Sickness and Psychogenic Illness
The Canterbury ME (chronic fatigue syndrome, or CFS) are up in arms over proposed tighter controls on patients receiving both invalid and sickness benefits. CFS patients want funding for “residential detoxification services and “subsidies on natural remedies”. CFS is a classical psychogenic illness and as such it is quite improper for any affected patient to be on any long-term benefit on their own terms. Because of self-denial these patients resist any sensible suggestions on treatment and end up chronically unwell in a fulfilment of Abraham Lincoln’s statement that “most folks are as happy as they make up their mind to be.”
I managed to persuade such a patient to take anti-depressants and the improvement in well-being was amazing. This same person had paid to have all amalgam dental fillings removed and replaced with a predictable lack of improvement. A characteristic of CFS is the almost fanatical belief of the patients that their “illness” has a physical cause. Here is a report from a clinical psychologist about such a patient: “He scored nought on the depression inventory and three on the anxiety inventory. This is a person who does not wish to reveal anything about himself. During the interview he made it clear that he sees his problem in terms of recovery from a physical illness with no concomitant psychological manifestation.”
This fanatical belief in a physical cause of ME is also shared by many doctors whose therapeutic contact with their patients becomes a classic folie a deux.
Cultural variations were found in a WHO study which looked at depression worldwide. Only 5% of patients who were depressed said that they had psychological problems. Such a level of denial is compounded by the useless treatments offered by doctors. For example, antidepressants were prescribed for anxiety as often as for depression. Japan had a low incidence of depression due to the Japanese concept of jibyo signifying a mild chronic illness which a person carries through life and is not considered serious.
It should be mandatory for all patients with a diagnosis of CFS to undergo assessment by a Mental Health team. No person with CFS should be entitled to any long-term benefit unless they have had at least a six month trial of anti-depressant therapy. (Christchurch Press 18/7/95 New Scientist 25/3/95 p10)
Multiple Personality Disorder
This is a typically loony belief of New Age psychiatrists and it has received widespread acceptance in the US. This is hardly surprising in a culture where thousands of people believe that they have been abducted by aliens. Even such an august institution as Harvard Medical School has a psychiatrist who believes that extraterrestrial beings have visited this planet and abducted Earthlings! Striking a blow for academic freedom, the Dean of the Medical School “reaffirmed Dr Mack’s freedom to study what he wishes and to state his opinions without impediment.” In contrast, the British specialists have condemned the idea in scathing terms. Imagine the convenience of being able to blame an alternative personality for some misfortune such as a criminal offence. This absurd concept of MPD fits in to the prevailing “victim” philosophy of life whose adherents view themselves as being subject to forces beyond their control. (New Scientist 17 June 95, GP Weekly 23/8/95)
Continuing OOS Delusions
The occupational health professionals continue to indulge themselves over OOS. ACC is reported as being concerned about the vague nature of OOS and the fact that claims cannot be satisfactorily proved or disproved. Claims against ACC reached $4 million in the year ended 30 June 1994 and are increasing. The huge army of consultants advising on posture are doing just that — posturing.
At least I managed to get my contrary view published in Safeguard. Bernard Howard also sent me a newspaper cutting of a story concerning a musician allegedly suffering from OOS. I will quote his remarks which need no further comment: “After centuries of playing their instruments for hours per day, every day, musicians are only now developing OOS. Come back Paganini…all’s forgiven!” (Safeguard Update Nos 26, 27 1995.)
15,000 French doctors practise acupuncture and many also use “high-dilution” homeopathic medicines. It is not surprising then that a hospital dedicated to traditional Chinese medicine will open in Paris next year under the joint sponsorship of the Chinese and French Ministries of health. It is promoted as a measure to control spiralling health costs.
This trendy quackery will help the “worried well” but will do nothing to control spiralling health costs which are a feature of unreasonable patient expectation and over-application of medical technology. (British Medical Journal Vol 310 p1285)
Uncontrolled Medical Appetites
Magnetic resonance imaging (MRI) is a radiological technique which is valuable for examining internal organs. In NZ Doctor, an American doctor outlines what he calls MRI madness. Americans are so obsessed with MRI technology that there are 25 times as many machines in California as in Canada, which has about the same population. Patients demand MRI scans for virtually any medical condition and as a third party (ie. insurance company) is paying, they get what they want.
Just about everyone with low back pain gets an MRI scan. However, a new study found that two out of three people without back pain have evidence of a disc protrusion. The authors concluded that anatomical abnormalities are common in normal people.
A skeptical US doctor described the obsession with MRI as “MRI tiger balm”. (GP Weekly 27/7/94, NZ Doctor 23/6/95)
A Reader Writes
In Skeptic 36 I asked how long before magic mushrooms (Kombucha) arrived in New Zealand. John Turner has written from Motueka to tell me that they are here! [See also Forum] I hope I am not compromising his continued existence in Golden Bay by passing on his description of the area as being a “bloated gelatinous pancake of new Ageism.” As John describes it: “the ‘mushroom’ has a baby which is then passed on to someone else.”
One convert claimed he was cured of “toxins” which coloured his urine brown as they left his body. John quite reasonably enquired as to what colour the mushroom brew was. It was brown! Those readers contemplating a visit to Golden Bay will be pleased to know that every quack treatment is available from holistic pulsing to sound healing with “yidaki” or as it is more commonly known, didgeridoo therapy. This may all sound like a lot of didgeridoodoo but in the US a woman died and another was hospitalised due to severe acidosis after drinking Kombucha tea. (John Turner (personal communication), Nelson Evening Mail 8/7/95, NCAHF Vol 18 No.3)
I recently complained to the Medical Practioners Disciplinary Committee (MPDC) about a doctor who made a series of ignorant and unproven claims in respect of immunisation. The MPDC is fairly toothless when it comes to dealing with scientific incompetence in medical practitioners and the unrepentant doctor even wrote me a letter declaring he was proud to be a member of the American Quack Association (Quack = Quality, Care and Kindness). I will quote a short passage to show how impossible it is to argue with such people.
I challenged his claim that Vitamin C is an effective treatment for viral diseases (7 placebo controlled trials showed lack of effect for Vit C in the treatment of cold virus infections). Here is his reply: “There is extensive peer-reviewed literature bearing witness to the clinical effectiveness of ascorbic acid in viral diseases. You will not find reference to this in Medline or Index Medicus journals that represent only about 10% of the world’s scientific journals and are controlled by the international pharmaceutical industry.”
This one paragraph contains two of the main quack elements. Firstly the suggestion that some alternative inferior data base is an acceptable alternative to controlled trials, and secondly the familiar old conspiracy bogey that scientific journals are controlled by vested interests.
The President of the Australian Medical Association has come out a lot more strongly than the NZ MPDC, by recommending that doctors who use their scientific standing in the community to support the anti-immunisation movement should be charged with medical negligence. At the time he made this remark Australia came near the bottom of a list of industrialised nations when rates of childhood immunisations were compared.
It is sad that at time of writing Russia is in the grip of an epidemic of diptheria which has killed more than 2000 people. This was a direct result of allowing immunisation levels to drop below the 95% required to prevent epidemics. (Dr Quack (personal communication), British Medical Journal Vol 310, p760. Lancet Vol 345 p715)
Evidence Based Medicine
Although my main interest is alternative medical quackery there are many traditionally accepted medical practices which have never been critically evaluated. I mentioned counselling in Skeptic 36 and this was enlarged on by Jim Ring in the last issue.
In Britain, the BMJ is sponsoring a Journal of Evidence-Based Medicine which is aimed at critically evaluating both new and old treatments. The key element is randomised controlled trials (RCT’s) in which patients must be randomly allocated to either a new treatment group or a control group (may be the existing treatment or no treatment). A survey of RCT’s in pregnancy and childbirth found that out of 100 procedures commonly carried out by obstetricians and midwives, about 20 are actually harmful.
If you go to your doctor complaining of a cough, the chances are that you will come away with a prescription for an antibiotic. This is despite the fact that seven RCT’s have shown no benefit for such treatment. It was also difficult to carry out the trials because in one survey 60% of eligible patients refused to enter a trial because they felt that antibiotics were absolutely necessary to cure their condition. Perhaps this is a good argument for using harmless placebos in such cases? I should mention a note of caution against blindly imposing the results of RCT’s on patients and this point was well expounded by Sir John Scott at our last conference. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? (Lancet Vol 345 p665)
Aminophylline-containing cream is a popular quack remedy for reducing the size of large thighs. In a test, researchers studied women who were asked to massage either the cream or a placebo into one thigh and one side of the stomach. 11 out of the 17 women completed the study and, as anyone could have predicted, there was no fat-reducing effect. Despite measurements to the contrary, one woman was convinced that the cream worked. If it is important for people to believe in something, no amount of evidence to the contrary will convince them. (National Council Against Health Fraud (NCAHF) Vol 18 N0.3)
Civic Creche Case
Professor Michael Hill examined some of the issues behind the civic creche case in an article in the Christchurch Press 31/3/95 which I have forwarded to our editor. Hill coins the phrase “culture of complaint” in which disaffected people take little responsibility for their own lives and look instead for someone to blame. The existence of compensation through litigation completes this ‘Americanisation’ of our culture. It is incredible how quickly the false ideas behind ritual sexual abuse spread and were recreated throughout NZ.
I was disgusted with the judiciary over the civic creche case although the whole process was hijacked by the usual cohort of poorly trained quack therapists. The prosecution was able to get away with not presenting evidential material so ridiculous that it would have weakened their case. In a trial of any kind all the evidence should be available to both sides. My heart goes out to the falsely accused women whose lives have been ruined by this evil nonsense. I seriously question whether there was any chance at all of Peter Ellis getting a fair trial in an atmosphere of hysteria reminiscent of the Salem witch hunts.
A group of scientists have petitioned the FDA to place tighter restrictions on homeopathic remedies by making them reach the same standards of safety and effectiveness as other OTC drugs. There should not be any problem over safety since such remedies are the pharmacological version of the emperor’s new clothes. The drug exists in the imagination only.
Predictably there has been opposition from the National Centre for Homeopathy because “homeopathy doesn’t treat diseases but treats people who are ill.” The NCH wants a different type of evaluation. This is rather like admitting that homeopathy is scientifically inexplicable so a new science must be created to explain it.