Agent Orange: Déjà vu all over again?

If you don’t get the answers you want from a Government inquiry, press for another inquiry. Vietnam war veterans have continued such a campaign and have produced a map to confirm that they were present in areas that were sprayed with the defoliant under the US Army “Operation Ranch Hand”.

The Dominion Post (4 October) reports: “The year-long inquiry [the third] heard new medical evidence and harrowing testimonies from veterans, who related the effects of Agent Orange on their health and the health of their children.”

As we all know, harrowing stories get a much better press than the facts. A map confirming exposure is irrelevant. A study of veterans of Operation Ranch Hand found no association between exposure to Agent Orange and birth defects. The US Environmental Protection Agency’s (EPA) Science Advisory Board concluded that dioxin (the alleged carcinogen found in Agent Orange) caused no health effects except for a skin disease seen at very high exposure levels. This is “chloracne”: a recent classic example is the ravaged face of the new President of the Ukraine who was poisoned with dioxin by political rivals.

Victims of the Seveso (dioxin) disaster have been followed up now for 15 years (Epidemiology 1997; 8: 646-652). When all types of cancer were grouped into one category, no statistically significant excess of cancer was observed. However, some cancers have a much longer leadin time, say 20-25 years. My crystal ball tells me that these current findings will stand the extra test of time.

All of this reminds me of a similar campaign to define or legitimise the problems that US Vietnam veterans had in reentering American society. As Edward Shorter puts it (A History of Psychiatry, p.304-5) “In language that anticipated the ‘struggle for recognition’ of numerous later illness attributions, such as repressed memory syndrome, the veterans and their psychiatrists argued that “delayed massive trauma” could produce subsequent “guilt, rage, the feeling of being scapegoated , psychic numbing and alienation.” In 1978 the world was presented with the new diagnosis of “post traumatic stress disorder”, commonly referred to as PTSD. Commenting on this politicisation of science Shorter comments: “Given such antics, it would be difficult to take seriously any official psychiatric pronouncements about problems surrounding … the psychiatry of stress.”

The Near Starvation Diet

Drastic calorie reduction (CR) is the latest diet fad for narcissistic yuppies and is based on experiments that showed animals lived longer and looked younger when fed less. Proponents of CR consume about half the calories normally advised for healthy eating. As if you hadn’t already guessed, the CR Society is California based. There must be more fruitcakes in California than anywhere else but it (fruitcake) would definitely be off limits for a CR adherent.

As one of them is quoted as saying: “ageing is a horror that has got to stop now.” The society’s website “includes a ‘better chocolate pudding’ made with, among other things, 13 squirts of sucralose concentrate, guar gum and micronised cellulose.” It sounds more like a chemistry experiment! CR is basically on the right track but like all such extreme movements has gone too far. Fat people are overweight because they eat too much of the wrong food and they lie to themselves about how much exercise they take. Eating the right quantity of food in the right mix will allow most people to maintain a healthy weight for their height.

ACC Fraud

An ACC beneficiary was jailed for almost three years for obtaining $80,000 by fraud. This was through the use of falsified documents and invoices for home help Dominion Post 6 July). A careful reading of the article reveals the source of the real fraud. The claimant in this case had received cover for the pseudo-scientific diagnoses of “fibromyalgia” and “occupational overuse syndrome”. Fibromyalgia is claimed to be a disorder where there are tender spots all over the body. The French called these “points hysteriques” and I have also seen it humorously described as the German “unt here” syndrome. The patient has pain “here, unt here, unt here”. The diagnosis of fibromyalgia is a logical fallacy as outlined by Quintner (Lancet 1999; 353: 1092-1094).” Fibromyalgia has been promoted as ‘a common and recognisable cause of chronic, diffuse musculoskeletal pain’. This statement violates the dictum in logic that an effect — in this case an illness — should not be confused with its own cause.”

Many such syndromes can be easily explained by existing psychological paradigms and it is clear that fibromyalgia is merely a rheumatological interpretation of chronic fatigue syndrome. As for OOS, those of you who were at the conference will remember the terrific presentation by Dr Lucire who argued persuasively that OOS is a psychological disorder caused by somatisation. This same model could easily fit for fibromyalgia. The real fraud as I say, is when quack doctors endorse complaints as being workrelated and therefore penalising innocent employers as well as being a fraud against ACC.

In Brief

  • Worried about cancer? Why not schedule a whole body CT scan! This sort of absurd over investigation (“gropea-gram”) could only happen in the US where the phenomenon of third-party insurance ensures that people can get any investigation they request. Radiologists have warned that there is a cancer risk from this radiation. One such scan every year for 30 years would produce a cancer risk of 1 in 50 (NZ Doctor, 8 September).
  • An armed robber is suing the police because a police dog bit him. “He suffered recurring flashbacks and nightmares from which he woke in a cold sweat. A prison psychologist had treated him for the after effects of the dog attacks and childhood sexual abuse.” Yes — he has received a diagnosis of PTSD. But wait a moment, doesn’t PTSD require experience of events outside of normal experience. I would have thought that being bitten by a police dog is a normal part of life for such criminals. Still, a diagnosis of PTSD could be useful in getting an ACC claim or getting a sickness benefit. I am more concerned about the police dog. It’s probably quite upset about being made to bite people. I recommend referral to the homeopathic vet and treatment for Pooch Traumatic Stress Disorder (Christchurch Press 31 August).
  • It is claimed that an alcohol vapouriser can produce a feeling of euphoria but not drunkenness. The device has been introduced into the US and uses alcohol combined with pressurised oxygen. I don’t think so! For a start, euphoria is just another term for a form of drunkenness. If alcohol is being delivered to the brain then subjects must therefore be under the influence of alcohol. Pressurised oxygen is highly dangerous and I doubt very much if it could be combined with alcohol without giving subjects a “real blast” (Christchurch Press, 24 August). My favourite story about the dangers of oxygen and inflammable substances is the story of a USAAF pilot who turned up for work with his hair liberally impregnated with a petroleum-based hair gel. As he strapped himself into his jet he felt a bit hungover so turned his oxygen on to 100% and had a few whiffs to clear his head. Horrified ground staff witnessed the explosion as his helmet blew off with most of his hair leaving him alive but badly burned.
  • A celebrity chef lost her licence for exceeding the NSW Blood Alcohol Level (BAL) of 0.05. That is, 50mg per 100ml of blood. The NZ limit is 80mg% or 0.08. The chef claimed to have drunk one glass of wine four hours earlier. This is absurd as in order to exceed that limit she would need to have had at least three to four drinks over that period. A single glass of wine would have been fully metabolised over the course of four hours. Some Asians lack an enzyme essential for the metabolism of alcohol but I doubt whether this would be an effective defence. With respect to drink driving, I suspect that judges must have heard every excuse possible and this one just doesn’t wash! Perhaps she had unwisely experimented with the “alcohol vapouriser” (Dominion Post, 25 January).

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