More on Chronic Fatigue Syndrome
An American study reported in the GP Weekly (2 Sep 1992) found that chronic fatigue syndrome was indistinguishable from depressive disorders. (Refer also Skeptic 21) Patients diagnosed as having CFS were likely to believe that their illness had a viral cause, but it is more likely that CFS is a new age variant of the 19th century neurasthenia.1
A large study reported in the BMJ is worth looking at in detail. 200 patients with CFS were studied. Many of the patients had tried alternative therapies which were “not helpful,” namely diets (27%), homeopathy (20%), hypnosis (5%). This has been confirmed in NZ by Murdoch, writing in the NZ Family Physician (Autumn 1992).
Again, most patients believed that their illness was caused by a virus and the study found that most patients had an emotional disorder. Despite this, most patients had recovered after two years and this outcome is also confirmed by Murdoch in an unpublished survey of New Zealanders with CFS. At all stages in the illness, “functional impairment was associated with several patient factors, including belief in a viral cause, leaving or changing employment, coping with illness by avoidance of exercise and alcohol, membership of a patient organisation, and emotional disorder.” The authors acknowledge that these factors may reflect a more severe illness and call for more prospective studies.
Despite the high incidence of emotional disorder, very few of the patients had been referred to a psychiatric outpatient clinic.
Despite the considerable evidence against an infectious cause of CFS, an Australian doctor has been treating patients with intravenous gamma globulin2 in what is described as a placebo controlled trial. Unfortunately, no reference is given to the trial and until I can get these details I will have to reserve judgement. Watch this space!
Clearly patients resist the suggestion that chronic fatigue has a psychological basis, and unfortunately some members of the medical profession continue to foster this belief. Of concern is the activity of quacks touting EAV, homeopathy, anti-candida diets and other useless nostrums. Patients should not be allowed DSW benefits unless they have willingly cooperated with a program of cognitive based psychotherapy.
1. Chronic Fatigue Syndrome. American Family Physician March 1992 p1205.
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2. Acceptance and treatment of CFS is improving. NZ Doctor International Oct 1st 1992.
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Follow up of patients presenting with fatigue to an infectious diseases clinic. British Medical Journal July 18th 1992 (also reported in New Zealand Medical Journal Sep 9th 1992, p366)
Chronic fatigue syndrome. The Lancet May 30th 1992, p1349
Psychiatric diagnosis and CFS link. GP Weekly Sep 2nd 1992
I was only mildly surprised to read in the BMJ (June 27th 1992, p1652) that a doctor with no medical qualifications had worked for 30 years as a general practitioner. All that is required to be a successful GP is the ability to listen sympathetically to patients. This is more effective than the millions of dollars wasted on drugs such as tranquilisers and antidepressants.
It took some time before the local chemists became suspicious and I quote one of them:
“If one 5 ml spoonful of hair shampoo is to be taken three times a day you tend to think there is something wrong. Time and time again there were inhalers to be injected, tablets to be rubbed in — all very unusual.”
Unfortunately no information was given as to whether any patients had been harmed and, conversely nothing from grateful patients. How on earth did he last 30 years before being exposed? I conclude that he must have been helping enough of his patients to forestall complaints about his eccentric prescribing. The English have a reputation for eccentricity and they certainly must have indulged themselves with this doctor!
In a tribute to anthropomorphism, a Dr Motha will be birthing mothers in the company of dolphins who can “make ultrasonic communications with the fetuses.” All becomes clear when we are told that Dr Motha runs an alternative medicine clinic “including aromatherapy and reflexology.”
Personally I have always thought that dolphin intelligence was over rated since reading Restaurant at the End of the Universe when, at the end of the world, dolphin squeaks were translated as “goodbye and thanks for all the fish.”
GP Weekly August 19th 1992
Fringe Medicine and the Medical Practitioner
The New Zealand Medical Council normally does not involve itself in criticising unorthodox treatments unless the patient suffers harm. Doctors practising quackery are protected by a clause in Section 58, subsection 4 (2) of the medical registration legislation, which states: “no person shall be guilty of infamous conduct merely because of the adoption and practice of any theory of medicine or surgery if in doing so he has acted honestly and in good faith.” I find this statement disappointing, because a medical degree surely implies a knowledge and acceptance of scientific principles.
This clause has been dropped from the same legislation in Australia, Britain and Canada. However, the Medical Council has made it quite clear that quack doctors have to satisfy the doctrine of informed consent by fully briefing their patients “that these treatments are not part of conventional medicine and hence he or she is not practising as a registered medical practitioner in providing these therapies.” The medical registration authorities in Ontario, Canada obtained a change in their act which allowed them to ban such unproven remedies as amnion implants and chelation therapy. They also erased from the register a doctor who combined pendulum dowsing with a form of vega testing. I look forward to similarly robust attitudes towards dealing with quackery by our own authorities.
Having enjoyed the study of general science, I am amazed at the capacity of some doctors to believe in quackery. As H. L. Mencken said, “How is it possible for a human brain to be divided into two insulated halves, one functioning normally, naturally, and even brilliantly, and the other capable of ghastly balderdash?” The reference quoted below is well worth reading.
Unorthodoxy and the Registered Medical Practitioner. David Cole. Patient Management Vol 21 No 9.
In Skeptic 22 I criticised the promotion of Irlen lenses in New Zealand and called these a quack remedy. Since then I have been criticised by Matthew Hobbs (Skeptic 24 — nice to have some feedback) on the grounds that it remains to be seen whether these lenses are a proven remedy for reading difficulties such as scotopic sensitivity.
My use of quack in this context is straight from the Concise English Dictionary: “one who offers wonderful remedies or devices.” Firstly, there is no evidence of the existence of the condition “scotopic sensitivity” and secondly, as the coloured lenses have not been tested they should not be used, as efficacy has not been established.
An article in the Marlborough Express (Sep 24th 1992) outlined how a 10 year old with reading difficulties was fitted with coloured plastic lenses. After six months his reading had improved 100 percent. What alternative explanation is there for this improvement, and how was the improvement measured? It is most likely that his reading disorder was related to aberrant conditioning. The more his parents expressed concern, the more reinforcement was given to the “poor reading.” The coloured lenses are a placebo associated with a change in management which, along with the passage of time, has lead to an improvement in his reading.
Dr Keith Davidson kindly informed me of the source of the quote mentioned in Skeptic 24 “Every day in every way, I’m getting better and better.” It came from someone called Emile Cove. Keith also sent me a cutting from the Christchurch Press detailing the activities of an American faith-healer by the name of Morris Cerullo.
The article demonstrates the obscene side of evangelical fervor. People were warned “Cynicism will sour you, bring cancer to you, and disable you.” The audience revelled in an atmosphere of mass hysteria and were told by an expert on “biblical economics” that there was no pressure to give money but the amount given would determine how far God would move towards miracles! The cartoon that came with the article is great. It shows Cerullo gesticulating while his shadow is the outline of a devil.
The evidence for faith healing is not good. As most deluded beliefs rest on faith, and faith is not amenable to testing, it is unlikely that testing will ever be done. In fact believers are on record as saying that testing claims of faith healing would be disrespectful to God.
Skeptics and Consumerism
Members of the NZ Skeptics have enjoyed some media exposure lately. Denis Dutton has been conducting a vigorous rebuttal of acupuncture beliefs (Patient Management, September 1992) and Vicki Hyde is “Eyeing Alternative Medicine” in the August edition of the NZ Science Monthly.
Consumer magazine were so unhappy with our criticisms of their alternative medicine story that they came out fighting and awarded us with a magnifying glass. I have used it in vain to re-examine their original article, but I have not changed my mind about its feeble journalism. Consumer journalists should read NZSM to see how their story should have been treated.
A new development is Maori medicine, or rongoa, (NZ Doctor, August 20th 1992) Given reasons for its use by Maori are an inability to pay for prescriptions and a belief that rongoa can provide something that western medicine cannot. The Bay of Plenty Area Health Board has provided $15,000 for traditional Maori remedies, such as red matipo to purify the blood and para blue gum for asthma. These treatments are administered in an atmosphere of “love and kindness.”
I doubt whether any of these remedies will ever be subjected to a clinical trial, because such treatments have to have some kind of rational basis to start with, and any results are clearly explained by the very powerful and under-rated placebo effect. At a time when Maori health has never been worse (e.g. smoking-related disease) I find it incredible that an AHB can waste money on this nonsense.
After our little tiff with Consumer magazine, I wrote to the School of Pharmacy in Dunedin to ask whether they would consider doing some tests of homeopathic solutions. Peter Hayes (Lecturer) kindly replied to my letter and enclosed a copy of a paper entitled “A case for homeopathy” written by a Scottish pharmacist, Dr Steven Kayne.
It is fascinating to read the intellectual rationalisations used by otherwise intelligent people in order to indulge their deluded beliefs.
Kayne concedes that increasing dilutions leave no discernible molecules in solution and then goes on to say “chemical analysis is therefore inappropriate”!!!
He further concedes that he cannot explain the mechanism of action but goes on to say “it is extremely difficult not to be impressed when one sees therapeutic efficacy clearly demonstrated.”
Evidently he discounts the placebo effect and refers to “published work in human and veterinary environments.” None of the references quoted support these claims. Furthermore, he says “It is inconceivable that consumers would continue to buy these [homeopathic] products if it was all a giant confidence trick.” He obviously needs to have a chat to some of our skeptical psychologists.
Finally, he refers to the enormous volume of circumstantial evidence “that the remedies actually work — patients do get better.” This is called the “Bellman’s fallacy” — because something has been said many times it must be true. His last word is “homeopathy should be available because patients want it, because it is safe and because it works.”
The Dean of the Pharmacy School also wrote and pointed out “because of patients’ belief in complementary medicine, I doubt that even if we were to show that they were purchasing pure water, it would cause any change in attitudes.”
I am forced to agree with him, but I could not help wondering what would happen if I started selling pure water labeled as various homeopathic remedies. I could make a fortune and it would be difficult to be prosecuted for fraud. Anybody want to go into business?
The same day that I was writing all this, I received an article from Bernard Howard written by one of my favourite skeptics, Petr Skrabanek. One of his best articles on the philosophy of skepticism is “Demarcation of the Absurd,” The Lancet April 26th 1986, in which he argues that it is possible to be too open minded.
Briefly, he argues that we need a demarcation of the absurd so that we don’t bother spending our whole lives on the look-out for flying pigs. Instead, we accept that the probability is so low that we don’t waste our time either looking or testing for airborne swine.
The article that Bernard sent is called “Why we must keep the lid on the black magic box” (Healthwatch Newsletter Summer 1992) and in it Skrabanek argues that testing of irrational beliefs can give them spurious respectability and “no amount of testing will convince a believer that he is mistaken.” Skrabanek also reviews the development of “black-box” quackery, which I have already mentioned can be practised in NZ with impunity due to our feeble medical registration legislation.
That reminds me of a television program on water divining where James Randi tested the top water diviners in Australia. None of them detected water flowing through one of ten pipes any better than chance. At the conclusion of the experiment he asked them about their beliefs which were totally unshaken!