical attention. Although a confirmed Francophile, I wonder whether they have any effective organised groups of skeptics. Homeopathy is part of mainstream medicine and astrology is big business.

Thallasotherapie is described as a treatment modality using seawater and its products. Patients (or, in newspeak, clients) can either float in seawater or apply heated mud made from seaweed. Obese subjects will be delighted to know that their tissues can be “deflated by various jets and massages.”

It is claimed that elements such as magnesium and calcium are able to “get into human tissues” and “engender the same consequences as a hoemeopathic treatment: stronger immune system and stimulation of cells.” In fact, human skin is relatively impermeable and certainly does not behave like a semipermeable membrane. Essentially this therapy can be carried out for nothing in the privacy of your own home by having a long soak in a hot bath. If you feel so inclined, toss in a handful of seaweed.

More on RSI

There has been a lot written on this subject, but so far little written to explore alternative explanations for these spurious symptoms which are essentially a conversion disorder (well described in basic psychology texts).

Whole forests have ended up as publications on ergonomics and an army of occupational physicians continue to pontificate over the delusion of RSI. It is therefore refreshing to read letters (Medical Journal of Australia Vol 157, Sep 21 1992, page 427) from skeptical occupational physicians who have both correctly diagnosed this condition as a conversion disorder and correctly treated it by “helping patients sort out their personal, social, family and financial problems.”

Even More on Chronic Fatigue Syndrome

In Skeptic 21 I summarised the key research in this area, which does not support any infectious cause and shows clearly that the condition is a somatisation disorder.

If any readers are interested in further reading on this subject, there is a very good article in Patient Management Nov 1992, p13 by Robert Loblay. He reviews the historical development of immunology and demonstrates conclusively how history tends to repeat itself. For example, neurasthenia has been resurrected as chronic fatigue syndrome.

Many symptoms which people present to their doctors are often functional (somatisation disorders) and have no basis in serious disease. Some doctors have difficulty in accepting their own limitations in this respect, or the existence of psychological disorders, and it is easy for these practitioners to seek “magic” solutions such as acupuncture, homeopathy and dietary manipulations.

Psychological disorders cannot be explored within the context of the traditional five-minute NZ consultation and it is hardly surprising that alternative medical practitioners have more success when they give the patient one or two hours of their undivided attention (itself a form of psychotherapy).

Chelation Therapy

This is an intravenous treatment with a cocktail of vitamins and the drug EDTA, which is believed to chelate calcium which has been deposited in atheromatous plaques. Atheroma (Greek for porridge!) is an ageing process leading to fatty deposits in arteries (accelerated by smoking, high blood pressure, excessive dietary fat and diabetes) leading to coronary artery disease (CAD) and peripheral vascular disease (PVD). Poor blood supply through the narrowed vessels leads to chest pain in the case of CAD and painful legs in the case of PVD.

There is a proper double blind placebo controlled trial of chelation therapy for PVD currently under way in Dunedin Hospital. A similar study in America (Journal of Internal Medicine 1992, pp 231-267) showed no difference between chelation and placebo treatment. I hope to do a similar study of chelation treatment for CAD. We await the outcome.

Monkey Business

From Jerusalem comes news that Israel’s former Chief Rabbi Ovadia Yosef has ruled that trained monkeys may turn off lights or do other domestic chores forbidden to Jews on the sabbath. But only a borrowed monkey — or a dog or other animal capable of performing such tasks — can be used because their own beasts must be allowed to rest.

Skeptic Carl Wyant, who has sent us this information, says that it bugs him: “Apparently God doesn’t care if gentile monkeys get a day of rest or not.”

The Placebo Effect

Many people will remember Dr Bill Morris’s entertaining autobiographical talk at the last Skeptics’ conference in Wellington. From his presentation, we extract this discussion of what is still the most persistent and potent medical effect known to the human race.

The word “placebo” may or may not be recognisable to you as being of Latin origin, from the verb placeo, placere, to please, and placebo is the first person singular of the future indicative tense, or “I shall please.” Its first recorded use in the English language was in 1225 in reference to Vespers in the Office for the Dead, and the word was derived from the first word of Psalm 116 v 9 “Placebo Domino in regione vivorum.” This is usually translated as “I shall walk before the lord in the land of the living,” but as the Vespers for the dead was in effect a request for the dead to intercede with God for the benefit of the living, it is better translated as “I shall please or intercede with God on behalf of those in the land of the living.”

By 1386 it had appeared in Chaucer’s Merchant’s Tale to mean a flatterer and by 1811 it had acquired one of its modern senses as “…an epithet given to a medicine adapted more to please than to benefit the patient.”

It may surprise you to learn that it was as late as 1938 before the word appeared in its other modern sense, that of a dummy medication used as a control, and probably the first well documented randomised placebo controlled trial was that of streptomycin for the treatment of tuberculosis of the lung, in 1948.

The Medical Research Council pointed out that the natural history of tuberculosis of the lung was so variable that “evidence of improvement or cure following the use of a new drug in a few cases cannot be accepted as proof of the effect of that drug” by contrast with tuberculous meningitis which was invariably fatal without treatment.

The placebo treatment was bed rest alone, whereas the streptomycin group received both bed rest and streptomycin. In this instance the patients obviously knew they were getting streptomycin as it has to be given by injection, but the progress of the disease was followed on chest X-rays which were assessed without knowledge of which treatment the patients had received.

Ethical considerations did not apply, as the only possible alternative treatment at that time was bed rest, and in any case only limited amounts of streptomycin were available. Nearly forty five years on, it is difficult to accept that bed rest alone was perceived to be an effective treatment.

By 1950 the Journal of Clinical Investigation wrote, “It is customary to control drug experiments on various clinical syndromes with placebos, especially when the data to be evaluated are chiefly subjective.” and so by this date, the use of dummy medication in drug trials was firmly established.

It soon became clear that many people reported side effects or improvement when receiving placebos in trials and it soon became possible, though perhaps not useful, to say that the placebo effect was that which all treatments have in common. Perhaps more useful is to combine the two definitions and say that it is a non-specific effect of a treatment attributable to it but not to its pharmacological properties.

Any form of treatment can act as a placebo, and the strength of the reaction varies with the supposed potency of the treatment so that a capsule is better than a tablet, an injection is better than a capsule, an injection that stings is better than one that doesn’t and an operation is even better than an injection that stings.

In 1939 it was suggested in Italy that tying off the internal mammary arteries could greatly reduce the pain of angina pectoritis. The operation eventually became fashionable in the USA with quite spectacular results. The patients said they felt better and there was objective evidence to support this in that they could walk further and their consumption of angina pills decreased.

Eventually a double blind controlled study was done in which half the patients had their internal mammary arteries tied and the other half simply had them exposed without tying them. Neither the patients nor those who assessed them knew until the study was completed who belonged to which group. It turned out that ligation had no greater effect than the dummy operation. Since ligation of the internal mammary arteries was quite a major operation with potential for harm as well as good, and there was genuine doubt that it was useful, not only was the trial ethical, but it would have been unethical not to have done it.

Placebos can also cause toxic effects just like those of an active drug, and in a study of 25 patients given placebos, ten reported sleepiness, nine palpitations, eight irritability, five weakness with a fall in blood pressure of more than 20 mm of mercury, four reported diarrhoea, two collapse and two itching. Three of the patients also developed dependence on the placebo (lactose) and had withdrawal symptoms when it was stopped.

Now one suspects that if we stopped people in the street at random they might report a similar rate of these symptoms, and at the 1992 Skeptics Conference, on asking for a show of hands, I found that the proportions enjoying the symptoms listed above were greatly exceeded.

As soon as the placebo effect became clear, investigators began to look for factors which might identify the placebo responder in the hope that eliminating them from the studies would make the data much clearer.

A variety of psychological studies has been done but there are so many inconsistencies among the results that one can conclude that there is no single personality trait that characterises the positive placebo reactor, with the possible exception that stress or anxiety has been rather consistently associated with placebo reactivity. Expectation has been cited as a possible mechanism.

In one study, experimenters were told that their rats had been bred especially either for intelligence or dullness, although in fact all the rats were from the same genetic strain. The experimenters then performed learning experiments on the rats and obtained results that conformed to their expectation.

Brody cites this as possible support for the idea that if experimenters can somehow communicate their expectations of the rats’ behaviour to the rats “It seems reasonable to assume that physicians can unknowingly communicate their expectations and attitudes to the patients, altering the patients’ therapeutic outcomes as a result.” My own view is that old Procrustes is at it again, altering the accuracy of the experimenters’ observations rather than the rats’ behaviour.

Theories of placebo action have been largely psychological or psychoanalytical, but a reductionist like myself sees behaviour, feelings, thoughts and so on in terms of as yet poorly understood physico-chemical activities in the brain and peripheral nervous system, rather than as something happening somewhere in a bubble marked “psyche.” A little support for this view comes from a randomised double blind placebo controlled study by Levine and others into the mechanism of pain relief following extraction of impacted lower wisdom teeth. A third were given naloxone, a substance which is believed to inhibit the action of naturally occurring pain relieving substances in the brain called endorphins, a third were given a placebo and a third were given morphine. Those given naloxone reported significantly more pain than those given the placebo.

Levine hypothesised on this basis that placebo pain relief is mediated by endorphin release, but as Skrabanek pointed out later, they did not test their hypothesis by actually measuring endorphin levels, and in any case the results were exactly what might be expected if the naloxone were acting as a placebo itself. The paper was also severely criticised by Korczyn, but nevertheless it continues to be quoted quite extensively as “demonstrating” that pain relief by placebos is mediated by endorphins, a claim, incidentally, that is also made for pain relief by acupuncture.

We simply do not know why about thirty percent of patients experience relief of symptoms when given a therapy that cannot be expected to have any effect. In a sense, the history of medicine up to about 1950 is largely the history of placebos. We may find it amusing to look at some of the truths of yesterday which are the falsehoods of today, like the fashion for enemata in eighteenth and nineteenth century France. Sometimes enemata even of tobacco smoke were administered, and while we cannot feel entirely confident that the Tobacco Institute would disapprove of this, we can feel sure that many of our present day medical practices will appear stupid and ignorant to our great grand-children.

For the last forty five years we have had the means to set a limit to our errors, and yet colleagues tend to set store by anecdotes and case series which are in truth little better than a succession of anecdotes. The results of poorly designed case control studies continue to be accepted without proper caution. If physics is the queen of the sciences, then the randomised double blind placebo controlled study is the queen of medical investigation, though for events that occur relatively rarely, cohort studies and case control studies are inevitable second and third best choices.

People, including I am sad to say, doctors, have said to me “What does it matter whether a treatment is a placebo or not as long as it works? Surely the thing is to cure the patient and when you cannot cure, to comfort.” I can certainly agree with the aim, but not that it does not matter how we do it. If we do not make sure of the truth then we shall not be able to separate the wheat of science from the chaff of falsehood, and as Berthold Brecht put it, the aim of science is not to open a door to infinite wisdom, but to set a limit to infinite error.

Magic Medicine Turns Businessman into Sex Zombie

Magic potions made from natural ingredients are generally hailed as environmentally friendly. But is this necessarily true? Not if you’re a rhinocerous!

Rhino horn is highly valued for its alleged power as an aphrodisiac and can sell for up to three times the price of gold.

In 1968 there were 18,000 rhinos cantering playfully on the plains of Kenya; now there are 400. Organic horn harvesters have hunted the rhino to virtual extinction. But hey, there are culturally sensitive traditions to uphold… not to mention the oldest tradition of them all — wrangling money from the gullible.

TVNZ Newsman Writes Book!

The TVNZ fortnightly newsletter, Networks, recently carried the welcome news that a Senior Editor in TVNZ’s news division has written a book. The Astrologer and the Paradigm Shift will, according to Networks “clear up many common misconceptions about astrology.”

According to the author of the book, “Astrology is loosely grouped with modern New Age beliefs but it is in fact an ancient philosophical tradition out of which modern science arose.”

The newsman, a physics graduate, gave up his intention to pursue a scientific career when he found “physics didn’t address the connection between the human being and the environment, so was too divorced from reality.”

His book is 468 pages long. When asked how his colleagues felt about having the author of a book in their midst, he said that some of them didn’t know how to handle it, “although lots are intuitively sympathetic to where I’m coming from. I’ve done chart readings for several people” at TVNZ.

As is so often obvious, TVNZ news has no qualified specialist science or medical reporters. (In the recent flap over their carcinogenic potential, cellphones were in one TVNZ report repeatedly referred to as “radioactive.”) Nevertheless, it is heartening to learn that it now has a qualified astrologer to cast horoscopes for the staff.

Video Library Update – New Titles, July 1992

A CSICOP video library is run by Alastair Bricknell, RD2 Kuaotunu, Whitianga. Tapes may be hired for the cost of postage and packing, around $5 (extra donations gratefully accepted).

Homeopathy — Medicine or Magic?, QED (BBC TV), 1990, 30 minutes

A very interesting look at the state of homeopathy in the UK in the ’90s including its use by some “conventional” doctors and vets. Details are given of a few trials (some double and triple blind) that have been conducted claiming to give support to homeopathic techniques. Unfortunately, relatively little time is permitted for dissenting views and I am sure many of our rural members will have other explanations for some of the “miraculous” animal cures presented. A thought provoking programme nevertheless; it should be essential viewing for any skeptic confronting homeopathic enthusiasts.

Secrets of Sedona, 48 Hours (CBS), 1991, 60 minutes

A visit to Sedona, Arizona, a centre for “New Age” thinking(?) in the US. Topics covered include fire walking, astrology, UFOs, vortexes (vortices?), pendulums, channelling, reincarnation, and New Age music — surely there is something for every skeptic in this one. The programme shows how some successful businessmen and women use New Age techniques to influence their business decisions and the industry that has built up around this philosophy in a beautiful part of the American west. A good balanced look at a phenomenon that is starting to become increasingly popular in New Zealand,

Spiritual Healing, Foreign Correspondent (TVNZ), 1992, 15 minutes

A brief but interesting and relatively balanced look at the healing scene in the UK. Topics covered include New Age healing methods, “Touch for Health” healing (some skeptics might say “Clutch for Wealth” would be more appropriate), the charismatic Christian movement, and several other alternative medical practices. A revealing discussion with a conventional medical practitioner illustrates the tragic consequences that can arise for those relying on these fringe methods while cancers continue to grow.

Chelation Therapy, Frontline (TVNZ), 1992, 15 minutes

A good introduction to chelation therapy as practised in New Zealand at present. Discusses the double blind trial currently underway in Dunedin that is due to end in a few months. Sensible comments from conventional medical practitioners about the merits of this controversial therapy provide some balance to this interesting program.

Acupuncture Exchange

In the medical magazine Patient Management, Denis Dutton last year presented a tongue-in-cheek account of how GPs might incorporate alternative techniques into their practices. The article generated an interesting exchange.

Dr Denis Dutton’s original article in the March edition (“Increasing Your Income While Appeasing Your Patients”, pp. 9-11), and his more recent reply to Dr Campbell’s letter in the June edition (“One rule for Orthodoxy, Another for the Rest of Us”, p. 7) raise several interesting issues.

Our society comprises Western-trained doctors who study and practise acupuncture. For many of us, enthusiasm was first sparked by noticing the beneficial effects of acupuncture in the clinical setting. Most of our members are experienced clinicians and in their opinion, the effects of acupuncture amount to more than the sum of willing, motivated doctors enhancing a placebo response.

Many have been motivated to study the philosophies and pathophysiology of Eastern medicine, in particular traditional Chinese medicine. The collection of clinical material has been meticulously recorded by the Chinese for centuries, but it is only in the last 15 years that textbooks have been available to us, showing the logic and complexity of this study of medicine.

The marriage of Eastern and Western medicines is an exciting and vital factor in many parts of the world. The double-blind crossover trial, which all doctors would agree has been a cornerstone for the development of safe, effective Western medicine, is, however, an inappropriate measure of acupuncture. The reasond for this become obvious when Western doctors study the basics of acupuncture. The observations of the Chinese seem to fit in with modern advances in biophysics and it is ultimately the advancement of these basic sciences which will make the who subject more understandable to non- clinicians like Denis Dutton.

By reacting to acupuncture and claiming Chinese medicine is based on primitive and fanciful concepts, the American NCAHF exposes itself as being either unaware of the complexities of the subject, or worse still, threatened by them.

The medical profession, if it is to continue to earn the respect of the public, should study both Western and Eastern medicine with open minds.

Only then can valued judgements be made.

Dr Robin Kelly, President, Medical Acupunture Society (NZ)

Dr Dutton’s Reply

According to Dr Kelly, modern advances in biophysics will make acupuncture finally understandable to stubbornly sceptical non- clinicians like me. Wrong: the mechanism of the treatment is not the issue. I don’t know how Panadeine works, but I accept that it does. It is not the failure of acupuncture’s supporters to demonstrate an intelligible mechanism that is in question, but the straightforward clinical claims made on its behalf. The history of medicine is littered with episodes of “willing, motivated doctors enhancing a placebo response”. There need be nothing the least bit stupid or venal about this; in their eagerness to help their patients, an intelligent doctor can develop a sincere faith in an ineffective treatment modality. Blind testing routines are our best defence agaist this possibility.

On the subject of mechanism, it is worth remarking that I am aware of two local medical practitioners who were trained in acupuncture (one in Beijing, the other in Auckland) and who have used it extensively. Becoming increasingly suspicious, both of these practitioners had the idea of intentionally placing their needles at the wrong points, according to the Chinese charts (which don’t all agree with one another, incidentally). They found no difference in the perceived effect. One of these doctors has stopped using acupuncture, and the other continues to use it in the opinion that it is the time and attention he is giving the patient that produces the benefit, rather than a psychological effect of turning the patient into a pin-cushion.

Claim and counter-claim about the clinical effectiveness of acupuncture is all fair enough, and I hope doctors interested in these issues will consult both sides of the debate [start with P. Skrabanek, Lancet 1: 1169-1171, 1984; Irish Med J 79(12): 334-335, 1986]. What I find deeply disturbing is that Dr Kelly would claim that blind trials, though they are a cornerstone of safe, effective Western medicine, are “an inappropriate measure of acupuncture”.

This is a claim frequently made on behalf of alternative treatments and I believe it should be regarded with the utmost contempt. When a patient asks about the symptoms that might be alleviated by acupuncture, a definite answer is forthcoming; no one ever says “Oh, we have no idea what symptoms acupuncture is good for”. When the patient asks how much it costs, again a definite answer is immediately ascertainable. But in the present case, when we further ask if the modality has been shown through blind testing to be clinically effective, we’re told by the President of the Medical Acupuncture Society of New Zealand that this would be inappropriate. Not that it hasn’t been done, or that the results have been in his view indecisive, but that it would be inappropriate. Why? His society’s members deem acupuncture appropriate for the patient’s symptoms, which are demonstrably real. Real money is deemed appropriate for the demonstrably real account the doctor sends out. Why shouldn’t the paying patient demand that her treatment be just as real, as demonstrated by scientific tests? How can anything else be “appropriate” except the magic question: is acupuncture clinically effective beyond the usual placebo responses?

The “exciting and vital” marriage Dr Kelly describes looks to me like one in which Western medicine has taken Eastern superstition as a mail-order bride.

Dr Denis Dutton, School of Fine Arts, University of Canterbury

Forum

Confronting Creationism

The article on creationism by Barend Vlaardingerbroek (Skeptic 24) contains much with which I would agree, but there are also several points that could be contested.

The mainstream christian churches as allies? Census figures suggest that in NZ their membership is declining so fast that support would be limited. In America in the past they have been useful allies (at the Scopes trial in particular) but most of their rapidly ageing congregations have little interest in creationism and even less in biblical scholarship.

“If we live in a secular democracy…” Barend Vlaardingerbroek seems to assume that we do, but this is one of the points that creationists dispute. If we do not want our democracy to become less secular we will have to fight for it.

Writing articles in academic journals may indeed be preaching to the converted, but combating creationist propaganda in the media is essential. If lies are repeated often enough without any protest people will start to believe them.

Contrary to Barend Vlaardingerbroek’s view, there is an excellent case for attacking creationists through their religious beliefs, for this is their weakest point. Creationists, one should note, say as little as possible about creationism. Nearly all of their diatribe is an attempt to ridicule evolution. While it is necessary to point out their major distortions of science, our best strategy is to go on the attack and ridicule creationism.

A person who claims to believe that the biblical account of creation is infallibly true, when the first two chapters of Genesis contain two separate and contradictory accounts, has got to be on shaky ground. Pointing this out will sway the public towards skepticism more than any defense of evolution.

Nor does one have to be qualified in the area of biblical scholarship to take this approach, although obviously some reading is required. For an introduction to the first five chapters of Genesis, may I recommend Isaac Asimov’s In the Beginning.

It is always vital not to underestimate one’s opponents, but in the case of creationists it is easy to overestimate their knowledge of the bible. An overseas creationist on a New Zealand tour accidentally revealed in debate that he did not know the Old Testament had been written in Hebrew. The audience responded with scornful laughter, much to his discomfort. Does this story sound too much for good skeptics? I assure you I have witnesses.

Barend Vlaardingerbroek seems to assert the old proposition that one should not scoff at religion. But why not? The best weapon against ridiculous belief is ridicule, and there is excellent evidence to show that this is excellent PR. People enjoy being made to laugh.

Robert Ingersoll in nineteenth century America used this approach to attack the views nominally held by the majority of its citizens and he was enormously successful. He became both affluent and politically influential. Although described as the most hated man in the country, he was extremely popular. His lectures on Some Mistakes of Moses are a superb send-up of creationism.

On the other hand, it would be a mistake to imagine that creationism will ever go away. There will always be flat-earth societies. But surely the tide turned several years ago and the creationists have long been fighting a losing battle in New Zealand? In America, their high-water mark was clearly at Little Rock on Jan 5th 1982 with the Overton judgement.

Jim Ring, Nelson

Homeopathy Works

I wish to protest the criticism of homeopathic medicine in Skeptic 25.[Skeptics Bite Watchdog]

Certainly, homeopathic medicines are just water. But what more is needed? The magical qualities of water are well documented. It cures everything! Not only is it very good for the digestive system, but — as any sports enthusiast will confirm — it is a superbly effective cure for any injury incurred on the field of play. Many is the time I have seen a player with serious injuries get up and run away with (if anything) even more agility than before, following the application of water to the injured area.

This is not just a vague impression. I have spent thousands of hours in front of the television in dedicated study of this phenomenon, and I have managed to establish this as scientific fact in the same exhaustive fashion as the esteemed Consumer magazine: I have found another person who believes in this treatment.

My friend Mike not only studies the Water Cure Phenomenon on television, but also drinks large quantities of liquids containing water while engaged in his scientific studies. He claims that he feels happier and more confident after consuming these water bearing fluids, and that’s hardly surprising.

He insists that on one occasion he even saw water used to successfully solve a problem involving decapitation. Bloody Australians!

I can’t help wondering why Syd Eru, the Rugby League player (Skeptic 25), did not simply cure his broken wrist with water at the time of the injury. He could have finished that game. Still, I think his case provides solid proof of the value of faith healing.

While the medical “profession” sneeringly suggested he would be out of action for six weeks, the faith healer’s involvement enabled him to take the field for the New Zealand Maori side on October 17th, only five weeks and six days after his wrist was broken.

Grant Gillatt, Lower Hutt

A Challenge

Being a priest in a Christian church, and a confirmed Skeptic (a situation I enjoy so much I don’t attempt to resolve it), I am fascinated by Carl Wyant’s article “Angelic Sexism and the Politically Correct” [Skeptic 25].

As far as I can see, it would be a great advantage all round if the Skeptics did show an interest in religion and big-time superstition.

Mind you, it may be difficult to express this in an informed manner. I found it difficult to recognise familiar territory in Carl Wyant’s article, and there may not be many readers of the Skeptic who are up to date with the latest religious trends. But who could not but profit from the refreshing effects of reasonable doubt?

However much the contrary might be wished, religion is very much part of New Zealand society, and is a deep-rooted and powerful force amongst us. Nothing so significant should be beyond investigation, or be regarded as untestable.

I devoutly and piously hope that you will see your way to permitting investigation and debate on these absorbing issues.

Leicester Kyle, Vicarage, Kerikeri

When Faith-Healing Works

Sometimes feeling better isn’t a good sign at all… Carl Wyant recalls an occasion when faith healing showed itself better at handling symptoms than causes.

The following story is true; the names have been changed to protect the lame-brained. It’s not a terribly dramatic story of its type — that is, no one died — but it illustrates an important point. Over the years I have found, as a general rule of thumb, that most “natural healers” know hardly anything about the human body.

Once upon a time there was an attractive, young married couple, Jack and Jill, and Jack’s mother, a charming, vivacious 50-ish woman, with a growing reputation as a “spiritual healer.” I was deep into my Zen phase at the time, and too caught-up in the mysteries of the void and the unfathomable wisdom of one hand clapping to remember every last detail of the case, but here’s the basic gist.

Stomach Ache

Jack and Jill were around at our place, when late in the day Jill began to complain of a bad lower stomach pain. Being an occasional pancreatitis sufferer, I tend to take bad stomach pains seriously, so I suggested she see a doctor. But of course, being budding New Agers, they said, “we’ll see what mom says”; which is what I figured they’d say. I forgot about it.

When I saw Jack a couple of days later I asked him how Jill was. “She’s fine,” he said. “She had a few sessions with mom and it just went away. Tension, apparently, from a block in her sexual energies.”

Jack’s mom specialised in blockages of the “life airs” or vapours, ethers, chi, or whatever term is popular at the time. She was able to determine where these alleged blockages were by studying the client’s aura and then healed them by focusing her energy on the trouble spots.

Admittedly, I’m not a doctor, but somehow the kind of pain Jill had been describing, to my uncultured, insensitive, skeptical ear at least, didn’t sound like an everyday, run-of-the-mill type of pain, and for a minute I was almost disappointed that my more fearful diagnosis was so far off the mark.

More Than a Stomach Ache

Some days later I was informed that Jill was in the hospital recuperating from an operation to remove a burst appendix. Jack’s mom had miraculously stopped the pain sure enough, but not the progression of the appendicitis.

One would think that if a person was genuinely interested in healing people they would endeavour to learn as much about the body and its problems as possible. But most occult and natural healers don’t do this. For them, the main premise of New Age healing is that modern western science is all hogwash because it lacks the “spiritual” dimension. It’s not worth knowing.

This “no need to know” theme is a common one among paranormalists. Indeed, most religions would burn every book on Earth right now if they had the chance. Throughout history, religions have always hit the libraries.

It would behoove us to remember that despite the alleged “spiritual” dimension, the body is still a machine of sorts, and just as we take our cars to people who know a lot about cars, rather than, say, windmill systems, we should take our bodies to people who know a lot about bodies rather than, say, ritualistic superstition and fairytales.

Luckily there are people available who do try and find out as much as they can about the body; they’re called doctors.

Hokum Locum

More on Chronic Fatigue Syndrome

An American study reported in the GP Weekly (2 Sep 1992) found that chronic fatigue syndrome was indistinguishable from depressive disorders. (Refer also Skeptic 21) Patients diagnosed as having CFS were likely to believe that their illness had a viral cause, but it is more likely that CFS is a new age variant of the 19th century neurasthenia.1

A large study reported in the BMJ is worth looking at in detail. 200 patients with CFS were studied. Many of the patients had tried alternative therapies which were “not helpful,” namely diets (27%), homeopathy (20%), hypnosis (5%). This has been confirmed in NZ by Murdoch, writing in the NZ Family Physician (Autumn 1992).

Again, most patients believed that their illness was caused by a virus and the study found that most patients had an emotional disorder. Despite this, most patients had recovered after two years and this outcome is also confirmed by Murdoch in an unpublished survey of New Zealanders with CFS. At all stages in the illness, “functional impairment was associated with several patient factors, including belief in a viral cause, leaving or changing employment, coping with illness by avoidance of exercise and alcohol, membership of a patient organisation, and emotional disorder.” The authors acknowledge that these factors may reflect a more severe illness and call for more prospective studies.

Despite the high incidence of emotional disorder, very few of the patients had been referred to a psychiatric outpatient clinic.

Despite the considerable evidence against an infectious cause of CFS, an Australian doctor has been treating patients with intravenous gamma globulin2 in what is described as a placebo controlled trial. Unfortunately, no reference is given to the trial and until I can get these details I will have to reserve judgement. Watch this space!

Clearly patients resist the suggestion that chronic fatigue has a psychological basis, and unfortunately some members of the medical profession continue to foster this belief. Of concern is the activity of quacks touting EAV, homeopathy, anti-candida diets and other useless nostrums. Patients should not be allowed DSW benefits unless they have willingly cooperated with a program of cognitive based psychotherapy.

References:

1. Chronic Fatigue Syndrome. American Family Physician March 1992 p1205.
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2. Acceptance and treatment of CFS is improving. NZ Doctor International Oct 1st 1992.
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Follow up of patients presenting with fatigue to an infectious diseases clinic. British Medical Journal July 18th 1992 (also reported in New Zealand Medical Journal Sep 9th 1992, p366)

Chronic fatigue syndrome. The Lancet May 30th 1992, p1349

Psychiatric diagnosis and CFS link. GP Weekly Sep 2nd 1992

Fake GP

I was only mildly surprised to read in the BMJ (June 27th 1992, p1652) that a doctor with no medical qualifications had worked for 30 years as a general practitioner. All that is required to be a successful GP is the ability to listen sympathetically to patients. This is more effective than the millions of dollars wasted on drugs such as tranquilisers and antidepressants.

It took some time before the local chemists became suspicious and I quote one of them:

“If one 5 ml spoonful of hair shampoo is to be taken three times a day you tend to think there is something wrong. Time and time again there were inhalers to be injected, tablets to be rubbed in — all very unusual.”

Unfortunately no information was given as to whether any patients had been harmed and, conversely nothing from grateful patients. How on earth did he last 30 years before being exposed? I conclude that he must have been helping enough of his patients to forestall complaints about his eccentric prescribing. The English have a reputation for eccentricity and they certainly must have indulged themselves with this doctor!

Fishy Tale?

In a tribute to anthropomorphism, a Dr Motha will be birthing mothers in the company of dolphins who can “make ultrasonic communications with the fetuses.” All becomes clear when we are told that Dr Motha runs an alternative medicine clinic “including aromatherapy and reflexology.”

Personally I have always thought that dolphin intelligence was over rated since reading Restaurant at the End of the Universe when, at the end of the world, dolphin squeaks were translated as “goodbye and thanks for all the fish.”
GP Weekly August 19th 1992

Fringe Medicine and the Medical Practitioner

The New Zealand Medical Council normally does not involve itself in criticising unorthodox treatments unless the patient suffers harm. Doctors practising quackery are protected by a clause in Section 58, subsection 4 (2) of the medical registration legislation, which states: “no person shall be guilty of infamous conduct merely because of the adoption and practice of any theory of medicine or surgery if in doing so he has acted honestly and in good faith.” I find this statement disappointing, because a medical degree surely implies a knowledge and acceptance of scientific principles.

This clause has been dropped from the same legislation in Australia, Britain and Canada. However, the Medical Council has made it quite clear that quack doctors have to satisfy the doctrine of informed consent by fully briefing their patients “that these treatments are not part of conventional medicine and hence he or she is not practising as a registered medical practitioner in providing these therapies.” The medical registration authorities in Ontario, Canada obtained a change in their act which allowed them to ban such unproven remedies as amnion implants and chelation therapy. They also erased from the register a doctor who combined pendulum dowsing with a form of vega testing. I look forward to similarly robust attitudes towards dealing with quackery by our own authorities.

Having enjoyed the study of general science, I am amazed at the capacity of some doctors to believe in quackery. As H. L. Mencken said, “How is it possible for a human brain to be divided into two insulated halves, one functioning normally, naturally, and even brilliantly, and the other capable of ghastly balderdash?” The reference quoted below is well worth reading.

Unorthodoxy and the Registered Medical Practitioner. David Cole. Patient Management Vol 21 No 9.

Irlen Lenses

In Skeptic 22 I criticised the promotion of Irlen lenses in New Zealand and called these a quack remedy. Since then I have been criticised by Matthew Hobbs (Skeptic 24 — nice to have some feedback) on the grounds that it remains to be seen whether these lenses are a proven remedy for reading difficulties such as scotopic sensitivity.

My use of quack in this context is straight from the Concise English Dictionary: “one who offers wonderful remedies or devices.” Firstly, there is no evidence of the existence of the condition “scotopic sensitivity” and secondly, as the coloured lenses have not been tested they should not be used, as efficacy has not been established.

An article in the Marlborough Express (Sep 24th 1992) outlined how a 10 year old with reading difficulties was fitted with coloured plastic lenses. After six months his reading had improved 100 percent. What alternative explanation is there for this improvement, and how was the improvement measured? It is most likely that his reading disorder was related to aberrant conditioning. The more his parents expressed concern, the more reinforcement was given to the “poor reading.” The coloured lenses are a placebo associated with a change in management which, along with the passage of time, has lead to an improvement in his reading.

Faith Healing

Dr Keith Davidson kindly informed me of the source of the quote mentioned in Skeptic 24 “Every day in every way, I’m getting better and better.” It came from someone called Emile Cove. Keith also sent me a cutting from the Christchurch Press detailing the activities of an American faith-healer by the name of Morris Cerullo.

The article demonstrates the obscene side of evangelical fervor. People were warned “Cynicism will sour you, bring cancer to you, and disable you.” The audience revelled in an atmosphere of mass hysteria and were told by an expert on “biblical economics” that there was no pressure to give money but the amount given would determine how far God would move towards miracles! The cartoon that came with the article is great. It shows Cerullo gesticulating while his shadow is the outline of a devil.

The evidence for faith healing is not good. As most deluded beliefs rest on faith, and faith is not amenable to testing, it is unlikely that testing will ever be done. In fact believers are on record as saying that testing claims of faith healing would be disrespectful to God.

Skeptics and Consumerism

Members of the NZ Skeptics have enjoyed some media exposure lately. Denis Dutton has been conducting a vigorous rebuttal of acupuncture beliefs (Patient Management, September 1992) and Vicki Hyde is “Eyeing Alternative Medicine” in the August edition of the NZ Science Monthly.

Consumer magazine were so unhappy with our criticisms of their alternative medicine story that they came out fighting and awarded us with a magnifying glass. I have used it in vain to re-examine their original article, but I have not changed my mind about its feeble journalism. Consumer journalists should read NZSM to see how their story should have been treated.

A new development is Maori medicine, or rongoa, (NZ Doctor, August 20th 1992) Given reasons for its use by Maori are an inability to pay for prescriptions and a belief that rongoa can provide something that western medicine cannot. The Bay of Plenty Area Health Board has provided $15,000 for traditional Maori remedies, such as red matipo to purify the blood and para blue gum for asthma. These treatments are administered in an atmosphere of “love and kindness.”

I doubt whether any of these remedies will ever be subjected to a clinical trial, because such treatments have to have some kind of rational basis to start with, and any results are clearly explained by the very powerful and under-rated placebo effect. At a time when Maori health has never been worse (e.g. smoking-related disease) I find it incredible that an AHB can waste money on this nonsense.

Homeopathy

After our little tiff with Consumer magazine, I wrote to the School of Pharmacy in Dunedin to ask whether they would consider doing some tests of homeopathic solutions. Peter Hayes (Lecturer) kindly replied to my letter and enclosed a copy of a paper entitled “A case for homeopathy” written by a Scottish pharmacist, Dr Steven Kayne.

It is fascinating to read the intellectual rationalisations used by otherwise intelligent people in order to indulge their deluded beliefs.

Kayne concedes that increasing dilutions leave no discernible molecules in solution and then goes on to say “chemical analysis is therefore inappropriate”!!!

He further concedes that he cannot explain the mechanism of action but goes on to say “it is extremely difficult not to be impressed when one sees therapeutic efficacy clearly demonstrated.”

Evidently he discounts the placebo effect and refers to “published work in human and veterinary environments.” None of the references quoted support these claims. Furthermore, he says “It is inconceivable that consumers would continue to buy these [homeopathic] products if it was all a giant confidence trick.” He obviously needs to have a chat to some of our skeptical psychologists.

Finally, he refers to the enormous volume of circumstantial evidence “that the remedies actually work — patients do get better.” This is called the “Bellman’s fallacy” — because something has been said many times it must be true. His last word is “homeopathy should be available because patients want it, because it is safe and because it works.”

The Dean of the Pharmacy School also wrote and pointed out “because of patients’ belief in complementary medicine, I doubt that even if we were to show that they were purchasing pure water, it would cause any change in attitudes.”

I am forced to agree with him, but I could not help wondering what would happen if I started selling pure water labeled as various homeopathic remedies. I could make a fortune and it would be difficult to be prosecuted for fraud. Anybody want to go into business?

Open-mindedness

The same day that I was writing all this, I received an article from Bernard Howard written by one of my favourite skeptics, Petr Skrabanek. One of his best articles on the philosophy of skepticism is “Demarcation of the Absurd,” The Lancet April 26th 1986, in which he argues that it is possible to be too open minded.

Briefly, he argues that we need a demarcation of the absurd so that we don’t bother spending our whole lives on the look-out for flying pigs. Instead, we accept that the probability is so low that we don’t waste our time either looking or testing for airborne swine.

The article that Bernard sent is called “Why we must keep the lid on the black magic box” (Healthwatch Newsletter Summer 1992) and in it Skrabanek argues that testing of irrational beliefs can give them spurious respectability and “no amount of testing will convince a believer that he is mistaken.” Skrabanek also reviews the development of “black-box” quackery, which I have already mentioned can be practised in NZ with impunity due to our feeble medical registration legislation.

That reminds me of a television program on water divining where James Randi tested the top water diviners in Australia. None of them detected water flowing through one of ten pipes any better than chance. At the conclusion of the experiment he asked them about their beliefs which were totally unshaken!

Dr Jim Woolnough

The New Zealand Skeptics lost one of its founders with the recent death of Dr Jim Woolnough, aged 77.

Jim was not only a passionate Skeptic, but a courageous fighter for the rights of New Zealand women to obtain safe, legal abortions. He was indicted in 1974 for performing abortions for the Auckland Medical Aid Centre; his acquittal on appeal in 1975 resulted in the Contraception, Sterilisation and Abortion Act of 1977, which made abortion legal in most cases.

Jim will be missed.