No Medical Ghetto
In the last issue I warned of the dangers of a medical ghetto developing on the Auckland North Shore. Fifty new doctors set up practice in Auckland last year and even more overseas doctors are pouring into New Zealand. There has not been a corresponding drop in consultation fees in a local aberration of the law of supply and demand. Fortunately, the Northern Region Health Authority has moved to cap any further increases in doctor numbers which have already cost an extra $20 million in subsidy claims. (Christchurch Press 24/4/95)
Retired British policeman Peter Bennett claims that criminal behaviour can be controlled by dietary manipulations. Following a shooting spree in the US, an offender claimed that he was temporarily insane due to excessive dietary sugar (the Twinkies defence, named after a proprietary candy bar). After a special diet, it was claimed that nine recidivist criminals showed a dramatic improvement in behaviour.
Such claims have been made before in connection with children’s behaviour and shown in placebo-controlled trials to be wrong. What Mr Bennett has overlooked is that changes in diet are associated with a change in management, and it is this that has the effect rather than the diet. (Dominion 3/4/95)
Magic Mushrooms in Fiji
Following its importation by a soldier returning from overseas, Fiji has been in the grip of mass hysteria over the magical properties of a tea made from mushrooms. As with most other quack remedies it is claimed to cure everything from baldness to diabetes.
The mushroom, which looks like a bloated, gelatinous pancake, is floated in sweetened black tea and the fermented brew is drunk a week later. The brew is also known as “kombucha” and is gaining popularity in the US and some other Asian countries, and has been touted as an AIDS remedy. (NCAHF Vol 18, No 2) It is in fact a symbiotic colony of yeast and bacteria. I wonder how long before the brew arrives in New Zealand. (Marlborough Express 10/4/95)
Attention deficit disorder (ADD) is alleged to be an organically based condition where children are impulsive, overactive and have a short attention span. ADD has previously been known as minimal brain dysfunction, hyperactivity, hyperkinesis and Strauss syndrome, to name but a few.
In fact, ADD is yet another example of the expansionist activities of health professionals who “convert” ills into illnesses. This is the very activity which Illich warned about with respect to the medical profession.
ADD is far more likely to be simply a description of badly behaved children. Instead of concentrating on the behaviour (an effective strategy), people form support groups and look for organic causes which is a waste of time and resources. (GP Weekly 14/4/95)
Occupational Health Delusions
In a landmark decision, a company was fined after admitting a charge that they failed to take steps to protect an employee against occupational overuse syndrome. The employee had been in the new job for four days. I wrote to the company urging them to defend the case but they chose to plead guilty.
After this ludicrous decision I wrote to the Dominion but they chose not to publish my letter. I have also written to the occupational health publication Safeguard but I am not confident on seeing any expression of opposition to the absurd idea that anyone can develop OOS after four days in a new job.
There are, however, some glimmerings of understanding creeping into the literature. A judge in the UK rejected the concept of OOS and in the US a court rejected a claim that computer keyboard design causes it.
Writing in Safeguard (No.30 1995) Alan Boyd lamented the fact that ergonomic changes in the workplace had not lessened the prevalence of OOS. This is not at all surprising to me as no amount of ergonomic posturing can lessen the prevalence of a psychogenic (produced as a result of psychological stresses) condition such as OOS.
In Safeguard Update (27/3/95), Chris Walls acknowledges that anxiety and depression are common in New Zealand, affecting 13% of the population. Exercise is prescribed to relieve anxiety and reduce the chance of OOS. I find it ironic that in their own literature, all the clues are there for a proper understanding of OOS but occupational health workers continue to miss the bigger picture.
When a job becomes too difficult and less socially enjoyable, people start to focus on their symptoms. Attribution to work then means that the problem is the fault of the employer and the availability of compensation validates the “illness”. OOS can only be understood by looking at the historical record of psychogenic illness. This is brilliantly examined in a new book, From Paralysis to Fatigue by Edward Shorter (The Free Press, 1992) which is supported with superb clinical examples from the medical literature.
A striking theme is the gullibility of doctors who validated such presentations as fits and paralysis. It is interesting to find that patients have always resisted the concept of psychogenic illness and have tended to find more socially accepted labels. This is why neurasthenia has been replaced with chronic fatigue syndrome, and Charcot’s hysteria with other conditions such as total allergy syndrome and multiple chemical sensitivity.
I recommend this book to all readers interested in medical history. It should be required reading for health professionals.
The (Un)laying-on of Hands
A physiotherapy technique known as cupping has been suspected of causing the deaths of five babies and brain damage in eight others. The technique involves tapping the chest with a soft latex cup in an unproven method of clearing chest secretions. Like many physiotherapy techniques, this method of treatment has never been subjected to critical analysis.
The use of the term “cupping” for the procedure is a little unfortunate. Cupping used to be a medieval practice of applying suction cups to the skin to cause localised counter-irritation to some disease process or symptom. Acupuncture and moxibustion are other examples of counter-irritation quackery. Lancet 25/2/95 Vol 345 p510
In the US, case-management became the central tenet of the care of people with severe mental disorders. The case manager takes a full and comprehensive responsibility for the client. This concept spread to the UK because it was believed to be effective.
However, a randomised trial found virtually no difference in outcome for case-managed clients compared with a control group. The authors concluded “it is unfortunate, in view of the limited effectiveness we have shown, that social services case-management was not evaluated in randomised controlled trials before its implementation in the UK.” (Lancet 18/2/95 Vol 345 p409-412)
Once again, this article demonstrates the absolute necessity of critically evaluating new treatments. This process should be extended to evaluate many of our existing treatments across the whole health area.
In a form of primitive immunotherapy, Herb Saunders injected his cows with patients’ blood and then sold the bovine colostrum (“first milk”) with the claim that it would cure cancer and other serious diseases.
Saunders sold each patient a cow for US$2500, but not only kept the cow on his farm but charged the patients $35 a bottle for the worthless nostrum. He was charged with practising medicine without a licence but the jury were unable to find a majority verdict of guilty. In my opinion Saunders was definitely guilty of milking his patients!
The California Medical Board has been attempting to prevent the use of chelation therapy for unapproved indications. At a meeting, dozens of patients gave impassioned personal testimonials claiming cures after chelation treatment. It was noted by observers that the “tense atmosphere did not lend itself to rational decision-making.” Despite several impeccable trials that showed no benefit, chelation therapy continues to be offered in New Zealand.
With respect to the dramatic improvements claimed, it is more likely that there has been a fraud rather than a miracle. When confronted with the ravages of arterial disease, people often make profound health and lifestyle changes. They quit smoking, lose weight, exercise and make substantial changes to their risk-factor profiles. These same people are also the ones most likely to seek out chelation therapy. How ironic that they end up paying out thousands of dollars for a treatment whose benefits have been produced entirely by their own effort. (NCAHF Vol 18, No.2)