Time for a new name?

Over the last few years, there have been frequent suggestions that the Skeptics organisation in New Zealand should have a new name. At present, our formal name is the New Zealand Committee for Scientific Investigation of Claims of the Paranormal Inc. Originally, this was an adaptation of the name of our sister organisation in the US, the Committee for Scientific Investigation of Claims of the Paranormal. The American organisation has recently changed its formal name to Committee for Skeptical Inquiry. This has been a prompt for our committee to re-open the issue here. The reasons put forward for change, both here and in the US, can be summarised as:

The present name is very cumbersome, and few people can remember it, let alone use it.

Because of its length, it is very seldom used by the media.

Perhaps most importantly, the emphasis on ‘paranormal’ does not accurately reflect the current breadth of our interests.

On this last point, it is interesting to note that over the last several years there have been very few, if any, journal articles or conference presentations on paranormal issues, particularly if one takes the common perception of ‘paranormal’ as being substantially equivalent to ‘supernatural’. To quote one of the arguments put forward for the USA change, “We have never been limited to just the ‘paranormal’. From the beginning we have been concerned with all manner of empirical claims credulously accepted without sufficient critical examination. Our goal has been to provide scientific examinations of these claims, so that reliable, fact based, verified information can be used in making judgments about them.”

If it is accepted that there is a case for change here, we are then faced with the choice of a new name. The first obvious thought is to once again mirror the US name. We would then become the New Zealand Committee for Skeptical Inquiry. However, the word ‘Committee’ seems inappropriate in New Zealand usage. Our organisation is a large and broad-based national society, and is legally a registered incorporated society. This leads to an option ‘New Zealand Society for Skeptical Inquiry Inc’.

Another suggestion is ‘Skeptical Enquiry New Zealand (Inc)’ (SENZ).

(It is probably worth noting here that the use of the word ‘inquiry’ in any new name would be in line with the traditional distinction that reserves ‘inquiry’ as pertaining to ‘a formal investigation’ rather than simply asking for information or clarification, the traditional meaning of ‘enquiry’. However, ‘Skeptical Inquiry New Zealand’ would be an unfortunate choice as it would leave us with the acronym SINZ.)

It has also been suggested by some that we should move away from the term ‘skeptic’ completely, because it has negative connotations and is commonly misunderstood. To quote one of our committee members, “I get fed up with explaining to people that sceptic does not mean cynic and we are not party-poopers!” However, it is difficult to come up with a suitable alternative. Terms such as ‘Society for Science and Reason’, ‘Sense About Science’ and ‘Common Sense About Nonsense’ have arisen, but none of these seem to properly reflect our raison d’être.

If we are to change the name, it will require a resolution at our next AGM. For the moment, the committee invites discussion and suggestions on whether we need a name change and what it should be.

Email: chair@skeptics.org.nz

Hokum Locum

Liquor still quicker

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

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

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

From the Journals

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

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

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

Fat Lazy Teenagers

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

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

Occupational Health-Disease of the month

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

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

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

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

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

Sickie Busters

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

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

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

Sunday Telegraph Australia, 12 November 2006

Selenium Poisoning

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

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

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

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

Keeping it in perspective

The promotion of critical thinking can seem an uphill struggle, but at least we don’t get torn limb from limb for trying.

As skeptics, we fight to uphold certain freedoms: freedom of enquiry, freedom of speech, academic freedom. The battles are worth waging to enjoy the blessings these principles bring, including knowledge and understanding, and because the alternative is darkness.

Skeptics skirmish in public debates, across the kitchen table, and in the workplace. While I think every academic should be a skeptic, I work alongside lecturers who oppose our organisation and who are hostile to science. Some of them believe in Creationism, homeopathy, or the Book of Mormon as a divinely inspired history of ancient America. Such lecturers exasperate me. University managers who do not appreciate academic freedom irk me. Being a skeptic can be tiring and frustrating.

Still, we need to keep our battles in perspective. In parts of the world, debating a university speech code is the farthest thing from the concerns of millions of people. For example, the girls and women of Afghanistan would be overjoyed to have any education at all. Five years after being ousted by the United States, the Taliban still control large parts of Afghanistan. They invoke societal codes in the name of custom and religion as justification for denying women their rights, including the right to an education.

The director of education at Ghazni, Fatima Mustaq, says she has received death threats for refusing to send girls home from school. The threats are also against her husband and their eight children. During the Taliban’s rule, she and her sister secretly taught girls at their home. “They found out and raided us. We managed to persuade them that we were only teaching the Koran. But they spied and found out we were teaching algebra. So they came and beat us. Can you imagine, beating someone for teaching algebra?”

In November, gunmen came for Mohammed Halim and dragged him from his home at Ghazni while his children cried and his wife begged for mercy. The 46-year-old schoolteacher was then partly disembowelled before being torn apart with his legs and arms tied to motorbikes. His remains were put on display as a warning to others to stop educating girls. Halim was one of four teachers killed in rapid succession at Ghazni for defying a Taliban order to not teach girls.

Before they can hope to gain an education, Afghan women and girls need protection from abduction and rape by armed men, being traded to settle disputes and debts, and forced and underage marriage. By being married as young as 12, females are denied their right to education and the freedom to decide the course that they wish their lives to take. A ban on interaction between unrelated men and women greatly inhibits women’s access to the workplace, courts, and schools, because these places are segregated or exclusively male.

Afghan women get almost no protection from the state. In fact, a report issued in November by the Pentagon and the US State Department found that the police force in Afghanistan is largely incapable of carrying out routine law enforcement. Violence against Afghan women is normal. It is tolerated at the highest levels of government. Some judges disregard the law and rely on tradition to hold women responsible for being attacked, thus sanctioning brutality. The perpetrators of violence against women are rarely charged. If cases are prosecuted, the men are usually let go or punished lightly. Women who report rape risk being accused of having committed the crime of having sex outside marriage.

Violence against women by family members also is common. It ranges from forced deprivation of education to beatings, sexual violence and killings. Many acts of violence involve traditional crimes of honour, when a female is punished by her family for shaming them; perhaps she got raped. Punishment can mean being stoned or burned or beaten to death.

Glimmers of progress are visible in Afghanistan. In 2004 a new constitution was adopted which proclaimed that “the citizens of Afghanistan-whether man or woman-have equal rights before the law.” It also provides for a minimum representation of women in both houses of parliament.

In 2005 the first woman was appointed as governor of a province. Over 40 percent of women were registered as voters in 2004. Women are officially allowed to seek employment-albeit with permission from family members. One in five girls now attends primary school. Nearly all the younger women interviewed recently by Amnesty International expressed their wish for the future as simply being able to continue their education. As skeptics in New Zealand look to soldier on in 2007, we can be thankful for the freedoms we enjoy.

A skeptical columnist bows out

ONE of New Zealand’s most senior journalists, and a long-standing member of the NZ Skeptics, has announced his retirement (Dominion Post, 2 December, Sunday Star Times, 3 December). Frank Haden has been best known in recent years for his columns in the Sunday Star Times, but his 50 year career in journalism has included time as editor of the Sunday Times and assistant editor of the Dominion.

Continue reading

The demon-haunted universe

Some people are skeptical about UFOs and alien abductions-but for all the wrong reasons.

Gary Bates is the latest in a long line of Australian creationists who have mounted tours of New Zealand since the early 1990s. Every year, speakers from Creation Ministries International (formerly Answers in Genesis, and before that the Creation Science Foundation) make the journey across the Tasman to address church halls full of the faithful on the importance of adhering to strict biblical literalism, and to distribute an ever-expanding catalogue of books, videos and magazine subscriptions. This strategy, dubbed ‘linking and feeding’ by CMI chief executive officer Carl Wieland (see NZ Skeptic 45), is quietly but very effectively establishing a broad-based creationist movement in this country, avoiding the largely unsuccessful head-on confrontations with the educational establishment which have characterised the creationist movement in the US. There are now several locally grown speakers on the circuit, groomed by the New Zealand branch of CMI from its base in Howick.

In October I was one of four local skeptics who attended a meeting addressed by Bates in Rotorua. He began with a reminder that their ministry was fully ‘faith-funded’, and urged his audience to support it by purchasing his merchandise during the intermission. This was to be a recurring theme throughout the night. A form was passed round on which people could subscribe to CMI’s Creation magazine; there were plenty of takers.

He then launched into the now-standardised CMI patter. We are engaged in a “War of the Worldviews”, he said, with our allegiances determined by where we think we came from. Morality is a Christian virtue, grounded in Genesis, and those who refuse to accept that book’s authority have no basis for ethical behaviour. This, he maintained, was the root cause of the modern world’s ills. We had a choice between accepting the words of men or the Word of God.

Well, no, actually. We can’t climb Mt Sinai and ask God Himself whether He wrote the Bible. We only have the word of men like Bates that He really is its author. So it comes down to making a choice as to which set of men one listens to.

Bates then turned to some of the alleged evidence against evolution-20-year-old fossilised felt hats, “unfossilised” T. rex bones containing red blood cells, complex geological structures formed in a matter of days at Mt St Helens, and the way dead fish float, rather than lying on the sea bed to be fossilised. None of this material was new, and space precludes a refutation of it all here, but I’ve appended some websites which cover it.

But Bates has a point of difference from other creationist speakers. He is the author of Alien Intrusion: UFOs and the Evolution Connection, and after the intermission (and more exhortations to purchase stuff) he outlined the book’s argument. In a nutshell, it is that life elsewhere in the universe does not exist, and that reported encounters with extraterrestrials, including UFO sightings and alien abductions, are actually the work of demons, who are on a “crash and burn” mission to bring down as many human souls as they can in order to spite God, in a cosmic war that began in Eden.

Ironically, there was some material that a skeptic could agree with. He did a fair job of explaining the sheer immensity of the universe and the difficulties that would confront any would-be space-farer wanting to visit our little blue dot, although some basic errors (the Hubble telescope in “geosynchronous” orbit, Proxima Centauri the closest galaxy) revealed a strictly limited knowledge of astronomy. But then he explained there couldn’t be any aliens to make the trip anyway, because the Bible said so. If aliens existed elsewhere, they would be under the curse of Adam. Since the Church is described as Christ’s bride through all eternity, and since Christian marriage is monogamous, he cannot have brides (ie churches) on other planets. Nor will he be crucified and raised again elsewhere, because his death and resurrection was for all of Creation. Many in the audience dutifully nodded at each of these points.

Belief in aliens is predicated on evolution, Bates says, and Lucifer is using this belief to mount a campaign based on deception. By creating apparitions of UFOs, he encourages people to doubt biblical truth, and by subjecting people to alien abduction experiences he spreads misery and sows confusion. In the past he has adopted other guises, says Bates. Among these were his appearances, disguised as an angel, to Muhammad and to Mormonism founder Joseph Smith.

His audience lapped it all up, although after almost two and a half hours some of the children were dozing off. Finally, he came to an end and the small skeptical contingent headed home for reviving hot chocolates. We didn’t buy anything.


T. rex bones: home.austarnet.com.au/stear/YEC_and_dino_blood.htm

Floating fish: home.austarnet.com.au/stear/fossil_foolishness.htm

Mount St Helens canyon: home.comcast.net/~fsteiger/grandcyn.htm

Rapid fossilisation: talkorigins.org/indexcc/CC/CC361.html

Other creationist arguments used by Bates and others: www.talkorigins.org/indexcc/list.html

When good doctors go bad

Alternative medical practitioners often start out in the mainstream, but other currents may take them into new channels. This article is adapted from a presentation at the 2006 NZ Skeptics conference.

A recent survey of general practitioners found that about one third practised some form of complementary and alternative medicine (CAM). The term CAM refers to a range of medical treatments which are considered outside the realms of conventional medicine because they remain scientifically unproven. Why is it that so many GPs get involved with CAM? Should we accept the term CAM? There can surely be only proven and unproven medical treatments.

I entered medical school in 1971 when I was 19. For the next six years I studied and was taught that doctors were supposed to talk to people, examine them and make a diagnosis. This is quite a sound approach for hospital-based medicine but not very useful in general practice which is where I found myself.

Many general practice surveys have shown that a large proportion of patients do not have a clear diagnosis. These people are often referred to as the ‘worried well’. They have symptoms rather than diseases. There are GP abbreviations for common conditions such as TATT syndrome for ‘Tired all the time’. People who attend regularly with a litany of such complaints are often referred to as ‘heart sink’ patients.

In my own general practice I had the same sort of patients. I became dissatisfied with my inability to diagnose and treat problematic conditions and was in the right frame of mind to try something new, something alternative. Acupuncture seemed to offer all the answers.

I spent a week training in Auckland. The trainer had palatial rooms and drove a Mercedes. He was a charismatic figure. I was impressed! However, some things troubled me. I noticed that acupuncture points seemed to be very close together and it was time-consuming having to refer to charts to locate the correct points. Why use a particular set of points? The trainer said to me “Don’t worry John, acupuncture is very forgiving”.

My scientific curiosity was provoked and I immediately wondered whether it mattered at all where acupuncture needles were placed. I found that it didn’t and got the same results just sticking them in at random.

I soon lost interest in acupuncture.

The great thing about learning from your mistakes is that you recognise them when you make them again. My next experiment was with spinal manipulation. I attended a weekend workshop run by another GP who had written a book on the subject. The techniques were easily learned and I was soon able to produce pleasing noises from any part of the spine. The results could be spectacular and soon my appointment books were full and I was making a lot of money. I realised I had unwittingly stumbled across the secret of chiropractic and osteopathy. Create a need or a belief and then fill it.

I stopped doing spinal manipulation when I had a patient faint after I had manipulated her neck. I thought I had either damaged the spinal cord or damaged arteries in her neck.

There is a known association between manipulation of the neck and stroke. The shearing forces used in manipulation of the neck are capable of damaging the blood supply to the brain. It was always believed that this complication was rare but when a stroke unit started specifically enquiring about prior chiropractic or osteopathic manipulations they found that the incidence of stroke was ten times higher than previously suspected. A sore neck will get better on its own with no risk of such complications. I think I was wise to abandon spinal manipulation.

Case Studies

All of the information for the following case studies has come from the public domain. I have referred to some patients as index patients where for some reason they became important either through media interest or disciplinary proceedings.

Case One

Dr A became interested in Vega testing and homeopathy when he was about 35. The Vega test machine is a derivation of the Wheatstone bridge, an instrument used to measure resistance. Most alternative medical devices are derived from legitimate scientific instruments.

Testing of a small child involved the application of one electrode to the mother’s left middle toe while she held the other electrode in one hand. The child, who was not actually examined, sat in her lap until he became bored and ran around the surgery. Dr A directed questions telepathically to the mother with the responses being analysed by the Vega machine. This revealed allergies as well as evil miasmas which were treated by homeopathic solutions. Homeopathic solutions contain only water but they can also contain a lactose base. The child had lactose intolerance and suffered what was described as a violent gastrointestinal disturbance.

The next child was tested in the same manner and the diagnosis was further evil miasmas from a promiscuous grandmother but this time the mother was also diagnosed with latent diabetes and cancer of the cervix.

Another child with suspected allergies and asthma was diagnosed as having selenium deficiency, allergies to wheat, caffeine and dairy products, as well as more evil miasmas inherited from criminal ancestors. The Vega machine was obviously working to capacity on this day because Dr A was also able to predict for the child diabetes at age 40, and Alzheimer’s at 70, provided he did not succumb from the possibility of a fatal motor vehicle accident at 17. However, the machine failed to see the heavy hand of the Medical Practitioners’ Disciplinary Committee (MPDC) and Dr A was rebuked and heavily fined.

Case Two

Dr B was aged 32 years and a GP at the time of an emerging interest in CAM.

As a fourth year medical student, he was involved in the care of a patient who suffered a fatal drug reaction and died. At the time Dr B said “I was pretty horrified and from then on I questioned the whole philosophy of medicine.” Distraught, he dropped out for a while and then began using nutritional supplements in general practice. He consulted with a lawyer to avoid any breach of medical ethics and continued using nutritional supplements, hair analysis and chelation therapy.

The index patient was a 62 year old with terminal brain cancer who was not confident about proven medical treatments. He was diagnosed with heavy metal poisoning on the basis of hair analysis and treated with chelation therapy and nutritional products for which the GP was getting a 25 percent commission from Neo Life, a multi-level marketing organisation.

The patient’s son complained that his father was spending $800-1000 per month on these.

Dr B was investigated by the MPDC and Consumer but there was no adverse finding in law because Dr B had demonstrated the “honesty and good faith” required by the Medical Practitioners Act. Dr B said “there are some large powers that have financial interests in maintaining general practice as it is, with doctors writing a lot of prescriptions.” The irony of this appears to have been overlooked by Dr B whose own financial interests appeared to be flourishing.

Case Three

Dr C practises electroacupuncture using black box devices such as the Vega machine to diagnose mercury poisoning and other environmental illnesses.

Dr C is anti-immunisation, anti-fluoridation, anti-dental amalgam and claims that ascorbic acid (vitamin C) “is uniformly effective in treating all of the childhood illnesses including hepatitis and polio.”

In 1995 I complained to the MPDC about his anti-immunisation activities. Off the record, I was told that at least 30 other doctors had written similar complaints but the MPDC was powerless to act until a patient either made a complaint or was harmed.

Case Four

Dr D is also a GP who graduated in 1977. He became interested in an unconventional approach following a mysterious family illness which allegedly turned out to be arsenic poisoning, an unlikely diagnosis in my opinion.

Dr D took up using a combination of Bi-Digital O-Ring Test (BDORT) or peak muscle resistance testing as well as homeopathy and prayer.

Some patients complained they had been harmed by his treatments and duly complained to the MPDC. During this hearing one of the expert witnesses offered to devise a blind trial of BDORT and Dr D declined. Dr D was struck off the medical register and fined.

Some time later he was back for a second appearance. This time there was a complaint from a patient who had been suffering from abdominal pain, flatulence and was passing blood in his bowel motions. The patient was seen 19 times and diagnosed with: salmonella, campylobacter, helicobacter, bowel bug, blood fluke, Tordon poisoning, amoebic infection, colitis and irritable bowel syndrome.

He was seen by another doctor who organised a colonoscopy which revealed terminal bowel cancer.

So why do so many GPs get involved with CAM?

Doctor factors

There is still a great deal of uncertainty in medicine. Some doctors find it difficult to cope with uncertainty and are attracted to any pseudoscience that ends uncertainty and reduces complexity by relying on a simple diagnostic or treatment method.Some become disillusioned with medicine due to bad experiences in training or become unhinged by life events.

Psychologists refer to the “power of vivid instances” and this can apply equally to both good and bad experiences. Medical students are selected from the general population and bring with them their own belief systems.

Some doctors have a powerful personality and although they may be aware of and sensitive to the placebo effect this is no guarantee against becoming subject to a belief in their own placebo. Some doctors practising CAM have been challenged to put their methods to the test. They will generally refuse; since these doctors know that their methods work, they conclude there must be something wrong with the scientific method which must therefore be avoided. They will argue that their belief system works through some as yet unknown mechanism. This argument has been described as loopholeism or “the plea for special dispensation”. It is such a common argument that when it is invoked it is diagnostic of quackery.

There is no doubt that some doctors are motivated by money and this wealth becomes a de facto validation of their practices.

I could not find any comparable surveys of specialists who are actively involved with CAM but I suspect that few specialists would be, because the focused nature of specialist practice would tend to exclude unproven treatments.

Patient Factors

The essentially psychosomatic symptoms of the ‘worried well’ have changed very little from the 1920s, with pain and fatigue being dominant symptoms.

There is a huge market for all sorts of unscientific treatments and people are ready and willing to pay for these.

There has been a loss of the folk culture of knowledge which gave people commonsense understanding of their own bodily sensations. As a child I can hardly remember being taken to a doctor. My mother treated our colds, sprains and other injuries. Now people demand antibiotics, X-rays and physiotherapy.

The pharmaceutical industry has not been slow to exploit this by promoting drugs for symptoms rather than diseases. For example, indigestion is now called gastro-oesophageal reflux disease and widely treated with omeprazole or Losec.

Modern medicine can exclude organic illness with a high degree of certainty. Psychological illness is neither fashionable nor acceptable. Symptomatic individuals attribute their symptoms to some external cause such as poisons or toxins and there is a constant background of conditions such as total allergy syndrome and yeast infection, punctuated by epidemics such as Chronic Fatigue Syndrome and Occupational Overuse Syndrome. Because such conditions are largely rejected by conventional medicine they provide a fertile source of income for CAM treatments.

The treatment of cancer is often unpleasant and again it is hardly surprising that sufferers are attracted by the promise of painless treatments with good results. The Lyprinol scandal is a case in point. People are living longer and tend to accumulate a range of chronic disorders such as arthritis, insomnia, and diabetes. Chronic diseases typically undergo a cyclical course with peaks and troughs and the trick is to provide a CAM treatment during a trough so as to coincide with a naturally occurring improvement.

Lessons from Medical History

One hundred and fifty years ago you could easily argue that most doctors were quacks. Medicine had little scientific basis and treatments were often dangerous if not lethal. It was safer to have no treatment at all rather than subject yourself to bleeding or purging. Homeopathy was much safer and the doctors who chose such treatments would have had a following.

As medicine built on a secure knowledge base, the advent of the randomised placebo controlled trial (RPCT) meant the arrival of effective treatment.

Such trials are a threat to unscientific treatments and are able to refute them. A common argument is that RPCTs cannot be used to evaluate homeopathy, for example, because the homeopathic treatment is especially tailored for each patient. This has led to the testimonial becoming the form of evidence favoured by alternative medicine.

People are not comfortable with the idea that they have a psychosomatic condition. It’s easier to admit you have a broken arm than that you are depressed. In the 20th century the dominant theme is the loss of the nuclear family with associated isolation and a loss of intimacy leading to a great fear of the outside world, expressed as agoraphobia and multiple chemical sensitivity.

Perhaps the greatest lesson from medical history is the way various ideas are constantly recycled. The early 1900s was the era of autointoxication from the large bowel. People have always been obsessed by constipation and at one stage a fashionable surgeon, Sir Arbuthnot Lane, was performing total colectomies for this spurious condition. The operation soon fell into disrepute but the theory of autointoxication has undergone a revival with ‘colonic cleansing clinics’.

During the 19th century Parliament recognised the need for some kind of registration of doctors in order to give them some legal standing and acknowledgment of proper medical training. The first medical registration act passed in 1858 included a ‘homeopathy clause’ that has persisted to this day, which says in effect that no doctor can be found guilty of misconduct merely because of a particular practice or belief if he has acted honestly and in good faith.

In practice this means that registered medical practitioners can practise the most blatant quackery and get away with it provided that they don’t harm any patients. Some countries such as Canada have dropped the homeopathy clause and NZ should do the same.


Doctors used to be an authoritative source of health information. Now anyone can go online and access health information. Informed choice has become fashionable. An element of consumerism has crept into medi-cine and as well as being GPs, doctors have to run a successful business. CAM is a lucrative area and if people are prepared to pay it’s hardly surprising that many doctors cater for this demand. A recurring theme is natural versus unnatural. There is a nostalgia for the natural remedies used by Rousseau’s noble savage. Many herbal remedies vary widely in composition. Some brands of ginseng don’t contain any active ingredient at all. At least you get what’s on the label when you fill a prescription for digoxin.


There is something about general practice which attracts an interest in CAM. The case studies are extreme but there are plenty of GPs continuing to use such diagnostic methods and treatments. Is it acceptable for medical graduates with a science degree to be allowed to carry on in this manner? Should we amend the relevant legislation so they can’t? I welcome your thoughts and suggestions.