Oxygenated food for the brain?

Alison Campbell finds some claims about raw foods hard to swallow.

I was reading a couple of articles about ‘raw foods’ today. This is ‘raw foods’ as in ‘foods that you don’t heat above 40°C in processing them.’ It’s also as in, a vegetarian diet. (I do rather enjoy vegetarian food, but I don’t think I could eat nothing but, all the time; I like meat too much.) Anyway, what caught my eye wasn’t so much the diet programme itself but the mis-use of science to promote it. That did rather get my goat broccoli.

Apparently you should get your kids to eat their greens (along with the rest of the diet) by telling them that plants do this wonderful thing: they turn sunlight into chlorophyll and – when you eat it – it will give you extra oxygen. Sigh&#8230 This concept was repeated in the second article, which told me that raw (but not cooked) foods are ‘oxygenated’ and thus better for your brain, which needs to be fully oxygenated to work properly.

Well, yes, and so do all your other bits and pieces, and they don’t get the oxygen from food. As Ben Goldacre once said, even if chlorophyll were to survive the digestive process and make it through to the intestine, it needs light in order to photosynthesise, quite apart from the fact that you don’t normally absorb oxygen across the gut wall. And it’s kind of dark inside you.

The second shaky claim related to digestive enzymes. Because raw foods are ‘alive’ then they are full of enzymes. And so we’re told that eating them will help you to digest your meals better.

Er, no. First, because when said enzymes – being proteins – hit the low pH environment of your stomach they are highly likely to be denatured. This change in shape means that they lose the ability to function as they should, and in fact they’ll be chopped up into amino acids like any other protein in your food, before being absorbed and then used by your cells to make their own enzymes.

And second – the raw foods diet is plant-based. Yes, plants and animals are going to have some enzymes in common. I’d expect that those involved in cellular respiration and DNA replication/protein synthesis would be very similar, for example, because these are crucial processes in any cell’s life and any deviations in form and function are likely to be severely punished by natural selection. But we already have those enzymes; they’re manufactured in situ as required. In other words, even if the plant enzymes somehow made it into cells intact and capable of functioning, they’d be redundant.

However, with a very few exceptions, plants aren’t in the habit of consuming other organisms so, in regard to plant cells being a good source of the digestive enzymes required for the proper functioning of an omnivore’s gut – no, I don’t think so. No.

Some might ask, why on earth do I bother about this stuff? After all, it’s not doing any harm. But the thing is – science is so cool, so exciting; it tells us so much about the world – why do people have to prostitute it in this way? Kids (and others) are fascinated by the way their bodies’ organ systems work, and I can’t see why there seems to be a need to provide ‘simple’ – and wrong! – alternative ‘explanations’ when the real thing is so wonderful.

Hokum Locum

Bogus chiropractor?

I thought they were all bogus! A Motueka man, Michael Dawson, was fined $4000 for describing himself as a chiropractor. This upset Nelson chiropractor Dr John Dawson who was quoted as saying his “unrelated namesake tainted the industry.” Quite apart from Dr Dawson’s pretentious use of the title ‘Dr’, his description of chiropractic as an industry is particularly apt. It is a massage business based on aggressive marketing and creating a non-existent need for gullible people to have their backs rubbed and clicked.

‘Dr’ Dawson was further quoted: “I’m sure there are a few people out there who have written off chiropractors because of him.” One can only hope.

It’s ironic that Michael Dawson was prosecuted by the Ministry of Health, a body supposedly watching over the health system and now seen to be protecting quacks by picking on unregistered quacks. Michael Dawson claims to be able to cure Hepatitis C and wake people from comas. These are claims that can readily be checked and will prove to be false, like most chiropractic claims.

ACC is currently experiencing budget woes and a great deal of this relates to treatment costs. Chiropractors favour prolonged and expensive treatments which have contributed to this problem. A recent study of back pain found conclusively that chiropractic manipulation was of no benefit (www.medscape.com/viewarticle/580409). This is consistent with earlier findings of the Cochrane Database.

I discovered another reference to an article in the Nelson Evening Mail which confirmed Michael Dawson did in fact have a chiropractic qualification but had failed to gain registration in New Zealand. This registration process is a farce and merely gives spurious respectability to an absurd belief system.

Consider the following; a patient goes to a chiropractor and receives a diagnosis of cervical spine subluxations for which manipulation is administered. The patient suffers an injury to arteries in the neck and has a stroke. The Health and Disability Commissioner (HDC) investigates by asking his ‘expert’ chiropractor whether the treatment was properly administered according to chiropractic tenets. The answer is yes so does this mean the chiropractor is off the hook? The patient can file an ACC claim for treatment injury and loses the right to sue as a result. ACC picks up the tab for an unnecessary and dangerous quack treatment.

While working at the hospital the other night a young man came in with toothache. He knew he had an impacted wisdom tooth because he had been x-rayed by his chiropractor whose course of treatments had extended out to 15 weeks. That’s a lot of subluxations. In a fit of whimsy I recently labeled such extended treatments as ‘chiroprotracted’.

Marlborough Express 22 August 2008

Cosmetic Acupuncture

It appears that there is no end to the absurd claims made of acupuncture. Acupuncture face renewal is now available at Arch Hill Acupuncture. A credulous journalist visited the clinic and reported after only one treatment: “I felt – and looked – like I had spent a week in Fiji.” A complete treatment usually involves 12 visits and I would commend the journalist on the Fiji suggestion, a far better use of one’s money.

Have a browse around the website www.archhillacupuncture.co.nz It contains the usual testimonials seen on such web pages as well as some clues to the success of this particular option. The owner of the business comes across as attractive, pleasant and supportive, all of which are good qualities to elicit an excellent placebo response. As a lot of readers will know, I can teach anyone to be a competent and safe acupuncturist in the course of a one-hour lecture. There is no need for several years’ training when something has no scientific basis.

The owner is quoted as saying: “I liken cosmetic acupuncture treatment to a gardener tending the soil of a plant to produce a healthy flower.” Isn’t that what manure is for?

Sunday Star Times 26 October 2008

The loopy left?

The Labour-run Lambeth Council in South London is spending 90,000 to send reflexologists into schools to massage the feet of unruly pupils. Reflexology is based on the same nonsensical ideas behind acupuncture, that pressure applied to areas on the foot can influence health and behaviour. The article contains a very interesting and important statement linked to what I was saying earlier: “Refexology is not a regulated therapy and medical authorities have raised concerns that qualifications are not needed to perform the massages.” The medical authorities ought to be denouncing this nonsense, not wittering on about ‘regulation’. Regulation merely provides spurious recognition, similar to the ridiculous situation of having ‘unregistered chiropractors’ versus ‘registered chiropractors’.

I fear that political considerations are behind a lot of these dopey decisions. At one of our conferences somebody asked a senior ACC doctor why ACC continued to fund acupuncture when it is an expensive and useless treatment. The answer was given that whenever they tried to cut back on acupuncture spending patients complained to their MP and he would get a call from the Minister asking, “why aren’t you funding acupuncture?”

Given the financial woes of ACC, one can only hope that the new Minister instructs ACC to do something about treatment spending. There are too many snouts in the trough!

Christchurch readers interested in reflexology training will be pleased to know they can do a Diploma course (NZQA accredited level 6) at the Canterbury College of Natural Medicine.

www.dailymail.co.uk

Fluoridation

Bruce Spittle (Forum 89) invited me to review his book entitled Fluoride Fatigue. I can report that I have read parts of it but had to stop because I became depressed. I will leave readers to make their own assessment. It is available free at www.pauapress.com

I would certainly not pay to buy this book which is a collection of anecdotal case reports and quotes from other people who share the author’s views. It is written in the style of the sort of books found in the New Age section of a bookshop or library. Here is an example:

“Neither in the hospital nor after her discharge was she given any medication. Instead, she was instructed to avoid fluoridated water strictly, not only for drinking but also for cooking her food as well. She was also told to avoid both tea and seafood because of their high fluoride content. The headaches, eye disturbances, and muscular weakness disappeared in a most dramatic manner. After about two weeks her mind began to clear, and she underwent a complete change in personality. For the first time in two years she was able to undertake her household duties without having to stop and rest. Within a four-week period she had gained five pounds.”

This is a classic description of the sort of person who gets chronic fatigue syndrome, gulf war syndrome, multiple chemical sensitivity – take your pick. A person with vague symptoms looking for some convenient attribution.

I was interested however in the link to the author’s website on moa sightings. At least the extinction of the moa can’t be blamed on fluoridation.

Apart from both words starting with ‘F’, there is no medical evidence to link fluoride with fatigue (or depression). Fatigue is common and is not a diagnosis. In a random survey of the US population in 1974-75, 14 percent of the men and 20 percent of the women said they suffered from fatigue.

The best place to read well- balanced accounts of fluoridation is a Ministry of Health web page. In contrast, a casual browse through the many anti-fluoridation web pages would make anybody justified in using the term ‘crackpot’.

Bionase

I was forwarded an email from Rod who was interested in some product that shines red light up the nose for treatment of hay fever. I googled “shine red light up nose” and immediately arrived at the web page of Bionase. The product has two nasal probes that shine a red light up the nose. It was claimed that this had been scientifically tested and there was a link to an impressive looking study published in the Annals of Allergy Asthma & Immunology. A search of Medline revealed that this was the only study, described as double-blind and placebo-controlled. The paper appeared plausible but continued reading revealed a fatal flaw. Use of the probes caused the nose to light up red. The placebo device did not do this. The experiment is therefore not double-blind. Whilst not given to predictions I will say that if this trial is repeated with a proper blinding this device will be shown to be useless. It is simply biologically implausible, just like homoeopathic trials claiming to treat hay fever. As somebody once said, if any homoeopathic trail showed a beneficial effect your first action is to question the conduct and design of the trial (google Benveniste).

Magnets repelled

Magnetic fields are no better for your water or your car than they are for your arthritis

Powermax magnetic water-treatment conditioners have been controversial since they were introduced in New Zealand in 1998. Now they’ve been withdrawn and the Consumer’s Institute believes customers are due a refund.

Questionable science

Powermax is simple – two magnets clip to your water pipe. It’s imported by Pat Julian of Julian’s Electrical and Energy Conservation in Inglewood. Julian’s is also the importer of a similar dubious gadget, Fuelmax. Julian has made many claims about Powermax’s powers. These include: eliminating bacteria and parasites; dissolving faecal wastes; removing silt, chlorine and scale; stabilising pH; and stopping diarrhoea in cows.

Julian’s website said Powermax worked on the principle of “magnetic frequency resonation”. That might sound scientific but a Google search shows this was the only website in the world to use the term! The website also gave a brief explanation of how it works. “In simple terms, when the water passes through the magnetic field the magnetic polarity of the molecules reverse. The molecules separate, break down into microscopic size and remain in suspension.”

We asked two professional chemists to assess these claims. Both agreed that the statements were meaningless. One told us it generated gales of laughter from his colleagues. The other said, “It’s all gobbledegook wrapped up with some scientific buzz-words to make it sound authentic to the average Joe Blow.” Neither scientist believed the Powermax could do what it claimed to do. We asked importer Pat Julian about his website and its claims. He said the information on the website came from the manufacturer, International Research and Development (IR&D). “It’s not just something we had dreamed up – we don’t work like that.” Julian also offered to provide customer testimonials.

Questionable products

Readers started asking Consumer’s Institute about Powermax in 1999. We said then we had doubts that the magnets could affect bacteria.

Our doubts were borne out in 2001 when the Commerce Commission took Julian’s to court. Julian admitted that “Powermax does not and cannot” treat water for bacteria, parasites, giardia, cryptosporidium or faecal wastes. “People believing these spurious claims and then drinking or swimming in dirty water ‘conditioned’ by Powermax are at risk of potentially serious illness,” Commission chair John Belgrave said. Julian says he refunded dissatisfied customers at the time.

The Commission also criticised Julian for accepting IR&D’s claims. “Distributors are responsible for the goods they provide and must take reasonable steps to check them. They cannot simply rely on claims made by a manufacturer,” the Commission said.

Then in 2001 Julian took exception to a TV One item about Powermax. He tried to sue for defamation but the case was settled this year before it got to court. And this year US courts ordered IR&D to stop promoting Fuelmax.

Fuelmax is a magnetic gizmo for fuel lines in motor vehicles. The court decision related to claims that Fuelmax reduced emissions and fuel consumption. Julian’s withdrew Fuelmax in May as a result. Last month, after more questions from us about Powermax’s claimed performance, Julian withdrew that product from the market too.

Questionable claims

Julian says all the technical information for Fuelmax and Powermax came from manufacturer IR&D. He told us he was disappointed with the US court decision.

“IR&D certainly have not been honest with us. The technical explanations used in our sales literature came from the information supplied by them, and we are therefore currently investigating the question of taking legal action in the US to recover the costs of what is unsaleable stock.”

This raises two points. First, Julian was warned in 2001 that he could not rely on IR&D’s claims and he should check them out himself. And if he wants IR&D to repay him for unsaleable stock, then it’s only fair that he should refund anyone who bought a Fuelmax or Powermax from him.

Pat Julian says he still believes in magnetic water and fuel treatment, and he plans to import a similar range of products from a new manufacturer.

Consumer’s view

Anyone using Powermax or Fuelmax should return them to Julian’s Electrical and demand a refund. We believe you are entitled to one under the Consumer Guarantees Act, as the products are not fit for the purpose they were sold for. And Julian was warned in 2001 that he cannot rely on claims made by manufacturers. We hope he won’t fall into this trap again.

This article appeared originally in Consumer magazine. The institute is currently interested in magnetic and other fuel-saving devices. If you spot any, please send email to Martin Craig.

Prayer – Not so effective after all

A widely publicised trial which appeared to show prayer was effective in enhancing fertility now appears to have been fraudulent.

In 2001 an extraordinary paper, from the highly regarded Columbia University Medical Center, New York, appeared in the also highly regarded Journal of Reproductive Medicine. About 100 women in South Korea who were undergoing in vitro fertilisation treatment were divided into two groups; half had their photographs prayed over anonymously by persons in the US, the other half were not so prayed over. Astoundingly, the conception rate in the “prayed for” group was twice that in the “not prayed for” group. The work was hard to fault from internal evidence, as it had apparently been done using all the procedures of a modern clinical trial, and it became widely quoted as firm evidence for the efficacy of prayer. Publicity was aided by a press release from the university.

This intrigued Dr Bruce Flamm, clinical professor of obstetrics and gynecology at California University. The scandalous nature of his findings is described in a recent Skeptical Inquirer. He wrote to the three authors and the journal editor, asking, as one would of a colleague in the same field, for access to the raw data of the experiments. Over a period of some years repeated similar inquiries have elicited no answer, not even an acknowledgment, from either journal or authors. Such behaviour is not only unusual and discourteous, it is also unethical, and inviting of suspicion.

Complications

In his article, Dr Flamm first comments on the unnecessary complication of the praying arrangements. Not only were the Korean women prayed for, but the Americans who were praying for them had their prayers “fortified” by themselves being prayed for by another group. And yet a third tier of prayers was added, praying that the prayers of the middle tier would be answered. The paper offered no reasons for this complexity, which would seem to introduce unnecessary confusion into the trial. Some prayers asked that “God’s will be done”, so, in the absence of knowledge of what God’s will is, any result is a “success”. How much prayer was offered, and whether the prayer and the prayed-for acknowledge the same God, were not enquired into.

The Korean women were quite unaware of all this praying, and the university had later to admit it was wrong not to have obtained informed consent. The university had initially described one man (Lobo) as lead author, but when Dr Flamm did get a reply from the vice-chancellor, this person was said to have not known of the work until well after it was done, and had had a merely editorial role in the paper. Another author had recently left the university, while the third has a long criminal history, and is now in jail for fraud. This man, Daniel Wirth, has also a history of publishing reports of “healing” in several papers in obscure paranormal journals.

Why a respectable journal was conned into publishing such a bizarre paper remains a mystery, because the editor refuses to communicate with Dr Flamm, or media inquirers. Despite the criticisms of Dr Flamm and others, the journal kept this paper on its website until a few months ago. Were the claims made in this paper true, they would represent possibly the greatest discovery of all time. That the journal was so incredibly sloppy in its editing, and so obdurate in retracting the paper, is highly damaging to its reputation, and suggests the editor is blinded by his religion.

Another miracle paper

Reading Dr Flamms critique, I am reminded of the now notorious homeopathy claim of Benveniste et al published in Nature. Some useful comparisons can be made. In 1988, as in 2001, reports containing claims of events that should not have occurred according to current scientific understanding, arrived in the respective editorial offices. We are told that the question of publishing Benveniste’s was fiercely argued at Nature, and printed, most unusually, with an explanatory note. As far as is known, the other paper, from workers at the Columbia University Medical Center, had a smooth ride editorially, and was printed without comment.

Nature received a flood of letters to the editor, and several critical of the paper and of the editor for publishing it were printed. Whether anything similar happened at JRM was never admitted. Dr Flamm’s repeated requests for information and discussion were never acknowledged.

Benveniste’s extraordinary claims led the Nature editor to an extraordinary action; he sent a team of investigators to Benveniste’s laboratory in Paris to observe what was done “at the bench”. The flaws in technique thus revealed destroyed Benveniste’s claims. The team’s findings, when published in Nature, caused the authorities to close Benveniste’s laboratory, and almost ended his scientific career. The Columbia University Medical Center appears unmoved and unchanged in the face of Dr Flamm’s criticisms, and two of the three authors of the “Prayer” paper are pursuing their careers apparently unhindered.

L’Affaire Benveniste is now well in the past. Science is still, as before, opposed to homeopathy, and Nature retains its position at the top of the heap of scientific journals. On the contrary, thanks to Columbia University Medical Center and the Journal of Reproductive Medicine, the issue of the efficacy of prayer remains to clog the stream of medical thinking and inhibits progress. And what researcher who values his reputation and the standards of his work will now wish to offer papers to the JRM?

Published with acknowledgment to, and approval of, Skeptical Inquirer, Buffalo, NY,USA.

Currents of fear

Given his ratings, only a tiny handful of you probably saw Paul Holmes in his new slot on Prime a few weeks back, talking to Don Maisch, described as an Australian expert on the health effects of magnetic fields. More precisely, he’s doing a PhD in the Arts Faculty of Wollongong University on changes in the health status of Chronic Fatigue Syndrome patients following removal of excessive 50 Hz magnetic field exposure.

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Forum

It is with sadness that I see that the Skeptic is still accepting articles and letters with political bias. I would like to spend much of this letter countering some of Owen McShane’s arguments from his article “Why are we crying into our beer?”, but I see we are still arguing in the pages of our magazine about science. It would be really nice if Jim Ring or C Morris could explain to me and I’m sure others who are puzzled by this whole affair, as to what legitimate arguments between legitimate scientists have to do with scepticism.

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Get Your Facts Straight

A couple of months ago we were visiting my brother, and got talking about a friend of his, who had enrolled in a counselling course. It turned out that the course had come to be dominated by some rather staunch Maori elements, and my brother’s friend, as one of only two non-Maori on the course, was embroiled in a dispute in which racial lines were very clearly drawn. But he was confident he had ammunition which would knock the course leaders off their perch, in the form of a book, Ancient Celtic New Zealand (see Feature Article). This purported to show that Europeans had in fact colonised this country thousands of years ago, and had established a thriving neolithic culture, until they were displaced by Maori early in the last millennium.

Whatever position one takes on New Zealand’s so-called race debate, it is essential it is based on sound history. There is of course room for disagreement on the interpretation of events, and the weight that should be accorded to each, which is why the debate exists at all. But claims of ancient Celts in New Zealand fly in the face of almost two centuries of scholarship, and can only confuse the issue. Yet such beliefs appear to be quite widespread; there is currently a variation on this theme being championed in the Letters page of one of Hamilton’s weekly newspapers.

A similar situation applies in the arguments surrounding immunisation, which have flared up again in the wake of the meningococcal vaccination programme. Though it probably puts me in a minority among Skeptics, I have to admit to reservations about vaccinating very young children against a whole host of diseases, while acknowledging vaccination does have a valuable role to play in disease prevention. This is not the place to go into my reasons, but they have very little to do with the arguments promoted by the anti-immunisation lobby, who generally show a very poor understanding of science. Some still cling to the ideas of Antoine Béchamp, a contemporary of Pasteur, who believed the basic unit of life was something called a microzyma. All living cells are associations of microzymas, he said, and they remain imperishable after the death of the organism; disease is due to imbalances in the vital forces of the host, while the bacteria we mistakenly believe to be pathogenic have been formed by microzymas to rebuild dead or diseased tissue. Again, there can be no reasonable debate if one side remains stuck in the 19th century.

Almost time for the conference again. Hopefully by now you’ll have received your registration form in the mail; if not, there’s another form with this issue, and the latest information on what looks a very interesting and enjoyable line-up of speakers and events.

Annette's signature

The Holcomb Hallucination

Dr Robert R Holcomb was in Wellington in January to announce a technological breakthrough. Before an audience of New Zea-land government, business and environmental leaders, he announced for the first time a revolutionary new technology, Electron Stream Carbon Dioxide Reduction (ESCO2R), commonly called the Carbon Dioxide Converter, that goes to the heart of the global warming problem. The converter is patented.

“The unique technology of the Carbon Dioxide Converter permanently splits the molecular structure of carbon dioxide into its basic elements — carbon and oxy-gen,” said Dr Holcomb.

Nobody seems to have noticed in all the excitement that coal is mostly carbon, so if Holcomb is right we can produce unlimited power forever by recycling the same bucket of coal. But then if he is right, why should he trouble to come to Wellington to make such an earth-shattering announcement? And who looked after his day job — he is a paediatric neurologist — while he was away?

This is a no brainer — scientists have known for 180 years that such “perpetual motion” tricks are impossible. It is like the Irish lady who cycled to church every Sunday and returned by a different route: “It’s downhill both ways.”

However, there is a device that does everything Dr Holcomb claims, except that the carbon it produces is mixed up with other combustible material. Like Dr Holcomb’s process it absorbs energy, but it uses low-grade energy from the environment and does not have to burn coal. It is a bit slow but it does at least obey the laws of physics. It is called a tree.

Budget Science

Owen McShane examines last year’s Great Soya Sauce Scare

There’s a lot of Budget Science going on.

Budget Science is not low cost science. It’s certainly not amateur science driven solely by the noble search for truth. Budget Science is state-funded science which jacks up next year’s funding.

The great soya sauce scare was a fine example. The Ministry of Health (MoH), with the enthusiastic support of our tabloid media, panicked the nation into believing that Soya Sauce would strike us down with cancer. The health police swooped on supermarkets and hauled away the stuff of healthy stir-fries, while leaving cigarettes safely on the shelves above the check-out.

How did this happen?

The story begins when some lab somewhere carried out the notoriously unreliable rodent test on a group of chemicals known as chloropropanols. Sure enough these chemically-overloaded lab rats got cancer. We should remember that just about all foods – organic, GM or whatever – contain scores of chemicals which have failed the rodent test. There are at least 12 of them in your morning cup of coffee.

Anyhow, one of these chloropropanols, known as 3-MCPD, occurs in foods which have used acid hydrolysis, roasting, and similar processes to enhance their flavour.

A laboratory in England soon announced a test to detect 3-MCPDs down to one part in a million or lower. The European Food Safety Agency then decided that this detectable level should establish the safe level.

You can be sure that “safe” levels set by “detectable levels” are unsupported by any epidemiological evidence whatever. But such standards sell a lot of tests and keep lots of lab-workers busy.

And so the EU bureaucrats set the labs to work testing soya sauce, which was suitably foreign and known to contain 3-MCPDS. Lo and behold, several brands failed the test.

The news spread rapidly round the world. Scaring the hell out of people is a shortcut to fame for both young scientists and even younger media hacks.

However, not everyone knee-jerked into action. The Canadian Cancer Society reached the following measured conclusions:

  • 3-MCPD is a member of the chloropropanol group of chemicals and is a possible carcinogen in humans.
  • Health Canada has reviewed the situation and has found there is no health risk to Canadians from existing stocks of soy and oyster sauces.
  • Continuous lifetime exposure to high levels of 3-MCPD could pose a health risk to Canadians, but future imported stocks will be below the legal tolerance limit of 1.0 ppm. The Canadian authorities saw no point in raiding their supermarkets.

So why did we wage war on soya sauce? After all, the European Food Agency found quantifiable levels of 3-MCPD in breads, savoury crackers, toasted biscuits, toasted cereals, cheeses, doughnuts, burgers and salamis.

The survey also found 3-MCPD in a long list of food ingredients, including bread-crumbs, meat extracts, modified starches (used in glazes, yoghurt, soups and ready-made meals), malt and malt-based ingredients (used in confectionery, cereal products, sauces, bakery products, snack seasonings, beers and malted drinks).

Funny that. I don’t remember our health police clearing the shelves of cheddar, Weet-Bix, yoghurt and beer.

Surely the cancer risk will be determined by the total volume of foods containing 3-MCPD we ingest regularly over long periods – not the level within a single sauce used occasionally at best.

So what was going on here? Why did our ever-so-caring Ministry of Health decide to scare the hell out of us, when their peers in other countries found more useful things to do? How much extra risk did soya sauce pose to our biscuit, cereal, cheese and cracker-chomping pop-ulation?

The answer is simple – Budget Science ruled.

While the Europeans were demonising soya sauce, our own MoH was being criticised for failing to develop a rational, risk-based, food safety policy. The Cabinet was debating whether to shift responsibility for the Food Act from the MoH to the Ministry of Agriculture and Forestry (Maf) under a new Food Assurance Authority. MoH officials saw millions of dollars disappearing into the maws of Maf. So they raided the supermarkets to show their determination to protect us from Asian imports.

It didn’t work – the funds were transferred to Maf anyway.

But what about our health? There is no epidemiological evidence connecting soya sauce to cancer rates. Indeed Asians have low rates of digestive tract cancer.

We do know that New Zealand’s high rate of bowel and stomach cancer is caused by our low intake of dietary fibre. We eat too much meat and too few vegetables.

Those New Zealanders who found no soya sauce on the shelves were probably going to make a stir-fry for dinner. Stir fries are low in meat and high in fibre. Budget Science probably persuaded lots of them that sausages and chips are safer.

A few more New Zealanders may die of cancer.

Budget Science is like that.

Gulf War Syndrome

MBChB, DipAvMed, MRNZCGP, MRAes

Warfare has always been stressful for its participants. Before the psychological impacts of the conflict in Afghanistan became apparent, our regular medical columnist looks at the history of post-war syndromes

For a very short-lived conflict the Gulf War has produced an enigmatic legacy of illness which has continued to produce wide-ranging theories as to the cause of what has become known as Gulf War Syndrome (GWS). My view is that GWS can best be understood by examining the history of ill-health both during and after warfare.

Disturbed behaviour during or after conflict was recorded during Greco-Roman times.

In 1678 the Swiss Physician Johannes Hofer described this behaviour in terms of a longing for home and family, and coined the term “nostalgia”.

By 1755 nostalgia was recognised as endemic. However, it did not prove a particularly severe problem in terms of casualties because battle fatigue and exhaustion were limited by the short time scale of early conflicts. For example, the Battle of Agincourt could be measured in a few hours and Waterloo was over in three days. Given such circumstances, it is easy to see that nostalgia was related to prolonged periods away from home rather than the stress of imminent conflict.

The American Civil War provided some useful records and during the first two years of the conflict nostalgia produced a casualty rate of 2-3 per thousand. The American Civil War was a conflict where the weaponry was greatly in advance of the tactics and this led troops to have a certain anxiety about the blast effects of artillery. This led to the concept of “windage”, where it was thought that the pressure wave of a passing shell could produce paralysis of one or more limbs. Two percent of the Union Army were discharged owing to such paralysis.

In 1866, Sir John Erichsen had introduced the concept of “railway spine”, the idea being that the shock of a railway accident could produce functional disturbances of memory and neurological function in the absence of any physical injury. No connection appears to have been made between this syndrome and windage injury in soldiers. Doctors were, however, trying to come up with a classification system for mental illness. The term “neurosis” had already been coined by William Cullen in the 18th century as a blanket expression for all nervous disorders. Later, George Beard introduced the concept of neurasthenia which sought to explain nervous symptoms through some physical exhaustion of the nerves.

By 1910, Professor Glynn, writing in the Lancet, concluded that an emotional disturbance “probably plays a more important part in the production of the traumatic neurosis than physical injury. ” It was therefore easy to describe at this time how experience of war could lead to a war neurosis.

During the Boer War, MOs were highly suspicious of functional disorders which were widely believed to be a manifestation of malingering. Psychological theory, moreover, was strongly influenced by class considerations.

Nevertheless, there was a high rate of discharge for insanity which was probably really a description of “shell-shock”, an expression originally coined by Charles S. Myers of the RAMC in 1915. About the same time, American Physician John T. MacCurdy described conversion hysteria where the stress of combat exposure led to the development of loss of speech, deafness and limb paralysis.

Belief in windage persisted during WW1 and soldiers believed that the percussion of a near miss could produce some mysterious changes in the nervous system capable of destroying their self control. This illness perception was subject to local interpretation; for example, German troops developed a Parkinsonian type of tremor while French troops developed limb paralyses as a result of conversion hysteria. British soldiers suffered from effort syndrome which was a psychosomatic condition producing shortness of breath.

Widespread concern

By 1915 there was widespread public concern at the diagnosis of shellshock, in particular the number of soldiers sent home with the label of insanity. Army GS did not accept the diagnosis of shellshock as a defence at Courts Martial for cowardice and desertion. This is not surprising when many MO’s held opinions like one anonymous RMO on the Western front: “If a man lets his comrades down he ought to be shot. If he’s a loony so much the better.”

In the opposing trenches the German Army held to similar views. War neurosis was initially seen as a violation of military discipline with underlying suspicion of malingering. In the best Teutonic tradition, treatment consisted of strict military discipline and electric shock treatment. By 1916 most German neurologists agreed that shell-shock was purely psychological and it was realised that the best treatment was rest with the expectation of return to the front line. It was found that repatriation led to symptoms becoming entrenched and also encouraged a hysterical contagion to others.

Increasing public concern in the UK led to the Royal Society of Medicine Symposium on Shellshock in Jan 1916, where a consensus was sought. Some measure of the size of the problem can be gauged by the figures for the 12 month period up to April 30th 1916, when 1300 Officers and 10,000 other ranks were repatriated because of shell-shock.

By July 1916, shellshock was widely accepted as a legitimate label for disturbed behaviour not caused by any physical injury, but the military authorities remained anxious to separate those suffering from this disorder from those with “insufficient stoutness of heart”, a euphemism for cowardice.

By WW2, both Commanders and their MOs had a much better understanding of shellshock. It was clearly understood that the syndrome involved a stress reaction which could occur either at the time of combat or some time afterwards, something we now know as Post Traumatic Stress Disorder (PTSD).

It was also known that the common initiating pathway was combat fatigue. Lack of sleep was an important factor. US studies during the Italian campaign found that one third of men in the frontline got less than four hours sleep per 24 hours. Only 13 per cent of troops got more than seven hours sleep.

Stress inoculation

Basic military skills training became extremely realistic and gave soldiers the confidence to be able to withstand combat stress. This process has been described as “stress inoculation”.

It was found empirically that soldiers operated at peak efficiency up to 90 days in the field and became burnt out after 200-240 days. During the Libyan campaign a “left out of battle scheme” meant that 20 per cent of front-line troops were regularly left in rear areas in order to recuperate from the stress of battle.

Total US neuropsychiatric casualties during WW2 numbered 400,000 of whom 25 per cent were repatriated.

The pattern of stress symptoms became changed and motor hysteria was replaced by cardiac and gastrointestinal symptoms. Advances in neurology meant that limb paralysis had become too easily diagnosed as hysterical.

The psychiatric casualty rate steadily diminished and was lowest after the Vietnam War. The major problem after this conflict was the late emergence of PTSD.

Individual susceptibility

Attention now became focused on the individual soldier and his or her susceptibility. For a period it was hoped that psychological screening on entry would detect those individuals most likely to become psychological casualties. This belief was tested during the Korean War and was found to be worthless. There was simply not enough time to screen candidates during enlistment. Despite this failure of prevention, the management of battle fatigue was considerably improved and only 6 per cent of psychiatric casualties had to be repatriated. This was due in part to a Command Policy that limited front-line service to a nine month rotation.

During the Vietnam War, it appeared that things were improving, with an all-time low casualty rate of 10-12 per thousand from war neurosis but it soon emerged that the major problem for veterans of this conflict was their integration back into civilian life. The Vietnam war was politically unpopular and it is hardly surprising that returned servicemen were met with hostility and rejection.

Fifteen percent of veterans (In NZ 20 per cent) claimed to be suffering from a disorder that became known as PTSD. This disorder entered the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 after a prolonged campaign by well organised pressure groups and the label owes more to this process than any real scientific validity. Nevertheless, PTSD is defined as a constellation of symptoms and signs related to painful memories arising from experiences outside of normal human experience. The definition seems to have lost sight of the fact that shooting somebody or sticking a bayonet in them is generally outside of normal human experience. PTSD is believed to be caused by psychological arousal that produces chronic symptoms of anxiety and emotional withdrawal. In one major study that traced over three million Vietnam vets, 25 per cent were suffering some degree of PTSD.

Falklands War

The situation was even worse following the Falklands War. Fifty percent of veterans still serving had some of the symptoms of PTSD while 22 per cent had the complete PTSD syndrome as defined in DSM-III. Concerns at this high rate led one research project to look at the efficacy of psychological debriefing following experience of mental, physical or emotional trauma. It was hoped that an appropriate debrief would prevent the development of PTSD. Unfortunately the incidence of PTSD was exactly the same whether or not those exposed received immediate psychological debriefing.

In summary, up to the time of the Gulf War, there is a long recorded history of war-related psychological illness which start as battle fatigue and progress to either an acute neuropsychiatric syndrome or a much later expression as PTSD. The important question is whether GWS is a variation of PTSD or whether it is indeed some unique syndrome arising from some specific consequence of the Gulf War.

Chemical/biological threats

The Gulf War started with the Coalition forces ranged against the real threat of Iraqi troops hardened by years of war with Iran. The threat of chemical and biological weapons was also very real and the requirement to use respirators and restrictive protective clothing caused added stress in an already hostile environment. A US MO observed at the time that most acute medical problems had an emotional basis, frequently rooted in separation anxiety from family and friends. This is an exact modern description of Hofer’s nostalgia.

Soldiers were scared about chemical weapons, which is precisely the value of such agents. Panic, hyperventilation and inability to use respirators were reported in a number of subjects as was the inappropriate use of various remedies against chemical agents.

Since the Gulf War ended in 1991, large numbers of veterans have presented with a diversity of unexplained symptoms such as fatigue, headache, joint pains, skin rash, shortness of breath, sleep disturbances, difficulty concentrating and forgetfulness. It has been claimed by sufferers that GWS has somehow been transmitted to family members and even their medical attendants These symptoms have affected nearly 10 per cent of 697,000 US Veterans but only about one percent of 45,000 UK veterans. Some members of the Coalition forces have had no cases of GWS despite serving in exactly the same circumstances as those who claim to have the syndrome.

GWS has generated a vast number of studies and theories about causation. One such study costing $80 million and surveying 18,924 vets found “no single cause or mystery ailment to support suspicions about the existence of a GWS.” These findings have been confirmed by similar British and Canadian studies.

Random medical events

Despite these findings, researchers continue to promote ever more theories about the cause of GWS in which random medical events are now reported as proof of illness.

Over-investigation (the “million dollar work-up”) has produced unexpected laboratory results leading to further confusion and controversy about suspected aetiologies. Theories abound in direct proportion to the number of specialists involved and the mass media has become involved in popularising GWS with its disease of the month mentality. Veterans have developed a “fixed illness belief” characterised by paranoia and conspiracy theories. These are amply served by websites on the Internet and support groups. Veterans react angrily to any suggestion that GWS has a psychological basis such as a form of PTSD.

Throughout all of this, the US Government has been cautious and sympathetic and Vets with GWS are entitled to disability payments.

I believe that GWS is a functional disorder arising from psychological arousal. In other words, a somatoform disorder. The rates of symptoms reported are the same as in the civilian community and this explains the resemblance to Chronic Fatigue syndrome (CFS) which has an identical causation. GWS should be labeled with the more generic description of post-war syndrome.

Failure to recognise this has led to an entrenched illness perception with associated paranoia and conspiracy delusions. Continued over-investigation and speculation has paralleled a similar process in CFS. This fundamental misunderstanding of the true nature of post-war syndromes has already led to a new variant – Balkans Syndrome alleged to be due to exposure to depleted uranium.

A combination of factors

My own theory as to the actual initiation of post-war syndromes is that they arise from a combination of factors such as Hofer’s nostalgia and a rejection of warfare as a means of solving disputes, with the major factor being psychological activation and the creation of perceived illness. This illness is real to the afflicted individuals and the real challenge is to work with them rather than deny their symptoms. No funding should be made available for conducting further investigations and tests as these are irrelevant to the causation of GWS.

Bibliography

Shell Shock, A History of the Changing Attitude to War Neurosis. Anthony Babington

Trauma and the Vietnam War Generation. Report of the Findings from the National Vietnam Veterans Readjustment Study 1990

Hystories, Hysterical Epidemics and Modern Media. Elaine Showalter

A History of Psychiatry. Edward Shorter

From Paralysis to Fatigue. A History of Psychosomatic Illness in the Modern Era. Edward Shorter.

Comprehensive Clinical Evaluation Program for Gulf War Veterans. Department of Defense 1995

Illness of Persian Gulf Veterans. Hearing Before Committess of Veteran’s Affairs Serial No. 102-51

She went to War. The Rhonda Cornum Story. Presidio Press 1992

GWS. Letter in BMJ 1995; 310:1073 (22 April)