Orthodoxy? – Revisiting the Cartwright Report (Part 2)

NZ Skeptic issues 96, 97 and 98 contained articles presenting different viewpoints on the ‘Unfortunate Experiment’ at National Women’s Hospital and its aftermath. Wellington registered nurse and NZ Skeptics treasurer Michelle Coffey continues the discussion in this web-only special.

When I wrote my original article (NZ Skeptic 97), it was written with the intention that it could stand alone as a more thorough discussion of the findings of the Cartwright Report and later research. This was because there were a number of important issues raised as a result of the report which have been almost lost in the debate, many of them systemic ones. While I’m sure that readers interested enough can source the relevant material and judge for themselves, in Skeptic 98, Linda Bryder has responded and the statements made merit a response to clarify several points. I referenced the Bryder’s book for a complete review of the topic, but did not address it in the original article as while it does deal with aspects of the ‘Unfortunate Experiment’ the book ultimately fails to provide any complete assessment of the matter due to the book omitting to investigate key figures such as McIndoe or dealing with the health care system (in particular it’s politics) as opposed to social movements.

1. “There was no medical certainty about the proportion of cases of CIS…”

None of the references support the contention that there was no medical certainty about the proportion of CIS cases that would advance to invasion, and in any case proportion of cases isn’t the point – it’s whether CIS was considered to be a precursor of invasive cancer. This appears to be the case. In the Cartwright Report1 (p23) a compilation of studies was introduced into evidence giving figures that indicate over time, a significant proportion would progress to invasion.

The 1976 Editorial2 cited is discussing screening and states “The report faces up to the problems which still cause fierce controversy – those of the natural progression and regression of early lesions, the discrepancy between total [CIS] cases and the combined number of number of clinical invasive cases, and the incidence and mortality rates.” The Walden Report3 it is referring to states unequivocally that “The significance of [CIS] as a precursor of invasive disease has been recognised for more than 3 decades. Several series of patients, followed for months or years, have demonstrated progression from [CIS] to invasive disease at rates ranging from 25 to 70%.” The issue of where earlier dysplastic changes fit appears to be where any “controversy” laid rather than the concept of progression from pre-invasive lesion to invasion. The report placed these earlier changes a decade or so prior to invasive disease as a precursor state stating “the concept that progressive degrees of cervical dysplasia are part of the natural history of neoplastic disease of the cervix now seems firm.” This is relevant to developing a screening programme given that there is a window of many years in which the condition could be detected and treated. Ostor4 in his statement “The ultimate fate of patients with CIN is the most controversial issue facing investigators interested in cervical neoplasia.” is discussing similar issues to that discussed in the Walden report which is relevant in terms of assessing the relevance of findings and being able to predict the behaviour of these ‘atypias’. Most studies ended at the point of CIS. Ostor looked at not only progression to invasion but the likelihood of regression, persistence and progression to CIN3 (11% in the case of CIN1) with the conclusion that the probability of invasion increases with severity of dysplasia, but there is potential for regression which reflects on therapy.

One man’s dysplasia is another man’s carcinoma #40;notably without insertions to influence the reader to place a particular meaning on it) is a statement that crops up frequently. One issue is the correlation between cytology and histological confirmation, while this wasn’t perfect it was generally agreed that smears could reliably indicate an existing lesion. Histological confirmation was required, but there could be a lack of agreement between pathologists and laboratories on the histological criteria meaning that the precise differentiation between dysplasia and CIS varied. These uncertainties don’t seem to have impacted on the confidence of pathologists regarding screening for cervical malignancies and grading of a lesion was seen by surgical pathologists as more a statement of probability of progression which had limited applicability in clinical management as noted in Löwy’s history5. The precise definition didn’t matter as much as understanding that it was the same disease that was being managed. This is nothing other than a fairly typical debate as biology and medicine rarely, if ever, give certainties.

1. ” Coffey cites 1958 ” official policy… to show this.”

It’s important to note for clarity that there could be variation in policies in other areas but what is more critical in this case was policy at NWH, the hospital where Green practised which set the standard of care. Policies at NWH evolved over a period of time. In 1955 the formation of a cancer team to which all cases of carcinoma of the cervix were to be referred to for treatment was unanimously supported. Over the next ten years, policies regarding the diagnosis and treatment of CIS and invasive cancer were regularly reviewed. This wasn’t just agreed to at a meeting of “…only nine senior consultants…”the decision was made a formal meeting of the Hospital Medical Committee, with a majority which indicates that the committee was happy with the level of evidence for the policy. The clear majority and evolving policy don’t seem to fit too well with the narrative that there was considerable medical uncertainty and controversy about CIS and its progression.

2. “Professor Barbara Heslop explained this more appropriately…”

Heslop’s6 article is one to which I referred to in writing my article as I found some aspects of it informative. However, it is based in the opinions of the author so it’s unsafe to use this article to make certain statements about Green. Heslop considers that Green was doing research but seeks to place this in context stating “Herb Green aimed to ‘prove’ his hypothesis by carefully observing that dysplasia did not lead to cancer…Unfortunately, the proposed methodology was equally appropriate for showing dysplasia did lead to cancer. Paradoxically, and I am sure unintentionally, he ended up demonstrating…more convincingly than had been done before, the transition of dysplasia to cancer.” It was demonstrable that Green considered his work as a study initiated to test a theory and his 1974 paper said (p65) “This…represents the nearest approach yet to the classical method of deciding such an issue as the change or not of a disease from one state to another – the randomised controlled trial. It has not been randomised and it is not well controlled but it has at least been prospective…”

While Baker may have had the presumption that the therapeutic relationship would predominate, little suggests this happening in the case of Green. Whether he knew about such things as falsifiability, Green set out to prove his ‘dormant cancer’ idea despite indications early on that following such patients was unsafe (such as three cases of invasive disease in patients followed with positive cytology occurring by 1969). If the therapeutic relationship was predominant, those cases should have prompted reconsideration of the hypothesis; instead they were reclassified and removed from the study.

3. The 1966 management protocol was to “extend” conservative treatment…”

What seems to be being said here is that under 35 doesn’t mean that, but that it means older patients can be included as well. It should mean what it says as this was a safeguard intended to protect patients which Green then breached. When aging occurs, physiological changes mean it is more difficult to view areas of abnormality and Green and his colleagues were aware of this and the additional risks. The report (p37) stated “As a woman gets older, the squamocolumnar junction is more likely to lie in the endocervical canal and therefore be invisible to the colposcopist.” This means that it can’t be determined whether lesions extending further are suspicious and it was impossible to get a sample without a cone biopsy. Older women were more likely to have unsuspected invasive carcinoma. The use of words like treat is misleading as the intention was not to extend conservative treatment, but to monitor women with positive cytology to fulfil the aim of the proposal. As an example the proposal stipulated punch biopsies and used the word treat and treated (p 21 “four have been treated by punch biopsy alone.”) however this was regarded as a diagnostic procedure. The only way a punch biopsy could be a ‘treatment’ is if somehow by accident or design, the biopsy managed to obliterate a small lesion.

4. “Coffey presents this as a negative outcome, as if it was unnecessary outcome for the women.”

It was. There is a difference between ongoing monitoring which often can be done at primary care level and repeated attendances at a hospital over many years for multiple tests and interventions. Patient 4M (p44) was first admitted in 1970 with abnormal smears. In between 1970 and 1983 she had 38 appointments and six biopsies (wedge, ring, cone, surface) were performed with two occasions being histologically incomplete. A review of patient notes (p42) showed many women had more than one cone biopsy and in some cases up to six. Testimony showed that doing this more than twice was not considered unless under exceptional circumstances and doing this procedure could have effects such as stenosis or haemorrhage and make later evaluation difficult. Bonham testified that this was a dangerous practice and with the third or fourth conisation, it was probably a greater risk than hysterectomy.

Nothing in medicine is benign, and there are obligations to treat patients ethically. This includes minimising as far as possible unnecessary medical procedures as there are a number of risks entailed every time intervention is made. In a condition as treatable as CIS that could have been simply excised that means that over a period of time many women had a number of procedures that were unnecessary and posed excess risk to them that still left them with positive cytology resulting in risk of progression with its own complications. The associated disruption, pain and discomfort of these multiple interventions shouldn’t be trivialised.

5. Regarding the infant vaginal swabs, a press release by Judge Cartwright’s counsel stated “Mothers were told of the tests.”

Any kind of consent would have sufficed. Judge Cartwright stated (p141) “&#8230 there was no provision made to comply with the fundamental requirement that children are not included in research with the consent of their guardians.” This was not a test but a trial and was non-therapeutic research that held no benefit for the infant. Green quickly realised after 200 babies had undergone the procedure that it was a waste of time and lost interest in the study without communicating this to the nursing staff leading to over 2000 babies being subjected to an unnecessary and potentially harmful vaginal vault smear for the purposes of research without the consent of their parent or guardian.

With randomisation of Green’s 1972 “R series” radiotherapy and hysterectomy trial it is difficult to see that it conformed to international practice. Randomisation is aimed at preventing systematic differences between groups and preventing bias but in this case, the selection criteria were made in advance but there was no allocation of patients prior to anaesthesia, grading and decision on surgical treatment so no concealment. Enrolment could have been influenced by biases such as the need to enrol sufficient patients into the study along with the potential for further bias to be added with the use of coin tossing. The patients were not given any opportunity to consent, and were mislead about the treatment decision. Testimony on p170 states “Dr Green and myself and others discussed this question of informing women in the trial about it when it was initiated in 1972. We decided in the end not to tell patients about the trial. We told them they would be examined under anaesthetic when the most appropriate mode of treatment would be decided and then we would proceed accordingly.”

I can contrast this lack of any kind of consent from the parents or “R series” patients with the oral consent obtained by Sir Liley for his intra-uterine infusions where he sufficiently informed the patient of the possible risks and that the treatment was experimental. His case study published in 19637 states “the patient and her husband were an intelligent couple, and the prognosis for the foetus, the possibility and uncertainty of intrauterine transfusion, and the potential hazards to the mother were fully explained to and discussed with them.” This was not the case with Green and his research projects, as no real attempt was made to provide any kind of informed consent.

6. “Despite writing this, Coffey herself makes it clear that the two groups…had nothing to do with the two groups whose records Green analysed.”

This is an assertion and no reason is given as to why you state this. As such, there is nothing there to counter other than to say they had everything to do with those groups. McIndoe et al8 was retrospective while Green’s research was prospective, which made a difference in how the study was conducted but they were measuring the same thing as Green’s 1974 paper (p65) describes: “This series of 750 cases of in situ cervical cancer, and the following of 96 of them with positive cytology for at least two years…” The McIndoe paper was also a comparison of two groups of women, one with normal follow-up cytology and one without and was the final paper that Green never wrote that completed follow-up on the patients that were the subjects of his study. In my discussion, I highlighted the summary in the paper of patients who were included in the punch biopsy special series and that alone should make it clear the relationship between the “special series” and the study. I’m sure if Green could have asserted the same he would have, but couldn’t. The report didn’t rest on this paper alone but reviewed 1200 patient files and 226 were used as exhibits.

7. “Cartwright accepted this as “accurately reflect[ing] the findings of the 1984 McIndoe paper.”

Except Judge Cartwright did not. This is selective quotation that distorts the statements in the report and falls short of what you would expect from an historian whom you would expect to take care to fairly represent the context and statements in documents. The statement is from Ch4 “Expressions of Concern” where the article is addressed as it was the subject of public comment and had prompted the Hospital Board to request an inquiry. This put the article under scrutiny and criticism by some witnesses. Under the title “Was the magazine article accurate?” It is stated that the manuscript was submitted and editorial changes explained but there were some errors in the article that was finally published. This section states:

1.Significant editorial changes: The matter of accuracy was raised firstly by the authors themselves. In her evidence Sandra Coney drew attention to two editing changes which she considered substantially altered the meaning of sentences in the magazine article.

a. “Twelve of the total number of women had died from invasive cancer as had four, or 0.5%, of the group-one women, and eight, or 6% of the group-two women who had limited or no treatment.”

In the original manuscript the authors had written: “Twelve of the total number of women died from invasive carcinoma. Four (0.5%) of the Group-one women, and eight (6%) of the Group-two women who had limited or no treatment. Thus women in the limited treatment group were twelve times more likely to die as the fully treated group.”

I accept that the unedited material more accurately reflects the findings of the 1984 McIndoe paper. The edited version is not accurate.

It’s clear when looked in context that the statement was sourced from the original manuscript of the article and those words cannot be attributed to Cartwright. Cartwright is accepting that the original manuscript more accurately reflected the findings of the paper and is being misquoted to say something else. It is of note that in Bryder9 p33 that this statement is used to say “Cartwright too suggested differential treatment. In her report she quoted Coney and Bunkle’s statement that: ‘Twelve of the total number of women died from invasive carcinoma… [etc]” Cartwright accepted that this accurately reflected the findings of the 1984 McIndoe paper.” This statement is again used misleading to say something other than what it actually says and is being used inconsistently.

8.“How had they “returned to negative cytology”

McIndoe did not say treatment did not enter the study. The citation in Bryder used to reference this says only “The detailed management of patients is not under consideration in this paper…” The paper looks at the initial management and in some cases more detailed management of patients as Bryder would be aware. Here, it does become evident that there were differences, for instance in group 1 cone biopsies excision was incomplete in 24%, but in group 2, 74% were incomplete with the difference likely to be largely due to management where complete excision is not a necessity. The paper states “…any examination of the natural history of CIS of the cervix must depend on a representative, though incomplete, biopsy specimen on which to base the initial diagnosis. Thereafter, meticulous long-term follow-up of all patients using techniques such as clinical examination, cytology, and colposcopy, and if indicated biopsy, is required.” The paper detailed some limitations, such as small biopsies or possibly trauma eradicating lesions, or inadequate biopsies missing abnormalities. So in answer to that question, it was because initial management in group 1 patients either intentionally or unintentionally was adequate in treating the lesion and restoring them to negative cytology. Of this group only 0.7% had recurrence of CIS. In group 2, follow-up showed continuing positive cytology after initial management either by limited biopsy or incomplete treatment which was ideal for studying the natural history of CIS as set out in the 1966 proposal.

9. “Coffey refers to the 1986 paper…as critical of conservative treatment…”

This paper10 was only briefly mentioned before moving on with discussion of McIndoe et al as there was insufficient space to deal with it in detail. Here long term follow-up of vulvar carcinoma shows that of 31 patients managed by surgical excision, there were 4 recurrences and one developed a vulvar carcinoma 17 years later. 4 women managed only by biopsy progressed to invasion in 2-8 years and one additional patient managed with incomplete excision after a lengthy period of observation progressed to invasion. The paper demonstrated that untreated lesions have significant invasive potential. This approach was an extension of Green’s study of CIS of the cervix, and in this case a biopsy cannot be considered treatment at all. While the authors were advocating conservative treatment this was excision of the lesion not biopsies or incomplete excision.

10.“Would a modern gynaecologist agree with this assessment?”

The relevant sentence is presented as a statement, but it omits a significant portion of the sentence which is “This needs to be explained, as those figures strongly suggest the progression of CIS to invasion when it is and was a totally curable lesion.” Gynaecologists would accept the statement that CIS is a curable lesion which can be readily treated with a variety of local destructive methods with complete removal of the lesion and reversion to negative cytology which then prevents the risk of the lesion progressing. In the quoted statement McIndoe et al is referring to group 1 patients, whose cytology had returned to normal. It states “However, contrary to what would be expected, of the 139 group 1 patients with incomplete excision of the original lesion, only five (3.5%) later developed invasive carcinoma. Thus whether or not the lesion is completely excised does not appear to influence the possibility of invasion occurring subsequently.” In this case it didn’t, the rate of recurrence was unexpectedly small probably due to the initial intervention influencing the condition.

Treatment of a diagnosed lesion is then conflated with cervical cancer at a population level in asking for an explanation of why cervical cancer hasn’t been completely eliminated. In an ideal world this might be possible, but in the real world there are a number of difficulties to be faced in ensuring the entire population at risk is screened and treated if necessary. Green’s conclusion was that screening was not effective, however the conclusion was unjustified. The report discusses this on page 56 and crucially treatment needs to improve the prognosis as if subsequent cases are not adequately treated there is little value in screening in the first place. Also, if screening is done in low risk cases and high risk populations are missed, that means screening will be limited in being able to affect morbidity and mortality. In McIndoe et al, the age-standardised incidence of invasive carcinoma in group 2 was 1141/100,000 compared with 18.2/100,000 in the general population in 1975. This has since dropped considerably.

11. “As stated above, group 1 and group 2 had a similar range of treatments…”

My statements stand on this matter that “this ignores that while many women were treated with various procedures, there was evidence of continuing disease, demonstrating that the intervention was inadequate. This was not followed up, posing a high risk of development of invasive disease.” To prove that CIS is not a premalignant disease necessitated the area is sampled for diagnosis, but done in a way that left the lesion available for further study. In some cases there was no treatment, for instance the punch biopsy series which only used a diagnostic method. The criteria included that “the colpscopically-significant area is large enough not to be completely excised by the diagnostic punch biopsy.” The intention was to leave the lesion as undisturbed as possible. The use of cone biopsy is covered in q 5 and 9 as this could also be diagnostic. Of the hysterectomy series, only 4 out of 25 had the procedure for CIS so the procedure was done but not often specifically for CIS. Either way, women were left with positive cytology which put them at risk.

12. ” The methodology of the 2008 paper has been questioned by Sandercock and Burls…”

I would be embarrassed to cite this letter11 as an example of “questioning”. Every paper is flawed to a degree but this isn’t the right criticism to make. They cite a secondary source and claim this explains what they say is a problem with McIndoe et al – “He points out that, not only were the two group retrospectively divided on the basis of persistent abnormal cytology during follow-up and not prospectively as experimental groups for the comparison of different treatment strategies…” They misread the letter12 which does not appear to state anything regarding type of study and apparently draw from Overton’s misleading statement that “…Green and other senior NWH clinicians endorsed policy changes in dysplasia management. Younger women were to be continuously monitored, by repeat smears, colposcopy, lesser biopsies and appropriate more major surgery if evidence of early cancer.” which omits mention of Green’s role and his published studies. Sandercock and Burls then make an erroneous conclusion that McIndoe’s research should have been prospective and be following different treatments without realising that prospective research had already been done by Green. They cannot have read McIndoe et al despite citing the paper otherwise they would have seen the paper outlined the 1966 proposal. A few minutes reading would have shown the difference in between the statements which if they were honestly critiquing the study they should have checked.

Sandercock and Burls then claim a similar “problem” with McCredie et al even though they are aware it was retrospective. This might be correct to say for prospective studies that ask a question and look forward such as Green’s as this type of study should assess outcomes relative to interventions but retrospective studies are meant to pose a question and then look back. McIndoe et al looked at the question of outcomes for patients with CIS with the patient groups defined by presence of positive or negative cytology which categorised according to the risk they had persistent disease. McCredie13 takes this a step further with the approach being to look at the question of outcomes for patient groups classified by management that was adequate or inadequate. There is no problem with this approach; the problem lies with Sandercock and Burls.

13. “…It should be noted a study on outcomes cannot make such pronouncements…”

It can however tell a story, one that is further strengthened by understanding what the author is trying to achieve. Papers are meant to be considered in the light of all the evidence and that includes context. McCredie et al shows half the cancers in women initially managed with punch/wedge biopsy were diagnosed within 5 years of a finding of CIN3. It can be judged objectively there that merely doing a diagnostic procedure in patients with CIN3 leads to a high risk of developing cancer in a relatively short period of time, while the context shows up much more and shows the unethical nature of the original research which meant they were managed in that manner.

14. “Yet Green’s achievement was to encourage an openness to look at the evidence.”

Which story is it that is being referred to? The one where there is a controversy in medicine? If so, he wasn’t the spirited free-thinker he is being cast as. If it is the one where Green was the controversial one, willing to question modern medicine then the controversy wasn’t in medicine. If he is going to be cast as Galileo type of figure, persecuted for his heresy, the critical point is that Galileo was proven correct. So where are his papers? Even his supporters never present his papers to support their claims. Their resort is to complain about everything else.

Green’s ‘achievement’ was the reverse. On p108 of the report, in an Auckland Star article in 1972 it was reported that “Professor Green asserted that a woman with a positive cervical smear showing what is called [CIS] is no more likely to develop invasive or malignant cancer of the cervix than any other woman of the same age. In other words, in situ cancer is not a forerunner of invasive cancer, and the smear test is over-rated.” There is no shift in attitude over time, despite that over the years, much more would have been studied on the matter and medical practice would have changed. Green’s set views were taught, leading to Registrars and other staff being under the impression that screening for cancer precursors was a waste of time. Apparently he kept an Ogden Nash quotation on his blackboard for many years saying “My mind is made up – don’t confuse me with the facts”. None of this shows any willingness to debate the evidence; on the contrary when faced with evidence of patients with invasive cancer that he had originally diagnosed with CIS though not a trained pathologist, he reclassified them and excluded them from the study. They did not fit, so he changed the evidence to suit his theory. True scepticism is not about holding an idea or defending a position but about being open to the evidence and being willing to examine it and change if necessary. Hitting on the hard edges of scientific debate is a tough experience but it serves no one if the record is distorted to hold an untenable position and legitimate questioning of this is taken to be persecution instead of honestly examining whether the position is, in fact, a correct one to hold.

References

  1. “The Cartwright Report”: http://www.nsu.govt.nz/current-nsu-programmes/3233.asp
  2. “Screening for cervical cancer” 1976: BMJ 659-60
  3. The Walden Report: June 5, 1976: CMA Journal Vol. 114 1003-1012
  4. Ostor, AG 1993: Intern. J. Gyn. Path. 12, 2, 186-92
  5. Lowy, I July 2010 Historia, Ciencias, Saude – Manguinhos V. 17, supl. 1, 53-67
  6. Heslop, B 2004: NZMJ 117,1199
  7. Liley, A.W. 2 November 1963: BMJ Vol 2, Issue 5365 1107-1108
  8. McIndoe, WA; McLean, MR; Jones, RW; Mullins, PR 1984: Obstet Gynecol. 64, 4, 454.
  9. Bryder, L 2009: A history of the ‘Unfortunate Experiment’ at National Women’s Hospital, Auckland University Press, Auckland
  10. Jones, RW; McLean, MR; 1986: Obstet Gynecol. 68, 4, 499-503.
  11. Sandercock, J. Burls, A. 2010, NZMJ 123, 1320
  12. Overton, G.H. 2010, NZMJ 123, 1319
  13. McCredie, M. 2010, NZMJ 123, 1321

Yet more reasons why people believe weird things

Research at Victoria University of Wellington is shedding light on the often irrational processes by which people assess new information. This article is based on presentations to the 2010 NZ Skeptics conference.

Jacqui Dean was alarmed. The Otago MP had received an email reporting the deaths of thousands of people – deaths caused by the compound dihydrogen monoxide. Dihydrogen monoxide is commonly used as an industrial solvent and coolant, it is fatal if inhaled, and is a major component of acid rain (see dhmo.org for more facts about dihydrogen monoxide). Only after she declared her plans to ban dihydrogen monoxide did she learn of its more common name: water (NZ Herald, 2007).

Ms Dean’s honest mistake may be amusing, but when large groups of people fail to correctly assess the veracity of information that failure can have tragic consequences. For example, a recent US survey found 25 percent of parents believe that vaccines can cause autism, a belief that may have contributed to the 11.5 percent of parents refusing at least one recommended vaccine for their child (Freed et al, 2010).

Evidence from experimental research also demonstrates the mistakes people can make when evaluating information. Over a number of studies researchers have found that people believe:

  • that brand name medication is more effective than generic medication;
  • that products that cost more are of higher quality;
  • and that currency in a familiar form – eg, the US dollar bill, is more valuable than currency in a less familiar form – eg, a dollar coin (Alter & Oppenheimer, 2008; for a review, see Rao & Monroe, 1989).

Why is it that people believe these weird things and make mistakes evaluating information?

Usually people can evaluate the veracity of information by relying on general knowledge. But when people have little relevant knowledge they often turn to feelings to inform their decisions (eg Unkelbach, 2007). Consider the following question: Are there more words in the English language that start with the letter K or have K in the third position? When Nobel prize winner Daniel Kahneman and his colleague Amos Tversky (1973) asked this question most people said there are more words that start with the letter K. And they were wrong. People make this error because words that start with the letter K, like kite, come to mind more easily than words that have a K in the third position, like acknowledge, so they judge which case is true based on a feeling – the experience of ease when generating K examples.

Generally speaking, information that is easy to recall, comprehend, visualise, and perceive brings about a feeling of fluent processing – the information feels easy on the mind, just like remembering words such as kite (Alter & Oppenheimer, 2009). We are sensitive to feelings of fluent processing (fluency), and we use it as a cue to evaluate information. For example, repeated information feels easy to bring to mind, and tends to be judged as more true than unrepeated information; trivia statements written in high colour contrast (Osorno is the capital of Chile) are easier to perceive and are judged as more true than statements written in low colour contrast (Osorno is the capital of Chile); and financial stocks with easy to pronounce ticker symbols (eg KAR) outperform those with difficult to pronounce ticker symbols such as RDO (Alter & Oppenheimer, 2006; Hasher et al, 1977; Reber & Schwarz, 1999).

Most of the time, fluently processed information is evaluated more positively – we say it is true, we think it is more valuable. And on the face of it, fluency can be a great mental shortcut: decisions based on fluency are quick and require little cognitive effort. But feelings of fluency can also lead people to make systematic errors. In our research, we examine how feelings of fluency affect beliefs, confidence, and evaluations of others. More specifically, we examine how photos affect people’s judgements about facts; how repeated statements affect mock- jurors’ confidence; and how the complexity of a name affects people’s evaluations of that person.

Can decorative photos influence your beliefs about information?

If we told you that the Barringer Crater is on the northern hemisphere of the moon, would that statement be more believable if we showed you a photo of the Barringer Crater? Because the photo is purely decorative – that is, it doesn’t actually tell you anything about the location of the Barringer Crater (which is in fact in Arizona) – you probably wouldn’t expect it to influence your beliefs about the statement.

Yet, evidence from fluency research suggests that in the absence of relevant knowledge, people rely on feelings to make decisions (eg Unkelbach, 2007). Thus, not knowing what the Barringer Crater is or what it looks like, you might turn to the photo when considering whether the statement is true. The photo might bring about feelings of fluency, and make the statement seem more credible by helping you easily picture the crater and bring to mind related information about craters – even though this would still give you no objective information about where the crater is located. In our research, we ask whether decorative photos can lead people to be more willing to believe information.

How did we answer our research question?

In one experiment, people responded true or false to trivia statements that varied in difficulty; some were easy to answer (eg, Neil Armstrong was the first person to walk on the moon), some were more difficult (eg, Turtles are deaf). Half of the time, statements were paired with a related photo (eg, a turtle). In a second study, people evaluated wine labels and guessed whether each of the wine labels had won a medal. We told people that the wine companies were all based in California. In fact, we created all of the wine names by pairing an adjective (eg, Clever) with a noun (eg, Clever Geese). Some of the wine labels contained familiar nouns (eg, Flower) and some contained unfamiliar nouns (eg, Quills). Half of the wine labels appeared with a photo of the noun.

What did we find?

Overall, when people saw trivia statements or wine names paired with photos, they were more likely to think that statements were true or that the wines had won a medal. However, photos only exerted these effects when information was difficult – that is, for those trivia statements that were difficult to answer and wine names that were relatively unfamiliar. Put more simply, decorative photos can lead you to believe claims about unfamiliar information.

Is one eyewitness repeating themselves as believable as three?

If you were a juror in a criminal case, you would probably be more willing to convict a man based on the testimony of multiple eyewitnesses, rather than the testimony of a single eyewitness. But why would you be more likely to believe multiple eyewitnesses? On the one hand, you might think that the converging evidence of multiple eyewitnesses is more accurate and more convincing than evidence from a single eyewitness, and indeed, multiple eyewitnesses are generally more accurate than a single eyewitness (Clark & Wells, 2008).

On the other hand, as some of the fluency research discussed earlier suggests, you may be more likely to believe multiple eyewitnesses simply because hearing from multiple eyewitnesses means hearing the testimony multiple times (Hasher et al, 1977). Put another way, it may be the repetition of the testimony, rather than the number of independent eyewitnesses, that makes you more likely to believe the testimony. In our research, we wanted to know whether it is the overlap of statements made by multiple eyewitnesses or the repetition of those statements that makes information more believable.

How did we answer our research question?

We asked subjects to read three eyewitness reports about a fictitious crime. We told half of the subjects that each report was written by a different eyewitness, and we told the other half that all three reports were written by the same eyewitness. In addition, half of these subjects read some specific claims about the crime (eg, The thief read a Newsweek magazine) in one of the eyewitness reports, while the other half read those same specific claims in all three reports. Later, we asked subjects to tell us how confident they were that certain claims made in the eyewitness reports really happened during the crime (eg, How confident are you that the thief read a Newsweek magazine?).

What did we find?

This study had two important findings. First, regardless of whether one or three different eyewitnesses ostensibly wrote the reports, subjects who read claims repeated across all three reports were more confident about the accuracy of the claims than subjects who read those claims in only one report. Second, when the claims were repeated, subjects were just as confident about the accuracy of a single eyewitness as the accuracy of multiple eyewitnesses. These findings tell us that repeated claims were relatively more fluent than unrepeated claims – making people more confident simply because the claims were repeated, not because multiple eyewitnesses made them.

Would a name influence your evaluations of a person?

Your immediate response might be that it shouldn’t – people’s names provide no objective information about their character. We hope that we make decisions about others by recalling information from memory and gathering evidence about a person’s attributes. Indeed, research shows that when we have knowledge about a topic, a person or a place, we do just that – use our knowledge to make a judgement- and we can be reasonably accurate in doing so (eg, Unkelbach, 2007).

But when we don’t know a person and we can’t draw on our knowledge, we might be influenced by their name. As we have described, when people cannot draw on memory to make a judgement, they unwittingly turn to tangential information to make their decisions. Therefore, when people evaluate an unfamiliar name, tangential information, like the complexity of that name, might influence their judgements. More specifically, we thought that unknown names that were phonologically simple – easier to pronounce – would be judged more positively on a variety of attributes than names that were difficult to pronounce.

How did we answer our research question?

We showed people 16 names gathered from international newspapers. Half of the names were easy to pronounce (eg, Lubov Ershova), and half were difficult to pronounce (eg, Czeslaw Ratynska). We matched the names on a number of factors to make sure any differences we found were not due to effects of culture or name length. So for example, people saw an easy and difficult name from each region of the world and names were matched on length. Across three experiments, we asked subjects to judge whether each name was familiar (Experiment 1), trustworthy (Experiment 2), or dangerous (Experiment 3).

What did we find?

Although the names were not objectively different from each other on levels of familiarity, trustworthiness, or danger, people systematically judged easy names more positively than difficult names. Put another way, people thought that easy-to-pronounce names were more familiar, more trustworthy, and less dangerous than difficult-to-pronounce names. So although we would like to think we would not evaluate a person based on their name, we may unwittingly use trivial information like the phonological complexity of a name in our judgements.

Conclusions

Why is it that people believe these weird things and make mistakes when evaluating information? Our research suggests that decorative photos, repetition of information, and a person’s name all influence the way people interpret information. More specifically, decorative photos lead people to think information is more credible; repetition leads mock-jurors to be more confident in eyewitness statements – regardless of how many eyewitnesses provided the statements; and an easy-to-pronounce name can lead people to evaluate a person more positively.

Relying on feelings of fluency can result in sensible, accurate decisions when we are evaluating credible facts, accurate eyewitness reports, and trustworthy people. But the same feelings can lead people into error when we are evaluating inaccurate facts, mistaken eyewitnesses, and unreliable people. More specifically, feelings of fluency might lead us to think false facts are true, be more confident in inaccurate eyewitness reports, and more positively evaluate an unreliable person.

A common finding across our studies is that the effect of fluency was specific to situations where people had limited general knowledge to draw on. In the real world, we might see these effects even when people have sufficient knowledge to draw on. That is because we juggle a lot of information at any one time and we do not have the cognitive resources to carefully evaluate every piece of information that reaches us – as a result we may turn to feelings to make some decisions. Therefore it is inevitable that we will make at least some mistakes. We can only hope that our mistakes are comical rather than tragic.

The authors thank Professor Maryanne Garry for her invaluable guidance and her inspiring mentorship on these and other projects.

References

Alter, A, Oppenheimer, D 2006: Proc. Nat. Acad. Sci. 103, 9369-9372.
Alter, A, Oppenheimer, D 2008: Psychonomic Bull. & Rev. 15, 985-990.
Alter, A; Oppenheimer, D 2009: Personality and Soc. Psych. Rev. 13, 219-236.
Clark, SE; Wells, GL 2008: Law & Human Behavior 32, 406-422.
Dihydrogen Monoxide – DHMO Homepage. (2010).dhmo.org
Freed, G; Clark, S; Butchart, A; Singer, D; Davis, M 2010: Pediatrics, 125, 653-659.
Hasher, L; Goldstein, D; Toppino, T 1977: J. Verbal Learning & Verbal Behavior 16, 107-112.
NZ Herald 2007:www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10463579
Rao, A; Monroe, K 1989: J. Marketing Research, 26, 351-357.
Reber, R; Schwarz, N 1999: Consciousness & Cognition 8, 338-342.
Tversky, A; Kahneman, D 1973: Cognitive Psych. 5, 207-232.
Unkelbach, C 2007: J. Exp. Psych.: Learning, Memory, & Cognition 33, 219-230.

NearZero Inc: A sadly prophetic company name

Many people lost a lot of money investing in non-existent data compression software because well:established principles of information theory were ignored. This article is based on a presentation to the 2010 NZ Skeptics conference.

In the late 1990s, Nelson man Philip Whitley claimed to have invented a new data compression technology worth billions of dollars. Over the next decade money was raised on a number of occasions to develop this technology, culminating in a company called NearZero Inc raising $5.3 million from shareholders. According to a well:established body of theory, Whitley’s claims were obviously false. Unsurprisingly, within a few months of NearZero’s formation, it was in liquidation, with its funds gone.

I thought the saga of NearZero could be of interest to skeptics as it involves claims that were clearly false according to well&#8211established theory, and those claims cost investors a lot of money.

But first, a quick introduction to how data is stored by computers, and how that data can be compressed. Computers store data digitally, using the digits 0 and 1 in a binary code. A piece of storage capable of storing a 0 or a 1 is known as a bit (short for binary digit). With 1 bit we can store two values: 0 and 1. While this might be enough to store a simple data value (such as whether someone is male or female), for most pieces of data we need to store a larger range of values. With each bit we add, the number of possible values doubles; by the time we get to 8 bits we have 256 different values. The byte (a group of 8 bits) has proved to be a very useful unit of storage; storage sizes are usually quoted in bytes.

Character data is usually stored 1 byte per character (in European languages). Lower case ‘a’ is represented as 01100001, for example. A picture is a grid of dots. Each dot is called a pixel, and usually 4 bytes are used to encode the colour of a pixel. Standards are needed so that everyone interprets bit patterns in the same way.

Data representation methods are often chosen based on how easy it is to process the data. Often, the same data can be stored more compactly at the cost of making it harder to process. The process of translating a piece of data into a more compact form (and back again) is known as data compression. Compressing data allows us to put more data onto a data storage device, and to send it more quickly across a communications link. The size ratio between the compressed version and the uncompressed version is known as the compression ratio.

In ‘lossless’ compression, the uncompressed data is always identical (bit for bit) to the original data we started with. A compression method designed to work with any type of data must be lossless.

In ‘lossy’ compression, we are willing to accept small differences between the original data and the uncompressed data. In some situations we do not want to risk data being changed by compression, and lossless methods must be used. With images and sound, small changes that are difficult for humans to detect are tolerable if they lead to big space savings. The JPG image format and mp3 video/audio format have lossy compression methods built in to them. Users can choose the tradeoff between quality and space.

A question of pattern

For it to be possible to compress data, there must be some pattern to the data for the compression method to exploit. Letter frequencies in English text are well known, and could be the basis for a text compression method. We can do better if we take context into account. The most frequent letter is ‘e’ (12.7 percent), but if we know the next letter is the first in a word then ‘t’ is the most likely (16.7 percent). If we know the previous letter was (q) then the next will almost certainly be (u). A compression method that takes context into account will do better than one that doesn’t, as the context-based one will be a better predictor of the next symbol.

Likewise images are not random collections of coloured dots (pixels). Rather, pictures typically include large areas that have much the same colour. Sequences of frames in a movie often differ little from each other, and this can be exploited by compression methods.

The effectiveness of a compression method depends on how predictable / random the data is, and how good the compression method is at exploiting whatever predictability exists. If data are random, then no compression is possible. In these cases compression methods can actually create a compressed file larger than the original, because the compression methods have some costs. A compressed file is much more random than the uncompressed version, because the compression method has removed patterns that were present in the original.

In many branches of computer science it is important to establish the best possible way in which something could be done, to serve as a benchmark for current methods. In information theory, Shannon’s entropy is a measure of the underlying information content of a piece of data. A 1000-character extract from a book has more information content than 1000 letter ‘x’ characters, even though both might be represented using 1000 characters. To quote Wikipedia: ” Shannon’ s entropy represents an absolute limit on the best possible lossless compression of any communication” . Modern compression algorithms are so good that ” The performance of existing data compression algorithms is often used as a rough estimate of the entropy of a block of data” . In other words, it is not possible to achieve large improvements over current compression techniques.

The claims

It is time to have a look at Philip Whitley’ s claims. He claimed that he could compress (losslessly) any file to under seven percent of its original size, but this is not credible. Compression potential varies widely depending on patterns in the original file. Many files are already compressed, so have little potential for further compression. Even for uncompressed files, seven percent is achievable only in exceptional cases (English text entropy means the best achievable for English text is around 15 percent).

If it was possible to compress any file to less than seven percent of its original size then it would be possible to compress any file down to 1 bit. The first compression takes you down to under seven percent of the original file. Given that Whitley claimed his technique worked on any file, we could then compress the compressed file, reducing it to less than 0.5 percent of the original size, and so on.

Initial tests of Whitley’s technology were done on one computer. This made it easy to cheat. The ‘compression’ program can easily save a copy of the original file somewhere on disk as well as producing the ‘compressed’ version. Then, when the compressed version is ‘expanded’, the hidden copy can be restored. Whitley remained in control of the equipment, ostensibly to prevent anybody from stealing his software.

Critical assessment

Philip Whitley’s company Astute Software paid Tim Bell (an associate professor of computer science at the University of Canterbury) for an opinion on the technology. Tim Bell has an international reputation in the field of data compression; Microsoft has used him as an expert witness, and he has co-authored two well-known compression textbooks. An irony of the NearZero case is that New Zealand has more expertise in this field than you might expect for a small country (the co-authors of the two text books are New Zealand-born or live in New Zealand).

Tim Bell’s views were blunt: “The claims they were making at the time defied what is mathematically possible, and were very similar to claims made by other companies around the world that had defrauded investors.” One of his criticisms was that the tests were not two-computer tests. In such a test the compression is performed on one computer and the compressed file is transferred to a second computer, where it is decompressed. A two-computer test prevents the hidden-file form of cheating. It is reasonably easy to monitor the network cable between two computers, to check that the original file is not sent in addition to the compressed file (though the tester must be alert for other possible communication paths, such as wireless networks).

A two-computer test was subsequently conducted, and described in a 14-page report by Titus Kahu of Logical Networks. At first glance the report looks impressive, but on closer reading flaws quickly emerge. The two computers used were Whitley’s. The major flaw was that Kahu was limited to testing a set of 24 files selected by Whitley. The obvious form of cheating this allows is that the set of files can be placed on the second computer before the tests. Then all that the first computer needs to do is to include in the ‘compressed’ data details of which file is required (a number between 1 and 24 would suffice). The receiving computer can then locate the required file in its hiding place.

Titus Kahu did check the receiving computer to see if files with the names of those used in the test were present, but you would expect that someone setting out to deceive would at the very least rename the files.

The report makes for interesting reading. The files were of a number of types, including text files, pictures in JPG and GIF formats, MP3 audio files, and tar files. A tar file is a way of collecting a number of files together into a single file (zip files in Windows serve the same purpose).

One would expect text files to compress well, but JPG, GIF and MP3 files to compress poorly (they are all compressed formats). How well a tar file will compress depends on the files that it contains.

A simple comparison

To get some data to compare with the results in the report, I ran some tests using gzip (a widely used lossless compression method) on some text, tar and JPG files. I managed to locate two of the tar files used in the Titus Kahu tests: Calgary.tar and Canterbury.tar. Gzip achieved savings of 67.24 percent and 73.80 percent (so Calgary.tar was compressed to about one third of its original size, and Canterbury.tar to about one quarter). I also located three text files that were later versions of text files used by Kahu: on these Gzip achieved savings of 63.08 percent, 62.05 percent, and 70.77 percent. I also compressed a JPG file using gzip, and achieved a saving of 2.34 percent.

There are no great surprises in my results. There was quite a variation in the compression achieved, even amongst files of the same data type (the three text files for example). Compressing a JPG file gave little extra compression (not enough to make it worth further compression with gzip).

By comparison, savings in the report were 93.52 percent for four files and 93.53 percent for the other 20. I suspect that the difference in the fourth significant figure is due to rounding the file size to the nearest byte. These results are not remotely believable. The compression achieved is too good to be true even for data that compresses well (such as text), let alone for data formats that are already compressed. The incredible consistency of the compression achieved is also not credible.

Downfall

Having looked at some background, it is time to look at the chain of events that culminated in NearZero Inc’s rise and fall. Philip Whitley’s early forays into business were not promising. In 1995 he was adjudged bankrupt (discharged in 1998). In 1997 he became a shareholder in Nelic Computing Ltd, which went into liquidation in 1999, owing unsecured creditors $70,000.

In 1999 Philip Whitley formed a software company (Astute Software) with a number of Nelson investors (who put in $292,000). Astute worked on a number of projects, and developed the data compression technology. In early 2001 the ‘one-computer’ tests were done, and Tim Bell’s opinion was sought. In mid 2001 the logical Networks ‘two-computer’ tests were done by Titus Kahu. In 2002, a Mr Cohen (an investor) asked for a (long-awaited) copy of the compression technology; he was told by Philip Whitley the only copies had been accidentally burnt when cleaning out his safe. Later in 2002 work stopped due to Whitley becoming ill.

In 2005 Whitley resumed work on the technology. Some of the original investors put in a further $125,000. On 10 July 2006, NearZero was incorporated in Nevada, with Philip Whitley as president, treasurer and sole director. Later in 2006 Titus Kahu became engineering director for Syntiro (a Philip Whitley company doing development work for NearZero) on the generous salary of $250,000 a year.

In February to April 2007 NearZero share purchase meetings were held in Auckland, Wellington and Christchurch. A total of 490 investors invested $5.3 million. The investment opportunity brochure forecast that the near-term NearZero market capitalisation would be US$482 billion to $780 billion, and was expected to exceed one trillion US dollars. Note that the largest company in the world, Petrochina, is a US$405 billion company, and the largest US companies, including Exxon Mobil, Apple and Microsoft, are in the 200 to 300 billion bracket.

Things quickly went wrong. In May 2007, the Securities Commission started investigating the legality of the NearZero share offer (there is no registered prospectus, for example). Also in May, Price Waterhouse Coopers (PWC) were appointed as interim liquidators for NearZero, and moved to sell houses and cars. In June, PWC said $218,000 went to Richmond City Football Club, $523,000 on vehicles, $852,000 on property, $683,000 to US-based company secretary Sherif Safwat, and $270,000 on household expenses. They found little evidence of money spent developing compression technology.

In June Whitley invited investors to contribute money to fund legal action to prevent liquidation. Also in June PWC found no evidence of any compression technology. Whitley claimed to have wiped it; PWC found no evidence of use of wiping software.

Then in July Whitley made some rather curious statements in an affidavit sworn in relation to the liquidation: “I will however say that it isn’t binary and therefore not subject to Shannon’s Law of algorithmic limitation.” If there was a real technology that was not based on binary it is hard to see it being of widespread use in computer and communication systems that store, transmit and process all data in binary. The affidavit continues: “Shannon’s Law is attached to this affidavit as Annexure “Y” and it can be seen that this is a 1948 paper”. Claude Shannon founded information theory, which is the basis of how digital computers represent data (according to one tribute, the digital revolution started with information theory). Shannon coined the term bit, and introduced the concept of information entropy referred to earlier. It is interesting that Shannon’s fundamental research results are dismissed as being in “a 1948 paper”.

He also stated: “In regard to the item 3/ I have never asserted that the technology is based on an algorithm”. In computer science, an algorithm is simply a description of how to do something in a series of steps. A common analogy is to say that a cooking recipe is an algorithm for preparing food. If Philip Whitley’s compression technology is not based on an algorithm then that implies it cannot be described as a sequence of steps, and therefore cannot actually be implemented!

In November, Associate Judge Christiansen ordered NearZero’s liquidation, and ruled that the compression technology had no value. Then in August 2008 Whitley faced the much more serious charge of making fraudulent claims about his technology.

In September 2008 all shareholders were given the option of keeping their shares or getting their money back. They proved to be remarkably loyal: $3.1m voted to stay in; $2.2m voted for reimbursement. I’m not sure whether there was any money to reimburse those who voted that way (probably not). In August 2009 Philip Whitley was convicted and fined for making allotments without having a registered prospectus.

The trial

In February 2010 the fraud trial began in Nelson. Whitley was charged with making a false statement as a promoter between July 2006 and May 2007. There were many sad stories in the Nelson Mail about wasted money and time (and resulting stress). Some of the information to emerge in the trial:

  • Philip Whitley hired a team of seven body guards headed by “Oz” (Oswald Van Leeuwen), who was on a salary of $300,000. This level of security was needed because of the (supposed) enormous value of the compression technology
  • According to Sherif Safwat, Philip Whitley believed a Chechnyan hit team had arrived in New Zealand on a Russian fishing boat.
  • Philip Whitley: “The [security guards] said that the Russians were trying to penetrate and we ended up with security guards living in my house, camped on the floor … I couldn’t go out of the house without having security … it just built up inside me to the point where I just lost it from a point of paranoia.”

In his summing up on May 27, the defence lawyer said:

  • “Whitley had a distorted view of reality which led him to believe his data compression technology was real.”
  • “… [we are] not challenging the evidence of … Prof Bell that Whitley’s claimed invention was mathematically impossible.”

In July Philip Whitley was found guilty on two counts of fraud (but maintains he still has his inventions).

On August 10, 2010, he was sentenced to five years and three months in prison.

The NearZero mess should not have happened. New Zealand has more researchers in this field than you would expect for a country of this size. One of the most prominent, Tim Bell, clearly stated in 2001 that the claims were false. However, investors still committed (and lost) millions of dollars over a number of years. Compression claims are easily tested (much more easily than medical claims, for example). Whitley refused to allow his technology to be independently tested using the excuse of protecting his intellectual property. Many people have been harmed, especially the investors. Moreover, this type of case is not good for the reputation of the IT industry, which struggles to attract investment.

I was asked at the conference how non-technical NearZero investors could have protected themselves. I had no answers at the time, but have given it some thought since. Some things they could have done:

  • Google the names of the company principals.
  • Check to see how the predicted market capitalisation compared to that of existing companies. Finding that the lowest estimate would make NearZero the biggest company in the world should have lead to some scepticism.
  • Google the terms ‘data compression’ and ‘scam’.

Much of the information in this article is based on the Nelson Mail’s extensive reporting of the issue, for which they are to be congratulated. Another good source of information was nearzero.bravehost.com, a website set up by and for NearZero’s shareholders in 2007 in response to the liquidation of NearZero. An article by Matt Philp on Philip Whitley and NearZero appeared in the October 2010 issue of North & South.

Newsfront

Psychic and TVNZ join forces to profit from child’s disappearance

When Sensing Murder psychic Deb Webber announced on TV One’s Breakfast show that missing Auckland toddler Aisling Symes was in “a ditch, hole” it raised eyebrows all over the place (NZ Herald, 9 October).

Webber was appearing on the show to plug her upcoming nationwide tour – and also the latest series of Sensing Murder, screening on the same channel. Later that day TVNZ journalist Amy Kelley asked the police at a press conference how seriously they would take Webber’s “information”.

TVNZ then approached a friend of the Symes family and subsequently Webber had met them. The state broadcaster seemed to have far too cosy a relationship with the psychic.

TVNZ spokeswoman Andi Brotherston defended the channel’s role, saying, “You know what they are doing? They are being human. They have a family out there that are desperate to find their child.”

Interestingly, Webber’s Sensing Murder co-star Kelvin Cruickshank said at a public show in Hamilton (see p. 16) that his spirits had told him to keep clear of the case, because the family were devout Baptists who didn’t believe in spiritualism.

It is worth remembering that at the time Webber made these comments (less than 48 hours after Aisling’s disappearance) misadventure seemed the most likely explanation. It was only as time went on that the abduction scenario gained favour. When her body was eventually discovered in a concrete stormwater pipe the Waikato Times (13 October) reported Webber had been “proved correct”.

But “ditch” or “hole” covers almost all the likely options – including a shallow grave. Again, the standard psychic’s ploy of making a vague statement which is then misremembered as more accurate than it was, paid dividends.

Hunt on for ‘panther’

A few years back the annual NZ Skeptics conference heard about reports of big cats in the South Island high country. Now someone has built a trap for the mystery beast (Sunday Star-Times, 13 December).

High country farmer David Wightman says he’s never seen the “panther”, but others on his 9500ha Winterslow Station in North Canterbury have, on at least four occasions. “Too many people have seen it to doubt what it is – without actually capturing it and doing a DNA test on it, one can only assume it is a black leopard or black panther.”

Wightman said he planned to use a live goat to lure the panther into the trap. The panther would be unable to harm the goat because it would be in a separate enclosure, but its bleating should be enough to attract the cat. There was no evidence of a large predator attacking free-ranging stock, however.

We should apply the skeptical adage, when you hear hoofbeats in the night, think of horses, not of zebras. Big cats have been reported very widely, and sometimes are reported as brown or grey, suggesting that breeding populations of at least two species are involved. Black leopards (‘panthers’) are rare within their natural range compared to the more common spotted variety, yet no spotted leopards have been sighted roaming free in New Zealand.

Far more likely that the big cats are just that – big cats. Feral domestic cats can grow remarkably large – I once saw one in the Lewis Pass which must have been almost a metre nose to tail – and people are very poor at judging scale at long distances (hmm, maybe that cat wasn’t so big after all!).

Scientology ‘organised fraud’

The church of Scientology has been branded an “organised fraud” by a French court and fined 600,000 euros ($1.2m) for preying financially on vulnerable believers (NZ Herald, 28 October).

Judges in the Paris criminal court ordered the church to pay for adverts carrying its findings to be placed in newspapers around the world. It is believed to be the first time that Scientology has been declared fraudulent by a court in a large, democratic country, although individual scientologists, including its founder L Ron Hubbard, have previously been convicted of fraudulent activities. The Paris decision went further and declared the core claims of Scientology were “fallacious” and designed to “hook” members into paying large amounts of money.

Two French female plaintiffs alleged that, between 1997 and 1999, the Scientology movement persuaded them to pay the equivalent of 21,000 euros and 49,500 euros for treatments to improve their mental and physical health. The two main Scientology bodies in France were put on trial for “systematic use of personality tests of no scientific value… with the sole aim of selling services and products”.

Scientology spokeswoman Agnes Bron said the verdict was the result of an “inquisition of modern times” and that they would appeal.

Science writer wins ruling in libel battle

Brtiish science writer Simon Singh, who is being sued for libel by the British Chiropractic Association, is to fight on after a preliminary judgment against him was opened to appeal (The Guardian, 14 October).

Singh was sued after writing an article in the Guardian criticising the association for supporting members who claim that chiropractic treatments can treat children’s colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying.

Singh described the treatments as “bogus” and criticised the BCA for “happily promoting” them.

In May, Mr Justice Eady in the high court ruled on the meaning of the words, saying they implied the BCA was being deliberately dishonest. Singh was initially refused leave to appeal, but Eady’s interpretation was deemed to be open to argument by Lord Justice Laws, who said Eady had risked swinging the balance of rights too far in favour of the right to reputation and against the right to free expression.

Many scientists and science writers have rallied to Singh’s support, claiming that the freedom of scientific opinion is at stake. “Simon Singh’s battle in this libel case is not only a glaring example of how the law and its interpretation are stifling free expression, it shows how urgent the case for reform has become,” said Jo Glanville, editor of Index on Censorship.

‘Tumour’ thrown at meeting

The hysteria over the Dept of Conservation’s use of brodifacoum to eradicate pests on Rangitoto and Motutapu, reported in last issue’s Newsfront, has continued (NZ Herald, 15 October).

A woman, Donna Bird, was ejected from a 14 October meeting on Auckland’s North Shore after hurling abuse and objects – one of which she claimed was a tumour that had been taken out of her – at DoC speaker Richard Griffiths. The department were “parasites” and “disease mongerers”, she said.

Others at the meeting accused DoC of spreading poison in the gulf, and of being blinded by science. Six dogs died and others became unwell after apparent exposure to tetrodotoxin, a natural marine toxin, on Auckland beaches. Marine organisms, including penguins and dolphins, had also been found dead in the area. Mr Griffiths told the meeting toxicology results ruled out brodifacoum as being responsible. “I’m not sure what else we can say.”

Thief warned of sex change curse

A thief in Auckland may get more than he or she bargained for with a terracotta flower pot taken from a Gulf Harbour home (Rodney Times, 3 December).

The owner says it contains his African witchdoctor grandma’s ashes and is now cursed. In a letter to the Rodney Times, At du Plooy says his grandmother was a sangoma or witchdoctor who died in Africa aged 93. Du Plooy claims to be a medium who keeps in contact with her spirit. While he should be able to trace the pot, through this link, it appears grandma is unfamiliar with the area concerned.

Instead, she has cursed a one kilometre area around the pot with sex-change ions – meaning men may gradually change to women and vice versa. Dumping the contents won’t break the spell, du Plooy says, only its return.

History denied is history repeated

Today, gonorrhoea infections in young girls are taken as certain evidence of sexual abuse. Yet there is an extensive but now-forgotten literature showing that this is not necessarily the case. This article is based on a presentation to the NZ Skeptics 2008 conference in Hamilton, September 26-28.

In 2006 I was asked for my forensic opinion in a case involving a 13 month old Pacific Island girl, Lana,* found to have a gonorrhoeal infection of her vagina and vaginal lips. Her 19-year-old mother and 20-year-old father had also tested positive for gonorrhoea. Her father had acquired this infection through having an affair when Lana was aged 10 months. Both parents had noticed they had a discharge but had not sought treatment, but when Lana developed symptoms they took her to their GP. Once gonorrhoea was diagnosed, it was immediately decided that either her mother or her father must have sexually abused her and she was taken into foster care.

The parents denied any abuse. They lived in an extended family household, shared a room, bed, and towels, sometimes bathed together, and the mother would use her sarong as a nappy when she ran out of disposables. They accepted that they must have been the source of Lana’s infection, but denied any sexual contact and said that she must have acquired the infection through contamination. They were battling in the Family Court to get their daughter back. The doctors for Child Youth and Family (CYF) insisted that gonorrhoea can only be transmitted by “mucous membrane to mucous membrane” and that gonorrhoea infection in a child under the age of puberty (ruling out vertical transmission when a newborn baby acquires the infection at delivery from the birth canal of an infected mother) is considered diagnostic of sexual abuse.

I was therefore asked by the parents’ lawyer whether gonorrhoea can be transmitted non-sexually in pre-pubertal children after the newborn period. In my opinion gonorrhoea was exclusively a sexually transmitted disease. Experts in the field, both in New Zealand (such as Auckland paediatrician Patrick Kelly) and internationally (for example Margaret Hammerschlag and Nancy Kellogg in the USA) say that gonorrhoea in a child, other than a newborn, is presumptive evidence of sexual abuse.

Various international guidelines indicate that gonorrhoea in pre-pubertal children is nearly always a sexually transmitted disease, although the possibility on non-sexual transmission is not conclusively excluded. In the US Committee on Child Abuse & Neglect (American Association of Paediatricians, 2005), gonorrhoea is said to be diagnostic of sexual abuse “if not perinatally acquired and rare nonsexual vertical transmission is excluded” and a positive culture for Neisseria gonorrhoeae makes “the diagnosis of sexual abuse a near medical certainty”. The UK National guideline for the management of suspected sexually transmitted infections in children and young people (2003) states that “The bulk of evidence strongly suggests that gonorrhoea in young people over one year is sexually transmitted and the isolation of a gonococcal infection is highly suggestive of sexual abuse”.

Certainly there is no doubt that children as well as adults can and do contract gonorrhoea from sexual contact and sexual abuse. I agreed to conduct a systematic literature review to establish whether there is evidence on the possible non-sexual transmission of N. gonorrhoeae in children after the neonatal period. After some months, having accessed and read several hundred papers, it was apparent that there is overwhelming evidence of thousands of reported instances of possible, probable and definite non-sexual transmission of gonorrhoea.

Results of the literature review

The bacteria which causes this infection, N. gonorrhoeae, will grow at temperatures between 25 and 39 degrees Celsius, It is killed by heat (five minutes at 55 degrees) and dies quickly if dried, but thrives in warm humid conditions. It grows on the mucous membranes of the body and hence can infect the mouth, throat, conjunctiva of the eyes, the urethra, anal canal and cervix. Pre-pubertal girls (but not adult women) are susceptible to infection of the vagina and vaginal lips (vulvovaginitis). The mucous membrane of a young girl’s vagina is more delicate than that of an adolescent or adult because of lack of oestrogen and it has a neutral pH which renders it an excellent culture medium for the bacteria.

Survival on inanimate objects

Studies have been conducted where various objects are contaminated with the organism and then attempts made to culture it after periods of time. It has been recovered and grown from a variety of surfaces including paper, swabs, fabric, rubber, wood, glass and condom after a number of hours, and has been grown from infected bathwater after 24 hours. It can live in pus on towels and other fabric for hours or days. Studies of toilet seats have found that these are unlikely to be sources of infection. Gonorrhoea was not grown in a study of random swabs of public toilet seats. When seats were inoculated with the bacteria, it died within 10 minutes if dried, although it could be grown from pus on the seat after two to three hours.

People are at greater risk from contaminated toilet paper rather than toilet seats. There is one case study of an eight-year-old Australian girl who travelled for 72 hours on a plane from Russia to Sydney. The toilets were very dirty and the girl, instructed by her mother, wiped the seat with toilet paper before using it. A few days after arriving in Australia she developed a gonococcal infection. Despite extensive questioning she remained adamant that she had never been subjected to any sexual contact and it was presumed that she had probably contracted the infection from self-inoculation, wiping herself with contaminated fingers.

Accidental transmissions

The literature contains a number of examples of accidental transmission. The three-year-old son of a laboratory technician was left in the car while his mother shopped, ate infected chocolate agar from a culture plate and subsequently developed gonorrhoea of the throat. Laboratory technicians have developed cases of infected eyes (conjunctivitis) from being struck in the eye with the strap of an infected face mask, and from accidentally spraying their face and eyes with infected fluid. There is an unusual cultural practice of Filipinos using their own urine as an eyewash, and a case series is reported of 13 men with genital gonorrhoea who inadvertently gave themselves gonorrhoeal infection in their eyes. Another case of indirect transmission is of a soldier immobilised in bed for many weeks with fractured legs who acquired urethral gonorrhoea from sharing a urinal bottle with an infected patient in the next bed. An even more bizarre case is one of a sea captain acquiring gonorrhoea from using an inflatable sex doll belonging to the chief engineer who had contracted the infection in a previous port.

Epidemics of conjunctivitis

Large-scale epidemics of gonorrhoeal infections, largely affecting the eyes, are reported in communities where there are overcrowded conditions in substandard housing, insufficient water supply with poor sanitation, inadequate hygiene and a high fly density. Such epidemics are prevalent in parts of rural Africa and outback Australia. For example in 1988 an epidemic involving over 9000 cases over an eight-month period was reported in a district in Ethiopia. Most of those infected were children aged under five years, with no concurrent genital outbreak in the adult population. Similar epidemics of gonococcal conjunctivitis have been reported in Aboriginal communities in outback Australia throughout the 1980s and 1990s. Those affected are predominantly children, most under five years of age. A prospective study of 432 cases in one epidemic in 1991 found that risk factors for infection were being aged under five years and having unwashed hands and faces. Although not definitively demonstrated, it appears likely that flies act as vectors of the disease in these African and Australian outbreaks.

Epidemics of gonorrhoea in children’s hospitals and orphanages

What my review uncovered through successive hand-searching of the references of various papers was a large body of academic literature published between the 1880s and 1920s. I found case reports of over 40 epidemics of gonorrhoea in institutions throughout Europe and the United States involving thousands of children. While the original case may have been sexually transmitted, once a young girl with gonorrhoea was admitted into a children’s hospital or orphanage, this infection would spread rapidly through the inmates. Because no antibiotics were available for treatment, these infections had a huge impact and were the subject of intense international discussion.

The most common site of infection was vaginal in prepubertal girls, but children also developed infections in the eyes, rectum, and joints. In cases of serious infections some children died. In 1883 after an infected girl was admitted into a Budapest hospital, 25 girls developed vulvovaginitis and a nurse contracted conjunctivitis. The infection was thought to be transmitted via contaminated bedding, instruments and bandages. In one case in Posen (now in Poland), 236 little girls developed the infection from sharing a public bath. In 1896 after an infected child was admitted into a New York City orphanage, 65 girls developed vulvovaginitis with some progressing to peritonitis. In this case the disease was spread by common bathing of 20 to 30 children in a tub. A boy also developed an infected eye from a towel. A 1927 epidemic in a Philadelphia hospital involved 67 babies in same ward. The initial case was likely a vertical transmission from birth but the infection was probably spread by the use of a rectal thermometer leading to the babies developing vulvovaginitis, rectal infection and arthritis.

For most of these cases there can be no doubt that the infective organism was gonorrhoea. Neisseria gonorrhoeae is a gram-negative diplococcal (‘double rod’ shaped) bacterium. It was diagnosed microscopically by seeing the bacteria inside cells from gram-stained smears of secretions and also by culture of the bacteria on selective media wiped with infected swabs. There are many other species of Neisseria as well as N. gonorrhoeae (for example, N. lactimica, N. cinera, N. meningitides) which may be present normally in the mouths and throats of adults and children. However these do not cause infections such as vulvovaginitis. The combination of the vaginal symptoms plus identification by both gram stain and culture realistically means there is no other organism that could have been responsible for these outbreaks.

The only means of control of these epidemics was identification and prevention of the source of transmission. Strict isolation strategies were introduced. In some institutions girls underwent vaginal cultures and were refused admission if they were found positive with gonorrhoea. In other cases, infected children were kept isolated with separate rooms and separate nurses. Strategies documented in the literature to curb outbreaks include no sharing of clothes, wash cloths, towels or bathwater. Infected children were provided with individualised thermometers, nursing bottles and combs. Nappies were sterilised or made of light muslin and then destroyed. Strict attention to hand-washing in caregivers, especially nurses, was introduced and in one institution an epidemic was finally brought under control by nurses wearing rubber gloves to change nappies.

Household transmission

There are a number of cases reported in the literature of clusters of gonorrhoea infection (vulvovaginal, urethral and conjunctival) occurring in over-crowded living conditions where there are many family members in small crowded dwellings. In these circumstances there is often sharing of bedding, towels and under-clothes, and lack of available water for personal and laundry washing. Case reports come from all over the world from countries such as Nigeria, Malaysia and Alaska. There is a British report of an eight-month-old boy who presumably developed gonococcal conjunctivitis from the towel of 21-year-old infected female lodger, and two preschool children similarly contracted eye infections from towels used by infected parents.

In household cases often it will not be possible to determine whether transmission has been sexual or non-sexual. However in these circumstances, especially where there is no disclosure of sexual abuse by the children, nor any sign of trauma on examination, some cases are likely to have resulted from contamination rather than sexual abuse.

What happened to Lana

Lana was 13 months old when she was taken into foster care. Her mother was pregnant at this time. Two months later her parents separated for a month in an attempt for Lana to be returned to her mother, but the doctors involved were adamant that either her mother or her father had sexually abused her and therefore she was safe with neither. A month later the couple reunited. When Lana was aged 18 months her brother was born. CYF had been considering uplifting him at birth but they decided to allow the parents to keep their boy. Lana was cared for in a number of different foster homes.

By the time the case was heard by the Family Court, she was aged two years six months. I wrote a report on the possibility of both sexual and non-sexual transmission, and provided the doctor for CYF with photocopies of all the papers in my review. However she stated that

Mothers and fathers can abuse children and there has had to have been transmission from and to mucous membranes

Furthermore:

It does not help that Dr Goodyear-Smith is suggesting that accidental contamination is possible when there is no scientific evidence in the literature that has ever confirmed this possibility

She dismissed all literature prior to 1980 as unreliable, and considered that the institutional cases were either all cases of unrecognised sexual abuse, or alternatively were caused by an organism other than gonorrhoea. She said that the vagina was a different “immunological compartment” to the conjunctiva (hence you could have non-sexual transmission in the eyes but not the vagina), and persisted with the orthodox view that gonorrhoea in a child beyond the newborn age is sexually transmitted.

The judgement was reserved for another two months, and was released when Lana was aged two years eight months. The judge accepted the orthodox view, decided that it was more likely than not that Lana’s infection had been sexually transmitted, could not determine whether it was her mother or her father who had abused her, expressed concern at her parents’ steadfast and united denial of sexual abuse, considered that there was a grave risk that Lana was likely to be sexually harmed if she was returned home and therefore made a declaration that the little girl was in need of care and protection as a ward of the state.

An Australian case

I was involved in a similar case in Australia where a father, who had transmitted gonorrhoea to his young daughter, was similarly accused of sexual assault. He had been acquitted in the criminal court but the social services would not allow him to have any contact with his wife and daughter. They were fighting to be reunited as a family and the case finally reached the Appeal Court in March 2008. I attended a conference of expert witnesses in Australia, where myself, an Australian pathologist, two Australian sexual health physicians and an American paediatrician spent a day with an independent mediator to discuss the possibilities of non-sexual transmission. The three Australians and myself were in agreement that non-sexual transmission could occur, and in our opinion was the likely cause of the child’s infection in this case. The paediatrician was adamant that non-sexual transmission was not possible. The case was heard in the Appeal Court over the next few days and resulted in the judgement being in favour of the opinion of myself and my Australian colleagues.

International controversy

British Medical Journal

Having conducted this comprehensive systematic review, I considered it important for this information to be disseminated professionally in the peer-reviewed academic literature. I submitted my paper for consideration to the British Medical Journal (BMJ). Their review process took considerably longer than usual. I later learnt that this was because of debates by the journal editors on whether to consider it for review, and then difficulty finding someone to review it. Eventually it received one of the best reviews I have had. The reviewer wrote:

“The paper tries to redress some balance to this emotive area and uses evidence to show that each case of infection should be judged on individual merit … the paper is important and should be accepted for publication.”

Despite this review, the BMJ editors then rejected the paper because:

“We can find no evidence that the guidelines (or anyone really) would suggest that a mere finding of this sort would merit removal of a child from its family as suggested in the intro to this piece. All authorities in the UK would say that it is just one piece of evidence to be added to others.”

Journal of Forensic and Legal Medicine

I subsequently, in 2007, published my review in a peer-reviewed forensic medical journal, the Journal of Forensic and Legal Medicine, (JFLM). I also presented my review at the Faculty of Forensic and Legal Medicine, Royal College of Physicians Conference in Torquay, England in 2007 to a responsive audience. My paper solicited a long and scathing Letter to the Editor by Nancy Kellogg, author of the USA guidelines (Committee on Child Abuse and Neglect. Clinical Report: the evaluation of sexual abuse in children, published in the journal Paediatrics in 2005). Kellogg described my review as “One person’s speculative journey into her belief that non-sexual transmission is not rare” claiming “She provides neither evidence nor a systematic review.” She suggested that the numerous institutional cases were either all cases of sexual abuse or alternatively were due to an organism other than gonorrhoea. She wrote:

” It is totally baffling why case reports met the criteria for this ”systematic review,” yet randomized controlled trials, comparing, for example, the gonorrhea rates of children who were sexually abused to children who were not, were excluded.”

Kellogg’s letter was published with my rebuttal. I responded that hers was a strawman argument, because fortunately gonococcal infection in prepubertal children is a rare event, by whichever means it has been acquired. Mine is in fact a rigorous systematic review, meeting all the required criteria, and the reason why no randomised controlled trials were included were because none exist, and would of course be unethical to conduct.

NZLawyer

An article about my review was published in the NZ Lawyer 12 October, 2007). NZ members of DSAC (Doctors for Sexual Abuse Care) Drs Janet Say and Patrick Kelly wrote a Letter to the Editor the following month, claiming that mine was not a systematic review, that the outbreaks in institutions were caused by non-gonococcal organisms, that the outbreaks in institutions were caused by sexual abuse, that “The eye (anatomically, immunologically, and physiologically) is different from the genitalia” and that I had not conducted a forensic sexual abuse examination in 20 years.

Again I had right of reply and had the opportunity to explain how the review was systematically conducted, and why the papers reviewed involved cases where the diagnosis of gonorrhoea in institutions was not in doubt.

The physical signs of child sexual abuse

The Royal College of Paediatrics and Child Health (RCPCH) was conducting a major revision of their child sexual abuse guidelines, and colleagues of mine in the Faculty of Forensic and Legal Medicine, Royal College of Physicians, sent them my review to include in their chapter on sexually transmitted diseases. The physical signs of child sexual abuse: An evidence-based review and guidance for best practice was published in March 2008. Despite receiving my review, this book persisted with the message that gonorrhoea in children after the newborn period indicates sexual abuse. They wrote:

“sexual abuse is the most likely mode of transmission in pubertal and prepubertal children with gonorrhoea”

and:

“In a recent systematic review, Goodyear (2007) considered the evidence for non-sexual transmission of gonorrhoea in children after the neonatal period. This review did not have the rigorous criteria used in this evidence-based guidance concerning the certainty of diagnosis/exclusion of abuse and included conjunctival infections”.

At the book launch the leading authors of this chapter, Drs Karen Rogstad and Amanda Thomas, said that there was no evidence of children acquiring gonorrhoea from non-sexual means. The full audiotape of the proceedings was posted on the RCPCH website. When asked about my review Dr Rogstad said that it was a very dangerous paper developed by someone producing papers to support an incongruous belief and that it was a harmful editorial that had not been peer-reviewed.

My subsequent complaint to the RCPCH has resulted in their removal of the audio-taped recording of the book launch from their website, and an apology that my work was not “a non-peer reviewed editorial”, but has made no concessions regarding the possibility of non-sexual transmission in children. What I asked for but did not receive was a page insert into the book (in those volumes not yet sold) explaining the importance of considering both non-sexual and sexual transmission when gonorrhoea is found in children, looking at it case-by-case for possibility of both sexual contact and accidental contamination, with reference to my review plus Kellogg’s letter and my reply. I also requested that this statement be posted on the RCPCH website at www.rcpch.ac.uk/Research/CE/RCPCH-guidelines where the book is promoted.

Does it matter?

While Drs Kellogg, Rogstad, Thomas, Kelly and others have made disparaging remarks about me and erroneously criticised and discredited my work, I am well used to such attacks which in themselves have little impact on me. However, The physical signs of child sexual abuse is a guidance published by the RCPCH which purports to promote best practice based on an evidence review. This potentially is a highly influential publication in the English-speaking world.

It is my presumption that my review is considered as “dangerous” because it was perceived that it might assist guilty men be acquitted, and children returned into unsafe homes. My view is that in the absence of any supporting evidence or suspicion of sexual abuse, the presence of gonorrhoea alone may not be adequate evidence to convict beyond reasonable doubt, nor even to remove a child from its family on the balance of probability that the child has been sexually abused. While I do not want guilty men to go free nor children returned to abusive situations, nor do I want innocent men convicted and non-abused children losing their families.

This has very significant medicolegal ramifications. In most instances where children are diagnosed with N. gonorrhoeae there has been no disclosure of child sexual abuse. Clearly the possibility of abuse must be immediately and seriously entertained and investigated. However forensic physicians and paediatricians using The physical signs of child sexual abuse as their guideline will be unaware that non-sexual (indirect or fomite) transmission may be the mode of infection in some children, and that this possibility must also be considered on a case-by-case basis.

Furthermore, doctors including myself who put forward the possibility of non-sexual transmission in particular cases in the courtroom, are likely to be presented with statements from The physical signs of child sexual abuse which will be used to discredit or override my review. These guidelines may serve to misinform some of those involved in the care of children and young people.

Apart for the cases in which I have been involved, it is clear that in New Zealand at least, if gonorrhoea is found in a pre-pubertal child beyond the newborn age sexual abuse is presumed a “medical certainty”. In 11 years there were 14 cases seen at the Auckland children’s hospital (Kelly P. 2002: NZ Med J 2002;115(1163). All were taken to their GP with genital symptoms and abuse was not suspected until the gonorrhoea was detected, but all cases were deemed sexual abuse. The identity of the perpetrator was deduced ‘based on who was in contact with child during incubation period’. The outcome of these cases were convictions of suspected abusers, children taken into care and families fleeing the country. It is not possible to know if at least some of these cases were the result of accidental transmission, because this possibility was not considered. It is not known how many cases are occurring in the UK and elsewhere where children are found to be positive for gonorrhoea and sexual abuse is automatically assumed.

Clearly it is difficult to determine whether transmission has been sexual or non-sexual. In the past, cases of sexual abuse may have been missed. The current thinking is that gonorrhoea is definitive evidence of sexual abuse or contact, yet there is conclusive evidence that accidental contamination may occur on occasions. It is my recommendation that all such cases must be taken seriously and considered on case-by-case basis. Missing sexual abuse has serious social and legal consequences, but removing children from their parents on wrongful assumptions can be equally damaging. Doctors and lawyers should be cognisant of the large body of literature demonstrating both sexual and non-sexual means of transmission of gonorrhoea in children.

Defrauding the dying


Mexican cancer clinics continue to do a roaring trade, despite their poor track record.

When civil rights leader Martin Luther King was assassinated in 1968, the world lost a voice for decency and truth. The death of his widow earlier this year, however, was attended by greed and lies. The family of Coretta Scott King rushed her to Hospital Santa Monica at Rosarito Beach, Mexico, on 26 January. She died five days later. The underlying cause of her death was ovarian cancer. King’s death in one of alternative medicine’s dodgiest facilities highlights a relationship between quacks and Mexicans that is evil.

Hospital Santa Monica is located near crashing surf, 25 kilometres south of San Diego. The climate there may be the best in the world, consistently pleasant. Cruise ships call at beach resorts along the coast, unloading passengers who like the sunshine and the cheap peso. The region also has about 20 alternative medical clinics for desperate patients, almost all from the United States. Coretta Scott King was barely alive when she arrived in Mexico, but like the tourists, she had money. She was one of perhaps 10,000 paying US citizens who check into some Mexican clinic every year. Mexican locals and authorities welcome money from both the tourists and the sick.

Sadly, Hospital Santa Monica and the dozens of similar facilities sell patients only false hope. Kurt W Donsbach founded the Rosarito Beach facility. “The major patient clientele is comprised of cancer patients who have been told that there is no more hope, all traditional therapies having failed,” he boasts on his website. Donsbach claims to use “wholistic” techniques to treat the “whole” person; body, mind and spirit. He repeats the usual twaddle favoured by quacks: about how orthodox doctors treat only symptoms, not the disease; about detoxing the body and boosting the immune system; about avoiding standard treatments because they make cancer worse. Hospital Santa Monica offers “a very eclectic approach,” he says, including ultraviolet blood purification, mag-ray lamps, hydrogen peroxide solutions dripped into veins, ozone gas blown into the colon, a microwave hyperthermia machine (with a rectal probe), induced hypoglycemia by administering insulin, shark cartilage, a Rife frequency generator machine (remember Liam Williams-Holloway?), magnet therapy and other nonsense. Deluded groups such as the so-called Cancer Control Society, based in Pasadena, California, run trips to such Mexican clinics, taking thousands of cancer patients there for useless treatment.

Donsbach fails to reveal on his website that he has a criminal record but no medical degree. Born in 1933, he graduated in 1957 from a chiropractic college in Oregon. By the late 1960s he was running a health-food store in California, selling supplements that he said treated cancer. Throughout the 1970s and 1980s, he was repeatedly in legal trouble for practising medicine without a licence, selling unapproved drugs and related wrongs. In 1979 he founded a correspondence school – the nonaccredited Donsbach University – that awarded bogus degrees in nutrition, and he sold his own supplements. Officials in New York said the products were useless and sued him. Under pressure in the US, Donsbach started the Mexican clinic in 1983. In 1996 he pleaded guilty to charges of smuggling $250,000 worth of unapproved, adulterated or misbranded medicines from Mexico into the US. Sentenced to prison, he avoided serving time by plea bargaining. In other words, Kurt W Donsbach’s life has been devoted to a range of health-related scams.

The Mexican medical clinics are a blot on the page of human history, but they continue to exist because they attract money. Mexico is a very corrupt country, and bribes and fraud allow unconscionable activity to thrive there. Mexican officials claim they can investigate the facilities only if there are complaints, which are rare because the clinics usually treat non-Mexicans and do not advertise in Mexico. Sometimes clinics get shut down, but they re-open. A week after Coretta Scott King died, the Mexican government closed Hospital Santa Monica, saying it lacked authority to carry out some of its treatments and that several of its unconventional practices put patients at high risk. Patients from the US, Canada, Australia and Italy were at the facility when it was closed. Interviewed by the Los Angeles Times, Donsbach was shameless. He blamed the closure on the US medical establishment and predicted that his clinic would reopen soon: “The moment they close down a clinic, they open it up very quickly, the same place, same people.” Immoral quacks and their allies continue to fleece the dying.

Psychologists Not Suited to Court Work

Should we trust psychologists and psychiatrists, especially as expert witnesses in court cases?

This is an important question because, depending on their opinions, a person can inherit vast sums of money, lose custody of a child, be tried for murder or shut away for life in gaol or an asylum.

Two American psychologists, Jay Ziskin and David Faust, have looked at the performance of their own profession with a scientific eye and think they have good reason to question the accuracy of their colleagues’ opinions in courts. They point to several famous experiments.

In one study, several psychologists examined the same group of mental patients. The experts disagreed on the patients’ diagnoses, motivations or conflicts, and their conscious and unconscious feelings more often than they agreed on these things.

In other experiments, professional psychologists did no better than office secretaries in recognizing people with damaged brains, and few clinicians could distinguish between people with real brain damage and those only pretending. More studies showed that children feigning brain damage fooled most practitioners and professional psychologists did no better than high school students in predicting violent behaviour.

Several studies showed that psychiatric judgment did not improve with wide experience or special qualifications. Highly qualified old psychiatrists were no better than novices in spotting the presence, location or cause of brain damage.

Drs Faust and Ziskin think that many of these experts are ill fitted to work on criminal courts for two reasons. In their day-to-day work, psychologists and psychiatrists have an ingrained tendency to help and sympathise with their patients. But in the unfamiliar arena of the court they must do something quite different — uncover truth whatever the implications are for the accused, so their judgment is often clouded.

Another reason for their failure is because their disciplines are not yet true sciences. Human thought and behaviour still resist objective, direct, reliable observation and measurement, so clinicians can make few accurate predictions. In the place of science, psychology has only loosely bound conjectures — dozens of fash-ionable personality theories and hundreds of ever-changing approaches to psychotherapy. New theory may not be better, only a fresh attempt to resolve a recalcitrant problem.

Check this out in Jay Ziskin and David Faust’s three-volume Coping with Psychiatric and Psychological Testimony. Fifth Edition 1997. Nothing here about New Zealand psychologists and psychiatrists who are, of course, a cut or two above their American counterparts.

Originally published in the Dominion Post, January 26, 2003. A book of Bob Brockie’s collected columns is being released August 2003.

Legal Evidence

Skepticism is very much concerned with assessing the quality of evidence in support of a particular claim. But evidence means different things to different people. In the first of a two-part series, Jim Ring examines the legal profession’s view of the matter.

Our knowledge of the world is never certain, so what should count as evidence that a claim is true? For many people trained in science the legal system contains some very strange anomalies. Material can be accepted as evidence in court even though it would be given no weight at all in a scientific context.

People are sometimes imprisoned because juries are prepared to accept the unsupported word of witnesses. David Dougherty was in jail three years for raping a young neighbour. She said he had done so. No other evidence pointed to a conviction; tests on DNA were inconclusive. Later, better tests indicated that the girl had had sex with a man other than Dougherty.

Peter Ellis (the Christchurch crèche case) was jailed because some small children told the court he had done dreadful things. The same children told questioners that some women had done dreadful things, but they were not believed. They also told stories about Ellis that could not possibly be true and these were edited out of the story put to the jury.

In science experiments a control is a most important feature. Unfortunately controls are generally ruled inadmissible by judges. In the Ellis case there was an excellent control for the children’s credibility. How reliable were the children’s stories about the women, and how reliable were their stories about Satanism and black magic?

Eyewitness accounts are given great weight in our justice system; yet in the US it has been estimated that mistaken eyewitness evidence is responsible for about 80 per cent of the wrongful convictions that occur. The trial of Scott Watson (Marlborough Sounds New Year murders) was unusual in that eyewitness evidence was treated in a different manner. The prosecution held that part of the evidence of one of their own witnesses was in error. He had a distinct memory of a two-masted yacht; the prosecution argued that he must have seen one with a single mast. In future will eyewitness evidence be treated as less conclusive?

In New Zealand a cell-mate can claim to have received a confession of guilt from a person awaiting trial. That such an anecdote can be accepted as evidence in court would be beyond belief – except it happens!

It was reported last year in the UK that a judge instructed a jury not to bother about statistics and just to use their common sense (let us hope this report was inaccurate). But common sense is not a reliable guide in complex matters. Science and statistics often produce results that are quite counter-intuitive.

A conviction is only supposed to take place when evidence is beyond all reasonable doubt. In New Zealand people are sometimes convicted in spite of reasonable doubt.

Justice Lives

The Geller case has ended — the “psychic” is to begin a court-ordered payment of up to $120,000 to CSICOP USA.

Skeptics will be pleased to know that Uri Geller has paid the Committee for the Scientific Investigation of Claims of the Paranormal the first $40,000 of up to $120,000 as part of a settlement agreement for what the court described as a “frivolous complaint” made by Geller against CSICOP. The case began when Geller filed a $115 million suit against CSICOP and magician James Randi alleging defamation, invasion of privacy and tortious interference with prospective advantage. He filed suit because Randi has stated in an interview with the International Herald Tribune that Geller had “tricked even reputable scientists” with tricks that “are the kind that used to be on the back of cereal boxes when I was a kid. Apparently scientists don’t eat cornflakes anymore.”

CSICOP maintained that the suit was essentially a “gagging writ” designed to harass the organisation into inactivity. The court first ruled in favour of CSICOP in July 27 1993 but since then Geller has tried to overturn the decision by a series of court actions and appeals. He has now done his dash — evidently he was unable to foresee the outcome even though the decisions were not in sealed envelopes inside other sealed envelopes and concealed in remote places.

Paul Kurtz, CSICOP chairman said: “When the principles upon which CSICOP was founded are at stake, we are prepared to do battle all the way if it should prove necessary. We believe deeply in a free press, freedom of speech, and scientific enquiry, and the importance of dissent.” He characterised the Geller suit as the “kind of suit being used as a means of silencing debate on significant scientific issues.”

All in all it looks like a fair cop for CSICOP.

From a report in the Skeptical Enquirer, May/June 1995.

CSICOP Conference Proceedings

Thanks to a member who was present, we now have a set of audiotapes which record the complete proceedings of the 1994 CSICOP Conference in Seattle, on The Psychology of Belief

Topics discussed include: Alien Abductions, Anomalies of Perception, Memory, CSICOP and the Law, Beliefs in the Courtroom, Conspiracy Theories.

Speakers include Paul Kurtz, Philip Klass, Susan Blackmore, John Maddox, Carl Sagan, Elizabeth Loftus and other illustrious Skeptics.

Members are invited to obtain a detailed list from the Secretary (Bernard Howard, 150 Dyers Pass Road, Christchurch), who is prepared to negotiate loans of individual tapes.

A Small Step Towards Common Sense

In a landmark case on September 30, a 59-year-old man, Bill1, was acquitted by a jury in the Auckland High Court on charges of sexually abusing three of his daughters about 20 years ago. The complainants alleged sodomy and rape, and indecent acts such as the insertion of a coat hanger in the vagina causing bleeding and loss of consciousness. The women claimed they had suppressed the memories which had only resurfaced in later life. All three daughters had attended therapy and made claims for damages from the ACC before they laid the criminal charges against their father. Two of the daughters reported memories of events happening in their cots when aged one year old or less. Bill was defended by Mr Peter Williams, QC, who dismissed evidence based on “recovered memories” as dangerous and fallacious.

The mother of the girls, Bill’s former de facto wife, gave evidence (for the Crown) that she had never noticed any indication of such abuse taking place. She had never seen any signs on her girls of the violent trauma they now claimed to have suffered, nor had she ever encountered blood on their sheets and clothing.

Clinical psychologist Eileen Swan, expert witness for the Crown, supported the phenomenon of “memory retrieval”. She told the jury that it was possible for people to block out memories of unpleasant events as a psychological mechanism if they were “too hard to deal with”. These memories could return piecemeal at a later date. Ms Swan claimed that there is a “paucity of knowledge on memory” but admitted that her life is so busy she has trouble keeping up with her education on the subject.

Dr Frank Rawlinson, a psychiatrist called for the defence, has read widely and deeply on the topic. He recently visited the US and consulted with some of the leading professionals in memory research, and returned with a large number of current books and articles, including Elizabeth Loftus and Katherine Ketcham’s The Myth of Repressed Memory: false memories and allegations of sexual abuse2.

Witch Hunting

Dr Rawlinson compared the use of recovered memory in sexual abuse cases to the 16th- and 17th-century witch-hunts in Europe. He said that whilst recovered memory theory (or any other theory) could never be disproved, there was no scientific evidence to date to substantiate such a belief. He explained that, on the other hand, it is very easy to create false memories. He disputed Ms Swan’s claim that people repress memories of traumatic events as a psychological mechanism. He explained that adults have no memories of childhood under the age of three, and the alleged memories by two of the daughters at the age of one or younger were not possible.

In his summing up, Justice Sir Ian Barker told the jury they had to decide whether there was indeed repressed memory of sexual abuse which had been retrieved, and whether that memory was reliable. The jury concluded that these were not accurate memories of real events.

Bill was found to be innocent. It cost him $117,000 to defend himself. His three daughters were found to have made false allegations. Each had received at least $10,000 “compensation” from ACC, which is not affected by the outcome of the trial.

This case brings up many issues. There are currently men in prison convicted solely on the basis of “recovered memories” (reconstructed visualisations) of incidents alleged to have occurred two or three decades ago. If Bill had not been able to afford the best in legal representation and psychiatric expertise, it is very likely he would have joined them. Possible future actions for those falsely accused through “memory retrieval” include applying for court costs from the Crown, and legal action against therapists who have implanted or supported the false memories. The anomaly of compensating those who make false accusations might also be addressed.

Already there has been a trend for people who recover memories in therapy to later change their testimony and declare that in fact they had always remembered the trauma. One of Bill’s daughters did just this. Although her counsellor had “shredded the counselling notes” and hence had no records from which to refer, she testified that her client had always remembered her abuse. However, examination of the daughter’s initial police statement revealed that she had told the police that she had only discovered the abuse in the course of her therapy. Victims/survivors subsequently remembering that they had always remembered the abuse is not a course of action likely to occur in the US. This is because their Statute of Limitations allows law suits relating to alleged long ago events on the basis that the Statute starts from the time the “memory” was exhumed.

This is the first case in New Zealand where a jury has decided that “recovered memories” are not reliable evidence. Although a great step forward, there is still a long way to go. Many professionals believe that memories can be repressed and accurately retrieved, despite there being no scientific evidence to support this. A stream of US “experts” continue to teach that recovered memories are valid, and there is a reluctance within the sexual abuse industry to examine any evidence which challenges their beliefs. Critics who claim that some sexual allegations might be false are labelled as part of the “backlash” and accused of being “in denial” about sexual abuse.

1) Not his real name [back]

2) St Martin’s Press, New York, 1994, highly recommended [back]

Oh, What a Lovely World!

Late in his life, in answer to a question, Freud compared the human condition approximately to the contents of a baby’s nappy. When I first heard this story, it seemed to mark a bitter old man. That was when I was in high school in the late 1950s. Higher education was spreading in the world’s democracies. Ignorance and superstition, the plague of the human species since the caves, were on the way out. Reason, knowledge and tolerance would rule the future of the world. Or so it seemed. Does it look like that today, even to high school students? A few news items:

  • A British insurance salesman is convicted of double murder on the testimony from one of his victims, who was contacted during deliberations by three jurors using a Ouija board. Because British law normally does not allow even appeal courts to question jury deliberations, the conviction may stand.
  • Australian medical schools are being filled by significant intakes of Darwin-doubting fundamentalists, possibly 20%-25% of students. These wholesome young people will in the course of time advance, attaining places on the policy boards of hospitals, using their authority to determine health policies.
  • In South Africa a woman was forced by a mob to douse her mother in petrol and set her alight, before she and the rest of her family were killed. Her crime: being a witch. There is a steep increase in killing of witches in South Africa.
  • The Oz Skeptics have awarded their annual Bent Spoon to the Australian Attorney General, who has made it possible for workers in his department to take sick leave with a note from an iridologist, naturopath, homeopath or other alternative practitioner.
  • Freud’s doctrine of repression is itself responsible for the smell of nappy-contents that surrounds “recovered memory” therapy, probably the most vicious pseudoscientific fad ever to be adopted by the counselling industry. The fashion to blame all of life’s disappointments on “repressed” episodes of incest has caused more human suffering than any single issue to confront the New Zealand Skeptics.
  • Not that the therapists want to stop beating the drum of victimhood. When the BBC went across the Channel to give its extensive coverage to the D-Day commemorations, it made free counselling available to all its employees who might be upset by the experience. I’m not making this up. It’s more than the survivors of Omaha Beach got, but we’re so much more sensitive these days!

The meliorism of the 1950s has evaporated. Why? Some talk of abandonment of moral standards, others the rise of the nuclear threat — or the decline of the nuclear family, while others will blame it on the fall of religion — or of communism. My candidate is the degradation of education in its broadest sense — the failure of the modern democracies to give sufficient knowledge and critical, analytical abilities to young people at all levels. The dumbing down of public education, with its mantras in praise of self-esteem rather than hard-won knowledge is bad enough. But even school is being replaced by television, with all its shallowness and sentimentality, as the major enculturating force. Ignorance, prejudice, and superstitions thrive in ways that would have amazed me thirty years ago.

The next time someone tells you how much better the world is becoming with instant global communications, innovative educational methodologies, and your therapy needs covered by ACC — think skeptically!