Hokum Locum

NZ Qualifications Authority

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

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

Recovered Memory Syndrome

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

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

Sporting Excesses

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

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

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

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

Turbulent Priests

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

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

Medicines

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

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

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

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

Christmas Shopping Blues?

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

Over-investigation

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

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

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

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

Sickness Benefit Abuses

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

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

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

Breast implants

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

NHS goes bananas?

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

Smoothing away the years

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

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

Demons, Drought and Bullfeathers

Pull up a chair and hearken to the tale of the Great Drought of ’94

“Skeptical?” piped up the old timer. “Of course I’m flaming skeptical, ye addlepated mudfish!

“Aye, but it wasn’t always so. I was a dour and solemn Presbyterian from birth onwards, and bar the whisky, gossip columns, loose floozies and muckraking, a devout one too! But all this changed suddenly in the winter of ’94, twenty years ago, when Auckland was struck by drought.

“It was a fearful time. The people were downcast and grimy, and dirt and dust grew on the city like a blight, until you could scarce tell a regional authority from a whorehouse, resulting in all manner of dire ruction and scandal, driving middle-management to the limits of despair and provoking the wrath of the waterblasting community.

“I sought spiritual comfort during the crisis by moving into the Protestant and Trumpet Pub, where I followed the drought’s progress by radio and word of mouth, buttressing myself against evil with 17 barrels of ale and religious austerities.

“It might have been a straightforward drought, but a gimp appeared in the scenario when the North Shore City Council imported a wizard from the pagan South Island wop wops to perform rain-making ceremonies. A simple measure, you might think, to divert the suffering masses from their woe.

“But plagues from heaven upon me if as soon as the news broke the blasted Christians didn’t arise in a spluttering fit of hellfire and damnation, claiming that such heretical pranks were proof that the country had gone to the Devil, and forthwith raised such an almighty hullaballoo of scriptural vociferation that by the time the wizard landed the Council had already taken heed of the Christian catchcall, “Thou shalt not suffer a witch to live,” and quelled the pitchfork and torch uprising by cancelling the performance.

“I was flabbergasted, and even the publican, Haggis McDonnagle, was visibly shaken, stating right then and there that he was considering changing the name of the pub to the Secular Humanist, for in all his born days he’d never seen a witch, wizard or soothsayer with any more flair for the miraculous than a card shark, and to ban such blarney was nothing short of idiocy multiplied.

“But the wizard wasn’t unemployed for long. The barbarian villages north of the city thought it madness to let an available wizard slip through their fingers and thereupon hired him, leaving the North Shore City Council looking like a prize-winning jackass.

“By now the Christians were nigh delirious with joyous condemnation. It wasn’t often they got a chance to go rabid over devil worship and they meant to make the most of it.

“For days the talkback lines ran hot with seething Born Agains, witnessing for the Lord and staking their souls on the blood of the Lamb that the whole country was in the grip of Satan, and unless we clung to the True Vine and threw ourselves down at the feet of the Lord, the Deceiver himself would drag us into the black pits of Hell wherein we would rot in unspeakable anguish until the end of time.

“By now it had been raining for several days. I tell you, if the cat wasn’t among the pigeons now it would never get much closer, for lo and behold — both sides claimed responsibility for the miracle!

“The Christians held that the extra energy they had to put in to counteract the forces of darkness brought forth the Mercy of God. And forsooth, the Presence was strong! The halls of the pentecostals were abuzz with the Unknown Tongue, and rumour has it even non-pentecostals were heard to glossolate, and I’d be prepared to bet money — I take that back, Haggis would be prepared to bet money — that the Graph of Visions and Apparitions showed an upward curve through this period.

“The wizard himself took no credit; the peasants did it for him. He departed secretly, as fast as possible, saying little but to remark that if fools were kiwifruit we could start a new export industry, or something to that effect, for between the jet engines, caterwauling Christians and the Morris dancers it was hard to hear much of anything, and all told the whole dadblanged circus was such an unearthly blaze of flailing sticks and Biblical injunctions that objective observation may not even be applicable in this case.

“Me and Haggis drank a tragic amount of whisky thinking about these things and ten days later resolved, as witnessed by Mrs McDonnagle, to suspend judgement on the Tree of the Unseen until it yielded a visible persimmon; arguing that invisible anti-persimmons didn’t constitute enough evidence to lynch tarot card readers.

“As I say, it was many years ago and the details are hazy; but by crikey, I’ve been on the alert ever since. So hark ye doorknocking gospelizer — if you or any other evangelical hot-air agent ever darkens my front porch again, I’ll flatten your cursed head with a spade.”

Hokum Locum

MSG Myth Laid to Rest

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

Poppycock

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

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

Naturopathology?

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

Psychobabble?

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

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

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

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

Medical News

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

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

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

Mass Hysteria

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

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

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

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

Bioenergetic Medicine

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

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

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

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

Fraudulent Food & Drink

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

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

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

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

Hokum Locum

A Menu of Dietary Delusions

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

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

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

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

Smart Drinks

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

Sick of Work?

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

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

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

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

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

Laying On of Hands

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

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

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

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

Alexander Technique

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

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

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

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

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

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

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

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

Ischaemic Heart Disease

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

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

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

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

Death or Compensation

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

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

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

Deliver Us From Gynaecologists?

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

Failing the Sex Test

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

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

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

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

Dr Jekyll and Mrs McPherson

Our intrepid correspondent finds himself suffering from that most fashionable of psychological afflictions, Multiple Personality Disorder!

The Jekyll/Hyde character has been used to express duality in human nature for so long it’s become a cliche. And like most cliches, it’s true.

Everyone has at least one extra personality, and usually more. For example, I seem to be the field of activity for three distinct players — the amiable Dr Jekyll, the despicable Mr Hyde and, much to my consternation, Mrs McPherson, apparently a Scottish Presbyterian.

None of these characters have much in common. Jekyll doesn’t like Hyde and views McPherson as an unimaginative busybody. Hyde hates everyone’s guts and thinks Jekyll and McPherson should be dumped in the knacker’s yard. Mrs McPherson considers Jekyll an impractical dreamer and vociferously wants Hyde consigned to the pits of hell.

Actually, I’m thankful for Mrs McPherson. She’s the only one with the gumption to deal with Hyde. Jekyll is too warm and caring and holistic to wrestle with a degenerate bastard like Hyde. But no one argues with Mrs McPherson.

For the most part this unlikely crew bubbles along in inexplicable harmony, doing good and bringing happiness upon the land. But every so often a defection occurs and one or another goes ape.

It doesn’t much matter if Jekyll gets loose. I mean, what harm can he do? Bore someone to death by telling them to be here now? Scare a neighbour with a bean salad? I like Jekyll, but let’s face it — he’s a wuss.

It’s more nerve-wracking when Mrs McPherson gets out. Mrs McPherson does not tolerate horseplay! Hard work, prudence and the fear of God are her mottoes, and you can either like it or have it taken out of your hide with a hickory stick.

But woe upon us when Hyde escapes! You’ve heard the phrase, “…it’s like the devil gets into him,” well, that’s Hyde. Hyde is the devil. The deceiver, the pillager, the glutton. When Hyde appears, disaster and degradation follow.

You can see why I’m thankful for Mrs McPherson. Jekyll doesn’t have a hope in hell of quelling Hyde’s insane rampages. He’d probably suggest breathing exercises or something. Leave it to Jekyll to try stopping Godzilla with a tennis racket.

These insurrections are usually short-lived, and balance and order are soon restored.

But supposing one of these characters got the upper hand, or broke off and declared himself independent. Holy mackerel! What if Mrs McPherson seized control!

Imagine being possessed by a Bible-belting, turn-of-the-century, galleon-shaped, prohibitionist women’s rights activist! The very thought makes me nervous.

Heck, if Hyde staged a coup, most likely I’d just end up dead or in jail. But if McPherson managed a takeover I’d have to do really weird things like dynamite disco joints and drive money-lenders out of the temple and stuff like that. It’s too much to even think about! Thanks to Jekyll’s goofball influence I just don’t think I’m emotionally prepared for demolishing bar-rooms with axes and driving harlots into honest work.

But worse still, spirit mediums and New Age journalists would proclaim me a legitimate case of possession and write books about it and make me talk about sin and redemption and magnetic healing on talkback radio.

It’s like Flash Gordon Versus the Psychic Vampires, except worse. Flash’s foes were little more than mind-draining bat people. Anyone could deal with that. But what in the name of all that is merciful do you do about Mrs McPherson?

The terrible thing is, I know she’s in there. Waiting. Waiting to escape. Waiting to ban tobacco and catch kids chewing gum in class.

First she’ll take my mind, then yours, then the country, the planet, the solar system, the…

Make no mistake; Mrs McPherson must be stopped.

Hokum Locum

Arthritis and Placebos

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

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

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

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

Gulf Gas Mystery

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

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

Sick Building Syndrome (SBS)

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

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

Child Abuse

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

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

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

More on Dental Amalgam

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

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

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

Conversion Disorders

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

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

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

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

Pond Scum Scam?

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

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

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

C is for Cancer

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

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

Oil Strikes Out

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

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

If You Can’t Beat ’em?

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

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

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

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

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

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

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

Hokum Locum

Manipulation of the Colon

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

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

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

Conductive Education

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

Homeopathic Immunisation

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

Psychic Surgery revisited

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

Yin Yang Tiddle I Po

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

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

Japanese Herbal Medicine

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

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

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

The Cocaine and Guinea-pig Diet

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

Generalised Chemical Sensitivity

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

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

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

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

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

Quackery in the US

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

The End Is Nigh – Or Thereabouts

Are the End Times drawing nigh? Are fires and floods from heaven on the brink of seething down in wrathful purge, damning the damned and raising the faithful? Is God’s finger poised on the panic button?

It could be, but I wouldn’t cancel the beach party on the evidence. Doom forecasters have been striking out with almost miraculous regularity since the dawn of time.

Putting the history of the end of the world into a fast 400 words isn’t easy. In fact it borders on madness. It’s like stuffing the entire Labour Party into a phone booth, except weirder. I mean, you can always push a Labour-packed phone booth off a cliff; but who’s going to push 400 words off a cliff? It doesn’t make sense. Armageddon does this to you after a while.

Disaster merchants have always been around, but it was the Christians who really put death and destruction on a pedestal when they gave us the Book of Revelation.

No one knows what this book means, but it’s so horrifically spectacular it doesn’t matter. More importantly, it doesn’t give any dates, thus giving open slather to soothsayers and paving the way for twenty centuries of inaccurate predictions.

Methods of prediction vary. For some it’s a case of creative arithmetic. Dates with big simple numbers, like 500, are good too. Anything goes in number juggling.

Christians, for instance, were driven to a near frenzy of ecstatic fear as year 1000 approached. Signs and portents were sought and found. The tension grew. Sinners repented in droves and fled to the hilltops. The time was nigh! But…

No worries! The Apocalypse should have been dated from the death of Christ instead of the birth. But…

In the early 1800s a New York farmer named William Miller made a two-year study of the Bible and was astonished to discover that the world would end in 1843! He gathered a sizable flock who put up with three false-alarms before losing interest. Refugees from Miller’s movement evolved into Jehovah’s Witnesses and Seventh-Day Adventists, both doomsday fanciers.

The Witnesses maintained a healthy zero batting average by striking out in 1874, 1914 and 1975. Surprisingly, few left the church, which shows you how integral reason is to religion.

Hearing voices is another popular method of predicting doomsday. This process is known as channeling. Here the “prophet”, or channel, gets “the word” first-hand from angels or devils, or nowadays, mysterious space aliens. But in either case, the amount of reliable information received adds up the same — nilch!

Objective investigators are more inclined to explain channeling in terms of multiple-personality-disorders and related mental problems, rather than invisible space lizards… but try telling that to the faithful.

Little has changed over the years. The methods are eternally the same and the results are eternally wrong.

As the year 2000 approaches I predict many predictions.

Hokum Locum

The sting

Following his own empirical observations that bee “treatments” helped his arthritis, a Levin bee-keeper is claiming that he is being ignored by the medical profession. (Press 3/8/93) Not surprisingly, his trial of 11 patients failed to impress skeptical observers. Two patients dropped out and the remainder reported that the “sting” was effective. Having paid for the privilege of being stung, a sensation to be normally avoided, they are hardly likely to say that the treatment was worthless.

In the middle ages, hornets were applied to the skin as a treatment for plague. Nothing appears to have been learned from such unpleasant, not to say dangerous, treatments.

Bogus professor

An unqualified woman who posed as a doctor and professor, was sent to prison for 6 months for fraudulently claiming that she could cure cancer and AIDS. Analysis of her product, Cancelle, or CH6, showed “it had no medicinal properties and contained toxic elements.” (BMJ 306 p1499).

It is ironic that the courts (in the UK at least) will move swiftly to deal with quacks, but the medical profession has failed to take action against registered medical practitioners who practice quackery such as homeopathy and EAV diagnosis.

Caesarean sections

Australia has a high rate (30-35%) of caesarean sections among private patients, and the introduction of a global obstetric fee that applied irrespective of the mode of delivery did not change the proportion of caesarean deliveries. (BMJ 306 p1218) The caesarean rate in Brazil is an amazing 50% on average, with the highest rates among the poor. Two reasons for this are a virtual absence of midwives and the belief (encouraged by obstetricians) that a vaginal delivery will permanently impair normal intercourse afterwards. Both of these examples demonstrate how doctors can develop bad practices when the socio-cultural environment allows this to happen. Only patient education with strong and ethical professional medical leadership, can prevent this kind of surgical abuse.

Low back pain

Readers will remember Denis Dutton reporting his experiences with an episode of low back pain, or lumbago (Skeptic 24). A Canadian study (British Journal of Industrial Medicine 1993; 50:385-8) found that the best treatment for uncomplicated lumbago was to remain active. The traditional treatment of bed rest was thought to encourage chronic invalidism.

This theme was continued by Robin McKenzie (Press 11/6/93) who attacked the current traditional approach to low back pain. Of physiotherapy, he said “it had for 75 years relied on unproven methods and `hocus-pocus’ electrical gadgetry” and he went on to say that “doctors should prescribe active rather than passive therapies.” Most controversial was his statement that “50% of workers on compensation were feigning illness.”

I am sure that there is an element of truth here. Physiotherapists use a wide variety of treatments and machines, many of which have not been adequately tested. It is too easy for people to refuse to accept responsibility for their own recovery and become chronically dependent on ACC. This applies not only to back injuries but other conditions such as chronic fatigue syndrome (CFS) and occupational overuse syndrome (OOS).

Work-related illness

Readers will be familiar with my position with respect to OOS, which has its roots in abnormal illness behaviour and psychological factors. It is interesting to compare it with the “sick building syndrome” (SBS), another new age medical invention. At last someone has done a trial of randomly increasing the ventilation rate while getting workers to report their perception of the indoor environment. (NEJE 328: 821-7)

To quote the authors: “Increases in the supply of outdoor air did not appear to affect workers’ perceptions of their office environment or their reporting of symptoms considered typical of the sick building syndrome.”

I would like to offer what I regard as a more likely explanation of the SBS which also relates to OOS. People crowded into a large building, working at VDUs and perhaps isolated from each other are always going to be vulnerable to a belief that the working environment is in some way responsible for vague and ill-defined malaise.

A report of a survey in the Christchurch Press (21/5/93) confirmed a high level of stress and dissatisfaction in the workplace. Half of the respondents said they would change jobs if they could and many felt that changes in conditions had resulted in more work for less pay. Most felt that they had less power to control their work environment.

Such surveys are extremely valuable because they provide a clue to the origin of conditions such as CFS, SBS, and OOS. I have no difficulty in accepting job-related stress, but I would prefer to see some honest acknowledgement of this by patients and doctors instead of the fraudulent collusion which creates mythical conditions as CFS, SBS and OOS.

Placebo controlled trials

Since such trials appeared in the late 1940s they have continued to be a valuable tool for investigating the efficacy of new treatments and drugs. Fish oil supplements were tested against placebo capsules for the treatment of psoriasis and there was no significant improvement in either group (NEJM — reported in GP Weekly 7 July 93). Refer also Skeptic 27 for an excellent review of the placebo effect by Dr Bill Morris.

Weight loss delusions

The diet industry is worth millions as women strive to achieve the impossible standards set by the fashion industry. Journalists have even invented a new term for fat, “cellulite”, which apparently looks and feels different from other body fat. (Marlborough Express 24 Sep 92) It can be removed by massage and body treatment products. Obese subjects can pay $180 to be blasted with water jets which “eliminate fat deposits and excess fluid” while hydrotherapy with miracle algae can “restore a balanced energy flow to the body”. (New Scientist 1 June 1991 p47) I hope this particular clinic has good grease traps in its drains.

Other researchers try and tell us that obesity is inherited and therefore nothing can be done. This ignores the success of weight-watchers and the obvious argument that if weight can be gained it must also be able to be lost.

A study (NEJM reported in Patient Management June 1993) found that diet-resistant patients under-reported their actual food intake by 47% and over-reported their physical activity by 51% and “diet-resistant patients were significantly more likely than control subjects to believe that they had a genetic or metabolic cause for their obesity, and to describe their eating behaviour as relatively normal”. This important work clearly demonstrates yet again the importance of patient beliefs in relation to illness behaviour.

While on the subject of over-eating, I note that a typical cat living in Britain is given twice as much protein a day as that eaten by a typical poor African.(BMJ Vol 306 p1078)

Homeopathy

In Skeptic 26 I offered to go into business with anyone prepared to join me in selling pure water labelled as “homeopathic preparations”. Two homeopaths were indignant about the use of active ingredients in the case of herbal medicine poisoning I described in Skeptic 28 and one went on to say “it is absolutely unethical for any medicine to be sold as natural and especially as homeopathic if it were to include pharmacologically active ingredients”. (Letters – BMJ Vol 306 p656)

I still think it would be a bit of fun to sell some pure water (labelled as homeopathic preparations), invite prosecution and argue it out in court. It could prove to be a more useful arena in which to examine the enduring scam of homeopathy. I could enjoy hearing homeopaths being cross-examined by a skeptical lawyer. At least selling pure water is honest!

Poached Tiger?

Not content with exterminating tigers in their own country, the Chinese have over 110 factories turning tiger bone into tablets, wine and various confections. Presumably the ingestion of such products is believed to confer some of the vigor and vitality of the unfortunate tiger. There are only about 6,000 tigers globally and trading in tiger products is banned by international convention. What a monumental folly that these magnificent and intelligent animals end up being turned into useless traditional medicines because of human stupidity and superstition. (Lancet Vol 341 p46)

The Wyant Heavy-Weight Motor

It may interest skeptics to know that I have solved the world’s energy problems. The concept is surprisingly simple… but then works of great brilliance often are.

Our methods employ what we call “The Straw that Broke the Camel’s Back Technologies.” I won’t mind however, if future generations call them “Carl Systems.”

As etheric physicists know, all objects on Earth inherently “want” to leave the planet. But they can’t, because gravity holds them down. We call this syndrome “weight frustration.” Thus, metals like gold or lead are “extremely frustrated,” whereas subjects such as feathers and dry leaves are only “mildly neurotic.”

The Wyant Heavy-Weight Motor — simply called by the boys and girls at the lab the “Wymo” — works according to ancient cosmic principles.

The fuel, already desperate to fly forth from the Earth, but held back by the forces of gravity, is subjected to further “annoyance” by way of a powerful screw-driven press. This “further annoyance” is The Straw That Broke The Camel’s Back, known as “strack” among professionals.

Basically, Wymos and other strack devices increase “annoyance” until the fuel “freaks out” and discharges its “frustration.”

So far we have found lead to be the best fuel for strack machines. Forty pounds of lead will drive a six-foot turbine at 190 RPM for five hours, producing ten times as much energy as it takes to drive the press.

Granite and other hard rocks are also proving to be good sources of frustration. And with the current development of strack amplification units we expect major breakthroughs with alarm clocks and bulk copies of the Listener any day now.

Some alternative fuels, unfortunately, have not shown favourable graphs. For example, repeated stracking trials using glossy magazine editors and cow-shooting journalists for fuel have failed to turn over our smallest turbines, much less “over produce.”

We have hopes of explaining this anomaly in the near future. But for now, why 20 pounds of granite yields more energy than 150 pounds of journalist remains a hotly debated issue at the Wymo lab.

In the meantime, we persist with our work. We are confident the patent office will soon recognise the importance of the Heavy-Weight Motor.

Hokum Locum

Skin Lighteners

The pop star Michael Jackson has denied that he uses chemicals to lighten his skin and claimed to be suffering from a disorder called “vitiligo,” which is a spontaneous loss of skin pigment. Jackson said “There is no such thing as skin bleaching. I’ve never seen it. I don’t know what it is.” (GP Weekly 24 Feb, 1993)

In fact, skin lighteners are used extensively by Afro-Caribbean women in response to social pressures. These preparations contain hydroxyquinone which inhibits the production of melanin (normal skin pigment) but cause skin damage with prolonged usage.

“Because the creams are cosmetics rather than drugs they are not subject to stringent tests or regulations and of 33 skin lighteners for sale in Southwark, half were wrongly labelled; six had illegally high hydroxyquinone contents; three contained mercury, which is banned by European law; and two contained cortisone, which should be available only on prescription.” (BMJ Vol 305 p333)

This is a classic illustration of the abuses that occur when potent drugs are allowed to be dispensed as “cosmetics”. I do not know whether Michael Jackson truly does suffer from vitiligo, but with his history of repeated cosmetic surgery and hyperbaric oxygen treatment I would not be surprised if he is using skin lighteners.

Addicted to Sugar

Woman’s Weekly 14/12/92 carries the story of a woman who was chronically depressed until she saw an iridologist who proclaimed the patient “a sugar addict. Her exceptionally high sugar-loaded diet had filled her body with toxins. The whites of her eyes were yellow, and her colon contained faeces which had been present for years.”

This story has all the elements of quackery. Iridology is arrant nonsense adequately dealt with in one of our truth kits, and just what are the “toxins” so favoured by quacks? Can the colon really hold faeces that “have been present for years”? The world’s record for constipation is held by a man who resisted the temptations of the toilet for 368 days. He is said to have become weak after delivering 36 litres of faeces on June 21, 1901, but “there was much rejoicing in the family.” (CMA Journal May 22, 1976/Vol. 114)

This woman clearly suffered from a depression and wasted years in looking for outside “causes”. The iridology diagnosis and treatment is a form of placebo validation of her symptoms, which has allowed her to get better without facing up to more important psychosocial issues. The standard of such stories in the Woman’s Weekly is so pathetic that the staff surely deserve a permanent bent spoon award.

Sports Enhancement

It appears that athletes will do anything to enhance their performance in their chosen sport. Ben Johnson could not give up the use of anabolic steroids and has earned himself a permanent disqualification. Other athletes, such as Katrina Krabbe, have received feeble punishments for the same abuses. Some athletes go to extraordinary lengths to either justify or rationalise their use of performance enhancing drugs. A swimmer (Marlborough Express 16/3/93) complained that a heavy beer-drinking session led to her urine test showing twice the permitted testosterone levels.

A survey of private gymnasiums (British Journal of Sports Medicine 1992;26:259-61) found that 62 out of 160 customers had taken anabolic steroids, along with other drugs to counter the side effects of the steroids. Steroids have been used by some occupational groups, such as debt collectors and bouncers, to enhance physical size and improve employment prospects.

Users have also been observed to participate in needle exchange services through their requirement to administer the drugs intramuscularly. (BMJ Vol 306 13/1/93 p459)

Cooking with Radon

Disused uranium mines are finding a new use as chronically ill people rush to sit in the “health mines” in order to inhale radon gas which is touted to cure everything from migraine to blindness. For as little as $2.50 you receive exposure to radiation while “having a good time playing cards, doing jigsaw puzzles, and reading magazines.” (People Magazine)

(Un) Natural Remedies

Readers will remember the tragic deaths of twin infants from congenital infection of the mother with Listeria, a type of bacteria widely found in seawater and in particular, mussels. It is alleged that the infection was acquired through mussels eaten by the woman as a “natural” source of iron. If only she had taken the completely safe iron tablets available from her local chemist but then, they are not “natural.”

In Belgium, many women have suffered renal failure and died through taking slimming powders containing Chinese herbs, in some cases prescribed by doctors! (GP Weekly 3/3/93) Women are cynically targeted by the diet industry, and it is not surprising that obese people continue to be attracted to slimming remedies which can be eaten.

Oddities of the East

In China, ants are being used in the treatment of Hepatitis B and various rheumatoid diseases. 28000 patients have been treated using medicine made from ants which are rich in zinc and (unspecified) trace elements. 20 percent of a survey of 339 patients were described as “cured,” 77 percent were helped and only 2 percent remained unchanged. No one was made worse. The application of percentages and vague reports of “improvement” does not improve a fundamentally implausible study. (GP Weekly 20/1/93) Applying Skrabanek’s demarcation of the absurd theory, a clinical trial is not indicated.

Chinese herbal preparations often have inscrutable ingredients. A post-menopausal woman attending gynaecology outpatients had a biopsy taken from her uterus, which showed tissue changes consistent with the use of hormones. She was on no medication apart from a herbal remedy prescribed by a homeopath. The doctors found that the list of ingredients included 10 [micro]g of ethinyl-oestradiol (a potent female sex-hormone) with no warnings about long term use. (BMJ Vol 306 16 Jan 93 p212)

The irony of a homeopath prescribing a potent remedy will not be lost on readers. Homeopaths should confine their prescribing to their harmless placebos.

Continuing the theme of arcane Eastern practices, even forms of therapeutic massage are not without side effects. Following a vigorous bout of Shiatsu (Japanese style massage) a patient developed an attack of shingles caused by a reactivation of latent Herpes zoster infection of the affected skin area. (NZ Doctor 18 March 1993)

A man from Belize (Central America) was admitted to hospital with an abscess on his arm which was leaking a shiny pus. He admitted to injecting “white magic” into his forearm a month earlier and an X-Ray showed high density globules in the muscle of his arm.

The material in the injection was mercury, used according to Mayan superstition to ward off evil spirits and increase sexual potency. Tubes of mercury are cheap and freely available in Belize. Historical figures such as Henry VIII were treated for syphilis with mercury, which led to the expression “a night with Venus and a lifetime with mercury.”

The herb chaparral (aka. creosote bush) has been in the news lately, implicated as a cause of toxic liver hepatitis. It is under scrutiny in the US (NCAHF Vol 16 No 1), but as usual our own Health Department is dithering instead of banning it and putting the onus on the distributor to prove that it is safe. I have sent them a copy of the NCAHF article.

Natural Remedies Neglected

Neglect of proven health and hygiene measures can lead to disease as well. 46 people were infected with Salmonella from an imported Irish cheese made with unpasteurised milk. The infection was traced to four cows excreting the same strain of Salmonella in their faeces. There is no excuse for these human infections because pasteurisation kills all disease-producing bacteria commonly transmitted in milk. (BMJ Vol 306 13/2/93 p464)

Soviet Russia had fewer than 60 cases of Diptheria during the mid-1970s. The present social and economic chaos has led to a resurgence of this disease and almost 4000 cases occurred in 1992. Immunisation used to be compulsory but there are now fears that the vaccine is dangerous and AIDS may be caught from the needles. Diptheria has become endemic in rural areas where the standard of health care is very low. (BMJ Vol 306 13/2/93)

Even New Zealand has groups of ignorant people actively campaigning against immunisation. Those who forget the past are condemned to repeat it!

Non-medicine

Thoracic outlet syndrome (TOS) is characterised by subjective complaints of pain and sensory changes in the upper limbs. Skepticism in the literature prompted researchers to examine data, which showed that the diagnosis of TOS is heavily influenced by a patient’s insurance coverage. Those without such cover are rarely diagnosed as having TOS. (NCAHF Vol 16 No1)

There are many operations performed by surgeons which are of questionable indication. Surgery has a potent placebo effect and most surgeons would be reluctant to put operations to the test of a placebo controlled trial as outlined by Dr Bill Morris in the last issue of this journal.

Black Spot Mystery

Many mysteries turn out to have mundane explanations which are seldom accorded the same publicity as, for example, alien abduction stories (actually due to a dream state in susceptible individuals). Local health authorities in Green River, Wyoming sent out questionnaires, mapped homes and exhaustively tested scabby spots from the scalps of school children before concluding that the spots were flakes of tar which had blown off the school roof! (NZ Doctor 1/4/93)

The Skeptical Hairdresser

“Mind my left ear.” cautioned Mrs X, “there’s a needle in it.”

“A needle?” I said, combing up a section of hair on the side of her head to check it out.

“An acupuncture needle,” she said.

Sure enough, there it was, just up from a normal earring hole, a tiny needle with a wee piece of tape over it to hold it in place.

“Fascinating,” I said.

She produced a small metallic rod and held it against the needle. “It’s a magnet,” she explained. “I’m supposed to keep it magnetised.”

I racked my mind for information on magnetism and came up with nothing except a vague recollection that therapeutic use fizzled out around the time of Mesmer. But of course, this is the very hallmark of New Age ideas — they’re always old.

“What’s the treatment for?” I inquired.

“Tennis elbow.”

I deemed it wisest to move on to a new subject. But in one of my rare instances of foreseeing the future, I suddenly knew that it was going to be one of those days.

It was one of those days. Next I got a woman with two sniffly, whinging kids. She assured me that as soon as she got home she’d put them on the colour machine for a good hour.

I didn’t even ask. I’d seen variations of these things before. Of all the New Age gadgets (NAGs) I’ve run into, these may rank among the most exasperating. Most NAGs at least seem to be doing something; they hum or strobe, make pink noise, cause meters to flicker, hurt, relax or irritate… but the colour machine does absolutely nothing whatsoever. It’s just a small black box with a lightbulb of the selected colour on the outside. The box plugs into an ordinary wall socket and the patient is attached by means of a wire with a sort of bracelet on the end. Sometimes an alligator clip is used instead of the bracelet, and is simply clipped onto the patient’s clothes or hair.

The machine supposedly generates a flow of the patient’s own personal colour vibration (determined by the therapist who prescribes the machine) and thus augments the healing process. Call it an irrational fear of the unknown, but I hate them.

After she left I made a desperate attempt to slip out for a cigarette, but I wasn’t fast enough. A brisk young chap requiring a precision flat-top bustled in. He seemed innocuous enough at first, but by the time he left he had not only examined my eyes but had written out a list of at least a hundred and fifty dollars worth of vitamins I urgently needed. He was an iridologist.

Described by some as “living fossils,” iridologists just won’t go away. Iridology appeared on the scene in the 1880s, though undoubtedly variations on the theme go way back. It died a natural death not long after the turn of the century because of its failure to diagnose with any more accuracy than chance.

I was reaching for a pack of cigarettes when Slasher, a guy I met years ago during a lengthy investigation into the Hare Krishna movement, sauntered in to get his sides buzzed. Slasher left the movement during the great guru scandles of the late 1980s, when many of the top dogs were dumped for corruption and drastic disregard for the precepts, but like most Hare defectors, he had never fully readjusted to earth life.

Slasher was deeply concerned about the Alien Menace; in particular the small, grey, paranormal fiends known in the trade as Greys, famous for abducting human beings and performing bizarre experiments on them.

“It’s these damned surgical cattle mutilations,” he said seriously. “It’s intense man.”

“Yes; its…it’s…”

“It’s the Greys,” he said.

The alien menace people believe that mankind is caught in the middle of an invisible war between the sinister Greys and the blond, beautiful Space Brothers. It all boils down to an updated version of the old angels and devils gambit, and as always, is ancient history.

“Four of us saw it. It was a good sighting,” Slasher was saying as I whisked the cape off him.

“Yeah; I heard about it,” I said.

“Maybe you should write up a report,” he suggested.

“I thought about it… but the fact that you were all on acid at the time kind of throws a spanner in the works.”

“Mushrooms, actually,” he pointed out.

“Whatever,” I said.

By sundown I was on the brink of madness. It was as though the sky had opened up and rained dingbats. “It’s the Dark Ages all over again,” I moaned, glancing forlornly at the unattainable cigarettes hardly an arm’s-length away. “Investigative thinking has proved too tough for poor homo sap. It’s the end…”

I said little as I attended my last client. I was sure she was into Reichian orgone accumulators and I just didn’t want to know about it. But my fears were unjustified — she was clean.

It wasn’t until she was about to leave, she turned and said: “Carl, do you know that Jesus loves you…”

I was last seen running screaming down Wyndham Street, apparently stark staring mad…