Of feeding tubes and foetuses
Now that Terri Schiavo has been allowed to die peacefully there is an opportunity to reflect on the matter free from the hysteria and religious arguments advanced as an excuse to maintain her in a vegetative state. When discussing the ethics of the situation with a local surgeon he commented that the main problem was that the feeding tube should never have been inserted in the first place. A feeding tube is surgically inserted into the stomach through a hole in the abdominal wall. Once such medical interventions have been made it is very hard to reverse them. In this case the debate appears to have been hijacked by Catholic pressure groups.
As a doctor I continue to make decisions to withdraw or stop treatment when the situation is hopeless. I do not find it difficult because the process is based on commonsense, logic and ethical considerations, all qualities familiar to readers. Of paramount importance is the question — “what is in the best interests of the patient?” It can be in the interests of the patient to die quietly and peacefully. This is partly influenced by the wishes of next of kin and family and in my experience it is usually possible to come to a consensus and make the right decision.
A Google search returned 5 million hits for “Schiavo” and it is well worth surfing a few sites to gauge the depth of feelings stirred up by this event.
Aborted foetuses and stem cell injections
Given the huge number of abortions taking place in most countries it was inevitable that somebody would dream up a commercial use for the aborted foetuses. The idea is that undifferentiated stem cells from the foetus are injected into a diseased or injured area and somehow differentiate into new cells in that tissue.
Motor neurone disease (MND) is a degenerative condition of the neurones controlling muscle movement. It affects both upper motor neurones (ie brain) and lower motor neurones (ie spinal cord). There is progressive paralysis and eventually death from pneumonia, which is in most cases a merciful release. Feeding tubes have been used in this condition, an act criticised by some as “striving officiously to keep alive.”
An enterprising Chinese surgeon is treating MND by injecting 2 million stem cells directly into the brain and a NZ woman recently underwent this procedure. This has created huge media interest and the Dominion Post reported: “Before the operation Mrs – had difficulty swallowing, but afterwards drank a glass of juice in one go. That was really really exciting … it was amazing, really amazing.”
Yes, well, as we all know when something is reported as “amazing” it’s more likely that there is a more mundane explanation. The Chinese surgeon has refused to conduct any clinical trials or publish any data in peer-reviewed journals. This is a hallmark of quackery. The stem cell injections make no scientific sense, as injections into the brain will do nothing for degeneration in the spinal cord. This procedure remains experimental and should not be used on humans. Gazing into my crystal ball I predict that stem cell injections will prove to be a failure for treating MND.
Dominion Post 17 March, 23 March
Aborted foetuses, stem cell injections and beauty salons
In a grotesque parody of the activities of the Chinese surgeon, Moscow beauty salons are using stem cell injections to “rejuvenate skin and cure a raft of diseases” (The Guardian Weekly Vol 172 No18, April 22-28).
Ukrainian women are paid a few hundred dollars to have an abortion and the foetuses can be sold in Russia for thousands of dollars. Salons charge their clients up to $20,000 for a course of treatments. A professor of medicine is quoted as saying “We are talking about a huge, corrupt and dangerous trade in quack therapies.”
The whole process is marginally more advanced than the use of animal cells. Remember monkey glands? Recycling past quackery is now an industry but it’s important to use more plausible treatments, in this case human foetal cells.
Having failed as a cancer cure, the mussel extract is now touted as beneficial for asthma and is being marketed as a dietary supplement. The distributors have learned their lesson and are avoiding making the same therapeutic claims that breached the Medicines Act in 1999 when it sold more than 2 million dollars worth in one day.
Australian athlete Jana Pittman, who takes it for her chronic asthma, is now promoting Lyprinol. If, as claimed, Lyprinol has an anti-inflammatory activity it may well help asthma, which is an inflammatory disorder of the airways. This is why inhaled steroids are so effective in preventing asthma. It is difficult to see why an oral preparation should work in the same way.
It will be very easy to perform a randomised controlled trial (RCT) of Lyprinol and gazing into my crystal ball once again I predict that Lyprinol will turn out to be a placebo. As it is being sold through Asian health shops, my advice to the distributors is to put a powerful steroid (say 20mg prednisone) into each capsule. This sort of adulteration of ineffective products with effective conventional drugs is already commonplace in Chinese alternative medicine.
Chinese “Herbal” Medicines
I have in the past referred to traditional Chinese herbalism as “Kentucky Fried Medicine” because they contain secret herbs and spices. If they appear to work that is easily explained by the placebo effect. The preparations that do have a dramatic effect are usually adulterated with conventional medicines such as steroids and other nonsteroidal anti-inflammatory drugs (NSAIDs). Med-safe (www.medsafe.govt.nz/hot.htm) recently warned against three herbal products which turned out to contain frusemide (a powerful diuretic), piroxicam (NSAID) and betamethasone (a powerful steroid).
Alternative Medicine Practitioners
Picton now has an osteopath with a B Ost (Hons). It beggars belief that the study of such a pseudoscience can be rewarded with an honours degree, but New Zealand has the NZQA and as long as they have certified your educational process anything goes.
Australian naturopath Gary Martin was in NZ recently promoting his crazy ideas about dentistry and health. According to the article “he said he had clinical proof connecting serious and terminal diseases to dental infections caused by mercury fillings and root canals.” It annoys me that lazy journalists allow people to get away with making claims like this without demanding written proof such as published papers, clinical notes and other forms of verifiable evidence. Even the reporting is faulty. How does a mercury filling cause an infection? The other thing that annoys me is the large amount of space devoted to such articles, which are effectively advertising puffery.
Blenheim recently held a “Psychic & Healing Fair” where you could attend an open discussion with an osteopath about “the issue of whether to vaccinate your child against disease.” Could there be anything more ridiculous?
Into the mouths of babes?
Psychiatrists continue to insist that ADHD is underdiagnosed and this has led me to flippantly suggest that we put methylphenidate (Ritalin) into the water supply as a public health measure. Doctors are the main source of such street drugs, which arrive for sale via legal prescriptions. When the actor Natalie Portman was interviewed recently she had some insightful comments about Ritalin and ADHD. “People at my school used to use Ritalin like a party drug, or a study drug … and it’s easy to get because ADHD is so heavily overdiagnosed.” Tell us something we don’t know.
Then we have psychologists claiming that ADHD is undiagnosed in many low income families, particularly solo parent families. It is claimed that such families are being forced to visit food banks as they have spent their grocery money on repairing windows or furniture destroyed by their children. Parents are, however, entitled to a weekly disability allowance but only when their child’s condition has been “diagnosed”. They should call it the “Ritalin allowance”.