A good excuse for a party

FEBRUARY 12 is Charles Darwin’s 200th birthday, and the old guy, or at least his ideas, are still in pretty good shape. While evolutionary theory has been broadened and elaborated extensively in the 150 years since The Origin of Species was published in 1859, Darwin’s fundamental concept of natural selection remains central to our understanding of life’s diversity. New Scientist noted that 2009 is also the 400th anniversary of Galileo’s first use of the telescope, and used this as an excuse to ask a panel of eight whether Galileo or Darwin had done more to knock man off his pedestal. Opinion was divided, but Darwin was favoured by a small majority. One comment in the introduction by Michael Brooks was that Galileo has had more impact in the long term. His rationale for saying this was that far more people believe the Earth goes round the sun than believe people are descended from animals via natural selection, with the figures in the US being 80 percent and 50 percent respectively. Perhaps this is just a

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Why do men have nipples?

Nikos Petousis, in his article Skepticism Greek-style answers many questions which have previously puzzled me, for which I thank him sincerely.

In return, may I answer one of his own unanswered questions? He had asked why God gave us such useless things as nipples on men. Many people, doubtless not attendees at the 2008 Skeptics conference, would claim Intelligent Design or Divine Guidance.

I know better. Those apparently useless appendages evolved for two excellent reasons, both for the benefit of the medical profession. The first reason is so that the doctor knows where to apply a cold stethoscope for maximum effect. The second is so that if the patient is unclothed, the doctor knows if s/he is looking at the front or the back. Q.E.D. (Sorry to revert to Latin, but I don’t know the Greek for this. Perhaps Nikos could help).

PS If you are in doubt about my theory, please check with John Welch for a second opinion.

PPS I’ve just realised that in sending this by email I cannot sign this in my usual manner (copyrighted) which you seem to have appropriated! However, I hasten to assure you that I am not planning legal action in the matter. When I did attempt to sign in my usual manner, the pen skidded on the monitor screen, which now has some nasty inky scratches.

(That’s OK – we Davids have to stick together! – ed.)

History denied is history repeated

Today, gonorrhoea infections in young girls are taken as certain evidence of sexual abuse. Yet there is an extensive but now-forgotten literature showing that this is not necessarily the case. This article is based on a presentation to the NZ Skeptics 2008 conference in Hamilton, September 26-28.

In 2006 I was asked for my forensic opinion in a case involving a 13 month old Pacific Island girl, Lana,* found to have a gonorrhoeal infection of her vagina and vaginal lips. Her 19-year-old mother and 20-year-old father had also tested positive for gonorrhoea. Her father had acquired this infection through having an affair when Lana was aged 10 months. Both parents had noticed they had a discharge but had not sought treatment, but when Lana developed symptoms they took her to their GP. Once gonorrhoea was diagnosed, it was immediately decided that either her mother or her father must have sexually abused her and she was taken into foster care.

The parents denied any abuse. They lived in an extended family household, shared a room, bed, and towels, sometimes bathed together, and the mother would use her sarong as a nappy when she ran out of disposables. They accepted that they must have been the source of Lana’s infection, but denied any sexual contact and said that she must have acquired the infection through contamination. They were battling in the Family Court to get their daughter back. The doctors for Child Youth and Family (CYF) insisted that gonorrhoea can only be transmitted by “mucous membrane to mucous membrane” and that gonorrhoea infection in a child under the age of puberty (ruling out vertical transmission when a newborn baby acquires the infection at delivery from the birth canal of an infected mother) is considered diagnostic of sexual abuse.

I was therefore asked by the parents’ lawyer whether gonorrhoea can be transmitted non-sexually in pre-pubertal children after the newborn period. In my opinion gonorrhoea was exclusively a sexually transmitted disease. Experts in the field, both in New Zealand (such as Auckland paediatrician Patrick Kelly) and internationally (for example Margaret Hammerschlag and Nancy Kellogg in the USA) say that gonorrhoea in a child, other than a newborn, is presumptive evidence of sexual abuse.

Various international guidelines indicate that gonorrhoea in pre-pubertal children is nearly always a sexually transmitted disease, although the possibility on non-sexual transmission is not conclusively excluded. In the US Committee on Child Abuse & Neglect (American Association of Paediatricians, 2005), gonorrhoea is said to be diagnostic of sexual abuse “if not perinatally acquired and rare nonsexual vertical transmission is excluded” and a positive culture for Neisseria gonorrhoeae makes “the diagnosis of sexual abuse a near medical certainty”. The UK National guideline for the management of suspected sexually transmitted infections in children and young people (2003) states that “The bulk of evidence strongly suggests that gonorrhoea in young people over one year is sexually transmitted and the isolation of a gonococcal infection is highly suggestive of sexual abuse”.

Certainly there is no doubt that children as well as adults can and do contract gonorrhoea from sexual contact and sexual abuse. I agreed to conduct a systematic literature review to establish whether there is evidence on the possible non-sexual transmission of N. gonorrhoeae in children after the neonatal period. After some months, having accessed and read several hundred papers, it was apparent that there is overwhelming evidence of thousands of reported instances of possible, probable and definite non-sexual transmission of gonorrhoea.

Results of the literature review

The bacteria which causes this infection, N. gonorrhoeae, will grow at temperatures between 25 and 39 degrees Celsius, It is killed by heat (five minutes at 55 degrees) and dies quickly if dried, but thrives in warm humid conditions. It grows on the mucous membranes of the body and hence can infect the mouth, throat, conjunctiva of the eyes, the urethra, anal canal and cervix. Pre-pubertal girls (but not adult women) are susceptible to infection of the vagina and vaginal lips (vulvovaginitis). The mucous membrane of a young girl’s vagina is more delicate than that of an adolescent or adult because of lack of oestrogen and it has a neutral pH which renders it an excellent culture medium for the bacteria.

Survival on inanimate objects

Studies have been conducted where various objects are contaminated with the organism and then attempts made to culture it after periods of time. It has been recovered and grown from a variety of surfaces including paper, swabs, fabric, rubber, wood, glass and condom after a number of hours, and has been grown from infected bathwater after 24 hours. It can live in pus on towels and other fabric for hours or days. Studies of toilet seats have found that these are unlikely to be sources of infection. Gonorrhoea was not grown in a study of random swabs of public toilet seats. When seats were inoculated with the bacteria, it died within 10 minutes if dried, although it could be grown from pus on the seat after two to three hours.

People are at greater risk from contaminated toilet paper rather than toilet seats. There is one case study of an eight-year-old Australian girl who travelled for 72 hours on a plane from Russia to Sydney. The toilets were very dirty and the girl, instructed by her mother, wiped the seat with toilet paper before using it. A few days after arriving in Australia she developed a gonococcal infection. Despite extensive questioning she remained adamant that she had never been subjected to any sexual contact and it was presumed that she had probably contracted the infection from self-inoculation, wiping herself with contaminated fingers.

Accidental transmissions

The literature contains a number of examples of accidental transmission. The three-year-old son of a laboratory technician was left in the car while his mother shopped, ate infected chocolate agar from a culture plate and subsequently developed gonorrhoea of the throat. Laboratory technicians have developed cases of infected eyes (conjunctivitis) from being struck in the eye with the strap of an infected face mask, and from accidentally spraying their face and eyes with infected fluid. There is an unusual cultural practice of Filipinos using their own urine as an eyewash, and a case series is reported of 13 men with genital gonorrhoea who inadvertently gave themselves gonorrhoeal infection in their eyes. Another case of indirect transmission is of a soldier immobilised in bed for many weeks with fractured legs who acquired urethral gonorrhoea from sharing a urinal bottle with an infected patient in the next bed. An even more bizarre case is one of a sea captain acquiring gonorrhoea from using an inflatable sex doll belonging to the chief engineer who had contracted the infection in a previous port.

Epidemics of conjunctivitis

Large-scale epidemics of gonorrhoeal infections, largely affecting the eyes, are reported in communities where there are overcrowded conditions in substandard housing, insufficient water supply with poor sanitation, inadequate hygiene and a high fly density. Such epidemics are prevalent in parts of rural Africa and outback Australia. For example in 1988 an epidemic involving over 9000 cases over an eight-month period was reported in a district in Ethiopia. Most of those infected were children aged under five years, with no concurrent genital outbreak in the adult population. Similar epidemics of gonococcal conjunctivitis have been reported in Aboriginal communities in outback Australia throughout the 1980s and 1990s. Those affected are predominantly children, most under five years of age. A prospective study of 432 cases in one epidemic in 1991 found that risk factors for infection were being aged under five years and having unwashed hands and faces. Although not definitively demonstrated, it appears likely that flies act as vectors of the disease in these African and Australian outbreaks.

Epidemics of gonorrhoea in children’s hospitals and orphanages

What my review uncovered through successive hand-searching of the references of various papers was a large body of academic literature published between the 1880s and 1920s. I found case reports of over 40 epidemics of gonorrhoea in institutions throughout Europe and the United States involving thousands of children. While the original case may have been sexually transmitted, once a young girl with gonorrhoea was admitted into a children’s hospital or orphanage, this infection would spread rapidly through the inmates. Because no antibiotics were available for treatment, these infections had a huge impact and were the subject of intense international discussion.

The most common site of infection was vaginal in prepubertal girls, but children also developed infections in the eyes, rectum, and joints. In cases of serious infections some children died. In 1883 after an infected girl was admitted into a Budapest hospital, 25 girls developed vulvovaginitis and a nurse contracted conjunctivitis. The infection was thought to be transmitted via contaminated bedding, instruments and bandages. In one case in Posen (now in Poland), 236 little girls developed the infection from sharing a public bath. In 1896 after an infected child was admitted into a New York City orphanage, 65 girls developed vulvovaginitis with some progressing to peritonitis. In this case the disease was spread by common bathing of 20 to 30 children in a tub. A boy also developed an infected eye from a towel. A 1927 epidemic in a Philadelphia hospital involved 67 babies in same ward. The initial case was likely a vertical transmission from birth but the infection was probably spread by the use of a rectal thermometer leading to the babies developing vulvovaginitis, rectal infection and arthritis.

For most of these cases there can be no doubt that the infective organism was gonorrhoea. Neisseria gonorrhoeae is a gram-negative diplococcal (‘double rod’ shaped) bacterium. It was diagnosed microscopically by seeing the bacteria inside cells from gram-stained smears of secretions and also by culture of the bacteria on selective media wiped with infected swabs. There are many other species of Neisseria as well as N. gonorrhoeae (for example, N. lactimica, N. cinera, N. meningitides) which may be present normally in the mouths and throats of adults and children. However these do not cause infections such as vulvovaginitis. The combination of the vaginal symptoms plus identification by both gram stain and culture realistically means there is no other organism that could have been responsible for these outbreaks.

The only means of control of these epidemics was identification and prevention of the source of transmission. Strict isolation strategies were introduced. In some institutions girls underwent vaginal cultures and were refused admission if they were found positive with gonorrhoea. In other cases, infected children were kept isolated with separate rooms and separate nurses. Strategies documented in the literature to curb outbreaks include no sharing of clothes, wash cloths, towels or bathwater. Infected children were provided with individualised thermometers, nursing bottles and combs. Nappies were sterilised or made of light muslin and then destroyed. Strict attention to hand-washing in caregivers, especially nurses, was introduced and in one institution an epidemic was finally brought under control by nurses wearing rubber gloves to change nappies.

Household transmission

There are a number of cases reported in the literature of clusters of gonorrhoea infection (vulvovaginal, urethral and conjunctival) occurring in over-crowded living conditions where there are many family members in small crowded dwellings. In these circumstances there is often sharing of bedding, towels and under-clothes, and lack of available water for personal and laundry washing. Case reports come from all over the world from countries such as Nigeria, Malaysia and Alaska. There is a British report of an eight-month-old boy who presumably developed gonococcal conjunctivitis from the towel of 21-year-old infected female lodger, and two preschool children similarly contracted eye infections from towels used by infected parents.

In household cases often it will not be possible to determine whether transmission has been sexual or non-sexual. However in these circumstances, especially where there is no disclosure of sexual abuse by the children, nor any sign of trauma on examination, some cases are likely to have resulted from contamination rather than sexual abuse.

What happened to Lana

Lana was 13 months old when she was taken into foster care. Her mother was pregnant at this time. Two months later her parents separated for a month in an attempt for Lana to be returned to her mother, but the doctors involved were adamant that either her mother or her father had sexually abused her and therefore she was safe with neither. A month later the couple reunited. When Lana was aged 18 months her brother was born. CYF had been considering uplifting him at birth but they decided to allow the parents to keep their boy. Lana was cared for in a number of different foster homes.

By the time the case was heard by the Family Court, she was aged two years six months. I wrote a report on the possibility of both sexual and non-sexual transmission, and provided the doctor for CYF with photocopies of all the papers in my review. However she stated that

Mothers and fathers can abuse children and there has had to have been transmission from and to mucous membranes

Furthermore:

It does not help that Dr Goodyear-Smith is suggesting that accidental contamination is possible when there is no scientific evidence in the literature that has ever confirmed this possibility

She dismissed all literature prior to 1980 as unreliable, and considered that the institutional cases were either all cases of unrecognised sexual abuse, or alternatively were caused by an organism other than gonorrhoea. She said that the vagina was a different “immunological compartment” to the conjunctiva (hence you could have non-sexual transmission in the eyes but not the vagina), and persisted with the orthodox view that gonorrhoea in a child beyond the newborn age is sexually transmitted.

The judgement was reserved for another two months, and was released when Lana was aged two years eight months. The judge accepted the orthodox view, decided that it was more likely than not that Lana’s infection had been sexually transmitted, could not determine whether it was her mother or her father who had abused her, expressed concern at her parents’ steadfast and united denial of sexual abuse, considered that there was a grave risk that Lana was likely to be sexually harmed if she was returned home and therefore made a declaration that the little girl was in need of care and protection as a ward of the state.

An Australian case

I was involved in a similar case in Australia where a father, who had transmitted gonorrhoea to his young daughter, was similarly accused of sexual assault. He had been acquitted in the criminal court but the social services would not allow him to have any contact with his wife and daughter. They were fighting to be reunited as a family and the case finally reached the Appeal Court in March 2008. I attended a conference of expert witnesses in Australia, where myself, an Australian pathologist, two Australian sexual health physicians and an American paediatrician spent a day with an independent mediator to discuss the possibilities of non-sexual transmission. The three Australians and myself were in agreement that non-sexual transmission could occur, and in our opinion was the likely cause of the child’s infection in this case. The paediatrician was adamant that non-sexual transmission was not possible. The case was heard in the Appeal Court over the next few days and resulted in the judgement being in favour of the opinion of myself and my Australian colleagues.

International controversy

British Medical Journal

Having conducted this comprehensive systematic review, I considered it important for this information to be disseminated professionally in the peer-reviewed academic literature. I submitted my paper for consideration to the British Medical Journal (BMJ). Their review process took considerably longer than usual. I later learnt that this was because of debates by the journal editors on whether to consider it for review, and then difficulty finding someone to review it. Eventually it received one of the best reviews I have had. The reviewer wrote:

“The paper tries to redress some balance to this emotive area and uses evidence to show that each case of infection should be judged on individual merit … the paper is important and should be accepted for publication.”

Despite this review, the BMJ editors then rejected the paper because:

“We can find no evidence that the guidelines (or anyone really) would suggest that a mere finding of this sort would merit removal of a child from its family as suggested in the intro to this piece. All authorities in the UK would say that it is just one piece of evidence to be added to others.”

Journal of Forensic and Legal Medicine

I subsequently, in 2007, published my review in a peer-reviewed forensic medical journal, the Journal of Forensic and Legal Medicine, (JFLM). I also presented my review at the Faculty of Forensic and Legal Medicine, Royal College of Physicians Conference in Torquay, England in 2007 to a responsive audience. My paper solicited a long and scathing Letter to the Editor by Nancy Kellogg, author of the USA guidelines (Committee on Child Abuse and Neglect. Clinical Report: the evaluation of sexual abuse in children, published in the journal Paediatrics in 2005). Kellogg described my review as “One person’s speculative journey into her belief that non-sexual transmission is not rare” claiming “She provides neither evidence nor a systematic review.” She suggested that the numerous institutional cases were either all cases of sexual abuse or alternatively were due to an organism other than gonorrhoea. She wrote:

” It is totally baffling why case reports met the criteria for this ”systematic review,” yet randomized controlled trials, comparing, for example, the gonorrhea rates of children who were sexually abused to children who were not, were excluded.”

Kellogg’s letter was published with my rebuttal. I responded that hers was a strawman argument, because fortunately gonococcal infection in prepubertal children is a rare event, by whichever means it has been acquired. Mine is in fact a rigorous systematic review, meeting all the required criteria, and the reason why no randomised controlled trials were included were because none exist, and would of course be unethical to conduct.

NZLawyer

An article about my review was published in the NZ Lawyer 12 October, 2007). NZ members of DSAC (Doctors for Sexual Abuse Care) Drs Janet Say and Patrick Kelly wrote a Letter to the Editor the following month, claiming that mine was not a systematic review, that the outbreaks in institutions were caused by non-gonococcal organisms, that the outbreaks in institutions were caused by sexual abuse, that “The eye (anatomically, immunologically, and physiologically) is different from the genitalia” and that I had not conducted a forensic sexual abuse examination in 20 years.

Again I had right of reply and had the opportunity to explain how the review was systematically conducted, and why the papers reviewed involved cases where the diagnosis of gonorrhoea in institutions was not in doubt.

The physical signs of child sexual abuse

The Royal College of Paediatrics and Child Health (RCPCH) was conducting a major revision of their child sexual abuse guidelines, and colleagues of mine in the Faculty of Forensic and Legal Medicine, Royal College of Physicians, sent them my review to include in their chapter on sexually transmitted diseases. The physical signs of child sexual abuse: An evidence-based review and guidance for best practice was published in March 2008. Despite receiving my review, this book persisted with the message that gonorrhoea in children after the newborn period indicates sexual abuse. They wrote:

“sexual abuse is the most likely mode of transmission in pubertal and prepubertal children with gonorrhoea”

and:

“In a recent systematic review, Goodyear (2007) considered the evidence for non-sexual transmission of gonorrhoea in children after the neonatal period. This review did not have the rigorous criteria used in this evidence-based guidance concerning the certainty of diagnosis/exclusion of abuse and included conjunctival infections”.

At the book launch the leading authors of this chapter, Drs Karen Rogstad and Amanda Thomas, said that there was no evidence of children acquiring gonorrhoea from non-sexual means. The full audiotape of the proceedings was posted on the RCPCH website. When asked about my review Dr Rogstad said that it was a very dangerous paper developed by someone producing papers to support an incongruous belief and that it was a harmful editorial that had not been peer-reviewed.

My subsequent complaint to the RCPCH has resulted in their removal of the audio-taped recording of the book launch from their website, and an apology that my work was not “a non-peer reviewed editorial”, but has made no concessions regarding the possibility of non-sexual transmission in children. What I asked for but did not receive was a page insert into the book (in those volumes not yet sold) explaining the importance of considering both non-sexual and sexual transmission when gonorrhoea is found in children, looking at it case-by-case for possibility of both sexual contact and accidental contamination, with reference to my review plus Kellogg’s letter and my reply. I also requested that this statement be posted on the RCPCH website at www.rcpch.ac.uk/Research/CE/RCPCH-guidelines where the book is promoted.

Does it matter?

While Drs Kellogg, Rogstad, Thomas, Kelly and others have made disparaging remarks about me and erroneously criticised and discredited my work, I am well used to such attacks which in themselves have little impact on me. However, The physical signs of child sexual abuse is a guidance published by the RCPCH which purports to promote best practice based on an evidence review. This potentially is a highly influential publication in the English-speaking world.

It is my presumption that my review is considered as “dangerous” because it was perceived that it might assist guilty men be acquitted, and children returned into unsafe homes. My view is that in the absence of any supporting evidence or suspicion of sexual abuse, the presence of gonorrhoea alone may not be adequate evidence to convict beyond reasonable doubt, nor even to remove a child from its family on the balance of probability that the child has been sexually abused. While I do not want guilty men to go free nor children returned to abusive situations, nor do I want innocent men convicted and non-abused children losing their families.

This has very significant medicolegal ramifications. In most instances where children are diagnosed with N. gonorrhoeae there has been no disclosure of child sexual abuse. Clearly the possibility of abuse must be immediately and seriously entertained and investigated. However forensic physicians and paediatricians using The physical signs of child sexual abuse as their guideline will be unaware that non-sexual (indirect or fomite) transmission may be the mode of infection in some children, and that this possibility must also be considered on a case-by-case basis.

Furthermore, doctors including myself who put forward the possibility of non-sexual transmission in particular cases in the courtroom, are likely to be presented with statements from The physical signs of child sexual abuse which will be used to discredit or override my review. These guidelines may serve to misinform some of those involved in the care of children and young people.

Apart for the cases in which I have been involved, it is clear that in New Zealand at least, if gonorrhoea is found in a pre-pubertal child beyond the newborn age sexual abuse is presumed a “medical certainty”. In 11 years there were 14 cases seen at the Auckland children’s hospital (Kelly P. 2002: NZ Med J 2002;115(1163). All were taken to their GP with genital symptoms and abuse was not suspected until the gonorrhoea was detected, but all cases were deemed sexual abuse. The identity of the perpetrator was deduced ‘based on who was in contact with child during incubation period’. The outcome of these cases were convictions of suspected abusers, children taken into care and families fleeing the country. It is not possible to know if at least some of these cases were the result of accidental transmission, because this possibility was not considered. It is not known how many cases are occurring in the UK and elsewhere where children are found to be positive for gonorrhoea and sexual abuse is automatically assumed.

Clearly it is difficult to determine whether transmission has been sexual or non-sexual. In the past, cases of sexual abuse may have been missed. The current thinking is that gonorrhoea is definitive evidence of sexual abuse or contact, yet there is conclusive evidence that accidental contamination may occur on occasions. It is my recommendation that all such cases must be taken seriously and considered on case-by-case basis. Missing sexual abuse has serious social and legal consequences, but removing children from their parents on wrongful assumptions can be equally damaging. Doctors and lawyers should be cognisant of the large body of literature demonstrating both sexual and non-sexual means of transmission of gonorrhoea in children.

Hokum Locum

Bogus chiropractor?

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

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

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

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

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

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

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

Marlborough Express 22 August 2008

Cosmetic Acupuncture

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

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

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

Sunday Star Times 26 October 2008

The loopy left?

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

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

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

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

www.dailymail.co.uk

Fluoridation

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

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

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

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

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

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

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

Bionase

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

Magic for Mosquitoes

While we were in Fiji recently there was a dengue fever alert. This unpleasant virus is carried by mosquitoes and naturally we were careful to use insect repellent.

We stayed in a Suva hotel; in the swimming pool area there was a large sign stating that guests should not worry about infections carried by insects because the pool area was protected by a MAGNETIC MOSQUITO DEFFENDER.

I searched diligently but could find no evidence of magnets, either electrical or solid state. However we decided that an invisible MAGNETIC MOSQUITO DEFFENDER would probably work as well as one that could be seen.

Some years ago I wrote in this journal that it was safe to drink tap water in Fiji. This is no longer the case, particularly in Suva.

Superstitious? Me? That depends

When the Sunday Star-Times decided to survey the nation on how superstitious New Zealanders are and about what, I got used as guinea pig. Having done a lot of survey design and analysis during the course of my hodge-podge of an academic career, I often end up writing more about the questions than answering them. Add to that the tendency for being, as Margaret Mahy once characterised our group, “a person in a state of terminal caution”, and you can imagine the result.

Well, actually, you don’t have to imagine. Here, from the files of the Chair-entity, is the first half of the response the Star-Times got. See next issue for the rest.

Superstitions

The list below describes actions or events that are often considered lucky or unlucky. Please indicate the extent to which you would try to avoid each one OR make a particular effort to try to make it happen. (7 = I would do this, 1 = I would try hard to avoid this, 4 = Neutral)

• A black cat crossing your path

Not worried about this – 4? Course that might just be the Toxoplasma gondii speaking (a cat-borne parasite that sits inside the human brain making you more prone to car accidents – truly! look it up!)

• ‘Knocking on’ or ‘touching’ wood

5 – for cultural reasons, from time to time to emphasise a point. In much the same way that I’d say “God forbid” without actually expecting the old chap to take a personal hand in things.

• Tossing spilt salt over your shoulder

2 – wouldn’t usually bother, as it’s messy

• Walking under a ladder

2 – if only for safety reasons; I always look up.

When the Skeptics Conference opened one year on a Friday 13th, we had a ladder parked over the entrance doorway and everyone came through under it. We also had a box of mirror glass to break, chain mail letters to ignore, salt to spill, umbrellas to open inside – 13 superstitious activities in all. And it was the one conference where all the speakers ran to time and all the technology was cooperative …

• Throwing a coin into a fountain or well

5 – for cultural reasons (and often because the money is collected for a good cause, also to help future archaeologists have a good time 🙂

• Breaking a mirror

2 – not usually deliberately, though I had fun dropping a large box of mirror glass into the transfer station with suitably satisfying sounds of shattering – should have permanent bad luck as a result!

• Wearing a piece of lucky clothing or uniform to a sports game or an exam

4 – I don’t have anything like that in my wardrobe.

• Thinking about something you really want to happen/are looking forward to

7 – Huh? What’s superstitious about that? You don’t have to enlist the aid of creative visualisation or The Secret (TM) to daydream!

• Wishing on a falling star

7 – Doesn’t stop me from marvelling at the thought of tons of space dust landing on our planet every day, nor wondering what would happen were the thing to be a bit bigger and land in the Pacific …

• Looking at the new moon through glass

Wow, hadn’t heard of this one – what kind of astronomy writer does that make me?!

• Carrying a rabbit’s foot

1 – Kinda gross really. I’d rather wear a half-billon-year-old trilobite fossil (got a silver-mounted one for Christmas), but that’s only ‘cos it’s truly awesome to think it was once wombling around on the ocean floor, not because I think it will bring me luck.

• Standing chopsticks upright in a bowl of food

1 – For culturally sensitive reasons. I lived for five years in Japan, so I would no more do this than put my hat on the table in the wharekai. That said, I once had the most appalling meal of my life in a Japanese restaurant in London and, as a mark of disgust, I stuck the hashi upright when I left. Don’t think the staff noticed – they were French and Korean, which might explain the absolutely awful food …

• Finding a four-leaf clover

4 – Fun in a vaguely interesting way, but not exactly an exciting pastime.

• Crossing your fingers

5 – For cultural reasons or to make a point verbally (see knock on wood above).

Urban Legends – or are they?

Below is a list of (sometimes controversial) theories and beliefs (some of which are definitely true, by the way). Please read through, and indicate how likely these are to be true.7 = Very Likely, 1 = Very Unlikely

• If you go swimming within an hour of eating you’re more likely to get cramp and drown

1 – I’ve researched this one – my son wanted to do it as a science fair project, but we figured getting ethical consent to experiment on his classmates would be difficult!

• The food colourants cochineal and carmine are made from crushed beetles

7 – Cochineal definitely, not so sure about carmine as I don’t know much about that apart from the colour name. Though I daresay these aren’t used much today with synthetic alternatives being available.

• We use only ten percent of our brains

1 – This hoary old one comes up all the time and is a total misinterpretation of the original quote that just doesn’t seem to die.

• Eating carrots improves your eyesight

1 – I love the story of Bomber Command putting this about to try to disguise the development of radar during WWII.

Course, if you want to use this as a metaphor for having a balanced diet and needing some of the vitamins/minerals carrots can give you, then it’s probably better to eat the carrot than not eat it. Don’t overdo it though or you’ll end up looking vaguely jaundiced (there have been cases of that in New Zealand)!

• If you spend too much time at a tanning salon, you can cook your internal organs

2 – Hmm, I’m sure Mythbusters have done something on this but, like so many of their things, I remember them doing it but not the results. I think it unlikely, particularly if the sessions are being run to proper standards. If you just stayed in there it’s possible there many be some low-level thermal damage, but I suspect it would take a long time and/or would not penetrate much.

• Using a cellphone at a petrol station can cause an explosion

2 – Ah, a Mythbusters episode I do remember. They had to go through some highly convoluted situations to get finally an explosion. It doesn’t look like ordinary usage can do this, which doesn’t stop people being told to switch their phones off. Course, they shouldn’t have their phones on in the car in the first place, but that’s another story …

• Pet baby alligators have grown to enormous size in sewers after being flushed down the toilet

5 – For a certain value of enormous which I suspect is pretty small. You can flush a baby alligator down the toilet, depending on the sewerage system you have, and it can grow down there if the rats don’t get it first. Ever read Harlan Ellison’s short piece about the giant albino alligators living on the dope flushed down the sewers of New York? Now there’s an urban legend to conjure with!

• The seasons are caused mainly by changes in the earth’s distance from the sun during its orbit

5 – Not an urban legend as such. Having an elliptical orbit helps, as does having a planet with a 23.5 degree tilt. You could also argue that local variation has as important a role – in Auckland, the oak trees tend to be green one day, then brown and on the ground the next, with hardly any autumn to show for it; in Arrowtown, the autumnal colours are spectacular.

• As long as you pick up a piece of food dropped on the floor within 5 seconds it won’t be contaminated by germs

5-3 – Depends where you drop it of course, as some surfaces are more contaminated than others. I always had the 5-second rule with my kids – helps build the immune system as well as save money!

•There is a giant black cat living wild in the South Island countryside

5 – Fence-sitting on this one. If you’d said ‘panther’ I’d give it a 1 straight away as extremely unlikely – those things are humongous (hip height to an adult, weighing the same as Dan Carter!).

But there could be a ‘giant’ black cat, as in one (or more) larger than the ordinary moggy out there. Feral cats can get very big. That said, none of the videos or photos to date have indicated that the cat/s are particularly large once you take into account distance, scale effects, the cat running etc.

My Habits

How frequently have you done any of the following?

(Answer daily/weekly/monthly/once a year/occasionally/etc)

• Visited an astrologer

Never. Though I used to cast charts while studying astrophysics at university! That’s how I learned it was more a matter of psychology than anything else.

•Looked up your (or someone else’s) horoscope

Occasionally. Not for a long time though. That’s because I got to the point of thinking that being told to be wary of someone simply because they were a Scorpio was as distasteful as being told to be wary of Samoans or Jews. Stereotyping people in the name of entertainment is nonetheless stereotyping them, to all our detriment.

So when someone asks me my star sign, I say I’m an Asparagus.

• Watched a TV psychic (eg, John Edward, Colin Fry)

Sadly, yes, from time to time, but only in a professional capacity in order to make an informed comment.

• Visited a Tarot reader

Once, just to see how they operated.

• Looked up your (or someone else’s) biorhythm profile

Couple of times as a teenager. Seemed to have no relationship whatsoever to what was going on.

• Visited a palm reader

Haven’t encountered one. I’d be intrigued to hear what they think of my lifeline – it doesn’t end but disappears into my wrist skin.

• Prayed to St Christopher to help you find something

No you idiot, that’s St Anthony!

• Visited a psychic

Not personally, but have been to psychic readings and book launches and other promotional marketing activities by the performers involved in this growing industry. Seen the same old dreary parlour tricks time after time, which is sad, ‘specially when you see vulnerable people being ripped off.

• Attended a séance

No.

• Watched ‘Sensing Murder’

Sadly, yes, from time to time, but only in a professional capacity in order to make an informed comment. I find such psychological manipulation ethically objectionable, especially as an excuse for exploitainment. (Isn’t that a fine word – we need to introduce it into the idiom!)