Dark Eddies in the Mainstream

So-called conventional medicine isn’t immune to nonsense.

I do not confine myself to examining the conduct of alternative medicine. The conventional medical literature also presents rich examples of foolish and fanciful activity. Have a look at bmj.bmjjournals.com/cgi/content/full/331/7527/1231?etoc which has the title, Randomised controlled trial of animal facilitated therapy with dolphins in the treatment of depression. Surely there are more important research topics than this nonsense. Another recent favourite of mine was a MRI scan of two people having sex inside the scanner. One finding was that the penis is boomerang shaped during coitus. bmj.bmjjournals.com/cgi/content/full/319/7225/1596

That piece of weirdness won the 2000 Ig Nobel award for medicine. And you thought homoeopathy trials were nonsense! Speaking of which…

What is homoeopathy?

I found a useful article in Next Magazine Dec 2005 and learned that “gone are the days of the natural health practitioner wearing a long, flowing purple dress and rings in the nose. Today’s homoeopaths are more corporate and business orientated.” As we all know, there’s plenty of money to be made in quackery. One homoeopath spent five years studying biology, chemistry, physics, anatomy and physiology, pathology and pharmacology to gain a Masters degree in the subject. One cringes to think that this nonsense is now creeping into tertiary training institutions in New Zealand. It is the height of absurdity that anyone could study chemistry and physics and somehow reconcile that with homoeopathic theories.

Drain cleaner for health

Grapefruit seed extract (GSE) has been promoted as a “natural antimicrobial”. Bandolier 142 (December 2005 Volume 12 Issue 12) found no evidence that this was true but did find that the GSE was contaminated with cleaning chemicals such as benzalkonium chloride, triclosan and methyl parabene. These are actually contaminants from the manufacturing process and are not found in the grapefruit before processing. It is these contaminants, which are responsible for the “antimicrobial effect”! Bandolier rightly takes the media to task for promoting this product and the expression “Wake up and smell the drain cleaner” is apt.

Cough mixture flunks

You only have to visit your local pharmacy to see that there is a lot of money to be made from cough mixtures. Most of them are illogical mixtures containing both expectorants (make you cough) and anti-tussives (stop you coughing) in the same mixture.

I recall years ago a Consumer article finding that they were useless and this was my own experience raising two children. Of course they asked for them because the mixtures are sugary and tasty. It gives parents something to do when their children are sick. In many households, both parents are working and have a low tolerance of a coughing child keeping the household awake. This is probably also the reason for the absurd amount of antibiotics given to children for ‘bronchitis’ or ‘chest infection’, both pseudoscientific diagnoses used to justify such prescribing. The vast majority of these paediatric infections are viral and self-limiting.

More recently, research has confirmed that cough mixtures are placebos. If they continue to be sold I would have thought there would be a case for invoking various consumer protection laws. BMJ 2006;332:8 7 January 2006

Saw Palmetto

Saw palmetto is an herbal treatment taken for the relief of benign prostatic hypertrophy (BPH) by an estimated 2 million men in the US. BPH is a gradual age related increase in the size of the prostate gland, which sits at the base of the bladder. BPH causes symptoms related to obstruction of urinary outflow, eg slow urinary flow, retention of urine and incomplete bladder emptying. Some poorly designed trials had shown some improvement in these symptoms with the use of saw palmetto. A randomised, double blind study found however that saw palmetto is of no benefit in the treatment of BPH. There is a curious rider at the end and this is another hallmark of quackery: “this study tested a specific preparation of saw palmetto, leaving open the possibility that a different preparation or dose of saw palmetto might have been effective.” I call this ‘shifting the goalposts’ and it is a frequent strategy to defeat testing of a particular product.

In a nutshell, this illustrates the difference between “alternative and complementary medicine”, call it what you will, and the scientific method. How often do we find gushing reports of some new herbal wonder remedy which is dutifully promoted via the medium of shonky and poorly designed trials. Then somebody comes along and does a properly conducted trial and the claimed benefits mysteriously disappear! It’s little wonder that quacks fear and condemn the randomised placebo controlled trial. It’s their greatest threat. Men with BPH would be well advised to take cough mixture — it’s likely to be a cheaper placebo.
New England Medical Journal Feb 2006

Traditional Maori therapies

In the year 2004/2005, 1.3 million dollars were wasted on ridiculous treatments such as prayer and “the use of hot rocks applied to the body to treat cancer” (hangi therapy). It is a scandal that such absurd treatments are being funded at a time when Maori have appalling health outcomes from diseases such as diabetes, ischaemic heart disease, gout and hypertension, not to mention other complications such as renal failure.

The government have chosen not to refer these traditional therapies for evaluation by its own quango, the Ministerial Advisory Committee on Complementary and Alternative Health (MACCAH). MACCAH, as suspected, has turned out to be a useless and expensive white elephant. Of course, it might be culturally unacceptable to test massage and prayer and show that they are useless.

A Mr Morrison from Rotorua says, “doctors themselves occasionally miss the mark” and “does the GP have to give back funding for failed attempts?” A GP is quoted as saying “we’ve got to be careful about using our tools on another culture” and calls on us to recognise where “efficacy is unproven in conventional medicine”.

These are pathetic arguments, based as they are on using the failings of medical science to justify the alternative use of ‘non-science’. Prayer (karakia) has been tested and shown to be useless. Why even bother to test hangi therapy? Perhaps the early Maori weren’t actually cooking and eating each other. These were Hangi treatment sessions that went too far! Revisionist historians read on. This whole futile and silly waste of money is pandering to fanciful cultural whims which are sadly redundant in the face of the onslaught of western style disease and it is western medicine that has the solution, not prayer and herbs.

Doctor 22/2/2006

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