Believe It or Not!

One of the interesting things about the Skeptics is the wide range of opinions that can be found in our group — not to mention the ever-readiness to express them. So I was interested to read Frank Haden’s column on the conference and how he found it.

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Postmodernism

Postmodern thinkers claim to have broken the fetters of logic that have characterised rational discourse since the enlightenment. They claim to have ushered in a new age of freedom of communication, that rationality is no longer the only, or even the major, “communicative virtue” and that social, psychological, political and historical considerations must all take precedence over logic and reason.

Freed from the confines of logic, discourse can now become open, honest, sincere, politically sensitive and historically conditioned. While premoderns and moderns judged a speaker’s claims on how well it was based on the facts of the case and the logic of the argument, the postmoderns “play the believing game” which accepts the speaker’s claims according to the degree of sincerity exhibited by the speaker. Hence expertise and authority are no longer possessed only by an elite few. Communication is truly democratic. We are all informed; we are all rational.

Hence we find educational curricula based on the premise that anyone can teach anyone else and the great sin is lecturing or instructing. Richard Rorty the American postmodernist has said our only task is to keep the conversation going.

The postmodernists conclude that there is no Truth to be aspired to, but that there are at any time a great many “little truths”. Each of these little truths depends on the social, psychological, political and other contexts of their utterance. Person A speaks as a woman, as an oriental, as an unemployed person, as a mother and so on. Person B speaks as a male, or as a Maori, or as an artist and so on. One person’s X is another’s NOT-X depending on who (and where, and when and what gender, race, and age) they both are.

This new age of Postmodernism has helped to foster the “New Age” of healing crystals, channelling, UFO abductions and the other beliefs of the Shirley Maclaine tribe because we are encouraged to ignore nonsense, unreason, and irrationality.

These postmoderns see science as “no more than the handmaiden of technology” according to Rorty. And technology is viewed as evil itself, because it is perceived to be the cause of most of today’s economic, environmental and medical ills.

Education has contributed to this evil advance and must be reformed in the postmodernist image. The enlightenment tradition must be rejected on moral grounds. There can be no separation of teacher (master) and student (slave) when there are no universal standards of truth. School children must be allowed to discover their own reality while facilitators encourage their creative and free ranging thought.

Postmoderns at first appear to be superbly tolerant. After all, if all ideas are equally true then your truths are equal to mine. We are truly all equal before this lore. My idea that Jim Anderton’s recent move in and out of party leadership reflects a similar trauma in one of his earlier lives and your idea that it reflects a complex interaction between public and private life are on a par with each other. Each deserves to be tolerated and given due recognition.

But just as Doris Lessing found that her Marxist friends seemed to love humanity but hated people so too this universal tolerance for ideas seems to go hand in hand with a remarkable intolerance for individual expressions of thought.

This apparent anomaly has its own internal logic. The philosophy that seeks only “local” truths rather than aspiring to universal truths not only repudiates science but divides people according to their “locality”, which means dividing them according to who, where, when, and what colour, gender they are or what political beliefs they hold. The natural result of such division is an intolerance that tends to manifest itself in racism, nationalism, sexism and all the expressions of hostility and intolerance which we identify as Political Correctness. It’s not the Truth that counts–but the Politics which give rise to your local truth.

When my truth and your truth are allowed to differ depending on the differences between us, then the differences between us can no longer even claim to be ignored–simply because these differences play far too great a role in our social discourse. Universities used to be places where we could escape the petty confines in which we had been bound by race, nation, status or class. Some universities of today seem determined to reinforce these schisms rather than to replace them with the ideal of the universal community of scholars.

Academic discourse too frequently focuses on where its students “are coming from” rather than on where they might be trying to go.

In more innocent times the Skeptics existed to challenge pseudoscience and the paranormal by applying the universally accepted standards of scientific method and logical argument which had been accepted since the Enlightenment.

We now face a large and more challenging task–which is to challenge those ideas which would challenge the utility of science and logic itself.

Homeopathy – Witchcraft for the Times

For a host of reasons which the NZ Skeptic will examine further in a later issue, the so-called “natural health” industry is enjoying a remarkable resurgence. One cannot refute the argument that we should take responsibility for our own health and that we should not expect modern medicine to provide on demand pills to cure all our ills, particularly those which are self-induced or the result of old age. Moderation in all things (including moderation) will generally help any of us to lead a vital and active life.

However, a host of charlatans have now hitched their star to this valid need to take some responsibility for our own health, and are busy peddling nostrums which are useless at best and harmful at worst. These new medical and psycho therapists follow the proven pattern of the Greenshirts by promoting fears and frights and then providing the cure to the fancied ills. Read any natural therapy propaganda and you would think that rather than being the best fed, healthiest and longest lived population that has ever lived, we are all being poisoned and driven to untimely deaths by a combination of conspiracy theories and the fruits of civilisation. It’s a dirty trick but it seems to work.

Just as people who don’t believe in astrology believe in it, so homeopathy in particular seems to have crossed the border from fringe medicine into widespread acceptance. A commitment to homeopathic practice is now presented as evidence that some natural healing clinic is legitimate rather than promoting plain quackery.

The best way to deal with this belief is to set down in print the principles of homeopathy as first espoused by its inventor Dr Hahnemann. Readers can then judge for themselves whether they are can seriously subscribe to such a treatment regime as we near the end of the twentieth century or whether they should laugh it off as voodoo magic in modern dress or drag.

Any medical historian will recognise that Dr Hahnemann got off to a good start. He developed his system towards the end of the eighteenth century at a time when a trip to your doctor was almost certain to make your condition worse and probably kill you. All of Louis XV’s brothers and sisters were killed by their doctors. Louis XV survived only because his nanny hid him whenever the doctors made a palace-call. In such dangerous times any system of treatment which genuinely did no harm was bound to look successful by comparison. If Louis XV’s nurse had been really smart she could have promoted a new medical regime called “underbed-therapy” or similar based on forcing the patient to lie under the bed for an hour at a time. After all, it had saved the life of a future king. The royals of Europe were a tight-knit club. Hahnemann’s success with the royal families of 18th century Europe is evidenced by the house of Windsor’s belief in homeopathy to this day.

If any of us had been alive as commoners in those times, we too would have been well advised to visit Dr Hahnemann rather that suffer exposure to the contemporary regimes of bleeding, emetics, enemas and other horrors. (Curiously, enemas, in the form of colonic irrigation, are making a natural therapy comeback. Learning to water-ski is probably just as effective and more fun.) However, modern medicine has made great strides and most of us expect some systematic diagnosis and intervention from the medical profession rather than a programme of benign neglect.

Here are the cardinal principles of homeopathy according to the man himself:

The Psora (Itch) and Vitalism

The psora is the sole, true and fundamental cause that produces all the other countless forms of disease — the long list which follows includes insanity, rickets, cancer and paralysis. Hahnemann believed that diseases represent a disturbance in the body’s ability to heal itself and that only a small stimulus is needed to begin the healing process. As a man of his time, he believed in the principle of vitalism, which held that life is a spiritual non-material process which can be influenced by dynamic forces such as magnetic influences, the moon and the tides, and so on. [Can they really teach this stuff in a Polytech?]

The Law of Similia

Hahnemann was led to the homeopathic principle after he took a dose of quinine and noticed that the effect of the quinine was similar to that of malaria. He was also drawing on the primitive monism of the time which held that “like is like”, (eating the heart for courage) “like makes like” (idolatry) and “like cures like” (snake-root was used for curing snake-bite). Hahnemann revived Paracelsus’s “Doctrine of Signatures” which declared that herbs would cure conditions associated with the anatomical parts they resembled. [Or this stuff too?] Surely any patient today would run out of the waiting room if a GP suggested such nonsense. But if patients buy into homeopathy they are buying into this whole set of beliefs.

The Law of Infinitesimal Potentising

This law holds that the smaller the dose of a medication, the more powerful its healing effects. Hahnemann taught that substances could be potentised (i.e. “their immaterial and spiritual powers released”) by sequential dilution of remedial agents by “succussion”, in which mixtures would be shaken “at least 40 times”, nine parts dumped and nine parts solvent added and shaken again. Hahnemann held that tapping on a leather pad or the heel of the hand would double the dilution — which is patent nonsense. [How do you present this in the class without bursting out laughing?] The laws of chemistry tell us that there is a limit to which a substance can be diluted without losing the original substance altogether. This limit, called Avogadro’s number, corresponds to “homeopathic potencies of 12C” or 1 part in 1024. At this dilution there is less than a 50% chance that even one molecule of the original active material remains. Hahnemann recognised this apparent anomaly but explained it away in metaphysical terms — i.e. by witchcraft.

So we find that Hahnemann’s texts recommended highly diluted coffee as a cure for “sleeplessness, digestive, urinary, respiratory and heart symptoms” and diluted tincture of tarantula (that’s right, the big hairy spider) to treat “mania, hyper-activity, chorea and septic outbreaks”. One suspects he was shrewd enough not to recommend highly diluted alcohol as the rapid route to drunkenness.

What all this means is that if you visit your pharmacist and buy a liquid homeopathic remedy, you are buying “diluted water”. If it comes in crystal form then the diluted water will have been dropped onto sugar crystals, and you are parting with your hard-earned cash for “evaporated diluted water”. We can see why there is a buck in it and why naturopaths are so keen on homeopathic remedies. Selling diluted water beats the hell out of spending millions of dollars on systematic research to find some effective pharmaceutical and then spending hundreds of millions on clinical trials and registration procedures around the world. Of course, such a “medicine” can do no harm and nine times out of ten the body truly does heal itself just as the naturopaths claim. Again the homeopaths keep well away from broken bones, severe bleeding, brain tumours, or raging infections where the patient demands real and immediate results.

The defenders of homeopathy argue that even though the whole system appears to contradict common sense (i.e. that a diluted scotch will be more intoxicating than a neat shot) there is evidence that the system works and that numerous publications endorse this efficacy. (John Eisen of the AIT Press quotes the famous 96 papers at every opportunity)

The most famous recent study which appeared to demonstrate an operative mechanism was a report by a French scientist working at that country’s prestigious INSRM institute. His paper claimed that high dilutions of substances in water left a “memory” which explained their “efficacy”. Subsequent investigations proved that the research, which was funded by a major manufacturer of homeopathic medicine, was “improperly carried out” and the scientist was subsequently suspended.

A 1991 survey of 107 controlled trials appearing in the 96 published reports (the list quoted by John Eisen) found that “the evidence of clinical trials is positive but not sufficient to draw definite conclusions because most trials are of low methodological quality and because of the unknown role of publication bias.” An earlier study (1984) also concluded “It is obvious from this review that despite much experimental and clinical work there is only little evidence to suggest that homeopathy is effective. This is because of bad design, execution, reporting, analysis and particularly the failure to repeat promising experimental work…”

In the tradition of scientific literature this is “damning with faint praise”. We should take of note of Thomas Paine’s famous question “Is it easier to believe that nature has gone out of her course or that a man would tell a lie?”

The NZ Skeptic is not suggesting that homeopathy be banned. But this short essay should encourage readers to ask themselves whether they should be tempted to buy overpriced dilute water — given that homeopathic theory would suggest that a quick dip in a spa pool should cure every disease known to man — or at least those of those who have dipped before you. And we should also ask if such mumbo jumbo can be taught in a tertiary class-room given that it cannot possibly be the subject of informed and critical debate. It is simply not possible to believe in modern physics and chemistry, or even the principles of mathematics, while believing in homeopathy. If the New Zealand Qualifications Authority decides to endorse the establishment of a School of Witchcraft, then homeopathy will have found a home, for that is where it belongs.

Pseudoscience and the Midwife

Recent issues of the Skeptic have contained expressions of puzzlement at some subjects being taught to tertiary students in New Zealand. The worst example is the Degree in Naturopathy planned for Aoraki Polytechnic. But is this really all that surprising?

Currently, health courses in polytechnics are including all manner of “alternative” medicine instruction as part of core courses. In my experience, the worst offenders are courses in midwifery.

Most midwives in New Zealand train for one year at a polytechnic, having previously completed a three-year course in nursing. There are three-year direct entry courses, but these are quite new and their first students have not yet graduated.

I teach anaesthetics in the one-year course at Wellington. The time allocated to me is one hour. The senior tutor also teaches this topic for one hour, a total of only two hours’ formal instruction in the whole course.

How relevant is anaesthetics to midwifery? I agree that the amount of knowledge needed by a midwife in this area is limited, but it is not generally recognised just how dangerous anaesthesia can be in the pregnant female. General anaesthesia is the third or fourth commonest cause of death in labouring women in the developed world. The situation is worse in Japan, where it ranks first or second. (The “or” is included because figures change from year to year. The United States has pushed anaesthesia down a slot as a cause of death in pregnant women by bringing gunshot into the top three.)

The point I am hoping to make is that anaesthesia can have a major impact in obstetrics, and I, for one, think that anyone involved in the care of pregnant women should have a sound background in the principles of anaesthesia, and why it can be so dangerous.

So is two hours enough? An open question, but homeopathy gets more than twice as much formal teaching time, and I assume the tutors are paid out of taxpayers’ money and student fees.

Midwives as a group seem to have a fascination with homeopathy. When challenged, defences range from “scientific proof” to “patient choice”. I will disregard the first of these, except to say that I have yet to be offered science or proof in any discussion of homeopathy with a midwife. (As an aside, the weakest defence I have heard is that the Queen is interested in homeopathy, so there must be something in it. These days, one would have thought that royal patronage of anything was guaranteed to ensure its failure, but I digress.)

“Patient choice” is fast becoming the defence of scoundrels. Should patient choice be the final arbiter in medical practice? It is a nice, politically correct idea, but choice is limited to what is realistically available. To defend the inclusion of something in a professional curriculum purely because the students or the patients are interested in it is lacking in sense and responsibility. I would guess that midwifery students might also be interested in skiing and wine tasting, and their potential patients may express an interest in Fascism or safe-breaking. Following along the lines of “choice” may lead to a more entertaining course, but would it advance the care of mothers and babies?

The whole question of choice leads onto the matter of informed consent. Does a midwife who uses homeopathy fully inform her patient (sorry, sorry; I should say her “client”) that she is using something that is unrecognised as a form of scientifically proven medicine, and that its use may put the patient (“client”; there I go again) beyond compensation by ACC should something go seriously wrong? Like hell she does.

Homeopathy is not the only intruder of its type in midwifery. Acupuncture is praised not only for its analgesia, but also as a means of inducing labour, stopping early labour, and turning breech babies the right way up before delivery. Aromatherapy has its advocates, and I have attended a labouring mother whose midwife insisted on having a lighted candle in the room as part of her client’s care. (Delivery rooms are oxygen-enriched environments, and she was not happy when I refused to proceed until the flame was extinguished. The hospital fire officer was even less impressed when I referred the matter to him.)

I was horrified recently to hear of the advice offered to the wife of one of my junior colleagues. She is expecting her second baby, and the baby has turned breech — i.e. bum first instead of head first. A midwife told her that she should lie flat on her back with her feet up until she felt dizzy and breathless, then walk around for a while. This was to be repeated several times a day, and would turn the baby back to present in the proper manner.

Anyone with the slightest knowledge of the physiology of pregnancy should know that if the mother is becoming breathless and dizzy, the baby is likely to be in an even worse state. In late pregnancy, lying flat can pose a significant risk to mother and baby, as the weight of the uterus can press on the aorta, reducing the blood supply to the placenta, and also on the vena cava, reducing the blood flow back to the mother’s heart.

Needless to say, the advice was ignored and the prospective parents are due to see a consultant obstetrician.

Pseudoscience is alive and well in the midwifery world, and is being taught to midwifery students.

The Challenge to Reason

Tertiary institutes around the country are beginning to offer courses, and even entire degrees, in subjects that are pure pseudoscience.

The Aoraki Polytechnic has applied to the New Zealand Qualifications Authority seeking approval for its proposed Bachelor’s Degree in Naturopathy. If approved it will be the first degree programme of its kind in this country.

With generous assistance from all of us, the Northland Polytechnic is offering a course in Astrology. (Only $25.40 on study-right, but the full $50.70 non-study-right). Evidently the tutor was a scientist until his teacher “who was recognised as an incarnate lama or tunku by the Tibetans” instructed him in Tibetan Tantric Buddhism. After several months’ psychotherapy in Morocco he went to India where he was empowered by the Sakyapa Lama. Evidently this powered him to Kerikeri where he now lives in a bus.

In the meantime, the Auckland Institute of Technology Press has been pouring out a stream of pseudoscientific books dealing with subjects ranging from faces on Mars to conspiracies to repress benevolent inventions and most recently The Poisoning of New Zealand.

This last book promotes the homeopathic line that increased dilution increases potency. (Sadly it doesn’t work with alcohol.) This leads to the remarkable conclusion that while concentrations of pesticides in our food and water may be well below those found toxic in laboratory experiments, extreme dilutions, of say one part per billion, are much more dangerous than concentrations of one part per hundred thousand.

In sum we have tertiary educational institutions subsidised by taxpayers offering courses and publishing books which are based on pseudoscience and superstition.

Does this matter?

It depends on your point of view. The Minister of Education has suggested that if there is a demand for these subjects then maybe the institutions have a duty to offer them –although he sounded as though he did not want to be seen as putting himself in the way of an employment opportunity. And we have to admit that naturopathy signboards (untreated timber only) are springing up like daffodils around our suburbs.

Science and Democracy

I happen to believe, along with Karl Popper and his many disciples, that there is a connection between the proper functioning of democracy and the rational or scientific approach to solving problems and learning about the world.

Since the days of the Enlightenment we have tended to the view that rational thought is the best basis for political action. Democratic government knows that there is no Utopian model of the static perfect society, just as science knows that no theory is ever finally proven to be true. The scientific method progresses towards truth without ever reaching it, while the democratic process “muddles through” to a better world by a process of continual experiment, debate and reform.

It is no coincidence that those who attack democracy look to pseudoscience to support their cases. The Socialists looked to the pseudoscience of Marxism, the laissez-faire anarchists of the nineteenth century looked to social (pseudo) Darwinism, while the Nazis blended social Darwinism and eugenics (pseudo-genetics) to boost their nationalistic dreams of a master race.

These days the centralists find support in the pseudoscience of the apocalyptic environmentalists, whose message is that democracy is unable to meet the challenge of the forces which “threaten the planet”. They make these claims even though the centrally planned states of the Eastern block appear to have committed ecocide. The miracle is that they could pollute so much while producing so little.

University Unreason

Yet contemporary Western society now seems hell-bent on destroying its faith in reason. The deconstructionists and post-structuralists in our universities now argue that there is no knowable truth, that science is no different to any other body of knowledge or superstition, and that students should not be taught a body of knowledge but should be encouraged to construct their personal models of the world. American universities, cringing under a wave of political correctness and an extreme form of “multi-culturalism”, are abandoning programmes which present the history of Western Civilisation as anything other than the history of the rape and plunder of minorities and other victims by a conspiracy of middle-class white males.

Given this widespread attack on science and rationality, it comes as no surprise to find that our tertiary institutions appear to be ready and willing to mount degree courses in naturopathy, including homeopathy and iridology.

The test of a scientific theory is that it can be refuted by an experiment or trial. Homeopathy has been subject to numerous trials and has yet to demonstrate any benefit other than those attributable to the placebo effect. This is not surprising, given that homeopathic medicine is water in which a potent substance has been diluted to levels where there is virtually no chance that an original molecule of the potent substance survives.

These are truly “dilutions of grandeur”. Frequently this “diluted water” is absorbed into a sugar crystal for packaging and will have typically evaporated by the time the patient gets round to taking it. The argument that homeopathic medicine can do no harm is almost certainly sound –what harm can be done by a dose of evaporated diluted water?

Against all this evidence the belief in homeopathy survives.

This raises the question of how a tertiary institution can possibly teach such subjects within a genuine environment of learning and research. Universities and polytechnics are supposed to encourage free and informed debate. If students of homeopathy come to an examination armed with all the published refutations of the practice, would they be able to pass the course? Probably not. Homeopathy is a belief system like astrology or witchcraft. You either believe it or you don’t, and any refutational evidence is dismissed as somewhat irrelevant. The standard argument is that sceptical observers cause bad vibrations which interfere with the efficacy of the treatment.

Can we really tolerate a course within a tertiary institution which argues that healthy scepticism interferes with proper analysis?

Wheat Amongst the Chaff

The proper place to present the field of natural medicine, or its more legitimate cousin, the whole body approach to medicine, is within the school of medicine itself. At least it will be subject to debate, and the wheat can be sorted from the chaff. And there is real wheat in there. Modern medicine has gone too far in the pursuit of the science of medicine as opposed to the art of healing. The placebo effect is powerful and we need to learn how to harness its potential to achieve maximum benefit. But we will make no progress while such investigations are accompanied by nonsense such as iridology or EVA, and where belief cannot be subject to critical experiment and refutation.

Where does the AIT Press fit into this? There are a host of publishers making money out of publishing the latest hocus pocus on the works of Nostradamus or whatever else is providing the latest means of extracting dollars from the gullible. Many readers are trying consciously to make sense of the widely differing views of the world presented by the Uri Gellers on one hand and the Stephen Hawkings on the other. If they wander into a library or bookshop and find a book on repressed inventions, or the international conspiracy to poison us all with pesticides, such readers are likely to assume that books published by the Auckland Institute of Technology (which could be expected to share the aspirations of MIT — otherwise why did the ATI change their name to AIT?) will have been subject to a higher standard of editorial criticism and intellectual rigour than the latest piece of flim flam from the “Centre for Zodiacal Peace Freedom and Inner Radiance”.

Well, I am sorry, they would be wrong. It looks as though the AIT has decided if there is a buck in it, they publish. And no doubt their response to this criticism will be to blame the government for not giving them enough money to start with. Is this an excuse to abandon principles?

Surely this is simply bad business practice on the part of the AIT. The AIT teaches courses in business, which presumably advise students that the most important asset of a modern organisation is its intellectual property. I would have thought that a critical part of the intellectual property of any tertiary institution would be its reputation for intellectual rigour and honesty. This reputation must surely be debased by a publishing house which is fast becoming a bad joke among the critical and informed readers of this country. I certainly would not recommend attendance at AIT to anyone I know if these publications represent the polytechnic’s attitude to the pursuit and dissemination of knowledge.

So the Qualifications Authority should stand firm and give accreditation only to those courses in medicine, science and technology which admit to critical analysis and are prepared to expose themselves to the normal standards of the scientific process — which means that if a belief is disproved then it must be abandoned.

Do Believers Really Believe?

One of the problems with naturopathy and similar belief systems is that even people who don’t believe in them believe in them. This may sound like nonsense. But if you are one of the many readers who are upset by these arguments and have some belief in naturopathy in any of its manifestations, ask yourself this question:

You have just had a terrible car accident. You are lying in the road and feel your life ebbing away and you suspect that other members of your family are in a similar state. A crowd has gathered around, but no-one is equipped to deal with the carnage. Then you hear dimly that wonderful sound, “Step back, make way! Step back, make way!” At last, you think, help is at hand. And then the final chant is “Step back, make way, here I am — and I’m a qualified naturopath”.

What do you believe in now?

We have to recognize the inability of modern medicine to meet the unrealistic expectations it created in the fifties and sixties. These have created a market driven by those who believe that their chronic ailments must be able to be cured by some magic medicine and will keep on searching until they find it. During the process the body often cures itself — and so success is frequently found and the last treatment is declared effective.

This process has opened the door for the irrational to enter our institutions of higher learning and to further close the door on freedom of speech and expression. You may not think this is a bad thing — especially if it provides a few more people with work and earns some money for the education system.

But how would the Minister of Education respond to a proposal to set up the Divine School of Engineering, or the Natural Light School of Veterinary Science, or the Tantric School of Economics? How will you feel when the building inspector uses an EAV meter to decide whether your building is earthquake proof or an acupuncturist is called in to test your herd for bovine TB or a Tantric Guru is appointed Governor of the Reserve Bank?

How come we would be prepared to let these people play games with our health, but not with our buildings, our cattle or our economy?

Hokum Locum

NZ Qualifications Authority

An editorial in the Christchurch Press (23 Nov 94) was critical of the Universities who are seeking approval from the NZQA and argued that they should continue to set their own high standards.

The Aoraki Polytechnic has applied to the NZQA for recognition of a Bachelor Degree of Applied Science (Naturopathy). Naturopathy can mean anything from treatment with homeopathic remedies to colonic irrigation. I wrote to the NZQA and was told that the Aoraki application “involves review by a panel of peers…having a mix of professional and academic backgrounds.” I await the decision of the panel with considerable interest as the thought of a Bachelor of Applied Science (Naturopathy) holding equal weight with say a Bachelor of Applied Science (Biochemistry) is completely ludicrous.

Recovered Memory Syndrome

“ACC payments of $10,000 to three women who recalled `memories’ of rape and abuse as children are to be re-examined after aquittal of their father.” However, unbelievably, ACC’s Fred Cochram says “it is possible for people’s suffering to be deemed valid for compensation even if abuse was disproved in the courts! (Dominion Oct 5 1994)

It is absurd that at a time when ACC is making it more and more difficult for victims of genuine accidents to gain adequate compensation, they continue to provide money for the fraudulent activities of an army of counsellors who are poorly trained and following their own feminist agendas.

Sporting Excesses

I have previously commented on the insane activities of athletes who take performance enhancing drugs which in many cases do enhance phsyique but have no more than a placebo effect on performance. (Skeptic 28)

A former Russian gymnast alleged that her trainers forced her to become pregnant and then have an abortion because “the body of a pregnant woman produced more male hormones and could therefore become stronger.” (Christchurch Press 24 Nov 94)

There has been much speculation about possible illicit practices by Chinese athletes. I think we can reasonably discount anything other than a placebo effect from a secret elixir containing “turtle blood, ginseng and other spices” used by China’s track team. Why “turtle blood” for runners? Surely it would be more logical to give it to their swimmers? In fact it doesn’t really matter what the product contains because the Chinese expect to sell about 20,000 bottles of the quack tonic in Japan.

Eleven of China’s long distance runners have had their appendices removed because “they were getting sick and having toxicological problems.” Leading sports doctors were reported as being puzzled and amazed. (Marlborough Express 13 Oct 94) I am neither puzzled nor amazed as China continues to be a rich source of medieval superstition and quackery such as acupuncture. Medical history tells us that it was widely believed that “toxins” were a cause of many ailments and as a result people were purged, had all their teeth removed, tonsils extracted and any organs such as the appendix were also removed. In some cases patients had their entire large colon removed and enjoyed diarrhoea for the rest of their lives. When history is ignored it tends to get “rediscovered”.

Turbulent Priests

A rather extreme Catholic school principal and priest has refused to give his pupils a combined vaccine because it was obtained from cell culture originally obtained from an aborted foetus in the 1960’s. I have no argument with any religion provided it does not interfere with the state but the Catholic religion has an unenviable reputation for continually interfering with public health issues.

A more recent example is their attempted sabotage, along with Muslim extremists, of the recent global conference on population planning. (Marlborough Express 27 Oct 94).

Medicines

Correct me if I am wrong, but I think it was GB Shaw who said that the main distinguishing feature of humans from animals was their desire to take medicines.

Health expenditure in Switzerland reached 18 billion pounds last year of which drugs were 10.7 percent. About 60 percent of all drugs are available over the counter (OTC) and the Swiss are at the top of Europe’s self-medication league. (The Lancet Vol 344 p322).

The New Zealand drug bill shows a healthy annual growth rate and is rapidly approaching the NZ$1 billion mark. One Government attempt to control these excesses was thwarted by GP’s who simply prescribed more drugs on each prescription. If people wish to poison themselves with drugs I think we should follow the Swiss example and make them available OTC. People can then personally pay for their drugs which will not detract from the health vote. The oral contraceptive is incredibly safe for OTC availability, however there is an excellent case for requiring a prescription for cigarettes.

Prozac is a new antidepressant drug which may be safer than exisitng drugs but is also much more expensive and has been already grossly over-prescribed in the US. There is already considerable pressure to allow its unrestricted use here in New Zealand.

Christmas Shopping Blues?

A major trial has found that the drug Fluvoxamine prevented compulsive shopping in all seven patients. Fluvoxamine is frequently used to treat obsessive-compulsive disorder which causes people to repeatedly wash their hands, pull out their hair or to hoard strange objects. It could also help doctors who repeatedly over-prescribe drugs.

Over-investigation

The medical model applied when I went through medical school suggested that patients had either an accepted organic illness or something less well defined such as “conversion disorder” ie. stress producing symptoms and signs. (eg. RSI or OOS) The evolution of investigative technology means that this model has the potential to be mis-applied.

I will quote in full an item from the BMJ Vol 309 p420). Irritable bowel syndrome is a condition where people complain of abdominal pain and constipation for which no cause is found.

“Six patients with the irritable bowel syndrome between them had 29 operations and 46 investigations, says a report in the Scottish Medical Journal. It warns that other studies have shown that around one third of patients with the disorder have appendicectomies and half the women have major gynaecological operations.”

I recently saw a woman with a clear history of hyperventilation syndrome (over-breathing, similar to what happens when blowing up a balloon) which causes neurological disturbances. The patient had had a CAT scan and an electroencephalogram after which a (foreign) neurologist prescribed Tryptanol (an antidepressant), Prednisone (a steroid anti-inflammatory) and Dilantin (an anti-epileptic)! Presumably this lethal cocktail was prescribed “just in case”.

Sickness Benefit Abuses

As I outlined in a previous column (Skeptic 32), all that is needed to get extra money when unemployed is a certificate from a doctor saying that you are “sick”. Not surprisingly there has been a steady growth in the benefits industry since most doctors derive their income from signing forms. In 6 years the number of people on sickness benefits went from 20,000 to 34,000. When combined with the invalid benefit this costs nearly 1 billion dollars annually. (Evening Post 18 Nov 94)

The cause of this fraudulent activity is the discrepancy between income support and invalidity benefit. A British GP (BMJ Vol 309 p673-4) noted that 23 out of 24 of his drug addict patients were receiving invalidity benefits despite guidelines that GPs should not issue sick notes to drug users unless they have a co-exisitng medical or psychiatric condition. In New Zealand I have known of drug addicts getting both sick notes and their drugs from the same doctor!

I am pleased to see that our own Social Welfare Minister has acknowledged that the numbers on such benefits falls once a more consistent policy is taken to assess eligibility.

Breast implants

A judge in Alabama has approved a US$4.25 billion compensation deal for more than 90,000 women worldwide with silicon breast implants. Many women have suffered proven ill-health but those who have difficulty finding an excuse to get their pot of gold can claim for “silicon disease”. This only requires at least five of a range of symptoms, including rashes, chronic fatigue, muscle weakness and memory loss. These are of course very vague symptoms and could be attributable to a wide range of other conditions such as CFS and alleged chemical “poisoning”.

NHS goes bananas?

GPs in the UK National Health Service (NHS) have won a partial refund for their patients who are spending $1250 on transcendental meditation courses. TM is an invention of an Indian guru and has no legitimate place in any health system. The Beatles flirted briefly with TM but became disillusioned when the guru persisted in making sexual overtures to their girlfriends.

Smoothing away the years

Need a face-lift? Look no further than CACI (computer aided cosmetology instrument). CACI delivers a tiny current to the skin and muscles in order to “re-educate muscles”. It is allegedly FDA approved. I have written to NCAHF to check this claim and will report in due course.

Best wishes for the New year to all readers and don’t forget Fluvoxamine if you feel a Christmas shopping compulsion. If Christmas awakens repressed memories of ritual satanic abuse at the hands of Santa I recommend a $10,000 payout from ACC will also help with the shopping.

Hokum Locum

MSG Myth Laid to Rest

Another sacred cow from my medical school days has been laid to rest. A letter in the New England Journal of Medicine in 1968 triggered a rash of anecdotal reports about facial flushing allegedly caused by monosodium glutamate (MSG) in Chinese food. “Chinese restaurant syndrome” had entered the popular medical mythology. Finally, 26 years later, two Australian scientists conducted a double-blind placebo controlled trial and found that some reaction to MSG was experienced by 15% of the subjects but the same reactions were also experienced by 14% of the placebo subjects. The scientists believe that the true cause of Chinese restaurant syndrome are histamine compounds found in fermented ingredients such as soy sauce, black bean sauce and shrimp paste. New Scientist 15 Jan ’94 p15

Poppycock

A US plastic surgeon found that the majority of his patients presenting for operative penile enlargement were motivated by anxiety over the size of their privy member rather than its performance. In fact one patient’s partner reportedly phoned the surgeon before her husband’s operation and told him she would rather have a fur coat! (GP Weekly) The procedure of penile enlargement was developed in China by the appropriately named Dr Long Daochou.

This absurd operation is not at all unusual in a culture where people also have silicon inserts into their muscles in order to look good at the beach. In fact, Ken and Barbie dolls are good models for such people who prefer plastic moulding to the real thing. Speaking of which, Barbie now has her own spiritual “channeller” (Barbie:”I need respect”!) and a “Barbie Channelling Newsletter”. Sadly, Barbie’s cries for help were treated with derision by Mattel Corporation who threatened the channeller with a multi-million dollar lawsuit. Sunday Star Times 5 June ’94

Naturopathology?

I was absolutely stunned to read in the Christchurch Press (12/8/94) that the Aoraki Polytechnic in Timaru is planning to offer a three-year Bachelor of Applied Science in naturopathy. Incredibly, the Qualifications Authority (QA) will be visiting the polytechnic to assess the course. The list of “basic sciences” to be studied includes herbal medicine (Kentucky fried medicine) and homeopathy (dilutions of grandeur). Is there anyone out there with any influence on the QA? Should market forces be allowed to dictate what constitutes a “basic science”? These are serious questions.

Psychobabble?

Can anybody help me come to an understanding of post-traumatic stress disorder (PTSD)? I know it is the new term for what used to be called “shell-shock” but can anyone tell me if the condition is seen in societies which do not have compensation available and are therefore not subject to Welch’s law (see NZ Skeptic 32).

Three passengers on the cruise liner Mikhail Lermontov were awarded a total of nearly $300,000 compensation for PTSD and a further 18 plaintiffs are waiting for their pot of gold. In order for PTSD to have a valid aetiology there must be an equal incidence of cases in the NZ passengers.

I briefly mentioned similar cases related to military service (NZ Skeptic 32) and most people will have heard about “Agent Orange” and alleged links with ill-health in Vietnam vets. It proved cheaper for the manufacturer to settle out of court but this decision has now entered the popular mythology as proof of causation.

Gulf War veterans (something of a misnomer since very few saw any active service) are claiming that symptoms such as fatigue and memory loss constitute a syndrome for which they will no doubt be claiming compensation. (NZ Skeptic 31) I have been following this saga in the medical literature, and investigators are coming up with ever more fanciful theories to explain what is nothing more than mass hysteria. Christchurch Press 14/6/94

Medical News

A therapist who become famous through treating Diana, the Princess of Wales, has been ejected from his Harley St consulting rooms because his claimed medical qualifications were found to be bogus. Presumably he must have had some success with his treatments but the real Harley St doctors were offended and he had to go. What about the opposite situation — real doctors who persist in offering bogus treatments? We have plenty of these in New Zealand and a medical registration system which can do absolutely nothing about the situation!

There will be no sensible policy on smoking in Israel because the acting health minister, Prime Minister Rabin, is a chain-smoker and refuses to sign a bill prohibiting smoking in public places!

Finally, a common inclusion in 17th century Dutch paintings of women visiting the doctor is a charcoal burner and string. The string was burnt near the nose of hysterical women so the fumes can drive the “wandering uterus from the woman’s upper body back to its proper place in the pelvis.” A quaint theory which has been replaced in our time with food and multiple chemical allergy, RSI, CFS. Have we made any progress? Lancet Vol 343 p 663, BMJ Vol 308 p606, International Express 31/8/94.

Mass Hysteria

Some of you will have noted the derivation of hysteria from the Greek “hysteros” for the female uterus which was thought to wander about the body causing hysteria.

Many of you will remember two cases in the US (where else?) where “poisonous” patients caused ill-health to their medical attendants. The first case concerned a 31-year-old woman receiving chemotherapy for cervical cancer. Following the taking of a blood sample in the emergency room, a nurse noted a smell and promptly passed out followed by other emergency team members. Following exhaustive tests no toxic chemical was found and I quote “no one seems to have seriously attributed the mystery illness to hysteria”. The second case followed a similar course.

Both of these cases are in fact classical examples of mass hysteria which is an unfortunate term with connotations of misbehaviour. Mass hysteria is better described as a contagious psychogenic illness. Psychogenic refers to the production of physical symptoms under conditions of stress and should not be confused with neurosis or malingering. The classical sequence of events begins with a generalised belief about a toxic substance in the workplace followed by a precipitating event, typically, as in the above example, a smell. This perceived threat to health and safety leads to psychological arousal and typical symptoms and signs such as dizziness and fainting. There have been many examples of mass hysteria in New Zealand — the Parnell civil defence emergency 1973 (NZ Med J April 28 1982 p277 and also Australian and NZ Journal of Psychiatry 1975 9:225) and the ICI Chemical fire. Occupational overuse syndrome and sick-building syndrome are good examples of mass hysteria in the workplace.

See Scand, J., Work Environ Health 10 (1984) 501-504) for a good review on the subject.

Bioenergetic Medicine

An advertisement for a course in bioenergetic medicine in GP Weekly (25/5/94) recently caught my attention. The location was the same place where I did a week-long basic acupuncture course in 1987. I spent a week and about $1,000 in total expenses learning a practice which is totally unscientific and can be taught in about half an hour to any intelligent skeptic.

During my course the tutor introduced a market-gardener with alleged “allergy” to tomatoes. The patient was connected up to a Vega machine or equivalent and we were given a demonstration of how his muscle strength was diminished when exposed to the killer tomatoes. A container of steroid was then introduced into the circuit and the muscle “weakness” was cured.

Unfortunately one of the other skeptics in the room had actually removed the vial of steroid from the box and revealed it at the conclusion of the demonstration. Incredibly, the tutor was unfazed and attributed the “improvement” to steroid residues (presumably homeopathic) in the box! Truly a graphic demonstration of the power of belief, one which got me interested in active skepticism as a scientific philosophy highly relevant to my own chosen area of medicine.

I suspect that bioenergetic medicine is very similar to applied kinesiology (AK) where muscle strength is tested while a person is subjected to various influences such as foods, vitamins, homeopathic remedies etc. Controlled studies of AK have repeatedly shown that responses are random under conditions where both tester and test subject are unaware of the substance being tested. My own anecdote is a good example of this. NCAHF Vol 17 No 3 has a brief overview

Fraudulent Food & Drink

Yuri Tkachenko, of the resort town of Sochi, has been given permission by city authorities to “magnetise” the Sochi river and thereby lessen the flow of pollutants into the Black Sea. As the river water quality is obviously a little suspect you might like to try some of his “magnetic” vodka which is guaranteed not to cause hangovers.

On the other hand, if you are mainly worried about getting rid of heavy metals, look no further than a new Hungarian oat-bran extract guaranteed to soak up lead and radioactive strontium carried in the blood stream. The pill, Avenan, has been developed by Lajos Szakasi who needs few lessons in the marketing of quack remedies. Avenan will go on sale as a health supplement rather than a medication because “it can be approved after a simple registration procedure”. To quote Lajos again “I believe the product will be successful because…people will always spend on their health.”

More fantastic still is a report from Japan where Kazu Takeishi has been arrested for giving medical advice and medicines without being properly qualified. It all began with his “healthy” vegetable soup which can be mixed with urine to become a miracle medicine, particularly effective against AIDS and cancer. Kazu claimed to make his diagnoses by touching patients’ knees and the palms of their hands. Like all good quacks Kazu is sure of his market and it’s a good one — $30,000 a day and a two-month waiting list (must have been getting behind on the urine supply). Cancer is a taboo subject in Japanese culture and doctors are even protected in law from informing patients about such a diagnosis.

Now, if I could get the recipe for this soup, I could mix it with urine and treat cancer patients for $300 per consultation and there is nothing the medical council can do — because I’m a doctor!