Hokum Locum

Skull manipulation takes a lot of ‘training’

Cranial osteopathy is based on the notion that the bones of the skull can be manipulated. Even doctors have been taken in by this nonsense. The following account is by a registered medical practitioner, Dr Putative (not his real name).

The craniosacral movement is a rhythmical expansion of the skull and meninges around the cerebrospinal fluid. “It is a very subtle small amplitude excursion which is palpable with careful trained hands.” (So there, all you Skeptics: if-like me-you can’t feel it, you lack training.)

“The bones of the skull open and close rather like a flower opening to the sun.”
“It must be emphasised the movement is very subtle and can only be felt after considerable practice.”

The article goes on to claim that cranial osteopathy can successfully treat colic, a blocked nose, Bell’s palsy, and facial asymmetry in infants. I wish it could cure terminal gullibility! When doctors involve themselves with such nonsense, it always reminds me of HL Mencken’s criticism of an American gynecologist who believed in the literal truth of the story about Jonah in the belly of the whale. I can’t remember the exact words but it goes something like this: “How is it possible for the human brain to be divided into two halves? One capable of brilliant thought and the other complete balderdash!”

This quote could also apply to Dr John E Mack. (In 2004 he died after being hit by a car.) He collected a group of fantasy-prone individuals whom he gradually came to believe had been abducted by aliens. Harvard was furious; some of his colleagues started a movement, Knife the Mack, but Mack became very wealthy from his book about these patients. He basically argued that because psychiatry can’t explain such matters the accounts must be true. Wrong. It is well known that certain fantasy-prone individuals experience vivid dreams (hypnagogic) at certain stages of sleep.

Iridology

This absurd nonsense has now become part of mainstream pharmacy. Commercial pressures and PHARMAC, the government drug buying agency, have squeezed profits and many pharmacies stock a wide range of unproven and ridiculous pro-ducts. One local pharmacy has a range of such items which is larger than the OTC section.

Another local pharmacy advertised it was going to have an in-store iridologist for the day. The iridologist was described as having a Bachelor Degree in Health Science. (BHSc) It is little wonder that universities continue to oppose the granting of such degrees by various polytechnic institutions.

Chinese Frauds and Dangerous Products

The Chinese are already recognised as an international threat in regard to traffic in endangered species (eg tigers and bears) as well as promoting ‘traditional products’ which are adulterated with Western drugs such as steroids and Viagra.

A Chinese-made toothpaste (Excel) was withdrawn from sale in New Zealand when it was found to contain diethylene glycol, normally found as antifreeze in the radiator of your vehicle. Hmmm, could be useful when brushing your teeth in Antarctica.

It appears that Chinese doctors can be as venal and corrupt as their herbal industry. Reporters posing as patients produced urine samples which were actually green tea. The diagnosis made was urinary infection and the prescribed treatment cost $40. One reporter re-submitted the same sample and received the same diagnosis. At least the quacks were consistent. These frauds are to be expected in a poor country where doctors are underpaid.

Some NZ Doctors perpetrate similar frauds by using ‘black box’ devices and other unproven treatments. These frauds are not to be expected in a country where doctors are both well paid and well educated!

Dominion Post 24 March
BMJ 9 June 2007 Volume 334 p1183

The Culture of Complaint

In his book, From Paralysis to Fatigue, Edward Shorter predicted that the next era of medicine would revolve around psychosomatic medicine. This also encompasses a culture of complaint which sees a whining populace avoiding responsibility for their own actions by finding someone else to blame for their misfortune.

There is a new vaccine (Gardasil) against human papilloma virus (HPV). HPV is the main risk factor for cervical cancer in women. Following vaccination at a school, about 25 girls presented to the sick bay with headache, nausea and dizziness. The media had a field day while more sensible people correctly diagnosed ‘mass sociogenic illness’ which is a polite way of saying ‘mass hysteria’. There is an excellent account online at www.crikey.com.au/Politics/20070528-Schoolgirls-have-mass-sociogenic-illness-but-Neil-Mitchell-needs-the-smelling-salts.html

There is a huge and fascinating published literature on mass hysteria. A constant feature is the rejection of this label by people involved in the incident. People do not like to accept that they have been victims of their own panic. It’s much better to believe in a mysterious vapour or poison. My favorite mass hysteria story concerned a kitchen which was evacuated due to a bad smell causing symptomatic illness. It was traced to a rotten onion in a cupboard!

In the case of the Gardasil story, the media beat-up wiped $A1 billion off the market value of the drug company.

Marlborough Express 26 April

Physiotherapy

Some time ago I roamed the internet looking for evidence supporting the efficacy of physiotherapy. I was interested in its scientific basis. I looked in vain. There are a few trials which showed certain practices were either useless or even dangerous.

I recently received a report from a specialist which included the following gem:

“I do not think that there is any specific medical contraindication to his undergoing whatever rigorous physiotherapy programme is planned for him, although by the same token I am not all that enthusiastic about physiotherapy in these situations: my opinion is that physiotherapy simply helps to pass the time and I cannot really understand what good it is meant to be doing. However…that..opinion does not sit comfortably with the ACC’s and patient’s enthusiasm for having their bodies tweaked and pummeled at great expense in the name of ‘rehabilitation’.”

The phrase “great expense” is important. There are so many treatment providers with their snouts in the ACC trough that treatment costs have become excessive. These treatment providers have developed a beneficiary mentality and whenever ACC attempts to control or restrict treatment practices there are indignant protests.

ACC reforms mean that patients can go to a treatment provider and register a claim and have treatment. If they need time off work this can only be provided by a doctor. The ‘gate keeper’ function of the doctor has been lost. I heard of two recent examples of how people can be harmed by this practice.

An osteopath gave a maximal number of treatments to a patient who was eventually diagnosed as having a complete rupture of the rotator cuff muscles of the shoulder. Osteopathic treatment is completely useless for this injury. In fact there is no published evidence showing that it works for any injury.

In the other case a 15-year-old child was treated by a physiotherapist for some time for a sore leg and was eventually diagnosed with bone cancer.

Hokum Locum

Debunking debriefing

It has become a clich√© that whenever something bad happens, a horde of counsellors descend on the survivors to make their lives a misery. It’s true. Counselling does make you more sick compared to doing nothing.

A child is run over and killed. Instead of teachers and parents rallying around and doing what they have done for hundreds of years, ‘professionals’ are now called in to make things worse. In a study, survivors were randomly allocated to “emotional ventilation debriefing” (whatever that is), educational debriefing or nothing and were followed up at two weeks, six weeks and six months. The only difference in outcome was that at six months the first group had significantly more emotional distress.

Not only are these forms of counselling useless they are harmful and the relevant authorities should face up to this by not inflicting it on people. People have always coped with death and disaster and feelings naturally settle with time. Ordinary people underestimate their own ability to just be there for their friends and family and support them. No fancy talk is necessary. bjp.rcpsych.org/cgi/content/abstract/189/2/150

More on Placebos

It can easily be argued that the history of complementary and alternative medicine (CAM) is intimately involved with the history of the placebo effect. The placebo effect is also intimately involved with the practice of medicine although attempts are made to control for it.

The placebo effect is poorly understood, even by doctors, and if you interview specialists they generally discount the placebo effect in their own specialty and attribute it to their colleagues in other specialties. Orthopaedic surgery is rife with placebo procedures such as arthroscopic washout of arthritic knees. At least two good trials have shown that it is worthless yet orthopaedic surgeons continue to inflict this useless procedure on their patients. I confronted one such specialist and he argued that “in my experience it makes the knee feel better.” This is the typical feeble appeal to authority which is the lowest and most contemptible form of evidence. This refusal to accept the evidence is not unusual and in the past other placebo operations have been performed for years until such time as there is a critical mass of peers crying stop.

With respect to homeopathy, there are wide variations in the results of placebo controlled trials because, as someone put it, not all placebos are equal. One wag suggested that “double strength placebos” were needed.

In an interesting study subjects were given placebo analgesia and subjected to painful stimuli. The painful stimuli were then surreptitiously reduced to make the analgesia appear even more effective. This enhanced learned response lasted up to seven days and the authors concluded that this effect “may explain the large variability of the placebo responses that is found in many studies.”

My conclusion from all of this is that my own profession fails to use the placebo effect in a positive way. It is viewed instead as a nuisance to be controlled or minimised. The CAM industry has shown no such reluctance and the placebo effect is behind most of these treatments. Perhaps this explains the public fascination with quackery?

www.chaser.com.au/index.php?option=com_content&task=view&id=1182&Itemid=26

Medical Journal of Australia Vol 179 18 Aug 2003

Pain Vol 24 Issues 1-2, Sep 2005 Pg126-133

Traditional Chinese Medicine (TCM)

Advocates of TCM argue that it cannot be evaluated by clinical trials because TCM has a different philosophical basis to western medicine. This is a typical argument known as the ‘plea for special dispensation’ and is a hallmark of quackery.

TCM evolved in China in the same manner as western medicine under the teachings of Galen. Authoritative teachings were gospel and anyone who dissented was criticised. In many respects this process has some of the features of a religion where beliefs are more important than scientific facts.

Galen solved the problem of the circulation of the blood by proposing that blood got from one side of the heart to the other through tiny pores in the heart. No one was ever able to demonstrate these pores but it was taken as fact. When Harvey described what actually happened in the circulation of the blood (ie arteries to capillaries to veins and back again) based on his anatomical studies he was treated as a heretic. TCM is a placebo-based philosophy and every time there is a scandal such as herbs adulterated with western drugs, for example Viagra and steroids, this strengthens the argument that such products and practices should be banned as being consumer fraud.

Occupational Health Delusions

Unhappy people in boring jobs can escape their stressful situation by attributing some mythical illness to the workplace. This entitles them to compensation from ACC. Many such people become extremely litigious and unpleasant if there is any suggestion that their illness is psychosomatic. Complaints and symptoms are out of all proportion to any evidence of an actual injury.

A recurring theme in the occupational health literature is the statement that “psychological factors might be important.” There is seldom any suggestion that a condition has nothing to do with work. Conditions such as railway spine and miners’ nystagmus were compensated when we now know that these conditions were a delusion, a folie a deux between plaintiffs and their gullible doctors.

Sick building syndrome (SBS) is a modern example of this delusional thinking. I recall an earlier study where symptoms bore no relationship with building ventilation. This experiment involved varying the ventilation rate without the workers’ knowledge. If the air was being changed at a very high rate there should have been a corresponding drop in symptoms.

Another recent study has found “symptoms of SBS are more strongly associated with job demands, workload, social stressors, and support at work than with the physical environment.” Occupational and Environmental Medicine 2006;63:283-289

More on Goji Juice

I revisited the goji juice site www.best-goji-juice.com and decided to investigate Dr Earl Mindell. He has a legitimate Bachelor’s degree from the University of North Dakota and a PhD from a diploma mill, the University of Beverly Hills. Quackwatch has some good information about his vitamin industry and the goji juice industry is a good example of multilevel marketing similar to Amway. Has anybody tried the stuff? I would be interested to hear.

The ideal marriage?

Consider an iridologist married to a reflexologist. The iridologist can look into her partner’s eyes and tell him what’s wrong with his feet. The reflexologist can look at her feet and tell her what’s wrong with her eyes. Many thanks to whoever it was who passed that on at the conference and thanks to Dr Keith Davidson for passing on a half page advertisement devoted to reflexology from the Christchurch Press, 26 September. It’s clearly a growth industry with their own website www.reflexology.org.nz. You can train at a reflexology school or even gain a diploma from the Canterbury College of Natural Medicine.