Following his own empirical observations that bee “treatments” helped his arthritis, a Levin bee-keeper is claiming that he is being ignored by the medical profession. (Press 3/8/93) Not surprisingly, his trial of 11 patients failed to impress skeptical observers. Two patients dropped out and the remainder reported that the “sting” was effective. Having paid for the privilege of being stung, a sensation to be normally avoided, they are hardly likely to say that the treatment was worthless.
In the middle ages, hornets were applied to the skin as a treatment for plague. Nothing appears to have been learned from such unpleasant, not to say dangerous, treatments.
An unqualified woman who posed as a doctor and professor, was sent to prison for 6 months for fraudulently claiming that she could cure cancer and AIDS. Analysis of her product, Cancelle, or CH6, showed “it had no medicinal properties and contained toxic elements.” (BMJ 306 p1499).
It is ironic that the courts (in the UK at least) will move swiftly to deal with quacks, but the medical profession has failed to take action against registered medical practitioners who practice quackery such as homeopathy and EAV diagnosis.
Australia has a high rate (30-35%) of caesarean sections among private patients, and the introduction of a global obstetric fee that applied irrespective of the mode of delivery did not change the proportion of caesarean deliveries. (BMJ 306 p1218) The caesarean rate in Brazil is an amazing 50% on average, with the highest rates among the poor. Two reasons for this are a virtual absence of midwives and the belief (encouraged by obstetricians) that a vaginal delivery will permanently impair normal intercourse afterwards. Both of these examples demonstrate how doctors can develop bad practices when the socio-cultural environment allows this to happen. Only patient education with strong and ethical professional medical leadership, can prevent this kind of surgical abuse.
Low back pain
Readers will remember Denis Dutton reporting his experiences with an episode of low back pain, or lumbago (Skeptic 24). A Canadian study (British Journal of Industrial Medicine 1993; 50:385-8) found that the best treatment for uncomplicated lumbago was to remain active. The traditional treatment of bed rest was thought to encourage chronic invalidism.
This theme was continued by Robin McKenzie (Press 11/6/93) who attacked the current traditional approach to low back pain. Of physiotherapy, he said “it had for 75 years relied on unproven methods and `hocus-pocus’ electrical gadgetry” and he went on to say that “doctors should prescribe active rather than passive therapies.” Most controversial was his statement that “50% of workers on compensation were feigning illness.”
I am sure that there is an element of truth here. Physiotherapists use a wide variety of treatments and machines, many of which have not been adequately tested. It is too easy for people to refuse to accept responsibility for their own recovery and become chronically dependent on ACC. This applies not only to back injuries but other conditions such as chronic fatigue syndrome (CFS) and occupational overuse syndrome (OOS).
Readers will be familiar with my position with respect to OOS, which has its roots in abnormal illness behaviour and psychological factors. It is interesting to compare it with the “sick building syndrome” (SBS), another new age medical invention. At last someone has done a trial of randomly increasing the ventilation rate while getting workers to report their perception of the indoor environment. (NEJE 328: 821-7)
To quote the authors: “Increases in the supply of outdoor air did not appear to affect workers’ perceptions of their office environment or their reporting of symptoms considered typical of the sick building syndrome.”
I would like to offer what I regard as a more likely explanation of the SBS which also relates to OOS. People crowded into a large building, working at VDUs and perhaps isolated from each other are always going to be vulnerable to a belief that the working environment is in some way responsible for vague and ill-defined malaise.
A report of a survey in the Christchurch Press (21/5/93) confirmed a high level of stress and dissatisfaction in the workplace. Half of the respondents said they would change jobs if they could and many felt that changes in conditions had resulted in more work for less pay. Most felt that they had less power to control their work environment.
Such surveys are extremely valuable because they provide a clue to the origin of conditions such as CFS, SBS, and OOS. I have no difficulty in accepting job-related stress, but I would prefer to see some honest acknowledgement of this by patients and doctors instead of the fraudulent collusion which creates mythical conditions as CFS, SBS and OOS.
Placebo controlled trials
Since such trials appeared in the late 1940s they have continued to be a valuable tool for investigating the efficacy of new treatments and drugs. Fish oil supplements were tested against placebo capsules for the treatment of psoriasis and there was no significant improvement in either group (NEJM — reported in GP Weekly 7 July 93). Refer also Skeptic 27 for an excellent review of the placebo effect by Dr Bill Morris.
Weight loss delusions
The diet industry is worth millions as women strive to achieve the impossible standards set by the fashion industry. Journalists have even invented a new term for fat, “cellulite”, which apparently looks and feels different from other body fat. (Marlborough Express 24 Sep 92) It can be removed by massage and body treatment products. Obese subjects can pay $180 to be blasted with water jets which “eliminate fat deposits and excess fluid” while hydrotherapy with miracle algae can “restore a balanced energy flow to the body”. (New Scientist 1 June 1991 p47) I hope this particular clinic has good grease traps in its drains.
Other researchers try and tell us that obesity is inherited and therefore nothing can be done. This ignores the success of weight-watchers and the obvious argument that if weight can be gained it must also be able to be lost.
A study (NEJM reported in Patient Management June 1993) found that diet-resistant patients under-reported their actual food intake by 47% and over-reported their physical activity by 51% and “diet-resistant patients were significantly more likely than control subjects to believe that they had a genetic or metabolic cause for their obesity, and to describe their eating behaviour as relatively normal”. This important work clearly demonstrates yet again the importance of patient beliefs in relation to illness behaviour.
While on the subject of over-eating, I note that a typical cat living in Britain is given twice as much protein a day as that eaten by a typical poor African.(BMJ Vol 306 p1078)
In Skeptic 26 I offered to go into business with anyone prepared to join me in selling pure water labelled as “homeopathic preparations”. Two homeopaths were indignant about the use of active ingredients in the case of herbal medicine poisoning I described in Skeptic 28 and one went on to say “it is absolutely unethical for any medicine to be sold as natural and especially as homeopathic if it were to include pharmacologically active ingredients”. (Letters – BMJ Vol 306 p656)
I still think it would be a bit of fun to sell some pure water (labelled as homeopathic preparations), invite prosecution and argue it out in court. It could prove to be a more useful arena in which to examine the enduring scam of homeopathy. I could enjoy hearing homeopaths being cross-examined by a skeptical lawyer. At least selling pure water is honest!
Not content with exterminating tigers in their own country, the Chinese have over 110 factories turning tiger bone into tablets, wine and various confections. Presumably the ingestion of such products is believed to confer some of the vigor and vitality of the unfortunate tiger. There are only about 6,000 tigers globally and trading in tiger products is banned by international convention. What a monumental folly that these magnificent and intelligent animals end up being turned into useless traditional medicines because of human stupidity and superstition. (Lancet Vol 341 p46)