At the Skeptics’ conference we were treated to one official’s view of the status of scientific medicine relative to alternative treatment systems and beliefs. This presentation reinforced many of our fears that modern medicine is truly the victim of its own success. Now that so many of us live to old age, and find that pharmaceuticals and surgery can do little to prevent inevitable decline, we are encouraged to turn to away from “Western orthodoxy” towards “alternative” systems of other, more “spiritual and “holistic cultures”.
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Chelation Study
Ian McWilliam’s comments on the Dunedin Chelation Study [Forum, September] indicates the many difficulties in understanding medical research papers. In consideration of his critique of the study:
Re the number of patients:
- Whilst 32 is not many, they were all typical claudication sufferers, being mainly smokers, male, and average age 67.
- Van Rij et al arrived at this number in the correct method: using “power” and type error and allowing for detecting a predicted significant improvement in the order of 10% in terms of walking distance. Thus the study would easily detect the sorts of improvement that would be clinically significant (ie the 50-100% touted by some chelation clinics).
Re Mr McWilliam’s doctor friend’s analysis:
- His statement that only 12% of the controls achieved 100% walking distance improvement versus 26% for the chelation group is poor presentation of statistics: We don’t know how many of the controls achieved 99% or similar walking distance improvement.
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Van Rij et al quote a change in the average walking distance to pain (ie how long before the patients stopped walking because of pain) in the order of 25 metres improvement for the controls verses only 12 metres for the chelation patients. In other words the chelation group did worse. An average is a better statistic in this case than the ones quoted by Mr McWilliam.
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Mr McWilliam’s statistical analysis (95% confidence limits) is irrelevant given no explanation of the statistical method used and who performed the test.
Comments that “Those who supply the expensive drugs, equipment and surgery would lose much if research into other simpler, less expensive…” ignores the extensive research by the “heart industry” into the likes of aspirin and warfarin, hardly expensive medications.
I have found the results of the Dunedin Chelation Study significant for my clinical practice: It has reaffirmed my clinical observation of several patients who have undergone chelation; they all feel significantly better for the extensive attention they receive and the improvements they achieve in their lifestyle — i.e. enhanced placebo effect. Unfortunately the cost of this “placebo” is excessive, its long-term effects questionable and I have a degree of unease when I consider the number of chelation-treated patients I have had die from their heart and circulation disease within two years following therapy.
Jim Vause, Blenheim
Hokum Locum
Joint Manipulation
An article in NCAHF reminded me of past activities with respect to joint manipulation. Following a one week course I embarked on a short-lived career in spinal manipulation which is very easy to learn and causes a greatly inflated belief in one’s ability to “cure” spinal ailments.
The first problem was that patients kept coming back repeatedly to have their back or neck “put back.” I soon realised that if, as the quacks claim, the spine can easily be “put back” then it can just as easily “go out” again. All I had done was create a perception with the patients that every time their back or neck hurt it required a specific manipulation. If only I was more unscrupulous…what a wonderful money-making idea!
What finally cured me of such activities was the day I manipulated a patient’s neck with the usual psychologically satisfying crack from the spine. She sat up, went pale and slumped back onto the couch. Distraught, and thinking that I had killed her I rushed through to get the assistance of my receptionist who took one look and said to me “You twit. She’s only fainted.”
As a reformed manipulator, I was therefore interested in the following which I will quote in full:
“The popping sound associated with ‘putting bones back-into-place’ (though it may be accomplished by manipulating a normal joint) is one of the cleverest and most effective forms of suggestive therapy ever devised. This has a tremendous psychological influence over the mind. While the popping sound itself is quite meaningless, this influence might possibly be used to advantage in curing psychosomatic conditions — provided the patient is informed that the bone is ‘back-in-place’ and will stay there. By the same token, however, such treatment can cause a great deal of harm; that is by perpetuating a psychosomatic condition or even creating a new psychological illness.”
Manipulative therapy is well documented as leading to spinal cord damage and paralysis. Quacks will claim that this only occurs in a few cases per 100,000 patients treated but the easy answer to this is that all of these conditions get better without the risk of paralysis from manipulation, therefore any risk of spinal cord damage is unacceptable. (NCAHF Vol 18, No 3)
Alleged Allergies
Although I don’t see many children in the course of my work, I am amazed at how often mothers allege that their children can’t have milk because of various allergies. In one study, researchers found that people who perceive that they are allergic to milk simply misinterpret ordinary abdominal feelings. From a group of 30 subjects, 21 were identified who were genuinely intolerant of lactose. They were divided into two groups and given either normal milk or lactose-free milk. There was no difference in the amount of abdominal distress reported by the two groups.
Full of Wind?
A report on a new breathing therapy for asthma initially looked quite interesting until I came across the following statement: “by learning to saturate their bodies with carbon dioxide, patients can lessen muscle tension and slow breathing to a normal rate.” After reading this I was still interested until I came to the end: “the technique is also used to treat angina, high and low blood pressure, piles, varicose veins and even cancer.” This is an absurd range of indications for any one treatment and such claims are absolutely diagnostic of quack therapies.
Carbon dioxide is one of the most potent stimuli of the respiratory centre which triggers breathing. Any attempt to saturate the body with carbon dioxide will stimulate the breathing reflex so the whole therapy concept is a contradiction in terms.
Silicon Implants
Are there any American female actors who have not had their breasts surgically enhanced? I was reading a magazine which was profiling Baywatch star Pamela Anderson. Pamela cannot stay in cold water for very long because her implants start to solidify and ruin her mammary profile.
In Skeptic 34 I outlined how women could claim for silicon disease if they had vague symptoms such as chronic fatigue, muscle weakness and memory loss. A study reported in the British Medical Journal (Vol 311, p138) found no connection between silicon breast implants and connective tissue disorders.
Gulf War Syndrome
A study of 10,020 Gulf War veterans found that the range of complaints they had was no different to the general population. I imagine that this conclusive study will not settle the matter as long as there is the prospect for compensation. There was very little actual fighting in the Gulf War and more Americans were killed in accidents than in actual combat.
Like most sensible people in the military, I am opposed to ritual combat as a means of solving disputes. In future wars, I can see soldiers going into battle followed by support companies of psychologists and counsellors, available to give emotional first-aid following the shock of finding that the enemy are firing live rounds.
The American study confirmed a British study of 45,000 soldiers which concluded “no evidence has emerged that any organic disorder has occurred more commonly in Gulf veterans than in any similar population over a similar four year period.” Hopefully this will be the last we hear of “Gulf War syndrome.” (GP Weekly 16/8/95, BMJ Vol 310, p1073)
Size Does Matter!
Before being released from prison, convicted sex offenders in the UK are being subjected to penile plethysmography (PPG). PPG detects minute changes to the penile blood supply while the prisoners are shown sexually explicit material. Sexual arousal is defined as a “deviant response”. The psychologist in charge of this program claims that the scientific literature says that the test is “valuable”. Another psychiatrist condemned it as a “gross abuse of human rights”. As a rational skeptic (after Skrabanek) I suspect that PPG is an unproven and extremely unlikely test which is likely to have a very high false positive response. Sexual arousal in males can occur at all sorts of embarrassing moments and it is likely that most males would show a degree of arousal when exposed to sexually explicit material. (Christchurch Press 1/6/95)
Berry Silly
The Auckland Sunday paper (27/8/95) carried a small article which claimed that World War Two airmen improved their night vision by eating blueberry jam. This contains “anthocyanosides” which are alleged to improve night vision and treat visual fatigue. It is no surprise that a drug company is now marketing pills containing this substance. This is another good situation for Skrabanek’s rules. Is this claim at all plausible and is there any more likely explanation for claimed improvements in night vision? Clearly, the placebo effect is at work here and no further testing is warranted.
Quackery and Chemists
If you go into the average chemist’s shop you will often see displays of homeopathic remedies along with vitamins and other dubious preparations. Most chemists derive the majority of their income from OTC sales and if they didn’t sell these things, someone else would. I draw the line, though, when chemists start promoting quack ideas and remedies.
A member handed me a newspaper clipping which quoted a chemist as saying “zinc detoxifies chemicals like alcohol, improves behavioural problems such as depression, anorexia, bulimia, fatigue and loss of libido.”
Prior to rushing off to get some zinc, readers will be pleased to know that there is a simple test for zinc deficiency. A sip of zinc septahydrate solution is held in the mouth and “from the taste the zinc level is determined.” I tried it and got a taste reminiscent of bullshit.
I forwarded this clipping to the Pharmaceutical Society of NZ and got the following reply: “whilst not every pharmacist would share these views, it is not considered that they bring the profession into disrepute. There have been many studies carried out on zinc which would appear to support the general thrust of these claims.”
Sick Building Syndrome (SBS)
Investigators have finally done the obvious and looked at buildings for which there are no complaints of SBS. Measured levels of contaminants were low and the authors found that complaints about the working environment were related to “perceptions about air movement, dryness, odours and noise.”
As I have said before, SBS, like CFS and OOS, is based on a notional but false belief that psychogenic symptoms have some exterior cause. The availability of compensation completes the picture although, in the case of SBS, compensation is not available for any occupational disease associated with air-conditioning and this is probably why there has not been a flood of claims.
Occupational health workers continue to perpetuate false ideas in their own literature because they lack a perspective on history and human behaviour. The Lancet (Vol 345, p1361) reviews such a publication which claims that SBS is due to environmental factors. It is time that this false concept of SBS was laid to rest. (Occupational Health May 1995, p174)
Other Readers Write
Thanks to Dr Graham Sharpe who wrote from Wellington and enclosed some material about interesting developments in midwifery. Homeopathy is popular with midwives who use it during childbirth. Dr Sharpe also mentions a case known to him where a child died from a brain abscess due to a delay while homeopathic remedies were administered. The other case concerned a case of poisoning when a naturopathic remedy contained aconite. Aconite is severely toxic to the heart and this example shows why naturopathic remedies should be subject to the same restrictions and controls as other drugs.
Denis Dutton forwarded two articles as well. One from Annals of Internal Medicine (Vol 121, No.10) outlined the well-known complication of liver damage which can be caused by a wide variety of Chinese herbal treatments, in this case “Jin Bu Huan” tablets. The other article, entitled “Bitter Herbs: Mainstream, Magic, and Menace”, is an editorial from the same issue as the journal above.
The FDA managed to ban the use of Jin Bu Huan, but their job will be made more difficult by the Hatch bill. This is “The Dietary Supplement Health and Education Act of 1994” which was shepherded through the US Congress by the quack-apologist Senator Hatch. Its language is so imprecise as to be a triumph for the promoters of quackery everywhere. The editorial ends with a plea for doctors to spend more time with patients exploring the “human interactions that are central to the physician-patient relationship.”
Hoxsey Cancer Quackery
Soon after I returned home from our annual conference, Bernard Howard sent me a travel guide for patients planning to go to Mexico and gift their money to a pack of criminal fraudsters who know that the Hoxsey treatment is useless. As well as the airfares to the US, the Hoxsey clinic charges are US$1250-1600. Presumably this is to cover the costs of the “tonics” or as I call them, Kentucky fried medicine. As I explained at the conference, we know what these quack formulae contain and they could be made up in New Zealand for a few dollars.
MVA Insurance Fraud
Los Angeles is the capital for staged motor vehicle accidents (MVAs) where professional criminals, unscrupulous lawyers and doctors participate in phony insurance claims. Until I read about this I was aware of a problem with “whiplash” (also known as chronic remunerative neck injury), which has been a rich source of money for litigants. Phony claims fall into several groups: personal injury, claims for accidents that never happened or actual crashes involving unsuspecting drivers and staged accidents involving previously damaged vehicles. (Christchurch Press 24/7/95)
Faking It?
Vicki Hyde passed on to me a peculiar letter from a Dr Hussein of Jordan asking us to participate in research in the paranormal immunity of fakirs to pain. The letter is the usual mixture of pseudoscience. In fact, no individuals possess any “paranormal” immunity to pain, unless of course they are lucky enough to lack the spinothalamic tracts which carry pain messages to the brain.
Humans possess widely varying responses to pain stimuli which are subject to attenuation by cultural factors, conditioning and belief. Slowly rising pain stimuli can be centrally blocked. I have seen (and discouraged!) my daughter pushing needles through her finger. I reviewed the question of pain control in my paper on acupuncture which is available from our organisation.
Forum
Hypnosis
TV3 on 20/20 at 8.30pm on Monday 19/06/95 screened an American story titled “A State of Mind”. Extravagant claims were made about the medical significance of hypnosis and its therapeutic uses. One doctor claimed that up to 50% of her patients could be cured by hypnosis. I have just completed a course in rehabilitation studies at Massey University. The course text book had an interesting summary on hypnosis.
“Despite evidence that the use of hypnosis can produce analgesia for acute pain such as that experienced during surgery and childbirth (Hilgard & Hilgard, 1986), studies of the effects of hypnosis on experimentally induced pain and on chronic pain show no reliable evidence that it is more effective than that oldest of remedies for pain, the placebo procedure. For example, Melzack and Perry (1975) analysed the effects of hypnosis on patients suffering from a variety of chronic pain problems, such as low back, arthritis and cancer. An average pain reduction of 22% was achieved, which was not significantly greater than the 14% reduction obtained in placebo baseline sessions. In summary, hypnosis itself does not have a sufficiently powerful effect on clinical chronic pain to be considered a reliable and useful therapy. Merskey (1983) concluded that hypnosis is not worth using in anyone with a pain of physical origin and very rarely in patients with pain which is psychological in origin (p39).”
Text quote was taken from:
Young, M. (1991) Chronic pain and the rehabilitation process. In B. Hesketh and A. Adam’s (Eds), Psychological Perspectives on Occupational Health and Rehabilitation. (pp376) Marrickville, NSW; Harcourt Brace Jovanich
Andrew Hart, Tauranga
Magic Mushrooms Materialise
The extract quoted from the Marlborough Express by Dr John Welch regarding magic mushrooms in Fiji [Hokum Locum, Skeptic 36] is most interesting. They are well and truly established in New Zealand! I first heard about them a year ago from an elderly woman in Rotorua. At the time they were called Manchurian mushrooms and she assured me they were associated with Shangri-La as featured in Lost Horizons (book and film) and were connected with eternal youth. She swore by the efficacy of the brew and was quite upset when I asked where they were purchased. It is all done by giving and receiving, not by commercial transaction.
A sheet of instructions goes with each gift. The mushroom must be treated kindly. It must be talked to gently. If bad behaviour occurs near by (swearing, fighting) it will die. When the mother mushroom has budded off a daughter ready for the next brew the old one must be buried under a fruit tree.
I returned to Auckland convinced that life beyond the Bombay Hills was primitive indeed. A few weeks later I was with a group of young mothers several of whom were exchanging ideas about their Manchurian mushrooms and I have since learned that in the offices of several Auckland firms dealing with modern technologies that the mushrooms are all the rage.
I guess the concoction is no worse or more effective than the yeast brew willingly swallowed by me in the 1940s for a few months to combat adolescent pimples. After a few years the pimples went. Proof positive indeed!
P. Williams, Auckland
EDTA Chelation
I am at least as skeptical about the methodology and results of the EDTA chelation trial in Dunedin as I am about the efficacy of the treatment. The trial involved only 32 people, 15 in the treatment group and 17 in the control group, which I would have thought was rather too few to produce definitive results.
A doctor friend of mine, who runs a chelation clinic, tells me that he had to engage the services of the Ombudsman to obtain a copy of the raw data. Why was it not readily available? He says the results were published in the Circulation Journal of the US. Heart Association and the conclusion reached that, as 60% (9/15) of the treatment group and 58% (10/17) of the control group achieved an increase in walking distance, chelation was no more effective than placebo. His analysis of the raw data produced a different conclusion:
- 26% (4/15) of the treatment group compared with only 12% (2/17) of the control group achieved 100% increase in walking distance;
- Of the non-smokers and those who had stopped smoking (six in each group continued to smoke tobacco) 66% (6/9) in the treatment group improved with an average of 86% increase in distance walked compared with 45% (5/11) in the control group with an average increase of 56% in distance walked; and
- Only 6% (1/15) of the treatment group showed a decrease in blood flow to the feet by Doppler measurement compared with 35% (6/17) of the control group.
My friend claims that independent statistical analysis of these results confirmed a 95% confidence factor.
In deference to my medical friend, my wife and I submitted ourselves to the minimum 21 EDTA chelation treatments two and a half years ago. I was in good health but my wife suffered high blood pressure and had been told she should take appropriate medication for the rest of her life. Following chelation her blood pressure fell to a marginal level and has remained so without medication. I can vouch for the fact that pre-chelation her lower legs and feet were freezing when she came to bed whereas since chelation they are warm.
Science, being a human pursuit, is sometimes the victim of human failings. I recall my time amid about 70 agricultural research scientists who tended to debunk what, in their own fields, they could not explain. So a lady farmer who claimed that zinc supplementation was effective in the prevention of facial eczema was derided until her persistence led to official trials. Eventually she was proved correct and awarded the OBE for her work.
The controversy over chelation admits at least the possibility of less innocent human failings. It should be no secret that the “heart industry” includes a very powerful and very wealthy international lobby of vested interests. Those who supply the expensive drugs, equipment and surgery would lose much if research into other, simpler, less expensive and less glamorous procedures proved fruitful. Likewise the researchers have their substantial funding to lose.
Chelation is accepted practice for the removal of heavy metals from the bloodstream, but not for removal of the plaque which clogs arteries. Could in vitro laboratory experiments not establish the effect of EDTA on plaque?
Alan McWilliam, Rotorua
Homeopathy – Witchcraft for the Times
For a host of reasons which the NZ Skeptic will examine further in a later issue, the so-called “natural health” industry is enjoying a remarkable resurgence. One cannot refute the argument that we should take responsibility for our own health and that we should not expect modern medicine to provide on demand pills to cure all our ills, particularly those which are self-induced or the result of old age. Moderation in all things (including moderation) will generally help any of us to lead a vital and active life.
However, a host of charlatans have now hitched their star to this valid need to take some responsibility for our own health, and are busy peddling nostrums which are useless at best and harmful at worst. These new medical and psycho therapists follow the proven pattern of the Greenshirts by promoting fears and frights and then providing the cure to the fancied ills. Read any natural therapy propaganda and you would think that rather than being the best fed, healthiest and longest lived population that has ever lived, we are all being poisoned and driven to untimely deaths by a combination of conspiracy theories and the fruits of civilisation. It’s a dirty trick but it seems to work.
Just as people who don’t believe in astrology believe in it, so homeopathy in particular seems to have crossed the border from fringe medicine into widespread acceptance. A commitment to homeopathic practice is now presented as evidence that some natural healing clinic is legitimate rather than promoting plain quackery.
The best way to deal with this belief is to set down in print the principles of homeopathy as first espoused by its inventor Dr Hahnemann. Readers can then judge for themselves whether they are can seriously subscribe to such a treatment regime as we near the end of the twentieth century or whether they should laugh it off as voodoo magic in modern dress or drag.
Any medical historian will recognise that Dr Hahnemann got off to a good start. He developed his system towards the end of the eighteenth century at a time when a trip to your doctor was almost certain to make your condition worse and probably kill you. All of Louis XV’s brothers and sisters were killed by their doctors. Louis XV survived only because his nanny hid him whenever the doctors made a palace-call. In such dangerous times any system of treatment which genuinely did no harm was bound to look successful by comparison. If Louis XV’s nurse had been really smart she could have promoted a new medical regime called “underbed-therapy” or similar based on forcing the patient to lie under the bed for an hour at a time. After all, it had saved the life of a future king. The royals of Europe were a tight-knit club. Hahnemann’s success with the royal families of 18th century Europe is evidenced by the house of Windsor’s belief in homeopathy to this day.
If any of us had been alive as commoners in those times, we too would have been well advised to visit Dr Hahnemann rather that suffer exposure to the contemporary regimes of bleeding, emetics, enemas and other horrors. (Curiously, enemas, in the form of colonic irrigation, are making a natural therapy comeback. Learning to water-ski is probably just as effective and more fun.) However, modern medicine has made great strides and most of us expect some systematic diagnosis and intervention from the medical profession rather than a programme of benign neglect.
Here are the cardinal principles of homeopathy according to the man himself:
The Psora (Itch) and Vitalism
The psora is the sole, true and fundamental cause that produces all the other countless forms of disease — the long list which follows includes insanity, rickets, cancer and paralysis. Hahnemann believed that diseases represent a disturbance in the body’s ability to heal itself and that only a small stimulus is needed to begin the healing process. As a man of his time, he believed in the principle of vitalism, which held that life is a spiritual non-material process which can be influenced by dynamic forces such as magnetic influences, the moon and the tides, and so on. [Can they really teach this stuff in a Polytech?]
The Law of Similia
Hahnemann was led to the homeopathic principle after he took a dose of quinine and noticed that the effect of the quinine was similar to that of malaria. He was also drawing on the primitive monism of the time which held that “like is like”, (eating the heart for courage) “like makes like” (idolatry) and “like cures like” (snake-root was used for curing snake-bite). Hahnemann revived Paracelsus’s “Doctrine of Signatures” which declared that herbs would cure conditions associated with the anatomical parts they resembled. [Or this stuff too?] Surely any patient today would run out of the waiting room if a GP suggested such nonsense. But if patients buy into homeopathy they are buying into this whole set of beliefs.
The Law of Infinitesimal Potentising
This law holds that the smaller the dose of a medication, the more powerful its healing effects. Hahnemann taught that substances could be potentised (i.e. “their immaterial and spiritual powers released”) by sequential dilution of remedial agents by “succussion”, in which mixtures would be shaken “at least 40 times”, nine parts dumped and nine parts solvent added and shaken again. Hahnemann held that tapping on a leather pad or the heel of the hand would double the dilution — which is patent nonsense. [How do you present this in the class without bursting out laughing?] The laws of chemistry tell us that there is a limit to which a substance can be diluted without losing the original substance altogether. This limit, called Avogadro’s number, corresponds to “homeopathic potencies of 12C” or 1 part in 1024. At this dilution there is less than a 50% chance that even one molecule of the original active material remains. Hahnemann recognised this apparent anomaly but explained it away in metaphysical terms — i.e. by witchcraft.
So we find that Hahnemann’s texts recommended highly diluted coffee as a cure for “sleeplessness, digestive, urinary, respiratory and heart symptoms” and diluted tincture of tarantula (that’s right, the big hairy spider) to treat “mania, hyper-activity, chorea and septic outbreaks”. One suspects he was shrewd enough not to recommend highly diluted alcohol as the rapid route to drunkenness.
What all this means is that if you visit your pharmacist and buy a liquid homeopathic remedy, you are buying “diluted water”. If it comes in crystal form then the diluted water will have been dropped onto sugar crystals, and you are parting with your hard-earned cash for “evaporated diluted water”. We can see why there is a buck in it and why naturopaths are so keen on homeopathic remedies. Selling diluted water beats the hell out of spending millions of dollars on systematic research to find some effective pharmaceutical and then spending hundreds of millions on clinical trials and registration procedures around the world. Of course, such a “medicine” can do no harm and nine times out of ten the body truly does heal itself just as the naturopaths claim. Again the homeopaths keep well away from broken bones, severe bleeding, brain tumours, or raging infections where the patient demands real and immediate results.
The defenders of homeopathy argue that even though the whole system appears to contradict common sense (i.e. that a diluted scotch will be more intoxicating than a neat shot) there is evidence that the system works and that numerous publications endorse this efficacy. (John Eisen of the AIT Press quotes the famous 96 papers at every opportunity)
The most famous recent study which appeared to demonstrate an operative mechanism was a report by a French scientist working at that country’s prestigious INSRM institute. His paper claimed that high dilutions of substances in water left a “memory” which explained their “efficacy”. Subsequent investigations proved that the research, which was funded by a major manufacturer of homeopathic medicine, was “improperly carried out” and the scientist was subsequently suspended.
A 1991 survey of 107 controlled trials appearing in the 96 published reports (the list quoted by John Eisen) found that “the evidence of clinical trials is positive but not sufficient to draw definite conclusions because most trials are of low methodological quality and because of the unknown role of publication bias.” An earlier study (1984) also concluded “It is obvious from this review that despite much experimental and clinical work there is only little evidence to suggest that homeopathy is effective. This is because of bad design, execution, reporting, analysis and particularly the failure to repeat promising experimental work…”
In the tradition of scientific literature this is “damning with faint praise”. We should take of note of Thomas Paine’s famous question “Is it easier to believe that nature has gone out of her course or that a man would tell a lie?”
The NZ Skeptic is not suggesting that homeopathy be banned. But this short essay should encourage readers to ask themselves whether they should be tempted to buy overpriced dilute water — given that homeopathic theory would suggest that a quick dip in a spa pool should cure every disease known to man — or at least those of those who have dipped before you. And we should also ask if such mumbo jumbo can be taught in a tertiary class-room given that it cannot possibly be the subject of informed and critical debate. It is simply not possible to believe in modern physics and chemistry, or even the principles of mathematics, while believing in homeopathy. If the New Zealand Qualifications Authority decides to endorse the establishment of a School of Witchcraft, then homeopathy will have found a home, for that is where it belongs.
Pseudoscience and the Midwife
Recent issues of the Skeptic have contained expressions of puzzlement at some subjects being taught to tertiary students in New Zealand. The worst example is the Degree in Naturopathy planned for Aoraki Polytechnic. But is this really all that surprising?
Currently, health courses in polytechnics are including all manner of “alternative” medicine instruction as part of core courses. In my experience, the worst offenders are courses in midwifery.
Most midwives in New Zealand train for one year at a polytechnic, having previously completed a three-year course in nursing. There are three-year direct entry courses, but these are quite new and their first students have not yet graduated.
I teach anaesthetics in the one-year course at Wellington. The time allocated to me is one hour. The senior tutor also teaches this topic for one hour, a total of only two hours’ formal instruction in the whole course.
How relevant is anaesthetics to midwifery? I agree that the amount of knowledge needed by a midwife in this area is limited, but it is not generally recognised just how dangerous anaesthesia can be in the pregnant female. General anaesthesia is the third or fourth commonest cause of death in labouring women in the developed world. The situation is worse in Japan, where it ranks first or second. (The “or” is included because figures change from year to year. The United States has pushed anaesthesia down a slot as a cause of death in pregnant women by bringing gunshot into the top three.)
The point I am hoping to make is that anaesthesia can have a major impact in obstetrics, and I, for one, think that anyone involved in the care of pregnant women should have a sound background in the principles of anaesthesia, and why it can be so dangerous.
So is two hours enough? An open question, but homeopathy gets more than twice as much formal teaching time, and I assume the tutors are paid out of taxpayers’ money and student fees.
Midwives as a group seem to have a fascination with homeopathy. When challenged, defences range from “scientific proof” to “patient choice”. I will disregard the first of these, except to say that I have yet to be offered science or proof in any discussion of homeopathy with a midwife. (As an aside, the weakest defence I have heard is that the Queen is interested in homeopathy, so there must be something in it. These days, one would have thought that royal patronage of anything was guaranteed to ensure its failure, but I digress.)
“Patient choice” is fast becoming the defence of scoundrels. Should patient choice be the final arbiter in medical practice? It is a nice, politically correct idea, but choice is limited to what is realistically available. To defend the inclusion of something in a professional curriculum purely because the students or the patients are interested in it is lacking in sense and responsibility. I would guess that midwifery students might also be interested in skiing and wine tasting, and their potential patients may express an interest in Fascism or safe-breaking. Following along the lines of “choice” may lead to a more entertaining course, but would it advance the care of mothers and babies?
The whole question of choice leads onto the matter of informed consent. Does a midwife who uses homeopathy fully inform her patient (sorry, sorry; I should say her “client”) that she is using something that is unrecognised as a form of scientifically proven medicine, and that its use may put the patient (“client”; there I go again) beyond compensation by ACC should something go seriously wrong? Like hell she does.
Homeopathy is not the only intruder of its type in midwifery. Acupuncture is praised not only for its analgesia, but also as a means of inducing labour, stopping early labour, and turning breech babies the right way up before delivery. Aromatherapy has its advocates, and I have attended a labouring mother whose midwife insisted on having a lighted candle in the room as part of her client’s care. (Delivery rooms are oxygen-enriched environments, and she was not happy when I refused to proceed until the flame was extinguished. The hospital fire officer was even less impressed when I referred the matter to him.)
I was horrified recently to hear of the advice offered to the wife of one of my junior colleagues. She is expecting her second baby, and the baby has turned breech — i.e. bum first instead of head first. A midwife told her that she should lie flat on her back with her feet up until she felt dizzy and breathless, then walk around for a while. This was to be repeated several times a day, and would turn the baby back to present in the proper manner.
Anyone with the slightest knowledge of the physiology of pregnancy should know that if the mother is becoming breathless and dizzy, the baby is likely to be in an even worse state. In late pregnancy, lying flat can pose a significant risk to mother and baby, as the weight of the uterus can press on the aorta, reducing the blood supply to the placenta, and also on the vena cava, reducing the blood flow back to the mother’s heart.
Needless to say, the advice was ignored and the prospective parents are due to see a consultant obstetrician.
Pseudoscience is alive and well in the midwifery world, and is being taught to midwifery students.
The Challenge to Reason
Tertiary institutes around the country are beginning to offer courses, and even entire degrees, in subjects that are pure pseudoscience.
The Aoraki Polytechnic has applied to the New Zealand Qualifications Authority seeking approval for its proposed Bachelor’s Degree in Naturopathy. If approved it will be the first degree programme of its kind in this country.
With generous assistance from all of us, the Northland Polytechnic is offering a course in Astrology. (Only $25.40 on study-right, but the full $50.70 non-study-right). Evidently the tutor was a scientist until his teacher “who was recognised as an incarnate lama or tunku by the Tibetans” instructed him in Tibetan Tantric Buddhism. After several months’ psychotherapy in Morocco he went to India where he was empowered by the Sakyapa Lama. Evidently this powered him to Kerikeri where he now lives in a bus.
In the meantime, the Auckland Institute of Technology Press has been pouring out a stream of pseudoscientific books dealing with subjects ranging from faces on Mars to conspiracies to repress benevolent inventions and most recently The Poisoning of New Zealand.
This last book promotes the homeopathic line that increased dilution increases potency. (Sadly it doesn’t work with alcohol.) This leads to the remarkable conclusion that while concentrations of pesticides in our food and water may be well below those found toxic in laboratory experiments, extreme dilutions, of say one part per billion, are much more dangerous than concentrations of one part per hundred thousand.
In sum we have tertiary educational institutions subsidised by taxpayers offering courses and publishing books which are based on pseudoscience and superstition.
Does this matter?
It depends on your point of view. The Minister of Education has suggested that if there is a demand for these subjects then maybe the institutions have a duty to offer them –although he sounded as though he did not want to be seen as putting himself in the way of an employment opportunity. And we have to admit that naturopathy signboards (untreated timber only) are springing up like daffodils around our suburbs.
Science and Democracy
I happen to believe, along with Karl Popper and his many disciples, that there is a connection between the proper functioning of democracy and the rational or scientific approach to solving problems and learning about the world.
Since the days of the Enlightenment we have tended to the view that rational thought is the best basis for political action. Democratic government knows that there is no Utopian model of the static perfect society, just as science knows that no theory is ever finally proven to be true. The scientific method progresses towards truth without ever reaching it, while the democratic process “muddles through” to a better world by a process of continual experiment, debate and reform.
It is no coincidence that those who attack democracy look to pseudoscience to support their cases. The Socialists looked to the pseudoscience of Marxism, the laissez-faire anarchists of the nineteenth century looked to social (pseudo) Darwinism, while the Nazis blended social Darwinism and eugenics (pseudo-genetics) to boost their nationalistic dreams of a master race.
These days the centralists find support in the pseudoscience of the apocalyptic environmentalists, whose message is that democracy is unable to meet the challenge of the forces which “threaten the planet”. They make these claims even though the centrally planned states of the Eastern block appear to have committed ecocide. The miracle is that they could pollute so much while producing so little.
University Unreason
Yet contemporary Western society now seems hell-bent on destroying its faith in reason. The deconstructionists and post-structuralists in our universities now argue that there is no knowable truth, that science is no different to any other body of knowledge or superstition, and that students should not be taught a body of knowledge but should be encouraged to construct their personal models of the world. American universities, cringing under a wave of political correctness and an extreme form of “multi-culturalism”, are abandoning programmes which present the history of Western Civilisation as anything other than the history of the rape and plunder of minorities and other victims by a conspiracy of middle-class white males.
Given this widespread attack on science and rationality, it comes as no surprise to find that our tertiary institutions appear to be ready and willing to mount degree courses in naturopathy, including homeopathy and iridology.
The test of a scientific theory is that it can be refuted by an experiment or trial. Homeopathy has been subject to numerous trials and has yet to demonstrate any benefit other than those attributable to the placebo effect. This is not surprising, given that homeopathic medicine is water in which a potent substance has been diluted to levels where there is virtually no chance that an original molecule of the potent substance survives.
These are truly “dilutions of grandeur”. Frequently this “diluted water” is absorbed into a sugar crystal for packaging and will have typically evaporated by the time the patient gets round to taking it. The argument that homeopathic medicine can do no harm is almost certainly sound –what harm can be done by a dose of evaporated diluted water?
Against all this evidence the belief in homeopathy survives.
This raises the question of how a tertiary institution can possibly teach such subjects within a genuine environment of learning and research. Universities and polytechnics are supposed to encourage free and informed debate. If students of homeopathy come to an examination armed with all the published refutations of the practice, would they be able to pass the course? Probably not. Homeopathy is a belief system like astrology or witchcraft. You either believe it or you don’t, and any refutational evidence is dismissed as somewhat irrelevant. The standard argument is that sceptical observers cause bad vibrations which interfere with the efficacy of the treatment.
Can we really tolerate a course within a tertiary institution which argues that healthy scepticism interferes with proper analysis?
Wheat Amongst the Chaff
The proper place to present the field of natural medicine, or its more legitimate cousin, the whole body approach to medicine, is within the school of medicine itself. At least it will be subject to debate, and the wheat can be sorted from the chaff. And there is real wheat in there. Modern medicine has gone too far in the pursuit of the science of medicine as opposed to the art of healing. The placebo effect is powerful and we need to learn how to harness its potential to achieve maximum benefit. But we will make no progress while such investigations are accompanied by nonsense such as iridology or EVA, and where belief cannot be subject to critical experiment and refutation.
Where does the AIT Press fit into this? There are a host of publishers making money out of publishing the latest hocus pocus on the works of Nostradamus or whatever else is providing the latest means of extracting dollars from the gullible. Many readers are trying consciously to make sense of the widely differing views of the world presented by the Uri Gellers on one hand and the Stephen Hawkings on the other. If they wander into a library or bookshop and find a book on repressed inventions, or the international conspiracy to poison us all with pesticides, such readers are likely to assume that books published by the Auckland Institute of Technology (which could be expected to share the aspirations of MIT — otherwise why did the ATI change their name to AIT?) will have been subject to a higher standard of editorial criticism and intellectual rigour than the latest piece of flim flam from the “Centre for Zodiacal Peace Freedom and Inner Radiance”.
Well, I am sorry, they would be wrong. It looks as though the AIT has decided if there is a buck in it, they publish. And no doubt their response to this criticism will be to blame the government for not giving them enough money to start with. Is this an excuse to abandon principles?
Surely this is simply bad business practice on the part of the AIT. The AIT teaches courses in business, which presumably advise students that the most important asset of a modern organisation is its intellectual property. I would have thought that a critical part of the intellectual property of any tertiary institution would be its reputation for intellectual rigour and honesty. This reputation must surely be debased by a publishing house which is fast becoming a bad joke among the critical and informed readers of this country. I certainly would not recommend attendance at AIT to anyone I know if these publications represent the polytechnic’s attitude to the pursuit and dissemination of knowledge.
So the Qualifications Authority should stand firm and give accreditation only to those courses in medicine, science and technology which admit to critical analysis and are prepared to expose themselves to the normal standards of the scientific process — which means that if a belief is disproved then it must be abandoned.
Do Believers Really Believe?
One of the problems with naturopathy and similar belief systems is that even people who don’t believe in them believe in them. This may sound like nonsense. But if you are one of the many readers who are upset by these arguments and have some belief in naturopathy in any of its manifestations, ask yourself this question:
You have just had a terrible car accident. You are lying in the road and feel your life ebbing away and you suspect that other members of your family are in a similar state. A crowd has gathered around, but no-one is equipped to deal with the carnage. Then you hear dimly that wonderful sound, “Step back, make way! Step back, make way!” At last, you think, help is at hand. And then the final chant is “Step back, make way, here I am — and I’m a qualified naturopath”.
What do you believe in now?
We have to recognize the inability of modern medicine to meet the unrealistic expectations it created in the fifties and sixties. These have created a market driven by those who believe that their chronic ailments must be able to be cured by some magic medicine and will keep on searching until they find it. During the process the body often cures itself — and so success is frequently found and the last treatment is declared effective.
This process has opened the door for the irrational to enter our institutions of higher learning and to further close the door on freedom of speech and expression. You may not think this is a bad thing — especially if it provides a few more people with work and earns some money for the education system.
But how would the Minister of Education respond to a proposal to set up the Divine School of Engineering, or the Natural Light School of Veterinary Science, or the Tantric School of Economics? How will you feel when the building inspector uses an EAV meter to decide whether your building is earthquake proof or an acupuncturist is called in to test your herd for bovine TB or a Tantric Guru is appointed Governor of the Reserve Bank?
How come we would be prepared to let these people play games with our health, but not with our buildings, our cattle or our economy?
Hokum Locum
NZ Qualifications Authority
An editorial in the Christchurch Press (23 Nov 94) was critical of the Universities who are seeking approval from the NZQA and argued that they should continue to set their own high standards.
The Aoraki Polytechnic has applied to the NZQA for recognition of a Bachelor Degree of Applied Science (Naturopathy). Naturopathy can mean anything from treatment with homeopathic remedies to colonic irrigation. I wrote to the NZQA and was told that the Aoraki application “involves review by a panel of peers…having a mix of professional and academic backgrounds.” I await the decision of the panel with considerable interest as the thought of a Bachelor of Applied Science (Naturopathy) holding equal weight with say a Bachelor of Applied Science (Biochemistry) is completely ludicrous.
Recovered Memory Syndrome
“ACC payments of $10,000 to three women who recalled `memories’ of rape and abuse as children are to be re-examined after aquittal of their father.” However, unbelievably, ACC’s Fred Cochram says “it is possible for people’s suffering to be deemed valid for compensation even if abuse was disproved in the courts! (Dominion Oct 5 1994)
It is absurd that at a time when ACC is making it more and more difficult for victims of genuine accidents to gain adequate compensation, they continue to provide money for the fraudulent activities of an army of counsellors who are poorly trained and following their own feminist agendas.
Sporting Excesses
I have previously commented on the insane activities of athletes who take performance enhancing drugs which in many cases do enhance phsyique but have no more than a placebo effect on performance. (Skeptic 28)
A former Russian gymnast alleged that her trainers forced her to become pregnant and then have an abortion because “the body of a pregnant woman produced more male hormones and could therefore become stronger.” (Christchurch Press 24 Nov 94)
There has been much speculation about possible illicit practices by Chinese athletes. I think we can reasonably discount anything other than a placebo effect from a secret elixir containing “turtle blood, ginseng and other spices” used by China’s track team. Why “turtle blood” for runners? Surely it would be more logical to give it to their swimmers? In fact it doesn’t really matter what the product contains because the Chinese expect to sell about 20,000 bottles of the quack tonic in Japan.
Eleven of China’s long distance runners have had their appendices removed because “they were getting sick and having toxicological problems.” Leading sports doctors were reported as being puzzled and amazed. (Marlborough Express 13 Oct 94) I am neither puzzled nor amazed as China continues to be a rich source of medieval superstition and quackery such as acupuncture. Medical history tells us that it was widely believed that “toxins” were a cause of many ailments and as a result people were purged, had all their teeth removed, tonsils extracted and any organs such as the appendix were also removed. In some cases patients had their entire large colon removed and enjoyed diarrhoea for the rest of their lives. When history is ignored it tends to get “rediscovered”.
Turbulent Priests
A rather extreme Catholic school principal and priest has refused to give his pupils a combined vaccine because it was obtained from cell culture originally obtained from an aborted foetus in the 1960’s. I have no argument with any religion provided it does not interfere with the state but the Catholic religion has an unenviable reputation for continually interfering with public health issues.
A more recent example is their attempted sabotage, along with Muslim extremists, of the recent global conference on population planning. (Marlborough Express 27 Oct 94).
Medicines
Correct me if I am wrong, but I think it was GB Shaw who said that the main distinguishing feature of humans from animals was their desire to take medicines.
Health expenditure in Switzerland reached 18 billion pounds last year of which drugs were 10.7 percent. About 60 percent of all drugs are available over the counter (OTC) and the Swiss are at the top of Europe’s self-medication league. (The Lancet Vol 344 p322).
The New Zealand drug bill shows a healthy annual growth rate and is rapidly approaching the NZ$1 billion mark. One Government attempt to control these excesses was thwarted by GP’s who simply prescribed more drugs on each prescription. If people wish to poison themselves with drugs I think we should follow the Swiss example and make them available OTC. People can then personally pay for their drugs which will not detract from the health vote. The oral contraceptive is incredibly safe for OTC availability, however there is an excellent case for requiring a prescription for cigarettes.
Prozac is a new antidepressant drug which may be safer than exisitng drugs but is also much more expensive and has been already grossly over-prescribed in the US. There is already considerable pressure to allow its unrestricted use here in New Zealand.
Christmas Shopping Blues?
A major trial has found that the drug Fluvoxamine prevented compulsive shopping in all seven patients. Fluvoxamine is frequently used to treat obsessive-compulsive disorder which causes people to repeatedly wash their hands, pull out their hair or to hoard strange objects. It could also help doctors who repeatedly over-prescribe drugs.
Over-investigation
The medical model applied when I went through medical school suggested that patients had either an accepted organic illness or something less well defined such as “conversion disorder” ie. stress producing symptoms and signs. (eg. RSI or OOS) The evolution of investigative technology means that this model has the potential to be mis-applied.
I will quote in full an item from the BMJ Vol 309 p420). Irritable bowel syndrome is a condition where people complain of abdominal pain and constipation for which no cause is found.
“Six patients with the irritable bowel syndrome between them had 29 operations and 46 investigations, says a report in the Scottish Medical Journal. It warns that other studies have shown that around one third of patients with the disorder have appendicectomies and half the women have major gynaecological operations.”
I recently saw a woman with a clear history of hyperventilation syndrome (over-breathing, similar to what happens when blowing up a balloon) which causes neurological disturbances. The patient had had a CAT scan and an electroencephalogram after which a (foreign) neurologist prescribed Tryptanol (an antidepressant), Prednisone (a steroid anti-inflammatory) and Dilantin (an anti-epileptic)! Presumably this lethal cocktail was prescribed “just in case”.
Sickness Benefit Abuses
As I outlined in a previous column (Skeptic 32), all that is needed to get extra money when unemployed is a certificate from a doctor saying that you are “sick”. Not surprisingly there has been a steady growth in the benefits industry since most doctors derive their income from signing forms. In 6 years the number of people on sickness benefits went from 20,000 to 34,000. When combined with the invalid benefit this costs nearly 1 billion dollars annually. (Evening Post 18 Nov 94)
The cause of this fraudulent activity is the discrepancy between income support and invalidity benefit. A British GP (BMJ Vol 309 p673-4) noted that 23 out of 24 of his drug addict patients were receiving invalidity benefits despite guidelines that GPs should not issue sick notes to drug users unless they have a co-exisitng medical or psychiatric condition. In New Zealand I have known of drug addicts getting both sick notes and their drugs from the same doctor!
I am pleased to see that our own Social Welfare Minister has acknowledged that the numbers on such benefits falls once a more consistent policy is taken to assess eligibility.
Breast implants
A judge in Alabama has approved a US$4.25 billion compensation deal for more than 90,000 women worldwide with silicon breast implants. Many women have suffered proven ill-health but those who have difficulty finding an excuse to get their pot of gold can claim for “silicon disease”. This only requires at least five of a range of symptoms, including rashes, chronic fatigue, muscle weakness and memory loss. These are of course very vague symptoms and could be attributable to a wide range of other conditions such as CFS and alleged chemical “poisoning”.
NHS goes bananas?
GPs in the UK National Health Service (NHS) have won a partial refund for their patients who are spending $1250 on transcendental meditation courses. TM is an invention of an Indian guru and has no legitimate place in any health system. The Beatles flirted briefly with TM but became disillusioned when the guru persisted in making sexual overtures to their girlfriends.
Smoothing away the years
Need a face-lift? Look no further than CACI (computer aided cosmetology instrument). CACI delivers a tiny current to the skin and muscles in order to “re-educate muscles”. It is allegedly FDA approved. I have written to NCAHF to check this claim and will report in due course.
Best wishes for the New year to all readers and don’t forget Fluvoxamine if you feel a Christmas shopping compulsion. If Christmas awakens repressed memories of ritual satanic abuse at the hands of Santa I recommend a $10,000 payout from ACC will also help with the shopping.
Hokum Locum
MSG Myth Laid to Rest
Another sacred cow from my medical school days has been laid to rest. A letter in the New England Journal of Medicine in 1968 triggered a rash of anecdotal reports about facial flushing allegedly caused by monosodium glutamate (MSG) in Chinese food. “Chinese restaurant syndrome” had entered the popular medical mythology. Finally, 26 years later, two Australian scientists conducted a double-blind placebo controlled trial and found that some reaction to MSG was experienced by 15% of the subjects but the same reactions were also experienced by 14% of the placebo subjects. The scientists believe that the true cause of Chinese restaurant syndrome are histamine compounds found in fermented ingredients such as soy sauce, black bean sauce and shrimp paste. New Scientist 15 Jan ’94 p15
Poppycock
A US plastic surgeon found that the majority of his patients presenting for operative penile enlargement were motivated by anxiety over the size of their privy member rather than its performance. In fact one patient’s partner reportedly phoned the surgeon before her husband’s operation and told him she would rather have a fur coat! (GP Weekly) The procedure of penile enlargement was developed in China by the appropriately named Dr Long Daochou.
This absurd operation is not at all unusual in a culture where people also have silicon inserts into their muscles in order to look good at the beach. In fact, Ken and Barbie dolls are good models for such people who prefer plastic moulding to the real thing. Speaking of which, Barbie now has her own spiritual “channeller” (Barbie:”I need respect”!) and a “Barbie Channelling Newsletter”. Sadly, Barbie’s cries for help were treated with derision by Mattel Corporation who threatened the channeller with a multi-million dollar lawsuit. Sunday Star Times 5 June ’94
Naturopathology?
I was absolutely stunned to read in the Christchurch Press (12/8/94) that the Aoraki Polytechnic in Timaru is planning to offer a three-year Bachelor of Applied Science in naturopathy. Incredibly, the Qualifications Authority (QA) will be visiting the polytechnic to assess the course. The list of “basic sciences” to be studied includes herbal medicine (Kentucky fried medicine) and homeopathy (dilutions of grandeur). Is there anyone out there with any influence on the QA? Should market forces be allowed to dictate what constitutes a “basic science”? These are serious questions.
Psychobabble?
Can anybody help me come to an understanding of post-traumatic stress disorder (PTSD)? I know it is the new term for what used to be called “shell-shock” but can anyone tell me if the condition is seen in societies which do not have compensation available and are therefore not subject to Welch’s law (see NZ Skeptic 32).
Three passengers on the cruise liner Mikhail Lermontov were awarded a total of nearly $300,000 compensation for PTSD and a further 18 plaintiffs are waiting for their pot of gold. In order for PTSD to have a valid aetiology there must be an equal incidence of cases in the NZ passengers.
I briefly mentioned similar cases related to military service (NZ Skeptic 32) and most people will have heard about “Agent Orange” and alleged links with ill-health in Vietnam vets. It proved cheaper for the manufacturer to settle out of court but this decision has now entered the popular mythology as proof of causation.
Gulf War veterans (something of a misnomer since very few saw any active service) are claiming that symptoms such as fatigue and memory loss constitute a syndrome for which they will no doubt be claiming compensation. (NZ Skeptic 31) I have been following this saga in the medical literature, and investigators are coming up with ever more fanciful theories to explain what is nothing more than mass hysteria. Christchurch Press 14/6/94
Medical News
A therapist who become famous through treating Diana, the Princess of Wales, has been ejected from his Harley St consulting rooms because his claimed medical qualifications were found to be bogus. Presumably he must have had some success with his treatments but the real Harley St doctors were offended and he had to go. What about the opposite situation — real doctors who persist in offering bogus treatments? We have plenty of these in New Zealand and a medical registration system which can do absolutely nothing about the situation!
There will be no sensible policy on smoking in Israel because the acting health minister, Prime Minister Rabin, is a chain-smoker and refuses to sign a bill prohibiting smoking in public places!
Finally, a common inclusion in 17th century Dutch paintings of women visiting the doctor is a charcoal burner and string. The string was burnt near the nose of hysterical women so the fumes can drive the “wandering uterus from the woman’s upper body back to its proper place in the pelvis.” A quaint theory which has been replaced in our time with food and multiple chemical allergy, RSI, CFS. Have we made any progress? Lancet Vol 343 p 663, BMJ Vol 308 p606, International Express 31/8/94.
Mass Hysteria
Some of you will have noted the derivation of hysteria from the Greek “hysteros” for the female uterus which was thought to wander about the body causing hysteria.
Many of you will remember two cases in the US (where else?) where “poisonous” patients caused ill-health to their medical attendants. The first case concerned a 31-year-old woman receiving chemotherapy for cervical cancer. Following the taking of a blood sample in the emergency room, a nurse noted a smell and promptly passed out followed by other emergency team members. Following exhaustive tests no toxic chemical was found and I quote “no one seems to have seriously attributed the mystery illness to hysteria”. The second case followed a similar course.
Both of these cases are in fact classical examples of mass hysteria which is an unfortunate term with connotations of misbehaviour. Mass hysteria is better described as a contagious psychogenic illness. Psychogenic refers to the production of physical symptoms under conditions of stress and should not be confused with neurosis or malingering. The classical sequence of events begins with a generalised belief about a toxic substance in the workplace followed by a precipitating event, typically, as in the above example, a smell. This perceived threat to health and safety leads to psychological arousal and typical symptoms and signs such as dizziness and fainting. There have been many examples of mass hysteria in New Zealand — the Parnell civil defence emergency 1973 (NZ Med J April 28 1982 p277 and also Australian and NZ Journal of Psychiatry 1975 9:225) and the ICI Chemical fire. Occupational overuse syndrome and sick-building syndrome are good examples of mass hysteria in the workplace.
See Scand, J., Work Environ Health 10 (1984) 501-504) for a good review on the subject.
Bioenergetic Medicine
An advertisement for a course in bioenergetic medicine in GP Weekly (25/5/94) recently caught my attention. The location was the same place where I did a week-long basic acupuncture course in 1987. I spent a week and about $1,000 in total expenses learning a practice which is totally unscientific and can be taught in about half an hour to any intelligent skeptic.
During my course the tutor introduced a market-gardener with alleged “allergy” to tomatoes. The patient was connected up to a Vega machine or equivalent and we were given a demonstration of how his muscle strength was diminished when exposed to the killer tomatoes. A container of steroid was then introduced into the circuit and the muscle “weakness” was cured.
Unfortunately one of the other skeptics in the room had actually removed the vial of steroid from the box and revealed it at the conclusion of the demonstration. Incredibly, the tutor was unfazed and attributed the “improvement” to steroid residues (presumably homeopathic) in the box! Truly a graphic demonstration of the power of belief, one which got me interested in active skepticism as a scientific philosophy highly relevant to my own chosen area of medicine.
I suspect that bioenergetic medicine is very similar to applied kinesiology (AK) where muscle strength is tested while a person is subjected to various influences such as foods, vitamins, homeopathic remedies etc. Controlled studies of AK have repeatedly shown that responses are random under conditions where both tester and test subject are unaware of the substance being tested. My own anecdote is a good example of this. NCAHF Vol 17 No 3 has a brief overview
Fraudulent Food & Drink
Yuri Tkachenko, of the resort town of Sochi, has been given permission by city authorities to “magnetise” the Sochi river and thereby lessen the flow of pollutants into the Black Sea. As the river water quality is obviously a little suspect you might like to try some of his “magnetic” vodka which is guaranteed not to cause hangovers.
On the other hand, if you are mainly worried about getting rid of heavy metals, look no further than a new Hungarian oat-bran extract guaranteed to soak up lead and radioactive strontium carried in the blood stream. The pill, Avenan, has been developed by Lajos Szakasi who needs few lessons in the marketing of quack remedies. Avenan will go on sale as a health supplement rather than a medication because “it can be approved after a simple registration procedure”. To quote Lajos again “I believe the product will be successful because…people will always spend on their health.”
More fantastic still is a report from Japan where Kazu Takeishi has been arrested for giving medical advice and medicines without being properly qualified. It all began with his “healthy” vegetable soup which can be mixed with urine to become a miracle medicine, particularly effective against AIDS and cancer. Kazu claimed to make his diagnoses by touching patients’ knees and the palms of their hands. Like all good quacks Kazu is sure of his market and it’s a good one — $30,000 a day and a two-month waiting list (must have been getting behind on the urine supply). Cancer is a taboo subject in Japanese culture and doctors are even protected in law from informing patients about such a diagnosis.
Now, if I could get the recipe for this soup, I could mix it with urine and treat cancer patients for $300 per consultation and there is nothing the medical council can do — because I’m a doctor!
Hokum Locum
A Menu of Dietary Delusions
Neither Nutrasweet nor sugar-rich diets produce any change in children’s behaviour. (New England Journal of Medicine 330:301-307, 1994)
The subjects were tested in a double-blind, placebo-controlled trial. The trial was reported in the local press and produced a predictably outraged response from local nutritional quacks who have carried on regardless. Their beliefs are based on faith and are therefore not amenable to reason. For another good New Zealand review see NZ Medical Journal 27/9/89 (Diet and Behaviour) and 23/8/89 (Children’s diets: what do parents add and avoid?).
Evening primrose oil has been touted widely as a “natural” remedy for a host of conditions such as pre-menstrual tension and menopausal symptoms. The active ingredient is gamma-linolenic acid and it was tested in a randomised, double-blind, placebo-controlled trial of 56 menopausal women experiencing episodes of sweating or flushing. It was found to be no better than a placebo.
It is worth noting the value of such studies. Randomisation means that patients have an equal chance of receiving either the “test” substance (gamma-linolenic acid) or a placebo. This ensures that both wings of the trial are identical in terms of age, sex, number of smokers, etc. Double-blind means that neither the subjects nor the investigators know who was taking the “test” substance or placebo until the study has finished. It is no wonder that quacks decry such studies which remove bias, prevent cheating and usually show that quack remedies are useless. (BMJ 308: 501-503, 1994)
Smart Drinks
These are amino acids and other precursors of neurotransmitters which are being promoted among teenagers at music and cultural festivals. Smart drinks are claimed to “fire up the brain” and give the young executive an “edge”. Could there be anything more loathsome than a hyperactive yuppie? I remember reading about the smart drinks phenomenon in the US and I am not surprised that they have arrived in New Zealand. There is no evidence that smart drinks have any effect on either memory or intelligence. (NZ Doctor 31/3/94)
Sick of Work?
All that is necessary in New Zealand to get a sickness benefit ($22 per week more than the dole for those under 25 years of age) is to persuade a doctor to sign a prescribed form from the DSW.
Over the years I have seen many flagrant abuses of the SB. The best one was a young person who had been on a SB for over two years because of a perforated ear-drum. When I refused to sign the certificate she simply went to a more compliant doctor.
The court news regularly detail the activities of professional criminals and drug addicts who are described as “sickness beneficiaries”. My attempts to find out which doctors were signing these certificates were thwarted by DSW who cited “medical confidentiality”. The great irony is that at the time they were expecting doctors to inform on beneficiaries who were fiddling the system but were not prepared to put their own administration under scrutiny.
A reporter in Germany was able to obtain 41 days sick leave from five different doctors even though he told them he was perfectly well but just wanted a few days away from the office. One visit lasted four minutes, involved no examination and was worth 12 days off! (Dominion 29/3/92, Worker highlights easy access to sick leave)
This sort of abuse arises from poor ethical standards, which also extend in Germany into drug licensing (see Skeptic 27).
Laying On of Hands
The introduction of ACC around 1972 saw a great increase in both the use of physiotherapy and private physiotherapy practices. In Skeptic 29 I commented briefly on the widespread use by physiotherapists of unproven treatment modalities such as ultrasound. Ultrasound treatments have been introduced on a basis of applied experience rather than from controlled scientific study. Dr Linda Maxwell writing in the NZ Science Monthly, March 1994, has studied cellular processes at injury sites and found that ultrasound may enhance inflammation and actually cause more injury.
Physiotherapy is also traditionally used to build up muscle strength in patients with rheumatoid arthritis. A controlled trial by physiologists (New Scientist 16 Oct 1993 p17) found that this approach tended to worsen the flexion deformities seen in this condition. Work continues in the area of electrically stimulating the extensor muscles in an effort to counteract the tendency to flexion deformity.
Most injuries recover with time and I doubt whether the laying on of hands or the use of electrical gadgets by physiotherapists accelerates this process. Many of my patients become upset if they do not receive a referral for physiotherapy and few doctors will refuse in such circumstances.
It is no surprise that costs of the ACC scheme have continued to rise each year. The burden of proving that their treatments are worthwhile rests with the physiotherapy profession. ACC should not pay for any treatments unless they can be shown to be both cost effective and scientifically valid.
Alexander Technique
The “Alexander Technique” (AT) is an extreme example of the laying on of hands. To quote a recent magazine article, “…by extending the neck and opening the back, it literally makes you taller and releases the body’s natural energy flow”.
Note the typical vague language of quackery: what does “open the back” mean and just what is this “natural energy flow” that quacks keep going on about? The usual anecdotal reports are quoted by satisfied patients: “My singing has improved tremendously…I felt lighter, taller…I’ve learnt to relax by opening and lengthening the back muscles!”
The founder, Frederick Alexander, was born in Tasmania in 1869 and longed to be an actor but suffered a mysterious loss of voice. The rest is worth quoting: “Sitting alone for nine years in a room containing only mirrors and a chair, he studied his position in every detail. It took two years for Alexander to discover only the fact that when he talked he was moving his face and chin forward and contracting the vertebrae in his neck. The muscles of his neck were becoming very tight and causing obstruction in his voicebox.”
I would have described his position as ridiculous and if he found the problem after two years what did he do for the other seven years? How does one “contract the vertebrae in the neck”?
Feeling a need to inform us further about AT the author followed up with three more anecdotal reports from satisfied customers who all described how they feel “happier, more positive, less stressed”.
Quackery has many recurrent themes. The founder of AT suffered a profound illness which was clearly psychological (nine years in a room with mirrors!) and led to him feeling that he had discovered the meaning of life.
The laying on of hands is the basis for the clinical effects (essentially placebo) of most forms of physical therapy such as chiropractic, osteopathy and AT.
Massage and postural “adjustments” are pleasant procedures for patients and it is not surprising that they go away feeling empowered and improved. Unfortunately, many become dependent on therapy and I have met many people who feel it essential to consult such therapists on a regular basis for years. This of course is encouraged by such quacks because it is great for business and they are able to take advantage of people who are incapable of taking responsibility for their own lives and health.
Ischaemic Heart Disease
Ischaemic heart disease (IHD) is a serious public health issue in New Zealand and is the leading cause of death for New Zealand adults. My own father died suddenly of a heart attack while on a golf course. He was 71 years old and had no known risk factors yet autopsy showed severe coronary artery disease.
The costs of treating IHD are considerable and surgical treatment is popular. Political pressure has seen the creation in New Zealand of an absurd number of cardiac surgical units compared to similar western countries. An American study (quoted in Lancet Vol 343 p412) of 1,252 patients showed no difference in employment status after one year between comparable patients who underwent either surgical treatment (angioplasty or bypass) or medical treatment (lifestyle modification, drug treatment).
Angioplasty involves passing a fine balloon catheter into an area of blockage and inflating it, while bypass surgery involves using lengths of vein to bypass the blocked area in the coronary artery. In a subset of 72 patients the median number of days from the start of treatment to return to work was 14 days for medical treatment, 18 days for angioplasty and 54 days for bypass surgery.
Clearly surgery is not always the best option and a lot more of our health resources could be better spent on prevention of this condition by risk factor reduction.
Death or Compensation
A court in the UK awarded a Falklands War veteran $220,000 for post-traumatic stress disorder acquired as a result of serving during that campaign.
This drew a sharp response from the defence editor of the Daily Telegraph (Dominion 10/3/94) who asks how this can be taken seriously at a time when thousands of veterans are converging on Normandy to commemorate the D-Day landings. The Falklands War veteran received his award for the stress of an action over two days! Many WWII vets saw active service for five years and returned to lead happy and successful lives.
Wars are horrible experiences from which soldiers can recover without the need or right to compensation. Post-traumatic stress disorder is simply a New Age euphemism for shell shock, and an insult to all servicemen who have done their duty and returned to civilian life. This absurd monetary award is an example of Welch’s law (after Parkinson): “Whenever compensation is available conditions will emerge to take up the compensation available”.
Deliver Us From Gynaecologists?
In Skeptic 29 I referred to abuses of gynaecology. In Florida, where 25% of deliveries are by caesarean section, the state legislature has forced doctors to change their practices, wanting the rate to be less than 20% by 1997. There is a higher rate of Caesarean delivery among patients with better health insurance and higher incomes, and the rate is lowest in teaching hospitals. (BMJ Vol 308 p432)
Failing the Sex Test
This is the headline of an article which appeared in the Dominion 17/3/94, and concerns an Indian clan which murders unwanted female children. Because of the illegal dowry system, girl children are too expensive so are murdered by being either strangled or smothered soon after birth. The tribe cannot afford amniocentesis which is also abused in order to predetermine sex so that female foetuses can be aborted.
It is important that such cultural practices are highlighted and discussed. It has been interesting to see how various other equally vicious cultural practices have fared following migration to western countries. Some doctors have been de-registered for performing female circumcision and I have even seen a reference in print defending this procedure!
The Indian authorities have taken little action over these murders since the status of women in India remains low. If there are problems over the dowry after marriage, it is a traditional practice to set fire to one’s wife and make the murder look like a kitchen accident.
How far should we go in either acknowledging or accepting traditional cultural practices? Nurses in New Zealand are judged on their “cultural safety” regarding Maori traditions and customs, which fortunately do not honour such abuses as infanticide.
A Man with Rheumatoid Arthritis
A couple of weeks before my medical finals late last year I sat down in the waiting area of the Christchurch rheumatology clinic. I struck up conversation with the only other person there, a man in his late forties. The story he told me about his arthritis made my few remaining strands of hair stand on end.
This unfortunate gentleman (whom I’ll call “Barry”) had suffered from rheumatoid arthritis in his hands and feet for about seven months. Shortly after the start of his symptoms he consulted his general practitioner who advised him, and provided him with a typical course of physiotherapy and aspirin-like drugs to try to prevent loss of function, and to relieve the inflammation and the pain.
This approach didn’t seem to be working and shortly thereafter Barry consulted a naturopath in his suburb. The experience completely changed his life.
Barry was an uncomplicated man, surviving on his own, on an unemployment benefit. A weekly visit to the naturopath cost twenty dollars, which initially seemed reasonable, but the remedies prescribed cost a further eighty dollars each week. These were initially in the form of homeopathic pill preparations; subsequently there were caustic foot baths (“which made my skin fall off”) and magnets to wear. Then there was the list of forbidden foods which, he said, “was practically everything I ate”. Onion soup was given the green light however, and Barry had quite literally attempted to live on this for the months until his rescue. He felt there was little option though, as he had no money to buy food now anyway. This continued for a considerable time and Barry’s return for “therapy” each week was partly promoted by the naturopath telephoning him each morning and each night, every day, reminding him to do so.
Barry remembers no attempt to formally test whether or not his arthritis was improving. He felt there was no improvement.
Old neighbours called around one day, not having heard from him for a time. They found Barry lethargic, pale and malnourished. He had the feeling that the naturopath had control over his mind, and he wanted to kill himself. The neighbours’ very humane response to this was to temporarily remove him from his house, and simultaneously clean it and contact the Arthritis Foundation. And Barry found himself back in medical care, where I met him.
There was a post script to this ghastly affair. Barry called the naturopath to tell her that he would no longer be attending, and that he would be submitting the remedies he had left to “the DSIR” to see if she had been poisoning him. He was told that unless any remaining medicines were returned to her within twenty-four hours the police would be informed that he had stolen them. He took them back.
How could this have happened?
The chronic nature of many rheumatic disorders often leads sufferers to seek treatments alternative to those given by their doctors1. In one study published in England2, 40% of Scandinavian rheumatoid arthritis sufferers had consulted a practitioner in at least one of the following disciplines (a further 3% were unclassified): acupuncture, anthroposophical medicine, astrology, cell therapy, auriculo therapy, enzyme therapy, faith healing, spa treatment centre, herbalism, homeopathy, hypnotherapy, iridology, manipulation, naturopathy, neural therapy, hand healing.
An article in Pediatrics3 states that 70% of sufferers of juvenile arthritis used “unconventional” remedies at some time.
Homeopathy is possibly the most widely available alternative therapy in Christchurch, but there is a real smorgasbord of alternatives now as readers will know. Even my much admired medical handbook4 appears to support the system, referring to a British Medical Journal paper5 and stating that an analysis of the clinical trials suggests real benefit. Closer scrutiny of that very article however, does not to my mind bear this out, and the conclusions the authors draw from their own analysis are contradictory.
Some authors in apparently reputable medical journals are startlingly uncritical. Most authors suggest that more research must take place. Not so Skrabanek, who says “…this leaves the sufferers, and also healthy people labelled with non-existent diseases, bleeding prey for the sharks roving the seas of medical ignorance”.6
Questions remain. Why do people seek out alternative therapies, and often believe uncritically in them? Are they dangerous?
My belief is that as a group, we are not fulfilling all of our duties as caring doctors. Patients who visit alternative practitioners tend to have less satisfaction in their regular doctor in psychosocial ways than those who have never consulted an alternative medicine practitioner2.
I think that we would all accept that our medicine may fail to arrest the biological progress of a patient’s disease. But if we also fail to recognise and help with the psychological and social aspects when they consult us, help in all aspects of a disorder may be sought elsewhere. This could be registered as a dissatisfaction “with the dehumanising aspects of modern technological medicine”6.
As to the hotly-debated question of dangerousness2, arguing against any particular danger is the innocuous biological inactivity of the majority of alternative therapies — homeopathic remedies made in the classic way contain no active ingredient, and can therefore do the patient no harm. But surely this is too simplistic. Many skeptics would consider these “therapies” potentially dangerous because the patients they may be encouraged to waive their usual medication, they pay large sums of (unsubsidised) money, acquire weird false hopes, and are seduced into accepting bizarre magical thinking. And they don’t get their diseases treated.
References
1) Andrade, L., Ferraz, M., Atra, E., Castro, A., Silva, M. “A randomized controlled trial to evaluate the effectiveness of homeopathy in rheumatoid arthritis.” Scandinavian Journal of Rheumatology 20(3): 204-208, 1991. Return to text
2) Visser, G., Peters, L., Rasker, J. “Rheumatologists and their patients who seek alternative care: an agreement to disagree.” British Journal of Rheumatology 31:485-490, 1992. Return to text
3) Southwood, T., Mallelson, P., Roberts-Thomson, P., Mahy, M. “Unconventional remedies used for patients with juvenile arthritis.” Pediatrics 85(2):150-154, 1990. Return to text
4) Collier, J., Longmore, J., Harvey, J. Oxford Handbook of Clinical Specialties (3rd Edition). Oxford University Press, Oxford, 1991. Return to text
5) Kleijen, J., Knipschild, P., ter Riet, G. “Clinical trials of homoeopathy.” British Medical Journal 302:316-323, 1991. Return to text
6) Skrabanek, P. “Paranormal health claims.” Experientia 44(4):303-309, 1988. Return to text
Hokum Locum
The sting
Following his own empirical observations that bee “treatments” helped his arthritis, a Levin bee-keeper is claiming that he is being ignored by the medical profession. (Press 3/8/93) Not surprisingly, his trial of 11 patients failed to impress skeptical observers. Two patients dropped out and the remainder reported that the “sting” was effective. Having paid for the privilege of being stung, a sensation to be normally avoided, they are hardly likely to say that the treatment was worthless.
In the middle ages, hornets were applied to the skin as a treatment for plague. Nothing appears to have been learned from such unpleasant, not to say dangerous, treatments.
Bogus professor
An unqualified woman who posed as a doctor and professor, was sent to prison for 6 months for fraudulently claiming that she could cure cancer and AIDS. Analysis of her product, Cancelle, or CH6, showed “it had no medicinal properties and contained toxic elements.” (BMJ 306 p1499).
It is ironic that the courts (in the UK at least) will move swiftly to deal with quacks, but the medical profession has failed to take action against registered medical practitioners who practice quackery such as homeopathy and EAV diagnosis.
Caesarean sections
Australia has a high rate (30-35%) of caesarean sections among private patients, and the introduction of a global obstetric fee that applied irrespective of the mode of delivery did not change the proportion of caesarean deliveries. (BMJ 306 p1218) The caesarean rate in Brazil is an amazing 50% on average, with the highest rates among the poor. Two reasons for this are a virtual absence of midwives and the belief (encouraged by obstetricians) that a vaginal delivery will permanently impair normal intercourse afterwards. Both of these examples demonstrate how doctors can develop bad practices when the socio-cultural environment allows this to happen. Only patient education with strong and ethical professional medical leadership, can prevent this kind of surgical abuse.
Low back pain
Readers will remember Denis Dutton reporting his experiences with an episode of low back pain, or lumbago (Skeptic 24). A Canadian study (British Journal of Industrial Medicine 1993; 50:385-8) found that the best treatment for uncomplicated lumbago was to remain active. The traditional treatment of bed rest was thought to encourage chronic invalidism.
This theme was continued by Robin McKenzie (Press 11/6/93) who attacked the current traditional approach to low back pain. Of physiotherapy, he said “it had for 75 years relied on unproven methods and `hocus-pocus’ electrical gadgetry” and he went on to say that “doctors should prescribe active rather than passive therapies.” Most controversial was his statement that “50% of workers on compensation were feigning illness.”
I am sure that there is an element of truth here. Physiotherapists use a wide variety of treatments and machines, many of which have not been adequately tested. It is too easy for people to refuse to accept responsibility for their own recovery and become chronically dependent on ACC. This applies not only to back injuries but other conditions such as chronic fatigue syndrome (CFS) and occupational overuse syndrome (OOS).
Work-related illness
Readers will be familiar with my position with respect to OOS, which has its roots in abnormal illness behaviour and psychological factors. It is interesting to compare it with the “sick building syndrome” (SBS), another new age medical invention. At last someone has done a trial of randomly increasing the ventilation rate while getting workers to report their perception of the indoor environment. (NEJE 328: 821-7)
To quote the authors: “Increases in the supply of outdoor air did not appear to affect workers’ perceptions of their office environment or their reporting of symptoms considered typical of the sick building syndrome.”
I would like to offer what I regard as a more likely explanation of the SBS which also relates to OOS. People crowded into a large building, working at VDUs and perhaps isolated from each other are always going to be vulnerable to a belief that the working environment is in some way responsible for vague and ill-defined malaise.
A report of a survey in the Christchurch Press (21/5/93) confirmed a high level of stress and dissatisfaction in the workplace. Half of the respondents said they would change jobs if they could and many felt that changes in conditions had resulted in more work for less pay. Most felt that they had less power to control their work environment.
Such surveys are extremely valuable because they provide a clue to the origin of conditions such as CFS, SBS, and OOS. I have no difficulty in accepting job-related stress, but I would prefer to see some honest acknowledgement of this by patients and doctors instead of the fraudulent collusion which creates mythical conditions as CFS, SBS and OOS.
Placebo controlled trials
Since such trials appeared in the late 1940s they have continued to be a valuable tool for investigating the efficacy of new treatments and drugs. Fish oil supplements were tested against placebo capsules for the treatment of psoriasis and there was no significant improvement in either group (NEJM — reported in GP Weekly 7 July 93). Refer also Skeptic 27 for an excellent review of the placebo effect by Dr Bill Morris.
Weight loss delusions
The diet industry is worth millions as women strive to achieve the impossible standards set by the fashion industry. Journalists have even invented a new term for fat, “cellulite”, which apparently looks and feels different from other body fat. (Marlborough Express 24 Sep 92) It can be removed by massage and body treatment products. Obese subjects can pay $180 to be blasted with water jets which “eliminate fat deposits and excess fluid” while hydrotherapy with miracle algae can “restore a balanced energy flow to the body”. (New Scientist 1 June 1991 p47) I hope this particular clinic has good grease traps in its drains.
Other researchers try and tell us that obesity is inherited and therefore nothing can be done. This ignores the success of weight-watchers and the obvious argument that if weight can be gained it must also be able to be lost.
A study (NEJM reported in Patient Management June 1993) found that diet-resistant patients under-reported their actual food intake by 47% and over-reported their physical activity by 51% and “diet-resistant patients were significantly more likely than control subjects to believe that they had a genetic or metabolic cause for their obesity, and to describe their eating behaviour as relatively normal”. This important work clearly demonstrates yet again the importance of patient beliefs in relation to illness behaviour.
While on the subject of over-eating, I note that a typical cat living in Britain is given twice as much protein a day as that eaten by a typical poor African.(BMJ Vol 306 p1078)
Homeopathy
In Skeptic 26 I offered to go into business with anyone prepared to join me in selling pure water labelled as “homeopathic preparations”. Two homeopaths were indignant about the use of active ingredients in the case of herbal medicine poisoning I described in Skeptic 28 and one went on to say “it is absolutely unethical for any medicine to be sold as natural and especially as homeopathic if it were to include pharmacologically active ingredients”. (Letters – BMJ Vol 306 p656)
I still think it would be a bit of fun to sell some pure water (labelled as homeopathic preparations), invite prosecution and argue it out in court. It could prove to be a more useful arena in which to examine the enduring scam of homeopathy. I could enjoy hearing homeopaths being cross-examined by a skeptical lawyer. At least selling pure water is honest!
Poached Tiger?
Not content with exterminating tigers in their own country, the Chinese have over 110 factories turning tiger bone into tablets, wine and various confections. Presumably the ingestion of such products is believed to confer some of the vigor and vitality of the unfortunate tiger. There are only about 6,000 tigers globally and trading in tiger products is banned by international convention. What a monumental folly that these magnificent and intelligent animals end up being turned into useless traditional medicines because of human stupidity and superstition. (Lancet Vol 341 p46)