Hokum Locum

Money well spent?

Tim Hume (Sunday Star Times June 21) has written a good account of traditional Maori Medicine (Rongoa Maori). The Health Ministry provides $1.9 million annually for this nonsense. That money would pay for approximately 1000 hip replacements.

One woman is described as taking her “traveling medicine show” overseas. It has all the elements of quackery – the laying on of hands, mysterious signs, mysticism and spiritualism. Her grandson is described as already showing the healing gifts.

Maori curses (makutu) are no problem. These can be cured, even remotely. We are told that the spiritual healer performed a “remote cleansing” in America but knocked over a chair while leaving the room. Tim Hume comments: “statements like this … tend to invite disbelief, if not ridicule”. And so they should!

One of these practitioners was recently convicted of “sexually assaulting two women with potatoes”. Why potatoes? I thought carrots or a cucumber would have been more useful. He had diagnosed a woman as having both breast cancer and liver disease. She had neither. He claimed to be able to detect abuse by smelling the patient. Unfortunately for him, the patient smelled a rat. Still, smelling the patient makes as much sense as recovered memory.

Rongoa can even cure orthopaedic conditions such as one leg shorter than the other (the leg pull?).

A woman who had failed to achieve pregnancy after one year went for treatment that involved deep massage “dislodging afterbirth remaining from her first pregnancy”. The only way quacks can flourish is when people are ignorant and gullible. The cure is education and an appropriate degree of scepticism starting during early education.

Tim Hume is right on target when he comments: “it sounds like the placebo effect dressed up in cultural justifications.”

At a time when Maori are afflicted with diabetes, obesity, hypertension and renal failure, Rongoa Maori is a colossal waste of money. Anyone daring to criticise it will of course be labeled as a racist.

Deadly allergy treatments

A Dublin man died while receiving treatment for peanut allergy from a kinesiologist. The kinesiologist was using an elimination technique called muscle testing. This is total quackery and I know of at least one NZ doctor who was struck off for harming patients while using this technique. The perpetrator in the Irish case is described as “Dr Brett Stevens”. I was unable to find any such registered doctor of that name on the Irish Medical Register so I can only conclude that this is yet another example of pretentious quacks giving themselves airs.

While I was doing an acupuncture course I saw a demonstration of this nonsense, not realising at the time exactly what was going on. I certainly recognised it as nonsense and I have written before about how astounded I was at the credulity of the other doctors present. Briefly, a patient was presented allegedly suffering from an allergy to tomatoes. While the patient pinched his index finger and thumb together the examiner tried to separate them (the muscle testing, sometimes called bidigital O ring testing) demonstrating a baseline measure of strength. When the patient held a tomato the examiner showed how the pinch grip was weaker. There is absolutely no scientific basis for this absurd test which is totally subjective. There are still quacks using it in New Zealand as well as some doctors but they keep pretty quiet about it for obvious reasons. If I heard of any registered medical practitioner using this test I would not hesitate to report them to the Medical Council.

The unfortunate Irishman collapsed and died on the way to the hospital. The coroner expressed concern but instead of denouncing the quack treatment he “called for re-evaluation of the allergy elimination technique.” This technique doesn’t need re-evaluation, it needs condemnation and the kinesiologist should have been prosecuted for manslaughter.

Allergy Today, Winter 2009

Acupuncture flunks again A trial subjected randomised chronic back pain sufferers to either sham acupuncture, normal care or real acupuncture. Sham acupuncture was administered using toothpicks concealed inside guide tubes. The two acupuncture groups did equally well and significantly better than the normal care group. The improvement gradually waned over a year.

ACC has also examined acupuncture in the context of acute back pain and any effect is short-lived and soon disappears.

It is unclear whether the chronic back pain group showed any functional improvement since the measurements of improvement were all subjective. For example, did large numbers return to work? This is the true test of a treatment, whether it is clinically important rather than just showing some statistical improvement.

What this trial essentially shows is that gimmick + fake gimmick is superior to normal care. What needs to be done next is the same trial using laser acupuncture. The same patients are randomised to normal care, laser acupuncture and (blinded) laser simulated acupuncture. Whilst not given to divination I will modestly predict the results of such an experiment. Both treatment groups will show the same degree of improvement which will be superior to normal care. Just to add a twist, you could add a fourth group being treated by some really motivational and enthusiastic physiotherapists. This of course enhances the placebo effect and could just close the gap between the “normal care” and the two active treatment groups.

Arch Intern Med. 2009; 169(9): 858-866.

And again I was at a conference recently and was alerted to a trial published in the BMJ that allegedly showed that acupuncture led to improved outcomes during IVF therapy for childless couples. In other words, an improved pregnancy rate. This is a load of rubbish and I recommend you look up the article and in particular read the rapid responses. The best one was from Edzard Ernst and after reading it I recalled something I had read in his book Healing, Hype or Harm. Sure enough, it was in a commentary by James Randi who was commenting on scientific misbehaviour around a published article purporting to show improved pregnancy rates for IVF patients who were subjected to prayer from total strangers from around the world. These results were a fraud.

I am not claiming that the BMJ paper is a fraud. It is simply absurd and should be treated in the same way as a paper purporting to show a beneficial effect from homeopathy. As a skeptic you simply think along the following lines: Is it more likely that this is a true effect or more likely to be a mistake or even fraud? A more crude response on this paper would be “bullshit baffles brains”.

Skrabanek has a good take on this as well: Extraordinary claims require extraordinary evidence, and randomised clinical trials, applied to absurd claims, are more likely to mislead than illuminate.

BMJ, doi: 10.1136/bmj. 39471.430451.BE (Published 7 February 2008). Skranabek P. Demarcation of the absurd. Health Watch Newsletter (5) 1990, 7.

Hokum Locum

Bogus chiropractor?

I thought they were all bogus! A Motueka man, Michael Dawson, was fined $4000 for describing himself as a chiropractor. This upset Nelson chiropractor Dr John Dawson who was quoted as saying his “unrelated namesake tainted the industry.” Quite apart from Dr Dawson’s pretentious use of the title ‘Dr’, his description of chiropractic as an industry is particularly apt. It is a massage business based on aggressive marketing and creating a non-existent need for gullible people to have their backs rubbed and clicked.

‘Dr’ Dawson was further quoted: “I’m sure there are a few people out there who have written off chiropractors because of him.” One can only hope.

It’s ironic that Michael Dawson was prosecuted by the Ministry of Health, a body supposedly watching over the health system and now seen to be protecting quacks by picking on unregistered quacks. Michael Dawson claims to be able to cure Hepatitis C and wake people from comas. These are claims that can readily be checked and will prove to be false, like most chiropractic claims.

ACC is currently experiencing budget woes and a great deal of this relates to treatment costs. Chiropractors favour prolonged and expensive treatments which have contributed to this problem. A recent study of back pain found conclusively that chiropractic manipulation was of no benefit (www.medscape.com/viewarticle/580409). This is consistent with earlier findings of the Cochrane Database.

I discovered another reference to an article in the Nelson Evening Mail which confirmed Michael Dawson did in fact have a chiropractic qualification but had failed to gain registration in New Zealand. This registration process is a farce and merely gives spurious respectability to an absurd belief system.

Consider the following; a patient goes to a chiropractor and receives a diagnosis of cervical spine subluxations for which manipulation is administered. The patient suffers an injury to arteries in the neck and has a stroke. The Health and Disability Commissioner (HDC) investigates by asking his ‘expert’ chiropractor whether the treatment was properly administered according to chiropractic tenets. The answer is yes so does this mean the chiropractor is off the hook? The patient can file an ACC claim for treatment injury and loses the right to sue as a result. ACC picks up the tab for an unnecessary and dangerous quack treatment.

While working at the hospital the other night a young man came in with toothache. He knew he had an impacted wisdom tooth because he had been x-rayed by his chiropractor whose course of treatments had extended out to 15 weeks. That’s a lot of subluxations. In a fit of whimsy I recently labeled such extended treatments as ‘chiroprotracted’.

Marlborough Express 22 August 2008

Cosmetic Acupuncture

It appears that there is no end to the absurd claims made of acupuncture. Acupuncture face renewal is now available at Arch Hill Acupuncture. A credulous journalist visited the clinic and reported after only one treatment: “I felt – and looked – like I had spent a week in Fiji.” A complete treatment usually involves 12 visits and I would commend the journalist on the Fiji suggestion, a far better use of one’s money.

Have a browse around the website www.archhillacupuncture.co.nz It contains the usual testimonials seen on such web pages as well as some clues to the success of this particular option. The owner of the business comes across as attractive, pleasant and supportive, all of which are good qualities to elicit an excellent placebo response. As a lot of readers will know, I can teach anyone to be a competent and safe acupuncturist in the course of a one-hour lecture. There is no need for several years’ training when something has no scientific basis.

The owner is quoted as saying: “I liken cosmetic acupuncture treatment to a gardener tending the soil of a plant to produce a healthy flower.” Isn’t that what manure is for?

Sunday Star Times 26 October 2008

The loopy left?

The Labour-run Lambeth Council in South London is spending 90,000 to send reflexologists into schools to massage the feet of unruly pupils. Reflexology is based on the same nonsensical ideas behind acupuncture, that pressure applied to areas on the foot can influence health and behaviour. The article contains a very interesting and important statement linked to what I was saying earlier: “Refexology is not a regulated therapy and medical authorities have raised concerns that qualifications are not needed to perform the massages.” The medical authorities ought to be denouncing this nonsense, not wittering on about ‘regulation’. Regulation merely provides spurious recognition, similar to the ridiculous situation of having ‘unregistered chiropractors’ versus ‘registered chiropractors’.

I fear that political considerations are behind a lot of these dopey decisions. At one of our conferences somebody asked a senior ACC doctor why ACC continued to fund acupuncture when it is an expensive and useless treatment. The answer was given that whenever they tried to cut back on acupuncture spending patients complained to their MP and he would get a call from the Minister asking, “why aren’t you funding acupuncture?”

Given the financial woes of ACC, one can only hope that the new Minister instructs ACC to do something about treatment spending. There are too many snouts in the trough!

Christchurch readers interested in reflexology training will be pleased to know they can do a Diploma course (NZQA accredited level 6) at the Canterbury College of Natural Medicine.



Bruce Spittle (Forum 89) invited me to review his book entitled Fluoride Fatigue. I can report that I have read parts of it but had to stop because I became depressed. I will leave readers to make their own assessment. It is available free at www.pauapress.com

I would certainly not pay to buy this book which is a collection of anecdotal case reports and quotes from other people who share the author’s views. It is written in the style of the sort of books found in the New Age section of a bookshop or library. Here is an example:

“Neither in the hospital nor after her discharge was she given any medication. Instead, she was instructed to avoid fluoridated water strictly, not only for drinking but also for cooking her food as well. She was also told to avoid both tea and seafood because of their high fluoride content. The headaches, eye disturbances, and muscular weakness disappeared in a most dramatic manner. After about two weeks her mind began to clear, and she underwent a complete change in personality. For the first time in two years she was able to undertake her household duties without having to stop and rest. Within a four-week period she had gained five pounds.”

This is a classic description of the sort of person who gets chronic fatigue syndrome, gulf war syndrome, multiple chemical sensitivity – take your pick. A person with vague symptoms looking for some convenient attribution.

I was interested however in the link to the author’s website on moa sightings. At least the extinction of the moa can’t be blamed on fluoridation.

Apart from both words starting with ‘F’, there is no medical evidence to link fluoride with fatigue (or depression). Fatigue is common and is not a diagnosis. In a random survey of the US population in 1974-75, 14 percent of the men and 20 percent of the women said they suffered from fatigue.

The best place to read well- balanced accounts of fluoridation is a Ministry of Health web page. In contrast, a casual browse through the many anti-fluoridation web pages would make anybody justified in using the term ‘crackpot’.


I was forwarded an email from Rod who was interested in some product that shines red light up the nose for treatment of hay fever. I googled “shine red light up nose” and immediately arrived at the web page of Bionase. The product has two nasal probes that shine a red light up the nose. It was claimed that this had been scientifically tested and there was a link to an impressive looking study published in the Annals of Allergy Asthma & Immunology. A search of Medline revealed that this was the only study, described as double-blind and placebo-controlled. The paper appeared plausible but continued reading revealed a fatal flaw. Use of the probes caused the nose to light up red. The placebo device did not do this. The experiment is therefore not double-blind. Whilst not given to predictions I will say that if this trial is repeated with a proper blinding this device will be shown to be useless. It is simply biologically implausible, just like homoeopathic trials claiming to treat hay fever. As somebody once said, if any homoeopathic trail showed a beneficial effect your first action is to question the conduct and design of the trial (google Benveniste).

Hokum Locum

Poison for Profit

There is something rotten in the state of China, a country where greedy people are quite happy to poison their own citizens in the name of profit. Milk powder is assayed for protein content by detecting nitrogen levels. Melamine, being a nitrogen-rich compound, gives a return in this test which indicates for protein, so if you have a poor milk product or it has been watered down, melamine can be added to make the product look as if it is up to normal protein levels.

The Chinese have been down this path before when they used melamine in pet food and it caused similar problems with kidney stones.

They also have a history of adding effective western drugs such as Viagra and steroids to enhance useless herbal remedies.

Melamine is relatively non-toxic but is relatively insoluble so tends to precipitate out and form stones in any animal that has the ability to concentrate urine.

Some animals such as cats and dogs are at a higher risk than humans because their urine is acidic and melamine has a lower solubility in acid urine.

I recall a previous scandal in the Chinese health system where the chief culprit was convicted and immediately shot. Despite my reservations about capital punishment one is tempted to wish the same fate on the criminals who have visited so much illness and suffering on small children.

Herbal Remedies for long life?

Folk wisdom is often seen as being somehow superior to modern medicine. Inductive logic is frequently used as a justification for quaint belief, reasoning from the specific case to the general case. For example, Great Uncle Fred took arsenic every day and lived to be 100 so therefore…

A nutritionist found a book in her late mother’s attic and has used it on a website promoting folk remedies such as pepper for earache, plantain leaves for toothache and horseradish mixed with gin for premenstrual tension. (Just as an aside, do women have postmenstrual docility?)


You can even download the book, How to Live 100 Years. The nutritionist recalled her father treating her for mumps -“he put boiled onions on my neck.” This sounds remarkably like the medieval philosophy known as the doctrine of signatures where it was believed that God provided a ‘signature’ to plants as a sign for what ailments they might be useful for. An onion resembles the swelling of the neck with mumps so according to this doctrine an onion is the appropriate cure.

Marlborough Express 16 July 2008


An article in the Australian Medical Journal ( 2007; 187:337- 341) claimed to show that acupuncture was an effective treatment for allergic rhinitis. This struck me as absurd and also drew a sharp criticism from Edzard Ernst, Professor of Complementary Medicine, University of Exeter. Ernst has experience of a wide variety of modalities such as acupuncture, spinal manipulation and homeopathy. Despite what you might expect of his appointment he has proved to be something of a gadfly for those who make claims about alternative medicine.

The study had a fatal flaw as outlined by Ernst. It was supposed to be a ‘randomised sham controlled trial’ as follows. Needles were inserted into acupuncture points and stimulated when ‘chi’ was elicited. Chi is the subjective sensation associated with the needling of an acupuncture point. In the sham group needles were inserted at non-acupuncture points, where according to acupuncture theory no chi would be experienced! Ernst commented: ‘Thus the intervention patients were experiencing chi, and the control patients were not. This means that neither the patients nor the therapist were blinded.’ (just as an aside, ‘ blinding’ could have been achieved with acupuncture needles – the ‘ King Lear’ trial).

Another study I came across had the grand title ‘Laser acupuncture in children with headache: A double blind, randomized, bicentre, placebo controlled trial.’ Some years ago, when I reviewed the literature on acupuncture, I found the most poorly designed trials were the ones claiming the greatest results. A similar trial claimed to show laser stimulation of acupuncture points produced a ‘dramatic’ relief of pain in patients with rheumatoid arthritis. Some more sceptical people repeated the study and obtained the same improvement even when the laser was switched off!

Ancient Wisdom

While in Australia recently I saved an article from the Sunday Telegraph (21 September).

It claimed that the overburdened Australian Health System is causing large numbers of people to seek out traditional Chinese remedies.

According to Dr Alan Bensoussan, ‘The Chinese have linked particular signs together, connecting not only physical symptoms, such as the colour of the tongue and the quality of the pulse on the wrist, but also their predominant emotions, to make a diagnosis.’ What happens if you have a consultation straight after eating a raspberry ice block?

The article contains the usual anecdotal reports. A woman with asthma claimed that repeated courses of antibiotics had failed to cure chest infections which aggravated her asthma. She was cured by a one-week course of some unspecified herb.

The majority of chest infections in asthmatics are in fact caused by viruses so I have no argument there. As to the herb: probably as effective as powdered fox lung, a traditional English remedy for asthma.

Another person complained that he got the flu despite being immunised and taking a course of antibiotics. He now takes regular doses of herbal medicine and no longer gets the flu.

Immunisation is not 100 percent effective and as we all know antibiotics are ineffective against viruses. I wish journalists would challenge people on these issues instead of promulgating myths about antibiotics.

An example is given of the difference ( East vs West) between traditional Chinese and western medicine.

Six patients are found to have peptic ulcers and are all treated the same way by western doctors, regardless of sex, age and emotional state.

The Chinese traditional medicine practitioner however, takes into account differences in build, pulse quality, complexion, tongue colour, moods, sleeping patterns and length of nostril hairs. (No, I made that last one up). Each patient is diagnosed with a different root ( unintentional pun here) cause for their ulcer, based on their unique clinical picture.

I deliberately highlighted the last bit because this sort of treatment requirement is often quoted as a reason why such traditional treatments cannot be subjected to traditional drug trials. In order to give a patient an individual treatment they cannot by definition be randomised into a clinical trial. This often quoted as the ‘ plea for special dispensation.’ The other argument used is: ‘ we know our treatments work so there must be something wrong with your trial.’

However, I am mindful of the fact, pointed out by Professor Sir John Scott at last year’s conference, that a great deal of traditional western treatments and practices have never been put to the test. This is true but at least modern medicine is based on plausible ideas derived from scientific study of anatomy, physiology and pathology.

Chinese traditional medicine is based on highly implausible beliefs that defy logic and common sense.

Hokum Locum

Drink your way to good health

Don’t scoff. A magazine as authoritative as Woman’s Day reports a case where a woman treated her breast cancer by drinking her own urine. Following a mammogram and ultrasound examination the patient reports: “I was introduced to a surgeon who said I needed to have both my breasts removed right away.” This is complete nonsense as no surgeon would ever perform a bilateral mastectomy without a tissue sample confirming the diagnosis. It is quite clear that she never had cancer at all, but a condition colloquially known as lumpy breasts or benign fibrocystic breast disease.

Such people are a godsend for cancer quacks. There’s nothing easier than curing somebody who was never ill in the first place. In fact, that’s the whole basis of ‘alternative medicine’.

I googled the subject of urine drinking and there are a surprising number of articles on the subject. My favourite was a reference to the Koryak tribe of Siberia who used to get stoned by consuming the fly agaric toadstool, Amanita muscaria. The hallucinogens are excreted in the urine and as the account goes: “those who cannot afford the fairly high price (of the fungi) drink the urine of those who have eaten it, whereupon they become intoxicated.” (Wasson, quoted in Murder, Magic and Medicine, by John Mann)

Hyperbaric Oxygen-I don’t think so!

A local clinic offers “Hyperbaric Oxygen Therapy” at a cost of $60-$110. The pamphlet says:

“A cleanse with intraceuticals products first followed by a deep exfoliation. Oxygen Therapy applied with serums suitable to skin condition – a relaxing soothing treatment incorporating lymphathic (sic) drainage for a complete rejuvenation/brightening or reduction of fine lines. Also treats acne, rosacea, eczema and open pores-super hydrates. Complimentary home care product if a course of six treatments (weekly) booked.”

This clearly constitutes false advertising as well as an affront to grammar and spelling. Hyperbaric oxygen means oxygen under pressure and this requires either a pressurised mask or a chamber which can be pressurised. I have contacted the Commerce Commission over this false claim and I will keep you posted.

Cancer Diversions

A friend has been unlucky enough to develop bowel cancer last year and then go down with breast cancer this year. She has faced up to all of this with equanimity. Another acquaintance of mine, a doctor, has been diagnosed with a form of cancer which is likely to be terminal. This person is now on a vegetarian diet with no alcohol and is described by friends as “doing very well.”

It’s hard to imagine the fear and horror of being diagnosed with cancer. It leads to all sorts of irrational thinking, even by doctors. If I ever got cancer I would take up smoking again, use hard drugs, drink as much as I liked and indulge myself in dangerous sports. Go out with a bang, not a whimper! Such a strategy could well see cancer cells shrinking against an onslaught of nasty substances.

“Magical” thinking about cancer extends to psychological issues. An Australian study comprehensively debunked the idea that mental attitude has anything to do with beating cancer. For example, women who were preoccupied about their cancer were more likely to get a relapse. The researchers found that such women had the worst tumors-they were anxious and preoccupied for a reason! This sort of analysis is at the heart of skepticism – looking at the facts and coming up with the most likely explanation-not some horribly deprivational diet that denies people meat, wine and what little enjoyment of life they have left.

The chief executive of the Cancer Council Australia, Professor Ian Olver said that he had been involved with a smaller study with lung cancer and had reached a similar conclusion. Marlborough Express 4 June

Bogus Body Enhancer

Winston and Sylvia Gallot were ordered to pay $632,500 and $130,000 costs after being convicted of breaching the Fair Trading Act. Their weight loss product, Body Enhancer, was described by the judge as being ineffective. The High Court dismissed the quacks’ appeal but reduced the fines to $394,500.

Never mind, the couple must be laughing all the way to the bank as it was estimated that about $5 million of the product had been sold. If you google the offending product there is a wealth of material to review. I particularly enjoyed the Judge’s descriptions as follows:

“Mr Gallot was described as a man of considerable intelligence, style and charm, but he was exposed as ‘calculatedly dishonest’ and blamed everyone but himself.”

Judge Moore referred to a “succession of blatant untruths” by Mrs Gallot in trying to launch Body Enhancer in Britain.’

Marlborough Express 30 May

Another useless product

The Commerce Commission successfully prosecuted another useless product which claimed to “melt away fat and cellulite.” A judge said anyone who purchased Celluslim wasted their money.

The company had claimed that the product “had been scientifically tested by a fictitious doctor at the fictitious Saint Alto Research Centre in Switzerland.” When their useless product ran out they merely substituted honey, garlic and apple cider vinegar pills.

Marlborough Express 30 May

Amalgam again

A local dentist missed out on a health contract because of his opposition to dental amalgam. The amalgam debate has raged for decades and has parallels with the pure water crackpots who oppose fluoridation. Amalgam is a stable compound that is not ideal but it is the most cost effective agent at present. When something better comes along it will be superseded. I have a mouth full of amalgam fillings-a legacy of growing up without fluoridation. My mother gave fluoride tablets to the remaining four siblings who all have perfect teeth. People who elect to have their amalgam fillings removed expose themselves to a great deal of mercury which is released during destruction of their fillings. Those of us who sensibly live with our existing amalgam fillings can rest assured that our major mercury exposure comes from fish and chips.

Marlborough Express 25 March

Body Talk

I will have to rethink my theory that “wacky ideas are promoted by people who are bald and have beards”. After rubbishing body talk in an earlier column I was stunned to see that this ludicrous nonsense has arrived in Blenheim. Get this-straight from the reporter:

“I lie down on the consultation table and she holds my hand loosely over my stomach. A series of yes or no questions are asked and she lifts my hand in a circular motion each time, sensing resistance or acceptance of the question. It’s when she picks up on a positive response; she places my hand over my sternum and then taps me several times on the head, then taps me on my heart zone.”

The reporter accidentally stumbles across the mechanism when reporting: “It bears a resemblance to the ‘laying on of hands’ popular among some born again Christian groups.”

This whole mélange of hocus pocus is of course a placebo. It is staggering that such nonsense can gain credence and it beggars belief that a newspaper should even bother reporting it. How ridiculous does something have to be before an editor would reject it?

Saturday Express 24 May

Hokum Locum

Yet another military syndrome

I imagine that most people joining the Armed Forces would expect the likelihood of a posting to an area of conflict. I know I did. I spent six months in Iraq between the two Gulf Wars. I admit that it was stressful but it was also one of the most exciting and interesting experiences that I have ever had. But that’s another story.

It appears however, that many would prefer a safe posting at home, typing memoranda or serving tea in the mess. The only risks from these activities are RSI or perhaps a minor burn from slopping the tea. When military personnel are posted to an area of conflict this comes as a shock. Compensation is fortunately available. It appears that shell shock and post traumatic stress disorder are passé. The new ‘buzz diagnosis’ is MTBI, or ‘mild traumatic brain injury’.

The cause is blast from roadside bombs and this can lead to “memory loss, depression and anxiety”. The US has instituted a screening programme for those returning from active service and they estimate as many as 20 percent may be at risk of MTBI. The UK MOD remains skeptical and is quoted as saying: “It is a very complex area. We have no way of knowing whether (the US assessment) is accurate because there is a level of dispute as to what constitutes MTBI.” You could apply the same logic to stories of alien abduction.

Skeptics could note that the diagnosis is largely subjective but should be alarmed that therapists such as Kit Malia are poised to cash in: “If the American figures are correct, this is massive, absolutely massive.” More work for the army of counsellors.

As the saying goes, war is hell. Many returned servicemen will tell you that and they fervently wish for an end to all conflict. Instead of pursuing this aim, we continue to send young men and women to various hell-holes and wonder why they fall apart. It is hardly surprising that they choose to fall apart in culturally acceptable ways with diagnoses such as GWS, PTSD and now MTBI. Screening programmes, websites and a telephone help line will ensure that those suffering from MTBI are suitably coached into supplying the right symptoms of this disorder.

When I read about these daft syndromes, I often think of my late father who experienced combat as an infantryman in World War Two. He came home, resumed his career and the only disability he had was spinal tuberculosis, contracted in Japan while serving with the occupation forces. The only compensation was the opportunity for resuming academic studies. Perhaps we could retrospectively label this ‘mild tubercular back injury’.

Today’s military personnel are not conscripted. They have a choice. I say, take the money and accept the consequences. Let’s either call an end to absurd diagnoses such as MTBI, or have the moral courage to eschew warfare and refuse to send our men and women on such missions.

The Guardian Weekly Vol 177 No 20 p11

Sensory Processing Disorder

Some children become upset when confronted with new sounds or places. They scream and misbehave. This behaviour is set to become yet another disorder of childhood-‘Sensory Processing Disorder’. Advocates are pressing the American Psychiatric Association to include this condition in its manual of mental disorders. Sound familiar?

Therapists have already set up clinics to deal with this new ‘disease’. One such clinic is Paediatric Potentials, where children experience play therapy including a spandex cocoon that can calm them. The condition was studied in the 1960s by a psychologist who called it ‘Sensory Integration Dysfunction’.

This has all the hallmarks of a fad diagnosis. The symptoms and signs of the condition are completely subjective. The condition relies on interpreting extremes of behaviour as being pathological. Physician enthusiasts are recruited to popularise the condition. Pressure is put on the relevant authorities to endorse it. This is precisely the path that led to the diagnostic labels of PTSD and ADHD. It appears that some academics are incapable of understanding normal human behaviour.

I’m still waiting for alien abduction to follow the same pathway to recognition. It’s just as valid as Sensory Processing Disorder.

Marlborough Express 15 November 2007

Are your children reaching their full potential?

So reads the advertisement from a local pharmacy. Perhaps this is the solution to SPD? For only $20 you can get 60 capsules of ‘Clever Kids Omega 3’. This product has been designed to “help support brain development and learning ability, including concentration, memory and problem solving, and may assist in the temporary relief of mild anxiety and irritability.”

This is the perfect product for families where parents are too busy to have time to interact with their children. If anybody could be bothered to test this useless product, I predict it will have no advantage over placebo.

Ritalin Substitute

Pharmac, the Government’s drug buying agency, is constantly looking at saving money on our huge national drug bill. Ritalin (methylphenidate) has been supplanted by a cheaper generic equivalent, Rubifen, which is one million dollars a year cheaper. Methylphenidate is used in the treatment of ADHD, another fad diagnosis like SPD. Parents remain unconvinced and many are demanding a switch back to Ritalin. This is typical of placebo dependence where people become convinced that the new small yellow pill is somehow inferior to their familiar big red pill. Given that ADHD is an entirely subjective disorder it is not surprising that there is a subjective obsession over the familiar drug versus a generic equivalent.

While I’m on the subject of useless products …

Red Bull OD

An Australian man drank eight Red Bull energy drinks in five hours and suffered a cardiac arrest while competing in a motocross event. This equated to a caffeine intake of 400mg which is close to the toxicity level for an average adult. The label warned against consuming more than one to two cans or bottles of the product per day. The victim was quoted as saying he drank four Red Bull drinks per day because “With the work I do I don’t have a lot of time to eat.” On the day of his acute illness he suffered a cardiac arrest and required defibrillation. He admitted to consuming eight Red Bull drinks over a five-hour period as follows: “It was to get a bit of a buzz and keep down my reaction times.”

It is difficult to feel sympathy for such moronic behaviour. Red Bull is a useless and unnecessary product which has been successfully marketed for idiots. While I’m on this topic how about …

Cold medicines

The US Food and Drug Administration (FDA) commissioned some outside experts to advise on medicines used by parents to treat their children’s coughs and colds. The conclusion was that products such as cough suppressants do not work and may cause side effects in young children. I recall that Consumer has reported on these products and the evidence is that they are not worth the money. This is the familiar placebo effect at work.

Hokum Locum

Skull manipulation takes a lot of ‘training’

Cranial osteopathy is based on the notion that the bones of the skull can be manipulated. Even doctors have been taken in by this nonsense. The following account is by a registered medical practitioner, Dr Putative (not his real name).

The craniosacral movement is a rhythmical expansion of the skull and meninges around the cerebrospinal fluid. “It is a very subtle small amplitude excursion which is palpable with careful trained hands.” (So there, all you Skeptics: if-like me-you can’t feel it, you lack training.)

“The bones of the skull open and close rather like a flower opening to the sun.”
“It must be emphasised the movement is very subtle and can only be felt after considerable practice.”

The article goes on to claim that cranial osteopathy can successfully treat colic, a blocked nose, Bell’s palsy, and facial asymmetry in infants. I wish it could cure terminal gullibility! When doctors involve themselves with such nonsense, it always reminds me of HL Mencken’s criticism of an American gynecologist who believed in the literal truth of the story about Jonah in the belly of the whale. I can’t remember the exact words but it goes something like this: “How is it possible for the human brain to be divided into two halves? One capable of brilliant thought and the other complete balderdash!”

This quote could also apply to Dr John E Mack. (In 2004 he died after being hit by a car.) He collected a group of fantasy-prone individuals whom he gradually came to believe had been abducted by aliens. Harvard was furious; some of his colleagues started a movement, Knife the Mack, but Mack became very wealthy from his book about these patients. He basically argued that because psychiatry can’t explain such matters the accounts must be true. Wrong. It is well known that certain fantasy-prone individuals experience vivid dreams (hypnagogic) at certain stages of sleep.


This absurd nonsense has now become part of mainstream pharmacy. Commercial pressures and PHARMAC, the government drug buying agency, have squeezed profits and many pharmacies stock a wide range of unproven and ridiculous pro-ducts. One local pharmacy has a range of such items which is larger than the OTC section.

Another local pharmacy advertised it was going to have an in-store iridologist for the day. The iridologist was described as having a Bachelor Degree in Health Science. (BHSc) It is little wonder that universities continue to oppose the granting of such degrees by various polytechnic institutions.

Chinese Frauds and Dangerous Products

The Chinese are already recognised as an international threat in regard to traffic in endangered species (eg tigers and bears) as well as promoting ‘traditional products’ which are adulterated with Western drugs such as steroids and Viagra.

A Chinese-made toothpaste (Excel) was withdrawn from sale in New Zealand when it was found to contain diethylene glycol, normally found as antifreeze in the radiator of your vehicle. Hmmm, could be useful when brushing your teeth in Antarctica.

It appears that Chinese doctors can be as venal and corrupt as their herbal industry. Reporters posing as patients produced urine samples which were actually green tea. The diagnosis made was urinary infection and the prescribed treatment cost $40. One reporter re-submitted the same sample and received the same diagnosis. At least the quacks were consistent. These frauds are to be expected in a poor country where doctors are underpaid.

Some NZ Doctors perpetrate similar frauds by using ‘black box’ devices and other unproven treatments. These frauds are not to be expected in a country where doctors are both well paid and well educated!

Dominion Post 24 March
BMJ 9 June 2007 Volume 334 p1183

The Culture of Complaint

In his book, From Paralysis to Fatigue, Edward Shorter predicted that the next era of medicine would revolve around psychosomatic medicine. This also encompasses a culture of complaint which sees a whining populace avoiding responsibility for their own actions by finding someone else to blame for their misfortune.

There is a new vaccine (Gardasil) against human papilloma virus (HPV). HPV is the main risk factor for cervical cancer in women. Following vaccination at a school, about 25 girls presented to the sick bay with headache, nausea and dizziness. The media had a field day while more sensible people correctly diagnosed ‘mass sociogenic illness’ which is a polite way of saying ‘mass hysteria’. There is an excellent account online at www.crikey.com.au/Politics/20070528-Schoolgirls-have-mass-sociogenic-illness-but-Neil-Mitchell-needs-the-smelling-salts.html

There is a huge and fascinating published literature on mass hysteria. A constant feature is the rejection of this label by people involved in the incident. People do not like to accept that they have been victims of their own panic. It’s much better to believe in a mysterious vapour or poison. My favorite mass hysteria story concerned a kitchen which was evacuated due to a bad smell causing symptomatic illness. It was traced to a rotten onion in a cupboard!

In the case of the Gardasil story, the media beat-up wiped $A1 billion off the market value of the drug company.

Marlborough Express 26 April


Some time ago I roamed the internet looking for evidence supporting the efficacy of physiotherapy. I was interested in its scientific basis. I looked in vain. There are a few trials which showed certain practices were either useless or even dangerous.

I recently received a report from a specialist which included the following gem:

“I do not think that there is any specific medical contraindication to his undergoing whatever rigorous physiotherapy programme is planned for him, although by the same token I am not all that enthusiastic about physiotherapy in these situations: my opinion is that physiotherapy simply helps to pass the time and I cannot really understand what good it is meant to be doing. However…that..opinion does not sit comfortably with the ACC’s and patient’s enthusiasm for having their bodies tweaked and pummeled at great expense in the name of ‘rehabilitation’.”

The phrase “great expense” is important. There are so many treatment providers with their snouts in the ACC trough that treatment costs have become excessive. These treatment providers have developed a beneficiary mentality and whenever ACC attempts to control or restrict treatment practices there are indignant protests.

ACC reforms mean that patients can go to a treatment provider and register a claim and have treatment. If they need time off work this can only be provided by a doctor. The ‘gate keeper’ function of the doctor has been lost. I heard of two recent examples of how people can be harmed by this practice.

An osteopath gave a maximal number of treatments to a patient who was eventually diagnosed as having a complete rupture of the rotator cuff muscles of the shoulder. Osteopathic treatment is completely useless for this injury. In fact there is no published evidence showing that it works for any injury.

In the other case a 15-year-old child was treated by a physiotherapist for some time for a sore leg and was eventually diagnosed with bone cancer.

Hokum Locum

Members of the Royal Society and other eminent doctors have written to every hospital in the UK urging them not to suggest anything but evidence-based medicine to their patients (Guardian Weekly Vol 174 No 23). This was a timely reminder given that Prince Charles had just been urging the World Health Assembly to promote alternative medicine. The letter writers reminded people that alternative and complementary medicine needs to be evaluated on the same criteria as conventional medicine. This was precisely the same argument most of us took when making submissions to MACCAH.

Continue reading

Hokum Locum

Debunking debriefing

It has become a cliché that whenever something bad happens, a horde of counsellors descend on the survivors to make their lives a misery. It’s true. Counselling does make you more sick compared to doing nothing.

A child is run over and killed. Instead of teachers and parents rallying around and doing what they have done for hundreds of years, ‘professionals’ are now called in to make things worse. In a study, survivors were randomly allocated to “emotional ventilation debriefing” (whatever that is), educational debriefing or nothing and were followed up at two weeks, six weeks and six months. The only difference in outcome was that at six months the first group had significantly more emotional distress.

Not only are these forms of counselling useless they are harmful and the relevant authorities should face up to this by not inflicting it on people. People have always coped with death and disaster and feelings naturally settle with time. Ordinary people underestimate their own ability to just be there for their friends and family and support them. No fancy talk is necessary. bjp.rcpsych.org/cgi/content/abstract/189/2/150

More on Placebos

It can easily be argued that the history of complementary and alternative medicine (CAM) is intimately involved with the history of the placebo effect. The placebo effect is also intimately involved with the practice of medicine although attempts are made to control for it.

The placebo effect is poorly understood, even by doctors, and if you interview specialists they generally discount the placebo effect in their own specialty and attribute it to their colleagues in other specialties. Orthopaedic surgery is rife with placebo procedures such as arthroscopic washout of arthritic knees. At least two good trials have shown that it is worthless yet orthopaedic surgeons continue to inflict this useless procedure on their patients. I confronted one such specialist and he argued that “in my experience it makes the knee feel better.” This is the typical feeble appeal to authority which is the lowest and most contemptible form of evidence. This refusal to accept the evidence is not unusual and in the past other placebo operations have been performed for years until such time as there is a critical mass of peers crying stop.

With respect to homeopathy, there are wide variations in the results of placebo controlled trials because, as someone put it, not all placebos are equal. One wag suggested that “double strength placebos” were needed.

In an interesting study subjects were given placebo analgesia and subjected to painful stimuli. The painful stimuli were then surreptitiously reduced to make the analgesia appear even more effective. This enhanced learned response lasted up to seven days and the authors concluded that this effect “may explain the large variability of the placebo responses that is found in many studies.”

My conclusion from all of this is that my own profession fails to use the placebo effect in a positive way. It is viewed instead as a nuisance to be controlled or minimised. The CAM industry has shown no such reluctance and the placebo effect is behind most of these treatments. Perhaps this explains the public fascination with quackery?


Medical Journal of Australia Vol 179 18 Aug 2003

Pain Vol 24 Issues 1-2, Sep 2005 Pg126-133

Traditional Chinese Medicine (TCM)

Advocates of TCM argue that it cannot be evaluated by clinical trials because TCM has a different philosophical basis to western medicine. This is a typical argument known as the ‘plea for special dispensation’ and is a hallmark of quackery.

TCM evolved in China in the same manner as western medicine under the teachings of Galen. Authoritative teachings were gospel and anyone who dissented was criticised. In many respects this process has some of the features of a religion where beliefs are more important than scientific facts.

Galen solved the problem of the circulation of the blood by proposing that blood got from one side of the heart to the other through tiny pores in the heart. No one was ever able to demonstrate these pores but it was taken as fact. When Harvey described what actually happened in the circulation of the blood (ie arteries to capillaries to veins and back again) based on his anatomical studies he was treated as a heretic. TCM is a placebo-based philosophy and every time there is a scandal such as herbs adulterated with western drugs, for example Viagra and steroids, this strengthens the argument that such products and practices should be banned as being consumer fraud.

Occupational Health Delusions

Unhappy people in boring jobs can escape their stressful situation by attributing some mythical illness to the workplace. This entitles them to compensation from ACC. Many such people become extremely litigious and unpleasant if there is any suggestion that their illness is psychosomatic. Complaints and symptoms are out of all proportion to any evidence of an actual injury.

A recurring theme in the occupational health literature is the statement that “psychological factors might be important.” There is seldom any suggestion that a condition has nothing to do with work. Conditions such as railway spine and miners’ nystagmus were compensated when we now know that these conditions were a delusion, a folie a deux between plaintiffs and their gullible doctors.

Sick building syndrome (SBS) is a modern example of this delusional thinking. I recall an earlier study where symptoms bore no relationship with building ventilation. This experiment involved varying the ventilation rate without the workers’ knowledge. If the air was being changed at a very high rate there should have been a corresponding drop in symptoms.

Another recent study has found “symptoms of SBS are more strongly associated with job demands, workload, social stressors, and support at work than with the physical environment.” Occupational and Environmental Medicine 2006;63:283-289

More on Goji Juice

I revisited the goji juice site www.best-goji-juice.com and decided to investigate Dr Earl Mindell. He has a legitimate Bachelor’s degree from the University of North Dakota and a PhD from a diploma mill, the University of Beverly Hills. Quackwatch has some good information about his vitamin industry and the goji juice industry is a good example of multilevel marketing similar to Amway. Has anybody tried the stuff? I would be interested to hear.

The ideal marriage?

Consider an iridologist married to a reflexologist. The iridologist can look into her partner’s eyes and tell him what’s wrong with his feet. The reflexologist can look at her feet and tell her what’s wrong with her eyes. Many thanks to whoever it was who passed that on at the conference and thanks to Dr Keith Davidson for passing on a half page advertisement devoted to reflexology from the Christchurch Press, 26 September. It’s clearly a growth industry with their own website www.reflexology.org.nz. You can train at a reflexology school or even gain a diploma from the Canterbury College of Natural Medicine.

Hokum Locum

Liquor still quicker

There is little doubt there are criminals who are prepared to drug women in order to sexually assault them. History records the commonest drug used was chloral hydrate in an alcoholic drink (Mickey Finn). The modern equivalent is rohypnol, a drug discontinued in New Zealand owing to its abuse potential. However, as Ogden Nash observed “liquor is quicker” and alcohol remains the most likely cause of incapacity leading to unwanted sexual activity.

There has been recent publicity alleging ‘drink spiking’ but a remarkable dearth of evidence to support these allegations. Invoking the law of parsimony, if women drink a lot of alcohol it is more likely that they were drunk rather than drugged by some additional chemical. This has been my experience in clinical practice. I was working in a hospital emergency department and a woman brought in her daughter who alleged she had been drugged during an evening out. They requested a blood test. I ordered a drug screen as well as an alcohol level. The time was 3pm the day after her night out. The drug screen was negative; however, the young woman’s blood alcohol was still 112 mg/100ml blood. The legal limit for driving is 80mg/100ml blood. I leave it to readers to do the maths but I suggest she must have been seriously intoxicated the night before!

The current hysteria about ‘date rape’ is a smoke screen to cover up serious alcohol abuse by many young people.

From the Journals

Bromelain, an aqueous extract of the pineapple plant, is widely sold as a natural organic anti-inflammatory agent. The results of a randomised controlled trial cast doubt on claims that it is an effective treatment for osteoarthritis. Although the trial was too small to be definitive, there was no benefit over placebo (Quarterly Journal of Medicine 2006, 99: 841-50).

High blood pressure features in a randomised controlled trial of acupuncture appropriately named SHARP (Stop Hypertension with the Acupuncture Research Program). Despite the promise suggested by case reports and small observational studies, active acupuncture was no better than invasive sham acupuncture at reducing systolic or diastolic blood pressure in 192 patients with untreated blood pressure (Hypertension 2006, 48: 838-45).

A New Zealand doctor has been given a grant of $5000 to continue her research into the treatment of autism. Her alternative methods involve dietary manipulations. In one case, “within a week of having colours and preservatives removed from his diet”, Dr Gullible (not her real name) claimed the subject had a vocabulary of 200 words. Well then, within a few more months he will have conquered the Concise Oxford Dictionary! Dietary manipulations involve a change in management and attention and it is this which is responsible for any observed improvements. These are placebo interventions (NZ Doctor, 15 November 2005).

Fat Lazy Teenagers

Claims have been made that overweight adolescents should have surgery. Some of these fatties have weighed in at 150-200kg. They can be seen in any shopping mall, usually eating a bag of chips and clutching a bottle of soft drink. The parents, usually the mother, are also obese and the situation is not a disease but one of child abuse. The standard of reporting and medical insight is pitiful. A report in the Christchurch Press (23-24 December, 2006) claimed that a possible cause of obesity was hyperinsulinaemia, an excessive production of insulin. Obese people who develop diabetes do have hyperinsulinaemia but this is caused by their obesity, not the other way round. The obesity causes an insulin resistance at the cellular level and the pancreas responds by cranking up its production of insulin.

After surgery, one teenager lost 80kg and is now training to be a chef! I think there needs to be a great deal more informed debate before the health system starts funding this sort of surgery.

Occupational Health-Disease of the month

The history of occupational medicine is full of examples of absurd complaints being linked to the workplace. For example, pain syndromes in women who are only typing a few words per minute (refer Dr Yolande Lucire’s book: RSI Belief and Desire).

The latest medical construct is ‘acoustic shock’ seen in call centre workers. Seven hundred employees have reached out-of-court settlements in the UK with a payout of three million pounds. A further 300 cases are pending. It pays to have an employer with deep pockets. An article in the Guardian Weekly (24 November, 2006) advises that “acoustic shock is caused by exposure to a sudden increase in noise, but people who are already anxious or under stress appear to be particularly prone to it.”

Note the careful wording. The ‘disease’ is not created in normal people but in those who are naturally “anxious or under stress”. These words are designed to obscure the fact that this is not an occupational disease but an attempt to attribute personal angst to the workplace.

Although not given to crystal ball gazing, I predict that this condition will next appear in Australia closely followed by New Zealand. Furthermore, I predict that the condition will remain unheard of in India, the origin of most call centre calls, since there is no compensation available.

The next time you are disturbed by a call centre while eating dinner, yell loudly down the phone and tell the caller to make a claim for ‘acoustic shock’.

Sickie Busters

Fraudulent absenteeism is just as common across the Tasman as it is here. Absenteeism costs Australian industries an estimated $7 billion dollars per year. Rates are around 3.5 percent but this figure can double with-you guessed it-call centres! These must be the people who are away from work while consulting their advisors about their claim for ‘acoustic shock’.

Some savvy people have set up a business (Direct Health Solutions) and they check up on people taking a sickie. Client absenteeism has been reduced by one third and for every dollar spent there have been gains of $12 saved in terms of productivity.

A DHS Nurse reports “you can always tell people throwing a sickie, because very often they haven’t decided what’s wrong with them”.

Sunday Telegraph Australia, 12 November 2006

Selenium Poisoning

A 75-year-old man had a blood test which showed an elevated prostate specific antigen (PSA). He became concerned about prostate cancer. The article does not say whether there was a suspicion of prostate cancer or whether the PSA test was done as a ‘check’. Prostate cancer is certainly common in males of this age, being found incidentally at autopsy in 40 percent of those over the age of 75 years. A screening ‘check’ of PSA cannot be defended in this case because a male diagnosed with prostate cancer at the age of 75 years is more likely to die from some other cause (ie with the disease rather than from it).

The patient visited one of “287,000 sites discussing the use of selenium in prevention and treatment of prostate cancer” and “was able to purchase 200g of sodium selenite powder without adequate instructions.” Three to four hours after ingesting 10g of the powder he presented to an emergency department, acutely unwell, and subsequently died of acute selenium toxicity.

The authors comment: “This case highlights the risks associated with failure to critically evaluate Internet material and exposed the myth that natural therapies are inherently safe”.

Medical Journal of Australia 2006, 185 (7): 388-389