Tag: herbalism

Anti-oxidants: the key to nutritional success?

Extravagant claims are often made for the health-giving effects of anti-oxidants in the foods we eat. But sorting out the truth from the hype is not at all easy.

In the window of a health-food shop, I saw an advertisement extolling the merits of Goji berries. The advertisement said that an ‘ORAC test’ had shown that Goji berries have a lot of anti-oxidants in them. ‘ORAC test’ has a scientific ring about it-Goji berries must be good!

Anti-oxidants have attracted a reputation as beneficial ingredients of foods, nutritional supplements and cosmetics. So I thought I would try to describe what anti-oxidants are, and explain what the ORAC test is and its limitations. I’ll also give some examples of anti-oxidants in fruits and vegetables, and make some comments as to whether it’s worthwhile taking supplements containing these anti-oxidants in an attempt to get more of them inside you than is usual from a healthy diet.

What are anti-oxidants? Let’s start with oxidation and move onto food. Oxidation is a process in which electrons are removed from atoms and molecules. Oxygen is the classic oxidising agent. Digestion of food and extraction of energy from it is essentially an oxidative process. It occurs over many steps but one of the final outcomes is the transfer of electrons to oxygen (which is why our existence is dependent on a supply of this gas*). When the electrons are passed to oxygen, water is formed but oxygen ‘radicals’ are also formed as a side effect. Radicals are atoms or molecules which have one or more unpaired electrons. By virtue of the unpaired electrons, radicals (sometimes referred to as ‘free radicals’) are extremely reactive. The oxygen radicals are no exception and if not mopped up will cause all sorts of havoc by reacting with molecules that they shouldn’t react with. In short, oxygen radicals are toxic.

An example of an oxygen radical generated in our bodies is the ‘superoxide radical’: O₂^.-, two oxygen atoms linked together to form a molecule that has an unpaired electron (the dot) and a negative charge (the dash). It’s been estimated that an adult weighing 70 kg makes about 1.7 kg of superoxide radicals a year. This is equivalent to about one percent of total oxygen consumption.

Molecules that can neutralise free radicals are called anti-oxidants. Anti-oxidants do not react only with oxygen radicals. Other ‘reactive species’ capable of causing oxidative damage and that react with anti-oxidants may contain, for example, nitrogen and sulphur. Barry Halliwell and John Gutteridge give a more formal definition of an anti-oxidant in Free Radicals and Biology in Medicine (2007), which is: “any substance that delays, prevents or removes oxidative damage to target molecules”.

Reactive species in addition to oxygen radicals also end up in our bodies. Cigarette smoke, for example, contains free radicals. Given the toxicity of oxygen radicals and other reactive species, it’s not suprising that anti-oxidants are considered a good thing, and that it’s thought a good idea to make sure we have as much of them inside our bodies as possible. Fortunately, our bodies have a number of built-in anti-oxidant systems to protect us against oxygen radicals formed as we breathe, and other reactive species. I am not going to deal with these systems but will confine my attention to dietary sources of anti-oxidants as it is these which are usually discussed in dietary advice and turn up in nutritional supplements. These anti-oxidants are, by and large, derived from plants.

Measuring Anti-oxidants

The ORAC test is one of the principal assays used to estimate the anti-oxidant content of such materials. (If all this seems a bit dry, bear with me because the nature of assays for anti-oxidants is central to claims that supplements, foods, etc, contain a lot of them.)

When an analyst is faced with developing a chemical assay to find out how much of something is in a sample of fruit or vegetable, one approach is to find some reagents which when added to the sample react with the substance(s) in question and in so doing exhibit a measurable change in some property of the mixture, eg an increase in colour intensity. Hopefully the technique is sufficiently sensitive (will measure quantities that are of interest to the analyst), selective (ideally the reagents react only with the substance(s) in question) and quantitative (the properties of the mixture change in a regular way as the amount of substance changes). Many assays are quite selective; others only give an indication of the amount of a class of compound. The ORAC test is of this latter type.

There are dozens of molecules that can be classed as anti-oxidants and it would be a lengthy and expensive task to identify the compounds in a sample every time an estimate of the overall level of anti-oxidant activity was required. Tests like the ORAC assay are used to estimate overall activity in a sample, the amount of activity being expressed as ‘equivalent to’ an amount of a ‘standard’ anti-oxidant compound.

ORAC stands for Oxygen Radical Absorbance Capacity. The basic premise behind this assay is that the ability of a sample to neutralise free radicals indicates the presence of anti-oxidants. When exposed to light, a substance called fluorescein emits light of a longer wavelength than that shining on it; this ‘fluorescence’ can be measured using a fluorimeter. Fluorescein also has the useful property that its fluorescence is diminished in the presence of free radicals. We would have the basis of an assay if we mixed our sample with fluorescein and a source of free radicals and saw that the decrease in fluorescence was less than in the absence of the sample because of the protective effect of anti-oxidants. This wouldn’t get us very far as about all we could do would be to say that one sample had more or less anti-oxidant activity than another. The assay could be made more quantitative if we were able to compare estimates of activity from various samples with those obtained using a known standard anti-oxidant. A commonly used one is Trolox, a synthetic analogue of vitamin E.

So in the complete assay we would measure the fluorescence coming from a series of solutions containing increasing amounts of Trolox but constant amounts of fluorescein and free radicals. If we run everything correctly there will be a regular and positive relationship between the fluorescence emitted and the amount of Trolox present. We would also measure the fluorescence coming from solutions containing the free radicals and our extract of Goji berries (no Trolox), and calculate that a measured amount of Goji berries contained an anti-oxidant activity equivalent to that provided by a known amount of Trolox. Another way of looking at this is that we have estimated so many grams of berries as having the same ability as a certain amount of Trolox to protect fluorescein from oxidation by the free radicals.

Remember that the ORAC test only gives a measure of the ability of our extract to protect fluorescein from the action of free radicals in vitro (in vitro-in the test tube; in vivo-in the living body). It says nothing about the anti-oxidant activity of the extract once it has been ingested (in vivo). A high ORAC value simply tells us that the extract contains molecules that might have some anti-oxidant activity in vivo.

The principal value of an assay of this type lies in the ability to compare different samples of plants, foods etc according to a single property. The table below contains some ORAC values for anti-oxidant levels in some fruits and vegetables. These values have been taken from a larger set published by the United States Department of Agriculture (USDA, 2007).

The units of measurement are µmol Trolox Equivalents per 100 g fresh weight (FW) of fruit or vegetable. Fresh weight is the weight of the leaf, fruit etc as it is harvested with no adhering dirt, fully hydrated but with no surface drops of water. A mole (abbreviated as mol) is a measure of the amount of Trolox and 1 µmol of Trolox has a mass of 0.00025 g. So, if a vegetable has an ORAC value of 1000 TE per 100 g FW, then 100 g FW of the vegetable has the same ability, in the test-tube, to neutralise free radicals as 1000 µmol or 0.25 g of Trolox.

	µmol TE / 100 g FW
Turmeric	119346
Curry powder	6665
Blueberries	6552
Apples, Granny Smith, raw with skin	3898
without skin	2573
Cashew nuts, raw	1948
Avocadoes, Hass	1933
Onions, raw	1034
Green peppers, raw	923
Bananas,raw	879
Carrots, raw	666
Cabbage,raw	508
Tomatoes, raw	367
…and Goji berries? It’s not easy to find a reputable ORAC value but it does seem to be considerably higher than most other plants tested.

Examples of anti-oxidants

What are these anti-oxidants of plant origin? Here are a few examples, with some comments as to whether they exert a beneficial effect in vivo.

Vitamin C or ascorbic acid: This is an essential nutrient, famous for its role in the prevention of scurvy. It is an anti-oxidant in vitro but it is uncertain as to whether it has any major effects as an anti-oxidant in vivo. Sufficient vitamin C to maintain health can be obtained from a diet including fruits and vegetables. With such a diet, there is no evidence of beneficial effects of supplementary doses.

(Scurvy is a deficiency disease of connective tissue. The role of vitamin C here is not that of an anti-oxidant but to ensure that enzymes involved in the synthesis of connective tissue function effectively.)

Vitamin E: Vitamin E was first defined as a fat-soluble ‘factor’ necessary for reproduction in rats. It is not a single compound, a number of substances having vitamin E activity. The principal ‘natural’ form is α-tocopherol. Mixtures of tocopherols are found, for example, in soybean, corn, walnut and rapeseed oils. The evidence for anti-oxidant effects in well-nourished humans is limited.

Carotenoids: These are orange and yellow pigments found in plants, most typically in carrots. ß-carotene is a common carotenoid. There is only weak evidence that they have an anti-oxidant role in vivo. (They do have an important role in the diet for other reasons, principally as a precursor for vitamin A.)

Polyphenols: Polyphenols are compounds that have groups of six carbon atoms linked together in rings. The rings have hydroxyl groups (-OH) attached to them. Polyphenols of plant origin are excellent anti-oxidants in vitro, but it does not follow that they have the same effect in vivo. This group contains the compounds found in blueberries and blackcurrants and some have become quite well known through discussion of their potential anti-oxidant properties, eg resveratrol from red wine, quercetin in teas and onions, and curcumin from turmeric.

Epidemiology

There is evidence from epidemiological studies of correlations between anti-oxidant levels in the body and good health, and between good health and diets rich in fruit and vegetables. Correlations however do not prove causation and it remains uncertain whether the correlations observed are due to compounds exerting anti-oxidant effects in vivo. A further problem in interpreting epidemiological studies is that it is difficult to be accurate about the relationship between dietary intake and incidence of disease, particularly when studies seek to understand data gathered across different countries. Intervention studies

Intervention studies (where one group of subjects is provided with a supplement, and their health and physiological status is compared to a matched group receiving a placebo) might help us decide whether supplements are worth taking, but it has proved difficult to obtain evidence of a cause and effect relationship in these. Halliwell & Gutteridge (2007) describe the literature on intervention studies seeking to demonstrate a link between diet and supplementary anti-oxidants as a “morass of confusing data”.

Some clarity on the effects of supplements of some anti-oxidants (ß-carotene, vitamins A, C, E) and selenium has been given by a recent Cochrane review (Bjelakovic et al., 2008). This review considered 67 trials, involving 232,550 people, of the effects of taking supplements of these anti-oxidants. The principal conclusion from consideration of all this data was that overall, there is no evidence for an effect of these supplements on mortality in healthy people or those with various diseases. When the effects of different supplements were looked at separately, there was an increased risk (which only just reached statistical significance) of mortality associated with supplements of vitamins A, E and beta-carotene. There were no significant effects on mortality from vitamin C or selenium supplementation. (Selenium is an essential nutrient and is a component of several enzymes, some of which are thought to have anti-oxidant functions.)

Conclusion

What to do? If we take the epidemiological evidence as our guide, eating lots of fruit and vegetables is sensible advice. They have established beneficial effects, such as being enjoyable to eat, providing fibre and helping to maintain adequate levels of vitamins and minerals. The anti-oxidants they contain might exert a direct beneficial effect in vivo. At this point in our knowledge of dietary anti-oxidants and their effects in vivo, there seems little, if any, point in spending money on supplements of anti-oxidants.

Alan Hart spent over 30 years doing biology research. The last 15 were spent developing assays of various kinds. He has an interest in the meaning and practice of biological measurement.

*An excellent and readable account of the role of oxygen in our world, including a discussion of oxygen radicals and anti-oxidants, is Nick Lane, 2002: Oxygen, The molecule that made the world, Oxford University Press.

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Dark Eddies in the Mainstream

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Snake Oil: a brief history of alternative medicine

Early in 2005 Professor Kaye Ibbertson, the relentless grand vizier of the Marion Davis Library and Museum, asked David Cole to offer the Medical Historical Society some comments about the history of unorthodox medicine. He was in the process of assembling several convincing excuses, when Ibbertson turned off his hearing aid and any excuses were set aside. This article is based on the talk which resulted.

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Now that Terri Schiavo has been allowed to die peacefully there is an opportunity to reflect on the matter free from the hysteria and religious arguments advanced as an excuse to maintain her in a vegetative state. When discussing the ethics of the situation with a local surgeon he commented that the main problem was that the feeding tube should never have been inserted in the first place. A feeding tube is surgically inserted into the stomach through a hole in the abdominal wall. Once such medical interventions have been made it is very hard to reverse them. In this case the debate appears to have been hijacked by Catholic pressure groups.

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Selenium – Too Much of a Good Thing?

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

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

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

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

Animal Homeopathy

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

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

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

Snake Oil Flunks for Snake Bite

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

Counsellors

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

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

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

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

Hair Analysis

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

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

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

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

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

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

Shockwaves for chronic heel pain

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

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

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

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

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Claytons Vaccines, Claytons Protection

This article was originally presented on National Radio’s Sunday Supplement

Be wary of “the health professional you see most often”. In some cases be afraid, be very afraid.

Why? Well in some cases, the advice you get from your friendly pharmacist could be deadly.

I try to ignore the herbs of dubious quality, the effusive claims for magnetic bracelets, the offers to feel my feet to see what ails me – all those things which seem a core part of pharmacy stock and trade. I do wonder about the business and medical ethics. After all, what’s worse – a pharmacist who apparently can’t distinguish between tested, regulated medicines and the hope and hokum variety; or the pharmacist who does know and doesn’t care because such stuff sells?

But the whole sorry state of that industry took a chilling turn recently with the report of an Auckland pharmacy selling a homeopathic meningococcal vaccine.

Many homeopaths would argue that the 300-year-old practice of diluting substances into infinitesimal amounts is akin to taking a vaccine. “Like cures like” as they say. What they don’t say is that the massive dilutions they use would require you to drink almost 8,000 gallons of homeopathic solution to get just one molecule of any medicinal substance involved.

You can pay a hefty price for this diluted water, but you can pay a much bigger price if you use it in place of stuff that actually works.

The Council of the Faculty of Homeopathy, the registered organisation for UK doctors qualified in homeopathy, recommends immunisation with conventional vaccines. As GPs, they know you ignore real vaccination at your peril. It’s a pertinent warning here when we’re considering a large-scale vaccination programme against meningitis.

Small wonder that the head of our Health Ministry’s meningococcal vaccine strategy was concerned about the sale of homeopathic vaccines, warning in a Herald article that it could give people a false sense of security.

However, I think the real false sense of security comes from the hopeful notion that we have some legislative protection from purveyors of such patently misleading products. There’s no protection under the Medicines Act it seems, for the Health Ministry’s compliance team leader Peter Pratt noted in the same Herald item that such preparations are permissible so long as they were “sufficiently diluted”.

Yet it’s the dilution that make this approach to vaccination so dubious in the first place, and not just to the skeptical. Alternative practitioner and homeopath Dr Dominik Marsiello states unequivocally that “there is no such thing as a homeopathic vaccine”. He goes on to acknowledge that “homeopathic remedies are too dilute to stimulate an immune response and confer immunity. There is no basis, historically or scientifically, for such a practice.”

Yet we have bottles of water labelled “meningococcal vaccine” and “hepatitis B vaccine” in our pharmacies, sold by health professionals, as a protection against these terrible diseases. Some apologists have said that “vaccine” in this case actually means “immune booster”. But “vaccine” has a specific meaning – it’s something which confers immunity through the production of antibodies. This is an easily testable claim, but apparently not one our Ministry of Health considers worth bothering about.

I shouldn’t be too surprised. After all, last time concerns were raised about a comparable product, our Commerce Commission – the organisation charged with protecting us from fraudulent claims – passed the buck to the Ministry of Health, saying it was a health issue. The health ministry, in turn, washed its hands of the business saying that “water is not a medicine”, thus it had nothing to do with them.

Contrast this with the activities of the Australian Competition and Consumer Commission, their state Health Care Complaints Commissions, their Fair Trading Ministers, and the Australian Therapeutic Goods Administration. They are taking an increasing interest in those areas where bogus medicines, fraudulent claims and consumer rights intersect. The TGA took a very dim view of having a fake vaccine on the Australian market, banning it and warning consumers. And the New South Wales Fair Trading Minister referred to the earlier incident where people were paying a 400,000 percent mark-up on a small bottle of water as “a New Age spin on an old-fashioned rip-off”.

Strong words, but ones which need to be said, and said loudly. I know of one New Zealand baby dead of meningitis because homeopathic treatment was chosen over real medicine. I don’t want to see any more. I just wish our Health Ministry felt the same.

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Providence based medicine

If the caring practitioner has no idea of what to do next, the decision may be best left in the hands of the Almighty. Too many clinicians, unfortunately, are unable to resist giving God a hand with the decision-making.
New Zealand Medical Journal Vol 113 No 1122 p479

Acupuncture and ACC

I am pleased to report that I received a reply from Dr David Rankin acknowledging the dearth of evidence for the widespread use of acupuncture. ACC are taking a responsible attitude and are commissioning a wide range of studies looking at current treatments in order to assess which of them are truly effective in speeding recovery and the return to work.

Saint Goncalo of the Immaculate Perineum?

Haemorrhoid sufferers are flocking to a church in Portugal in the belief that exposing their afflicted behinds to the statue of a local saint will cure them. I have named this pious act “anoflection”. However, the local Priest drew the line at allowing a young woman to pray naked in the hope that this would cure her severe acne. Given the revelations of widespread sexual abuse by priests, it would appear most unwise to expose oneself in this manner in a church.

Saint Goncalo, a 13th Century priest, also has a history of helping women find husbands. Every June, during a festival in his honour, unmarried men and women exchange penis-shaped cakes as tokens of their affection.

There is clearly no need for our organisation to attack or ridicule religious belief when the Catholic Church is doing it for us. I believe that we should sincerely welcome these quaint rituals into our culture. I look forward to a new range of phallic pastries at my local bakery.
Dominion Post 14/1/03

Placebos and homeopathy

The business of science is generating testable hypotheses. This is the classical approach espoused by Popper who put it in a negative sense in that he proposed that for something to fall within the realms of science, it had to be capable of being falsified (proved wrong). This approach has been criticised by Skrabanek in particular because he felt that nonsensical propositions should not be tested. In this respect Skrabanek raised the idea of having some kind of demarcation of the absurd which would avoid dignifying pseudoscience by testing it. For example, the Popperian approach requires us to test homeopathy in double-blind placebo controlled trials. Skrabanek’s approach would be to argue that homeopathy breaches so many scientific laws that it is already outside the tenure of science.

With respect to homeopathy, it is clear that placebo controlled trials of homeopathy are trials of one placebo against another. This explains the tendency for published trials to fluctuate around a midpoint with some showing a small positive effect and some no effect. The philosophy of David Hume teaches us to suspect either self-delusion or fraud if any published trial of homeopathy shows a dramatic effect of homeopathic solutions in any biological sense. The best example of this is the famous Benveniste study published in Nature. (Davenas et al., Nature, 1988, 333:816). This study could not be replicated by any other laboratory unless the experimental work was done under the supervision of Elizabeth Davenas.

After a team of skeptics (Randi et al) supervised a repeat of the work under their close scrutiny the original results were shown to be a delusion with implications of fraud and Benveniste was summarily sacked. People who believe in homeopathy are in the grip of an enduring delusion. Benveniste is a classic example of this and he has recently published a paper titled “Transatlantic transfer of digitised antigen signal by telephone link” (J. Allergy Clin. Immunol. 99:S175, 1997).

The claim is made that “ligands so dilute that no original molecule remained still retained biological activity”. The abstract is classically incomprehensible pseudoscience and Benveniste has the Gallic arrogance to quote his original discredited trial in the references!

Ginkgo flunks

Ginkgo is an herbal type product claimed to enhance and improve memory. Given what I have just written about placebo controlled trials it will come as no surprise that ginkgo provides no measurable benefit in memory or other related cognitive function. This will have absolutely no effect on the sales of this product because if people believe that it works then they will continue to buy it. Those people who sell the product will find endless reasons to defend their promotion of this useless remedy. I referred earlier to science involving the generation of a testable hypothesis. The practitioners and promoters of pseudoscience have become very skilled at generating endless secondary hypotheses to the point where further testing is impossible. Here are some examples:

The trial was too short/long
They should have used “x” and not “y” strength ginkgo
They should have used added vitamin C, selenium etc. etc

Ginkgo for memory enhancement: a randomised controlled trial. Solomon et al. JAMA. 21 Aug 2002. Vol. 288. No.7. p835-40

Chelation Fraud

A reader of the New Zealand Family Physician (Vol 29 Number 6, December 2002 p366) recently took issue with a review of a paper (Knudston et al., JAMA 23 Jan 2002, Vol 287 No. 4 pp481-6) which concluded “there is no evidence to support a beneficial effect of chelation therapy in patients with ischaemic heart disease, stable angina, and a positive treadmill test for ischaemia”. This was a placebo-controlled trial and the conclusions are the same as for similar published trials. The reader, however, objected to the use of an active placebo and claimed that this rendered the conclusions invalid. The debate raises several important issues.

Chelation quackery is a worldwide growth industry worth millions of dollars. The hypothesis is that symptoms of coronary artery disease (CAD) will improve following the removal (by chelation) of calcium from atherosclerotic plaques in the coronary arteries. Despite an overly simplistic view of CAD it seems like this is a testable hypothesis but wait a minute. Chelation clinics exist all over New Zealand and as yet there are no, and I repeat no double blind placebo controlled trials proving that chelation is more than a placebo. In fact, the Knudston trial is further evidence that chelation is ineffective. There is a worrying trend here, seen also with acupuncture, where unproven therapies are introduced into practice and opponents of such quackery are then challenged to prove that the given therapy is ineffective. I object to this argument. It is up to the proponents of new therapies to prove that their treatments are superior to placebo. In other words, put up or shut up.
The reader wrote in and objected that the Knudston trial used an active placebo. A placebo is by definition an inert substance. However, some drugs or treatments produce marked effects. For example, if the drug under test caused the patient’s skin to turn green it would be easy for both patient and doctor to determine who was receiving the drug or the placebo. The experiment has become “unblinded” and this is fatal to any conclusions that might be drawn. This problem is well recognized and some trials even invite participants to try and predict whether they received the test drug or the placebo. This is a sensible test of the blinding. Chelation mixtures are based around EDTA, which allegedly leaches calcium out of atherosclerotic plaques. Along with EDTA the preparations contain other drugs such as lignocaine, magnesium, vitamin C. Many of these are vasoactive and cause people to feel flushed or a little euphoric. If a true placebo was used it would not cause these effects and therefore the experiment would have become unblinded. It is therefore sometimes important to use active placebos whose side effects mimic those of the drug under evaluation. For example and I quote: “forty (59%) of 68 of the antidepressant studies published between 1968 and 1972 using an inert placebo control reported the antidepressant as effective, compared to only one (14%) of seven studies using an active placebo (atropine)”. (The Powerful Placebo, Shapiro, page 206). The antidepressants under test all caused a dry mouth and slightly blurred vision as does atropine. The use of an active placebo was clearly very important and shows once again how the expectations and optimism of researchers can lead to a serious overestimate of the efficacy of new drugs.
Chelation mixtures are non-standard and contain a wide range of drugs in addition to the chelating agent EDTA. This allows quacks to get maximum effect from the generation of endless secondary hypotheses. Suppose we test just EDTA versus placebo and produce the expected result of no effect. The quacks will start bleating that we didn’t have Vitamin C, magnesium, rhubarb, senna pods (pick anything you like) so back to the laboratory. No sooner do you test one combination and they will come up with another. This is the generation of the endless secondary hypotheses and this is a sure sign of a pseudoscience. The hallmark of science is the generation of what Staudenmayer (Environmental Illness: Myth and Reality, Lewis 1999) calls a “hard core postulate” and he goes on to say: “When hard-core postulates cannot explain a phenomenon, auxiliary postulates (ie. Secondary hypotheses) are often invoked to protect them from refutation (ie. being proved wrong).

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ACC Decisions

The recent decision to award compensation to a lawyer who suffered depression because his bank loan was turned down is but one example of increasingly bizarre decisions by the ACC (Anything-goes Compensation Corporation). Money has also been paid out to victims for “memories” of childhood sexual abuse but in one recent case the alleged offender was aquitted and we are still waiting to see whether ACC will ask for their money back. (see Skeptic 34).

I obtained information about a court judgement involving ACC who awarded compensation to an employee of the Fire Service, one of a number of people affected by mass hysteria after the ICI Chemical Fire. Advising doctors said that his condition was not considered to be due to chemical exposure but his emotional state could be attributed to some stress surrounding attendance at the fire. The judge had no alternative under current law to do anything other than award full rights to compensation.

Not only do these decisions show a lack of common sense, they also illustrate what happens when no one is prepared to stand up and resist such claimants, who will continue to come forward as long as there is money available. This prevailing community belief that everyone is entitled to compensation for their “pain” whatever it is, is not limited to New Zealand. There is a worldwide growth in anti-medical science groups with self-denied psychiatric conditions. In the UK a sufferer from chronic fatigue syndrome (see Skeptic 21, 26) was awarded compensation because the stress of a car accident in which he received no physical injuries, made his symptoms worse!

Hoxsey Cancer Quackery

Bruno Lawrence recently went public with the fact that he is suffering from lung cancer and plans to make a TV documentary about his treatment at a Hoxsey Clinic in Mexico. About the same time, a syndicated article appeared in my local paper with the news that a Tauranga herbalist intended setting up such a clinic and applying to the local area health board for approval.

Hoxsey (1901-1973) developed a secret recipe of herbs and spices which he used to treat cancer patients. This followed an observation that a horse with cancer cured itself by grazing on certain plants. Hoxsey fought prolonged court battles with both the American Medical Association (AMA) and the FDA before taking his quack therapy to unregulated Mexico. He died from cancer despite self-treatment with his quack remedy.

His original nurse, Mildred Nelson, was still administering this quackery as recently as 1988. The American Cancer Society (ACS) has extensively investigated Hoxsey’s cancer quackery and I quote from the last paragraph of their report which I am happy to supply free to any reader as long as you send a stamped SAE: “In summary, the Hoxsey medicines for cancer have been extensively tested and found to be both useless and archaic. The ACS does not recommend their use by cancer patients.”

Quackery often follows a pattern as follows:

An apparently profound observation or emotional experience — in Hoxsey’s case, a sick horse, and in the case of iridology certain patterns in the iris of a sick bird. Doctors often revert to quackery following either job stress or a seemingly profound success with a new treatment such as acupuncture, homeopathy etc. (usually a placebo response).
An element of paranoia is useful, because this heightens the belief of the quack that the particular treatment is valuable and “everyone’s out to get me!” and leads to…
Conspiracy theory. In the case of Hoxsey, he developed the theme that doctors and the AMA had cornered the cancer market (is there one?). This is a very useful strategy for discrediting conventional medicine.
The quack remedy should be completely safe and quite expensive because patients will show improvement in proportion to money spent. Distilled water is cheaper and more convenient than homeopathic remedies and is already an accepted consumer fraud.
Reliance solely on testimonials and strict avoidance of clinical trials or any form of testing of the quack remedy. Testimonials are personal, entertaining and are excellent advertising, unlike the prosaic clinical trial which will show that the quack remedy is for the ducks. If a clinical trial or, in the case of Milan Brych, a court case, proves quackery, then all is not lost. Off-shore operations will ensure patients keep on coming, which is what hundreds of people did even after Brych was shown to be a complete fraud and actually in prison at the time he claimed to be at medical school. (I can think of a few doctors I would like to see in prison but that’s another story.)

Finally, the above information is subject to intellectual property rights and I expect a commission from any readers who set up successful cancer quackery clinics.

Psychopathology

An article in the BMJ (Vol 309 p883, “The dangers of good intentions”) caught my eye, as it is a devastating example of the psychopathology so evident in the helping professions. In 1939, 700 delinquents were randomly assigned to either a treatment group or a control group who received no treatment but were followed up 30 years later.

The treatment group received counselling, home help and other community assistance. After 30 years it was the treatment group who were sicker, drunker, poorer and more criminal! This shows that nothing can be taken for granted when trying to influence people’s behaviour, and often such programs create dependency. Our own welfare state is a classic illustration of this problem.

Psychobabble revisited

In Skeptic 33 I made a plea for hard data on the popular new condition of post-traumatic stress disorder (PTSD). Like any alleged medical condition it must be refutable, ie. capable of being proved wrong. A writer in the BMJ (Vol 309 p873) sharply criticised a case presentation on PTSD in a patient who was a heavy drinker. He pointed out that 40% of all patients diagnosed as having PTSD drink heavily and their symptoms (frightening ideas, nightmares) subside when they abstain. I am still cynically waiting to find out whether PTSD is described in populations which do not have compensation.

In Canada, a man was aquitted of stabbing to death his parents-in-law because a psychiatrist testified that the man was sleep-walking and therefore had not been responsible for his actions. The fact that the accused was also a gambler who had been caught embezzling money did not seem to be quite so important to the court!

Psychiatry as a specialty relies on rather soft science, and some psychiatrists are guilty of the most absurd psychobabble — eg, “Continuing success will reflect [the patient’s] ongoing committment to healing the wounded child within, which is the result of the experience of the poisonous pedagogy.”

Doctors’ signatures can certainly be very valuable. As far as patients are concerned, it means another ten paid weeks off work. Some 85,000 people have been collecting such benefits for more than one year and ACC is hoping to save $400 million by referring all cases to an independent medical panel.(GP Weekly, 22 Feb 95)

In the Australian Capital Territory (ACT) a new law allows people to use cannabis on a doctor’s prescription provided that the doctor keeps “research notes.” The ACT Health Minister described the new law as a “radical drug experiment”. I describe it as radical stupidity, as there is no evidence that cannabis is useful for the conditions proposed and I doubt the ability of individual GPs to conduct research. Here is my prediction: patients will flock to certain doctors who have found by research that their signature on a piece of paper is of considerable benefit to both the patient and the doctor’s bank manager. Buy ACT cannabis futures now! (GP Weekly, 22 Feb 95)

In the UK, a housing authority allowed preferential allocation for housing on receipt of a note from the doctor outling health reasons. However, they were able to revert to their normal process of allocation because everyone on the list had a note from their GP! All processes such as this become debased and degraded when subject to abuse.

Eau Dear!

Along with other legitimised quackery, the French government recognises a stay at a spa as a legitimate medical treatment. The National Audit Court pointed out that not only is there no proven scientific justification for spa treatment, but many carry bacterial health risks. Some spas have even been adding tap water to their natural mineral waters.

I seem to remember an investigation in New Zealand showing that certain “mineral waters” were indistinguishable from tap water. (New Scientist, 28 Jan 95)

Alternative Medical Remedies

The Medicines Act is being re-written, and already quacks are whining that the costs of licensing their remedies could force them off the market. Quacks also fear a ban on advertising that they can offer relief from various conditions. I don’t see any problem with the proposed law changes, as herbal remedies should come up to set standards of quality and safety and any claims of efficacy should be tested in randomised trials. (GP Weekly, 14/9/94)

After reading this I was intrigued to find a letter in the Lancet (Vol 344 p134) which looked at the ginseng composition of 50 commercial ginseng products. The authors found that 44 preparations ranged from 1.9% to 9.0% of ginsenosides, the active components. The remaining 6 preparations contained no ginsenosides at all. They also quoted a case of an athlete who failed a drug test. He thought he was only taking ginseng, but not only did his preparation not contain any ginseng, it consisted mainly of the banned performance-enhancing drug ephedrine.

Would anybody buy an aspirin that might contain either no aspirin at all or anywhere from 100mg to 500mg of the active drug? The authors conclude that “quality control is urgently needed for natural remedies with suspected or assumed biological activity.” I see a compelling case for continuing with a robust overhaul of our Medicines Act.

Face Lifts and Hair Growth

A Wellington plastic surgeon was critical of a recent proposal that GP’s could learn to do chemical face peels after watching a training video (Dominion, 15/9/94). GPs can buy a kit which contains enough chemicals and equipment to make a profit of $380 per patient for half an hour’s work. The process involves using glycolic acid to induce peeling and, by an unspecified process, cosmetic improvement. Just the thing for boosting the flagging profits of any North Shore Auckland medical practice where there are already so many doctors the place is in danger of turning into a ghetto.

I don’t intend watching the video, but the thought had crossed my mind that I could treat my vain patients in our RNZAF electroplating bay. A short dip in something caustic would give anyone’s face a good lift (off) or how about dermabrasion with a wire brush from the metal shop?

A much safer money-earning prospect is the exciting new treatment of electrotrichogenesis for bald men. I hope our editor can reproduce the advertisement which shows a futuristic looking chair with a hood poised to administer rejuvenating current to the recalcitrant scalp. [Unfortunately it’s a bit too dark to reproduce well — but it looks fascinating…]

Why not fill the waiting room with these chairs and invite balding males to pay for treatment while they wait to see the doctor on other matters. Even more doctors will be able to afford to go into practice on the North Shore!

health industry herbalism medicine psychology

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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!

alternative health treatments disease education food herbalism psychology

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Manipulation of the Colon

Some time ago I remember reading a letter in the Listener from a frustrated doctor who accused the public of being medically illiterate. Sometimes I feel this way myself but it is not a good practice to attack one’s audience. Public education cannot be achieved within the context of traditional ten-minute medical consultations compared with quacks who may spend up to an hour providing mis-information. Drug companies are on record as cynically exploiting a gullible public eg. “…neither government agencies nor industry, including the supplement industry, should be protecting people from their own stupidity”.
Letter to Hoffman-Laroche, quoted in NCAHF Vol 15 No.4

In a letter to Little Treasures, a writer who would probably prefer to remain anonymous claimed that her child’s constipation was cured by chiropractic manipulations because “one leg was slightly longer than the other and the passage to the bowel was obstructed by this”. The anatomical possibilities are intriguing! George Dunea writes a regular letter on the US medical scene for the BMJ and in an article reviewed the current activities of chiropractors in the US. Using aggressive marketing techniques they are claiming to treat an even wider range of self-limiting conditions such as colds and colic. One third of Americans use such unconventional treatments at a cost of $10 billion annually and one third of this cost is borne by public funds or private insurance. Dunea goes on to say: “Alternative treatments have also become popular for pets…one large dog, afraid to sleep because he had been beaten badly as a puppy, was described as taking his first afternoon nap after his spinal cord had been adjusted”.
Realigning the Spine. BMJ Vol 307 p71

An American doctor, posing as a concerned parent, surveyed 100 chiropractors and found that 80% of them would treat middle ear infections with cervical spine “adjustments”. Some 78% also sold vitamin supplements from their offices.
Chiros treating children. NCAHF Vol 16, No.6

Conductive Education

This is a treatment based on the teachings of the Peto Centre. Children suffering from cerebral palsy are treated with an intensive (and expensive) series of exercises aimed at developing alternative neurologic circuits to their paralysed limbs. These treatments have no scientific basis and a government financed controlled trial confirmed that the Peto system gives no better results than conventional treatment. There are frequent public appeals to raise money for this treatment but the money could be put to much better use by organisations such as the Crippled Children’s Society.
BMJ Vol 307 p812

Homeopathic Immunisation

Enough has already been said on the enduring myth of homeopathy. An Australian GP was rebuked for recording a homeopathic-type immunisation in a child’s health records and the Medical Defence Union said that such action makes the GP potentially liable if the child subsequently develops a serious illness such as whooping cough or measles.
NZ Doctor 11/11/93

Psychic Surgery revisited

Shirley MacLaine, the high priestess of new-age (rhymes with sewage) silliness has regained her health and happiness after visiting a Filipino psychic surgeon. In Shirl’s own words: “He inserted his hands into my body and withdrew clots of blood and internal matter of some kind, then withdrew his hands”. In defence of Woman’s Day they did add at the end of the article “Oh Really!”
Woman’s Day 31/8/93

Yin Yang Tiddle I Po

So went the song of the Goons (actually Yin tong..) making about as much sense as an article on Chinese medicine which appeared in NZ Doctor 22/7/93 entitled “Look to natural forces to maintain health”. It is written by a trained veterinarian (Massey 1980) who is now practising as a doctor of Chinese herbal medicine. If that isn’t a paradigm shift I don’t know what is! I would love to know what prompted him to change from scientifically based veterinary practice to this nonsense. The treatment of subclinical diseases is prompted by examination of the tongue and pulse. This is a wonderful scheme because all sorts of diseases can be treated and there is no way of disproving that they ever existed. “Iced food and drinks should be avoided like the plague, as these are discordant with the prevailing Qi of summer and will stress the body”.

In a child with eczema the Chinese diagnosis was “blood deficiency complicated with wind and damp. The prescription was designed to “nourish blood, expel wind, strengthen digestion, remove damp, and cool the emotions”. As I have mentioned before, Chinese herbs sometimes contain unexpected substances. A chronically ill man developed muscle wasting which proved to be due to triamcinolone (a potent steroid) contained in “herbal” tablets. Each “herbal” tablet contained 5.4 milligrams of triamcinolone.
GP Weekly 17/11/93

Japanese Herbal Medicine

Japanese doctors will soon be able to gain a degree in Japanese herbal medicine. Seventy percent of Japanese doctors already prescribe such remedies known as kampoyaku. In response to side-effects of modern drugs and a consumer sense of depersonalisation in western medicine, such remedies are now state funded to the tune of US$1.5 billion and increasing by 15% annually. Kampo is based on 4000-year-old medical texts and diagnosis depends on the skill and intuition of individual doctors. (Where have I heard that before?) Such clinical instincts have already been shown to be weak in Western medicine, eg. “only about 50% of gastroscopies, coronary artery grafts, and carotid endarterectomies could be justified by independent panels of experts”.
Viewpoint, The Lancet Vol 341, p878

It is interesting that the Japanese community sees fit to waste money in this area when they have a chronic shortage of trained anaesthetists, causing Japan to have a maternal mortality (during childbirth) twice as high as the UK. There is also a complete lack of information about crude surgical mortality rates because the large numbers of private hospitals are not required to report their operation numbers.

Their hospitals have also been struck by an epidemic of methicillin resistant staphylococcus aureus (MRSA) due to the widespread overprescribing of antibiotics (BMJ Vol 306, p740). MRSA is a nasty bacterium which becomes prevalent whenever antibiotics are prescribed either inappropriately or excessively. This epidemic occurred because doctors are paid a set price for drugs used, whereas the drug companies supply these at a discounted rate with the doctors pocketing the difference.
New life for old medicine, The Lancet Vol 342, p485; Health Research in Japan, Letter, The Lancet Vol 342 p500

The Cocaine and Guinea-pig Diet

Move over Jenny Craig! An entrepreneurial father and son have set up a weight loss clinic on the shores of Lake Titicaca, Bolivia, at 3810m above sea level. Obese guests are invited to chew a syrupy extract from coca leaves (cocaine in its crudest form!) and if that is not enough they can enjoy having their skin rubbed down with a live guinea pig. These attractions are hoped to restore the flagging tourist industry but it is bad news for the guinea pigs.
Economist August 31st 1992, p36

Generalised Chemical Sensitivity

This is a diagnosis beloved of quacks who validate essentially depressive symptoms that some patients develop after a real or imagined chemical exposure. Glutaraldehyde is a highly effective disinfectant which has good activity against both the hepatitis and HIV viruses, but can cause skin and other sensitivity. A nurse who used this chemical developed baffling symptoms and was seen by a number of specialists who are described as suggesting that “her illness may have had an `emotional’ component”. Note the implied suggestion that an emotional cause is somehow less honorable than a “real” illness.

Her most distressing symptoms were “mood swings, irritability, loss of judgement, poor concentration and short-term memory loss” which are classic depressive symptoms. She is described as being unable to enjoy a lengthy conversation without becoming exhausted. An occupational physician dogmatically stated “There’s no doubt in my mind that the chemical has affected her immune system, leading to a multi-system pathology”. He went on to decry the patient’s “degrading and demeaning experience in failing to have her condition acknowledged by specialists” and “they go away thinking it’s all in their minds”.

Here again is the implication that physical symptoms are either “real” or imaginary. As we know, symptoms are almost always real, but can be produced by anxiety or notional beliefs (somatisation, for example headaches with depression). The result is a person who is now chronically unwell and unemployed and who has received both the wrong treatment and the wrong diagnosis. Exposure to other foods and chemicals now “causes an immediate deterioration in her ability to think clearly”.

This is a classic case of somatisation and is clearly not an occupational disease. This patient’s illness has arisen from the notion that she has somehow been “poisoned” and the availability of compensation completes the process. Doctors who continue to deny the importance of psychological factors paradoxically encourage the abnormal illness behaviour while no doubt sincerely believing that they are acting in the patient’s best interests.

This whole area was briefly reviewed by NCAHF (Vol 16 No. 6) who coined the phrase “environmental anxiety disorder” and quoted research in which immunologic testing did not differentiate patients with chemical sensitivities from controls. Finally NCAHF says “the power of the imagination, operant conditioning, and practitioner influence can reinforce imaginary sensitivities”.
GP Weekly 17 Feb 93

Quackery in the US

The US National Institutes of Health Office (Alternative Medicine) has awarded nearly $1 million in research grants for topics which include: t’ai chi for balance disorders; massage for HIV-exposed babies; dance movement for cystic fibrosis patients; biofeedback for diabetics and acupuncture for depression. I predict that all of these trials will produce glowing reports of improvements, having failed to make any allowance for the placebo effect, natural disease variation and spontaneous improvement.

chiropractors herbalism homeopathy media reporting pseudoscience

Physical and Financial Health?

On Thursday, 19 August 1993, the Christchurch Press carried a full-page advertisement for the initial New Zealand opening of the “Matrol Opportunity”.

The product, Matrol-Km, was described as “a unique nutritional supplement comprised of a synergistic combination of 13 botanical ingredients that produces an unusually powerful bond at the molecular level”. It was developed over 60 years ago by Dr Karl Jurak (PhD, University of Vienna, 1922), originally for his own use.

We were told that the product “has been tested in the most demanding laboratory in the world — the human body — for over 70 years”. The goal of the company “is not to see how many distributors we can sign up. Our goal is to impact world health. [italics original] Matrol is unique in that its distributors are emotionally tied to its product. They are unwavering in their commitment to use the product daily and reap its health benefits on an ongoing basis. Which means that each distributor is his or her own best testimonial!”

In case the rather vaguely described health advantages of the product weren’t enough, the ad pointed out that Matrol offers “one of the most generous compensation plan[s] in the network marketing industry“. This seems to be 25-40% profits, plus additional 5% commissions on sales made by “supervisors”> under you.

I was intrigued enough by the claims of an unusually powerful molecular bond to attend the evening meeting. Unfortunately the nature of this bond was not mentioned at the meeting, although the herbal ingredients were.

Matrol-Km consists of a dark-coloured, admittedly unpleasant-tasting liquid, which you are supposed to take daily for at least a month to be assured of achieving health effects (although some persons respond inside a day), and which you can then expect to take for the rest of your life. This costs $NZ90 per month per person, unless in self-defense you become a Matrol reseller to obtain wholesale discounts.

The health benefits were not much specified at the meeting. Phrases used included “extra energy”, “better sleep”, “look younger, feel younger”, “clarity of mind”, “an insurance for good health”. I was impressed by the frequency with which speakers talked of having encountered Matrol-Km at financial and/or emotional low-points in their life. We were reminded that the product is for both physical and financial health, and there was to my mind considerable intermingling of the two concepts.

The bottles themselves (one month’s supply, 946 ml), give an admirably thorough list of ingredients, presumably in order of diminishing concentration: water, caramel, potassium citrate, glycerophosphate, calcium glycerophosphate, magnesium glycerophosphate, potassium hydroxide, potassium glycerophosphate, iron glycerophosphate, followed by 13 herbs, plus traces of clove and peppermint oil as flavourings. The mixture, which is non-alcoholic, is preserved by paraben and methyl paraben. Below, I’ve summarised the Matrol claims for each herb as given on a sales pamphlet, and the descriptions given by S. Talalaj and A.S. Czechowicz in their book Herbal Remedies: Harmful and Beneficial Effects.

(1) Chamomile flowers (Matricaria chamomilla).

Matrol: consecrated to the Egyptian Gods; used by Romans for nutritional properties; used to make a tea; high in calcium, magnesium, iron and trace minerals.

T&C: active ingredients are matricine, a volatile oil (1%) containing bisabolols and chamazulene… Also glycosides apigenin, apigetrin, rutin, coumarins, and flavonoids. Pharmacological action: anti-inflammatory, antispasmodic (“cramps”), carminative (anti-farting), sedative, antiseptic, vulnerary (promotes wound healing). A “therapeutically valuable remedy” with mild calming effect useful in treatment of nervous conditions, excitement, and restlessness… Harmless even if taken over a prolonged period.

(2) Saw palmetto berry (sabal, Serenoa repens).

Matrol: N American Indians made tea from berry, which contains many primary nutrients and elemental minerals.

T&C: Active constituents are oestrogen-like steroidal glycosides. Low-toxicity plant, but its use should be discussed with a medical practitioner because of the oestrogen-like effects. Has been used to treat chronic cystitis, might show beneficial effect in treatment of benign enlargement of prostate.

(3) Angelica root (Archangelica officinalis).

Matrol: regarded as holy plant, chewed regularly by Laplanders, rich in essential oils, calcium, vitamin E and vitamin B-12, which is rare in vegetation.

T&C: Active constituents are volatile oil, furanocoumarins, resin, bitter principles, and triterpenoids. Relatively safe in moderate curative doses. (“Fresh root is extremely toxic and is used as a homicidal poison among Canadian Indians.”) Pharmacological action is to increase gastric secretions, antispasmodic, diuretic, sedative. Has mainly been used in treatment of indigestion and flatulent colic… stimulates the appetite in anorexia nervosa, also used for treatment of cystitis and urinary inflammations. Decreases muscular tension and exhibits a mild sedative action….

(4) Thyme (Thymus vulgaris).

Matrol: Signifies graceful elegance in Greece, bravery in European chivalry. Abundant in thiamine, also B-complex, vitamins C and D, and trace minerals.

T&C: Active constituents volatile oil (2-3%)… Also tannins (10%), saponins, flavonoids. Harmless when used in a low dose (oil highly toxic when digested in ml quantities). Pharmacological actions are antiseptic, anthelmintic (intestinal worms), astringent, expectorant, carminative. Has been used in treatment of cough, whooping cough, bronchitis, dyspepsia and stomach disorders, occasionally as anthelmintic.

(5) Passion flower (Passiflora incarnata).

Matrol: cultivated and used by Indians of Virginia (US). Plentiful in nutrient complexes, especially calcium and magnesium.

T&C: Active ingredients indole alkaloids (0.1%) including harmine, harmaline and harman. Also flavonoids, steroidal substances, cyanogenic glycosides and saponins. Harmless if used in a low curative dose, but should only be used under medical supervision. Reputation of being an effective sedative.

(6) Gentian root (Gentiana lutea).

Matrol: popular in Europe as mid-day tea. Rich in B-complex nutrients, vitamin F, niacin, inositol and many trace elements.

T&C: Active constituents are bitter glycosides, also alkaloids, flavonoids, tannins and mucilage. Harmless in low therapeutic doses, but should be avoided in cases of acute gastritis, stomach ulcer, and haemorrhages in gastro-intestinal tract, also by patients with excessive number of red blood cells. Not advisable in breast-feeding women because breast milk may become bitter. Popular bitter gastric stimulant, used as appetizer, to increase gastric secretion in dyspepsia, and to relieve flatulence, also useful for gall-bladder dysfunction and liver problems.

(7) Licorice root (Glycyrrhzia glabra).

Matrol: used anciently in China, Greece. Contains vitamin E, B-complex, biotin, niacin, pantothenic acid, lecithin, manganese and other trace minerals.

T&C: Active constituents are triterpenoid saponins… also flavonoids, oestrogen-like steroids, coumarins, tannins and volatile oil. No adverse effects in low curative doses. Pharmacological action as anti-inflammatory, expectorant (loosens phlegm), anti-spasmodic (cramps), demulcent (eases irritation of skin and lining of digestive tract). Popular remedy mainly for gastric ulcer. Shows beneficial anti-inflammatory effects, reduces gastric acid secretion and promotes ulcer healing. Also used for cough, bronchitis and allergic skin disease.

(8) Senega root (milkwort, Polygala senega).

Matrol: valued by N American Indians for its refreshing mint-like flavour and for many nutrients. Rich in magnesium, iron and other trace minerals.

T&C: Active constituents are triterpenoid saponins (up to 10%) including senegin… Also sterols, resin, and methyl salicylate (oil of wintergreen). Toxic when used in an excessive dose, may cause vomiting diarrhoea, vertigo, visual disturbances, and inflammation of the oesophagus. Should be avoided during pregnancy and G-I inflammation or stomach bleeding. Mainly used to treat cough and chronic bronchitis, often in combination with ipecac, or in combination with other plants as an asthma remedy.

(9) Horehound root (Ballota nigra).

Matrol: member of mint family, praised 4 centuries ago by Gerard for its usefulness. Rich in Vitamins A, E, C, F and B-complex, also contains iron and potassium.

T&C: Active ingredients are flavonoids, “bitter principle” and volatile oil. No adverse effects reported. Used for dyspepsia, flatulence and anti-emetic in pregnancy.

10) Celery seed (Apium graveolens).

Matrol: in use for centuries from Central Europe to East Indies and South America. Seed contains a group of useful organic compounds called phthalides, also vitamins A, B, and C, and iron.

T&C: Active ingredients are volatile oil (3%) containing mainly limonene and selinen, also flavonoid glycoside apiin. A low toxicity plant, but excessive doses should not be used during pregnancy. Mainly used to treat inflammation of urinary tract and cystitis, regarded as an effective urinary antiseptic. Also used to treat arthritis, rheumatism, gout, asthma and bronchitis.

(11) Sarsaparilla root (Smilax officinalis).

Matrol: used by early Americans as “spring tea”. Spanish Conquistadors recorded its [unspecified] legendary qualities. Contains vitamin C and B-complex.

T&C: Active ingredients are steroidal saponins… and parillin. Also tannins, resin and sterols. A low toxicity plant, but excessive dose or prolonged internal use should be avoided. Should not be used in cases of kidney disorder. Pharmacological action is carminative, diuretic, diaphoretic (causing profuse perspiration), antirheumatic. Once had a great reputation in the treatment of rheumatism and skin disease, especially psoriasis.

(12) Alfalfa (Medicago sativa).

Matrol: revered by ancients as “King of Plants”, an excellent source of easily assimilated vitamins and minerals. Contains 14 of the 16 principal mineral elements and all known vitamins, but is especially rich in some amino acids and vitamins A, D and K, and iron.

T&C: Active constituents are oestrogen-like isoflavonoids, alkaloids, carotenoids (provitamin A), and vitamins B1, B2, K, C and D. Also coumarins and mineral salts of calcium, potassium, iron and phosphorus. Excessive doses taken internally can cause flatulence and diarrhoea. Long term application can produce reactivation of systemic lupus erythematosus and produce skin ulceration. Excessive doses can also produce an oestrogen-like response. Pharmacological action as anti-anaemic, nutritive. Mainly used as a nutrient for convalescent patients.

Note that this is just about the only case where the Matrol literature agrees with Talalaj and Czechowicz.

(13) Dandelion root (Taraxacum officinale).

Matrol: Rich in vitamin complexes, choline, a B-vitamin, and a main component of lecithin. Also contains vitamins A and C, and essential linolenic acid.

T&C: Active ingredients are taraxacin, inulin (a fructose polymer), potassium salts, and vitamin A. Harmless. Used for liver ailments and gallstones.

The remarkable thing about the Matrol descriptions is that they concentrate, rather boringly, on the mineral and vitamin contents of their herbal ingredients.

Minerals and vitamins are easily obtained, in relatively cheap multi-purpose vitamin pills, if not in our ordinary diet. In any case, Matrol-Km must contain more potassium, magnesium, calcium, and iron in the form of a glycerophosphate complex than would be contributed by the tinier amounts of herbs. What is special about herbs is their content of pharmacologically active ingredients. I would be flabbergasted if the grossly impure (oops, “complexly formulated”) mixture of chemicals in a given herb is optimal for a particular treatment.

Why doesn’t the Matrol literature mention the pharmacology of their herbal ingredients? Perhaps that would amount to making medical claims. Does Matrol-Km contain enough herbal content to have a pharmacological effect? If so, the foregoing list suggests there could be something beneficial for everyone, although the bitter stomach-stimulating actions of gentian would seem to be fighting the stomach-soothing actions of licorice.

One might be concerned at the oestrogen-like properties of a number of ingredients. Since oestrogens are used in hormone-replacement therapy for menopausal women, could this account for some of the beneficial effects of Matrol-Km? Is it safe for a man to take it? Where is the medical study that shows this mixture is safe for lifelong ingestion? (I’m not even asking for evidence about efficacy!)

After studying the list of ingredients, I’m personally convinced that the original mixture of Dr Jurak might have been useful. In fact I’m going to pick up most of the herbal remedies at the health-food section of the supermarket next week, just to have on hand as cheap try-it-and-see remedies in case mild episodes of the pertinent illnesses arise, say, on a weekend.

I dare say it will cost far less than $90, and I’ll use just the herbs that seem appropriate to a given requirement rather than a shot-gun mixture.

biology herbalism medicine

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

Bibliography

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).

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Tag: herbalism

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(1) Chamomile flowers (Matricaria chamomilla).

(2) Saw palmetto berry (sabal, Serenoa repens).

(3) Angelica root (Archangelica officinalis).

(4) Thyme (Thymus vulgaris).

(5) Passion flower (Passiflora incarnata).

(6) Gentian root (Gentiana lutea).

(7) Licorice root (Glycyrrhzia glabra).

(8) Senega root (milkwort, Polygala senega).

(9) Horehound root (Ballota nigra).

10) Celery seed (Apium graveolens).

(11) Sarsaparilla root (Smilax officinalis).

(12) Alfalfa (Medicago sativa).

(13) Dandelion root (Taraxacum officinale).

Common Poisonous Plants