Hokum Locum

A Menu of Dietary Delusions

Neither Nutrasweet nor sugar-rich diets produce any change in children’s behaviour. (New England Journal of Medicine 330:301-307, 1994)

The subjects were tested in a double-blind, placebo-controlled trial. The trial was reported in the local press and produced a predictably outraged response from local nutritional quacks who have carried on regardless. Their beliefs are based on faith and are therefore not amenable to reason. For another good New Zealand review see NZ Medical Journal 27/9/89 (Diet and Behaviour) and 23/8/89 (Children’s diets: what do parents add and avoid?).

Evening primrose oil has been touted widely as a “natural” remedy for a host of conditions such as pre-menstrual tension and menopausal symptoms. The active ingredient is gamma-linolenic acid and it was tested in a randomised, double-blind, placebo-controlled trial of 56 menopausal women experiencing episodes of sweating or flushing. It was found to be no better than a placebo.

It is worth noting the value of such studies. Randomisation means that patients have an equal chance of receiving either the “test” substance (gamma-linolenic acid) or a placebo. This ensures that both wings of the trial are identical in terms of age, sex, number of smokers, etc. Double-blind means that neither the subjects nor the investigators know who was taking the “test” substance or placebo until the study has finished. It is no wonder that quacks decry such studies which remove bias, prevent cheating and usually show that quack remedies are useless. (BMJ 308: 501-503, 1994)

Smart Drinks

These are amino acids and other precursors of neurotransmitters which are being promoted among teenagers at music and cultural festivals. Smart drinks are claimed to “fire up the brain” and give the young executive an “edge”. Could there be anything more loathsome than a hyperactive yuppie? I remember reading about the smart drinks phenomenon in the US and I am not surprised that they have arrived in New Zealand. There is no evidence that smart drinks have any effect on either memory or intelligence. (NZ Doctor 31/3/94)

Sick of Work?

All that is necessary in New Zealand to get a sickness benefit ($22 per week more than the dole for those under 25 years of age) is to persuade a doctor to sign a prescribed form from the DSW.

Over the years I have seen many flagrant abuses of the SB. The best one was a young person who had been on a SB for over two years because of a perforated ear-drum. When I refused to sign the certificate she simply went to a more compliant doctor.

The court news regularly detail the activities of professional criminals and drug addicts who are described as “sickness beneficiaries”. My attempts to find out which doctors were signing these certificates were thwarted by DSW who cited “medical confidentiality”. The great irony is that at the time they were expecting doctors to inform on beneficiaries who were fiddling the system but were not prepared to put their own administration under scrutiny.

A reporter in Germany was able to obtain 41 days sick leave from five different doctors even though he told them he was perfectly well but just wanted a few days away from the office. One visit lasted four minutes, involved no examination and was worth 12 days off! (Dominion 29/3/92, Worker highlights easy access to sick leave)

This sort of abuse arises from poor ethical standards, which also extend in Germany into drug licensing (see Skeptic 27).

Laying On of Hands

The introduction of ACC around 1972 saw a great increase in both the use of physiotherapy and private physiotherapy practices. In Skeptic 29 I commented briefly on the widespread use by physiotherapists of unproven treatment modalities such as ultrasound. Ultrasound treatments have been introduced on a basis of applied experience rather than from controlled scientific study. Dr Linda Maxwell writing in the NZ Science Monthly, March 1994, has studied cellular processes at injury sites and found that ultrasound may enhance inflammation and actually cause more injury.

Physiotherapy is also traditionally used to build up muscle strength in patients with rheumatoid arthritis. A controlled trial by physiologists (New Scientist 16 Oct 1993 p17) found that this approach tended to worsen the flexion deformities seen in this condition. Work continues in the area of electrically stimulating the extensor muscles in an effort to counteract the tendency to flexion deformity.

Most injuries recover with time and I doubt whether the laying on of hands or the use of electrical gadgets by physiotherapists accelerates this process. Many of my patients become upset if they do not receive a referral for physiotherapy and few doctors will refuse in such circumstances.

It is no surprise that costs of the ACC scheme have continued to rise each year. The burden of proving that their treatments are worthwhile rests with the physiotherapy profession. ACC should not pay for any treatments unless they can be shown to be both cost effective and scientifically valid.

Alexander Technique

The “Alexander Technique” (AT) is an extreme example of the laying on of hands. To quote a recent magazine article, “…by extending the neck and opening the back, it literally makes you taller and releases the body’s natural energy flow”.

Note the typical vague language of quackery: what does “open the back” mean and just what is this “natural energy flow” that quacks keep going on about? The usual anecdotal reports are quoted by satisfied patients: “My singing has improved tremendously…I felt lighter, taller…I’ve learnt to relax by opening and lengthening the back muscles!”

The founder, Frederick Alexander, was born in Tasmania in 1869 and longed to be an actor but suffered a mysterious loss of voice. The rest is worth quoting: “Sitting alone for nine years in a room containing only mirrors and a chair, he studied his position in every detail. It took two years for Alexander to discover only the fact that when he talked he was moving his face and chin forward and contracting the vertebrae in his neck. The muscles of his neck were becoming very tight and causing obstruction in his voicebox.”

I would have described his position as ridiculous and if he found the problem after two years what did he do for the other seven years? How does one “contract the vertebrae in the neck”?

Feeling a need to inform us further about AT the author followed up with three more anecdotal reports from satisfied customers who all described how they feel “happier, more positive, less stressed”.

Quackery has many recurrent themes. The founder of AT suffered a profound illness which was clearly psychological (nine years in a room with mirrors!) and led to him feeling that he had discovered the meaning of life.

The laying on of hands is the basis for the clinical effects (essentially placebo) of most forms of physical therapy such as chiropractic, osteopathy and AT.

Massage and postural “adjustments” are pleasant procedures for patients and it is not surprising that they go away feeling empowered and improved. Unfortunately, many become dependent on therapy and I have met many people who feel it essential to consult such therapists on a regular basis for years. This of course is encouraged by such quacks because it is great for business and they are able to take advantage of people who are incapable of taking responsibility for their own lives and health.

Ischaemic Heart Disease

Ischaemic heart disease (IHD) is a serious public health issue in New Zealand and is the leading cause of death for New Zealand adults. My own father died suddenly of a heart attack while on a golf course. He was 71 years old and had no known risk factors yet autopsy showed severe coronary artery disease.

The costs of treating IHD are considerable and surgical treatment is popular. Political pressure has seen the creation in New Zealand of an absurd number of cardiac surgical units compared to similar western countries. An American study (quoted in Lancet Vol 343 p412) of 1,252 patients showed no difference in employment status after one year between comparable patients who underwent either surgical treatment (angioplasty or bypass) or medical treatment (lifestyle modification, drug treatment).

Angioplasty involves passing a fine balloon catheter into an area of blockage and inflating it, while bypass surgery involves using lengths of vein to bypass the blocked area in the coronary artery. In a subset of 72 patients the median number of days from the start of treatment to return to work was 14 days for medical treatment, 18 days for angioplasty and 54 days for bypass surgery.

Clearly surgery is not always the best option and a lot more of our health resources could be better spent on prevention of this condition by risk factor reduction.

Death or Compensation

A court in the UK awarded a Falklands War veteran $220,000 for post-traumatic stress disorder acquired as a result of serving during that campaign.

This drew a sharp response from the defence editor of the Daily Telegraph (Dominion 10/3/94) who asks how this can be taken seriously at a time when thousands of veterans are converging on Normandy to commemorate the D-Day landings. The Falklands War veteran received his award for the stress of an action over two days! Many WWII vets saw active service for five years and returned to lead happy and successful lives.

Wars are horrible experiences from which soldiers can recover without the need or right to compensation. Post-traumatic stress disorder is simply a New Age euphemism for shell shock, and an insult to all servicemen who have done their duty and returned to civilian life. This absurd monetary award is an example of Welch’s law (after Parkinson): “Whenever compensation is available conditions will emerge to take up the compensation available”.

Deliver Us From Gynaecologists?

In Skeptic 29 I referred to abuses of gynaecology. In Florida, where 25% of deliveries are by caesarean section, the state legislature has forced doctors to change their practices, wanting the rate to be less than 20% by 1997. There is a higher rate of Caesarean delivery among patients with better health insurance and higher incomes, and the rate is lowest in teaching hospitals. (BMJ Vol 308 p432)

Failing the Sex Test

This is the headline of an article which appeared in the Dominion 17/3/94, and concerns an Indian clan which murders unwanted female children. Because of the illegal dowry system, girl children are too expensive so are murdered by being either strangled or smothered soon after birth. The tribe cannot afford amniocentesis which is also abused in order to predetermine sex so that female foetuses can be aborted.

It is important that such cultural practices are highlighted and discussed. It has been interesting to see how various other equally vicious cultural practices have fared following migration to western countries. Some doctors have been de-registered for performing female circumcision and I have even seen a reference in print defending this procedure!

The Indian authorities have taken little action over these murders since the status of women in India remains low. If there are problems over the dowry after marriage, it is a traditional practice to set fire to one’s wife and make the murder look like a kitchen accident.

How far should we go in either acknowledging or accepting traditional cultural practices? Nurses in New Zealand are judged on their “cultural safety” regarding Maori traditions and customs, which fortunately do not honour such abuses as infanticide.

Beware – This Tea Could Be Dangererous

Where’er you be
Don’t drink comfree
For drinking such tea
Could be the death of thee!

John R. L. Walker

Our everyday “cuppa” comes from the plant Camellia sinensis and it, together with a number of other common drinks including coffee, cocoa, guarana and maté contain small quantities (10-100 mg per cup) of caffeine, a mildly stimulatory alkaloid. In addition many people enjoy hot and cold beverages made from a wide variety of other herbs such as chamomile and dried raspberry leaves.

Unfortunately, an uncritical mythology has developed regarding herbal teas made from other plants that maybe very dangerous. Notable among these are herbal teas made from comfrey, coltsfoot and sassafras; the former contain toxic alkaloids while the latter contains the carcinogen safrole. Recently, the German government’s health authority, the Bundesgesundheitampt (BGA), has decided to ban some fifty herbal and homeopathic remedies because they are ineffective or contain toxic alkaloids. High on their list is comfrey.

They comment that although a medicament is derived from a common plant, it can be just as dangerous as any laboratory-synthesised chemical. This fact has been well known since the death of Socrates from a dose of hemlock (which contains the alkaloid coniine), but is all too often conveniently ignored by the herbal mystics.

Here in New Zealand there are many recorded animal deaths from ingestion of tutu (Coraria arborea) which contains “tutin”, a poisonous picrotoxinin.

Comfrey (Symphytum officinale) has aquired an almost magical status in herbal medicine, comparable almost to that of ginseng. It is one of the most often sold herbal remedies. However, unlike ginseng, comfrey has been shown to contain highly toxic alkaloids, yet many modern herbalists still wax lyrical about its safety and almost universal healing properties.

Comfrey is frequently used in folk medicine as an externally applied poultice for wound healing, and such treatments may be useful since comfrey contains allantoin, which promotes cell proliferation, tannins and mucilage.

So far so good, but comfrey is also recommended by many herbalists to be taken internally as a “blood purifier” and as a universal panacea for numerous other ailments including respiratory complaints and ulcers of the bowels, stomach, liver or gall bladder.

Now, in the light of much well-documented research, the German BGA has banned the sale of herbal remedies containing comfrey. This is because comfrey contains a group of chemicals known as the pyrrolizidine alkaloids which have been shown to be carcinogenic and to cause severe, even fatal, damage to the liver.

Coltsfoot (Tussilago farfara) and Senecio species, such as groundsel, are other common herbal remedies which also contain these dangerous pyrrolizidine alkaloids, although for many years coltsfoot has been prescribed as an ingredient of herbal cough syrups and smoking mixtures. Japanese and other research workers have shown that these preparations may be potential causes of liver damage.

Problems with herbal remedies nay also arise from other causes such as adulteration, contamination and misidentification. The latter should be of major concern since, for most herbal products, there is no guarantee that the original plant(s) were unequivocally identified by a competent botanist.

As with any drug, susceptibility to poisoning varies between individuals and may be affected by gender, age and state of health. in a recent paper Dr Ryan J. Huxtable comments that, in North America, more people are killed or injured by plant derived substances than by animals. Yet, despite this, the US herbal industry is still virtually unregulated and without legal safeguards to demonstrate the safety or efficacy of its products.

Locally sourced herbal teas from New Zealand native plants are now becoming available, but we should remember that many of our native plants produce alkaloids and other toxins which are dangerous if ingested. I therefore caution anyone who buys a herbal beverage to require not only a list of its plant components but also to be sure that these plants were competently identified.

For the edification of readers I append a list of a few common poisonous plants found in New Zealand and which I would not want in “my cup of tea”.

Common Poisonous Plants

Plant Botanical Name Toxic Principle
Apricot (kernals) Persea armeniaca Cyanogenic glycosides
Bittersweet Solanum dulcamara Alkaloids
Foxglove Digitalis purpurea Steroidal glycosides
Hellebore Helleborus sp Steroidal glycosides
Karaka (fruit) Cornyocarpus laevigatus Cyanogenic glycosides
Kowhai Sophora sp Alkaloids
Ngaio Myoporum laetum Ngaione
Peach (kernals) Prunus persica Cyanogenic glycosides
Porporo solanum aviculare steroidal glycoalkaloids
Ragworts Senecio sp Pyrrolizidine alkaloids
Tutu Coraria sp Tutin


Connor, H.E. The Poisonous Plants in New Zealand. (1977) Govt Printer, Wgtn.

Huxtable, R.J. (1992) The Myth of Benificent Natue; the risks of herbal preparations. Annals of Internal Medicine 117; 165-166.

Stewart, J. Plants in New Zealand Poisonous to Man. (1975) Govt Printer, Wgtn.

Tyler, V.E. The New Honest Herbal (1987) George F Stickley Co. Philadelphia. (Highly recommended).