Church Hit With Judgement

A jury which in August ordered the Christian Science church to pay $US5.2 million ($NZ9.6 million) in damages in the diabetes death of an 11-year-old boy followed this by adding a further $US9 million in punitive damages.

A juror told reporters after that decision that the issue was not one of freedom of religion, but whether the boy had any choice in determining medical care which could have saved his life.

The boy’s mother had turned to the faith healing teachings of the church instead of traditional medicine when he fell ill.

The Hennepin County District Court jury had considered the punitive portion of the damages for several days after the actual damages award against members of the church, following a trial lasting five weeks.

The case involved the 1989 death of Ian Lundman of Independence, Minnesota, who succumbed after a sudden four-day bout with juvenile onset diabetes.

The boy’s father, Douglas, sued the boy’s mother — his ex-wife Kathy McKown — and her current husband William, as well as a nursing home affiliated with the First Church of Christ, Scientist, as well as a nurse, a church practitioner and another church official, charging negligence.

Lundman’s lawyers said it was the first US civil action involving a death and the church to go to trial.

Reuter

The Skeptical Hairdresser

“Mind my left ear.” cautioned Mrs X, “there’s a needle in it.”

“A needle?” I said, combing up a section of hair on the side of her head to check it out.

“An acupuncture needle,” she said.

Sure enough, there it was, just up from a normal earring hole, a tiny needle with a wee piece of tape over it to hold it in place.

“Fascinating,” I said.

She produced a small metallic rod and held it against the needle. “It’s a magnet,” she explained. “I’m supposed to keep it magnetised.”

I racked my mind for information on magnetism and came up with nothing except a vague recollection that therapeutic use fizzled out around the time of Mesmer. But of course, this is the very hallmark of New Age ideas — they’re always old.

“What’s the treatment for?” I inquired.

“Tennis elbow.”

I deemed it wisest to move on to a new subject. But in one of my rare instances of foreseeing the future, I suddenly knew that it was going to be one of those days.

It was one of those days. Next I got a woman with two sniffly, whinging kids. She assured me that as soon as she got home she’d put them on the colour machine for a good hour.

I didn’t even ask. I’d seen variations of these things before. Of all the New Age gadgets (NAGs) I’ve run into, these may rank among the most exasperating. Most NAGs at least seem to be doing something; they hum or strobe, make pink noise, cause meters to flicker, hurt, relax or irritate… but the colour machine does absolutely nothing whatsoever. It’s just a small black box with a lightbulb of the selected colour on the outside. The box plugs into an ordinary wall socket and the patient is attached by means of a wire with a sort of bracelet on the end. Sometimes an alligator clip is used instead of the bracelet, and is simply clipped onto the patient’s clothes or hair.

The machine supposedly generates a flow of the patient’s own personal colour vibration (determined by the therapist who prescribes the machine) and thus augments the healing process. Call it an irrational fear of the unknown, but I hate them.

After she left I made a desperate attempt to slip out for a cigarette, but I wasn’t fast enough. A brisk young chap requiring a precision flat-top bustled in. He seemed innocuous enough at first, but by the time he left he had not only examined my eyes but had written out a list of at least a hundred and fifty dollars worth of vitamins I urgently needed. He was an iridologist.

Described by some as “living fossils,” iridologists just won’t go away. Iridology appeared on the scene in the 1880s, though undoubtedly variations on the theme go way back. It died a natural death not long after the turn of the century because of its failure to diagnose with any more accuracy than chance.

I was reaching for a pack of cigarettes when Slasher, a guy I met years ago during a lengthy investigation into the Hare Krishna movement, sauntered in to get his sides buzzed. Slasher left the movement during the great guru scandles of the late 1980s, when many of the top dogs were dumped for corruption and drastic disregard for the precepts, but like most Hare defectors, he had never fully readjusted to earth life.

Slasher was deeply concerned about the Alien Menace; in particular the small, grey, paranormal fiends known in the trade as Greys, famous for abducting human beings and performing bizarre experiments on them.

“It’s these damned surgical cattle mutilations,” he said seriously. “It’s intense man.”

“Yes; its…it’s…”

“It’s the Greys,” he said.

The alien menace people believe that mankind is caught in the middle of an invisible war between the sinister Greys and the blond, beautiful Space Brothers. It all boils down to an updated version of the old angels and devils gambit, and as always, is ancient history.

“Four of us saw it. It was a good sighting,” Slasher was saying as I whisked the cape off him.

“Yeah; I heard about it,” I said.

“Maybe you should write up a report,” he suggested.

“I thought about it… but the fact that you were all on acid at the time kind of throws a spanner in the works.”

“Mushrooms, actually,” he pointed out.

“Whatever,” I said.

By sundown I was on the brink of madness. It was as though the sky had opened up and rained dingbats. “It’s the Dark Ages all over again,” I moaned, glancing forlornly at the unattainable cigarettes hardly an arm’s-length away. “Investigative thinking has proved too tough for poor homo sap. It’s the end…”

I said little as I attended my last client. I was sure she was into Reichian orgone accumulators and I just didn’t want to know about it. But my fears were unjustified — she was clean.

It wasn’t until she was about to leave, she turned and said: “Carl, do you know that Jesus loves you…”

I was last seen running screaming down Wyndham Street, apparently stark staring mad…

Hokum Locum

Quackery

In the last issue I discussed how quackery can be practised by New Zealand doctors with impunity, “if they do so honestly and in good faith.” Alaska has a similar clause which only disciplines maverick doctors if they harm their patients. In fact, the latest NCAF newsletter outlines how a Dr Rowen has been appointed to the state medical board after “curing” the governor’s wife of lumbago by extracting one of her teeth. The link between the tooth and the back was made by an electro-acupuncture circuit using a Vega machine.

Dr Rowan also practises chelation, homeopathy and is described as “anti-fluoridation, anti-aluminium cookware, and anti-dental amalgam.” The Alaskan State Medical Association has strongly protested and one medical board member has resigned.

More on Bands of Hope

Sea Bands are available from NZ Pharmacies as well as Elekiban which is another form used for musculoskeletal complaints. As outlined in Skeptic 26, these are acupressure devices which have no scientific effect other than placebo. I was interested to read that the Institute of Naval Medicine (INM) had tested Sea Bands because on my recent overseas trip I spent a day a day at INM having a look at their research programs on Hypothermia and Diving Medicine.

Acupressure is an equally false derivative of acupuncture which works through a combination of the placebo effect and suggestion. Having written a truth kit on acupuncture I was alarmed to read that the Medical Acupuncture Society of NZ (MASNZ) is setting up a register of medical acupuncturists (150 hours training minimum)(NZ Doctor 21/1/93). Since acupuncture has no proven basis this is totally unnecessary, rather like setting up an appreciation society for the emperor’s new clothes.

As a former acupuncturist, I can teach anyone to be a safe and confident acupuncturist in about one hour. Perhaps I should give a demonstration at our next conference in the style of Dr Bill Morris and his vivid demonstration of homeopathy.

Pharmaceuticals Around the World

I have long held the belief that NZ doctors tend to overprescribe drugs. While working in general practice myself, I was often aware of pressure from patients to prescribe drugs. However, until now I haven’t come across any comparative data from other western countries. A survey of 495 randomly chosen Australian GPs (Patient Management Nov 1992) found that a prescription item was issued for every consultation (a reduction from 1974 when 136 prescription items were issued per 100 consultations!)

In NZ our annual drug bill is about $600 million, or $185 per head, per annum. My family of four definitely does not consume $740 worth of drugs in a year! Some people must be consuming a lot of drugs. British doctors are described as “low prescribers of medicines” yet their costs were roughly the same at $165 per head per annum.(The Lancet Vol 340 August 8, 1992 page 364). Patients expect drugs, and doctors want to help their patients, so it is not surprising that prescription rates are high. The writing of a prescription is often a convenient way to end a consultation.

One of the major problems for third world countries is getting cheap, effective drugs which are truly necessary. Multinational drug companies continue to cynically exploit these countries by marketing both dangerous and useless drugs. In a letter to The Lancet (Vol 339: Feb 22, 1992 page 498), a Pakistani doctor explained how a child died after being given drops containing an anticholinergic drug and phenobarbitone. Such a preparation has no scientific medical indication and its use in NZ would not be allowed.

A survey from Peshawar (reported in The Lancet Vol 338:August 17, 1991 p438) found that 90% of general practitioners were using antibiotics and anti-diarrhoeals to treat diarrhoea instead of using the correct treatment of oral rehydration therapy.

In Bangladesh, (GP Weekly International 2/12/92), hundreds of children have been injured or killed by cheap brands of paracetamol containing toxic ethylene glycol.

Datura is a drug which is commonly abused by drug addicts. It contains atropine, which in high doses causes hyperactivity and hallucinations. Incredibly, cigarettes containing datura are licenced for the treatment of asthma in France because “many old people rely on the treatment because they don’t believe modern methods help them.” This is a classic example of the need to have a rational, scientifically-based pharmaceutical industry. Datura-containing cigarettes would not be allowed here (we used to have cannabis cigarettes on prescription up until the 1920s!) and their persistence in France is based on delusion, placebo effect and anecdotal reports of efficacy. (New Scientist 22 August 1992).

Drug treatment can also be irrational when it is used for a condition which has no clinical basis. On the European continent there is a widely held belief that low blood pressure is associated with specific symptoms and is a pathological state requiring treatment. There is no basis for this belief, because complaints of faintness and fatigue are made as often by patients with a normal blood pressure.

Blunderbuss Treatment

A doctor whose daughter fainted on a hot day (BMJ Vol 299, 18 Nov 1989, p1284) reported that a French doctor prescribed a proprietary preparation called Tensophoril which contains the following ingredients: dopamine hydrochloride 15 mg, boric acid 15 mg, amylobarbitone 15 mg, and ascorbic acid 250 mg.

This sort of combination has been rightly criticised as “blunderbuss” drug treatment. Dopamine is inactive when given by mouth; boric acid is toxic and should not be taken by mouth; amylobarbitone is a long acting barbiturate sedative and the ascorbic acid dose is that which would be found in about 5 oranges. Fortunately the doctor’s daughter elected not to take the treatment and recovered fully.

Drug Licensing

I was much more impressed with a letter (The Lancet Vol 340: August 15 1992, p432) which detailed how Israel dealt with homeopathy. Drug registration required proof of efficacy and this was still not forthcoming after three years. Unfortunately the new legislation did not apply to raw materials and homeopathic preparations were able to be imported as such. The author regretted that “the compromise is not entirely satisfactory in that scientific assessment of efficacy cannot be applied.”

The situation in Germany is hardly credible. Drug licencing does not depend on clinical trials, but on anecdotal evidence supplied by medical practitioners, many of whom are paid by the same companies whose products they are endorsing. This is hardly surprising when 7 out of 10 general practitioners practise alternative medicine.

For example, the Federal Health Office (BGA) was forced to licence a totally useless product containing “1 g loess soil” for the treatment of diarrhoea, because “German law does not define the term efficacy.”

Another useless drug is Arteparon, an extract of bovine lung used for the treatment of osteoarthritis when given by injection. The drug is licenced because the courts have determined that “the efficacy of old drugs must not be judged by modern scientific standards.” Arteparon causes severe allergic reactions, a fact not recognized by the courts because “proof of causality beyond any doubt was needed for each case of adverse reaction.” The judges obviously overlooked the irony of demanding a higher standard of proof of side effects than of efficacy. The cost of these crazy decisions is a huge drain on the German health system. One quarter of the DM20.7 billion spent annually on pharmaceuticals is for useless drugs.

I have no idea whether our own drug lists contain either questionable or useless drugs and these reports have prompted me to have a browse through the GP’s pharmacopoeia New Ethicals. Watch this space!

Thalassotherapie

While overseas I collected a number of articles worthy of skeptical attention. Although a confirmed Francophile, I wonder whether they have any effective organised groups of skeptics. Homeopathy is part of mainstream medicine and astrology is big business.

Thallasotherapie is described as a treatment modality using seawater and its products. Patients (or, in newspeak, clients) can either float in seawater or apply heated mud made from seaweed. Obese subjects will be delighted to know that their tissues can be “deflated by various jets and massages.”

It is claimed that elements such as magnesium and calcium are able to “get into human tissues” and “engender the same consequences as a hoemeopathic treatment: stronger immune system and stimulation of cells.” In fact, human skin is relatively impermeable and certainly does not behave like a semipermeable membrane. Essentially this therapy can be carried out for nothing in the privacy of your own home by having a long soak in a hot bath. If you feel so inclined, toss in a handful of seaweed.

More on RSI

There has been a lot written on this subject, but so far little written to explore alternative explanations for these spurious symptoms which are essentially a conversion disorder (well described in basic psychology texts).

Whole forests have ended up as publications on ergonomics and an army of occupational physicians continue to pontificate over the delusion of RSI. It is therefore refreshing to read letters (Medical Journal of Australia Vol 157, Sep 21 1992, page 427) from skeptical occupational physicians who have both correctly diagnosed this condition as a conversion disorder and correctly treated it by “helping patients sort out their personal, social, family and financial problems.”

Even More on Chronic Fatigue Syndrome

In Skeptic 21 I summarised the key research in this area, which does not support any infectious cause and shows clearly that the condition is a somatisation disorder.

If any readers are interested in further reading on this subject, there is a very good article in Patient Management Nov 1992, p13 by Robert Loblay. He reviews the historical development of immunology and demonstrates conclusively how history tends to repeat itself. For example, neurasthenia has been resurrected as chronic fatigue syndrome.

Many symptoms which people present to their doctors are often functional (somatisation disorders) and have no basis in serious disease. Some doctors have difficulty in accepting their own limitations in this respect, or the existence of psychological disorders, and it is easy for these practitioners to seek “magic” solutions such as acupuncture, homeopathy and dietary manipulations.

Psychological disorders cannot be explored within the context of the traditional five-minute NZ consultation and it is hardly surprising that alternative medical practitioners have more success when they give the patient one or two hours of their undivided attention (itself a form of psychotherapy).

Chelation Therapy

This is an intravenous treatment with a cocktail of vitamins and the drug EDTA, which is believed to chelate calcium which has been deposited in atheromatous plaques. Atheroma (Greek for porridge!) is an ageing process leading to fatty deposits in arteries (accelerated by smoking, high blood pressure, excessive dietary fat and diabetes) leading to coronary artery disease (CAD) and peripheral vascular disease (PVD). Poor blood supply through the narrowed vessels leads to chest pain in the case of CAD and painful legs in the case of PVD.

There is a proper double blind placebo controlled trial of chelation therapy for PVD currently under way in Dunedin Hospital. A similar study in America (Journal of Internal Medicine 1992, pp 231-267) showed no difference between chelation and placebo treatment. I hope to do a similar study of chelation treatment for CAD. We await the outcome.

Video Library Update – New Titles, July 1992

A CSICOP video library is run by Alastair Bricknell, RD2 Kuaotunu, Whitianga. Tapes may be hired for the cost of postage and packing, around $5 (extra donations gratefully accepted).

Homeopathy — Medicine or Magic?, QED (BBC TV), 1990, 30 minutes

A very interesting look at the state of homeopathy in the UK in the ’90s including its use by some “conventional” doctors and vets. Details are given of a few trials (some double and triple blind) that have been conducted claiming to give support to homeopathic techniques. Unfortunately, relatively little time is permitted for dissenting views and I am sure many of our rural members will have other explanations for some of the “miraculous” animal cures presented. A thought provoking programme nevertheless; it should be essential viewing for any skeptic confronting homeopathic enthusiasts.

Secrets of Sedona, 48 Hours (CBS), 1991, 60 minutes

A visit to Sedona, Arizona, a centre for “New Age” thinking(?) in the US. Topics covered include fire walking, astrology, UFOs, vortexes (vortices?), pendulums, channelling, reincarnation, and New Age music — surely there is something for every skeptic in this one. The programme shows how some successful businessmen and women use New Age techniques to influence their business decisions and the industry that has built up around this philosophy in a beautiful part of the American west. A good balanced look at a phenomenon that is starting to become increasingly popular in New Zealand,

Spiritual Healing, Foreign Correspondent (TVNZ), 1992, 15 minutes

A brief but interesting and relatively balanced look at the healing scene in the UK. Topics covered include New Age healing methods, “Touch for Health” healing (some skeptics might say “Clutch for Wealth” would be more appropriate), the charismatic Christian movement, and several other alternative medical practices. A revealing discussion with a conventional medical practitioner illustrates the tragic consequences that can arise for those relying on these fringe methods while cancers continue to grow.

Chelation Therapy, Frontline (TVNZ), 1992, 15 minutes

A good introduction to chelation therapy as practised in New Zealand at present. Discusses the double blind trial currently underway in Dunedin that is due to end in a few months. Sensible comments from conventional medical practitioners about the merits of this controversial therapy provide some balance to this interesting program.

Acupuncture Exchange

In the medical magazine Patient Management, Denis Dutton last year presented a tongue-in-cheek account of how GPs might incorporate alternative techniques into their practices. The article generated an interesting exchange.

Dr Denis Dutton’s original article in the March edition (“Increasing Your Income While Appeasing Your Patients”, pp. 9-11), and his more recent reply to Dr Campbell’s letter in the June edition (“One rule for Orthodoxy, Another for the Rest of Us”, p. 7) raise several interesting issues.

Our society comprises Western-trained doctors who study and practise acupuncture. For many of us, enthusiasm was first sparked by noticing the beneficial effects of acupuncture in the clinical setting. Most of our members are experienced clinicians and in their opinion, the effects of acupuncture amount to more than the sum of willing, motivated doctors enhancing a placebo response.

Many have been motivated to study the philosophies and pathophysiology of Eastern medicine, in particular traditional Chinese medicine. The collection of clinical material has been meticulously recorded by the Chinese for centuries, but it is only in the last 15 years that textbooks have been available to us, showing the logic and complexity of this study of medicine.

The marriage of Eastern and Western medicines is an exciting and vital factor in many parts of the world. The double-blind crossover trial, which all doctors would agree has been a cornerstone for the development of safe, effective Western medicine, is, however, an inappropriate measure of acupuncture. The reasond for this become obvious when Western doctors study the basics of acupuncture. The observations of the Chinese seem to fit in with modern advances in biophysics and it is ultimately the advancement of these basic sciences which will make the who subject more understandable to non- clinicians like Denis Dutton.

By reacting to acupuncture and claiming Chinese medicine is based on primitive and fanciful concepts, the American NCAHF exposes itself as being either unaware of the complexities of the subject, or worse still, threatened by them.

The medical profession, if it is to continue to earn the respect of the public, should study both Western and Eastern medicine with open minds.

Only then can valued judgements be made.

Dr Robin Kelly, President, Medical Acupunture Society (NZ)

Dr Dutton’s Reply

According to Dr Kelly, modern advances in biophysics will make acupuncture finally understandable to stubbornly sceptical non- clinicians like me. Wrong: the mechanism of the treatment is not the issue. I don’t know how Panadeine works, but I accept that it does. It is not the failure of acupuncture’s supporters to demonstrate an intelligible mechanism that is in question, but the straightforward clinical claims made on its behalf. The history of medicine is littered with episodes of “willing, motivated doctors enhancing a placebo response”. There need be nothing the least bit stupid or venal about this; in their eagerness to help their patients, an intelligent doctor can develop a sincere faith in an ineffective treatment modality. Blind testing routines are our best defence agaist this possibility.

On the subject of mechanism, it is worth remarking that I am aware of two local medical practitioners who were trained in acupuncture (one in Beijing, the other in Auckland) and who have used it extensively. Becoming increasingly suspicious, both of these practitioners had the idea of intentionally placing their needles at the wrong points, according to the Chinese charts (which don’t all agree with one another, incidentally). They found no difference in the perceived effect. One of these doctors has stopped using acupuncture, and the other continues to use it in the opinion that it is the time and attention he is giving the patient that produces the benefit, rather than a psychological effect of turning the patient into a pin-cushion.

Claim and counter-claim about the clinical effectiveness of acupuncture is all fair enough, and I hope doctors interested in these issues will consult both sides of the debate [start with P. Skrabanek, Lancet 1: 1169-1171, 1984; Irish Med J 79(12): 334-335, 1986]. What I find deeply disturbing is that Dr Kelly would claim that blind trials, though they are a cornerstone of safe, effective Western medicine, are “an inappropriate measure of acupuncture”.

This is a claim frequently made on behalf of alternative treatments and I believe it should be regarded with the utmost contempt. When a patient asks about the symptoms that might be alleviated by acupuncture, a definite answer is forthcoming; no one ever says “Oh, we have no idea what symptoms acupuncture is good for”. When the patient asks how much it costs, again a definite answer is immediately ascertainable. But in the present case, when we further ask if the modality has been shown through blind testing to be clinically effective, we’re told by the President of the Medical Acupuncture Society of New Zealand that this would be inappropriate. Not that it hasn’t been done, or that the results have been in his view indecisive, but that it would be inappropriate. Why? His society’s members deem acupuncture appropriate for the patient’s symptoms, which are demonstrably real. Real money is deemed appropriate for the demonstrably real account the doctor sends out. Why shouldn’t the paying patient demand that her treatment be just as real, as demonstrated by scientific tests? How can anything else be “appropriate” except the magic question: is acupuncture clinically effective beyond the usual placebo responses?

The “exciting and vital” marriage Dr Kelly describes looks to me like one in which Western medicine has taken Eastern superstition as a mail-order bride.

Dr Denis Dutton, School of Fine Arts, University of Canterbury

When Faith-Healing Works

Sometimes feeling better isn’t a good sign at all… Carl Wyant recalls an occasion when faith healing showed itself better at handling symptoms than causes.

The following story is true; the names have been changed to protect the lame-brained. It’s not a terribly dramatic story of its type — that is, no one died — but it illustrates an important point. Over the years I have found, as a general rule of thumb, that most “natural healers” know hardly anything about the human body.

Once upon a time there was an attractive, young married couple, Jack and Jill, and Jack’s mother, a charming, vivacious 50-ish woman, with a growing reputation as a “spiritual healer.” I was deep into my Zen phase at the time, and too caught-up in the mysteries of the void and the unfathomable wisdom of one hand clapping to remember every last detail of the case, but here’s the basic gist.

Stomach Ache

Jack and Jill were around at our place, when late in the day Jill began to complain of a bad lower stomach pain. Being an occasional pancreatitis sufferer, I tend to take bad stomach pains seriously, so I suggested she see a doctor. But of course, being budding New Agers, they said, “we’ll see what mom says”; which is what I figured they’d say. I forgot about it.

When I saw Jack a couple of days later I asked him how Jill was. “She’s fine,” he said. “She had a few sessions with mom and it just went away. Tension, apparently, from a block in her sexual energies.”

Jack’s mom specialised in blockages of the “life airs” or vapours, ethers, chi, or whatever term is popular at the time. She was able to determine where these alleged blockages were by studying the client’s aura and then healed them by focusing her energy on the trouble spots.

Admittedly, I’m not a doctor, but somehow the kind of pain Jill had been describing, to my uncultured, insensitive, skeptical ear at least, didn’t sound like an everyday, run-of-the-mill type of pain, and for a minute I was almost disappointed that my more fearful diagnosis was so far off the mark.

More Than a Stomach Ache

Some days later I was informed that Jill was in the hospital recuperating from an operation to remove a burst appendix. Jack’s mom had miraculously stopped the pain sure enough, but not the progression of the appendicitis.

One would think that if a person was genuinely interested in healing people they would endeavour to learn as much about the body and its problems as possible. But most occult and natural healers don’t do this. For them, the main premise of New Age healing is that modern western science is all hogwash because it lacks the “spiritual” dimension. It’s not worth knowing.

This “no need to know” theme is a common one among paranormalists. Indeed, most religions would burn every book on Earth right now if they had the chance. Throughout history, religions have always hit the libraries.

It would behoove us to remember that despite the alleged “spiritual” dimension, the body is still a machine of sorts, and just as we take our cars to people who know a lot about cars, rather than, say, windmill systems, we should take our bodies to people who know a lot about bodies rather than, say, ritualistic superstition and fairytales.

Luckily there are people available who do try and find out as much as they can about the body; they’re called doctors.

Hokum Locum

More on Chronic Fatigue Syndrome

An American study reported in the GP Weekly (2 Sep 1992) found that chronic fatigue syndrome was indistinguishable from depressive disorders. (Refer also Skeptic 21) Patients diagnosed as having CFS were likely to believe that their illness had a viral cause, but it is more likely that CFS is a new age variant of the 19th century neurasthenia.1

A large study reported in the BMJ is worth looking at in detail. 200 patients with CFS were studied. Many of the patients had tried alternative therapies which were “not helpful,” namely diets (27%), homeopathy (20%), hypnosis (5%). This has been confirmed in NZ by Murdoch, writing in the NZ Family Physician (Autumn 1992).

Again, most patients believed that their illness was caused by a virus and the study found that most patients had an emotional disorder. Despite this, most patients had recovered after two years and this outcome is also confirmed by Murdoch in an unpublished survey of New Zealanders with CFS. At all stages in the illness, “functional impairment was associated with several patient factors, including belief in a viral cause, leaving or changing employment, coping with illness by avoidance of exercise and alcohol, membership of a patient organisation, and emotional disorder.” The authors acknowledge that these factors may reflect a more severe illness and call for more prospective studies.

Despite the high incidence of emotional disorder, very few of the patients had been referred to a psychiatric outpatient clinic.

Despite the considerable evidence against an infectious cause of CFS, an Australian doctor has been treating patients with intravenous gamma globulin2 in what is described as a placebo controlled trial. Unfortunately, no reference is given to the trial and until I can get these details I will have to reserve judgement. Watch this space!

Clearly patients resist the suggestion that chronic fatigue has a psychological basis, and unfortunately some members of the medical profession continue to foster this belief. Of concern is the activity of quacks touting EAV, homeopathy, anti-candida diets and other useless nostrums. Patients should not be allowed DSW benefits unless they have willingly cooperated with a program of cognitive based psychotherapy.

References:

1. Chronic Fatigue Syndrome. American Family Physician March 1992 p1205.
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2. Acceptance and treatment of CFS is improving. NZ Doctor International Oct 1st 1992.
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Follow up of patients presenting with fatigue to an infectious diseases clinic. British Medical Journal July 18th 1992 (also reported in New Zealand Medical Journal Sep 9th 1992, p366)

Chronic fatigue syndrome. The Lancet May 30th 1992, p1349

Psychiatric diagnosis and CFS link. GP Weekly Sep 2nd 1992

Fake GP

I was only mildly surprised to read in the BMJ (June 27th 1992, p1652) that a doctor with no medical qualifications had worked for 30 years as a general practitioner. All that is required to be a successful GP is the ability to listen sympathetically to patients. This is more effective than the millions of dollars wasted on drugs such as tranquilisers and antidepressants.

It took some time before the local chemists became suspicious and I quote one of them:

“If one 5 ml spoonful of hair shampoo is to be taken three times a day you tend to think there is something wrong. Time and time again there were inhalers to be injected, tablets to be rubbed in — all very unusual.”

Unfortunately no information was given as to whether any patients had been harmed and, conversely nothing from grateful patients. How on earth did he last 30 years before being exposed? I conclude that he must have been helping enough of his patients to forestall complaints about his eccentric prescribing. The English have a reputation for eccentricity and they certainly must have indulged themselves with this doctor!

Fishy Tale?

In a tribute to anthropomorphism, a Dr Motha will be birthing mothers in the company of dolphins who can “make ultrasonic communications with the fetuses.” All becomes clear when we are told that Dr Motha runs an alternative medicine clinic “including aromatherapy and reflexology.”

Personally I have always thought that dolphin intelligence was over rated since reading Restaurant at the End of the Universe when, at the end of the world, dolphin squeaks were translated as “goodbye and thanks for all the fish.”
GP Weekly August 19th 1992

Fringe Medicine and the Medical Practitioner

The New Zealand Medical Council normally does not involve itself in criticising unorthodox treatments unless the patient suffers harm. Doctors practising quackery are protected by a clause in Section 58, subsection 4 (2) of the medical registration legislation, which states: “no person shall be guilty of infamous conduct merely because of the adoption and practice of any theory of medicine or surgery if in doing so he has acted honestly and in good faith.” I find this statement disappointing, because a medical degree surely implies a knowledge and acceptance of scientific principles.

This clause has been dropped from the same legislation in Australia, Britain and Canada. However, the Medical Council has made it quite clear that quack doctors have to satisfy the doctrine of informed consent by fully briefing their patients “that these treatments are not part of conventional medicine and hence he or she is not practising as a registered medical practitioner in providing these therapies.” The medical registration authorities in Ontario, Canada obtained a change in their act which allowed them to ban such unproven remedies as amnion implants and chelation therapy. They also erased from the register a doctor who combined pendulum dowsing with a form of vega testing. I look forward to similarly robust attitudes towards dealing with quackery by our own authorities.

Having enjoyed the study of general science, I am amazed at the capacity of some doctors to believe in quackery. As H. L. Mencken said, “How is it possible for a human brain to be divided into two insulated halves, one functioning normally, naturally, and even brilliantly, and the other capable of ghastly balderdash?” The reference quoted below is well worth reading.

Unorthodoxy and the Registered Medical Practitioner. David Cole. Patient Management Vol 21 No 9.

Irlen Lenses

In Skeptic 22 I criticised the promotion of Irlen lenses in New Zealand and called these a quack remedy. Since then I have been criticised by Matthew Hobbs (Skeptic 24 — nice to have some feedback) on the grounds that it remains to be seen whether these lenses are a proven remedy for reading difficulties such as scotopic sensitivity.

My use of quack in this context is straight from the Concise English Dictionary: “one who offers wonderful remedies or devices.” Firstly, there is no evidence of the existence of the condition “scotopic sensitivity” and secondly, as the coloured lenses have not been tested they should not be used, as efficacy has not been established.

An article in the Marlborough Express (Sep 24th 1992) outlined how a 10 year old with reading difficulties was fitted with coloured plastic lenses. After six months his reading had improved 100 percent. What alternative explanation is there for this improvement, and how was the improvement measured? It is most likely that his reading disorder was related to aberrant conditioning. The more his parents expressed concern, the more reinforcement was given to the “poor reading.” The coloured lenses are a placebo associated with a change in management which, along with the passage of time, has lead to an improvement in his reading.

Faith Healing

Dr Keith Davidson kindly informed me of the source of the quote mentioned in Skeptic 24 “Every day in every way, I’m getting better and better.” It came from someone called Emile Cove. Keith also sent me a cutting from the Christchurch Press detailing the activities of an American faith-healer by the name of Morris Cerullo.

The article demonstrates the obscene side of evangelical fervor. People were warned “Cynicism will sour you, bring cancer to you, and disable you.” The audience revelled in an atmosphere of mass hysteria and were told by an expert on “biblical economics” that there was no pressure to give money but the amount given would determine how far God would move towards miracles! The cartoon that came with the article is great. It shows Cerullo gesticulating while his shadow is the outline of a devil.

The evidence for faith healing is not good. As most deluded beliefs rest on faith, and faith is not amenable to testing, it is unlikely that testing will ever be done. In fact believers are on record as saying that testing claims of faith healing would be disrespectful to God.

Skeptics and Consumerism

Members of the NZ Skeptics have enjoyed some media exposure lately. Denis Dutton has been conducting a vigorous rebuttal of acupuncture beliefs (Patient Management, September 1992) and Vicki Hyde is “Eyeing Alternative Medicine” in the August edition of the NZ Science Monthly.

Consumer magazine were so unhappy with our criticisms of their alternative medicine story that they came out fighting and awarded us with a magnifying glass. I have used it in vain to re-examine their original article, but I have not changed my mind about its feeble journalism. Consumer journalists should read NZSM to see how their story should have been treated.

A new development is Maori medicine, or rongoa, (NZ Doctor, August 20th 1992) Given reasons for its use by Maori are an inability to pay for prescriptions and a belief that rongoa can provide something that western medicine cannot. The Bay of Plenty Area Health Board has provided $15,000 for traditional Maori remedies, such as red matipo to purify the blood and para blue gum for asthma. These treatments are administered in an atmosphere of “love and kindness.”

I doubt whether any of these remedies will ever be subjected to a clinical trial, because such treatments have to have some kind of rational basis to start with, and any results are clearly explained by the very powerful and under-rated placebo effect. At a time when Maori health has never been worse (e.g. smoking-related disease) I find it incredible that an AHB can waste money on this nonsense.

Homeopathy

After our little tiff with Consumer magazine, I wrote to the School of Pharmacy in Dunedin to ask whether they would consider doing some tests of homeopathic solutions. Peter Hayes (Lecturer) kindly replied to my letter and enclosed a copy of a paper entitled “A case for homeopathy” written by a Scottish pharmacist, Dr Steven Kayne.

It is fascinating to read the intellectual rationalisations used by otherwise intelligent people in order to indulge their deluded beliefs.

Kayne concedes that increasing dilutions leave no discernible molecules in solution and then goes on to say “chemical analysis is therefore inappropriate”!!!

He further concedes that he cannot explain the mechanism of action but goes on to say “it is extremely difficult not to be impressed when one sees therapeutic efficacy clearly demonstrated.”

Evidently he discounts the placebo effect and refers to “published work in human and veterinary environments.” None of the references quoted support these claims. Furthermore, he says “It is inconceivable that consumers would continue to buy these [homeopathic] products if it was all a giant confidence trick.” He obviously needs to have a chat to some of our skeptical psychologists.

Finally, he refers to the enormous volume of circumstantial evidence “that the remedies actually work — patients do get better.” This is called the “Bellman’s fallacy” — because something has been said many times it must be true. His last word is “homeopathy should be available because patients want it, because it is safe and because it works.”

The Dean of the Pharmacy School also wrote and pointed out “because of patients’ belief in complementary medicine, I doubt that even if we were to show that they were purchasing pure water, it would cause any change in attitudes.”

I am forced to agree with him, but I could not help wondering what would happen if I started selling pure water labeled as various homeopathic remedies. I could make a fortune and it would be difficult to be prosecuted for fraud. Anybody want to go into business?

Open-mindedness

The same day that I was writing all this, I received an article from Bernard Howard written by one of my favourite skeptics, Petr Skrabanek. One of his best articles on the philosophy of skepticism is “Demarcation of the Absurd,” The Lancet April 26th 1986, in which he argues that it is possible to be too open minded.

Briefly, he argues that we need a demarcation of the absurd so that we don’t bother spending our whole lives on the look-out for flying pigs. Instead, we accept that the probability is so low that we don’t waste our time either looking or testing for airborne swine.

The article that Bernard sent is called “Why we must keep the lid on the black magic box” (Healthwatch Newsletter Summer 1992) and in it Skrabanek argues that testing of irrational beliefs can give them spurious respectability and “no amount of testing will convince a believer that he is mistaken.” Skrabanek also reviews the development of “black-box” quackery, which I have already mentioned can be practised in NZ with impunity due to our feeble medical registration legislation.

That reminds me of a television program on water divining where James Randi tested the top water diviners in Australia. None of them detected water flowing through one of ten pipes any better than chance. At the conclusion of the experiment he asked them about their beliefs which were totally unshaken!

Consumer Bites Back

Not surprisingly, the awarding of the Bent Spoon to Consumer magazine saw a vigorous defence mounted by the Consumers’ Institute.

David Russell, chief executive of the institute, has said on a number of occasions that he considered that the institute had been “publically defamed” by the Skeptics, and that comments concerning the article were “extreme and defamatory.”

In the early days following the announcement, Mr Russell debated the issue with Dr Gordon Hewitt on Morning Report. He laughed off Kim Hill’s question of suing NZCSICOP over the alleged defamation.

The impression gained from Mr Russell during the debate was that the magazine had deliberately taken a soft line on alternative therapies because many people believed in them. Dr Hewitt picked up this point and challenged it by asking if Consumers’ Institute would then ignore taking action against a dangerous toaster merely because a lot of people used it.

The analogy was rejected, not answered. Mr Russell continued with this line elsewhere, stating that “given the strong public interest in [natural therapies] and surveys which indicate a large degree of satisfaction with natural therapies, we cannot see anything wrong with explaining to our members what is involved in a few of the more commonly-used therapies.”

One could argue that people were strongly interested in some of the various pyramid schemes that have appeared on the New Zealand scene, and that many were very supportive of them. This does not mean that they should be left uncriticised. In addition, NZCSICOP would have welcomed a real explanation of just what is involved in the therapies Consumer covered, but this was not done, as an examination of the article’s text clearly shows.

An astounding statement was made by David Hindley, research writer for the chief executive, in response to a letter of complaint made independently of the Skeptics. In it, Mr Hindley said:

If you are aware of recent research which conflicts with our findings, we would be very grateful if you could pass on details to us.

This suggests that Consumer‘s in-house research team came up with no such material, a suggestion which has extremely disturbing implications for the thoroughness of research and preparation put into the magazine’s material.

One point mentioned in the radio interview which, unfortunately, was not taken up was the suggestion Mr Russell made that alternative therapies can’t do anyone any harm, implying that one need not be concerned about them. There’s a dead baby in Wellington to disprove that. The unmonitored nature of alternative therapies and therapists means that there is very little hard data on the harm being done. Cases which end up in Coroner’s Court, however, cannot and should not be ignored.

The idea that “it’s all harmless anyway” had been repeated in other areas where Mr Russell has said that “our research into natural therapies indicates that, so long as the practitioner has the best training available, potential side effects are limited.” It would be startling to find direct side effects from water solutions and sugar tablets, foot massage or sniffing essential oils.

Mr Russell is apparently unaware that the vast majority of alternative therapists in New Zealand have very little in the way of actual medical training, and citing examples of such training from Britain or Europe is hardly applicable.

One could also question whethre there is any benefit in training in health-related practices which have no substantive evidence to support them. No matter how much time one spends training as a homeopath, this has no effect whatsoever on the fact that the materials used are dilute water and the methodology used medieval.

Nevertheless, Mr Russell states that he has “no qualms” about stating that there are “good” and “bad” homeopaths based on the level of training required in Europe.

A typical response has been to attack conventional medicine as not being adequate in some areas, in the apparent belief that adopting untested, unproven, undemonstrated therapies is somehow an answer to perceived inadequacies in orthodox medicine.

The language became stronger following the NZCSICOP conference, when renewed media interest was shown in the Bent Spoon Award. The Dominion reported Mr Russell as calling Skeptics “narrow-minded bigots.” [No we’re not suing for defamation either.] The report went on to quote him as saying:

In the 19th century, they would have been dismissing the discovery of penicillin because they did not have the evidence to prove it.

We can certainly agree with Mr Russell on this point, given that penicillin wasn’t discovered in the 19th century — it was first found in 1929 and not isolated until 1940…

However, questions of historical accuracy aside, the discovery and development of penicillin provides a perfect example of the sort of practice which Skeptics worldwide applaud. It produced miraculous cures but, unlike those of a more questionable nature, it did so under tested, controlled conditions time and time again. Within a few years of its mass production, penicillin had demonstratably saved thousands of lives, and it continues to do so.

The significance of penicillin was recognised in double-quick time, with the scientists involved awarded Nobel Prizes within four years of the substance’s purification. We would be interested to hear of Nobel Prizes, or any other recognised scientific awards, made for the “discoveries” of alternative therapists.

What is more, the incredible benefits of penicillin led to the search for, and discover of, other antibiotics which have also made obvious and effective contributions towards the good health and longer lives of a large proportion of this planet’s population.

What homeopathic remedy has had similar success? Consumer said that these remedies stimulate the body to heal illnesses, but there has been no clear evidence of this in the 200 years since their invention.

Mr Russell used the same analogy in the most recent issue of Consumer (September 1992), correcting his dating lapse. In this editorial, the Skeptics were accused of having a “surprisingly poor understanding…of how scientific knowledge is developed, and an even poorer ability to read properly.”

We feel that, on the contrary, Consumer and, by association, Consumers’ Institute have displayed an ignorance of basic scientific principles and scientific history, an unjustifiable defensiveness which has made them unwilling to admit any form of deficiency, and a degree of credulity unacceptable in a consumers’ protection organisation.

The editorial said that Consumers’ Institute is sending a magnifying glass to NZCSICOP to redress our reading problems — let’s hope that in the future their errors are so subtle we need the magnifying glass!

Skeptics Bite Watchdog

The Bent Spoon Award this year created more controversy than usual when it was awarded to Consumer magazine. Why did we feel it necessary to bite our consumer watchdog?

I was pleased when my copy of Consumer magazine arrived with a lead story on the natural way to health. I had had a survey a couple of months previously asking what I’d like to see in the magazine, and had replied that it was about time that an objective, hard-headed look at alternative medicine was done.

I was shocked and disappointed, therefore, when I found that the article did not meet Consumer‘s usual high standards, but was a startling blend of unsupported claims and sketchy, superficial statements. I really didn’t expect Consumer, of all publications, to produce something that so obviously deserved a Bent Spoon Award.

I wasn’t alone in this. Many Skeptics, it seems, are subscribers to Consumer — I put that down to the institute offering consumer protection for one’s physical environment, and the Skeptics providing such protection for one’s mental environment. And it soon became obvious from the phonecalls and faxes that a large number of you (and plenty of interested observers) were as disappointed as I. What to do?

We embarked on what has been perhaps one of the saddest Bent Spoon awards — sad in its implications for Consumers’ Institute and sad in that Consumer‘s apparent endorsement of what has been described as “controversial, even bogus, treatments” will make it so much harder in the future to debate these issues factually.

So what was in the article that virtually forced us to challenge Consumer and take on ourselves a great deal of misinformed abuse from the Institute?

The article, in the July 1992 issue, was titled “The Natural Way to Health — your guide to acupuncture, osteopathy, homeopathy and other natural therapies.”

“Natural therapies are popular and often effective,” it opened, with the caveat that going to an “untrained” therapist can be a waste of money and may be dangerous.

However, after that brief warning, the article continued:

When it comes to health, even Mother Teresa, Tina Turner and Queen Elizabeth have something in common. They all get help from non-conventional medicine, and homeopathy in particular. The Royal Family has consulted a homeopath for several generations.

Apparently an elderly nun, a former rock star and a clan of inbred blue-bloods are sufficient to validate some very questionable practices.

It noted that some practices, such as osteopathy and acupuncture, have their own professional bodies and are used by conventional doctors. It recommended looking for a trained, registered practitioner. After all, it added, “the best non-conventional therapists can offer highly effective treatment.”

This suggests that natural therapies are effective and the only caution necessary is to avoid untrained practitioners who may have got their fancy certificates through mail-order.

The article did say that radical treatment — such as having all your teeth pulled out — should lead you to seek a second opinion with your own GP or dentist.

It also ended with a case study of one therapist, pointing out problems such as the rejection of conventional medicine, promising cures and charging high prices. There was additional discussion of the Medicines Act, where it was stated, somewhat naively, that the Act limits what an alternative therapist can advertise or claim in the form of cures or treatment of certain illnesses. At least it did point out that the Institute was aware of cases where this law has been broken, but that it was not aware of any prosecutions.

Consumer recommended tightening up the Act and enforcing it more rigorously to “protect the public from untrained or improperly trained practitioners,” again suggesting that one need have no concern if one’s practitioner is trained in alternative therapies.

David Russell, chief executive of Consumers’ Institute, vigorously defended the article by pointing to these disclaimers. Dr Gordon Hewitt, head of the health professions school at the Central Institute of Technology and a Skeptic, in debating with Mr Russell on National Radio, compared this to two slices of thin bread, surrounding some very dubious meat.

It is obvious which part will be remembered, particularly by alternative therapists keen to cash in on the very supportive statements within the body of the text.

So what smelled rotten?

Acupuncture and Osteopathy

The acupuncture section talked about the flow of “life energy force” throughout the body, and that illness follows when the flow is blocked. It mentioned acupuncture’s successful use to treat a variety of complaints including headaches, sports injuries and muscular inflammation.

It supported this with the statement that stimulation of the acupuncture points releases endorphins, and that the World Health Organisation lists 71 disorders successfully treated by acupuncture.

In the Bent Spoon press release, our own Dr John Welch — himself trained in acupuncture — said that the section paid no regard to the large and growing scientific literature showing that it is clinically ineffective for diseases the magazine lists. There is now a Skeptic Truth Kit on acupuncture available for those interested in reading further about this.

The osteopathy section talked about the large body of scientific research behind the therapy, implying that its efficacy has been established but avoiding stating this definitively.

One Skeptic, in writing to Consumer independently before the award was announced, said that such a statement was exactly the type which Consumer has criticised advertisers for making.

“If there is any scientific basis for so contentious a therapy as osteopathy, then you owe it to your readers to explain it,” he added.

Consumer quoted a 1986 survey by its UK counterpart which showed that 82% of respondents who had visited osteopaths claimed to have been cured or improved by the treatment.

As one who is highly skeptical of survey techniques, I find the wording of this interesting. “Respondents” suggests that the responding to the survey was voluntary, which immediately skews results.

The other interesting point to note is that the material in the Skeptic Truth Kit on chiropractic explains that any form of back manipulation can produce apparently good results, but more from the nature of back pain itself than from actual efficacy. That is, pain is often a chimeric thing, disappearing of its own accord.

Once again, registered osteopaths are recommended as providing some form of protection, but the article does also mention that “improperly trained people advertising their services as osteopaths” can cause serious problems. There is no control over the use of the term “osteopath” — the implication is that someone with little or no training can use it legitimately — but this important point appeared not to be worthy of comment or criticism by our consumer watchdog.

Homeopathy

Consumer said that “many [homeopathic] remedies work only in specific cases” and that “a few remedies can be used widely.” There was no supporting information for these blanket claims. The institute was much more rigorous in recent tests of cough medicines, but did not subject homeopathic claims to the same criteria. Why not?

The magazine said that a homeopath will find the right treatment by conducting a detailed interview. Yes, but this is because homeopaths believe that certain extracts “match” certain personality types. Oyster shells, for example, are said to suit patients who are fearful and who feel better when constipated. This sort of dubious anthropomorphic alchemy was not mentioned.

While it may initially seem reasonable that such extracts could have some physiological effect, none of these substances actually come anywhere near the patient. This is because homeopaths believe that a preparation becomes much stronger when highly dilute — something akin to having sweeter coffee by putting less and less sugar in it.

Homeopathic preparations are diluted in 100-fold steps, commonly 30 times, but sometimes as much as 120 times. This is like stirring a teaspoonful of sugar into the Pacific Ocean — only that would give you a much higher concentration than that of most homeopathic solutions.

And how did Consumer report this? It said merely that the substances are “diluted in a particular way many times”. Hardly indicative of the true situation. If I tried selling a microwave that worked without being plugged in, I am sure that Consumer would be more than a little suspicious.

Even homeopaths admit that there is no substance in their solutions. They believe that shaking the solutions during dilution will “potentialise” them, causing physical changes in the water’s structure so that it remembers the substance long after it has disappeared. Presumably water at the base of any waterfall would be incredibly potentised through being violently shaken and thus highly dangerous in a homeopathic sense.

There is no physical mechanism for changing the basic molecular structure of water in this fashion. Consumer used the term “potentise” in its passing reference to the dilution process, but did not mention the idea that shaking water gives it these fantastic properties.

The magazine did note that the “scientific evidence is not conclusive,” but quoted only one positive study without any details, ignoring that a great many scientific trials, and basic science itself, are all against homeopathy.

In fact, the literature review which Consumer quotes is by no means as positive as suggested. The article says that the Dutch review of 107 (it was actually 105) homeopathic trials showed that 81 indicated that homeopathy worked and 21 did not. Consumer did not quote the review’s conclusions which said:

At the moment, the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias.

The doctors themselves noted that the most poorly performed trials produced the most positive results, and said that the inferences seemed to be over-optimistic at times. They also voiced concerns about the failure to submit negative results for publication. In addition, the most important positive trial in the review was reworked by the researchers involved and was found to show no firm evidence for the efficacy of homeopathic treatments.

You’d only know about this, however, if you had access to back issues of the British Medical Journal (Vol 302, 9 February 1991; 316-323; 2 March, 1991; 529; 23 March, 1992; 727).

Consumer also said that “homeopathy is taken seriously in many European countries”, as if this was enough to endorse it. Certainly homeopathy deserves to be taken seriously because serious problems can result from it, particularly with regard to the sometimes disastrous consequences of the anti-orthodox attitudes which are common to many alternative medicine followers.

Last year, a Wellington nurse refused antibiotics for her baby’s earache, preferring to have it treated homeopathically. Two weeks later, after a number of unsuccessful treatments, the child was taken back to her regular doctor who had her hospitalised immediately. Both the doctor and the hospital’s paediatrician had great difficulty in persuading the woman to allow conventional medicine to be used. It was all too late anyway, as the baby died. (See Skeptic #22 for Coroner’s Court report.)

Presumably the way to avoid this is to find a good homeopath, and Consumer provides addresses for finding ones with the “best” qualifications. It is to be hoped that those qualifications include learning how to recognise when real treatment is needed.

Other Therapies

Consumer then goes on to briefly look at other popular therapies which one can learn in a weekend or through books. These therapies are “often very gentle,” Consumer says. So’s my ferret, but he can be very dangerous too…

Aromatherapy, using plant oils in massages and baths, is said to help insomnia, anxiety, boils, rashes, acne, colds and chest infections. The magazine suggests reading a book or attending a workshop before embarking on this form of treatment, but notes that it is one of the easiest natural therapies to use yourself.

British nurses use lavender oil to massage patients and help them to relax, Consumer tells us. One wonders if the natural therapeutic properties are really anything to do with the specific type of oil used — surely the massage itself has a part to play?

A form of massage, reflexology, is said to help in psychological as well as physical areas. This may well be so, but is it really because of direct links between the extremities and other body organs and tissues, as suggested? There is no anatomical basis for many of the claims of reflexologists, but this is not mentioned.

Consumer does mention that “the crystalline deposits that reflexologists say they can feel has not been scientifically proven.” This implies that there is some real, substantive basis for these claims, and final, conclusive proof is all that is lacking. In fact, the overwhelming evidence of anatomy, physiology, radiology and so forth suggests that such claims are entirely without foundation.

Again, Consumer uses a single positive example which it calls “intriguing” to suggest that reflexology may be an effective diagnostic aid. Surely Consumers Institute, of all organisations, recognises that one personal anecdote — printed in an alternative health magazine to boot — is not adequate. I very much doubt that they would let a manufacturer get away with extraordinary claims “backed up” by just one happy customer.

In the section on herbal remedies, the article stated that “few manufacturers can afford clinical trials of their product.” What amounts to a grave omission on the part of people selling untested “medicines” is passed by with no comment.

Does this mean that Consumers’ Institute would find it acceptable that clothing manufacturers save money by ceasing to test their products for fire resistance? Struggling toy manufacturers no longer checking to see whether their latest product can be swallowed by toddlers? Surely not. Yet herbalists are apparently permitted such gross irresponsibility towards the consumer.

The section goes on to say that traditional folklore rather than scientific evidence will often be the basis for selecting a herbal treatment. Consumer then says that a better option is to go to an experienced herbalist, implying that they won’t be working on traditional folklore lines.

Certainly, as the article says, some modern drugs are based on plant extracts, but these are compounds which have been rigorously tested through clinical trials, not a mish-mash of “natural” ingredients. Consumer suggests that herbal experts will protect you from dangerous overdoses or inappropriate uses.

I wonder whether people will take the trouble to check whether their local health shop owner is a member of the New Zealand Natural Health Practitioners Accreditation Board before stocking up on their comfrey tea. Given comments I have heard from nutritionists and other health professionals, as well as personal experience, I am not particularly sanguine about the education or expertise of many health shop owners.

Missing

Perhaps one of the most disappointing things about the article was that there was no discussion of one of the primary ways in which many of these alternative therapies work — the placebo effect.

It is generally recognised that a significant proportion of medical conditions will get better with time, regardless of whether alternative or orthodox remedies are prescribed. Combine this with the provision of some form of treatment and you have a very powerful, though not necessarily valid, conjunction of “treatment” and “cure”.

In addition, people will respond to someone taking an active interest in their condition, and healers take advantage of this, whether by design or accident. The intense personal focus of alternative therapies has a strong advantage over the generally perceived impersonality of much of conventional medicine these days.

Yet there was no discussion of this vital point in the Consumer review. Nor was there any discussion of what is meant by “natural”, bar the note in the herbal discussion that suggests it involves being untested.

I wonder what Consumer would say if I sold “natural” iodine, extracted lovingly from organic kelp, and charged a small fortune for it, claiming that it is somehow more “natural” and healthier for you than the synthesised version…

It will be quite some time before many of us will be able to see Consumer‘s advertising boast — “Get the facts you need from the source you can trust” — without feeling a little betrayed.

D is for Dog, and for Doctor

A colouring book for young patients of chiropractors says “A is for alligator and adjustment. B is for bells and for back. C is for caterpillar and for chiropractor. D is for dog and for doctor.” The latter two may have more in common than is apparent at first glance.

It is as much of a surprise to the medical profession to find that their standards of back care are under attack as it would be to a high-rise executive to be attacked through his office window by fighter planes.

The orthopaedic surgeon, secure in his strength and apparently limited in his intellect, seems ill-equipped to withstand the challenges mounted against him from a variey of paramedical platforms. The face of the enemy may be unfamiliar, but the threat to the doctor’s authority is absolutely clear. The battleground is the low back. The opposing forces clash at the point of pain.

The public has little confidence in the medical profession’s ability to diagnose or manage back pain. Recently, on my way to conduct a seminar, I took a taxi from my hotel. The driver, seeing my carousel full of slides, observed I was going to give a lecture. When I responded to his questions that my topic was back pain, he observed I must be a chiropractor.

The medical profession is justifiably under attack because the conventional medical management for back pain is often wrong.

Prolonged bedrest beyond five days is of no proven value, and admitting a patient to hospital merely to sit on him is boring for the physician and makes it difficult for the patient to breathe. Getting high on drugs seems somehow more appropriate on the street than in the clinic. The prescription of modalities, such as traction, to treat a structural spinal abnormality leads to lengthy treatment producing temporary alteration but which ends precisely where it began, with a structural spinal abnormality.

Medicine’s fascination with excessive and even unnecessary investigations proceeds towards one of two unfortunate conclusions.

The patient is told, “The results of your tests were negative. Get lost.”

Or, the surgeon is seduced into operating on an x-ray. When the radiograph, rather than the patient, demands treatment, I recommend that the surgeon content himself with the film, a view box and a pair of scissors.
Faced with this apparent lack of medical success, there is little wonder that many patients seek out alternative treatment, searching for “a backache remedy that works”.
Therapeutic touch is one such alternative. It is a non-invasive therapy utilising “the body’s own electromagnetic field” which assists the client (no longer the patient) to return to “a more balanced state of body, mind and creative spirit”. I suspect the client/patient is not the only one who is being creative.

Polarised Haemoglobin

The Magnetic Four Season Band is typical of the commercially available remedies to relieve backaches. Naturally, since over 80% of backache subsides spontaneously within three months, the Four Season Band comes with a money-back guarantee.

The advertisement also explains the Band’s mode of action to relieve back pain, namely the polarisation of haemoglobin by small magnets. I have no idea what that means, but I feel better already just knowing my haemoglobin has been polarised.

The lack of proof or scientific validity seems no deterrent to the method, and the picture is confused, as it is with so many spurious treatments, by the coincidental subsidence of pain or some unrelated additional benefit.

In the case of the Magnetic Four Season Band, for example, you might use the magnets to attach yourself to the outside of a bus and be allowed to travel for half-fare.

Skull Manipulations

Perhaps striking closer to home is the practice of craniosacral therapy. Instruction in this art form throughout North America generates an annual revenue of more than three million dollars.

The therapy is based on a philosophy expounded in 1908 by an osteopathic student, who felt that since suture lines were visible on the human skull, God had intended there to be movement. The fact that no movement can be demonstrated and that the suture lines commonly fuse over the age of 50 was, and is, considered irrelevant.

Having spent considerable time and money, and having been required to memorise, for example, the over 20 articulations at the base of the skull (none of which move) as potential sources of pathology, it is little wonder that the initiated are reluctant to dismiss the technique as a waste of time.

Furthermore, patients find it comforting to lie in a darkened room, listening to soft music and having their heads massaged. But transient relaxation does not justify a belief in the repetitive expansion and contraction of the skull every five to ten seconds, nor does it establish cranioscaral’s link, as described in one of their texts, with Phillipine psychic surgery.

And I have great difficulty in accepting craniosacral’s “Laws of the Lines of Gravity”, which state:

Man deals with himself in such a manner that his brain becomes more perfect because he arranges his lines of gravity in a different manner from any other creature. Also, the gravity lines pass through his diaphragm, and no animal has this diaphragm-gravity relationship.

I advise patients who wish to have the bones of their skull rearranged to choose their therapist carefully.

Whiplash Worries

Clearly we are on the road to confusion, and it is the patient who may become the accident victim. And what motor vehicle injury is more classic than whiplash?

Every one of us who has ever worked in an Emergency Room has treated this problem, and yet whiplash is not a diagnosis. It describes only a particular mechanism, commonly seen in rear-end collisions, which may lead to a variety of neck injuries.

The pathology after an acceleration-deceleration injury may be as simple as a minor muscle haematoma or as devastating as a cervical fracture with cord damage.

Each is a distinct entity requiring specific treatment, and the diagnosis should reflect the individual conditions — not the common physical cause.

Whiplash to the chiropractor offers a different vista. Gone is the range of diagnoses, to be replaced by the ubiquitous vertebral subluxations. Anatomical reality is replaced with a line drawing where the neck bows like a willow in the wind.

In case of accident, medical attention is not recommended, but the admonition to see a chiropractor follows immediately after advice to remain at the scene of the accident until all information has been collected, and before being instructed to notify your insurance company.

Thorough examination by a chiropractor is presented as a wise precaution to determine the presence or absence of injuries.

As an example, headaches are a current complaint after a whiplash-type injury, and according to matrial supplied by the chiropractor:

Most headaches result from spinal subluxations, in other words, malfunctioning vertebrae. These subluxations cause irritation of the delicate nerves and arteries that supply the head and face area, causing pain. Subluxed neck vertebrae can also interfere with the blood circulation to the brain.

The chiropractor’s adjustment keeps the body free of nerve interference and allows normal blood flow. This allows the body to use its own inherent healing ability to maintain a state of health.

A Blow to the Head

For minor cervicel adjustments, a chiropractor may employ the activator gun. This instrument closely resembles a dental implement which used to be used to pound an artificial crown on a tooth. A spring-loaded plunger is propelled a centimetre or so beyond the end of the barrel.

Patients are told that contact with the skin and subcutaneous tissues creates a subtle pressure wave, sufficient to restore minor subluxations without the discomfort or potential risk of a full adjustment. In Ontario, each trigger pull is worth $10.

Market Forces

In health care, as in any retail business, effective marketing means listening to consumer demands. Giving the client/patient what he or she wants is the name of the game.

When the validity of treatment is not an issue, everything from electric pain management to dietary regulation can have a place in the control of back pain. When you treat a self-limiting condition, easy access, lucid explanations, emotional support and physical contact are powerful weapons.

It should come as little surprise that most sociological studies rank the chiropractor well above the doctor in the ability to control back pain.

And where is the doctor? Has the battle been lost by default? Medical training provides little knowledge or skill to justify the restoration of public confidence.

The modern medical attitude says, “Well, Bob, it looks like a paper cut, but just to be sure, let’s do lots of tests.”

Even the doctor confronted by a patient on whose back clings a large, green monster may be reluctant to make a definite diagnosis.

Although the doctor thinks he has found the trouble, he may refuse to make a commitment until all the investigations are complete, all the while muttering under his breath about the complexity of back pain and the possibility of arthritis or cancer.

D is certainly for Dog, and seems an appropriate mark for the doctor’s attempt at back care.

The fundamentals of patient back education are too often left to junior colleagues without the depth of knowledge necessary to answer questions or the depth of experience necessary to command respect.

A concerned patient requires a clear understanding of the problem, but the lesson in consumer satisfaction so clearly demonstrated by the chiropractor is lost on the physician.

Doctors Gullible Too

Equally quick to criticise the chiropractor for non-scientific methodology, the doctor is equally vulnerable to promotions based on scant medical research — an appeal through showmanship rather than science.

Consider the cold laser. Lasers are high energy light beams which travel in perfectly straight lines. They can be used to signal satellites or to burn holes in bricks. When the energy of the beam is reduced below the combustion point there is no known effect.

Laser surgery relies on the laser’s ability to vapourise tissue. Laser therapy relies on the laser’s unseen ability to increase the energy-containing capacity of the mitochondria within the cell. There is no way to measure this!

Lasers are said to normalise Brownian movement, the random particle movement typified by dust motes in a beam of light. Since random motion is an element of quantum mechanics, and cannot be measured in the living body, there is no way this theory can be tested.

Furthermore, I find it difficult, even in a large scale model, to differentiate between normal random movement and abnormal random movement.

Finally, the laser is heralded as being able to increase the nervous system’s light-carrying capacity, or bioluminascence. This capacity, unknown to the neurophysiologists and anatomists, is well recognised by those who sell medical lasers for $10,000 apiece. Still, lighting up the nervous system has a great deal of appeal.

Having purchased my own expensive equipment, in order to keep up with the clinic across the street, I intend to treat all my joggers so that they can run safely in the dark.

Mind-Body Interaction

The back is an emotional target, and is subject to storng mind-body interaction. Dreaming he is falling, Jerry forgets the well known “always wake up before you land” rule and is flattened like a pancake in his own bed. Here is mind-body interaction in the home.

Six months of inactivity with a bad back, too much beer and too much televisio, and we have the perfect male specimen poised to return to the job. Here is mind-body interaction in the workplace.

Lack of physical stamina limits performance. Strength requires exercise. The willingness to actively participate in the recovery process is a positive mind-body interaction.

Using exercise to control back pain is not a new idea. One manual published in the 1920s pictures the author, complete with bow tie, demonstrating his own routines.

But modern medicine’s love of technology threatens to make even this simple idea unmanageably complex. A bride in her wedding gown standing next to a computerised exercise machine smiles out from a glossy advertisement and exclaims, “Superb! I passed my dorsal stress test. Have you?” I haven’t the faintest idea what she is talking about. I think I prefer the man in the bow tie.

Active, Healthy Machines

Given the choice, of course, many of the doctor’s patients also prefer technology to exercise. One case in point is the passive exercise studio, where you can assure yourself of a healthy, attractive body, painlessly, without perspiration, without the discomfort of strained muscle and bruised joints, and never be out of breath.

The answer, of course, is the machines do all the work. An electric table folds in the middle, helping you with your sit-ups. After a busy day at the clinic, the machines are in great shape.

The same appeal possessed by passive exercise motivates many patients to visit the chiropractor. It is far easier to let something or someone else do the work and take the responsibility than to take charge of your own problems. But chiropractic is not unique in its emphasis on passive techniques. Nor is it alone in its apparent disregard for anatomical considerations.

Manual therapy, performed by a broad spectrum of experts, remains shrouded in folklore and mystery. Thoracic manipulation, as a means of moving the thoracic vertebrae independently, disregards the intervening skin, fat and muscle present in the average living patient.

This same disregard for proven functional anatomy appears in the descriptions of the neurolymphatic reflexes. For example, symptoms of conjunctivitis (an eye complaint) may be treated with pressure on the appropriate reflex location, the upper humerus at the deltoid insertion (arm-shoulder connection).

As surprising as this sounds at first, it is in fact one of the better recognised non-anatomical connections. The next time you meet someone whose eyes are red and bleary from a previous evening’s party, punch her or him sharply over the outer shoulder and watch the eyes fly open. You have just demonstrated a neurolymphatic reflex.

Fallacious anatomy can be used to justify massage or manipulation which brings only temporary pain relief, and yet the patient’s comfort may be enhanced through the erroneous belief that some structural malalignment has been correxted. But when applied in a more sinister fashion, anatomical misinformation can create unwarranted fear and justify the continuation of unnecessary treatment.

Anatomical Misinformation

Dozens of medical conditions are purported to arise because of minor vertebral malalignments. The anatomy seems reasonable, the terms sound familiar, and the medical problems are easily recognised, and yet something is amiss. To accept the diagnosis you must believe. But there are several conflicting belief systems at work in the realm of back pain.

Where better to indoctrinate the true believer than in childhood. Convincing new parents that their infant’s spine requires manipulation to ensure normal growth not only increases current practice, but fosters the child’s lifelong adherence to the principle. “Bring your children for an adjustment. Teach them the benefits of chiropractic.”

Without the knowledge that most back attacks subside spontaneously within 12 weeks, that back pain is a self-limiting condition, and that most back disorders can be controlled through simple measures of self- help, a chiropractic schedule of adjustments outlining intensive care for 13 weeks, reconstructive care for two to two and a half years, and maintenance care for a lifetime seems almost reasonable.

Dependency a Problem

Dependency can be a serious problem, but patients readily accept the idea that their back can somehow be straightened, pressed and cleaned in time for them to pick it up before the shop closes. Passive acquiescence and dependency are the antithesis of active participation and self control.

For those who allow back pain to dominate their lives, the statistics paint an ominous picture. Anyone remaining off work with a bad back for more than six months has only a 50% chance of returning to work on a regular, full-time basis.

Remain off the job for a year, and the chance falls to 25%.

Remain unemployed because of a bad back for two years, and there is virtually no statistical probability that you will ever return to your previous employment in a regular productive capacity.

It is the doctors, far more than the chiropractors, who have been guilty of creating dependency. It is little wonder that many patients will use more than the “apple a day” to keep the doctor away from their backs. The medical profession possesses the potential to eliminate back pain as a major socio-economic problem, but we have yet to demonstrate our understanding of the solution.

Too many meetings, too many publications, and too much time and effort are addressed to the perfect surgical solution while neglecting the simple fundamentals of intelligent and effective back care.

Patients need a simple answer to what can be a simple problem. Most need support, not surgery. They need a platform from which they can achieve their own success.

Joint Responsibility

This is not a popular message. There are too many vested interests and too many strongly held differences of opinion to gain consensus. But whether we like it or not, the battle has been joined and will continue. Both the doctor and the chiropractor have a responsibility to promote better back care.

No longer can the physician place unwarranted emphasis on investigative procedures and invasive therapies.

No longer can the chiropractor hide behind non-diagnoses like “concomitant intervertabral subluxation complexes,” nor report that “the form of treatment given is chiropractic care”.

No longer can the physical therapist be allowed to treat patients solely with modalities possessing no proven therapeutic value, providing temporary pain relief at the risk of long-term dependency.

Dr Hill presented this at a conference of the NZ Society of Physiotherapists.

Once When My Back Was Crook

I was struggling with the vacuum hose to reach an awkward corner of the kitchen.

“What’s wrong? Afraid to bend your back?” my wife asked. I felt a little pain and it didn’t go away. It got worse, seemed to improve for a day, stayed barely tolerable for a week, and then became intense.

It spread, and by the following weekend I was virtually immobile — unable to roll over in bed, racked with unbearable pain every time I moved. I finally phoned Skeptic Barrie Tait, who agreed to see me the next morning. My panic was dictated by an important conference I had to attend on Monday morning in Wellington. Things were looking bleak.

Dr Tait was the soul of courtesy and good-humoured professionalism. He’s the head of Musculoskeletal Medicine at Christchurch Hospital. I bragged about that. People always want to convince everyone — especially themselves — that their doctor is a genius.

Finally, after a gentle, thorough and obviously expert examination, Barrie took the crucial first step on the road to my recovery — he gave my disease a name.

“It’s lumbar dysfunction,” he said with quiet authority. I tried to translate from the Latin and kept coming up with something that seemed to mean “back not working too well.” What could he do for it, I asked eagerly.

“Nothing,” he said. Take pain killers and anti-inflammatories and your back will gradually heal itself. There was no specific medicine or treatment. I should go ahead and walk as much as possible.

Which is what I did. I stopped by the chemist and, by the time I was limping up to Victoria University things were improving. As the hours wore on, my back got better and better, and at home later that evening I was virtually able to turn cartwheels. The pain was gone. After over two weeks of agony, my tortured back was miraculously “cured”.

Over the years, the Skeptics have been relatively unsuccessful in altering the general public credulousness toward alternative medicine. In light of my experience, it’s not hard to see why.

What if Barrie had twirled a pendulum over me, said a mantra, given me chiropractic manipulation, a homeopathic preparation, or analysed my irises? And what if — like most desperate, pain-wracked patients — I’d wanted to believe it?

Barrie would have had a convert for life. The psychological evidence of my spectacular “cure”, coming as it did after weeks of suffering, was overwhelming. Who cares what the Skeptics think about alternative medicine when sufferers are similarly “cured” on a daily basis by chiropractors and other healers?

And it’s not just back pain that has spontaneous remission, but countless other afflictions. This — combined with the fact that people want to believe in their healer, orthodox or quack — means there will always be an army of satisfied customers ready to testify that some placebo cured them after all the marvels of scientific medicine had failed.

Having said all that, and accepting it at a rational level, I still in my heart believe Barrie Tait is a medical genius. I can’t help it. You see, once when my back was crook…