Hokum Locum

Selenium – Too Much of a Good Thing?

New Zealand soils are deficient in selenium and this can cause serious health problems for animals. A 500kg animal needs about 1mg selenium daily. There is no evidence that New Zealand adults need selenium supplements and this situation has been described as “a deficiency in search of a syndrome”.

A 52-year-old dairy farmer presented to her doctor with chronic aches and pains, lethargy, sore throat and painful swallowing. After some weeks of fruitless investigations she admitted to taking 0.5ml daily of a solution containing 5mg/ml of selenium, several times the recommended daily human dose. All of her symptoms disappeared once she stopped taking the supplement.

Despite the lack of proof for any deficiency syndrome in adults, local pharmacy leaflets stated “selenium is an essential trace element” and that “low levels of selenium are linked to a higher risk for cancer, cardiovascular disease, inflammatory diseases and other conditions associated with free radical damage, including premature ageing and cataract formation.”

It is quite clear that it would have been much safer for this woman to have taken a homeopathic selenium remedy and there would have been no risk at all of any toxicity from over dosage.
NZ Family Physician Vol 30 Number 6, Dec 2003

Animal Homeopathy

I know that homeopathy has been done to death but it crops up everywhere, even in the treatment of animals. People defend this delusion by claiming that the placebo effect does not work in animals, therefore any observed effect must be real. Any observed effect is clearly due to expectation on the part of the person administering the water, sorry, I mean the homeopathic remedy. An article in the Christchurch Press (March 12, 2004) described how Taranaki’s first qualified animal homeopath has gained an “advanced diploma of homeopathy”. She also has a BSc and it beggars belief that someone with that background can take up a pseudoscience such as homeopathy. This is what HL Mencken was referring to when he said: “How is it possible for a human brain to be divided into two insulated halves, one functioning normally, naturally, and even brilliantly, and the other capable of ghastly balderdash?”

I find it amusing reading such accounts because the clue to the belief system is usually contained in the article but is unrecognised. In this case the animals are described as “glowing with health in a way that suggests good feeding and love but their appearance is so striking it indicates there is another ingredient as well”. You guessed it — the other ingredient is homeopathy! It’s obvious that the animals’ condition is due to the “good feeding and love” and to claim otherwise is a delusion.

It would not in the least surprise me if the diploma of advanced homeopathy is NZQA approved.

Snake Oil Flunks for Snake Bite

Boonreung Bauchan was known in Thailand as the “Snake Man” and held a Guinness world record for spending seven days in a snake enclosure. The Mamba family of snakes are extremely venomous and when one of them bit him on the elbow he relied on a traditional herbal remedy and a shot of whisky. As we all know, herbal remedies are mostly placebos and should not be used for serious or life-threatening conditions and Boonreung is sadly no longer with us. Had he taken a proper antidote, his chances of survival would have been excellent.
Christchurch Press March 23, 2004

Counsellors

If you get up in the morning and find your letterbox has been vandalised, don’t worry, counselling is available to help with your distress and grief. (Dominion Post March 6, 2004).

Following September 11, an estimated 9000 grief counsellors turned up in New York and one hotel was booked out by a single group of 350 counsellors. This absurd behaviour is of course defended by the counselling “industry” despite the existence of research that shows that many of such interventions are actually harmful. Counsellors defend their behaviour by claiming that it cannot be scientifically tested. For example: “People working from the scientific model want to measure outcomes. A lot of people would say, ‘I feel better’, but that doesn’t fit a scientific model.”

Such claims should be treated with complete contempt. This sort of reasoning could be used to justify the implementation of all sorts of quackery because it makes people “feel better”.

To put it bluntly, counselling is a placebo therapy. Third-party funding ensures that an industry has been able to develop. This has disempowered people from learning to deal with personal trauma by simply talking to a friend or other family members.

Hair Analysis

Last year I spent some time working in Westport and noticed an advertisement for hair analysis. Hair analysis does have a scientific basis but it has been taken over by quacks who offer all sorts of ridiculous assessments. When I got home I wrote to the address and sent hair from my wife Claire and my oldest daughter Eve, under their own names, and some hair from “Russell”. “Russell” was actually my daughter’s dog, a wheaten terrier.

For $40 I received a detailed four-page handwritten report and after reading it I felt quite mean because the writer’s sincerity was obvious. I have sent a copy of the letter to the Editor but will summarise the main findings. I see no value in exposing the writer because the letter was written in good faith but note that sincerity and good faith can go hand in hand with gullibility and foolishness. His findings were as follows:

Claire needs natural estrogen — “raspberry leaf” two tabs daily. Wormwood — 5 drops in water daily. Bach flower remedies — “Mimulus, Rock Rose”. Conscious deep breathing — practise six times daily. There was also a recommendation to have “faith” and consider the Bahai religion for that reason.

Eve had a systemic yeast infection. Recommended treatment: nystatin, aloe vera juice, Blackmores chewable tablets, wheatgerm capsules, super strength kelp, rescue remedy (Homeopathic), extra progesterone in the form of “wild yam cream”.

Russell also had a systemic yeast infection, and iodine deficiency. Recommended treatment: nystatin (oral antifungal agent), self heal tincture — 50 drops twice daily, herbal B vitamins — six tabs daily, super strength kelp — three tabs daily. Repeat hair analysis in three months.

It is easy to see that such a “scatter gun” approach to treatment would be bound to work in a well-motivated believer. I did not inquire as to the method of hair analysis but this is unimportant because any diagnostic method will work provided it is plausible and the treatment offered is congruent with the particular belief system. The homeopathic vet would no doubt approve of Russell’s diagnosis and treatment.

Shockwaves for chronic heel pain

High energy sound waves are now being used to treat various conditions such as tennis elbow and other painful areas such as the heel, knee and shoulder. It is claimed that 60-70 per cent of patients will gain relief from the treatment.

The same technology (extra-corporeal shockwave therapy or ESWT) is used to disintegrate kidney stones.

In the case of kidney stones there is no need for a randomised controlled trial (RCT) because it is obvious when a large stone has been broken down into smaller pieces.

When treating various painful conditions with no such “marker”, one has to be much more cautious and this therapy is crying out for a randomised controlled trial with a placebo group who would receive treatment administered when neither the patient nor the technician were aware that the machine was actually switched off. I predict that when such trials are carried out, there will be no advantage over placebo.
NZ GP November 12, 2003

Dummies Guide a Bit of a Parson’’s Egg

ALTERNATIVE MEDICINE FOR DUMMIES, by James Dillard and Terra Diane Ziporyn. Hungry Minds, Inc.

These books are all subtitled “A Reference for the Rest of Us!”. Perhaps I’m prejudiced but as far as I’m concerned, dummies is a better term for anyone who uses alternative medicine. Having said that, this book, written by a chiropractor and a science writer with a PhD in the history of medicine and science, is not as bad as I thought it was going to be.

I couldn’t be bothered grinding my way through the lot, but I did read the introduction, the chapter on chiropractic (because of the author) and those on homoeopathy and naturopathy. I then skimmed through various other chapters on Chinese and Indian traditional medicines, acupuncture, osteopathy, and aromatherapy. I guess the main problem with this book is that as part of a series, the objective is to sell books rather than to inform. In an effort to avoid offending anyone, including so-called conventional medical practitioners, it has a bob each way on just about everything.

The introduction is probably the worst example of this. Controlled, randomised, double-blind clinical trials are described as the “gold standard” of evidence. It makes the point that often alternative studies rely on anecdotal evidence or other less than perfect techniques. This is repeated in all the chapters that I studied, with the caution that if you have a serious physical illness, you should see an MD. Good sensible advice, which is then undercut in almost every chapter by saying that if you haven’t got a serious physical illness by all means go with what feels good, and that double-blind trials are not the be-all and end-all of medical evidence. Of course they’re not, necessarily, but in the section on acupuncture for instance; little evidence is offered other than the idea that “2500 years of History Can’t Be All Wrong”.

The section on chiropractic is the most interesting because one of the authors is both an MD and a chiropractor. It completely avoids the wild claims made in the past, explaining that it is only good for back pain and related problems, and then only for non-chronic types.

It goes on to explain that most back pain goes away no matter what you do, and that chiropractic is good for back pain largely because patients get “satisfaction” from it. (This satisfaction seems to be a major reason for indulging in almost any alternative therapy according to these authors, and in my mind shows one of the problems with conventional medicine, that perhaps not enough attention is paid to the emotional state of the patient.) Almost every treatment has a small section on possible complications, and in this case these are glossed over in that the problems associated with rapid neck twisting are not mentioned at all.

The authors are a little harder on most other types of treatment, for instance homoeopathy is called a science — in inverted commas. The points are made that it may delay or prevent treatment for serious illness, and that you are in fact taking nothing. To avoid offending the homeopaths too much, however, a couple of meta-analyses from the Lancet and British Medical Journal are thrown in which allegedly show effects more powerful than a placebo.

Naturopathy fares equally badly. To be fair though, the lifestyle changes promoted by naturopaths are represented as safe and good for you, and of course a healthy diet and regular exercise probably are.

One thing I do like about this book is that it invariably recommends seeing a conventional physician first to rule out a serious condition before you see an alternative medical practitioner. Alternative medicine in these cases is used as complementary therapy, and just involves extra expense.

Readers are also told to make sure they tell their physicians and their complementary therapists just what treatment they are receiving from each to avoid complications. Again sensible advice, but one wonders if it is done out of the sense of conviction or just to avoid litigation from the American market if someone reads the book, takes the advice, and has something horrible happen to them afterwards.

I must admit to being in two minds about this sort of book. On the one hand this is a series with some clout, I myself have used some of their sister publications, particularly those on computing, and I feel that this association gives it an authority it possibly doesn’t deserve. On the other hand it’s nice to see the book written by people who obviously support alternative treatments being relatively objective about them, and if I knew any dummies who were determined to seek out alternative therapies I would prefer them to read this book rather than any other.

Peppering the Painted Apple Moth

The Painted Apple Moth spraying programme in the western suburbs of Auckland has generated considerable controversy. An alternative programme was evaluated at last year’s Skeptics

The Painted apple moth was first recorded in the Auckland suburb of Glendene on 5 May 1999. Subsequently, it was reported from the Auckland suburb of Mt Wellington. Since this moth species has the potential to seriously impact on New Zealand’s forestry, conservation and horticulture, an eradication attempt was launched.

Following on from a meeting in November, on 14 December 2001, the Ministry of Agriculture and Forestry received a formal “Peppering Trial Proposal against the Painted Apple Moth”.

The submission was made by the Painted Apple Moth Community Coalition (CC-PAM), supported by the Community Advisory Group, an advisory group originally convened by Maf. It was prepared by Hana Blackmore (a Green candidate in the Tamaki electorate) with the assistance of Glen Atkinson of Garuda Biodynamics, Glenys Bean, John Clearwater and Meriel Watts (a Green candidate in the Waitakere electorate).

To quote from the proposal:

“Peppering is a biodynamic method of pest control, which aims to inhibit the reproductive potential of the pest being targeted…

The theory holds that the specific preparation methods produce the negative “energy” of the pest’s reproductive force, operating on a vibrational level, not a material one. Used in the field it enters the soil and surrounding vegetation producing an “unfriendly” and inhibiting environment. It is host specific and non-toxic, and does not have a lethal effect. The method has been used commercially in New Zealand for a number of years with verifiable success.”

The proposal consisted of two trials:

Field Broadcast Trial

Proposal – that Garuda install a Field Broadcast pipe containing the biodynamic preparation of the painted apple moth on the infested Traherne Island.

“The trial will aim to produce a statistically significant reduction in the painted apple moth population on the island. [R]ecent innovative developments by Garuda allow the establishment or enhancement of the reproductive inhibiting ‘pattern’ via Field Broadcast pipes. These are simple PVC pipes with internal copper circuits that can ‘radiate’ the biodynamic preparation that is placed within it.”

Peppering Ground Spray Trial

Proposal – that Garuda conduct a peppering ground spray of the biodynamic preparation of the painted apple moth on one hectare of public land in the heavily infested zone, and that a similar control area is sprayed with water.

“The trial will aim to produce a statistically significant drop in the moth catches in the actively sprayed zone, compared to both the control site and the areas surrounding the active site.”

The Technical Advisory Group (TAG), which assessed the proposal, comprised 21 members (16 scientists, 3 operations experts, 2 local council representatives) and six observers, including a representative from the Community Advisory Group. The group was devised to provide advice and make recommendations relating to the campaign against painted apple moth, including containment, control and eradication options.

One TAG member noted the following with regard to the efficacy of peppering:

“Peppering has been used commercially, as indicated in the proposal, but the “verifiable success” must be questioned. The testimonials from growers are data-free, and relate to insects with a naturally patchy distribution over both time and space. There is no numerical data to support the efficacy of peppering.”

Concern was also expressed regarding changes to the predicted outcome of the trial. The original proposal said that the peppering would affect adult dispersal, so that they were dissuaded from entering, or encouraged to leave, the treated zone; and that it would render the F1 generation sterile. As the aim was to eradicate painted apple moth, causing adults to disperse elsewhere was not considered helpful.

The usual claims about peppering relate to deterrent action, but claims of reproductive inhibition have become more common. Ultimately (and one could suggest, as a result of discussions at the meeting), the final proposal only referred to the sterilising effect of peppering – yet no measurement of this supposed effect was incorporated in the proposal.

The claims of repellent or reproductive inhibition made by the biodynamic proponents could have led to them requiring approval under the HSNO (Hazardous Substances and New Organisms) Act or the ACVM (Agricultural Compounds and Veterinary Medicines) Act. However, such registration may have been waived due to the perception of low risk or low residue involved. Ironically, such a registration could have served to legitimise the claims made for this approach.

Further critique of the proposal concerned a number of other flaws in its approach:

“The proposal(s) focus entirely on comparing numbers of males in traps in the peppered areas with those in non-peppered areas. There is no proposal to measure any infertility, nor to target any other insect. Thus, the proposal does not address the key issues discussed and agreed to at the November 14 meeting.

“Furthermore, it is proposed to run the trial over the entire period of Foray (Btk) spraying, so any results will be compromised by a known effective treatment.

“[T]he proposal as written is technically flawed, and is not capable of demonstrating any effect of peppering on painted apple moth.”

At its 15 January 2002 meeting, the Technical Advisory Group recommended that a peppering trial be undertaken on another species where there was no eradication programme in place. On the basis of this recommendation, MAF declined to supply the proponents of the peppering trial with moths.

On reflection, I have not ceased to be amazed at how officialdom has become so PC that at a critical time in an eradication campaign, much time and money can be wasted on unproven and questionable proposals.

While peppering as a pest control method now has a profile that deserves quantitative scrutiny, an eradication campaign is not the appropriate platform on which to evaluate this biodynamic approach – certainly not without compromising our biosecurity.

Behind the Screen

Mass screening programmes have generated considerable controversy in this country. But these programmes have inherent limitations, which need to be better understood

In 1996 the Skeptical Inquirer published an article by John Allen Paulos on health statistics. Among other things this dealt with screening programmes. Evaluating these requires some knowledge of conditional probabilities, which are notoriously difficult for humans to understand.

Paulos presented his statistics in the form of a table; a modified version of this is shown in the table below.

Have the
condition		 Do not have
the condition		 Totals
Test Positive 990 9,990 10,980
Test Negative 10 989,010 989,020
Totals 1,000 999,000 1,000,000
Table 1

Of the million people screened, one thousand (0.1%) will have the condition. Of these 1% will falsely test negative (10) and 99% will correctly exhibit the condition. So far it looks good, but 1% of those who do not have the condition also test positive, so that the total number who test positive is 10980. Remember that this is a very accurate test. So what are the odds that a random person who is told by their doctor that s/he has tested positive, actually has the condition? The answer is 990/10980 or 9%.

In this hypothetical case the test is 99% accurate, a much higher accuracy rate than any practical test available for mass screening. Yet over 90% of those who test positive have been diagnosed incorrectly.

In the real world (where tests must be cheap and easy to run) a very good test might achieve 10% false negatives and positives. To some extent the total percentage of false results is fixed, but screening programmes wish to reduce the number of false negatives to the absolute minimum; in some countries they could be sued for failing to detect the condition. This can only be done by increasing the chance of false positives or inventing a better test. Any practical test is likely to have its results swamped with false positives.

Consider a more practical example where the base rate is the same as previously, but there are 10% false negatives and positives, ie the test is 90% accurate. Again 1 million people are tested (see Table 2 below).

Have the
condition		 Do not have
the condition		 Totals
Test Positive 900 99,000 100,800
Test Negative 100 889,100 899,200
Totals 1,000 999,000 1,000,000
Table 2. Base rate is 0.1%. Level of false positives=10%; level of false negatives=10%

This time the total number testing positive is 100800. But nearly one hundred thousand of them do not have the condition. The odds that any person who tested positive actually has the condition is 900/100800, or a little under 1%. This time, although 90% of these people have been correctly diagnosed, 99% of those who test positive have been diagnosed incorrectly.

In both these cases the incidence of the condition in the original population was 0.1%. In the first example the screened population testing positive had an incidence two orders of magnitude higher than the original population, but this was unrealistic. In the second example those testing positive in the screened population had an incidence one order of magnitude higher than the general population.

This is what a good mass screening test can do – to raise the incidence of the condition by one order of magnitude above the general population. However any person who tests positive is unlikely to have the condition and all who test positive must now be further investigated with a better test.

So screening programmes should not be aimed at the general population, unless the condition has a very high incidence. Targeted screening does not often improve the accuracy of the tests, but it aims at a sub-population with a higher incidence of the condition. For example, screening for breast cancer (a relatively common condition anyway) is aimed at a particular age group.

Humans find it very difficult to assess screening, and doctors (unless specifically trained) are little better than the rest of the population. It has been shown fairly convincingly that data are most readily understood when presented in tables as above. For example the data in Table 3 was presented to doctors in the UK. Suppose they had a patient who screened positive; what was the probability that that person actually had the condition?

When presented with the raw data, 95% of them gave an answer that was an order of magnitude too large. When shown the table (modified here for consistency with previous examples) about half correctly assessed the probability of a positive test indicating the presence of the disease.

Have the
condition		 Do not have
the condition		 Totals
Test Positive 8,00 99,000 107,000
Test Negative 2,000 891,000 893,000
Totals 10,000 990,000 1,000,000
Table 3. Base rate is 1%. False negative rate=20%; False positive rate=10%

This time the total number who test positive is 107 000. But nearly one hundred thousand of them do not have the condition. The odds that any person who tested positive actually has the condition are 8000/107 000 or about 7.5%. Now remember that nearly half the UK doctors, even when shown this table could not deduce the correct result. If your doctor suggests you should have a screening test, how good is this advice?

Patients are supposed to be supplied with information so that they can make an informed decision. Anybody who presents for a screening test in NZ may find it impossible to do this. My wife attempted to get the data on breast screening from our local group. She had to explain the meaning of “false negative”, “false positive” and “base rate”. The last is a particularly slippery concept. From UK figures the chances of a 40-year-old woman developing breast cancer by the age of 60 is nearly 4% (this is the commonest form of cancer in women). However, when a sample of women in the 40-60 age group are screened, the number who should test positive is only about 0.2%. Only when they are screened each year, will the total of correct positives approach 4%.

The number of false positives (again using overseas figures) is about 20 times the number of correct positives so a women in a screening programme for 20 years will have a very good chance of at least one positive result, but a fairly low probability of actually having breast cancer. I do not think NZ women are well prepared for this.

The Nelson group eventually claimed that the statistics my wife wanted on NZ breast cancer screening did not seem to be available. But, they added, “we (the local lab) have never had a false negative.” From the recent experience of a close friend, who developed a malignancy a few months after a screening test, we know this to be untrue. What they meant was that they had never seen a target and failed to diagnose it correctly as a possible malignancy requiring biopsy. This may have been true but it is no way to collect statistics.

Screening for breast cancer is generally aimed at the older age group. In the US a frequently quoted figure is that a woman now has a one in eight chance of developing breast cancer, which is higher than in the past. This figure is correct but it is a lifetime incidence risk; the reason it has risen is that on average women are living longer. The (breast cancer) mortality risk for women in the US is one in 28. A large number who develop the condition do so very late in life and die of some other condition before the breast cancer proves fatal.

Common Condition

Breast cancer is a relatively common condition and would appear well suited for a screening programme. The evaluation of early programmes seemed to show they offered considerable benefit in reducing the risk of death. However later programmes showed less benefit. In fact as techniques improved, screening apparently became less effective. This caused some alarm and a study published in 1999 by the Nordic Cochrane Centre in Copenhagen looked at programmes world wide, and attempted to better match screened populations with control groups. The authors claimed that women in screening programmes had no better chance of survival than unscreened populations. The reactions of those running screening programmes (including those in NZ) were to ignore this finding and advise their clients to do the same.

If there are doubts as to the efficacy of screening for breast cancer, there must be greater doubts about screening for other cancers in women, for other cancers are rarer. Any other screening programme should be very closely targeted. Unfortunately the risk factors for a disease may make targeting difficult. In New Zealand we have seen cases where people outside the target group have asked to be admitted into the screening programme, so they also “can enjoy the benefits”. Better education is needed.

Late-onset diabetes is more common among Polynesians than among New Zealanders in general, and Polynesians have very sensibly accepted that this is true. Testing Polynesians over a certain age for diabetes makes sense, particularly as a test is quick, cheap and easy to apply. Testing only those over a certain body mass would be even more sensible but may get into problems of political correctness.

Cervical cancer is quite rare so it is a poor candidate for a mass screening programme aimed at a large percentage of the female population. The initial screening is fast and cheap. If the targeted group has an incidence that is one order of magnitude higher than the general population, then the targeting is as good as most tests. Screening the whole female population for cervical cancer is a very dubious use of resources.

My wife and I were the only non-locals travelling on a bus in Fiji when we heard a radio interview urging “all women” to have cervical screening done regularly. The remarkably detailed description of the test caused incredible embarrassment to the Fijian and Indian passengers; we had the greatest difficulty in concealing our amusement at the reaction. The process was subsidised by an overseas charity. In Fiji, where personal hygiene standards are very high, and (outside Suva) promiscuity rates pretty low, and where most people pay for nearly all health procedures, this seemed an incredibly poor use of international aid.

Assessment Impossible

Screening for cervical cancer has been in place in NZ for some time. Unfortunately we cannot assess the efficacy of the programme because proper records are not available. An attempt at an assessment was defeated by a provision of the Privacy Act. The recent case of a Gisborne lab was really a complaint that there were too many false negatives coming from a particular source. However this was complicated by a general assumption among the public and media that it is possible to eliminate false negatives. It should be realised that reducing false negatives can only be achieved by increasing the percentage of false positives. As can be seen from the data above, it is false positives that bedevil screening programmes.

Efforts to sue labs for false negatives are likely to doom any screening programme. To some extent this has happened in the US with many labs refusing to conduct breast xray examinations, as the legal risks from the inevitable false negatives are horrendous.

Large sums are being spent in NZ on screening programmes; taxation provides the funds. Those running the programmes are convinced of their benefits, but it is legitimate to ask questions. Is this spending justified?

Some Post-Scripts:

January 15 2000 New Scientist P3: Ole Olsen & Peter Gøtzsche of the Nordic Cochrane Centre in Copenhagen published the original meta-analysis of seven clinical trials in 2000. The resulting storm of protest, particularly from cancer charities, caused them to take another look. They have now reached the same conclusion: mammograms do not reduce breast cancer deaths and are unwarranted.

October 2001: In recent TV interviews some people concerned with breast cancer screening in NZ were asked to comment on this meta-analysis. Once again the NZ commentators stated firmly that they were certain that screening programmes in NZ “had saved lives” but suggested no evidence to support their view.

March 23 2002 New Scientist P6: The International Agency for Research on Cancer (IARC) funded by the WHO claims to have reviewed all the available evidence. They conclude that screening women below the age of 50 is not worthwhile. However, screening women aged from 50-69 every two years reduces the risk of dying of breast cancer by 35%.

According to New Scientist, the figures from Britain are that of 1000 women aged 50, 20 will get breast cancer by the age of 60 (2%); of these six will die. Screening every two years would cut the death rate to four. [It is obvious that these are calculations, not the result of a controlled study!]

The IARC states that organised programmes of manual breast examination do not bring survival benefits (they call for more studies on these). If NZ has similar rates then screening programmes aimed at 50-60 year old women should save approximately 50 lives per annum.

Alternatives to Evidence Based Medicine

Alternatives to Evidence Based Medicine

I will detail these seven alternatives in forth-coming issues of the magazine. For now here is Eminence based medicine: The more senior the colleague, the less importance he or she places on the need for anything as mundane as evidence. Experience, it seems, is worth any amount of evidence. These colleagues have a touching faith in clinical experience, which has been defined as “making the same mistakes with increasing confidence over an impressive number of years.” New Zealand Medical Journal Vol 113 No 1122 p479

Homeopathy Flunks

It’s most unusual to see published trials showing that homeopathy is ineffective. The common term for this is “publication bias” where trials tend to be published only when they show something positive. One of the authors is GT Lewith, a long time apologist for homeopathy and that makes it even more remarkable. Should we give them one of our awards?

A double blind, randomised trial evaluated the efficacy of homeopathic immunotherapy on lung function. The conclusion: homeopathic immunotherapy is not effective in the treatment of patients with asthma. BMJ 2002;324:520-3

An accompanying editorial comments: “we believe that new trials of homeopathic medicines against placebo are no longer a research priority.”

All responsible health professionals must ensure that homeopathy is never funded by the health system. It would be grossly irresponsible to waste public money on “dilutions of grandeur”.

Ministerial Advisory Committee on Complimentary and Alternative Medicine (MACCAH)

Have a look at their Website: www.newhealth.govt.nz/MACCAH/. I have been visiting from time to time in keen anticipation of the result of their deliberations and to see what quackery will be introduced into our failing health system. The committee comprises a sociologist (chairperson), iridologist, doctor of medicine, naturopath, acupuncturist, paediatric nurse (and massage therapist), and teacher. The iridologist is David Holden who organised the International Iridology and Sclerology Conference that I mentioned in an earlier column.

Certain members of the committee have asterisks alongside their names as a reflection of a possible conflict of interest. Readers will recall that our organisation was unsuccessful in getting any skeptics on this committee. Would such a putative member have warranted an especially large asterisk?

There is a similar committee in the USA. It has become a scandal that the National Institute of Health (NIH) has distributed (wasted?) hundreds of millions of dollars on testing what Americans refer to as CAM, or complimentary and alternative medicine. They spent $1 million testing “magnet therapy”. The majority of the studies have been inconclusive and have led to the need for more tests. This has tended to give such quackery a spurious degree of acceptability. As critics point out, how many studies have been published showing that CAM doesn’t work? Read a very good critique of this area at www.washingtonmonthly.com/features/2001/0204.mooney.html

It is quite clear, given the US experience, that the MACCAH will produce nothing of any value and furthermore I predict that they will never publish a single article stating that any CAM modality is useless. I sincerely hope to be proved wrong.

Laying on of Hands

Every doctor of medicine knows the importance of properly examining patients even when they do not expect to find anything wrong. The act of touching people in a therapeutic context carries a very powerful placebo effect. This is a legitimate part of the "art" of medicine and when coupled with good communication leads to a good outcome. This effect is sometimes referred to as the “laying on of hands”, itself derived from the concept of mediated divine healing. For example, the King’s touch was supposed to cure scrofula, a cutaneous form of tuberculosis.

The extreme version of this is the absurd delusion of therapeutic touch where the patient is not actually touched but their energy fields are "corrected". Don’t laugh; this is part of mainstream nursing at Wellington Hospital!

The laying on of hands effect explains the apparent success of many physical treatment modalities such as osteopathy and chiropractic. They all do exceptionally well out of ACC-provided funding and it is no wonder that a recent provider survey found a high level of satisfaction from chiropractors (79%) and physiotherapists (76%). I once asked an ACC Colleague why they funded quackery such as osteopathy and chiropractic and his reply was that ACC didn’t care about anything except getting people back to work. Applying that logic I could set up a military consultancy (Boot Camp Rehabilitation Inc) and get people back to work by threatening them with military-style discipline.

Here is an extract from an advertisement from my local paper: "cranial osteopathy for babies and children to help with poor sleeping patterns, restlessness, crying and poor concentration". This quackery involves allegedly manipulating the bones of the skull to regulate the flow of cerebrospinal fluid. It is complete and utter nonsense that relies for its effect on the touching, a plausible patter and a gullible consumer.

ACC News October 2001 Issue 39

Bye, Bye, Bivalve

Trials of green-lipped mussel extract have been stopped after it was found that “the extract didn’t work.” (Marlborough Express March 11, 2002). Green-lipped mussel extract was marketed in NZ as Lyprinol and more than $1 million of the product was sold after it was claimed that it was a cure for cancer. Successful prosecutions were taken against those responsible for the scam.

The media frenzy showed that journalists had learned nothing from the Milan Brych affair.

I feed our cat (Gilgamesh) on green-lipped mussels, and as well as a lustrous coat he has shown no sign of developing cancer. I rest my case. In order to satisfy the most sceptical of journalists I enclose this picture as proof as he and Claire read the Lyprinol story.

Healthy Options

This is the title of a magazine that contains some of the most nonsensical rubbish I have ever seen. The editor is the woman responsible for promoting the Hoxsey quackery in Tauranga, which led to dozens of desperate cancer suffers taking one-way trips to Mexico to receive treatment. Tauranga travel agents made a killing in every sense of the word. This magazine should be read by all Skeptics in order to get a taste of what could be inflicted on the health system by the MACCAH. One ray of hope however – they mentioned www.quackwatch.com and stated that “this leads the public to believe that natural medicines are a fraud.” Well-enough said!

Possum Peppering

Is this delusion never going to go away? How many trials does it take to show that burnt possum testicles do not deter possums from eating vegetation sprinkled with said preparation? The Green party are already a bit of a joke and this latest nonsense makes me wonder whether they have all been partaking of ganja while worshipping with Nachos Tandoori. However, there is more to this than meets the eye, or testicle. I tried sprinkling some of a late relative’s ashes around our garden and I haven’t seen the mother-in-law for months. I rest my case. It must also be horribly lonely for all of those people living downwind of a crematorium – they never get any visitors at all!

Placebos All in Researchers’ Minds?

The placebo effect has long been of interest to skeptics for its presumed role in alternative medicine. The Skeptics’ Dictionary (http://www.skepdic.com) has a lengthy entry, describing a placebo as an inert substance, or fake surgery or therapy, used as a control in an experiment or given to a patient for its probable beneficial effect. It goes on to add the effect has at least three components.

The first is psychological, due either to a real effect caused by belief, or to a subjective delusion – “if I believe the pill will help, then it will help.” Alternatively, the effect may be largely illusory – an illness or injury will often get better by itself, whether it is treated or not.

As a third alternative, the process of treatment, involving attention, care, and affection may itself trigger physical reactions in the body which promote healing, regardless of the nature of the treatment.

The second alternative has received a boost from a study published in May in the New England Journal of Medicine. Danish researchers Asbjorn Hrobjartsson and Peter C. Gotzsche performed a meta-study of 114 studies in which the experimental design included a genuine treatment, a placebo, and no treatment at all. In these studies, they found a slight effect of placebos on subjective outcomes, such as pain, reported by patients, but no significant effect on binary outcomes. Even the slightly positive subjective outcome result could be a reporting effect – patients want to please the doctor, so say they feel slightly better.

Reaction to the report has been mixed. Some researchers have said it confirms what they’d suspected all along, there is no placebo effect, it’s an illusion due to the simple fact that people often get better without treatment. Others argue that the metanalysis used is inappropriate for such a disparate group of studies. But however it turns out in the end, the affair raises some interesting points. One is the origin of the oft-repeated claim that, on average, a placebo effect will help 35% of patients. This has attained almost the status of an urban legend, but Hrobjartson eventually tracked its origin to a single 1955 paper in the Journal of the American Medical Association. Its author, Boston anaesthesiologist Henry Beecher, based his claim on a review of 12 studies, and, like other articles read by Hrobjartsson, it did not distinguish between the placebo effect and the natural course of the disease.

It’s hard to accept there is nothing to the placebo effect at all. There are reports of people developing addictions to placebos, or demonstrating adverse side effects, and trials showing patients with placebos do better than others simply left on waiting lists. But it’s a complex, multi-faceted phenomenon. If we are going to assert that an alternative health treatment is “just a placebo”, we need to be careful about what we mean by that. Does it mean the patient is experiencing a subjective delusion, or genuine healing through care and support, or simply going through the natural course of an illness? The Danish study won’t be the last word on this subject, but it has very nicely focused an issue which has had some very fuzzy edges.

Annette's signature

Newsfront

If I Could Talk to the Dead Animals

Pet psychic Carol Schultz of Chicago has been gaining a lot of international attention, with identical reports featured in June editions of the Cairns Post and Evening Post. Journalist Marilynn Marchione seems to have written the piece with eyebrows permanently raised, as Schultz talks of her ability to speak with dogs, cats and horses, even if they’re dead. She even reads cats’ paws! Yes, it’s true! The article goes on to tell of a dog trapped in a cat’s body – it didn’t help that he was named Duke. Schultz also helps people get in touch with their departed loved ones – one woman who had had two dogs die recently wanted to know why they needed to leave her.

Consultations cost $35 for an email consultation, $50 by phone, or $75 plus travel for a personal visit. That’s US dollars.

Evening Post, 16 June, Cairns Post, 5 June

Seagull healed

Not to be outdone by the Americans, New Zealand also has its resident pet psychics. Paul and Victoria Woodward of Upper Moutere charge only $15 a session to lay hands on an animal and unblock its energy channels, which is a lot more reasonable. Victoria Woodward says animals seem to know the healing could help them.

“I’ve even treated a seagull, I didn’t touch him, but he got close enough for the treatment to work and simply flew off when he’d had enough.” How she knew the bird was ill (or male), or had been healed, she didn’t say.

Nelson Mail, 8 May

Open wide, please

The British Dental Journal reports that an acupuncture needle, inserted into an anti-gagging point on the ear is just the thing to overcome fear-induced nausea during a visit to the dentist. Some patients are so apprehensive, according to Dr Janice Fiske of the Guy’s, King’s and St Thomas’ Dental Institute, they develop a gagging reflex, which causes their jaws to clench. The needles were tried on 10 subjects, and it worked every time. Without the needles, six could only bear to open their mouths after sedation. Now if they could just come up with something to deal with a fear of needles…

Evening Post, 14 June

Aromatherapy all in the mind

The placebo effect (see Editorial) was in the news again with a report on a team of German and Austrian scientists, who found that oils used in aromatherapy improve mental ability – but only if you believe they do. The team, led by Josef Ilmberger of the Ludwig-Maximilians University, Munich, sprinkled water onto surgical masks worn by volunteers, then tested their reaction times. Essential oils used to promote alertness, such as peppermint, jasmine and ylang-ylang, were then sprayed on the masks of some of the volunteers, while others had water, and reaction times were again tested. No difference was found in reactions in subjects treated with oil or water, suggesting the oils do not have a direct influence on the brain when inhaled. However, when asked to rate how stimulating, strong or pleasant they found each liquid, those subjects who gave high ratings showed small improvements in their reaction times. Ilmberger concluded the effects of essential oils on basic forms of attentional behaviour were mainly psychological.

Dominion, Evening Post, 20 April

Exorcism goes awry

One of the grislier news items of recent times concerned the death of 37-year-old Joanna Lee in December. Pastor Luke Lee was committed to trial for Ms Lee’s manslaughter in June after allegedly strangling her during an exorcism. Neighbours heard screams and chanting prayers from the Auckland house, but didn’t think anything of it, as such noises were common. Six days after the exorcism, police found Ms Lee’s fly-blown body, still lying in bed while members of Pastor Lee’s Lord of All church prayed over her, occasionally wiping her body with alcohol to keep the smell at bay. Lee told police she had been sick and was sleeping.

“We are innocent. God knows. If we pray, Joanna will come back. God knows,” Lee said.

Church members said in written statements that Lee regularly performed exorcisms on them, one noting that for a small man he used a lot of force. Most of his 30-strong congregation was gathered from Queen St on Friday nights, though many who did join quickly became disturbed by Lee’s aggressive behaviour and left again. Joanna Lee, who had arrived from Korea six weeks previously, was described by church members as “a very smiley person”.

Dominion, 12 June

“Yeti” hair passes genetic test

British scientists on the trail of the yeti have found some of the best evidence yet of the existence of the mythical Himalayan creature – a sample of hair that has proved impossible to identify.

The hair was gathered from a tree in eastern Bhutan, and matches no known animal, raising the strong possibility that it was from an unknown species. An “official yeti hunter” led the expedition, working on the documentary series To the Ends of the Earth, to an area where he was convinced an animal was at large, and collected the hair from a hollow in a cedar tree.

Bryan Sykes, professor of human genetics at the Oxford Institute of Molecular Medicine said the hair wasn’t human or bear, or anything else they’d been able to identify.

“It’s a mystery and I never thought this would end in a mystery. We have never encountered DNA that we couldn’t recognise before.”

Of course, it may not have come from a large hairy primate. Wonder if they compared it with Fiordland moose hair?

Dominion, 3 April

Forum

Chelation Study

Ian McWilliam’s comments on the Dunedin Chelation Study [Forum, September] indicates the many difficulties in understanding medical research papers. In consideration of his critique of the study:

Re the number of patients:

  1. Whilst 32 is not many, they were all typical claudication sufferers, being mainly smokers, male, and average age 67.

  2. Van Rij et al arrived at this number in the correct method: using “power” and type error and allowing for detecting a predicted significant improvement in the order of 10% in terms of walking distance. Thus the study would easily detect the sorts of improvement that would be clinically significant (ie the 50-100% touted by some chelation clinics).

Re Mr McWilliam’s doctor friend’s analysis:

  1. His statement that only 12% of the controls achieved 100% walking distance improvement versus 26% for the chelation group is poor presentation of statistics: We don’t know how many of the controls achieved 99% or similar walking distance improvement.

  2. Van Rij et al quote a change in the average walking distance to pain (ie how long before the patients stopped walking because of pain) in the order of 25 metres improvement for the controls verses only 12 metres for the chelation patients. In other words the chelation group did worse. An average is a better statistic in this case than the ones quoted by Mr McWilliam.

  3. Mr McWilliam’s statistical analysis (95% confidence limits) is irrelevant given no explanation of the statistical method used and who performed the test.

Comments that “Those who supply the expensive drugs, equipment and surgery would lose much if research into other simpler, less expensive…” ignores the extensive research by the “heart industry” into the likes of aspirin and warfarin, hardly expensive medications.

I have found the results of the Dunedin Chelation Study significant for my clinical practice: It has reaffirmed my clinical observation of several patients who have undergone chelation; they all feel significantly better for the extensive attention they receive and the improvements they achieve in their lifestyle — i.e. enhanced placebo effect. Unfortunately the cost of this “placebo” is excessive, its long-term effects questionable and I have a degree of unease when I consider the number of chelation-treated patients I have had die from their heart and circulation disease within two years following therapy.

Jim Vause, Blenheim

Forum

Hypnosis

TV3 on 20/20 at 8.30pm on Monday 19/06/95 screened an American story titled “A State of Mind”. Extravagant claims were made about the medical significance of hypnosis and its therapeutic uses. One doctor claimed that up to 50% of her patients could be cured by hypnosis. I have just completed a course in rehabilitation studies at Massey University. The course text book had an interesting summary on hypnosis.

“Despite evidence that the use of hypnosis can produce analgesia for acute pain such as that experienced during surgery and childbirth (Hilgard & Hilgard, 1986), studies of the effects of hypnosis on experimentally induced pain and on chronic pain show no reliable evidence that it is more effective than that oldest of remedies for pain, the placebo procedure. For example, Melzack and Perry (1975) analysed the effects of hypnosis on patients suffering from a variety of chronic pain problems, such as low back, arthritis and cancer. An average pain reduction of 22% was achieved, which was not significantly greater than the 14% reduction obtained in placebo baseline sessions. In summary, hypnosis itself does not have a sufficiently powerful effect on clinical chronic pain to be considered a reliable and useful therapy. Merskey (1983) concluded that hypnosis is not worth using in anyone with a pain of physical origin and very rarely in patients with pain which is psychological in origin (p39).”

Text quote was taken from:

Young, M. (1991) Chronic pain and the rehabilitation process. In B. Hesketh and A. Adam’s (Eds), Psychological Perspectives on Occupational Health and Rehabilitation. (pp376) Marrickville, NSW; Harcourt Brace Jovanich

Andrew Hart, Tauranga

Magic Mushrooms Materialise

The extract quoted from the Marlborough Express by Dr John Welch regarding magic mushrooms in Fiji [Hokum Locum, Skeptic 36] is most interesting. They are well and truly established in New Zealand! I first heard about them a year ago from an elderly woman in Rotorua. At the time they were called Manchurian mushrooms and she assured me they were associated with Shangri-La as featured in Lost Horizons (book and film) and were connected with eternal youth. She swore by the efficacy of the brew and was quite upset when I asked where they were purchased. It is all done by giving and receiving, not by commercial transaction.

A sheet of instructions goes with each gift. The mushroom must be treated kindly. It must be talked to gently. If bad behaviour occurs near by (swearing, fighting) it will die. When the mother mushroom has budded off a daughter ready for the next brew the old one must be buried under a fruit tree.

I returned to Auckland convinced that life beyond the Bombay Hills was primitive indeed. A few weeks later I was with a group of young mothers several of whom were exchanging ideas about their Manchurian mushrooms and I have since learned that in the offices of several Auckland firms dealing with modern technologies that the mushrooms are all the rage.

I guess the concoction is no worse or more effective than the yeast brew willingly swallowed by me in the 1940s for a few months to combat adolescent pimples. After a few years the pimples went. Proof positive indeed!

P. Williams, Auckland

EDTA Chelation

I am at least as skeptical about the methodology and results of the EDTA chelation trial in Dunedin as I am about the efficacy of the treatment. The trial involved only 32 people, 15 in the treatment group and 17 in the control group, which I would have thought was rather too few to produce definitive results.

A doctor friend of mine, who runs a chelation clinic, tells me that he had to engage the services of the Ombudsman to obtain a copy of the raw data. Why was it not readily available? He says the results were published in the Circulation Journal of the US. Heart Association and the conclusion reached that, as 60% (9/15) of the treatment group and 58% (10/17) of the control group achieved an increase in walking distance, chelation was no more effective than placebo. His analysis of the raw data produced a different conclusion:

  1. 26% (4/15) of the treatment group compared with only 12% (2/17) of the control group achieved 100% increase in walking distance;
  2. Of the non-smokers and those who had stopped smoking (six in each group continued to smoke tobacco) 66% (6/9) in the treatment group improved with an average of 86% increase in distance walked compared with 45% (5/11) in the control group with an average increase of 56% in distance walked; and
  3. Only 6% (1/15) of the treatment group showed a decrease in blood flow to the feet by Doppler measurement compared with 35% (6/17) of the control group.

My friend claims that independent statistical analysis of these results confirmed a 95% confidence factor.

In deference to my medical friend, my wife and I submitted ourselves to the minimum 21 EDTA chelation treatments two and a half years ago. I was in good health but my wife suffered high blood pressure and had been told she should take appropriate medication for the rest of her life. Following chelation her blood pressure fell to a marginal level and has remained so without medication. I can vouch for the fact that pre-chelation her lower legs and feet were freezing when she came to bed whereas since chelation they are warm.

Science, being a human pursuit, is sometimes the victim of human failings. I recall my time amid about 70 agricultural research scientists who tended to debunk what, in their own fields, they could not explain. So a lady farmer who claimed that zinc supplementation was effective in the prevention of facial eczema was derided until her persistence led to official trials. Eventually she was proved correct and awarded the OBE for her work.

The controversy over chelation admits at least the possibility of less innocent human failings. It should be no secret that the “heart industry” includes a very powerful and very wealthy international lobby of vested interests. Those who supply the expensive drugs, equipment and surgery would lose much if research into other, simpler, less expensive and less glamorous procedures proved fruitful. Likewise the researchers have their substantial funding to lose.

Chelation is accepted practice for the removal of heavy metals from the bloodstream, but not for removal of the plaque which clogs arteries. Could in vitro laboratory experiments not establish the effect of EDTA on plaque?

Alan McWilliam, Rotorua

Is Counselling Useful?

Surprising results from a US study of the effectiveness of counselling on reducing juvenile crime.

In the March NZ Skeptic, Dr John Welch’s excellent column mentioned an article in the British Medical Journal (BMJ) about a social experiment which started in 1939. I have not seen the BMJ article but it can only refer to the Cambridge-Somerville experiment. Not just because this was the only such study started in 1939, but it is still (to the best of my knowledge) the only large-scale, long-term study on the effects of counselling which can reasonably be regarded as good science.

It is worth looking at this famous experiment in a little more detail. The instigator was the Harvard Professor of Medicine and Social Ethics. The subjects were boys between the age of five and 13 thought to be “at risk” of juvenile delinquency. It was proposed that a programme be started to prevent these boys becoming delinquent. It would involve “all the aid that a resourceful counsellor could possibly give, backed by the school and community agencies”.

In fact it eventually involved churches, scouts, YMCA, and summer camps plus, where necessary, medical and psychiatric treatment. The counsellors were particularly concerned to involve the families of the boys and this was done whenever possible. The treatment programme was intensive and lengthy; on average it lasted five years — a considerable time in the life of a child.

Professor Cabot (who died in the year the project started), while convinced the programme would be valuable, was concerned that it should be properly assessed. Thus the boys were grouped into 325 matched pairs, each pair being similar in age, background, etc. One of each pair was randomly assigned to the treatment group, the other to the control. It is because of this that it was possible to decide “Did the treatment help?”.

Major papers on this study were published in 1949 and 1951 and the final paper, by Dr Joan McCord, was published in 1978. Some 253 of the matched pairs had completed the programme and 30 years after the project started, Dr McCord was able to locate 480 of the men involved.

About half of these were from the treatment group, and about two thirds of them felt the project had been helpful and improved their lives. Most had fond memories of their counsellors.

Dr Welch writes that the BMJ article found the treatment group to be “sicker, drunker, poorer and more criminal”. This is true but I think it important to note the individual differences were very small.

The project was started to prevent juvenile crime. Of the treatment group, 72 had a juvenile criminal record, compared with 67 from the control group. This is a very slight difference, but clearly the project failed in its main aim which was to prevent juvenile delinquency.

Similarly, 49 of the treatment group had been involved in serious adult crime, compared with 42 of the control group. Again a very slight difference. For factors such as recidivism, alcoholism, stress-related illness, and job satisfaction the pattern was similar. That is, the control group did better than those who were treated — but only by a very small amount.

In only one important way was the treatment group better — minor adult crime. But again the difference was very slight: 119 of the treatment group had minor criminal records, compared with 126 for the control group.

It is true, however, that taken together the differences between the two groups were found to be statistically significant. The treated group had been harmed by the treatment, although the harm was minimal and would not have been revealed by a small-scale study.

There are several major lessons for skeptics here. Firstly, all treatments should be properly assessed and that means using a control group (obviously in this kind of treatment “blind” studies are not possible). How much money (taxpayers’ money) is being spent in New Zealand on counselling? Is the money well spent? Is any attempt being made to assess the value of the treatment?

Secondly, the natural and powerful objections to such assessments must be resisted. The idea of using a control group horrifies many people — “But these people are being used in an experiment! They are not being treated!” Such objections assume we already know the treatment works. But we do not know this and our intuition may be completely wrong.

Thirdly, people are incapable of objectively assessing their own treatment. That is why testimonials to the healing power of any treatment are completely worthless.

Fourthly, non-intervention may be the best treatment. The problem is that it is the hardest to apply because there are powerful forces mobilised against it. The patient welcomes treatment (just how neglected did those boys in the control group feel?) and the professional wants to help.

Counselling is getting to be a major industry in New Zealand but its value should be questioned. All such professionals should adopt the motto “First do no harm”, but until proper assessments are made, how do they know whether they are doing harm or good?

Hokum Locum

No Medical Ghetto

In the last issue I warned of the dangers of a medical ghetto developing on the Auckland North Shore. Fifty new doctors set up practice in Auckland last year and even more overseas doctors are pouring into New Zealand. There has not been a corresponding drop in consultation fees in a local aberration of the law of supply and demand. Fortunately, the Northern Region Health Authority has moved to cap any further increases in doctor numbers which have already cost an extra $20 million in subsidy claims. (Christchurch Press 24/4/95)

Dietary Delusions

Retired British policeman Peter Bennett claims that criminal behaviour can be controlled by dietary manipulations. Following a shooting spree in the US, an offender claimed that he was temporarily insane due to excessive dietary sugar (the Twinkies defence, named after a proprietary candy bar). After a special diet, it was claimed that nine recidivist criminals showed a dramatic improvement in behaviour.

Such claims have been made before in connection with children’s behaviour and shown in placebo-controlled trials to be wrong. What Mr Bennett has overlooked is that changes in diet are associated with a change in management, and it is this that has the effect rather than the diet. (Dominion 3/4/95)

Magic Mushrooms in Fiji

Following its importation by a soldier returning from overseas, Fiji has been in the grip of mass hysteria over the magical properties of a tea made from mushrooms. As with most other quack remedies it is claimed to cure everything from baldness to diabetes.

The mushroom, which looks like a bloated, gelatinous pancake, is floated in sweetened black tea and the fermented brew is drunk a week later. The brew is also known as “kombucha” and is gaining popularity in the US and some other Asian countries, and has been touted as an AIDS remedy. (NCAHF Vol 18, No 2) It is in fact a symbiotic colony of yeast and bacteria. I wonder how long before the brew arrives in New Zealand. (Marlborough Express 10/4/95)

Naughty Children?

Attention deficit disorder (ADD) is alleged to be an organically based condition where children are impulsive, overactive and have a short attention span. ADD has previously been known as minimal brain dysfunction, hyperactivity, hyperkinesis and Strauss syndrome, to name but a few.

In fact, ADD is yet another example of the expansionist activities of health professionals who “convert” ills into illnesses. This is the very activity which Illich warned about with respect to the medical profession.

ADD is far more likely to be simply a description of badly behaved children. Instead of concentrating on the behaviour (an effective strategy), people form support groups and look for organic causes which is a waste of time and resources. (GP Weekly 14/4/95)

Occupational Health Delusions

In a landmark decision, a company was fined after admitting a charge that they failed to take steps to protect an employee against occupational overuse syndrome. The employee had been in the new job for four days. I wrote to the company urging them to defend the case but they chose to plead guilty.

After this ludicrous decision I wrote to the Dominion but they chose not to publish my letter. I have also written to the occupational health publication Safeguard but I am not confident on seeing any expression of opposition to the absurd idea that anyone can develop OOS after four days in a new job.

There are, however, some glimmerings of understanding creeping into the literature. A judge in the UK rejected the concept of OOS and in the US a court rejected a claim that computer keyboard design causes it.

Writing in Safeguard (No.30 1995) Alan Boyd lamented the fact that ergonomic changes in the workplace had not lessened the prevalence of OOS. This is not at all surprising to me as no amount of ergonomic posturing can lessen the prevalence of a psychogenic (produced as a result of psychological stresses) condition such as OOS.

In Safeguard Update (27/3/95), Chris Walls acknowledges that anxiety and depression are common in New Zealand, affecting 13% of the population. Exercise is prescribed to relieve anxiety and reduce the chance of OOS. I find it ironic that in their own literature, all the clues are there for a proper understanding of OOS but occupational health workers continue to miss the bigger picture.

When a job becomes too difficult and less socially enjoyable, people start to focus on their symptoms. Attribution to work then means that the problem is the fault of the employer and the availability of compensation validates the “illness”. OOS can only be understood by looking at the historical record of psychogenic illness. This is brilliantly examined in a new book, From Paralysis to Fatigue by Edward Shorter (The Free Press, 1992) which is supported with superb clinical examples from the medical literature.

A striking theme is the gullibility of doctors who validated such presentations as fits and paralysis. It is interesting to find that patients have always resisted the concept of psychogenic illness and have tended to find more socially accepted labels. This is why neurasthenia has been replaced with chronic fatigue syndrome, and Charcot’s hysteria with other conditions such as total allergy syndrome and multiple chemical sensitivity.

I recommend this book to all readers interested in medical history. It should be required reading for health professionals.

The (Un)laying-on of Hands

A physiotherapy technique known as cupping has been suspected of causing the deaths of five babies and brain damage in eight others. The technique involves tapping the chest with a soft latex cup in an unproven method of clearing chest secretions. Like many physiotherapy techniques, this method of treatment has never been subjected to critical analysis.

The use of the term “cupping” for the procedure is a little unfortunate. Cupping used to be a medieval practice of applying suction cups to the skin to cause localised counter-irritation to some disease process or symptom. Acupuncture and moxibustion are other examples of counter-irritation quackery. Lancet 25/2/95 Vol 345 p510

Case-management Flunks

In the US, case-management became the central tenet of the care of people with severe mental disorders. The case manager takes a full and comprehensive responsibility for the client. This concept spread to the UK because it was believed to be effective.

However, a randomised trial found virtually no difference in outcome for case-managed clients compared with a control group. The authors concluded “it is unfortunate, in view of the limited effectiveness we have shown, that social services case-management was not evaluated in randomised controlled trials before its implementation in the UK.” (Lancet 18/2/95 Vol 345 p409-412)

Once again, this article demonstrates the absolute necessity of critically evaluating new treatments. This process should be extended to evaluate many of our existing treatments across the whole health area.

Udder Nonsense?

In a form of primitive immunotherapy, Herb Saunders injected his cows with patients’ blood and then sold the bovine colostrum (“first milk”) with the claim that it would cure cancer and other serious diseases.

Saunders sold each patient a cow for US$2500, but not only kept the cow on his farm but charged the patients $35 a bottle for the worthless nostrum. He was charged with practising medicine without a licence but the jury were unable to find a majority verdict of guilty. In my opinion Saunders was definitely guilty of milking his patients!

Chelation Abuses

The California Medical Board has been attempting to prevent the use of chelation therapy for unapproved indications. At a meeting, dozens of patients gave impassioned personal testimonials claiming cures after chelation treatment. It was noted by observers that the “tense atmosphere did not lend itself to rational decision-making.” Despite several impeccable trials that showed no benefit, chelation therapy continues to be offered in New Zealand.

With respect to the dramatic improvements claimed, it is more likely that there has been a fraud rather than a miracle. When confronted with the ravages of arterial disease, people often make profound health and lifestyle changes. They quit smoking, lose weight, exercise and make substantial changes to their risk-factor profiles. These same people are also the ones most likely to seek out chelation therapy. How ironic that they end up paying out thousands of dollars for a treatment whose benefits have been produced entirely by their own effort. (NCAHF Vol 18, No.2)