Hokum Locum

Get in Now While the Getting’s Good

John Welch finds that the sexual abuse industry rolls on unabated.

Sexual Abuse Rort

ACC (aka “Aggrieved Clamouring Claimants”) has thrown the doors wide open for sexual abuse claimants. They have budgeted 60 million dollars for sufferers who can claim up to $175,000 “without having to complain to the Police or name their abuser.” Not surprisingly, a Christchurch Law Firm has shown commendable initiative in touting for business with a leaflet drop because “lawyers had a professional obligation to make the public aware of entitlements.”

It is highly significant that a Christchurch firm has seen fit to profit from this ludicrous state of affairs. Proof of sexual abuse has never been required in Christchurch, the Salem of the South Pacific. Dozens of families pocketed tens of thousands of dollars for sexual abuse that never happened while dedicated and talented Christchurch Civic Creche workers had their lives ruined.

I am not sure that James Randi would approve of my challenge but here it is. I offer my endorsement of any claimant who is prepared to claim for ‘ritual satanic alien abuse’, especially if it occurs in a parallel universe.

Given the refusal of the Minister of Justice to read Lynley Hood’s book on the Christchurch Civic Creche debacle, readers could be forgiven for thinking that he and key members of the legal profession currently inhabit a parallel universe.

Several years ago a man spent $80,000 defending himself against charges of sexual abuse “remembered” by his two daughters. He was acquitted as he was able to prove that the alleged abuse not only did not happen but it was impossible for it to happen. A reporter reasonably asked the question of ACC whether the two daughters would have to repay their compensation. “Oh no,” said the Spokesperson, “they are entitled to it for their suffering.”

The budgeted sum of 60 million dollars will experience a blowout version of “Welch’s Law” which states that claims expand to take up the amount of compensation available.

Marlborough Express 9 Jan 2002

The Vigorex Products – Oat cuisine?

These are homeopathic extracts of ‘avena sativa’ and contain nothing injurious to health. Readers familiar with homeopathic theory will know that such a product description is entirely true. Homeopathic preparations contain precisely nothing and placebo controlled trials of homeopathic preparations are in fact trials of one placebo versus another. This explains why placebo controlled trials of homeopathy will sometimes produce a result favouring the homeopathic wing of the trial. This led one wag to suggest that what was needed were “double-strength” placebos!

Vigorex is a product developed from oats. Readers will be interested in the admission that “skeptics have doubted the existence of an effective sex enhancer.”

Reports indicated that “some fell (sic) an increase in energy within one or two hours and use it instead of coffee to get going in the morning … some say they start taking it on a Thursday or Friday in anticipation of a sexual weekend.”

I decided to rise to the challenge, hopefully in every sense. After extensive product testing I have to say that my wife developed a headache which was not relieved by another homeopathic preparation.

The Scots have eaten porridge for years so there may be more to this than meets the eye.

Pamphlet Supplied

Homeopathy useless against Malaria

Because of conventional drug side effects, a woman decided to rely on homeopathic drugs for malaria protection whilst holidaying in Africa. These homeopathic products were made from “African swamp water containing impurities, algae and plants as well as mosquito slough, larvae and eggs.” Following her return home she became very unwell and was admitted to an intensive care unit with multiple organ system failure due to malaria infection.

There will be no claim for medicolegal liability because “the manufacturer, who has performed no clinical trials on this drug, declines all responsibility regarding its use.”

Homeopathic remedies should only be used for harmless self-limiting disorders that require no treatment, which is precisely what homeopathy is all about.

BMJ Vol 321 18 Nov 2000 p 1288

Kentucky Fried Medicine

The NZ Health Authorities recently had to warn all doctors that two Chinese herbal medicine capsules contained the potent corticosteroid betamethasone. These were Cheng Kum and Shen Loon. The Ministry of Health had earlier removed Cheng Kum from the market when it was shown to contain the antihistamine chlorpheniramine.

Since most Chinese herbal remedies are either useless or dangerous it is hardly surprising that they are incorporating effective Western drugs in a fraudulent attempt to demonstrate effectiveness. The same problem has occurred in the UK where random tests were still finding banned substances such as mercury, arsenic and steroids in traditional Chinese medicine. Some also contained parts from endangered animal species.

Why should we respect medieval beliefs that endanger the continued existence of magnificent animals such as tigers because superstition demands the use of their bones? The criminals responsible for these excesses should be ground up themselves and processed into traditional remedies, and in this spirit I have formed a company marketing a new herbal remedy for cats called Meow Zedung.

BMJ Vol 323 6 Oct 2001 p770; MEDSAFE 14 Dec 2001

Flux for Flux?

While in Ireland recently I kept a watchful eye for useful material and was not disappointed by an article in the Irish Examiner of 14-11-01. A company managed to sell to over 485 schools, a $70 magnetic clip designed to be attached to the underwear and claimed to “banish the misery of painful periods.” The device is the size of a 10p piece and it is claimed “sends out a magnetic field which penetrates up to 7 inches into the body.”

This device is a classic placebo and it is easy to see how successful it would be in a Priest-ridden country where the Catholic religion ensures young women are made to feel bad about their emerging sexuality.

The article goes on to make the following claim “…66 out of 100 painful period sufferers took significantly less medication when wearing the device during their periods.” If these young women received sympathetic advice and explanation about their periods in a climate of healthy acceptance, there would be an equally impressive improvement.

I know of a much better market for this device. Some enterprising person should promote it for male impotence.

Fad Allergies

Around 20 in 100 Britains believe they suffer from allergies and intolerance to dairy foods and wheat-based products. However, nutritional research reveals the true figure is less than 1 per 100.

This is an area rife with quacks conducting all sorts of unscientific tests and giving potentially dangerous advice. People are using food allergies and intolerance as an excuse for weight gain and niggling health problems such as every GP’s fear – TATT (tired all the time) syndrome. The very idea that you can have a food allergy and gain weight is preposterous.

The Daily Telegraph 5 Nov 2001

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Arthritis and Placebos

In Skeptic 30, John Britten outlined the tragic results which can occur when patients fall into the clutches of quacks. In this case, a man with rheumatoid arthritis was not only starved but ended up paying for expensive and useless medications. Most doctors can relate similar examples.

Uncontrolled trials claimed to show dramatic improvements in rheumatoid arthritis patients following laser treatment. However, a placebo-controlled trial showed that sham treatment (placebo) gave just as good results as the laser. (BMJ Vol 307 30 Oct 1993 p1154)

A placebo-controlled trial of diclofenac (an anti-inflammatory drug) for osteoarthritis of the knee, found that half of the patients allocated to placebo stayed on this treatment for two years without any worsening of their symptoms! (BMJ Vol 307 Aug 1993 p394)

Reports of pain relief from subcutaneous injections of water drew a sharp reply from Skrabanek writing in the Lancet (April 3 p905). He pointed out that a historical perspective of such “counter-irritation” methods can help prevent over-enthusiastic adoption of such unlikely treatments. In fact, I seem to remember that water injections were one of the scams exposed in the novel by A.J. Cronin, The Citadel, which should be required reading for any doctor of medicine.

Gulf Gas Mystery

An article in Time magazine (Nov 22 1993) outlines how 8,000 veterans of the Gulf War have claimed that they were exposed to chemical agents producing such symptoms as diarrhoea, aching joints and difficulty in breathing. It is alleged that “multiple chemical sensitivity” may be the cause but nowhere is there any mention of psychological causes such as stress. Many of the claimants have been dismissed as malingerers.

War is hell and it is a terrible experience for some soldiers. Stress-related disorders are common and resulted in shell shock and effort syndrome in WW1, anxiety neurosis after WW2 and alleged Agent Orange poisoning after the Vietnam war. History shows that such claims will continue to occur, as in this case, but I would prefer to see psychological causes included in the differential diagnosis.

Sick Building Syndrome (SBS)

Researchers have finally got around to acknowledging that SBS may be due to “a high level of job stress among individuals with symptoms” (GP Weekly 19 Jan 1994 p15). As would be expected there are now concerns about “sick plane syndrome” (SPS) reported in New Scientist (7 Aug 93 p7). Several cabin attendants reported difficulty breathing, dizziness, fatigue, nausea and headaches during a cross-country flight. “The cause was never determined.”

I wonder if they considered mass hysteria, which is the most likely scenario for both SBS and SPS. Hysteria is not the best word to use — perhaps mass conversion disorder is less pejorative. Essentially, groups of people under stress tend to develop similar symptoms in the face of a common stress. A good example which I have seen myself is mass fainting occuring in military recruits awaiting both blood tests and vaccinations.

Child Abuse

Christian “Scientists” believe that illnesses can be healed with prayer and Bible readings. The religion’s founder, Mary Baker Eddy, was described by Mark Twain as the “queen of hypocrites”. There are numerous examples of people who have died from lethal but eminently treatable conditions. I have no problem with deluded adults who want to be treated in this way but children are entitled to a standard of medical care expected by any reasonable parent.

As would be expected from common sense, there is no evidence that faith has ever produced a cure of any illness. Is it at all likely that faith can produce insulin secretion from a failed diabetic pancreas? In the US, a couple killed their diabetic son by withholding treatment for his diabetes (Lancet Vol 342 Sep 4 1993 p610). Incredibly, the parents were not criminally prosecuted because of “a state law that protects from child neglect statutes, parents who rely on prayer to heal their children”. However, the child’s estranged parent filed a civil suit and the Christian Science church has been ordered to pay US$11.3 million in damages.

The law in the UK seems more rational. A Rastafarian couple refused on religious grounds to allow their diabetic daughter to have insulin and she duly died. As any reasonable person would expect, the parents were charged with manslaughter and convicted (Lancet Vol 342 Nov 13 1993 p1189).

More on Dental Amalgam

As I have previously explained, there is no evidence to implicate mercury in amalgam with significant human illness. An article in the Marlborough Express (24/8/93) outlined an illness which caused weight loss, stomach cramps and nausea in a 34-year-old man. After paying more than $2,000 in medical bills he was no better. As a doctor I know straight away that there is only a slight chance of a significant organic illness (e.g., cancer) either occuring or being overlooked in a 34-year-old.

I have seen this combination of symptoms before in many patients and they all turned out to have depression and were cured with appropriate treatment. However, as I have mentioned many times, psychological causes for illness are seen as somehow inferior to a “physical” cause. To quote the patient: “I was getting worried that it was something psychological. The medical profession was giving me ideas that it was depression, stress, bodily changes.”

In this case, the patient received a diagnosis of “mercury poisoning” following an assessment with a quack “black box” involving electroacupuncture. He then paid $1,000 to have all his amalgam fillings replaced and is reported to be slowly improving. Truly another remarkable example of the placebo effect which is very powerful with any kind of surgical or operative treatment.

Conversion Disorders

These are symptoms or signs produced by notional beliefs (e.g., mass fainting due to a perceived chemical or environmental threat), and are the basis of occupational overuse syndrome, chronic fatigue syndrome, sick building syndrome etc.

“Retractor” is an expatriate Kiwi living in Australia who wrote an interesting article on allergy to local anaesthetic (LA) (NZ Doctor 16 Sep 1993 p7). He found that patients demonstrated their “allergic” reactions even when injected with normal saline solution.

One 12-year-old had fits after dentally administered LA and was investigated with two electroencephalograms (brain-wave recordings), a CT scan and a MRI scan. Following an injection of normal saline (which the patient believed was LA) he had a fit and was incontinent!

“Retractor” was mostly successful in helping patients deal with their subsequent embarrassment but some had trouble and went so far as to dispute the matter. Descartes was certainly completely wrong when he proposed his theory of complete separation between mind and body. Clearly the mind (belief) can have a potent effect on the body.

Pond Scum Scam?

Pro-algal quacks claim that algae harvested from a pond “may be beneficial” for the treatment of AIDS, cancer, heart disease, etc. The product has re-surfaced since the FDA shut down the marketing company, Cell Tech, in 1986.

Note the absurd range of indications of the product, in contrast to the specific use of drugs for particular diseases.

The FDA faces an uphill battle in countering this sort of quackery, as the law is vague on whether such items should be classified as drugs, foods or dietary supplements. A sensible law was passed by Congress in 1990 which prohibited any health claims about such products unless approved by the FDA. The powerful quack lobby has managed to introduce another law which dilutes scientific standards and shifts the burden of proving safety onto the FDA!

C is for Cancer

Linus Pauling’s faith in Vitamin C is undaunted by his cancer (NCAHF Vol 15, No4). Despite it being out of his field (nuclear physics), Pauling has championed the anti-cancer benefits of Vitamin C. Sadly, he has been diagnosed as having prostate cancer but, despite being poorly, his faith in Vitamin C is unshaken. “He credits his high-C regimen with delaying the disease until his present age of 91 yrs.” The physiology of Vitamin C is well described, and excessive amounts are simply excreted in the urine. Prostatic cancer occurs more often with increasing age and if men live long enough there is an almost 100% incidence.

Pauling has helped keep Vitamin C as the number two on the list of the top dietary supplements in the US. Dietary supplements are worth $1.4 billion US annually and are currently 37% of all health food sales.

Oil Strikes Out

The film Lorenzo’s Oil concerns the efforts of a family to save their son from a rare genetic disorder using a highly purified cooking oil of the same name. Thanks to the media there is now a new popular mythology that the oil is effective and that attempts to use it have been obstructed by the unreasonable medical profession.

A French team of scientists have tested the oil and found no evidence of any clinical benefit. Once again, extravagant claims are found wanting when subjected to critical scrutiny.

If You Can’t Beat ’em?

Bernard Howard first drew my attention to worrying trends towards the inclusion of unorthodox therapies into conventional medical practice.

The BMA has acknowledged that acupuncture, osteopathy, homeopathy etc. are “indeed a good thing” provided the practitioners are “properly qualified members of their crafts”. In an article in New Scientist (31 July 1993), Donald Gould comments on this Pauline conversion and accuses the medical profession of a change prompted by concern over the loss of patients to alternative medicine. A “properly qualified homeopath” is still a quack peddling water, and professional registers simply give quackery a spurious respectability.

The NCAHF has already shown how licencing of quackery is soon followed by that body actively lobbying for an expanded scope of practice. In New Mexico, the state Acupuncture Board allows acupuncturists to order tests and procedures such as MRI scans, writing prescriptions and performing bone and muscle manipulations. Chiropractors were predictably indignant and two doctors on the Board resigned in protest. (NCAHF Vol 16, No 5).

I briefly commented on this trend in Skeptic 30 (“Quackery in the US”). The Office of Alternative Medicine has been set up within the US National Institutes of Health at the instigation of a former congressman, Bedell, who claims to have been cured of a “possible recurrence” of prostate cancer by an unconventional “nitrogen enhancement” therapy (unspecified). What Bedell does not say is that he was also receiving conventional treatment for prostatic carcinoma and “possible recurrence” is an example of the meaningless terms and vague language that permeates alternative medicine.

The director of the Office holds establishment credentials and describes himself as a skeptic, yet favours simple outcome studies rather than the proven double-blind, placebo-controlled trial. Outcome studies are weak and will allow for all sorts of extravagant claims. The reason that quacks hate proper clinical trials is that they usually show that quack beliefs are a delusion.

Members of the Office of Alternative Medicine can use their affiliation to advertise their quackery because, as an ad hoc body, they are not subject to normal regulations. One of the members has already claimed to have cured AIDS using herbs. No evidence was offered to support such an extravagant claim.

In New Zealand the ACC will pay for acupuncture, which is an unproven treatment, on the referral of a doctor. I had a patient with a severe neck injury which required (on the advice of a specialist neurosurgeon) an MRI scan but ACC does not pay for this test because it is “not an approved investigation”! This is a good example of politics controlling medicine, instead of science.

The Placebo Effect

Many people will remember Dr Bill Morris’s entertaining autobiographical talk at the last Skeptics’ conference in Wellington. From his presentation, we extract this discussion of what is still the most persistent and potent medical effect known to the human race.

The word “placebo” may or may not be recognisable to you as being of Latin origin, from the verb placeo, placere, to please, and placebo is the first person singular of the future indicative tense, or “I shall please.” Its first recorded use in the English language was in 1225 in reference to Vespers in the Office for the Dead, and the word was derived from the first word of Psalm 116 v 9 “Placebo Domino in regione vivorum.” This is usually translated as “I shall walk before the lord in the land of the living,” but as the Vespers for the dead was in effect a request for the dead to intercede with God for the benefit of the living, it is better translated as “I shall please or intercede with God on behalf of those in the land of the living.”

By 1386 it had appeared in Chaucer’s Merchant’s Tale to mean a flatterer and by 1811 it had acquired one of its modern senses as “…an epithet given to a medicine adapted more to please than to benefit the patient.”

It may surprise you to learn that it was as late as 1938 before the word appeared in its other modern sense, that of a dummy medication used as a control, and probably the first well documented randomised placebo controlled trial was that of streptomycin for the treatment of tuberculosis of the lung, in 1948.

The Medical Research Council pointed out that the natural history of tuberculosis of the lung was so variable that “evidence of improvement or cure following the use of a new drug in a few cases cannot be accepted as proof of the effect of that drug” by contrast with tuberculous meningitis which was invariably fatal without treatment.

The placebo treatment was bed rest alone, whereas the streptomycin group received both bed rest and streptomycin. In this instance the patients obviously knew they were getting streptomycin as it has to be given by injection, but the progress of the disease was followed on chest X-rays which were assessed without knowledge of which treatment the patients had received.

Ethical considerations did not apply, as the only possible alternative treatment at that time was bed rest, and in any case only limited amounts of streptomycin were available. Nearly forty five years on, it is difficult to accept that bed rest alone was perceived to be an effective treatment.

By 1950 the Journal of Clinical Investigation wrote, “It is customary to control drug experiments on various clinical syndromes with placebos, especially when the data to be evaluated are chiefly subjective.” and so by this date, the use of dummy medication in drug trials was firmly established.

It soon became clear that many people reported side effects or improvement when receiving placebos in trials and it soon became possible, though perhaps not useful, to say that the placebo effect was that which all treatments have in common. Perhaps more useful is to combine the two definitions and say that it is a non-specific effect of a treatment attributable to it but not to its pharmacological properties.

Any form of treatment can act as a placebo, and the strength of the reaction varies with the supposed potency of the treatment so that a capsule is better than a tablet, an injection is better than a capsule, an injection that stings is better than one that doesn’t and an operation is even better than an injection that stings.

In 1939 it was suggested in Italy that tying off the internal mammary arteries could greatly reduce the pain of angina pectoritis. The operation eventually became fashionable in the USA with quite spectacular results. The patients said they felt better and there was objective evidence to support this in that they could walk further and their consumption of angina pills decreased.

Eventually a double blind controlled study was done in which half the patients had their internal mammary arteries tied and the other half simply had them exposed without tying them. Neither the patients nor those who assessed them knew until the study was completed who belonged to which group. It turned out that ligation had no greater effect than the dummy operation. Since ligation of the internal mammary arteries was quite a major operation with potential for harm as well as good, and there was genuine doubt that it was useful, not only was the trial ethical, but it would have been unethical not to have done it.

Placebos can also cause toxic effects just like those of an active drug, and in a study of 25 patients given placebos, ten reported sleepiness, nine palpitations, eight irritability, five weakness with a fall in blood pressure of more than 20 mm of mercury, four reported diarrhoea, two collapse and two itching. Three of the patients also developed dependence on the placebo (lactose) and had withdrawal symptoms when it was stopped.

Now one suspects that if we stopped people in the street at random they might report a similar rate of these symptoms, and at the 1992 Skeptics Conference, on asking for a show of hands, I found that the proportions enjoying the symptoms listed above were greatly exceeded.

As soon as the placebo effect became clear, investigators began to look for factors which might identify the placebo responder in the hope that eliminating them from the studies would make the data much clearer.

A variety of psychological studies has been done but there are so many inconsistencies among the results that one can conclude that there is no single personality trait that characterises the positive placebo reactor, with the possible exception that stress or anxiety has been rather consistently associated with placebo reactivity. Expectation has been cited as a possible mechanism.

In one study, experimenters were told that their rats had been bred especially either for intelligence or dullness, although in fact all the rats were from the same genetic strain. The experimenters then performed learning experiments on the rats and obtained results that conformed to their expectation.

Brody cites this as possible support for the idea that if experimenters can somehow communicate their expectations of the rats’ behaviour to the rats “It seems reasonable to assume that physicians can unknowingly communicate their expectations and attitudes to the patients, altering the patients’ therapeutic outcomes as a result.” My own view is that old Procrustes is at it again, altering the accuracy of the experimenters’ observations rather than the rats’ behaviour.

Theories of placebo action have been largely psychological or psychoanalytical, but a reductionist like myself sees behaviour, feelings, thoughts and so on in terms of as yet poorly understood physico-chemical activities in the brain and peripheral nervous system, rather than as something happening somewhere in a bubble marked “psyche.” A little support for this view comes from a randomised double blind placebo controlled study by Levine and others into the mechanism of pain relief following extraction of impacted lower wisdom teeth. A third were given naloxone, a substance which is believed to inhibit the action of naturally occurring pain relieving substances in the brain called endorphins, a third were given a placebo and a third were given morphine. Those given naloxone reported significantly more pain than those given the placebo.

Levine hypothesised on this basis that placebo pain relief is mediated by endorphin release, but as Skrabanek pointed out later, they did not test their hypothesis by actually measuring endorphin levels, and in any case the results were exactly what might be expected if the naloxone were acting as a placebo itself. The paper was also severely criticised by Korczyn, but nevertheless it continues to be quoted quite extensively as “demonstrating” that pain relief by placebos is mediated by endorphins, a claim, incidentally, that is also made for pain relief by acupuncture.

We simply do not know why about thirty percent of patients experience relief of symptoms when given a therapy that cannot be expected to have any effect. In a sense, the history of medicine up to about 1950 is largely the history of placebos. We may find it amusing to look at some of the truths of yesterday which are the falsehoods of today, like the fashion for enemata in eighteenth and nineteenth century France. Sometimes enemata even of tobacco smoke were administered, and while we cannot feel entirely confident that the Tobacco Institute would disapprove of this, we can feel sure that many of our present day medical practices will appear stupid and ignorant to our great grand-children.

For the last forty five years we have had the means to set a limit to our errors, and yet colleagues tend to set store by anecdotes and case series which are in truth little better than a succession of anecdotes. The results of poorly designed case control studies continue to be accepted without proper caution. If physics is the queen of the sciences, then the randomised double blind placebo controlled study is the queen of medical investigation, though for events that occur relatively rarely, cohort studies and case control studies are inevitable second and third best choices.

People, including I am sad to say, doctors, have said to me “What does it matter whether a treatment is a placebo or not as long as it works? Surely the thing is to cure the patient and when you cannot cure, to comfort.” I can certainly agree with the aim, but not that it does not matter how we do it. If we do not make sure of the truth then we shall not be able to separate the wheat of science from the chaff of falsehood, and as Berthold Brecht put it, the aim of science is not to open a door to infinite wisdom, but to set a limit to infinite error.